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Charge Master CodeDescriptionInvoice LabelDynamic PricingPrice Soft Code HCPCS CodeHCPCS MultiplierRevenue Code

2500000 ACCUPRIL (QUINAPRIL)ACCUPRIL (QUINAPRIL) 5 1 250

2500001 ACETADOTE (ACETYLCYSTEIN)ACETADOTE (ACETYLCYSTEIN)400 J0132 2 250

2500003 ACTOS (PIGLITAZONE HCL)ACTOS (PIGLITAZONE HCL) 14 1 250

2500005 ADENOSINE (ADENACARD)ADENOSINE (ADENACARD) 53 J0153 6 250

2500008 AFRIN (OXYMETAZOLINE) NASAL SPRAYAFRIN (OXYMETAZOLINE) NASAL SPRAY6 1 250

2500009 ALBUTEROL NEB SOLALBUTEROL NEB SOL 5 J7613 1 250

2500010 ALBUTEROL NEB SOLALBUTEROL NEB SOL 5 J7620 1 250

2500011 ALBUTEROL (VENTOLIN) MDIALBUTEROL (VENTOLIN) MDI 143 1 250

2500015 ALLOPURINOL TABALLOPURINOL TAB 3 1 250

2500018 AMBIEN (ZOLPIDEM)AMBIEN (ZOLPIDEM) 10 1 250

2500020 AMIODARONE (PACERONE)AMIODARONE (PACERONE) 7 1 250

2500021 AMIODARONE INJAMIODARONE INJ 25 J0282 5 250

2500024 AMITRIPTYLINE TABAMITRIPTYLINE TAB 3 1 250

2500026 AMOXICILLIN SUSPENSIONAMOXICILLIN SUSPENSION 7 1 250

2500030 AMPICILLIN INJAMPICILLIN INJ 39 J0290 2 250

2500034 ARICEPT (DONEPEZIL) TABARICEPT (DONEPEZIL) TAB 3 1 250

2500037 ASPIRIN CHEWABLE (ASA)TABASPIRIN CHEWABLE (ASA)TAB 3 1 250

2500039 ASPIRIN EC (ASA) TABASPIRIN EC (ASA) TAB 3 1 250

2500040 ATACAND (CANDASARTANCIL) TABATACAND (CANDASARTANCIL) TAB7 1 250

2500041 ATENOLOL (TENORMIN) TABATENOLOL (TENORMIN) TAB 3 1 250

2500042 ATIVAN (LORAZEPAM) TABATIVAN (LORAZEPAM) TAB 3 1 250

2500043 ATIVAN (LORAZEPAM) INJATIVAN (LORAZEPAM) INJ 25 J2060 1 250

2500044 ATROPINE SULFATE INJATROPINE SULFATE INJ 44 J0461 10 250

2500050 AVAPRO TABAVAPRO TAB 7 1 250

2500051 AVAPRO TABAVAPRO TAB 8 1 250

2500052 AVALOX PREMIX INJAVALOX PREMIX INJ 97 1 250

2500054 CYANOCOBALAMIN (B12) INJCYANOCOBALAMIN (B12) INJ 34 1 250

2500055 BACTRIM DS (SULFA/TRIM) TABBACTRIM DS (SULFA/TRIM) TAB 3 1 250

2500056 BACTROBAN (MUPIROCIN) OINTMENTBACTROBAN (MUPIROCIN) OINTMENT86 1 250

2500057 BENADRYL (DIPHENHYDRAMINE) LIQBENADRYL (DIPHENHYDRAMINE) LIQ6 1 250

2500058 BENADRYL (DIPHENHYDRAMINE) CAPBENADRYL (DIPHENHYDRAMINE) CAP3 1 250

2500059 BENADRYL (DIPHENHYDRAMINE) INJBENADRYL (DIPHENHYDRAMINE) INJ25 J1200 1 250

2500060 BENTYL (DICYCLOMINE) TABBENTYL (DICYCLOMINE) TAB 3 1 250

2500061 BENTYL (DICYCLOMINE) INJBENTYL (DICYCLOMINE) INJ 241 J0500 1 250

2500067 BUPIVACAINE (MARCAINE) 0.5% VIALBUPIVACAINE (MARCAINE) 0.5% VIAL25 1 250

2500069 CALCIUM+D TABCALCIUM+D TAB 3 1 250

2500070 CALCIUM+D TABCALCIUM+D TAB 3 1 250

2500071 CALCIUM CHLORIDE PFSCALCIUM CHLORIDE PFS 44 J3490 10 250

2500073 CALCIUM GLUCONATE INJCALCIUM GLUCONATE INJ 69 J0610 1 250

2500077 CARDIZEM CD (DILTIAZEM CD) TABCARDIZEM CD (DILTIAZEM CD) TAB3 1 250




2500081 CARDURA (DOXAZOSIN MESYLAT) TABCARDURA (DOXAZOSIN MESYLAT) TAB3 1 250

2500085 CEFEPIME (MAXIPIME) INJCEFEPIME (MAXIPIME) INJ 25 1 250

2500087 CEFTIN (CEFUROXIME) TABCEFTIN (CEFUROXIME) TAB 10 1 250

2500091 CILOXIN (CIPRO HCL) 0.3% OPHTH SOL.CILOXIN (CIPRO HCL) 0.3% OPHTH SOL.41 1 250

2500093 CIPRO (CIPROFLOXZCIN) INJCIPRO (CIPROFLOXZCIN) INJ 25 J0744 2 250

2500096 CIPRO OTIC SOL.CIPRO OTIC SOL. 34 1 250

2500099 CLAFORAN (CEFOTAXIME) INJCLAFORAN (CEFOTAXIME) INJ 61 J0698 1 250

2500103 CLINDAMYCIN (CLEOCIN) INJCLINDAMYCIN (CLEOCIN) INJ 25 S0077 1 250

2500108 CLONIDINE (CATAPRESS) TABCLONIDINE (CATAPRESS) TAB 3 J0735 1 250

2500109 COLACE (DOCUSATE) GEL CAPCOLACE (DOCUSATE) GEL CAP 3 1 250

2500112 COREG (CARVEDILOL) TABCOREG (CARVEDILOL) TAB 5 1 250


2500120 COZAAR (LOSARTAN) TABCOZAAR (LOSARTAN) TAB 4 1 250

2500121 CROFAB (CROTALIDAE) VIAL INJCROFAB (CROTALIDAE) VIAL INJ4700 J0840 1 250

2500125 DECADRON (DEXAMETHASONE) INJDECADRON (DEXAMETHASONE) INJ25 J1100 4 250

2500130 DEPAKOTE EC (DIVALPRX SD) TABDEPAKOTE EC (DIVALPRX SD) TAB4 1 250

2500132 DEPO PROVERA (MEDROXYPROGESTERONE) INJDEPO PROVERA (MEDROXYPROGESTERONE) INJ216 J1050 150 250

2500137 DEXTROSE 50% PREFILLED SYRINGEDEXTROSE 50% PREFILLED SYRINGE39 1 250

2500141 DILANTIN (PHENYTOIN) INJDILANTIN (PHENYTOIN) INJ 25 J1165 2 250

2500142 DILAUDID (HYDROMORPHONE) INJDILAUDID (HYDROMORPHONE) INJ25 J1170 1 250

2500146 DOBUTAMINE INJDOBUTAMINE INJ 27 J1250 1 250

2500150 DONNATOL ELIXIRDONNATOL ELIXIR 45 1 250

2500151 DOPAMINE 400MG/250ML PREMIXDOPAMINE 400MG/250ML PREMIX63 J1265 10 250

2500152 DOXYCYCLINE TABDOXYCYCLINE TAB 12 1 250

2500153 DULCOLAX (BISACODYL) SUPPOSITORYDULCOLAX (BISACODYL) SUPPOSITORY3 1 250

2500154 DULCOLAX (BISACODYL) TABDULCOLAX (BISACODYL) TAB 3 1 250

2500155 DUONEB (IPRATROP/ALBUTE) 3ML NEB SOL.DUONEB (IPRATROP/ALBUTE) 3ML NEB SOL.5 1 250

2500160 ENALAPRIL (VASOTEC) INJENALAPRIL (VASOTEC) INJ 25 1 250

2500161 ENALAPRIL (VASOTEC) TABENALAPRIL (VASOTEC) TAB 3 1 250

2500162 FLEET ENEMA 4.5 0Z BOTTLEFLEET ENEMA 4.5 0Z BOTTLE 4 1 250

2500163 EPINEPHRINE 1:10,000 PREFILLED INJEPINEPHRINE 1:10,000 PREFILLED INJ22 1 250

2500167 EYE WASH SOLUTION 4OZ BOTTLEEYE WASH SOLUTION 4OZ BOTTLE14 1 250

2500168 FENTANYL (SUBLIMAZE) INJFENTANYL (SUBLIMAZE) INJ 25 J3010 100 250

2500171 FLAGYL (METRONIDAZOLE) 500MG PREMIXFLAGYL (METRONIDAZOLE) 500MG PREMIX25 S0030 1 250

2500173 FLOMAX (TAMSULOSIN) CAPFLOMAX (TAMSULOSIN) CAP 3 1 250

2500176 FOLIC ACID TABFOLIC ACID TAB 3 1 250

2500461 GAS X (SIMETHACONE) TABGAS X (SIMETHACONE) TAB 3 1 250

2500462 GENTAMYCIN INJGENTAMYCIN INJ 25 J1580 1 250

2500463 GENTAMICIN 0.3% OPHTH. SOLGENTAMICIN 0.3% OPHTH. SOL39 1 250

2500465 GLUCAGON PREFILLED INJGLUCAGON PREFILLED INJ 515 J1610 1 250

2500466 GLUCOTROL (GLIPIZIDE) TABGLUCOTROL (GLIPIZIDE) TAB 3 1 250

2500468 HALDOL (HALOPERIDOL) INJHALDOL (HALOPERIDOL) INJ 39 J1630 1 250

2500469 HCTZ (HYDROCHLOROTHIAZIDE) TABHCTZ (HYDROCHLOROTHIAZIDE) TAB3 1 250

2500470 HEPARIN INJHEPARIN INJ 25 J1644 5 250

2500473 HEPATITIS B (ADULT) VACCINEHEPATITIS B (ADULT) VACCINE120 90746 1 250

2500474 HUMALOG INSULIN INJHUMALOG INSULIN INJ 7 J1815 1 250

2500475 HUMULIN 70/30 INSULIN INJHUMULIN 70/30 INSULIN INJ 5 J1815 1 250

2500476 HUMULIN N INSULIN INJHUMULIN N INSULIN INJ 3 J1815 1 250

2500477 HUMULIN R INSULIN INJHUMULIN R INSULIN INJ 8 J1815 1 250

2500478 HYDROCODONE/ACET 5/325MG TABHYDROCODONE/ACET 5/325MG TAB3 1 250

2500479 HYDROCODONE/ACET 10/325MG TABHYDROCODONE/ACET 10/325MG TAB5 1 250

2500481 HYZAAR (LOSARTAN/HCTZ) 50/12.5MG TABHYZAAR (LOSARTAN/HCTZ) 50/12.5MG TAB3 1 250

2500482 OCUVITE (MACUVITE) OTC TABOCUVITE (MACUVITE) OTC TAB 3 1 250

2500483 IBUPROFEN 100MG/5ML LIQIBUPROFEN 100MG/5ML LIQ 3 1 250

2500484 IBUPROFEN TABIBUPROFEN TAB 3 1 250

2500485 IMDUR (ISOSORBIDE MONO) TABIMDUR (ISOSORBIDE MONO) TAB4 1 250

2500488 IMODIUM AD (LOPERAMIDE) TABIMODIUM AD (LOPERAMIDE) TAB3 1 250

2500489 INFLUENZA (FLU) VACCINE INJINFLUENZA (FLU) VACCINE INJ 20 90686 1 250

2500491 KCL (POTASSIUM CL) TABKCL (POTASSIUM CL) TAB 4 1 250

2500492 KCL (POTASSIUM CH) INJKCL (POTASSIUM CH) INJ 25 J3480 10 250

2500493 KCL (POTASSIUM CL) TABKCL (POTASSIUM CL) TAB 3 1 250

2500497 KEFLEX (CEPHALEXIN) CAPKEFLEX (CEPHALEXIN) CAP 3 1 250

2500498 KEFZOL (CEFAZOLIN) INJKEFZOL (CEFAZOLIN) INJ 25 J0690 2 250

2500500 KENALOG INJKENALOG INJ 26 J3301 4 250

2500502 KEPPRA (LEVETIRACETAM) TABKEPPRA (LEVETIRACETAM) TAB 3 1 250

2500504 LABETALOL TABLABETALOL TAB 3 1 250

2500505 LACRALUBE OPHTH. OINTMENTLACRALUBE OPHTH. OINTMENT61 1 250

2500507 LANOXIN (DIGOXIN) TABLANOXIN (DIGOXIN) TAB 6 1 250

2500509 LANOXIN (DIGOXIN) INJLANOXIN (DIGOXIN) INJ 30 J1160 1 250

2500510 LANTUS (GLARGINE)LANTUS (GLARGINE) 5 J1815 1 250

2500511 LASIX (FUROSEMIDE) INJLASIX (FUROSEMIDE) INJ 25 J1940 1 250

2500512 LASIX (FUROSEMIDE) TABLASIX (FUROSEMIDE) TAB 3 1 250

2500513 LASIX (FUROSEMIDE) INJLASIX (FUROSEMIDE) INJ 25 1 250

2500514 LASIX (FUROSEMIDE) TABLASIX (FUROSEMIDE) TAB 3 1 250

2500521 LEVEMIR INSULINLEVEMIR INSULIN 5 1 250

2500522 LEXAPRO (ESCITALOPRAM) TABLEXAPRO (ESCITALOPRAM) TAB 9 1 250

2500523 LIDOCAINE 2% (CARDIAC) PFS INJLIDOCAINE 2% (CARDIAC) PFS INJ16 J2001 10 250

2500525 LIPITOR (ATORVASTATIN) TABLIPITOR (ATORVASTATIN) TAB 3 1 250

2500528 LISINOPRIL (ZESTRIL)LISINOPRIL (ZESTRIL) 3 1 250

2500529 LOMOTIL (DIPHENOX/ATROP) TABLOMOTIL (DIPHENOX/ATROP) TAB3 1 250

2500530 LOPRESSOR (METOPROLOL) TABLOPRESSOR (METOPROLOL) TAB3 1 250

2500532 LOPRESSOR (METOPROLOL)LOPRESSOR (METOPROLOL) 25 J3490 5 250

2500533 LOTENSIN (BENAZEPRIL) TABLOTENSIN (BENAZEPRIL) TAB 3 1 250

2500535 LOVENOX (ENOXAPARIN) INJLOVENOX (ENOXAPARIN) INJ 72 J1650 10 250




2500540 LYRICA (PREGABALIN) CAPLYRICA (PREGABALIN) CAP 18 1 250

2500542 M.O.M. (MILK OF MAG) UD SUSPM.O.M. (MILK OF MAG) UD SUSP3 1 250

2500544 MAGNESIUM SULFATE INJMAGNESIUM SULFATE INJ 25 J3475 2 250

2500545 MAGNESIUM CITRATE 10OZ BOTTLEMAGNESIUM CITRATE 10OZ BOTTLE4 1 250

2500546 MAGNESIUM OXIDE (MAG-OX) TABMAGNESIUM OXIDE (MAG-OX) TAB3 1 250

2500548 MECLIZINE (ANTIVERT) TABMECLIZINE (ANTIVERT) TAB 3 1 250

2500549 MEGACE (MEGESTROL) LIQMEGACE (MEGESTROL) LIQ 9 S0179 20 250

2500550 METFORMIN TABMETFORMIN TAB 3 1 250

2500551 MIRALAX UDMIRALAX UD 4 1 250

2500554 MOBIC (MELOXICAM) TABMOBIC (MELOXICAM) TAB 7 1 250

2500555 MORPHINE SULFATE PFS INJMORPHINE SULFATE PFS INJ 25 J2270 1 250



2500558 MUCINEX (OTC) TABMUCINEX (OTC) TAB 3 1 250

2500560 INFUVITE (MVI) VIALINFUVITE (MVI) VIAL 49 1 250

2500563 NAFCILLIN VIALNAFCILLIN VIAL 58 1 250

2500567 NARCAN (NALOXONE HCL) VIALNARCAN (NALOXONE HCL) VIAL76 J2310 1 250

2500570 NEUPOGEN (FILGRASTIM) INJNEUPOGEN (FILGRASTIM) INJ1117 J1442 480 250

2500571 NEURONTIN (GABAPENTIN) CAPNEURONTIN (GABAPENTIN) CAP 3 1 250

2500573 NEURONTIN (GABAPENTIN) CAPNEURONTIN (GABAPENTIN) CAP 3 1 250

2500574 NEUT 5ML VIALNEUT 5ML VIAL 37 1 250

2500575 NEXIUM (ESOMEPRAZOLE) CAPNEXIUM (ESOMEPRAZOLE) CAP28 1 250

2500576 NITRO 50MG/D5W 250ML PREMIXNITRO 50MG/D5W 250ML PREMIX60 1 250

2500577 NITRO BID OINTMENT PACKETNITRO BID OINTMENT PACKET 11 1 250

2500578 NITRO STAT TABNITRO STAT TAB 5 1 250

2500579 NORFLEX VIAL INJNORFLEX VIAL INJ 90 J2360 1 250

2500580 NORVASC (AMLODIPINE) TABNORVASC (AMLODIPINE) TAB 4 1 250

2500582 NYSTOP TOPICAL POWDER 15G BOTTLENYSTOP TOPICAL POWDER 15G BOTTLE76 1 250

2500583 OCTREOTIDE ACETATE INJOCTREOTIDE ACETATE INJ 25 J2354 4 250

2500584 PAXIL (PAROXETINE) TABPAXIL (PAROXETINE) TAB 3 1 250

2500586 PEPCID (FAMOTIDINE) TABPEPCID (FAMOTIDINE) TAB 3 1 250

2500587 PHENERGAN (PROMETHAZINE) INJPHENERGAN (PROMETHAZINE) INJ25 J2550 1 250

2500588 PHENERGAN (PROMETHAZINE) SUPPPHENERGAN (PROMETHAZINE) SUPP36 1 250

2500589 PHENERGAN (PROMETHAZINE) INJPHENERGAN (PROMETHAZINE) INJ3 1 250

2500590 PLAVIX (CLOPRIDOGREL) TABPLAVIX (CLOPRIDOGREL) TAB 14 1 250

2500592 PNEUMONIA VACCINE 23 INJPNEUMONIA VACCINE 23 INJ 199 90732 1 250

2500593 PRAVASTATIN (PRAVACHOL) TABPRAVASTATIN (PRAVACHOL) TAB5 1 250

2500595 PREDNISOLONE (PEDIAPRED) 5MG/5ML LIQPREDNISOLONE (PEDIAPRED) 5MG/5ML LIQ3 J7510 1 250

2500596 PRENISOLONE (PREDNISONE) 15MG/5ML LIQPRENISOLONE (PREDNISONE) 15MG/5ML LIQ3 J7510 3 250

2500597 PREDNISONE TABPREDNISONE TAB 3 1 250

2500599 PRILOSEC (OMEPRAZOLE) CAPPRILOSEC (OMEPRAZOLE) CAP 3 1 250

2500600 PRIMAXIN VIAL INJPRIMAXIN VIAL INJ 69 J0743 2 250

2500602 PROCARDIA XL (NIFIDIPINE XL) TABPROCARDIA XL (NIFIDIPINE XL) TAB3 1 250

2500604 PROCRIT (EPOETIN ALFA) NON ESRD INJPROCRIT (EPOETIN ALFA) NON ESRD INJ2161 J0885 40 250

2500605 PROSCAR (FINASTERIDE) TABPROSCAR (FINASTERIDE) TAB 7 1 250

2500606 PROTAMINE SULFATE SDVPROTAMINE SULFATE SDV 169 J2720 1 250

2500607 PROTONIX (PANTOPRAZOLE) INJPROTONIX (PANTOPRAZOLE) INJ25 C9113 1 250

2500608 PROTONIX (PANTOPRAZOLE) TABPROTONIX (PANTOPRAZOLE) TAB3 1 250

2500609 PROZAC (FLUOXETINE) TABPROZAC (FLUOXETINE) TAB 5 1 250

2500610 RACEPINEPHRINE NEB. SOLRACEPINEPHRINE NEB. SOL 8 1 250

2500611 REGLAN (METOCLOPRAMIDE) INJREGLAN (METOCLOPRAMIDE) INJ25 1 250

2500612 REMICADE POWDER VIAL INJREMICADE POWDER VIAL INJ2453 J2765 10 250

2500613 RESTORIL (TEMAZEPAM) CAPRESTORIL (TEMAZEPAM) CAP 3 1 250

2500614 RISPERDAL (RISPERIDONE) TABRISPERDAL (RISPERIDONE) TAB 7 1 250

2500615 RISPERDAL (RISPERIDONE) TABRISPERDAL (RISPERIDONE) TAB 5 1 250

2500618 ROCEPHIN (CEFTRIAXONE)ROCEPHIN (CEFTRIAXONE) 45 J0696 4 250

2500619 ROCEPHIN (CEFTRIAXONE)ROCEPHIN (CEFTRIAXONE) 107 J0696 2 250

2500621 ROMAZICON 0.1MG/ML 5ML VIALROMAZICON 0.1MG/ML 5ML VIAL25 1 250

2500622 SALINE NASAL SPRAYSALINE NASAL SPRAY 8 1 250

2500624 SCOPOLAMINE TD PATCHSCOPOLAMINE TD PATCH 78 1 250

2500626 SIMVASTATIN (ZOCOR) TABSIMVASTATIN (ZOCOR) TAB 3 1 250

2500627 SINGULAIR (MONTELUKAST) TABSINGULAIR (MONTELUKAST) TAB5 1 250

2500628 SOLU-MEDROL INJSOLU-MEDROL INJ 30 J2930 1 250

2500629 SOLU-MEDROL INJSOLU-MEDROL INJ 29 J2920 1 250

2500631 SPIRIVA HANDI-HALER INHALER 5SPIRIVA HANDI-HALER INHALER 5379 1 250

2500632 SUCCINYLCHOLINE (ANECTINE) VIAL INJSUCCINYLCHOLINE (ANECTINE) VIAL INJ60 J0330 1 250

2500635 SYNTHROID (LEVOTHYROXIN) TABSYNTHROID (LEVOTHYROXIN) TAB3 1 250



2500638 TAMIFLU (OSELTMIVIR PHOS) CAPTAMIFLU (OSELTMIVIR PHOS) CAP37 1 250

2500639 TAO (TRIPLEANTIBIOTIC) OINTMENTTAO (TRIPLEANTIBIOTIC) OINTMENT3 1 250

2500640 TDAP PREFILLED SYRINGETDAP PREFILLED SYRINGE 187 90715 1 250

2500641 TERAZOSIN (HYTRIN) CAPTERAZOSIN (HYTRIN) CAP 3 1 250

2500642 TESSALON (BENZONATATE) LIQ GELTESSALON (BENZONATATE) LIQ GEL4 1 250

2500645 THERA VITE (MULTIVITAMIN)THERA VITE (MULTIVITAMIN) 3 1 250

2500646 THIAMIN (B-1) TABTHIAMIN (B-1) TAB 3 1 250

2500647 THIAMINE INJTHIAMINE INJ 32 J3411 2 250

2500648 TNK (TENECTEPLASE) INJTNK (TENECTEPLASE) INJ 12310 J3101 100 636

2500649 TOPROL XL (METOPROLOL SUCCINATE) TABTOPROL XL (METOPROLOL SUCCINATE) TAB3 1 250

2500651 TORADOL (KETOROLAC) INJTORADOL (KETOROLAC) INJ 25 J1885 2 250

2500652 TORADOL (KETOROLAC) INJTORADOL (KETOROLAC) INJ 25 J1885 4 250

2500654 TRAZADONE (OLEPTRO) TABTRAZADONE (OLEPTRO) TAB 3 1 250

2500656 TUBERCULIN PPD IDTUBERCULIN PPD ID 0 1 250

2500657 TUMS TAB TUMS TAB 2 1 250

2500658 TUSSIONEX (CHLOR/HYDRO)TUSSIONEX (CHLOR/HYDRO) 6 1 250

2500659 TYLENOL (ACETAMINOPHEN) SUPPTYLENOL (ACETAMINOPHEN) SUPP3 1 250

2500660 TYLENOL (ACETAMINOPHEN) TABTYLENOL (ACETAMINOPHEN) TAB3 1 250

2500661 TYLENOL (ACETAMINOPHEN) TABTYLENOL (ACETAMINOPHEN) TAB3 1 250


2500664 TYLENOL (ACETAMINOPHEN) CHILDREN'S SUSPTYLENOL (ACETAMINOPHEN) CHILDREN'S SUSP4 1 250

2500665 TYLENOL W/CODEINE 120/12/5ML ELIXIRTYLENOL W/CODEINE 120/12/5ML ELIXIR3 1 250

2500666 ULTRAM (TRAMADOL) TABULTRAM (TRAMADOL) TAB 3 1 250

2500667 UNASYN (AMPICILLIN/SUBAC) VIAL INJUNASYN (AMPICILLIN/SUBAC) VIAL INJ39 J0295 1 250

2500669 VALIUM (DIAZEPAM) INJVALIUM (DIAZEPAM) INJ 83 J3360 2 250

2500670 VALIUM (DIAZEPAM) TABVALIUM (DIAZEPAM) TAB 3 1 250

2500671 VANCOMYCIN (VANCOCIN) INJVANCOMYCIN (VANCOCIN) INJ 39 J3370 1 250

2500672 VANCOMYCIN (VANCOCIN) INJVANCOMYCIN (VANCOCIN) INJ 30 J3370 2 250

2500677 VERSED (MIDAZOLAM) INJVERSED (MIDAZOLAM) INJ 25 J2250 2 250

2500681 XANAX (ALPRAZOLAM) TABXANAX (ALPRAZOLAM) TAB 3 1 250

2500682 XARELTO (RIVAROXABIN) TABXARELTO (RIVAROXABIN) TAB 34 1 250

2500683 XOPENEX (LEVALBUTEROL)UD NEB. SOLUTIONXOPENEX (LEVALBUTEROL)UD NEB. SOLUTION7 1 250

2500684 XYLOCAINE (LIDOCAINE) 1% VIALXYLOCAINE (LIDOCAINE) 1% VIAL0 1 250

2500685 XYLOCAINE (LIDOCAINE) 2% VIALXYLOCAINE (LIDOCAINE) 2% VIAL14 J3490 1 250

2500686 XYLOCAINE (LIDOCAINE) 2% W/EPIXYLOCAINE (LIDOCAINE) 2% W/EPI19 1 250

2500687 XYLOCAINE (LIDOCAINE) 2% JELLY 15G TUBEXYLOCAINE (LIDOCAINE) 2% JELLY 15G TUBE19 1 250

2500688 XYLOCAINE (LIDOCAINE) VISCOUS UDXYLOCAINE (LIDOCAINE) VISCOUS UD5 1 250

2500689 ZESTORETIC (LISIN/HCTZ) 20/25MG TABZESTORETIC (LISIN/HCTZ) 20/25MG TAB3 1 250

2500690 ZESTORETIC (LISIN/HCTZ) 10/12.5MG TABZESTORETIC (LISIN/HCTZ) 10/12.5MG TAB3 1 250

2500691 ZITHROMAX (AZITHROMYCIN) TABZITHROMAX (AZITHROMYCIN) TAB16 1 250

2500692 ZITHROMAX (AZITHROMYCIN) INJZITHROMAX (AZITHROMYCIN) INJ44 J0456 1 250

2500694 ZOFRAN (ONDANSETRON) ODTZOFRAN (ONDANSETRON) ODT47 S0119 1 250

2500695 ZOFRAN (ONDANSETRON) INJZOFRAN (ONDANSETRON) INJ 25 J2405 4 250

2500696 ZOLOFT (SERTRALINE) TABZOLOFT (SERTRALINE) TAB 3 1 250

2500699 ZOVIRAX (ACYCLOVIR) TABZOVIRAX (ACYCLOVIR) TAB 5 1 250

2500701 ZYRTEC (CETIRIZINE) TABZYRTEC (CETIRIZINE) TAB 3 1 250


2500705 BUDESONIDE INH SUSP UD 0.5MG/2MLBUDESONIDE INH SUSP UD 0.5MG/2ML16 J7626 1 250

2500706 SERAQUEL (QUETIAPINE FUM) TABSERAQUEL (QUETIAPINE FUM) TAB8 1 250

2500707 SPIRONOLACTONE TABSPIRONOLACTONE TAB 3 1 250

2500708 LISINOPRIL (ZESTRIL) TABLISINOPRIL (ZESTRIL) TAB 3 1 250

2500711 FLUORESCEIN OPHTHALMIC STRIPFLUORESCEIN OPHTHALMIC STRIP2 1 250

2500712 NYSTATIN 500,000 UNITS SUSPNYSTATIN 500,000 UNITS SUSP 5 1 250

2500713 MELATONIN TABMELATONIN TAB 3 1 250

2500715 ETOMIDATE 20MG/10ML VIALETOMIDATE 20MG/10ML VIAL 27 1 250

2500716 VECURONIUM BROMIDE VIALVECURONIUM BROMIDE VIAL 25 1 250

2500719 BACITRACIN OPHTHALMIC OINTMENTBACITRACIN OPHTHALMIC OINTMENT75 1 250

2500720 GENTAMICIN OPHTH. OINTMENTGENTAMICIN OPHTH. OINTMENT71 1 250

2500721 CLINDAMYCIN HCL CAPCLINDAMYCIN HCL CAP 3 1 250

2500722 DEPAKOTE EC (DIVALPRX SD) TABDEPAKOTE EC (DIVALPRX SD) TAB5 1 250

2500726 PITOCIN INJPITOCIN INJ 25 J2590 1 250

2500728 XYLOCAINE (LIDOCAINE) 1% W/EPI VIALXYLOCAINE (LIDOCAINE) 1% W/EPI VIAL36 1 250

2500729 ZANTAC (RANITIDINE) INJZANTAC (RANITIDINE) INJ 62 J2780 2 250

2500733 VITAMIN D 5000 IUVITAMIN D 5000 IU 3 1 250

2500734 NARCAN (NALOXONE HCL) VIALNARCAN (NALOXONE HCL) VIAL99 J2310 2 250

2500735 PROPAFOL 1% 10 ML VIALPROPAFOL 1% 10 ML VIAL 25 J2704 10 250

2500742 KETAMINE HCL INJKETAMINE HCL INJ 25 1 250

2500743 ROCURONIUM BROMIDE 5ML VIALROCURONIUM BROMIDE 5ML VIAL25 1 250

2500841 ESMOLOL HCL 10ML VIALESMOLOL HCL 10ML VIAL 35 J3490 1 250

2500890 B COMPLEX TABB COMPLEX TAB 3 1 250

2500915 SLOW MAG 64 TABSLOW MAG 64 TAB 3 1 250

2500918 VITAMIN D3 1000 IU TABVITAMIN D3 1000 IU TAB 3 1 250

2500925 ULTRACET (TRAM/ACET) 37.5/325MG TABULTRACET (TRAM/ACET) 37.5/325MG TAB3 1 250


2500965 PROCHLORPERAZINE SUPPISITORYPROCHLORPERAZINE SUPPISITORY26 1 250

2500971 REMERON (MIRTAZAPINE) TABREMERON (MIRTAZAPINE) TAB 7 1 250

2500973 DIOVAN (VALSARATAN) TABDIOVAN (VALSARATAN) TAB 13 1 250

2500977 LEVOPHED (NOREPINEPHRINE BAR.) INJLEVOPHED (NOREPINEPHRINE BAR.) INJ61 1 250

2500978 ATIVAN INTENSOL (LORAZEPAM) LIQATIVAN INTENSOL (LORAZEPAM) LIQ7 1 250

2500980 LORATADINE (CLARITIN) TABLORATADINE (CLARITIN) TAB 3 1 250

2500984 BUSPAR (BUSPIRONE HCL) TABBUSPAR (BUSPIRONE HCL) TAB 3 1 250

2501010 MORPHINE SULFATE O/S 10MG/5ML UDMORPHINE SULFATE O/S 10MG/5ML UD4 1 250

2501021 ZYVOX 600MG/NS PREMIX 300MLZYVOX 600MG/NS PREMIX 300ML164 J2020 3 250

2501025 LEVOTHYROXINE (SYNTHROID) TABLEVOTHYROXINE (SYNTHROID) TAB3 1 250

2501036 SINEMET (LEVO/CARB) 25/225 TABSINEMET (LEVO/CARB) 25/225 TAB4 1 250

2501040 MAALOX (MI-ACID) LIQMAALOX (MI-ACID) LIQ 3 1 250

2501049 TRANXENE (CLORAZEPATE) TABTRANXENE (CLORAZEPATE) TAB 5 1 250

2501050 EFFEXOR XR (VENLAFAXINE) CAPEFFEXOR XR (VENLAFAXINE) CAP9 1 250

2501052 CRESTOR (ROSUVASTATIN CALCIUM) TABCRESTOR (ROSUVASTATIN CALCIUM) TAB18 1 250

2501062 ASPIRIN (ASA) EC TABASPIRIN (ASA) EC TAB 3 1 250

2501074 AMARYL (GLIMEPIRIDE) TABAMARYL (GLIMEPIRIDE) TAB 3 1 250

2501080 SINEMET (LEVO/CARB) 25/100 TABSINEMET (LEVO/CARB) 25/100 TAB3 1 250

2501105 DIABETA (GLYBURIDE) TABDIABETA (GLYBURIDE) TAB 3 1 250

2501109 ZANAFLEX (TIZANIDINE) TABZANAFLEX (TIZANIDINE) TAB 4 1 250

2501129 SINEMET (LEVO/CARB) 25/250SINEMET (LEVO/CARB) 25/250 4 1 250

2501173 ZANTAC (RANITIDINE) TABZANTAC (RANITIDINE) TAB 4 1 250

2501177 ZINACEF (CEFUROXIME) INJZINACEF (CEFUROXIME) INJ 25 J0697 1 250

2501182 SILVER NITRATE APPLICATOR STICKSILVER NITRATE APPLICATOR STICK5 1 250

2501218 REQUIP (ROPINIROLE) TABREQUIP (ROPINIROLE) TAB 5 1 250

2501300 CELEBREX (CELECOXIB) CAPCELEBREX (CELECOXIB) CAP 9 1 250


2501405 CLONAZEPAM (KLONOPIN) TABCLONAZEPAM (KLONOPIN) TAB 4 1 250

2501407 PROLIA PFSPROLIA PFS 2486 J0897 60 250

2501410 PREPERATION H OINTMENTPREPERATION H OINTMENT 10 1 250

2501416 FLONASE (FLUTICASONE) NASAL SPRAYFLONASE (FLUTICASONE) NASAL SPRAY169 1 250

2501447 AMOXICILLIN CAPAMOXICILLIN CAP 3 1 250

2501448 METHOCARBAMOL (ROBAXIN)METHOCARBAMOL (ROBAXIN) 3 1 250

2501468 FOLIC ACID INJFOLIC ACID INJ 25 J3490 1 250

2501477 TPA (ACTIVASE)TPA (ACTIVASE) 18481 1 250

2501479 METHYLENE BLUE INJMETHYLENE BLUE INJ 44 Q9968 10 250

2501482 CIPRO (CIPROFLOXACIN) TABCIPRO (CIPROFLOXACIN) TAB 3 1 250

2501490 BROVANA 15MCG/2ML UD VIALBROVANA 15MCG/2ML UD VIAL34 J7605 1 250

2501503 VITAMIN K (PHYTONADIONE) INJVITAMIN K (PHYTONADIONE) INJ25 J3430 1 250

2501510 POLYTRIM (POLY B/ TRIMETHOPRIM) OPTHPOLYTRIM (POLY B/ TRIMETHOPRIM) OPTH52 1 250

2501521 CYMBALTA (DULOXETINE) CAPCYMBALTA (DULOXETINE) CAP 16 1 250

2501537 PLETAL (CILOSTAZOL) TABPLETAL (CILOSTAZOL) TAB 5 1 250

2501550 RIFAMPIN INJRIFAMPIN INJ 771 J3490 1 250

2501560 ELIQUIS TABELIQUIS TAB 20 1 250

2501561 ZYPREXA (OLANZEPINE) TABZYPREXA (OLANZEPINE) TAB 23 1 250


2501578 MEROPENEM INJMEROPENEM INJ 91 J2185 10 250

2501580 ACYCLOVIR INJACYCLOVIR INJ 64 J0133 100 250

2501586 ARMOUR THYROID 1 GRAIN TABARMOUR THYROID 1 GRAIN TAB3 1 250

2501592 ONE TOUCH ULTRA CONTROL SOLUTIONONE TOUCH ULTRA CONTROL SOLUTION0 1 250

2501595 ONE TOUCH ULTRA TEST STRIPSONE TOUCH ULTRA TEST STRIPS 0 1 250

2501596 PRADAXA CAPPRADAXA CAP 17 1 250

2501599 RIFAXAMIN TABRIFAXAMIN TAB 78 1 250

2501636 SODIUM CHLORIDE 10ML BOTTLESODIUM CHLORIDE 10ML BOTTLE3 1 250

2501639 VANCOMYCIN (VANCOCIN) PO CAPVANCOMYCIN (VANCOCIN) PO CAP63 1 250

2501642 MENACTRA (MENNINGICOCCAL) VACCINE SUSPMENACTRA (MENNINGICOCCAL) VACCINE SUSP244 90734 1 250

2501643 HEPATITIS A (HAVRIX)(PEDI) VACCINEHEPATITIS A (HAVRIX)(PEDI) VACCINE96 90633 1 250

2501646 DURAGESIC (FENTANYL) TD PATCHDURAGESIC (FENTANYL) TD PATCH158 1 250

2501647 INDERAL (PROPANALOL) TABINDERAL (PROPANALOL) TAB 3 1 250

2501649 SINEMET (CARB/LEVO) ER 50-200MG TABSINEMET (CARB/LEVO) ER 50-200MG TAB4 1 250

2501658 OXYCODONE/APAP 5/325MG TABOXYCODONE/APAP 5/325MG TAB3 1 250

2501665 PHENOL E-Z SWABPHENOL E-Z SWAB 22 1 250

2501668 HYDRALAZINE PO TABHYDRALAZINE PO TAB 3 1 250

2501670 PRADAXA CAPPRADAXA CAP 17 1 250

2501673 SANTYL TOPICAL OINTMENT TUBESANTYL TOPICAL OINTMENT TUBE678 1 250

2501674 PREVNAR 13PREVNAR 13 378 90670 1 250

2501680 HYDROXYZINE PAMOATE (VISTARIL) CAPHYDROXYZINE PAMOATE (VISTARIL) CAP3 1 250

2501682 EFFEXOR XR (VENLAFAXINE) CAPEFFEXOR XR (VENLAFAXINE) CAP5 1 250

2501685 ZOSTAVAX SQ POWDER 19400 UNITSZOSTAVAX SQ POWDER 19400 UNITS670 90736 1 250

2501686 DEPAKOTE (DIVALPRX ) SPRINKLES CAPDEPAKOTE (DIVALPRX ) SPRINKLES CAP4 1 250

2501687 DEPACON (VALPROATE) VIALDEPACON (VALPROATE) VIAL 83 1 250

2501690 ONE TOUCH VERIO TEST STRIPS (100)ONE TOUCH VERIO TEST STRIPS (100)0 1 250

2501708 ORBACTIV IV POWDER VIALORBACTIV IV POWDER VIAL 2030 J2407 40 250

2501714 OFIRMEV (ACETAMINOPHEN) IV PREMIXOFIRMEV (ACETAMINOPHEN) IV PREMIX85 J0131 100 250

2501730 RANEXA TABRANEXA TAB 15 1 250

2501733 AZILECT TABAZILECT TAB 50 1 250

2501734 ENTACAPONE TABENTACAPONE TAB 10 1 250

2501736 ONE TOUCH ULTRA METERONE TOUCH ULTRA METER 0 1 250

2501738 REGLAN (METOCLOPRAMIDE) TABREGLAN (METOCLOPRAMIDE) TAB3 1 250

2501744 SINEMET (CARB/LEVO) 10-100MG TABSINEMET (CARB/LEVO) 10-100MG TAB4 1 250

2501745 CT OMNIPAQUE 300MG/ML (30ML)CT OMNIPAQUE 300MG/ML (30ML)125 Q9966 1 250

2501757 TAMBACOR (FLECANIDE) TABTAMBACOR (FLECANIDE) TAB 5 1 250

2501758 MMR II (MEASELS MUMPS RUBELLA) VACC VIALMMR II (MEASELS MUMPS RUBELLA) VACC VIAL149 90707 1 250

2501788 DIOVAN (VALSARTAN) TABDIOVAN (VALSARTAN) TAB 8 1 250

2501792 GARDASIL 9 VACCINE SUSP IMGARDASIL 9 VACCINE SUSP IM430 90651 1 250

2501794 WATER FOR INJECTIONWATER FOR INJECTION 0 1 250

2501800 CREON 24000 UNITS CAPCREON 24000 UNITS CAP 14 1 250

2501801 KINRIX (DTAP/IPV) VACC SUSP IMKINRIX (DTAP/IPV) VACC SUSP IM106 90696 1 250

2501803 ENGERIX-B (PEDI) 10MCG/0.5ML VACC SUSP PFSENGERIX-B (PEDI) 10MCG/0.5ML VACC SUSP PFS69 90743 1 250

2501804 BACLOFEN PO TABBACLOFEN PO TAB 3 1 250

2501806 PEDIARIX (DTAP/HEP-B/IPV) VACC IM SUSPPEDIARIX (DTAP/HEP-B/IPV) VACC IM SUSP161 90723 1 250

2501807 PROQUAD (MMR VARICELLA) VACC IM SUSPPROQUAD (MMR VARICELLA) VACC IM SUSP425 90710 1 250

2501808 ACETAMINOPHEN (TYLENOL) #4 60/300MG TABACETAMINOPHEN (TYLENOL) #4 60/300MG TAB3 1 250

2501815 GALANTAMINE HYDROBROMIDE TABGALANTAMINE HYDROBROMIDE TAB9 1 250

2501824 CYMBALTA (DULOXETINE) CAPCYMBALTA (DULOXETINE) CAP 17 1 250

2501837 FLUZONE PEDI (6-35MOS) VACC IMFLUZONE PEDI (6-35MOS) VACC IM70 90685 1 250

2501844 LISINOPRIL (ZESTRIL) TABLISINOPRIL (ZESTRIL) TAB 3 1 250

2501847 VARIVAX PEDI CHICKEN POX) VACC SQ 1350PFUVARIVAX PEDI CHICKEN POX) VACC SQ 1350PFU256 90716 1 250

2501856 FLAGYL (METRONIDAZOLE) TABFLAGYL (METRONIDAZOLE) TAB 3 1 250

2501862 ACTIDOSE W/SORBITOL 50 G BOTTLEACTIDOSE W/SORBITOL 50 G BOTTLE74 1 250

2501864 CATAPRESS TTS-2 PATCHCATAPRESS TTS-2 PATCH 112 1 250

2501866 CARDIZEM ER ( DILTIAZEM ER) 300MG CAPCARDIZEM ER ( DILTIAZEM ER) 300MG CAP6 1 250

2501867 AZTREONAM (AZACTAM) VIALAZTREONAM (AZACTAM) VIAL 88 S0073 2 250

2501870 DEPO MEDROL VIALDEPO MEDROL VIAL 51 J1030 1 250

2501873 DILANTIN (PHENYTOIN) ER CAPDILANTIN (PHENYTOIN) ER CAP 3 1 250

2501878 DALVANCE VIAL INJDALVANCE VIAL INJ 3223 J0875 100 250

2501884 CT OMNIPAQUE 300 (50ML)CT OMNIPAQUE 300 (50ML) 116 Q9967 1 250

2501890 KEPPRA (LEVETIRACETAM) 100MG/MLKEPPRA (LEVETIRACETAM) 100MG/ML3 1 250

2501916 DILTIAZEM (CARDIZEM) TABDILTIAZEM (CARDIZEM) TAB 3 1 250

2501921 DRONABINOL (MARINOL) GEL CAPDRONABINOL (MARINOL) GEL CAP11 1 250

2501923 XARELTO (RIVAROXABIN) TABXARELTO (RIVAROXABIN) TAB 34 1 250

2501931 NEXIUM (ESOMEPRAZOLE) IV VIALNEXIUM (ESOMEPRAZOLE) IV VIAL105 1 250

2501938 ONE TOUCH VERIO CONTROL SOLUTIONONE TOUCH VERIO CONTROL SOLUTION0 1 250

2501972 TYLENOL #3 (ACET/COD) 300/30MG TABTYLENOL #3 (ACET/COD) 300/30MG TAB3 1 250

2501986 GLUCOSE GEL TUBEGLUCOSE GEL TUBE 6 1 250


2501990 MELATONIN TABMELATONIN TAB 3 1 250

2501991 LACTULOSE 10G/15ML UD O/SLACTULOSE 10G/15ML UD O/S 5 1 250

2501996 CATAPRESS TTS-1 PATCH 0.1MG/24HCATAPRESS TTS-1 PATCH 0.1MG/24H67 1 250



2502009 VITAMIN D 50,000 IU CAPVITAMIN D 50,000 IU CAP 3 1 250

2502019 LANCETS UNISTIK 23G (50/BX)LANCETS UNISTIK 23G (50/BX) 0 1 250

2502037 TRANEXAMIC ACID 1000MG/10ML VIALTRANEXAMIC ACID 1000MG/10ML VIAL94 1 250

2500074 CARDIZEM (DILTIAZEM) 25MG/5ML VIALCARDIZEM (DILTIAZEM) 25MG/5ML VIAL25 J3490 5 250

2500092 CIPRO (CIPROFLOXZCIN) INJCIPRO (CIPROFLOXZCIN) INJ 25 J0744 1 250

2501051 PROCHLORPERAZINE (COMPAZINE) INJPROCHLORPERAZINE (COMPAZINE) INJ89 J0780 1 250

2501298 BENADRYL SPRAY APPLICATIONBENADRYL SPRAY APPLICATION 3 1 250

3100259 ANTITHROMBIN III ACTIVITYANTITHROMBIN III ACTIVITY 64 85300,90 1 305

3100332 FECAL CALPROTECTINFECAL CALPROTECTIN 383 83993,90 1 301

400092 STRAPPING SHOULDERSTRAPPING SHOULDER 122 29240 1 450

3100003 ADRENOCORTICOTROPIC ACTHADRENOCORTICOTROPIC ACTH246 82024,90 1 301

9600069 TREAT CLOSED RADIAL FX W MANIPTREAT CLOSED RADIAL FX W MANIP900 25605,54 1 960

2700524 ELECTRODE CLOTH 3/PACKAGEELECTRODE CLOTH 3/PACKAGE 5 1 271

3100233 TRILEPTAL TRILEPTAL 145 80183,90 1 301

4300024 OT BODY POS CURRENT G8981CJOT BODY POS CURRENT G8981CJ0.01 G8981,CJ,GO 1 439

3140010 PC IMMUNOASSAY QUALITAT OR SEMIQUANTPC IMMUNOASSAY QUALITAT OR SEMIQUANT70 83520,90 1 302

4300182 OT COMMUNITY/WORK REINTEGRTN EA 15 MINOT COMMUNITY/WORK REINTEGRTN EA 15 MIN100 97537,GO 1 431

9600313 NASAL/ORO-GASTRIC W/TUBE PLCMTNASAL/ORO-GASTRIC W/TUBE PLCMT98 43752 1 960

400058 BURN TX PART THCK MEDBURN TX PART THCK MED 252 16025 1 450

3140005 PC AMITRIPTYLINE ASSAYPC AMITRIPTYLINE ASSAY 97 80335,90 1 301

3140136 PC CALCIUM URINE RANDOM OR 24 HOURPC CALCIUM URINE RANDOM OR 24 HOUR46 82340,90 1 301

9600075 TREAT CLOSED PATELLAR DISLOCATIONTREAT CLOSED PATELLAR DISLOCATION662 27560,54 1 960

2700234 GAUZE SPONGE 4X4 12PLYGAUZE SPONGE 4X4 12PLY 5 A6402 1 272

2700208 ORTHO STRAP CLAVICLE MEDIUMORTHO STRAP CLAVICLE MEDIUM47 L3650 1 270

500017 SHAVE SKIN LES S N H F G 0.6-1.0CMSHAVE SKIN LES S N H F G 0.6-1.0CM169 11306 1 761

4200074 PT MOBILITY DC G8980CJPT MOBILITY DC G8980CJ 0.01 G8980,CJ,GP 1 429

2700092 CONFORM 2INCONFORM 2IN 5 A6445 1 272

2900010 BB CROSSMATCHBB CROSSMATCH 79 86920,90 1 302

500052 EX MALIG LES S N H F G 3.1-4.0 CMEX MALIG LES S N H F G 3.1-4.0 CM1683 11624 1 761

500117 AVULSION NAIL PLATE SINGLEAVULSION NAIL PLATE SINGLE336 11730 1 761

3100049 CHLORIDE URINECHLORIDE URINE 33 82436,90 1 301

3140137 PC CHLORIDE URINEPC CHLORIDE URINE 33 82436,90 1 301

3100276 METHADONEMETHADONE 514 80358,90 1 301

9600133 OBSERVATION INITIAL CARE LVL 3OBSERVATION INITIAL CARE LVL 3405 99220 1 982

4400131 ST EVALSPEECH DEVICE ADDL 30 MINST EVALSPEECH DEVICE ADDL 30 MIN160 92608,GN 1 444

2700378 MINI TRACHMINI TRACH 55 1 270

2700327 SUTURE 4-0 PROLENE 8699GSUTURE 4-0 PROLENE 8699G 81 A4550 1 272

9600159 HOME HEALTH RE-CERTIFI MDCRHOME HEALTH RE-CERTIFI MDCR155 G0179 1 960

3200068 XR SINUS <3 VIEWXR SINUS <3 VIEW 140 70210 1 320

400007 EVACUATION SUBUNGUAL HEMATOMAEVACUATION SUBUNGUAL HEMATOMA64 11740 1 450

500087 REMOVE IMPACT CERUMENREMOVE IMPACT CERUMEN 112 69210 1 761

4200007 PT BODY POS CURRENT G8981CMPT BODY POS CURRENT G8981CM0.01 G8981,CM,GP 1 429

400100 STRAPPING ANKLE ANDOR FOOTSTRAPPING ANKLE ANDOR FOOT122 29540 1 450

4300089 OT ATTEN DC G9167CLOT ATTEN DC G9167CL 0.01 G9167,CL,GN 1 439

3140043 PC HERPES SIMPLEX II IGMPC HERPES SIMPLEX II IGM 78 86695,90 1 302

4300148 OT SELFCARE CURRENT G8987CHOT SELFCARE CURRENT G8987CH0.01 G8987,CH,GO 1 439

3100105 FLUID CELL COUNT W DIFFLUID CELL COUNT W DIF 45 89051,90 1 309

3500001 CT ABDOMEN PELVIS W CONTRASTCT ABDOMEN PELVIS W CONTRAST1928 74177 1 350

3100265 STONE ANALYSISSTONE ANALYSIS 96 82365,90 1 301

3100320 ANTI RNP ANTI RNP 72 86771,90 1 301

9600084 APPLY SHORT ARM SPLINTAPPLY SHORT ARM SPLINT 127 29125 1 960

2720026 TUBING O2 7FTTUBING O2 7FT 5 1 270

4200102 PT OTHER PT OT GOAL G8991CJPT OTHER PT OT GOAL G8991CJ0.01 G8991,CJ,GP 1 429

3100187 PROTEIN TOTAL REFRACTOMETRYPROTEIN TOTAL REFRACTOMETRY20 84160,90 1 301

4400031 ST LANG EXPRESS GOAL G9163CJST LANG EXPRESS GOAL G9163CJ0.01 G9163,CJ,GN 1 449

9600015 EX B9 LES TRK ARM LEG 1.1-2.0CMEX B9 LES TRK ARM LEG 1.1-2.0CM280 11402 1 960

4300139 OT OTHER PT OT DC G8992CMOT OTHER PT OT DC G8992CM0.01 G8992,CM,GO 1 439

400147 IV INF CHEMO EA ADD HRIV INF CHEMO EA ADD HR 89 96415 1 335

500004 INCIS REMOV FB SUBQ SIMPLEINCIS REMOV FB SUBQ SIMPLE1683 10121 1 761

2702046 ENEMA BUCKETENEMA BUCKET 10 1 270

2700229 STERI STRIPS 1/8INSTERI STRIPS 1/8IN 5 A4649 1 272

4300166 OT SUB PT OT DC G8995CLOT SUB PT OT DC G8995CL 0.01 G8995,CL,GO 1 439

3140035 CHARGE STOOL CSCHARGE STOOL CS 51 87046,90 1 306

4400177 ST MEMORY FUNC LIMIT CURRENT G9169CIST MEMORY FUNC LIMIT CURRENT G9169CI0.01 G9169,CI,GN 1 449

2700346 DETACHOL DETACHOL 10 1 270

2600001 D5W 250 MLD5W 250 ML 35 1 258

4400032 ST LANG EXPRESS GOAL G9163CKST LANG EXPRESS GOAL G9163CK0.01 G9163,CK,GN 1 449

2700146 MORGAN FLOW LENSMORGAN FLOW LENS 60 1 270

400093 SRAPPING ELBOW OR WRISTSRAPPING ELBOW OR WRIST 122 29260 1 450

4200180 PT WHIRLPOOL EXTREMITYPT WHIRLPOOL EXTREMITY 78 97022,GP 1 421

2700050 CATH FOLEY 8FR/3MLCATH FOLEY 8FR/3ML 13 1 270

4200139 PT IONTOPHORESIS EA 15 MINUTESPT IONTOPHORESIS EA 15 MINUTES108 97033,GP 1 421

4400174 ST MEMORY FUNC LIMIT G9168CMST MEMORY FUNC LIMIT G9168CM0.01 G9168,CM,GN 1 449

2700214 SPLINT COLLES SM LTSPLINT COLLES SM LT 10 A4570 1 271

2700400 SENSOR SP02 NELLCOR ADULTSENSOR SP02 NELLCOR ADULT 67 A4649 1 272

500133 RPR SMP S N A GEN TR EXT 2.6-7.5CMRPR SMP S N A GEN TR EXT 2.6-7.5CM202 12002 1 450

9600033 RPR F E EY N L M 2.5 CM <RPR F E EY N L M 2.5 CM < 280 12011 1 960

2710014 SUB-Q INFUSION SETSUB-Q INFUSION SET 14 1 272

9600172 PUNCTURE SPINAL LUMBAR DIAGNOSTICPUNCTURE SPINAL LUMBAR DIAGNOSTIC1000 62270 1 960

400128 INJ ANES AGENT OTHER PERIPH NRVINJ ANES AGENT OTHER PERIPH NRV598 64450 1 450

3140092 PC SALMONELLA TOTAL AB EIAPC SALMONELLA TOTAL AB EIA44 86768,90 1 302

500094 IV INF SEQ NEW DRUG UP TO 1 HRIV INF SEQ NEW DRUG UP TO 1 HR89 96367 1 761

3140085 PC PSA TOTALPC PSA TOTAL 99 84153,90 1 301

2700238 STWATERIRRIGATION SOL250MLSTWATERIRRIGATION SOL250ML10 A4217 1 272

2700193 SALEM SUMP 16FRSALEM SUMP 16FR 6 1 270

3100025 BORDETELLA PERTUSISBORDETELLA PERTUSIS 165 87265,90 1 302

4300070 OT SELFCARE DC G8989CNOT SELFCARE DC G8989CN 0.01 G8989,CN,GO 1 439


4300141 OT OTHER PT OT GOAL G8991CHOT OTHER PT OT GOAL G8991CH0.01 G8991,CH,GO 1 439

2700055 CATH MALE FREEDOM SMCATH MALE FREEDOM SM 5 1 270

2700691 NASALCANNULA NIVNASALCANNULA NIV 34 1 270

400042 RPR INT F E EY N L MM > 30.0 CMRPR INT F E EY N L MM > 30.0 CM717 12057 1 450

3300001 MRA HEAD WO CONTMRA HEAD WO CONT 3150 70544 1 610

2720007 CONNECTOR O2 6&1CONNECTOR O2 6&1 5 1 271

4300025 OT BODY POS CURRENT G8981CKOT BODY POS CURRENT G8981CK0.01 G8981,CK,GO 1 439

2700159 NASAL AIRWAY 34FRNASAL AIRWAY 34FR 7 1 270

2702048 FEEDING BAGFEEDING BAG 15 1 270

2700124 HAND HELD NEBULIZER SET W MOUTHPIECEHAND HELD NEBULIZER SET W MOUTHPIECE5 1 270

3400022 US OB 1ST TRIMESTERUS OB 1ST TRIMESTER 385 76801 1 402

2700312 VASELINE GAUZE 3INX18INVASELINE GAUZE 3INX18IN 5 A6224 1 272

9600081 TREAT CLOSED MP TOE DISLOCATIONTREAT CLOSED MP TOE DISLOCATION460 28630 1 960

2700299 TUBE LEVIN 8FRTUBE LEVIN 8FR 54 1 270

4300015 OT ATTEN GOAL G9166CHOT ATTEN GOAL G9166CH 0.01 G9166,CH,GN 1 439

4400155 ST ATTENTION FUNCT LIMIT CURRENT G9166CHST ATTENTION FUNCT LIMIT CURRENT G9166CH0.01 G9166,CH,GN 1 449

3200112 XR SCOLIOSIS SERIESXR SCOLIOSIS SERIES 243 72082 1 320

400154 CRITICAL CARE 1ST HRCRITICAL CARE 1ST HR 1205 99291 1 450



2700315 CATH TROCAR 28F16INCATH TROCAR 28F16IN 45 1 270

400142 INJ THER IM SUBQINJ THER IM SUBQ 54 96372 1 450

2710021 NON CHARGABLE NOW IV CATH 24GNON CHARGABLE NOW IV CATH 24G5 1 270

3100074 CHARGE STOOL EACH ADDCHARGE STOOL EACH ADD 156 87046,90 1 306



270257 KING TUBE SIZE 4KING TUBE SIZE 4 0 1 270

4200179 PT COMMUNITYWORK REINTEGRTN EA 15 MINPT COMMUNITYWORK REINTEGRTN EA 15 MIN100 97537,GP 1 421

3100020 BETA 2 MICROGLOBULIN BLOODBETA 2 MICROGLOBULIN BLOOD129 82232,90 1 301

3140088 PC ANTIBODY LEGIONELLAPC ANTIBODY LEGIONELLA 83 86713,90 1 302

4400122 ST VOICE GOAL G9172CJST VOICE GOAL G9172CJ 0.01 G9172,CJ,GN 1 449


9600120 REMOVE FB CONJUNCTIVALREMOVE FB CONJUNCTIVAL 163 65205 1 960

4200122 PT SUB PT OT DC G8995CIPT SUB PT OT DC G8995CI 0.01 G8995,CI,GP 1 429

2720015 MASK O2 REBREATHER ADULTMASK O2 REBREATHER ADULT 5 1 270

400014 RPR SMP S N A G T EX 20.1-30.0 CMRPR SMP S N A G T EX 20.1-30.0 CM228 12006 1 450

4300126 OT MOBILITY DC G8980CNOT MOBILITY DC G8980CN 0.01 G8980,CN,GO 1 439

3100169 NORTRIPTYLLINENORTRIPTYLLINE 145 80335,90 1 300

3900001 CARDIAC REHAB WO ECG MONITORINGCARDIAC REHAB WO ECG MONITORING200 93797 1 943

2700057 SYRINGE CATH TIP 60MLSYRINGE CATH TIP 60ML 5 1 270

3100114 GASTRIN GASTRIN 87 82941,90 1 301

2702061 SKIN STAPLER 35W DISPSKIN STAPLER 35W DISP 38 1 270

3100043 CCP ANTIBODYCCP ANTIBODY 70 86200,90 1 302

3100183 PROTEIN C CLOT INHIBIT ACTIVITYPROTEIN C CLOT INHIBIT ACTIVITY115 85303,90 1 305

4300001 OT OTHER PT OT CURRENT G8990CHOT OTHER PT OT CURRENT G8990CH0.01 G8990,CH,GO 1 439


3100273 ANTI-DIURETIC HORMONEANTI-DIURETIC HORMONE 183 84588,90 1 301

3140065 PC GG IG SUBCLASSES EACHPC GG IG SUBCLASSES EACH 23 82787,90 1 301

9600102 IV INSERTIONIV INSERTION 200 36000 1 960

2700027 SUPPORT ANKLE ELASTIC MEDIUMSUPPORT ANKLE ELASTIC MEDIUM58 A4649 1 271

2700561 SPECULUM ER SPEC VAGINAL WLED LGSPECULUM ER SPEC VAGINAL WLED LG96 A4649 1 271

4200091 PT OTHER PT OT CURRENT G8990CMPT OTHER PT OT CURRENT G8990CM0.01 G8990,CM,GP 1 429

4300146 OT OTHER PT OT GOAL G8991CMOT OTHER PT OT GOAL G8991CM0.01 G8991,CM,GO 1 439

500142 DESTRUCT SKIN LESION S/N/H/F/G2.1-3.0CM /DESTRUCT SKIN LESION S/N/H/F/G2.1-3.0CM /631 17273 1 761

400170 MODERATE SEDATION PHYS/QHP 5YRS/> 1ST 15MODERATE SEDATION PHYS/QHP 5YRS/> 1ST 15420 99152 1 450

3100263 BENZENE URINEBENZENE URINE 535 84600,90 1 301

4300049 OT MEMORY CURRENT G9168CNOT MEMORY CURRENT G9168CN0.01 G9168,CN,GN 1 439

400113 RPR LAC MOUTHANT TONGUE 2.5 CMOR <RPR LAC MOUTHANT TONGUE 2.5 CMOR <176 41250 1 450

3100206 SED RATE AUTOMATED - RLSED RATE AUTOMATED - RL 30 85652,90 1 305

4200110 PT SELFCARE CURRENT G8987CKPT SELFCARE CURRENT G8987CK0.01 G8987,CK,GP 1 429

4200027 PT SELFCARE DC G8989CLPT SELFCARE DC G8989CL 0.01 G8989,CL,GP 1 429

2720022 MASK O2 VENTI ADULTMASK O2 VENTI ADULT 97 1 270

3100190 PSA SCREENINGPSA SCREENING 114 G0103,90 1 300

4400189 ST MEMORY FUNCT LIMIT G9170CNST MEMORY FUNCT LIMIT G9170CN0.01 G9170,CN,GN 1 449

400121 CATH INSERT ST RESIDUAL URINECATH INSERT ST RESIDUAL URINE112 51701 1 450

2720050 IMMOBILIZER HEAD ADULTIMMOBILIZER HEAD ADULT 32 1 272

2700365 HOT PACK HOT PACK 5 1 270

9600187 RPR LACERATION VESTIBULE MOUTH >2.5CMRPR LACERATION VESTIBULE MOUTH >2.5CM780 40831 1 960

4200060 PT CARRY CURRENT G8984 CJPT CARRY CURRENT G8984 CJ0.01 G8984,CJ,GP 1 429

4200064 PT CARRY CURRENT G8984 CNPT CARRY CURRENT G8984 CN0.01 G8984,CN,GP 1 429

4200054 PT BODY POS GOAL G8982CKPT BODY POS GOAL G8982CK0.01 G8982,CK,GP 1 429

4300093 OT BODY POS DC G8983CIOT BODY POS DC G8983CI 0.01 G8983,CI,GO 1 439

9600125 GASTRIC INTUBATION ASPIRATEGASTRIC INTUBATION ASPIRATE177 43753 1 960

3100087 DNA PROBES W GONORRHOEDNA PROBES W GONORRHOE377 87591,90 1 306

9600087 STRAPPING ELBOW OR WRISTSTRAPPING ELBOW OR WRIST 91 29260 1 960

500074 INTRO NEEDLE CATH VEININTRO NEEDLE CATH VEIN 91 36000 1 761

3500000 CT 3 D RENDERINGCT 3 D RENDERING 960 76376 1 350

4400077 ST VOICE CURRENT G9171CNST VOICE CURRENT G9171CN0.01 G9171,CN,GN 1 449

4300117 OT MOBILITY CURRENT G8978 CLOT MOBILITY CURRENT G8978 CL0.01 G8978,CL,GO 1 439

500119 REMOVE NON BIODEGR DRUG DELIVERY IMPLANTREMOVE NON BIODEGR DRUG DELIVERY IMPLANT221 11982 1 761

4400038 ST MOTOR SPEECH GOAL G9186CJST MOTOR SPEECH GOAL G9186CJ0.01 G9186,CJ,GN 1 449


300014 IV INF CONCURRENTIV INF CONCURRENT 89 96368 1 760

3100090 EPSTEIN BARR EB VIRALEPSTEIN BARR EB VIRAL 104 86665,90 1 302

2700278 TRAY GASTRIC LAVAGETRAY GASTRIC LAVAGE 83 1 270

3140148 PC C CHROMOTAGRAHPY QUAL/QUANPC C CHROMOTAGRAHPY QUAL/QUAN97 82542,90 1 301

3100125 HEMOGLOBIN FRACTIONATIONHEMOGLOBIN FRACTIONATION127 83021,90 1 301

4400058 ST SPEECH LANG GOAL G9175CIST SPEECH LANG GOAL G9175CI0.01 G9175,CI,GN 1 449

4200112 PT SELFCARE CURRENT G8987CMPT SELFCARE CURRENT G8987CM0.01 G8987,CM,GP 1 429


3100287 KEPPRA (LEVETIRACETAM)KEPPRA (LEVETIRACETAM) 48 80177,90 1 301

4300056 OT MEMORY DC G9170CNOT MEMORY DC G9170CN 0.01 G9170,CN,GN 1 439

3100251 PS PS 36 88164,90 1 311

2700348 FORCEPS DRESSING ST STERILE 5.5INFORCEPS DRESSING ST STERILE 5.5IN5 1 272

3100193 RBC SICKLE CELL SCREENRBC SICKLE CELL SCREEN 39 85660,90 1 305

2700657 NASAL SPECULUM DISPOSABLENASAL SPECULUM DISPOSABLE 7 1 271

400089 SPLINT APPLICATION LONG ARMSPLINT APPLICATION LONG ARM213 29105 1 450

2700186 CHEST DRAIN PLUER EVAC SYSTEMCHEST DRAIN PLUER EVAC SYSTEM442 1 270

2700722 STEAM CHEM INTEGRATORSSTEAM CHEM INTEGRATORS 0 1 270

2700331 SCISSOR METZEN CURVED STRL 7INSCISSOR METZEN CURVED STRL 7IN22 1 270

3100220 T 3 T 3 76 84479,90 1 301

4200070 PT MOBILITY CURRENT G8978 CMPT MOBILITY CURRENT G8978 CM0.01 G8978,CM,GP 1 429

1400008 PSYCHIATRIC DIAGNOSTIC EVALPSYCHIATRIC DIAGNOSTIC EVAL300 90791 1 900

500038 EX BEN LES FA EA EY N L M 1.1-2.0CMEX BEN LES FA EA EY N L M 1.1-2.0CM1314 11442 1 761

2900011 BB DIRECT COOMBSBB DIRECT COOMBS 43 86880,90 1 390

2710003 BROSELOW PEDI BLUEBROSELOW PEDI BLUE 33 1 271

4200006 PT BODY POS CURRENT G8981CLPT BODY POS CURRENT G8981CL0.01 G8981,CL,GP 1 429

3100079 CYSTINES URINECYSTINES URINE 91 82615,90 1 301

2600018 NS 50 ML NS 50 ML 30 1 258

3140031 PC CHLAMYDIA T AMPLIF NA PROBE PANELPC CHLAMYDIA T AMPLIF NA PROBE PANEL189 87491,90 1 312

4400008 ST LANG COMP DC G9161CHST LANG COMP DC G9161CH 0.01 G9161,CH,GN 1 449


2702064 SKIN STAPLER 35W DISPSKIN STAPLER 35W DISP 231 A4649 1 272

4300095 OT BODY POS DC G8983CKOT BODY POS DC G8983CK 0.01 G8983,CK,GO 1 439

4400021 ST LANG COMP GOAL G9160CNST LANG COMP GOAL G9160CN0.01 G9160,CN,GN 1 449

2720013 MASK O2 NONREBREATHER ADULTMASK O2 NONREBREATHER ADULT5 A4649 1 271

3140015 PC PARTICLE AGGLUTINATION SCREEN EAPC PARTICLE AGGLUTINATION SCREEN EA55 86403,90 1 302

2700333 SCISSORS IRIS STRAIGHT STRL 4.5SCISSORS IRIS STRAIGHT STRL 4.57 A4550 1 272

3150057 PC PSA TOTAL AND PERCENT FREE PANELPC PSA TOTAL AND PERCENT FREE PANEL0 1 301

270262 MASK SAFETY SEALAND SURGICAL SMALLMASK SAFETY SEALAND SURGICAL SMALL13 1 270

3140051 PC MERCURY QUANTITATIVEPC MERCURY QUANTITATIVE 70 83825,90 1 301

9600055 DESTRUCT PREMALG LESIONDESTRUCT PREMALG LESION 240 17000 1 960

3140025 PC GG IGA IGD IGG IGM EAPC GG IGA IGD IGG IGM EA 50 82784,90 1 301

4300183 OT WHEELCHAIR MGMT EA 15 MINOT WHEELCHAIR MGMT EA 15 MIN106 97542,GO 1 431

4200041 PT SUB PT OT GOAL G8994CLPT SUB PT OT GOAL G8994CL0.01 G8994,CL,GP 1 429

9600079 TREAT CLOSED GREAT TOE FX W MANIPTREAT CLOSED GREAT TOE FX W MANIP455 28495,54 1 960

2700406 TAPE MEDIPORE 1TAPE MEDIPORE 1 0 1 270

500012 SHAVE SKIN LES TK ARM LEG 0.5 CM<SHAVE SKIN LES TK ARM LEG 0.5 CM<161 11300 1 761

3100131 HEPARIN ASSAYHEPARIN ASSAY 78 85520,90 1 305

4300046 OT MEMORY CURRENT G9168CKOT MEMORY CURRENT G9168CK0.01 G9168,CK,GN 1 439

4300053 OT MEMORY DC G9170CKOT MEMORY DC G9170CK 0.01 G9170,CK,GN 1 439

4300110 OT CARRY CURRENT G8984 CLOT CARRY CURRENT G8984 CL0.01 G8984,CL,GO 1 439

3140139 PC CREATININE URINEPC CREATININE URINE 28 82570,90 1 301

4300127 OT MOBILITY GOAL G8979CHOT MOBILITY GOAL G8979CH0.01 G8979,CH,GO 1 439

4200077 PT MOBILITY DC G8980CMPT MOBILITY DC G8980CM 0.01 G8980,CM,GP 1 429

4200119 PT SUB PT OT CURRENT G8993CMPT SUB PT OT CURRENT G8993CM0.01 G8993,CM,GP 1 429

4300060 OT MEMORY GOAL G9169CKOT MEMORY GOAL G9169CK 0.01 G9169,CK,GN 1 439

3150038 PC HELICO PYLORI IGG IGM IGA AB PANELPC HELICO PYLORI IGG IGM IGA AB PANEL0 1 302

4400153 ST ATTENTION FUNC LIMIT G9165CMST ATTENTION FUNC LIMIT G9165CM0.01 G9165,CM,GN 1 449

3500039 CT PELVIS WO CONTRASTCT PELVIS WO CONTRAST 1560 72192 1 350

3200045 XR KNEE 3 VIEW RIGHTXR KNEE 3 VIEW RIGHT 126 73562,RT 1 320

3400045 US ECHO LIMITEDUS ECHO LIMITED 523 93308 1 483

2700201 SKIN STAPLER 5SKIN STAPLER 5 13 A4649 1 272

2700009 BROSELOW PEDI PURPLEBROSELOW PEDI PURPLE 135 1 270

4300100 OT BODY POS GOAL G8982CIOT BODY POS GOAL G8982CI 0.01 G8982,CI,GO 1 439

500089 INJ IMMUNIZATION ADMININJ IMMUNIZATION ADMIN 54 90471 1 771

3140084 PC SMEAR COMPLEX STAINPC SMEAR COMPLEX STAIN 97 87209,90 1 306

500064 DESTRUCT PRE MAL LES 2-14 EACHDESTRUCT PRE MAL LES 2-14 EACH26 17003 1 761

9600184 I & D HEMATOMA SEROMA FLUID COLLECTIONI & D HEMATOMA SEROMA FLUID COLLECTION219 10140 1 960

2700197 SCALPEL #11 DISPSCALPEL #11 DISP 5 A4649 1 272

3100256 CLOTTING FACTOR V LABILE FACTORCLOTTING FACTOR V LABILE FACTOR95 85220,90 1 305

9600298 HOLTER >48HR-21DAY RVW & INTERP BY PHYSHOLTER >48HR-21DAY RVW & INTERP BY PHYS340 0298T 1 985

400130 REMOVE FB CORNEA WO SLREMOVE FB CORNEA WO SL 167 65220 1 450


3300004 MRA NECK WO CONTMRA NECK WO CONT 3150 70547 1 610

2700006 ACE4IN ACE4IN 10 A6449 1 271

400024 RPR INT SC AX TR EXT 2.5 CM<RPR INT SC AX TR EXT 2.5 CM<566 12031 1 450

4300044 OT MEMORY CURRENT G9168CIOT MEMORY CURRENT G9168CI0.01 G9168,CI,GN 1 439

4300168 OT SUB PT OT DC G8995CNOT SUB PT OT DC G8995CN 0.01 G8995,CN,GO 1 439

2702053 GAUZE SPONGES 4X4 12PLYGAUZE SPONGES 4X4 12PLY 17 A6402 1 270

3140120 CHARGE GRAM STAINCHARGE GRAM STAIN 133 87205,90 1 306

4200033 PT SELFCARE GOAL G8988CKPT SELFCARE GOAL G8988CK 0.01 G8988,CK,GP 1 429

4300057 OT MEMORY GOAL G9169CHOT MEMORY GOAL G9169CH0.01 G9169,CH,GN 1 439

500014 SHAVE SKIN LES TK ARM LEG 1.1-2.0CMSHAVE SKIN LES TK ARM LEG 1.1-2.0CM176 11302 1 761

9600085 APPLY FINGER SPLINT STATICAPPLY FINGER SPLINT STATIC 100 29130 1 960

2700246 CATH SUCTION 18FRCATH SUCTION 18FR 5 1 270

4300022 OT BODY POS CURRENT G8981CHOT BODY POS CURRENT G8981CH0.01 G8981,CH,GO 1 439


2720062 INTRODUCER TRACH ST 15F 70CMINTRODUCER TRACH ST 15F 70CM17 S8189 1 272

4400014 ST LANG COMP DC G9161CNST LANG COMP DC G9161CN 0.01 G9161,CN,GN 1 449

3100218 CHARGE SENSI MANUALCHARGE SENSI MANUAL 46 87184,90 1 306

2700724 DEFIBRILLATOR PADS 3M HEALTHCARE 4.5X6DEFIBRILLATOR PADS 3M HEALTHCARE 4.5X622 1 270

500110 ALLERGY INJECTION 2 OR >ALLERGY INJECTION 2 OR > 42 95117 1 771

4200126 PT SUB PT OT DC G8995CMPT SUB PT OT DC G8995CM 0.01 G8995,CM,GP 1 429

4300005 OT OTHER PT OT CURRENT G8990CLOT OTHER PT OT CURRENT G8990CL0.01 G8990,CL,GO 1 439

2700332 SCISSORS IRIS CURVED STERILESCISSORS IRIS CURVED STERILE 5 1 270

2700102 TEGADERM 4INX43/4INTEGADERM 4INX43/4IN 5 A6258 1 272

2702054 EPISTASIS DEVICE RAPID RHINO 450EPISTASIS DEVICE RAPID RHINO 45072 A4649 1 271

3140014 PC AB ASPERGILLUSPC AB ASPERGILLUS 44 86606,90 1 302

4300165 OT SUB PT OT DC G8995CKOT SUB PT OT DC G8995CK 0.01 G8995,CK,GO 1 439

3140115 PC PROTEIN E PHORESIS URINE CSFPC PROTEIN E PHORESIS URINE CSF96 84166,90 1 301

4200061 PT CARRY CURRENT G8984 CKPT CARRY CURRENT G8984 CK0.01 G8984,CK,GP 1 429

2720083 HOLDER ET TUBE LAERDAL THOMAS PEDIHOLDER ET TUBE LAERDAL THOMAS PEDI23 1 271

4200152 PT DEBRID TISS SELECT EA ADDL 20 SQ CMPT DEBRID TISS SELECT EA ADDL 20 SQ CM292 97598,GP 1 421

400144 INJ IVP SEQ NEW DRUGINJ IVP SEQ NEW DRUG 89 96375 1 450

4300017 OT ATTEN GOAL G9166CJOT ATTEN GOAL G9166CJ 0.01 G9166,CJ,GN 1 439

3100146 IMMUNOFIXATION E PHORESIS SERUMIMMUNOFIXATION E PHORESIS SERUM154 86334,90 1 302

9600145 SAME DAY ADMIT DISCH OBS IP L3SAME DAY ADMIT DISCH OBS IP L3585 99236 1 987

4300074 OT SELFCARE GOAL G8988CKOT SELFCARE GOAL G8988CK0.01 G8988,CK,GO 1 439

3140111 PC AB HSV IPC AB HSV I 71 86695,90 1 302

2700540 TUBE GASTROSTOMY 22F 3 PORTTUBE GASTROSTOMY 22F 3 PORT257.5 1 272

2710023 ARMBOARD ORTH DISP INFAN 004/070ARMBOARD ORTH DISP INFAN 004/0705 1 271

1500015 FAMILY PSYCHOTHER W PT PRESENTFAMILY PSYCHOTHER W PT PRESENT295 90847 1 916

9600101 PERICARDIOCENTESISPERICARDIOCENTESIS 460 33010 1 960

500053 EX MALIG LES S N H F G >4.0 CMEX MALIG LES S N H F G >4.0 CM1964 11626 1 761

3100130 HEP C RNA QUANTITATIVEHEP C RNA QUANTITATIVE 291 87522,90 1 306

4400025 ST LANG EXPRESS CURRENT G9162CKST LANG EXPRESS CURRENT G9162CK0.01 G9162,CK,GN 1 449

2720024 TUBE HOLDER TRACH PEDITUBE HOLDER TRACH PEDI 30 A4649 1 271

3100037 CARBOHYDRATE DEFICIENT TRANSFERRINCARBOHYDRATE DEFICIENT TRANSFERRIN299 82373,90 1 301

2702030 AMBU BAG NEONATALAMBU BAG NEONATAL 110.3 1 271

3140059 PC BC AEROBIC-ADDTL IDPC BC AEROBIC-ADDTL ID 44 87077,90 1 306

400067 DRAIN FINGER ABSCESS SIMPLEDRAIN FINGER ABSCESS SIMPLE283 26010 1 450

3150078 PC STONE RISK PROFILE PANELPC STONE RISK PROFILE PANEL 0 1 301

4200155 PT NEG PRESS WOUND VAC >50 SQ CMPT NEG PRESS WOUND VAC >50 SQ CM292 97606,GP 1 421

2720012 MASK O2 FACE TENTMASK O2 FACE TENT 12 1 270

2720044 SUTURE SURGIPROL 6-0 SP- 660GSUTURE SURGIPROL 6-0 SP- 660G16 1 272

2700753 SOFT FOAM NECK BRACE SMSOFT FOAM NECK BRACE SM 6 1 270

4400083 ST VOICE DC G9173CMST VOICE DC G9173CM 0.01 G9173,CM,GN 1 449

2700079 DERMABLADEDERMABLADE 5 A4649 1 272

4400185 ST MEMORY FUNCT LIMIT G9170CJST MEMORY FUNCT LIMIT G9170CJ0.01 G9170,CJ,GN 1 449

4400061 ST SPEECH LANG GOAL G9175CLST SPEECH LANG GOAL G9175CL0.01 G9175,CL,GN 1 449

2700692 EYE PATCH (HARD) ELASTIC BANDEYE PATCH (HARD) ELASTIC BAND5 1 270

4400022 ST LANG EXPRESS CURRENT G9162CHST LANG EXPRESS CURRENT G9162CH0.01 G9162,CH,GN 1 449

9600058 INJECT TENDON SHEATH SINGLEINJECT TENDON SHEATH SINGLE137 20550 1 960

4200131 PT CANALITH REPOSITIONING PER DAYPT CANALITH REPOSITIONING PER DAY166 95992,GP 1 421



4400087 ST LANG EXPRESS DC G9164 CJST LANG EXPRESS DC G9164 CJ0.01 G9164,CJ,GN 1 449

2700314 YANKAUER SUCTIONYANKAUER SUCTION 5 1 270

3140096 PC DNA ANTIBODYPC DNA ANTIBODY 74 86225,90 1 302

3100212 SMEAR WET PREPSMEAR WET PREP 29 87210,90 1 306

2700200 SKIN STAPLE REMOVER KITSKIN STAPLE REMOVER KIT 7 A4649 1 272

3150041 PC HERPES SIMPLES VIRUS IGG PANELPC HERPES SIMPLES VIRUS IGG PANEL0 1 302

4300071 OT SELFCARE GOAL G8988CHOT SELFCARE GOAL G8988CH0.01 G8988,CH,GO 1 439

3100158 LEGIONELLA ANTIBODYLEGIONELLA ANTIBODY 164 86713,90 1 302

4400133 ST EVAL ORAL PHARYN SWALL FUNCTST EVAL ORAL PHARYN SWALL FUNCT227 92610,GN 1 444

2700228 PICC/CVC PICC/CVC 27 1 270

400151 EMERGENCY DEPT LEVEL 3EMERGENCY DEPT LEVEL 3 323 99283 1 450

3400023 US OB AFTER 1ST TRIMESTERUS OB AFTER 1ST TRIMESTER 420 76805 1 402

2700188 NASAL RHINO ROCKET ALL SIZESNASAL RHINO ROCKET ALL SIZES45 A4649 1 271

2700767 Z-SLIDER TRANSFER SHEETZ-SLIDER TRANSFER SHEET 6 1 270

3100311 ENTERIC PARASITE PANELENTERIC PARASITE PANEL 120 87507,90 1 306

9600142 INPATIENT SUBSEQ HOSP LVL 3INPATIENT SUBSEQ HOSP LVL 3300 99233 1 987

4400004 ST LANG COMP CURRENT G9159CKST LANG COMP CURRENT G9159CK0.01 G9159,CK,GN 1 449

4400098 ST MOTOR SPEECH CURRENT G8999CNST MOTOR SPEECH CURRENT G8999CN0.01 G8999,CN,GN 1 449

2700589 CATH SUCTION 10FR W/VALVECATH SUCTION 10FR W/VALVE 5 A4624 1 272

2700560 SPECULUM ER SPEC VAGINAL WLED MEDSPECULUM ER SPEC VAGINAL WLED MED33 A4649 1 271

3140104 CELL COUNT W DIFFERENTIAL COUNT PCCELL COUNT W DIFFERENTIAL COUNT PC130 89051,90 1 300

3100161 LUTEINIZING HORMONE LHLUTEINIZING HORMONE LH 118 83002,90 1 301

3100128 HEP C CONFIRMATORY TESTHEP C CONFIRMATORY TEST 83 86804,90 1 302

2720033 BROSELOW PEDI GREENBROSELOW PEDI GREEN 198 1 270

3100069 CULTURE CHLAMYDIACULTURE CHLAMYDIA 95 87110,90 1 306

4400013 ST LANG COMP DC G9161CMST LANG COMP DC G9161CM0.01 G9161,CM,GN 1 449

400032 RPR INT NE HA FT GEN 7.6-12.5 CMRPR INT NE HA FT GEN 7.6-12.5 CM591 12044 1 450

3100304 COCAINE CONFIRMATIONCOCAINE CONFIRMATION 423 80353,90 1 301

2700320 CATH TROCAR 16F 9INCATH TROCAR 16F 9IN 98 1 270


2700215 SPLINT COLLES SM RTSPLINT COLLES SM RT 10 A4570 1 271

400094 STRAPPING HAND OR FINGERSTRAPPING HAND OR FINGER 122 29280 1 450

1400005 MED NUTRITION INTERV SUBSQT EA 15MMED NUTRITION INTERV SUBSQT EA 15M63 97803 1 942

3100163 MASS SPECTROMETRY QUANTITATIVEMASS SPECTROMETRY QUANTITATIVE150 83789,90 1 301

4300068 OT SELFCARE DC G8989CLOT SELFCARE DC G8989CL 0.01 G8989,CL,GO 1 439

400048 RPR CMPLX SC ARM LEG EA ADD 5 CM<RPR CMPLX SC ARM LEG EA ADD 5 CM<193 13122 1 450

3100282 METHADONE ASSAY CONFIRMATIONMETHADONE ASSAY CONFIRMATION514 80358,90 1 301

2700084 ABD SMALL 5INX9INABD SMALL 5INX9IN 5 A6407 1 270

3500044 CT SOFT TISSUE NECK W CONTRASTCT SOFT TISSUE NECK W CONTRAST1512 70491 1 350

2702052 SOCKS LARGESOCKS LARGE 5 1 270

4300125 OT MOBILITY DC G8980CMOT MOBILITY DC G8980CM 0.01 G8980,CM,GO 1 439

2700076 CRUTCHES CHILD 4FT-4.6FTCRUTCHES CHILD 4FT-4.6FT 34 E0114 1 271

3150067 PC TORCH PANEL IGM QUANTITATIVEPC TORCH PANEL IGM QUANTITATIVE0 1 302

300009 IV INF HYDRATE INIT 31 MINS-1 HRIV INF HYDRATE INIT 31 MINS-1 HR168 96360 1 760

400171 RPR LAC VESTIB MOUTH 2.5CM OR LESSRPR LAC VESTIB MOUTH 2.5CM OR LESS905 40830 1 450

3140107 PC TES TOTPC TES TOT 139 84403,90 1 301

2700272 STOCKING ANITEMBOLI KNEE XLGSTOCKING ANITEMBOLI KNEE XLG10 1 270

500018 SHAVE SKIN LES S N H F G 1.1-2.0CMSHAVE SKIN LES S N H F G 1.1-2.0CM176 11307 1 761


390002 CARDIAC REHAB W ECG MONITORINGCARDIAC REHAB W ECG MONITORING240 93798 1 943

2720049 MASK ELONGATED ADULTMASK ELONGATED ADULT 64 A6446 1 272

3150071 PC CULTURE SPUTUM PANELPC CULTURE SPUTUM PANEL 0 1 306

2700307 TUBE ET 8.0TUBE ET 8.0 5 1 270

270258 MASK O2 ADULTMASK O2 ADULT 5 1 270

3100231 TOBRAMYCINTOBRAMYCIN 117 80200,90 1 301

3140041 PC EPSTEIN BARR VIRUS NUCLEAR ANTIGENPC EPSTEIN BARR VIRUS NUCLEAR ANTIGEN83 86664,90 1 302

4400095 ST MOTOR SPEECH CURRENT G8999CKST MOTOR SPEECH CURRENT G8999CK0.01 G8999,CK,GN 1 449

2702039 CATH TER PLUGCATH TER PLUG 0 1 270

4200115 PT SUB PT OT CURRENT G8993CIPT SUB PT OT CURRENT G8993CI0.01 G8993,CI,GP 1 429

2700672 COLOSTOMY BAG (CONVATEC)COLOSTOMY BAG (CONVATEC) 7 1 270

3100053 CLOSTRIDIUMCLOSTRIDIUM 122 87230,90 1 306

9600186 EX MALIG LES TR ARM LEG >4.0 CMEX MALIG LES TR ARM LEG >4.0 CM862 11606 1 960

3140076 PC ESTRIOL UNCONJUGATEDPC ESTRIOL UNCONJUGATED 130 82677,90 1 301

2700236 TRAP SPECIMEN STERILETRAP SPECIMEN STERILE 5 1 270

3500046 CT SOFT TISSUE NECK WWO CONTRASTCT SOFT TISSUE NECK WWO CONTRAST1936 70492 1 350

4200023 PT SELFCARE DC G8989CHPT SELFCARE DC G8989CH 0.01 G8989,CH,GP 1 429

4200123 PT SUB PT OT DC G8995CJPT SUB PT OT DC G8995CJ 0.01 G8995,CJ,GP 1 429

4300033 OT CARRY DC G8986CLOT CARRY DC G8986CL 0.01 G8986,CL,GO 1 439

3140024 PC IF EA AB INDIRECTPC IF EA AB INDIRECT 121 88347,90 1 312

2702035 CATH THORACIC PVC STRAIT 28FR/20INCATH THORACIC PVC STRAIT 28FR/20IN0 1 270

9600029 RPR WND S N AX GEN TNK 2.6-7.5RPR WND S N AX GEN TNK 2.6-7.5360 12002 1 960

2700413 TRIPLE ANTIBIOTICTRIPLE ANTIBIOTIC 0 1 270

2700330 TRAY EPISTAXSISTRAY EPISTAXSIS 78 1 270

2720034 SUTURE 2-0 PROLENE 8689HSUTURE 2-0 PROLENE 8689H 49 1 271


500086 REMOVE FB EXT EAR WO ANESTHREMOVE FB EXT EAR WO ANESTH112 69200 1 761

500138 REMOVE FB CORNEA WO SLREMOVE FB CORNEA WO SL 170 65220 1 450

4400048 ST SPEECH LANG CURRENT G9174CMST SPEECH LANG CURRENT G9174CM0.01 G9174,CM,GN 1 449

4400000 ST ATTENTION FUNCT LIMIT G9165CLST ATTENTION FUNCT LIMIT G9165CL0.01 G9165,CL,GN 1 449

2700586 AMD ANTIMICROBIAL FOAM DISC1AMD ANTIMICROBIAL FOAM DISC120 A4649 1 271

400060 FX CLSD TX RIB EACHFX CLSD TX RIB EACH 301 1 450

9600111 I D ABSCESS SUBMUCOSAL RECTUMI D ABSCESS SUBMUCOSAL RECTUM554 45005 1 960

1500009 PSYCHOTHER CRISIS MGMT 1ST 60M (30-74M)PSYCHOTHER CRISIS MGMT 1ST 60M (30-74M)248 90839 1 900

9600144 SAME DAY ADMIT DISCH OBS IP L2SAME DAY ADMIT DISCH OBS IP L2487.5 99235 1 987

9600104 CVP INSERTION 5 YRS OLDERCVP INSERTION 5 YRS OLDER 800 36556 1 960

400123 CATH INSERT FOLEY COMPLICATEDCATH INSERT FOLEY COMPLICATED185 51703 1 450

3100222 T 3 REVERSET 3 REVERSE 76 84482,90 1 301

4200118 PT SUB PT OT CURRENT G8993CLPT SUB PT OT CURRENT G8993CL0.01 G8993,CL,GP 1 429

4300042 OT CARRY GOAL G8985CNOT CARRY GOAL G8985CN 0.01 G8985,CN,GO 1 439

270259 MASK NONREBREATHER PEDIMASK NONREBREATHER PEDI 5 1 270

9600158 SUPERVISE HOSPICE PT 30MINS OR > MOSUPERVISE HOSPICE PT 30MINS OR > MO255 99378 1 960

500063 DESTRUCT PRE MAL FIRST LESDESTRUCT PRE MAL FIRST LES161 17000 1 761

2700141 IODOFORM 1INX5IODOFORM 1INX5 6 A6266 1 272

2720045 EXUDERM ODO SHIELD 4INX3.6INEXUDERM ODO SHIELD 4INX3.6IN24 1 271

3200027 XR FOOT 2 VIEW RIGHTXR FOOT 2 VIEW RIGHT 123 73620,RT 1 320

2600003 D5W 1000 MLD5W 1000 ML 45 1 258

4400060 ST SPEECH LANG GOAL G9175CKST SPEECH LANG GOAL G9175CK0.01 G9175,CK,GN 1 449

3100306 ISLET CELL ANTIBODYISLET CELL ANTIBODY 61 86341,90 1 301

500131 CAST APPLICATION LONG ARMCAST APPLICATION LONG ARM426 29065 1 450

4200128 PT STRAPPING UNNA BOOTPT STRAPPING UNNA BOOT 236 29580,GP 1 421

4200144 PT GAIT TRAINING THERAPY EA 15 MINPT GAIT TRAINING THERAPY EA 15 MIN97 97116,GP 1 421

500091 IV INF HYDRATE EA ADD HRIV INF HYDRATE EA ADD HR 61 96361 1 761

4400134 ST RADIOPAQUE SWALLOW STUDYST RADIOPAQUE SWALLOW STUDY292 92611,GN 1 444

2700101 TEGADERM+PAD 2X2.75TEGADERM+PAD 2X2.75 5 A6257 1 270

3140011 PC FLUORESCENT NONINFECTIOUS AGENT ABPC FLUORESCENT NONINFECTIOUS AGENT AB65 86255,90 1 302

3400025 US PELVIC NON OBUS PELVIC NON OB 350 76856 1 402

4200015 PT CARRY DC G8986CNPT CARRY DC G8986CN 0.01 G8986,CN,GP 1 429

4300085 OT ATTEN DC G9167CHOT ATTEN DC G9167CH 0.01 G9167,CH,GN 1 439

3400014 US EXTREMITY VEIN BILAT STUDYUS EXTREMITY VEIN BILAT STUDY624 93970 1 921

4200108 PT SELFCARE CURRENT G8987CIPT SELFCARE CURRENT G8987CI0.01 G8987,CI,GP 1 429

2700723 STEAM INDICATOR ATTEST 1262PSTEAM INDICATOR ATTEST 1262P0 1 270

2700404 TAPE HYPAFIX 2TAPE HYPAFIX 2 0 1 270

2700087 ADAPTIC 3INX8INADAPTIC 3INX8IN 5 A6223 1 272

2700137 STYLET INTUBATING 6FRSTYLET INTUBATING 6FR 7 1 270

4400005 ST LANG COMP CURRENT G9159CLST LANG COMP CURRENT G9159CL0.01 G9159,CL,GN 1 449

3100291 CULTURE VIRALCULTURE VIRAL 94.75 87252,90 1 306

4200089 PT OTHER PT OT CURRENT G8990CKPT OTHER PT OT CURRENT G8990CK0.01 G8990,CK,GP 1 429

4400091 ST LANG EXPRESS DC G9164 CNST LANG EXPRESS DC G9164 CN0.01 G9164,CN,GN 1 449

3150040 PC HEPATITIS E VIRUS IGG IGM AB PANELPC HEPATITIS E VIRUS IGG IGM AB PANEL0 1 302

3500006 CT ABDOMEN WWO CONTRASTCT ABDOMEN WWO CONTRAST2240 74170 1 350

4400115 ST SWALLOW DC G8998CJST SWALLOW DC G8998CJ 0.01 G8998,CJ,GN 1 449

400138 IV INF DRUG INIT UP TO 1 HRIV INF DRUG INIT UP TO 1 HR 330 96365 1 450

3100135 HEPATITIS PANEL ACUTEHEPATITIS PANEL ACUTE 335 80074,90 1 301

3140108 PC THYROGLOBULINPC THYROGLOBULIN 87 84432,90 1 301

3200003 XR ABDOMEN ACUTE COMPLETE W CHESTXR ABDOMEN ACUTE COMPLETE W CHEST205 74022 1 320

400115 REMOVE FB PHARYNXREMOVE FB PHARYNX 112 42809 1 450

2720063 MASK CPAP MIRAGE QUATTRO FFM SML-AMRMASK CPAP MIRAGE QUATTRO FFM SML-AMR17 1 271


4400123 ST VOICE GOAL G9172CKST VOICE GOAL G9172CK 0.01 G9172,CK,GN 1 449

3100333 RENIN RENIN 118 84244,90 1 301

3100116 GGT GGT 39 82977,90 1 301

3100129 HEP C GENOTYPE DNAHEP C GENOTYPE DNA 984 87902,90 1 306

3100296 SELENIUM BLOODSELENIUM BLOOD 89.5 84255,90 1 301

4300054 OT MEMORY DC G9170CLOT MEMORY DC G9170CL 0.01 G9170,CL,GN 1 439

3100166 METHEMOGLOBIN QUALITATIVE BLOODMETHEMOGLOBIN QUALITATIVE BLOOD91 83045,90 1 301

4200046 PT BODY POS DC G8983CJPT BODY POS DC G8983CJ 0.01 G8983,CJ,GP 1 429

4300115 OT MOBILITY CURRENT G8978 CJOT MOBILITY CURRENT G8978 CJ0.01 G8978,CJ,GO 1 439

2710024 ARMBOARD ORTH DISP 2X4ARMBOARD ORTH DISP 2X4 5 1 271

3100283 OPIATES ASSAY 1 OR > CONFIRMATIONOPIATES ASSAY 1 OR > CONFIRMATION576 80361,90 1 301

9600057 REMOVE FB MUSCLE SIMPLEREMOVE FB MUSCLE SIMPLE 440 20520 1 960

2700328 SUTURE ETHILON 5-0 698HSUTURE ETHILON 5-0 698H 56 1 270

3200032 XR HAND 2 VIEW LEFTXR HAND 2 VIEW LEFT 123 73120,LT 1 320

400084 DISLOC IP JT W MANIP WO ANESDISLOC IP JT W MANIP WO ANES301 28660 1 450

500076 CHANGE GASTROSTOMY TUBE WO IMAGCHANGE GASTROSTOMY TUBE WO IMAG354 43760 1 761

3100083 DHEA DHEA 136 82627,90 1 301

3100297 CA 15-3 CA 15-3 112 86300,90 1 302

500090 IV INF HYDRATE INIT 31 MINS-1 HRIV INF HYDRATE INIT 31 MINS-1 HR168 96360 1 761

4400187 ST MEMORY FUNCT LIMIT G9170CLST MEMORY FUNCT LIMIT G9170CL0.01 G9170,CL,GN 1 449

9600035 RPR F E EY N L M 5.1-7.5CMRPR F E EY N L M 5.1-7.5CM 400 12014 1 960

2720056 INTRODUCER TRACH ST 15F 70CMINTRODUCER TRACH ST 15F 70CM213 1 271

4300134 OT OTHER PT OT DC G8992CHOT OTHER PT OT DC G8992CH0.01 G8992,CH,GO 1 439

4300059 OT MEMORY GOAL G9169CJOT MEMORY GOAL G9169CJ 0.01 G9169,CJ,GN 1 439


3150029 PC CULTURE STOOL PANELPC CULTURE STOOL PANEL 0 1 306

3100063 CRYPTOSPORIDIUMCRYPTOSPORIDIUM 70 87328,90 1 306

9600304 TUBE THORACOSTOMYTUBE THORACOSTOMY 450 32551 1 960

9600195 CLOSURE WOUND DEHIS SMPLCLOSURE WOUND DEHIS SMPL486 12020 1 960

2702059 SOCKS MEDIUMSOCKS MEDIUM 5 1 270

500073 SPLINT APPLICATION SHORT ARMSPLINT APPLICATION SHORT ARM194 29125 1 761

3140146 PC SULFATE URINEPC SULFATE URINE 30 84392,90 1 301


3100277 VITAMIN A VITAMIN A 41 84590,90 1 301

4300041 OT CARRY GOAL G8985CMOT CARRY GOAL G8985CM 0.01 G8985,CM,GO 1 439

4200022 PT CARRY GOAL G8985CNPT CARRY GOAL G8985CN 0.01 G8985,CN,GP 1 429

4300083 OT SUB PT OT GOAL G8994CMOT SUB PT OT GOAL G8994CM0.01 G8994,CM,GO 1 439

2710013 SEC MED SEC MED 14 1 272

3100121 H PYLORI QUANTITATIVE RLH PYLORI QUANTITATIVE RL 132 87339,90 1 306

2700536 SUTURE VICYRL 5-0 18CTDVIOBRP-3 J463GSUTURE VICYRL 5-0 18CTDVIOBRP-3 J463G27 A4649 1 272


4400190 ST COGNITIVE PERFORMANCE TESTING /HRST COGNITIVE PERFORMANCE TESTING /HR319 96125,GN 1 444

4200107 PT SELFCARE CURRENT G8987CHPT SELFCARE CURRENT G8987CH0.01 G8987,CH,GP 1 429

4200178 PT COGNITIVE SKILL DEVELPT COGNITIVE SKILL DEVEL 90 97127,GP 1 421

500111 INJ DIAG/THERAP SUBSTANCE LUMBAR/SACRALINJ DIAG/THERAP SUBSTANCE LUMBAR/SACRAL1273 62311 1 761

4300091 OT ATTEN DC G9167CNOT ATTEN DC G9167CN 0.01 G9167,CN,GN 1 439

3140083 PC OVA AND PARASITES DIR SMR W IDPC OVA AND PARASITES DIR SMR W ID47 87177,90 1 306

4200072 PT MOBILITY DC G8980CHPT MOBILITY DC G8980CH 0.01 G8980,CH,GP 1 429

4400029 ST LANG EXPRESS GOAL G9163CHST LANG EXPRESS GOAL G9163CH0.01 G9163,CH,GN 1 449

400026 RPR INT SC AX TR EXT 7.6-12.5CMRPR INT SC AX TR EXT 7.6-12.5CM617 12034 1 450


3140143 PC PHOSPHATE URINEPC PHOSPHATE URINE 34 84105,90 1 301

3100051 OXCARBAZEPINE (TRILEPTAL)OXCARBAZEPINE (TRILEPTAL) 100 82542,90 1 301

9600128 RHYTHM STRIP INTRPRETATIONRHYTHM STRIP INTRPRETATION60 93042 1 985

2700103 TEGADERM LARGE 6INX8INTEGADERM LARGE 6INX8IN 6 A6259 1 272

500056 EX MALIG LES F ER EY N L1.1-2.0CMEX MALIG LES F ER EY N L1.1-2.0CM825 11642 1 761

500045 EX MALIG LES TR ARM LEG 2.1-3.0 CMEX MALIG LES TR ARM LEG 2.1-3.0 CM1314 11603 1 761

500108 ADMIN PNEUMONIA INJADMIN PNEUMONIA INJ 54 90471 1 771


9600112 I D ISCHIORECTAL RECTAL ABSCESI D ISCHIORECTAL RECTAL ABSCES796 46040,54 1 960


2720011 MASK O2 AEROSOL PEDIMASK O2 AEROSOL PEDI 5 1 270

4400109 ST SWALLOW CURRENT G8996CKST SWALLOW CURRENT G8996CK0.01 G8996,CK,GN 1 449

9600053 BURN DEBRIDEMENT SMALLBURN DEBRIDEMENT SMALL 140 16020 1 960

3200015 XR COLON BE WWO KUBXR COLON BE WWO KUB 350 74270 1 320


9600056 CHEMICAL CAUTERIZATIONCHEMICAL CAUTERIZATION 160 17250 1 960

3140100 PC COMPLEMENT ANTIGEN EAPC COMPLEMENT ANTIGEN EA 65 86160,90 1 302

9600063 REDUCTION DISLOCATIONREDUCTION DISLOCATION 337 21480 1 960

3100288 ETHYLENE GLYCOLETHYLENE GLYCOL 211 82693,90 1 301

3140129 PC 6-THIOGUANINEPC 6-THIOGUANINE 97 82491,90 1 301

400136 IV INF HYDRATE INIT 31 MINS-1HRIV INF HYDRATE INIT 31 MINS-1HR168 96360 1 450

1400012 PSYCHOTHER W PT AND OR FAMILY 60 MINPSYCHOTHER W PT AND OR FAMILY 60 MIN276 90837 1 914

3140023 PC IA NOT INFECT AGENT NOS C SEROPC IA NOT INFECT AGENT NOS C SERO70 83520,90 1 301

4200066 PT MOBILITY CURRENT G8978 CIPT MOBILITY CURRENT G8978 CI0.01 G8978,CI,GP 1 429

2600002 D5W 500 MLD5W 500 ML 41 1 258

3100102 FLORESCENT ANTIBODY SCREENFLORESCENT ANTIBODY SCREEN100 86255,90 1 302

3140055 PC AB VIRUS NESPC AB VIRUS NES 44 86790,90 1 302

9600126 CARDIOPULMONARY RESUSCITATIONCARDIOPULMONARY RESUSCITATION458 92950 1 960

500042 EX MAGLIG LES TR ARM LEG 0.5CM<EX MAGLIG LES TR ARM LEG 0.5CM<757 11600 1 761

400156 TRT CLSD FX HUMERAL EPICONDYLAR W MANIPTRT CLSD FX HUMERAL EPICONDYLAR W MANIP301 24565 1 450

2700257 SUTURE CHROMIC GUT 5-0SUTURE CHROMIC GUT 5-0 14 1 270

4200038 PT SUB PT OT GOAL G8994CIPT SUB PT OT GOAL G8994CI 0.01 G8994,CI,GP 1 429

2700755 SOFT FOAM NECK BRACE LSOFT FOAM NECK BRACE L 6 1 270


400030 RPR INT NE HA FT GEN 2.5 CM<RPR INT NE HA FT GEN 2.5 CM<193 12041 1 450

3100015 ANTINUCLEAR ANTIBODIESANTINUCLEAR ANTIBODIES 87 86038,90 1 302

270264 PILLOW PILLOW 0 1 270

9600048 RPR CMPLX TRUNK 1.1-2.5CMRPR CMPLX TRUNK 1.1-2.5CM200 13100 1 960

2700326 SUTURE 3-0 VICRYL J258HSUTURE 3-0 VICRYL J258H 27 1 270

4300114 OT MOBILITY CURRENT G8978 CIOT MOBILITY CURRENT G8978 CI0.01 G8978,CI,GO 1 439

2700599 BASELINE TACTILE MONOFILAMENTBASELINE TACTILE MONOFILAMENT10 1 270

3100022 BLASTOMYCES ANTIBODYBLASTOMYCES ANTIBODY 77 86612,90 1 302


2700289 TUBE ET 3.5TUBE ET 3.5 22 1 270

1500003 BH PSYCHOTHER W PT AND OR FAMILY 60 MINSBH PSYCHOTHER W PT AND OR FAMILY 60 MINS158 90837 1 914

300018 INJ IVP SEQ SAME DRUGINJ IVP SEQ SAME DRUG 61 96376 1 760


3100091 EPSTEIN BARR NUCLEAR ANTIGENEPSTEIN BARR NUCLEAR ANTIGEN82 86664,90 1 302

3140046 PC AB ADENOVIRUSPC AB ADENOVIRUS 44 86603,90 1 302

2700311 URINE STRAINERURINE STRAINER 5 1 270

2700156 NASAL PACKNASAL PACK 5 A4649 1 272

3100234 URIC ACID OTHER SOURCEURIC ACID OTHER SOURCE 37 84560,90 1 301

4300092 OT BODY POS DC G8983CHOT BODY POS DC G8983CH 0.01 G8983,CH,GO 1 439

2700017 GAUZE DRESSING 4INX4IN TRAYGAUZE DRESSING 4INX4IN TRAY13 A6402 1 272

3140119 CHARGE GEN IDCHARGE GEN ID 71 87070,90 1 306

2700007 ACE6IN ACE6IN 15 A6450 1 271


3100271 VANCOMYCIN PEAKVANCOMYCIN PEAK 73 80202,90 1 301

500100 IV INF CHEMO INIT UP TO 1 HRIV INF CHEMO INIT UP TO 1 HR519 96413 1 335

3140020 PC BRUCELLA IGM EIAPC BRUCELLA IGM EIA 44 86622,90 1 302

2700594 CANNULA ADULT DIVIDED 7' TUBE MALE ORANGCANNULA ADULT DIVIDED 7' TUBE MALE ORANG120 1 270

500125 INTUBATION ENDO EMERGENCYINTUBATION ENDO EMERGENCY362 31500 1 761

2702050 FOLEY EXTENSION TUBEFOLEY EXTENSION TUBE 24 1 270

3100066 CHARGE ANAEROBE CSCHARGE ANAEROBE CS 151 87076,90 1 306

3200081 XR UGI AND SMALL BOWELXR UGI AND SMALL BOWEL 490 74245 1 320

2700545 COLLAGEN COLLAGEN 21 1 270

4200051 PT BODY POS GOAL G8982CHPT BODY POS GOAL G8982CH0.01 G8982,CH,GP 1 429

400049 RPR CMPLX F C A G 1.1-2.5 CMRPR CMPLX F C A G 1.1-2.5 CM566 13131 1 450

2700527 WALKING HEEL CAST CHILDWALKING HEEL CAST CHILD 50 1 271

2720079 TUBE ET 9.0TUBE ET 9.0 29 1 271

9600070 DRAINAGE OF FINGER ABSCESSDRAINAGE OF FINGER ABSCESS663 26010 1 960

2700587 CHEST DRAIN HEIMLICHEACHEST DRAIN HEIMLICHEA 247 A4649 1 272

3100002 ACID FAST SMEARACID FAST SMEAR 39 87206,90 1 306

400172 THROMBOLYSIS CORONARY BY INTRAVENOUS INFTHROMBOLYSIS CORONARY BY INTRAVENOUS INF450 92977 1 450

9600141 INPATIENT SUBSEQ HOSP LVL 2INPATIENT SUBSEQ HOSP LVL 2180 99232 1 987


2720016 MASK O2 TRACHMASK O2 TRACH 10 1 270

9600080 TREAT CLOSED TOE FXTREAT CLOSED TOE FX 296 28510,54 1 960


9600062 ARTHROCENTISIS LARGE JTARTHROCENTISIS LARGE JT 177 20610 1 960

3100095 ESTROGEN TOTALESTROGEN TOTAL 160 82672,90 1 301

300101 OBSERVATION EA ADDITIONAL HOUROBSERVATION EA ADDITIONAL HOUR26 G0378 1 762

3100132 HEPATITIS B SURFACE ANTIBODY (HBSAB)HEPATITIS B SURFACE ANTIBODY (HBSAB)70 86706,90 1 302

3100171 OVA AND PARASITESOVA AND PARASITES 144 87177,90 1 306

400080 FX CLSD METATRSAL W MANIPFX CLSD METATRSAL W MANIP301 28475 1 450

400169 TRMT OF RADIAL HEAD OR NECK FX W MANIPULTRMT OF RADIAL HEAD OR NECK FX W MANIPUL380 24655 1 450

2700104 TELFA 2INX3INTELFA 2INX3IN 5 A6402 1 272


2700062 CERVICAL EXTRICATION COLLAR BABY NONECKCERVICAL EXTRICATION COLLAR BABY NONECK14 1 270

2700510 CATHETER MALE EXTERNAL 36MMCATHETER MALE EXTERNAL 36MM5 1 270

3100223 TESTOSTERONE FREETESTOSTERONE FREE 150 84402,90 1 301

400122 CATH INSERT FOLEY SIMPLECATH INSERT FOLEY SIMPLE 112 51702 1 450

4300052 OT MEMORY DC G9170CJOT MEMORY DC G9170CJ 0.01 G9170,CJ,GN 1 439

4400151 ST ATTENTION FUNCT LIMIT G9165CKST ATTENTION FUNCT LIMIT G9165CK0.01 G9165,CK,GN 1 449

400091 SPLINT APPLICATION FINGER STATICSPLINT APPLICATION FINGER STATIC122 29130 1 450

4200135 PT MECHANICAL TRACTIONPT MECHANICAL TRACTION 61 97012,GP 1 421

3150039 PC HEMOGLOBIN ELECTROPHORESIS PANELPC HEMOGLOBIN ELECTROPHORESIS PANEL0 1 301

300022 RPR FA EARS EYLDS NOS LIPS MM 2.6-5.0CMRPR FA EARS EYLDS NOS LIPS MM 2.6-5.0CM202 12013 1 760

400003 INCIS REMOV FB SUBQ COMPLICATEDINCIS REMOV FB SUBQ COMPLICATED1683 10121 1 450

2700089 DRESSING CONFORM NS 3IN/YDDRESSING CONFORM NS 3IN/YD5 A6443 1 271

3140116 PC URINE TOTAL PROTEINPC URINE TOTAL PROTEIN 20 84156,90 1 301

4200103 PT OTHER PT OT GOAL G8991CKPT OTHER PT OT GOAL G8991CK0.01 G8991,CK,GP 1 429

3100240 VIT D 25 HYDROXYVIT D 25 HYDROXY 254 82306,90 1 301

3100262 BENZENE BLOODBENZENE BLOOD 535 84600,90 1 301

9600127 EKG INTERPRETATIONEKG INTERPRETATION 67.5 93010 1 985

2700093 CONFORMST3INCONFORMST3IN 5 A6446 1 272

3140079 PC CHRONIC GONADOTROPINPC CHRONIC GONADOTROPIN 47 84702,90 1 301

4300076 OT SELFCARE GOAL G8988CMOT SELFCARE GOAL G8988CM0.01 G8988,CM,GO 1 439

400004 I D HEMATOMAI D HEMATOMA 1089 10140 1 450

2600009 LR 1000 MLLR 1000 ML 45 J7121 1 258

2700259 SUTURE ETHILON 4-0 662GSUTURE ETHILON 4-0 662G 11 1 270

3140151 CMV DNA CMV DNA 153 87497,90 1 312

2702057 CATH FOLEY COUDE 18FRCATH FOLEY COUDE 18FR 30 1 270

2702042 CERVICAL COLLAR WITH TRACH MEDIUMCERVICAL COLLAR WITH TRACH MEDIUM54 1 270

3100221 T 3 FREE T 3 FREE 144 84481,90 1 301

2700285 TRAY THORACENTESISTRAY THORACENTESIS 214 1 270

3400005 US DOPPLER COLOR FLOWUS DOPPLER COLOR FLOW 367 93325 1 480

3100201 RSV RSV 213 86756,90 1 302

4400036 ST MOTOR SPEECH GOAL G9186CHST MOTOR SPEECH GOAL G9186CH0.01 G9186,CH,GN 1 449

270255 GASTEROSTOMY 22F TUBE WITH BALLOONGASTEROSTOMY 22F TUBE WITH BALLOON46 1 270


3140123 PC BENZENE BLOODPC BENZENE BLOOD 324 84600,90 1 301

4200157 PT ORTHOTIC TRAININGMGMT EA 15 MINPT ORTHOTIC TRAININGMGMT EA 15 MIN127 97760,GP 1 421

4200044 PT BODY POS DC G8983CHPT BODY POS DC G8983CH 0.01 G8983,CH,GP 1 429

2700686 SLEEVE, COMPRESSION, MED, DISPSLEEVE, COMPRESSION, MED, DISP104 1 270

2700269 TAPE SILK 1INTAPE SILK 1IN 5 1 271

2700757 INTRODUCER (BOUGIE) PEDIINTRODUCER (BOUGIE) PEDI 18 1 270

2700685 SLEEVE, SCD, KNEE LENGTH - LG DISPSLEEVE, SCD, KNEE LENGTH - LG DISP140 1 270

400075 FX CLSD DIS FIB WO MANIPFX CLSD DIS FIB WO MANIP 301 27786 1 450

2700114 ELECTRODES DEFIB PEDI-PADZELECTRODES DEFIB PEDI-PADZ122 1 270

400029 RPR INT SC AX TR EXT >30.0 CMRPR INT SC AX TR EXT >30.0 CM692 12037 1 450

4300072 OT SELFCARE GOAL G8988CIOT SELFCARE GOAL G8988CI 0.01 G8988,CI,GO 1 439

500044 EX MAGLIG LES TR ARM LEG 1.1-2.0 CMEX MAGLIG LES TR ARM LEG 1.1-2.0 CM825 11602 1 761

9600191 SHAVE SKIN LES S N H F G 0.5CM OR <SHAVE SKIN LES S N H F G 0.5CM OR <212 11305 1 960

4200159 PT ORTHO/PROSTHETIC CO EA 15PT ORTHO/PROSTHETIC CO EA 15159 97763,GP 1 421

4400023 ST LANG EXPRESS CURRENT G9162CIST LANG EXPRESS CURRENT G9162CI0.01 G9162,CI,GN 1 449

4200121 PT SUB PT OT DC G8995CHPT SUB PT OT DC G8995CH 0.01 G8995,CH,GP 1 429

2700541 TIP ELECTROLASE SHARP NS 100BTIP ELECTROLASE SHARP NS 100B5 1 271

2720031 NEEDLE HOLDERNEEDLE HOLDER 8 1 270

3100303 OXYCODONE CONFIRMATORYOXYCODONE CONFIRMATORY218.5 80361,90 1 301

1500014 PSYCHOTHERAPY COURT APPEARANCEPSYCHOTHERAPY COURT APPEARANCE500 1 914

3150060 PC SERUM PROTEIN ELECTROPHORESIS PANELPC SERUM PROTEIN ELECTROPHORESIS PANEL0 1 301

3300007 MRI ABDOMEN WO CONTMRI ABDOMEN WO CONT 3150 74181 1 610

3140040 PC EPSTEIN BARR VIURS VIRAL CAPSIDPC EPSTEIN BARR VIURS VIRAL CAPSID98 86665,90 1 302

2700379 MULTILUMEN CVC KITMULTILUMEN CVC KIT 100 1 270

3100227 THROMBOPLASTINTHROMBOPLASTIN 43 85730,90 1 305

9400002 RESPITORY FUNCTION THERAPY 15 MINRESPITORY FUNCTION THERAPY 15 MIN88 G0238 1 410

2900008 BB BLOOD TYPING RH (D)BB BLOOD TYPING RH (D) 29 86901,90 1 302

2720019 SPO2 ADHES SENSOR PEDISPO2 ADHES SENSOR PEDI 96 1 270

4300108 OT CARRY CURRENT G8984 CJOT CARRY CURRENT G8984 CJ0.01 G8984,CJ,GO 1 439

3100260 CADMIUM BLOODCADMIUM BLOOD 330 82300,90 1 301

4200138 PT ESTIM 1 ON 1 EA 15 MINUTESPT ESTIM 1 ON 1 EA 15 MINUTES65 97032,GP 1 421

3150069 PC WEST NILE VIRUS IGG IGM SERUM PANELPC WEST NILE VIRUS IGG IGM SERUM PANEL0 1 302


4200075 PT MOBILITY DC G8980CKPT MOBILITY DC G8980CK 0.01 G8980,CK,GP 1 429

2700550 SET PNEMOTHORAX TURNER PIGTAIL RTAN6.3SET PNEMOTHORAX TURNER PIGTAIL RTAN6.3429 1 272

2710005 BROSELOW PEDI ORANGEBROSELOW PEDI ORANGE 20 1 270

3100033 CALCIUM IONIZEDCALCIUM IONIZED 73 82330,90 1 301

2700695 FINGER TRAP LG MESH STERILEFINGER TRAP LG MESH STERILE70 1 270

3100001 ACETONE KETONES QUALITATIVE SERUMACETONE KETONES QUALITATIVE SERUM39 82009,90 1 301

2720003 CANNULA O2 NASAL 7FT ADULTCANNULA O2 NASAL 7FT ADULT 5 1 271

3100176 POTASSIUM URINE RANDOM OR 24 HOURPOTASSIUM URINE RANDOM OR 24 HOUR27 84133,90 1 301

9600300 EX MAGLIG LES TR ARM LEG 0.5CM<EX MAGLIG LES TR ARM LEG 0.5CM<409 11600 1 960

2700165 NS ST IRRIGATION SOL 250MLNS ST IRRIGATION SOL 250ML 10 A4217 1 272

4400132 ST SPEECH DEVICE TRAININGST SPEECH DEVICE TRAINING 329 92609,GN 1 441

2700396 SHOULDER HOTPACK REGULARSHOULDER HOTPACK REGULAR 0 1 270

4400150 ST ATTENTION FUNCT LIMIT G9165CJST ATTENTION FUNCT LIMIT G9165CJ0.01 G9165,CJ,GN 1 449

9600164 TRT CLSD FX HUMERAL EPICONDYLAR W MANIPTRT CLSD FX HUMERAL EPICONDYLAR W MANIP1014 24565,54 1 960

4300080 OT SUB PT OT GOAL G8994CJOT SUB PT OT GOAL G8994CJ0.01 G8994,CJ,GO 1 439


3100172 OXALATE URINEOXALATE URINE 73 83945,90 1 301

3140133 PC URINALYSIS AUTO W/O MICROPC URINALYSIS AUTO W/O MICRO12 81003,90 1 307

4300069 OT SELFCARE DC G8989CMOT SELFCARE DC G8989CM 0.01 G8989,CM,GO 1 439

3100299 IODINE BLOODIODINE BLOOD 495 83018,90 1 301


9600024 EVACUATION HEMATOMA NAILEVACUATION HEMATOMA NAIL120 11740 1 960

3100210 SIROLIMUS SIROLIMUS 108 80195,90 1 301


4200149 PT ADLHOME MGMT TRAINING EA 15 MINUTEPT ADLHOME MGMT TRAINING EA 15 MINUTE117 97535,GP 1 421

2700213 SPLINT COLLES MED LTSPLINT COLLES MED LT 11 A4570 1 271

4400007 ST LANG COMP CURRENT G9159CNST LANG COMP CURRENT G9159CN0.01 G9159,CN,GN 1 449

4300038 OT CARRY GOAL G8985CJOT CARRY GOAL G8985CJ 0.01 G8985,CJ,GO 1 439

4300107 OT CARRY CURRENT G8984 CIOT CARRY CURRENT G8984 CI0.01 G8984,CI,GO 1 439

2720038 CO2 DETECTOR ADULTCO2 DETECTOR ADULT 86 1 272

2700098 OPTIFOAM 4INX4IN NONADHESOPTIFOAM 4INX4IN NONADHES10 A6209 1 272

3100010 ALUMINUMALUMINUM 192 82108,90 1 301

4100004 EVALUATE PT USE OF INHALER 1 PER DAY ONLEVALUATE PT USE OF INHALER 1 PER DAY ONL72 94664 1 412

2700167 DRESSING OPSITE 4INX5-1/2INDRESSING OPSITE 4INX5-1/2IN 5 1 270

2700507 CALMOSEPTINE 1/8OZCALMOSEPTINE 1/8OZ 5 1 270


3150079 PC TPMT ENZYME PANELPC TPMT ENZYME PANEL 64.66 1 300

2700375 LEMON GLYCERIN SWABSTICKSLEMON GLYCERIN SWABSTICKS 5 A4550 1 270

2700279 TRAY CENTRAL LINETRAY CENTRAL LINE 250 1 270

4300101 OT BODY POS GOAL G8982CJOT BODY POS GOAL G8982CJ0.01 G8982,CJ,GO 1 439

4300007 OT OTHER PT OT CURRENT G8990CNOT OTHER PT OT CURRENT G8990CN0.01 G8990,CN,GO 1 439

3100045 CD4 CD8 CD4 CD8 237 86360,90 1 302

3100199 RICKETTSIA ANTIBODYRICKETTSIA ANTIBODY 416 86757,90 1 302

4200056 PT BODY POS GOAL G8982CMPT BODY POS GOAL G8982CM0.01 G8982,CM,GP 1 429

2700118 GLOVE ST 9GLOVE ST 9 5 1 270

2600013 D5 1/2 NS 1000 MLD5 1/2 NS 1000 ML 50 1 258

3140078 PC FREE ESTRIOLPC FREE ESTRIOL 130 82677,90 1 301

4400043 ST SPEECH LANG CURRENT G9174CHST SPEECH LANG CURRENT G9174CH0.01 G9174,CH,GN 1 449

3100334 CHARGE DNA/RNA SEQUENCINGCHARGE DNA/RNA SEQUENCING831 87153,90 1 306

500048 EX MALIG LES S N H F G 0.5CM<EX MALIG LES S N H F G 0.5CM<757 11620 1 761

3100266 ANTI-SMOOTH MUSCLE ANTIBODYANTI-SMOOTH MUSCLE ANTIBODY48 83516,90 1 301

2900001 BB ANTIBODY SCREENBB ANTIBODY SCREEN 295 86850,90 1 302

4300105 OT BODY POS GOAL G8982CNOT BODY POS GOAL G8982CN0.01 G8982,CN,GO 1 439

400097 SPLINT APPLICATION LONG LEGSPLINT APPLICATION LONG LEG213 29505 1 450

3100230 TISSUE TRANSGLUTAMINASE IGGTISSUE TRANSGLUTAMINASE IGG116 83516,90 1 301

3100177 PREALBUMINPREALBUMIN 92 84134,90 1 301

3100293 TCA CONFIRMATIONTCA CONFIRMATION 738 80324,90 1 301

3100305 PHENYTOIN FREEPHENYTOIN FREE 102.5 80186,90 1 301

2700552 FORCEPS FOERSTER SPONGEFORCEPS FOERSTER SPONGE 19 1 272

4200052 PT BODY POS GOAL G8982CIPT BODY POS GOAL G8982CI 0.01 G8982,CI,GP 1 429

9600143 SAME DAY ADMIT DISCH OBS IP L1SAME DAY ADMIT DISCH OBS IP L1345 99234 1 987


3140061 PC ASSAY IGA IGD IGG IGM EACHPC ASSAY IGA IGD IGG IGM EACH50 82784,90 1 301

9600049 RPR CMPLX TRUNK 2.6-7.5CMRPR CMPLX TRUNK 2.6-7.5CM540 13101 1 960

2600005 NS 250 ML NS 250 ML 35 1 258

3100321 INSULIN ANTIBODIESINSULIN ANTIBODIES 172.2 86337,90 1 302

3140082 LEPTIN LEPTIN 92 82397,90 1 301

3140097 PC EXTRACTABLE NUCLEAR ANTIGENPC EXTRACTABLE NUCLEAR ANTIGEN97 86235,90 1 302

2720010 MASK O2 AEROSOL ADULTMASK O2 AEROSOL ADULT 5 A4649 1 271

4200043 PT SUB PT OT GOAL G8994CNPT SUB PT OT GOAL G8994CN0.01 G8994,CN,GP 1 429

2700556 BURN SHEET STERILE DMI GAMBURN SHEET STERILE DMI GAM36 1 272

9600045 RPR INTMD F E EY N L MM 2.5 <RPR INTMD F E EY N L MM 2.5 <460 12051 1 960

4400016 ST LANG COMP GOAL G9160CIST LANG COMP GOAL G9160CI0.01 G9160,CI,GN 1 449

9600157 SUPERVISE HOSPICE PT 15-29 MIN MOSUPERVISE HOSPICE PT 15-29 MIN MO135 99377 1 960

4200005 PT BODY POS CURRENT G8981CKPT BODY POS CURRENT G8981CK0.01 G8981,CK,GP 1 429

1400009 PSYCHOTHER CRISIS MGMT 1ST 60M (30-74M)PSYCHOTHER CRISIS MGMT 1ST 60M (30-74M)248 90839 1 914

4300014 OT ATTEN CURRENT G9165CNOT ATTEN CURRENT G9165CN0.01 G9165,CN,GN 1 439

2700051 CATH FOLEY TRAY 16FR 100% SILICONECATH FOLEY TRAY 16FR 100% SILICONE19 A4315 1 272

2700334 SCISSORS METZ STRAIGHT 5.5 STRLSCISSORS METZ STRAIGHT 5.5 STRL22 A4550 1 270

4400010 ST LANG COMP DC G9161CJST LANG COMP DC G9161CJ 0.01 G9161,CJ,GN 1 449

3500261 CT OMNIPAQUE 300 30MLCT OMNIPAQUE 300 30ML 121 Q9967 1 255

2700287 BANDAGE TRIANGULARBANDAGE TRIANGULAR 5 1 270

4400065 ST SWALLOW GOAL G8997CIST SWALLOW GOAL G8997CI 0.01 G8997,CI,GN 1 449

4200199 PT EVAL LOW COMPLEXITYPT EVAL LOW COMPLEXITY 251 97161,GP 1 424

4200067 PT MOBILITY CURRENT G8978 CJPT MOBILITY CURRENT G8978 CJ0.01 G8978,CJ,GP 1 429

4300109 OT CARRY CURRENT G8984 CKOT CARRY CURRENT G8984 CK0.01 G8984,CK,GO 1 439

2700163 NS ST IRRIGATION SOL 1000MLNS ST IRRIGATION SOL 1000ML10 A4217 1 272

400039 RPR INT F E EY N L MM 7.6-12.5 CMRPR INT F E EY N L MM 7.6-12.5 CM642 12054 1 450

1500006 BH CO-PARENTING EDUCATION SESSIONBH CO-PARENTING EDUCATION SESSION60 S9444 1 916

3100019 BETA 2 GLYCOPROTEIN ANTIBODYBETA 2 GLYCOPROTEIN ANTIBODY125 86146,90 1 302

4200016 PT CARRY GOAL G8985CHPT CARRY GOAL G8985CH 0.01 G8985,CH,GP 1 429

4200057 PT BODY POS GOAL G8982CNPT BODY POS GOAL G8982CN0.01 G8982,CN,GP 1 429

2720014 MASK O2 PEDIMASK O2 PEDI 15 1 270

2700597 COOK EMERG PNEUMOTHORAX SET 8.5FR 6CMCOOK EMERG PNEUMOTHORAX SET 8.5FR 6CM5.57 1 272

3200005 XR ANKLE 2 VIEW LEFTXR ANKLE 2 VIEW LEFT 123 73600,LT 1 320

9600004 I R FB SUBQ TISSUE SIMPLEI R FB SUBQ TISSUE SIMPLE 260 10120 1 960

300100 OBSERVATION 1ST HOUROBSERVATION 1ST HOUR 202 G0378 1 762

4200083 PT MOBILITY GOAL G8979CLPT MOBILITY GOAL G8979CL 0.01 G8979,CL,GP 1 429

4300048 OT MEMORY CURRENT G9168CMOT MEMORY CURRENT G9168CM0.01 G9168,CM,GN 1 439

4400033 ST LANG EXPRESS GOAL G9163CLST LANG EXPRESS GOAL G9163CL0.01 G9163,CL,GN 1 449

3500040 CT PELVIS WWO CONTRASTCT PELVIS WWO CONTRAST 2200 72194 1 350

9600039 RPR INTMD S A T EXT 7.5-12.5CMRPR INTMD S A T EXT 7.5-12.5CM520 12034 1 960

2940008 BB BLOOD TYPING RH (D)BB BLOOD TYPING RH (D) 0 86901,90 1 390

4200030 PT SELFCARE GOAL G8988CHPT SELFCARE GOAL G8988CH 0.01 G8988,CH,GP 1 429


400054 RPR CMPLX EYELD N EAR LIP 2.6-7.5CMRPR CMPLX EYELD N EAR LIP 2.6-7.5CM964 13152 1 450

4200004 PT BODY POS CURRENT G8981CJPT BODY POS CURRENT G8981CJ0.01 G8981,CJ,GP 1 429

2700111 EAR BULB SYRINGEEAR BULB SYRINGE 5 1 270

270270 OR PAN SET WITH WRAPOR PAN SET WITH WRAP 47 1 270

500041 EX BEN LES FA EA EY N L M >4.0 CMEX BEN LES FA EA EY N L M >4.0 CM2492 11446 1 761

3100084 DSDNA DSDNA 82 86225,90 1 302


9600096 CONTROL NOSE BLEED ANTE CMPLXCONTROL NOSE BLEED ANTE CMPLX320 30903 1 960


2700161 NEEDLE IO15G 1.8MMX45MMNEEDLE IO15G 1.8MMX45MM163 1 270

2700176 OXYGEN MINIMUM CHARGEOXYGEN MINIMUM CHARGE 45 1 270

2700063 CERVICAL EXTRICATION COLLAR PEDIATRICCERVICAL EXTRICATION COLLAR PEDIATRIC14 1 270

4400102 ST MOTOR SPEECH DC G9158CKST MOTOR SPEECH DC G9158CK0.01 G9158,CK,GN 1 449

500123 RPR INT SC AX TR EXT 12.6-20.0 CMRPR INT SC AX TR EXT 12.6-20.0 CM861 12035 1 761

3140138 PC CITRATE URINEPC CITRATE URINE 136 82507,90 1 301

4200111 PT SELFCARE CURRENT G8987CLPT SELFCARE CURRENT G8987CL0.01 G8987,CL,GP 1 429

2720040 OPTIFOAM 7X7OPTIFOAM 7X7 6 1 272

9600178 REMOVE NON BIODEGR DRUG DELIVERY IMPLANTREMOVE NON BIODEGR DRUG DELIVERY IMPLANT340 11982 1 960


4400024 ST LANG EXPRESS CURRENT G9162CJST LANG EXPRESS CURRENT G9162CJ0.01 G9162,CJ,GN 1 449

3100099 FIBRIN SPLIT PRODUCTFIBRIN SPLIT PRODUCT 44 85362,90 1 305

9600170 SHAVE LES SCP NK HDS FT GENT 0.6-1.0 CMSHAVE LES SCP NK HDS FT GENT 0.6-1.0 CM255 11306 1 960

3100082 DESIPRAMINEDESIPRAMINE 92 80335,90 1 301

4100005 CHEST PERCUSSION INITIAL OR EVALCHEST PERCUSSION INITIAL OR EVAL79 94667 1 410

4400063 ST SPEECH LANG GOAL G9175CNST SPEECH LANG GOAL G9175CN0.01 G9175,CN,GN 1 449

2700322 FLATUS BAGFLATUS BAG 7 1 270

4200117 PT SUB PT OT CURRENT G8993CKPT SUB PT OT CURRENT G8993CK0.01 G8993,CK,GP 1 429

4300037 OT CARRY GOAL G8985CIOT CARRY GOAL G8985CI 0.01 G8985,CI,GO 1 439

2700029 BURN SHEETBURN SHEET 24 1 270

3140140 PC MAGNESIUM URINEPC MAGNESIUM URINE 53 83735,90 1 301


2700115 ELECTRODES DEFIB PRO PADZELECTRODES DEFIB PRO PADZ168 1 270


4200035 PT SELFCARE GOAL G8988CMPT SELFCARE GOAL G8988CM0.01 G8988,CM,GP 1 429

400051 RPR CMPLX F C A G EA ADD 5 CMRPR CMPLX F C A G EA ADD 5 CM566 13133 1 450

400074 FX CLSD MED MALLEOLUS W MANIPFX CLSD MED MALLEOLUS W MANIP1880 27762 1 450

3140053 PC HGB CHROMATOGRAPHYPC HGB CHROMATOGRAPHY 97 83021,90 1 301

4400030 ST LANG EXPRESS GOAL G9163CIST LANG EXPRESS GOAL G9163CI0.01 G9163,CI,GN 1 449

3100208 SHIGELLA ANTIBODYSHIGELLA ANTIBODY 65 86771,90 1 301

4400126 ST VOICE GOAL G9172CNST VOICE GOAL G9172CN 0.01 G9172,CN,GN 1 449

4300149 OT SELFCARE CURRENT G8987CIOT SELFCARE CURRENT G8987CI0.01 G8987,CI,GO 1 439

3100092 ERYTHROPOIETINERYTHROPOIETIN 149 82668,90 1 301

2700064 CERVICAL EXTRICATION COLLAR SHORT 4CERVICAL EXTRICATION COLLAR SHORT 414 1 270

9600318 CAST REMOVAL /CAST REMOVAL / 75 29700 1 960


2700002 AMBU BAG ADULTAMBU BAG ADULT 97 1 271

3100352 ANTI-LIVER KIDNEY MICROSOMALANTI-LIVER KIDNEY MICROSOMAL78 86376,90 1 302

3100101 TACROLIMUSTACROLIMUS 167 80197,90 1 301

2700187 RAPE KIT RAPE KIT 157 1 270

4400080 ST VOICE DC G9173CJST VOICE DC G9173CJ 0.01 G9173,CJ,GN 1 449

3400004 US CHEST US CHEST 280 76604 1 402

4400100 ST MOTOR SPEECH DC G9158CIST MOTOR SPEECH DC G9158CI0.01 G9158,CI,GN 1 449

4300150 OT SELFCARE CURRENT G8987CJOT SELFCARE CURRENT G8987CJ0.01 G8987,CJ,GO 1 439

9600020 EX B9 LES FACE 0.5 CM OR <EX B9 LES FACE 0.5 CM OR < 300 11440 1 960

400036 RPR INT F E EY N L MM 2.5 CM<RPR INT F E EY N L MM 2.5 CM<566 12051 1 450

3100314 GLUTAMIC ACID DECARBOXYLASEGLUTAMIC ACID DECARBOXYLASE73 83516,90 1 301

2700112 SUPPORT ELBOW PADDEDSUPPORT ELBOW PADDED 20 1 270

2700127 CAUTERY PEN HIGH TEMPCAUTERY PEN HIGH TEMP 17 1 270

3100071 CHARGE CS AEROBICCHARGE CS AEROBIC 252 87077,90 1 306

3500037 CT MASTOID/IAC WWO CONTRASTCT MASTOID/IAC WWO CONTRAST1936 70482 1 350

400176 TREATMENT FINGER FRACTURETREATMENT FINGER FRACTURE471.6 26725 1 450

2700761 ORAL PHARYNGEAL AIRWAY 90MMORAL PHARYNGEAL AIRWAY 90MM5 1 270

4200142 PT THERAPEUTIC EXERCISES EA 15 MINPT THERAPEUTIC EXERCISES EA 15 MIN108 97110,GP 1 421

2700256 SUTURE CHROMIC GUT 4-0 G181HSUTURE CHROMIC GUT 4-0 G181H10 1 270

500114 INJ NERVE BLOCK GREATER OCCIPITAL NERVEINJ NERVE BLOCK GREATER OCCIPITAL NERVE796 64405 1 761

4300173 OT ULTRASOUND/PHONPHOR EA 15 MINOT ULTRASOUND/PHONPHOR EA 15 MIN48 97035,GO 1 431



3100048 CERULOPLASMINCERULOPLASMIN 42 82390,90 1 301

4300140 OT OTHER PT OT DC G8992CNOT OTHER PT OT DC G8992CN0.01 G8992,CN,GO 1 439

9600140 INPATIENT SUBSEQ HOSP LVL 1INPATIENT SUBSEQ HOSP LVL 1112.5 99231 1 987

400017 RPR SMP F E EY N L MM 2.6-5 CMRPR SMP F E EY N L MM 2.6-5 CM202 12013 1 450

9600136 INPATIENT INITIAL HOSP LVL 3INPATIENT INITIAL HOSP LVL 3427.5 99223 1 987

4400046 ST SPEECH LANG CURRENT G9174CKST SPEECH LANG CURRENT G9174CK0.01 G9174,CK,GN 1 449

4300143 OT OTHER PT OT GOAL G8991CJOT OTHER PT OT GOAL G8991CJ0.01 G8991,CJ,GO 1 439

2700286 TRAY TOENAILTRAY TOENAIL 83 A4550 1 272


300021 INJ IVP CHEMO INITIALINJ IVP CHEMO INITIAL 345 96409 1 335

3100018 ASPERGILLUS ANTIBODYASPERGILLUS ANTIBODY 123 86606,90 1 302

2720017 MASK O2 VENTI ADULTMASK O2 VENTI ADULT 13 1 270

500006 TRIM SKIN LESION SINGLE CORNCALLUSTRIM SKIN LESION SINGLE CORNCALLUS161 11055 1 761

4400006 ST LANG COMP CURRENT G9159CMST LANG COMP CURRENT G9159CM0.01 G9159,CM,GN 1 449

3200020 XR FACIAL BONE <3 VIEWXR FACIAL BONE <3 VIEW 126 70140 1 320

4400108 ST SWALLOW CURRENT G8996CJST SWALLOW CURRENT G8996CJ0.01 G8996,CJ,GN 1 449

4300058 OT MEMORY GOAL G9169CIOT MEMORY GOAL G9169CI 0.01 G9169,CI,GN 1 439

4200019 PT CARRY GOAL G8985CKPT CARRY GOAL G8985CK 0.01 G8985,CK,GP 1 429

3100159 LEVEL IV SURG PATHOLOGY TECHLEVEL IV SURG PATHOLOGY TECH150 88305,90 1 311

4300098 OT BODY POS DC G8983CNOT BODY POS DC G8983CN 0.01 G8983,CN,GO 1 439

2700218 SPLINT FINGER ALUM LGSPLINT FINGER ALUM LG 5 A4570 1 271

3100241 VITAMIN B 1VITAMIN B 1 128 84425,90 1 301

9600174 EX MALIG LES TR ARM LEG 0.6-1.0 CMEX MALIG LES TR ARM LEG 0.6-1.0 CM428 11601 1 960

500069 ARTHRO ASP ANDOR INJ SM JOINTARTHRO ASP ANDOR INJ SM JOINT411 20600 1 761

4300144 OT OTHER PT OT GOAL G8991CKOT OTHER PT OT GOAL G8991CK0.01 G8991,CK,GO 1 439

2700070 CHEST DRAIN OCEAN WATER SEALCHEST DRAIN OCEAN WATER SEAL109 1 270

500078 IRRIGATION BLADDER SIMPLEIRRIGATION BLADDER SIMPLE344 51700 1 761

3140086 PC PSA FREEPC PSA FREE 99 84154,90 1 301

3140004 PC PHOSPHATASE ALKALINE ISOENZYMESPC PHOSPHATASE ALKALINE ISOENZYMES47 84080,90 1 301

3140128 PC PROTHROMBIN TIMEPC PROTHROMBIN TIME 22 85610,90 1 305

4300118 OT MOBILITY CURRENT G8978 CMOT MOBILITY CURRENT G8978 CM0.01 G8978,CM,GO 1 439

3140018 PC KAPPA/LAMBDA LIGHT CHAINSPC KAPPA/LAMBDA LIGHT CHAINS219 83883,90 1 301

4200104 PT OTHER PT OT GOAL G8991CLPT OTHER PT OT GOAL G8991CL0.01 G8991,CL,GP 1 429

3100244 WEST NILE VIRUSWEST NILE VIRUS 121 86790,90 1 302



3140087 PC ANTIBODY CHLAMYDIAPC ANTIBODY CHLAMYDIA 44 86631,90 1 302

3140063 PC ALBUMIN SERUMPC ALBUMIN SERUM 27 82040,90 1 301

400009 REPAIR OF NAIL BEDREPAIR OF NAIL BED 193 11760 1 450

4200081 PT MOBILITY GOAL G8979CJPT MOBILITY GOAL G8979CJ 0.01 G8979,CJ,GP 1 429

2700585 ULTRASITE VALVEULTRASITE VALVE 8 1 270

2700684 SPLIT SPONE 6PLY 4X4SPLIT SPONE 6PLY 4X4 5 1 270

4300019 OT ATTEN GOAL G9166CLOT ATTEN GOAL G9166CL 0.01 G9166,CL,GN 1 439

3500042 CT SINUS WO CONTRASTCT SINUS WO CONTRAST 1304 70486 1 350

400023 CLOSURE WOUND DEHIS SMPLCLOSURE WOUND DEHIS SMPL886 12020 1 450

4400054 ST SPEECH LANG DC G9176CLST SPEECH LANG DC G9176CL0.01 G9176,CL,GN 1 449

400090 SPLINT APPLICATION SHORT ARMSPLINT APPLICATION SHORT ARM194 29125 1 450

9600312 INJ SKIN LESION </W7INJ SKIN LESION </W7 75 11900 1 960

3100007 ALLERGEN SPECIFIC IGGALLERGEN SPECIFIC IGG 35 86001,90 1 302

3140118 WEST NILE VIRUS IGMWEST NILE VIRUS IGM 28 86788,90 1 302

2720025 TUBING O2 25FTTUBING O2 25FT 8 S8096 1 271

9600135 INPATIENT INITIAL HOSP LVL 2INPATIENT INITIAL HOSP LVL 2330 99222 1 987

2700179 DRESSING PLAIN 1INDRESSING PLAIN 1IN 5 A6407 1 270

3150035 PC FUNGAL ANTIBODY PANELPC FUNGAL ANTIBODY PANEL 0 1 302

4200156 PT PHYS PERF TEST W REPORT EA 15 MINPT PHYS PERF TEST W REPORT EA 15 MIN112 97750,GP 1 421

9600083 APPLY LONG ARM SPLINTAPPLY LONG ARM SPLINT 180 29105 1 960

4300204 OT EVALUATION MODERATE COMPLEXITYOT EVALUATION MODERATE COMPLEXITY291 97166,GO 1 434


2700067 CATH TROCAR 24FR/16INCATH TROCAR 24FR/16IN 44 1 270


2700539 TIP ELECTROLASE BLUNT NS 100BTIP ELECTROLASE BLUNT NS 100B5 1 271

500030 EX B9 LES SC N H FT GE 0.5 CM<EX B9 LES SC N H FT GE 0.5 CM<1314 11420 1 761


3100167 METHYLMALONIC ACID QUANTITATIVEMETHYLMALONIC ACID QUANTITATIVE133 83918,90 1 301

4200145 PT MASSAGE THERAPY EA 15 MINUTESPT MASSAGE THERAPY EA 15 MINUTES89 97124,GP 1 421

4300120 OT MOBILITY DC G8980CHOT MOBILITY DC G8980CH 0.01 G8980,CH,GO 1 439

4300136 OT OTHER PT OT DC G8992CJOT OTHER PT OT DC G8992CJ0.01 G8992,CJ,GO 1 439

2700401 SUTURE CHOMATIC GUT 3/0 P3SUTURE CHOMATIC GUT 3/0 P311 1 270

4200059 PT CARRY CURRENT G8984 CIPT CARRY CURRENT G8984 CI0.01 G8984,CI,GP 1 429

400079 FX CLSD CANCANEAL WO MANIPFX CLSD CANCANEAL WO MANIP301 28400 1 450

3100097 ANTI-SMITHANTI-SMITH 105 86235,90 1 302

3100247 ZINC LEVEL ZINC LEVEL 92 84630,90 1 301

3200012 XR CHEST 2 VIEWXR CHEST 2 VIEW 133 71046 1 320

2700385 ORTHOGLAS SPLINT ROLL 3INX15FORTHOGLAS SPLINT ROLL 3INX15F0 A4590 1 271

4300067 OT SELFCARE DC G8989CKOT SELFCARE DC G8989CK 0.01 G8989,CK,GO 1 439

9600021 EX MAL LES SC NK HD FT GT 0.6 TO 1.0CMEX MAL LES SC NK HD FT GT 0.6 TO 1.0CM500 11621 1 960

3140008 PC UNLISTED CHEMISTRY PROCEDUREPC UNLISTED CHEMISTRY PROCEDURE54 84999,90 1 301


4300152 OT SELFCARE CURRENT G8987CLOT SELFCARE CURRENT G8987CL0.01 G8987,CL,GO 1 439

4200009 PT CARRY DC G8986CHPT CARRY DC G8986CH 0.01 G8986,CH,GP 1 429

3400016 US EXTREMITY VEIN SCAN LIMITED RIGHTUS EXTREMITY VEIN SCAN LIMITED RIGHT504 93971 1 921

2700553 MAD NASALMAD NASAL 38 A4649 1 271

3100014 ANTI-MICRO TPO ANTIBODIESANTI-MICRO TPO ANTIBODIES 96 86376,90 1 302

3140147 PC URIC ACID OTHER SOURCE; URINEPC URIC ACID OTHER SOURCE; URINE37 84560,90 1 301

400129 REMOVE FB CONJUNCTIVA EXTERNALREMOVE FB CONJUNCTIVA EXTERNAL152 65205 1 450

4200143 PT NEUROMUSCULAR REEDUCATION EA 15 MINPT NEUROMUSCULAR REEDUCATION EA 15 MIN111 97112,GP 1 421

2700274 STOCKING ANTIEMBOITHIGH MEDSTOCKING ANTIEMBOITHIGH MED11 1 270

4100001 PULMONARY FUNCTION TESTPULMONARY FUNCTION TEST142 94010 1 460

3300005 MRA NECK WWO CONTMRA NECK WWO CONT 3850 70549 1 610

270254 GASTROSTOMY TUBE 3PORT 26FGASTROSTOMY TUBE 3PORT 26F47 1 270

2720082 HOLDER ET TUBE LAERDAL THOMAS ADULTHOLDER ET TUBE LAERDAL THOMAS ADULT23 1 271

3140012 PC ARSENICPC ARSENIC 102 82175,90 1 301

2700261 SUTURE 6-0 1698GSUTURE 6-0 1698G 11 1 270

3140126 PC RUSSELL VIPER VENOMPC RUSSELL VIPER VENOM 38 85613,90 1 305

9600017 EX B9 LES SC NK HD FT GT 0.5CMEX B9 LES SC NK HD FT GT 0.5CM240 11420 1 960

3100136 HEPATITIS PCRHEPATITIS PCR 167 87521,90 1 306

2700351 VASELINE GAUZE 1X8VASELINE GAUZE 1X8 5 1 270

4300104 OT BODY POS GOAL G8982CMOT BODY POS GOAL G8982CM0.01 G8982,CM,GO 1 439

2700530 LARYNGOSCOPE VIDEO (GVL4STAT) SIZE4LARYNGOSCOPE VIDEO (GVL4STAT) SIZE472 1 272

4200002 PT BODY POS CURRENT G8981CHPT BODY POS CURRENT G8981CH0.01 G8981,CH,GP 1 429

4400075 ST VOICE CURRENT G9171CLST VOICE CURRENT G9171CL 0.01 G9171,CL,GN 1 449

4300184 OT ORTHOTIC TRAINING MGMT EA 15 MINOT ORTHOTIC TRAINING MGMT EA 15 MIN127 97760,GO 1 431

2700399 SENSOR SP02 NELLCOR PEDISENSOR SP02 NELLCOR PEDI 67 A4649 1 272


4400154 ST ATTENTION FUNCT LIMIT G9165CNST ATTENTION FUNCT LIMIT G9165CN0.01 G9165,CN,GN 1 449

3100056 COLD AGGLUTININ SCREENCOLD AGGLUTININ SCREEN 56 86156,90 1 302

4200011 PT CARRY DC G8986CJPT CARRY DC G8986CJ 0.01 G8986,CJ,GP 1 429

500120 RPR SIMP WND S/N/A/G/TR/E 7.6-12.5 CMRPR SIMP WND S/N/A/G/TR/E 7.6-12.5 CM222 12004 1 761

3100185 PROTEIN ELECTROPHORESIS SERUMPROTEIN ELECTROPHORESIS SERUM96 84165,90 1 301

3100217 SURGICAL PATH LEVEL III TECHSURGICAL PATH LEVEL III TECH 53 88304,90 1 310

3100324 HBEAG HBEAG 62 86707,90 1 302

3140077 PC INHIBIN APC INHIBIN A 84 86336,90 1 302

2700716 FINGER TRAP MED MESH STERILEFINGER TRAP MED MESH STERILE70 1 270

400015 RPR SMP S N A G T EX >30.0 CMRPR SMP S N A G T EX >30.0 CM236 12007 1 450

2710002 BROSELOW PEDI ORANGEBROSELOW PEDI ORANGE 15 1 271


2700031 CO2 DETECTOR PEDICO2 DETECTOR PEDI 88 1 270

4400106 ST SWALLOW CURRENT G8996CHST SWALLOW CURRENT G8996CH0.01 G8996,CH,GN 1 449

2702047 EXPENDABLE ILLUMINATOREXPENDABLE ILLUMINATOR 24 1 270


3500003 CT ABDOMEN PELVIS WWO CONTRASTCT ABDOMEN PELVIS WWO CONTRAST2552 74178 1 350

3100122 HAPTOGLOBIN QUANTITATIVEHAPTOGLOBIN QUANTITATIVE104 83010,90 1 305

3100203 RUBELLA TITERRUBELLA TITER 84 86762,90 1 302

2700147 MORGAN LENS DELIVERY SETMORGAN LENS DELIVERY SET 17 1 270

3100151 INHIBIN B INHIBIN B 116 83520,90 1 301

3100191 PSA TOTAL MONITORINGPSA TOTAL MONITORING 114 84153,90 1 301

9600091 STRAPPING ANKLE OR FOOTSTRAPPING ANKLE OR FOOT 74 29540 1 960

3400024 US OB LIMITEDUS OB LIMITED 301 76815 1 402

9600028 RPR WND S N AX GEN TNK 2.5 <RPR WND S N AX GEN TNK 2.5 <260 12001 1 960

4300145 OT OTHER PT OT GOAL G8991CLOT OTHER PT OT GOAL G8991CL0.01 G8991,CL,GO 1 439

4200082 PT MOBILITY GOAL G8979CKPT MOBILITY GOAL G8979CK 0.01 G8979,CK,GP 1 429

9600154 CRITICAL CARE ADDL 30CRITICAL CARE ADDL 30 315 99292 1 981

300023 CPR CPR 536 92950 1 760

3100319 ANTI GLOMERULAR BASEMENT MEMBRANCEANTI GLOMERULAR BASEMENT MEMBRANCE65 86256,90 1 301

2700069 CHEST TUBE KIT PLEURAGUIDECHEST TUBE KIT PLEURAGUIDE353 1 270

400011 RPR SMP S N A GEN TR EXT 2.6-7.5CMRPR SMP S N A GEN TR EXT 2.6-7.5CM202 12002 1 450

3140062 PC IGG 1 2 3 OR 4 EAPC IGG 1 2 3 OR 4 EA 23 82787,90 1 301

2700005 ACE3IN ACE3IN 8 A4649 1 271

4200012 PT CARRY DC G8986CKPT CARRY DC G8986CK 0.01 G8986,CK,GP 1 429

2720059 MASK MIRAGE QUATTRO V-PAPFFMLGE-AMERMASK MIRAGE QUATTRO V-PAPFFMLGE-AMER435 1 270

400148 REMOV DEVITAL TISS 20CM OR LESSREMOV DEVITAL TISS 20CM OR LESS241 97597 1 450

3140019 PC BRUCELLA IGG EIAPC BRUCELLA IGG EIA 44 86622,90 1 302

4200058 PT CARRY CURRENT G8984 CHPT CARRY CURRENT G8984 CH0.01 G8984,CH,GP 1 429

4100006 PULSE OXIMETRY SINGLE DETERMINATIONPULSE OXIMETRY SINGLE DETERMINATION16 94760 1 460


2700097 EXUDERM 4X4INEXUDERM 4X4IN 5 A6234 1 270

500132 RPR SMP S N A GEN TR EXT 2.5 CM<RPR SMP S N A GEN TR EXT 2.5 CM<193 12001 1 450

3100165 METANEPHRINESMETANEPHRINES 167 83835,90 1 301

3100307 ANTI NEUTROPHILANTI NEUTROPHIL 65 86038,90 1 302

4400169 ST MEMORY FUNCT LIMIT CURRENT G9168CHST MEMORY FUNCT LIMIT CURRENT G9168CH0.01 G9168,CH,GN 1 449

9600099 THORACENTISISTHORACENTISIS 471 32554 1 960

4400117 ST SWALLOW DC G8998CLST SWALLOW DC G8998CL 0.01 G8998,CL,GN 1 449

500059 EX MALIG LES F ER EY N L >4.0 CMEX MALIG LES F ER EY N L >4.0 CM2492 11646 1 761

500013 SHAVE SKIN LES TK ARM LEG 0.6-1.0CMSHAVE SKIN LES TK ARM LEG 0.6-1.0CM169 11301 1 761

3140081 PC ESTRIOLPC ESTRIOL 130 82677,90 1 301


9600106 RPR LACERATION MOUTH 2.5CM 0R LESSRPR LACERATION MOUTH 2.5CM 0R LESS431 40830 1 960

2720006 CONNECTOR O2 5&1CONNECTOR O2 5&1 5 1 271

2720027 XMAS TREEXMAS TREE 5 1 270

9600152 ER PRO FEE HIGH SEVER PRO FEE HIGH SEV 555 99285 1 981

3100140 HOMOCYSTE SINGLE QUANTITATIVEHOMOCYSTE SINGLE QUANTITATIVE120 82131,90 1 301

9600305 EX B9 LES SP NK HD FT GT 2.1-3.0CEX B9 LES SP NK HD FT GT 2.1-3.0C320 11422 1 960

400108 TRACHEOTOMY TUBE CHANGETRACHEOTOMY TUBE CHANGE228 31502 1 450


2700412 TRAY-CUT DOWNTRAY-CUT DOWN 0 1 270

9600044 RPR INTMD N-HF GENIT 7.6-12.5CMRPR INTMD N-HF GENIT 7.6-12.5CM540 12044 1 960

400157 ARTHO ASPIRATE &/OR INJ MED JOINTARTHO ASPIRATE &/OR INJ MED JOINT430 20605 1 450

3200065 XR SHOULDER 1 VIEW RIGHTXR SHOULDER 1 VIEW RIGHT 123 73020,RT 1 320

2700004 ACE2IN ACE2IN 8 A6448 1 271

4400116 ST SWALLOW DC G8998CKST SWALLOW DC G8998CK 0.01 G8998,CK,GN 1 449

400082 FX CLSD PHALANX NOT GRT TOE W MANIPFX CLSD PHALANX NOT GRT TOE W MANIP301 28515 1 450

3150036 PC HEAVY METAL URINE SCREEN PANELPC HEAVY METAL URINE SCREEN PANEL0 1 301

3500041 CT SINUS W CONTRASTCT SINUS W CONTRAST 1512 70487 1 350

4400118 ST SWALLOW DC G8998CMST SWALLOW DC G8998CM 0.01 G8998,CM,GN 1 449

500070 ARTHRO ASP ANDOR INJ MED JOINTARTHRO ASP ANDOR INJ MED JOINT430 20605 1 761

4200036 PT SELFCARE GOAL G8988CNPT SELFCARE GOAL G8988CN0.01 G8988,CN,GP 1 429

3100032 CA 19 9 CA 19 9 136 86301,90 1 302

2700235 STERILE BARRIERSTERILE BARRIER 5 1 270

500130 AVULSION NAIL PLATE ADDLAVULSION NAIL PLATE ADDL 120 11732 1 761

4400047 ST SPEECH LANG CURRENT G9174CLST SPEECH LANG CURRENT G9174CL0.01 G9174,CL,GN 1 449

2710015 VENTED NITRO TUBINGVENTED NITRO TUBING 14 1 272

3100258 THYROID STIMULATING IMMUNOGLOBULINTHYROID STIMULATING IMMUNOGLOBULIN273 84445,90 1 301

2700206 SLING ARM MEDSLING ARM MED 7 A4565 1 271

1400001 FOCUS GRP THERAPY INITIALFOCUS GRP THERAPY INITIAL 170 90853 1 915

3150037 PC HEAVY METAL BLOOD SCREEN PANELPC HEAVY METAL BLOOD SCREEN PANEL0 1 301

2720054 DEFIBRILLATOR LIFEPAK 12 PEDIDEFIBRILLATOR LIFEPAK 12 PEDI138 1 271


4300094 OT BODY POS DC G8983CJOT BODY POS DC G8983CJ 0.01 G8983,CJ,GO 1 439

1400006 PROCESS GRP THERAPY INITIALPROCESS GRP THERAPY INITIAL170 90853 1 915

9600097 CONTROL NOSE BLEED POSTERIORCONTROL NOSE BLEED POSTERIOR580 30905 1 960

3140034 CHARGE STOOL CS2CHARGE STOOL CS2 51 87045,90 1 306

4400050 ST SPEECH LANG DC G9176CHST SPEECH LANG DC G9176CH0.01 G9176,CH,GN 1 449


3140106 PC TEST FREEPC TEST FREE 137 84402,90 1 301

9600103 CVP INSERTION < 5 YRSCVP INSERTION < 5 YRS 1000 36555 1 960

4400066 ST SWALLOW GOAL G8997CJST SWALLOW GOAL G8997CJ 0.01 G8997,CJ,GN 1 449

2700264 TRAY SUTURE REMOVALTRAY SUTURE REMOVAL 6 A4550 1 272

9600095 CONTROL NOSE BLEED ANTE SMPLECONTROL NOSE BLEED ANTE SMPLE225 30901 1 960


500122 DISLOCATION SHLDR CLSD W MANIP WO ANESDISLOCATION SHLDR CLSD W MANIP WO ANES482 23650 1 761

3200026 XR FOOT 2 VIEW LEFTXR FOOT 2 VIEW LEFT 123 73620,LT 1 320

4400056 ST SPEECH LANG DC G9176CNST SPEECH LANG DC G9176CN0.01 G9176,CN,GN 1 449

2700584 HUBER INFUSION SET MINILOC 20GX.75INHUBER INFUSION SET MINILOC 20GX.75IN45 1 270

2700096 DRESSING DUODERM 4IN X 4INDRESSING DUODERM 4IN X 4IN16 A6234 1 272

4300081 OT SUB PT OT GOAL G8994CKOT SUB PT OT GOAL G8994CK0.01 G8994,CK,GO 1 439


4200085 PT MOBILITY GOAL G8979CNPT MOBILITY GOAL G8979CN0.01 G8979,CN,GP 1 429

2700109 EAR CURETTE ADULT DISPEAR CURETTE ADULT DISP 5 A4649 1 271

2600008 NS 1/2 1000 MLNS 1/2 1000 ML 45 1 258

2700650 COOK EMERGENCY PNEUMOTHORAX SET 14.0FRCOOK EMERGENCY PNEUMOTHORAX SET 14.0FR609 1 272

9600061 ARTHROCENTISIS MEDIUM JTARTHROCENTISIS MEDIUM JT 150 20605 1 960

4300031 OT CARRY DC G8986CJOT CARRY DC G8986CJ 0.01 G8986,CJ,GO 1 439

4300028 OT BODY POS CURRENT G8981CNOT BODY POS CURRENT G8981CN0.01 G8981,CN,GO 1 439

9600105 INTRAOSSEOUS INFUSIONINTRAOSSEOUS INFUSION 260 36680 1 960


500118 WEDGE EX SKIN NAIL FOLD INGROWN TOENAILWEDGE EX SKIN NAIL FOLD INGROWN TOENAIL189 11765 1 761

3150070 PC WEST NILE VIRUS TITER IGG IGM CSF PANPC WEST NILE VIRUS TITER IGG IGM CSF PAN0 1 302

2700357 FORCEPS ALLIGATOR 3.5 STRLFORCEPS ALLIGATOR 3.5 STRL 24 1 270

4400069 ST SWALLOW GOAL G8997CMST SWALLOW GOAL G8997CM0.01 G8997,CM,GN 1 449

9600179 DESTUCT PREMALIG LESION 2ND - 14TH EACHDESTUCT PREMALIG LESION 2ND - 14TH EACH21 17003 1 960



3140145 PC SODIUM URINE RANDOM OR 24 HOURPC SODIUM URINE RANDOM OR 24 HOUR31 84300,90 1 301


9600082 TREAT CLOSED IP TOE DISLOCATIONTREAT CLOSED IP TOE DISLOCATION320 28660 1 960


2710022 PRESSURE INFUSION CUFF 1000MLPRESSURE INFUSION CUFF 1000ML5 1 271

3100029 C PEPTIDE SUPRES PANEL INSUL INDUCC PEPTIDE SUPRES PANEL INSUL INDUC112 80432,90 1 301

4400137 ST SPEECH LANG THERAPY GROUPST SPEECH LANG THERAPY GROUP70 92508,GN 1 441


3100189 PSA FREE PSA FREE 99 84154,90 1 301

4300176 OT MANUAL THERAPY EA 15 MINUTESOT MANUAL THERAPY EA 15 MINUTES107 97140,GO 1 431


2702063 MASK CHILD PROCEDUREMASK CHILD PROCEDURE 226 1 270

3100067 CULTURE BETA STREPCULTURE BETA STREP 46 87081,90 1 306

2700211 SPLINT COLLES LG LTSPLINT COLLES LG LT 12 A4570 1 271

2702060 MASK CHILD PROCEDUREMASK CHILD PROCEDURE 0 1 270

9600025 EX NAIL NAIL MATRIXEX NAIL NAIL MATRIX 660 11750 1 960

3100246 YERSINIA ABYERSINIA AB 74 86793,90 1 302

4300116 OT MOBILITY CURRENT G8978 CKOT MOBILITY CURRENT G8978 CK0.01 G8978,CK,GO 1 439

4300029 OT CARRY DC G8986CHOT CARRY DC G8986CH 0.01 G8986,CH,GO 1 439

400143 INJ IVP DRUG SINGLE INITIALINJ IVP DRUG SINGLE INITIAL 89 96374 1 450

2710001 BROSELOW PEDI YELLOWBROSELOW PEDI YELLOW 13 1 271

9400005 PULMONARY REHAB/GROUP/NON-CPOD 15 MINPULMONARY REHAB/GROUP/NON-CPOD 15 MIN106 G0239 1 410

9600006 PARE BENIGN LESION SINGLEPARE BENIGN LESION SINGLE 100 11055 1 960

2600007 NS 1000 MLNS 1000 ML 45 J7030 1 258

500105 TREATMENT ROOM LEVEL 4TREATMENT ROOM LEVEL 4 249 99214 1 761

4200136 PT ESTIM UNATTENDEDPT ESTIM UNATTENDED 53 97014,GP 1 421

2700387 RANGE OF MOTIONRANGE OF MOTION 0 1 270

3140007 PC AMYLASEPC AMYLASE 35 82150,90 1 301

2700255 SUTURE 4-0 VICRYL J213HSUTURE 4-0 VICRYL J213H 5 1 270

4300130 OT MOBILITY GOAL G8979CKOT MOBILITY GOAL G8979CK0.01 G8979,CK,GO 1 439

9600086 STRAPPING SHOULDERSTRAPPING SHOULDER 120 29240 1 960

2700254 SUTURE 5-0 PROLENE 8635GSUTURE 5-0 PROLENE 8635G 15 1 270



2700180 BORDER GAUZE 4X4BORDER GAUZE 4X4 129 A6219 1 270


2700372 ISOLATION MASKISOLATION MASK 5 1 270

3400021 US LOWER EXT ARTERY STUDY LIM RIGHTUS LOWER EXT ARTERY STUDY LIM RIGHT600 93926 1 921


3100005 ALKALINE PHOS FRACTIONATEALKALINE PHOS FRACTIONATE 87 84080,90 1 301

3140013 PC CREATININE OTHER SOURCE NOT BLOODPC CREATININE OTHER SOURCE NOT BLOOD28 82570,90 1 301

4200034 PT SELFCARE GOAL G8988CLPT SELFCARE GOAL G8988CL 0.01 G8988,CL,GP 1 429

4300087 OT ATTEN DC G9167CJOT ATTEN DC G9167CJ 0.01 G9167,CJ,GN 1 439

2700284 TRAY LUMBAR PUNCTURE PEDITRAY LUMBAR PUNCTURE PEDI83 1 270


2700349 DRESSING NONSTERILE 2X2INDRESSING NONSTERILE 2X2IN 5 1 270

3100013 ANTIGEN DETECTIONANTIGEN DETECTION 81 87449,90 1 306

3150058 PC RESPIRATORY INFECTION PANEL APC RESPIRATORY INFECTION PANEL A0 1 302


3100111 KOH PREP KOH PREP 27 87220,90 1 306

9600173 INJ SING/MULTI TRIGGER PTS 3/> MUSCLESINJ SING/MULTI TRIGGER PTS 3/> MUSCLES258 20553 1 960

4200098 PT OTHER PT OT DC G8992CMPT OTHER PT OT DC G8992CM0.01 G8992,CM,GP 1 429

400062 DISLOCATION SHLDR CLSD W MANIP WO ANESDISLOCATION SHLDR CLSD W MANIP WO ANES482 23650 1 450

500077 INCISE HEMORRHOID THROMBOS EXTINCISE HEMORRHOID THROMBOS EXT344 46083 1 761

4300051 OT MEMORY DC G9170CIOT MEMORY DC G9170CI 0.01 G9170,CI,GN 1 439


3100060 CORTISOL TOTALCORTISOL TOTAL 115 82533,90 1 301

4200201 PT EVALUATION HIGH COMPLEXITYPT EVALUATION HIGH COMPLEXITY331 97163,GP 1 424

3100042 CATECHOLAMINES URINECATECHOLAMINES URINE 135 82382,90 1 301

4400130 ST EVALSPEECH DEVICE 1ST HOURST EVALSPEECH DEVICE 1ST HOUR399 92607,GN 1 444

4200151 PT DEBRID TISSUE SELECTIV 1ST 20 SQ CMPT DEBRID TISSUE SELECTIV 1ST 20 SQ CM292 97597,GP 1 421

3100315 PINWORM EXAM CELLOPHANE TAPEPINWORM EXAM CELLOPHANE TAPE15 87172,90 1 306

9600119 INJ ANES AGENT OTHR PERI NERVEINJ ANES AGENT OTHR PERI NERVE152 64450 1 960

4400186 ST MEMORY FUNCT LIMIT G9170CKST MEMORY FUNCT LIMIT G9170CK0.01 G9170,CK,GN 1 449

2700072 COBAN3IN COBAN3IN 5 A6454 1 271

3100184 PROTEIN ELECTOPHORESIS URINEPROTEIN ELECTOPHORESIS URINE143 84166,90 1 301

2900002 ANTIBODY SCREEN QUALITANTIBODY SCREEN QUALIT 95 86885,90 1 390

400166 TRMT OF CLSD ELBOW DISLOCATIONTRMT OF CLSD ELBOW DISLOCATION340 24600 1 450

3100178 PRENATAL OBSTETRIC PANELPRENATAL OBSTETRIC PANEL 209 80055,90 1 301

2700073 CPR MASK CPR MASK 16 1 270

2700012 PUNCH BIOPSY 2MMPUNCH BIOPSY 2MM 8 1 270


4300064 OT SELFCARE DC G8989CHOT SELFCARE DC G8989CH 0.01 G8989,CH,GO 1 439

3100285 METHAMPHETAMINE ASSAY 3-4 CONFIRMATIONMETHAMPHETAMINE ASSAY 3-4 CONFIRMATION197 80325,90 1 301

3400028 US TRANSVAGINALUS TRANSVAGINAL 399 76830 1 402

400019 RPR SMP F E EY N L MM 7.6-12.5 CMRPR SMP F E EY N L MM 7.6-12.5 CM219 12015 1 450

500085 BIOPSY EXTERNAL EARBIOPSY EXTERNAL EAR 518 69100 1 761

3400019 US HEAD NECK SOFT TISSUEUS HEAD NECK SOFT TISSUE 280 76536 1 402

3500030 CT LUMBAR SPINE WWO CONTRASTCT LUMBAR SPINE WWO CONTRAST2304 72133 1 350

2700207 SLING ARM SMALLSLING ARM SMALL 7 A4565 1 271

3100316 TRYPANOSOMA CRUZI IGGTRYPANOSOMA CRUZI IGG 182.5 86753,90 1 302


4200096 PT OTHER PT OT DC G8992CKPT OTHER PT OT DC G8992CK0.01 G8992,CK,GP 1 429

9600060 ARTHROCENTISIS SMALL JTARTHROCENTISIS SMALL JT 136 20600 1 960

3900002 CARDIAC REHAB W ECG MONITORINGCARDIAC REHAB W ECG MONITORING240 93798 1 943

2900005 BB ANTIGLOBULIN TECHNIQUEBB ANTIGLOBULIN TECHNIQUE 68 86922,90 1 390

400066 FX CLSD CRPL SCAPH W MANIPFX CLSD CRPL SCAPH W MANIP898 25624 1 450

3140036 PC SHIGA LIKE TOXINPC SHIGA LIKE TOXIN 65 87427,90 1 306

2600004 NS 100 ML NS 100 ML 30 1 258

3100174 PHENOBARBITALPHENOBARBITAL 118 80184,90 1 301

4300034 OT CARRY DC G8986CMOT CARRY DC G8986CM 0.01 G8986,CM,GO 1 439

4400136 ST COGNITIVE SKILL DEVELST COGNITIVE SKILL DEVEL 90 97127,GN 1 441

2700535 SUTURE VICYRL 6-0 18CTDUNDBRP-3 J492GSUTURE VICYRL 6-0 18CTDUNDBRP-3 J492G27 A4649 1 272

3100160 LITHIUM LITHIUM 59 80178,90 1 301

4300011 OT ATTEN CURRENT G9165CKOT ATTEN CURRENT G9165CK0.01 G9165,CK,GN 1 439

270253 FORCEPS FINEPOINT SPLINTERFORCEPS FINEPOINT SPLINTER 15 A4649 1 272

3100076 URINE BAC IDURINE BAC ID 42 87088,90 1 306

4200200 PT EVALUATION MODERATE COMPLEXITYPT EVALUATION MODERATE COMPLEXITY291 97162,GP 1 424

2700528 WALKING HEEL CAST ADULTWALKING HEEL CAST ADULT 50 1 271

3150061 PC SLE SYSTEMIC LUPUS ERYTHEM A PANELPC SLE SYSTEMIC LUPUS ERYTHEM A PANEL0 1 301

3100137 HISTOPLASMA ANTIBODYHISTOPLASMA ANTIBODY 88 86698,90 1 302

3140132 PC BILIRUBIN TOTALPC BILIRUBIN TOTAL 227.25 82247,90 1 301

3100038 CARDIOLIPIN ANTIBODY EACARDIOLIPIN ANTIBODY EA 136 86147,90 1 302

2720090 MOUTHPIECE SPIRETTEMOUTHPIECE SPIRETTE 10 1 271

3140049 PC CADMIUMPC CADMIUM 125 82300,90 1 301

4300164 OT SUB PT OT DC G8995CJOT SUB PT OT DC G8995CJ 0.01 G8995,CJ,GO 1 439

4200073 PT MOBILITY DC G8980CIPT MOBILITY DC G8980CI 0.01 G8980,CI,GP 1 429


1500007 BH ANGER MNG SESS IND COURT ORDER 60 MBH ANGER MNG SESS IND COURT ORDER 60 M60 90899 1 916

4400104 ST MOTOR SPEECH DC G9158CMST MOTOR SPEECH DC G9158CM0.01 G9158,CM,GN 1 449

3140144 PC POTASSIUM URINE RANDOM OR 24 HOURPC POTASSIUM URINE RANDOM OR 24 HOUR27 84133,90 1 301

3140149 PC ENZYME ACTIVITY BC NOT RAPC ENZYME ACTIVITY BC NOT RA97 82657,90 1 301

3140052 PC AB HELICOBACTER PYLORIPC AB HELICOBACTER PYLORI 44 86677,90 1 302

4400121 ST VOICE GOAL G9172CIST VOICE GOAL G9172CI 0.01 G9172,CI,GN 1 449

2720047 DRESSING OPTIFOAM 7X7DRESSING OPTIFOAM 7X7 57 A6213 1 272

2700283 TRAY LUMBAR PUNCTURE ADULTTRAY LUMBAR PUNCTURE ADULT90 1 270

9600182 CARDIOVERSION EXTERNAL ELECTIVECARDIOVERSION EXTERNAL ELECTIVE594 92960 1 960

4200080 PT MOBILITY GOAL G8979CIPT MOBILITY GOAL G8979CI 0.01 G8979,CI,GP 1 429

4300174 OT THERAPEUTIC EXERCISES EA 15 MINOT THERAPEUTIC EXERCISES EA 15 MIN108 97110,GO 1 431


3100126 HEP A IGM ANTIBODYHEP A IGM ANTIBODY 72 86709,90 1 302

400158 BIOPSY SKIN SUBQ SINGLE LESIONBIOPSY SKIN SUBQ SINGLE LESION241 11100 1 450

400164 FX CLSD FEMORAL W MANIPFX CLSD FEMORAL W MANIP 350 27268 1 450

3100021 BETA HCG QUANTITATIVEBETA HCG QUANTITATIVE 109 84702,90 1 301

3100175 PHOSPHATE URINEPHOSPHATE URINE 34 84105,90 1 301

2700353 EAR E-Z WRAPEAR E-Z WRAP 5 1 270

4400011 ST LANG COMP DC G9161CKST LANG COMP DC G9161CK 0.01 G9161,CK,GN 1 449

4300163 OT SUB PT OT DC G8995CIOT SUB PT OT DC G8995CI 0.01 G8995,CI,GO 1 439

3150042 PC HERPES SIMPLES VIRUS IGM PANELPC HERPES SIMPLES VIRUS IGM PANEL0 1 302

2700140 IODOFORM 1/2INX5IODOFORM 1/2INX5 5 A6266 1 272

3100139 HIV PROFILEHIV PROFILE 85 86701,90 1 302

3100245 X RAY STONE ANALYSISX RAY STONE ANALYSIS 67 82370,90 1 301

9600089 APPLY SHORT LEG SPLINTAPPLY SHORT LEG SPLINT 139 29515 1 960

4400125 ST VOICE GOAL G9172CMST VOICE GOAL G9172CM 0.01 G9172,CM,GN 1 449

9600050 RPR CMPLX S A L 1.1-2.5 CMRPR CMPLX S A L 1.1-2.5 CM 440 13120 1 960

9600124 REMOVE EAR CERUMENREMOVE EAR CERUMEN 120 69210 1 960

500025 EX B9 LES TR ARM LEG 0.6-1.0 CMEX B9 LES TR ARM LEG 0.6-1.0 CM791 11401 1 761

1400002 FOCUS GRP THERAPY SUBSQFOCUS GRP THERAPY SUBSQ 170 90853 1 915

500033 EX BEN LES SC N H FT GE 2.1-3.0 CMEX BEN LES SC N H FT GE 2.1-3.0 CM1683 11423 1 761

2700071 CHEST SEAL ASHERMAN EACHEST SEAL ASHERMAN EA 29 1 270

2700752 SOFT FOAM NECK BRACE XSSOFT FOAM NECK BRACE XS 6 1 270


3500004 CT ABDOMEN W CONTRASTCT ABDOMEN W CONTRAST 1792 74160 1 350

4300142 OT OTHER PT OT GOAL G8991CIOT OTHER PT OT GOAL G8991CI0.01 G8991,CI,GO 1 439

9600002 I D ABSCESS COMPLICATEDI D ABSCESS COMPLICATED 420 10061 1 960


2700162 NEEDLE IO 15G 1.8MMX25MMNEEDLE IO 15G 1.8MMX25MM163 1 270


2720023 TUBE HOLDER TRACH ADULTTUBE HOLDER TRACH ADULT 8 1 270

3100078 CYCLOSPORINECYCLOSPORINE 206 80158,90 1 301

4400073 ST VOICE CURRENT G9171CJST VOICE CURRENT G9171CJ 0.01 G9171,CJ,GN 1 449

4200020 PT CARRY GOAL G8985CLPT CARRY GOAL G8985CL 0.01 G8985,CL,GP 1 429

400175 INSERT NEEDLE BONE CAVITYINSERT NEEDLE BONE CAVITY 610 36680 1 450

4300061 OT MEMORY GOAL G9169CLOT MEMORY GOAL G9169CL 0.01 G9169,CL,GN 1 439

9600138 OBSERVATION SUBSEQ CARE LVL 2OBSERVATION SUBSEQ CARE LVL 2147 99225 1 982


9600307 TREAT RADIAL HEAD OR NECK FX W MANIPULATTREAT RADIAL HEAD OR NECK FX W MANIPULAT560 24655 1 960

4200025 PT SELFCARE DC G8989CJPT SELFCARE DC G8989CJ 0.01 G8989,CJ,GP 1 429

400125 PUNCTURE LUMABAR DIAGNOSTICPUNCTURE LUMABAR DIAGNOSTIC657 62270 1 450

4200076 PT MOBILITY DC G8980CLPT MOBILITY DC G8980CL 0.01 G8980,CL,GP 1 429

400111 INSERTION CV CATH NON TUNNEL 5YRS>INSERTION CV CATH NON TUNNEL 5YRS>1769 36556 1 450

4200032 PT SELFCARE GOAL G8988CJPT SELFCARE GOAL G8988CJ 0.01 G8988,CJ,GP 1 429

2720052 VAGINAL IRRAGATION SETVAGINAL IRRAGATION SET 0 1 271


2700758 ORTHO-GLASS SPLINTING 6X15ORTHO-GLASS SPLINTING 6X15289 1 270


2700538 SUTURE PROLENE 3-0 PS28687HSUTURE PROLENE 3-0 PS28687H27 A4649 1 272

500139 INJ SKIN LESIONS </W7INJ SKIN LESIONS </W7 354 11900 1 761

2700689 DRAINAGE, PLEURX KITDRAINAGE, PLEURX KIT 217 1 270

2600015 EMS NORMAL SALINE 500 MLEMS NORMAL SALINE 500 ML1.44 1 258

3140067 PC DESIPRAMINE ASSAYPC DESIPRAMINE ASSAY 93 80335,90 1 301

3100085 DNA ANTIBODY SINGLE STDNA ANTIBODY SINGLE ST 65 86226,90 1 302

4400064 ST SWALLOW GOAL G8997CHST SWALLOW GOAL G8997CH0.01 G8997,CH,GN 1 449

4300096 OT BODY POS DC G8983CLOT BODY POS DC G8983CL 0.01 G8983,CL,GO 1 439


2700185 DRESSING PLAIN 1/2INDRESSING PLAIN 1/2IN 5 A6407 1 272


4400002 ST LANG COMP CURRENT G9159CIST LANG COMP CURRENT G9159CI0.01 G9159,CI,GN 1 449

4300032 OT CARRY DC G8986CKOT CARRY DC G8986CK 0.01 G8986,CK,GO 1 439

2700368 INFUSION SET 22G X .75 ININFUSION SET 22G X .75 IN 0 1 270

2700336 SCISSORS WEBSTER NH 5.25 STRLSCISSORS WEBSTER NH 5.25 STRL22 1 270

2700273 STOCKING ANTIEMBOI THIGH LGSTOCKING ANTIEMBOI THIGH LG11 1 270

400098 SPLINT APPLICATION SHORT LEGSPLINT APPLICATION SHORT LEG215 29515 1 450

9600139 OBSERVATION SUBSEQ CARE LVL 3OBSERVATION SUBSEQ CARE LVL 3220.5 99226 1 982

3140047 PC BLASTOMYCESPC BLASTOMYCES 44 86612,90 1 302

9600161 VAGINAL DELIVERYVAGINAL DELIVERY 2578 59409 1 960

2720058 MASK MIRAGE QUATTRO V-PAP FFMMED-AMERMASK MIRAGE QUATTRO V-PAP FFMMED-AMER435 1 270

4200125 PT SUB PT OT DC G8995CLPT SUB PT OT DC G8995CL 0.01 G8995,CL,GP 1 429


2700239 STETHOSCOPESTETHOSCOPE 6 1 270

9600098 INTUBATION EMERGENCYINTUBATION EMERGENCY 403 31500 1 960

2700592 DRESSING OPTIFOAM (ALVN) 15.4MX15.DRESSING OPTIFOAM (ALVN) 15.4MX15.280 A6212 1 271

4400082 ST VOICE DC G9173CLST VOICE DC G9173CL 0.01 G9173,CL,GN 1 449

500023 SHAVE SKIN LES F E N E N L > 2.0 CMSHAVE SKIN LES F E N E N L > 2.0 CM252 11313 1 761

9600160 HOME HEALTH CERTIFI MDCRHOME HEALTH CERTIFI MDCR183 G0180 1 960

300012 IV INF DRUG EA ADD HRIV INF DRUG EA ADD HR 61 96366 1 760

4200127 PT SUB PT OT DC G8995CNPT SUB PT OT DC G8995CN 0.01 G8995,CN,GP 1 429


2700233 DRESSING GAUZE 4IN X4IN ST 10/PKGDRESSING GAUZE 4IN X4IN ST 10/PKG5 A6402 1 272

3100027 C DIFF AMPLIFIED PROBEC DIFF AMPLIFIED PROBE 260 87493,90 1 306

400104 CONTROL NASAL HEMORRHAGE ANT SIMPLECONTROL NASAL HEMORRHAGE ANT SIMPLE176 30901 1 450

400073 DISLC IP JT W MANIP WO ANESDISLC IP JT W MANIP WO ANES301 26770 1 450

2700054 CATH MALE FREEDOM MEDCATH MALE FREEDOM MED 5 1 270

4300006 OT OTHER PT OT CURRENT G8990CMOT OTHER PT OT CURRENT G8990CM0.01 G8990,CM,GO 1 439

9600074 TREAT CLOSED FINGER DISLOCATIONTREAT CLOSED FINGER DISLOCATION552 26770,54 1 960

4100009 PULMONARY FUNC TEST W BRONCHODILATIONPULMONARY FUNC TEST W BRONCHODILATION576 94060 1 460


3100308 CYTOPLASMIC ANTIBODYCYTOPLASMIC ANTIBODY 65 86255,90 1 302

4300030 OT CARRY DC G8986CIOT CARRY DC G8986CI 0.01 G8986,CI,GO 1 439



4300045 OT MEMORY CURRENT G9168CJOT MEMORY CURRENT G9168CJ0.01 G9168,CJ,GN 1 439

500016 SHAVE SKIN LES S N H F G 0.5 CM<SHAVE SKIN LES S N H F G 0.5 CM<161 11305 1 761

4200105 PT OTHER PT OT GOAL G8991CMPT OTHER PT OT GOAL G8991CM0.01 G8991,CM,GP 1 429

4200026 PT SELFCARE DC G8989CKPT SELFCARE DC G8989CK 0.01 G8989,CK,GP 1 429

3400027 US SCROTUMUS SCROTUM 315 76870 1 402

3100173 PARATHYROID HORMONEPARATHYROID HORMONE 261 83970,90 1 301


4300172 OT PARAFFIN BATHOT PARAFFIN BATH 37 97018,GO 1 431

3100050 CHOLINESTERASE SERUMCHOLINESTERASE SERUM 66 82480,90 1 301

3100294 THC CONFIRMATIONTHC CONFIRMATION 421.5 80349,90 1 301

4400070 ST SWALLOW GOAL G8997CNST SWALLOW GOAL G8997CN0.01 G8997,CN,GN 1 449

4300012 OT ATTEN CURRENT G9165CLOT ATTEN CURRENT G9165CL0.01 G9165,CL,GN 1 439

500054 EX MALIG LES F ER EY N L 0.5CM<EX MALIG LES F ER EY N L 0.5CM<757 11640 1 761

4400149 ST ATTENTION FUNC LIMIT CURRENT G9165CIST ATTENTION FUNC LIMIT CURRENT G9165CI0.01 G9165,CI,GN 1 449

4200150 PT WHEELCHAIR MGMT EA 15 MINPT WHEELCHAIR MGMT EA 15 MIN106 97542,GP 1 421

4400111 ST SWALLOW CURRENT G8996CMST SWALLOW CURRENT G8996CM0.01 G8996,CM,GN 1 449

4300157 OT SUB PT OT CURRENT G8993CJOT SUB PT OT CURRENT G8993CJ0.01 G8993,CJ,GO 1 439

4300133 OT MOBILITY GOAL G8979CNOT MOBILITY GOAL G8979CN0.01 G8979,CN,GO 1 439

3150032 PC EBV VCA IGG PANELPC EBV VCA IGG PANEL 0 1 302

4400144 ST EVALUATION SOUND PRODUCTIONST EVALUATION SOUND PRODUCTION224 92522,GN 1 444

4200039 PT SUB PT OT GOAL G8994CJPT SUB PT OT GOAL G8994CJ 0.01 G8994,CJ,GP 1 429


2700676 WRIST SUPPORT (SMALL) EPXAMBIWRIST SUPPORT (SMALL) EPXAMBI25 1 270

3500028 CT LUMBAR SPINE W CONTRASTCT LUMBAR SPINE W CONTRAST1840 72132 1 350

4400076 ST VOICE CURRENT G9171CMST VOICE CURRENT G9171CM0.01 G9171,CM,GN 1 449


3100115 GENTAMICINGENTAMICIN 121 80170,90 1 301

2700395 SHOULDER HOTPACK OVERSIZEDSHOULDER HOTPACK OVERSIZED0 1 270

4300135 OT OTHER PT OT DC G8992CIOT OTHER PT OT DC G8992CI0.01 G8992,CI,GO 1 439

4300102 OT BODY POS GOAL G8982CKOT BODY POS GOAL G8982CK0.01 G8982,CK,GO 1 439

3140060 PC MICROBE SUSCEPTIBLE MICPC MICROBE SUSCEPTIBLE MIC47 87186,90 1 306

2700559 SPECULUM ER SPEC VAGINAL WLED SMSPECULUM ER SPEC VAGINAL WLED SM33 A4649 1 271

2720018 MASK O2 VENTI PEDIMASK O2 VENTI PEDI 20 1 270


3100009 ALPHA I ANTITRYSPIN TOTALALPHA I ANTITRYSPIN TOTAL 102 82103,90 1 301

400106 CONTROL NASAL HEMORRHAGE POST INITCONTROL NASAL HEMORRHAGE POST INIT176 30905 1 450

400088 CAST APPLICATION FINGERCAST APPLICATION FINGER 213 29086 1 450


500003 INCIS REMOV FB SUBQ COMPLICATEDINCIS REMOV FB SUBQ COMPLICATED477 10120 1 761


300003 PUNCTURE ARTERIALPUNCTURE ARTERIAL 53 36600 1 760

3140095 PC IMMUNOASSAYPC IMMUNOASSAY 70 83520,90 1 301

2700350 DRESSING TELFA 3X6DRESSING TELFA 3X6 5 1 270

9600018 EX B9 LES SP NK HD FT GT 0.6-1CMEX B9 LES SP NK HD FT GT 0.6-1CM301 11421 1 960

3100205 SALICYLATE QUANTITATIVESALICYLATE QUANTITATIVE 70 80329,90 1 301

4400107 ST SWALLOW CURRENT G8996CIST SWALLOW CURRENT G8996CI0.01 G8996,CI,GN 1 449

3200001 XR ABDOMEN 1 VIEWXR ABDOMEN 1 VIEW 123 74018 1 320

9600008 BX SKIN EA ADDTIONAL LESIONBX SKIN EA ADDTIONAL LESION62 11101 1 960

3100145 IGE IGE 94 82785,90 1 301

3100109 FTA ABS FTA ABS 35 86780,90 1 302

400000 I D ABSCESS SIMPLEI D ABSCESS SIMPLE 283 10060 1 450

2700525 DRESSING AQUACEL AG EXTRA HYDROFIBER2X2DRESSING AQUACEL AG EXTRA HYDROFIBER2X260 A6196 1 272


9600315 RPR CMPLX EYELID, NOSE, LIP 2.6 TO 7.5CMRPR CMPLX EYELID, NOSE, LIP 2.6 TO 7.5CM675 13152 1 960

3100143 HYDROXYPROGESTERONE 17 DHYDROXYPROGESTERONE 17 D140 83498,90 1 300

3100179 PROCAINAMIDEPROCAINAMIDE 90 80190,90 1 301

2700754 SOFT FOAM NECK BRACE MDSOFT FOAM NECK BRACE MD 6 1 270

9600192 EX MAL LES SC NK HD FT GT 0.5CM OR <EX MAL LES SC NK HD FT GT 0.5CM OR <340 11620 1 960

2702044 DRESSING TEGA DERM FILM 1624WDRESSING TEGA DERM FILM 1624W5 A6257 1 270

2700108 XEROFORM 5INX9INXEROFORM 5INX9IN 5 A6223 1 272

3100257 THYROTROPIN RECEPTOR ANTIBODYTHYROTROPIN RECEPTOR ANTIBODY390 83520,90 1 301

2700343 CHEST DRAINAGE SETCHEST DRAINAGE SET 0 1 270

9600134 INPATIENT INITIAL HOSP LVL 1INPATIENT INITIAL HOSP LVL 1187.5 99221 1 987

3100073 CULTURE STOOLCULTURE STOOL 203 87045,90 1 306

4400086 ST LANG EXPRESS DC G9164 CIST LANG EXPRESS DC G9164 CI0.01 G9164,CI,GN 1 449

400105 CONTROL NASAL HEMORRHAGE ANT COMPLXCONTROL NASAL HEMORRHAGE ANT COMPLX184 30903 1 450

4400003 ST LANG COMP CURRENT G9159CJST LANG COMP CURRENT G9159CJ0.01 G9159,CJ,GN 1 449

2700034 ORTHO CAST SHOE ADULT SMALLORTHO CAST SHOE ADULT SMALL72 L3260 1 270

3140026 PC CREATINE KINASEPC CREATINE KINASE 35 82550,90 1 301

3100155 LACTOFERRIN FECAL QUALITATIVELACTOFERRIN FECAL QUALITATIVE146 83630,90 1 301

4300162 OT SUB PT OT DC G8995CHOT SUB PT OT DC G8995CH 0.01 G8995,CH,GO 1 439

2700398 STERILE FIELD TOWEL/DRAPESTERILE FIELD TOWEL/DRAPE 0 1 270

2700593 HEMOSTAT ABSORBABLE SURGICEL 2X3HEMOSTAT ABSORBABLE SURGICEL 2X3453 1 272

3140124 PC BENZENE URINEPC BENZENE URINE 324 84600,90 1 301

400047 RPR CMPLX SC ARM LEG 2.6-7.5 CMRPR CMPLX SC ARM LEG 2.6-7.5 CM591 13121 1 450

2700260 SUTURE ETHILON P3 5-0 690GSUTURE ETHILON P3 5-0 690G 11 1 270

2700226 CATH TRAY STRAIGHT RED RUBBER 15FRCATH TRAY STRAIGHT RED RUBBER 15FR5 A4353 1 272

4300154 OT SELFCARE CURRENT G8987CNOT SELFCARE CURRENT G8987CN0.01 G8987,CN,GO 1 439

3500047 CT THORACIC SPINE WO CONTRASTCT THORACIC SPINE WO CONTRAST1536 72128 1 350

2600010 D5 NS 1000 MLD5 NS 1000 ML 50 1 258

400114 DRAIN ABSC CYST HMTA DENTOALVEOLARDRAIN ABSC CYST HMTA DENTOALVEOLAR282 41800 1 450

3100089 EPSTEIN BARR EB EARLY ANTIBODYEPSTEIN BARR EB EARLY ANTIBODY85 86663,90 1 302

4400147 ST SENSORY INTEGRATION EA 15 MINST SENSORY INTEGRATION EA 15 MIN85 97533,GN 1 441

2700306 TUBE ET 2.0TUBE ET 2.0 22 1 270

9600116 CATH INSERTION INDWELLINGCATH INSERTION INDWELLING226 51702 1 960

2700145 MASTISOL PER VIALMASTISOL PER VIAL 7 A4364 1 272

3100255 LAMICTAL LEVELLAMICTAL LEVEL 74 80175,90 1 301

3100108 FRUCTOSAMINEFRUCTOSAMINE 81 82985,90 1 301

3100098 FERRITIN FERRITIN 106 82728,90 1 301

3400013 US EXTREMITY UPPER STUDY COMP RIGHTUS EXTREMITY UPPER STUDY COMP RIGHT864 93930 1 921

9600047 RPR INTMD F E EY N L MM 5.1-7.5 CMRPR INTMD F E EY N L MM 5.1-7.5 CM500 12053 1 960

1500012 PSYCHOTHERAPY PHONE CONFERENCE 2 HOURPSYCHOTHERAPY PHONE CONFERENCE 2 HOUR200 1 914

3100127 HEP B CORE ANTIBODYHEP B CORE ANTIBODY 74 86705,90 1 302

9600022 TRIMMING OF NAILS ANY NUMBERTRIMMING OF NAILS ANY NUMBER60 11719 1 960

400103 REMOVE FB INTRANASALREMOVE FB INTRANASAL 112 30300 1 450


3100254 PAP SMEAR TYPE 2PAP SMEAR TYPE 2 72 88164,90 1 311

500009 BIOPSY SKIN SUBQ EA ADD LESBIOPSY SKIN SUBQ EA ADD LES161 11101 1 761

4400127 ST EVALUATION SPEECH FLUENCYST EVALUATION SPEECH FLUENCY275 92521,GN 1 444

4300128 OT MOBILITY GOAL G8979CIOT MOBILITY GOAL G8979CI 0.01 G8979,CI,GO 1 439

3140050 PC LEAD PC LEAD 66 83655,90 1 301


2700204 SLING ARM XLGSLING ARM XLG 16 A4565 1 271

500010 REMOVE SKIN TAGS UP TO 15REMOVE SKIN TAGS UP TO 15161 11200 1 761


4300151 OT SELFCARE CURRENT G8987CKOT SELFCARE CURRENT G8987CK0.01 G8987,CK,GO 1 439

4300113 OT MOBILITY CURRENT G8978 CHOT MOBILITY CURRENT G8978 CH0.01 G8978,CH,GO 1 439

4400057 ST SPEECH LANG GOAL G9175CHST SPEECH LANG GOAL G9175CH0.01 G9175,CH,GN 1 449

3100055 COCCIDIOIDES ANTIBODYCOCCIDIOIDES ANTIBODY 78 86635,90 1 302

9600068 TREAT CLOSED RADIAL FX DISTALTREAT CLOSED RADIAL FX DISTAL700 25600,54 1 960

3140070 PC INFLUENZA B VIRUSPC INFLUENZA B VIRUS 73 86710,90 1 302


9600122 BIOPSY EXTERNAL EARBIOPSY EXTERNAL EAR 233 69100 1 960

4200071 PT MOBILITY CURRENT G8978 CNPT MOBILITY CURRENT G8978 CN0.01 G8978,CN,GP 1 429


3200064 XR SHOULDER 1 VIEW LEFTXR SHOULDER 1 VIEW LEFT 123 73020,LT 1 320

3100147 IMMUNOFIXATION E PHORESIS URINE CSFIMMUNOFIXATION E PHORESIS URINE CSF161 86335,90 1 307

3100096 ETHCHLORVYNOLETHCHLORVYNOL 150 80368,90 1 301

3140068 PC GAMMAGLOBULINPC GAMMAGLOBULIN 50 82784,90 1 301

4300086 OT ATTEN DC G9167CIOT ATTEN DC G9167CI 0.01 G9167,CI,GN 1 439

400053 RPR CMPLX EYLD N EAR LIP 1.1-2.5 CMRPR CMPLX EYLD N EAR LIP 1.1-2.5 CM925 13151 1 450


2700304 TUBE ET 7.0TUBE ET 7.0 5 1 270

500137 I D ISHIORECTALPERI ABSCI D ISHIORECTALPERI ABSC 2870 46040 1 450

2700110 EAR CURETTE INFANTEAR CURETTE INFANT 5 A4649 1 271

2700533 BUCKET PLASTERBUCKET PLASTER 26 1 271

2720001 AIRWAY DISP ALL SIZESAIRWAY DISP ALL SIZES 20 1 271

9600303 PARACENTESIS AB WO IMGPARACENTESIS AB WO IMG 450 49082 1 960


3100289 POLIOVIRUS ANTIBODIESPOLIOVIRUS ANTIBODIES 132 86658,90 1 302

3100200 ROTAVIRUS AG EIAROTAVIRUS AG EIA 66 87425,90 1 306

400061 FX CLSD TX CLAVICULAR WO MANFX CLSD TX CLAVICULAR WO MAN301 23500 1 450

3500043 CT SINUS WWO CONTRASTCT SINUS WWO CONTRAST 1936 70488 1 350


2900014 BB RBC LEUKOCYTE REDUCEBB RBC LEUKOCYTE REDUCE 510 P9016,BL 1 381

3500036 CT MASTOID/IAC WO CONTRASTCT MASTOID/IAC WO CONTRAST1304 70480 1 350

400046 RPR CMPLX SC ARM LEG 1.1-2.5 CMRPR CMPLX SC ARM LEG 1.1-2.5 CM566 13120 1 450

500097 INJ IVP DRUG SINGLE INITINJ IVP DRUG SINGLE INIT 89 96374 1 761

3100292 AMPHETAMINE CONFIRMATIONAMPHETAMINE CONFIRMATION514 80307,90 1 301

2700362 HEEL PROTECTORSHEEL PROTECTORS 18 1 270


3100168 MUMPS VIRUS IMMUNE ANTIBODYMUMPS VIRUS IMMUNE ANTIBODY77 86735,90 1 302


500066 DESTR B9 LES NOT SKIN TAG UP TO 14DESTR B9 LES NOT SKIN TAG UP TO 14161 17110 1 761

300002 INSERTION CV CATH NON TUNNEL 5YRS/>INSERTION CV CATH NON TUNNEL 5YRS/>1769 36556 1 760

3140032 PC NEISSERIA AMPLIF NA PROBEPC NEISSERIA AMPLIF NA PROBE189 87591,90 1 306

3500007 CT ANGIO ABDOMEN WWO CONTRASTCT ANGIO ABDOMEN WWO CONTRAST2000 74175 1 350

500107 INJ INFLUENZA ADMININJ INFLUENZA ADMIN 54 90471 1 771

400163 CL TX RADIAL & ULNA FX W MANIPCL TX RADIAL & ULNA FX W MANIP481 25565 1 450

4300180 OT SENSORY INTEGRATION EA 15 MINOT SENSORY INTEGRATION EA 15 MIN97 97533,GO 1 431

2700557 FORCEPS KELLY CURVED 5.5FORCEPS KELLY CURVED 5.5 19 A4550 1 272

4300063 OT MEMORY GOAL G9169CNOT MEMORY GOAL G9169CN0.01 G9169,CN,GN 1 439

9600010 SHAVE LES TRNK EXTREM .5CM <SHAVE LES TRNK EXTREM .5CM <200 11300 1 960

3100086 DNA PROBES W CHLAMYDIADNA PROBES W CHLAMYDIA 377 87491,90 1 306



4300003 OT OTHER PT OT CURRENT G8990CJOT OTHER PT OT CURRENT G8990CJ0.01 G8990,CJ,GO 1 439

4200028 PT SELFCARE DC G8989CMPT SELFCARE DC G8989CM 0.01 G8989,CM,GP 1 429

2700554 FORCEPS ADSON TISSUE 4.5 STFORCEPS ADSON TISSUE 4.5 ST 12 1 272

2702040 CERVICAL COLLAR UNIVERSALCERVICAL COLLAR UNIVERSAL 54 1 270





500068 INJ SNGLMULT TRIGGER PT 1-2 MUSCLEINJ SNGLMULT TRIGGER PT 1-2 MUSCLE411 20552 1 761

400076 FX CLSD TRIMALLEOLAR W MANIPFX CLSD TRIMALLEOLAR W MANIP898 27818 1 450

9600117 INJ NERVE BLOCK TRIGEMINALINJ NERVE BLOCK TRIGEMINAL500 64400 1 960

3100112 G6PD ENZYMEG6PD ENZYME 74 82955,90 1 301

9600026 REPAIR OF NAIL BEDREPAIR OF NAIL BED 640 11760 1 960

9600052 INITIAL TREAT 1ST DEGREE BURNINITIAL TREAT 1ST DEGREE BURN179 16000 1 960

3100149 CHROMOGRANIN ACHROMOGRANIN A 117 86316,90 1 302

9600090 STRAPPLING KNEESTRAPPLING KNEE 103 29530 1 960

9600076 TREAT CLOSED ANKLE DISLOCATIONTREAT CLOSED ANKLE DISLOCATION905 27840,54 1 960



2700291 TUBE ET 5.0TUBE ET 5.0 0 1 272

4400099 ST MOTOR SPEECH DC G9158CHST MOTOR SPEECH DC G9158CH0.01 G9158,CH,GN 1 449


9600190 EX B9 LES FACE 0.6 -1.0CMEX B9 LES FACE 0.6 -1.0CM 363 11441 1 960

9600065 TREAT CLOSED SHOULDER DISLOCATIONTREAT CLOSED SHOULDER DISLOCATION640 23650,54 1 960

4200037 PT SUB PT OT GOAL G8994CHPT SUB PT OT GOAL G8994CH0.01 G8994,CH,GP 1 429

9600177 EX MAL LES TRK ARMS LEGS 1.1-2.0CMEX MAL LES TRK ARMS LEGS 1.1-2.0CM464 11602 1 960

3100242 VITAMIN B 12VITAMIN B 12 102 82607,90 1 301

2720004 CANNULA O2 NASAL PEDICANNULA O2 NASAL PEDI 36 1 271


2700768 ARM SLING TODDLER 070/004ARM SLING TODDLER 070/004 9 1 270

2720008 EXERCISER VOLUME SPIROMETEREXERCISER VOLUME SPIROMETER24 1 270

4400020 ST LANG COMP GOAL G9160CMST LANG COMP GOAL G9160CM0.01 G9160,CM,GN 1 449

4200154 PT NEG PRESS WOUND VAC 50 SQ CM<PT NEG PRESS WOUND VAC 50 SQ CM<195 97605,GP 1 421

3100052 CITRATE CITRATE 136 82507,90 1 301

4400045 ST SPEECH LANG CURRENT G9174CJST SPEECH LANG CURRENT G9174CJ0.01 G9174,CJ,GN 1 449

3100317 P ANCA P ANCA 65 86255,90 1 302

3100040 CATECHOLAMINES THREECATECHOLAMINES THREE 202 82384,90 1 301


3100275 ACETYLCHOL BINDING ANTIBODYACETYLCHOL BINDING ANTIBODY216 83519,90 1 301

400063 SUBLUX ELBOW CLSD TX W MANIPSUBLUX ELBOW CLSD TX W MANIP301 24640 1 450



4300099 OT BODY POS GOAL G8982CHOT BODY POS GOAL G8982CH0.01 G8982,CH,GO 1 439

400008 EX NAIL MATRIX PERMANENT REMOVALEX NAIL MATRIX PERMANENT REMOVAL718 11750 1 450

2700360 GAITBELTS 60INGAITBELTS 60IN 9 1 270

4100002 HHN TREATMENTHHN TREATMENT 79 94640 1 412

4200087 PT OTHER PT OT CURRENT G8990CIPT OTHER PT OT CURRENT G8990CI0.01 G8990,CI,GP 1 429

2700266 SYRINGE LEURLOCK 60MLSYRINGE LEURLOCK 60ML 5 1 270


100005 PUNCTURE LUMBAR DIAGNOSTICPUNCTURE LUMBAR DIAGNOSTIC657 62270 1 220

400071 FX CLSD ART MPIP JT W MANIPFX CLSD ART MPIP JT W MANIP301 26742 1 450

3100057 COLD AGGLUTININ TITERCOLD AGGLUTININ TITER 56 86157,90 1 302

4400088 ST LANG EXPRESS DC G9164 CKST LANG EXPRESS DC G9164 CK0.01 G9164,CK,GN 1 449

2700035 CATH FEMALE FASTCATH FEMALE FAST 50 A4353 1 272

2700537 SUTURE BLACK 0-0 18PERMAHANDFSL678GSUTURE BLACK 0-0 18PERMAHANDFSL678G13 A4649 1 272

3100072 CULTURE OTHERCULTURE OTHER 71 87070,90 1 306

1400003 MED NUTRITION ASSESS INITIAL EA 15MMED NUTRITION ASSESS INITIAL EA 15M73 97802 1 942

4300129 OT MOBILITY GOAL G8979CJOT MOBILITY GOAL G8979CJ 0.01 G8979,CJ,GO 1 439


500135 PUNCTURE LUMABAR DIAGNOSTICPUNCTURE LUMABAR DIAGNOSTIC660 62270 1 450

500067 INJ SNGL TENDON SHEATHLIGAMENTINJ SNGL TENDON SHEATHLIGAMENT411 20550 1 761

2700720 FILTER LINE SETSFILTER LINE SETS 27 1 270

3140099 PC ANTINUCLEAR AB ANAPC ANTINUCLEAR AB ANA 65 86038,90 1 302

500129 INJ IMMUNIZATION ADMIN EA ADDLINJ IMMUNIZATION ADMIN EA ADDL42 90472 1 771

4200069 PT MOBILITY CURRENT G8978 CLPT MOBILITY CURRENT G8978 CL0.01 G8978,CL,GP 1 429

2700113 ELECTRODE PADS 5/PKELECTRODE PADS 5/PK 5 A4556 1 270

4300097 OT BODY POS DC G8983CMOT BODY POS DC G8983CM 0.01 G8983,CM,GO 1 439

3100028 C PEPTIDE C PEPTIDE 146 84681,90 1 301

3140142 PC OXALATE URINEPC OXALATE URINE 73 83945,90 1 301

400165 ARTHRO ASP ANDOR INJ MAJ JOINTARTHRO ASP ANDOR INJ MAJ JOINT448 20610 1 761

2700178 DRESSING PLAIN 1/4INDRESSING PLAIN 1/4IN 5 A6407 1 272


3140150 INSULIN GROWTH FACTOR 1INSULIN GROWTH FACTOR 1 86 84305,90 1 301


2700205 SLING ARM LGSLING ARM LG 8 A4565 1 271

2700355 FORCEP HALSTEAD CURVED STRL 5INFORCEP HALSTEAD CURVED STRL 5IN0 1 270

4300077 OT SELFCARE GOAL G8988CNOT SELFCARE GOAL G8988CN0.01 G8988,CN,GO 1 439

2700248 CATH SUCTION 18 FRCATH SUCTION 18 FR 5 1 272

300007 PUNCTURE LUMBAR DIAGNOSTICPUNCTURE LUMBAR DIAGNOSTIC657 62270 1 760

4400119 ST SWALLOW DC G8998CNST SWALLOW DC G8998CN 0.01 G8998,CN,GN 1 449

3150065 PC TEST T&FPC TEST T&F 0 1 301


3200041 XR HIP UNI 2-3 VIEW RIGHTXR HIP UNI 2-3 VIEW RIGHT 210 73502,RT 1 320

2720057 MASK MIRAGE QUATTRO V-PAP FFMSML-AMERMASK MIRAGE QUATTRO V-PAP FFMSML-AMER435 1 271

500141 CAST REMOVAL /CAST REMOVAL / 476 29700 1 450

400081 FX CLSD GREAT TOE W MANIPFX CLSD GREAT TOE W MANIP301 28495 1 450

4400053 ST SPEECH LANG DC G9176CKST SPEECH LANG DC G9176CK0.01 G9176,CK,GN 1 449

4200106 PT OTHER PT OT GOAL G8991CNPT OTHER PT OT GOAL G8991CN0.01 G8991,CN,GP 1 429

9600131 OBSERVATION INITIAL CARE LVL 1OBSERVATION INITIAL CARE LVL 1180 99218 1 982

3200006 XR ANKLE 2 VIEW RIGHTXR ANKLE 2 VIEW RIGHT 123 73600,RT 1 320

4200053 PT BODY POS GOAL G8982CJPT BODY POS GOAL G8982CJ 0.01 G8982,CJ,GP 1 429

3100006 ALLERGEN SPECIFIC IGEALLERGEN SPECIFIC IGE 73.8 86003,90 1 302

400116 CHANGE GASTROSTOMY TUBE WO IMACHANGE GASTROSTOMY TUBE WO IMA354 43760 1 450


9600147 INPATIENT DISCH > 30 MINSINPATIENT DISCH > 30 MINS 450 99239 1 987

4300171 OT APPLICATION HOT COLD PACKSOT APPLICATION HOT COLD PACKS30 97010,GO 1 431

3100224 TESTOSTERONE TOTALTESTOSTERONE TOTAL 275 84403,90 1 301

2720039 FOLEY CATHETERS 6FFOLEY CATHETERS 6F 24 1 272

2700409 TONGUE BLADE STERILETONGUE BLADE STERILE 0 1 270

4400051 ST SPEECH LANG DC G9176CIST SPEECH LANG DC G9176CI0.01 G9176,CI,GN 1 449

2700344 COLD PACK XLCOLD PACK XL 5 1 270

2702062 LIFT SWINGLIFT SWING 212 1 270

4200116 PT SUB PT OT CURRENT G8993CJPT SUB PT OT CURRENT G8993CJ0.01 G8993,CJ,GP 1 429

270266 SHOECOVERSHOECOVER 24 1 270



400102 DRAIN ABSCESSHEMATOMA NOSE INTERDRAIN ABSCESSHEMATOMA NOSE INTER518 30000 1 450

2700715 FINGER TRAP SM MESH STERILEFINGER TRAP SM MESH STERILE70 1 270

4400094 ST MOTOR SPEECH CURRENT G8999CJST MOTOR SPEECH CURRENT G8999CJ0.01 G8999,CJ,GN 1 449

4200090 PT OTHER PT OT CURRENT G8990CLPT OTHER PT OT CURRENT G8990CL0.01 G8990,CL,GP 1 429

3100310 BARBITURATE CONFIRMATORYBARBITURATE CONFIRMATORY364 80345,90 1 301

2700060 CERVICAL EXTRICATION COLLAR NECKLESS 3CERVICAL EXTRICATION COLLAR NECKLESS 314 1 270

9600302 AVULSION NAIL PLATE ADDLAVULSION NAIL PLATE ADDL 90 11732 1 960

2900007 BB BLOOD TYPING ABOBB BLOOD TYPING ABO 28 86900,90 1 302

4400093 ST MOTOR SPEECH CURRENT G8999CIST MOTOR SPEECH CURRENT G8999CI0.01 G8999,CI,GN 1 449

400035 RPR INT NE HA FT GEN > 30.0 CMRPR INT NE HA FT GEN > 30.0 CM667 12047 1 450

2700253 SUTURE 5-0 PLAIN 686GSUTURE 5-0 PLAIN 686G 10 1 270

4400001 ST LANG COMP CURRENT G9159CHST LANG COMP CURRENT G9159CH0.01 G9159,CH,GN 1 449

4300073 OT SELFCARE GOAL G8988CJOT SELFCARE GOAL G8988CJ 0.01 G8988,CJ,GO 1 439

2702043 CERVICAL COLLAR WITH TRACH SMALLCERVICAL COLLAR WITH TRACH SMALL54 1 270

4200202 PT RE EVALUATIONPT RE EVALUATION 141 97164,GP 1 424

3100062 CREATININE URINECREATININE URINE 28 82570,90 1 301

2700358 FORCEPS HALSTEAD STRAIGHT 5INFORCEPS HALSTEAD STRAIGHT 5IN10 1 270


4400035 ST LANG EXPRESS GOAL G9163CNST LANG EXPRESS GOAL G9163CN0.01 G9163,CN,GN 1 449

4300079 OT SUB PT OT GOAL G8994CIOT SUB PT OT GOAL G8994CI0.01 G8994,CI,GO 1 439

2710008 IV START PAKIV START PAK 5 1 272

9600148 ER PRO FEE LIMITED MER PRO FEE LIMITED M 95 99281 1 981

4300181 OT ADL/HOME MGMT TRAINING EA 15 MINOT ADL/HOME MGMT TRAINING EA 15 MIN117 97535,GO 1 431

4400055 ST SPEECH LANG DC G9176CMST SPEECH LANG DC G9176CM0.01 G9176,CM,GN 1 449


3140003 PC PHOSPHATASE ALKALINEPC PHOSPHATASE ALKALINE 28 84075,90 1 301

4400129 ST DYSPH ORAL FUNCTION THERAPYST DYSPH ORAL FUNCTION THERAPY260 92526,GN 1 441

3140075 PC ALPHA FETOPROTEIN SERUMPC ALPHA FETOPROTEIN SERUM75 82105,90 1 301

4300161 OT SUB PT OT CURRENT G8993CNOT SUB PT OT CURRENT G8993CN0.01 G8993,CN,GO 1 439

4400019 ST LANG COMP GOAL G9160CLST LANG COMP GOAL G9160CL0.01 G9160,CL,GN 1 449

3400018 US EXTREMITY VEIN STUDY COMP RIGHTUS EXTREMITY VEIN STUDY COMP RIGHT282 93965 1 921

400162 RPR LACERATION VESTIBULE MOUTH >2.5CMRPR LACERATION VESTIBULE MOUTH >2.5CM1294 40831 1 450

3100237 VANCOMYCIN RANDOMVANCOMYCIN RANDOM 73 80202,90 1 301

3140121 PC CADMIUM BLOODPC CADMIUM BLOOD 142 82300,90 1 301


3100162 LYME TITERLYME TITER 92 86617,90 1 302

9600132 OBSERVATION INITIAL CARE LVL 2OBSERVATION INITIAL CARE LVL 2322.5 99219 1 982


3100295 COMPLEMENT CH50COMPLEMENT CH50 65.75 86162,90 1 301

4300066 OT SELFCARE DC G8989CJOT SELFCARE DC G8989CJ 0.01 G8989,CJ,GO 1 439

4300205 OT EVALUATION HIGH COMPLEXITYOT EVALUATION HIGH COMPLEXITY331 97167,GO 1 434

2700075 CRUTCHES ADULT TALL 5.10FT-6.6FTCRUTCHES ADULT TALL 5.10FT-6.6FT44 E0114 1 271

500062 RPR INT WND F E EY N L MM 2.5<RPR INT WND F E EY N L MM 2.5<514.64 12051 1 761

3100080 CYTOPATH CON TECH SMEARS TECHCYTOPATH CON TECH SMEARS TECH90 88108,90 1 311

2700501 BETADINE SWABBETADINE SWAB 5 1 270

9600165 ADMIN IVP INITIAL/SINGLE SUBSTANCE PROADMIN IVP INITIAL/SINGLE SUBSTANCE PRO98 96374 1 981

400135 PACING TEMP EXTERNALPACING TEMP EXTERNAL 362 92953 1 450

3100058 COMPLEMENT ANTIGENCOMPLEMENT ANTIGEN 135 86160,90 1 302

4200130 PT APPLY SURFACE NEUROSTIMULATORPT APPLY SURFACE NEUROSTIMULATOR70 64550,GP 1 421

300016 INJ IVP DRUG SINGLE INITINJ IVP DRUG SINGLE INIT 89 96374 1 760

4400074 ST VOICE CURRENT G9171CKST VOICE CURRENT G9171CK 0.01 G9171,CK,GN 1 449

4200120 PT SUB PT OT CURRENT G8993CNPT SUB PT OT CURRENT G8993CN0.01 G8993,CN,GP 1 429


3400034 US UPR LXTR ART STDY 2 LEVELS RIGHTUS UPR LXTR ART STDY 2 LEVELS RIGHT204 93922,RT 1 921

4300050 OT MEMORY DC G9170CHOT MEMORY DC G9170CH 0.01 G9170,CH,GN 1 439

4300004 OT OTHER PT OT CURRENT G8990CKOT OTHER PT OT CURRENT G8990CK0.01 G8990,CK,GO 1 439

2700678 WRIST SUPPORT (LG) EPXAMBIWRIST SUPPORT (LG) EPXAMBI25 1 270

400095 CAST BRACE APPICATION LONG LEGCAST BRACE APPICATION LONG LEG426 29358 1 450

4200181 PT AQUATIC THERAPY EA 15 MINPT AQUATIC THERAPY EA 15 MIN144 97113,GP 1 421

2700217 SPLINT FINGER ALUM MEDSPLINT FINGER ALUM MED 5 A4570 1 271

9600011 SHAVE LES FACE 0.5CM <SHAVE LES FACE 0.5CM < 260 11310 1 960

4400040 ST MOTOR SPEECH GOAL G9186CLST MOTOR SPEECH GOAL G9186CL0.01 G9186,CL,GN 1 449

2700305 TUBE ET 7.5TUBE ET 7.5 5 1 270

4300016 OT ATTEN GOAL G9166CIOT ATTEN GOAL G9166CI 0.01 G9166,CI,GN 1 439

3200070 XR SKULL <4 VIEWXR SKULL <4 VIEW 126 70250 1 320

9600009 REMOVAL SKIN TAGS 1-15 LESIONSREMOVAL SKIN TAGS 1-15 LESIONS180 11200 1 960

9600299 TREAT CLOSED FEMORAL FX W MANIPTREAT CLOSED FEMORAL FX W MANIP950 27268,54 1 960

3140009 PC CARDIOLIPIN ANTIBODYPC CARDIOLIPIN ANTIBODY 43 86147,90 1 302

2720043 TUBE ET 8.5TUBE ET 8.5 29 1 272

500127 REM GAUNTLET BOOT/BODY CASTREM GAUNTLET BOOT/BODY CAST288 29700 1 761

2900004 ANTIGEN SCREENANTIGEN SCREEN 116 86905,90 1 390

9600317 TREATMENT FINGER FRACTURETREATMENT FINGER FRACTURE736.08 26725 1 960

2700212 SPLINT COLLES LG RTSPLINT COLLES LG RT 12 A4570 1 271

9600005 PUNCTURE ASPIRATE ABSCESSPUNCTURE ASPIRATE ABSCESS330 10160 1 960

500015 SHAVE SKIN LES TK ARM LEG >2.0 CMSHAVE SKIN LES TK ARM LEG >2.0 CM241 11303 1 761



3100034 CALCIUM URINE RANDOM OR 24 HOURCALCIUM URINE RANDOM OR 24 HOUR146 82340,90 1 301

3100290 AMPHETAMINEAMPHETAMINE 198 80324,90 1 301

2700033 ORTHO CAST SHOE ADULT MEDIUMORTHO CAST SHOE ADULT MEDIUM72 L3260 1 271

3100330 VITAMIN B6VITAMIN B6 98 84207,90 1 301

2700181 TAPE PAPER 1INTAPE PAPER 1IN 5 1 270


9600003 I D PILONIDAL CYST SIMPLEI D PILONIDAL CYST SIMPLE 216 10080 1 960

2700028 SUPPORT ANKLE ELASTIC SMALLSUPPORT ANKLE ELASTIC SMALL58 A4649 1 271

3100232 TRANSFERRINTRANSFERRIN 90 84466,90 1 301

9600175 SHAVE LES TRK ARM LEG 0.6-1.0 CMSHAVE LES TRK ARM LEG 0.6-1.0 CM300 11301 1 960

2700719 FORCEPS SPLINTER STRAIGHT CARMALTFORCEPS SPLINTER STRAIGHT CARMALT16 1 270

9600188 I & D VULVA/PERINEAL ABSCESSI & D VULVA/PERINEAL ABSCESS240 56405 1 960

2700290 TUBE ET 4.0TUBE ET 4.0 22 1 270

4200017 PT CARRY GOAL G8985CIPT CARRY GOAL G8985CI 0.01 G8985,CI,GP 1 429


9600151 ER PRO FEE HIGH SEVEER PRO FEE HIGH SEVE 375 99284 1 981

2700321 COBAN2IN COBAN2IN 15 A6455 1 272

9600310 ARTHROCENTISIS LARGE JT W/ US GUIDANCEARTHROCENTISIS LARGE JT W/ US GUIDANCE175 20611 1 960


2700088 CENTRAL LINE CHANGECENTRAL LINE CHANGE 9 1 270

2700677 WRIST SUPPORT (MED) EPXAMBIWRIST SUPPORT (MED) EPXAMBI27 1 270

500071 ARTHRO ASP ANDOR INJ MAJ JOINTARTHRO ASP ANDOR INJ MAJ JOINT448 20610 1 761

9600108 DRAINAGE ABSCESS DENTOALVEOLARDRAINAGE ABSCESS DENTOALVEOLAR240 41800 1 960

2700714 BLANKET WARMING QUICKBLANKET WARMING QUICK 40 1 270

4200021 PT CARRY GOAL G8985CMPT CARRY GOAL G8985CM 0.01 G8985,CM,GP 1 429

4200147 PT GROUP THERAPY 2> INDIVIDUALSPT GROUP THERAPY 2> INDIVIDUALS70 97150,GP 1 421

4400120 ST VOICE GOAL G9172CHST VOICE GOAL G9172CH 0.01 G9172,CH,GN 1 449

3140098 PC RHEUMATOID FACTOR QUANTITATIVEPC RHEUMATOID FACTOR QUANTITATIVE31 86431,90 1 302

1400004 MED NUTRITION GRP EA 30MMED NUTRITION GRP EA 30M 35 97804 1 942

2710004 HL CLEARLINK EXTHL CLEARLINK EXT 11 1 272

4300112 OT CARRY CURRENT G8984 CNOT CARRY CURRENT G8984 CN0.01 G8984,CN,GO 1 439

2702055 EPISTASIS DEVICE RAPID RHINO 750EPISTASIS DEVICE RAPID RHINO 750170 A4649 1 271

3100235 URINE CYTOLOGYURINE CYTOLOGY 205 88108,90 1 307

400109 TUBE THORACOSTOMYTUBE THORACOSTOMY 928 32551 1 450


3100238 VARICELLA TITERVARICELLA TITER 72 86787,90 1 302

3100214 ST0NE QUANTITATIVEST0NE QUANTITATIVE 76 82360,90 1 301

4200148 PT THERAPEUTIC ACTIVITIES EA 15 MINPT THERAPEUTIC ACTIVITIES EA 15 MIN116 97530,GP 1 421

4300153 OT SELFCARE CURRENT G8987CMOT SELFCARE CURRENT G8987CM0.01 G8987,CM,GO 1 439

3400006 US ECHO TRANSTHORACIC COMPUS ECHO TRANSTHORACIC COMP840 93303 1 483

2710009 CONT FLO CONT FLO 14 1 272

3100044 CD4 CD4 148 86361,90 1 302

4300035 OT CARRY DC G8986CNOT CARRY DC G8986CN 0.01 G8986,CN,GO 1 439

4300122 OT MOBILITY DC G8980CJOT MOBILITY DC G8980CJ 0.01 G8980,CJ,GO 1 439


400069 FX CLSD METACARP WO MANIP EA BONEFX CLSD METACARP WO MANIP EA BONE301 26600 1 450

3300008 MRI ABDOMEN WWO CONTMRI ABDOMEN WWO CONT 3850 74183 1 610

400005 DEBRIDE SQ 1ST 20 SQ CMDEBRIDE SQ 1ST 20 SQ CM 472 11042 1 450

4200050 PT BODY POS DC G8983CNPT BODY POS DC G8983CN 0.01 G8983,CN,GP 1 429

4300055 OT MEMORY DC G9170CMOT MEMORY DC G9170CM 0.01 G9170,CM,GN 1 439

3300000 MRA HEAD W CONTMRA HEAD W CONT 3500 70545 1 610


3100280 BENZODIAZEPINES ASSAY CONF 1 ANALYTEBENZODIAZEPINES ASSAY CONF 1 ANALYTE439 80346,90 1 301

9600109 INSERTION GASTROSTOMY TUBEINSERTION GASTROSTOMY TUBE1420 43246 1 960

9600012 SHAVE LES FACE 0.6-1.0 CMSHAVE LES FACE 0.6-1.0 CM 266 11311 1 960

4300111 OT CARRY CURRENT G8984 CMOT CARRY CURRENT G8984 CM0.01 G8984,CM,GO 1 439

3140066 PC IMIPRAMINE TOFRANILPC IMIPRAMINE TOFRANIL 93 80335,90 1 301

4300036 OT CARRY GOAL G8985CHOT CARRY GOAL G8985CH 0.01 G8985,CH,GO 1 439

4300158 OT SUB PT OT CURRENT G8993CKOT SUB PT OT CURRENT G8993CK0.01 G8993,CK,GO 1 439

3140091 PC SALMONELLAPC SALMONELLA 44 86768,90 1 302


2700675 SCALPEL # 12SCALPEL # 12 5 1 270

400045 RPR CMPLX TRUNK EA ADD 5.0 CM<RPR CMPLX TRUNK EA ADD 5.0 CM<566 13102 1 450

3150031 PC EBV IGG ANTIBODIES VCA (EA) PANELPC EBV IGG ANTIBODIES VCA (EA) PANEL0 1 302

4400081 ST VOICE DC G9173CKST VOICE DC G9173CK 0.01 G9173,CK,GN 1 449

500036 EX BEN LES FA EA EY N L M 0.5 CM<EX BEN LES FA EA EY N L M 0.5 CM<757 11440 1 761

2900000 BB ANTIBODY IDBB ANTIBODY ID 256 86870,90 1 302

3100331 TRICHOMONAS SCREENTRICHOMONAS SCREEN 326 87661,90 1 306

1400000 FAMILY PSYCHOTHER W PT PRESENTFAMILY PSYCHOTHER W PT PRESENT289 90847 1 916

3200011 XR CHEST 1 VIEWXR CHEST 1 VIEW 123 71045 1 320

2702049 FOLEY ELASTOMER SILICONE 14FRFOLEY ELASTOMER SILICONE 14FR24 1 270

3200040 XR HIP UNI 2-3 VIEW LEFTXR HIP UNI 2-3 VIEW LEFT 210 73502,LT 1 320

2700282 IRRIGATION TRAYIRRIGATION TRAY 5 A4320 1 272

500128 INSERT DRUG IMPLANTINSERT DRUG IMPLANT 206 11981 1 761


2700083 CATH URINARY DRAINAGE BAGCATH URINARY DRAINAGE BAG12 1 270

3150059 PC SAMONELLA AGGLUTININS PANELPC SAMONELLA AGGLUTININS PANEL0 1 302

3140110 CMV ANTIBODYCMV ANTIBODY 78 86645,90 1 302

3100301 CYFRA 21-1CYFRA 21-1 416.25 86316,90 1 301

3100061 CREATININE CLEARANCE 24 HOURCREATININE CLEARANCE 24 HOUR78 82575,90 1 301

4300179 OT COGNITIVE SKILL DEVELOT COGNITIVE SKILL DEVEL 90 97127,GO 1 431

500011 REMOVE SKIN TAGS EA ADD 10REMOVE SKIN TAGS EA ADD 10161 11201 1 761

4200018 PT CARRY GOAL G8985CJPT CARRY GOAL G8985CJ 0.01 G8985,CJ,GP 1 429

4300132 OT MOBILITY GOAL G8979CMOT MOBILITY GOAL G8979CM0.01 G8979,CM,GO 1 439

3100350 ANTI MITOCHRONDRIAL ANTIBODYANTI MITOCHRONDRIAL ANTIBODY42 83516,90 1 302

3100138 HIV ANTIBODYHIV ANTIBODY 85 86703,90 1 302

9600189 EX MALIG LES R ARM LEG 2.1-3.0 CMEX MALIG LES R ARM LEG 2.1-3.0 CM542 11603 1 960

3200085 XR WRIST 2 VIEW RIGHTXR WRIST 2 VIEW RIGHT 123 73100,RT 1 320

2700077 CRUTCHES YOUTH 4.6FT-5.2FTCRUTCHES YOUTH 4.6FT-5.2FT 38 E0114 1 271


9600137 OBSERVATION SUBSEQ CARE LVL 1OBSERVATION SUBSEQ CARE LVL 184 99224 1 982

400072 FX CLSD DISTAL PHALANGEAL W MANIPFX CLSD DISTAL PHALANGEAL W MANIP301 26755 1 450

400012 RPR SMP S N A G TR EXT 7.6-12.5 CMRPR SMP S N A G TR EXT 7.6-12.5 CM211 12004 1 450

4400079 ST VOICE DC G9173CIST VOICE DC G9173CI 0.01 G9173,CI,GN 1 449

3100113 IGA IGA 150 82784,90 1 301

500022 SHAVE SKIN LES F E N E N L1.1-2.0CMSHAVE SKIN LES F E N E N L1.1-2.0CM241 11312 1 761

2700164 NS ST IRRIGATION SOL 500MLNS ST IRRIGATION SOL 500ML 10 A4217 1 272

3400007 US ECHOCARDIOGRAMUS ECHOCARDIOGRAM 420 93320 1 480

2700544 FORCEPS ADSON 4.75FORCEPS ADSON 4.75 12 1 272

3140064 PC ALBUMIN QUANT - RLPC ALBUMIN QUANT - RL 28 82042,90 1 301

400056 BURN INIT TX 1ST DEGREEBURN INIT TX 1ST DEGREE 161 16000 1 450

500112 EX NAIL MATRIX PERMANENT REMOVALEX NAIL MATRIX PERMANENT REMOVAL718 11750 1 761

2700026 SUPPORT ANKLE ELASTIC LARGESUPPORT ANKLE ELASTIC LARGE58 A4649 1 271

3150064 PC SYNOVIAL FLUID ANALYSIS PANELPC SYNOVIAL FLUID ANALYSIS PANEL0 1 300



3100148 IMMUNOGLOBULIN SUBCLASS EACHIMMUNOGLOBULIN SUBCLASS EACH117 82787,90 1 301

2700268 TAPE KIND REMOVAL SILICONE 1INX1.5YDSTAPE KIND REMOVAL SILICONE 1INX1.5YDS5 A4450 1 271

2720088 KING AIRWAY SIZE 2KING AIRWAY SIZE 2 414 1 270

3100156 LDH ISOENZYMESLDH ISOENZYMES 69 83625,90 1 301

4400026 ST LANG EXPRESS CURRENT G9162CLST LANG EXPRESS CURRENT G9162CL0.01 G9162,CL,GN 1 449

9600007 BX SKIN SUBQ MM SINGLE LESIONBX SKIN SUBQ MM SINGLE LESION140 11100 1 960

3140048 PC COCCIDIODESPC COCCIDIODES 44 86635,90 1 302

3140021 PC IA NOT INFECT AGENT NOSPC IA NOT INFECT AGENT NOS 70 83516,90 1 301

500019 SHAVE SKIN LES S N H F G >2.0 CMSHAVE SKIN LES S N H F G >2.0 CM241 11308 1 761

500088 DEBRIDE MASTOIDECTOMY CAVITY SMPLDEBRIDE MASTOIDECTOMY CAVITY SMPL161 69220 1 761

2700011 DRESSING BIO PATCH 1IN DISKDRESSING BIO PATCH 1IN DISK 75 1 270

2900006 BB BLOOD TRANSFUSIONBB BLOOD TRANSFUSION 610 36430 1 391

3100068 CULTURE BLOODCULTURE BLOOD 272 87040,90 1 306

2700116 EYE SHIELD (SOFTCOTTON) STERILEEYE SHIELD (SOFTCOTTON) STERILE5 1 270


400068 DRAIN FINGER ABSCESS COMPLICATEDDRAIN FINGER ABSCESS COMPLICATED1089 26011 1 450

3150033 PC EPSTEIN BARR VIRUS COMP PANELPC EPSTEIN BARR VIRUS COMP PANEL0 1 302

3100031 CA 125 CA 125 135 86304,90 1 302

9600094 REMOVE FB NOSEREMOVE FB NOSE 311 30300 1 960

4300010 OT ATTEN CURRENT G9165CJOT ATTEN CURRENT G9165CJ0.01 G9165,CJ,GN 1 439

400077 DISLOC ANKLE CLSD TX WO ANESTHDISLOC ANKLE CLSD TX WO ANESTH301 27840 1 450

2702032 TOWEL BLUE ORTOWEL BLUE OR 6 1 270

270265 SCISSOR IRIS CURVED NON STERILESCISSOR IRIS CURVED NON STERILE22.62 1 270


3500029 CT LUMBAR SPINE WO CONTRASTCT LUMBAR SPINE WO CONTRAST1536 72131 1 350

4400135 ST ASSESS APHASIA INTERP RPT PER HRST ASSESS APHASIA INTERP RPT PER HR319 96105,GN 1 444

4300156 OT SUB PT OT CURRENT G8993CIOT SUB PT OT CURRENT G8993CI0.01 G8993,CI,GO 1 439

4300170 OT RE-EVALUATIONOT RE-EVALUATION 176 97004,GO 1 434

9600013 EX B9 LES TRNK ARM LEG 0.5CM <EX B9 LES TRNK ARM LEG 0.5CM <220 11400 1 960

4300040 OT CARRY GOAL G8985CLOT CARRY GOAL G8985CL 0.01 G8985,CL,GO 1 439

400043 RPR CMPLX TRUNK 1.1-2.5 CMRPR CMPLX TRUNK 1.1-2.5 CM886 13100 1 450

3300002 MRA HEAD WWO CONTMRA HEAD WWO CONT 3850 70546 1 610


3100088 DRUG SCREEN URINE MULTI CLASSESDRUG SCREEN URINE MULTI CLASSES90 80301,90 1 301

270260 MASK PEDI PROCEDUREMASK PEDI PROCEDURE 0 1 270

3400031 US UPPER EXTREM ART UNILAT/LIMITEDUS UPPER EXTREM ART UNILAT/LIMITED648 93931 1 921

3100194 RESPIRATORY INFECTIONRESPIRATORY INFECTION 45 86171,90 1 302

500035 EX BEN LES SC N H FT GE >4.0 CMEX BEN LES SC N H FT GE >4.0 CM2492 11426 1 761

3100157 LEAD LEVELLEAD LEVEL 84 83655,90 1 301

500021 SHAVE SKIN LES F E N E N L0.6-1.0CMSHAVE SKIN LES F E N E N L0.6-1.0CM169 11311 1 761

3100186 PROTEIN S FREE CLOT INHIBITPROTEIN S FREE CLOT INHIBIT115 85306,90 1 305

4200100 PT OTHER PT OT GOAL G8991CHPT OTHER PT OT GOAL G8991CH0.01 G8991,CH,GP 1 429

3100261 CADMIUM URINECADMIUM URINE 330 82300,90 1 301

400037 RPR INT F E EY N L MM 2.6-5 CMRPR INT F E EY N L MM 2.6-5 CM591 12052 1 450

4200024 PT SELFCARE DC G8989CIPT SELFCARE DC G8989CI 0.01 G8989,CI,GP 1 429

500136 ARTHRO ASP &OR INJ MAJ JOINT USARTHRO ASP &OR INJ MAJ JOINT US448 20611 1 761

9600163 ABPM REVIEW INTERPRETATION & REPORTABPM REVIEW INTERPRETATION & REPORT72 93790 1 982

4300088 OT ATTEN DC G9167CKOT ATTEN DC G9167CK 0.01 G9167,CK,GN 1 439

4400042 ST MOTOR SPEECH GOAL G9186CNST MOTOR SPEECH GOAL G9186CN0.01 G9186,CN,GN 1 449

4300018 OT ATTEN GOAL G9166CKOT ATTEN GOAL G9166CK 0.01 G9166,CK,GN 1 439

4200008 PT BODY POS CURRENT G8981CNPT BODY POS CURRENT G8981CN0.01 G8981,CN,GP 1 429


3100270 FECAL FAT STOOLFECAL FAT STOOL 91 82710,90 1 301

9600180 FX METATARSAL W MANIPULATION EACHFX METATARSAL W MANIPULATION EACH610 26605,54 1 960

4400113 ST SWALLOW DC G8998CHST SWALLOW DC G8998CH 0.01 G8998,CH,GN 1 449

4300039 OT CARRY GOAL G8985CKOT CARRY GOAL G8985CK 0.01 G8985,CK,GO 1 439

4400027 ST LANG EXPRESS CURRENT G9162CMST LANG EXPRESS CURRENT G9162CM0.01 G9162,CM,GN 1 449

2700296 TUBE ET 2.5TUBE ET 2.5 5 1 270

4400128 ST SPEECH LANG THERAPY INDIVIDUALST SPEECH LANG THERAPY INDIVIDUAL240 92507,GN 1 441

3100150 INHIBIN A INHIBIN A 86 86336,90 1 302

400099 STRAPPING KNEESTRAPPING KNEE 122 29530 1 450

3100008 ALPHA-FETOPROTEIN (AFP) SERUMALPHA-FETOPROTEIN (AFP) SERUM130 82105,90 1 301


2700292 TUBE ET 6.0TUBE ET 6.0 22 1 270

4400072 ST VOICE CURRENT G9171CIST VOICE CURRENT G9171CI 0.01 G9171,CI,GN 1 449

3100335 CULTURE VIRALCULTURE VIRAL 46 87070,90 1 306


4300159 OT SUB PT OT CURRENT G8993CLOT SUB PT OT CURRENT G8993CL0.01 G8993,CL,GO 1 439

3140090 PC AB MYCOPLASMAPC AB MYCOPLASMA 72 86738,90 1 302

3100226 THORAZINETHORAZINE 117 80342,90 1 301

4300009 OT ATTEN CURRENT G9165CIOT ATTEN CURRENT G9165CI0.01 G9165,CI,GN 1 439

2700562 AQUACEL AG EXTRA HYDROFIBER 4X5AQUACEL AG EXTRA HYDROFIBER 4X5120 A6196 1 272


3100286 METHAMPHETAMINE ASSAY 5 OR > CONFIRMMETHAMPHETAMINE ASSAY 5 OR > CONFIRM197 80326,90 1 301

4300203 OT EVAL LOW COMPLEXITYOT EVAL LOW COMPLEXITY 251 97165,GO 1 434

400086 CAST APPLICATION SHORT ARMCAST APPLICATION SHORT ARM426 29075 1 450

3100077 CULTURE URINECULTURE URINE 251 87086,90 1 306



1500010 PSYCHOTHER CRISIS MGMT EA ADD 30MPSYCHOTHER CRISIS MGMT EA ADD 30M101 90840 1 914

4300124 OT MOBILITY DC G8980CLOT MOBILITY DC G8980CL 0.01 G8980,CL,GO 1 439

2700329 SUTURE ETHILON 6-0 P3 1698GSUTURE ETHILON 6-0 P3 1698G61 1 270

2700203 SLING ARM CHILDSLING ARM CHILD 12 A4565 1 271

2700276 STOCKING ANTIEMBOI THIGH XLGSTOCKING ANTIEMBOI THIGH XLG17 1 271

4400078 ST VOICE DC G9173CHST VOICE DC G9173CH 0.01 G9173,CH,GN 1 449

2700405 TAPE HYPAFIX 6TAPE HYPAFIX 6 0 1 270

4200097 PT OTHER PT OT DC G8992CLPT OTHER PT OT DC G8992CL0.01 G8992,CL,GP 1 429

3200072 XR SPINE 1 VIEWXR SPINE 1 VIEW 123 72020 1 320

2900009 BB BLOOD TYPING SERUMBB BLOOD TYPING SERUM 50 86904,90 1 302

500126 GASTRO INTUBATION W/ASPIRATIONGASTRO INTUBATION W/ASPIRATION496 43753 1 761


100001 INSERT NON TUN CV CATH 5 YRS>INSERT NON TUN CV CATH 5 YRS>1769 36556 1 220

390001 CARDIAC REHAB WO ECG MONITORINGCARDIAC REHAB WO ECG MONITORING200 93797 1 943

2700024 ORTHO WALKING BOOT LARGEORTHO WALKING BOOT LARGE189 1 270

400167 DISLOCATION SHLDR CLSD W MANIP W ANESTDISLOCATION SHLDR CLSD W MANIP W ANEST682 23655 1 450

4300119 OT MOBILITY CURRENT G8978 CNOT MOBILITY CURRENT G8978 CN0.01 G8978,CN,GO 1 439

3140117 WEST NILE VIRUS IGGWEST NILE VIRUS IGG 82 86789,90 1 302

9600051 RPR CMPLX FACE N AX G H F 1.1-2.5CMRPR CMPLX FACE N AX G H F 1.1-2.5CM580 13131 1 960

3140141 PC OSMOLALITY URINE RLPC OSMOLALITY URINE RL 72 83935,90 1 301



2700555 NEEDLE IO 15G 1.8MMX15MM PEDIATRICNEEDLE IO 15G 1.8MMX15MM PEDIATRIC375 1 270


3100104 FLOW CYTOMETRYFLOW CYTOMETRY 353 88182,90 1 310

4400090 ST LANG EXPRESS DC G9164 CMST LANG EXPRESS DC G9164 CM0.01 G9164,CM,GN 1 449

3300003 MRA NECK WITH CONTMRA NECK WITH CONT 3500 70548 1 610

500075 INSERTION CV CATH NON TUNNEL 5YRS>INSERTION CV CATH NON TUNNEL 5YRS>1769 36556 1 761

3500035 CT MASTOID/IAC W CONTRASTCT MASTOID/IAC W CONTRAST1512 70481 1 350

270261 PROCEDURE MASK ADULTPROCEDURE MASK ADULT 0 1 270


3100207 SENSITIVITYSENSITIVITY 46 87181,90 1 306

3100228 THYROXINE TOTALTHYROXINE TOTAL 45 84436,90 1 301

3140033 PC ISOENZYMESPC ISOENZYMES 72 82552,90 1 301

2700380 NASAL TUBE FASTENERNASAL TUBE FASTENER 0 1 270

3200036 XR HIP UNI 1 VIEW LEFTXR HIP UNI 1 VIEW LEFT 175 73501,LT 1 320

3100181 PROLACTINPROLACTIN 113 84146,90 1 301

3100329 ANTI SACCHARMYCES CEREVISIAE ANTIBODYANTI SACCHARMYCES CEREVISIAE ANTIBODY46.5 86771,90 1 301

3140131 ADENOSINE DEAMINASEADENOSINE DEAMINASE 218.25 84311,90 1 301

3140056 PC HERPES SIMPLEX I IGGPC HERPES SIMPLEX I IGG 78 86694,90 1 302


3200033 XR HAND 2 VIEW RIGHTXR HAND 2 VIEW RIGHT 123 73120,RT 1 320

3100239 VDRL VDRL 36 86592,90 1 302

9600046 RPR INTMD F E EY N L MM 2.6-5.0 CMRPR INTMD F E EY N L MM 2.6-5.0 CM480 12052 1 960

2702038 CATH TROCAR 32FR/20INCATH TROCAR 32FR/20IN 98 1 270

2600000 D5W 100 MLD5W 100 ML 30 1 258


3140022 PC FLUORESCENT AB TITER EA ABPC FLUORESCENT AB TITER EA AB65 86255,90 1 302

500031 EX B9 LES SC N H FT GE 0.6-1.0 CMEX B9 LES SC N H FT GE 0.6-1.0 CM1372 11421 1 761


9600115 CATH INSERTION NONINDWELLINGCATH INSERTION NONINDWELLING166 51701 1 960

400087 CAST APPLICATION HAND WRISTCAST APPLICATION HAND WRIST213 29085 1 450

2700370 IODOFORM 1/4INIODOFORM 1/4IN 9 1 270

500024 EX B9 LES TR ARM LEG 0.5 CM<EX B9 LES TR ARM LEG 0.5 CM<757 11400 1 761

2720053 DEFIBRILLATOR LIFEPAK 12 ADULTDEFIBRILLATOR LIFEPAK 12 ADULT120 1 272

2700053 CATH MALE FREEDOM LGCATH MALE FREEDOM LG 5 1 270

3100118 GLUCOSE BODY FLUIDGLUCOSE BODY FLUID 28 82945,90 1 301

500072 REMOVE FB SHOULDER SCREMOVE FB SHOULDER SC 1314 23330 1 761

2700001 AMBU BAG PEDIAMBU BAG PEDI 60 1 271

2700547 ANITEMBOLI KNEE XXXLGANITEMBOLI KNEE XXXLG 98 1 271

9600100 INJ DIAG/THERAP SUBSTANCE LUMBAR SACRALINJ DIAG/THERAP SUBSTANCE LUMBAR SACRAL447 62311 1 960

3140042 PC HERPES SIMPLEX I IGMPC HERPES SIMPLEX I IGM 78 86694,90 1 302

500007 TRIM SKIN LESIONS 2-4 CORNCALLUSTRIM SKIN LESIONS 2-4 CORNCALLUS179 11056 1 761

2720061 TRAY TRACHEOSTOMY CARE KITTRAY TRACHEOSTOMY CARE KIT17 A4629 1 272

2700361 GASTRIC LAVAGE TRAY 34FX36INGASTRIC LAVAGE TRAY 34FX36IN29 1 270

3100298 SEX HORMONE BINDING GLOBULINSEX HORMONE BINDING GLOBULIN80 84270,90 1 302

2700745 CERVICAL DILATOR SET DISPOSABLECERVICAL DILATOR SET DISPOSABLE143 1 270

500109 ALLERGY INJECTION SINGLEALLERGY INJECTION SINGLE 30 95115 1 761

3100106 FOLIC ACID RBCFOLIC ACID RBC 140 82747,90 1 301

2700059 CERVICAL EXTRICATION COLLAR ADULTCERVICAL EXTRICATION COLLAR ADULT27 1 270

4200014 PT CARRY DC G8986CMPT CARRY DC G8986CM 0.01 G8986,CM,GP 1 429

3100026 LYME IGG/IGMLYME IGG/IGM 121 86618,90 1 302

4300090 OT ATTEN DC G9167CMOT ATTEN DC G9167CM 0.01 G9167,CM,GN 1 439

3100144 I STUDY EACH ANTIBODYI STUDY EACH ANTIBODY 219 88347,90 1 300



9600064 TREAT CLOSED CLAVICLE FXTREAT CLOSED CLAVICLE FX 580 23500,54 1 960

3200037 XR HIP UNI 1 VIEW RIGHTXR HIP UNI 1 VIEW RIGHT 175 73501,RT 1 320

9600156 SUPERVISION HH PT 30 MINS OR > MOSUPERVISION HH PT 30 MINS OR > MO255 99375 1 960


4400067 ST SWALLOW GOAL G8997CKST SWALLOW GOAL G8997CK0.01 G8997,CK,GN 1 449

4100011 VENTILATION ASSIST/MNG INTL IP/OBSVENTILATION ASSIST/MNG INTL IP/OBS1029 94002 1 412

2900012 BB PLT UNITSBB PLT UNITS 1947 P9021 1 390


4400071 ST VOICE CURRENT G9171CHST VOICE CURRENT G9171CH0.01 G9171,CH,GN 1 449

3100134 HEPATITIS C ANTIBODYHEPATITIS C ANTIBODY 85 86803,90 1 302

3100103 FLORESCENT ANTIBODY TITERFLORESCENT ANTIBODY TITER 95 86256,90 1 302

2700718 FINGER TRAP XL MESH STERILEFINGER TRAP XL MESH STERILE70 1 270

2702041 CERVICAL COLLAR WITH TRACH LARGECERVICAL COLLAR WITH TRACH LARGE54 1 270

2700216 SPLINT FINGER ALUM SMSPLINT FINGER ALUM SM 5 A4570 1 271

4300078 OT SUB PT OT GOAL G8994CHOT SUB PT OT GOAL G8994CH0.01 G8994,CH,GO 1 439


4300131 OT MOBILITY GOAL G8979CLOT MOBILITY GOAL G8979CL 0.01 G8979,CL,GO 1 439

2700546 ANITEMBOLI KNEE XXLGANITEMBOLI KNEE XXLG 20 1 271

4300043 OT MEMORY CURRENT G9168CHOT MEMORY CURRENT G9168CH0.01 G9168,CH,GN 1 439

4400015 ST LANG COMP GOAL G9160CHST LANG COMP GOAL G9160CH0.01 G9160,CH,GN 1 449

3140073 PC PAPPA SERUMPC PAPPA SERUM 47 84163,90 1 301

4400096 ST MOTOR SPEECH CURRENT G8999CLST MOTOR SPEECH CURRENT G8999CL0.01 G8999,CL,GN 1 449


2700598 COOK EMERG PNEUMOTHORAX SET 8.7FRCOOK EMERG PNEUMOTHORAX SET 8.7FR467 1 272

4200003 PT BODY POS CURRENT G8981CIPT BODY POS CURRENT G8981CI0.01 G8981,CI,GP 1 429

9600042 RPR INTMD N HF GENIT 2.5CM <RPR INTMD N HF GENIT 2.5CM <440 12041 1 960

3140094 PC PROTEIN TOTAL EXCEPT REFRACTOMETRYPC PROTEIN TOTAL EXCEPT REFRACTOMETRY39 84160,90 1 301

3100036 CARBAMAZEPINE TOTALCARBAMAZEPINE TOTAL 102 80339,90 1 301

4100008 PULSE OXIMETRY CONTINUOUSPULSE OXIMETRY CONTINUOUS150 94762 1 460

4200062 PT CARRY CURRENT G8984 CLPT CARRY CURRENT G8984 CL0.01 G8984,CL,GP 1 429



400016 RPR SMP F E EY N L MM 2.5 CM<RPR SMP F E EY N L MM 2.5 CM<193 12011 1 450

2700177 OXYGEN PER DAYOXYGEN PER DAY 192 1 270

2720009 HUMIDIFIER O2HUMIDIFIER O2 16 1 270

3500045 CT SOFT TISSUE NECK WO CONTRASTCT SOFT TISSUE NECK WO CONTRAST1304 70490 1 350

9400003 PULM REHAB W EXERC 1HR PER SESSIONPULM REHAB W EXERC 1HR PER SESSION120 G0424 1 943

3200084 XR WRIST 2 VIEW LEFTXR WRIST 2 VIEW LEFT 123 73100,LT 1 320

400119 PARACENTESIS AB WO IMGPARACENTESIS AB WO IMG 928 49082 1 450

2720005 CLIP NOSE CLIP NOSE 5 1 271

3100279 TETANUS TOXOID ANTIBODYTETANUS TOXOID ANTIBODY 198 86774,90 1 302

3100046 CEA CEA 124 82378,90 1 301

3100012 ANGIOTENSIN I ENZYME TESTANGIOTENSIN I ENZYME TEST 121 82164,90 1 301

4200049 PT BODY POS DC G8983CMPT BODY POS DC G8983CM 0.01 G8983,CM,GP 1 429

4300138 OT OTHER PT OT DC G8992CLOT OTHER PT OT DC G8992CL0.01 G8992,CL,GO 1 439

4200099 PT OTHER PT OT DC G8992CNPT OTHER PT OT DC G8992CN0.01 G8992,CN,GP 1 429

4300084 OT SUB PT OT GOAL G8994CNOT SUB PT OT GOAL G8994CN0.01 G8994,CN,GO 1 439

2720055 TRAY TRACHE OSTOMY CARE KITTRAY TRACHE OSTOMY CARE KIT11 A6266 1 272


2720081 MOUTH PIECE SPIRETTEMOUTH PIECE SPIRETTE 13 1 271

400059 EXPLORE WOUND EXTREMITYEXPLORE WOUND EXTREMITY1633 20103 1 450

4200079 PT MOBILITY GOAL G8979CHPT MOBILITY GOAL G8979CH 0.01 G8979,CH,GP 1 429

3100264 HLA-B27 HLA-B27 139 86812,90 1 302


3140125 PC BETA 2 MICROGLOBULIN BLOODPC BETA 2 MICROGLOBULIN BLOOD129 82232,90 1 301

3100268 ESTRONE ESTRONE 134 82679,90 1 301

2720080 NEBULIZER SET WMASK PEDINEBULIZER SET WMASK PEDI 9 1 271

4200088 PT OTHER PT OT CURRENT G8990CJPT OTHER PT OT CURRENT G8990CJ0.01 G8990,CJ,GP 1 429

4200093 PT OTHER PT OT DC G8992CHPT OTHER PT OT DC G8992CH0.01 G8992,CH,GP 1 429


2700184 PEROXIDE 4 OZPEROXIDE 4 OZ 5 1 270

500034 EX BEN LES SC N H FT GE 3.1-4.0 CMEX BEN LES SC N H FT GE 3.1-4.0 CM1964 11424 1 761

3100211 SMEAR COMPLEX STAINSMEAR COMPLEX STAIN 98 87209,90 1 306

3200083 XR UROGRAPHYXR UROGRAPHY 479 74400 1 320

3100327 TISSUE TRANSGLUTAMINASE IGATISSUE TRANSGLUTAMINASE IGA40.25 83516,90 1 301

2720030 ORTHO WALKING BOOTSORTHO WALKING BOOTS 76 1 270



2700310 URINE DRAIN BAGURINE DRAIN BAG 12 1 270

1400007 PROCESS GRP THERAPY SUBSQPROCESS GRP THERAPY SUBSQ170 90853 1 915

400155 CRITICAL CARE EA ADD 30MINCRITICAL CARE EA ADD 30MIN400 99292 1 450

2700673 DERMAFLEX TISSUE ADHESIVEDERMAFLEX TISSUE ADHESIVE 52 1 270

4200047 PT BODY POS DC G8983CKPT BODY POS DC G8983CK 0.01 G8983,CK,GP 1 429

2700074 CRUTCHES ADULT MED 5.2FT-5.10FTCRUTCHES ADULT MED 5.2FT-5.10FT41 E0114 1 271

4300178 OT THERAPEUTIC ACTIVITIES EA 15 MINOT THERAPEUTIC ACTIVITIES EA 15 MIN116 97530,GO 1 431

2700316 CATH TROCAR 16F 20INCATH TROCAR 16F 20IN 44 1 270

3140127 PC THROMBOPLASTIN TIMEPC THROMBOPLASTIN TIME 33 85730,90 1 305

2700347 DISPOSABLE DERMAL CURETTEDISPOSABLE DERMAL CURETTE 0 1 270

4400009 ST LANG COMP DC G9161CIST LANG COMP DC G9161CI 0.01 G9161,CI,GN 1 449

3100318 C ANCA C ANCA 165 86255,90 1 302

1500005 BH GROUP PSYCHOTHERAPYBH GROUP PSYCHOTHERAPY 88 90853 1 916

9600301 TREAT CLSD SHLDR DISLOCATION W MANIPULATTREAT CLSD SHLDR DISLOCATION W MANIPULAT740 23655,54 1 960

4300106 OT CARRY CURRENT G8984 CHOT CARRY CURRENT G8984 CH0.01 G8984,CH,GO 1 439


2700335 SCISSORSORSTRAIGHT5.5STRLSCISSORSORSTRAIGHT5.5STRL 29 1 270

3140069 PC INFLUENZA A VIRUSPC INFLUENZA A VIRUS 73 86710,90 1 302

3200073 XR SPINE ENTIRE AP AND L VIEWXR SPINE ENTIRE AP AND L VIEW462 72082 1 320

4300062 OT MEMORY GOAL G9169CMOT MEMORY GOAL G9169CM0.01 G9169,CM,GN 1 439

4400114 ST SWALLOW DC G8998CIST SWALLOW DC G8998CI 0.01 G8998,CI,GN 1 449

3100278 BK VIRUS IA DNA OR RNA QUANTBK VIRUS IA DNA OR RNA QUANT1122 87799,90 1 306


2700674 SUTURE, PROLENE 6-0 PC18617GSUTURE, PROLENE 6-0 PC18617G15 1 270

3140122 PC CADMIUM URINEPC CADMIUM URINE 142 82300,90 1 301

2700549 BAIRHUGGER TEMP BLANKET FULL UNDERBAIRHUGGER TEMP BLANKET FULL UNDER128 1 271

3100065 CULTURE ACID FASTCULTURE ACID FAST 76 87116,90 1 306

3100198 HRL RHEUMATOID FACTOR QUANTITATIVEHRL RHEUMATOID FACTOR QUANTITATIVE47 86431,90 1 302


4400059 ST SPEECH LANG GOAL G9175CJST SPEECH LANG GOAL G9175CJ0.01 G9175,CJ,GN 1 449

9600123 REMOVE FB EARREMOVE FB EAR 200 69200 1 960

500113 RPR SMP F E EY N L MM 2.5 CM<RPR SMP F E EY N L MM 2.5 CM<193 12011 1 761

2700086 ADAPTIC 3INX3INADAPTIC 3INX3IN 5 A6222 1 272

2700003 ORTHO BACK SUPPORT 4XLORTHO BACK SUPPORT 4XL 216 L0625 1 270

500008 BIOPSY SKIN SUBQ SINGLE LESBIOPSY SKIN SUBQ SINGLE LES241 11100 1 761

3100059 CORTISOL FREECORTISOL FREE 124 82530,90 1 301

3100281 BENZODIAZEPINES ASSAY CONF 13 OR >BENZODIAZEPINES ASSAY CONF 13 OR >439 80347,90 1 301

2700756 SOFT FOAM NECK BRACE XLSOFT FOAM NECK BRACE XL 6 1 270

2700052 CATH LEG BANDCATH LEG BAND 12 A4334 1 271


3100016 ARSENIC ARSENIC 74 82175,90 1 301

2720002 ORTHO WALKING BOOT MEDORTHO WALKING BOOT MED 74 1 271

4400124 ST VOICE GOAL G9172CLST VOICE GOAL G9172CL 0.01 G9172,CL,GN 1 449

2900003 BB ANTIGEN SCREENBB ANTIGEN SCREEN 610.03 86902,90 1 390

4200129 PT APPL MULTILYR COMP LEG BELOW KNEEPT APPL MULTILYR COMP LEG BELOW KNEE236 29581,GP 1 421

4300020 OT ATTEN GOAL G9166CMOT ATTEN GOAL G9166CM 0.01 G9166,CM,GN 1 439

9600130 OBSERVATION DISCHARGE MGMTOBSERVATION DISCHARGE MGMT135 99217 1 982

3100209 SHIGATOXINSHIGATOXIN 68 87427,90 1 306

3100215 STOOL CONCENTRATIONSTOOL CONCENTRATION 144 87015,90 1 306


4400084 ST VOICE DC G9173CNST VOICE DC G9173CN 0.01 G9173,CN,GN 1 449

3140089 PC ANTIBODY ADENOVIRUSPC ANTIBODY ADENOVIRUS 44 86603,90 1 302

2700345 COLOSTOMY WAFER SURFIT REF #404593COLOSTOMY WAFER SURFIT REF #40459324 1 270

9600169 INJ NERVE BLOCK OCCIPITAL NERVEINJ NERVE BLOCK OCCIPITAL NERVE215 64405 1 960

9600309 EXCISION THROMBOSED HEMORRHOID EXTEXCISION THROMBOSED HEMORRHOID EXT425 46320 1 960

2700271 STOCKING ANITEMBOLI KNEE MEDSTOCKING ANITEMBOLI KNEE MED6 1 270

2700548 UNNA W CALAMINE 3INX10YDS (PT)UNNA W CALAMINE 3INX10YDS (PT)67 A6456 1 272

9600037 RPR INTMD S A T EXT 2.5 CM <RPR INTMD S A T EXT 2.5 CM <280 12031 1 960

2700415 WELCH ALLYN CLEAN SPECULUM LARGE 590WELCH ALLYN CLEAN SPECULUM LARGE 5900 1 270

4200040 PT SUB PT OT GOAL G8994CKPT SUB PT OT GOAL G8994CK0.01 G8994,CK,GP 1 429

4300155 OT SUB PT OT CURRENT G8993CHOT SUB PT OT CURRENT G8993CH0.01 G8993,CH,GO 1 439


4300103 OT BODY POS GOAL G8982CLOT BODY POS GOAL G8982CL0.01 G8982,CL,GO 1 439

4200048 PT BODY POS DC G8983CLPT BODY POS DC G8983CL 0.01 G8983,CL,GP 1 429

4400049 ST SPEECH LANG CURRENT G9174CNST SPEECH LANG CURRENT G9174CN0.01 G9174,CN,GN 1 449

2940007 BB BLOOD TYPING ABOBB BLOOD TYPING ABO 28 86900,90 1 390

3140109 PC THYROGLOBULIN ANTIBODYPC THYROGLOBULIN ANTIBODY86 86800,90 1 302

500047 EX MAGLIG LES TR ARM LEG >4.0 CMEX MAGLIG LES TR ARM LEG >4.0 CM1683 11606 1 761

SBRMCHRGSWING BED ROOM CHARGESWING BED ROOM CHARGE 550 1 120

2700551 SETPNEMOTHORAXTURNERPIGTAILSETPNEMOTHORAXTURNERPIGTAIL677 1 272

4300082 OT SUB PT OT GOAL G8994CLOT SUB PT OT GOAL G8994CL0.01 G8994,CL,GO 1 439

2700130 ORTHO IMMOBILIZER KNEE 16INORTHO IMMOBILIZER KNEE 16IN45 L1830 1 270

3100039 CARNITINE CARNITINE 119 82379,90 1 301

2700526 FORCEPS MAGILL NS 9.5FORCEPS MAGILL NS 9.5 105 1 272

9600185 FX CLSD MED MALLEOLUS W MANIPFX CLSD MED MALLEOLUS W MANIP916 27762 1 960

4300123 OT MOBILITY DC G8980CKOT MOBILITY DC G8980CK 0.01 G8980,CK,GO 1 439

9600072 TREAT CLOSED PHALANX FXTREAT CLOSED PHALANX FX 407 26720,54 1 960

3140103 PC EXTRACTABLE NUCLEAR ANTIBODYPC EXTRACTABLE NUCLEAR ANTIBODY97 86235,90 1 302

4200055 PT BODY POS GOAL G8982CLPT BODY POS GOAL G8982CL0.01 G8982,CL,GP 1 429

9600118 INJ INTERCOSTAL NERVE SINGLEINJ INTERCOSTAL NERVE SINGLE300 64420 1 960

4400089 ST LANG EXPRESS DC G9164 CLST LANG EXPRESS DC G9164 CL0.01 G9164,CL,GN 1 449

4200068 PT MOBILITY CURRENT G8978 CKPT MOBILITY CURRENT G8978 CK0.01 G8978,CK,GP 1 429

4400012 ST LANG COMP DC G9161CLST LANG COMP DC G9161CL 0.01 G9161,CL,GN 1 449

4200063 PT CARRY CURRENT G8984 CMPT CARRY CURRENT G8984 CM0.01 G8984,CM,GP 1 429

3100351 BARTONELLA TITER (IGG/IGM)BARTONELLA TITER (IGG/IGM) 88 86611,90 1 302

400010 RPR SMP S N A GEN TR EXT 2.5 CM<RPR SMP S N A GEN TR EXT 2.5 CM<193 12001 1 450

2700139 IODOFORM 1/4INX5IODOFORM 1/4INX5 5 A6266 1 272

2700374 LACERATION TRAYLACERATION TRAY 21 A4550 1 272

3140039 PC EPSTEIN BARR VIRUS EARLY ANTIGENPC EPSTEIN BARR VIRUS EARLY ANTIGEN71 86663,90 1 302

4400017 ST LANG COMP GOAL G9160CJST LANG COMP GOAL G9160CJ0.01 G9160,CJ,GN 1 449

4400112 ST SWALLOW CURRENT G8996CNST SWALLOW CURRENT G8996CN0.01 G8996,CN,GN 1 449

2700591 OPTIFOAM SACRUM 6X6OPTIFOAM SACRUM 6X6 73 A6214 1 271

9600092 REMOVE GAUNTLET BOOT BODY CASTREMOVE GAUNTLET BOOT BODY CAST105 29700 1 960

2700061 CERVICAL EXTRICATION COLLAR TALL 6CERVICAL EXTRICATION COLLAR TALL 614 1 270



3140135 PC AMMONIA TEST URINEPC AMMONIA TEST URINE 118 82140,90 1 301

2710012 NON CHARGABLE NOW IV CATH14GNON CHARGABLE NOW IV CATH14G29 1 270

9600016 EX B9 LES TRK ARM LEG >4.0 CMEX B9 LES TRK ARM LEG >4.0 CM480 11406 1 960

2700600 WAYNE PNEUMOTHORAX SET 14FR/29CM/19GWAYNE PNEUMOTHORAX SET 14FR/29CM/19G609 1 272

400044 RPR CMPLX TRUNK 2.6-7.5 CMRPR CMPLX TRUNK 2.6-7.5 CM925 13101 1 450

9600176 EX B9 LES TRK ARM LEG 2.1-3.0 CMEX B9 LES TRK ARM LEG 2.1-3.0 CM360 11403 1 960

9600181 RPR LIP FULL THICKNESS VERMILION ONLYRPR LIP FULL THICKNESS VERMILION ONLY844 40650 1 960

3100004 ALDOSTERONEALDOSTERONE 248 82088,90 1 301

1400013 TELEHEALTH ORIGINATING SITE FAC FEETELEHEALTH ORIGINATING SITE FAC FEE50 Q3014 1 761

3100328 TISSUE TRANSGLUTAMINASE IGGTISSUE TRANSGLUTAMINASE IGG40.25 83516,90 1 301

500115 INJ SNGL/MULTI TRIGGER PTS 3/> MUSCLESINJ SNGL/MULTI TRIGGER PTS 3/> MUSCLES455 20553 1 761


4400052 ST SPEECH LANG DC G9176CJST SPEECH LANG DC G9176CJ0.01 G9176,CJ,GN 1 449

500134 EXCISION OF THROMBOSED HEMORRHOID EXTEXCISION OF THROMBOSED HEMORRHOID EXT425 46320 1 761

3150068 PC URINE PROTEIN ELECTROPHORESIS PANELPC URINE PROTEIN ELECTROPHORESIS PANEL0 1 301

4200031 PT SELFCARE GOAL G8988CIPT SELFCARE GOAL G8988CI 0.01 G8988,CI,GP 1 429

4200042 PT SUB PT OT GOAL G8994CMPT SUB PT OT GOAL G8994CM0.01 G8994,CM,GP 1 429

3100075 CULTURE HERPESCULTURE HERPES 134 87252,90 1 306

3100213 SODIUM URINE RANDOM OR 24 HOURSODIUM URINE RANDOM OR 24 HOUR31 84300,90 1 301

400161 RPR LIP FULL THICKNESS VERMILION ONLYRPR LIP FULL THICKNESS VERMILION ONLY1455 40650 1 450

3100180 PROGESTERONEPROGESTERONE 112 84144,90 1 301

2700690 NEEDLE 25GX1NEEDLE 25GX1 3 1 360

4200114 PT SUB PT OT CURRENT G8993CHPT SUB PT OT CURRENT G8993CH0.01 G8993,CH,GP 1 429

400134 CPR CPR 536 92950 1 450

400022 RPR SMP F E EY N L MM > 30.0 CMRPR SMP F E EY N L MM > 30.0 CM566 12018 1 450

2700522 TUBE GASTROSTOMY ADULT 20FRTUBE GASTROSTOMY ADULT 20FR46 1 272

4100003 HHN TX SUBSQUENTHHN TX SUBSQUENT 79 94640,76 1 412

3500002 CT ABDOMEN PELVIS WO CONTRASTCT ABDOMEN PELVIS WO CONTRAST1016 74176 1 350

2600006 NS 500 ML NS 500 ML 40 1 258

3300006 MRI ABDOMEN W CONTMRI ABDOMEN W CONT 3500 74182 1 610

300102 OBSERVATION DIRECT ADMITOBSERVATION DIRECT ADMIT400 G0379 1 762

500121 I&D LEG/ANKLE DEEP ABSCESS/HEMATOMAI&D LEG/ANKLE DEEP ABSCESS/HEMATOMA3681 27603 1 761

4200029 PT SELFCARE DC G8989CNPT SELFCARE DC G8989CN 0.01 G8989,CN,GP 1 429

500032 EX B9 LES SC N H FT GE 1.0-2.0 CMEX B9 LES SC N H FT GE 1.0-2.0 CM1430 11422 1 761

9600107 RPR LACERATION TONGUERPR LACERATION TONGUE 392 41250 1 960

2720087 KING AIRWAY 5KING AIRWAY 5 414 1 271



2720041 GAUZE BAND ROLL 4.5INX4.1IN STGAUZE BAND ROLL 4.5INX4.1IN ST5 1 272

9600167 SWINGBED NF SUBSEQ CARE LVL 1SWINGBED NF SUBSEQ CARE LVL 1100 99307 1 524


4200095 PT OTHER PT OT DC G8992CJPT OTHER PT OT DC G8992CJ0.01 G8992,CJ,GP 1 429

4400092 ST MOTOR SPEECH CURRENT G8999CHST MOTOR SPEECH CURRENT G8999CH0.01 G8999,CH,GN 1 449

4200086 PT OTHER PT OT CURRENT G8990CHPT OTHER PT OT CURRENT G8990CH0.01 G8990,CH,GP 1 429

4300147 OT OTHER PT OT GOAL G8991CNOT OTHER PT OT GOAL G8991CN0.01 G8991,CN,GO 1 439

9600054 BURN DEBRIDEMENT MEDIUMBURN DEBRIDEMENT MEDIUM252 16025 1 960

2700294 QUICK TRACH KIT 4.0QUICK TRACH KIT 4.0 552 1 270

4200158 PT PROSTHETIC TRAINING EA 15 MINPT PROSTHETIC TRAINING EA 15 MIN114 97761,GP 1 421

400174 NASAL/ORO-GASTRIC W/TUBE PLCMTNASAL/ORO-GASTRIC W/TUBE PLCMT610 43752 1 450

3100024 BORDATELLA IGG IGMBORDATELLA IGG IGM 75 86615,90 1 302

2700366 HUMIDIFIER ADAPTERHUMIDIFIER ADAPTER 5 1 270

4300023 OT BODY POS CURRENT G8981CIOT BODY POS CURRENT G8981CI0.01 G8981,CI,GO 1 439

2700107 TELFA 3INX8INTELFA 3INX8IN 5 A6403 1 272

4200010 PT CARRY DC G8986CIPT CARRY DC G8986CI 0.01 G8986,CI,GP 1 429

4400097 ST MOTOR SPEECH CURRENT G8999CMST MOTOR SPEECH CURRENT G8999CM0.01 G8999,CM,GN 1 449

3140105 PC CRYSTAL IDENTIFICATIONPC CRYSTAL IDENTIFICATION 39 89060,90 1 300

2700529 LARYNGOSCOPE VIDEO (GVL3STAT) SIZE3LARYNGOSCOPE VIDEO (GVL3STAT) SIZE372 1 272


3140006 PC NORTRIPTYLINE ASSAYPC NORTRIPTYLINE ASSAY 73 80335,90 1 301

3140130 PC MERCAPTOPURINEPC MERCAPTOPURINE 97 82491,90 1 301

400173 INJ SNGLMULT TRIGGER PT 1-2 MUSCLEINJ SNGLMULT TRIGGER PT 1-2 MUSCLE411 20552 1 761

4200078 PT MOBILITY DC G8980CNPT MOBILITY DC G8980CN 0.01 G8980,CN,GP 1 429

3200044 XR KNEE 3 VIEW LEFTXR KNEE 3 VIEW LEFT 126 73562,LT 1 320

4300167 OT SUB PT OT DC G8995CMOT SUB PT OT DC G8995CM 0.01 G8995,CM,GO 1 439

400013 RPR SMP S N A G T EX 12.6-20 CMRPR SMP S N A G T EX 12.6-20 CM219 12005 1 450

2700252 SUCTION TUBINGSUCTION TUBING 37 1 270

4400034 ST LANG EXPRESS GOAL G9163CMST LANG EXPRESS GOAL G9163CM0.01 G9163,CM,GN 1 449


4200137 PT PARAFFIN BATHPT PARAFFIN BATH 37 97018,GP 1 421

3150066 PC THYROGLOBULIN PANELPC THYROGLOBULIN PANEL 0 1 301

3100267 HELICOBACTER PYLORI ANTIGEN STOOLHELICOBACTER PYLORI ANTIGEN STOOL78 87338,90 1 306

4200141 PT ULTRASOUNDPHONOPHOR EA 15 MINUTESPT ULTRASOUNDPHONOPHOR EA 15 MINUTES48 97035,GP 1 421

4400103 ST MOTOR SPEECH DC G9158CLST MOTOR SPEECH DC G9158CL0.01 G9158,CL,GN 1 449

4300160 OT SUB PT OT CURRENT G8993CMOT SUB PT OT CURRENT G8993CM0.01 G8993,CM,GO 1 439

3100322 ALLERGEN SPECIFIC IGE QUALITATIVE MUTLIALLERGEN SPECIFIC IGE QUALITATIVE MUTLI24.6 86005,90 1 302

3100123 HBV DNA LEVEL BY PCRHBV DNA LEVEL BY PCR 189 87516,90 1 300

4200094 PT OTHER PT OT DC G8992CIPT OTHER PT OT DC G8992CI 0.01 G8992,CI,GP 1 429


2700105 TELFA 3INX4INTELFA 3INX4IN 10 1 270

3100312 BUPRENORPHINE CONFBUPRENORPHINE CONF 635 80345,90 1 301

9600150 ER PRO FEE MODERATEER PRO FEE MODERATE 247.5 99283 1 981

4300008 OT ATTEN CURRENT G9165CHOT ATTEN CURRENT G9165CH0.01 G9165,CH,GN 1 439

4300047 OT MEMORY CURRENT G9168CLOT MEMORY CURRENT G9168CL0.01 G9168,CL,GN 1 439


500065 DESTRUCT PRE MAL LES 15 OR >DESTRUCT PRE MAL LES 15 OR >472 17004 1 761



2700371 ISOLATION GOWN ADULTISOLATION GOWN ADULT 5 1 270

400132 REMOVE IMPACT CERUMEN W INSTRUMENTREMOVE IMPACT CERUMEN W INSTRUMENT112 69210 1 450

3100182 PROSTATIC ACID PHOSPHATASEPROSTATIC ACID PHOSPHATASE69 84066,90 1 301

3100041 CATECHOLAMINES BLOODCATECHOLAMINES BLOOD 163 82383,90 1 301

400127 INJ ANES AGENT INTERCOSTAL NRV SNGLINJ ANES AGENT INTERCOSTAL NRV SNGL598 64420 1 450

4200101 PT OTHER PT OT GOAL G8991CIPT OTHER PT OT GOAL G8991CI0.01 G8991,CI,GP 1 429

3100204 RUBEOLA TITERRUBEOLA TITER 73 86765,90 1 302

3100100 FIBRINOGENFIBRINOGEN 54 85384,90 1 305

3140102 RABIES ANTIBODY TITERRABIES ANTIBODY TITER 81 86317,90 1 302

4400062 ST SPEECH LANG GOAL G9175CMST SPEECH LANG GOAL G9175CM0.01 G9175,CM,GN 1 449

400126 INJ NERVE BLOCK TRIGIMINALINJ NERVE BLOCK TRIGIMINAL411 64400 1 450

9600153 CRITICAL CARE FIRST HOURCRITICAL CARE FIRST HOUR 669 99291 1 981

4200146 PT MANUAL THERAPY 1>REGIONS EA 15 MINPT MANUAL THERAPY 1>REGIONS EA 15 MIN107 97140,GP 1 421

9600121 REMOVE FB CORNEAL WO SLIT LAMPREMOVE FB CORNEAL WO SLIT LAMP192 65220 1 960

2700081 DERMABONDDERMABOND 40 A4650 1 272


2720036 SUTURE SURGIPROL 6-0 SP-660GSUTURE SURGIPROL 6-0 SP-660G19 A4461 1 272

4200013 PT CARRY DC G8986CLPT CARRY DC G8986CL 0.01 G8986,CL,GP 1 429

2720084 MASK CPR SML ADULT AMBUMASK CPR SML ADULT AMBU 65 1 271

IPRMCHRG ACUTE BED ROOM CHARGEACUTE BED ROOM CHARGE 825 1 210

4400018 ST LANG COMP GOAL G9160CKST LANG COMP GOAL G9160CK0.01 G9160,CK,GN 1 449

4200065 PT MOBILITY CURRENT G8978 CHPT MOBILITY CURRENT G8978 CH0.01 G8978,CH,GP 1 429

500084 DRAIN EXT EAR ABSCESS HMTMA SMPLDRAIN EXT EAR ABSCESS HMTMA SMPL283 69000 1 761

3100274 PROINSULINPROINSULIN 96 84206,90 1 301

400131 REMOVE FB EAR EXT WO ANESREMOVE FB EAR EXT WO ANES112 69200 1 450

2700125 NEBULIZER SET W MASK-NOMICROMIST!NEBULIZER SET W MASK-NOMICROMIST!5 1 270

4400028 ST LANG EXPRESS CURRENT G9162CNST LANG EXPRESS CURRENT G9162CN0.01 G9162,CN,GN 1 449

4300002 OT OTHER PT OT CURRENT G8990CIOT OTHER PT OT CURRENT G8990CI0.01 G8990,CI,GO 1 439

9600067 TREAT CLOSED NURSEMAID ELBOWTREAT CLOSED NURSEMAID ELBOW520 24640 1 960

4300075 OT SELFCARE GOAL G8988CLOT SELFCARE GOAL G8988CL 0.01 G8988,CL,GO 1 439

9600146 INPATIENT DISCH 30 MINS OR <INPATIENT DISCH 30 MINS OR <270 99238 1 987


3100272 VANCOMYCIN TROUGHVANCOMYCIN TROUGH 73 80202,90 1 301

2700227 ST WATER IRRIGATION SOL 500MLST WATER IRRIGATION SOL 500ML5 A4217 1 272

4300021 OT ATTEN GOAL G9166CNOT ATTEN GOAL G9166CN 0.01 G9166,CN,GN 1 439

4400146 ST BEHAV & QUAL ANAL VOICE & RESONANCEST BEHAV & QUAL ANAL VOICE & RESONANCE233 92524,GN 1 444

4400068 ST SWALLOW GOAL G8997CLST SWALLOW GOAL G8997CL0.01 G8997,CL,GN 1 449


3150072 PC CULTURE BACTERIA PANELPC CULTURE BACTERIA PANEL 0 1 306

3150062 PC SLE SYSTEMIC LUPUS ERYTHEM B PANLPC SLE SYSTEMIC LUPUS ERYTHEM B PANL0 1 302

4300027 OT BODY POS CURRENT G8981CMOT BODY POS CURRENT G8981CM0.01 G8981,CM,GO 1 439

4300175 OT NEUROMUSCULAR REEDUCATION EA 15 MINOT NEUROMUSCULAR REEDUCATION EA 15 MIN111 97112,GO 1 431


4200113 PT SELFCARE CURRENT G8987CNPT SELFCARE CURRENT G8987CN0.01 G8987,CN,GP 1 429

2700275 STOCKING ANTIEMBOI THIGH SMSTOCKING ANTIEMBOI THIGH SM17 1 270

2700694 SOCKS XL SOCKS XL 5 1 270

2700505 CARBON CLOTH ELECTRODES 2CARBON CLOTH ELECTRODES 2 0 1 270



2700671 CLAMP TAIL CLOSURECLAMP TAIL CLOSURE 10 1 270

3100119 GONDADOTROPIN FSHGONDADOTROPIN FSH 117 83001,90 1 301

4300065 OT SELFCARE DC G8989CIOT SELFCARE DC G8989CI 0.01 G8989,CI,GO 1 439

500005 I & D HEMATOMA SEROMA FLUID COLLECTIONI & D HEMATOMA SEROMA FLUID COLLECTION1485 10140 1 761

3140113 PC TOXOPLASMA ANTIBODYPC TOXOPLASMA ANTIBODY 69 86778,90 1 302

3100300 PREGNENOLONEPREGNENOLONE 220 84140,90 1 301

2720028 MASK AMBU ADULTMASK AMBU ADULT 16 1 270

3140045 PC HISTOPLASMAPC HISTOPLASMA 44 86698,90 1 302

2700195 WOUND WASH SALINEWOUND WASH SALINE 11 1 270

4300185 OT E-STIM UNATTENDED OTOT E-STIM UNATTENDED OT 53 97014,GO 1 431


3100302 HUMAN GROWTH HORMONEHUMAN GROWTH HORMONE 90 83003,90 1 301


3500038 CT PELVIS W CONTRASTCT PELVIS W CONTRAST 1760 72193 1 350

4400101 ST MOTOR SPEECH DC G9158CJST MOTOR SPEECH DC G9158CJ0.01 G9158,CJ,GN 1 449

3140112 PC RUBELLA ANTIBODYPC RUBELLA ANTIBODY 78 86762,90 1 302

4300013 OT ATTEN CURRENT G9165CMOT ATTEN CURRENT G9165CM0.01 G9165,CM,GN 1 439

2720060 DEFIBRILLATOR LIFEPAK 12 PEDIDEFIBRILLATOR LIFEPAK 12 PEDI17 1 270

2710010 SECMED SECMED 5 1 271

400101 STRAPPING TOESSTRAPPING TOES 122 29550 1 450

3140054 PC SICKLING OF RBC REDUCTIONPC SICKLING OF RBC REDUCTION30 85660,90 1 305

4300026 OT BODY POS CURRENT G8981CLOT BODY POS CURRENT G8981CL0.01 G8981,CL,GO 1 439

3100093 ESTRADIOL ESTRADIOL 176 82670,90 1 301


2720035 SUTURE VICRYL 4-0 BRAIDEDJ415HSUTURE VICRYL 4-0 BRAIDEDJ415H28 1 270

4400145 ST EVAL SOUND & LANGUAGE EXPRESSIONST EVAL SOUND & LANGUAGE EXPRESSION464 92523,GN 1 444

3100094 ESTRIOL ESTRIOL 130 82677,90 1 301

400096 CAST APPLICATION SHORT LEGCAST APPLICATION SHORT LEG426 29405 1 450

270269 NASOGASTRIC FEEDING TUBE 12FNASOGASTRIC FEEDING TUBE 12F25 1 270

4400105 ST MOTOR SPEECH DC G9158CNST MOTOR SPEECH DC G9158CN0.01 G9158,CN,GN 1 449

4400039 ST MOTOR SPEECH GOAL G9186CKST MOTOR SPEECH GOAL G9186CK0.01 G9186,CK,GN 1 449

2700078 CUFF DISP BLOOD PRESSURECUFF DISP BLOOD PRESSURE 5 1 270


2700298 TUBE ET 5.5TUBE ET 5.5 5 1 270

3100188 PROTEIN TOTAL URINE 24 HOURPROTEIN TOTAL URINE 24 HOUR40 84156,90 1 301

400083 DISLOC MP CLSD TX JOINTDISLOC MP CLSD TX JOINT 301 28630 1 450


500082 CATH INSERT FOLEY COMPCATH INSERT FOLEY COMP 185 51703 1 761

2700202 MARKER SKIN STERILEMARKER SKIN STERILE 5 1 270

3100236 VALPROIC ACIDVALPROIC ACID 94 80164,90 1 301

2700008 BROSELOW PEDI WHITEBROSELOW PEDI WHITE 229 1 270

3140074 PC GONADOTROPIN CHORIONIC HCG QUANPC GONADOTROPIN CHORIONIC HCG QUAN47 84702,90 1 301

2700293 TUBE ET 6.5TUBE ET 6.5 22 1 270

9600073 TREAT CLOSED PHALANX FX DISTALTREAT CLOSED PHALANX FX DISTAL388 26750,54 1 960

3100195 RETIC COUNTRETIC COUNT 28 85045,90 1 305

4200045 PT BODY POS DC G8983CIPT BODY POS DC G8983CI 0.01 G8983,CI,GP 1 429

2950000 BB BLOOD TYPING ABO & RH (D) PANELBB BLOOD TYPING ABO & RH (D) PANEL0 1 390


3100142 HYDROXYINDOLACETIC ACIDHYDROXYINDOLACETIC ACID 101 83497,90 1 301

4300121 OT MOBILITY DC G8980CIOT MOBILITY DC G8980CI 0.01 G8980,CI,GO 1 439


9600059 INJ SING/MULTI TRIGGER POINTS 1-2 MUSCLEINJ SING/MULTI TRIGGER POINTS 1-2 MUSCLE93 20552 1 960

9600066 TREAT CLOSED ELBOW DISLOCATIONTREAT CLOSED ELBOW DISLOCATION700 24600,54 1 960

3100064 CRYSTAL IDENTIFICATIONCRYSTAL IDENTIFICATION 66 89060,90 1 309

2700237 WATER ST IRRIGATION SOL 1000MLWATER ST IRRIGATION SOL 1000ML10 A4217 1 272

3100120 GRAM STAINGRAM STAIN 33 87205,90 1 306

2700397 SPO2 ADHES SENSOR LNCSNE O-3SPO2 ADHES SENSOR LNCSNE O-3112 A4649 1 271

3100225 THEOPHYLLINETHEOPHYLLINE 104 80198,90 1 301

2700010 QUICK TRACH KIT 2.0QUICK TRACH KIT 2.0 117 1 270

4200084 PT MOBILITY GOAL G8979CMPT MOBILITY GOAL G8979CM0.01 G8979,CM,GP 1 429

3100202 RSV ANTIGENRSV ANTIGEN 66 87420,90 1 306

400050 RPR CMPLX F C A G 2.6-7.5 CMRPR CMPLX F C A G 2.6-7.5 CM886 13132 1 450


2900013 BB RBC LEUKOCYTE RED STORBB RBC LEUKOCYTE RED STOR100 P9016,BL 1 390

3140017 PC IMMUNFIX E PHORSIS URINE CSFPC IMMUNFIX E PHORSIS URINE CSF158 86335,90 1 302

3500005 CT ABDOMEN WO CONTRASTCT ABDOMEN WO CONTRAST1440 74150 1 350

3100170 OSMOLALITY URINE RLOSMOLALITY URINE RL 72 83935,90 1 301

2720021 MASK O2 TRACHMASK O2 TRACH 86 1 270

4400044 ST SPEECH LANG CURRENT G9174CIST SPEECH LANG CURRENT G9174CI0.01 G9174,CI,GN 1 449

1500004 BH FAMILY PSYCHOTHER W PT PRESENTBH FAMILY PSYCHOTHER W PT PRESENT158 90847 1 916

2700189 BORDERED GUAZE 2X2BORDERED GUAZE 2X2 49 A6219 1 270

3100243 VMA URINEVMA URINE 130 84585,90 1 301

3100054 CLOSTRIDIUM DIFFICILE TOXINCLOSTRIDIUM DIFFICILE TOXIN 71 87324,90 1 306

500043 EX MAGLIG LES TR ARM LEG 0.6-1.0 CMEX MAGLIG LES TR ARM LEG 0.6-1.0 CM791 11601 1 761

3140057 PC HERPES SIMPLEX II IGGPC HERPES SIMPLEX II IGG 71 86695,90 1 302

2700277 STOCKING ANITEMBOLI KNEE SMSTOCKING ANITEMBOLI KNEE SM6 1 270

2700531 TAPE MEDFIX 2INX11YDSTAPE MEDFIX 2INX11YDS 6 1 271

4400037 ST MOTOR SPEECH GOAL G9186CIST MOTOR SPEECH GOAL G9186CI0.01 G9186,CI,GN 1 449

2702037 CATH MALE FREEDOM INTERMEDIATECATH MALE FREEDOM INTERMEDIATE24 1 270

4200092 PT OTHER PT OT CURRENT G8990CNPT OTHER PT OT CURRENT G8990CN0.01 G8990,CN,GP 1 429

9600071 TREAT KNUCKLE DISLOCATIONTREAT KNUCKLE DISLOCATION518 26700,54 1 960

3100192 QUINIDINE QUINIDINE 109 80194,90 1 301


2700288 TUBE ET 3.0TUBE ET 3.0 22 1 270

3100164 MERCURY MERCURY 51 83825,90 1 301

4200109 PT SELFCARE CURRENT G8987CJPT SELFCARE CURRENT G8987CJ0.01 G8987,CJ,GP 1 429

9400001 RESPITORY MUSCLE THERAPY PER 15 MINRESPITORY MUSCLE THERAPY PER 15 MIN88 G0237 1 410

3100219 CHARGE SENSI MICROCHARGE SENSI MICRO 256 87186,90 1 306

3100152 INSULIN TOTALINSULIN TOTAL 116 83525,90 1 301

400064 FX CLSD DISTAL RADIUS W MANIPFX CLSD DISTAL RADIUS W MANIP817 25605 1 450

3100110 FUNGI ID YEASTFUNGI ID YEAST 59 87106,90 1 306

3100124 HEAVY METAL SCREENHEAVY METAL SCREEN 237 83015,90 1 301

400055 RPR CMPLX EYELD N EAR LIP EA AD 5CMRPR CMPLX EYELD N EAR LIP EA AD 5CM566 13153 1 450

1500008 BH PSYCHIATRIC DIAGNOSTIC EVALUATIONBH PSYCHIATRIC DIAGNOSTIC EVALUATION158 90791 1 900

9600088 APPLY LONG LEG SPLINTAPPLY LONG LEG SPLINT 201 29505 1 960

3200082 XR UGI WO KUBXR UGI WO KUB 294 74240 1 320


4200134 PT APPLICATION HOTCOLD PACKSPT APPLICATION HOTCOLD PACKS30 97010,GP 1 421

2600014 EMS NORMAL SALINE 1000 MLEMS NORMAL SALINE 1000 ML 1 1 258

400065 FX CLSD DIS RADIUS W MANIPFX CLSD DIS RADIUS W MANIP301 25605 1 450

3140080 PC ALPHA FETOPROTEINPC ALPHA FETOPROTEIN 91 82105,90 1 301

3100141 HOMOCYSTEINEHOMOCYSTEINE 195 83090,90 1 301

3100070 CULTURE FUNGUSCULTURE FUNGUS 51 87102,90 1 306

1400014 PSYCHOTHER CRISIS MGMT EA ADD 30MPSYCHOTHER CRISIS MGMT EA ADD 30M101 90840 1 914

3100250 URINE RANDOM PROTEINURINE RANDOM PROTEIN 20 84156,90 1 301

400117 I D ISHIORECTALPERI ABSCI D ISHIORECTALPERI ABSC 2878 46040 1 450

3100117 GIARDIA ANTIGENGIARDIA ANTIGEN 82 87329,90 1 306

3100017 HRL ASO TITERHRL ASO TITER 40 86060,90 1 302

9600093 WEDGING OF CASTWEDGING OF CAST 164 29740 1 960

4400041 ST MOTOR SPEECH GOAL G9186CMST MOTOR SPEECH GOAL G9186CM0.01 G9186,CM,GN 1 449

9600014 EX B9 LES TRNK ARM LEG 0.6-1.0CMEX B9 LES TRNK ARM LEG 0.6-1.0CM260 11401 1 960

2700323 SUPPORT KNEE ELASTIC XLSUPPORT KNEE ELASTIC XL 19 1 270

4300177 OT GROUP THERAPY OTOT GROUP THERAPY OT 70 97150,GO 1 431

4400085 ST LANG EXPRESS DC G9164 CHST LANG EXPRESS DC G9164 CH0.01 G9164,CH,GN 1 449

9600027 WEDGE EX OF NAIL FOLDWEDGE EX OF NAIL FOLD 545 11765 1 960

400070 FX CLSD METACARP W MANIPFX CLSD METACARP W MANIP301 26605 1 450

3100313 FACTOR 5 LEIDENFACTOR 5 LEIDEN 88 81241,90 1 301

2700309 URINARY LEG BAGURINARY LEG BAG 9 A4358 1 272

2700532 TAPE MEDFIX 6INX10YDSTAPE MEDFIX 6INX10YDS 33 1 271

9600162 HOLTER MONITOR REVIEW & INTERP BY PHYSHOLTER MONITOR REVIEW & INTERP BY PHYS340 93227 1 985


3100216 SUDAN STAINSUDAN STAIN 30 89125,90 1 309


3100284 METHAMPHETAMINE ASSAY 1-2 CONFIRMATIONMETHAMPHETAMINE ASSAY 1-2 CONFIRMATION197 80324,90 1 301

500029 EX B9 LES TR ARM LEG >4.0 CMEX B9 LES TR ARM LEG >4.0 CM1964 11406 1 761

400057 BURN TX PART THCK SMALLBURN TX PART THCK SMALL 241 16020 1 450

9600077 REMOVE FB FOOT SUBQREMOVE FB FOOT SUBQ 462 28190 1 960

2720032 TUBING O2 7FTTUBING O2 7FT 13 1 270

3140134 PC HOMOCYSTE SINGLE QUANT URINEPC HOMOCYSTE SINGLE QUANT URINE85 82131,90 1 301

9600019 EX B9 LES SP NK HD FT GT 2.1-3.0CEX B9 LES SP NK HD FT GT 2.1-3.0C460 11423 1 960

4400110 ST SWALLOW CURRENT G8996CLST SWALLOW CURRENT G8996CL0.01 G8996,CL,GN 1 449

9600183 I&D LEG/ANKLE DEEP ABSCESS/HEMATOMAI&D LEG/ANKLE DEEP ABSCESS/HEMATOMA1100 27603,54 1 960

4200124 PT SUB PT OT DC G8995CKPT SUB PT OT DC G8995CK 0.01 G8995,CK,GP 1 429

500020 SHAVE SKIN LES F E N E N L 0.5 CM<SHAVE SKIN LES F E N E N L 0.5 CM<161 11310 1 761

3100196 MANUAL RCMANUAL RC 28 85044,90 1 305

3400039 US AAA SCREENINGUS AAA SCREENING 294 76706 1 402

9600166 DESTRUCTION WARTS/OTR B9 LESIONS UPTO 14DESTRUCTION WARTS/OTR B9 LESIONS UPTO 14204 17110 1 960

2700243 CANISTER SUCTION DISP(DARKBLUE)CANISTER SUCTION DISP(DARKBLUE)9 1 270

2710006 BROSELOW PEDI BLUEBROSELOW PEDI BLUE 40 1 272

4300137 OT OTHER PT OT DC G8992CKOT OTHER PT OT DC G8992CK0.01 G8992,CK,GO 1 439

3400020 US UNILAT LWR EXTREM ART STUDY LIMUS UNILAT LWR EXTREM ART STUDY LIM600 93926 1 921

4200153 PT REMOVE DEVIT TISS NON SEL PER SESSNPT REMOVE DEVIT TISS NON SEL PER SESSN195 97602,GP 1 421

9600078 TREAT CLOSED GREAT TOE FXTREAT CLOSED GREAT TOE FX 343 28490,54 1 960

9600043 RPR INTMD N-HF GENIT 2.6-7.5CMRPR INTMD N-HF GENIT 2.6-7.5CM460 12042 1 960

2700751 OXYGEN CONNECTORS FOR TUBINGOXYGEN CONNECTORS FOR TUBING3 1 270

9600149 ER PRO FEE LOW MODERER PRO FEE LOW MODER 150 99282 1 981


9600110 CHANGE OF GASTROSTOMYCHANGE OF GASTROSTOMY 351 43760 1 960

3100035 CALCULUS ANALYSIS QUALITATIVECALCULUS ANALYSIS QUALITATIVE67 82355,90 1 301

2720020 PEAKFLOW METERPEAKFLOW METER 68 1 270

2700090 DRESSING CONFORM NS 4IN/YDDRESSING CONFORM NS 4IN/YD5 A6444 1 271

2700267 TAPE TRANSPORE(SURG) 1INTAPE TRANSPORE(SURG) 1IN 5 1 270

2600011 NS 3% 500 MLNS 3% 500 ML 50 J3490 1 258

3150063 PC SMITH AND RNP ANTIBODIES PANELPC SMITH AND RNP ANTIBODIES PANEL0 1 302

500046 EX MALIG LES TR ARM LEG 3.1-4.0EX MALIG LES TR ARM LEG 3.1-4.01372 11604 1 761

4100007 PULSE OXIMETRY MULTI DETERMINATIONPULSE OXIMETRY MULTI DETERMINATION75 94761 1 460


3140037 PC CAMPYLOBACTER ANTIGENPC CAMPYLOBACTER ANTIGEN 65 87449,90 1 306

3100269 STOOL REDUCING SUBSTANCESTOOL REDUCING SUBSTANCE 25 84376,90 1 301

2720089 KING AIRWAY SIZE 2.5KING AIRWAY SIZE 2.5 414 1 270

9600194 INSERT DRUG IMPLANTINSERT DRUG IMPLANT 303 11981 1 960

270263 MED CUPS PLASTICMED CUPS PLASTIC 0 1 270

9600155 SUPERVISION HH PT 15-29 MINS MOSUPERVISION HH PT 15-29 MINS MO135 99374 1 960


2700126 CAUTERY PEN LOW TEMPCAUTERY PEN LOW TEMP 17 1 270

2700297 TUBE ET 4.5TUBE ET 4.5 5 1 270

3400030 US TTE WO DOPPLER COMPLETEUS TTE WO DOPPLER COMPLETE936 93307 1 480

2720046 FOLEY CATHETERS 6FFOLEY CATHETERS 6F 63 1 272

4200140 PT CONTRAST BATH EA 15 MINUTESPT CONTRAST BATH EA 15 MINUTES60 97034,GP 1 421

4100010 CPAP/BIPAP VENTILATION INITIATE & MANAGECPAP/BIPAP VENTILATION INITIATE & MANAGE160 94660 1 412

3100133 HEPATITIS B SURFACE ANTIGENHEPATITIS B SURFACE ANTIGEN65 87340,90 1 306

9600193 CL TX RADIAL & ULNA FX W MANIPCL TX RADIAL & ULNA FX W MANIP1038 25565 1 960

400078 REMOVE FB FOOT SUBQREMOVE FB FOOT SUBQ 1314 28190 1 450

500040 EX BEN LES FA EA EY N L M 3.1-4.0CMEX BEN LES FA EA EY N L M 3.1-4.0CM1430 1 761

2502063 GI COCKTAIL LIQUID 60MLGI COCKTAIL LIQUID 60ML 95 1 250

2500029 AMOXICILLIN SUSPENSIONAMOXICILLIN SUSPENSION 5 1 250

2500089 CELEXA (CITALOPRAM) TABCELEXA (CITALOPRAM) TAB 5 1 250

2500164 EPINEPHRINE 1:1000 PREFILLED INJEPINEPHRINE 1:1000 PREFILLED INJ70 J0170 10 250

2500515 LEVAQUIN (LEVOFLOXACIN) INJLEVAQUIN (LEVOFLOXACIN) INJ34 J1956 2 250


2500568 NATURAL TEARS SINGLE USE VIALSNATURAL TEARS SINGLE USE VIALS3 1 250

2500718 PHENTOLAMINE MESYLATE INJPHENTOLAMINE MESYLATE INJ882 J2760 1 250

2501419 CHLORASEPTIC THROAT SPRAYCHLORASEPTIC THROAT SPRAY 24 1 250

2501496 SODIUM CHLORIDE FOR INHALATION UD 3MLSODIUM CHLORIDE FOR INHALATION UD 3ML3 1 250

2501600 PAIN EASE LIDOCAINE SPRAYPAIN EASE LIDOCAINE SPRAY 15 1 250

2501659 PLAQUENIL TABPLAQUENIL TAB 9 1 250

2500165 ERYTHROMYCIN OPHTH. OINTMENTERYTHROMYCIN OPHTH. OINTMENT72 1 250

2500177 FORTAZ (CEFTAZIDIME) INJFORTAZ (CEFTAZIDIME) INJ 25 J0713 2 250

2501508 ANUSOL HC SUPPOSITORYANUSOL HC SUPPOSITORY 57 1 250

2500985 HEPARIN 100UNITS/ML PREFILL SYRINGE 5MLHEPARIN 100UNITS/ML PREFILL SYRINGE 5ML10 J1642 50 250

2500517 LEVAQUIN (LEVOFLOXACIN) 500MG/100 PREMIXLEVAQUIN (LEVOFLOXACIN) 500MG/100 PREMIX33 J1956 2 250

2501444 NEXTERONE (AMIODARONE) 150MG/100ML BAGNEXTERONE (AMIODARONE) 150MG/100ML BAG105 J0282 5 250

2501094 NICOTINE TRANSDERMAL PATCHNICOTINE TRANSDERMAL PATCH5 1 250

2508002 CT OMNIPAQUE 300MG/ML (100ML) INJCT OMNIPAQUE 300MG/ML (100ML) INJ435 Q9967 1 255




2500697 ZOSYN (PIPER/TAZO) INJZOSYN (PIPER/TAZO) INJ 53 J2543 3 250

2500625 SILVADINE CR 1% TUBESILVADINE CR 1% TUBE 36 1 250

2501912 SODIUM BICARB (PEDI) 4.2% PFSSODIUM BICARB (PEDI) 4.2% PFS52 1 250

2500562 NA BICARB 8.4% PFSNA BICARB 8.4% PFS 51 1 250

2500643 TETRACAINE EYE GTTSTETRACAINE EYE GTTS 40 1 250

2500503 LABETALOL INJLABETALOL INJ 25 J3490 4 250

2500172 FLEXARIL (CYCLOBENZAPRINE) TABFLEXARIL (CYCLOBENZAPRINE) TAB3 1 250

2501942 DEFINITY 1.1 MG/ML VIAL 2 mL, 2 mLDEFINITY 1.1 MG/ML VIAL 2 mL, 2 mL300 1 250

2500076 dilTIAZem 25 MG/5 ML VIAL 25 mg, 5 mLdilTIAZem 25 MG/5 ML VIAL 25 mg, 5 mL25 1 250

2501251 PROCHLORPERAZINE 10 MG/2 ML VL 10 mg, 2 mLPROCHLORPERAZINE 10 MG/2 ML VL 10 mg, 2 mL25 1 250

2600010 DEXTROSE 5%-0.9% NACL IV SOLN 1000 mL, 1000 mLDEXTROSE 5%-0.9% NACL IV SOLN 1000 mL, 1000 mL50 1 258

2600013 DEXTROSE 5%-0.45% NACL IV SOLN 1000 mL, 1000 mLDEXTROSE 5%-0.45% NACL IV SOLN 1000 mL, 1000 mL50 1 258

2600001 DEXTROSE 5%-WATER IV SOLN 250 mL, 250 mLDEXTROSE 5%-WATER IV SOLN 250 mL, 250 mL35 1 258




2600009 LACTATED RINGERS INJECTION 1000 mL, 1000 mLLACTATED RINGERS INJECTION 1000 mL, 1000 mL45 1 258

2600008 SODIUM CHLORIDE 0.45% SOLN 1000 mL, 1000 mLSODIUM CHLORIDE 0.45% SOLN 1000 mL, 1000 mL45 1 258

2600005 SODIUM CHLORIDE 0.9% SOLUTION 250 mL, 250 mLSODIUM CHLORIDE 0.9% SOLUTION 250 mL, 250 mL35 1 258





2600011 SODIUM CHLORIDE 3% IV SOLN 500 mL, 500 mLSODIUM CHLORIDE 3% IV SOLN 500 mL, 500 mL50 1 258

2500094 CIPRO (CIPROFLOXZCIN) INJ 400MG/250 PREMIXCIPRO (CIPROFLOXZCIN) INJ 400MG/250 PREMIX25 J0744 2 250

2502049 CIPROFLOXACN-D5W 200 MG/100 ML 200 mg, 100 mLCIPROFLOXACN-D5W 200 MG/100 ML 200 mg, 100 mL25 1 250

2501548 MAGNESIUM SULF 1 G/100 ML-D5W 1 g, 100 mLMAGNESIUM SULF 1 G/100 ML-D5W 1 g, 100 mL36 1 250

2502043 levETIRAcetam 500 MG/5 ML VIAL 500 mg, 5 mLlevETIRAcetam 500 MG/5 ML VIAL 500 mg, 5 mL51 1 250

2502070 DEXTROSE 50%-WATER VIAL 50 mL, 50 mLDEXTROSE 50%-WATER VIAL 50 mL, 50 mL25 1 250

2500495 POTASSIUM CL 2 MEQ/ML VIAL 40 mEq, 20 mLPOTASSIUM CL 2 MEQ/ML VIAL 40 mEq, 20 mL27 1 250

2501446 AMOXICILLIN 200 MG/5 ML SUSP 200 mg, 50 mLAMOXICILLIN 200 MG/5 ML SUSP 200 mg, 50 mL10 1 250

2500490 KAYEXALATEKAYEXALATE 4 1 250

2500075 SUCRALFATE 1 GM/10 ML SUSP 1 g, 10 mLSUCRALFATE 1 GM/10 ML SUSP 1 g, 10 mL21 1 250

2502064 CENTRUM CHEWABLE TABLET 1 ea, 100 eachesCENTRUM CHEWABLE TABLET 1 ea, 100 eaches3 1 250

2502058 DEMECLOCYCLINE 300 MG TABLET 300 mg, 48 eachesDEMECLOCYCLINE 300 MG TABLET 300 mg, 48 eaches30 1 250

2501720 levoFLOXacin 250 MG TABLET 250 mg, 50 eacheslevoFLOXacin 250 MG TABLET 250 mg, 50 eaches30 1 250

2501767 LOVASTATIN TABLOVASTATIN TAB 5 1 250

2502011 OMEGA-3 ETHYL ESTERS 1 GM CAP 1 g, 120 eachesOMEGA-3 ETHYL ESTERS 1 GM CAP 1 g, 120 eaches5 1 250

2500932 FENOFIBRATE 145 MG TABLET 145 mg, 1 eachFENOFIBRATE 145 MG TABLET 145 mg, 1 each11 1 250

2501661 metOLazone 2.5 MG TABLET 2.5 mg, 100 eachesmetOLazone 2.5 MG TABLET 2.5 mg, 100 eaches5 1 250

2501880 IPOL VIAL 0.5 mL, 5 mLIPOL VIAL 0.5 mL, 5 mL 186 1 250

2502071 MIDAZOLAM HCL 10 MG/2 ML VIAL 10 ea, 2 mLMIDAZOLAM HCL 10 MG/2 ML VIAL 10 ea, 2 mL25 1 250

3000100 D-DIMER QUANTITATIVED-DIMER QUANTITATIVE 150 85379 1 305

3000124 VITAMIN B-12 (IN HOUSE)VITAMIN B-12 (IN HOUSE) 171 82607 1 301

3000204 APTT THROMBOPLASTIN TIMEAPTT THROMBOPLASTIN TIME 45 85730 1 305

3000045 DIGOXIN TOTAL LEVELDIGOXIN TOTAL LEVEL 135 80162 1 301

3000062 LDH LDH 68 83615 1 301

3000070 MONO SPOT TESTMONO SPOT TEST 36 86308 1 302

3000069 MICROALBUMIN URINEMICROALBUMIN URINE 66 82043 1 301

3000023 AST AST 45 84450 1 301

3000210 TRANSFERRIN SATURATIONTRANSFERRIN SATURATION 0 84466,90 1 301

4093225 HOLTER MONITOR CONNECT RECORD DISCONNECTHOLTER MONITOR CONNECT RECORD DISCONNECT310 93225 1 731

3000020 AMYLASE AMYLASE 168 82150 1 301

4000297 HOLTER >48HRS - 21 DAY SCAN ANALYS W RPTHOLTER >48HRS - 21 DAY SCAN ANALYS W RPT250 0297T 1 731

3000083 SED RATE NON AUTOMATEDSED RATE NON AUTOMATED 136 85651 1 305

4093788 ABPM SCANNING ANALYSIS W RPRT 24 HRS/ >ABPM SCANNING ANALYSIS W RPRT 24 HRS/ >200 93788 1 480

3000114 THYROXINE TOTAL (IN HOUSE)THYROXINE TOTAL (IN HOUSE)58.5 84436 1 301

3000046 DILANTIN (PHENYTOIN) LEVELDILANTIN (PHENYTOIN) LEVEL125 80185 1 301

3000054 GLUCOSE BLOODGLUCOSE BLOOD 45 82947 1 301

3000207 THERAPEUTIC PHLEBOTOMYTHERAPEUTIC PHLEBOTOMY 480 99195 1 940

3000063 LDL CHOLESTEROLLDL CHOLESTEROL 68 83721 1 301

3000091 URIC ACID LEVEL BLOODURIC ACID LEVEL BLOOD 50 84550 1 301

3000115 BETA HCG QUANT (IN HOUSE)BETA HCG QUANT (IN HOUSE)141 84702 1 301

3000040 COMPLETE CBC W AUTO DIFFCOMPLETE CBC W AUTO DIFF 90 85025 1 305

3000057 HEMATOCRITHEMATOCRIT 18 85014 1 305

3000026 BILIRUBIN TOTALBILIRUBIN TOTAL 45 82247 1 301

3000190 PSA SCREENING FOR CANCER (IH)PSA SCREENING FOR CANCER (IH)225 G0103 1 300

3000066 LIPOPROTEIN HDLLIPOPROTEIN HDL 81 83718 1 301

4093005 EKG EKG 120 93005 1 730

4040000 PC EKG PC EKG 120 93005 1 730

3000107 LACTIC ACID LEVEL (IN HOUSE)LACTIC ACID LEVEL (IN HOUSE)281 83605 1 301

3000049 ELECTROLYTE PANELELECTROLYTE PANEL 69 80051 1 301

3000041 COMPREHENSIVE METABOLIC PANELCOMPREHENSIVE METABOLIC PANEL226 80053 1 301

3000050 FREE T 4 FREE T 4 172 84439 1 301

3000117 FERRITIN LEVEL (IN HOUSE)FERRITIN LEVEL (IN HOUSE) 98 82728 1 301

3000042 CPK CPK 68 82550 1 301

3000094 URINALYSIS W MICROSCOPICURINALYSIS W MICROSCOPIC 33 81001 1 307

3000056 HELICOBACTER PYLORIHELICOBACTER PYLORI 104 86677 1 302

3000073 OCCULT BLOOD STOOL SCREEN INITLOCCULT BLOOD STOOL SCREEN INITL39 82270 1 301

3000113 PSA TOTAL DIAGNOSTIC (IN HOUSE)PSA TOTAL DIAGNOSTIC (IN HOUSE)190 84153 1 301

3000103 AMMONIA LEVEL (IN HOUSE)AMMONIA LEVEL (IN HOUSE) 167 82140 1 301

3000096 URINE DRUG SCREEN IN HOUSEURINE DRUG SCREEN IN HOUSE206 80307 1 301

30000206 UREA NITROGEN, URINEUREA NITROGEN, URINE 25.5 84540 1 301

3000082 ROUTINE VENIPUNCTUREROUTINE VENIPUNCTURE 13 36415 1 300

3000079 PROTEIN TOTALPROTEIN TOTAL 50 84155 1 301

3000035 CARBON DIOXIDECARBON DIOXIDE 41 82374 1 301

3000090 TSH TSH 172 84443 1 301

3000116 TESTOSTERONE TOTAL (IN HOUSE)TESTOSTERONE TOTAL (IN HOUSE)292.5 84403 1 301

3000017 ALBUMIN SERUMALBUMIN SERUM 45 82040 1 301

3000108 RHEUMATOID FACTOR QUAL SCREEN (IN HOUSE)RHEUMATOID FACTOR QUAL SCREEN (IN HOUSE)54 86430 1 302

3000047 DIRECT BILIRUBINDIRECT BILIRUBIN 45 82248 1 301

3000038 CK MB FRACTIONCK MB FRACTION 281 82553 1 301

3000019 ALT ALT 154 84460 1 301

3000051 GASTROCCULTGASTROCCULT 23 82271 1 301

3000071 MYOGLOBINMYOGLOBIN 108 83874 1 301

3000065 LIPID PROFILELIPID PROFILE 170 80061 1 301

3000088 TROPONIN ITROPONIN I 250 84512 1 301

3000109 ANTISTREPTOLYSIN O QUALITATIVEANTISTREPTOLYSIN O QUALITATIVE54 86060 1 302

3000075 PHOSPHORUS LEVELPHOSPHORUS LEVEL 45 84100 1 301

3000173 OCCULT BLOOD STOOL SCREEN SUBSQNTOCCULT BLOOD STOOL SCREEN SUBSQNT0 82272 1 301

3000098 GLUCOSE FINGER STICK HOSPITALGLUCOSE FINGER STICK HOSPITAL23 82962 1 301

3000067 LIVER PANELLIVER PANEL 77 80076 1 301

3000037 CHOLESTEROLCHOLESTEROL 36 82465 1 301

3000061 INFLUENZA TESTINFLUENZA TEST 213 87804 1 306

3000076 PLATELET COUNTPLATELET COUNT 45 85049 1 305

4000296 HOLTER >48HRS - 21 DAY RCRD/CNT/DISCNTHOLTER >48HRS - 21 DAY RCRD/CNT/DISCNT310 0296T 1 731

3000055 GLUCOSE TOLERANCE 3 SPECIMENSGLUCOSE TOLERANCE 3 SPECIMENS95 82951 1 301

3000087 TRIGLYCERIDES LEVEL BLOODTRIGLYCERIDES LEVEL BLOOD 50 84478 1 301

3000205 VIT D 1,25 DIHYDROXYVIT D 1,25 DIHYDROXY 207 82652 1 301

3000081 RENAL FUNCTION PANELRENAL FUNCTION PANEL 113 80069 1 301

4093226 HOLTER MONITOR SCANNING ANALYSIS W REPORHOLTER MONITOR SCANNING ANALYSIS W REPOR250 93226 1 731

3000032 BNP BNP 581 83880 1 301

3000078 SERUM PREGNANCY TESTSERUM PREGNANCY TEST 158 84703 1 301

3000028 BLOOD ALCOHOL LEVELBLOOD ALCOHOL LEVEL 114 80320 1 301

3000022 ARTERIAL BLOOD GASARTERIAL BLOOD GAS 278 82803 1 301

3000208 SALICYLATE QUANTITATIVE INHOUSESALICYLATE QUANTITATIVE INHOUSE70 80307,90 1 301

3000059 HEMOGLOBINHEMOGLOBIN 23 85018 1 305

4093786 ABPM RECORDING ONLY 24 HRS OR >ABPM RECORDING ONLY 24 HRS OR >220 93786 1 480

3000068 MAGNESIUM LEVELMAGNESIUM LEVEL 163 83735 1 301

3000206 DIHYDROTESTOSTERONEDIHYDROTESTOSTERONE 207 G6047 1 301

3000209 ACETAMINOPHEN INHOUSEACETAMINOPHEN INHOUSE 109 80307,90 1 301

3000036 CHLORIDE BLOODCHLORIDE BLOOD 36 82435 1 301

3000060 HEMOGLOBIN A1CHEMOGLOBIN A1C 67 83036 1 301

3000025 BASIC METABOLIC PANELBASIC METABOLIC PANEL 199 80048 1 301

3000106 TIBC (IN HOUSE)TIBC (IN HOUSE) 86 83550 1 301

3000118 FOLIC ACID SERUM LEVEL (IN HOUSE)FOLIC ACID SERUM LEVEL (IN HOUSE)162 82746 1 301

3000018 ALK PHOSPHATASEALK PHOSPHATASE 50 84075 1 301

3000097 URINE PREGNANCY TESTURINE PREGNANCY TEST 31 81025 1 307

3000119 VIT D 25 HYDROXY (IN HOUSE)VIT D 25 HYDROXY (IN HOUSE)324 82306 1 301

3000105 C-REACTIVE PROTEIN (IN HOUSE)C-REACTIVE PROTEIN (IN HOUSE)59 86140 1 302

3000034 CALCIUM LEVEL TOTALCALCIUM LEVEL TOTAL 45 82310 1 301

3000033 BUN BUN 50 84520 1 301

3000101 HANDLING SPECIMEN CHARGEHANDLING SPECIMEN CHARGE 30 99001 1 300

3000064 LIPASE LEVELLIPASE LEVEL 77 83690 1 301

3000044 CREATININE BLOODCREATININE BLOOD 54 82565 1 301

3000104 IRON LEVEL (IN HOUSE)IRON LEVEL (IN HOUSE) 72 83540 1 301

3000084 SODIUM BLOODSODIUM BLOOD 41 84295 1 301

3000077 POTASSIUM BLOODPOTASSIUM BLOOD 45 84132 1 301

3000021 ARTERIAL PUNCTUREARTERIAL PUNCTURE 221 36600 1 410

2502075 Neupogen 300 MCG/0.5 ML SYR 300 mcg, 0.5 mLNeupogen 300 MCG/0.5 ML SYR 300 mcg, 0.5 mL1002 1 250

ZERO000 MISC ZERO DOLLAR 0 1 100

2502076 XARELTO 10 MG TABLET 10 mg, 100 eachesXARELTO 10 MG TABLET 10 mg, 100 eaches34 1 250

3050011 CARDIAC PANEL 910 1 300

2501520 BI-CILLIN LA 1.2 MU/ 2ML PFSBI-CILLIN LA 1.2 MU/ 2ML PFS331 J0561 2 250

2710011 IV START PAKIV START PAK 12 1 270

2502078 FLUCAINE EYE DROPS 1 ea, 5 mLFLUCAINE EYE DROPS 1 ea, 5 mL3 1 250

2500169 FERROUS SULFATE TABFERROUS SULFATE TAB 3 1 250

2502079 FLUCELVAX QUAD 2018-2019 VIAL 0.5 mL, 5 mLFLUCELVAX QUAD 2018-2019 VIAL 0.5 mL, 5 mL20 1 250

4200203 PT ZERO CHARGE NURSING HOME 0 1 421

2502080 DIGOXIN 250 MCG TABLET 250 mcg, 100 eachesDIGOXIN 250 MCG TABLET 250 mcg, 100 eaches5 1 250

2502081 PROCRIT 4,000 UNITS/ML VIAL 4000 unit, 1 mLPROCRIT 4,000 UNITS/ML VIAL 4000 unit, 1 mL217 J0885 4 250

2500156 DURAGESIC (FENTANYL) TDDURAGESIC (FENTANYL) TD 43 1 250




3500008 CT ANGIO LOWER EXT LEFTCT ANGIO LOWER EXT LEFT 2000 73706,LT 1 350

3500054 CT ANGIO LOWER EXT RIGHTCT ANGIO LOWER EXT RIGHT2000 73706,RT 1 350

3500009 CT ANGIO UPPER EXT LEFTCT ANGIO UPPER EXT LEFT 2000 73206,LT 1 350

3500010 CT ANGIO UPPER EXT RIGHTCT ANGIO UPPER EXT RIGHT 2000 73206,RT 1 350

3500011 CT ANGIO RUNOFFCT ANGIO RUNOFF 2000 75635 1 350

3500015 CT ANGIO PELVISCT ANGIO PELVIS 2000 72191 1 350

3500034 CT CERVICAL SPINE WO CONTRASTCT CERVICAL SPINE WO CONTRAST1536 72125 1 350

3500055 CT CHEST LOW DOSECT CHEST LOW DOSE 1450 G0297 1 350

3500016 CT CHEST W CONTRASTCT CHEST W CONTRAST 1816 71260 1 350

3500017 CT CHEST WO CONTRASTCT CHEST WO CONTRAST 1552 71250 1 350

3500018 CT CHEST WWO CONTRASTCT CHEST WWO CONTRAST 2264 71270 1 350

3500031 CT FACIAL BONES W CONTRASTCT FACIAL BONES W CONTRAST1512 70487 1 350

3500032 CT FACIAL BONES WO CONTRASTCT FACIAL BONES WO CONTRAST1304 70486 1 350

3500033 CT FACIAL BONES WWO CONTRASTCT FACIAL BONES WWO CONTRAST1936 70488 1 350

3500019 CT HEAD W CONTRASTCT HEAD W CONTRAST 1512 70460 1 350

3500020 CT HEAD WO CONTRASTCT HEAD WO CONTRAST 1304 70450 1 350

3500021 CT HEAD WWO CONTRASTCT HEAD WWO CONTRAST 1936 70470 1 350

3500251 CT ORBITS/MASTOIDS W CONTRASTCT ORBITS/MASTOIDS W CONTRAST1760 70481 1 350

3500250 CT ORBITS/MASTOIDS WO CONTRASTCT ORBITS/MASTOIDS WO CONTRAST1304 70480 1 350

3500252 CT ORBITS/MASTOIDS W/WO CONTRASTCT ORBITS/MASTOIDS W/WO CONTRAST1936 70482 1 350

3300009 MRI BRAIN W CONTRASTMRI BRAIN W CONTRAST 3500 70552 1 610

3300010 MRI BRAIN WO CONTRASTMRI BRAIN WO CONTRAST 3150 70551 1 610

3300011 MRI BRAIN WWO CONTRASTMRI BRAIN WWO CONTRAST3850 70553 1 610

3300012 MRI CERVICAL SPINE W CONTRASTMRI CERVICAL SPINE W CONTRAST3500 72142 1 610

3300013 MRI CERVICAL SPINE WO CONTRASTMRI CERVICAL SPINE WO CONTRAST3150 72141 1 610

3300014 MRI CERVICAL SPINE WWO CONTRASTMRI CERVICAL SPINE WWO CONTRAST3850 72156 1 610

3500012 CT ANGIO CHEST (PE STUDY)CT ANGIO CHEST (PE STUDY)2000 71275 1 350

3500013 CT ANGIO HEADCT ANGIO HEAD 2000 70496 1 350

3500014 CT ANGIO NECKCT ANGIO NECK 2000 70498 1 350

3500022 CT LOWER EXT W CONTRAST LEFTCT LOWER EXT W CONTRAST LEFT1560 73701,LT 1 350

3500023 CT LOWER EXT W CONTRAST RIGHTCT LOWER EXT W CONTRAST RIGHT1560 73701,RT 1 350

3500024 CT LOWER EXT WO CONTRAST LEFTCT LOWER EXT WO CONTRAST LEFT1360 73700,LT 1 350

3500025 CT LOWER EXT WO CONTRAST RIGHTCT LOWER EXT WO CONTRAST RIGHT1360 73700,RT 1 350

3500026 CT LOWER EXT WWO CONTRAST LEFTCT LOWER EXT WWO CONTRAST LEFT1960 73702,LT 1 350

3500027 CT LOWER EXT WWO CONTRAST RIGHTCT LOWER EXT WWO CONTRAST RIGHT1960 73702,RT 1 350

3500048 CT UPPER EXT W CONTRAST LEFTCT UPPER EXT W CONTRAST LEFT1560 73201,LT 1 350

3500049 CT UPPER EXT W CONTRAST RIGHTCT UPPER EXT W CONTRAST RIGHT1560 73201,RT 1 350

3500050 CT UPPER EXT WO CONTRAST LEFTCT UPPER EXT WO CONTRAST LEFT1360 73200,LT 1 350

3500051 CT UPPER EXT WO CONTRAST RIGHTCT UPPER EXT WO CONTRAST RIGHT1360 73200,RT 1 350

3500052 CT UPPER EXT WWO CONTRAST LEFTCT UPPER EXT WWO CONTRAST LEFT1960 73202,LT 1 350

3500053 CT UPPER EXT WWO CONTRAST RIGHTCT UPPER EXT WWO CONTRAST RIGHT1960 73202,RT 1 350

3400001 US ABD COMPLETEUS ABD COMPLETE 385 76700 1 402

3400002 US ABD LIMITEDUS ABD LIMITED 294 76705 1 402

3400000 US ABD VASCULAR COMPLETEUS ABD VASCULAR COMPLETE747 93975 1 921

3400036 US ABD VASCULAR LIMITEDUS ABD VASCULAR LIMITED 636 93976 1 921

3400033 US ABI 2 LEVELSUS ABI 2 LEVELS 204 93922 1 921

3400035 US ABI 3 LEVELSUS ABI 3 LEVELS 566 93923 1 921

3400037 US AORTA COMPLETEUS AORTA COMPLETE 816 93978 1 921

3400038 US AORTA LIMITEDUS AORTA LIMITED 624 93979 1 921

3400003 US BREAST COMPLETE LEFTUS BREAST COMPLETE LEFT 245 76641,LT 1 402

3400046 US BREAST COMPLETE RIGHTUS BREAST COMPLETE RIGHT 245 76641,RT 1 402

3400041 US BREAST LIMITED LEFTUS BREAST LIMITED LEFT 120 76641,LT 1 402

3400047 US BREAST LIMITED RIGHTUS BREAST LIMITED RIGHT 120 76642,RT 1 402

3400008 US CAROTIDS COMPLETEUS CAROTIDS COMPLETE 768 93880 1 921

3400009 US CAROTIDS LIMITEDUS CAROTIDS LIMITED 421 93882 1 921

3400029 US ECHO COMPLETE (CONTRAST PRN)US ECHO COMPLETE (CONTRAST PRN)1152 93306 1 483

3400043 US ECHO COMPLETE W/ CONTRASTUS ECHO COMPLETE W/ CONTRAST1620 C8929 1 483

3400042 US EXT NON-VASCULAR LIMITEDUS EXT NON-VASCULAR LIMITED230 76882 1 402

3400017 US EXT VEIN BILATUS EXT VEIN BILAT 624 93970 1 921

3400015 US EXT VEIN LEFTUS EXT VEIN LEFT 500 93971,LT 1 921

3400048 US EXT VEIN RIGHTUS EXT VEIN RIGHT 500 93971,RT 1 921

3400044 US GUIDED NEEDLE PLACEMENTUS GUIDED NEEDLE PLACEMENT74 76942 1 402

3400010 US LOWER EXT ART BILATUS LOWER EXT ART BILAT 720 93925 1 921

3400011 US LOWER EXT ART LEFTUS LOWER EXT ART LEFT 600 93926,LT 1 921

3400049 US LOWER EXT ART RIGHTUS LOWER EXT ART RIGHT 600 93926,RT 1 921

3400026 US RENAL COMPLETEUS RENAL COMPLETE 392 76770 1 402

3400040 US RENAL LIMITEDUS RENAL LIMITED 294 76775 1 402

3400050 US THYROIDUS THYROID 280 76536 1 402

3400012 US UPPER EXT ART BILATUS UPPER EXT ART BILAT 864 93930 1 921

3400032 US UPPER EXT ART LEFTUS UPPER EXT ART LEFT 648 93931,LT 1 921

3400051 US UPPER EXT ART RIGHTUS UPPER EXT ART RIGHT 648 93931,RT 1 921

3200004 XR ABDOMEN FLAT & UPRIGHTXR ABDOMEN FLAT & UPRIGHT175 74019 1 320

3200002 XR ABDOMEN 3 VIEW MINXR ABDOMEN 3 VIEW MIN 123 74021 1 320

3200007 XR ANKLE 3 VIEW MIN LEFTXR ANKLE 3 VIEW MIN LEFT 126 73610,LT 1 320

3200008 XR ANKLE 3 VIEW MIN RIGHTXR ANKLE 3 VIEW MIN RIGHT 126 73610,RT 1 320

3200009 XR CALCANEUS LEFTXR CALCANEUS LEFT 123 73650,LT 1 320

3200010 XR CALCANEUS RIGHTXR CALCANEUS RIGHT 123 73650,RT 1 320

3200013 XR CLAVICLE LEFTXR CLAVICLE LEFT 123 73000,LT 1 320

3200014 XR CLAVICLE RIGHTXR CLAVICLE RIGHT 123 73000,RT 1 320

3200016 XR CERVICAL SPINE 3 VIEWXR CERVICAL SPINE 3 VIEW 140 72040 1 320

3200017 XR CERVICAL SPINE 4-5 VIEWXR CERVICAL SPINE 4-5 VIEW 217 72050 1 320

3200018 XR ELBOW LEFTXR ELBOW LEFT 126 73070,LT 1 320

3200019 XR ELBOW RIGHTXR ELBOW RIGHT 126 73070,RT 1 320

3200021 XR FACIAL BONE 3 VIEW MINXR FACIAL BONE 3 VIEW MIN 182 70150 1 320

3200022 XR FEMUR LEFTXR FEMUR LEFT 196 73552,LT 1 320

3200023 XR FEMUR RIGHTXR FEMUR RIGHT 196 73552,RT 1 320

3200024 XR FINGER LEFTXR FINGER LEFT 123 73140,LT 1 320

3200025 XR FINGER RIGHTXR FINGER RIGHT 123 73140,RT 1 320

3200028 XR FOOT 3 VIEW MIN LEFTXR FOOT 3 VIEW MIN LEFT 127 73630,LT 1 320

3200029 XR FOOT 3 VIEW MIN RIGHTXR FOOT 3 VIEW MIN RIGHT 127 73630,RT 1 320

3200030 XR FOREARM LEFTXR FOREARM LEFT 123 73090,LT 1 320

3200031 XR FOREARM RIGHTXR FOREARM RIGHT 123 73090,RT 1 320

3200034 XR HAND 3 VIEW MIN LEFTXR HAND 3 VIEW MIN LEFT 126 73130,LT 1 320

3200035 XR HAND 3 VIEW MIN RIGHTXR HAND 3 VIEW MIN RIGHT 126 73130,RT 1 320

3200094 XR HIP UNI 4 VIEW MIN LEFTXR HIP UNI 4 VIEW MIN LEFT 245 73503,LT 1 320

3200095 XR HIP UNI 4 VIEW MIN RIGHTXR HIP UNI 4 VIEW MIN RIGHT245 73503,RT 1 320

3200091 XR HIPS 2 VIEW BILATXR HIPS 2 VIEW BILAT 210 73521 1 320

3200092 XR HIPS 3-4 VIEW BILATXR HIPS 3-4 VIEW BILAT 245 73522 1 320

3200093 XR HIPS 5 VIEW MIN BILATXR HIPS 5 VIEW MIN BILAT 280 73523 1 320

3200042 XR HUMERUS LEFTXR HUMERUS LEFT 126 73060,LT 1 320

3200043 XR HUMERUS RIGHTXR HUMERUS RIGHT 126 73060,RT 1 320

3200046 XR KNEE 2 VIEW LEFTXR KNEE 2 VIEW LEFT 123 73560,LT 1 320

3200047 XR KNEE 2 VIEW RIGHTXR KNEE 2 VIEW RIGHT 123 73560,RT 1 320

3200088 XR KNEE 4 VIEW MIN LEFTXR KNEE 4 VIEW MIN LEFT 158 73564,LT 1 320

3200089 XR KNEE 4 VIEW MIN RIGHTXR KNEE 4 VIEW MIN RIGHT 158 73564,RT 1 320

3200048 XR LUMBAR SPINE 2-3 VIEWXR LUMBAR SPINE 2-3 VIEW 140 72100 1 320

3200049 XR LUMBAR SPINE 4 VIEW MINXR LUMBAR SPINE 4 VIEW MIN205 72110 1 320

3200050 XR MANDIBLEXR MANDIBLE 140 70100 1 320

3200051 XR MASTOIDSXR MASTOIDS 175 70130 1 320

3200052 XR NASAL BONESXR NASAL BONES 140 70160 1 320

3200054 XR ORBIT LEFTXR ORBIT LEFT 182 70200,LT 1 320

3200055 XR ORBIT RIGHTXR ORBIT RIGHT 182 70200,RT 1 320

3200056 XR PELVIS 1-2 VIEWXR PELVIS 1-2 VIEW 140 72170 1 320

3200057 XR RIB 2 VIEW LEFTXR RIB 2 VIEW LEFT 140 71100,LT 1 320

3200058 XR RIB 2 VIEW RIGHTXR RIB 2 VIEW RIGHT 140 71100,RT 1 320

3200059 XR RIB 3 VIEW MIN LEFTXR RIB 3 VIEW MIN LEFT 161 71101,LT 1 320

3200060 XR RIB 3 VIEW MIN RIGHTXR RIB 3 VIEW MIN RIGHT 161 71101,RT 1 320

3200061 XR SACRUM/COCCYXXR SACRUM/COCCYX 123 72220 1 320

3200062 XR SCAPULA LEFTXR SCAPULA LEFT 123 73010,LT 1 320

3200063 XR SCAPULA RIGHTXR SCAPULA RIGHT 123 73010,RT 1 320

3200066 XR SHOULDER 2 VIEW MIN LEFTXR SHOULDER 2 VIEW MIN LEFT123 73030,LT 1 320

3200067 XR SHOULDER 2 VIEW MIN RIGHTXR SHOULDER 2 VIEW MIN RIGHT123 73030,RT 1 320

3200097 XR SI JOINTSXR SI JOINTS 123 72202 1 320

3200069 XR SINUS 3 VIEW MINXR SINUS 3 VIEW MIN 161 70220 1 320

3200071 XR SKULL 4 VIEW MINXR SKULL 4 VIEW MIN 210 70260 1 320

3200053 XR SOFT TISSUE NECKXR SOFT TISSUE NECK 123 70360 1 320

3200074 XR STERNUMXR STERNUM 140 71120 1 320

3200075 XR TIB/FIB LEFTXR TIB/FIB LEFT 123 73590,LT 1 320

3200076 XR TIB/FIB RIGHTXR TIB/FIB RIGHT 123 73590,RT 1 320

3200077 XR TOE LEFTXR TOE LEFT 123 73660,LT 1 320

3200078 XR TOE RIGHTXR TOE RIGHT 123 73660,RT 1 320

3200079 XR THORACIC SPINE 2 VIEWXR THORACIC SPINE 2 VIEW 140 72070 1 320

3200090 XR THORACIC SPINE 3 VIEWXR THORACIC SPINE 3 VIEW 175 72072 1 320

3200080 XR THORACIC SPINE 4 VIEW MINXR THORACIC SPINE 4 VIEW MIN210 72074 1 320

3200086 XR WRIST 3 VIEW MIN LEFTXR WRIST 3 VIEW MIN LEFT 123 73110,LT 1 320

3200087 XR WRIST 3 VIEW MIN RIGHTXR WRIST 3 VIEW MIN RIGHT 123 73110,RT 1 320

3300015 MRI CHEST W CONTRASTMRI CHEST W CONTRAST 3500 71551 1 610

3300016 MRI CHEST WO CONTRASTMRI CHEST WO CONTRAST 3150 71550 1 610

3300017 MRI CHEST WWO CONTRASTMRI CHEST WWO CONTRAST3850 71552 1 610

3300018 MRI LOWER EXT JT W CONTRAST LEFTMRI LOWER EXT JT W CONTRAST LEFT3500 73722,LT 1 610

3300019 MRI LOWER EXT JT W CONTRAST RIGHTMRI LOWER EXT JT W CONTRAST RIGHT3500 73722,RT 1 610

3300020 MRI LOWER EXT JT WO CONTRAST LEFTMRI LOWER EXT JT WO CONTRAST LEFT3150 73721,LT 1 610

3300021 MRI LOWER EXT JT WO CONTRAST RIGHTMRI LOWER EXT JT WO CONTRAST RIGHT3150 73721,RT 1 610

3300022 MRI LOWER EXT JT WWO CONTRAST LEFTMRI LOWER EXT JT WWO CONTRAST LEFT3850 73723,LT 1 610

3300023 MRI LOWER EXT JT WWO CONTRAST RIGHTMRI LOWER EXT JT WWO CONTRAST RIGHT3850 73723,RT 1 610

3300024 MRI LOWER EXT NON JT W CONTRAST LEFTMRI LOWER EXT NON JT W CONTRAST LEFT3500 73719,LT 1 610

3300025 MRI LOWER EXT NON JT W CONTRAST RIGHTMRI LOWER EXT NON JT W CONTRAST RIGHT3500 73719,RT 1 610

3300026 MRI LOWER EXT NON JT WO CONTRAST LEFTMRI LOWER EXT NON JT WO CONTRAST LEFT3150 73718,LT 1 610

3300027 MRI LOWER EXT NON JT WO CONTRAST RIGHTMRI LOWER EXT NON JT WO CONTRAST RIGHT3150 73718,RT 1 610

3300028 MRI LOWER EXT NON JT WWO CONTRAST LEFTMRI LOWER EXT NON JT WWO CONTRAST LEFT3850 73720,LT 1 610

3300029 MRI LOWER EXT NON JT WWO CONTRAST RIGHTMRI LOWER EXT NON JT WWO CONTRAST RIGHT3850 73720,RT 1 610

3300030 MRI LUMBAR SPINE W CONTRASTMRI LUMBAR SPINE W CONTRAST3500 72149 1 610

3300031 MRI LUMBAR SPINE WO CONTRASTMRI LUMBAR SPINE WO CONTRAST3150 72148 1 610

3300032 MRI LUMBAR SPINE WWO CONTRASTMRI LUMBAR SPINE WWO CONTRAST3850 72158 1 610

3300033 MRI ORBIT/FACE/NECK W CONTRASTMRI ORBIT/FACE/NECK W CONTRAST3500 70542 1 610

3300034 MRI ORBIT/FACE/NECK WO CONTRASTMRI ORBIT/FACE/NECK WO CONTRAST3150 70540 1 610

3300035 MRI ORBIT/FACE/NECK WWO CONTRASTMRI ORBIT/FACE/NECK WWO CONTRAST3850 70543 1 610

3300036 MRI PELVIS W CONTRASTMRI PELVIS W CONTRAST 3500 72196 1 610

3300037 MRI PELVIS WO CONTRASTMRI PELVIS WO CONTRAST 3150 72195 1 610

3300038 MRI PELVIS WWO CONTRASTMRI PELVIS WWO CONTRAST3850 72197 1 610

3300039 MRI THORACIC SPINE W CONTRASTMRI THORACIC SPINE W CONTRAST3500 72147 1 610

3300040 MRI THORACIC SPINE WO CONTRASTMRI THORACIC SPINE WO CONTRAST3150 72146 1 610

3300041 MRI THORACIC SPINE WWO CONTRASTMRI THORACIC SPINE WWO CONTRAST3850 72157 1 610

3300042 MRI UPPER EXT JOINT W CONTRAST LEFTMRI UPPER EXT JOINT W CONTRAST LEFT3500 73222,LT 1 610

3300043 MRI UPPER EXT JOINT W CONTRAST RIGHTMRI UPPER EXT JOINT W CONTRAST RIGHT3500 73222,RT 1 610

3300044 MRI UPPER EXT JOINT WO CONTRAST LEFTMRI UPPER EXT JOINT WO CONTRAST LEFT3150 73221,LT 1 610

3300045 MRI UPPER EXT JOINT WO CONTRAST RIGHTMRI UPPER EXT JOINT WO CONTRAST RIGHT3150 73221,RT 1 610

3300046 MRI UPPER EXT JOINT WWO CONTRAST LEFTMRI UPPER EXT JOINT WWO CONTRAST LEFT3850 73223,LT 1 610

3300047 MRI UPPER EXT JOINT WWO CONTRAST RIGHTMRI UPPER EXT JOINT WWO CONTRAST RIGHT3850 73223,RT 1 610

3300048 MRI UPPER EXT NON JT W CONTRAST LEFTMRI UPPER EXT NON JT W CONTRAST LEFT3500 73219,LT 1 610

3300049 MRI UPPER EXT NON JT W CONTRAST RIGHTMRI UPPER EXT NON JT W CONTRAST RIGHT3500 73219,RT 1 610

3300050 MRI UPPER EXT NON JT WO CONTRAST LEFTMRI UPPER EXT NON JT WO CONTRAST LEFT3150 73218,LT 1 610

3300051 MRI UPPER EXT NON JT WO CONTRAST RIGHTMRI UPPER EXT NON JT WO CONTRAST RIGHT3150 73218,RT 1 610

3300052 MRI UPPER EXT NON JT WWO CONTRAST LEFTMRI UPPER EXT NON JT WWO CONTRAST LEFT3850 73220,LT 1 610

3300053 MRI UPPER EXT NON JT WWO CONTRAST RIGHTMRI UPPER EXT NON JT WWO CONTRAST RIGHT3850 73220,RT 1 610

4200133 PT REEVALUATIONPT REEVALUATION 0 97002,GP 1 424

4200132 PT INITIAL EVALUATIONPT INITIAL EVALUATION 0 97001,GP 1 424

3050001 GLUCOSE 1HR OB 145 82950 1 301

2502077 NORMAL SALINE FLUSH SYRINGE 3 mL, 3 mLNORMAL SALINE FLUSH SYRINGE 3 mL, 3 mL3 1 250

2500623 SALINE FLUSH SYRINGSALINE FLUSH SYRING 3 1 250

2502082 ARIPiprazole 2 MG TABLET 1 ea, 30 eachesARIPiprazole 2 MG TABLET 1 ea, 30 eaches56 1 250

3100337 CANDIDA IGG IGM 88 1 301

3100338 MAGNESIUM, RBC 24 1 301

3100339 A GALACTOMANNAN AG 196 1 301

2502083 lamoTRIgine 25 MG TABLET 1 ea, 500 eacheslamoTRIgine 25 MG TABLET 1 ea, 500 eaches11 1 250

2700134 ORTHO IMMOBILIZER SHOULDER SLING 20 1 270

3100341 IMMUNOCAP NUTMIX GROUP 138 1 301

3100343 IMMUNOCAP ALLERGY PROFILE 705 1 301

3100342 FIBROSURE NASH 1035 1 301

3100344 IMMUNOCAP FOOD PANEL 20 513 1 301

2700781 FEEDING TUBE 28FR KCCC 88 1 270

3140028 SPUTUM CYTOLOGY 426 1 301

500151 ADMIN PNEUMONIA INJ 54 G0009 1 771

500150 INJ INFLUENZA ADMIN 54 G0008 1 771

3000086 STREPTOCOCCUS GRP A SCREENSTREPTOCOCCUS GRP A SCREEN213 87880 1 306

2502084 TETANUS DIPHTHERIA TOXOIDS 1 ea, 0.5 mLTETANUS DIPHTHERIA TOXOIDS 1 ea, 0.5 mL58 90718 1 250

2501987 AUGMENTIN (AMOX-CLAV) TABAUGMENTIN (AMOX-CLAV) TAB 8 1 250

2500048 AUGMENTIN (AMOX-CLAV) TABAUGMENTIN (AMOX-CLAV) TAB11 1 250

4200204 PT ESTIM UNATTENDED 53 G0283 1 421

3100340 PERIPHERAL SMEAR 125 85060 1 300

3000031 MANUAL DIFFERENTIAL 90 85007 1 300

2700870 SCRUB BRUSH 5 1 270

2502085 BUMETANIDE 2 MG TABLET 1 ea, 100 eachesBUMETANIDE 2 MG TABLET 1 ea, 100 eaches3 1 250

2502086 SILDENAFIL 20 MG TABLET 1 ea, 90 eachesSILDENAFIL 20 MG TABLET 1 ea, 90 eaches11 1 250

2502087 ketorolac 15 MG/ML VIAL 1 ea, 1 mLketorolac 15 MG/ML VIAL 1 ea, 1 mL25 1 250

9600321 REMOVAL IMP ERUMEN IRRIG/LAV, UNILATERAL70 69209 1 960

400177 REMOVAL IMP CERUMEN USING IRRIG/LAV, UNILATERAL60 69209 1 450

3000080 PROTHROMBIN TIMEPROTHROMBIN TIME 31 85610 1 305

2700830 WEBRIL UNDERCAST PADDING 14 1 270

2502088 BUMETANIDE 1 MG/4 ML VIAL 1 mg, 4 mLBUMETANIDE 1 MG/4 ML VIAL 1 mg, 4 mL25 1 251

2502089 OLMESARTAN MEDOXOMIL 20 MG TAB 1 ea, 30 eachesOLMESARTAN MEDOXOMIL 20 MG TAB 1 ea, 30 eaches13 1 250

2501960 CALTRATE+D3 PLUS MINERAL MINIS 1 ea, 150 eachesCALTRATE+D3 PLUS MINERAL MINIS 1 ea, 150 eaches3 1 250

3000052 GENERAL HEALTH PANELGENERAL HEALTH PANEL 488 80050 1 301

3000052 GENERAL HEALTH PANELGENERAL HEALTH PANEL 434 80050 1 301

2502091 FLUDROCORTISONE 0.1 MG TABLET 1 ea, 100 eachesFLUDROCORTISONE 0.1 MG TABLET 1 ea, 100 eaches5 1 250

2502090 UNASYN 3 GM VIAL 1 ea, 1 eachUNASYN 3 GM VIAL 1 ea, 1 each69 1 250

2502092 MUSCLE RUB CREAM 1 ea, 85 gMUSCLE RUB CREAM 1 ea, 85 g15 1 637

250 UNASYN 3 GM VIAL 1 ea, 1 eachUNASYN 3 GM VIAL 1 ea, 1 each69 1 252

2500114 COUMADIN (WARFARIN)COUMADIN (WARFARIN) 3 1 250


2502093 Coumadin 5 MG TABLET 1 ea, 100 eachesCoumadin 5 MG TABLET 1 ea, 100 eaches3 1 250


2700873 BLOOD TUBING 12 1 272


500146 IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS132 96523 1 761

2502094 IPRATROPIUM BR 0.02% SOLN 1 ea, 2.5 mLIPRATROPIUM BR 0.02% SOLN 1 ea, 2.5 mL5 J7644 1 250

Effective DateExpiration DateDepartmentFractional BillingMinimum PriceDefault CostCost MultiplierCharge Code Type

######## CC_PHARMACY 5 5 Pharmacy

######## CC_PHARMACY 1 400 400 Pharmacy



































































######## ######## CC_PHARMACY 1 25 25 Pharmacy



######## ######## CC_PHARMACY 3 3 Pharmacy

7/1/2018 CC_REFERENCE LAB Standard


7/1/2018 Emergency Room Standard


7/1/2018 CC_PRO FEES Standard

7/1/2018 CC_CENTRAL SUPPLY Standard


7/1/2018 CC_OT Standard










7/1/2018 TREATMENT ROOM Standard

7/1/2018 CC_PT Standard


7/1/2018 CC_BLOOD BANKING Standard







7/1/2018 CC_ST Standard




7/1/2018 CC_XRAY Standard









7/1/2018 CC_CT Standard


















7/1/2018 CC_IV THERAPY Standard



























7/1/2018 CC_MRI Standard






7/1/2018 CC_ULTRASOUND SONOGRAM Standard




























7/1/2018 CARDIAC/PULM REHAB Standard












































7/1/2018 CC_OBSERVATION Standard




















7/1/2018 ALTERNATIVES PROGRAM Standard
















































7/1/2018 MED SURG Standard























































7/1/2018 BEHAVIORAL HEALTH Standard


















7/1/2018 CC_IV THERAPY 1 Standard





































7/1/2018 RESP THERAPY Standard

















7/1/2018 CARDIAC/PULM REHAB Standard









































































8/8/2018 CC_PHARMACY 95 95 Pharmacy

































######## CC_IV THERAPY 50 50 Pharmacy
































7/1/2018 CC_LAB Standard


























7/1/2018 CC_EKG Standard

7/1/2018 CC_EKG Standard
























######## ADMINISTRATIVE Standard


######## CC_LAB Standard


7/1/2018 ######## CC_CENTRAL SUPPLY Standard




######## CC_PT Standard









































7/1/2018 9/1/2018 CC_PT Standard

7/1/2018 9/1/2018 CC_PT Standard





######## CC_REFERENCE LAB Standard




######## Emergency Room Standard





######## TREATMENT ROOM Standard















######## CC_PRO FEES Standard








7/1/2018 ######## CC_LAB Standard













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