code description unit price - amazon web services · 275206 r&b m/s pvt telem ( 1,588.00)...
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Code Description Unit Price 15110 R&B M/S PRIVATE ( 988.00) 15120 R&B M/S SEMI PRIVATE ( 791.00) 15164 R&B ISOLATION ( 1,488.00) 15206 R&B M/S PVT TELEM ( 1,588.00) 15207 R&B M/S SEMI PVT TEL ( 1,091.00) 25110 R&B M/S PRIVATE ( 988.00) 25120 R&B M/S SEMI PRIVATE ( 791.00) 25164 R&B ISOLATION ( 1,488.00) 25206 R&B M/S PVT TELEM ( 1,588.00) 25207 R&B M/S SEMI PVT TEL ( 1,091.00) 55110 R&B M/S PRIVATE ( 988.00) 55164 R&B ISOLATION ( 1,488.00) 55206 R&B M/S PVT TELEM ( 1,588.00) 65110 R&B M/S PRIVATE ( 988.00) 65120 R&B M/S SEMI PRIVATE ( 791.00) 65164 R&B ISOLATION ( 1,488.00) 65206 R&B M/S PVT TELEM ( 1,588.00) 65207 R&B M/S SEMI PVT TEL ( 1,091.00) 115110 R&B M/S PRIVATE ( 988.00) 115120 R&B M/S SEMI PRIVATE ( 791.00) 115206 R&B M/S PVT TELEM ( 1,588.00) 115207 R&B M/S SEMI PVT TEL ( 1,091.00) 125110 R&B M/S PRIVATE ( 988.00) 125120 R&B M/S SEMI PRIVATE ( 791.00) 125164 R&B ISOLATION ( 1,488.00) 125206 R&B PRIVATE TELEM ( 1,588.00) 125207 R&B SEMI PVT TELEM ( 1,091.00) 135110 R&B M/S PRIVATE ( 988.00) 135120 R&B M/S SEMI PRIVATE ( 791.00) 135164 R&B ISOLATION ( 1,488.00) 135206 R&B PRIVATE TELEM ( 1,588.00) 135207 R&B SEMI PVT TELEM ( 1,091.00) 145110 R&B M/S PRIVATE ( 988.00) 145120 R&B M/S SEMI PRIVATE ( 791.00) 145164 R&B ISOLATION ( 1,488.00) 145206 R&B PRIVATE TELEM ( 1,588.00) 145207 R&B SEMI PVT TELEM ( 1,091.00) 155110 R&B M/S PRIVATE ( 988.00) 155206 R&B PRIVATE TELEM ( 1,588.00) 165110 R&B M/S PRIVATE ( 988.00)
165113 R&B PEDIATRIC PVT ( 1,378.16) 165120 R&B M/S SEMI PRIVATE ( 791.00) 165123 R&B PEDIATRIC SEMI ( 846.37) 165164 R&B PEDIATRIC ISOLAT ( 1,488.00) 165206 R&B PEDS PVT TELEM ( 1,588.00) 165207 R&B PEDS SEMI TELEM ( 1,091.00) 175164 R&B PROGRESSIVE ISOL ( 1,488.00) 175206 R&B PROGRESSIVE PVT ( 1,612.00) 182500 OBSERVATION 1ST HOUR ( 247.17) 182501 OBSRVATION ADDL HOUR ( 28.89) 182502 DIRECT ADMIT TO OBS ( 1,383.51) 195110 R&B M/S PRIVATE ( 988.00) 195120 R&B M/S SEMI PRIVATE ( 791.00) 195164 R&B ISOLATION ( 1,488.00) 195206 R&B PRIVATE TELEM ( 1,588.00) 195207 R&B SEMI PVT TELEM ( 1,091.00) 200001 GUEST TRAY ( 6.88) 215111 R&B GYN PRIVATE ( 988.00) 215112 R&B OB PRIVATE ( 988.00) 215121 R&B GYN SEMI PRIVATE ( 791.00) 215122 R&B OB SEMI PRIVATE ( 791.00) 215164 R&B OB/GYN ISOLATION ( 1,488.00) 215206 R&B OB/GYN TELEMETRY ( 1,588.00) 225110 R&B M/S PRIVATE ( 1,088.00) 225120 R&B M/S SEMI PRIVATE ( 791.00) 225206 R&B M/S PVT TELEM ( 1,588.00) 235110 R&B M/S PRIVATE ( 1,088.00) 235120 R&B M/S SEMI PRIVATE ( 791.00) 235164 R&B ISOLATION ( 1,488.00) 235206 R&B M/S PVT TELEM ( 1,588.00) 235207 R&B M/S SEMI PVT TEL ( 1,091.00) 245171 R&B NURSERY LEVEL 1 ( 548.91) 245172 R&B NURSERY LEVEL 2 ( 1,362.11) 245173 R&B NURSERY LEVEL 3 ( 2,039.42) 245191 R&B SICK BABY LVL 1 ( 1,362.11) 245192 R&B SICK BABY LVL 2 ( 1,862.11) 245193 R&B SICK BABY LVL 3 ( 2,362.11) 247191 R&B HLTH BOARDER ( 488.00) 275110 R&B M/S PRIVATE ( 988.00) 275117 R&B M/S PRIVATE ONC ( 988.00) 275164 R&B ISOLATION ( 1,488.00)
275206 R&B M/S PVT TELEM ( 1,588.00) 282801 LABOR LEVEL 1 PER HR ( 187.25) 282802 LABOR LEVEL 2 PER HR ( 267.50) 282803 LABOR LEVEL 3 PER HR ( 347.75) 282804 THERAPEUTIC DX SQ IM ( 179.00) 282805 CATH URINE SPECIMEN ( 17.00) 282807 AUD EVP-EVR-CNS LIM ( 519.00) 282808 CAR SEAT BED TST 60M ( 122.00) 282809 CAR SE-BED TST AD 30 ( 61.00) 282811 DELIVERY LEVEL 1 ( 3,389.76) 282812 DELIVERY LEVEL 2 ( 3,898.01) 282813 DELIVERY LEVEL 3 ( 4,482.23) 282819 L&D DIRECT ADMIT OBS ( 1,293.00) 282820 BLOOD TRANSFUSION ( 1,020.00) 282821 L&D REC LEV 1 PER HR ( 607.76) 282822 L&D REC LVL 2 PER HR ( 760.77) 282824 IMM ADM HEP B VACCIN ( 169.00) 282825 PULSE OX NWBRN MULTI ( 112.00) 282831 LDR PROCEDURE MINOR ( 374.00) 282832 LDR PROCEDURE-INTERM ( 545.00) 282833 LDR PROCEDURE-MAJOR ( 681.00) 282841 L&D OBSERV 1ST HOUR ( 222.56) 282842 L&D OBSERV ADDL HOUR ( 28.89) 282843 EXTERNAL CEPHALIC VE ( 6,762.00) 282844 FETAL CONTRACTION ST ( 551.05) 282845 FETAL NON STRESS TES ( 576.73) 282846 CIRCUMCISION NEWBORN ( 6,353.66) 282850 LACTATION CONSULT ( 289.00) 282851 OB TRIAGE LVL 1 EP ( 285.69) 282910 IMM ADM 1ST VACCINE ( 179.00) 282911 IMM ADM EA ADD VACC ( 155.00) 282920 IV HYDRATION 1 HR ( 375.00) 282921 IV HYDRAT EA ADD HR ( 316.00) 282930 IV THERAPY DX 1 HR ( 610.00) 282931 IV THERAPY EA AD HR ( 109.00) 282932 IV THER AD SEQ 1 HR ( 296.00) 282933 CONCURRENT IV THER ( 273.00) 282940 THERAPEUTIC IV PUSH ( 375.00) 282941 THERA EA AD IV PUSH ( 228.00) 282942 THER AD IVP SAME MED ( 288.00) 282950 IMM ADM FLU VACCINE ( 147.00)
282951 IMM ADM PNEU VACCINE ( 170.00) 315200 R&B ICU ( 1,985.92) 325210 R&B CCU ( 1,985.92) 335200 R&B ICU/CCU ( 1,767.00) 335214 R&B INTERMED CCU ( 1,856.00) 345201 R&B ICU ( 1,985.92) 355164 R&B STEPDOWN ISOL ( 1,912.00) 355206 R&B STEPDOWN PVT ( 1,612.00) 355207 R&B STEPDOWN SEMI ( 1,212.00) 365200 R&B ICU ( 1,985.92) 365214 R&B ICU/CCU ( 1,612.00) 375206 R&B PROGRESSIVE PVT ( 1,612.00) 390001 S-DECLOT VASC DEV ( 896.10) 390022 S-NON-ROUT DRAW GRT3 ( 71.38) 395001 S-INS PICC WO SQP U5 ( 3,905.21) 395002 S-RPL COMP PICC WO ( 4,352.18) 395003 S-INS PICC WO SQ O5 ( 3,905.21) 635114 R&B GERO-PSYCH PRIV ( 1,446.64) 635124 R&B GERO-PSYCH SEMI ( 830.00) 1010014 NI-EKG, 12 LEADS ( 463.76) 1010015 NI-STRESS TEST ( 1,132.60) 1010017 NI-EKG, 1-3 LEADS ( 220.23) 1010045 NI-HOLTER RECRD TO48 ( 285.32) 1010046 NI-HOLTER W-SCAN 48 ( 419.27) 1010047 NI-TILT TABLE ( 1,930.80) 1020030 EEG 41-60 MIN ( 1,011.51) 1020031 EEG GT 1 HOUR ( 1,163.97) 1020032 EEG AWAKE DROWSY ( 959.41) 1020033 EEG AWAKE ASLEEP ( 995.11) 1020034 EEG ASLEEP ( 895.16) 1020035 EEG EVAL CEREBR ( 1,119.49) 1020036 EEG ALL NIGHT ( 1,295.91) 1020043 EEG MONITORING ( 1,295.91) 1020045 EEG MONITOR VIDEOREC ( 2,797.64) 1020046 AMB EEG MONITORING ( 3,108.01) 1030002 EMG, 1 EXTREM ( 397.49) 1030003 EMG, 2 EXTREM ( 578.26) 1030005 EMG, 4 EXTREM ( 578.26) 1030061 MTR-SENS 1-2 NRV TST ( 1,881.79) 1030062 MTR-SENS 3-4 NRV TST ( 1,881.79) 1030063 MTR-SENS 5-6 NRV TST ( 1,881.79)
1030064 MTR-SENS 7-8 NRV TST ( 1,881.79) 1030065 MTR-SES 9-10 NRV TST ( 1,881.79) 1030066 MTR-SES 11-12 NRV TS ( 1,881.79) 1030067 MTR-SNS 13 OR MORE ( 1,881.79) 1040020 NI-CARD REHAB W-O MO ( 413.82) 1040021 NI-CARDI REHAB W- MO ( 464.93) 1050084 NI-TTE CONG COMP WO ( 1,380.85) 1050086 NI-TTE STRESS WO ( 3,147.29) 1050089 NI-TEE COMP WO ( 3,728.74) 1050090 NI-TTE 2D MM LTD WO ( 1,675.60) 1050092 NI-TTE 2D W DOPP WO ( 2,303.66) 1050095 P-PM DEV PRGR EVAL 1 ( 162.26) 1050096 P-PM DEV PRGR EVAL 2 ( 469.36) 1050097 P-PM DEV PRGR EVAL3+ ( 131.77) 1050098 P-ICD DEV PRG EVAL 1 ( 131.77) 1050099 P-ICD DEV PRG EVAL 2 ( 139.39) 1050100 P-ICD DEV PRG EVAL3+ ( 249.38) 1050101 P-ILR DEV EVAL PRGR ( 131.77) 1050102 P-PREOP PM DEV EVAL ( 91.48) 1050103 P-PREOP ICD DEV EVAL ( 91.48) 1050132 NI-HOLTER RECRD TO48 ( 272.25) 1050133 NI-HOLTER W-SCAN 48 ( 399.66) 1060001 FL-FLUORO 1 HOUR DR ( 646.70) 1061201 CC-INSERT SG CATH ( 6,606.96) 1061229 CC-ILIAC ANG W-CATH ( 4,274.06) 1061230 CC-PERICARDIO INI ( 2,424.11) 1061232 CC-INSERT IABP ( 3,339.55) 1061233 CC-REMOVE IABP ( 446.28) 1061239 IC-COR THROMBECTOMY ( 17,798.89)1061242 IC-IVUS, INIT ( 1,024.24) 1061243 IC-IVUS, ADDL ( 1,024.24) 1061246 IC-PTCA, SINGLE ( 20,999.78)1061247 IC-PTCA, ADDL ( 20,062.93)1061248 IC-VALVPLSTY AORTIC ( 21,018.57)1061249 IC-VALVPLSTY MITRAL ( 42,481.59)1061250 IC-VALVPLSTY PULM ( 42,481.59)1061251 IC-ATHERCT CORO INI ( 37,476.13)1061252 IC-ATHERECT CORO ADD ( 34,433.71)1061259 EP-EVAL GEN, INDUC ( 2,815.07) 1061260 EP-EVAL PREV DEVICE ( 3,398.98) 1061261 EP-ABLATE AV NODE ( 18,633.88)
1061264 EP-INTCRD ECHO INTER ( 1,822.99) 1061265 P-INS GEN-LEAD ATR ( 52,209.30)1061266 P-INS GEN-LEAD VEN ( 52,414.38)1061267 P-INS DUAL PAC SYS ( 62,612.47)1061268 P-INS TMP PAC LD SGL ( 25,477.75)1061271 P-INS-RPL GEN DUAL ( 43,857.72)1061272 P-UPGRD SNG TO DUAL ( 41,231.66)1061273 P-REPOS RA-RV LEAD ( 10,625.73)1061274 P-INS LEAD SNGL ( 25,477.75)1061275 P-INS LEAD DUAL ( 24,264.75)1061278 P-REVSE POCKET PACE ( 6,201.35) 1061279 P-REVSE POCKET ICD ( 5,732.50) 1061280 P-INS LV LEAD EXIST ( 79,042.21)1061282 P-REPOS LV LEAD EXIS ( 5,733.59) 1061283 P-REMOV PACE GEN ( 25,477.75)1061284 P-REMOV LEAD, SNG ( 9,561.88) 1061285 P-REMOV LEAD, DUAL ( 8,936.33) 1061286 P-REMOV ICD GEN ( 9,595.67) 1061287 P-REMOV ICD LEAD ( 8,290.56) 1061288 P-IMPLNT LOOP REC ( 29,491.97)1061289 P-REMOV LOOP REC ( 4,729.67) 1061297 S-INJ VENOGRAPHY ( 2,088.00) 1061322 S-CATH EXTREM ART ( 542.32) 1061325 S-INTROCATH AORTA ( 1,204.85) 1061326 S-THORACIC 1ST ORDER ( 1,743.18) 1061327 S-THORACIC 2ND ORDER ( 3,079.70) 1061329 S-THORACIC ADD ORDER ( 2,343.28) 1061330 S-ABDOMEN 1ST ORDER ( 1,710.56) 1061331 S-ABDOMEN 2ND ORDER ( 1,560.24) 1061332 S-ABDOMEN 3RD ORDER ( 1,642.97) 1061377 IR-INTRAVASC US INI ( 701.32) 1061398 EP-HIS BUNDLE REC ( 16,058.39)1061399 EP-INTRAATRIAL REC ( 16,058.39)1061400 EP-RV RECORD ( 3,776.65) 1061401 EP-MAP TACHY ( 2,063.66) 1061402 EP-INTRAATRIAL PAC ( 16,058.39)1061403 EP-INTRAVENT PAC ( 16,058.39)1061404 EP-MAP ADD ( 1,322.05) 1061407 EP-INDUC ARRY PAC ( 3,025.24) 1061408 EP-COMP EP W-O ARRY ( 18,633.88)1061409 EP-COMP EP W- ARRY ( 18,458.55)
1061410 EP-LA PACING, ADD ( 6,270.46) 1061411 EP-LV PACING, ADD ( 3,919.31) 1061412 EP-PROG STIM IV DRUG ( 1,505.00) 1061418 HEART FLOW MEASURE ( 2,056.03) 1061419 HEART FLOW MEAS ADD ( 187.31) 1061448 S-PRIM ART MECH THRO ( 13,498.02)1061454 P-INSERT ICD GEN ( 99,999.99)1061462 S-INC HEM-SER-F DRN ( 5,386.72) 1061464 IR-VENGRM JUGULAR ( 3,010.00) 1061467 S-INS-REP PACE-DEFIB ( 99,999.99)1061473 CC-INS NT CVC GT 5YR ( 3,980.30) 1061479 NI-TEMP EXT PACE ( 1,711.91) 1061480 NI-CARDIOVERSION ( 1,831.74) 1061489 NI-TILT TABLE ( 1,930.80) 1061501 CC-RHC ( 14,359.55)1061502 CC-LHC VENT PUNC ( 19,214.32)1061503 CC-R-L CATH LV PUNC ( 23,716.24)1061504 CC-ANGIO CORON ONLY ( 15,281.94)1061505 CC-S-I VNT ATR ANGIO ( 15,500.83)1061506 CC-R HRT CORONRY ART ( 20,267.38)1061507 CC-R HRT ART-GRF ANG ( 23,923.15)1061508 CC-L HRT ARTERY-VENT ( 26,039.08)1061509 CC-L HRT ART-GRF ANG ( 25,779.90)1061510 CC-R-L HRT ART-VENT ( 31,917.50)1061511 CC-R-L HRT ART-ANGIO ( 29,044.72)1061513 S-ILIAC REVASC ( 18,386.68)1061514 S-ILIAC REVAS W STNT ( 35,672.37)1061517 S-FEM POP REVAS TLA ( 18,386.68)1061518 S-FEM POP REVAS ATHR ( 42,938.18)1061519 S-FEM POP REVAS STNT ( 39,034.12)1061520 S-FEM POP STNT ATHR ( 74,363.45)1061521 S-TIB PER REVAS W TL ( 35,024.42)1061522 S-TIB PER REVAS ATHR ( 54,008.96)1061523 S-TIB PER REVAS STNT ( 54,008.96)1061524 S-TIB PER REV STN AT ( 77,138.23)1061526 S-INS CATH RENART 1U ( 10,735.36)1061527 S-INS CATH RENART 1B ( 21,471.81)1061528 S-INS CATH RENART 2U ( 6,798.63) 1061540 S-REM-REP PM GEN SNG ( 28,352.12)1061541 S-REM-REP PM GEN DUL ( 34,535.46)1061542 S-REM-REP PM GEN MLT ( 59,687.00)
1061543 S-INS PULSE GEN DUAL ( 94,266.02)1061544 S-INS ICD PLS GN MLT ( 99,999.00)1061545 S-REM-REP CVD SINGLE ( 98,979.21)1061546 S-REM-REP CVD DUAL ( 99,999.47)1061547 S-REM-REP CVD MULT ( 99,999.00)1061550 S-PERC INS VAD ART ( 99,999.00)1061552 S-PERC RMVL VAD ( 99,999.00)1061553 S-PERC REPOS VAD ( 99,999.00)1061554 IC-PRQ CRD STN W-ANG ( 35,024.42)1061555 IC-PRQ STNT W-ANG EA ( 31,296.77)1061556 IC-PRQ CRD ST-AT-ANG ( 54,008.96)1061557 IC-PRQ ST-AT-ANG EA ( 23,032.35)1061558 IC-PRQ RV BYP GRF IN ( 35,024.42)1061559 IC-PRQ RV BYP GRF AD ( 26,390.83)1061560 IC-PRQ CARD REV 1 VS ( 35,024.42)1061561 IC-PRQ REVSC CHR 1VS ( 35,024.42)1061562 IC-PRQ REVSC CHR ADD ( 25,290.94)1061564 IC-PRQ DE COR STNT ( 35,024.42)1061565 IC-PRQ DE COR STNT B ( 31,730.19)1061566 IC-PRQ DE CR STNT AR ( 54,008.96)1061567 IC-PR DE CR STN AR B ( 30,874.24)1061568 IC-PRQ DE CR REV CAB ( 35,024.42)1061569 IC-PR DE CR RV CAB B ( 29,933.34)1061570 IC-PRQ DE CR REV AMI ( 54,008.96)1061571 IC-PRQ DE COR REV CH ( 54,008.96)1061572 IC-PR DE CR RV CH EA ( 30,874.24)1061573 S-TRNSCTH THROM ART ( 9,910.99) 1061575 S-TRNCTH THRM ART VN ( 9,709.52) 1061576 S-TRNCTH CESS CTH RM ( 9,910.99) 1061577 EP-ABLATE SPRVNT ART ( 53,957.77)1061578 EP-ABLATE VENT TACY ( 52,246.95)1061579 EP-ATR FIB PULM VN I ( 52,246.95)1061580 IR-ANG EXT CRT NS ( 18,707.93)1061581 IR-ANG CRT EXT CC UN ( 14,932.37)1061583 IR-ANG CARTD IPS UNI ( 15,541.12)1061586 IR-ANG INT CAR IP BI ( 11,860.30)1061587 IR-ANG SUBCL IPS UNI ( 15,408.26)1061595 IR-VASC EMB-OCC ARTY ( 36,984.62)1061598 IR-TC PLC STN ART IN ( 36,659.01)1061616 CC-TRNS CTH PLC CRTD ( 3,589.34) 1061627 CC-TAVR TRANSAPICAL ( 1,581.23)
1061630 CC-LDLS C PM INS VNT ( 69,784.82)1061631 CC-LDLS C PM RMV VNT ( 10,858.38)1061702 IR-CAT DIAL TRAN BAL ( 18,005.53)1061705 IR-THRMBC TRAN BAL ( 30,521.40)1061801 IR-TLUM BAL ANG 1STA ( 31,305.48)1061802 IR-TLUM BAL ANG 1STV ( 34,013.83)1110801 OR LEV 1 INI 15 MIN ( 4,312.16) 1110802 OR LEV 2 INI 15 MIN ( 5,174.83) 1110803 OR LEV 3 INI 15 MIN ( 6,210.03) 1110804 OR LEV 4 INI 15 MIN ( 7,451.57) 1110805 OR LEV 5 INI 15 MIN ( 8,941.42) 1110806 OR LEV 6 INI 15 MIN ( 10,729.70)1110811 OR LEV 1 EA ADD MIN ( 106.08) 1110812 OR LEV 2 EA ADD MIN ( 114.24) 1110813 OR LEV 3 EA ADD MIN ( 141.06) 1110814 OR LEV 4 EA ADD MIN ( 219.16) 1110815 OR LEV 5 EA ADD MIN ( 279.78) 1110816 OR LEV 6 EA ADD MIN ( 359.06) 1110821 AD PROCEDURE OR LV 1 ( 1,294.00) 1110822 AD PROCEDURE OR LV 2 ( 1,552.80) 1110823 AD PROCEDURE OR LV 3 ( 1,862.89) 1110824 AD PROCEDURE OR LV 4 ( 2,235.94) 1110825 AD PROCEDURE OR LV 5 ( 2,682.43) 1110826 AD PROCEDURE OR LV 6 ( 3,219.84) 1110851 PERFUSION LEVEL 1 ( 2,925.31) 1110852 PERFUSION LEVEL 2 ( 4,085.63) 1110853 PERFUSION LEVEL 3 ( 5,447.50) 1110864 LITHOTRIPSY ( 39,960.09)1110865 BILAT LITHOTRIPSY ( 7,265.05) 1120001 PACU LEV 1 INI 15 MN ( 349.73) 1120002 PACU LEV 2 INI 15 MN ( 384.70) 1120003 PACU LEV 3 INI 15 MN ( 425.50) 1120004 PACU LEV 4 INI 15 MN ( 466.31) 1120011 PACU LEV 1 EA ADD MN ( 11.66) 1120012 PACU LEV 2 EA ADD MN ( 12.82) 1120013 PACU LEV 3 EA ADD MN ( 15.15) 1120014 PACU LEV 4 EA ADD MN ( 17.49) 1131111 ANES LV 1 INI 15 MIN ( 1,142.45) 1131112 ANES LV 2 INI 15 MIN ( 1,256.69) 1131113 ANES LV 3 INI 15 MIN ( 1,445.55) 1131114 ANES LV 4 INI 15 MIN ( 2,168.32)
1131121 ANES LV 1 EA ADD MIN ( 75.77) 1131122 ANES LV 2 EA ADD MIN ( 83.94) 1131123 ANES LV 3 EA ADD MIN ( 96.76) 1131124 ANES LV 4 EA ADD MIN ( 144.55) 1138501 LABOR EPIDURAL ( 3,051.69) 1140211 OR LEV 1 INI 15 MIN ( 3,679.24) 1140212 OR LEV 2 INI 15 MIN ( 4,047.49) 1140213 OR LEV 3 INI 15 MIN ( 4,452.79) 1140214 OR LEV 4 INI 15 MIN ( 4,897.30) 1140215 OR LEV 5 INI 15 MIN ( 5,387.58) 1140221 OR LEV 1 EA ADD MIN ( 90.43) 1140222 OR LEV 2 EA ADD MIN ( 96.97) 1140223 OR LEV 3 EA ADD MIN ( 129.65) 1140224 OR LEV 4 EA ADD MIN ( 186.30) 1140225 OR LEV 5 EA ADD MIN ( 237.51) 1140231 AD PROCEDURE OR LV 1 ( 1,103.66) 1140232 AD PROCEDURE OR LV 2 ( 1,214.79) 1140233 AD PROCEDURE OR LV 3 ( 1,335.73) 1140234 AD PROCEDURE OR LV 4 ( 1,469.74) 1140235 AD PROCEDURE OR LV 5 ( 1,615.73) 1160111 GI LAB LEV 1 1ST 15 ( 3,923.96) 1160112 GI LAB LEV 2 1ST 15 ( 4,119.81) 1160113 GI LAB LEV 3 1ST 15 ( 4,326.15) 1160114 GI LAB LEV 4 1ST 15 ( 4,541.82) 1160121 GI LEV 1 EA ADD MIN ( 61.79) 1160122 GI LEV 2 EA ADD MIN ( 74.61) 1160123 GI LEV 3 EA ADD MIN ( 116.58) 1160124 GI LEV 4 EA ADD MIN ( 122.41) 1160131 AD PROCEDURE GI LV 1 ( 1,177.42) 1160132 AD PROCEDURE GI LV 2 ( 1,235.71) 1160133 AD PROCEDURE GI LV 3 ( 1,297.50) 1160134 AD PROCEDURE GI LV 4 ( 1,362.78) 1160155 BREATH HYDROGEN TEST ( 478.29) 1160158 GI TRACT CAPSL ENDOS ( 3,247.80) 1160164 ESOPHAG CAPSULE ENDO ( 3,247.80) 1210006 AMOXIC 400MG/5ML UD ( 2.22) 1210007 IVIG (OCTAGAM) 500MG ( 253.71) 1210008 IVIG (GAMMAGD) 500MG ( 267.17) 1210011 RHOPHYLAC 100UNT ( 432.00) 1210012 HEPAGAM B IM 0.5ML ( 293.00) 1210013 ZOLEDRONIC ACID 1MG ( 89.88)
1210014 RISPERIDONE 3MG TAB ( 38.80) 1210016 CEPHALEX 250/5 100ML ( 106.26) 1210019 PHENYLEPHRINE 10MGTB ( 0.63) 1210021 SACCHAROM BO 250MGCP ( 2.79) 1210027 ALTEPLASE RECOM 1MG ( 280.56) 1210028 PENI G PROC 600000UN ( 74.36) 1210031 NICARDIP 25/10ML INJ ( 513.34) 1210035 LEVALBUT1.25MG/0.5ML ( 33.71) 1210056 QUETIAPINE 200MGSRTB ( 54.14) 1210060 MICONAZ 2%VAG CR 45G ( 52.28) 1210061 ROTIGOT 4MG/24HR PTC ( 77.60) 1210067 SMZ-TMP 400-800 INJ ( 22.58) 1210071 FLUTICASON 44MCG PUF ( 822.92) 1210077 ALBUTEROL 90MCG PUFF ( 4.76) 1210083 HYDROMORPH UP TO 4MG ( 122.18) 1210090 LEVETIRACET 10MG INJ ( 4.11) 1210091 TEMSIROLIMUS 1MG INJ ( 296.35) 1210093 PENTAMIDIN NEB 300MG ( 387.92) 1210115 RIVASTIG 9.5MG PATCH ( 43.01) 1210116 RIVASTIG 4.6MG PATCH ( 37.90) 1210121 ACETYLCYS 10%INH 10M ( 56.85) 1210137 DACTINOMYCIN 0.5MG ( 5,616.05) 1210138 SOD BICARB 4.2% 5ML ( 25.75) 1210145 CEFEPIME 500MG INJ ( 61.38) 1210146 CEFOTAXIME NA 1GM ( 70.10) 1210147 ALTEPLASE RECOM 1MG ( 160.81) 1210148 ALTEPLASE RECOM 1MG ( 307.58) 1210149 CEFOXITIN 1GM IJ ( 59.27) 1210153 LUPR 7.5 MALES>18YRS ( 838.84) 1210154 LUPR 7.5 MALES>18YRS ( 5,499.28) 1210160 OCTREOTIDE DEP 1MG ( 548.10) 1210161 OCTREOTIDE DEP 1MG ( 678.96) 1210162 OCTREOTIDE ND 25MCG ( 31.29) 1210164 OCTREOTIDE ND 25MCG ( 28.41) 1210165 OCTREOTIDE ND 25MCG ( 14.40) 1210166 PAMIDRONATE 30MG IJ ( 19.68) 1210169 CARBOPLATIN 50MG INJ ( 2.00) 1210173 DAUNORUBICIN 10MG ( 515.54) 1210175 RITUXIMAB 100MG INJ ( 4,061.32) 1210176 FOSPHENYTOIN 50MG ( 74.74) 1210178 CETUXIMAB INJECTION ( 206.51)
1210179 APREPITANT 5MG PO ( 27.45) 1210181 ENOXAPARIN 10MG INJ ( 48.41) 1210182 ENOXAPARIN 10MG INJ ( 46.11) 1210183 ENOXAPARIN 10MG INJ ( 43.91) 1210185 ENOXAPARIN 10MG INJ ( 48.41) 1210186 ENOXAPARIN 10MG INJ ( 46.11) 1210187 ENOXAPARIN 10MG INJ ( 48.41) 1210188 AMPICILLIN/SUB 1.5GM ( 64.50) 1210190 LEUCOVORIN 50MG INJ ( 53.48) 1210191 LEUCOVORIN 50MG INJ ( 48.59) 1210192 LEUCOVORIN 50MG INJ ( 45.49) 1210194 CEFAZOLIN 500MG INJ ( 107.60) 1210195 CEFTRIAXONE 250MGINJ ( 79.67) 1210196 CEFTRIAXONE 250MGINJ ( 79.68) 1210197 CEFTRIAXONE 250MGINJ ( 52.30) 1210198 CEFUROXIME 750MG INJ ( 55.78) 1210199 CEFTAZIDIM 500MG INJ ( 53.12) 1210200 CILAS NA IMIP 250MG ( 115.37) 1210202 CIPROFLOXAC 200MG IV ( 87.40) 1210203 CIPROFLOXAC 200MG IV ( 83.07) 1210205 DEXAMETH NA 1MG INJ ( 14.78) 1210206 PHENYTOIN NA 50MGINJ ( 4.43) 1210207 DOBUTAMINE 250MG INJ ( 111.65) 1210208 ERYTHROMYC 500MG INJ ( 75.21) 1210209 CEFOTAXIME NA 1GM ( 54.33) 1210210 MEROPENEM 100MG INJ ( 16.77) 1210211 ACYCLOVIR 5MG INJ ( 51.36) 1210212 ACYCLOVIR 5MG INJ ( 48.00) 1210214 OXALIPLATIN .5MG INJ ( 69.63) 1210219 PANITUMUMAB 10MG IJ ( 520.38) 1210221 FONDAPARINUX 0.5MG ( 65.86) 1210222 FONDAPARINUX 0.5MG ( 65.79) 1210223 FONDAPARINUX 0.5MG ( 65.86) 1210224 LEVOFLOXAC 250MG INJ ( 117.39) 1210225 LEVOFLOXAC 250MG INJ ( 149.22) 1210229 IVIG (OCTAGAM) 500MG ( 242.60) 1210231 IVIG (GAMMAGD) 500MG ( 159.13) 1210233 KETOROLAC 15MG INJ ( 16.27) 1210234 ONDANSETRON 1MG INJ ( 14.31) 1210236 AMPICILLIN 500MG INJ ( 31.91) 1210237 AMPICILLIN 500MG INJ ( 39.79)
1210238 FLUCONAZOL 200MG INJ ( 566.33) 1210239 OXACILLIN 250MG INJ ( 10.80) 1210243 BISMUTH SUB 262MG/15 ( 0.82) 1210250 BUPIVAC-MPF .5% 30ML ( 63.22) 1210252 MORPHINE PF 10MG INJ ( 79.73) 1210255 BETAXOLOL 0.5% OS 5M ( 278.00) 1210257 CYCLOBENZAPRI 5MG TB ( 11.79) 1210262 FUROSEMIDE 20MG INJ ( 3.62) 1210263 FUROSEMIDE 20MG INJ ( 21.88) 1210266 MEGESTROL 400MG/10ML ( 1.35) 1210267 MEPERID HCL 100MGINJ ( 4.28) 1210270 MEPERID HCL 100MGINJ ( 23.87) 1210282 CLOBETAS .05% CR 30G ( 769.38) 1210290 PHENYLEPH 2.5%OS 15M ( 36.10) 1210291 GENTAMIC.1% OIN 30GM ( 27.41) 1210294 PIPER/TAZOB 1G/.125G ( 66.33) 1210305 DOCUS NA 10MG/ML 25M ( 3.21) 1210327 EPTIFABITIDE 5MG IJ ( 144.54) 1210328 CALC600-VITD3 400 TB ( 5.56) 1210330 APAP/OXYCOD325/5 5ML ( 41.06) 1210331 ALUMINUM HYD 320/5ML ( 0.95) 1210337 OXYCODONE 15MG TAB ( 10.35) 1210338 ESTROPIPATE 1.5MG TB ( 3.72) 1210342 AMIODARONE 30MG INJ ( 6.72) 1210346 SOD CHL 5%OIN 3.5GM ( 64.10) 1210348 VITAMIN A&D OIN 5GM ( 11.83) 1210355 ATROPINE SUL1%OS 15M ( 184.80) 1210357 CEFPODOX 100/5ML 50M ( 25.85) 1210359 BENZOC 20% REC OIN30 ( 107.89) 1210366 PHEN-SHK-MO-PE OIN30 ( 21.69) 1210371 CARBID25-LEVO100MGTB ( 10.76) 1210382 FORMOTER 12MCG INHCP ( 198.06) 1210391 ATROPINE SUL1%OS 2ML ( 46.13) 1210399 HYDROXYZINE PAM 25MG ( 4.91) 1210407 EMOLLIENT LOT 120ML ( 42.00) 1210408 DOBUTAMINE 250MG INJ ( 40.40) 1210434 DOXEPIN 150MG CAP ( 12.99) 1210436 PED MVI/FE 10/ML 50M ( 54.89) 1210439 CLOBETAS .05% CR 15G ( 99.14) 1210443 LANTHAN 1000MG CHEW ( 10.77) 1210466 NEBIVOLOL 5MG TAB ( 12.08)
1210468 NEBIVOLOL 10MG TAB ( 7.90) 1210474 PANTOPRAZ 40MG PKT ( 25.62) 1210475 SOD TETRAD SUL 3% IJ ( 57.65) 1210476 IXABEPILONE 1MG INJ ( 412.44) 1210487 VANCOMYCIN 500MG INJ ( 101.74) 1210498 THROMBIN 5000U RECOM ( 263.55) 1210501 KETOROLAC .5%OS 5ML ( 344.66) 1210505 OLANZAPINE 10MG ODT ( 62.22) 1210507 DEXAMETH 0.25MG ORAL ( 0.50) 1210526 OXYMORPHON 10MG SRTB ( 16.16) 1210532 BRIMO.2-TIMO.5%OS 5M ( 236.13) 1210538 MIDAZOL HCL 1MG INJ ( 13.93) 1210539 HEPARIN 1000U INJ ( 10.80) 1210552 PHYTONADIONE 1MG INJ ( 25.07) 1210554 IPRA-ALBU.5-2.5MG/3M ( 6.90) 1210558 VANCOMYCIN 500MG INJ ( 142.73) 1210561 CEFDINIR250MG/5 60ML ( 421.66) 1210569 POTASSI CHL 2MEQ INJ ( 0.79) 1210577 FE POLYSAC-B12-FA CP ( 3.00) 1210585 GENTAMIC .1%CRM 15GM ( 12.37) 1210587 KETOCONAZ 2%CRM 60GM ( 237.39) 1210595 RALTEGRAVIR 400MG TB ( 89.75) 1210601 MENTH-METH SA CR 60G ( 13.26) 1210607 ESTRAD.05MG/24 PT 2X ( 41.01) 1210609 LIDO-MPF 0.5% 50ML ( 70.37) 1210614 BENZO 20%DENT GEL 7G ( 13.92) 1210638 DIGOX 250MCG/5ML 5ML ( 22.68) 1210665 DESVENLAF 50MG SR TB ( 17.41) 1210666 LUBIPROSTONE 8MCG CP ( 21.64) 1210670 CYCLOPENTO 1%OS 5ML ( 148.98) 1210711 LIDOC-MPF 2% INJ 2ML ( 13.43) 1210730 ESTRAD.1MG/24HR PT2X ( 45.77) 1210736 MAGNES SULF 500MGINJ ( 69.74) 1210739 POTASSI CHL 2MEQ INJ ( 0.18) 1210740 MORPHINE UP TO 10MG ( 22.00) 1210741 MORPHINE UP TO 10MG ( 26.69) 1210743 OXYCODO 20MG/ML 30ML ( 21.88) 1210746 MULTIVITAM INJ 10ML ( 76.28) 1210752 VIT D3 1000UNT TAB ( 5.52) 1210757 TRANEXAMIC 1000MG IJ ( 426.11) 1210800 CEFAZOLIN 500MG INJ ( 1.98)
1210801 DEXAMETH NA 1MG INJ ( 39.53) 1210802 DEXAMETH NA 1MG INJ ( 1.98) 1210816 FENTANY CIT 0.1MGINJ ( 10.41) 1210822 ALBUMIN 25% 50ML IV ( 304.04) 1210823 ALBUMIN 5% 250ML IV ( 326.74) 1210826 IMMU GLOB LYO 500MG ( 159.41) 1210829 TRACE METALS NEO 2ML ( 13.52) 1210837 TROSPIUM XR 60MG CAP ( 28.13) 1210850 MEXILETINE 250MG CAP ( 8.41) 1210860 POTASS CIT 5MEQ CRTB ( 5.28) 1210870 BENDAMUSTINE 1MG INJ ( 74.22) 1210876 RANITIDINE 25MG INJ ( 15.13) 1210881 DEXAMETH 0.25MG ORAL ( 6.43) 1210882 DEXAMETH 0.25MG ORAL ( 2.48) 1210883 DEXAMETH 0.25MG ORAL ( 1.15) 1210885 DEXAMETH 0.25MG ORAL ( 0.93) 1210891 FENTANY CIT 0.1MGINJ ( 10.68) 1210894 TACROLIMUS 1MG PO ( 18.61) 1210895 TACROLIMUS 1MG PO ( 20.53) 1210901 HEPARIN 1000U INJ ( 12.83) 1210902 HEPARIN 1000U INJ ( 2.54) 1210920 ROMIPLOSTIM 10MCG IJ ( 271.50) 1210921 FACTOR VIIA 1MCG ( 5.98) 1210924 LANTREOTIDE 1MG INJ ( 200.16) 1210931 INTEGRA BMWD SQ CM ( 2,012.34) 1210947 BEVACIZUMAB 10MG INJ ( 324.72) 1210949 MEPIVACAINE 10ML INJ ( 43.31) 1210952 MEPIVACAINE 10ML INJ ( 26.99) 1210961 REGADENOSON 0.1MG IJ ( 320.68) 1210968 LORAZEPAM 2MG INJ ( 4.63) 1210970 PED VIT A/D/C 50MLDR ( 31.00) 1210984 LOPINA/RITONA 100/25 ( 11.94) 1211017 MELATONIN 1MG TAB ( 3.24) 1211034 POTASSI CHL 2MEQ INJ ( 7.05) 1211037 MIDAZOL HCL 1MG INJ ( 13.93) 1211039 GENTAMICIN UPTO 80MG ( 21.56) 1211040 GENTAMICIN UPTO 80MG ( 286.40) 1211043 PEMETREXED 10MG INJ ( 348.24) 1211045 METHOTREX NA 5MG ( 13.73) 1211046 METHOTREXATE NA 50MG ( 14.33) 1211048 EPO NESRD 1000 U INJ ( 100.19)
1211052 EPO NESRD 1000 U INJ ( 100.19) 1211058 FLUCON 10MG/ML 35ML ( 143.60) 1211068 METHYLPR ACE 40MGINJ ( 23.00) 1211077 VINORELBINE TAR 10MG ( 202.79) 1211079 CALCIUM GLUC 10%10ML ( 25.26) 1211080 TRIAMCIN ACE 10MGINJ ( 13.89) 1211081 GEMCITABIN 200MG INJ ( 513.60) 1211082 PAPAVERINE UPTO 60MG ( 24.96) 1211091 HYDROCORTIS 100MGINJ ( 28.38) 1211094 METHYLPRED 125MG INJ ( 47.25) 1211109 ACETYLCYS 20%INH 30M ( 109.90) 1211117 HEPARIN NA 10U FLUSH ( 0.41) 1211118 HEPARIN 1000U INJ ( 1.81) 1211119 MAGNES SULF 500MGINJ ( 2.79) 1211122 TRIAMCIN ACE 10MGINJ ( 12.68) 1211123 METHYLPRED 125MG INJ ( 24.84) 1211128 DEXAMETH 0.25MG ORAL ( 4.00) 1211129 DEXAMETH 0.25MG ORAL ( 2.70) 1211140 ROPIVACAINE 1MG INJ ( 0.46) 1211142 CEFOXITIN 1GM IJ ( 73.84) 1211147 HEPARIN 1000U INJ ( 14.43) 1211153 CEFAZOLIN 500MG INJ ( 15.12) 1211154 VANCOMYCIN 500MG INJ ( 83.96) 1211157 SOD CHLOR .9% 10ML ( 27.89) 1211158 CEFTAZIDIM 500MG INJ ( 23.76) 1211159 MAGNES SULF 500MGINJ ( 8.45) 1211166 HYDROXYZI UP TO 25MG ( 2.74) 1211167 NITROFUR MONO 100MG ( 15.18) 1211176 MAGNES SULF 500MGINJ ( 5.67) 1211178 PROTAMINE 10MG INJ ( 7.81) 1211179 HEPARIN 1000U INJ ( 152.57) 1211180 AMPICILLIN 500MG INJ ( 37.18) 1211183 CIPROFLOXAC 200MG IV ( 87.01) 1211186 PHENYLEPHRIN 1ML INJ ( 43.18) 1211187 MAGNES SULF 500MGINJ ( 25.50) 1211191 VASOPRESSIN 20U/ML ( 24.93) 1211192 CALCIUM CL 10% 10ML ( 27.89) 1211196 PHENYLEPH.25%SPR 30M ( 14.49) 1211199 DEXTROSE 50% 50ML ( 38.45) 1211202 MULTIVIT-MIN LIQ 5ML ( 0.95) 1211205 MULTIVITAMIN W/MINER ( 0.24)
1211206 APAP/COD 120-12/5ML ( 14.88) 1211208 K & NA PHOS PWD PKT ( 7.09) 1211212 MORPH PO 10MG/5ML 5M ( 14.92) 1211213 RABIES VAC IM ( 1,091.10) 1211215 AMINOPHYLL 250MG INJ ( 23.69) 1211216 DOBUTAMINE 250MG INJ ( 46.27) 1211217 MORPHINE PF 10MG INJ ( 58.68) 1211223 METHYLPRED 125MG INJ ( 32.35) 1211226 MORPHINE UP TO 10MG ( 8.22) 1211234 ARTIFIC SALIVA 45ML ( 21.48) 1211267 ENTECAVIR 0.5MG TAB ( 133.32) 1211283 ERYTHRO 200MG/5ML 5M ( 1.46) 1211312 PED MULTVIT/C&FA CHW ( 5.58) 1211324 DESMOPRESSIN 1MCGINJ ( 85.07) 1211325 PIMOZIDE 2MG TABLET ( 7.32) 1211330 FAMOTIDINE 200MG/20M ( 32.40) 1211346 POVI-IODINE 10% SWAB ( 12.96) 1211347 MILRINONE 5MG INJ ( 309.11) 1211348 FLUOROURACIL 500MG ( 1.62) 1211352 PREDNISOLONE 5MG TAB ( 6.75) 1211362 QUETIAPINE 50MG SRTB ( 27.06) 1211364 FENTANY CIT 0.1MGINJ ( 42.64) 1211367 IRINOTECAN 20MG INJ ( 725.97) 1211376 IVIG (GAMUNEX) 500MG ( 155.78) 1211383 PED MVI/MIN/C 45/1ML ( 1.85) 1211393 CARBAMAZE 100MG/5ML ( 18.55) 1211396 DAKINS.125%SOL 480ML ( 36.80) 1211404 QUINIDINE SULF 300MG ( 5.06) 1211431 SKIN CREAM 454GM ( 22.65) 1211456 IVIG (GAMUNEX) 500MG ( 155.78) 1211458 IVIG (GAMUNEX) 500MG ( 173.99) 1211460 ACETYLCYS 10%INH 4ML ( 51.00) 1211500 FEBUXOSTAT 40MG TAB ( 24.44) 1211503 RABIES IG HEAT TX ( 1,300.57) 1211507 DRONEDRARONE 400MG ( 25.87) 1211512 ARFORMOTL 15MCG/2ML ( 30.59) 1211515 IDARUBICIN HCL 5MG ( 157.90) 1211520 PRASUGREL 10MG TAB ( 35.81) 1211521 PRASUGREL 5MG TAB ( 73.44) 1211522 TOLVAPTAN 30MG TAB ( 371.18) 1211523 TOLVAPTAN 15MG TAB ( 357.80)
1211524 LACOSAMIDE 50MG TAB ( 21.96) 1211529 DOXORUBICIN 10MG INJ ( 1.54) 1211531 NEOSTIGMINE .5MG INJ ( 3.44) 1211537 LIDOCAINE 2% INJ 2ML ( 3.40) 1211555 LORATADINE 5MG/5ML ( 2.30) 1211571 CARBOPLATIN 50MG INJ ( 2.16) 1211576 SOD CHL 7% 4ML NEB ( 7.50) 1211577 TAPENTADOL 50MG TAB ( 15.95) 1211593 POTASSI CHL 2MEQ INJ ( 0.39) 1211616 LACOSAMIDE 1MG INJ ( 0.94) 1211630 PALIPERIDONE 1MG INJ ( 37.67) 1211631 PALIPERIDONE 1MG INJ ( 31.39) 1211639 GLYCERIN 2GM SUPP ( 0.60) 1211643 ATROPINE 0.01MG INJ ( 0.79) 1211644 ATROPINE 0.01MG INJ ( 0.79) 1211645 ATROPINE 0.01MG INJ ( 0.45) 1211652 FERUMOXYTOL1MG NESRD ( 4.67) 1211698 AMY-LIP-PRO 60-12-38 ( 6.75) 1211764 TIMOLOL 0.25% GL 5ML ( 120.32) 1211786 PN VIT/FE/FA 27-.8TB ( 5.00) 1211792 PNEUMOCOC 13-VAL IM ( 591.93) 1211796 ARTIFIC TEAR OIN3.5G ( 35.32) 1211880 FERR SUL 75MG/ML 1ML ( 0.81) 1211883 ILOPERIDONE 12MG TAB ( 46.79) 1211886 RIFAXIMIN 550MG TAB ( 91.48) 1211890 SENNOSIDES 15MG TAB ( 4.10) 1211901 LAMOTRIG 25MG DISPTB ( 9.60) 1211906 AMY-LIP-PRO 27-5-17 ( 13.99) 1211907 LIP10-PRO34-AMY55DCP ( 9.21) 1211908 AMY82-LIP15-PRO51DCP ( 12.27) 1211909 LIP20-PRO68-AMY109CP ( 17.71) 1211910 TELAVANCIN 10MG INJ ( 15.34) 1211958 WITCH HAZEL-GLYC PAD ( 15.20) 1212061 TETRAHYDROZ.05% 15ML ( 13.47) 1212086 RISPERIDONE LA 0.5MG ( 28.21) 1212096 DABIGATRAN 75MG TAB ( 18.40) 1212100 DENOSUMAB 1MG INJ ( 73.89) 1212109 DABIGATRAN 150MG TAB ( 19.32) 1212114 CROTALID POLY IM 1GM ( 11,482.90)1212115 CABAZITAXEL 1MG INJ ( 808.90) 1212118 ADRENL/EPINEP 0.1MG ( 2.53)
1212119 ADRENL/EPINEP 0.1MG ( 0.19) 1212120 ADRENL/EPINEP 0.1MG ( 83.49) 1212131 TOPOTECAN 0.1MG INJ ( 26.87) 1212133 PCN G BENZ/PROC 100K ( 16.28) 1212135 PEN G BENZ INJ 100K ( 25.63) 1212136 PEN G BENZ INJ 100K ( 17.04) 1212137 PEN G BENZ INJ 100K ( 47.68) 1212148 ERIBULIN 0.1MG INJ ( 330.94) 1212162 EMOLLIENT CREAM113GM ( 10.80) 1212167 DTAP-HIB-IPV INJ ( 249.00) 1212192 ACETAMINO 10MG INJ ( 0.60) 1212213 CEFTAROLIN 10MG INJ ( 13.00) 1212217 INSULIN 1 UNT INJ ( 0.39) 1212218 INSULIN 1 UNT INJ ( 0.39) 1212219 INSULIN 1 UNT INJ ( 0.39) 1212220 INSULIN 1 UNT INJ ( 0.39) 1212221 INSULIN 1 UNT INJ ( 0.97) 1212223 INSULIN 1 UNT INJ ( 0.98) 1212224 INSULIN 1 UNT INJ ( 8.50) 1212226 INSULIN 1 UNT INJ ( 0.92) 1212227 INSULIN 1 UNT INJ ( 0.39) 1212229 GANCICLOV 0.15% 5GM ( 797.17) 1212232 BELIMUMAB 10MG INJ ( 138.74) 1212245 TOCILIZUMAB 1MG INJ ( 14.17) 1212247 FLUPHENAZ 2.5MG/1 IJ ( 48.80) 1212249 CALC CIT315-D250 TAB ( 0.15) 1212257 CHLORHEXIN .12% 15ML ( 12.37) 1212258 LURASIDONE 80MG TAB ( 83.76) 1212259 LURASIDONE 40MG TAB ( 63.25) 1212260 TOCILIZUMAB 1MG INJ ( 14.17) 1212266 DENOSUMAB 1MG INJ ( 107.69) 1212267 DOCETAXEL 1MG INJ ( 74.00) 1212280 FIDAXOMICIN 200MG TA ( 670.09) 1212283 RIVAROXABAN 10MG TAB ( 38.42) 1212285 CYTARABINE 100 MG ( 142.66) 1212286 ROFLUMILAS 500MCG TB ( 31.00) 1212287 OSELTAMIVIR 30MG/5ML ( 42.99) 1212294 TICAGRELOR 90MG TAB ( 19.08) 1212295 VILAZODONE 20MG TAB ( 22.28) 1212307 HEPATITIS B GLOB 1ML ( 497.09) 1212311 MYCOPHE MOF 250MG PO ( 32.36)
1212332 RIVAROXABAN 15MG TAB ( 10.02) 1212333 RIVAROXABAN 20MG TAB ( 42.54) 1212334 METHYLENE BLUE1% 1ML ( 4.48) 1212335 VITAMIN K 100MCG TAB ( 3.43) 1212342 BRENTUXIMAB 1MG INJ ( 491.90) 1212347 SIPULEUCEL-T 250ML ( 99,999.00)1212349 LEVOTHYROX 100MCG IV ( 66.59) 1212350 RANITIDIN 150MG/10ML ( 7.30) 1212354 BESIFLOXACN 0.6% 5ML ( 527.70) 1212359 CLONAZEPAM 0.5MG ODT ( 4.45) 1212360 FENT2MC-BUP.0625%250 ( 250.00) 1212361 H-COD7.5-APAP325 15M ( 11.42) 1212365 EPIFIX SQ CM ( 767.41) 1212377 LEVETIRACET 10MG INJ ( 1.97) 1212381 IPILIMUMAB 1MG INJ ( 501.00) 1212382 IPILIMUMAB 1MG INJ ( 501.00) 1212389 ONDANSETRON 8MG PO ( 189.32) 1212398 BENZ 20%DENT LIQ 60G ( 118.47) 1212406 CYCLOPHOSPHAMI 100MG ( 159.02) 1212407 CYCLOPHOSPHAMI 100MG ( 330.00) 1212416 CEFAZOLIN 500MG INJ ( 26.28) 1212425 DOXORUBICIN LIP 10MG ( 1,499.72) 1212429 BIMATOPRO.01%OS 2.5M ( 376.92) 1212430 SEVELAM CARB 800MGTB ( 11.96) 1212441 DOXORUBICIN LIP 10MG ( 1,499.72) 1212443 DOXORUBICIN 10MG INJ ( 7.20) 1212444 DOXORUBICIN 10MG INJ ( 1.54) 1212449 ESTROGEN VAG CR 30GM ( 545.46) 1212470 NEOSTIGMINE .5MG INJ ( 1.58) 1212478 PREDNIS ACE 1%OS 1ML ( 74.22) 1212498 ADRENL/EPINEP 0.1MG ( 2.98) 1212507 HEP A PED/ADOL X2 IM ( 240.39) 1212511 ETOPOSIDE 10MG INJ ( 2.73) 1212517 HEPATITIS B GLOB 1ML ( 418.57) 1212527 PHENOBARB 120MG INJ ( 10.25) 1212528 CARFILZOMIB 1MG INJ ( 119.35) 1212530 MEPERID HCL 100MGINJ ( 20.60) 1212531 MEPERID HCL 100MGINJ ( 22.31) 1212534 MOME/FORM 100/5 PUF ( 7.19) 1212535 MOME/FORM 200/5 PUF ( 7.19) 1212542 HALOPER DEC 50MGINJ ( 129.10)
1212543 PIPER/TAZOB 1G/.125G ( 66.33) 1212545 PIPER/TAZOB 1G/.125G ( 22.83) 1212547 ROPIVACAINE 1MG INJ ( 0.66) 1212548 ROPIVACAINE 1MG INJ ( 0.55) 1212549 ROPIVACAINE 1MG INJ ( 0.68) 1212550 ROPIVACAINE 1MG INJ ( 0.03) 1212552 CYCLOSPORNE 100MG PO ( 36.30) 1212556 BUPIVACAINE LIPO 1MG ( 4.55) 1212565 ETOPOSIDE 10MG INJ ( 2.73) 1212571 METHYLPREDNIS 4MG PO ( 12.96) 1212579 PED MULTIVIT-FL CHW ( 0.12) 1212581 EXTRACELL WND COVER ( 610.71) 1212582 TISSUE MATRIX INJ ( 17,664.00)1212585 ATROPINE 0.01MG INJ ( 0.35) 1212614 MAGNES SULF 500MGINJ ( 2.25) 1212625 HEPARIN 1000U INJ ( 3.70) 1212633 HEPARIN NA 10U FLUSH ( 2.87) 1212634 HEPARIN NA 10U FLUSH ( 3.07) 1212637 HEPARIN NA 10U FLUSH ( 5.58) 1212645 VANCOM 50MG/MLOR 5ML ( 12.18) 1212647 FOSAPREPITANT 1MG IJ ( 9.42) 1212654 CEFTRIAXONE 250MGINJ ( 2.70) 1212657 POTASSI CHL 2MEQ INJ ( 26.87) 1212660 P-EPHR/HRDFAT .25SUP ( 3.59) 1212665 DOPAMIN HCL 40MG INJ ( 7.38) 1212667 MEPIVACAINE 10ML INJ ( 29.75) 1212670 MILRINONE 5MG INJ ( 140.65) 1212679 CARBAMAZE 100MG SRCP ( 9.18) 1212680 DEXAME NAPHOS.1%OS5M ( 210.84) 1212688 AUG BETAM.05%OIN 15G ( 190.29) 1212689 FOLIC AC/B COMX W/C ( 6.13) 1212695 TIMOLOL MAL.5%OS 5ML ( 72.51) 1212701 CLOBETA .05% OIN 15G ( 99.09) 1212719 CYTARABINE 100 MG ( 22.50) 1212720 MYCOPHENOL AC 180MG ( 39.33) 1212723 HYDROXYZI UP TO 25MG ( 12.31) 1212724 POTASSI CHL 2MEQ INJ ( 0.61) 1212728 CYCLOSPORINE 25MG PO ( 11.74) 1212736 DEXTRAN 40 500ML INF ( 88.00) 1212742 RABIES IG IM/SC 150U ( 853.44) 1212805 MICONAZOL 2%SPY 113G ( 26.91)
1212809 ZIV-AFLIBERC 1MG INJ ( 57.61) 1212812 METHYLNALTR .1MG INJ ( 3.41) 1212836 EMOLLIENT OINT 454GM ( 65.81) 1212837 OXYTOCIN UP TO 10UN ( 63.29) 1212839 AMOX250/CLAV62.5 75M ( 210.84) 1212846 TERBINAFIN 1% CR15GM ( 47.70) 1212847 LINACLOTID 290MCG CP ( 30.91) 1212856 DOCETAXEL 1MG INJ ( 74.00) 1212857 DOCETAXEL 1MG INJ ( 74.00) 1212863 BACITR ZN 1GM UD PKT ( 11.27) 1212864 BACIT ZN 500/GM 15GM ( 0.71) 1212865 BACIT ZN 500/GM 30GM ( 33.99) 1212867 ASA/CA CARB/AL/MG325 ( 0.08) 1212873 ZINC OX 12.8%OIN 60G ( 21.58) 1212874 ZINC OX 16% OINT 28G ( 12.86) 1212879 TOBRAMYCIN UPTO 80MG ( 1.78) 1212889 BARIUM SULF 2.1% 1ML ( 0.04) 1212926 CEFEPIME 500MG INJ ( 44.82) 1212928 AL200-MG200/5 30ML ( 0.19) 1212931 AL200-MG200-SIM20/5M ( 0.80) 1212940 EPIRUBICIN HCL 2MG ( 22.27) 1212964 CARBOXYME .5%OS 15ML ( 28.41) 1212966 CARBOXYME .5%OS .4ML ( 20.45) 1212967 LUPR 7.5 MALES>18YRS ( 13,008.64)1212982 GENTAMICIN UPTO 80MG ( 287.72) 1212983 GENTAMICIN UPTO 80MG ( 260.97) 1212984 GENTAMICIN UPTO 80MG ( 11.96) 1213002 OXALIPLATIN .5MG INJ ( 69.63) 1213008 MITOMYCIN 5MG INJ ( 817.38) 1213009 MITOMYCIN 5MG INJ ( 361.55) 1213010 FLUOROURACIL 500MG ( 46.26) 1213012 GEMCITABIN 200MG INJ ( 160.68) 1213014 GEMCITABIN 200MG INJ ( 119.70) 1213018 DEGARELIX 1MG INJ ( 22.68) 1213021 VINCRISTIN SULF 1MG ( 208.80) 1213037 NALOXONE HCL 1MG INJ ( 19.89) 1213038 APIXABAN 2.5MG TAB ( 22.73) 1213039 APIXABAN 5MG TAB ( 22.73) 1213041 LINACLOTID 145MCG CP ( 32.95) 1213102 MESALAMIN 800MG DRTB ( 19.69) 1213114 VENLAFAXI 37.5M SRTB ( 18.55)
1213136 MORPHINE PF 10MG INJ ( 27.89) 1213141 LAMOTRIGIN 100MGSRTB ( 42.08) 1213158 BETAXOLOL .25%OS 5ML ( 251.74) 1213174 CHOLECAL 400UN/ML 1M ( 0.48) 1213187 ZOLEDRONIC ACID 1MG ( 145.09) 1213204 SELENIUM 200MCG CRTB ( 1.00) 1213226 SILV SULF 1%CRM 85GM ( 85.42) 1213233 DIPHE2-ZNACE.1%CR30G ( 15.98) 1213240 BENZ-PECT 15-5MG LOZ ( 0.54) 1213242 HEPARIN 1000U INJ ( 14.43) 1213275 RECT PROT/EMOL OIN57 ( 0.21) 1213318 ADO-TRASTUZU EMT 1MG ( 99.85) 1213324 DOXYCYC MON 100MG CP ( 7.01) 1213328 RITONAVIR 100MG TAB ( 27.10) 1213329 HYOSCYAM.125MG DSPTB ( 3.39) 1213336 PETROLATUM GEL 52GM ( 6.11) 1213338 CALAM-ZN OX LOT 177M ( 7.67) 1213375 MEDROXYPROG 1MG INJ ( 2.24) 1213381 CALC CARB 1250MG/5ML ( 4.82) 1213389 MESALAMIN 400MG DRCP ( 10.82) 1213393 PHENOL 1.4%SPR 20ML ( 9.15) 1213394 DIAZEPAM 5MG INJ ( 17.75) 1213396 PERMETHRI 1%CRM 60ML ( 35.97) 1213399 TRACE 4 MINERALS 1ML ( 11.25) 1213403 PSYLLIUM 58.12%PWDPK ( 5.44) 1213407 TRACE 5 MINERALS 1ML ( 30.00) 1213408 AZITHROM 900MG/22.5M ( 160.23) 1213425 CEPHALEX 250MG/5MLUD ( 0.86) 1213429 DARUNAVIR 800MG TAB ( 183.08) 1213431 CLINDAMYC 75MG/5MLUD ( 12.41) 1213433 HEP B VAC PED ( 192.72) 1213440 MELATONIN 5MG TAB ( 3.15) 1213451 SORBITOL SOL 1ML ( 13.80) 1213466 FLUDARABIN PHOS 50MG ( 65.84) 1213477 IRON SUCROSE 1MG INJ ( 1.91) 1213479 IPRA20-ALBU100 PUF ( 7.71) 1213527 HYDROMORPH UP TO 4MG ( 11.88) 1213566 K PHOS DI 3MM/ML 5ML ( 4.66) 1213605 PHYTONADI 1MG/ML 1ML ( 12.00) 1213610 PROTHROMB COM 1UN IX ( 6.57) 1213611 LURASIDONE 20MG TAB ( 91.46)
1213614 LABETALOL 5MG/1ML 1M ( 8.43) 1213624 AZITHRO 200MG/5ML 5M ( 17.44) 1213625 CEFDIN 125MG/5ML 5ML ( 2.55) 1213626 CEFDIN 250MG/5ML 5ML ( 4.97) 1213656 SOD CHLOR .9% 100ML ( 7.11) 1213670 RALTEGRAVI 100MG CHW ( 22.50) 1213687 AZITHROMY 300MG/15ML ( 160.61) 1213701 FILGRASTI G-CSF 1MCG ( 1,753.92) 1213702 FILGRASTI G-CSF 1MCG ( 1,753.92) 1213706 PERTUZUMAB 1MG INJ ( 41.71) 1213711 ADENOSINE 1MG INJ ( 7.00) 1213712 CHLORPROMAZIN 5MG PO ( 2.38) 1213713 CHLORPROMAZIN 5MG PO ( 0.92) 1213751 BELIMUMAB 10MG INJ ( 196.38) 1213754 BENZ20-BENZE.2%SP78G ( 17.34) 1213756 TRAVOPR.004%OS 2.5ML ( 371.04) 1213760 K155-NA852-NA130MGTB ( 3.59) 1213835 OBINUTUZUM 10MG INJ ( 186.00) 1213847 MITOM 1MG/ML IRR 1ML ( 1,061.73) 1213848 BLEOMYCIN SUL 15 U ( 124.20) 1213880 ERYTHROMY 250MG DRTB ( 26.49) 1213896 RAMUCIRUMAB 5MG INJ ( 194.84) 1213936 MORPHINE PF 10MG INJ ( 22.00) 1213955 PHEN-MIN-PETR OIN60G ( 15.36) 1213969 FER CARBOXYM 1MG INJ ( 4.43) 1213988 CYCLOPHOSPH 25MG PO ( 24.87) 1213993 ORITAVANCIN 10MG INJ ( 87.00) 1214001 GEMCITABIN 200MG INJ ( 513.60) 1214002 FLU VAC QUAD 6-35MO ( 59.40) 1214003 ADENOSINE 1MG INJ ( 17.89) 1214006 TESTOSTER CYPION 1MG ( 0.41) 1214008 PROPOFOL 10MG INJ ( 3.22) 1214009 PROPOFOL 10MG INJ ( 3.89) 1214010 PROPOFOL 10MG INJ ( 3.19) 1214014 PACLITAXEL 1MG INJ ( 9.21) 1214015 PACLITAXEL 1MG INJ ( 9.21) 1214020 IVIG (OCTAGAM) 500MG ( 192.00) 1214022 BENDAMUSTINE 1MG INJ ( 97.21) 1214028 IVIG (OCTAGAM) 500MG ( 258.28) 1214029 IVIG (OCTAGAM) 500MG ( 332.21) 1214033 DALBAVANCIN 5MG INJ ( 53.64)
1214036 DOLUTEGRAVIR 50MG TB ( 265.21) 1214046 ZINC OX 40% PST 30GM ( 7.92) 1214049 LINEZOLID 200 MG ( 207.86) 1214074 MAGIC MOUTHWASH .5ML ( 1.50) 1214087 CEFTO50-TAZO25MG INJ ( 18.98) 1214099 NIVOLUMAB 1MG INJ ( 88.92) 1214112 CEFTA.5-AVIBAC.125GM ( 393.22) 1214121 NIVOLUMAB 1MG INJ ( 88.92) 1214122 COLCHICINE 0.6MG CAP ( 18.48) 1214124 IVABRADINE 5MG TAB ( 24.34) 1214136 LIDOCAINE 1% 1ML ( 1.61) 1214146 PEMBROLIZUM 1MG INJ ( 191.86) 1214154 SACUT24-VALSA26MG TB ( 16.98) 1214159 SACUT49-VALSA51MG TB ( 16.98) 1214160 SACUT97-VALSA103MGTB ( 24.28) 1214169 HYDROMO 30MG/30MLPCA ( 152.49) 1214178 TICAGRELOR 60MG TAB ( 21.18) 1214180 PURAPLY/PUR AM SQ CM ( 358.29) 1214188 ANTICOAG CIT DEX 500 ( 39.48) 1214215 CYCLOPHOSPH 25MG PO ( 9.38) 1214216 IDARUCIZU 2.5GM/50ML ( 3,500.00) 1214244 ABA600-DOL50-LAM300T ( 264.90) 1214281 TBO-FILGRASTIM 1MCG ( 2.77) 1214282 TBO-FILGRASTIM 1MCG ( 2.76) 1214284 PREDNISONE 1MG ORAL ( 1.21) 1214285 PREDNISONE 1MG ORAL ( 0.53) 1214286 PREDNISONE 1MG ORAL ( 0.27) 1214287 PREDNISONE 1MG ORAL ( 0.10) 1214292 DARATUMUMAB 10MG INJ ( 135.00) 1214294 DARATUMUMAB 10MG INJ ( 135.00) 1214300 IRINOTECAN LIPO 1MG ( 118.67) 1214307 TRABECTEDIN .1MG INJ ( 931.50) 1214311 SUGAMMED 100MG/ML 2M ( 311.00) 1214314 PATIROMER 8.4GM PKT ( 428.40) 1214319 NECITUMUMAB 1MG INJ ( 18.00) 1214332 BENDAMUSTINE 1MG INJ ( 85.60) 1214340 ATEZOLIZUM 10MG INJ ( 258.60) 1214363 ELOTUZUMAB 1MG INJ ( 21.31) 1214375 METHYLENE BLUE.5%10M ( 335.58) 1214378 NUSHIELD SQ CM ( 475.00) 1214394 LIDOCAINE 4% PATCH ( 5.55)
1214397 TETRACAINE.5%OS 4ML ( 34.73) 1214405 ARGATROBAN 1MG NESRD ( 33.56) 1214438 OLARATUMAB 10MG INJ ( 173.34) 1214513 OCRELIZUMAB 1MG INJ ( 162.50) 1214524 TRASTUZUMAB 10MG INJ ( 490.07) 1214530 DURVALUMAB 10MG INJ ( 334.00) 1214531 DURVALUMAB 10MG INJ ( 334.00) 1214545 EDAVARONE 1MG INJ ( 86.88) 1214594 LIP5-PRO17-AMY24DRCP ( 5.57) 1215001 PATIENTS OWN MED ( - ) 1215002 NON FORMULARY MED ( - ) 1215003 RX NON-CHARGEABLE ( - ) 1215005 PAT OWN MED-CONT SUB ( - ) 1215006 HEP B VAC NON-CHARGE ( - ) 1216929 BRINZOLAMID 1%OS 10M ( 602.10) 1216934 EDROPHO/ATROP 5ML IJ ( 69.05) 1216939 ABACAVIR 300MG TAB ( 30.12) 1216941 ACEBUTOLOL 200MG CAP ( 9.28) 1216942 APAP 160MG/5ML ( 0.99) 1216944 ACETAMINOPHEN 325MGS ( 1.99) 1216945 ACETAMINOPH 500MG TB ( 1.99) 1216946 ACETAMINOPHEN 120MGS ( 5.37) 1216947 ACETAMINOPHEN 325MG ( 1.99) 1216948 ACETAMINOPHEN 650MGS ( 1.99) 1216950 ACETAZOLAMIDE 250MG ( 6.60) 1216952 ACETYLCHOL INTR 20MG ( 265.90) 1216953 ACETYLCYS 10%INH 30M ( 81.45) 1216955 ACTIV CHARC LIQ 120M ( 0.45) 1216956 ACYCLOVIR 5% OINT 15 ( 648.06) 1216958 ACYCLOVIR 200MG CAP ( 11.93) 1216961 ALBUTEROL 2MG TAB ( 4.66) 1216962 ALBUTEROL 2MG/5ML 5M ( 2.10) 1216966 ALLOPURINOL 100MG TB ( 5.42) 1216967 ALLOPURINOL 300MG TB ( 7.96) 1216969 ALPRAZOLAM 0.25MG TB ( 11.88) 1216970 ALPRAZOLAM 1MG TAB ( 12.80) 1216971 ALPRAZOLAM 0.5MG TAB ( 12.10) 1216973 AMANTADINE 100MG CAP ( 7.60) 1216974 AMANTADINE 50MG/5ML ( 3.08) 1216980 AMITRIPTYLINE 25MGTB ( 5.91) 1216981 AMITRIPTYLINE 10MG T ( 4.61)
1216982 AMITRIPTYLIN 50MG TB ( 6.86) 1216983 AMLODIPINE 5MG TAB ( 13.91) 1216984 AMMONIA AROMATIC INH ( 25.78) 1216985 GUAIFEN-DM 600-30MGT ( 5.71) 1216986 AMMON LAC12%LOT 225G ( 171.57) 1216990 AMOX500-KCLAV125MGTB ( 28.55) 1216991 AMOX875-CLAV125MG TB ( 38.81) 1216993 AMOXICILLIN 250MG CP ( 4.74) 1216997 ANASTROZOLE 1MG TAB ( 47.75) 1217006 ASCORBIC AC 500MG TB ( 28.44) 1217007 ASPIRIN 325MG DR TAB ( 1.99) 1217008 ASPIRIN 300MG SUPP ( 5.66) 1217009 ASPIRIN 325MG TAB ( 1.99) 1217010 ASPIRIN 81MG CHEW ( 1.99) 1217011 ASPIRIN 81MG DR TAB ( 1.99) 1217012 ASPI25-DIPYR200 SRCP ( 14.38) 1217013 ATENOLOL 25MG TAB ( 7.86) 1217014 ATENOLOL 50MG TAB ( 8.98) 1217016 ATORVASTATIN 10MG TB ( 18.34) 1217017 ATOVAQU 750MG/5ML 5M ( 112.90) 1217020 ATROPINE SUL1%OS 5ML ( 19.44) 1217023 AZELASTINE 137MCG/SP ( 400.32) 1217025 AZITHROMY 600MG/15ML ( 171.45) 1217026 AZITHROMYCIN 250MGTB ( 54.28) 1217028 AZTREONAM 1GM SOLR ( 171.45) 1217030 BACITR 500U/GM 15GM ( 31.49) 1217032 BACITRACIN 50000U IM ( 136.02) 1217034 BACLOFEN 10MG TAB ( 7.39) 1217039 BELLA/PHEN 16.2MG/5M ( 8.15) 1217042 BENAZEPRIL 10MG TAB ( 4.20) 1217044 BENZ20-MENTH.5%SP56G ( 61.89) 1217046 BENZONATATE 100MG CP ( 8.37) 1217048 BENZTROPINE ME 1MGTB ( 5.49) 1217049 BENZTROPIN ME .5MGTB ( 5.69) 1217057 BETHANECHOL 25MG TAB ( 12.64) 1217058 BICALUTAMIDE 50MG TB ( 75.82) 1217059 BISACODYL 5MG DR TAB ( 4.23) 1217060 BISACODYL 10MG SUPP ( 5.91) 1217071 BUMETANIDE 1MG/4ML ( 28.44) 1217072 BUMETANIDE 0.5MG TAB ( 9.93) 1217073 BUMETANIDE 1MG TAB ( 10.82)
1217077 BUPIVAC-MPF .5% 10ML ( 8.23) 1217078 BUPIVACAIN .75% 30ML ( 64.27) 1217079 BUPIV.75/DEX8.25% 2M ( 36.11) 1217080 BUPI-MPF.25%/EPI 10M ( 13.16) 1217081 BUPIV.5%/EPI PF 10ML ( 10.84) 1217084 BUPIVAC .25% MPF 10M ( 37.79) 1217085 BUPROPION 100MG SRTB ( 11.95) 1217087 BUPROPION 75MG TAB ( 7.09) 1217088 BUSPIRONE 5MG TAB ( 7.19) 1217092 CADEXOM IOD.9%GL 40G ( 454.49) 1217094 CALCITO 200UN/AC 3.7 ( 433.13) 1217095 CALCITRIOL .25MCG CP ( 9.72) 1217096 CALCIUM ACE 667MG CP ( 6.25) 1217097 CALC CARB 600MG TAB ( 5.38) 1217098 TALC INTRAPLE PWD 5G ( 347.81) 1217099 TAMOXIFEN 10MG TAB ( 14.87) 1217100 TAMSULOSIN 0.4MG CAP ( 23.87) 1217103 TEMAZEPAM 15MG CAP ( 10.34) 1217105 TERAZOSIN 1MG CAP ( 10.48) 1217106 TERBINAFIN 1% CR12GM ( 26.79) 1217108 TERBUTALINE 2.5MG TB ( 7.80) 1217115 THEOPHYLL 100MG SRCP ( 6.38) 1217116 THEOPHYLL 200MG SRCP ( 5.92) 1217120 THIAMINE 100MG TAB ( 5.85) 1217122 THIORIDAZINE 10MG TB ( 5.56) 1217123 THIORIDAZINE 25MG TB ( 6.16) 1217125 THIOTHIXENE 5MG CAP ( 14.49) 1217126 THIOTHIXENE 1MG ( 4.53) 1217129 THYROID 60MG TAB ( 2.52) 1217134 TIMOLOL .25% OS 5ML ( 75.26) 1217138 TOBR.3-DEX.1%OS2.5ML ( 240.01) 1217139 TOBR.3-DEXA.1%OIN3.5 ( 538.03) 1217140 TOLTERODINE 2MG TAB ( 14.37) 1217141 TOPIRAMATE 25MG TAB ( 17.44) 1217142 TORSEMIDE 20MG TAB ( 10.94) 1217143 TRAMADOL 50MG TAB ( 8.32) 1217147 TRAZODONE 50MG TAB ( 7.42) 1217148 TRETINOIN 10MG CAP ( 125.45) 1217154 GUAIFENE SR 600MG TB ( 5.97) 1217157 TRIAMT/HCTZ 75-50MGT ( 8.43) 1217158 TRIAMTER/HCTZ 50MG ( 7.93)
1217161 TRIHEXYPHENIDY 2MGTB ( 4.40) 1217164 TRIMETHOPRI 100MG TB ( 6.86) 1217168 TUBERCU 5U/.1ML .1ML ( 42.17) 1217169 URSODIOL 300MG CAP ( 17.07) 1217171 VALACYCLOVI 500MG TB ( 30.31) 1217173 VALGANCICLOV 450MGTB ( 135.44) 1217175 VALPROIC AC 250MG CP ( 7.03) 1217178 VANCOMCYIN 125MG CAP ( 100.56) 1217179 VASOPRESSIN 20U/ML ( 52.26) 1217180 VECURONIUM 10MG INJ ( 63.56) 1217181 VENLAFAXI 37.5MG TAB ( 15.15) 1217182 VENLAFAXI 75MG SR CP ( 15.56) 1217183 VENLAFAXINE 75MG TAB ( 14.21) 1217185 VENLAFAXI 37.5M SRCP ( 11.92) 1217187 VERAPAMIL 80MG TAB ( 8.03) 1217189 VERAPAMIL 240MG CRTB ( 9.28) 1217190 VERAPAMIL 120MG CRTB ( 10.82) 1217192 FLUOXETINE 10MG CAP ( 16.86) 1217193 VERAPAMIL 180MG CRTB ( 11.36) 1217194 B-COMPLEX/VIT C TAB ( 5.97) 1217195 VIT. E 1000U CAP ( 0.53) 1217198 WARFARIN 1MG TAB ( 9.48) 1217199 WARFARIN 2.5MG TAB ( 9.48) 1217200 WARFARIN 5MG TAB ( 9.95) 1217201 WARFARIN 7.5MG TAB ( 9.95) 1217205 ZIDOVUDINE 100MG CAP ( 6.06) 1217207 ZINC OX 20% OINT 30G ( 11.24) 1217208 ZINC SULF 220MG CAP ( 5.42) 1217211 ZIPRASIDONE 20MG CAP ( 30.31) 1217212 ZOLPIDEM 5MG TAB ( 25.65) 1217213 FUROSEMIDE 20MG TAB ( 5.97) 1217214 FUROSEMIDE 40MG TAB ( 5.97) 1217215 GABAPENTIN 300MG CAP ( 13.19) 1217216 GABAPENTIN 100MG CAP ( 9.95) 1217217 GABAPENTIN 400MG CAP ( 13.88) 1217218 GALANTAMINE 4MG TAB ( 15.53) 1217223 GEMFIBROZIL 600MG TB ( 9.43) 1217224 GENTAMCYI.3%OIN 3.5G ( 171.13) 1217227 GENTAMIC.1% OIN 15GM ( 21.93) 1217230 GLIPIZIDE 5MG SR TAB ( 6.56) 1217231 GLIPIZIDE 2.5MG SRTB ( 7.22)
1217232 GLIPIZIDE 5MG TAB ( 7.96) 1217233 GLYBURIDE 5MG TAB ( 6.47) 1217234 GLYBURIDE 2.5MG TAB ( 7.60) 1217237 GLYCERIN 1.2GM SUPP ( 5.42) 1217239 GLYCOPYR 0.2MG/ML 1M ( 18.10) 1217242 GUAIF-COD 100-10/5ML ( 11.01) 1217245 HALOPERIDOL 1MG TAB ( 5.56) 1217246 HALOPERIDOL 5MG TAB ( 7.33) 1217248 HC ACE/PRAM 1-1% 30G ( 436.74) 1217249 HC2.5-PRAM1%CRM 30GM ( 126.50) 1217250 HC1-PRAMOX1% FM 10GM ( 141.99) 1217254 HETASTARCH 6% 500ML ( 154.39) 1217256 CALC CARB 500MG CHW ( 5.16) 1217260 CALCIUM CL 10% 10ML ( 32.57) 1217261 FLUOXETINE 20MG CAP ( 19.75) 1217263 CALCIUM GLUC 500MGTB ( 5.15) 1217266 CAPTOPRIL 12.5MG TAB ( 7.22) 1217267 CAPTOPRIL 25MG TAB ( 7.60) 1217268 CARBACHOL .01% 1.5ML ( 106.62) 1217269 CARBAMAZEP 100MG CHW ( 4.90) 1217270 CARBAMAZEPINE 200MGT ( 5.86) 1217271 CARBAMAZEP 100MGSRTB ( 5.29) 1217275 CARBOPROST 250MCG/ML ( 331.48) 1217278 CARISOPRODOL 350MGTB ( 7.41) 1217279 CARVEDILOL 6.25MG TB ( 13.17) 1217280 CARVEDILOL 25MG TAB ( 14.09) 1217284 CEFACLOR 250MG CAP ( 8.00) 1217294 CEFUROXIME 250MG TAB ( 25.87) 1217295 CELECOXIB 100MG CAP ( 15.12) 1217299 CEPHALEX 125/5 100ML ( 43.21) 1217300 CETIRIZINE 10MG TAB ( 18.95) 1217301 CETIRIZINE 5MG/5ML ( 7.74) 1217302 CHARCOAL/SORBITOL50G ( 89.52) 1217304 CHLORDIAZEPOXIDE 25M ( 10.62) 1217305 CHLORDIAZEPOX 10MGCP ( 10.11) 1217306 CHLORDIAZEPOXIDE 5MG ( 9.02) 1217308 CHLORHEXIN.12% 473ML ( 65.63) 1217311 CHLORPHENIRAMINE 4MG ( 4.77) 1217314 CHLORTHALIDONE 25MGT ( 6.84) 1217315 CHLORZOXAZON 500MGTB ( 7.60) 1217317 CHOLESTYRAMINE 4GMPK ( 12.66)
1217318 CILOSTAZOL 100MG TAB ( 13.85) 1217320 PENTOXIFYL 400MGCRTB ( 7.20) 1217324 CIPROFLOXACI 500MGTB ( 30.27) 1217325 CIPROFL.3%OPOIN 3.5G ( 115.69) 1217327 CISATRACUR 10MG/5ML ( 74.22) 1217328 CITALOPRAM 20MG TAB ( 19.85) 1217329 NA CIT500-CIT A334/5 ( 2.58) 1217331 CLARITHROMY 500MG TB ( 30.31) 1217332 CLARITHROMYC 250MGTB ( 20.98) 1217333 CLARITHROM 500MGSRTB ( 33.96) 1217334 CLINDI2.5-CHLOR5MGCP ( 7.60) 1217335 CLINDAMYCIN 150MG CP ( 9.43) 1217336 CLINDAMY 75/5ML 100M ( 142.13) 1217338 CLINDAMYCIN600MG/4ML ( 77.48) 1217339 CLONAZEPAM 0.5MG TAB ( 11.46) 1217340 CLONIDINE-TTS-1 .1MG ( 72.02) 1217341 CLONIDINE-TTS-2 .2MG ( 116.69) 1217342 CLONIDINE-TTS-3 .3MG ( 161.08) 1217343 CLONIDINE 0.1MG TAB ( 5.97) 1217344 CLONIDINE 0.2MG TAB ( 5.97) 1217345 CLONIDINE 0.3MG TAB ( 7.60) 1217346 CLOPIDOGREL 75MG TAB ( 27.69) 1217347 CLORAZEPATE 7.5MG TB ( 13.49) 1217349 CLOTRIMAZ 1%CRM 15GM ( 51.17) 1217350 CLOTRIMAZOLE 10MG TR ( 13.66) 1217352 COCAINE 4% 4ML SOLN ( 46.29) 1217354 ACET/CODEI 300/30 TB ( 23.01) 1217355 APAP300-CODEI60MG TB ( 19.51) 1217358 ACET/CODEINE300-15TB ( 20.39) 1217364 COLESTIPOL 5GM PKT ( 13.49) 1217365 COLLAGENA 250OIN 15G ( 310.35) 1217370 CYCLOBENZAPRINE 10MG ( 10.45) 1217371 CYCLOPENTO 1%OS 2ML ( 44.27) 1217372 CYPROHEPTADINE 4MGTB ( 7.22) 1217377 DANTROLENE 25MG CAP ( 12.20) 1217381 DESIPRAMINE 25MG TAB ( 5.47) 1217385 DEXAMETHAS .1%OS 5ML ( 256.11) 1217386 DEXTROSE25%-H2O 10ML ( 36.67) 1217389 DIAZEPAM 2MG TAB ( 9.17) 1217390 DIAZEPAM 5MG TAB ( 9.30) 1217391 DICLOFEN .1%OS 2.5ML ( 182.28)
1217392 DICLOFEN NA 75MGDRTB ( 9.05) 1217393 DICLOFE NA 100MGSRTB ( 26.69) 1217399 DIGOXIN .05MG/ML 1ML ( 8.40) 1217400 DIGOXIN 0.125MG TAB ( 5.89) 1217401 DIGOXIN 0.25MG TAB ( 5.97) 1217403 DILTIAZEM 60MG TAB ( 7.10) 1217404 DILTIAZEM 30MG TAB ( 7.59) 1217406 DILTIAZE 180MG SR CP ( 9.61) 1217407 DILTIAZEM 240MG SRCP ( 6.15) 1217408 DILTIAZE 300MG SR CP ( 16.72) 1217412 HYDRALAZINE 25MG TAB ( 6.39) 1217413 HYDRALAZINE 10MG TAB ( 5.46) 1217416 HCTZ 25MG TAB ( 5.85) 1217423 HYDROCORT 1%OIN 30GM ( 73.98) 1217425 HYDROCORT 2.5%CR 30G ( 73.98) 1217426 HYDROCOR 2.5%OIN 30G ( 75.87) 1217427 HYDROCORT 1%CR 30GM ( 73.98) 1217431 HYDROXYZINE 10MG/5ML ( 1.56) 1217432 HYDROXYZINE 25MG TAB ( 8.21) 1217433 HYDROXYZINE 10MG TAB ( 6.82) 1217440 GUANFACINE 1MG TAB ( 8.03) 1217441 HYOSCYAM 0.125MG/ML ( 119.19) 1217442 HYCOSCYA .375MG SRTB ( 2.96) 1217444 IBUPROFEN 100MG/5ML ( 7.06) 1217445 IBUPROFEN 200MG TAB ( 1.82) 1217446 IBUPROFEN 400MG TAB ( 1.99) 1217447 IBUPROFEN 600MG TAB ( 1.99) 1217449 IMIPRAMINE 25MG TAB ( 9.46) 1217450 IMIPRAMINE 10MG TAB ( 5.44) 1217453 INDOMETHACIN 25MG CP ( 7.15) 1217461 FE POLYSAC 150MG CAP ( 5.17) 1217465 ISONIAZID 100MG TAB ( 3.83) 1217466 ISONIAZID 300MG TAB ( 5.17) 1217467 ISOPROTERENOL1MG/5ML ( 1,432.80) 1217468 ISOSORBIDE DI 10MGTB ( 5.69) 1217469 ISOSORBIDE DI 20MGTB ( 5.97) 1217471 ISOSORBI MON 20MG TB ( 7.09) 1217473 ISOSORB MON 30MGSRTB ( 11.30) 1217474 ISOSORB MON 60MGSRTB ( 11.01) 1217476 ITRACONAZOL 100MG CP ( 46.83) 1217478 KETAMINE 500MG/5ML ( 7.11)
1217480 KETAMINE 500MG/10ML ( 371.90) 1217481 KETOCONAZ 2%SHAM 120 ( 164.38) 1217482 KETOCONAZ 2%CRM 15GM ( 92.05) 1217483 KETOCONAZOL 200MG TB ( 9.48) 1217486 KETOROLAC 10MG TAB ( 8.21) 1217488 LABETALOL 100MG TAB ( 5.40) 1217489 LACTULOSE 20GM/30ML ( 17.11) 1217491 LAMIVUDINE 10MG/ML ( 68.00) 1217492 LAMIVUDINE 150MG TAB ( 24.51) 1217493 LAMOTRIGINE 100MG TB ( 25.07) 1217497 LANSOPRAZO 30MG DRCP ( 27.78) 1217498 LATANOPR.005%OS 2.5M ( 294.16) 1217504 LEVOFLOXACIN 250MGTB ( 50.47) 1217505 LEVOFLOXAC .5%OS 5ML ( 57.22) 1217506 LEVOTHYROXI 25MCG TB ( 5.60) 1217507 LEVOTHYROX 125MCG TB ( 7.71) 1217511 LEVOTHYROX 200MCG IV ( 186.19) 1217513 LEVOTHYROXIN 75MCGTB ( 6.69) 1217514 LEVOTHYROXI 88MCG TB ( 5.69) 1217515 LIDOCAINE 5% PATCH ( 29.60) 1217516 LIDOCAINE 2% GEL 5ML ( 46.49) 1217517 LIDOCAINE 50MG/5ML ( 20.92) 1217519 LIDOCAINE 2% GEL10ML ( 52.92) 1217520 LIDOCAINE 1% 20ML ( 17.04) 1217521 LIDOCAINE 2% INJ 20M ( 23.68) 1217527 LIDOCAINE-MPF1% 30ML ( 36.47) 1217529 LIDOCAINE 2% INJ 10M ( 23.21) 1217530 LISINOPRIL 5MG TAB ( 9.78) 1217532 LIDOC-MPF 2% INJ 10M ( 17.68) 1217534 LIDOCAIN 1%/EPI 30ML ( 0.65) 1217537 LIDOCAI 1.5%/EPI 10M ( 31.83) 1217538 LIDO2.5-PRIL2.5CR 5G ( 89.52) 1217540 LIDO2.5-PRIL2.5CR30G ( 47.38) 1217543 LINEZOLID 600MG TAB ( 310.40) 1217544 LIOTHYRONINE 25MCGTB ( 8.28) 1217545 LIOTHYRONINE 5MCG TB ( 8.43) 1217547 LISINOPRIL 10MG TAB ( 9.68) 1217548 LITHIUM CARB 300MGCP ( 7.22) 1217549 LITHIUM CARB 150MGCP ( 4.43) 1217550 LOPERAMIDE 2MG CAP ( 7.29) 1217552 LORATADINE 10MG TAB ( 9.92)
1217553 LORAZEPAM 0.5MG TAB ( 11.00) 1217554 LORAZEPAM 1MG TAB ( 11.77) 1217555 LOSARTAN 50MG TAB ( 15.92) 1217558 LOXAPINE 25MG CAP ( 10.58) 1217559 LOXAPINE 5MG CAP ( 7.20) 1217561 MAGNESIUM CITR 300ML ( 9.95) 1217564 MAGNESIUM OX 400MGTB ( 5.56) 1217569 DINOPROS 10MG VG INS ( 915.35) 1217571 DIPHENHY 12.5/5ML 5M ( 6.52) 1217573 DIPHENHYDRAMI25MG CP ( 3.98) 1217575 DIPHENO2.5-ATR.025TB ( 9.30) 1217577 DIPYRIDAMOLE 25MG TB ( 7.22) 1217579 DIPYRIDAMOLE 75MG TB ( 9.15) 1217581 DIVALPROEX 250MGDRTB ( 7.35) 1217582 DIVALPROEX 125MGDRCP ( 7.33) 1217583 DIVALPROEX 500MGDRTB ( 16.63) 1217585 DOCUSATE CA 240MG CP ( 5.97) 1217588 DOCUSATE NA 100MG CP ( 5.97) 1217589 DONEPEZIL 5MG TAB ( 30.31) 1217593 DOXAZOSIN 4MG TAB ( 11.36) 1217595 DOXEPIN 10MG CAP ( 5.42) 1217596 DOXEPIN 25MG CAP ( 5.45) 1217597 DOXEPIN 50MG CAP ( 7.96) 1217598 DOXEPIN 75MG CAP ( 8.82) 1217600 DOXYCYCLINE 100MG IV ( 84.96) 1217602 DOXYCYCL 25MG/5ML 5M ( 0.40) 1217609 ENALAPRIL 5MG TAB ( 8.58) 1217611 ENTACAPONE 200MG TAB ( 16.07) 1217618 RACEPINEPH 2.25% .5M ( 13.85) 1217619 ERGOCALCI 50000UN CP ( 13.93) 1217621 ERYTHROMYCIN 333MGTB ( 33.35) 1217623 ERYTHR OP5MG/GM 3.5G ( 72.19) 1217624 ERYTHR OP5MG/GM 1GM ( 34.29) 1217625 ERYTHROMYCIN 400MGTB ( 4.53) 1217632 ESMOLOL 10MG/ML 10ML ( 123.05) 1217633 ESTRAD.05MG/24 PT 1X ( 88.40) 1217634 ESTRADIOL 1MG TAB ( 5.58) 1217638 ESTROGEN, CONJ 0.3MG ( 11.93) 1217640 ESTROGEN,CONJ.625 TB ( 10.82) 1217642 ESTROGEN 0.9MG TABS ( 9.63) 1217646 ALCOHOL ABS 98% 5ML ( 119.90)
1217648 ETODOLAC 400MG TAB ( 10.62) 1217649 ETOMIDATE 2MG/ML 10M ( 120.78) 1217650 FAMCICLOVIR 500MG TB ( 47.62) 1217651 FAMOTIDINE 20MG/2ML ( 45.44) 1217652 FAMOTIDINE 20MG TAB ( 13.80) 1217659 FLUPHENAZINE 1MG TAB ( 6.60) 1217660 FLUPHENAZINE 2.5MGTB ( 8.59) 1217671 FLUVOXAMINE 50MG TAB ( 15.18) 1217672 FOLIC ACID 1MG TAB ( 5.70) 1217673 FOLIC ACID 50MG/10ML ( 295.11) 1217679 FELODIPINE 5MG SR TB ( 11.89) 1217680 FENOFIBRATE 54MG TAB ( 9.00) 1217681 FENOFIBRATE 160MG TB ( 37.79) 1217682 FENOLDOPAM 10MG/ML ( 266.23) 1217684 FENTANYL 25MCG/HR PT ( 81.48) 1217685 FENTANYL 50MCG/HR PT ( 146.81) 1217686 FENTANYL 75MCG/HR PT ( 151.60) 1217687 FENTANY 100MCG/HR PT ( 223.61) 1217688 FERROUS GLUC 324MGTB ( 5.42) 1217689 FERR SULF 300MG/5 UD ( 3.00) 1217691 FERR SULF 325MG TAB ( 5.97) 1217693 FEXOFENADINE 180MGTB ( 18.86) 1217694 FEXOFENADINE 60MG TB ( 11.43) 1217696 FLUCONAZOLE 100MG TB ( 52.59) 1217697 FLUDROCORTIS .1MG TB ( 8.37) 1217698 FLUMAZENIL 0.5MG/5ML ( 57.89) 1217702 FLUOC ACE.025%CRM15G ( 56.60) 1217709 MEBENDAZOLE 100MG CH ( 30.00) 1217710 MECLIZINE 12.5MG TAB ( 4.75) 1217712 MEDROXYPROGE 2.5MGTB ( 4.93) 1217714 MEGESTROL ACE 40MGTB ( 9.31) 1217716 MELOXICAM 7.5MG TAB ( 21.88) 1217718 MEPERIDINE 50MG TAB ( 10.35) 1217733 ACYCLOVIR 800MG TAB ( 22.91) 1217736 AMLODIPINE 2.5MG TAB ( 12.45) 1217737 AMOXICILLIN 500MG CP ( 7.00) 1217739 AMPICILLIN 250MG CAP ( 5.09) 1217741 HYDROCORT 25MG SUPP ( 6.75) 1217742 BUT50-APAP325-CF40TB ( 5.10) 1217743 ARTIFIC TEARS OS15ML ( 99.57) 1217746 ATRACURIUM 50MG INJ ( 22.85)
1217749 BELLADONNA/OPIUM 15A ( 23.03) 1217752 BENZOCAINE 20%OT 15M ( 4.65) 1217753 ANTIP/BENZ 54-14 10M ( 48.75) 1217757 BISMUTH SU 262MG CHW ( 4.08) 1217761 BROMOCRIPT 2.5MG TAB ( 14.81) 1217766 CAPSAICIN.025%CR 60G ( 61.40) 1217769 CARBID10-LEVO100MGTB ( 7.22) 1217770 CARBI25-LEVOD250MGTB ( 12.64) 1217771 CARVEDILO 3.125MG TB ( 14.09) 1217774 CICLOPIROX.77%CR 15G ( 94.80) 1217776 CLORAZEPATE 3.75MGTB ( 12.64) 1217779 DANTROLENE 20MG INJ ( 499.57) 1217780 DICLOXACILL 250MG CP ( 6.63) 1217786 DRONABINOL 2.5MG CAP ( 31.43) 1217788 EPHEDRINE 50MG INJ ( 20.45) 1217790 ESTROG CONJ 1.25MGTB ( 10.10) 1217791 ESTROPIPATE .75MG TB ( 4.40) 1217792 FELODIPINE 2.5MGSRTB ( 11.00) 1217797 SOD PHOS ENEMA 66ML ( 9.02) 1217798 MINERAL OIL EN 135ML ( 18.51) 1217800 FLUOROMETH 0.1% 5ML ( 109.63) 1217801 GLYCOPYRROLATE 1MGTB ( 10.11) 1217802 GOLYTELY 4L ( 73.83) 1217803 HALOPERIDOL 0.5MG TB ( 4.70) 1217808 HYDROCORT 20MG TAB ( 5.31) 1217810 HYDROMORPHONE 2MG TA ( 11.50) 1217811 HYDROXYCHLOR 200MGTB ( 9.69) 1217812 H-COD7.5-IBUP200MGTB ( 16.81) 1217816 LAMOTRIGINE 25MG TAB ( 23.50) 1217818 LISINOPRIL 20MG TAB ( 9.95) 1217824 MESALAMINE 250MG CAP ( 6.86) 1217825 METFORMIN 500MG TAB ( 7.38) 1217826 METFORMIN 850MG TAB ( 8.98) 1217828 METHYLPRED. 4MG DOSP ( 8.13) 1217829 METOLAZONE 5MG TAB ( 13.93) 1217830 METOPROLOL 50MG SRTB ( 9.95) 1217832 MIRTAZAPINE 30MG TAB ( 17.07) 1217833 MISOPROSTO 100MCG TB ( 8.86) 1217837 MORPHINE 30MG SR TAB ( 17.92) 1217839 MUPIROCIN 2%OIN 22GM ( 149.23) 1217840 NABUMETONE 500MG TAB ( 9.51)
1217843 NEO-COL-HC-THON OT5M ( 156.43) 1217846 NITROFUR MAC 100MG ( 11.81) 1217847 NITROGLY. 50MG/250ML ( 163.53) 1217849 OLANZAPINE 10MG TAB ( 61.85) 1217853 PAROXETINE 10MG TAB ( 17.28) 1217879 PRIMIDONE 250MG TAB ( 9.46) 1217880 PROBENECID 500MG TAB ( 9.72) 1217882 PROPRANOLOL 20MG TAB ( 5.58) 1217888 PSYLIUM PACK ( 4.01) 1217897 ROPINIROLE 1MG TAB ( 12.45) 1217902 SOD BICARB 8.4% 10ML ( 32.67) 1217904 SULFASALAZIN 500MGTB ( 4.72) 1217905 SUMATRIPTAN 25MG TAB ( 109.27) 1217908 TEMAZEPAM 30MG CAP ( 11.15) 1217909 TERAZOSIN 5MG CAP ( 10.81) 1217910 TERBINAFINE 250MG TB ( 59.55) 1217911 TERBUTALINE 5MG TAB ( 7.44) 1217914 THEOPHYLLI 400MG TAB ( 15.00) 1217918 TOBRAMYCIN UPTO 80MG ( 307.66) 1217919 TOBRAMYCI .3% OS 5ML ( 225.60) 1217920 TOBRA.3%OPH OIN 3.5G ( 293.95) 1217921 TOLNAFTATE 1%PWD 45G ( 21.93) 1217922 TOLNAFTATE 1%CR 15GM ( 16.86) 1217925 TOLTERODINE 2MG SRCP ( 17.53) 1217938 VITAMIN E 100IU CAP ( 5.57) 1217939 VITAMIN E 400IU CAP ( 5.64) 1217940 WARFARIN 2MG TAB ( 9.48) 1217942 PAROXETIN 25MG SR TB ( 18.52) 1217944 SIMVASTATIN 40MG TAB ( 31.83) 1217945 TRAZODONE 100MG TAB ( 7.20) 1217949 ZOLMITRIPTAN 2.5MGTB ( 100.57) 1217950 ZOLPIDEM 10MG TAB ( 27.84) 1217952 LEVOFLOXIN 500MG TAB ( 67.65) 1217954 METHAZOLAMID 25MG TB ( 15.32) 1217957 EZETIMIBE 10MG TAB ( 18.95) 1217961 CILOSTAZOL 50MG TAB ( 10.69) 1217972 METFORMIN 500MG SRTB ( 8.75) 1217975 METHADONE 10MG TAB ( 9.30) 1217976 METHENAMINE MAN .5GM ( 4.48) 1217977 METHOCARBAM 750MG TB ( 7.27) 1217978 METHOCARBAM 500MG TB ( 5.99)
1217979 METHYLDOPA 250MG TAB ( 5.74) 1217982 METHYLENE BLUE1%10ML ( 604.07) 1217983 METHYLERGONOV .2MGTB ( 9.02) 1217986 METOCLOPRAMID 10MGTB ( 5.92) 1217987 METOCLOPRAMIDE 5MGTB ( 7.10) 1217988 METOLAZONE 2.5MG TAB ( 11.81) 1217990 METOPROLOL 50MG TAB ( 9.95) 1217991 METOPROLO 1MG/ML 5ML ( 31.62) 1217992 METRONIDAZOL 250MGTB ( 6.49) 1217996 MEXILETINE 150MG CAP ( 8.43) 1217997 MEXILETINE 200MG CAP ( 9.46) 1217998 MICONAZ VAG 100MGSUP ( 43.21) 1218000 MICROFIBR COLL 1GM ( 616.18) 1218003 MINERAL OIL 30ML ( 0.18) 1218004 MINOCYCLINE 100MG CP ( 19.48) 1218005 MINOXIDIL 2.5MG TAB ( 6.12) 1218006 MINOXIDIL 10MG TAB ( 9.96) 1218007 MIRTAZAPINE 15MG TAB ( 21.14) 1218008 MIRTAZAPINE 15MG ODT ( 16.02) 1218009 SKIN CREAM 120GM ( 23.63) 1218010 EMOLLIENT LOT 180ML ( 17.63) 1218011 DOXAZOSIN 2MG TAB ( 9.30) 1218012 EMOLLIENT LOT 237ML ( 15.24) 1218014 CEFOXITIN 1GM IJ ( 71.07) 1218016 NIACIN 250MG CR CAP ( 5.42) 1218017 TIZANIDINE 4MG TAB ( 12.67) 1218024 LACTASE 9000UN TAB ( 5.42) 1218027 PHENYLEPH.25%SPR 15M ( 77.59) 1218028 PHENYLEPH.5% SPR 15M ( 32.49) 1218033 MONTELUKAST 10MG TAB ( 21.88) 1218034 MONTELUKAST 4MG CHEW ( 19.13) 1218035 MORPHINE 15MG SR TAB ( 7.90) 1218036 MORPHINE 30MG TAB ( 15.18) 1218037 MORPHINE 15MG TAB ( 11.29) 1218038 MORPHINE 100MG SR TB ( 29.84) 1218041 PED MVI/C 35MG/ML 1M ( 1.28) 1218047 MUPIROCIN 2% OIN 1GM ( 8.37) 1218052 NADOLOL 20MG TAB ( 7.80) 1218053 NAFCILLIN 2GM SOLR ( 113.41) 1218054 NAFCILLIN 1GM SOLR ( 72.19) 1218059 NAPHAZOLINE/PHEN15ML ( 12.64)
1218060 NAPROXEN 250MG TAB ( 6.92) 1218062 NAPROXEN 500MG TAB ( 10.82) 1218063 NAPROXEN 550MG TAB ( 10.61) 1218064 NATEGLINIDE 60MG TAB ( 5.86) 1218068 NEO/POLY/DEX.1%OS 5M ( 37.10) 1218069 NEO-BAC-POLY OIN 15G ( 21.34) 1218071 NEOM-POLY-GRAM OS10M ( 26.62) 1218073 NEO-POLY-HC OTIC10ML ( 152.65) 1218076 NEOMYCIN 500MG TAB ( 12.09) 1218081 NIACIN 500MG TAB CR ( 10.85) 1218082 NICOTINE 7MG/24HR PT ( 12.48) 1218083 NICOTINE 14MG/24HR P ( 27.00) 1218084 NICOTINE 21MG/24HR P ( 28.23) 1218086 NICOTINE 2MG GUM ( 6.75) 1218087 NIFEDIP OSM 30MGSRTB ( 10.95) 1218088 NIFEDIP OSM 90MGSRTB ( 7.82) 1218089 NIFEDIPINE 10MG CAP ( 7.96) 1218090 NIMODIPINE 30MG CAP ( 45.86) 1218091 NITROFURANTOIN50MGCP ( 9.46) 1218092 NITROGLYC 2.5MG CRCP ( 4.80) 1218093 NITROGLYC 0.3MG/HR P ( 13.49) 1218094 NITROGLY 0.6MG/HR PT ( 13.49) 1218095 NITROGLYC 6.5MG CRCP ( 5.41) 1218096 NITROGLYCE 50MG/10ML ( 29.14) 1218098 NITROGLYC .2MG/HR PT ( 9.98) 1218099 NITROGLYCER 0.4MG/HR ( 15.15) 1218100 NITROGLYC 0.1MG/HR P ( 8.85) 1218102 NITROGLYCE .4MG SLTB ( 5.35) 1218106 NITROPRUSS 50MG/2ML ( 754.46) 1218107 NOREPINEPH 4MG/4ML ( 73.02) 1218108 NORTRIPTYLINE 10MGCP ( 5.82) 1218109 NORTRIPTYLIN 25MG CP ( 7.78) 1218112 NYSTATIN 500000U/5ML ( 9.33) 1218113 NYSTAT 100KU/G CR15G ( 20.45) 1218114 NYSTATI TOP PWD 15GM ( 165.14) 1218116 NYS100K-TRI.1CRM 15G ( 61.36) 1218118 OFLOXACIN .3%OS 5ML ( 213.71) 1218119 OFLOXAC .3%OTIC 5ML ( 420.33) 1218123 OMEPRAZOLE 20MG DRCP ( 21.65) 1218124 BELLADON/OPIUM SUPPO ( 100.36) 1218126 ORPHENADR UP TO 60MG ( 145.24)
1218127 OSELTAMIVIR 75MG CAP ( 45.52) 1218130 OXCARBAZEPI 150MG TB ( 11.52) 1218131 OXYBUTYNIN 5MG TAB ( 7.12) 1218132 OXYBUTYNIN 5MG SR TB ( 19.32) 1218133 OXYCODONE 5MG TAB ( 9.30) 1218143 CEFDINIR 300MG CAP ( 26.90) 1218144 P-EPH/LORAT 120-5 TB ( 7.20) 1218147 PANTOPRAZO 40MG ECTB ( 25.87) 1218151 PAROXETINE 20MG TAB ( 20.66) 1218152 PAROXETIN SR 12.5 TB ( 17.90) 1218156 POT CL20MEQ MIC CRTB ( 5.42) 1218160 PEPPERMINT OIL ( 72.51) 1218162 PERPHENAZINE 2MG TAB ( 6.57) 1218166 PHENOBARBITAL 15MGTB ( 7.33) 1218168 PHENYLEPH 2.5%OS 2ML ( 121.89) 1218171 PHENYTOIN 50MG CHWTB ( 5.24) 1218172 PHENYTOIN 125MG/5ML ( 4.34) 1218176 PILOCARPINE 1%OS 15M ( 295.68) 1218177 PILOCARPINE 4%OS 15M ( 317.07) 1218178 PIOGLITAZONE 30MG TB ( 34.11) 1218179 PIOGLITAZONE 45MG TB ( 34.84) 1218184 POLYETH GLY 3350 PKT ( 16.05) 1218185 POLYMYXIN B 500000U ( 85.97) 1218186 POTAS ACE 40MEQ/20ML ( 20.84) 1218187 POTASS BI 25MEQ EFTB ( 5.04) 1218190 POTAS CHL 10MEQ CRTB ( 5.58) 1218194 K PHOS DI 3MM/ML 15M ( 21.88) 1218202 PRAMOXINE 1%FOAM 15G ( 171.72) 1218205 PRAZOSIN 1MG CAP ( 5.31) 1218206 PRAZOSIN 5MG CAP ( 9.26) 1218211 PRIMIDONE 50MG TAB ( 6.70) 1218215 PROCHLORPER 25MG SUP ( 17.84) 1218216 PROMETHAZINE 25MG SP ( 21.64) 1218217 PROMETHAZINE 12.5 SP ( 20.38) 1218218 PROMETHAZINE 6.25/5M ( 4.72) 1218219 PROPAFENONE 150MG TB ( 12.52) 1218225 PROPRANOLOL 1MG/ML ( 61.35) 1218226 PROPRANOLOL 10MG TAB ( 5.35) 1218227 PROPRANOLOL 40MG TAB ( 6.79) 1218228 PROPYLTHIOURA 50MGTB ( 4.28) 1218230 PSEUDOPHED 30MG TAB ( 1.99)
1218232 PYRAZINAMIDE 500MGTB ( 8.18) 1218233 PYRIDOSTIGMI 60MG TB ( 6.21) 1218234 PYRIDOXINE 50MG TAB ( 4.42) 1218235 QUETIAPINE 100MG TAB ( 19.32) 1218236 QUETIAPINE 25MG TAB ( 17.48) 1218244 RALOXIFENE 60MG TAB ( 18.95) 1218246 RAMIPRIL 5MG CAP ( 11.06) 1218250 RIFAMPIN 150MG CAP ( 11.11) 1218251 RIFAMPIN 300MG CAP ( 12.48) 1218252 RIFAMPIN 600MG SOLR ( 342.67) 1218256 RISPERIDONE 1MG TAB ( 24.18) 1218257 RIVASTIGMINE 1.5MGCP ( 18.41) 1218259 ROCURONIUM 50MG/5ML ( 89.52) 1218266 SALSALATE 500MG TAB ( 5.54) 1218267 SCOPOLAMINE 1.5MG PT ( 51.20) 1218270 SENNA/DOCUS 8.6-50TB ( 5.97) 1218272 SERTRALINE 50MG TAB ( 18.25) 1218275 SILVER NITRATE APPLI ( 16.37) 1218277 SILV SULF 1%CRM 400G ( 189.13) 1218279 SIMETHICONE 80MG CHW ( 5.67) 1218280 SIMETH 40MG/.6ML .6M ( 0.71) 1218282 SIMVASTATIN 5MG TAB ( 14.37) 1218283 SIMVASTATIN 10MG TAB ( 18.55) 1218284 SIMVASTATIN 20MG TAB ( 30.31) 1218285 SIMVASTATIN 80MG TAB ( 26.98) 1218289 SOD ACET 40MEQ/20ML ( 29.35) 1218290 SOD BICARB 8.4% 50ML ( 37.42) 1218293 SOD BICARB 4.2% 10ML ( 32.07) 1218295 SOD CLOR 2% 15ML OPT ( 91.10) 1218296 SOD CHLOR 23.4% 30ML ( 24.06) 1218297 SOD CHLOR 5% 15ML OS ( 109.43) 1218298 SOD CHLOR .9% 10ML ( 120.91) 1218299 SOD CHL .9% 3ML NEB ( 11.98) 1218304 SOD PHOS 45MMOL/15ML ( 7.23) 1218309 SOTALOL 80MG TAB ( 19.42) 1218310 SPIRONOLACTON 25MGTB ( 6.16) 1218313 SUCRALFATE 1GM TAB ( 7.93) 1218314 SUCRALFATE 1000MG/10 ( 16.26) 1218315 SUFENTANIL 100MCG/2M ( 49.52) 1218318 SULFACETA 10%OS 15ML ( 27.87) 1218319 SULFA-TMP 800-160 TB ( 10.91)
1218320 SULFAMETH-TRIME 10ML ( 48.30) 1218321 SULFAME-TMP 200-40/5 ( 3.10) 1218324 SUMATRIPTAN 50MG TAB ( 109.50) 1218328 SOD CHLOR .9% 500ML ( 141.94) 1218330 CAPTOPRIL 50MG TAB ( 8.70) 1218334 METOCLOP 1MG/ML 10ML ( 7.22) 1218337 OPTHAL IRR INTR 15ML ( 59.71) 1218338 NICARDIPINE 20MG CAP ( 6.88) 1218355 THROMBIN 5000U ( 0.32) 1218374 COLESTID 1GM TAB ( 6.93) 1218386 ENALAPRIL 10MG TAB ( 9.35) 1218387 OXCARBAZEPI 300MG TB ( 15.72) 1218388 TOPIRAMATE 100MG TAB ( 36.97) 1218389 LITHIUM CA 450MGCRTB ( 7.22) 1218390 MECLIZINE 25MG TAB ( 5.97) 1218392 ATORVASTATIN 20MG TB ( 24.47) 1218393 OLANZAPINE 5MG TAB ( 3.85) 1218395 DONEPEZIL 10MG TAB ( 30.31) 1218397 PROMETHAZ 12.5MG TB ( 8.28) 1218398 LOSARTAN 25MG TAB ( 13.93) 1218403 IBUPROFEN 800MG TAB ( 1.99) 1218416 BUEDSON .5MG/2ML INH ( 39.32) 1218419 CLONAZEPAM 1MG TAB ( 11.00) 1218420 TORSEMIDE 10MG TAB ( 9.30) 1218422 FLURAZEPAM 15MG CAP ( 8.70) 1218423 ZIPRASIDONE 40MG CAP ( 27.09) 1218424 GUAIFENESIN 100MG/5M ( 0.58) 1218431 CIPROFLOXAC 250MG TB ( 26.49) 1218441 MISOPROSTO 200MCG TB ( 6.23) 1218442 METHADONE 5MG TAB ( 8.13) 1218454 SOD CHLORIDE 1GM TAB ( 4.21) 1218458 OLANZAPINE 5MG ODT ( 47.38) 1218460 AMOX 125MG/5ML 100ML ( 0.12) 1218461 AMOX 250MG/5ML 100ML ( 37.90) 1218481 DEMECLOCYCL 150MG TB ( 39.24) 1218482 IVERMECTIN 3MG TAB ( 14.91) 1218484 AMILORIDE 5MG TAB ( 6.75) 1218491 LOSAR/HCTZ 50-12.5TB ( 15.92) 1218493 LOVASTATIN 20MG TAB ( 13.78) 1218496 RIZATRIPTAN 5MG ODT ( 116.76) 1218501 CARVEDILOL 12.5MG TB ( 14.09)
1218503 ROPINIROLE 0.25MG TB ( 13.79) 1218507 PROMETHAZ 50MG SUPP ( 27.12) 1218509 VENLAFAXINE 25MG TAB ( 12.36) 1218510 VENLAFAXINE 50MG TAB ( 14.59) 1218515 PRAMIPEXOLE .125MGTB ( 13.26) 1218523 CEFPODOXIME 200MG TB ( 34.00) 1218526 TOLTERODINE 4MG SRCP ( 19.85) 1218529 RIFABUTIN 150MG CAP ( 39.00) 1218546 CELECOXIB 200MG CAP ( 19.18) 1218551 ACARBOSE 50MG TAB ( 7.61) 1218561 AMOX400-CLAV57 5ML ( 10.35) 1218565 MESALAMI ENM 4G/60ML ( 72.51) 1218567 MORPHINE 60MG SR TAB ( 20.45) 1218576 POV-IODIN 10%OIN 30G ( 33.65) 1218582 GLIMEPIRIDE 1MG TAB ( 5.88) 1218583 GLIMEPIRIDE 4MG TAB ( 11.52) 1218584 TOPIRAMATE 200MG TAB ( 31.88) 1218593 FLUCONAZOLE 200MG TB ( 65.38) 1218594 FLUCONA 40MG/ML 35ML ( 633.44) 1218595 FLUCONAZOLE 150MG TB ( 66.95) 1218597 SERTRALINE 25MG TAB ( 17.06) 1218601 MIDAZOLAM 2MG/ML 1ML ( 2.21) 1218604 DICLOFEN NA 50MGDRTB ( 8.43) 1218605 LEUCOVOR CAL 5MG TAB ( 16.69) 1218611 FUROSEMID 8MG/ML 5ML ( 10.02) 1218612 HYDROMORPHONE 4MG TB ( 10.25) 1218613 LOPERAMIDE 1MG/5ML ( 1.09) 1218614 MINERAL OIL 10ML ( 35.91) 1218615 PSEUDOEPHED 60MG TAB ( 2.00) 1218617 WARFARIN 3MG TAB ( 9.02) 1218618 EFAVIRENZ 200MG CAP ( 36.40) 1218619 CARB25-LEVO100MGSRTB ( 8.21) 1218628 OLOPATADINE.1%OS 5ML ( 469.41) 1218636 AMLODIPINE 10MG TAB ( 14.88) 1218639 AZITHROMY 1200MG/30M ( 150.62) 1218640 DOFETILIDE .125MG CP ( 17.33) 1218642 DOFETILIDE .5MG CAP ( 49.89) 1218643 ATORVASTATIN 40MG TB ( 18.39) 1218645 PHENYTOIN EXT 30MGCP ( 5.00) 1218660 LEVOTHYROX 137MCG TB ( 6.66) 1218661 TERAZOSIN 2MG CAP ( 10.14)
1218668 DIVALPROE 125MG DRTB ( 7.15) 1218669 RITONAVIR 100MG CAP ( 37.82) 1218672 DIVALPROEX 500MGSRTB ( 19.44) 1218674 RILUZOLE 50MG TAB ( 72.14) 1218677 CLOZAPINE 25MG TAB ( 20.42) 1218678 CLOZAPINE 100MG TAB ( 21.49) 1218680 LETROZOLE 2.5MG TAB ( 61.12) 1218682 ESTRAD.1MG/24HR PT1X ( 88.40) 1218684 OXCARBAZE 300MG/5ML ( 11.55) 1218685 VALSARTAN 160MG TAB ( 13.00) 1218688 CARBAMAZE 200MG SRTB ( 10.11) 1218693 FLUTAMIDE 125MG CAP ( 13.32) 1218698 ISOSORB MO 120MGSRTB ( 12.39) 1218708 TRAZODONE 150MG TAB ( 9.40) 1218723 METRONID.75%VGGL 70G ( 401.05) 1218724 ORPHENADR 100MG SRTB ( 14.43) 1218725 FLECAINIDE 50MG TAB ( 12.03) 1218731 VERAPAMIL PM 200MG ( 13.15) 1218746 CORTISONE 25MG TAB ( 12.50) 1218751 NYSTAT100K/GM OIN15G ( 57.35) 1218752 NEO/BAC/POLY UD PKT ( 23.03) 1218753 NEO/BAC/POLY OIN 30G ( 32.22) 1218756 NEO/BAC/POLY OO 3.5G ( 59.44) 1218757 NEO/BAC/POLY/HC 3.5G ( 164.62) 1218767 BACITRACI 1GM UD PKT ( 0.69) 1218768 MICONAZOLE 2% CR 30G ( 52.28) 1218769 LIDO 5% OINT 35.4GM ( 80.80) 1218770 REPAGLINIDE 0.5MG TB ( 10.61) 1218777 BUPROPION 100MG TAB ( 8.91) 1218778 PYRIMETHAMIN 25MG TB ( 54.58) 1218787 CEFUROXIME 250/5 50M ( 7.85) 1218788 LAMIVU150-ZIDO300 TB ( 59.17) 1218789 CHLORAMBUCIL 2MG TAB ( 13.90) 1218800 CYANOCOBAL 500MCG TB ( 5.32) 1218802 AMITRIPTYLINE 75MGTB ( 7.67) 1218807 ASA/CA CARB/MG 325MG ( 1.99) 1218810 SMZ/TMP 400-80 TAB ( 6.04) 1218811 SULFADIAZINE 500MG T ( 11.81) 1218815 LIDOCAINE 2% INJ 50M ( 34.45) 1218816 LIDOCAINE-MPF1% 5ML ( 16.10) 1218817 LIDOCAINE 4% 5ML ( 29.85)
1218818 LIDOC-MPF 2% INJ 5ML ( 19.91) 1218820 LIDOCAINE 1% 10ML ( 7.63) 1218821 LIDOCAINE-MPF1% 2ML ( 27.14) 1218823 LIDO 4% TOP SOLN 50 ( 58.81) 1218827 FELODIPINE 10MG SRTB ( 15.18) 1218829 BUDESONIDE 3MG SR CP ( 54.14) 1218832 ESOMEPRAZOL 20MGDRCP ( 28.37) 1218834 FLUCYTOSINE 500MG CP ( 303.90) 1218839 MAG GLUCON 500MG TAB ( 7.07) 1218848 METRONIDA.75%GEL 28G ( 180.93) 1218849 METRONIDA.75%CR 45GM ( 303.72) 1218860 NISOLDIPIN 20MG SRTB ( 24.00) 1218866 TRIHEXYPHENIDY 5MGTB ( 5.57) 1218868 VERAPAMIL 120MG SRCP ( 5.81) 1218872 INDAPAMIDE 1.25MG TB ( 6.10) 1218873 CHLORTHALIDON 50MGTB ( 6.75) 1218875 HCTZ 12.5MG CAP ( 6.76) 1218881 DILTIAZEM 60MG SR CP ( 7.60) 1218884 MAGNE SUL ORAL 454GM ( 5.00) 1218886 H-COD10/APAP325MG TB ( 13.02) 1218895 CITALOPRAM 10MG TAB ( 17.40) 1218896 CITALOPRAM 40MG TAB ( 20.45) 1218897 FOSFOMYC 3GM POW PKT ( 203.42) 1218901 ACETIC AC 2%OTIC 15M ( 217.93) 1218905 POT PHOS MON 500MGTB ( 3.93) 1218911 VERAPAMIL 10MG/4ML V ( 27.87) 1218915 CYANOCOBAL 100MCG TB ( 5.97) 1218916 CYANOCOBA 1000MCG TB ( 5.69) 1218918 VIT B COMPLEX CAP ( 9.93) 1218919 LIDOCAINE 10MG IV ( 1.49) 1218929 IPRATROPIUM 0.03% SP ( 11.81) 1218930 IPRATROP .06%SP 15ML ( 266.55) 1218940 TRIFLUOPERAZ 5MG TAB ( 9.26) 1218941 PERPHENAZINE 4MG TAB ( 8.75) 1218944 HALOPERIDOL 2MG TAB ( 6.29) 1218948 IMIPRAMINE 50MG TAB ( 10.11) 1218951 TEMAZEPAM 7.5MG CAP ( 21.36) 1218952 METHYLPHEN 10MG TAB ( 8.45) 1218957 VITAMIN A 10000IU CP ( 5.29) 1218960 NAPROXEN 220MG TAB ( 1.86) 1218963 BUMETANID 2.5MG/10ML ( 26.42)
1218971 BENZ5-RESOR2%CR 30GM ( 9.03) 1218976 ASPIRIN 325MG EFF TB ( 4.29) 1218978 FAMOTIDINE 10MG TAB ( 5.32) 1218982 BACITR/POLYB OO 3.5G ( 104.23) 1218985 BENZO/MENT 15-3.6LOZ ( 0.49) 1218987 NEO/POLY/HC1%OTIC 10 ( 200.33) 1218991 DIBUCAINE 1%OIN 30GM ( 24.64) 1218993 BACITR 500U/GM 30GM ( 27.22) 1218995 DESONIDE .05%CRM 15G ( 80.96) 1219000 CARBONYL FE 45MG TAB ( 0.73) 1219006 RISPERIDONE .25MG TB ( 21.29) 1219007 RISPERIDONE 2MG TAB ( 33.42) 1219011 CHLOROTHIAZ 250MG TB ( 4.10) 1219013 INDOMETHACIN 50MG CP ( 2.04) 1219017 FLUPHENAZINE 5MG TAB ( 9.10) 1219018 DOCUSATE NA 50MG CAP ( 5.07) 1219021 THIORIDAZIN 100MG TB ( 6.40) 1219022 THIOTHIXENE 2MG CAP ( 5.31) 1219025 CEPHALEXIN 250MG CAP ( 119.36) 1219026 CEPHALEXIN 500MG CAP ( 12.66) 1219028 SULINDAC 150MG TAB ( 6.97) 1219030 DILTIAZEM 90MG TAB ( 8.43) 1219031 NORTRIPTYL 50MG CAP ( 10.59) 1219032 GLIPIZIDE 10MG TAB ( 8.89) 1219033 NADOLOL 40MG TAB ( 9.91) 1219034 ACYCLOVIR 400MG TAB ( 14.88) 1219036 CARB50-LEVO200MGSRTB ( 14.43) 1219037 LABETALOL 200MG TAB ( 7.33) 1219044 ETHAMBUTOL 400MG TAB ( 10.59) 1219048 ETODOLAC 300MG CAP ( 5.62) 1219061 MIDODRINE 5MG TAB ( 13.94) 1219062 MAGNE CHL 535MG CRTB ( 4.40) 1219071 PILOCARPINE 5MG TAB ( 5.89) 1219080 NAPROXEN 500MG EC TB ( 10.11) 1219082 SEVELAMER 400MG TAB ( 6.76) 1219084 CARBAMAZE 200MG SRCP ( 10.11) 1219085 CARBAMAZE 300MG SRCP ( 9.41) 1219091 DIAZEPAM 2.5MG PEDKT ( 245.53) 1219093 ZONISAMIDE 100MG CAP ( 12.71) 1219099 APAP 80MG SUPPOS ( 1.70) 1219107 GLYBURIDE 1.25MG TAB ( 5.55)
1219118 NEO/POL/DEX.1%OIN3.5 ( 51.73) 1219120 NEO/BAC/POL/HC OINT ( 175.85) 1219122 NEO/POLYB/HC OS 7.5M ( 424.41) 1219127 HYDROCORT 2.5%CR 30G ( 128.19) 1219129 TENOFOV DISO 300MGTB ( 105.00) 1219132 PERMETHRIN 5%CRM 60G ( 12.64) 1219137 MODAFINIL 100MG TAB ( 56.01) 1219138 TIAGABINE 4MG TAB ( 14.38) 1219147 TRIAMTERENE 50MG CAP ( 7.71) 1219153 COLESEVELAM 625MG TB ( 8.96) 1219160 MENTH-METH SA CR 90G ( 19.32) 1219162 ACETAMINOP 80MG CHEW ( 0.23) 1219167 ACYCLOVIR 200MG/5ML ( 7.60) 1219177 ARIPIPRAZOLE 10MG TB ( 67.47) 1219181 ASP250-APAP250-CAF65 ( 4.92) 1219191 BUPI-MPF.25%/EPI 30M ( 60.22) 1219193 BUPIVACAINE .5% 50ML ( 0.17) 1219195 BUPIVACAIN.25% 50ML ( 54.74) 1219202 CARBAMDE PERX10%15ML ( 29.62) 1219206 CEFADROXIL 250MG/5ML ( 9.12) 1219212 CHOLESTYR LT POW 4GM ( 13.43) 1219218 CIPROFLOXA .3% 5ML ( 255.03) 1219220 CISATRACUR 200/20 VL ( 136.63) 1219221 CISATRACUR 20MG/10ML ( 112.13) 1219224 CLINDAMYC 1%GEL 30GM ( 128.69) 1219226 CLINDAMYCI 900MG/6ML ( 101.49) 1219238 CLOTRIM VAG 1%CRM45G ( 71.83) 1219249 COLLAGENA 250OIN 30G ( 420.48) 1219260 DEXTROM POLI 30MG/5M ( 2.44) 1219266 DILTIAZEM 125MG/25ML ( 260.81) 1219267 DILTIAZEM 50MG/10ML ( 53.70) 1219282 ECONAZOLE 1% CR 15GM ( 91.08) 1219285 ENALAPRILAT 2.5MG/2M ( 84.57) 1219293 ERYTHROMYC 250MG TAB ( 5.07) 1219310 FAT EMULS 20% 500ML ( 0.26) 1219315 FENT5MCG-BUP.125%100 ( 31.05) 1219319 FERRIC SUBSULFATE LI ( 0.66) 1219326 FLUOCINON.05%CRM 15G ( 99.52) 1219333 FLUORESCITE 10% 5ML ( 47.23) 1219338 FLURBIPRO.03%OS 2.5M ( 51.85) 1219349 GABAPEN 250MG/5ML 5M ( 6.03)
1219353 GENTAMICIN UPTO 80MG ( 287.72) 1219354 GLUCOSAMINE 500MG CP ( 4.71) 1219358 GLYCERIN LIQUID 1ML ( 0.12) 1219360 GLYCOPYR 0.2MG/ML 2M ( 16.82) 1219361 GLYCOPYRRO 1MG/5ML I ( 53.93) 1219362 GLYCOPYRRO 4MG/20ML ( 53.13) 1219388 HYDROCORT 1% LOT 120 ( 75.87) 1219391 HYDROCO VAL.2%OIN15G ( 269.42) 1219394 HYDROCORT 100MG ENEM ( 148.55) 1219401 HYDROXYUREA 500MG CP ( 9.51) 1219403 HYDROXYZINE 50MG TAB ( 7.85) 1219406 IBUPROFE 40MG/ML 1ML ( 0.12) 1219407 INDOCYAN GREEN 25MG ( 484.00) 1219417 LEVOBUNOL .5%OS 5ML ( 31.92) 1219419 LEVOTHYROX 112MCG TB ( 7.60) 1219420 LIDOCAIN 2%/EPI 50ML ( 40.16) 1219423 LIDOCAIN 2%/EPI 20ML ( 33.41) 1219427 LIDOCAI 1.5%/EPI 30M ( 47.38) 1219431 LORAZEPAM 2MG/ML 1ML ( 15.38) 1219434 AL HYD95-MG CA358/15 ( 3.59) 1219435 MG GLUCONATE 1GM/5ML ( 0.08) 1219444 MENINGOC A,C,Y,W-135 ( 406.10) 1219445 MENTHOL/CAMPHOR LOT ( 55.80) 1219447 METHADONE 1MG/1ML 5M ( 10.74) 1219454 METRONID 500MG/100ML ( 149.23) 1219456 MINERAL OIL 1ML ( 0.17) 1219460 MULTIVITAM INJ 5ML ( 52.13) 1219464 NA THIOSULF 25% 50ML ( 111.07) 1219471 NORETHINDRONE 5MG TB ( 7.95) 1219474 SOD CHLOR .9% 1000ML ( 147.60) 1219475 SOD CHLOR .9% 3000ML ( 146.10) 1219478 OSELTAMIVIR 12MG/ML ( 6.44) 1219480 OXYBUTYN 1MG/MLOR 5M ( 0.16) 1219494 PHENOBARB 4MG/1ML 5M ( 7.30) 1219500 PHENYLEPHRIN 1% DROP ( 11.97) 1219504 PHYSOSTIG 2MG/2M AMP ( 27.73) 1219520 POLY10K-TRIM.1%OS10M ( 72.19) 1219530 PREDNIS ACE.12%OS 5M ( 27.87) 1219538 PROPRANOLOL 20MG/5ML ( 2.25) 1219544 PYRIDOSTIGM 10MG/2ML ( 115.19) 1219551 ROCURONIUM 100MG/10M ( 170.55)
1219554 SELENIUM 1% SHAMPO ( 13.71) 1219561 SILV SULF 1%CRM 25GM ( 37.78) 1219562 SIMETHICONE 125 CHEW ( 4.81) 1219569 SOD PHOS 15MM/5ML VI ( 23.31) 1219577 SULFAME800-TMP160/20 ( 14.85) 1219585 TERCONAZ 0.4%CR 45GM ( 120.32) 1219589 TETRACAINE.5%OS 15ML ( 32.05) 1219591 TETRACAINE.5%OS 2ML ( 37.79) 1219599 TIMOLOL .5%OPGL 5ML ( 163.60) 1219607 TRIAMCIN.025%OIN 15G ( 12.37) 1219608 TRIAMCINOLN.1%CR454G ( 109.38) 1219609 TRIAMCIN.1% PST 5GM ( 28.06) 1219620 VIT E/B-COMP/C/ZN TB ( 5.58) 1219629 NIFEDIPINE 30MG SRTB ( 5.58) 1219634 NIFEDIP OSM 60MGSRTB ( 14.16) 1219636 ERYTHRO 200MG/5 100M ( 348.25) 1219638 ETOMIDATE 2MG/ML 20M ( 147.08) 1219648 HYDROCOR0.5%OIN 30GM ( 42.17) 1219651 BUPIVACAIN .75% 10ML ( 28.94) 1219664 TRIAMT/HCTZ 37.5 CAP ( 6.76) 1219666 SALINE.65%NAS SP 45M ( 16.26) 1219667 BUMETANIDE 0.5MG/2ML ( 19.87) 1219673 FE F/B12/C/FA/IFC CP ( 7.22) 1219685 CAFFEINE CIT 60MG/3M ( 75.41) 1219689 MOXIFLOXAC 400MG TAB ( 75.36) 1219690 PIMECROLIMUS 1% CR30 ( 19.21) 1219691 DILTIAZE 120MG SR CP ( 8.43) 1219701 LIDOCAINE 4% CR 5GM ( 99.00) 1219708 BETHANECHOL 10MG TAB ( 4.83) 1219713 DISOPYRAMIDE SR 150M ( 10.89) 1219716 PILOCARPINE 2%OS 2ML ( 25.25) 1219721 GENTAMYC 0.3%OS 5ML ( 155.21) 1219733 BUSPIRONE 15MG TAB ( 7.05) 1219734 CALC ACET/AL SULF PK ( 8.01) 1219747 DAPSONE 100MG TAB ( 4.66) 1219749 AMOXICILLIN 875MGTAB ( 15.13) 1219754 DICYCLOMINE 10MG CAP ( 5.22) 1219762 FERR SULF 44MG/ML 5M ( 0.77) 1219767 GABAPENTIN 600MG TAB ( 8.77) 1219779 LEVOFLOXACN 750MG TB ( 113.37) 1219780 LIDOCAINE 1% 50ML ( 0.36)
1219790 MIRTAZAPINE 30MG ODT ( 17.68) 1219800 NYS100K-TRI.1OIN 15G ( 335.82) 1219807 PEN-VK250MG/5ML 100M ( 14.50) 1219809 PETROLATUM GEL 5GM ( 0.78) 1219820 PRAMIPEXOLE .25MG TB ( 10.97) 1219829 SENNOSIDES 8.6MG TAB ( 4.37) 1219841 TRIAMCNOLO.5%CRM15GM ( 18.70) 1219847 VORICONAZOL 200MG TB ( 189.27) 1219849 ZINC OX 20% OINT 60G ( 65.64) 1219874 AZTREONAM IV 2GM VL ( 251.16) 1219878 ACTIVTD CHARC/SORBIT ( 61.58) 1219884 BENZO/MENTH 6-10 LOZ ( 5.07) 1219885 BENZ20-MENTH.5%SP78G ( 17.34) 1219890 VITAMIN A&D OIN 60GM ( 13.77) 1219895 CLOT1/BETA.05%CR 15G ( 129.93) 1219898 DILTIAZEM 25MG/5ML V ( 40.63) 1219899 TRIAMCINOL.1%OIN 15G ( 23.92) 1219900 TRIAMCINOLN.1%CR80GM ( 75.89) 1219903 HYDROCORT 0.5%CR 30G ( 13.80) 1219916 OXYMETAZLN HCL.05%15 ( 14.36) 1219918 PHENYTOIN 100MG/4ML ( 4.28) 1219920 PREDNISOLON 15MG/5ML ( 5.75) 1219927 SPS 15GM/60ML SUSP ( 20.76) 1219951 TRIAMCIN.025%CR 15GM ( 11.81) 1219952 TRIAMCIN.025%OIN 80G ( 33.45) 1219953 TRIAMCINOLN.1%CR15GM ( 23.21) 1219959 ERYTHROMYC 500MGDRTB ( 41.07) 1219960 NITROGLYCRN 2%OINTPK ( 13.93) 1219980 LIDOCAIN 1%/EPI 20ML ( 25.36) 1219993 RISPERIDONE .5MG ODT ( 34.72) 1219997 LIDO2%EPI1:200000/10 ( 88.63) 1220192 AA5D20W/LYTES1000ML ( 881.64) 1221000 D5LR UP TO 1000ML ( 151.64) 1221001 D5NS+KCL 20MEQ 1000M ( 197.33) 1221003 D5W/KCL 20MEQ 1000ML ( 181.13) 1221004 D10W 1000ML ( 217.53) 1221005 D10W 250ML ( 155.00) 1221008 D5.45NS/KCL20 1000ML ( 200.67) 1221009 D5.45NS/KCL40 1000ML ( 200.87) 1221010 D5 1/2NS/KCL10MEQ ( 181.13) 1221011 D5-0.2% NACL 1000ML ( 104.84)
1221014 RINGER LAC UP TO 1L ( 157.44) 1221015 RINGER LAC UP TO 1L ( 179.04) 1221019 NITROGLYC/D5W 250ML1 ( 139.47) 1221028 STERILE WATER 1000ML ( 135.42) 1221029 STERILE WATER 20ML ( 14.79) 1221033 ELECTROLYTE-A 500ML ( 20.63) 1221036 PDS 395MOSM/L 2000ML ( 105.00) 1221044 SOD CHLOR .45%1000ML ( 159.72) 1221046 SOD CHLOR .45% 500ML ( 149.65) 1221047 SOD CHLOR .45% 250ML ( 141.60) 1221061 KCL20-NS.2-D5W1000ML ( 9.63) 1221063 D545NS C KCL 30MEQ ( 181.13) 1221064 DEX 5%/WATER 25ML ( 171.96) 1221065 MANNITOL 20% 500ML ( 138.17) 1221067 MANNITOL 20% 250ML ( 264.40) 1221074 AMINO ACID 10% 500ML ( 403.76) 1221081 D5LR/KCL 20MEQ/1000 ( 182.45) 1221085 SOD CHLOR .9% 100ML ( 236.39) 1221086 NS W/ KCL 20MEQ/1000 ( 207.84) 1221087 NS W/ KCL 40MEQ/1000 ( 199.58) 1221088 KCL 20MEQ/.45%NS1000 ( 189.15) 1221091 D5W/0.9%NSS+40MEQ 1L ( 181.13) 1221092 DEXTROSE 20% (D20W) ( 87.93) 1221098 SOD CHLOR .9% 150ML ( 10.38) 1221104 SOD CHLOR 3% 500ML ( 189.09) 1221109 D5W/0.45%NACL 1000ML ( 74.47) 1221139 AA 5%/D20W 2000ML ( 581.10) 1221149 SOD CHLOR .9% 50ML ( 193.03) 1221150 SOD CHLOR .9% 100ML ( 159.50) 1221175 AA5D20W/LYTES2000ML ( 1,481.66) 1221178 AA 5%/D20W 1000ML ( 229.23) 1221179 AA5 D15W 1000ML ( 138.32) 1221180 DEXTROSE 50% 500ML ( 140.27) 1221181 FAT EMULSION 20% 250 ( 241.93) 1221190 DEXTROSE 70% 2000ML ( 57.72) 1221209 AA5 D15W 2000ML ( 138.32) 1221217 AA5/D15 LYTES 2000ML ( 42.00) 1221226 AMINO ACID 15% 500ML ( 675.58) 1221233 AA5/D15 LYTES 1000ML ( 127.77) 1221247 DEX2.5-NS.45 1000ML ( 60.73) 1221250 AA275/D5 LYTES 1000 ( 245.60)
1221266 PDS 344MOSM/L 6000ML ( 143.00) 1221267 PDS 395MOSM/L 6000ML ( 240.00) 1221268 PDS 483MOSM/L 6000ML ( 141.00) 1221274 AA275/D5 LYTES 2000 ( 939.29) 1221276 ELECTROLY-R 7.4 1000 ( 193.70) 1221284 PDS 344MOSM/L 2000ML ( 97.00) 1221300 SOD CHLOR .9% 50ML ( 183.20) 1221302 PDS 483MOSM/L 2000ML ( 109.00) 1221306 D5-.225% NACL 500ML ( 4.00) 1240001 LD ORLVL 1 INI 15MIN ( 1,501.51) 1240002 LD ORLVL 2 INI 15MIN ( 1,767.30) 1240003 LD ORLVL 3 INI 15MIN ( 2,078.56) 1240004 LD ORLVL 4 INI 15MIN ( 2,389.82) 1240011 LD ORLVL 1 EA ADDMIN ( 100.26) 1240012 LD ORLVL 2 EA ADDMIN ( 117.74) 1240013 LD ORLVL 3 EA ADDMIN ( 138.73) 1240014 LD ORLVL 4 EA ADDMIN ( 166.70) 1311073 BLOOD PRODUCT IRRAD ( 295.56) 1314000 PHLEBOTOMY THERAPEUT ( 333.96) 1314001 FFP THAWING ( 436.36) 1314005 PLATELETS POOLING ( 448.05) 1314006 RBC PRETREAT CHEM ( 132.68) 1314007 RBC PRETREAT ENZ ( 454.58) 1314010 AUTO COMPONENT,PROCS ( 975.12) 1314011 RBC PRETREAT,SER,INC ( 454.58) 1314014 RBC PRETREAT DIFF EA ( 276.23) 1314016 CATECHOL FRACTNTD ( 449.16) 1314026 CARBAMAZEPINE TOTAL ( 266.47) 1314027 CARBAMAZEPINE FREE ( 102.23) 1314028 CYCLOSPORINE ( 246.69) 1314033 ETHOSUXIMIDE ( 148.94) 1314036 HALOPERIDOL ( 189.23) 1314038 LIDOCAINE ( 201.19) 1314039 LITHIUM ( 133.82) 1314041 PHENOBARBITAL ( 201.31) 1314042 PHENYTOIN TOTAL ( 192.00) 1314043 PHENYTOIN FREE ( 187.34) 1314044 PRIMIDONE ( 174.54) 1314046 PROCAINAMIDE+NAPA ( 398.03) 1314049 TACROLIMUS ( 165.23) 1314050 THEOPHYLLINE ( 209.45)
1314051 TOBRAMYCIN ( 228.07) 1314052 TOPIRAMATE ( 161.74) 1314054 DRUG UNSPEC QUANT ( 216.43) 1314082 SPEC CHAIN CUSTODY ( 48.94) 1314083 BLOOD TYPING ABO ( 295.56) 1314084 BLOOD TYPING RH D ( 295.56) 1314087 BLD TYPING OTHER AG ( 295.56) 1314091 COMPATIB TEST IS ( 486.40) 1314092 COMPATIB TEST INCUB ( 486.40) 1314093 COMPATIB TEST AHG ( 486.40) 1314095 HEMOLYS-AGGLUT INCUB ( 195.49) 1314096 BILIRUBIN TOT TRANS ( 76.13) 1314102 ACYLCARNITINES QUANT ( 151.27) 1314103 ADRENOCORT ACTH ( 466.61) 1314104 ADENOSINE CYCL AMP ( 153.34) 1314105 ALBUMIN SERUM ( 88.44) 1314106 ALBUMIN FLUID ( 233.81) 1314108 GENERAL HEALTH PANEL ( 565.50) 1314109 ELECTROLYTE PANEL ( 134.98) 1314110 COMP METAB PANEL ( 329.31) 1314111 OBSTETRIC PANEL ( 282.75) 1314112 LIPID PANEL ( 321.16) 1314113 RENAL FUNCTION PANEL ( 171.05) 1314114 HEPATITIS ACUTE PANE ( 536.43) 1314115 HEPATIC FUNCTION PAN ( 145.45) 1314116 MICROALB QNT ( 212.94) 1314120 ALDOLASE ( 173.38) 1314121 ALDOSTERONE ( 477.09) 1314122 ALKALOIDS NOS MS ( 265.35) 1314123 ALPHA 1-ANTITRYP TOT ( 250.18) 1314124 ALPHA 1-ANTITRYP PHE ( 574.83) 1314125 AFP SERUM ( 304.87) 1314127 ALUMINUM ( 243.20) 1314131 AMINO ACID SING QUAN ( 185.02) 1314132 ALA DELTA ( 264.14) 1314133 AMINO ACID QUAN 2-5 ( 134.85) 1314134 AMINO ACID QUAN 6+ ( 189.67) 1314135 AMMONIA ( 287.42) 1314138 AMYLASE ( 125.67) 1314139 ANDROSTANEDIOL GLUC ( 306.03) 1314140 ANDROSTENEDIONE ( 743.56)
1314143 ANGIOTENSIN CONV ENZ ( 264.14) 1314144 APOLIPOPROTEIN EACH ( 146.62) 1314146 ASCORBIC ACID ( 114.04) 1314147 ATOMIC ABSORPTION ( 151.16) 1314148 BARBITURATES MS ( 155.93) 1314149 BETA-2 MICROGLOBULIN ( 282.76) 1314150 BILE ACIDS TOTAL ( 159.86) 1314152 BILIRUBIN TOTAL ( 122.18) 1314153 BILIRUBIN DIRECT ( 101.24) 1314155 BIOTINIDASE ( 139.64) 1314156 BLD OCCULT FECES 1-3 ( 69.60) 1314157 BLD OCCULT OTHER SRC ( 37.24) 1314160 CADMIUM ( 259.49) 1314161 VITAMIN D 25OH ( 508.50) 1314163 CALCITONIN ( 335.12) 1314164 CALCIUM TOTAL ( 128.00) 1314165 CALCIUM IONIZED ( 172.22) 1314167 CALCIUM URI QN TIMED ( 151.27) 1314170 CALCULUS INFRARED ( 124.51) 1314173 CARBON DIOXIDE CO2 ( 64.00) 1314174 CARBON MONOXIDE QUAN ( 538.76) 1314176 CARCINOEMBRYONIC AG ( 293.23) 1314177 CARNITINE ( 278.11) 1314178 CAROTENE ( 134.85) 1314179 CATECHOLAMINES URINE ( 363.05) 1314180 CATECHOLAMINES BLD ( 188.14) 1314183 CERULOPLASMIN ( 189.67) 1314184 CHEMILUM ASSAY NOS ( 179.44) 1314186 CHLORIDE BLOOD ( 61.67) 1314188 CHLORIDES OTHER FLD ( 56.55) 1314189 CHLORINATED HYDROCAR ( 54.38) 1314190 CHOLESTEROL TOTAL ( 93.09) 1314192 CHOLINESTERASE RBC ( 215.27) 1314200 CHROMIUM ( 131.59) 1314201 CITRATE ( 372.36) 1314202 COCAINE MS ( 561.15) 1314203 COLLAGEN CROSSLINKS ( 315.34) 1314206 CORTISOL FREE ( 372.36) 1314207 CORTISOL TOTAL ( 221.09) 1314208 CREATINE ( 29.09) 1314213 CPK TOTAL ( 118.69)
1314214 CPK ISOENZYMES ( 259.49) 1314215 CPK MB FRACTION ( 276.94) 1314217 CREATININE BLOOD ( 88.44) 1314218 CREATININE UR-OTHER ( 107.05) 1314219 CREATININE CLEARANCE ( 174.54) 1314220 CRYOFIBRINOGEN ( 113.10) 1314221 CRYOGLOBULIN ( 89.60) 1314222 CYANIDE ( 158.25) 1314223 VITAMIN B-12 ( 198.98) 1314224 VITAMIN B-12 BINDING ( 175.09) 1314226 DHEA ( 468.94) 1314227 DHEA-S ( 499.20) 1314234 DIHYDROXY VITAMIN D ( 762.17) 1314236 ENZYME ACTIVITY NOS ( 167.48) 1314238 ELECTROPHORETIC TECH ( 420.86) 1314240 ERYTHROPOIETIN ( 218.76) 1314241 ESTRADIOL ( 457.30) 1314242 ESTROGENS FRACT ( 191.40) 1314243 ESTROGEN TOTAL ( 297.89) 1314244 ESTRIOL ( 265.31) 1314245 ESTRONE ( 257.16) 1314247 ETHYLENE GLYCOL ( 196.65) 1314249 FAT-LIPID FECES QUAL ( 82.62) 1314250 FAT-LIPID FECES QUAN ( 164.07) 1314253 FATTY ACIDS LG CHAIN ( 430.54) 1314254 FERRITIN ( 175.71) 1314255 FETAL FIBRONECTIN ( 394.76) 1314258 FOLIC ACID SERUM ( 174.54) 1314259 FOLIC ACID RBC ( 154.76) 1314262 GALACTOSE ( 82.62) 1314263 GALACTOSE TRANS QUAN ( 228.07) 1314265 GAMMAGLOB M-G-A-D ( 72.14) 1314266 GAMMAGLOBULIN IGE ( 217.60) 1314267 IGG SUB 1,2,3 OR 4 ( 965.81) 1314268 GASES BLOOD PH ( 72.86) 1314269 BLD GAS-PH,PO2,PCO2 ( 300.15) 1314272 HEMOGLOBIN-O2 AFFIN ( 96.79) 1314276 GASTRIN ( 265.31) 1314278 GLUCOSE, BODY FLUID ( 101.24) 1314280 GLUCOSE, QUANT ( 86.11) 1314282 GLUCOSE, POST DOSE ( 148.99)
1314283 GTT 3 SPEC ( 321.16) 1314284 GTT ADD SP ( 96.58) 1314286 G6PD, QUANT ( 192.00) 1314292 GGT ( 131.49) 1314296 GLYCATED PROTEIN ( 146.62) 1314297 FOLLICLE STIM HORM ( 410.76) 1314298 LEUTEINIZING HORMONE ( 373.52) 1314299 GROWTH HORMONE ( 324.65) 1314301 HAPTOGLOBIN, QUANT ( 204.80) 1314303 H PYLORI,BREATH TEST ( 587.63) 1314304 H PYLORI, DRUG ADMIN ( 331.63) 1314305 HEAVY METALS, SCREEN ( 194.66) 1314306 HEAVY METALS, QUANT ( 420.07) 1314308 HEMOGLOBIN, CHROMA ( 256.00) 1314314 METHEMOGLOBIN, QUAN ( 76.80) 1314315 HEMOGLOBIN, PLASMA ( 137.03) 1314317 SULFHEMOGLOBIN, QNT ( 82.65) 1314319 HEMOGLOB, STABIL SCR ( 246.86) 1314320 HEMOGLOBIN, URINE ( 25.01) 1314321 HEMOSIDERIN, QUAL ( 29.36) 1314323 B-HEXOSAMINIDASE ( 104.40) 1314324 HISTAMINE ( 301.38) 1314325 HOMOCYSTEINE ( 159.42) 1314326 HOMOVANILLIC ACID ( 246.69) 1314327 CORTICOSTEROIDS ( 224.58) 1314328 5-HIAA ( 288.58) 1314329 HYDROXYPROGES 17-D ( 715.63) 1314331 HYDROXYPROLINE, FREE ( 185.96) 1314333 IMMUNOASSAY, OTHER ( 508.50) 1314335 IMMUNOASSAY, RIA ( 311.85) 1314336 IMMUNOASSAY, NOS ( 203.63) 1314337 INSULIN, TOTAL ( 316.51) 1314338 INSULIN, FREE ( 182.69) 1314340 IRON ( 100.07) 1314341 IRON BINDING CAPACIT ( 166.40) 1314344 17-KETOSTEROIDS, TOT ( 257.16) 1314346 LACTIC ACID ( 169.89) 1314347 LACTATE DEHYDROLDH ( 83.78) 1314348 LDH ISOENZYMES ( 118.54) 1314352 LEAD ( 187.34) 1314353 FETAL LUNG,L-S RATIO ( 279.27)
1314358 LIPASE ( 91.93) 1314360 LIPOPROTEIN,HIGH RES ( 164.07) 1314361 LIPOPROTEIN, HDL ( 121.02) 1314363 LIPOPROTEIN, LDL ( 95.42) 1314365 MAGNESIUM ( 123.34) 1314367 MANGANESE ( 246.86) 1314369 MASS SPECTRO QUANT ( 753.64) 1314371 MERCURY ( 202.47) 1314372 METANEPHRINES ( 285.09) 1314373 METHADONE MS ( 652.50) 1314379 MYELIN BASIC PROTEIN ( 509.67) 1314380 MYOGLOBIN ( 158.25) 1314381 NEPHELOMETRY, NOS ( 304.50) 1314399 NUCLEOTIDASE 5' ( 102.23) 1314400 OLIGOCLONAL BANDS ( 372.36) 1314401 ORGAN ACID,TOT,QUAN ( 72.86) 1314402 ORGAN ACID,QUAL,EA ( 152.25) 1314403 ORGAN ACID,SIN,QUAN ( 313.02) 1314405 OSMOLALITY, BLOOD ( 100.05) 1314406 OSMOLALITY,URINE ( 108.22) 1314408 OXALATE ( 339.78) 1314410 PARATHORMONE PTH ( 514.32) 1314412 PHENCYCLIDINE PCP MS ( 363.23) 1314414 PHENYLALANINE, BLOOD ( 570.18) 1314418 PHOSPHATASE, PROSTAT ( 59.81) 1314419 PHOSPHATASE,ALKALINE ( 94.25) 1314420 PHOSPHATASE,ALK HEAT ( 245.78) 1314421 PHOSPHATASE,ALK ISO ( 267.63) 1314422 PHOSPHATIDYLGLYCEROL ( 116.36) 1314425 PHOSPHORUS, BLOOD ( 90.76) 1314426 PHOSPHORUS, URINE ( 87.27) 1314427 PORPHOBILINOGEN,QUAL ( 50.03) 1314428 PORPHOBILINOGEN,QUAN ( 111.71) 1314430 PORPHYRINS,UR,QUAN ( 556.21) 1314433 POTASSIUM SER PL WB ( 94.25) 1314434 POTASSIUM, URINE ( 62.84) 1314435 PREALBUMIN ( 146.62) 1314438 PREGNENOLONE ( 108.75) 1314439 PREGNENOLONE,17-OH ( 151.27) 1314440 PROGESTERONE ( 364.21) 1314441 PROLACTIN ( 446.83)
1314442 PROSTAGLANDIN ( 117.45) 1314443 PSA, COMPLEXED ( 88.09) 1314444 PSA, TOTAL ( 218.76) 1314445 PSA, FREE ( 190.83) 1314446 PROTEIN TOT SER PLWB ( 88.44) 1314447 PROTEIN,TOTAL,REFRAC ( 52.20) 1314448 PROTEINELECTR FR-QNT ( 204.80) 1314449 WESTERN BLOT ( 416.51) 1314450 WESTERN BLOT, PROBE ( 1,780.35) 1314451 PROTOPORPH,RBC,QUAN ( 89.18) 1314453 PROINSULIN ( 330.47) 1314454 VITAMIN B-6 ( 742.39) 1314455 PYRUVATE ( 203.36) 1314456 PYRUVATE KINASE ( 100.05) 1314461 RECEPTOR, NON-ENDO ( 342.11) 1314462 RENIN ( 268.80) 1314463 VITAMIN B-2 ( 146.62) 1314464 SELENIUM ( 295.80) 1314465 SEROTONIN ( 378.18) 1314466 SEX HORM BIND GLOB ( 272.29) 1314469 SODIUM,SER PL OR WB ( 100.07) 1314470 SODIUM, URINE RANDOM ( 76.80) 1314471 SOMATOMEDIN ( 710.97) 1314472 SOMATOSTATIN ( 672.08) 1314473 SPECTROPHOTO, NOS ( 86.11) 1314474 SPECIFIC GRAVITY ( 68.65) 1314476 SUGARS, SING, QUAL ( 394.76) 1314478 SUGARS, SING, QUANT ( 104.40) 1314480 SULFATE, URINE ( 271.12) 1314481 TESTOSTERONE, FREE ( 586.47) 1314482 TESTOSTERONE, TOTAL ( 628.36) 1314483 VITAMIN B-1 ( 281.60) 1314484 THIOCYANATE ( 71.78) 1314485 THYROGLOBULIN ( 385.16) 1314486 THYROXINE T4,TOTAL ( 258.32) 1314488 THYROXINE T4, FREE ( 155.93) 1314489 THYROXINE BIND GLOB ( 167.56) 1314490 THYROID STIM TSH ( 209.45) 1314491 THYROID STIM IMMUNO ( 638.83) 1314492 VITAMIN E ( 158.25) 1314493 TRANSCORTIN ( 112.01)
1314494 TRANSFERASE AST ( 74.47) 1314495 TRANSFERASE ALT ( 88.44) 1314496 TRANSFERRIN ( 243.20) 1314497 TRIGLYCERIDES ( 141.96) 1314498 T3-T4 UPTAKE ( 103.56) 1314499 T3,TOTAL ( 373.52) 1314500 T3,FREE ( 266.47) 1314501 T3,REVERSE ( 535.27) 1314502 TROPONIN,QNT ( 179.20) 1314506 TYROSINE ( 122.18) 1314508 UREA NITROGEN,QUAN ( 77.96) 1314510 UREA NITROGEN,URINE ( 64.16) 1314512 URIC ACID, BLOOD ( 93.09) 1314513 URIC ACID,URINE RAND ( 150.11) 1314518 VMA, URINE ( 246.69) 1314519 VASOINTESTINAL PEP ( 435.20) 1314520 VASOPRESSIN ( 418.91) 1314521 VITAMIN A ( 224.58) 1314522 VITAMIN ASSAY, NOS ( 64.16) 1314523 VITAMIN K ( 381.67) 1314524 VOLATILES ( 183.79) 1314526 ZINC ( 260.65) 1314527 C-PEPTIDE ( 243.20) 1314529 HCG, QUAL ( 76.80) 1314531 CLIN CHEM TEST NOS ( 45.68) 1314532 ANTIBODY SCREEN, RBC ( 295.56) 1314533 ANTIBODY ELUTION,RBC ( 463.12) 1314534 ANTIBODY ID,EA PANEL ( 714.47) 1314535 DIRECT COOMBS TEST ( 486.40) 1314537 IDAT EACH AB TITER ( 667.73) 1314559 FEBRILE AGG EA AG ( 67.43) 1314560 PSA, SCREENING ( 204.80) 1314562 ALLERGEN IGE QUANT ( 69.82) 1314564 WBC AB IDENT ( 249.02) 1314565 PLATELET AB ( 549.23) 1314566 PLT ASSOC IMMUNOGLOB ( 84.94) 1314567 ANA ( 171.05) 1314568 ANA,TITER ( 100.05) 1314569 ASO,TITER ( 140.80) 1314571 C-REACTIVE PROTEIN ( 138.47) 1314572 CRP,HIGHLY SENS ( 155.93)
1314573 BETA-2 GLYCOPROT AB ( 143.13) 1314574 CARDIOLIPIN AB,IGG ( 451.49) 1314575 PHOSPHOLIPID AB ( 124.51) 1314578 COLD AGG, TITER ( 379.34) 1314579 COMPLEMENT AG, EA ( 214.11) 1314580 LACTOFERRIN,FEC QAL ( 96.79) 1314581 COMPLEMENT-FUNC ACT ( 100.05) 1314583 COMP, TOTAL CH50 ( 251.34) 1314584 PROT E-PHOR-URIN-CSF ( 208.29) 1314586 B CELLS, TOTAL COUNT ( 375.19) 1314588 IMM E-PHORS-URIN-CSF ( 296.89) 1314589 DEOXYRIBONUCLEASE AB ( 201.19) 1314590 NK CELLS, TOTAL CNT ( 375.19) 1314591 DNA AB,NATIVE-DOUBL ( 272.29) 1314593 DNA AB SINGLE STRAND ( 126.84) 1314594 RSV ASSAY W-OPTIC ( 269.96) 1314595 ANTI-ENA ( 236.22) 1314596 CATH URINE SPECIMEN ( 19.58) 1314599 FLUORESCENT AB,SCREE ( 131.49) 1314600 PANCREA ELASTAS,FEC ( 110.93) 1314601 FLUORESCENT AB,TITER ( 333.96) 1314605 TUMOR AG,QUAL IMMUNO ( 67.43) 1314606 TUMR AG CA15-3 27-29 ( 192.00) 1314607 TUMOR AG CA 19-9 ( 381.67) 1314608 TUMOR AG CA 125 ( 411.92) 1314609 HETEROPHILE AB SCREE ( 101.24) 1314612 TUMOR AG, OTHER ( 293.23) 1314613 INF AGENT IMMUNO QUA ( 210.62) 1314617 IMMUNOELECTRO CROSSD ( 141.38) 1314618 IMMUNODIFFUSION ( 223.42) 1314620 IMMUNE COMPLEX ASSAY ( 396.94) 1314621 IMMUNOFIXATION ELECT ( 318.83) 1314622 INHIBIN A ( 146.62) 1314623 INSULIN AB ( 152.43) 1314624 INTRINSIC FACTOR AB ( 141.96) 1314625 ISLET CELL AB ( 342.11) 1314626 LEUK HISTAMINE RELEA ( 77.21) 1314628 LYMPH TRANSFORM ( 914.59) 1314629 T CELLS, TOTAL ( 377.36) 1314630 T CELL,ABSO CD4-CD8 ( 684.21) 1314632 MICROSOMAL AB ( 172.22)
1314634 NEUTRALIZ TEST,VIRAL ( 188.14) 1314636 PART AGGLUT.SCREEN ( 139.64) 1314637 PART AGGLUT. TITER ( 127.24) 1314638 RHEUMATOID FACT,QUAL ( 115.20) 1314639 RHEUMATOID FACT QUAN ( 111.71) 1314643 SKIN TEST, TB INTRA ( 108.22) 1314646 SYPHILIS TEST, QUAL ( 82.62) 1314647 SYPHILIS TEST, QUANT ( 68.51) 1314649 ADENOVIRUS AB ( 132.68) 1314650 ASPERGILLUS AB ( 168.73) 1314651 BACTERUIM AB, NOS ( 116.36) 1314652 BARTONELLA AB ( 136.14) 1314653 BLASTOMYCES AB ( 125.67) 1314654 BORDETELLA AB ( 137.31) 1314655 BORRELIA BURG.CONFIR ( 205.96) 1314656 LYME DISEASE AB ( 210.62) 1314657 BORRELIA AB ( 82.65) 1314658 BRUCELLA AB ( 165.23) 1314660 CANDIDA AB ( 114.04) 1314661 CHLAMYDIA AB ( 308.36) 1314662 CHLAMYDIA IGM AB ( 328.14) 1314663 COCCIDIOIDES AB ( 151.27) 1314664 COXIELLA BRUN QFEV ( 218.76) 1314666 CMV AB ( 314.18) 1314667 CMV AB, IGM ( 330.47) 1314668 DIPHTHERIA AB ( 239.25) 1314669 ENCEPHALITIS, CALIF ( 107.66) 1314670 ENCEPH, EAST EQUINE ( 138.11) 1314671 ENCEPH, ST LOUIS ( 134.85) 1314672 ENCEPH, WEST EQUINE ( 133.82) 1314673 ENTEROVIRUS AB ( 908.79) 1314674 EPSTEIN-BARR AB, EA ( 126.84) 1314675 EPSTEIN-BARR, EBNA ( 150.08) 1314676 EPSTEIN-BARR, VCA ( 217.60) 1314677 EHRLICHIA AB ( 104.73) 1314678 FRANCISELLA TULARENS ( 146.81) 1314679 FUNGUS AB, NOS ( 130.33) 1314680 GIARDIA LAMBLIA AB ( 97.74) 1314681 H PYLORI AB QL ( 241.43) 1314682 HELMINTH AB, NOS ( 270.79) 1314683 HEMOPHILUS INFLUENZA ( 138.11)
1314684 HTLV-I AB ( 95.70) 1314686 HTLV-HIV AB CONFIRM ( 433.91) 1314687 HEPATITIS, DELTA AGE ( 151.16) 1314688 HERPES SIMP NON-SPEC ( 207.13) 1314689 HERPES SIMP TYPE 1 ( 239.71) 1314690 HERPES SIMP TYPE 2 ( 262.98) 1314691 HISTOPLASMA ( 143.13) 1314692 HIV-1 AB ELISA ( 51.20) 1314693 HIV-2 AB ELISA ( 133.76) 1314694 HIV1-HIV2 AB SNG RES ( 183.85) 1314695 HEP B CORE TOT ( 144.29) 1314696 HEP B CORE AB, IGM ( 164.07) 1314697 HEP B SURF AB ( 101.24) 1314698 HEP BE AB ( 100.07) 1314699 HEP A AB, TOTAL ( 196.84) 1314700 HEP A AB, IGM ( 145.73) 1314701 INFLUENZA VIRUS AB ( 192.49) 1314702 LEGIONELLA AB ( 190.83) 1314703 LEISHMANIA AB ( 125.06) 1314704 LEPTOSPIRA AB ( 244.69) 1314706 LYMPH CHORIOMENINGIT ( 112.01) 1314709 MUMPS AB ( 544.58) 1314710 MYCOPLASMA AB ( 247.85) 1314713 PARVOVIRUS AB ( 212.06) 1314714 PLASMODIUM AB ( 61.99) 1314715 PROTOZOA AB, NOS ( 151.16) 1314717 RICKETTSIA AB ( 221.09) 1314719 RUBELLA AB ( 212.94) 1314720 RUBEOLA AB ( 315.34) 1314721 SALMONELLA AB ( 161.74) 1314723 TETANUS AB ( 396.94) 1314724 TOXOPLASMA AB ( 203.63) 1314725 TOXOPLASMA AB, IGM ( 339.78) 1314726 TREP. PALLIDUM,CONFI ( 131.59) 1314727 TRICHINELLA AB ( 143.55) 1314728 VARICELLA-ZOSTER AB ( 141.96) 1314729 VIRUS AB, NOS ( 187.34) 1314730 YERSINIA AB ( 201.19) 1314731 THYROGLOBULIN AB ( 318.83) 1314732 HEPATITIS C AB TEST ( 366.54) 1314733 HEP C AB TEST,CONFIR ( 167.48)
1314738 HLA A,B,OR C,SING ( 421.23) 1314746 BLEEDING TIME ( 66.33) 1314747 WBC DIFF, MAN ( 43.05) 1314750 HEMATOCRIT, SPUN ( 44.59) 1314751 HEMATOCRIT, OTHER ( 57.02) 1314752 HEMOGLOBIN ( 53.53) 1314753 CBC W-PLT AUTO COMPD ( 93.09) 1314754 CBC W-PLT ( 112.87) 1314755 RBC COUNT ( 84.83) 1314756 RETIC COUNT, MANUAL ( 50.04) 1314757 RETIC COUNT, FLOW ( 23.93) 1314758 RETIC-HGB CONCENTRAT ( 32.63) 1314759 WBC COUNT ( 57.02) 1314761 CHROMO, SUBSTR,ASSAY ( 58.73) 1314764 FACTOR II,PROTHROMBI ( 102.40) 1314765 FACTOR V ASSAY ( 353.74) 1314766 FACTOR VII ASSAY ( 260.65) 1314767 FACTOR VIII, AHG ( 423.56) 1314768 FACTOR VIII REL AG ( 202.28) 1314769 FACTOR VIII RISTOCET ( 505.01) 1314770 FACTOR VIII VW AG ( 228.07) 1314771 FACT VIII,VW,MULTIME ( 425.21) 1314772 FACTOR IX ( 503.85) 1314773 FACTOR X ( 260.65) 1314774 FACTOR XI ( 283.84) 1314775 FACTOR XII ( 276.23) 1314776 FACTOR XIII ( 192.49) 1314778 PREKALLIKIEN FLETCHR ( 171.83) 1314779 KININOGEN FITZGERALD ( 89.18) 1314780 ANTITHROMBIN IIIACTI ( 140.80) 1314781 ANTITHROMBIN III, AG ( 222.25) 1314782 PROTEIN C, AG ( 360.72) 1314783 PROTEIN C, ACTIVITY ( 138.47) 1314784 PROTEIN S, TOTAL ( 378.18) 1314785 PROTEIN S, FREE ( 175.71) 1314786 PROTEIN C ACTIVATED ( 198.98) 1314787 FACTOR INHIBITOR TES ( 132.65) 1314790 COAG TIME ACTIVATED ( 60.51) 1314793 FDP-FSP AGG SLIDE ( 117.53) 1314794 FDP-FSP PARACOAG ( 68.51) 1314797 D-DIMER, QUANT ( 112.87)
1314798 FIBRINOGEN ACTIVITY ( 169.89) 1314801 FIBRINOLYTIC, PLASMI ( 52.20) 1314802 ALPHA-2 ANTIPLASMIN ( 47.85) 1314803 PLASMINOGEN ACTIVATO ( 160.58) 1314804 PLASMIN EXCEPT AG AS ( 66.34) 1314806 HEINZ BODIES, DIRECT ( 164.21) 1314808 FETAL HGB KLEIH-BETK ( 104.73) 1314809 FETAL HGB, ROSETTE ( 84.83) 1314811 HEPARIN ASSAY ( 140.80) 1314817 MURAMIDASE ( 215.33) 1314820 PLATELET AGGREGATION ( 190.83) 1314821 PLTT NEUTRALIZATION ( 302.33) 1314822 PROTHROMBIN TIME ( 77.96) 1314823 PROTHROMBIN, SUBSTIT ( 45.38) 1314825 RUSSELL VIPER VEN DI ( 140.80) 1314826 REPTILASE TEST ( 120.71) 1314827 SED RATE NONAUTOMATE ( 96.58) 1314829 SICKLE CELL TEST RED ( 71.78) 1314830 THROMBIN TIME ( 104.73) 1314833 THROMBOPLAST TIMEPTT ( 107.05) 1314834 PTT SUBSTITUT ( 102.23) 1314835 VISCOSITY EXAM ( 127.24) 1314836 HEME-COAG PROC, NOS ( 330.60) 1314838 PHYS BB SERV TRAN RE ( 444.79) 1314842 SPECIMEN CONCENTRATI ( 121.02) 1314843 CULTURE BLOOD BACTER ( 200.14) 1314844 CULT STL BACT W-ISOL ( 165.23) 1314845 CULT STL BACT EA ADD ( 81.56) 1314846 CULTURE BACTERIA OTH ( 190.83) 1314849 CULT BACT ANA ANY SO ( 158.25) 1314850 CULT ANAERO IDENT EA ( 87.00) 1314851 CULT AEROBIC IDENTIF ( 158.25) 1314852 CULTURE SCREEN ONLY ( 115.20) 1314854 CULT URINE-COLONY CT ( 95.42) 1314857 CULT FUNGUS ISOLATIO ( 75.64) 1314859 FUNGI IDENTIF YEAST ( 112.87) 1314860 FUNGI IDENTIF, MOLD ( 72.86) 1314861 CULT MYCOPLASMA ( 148.99) 1314862 CULTURE CHLAMYDIA ( 273.45) 1314863 CULT MYCOBACTERIA ( 134.98) 1314864 MYCOBACTERIA IDENTIF ( 183.79)
1314865 CULT TYPE IMMUNOFLUO ( 75.04) 1314867 CULT TYPE,IMMUNOLOGI ( 59.81) 1314868 CULT TYPE,NUCLEIC AC ( 178.35) 1314870 CULT TYP ADDED METHO ( 52.20) 1314874 MACRO EXAM PARASITE ( 96.58) 1314875 PINWORM EXAM ( 46.55) 1314876 TISSUE HOMOGENIZ CUL ( 56.55) 1314877 OVA-PARASITES SMEARS ( 168.73) 1314878 MICROB SUSCEP DIFFUS ( 42.41) 1314879 MICROBE SUSCEP DISK ( 76.80) 1314880 MICROB SUSCEP ENZYME ( 29.36) 1314881 MICROBE SUSCEPT MIC ( 66.33) 1314882 MICROBE SUSCEPT MLC ( 40.24) 1314883 MICRO SUSCEP MACROBR ( 51.11) 1314884 MICROB SUSCEP MYCOBA ( 37.24) 1314888 SMEAR,GRAM STAIN ( 84.94) 1314889 SMEAR FLUORES-ACI ST ( 96.58) 1314890 SMEAR,SPECIAL STAIN ( 353.74) 1314891 SMEARWET MOUNT SAL-I ( 83.78) 1314892 TISSUE EX FOR FUNGI ( 48.94) 1314893 ASSAY TOXIN/ANTITOXI ( 218.59) 1314895 VIRUS INOCULAT TISSU ( 436.36) 1314896 VIRUS INOCU TIS ADDL ( 201.19) 1314897 VIRUS INOCU SHELL VI ( 192.49) 1314900 CHLAMYDIA TRACHO AGI ( 82.62) 1314902 HERPES SIMPLEX2 AGIF ( 88.09) 1314903 HERPES SIMPLX1,AG,IF ( 88.09) 1314907 LEGION PNEUMOPH AG,I ( 58.18) 1314909 RESP SYNCYTIAL AG,IF ( 57.02) 1314910 PNEUMOCYSTIS CAR AGI ( 107.05) 1314911 RUBEOLA, AG, IF ( 53.29) 1314913 VARICELLA ZOSTER AGI ( 118.54) 1314914 ANTIB DETECT NOS, IF ( 80.48) 1314918 CLOSTRIDIUM DIF TOXN ( 160.58) 1314919 CRYPTOCOCCUS NEOF AG ( 114.19) 1314920 CRYPTOSPOR AG,EIA ( 132.65) 1314924 ENTAMOEB HIS GRP AGT ( 66.34) 1314925 HPYLORI,STOOL,EIA ( 211.78) 1314927 HBSAG ( 164.07) 1314928 HBSAG NEUTR ( 64.16) 1314929 HBEAG ( 187.34)
1314931 HISTOPLASM CAPSU AGE ( 155.51) 1314932 HIV-1 AG,EIA SERUM ( 89.60) 1314934 INFLUENZA A AG,EIA ( 236.22) 1314935 RESP SYNCYTIAL AG,EI ( 135.94) 1314936 ROTAVIRUS AG,EIA ( 183.85) 1314937 SHIGA-LIKE TOX AG,EI ( 74.47) 1314938 STREP A AG,EIA ( 250.18) 1314939 AG DETEC NOS,EIA MUL ( 169.65) 1314940 AG DETEC NOS,EIA SIN ( 139.20) 1314943 BARTONELLA DNA AMPPR ( 327.34) 1314946 LYME DIS DNA AMP PRO ( 532.88) 1314952 CHLMYD PNEUM DNA AMP ( 350.18) 1314954 CHLMYD TRACH DNA DIR ( 125.06) 1314955 CHLMYD TRACH DNA AMP ( 347.92) 1314958 CYTOMEG DNA AMP PROB ( 481.74) 1314959 CYTOMEG DNA QUANT ( 614.39) 1314964 HEPATITIS B,DNA AMPP ( 320.81) 1314965 HEPATITIS B,DNA QNT ( 448.05) 1314967 HEPATITIS C,RNA,AMPP ( 357.79) 1314968 HEPATITIS C,RNA,QUAN ( 651.63) 1314973 HSV, DNA, AMP PROBE ( 389.81) 1314974 HSV, DNA, QUANT ( 190.31) 1314976 HHV-6, DNA AMP PROBE ( 343.27) 1314979 HIV-1, DNA,AMP PROBE ( 183.79) 1314980 HIV-1, DNA, QUANT ( 1,201.69) 1314988 MYCOBACTERIA,DNA,AMP ( 320.81) 1314991 M.TUBERCULO,DNA,AMPP ( 385.16) 1314993 M.AVIUM-INTR,DNA DIR ( 125.06) 1314994 M.AVIUM-INTR,DNA,AMP ( 318.64) 1314997 M.PNEUM,DNA,AMP PROB ( 344.74) 1314999 N.GONORRHEA,DNA,DIR ( 125.06) 1315000 N.GONORRHO,DNA,AMPPR ( 338.61) 1315009 DETECT AGNTNOS,DNAAM ( 586.47) 1315010 DETECT AGNT NOS,DNAQ ( 287.10) 1315011 DETECT AGT MULT,DNAD ( 291.45) 1315012 DETECT AGT MULT,DNAA ( 697.09) 1315015 INFLUENZA ASSAY W-OP ( 332.78) 1315018 STREP A ASSAY W-OPTI ( 77.21) 1315019 AGENT NOS ASSAY W-OP ( 72.14) 1315020 MICROBIOLOGY PROCEDU ( 151.16) 1315021 UA, NONAUTO W-SCOPE ( - )
1315022 UA, AUTO W-SCOPE ( 41.89) 1315023 UA NONAUTO W-O SCOPE ( 73.31) 1315024 UA, AUTO, W-O SCOPE ( 25.60) 1315027 MICROSCOPIC EX OF UR ( 167.48) 1315029 URINE PREG TEST QL ( 102.40) 1315030 URINALYSIS,VOL MEASU ( 34.91) 1315033 GENOTYPE,DNA,HIV REV ( 3,043.91) 1315034 GENOTYPE,DNA,HEPAT C ( 2,008.42) 1315037 CELL CTW-ODIF BODYFL ( 30.25) 1315038 CELL CTW-DIF BODYFLU ( 67.43) 1315041 SPECIMEN FAT STAIN ( 87.00) 1315049 NASAL SMEAR-EOSINOPH ( 77.21) 1315076 NATRIURETIC PEPTIDE ( 417.74) 1315077 SODIUM OTHER SOURCE ( 25.60) 1315079 CBC-PLT AUTORP CDM ( 65.16) 1315081 VIRUS ISOLATION GEN ( 268.61) 1315083 CMV BY DFA CORP CDM ( 91.35) 1315084 LEUKOCY ASSES FEC QL ( 83.74) 1315089 CAPILLARY PUNCTURE ( 19.78) 1315091 PROT TOTL RANDOM URI ( 61.67) 1315092 PROTEIN TOT OTHR SRC ( 23.27) 1315097 INFAGT DT QLSQT GIAR ( 141.96) 1315101 SWEAT COLLECT IONTOP ( 368.87) 1315122 SIROLIMUS ( 128.33) 1315123 BLD OCC NON CA SCREE ( 17.40) 1315126 LIPOPROTEIN A ( 73.31) 1315127 LIPOPROT BLD BY NMR ( 167.56) 1315133 CCP ANTIBODY ( 139.20) 1315134 TB TEST CELL IM MEAS ( 578.55) 1315135 COMPAT TEST ELECTRIC ( 448.05) 1315137 SMEAR COMPLEX STN ( 121.02) 1315138 PHENOTYPE INFECT DRG ( 818.89) 1315146 WEST NILE VIR AB IGM ( 183.85) 1315147 WEST NILE VIR AB ( 96.58) 1315148 ASPERGILLUS AG EIA ( 100.05) 1315149 ENTEROVIRUS,DNA, PRO ( 326.98) 1315155 AFP-L3 AND TOTL AFP ( 338.21) 1315157 VENIPUNCTURE,ROUTINE ( 23.27) 1315564 CULT BAC AEROB OT QT ( 123.34) 1315669 RBC PRETREAT W-INHIB ( 448.05) 1315822 GENTAMICIN ( 250.18)
1315826 VANCOMYCIN ( 196.65) 1315834 CHLORIDE URINE RAN ( 70.98) 1315845 PH FLUID,NOS ( 64.00) 1315863 AMIKACIN ( 75.64) 1315878 ARSENIC ( 371.20) 1315881 COPPER SERUM ( 175.71) 1315893 HEMOGLOBIN A1C ( 176.87) 1316323 BASIC META W-ION CA ( 85.91) 1316334 CYSTATIN C ( 92.44) 1316335 CALPROTECTIN FECAL ( 157.09) 1316337 MONONUC CELL AG QT ( 169.65) 1316342 BASIC METABO CA TOTA ( 146.62) 1316348 ALLERGEN IGG QT ( 32.63) 1316359 ACETON-KETON SERM QT ( 60.51) 1316361 HCG QUANT ( 267.63) 1316362 GLU,HOME USE DIAGNOS ( 26.76) 1316364 CRYSTAL ID,TISSUE,FL ( 140.80) 1316372 ONCOPROTEIN DCP ( 319.73) 1316373 CLOTTING FUNCT ACTIV ( 120.71) 1316382 PROCALCITONIN PCT ( 154.43) 1316386 PAMG-1 QUALITATIVE ( 377.36) 1316409 PRS DRG IA VIS ( 118.69) 1316412 CELL FUNCT ASSAY STI ( 673.16) 1316417 DNA-RNA SEQUENCING ( 307.76) 1316422 HEXAGONAL PHOSPHOLIP ( 152.25) 1316424 ENUMERAT TCELL SUSP ( 432.83) 1316426 INFLU DNA AMP PROBE ( 425.21) 1316427 INFLU DNA AMP PRO AD ( 127.24) 1316428 HIV GEN DNA REV OTH ( 819.98) 1316430 HIV-1 AB EIA ( 81.56) 1316431 HIV-2 AB EIA ( 81.56) 1316432 GALECTIN 3 ( 108.75) 1316433 JOHN CUNNINGHAM AB ( 69.60) 1316442 RESP VIRUS 3-5 TARG ( 723.19) 1316443 RESP VIRUS 6-11 TARG ( 948.30) 1316446 GENOTYPE DNA HEP B ( 1,352.85) 1316449 VALPROIC ACID TOTAL ( 199.01) 1316450 BLD TYPE DONOR EA AG ( 276.23) 1316451 VALPROIC ACID FREE ( 199.01) 1316452 DIGOXIN TOTAL ( 151.16) 1316453 DIGOXIN FREE ( 144.64)
1316456 PRS DRG IA MET ( 85.91) 1316531 HIV1 AG W HIV 1 2 AB ( 126.15) 1316532 CAFFEINE QT ( 181.61) 1316534 EVEROLIMUS QT ( 66.34) 1316535 GABAPENTIN QT ( 288.19) 1316536 LAMOTRIGINE QT ( 162.04) 1316537 LEVETIRACETAM QT ( 288.19) 1316538 MYCOPENOLATE QT ( 711.23) 1316539 OXCARBAEPINE QT ( 117.45) 1316541 ZONISAMIDE QT ( 166.39) 1316542 T VAGINALIS AMP ( 174.00) 1316553 COL CHRM NODRG EA ( 163.13) 1316600 PRS DRG IA ANAZ ( 3,122.21) 1316611 ALCOHOLS MS ( 147.90) 1316631 ANTIDPRS NOS MS ( 753.64) 1316640 BUPRENORPHINE MS ( 128.33) 1316641 CANNABINDS NATUR MS ( 133.76) 1316644 FENTANYL MS ( 128.33) 1316645 GABAPENTIN NONBLD MS ( 88.09) 1316646 HEROIN METABOLITE MS ( 169.65) 1316647 KETAMINE NORKETMN MS ( 163.13) 1316650 METHYLPHENIDATE MS ( 92.44) 1316651 OPIATES MS 1 PL ( 169.65) 1316655 OXYCODONE MS ( 128.33) 1316656 PREGABALIN MS ( 265.35) 1316657 PROPOXYPHENE MS ( 164.21) 1316658 SEDATIVE HYPNOTIC MS ( 172.91) 1316673 AMPHETAMINES MS 1-2 ( 315.38) 1316676 ANABOLC STRD MS 1-2 ( 140.29) 1316678 ANALGS NON OP MS 1-2 ( 208.80) 1316684 ANTIDPRS TRIC MS 1-2 ( 266.44) 1316685 ANTIDPRS TRIC MS 3-5 ( 278.40) 1316686 ANTIDPRS TRIC MS 6PL ( 333.86) 1316687 ANTIEPILP NOS MS 1-3 ( 129.41) 1316688 ANTIEPILP NOS MS 4-6 ( 789.53) 1316689 ANTIEPILP NOS MS 7PL ( 947.21) 1316690 ANTIPSYCH NOS MS 1-3 ( 151.16) 1316693 BENZODIAZ MS 1-12 ( 196.84) 1316694 BENZODIAZ MS 13PL ( 247.95) 1316701 SKEL MSCL RLX MS 1-2 ( 137.03) 1316704 DEF DRUG NOS MS 1-3 ( 172.91)
1316705 DEF DRUG NOS MS 4-6 ( 789.53) 1316706 DEF DRUG NOS MS 7PL ( 947.21) 1316707 HIV COMB ASSAY ( 221.85) 1316708 RSV DNA/ MA AMP PROB ( - ) 1317000 ASPA GENE ANALY ( 752.55) 1317001 BCKDHB GENE ANALY ( 704.70) 1317002 BCR-ABL1 MAJOR QL-QN ( 813.45) 1317003 BCR-ABL1 MINOR QL-QN ( 761.25) 1317004 BCR-ABL1 OTHER QL-QN ( 797.14) 1317005 BLM GENE ANALY 7 VAR ( 270.79) 1317006 BRAF GENE ANALY V600 ( 690.56) 1317008 BRCA1,BRCA2 185DELAG ( 1,733.48) 1317010 BRCA1 GENE ANALY FUL ( 5,264.59) 1317014 CFTR GENE ANALY CV ( 143.55) 1317019 CYP2C19 GENE ANALY C ( 1,123.39) 1317020 CYP2D6 GENE ANALY CV ( 1,641.04) 1317022 CYTOGENOMIC-BAC-CGH ( 2,161.95) 1317023 CYTOGEN BAC-CGH-SNP ( 154.43) 1317024 F2 GEN ANALY 20210GA ( 258.83) 1317025 F5 GENE ANALY LEID V ( 303.41) 1317026 FANCC GENE ANALY CV ( 380.63) 1317027 FMR1 GENE ANALY AB ( 162.04) 1317028 FMR1 GENE ALLELES ( 190.31) 1317029 FLT2 IT DUP VARIANTS ( 638.36) 1317030 G6PC GENE ANALY CV ( 514.39) 1317031 GBA GENE ANALY CV ( 942.86) 1317033 HFE GENE ANALY CV ( 324.08) 1317034 HBA1-HBA2 GENE CDV ( 152.25) 1317035 IKBKAP GENE ANALY CV ( 383.89) 1317036 IGH GENE REARRANGE ( 990.71) 1317037 IGH GENE DIRECT PROB ( 216.41) 1317038 IGH VAR REG SMA ( 1,547.51) 1317039 IGK GENE REARRANGE ( 884.14) 1317040 COMPARATIVE ANALYS ( 1,343.06) 1317042 CHIMERSM POST TRANS ( 1,028.78) 1317044 JAK2 GEN ANALY V617F ( 454.58) 1317045 KRAS VARIANTS 12-13 ( 760.16) 1317049 MCOLN1 GENE ANALY CV ( 380.63) 1317050 MTHFR GENE ANALY CV ( 216.41) 1317051 MLH1 GENE ANALY FULL ( 3,337.54) 1317052 MLH1 KNOWN FAM VAR ( 1,425.71)
1317054 MSH2 GENE ANALY FULL ( 2,689.39) 1317056 MSH2 DUP-DEL VARIANT ( 874.35) 1317057 MSH6 GENE ANALY FULL ( 3,240.75) 1317058 MSH6 KNOWN FAM VAR ( 1,395.26) 1317060 MICROSAT INSTAB VAR ( 1,521.41) 1317061 MECP2 GENE ANALY ( 1,955.33) 1317062 MECP2 KNOWN FAM VAR ( 125.06) 1317064 NPM1 EXON 12 VARIANT ( 951.56) 1317065 PML-RAR TRANS QL-QN ( 922.20) 1317067 PMS2 GENE ANALY FULL ( 3,431.06) 1317068 PMS2 KNOWN FAM VAR ( 1,425.71) 1317070 SMPD1 GENE ANALY CV ( 639.45) 1317071 SNRPN-UBE3A METHYL ( 233.81) 1317072 SERPINA1 GENE ANA CV ( 216.41) 1317073 TRB GENE REARRANGE ( 1,097.29) 1317074 TRB DIRECT PROBE ( 261.00) 1317075 TRG GENE REARRANGE ( 1,058.14) 1317076 UTG1A1 GENE ANAYL CV ( 523.09) 1317079 HLA1 TYP LR CMP ( 1,095.11) 1317080 HLA1 TYP LR 1 LOC EA ( 552.45) 1317082 HLA2 TYP LR ( 1,094.03) 1317083 HLA2 TYP LR 1 LOC EA ( 605.74) 1317084 HLA2 TYP LR 1 AG EA ( 125.06) 1317086 HLA1 TYP HR CMP ( 1,662.79) 1317087 HLA1 TYP HR 1 LOC EA ( 878.70) 1317088 HLA1 TYP HR 1 AL EA ( 496.99) 1317089 HLA2 TYP HR 1 LOC EA ( 613.35) 1317090 HLA2 TYP HR 1 AL EA ( 541.58) 1317091 MOLEC PATH LEV 1 ( 152.25) 1317092 MOLEC PATH LEV 2 ( 143.55) 1317093 MOLEC PATH LEV 3 ( 143.55) 1317094 MOLEC PATH LEV 4 ( 162.04) 1317095 MOLEC PATH LEV 5 ( 162.04) 1317096 MOLEC PATH LEV 6 ( 162.04) 1317097 MOLEC PATH LEV 7 ( 162.04) 1317099 MOLEC PATH LEV 9 ( 162.04) 1317104 EGFR GENE COM VAR ( 1,294.13) 1317114 UNLIST MOLEC PATH ( 143.55) 1317121 FTL CGEN ABN 4 ANAL ( 221.85) 1317124 DMD DUP-DEL ANAL ( 43.50) 1317128 FLT3 TKD VARIANTS ( 361.05)
1317521 DMD DUP DELET ANALYS ( 456.75) 1317523 ABL1 GENE ( 1,433.33) 1317524 CEBPA GENE FULL SEQ ( 1,433.33) 1317525 CALR GENE COM VAR ( 721.01) 1317526 KIT GENE TARG SEQ AN ( 1,420.28) 1317528 KRAS GENE ADDL VAR ( 858.04) 1317530 PDGFRA GENE ( 1,433.33) 1321004 BONE MARROW INTERPRE ( 1,069.01) 1321011 AUTOPSY COMPL WO-CNS ( 303.71) 1321023 CYTOPATH CONCENT TEC ( 343.65) 1321038 CYTOP SMR OTH PRE-SC ( 132.68) 1321045 CYTOP EVAL,FNA,REPOR ( 583.99) 1321046 CELL MRK STDY CY-DNA ( 1,143.84) 1321048 TISSUE CULT LYMPHOCY ( 692.36) 1321049 TISSUE CULT SKIN/BIO ( 791.27) 1321050 TISSUE CULT, PLACENT ( 729.71) 1321051 TISSUE CULT BONEMARR ( 556.21) 1321052 TISSUE CULTURE TUMOR ( 783.12) 1321056 CHROMOSOM ANAL50-100 ( 1,589.93) 1321059 CHROMOSOME ANAL15-20 ( 1,132.21) 1321063 CHROMOSOM ANAL AMNIO ( 942.86) 1321064 CYTOGENETICS DNA-PRO ( 239.71) 1321066 CYTOGENETICS 10-30 ( 190.31) 1321067 CYTOGENETICS 25-99 ( 187.34) 1321068 CYTOGENETICS 100-300 ( 373.52) 1321069 CHROMOSOME KARYOT ST ( 152.43) 1321071 CHROMOSOME CT ADDITI ( 101.24) 1321072 CHROMOS STDY ADD HIG ( 209.45) 1321074 CYTOGENETIC STUDY ( 207.71) 1321075 SURG PATH GROSS LVL1 ( 174.00) 1321076 SURG PATH GROSS LVL2 ( 319.73) 1321077 SURG PATH GROSS LVL3 ( 356.70) 1321078 SURG PATH GROSS LVL4 ( 349.09) 1321079 SURG PATH GROSS LVL5 ( 731.89) 1321080 SURG PATH GROSS LVL6 ( 1,069.01) 1321081 DECALCIFY TISSUE ( 155.51) 1321082 SPECIAL STAINS GRP 1 ( 300.15) 1321083 SPECIAL STAINS GRP 2 ( 250.13) 1321086 ENZYME HISTOCHEMISTR ( 43.43) 1321089 COMPRE REVIEW OFDATA ( 802.58) 1321090 PATH CONSULT INTROP ( 191.40)
1321091 PATH CONSULT INT-1BL ( 714.47) 1321092 PATH CONSULT-INTRADD ( 341.48) 1321096 ELECTRON MICROSCOPY ( 3,085.24) 1321114 CYTOPATH FLD NOT V-C ( 192.49) 1321118 FLOWCYTOMET-TC,1 MRK ( 714.47) 1321119 FLOWCYTOMETRY-TC,ADD ( 367.71) 1321150 LAB PATHOLOGY CONSUL ( 667.73) 1321156 CHROMOSOME ANAL20-25 ( 738.41) 1321157 CHROMOSOME ANAL20-25 ( 790.10) 1321158 MICROSLIDE-CONSULN-P ( 711.23) 1321159 MICROSLID CONSUL-W-P ( 667.73) 1321161 MICRODISSECTION MANU ( 143.55) 1321175 PROSTATE NDL BX ANY ( 1,444.28) 1321179 CYTO UR 3-5PROB EA S ( 667.73) 1321183 CELL ENUM IS AND ID ( 1,456.16) 1321188 1ST SEP ID AB ( 376.28) 1321189 ICC ADD AB PER SLIDE ( 218.59) 1321194 TUMOR IHC QT MAN ( 667.73) 1321196 TIS HYBRD SPEC INIT ( 599.21) 1321197 TIS HYBRD AD SNG PRB ( 599.21) 1321205 IMF SPEC 1ST AB ST ( 667.73) 1321206 IMF/SPEC ADD AB ST ( 635.10) 1331030 S-H BLD L-R CMV- EA ( 872.18) 1331031 S-H PLAT HLA-M L-R E ( 3,281.42) 1331032 S-H BLD L-R FRZ-D-WA ( 1,397.44) 1331033 S-H PLT A-P L-R CMV- ( 2,011.88) 1331034 S-H BLD L-R IRRAD ( 554.63) 1331037 S-H CRYO EACH UNIT ( 292.07) 1331038 S-H RBC LEUKO REDU ( 1,225.30) 1331039 S-H 1 DONOR FFP ( 312.11) 1331040 S-H PLAT EACH UNIT ( 549.23) 1331042 S-H RED BLD-UNIT ( 634.01) 1331043 S-H WASHED RBC-UNIT ( 1,646.53) 1331044 S-H FRZ PLSM POOL-SD ( 330.60) 1331045 S-H PLAT LEUK REDU ( 505.69) 1331046 S-H PLAT IRRAD ( 691.65) 1331047 S-H PLAT L-R IRRAD ( 754.03) 1331048 S-H PLAT PHER ( 1,849.84) 1331049 S-H PLAT PHERE L-R ( 3,231.39) 1331050 S-H PLAT PHERE IRRAD ( 2,296.80) 1331051 S-H PLAT A-P L-R IRR ( 2,791.61)
1331052 S-H RBC IRRAD ( 895.01) 1331053 S-H RBC DEGLY ( 1,654.09) 1331054 S-H RBC L-R IRRAD ( 1,164.71) 1331056 S-H CRYOPRE REDU PLS ( 221.85) 1331066 S-H PLTPH LEUKCMV-EA ( 2,570.85) 1331068 S-HRBC FRZ-DE LRIREA ( 884.14) 1331070 S-HRBC LR CMV-IRR EA ( 1,084.24) 1331072 S-H FFP BTWN8-24HREA ( 339.78) 1331074 S-H WH BLD TRANS-EA ( 963.53) 1331078 S-H BLOOD SPLIT UNIT ( 445.88) 1410001 OTH STER SUPP LVL 1 ( 69.00) 1410002 OTH STER SUPP LVL 2 ( 196.00) 1410003 OTH STER SUPP LVL 3 ( 193.00) 1410004 OTH STER SUPP LVL 4 ( 274.00) 1410005 OTH STER SUPP LVL 5 ( 361.00) 1410006 OTH STER SUPP LVL 6 ( 748.00) 1410007 OTH STER SUPP LVL 7 ( 871.00) 1410008 OTH STER SUPP LVL 8 ( 998.00) 1410009 OTH STER SUPP LVL 9 ( 730.00) 1410010 OTH STER SUPP LVL 10 ( 1,174.00) 1410011 OTH STER SUPP LVL 11 ( 1,349.00) 1410012 OTH STER SUPP LVL 12 ( 1,952.00) 1410013 OTH STER SUPP LVL 13 ( 3,825.00) 1410014 OTH STER SUPP LVL 14 ( 6,517.00) 1410015 OTH STER SUPP LVL 15 ( 13,514.00)1410016 OTH STER SUPP LVL 16 ( 16,222.00)1410024 TUBE DRAIN CATH 4 ( 346.00) 1410025 TUBE DRAIN CATH 5 ( 438.00) 1410026 TUBE DRAIN CATH 6 ( 2,327.00) 1410038 AICD DUAL CHAMBER L4 ( 57,692.00)1410039 AICD DUAL CHAMBER L5 ( 99,999.00)1410042 LEAD LT VENT COR LV2 ( 4,750.00) 1410043 LEAD LT VENT COR LV3 ( 7,791.00) 1410044 LEAD LT VENT COR LV4 ( 15,000.00)1410047 PMKR SINGL RATE-RSL2 ( 14,300.00)1410048 PMKR SINGL RATE-RSL3 ( 27,000.00)1410052 LEAD PMKR NON-TRN L2 ( 4,500.00) 1410064 LEAD AICD ENDO SN L4 ( 12,978.00)1410065 LEAD AICD ENDO SN L5 ( 27,645.00)1410066 PMKR DUAL RATE-RS L2 ( 14,805.00)1410067 PMKR DUAL RATE-RS L3 ( 22,636.00)
1410074 LEAD AICD END DUL L4 ( 23,625.00)1410093 PMKR OTHR TH SNGL L3 ( 44,500.00)1410103 CATH-ANGIO NONLSR L3 ( 4,725.00) 1410104 CATH-ANGIO NONLSR L4 ( 14,250.00)1411002 AICD OHR THN SGL/DU2 ( 99,999.54)1411003 AICD OHR THN SGL/DU3 ( 99,999.00)1411007 CATH EP NOT COOL-TP2 ( 4,575.00) 1411008 CATH EP NOT COOL-TP3 ( 6,700.00) 1411103 ADT/EXT PACE/NEU LD3 ( 4,475.00) 1411250 CATH ABLATION NONVAS ( 11,900.00)1411401 EMBOLIZATION COIL 1 ( 412.00) 1411402 EMBOLIZATION COIL 2 ( 1,595.00) 1411403 EMBOLIZATION COIL 3 ( 4,925.00) 1411404 EMBOLIZATION COIL 4 ( 56,880.00)1411431 IMPLANT OTHER LVL 1 ( 1,500.00) 1411432 IMPLANT OTHER LVL 2 ( 717.00) 1411433 IMPLANT OTHER LVL 3 ( 1,475.00) 1411434 IMPLANT OTHER LVL 4 ( 2,527.00) 1411435 IMPLANT OTHER LVL 5 ( 4,700.00) 1411436 IMPLANT OTHER LVL 6 ( 11,132.00)1411437 IMPLANT OTHER LVL 7 ( 23,595.00)1411701 IMPELLA DEVICE L1 ( 80,000.00)1411702 IMPELLA DEVICE L2 ( 99,999.99)1413001 ADHESION BARRIER1 ( 963.00) 1413004 AICD OHR THN SGL/DU1 ( 23,475.00)1413006 AICD SINGLE CHAMBER2 ( 93,700.00)1413038 CATH BAL DIL NONVAS1 ( 492.00) 1413039 CATH BAL DIL NONVAS2 ( 1,066.79) 1413042 CATH EP 19 OR FEW 1 ( 1,240.00) 1413043 CATH EP 20 OR MORE 1 ( 1,175.00) 1413045 CATH EP DIG/ABL 3D 1 ( 3,816.00) 1413046 CATH EP NOT COOL-TP1 ( 1,999.96) 1413047 CATH EP DIG/ABL 3D 2 ( 21,000.00)1413053 CATH INTRA ECHOCARD3 ( 5,992.00) 1413054 CATH INTRA ECHOCARD4 ( 10,640.00)1413057 CATH SUPRPUBC-CYSTO1 ( 738.00) 1413067 CATH URETERAL 1 ( 455.82) 1413115 DIALYSIS ACCESS SYS1 ( 1,075.00) 1413116 DIALYSIS ACCESS SYS2 ( 1,525.00) 1413119 MID EAR PROSTHESES 1 ( 2,082.00) 1413120 MID EAR PROSTHESES 2 ( 2,590.00)
1413121 EAR TUBES DRAINAGE 1 ( 166.92) 1413124 EVENT RECRDR CARDIAC ( 25,920.75)1413125 GENRATE NEURO RECHR ( 46,882.00)1413143 CATH EP 19 OR FEW 2 ( 854.00) 1413166 INTRO/SHETH STRBL N3 ( 4,500.00) 1413179 LEAD AICD NO-SING L1 ( 231.00) 1413182 LEAD NEUROSTM TST K1 ( 4,975.00) 1413183 LEAD PMKR NON-TRN L1 ( 2,503.80) 1413189 MATRL FOR VOCAL CORD ( 1,209.10) 1413209 PATIENT PROGR NEURO1 ( 2,976.00) 1413211 PATIENT PROGR NEURO2 ( 5,468.00) 1413222 ASTIGMAT CORRCT IOL1 ( 2,475.00) 1413230 PRSTHS URNARY SPHC 1 ( 11,395.00)1413232 PRSTHS PENILE NNINF2 ( 2,726.00) 1413236 SEALANT PULMNRY LIQD ( 4,250.00) 1413242 CATH EP COOL-TIP L2 ( 2,500.00) 1413243 CATH EP COOL-TIP L3 ( 6,000.00) 1413252 REP DEV URNRY WO SL2 ( 2,034.00) 1413253 REP DEV URNRY WO SL3 ( 5,629.00) 1413258 STNT NONCOR TM W/O 1 ( 440.84) 1413259 STNT NONCOR TM W/O 2 ( 482.00) 1413265 TISSUE LOCALZ EXCISI ( 140.00) 1413323 CATH BAL DIL NONVAS3 ( 2,256.00) 1413324 CATH BAL DIL NONVAS4 ( 4,388.00) 1413325 CATH BAL DIL NONVAS5 ( 7,350.00) 1413327 CATH BAL DIL NONVAS7 ( 29,535.00)1413332 CATH EP 20 OR MORE 2 ( 5,250.00) 1413343 CATH EP 19 OR FEW 3 ( 4,550.00) 1414001 ANCHOR/SCRW LEVEL 1 ( 86.67) 1414002 ANCHOR/SCRW LEVEL 2 ( 134.82) 1414003 ANCHOR/SCRW LEVEL 3 ( 216.14) 1414004 ANCHOR/SCRW LEVEL 4 ( 341.33) 1414005 ANCHOR/SCRW LEVEL 5 ( 485.78) 1414006 ANCHOR/SCRW LEVEL 6 ( 686.94) 1414007 ANCHOR/SCRW LEVEL 7 ( 972.63) 1414008 ANCHOR/SCRW LEVEL 8 ( 1,254.04) 1414009 ANCHOR/SCRW LEVEL 9 ( 1,639.24) 1414010 ANCHOR/SCRW LEVEL 10 ( 2,513.43) 1414011 ANCHOR/SCRW LEVEL 11 ( 2,928.59) 1414012 ANCHOR/SCRW LEVEL 12 ( 4,978.71) 1414013 ANCHOR/SCRW LEVEL 13 ( 5,936.36)
1414014 ANCHOR/SCRW LEVEL 14 ( 7,644.08) 1414015 ANCHOR/SCRW LEVEL 15 ( 12,331.75)1414016 ANCHOR/SCRW LEVEL 16 ( 26,685.80)1414017 ANCHOR/SCRW LEVEL 17 ( 18,848.05)1414018 ANCHOR/SCRW LEVEL 18 ( 23,537.86)1414019 ANCHOR/SCRW LEVEL 19 ( 48,792.00)1414020 ANCHOR/SCRW LEVEL 20 ( 61,525.00)1414021 ANCHOR/SCRW LEVEL 21 ( 60,930.00)1414022 ANCHOR/SCRW LEVEL 22 ( 77,000.00)1414050 BONE CEMENT 1 ( 440.84) 1414051 BONE CEMENT 2 ( 1,139.55) 1414053 BONE CEMENT 4 ( 4,920.00) 1414054 BONE CEMENT 5 ( 10,852.00)1414102 BREAST IMPLANT 3 ( 4,824.00) 1414103 BREAST IMPLANT 4 ( 6,800.00) 1414153 CATH ABLTN NOCRD ED4 ( 21,000.00)1414175 CATH HEMODIAL LT 1 ( 508.25) 1414177 CATH HEMODIAL ST 1 ( 401.25) 1414178 CATH HEMODIAL ST 2 ( 802.50) 1414200 CATH INTRAVAS ULTRA1 ( 16,023.25)1414225 CATH OCCLUSION 2 ( 2,375.00) 1414226 CATH OCCLUSION 3 ( 7,180.00) 1414227 CATH OCCLUSION 4 ( 8,500.00) 1414249 CATH THRMB/EMBOL 1 ( 850.00) 1414250 CATH THRMB/EMBOL 2 ( 2,284.45) 1414251 CATH THRMB/EMBOL 3 ( 2,290.87) 1414252 CATH THRMB/EMBOL 4 ( 42,773.25)1414277 CATH TRNS ARTHR DIR3 ( 8,775.00) 1414278 CATH TRNS ARTHR DIR4 ( 13,725.00)1414285 CATH TRNS ARTHR ROT1 ( 5,341.44) 1414286 CATH TRNS ARTHR ROT2 ( 15,247.50)1414287 CATH TRNS ARTHR ROT3 ( 12,922.00)1414301 CATH TRNSLUM ANG LA2 ( 14,445.00)1414325 CATH-ANGIO LEVEL 1 ( 494.34) 1414326 CATH-ANGIO LEVEL 2 ( 1,284.00) 1414327 CATH-ANGIO LEVEL 3 ( 1,203.75) 1414328 CATH-ANGIO LEVEL 4 ( 2,794.84) 1414329 CATH-ANGIO LEVEL 5 ( 5,323.25) 1414330 CATH-ANGIO LEVEL 6 ( 14,975.00)1414331 CATH-ANGIO LEVEL 7 ( 31,475.00)1414350 CATH-DRAINAG LEVEL 1 ( 90.95)
1414351 CATH-DRAINAG LEVEL 2 ( 523.23) 1414352 CATH-DRAINAG LEVEL 3 ( 1,310.75) 1414355 CATH-DRAINAG LEVEL 6 ( 2,229.88) 1414375 CATHETER GUIDING 1 ( 194.74) 1414376 CATHETER GUIDING 2 ( 552.12) 1414377 CATHETER GUIDING 3 ( 1,745.17) 1414378 CATHETER GUIDING 4 ( 4,145.00) 1414400 CATH-INFUS PERIF 1 ( 127.33) 1414401 CATH-INFUS PERIF 2 ( 252.52) 1414402 CATH-INFUS PERIF 3 ( 529.65) 1414403 CATH-INFUS PERIF 4 ( 766.12) 1414404 CATH-INFUS PERIF 5 ( 1,035.76) 1414405 CATH-INFUS PERIF 6 ( 1,326.80) 1414406 CATH-INFUS PERIF 7 ( 1,440.22) 1414412 CATH-INFUS PERIF 13 ( 14,475.00)1414415 CATH-INFUS PERIF 16 ( 99,999.00)1414425 CATH-RETRIEVAL 1 ( 1,471.25) 1414426 CATH-RETRIEVAL 2 ( 3,250.00) 1414428 CATH-RETRIEVAL 4 ( 12,500.00)1414450 CLOSURE DEVIC VASC 1 ( 1,317.17) 1414451 CLOSURE DEVIC VASC 2 ( 2,975.00) 1414452 CLOSURE DEVIC VASC 3 ( 9,750.00) 1414475 CONN TISSUE HUMAN 1 ( 1,043.25) 1414476 CONN TISSUE HUMAN 2 ( 2,837.64) 1414477 CONN TISSUE HUMAN 3 ( 5,058.96) 1414478 CONN TISSUE HUMAN 4 ( 8,874.58) 1414479 CONN TISSUE HUMAN 5 ( 19,053.49)1414480 CONN TISSUE HUMAN 6 ( 26,177.55)1414481 CONN TISSUE HUMAN 7 ( 28,932.80)1414502 DRILL BIT/BLADE LVL3 ( 531.79) 1414503 DRILL BIT/BLADE LVL4 ( 1,417.75) 1414504 DRILL BIT/BLADE LVL5 ( 1,562.20) 1414505 DRILL BIT/BLADE LVL6 ( 1,975.00) 1414506 DRILL BIT/BLADE LVL7 ( 2,484.00) 1414507 DRILL BIT/BLADE LVL8 ( 2,881.00) 1414508 DRILL BIT/BLADE LVL9 ( 5,791.00) 1414525 EMBOLIZ PROTECT SYS1 ( 600.00) 1414528 EMBOLIZ PROTECT SYS4 ( 7,375.00) 1414529 EMBOLIZ PROTECT SYS5 ( 7,750.00) 1414576 GENRATR NEUROSTM 2 ( 55,240.00)1414600 GRAFT VASCULAR 1 ( 1,503.35)
1414601 GRAFT VASCULAR 2 ( 3,207.86) 1414602 GRAFT VASCULAR 3 ( 5,106.04) 1414603 GRAFT VASCULAR 4 ( 7,315.59) 1414605 GRAFT VASCULAR 6 ( 12,809.00)1414607 GRAFT VASCULAR 8 ( 44,365.00)1414625 GUIDEWIRE LEVEL 1 ( 266.43) 1414626 GUIDEWIRE LEVEL 2 ( 261.08) 1414627 GUIDEWIRE LEVEL 3 ( 448.33) 1414628 GUIDEWIRE LEVEL 4 ( 811.06) 1414629 GUIDEWIRE LEVEL 5 ( 2,086.50) 1414630 GUIDEWIRE LEVEL 6 ( 2,434.25) 1414631 GUIDEWIRE LEVEL 7 ( 3,151.15) 1414632 GUIDEWIRE LEVEL 8 ( 2,134.65) 1414633 GUIDEWIRE LEVEL 9 ( 3,745.00) 1414635 GUIDEWIRE LEVEL 11 ( 5,082.50) 1414637 GUIDEWIRE LEVEL 13 ( 9,600.00) 1414641 GUIDEWIRE LEVEL 17 ( 31,475.00)1414675 INT SHTH FIX NO-PL 1 ( 260.01) 1414677 INT SHTH FIX NO-PL 3 ( 2,281.00) 1414678 INT SHTH FIX NO-PL 4 ( 6,780.00) 1414691 INTRO/SHEATH LASER 2 ( 12,160.00)1414700 JOINT DEVICE IMPLT 1 ( 1,852.17) 1414701 JOINT DEVICE IMPLT 2 ( 4,314.24) 1414702 JOINT DEVICE IMPLT 3 ( 7,427.94) 1414703 JOINT DEVICE IMPLT 4 ( 12,026.80)1414704 JOINT DEVICE IMPLT 5 ( 14,453.56)1414705 JOINT DEVICE IMPLT 6 ( 20,440.21)1414706 JOINT DEVICE IMPLT 7 ( 23,697.29)1414707 JOINT DEVICE IMPLT 8 ( 29,276.27)1414750 MESH IMPLANTABLE 1 ( 423.72) 1414751 MESH IMPLANTABLE 2 ( 940.53) 1414752 MESH IMPLANTABLE 3 ( 1,566.48) 1414753 MESH IMPLANTABLE 4 ( 4,217.94) 1414754 MESH IMPLANTABLE 5 ( 2,982.09) 1414755 MESH IMPLANTABLE 6 ( 3,818.83) 1414756 MESH IMPLANTABLE 7 ( 5,020.44) 1414757 MESH IMPLANTABLE 8 ( 6,113.98) 1414758 MESH IMPLANTABLE 9 ( 7,437.57) 1414760 MESH IMPLANTABLE 11 ( 9,921.00) 1414761 MESH IMPLANTABLE 12 ( 29,775.00)1414763 MESH IMPLANTABLE 14 ( 79,000.00)
1414775 MORCELLATOR 1 ( 2,404.29) 1414776 MORCELLATOR 2 ( 4,144.11) 1414800 PEEL-AWAY SHEATH 1 ( 251.45) 1414801 PEEL-AWAY SHEATH 2 ( 321.00) 1414802 PEEL-AWAY SHEATH 3 ( 1,647.80) 1414826 PORT 2 ( 2,093.99) 1414875 PRSTHS PENILE INFL 1 ( 2,009.00) 1414876 PRSTHS PENILE INFL 2 ( 10,476.00)1414878 PRSTHS PENILE INFL 4 ( 26,456.00)1414900 REP DEV URINRY W/SL1 ( 2,464.00) 1414901 REP DEV URINRY W/SL2 ( 6,118.26) 1414902 REP DEV URINRY W/SL3 ( 19,685.00)1414924 SHEATH NON-LASR 1 ( 960.00) 1414925 SHEATH NON-LASR 2 ( 2,407.50) 1414926 SHEATH NON-LASR 3 ( 5,323.25) 1414951 STNT COAT/COV W/DEL1 ( 3,800.00) 1414952 STNT COAT/COV W/DEL2 ( 13,107.50)1414953 STNT COAT/COV W/DEL3 ( 13,480.93)1414954 STNT COAT/COV W/DEL4 ( 30,866.29)1414955 STNT COAT/COV W/DEL5 ( 99,999.60)1414961 STNT COAT/COV W/O 2 ( 15,290.30)1414970 STNT NO COCV W/DEL 1 ( 5,323.25) 1414971 STNT NO COCV W/DEL 2 ( 10,673.25)1414972 STNT NO COCV W/DEL 3 ( 13,348.25)1414979 STNT NO-COA/COV W/O2 ( 9,779.80) 1414985 STNT NON-COR TM DL 1 ( 775.75) 1414986 STNT NON-COR TM DL 2 ( 3,725.00) 1415232 PRSTHS URNARY SPHC 2 ( 23,850.00)1415501 NEUROMND NRV 0.5 CM ( 664.00) 1415508 NEUROMATRIX 0.5 CM ( 3,982.50) 1416000 POSTERIOR CHAMBR IOL ( 2,138.00) 1416002 ANTERIOR CHAMBER IOL ( 425.00) 1417003 SUTURE LEVEL 4 ( 426.93) 1417004 SUTURE LEVEL 5 ( 936.25) 1417005 SUTURE LEVEL 6 ( 1,215.00) 1417007 SUTURE LEVEL 8 ( 2,208.00) 1417008 SUTURE LEVEL 9 ( 6,723.00) 1417020 SURGICAL ACCESS PORT ( 5,400.00) 1417025 TISSUE MARKR IMPLT 1 ( 148.00) 1417026 TISSUE MARKR IMPLT 2 ( 581.00) 1417027 TISSUE MARKR IMPLT 3 ( 330.00)
1417032 BONE VOID PER 0.5CC3 ( 8,200.00) 1417033 BONE VOID PER 0.5CC4 ( 12,968.00)1417049 TISSUE NON-HUMAN 1 ( 498.00) 1417050 TISSUE NON-HUMAN 2 ( 5,296.50) 1417051 TISSUE NON-HUMAN 3 ( 5,102.83) 1417052 TISSUE NON-HUMAN 4 ( 13,139.60)1417053 TISSUE NON-HUMAN 5 ( 16,023.25)1417054 TISSUE NON-HUMAN 6 ( 11,877.00)1417055 TISSUE NON-HUMAN 7 ( 26,723.25)1417056 TISSUE NON-HUMAN 8 ( 35,818.25)1417057 TISSUE NON-HUMAN 9 ( 39,475.00)1417078 VENA CAVA FILTER 4 ( 6,250.00) 1417086 STAPLER/RELOAD 2 ( 505.04) 1417087 STAPLER/RELOAD 3 ( 1,307.54) 1417088 STAPLER/RELOAD 4 ( 2,117.53) 1417089 STAPLER/RELOAD 5 ( 2,492.03) 1417090 STAPLER/RELOAD 6 ( 4,597.79) 1417093 STAPLER/RELOAD 9 ( 35,000.00)1417117 STNT NO COCV W/DEL 4 ( 29,000.00)1417120 NEEDLES 2 ( 394.00) 1417121 NEEDLES 3 ( 698.00) 1417124 ADHESION BARRIER2 ( 1,271.16) 1417134 NEEDLES 4 ( 1,201.00) 1417135 NEEDLES 5 ( 2,475.00) 1417213 TRACHEOSTOMY SPK VLV ( 525.00) 1417226 LEAD NEUROSTIMULAT 3 ( 10,925.00)1417227 LEAD NEUROSTIMULAT 4 ( 21,000.00)1417291 METATARSAL JOINT IMP ( 12,450.00)1417294 MCARP PHAL JOINT IMP ( 6,965.00) 1417349 NEEDLES 8 ( 14,875.00)1510102 RT-RAD TX PLAN SIMP ( 489.38) 1510103 RT-RAD TX PLAN INT ( 1,076.63) 1510104 RT-RAD TX PLAN COMP ( 1,252.80) 1510105 RT-RAD TX SIMU SIMP ( 821.06) 1510106 RT-RAD TX SIMU INT ( 1,881.38) 1510107 RT-RAD TX SIMU COMP ( 2,183.70) 1510108 RT-RAD TX SIMU 3D ( 7,772.36) 1510109 RT-RAD TX UNLST PLAN ( 771.04) 1510110 RT-RAD TX DOSE PLAN ( 808.01) 1510111 RT-DOSE PLAN IMRT ( 6,831.68) 1510112 RT-ISODOSE PLAN SING ( 1,573.61)
1510114 RT-ISODOSE PLAN COMP ( 2,838.38) 1510115 RT-SPEC PORT PLAN ( 1,906.39) 1510117 RT-BRACHY ISO INTER ( 2,813.36) 1510119 RT-SPECIAL DOSIMETRY ( 874.35) 1510120 RT-TREATMENT AIDS SI ( 1,399.61) 1510121 RT-TREATMENT AIDS IN ( 1,496.40) 1510122 RT-TREATMENT AIDS CO ( 1,655.18) 1510123 RT-MEDPHYS CONSULT ( 852.60) 1510124 RT-MEDPHYS CONSLT SP ( 864.56) 1510125 RT-RAD TX UNLISTED ( 441.53) 1510127 RT-RAD TRTMNT SIMPLE ( 363.23) 1510131 RT-RAD TRTMNT INTMDT ( 479.59) 1510135 RT-RAD TRTMNT COMPLX ( 1,172.33) 1510139 RT-RAD TX PORT FILMS ( 489.38) 1510144 RT-RAD TX SPECIAL ( 3,270.11) 1510151 HY-HYPERTHERM DEEP ( 3,028.69) 1510152 HY-HYPRTHRM PROBE ( 2,867.74) 1510154 HY-HYPRTHRM INTERCAV ( 2,198.93) 1510156 RT-BRACHY APPL SIMP ( 2,198.93) 1510157 RT-BRACHY APPL INT ( 2,618.70) 1510167 RT-RAD SOURCE HANDLN ( 282.75) 1510168 RT-CLIN BRACHY UNLIS ( 999.41) 1510169 RT-STEREOSCOP X GUID ( 296.89) 1510173 RT-STEREOTAC RAD MGT ( 5,236.31) 1510174 LEVEL 1 N/P ( 280.58) 1510175 LEVEL 2 N/P ( 336.04) 1510176 LEVEL 3 N/P ( 339.30) 1510177 LEVEL 4 N/P ( 483.94) 1510178 LEVEL 5 N/P ( 600.30) 1510179 LEVEL 1 E/P ( 280.58) 1510180 LEVEL 2 E/P ( 345.83) 1510181 LEVEL 3 E/P ( 351.26) 1510182 LEVEL 4 E/P ( 404.55) 1510183 LEVEL 5 E/P ( 466.54) 1510191 CT-RAD TX TREAT PLAN ( 1,923.79) 1510192 RT-DESIGN MIC DEV ( 7,155.75) 1510200 RT-SRS LINEAR ( 11,463.34)1510202 RT-IMRT SIMPLE ( 3,451.73) 1510203 RT-IMRT COMPLEX ( 3,451.73) 1522011 LEVEL 1 EP ( 280.58) 1522021 PROCEDURE MINOR ( 436.36)
1522022 PROCEDURE INTERMEDIA ( 1,190.39) 1522023 PROCEDURE MAJOR ( 2,171.32) 1522038 THER APHERESIS RBC ( 6,097.61) 1522101 IV HYDRATION 1 HR ( 436.36) 1522102 IV HYDRAT EA ADD HR ( 367.71) 1522111 IV THERAPY DX 1 HR ( 709.81) 1522112 IV THERAPY EA AD HR ( 126.84) 1522113 IV THER AD SEQ 1 HR ( 361.89) 1522114 CONCURRENT IV THER ( 317.67) 1522115 THERAPEUTIC IV PUSH ( 436.36) 1522116 THERA EA AD IV PUSH ( 265.31) 1522117 THERAPEUTIC DX SQ IM ( 208.29) 1522131 IR-IRR PORT DRUG DEL ( 333.96) 1522132 BLD COLLECT VAD ( 333.96) 1522135 PHLEBOTOMY THERAPEUT ( 312.11) 1522136 S-INS PICC WO SQP U5 ( 3,272.29) 1522138 S-INS PICC WO SQ O5 ( 4,099.88) 1522140 IMM ADM FLU VACCINE ( 159.86) 1522141 IMM ADM PNEU VACCINE ( 194.66) 1522142 IMM ADM 1ST VACCINE ( 208.29) 1522143 IMM ADM EA ADD VACC ( 177.26) 1522301 APPL ON-BODY INJ ( 271.88) 1523111 CHEMO IV INFU 1ST HR ( 1,234.61) 1523112 CHEMO IV IN EA AD HR ( 208.29) 1523113 CHEMO IV EA SEQ INF ( 359.56) 1523114 CHEMO IV PUSH ( 709.81) 1523115 CHEMO EA AD IV PUSH ( 360.72) 1523119 CHEMO NON HORM IM SC ( 436.36) 1523120 CHEMO HORMONAL IM SC ( 194.66) 1523121 CHEMO IV PUMP GT 8HR ( 1,153.84) 1523122 CHEMO PUMP INF GT 8H ( 1,219.09) 1523127 CHEMO INTRATHEC ( 976.58) 1523128 CHEMO IV SQ RESRVOIR ( 753.64) 1523130 THER AD IVP SAME MED ( 313.20) 1523131 BLD DRAW CENTRAL LN ( 312.11) 1523132 SQ INFUSION INI 1 HR ( 753.64) 1523133 SQ INFUSION EA AD HR ( 133.76) 1523134 ADD SQ INF NEW SITE ( 238.16) 1523136 CATH URINE SPECIMEN ( 18.49) 1523138 IMM ADM HEP B VACCIN ( 183.79) 1523140 IV THERAPY OVER 8HRS ( 1,219.09)
1523147 BLOOD TRANSFUSION ( 1,109.25) 1580001 EXAM SURG SPECMN DR ( 1,530.11) 1580002 UNLISTED RAD EXAM DR ( 260.39) 1581002 US-GUIDE NEEDLE PLAC ( 463.28) 1581007 BR-DUCT GALGRM SING ( 1,165.80) 1581008 DEXA AXIAL ( 859.13) 1581009 DEXA PERIPHERAL ( 199.01) 1581010 BR-DIG MAMMO SCRN BI ( 988.54) 1581011 BR-DIG MAMMO BILAT ( 665.55) 1581012 BR-DIG MAMMO UNILAT ( 465.45) 1581022 DXA BONE DENS V FRAC ( 1,058.14) 1581023 BR-DIG MAMMO SCRN UN ( 508.95) 1581028 BR-PLC LOC DVCE 1ST ( 3,395.18) 1581029 BR-PLC LOC DVCE 1ST ( 1,525.76) 1581030 US-PLC LOC DVCE 1ST ( 1,617.11) 1581031 BR-BRST BX LOC CLP 1 ( 4,187.96) 1581032 US-BRST BX LOC CLP 1 ( 4,987.28) 1581033 BR-TOMO MAMMO UNI ( 550.75) 1581034 BR-TOMO MAMMO BI ( 698.31) 1581035 US-BREAST COMPLETE ( 510.04) 1581036 US-BREAST LIMITED ( 455.66) 1581037 DXA BONE DENS AXIAL ( 817.80) 1581038 US-BREAST COMPLET BI ( 679.69) 1581039 US-BREAST LIMITED BI ( 911.33) 1581041 US-EXT LTD JNT UNI ( 1,281.08) 1581042 BR-PLC DVC SFT TS1ST ( 2,091.26) 1590051 PET-BRAIN ALZHEIMERS ( 4,805.66) 1590057 PET-TUMR IMAG/CT,LMT ( 9,932.14) 1590058 PET-IMG /CT SKL-THI ( 9,654.83) 1590059 PET-IMG/CT FULL BODY ( 9,066.49) 1610001 HE-EYE FOREIGNBDY DR ( 549.23) 1610002 HE-MANDIBLE LTD DR ( 286.25) 1610003 HE-MANDIBLE 4VPLS DR ( 617.88) 1610005 HE-MASTOID 3VPLUS DR ( 855.26) 1610007 HE-FACIAL BNS LTD DR ( 345.60) 1610008 HE-FACIAL BNES 3V DR ( 630.68) 1610009 HE-NASAL BONES DR ( 474.76) 1610012 HE-ORBITS 4V DR ( 685.38) 1610013 HE-SINUSES LTD DR ( 318.83) 1610014 HE-SINUSES 3VPLUS DR ( 900.65) 1610016 HE-SKULL LIMITED DR ( 514.32)
1610017 HE-SKULL 4V PLUS DR ( 691.19) 1610022 HE-TMJ BILATERAL DR ( 676.07) 1610025 HE-ORTHOPANTOGRAM DR ( 552.45) 1610026 SP-NECK SOFT TISS DR ( 401.45) 1610027 CH-RIBS UNILAT DR ( 408.43) 1610028 CH-RIB UNI PA CXR DR ( 663.27) 1610029 CH-RIBS BILATERAL DR ( 374.69) 1610030 CH-RIBS BI PA CXR DR ( 738.90) 1610031 CH-STERNUM DR ( 487.56) 1610032 CH-STRNOCLAV JNTS DR ( 451.49) 1610033 SP-SPINE SNGL VW DR ( 437.52) 1610034 SP-CERV SP 2TO3VW DR ( 368.87) 1610035 SP-CERV SP 4TO5VW DR ( 842.81) 1610036 SP-CRV SPNE 6VPLS DR ( 838.46) 1610037 SP-T SPINE 2 VIEW DR ( 368.87) 1610038 SP-T SPINE 3 VIEW DR ( 351.41) 1610039 SP-T SPNE 4PLUS V DR ( 328.43) 1610040 SP-THORACOLMBR 2V DR ( 548.10) 1610042 SP-ENT SPN 2OR3 V DR ( 438.26) 1610045 SP-LS SPN 2 TO 3V DR ( 368.87) 1610046 SP-LS SPNE 4VPLUS DR ( 826.17) 1610047 SP-LS SPINE W BND DR ( 461.96) 1610049 LE-PELVIS DR ( 539.92) 1610050 LE-PELVIS 3V PLUS DR ( 481.74) 1610052 SP-SI JNTS 3VPLUS DR ( 480.58) 1610053 SP-SCRM COCCYX 2V DR ( 669.08) 1610055 UE-CLAVICLE BILAT DR ( 1,237.58) 1610056 UE-CLAVICLE DR ( 1,390.53) 1610058 UE-SCAPULA DR ( 595.78) 1610059 UE-SHOULDER 1V DR ( 429.38) 1610060 UE-SHLDR 2VW PLUS DR ( 961.15) 1610061 IR-ARTHROGM SHLDR DR ( 1,503.40) 1610062 UE-AC JTS BILAT DR ( 468.94) 1610063 UE-HUMERUS BILAT DR ( 1,585.58) 1610064 UE-HUMERUS DR ( 848.28) 1610065 UE-ELBOW 2V DR ( 882.03) 1610066 UE-ELBOW 3V DR ( 715.58) 1610067 UE-FOREARM 2V DR ( 697.01) 1610068 UE-UP EXT INFANT DR ( 900.65) 1610069 UE-WRIST 2V DR ( 712.14) 1610070 UE-WRIST 3V PLUS DR ( 897.15)
1610071 UE-HAND 2V DR ( 378.18) 1610072 UE-HAND 3V DR ( 902.97) 1610073 UE-FINGER S 2VPLS DR ( 453.81) 1610074 LE-HIP UNILAT 1V DR ( 309.52) 1610075 LE-HIP PV UN2OR3V DR ( 445.88) 1610076 LE-HIP PV UNMIN4V DR ( 668.81) 1610077 LE-HIP PLV BI 2V DR ( 394.76) 1610078 LE-HIP PV BI3OR4V DR ( 394.76) 1610079 LE-HIP PV BI MIN5VDR ( 789.53) 1610080 IR-ARTHROGRAM HIP DR ( 1,421.36) 1610081 LE-FEMUR 1V DR ( 197.93) 1610082 LE-FEMUR 2V DR ( 907.63) 1610083 LE-KNEE 1 TO 2V DR ( 900.65) 1610084 LE-KNEE 3V DR ( 887.85) 1610085 LE-KNEE 4V PLUS DR ( 994.90) 1610086 LE-KNEE BI AP STD DR ( 436.36) 1610087 LE-TIB FIB 2V DR ( 895.99) 1610088 LE-LWR EXT INFANT DR ( 883.19) 1610089 LE-ANKLE 2V DR ( 814.54) 1610090 LE-ANKLE 3VPLUS DR ( 911.12) 1610091 LE-FOOT 2V DR ( 614.39) 1610092 LE-FOOT 3V PLUS DR ( 905.30) 1610093 LE-CALCANEUS 2PLS DR ( 477.09) 1610094 LE-TOE S 2VPLUS DR ( 432.87) 1610095 CH-ABD SER PA CXR DR ( 844.79) 1610097 FL-SMALL BOWEL DR ( 1,005.37) 1610101 FL-IVP DR ( 1,444.06) 1610104 FL-UROGRAPH RETRO DR ( 1,061.23) 1610105 FL-UROGRAPHY ANTE DR ( 1,780.35) 1610106 FL-CYSTOGRM 3VPLS DR ( 1,061.23) 1610109 FL-UCG RETRO DR ( 1,427.89) 1610110 FL-UCG VOIDING DR ( 1,061.23) 1610112 IR-HYSTERSALPINGO DR ( 1,310.24) 1610114 FL-FLUORO 1 HOUR DR ( 645.81) 1610115 CH-BABYGRAM FB DR ( 893.66) 1610116 IR-FISTULOGRAM DR ( 1,224.53) 1610117 EXAM SURG SPECMN DR ( 1,530.11) 1610122 BONE AGE STUDY DR ( 368.87) 1610123 BONE LENGTH STUDY DR ( 434.03) 1610124 BNE SRVY LTD METS DR ( 577.16) 1610125 BNE SRVY CMP METS DR ( 620.21)
1610126 BONE SRVY INFANT DR ( 374.69) 1610127 JOINT SURVEY 1V DR ( 496.99) 1610131 UE-SHOULDER 1V BI DR ( 763.43) 1610132 UE-SHOULDER 2V BI DR ( 1,796.55) 1610134 UE-ELBOW 2VW BI DR ( 1,649.74) 1610135 UE-ELBOW 3VW BI DR ( 1,432.24) 1610136 UE-FOREARM 2VW BI DR ( 1,302.83) 1610137 UE-UPEXT INFNT BI DR ( 1,588.84) 1610138 UE-WRIST 2VW BI DR ( 1,332.19) 1610139 UE-WRIST 3VW BI DR ( 1,676.93) 1610140 UE-HAND 2VWS BI DR ( 706.88) 1610141 UE-HAND 3VWS BI DR ( 1,688.89) 1610142 UE-FINGER 2 VW BI DR ( 800.40) 1610144 LE-FEMUR 2VW BI DR ( 1,696.50) 1610145 LE-KNEE1TO2V BI DR ( 1,682.36) 1610146 LE-KNEE 3VWS BI DR ( 1,659.53) 1610147 LE-KNEE 4VWPLS BI DR ( 1,858.54) 1610148 LE-TIB FIB 2V BI DR ( 1,675.84) 1610149 LE-LWEXT INFNT BI DR ( 883.19) 1610150 LE-ANKLE 2VW BI DR ( 1,521.41) 1610151 LE-ANKLE 3VWS BI DR ( 1,703.03) 1610152 LE-FOOT 2VWS BI DR ( 1,148.40) 1610153 LE-FOOT 3VWPLS BI DR ( 1,692.15) 1610154 LE-CALCNEUS 2V BI DR ( 841.73) 1610155 LE-TOE S 2VWS BI DR ( 386.06) 1610163 CH-CHEST 1V DR ( 303.71) 1610164 CH-CHEST 2V DR ( 274.62) 1610165 CH-CHEST 3V DR ( 639.99) 1610166 CH-CHEST 4V DR ( 660.94) 1610167 CH-ABDOMEN 1 VIEW DR ( 378.18) 1610168 CH-ABDOMEN 2 VWS DR ( 497.90) 1610169 CH-ABDOMEN 3VWS DR ( 429.38) 1612102 HE-EYE FOREIGNBDY CR ( 549.23) 1612103 HE-MANDIBLE LTD CR ( 286.25) 1612104 HE-MANDIBLE 4VPLS CR ( 617.88) 1612106 HE-MASTOID 3VPLUS CR ( 855.26) 1612108 HE-FACIAL BNS LTD CR ( 345.60) 1612109 HE-FACIAL BNES 3V CR ( 630.68) 1612110 HE-NASAL BONES CR ( 474.76) 1612113 HE-ORBITS 4V CR ( 685.38) 1612114 HE-SINUSES LTD CR ( 318.83)
1612115 HE-SINUSES 3VPLUS CR ( 900.65) 1612117 HE-SKULL LIMITED CR ( 514.32) 1612118 HE-SKULL 4V PLUS CR ( 691.19) 1612123 HE-TMJ BILATERAL CR ( 676.07) 1612125 HE-ORTHOPANTOGRAM CR ( 552.45) 1612126 SP-NECK SOFT TISS CR ( 401.45) 1612128 FL-MOD BA SWALLOW ( 436.09) 1612134 CH-RIBS UNILAT CR ( 408.43) 1612135 CH-RIB UNI PA CXR CR ( 663.27) 1612136 CH-RIBS BILATERAL CR ( 374.69) 1612137 CH-RIBS BI PA CXR CR ( 738.90) 1612138 CH-STERNUM CR ( 487.56) 1612139 CH-STRNOCLAV JNTS CR ( 451.49) 1612141 SP-SPINE SNGL VW CR ( 437.52) 1612142 SP-CERV SP 2TO3VW CR ( 368.87) 1612146 SP-T SPINE 2 VIEW CR ( 368.87) 1612147 SP-T SPINE 3 VIEW CR ( 351.41) 1612148 SP-T SPNE 4PLUS V CR ( 328.43) 1612149 SP-THORACOLMBR 2V CR ( 548.10) 1612151 SP-LS SPN 2 TO 3V CR ( 368.87) 1612152 SP-LS SPNE 4VPLUS CR ( 826.17) 1612153 SP-LS SPINE W BND CR ( 461.96) 1612156 SP-SI JNTS 3VPLUS CR ( 480.58) 1612157 SP-SCRM COCCYX 2V CR ( 669.08) 1612158 IR-MYELO CERVICAL ( 3,953.06) 1612159 IR-MYELO THORACIC ( 3,953.06) 1612160 IR-MYELO LUMBAR ( 3,953.06) 1612161 IR-MYELO COMPLETE ( 6,186.79) 1612164 UE-CLAVICLE CR ( 1,390.53) 1612165 UE-SCAPULA CR ( 595.78) 1612166 UE-SHOULDER 1V CR ( 429.38) 1612167 UE-SHLDR 2VW PLUS CR ( 961.15) 1612168 UE-AC JTS BILAT CR ( 468.94) 1612169 UE-HUMERUS CR ( 848.28) 1612170 UE-ELBOW 2V CR ( 882.03) 1612171 UE-ELBOW 3V CR ( 715.58) 1612172 UE-FOREARM 2V CR ( 697.01) 1612173 UE-UP EXT INFANT CR ( 900.65) 1612174 UE-WRIST 2V CR ( 712.14) 1612175 UE-WRIST 3V PLUS CR ( 897.15) 1612176 UE-HAND 2V CR ( 378.18)
1612177 UE-HAND 3V CR ( 902.97) 1612178 UE-FINGER S 2VPLS CR ( 453.81) 1612179 LE-HIP UNILAT 1V CR ( 309.52) 1612184 LE-FEMUR 2V CR ( 907.63) 1612185 LE-KNEE 1 TO 2V CR ( 900.65) 1612186 LE-KNEE 3V CR ( 887.85) 1612187 LE-KNEE 4V PLUS CR ( 994.90) 1612188 LE-KNEE BI AP STD CR ( 436.36) 1612189 LE-TIB FIB 2V CR ( 895.99) 1612190 LE-LWR EXT INFANT CR ( 883.19) 1612191 LE-ANKLE 2V CR ( 814.54) 1612192 LE-ANKLE 3VPLUS CR ( 911.12) 1612193 LE-FOOT 2V CR ( 614.39) 1612194 LE-FOOT 3V PLUS CR ( 905.30) 1612195 LE-CALCANEUS 2PLS CR ( 477.09) 1612196 LE-TOE S 2VPLUS CR ( 432.87) 1612197 CH-ABDOMEN 1 VIEW CR ( 378.18) 1612198 CH-ABDOMEN 2 VWS CR ( 497.90) 1612199 CH-ABDOMEN 3VWS CR ( 429.38) 1612200 CH-ABD SER PA CXR CR ( 844.79) 1612203 FL-ESOPHAGUS ( 575.99) 1612204 FL-ESOPHAGUS W CINE ( 530.61) 1612206 FL-GI SERIES ( 1,159.28) 1612207 FL-GI SERIES W KUB ( 1,158.97) 1612208 FL-GI W SM BOWEL ( 1,606.97) 1612212 FL-SMALL BOWEL CR ( 1,005.37) 1612215 FL-BARIUM ENEMA ( 1,417.30) 1612216 FL-BARIUM ENEMA AIR ( 1,581.37) 1612220 SU-CHOLE W GRAMS ( 1,110.10) 1612226 FL-ENDO BIL PANC ( 767.78) 1612227 FL-GI TUBE PLACEMENT ( 466.54) 1612230 FL-GI DILATATION ( 444.79) 1612232 FL-IVP CR ( 1,444.06) 1612235 FL-UROGRAPH RETRO CR ( 1,061.23) 1612236 FL-UROGRAPHY ANTE CR ( 1,780.35) 1612237 FL-CYSTOGRM 3VPLS CR ( 1,061.23) 1612240 FL-UCG RETRO CR ( 1,427.89) 1612241 FL-UCG VOIDING CR ( 1,061.23) 1612243 IR-HYSTERSALPINGO CR ( 1,310.24) 1612252 FL-FLUORO 1 HOUR CR ( 645.81) 1612254 STRESS VIEWS JOINT ( 249.02)
1612255 CH-BABYGRAM FB CR ( 893.66) 1612256 BONE AGE STUDY CR ( 368.87) 1612257 BONE LENGTH STUDY CR ( 434.03) 1612258 BNE SRVY LTD METS CR ( 577.16) 1612259 BNE SRVY CMP METS CR ( 620.21) 1612260 BONE SRVY INFANT CR ( 374.69) 1612261 JOINT SURVEY 1V CR ( 496.99) 1612279 IR-ARTHROGM SHLDR CR ( 1,503.40) 1612280 IR-ARTHROGRAM ELBOW ( 1,530.11) 1612281 IR-ARTHROGRAM WRIST ( 1,381.13) 1612282 IR-ARTHROGRAM HIP CR ( 1,421.36) 1612284 IR-ARTHROGRAM KNEE ( 1,340.89) 1612286 CH-CHEST 1V CR ( 303.71) 1612288 CH-CHEST 2V CR ( 274.62) 1612290 CH-CHEST 3V CR ( 639.99) 1612292 CH-CHEST 4V CR ( 660.94) 1612299 UE-CLAVICLE BILAT CR ( 1,237.58) 1612301 UE-SHOULDER 1V BI CR ( 763.43) 1612302 UE-SHOULDER 2V BI CR ( 1,796.55) 1612303 UE-HUMERUS BILAT CR ( 1,585.58) 1612304 UE-ELBOW 2VW BI CR ( 1,649.74) 1612305 UE-ELBOW 3VW BI CR ( 1,432.24) 1612306 UE-FOREARM 2VW BI CR ( 1,302.83) 1612307 UE-UPEXT INFNT BI CR ( 1,588.84) 1612308 UE-WRIST 2VW BI CR ( 1,332.19) 1612309 UE-WRIST 3VW BI CR ( 1,676.93) 1612310 UE-HAND 2VWS BI CR ( 706.88) 1612311 UE-HAND 3VWS BI CR ( 1,688.89) 1612312 UE-FINGER 2 VW BI CR ( 800.40) 1612313 LE-FEMUR 2VW BI CR ( 1,696.50) 1612314 LE-KNEE 1TO2V BI CR ( 1,682.36) 1612315 LE-KNEE 3VWS BI CR ( 1,659.53) 1612316 LE-KNEE 4VWPLS BI CR ( 1,858.54) 1612317 LE-TIB FIB 2V BI CR ( 1,675.84) 1612318 LE-ANKLE 2VW BI CR ( 1,521.41) 1612319 LE-ANKLE 3VWS BI CR ( 1,703.03) 1612320 LE-FOOT 2VWS BI CR ( 1,148.40) 1612321 LE-FOOT 3VWPLS BI CR ( 1,692.15) 1612322 LE-CALCNEUS 2V BI CR ( 841.73) 1612323 LE-TOE S 2VWS BI CR ( 386.06) 1612342 FL-FLUORO CVAD ANY ( 807.56)
1612347 EXAM SURG SPECMN CR ( 1,530.11) 1612348 LE-PELVIS CR ( 539.92) 1612349 LE-PELVIS 3V PLUS CR ( 481.74) 1612352 LE-LWEXT INFNT BI CR ( 883.19) 1612353 FL-NEDL GUIDE FLUORO ( 381.71) 1612354 FL-FLUORO GUIDE SPIN ( 1,122.90) 1612364 IR-NG OROGASTRIC TUB ( 581.81) 1612369 IR-FISTULOGRAM CR ( 1,224.53) 1612372 IR-FIX G COLON TUBE ( 1,592.10) 1612374 IR-EXAM G COLON TUBE ( 645.98) 1612375 IR-RPL DUOD JEJ TUBE ( 2,099.96) 1612377 IR-VENOGRAM EXT UNI ( 3,033.04) 1612378 IR-VENOGRAM EXT BI ( 4,239.08) 1612381 IR-INJ W FLUR CV DEV ( 781.91) 1612382 IR-DRAIN TUBE CHANGE ( 901.54) 1612397 SP-CERV SP 4TO5VW CR ( 842.81) 1612398 SP-CRV SPNE 6VPLS CR ( 838.46) 1612422 IR-ANGIO EXTREM UNI ( 9,448.20) 1612430 IR-VENACAVAGRAM INF ( 10,759.73)1612431 IR-VENACAVAGRAM SUP ( 3,033.04) 1612452 SP-ENT SPN 2OR3 V CR ( 438.26) 1612456 LE-HIP PV UN2OR3V CR ( 445.88) 1612457 LE-HIP PV UNMIN4V CR ( 668.81) 1612458 LE-HIP PLV BI 2V CR ( 394.76) 1612459 LE-HIP PV BI3OR4V CR ( 394.76) 1612460 LE-HIP PV BI MIN5VCR ( 789.53) 1612461 LE-FEMUR 1V CR ( 197.93) 1612473 FL-PLC DVC SFT TS1ST ( 2,091.26) 1612482 FL-PHX SP EV W CINE ( 436.09) 1612483 FL-MOD BA SWALLOW ( 530.61) 1619004 MR-ARSHX DR ( - ) 1619006 IR-INJ CYSTO W FL DR ( - ) 1619007 IR-INJ CYSTOGR VD DR ( - ) 1619008 IR-HYSTEROSALPING DR ( - ) 1619010 IR-FISTULG PLS IJ DR ( - ) 1619957 MR-ARSHX ( - ) 1619961 IR-LUMB PUNC FL GUID ( - ) 1619963 IR-INJ CYSTOGRM W FL ( - ) 1619964 IR-INJ CYSTOGRM VOID ( - ) 1619965 IR-HYSTEROSALPINGRAM ( - ) 1619972 IR-ARTGRM WRST W INJ ( - )
1619974 IR-ARTGRM KNEE W INJ ( - ) 1619978 IR-FISTULG PLS IJ CR ( - ) 1619981 IR-ARTGRM ANKL W INJ ( - ) 1619982 IR-INJ HIPSHLDKNE FL ( - ) 1621503 US-ENCEPHALOGRAM ( 517.65) 1621510 US-HEAD NECK SFT TIS ( 699.34) 1621511 US-CHEST MEDIASTINUM ( 553.89) 1621513 US-ABDOMEN COMP WO ( 915.77) 1621514 US-ABDOMEN LTD WO ( 659.78) 1621515 US-ABDOMEN RETROPER ( 688.87) 1621516 US-ABDOMEN RETRO LMT ( 646.98) 1621517 US-KIDNEY TRANSPLANT ( 517.65) 1621518 US-SPINAL CANAL ( 535.05) 1621519 US-PELVIS PREG ( 950.68) 1621521 US-PELVIS PREG LTD ( 553.89) 1621522 US-PLV PREG FU ABD ( 387.15) 1621524 US-FETAL BIO NONST ( 924.38) 1621529 US-TRANSVAGINAL ( 677.23) 1621531 US-PELVIS NON OB ( 690.03) 1621532 US-PELVIS NON OB FU ( 439.35) 1621533 US-SCROTUM ( 680.72) 1621537 US-HIPS INFANT W MAN ( 613.23) 1621541 US-GUIDE ARTERY RPR ( 1,198.43) 1621543 US-GUIDE NEEDLE PLAC ( 520.14) 1621549 US-FOLLOW UP STUDY ( 322.99) 1621552 US-GUIDE INTRAOPERAT ( 890.66) 1621553 US-ULTRASOUND UNLSTD ( 356.07) 1621554 US-CAROTID DPLX SCAN ( 1,863.98) 1621555 US-EXT VEINS DPLX WC ( 1,333.28) 1621556 US-EXT ARTERIAL LTD ( 409.99) 1621557 US-LW EXT DPX ART UN ( 1,228.88) 1621559 US-NON INV ARTER EXT ( 581.81) 1621560 US-EXT VEINS DPX LTD ( 922.20) 1621561 US-ABD RETROPER DPLX ( 1,014.64) 1621562 US-LW EXT DPX ART BI ( 2,815.54) 1621564 US-UP EXT DPX ART BI ( 2,777.48) 1621566 US-UP EXT DPX ART UN ( 1,540.99) 1621572 US-DPLX SCN AV ACCES ( 506.78) 1621575 US-PELV PREG 14 WKS ( 622.54) 1621579 US-PLV PRG TRNSV ( 553.89) 1621581 US-VAS ACCSS SITES ( 150.08)
1621596 US-ABDOMN AAA SCREEN ( 338.22) 1621604 US-ABSC DRN CATH PLA ( 1,337.63) 1621618 US-EXT LTD JNT UNI ( 1,375.69) 1621623 US-ABD PARACEN W IMG ( 1,969.46) 1621625 US-THORACNTSIS W IMG ( 3,066.75) 1621626 US-THORCNT W TUB IMG ( 3,143.96) 1621627 US-BRST BX LOC CLP 1 ( 4,554.45) 1621628 US-PLC LOC DVCE 1ST ( 1,617.11) 1621630 US-CTH FLUID PER RET ( 5,386.39) 1621632 US-CATH FLUID DRAIN ( 2,711.14) 1621637 US-DRN INJ MAJR JT W ( 1,004.46) 1621638 US-BREAST COMPLETE ( 433.91) 1621639 US-BREAST LIMITED ( 455.66) 1621640 US-BREAST COMPLET BI ( 679.69) 1621641 US-BREAST LIMITED BI ( 911.33) 1621650 US-ABDOMEN COMP W ( 1,029.86) 1629930 US-PELV W TV NONOB ( - ) 1629933 US-PELVIS PREG W TV ( - ) 1629965 US-SCRTM ABD FLW LMT ( - ) 1630001 CT-ABSC DRN CATH PLA ( 1,337.63) 1630006 CT-HT CARD FUNC W ( 3,743.18) 1630007 CT-ABD PELVIS WO ( 3,200.51) 1630008 CT-ABD PELVIS W ( 3,750.79) 1630009 CT-ABD PELVIS WWO ( 5,164.54) 1630013 CT-PERC CHOLECYSTOST ( 10,679.25)1630014 CTA-ABDOMEN PELVIS ( 2,315.29) 1630017 CT-ABD PARACEN W IMG ( 1,969.46) 1630023 CT-DRAIN TUBE CHANGE ( 901.54) 1630028 CT-THORACNTSIS W IMG ( 2,921.03) 1630029 CT-THORCNT W TUB IMG ( 3,143.96) 1630030 CT-DEST BY AGENT PLX ( 5,949.71) 1630032 CT-CATH FLUID COLXN ( 6,244.43) 1630033 CT-CTH FLUID PER RET ( 5,386.39) 1630035 CT-CATH FLUID DRAIN ( 3,146.14) 1630036 CT-FISTULOGRAM ( 1,224.53) 1630038 CT-INJ ANES AGNT PLX ( 2,579.55) 1630055 CT-PERC SACRPSLTY BI ( 11,923.35)1631500 CTA-PELVIS ( 2,569.76) 1631501 CT-PELVIS WO ( 1,520.86) 1631502 CT-PELVIS W ( 1,988.64) 1631503 CT-PELVIS WWO ( 2,305.14)
1631504 CT-UPPER EXT WO BI ( 3,479.24) 1631505 CT-UPPER EXT W BI ( 4,898.86) 1631507 CTA-UPPER EXT BI ( 4,000.54) 1631508 CT-LOWER EXT WO BI ( 5,338.71) 1631509 CT-LOWER EXT W BI ( 5,704.09) 1631510 CT-LOWER EXT WWO BI ( 7,123.71) 1631511 CTA-LOWER EXT BI ( 5,707.58) 1631512 CT-GUIDE STEREOTACT ( 1,442.03) 1631513 CT-GUIDE NEEDLE BX ( 1,459.43) 1631514 CT-GUIDE TISSUE ABLA ( 660.11) 1631515 CT-RAD TX TREAT PLAN ( 1,923.79) 1631516 CT-LIMITED FOLLOW UP ( 1,570.89) 1631517 CT-HEAD WO ( 1,412.64) 1631518 CT-HEAD W ( 1,824.56) 1631519 CT-HEAD WWO ( 2,212.05) 1631520 CT-ORBIT EAR WO ( 1,618.60) 1631521 CT-ORBIT EAR W ( 1,874.85) 1631522 CT-ORBIT EAR WWO ( 1,788.49) 1631523 CT-MAXILLOFACIAL WO ( 2,098.02) 1631524 CT-MAXILLOFACIAL W ( 1,961.85) 1631525 CT-MAXILLOFACIAL WWO ( 1,904.85) 1631526 CT-NECK SOFT TIS WO ( 1,627.91) 1631527 CT-NECK SOFT TIS W ( 1,672.13) 1631528 CT-NECK SOFT TIS WWO ( 1,890.89) 1631529 CTA-HEAD ( 3,226.61) 1631530 CTA-NECK ( 2,788.35) 1631531 CT-CHEST WO ( 1,561.58) 1631532 CT-CHEST W ( 1,890.89) 1631533 CT-CHEST WWO ( 2,568.12) 1631534 CTA-CHEST ( 2,729.63) 1631535 CT-CERV SPINE WO ( 1,783.84) 1631536 CT-CERV SPINE W ( 2,044.49) 1631537 CT-CERV SPINE WWO ( 1,838.96) 1631538 CT-THOR SPINE WO ( 1,677.95) 1631539 CT-THOR SPINE W ( 1,644.30) 1631540 CT-THOR SPINE WWO ( 1,838.96) 1631541 CT-LUMB SPINE WO ( 1,620.93) 1631542 CT-LUMB SPINE W ( 2,203.91) 1631543 CT-LUMB SPINE WWO ( 1,767.19) 1631544 CT-UPPER EXT WO ( 2,435.47) 1631545 CT-UPPER EXT W ( 3,318.66)
1631546 CT-UPPER EXT WWO ( 3,679.01) 1631547 CTA-UPPER EXT ( 2,141.29) 1631548 CT-LOWER EXT WO ( 2,669.36) 1631549 CT-LOWER EXT W ( 3,294.22) 1631550 CT-LOWER EXT WWO ( 3,551.38) 1631551 CTA-LOWER EXT ( 2,666.55) 1631552 CT-ABDOMEN WO ( 1,703.55) 1631553 CT-ABDOMEN W ( 1,922.31) 1631554 CT-ABDOMEN WWO ( 2,706.59) 1631555 CTA-ABDOMEN ( 2,581.73) 1631556 CTA-ABD ART W RUNOFF ( 2,839.46) 1631567 CT-HEART WO QUAL ( 439.35) 1631569 CT-3D W POSTPROCESS ( 1,479.00) 1641000 MR-UPPER EXT WO ( 4,891.88) 1641002 MR-UPPER EXT WWO ( 5,758.78) 1641003 MR-UPPER JOINT WO ( 5,154.86) 1641004 MR-UPPER JOINT W ( 3,469.93) 1641005 MR-UPPER JOINT WWO ( 5,201.40) 1641007 MRA-NECK WO ( 2,257.43) 1641008 MRA-NECK W ( 2,257.43) 1641009 MRA-NECK WWO ( 6,996.88) 1641010 MR-CHEST WO ( 3,908.62) 1641012 MR-CHEST WWO ( 4,368.25) 1641014 MR-LOWER EXTR WO ( 4,469.48) 1641016 MR-LOWER EXTR WWO ( 6,621.03) 1641017 MR-LW JOINT WO ( 5,180.46) 1641018 MR-LW JOINT W ( 5,458.56) 1641019 MR-LW JOINT WWO ( 5,996.16) 1641020 MR-ABDOMEN WO ( 3,289.57) 1641022 MR-ABDOMEN WWO ( 3,710.80) 1641031 MRA-ABDOMEN W ( 3,551.38) 1641032 MRA-ABDOMEN WO ( 2,257.43) 1641033 MRA-ABDOMEN WWO ( 3,246.51) 1641035 MR-BREAST UNI WO ( 2,113.01) 1641036 MR-BREAST UNI WWO ( 4,184.70) 1641038 MR-BREAST BIL WO ( 4,432.65) 1641039 MR-BREAST BI WWO ( 4,517.48) 1641040 MRA-CHEST W ( 3,899.78) 1641041 MRA-CHEST WO ( 1,380.04) 1641043 MRA-LW EXTR W ( 2,906.12) 1641044 MRA-LW EXTR WO ( 2,218.11)
1641046 MR-ORBT FACE NECK WO ( 2,982.37) 1641048 MR-ORBT FAC NCK WWO ( 4,198.36) 1641049 MRA-HEAD WO ( 3,451.31) 1641050 MRA-HEAD W ( 3,177.86) 1641051 MRA-HEAD WWO ( 3,246.51) 1641052 MR-BRAIN WO ( 4,165.78) 1641053 MR-BRAIN W ( 2,875.32) 1641054 MR-BRAIN WWO ( 5,202.57) 1641055 MR-CERV SPINE WO ( 4,384.54) 1641057 MR-THOR SPINE WO ( 4,598.65) 1641058 MR-THOR SPINE W ( 2,397.07) 1641059 MR-LUMB SPINE WO ( 4,649.85) 1641060 MR-LUMB SPINE W ( 4,113.41) 1641061 MR-CERV SPINE WWO ( 5,338.71) 1641062 MR-THOR SPINE WWO ( 5,422.49) 1641063 MR-LUMB SPINE WWO ( 5,073.41) 1641065 MR-PELVIS WO ( 4,457.85) 1641067 MR-PELVIS WWO ( 4,235.60) 1641074 MR-UPPER EXT BI WO ( 4,659.15) 1641078 MR-LOWER EXTR BI WO ( 8,585.23) 1641079 MR-TMJS ( 3,345.42) 1641081 MR-LW JOINT W BI ( 4,858.95) 1641082 MR-LW JOINT WWO BI ( 10,051.76)1641083 MR-LW JOINT WO BI ( 9,684.19) 1641085 MRA-LW EXTR W BI ( 4,640.00) 1641087 MR-3D WO POSTPROCESS ( 165.23) 1641089 MR-UPPER JNT BIL WO ( 9,635.25) 1641091 MR-UPPER JNT BI WWO ( 4,629.49) 1641098 MR-LOWER EXTR BI WWO ( 5,893.16) 1649907 MR BRAIN ORBITS WO ( - ) 1649908 MR-BRAIN ORBITS WWO ( - ) 1649961 MR-AB WO 3D RECON WO ( - ) 1650015 NM-STRESS TEST ( 1,007.03) 1651011 NM-THYROID MET BODY ( 2,621.96) 1651014 NM-ADRENAL IMAGING ( 4,821.98) 1651027 NM-SPLEEN ( 1,447.46) 1651030 NM-LYMPHATICS NODES ( 2,878.81) 1651034 NM-LIVER SPECT ( 4,951.39) 1651035 NM-LIVER W FLW SPECT ( 1,960.76) 1651036 NM-LIVER AND SPLEEN ( 1,830.38) 1651041 NM-SALIVARY GLAND SE ( 1,447.46)
1651045 NM-GI REFLUX ( 1,309.35) 1651046 NM-GASTRIC EMPTYING ( 1,921.14) 1651052 NM-GI BLOOD LOSS ( 1,333.51) 1651054 NM-MECKELS SCAN ( 1,421.95) 1651055 NM-SHUNT PATENCY EX ( 1,187.55) 1651057 NM-BONE SCAN LMTD ( 1,371.91) 1651058 NM-BONE SCAN MULTI ( 1,384.39) 1651059 NM-BONE SCAN BODY ( 3,105.72) 1651060 NM-BONE SCAN 3 PHASE ( 3,240.70) 1651061 NM-BONE SCAN SPECT ( 1,334.68) 1651069 NM-VENOGRAM UNILAT ( 4,954.39) 1651073 NM-MYOCRD SPECT SNGL ( 4,753.41) 1651074 NM-MYOCRD SPECT MULT ( 4,753.41) 1651075 NM-MYOCARD INFARCT ( 1,447.46) 1651078 NM-GATED BLD POOL SN ( 2,657.72) 1651079 NM-GATED BLD POOL MU ( 2,568.68) 1651087 NM-LUNG PERF PARTICU ( 2,162.02) 1651099 NM-BRAIN STATIC W FI ( 2,053.20) 1651101 NM-BRAIN W VASC FLOW ( 1,919.44) 1651102 NM-BRAIN SPECT ( 4,821.98) 1651105 NM-BRAIN CSF CISTERN ( 2,053.20) 1651107 NM-BRAIN CSF SHUNT ( 2,470.80) 1651109 NM-BRAIN CSF LEAKAGE ( 2,120.63) 1651114 NM-KIDNEY VF NO PHRM ( 3,076.62) 1651115 NM-KID VF PHRM SNGL ( 2,179.47) 1651116 NM-KID VF PHRM MULT ( 1,919.44) 1651118 NM-KIDNEY FUNCTION ( 1,626.90) 1651121 NM-TESTICULAR FLOW ( 2,698.09) 1651125 NM-TUMOR LOC BODY ( 3,355.89) 1651126 NM-TUMOR LOC SPECT ( 2,567.59) 1651128 NM-ABSCESS LOC BODY ( 3,252.33) 1651129 NM-ABSCESS SPECT ( 2,567.59) 1651135 NM-INTRAARTICULAR TX ( 942.56) 1651137 NM-RX ORAL ADMIN ( 1,177.76) 1651138 NUCLEAR RX IV ADMIN ( 1,199.51) 1651140 IV INJ RA DRUG DX ST ( 1,326.75) 1651143 NM-HEPATOBILIARY SYS ( 1,434.41) 1651144 NM-HEPATOBIL W PHARM ( 1,434.41) 1651145 NM-LUNG VENT IMAGING ( 1,447.46) 1651146 NM-LUNG VENT PERFUS ( 1,659.53) 1651147 NM-LUNG PERFUS DIFFR ( 1,122.30)
1651149 NM-THYR UPT S-M-SUPP ( 1,447.46) 1651150 NM-THY UPT IMG W-BF ( 1,225.61) 1651151 NM-THYROID IMG W-BF ( 672.08) 1651152 NM-PAR PLAN THY IMG ( 2,489.29) 1651153 NM-PARA PLN IMG SPEC ( 2,489.29) 1651155 NM-GAST EMPT SM BWL ( 1,085.33) 1660001 HE-EYE FOREIGNBDY DR ( 488.29) 1660002 HE-MANDIBLE LTD DR ( 267.53) 1660003 HE-MANDIBLE 4VPLS DR ( 577.46) 1660004 HE-MASTOIDS LTD DR ( 544.84) 1660005 HE-MASTOID 3VPLUS DR ( 799.31) 1660007 HE-FACIAL BNS LTD DR ( 322.99) 1660008 HE-FACIAL BNES 3V DR ( 589.43) 1660009 HE-NASAL BONES DR ( 443.70) 1660012 HE-ORBITS 4V DR ( 640.54) 1660013 HE-SINUSES LTD DR ( 297.98) 1660014 HE-SINUSES 3VPLUS DR ( 841.73) 1660016 HE-SKULL LIMITED DR ( 480.68) 1660017 HE-SKULL 4V PLUS DR ( 678.60) 1660022 HE-TMJ BILATERAL DR ( 631.84) 1660026 SP-NECK SOFT TISS DR ( 375.19) 1660027 CH-RIBS UNILAT DR ( 381.71) 1660028 CH-RIB UNI PA CXR DR ( 619.88) 1660029 CH-RIBS BILATERAL DR ( 350.18) 1660030 CH-RIBS BI PA CXR DR ( 690.56) 1660031 CH-STERNUM DR ( 455.66) 1660032 CH-STRNOCLAV JNTS DR ( 421.95) 1660033 SP-SPINE SNGL VW DR ( 408.90) 1660034 SP-CERV SP 2TO3VW DR ( 344.74) 1660035 SP-CERV SP 4TO5VW DR ( 842.81) 1660036 SP-CRV SPNE 6VPLS DR ( 838.46) 1660037 SP-T SPINE 2 VIEW DR ( 344.74) 1660038 SP-T SPINE 3 VIEW DR ( 350.18) 1660039 SP-T SPNE 4PLUS V DR ( 328.43) 1660040 SP-THORACOLMBR 2V DR ( 548.10) 1660042 SP-ENT SPN 2OR3 V DR ( 432.83) 1660046 SP-LS SPN 2 TO 3V DR ( 344.74) 1660047 SP-LS SPNE 4VPLUS DR ( 772.13) 1660048 SP-LS SPINE W BND DR ( 431.74) 1660049 SP-LS SPINE BND DR ( 625.31) 1660050 LE-PELVIS DR ( 504.60)
1660051 LE-PELVIS 3V PLUS DR ( 429.56) 1660053 SP-SI JNTS 3VPLUS DR ( 471.98) 1660054 SP-SCRM COCCYX 2V DR ( 625.31) 1660056 UE-CLAVICLE BILAT DR ( 815.63) 1660057 UE-CLAVICLE DR ( 1,299.56) 1660059 UE-SCAPULA DR ( 556.80) 1660060 UE-SHOULDER 1V DR ( 401.29) 1660061 UE-SHLDR 2VW PLUS DR ( 898.28) 1660063 UE-AC JTS BILAT DR ( 438.26) 1660064 UE-HUMERUS BILAT DR ( 1,585.58) 1660065 UE-HUMERUS DR ( 792.79) 1660066 UE-ELBOW 2V DR ( 824.33) 1660067 UE-ELBOW 3V DR ( 715.58) 1660068 UE-FOREARM 2V DR ( 651.41) 1660069 UE-UP EXT INFANT DR ( 801.49) 1660070 UE-WRIST 2V DR ( 665.55) 1660071 UE-WRIST 3V PLUS DR ( 838.46) 1660072 UE-HAND 2V DR ( 353.44) 1660073 UE-HAND 3V DR ( 843.90) 1660074 UE-FINGER S 2VPLS DR ( 424.13) 1660075 LE-HIP UNILAT 1V DR ( 302.33) 1660076 LE-HIP PV UN2OR3V DR ( 445.88) 1660077 LE-HIP PV UNMIN4V DR ( 668.81) 1660078 LE-HIP PLV BI 2V DR ( 438.26) 1660079 LE-HIP PV BI3OR4V DR ( 394.76) 1660080 LE-HIP PV BI MIN5VDR ( 835.20) 1660083 LE-FEMUR 2V DR ( 848.25) 1660084 LE-KNEE 1 TO 2V DR ( 841.73) 1660085 LE-KNEE 3V DR ( 829.76) 1660086 LE-KNEE 4V PLUS DR ( 929.81) 1660087 LE-KNEE BI AP STD DR ( 388.24) 1660088 LE-TIB FIB 2V DR ( 837.38) 1660089 LE-LWR EXT INFANT DR ( 825.41) 1660090 LE-ANKLE 2V DR ( 761.25) 1660091 LE-ANKLE 3VPLUS DR ( 851.51) 1660092 LE-FOOT 2V DR ( 574.20) 1660093 LE-FOOT 3V PLUS DR ( 846.08) 1660094 LE-CALCANEUS 2PLS DR ( 445.88) 1660095 LE-TOE S 2VPLUS DR ( 404.55) 1660096 CH-ABD SER PA CXR DR ( 789.53) 1660097 FL-SMALL BOWEL DR ( 893.93)
1660101 FL-IVP DR ( 1,349.59) 1660103 FL-UROGRAPH W TOM DR ( 1,009.20) 1660105 FL-UROGRAPHY ANTE DR ( 1,584.49) 1660106 FL-CYSTOGRM 3VPLS DR ( 991.80) 1660107 FL-UCG RETRO DR ( 1,427.89) 1660108 FL-UCG VOIDING DR ( 991.80) 1660110 IR-HYSTERSALPINGO DR ( 1,224.53) 1660112 FL-FLUORO 1 HOUR DR ( 603.56) 1660114 IR-FISTULOGRAM DR ( 1,165.80) 1660116 TOMOGRAM ONE PLNE DR ( 450.23) 1660120 BONE AGE STUDY DR ( 344.74) 1660121 BONE LENGTH STUDY DR ( 405.64) 1660122 BNE SRVY LTD METS DR ( 539.40) 1660123 BNE SRVY CMP METS DR ( 579.64) 1660124 BONE SRVY INFANT DR ( 350.18) 1660129 UE-SHOULDER 1V BI DR ( 801.49) 1660130 UE-SHOULDER 2V BI DR ( 1,796.55) 1660132 UE-ELBOW 2VW BI DR ( 1,649.74) 1660133 UE-ELBOW 3VW BI DR ( 1,432.24) 1660134 UE-FOREARM 2VW BI DR ( 1,240.84) 1660136 UE-WRIST 2VW BI DR ( 1,332.19) 1660137 UE-WRIST 3VW BI DR ( 1,676.93) 1660138 UE-HAND 2VWS BI DR ( 706.88) 1660139 UE-HAND 3VWS BI DR ( 1,688.89) 1660140 UE-FINGER 2 VW BI DR ( 762.34) 1660142 LE-FEMUR 2VW BI DR ( 1,696.50) 1660143 LE-KNEE1TO2V BI DR ( 1,682.36) 1660144 LE-KNEE 3VWS BI DR ( 1,659.53) 1660145 LE-KNEE 4VWPLS BI DR ( 1,770.45) 1660146 LE-TIB FIB 2V BI DR ( 1,675.84) 1660148 LE-ANKLE 2VW BI DR ( 1,521.41) 1660149 LE-ANKLE 3VWS BI DR ( 1,703.03) 1660151 LE-FOOT 3VWPLS BI DR ( 1,692.15) 1660152 LE-CALCNEUS 2V BI DR ( 841.73) 1660153 LE-TOE S 2VWS BI DR ( 386.06) 1660161 CH-CHEST 1V DR ( 283.84) 1660162 CH-CHEST 2V DR ( 256.65) 1660163 CH-CHEST 3V DR ( 598.13) 1660164 CH-CHEST 4V DR ( 617.70) 1660165 CH-ABDOMEN 1 VIEW DR ( 353.44) 1660166 CH-ABDOMEN 2 VWS DR ( 497.90)
1660167 CH-ABDOMEN 3VWS DR ( 401.29) 1662404 IR-SHUNTOGRAM ( 654.68) 1663001 CTA-PELVIS ( 2,446.88) 1663002 CT-PELVIS WO ( 1,421.36) 1663003 CT-PELVIS W ( 1,858.54) 1663004 CT-PELVIS WWO ( 2,154.34) 1663005 CT-UPPER EXT WO BI ( 2,167.39) 1663009 CT-LOWER EXT WO BI ( 4,751.29) 1663012 CTA-LOWER EXT BI ( 5,334.19) 1663013 CT-GUIDE STEREOTACT ( 1,442.03) 1663016 CT-RAD TX TREAT PLAN ( 1,831.35) 1663017 CT-LIMITED FOLLOW UP ( 1,397.44) 1663018 CT-HEAD WO ( 1,320.23) 1663019 CT-HEAD W ( 1,623.64) 1663020 CT-HEAD WWO ( 2,067.34) 1663021 CT-ORBIT EAR WO ( 1,512.71) 1663022 CT-ORBIT EAR W ( 1,785.68) 1663023 CT-ORBIT EAR WWO ( 1,671.49) 1663024 CT-MAXILLOFACIAL WO ( 1,960.76) 1663025 CT-MAXILLOFACIAL W ( 1,961.85) 1663026 CT-MAXILLOFACIAL WWO ( 1,780.24) 1663027 CT-NECK SOFT TIS WO ( 1,521.41) 1663028 CT-NECK SOFT TIS W ( 1,562.74) 1663029 CT-NECK SOFT TIS WWO ( 1,767.19) 1663030 CTA-HEAD ( 3,226.61) 1663031 CTA-NECK ( 2,788.35) 1663032 CT-CHEST WO ( 1,459.43) 1663033 CT-CHEST W ( 1,767.19) 1663034 CT-CHEST WWO ( 2,400.11) 1663035 CTA-CHEST ( 2,729.63) 1663036 CT-CERV SPINE WO ( 1,667.14) 1663037 CT-CERV SPINE W ( 1,819.39) 1663038 CT-CERV SPINE WWO ( 1,838.96) 1663039 CT-THOR SPINE WO ( 1,568.18) 1663040 CT-THOR SPINE W ( 1,644.30) 1663041 CT-THOR SPINE WWO ( 1,838.96) 1663042 CT-LUMB SPINE WO ( 1,514.89) 1663043 CT-LUMB SPINE W ( 2,059.73) 1663044 CT-LUMB SPINE WWO ( 1,767.19) 1663045 CT-UPPER EXT WO ( 2,276.14) 1663046 CT-UPPER EXT W ( 3,101.55)
1663047 CT-UPPER EXT WWO ( 3,679.01) 1663048 CTA-UPPER EXT ( 2,141.29) 1663049 CT-LOWER EXT WO ( 2,494.73) 1663050 CT-LOWER EXT W ( 3,078.71) 1663051 CT-LOWER EXT WWO ( 3,319.05) 1663052 CTA-LOWER EXT ( 2,666.55) 1663053 CT-ABDOMEN WO ( 1,592.10) 1663054 CT-ABDOMEN W ( 1,796.55) 1663055 CT-ABDOMEN WWO ( 2,529.53) 1663056 CTA-ABDOMEN ( 2,581.73) 1663057 CTA-ABD ART W RUNOFF ( 2,704.61) 1663068 US-HEAD NECK SFT TIS ( 653.59) 1663069 US-CHEST MEDIASTINUM ( 517.65) 1663071 US-ABDOMEN COMP WO ( 855.86) 1663072 US-ABDOMEN LTD WO ( 616.61) 1663073 US-ABDOMEN RETROPER ( 643.80) 1663074 US-ABDOMEN RETRO LMT ( 604.65) 1663075 US-KIDNEY TRANSPLANT ( 493.73) 1663076 US-SPINAL CANAL ( 260.39) 1663077 US-PELVIS PREG ( 888.49) 1663079 US-PELVIS PREG LTD ( 517.65) 1663080 US-PLV PREG FU ABD ( 387.15) 1663082 US-FETAL BIO NONST ( 924.38) 1663087 US-TRANSVAGINAL ( 632.93) 1663089 US-PELVIS NON OB ( 644.89) 1663090 US-PELVIS NON OB FU ( 439.35) 1663091 US-SCROTUM ( 636.19) 1663095 US-HIPS INFANT W MAN ( 322.99) 1663101 US-GUIDE NEEDLE PLAC ( 463.28) 1663113 US-CAROTID DPLX SCAN ( 3,726.86) 1663114 US-EXT VEINS DPLX WC ( 1,333.28) 1663119 US-EXT VEINS DPX LTD ( 922.20) 1663120 US-ABD RETROPER DPLX ( 1,014.64) 1663136 US-PELV PREG 14 WKS ( 581.81) 1663140 US-PLV PRG TRNSV ( 517.65) 1663233 HE-EYE FOREIGNBDY CR ( 488.29) 1663234 HE-MANDIBLE LTD CR ( 267.53) 1663235 HE-MANDIBLE 4VPLS CR ( 577.46) 1663236 HE-MASTOIDS LTD CR ( 544.84) 1663237 HE-MASTOID 3VPLUS CR ( 799.31) 1663239 HE-FACIAL BNS LTD CR ( 322.99)
1663240 HE-FACIAL BNES 3V CR ( 589.43) 1663241 HE-NASAL BONES CR ( 443.70) 1663243 HE-ORBITS 4V CR ( 640.54) 1663244 HE-SINUSES LTD CR ( 297.98) 1663245 HE-SINUSES 3VPLUS CR ( 841.73) 1663247 HE-SKULL LIMITED CR ( 480.68) 1663248 HE-SKULL 4V PLUS CR ( 678.60) 1663253 HE-TMJ BILATERAL CR ( 631.84) 1663256 SP-NECK SOFT TISS CR ( 375.19) 1663261 CH-CHEST 1V CR ( 283.84) 1663263 CH-CHEST 2V CR ( 256.65) 1663265 CH-CHEST 3V CR ( 598.13) 1663267 CH-CHEST 4V CR ( 617.70) 1663270 CH-RIBS UNILAT CR ( 381.71) 1663271 CH-RIB UNI PA CXR CR ( 619.88) 1663272 CH-RIBS BILATERAL CR ( 350.18) 1663273 CH-RIBS BI PA CXR CR ( 690.56) 1663274 CH-STERNUM CR ( 455.66) 1663275 CH-STRNOCLAV JNTS CR ( 421.95) 1663277 SP-SPINE SNGL VW CR ( 408.90) 1663278 SP-CERV SP 2TO3VW CR ( 344.74) 1663282 SP-T SPINE 2 VIEW CR ( 344.74) 1663283 SP-T SPINE 3 VIEW CR ( 350.18) 1663284 SP-T SPNE 4PLUS V CR ( 328.43) 1663285 SP-THORACOLMBR 2V CR ( 548.10) 1663287 SP-LS SPN 2 TO 3V CR ( 344.74) 1663288 SP-LS SPNE 4VPLUS CR ( 772.13) 1663289 SP-LS SPINE W BND CR ( 431.74) 1663290 SP-LS SPINE BND CR ( 625.31) 1663291 LE-PELVIS CR ( 504.60) 1663292 LE-PELVIS 3V PLUS CR ( 429.56) 1663294 SP-SI JNTS 3VPLUS CR ( 471.98) 1663295 SP-SCRM COCCYX 2V CR ( 625.31) 1663296 UE-CLAVICLE CR ( 1,299.56) 1663297 UE-CLAVICLE BILAT CR ( 815.63) 1663298 UE-SCAPULA CR ( 556.80) 1663300 UE-SHOULDER 1V BI CR ( 801.49) 1663301 UE-SHOULDER 1V CR ( 401.29) 1663302 UE-SHOULDER 2V BI CR ( 1,796.55) 1663303 UE-SHLDR 2VW PLUS CR ( 898.28) 1663304 UE-AC JTS BILAT CR ( 438.26)
1663305 UE-HUMERUS CR ( 792.79) 1663306 UE-HUMERUS BILAT CR ( 1,585.58) 1663307 UE-ELBOW 2V CR ( 824.33) 1663308 UE-ELBOW 2VW BI CR ( 1,649.74) 1663309 UE-ELBOW 3V CR ( 715.58) 1663310 UE-FOREARM 2V CR ( 651.41) 1663311 UE-FOREARM 2VW BI CR ( 1,240.84) 1663313 UE-UP EXT INFANT CR ( 801.49) 1663314 UE-WRIST 2V CR ( 665.55) 1663315 UE-WRIST 2VW BI CR ( 1,332.19) 1663316 UE-WRIST 3VW BI CR ( 1,676.93) 1663317 UE-WRIST 3V PLUS CR ( 838.46) 1663318 UE-HAND 2V CR ( 353.44) 1663319 UE-HAND 2VWS BI CR ( 706.88) 1663320 UE-HAND 3V CR ( 843.90) 1663321 UE-HAND 3VWS BI CR ( 1,688.89) 1663322 UE-FINGER S 2VPLS CR ( 424.13) 1663323 UE-FINGER 2 VW BI CR ( 762.34) 1663324 LE-HIP UNILAT 1V CR ( 302.33) 1663328 LE-FEMUR 2V CR ( 848.25) 1663329 LE-FEMUR 2VW BI CR ( 1,696.50) 1663330 LE-KNEE 1 TO 2V CR ( 841.73) 1663331 LE-KNEE 1TO2V BI CR ( 1,682.36) 1663332 LE-KNEE 3V CR ( 829.76) 1663333 LE-KNEE 3VWS BI CR ( 1,659.53) 1663334 LE-KNEE 4VWPLS BI CR ( 1,770.45) 1663335 LE-KNEE 4V PLUS CR ( 929.81) 1663336 LE-KNEE BI AP STD CR ( 388.24) 1663337 LE-TIB FIB 2V BI CR ( 1,675.84) 1663338 LE-TIB FIB 2V CR ( 837.38) 1663339 LE-LWR EXT INFANT CR ( 825.41) 1663340 LE-ANKLE 2V CR ( 761.25) 1663341 LE-ANKLE 2VW BI CR ( 1,521.41) 1663342 LE-ANKLE 3VWS BI CR ( 1,703.03) 1663343 LE-ANKLE 3VPLUS CR ( 851.51) 1663344 LE-FOOT 2V CR ( 574.20) 1663346 LE-FOOT 3V PLUS CR ( 846.08) 1663347 LE-FOOT 3VWPLS BI CR ( 1,692.15) 1663348 LE-CALCANEUS 2PLS CR ( 445.88) 1663349 LE-CALCNEUS 2V BI CR ( 841.73) 1663350 LE-TOE S 2VWS BI CR ( 386.06)
1663351 LE-TOE S 2VPLUS CR ( 404.55) 1663352 CH-ABDOMEN 1 VIEW CR ( 353.44) 1663353 CH-ABDOMEN 2 VWS CR ( 497.90) 1663354 CH-ABDOMEN 3VWS CR ( 401.29) 1663355 CH-ABD SER PA CXR CR ( 789.53) 1663357 FL-ESOPHAGUS ( 538.31) 1663359 FL-GI SERIES ( 1,159.28) 1663360 FL-GI SERIES W KUB ( 1,083.15) 1663361 FL-GI W SM BOWEL ( 1,501.84) 1663365 FL-SMALL BOWEL CR ( 893.93) 1663368 FL-BARIUM ENEMA ( 1,324.58) 1663369 FL-BARIUM ENEMA AIR ( 1,407.23) 1663376 FL-IVP CR ( 1,349.59) 1663378 FL-UROGRAPH W TOM CR ( 1,009.20) 1663380 FL-UROGRAPHY ANTE CR ( 1,584.49) 1663381 FL-CYSTOGRM 3VPLS CR ( 991.80) 1663384 STRESS VIEWS JOINT ( 232.73) 1663386 BONE AGE STUDY CR ( 344.74) 1663387 BONE LENGTH STUDY CR ( 405.64) 1663388 BNE SRVY LTD METS CR ( 539.40) 1663389 BNE SRVY CMP METS CR ( 579.64) 1663390 BONE SRVY INFANT CR ( 350.18) 1663392 TOMOGRAM ONE PLNE CR ( 450.23) 1663427 CT-3D W POSTPROCESS ( 300.63) 1663428 UE-ELBOW 3VW BI CR ( 1,432.24) 1663465 FL-UCG VOIDING CR ( 991.80) 1663466 FL-FLUORO 1 HOUR CR ( 603.56) 1663484 IR-HYSTERSALPINGO CR ( 1,224.53) 1663503 US-ABDOMN AAA SCREEN ( 530.70) 1663532 FL-UCG RETRO CR ( 1,427.89) 1663577 IR-FISTULOGRAM CR ( 1,165.80) 1663601 CT-ABD PELVIS WO ( 3,200.51) 1663602 CT-ABD PELVIS W ( 3,750.79) 1663603 CT-ABD PELVIS WWO ( 5,164.54) 1663605 US-EXT LTD JNT UNI ( 1,409.40) 1663608 CTA-ABDOMEN PELVIS ( 2,315.29) 1663616 SP-CERV SP 4TO5VW CR ( 842.81) 1663617 SP-CRV SPNE 6VPLS CR ( 838.46) 1663621 CT-BONE LENGTH STUDY ( 387.15) 1663670 CT-LOW DOSE CNCR SCR ( 366.49) 1663690 SP-ENT SPN 2OR3 V CR ( 432.83)
1663694 LE-HIP PV UN2OR3V CR ( 445.88) 1663695 LE-HIP PV UNMIN4V CR ( 668.81) 1663696 LE-HIP PLV BI 2V CR ( 438.26) 1663697 LE-HIP PV BI3OR4V CR ( 394.76) 1663698 LE-HIP PV BI MIN5VCR ( 835.20) 1669930 US-PELV W TV NONOB ( - ) 1669931 US-PELVIS PREG TA TV ( - ) 1669965 US-SCRTM ABD FLW LMT ( - ) 1669968 MR-HD NCK ORB FC WWO ( - ) 1681587 CT-LIMITED FOLLOW UP ( 1,468.13) 1690001 IR-DISKOGRAPHY LUMB ( 12,107.31)1690004 FL-UROGRAPHY ANTE DR ( 1,663.88) 1690009 FL-FLUORO 1 HOUR DR ( 603.56) 1690010 IR-FISTULOGRAM DR ( 1,247.41) 1691001 FL-NEDL GUIDE FLUORO ( 381.71) 1691003 IR-REPLACE G C TUBE ( 2,502.34) 1691006 IR-XTRCRAN VERT STNT ( 60,047.10)1691009 IR-THOR AORTA SERIAL ( 9,363.38) 1691010 IR-ABD AORTA SERIAL ( 9,920.18) 1691011 IR-AABF SERIAL ( 9,920.18) 1691021 IR-ANGIO EXTREM UNI ( 9,920.18) 1691022 IR-ANGIO EXTREM BI ( 19,841.44)1691025 IR-ANGIO VISCERAL SE ( 19,343.36)1691026 IR-ANGIO ADRENAL UNI ( 2,975.97) 1691027 IR-ANGIO ADRENAL BI ( 10,268.61)1691028 IR-ANGIO PELVIC SEL ( 9,920.18) 1691029 IR-ANG PULMONARY UNI ( 9,920.18) 1691030 IR-ANG PULMONARY BI ( 19,841.44)1691033 IR-ANGIO ADD VESSEL ( 2,334.86) 1691035 IR-EMBOLIZATION THER ( 2,477.33) 1691037 IR-ANGIO EXIST CATH ( 3,184.20) 1691039 IR-REMVLOBSTR VENOUS ( 724.67) 1691053 IR-TRANSCATH BX ( 1,456.16) 1691067 IR-DILATION GU ( 6,488.03) 1691070 IR-VENOGRAM EXT BI ( 4,239.08) 1691071 IR-VENOGRAM RENAL UN ( 10,641.19)1691072 IR-VENGRM ADRENAL BI ( 17,070.62)1691073 IR-VENGRM JUGULAR ( 7,439.59) 1691074 IR-PORTOGRAM NO HEM ( 3,931.88) 1691075 IR-VENGRM HEPAT NON ( 10,268.61)1691076 IR-VENOUS SAMPL CATH ( 9,363.38)
1691079 IR-ABSC DRN CATH PLA ( 1,337.63) 1691080 IR-INJ W FLUR CV DEV ( 821.06) 1691083 FL-FLUORO GUIDE SPIN ( 1,049.44) 1691085 IR-ANGIO SPINAL ( 19,343.36)1691087 IR-VENOGRAM EXT UNI ( 3,184.20) 1691090 IR-DRAIN TUBE CHANGE ( 946.13) 1691092 FL-PERC BIL DIL STEN ( 2,230.46) 1691093 IR-VENACAVAGRAM INF ( 11,298.04)1691094 FL-GASTRO TUBE PLACE ( 3,900.86) 1691096 IR-VENOGRAM RENAL BI ( 11,826.56)1691097 IR-VENACAVAGRAM SUP ( 3,184.20) 1691098 IR-VENGRM ADRENAL UN ( 10,268.61)1691099 IR-VENGRM HEPAT HEM ( 9,920.18) 1691100 FL-FLUORO CVAD ANY ( 754.73) 1691108 FL-3D W POSTPROCESS ( 1,479.00) 1691109 IR-INSERTION TIPS ( 3,686.63) 1691110 IR-REVISION TIPS ( 35,115.38)1691111 IR-PRIM ART MECH THR ( 12,597.60)1691117 IR-RPL DUOD JEJ TUBE ( 2,099.96) 1691119 IR-VENOUS MECH THROM ( 15,018.38)1691120 IR-VENOUS M THROM AD ( 1,579.05) 1691124 IR-RM RENAL TUB W FL ( 2,186.96) 1691127 IR-RMV TUN CVC WO SQ ( 2,444.70) 1691128 IR-RMVL TU CVAD W SQ ( 4,331.51) 1691129 IR-EXAM G COLON TUBE ( 645.98) 1691135 IR-PARV INJ C-T L1 ( 2,579.55) 1691136 IR-PARV INJ L-S L1 ( 2,579.55) 1691141 US-VAS ACCSS SITES ( 150.08) 1691142 US-GUIDE NEEDLE PLAC ( 486.11) 1691148 IR-INJ ANES AGNT PLX ( 2,579.55) 1691156 IR-ILIAC REVASC ( 18,361.35)1691157 IR-ILIAC REVAS W SNT ( 35,623.24)1691158 IR-FEM POP REVAS TLA ( 18,361.35)1691159 IR-FEM POP REVAS ATH ( 42,879.04)1691160 IR-FEM POP REVAS SNT ( 38,980.35)1691161 IR-FEM POP STNT ATHR ( 74,261.03)1691162 IR-TIB PER REVS W TL ( 34,976.18)1691163 IR-TIB PER REVAS ATH ( 53,934.56)1691164 IR-TIB PER REVAS SNT ( 53,934.56)1691165 IR-TIB PER RE STN AT ( 77,032.27)1691166 IR-TRANS SNT CCA W E ( 76,309.88)
1691168 IR-TANSEPTI C T INJ ( 2,370.75) 1691170 IR-TRANSEPI INJ L S ( 2,301.15) 1691172 IR-INS TUN IP CATH P ( 8,783.74) 1691173 IR-PERC CHOLECYSTOST ( 11,213.21)1691175 IR-INS CATH RENAR 1U ( 10,720.58)1691176 IR-INS CATH RENAR 1B ( 21,442.24)1691177 IR-INS CATH RENAR 2U ( 9,920.18) 1691178 IR-INS CATH RENAR 2B ( 10,264.26)1691179 IR-INS ENDO VENA CAV ( 16,203.75)1691181 IR-REM ENDO VENA CAV ( 9,034.95) 1691183 IR-ABD PARACEN W IMG ( 1,969.46) 1691185 IR-DEST C T FACT JNT ( 1,087.50) 1691186 IR-DEST L S FAC JNT ( 1,291.95) 1691192 IR-ARTHROGRAM SI JTS ( 985.28) 1691193 IR-ARTHROGRM SI JT B ( 1,035.30) 1691194 IR-THORACNTSIS W IMG ( 3,066.75) 1691195 IR-THORCNT W TUB IMG ( 3,143.96) 1691196 IR-RETRIEVAL CATHETE ( 11,683.01)1691197 IR-TRNSCTH THROM ART ( 9,897.34) 1691198 IR-TRNSCTH THROM VEN ( 9,696.15) 1691199 IR-TRNS THRM ART VN ( 9,696.15) 1691200 IR-TRNCTH CES CTH RM ( 9,897.34) 1691203 IR-ANG EXT CRT NS ( 17,792.59)1691204 IR-ANG CRT EXT CC UN ( 14,911.80)1691205 IR-ANG CRT EXT CC BI ( 29,823.60)1691206 IR-ANG CARTD IPS UNI ( 15,519.71)1691207 IR-ANG CARTD IPS BI ( 31,040.51)1691208 IR-ANG INT CAR IP UN ( 19,343.36)1691209 IR-ANG INT CAR IP BI ( 34,759.76)1691210 IR-ANG SUBCL IPS UNI ( 15,387.04)1691211 IR-ANG SUBCL IPS BI ( 27,361.50)1691212 IR-ANG VERT IPS UNI ( 19,343.36)1691213 IR-ANG VERT IPS BI ( 34,759.76)1691216 IR-DISCOGRAPHY CT ( 11,530.76)1691239 IR-CHG URT STNT PERC ( 7,353.68) 1691240 IR-REM URT STNT PERC ( 1,291.95) 1691242 IR-CATH FLUID COLXN ( 6,244.43) 1691243 IR-CTH FLUID PER RET ( 5,386.39) 1691245 IR-VASC EMB OCC VENO ( 36,933.68)1691246 IR-VASC EMB OCC ARTY ( 36,933.68)1691247 IR-VASC EMB OCC ORGN ( 34,976.18)
1691248 IR-VASC EMB OCC BLED ( 34,976.18)1691249 IR-TC PLC STN ART IN ( 36,608.51)1691250 IR-TC PLC STNT VN IN ( 36,608.51)1691251 IR-CATH FLUID DRAIN ( 3,146.14) 1691255 IR-PERC CERVITHR INJ ( 11,125.13)1691256 IR-PERC LUMBSCRL INJ ( 11,125.13)1691257 IR-PERC VRT AUG THOR ( 26,260.95)1691258 IR-PERC VRT AUG LUMB ( 27,476.78)1691259 IR-PERC SACRPLTY UNI ( 11,923.35)1691260 IR-PERC SACRPSLTY BI ( 11,923.35)1691266 IR-ABL BONE TMR PERC ( 15,267.41)1691267 IR-TRNS CTH PLC CRTD ( 3,584.40) 1691272 NUCLEAR RX INTRA ART ( 1,203.86) 1691273 IR-INJ NEPH URT NEW ( 2,281.58) 1691274 FL-INJ PERC CHOL EXT ( 1,378.95) 1691275 FL-INJ PERC CHOL NEW ( 7,102.46) 1691276 IR-PLC BIL DRCT EXT ( 9,469.95) 1691277 IR-PLC BIL DRCT INEX ( 17,272.76)1691278 IR-CONVR EXT BIL CTH ( 7,102.46) 1691279 IR-EXCHG BIL DR CATH ( 7,102.46) 1691280 IR-RMV BIL DRG CATH ( 6,743.59) 1691281 IR-PRC PL BIL DCT ST ( 17,914.39)1691282 IR-PRC BLDCT ST WOPL ( 17,914.39)1691283 IR-PRC BLDCT ST WPLC ( 17,914.39)1691285 IR-INJ NEPH URT EXST ( 1,333.28) 1691286 IR-PLC NPHROSTMY CTH ( 4,418.51) 1691287 IR-PLC NPHRURTRL CTH ( 6,553.28) 1691288 IR-CNVT NPHSTMY CTH ( 4,418.51) 1691289 IR-EXCHG NPHSTMY CTH ( 5,350.50) 1691290 IR-PLC URTL STNT EXS ( 7,361.29) 1691291 IR-PLC URTL ST NW WO ( 7,361.29) 1691292 IR-PLC URTL ST NEW W ( 9,759.23) 1691296 IR-EVSC ADMN RX 1ST ( 17,458.25)1691297 CT-GUIDE TISSUE ABLA ( 660.11) 1691298 CT-GUIDE NEEDLE BX ( 1,459.43) 1691304 IR-PER ART THRMBCTMY ( 2,395.76) 1691310 IR-TCATH IV STENT IC ( 67,901.33)1691313 S-INTCRN BAL ANG PRC ( 23,226.69)1691314 S-BAL DIL INTC PRC I ( 11,146.88)1691701 IR-CAT DIAL DIAG ANG ( 3,184.20) 1691702 IR-CAT DIAL TRAN BAL ( 17,980.73)
1691703 IR-CAT DIAL TRAN STN ( 41,253.23)1691704 IR-THRMBC DIAG ANGIO ( 17,143.35)1691705 IR-THRMBC TRAN BAL ( 30,479.36)1691706 IR-THRMBC TRAN STENT ( 53,751.86)1691801 IR-TLUM BAL ANG 1STA ( 31,262.36)1691802 IR-TLUM BAL ANG 1STV ( 33,966.98)1691901 IR-DI C-T INJ W IM ( 3,628.99) 1691902 IR-DI L-S INJ W IM ( 3,628.99) 1710900 SPIROMETRY ( 627.19) 1710901 INTUBATION ( 1,579.05) 1710902 SUCTION PROC-NASOTRA ( 695.85) 1710903 ARTERIAL PUNCTURE ( 512.00) 1710904 ABG ANALYSIS ( 321.16) 1710906 BRONCHO EVAL PRE/PST ( 1,025.15) 1710908 VITAL CAPACITY ( 603.92) 1710933 MECH VENT INITIAL ( 2,206.23) 1710934 MECH VENT DAILY SUBS ( 1,454.53) 1710935 BIPAP/CPAP ( 639.99) 1710937 MANIP CHST WALL INIT ( 639.99) 1710938 MANIP CHST WALL SBSQ ( 226.91) 1710943 PULSE OXIMTRY SINGLE ( 16.29) 1710945 PULSE OX OVERNIGHT ( 603.92) 1710946 END-TIDAL CO2 ( 695.85) 1710953 CPR ASSIST (NON ER) ( 1,138.03) 1710969 NEWBORN RESUCITATION ( 2,031.45) 1719000 TRACH TUBE CHANGE ( 1,291.95) 1719002 BEHAV CHG SMOKE U 10 ( 113.10) 1719003 BEHAV CHG SMOKE GR10 ( 113.10) 1719006 SPUTUM SPEC AER TECH ( 667.73) 1719008 CARBON MONOXIDE QUAN ( 503.51) 1719009 METHEMOGLOBIN,QUAN ( 75.04) 1719017 PF TST PLETHYSMOGRA ( 586.16) 1719018 PF TEST BY GAS ( 586.16) 1719020 CO2-MEMBANE DIFF CAP ( 263.18) 1719023 INHALATION TRTMT INI ( 598.13) 1719024 INHALATION TRTMT SUB ( 600.30) 1719025 EVAL-DEMO INHL DEVCE ( 598.13) 1719027 HEMOGLOBIN ( 50.03) 1719032 MECHAN CHST WALL OSC ( 598.13) 1811001 PT EVAL- LOW COMP ( 428.48) 1811002 PT EVAL- MOD COMP ( 428.48)
1811003 PT EVAL- HGH COMP ( 428.48) 1812105 SPLNT SHRT ARM STATC ( 455.66) 1812106 SPLNT SHRT ARM DYNAM ( 392.59) 1812128 APP TRNSCU NEUROSTM ( 277.31) 1812130 BIOFDBK ANORCTL-VIS ( 411.08) 1812131 CANALITH PER DAY ( 215.33) 1812223 MUSL TST W-R EXT ( 125.06) 1812227 ROM W-R EA EXT-TRNK ( 151.16) 1812228 ROM W-R HND W-WO COM ( 188.14) 1812233 PT RE-EVAL-VISIT ( 282.76) 1812238 HOT-COLD PACKS ( 122.18) 1812239 MECH TRACTION-VISIT ( 209.45) 1812241 VASPNEUMATIC DEV-VIS ( 322.99) 1812242 PARAFFIN BATH-VISIT ( 155.93) 1812243 WHIRLPOOL THRPY-VIST ( 242.03) 1812247 ELEC STIM-MAN-15 MIN ( 201.31) 1812248 IONTOPHORESIS-15 MIN ( 186.18) 1812250 ULTRASOUND-15 MIN ( 308.36) 1812253 THERAP EXERCS-15 MIN ( 180.36) 1812254 NEURO RE-ED-15 MIN ( 216.43) 1812255 AQUA THRPY-15 MIN ( 203.63) 1812256 GAIT TRAINING-15 MIN ( 236.22) 1812257 MASSAGE THRPY-15 MIN ( 196.65) 1812260 MANUAL THRPY-15 MIN ( 155.93) 1812261 GROUP THRP PROC-VIST ( 80.29) 1812262 THERAP ACTVTS-15 MIN ( 162.91) 1812264 SENSORY INTEG-15 MIN ( 158.78) 1812265 SELF CARE MGT-15 MIN ( 112.01) 1812266 COM-WRK REINT-15 MIN ( 212.06) 1812267 WHEELCHR MGT-15 MIN ( 104.73) 1812270 DEBRIDE LE 20 SQ CM ( 637.67) 1812273 DEBRIDE NON-SELC-VIS ( 505.69) 1812276 PHYSICAL PERF-15 MIN ( 126.84) 1812278 ORTH TRAIN INI-15 MI ( 276.23) 1812279 PROS TRAIN INI-15 MI ( 133.82) 1812280 PROS-ORTH SUB-15 MIN ( 119.63) 1812301 ESTEM UNATD A-30 DAY ( 175.09) 1812303 ELEC STIM-UNATTND-VI ( 196.65) 1812333 DEBRIDE EA ADD 20CM ( 493.73) 1812335 NEG PRES WND LT 50CM ( 340.39) 1821001 PT EVAL- LOW COMP ( 428.48)
1821002 PT EVAL- MOD COMP ( 428.48) 1821003 PT EVAL- HGH COMP ( 428.48) 1822105 SPLNT SHRT ARM STATC ( 455.66) 1822106 SPLNT SHRT ARM DYNAM ( 392.59) 1822108 SPLNT FINGER DYNAM ( 356.70) 1822128 APP TRNSCU NEUROSTM ( 277.31) 1822130 BIOFDBK ANORCTL-VIS ( 411.08) 1822131 CANALITH PER DAY ( 215.33) 1822223 MUSL TST W-R EXT ( 125.06) 1822224 MUSL TST W-R HAND ( 165.30) 1822227 ROM W-R EA EXT-TRNK ( 151.16) 1822228 ROM W-R HND W-WO COM ( 107.66) 1822233 PT RE-EVAL-VISIT ( 252.30) 1822238 HOT-COLD PACKS ( 108.75) 1822239 MECH TRACTION-VISIT ( 195.75) 1822241 VASPNEUMATIC DEV-VIS ( 322.99) 1822242 PARAFFIN BATH-VISIT ( 145.73) 1822243 WHIRLPOOL THRPY-VIST ( 215.33) 1822247 ELEC STIM-MAN-15 MIN ( 179.44) 1822248 IONTOPHORESIS-15 MIN ( 165.30) 1822250 ULTRASOUND-15 MIN ( 288.19) 1822251 HUBBARD TANK EA15 MN ( 319.73) 1822253 THERAP EXERCS-15 MIN ( 168.56) 1822254 NEURO RE-ED-15 MIN ( 202.28) 1822255 AQUA THRPY-15 MIN ( 190.31) 1822256 GAIT TRAINING-15 MIN ( 220.76) 1822257 MASSAGE THRPY-15 MIN ( 183.79) 1822260 MANUAL THRPY-15 MIN ( 145.73) 1822261 GROUP THRP PROC-VIST ( 75.04) 1822262 THERAP ACTVTS-15 MIN ( 152.25) 1822263 COG SKILL DEV-15 MIN ( 115.28) 1822264 SENSORY INTEG-15 MIN ( 158.78) 1822265 SELF CARE MGT-15 MIN ( 112.01) 1822266 COM-WRK REINT-15 MIN ( 212.06) 1822267 WHEELCHR MGT-15 MIN ( 97.88) 1822270 DEBRIDE LE 20 SQ CM ( 567.68) 1822273 DEBRIDE NON-SELC-VIS ( 505.69) 1822276 PHYSICAL PERF-15 MIN ( 118.54) 1822278 ORTH TRAIN INI-15 MI ( 263.18) 1822279 PROS TRAIN INI-15 MI ( 125.06) 1822280 PROS-ORTH SUB-15 MIN ( 119.63)
1822301 ESTEM UNATD A-30 DAY ( 175.09) 1822303 ELEC STIM-UNATTND-VI ( 183.79) 1822314 ORAL FUNCTION TX-VIS ( 312.11) 1822333 DEBRIDE EA ADD 20CM ( 469.80) 1822335 NEG PRES WND LT 50CM ( 340.39) 1851001 OT EVAL- LOW COMP ( 299.06) 1851002 OT EVAL- MOD COMP ( 299.06) 1851003 OT EVAL- HGH COMP ( 299.06) 1852105 SPLNT SHRT ARM STATC ( 512.00) 1852106 SPLNT SHRT ARM DYNAM ( 420.07) 1852108 SPLNT FINGER DYNAM ( 381.67) 1852128 APP TRNSCU NEUROSTM ( 264.26) 1852130 BIOFDBK ANORCTL-VIS ( 391.50) 1852223 MUSL TST W-R EXT ( 125.06) 1852224 MUSL TST W-R HAND ( 165.30) 1852227 ROM W-R EA EXT-TRNK ( 151.16) 1852228 ROM W-R HND W-WO COM ( 188.14) 1852235 OT RE-EVAL-VISIT ( 189.67) 1852238 HOT-COLD PACKS ( 122.18) 1852241 VASPNEUMATIC DEV-VIS ( 345.60) 1852242 PARAFFIN BATH-VISIT ( 162.91) 1852243 WHIRLPOOL THRPY-VIST ( 230.40) 1852247 ELEC STIM-MAN-15 MIN ( 201.31) 1852248 IONTOPHORESIS-15 MIN ( 186.18) 1852250 ULTRASOUND-15 MIN ( 308.36) 1852253 THERAP EXERCS-15 MIN ( 180.36) 1852254 NEURO RE-ED-15 MIN ( 216.43) 1852255 AQUA THRPY-15 MIN ( 190.31) 1852256 GAIT TRAINING-15 MIN ( 210.98) 1852257 MASSAGE THRPY-15 MIN ( 196.65) 1852260 MANUAL THRPY-15 MIN ( 155.93) 1852261 GROUP THRP PROC-VIST ( 66.33) 1852262 THERAP ACTVTS-15 MIN ( 162.91) 1852263 COG SKILL DEV-15 MIN ( 123.34) 1852264 SENSORY INTEG-15 MIN ( 179.20) 1852265 SELF CARE MGT-15 MIN ( 125.67) 1852266 COM-WRK REINT-15 MIN ( 226.91) 1852270 DEBRIDE LE 20 SQ CM ( 607.41) 1852273 DEBRIDE NON-SELC-VIS ( 505.69) 1852278 ORTH TRAIN INI-15 MI ( 295.56) 1852280 PROS-ORTH SUB-15 MIN ( 128.00)
1852301 ESTEM UNATD A-30 DAY ( 175.09) 1852303 ELEC STIM-UNATTND-VI ( 187.34) 1852333 DEBRIDE EA ADD 20CM ( 469.80) 1861001 OT EVAL- LOW COMP ( 284.93) 1861002 OT EVAL- MOD COMP ( 284.93) 1861003 OT EVAL- HGH COMP ( 284.93) 1862102 CAST APP GAUNTLET ( 904.80) 1862104 SPLNT LONG ARM S-H ( 464.36) 1862105 SPLNT SHRT ARM STATC ( 455.66) 1862106 SPLNT SHRT ARM DYNAM ( 392.59) 1862107 SPLNT FINGER STATIC ( 377.36) 1862108 SPLNT FINGER DYNAM ( 356.70) 1862111 STRAPPING SHOULDER ( 619.88) 1862128 APP TRNSCU NEUROSTM ( 264.26) 1862130 BIOFDBK ANORCTL-VIS ( 391.50) 1862223 MUSL TST W-R EXT ( 125.06) 1862224 MUSL TST W-R HAND ( 165.30) 1862227 ROM W-R EA EXT-TRNK ( 151.16) 1862228 ROM W-R HND W-WO COM ( 188.14) 1862235 OT RE-EVAL-VISIT ( 168.56) 1862238 HOT-COLD PACKS ( 108.75) 1862241 VASPNEUMATIC DEV-VIS ( 322.99) 1862242 PARAFFIN BATH-VISIT ( 145.73) 1862243 WHIRLPOOL THRPY-VIST ( 215.33) 1862247 ELEC STIM-MAN-15 MIN ( 179.44) 1862248 IONTOPHORESIS-15 MIN ( 165.30) 1862250 ULTRASOUND-15 MIN ( 274.05) 1862253 THERAP EXERCS-15 MIN ( 159.86) 1862254 NEURO RE-ED-15 MIN ( 192.49) 1862255 AQUA THRPY-15 MIN ( 190.31) 1862256 GAIT TRAINING-15 MIN ( 210.98) 1862257 MASSAGE THRPY-15 MIN ( 175.09) 1862260 MANUAL THRPY-15 MIN ( 138.11) 1862261 GROUP THRP PROC-VIST ( 61.99) 1862262 THERAP ACTVTS-15 MIN ( 144.64) 1862263 COG SKILL DEV-15 MIN ( 115.28) 1862264 SENSORY INTEG-15 MIN ( 158.78) 1862265 SELF CARE MGT-15 MIN ( 112.01) 1862266 COM-WRK REINT-15 MIN ( 212.06) 1862270 DEBRIDE LE 20 SQ CM ( 567.68) 1862273 DEBRIDE NON-SELC-VIS ( 505.69)
1862278 ORTH TRAIN INI-15 MI ( 263.18) 1862279 PROS TRAIN INI-15 MI ( 125.06) 1862280 PROS-ORTH SUB-15 MIN ( 119.63) 1862301 ESTEM UNATD A-30 DAY ( 175.09) 1862303 ELEC STIM-UNATTND-VI ( 175.09) 1862333 DEBRIDE EA ADD 20CM ( 469.80) 1872130 BIOFDBK ANORCTL-VIS ( 391.50) 1872190 SP EVAL VOICE PROS D ( 526.35) 1872195 SP-LARYNGOSC W-STROB ( 1,403.96) 1872196 SP EVAL SP DEV 1STHR ( 479.41) 1872200 SP ADAPT TRAIN DEVIC ( 361.89) 1872202 SP EVAL SWL WO RADOP ( 678.39) 1872204 EVAL SWALLO W-RADOPQ ( 679.56) 1872206 SP ENDO EVAL SWAL WR ( 820.36) 1872218 EV REHB PRELING HEAR ( 191.40) 1872219 EV REHB POSTING HEAR ( 177.26) 1872222 EV SP FLUENCY ( 431.74) 1872223 EV SP PROD ( 431.74) 1872224 SP SOUND LANG COMP ( 655.76) 1872225 BEHAV QL ANAL VOICE ( 431.74) 1872229 APHASIA ASSESS-HOUR ( 403.78) 1872263 COG SKILL DEV-15 MIN ( 123.34) 1872264 SENSORY INTEG-15 MIN ( 169.89) 1872265 SELF CARE MGT-15 MIN ( 112.01) 1872308 SP-HEAR-TX-INDI VIST ( 442.18) 1872314 ORAL FUNCTION TX-VIS ( 333.96) 1872405 AURAL EVAL 1ST HOUR ( 564.41) 1872406 AU EVAL EA ADD 15MIN ( 63.08) 1882130 BIOFDBK ANORCTL-VIS ( 391.50) 1882190 SP EVAL VOICE PROS D ( 526.35) 1882196 SP EVAL SP DEV 1STHR ( 448.05) 1882200 SP ADAPT TRAIN DEVIC ( 338.21) 1882202 SP EVAL SWL WO RADOP ( 603.56) 1882204 EVAL SWALLO W-RADOPQ ( 604.65) 1882206 SP ENDO EVAL SWAL WR ( 766.69) 1882218 EV REHB PRELING HEAR ( 191.40) 1882219 EV REHB POSTING HEAR ( 177.26) 1882222 EV SP FLUENCY ( 411.08) 1882223 EV SP PROD ( 431.74) 1882224 SP SOUND LANG COMP ( 655.76) 1882225 BEHAV QL ANAL VOICE ( 411.08)
1882229 APHASIA ASSESS-HOUR ( 377.36) 1882231 DEVELOP TEST W-RPT ( 564.41) 1882263 COG SKILL DEV-15 MIN ( 115.28) 1882264 SENSORY INTEG-15 MIN ( 158.78) 1882265 SELF CARE MGT-15 MIN ( 112.01) 1882308 SP-HEAR-TX-INDI VIST ( 413.25) 1882314 ORAL FUNCTION TX-VIS ( 312.11) 1882405 AURAL EVAL 1ST HOUR ( 564.41) 1882406 AU EVAL EA ADD 15MIN ( 63.08) 1913221 BRIEF ED VISIT ( 374.69) 1913222 LIMITED ED VISIT ( 791.27) 1913223 INTERMEDIATE ED VIST ( 1,247.41) 1913224 EXTENDED ED VISIT ( 1,297.44) 1913225 COMPREHENSIVE ED VST ( 2,027.03) 1913226 CRITICAL CARE LT 74M ( 2,615.83) 1913227 CRIT CARE EA 30 MIN ( 587.63) 1913228 THER AD IVP SAME MED ( 335.12) 1913229 IMM ADM EA ADD VACC ( 177.26) 1913230 MINOR PROCEDURE ( 408.43) 1913231 INTERMEDIATE PROCEDR ( 1,190.39) 1913232 MAJOR PROCEDURE ( 2,171.32) 1913233 CPR ( 1,083.33) 1913234 NI-TEMP EXT PACE ( 1,741.95) 1913239 NI-CARDIOVERSION ( 1,741.95) 1913241 G TUBE REPLACEMENT ( 1,382.39) 1913242 IMM ADM 1ST VACCINE ( 208.29) 1913246 BLOOD TRANSFUSION ( 1,186.90) 1913248 THERAPEUTIC DX SQ IM ( 208.29) 1913249 INJECTION IV PUSH ( 436.36) 1913252 TRIAGE ONLY ( 300.22) 1913253 SUTURE REMOVAL/RECHE ( 300.22) 1913254 SIMPLE PROCEDURE ( 407.27) 1913255 DIALYSIS EMERGENT ( 3,188.55) 1913256 IV HYDRATION 1 HR ( 436.36) 1913257 IV HYDRAT EA ADD HR ( 367.71) 1913258 THERA EA AD IV PUSH ( 265.31) 1913259 IV THERAPY DX 1 HR ( 709.81) 1913260 IV THERAPY EA AD HR ( 126.84) 1913261 CONCURRENT IV THER ( 302.54) 1913262 IV THER AD SEQ 1 HR ( 344.43) 2010220 MNT INITIAL EA 15 MN ( 160.95)
2010221 MNT REASSES EA 15 MN ( 121.80) 2010222 MNT GROUP EA 30 MIN ( 55.46) 2010223 MNT 2ND REF EA 15 MN ( 121.80) 2010225 DSMT INDIVIDUAL 30M ( 220.89) 2041000 HEMODIALY SING EVAL ( 3,135.97) 2041006 DIALYSIS EMERGENT ( 3,347.33) 2070201 LEVEL 1 EP ( 280.58) 2070202 LEVEL 2 EP ( 345.83) 2070203 LEVEL 3 EP ( 351.26) 2070204 LEVEL 4 EP ( 404.55) 2070205 LEVEL 5 EP ( 489.38) 2070212 LEVEL 2 NP ( 336.04) 2070213 LEVEL 3 NP ( 408.90) 2070214 LEVEL 4 NP ( 460.01) 2070215 LEVEL 5 NP ( 600.30) 2070222 PROC WND CARE SIMPLE ( 854.78) 2070223 PROC WND CARE MINOR ( 602.48) 2070224 PROC WND CARE INTERM ( 1,065.75) 2070225 PROC WND CARE MAJOR ( 2,987.36) 2070226 PROC WND CARE COMPLX ( 6,902.36) 2070230 DEBRIDE LE 20 SQ CM ( 595.95) 2070232 NON SELECTIVE DEBRID ( 530.70) 2072333 DEBRIDE EA ADD 20CM ( 493.73) 2072335 NEG PRES WND LT 50CM ( 357.79) 2072337 NEG PRES WND GT 50CM ( 536.14) 2080001 HBO MEDICARE FB 30MN ( 528.53) 2080002 HBO COMM PER SESSION ( 2,054.29) 2082801 US-EXT ARTERIAL LTD ( 765.60) 2082802 US-NON INV ARTER EXT ( 1,065.75) 2270100 MULTI SLEEP LAT ( 5,650.56) 2270104 SLPSTDY UNATT RS EFF ( 966.79) 2270105 SLEEP TITRATE ATT ( 4,061.81) 2270112 POLYSOMNO GT4 GE6YO ( 5,253.71) 2270113 POLYS-CPAP GT4 GE6YO ( 5,366.81) 2270122 HOME SLEEP TYPE 2 ( 660.11) 2270123 HOME SLEEP TYPE 3 ( 699.26) 2520000 HE-EYE FOREIGNBDY CR ( 488.29) 2520002 HE-MANDIBLE LTD CR ( 254.48) 2520003 HE-MANDIBLE 4VPLS CR ( 550.28) 2520004 HE-MASTOIDS LTD CR ( 544.84) 2520005 HE-MASTOID 3VPLUS CR ( 799.31)
2520008 HE-FACIAL BNS LTD CR ( 307.76) 2520009 HE-FACIAL BNES 3V CR ( 561.15) 2520010 HE-NASAL BONES CR ( 421.95) 2520013 HE-ORBITS 4V CR ( 610.09) 2520014 HE-SINUSES LTD CR ( 283.84) 2520015 HE-SINUSES 3VPLUS CR ( 801.49) 2520017 HE-SKULL LIMITED CR ( 457.84) 2520018 HE-SKULL 4V PLUS CR ( 645.98) 2520023 HE-TMJ BILATERAL CR ( 631.84) 2520029 SP-NECK SOFT TISS CR ( 357.79) 2520035 CT-HEAD WO ( 1,257.15) 2520036 CT-HEAD W ( 1,623.64) 2520037 CT-HEAD WWO ( 1,968.38) 2520063 CH-CHEST 1V CR ( 270.79) 2520065 CH-CHEST 2V CR ( 244.69) 2520067 CH-CHEST 3V CR ( 569.85) 2520073 CH-RIBS UNILAT CR ( 363.23) 2520074 CH-RIB UNI PA CXR CR ( 589.43) 2520075 CH-RIBS BILATERAL CR ( 332.78) 2520076 CH-RIBS BI PA CXR CR ( 657.94) 2520077 CH-STERNUM CR ( 433.91) 2520078 CH-STRNOCLAV JNTS CR ( 401.29) 2520079 CT-CHEST WO ( 1,389.83) 2520080 CT-CHEST W ( 1,682.36) 2520081 CT-CHEST WWO ( 2,285.93) 2520087 SP-SPINE SNGL VW CR ( 389.33) 2520088 SP-CERV SP 2TO3VW CR ( 328.43) 2520092 SP-T SPINE 2 VIEW CR ( 328.43) 2520093 SP-T SPINE 3 VIEW CR ( 332.78) 2520094 SP-T SPNE 4PLUS V CR ( 328.43) 2520095 SP-THORACOLMBR 2V CR ( 522.00) 2520097 SP-LS SPN 2 TO 3V CR ( 328.43) 2520098 SP-LS SPNE 4VPLUS CR ( 735.15) 2520099 SP-LS SPINE W BND CR ( 411.08) 2520100 SP-LS SPINE BND CR ( 595.95) 2520120 LE-PELVIS CR ( 480.68) 2520121 LE-PELVIS 3V PLUS CR ( 429.56) 2520123 CT-PELVIS WO ( 1,353.94) 2520124 CT-PELVIS W ( 1,770.45) 2520125 CT-PELVIS WWO ( 2,052.11) 2520130 SP-SI JNTS 3VPLUS CR ( 449.14)
2520131 SP-SCRM COCCYX 2V CR ( 595.95) 2520141 UE-CLAVICLE CR ( 1,237.58) 2520142 UE-CLAVICLE BILAT CR ( 777.56) 2520143 UE-SCAPULA CR ( 530.70) 2520145 UE-SHOULDER 1V BI CR ( 763.43) 2520146 UE-SHOULDER 1V CR ( 381.71) 2520147 UE-SHOULDER 2V BI CR ( 1,711.73) 2520148 UE-SHLDR 2VW PLUS CR ( 855.86) 2520151 UE-AC JTS BILAT CR ( 417.60) 2520152 UE-HUMERUS CR ( 754.73) 2520153 UE-HUMERUS BILAT CR ( 1,510.54) 2520154 UE-ELBOW 2V CR ( 785.18) 2520155 UE-ELBOW 2VW BI CR ( 1,571.44) 2520156 UE-ELBOW 3V CR ( 681.86) 2520160 UE-FOREARM 2V CR ( 620.96) 2520161 UE-FOREARM 2VW BI CR ( 1,240.84) 2520163 UE-UP EXT INFANT CR ( 801.49) 2520164 UE-WRIST 2V CR ( 634.01) 2520165 UE-WRIST 2VW BI CR ( 1,269.11) 2520166 UE-WRIST 3VW BI CR ( 1,597.54) 2520167 UE-WRIST 3V PLUS CR ( 798.23) 2520170 UE-HAND 2V CR ( 336.04) 2520171 UE-HAND 2VWS BI CR ( 673.16) 2520172 UE-HAND 3V CR ( 803.66) 2520173 UE-HAND 3VWS BI CR ( 1,608.41) 2520174 UE-FINGER S 2VPLS CR ( 403.46) 2520175 UE-FINGER 2 VW BI CR ( 762.34) 2520198 LE-HIP UNILAT 1V CR ( 289.28) 2520207 LE-FEMUR 2V CR ( 848.25) 2520208 LE-FEMUR 2VW BI CR ( 1,696.50) 2520209 LE-KNEE 1 TO 2V CR ( 801.49) 2520210 LE-KNEE 1TO2V BI CR ( 1,602.98) 2520211 LE-KNEE 3V CR ( 790.61) 2520212 LE-KNEE 3VWS BI CR ( 1,580.14) 2520213 LE-KNEE 4VWPLS BI CR ( 1,770.45) 2520214 LE-KNEE 4V PLUS CR ( 885.23) 2520215 LE-KNEE BI AP STD CR ( 388.24) 2520218 LE-TIB FIB 2V BI CR ( 1,595.36) 2520219 LE-TIB FIB 2V CR ( 798.23) 2520221 LE-LWR EXT INFANT CR ( 825.41) 2520222 LE-ANKLE 2V CR ( 724.28)
2520223 LE-ANKLE 2VW BI CR ( 1,449.64) 2520224 LE-ANKLE 3VWS BI CR ( 1,622.55) 2520225 LE-ANKLE 3VPLUS CR ( 811.28) 2520228 LE-FOOT 2V CR ( 547.01) 2520230 LE-FOOT 3V PLUS CR ( 805.84) 2520231 LE-FOOT 3VWPLS BI CR ( 1,611.68) 2520232 LE-CALCANEUS 2PLS CR ( 425.21) 2520233 LE-CALCNEUS 2V BI CR ( 801.49) 2520234 LE-TOE S 2VWS BI CR ( 386.06) 2520235 LE-TOE S 2VPLUS CR ( 386.06) 2520256 CH-ABDOMEN 1 VIEW CR ( 336.04) 2520258 CH-ABDOMEN 3VWS CR ( 381.71) 2520259 CH-ABD SER PA CXR CR ( 752.55) 2520260 CT-ABDOMEN WO ( 1,515.98) 2520261 CT-ABDOMEN W ( 1,711.73) 2520262 CT-ABDOMEN WWO ( 2,408.81) 2520268 FL-ESOPHAGUS ( 513.30) 2520270 FL-GI SERIES ( 1,103.81) 2520271 FL-GI SERIES W KUB ( 1,032.04) 2520272 FL-GI W SM BOWEL ( 1,431.15) 2520276 FL-SMALL BOWEL CR ( 893.93) 2520282 FL-BARIUM ENEMA ( 1,261.50) 2520283 FL-BARIUM ENEMA AIR ( 1,407.23) 2520296 FL-IVP CR ( 1,285.43) 2520298 FL-UROGRAPH W TOM CR ( 1,009.20) 2520300 FL-UROGRAPHY ANTE CR ( 1,584.49) 2520301 FL-CYSTOGRM 3VPLS CR ( 945.04) 2520302 FL-UCG RETRO CR ( 1,360.46) 2520303 FL-UCG VOIDING CR ( 945.04) 2520308 IR-HYSTERSALPINGO CR ( 1,165.80) 2520326 FL-FLUORO 1 HOUR CR ( 574.20) 2520329 IR-FISTULOGRAM CR ( 1,165.80) 2520331 TOMOGRAM ONE PLNE CR ( 450.23) 2520354 US-HEAD NECK SFT TIS ( 623.14) 2520355 US-CHEST MEDIASTINUM ( 493.73) 2520357 US-ABDOMEN COMP WO ( 815.63) 2520358 US-ABDOMEN LTD WO ( 587.25) 2520359 US-ABDOMEN RETROPER ( 613.35) 2520360 US-ABDOMEN RETRO LMT ( 576.38) 2520361 US-KIDNEY TRANSPLANT ( 493.73) 2520363 US-PELV PREG 14 WKS ( 554.63)
2520365 US-PELVIS PREG ( 846.08) 2520371 US-PELVIS PREG LTD ( 493.73) 2520372 US-PLV PREG FU ABD ( 387.15) 2520373 US-PLV PRG TRNSV ( 493.73) 2520375 US-FETAL BIO NONST ( 880.88) 2520382 US-TRANSVAGINAL ( 603.56) 2520384 US-PELVIS NON OB ( 613.35) 2520385 US-PELVIS NON OB FU ( 418.69) 2520386 US-SCROTUM ( 605.74) 2520390 US-HIPS INFANT W MAN ( 545.93) 2520398 US-GUIDE NEEDLE PLAC ( 463.28) 2520428 STRESS VIEWS JOINT ( 232.73) 2520429 BONE AGE STUDY CR ( 328.43) 2520430 BONE LENGTH STUDY CR ( 387.15) 2520431 BNE SRVY LTD METS CR ( 539.40) 2520432 BNE SRVY CMP METS CR ( 552.45) 2520445 US-CAROTID DPLX SCAN ( 3,549.60) 2520456 US-EXT VEINS DPLX WC ( 1,270.20) 2520457 US-EXT VEINS DPX LTD ( 878.70) 2520459 US-ABD RETROPER DPLX ( 965.70) 2520494 US-ABDOMN AAA SCREEN ( 505.69) 2520504 US-EXT LTD JNT UNI ( 1,281.08) 2520506 CT-ABD PELVIS WO ( 3,048.26) 2520507 CT-ABD PELVIS W ( 3,571.35) 2520508 CT-ABD PELVIS WWO ( 4,918.76) 2520509 SP-CERV SP 4TO5VW CR ( 802.58) 2520510 SP-CRV SPNE 6VPLS CR ( 798.23) 2520543 SP-ENT SPN 2OR3 V CR ( 438.26) 2520546 LE-FEMUR 1V CR ( 264.26) 2520547 LE-HIP PV UN2OR3V CR ( 445.88) 2520548 LE-HIP PV UNMIN4V CR ( 668.81) 2520549 LE-HIP PLV BI 2V CR ( 438.26) 2520550 LE-HIP PV BI3OR4V CR ( 438.26) 2520551 LE-HIP PV BI MIN5VCR ( 835.20) 2811142 S-INJ EPI BLD PATCH ( 2,579.55) 2811151 S-BRST DUCTOGRM INJ ( 948.30) 2811159 S-INSRT CANNLA PERM ( 1,087.50) 2811167 INJ GAD-MR1 CONTR ML ( 24.29) 2811178 TC-99M SESTA / DOSE ( 1,120.57) 2811179 TC-99M TETRO/UNITDOS ( 1,222.35) 2811180 TC99M MEDRO TO 30MCI ( 297.89)
2811182 TL-201, PER MCI ( 182.70) 2811183 IN111 CAPRO PEND/DO ( 17,155.31)2811184 I131 PER 0.5 MCI ( 7,913.74) 2811189 I123 CAP,DX /100UCI ( 182.69) 2811190 TC99M EXAME / DOSE ( 3,662.70) 2811191 TC99M MEBROF /15MCI ( 399.12) 2811192 I131 SOD ID TX / MCI ( 143.55) 2811194 TC99M BICISATE/DOSE ( 4,519.65) 2811196 TC99M LABL RBC/30MCI ( 958.83) 2811198 I131 S I CAP DX/MCI ( 245.78) 2811203 TC99M PERTECHNET/MCI ( 23.27) 2811204 HOCM LT149 MG ML IOD ( 0.24) 2811209 HOCM 350-399MGML IOD ( 0.62) 2811211 TC99M PYROPHOS/25MCI ( 155.51) 2811212 TC99M PENTETAT/25MCI ( 140.29) 2811213 TC99M MAA/10MCI ( 151.27) 2811214 TC99M SULF COL/20MCI ( 1,746.60) 2811220 IN111 OXYQUINO/.5MCI ( 5,837.70) 2811221 IN111 PENTETAT/.5MCI ( 1,760.66) 2811222 TC99M SUCCIMER/10MCI ( 943.95) 2811223 F18 FDG / 45 MCI ( 4,071.60) 2811227 GA67 GALLIUM/MCI ( 295.56) 2811228 XE133 XENON 10MCI ( 366.54) 2811230 TC99M OXIDRONA/30MCI ( 190.31) 2811231 TC99M MERTIATI/15MCI ( 1,994.45) 2811236 LOCM 100-199MG/ML ML ( 11.96) 2811238 LOCM 200-299MG/ML ML ( 6.88) 2811240 LOCM 300-399MG/ML ML ( 5.15) 2811241 LOC2 300-399MG/ML ML ( 6.53) 2811290 S-ASPIR DECOMPR DISK ( 9,776.63) 2811294 S-ART CATH CAN SAMPL ( 175.09) 2811297 S-PNCTR ASP HEMA-CY ( 614.44) 2811298 S-DISKOGRM INJ LUMB ( 1,087.50) 2811301 S-PRI ART M THRO ADD ( 12,020.14)2811302 S-SEC ART M THRO ADD ( 10,276.88)2811309 S-PER PF ABL REN TUM ( 15,811.16)2811317 S-SHUNT TUBE PUNCTUR ( 1,772.63) 2811318 S-THYROID CORE BX ( 1,894.38) 2811324 S-CYSTOST TUBCHG SIM ( 753.64) 2811325 S-ASP BLDR W/SPU C ( 4,852.43) 2811330 S-ABD/RETRPER NDL BX ( 3,823.65)
2811334 S-PANCREAS BX PERC ( 3,823.65) 2811336 S-BIL ENDO W BX ( 16,205.93)2811337 S-BIL ENDO VIA TTUBE ( 8,045.33) 2811353 S-INS PICC WO SQP U5 ( 3,272.29) 2811354 S-TENDON-LIG INJ ( 734.10) 2811362 S-CYSTOGRAM INJ ( 600.43) 2811364 S-RETROURETHROCY INJ ( 491.55) 2811367 S-INJ CATH HYSTERSO ( 1,051.92) 2811369 S-MYELOGRAM INJ ( 1,611.68) 2811395 S-JNT ASP INJ MAJ UN ( 862.39) 2811397 S-BLOOD SAMPLING VEI ( 785.18) 2811398 S-INS TU CVC WOPU O5 ( 9,697.24) 2811403 S-RPL COMP NT CVC WO ( 4,023.75) 2811404 S-RPLC COMP T CVC WO ( 10,073.51)2811405 S-RPL COM TCVAD PORT ( 1,392.00) 2811406 S-RPL COMP PICC WO ( 4,569.68) 2811410 S-ME RM PERIC OB CVD ( 10,268.61)2811412 S-INTRO GAST TUBE ( 2,639.36) 2811414 S-INJ SHOULDER ARTH ( 588.79) 2811419 S-INJ WRIST ARTHRO ( 474.15) 2811420 S-INJ ELBOW ARTHRO ( 1,291.95) 2811421 S-INJ KNEE ARTHRO ( 281.66) 2811422 S-INJ HIP ARTHRO ( 465.45) 2811424 S-TUBE THORACOSTOMY ( 1,868.33) 2811425 S-BX NDL PLEURA ( 3,823.65) 2811426 S-BX NDL LUNG MEDIA ( 3,823.65) 2811432 S-BX NDL LIVER ( 3,823.65) 2811433 S-ASP/INJ RENL CYST ( 3,823.65) 2811435 S-SPINAL TAP DIAGNST ( 1,362.64) 2811436 S-NON-CNS EMBL/OCCL ( 41,508.79)2811437 S-CNS EMBL/OCCL ( 7,953.98) 2811439 S-INJ ILEAL CONDUIT ( 487.20) 2811442 S-DIL NEPH TRACT ( 7,728.86) 2811445 S-RENAL BX NEEDLE ( 3,823.65) 2811447 S-INJ CONT BY TUB CY ( 257.74) 2811448 S-DRNG CATH CHANGE ( 6,101.96) 2811450 S-STONE REMVL T-TUBE ( 10,274.70)2811451 S-BI END PRC W STNT ( 15,811.16)2811459 S-REPOSITION FEEDTUB ( 1,291.95) 2811460 S-CHNG GASTROST TUBE ( 1,160.36) 2811467 S-TRANSCATH BX ( 9,034.95)
2811470 S-REPOS CVAD W FLUOR ( 3,722.51) 2811471 S-INS PICC WO SQ O5 ( 4,099.88) 2811472 S-INS NT CVC GT 5YR ( 4,173.83) 2811473 S-INS CENTRAL PORT ( 11,140.35)2811474 S-PORTAL VEIN CATH ( 8,078.34) 2811480 S-SINUS TRCT INJ DIA ( 232.73) 2811482 S-BX BONE DEEP ( 6,565.24) 2811483 S-BX BONE SUPRFCL ( 3,002.59) 2811485 S-FIN NDL ASP W/IMG ( 2,388.15) 2811488 S-INJ EXTREMPSEUDOAN ( 2,776.39) 2811489 S-INJ VENOGRAPHY ( 2,192.00) 2811490 S-INTROCATH VENACAVA ( 842.00) 2811491 S-INTROCATH VEN 1ST ( 339.00) 2811492 S-INTROCATH VEN 2ND ( 463.00) 2811493 S-INTROCATH RHRT-PUL ( 504.80) 2811494 S-INTROCATH R L PULM ( 491.00) 2811495 S-INTROCATH SEGPULM ( 701.72) 2811513 S-CATH EXTREM ART ( 542.32) 2811516 S-INTROCATH AORTA ( 1,124.48) 2811517 S-THORACIC 1ST ORDER ( 1,626.90) 2811518 S-THORACIC 2ND ORDER ( 2,874.26) 2811519 S-THORACIC 3RD ORDER ( 2,321.81) 2811520 S-THORACIC ADD ORDER ( 2,186.96) 2811521 S-ABDOMEN 1ST ORDER ( 1,596.45) 2811522 S-ABDOMEN 2ND ORDER ( 1,456.16) 2811523 S-ABDOMEN 3RD ORDER ( 1,533.38) 2811524 S-ABDOMEN ADD ORDER ( 391.50) 2811525 S-DECLOT VASC DEV ( 896.10) 2811533 THERAPEUTIC IV PUSH ( 407.81) 2811546 S-BX LYMPH SUPRF NDL ( 3,823.65) 2811550 S-DIAG BONE MAR ASPI ( 2,915.59) 2811551 S-DIAG BONE MAR BX ( 3,002.59) 2811557 S-THYRODCYST ASP/INJ ( 1,770.45) 2811558 S-SALIVARY GLAND BX ( 2,703.53) 2811559 S-ID SENTINEL NODE ( 1,089.15) 2811564 S-BRST CYST ASPIRAT ( 1,770.45) 2811565 S-BRST ADDL CYST ( 1,087.50) 2811567 S-BX MUSCLE PERC NDL ( 3,823.65) 2811584 TC-99M AUTO WBC/DOSE ( 8,048.37) 2811585 IN-111 AUTO WBC/DOSE ( 7,782.15) 2811587 IN-111 PENTETRE/6MCI ( 11,710.20)
2811589 INJ MULTIHANCE /ML ( 8.35) 2811590 INJ MULTIHANCE MU/ML ( 8.35) 2811592 S-BIOPSY SKIN 1 LES ( 736.24) 2811602 S-BIOP SIMP SOFT TIS ( 3,002.59) 2811607 S-INS PLEURAL CATH ( 8,733.48) 2811619 S-N BLOCK INJ ILIO ( 1,362.64) 2811635 S-N BLOC INJ INTERCO ( 2,205.36) 2811636 S-N BLOC INJ INT MUL ( 2,267.44) 2811640 S-N BLOC INJ LUMBAR ( 1,909.65) 2811657 S-PERC CRYO ABL RENL ( 1,579.05) 2811664 IOBENGUAN I123 15MCI ( 16,686.60)2811665 S-INTERDISK PERQ ASP ( 4,097.70) 2811674 S-PLACE CLOSUR DEVIC ( 1,203.86) 2811705 GADOFOSVESET TRI 1ML ( - ) 2811723 ANAL NEUROSTIM COMPL ( 465.45) 2811727 S-REMOVE PERM CATH ( 8,666.29) 2811740 S-ILIAC REVAS ADD-ON ( 3,552.12) 2811741 S-ILIAC REVAS STNT A ( 18,361.35)2811750 S-TIB-PER REVAS ADD ( 18,361.35)2811751 S-TIB-PER REV ATH AD ( 44,478.75)2811752 S-REVS OPN-PRQ TIB-P ( 17,090.45)2811753 S-TIB-PER REVASC STN ( 20,951.78)2811772 BRACHTX SRC YTRIUM90 ( 67,757.78)2811776 ISOSULFAN BLUE 1MG ( 25.08) 2811777 S-NON-ROUT DRAW GRT3 ( 71.38) 2811778 GADOBUTROL INJ 0.1ML ( 2.33) 2811789 S-ABD PARACNT WO IMG ( 1,778.06) 2811793 S-ANG EXT CD IPS UN ( 854.78) 2811795 S-ANG INTRA BNCH UN ( 577.46) 2811798 CHEMO INTRATHEC ( 1,219.09) 2811820 S-RMV FOR BDY ST SIM ( 1,231.05) 2811823 BR-BRST BX LOC CLP A ( 1,201.69) 2811824 US-BRST BX LOC CLP A ( 2,149.99) 2811826 BR-PLC LOC DVCE ADD ( 3,126.56) 2811827 BR-PLC LOC DV AD STR ( 1,601.89) 2811828 US-PLC LOC DVCE ADD ( 740.59) 2811829 MR-PLC LOC DVCE ADD ( 3,203.78) 2811830 S-TC PLC STN ART EA ( 16,028.66)2811831 S-TC PLC STNT VN EA ( 16,028.66)2811832 CHEMO ADMIN IA PUSH ( 407.81) 2811837 S-RESP MOTION MGMT ( 1,450.73)
2811841 TC99 TILMAN DX .5MCI ( 420.86) 2811849 S-PERC CERV LUMB EA ( 10,421.51)2811850 S-PERC THOR LUMB EA ( 21,877.24)2811852 RADIUM RA223 DICHLRD ( 516.56) 2811853 BR-TOMOSYNTH MAMM AD ( 233.29) 2811854 S-PERC ABLT LIVER RF ( 16,557.19)2811855 BR-TOMOSYN SCR AD BI ( 466.58) 2811868 FL-PLC DVC SFT TISEA ( 721.00) 2811871 S-EVSC ADMN RX ADD ( 8,729.12) 2811874 S-DIL URETL STRC ( 835.68) 2811891 S-BAL DIL INTC PRC A ( 5,573.44) 2811892 S-BAL DIL IC PRC AVF ( 5,573.44) 2811895 PARV INJ L-S L2 ( 292.54) 2811898 PARV INJ L-S L3 ( 292.54) 2811907 US-PLV PRG 14 WKS AD ( 490.58) 2811908 US-PELVS PREG GESADD ( 605.55) 2811912 S-DIA BN MARW ASP-BX ( 1,172.80) 2811986 S-DIL BIL DUCT AMPUL ( 392.59) 2811987 S-ENDOLMNL BX BIL TR ( 2,015.14) 2812002 MSED SAMEGT5 1ST15 ( 211.58) 2812003 MODSED SAME ADD15MIN ( 44.63) 2812101 S-BALO ANGIOP DIAL ( 13,336.01)2812102 S-STENT PLMT DIAL ( 36,608.51)2812103 S-DIAL EMBOLJ ( 36,933.68)2812201 S-TRLUM BAL ANG ADLA ( 21,943.58)2812202 S-TRLUM BAL ANG ADLV ( 33,966.98)2850001 NI-ECHO DOP CO FL AD ( 524.35) 2850003 THERAPEUTIC DX SQ IM ( 194.93) 2850010 LOC2 200-299MG/ML ML ( 22.87) 2850011 LOCM 300-399MG/ML ML ( 6.53) 2850012 LOC2 300-399MG/ML ML ( 26.14) 2850020 THERAPEUTIC IV PUSH ( 408.38) 2850022 THERA EA AD IV PUSH ( 248.29) 2850026 IV THERAPY DX 1 HR ( 664.29) 2850027 IV THERAPY EA AD HR ( 118.70) 2850030 NI-ECHO DOPP COMP AD ( 1,166.40) 2850031 THER AD IVP SAME MED ( 313.63) 2850044 CC-INJ R VENT-ATRIAL ( 555.39) 2850045 CC-INJ SUPRV AORTOGR ( 261.36) 2850046 CC-INJ PULM ART HRTC ( 510.74) 2850048 S-ILIAC REVAS STNT A ( 18,386.68)
2850050 S-TIB-PER REV ATH AD ( 42,419.82)2850052 S-TIB-PER REVASC STN ( 20,980.67)2850053 CC-L HRT CATH TRNSPT ( 12,878.51)2850060 EP-ABLATE ART ADD-ON ( 1,152.16) 2850061 EP-ATR FIB PLM VN EA ( 1,436.39) 2850069 S-ABDOMEN ADD ORDER ( 373.53) 2850070 S-PRI ART M THRO ADD ( 12,036.72)2850071 S-SEC ART M THRO ADD ( 10,291.05)2850073 S-IVUS ADD VESSEL ( 126.32) 2850075 OXYGEN PER SHIFT ( 289.67) 2850078 IR-TC PLC STN ART EA ( 16,050.77)2850079 IR-TC PLC STNT VN EA ( 16,050.77)2850081 IR-THOR AORTA SERIAL ( 9,376.29) 2850082 IR-ABD AORTA SERIAL ( 9,933.86) 2850083 IR-AABF SERIAL ( 9,933.86) 2850085 IR-ANGIO EXTREM UNI ( 9,933.86) 2850086 IR-ANGIO EXTREM BI ( 19,868.81)2850089 IR-ANGIO PELVIC SEL ( 9,933.86) 2850093 IR-ANGIO ADD VESSEL ( 2,338.08) 2850101 IR-VENOGRAM EXT UNI ( 3,037.22) 2850102 IR-VENOGRAM EXT BI ( 8,012.86) 2850106 NI-ECHO GDE PERCARD ( 128.50) 2850107 NI-VAS ACCSS SITES ( 150.28) 2850108 MICROCAVITATION STDY ( 410.55) 2850120 P-INS LV LEAD NEW ( 83,780.04)2852002 MSED SAMEGT5 1ST15 ( 211.88) 2852003 MODSED SAME ADD15MIN ( 44.69) 2852101 S-BALO ANGIOP DIAL ( 13,354.41)2852102 S-STENT PLMT DIAL ( 36,659.01)2852201 S-TRLUM BAL ANG ADLA ( 21,973.84)2852202 S-TRLUM BAL ANG ADLV ( 34,013.83)2852803 IC-PTCA, ADDL ( 20,062.93)2852804 IC-ATHERECT CORO ADD ( 34,433.71)2852805 IC-PRQ STNT W-ANG EA ( 31,296.77)2852806 IC-PRQ ST-AT-ANG EA ( 23,032.35)2852807 IC-PRQ RV BYP GRF AD ( 26,390.83)2852808 IC-PRQ REVSC CHR ADD ( 25,290.94)2852809 IC-COR THROMBECTOMY ( 17,798.89)2852812 HEART FLOW MEASURE ( 2,056.03) 2852813 HEART FLOW MEAS ADD ( 187.31) 2852814 EP-MAP TACHY ( 2,063.66)
2852815 EP-MAP ADD ( 1,322.05) 2852816 EP-LA PACING, ADD ( 6,270.46) 2852817 EP-LV PACING, ADD ( 3,919.31) 2852818 EP-PROG STIM IV DRUG ( 1,505.00) 2852820 EP-INTCRD ECHO INTER ( 1,822.99) 2852822 IC-PRQ DE COR STNT B ( 31,730.19)2852823 IC-PR DE CR STN AR B ( 30,874.24)2852824 IC-PR DE CR RV CAB B ( 29,933.34)2852825 IC-PR DE CR RV CH EA ( 30,874.24)2891739 NBS BIOTINIDASE ( 130.50) 2891742 NBS HYDROXYPROG 17-D ( 637.28) 2891744 NBS THYROXINE T4 NEO ( 40.24) 2891756 NBS IMMUNOASSAY NOS ( 181.61) 2891757 NBS ACYLCARNITINE QT ( 134.85) 2891758 NBS AMINO ACID QT 6P ( 168.56) 2891759 NBS CARNITINE ( 259.91) 2891760 NBS GALACTOSE TRN QT ( 130.50) 2891761 NBS HEMOGLOBIN CHROM ( 227.29) 2891762 NBS THYROID STIM TSH ( 185.96) 2891767 NBS SCID ( 135.94) 2899001 NEWBORN SCREEN AR ( - ) 7210001 HYDROXYZI PAM 25MGCP ( 0.90) 7210004 PANGESTYME CN-10 CAP ( 9.21) 7210015 BUPIV.5%/EPI PF 30ML ( 60.22) 7210024 ALBUTEROL 0.083% NEB ( 12.70) 7210030 STERILE WATER 10ML ( 6.41) 7210031 AMIODARONE 200MG TAB ( 20.69) 7210033 GUAIFENESIN 200MG TB ( 6.61) 7210034 LISINOPRIL 2.5MG TAB ( 7.44) 7210036 PILOCARPIN 2%OS 15ML ( 33.51) 7210037 REPAGLINIDE 1 MG TAB ( 10.30) 7210041 TRYP/CAS/BAL OIN 60G ( 3.48) 7210048 BUPIVACAIN-EPI .75IJ ( 62.95) 7210051 MOXIFLOXA .5% OS 3ML ( 573.95) 7210073 ISOPROTER .2MG/ML1ML ( 183.26) 7210075 SELEN SUL2.5%LOT120M ( 43.07) 7210080 RANITIDIN 15MG/ML 1M ( 2.95) 7210081 MEMANTINE 5MG TAB ( 17.07) 7210091 CINACALCET 30MG TAB ( 53.96) 7210102 M-M-R II INJ ( 278.55) 7210103 HYDROCOD5-APAP325 TB ( 13.02)
7210111 FUROSEMI 10MG/ML 1ML ( 0.76) 7210148 OPTHAL IRR EXTR 30ML ( 75.74) 7210158 LIDOCAIN 1%/EPI 10ML ( 10.76) 7210162 AMINOCAP ACID 5GM IJ ( 89.91) 7210173 INDOMETHACIN 50MGSUP ( 9.39) 7210178 BENZ 20%DENT GEL 30G ( 2.28) 7210179 SOD BICARB 650MG TAB ( 3.64) 7210184 CARBA PERO6.5%OTIC15 ( 23.47) 7210188 LOMUSTINE 40 MG CAP ( 326.61) 7210193 CLINDAMYCIN 300MG IJ ( 9.44) 7210209 LEVETIRA 100MG/ML 1M ( 3.80) 7210211 CIPR.3-DEXAM.1% 7.5M ( 676.50) 7210226 BUPROPION 150MG SRTB ( 21.91) 7210230 BALSALAZ DIS 750MGCP ( 9.20) 7210231 ETHACRYNA AC 25MG TB ( 5.34) 7210236 OXCARBAZEPI 600MG TB ( 24.79) 7210238 BUPROPION 150MG SRTB ( 17.90) 7210239 DIVALPROEX 250MGSRTB ( 10.98) 7210241 FENOFIBRAT 145MG TAB ( 16.53) 7210242 TROSPIUM CHL 20MG TB ( 18.04) 7210244 H-COD10-CHLO POL8/5M ( 19.47) 7210251 ALBUTEROL2.5MG/.5NEB ( 11.76) 7210254 METAXALONE 800MG TAB ( 19.85) 7210256 OLANZAPINE 10MG INJ ( 14.97) 7210262 LANSOPRAZOL 30MG ODT ( 24.14) 7210264 DULOXETINE 30MG CAP ( 23.87) 7210270 STRONG IOD 5% 14ML ( 5.92) 7210273 DEXMEDETOM 200MCG/2M ( 189.86) 7210275 RIFAXIMINE 200MG TAB ( 37.89) 7210292 FENOFIBRATE 48MG TAB ( 6.13) 7210297 PHENYTOI EX 100MG CP ( 5.84) 7210299 EPLERENONE 25MG TAB ( 25.35) 7210300 MAG HYDR 2400MG/10ML ( 6.03) 7210304 IMATINIB 100MG TAB ( 119.04) 7210310 PHENOBARB 16.2MG PO ( 1.60) 7210323 DULOXETINE 20MG CAP ( 20.84) 7210334 EFAVIRENZ 600MG TAB ( 107.61) 7210336 DILTIAZEM 90MG SR CP ( 7.34) 7210341 SUCROSE/WATER PO ( - ) 7210351 ROSUVASTATIN 10MG TB ( 24.18) 7210357 ACAMPROSA 333MG DRTB ( 4.45)
7210358 LANTHANUM CHEW 500MG ( 14.03) 7210361 PREGABALIN 50MG CAP ( 13.02) 7210366 PREGABALIN 25MG CAP ( 12.64) 7210367 PREGABALIN 75MG CAP ( 13.02) 7210376 OLANZAPINE 15MG TAB ( 85.32) 7210382 TETRACAINE 1% INJ ( 33.24) 7210385 SILDENAFIL 20MG TAB ( 74.25) 7210387 FINASTERIDE 5MG TAB ( 21.85) 7210417 BACIT/POLYM OIN 30GM ( 140.76) 7210421 SUMATRIPTAN 100MG TB ( 115.28) 7210422 LAMOTRIGINE 200MG TB ( 27.89) 7210426 ESOMEPRAZO 40MG DRCP ( 28.37) 7210438 PRAMIPEXOLE 0.5MG TB ( 15.37) 7210439 PHENOBARB 97.2MG TAB ( 3.39) 7210441 PENICILL VK 500MG TB ( 5.57) 7210451 CA POLYCARB 625MG TB ( 4.38) 7210461 PHENOBARB 64.8MG TAB ( 6.53) 7210464 VECURONIUM 20MG SOLR ( 98.02) 7210476 VITAMIN D 400IU TAB ( 5.69) 7210482 PENICIL VK 250MG TAB ( 5.18) 7210484 LACTULOSE 10GM/15ML ( 13.02) 7210487 MULTIVITAMIN W/MINER ( 3.84) 7210488 METOPROLOL 25MG SRTB ( 9.95) 7210491 DM-GUAIF 10-100MG/5M ( 0.70) 7210495 TOBR.3-DEX.1%OS 5ML ( 86.52) 7210500 LIDOCAINE 2%VIS 100M ( 50.80) 7210502 LEVETIRACET 500MG TB ( 17.80) 7210509 OXYTOC 30U/NS 500ML ( 63.22) 7210511 MESALAMINE 1000MG SP ( 64.67) 7210526 NITAZOXANIDE 500MGTB ( 104.00) 7210527 CINACALCET 60MG TAB ( 103.67) 7210529 FENTANYL 12MCG/HR PT ( 64.76) 7210530 PANTOPRAZO 20MG ECTB ( 24.18) 7210533 SOLIFENACIN 5MG TAB ( 19.44) 7210536 METOPROLOL 25MG TAB ( 11.93) 7210541 FLUTICAS 50MCG/A 16G ( 404.63) 7210544 DARIFENAC 7.5MG SRTB ( 24.58) 7210546 PHENOL 1.4%SPR 177ML ( 14.48) 7210552 ESOMEPRAZOLE 40MG IV ( 148.27) 7210565 METHIMAZOLE 10MG TAB ( 6.86) 7210570 SALINE NASAL GL 14GM ( 10.31)
7210573 FENTANY CIT 0.1MGINJ ( 6.41) 7210576 MEMANTINE 10MG TAB ( 17.92) 7210577 ESMOLOL 2500MG/250ML ( 524.55) 7210586 BISOPROLOL 10MG TAB ( 7.32) 7210587 METOPROLO 100MG SRTB ( 10.78) 7210595 PROPAFEN 225MG SRCP ( 32.05) 7210596 AMOX 250MG/5ML 5MLUD ( 0.18) 7210602 MULTIVITAMIN TAB ( 7.93) 7210603 ACETAM 80MG/.8ML .8M ( 33.16) 7210609 CYCLOSPOR .05%OS UD ( 25.28) 7210625 SCOPOLAMINE 0.4MG IJ ( 27.14) 7210630 PREDNISONE 1MG ORAL ( 6.00) 7210631 NACL INJ 30ML (BACT) ( 110.21) 7210637 LANOLIN OINT 7GM ( 15.20) 7210645 AMOX1000-CLV62.5MGTB ( 21.16) 7210665 EMTRICI/TENO 200/300 ( 177.09) 7210678 GABAPENTIN 800MG TAB ( 19.34) 7210703 LEFLUNOMIDE 10MG TAB ( 69.94) 7210710 POTASS PHOS PWD 1GM ( 1.57) 7210717 POTASS CIT 10MEQCRTB ( 7.60) 7210719 PROPAFENONE 325MG ER ( 31.62) 7210725 TORSEMIDE 100MG TAB ( 17.38) 7210747 PARICALCITOL 1MCG CP ( 35.20) 7210752 OXYCODO 20MG/ML 1ML ( 18.40) 7210754 IPRATROPI 17MCG PUF ( 12.70) 7210765 FERROUS FUM 324MG TB ( 1.12) 7210772 VALPROATE 250MG/5ML ( 4.21) 7210773 LITHIUM CIT 8MEQ/5ML ( 0.72) 7210784 TD IM NO PRSRV GE 7Y ( 225.17) 7210785 ZOSTER VACC, SC ( 765.60) 7210787 CLIND 18MG/ML D5W 50 ( 175.85) 7210788 CLIND 12MG/ML D5W 50 ( 147.78) 7210790 RANOLAZI 500MG SR TB ( 23.87) 7210791 OXYCOD10-APAP325MGTB ( 6.57) 7210794 DIPH/TET/ACPERT .5ML ( 255.32) 7210805 ARIPIPRAZOLE 2MG TAB ( 70.05) 7210842 LUBIPROSTONE 24MCG ( 25.87) 7210862 SOLIFENACIN 10MG TAB ( 31.16) 7210874 VALPROATE 500MG/5ML ( 79.75) 7210896 LEVALBUTER0.63MG/3ML ( 21.53) 7210903 IPRATROPIU .02% 2.5M ( 3.02)
7210915 PAROXETINE 30MG TAB ( 18.55) 7210930 LIDOCAIN 2%/EPI 20ML ( 81.14) 7210946 DOXEPIN 100MG CAP ( 11.71) 7210953 CEFACLOR 500MG CAP ( 19.89) 7210963 NIFEDIPINE 20MG CAP ( 6.91) 7210979 DOCUS NA 10MG/ML 10M ( 7.96) 7210990 CIPROFLOX/HC OT 10ML ( 674.72) 7210993 COLISTIME UP TO 150M ( 120.87) 7210998 DESMOPRESS TAB 0.1MG ( 12.22) 7210999 GLUCOSE 4GM CHW TAB ( 0.70) 7211013 FAMCICLOVIR 250MG TB ( 26.22) 7211027 MELOXICAM 15MG TAB ( 27.89) 7211043 QUETIAPI FUM 200MGTB ( 31.06) 7211046 SERTRALIN 20MG/ML 60 ( 335.40) 7211064 PHENYLEP.125%SPR 15M ( 24.18) 7211065 PROMETHAZINE 25MG TB ( 6.78) 7211080 BUPIVAC .25% MPF 30M ( 63.22) 7211093 MOMETAS 220MCG SPR ( 707.07) 7211094 AMPICILL 250/5 100ML ( 39.72) 7211095 AMOX 125MG/5ML 5MLUD ( 10.68) 7211099 VARENICILINE .5MG TB ( 13.02) 7211116 DORZOLAMID 2%OS 10ML ( 619.23) 7211145 VARENICILINE 1MG TAB ( 12.64) 7211153 CLOMIPRAMINE 50MG CP ( 34.00) 7211157 OXYCO7.5-APAP325MGTB ( 8.15) 7211170 HYDROCORT 10MG TAB ( 5.45) 7211183 MONTELUKAST 5MG CHEW ( 18.77) 7211190 PHENAZOPYRID 95MG TB ( 3.00) 7211229 CAFFEINE 200MG TAB ( 4.60) 7211266 ETODOLAC 400MG SR TB ( 19.81) 7211269 VALACYCLOVIR 1GM TAB ( 63.77) 7211294 CEFDINI250MG/5 100ML ( 642.45) 7211308 DOCOSANOL 10% 2GM CR ( 61.66) 7211310 POSACONAZOLE 200MG/5 ( 187.33) 7211354 SOD CHLOR .9% 20ML ( 141.15) 7211357 STER WATER IRR1000ML ( 142.60) 7211359 STER WATER IRR 500ML ( 16.08) 7211412 SOD CHL/POT CHL TAB ( 3.58) 7211413 PENTOSAN 100MG CAP ( 18.61) 7211438 RISPERDONE 0.5MG TAB ( 23.71) 7211443 SITAGLIPTIN 100MG TB ( 33.44)
7211444 CARB/LEVO 25/100 ODT ( 2.40) 7211461 LEVOTHYROX 100MCG TB ( 7.06) 7211468 THROMBIN 20,000UN KT ( 184.65) 7211478 CALC500-VITD200MG TB ( 5.22) 7211486 OXYCOD5-APAP325MG TB ( 22.31) 7211489 PALIPERIDON 3MG SRTB ( 56.01) 7211493 CLIND 6MG/ML D5W 50M ( 133.88) 7211530 ONDANSET 4MG/5ML SOL ( 66.50) 7211537 RASAGILINE 1MG TAB ( 51.21) 7211544 FE SU105-C500-FA.8CR ( 7.25) 7211556 ALISKIREN 150MG TAB ( 15.04) 7211585 AMOX200/CLAV28.5 50M ( 83.07) 7211599 LIDOCAINE 2%VIS 15ML ( 3.52) 7211601 MICONAZ VAG 200MGSUP ( 50.60) 7211603 VERAPAMIL 5MG/2ML ( 15.92) 7211607 NACL INJ 10ML (BACT) ( 0.26) 7211618 ONDANSETRON 1MG ODT ( 17.88) 7211630 CHLORHEXIDIN 4% 15ML ( 2.70) 7211646 BENZOCAINE GEL 7.5GM ( 12.57) 7211647 ACTIV CHARC LIQ 240M ( 92.24) 7211648 CASTOR OIL 60ML ( 15.44) 7211649 PHENOBARBI 32.4MG TB ( 7.67) 7211665 TROLAMINE 10%CR 35GM ( 11.25) 7211695 MIDAZOLAM 2MG/ML 5ML ( 36.46) 7211701 STER WATER IRR1500ML ( 11.00) 7211721 PORACTANT 240MG/3ML ( 364.32) 7211731 H-COD7.5/APAP325MGTB ( 13.02) 7211742 CEFDIN 125MG/5ML 60M ( 181.77) 7211749 CALCIUM CARB 648MG T ( 0.05) 7211751 PENCIL G NA 5MU INJ ( 204.54) 7211782 RABIES IG IM/SC 150U ( 419.78) 7211790 RABIES VAC IM ( 1,062.95) 7211793 VARICELLA VIR VAC SC ( 414.12) 7211803 HEP B VAC PED ( 258.39) 7211804 PALIVIZUMAB 50MG ( 1,383.28) 7211805 PANTOPRAZOLE SOD VL ( 156.08) 7211807 DAPTOMYCIN 1 MG INJ ( 3.43) 7211809 BORTEZOMIB .1MG INJ ( 253.46) 7211817 CYCLOPHOSPHAMI 100MG ( 228.55) 7211818 LUPR 7.5 MALES>18YRS ( 5,499.28) 7211819 ABCIXIMAB 10MG ( 4,860.79)
7211821 AMIFOSTINE 500MG INJ ( 3,839.24) 7211825 AMPHOTER B LIPO 10MG ( 240.30) 7211827 BIVALIRUDIN 1MG INJ ( 14.76) 7211828 BOTULINUM TOXI A 1U ( 35.29) 7211832 DEXRAZOXANE 25OMG IJ ( 845.58) 7211833 EPTIFABITIDE 5MG IJ ( 143.40) 7211834 ERTAPENEM SOD/500MG ( 165.36) 7211839 GANCICLOVI SOD 500MG ( 309.94) 7211841 INFLIXIMAB 10 MG INJ ( 468.22) 7211845 MILRINONE 5MG INJ ( 140.65) 7211847 OCTREOTIDE ND 25MCG ( 31.69) 7211849 PAMIDRONATE 30MG IJ ( 21.06) 7211850 PGFILGRASTIM 6MG IJ ( 20,832.77)7211861 THYROTROPN .9MG INJ ( 6,318.75) 7211862 TIROFIBAN 0.25MG INJ ( 24.67) 7211867 ZIPRSIDNE MESYL 10MG ( 37.96) 7211873 FACTOR IX RECOMB 1U ( 6.18) 7211879 TACROLIMUS 1MG PO ( 21.59) 7211882 MYCOPHE MOF 250MG PO ( 18.05) 7211890 ARSENIC TRIOXIDE 1MG ( 196.26) 7211893 BLEOMYCIN SUL 15 U ( 423.19) 7211895 CISPLAT POW/SOL 10MG ( 28.35) 7211898 CYTARABINE LIPO 10MG ( 2,566.68) 7211899 DACARBAZINE 100MG ( 52.97) 7211904 ETOPOSIDE 10MG INJ ( 5.64) 7211907 GOSERELIN IMP 3.6MG ( 461.39) 7211908 IRINOTECAN 20MG INJ ( 725.97) 7211909 IFOSFAMIDE 1GM INJ ( 776.00) 7211910 MESNA 200MG INJ ( 53.61) 7211913 INTRFRON ALF2B 1 MIL ( 119.21) 7211922 MITOMYCIN 5MG INJ ( 379.63) 7211923 MITOXANTRONE 5 MG ( 610.92) 7211925 RITUXIMAB 100MG INJ ( 4,061.32) 7211928 TRASTUZUMAB 10MG INJ ( 490.07) 7211931 FULVESTRANT INJ 25MG ( 1,677.10) 7211933 EPO NESRD 1000 U INJ ( 100.19) 7211934 FOSPHENYTOIN 50MG ( 69.90) 7211937 CYTARABINE 100 MG ( 142.67) 7211938 AMINOPHYLL 250MG INJ ( 35.31) 7211939 COSYNTROPN .25MG INJ ( 590.13) 7211941 AZACITIDINE 1MG INJ ( 28.51)
7211956 CETUXIMAB 10MG INJ ( 277.74) 7211957 PEMETREXED 10MG INJ ( 348.24) 7211960 D5W/SOD CHL.9% 500ML ( 86.89) 7211961 VORICONAZOLE 10MG ( 47.35) 7211962 GLATIRAMER ACET 20MG ( 614.38) 7211964 PACLITAXEL PRTBD 1MG ( 55.99) 7211966 MAGNES SULF 500MGINJ ( 0.54) 7211968 NATALIZUMAB 1MG INJ ( 75.11) 7211970 ENOXAPARIN 10MG INJ ( 48.41) 7211971 AMPICILLIN/SUB 1.5GM ( 65.63) 7211972 SUCCINYLCHN 20MG INJ ( 6.97) 7211978 CALCIUM GLUC 10%10ML ( 29.84) 7211979 CALCITONIN,SAL 400IU ( 9,151.77) 7211980 CALCITRIOL .1MCG INJ ( 7.66) 7211981 LEUCOVORIN 50MG INJ ( 36.00) 7211982 CEFAZOLIN 500MG INJ ( 135.36) 7211983 CEFTRIAXONE 250MGINJ ( 91.37) 7211984 CEFUROXIME 750MG INJ ( 55.78) 7211985 CEFTAZIDIM 500MG INJ ( 60.24) 7211987 CAFFEINE CIT 5MG INJ ( 18.27) 7211988 CIPROFLOXAC 200MG IV ( 89.05) 7211989 PROCHLORPE UPTO 10MG ( 37.74) 7211991 METHYLPR ACE 40MGINJ ( 31.90) 7211994 DIGOXIN 0.5MG INJ ( 23.71) 7211997 HYDROMORPH UP TO 4MG ( 23.50) 7211999 DOBUTAMINE 250MG INJ ( 17.85) 7212002 ERYTHROMYC 500MG INJ ( 160.94) 7212003 HALOPERIDOL 5MG INJ ( 54.38) 7212004 HALOPER DEC 50MGINJ ( 153.57) 7212006 HYDROCORTIS 100MGINJ ( 23.02) 7212007 IRON SUCROSE 1MG INJ ( 3.05) 7212008 DROPERIDOL UP TO 5MG ( 25.87) 7212012 KETOROLAC 15MG INJ ( 17.91) 7212013 FUROSEMIDE 20MG INJ ( 21.88) 7212014 LEVOCARNITIN 1GM INJ ( 181.40) 7212016 LORAZEPAM 2MG INJ ( 34.21) 7212018 MIDAZOL HCL 1MG INJ ( 0.76) 7212021 NALOXONE HCL 1MG INJ ( 33.19) 7212022 PHENYLEPHRIN 1ML INJ ( 258.66) 7212023 ONDANSETRON 1MG INJ ( 16.38) 7212024 PIPER/TAZOB 1G/.125G ( 36.71)
7212027 DESMOPRESSIN 1MCGINJ ( 51.01) 7212029 PROGESTERON 50MG INJ ( 17.84) 7212031 PROTAMINE 10MG INJ ( 8.40) 7212032 METOCLOPRAM 10MG INJ ( 25.35) 7212034 ROPIVACAINE 1MG INJ ( 1.54) 7212036 SOD FERRIC 12.5MGINJ ( 39.83) 7212037 METHYLPRED 40MG INJ ( 58.37) 7212039 FENTANY CIT 0.1MGINJ ( 19.05) 7212041 CHLORPROM UP TO 50MG ( 63.65) 7212042 TRIMETHOBEN 200MGINJ ( 22.32) 7212043 TORSEMID 10MG/ML INJ ( 11.21) 7212045 TRIAMCIN ACE 10MGINJ ( 33.96) 7212048 VANCOMYCIN 500MG INJ ( 201.07) 7212049 HYDROXYZI UP TO 25MG ( 23.94) 7212050 VIT B12 CYAN 1000MCG ( 31.83) 7212051 PHYTONADIONE 1MG INJ ( 36.22) 7212053 POTASSI CHL 2MEQ INJ ( 28.14) 7212054 NORM SALIN 1000ML IV ( 189.13) 7212055 NORM SAL STER500MLIV ( 174.58) 7212062 DEX 5%/WATER 500ML ( 180.28) 7212063 DEX 5%/WATER 250ML ( 150.15) 7212064 DEX 5%/WATER 100ML ( 201.51) 7212065 DEX 5%/WATER 50ML ( 177.80) 7212066 AZATHIOPRINE 50MG TB ( 11.11) 7212068 CYCLOSPORINE 25MG PO ( 11.72) 7212073 BUDESON INH .25MG/2M ( 39.90) 7212077 METHOTREXATE 2.5MGPO ( 21.79) 7212078 BEVACIZUMAB 10MG INJ ( 324.72) 7212079 FLUOROURACIL 500MG ( 37.16) 7212081 VINBLASTIN SULF 1MG ( 18.40) 7212082 VINCRISTIN SULF 1MG ( 208.80) 7212085 ALBUMIN 25% 50ML IV ( 538.86) 7212086 PROCHLORPERAZ 5MG PO ( 7.38) 7212087 PROCHLORPERA 10MG TB ( 4.11) 7212091 HYDROXYZI PAM 50MGCP ( 1.04) 7212095 DOPAMIN HCL 40MG INJ ( 3.79) 7212104 THIAMINE 100MG INJ ( 71.65) 7212105 TERBUTALINE 1MG INJ ( 158.27) 7212109 AMPICILLIN 500MG INJ ( 40.98) 7212111 HYDRALAZINE 20MG INJ ( 107.28) 7212115 DICYCLOMINE 20MG INJ ( 112.90)
7212116 BENZTROPN MES 1MGINJ ( 99.50) 7212117 GLUCAGON 1MG INJ ( 532.36) 7212118 LIDOCAINE 10MG IV ( 9.95) 7212119 DIPHENHYDRAM 50MGINJ ( 23.65) 7212121 ESTROGEN CNJ 25MGINJ ( 657.69) 7212122 METHOCARBAML 10MLINJ ( 87.15) 7212124 AMIODARONE 30MG INJ ( 6.10) 7212125 METHYLERGONV .2MGINJ ( 38.60) 7212126 METHYLPRED 125MG INJ ( 49.74) 7212127 OXYTOCIN UP TO 10UN ( 40.13) 7212128 BUTORPHANOL 1MG INJ ( 59.68) 7212129 NALBUPHINE 10MG INJ ( 26.50) 7212133 KETOROLAC 15MG INJ ( 33.47) 7212135 ACETYLCYS 20%INH 10M ( 39.17) 7212137 FLUCONAZOL 200MG INJ ( 708.00) 7212138 PARICALCITOL 1MCGINJ ( 31.81) 7212139 NEOSTIGMINE .5MG INJ ( 2.29) 7212142 DEX 5%/WATER 1000ML ( 155.33) 7212144 GEMCITABIN 200MG INJ ( 128.40) 7212145 RISPERIDONE LA 0.5MG ( 28.69) 7212147 CEFOTAXIME NA 1GM ( 66.77) 7212148 CEFEPIME 500MG INJ ( 57.64) 7212149 MANNITOL 25% 50MLINJ ( 89.52) 7212150 NORM SALINE 250ML IV ( 149.66) 7212151 ACETAZOLAMI 500MGINJ ( 113.70) 7212155 MEROPENEM 100MG INJ ( 32.49) 7212156 MOXIFLOXAC 100MG INJ ( 59.55) 7212157 PYRIDOXINE 100MG INJ ( 32.05) 7212160 ACYCLOVIR 5MG INJ ( 1.02) 7212162 ALPROSTAD 1.25MCGINJ ( 3.06) 7212168 HYOSCYAMIN .25MG INJ ( 49.00) 7212170 METHYLPRED 80MG INJ ( 136.53) 7212171 METHYLPREDNIS 4MG PO ( 7.38) 7212173 PENICI G POT .6MUINJ ( 27.20) 7212174 PNEUMO-VAC 2YR-ADULT ( 214.89) 7212176 PROCAINAMID UPTO 1GM ( 28.30) 7212184 PAPAVERINE UPTO 60MG ( 18.95) 7212188 DIHYDROERGOT 1MG INJ ( 198.99) 7212190 PHENTOLAMINE 5MG INJ ( 464.47) 7212193 TETANUS IG HUM 250U ( 2,229.82) 7212194 FLUPHENZI UP TO 25MG ( 143.75)
7212201 ACTYLCYSTN INJ 100MG ( 724.18) 7212202 AMKCN SULF INJ 100MG ( 54.39) 7212208 DIGOXIN IMMUNE FAB ( 13,068.10)7212212 FOMEPIZOLE, 15 MG ( 61.71) 7212216 IRON DEX165 INJ 50MG ( 94.74) 7212217 IRON DEX267 INJ 50MG ( 100.02) 7212225 SINCALIDE INJ 5MCG ( 323.95) 7212233 INJ VONWILLEB FAC IU ( 7.81) 7212241 BETAM ACE/SOD PHO3MG ( 24.13) 7212243 MORPHINE UP TO 10MG ( 8.22) 7212244 PROMETHAZI UPTO 50MG ( 30.52) 7212247 AZITHROMYC 500MG IV ( 298.46) 7212248 GENTAMICIN UPTO 80MG ( 18.96) 7212251 DORNASE ALFA 1MG INH ( 138.05) 7212258 MICAFUNGIN 1MG INJ ( 13.89) 7212259 TIGECYCLINE 1 MG INJ ( 6.82) 7212261 TRIAMCIN HEX 5MG INJ ( 14.58) 7212267 IBANDRONATE 1MG INJ ( 733.03) 7212268 ABATACEPT 10MG INJ ( 104.91) 7212269 DIPH/TET/ACPERT .5ML ( 243.63) 7212274 HYDROMORPH UP TO 4MG ( 22.31) 7212277 NESIRITIDE 0.1MG INJ ( 228.46) 7212279 SUMATRIPTAN 6MG INJ ( 914.81) 7212280 DECITABINE 1MG INJ ( 117.03) 7212283 AMPICILLIN 125MG INJ ( 33.74) 7212286 PANITUMUMAB 10MG IJ ( 504.41) 7212290 HYALURONID RECOM 1UN ( 1.45) 7212305 EPO GE 10000/100 UNT ( 100.19) 7212318 CIDOFOVIR 375MG INJ ( 1,910.18) 7212319 IBUTILIDE 1MG INJ ( 251.91) 7212320 PENTAMIDIN 300MG INJ ( 451.69) 7212326 DIPTH/TETA/PERT PED ( 124.80) 7212328 IMMU GLOB LYO 500MG ( 207.29) 7212332 PREDNISOLON 15MG/5ML ( 7.70) 7212334 PIPER/TAZOB 1G/.125G ( 59.70) 7212335 FONDAPARINUX 0.5MG ( 65.66) 7212339 BUTORPHANOL 1MG INJ ( 50.60) 7212341 MENINGOCOCC VAC 0.5M ( 580.22) 7212343 LEVOFLOXAC 250MG INJ ( 142.13) 7212344 HAEMOPH B TETAN INJ ( 126.50) 7219036 CEFAZOLIN 500MG IVPB ( 83.74)
7870002 SP AR MCD TRMT 15MIN ( 393.68)