Service Number Description - Southern Inyo Services Alt Code NDC # NDC Units Qual NDC Unit Quan Rev Code Std Code Type Prim Std_Code_HCPC_CPT Medicare Medicaid Eff_Date_Cur Charge Cash_Price Anthem_Price Medicare_Price Advantage_Price 47 36 ORTHOVISC 30 MG 4760036 59676036001 ME 25 250 C J7324 Y Y 07/01/2025 "1,856.00" " 1,299.20 " " 1,633.28 " " 1,002.24 " " 1,002.24 " 317 2 "OBSERVATION, INITIAL 30 MINS HOSPT" 3170002 987 C 99218 Y Y 07/01/2025 742.00 519.40 652.96 400.68 400.68 317 5 OBSERVATION DISCHARGE HOSPITALIST 3170005 987 C 99217 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 317 15 SEMI-PRIVATE ACUTE 3170015 121 Y Y 07/01/2025 "3,766.00" " 2,636.20 " " 3,314.08 " " 2,033.64 " " 2,033.64 " 358 1 IV INFUSION THERAPY 1ST HOUR 3580001 260 C 96365 Y Y 07/04/2019 450.00 315.00 396.00 243.00 243.00 358 2 IV INFUSION THERAPY EA. ADDTL HOUR 3580002 260 C 96366 Y Y 07/02/2021 206.50 144.55 181.72 111.51 111.51 358 21 SEMI-PRIVATE SNF-REHAB 3580021 128 Y Y 07/01/2025 "1,260.00" 882.00 " 1,108.80 " 680.40 680.40 358 22 SEMI PRIVATE SNF SELF PAY 3580022 128 Y Y 07/01/2025 928.00 649.60 816.64 501.12 501.12 358 31 SKILLED NURS BEDHOLD/LOA 3580031 191 Y Y 07/01/2025 930.00 651.00 818.40 502.20 502.20 358 41 SEMI-PRIVATE SWING BED 3580041 128 Y Y 07/01/2025 930.00 651.00 818.40 502.20 502.20 400 1 THORACENTESIS W/O IMAGING 4000001 450 C 32554 Y Y 07/01/2025 "2,607.00" " 1,824.90 " " 2,294.16 " " 1,407.78 " " 1,407.78 " 400 2 E&M OBS OBS D/C DAY 4000002 982 C 99217 Y Y 07/04/2019 228.00 159.60 200.64 123.12 123.12 400 3 OBSERVATION- DIRECT ADMIT 4000003 450 H G0379 Y Y 07/01/2025 "1,400.00" 980.00 " 1,232.00 " 756.00 756.00 400 4 THER/DX IV INF ADD 4000004 UN 1 450 C 96366 Y Y 07/01/2025 409.00 286.30 359.92 220.86 220.86 400 5 I&D ABSC; SMPL OR SGL 4000005 450 C 10060 Y Y 07/01/2025 782.00 547.40 688.16 422.28 422.28 400 6 CL TX CALCANEAL FX; W/MAN 4000006 981 C 28405 Y Y 07/01/2025 "1,421.00" 994.70 " 1,250.48 " 767.34 767.34 400 7 MODERATE SEDATION >5 YR. 1ST 15 MI 4000007 450 C 99156 Y Y 07/01/2025 "1,174.00" 821.80 " 1,033.12 " 633.96 633.96 400 8 POWER MOBILITY DEVICE 4000008 521 H G0372 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 400 9 CLSD TR FX TOE W/O MANIP 4000009 450 C 28510 Y Y 07/01/2025 779.00 545.30 685.52 420.66 420.66 400 10 CPR 4000010 450 C 92950 Y Y 07/01/2025 "1,515.00" " 1,060.50 " " 1,333.20 " 818.10 818.10 400 11 "PLEURAL DRAINAGE,PERC/W/INSERT CAT" 4000011 450 C 32556 Y Y 07/01/2025 "3,027.00" " 2,118.90 " " 2,663.76 " " 1,634.58 " " 1,634.58 " 400 12 FN NEEDLE ASPIRATION W/O 4000012 450 C 10021 Y Y 07/04/2019 241.00 168.70 212.08 130.14 130.14 400 13 INSERT NONTUN CATH >5+ YR 4000013 450 C 36556 Y Y 07/01/2025 "1,792.00" " 1,254.40 " " 1,576.96 " 967.68 967.68 400 14 THER/DX/IV/INF/ADD 4000014 258 C 96366 Y Y 07/02/2020 193.00 135.10 169.84 104.22 104.22 400 15 DRAIN FINGER ABSCESS 4000015 450 C 26010 Y Y 07/01/2025 "1,249.00" 874.30 " 1,099.12 " 674.46 674.46 400 16 CLSD TRT SHOULDER W/ ANES 4000016 450 C 23655 Y Y 07/01/2025 "2,256.00" " 1,579.20 " " 1,985.28 " " 1,218.24 " " 1,218.24 " 400 17 EXCISION EXT HEMORRHOID 4000017 450 C 46320 Y Y 07/01/2025 "2,315.00" " 1,620.50 " " 2,037.20 " " 1,250.10 " " 1,250.10 " 400 18 I&D HEMATOMA/SEROMA/FLUID 4000018 450 C 10140 Y Y 07/01/2025 897.00 627.90 789.36 484.38 484.38 400 19 SIMPLE REPAIR 5.1-7.5CM 4000019 450 C 12014 Y Y 07/01/2025 787.00 550.90 692.56 424.98 424.98 400 20 "REPR,INT,FACE,EAR,EYELIDS" 4000020 450 C 12053 Y Y 07/01/2025 "1,574.00" " 1,101.80 " " 1,385.12 " 849.96 849.96 400 21 RMVL IMPACT CERUMEN 4000021 450 C 69209 Y Y 07/01/2025 186.00 130.20 163.68 100.44 100.44 400 22 SERVICE PROVIDED BETWEEN 10PM/8AM 4000022 450 C 99053 Y Y 07/01/2025 310.00 217.00 272.80 167.40 167.40 400 23 "CONTROL NASAL HEMORRHAGE, POSTERIO" 4000023 450 C 30905 Y Y 07/01/2025 "1,147.00" 802.90 " 1,009.36 " 619.38 619.38 400 24 I&D INTRAORAL ABSC/ TONGUE;LINGUAL 4000024 450 C 41000 Y Y 07/01/2025 756.00 529.20 665.28 408.24 408.24 400 25 MODERATE SED SAME DOC >5+YRS INIT 4000025 981 C 99152 Y Y 07/01/2025 "1,174.00" 821.80 " 1,033.12 " 633.96 633.96 400 26 MODERATE SED SAME DOC>5+YRS ADDIT. 4000026 969 C 99153 N N 07/01/2025 557.00 389.90 490.16 300.78 300.78 400 27 EXCN OF LESION;EYELID EXCPT CHALAZ 4000027 UN 1 450 C 67840 Y Y 07/01/2025 335.00 234.50 294.80 180.90 180.90 400 30 EXCSN OF LESION;EYELID EXCPT CHALA 4000030 981 C 67840 Y Y 07/01/2025 639.00 447.30 562.32 345.06 345.06 400 34 "TUBE THORACOSTOMY,OPEN" 4000034 450 C 32551 Y Y 07/01/2025 928.00 649.60 816.64 501.12 501.12 400 35 WOUND CARE: SELECTIVE 4000035 UN 1 981 C 97597 Y Y 07/01/2025 331.00 231.70 291.28 178.74 178.74 400 36 IMM ADM EA ADD VACC 4000036 UN 1 771 C 90472 Y Y 07/01/2025 132.00 92.40 116.16 71.28 71.28 400 37 HIP DISLOC/CLOSED W/ ANESTHESIA 4000037 UN 1 450 C 27252 Y Y 07/01/2025 "3,087.00" " 2,160.90 " " 2,716.56 " " 1,666.98 " " 1,666.98 " 400 38 "OPEN TX IP DISCLOCATION, INTL FIX." 4000038 UN 1 450 C 26785 Y Y 07/01/2025 866.00 606.20 762.08 467.64 467.64 400 39 CLSD TX IP DISLOCATION W/ ANESTH. 4000039 UN 1 450 C 26775 Y Y 07/01/2025 650.00 455.00 572.00 351.00 351.00 400 47 THERPY DX INJ SUBQ/IM 4000047 450 C 96372 Y Y 07/01/2025 186.00 130.20 163.68 100.44 100.44 400 50 LIMITED TRNSTHOR ECHOCARDIOGRM 4000050 UN 1 409 C 93308 Y Y 07/01/2025 304.00 212.80 267.52 164.16 164.16 400 55 LIMITED ADB US - ABD COMP 4000055 UN 1 402 C 76705 Y Y 07/01/2025 270.00 189.00 237.60 145.80 145.80 400 59 LIMITED CHEST US 4000059 UN 1 402 C 76604 Y Y 07/01/2025 178.00 124.60 156.64 96.12 96.12 400 145 IV INJ/EACH SEQ NEW RX 4000145 UN 1 450 C 96367 Y Y 07/01/2025 404.00 282.80 355.52 218.16 218.16 400 147 TDAP TOXICOID VACC 4000147 49281021515 UN 1 450 N Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 400 155 IV INJ/EACH SEQ SAME RX 4000155 450 C 96376 Y Y 07/02/2020 182.00 127.40 160.16 98.28 98.28 400 160 INSERT NON-INDWELL CATH 4000160 450 C 51701 Y Y 07/01/2025 322.00 225.40 283.36 173.88 173.88 400 163 SIMPLE INDEWLL CATH 4000163 450 C 51702 Y Y 07/01/2025 347.00 242.90 305.36 187.38 187.38 400 168 "INTRAVENOUS INFUSION, 31MINS-1HOUR" 4000168 450 C 96360 Y Y 07/01/2025 718.00 502.60 631.84 387.72 387.72 400 180 SUTURE REMOVAL W/ O ANESTE 4000180 UN 1 450 C 15854 Y Y 07/01/2025 50.00 35.00 44.00 27.00 27.00 400 189 EVAC SUBUNGUAL HEMA PF 4000189 450 C 11740 Y Y 07/01/2025 218.00 152.60 191.84 117.72 117.72 400 196 REM FB EYE W/O SLIT LAMP 4000196 450 C 65220 Y Y 07/01/2025 310.00 217.00 272.80 167.40 167.40 400 200 LEGAL BLOOD DRAW ALC ER 4000200 300 C 80320 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 400 202 E.R. URINE DIPSTICK ONLY 4000202 307 C 81003 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 400 203 E.R GLUCOSE BY REAG STP 4000203 301 C 82948 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 400 205 E.R.OCCULT BLD 1 SLDE 4000205 301 C 82272 Y Y 07/01/2025 130.00 91.00 114.40 70.20 70.20 400 210 EMERG LEVEL VI (CC) FACIL 4000210 450 C 99291 Y Y 07/01/2025 "2,718.00" " 1,902.60 " " 2,391.84 " " 1,467.72 " " 1,467.72 " 400 211 ER CRIT CARE ADD'L 30 MIN 4000211 450 C 99292 Y Y 07/01/2025 "1,494.00" " 1,045.80 " " 1,314.72 " 806.76 806.76 400 215 CATH FOR URINE COLLECTION 4000215 300 H P9612 Y Y 07/01/2025 101.00 70.70 88.88 54.54 54.54 400 220 THER/PROPH/DX INJ IV PUSH 4000220 UN 1 450 C 96374 Y Y 07/01/2025 533.00 373.10 469.04 287.82 287.82 400 222 "RHYTHM ECG, 1-3 LEADS W/O" 4000222 730 C 93041 Y Y 07/01/2025 174.00 121.80 153.12 93.96 93.96 400 223 ORTHOVISC HYALURONATE SOD 15MG/2ML 4000223 59676036001 UN 1 450 C J7324 Y Y 07/01/2025 475.00 332.50 418.00 256.50 256.50 400 226 OBSERVATION SVS - PER HOUR 4000226 762 H G0378 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 400 231 WOUND REPAIR SIMPLE 12PF 4000231 450 C 12005 Y Y 07/01/2025 892.00 624.40 784.96 481.68 481.68 400 236 UA AUTO W/O SCOPE 4000236 300 C 81003 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 400 287 INTUBATION ENDOTRACHEAL 4000287 450 C 31500 Y Y 07/04/2019 736.00 515.20 647.68 397.44 397.44 400 288 WND REPR INTRMD 12.6-20CM 4000288 450 C 12035 Y Y 07/01/2025 "1,722.00" " 1,205.40 " " 1,515.36 " 929.88 929.88 400 291 FACILITY ROOM FEE 4000291 500 O Y Y 07/01/2025 "1,483.00" " 1,038.10 " " 1,305.04 " 800.82 800.82 400 298 "WOUND RPR, FACIAL 7.6 - 12.5" 4000298 450 C 12015 Y Y 07/01/2025 928.00 649.60 816.64 501.12 501.12 400 300 EMERG LEVEL 1 FACILITY 4000300 450 C 99281 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 400 310 "EMERG LEVEL II, FACILITY" 4000310 450 C 99282 Y Y 07/01/2025 681.00 476.70 599.28 367.74 367.74 400 314 REPAIR OF NAIL BED 4000314 450 C 11760 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 400 320 EMERG LEVEL III FACILITY 4000320 450 C 99283 Y Y 07/01/2025 "1,052.00" 736.40 925.76 568.08 568.08 400 330 "EMERG LEVEL IV, FACILITY" 4000330 450 C 99284 Y Y 07/01/2025 "1,606.00" " 1,124.20 " " 1,413.28 " 867.24 867.24 400 338 WND REPR INTRMD 20.1-30CM 4000338 450 C 12036 Y Y 07/01/2025 "1,884.00" " 1,318.80 " " 1,657.92 " " 1,017.36 " " 1,017.36 " 400 339 CLSD TRT BI-ANKLE FX W/O 4000339 450 C 27808 Y Y 07/01/2025 "1,358.00" 950.60 " 1,195.04 " 733.32 733.32 400 340 EMERG LEVEL V FACILITY 4000340 450 C 99285 Y Y 07/01/2025 "2,286.00" " 1,600.20 " " 2,011.68 " " 1,234.44 " " 1,234.44 " 400 400 SLIT LAMP 4000400 450 C 92002 Y Y 07/01/2025 275.00 192.50 242.00 148.50 148.50 400 437 DRAIN ABS CYST HEMA DENT 4000437 450 C 41800 Y Y 07/01/2025 996.00 697.20 876.48 537.84 537.84 400 440 CONTROL NASAL HEMOR 4000440 450 C 30903 Y Y 07/01/2025 815.00 570.50 717.20 440.10 440.10 400 441 NASO-ORO TUBE PLACEMENT 4000441 450 C 43752 Y Y 07/01/2025 495.00 346.50 435.60 267.30 267.30 400 452 DRAIN ABSCES PAROTID SIMP 4000452 500 C 42300 Y Y 07/01/2025 480.00 336.00 422.40 259.20 259.20 400 462 F.B. RMVL SIMPFF 4000462 450 C 10120 Y Y 07/01/2025 634.00 443.80 557.92 342.36 342.36 400 463 "FB REMOVAL,COMPLICATED" 4000463 450 C 10121 Y Y 07/01/2025 "1,229.00" 860.30 " 1,081.52 " 663.66 663.66 400 478 I&D ABSCES COMPLEX 4000478 450 C 10061 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 400 520 CMPL/ EARNOSE LIP 1.1-2.5 4000520 450 C 13151 Y Y 07/01/2025 "1,900.00" " 1,330.00 " " 1,672.00 " " 1,026.00 " " 1,026.00 " 400 542 "REMOVAL OF FOREIGN BODY, FOOT; SUB" 4000542 450 C 28190 Y Y 07/01/2025 "1,251.00" 875.70 " 1,100.88 " 675.54 675.54 400 561 WOUND REP INTRMD<2.6CM 4000561 450 C 12031 Y Y 07/01/2025 "1,131.00" 791.70 995.28 610.74 610.74 400 568 COLLECT SPECIMEN VENOUS ACC DEVICE 4000568 761 C 36591 Y Y 07/01/2025 348.00 243.60 306.24 187.92 187.92 400 569 SNELLEN EYE TEST 4000569 450 C 99173 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 400 570 OUTPATIENT SERVICES BY RN (TRMT RM 4000570 761 C 99211 N Y 07/01/2025 86.00 60.20 75.68 46.44 46.44 400 574 SIMPLE FACIAL RPR 2.6CM-5 4000574 450 C 12013 Y Y 07/01/2025 666.00 466.20 586.08 359.64 359.64 400 575 DEBRIDEMENT SUBCU 20 CM < 4000575 450 C 11042 Y Y 07/01/2025 682.00 477.40 600.16 368.28 368.28 400 576 SIMPLE REPAIR 2.5CM < 4000576 450 C 12001 Y Y 07/01/2025 567.00 396.90 498.96 306.18 306.18 400 577 SIMPLE REPAIR 7.6-12.5 CM 4000577 450 C 12004 Y Y 07/01/2025 714.00 499.80 628.32 385.56 385.56 400 578 SIMPLE REPAIR 2.6-7.5 CM 4000578 450 C 12002 Y Y 07/01/2025 606.00 424.20 533.28 327.24 327.24 400 579 LAC REPAIR FACIAL 4000579 450 C 12041 Y Y 07/01/2025 714.00 499.80 628.32 385.56 385.56 400 580 REPAIR INTER FAC 2.6CM-5. 4000580 450 C 12052 Y Y 07/01/2025 "1,257.00" 879.90 " 1,106.16 " 678.78 678.78 400 581 INTERM REPAIR 20.1-30CM 4000581 450 C 12046 Y Y 07/01/2025 "2,166.00" " 1,516.20 " " 1,906.08 " " 1,169.64 " " 1,169.64 " 400 582 "REPAIR, INTERM. 7.6-12.5CM" 4000582 450 C 12034 Y Y 07/01/2025 "1,421.00" 994.70 " 1,250.48 " 767.34 767.34 400 583 WOUND REPR INTMD 2.6 -5.0 4000583 450 C 12042 Y Y 07/01/2025 "1,352.00" 946.40 " 1,189.76 " 730.08 730.08 400 586 CL TX OF DISTALFIBULAR FX 4000586 450 C 27786 Y Y 07/01/2025 "1,270.00" 889.00 " 1,117.60 " 685.80 685.80 400 587 "REPR, INTRMD FACIAL <2.6" 4000587 450 C 12051 Y Y 07/01/2025 "1,329.00" 930.30 " 1,169.52 " 717.66 717.66 400 589 "WOUND REPR,INTRM 2.6 - 7.5" 4000589 450 C 12032 Y Y 07/01/2025 "1,254.00" 877.80 " 1,103.52 " 677.16 677.16 400 637 WOUND REPR INTRMD7.6-12.5 4000637 450 C 12044 Y Y 07/01/2025 "1,602.00" " 1,121.40 " " 1,409.76 " 865.08 865.08 400 645 REPR INTRMD FACIAL 7.6-12 4000645 450 C 12054 Y Y 07/01/2025 "1,671.00" " 1,169.70 " " 1,470.48 " 902.34 902.34 400 652 LAC REPAIR NON-FACIAL 4000652 450 C 12041 Y Y 07/01/2025 "1,042.00" 729.40 916.96 562.68 562.68 400 657 IRRIG IMPLANTED VENOUS 4000657 450 C 96523 Y Y 07/01/2025 248.00 173.60 218.24 133.92 133.92 400 660 "WOUND REPR,FACIAL, 2.5 OR LESS " 4000660 450 C 12011 Y Y 07/01/2025 604.00 422.80 531.52 326.16 326.16 400 678 TX INC ABORT COMP SURG 4000678 450 C 59812 Y Y 07/01/2025 "1,545.00" " 1,081.50 " " 1,359.60 " 834.30 834.30 400 686 LUMBAR PUNTURE 4000686 450 C 62270 Y Y 07/01/2025 804.00 562.80 707.52 434.16 434.16 400 703 CLSD TX METACARPAL WO/MAN 4000703 450 C 26600 Y Y 07/01/2025 979.00 685.30 861.52 528.66 528.66 400 775 RMVL F.B. EYE CONJUN 4000775 450 C 65205 Y Y 07/01/2025 310.00 217.00 272.80 167.40 167.40 400 801 CONTROL NASAL HEM-SIMPLE 4000801 450 C 30901 Y Y 07/01/2025 449.00 314.30 395.12 242.46 242.46 400 835 PERIPHERAL NERVE BLOCK PF 4000835 450 C 64450 Y Y 07/02/2020 198.00 138.60 174.24 106.92 106.92 400 858 TX DIST PHLANG FX/WMANIP 4000858 450 C 26755 Y Y 07/01/2025 940.00 658.00 827.20 507.60 507.60 400 875 CLAVICLE FX 4000875 450 C 23500 Y Y 07/01/2025 723.00 506.10 636.24 390.42 390.42 400 884 CLSD TXT OF PATELLAR DISL 4000884 450 C 27560 Y Y 07/01/2025 433.00 303.10 381.04 233.82 233.82 400 946 COLLECTION CAPILLARY SPEC 4000946 450 C 36416 Y Y 07/01/2025 36.00 25.20 31.68 19.44 19.44 400 956 IV INFUS THERAPY 1ST HR 4000956 450 C 96365 Y Y 07/01/2025 639.00 447.30 562.32 345.06 345.06 400 987 POSTOP FOLLOW-UP VISI 4000987 450 C 99024 Y Y 07/01/2025 0.00 - - - - 400 999 ER FOLLOW UP 4000999 450 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 400 1009 IV INFUSION EACH ADDT HR 4001009 450 C 96361 Y Y 07/01/2025 231.00 161.70 203.28 124.74 124.74 400 1023 "INTRONEEDLE,INTRACTH:VEIN" 4001023 450 C 36000 Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 400 1145 IV INJ/EACH SEQ NEW RX 4001145 258 C 96367 Y Y 07/02/2020 225.00 157.50 198.00 121.50 121.50 400 1155 IV INJ EACH SEQ SAME RX 4001155 450 C 96376 Y Y 07/01/2025 242.00 169.40 212.96 130.68 130.68 400 1202 TX SUPFICAL W/PACKING 4001202 450 C 12021 Y Y 07/01/2025 524.00 366.80 461.12 282.96 282.96 400 1214 OXYGEN SATURATION 4001214 412 C 94760 N N 07/01/2025 75.00 52.50 66.00 40.50 40.50 400 1220 THER/PROPH/DX INJ IV PUSH 4001220 258 C 96374 Y Y 01/01/2000 155.48 108.84 136.82 83.96 83.96 400 1239 TX/PRO/DX INJ DRUG ADDON 4001239 UN 1 450 C 96375 Y Y 07/01/2025 257.00 179.90 226.16 138.78 138.78 400 1240 CHEMO ADMIN IV INFUSION TECHNIQUE 4001240 335 H Q0084 Y Y 07/01/2025 760.00 532.00 668.80 410.40 410.40 400 1241 IMMUNIZATION ADMIN 4001241 771 C 90471 Y Y 07/01/2025 122.00 85.40 107.36 65.88 65.88 400 1247 THERPY/DX INJ;SUBQ/IM 4001247 450 C 96372 Y Y 07/02/2020 198.00 138.60 174.24 106.92 106.92 400 1295 RMV/BIVALV;GAUNT/BDY CAST 4001295 450 C 29700 Y Y 07/01/2025 265.00 185.50 233.20 143.10 143.10 400 1379 HIP DISLOC/CLOSED 4001379 450 C 27250 Y Y 07/01/2025 "1,751.00" " 1,225.70 " " 1,540.88 " 945.54 945.54 400 1429 "DRAIN ABSCESS, SIMPLE" 4001429 450 C 40800 Y Y 07/01/2025 848.00 593.60 746.24 457.92 457.92 400 1720 EXTENSOR TENDON REPAIR 4001720 450 C 26418 Y Y 07/01/2025 "2,162.00" " 1,513.40 " " 1,902.56 " " 1,167.48 " " 1,167.48 " 400 1734 REMVL F.B CORNEAL /SPF 4001734 450 C 65222 Y Y 07/01/2025 196.00 137.20 172.48 105.84 105.84 400 1767 RMVL F.B. INTRANASAL PF 4001767 450 C 30300 Y Y 07/01/2025 390.00 273.00 343.20 210.60 210.60 400 1768 ER-OXYGEN THERAPY DAY 4001768 450 Y Y 07/04/2019 91.00 63.70 80.08 49.14 49.14 400 1825 SPECIAL CASTING SUPPLIES 4001825 272 H A4590 Y Y 07/01/2025 51.00 35.70 44.88 27.54 27.54 400 1866 SHOULDER DISLOC/CLOSEDPF 4001866 450 C 23650 Y Y 07/01/2025 "1,174.00" 821.80 " 1,033.12 " 633.96 633.96 400 1895 REPAIR TENDON/MUSCLE FLEX 4001895 450 C 25260 Y Y 07/01/2025 "2,718.00" " 1,902.60 " " 2,391.84 " " 1,467.72 " " 1,467.72 " 400 1956 "INTRAVENOUS INFUSION, 1ST HOUR" 4001956 260 C 96365 Y Y 07/02/2021 515.74 361.02 453.85 278.50 278.50 400 1957 THORACENTESIS W/O IMAGING 4001957 450 C 32554 Y Y 07/04/2019 "2,008.00" " 1,405.60 " " 1,767.04 " " 1,084.32 " " 1,084.32 " 400 2100 TRANSFUSION BLOOD COMPONE 4002100 450 C 36430 Y Y 07/01/2025 "1,483.00" " 1,038.10 " " 1,305.04 " 800.82 800.82 400 2126 I&D ABSCESS PERITONSILLA 4002126 450 C 42700 Y Y 07/01/2025 "1,021.00" 714.70 898.48 551.34 551.34 400 2210 THERAPEUTIC PHLEBOTOMY 4002210 305 C 99195 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 400 2260 ANKLE DISLOC W/ REDUCT 4002260 450 C 27840 Y Y 07/01/2025 600.00 420.00 528.00 324.00 324.00 400 2278 "CL TX, IP JOINT DISLOCA" 4002278 450 C 26770 Y Y 07/01/2025 615.00 430.50 541.20 332.10 332.10 400 2286 MCP DISLOC W/REDUCT PF 4002286 450 C 26700 Y Y 07/01/2025 519.00 363.30 456.72 280.26 280.26 400 2518 APPLY GAUNTLET CAST 4002518 450 C 29085 Y Y 07/01/2025 235.00 164.50 206.80 126.90 126.90 400 2617 PUNCTURE ASP/ABCESS PF 4002617 450 C 10160 Y Y 07/01/2025 265.00 185.50 233.20 143.10 143.10 400 2626 "STRAPPING; SHOULDER (EG, VELPEAU) " 4002626 450 C 29240 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 400 2633 ARTHROCENTESIS MAJOR JOINT 4002633 450 C 20610 Y Y 07/01/2025 298.00 208.60 262.24 160.92 160.92 400 2666 AVULSION NAIL PLATE PF 4002666 450 C 11730 Y Y 07/01/2025 399.00 279.30 351.12 215.46 215.46 400 2690 BLADDER IRRIGATION 4002690 450 C 51700 Y Y 07/01/2025 175.00 122.50 154.00 94.50 94.50 400 2835 CLO TX NASAL BONE STAB 4002835 450 C 21320 Y Y 07/01/2025 552.00 386.40 485.76 298.08 298.08 400 2880 ULNAR RADIUS FX CLOSED 4002880 450 C 25565 Y Y 07/01/2025 "1,705.00" " 1,193.50 " " 1,500.40 " 920.70 920.70 400 2915 CLS TX MONTEGGIA FX DISLO 4002915 450 C 24620 Y Y 07/01/2025 "2,015.00" " 1,410.50 " " 1,773.20 " " 1,088.10 " " 1,088.10 " 400 2920 CLSD TX HUMER SHAFT FX WO 4002920 450 C 24500 Y Y 07/01/2025 "1,081.00" 756.70 951.28 583.74 583.74 400 3050 CLS TX OF DISTAL RADIAL 4003050 450 C 25605 Y Y 07/01/2025 "1,412.00" 988.40 " 1,242.56 " 762.48 762.48 400 3195 BIMALEOLAR FX ANKLE CL TX 4003195 450 C 27810 Y Y 07/01/2025 "2,854.00" " 1,997.80 " " 2,511.52 " " 1,541.16 " " 1,541.16 " 400 3205 CLSD TX ANKLE FX W/MANIP 4003205 450 C 27818 Y Y 07/01/2025 "1,672.00" " 1,170.40 " " 1,471.36 " 902.88 902.88 400 3287 INTUBATION ENDOTRACHEAL 4003287 450 C 31500 Y Y 07/01/2025 "1,449.00" " 1,014.30 " " 1,275.12 " 782.46 782.46 400 3311 EKG-TRACE ONLY 4003311 730 C 93005 Y Y 07/01/2025 356.00 249.20 313.28 192.24 192.24 400 5000 CAST REMOVAL 4005000 360 C 29730 Y Y 07/01/2025 67.00 46.90 58.96 36.18 36.18 400 5001 APP LONG LEG SPLINT 4005001 450 C 29505 Y Y 07/01/2025 388.00 271.60 341.44 209.52 209.52 400 5002 SHORT LEG SPLINT 4005002 450 C 29515 Y Y 07/01/2025 202.00 141.40 177.76 109.08 109.08 400 5003 APPL SHORT ARM SPLINT 4005003 450 C 29125 Y Y 07/01/2025 455.00 318.50 400.40 245.70 245.70 400 5004 APPL FINGER SPLINT 4005004 450 C 29130 Y Y 07/01/2025 192.00 134.40 168.96 103.68 103.68 400 5005 CL TX FX PHALANGEAL W/MAN 4005005 450 C 26725 Y Y 07/01/2025 "1,257.00" 879.90 " 1,106.16 " 678.78 678.78 400 5006 LONG ARM SPLINT 4005006 450 C 29105 Y Y 07/01/2025 554.00 387.80 487.52 299.16 299.16 400 5007 CL TXT ULNA RADIUS FX W/O 4005007 450 C 25560 Y Y 07/01/2025 794.00 555.80 698.72 428.76 428.76 400 5555 APPLY ACE WRAP 4005555 450 Y Y 01/01/2000 0.00 - - - - 400 5641 REM DEVITALIZED TISSUE NONSELECTIV 4005641 500 C 97602 Y Y 07/02/2020 65.00 45.50 57.20 35.10 35.10 400 5697 TRT RADIUS FX W/O MANIP 4005697 450 C 25600 Y Y 07/01/2025 559.00 391.30 491.92 301.86 301.86 400 6152 COLLECTION OF PAP 4006152 521 H Q0091 Y Y 07/01/2025 82.00 57.40 72.16 44.28 44.28 400 6262 GLUCOSE BLOOD TEST 4006262 309 C 82962 Y Y 07/01/2025 82.00 57.40 72.16 44.28 44.28 400 6354 DEBRIDE:RMV:OPEN FX 4006354 450 C 11010 Y Y 07/01/2025 598.00 418.60 526.24 322.92 322.92 400 6543 TX CLSD ELBOW DISCLOC 4006543 450 C 24605 Y Y 07/01/2025 894.00 625.80 786.72 482.76 482.76 400 7500 CLOSED TMNT OF ANKLE DISLCNT W/ AN 4007500 UN 1 450 C 27842 Y Y 07/01/2025 681.00 476.70 599.28 367.74 367.74 400 7656 DERMABOND 4007656 270 Y Y 07/02/2020 67.00 46.90 58.96 36.18 36.18 400 7854 NO CHARGE VISIT 4007854 500 C 99024 Y Y 07/02/2020 0.00 - - - - 400 8000 "PHLEBOTOMY, THERAPEUTIC" 4008000 450 C 99195 Y Y 01/01/2000 189.09 132.36 166.40 102.11 102.11 400 8001 THERAPUTIC PHLEPOTOMY 4008001 100 C 99195 Y Y 01/01/2000 189.09 132.36 166.40 102.11 102.11 400 8002 VENIPUNCTURE ER BY RN 4008002 300 C 36415 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 400 8100 CLOSED TRMNT OF ANKLE DSLCTNT W/ A 4008100 UN 1 981 C 27842 Y Y 07/01/2025 "1,112.00" 778.40 978.56 600.48 600.48 400 8150 MODERATE SED 5 YR & UNDER 4008150 450 C 99144 Y Y 07/01/2025 331.00 231.70 291.28 178.74 178.74 400 8153 COMPLEX REPR 2.6-75CM 4008153 450 C 13121 Y Y 07/01/2025 "1,088.00" 761.60 957.44 587.52 587.52 400 8154 INTERM REPAIR 7.6-12.5CM 4008154 450 C 12034 Y Y 07/04/2019 475.00 332.50 418.00 256.50 256.50 400 8157 ARTHROCENTESIS ASPIRATION 4808157 982 C 20606 Y Y 07/02/2021 525.37 367.76 462.33 283.70 283.70 400 8542 SHAVING SKIN LESION 4008542 450 C 11301 Y Y 07/01/2025 249.00 174.30 219.12 134.46 134.46 400 8600 ARTHROCENTESIS; INTERMPF 4008600 450 C 20605 Y Y 07/01/2025 860.00 602.00 756.80 464.40 464.40 400 8752 CONCURRENT INFUSION 4008752 UN 450 C 96368 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 400 8964 "CURETTAGE, POSTPARTUM" 4008964 450 C 59160 Y Y 07/01/2025 543.00 380.10 477.84 293.22 293.22 400 8966 FLUORESCEIN ANGIOGRAPHY 4008966 450 C 92235 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 400 8968 URINE HCG PREGNANCY TEST 4008968 UN 1 450 C 81025 Y Y 07/01/2025 330.00 231.00 290.40 178.20 178.20 400 8969 FLU A & B TO OUTPATIENT 4008969 450 C 87400 Y Y 07/01/2025 18.00 12.60 15.84 9.72 9.72 400 8970 INFLUENZA ASSAY W/OPTIC 4008970 450 C 87804 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 400 8980 CLINDAMYCIN; PHOS/D5W 4008980 7261163925 UN 1 450 H S0077 Y Y 07/02/2021 400.00 280.00 352.00 216.00 216.00 400 9000 FLUORESCEIN ANGPHY UNILAT OR BIOLA 4009000 UN 1 450 C 92235 Y Y 07/01/2025 213.00 149.10 187.44 115.02 115.02 400 9901 "EKG ROUTINE, W/ INTRPTION & REPOR" 4009901 UN 1 730 C 93000 Y Y 07/01/2025 370.00 259.00 325.60 199.80 199.80 401 1 FN NEEDLE ASPIRATION W/O 4010001 981 C 10021 Y Y 07/01/2025 539.00 377.30 474.32 291.06 291.06 401 2 CLSD TRT SHOULDER W/ANES 4010002 981 C 23655 Y Y 07/01/2025 "3,181.00" " 2,226.70 " " 2,799.28 " " 1,717.74 " " 1,717.74 " 401 3 EXCISION EXT HEMORRHOID 4010003 981 C 46320 Y Y 07/01/2025 "2,487.00" " 1,740.90 " " 2,188.56 " " 1,342.98 " " 1,342.98 " 401 4 RMVL IMPACT CERUMEN 4010004 981 C 69209 Y Y 07/01/2025 311.00 217.70 273.68 167.94 167.94 401 5 I&D INTRAORAL ABSC/ TONGUE;LINGUAL 4010005 981 C 41000 Y Y 07/01/2025 411.00 287.70 361.68 221.94 221.94 401 6 UNUSUAL TRAVEL(TRANSPORT&ESCORT PT 4010006 977 C 99082 Y Y 07/01/2025 "1,818.00" " 1,272.60 " " 1,599.84 " 981.72 981.72 401 7 CLOSED TRT POST HIP ARTH;ANESTHESI 4010007 981 C 27266 Y Y 07/01/2025 "2,717.00" " 1,901.90 " " 2,390.96 " " 1,467.18 " " 1,467.18 " 401 8 "REMOVAL OF FOREIGN BODY, FOOT; SUB" 4010008 969 C 28190 Y Y 07/01/2025 "1,624.00" " 1,136.80 " " 1,429.12 " 876.96 876.96 401 9 SMOKING & TOBACCO CESSATION;3-10MI 4010009 981 C 99406 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 401 10 HIP DISLOC/CLOSED W/ ANESTHESIA PF 4010010 UN 1 981 C 27252 Y Y 07/01/2025 "4,224.00" " 2,956.80 " " 3,717.12 " " 2,280.96 " " 2,280.96 " 401 15 E&M OBS CARE LVL 3 4010015 987 C 99220 Y Y 07/01/2025 597.00 417.90 525.36 322.38 322.38 401 16 E&M OBS OBS D/C DAY 4010016 987 C 99217 Y Y 07/01/2025 750.00 525.00 660.00 405.00 405.00 401 17 THORACENTESIS ASP INIT SU 4010017 981 C 32421 Y Y 07/04/2019 807.00 564.90 710.16 435.78 435.78 401 18 "E&M,SUBSEQ OBSERV,MODER" 4010018 981 C 99225 Y Y 07/01/2025 298.00 208.60 262.24 160.92 160.92 401 20 "THORACENTESIS, ASP, W/O GUIDANCE" 4010020 981 C 32554 Y Y 07/01/2025 "1,480.00" " 1,036.00 " " 1,302.40 " 799.20 799.20 401 21 ER-READ CXR 2V 4010021 981 C 71020 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 401 22 "ER-READ ELBOW,3+V" 4010022 981 C 73080 Y Y 07/02/2020 171.00 119.70 150.48 92.34 92.34 401 23 "ER-READ, FOREARM,2V" 4010023 981 C 73090 Y Y 07/02/2020 135.00 94.50 118.80 72.90 72.90 401 24 "ER-READ,WRIST,3+V" 4010024 981 C 73110 Y Y 07/02/2020 173.00 121.10 152.24 93.42 93.42 401 25 WOUND CARE: SELECTIVE PF 4010025 UN 1 450 C 97597 Y Y 07/01/2025 398.00 278.60 350.24 214.92 214.92 401 30 INJECTION ANESTHETIC AGENT NRV BLK 4010030 UN 1 981 C 64450 Y Y 07/01/2025 161.00 112.70 141.68 86.94 86.94 401 34 TUBE THORACOSTOMY OPEN 4010034 981 C 32551 Y Y 07/01/2025 "1,698.00" " 1,188.60 " " 1,494.24 " 916.92 916.92 401 56 "OPEN TX IP DISLOCATION, PRO" 4010056 UN 1 981 C 26785 Y Y 07/01/2025 "2,170.00" " 1,519.00 " " 1,909.60 " " 1,171.80 " " 1,171.80 " 401 57 CLSD TX IP DISLOCATION W/ANESTH PR 4010057 UN 1 981 C 26775 Y Y 07/01/2025 "1,837.00" " 1,285.90 " " 1,616.56 " 991.98 991.98 401 58 "THROMBOLYSIS,COR;IV" 4010058 981 C 92977 Y Y 07/01/2025 "3,113.00" " 2,179.10 " " 2,739.44 " " 1,681.02 " " 1,681.02 " 401 66 "SERIAL TONOMETRY,I&R,S/DA" 4010066 981 C 92120 Y Y 07/01/2025 219.00 153.30 192.72 118.26 118.26 401 74 CLS TX ACROMIOCLAV DISL 4010074 981 C 23540 Y Y 07/01/2025 "1,082.00" 757.40 952.16 584.28 584.28 401 75 APPLY SHOULDER STRAPPING 4010075 981 C 29240 Y Y 07/01/2025 480.00 336.00 422.40 259.20 259.20 401 76 STRAPPING ELBOW/WRIST 4010076 981 C 29260 Y Y 07/01/2025 385.00 269.50 338.80 207.90 207.90 401 77 STRAPPING KNEE 4010077 981 C 29530 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 401 82 "INCIS TRACH,PLANNED;<2YO" 4010082 981 C 31601 Y Y 07/01/2025 "2,484.00" " 1,738.80 " " 2,185.92 " " 1,341.36 " " 1,341.36 " 401 90 TRACHEOSTOMY ER PROC 4010090 981 C 31603 Y Y 07/01/2025 "2,627.00" " 1,838.90 " " 2,311.76 " " 1,418.58 " " 1,418.58 " 401 127 REPR INTRM FACIAL 12.6-20 4010127 981 C 12055 Y Y 07/01/2025 "1,473.00" " 1,031.10 " " 1,296.24 " 795.42 795.42 401 130 OBSTETRICAL CARE 4010130 981 C 59409 Y Y 07/01/2025 "3,851.00" " 2,695.70 " " 3,388.88 " " 2,079.54 " " 2,079.54 " 401 132 VAG DELIV ONLY;WPOST CARE 4010132 981 C 59410 Y Y 07/01/2025 "5,057.00" " 3,539.90 " " 4,450.16 " " 2,730.78 " " 2,730.78 " 401 135 TX INC ABORT COMP SURG 4010135 981 C 59812 Y Y 07/01/2025 "2,075.00" " 1,452.50 " " 1,826.00 " " 1,120.50 " " 1,120.50 " 401 155 I&D HEMATOMASEROMA/FLUID 4010155 981 C 10140 Y Y 07/01/2025 636.00 445.20 559.68 343.44 343.44 401 157 "EPISIOTMY,VAG RPR OTH MD" 4010157 981 C 59300 Y Y 07/01/2025 813.00 569.10 715.44 439.02 439.02 401 165 VENIPUNC<3YO;SCALP VEIN 4010165 981 C 36405 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 401 173 "VENIPUNC<3YO;FEM,JUG,SAG" 4010173 981 C 36400 Y Y 07/01/2025 189.00 132.30 166.32 102.06 102.06 401 181 VENIPUNTOVER 3YRS PHY 4010181 981 C 36410 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 401 223 "WOUND RPR, FACIAL, OVER 30.0 " 4010223 981 C 12018 Y Y 07/01/2025 "1,779.00" " 1,245.30 " " 1,565.52 " 960.66 960.66 401 231 "WOUND REPAIR, SMPL 12.6-20 " 4010231 981 C 12005 Y Y 07/01/2025 "1,112.00" 778.40 978.56 600.48 600.48 401 240 CYSTOSCOPY AND TREATMENT 4010240 981 C 52281 Y Y 07/01/2025 777.00 543.90 683.76 419.58 419.58 401 241 CYSTOSCOPY&URETER CATHER 4010241 981 C 52005 Y Y 07/01/2025 659.00 461.30 579.92 355.86 355.86 401 249 "WOUND RPR, FACIAL12.6 - 20.0" 4010249 981 C 12016 Y Y 07/01/2025 "2,223.00" " 1,556.10 " " 1,956.24 " " 1,200.42 " " 1,200.42 " 401 256 SIMP TX SCALP 20.1-30PF 4010256 981 C 12006 Y Y 07/01/2025 "1,779.00" " 1,245.30 " " 1,565.52 " 960.66 960.66 401 264 WOND RPR FACIAL 20.1-30CM 4010264 981 C 12017 Y Y 07/01/2025 "1,409.00" 986.30 " 1,239.92 " 760.86 760.86 401 272 "WOUND RPR, FACIAL 5.1 - 7.5 " 4010272 981 C 12014 Y Y 07/01/2025 "1,111.00" 777.70 977.68 599.94 599.94 401 280 "WOUND RPR, FACIAL 2.6 - 5.0" 4010280 981 C 12013 Y Y 07/01/2025 "1,048.00" 733.60 922.24 565.92 565.92 401 298 "WOND RPR,FACIAL7.6-12.5CM" 4010298 981 C 12015 Y Y 07/01/2025 "1,428.00" 999.60 " 1,256.64 " 771.12 771.12 401 306 WOUND REPAIR SMPL 7.6-PF 4010306 981 C 12004 Y Y 07/01/2025 "1,017.00" 711.90 894.96 549.18 549.18 401 314 REPAIR OF NAIL BED 4010314 981 C 11760 Y Y 07/01/2025 954.00 667.80 839.52 515.16 515.16 401 322 REP COMPLX 2.6-7.5CM 4010322 981 C 13121 Y Y 07/01/2025 "2,142.00" " 1,499.40 " " 1,884.96 " " 1,156.68 " " 1,156.68 " 401 348 WOUND REPAIR SMPL 2.6-7.5 4010348 981 C 12002 Y Y 07/01/2025 810.00 567.00 712.80 437.40 437.40 401 355 REMOVAL IMPACT CERUMEMPF 4010355 981 C 69210 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 401 363 "LAC RPR,CX,TRNK;1.1-2.5CM" 4010363 981 C 13100 Y Y 07/01/2025 "1,231.00" 861.70 " 1,083.28 " 664.74 664.74 401 371 "REP COMPLX EA ADD 5CM,O" 4010371 981 C 13153 Y Y 07/01/2025 784.00 548.80 689.92 423.36 423.36 401 400 SLIT LAMP EXAM 4010400 450 C 92002 Y Y 07/01/2025 239.00 167.30 210.32 129.06 129.06 401 405 LONG ARM SPLINT PF 4010405 981 C 29105 Y Y 07/01/2025 368.00 257.60 323.84 198.72 198.72 401 410 SLIT LAMP EXAM-COMPLEX 4010410 981 C 92004 Y Y 07/01/2025 453.00 317.10 398.64 244.62 244.62 401 413 LONG LEG SPLINT PF 4010413 981 C 29505 Y Y 07/01/2025 261.00 182.70 229.68 140.94 140.94 401 421 SHORT ARM SPLINT PF 4010421 981 C 29125 Y Y 07/01/2025 308.00 215.60 271.04 166.32 166.32 401 439 SHORT LEG SPLINT PF 4010439 981 C 29515 Y Y 07/01/2025 335.00 234.50 294.80 180.90 180.90 401 447 FINGER SPLINT PF 4010447 981 C 29130 Y Y 07/01/2025 157.00 109.90 138.16 84.78 84.78 401 454 "REM FB MUS,TEND;DEEP,COMP" 4010454 981 C 20525 Y Y 07/01/2025 "1,522.00" " 1,065.40 " " 1,339.36 " 821.88 821.88 401 462 "F.B.RMVL-SUBCUT,SIMPPF" 4010462 981 C 10120 Y Y 07/01/2025 588.00 411.60 517.44 317.52 317.52 401 470 F.B. RMVL-MUSC/TENDON PF 4010470 981 C 20520 Y Y 07/01/2025 "1,043.00" 730.10 917.84 563.22 563.22 401 471 REM F/B PHARYNX PF 4010471 981 C 42809 Y Y 07/01/2025 709.00 496.30 623.92 382.86 382.86 401 496 CMPLX/EAR NOSE LIP <1.1CM 4010496 981 C 13150 Y Y 07/01/2025 "1,479.00" " 1,035.30 " " 1,301.52 " 798.66 798.66 401 512 "REP COMPLX,FACIAL1.1-2.5" 4010512 450 C 13131 Y Y 07/01/2025 "1,458.00" " 1,020.60 " " 1,283.04 " 787.32 787.32 401 520 CMPLX/EAR NOSE LIP1.1-2.5 4010520 981 C 13151 Y Y 07/01/2025 "1,698.00" " 1,188.60 " " 1,494.24 " 916.92 916.92 401 534 "MODERATE SEDATION, >5 YR 1S 15 MIN" 4010534 981 C 99152 Y Y 07/01/2025 460.00 322.00 404.80 248.40 248.40 401 535 MOD CS SAME PHYS 5 YR & UNDER 4010535 981 C 99144 Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 401 538 REPR COMPLX 1.1-2.5CM 4010538 981 C 13120 Y Y 07/01/2025 "1,283.00" 898.10 " 1,129.04 " 692.82 692.82 401 546 REP COMPLX FACIAL2.6- 7.5 4010546 981 C 13132 Y Y 07/01/2025 "2,393.00" " 1,675.10 " " 2,105.84 " " 1,292.22 " " 1,292.22 " 401 553 CMPLX/TRUNK 2.6-7.5CM 4010553 981 C 13101 Y Y 07/01/2025 "1,489.00" " 1,042.30 " " 1,310.32 " 804.06 804.06 401 561 "WOUND REP,INTRMD,<2.6CM" 4010561 981 C 12031 Y Y 07/01/2025 "1,357.00" 949.90 " 1,194.16 " 732.78 732.78 401 579 "WOUND REPR,INTRM, 2.5 OR LESS" 4010579 981 C 12041 Y Y 07/01/2025 "1,250.00" 875.00 " 1,100.00 " 675.00 675.00 401 587 "REPR,INTRMD FACIAL <2.6CM" 4010587 981 C 12051 Y Y 07/01/2025 "1,594.00" " 1,115.80 " " 1,402.72 " 860.76 860.76 401 595 "WOUND REPAIR,INTM > 30 CM" 4010595 981 C 12037 Y Y 07/01/2025 "2,533.00" " 1,773.10 " " 2,229.04 " " 1,367.82 " " 1,367.82 " 401 603 "WOUND RPR, INTRM, OVER 30.0" 4010603 981 C 12047 Y Y 07/01/2025 "2,699.00" " 1,889.30 " " 2,375.12 " " 1,457.46 " " 1,457.46 " 401 611 REPR INTRM FACIAL >30CM 4010611 981 C 12057 Y Y 07/01/2025 "2,223.00" " 1,556.10 " " 1,956.24 " " 1,200.42 " " 1,200.42 " 401 629 "WOUND REPR,INTRM,7.6-12.5" 4010629 981 C 12034 Y Y 07/01/2025 "1,705.00" " 1,193.50 " " 1,500.40 " 920.70 920.70 401 637 "WOUND REPR,INTRM, 7.6 - 12.5" 4010637 981 C 12044 Y Y 07/01/2025 "1,923.00" " 1,346.10 " " 1,692.24 " " 1,038.42 " " 1,038.42 " 401 645 REPR INTRMD FACIAL7.6-12. 4010645 981 C 12054 Y Y 07/01/2025 "2,006.00" " 1,404.20 " " 1,765.28 " " 1,083.24 " " 1,083.24 " 401 652 "WOUND REPAIR, SIMP <2.6CM" 4010652 981 C 12001 Y Y 07/01/2025 682.00 477.40 600.16 368.28 368.28 401 660 WOND REPR SMPL FACIAL<2.5 4010660 981 C 12011 Y Y 07/01/2025 "1,008.00" 705.60 887.04 544.32 544.32 401 678 SMPL RPR SCLP EXT OVER 30 4010678 981 C 12007 Y Y 07/01/2025 "1,779.00" " 1,245.30 " " 1,565.52 " 960.66 960.66 401 686 LUMBAR PUNCTURE PF 4010686 981 C 62270 Y Y 07/01/2025 729.00 510.30 641.52 393.66 393.66 401 689 "INJECTION, EPIDURAL, BLO" 4010689 981 C 62273 Y Y 07/01/2025 684.00 478.80 601.92 369.36 369.36 401 702 METACARPEL FX CLOSED S 4010702 981 C 26605 Y Y 07/01/2025 "1,905.00" " 1,333.50 " " 1,676.40 " " 1,028.70 " " 1,028.70 " 401 710 PHANGL SHFT FX W/MAN PF 4010710 981 C 26725 Y Y 07/01/2025 "1,592.00" " 1,114.40 " " 1,400.96 " 859.68 859.68 401 736 KNEE DISLOC W/REDUCT PF 4010736 981 C 27550 Y Y 07/01/2025 "2,445.00" " 1,711.50 " " 2,151.60 " " 1,320.30 " " 1,320.30 " 401 740 I & D ANKLE ABSC HEMA 4010740 981 C 27603 Y Y 07/01/2025 "2,120.00" " 1,484.00 " " 1,865.60 " " 1,144.80 " " 1,144.80 " 401 744 CLO TX HUM SHAF FX;WMANIP 4010744 981 C 24505 Y Y 07/01/2025 "2,445.00" " 1,711.50 " " 2,151.60 " " 1,320.30 " " 1,320.30 " 401 751 TIBIAL SHAFT FX CLOSED 4010751 981 C 27752 Y Y 07/01/2025 335.00 234.50 294.80 180.90 180.90 401 793 "BURN TX;WOANES,MEDIUM" 4010793 981 C 16025 Y Y 07/01/2025 629.00 440.30 553.52 339.66 339.66 401 801 NASAL HEMM ANTER COMPLPF 4010801 981 C 30903 Y Y 07/01/2025 448.00 313.60 394.24 241.92 241.92 401 819 CONTROL NASAL HEM-SIMPLE 4010819 981 C 30901 Y Y 07/01/2025 451.00 315.70 396.88 243.54 243.54 401 827 NASAL HEMM POST PF 4010827 981 C 30905 Y Y 07/01/2025 "1,377.00" 963.90 " 1,211.76 " 743.58 743.58 401 830 NASAL ENDOSCOPY DIAGNOSIS 4010830 981 C 31231 Y Y 07/01/2025 436.00 305.20 383.68 235.44 235.44 401 835 PERIPHERAL NERVE BLOCKPF 4010835 981 C 64450 Y Y 07/02/2020 249.00 174.30 219.12 134.46 134.46 401 843 CLSD TX NASAL BONE FXWOST 4010843 981 C 21315 Y Y 07/01/2025 815.00 570.50 717.20 440.10 440.10 401 868 TEMP PACEMAKER SGL CHMBER 4010868 981 C 33210 Y Y 07/01/2025 "1,023.00" 716.10 900.24 552.42 552.42 401 875 ULTRASOUND BLADDER 4010875 402 C 51798 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 401 876 ABD PARACENTESIS PF 4010876 981 C 49082 Y Y 07/01/2025 585.00 409.50 514.80 315.90 315.90 401 884 PATELLA DISLOC/CLOSED PF 4010884 981 C 27560 Y Y 07/01/2025 "1,613.00" " 1,129.10 " " 1,419.44 " 871.02 871.02 401 892 "PERICARDIOCENTESIS, INIT" 4010892 981 C 33010 Y Y 07/01/2025 677.00 473.90 595.76 365.58 365.58 401 900 ESOPHAGSCOPY DIAGNOSTIC 4010900 981 C 43200 Y Y 07/01/2025 591.00 413.70 520.08 319.14 319.14 401 905 UPPER GI ENDO DIAGNOSTIC 4010905 981 C 43235 Y Y 07/01/2025 777.00 543.90 683.76 419.58 419.58 401 910 UPPER GI ENDO INJ VARICE 4010910 981 C 43243 Y Y 07/01/2025 "1,434.00" " 1,003.80 " " 1,261.92 " 774.36 774.36 401 915 UP GI ENDOS W/REMOVAL FB 4010915 981 C 43247 Y Y 07/01/2025 "1,078.00" 754.60 948.64 582.12 582.12 401 920 GASTROSTOMY TUBE REPLCPF 4010920 981 C 43760 Y Y 07/01/2025 345.00 241.50 303.60 186.30 186.30 401 925 PERIANAL ABSC I&D PF 4010925 981 C 46050 Y Y 07/01/2025 "1,231.00" 861.70 " 1,083.28 " 664.74 664.74 401 926 INJ ANESTHETIC AGENT SNGL 4010926 981 C 64420 Y Y 07/01/2025 409.00 286.30 359.92 220.86 220.86 401 934 "INTUBATION, ENDOTRACHEAL" 4010934 981 C 31500 Y Y 07/01/2025 "1,519.00" " 1,063.30 " " 1,336.72 " 820.26 820.26 401 1007 "IV INFUS TX/DX,WMD;TO 1H" 4011007 270 C 96361 Y Y 07/02/2020 174.00 121.80 153.12 93.96 93.96 401 1008 IV INFUS THERAPY 1ST HR 4011008 270 C 96365 Y Y 07/02/2020 482.00 337.40 424.16 260.28 260.28 401 1009 IV INFUS THERAPY ADDL HR 4011009 270 C 96361 Y Y 07/02/2020 174.00 121.80 153.12 93.96 93.96 401 1011 MD 5150 MEDICAL EVAL 4011011 981 C 99283 Y Y 07/01/2025 512.00 358.40 450.56 276.48 276.48 401 1023 IV START-M.D. PF 4011023 981 C 36000 Y Y 07/01/2025 54.00 37.80 47.52 29.16 29.16 401 1060 "REP CMPLX EA ADD 5CM, 0" 4011060 981 C 13133 Y Y 07/01/2025 714.00 499.80 628.32 385.56 385.56 401 1064 "SCOPE LARYNX,DIR;DX,NB" 4011064 981 C 31520 Y Y 07/01/2025 894.00 625.80 786.72 482.76 482.76 401 1072 DIRECT LARYNSCOPY 4011072 981 C 31525 Y Y 07/01/2025 930.00 651.00 818.40 502.20 502.20 401 1075 LARNGOSCOPY W/FB REMOVAL 4011075 981 C 31530 Y Y 07/01/2025 "1,005.00" 703.50 884.40 542.70 542.70 401 1085 INDIRECT LARYNGOSCOPY PF 4011085 981 C 31505 Y Y 07/01/2025 278.00 194.60 244.64 150.12 150.12 401 1090 INDIRECT LARYG/RMV F.PF 4011090 981 C 31511 Y Y 07/01/2025 712.00 498.40 626.56 384.48 384.48 401 1098 "SCOPE LARYNX,DIR;ASPIRATE" 4011098 981 C 31515 Y Y 07/01/2025 626.00 438.20 550.88 338.04 338.04 401 1163 I&D PILONIDAL CYST;COMP 4011163 981 C 10081 Y Y 07/01/2025 777.00 543.90 683.76 419.58 419.58 401 1171 I&D PILONIDAL CYST;SIMP 4011171 981 C 10080 Y Y 07/01/2025 425.00 297.50 374.00 229.50 229.50 401 1189 EVAC SUBUNGUAL HEMA PF 4011189 981 C 11740 Y Y 07/01/2025 171.00 119.70 150.48 92.34 92.34 401 1205 "I&D ABSCES,SIMPLE,SINGL" 4011205 981 C 10060 Y Y 07/01/2025 647.00 452.90 569.36 349.38 349.38 401 1210 "N BLOCK INJ,BRACHIAL PLEX" 4011210 981 C 64415 Y Y 07/01/2025 371.00 259.70 326.48 200.34 200.34 401 1213 "INJ,ANES;AXILLARY NRV" 4011213 981 C 64417 Y Y 07/01/2025 424.00 296.80 373.12 228.96 228.96 401 1220 TRIGEMINAL NERVE BLOCK 4011220 981 C 64400 Y Y 07/01/2025 341.00 238.70 300.08 184.14 184.14 401 1221 "INJ,ANESTH FACIAL NRV" 4011221 981 C 64402 Y Y 07/01/2025 407.00 284.90 358.16 219.78 219.78 401 1225 INJ ANETH AG VAGUS NERVE 4011225 981 C 64408 Y Y 07/01/2025 498.00 348.60 438.24 268.92 268.92 401 1239 THERAP/DX INJ;IV 4011239 450 C 96374 Y Y 07/02/2020 311.00 217.70 273.68 167.94 167.94 401 1241 IMMUNIZATION ADIM 4011241 771 C 90471 Y Y 01/01/2000 31.52 22.06 27.74 17.02 17.02 401 1247 THERPY/DX INJ;SUBQ/IM 4011247 450 C 96372 Y Y 07/04/2019 49.00 34.30 43.12 26.46 26.46 401 1254 "INJ TEND,LIG,TRIG PT,CYST" 4011254 981 C 20550 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 401 1255 INJ 1/MORE TRIGPT 1-2MSC 4011255 981 C 20552 Y Y 07/01/2025 377.00 263.90 331.76 203.58 203.58 401 1262 "PLACE NEEDL,INTRAOS INFUS" 4011262 981 C 36680 Y Y 07/01/2025 721.00 504.70 634.48 389.34 389.34 401 1270 REPR INTRM FACIAL 12.6-5 4011270 981 C 12055 Y Y 07/01/2025 "1,838.00" " 1,286.60 " " 1,617.44 " 992.52 992.52 401 1288 "WOUND REPR,INTRM, 12.6 - 20" 4011288 981 C 12035 Y Y 07/01/2025 "1,265.00" 885.50 " 1,113.20 " 683.10 683.10 401 1295 BIVALVING FULL ARM/LEGPF 4011295 981 C 29705 Y Y 07/01/2025 265.00 185.50 233.20 143.10 143.10 401 1296 WOUND REPR INTMD 12.6 - 20 4011296 981 C 12045 Y Y 07/01/2025 "1,330.00" 931.00 " 1,170.40 " 718.20 718.20 401 1304 REPR INTERMD FACIAL2.6-5C 4011304 981 C 12052 Y Y 07/01/2025 "1,004.00" 702.80 883.52 542.16 542.16 401 1312 "WOUND REPR,INTRM 2.6 - 7.5" 4011312 981 C 12032 Y Y 07/01/2025 983.00 688.10 865.04 530.82 530.82 401 1320 "WOUND REPR,INTRM 2.6 - 5.0" 4011320 981 C 12042 Y Y 07/01/2025 971.00 679.70 854.48 524.34 524.34 401 1338 WND REPR INTRMD 20.1-30CM 4011338 981 C 12036 Y Y 07/01/2025 "1,493.00" " 1,045.10 " " 1,313.84 " 806.22 806.22 401 1346 "WOUND RPR, INTRM, 20.1-30.0" 4011346 981 C 12046 Y Y 07/01/2025 "1,570.00" " 1,099.00 " " 1,381.60 " 847.80 847.80 401 1353 REPR INTERM FACIAL20.1-30 4011353 981 C 12056 Y Y 07/01/2025 "1,838.00" " 1,286.60 " " 1,617.44 " 992.52 992.52 401 1363 REPR INTRM FACIAL 5.1-7.5 4011363 981 C 12053 Y Y 07/01/2025 "1,067.00" 746.90 938.96 576.18 576.18 401 1379 HIP DISLOC/CLOSED PF 4011379 981 C 27250 Y Y 07/01/2025 "2,627.00" " 1,838.90 " " 2,311.76 " " 1,418.58 " " 1,418.58 " 401 1395 NSL ENDOS W/CONTR HEMORR 4011395 981 C 31238 Y Y 07/01/2025 "1,151.00" 805.70 " 1,012.88 " 621.54 621.54 401 1403 "DRAIN ABSCES PALATE,UVULA" 4011403 981 C 42000 Y Y 07/01/2025 564.00 394.80 496.32 304.56 304.56 401 1411 "IO I&D ABSCES,LINGUAL" 4011411 981 C 41000 Y Y 07/01/2025 617.00 431.90 542.96 333.18 333.18 401 1429 "DRAIN ABSCES,MOUTH;SIMPLE" 4011429 981 C 40800 Y Y 07/01/2025 688.00 481.60 605.44 371.52 371.52 401 1430 DRAIN ANSCESS MOUTH COMP 4011430 981 C 40801 Y Y 07/01/2025 "1,206.00" 844.20 " 1,061.28 " 651.24 651.24 401 1437 DRAIN ABS CYST HEMA DENT 4011437 981 C 41800 Y Y 07/01/2025 618.00 432.60 543.84 333.72 333.72 401 1452 "DRAIN ABSCES,PAROTID;SIMP" 4011452 981 C 42300 Y Y 07/01/2025 836.00 585.20 735.68 451.44 451.44 401 1478 I&D ABSCES;COMPLEX PF 4011478 981 C 10061 Y Y 07/01/2025 "1,244.00" 870.80 " 1,094.72 " 671.76 671.76 401 1483 COLPOR SUT VAGINA NONOBS 4011483 981 C 57200 Y Y 07/01/2025 "1,635.00" " 1,144.50 " " 1,438.80 " 882.90 882.90 401 1486 I&D BARTHOLIN ABSCESS PF 4011486 981 C 56420 Y Y 07/01/2025 542.00 379.40 476.96 292.68 292.68 401 1490 I&D VULVA/PERINEAL ABCPF 4011490 981 C 56405 Y Y 07/01/2025 593.00 415.10 521.84 320.22 320.22 401 1494 INSRT CV TUN DEVICE W/O 4011494 981 C 36565 Y Y 07/01/2025 "1,976.00" " 1,383.20 " " 1,738.88 " " 1,067.04 " " 1,067.04 " 401 1510 "DRAIN EXT AUD CANAL,ABSC" 4011510 981 C 69020 Y Y 07/01/2025 793.00 555.10 697.84 428.22 428.22 401 1528 "DRAIN EXT EAR,ABSCES;SIMP" 4011528 981 C 69000 Y Y 07/01/2025 635.00 444.50 558.80 342.90 342.90 401 1569 RPR LIP MORE THAN 1/2 VER 4011569 981 C 40654 Y Y 07/01/2025 "2,333.00" " 1,633.10 " " 2,053.04 " " 1,259.82 " " 1,259.82 " 401 1570 REPAIR LIP FULL VERMILION ONLY 4011570 UN 1 981 C 40650 Y N 07/01/2025 944.00 660.80 830.72 509.76 509.76 401 1577 AMPU. FINGER/THUMB 4011577 981 C 26951 Y Y 07/01/2025 "3,582.00" " 2,507.40 " " 3,152.16 " " 1,934.28 " " 1,934.28 " 401 1589 "THROMBOLYSIS,CEREBRAL;IV" 4011589 981 C 37195 Y Y 07/01/2025 "1,294.00" 905.80 " 1,138.72 " 698.76 698.76 401 1593 I&D PERITONSILAR ABCESPF 4011593 981 C 42700 Y Y 07/01/2025 748.00 523.60 658.24 403.92 403.92 401 1650 EXCISE NAIL & NAIL MATPF 4011650 981 C 11750 Y Y 07/01/2025 944.00 660.80 830.72 509.76 509.76 401 1700 REMOVAL INGROWN TOENAIL 4011700 981 C 11765 Y Y 07/01/2025 356.00 249.20 313.28 192.24 192.24 401 1718 REPAIR EXTENSOR TENDOR 4011718 981 C 26410 Y Y 07/01/2025 "3,617.00" " 2,531.90 " " 3,182.96 " " 1,953.18 " " 1,953.18 " 401 1720 EXTENSOR TENDON REPAIR F 4011720 981 C 26418 Y Y 07/01/2025 "3,044.00" " 2,130.80 " " 2,678.72 " " 1,643.76 " " 1,643.76 " 401 1726 FLEXOR TENDON REPAIR 4011726 981 C 26350 Y Y 07/01/2025 "4,512.00" " 3,158.40 " " 3,970.56 " " 2,436.48 " " 2,436.48 " 401 1734 REMVL F.B.CORNEAL /SPF 4011734 981 C 65222 Y Y 07/01/2025 291.00 203.70 256.08 157.14 157.14 401 1741 DRAINAGE OF EYELID ABSCES 4011741 981 C 67700 Y Y 07/01/2025 503.00 352.10 442.64 271.62 271.62 401 1742 "RMVL F,B.INTRANASAL PF" 4011742 981 C 30300 Y Y 07/01/2025 671.00 469.70 590.48 362.34 362.34 401 1767 "EXC FB,EXT EYE;CONJ EMBED" 4011767 981 C 65210 Y Y 07/01/2025 272.00 190.40 239.36 146.88 146.88 401 1775 "RMVL F.B.EYE,CONJUNCPF" 4011775 981 C 65205 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 401 1783 REMVL F.B.AUDITORY CAPF 4011783 981 C 69200 Y Y 07/01/2025 574.00 401.80 505.12 309.96 309.96 401 1791 "REMOVAL FB CORNEA, W/O S" 4011791 981 C 65220 Y Y 07/01/2025 222.00 155.40 195.36 119.88 119.88 401 1809 DISTAL RADIUS FX CLOSED 4011809 981 C 25605 Y Y 07/01/2025 "3,042.00" " 2,129.40 " " 2,676.96 " " 1,642.68 " " 1,642.68 " 401 1817 NASO-ORO TUBE PLACEMENT 4011817 981 C 43752 Y Y 07/01/2025 199.00 139.30 175.12 107.46 107.46 401 1825 GASTRIC LAVAGE 4011825 981 C 43753 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 401 1826 BLOOD TRANSFUSION 4011826 391 C 36430 Y Y 07/01/2025 262.00 183.40 230.56 141.48 141.48 401 1833 CLSD TRT RAD HD SUBLUX 4011833 981 C 24640 Y Y 07/01/2025 457.00 319.90 402.16 246.78 246.78 401 1841 ELBOW DISLOCATION PF 4011841 981 C 24600 Y Y 07/01/2025 "1,760.00" " 1,232.00 " " 1,548.80 " 950.40 950.40 401 1858 TX DIST PHLANG FX/WMANIP 4011858 981 C 26755 Y Y 07/01/2025 "1,414.00" 989.80 " 1,244.32 " 763.56 763.56 401 1866 SHOULDER DISLOC/CLOSEDPF 4011866 981 C 23650 Y Y 07/01/2025 "1,491.00" " 1,043.70 " " 1,312.08 " 805.14 805.14 401 1874 TMJ DISLOC REDUCTION PF 4011874 981 C 21480 Y Y 07/01/2025 182.00 127.40 160.16 98.28 98.28 401 1882 "BURN-DRESS/DEBRIDE, SMPL" 4011882 981 C 16020 Y Y 07/01/2025 460.00 322.00 404.80 248.40 248.40 401 1916 EMERG LEVEL V PF 4011916 981 C 99285 Y Y 07/01/2025 "1,195.00" 836.50 " 1,051.60 " 645.30 645.30 401 1924 ECG; 12 LEADS;I&R 4011924 985 C 93010 Y Y 07/01/2025 139.00 97.30 122.32 75.06 75.06 401 1926 RHYTHM STRIP EVAL 4011926 981 C 93042 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 401 1957 EMERG LEVEL IV PF 4011957 981 C 99284 Y Y 07/01/2025 977.00 683.90 859.76 527.58 527.58 401 1965 EMERG LEVEL III PF 4011965 981 C 99283 Y Y 07/01/2025 639.00 447.30 562.32 345.06 345.06 401 1973 EMERG LEVEL II PF 4011973 981 C 99282 Y Y 07/01/2025 341.00 238.70 300.08 184.14 184.14 401 1981 EMERG LEVEL 1 PF 4011981 981 C 99281 Y Y 07/01/2025 290.00 203.00 255.20 156.60 156.60 401 1999 INCIS THRMBSD HEMMORRHPF 4011999 981 C 46083 Y Y 07/01/2025 534.00 373.80 469.92 288.36 288.36 401 2021 ADJ TSU TRF SCLP ARM <10S 4012021 981 C 14020 Y Y 07/01/2025 "3,215.00" " 2,250.50 " " 2,829.20 " " 1,736.10 " " 1,736.10 " 401 2040 "CYSTOSCOPY,REMOVAL OF CLO" 4012040 981 C 52001 Y Y 07/01/2025 "1,451.00" " 1,015.70 " " 1,276.88 " 783.54 783.54 401 2054 TRIMMING NAIL NONDYSTROP 4012054 981 C 11719 Y Y 07/01/2025 57.00 39.90 50.16 30.78 30.78 401 2062 LONG ARM CAST PF 4012062 981 C 29065 Y Y 07/01/2025 378.00 264.60 332.64 204.12 204.12 401 2070 LONG LEG CAST PF 4012070 981 C 29345 Y Y 07/01/2025 567.00 396.90 498.96 306.18 306.18 401 2096 SHORT ARM CAST PF 4012096 981 C 29075 Y Y 07/01/2025 339.00 237.30 298.32 183.06 183.06 401 2104 APPLY SHORT LEG CAST;WALK 4012104 981 C 29425 Y Y 07/01/2025 402.00 281.40 353.76 217.08 217.08 401 2112 SHORT LEG CAST PF 4012112 981 C 29405 Y Y 07/01/2025 363.00 254.10 319.44 196.02 196.02 401 2120 VENIPNTR CUT DOWN <1YR 4012120 981 C 36420 Y Y 07/01/2025 281.00 196.70 247.28 151.74 151.74 401 2138 VENIPNTR CUT DOWN >1YR 4012138 981 C 36425 Y Y 07/01/2025 516.00 361.20 454.08 278.64 278.64 401 2153 INSERT NONTUN CATH >5+ YR 4012153 981 C 36556 Y Y 07/01/2025 "1,008.00" 705.60 887.04 544.32 544.32 401 2179 CNTR VEN CATH NNTUN< 5YRS 4012179 981 C 36555 Y Y 07/01/2025 741.00 518.70 652.08 400.14 400.14 401 2195 "DEBRID;SKIN,PART THICK" 4012195 981 C 11012 Y Y 07/01/2025 161.00 112.70 141.68 86.94 86.94 401 2250 MONOTOR INTERST FLUID MU 4012250 981 C 20950 Y Y 07/01/2025 692.00 484.40 608.96 373.68 373.68 401 2257 IRRAG CORPORA CAVERNOS PR 4012257 981 C 54220 Y Y 07/01/2025 770.00 539.00 677.60 415.80 415.80 401 2260 ANKLE DISLOC W/REDUCT PF 4012260 981 C 27840 Y Y 07/01/2025 "1,892.00" " 1,324.40 " " 1,664.96 " " 1,021.68 " " 1,021.68 " 401 2278 IP JOINT DISLOC W/REDUPF 4012278 981 C 26770 Y Y 07/01/2025 "1,243.00" 870.10 " 1,093.84 " 671.22 671.22 401 2286 MCP DISLOC W/REDUCT PF 4012286 981 C 26700 Y Y 07/01/2025 "1,495.00" " 1,046.50 " " 1,315.60 " 807.30 807.30 401 2294 BIVALVING BOOT/GAUNTLETPF 4012294 981 C 29700 Y Y 07/01/2025 195.00 136.50 171.60 105.30 105.30 401 2296 WEDGING CLUBFOOT CAST 4012296 981 C 29750 Y Y 07/01/2025 419.00 293.30 368.72 226.26 226.26 401 2297 BIVALVING FULL ARM/LEG PF 4012297 981 C 29705 Y Y 07/01/2025 265.00 185.50 233.20 143.10 143.10 401 2302 INSERT TEMP CATH COMP 4012302 981 C 51703 Y Y 07/01/2025 465.00 325.50 409.20 251.10 251.10 401 2304 INSER TEMP INDWEL BLADDER 4012304 981 C 51702 Y Y 07/01/2025 174.00 121.80 153.12 93.96 93.96 401 2310 "CATHERIZATION, STRAIGHT" 4012310 981 C 51701 Y Y 07/01/2025 161.00 112.70 141.68 86.94 86.94 401 2315 CHANGE CYST TUBE SIMPLE 4012315 981 C 51705 Y Y 07/01/2025 381.00 266.70 335.28 205.74 205.74 401 2328 "CATH UMBILICAL VEIN,NB" 4012328 981 C 36510 Y Y 07/01/2025 406.00 284.20 357.28 219.24 219.24 401 2344 CLO TX CLAVICLE FX;WMANIP 4012344 981 C 23505 Y Y 07/01/2025 "1,329.00" 930.30 " 1,169.52 " 717.66 717.66 401 2351 DRAIN FINGER ABSCESS SPF 4012351 981 C 26010 Y Y 07/01/2025 473.00 331.10 416.24 255.42 255.42 401 2355 DRAIN FINGER ABSCESS CPF 4012355 981 C 26011 Y Y 07/01/2025 "1,032.00" 722.40 908.16 557.28 557.28 401 2365 REMOVAL IUD PF 4012365 981 C 58301 Y Y 07/01/2025 389.00 272.30 342.32 210.06 210.06 401 2377 CMPLX/EAR NOSE LIP2.6-7.5 4012377 981 C 13152 Y Y 07/01/2025 "2,294.00" " 1,605.80 " " 2,018.72 " " 1,238.76 " " 1,238.76 " 401 2476 CPR 4012476 981 C 92950 Y Y 07/01/2025 "1,792.00" " 1,254.40 " " 1,576.96 " 967.68 967.68 401 2479 TRANSCUTANEOUS PACING PF 4012479 981 C 92953 Y Y 07/01/2025 80.00 56.00 70.40 43.20 43.20 401 2484 TRACHEO CRICOTHYR MEMBRN 4012484 981 C 31605 Y Y 07/01/2025 "1,048.00" 733.60 922.24 565.92 565.92 401 2492 CRIT CARE-ADD'L 30 M.PF 4012492 981 C 99292 Y Y 07/01/2025 791.00 553.70 696.08 427.14 427.14 401 2500 EMERG LEVEL VI (CC) PF 4012500 981 C 99291 Y Y 07/01/2025 "1,959.00" " 1,371.30 " " 1,723.92 " " 1,057.86 " " 1,057.86 " 401 2518 APPLY/GAUNTLET CAST 4012518 981 C 29085 Y Y 07/01/2025 355.00 248.50 312.40 191.70 191.70 401 2534 INITIAL TX 1ST DEGR BURN 4012534 981 C 16000 Y Y 07/01/2025 258.00 180.60 227.04 139.32 139.32 401 2553 FORESKIN MANIPULATION 4012553 981 C 54450 Y Y 07/01/2025 350.00 245.00 308.00 189.00 189.00 401 2554 CORP CVERN FISTULIZATION 4012554 981 C 54435 Y Y 07/01/2025 "2,359.00" " 1,651.30 " " 2,075.92 " " 1,273.86 " " 1,273.86 " 401 2556 INJ CORP CAVERNOSA PHARM 4012556 981 C 54235 Y Y 07/01/2025 411.00 287.70 361.68 221.94 221.94 401 2559 DRAIN SKENE'S GLAND ABSCS 4012559 981 C 53060 Y Y 07/01/2025 "1,061.00" 742.70 933.68 572.94 572.94 401 2575 ANOSCOPY PF 4012575 981 C 46600 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 401 2583 ARTERIAL PUNCTURE 4012583 981 C 36600 Y Y 07/01/2025 230.00 161.00 202.40 124.20 124.20 401 2585 OXYGEN SATURATION 4012585 460 C 94760 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 401 2617 PUCT ASP/ABCESS PF 4012617 981 C 10160 Y Y 07/01/2025 319.00 223.30 280.72 172.26 172.26 401 2618 DEBRIDE EXT EXCEMA < 10% 4012618 450 C 11000 Y Y 07/01/2025 185.00 129.50 162.80 99.90 99.90 401 2620 I&D COMPLEX P/OP WND INF 4012620 981 C 10180 Y Y 07/01/2025 440.00 308.00 387.20 237.60 237.60 401 2625 "ARTHROCENTESIS, INTERMPF" 4012625 981 C 20605 Y Y 07/02/2021 525.37 367.76 462.33 283.70 283.70 401 2633 "ARTHROCENTESIS, MAJOR PF" 4012633 981 C 20610 Y Y 07/01/2025 999.00 699.30 879.12 539.46 539.46 401 2641 "ARTHROCENTESIS, SMALL PF" 4012641 981 C 20600 Y Y 07/01/2025 "1,404.00" 982.80 " 1,235.52 " 758.16 758.16 401 2666 AVULSION NAIL PLATE PF 4012666 981 C 11730 Y Y 07/01/2025 341.00 238.70 300.08 184.14 184.14 401 2682 REP COMPLX EA ADD 5CM 4012682 981 C 13122 Y Y 07/01/2025 468.00 327.60 411.84 252.72 252.72 401 2690 BLADDER IRRIGATION 4012690 981 C 51700 Y Y 07/01/2025 261.00 182.70 229.68 140.94 140.94 401 2716 DRESS/DEBRIDE BRN GRT 10% 4012716 981 C 16030 Y Y 07/01/2025 714.00 499.80 628.32 385.56 385.56 401 2724 CARDIOVERSION PF 4012724 981 C 92960 Y Y 07/01/2025 930.00 651.00 818.40 502.20 502.20 401 2732 "TX CMC FX DIS,THUM;WMANIP" 4012732 981 C 26645 Y Y 07/01/2025 "1,875.00" " 1,312.50 " " 1,650.00 " " 1,012.50 " " 1,012.50 " 401 2740 WINDOWING OF CAST 4012740 981 C 29730 Y Y 07/01/2025 257.00 179.90 226.16 138.78 138.78 401 2800 "DEBRIDE SKIN, FULL THICK" 4012800 981 C 11043 Y Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 401 2805 "DEBRID;SKIN,SUBQ TISSUE" 4012805 981 C 11042 Y Y 07/01/2025 279.00 195.30 245.52 150.66 150.66 401 2810 TX SUPERFICAL DEHISCENCE 4012810 981 C 12020 Y Y 07/01/2025 "1,029.00" 720.30 905.52 555.66 555.66 401 2820 MASTOTOMY W/ESP DRN ABS 4012820 981 C 19020 Y Y 07/01/2025 "1,478.00" " 1,034.60 " " 1,300.64 " 798.12 798.12 401 2825 "PUNCT,ASP,BREAST CYST" 4012825 981 C 19000 Y Y 07/01/2025 257.00 179.90 226.16 138.78 138.78 401 2830 INTERDENTAL WIRING 4012830 981 C 21497 Y Y 07/01/2025 "2,396.00" " 1,677.20 " " 2,108.48 " " 1,293.84 " " 1,293.84 " 401 2835 CLO TX NASAL BONE STAB 4012835 981 C 21320 Y Y 07/01/2025 769.00 538.30 676.72 415.26 415.26 401 2840 CLS PLATL/MAX FX DENTFX 4012840 981 C 21421 Y Y 07/01/2025 "3,289.00" " 2,302.30 " " 2,894.32 " " 1,776.06 " " 1,776.06 " 401 2845 CLO TX MANDIBLE FX:W/O 4012845 981 C 21450 Y Y 07/01/2025 "2,435.00" " 1,704.50 " " 2,142.80 " " 1,314.90 " " 1,314.90 " 401 2850 CL TX MANDIB FXWOMANIP 4012850 981 C 21450 Y Y 07/01/2025 934.00 653.80 821.92 504.36 504.36 401 2855 TX RIB FR;UNCOMPLIC EA 4012855 981 C 21800 Y Y 07/01/2025 381.00 266.70 335.28 205.74 205.74 401 2875 CLAVICLE FX 4012875 981 C 23500 Y Y 07/01/2025 "1,082.00" 757.40 952.16 584.28 584.28 401 2880 "ULNAR RADIUS FX, CLOSED" 4012880 981 C 25565 Y Y 07/01/2025 "2,557.00" " 1,789.90 " " 2,250.16 " " 1,380.78 " " 1,380.78 " 401 2885 CLS TX SCAPULA FX;W/O M 4012885 981 C 23570 Y Y 07/01/2025 "1,199.00" 839.30 " 1,055.12 " 647.46 647.46 401 2890 TREAT HUMERUS FRACTURE 4012890 981 C 23605 Y Y 07/01/2025 "1,964.00" " 1,374.80 " " 1,728.32 " " 1,060.56 " " 1,060.56 " 401 2895 "HUMERUS FX,CLOSED PF" 4012895 981 C 23600 Y Y 07/01/2025 "1,527.00" " 1,068.90 " " 1,343.76 " 824.58 824.58 401 2900 TREAT DISLOCATION/FRACTUR 4012900 981 C 23665 Y Y 07/01/2025 "1,802.00" " 1,261.40 " " 1,585.76 " 973.08 973.08 401 2905 TX GR TUBEROS FX;WOMANIP 4012905 981 C 23620 Y Y 07/01/2025 "1,273.00" 891.10 " 1,120.24 " 687.42 687.42 401 2915 CLS TX MONTEGGIA FX DISLO 4012915 981 C 24620 Y Y 07/01/2025 "3,029.00" " 2,120.30 " " 2,665.52 " " 1,635.66 " " 1,635.66 " 401 2920 CLSD TX HUMER SHAFT FXWOM 4012920 981 C 24500 Y Y 07/01/2025 "1,621.00" " 1,134.70 " " 1,426.48 " 875.34 875.34 401 2925 CLSD TX SUPRACONDYLAR/TR 4012925 981 C 24530 Y Y 07/01/2025 "1,763.00" " 1,234.10 " " 1,551.44 " 952.02 952.02 401 2935 CLS TX EPICOND FX WO MAN 4012935 981 C 24560 Y Y 07/01/2025 "1,417.00" 991.90 " 1,246.96 " 765.18 765.18 401 2940 CLS TX HUM EPICON FX MAN 4012940 981 C 24565 Y Y 07/01/2025 "2,560.00" " 1,792.00 " " 2,252.80 " " 1,382.40 " " 1,382.40 " 401 2945 CLSED TX HUMERAL CONDYL 4012945 981 C 24576 Y Y 07/01/2025 "1,545.00" " 1,081.50 " " 1,359.60 " 834.30 834.30 401 2950 CLS TX HUMERAL FX MANIP 4012950 981 C 24577 Y Y 07/01/2025 "2,671.00" " 1,869.70 " " 2,350.48 " " 1,442.34 " " 1,442.34 " 401 2955 RADIAL HEAD FX CLOSEDPF 4012955 981 C 24650 Y Y 07/01/2025 "1,171.00" 819.70 " 1,030.48 " 632.34 632.34 401 2960 CLS TX HEAD/NECK FX MAN 4012960 981 C 24655 Y Y 07/01/2025 "2,127.00" " 1,488.90 " " 1,871.76 " " 1,148.58 " " 1,148.58 " 401 2965 CLSD TX ULNAR FX PROXW/OM 4012965 981 C 24670 Y Y 07/01/2025 "1,321.00" 924.70 " 1,162.48 " 713.34 713.34 401 2970 CLS TX RD SFT FX DIST JT 4012970 981 C 25520 Y Y 07/01/2025 "2,847.00" " 1,992.90 " " 2,505.36 " " 1,537.38 " " 1,537.38 " 401 2975 CLSD TX RAD SHAFT W/O MAN 4012975 981 C 25500 Y Y 07/01/2025 "1,217.00" 851.90 " 1,070.96 " 657.18 657.18 401 2980 CLSD RAD SHAFT FX W/MA 4012980 981 C 25505 Y Y 07/01/2025 "2,468.00" " 1,727.60 " " 2,171.84 " " 1,332.72 " " 1,332.72 " 401 2985 CLSD TX ULNAR SHAFT W/O M 4012985 981 C 25530 Y Y 07/01/2025 "1,172.00" 820.40 " 1,031.36 " 632.88 632.88 401 3005 ULNA RADIUS FX PF 4013005 981 C 25560 Y Y 07/01/2025 "1,193.00" 835.10 " 1,049.84 " 644.22 644.22 401 3015 DISTAL RADIUS FX PF 4013015 981 C 25600 Y Y 07/01/2025 "1,323.00" 926.10 " 1,164.24 " 714.42 714.42 401 3020 SCAPHOID (NAVICULAR) FPF 4013020 981 C 25622 Y Y 07/01/2025 "1,356.00" 949.20 " 1,193.28 " 732.24 732.24 401 3025 TRAT WRIST BONE FRACTURE 4013025 981 C 25624 Y Y 07/01/2025 "1,897.00" " 1,327.90 " " 1,669.36 " " 1,024.38 " " 1,024.38 " 401 3030 CLS TX CASRPALFX WO MANIP 4013030 981 C 25630 Y Y 07/01/2025 "1,378.00" 964.60 " 1,212.64 " 744.12 744.12 401 3035 CLS TX CARP W/MAN EA BONE 4013035 981 C 25635 Y Y 07/01/2025 "1,983.00" " 1,388.10 " " 1,745.04 " " 1,070.82 " " 1,070.82 " 401 3040 "ULNASTYLOD FX, CLOSED PF" 4013040 981 C 25650 Y Y 07/01/2025 "1,468.00" " 1,027.60 " " 1,291.84 " 792.72 792.72 401 3050 CLS TX DIST RAD DISC MAN 4013050 981 C 25675 Y Y 07/01/2025 "2,127.00" " 1,488.90 " " 1,871.76 " " 1,148.58 " " 1,148.58 " 401 3065 METACARPEL FX CLOSED PF 4013065 981 C 26600 Y Y 07/01/2025 "1,224.00" 856.80 " 1,077.12 " 660.96 660.96 401 3070 CLS CARPO DISL THMB WMAN 4013070 981 C 26641 Y Y 07/01/2025 "1,708.00" " 1,195.60 " " 1,503.04 " 922.32 922.32 401 3080 PROXIMAL MID PHALANX FPF 4013080 981 C 26720 Y Y 07/01/2025 886.00 620.20 779.68 478.44 478.44 401 3085 CL TX ARTIC FX IP WO MAN 4013085 981 C 26740 Y Y 07/01/2025 "1,087.00" 760.90 956.56 586.98 586.98 401 3090 DISTAL PHALANX FX CLOPF 4013090 981 C 26750 Y Y 07/01/2025 879.00 615.30 773.52 474.66 474.66 401 3095 PERC FIX PHAL SHF FX MAN 4013095 981 C 26727 Y Y 07/01/2025 "2,615.00" " 1,830.50 " " 2,301.20 " " 1,412.10 " " 1,412.10 " 401 3115 CLSD TX POSTOP ARTHR DIS 4013115 981 C 27265 Y Y 07/01/2025 "2,217.00" " 1,551.90 " " 1,950.96 " " 1,197.18 " " 1,197.18 " 401 3133 RMVL FB DEEP THIGH KNEE 4013133 981 C 27372 Y Y 07/01/2025 "2,238.00" " 1,566.60 " " 1,969.44 " " 1,208.52 " " 1,208.52 " 401 3135 CLMS FEM FX DST W/O MANIP 4013135 981 C 27508 Y Y 07/01/2025 "2,653.00" " 1,857.10 " " 2,334.64 " " 1,432.62 " " 1,432.62 " 401 3140 CLSD TX FEMORAL FX DISTA 4013140 981 C 27510 Y Y 07/01/2025 "3,873.00" " 2,711.10 " " 3,408.24 " " 2,091.42 " " 2,091.42 " 401 3145 PATELLA FX CLOSED PF 4013145 981 C 27520 Y Y 07/01/2025 "1,486.00" " 1,040.20 " " 1,307.68 " 802.44 802.44 401 3150 TIBIA PLATEAN FX CLOSPF 4013150 981 C 27530 Y Y 07/01/2025 "1,940.00" " 1,358.00 " " 1,707.20 " " 1,047.60 " " 1,047.60 " 401 3155 CLS TX PROX TIBIA FX TRC 4013155 981 C 27532 Y Y 07/01/2025 "3,180.00" " 2,226.00 " " 2,798.40 " " 1,717.20 " " 1,717.20 " 401 3165 CLSD TRT TIBIAL SHAFT FX W/O MANIP 4013165 981 C 27750 Y Y 07/01/2025 "1,647.00" " 1,152.90 " " 1,449.36 " 889.38 889.38 401 3170 CLSD TX MEDIAL MALLEOSUS 4013170 981 C 27760 Y Y 07/01/2025 "1,557.00" " 1,089.90 " " 1,370.16 " 840.78 840.78 401 3180 CLSD TX FIBULA W/O MANIP 4013180 981 C 27780 Y Y 07/01/2025 "1,381.00" 966.70 " 1,215.28 " 745.74 745.74 401 3183 CLS TX PROX FIB W/MAN 4013183 981 C 27781 Y Y 07/01/2025 "2,097.00" " 1,467.90 " " 1,845.36 " " 1,132.38 " " 1,132.38 " 401 3185 CLOSED TX DIST FIB FX 4013185 981 C 27786 Y Y 07/01/2025 "1,455.00" " 1,018.50 " " 1,280.40 " 785.70 785.70 401 3190 BIMALLEOLAR ANKLE FX PF 4013190 981 C 27808 Y Y 07/01/2025 "1,537.00" " 1,075.90 " " 1,352.56 " 829.98 829.98 401 3193 CLSD TX DISTAL FIBULA W/ 4013193 981 C 27788 Y Y 07/01/2025 "2,109.00" " 1,476.30 " " 1,855.92 " " 1,138.86 " " 1,138.86 " 401 3195 "BIMALLEOLAR ANKLE FX, CL" 4013195 981 C 27810 Y Y 07/01/2025 "2,366.00" " 1,656.20 " " 2,082.08 " " 1,277.64 " " 1,277.64 " 401 3200 "TRIMALLEOLAR ANKLE FX,PF" 4013200 981 C 27816 Y Y 07/01/2025 "1,468.00" " 1,027.60 " " 1,291.84 " 792.72 792.72 401 3205 CLSD TX ANKLE FX W/MANIP 4013205 981 C 27818 Y Y 07/01/2025 "2,435.00" " 1,704.50 " " 2,142.80 " " 1,314.90 " " 1,314.90 " 401 3210 CLSD TX DISTAL TIB W/O M 4013210 981 C 27824 Y Y 07/01/2025 "1,562.00" " 1,093.40 " " 1,374.56 " 843.48 843.48 401 3212 CLSD TX DISTAL TIB W/MAN 4013212 981 C 27825 Y Y 07/01/2025 "2,735.00" " 1,914.50 " " 2,406.80 " " 1,476.90 " " 1,476.90 " 401 3230 CLSD TX CALCANEAL FX W/O 4013230 981 C 28400 Y Y 07/01/2025 "1,221.00" 854.70 " 1,074.48 " 659.34 659.34 401 3235 CLSD TX TALUS W/O MAN 4013235 981 C 28430 Y Y 07/01/2025 "1,087.00" 760.90 956.56 586.98 586.98 401 3240 TX TARSAL FX W/O MAN EA 4013240 981 C 28450 Y Y 07/01/2025 "1,021.00" 714.70 898.48 551.34 551.34 401 3245 METATARSAL FX CLOSED PF 4013245 981 C 28470 Y Y 07/01/2025 "1,026.00" 718.20 902.88 554.04 554.04 401 3250 CLSD TX FX GREAT TOE W/O 4013250 981 C 28490 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 401 3255 CLSD TX FX PHALANX OTHER 4013255 981 C 28510 Y Y 07/01/2025 617.00 431.90 542.96 333.18 333.18 401 3258 CLD TX FX PHALANX OTHER 4013258 981 C 28515 Y Y 07/01/2025 777.00 543.90 683.76 419.58 419.58 401 3260 TX OTH TARSL DISL;WOANES 4013260 981 C 28540 Y Y 07/01/2025 830.00 581.00 730.40 448.20 448.20 401 3270 CLS TX TARSOMET DISL RED 4013270 981 C 28600 Y Y 07/01/2025 "1,053.00" 737.10 926.64 568.62 568.62 401 3275 MTP DISLOC/CLOSED PF 4013275 981 C 28630 Y Y 07/01/2025 617.00 431.90 542.96 333.18 333.18 401 3277 IP JOINT DISLOC/CLOSDPF 4013277 981 C 28660 Y Y 07/01/2025 462.00 323.40 406.56 249.48 249.48 401 3285 LARYNGOSCPY FLEXIBLE DIAG 4013285 981 C 31575 Y Y 07/01/2025 436.00 305.20 383.68 235.44 235.44 401 3287 LARNG FLEX W/ REM FB 4013287 981 C 31577 Y Y 07/01/2025 871.00 609.70 766.48 470.34 470.34 401 3288 PARACENTESIS WITH IMAGE GUIDANCE 4013288 UN 1 981 C 49083 Y N 07/01/2025 "3,276.00" " 2,293.20 " " 2,882.88 " " 1,769.04 " " 1,769.04 " 401 8147 I&RVML FB SUBQ COMPLEX 4018147 981 C 10121 Y Y 07/01/2025 744.00 520.80 654.72 401.76 401.76 401 8250 MANIPULATION OF KNEE JOINT GEN ANE 4018250 UN 1 981 C 27570 Y Y 07/01/2025 303.00 212.10 266.64 163.62 163.62 401 8251 REDUCTION OF INCARC ING HERNIA 4018251 UN 1 981 C 49500 Y Y 07/01/2025 "1,625.00" " 1,137.50 " " 1,430.00 " 877.50 877.50 402 1 E&M OV/OUTPATIENT VISIT 5 MINUTES 4020001 761 C 99211 N Y 07/01/2025 186.00 130.20 163.68 100.44 100.44 402 2 E&M OUTPATIENT SERVICES 10-19 MIN 4020002 761 C 99212 Y Y 07/01/2025 294.00 205.80 258.72 158.76 158.76 402 3 E&M OV/OUTPATIENT VISIT 20-29 MIN 4020003 761 C 99213 Y Y 07/01/2025 347.00 242.90 305.36 187.38 187.38 402 4 E&M OV/OUTPATIENT VISIT 30-39 MIN 4020004 761 C 99214 Y Y 07/01/2025 427.00 298.90 375.76 230.58 230.58 402 5 "MODERATE SEDATION SVS 5 YRS+,1ST 1" 4020005 379 C 99152 Y Y 01/25/2021 289.00 202.30 254.32 156.06 156.06 402 6 "INTRAVENOUS INFUSION, 31MINS-1HOUR" 4020006 260 C 96360 Y Y 07/01/2025 566.00 396.20 498.08 305.64 305.64 402 7 "IV INFUSION, HYDRATION; EA ADDL HO" 4020007 260 C 96361 Y Y 07/01/2025 231.00 161.70 203.28 124.74 124.74 402 8 IV INFUSION THERAPY; 1ST HOUR 4020008 260 C 96365 Y Y 07/01/2025 639.00 447.30 562.32 345.06 345.06 402 9 IV INFUSION THERAPY; EA. ADDTL HR 4020009 260 C 96366 Y Y 07/01/2025 257.00 179.90 226.16 138.78 138.78 402 10 IV INFUSION; NEW DRUG/UP TO 1HR 4020010 260 C 96367 Y Y 07/01/2025 299.00 209.30 263.12 161.46 161.46 402 11 COVID-19 ADMINISTRATION DOSE #1 4020011 771 H 0011A Y Y 07/01/2025 25.00 17.50 22.00 13.50 13.50 402 12 COVID-19 ADMINISTRATION DOSE #2 4020012 771 H 0012A Y Y 07/01/2025 41.00 28.70 36.08 22.14 22.14 402 13 COVID-19 VACCINE (MODERNA) DOSE #1 4020013 8077727399 ML 0.5 250 C 91301 Y Y 07/01/2025 0.00 - - - - 402 14 COVID-19 VACCINE (MODERNA) DOSE #2 4020014 8077727399 ML 0.5 250 C 91301 Y Y 07/01/2025 0.00 - - - - 402 15 "TRANSFUSION, BLOOD OR BLOOD COMPON" 4020015 391 C 36430 Y Y 07/01/2025 "1,587.00" " 1,110.90 " " 1,396.56 " 856.98 856.98 402 16 IV PUSH SING/INITIAL SUB/DRUG NURS 4020016 UN 1 260 C 96374 Y Y 07/01/2025 412.00 288.40 362.56 222.48 222.48 402 17 MINOR OP PROCEDURE 4020017 UN 1 761 C 32554 Y Y 07/01/2025 993.00 695.10 873.84 536.22 536.22 402 18 MINOR OP PROCEDURE 4020018 UN 1 761 C 32555 Y Y 07/01/2025 993.00 695.10 873.84 536.22 536.22 402 19 MINOR OP PROCEDURE 4020019 UN 1 761 C 49082 Y Y 07/01/2025 993.00 695.10 873.84 536.22 536.22 402 20 MINOR OP PROCEDURE 4020020 UN 1 761 C 49083 Y Y 07/01/2025 993.00 695.10 873.84 536.22 536.22 402 21 LEGAL BLOOD DRAW NURSING 4020021 UN 1 300 C 80320 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 402 22 THERPY DX INJ SUBQ/IM 4020022 UN 1 260 C 96372 Y Y 07/01/2025 263.00 184.10 231.44 142.02 142.02 402 23 INDWELLING URINARY CATHETER 4020023 1 272 C 51702 Y Y 07/01/2025 273.00 191.10 240.24 147.42 147.42 402 24 RITUXAN INTRAVENOUS 10MG/ML 4020024 ML 10 272 C J9312 Y Y 01/01/2022 "1,400.00" 980.00 " 1,232.00 " 756.00 756.00 402 25 CHEMOTH ADMINISTRATION ANTI-NEOPLA 4020025 UN 1 331 C 96401 Y Y 07/01/2025 "1,015.00" 710.50 893.20 548.10 548.10 402 30 INJ PROC FOR SACROILIAC JOINT 4020030 UN 1 761 C 27096 Y Y 07/01/2025 450.00 315.00 396.00 243.00 243.00 402 66 INFLUENZA VIRUS VACCINE(IIV4) 4020066 771 C 90688 N Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 403 1 WOUND CARE SUPPLIES 4030001 272 C 99070 Y Y 07/01/2025 97.00 67.90 85.36 52.38 52.38 403 2 WOUND CARE; NONSELECTIVE DEBRIDEME 4030002 761 C 97602 Y Y 07/01/2025 618.00 432.60 543.84 333.72 333.72 403 3 TELEHEALTH ORIGIN FACILITY SITE FE 4030003 780 H Q3014 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 403 4 NEG PRESSURE WOUND THERAPY >50CM2 4030004 761 C 97605 Y Y 07/01/2025 495.00 346.50 435.60 267.30 267.30 403 5 STRAPPING/UNNA BOOT (WC) 4030005 761 C 29580 Y Y 07/01/2025 261.00 182.70 229.68 140.94 140.94 403 6 MODERATE SEDATION; EA ADDTL 15 MIN 4030006 379 C 99153 Y Y 07/01/2025 164.00 114.80 144.32 88.56 88.56 403 7 MODERATE SEDATION; INITIAL 15 MINS 4030007 379 C 99153 Y Y 01/25/2021 289.00 202.30 254.32 156.06 156.06 403 8 "DEBRID;SKIN,SUQ TISSUE 20CM OR LES" 4070003 969 C 11042 Y Y 07/02/2021 267.50 187.25 235.40 144.45 144.45 403 9 "MODERATE SEDATION, >5 YR 1ST 15 MI" 4070004 963 C 99152 Y Y 07/02/2021 299.60 209.72 263.65 161.78 161.78 403 10 "INJECTION, ANESTHETIC;SCIATIC NERV" 4070005 963 C 64445 Y Y 07/02/2021 187.25 131.08 164.78 101.12 101.12 403 11 "DEBRIDEMENT,SUBCU TIS; ADDTL 20 CM" 4070006 969 C 11045 Y Y 07/02/2021 53.50 37.45 47.08 28.89 28.89 403 12 IV PUSH SING/INITIAL SUB/DRUG (WC) 4030012 260 C 96374 Y Y 07/01/2025 594.00 415.80 522.72 320.76 320.76 403 13 IV PUSH SAME DRUG (WOUND CARE) 4030013 260 C 96376 Y Y 07/01/2025 349.00 244.30 307.12 188.46 188.46 403 14 APPLY MULTI-LAYER COMPRESS LOW LEG 4030014 761 C 29581 Y Y 07/01/2025 569.00 398.30 500.72 307.26 307.26 403 15 E&M OP SERVICES 10-19 MIN. (WC) 4030015 UN 1 969 C 99212 Y Y 07/01/2025 286.00 200.20 251.68 154.44 154.44 403 16 E&M OP SERVICES 20-29 MIN. (WC) 4030016 UN 1 969 C 99213 Y Y 07/01/2025 392.00 274.40 344.96 211.68 211.68 403 17 NEG PRESSURE WOUND THERAPY >50CM2 4030017 761 C 97605 Y Y 07/01/2025 519.00 363.30 456.72 280.26 280.26 403 18 NURSING SERVICES WOUND CARE 4030018 UN 1 982 C 99211 Y Y 07/01/2025 371.00 259.70 326.48 200.34 200.34 403 19 MEDICAL CONF. FTF 30 MIN+ (WC) 4030019 UN 1 500 C 99366 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 403 20 TREATMENT ROOM OP HOSPITAL 4030020 UN 1 761 H Z7500 N Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 403 21 "WOUND CARE: DEBRID., 1ST 20 SQ CM " 4030021 UN 1 761 C 97597 Y Y 07/01/2025 234.00 163.80 205.92 126.36 126.36 403 22 SEL WOUND CARE > 20CM 4030022 UN 1 761 C 97598 Y Y 07/01/2025 294.00 205.80 258.72 158.76 158.76 403 23 EPIFIX; SKIN GRAPH 2X4 4030023 UN 1 623 C 15271 Y Y 08/01/2023 "10,688.00" " 7,481.60 " " 9,405.44 " " 5,771.52 " " 5,771.52 " 403 24 EPIFIX; SKIN GRAPH 2X4 4030024 UN 8 636 C Q4186 Y Y 07/01/2025 "1,180.00" 826.00 " 1,038.40 " 637.20 637.20 403 25 LIGHT COMP BANDAGE; -0.3IN SIZE D 4030025 UN 1 761 H A6448 N Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 403 26 PARING/CUTTING H-KERATOTIC LS SING 4030026 1 969 C 11055 Y Y 07/01/2025 273.00 191.10 240.24 147.42 147.42 403 27 TRIMMING DYSTROPH NAIL ANY NUMBER 4030027 UN 1 761 H G0127 Y Y 04/01/2025 82.00 57.40 72.16 44.28 44.28 403 28 TRIMMING NONDYSTROPHC NAILS ANY NU 4030028 UN 1 761 C 11719 Y Y 04/01/2025 67.00 46.90 58.96 36.18 36.18 403 29 LIGHT COMP BANDGE; 3IN+/-5IN 4030029 UN 1 761 H A6449 N Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 403 30 "BIO CHG DRESSING 1"" DSK 4MM C" 4030030 UN 761 H A4221 Y Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 403 32 CENTURION KIT 4030032 UN 1 270 H A4649 Y Y 07/01/2025 95.00 66.50 83.60 51.30 51.30 403 34 EPIFIX; SKIN GRAPH 4X4 4030034 UN 1 623 C 15271 Y Y 08/01/2023 "21,376.00" " 14,963.20 " " 18,810.88 " " 11,543.04 " " 11,543.04 " 403 35 LIGHT COMP BANGAGE; SIZE F 10IN 4030035 UN 1 623 H A6449 N Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 403 36 EPIFIX; SKIN GRAPH 4X4 4030036 UN 16 636 C Q4186 Y Y 07/01/2025 "1,180.00" 826.00 " 1,038.40 " 637.20 637.20 403 39 LIGHT COMP BANGAGE; SIZE G 10IN 4030039 761 H A6449 N Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 403 40 WOUND VAC > 50CM 4030040 UN 761 C 97606 Y Y 07/01/2025 490.00 343.00 431.20 264.60 264.60 403 41 BRAVA STRIP PASTE 4030041 UN 1 270 H A4406 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 403 45 EPIFIX; SKIN GRAPH 5X6 4030045 UN 1 623 C 15271 Y Y 08/01/2023 "40,080.00" " 28,056.00 " " 35,270.40 " " 21,643.20 " " 21,643.20 " 403 47 EPIFIX; SKIN GRAPH 5X6 4030047 UN 30 636 C Q4186 Y Y 07/01/2025 "1,180.00" 826.00 " 1,038.40 " 637.20 637.20 403 48 EPIFIX; SKIN GRAPHS 7X7 4030048 UN 49 636 C Q4186 Y Y 07/01/2025 "1,180.00" 826.00 " 1,038.40 " 637.20 637.20 403 49 EPIFIX; EACH + OF 25SQCM 4030049 UN 1 960 C 15272 Y Y 07/01/2025 "1,336.00" 935.20 " 1,175.68 " 721.44 721.44 403 50 CHEMICAL CAUTERIZATION 4030050 761 C 17250 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 403 51 TX ROOM EPIFIX 4030051 UN 1 761 C 15271 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 403 55 "EPIFIX, ADMSTRN OF FIRST 25CM" 4030055 UN 1 969 C 15271 Y Y 07/01/2025 "1,336.00" 935.20 " 1,175.68 " 721.44 721.44 403 56 EPFIX; FIST 25 SQ CM FACE SCLP/FEE 4030056 UN 1 960 C 15275 Y Y 07/01/2025 "1,336.00" 935.20 " 1,175.68 " 721.44 721.44 403 60 IODOSRB GEL 10G TUBE 4030060 272 H Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 403 70 "AG ADVANTAGE 0.36X18""" 4030070 UN 1 272 H A6199 Y Y 07/01/2025 27.00 18.90 23.76 14.58 14.58 403 80 "AG ADVANTAGE 4X5""" 4030080 UN 1 272 H A6197 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 403 90 "AQUACEL FOAM PRO 3X3""" 4030090 UN 1 272 H A6212 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 403 100 "AQUACEL FOAM PRO 4X4""" 4030100 UN 1 272 H A6212 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 403 200 "AQUACEL FOAM PRO 9.4X8.7""" 4030200 UN 1 272 H A6213 Y Y 07/01/2025 51.00 35.70 44.88 27.54 27.54 403 300 "AQUACEL FOAM PRO 8X7""" 4030300 UN 1 272 H A6213 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 403 400 EUCERIN 30ML 4030400 UN 1 272 H A6250 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 403 500 "FINE NDLE ASP.BIO, W/O IMA; 1ST LE" 4030500 969 10021 Y Y 07/01/2025 300.00 210.00 264.00 162.00 162.00 404 1 TRANSPORT 1 WAY; 1 PT 4040001 220 H A0130 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 404 2 TRANSPORT 1 WAY; 2 PTS 4040002 220 H A0130 Y Y 07/01/2025 91.00 63.70 80.08 49.14 49.14 404 3 TRANSPORT 1 WAY; 3 PTS 4040003 220 H X0204 Y Y 07/01/2025 84.00 58.80 73.92 45.36 45.36 404 4 TRANSPORT 1 WAY; >3 PTS 4040004 220 H X0206 Y Y 07/01/2025 78.00 54.60 68.64 42.12 42.12 404 10 OXYGEN TANK 4040010 220 H X0220 Y Y 07/01/2025 83.00 58.10 73.04 44.82 44.82 404 15 ATTENDANT 4040015 220 H X0212 Y Y 08/01/2023 54.00 37.80 47.52 29.16 29.16 404 20 MILEAGE-PER PT MILE 4040020 220 H A0380 Y Y 07/01/2025 12.00 8.40 10.56 6.48 6.48 404 25 WHEELCHAIR USE 4040025 220 H X0208 Y Y 07/01/2025 15.00 10.50 13.20 8.10 8.10 404 30 WAIT TIME;>15MIN;EA 15MIN 4040030 220 H X0214 Y Y 07/01/2025 10.00 7.00 8.80 5.40 5.40 404 9999 UNLISTED; PER REPORT 4049999 220 H X0222 Y Y 07/01/2025 0.00 - - - - 406 22 STANDARDIZED COGNITIVE PERF. TEST 4060022 521 C 96125 Y Y 07/02/2021 132.68 92.88 116.76 71.65 71.65 406 119 ALC/SUBS ABUSE SCR&BRIEF INT 15-30 4060119 521 C G0396 Y N 07/04/2019 70.00 49.00 61.60 37.80 37.80 406 121 ALC/SUBS ABUSE SCR&BRIEF INT >30 4060121 521 C G0397 Y N 07/04/2019 124.00 86.80 109.12 66.96 66.96 406 122 "ALCOHOL MISUSE SCREEN,15 MIN ANNUA" 4060122 521 H G0442 Y Y 07/01/2025 80.00 56.00 70.40 43.20 43.20 406 133 ALCOHOL AND/OR DRUG SCREENING 4060133 521 C H0049 N Y 07/04/2019 52.00 36.40 45.76 28.08 28.08 406 134 ALC/ DRUG SCR BRIEF INT PER 15 MIN 4060134 521 C H0050 N Y 07/04/2019 103.00 72.10 90.64 55.62 55.62 406 2785 HOME VISIT 4062785 522 C 99350 Y Y 07/01/2025 457.00 319.90 402.16 246.78 246.78 407 1 E&M OP SERVICES 10-19 MIN. (WC) 4070001 UN 1 969 C 99212 Y Y 07/01/2025 238.00 166.60 209.44 128.52 128.52 407 2 E&M OP SERVICES 20-29 MIN. (WC) 4070002 UN 1 969 C 99213 Y Y 07/01/2025 328.00 229.60 288.64 177.12 177.12 407 3 "DEBRID;SKIN,SUQ TISSUE 20CM OR LES" 4070003 UN 1 969 C 11042 Y Y 07/01/2025 398.00 278.60 350.24 214.92 214.92 407 4 MODERATE SEDATION >5 YR 1ST 15 MIN 4070004 UN 1 963 C 99152 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 407 5 "INJECTION, ANESTHETIC;SCIATIC NERV" 4070005 UN 1 963 C 64445 Y Y 07/01/2025 280.00 196.00 246.40 151.20 151.20 407 6 "DEBRIDEMENT, SUBQ TIS; ADDTL 20 CM" 4070006 UN 1 969 C 11045 Y Y 07/01/2025 82.00 57.40 72.16 44.28 44.28 407 7 I & D DRAINAGE ABSCESS SIMPLE 4070007 969 10060 Y Y 07/01/2025 782.00 547.40 688.16 422.28 422.28 407 8 WC HOME VISIT E&M 20 MIN OR MORE 4070008 969 99347 Y Y 07/01/2025 396.00 277.20 348.48 213.84 213.84 407 9 E&M OP SERVICE 30 MIN> (WC) 4070009 UN 1 960 C 99214 Y Y 07/01/2025 405.00 283.50 356.40 218.70 218.70 407 10 LEVEL 5; MOD-HIGH SEVERITY 4070010 UN 1 982 C 99215 Y Y 07/01/2025 "1,118.00" 782.60 983.84 603.72 603.72 407 12 PROLONGED OFF OP 15 MIN 4070012 UN 1 960 C 99417 Y Y 07/01/2025 765.00 535.50 673.20 413.10 413.10 407 14 E&M; OP NEW/ESTABLISHED PT 55MIN+ 4070014 UN 988 C 99245 Y Y 07/01/2025 "1,092.00" 764.40 960.96 589.68 589.68 408 1 THORACENTESIS W/O IMAGE GUIDANCE 4080001 UN 1 982 C 32554 Y Y 07/01/2025 "5,234.00" " 3,663.80 " " 4,605.92 " " 2,826.36 " " 2,826.36 " 408 2 THORACENTESIS WITH IMAGE GUIDANCE 4080002 UN 1 982 C 32555 Y Y 07/01/2025 "6,265.00" " 4,385.50 " " 5,513.20 " " 3,383.10 " " 3,383.10 " 408 3 PARACENTESIS W/O IMAGE GUIDANCE 4080003 UN 1 982 C 49082 Y Y 07/01/2025 "1,747.00" " 1,222.90 " " 1,537.36 " 943.38 943.38 408 4 PARACENTESIS WITH IMAGE GUIDANCE 4080004 UN 1 977 C 49083 Y Y 07/01/2025 "3,276.00" " 2,293.20 " " 2,882.88 " " 1,769.04 " " 1,769.04 " 408 172 E&M INT CARE SNF/SWG 25M 4080172 551 C 99304 Y Y 07/01/2025 406.00 284.20 357.28 219.24 219.24 408 196 E&M HOSPITALIST MOD- HIGH SEVERITY 4080196 988 C 99215 Y Y 07/01/2025 "1,117.00" 781.90 982.96 603.18 603.18 408 197 PROLONGED SERVICE INPATIENT 1ST HR 4080197 960 C 99356 Y Y 07/01/2025 964.00 674.80 848.32 520.56 520.56 408 198 D/C MGMT SNF/SWG <30 4080198 551 C 99315 Y Y 07/01/2025 357.00 249.90 314.16 192.78 192.78 408 199 D/C MGNT SNF/SWG>30 4080199 551 C 99316 Y Y 07/01/2025 406.00 284.20 357.28 219.24 219.24 408 975 "E&M,INIT IP/DA,COMP" 4080975 987 C 99223 Y Y 07/01/2025 "1,117.00" 781.90 982.96 603.18 603.18 408 976 PROLONGED INPT/ OBS EVAL & MGMT.SR 4080976 987 99418 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 408 983 "E&M,INIT IP/DA,BRIEF" 4080983 987 C 99221 Y Y 07/01/2025 487.00 340.90 428.56 262.98 262.98 408 991 "E&M,INIT IP/DA,INTER" 4080991 987 C 99222 Y Y 07/01/2025 668.00 467.60 587.84 360.72 360.72 408 992 IP CRITICAL CARE FIRST 30-74 MIN 4080992 UN 1 960 C 99291 Y Y 07/01/2025 730.00 511.00 642.40 394.20 394.20 408 993 IP CRITICAL CARE EA ADDIT 30 MIN 4080993 UN 1 960 C 99292 Y Y 07/01/2025 368.00 257.60 323.84 198.72 198.72 408 1021 "E&M,HOSP D/C DA,BRIEF" 4081021 987 C 99238 Y Y 07/01/2025 371.00 259.70 326.48 200.34 200.34 408 1022 "E&M,HOSP D/C DA,COMP" 4081022 987 C 99239 Y Y 07/01/2025 659.00 461.30 579.92 355.86 355.86 408 1047 "E&M,SUB HOSP/DA,COMP" 4081047 987 C 99233 Y Y 07/01/2025 519.00 363.30 456.72 280.26 280.26 408 1062 "E&M,SUB HOSP/DA,INTER" 4081062 987 C 99232 Y Y 07/01/2025 476.00 333.20 418.88 257.04 257.04 408 1123 SUBS CARE SNF/SWG HIGH 4081123 551 C 99310 Y Y 07/01/2025 411.00 287.70 361.68 221.94 221.94 408 1170 "DEBRID;SKIN,SUBQ TISSUE" 4081170 551 C 11042 Y Y 07/01/2025 279.00 195.30 245.52 150.66 150.66 408 1171 TRIMIMG OF NAILS 4081171 551 C 11719 Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 408 1172 SIX OR MORE TRIM NAILS 4081172 551 C 11721 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 408 1240 SUBS CARE SNF/SWG MED 4081240 551 C 99309 Y Y 07/01/2025 329.00 230.30 289.52 177.66 177.66 408 1387 "E&M,SUB HOSP/DA,BRIEF" 4081387 987 C 99231 Y Y 07/01/2025 261.00 182.70 229.68 140.94 140.94 408 1388 "E&M,ANN SNF H&P-BRIEF" 4081388 977 C 99222 Y Y 07/01/2025 566.00 396.20 498.08 305.64 305.64 408 1389 "E&M,ANN SNF H&P-INTER" 4081389 977 C 99213 Y Y 07/01/2025 371.00 259.70 326.48 200.34 200.34 408 1390 "E&M,ANN SNF H&P-COMP" 4081390 521 C 99214 Y Y 07/01/2025 453.00 317.10 398.64 244.62 244.62 408 1711 DESTRUCTION BENIGN LESION 4081711 551 C 17110 Y Y 07/01/2025 541.00 378.70 476.08 292.14 292.14 408 2311 "E&M, SUB SNF/DA,BRIEF" 4082311 521 C 99212 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 408 2312 "E&M, SUB SNF/DA,INTER" 4082312 977 C 99213 Y Y 07/01/2025 346.00 242.20 304.48 186.84 186.84 408 2313 "E&M, SUB SNF/DA, COMP" 4082313 521 C 99214 Y Y 07/01/2025 512.00 358.40 450.56 276.48 276.48 408 2314 SNF DISCHARGE 4082314 521 C 99213 Y Y 07/01/2025 346.00 242.20 304.48 186.84 186.84 408 2416 "E&M,INIT INPT CONS,INTER" 4082416 988 C 99253 Y Y 07/01/2025 572.00 400.40 503.36 308.88 308.88 408 2417 "E&M,INIT INPT CONS,XTEND" 4082417 988 C 99254 Y Y 07/01/2025 822.00 575.40 723.36 443.88 443.88 408 2418 "E&M,INIT INPT CONS,XTEND" 4082418 988 C 99255 Y Y 07/01/2025 "1,004.00" 702.80 883.52 542.16 542.16 408 2443 "E&M,INIT INPT CONS,BRIEF" 4082443 988 C 99252 Y Y 07/01/2025 371.00 259.70 326.48 200.34 200.34 408 6254 PHYCH E&M 60 MIN W/ PT 4086254 551 C 90837 Y Y 07/01/2025 712.00 498.40 626.56 384.48 384.48 408 6255 PSYCH E&M 30 MIN W/ PT 4086255 551 C 90832 Y Y 07/01/2025 326.00 228.20 286.88 176.04 176.04 408 6453 OBSERVATION/IP CARE ADM/DC 4086453 987 C 99234 Y Y 07/01/2025 816.00 571.20 718.08 440.64 440.64 408 6545 ANNUAL ASSESSMENT 4086545 551 C 99318 Y Y 07/01/2025 430.00 301.00 378.40 232.20 232.20 408 8145 REMOVAL NAIL PLATE 4088145 521 C 11730 Y Y 07/01/2025 480.00 336.00 422.40 259.20 259.20 408 8813 SUBS CARE SNF/SWG LOW 4088813 551 C 99308 Y Y 07/01/2025 268.00 187.60 235.84 144.72 144.72 408 8912 E&M INT CARE SNF/SWG 35 4088912 551 C 99305 Y Y 07/01/2025 431.00 301.70 379.28 232.74 232.74 408 8913 E&M INIT CARE SNF/SWG 4088913 551 C 99306 Y Y 07/01/2025 473.00 331.10 416.24 255.42 255.42 408 8914 SUBS CARE SNF/SWG 10 4088914 551 C 99307 Y Y 07/01/2025 233.00 163.10 205.04 125.82 125.82 408 9001 TB SKIN TEST/ SNF 4089001 920 C 86580 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 408 9100 ADMIN COVID BIVALENT BOOSTER/SNF 4089100 550 C 0144A N Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 408 9567 TRIM DYSTROPHIC NAILS 4089567 551 H G0127 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 408 9570 PSYCHOTHERAPY; 30 MIN W/ E&M 4089570 UN 1 551 C 90833 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 430 1 TREATMENT ROOM OUTPATIENT HOSPITAL 4030020 761 H Z7500 N Y 07/02/2021 25.43 17.80 22.38 13.73 13.73 447 0 0447055 270 Y Y 07/01/2000 31.52 22.06 27.74 17.02 17.02 447 1 MAXORB DRESSING AG A6196 271 H A6196 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 447 2 DRESSING/SKIN-PREP WIPES 4470002 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3 DRESSING ADAPTIC 4470003 272 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 4 TRAY SURGICAL W/ STN INTRMNTS 4470004 UN 1 270 Y Y 07/01/2025 202.00 141.40 177.76 109.08 109.08 447 5 BRUSH HAIR 4470005 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 6 COMB 4470006 999 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 7 TURNER PIGTAIL PNEUMOTHORAX SET 4470007 279 H Y N 07/01/2025 "1,250.00" 875.00 " 1,100.00 " 675.00 675.00 447 8 KANGAROO EPUMP SET 1000 ML 4470008 270 H B9999 Y Y 07/01/2025 59.00 41.30 51.92 31.86 31.86 447 9 DENTURE BRUSH 4470009 999 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 10 ANGIOCATH 20-GAUGE 4470010 272 H C1725 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 447 11 DRESSING ADAPTIC 3X8 4470011 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 12 IV PIGGYBACK SECONDARY 4470012 272 H S1015 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 13 PEDI BLOOD PRESSURE CUFF 4470013 271 H Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 447 14 LMA AIRWAY - ALL SIZES 4470014 279 Y Y 07/01/2025 366.00 256.20 322.08 197.64 197.64 447 15 TENDERLETT 4470015 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 16 EUCERIN LOTION 4470016 270 Y Y 07/01/2025 122.00 85.40 107.36 65.88 65.88 447 17 ELASTO-GEL DRESSING 4470017 270 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 447 18 THERA-PUTTY 4470018 270 H A9300 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 19 TELFA BARRIER DRESSING 4470018 270 H A6223 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 20 CHLORAPREP 4470020 270 H A4248 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 21 SILVASORB GEL 4470021 270 H A6248 Y Y 07/01/2025 6.00 4.20 5.28 3.24 3.24 447 22 OVER-THE-DOOR PULLEY 4470022 270 H E0860 Y Y 07/01/2025 6.00 4.20 5.28 3.24 3.24 447 23 HYPERGEL 4470023 270 H A6248 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 24 STRATASORB 4470024 270 H A6204 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 25 SCALPEL STERILE-SNGLE USE 4470025 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 26 COLACTIVE® PLUS AG 2X2 4470026 272 H A6021 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 447 28 CONDITIONER (HAIR) 4470028 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 29 KIT ADMIT 4470029 0 Y Y 07/01/2025 65.00 45.50 57.20 35.10 35.10 447 30 BURETTE IV 150 ML 4470030 264 Y Y 07/01/2025 78.00 54.60 68.64 42.12 42.12 447 31 HYPOTHERMIA BLANKET STRYKER 4470031 279 D Y Y 07/01/2025 424.00 296.80 373.12 228.96 228.96 447 32 DISPOSABLE TEMPERATURE PROBE 4470032 279 D Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 447 33 ASPIRATOR CANISTER 4470033 270 D Y Y 07/01/2025 72.00 50.40 63.36 38.88 38.88 447 34 SUPPORT WRIST/CT 4470034 271 H A4570 Y Y 07/01/2025 122.00 85.40 107.36 65.88 65.88 447 35 IV PUMP SET VENTED #3704 4470035 264 Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 447 36 OSTOMY SKIN BARRIER POWDER 1 OZ. 4470036 257 H A4371 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 447 37 APEX WOUND COVER TOWEL 4470037 UN 1 270 H A9286 Y Y 07/01/2025 14.00 9.80 12.32 7.56 7.56 447 40 PUREWICK FEM EXT CATHETER 4470040 UN 1 270 H A6590 N Y 07/01/2025 31.00 21.70 27.28 16.74 16.74 447 45 APPLICATORS STERILE 6 4470045 272 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 46 "CLOTH SILK TAPE 1"" - WOUND CART" 4470046 271 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 47 EXUDERM ODORSHIELD DRESSING 2X2 4470047 272 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 48 EXUDERM ODORSHIELD DRESSING 4X4 4470048 272 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 447 49 MAXORB ALGINATE DRESSING 4X4 4470049 272 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 447 50 MEDIHONEY PASTE 0.05 OZ 4470050 259 Y Y 07/01/2025 73.00 51.10 64.24 39.42 39.42 447 51 MELGISORB ALGINATE DRESSING 2X2 4470051 272 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 52 OPTIFOAM DRESSING 3X3 -WOUND CART 4470052 271 H Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 447 53 SKINTEGRITY HYDROGEL -WOUND CART 4470053 271 Y Y 07/01/2025 35.00 24.50 30.80 18.90 18.90 447 54 SKINTEGRITY WOUND CLEANSER 4470054 272 H Y Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 447 55 STERILE BORDERED GAUZE 2X2 4470055 272 H Y Y 07/01/2025 9.00 6.30 7.92 4.86 4.86 447 56 STERILE SALINE SOLUTION 110 MG CUP 4470056 272 H Y Y 07/01/2025 17.00 11.90 14.96 9.18 9.18 447 57 THERAHONEY FOAM DRESSING 4X4 4470057 272 H A4649 Y Y 07/01/2025 95.00 66.50 83.60 51.30 51.30 447 58 TRANSPARENT TAPE 1 INCH 4470058 271 H Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 59 GLIDESCOPE SPECTRUM SGL USE BLADE 4470059 272 H A4649 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 447 60 "EPIDURAL NEEDLE 22G X 3.5"" " 4470060 UN 1 272 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 61 STERILE ULTRASOUND GEL 4470061 UN 1 270 Y Y 07/01/2025 9.00 6.30 7.92 4.86 4.86 447 62 DURAPREP SOLUTION W/ APPLICATOR 4470062 UN 1 270 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 63 OPTIFOAM GENTLE 4X4 4470063 270 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 64 OPTIMFOAM GENTLE 6X6 4470064 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 65 OPTIFOAM GENLTE HEEL 4470065 270 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 447 66 OPTIFOAM GENTLE SACRAL 4470066 270 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 447 67 VERSATEL ONE 3X4 4470067 270 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 447 68 HYPERGEL 4470068 270 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 447 70 WALKER-WALKING AIDS 4470070 273 H E0143 Y Y 07/01/2025 298.00 208.60 262.24 160.92 160.92 447 71 AQUACEL HYDRO RIBBON DRESS W STRGH 4470071 270 H A6199 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 73 AQUACEL PRO 6X6 4470073 270 H A6212 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 75 AQCEL PRO HEEL FOAM DRSSING 8'X5.5 4470075 270 H A6213 Y Y 07/01/2025 41.00 28.70 36.08 22.14 22.14 447 80 DENTURE ADHESIVE 4470080 999 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 447 81 PROMOGRAN™ MATRIX 4.34 SQ INCH 4470081 272 H A6021 Y Y 07/01/2025 124.00 86.80 109.12 66.96 66.96 447 87 DUCANTO CATHETER 4470087 UN 1 270 H A4353 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 90 UNNA BOOT W/CALAMINE 4470090 270 H A6456 Y Y 07/01/2025 84.00 58.80 73.92 45.36 45.36 447 91 TUBULAR NETTING 01 4470091 UN 1 270 H A6457 Y Y 07/01/2025 34.80 24.36 30.62 18.79 18.79 447 93 TUBULAR NETTING 02 4470093 UN 1 270 H A6457 Y Y 07/01/2025 40.60 28.42 35.73 21.92 21.92 447 95 TUBULAR NETTING 03 4470095 UN 1 270 H A6457 Y Y 07/01/2025 48.56 33.99 42.73 26.22 26.22 447 96 TUBULAR NETTING 04 4470096 UN 1 270 H A6457 Y Y 07/01/2025 49.92 34.94 43.93 26.96 26.96 447 97 TUBULAR NETTING 05 4470097 UN 1 270 H A6457 Y Y 07/01/2025 54.76 38.33 48.19 29.57 29.57 447 98 BARIUM\REDI-CAT 2 4470098 255 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 99 "NEEDLE, STERILE, ANY SIZE, EACH" 4470099 UN 1 272 H A4215 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 100 TOENAIL REMOVAL KIT 4470100 UN 1 270 N Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 447 102 URINARY DRAINAGE--LEG BAG 4470102 272 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 105 SURGICAL TRAY 4470105 UN 1 272 H A4550 N Y 07/01/2025 497.00 347.90 437.36 268.38 268.38 447 120 COVER GOWNS-DISPOSABLE 4470120 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 128 ICE BAG DISPOSABLE (PACK) 4470128 271 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 447 144 FREEDOM CATH/MALE 4470144 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 151 URINARY DRAINAGE BAG 4470151 272 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 447 185 "PADDING BANDAGE, NON-ELASTIC" 4470185 271 H A6441 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 202 INCONTINENCE PADS 4470202 270 Y Y 07/01/2025 54.00 37.80 47.52 29.16 29.16 447 212 MEPILEX DRESSING 4470212 272 H A6212 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 447 213 OPSITE 2.4 X 2.8 4470213 270 H A6257 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 220 IRIS STRAIGHT SCISSORS 4470220 UN 1 270 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 447 222 IRIS FORECEPS; DISPOSABLE 4470222 UN 1 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 224 CRILE FORECEPS; NONSTERILE 4470224 UN 1 270 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 447 227 BANDAGE KLING 4 (KERLIX) 4470227 271 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 230 THERA BAND GREEN 4470230 UN 1 290 N Y 07/01/2025 630.00 441.00 554.40 340.20 340.20 447 233 THERABAND BLUE 4470233 290 N Y 07/01/2025 709.00 496.30 623.92 382.86 382.86 447 235 THERABAND YELLOW 4470235 290 N Y 07/01/2025 567.00 396.90 498.96 306.18 306.18 447 238 THERABAND YELLOW 4470238 UN 1 290 N Y 07/01/2025 579.00 405.30 509.52 312.66 312.66 447 240 THERABAND BLACK 4470240 UN 1 290 N Y 07/01/2025 660.00 462.00 580.80 356.40 356.40 447 248 KINESIOLOGY TAPE 4470248 UN 1 290 Y Y 07/01/2025 17.00 11.90 14.96 9.18 9.18 447 249 FOAM WRAP 4470249 UN 1 270 H A4450 Y Y 07/01/2025 11.00 7.70 9.68 5.94 5.94 447 250 BANDAGE KLING ALL 4470250 271 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 259 ACCUTHERM COLD PACK HALF 4470259 UN 1 299 Y Y 07/01/2025 30.00 21.00 26.40 16.20 16.20 447 276 ACCUTHERM COLD PACK OVERSIZE 4470276 UN 1 299 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 447 277 FREE-UP 4470277 UN 1 270 Y Y 07/01/2025 120.00 84.00 105.60 64.80 64.80 447 279 ACCUTHERM COLD PACK NECK 4470279 UN 1 299 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 280 TENS ELECTRODE 2X2 4470280 UN 1 299 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 447 281 TENS ELECTRODE 2X3.5 4470281 UN 1 299 Y Y 07/01/2025 27.00 18.90 23.76 14.58 14.58 447 283 ECONOMY OVER PULLY 4470283 UN 1 299 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 447 285 ACCUTHERM COLD PACK REG 4470285 UN 1 299 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 286 CAN-DO ANCHOR 4470286 UN 1 299 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 447 288 DYCEM BLUE 4470288 UN 1 270 Y Y 07/01/2025 383.00 268.10 337.04 206.82 206.82 447 290 THERA PUTTY RED 4470290 UN 1 299 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 292 KNEE BRACE OA-200-R 4470292 UN 1 270 Y Y 07/01/2025 84.00 58.80 73.92 45.36 45.36 447 293 FINGER PULSE OX 4470293 UN 1 299 H E0445 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 447 294 ACCUTHERM COLD PACH OUARTER 4470294 UN 1 299 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 447 295 ULTRASOUND GEL 4470295 UN 1 279 Y Y 07/01/2025 11.00 7.70 9.68 5.94 5.94 447 298 THERA PUTTY GREEN 4470298 UN 1 299 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 299 THERA PUTTY BLUE 4470299 UN 1 299 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 334 SECURA PERSONAL CLEANSER 4470334 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 338 SECURA EXTRA PRO CREAM 4470338 270 H Z7610 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 339 SKIN PREP LOLLIPOP 4470339 270 Y Y 07/01/2025 14.00 9.80 12.32 7.56 7.56 447 340 AQUAPHOR 3.5 OZ 4470340 270 H A6250 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 447 341 DYNA-HEX 4 (FOAM) 4470341 270 H A4248 Y Y 07/01/2025 14.00 9.80 12.32 7.56 7.56 447 391 BASIN SCRUB/SOAK 4470391 271 Y Y 07/01/2025 51.00 35.70 44.88 27.54 27.54 447 474 BELT RIB MEN/WOMEN ALL SZ 4470474 271 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 447 500 ER TRANSFER BLANKET 0447055 270 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 447 501 AQUACEL DRESSING 4470501 270 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 447 533 BINDER ABDOMINAL ALL SZ 4470533 271 Y Y 07/01/2025 210.00 147.00 184.80 113.40 113.40 447 534 "CURVED HEMOSTAT, 5.500"" (PK)" 4470534 272 H A4649 N Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 535 "HEMOSTAT FORCEPS STR 6.250""" 4470535 272 H A4649 N Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 537 SUPPORT ELBOW TENNIS 4470537 271 Y Y 07/01/2025 56.00 39.20 49.28 30.24 30.24 447 540 "FORCEP 1X2/STD 4.750"" (PK)" 4470540 272 H A4649 N Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 550 CENTERAL LINE DRESSING 4470550 270 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 447 555 E.T. TUBE HOLDER 4470555 270 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 447 557 STERILE SURGICAL GOWN 4470557 270 Y Y 07/01/2025 65.00 45.50 57.20 35.10 35.10 447 565 IV CATH NEEDLE - ALL SIZES 4470565 270 H Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 447 573 BIOPSY PUNCH 2MM 4470573 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 581 "BIOPSY PUNCH 3,4,5MM" 4470581 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 618 IV HUBER NEEDLE - ALL SIZES 4470618 270 H Y Y 07/01/2025 133.00 93.10 117.04 71.82 71.82 447 621 IV FILTER SET 4470621 270 H Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 447 630 INTERDRY:10INX144IN FABRIC ROLL 4470630 270 H A6250 Y Y 07/01/2025 721.00 504.70 634.48 389.34 389.34 447 656 BOARD FOOT 4470656 271 H Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 672 BRACE ANKLE ALL SZ 4470672 274 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 447 755 BRACE KNEE ALL SZ 4470755 274 H L1820 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 447 813 MONITOR CARDIAC 4470813 270 Y Y 07/04/2019 94.00 65.80 82.72 50.76 50.76 447 839 CAST SHOE/SANDAL ALL SZ 4470839 271 H L3260 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 447 888 URETHRAL FOLEY 8OR10 FR 4470888 272 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 447 904 CATH KIT FEMALE 4470904 272 H A4353 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 912 CATH SECURE 4470912 272 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 928 PARAFIN WAX 4470928 UN 1 270 Y Y 07/01/2025 72.00 50.40 63.36 38.88 38.88 447 985 MOLDING DOUGH YELLOW 4470985 UN 1 299 Y Y 07/01/2025 30.00 21.00 26.40 16.20 16.20 447 988 MOLDING DOUGH GREEN 4470988 UN 1 270 Y Y 07/01/2025 30.00 21.00 26.40 16.20 16.20 447 995 CATH PLUG 4470995 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 996 SUCTION CATHETER 4470996 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 999 SAF-CLENS WOUND CLEANSER 4470999 270 Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 447 1001 PACKING PLAIN 1 4471001 270 Y Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 447 1003 SCRUB BRUSH 4471003 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 1004 "CONFORMING BANDAGE, NON-ELASTIC" 4471004 UN 1 271 H A6443 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1005 "SELF-ADHERENT BNDG, ELASTIC" 4471005 UN 1 271 H A6454 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1009 THERAHONEY GEL 4471009 270 H A4649 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 447 1010 THREE-LAYER COM. KIT 4471010 272 H A6441 Y Y 07/01/2025 189.00 132.30 166.32 102.06 102.06 447 1027 URETHRAL CATH TRAY(STRGHT 4471027 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 1031 TUBE AIRWAY PHARYNGEAL 4471031 270 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 447 1049 URETHRAL ROBINSON RED 14F 4471049 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1056 "CATH, CENTRAL LINE SET" 4471056 272 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 447 1090 CATHETER SUCTION 4471090 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1092 CATHETER THORACIC:ALL SZ 4471092 270 Y Y 07/01/2025 77.00 53.90 67.76 41.58 41.58 447 1111 TUBULAR NETTING 06 4471111 UN 1 270 H A6457 Y Y 07/01/2025 72.04 50.43 63.40 38.90 38.90 447 1118 CAUTERY TIP PENCIL 4471118 270 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 447 1142 IV DIAL-A-FLO 4471142 270 H Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 447 1180 NAIL CLIPPERS 4471180 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1220 TUBULAR NETTING 07 4471220 UN 1 270 H A6457 Y Y 07/01/2025 82.08 57.46 72.23 44.32 44.32 447 1222 TUBULAR NETTING 08 4471222 UN 1 270 H A6457 Y Y 07/01/2025 171.92 120.34 151.29 92.84 92.84 447 1246 TUBULAR NETTING 09 4471246 UN 1 270 H A6457 Y Y 07/01/2025 187.60 131.32 165.09 101.30 101.30 447 1266 TUBULAR NETTING 10 4471266 UN 1 270 A6457 Y Y 07/01/2025 237.88 166.52 209.33 128.46 128.46 447 1274 COLLAR CERVICAL SERP:ALL 4471274 274 H L0120 Y Y 01/01/2000 18.25 12.78 16.06 9.86 9.86 447 1324 COLLAR STFN/ALL SIZES 4471324 270 Y Y 07/01/2025 82.00 57.40 72.16 44.28 44.28 447 1407 CRADDLE FOOT S/U 4471407 271 H Z7610 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1415 CART CRASH 4471415 270 Y Y 07/01/2025 578.00 404.60 508.64 312.12 312.12 447 1449 CRUTCHES 4471449 270 H E0114 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 447 1450 IV EXTENSION SET 4471450 270 H Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1456 CAST AIR LEG LEFT 4471456 270 Y Y 07/01/2025 546.00 382.20 480.48 294.84 294.84 447 1503 STABILIZED ANKLE BRACE 4471503 270 H L1902 Y Y 07/01/2025 140.00 98.00 123.20 75.60 75.60 447 1518 VENTILATOR SUPPLIES 4471518 270 Y Y 07/01/2025 172.00 120.40 151.36 92.88 92.88 447 1522 CAST WALKING HEEL(RUBBER) 4471522 270 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 447 1530 "SPLINT, AIR ANKLE" 4471530 270 H L4350 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 447 1548 AIR CAST ANKLE RIGHT 4471548 270 H L1904 Y Y 07/01/2025 143.00 100.10 125.84 77.22 77.22 447 1555 "SPLINT, AIR LEG" 4471555 270 Y Y 07/01/2025 411.00 287.70 361.68 221.94 221.94 447 1598 B/P MONITOR 4471598 270 Y Y 07/01/2025 205.00 143.50 180.40 110.70 110.70 447 1605 CUP PLASTIC W/SNAP ON LID 4471605 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1648 DIAPERS LARGE 1 PKG 4471648 270 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 447 1649 "DIAPERS, X-LARGE, 1 PK" 4471649 270 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 447 1650 DIAPERS MEDIUM 1 PKG 4471650 270 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 447 1655 "BREIF, ADULT 2LX" 4471655 270 Y Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 447 1660 BED BATH CLOTHS 4471660 999 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1688 DOPPLER IMEX 4471688 270 Y Y 07/01/2025 97.00 67.90 85.36 52.38 52.38 447 1712 DRAIN PENROSE 4471712 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1720 TROCAR KIT-4.5MM 4471720 UN 1 270 H A4550 N Y 07/01/2025 213.00 149.10 187.44 115.02 115.02 447 1740 DRESSING TELFA ALL SZ 4471740 270 H A6402 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 1779 DRESSING VASOLINE 4471779 270 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 447 1795 DRESSING XEROFORM 5X9 4X4 4471795 270 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 1798 BLOOD COLLECT SET TUBING/BUTTERFLY 4471798 272 H Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1803 DRESSING DUODERM4X4W/O B 4471803 270 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 1805 DERMABOND WOUND FILLER 4471805 1 270 H A6248 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 447 1815 DRESSING DERABOND 4471815 272 H A6248 Y Y 07/01/2025 503.00 352.10 442.64 271.62 271.62 447 1829 BANDAGE ELASTOPLAST/COBAN 4471829 270 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 1832 "ELECTRODES, IONTO" 4471832 271 H A4556 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 447 1845 TUBE ENDOTRACHEAL/ALL SZS 4471845 270 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 447 1902 ENEMA ADMIN UNIT 4471902 270 H A4458 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 1928 IV STARTER KIT 4471928 264 H Y Y 07/01/2025 18.00 12.60 15.84 9.72 9.72 447 1930 IV TUBING PEDIATRIC 4471930 270 H Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 447 1931 IV TUBING NONVENTED 4471931 270 H Y Y 07/01/2025 67.00 46.90 58.96 36.18 36.18 447 1933 IV TUBING EXTENSION SET 4471933 270 H Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 1936 IV INFUSION SET 4471936 270 H Y Y 07/01/2025 72.00 50.40 63.36 38.88 38.88 447 1940 BLOOD DRAW KIT 4471940 UN 1 272 C 36415 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 1993 "GASTROCCULT SLIDE, SINGLE" 4471993 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2074 "HEMOCCULT SLIDE, SINGLE" 4472074 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2140 IMMOBILIZ SHOULD ELAS/ALL 4472140 270 H L3650 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 447 2168 HEEL LIFT 4472168 270 Y Y 07/01/2025 67.00 46.90 58.96 36.18 36.18 447 2212 "MEDIPORE TAPE, 3 INCH" 4472212 270 Y Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 447 2213 MEDIPORE H-TAPE 4472213 270 Y Y 07/01/2025 57.00 39.90 50.16 30.78 30.78 447 2214 "MEDIPORE DRESS-IT, 4X8" 4472214 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2215 MEDIPORE DRESS-IT 4X4.5 4472215 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2220 ADAPT OSTOMY BARR RING 4.5MM 4472220 UN 1 270 H A4385 N Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 2225 DRESSING OPSITE 6X8 4472225 270 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 447 2226 DRESSING KALTO PKG #1681 4472226 270 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 2227 DRESSING MITRAFLEX 4X4 4472227 270 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 447 2229 ALGINATE DRESSING 4X4 4472229 270 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 447 2230 OPTIFOAM BASIC 4X4 4472230 270 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 2233 IRIS CURVED SCISSORS 4472233 UN 1 270 Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 447 2255 OROPHARYNGEAL-ALL SIZES 4472255 272 H Z7610 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2261 IGLOO IRRIG SYSTEM 4472261 272 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 447 2264 DURAPREP SOL W/ APPLCTN 4472264 ML 6 270 H A4649 Y Y 07/01/2025 14.00 9.80 12.32 7.56 7.56 447 2371 EPISTAXIS KIT 4472371 270 Y Y 07/01/2025 539.00 377.30 474.32 291.06 291.06 447 2447 LENS MEDI FLO MORGAN 4472447 270 H V2797 Y Y 07/01/2025 188.00 131.60 165.44 101.52 101.52 447 2460 NEEDLE SPINAL:ALL SIZES 4472460 270 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 447 2462 LOTION 4 OZ 4472462 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2512 ELECTRODE CARDIAC MONITOR 4472512 270 H A4556 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2520 MOUTHWASH 4472520 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2559 ETONOGESTREL IMPLANT SYSTEM 4472559 1 270 H J7307 Y Y 07/01/2025 "1,155.00" 808.50 " 1,016.40 " 623.70 623.70 447 2561 DRESSING OPSITE 2X3 4472561 270 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 2575 CHEST DRAIN TRAY:PEDI 4472575 270 H A4550 Y Y 07/01/2025 377.00 263.90 331.76 203.58 203.58 447 2579 DRESSING TRANSPARENT 4X5 4472579 270 H A6258 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2605 HINGED KNEE SUPPORT 4472605 270 H L1820 Y Y 07/01/2025 233.00 163.10 205.04 125.82 125.82 447 2615 "QUICKTRACH, 2.0MM" 4472615 270 Y Y 07/01/2025 "1,517.00" " 1,061.90 " " 1,334.96 " 819.18 819.18 447 2618 "QUICKTRACH, 4.0MM" 4472618 270 Y Y 07/01/2025 "1,355.00" 948.50 " 1,192.40 " 731.70 731.70 447 2620 BIOFREEZE 4472620 UN 1 270 N Y 07/01/2025 267.00 186.90 234.96 144.18 144.18 447 2630 "BOUGIE, SINGLE USE" 4472630 270 H Y Y 07/01/2025 143.00 100.10 125.84 77.22 77.22 447 2656 COLOSTOMY WAFER 2 1/4 4472656 270 H A4414 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 2744 PACKING PLAIN 1/4 & 1/2 4472744 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 2769 IV PRIMARY NONVENTED 4472769 270 H 99070 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 2777 PACKING PLAIN 2 4472777 270 99070 Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 447 2778 IV PIGGYBACK SECONDARY 4472778 270 H Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 447 2793 PACKING IODOFORM 1 4472793 270 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 447 2819 PACKING IODOFORM 1/4 4472819 270 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 447 2827 PACKING IODOFORM 1/2 4472827 270 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 2838 "RHINO ROCKET, MED" 4472838 270 Y Y 07/01/2025 133.00 93.10 117.04 71.82 71.82 447 2840 PACKING NASAL (DOYLE) 4472840 270 Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 447 2876 PAD EGGCRATE 4472876 270 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 447 2892 PAD EYE 4472892 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2900 PAD ABDOMINAL 4472900 270 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 2901 PAD DEFIB - ZOLL 4472901 270 Y Y 07/01/2025 576.00 403.20 506.88 311.04 311.04 447 2975 UNDERPADS 5-PACK 4472975 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 2983 UNDERPAD SINGLE 4472983 270 H A4554 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 3049 PAD SANITARY/OB (12-PK) 4473049 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3130 POWDER 5 OZ 4473130 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3132 CONVATEC FLEXI-SEAL 4473132 UN 1 270 H A4335 Y Y 07/01/2025 "1,195.00" 836.50 " 1,051.60 " 645.30 645.30 447 3155 PROTECTOR HEEL&ELBOW PAIR 4473155 270 Y Y 07/01/2025 65.00 45.50 57.20 35.10 35.10 447 3171 THREE WAY STOPCOCK 4473171 270 D Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 447 3239 PUMP LIFE CARE PER DAY 4473239 270 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 447 3240 PUMP KANGAROO FEEDING DSC 4473240 270 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 447 3247 RAZOR DISPOSABLE 4473247 999 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3270 RESTRAINT LIMB 4473270 270 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 3361 ELECTRODE 12-LD EKG(MARQ) 4473361 270 H A4556 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 3379 SHAMPOO 4473379 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3387 SHAVING CREAM 4473387 999 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3400 SUCTION CANISTER 2100ML 4473400 270 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 447 3500 SLING ARM UNIVERSAL 4473500 271 H A4565 Y Y 07/01/2025 310.00 217.00 272.80 167.40 167.40 447 3569 SLIPPERS 4473569 270 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 3570 DERMAL CURRETTE 4473570 270 C 17000 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 3577 SOAP 4473577 999 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3578 VENI-GARD ADULT 4473578 272 H Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 447 3601 SPECIMAN MEASURE 4473601 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3619 VAGINAL SPECULUM DISPOSAB 4473619 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3660 SPLINT FIBERGLASS 4473660 270 H A4570 Y Y 07/01/2025 73.00 51.10 64.24 39.42 39.42 447 3684 SPLINT CLAVICAL ALL SIZES 4473684 270 H A4570 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 447 3726 SPLINT FINGER ALL SIZES 4473726 270 H Q4049 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3742 IMMOBILIZER KNEE:ALL SZ 4473742 270 H L1830 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 447 3759 SPLINT NASAL 4473759 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3767 SPLINT LEG SHORT/LONG 4473767 270 H L4370 Y Y 07/01/2025 239.00 167.30 210.32 129.06 129.06 447 3858 SPLINT COLLES ALL SIZES 4473858 270 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 447 3908 SPLINT FINGER COT 3 4473908 270 H Q4049 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 3910 RTNTION NET; SZ 1/2 4473910 270 H A6457 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 447 3912 RTNTION NET; SZ 1 4473912 270 H A6457 Y Y 07/01/2025 30.00 21.00 26.40 16.20 16.20 447 3914 "RTNTION NET, SZ 2" 4473914 270 H A6457 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 447 3915 RTNTION NET; SIZE 3 4473915 270 H A6457 Y Y 07/01/2025 40.00 28.00 35.20 21.60 21.60 447 3918 RTNTION NET; SIZE 4 4473918 270 H A6457 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 447 3922 RTNTION NET; SIZE 5 4473922 270 H A6457 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 447 3924 RTNTION NET; SIZE 6 4473924 270 H A6457 Y Y 07/01/2025 51.00 35.70 44.88 27.54 27.54 447 3929 RTNTION NET; SIZE 7 4473929 270 H A6457 Y Y 07/01/2025 53.00 37.10 46.64 28.62 28.62 447 3930 RTNTION NET; SIZE 8 4473930 270 H A6457 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 447 3933 RTNTION NET; SIZE 9 4473933 270 H A6457 Y Y 07/01/2025 69.00 48.30 60.72 37.26 37.26 447 3935 RTNTION SIZE NET; SIZE 10 4473935 270 H A6457 Y Y 07/01/2025 90.00 63.00 79.20 48.60 48.60 447 3938 RTNTION NET; SIZE 11 4473938 270 H A6457 Y Y 07/01/2025 101.00 70.70 88.88 54.54 54.54 447 3940 RTNTION NET; SIZE 12 4473940 270 H A6457 Y Y 07/01/2025 147.00 102.90 129.36 79.38 79.38 447 3943 RTNTION NET; SIZE 22 4473943 270 H A6457 Y Y 07/01/2025 263.00 184.10 231.44 142.02 142.02 447 3973 SPLINT FIBERGLASS 5 4473973 270 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 447 3981 FIBERGLASS SPLINTS - ALL 4473981 270 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 447 4005 SPLINT COCK-UP WRIST 4474005 270 H L3809 Y Y 07/01/2025 78.00 54.60 68.64 42.12 42.12 447 4013 SPLINT COCK-UP UNDEFINED 4474013 270 H A4570 Y Y 07/01/2025 78.00 54.60 68.64 42.12 42.12 447 4070 SPONGE GAUZE 4X4 TRAY 4474070 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 4088 SPONGE GAUZE ALL 4474088 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 4104 BED BATH CLOTHS 4474104 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 4112 STAPLE REMOVER SKIN 4474112 270 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 4120 STAPLER SKIN DISPOSABLE 4474120 270 H A4649 Y Y 07/01/2025 66.00 46.20 58.08 35.64 35.64 447 4140 SKIN CLOSURE STRIP 1 4474140 270 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 447 4146 SKIN CLOSURE STRIP 4474146 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 4153 SKIN CLOSURE STRIPS 1/4 4474153 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 4203 STOCKING KNEE SIZE:ALL 4474203 270 H A6532 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 4260 "URINE FILTER, DISPOSABLE" 4474260 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 4292 STYLET INTUBATING ALL SZ 4474292 270 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 4302 SUCTION GASTRIC DYCH 4474302 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 4310 SUCTION GASTRIC STUP 4474310 270 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 447 4350 SUCTION LINER (RECEPTAL) 4474350 270 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 447 4994 SUPPORT THUMB SPICA 4474994 270 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 447 5000 STATLOCK PICC PLUS 4475000 UN 1 270 H A5200 Y Y 07/01/2025 68.00 47.60 59.84 36.72 36.72 447 5010 SUCTION GOMCO @ DAY N-O 4475010 270 Y Y 07/01/2025 77.00 53.90 67.76 41.58 41.58 447 5028 SUCTION GOMCO SET UP 4475028 270 Y Y 07/01/2025 116.00 81.20 102.08 62.64 62.64 447 5069 SUTURE REMOVAL SET 4475069 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5077 SUTURES 4475077 270 Y Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 447 5101 SWAB LEMON/GLYCERINE 4475101 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5119 SWABSTICK BETADINE 4475119 270 H A4247 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 5135 SYRINGE ALL SIZES 4475135 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5140 SYRINGE SPLASH SHIELD 4475140 270 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 447 5143 SYRINGE 60CC W/LUER LOCK 4475143 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 5150 EAR/ULCER BULB SYRINGE 4475150 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5176 TELEMETRY @ HR 4475176 270 C 93225 Y Y 07/01/2025 268.00 187.60 235.84 144.72 144.72 447 5200 THERMOMETER ORAL 4475200 270 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 447 5218 THERMOMETER RECTAL 4475218 270 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 447 5226 TISSUE 4475226 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5234 TONGUE DEPRESSOR STERILE 4475234 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 5242 TOOTHBRUSH 4475242 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5259 TOOTHPASTE 4475259 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5275 TOWEL STERILE 4475275 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5291 TOWELS STERILE/2 PK 4475291 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 5293 "TRNSFR BLNKT,SHEET,PILLOW" 4475293 272 C 99070 Y Y 07/01/2025 222.00 155.40 195.36 119.88 119.88 447 5333 TRACH TUBE W/ CUFF/ADULT 4475333 270 Y Y 07/01/2025 395.00 276.50 347.60 213.30 213.30 447 5341 TUBE TRACH W/OCUFF/PED 4475341 270 Y Y 07/01/2025 366.00 256.20 322.08 197.64 197.64 447 5432 TRAY CVP 4475432 270 Y Y 07/01/2025 906.00 634.20 797.28 489.24 489.24 447 5440 TRAY EAR IRRIGATION 4475440 270 Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 447 5465 TRAY SUTURE REGULAR 4475465 272 C 99070 Y Y 07/01/2025 134.00 93.80 117.92 72.36 72.36 447 5473 TRAY SUTURE PLASTIC 4475473 270 H A4550 Y Y 07/01/2025 140.00 98.00 123.20 75.60 75.60 447 5481 TRAY EYE EXAM 4475481 270 Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 447 5523 TRAY I & D 4475523 270 C 99070 Y Y 07/01/2025 140.00 98.00 123.20 75.60 75.60 447 5564 TRAY LUMBAR PUNCTURE/ADUL 4475564 270 Y Y 07/01/2025 172.00 120.40 151.36 92.88 92.88 447 5598 TRAY PARACENTESIS 4475598 270 C 99070 Y Y 07/01/2025 261.00 182.70 229.68 140.94 140.94 447 5614 TRAY LUMBAR PUNC PED 4475614 270 Y Y 07/01/2025 229.00 160.30 201.52 123.66 123.66 447 5622 TRAY SIGMOIDOSCOPY 4475622 270 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 447 5630 TRAY THORACENTESIS 4475630 270 Y Y 07/01/2025 275.00 192.50 242.00 148.50 148.50 447 5648 TRAY TRACHEOTOMY 4475648 270 Y Y 07/01/2025 375.00 262.50 330.00 202.50 202.50 447 5655 TRAY URETHRAL DILATION 4475655 270 Y Y 07/01/2025 139.00 97.30 122.32 75.06 75.06 447 5697 TRAY BIOPSY 4475697 270 Y Y 07/01/2025 182.00 127.40 160.16 98.28 98.28 447 5698 IVORY BODY WASH 4475698 270 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 447 5705 TRAY FOLEY BLADDER 4475705 270 H A4314 Y Y 07/01/2025 133.00 93.10 117.04 71.82 71.82 447 5713 TRAY CUTDOWN 4475713 270 Y Y 07/01/2025 227.00 158.90 199.76 122.58 122.58 447 5739 TRAY EAR LAVAGE 4475739 270 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 5812 IRRIGATION TRAY BULBORPIS 4475812 270 Y Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 447 6083 TUBE NASO FEED WT 8 FR 4476083 270 Y Y 07/01/2025 233.00 163.10 205.04 125.82 125.82 447 6125 TUBE LEVINE 16 FR 4476125 270 Y Y 07/01/2025 49.00 34.30 43.12 26.46 26.46 447 6216 TUBE FEEDING INFANT 5 FR 4476216 270 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 447 6232 TUBE SALEM SUMP ALL SZ 4476232 270 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 447 6290 DISPOSABLE BLOOD PRES CUF 4476290 270 Y Y 07/01/2025 84.00 58.80 73.92 45.36 45.36 447 6315 TUBE SUCTION YANKAUER TIP 4476315 270 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 447 6323 TUBING SUCT CONNECT 3/16 4476323 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 6330 "TRACH INNER CANNULA, DISP" 4476330 270 Y Y 07/01/2025 84.00 58.80 73.92 45.36 45.36 447 6331 CATH & GLOVE SUCTION 4476331 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 6332 SPONGES TRACH DRAIN 4X4 4476332 270 Y Y 07/01/2025 17.00 11.90 14.96 9.18 9.18 447 6349 "URETHRAL FOLEY, ALL" 4476349 272 H A4344 Y Y 07/01/2025 112.00 78.40 98.56 60.48 60.48 447 6356 URETHRAL FOLEY 14FR 4476356 270 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 6364 URETHRAL FOLEY 18FR 4476364 270 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 6366 URETHRAL FOLEY 18FR COUDE 4476366 270 H A4340 Y Y 07/01/2025 243.00 170.10 213.84 131.22 131.22 447 6370 "URETHRAL FOLEY, 30CC" 4476370 270 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 6372 URINAL DISPOSABLE 4476372 270 H E0325 Y Y 07/01/2025 28.00 19.60 24.64 15.12 15.12 447 6380 URINE COLLECTOR PEDIATRIC 4476380 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 6470 PERINEAL SPRAY 8OZ 4476470 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 6479 DEODORANT ROLL-ON 4476479 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 6489 OXYGEN SET UP 4476489 270 Y Y 07/01/2025 77.00 53.90 67.76 41.58 41.58 447 6518 NOSE AID 4476518 270 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 447 6533 JEVITY W/FIBER 1 LITER 4476533 270 Y Y 07/01/2025 56.00 39.20 49.28 30.24 30.24 447 6547 MEPORE DRESSING 4476547 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 6550 NORCO OPEN FINGER WRIST COMP GLOVE 4476550 270 N N 07/01/2025 75.00 52.50 66.00 40.50 40.50 447 6551 DIAPER ADULT 4476551 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 6612 CHEST DRAIN TRAY:ADULT 4476612 270 Y Y 07/01/2025 700.00 490.00 616.00 378.00 378.00 447 6654 TRAY CLINIC MINOR 4476654 270 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 447 6655 CAVILON SWAB 4476655 271 H A6250 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 447 6656 WOUND VAC CANISTER 4476656 UN 1 272 H A7000 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 447 6657 LILY PAD DRESSING 4476657 UN 272 H A6550 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 447 7040 "SPONGES, NON-STERILE" 4477040 270 Y Y 07/01/2025 17.00 11.90 14.96 9.18 9.18 447 7041 PULL UP BRIEFS 4477041 270 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 447 7051 DRESSING DUODERM 4X4W/BOR 4477051 271 Y Y 07/01/2025 126.00 88.20 110.88 68.04 68.04 447 7060 DRESSING WOUND;ALL 4477060 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 7065 CIRCAID JUXTALITE COMP WRAP BELOW 4477065 UN 1 270 H A6545 Y Y 07/01/2025 "1,268.00" 887.60 " 1,115.84 " 684.72 684.72 447 7070 DRESSING:LARGE 4477070 270 Y Y 07/01/2025 13.00 9.10 11.44 7.02 7.02 447 7090 FSBS/ONE TOUCH MONITOR 4477090 309 C 82962 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 447 7091 AIR PRESSURE MATTRESS 4477091 270 H E0181 Y Y 07/01/2025 366.00 256.20 322.08 197.64 197.64 447 8803 BETADINE/PHISOHEX SOLUTIO 4478803 270 H A4246 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 8804 EAR CANAL IRRIGATION TIP 4478804 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 8809 STAT PAD Z ELECTRODE 4478809 270 H A4556 Y Y 07/01/2025 548.00 383.60 482.24 295.92 295.92 447 8810 SPO2 ADHESIVE SENSOR 4478810 270 H T1999 Y Y 07/01/2025 260.00 182.00 228.80 140.40 140.40 447 9000 AG POWDER 4479000 272 H A6262 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 447 9001 STERILE INSTRUMENTS 4479001 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 447 9002 V-VAC CANISTER 4479002 272 Y Y 07/01/2025 153.00 107.10 134.64 82.62 82.62 447 9004 OPHTHALMIC BURR 4479004 270 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 447 9005 TERA-PUTTY/BANDS 4479005 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 9010 TEGAGEN 4X8 4479010 272 H A6196 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 447 9011 TEGASORB 6 3/4X63/8 4479011 272 H A6237 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 447 9012 TEGASORB THIN 4479012 272 H A6237 Y Y 07/01/2025 57.00 39.90 50.16 30.78 30.78 447 9015 OSTOMY BAG 4479015 272 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 447 9020 SELF CATH 4479020 272 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 447 9025 LEG BAG 4479025 272 H A5112 Y Y 07/01/2025 49.00 34.30 43.12 26.46 26.46 447 9035 "TRIPLE CNTRL VENOUS CATH SET, 7 FR" 4479035 UN 1 270 C 36556 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 447 9578 "CAST SUPPLIES, FIBERGLASS" 4479578 270 H Q4014 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 447 9623 XTRASORB DRESSING 4479623 270 Y Y 07/01/2025 84.00 58.80 73.92 45.36 45.36 447 9643 VAG SPEC W/LIGHT DISP 4479643 272 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 447 9644 COLLAR CERVICAL SERP-ALL 4479644 274 H L0120 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 447 9645 RAPID RHINO 7.5 CM 4479645 272 C 99070 Y Y 07/01/2025 311.00 217.70 273.68 167.94 167.94 447 9646 OPTILOCK 4X4 4479646 UN 1 270 H A6252 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 447 9647 OPTILOCK 7X11 4479647 UN 1 270 H A6198 Y Y 07/01/2025 68.00 47.60 59.84 36.72 36.72 447 9648 VERSATEL 8X12 4479648 UN 1 270 H A6198 Y Y 07/01/2025 139.00 97.30 122.32 75.06 75.06 447 9650 FINE SUTURING SET/CENTRION 4479650 UN 1 270 C A4550 Y Y 07/01/2025 128.00 89.60 112.64 69.12 69.12 447 9651 DEBRIDEMENT KIT DISPOSABLE 4479651 UN 270 H A4649 Y Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 450 0 WORKERS COMP DRUG SCREEN 4500000 300 CONTR Y Y 07/01/2025 202.00 141.40 177.76 109.08 109.08 450 1 "ALCOHOLS(ACETONE,ETHANOL,ISOPROPYL" 4500001 UN 301 C 80320 Y Y 07/01/2025 330.00 231.00 290.40 178.20 178.20 450 2 VANCOMYCIN TROUGH LEVEL 4500002 301 C 80202 Y Y 07/01/2025 428.00 299.60 376.64 231.12 231.12 450 3 * TEST REFERRED TO NIH 4500003 300 Y Y 07/01/2025 0.00 - - - - 450 4 * CULTURE TO NIH 4500004 300 Y Y 07/01/2025 0.00 - - - - 450 6 * PAP TO SNL 4500006 300 Y Y 07/01/2025 0.00 - - - - 450 7 TEST REFERRED TO LABCORP 4500007 300 N N 07/01/2025 38.00 26.60 33.44 20.52 20.52 450 8 * PATH SPEC TO NIH 4500008 300 Y Y 07/01/2025 0.00 - - - - 450 9 VENIPUNCTURE COLLECT SPECIMEN (MC) 4500009 300 H G0001 Y N 07/01/2025 45.00 31.50 39.60 24.30 24.30 450 10 "COVID-19/NON-CDC, ANY TECHNIQUE" 4500010 306 H U0002 Y Y 07/01/2025 179.00 125.30 157.52 96.66 96.66 450 11 SPECIMEN COLLECTION COVID-19/SARS 4500011 300 H C9803 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 450 12 COVID-19/SARS;AMPLI PROBE TECHNIQU 4500012 300 C 87635 Y Y 07/01/2025 179.00 125.30 157.52 96.66 96.66 450 13 CORONACHEK COV-19 SNGL STEP METHOD 4500013 300 C 86328 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 450 14 SPECIMEN COLLECTION COVID-19 - SNF 4500014 300 H G2024 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 450 15 COVID-19 INFECTIOUS ANTIGEN TEST 4500015 302 C 87426 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 450 16 ACETAMINOPHEN TOXICITY 4500016 309 C 80143 Y Y 07/01/2025 330.00 231.00 290.40 178.20 178.20 450 17 COVID-19 ANTIGEN TEST INYO/CHP 4500017 UN 1 302 C 87426 Y Y 07/01/2025 68.00 47.60 59.84 36.72 36.72 450 24 BLOOD TYPING-ABO 4500024 302 H 86900 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 450 26 D-DIMER QUANT 4500026 305 C 85379 Y Y 07/01/2025 235.00 164.50 206.80 126.90 126.90 450 29 VITAMIN D 25 HYDROXY 4500029 UN 1 301 C 82306 Y Y 07/01/2025 0.00 - - - - 450 30 TPO AB 4500030 UN 1 300 C 86376 Y Y 07/01/2025 0.00 - - - - 450 31 PSA 4500031 UN 1 300 C G0103 Y Y 04/23/2025 0.00 - - - - 450 33 T3 4500033 UN 1 300 C 84480 Y Y 07/01/2025 0.00 - - - - 450 35 T4/FT4 4500035 UN 1 300 C 84439 Y Y 07/01/2025 0.00 - - - - 450 37 MMR IMMUNITY 4500037 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 38 TESTOSTERONE FREE 4500038 UN 1 300 84402 Y Y 07/01/2025 0.00 - - - - 450 39 TESTOSTERONE TOTAL 4500039 UN 1 300 C 84403 Y Y 07/01/2025 0.00 - - - - 450 49 AEROBIC EAR CULTURE 008649 306 C 87070 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 450 50 INFLUENZA TEST 4500050 306 C 87804 Y Y 07/01/2025 180.00 126.00 158.40 97.20 97.20 450 52 VARICELLA ZOSTER 4500052 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 54 DHEA-S 4500054 UN 1 300 C 82627 Y Y 07/01/2025 0.00 - - - - 450 55 PTH INTACT 4500055 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 57 TESTOSTERONE T 4500057 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 58 VITAMIN D HYDROXY 4500058 UN 1 300 C 82306 Y Y 04/23/2025 0.00 - - - - 450 60 VITAMIN B12 4500060 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 61 LEVETIRACETAM 4500061 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 65 ACETONE/KETONE 4500065 301 C 82009 Y Y 07/01/2025 78.00 54.60 68.64 42.12 42.12 450 70 TOPIRAMATE 4500070 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 73 CARBAMAZEPINE 4500073 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 75 PSA ULTRASENSITIVE 4500075 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 77 RHEUMATOID FACTOR (RF) 4500077 300 Y Y 04/23/2025 0.00 - - - - 450 79 "ANTI-CCP AB, IGG/IGA" 4500079 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 80 ANTI-MULLERIAN H 4500080 UN 1 300 Y Y 04/23/2025 0.00 - - - - 450 100 MED DRUG SCREENING 4500100 300 C 80305 Y Y 07/01/2025 261.00 182.70 229.68 140.94 140.94 450 107 COOMBS-DIRECT 4500107 302 C 86880 Y Y 07/01/2025 107.00 74.90 94.16 57.78 57.78 450 111 MAGNESIUM LC 4500111 UN 1 301 C 83735 Y Y 07/01/2025 0.00 - - - - 450 112 TIBC IRON 4500112 UN 1 300 C 83550 Y Y 07/01/2025 0.00 - - - - 450 122 AMYLACE 4500122 UN 1 301 C 82150 Y Y 07/01/2025 0.00 - - - - 450 123 ALBUMIN; SERUM 4500123 301 C 82040 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 450 125 ESTRADIOL 4500125 UN 1 301 C 82670 Y Y 07/01/2025 0.00 - - - - 450 127 BASIC METABOLIC PNL 4500127 UN 1 301 C 80048 Y Y 07/01/2025 0.00 - - - - 450 128 TESTOSTERONE FREE AND TOTAL 4500128 UN 1 301 C 84270 Y Y 07/01/2025 0.00 - - - - 450 129 CBC WITH DIFF PLT 4500129 UN 1 301 C 85025 Y Y 07/01/2025 0.00 - - - - 450 130 ESTRADIOL 4500130 UN 1 300 C 82670 Y Y 07/01/2025 0.00 - - - - 450 133 GROWTH HORMONE 4500133 UN 1 300 C 83003 Y Y 07/01/2025 0.00 - - - - 450 134 AMH 4500134 UN 1 300 C 82166 Y Y 07/01/2025 0.00 - - - - 450 135 CRP CARDIAC 4500135 UN 1 300 C 86141 Y Y 07/01/2025 0.00 - - - - 450 138 PROGESTERONE 4500138 UN 1 300 C 84144 Y Y 07/01/2025 0.00 - - - - 450 139 FSH/LH 4500139 UN 1 300 C 83001 Y Y 07/01/2025 0.00 - - - - 450 140 CRP QUANT 4500140 UN 1 300 C 86140 Y Y 07/01/2025 0.00 - - - - 450 149 ETOH 4500149 300 C 82077 Y Y 03/01/2025 330.00 231.00 290.40 178.20 178.20 450 150 ALCOHOL (ETHANOL); BREATH 4500150 UN 1 301 C 82075 N N 07/01/2025 107.00 74.90 94.16 57.78 57.78 450 152 RH FACTOR 4500152 UN 1 300 C 86901 Y Y 07/01/2025 0.00 - - - - 450 155 ANA 4500155 UN 1 300 C 86038 Y Y 07/01/2025 0.00 - - - - 450 156 ALP 4500156 301 C 84075 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 450 157 CONTRACT HEP B TITER 4500157 309 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 450 160 HBV 4500160 UN 1 300 C 86704 Y Y 07/01/2025 0.00 - - - - 450 161 CHLAMYDIA GC TRICHOMONAS 4500161 UN 1 300 Y Y 07/01/2025 0.00 - - - - 450 172 ALANINE AMINO ALT 4500172 301 C 84460 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 450 180 HCV 4500180 UN 1 300 C 86803 Y Y 07/01/2025 0.00 - - - - 450 182 HCV CONFIRMATION TEST 4500182 UN 1 300 C 86804 Y Y 07/01/2025 0.00 - - - - 450 185 B HYDROXYBUTYRATE 4500185 UN 1 300 C 82010 Y Y 07/01/2025 0.00 - - - - 450 188 CBC DIFF PLT NLR 4500188 UN 1 301 C 85025 Y Y 07/01/2025 0.00 - - - - 450 189 SYPHILIS 4500189 UN 1 300 C 86592 Y Y 07/01/2025 0.00 - - - - 450 191 HIV 4500191 UN 1 300 C G0432 Y Y 07/01/2025 0.00 - - - - 450 192 STI PANEL - TST #144027 4500192 UN 1 300 Y Y 07/01/2025 0.00 - - - - 450 195 HIV/ELISA 4500195 UN 1 300 C G0433 Y Y 07/01/2025 0.00 - - - - 450 199 COMP MET PNL 13 4500199 UN 1 301 C 80053 Y Y 07/01/2025 0.00 - - - - 450 200 DRUG SCREEN-INDUSTRIAL 4500200 300 CONTR Y Y 07/01/2025 84.00 58.80 73.92 45.36 45.36 450 210 MRO FEE 4500210 300 CONTR Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 450 215 PSA 4500215 301 C 84153 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 450 222 ANTIBODY SCREEN 4500222 300 C 86850 Y Y 07/01/2025 160.00 112.00 140.80 86.40 86.40 450 255 "ABG, ANY COMB. PH,02 CALC" 4500255 301 C 82805 Y Y 07/01/2025 602.00 421.40 529.76 325.08 325.08 450 297 AST 4500297 301 C 84450 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 450 299 ANNUAL PSA SCREENING 4500299 301 H G0103 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 450 305 PREGNANCY TEST 4500305 301 C 84703 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 450 328 ANNUAL IFOB SCREENING 4500328 301 H G0328 Y Y 07/01/2025 130.00 91.00 114.40 70.20 70.20 450 333 GGT 4500333 UN 1 301 C 82977 Y Y 07/01/2025 0.00 - - - - 450 354 CARBON DIOXIDE 4500354 301 C 82374 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 450 361 BILIRUBIN-DIRECT 4500361 301 C 82248 Y Y 07/01/2025 107.00 74.90 94.16 57.78 57.78 450 362 BILLIRUBIN TOTAL 4500362 301 C 82247 Y Y 07/01/2025 93.00 65.10 81.84 50.22 50.22 450 404 BLOOD COUNT; COMPLETE; AUTOMATED 4500404 305 C 85027 Y Y 07/01/2025 126.00 88.20 110.88 68.04 68.04 450 453 UREA NITROGEN (BUN) 4500453 301 C 84520 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 450 487 "CALCIUM, TOTAL" 4500487 301 C 82310 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 450 537 MANUAL DIFFERENTIAL 4500537 305 C 85007 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 450 578 CHLORIDE; BLOOD 4500578 301 C 82435 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 450 620 CHOLESTEROL 4500620 301 C 82465 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 450 621 ACETAMINOPHEN TESTING 4500621 301 C 80302 Y Y 01/01/2000 127.11 88.98 111.86 68.64 68.64 450 622 "ANALGESIC,NONOPIOD 1 OR 2" 4500622 301 C 80329 Y Y 07/01/2025 330.00 231.00 290.40 178.20 178.20 450 625 DRUG TEST-CHEM ANALYZERS 4500625 300 C 80307 Y Y 07/01/2025 261.00 182.70 229.68 140.94 140.94 450 628 MB FRACTION ONLY 4500628 301 C 82553 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 450 649 AERBIC EAR CULTURE 008649 301 C 87070 Y Y 01/31/2024 0.00 - - - - 450 660 PH-BLOOD 4500660 301 C 82800 Y Y 07/01/2025 199.00 139.30 175.12 107.46 107.46 450 710 BINAXNOW RSV TEST 4500710 11877043022 UN 1 306 C 87807 Y Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 450 768 "CK,CPK;TOTAL" 4500768 301 C 82550 Y Y 07/01/2025 166.00 116.20 146.08 89.64 89.64 450 792 "CREATININE, BLOOD" 4500792 301 C 82565 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 450 818 CROSSMATCH 4500818 300 C 86922 Y Y 07/01/2025 395.00 276.50 347.60 213.30 213.30 450 819 CROSSMATCH COMPATIBLE 2 4500819 300 C 86922 Y Y 07/01/2025 0.00 - - - - 450 820 CROSSMATCH COMPATIBLE3 04500820 300 C 86922 Y Y 07/01/2025 0.00 - - - - 450 821 CROSSMATCH COMPATIBLE 4 04500821 300 C 86922 Y Y 07/01/2025 0.00 - - - - 450 855 HEPATIC PANEL-- 4500855 UN 1 301 C 80076 Y Y 07/01/2025 0.00 - - - - 450 899 TB QUANTIFERON GOLD 4500899 UN 1 301 C 86480 Y Y 07/01/2025 0.00 - - - - 450 988 LDH - LC 4500988 UN 1 301 C 83615 Y Y 07/01/2025 0.00 - - - - 450 999 LIPID PNL LDL/HDL 4500999 UN 1 301 C 80061 Y Y 07/01/2025 0.00 - - - - 450 1063 ELECTROLYTE PANEL 4501063 300 C 80051 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 450 1096 DRUG SCRN 4501096 300 C 80305 Y Y 07/01/2025 80.00 56.00 70.40 43.20 43.20 450 1099 PREGNENOLONE 4501099 UN 1 301 84140 Y Y 07/01/2025 0.00 - - - - 450 1154 SEDIMENTATION RATE 4501154 305 C 85651 Y Y 07/01/2025 107.00 74.90 94.16 57.78 57.78 450 1162 OCCULT BLOOD; FECES 4501162 301 C 82272 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 450 1174 IFOB (FECAL OCCULT BLOOD) 4501174 301 C 82274 Y Y 07/01/2025 130.00 91.00 114.40 70.20 70.20 450 1246 GTT EACH ADDITIONAL 4501246 301 C 82952 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 450 1261 "GTT, 3 SPECIMENS" 4501261 301 C 82951 Y Y 07/01/2025 251.00 175.70 220.88 135.54 135.54 450 1262 "GTT, 2 HOUR" 4501262 301 C 82951 Y Y 07/01/2025 251.00 175.70 220.88 135.54 135.54 450 1263 D-DIMER 4501263 301 C 85379 Y Y 07/02/2021 157.29 110.10 138.42 84.94 84.94 450 1264 ALCOHOL/ETHANOL/ISOPROPYL TEST 4501264 301 C 80320 Y N 07/01/2025 330.00 231.00 290.40 178.20 178.20 450 1265 PACKED RED BLOOD CELLS 4501265 381 H P9021 Y Y 07/01/2025 441.00 308.70 388.08 238.14 238.14 450 1266 TYPE & SCREEN 4501266 301 C 86900 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 450 1267 "PLATELETS, PHERESIS, LEUKO-REDUCED" 4501267 390 H P9035 Y Y 07/01/2025 "1,081.00" 756.70 951.28 583.74 583.74 450 1290 POST-PRANDIAL GLUCOSE 2 HR 4501290 301 C 82950 Y Y 07/01/2025 89.00 62.30 78.32 48.06 48.06 450 1291 GESTATIONAL DIABETES EVAL 4501291 301 C 82950 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 450 1292 HGB A1C 4501292 301 C 83036 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 450 1295 "GLUCOSE, QUANT, BLOOD" 4501295 301 C 82947 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 450 1297 GLUCOSE BY REAGENT STRIP 4501297 301 C 82948 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 450 1298 GLUCOSE POST 75G 2 HOUR 4501298 301 C 82950 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 450 1329 HDL CHOLESTEROL 4501329 301 C 83718 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 450 1469 LIPID PANEL 4501469 300 C 80061 Y Y 07/01/2025 179.00 125.30 157.52 96.66 96.66 450 1476 ACUTE HEPATITIS PANEL 4501476 300 C 80074 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 450 1477 HEPATIC FUNCTION PANEL 4501477 300 C 80076 Y Y 07/01/2025 166.00 116.20 146.08 89.64 89.64 450 1485 MAGNESIUM 4501485 301 C 83735 Y Y 07/01/2025 153.00 107.10 134.64 82.62 82.62 450 1519 BASIC METABOLIC PANEL 4501519 300 C 80048 Y Y 07/01/2025 161.00 112.70 141.68 86.94 86.94 450 1521 COMP METABOLIC PANEL 4501521 300 C 80053 Y Y 07/01/2025 206.00 144.20 181.28 111.24 111.24 450 1584 "VENIPUNC, <3YR; OTH VEIN" 4501584 300 C 36406 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 450 1634 "TRIIODOTHYRONINE, FREE T3" 4501634 301 C 84481 Y Y 07/01/2025 179.00 125.30 157.52 96.66 96.66 450 1720 "DRUG TEST(S),DF,DRUG ID,IND DRUGS" 4501720 UN 1 300 H G0480 Y Y 07/01/2025 371.00 259.70 326.48 200.34 200.34 450 1723 "PHOSPHORUS, SERUM" 4501723 301 C 84100 Y Y 07/01/2025 93.00 65.10 81.84 50.22 50.22 450 1766 "POTASSIUM, SERUM" 4501766 301 C 84132 Y Y 07/01/2025 91.00 63.70 80.08 49.14 49.14 450 1815 SPECIMEN HANDLING/TRANSFE 4501815 300 C 99001 N N 07/01/2025 25.00 17.50 22.00 13.50 13.50 450 1831 "UA,AUTO,WSCOPE" 4501831 307 C 81001 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 450 1850 "PROTEIN, TOTAL" 4501850 301 C 84155 Y Y 07/01/2025 73.00 51.10 64.24 39.42 39.42 450 1873 PROTHROMBIN TIME 4501873 305 C 85610 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 450 1899 PTT 4501899 305 C 85730 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 450 1964 BLOOD TYPING-RH(D) 4501964 305 C 86901 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 450 2020 T2 BACTERIA PANEL;1/5 4502020 301 C 87640 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 450 2022 T2 BACTERIA PANEL; 4/5 4502022 301 C 87798 Y Y 07/01/2025 175.00 122.50 154.00 94.50 94.50 450 2082 LACTIC ACID 4502082 301 C 83605 Y Y 07/01/2025 199.00 139.30 175.12 107.46 107.46 450 2087 GRAM STAIN 4502087 306 C 87205 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 450 2103 "SODIUM, SERUM" 4502103 301 C 84295 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 450 2152 STREP SCREEN DIRECT 4502152 302 C 87880 Y Y 07/01/2025 182.00 127.40 160.16 98.28 98.28 450 2191 "TROPONIN, QUANT" 4502191 301 C 84484 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 450 2192 BNP 4502192 301 C 83880 Y Y 07/01/2025 363.00 254.10 319.44 196.02 196.02 450 2195 LIPASE 4502195 301 C 83690 Y Y 07/01/2025 139.00 97.30 122.32 75.06 75.06 450 2198 THYROXINE; FREE 4502198 301 C 84439 Y Y 07/01/2025 179.00 125.30 157.52 96.66 96.66 450 2244 TRIGLYCERIDES 4502244 301 C 84478 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 450 2269 TSH 4502269 301 C 84443 Y Y 07/01/2025 324.00 226.80 285.12 174.96 174.96 450 2285 URIC ACID SERUM 4502285 301 C 84550 Y Y 07/01/2025 91.00 63.70 80.08 49.14 49.14 450 2360 "UA,NON-AUTO,WOSCOPE" 4502360 300 C 81003 Y Y 07/01/2025 83.00 58.10 73.04 44.82 44.82 450 2370 "UA,MICROSCOPE ONLY" 4502370 300 C 81015 Y Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 450 2380 "UACR, CREATININE" 4502380 300 C 82570 Y Y 07/01/2025 68.00 47.60 59.84 36.72 36.72 450 2381 "UACR, MICROALBUMIN" 4502381 300 C 82043 Y Y 07/01/2025 68.00 47.60 59.84 36.72 36.72 450 2392 "ROUTINE VENIPUNC, COL" 4502392 300 C 36415 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 450 2442 WET MOUNT 4502442 306 C 87210 Y Y 07/01/2025 107.00 74.90 94.16 57.78 57.78 450 2459 WRIGHT'S STAIN 4502459 306 C 87205 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 450 2592 MYOGLOBIN 4502592 301 C 83874 Y Y 07/01/2025 351.00 245.70 308.88 189.54 189.54 450 2593 RENAL PANEL 4502593 300 C 80069 Y Y 07/01/2025 189.00 132.30 166.32 102.06 102.06 450 2595 "6 PANEL; AMP,COC,OPI,PCP,THC" 4502595 UN 1 300 H 80305 N Y 07/01/2025 12.00 8.40 10.56 6.48 6.48 450 2599 10 PANEL; TEST CODE 788773 4502599 UN 1 300 C 80305 N Y 07/01/2025 13.00 9.10 11.44 7.02 7.02 450 3500 14 PANEL; TEST CODE 713323 4503500 UN 1 300 80305 N N 07/01/2025 18.00 12.60 15.84 9.72 9.72 450 6297 AMMONIA 4506297 301 C 82140 Y Y 07/01/2025 271.00 189.70 238.48 146.34 146.34 450 7500 CBC AUTO 4507500 305 C 85025 Y Y 07/01/2025 166.00 116.20 146.08 89.64 89.64 450 7508 TSH FT4 4507508 UN 1 309 Y Y 07/01/2025 0.00 - - - - 450 7533 T3 FREE 4507533 UN 1 309 Y Y 04/11/2025 0.00 - - - - 450 7555 INSULIN 4507555 UN 1 309 Y Y 07/01/2025 0.00 - - - - 450 7582 TB QUANT GOLD 4507582 UN 1 309 Y Y 07/01/2025 0.00 - - - - 450 7596 VALPROIC ACID 4507596 UN 1 309 Y Y 07/01/2025 0.00 - - - - 450 7600 HEAVY METAL PROF I; BLOOD 042580 4507600 300 Y Y 07/01/2025 730.00 511.00 642.40 394.20 394.20 450 7601 HEAVY METAL PROF II; BLOOD 706200 4507601 300 Y Y 07/01/2025 "1,014.00" 709.80 892.32 547.56 547.56 450 8997 CHLAMYDIA/GE APTIMA 4508997 UN 1 301 C 87491 Y Y 07/01/2025 0.00 - - - - 450 9000 "CULTURE,PRES,ORGANISMS" 4509000 300 C 87081 Y Y 07/01/2025 228.00 159.60 200.64 123.12 123.12 450 9762 VITAMIN D OH 25 4509762 301 C 82306 Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 450 9763 VENIPUNCTURE OR PHLEBOTOMY 4509763 UN 1 300 C 36592 Y Y 07/01/2025 65.00 45.50 57.20 35.10 35.10 450 9765 T2 BIOSYSTEMS T2CANDIDA 1.1 4509765 300 C 87481 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 450 9766 INFECTIOUS AGENT ANTIGEN DETECT 4509766 302 C 87420 Y Y 07/02/2021 90.95 63.67 80.04 49.11 49.11 450 9800 STAPHYLOCOCCUS AUREUS T2 BACT. PAN 4509800 300 C 87640 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 450 9805 INFECT AGENT DETECT BY NUCL ACID 4509805 300 87798 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 450 9810 CREATININE STAT SENSOR 4509810 UN 1 301 C 82565 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 450 9999 CALL BACK-LAB TECH 4509999 300 Y Y 07/01/2025 155.00 108.50 136.40 83.70 83.70 454 25 "RED BLOOD CELLS, EA UNIT" 4540025 381 H P9021 Y Y 07/01/2025 475.00 332.50 418.00 256.50 256.50 454 26 PACKED RBC 3 4540026 381 C P9021 Y Y 07/01/2025 0.00 - - - - 454 27 PACKED RBC 4 4540027 381 C P9021 Y Y 07/01/2025 0.00 - - - - 454 28 "RED BLOOD CELLS, EACH UNIT " 04540028 381 H P9021 Y Y 07/01/2025 13.00 9.10 11.44 7.02 7.02 454 29 ASPIRIN/SALICYLATE 4540029 251 H G8598 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 459 0 ECHO 2 DU MODE 4590000 480 C 93307 Y Y 07/01/2025 "1,201.00" 840.70 " 1,056.88 " 648.54 648.54 459 1 ECHO CARDIOGRAPHY; COMPLETE 4590001 UN 1 480 C 93307 Y Y 07/01/2025 "3,087.00" " 2,160.90 " " 2,716.56 " " 1,666.98 " " 1,666.98 " 459 2 DOPPLER COLOR FLOW 4590002 480 C 93325 Y Y 07/01/2025 395.00 276.50 347.60 213.30 213.30 459 5 NEW PT; INITIAL VISIT W/ PROC* 4590005 UN 1 761 C 99025 Y Y 04/20/2024 90.00 63.00 79.20 48.60 48.60 459 6 POST OP FU @ NO CHARGE 4590006 UN 1 480 C 99024 Y Y 07/01/2025 0.00 - - - - 459 7 LEVEL 1; EST PT- BRIEF 5 MIN 4590007 UN 1 761 C 99211 Y Y 07/01/2025 189.00 132.30 166.32 102.06 102.06 459 8 EKG 4590008 730 C 93005 Y Y 07/01/2025 428.00 299.60 376.64 231.12 231.12 459 9 CARDIOTELEMETRY UP TO 30 DAYS TECH 4590009 UN 1 480 C 93229 Y Y 02/01/2025 "2,234.00" " 1,563.80 " " 1,965.92 " " 1,206.36 " " 1,206.36 " 459 10 ECHO DOPPLER 4590010 480 C 93320 Y Y 07/01/2025 665.00 465.50 585.20 359.10 359.10 459 160 ECG; 12 LEADS;I&R 4590160 UN 1 985 C 93010 Y Y 04/01/2025 132.00 92.40 116.16 71.28 71.28 459 165 ECG 12-LEAD - SCREEN IPPE I&R 4590165 480 H G0403 Y Y 07/01/2025 361.00 252.70 317.68 194.94 194.94 460 1 READ-US ECHO COMPLETE 4600001 UN 1 972 C 93306 Y Y 08/01/2023 527.00 368.90 463.76 284.58 284.58 460 2 READ-US ECHO LIMITED 4600002 UN 1 972 C 93308 Y Y 07/01/2025 252.00 176.40 221.76 136.08 136.08 460 4 LEVEL 2; LIMITED 20 MIN 4600004 UN 1 982 C 99202 Y Y 07/01/2025 277.00 193.90 243.76 149.58 149.58 460 6 LEVEL 3; EXPANDED; 30 MIN 4600006 UN 1 982 C 99203 Y Y 07/01/2025 385.00 269.50 338.80 207.90 207.90 460 8 LEVEL 4; COMPREHENSIVE; 45 MIN 4600008 UN 1 982 C 99204 Y Y 07/01/2025 490.00 343.00 431.20 264.60 264.60 460 9 EXT MOBIL CARDIO PROV INTER 30 DAY 4600009 960 C 93228 Y Y 02/01/2025 72.00 50.40 63.36 38.88 38.88 460 10 LEVEL 5; COMPREHENSIVE; 60 MIN 4600010 UN 1 982 C 99205 Y Y 07/01/2025 518.00 362.60 455.84 279.72 279.72 460 12 LEVEL 2; EST PT- LIMITED 10-19MIN 4600012 UN 1 982 C 99212 Y Y 07/01/2025 198.00 138.60 174.24 106.92 106.92 460 14 LEVEL 3; EXPANDED 20-29 MIN EST PT 4600014 UN 1 982 C 99213 Y Y 07/01/2025 251.00 175.70 220.88 135.54 135.54 460 15 LEVEL 4; COMPREHENSIVE 30-39MIN ES 4600015 UN 1 982 C 99214 Y Y 07/01/2025 343.00 240.10 301.84 185.22 185.22 460 17 LEVEL 5; COMPREHENSIVE EST PT 40MI 4600017 988 C 99215 Y Y 07/01/2025 "1,117.00" 781.90 982.96 603.18 603.18 460 19 PROLONGED OP EVAL;MANAGMENT SERV 4600019 UN 1 960 C 99417 Y I 07/01/2025 765.00 535.50 673.20 413.10 413.10 463 0 XR-AC JT BILAT W/WO WEIGHTED_ 4630000 320 C 73050 Y Y 07/01/2025 475.00 332.50 418.00 256.50 256.50 463 1 "US,AAA,REAL TIME -IMAGE" 4630001 402 C 76706 Y Y 07/02/2020 "1,105.00" 773.50 972.40 596.70 596.70 463 2 US SOFT TIS HEAD&NECK 4630002 402 C 76536 Y Y 07/02/2020 "1,385.00" 969.50 " 1,218.80 " 747.90 747.90 463 3 "XR- C-SPINE, 4-5V" 4630003 320 C 72050 Y Y 07/01/2025 "1,206.00" 844.20 " 1,061.28 " 651.24 651.24 463 4 XR-HIPS W/PELVIS BILATERAL MIN 2V 4630004 320 C 73521 Y Y 07/01/2025 "1,005.00" 703.50 884.40 542.70 542.70 463 8 XR- HIPS W/PELVIS 3-4V BILATERAL 4630008 320 C 73522 Y Y 07/01/2025 "1,306.00" 914.20 " 1,149.28 " 705.24 705.24 463 10 "US BREAST, UNI/BILAT COMPLETE" 4630010 402 C 76642 Y Y 07/02/2020 441.00 308.70 388.08 238.14 238.14 463 11 XR- CHEST 1V-BED SIDE 4630011 320 C 71010 Y Y 01/01/2000 283.64 198.55 249.60 153.17 153.17 463 12 XR- SCOLIOSIS EXAM 2-3 VIEWS 4630012 320 C 72082 Y Y 07/01/2025 "1,379.00" 965.30 " 1,213.52 " 744.66 744.66 463 13 XR- SMALL BOWEL SERIES 4630013 320 C 74250 Y Y 07/01/2025 "1,535.00" " 1,074.50 " " 1,350.80 " 828.90 828.90 463 16 EKG 4630016 730 C 93005 Y Y 07/02/2020 279.00 195.30 245.52 150.66 150.66 463 20 SAC JOINTS 3V 4630020 UN 1 320 C 72202 Y Y 07/01/2025 897.00 627.90 789.36 484.38 484.38 463 26 XR- ABDOMEN COMPLETE W/DCUB&ERECT 4630026 320 C 74020 Y Y 07/01/2025 649.00 454.30 571.12 350.46 350.46 463 27 XR- HIP W/PELVIS UNILAT 1V 4630027 320 C 73501 Y Y 07/01/2025 487.00 340.90 428.56 262.98 262.98 463 30 XR- CHEST 4 VIEWS 4600030 320 C 71030 Y Y 01/01/2000 860.00 602.00 756.80 464.40 464.40 463 34 XR- ACUTE ABDOMEN SERIES 4630034 320 C 74022 Y Y 07/01/2025 "1,153.00" 807.10 " 1,014.64 " 622.62 622.62 463 36 FLUOROSCOPY UP TO 1 HR SEPARTE PRO 4630036 325 C 76000 Y Y 07/01/2025 122.00 85.40 107.36 65.88 65.88 463 38 THROAT X-RAY & FLUOROSCOPY 4630038 1 325 C 70370 Y Y 07/01/2025 122.00 85.40 107.36 65.88 65.88 463 41 "INJ, ANSTC AGNT; LUMBAR OR THORACI" 4630041 1 325 C 64520 Y Y 07/01/2025 357.00 249.90 314.16 192.78 192.78 463 43 FLUOROSCOPIC GUIDANCE. 4630043 325 C 77003 Y Y 07/01/2025 122.00 85.40 107.36 65.88 65.88 463 45 FLUOROSCOPIC GUIDANCE FOR BIOPSY 4630045 325 C 77002 Y Y 07/01/2025 132.00 92.40 116.16 71.28 71.28 463 58 "XR- ABDOMEN, 1 VIEW" 4630058 320 C 74018 Y Y 07/01/2025 674.00 471.80 593.12 363.96 363.96 463 59 XR- ABDOMEN; AP 4630059 320 C 74000 Y Y 01/01/2000 209.05 146.34 183.96 112.89 112.89 463 67 "XR- ABDOMEN, 2 VIEWS" 4630067 320 C 74019 Y Y 07/01/2025 "1,048.00" 733.60 922.24 565.92 565.92 463 157 "RHYTHM ECG, 1-3 LEADS; W/ INTER&RE" 4630157 730 C 93040 Y Y 07/01/2025 402.00 281.40 353.76 217.08 217.08 463 158 XR- ANKLE 2 VIEWS LEFT 4630158 320 C 73600 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 159 XR- ANKLE 2 VIEWS RIGHT 4630159 320 C 73600 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 160 XR- ANKLE 2 VIEWS BILATERAL 4630160 320 C 73600 Y Y 07/01/2025 497.00 347.90 437.36 268.38 268.38 463 182 XR- ANKLE COMPLETE MIN 3V LEFT 4630182 320 C 73610 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 183 XR- ANKLE COMPLETE MIN 3V RIGHT 4630183 320 C 73610 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 184 XR- ANKLE COMPLETE MIN 3V BILATERA 4630184 320 C 73610 Y Y 07/01/2025 582.00 407.40 512.16 314.28 314.28 463 273 XR- BONE SURVEY INFANT 4630273 320 C 77076 Y Y 07/01/2025 663.00 464.10 583.44 358.02 358.02 463 300 XR- BONE SURVEY COMPLETE 4630300 320 C 77075 Y Y 07/01/2025 "1,258.00" 880.60 " 1,107.04 " 679.32 679.32 463 301 XR-NOSE TO RECTUM (BABYGRAM) 4630301 320 C 76010 Y Y 07/01/2025 671.00 469.70 590.48 362.34 362.34 463 307 XR- SPINE 1 VIEW SPFY LVL 4630307 320 C 72020 Y Y 07/01/2025 890.00 623.00 783.20 480.60 480.60 463 315 "XR- C-SPINE, AP & LAT" 4630315 320 C 72040 Y Y 07/01/2025 837.00 585.90 736.56 451.98 451.98 463 331 "XR- C-SPINE, 6+ VIEWS" 4630331 320 C 72052 Y Y 07/01/2025 "1,361.00" 952.70 " 1,197.68 " 734.94 734.94 463 355 XR- CHEST SINGLE VIEW 4630355 324 C 71045 Y Y 07/01/2025 734.00 513.80 645.92 396.36 396.36 463 356 "XR- CHEST, 1V FRNTL" 4630356 324 C 71010 Y Y 01/01/2000 262.63 183.84 231.11 141.82 141.82 463 357 XR- CHEST 2 VIEWS 4630357 324 C 71046 Y Y 07/01/2025 738.00 516.60 649.44 398.52 398.52 463 358 XR- CHEST 3 VIEWS 4630358 324 C 71047 Y Y 07/01/2025 772.00 540.40 679.36 416.88 416.88 463 364 "XR- CHEST 2V,FRNT,LAT" 4630364 324 C 71020 Y Y 01/01/2000 315.16 220.61 277.34 170.19 170.19 463 372 XR- CHEST 3VWALP 4630372 320 C 71021 Y Y 01/01/2000 367.68 257.38 323.56 198.55 198.55 463 408 HOLTER MONITOR & READING 4630408 731 C 93224 Y Y 07/01/2025 "1,109.00" 776.30 975.92 598.86 598.86 463 409 HOLTER/HOOK UP-RECORD-DI 4630409 489 C 93225 Y Y 07/01/2025 519.00 363.30 456.72 280.26 280.26 463 414 "XR- CLAVICLE, COMPLETE LEFT" 4630414 320 C 73000 Y Y 07/01/2025 692.00 484.40 608.96 373.68 373.68 463 415 "XR- CLAVICLE, COMPLETE RIGHT" 4630415 320 C 73000 Y Y 07/01/2025 692.00 484.40 608.96 373.68 373.68 463 416 "XR- CLAVICLE, COMPLETE BILATERAL" 4630416 320 C 73000 Y Y 07/01/2025 692.00 484.40 608.96 373.68 373.68 463 448 CD COPY 4630448 1 Y N 07/01/2025 13.00 9.10 11.44 7.02 7.02 463 489 XR- ELBOW 2 VIEWS LEFT 4630489 320 C 73070 Y Y 07/01/2025 734.00 513.80 645.92 396.36 396.36 463 490 XR- ELBOW 2 VIEWS RIGHT 4630490 320 C 73070 Y Y 07/01/2025 734.00 513.80 645.92 396.36 396.36 463 491 XR- ELBOW 2 VIEWS BILATERAL 4630491 320 C 73070 Y Y 07/01/2025 408.00 285.60 359.04 220.32 220.32 463 497 XR- ELBOW COMPLETE MIN 3V LEFT 4630497 320 C 73080 Y Y 07/01/2025 798.00 558.60 702.24 430.92 430.92 463 498 XR- ELBOW COMPLETE MIN 3V RIGHT 4630498 320 C 73080 Y Y 07/01/2025 798.00 558.60 702.24 430.92 430.92 463 499 XR- ELBOW COMPLETE MIN 3V BILATERA 4630499 320 C 73080 Y Y 07/01/2025 555.00 388.50 488.40 299.70 299.70 463 554 XR- FACIAL BONE 1-2 V 4630554 320 C 70140 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 562 XR- FACIAL BONES MIN 3V 4630562 320 C 70150 Y Y 07/01/2025 997.00 697.90 877.36 538.38 538.38 463 612 "XR- FEMUR, MIN 2V LEFT" 4630612 320 C 73552 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 613 "XR- FEMUR, MIN 2V RIGHT" 4630613 320 C 73552 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 616 "US, ABI 1-2 LEVELS" 4670616 320 C 93922 Y Y 07/02/2020 688.00 481.60 605.44 371.52 371.52 463 648 XR- FINGER/THUMB 2+V LEFT 4630648 320 C 73140 Y Y 07/01/2025 600.00 420.00 528.00 324.00 324.00 463 649 XR- FINGER/THUMB 2+V RIGHT 4630649 320 C 73140 Y Y 07/01/2025 600.00 420.00 528.00 324.00 324.00 463 650 "XR- FINGER 1ST LEFT,MIN 2V" 4630650 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 651 "XR- FINGER 1ST RIGHT, MIN 2V" 4630651 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 652 "XR- FINGER 2ND LEFT,MIN 2V" 4630652 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 653 "XR- FINGER 2ND RIGHT, MIN 2V" 4630653 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 655 "XR- FINGER 3RD LEFT, MIN 2V" 4630655 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 656 "XR- FINGER 3RD RIGHT, MIN 2V" 4630656 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 657 "XR- FINGER 4TH LEFT, MIN 2V" 4630657 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 658 "XR- FINGER(S), 2 VIEW" 4630658 320 C 73140 Y Y 07/02/2020 327.00 228.90 287.76 176.58 176.58 463 687 XR- FOOT 2 VIEWS LEFT 4630687 320 C 73620 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 688 XR- FOOT 2 VIEWS RIGHT 4630688 320 C 73620 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 689 XR- FOOT 2 VIEWS BILATERAL 4630689 320 C 73620 Y Y 07/01/2025 416.00 291.20 366.08 224.64 224.64 463 695 XR- FOOT COMPLETE MIN 3V LEFT 4630695 320 C 73630 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 696 XR- FOOT COMPLETE MIN 3V RIGHT 4630696 320 C 73630 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 697 XR- FOOT COMPLETE MIN 3V BILATERAL 4630697 320 C 73630 Y Y 07/01/2025 483.00 338.10 425.04 260.82 260.82 463 729 "XR- FOREARM, 2 VIEWS LEFT" 4630729 320 C 73090 Y Y 07/01/2025 682.00 477.40 600.16 368.28 368.28 463 730 "XR- FOREARM, 2 VIEWS RIGHT" 4630730 320 C 73090 Y Y 07/01/2025 682.00 477.40 600.16 368.28 368.28 463 731 "XR- FOREARM, 2 VIEWS BILATERAL" 4630731 320 C 73090 Y Y 07/02/2020 209.00 146.30 183.92 112.86 112.86 463 737 XR- FOREARM 3+V LEFT 4630737 320 C 73090 Y Y 07/02/2020 229.00 160.30 201.52 123.66 123.66 463 738 XR- FOREARM 3+V RIGHT 4630738 320 C 73090 Y Y 07/02/2020 229.00 160.30 201.52 123.66 123.66 463 739 XR- FOREARM 3+V BILATERAL 4630739 320 C 73090 Y Y 07/02/2020 229.00 160.30 201.52 123.66 123.66 463 779 XR- HAND RIGHT MIN 3 VIEWS 4630779 320 C 73130 Y Y 07/01/2025 745.00 521.50 655.60 402.30 402.30 463 786 XR- HAND LEFT MIN 3 VIEWS 4630786 320 C 73130 Y Y 07/01/2025 745.00 521.50 655.60 402.30 402.30 463 787 XR- HAND BILATERAL MIN 3 VIEWS 4630787 320 C 73130 Y Y 07/01/2025 464.00 324.80 408.32 250.56 250.56 463 794 XR- HAND 2V LEFT 4630794 320 C 73120 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 795 XR- HAND 2V RIGHT 4630795 320 C 73120 Y Y 07/01/2025 727.00 508.90 639.76 392.58 392.58 463 796 XR- HAND 2V BILATERAL 4630796 320 C 73120 Y Y 07/01/2025 427.00 298.90 375.76 230.58 230.58 463 810 XR- CALCANEUS; MIN 2V LEFT 4630810 320 C 73650 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 811 XR- CALCANEUS; MIN 2V RIGHT 4630811 320 C 73650 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 812 XR- CALCANEUS; MIN 2V BILATERAL 4630812 320 C 73650 Y Y 07/01/2025 488.00 341.60 429.44 263.52 263.52 463 893 "XR- HIP,COMP 2-3 VIEWS, UNILATERAL" 4630893 320 C 73502 Y Y 07/04/2019 428.00 299.60 376.64 231.12 231.12 463 894 "XR- HIP COMPLETE 2-3V, UNILAT" 4630894 320 C 73502 Y Y 07/01/2025 837.00 585.90 736.56 451.98 451.98 463 895 "XR- HIP, COMP 2-3V BILATERAL" 4630895 320 C 73502 Y Y 07/04/2019 455.00 318.50 400.40 245.70 245.70 463 935 "XR- HUMERUS, MIN 2V LEFT" 4630935 320 C 73060 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 936 "XR- HUMERUS, MIN 2V RIGHT" 4630936 320 C 73060 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 937 "XR- HUMERUS, MIN 2V BILATERAL" 4630937 320 C 73060 Y Y 07/01/2025 554.00 387.80 487.52 299.16 299.16 463 1030 XR- CHEST COMPLETE 4 VIEWS 4631030 324 C 71030 Y Y 07/01/2000 630.32 441.22 554.68 340.37 340.37 463 1081 XR- SI JOINTS 1-2 VIEWS 4631081 320 C 72200 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 1107 "XR- KNEE, 3 VIEWS LEFT" 4631107 320 C 73562 Y Y 07/01/2025 821.00 574.70 722.48 443.34 443.34 463 1108 "XR- KNEE, 3 VIEWS RIGHT" 4631108 320 C 73562 Y Y 07/01/2025 821.00 574.70 722.48 443.34 443.34 463 1109 "XR- KNEE, 3 VIEWS BILATERAL" 4631109 320 C 73562 Y Y 07/01/2025 510.00 357.00 448.80 275.40 275.40 463 1115 XR- KNEE COMPLETE MIN 4+V LEFT 4631115 320 C 73564 Y Y 07/01/2025 968.00 677.60 851.84 522.72 522.72 463 1116 XR- KNEE COMPLETE MIN 4+V RIGHT 4631116 320 C 73564 Y Y 07/01/2025 968.00 677.60 851.84 522.72 522.72 463 1117 XR- KNEE COMPLETE MIN 4+V BILATERA 4631117 320 C 73564 Y Y 07/01/2025 554.00 387.80 487.52 299.16 299.16 463 1120 "COMPUTED TOMOGRAPHY, UPPER EXTREMI" 4631120 UN 1 400 C 73202 Y Y 07/01/2025 788.00 551.60 693.44 425.52 425.52 463 1131 "XR- KNEE, 1 OR 2V LEFT" 4631131 320 C 73560 Y Y 07/01/2025 725.00 507.50 638.00 391.50 391.50 463 1132 "XR- KNEE, 1 OR 2V RIGHT" 4631132 320 C 73560 Y Y 07/01/2025 725.00 507.50 638.00 391.50 391.50 463 1133 "XR- KNEE, 1 OR 2V BILATERAL" 4631133 320 C 73560 Y Y 07/01/2025 441.00 308.70 388.08 238.14 238.14 463 1149 XR- LUMBAR BENDING 2-3 V 4631149 320 C 72120 Y Y 07/01/2025 881.00 616.70 775.28 475.74 475.74 463 1164 "XR- LUMBAR SPINE, 2-3 VIEWS" 4631164 320 C 72100 Y Y 07/01/2025 912.00 638.40 802.56 492.48 492.48 463 1172 XR- LUMBAR SPINE + BEND MIN 6V 4631172 320 C 72114 Y Y 07/01/2025 "1,361.00" 952.70 " 1,197.68 " 734.94 734.94 463 1198 XR- LUMBAR SPINE MIN 4V 4631198 320 C 72110 Y Y 07/01/2025 "1,278.00" 894.60 " 1,124.64 " 690.12 690.12 463 1222 XR- TIB & FIB 2 VEWS LEFT 4631222 320 C 73590 Y Y 07/01/2025 734.00 513.80 645.92 396.36 396.36 463 1223 XR- TIB & FIB 2 VIEWS RIGHT 4631223 320 C 73590 Y Y 07/01/2025 734.00 513.80 645.92 396.36 396.36 463 1224 XR- TIB & FIB 2 VEWS BILATERAL 4631224 320 C 73590 Y Y 07/01/2025 434.00 303.80 381.92 234.36 234.36 463 1271 XR- MANDIBLE 1-3 VIEWS 4631271 320 C 70100 Y Y 07/01/2025 696.00 487.20 612.48 375.84 375.84 463 1297 XR- MANDIBLE MIN 4VIEWS 4631297 320 C 70110 Y Y 07/01/2025 "1,081.00" 756.70 951.28 583.74 583.74 463 1362 XR- NASAL BONES MIN 3V 4631362 320 C 70160 Y Y 07/01/2025 767.00 536.90 674.96 414.18 414.18 463 1420 XR- NECK SOFT TISSUE 4631420 320 C 70360 Y Y 07/01/2025 641.00 448.70 564.08 346.14 346.14 463 1511 XR- KNEE AP STANDING BILATERAL 4631511 320 C 73565 Y Y 07/01/2025 682.00 477.40 600.16 368.28 368.28 463 1529 XR- PATELLA ADDITIONAL VIEW 4641529 420 C 73560 Y Y 07/02/2020 201.00 140.70 176.88 108.54 108.54 463 1545 XR- PELVIS 1-2 VIEWS 4631545 320 C 72170 Y Y 07/01/2025 680.00 476.00 598.40 367.20 367.20 463 1552 "XR- PELVIS, MIN 3V" 4631552 320 C 72190 Y Y 07/01/2025 772.00 540.40 679.36 416.88 416.88 463 1644 "XR- RIBS UNILATWPA CXR, LT 3V" 4631644 320 C 71101 Y Y 07/01/2025 997.00 697.90 877.36 538.38 538.38 463 1645 "XR- RIBS UNILATWPA CXR, RT 3V" 4631645 350 C 71101 Y Y 07/01/2025 997.00 697.90 877.36 538.38 538.38 463 1669 "XR- RIBS BILATERAL, 3 VIEWS" 4631669 320 C 71110 Y Y 07/01/2025 "1,005.00" 703.50 884.40 542.70 542.70 463 1677 XR- RIBS BILAT 4+V 4631677 320 C 71111 Y Y 07/01/2025 "1,247.00" 872.90 " 1,097.36 " 673.38 673.38 463 1693 XR- RIBS 2V LEFT 4631693 320 C 71100 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 1694 XR- RIBS 2V RIGHT 4631694 320 C 71100 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 1695 XR- RIBS 2V BILATERAL 4631695 320 C 71100 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 1743 XR- SAC & COCC 2V 4631743 320 C 72220 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 1800 "XR- SCAPULA, COMPLETE LEFT" 4631800 320 C 73010 Y Y 07/01/2025 416.00 291.20 366.08 224.64 224.64 463 1801 XR- SCAPULA COMPLETE RIGHT 4631801 320 C 73010 Y Y 07/01/2025 416.00 291.20 366.08 224.64 224.64 463 1802 "XR- SCAPULA, COMPLETE BILATERAL" 4631802 320 C 73010 Y Y 07/01/2025 416.00 291.20 366.08 224.64 224.64 463 1834 XR- SHOULDER 1V LEFT 4631834 320 C 73020 Y Y 07/01/2025 578.00 404.60 508.64 312.12 312.12 463 1835 XR- SHOULDER 1V RIGHT 4631835 320 C 73020 Y Y 07/01/2025 578.00 404.60 508.64 312.12 312.12 463 1836 XR- SHOULDER 1V BILATERAL 4631836 320 C 73020 Y Y 07/01/2025 355.00 248.50 312.40 191.70 191.70 463 1842 XR- SHOULDER COMPLETE 2+V LEFT 4631842 320 C 73030 Y Y 07/01/2025 767.00 536.90 674.96 414.18 414.18 463 1843 XR- SHOULDER COMPLETE 2+V RIGHT 4631843 320 C 73030 Y Y 07/01/2025 767.00 536.90 674.96 414.18 414.18 463 1844 XR- SHOULDER COMPLETE 2+V BILATERA 4631844 320 C 73030 Y Y 07/01/2025 434.00 303.80 381.92 234.36 234.36 463 1909 XR- SINUSES 1-2V 4631909 320 C 70210 Y Y 07/01/2025 682.00 477.40 600.16 368.28 368.28 463 1917 XR- SINUSES MIN 3V 4631917 320 C 70220 Y Y 07/01/2025 997.00 697.90 877.36 538.38 538.38 463 1933 XR- SKULL 1-3 VIEWS 4631933 320 C 70250 Y Y 07/01/2025 745.00 521.50 655.60 402.30 402.30 463 1941 "XR- SKULL, COMPLETE, MIN 4V" 4631941 320 C 70260 Y Y 07/01/2025 "1,206.00" 844.20 " 1,061.28 " 651.24 651.24 463 2022 XR- STERNUM 2 VIEWS 4632022 320 C 71120 Y Y 07/01/2025 943.00 660.10 829.84 509.22 509.22 463 2071 XR- T-SPINE 2V 4632071 320 C 72070 Y Y 07/01/2025 797.00 557.90 701.36 430.38 430.38 463 2097 XR- T-SPINE 3V 4632097 320 C 72072 Y Y 07/01/2025 950.00 665.00 836.00 513.00 513.00 463 2139 XR- TMJ BILATERAL 4632139 320 C 70330 Y Y 07/01/2025 960.00 672.00 844.80 518.40 518.40 463 2147 XR- TOE GREAT LEFT 4632147 320 C 73660 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 463 2148 XR- TOE GREAT RIGHT 4632148 320 C 73660 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 463 2150 XR- TOE 2ND RIGHT 4632150 320 C 73660 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 463 2151 XR- TOE 3RD LEFT 4632151 320 C 73660 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 463 2154 "XR- TOE(S), MIN 2V " 4632154 320 C 73660 Y Y 07/01/2025 551.00 385.70 484.88 297.54 297.54 463 2155 "XR- TOE(S), MIN 2V RT" 4632154 320 C 73660 Y Y 07/02/2020 258.00 180.60 227.04 139.32 139.32 463 2156 XR- TOE 4TH RIGHT 4632156 320 C 73660 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 463 2157 XR- TOE 5TH LEFT 4632157 320 C 73660 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 463 2158 XR- TOE 5TH RIGHT 4632158 320 C 73660 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 463 2337 XR- WRIST 2V LEFT 4632337 320 C 73100 Y Y 07/01/2025 605.00 423.50 532.40 326.70 326.70 463 2338 XR- WRIST 2V RIGHT 4632338 320 C 73100 Y Y 07/01/2025 605.00 423.50 532.40 326.70 326.70 463 2339 XR- WRIST 2V BILATERAL 4632339 320 C 73100 Y Y 07/01/2025 605.00 423.50 532.40 326.70 326.70 463 2345 XR- WRIST COMPLETE MIN 3V LEFT 4632345 320 C 73110 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 2346 XR- WRIST COMPLETE MIN 3V RIGHT 4632346 320 C 73110 Y Y 07/01/2025 789.00 552.30 694.32 426.06 426.06 463 2347 XR- WRIST COMPLETE MIN 3V BILATERA 4632347 320 C 73110 Y Y 07/01/2025 415.00 290.50 365.20 224.10 224.10 463 5050 XR- ESOPHAGUS 4635050 320 C 74220 Y Y 07/01/2025 915.00 640.50 805.20 494.10 494.10 463 5051 XR-THORACOLUMBAR 2V 4635051 320 C 72080 Y Y 07/01/2025 813.00 569.10 715.44 439.02 439.02 463 9000 XR- CORONER WHOLE BODY 4639000 999 Y Y 07/01/2025 "1,758.00" " 1,230.60 " " 1,547.04 " 949.32 949.32 463 9001 XR- CORONER UPPER EXTREMITIES 4639001 999 Y Y 07/01/2025 441.00 308.70 388.08 238.14 238.14 463 9002 XR- CORONER LOWER EXTREMITIES 4639002 999 Y Y 07/01/2025 441.00 308.70 388.08 238.14 238.14 463 9003 XR- CORONER HEAD & NECK 4639003 999 Y Y 07/01/2025 222.00 155.40 195.36 119.88 119.88 464 1 READ-US AAA 4640001 972 C 76706 Y Y 07/01/2025 241.00 168.70 212.08 130.14 130.14 464 2 "READ-XR AC JNT BL, W/WO WEIG" 4640002 972 C 73050 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 464 3 READ-XR C-SPINE; 4-5V 4640003 972 C 72050 Y Y 07/01/2025 263.00 184.10 231.44 142.02 142.02 464 4 READ-XR HIPS W/PELVIS BILAT MIN 2V 4640004 972 C 73521 Y Y 07/01/2025 220.00 154.00 193.60 118.80 118.80 464 8 "READ-UTZ,BREAST, LTD" 4640008 983 C 76642 Y Y 07/02/2020 177.00 123.90 155.76 95.58 95.58 464 9 READ-US EXTREMITY NON-VASC LTD 4640009 972 C 76882 Y Y 07/01/2025 216.00 151.20 190.08 116.64 116.64 464 10 READ-US ECHO COMPLETE 4640010 UN 1 972 C 93306 Y Y 07/01/2025 621.00 434.70 546.48 335.34 335.34 464 11 READ - CHEST 1V-BED SIDE 4640011 972 C 71010 Y Y 01/01/2000 169.13 118.39 148.83 91.33 91.33 464 12 "READ-XR SCOLIOSIS EXAM, 2-3 VIEWS" 4640012 972 C 72082 Y Y 07/01/2025 302.00 211.40 265.76 163.08 163.08 464 13 READ-XR SMALL BOWEL SERIES 4640013 972 C 74250 Y Y 07/01/2025 335.00 234.50 294.80 180.90 180.90 464 14 READ-US ECHO LIMITED 4640014 UN 1 972 C 93308 Y Y 07/01/2025 252.00 176.40 221.76 136.08 136.08 464 20 READ-SAC JOINTS 3V 4640020 UN 1 972 C 72202 Y Y 07/01/2025 542.00 379.40 476.96 292.68 292.68 464 26 READ-XR ABD COMPLETE W/DCUB&ERECT 4640026 972 C 74020 Y Y 07/01/2025 142.00 99.40 124.96 76.68 76.68 464 30 READ- CT HEAD W/O 4640030 972 C 70450 Y Y 07/01/2025 956.00 669.20 841.28 516.24 516.24 464 34 READ-XR ACUTE ABDOMEN SERIES 4640034 972 C 74022 Y Y 07/01/2025 252.00 176.40 221.76 136.08 136.08 464 58 READ-XR ABDOMEN 1 VIEW /KUB 4640058 972 C 74018 Y Y 07/01/2025 147.00 102.90 129.36 79.38 79.38 464 59 READ-ABDOMEN; AP 4640059 972 C 74000 Y Y 01/01/2000 65.00 45.50 57.20 35.10 35.10 464 67 READ-XR ABD 2 VIEWS 4640067 972 C 74019 Y Y 07/01/2025 229.00 160.30 201.52 123.66 123.66 464 90 READ-US CHEST 4640090 972 C 76604 Y Y 07/01/2025 288.00 201.60 253.44 155.52 155.52 464 92 READ-US BREAST UNI/BILAT COMPLETE 4640092 972 C 76641 Y Y 07/01/2025 268.00 187.60 235.84 144.72 144.72 464 100 "READ-CT ANGIO,ABD AORTA&BIL EXT" 4640100 972 C 75635 Y Y 07/01/2025 "1,818.00" " 1,272.60 " " 1,599.84 " 981.72 981.72 464 158 READ-XR ANKLE 2 VIEWS 4640158 972 C 73600 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 182 READ-XR ANKLE 3V LEFT 4640182 972 C 73610 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 183 READ-XR ANKLE 3V RIGHT 4640183 972 C 73610 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 273 READ-XR BONE SURVEY INFANT 4640273 972 C 77076 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 464 300 READ-XR BONE SURVEY COMPLETE 4640300 972 C 77075 Y Y 07/01/2025 277.00 193.90 243.76 149.58 149.58 464 301 READ- XR NOSE TO RECTUM (BABYGRAM) 4640301 972 C 76010 Y Y 07/01/2025 146.00 102.20 128.48 78.84 78.84 464 307 READ-XR SPINE 1 VIEW SPFY LVL 4640307 972 C 72020 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 464 315 READ-XR C-SPINE; AP & LAT 4640315 972 C 72040 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 464 331 READ-XR C-SPINE 6+ VIEWS 4640331 972 C 72052 Y Y 07/01/2025 298.00 208.60 262.24 160.92 160.92 464 355 READ-XR CHEST SINGLE VIEW 4640355 972 C 71045 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 464 356 "READ-CHEST 1V, FRONTAL" 4640356 972 C 71010 Y Y 07/02/2020 149.00 104.30 131.12 80.46 80.46 464 357 READ-XR CHEST 2 VIEWS 4640357 972 C 71046 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 464 364 "READ-CHES 2V, FRNT, LAT" 4640364 972 C 71046 Y Y 07/02/2020 181.00 126.70 159.28 97.74 97.74 464 372 READ-XR CHEST 3 VIEWS 4640372 972 C 71047 Y Y 07/01/2025 170.00 119.00 149.60 91.80 91.80 464 414 "READ-XR CLAVICLE, COMPLETE LEFT" 4640414 972 C 73000 Y Y 07/01/2025 153.00 107.10 134.64 82.62 82.62 464 415 READ-XR CLAVICLE COMPLETE RIGHT 4640415 972 C 73000 Y Y 07/01/2025 153.00 107.10 134.64 82.62 82.62 464 419 READ- CT TEMPORAL/IAC/ORBIT W/WO 4640419 972 C 70482 Y Y 07/01/2025 "1,290.00" 903.00 " 1,135.20 " 696.60 696.60 464 489 READ-XR ELBOW 1-2 VIEWS LT 4640489 972 C 73070 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 464 490 READ- XR ELBOW 1-2 VIEWS RT 4640490 972 C 73070 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 464 497 READ-XR ELBOW COMPLETE 3V LT 4640497 972 C 73080 Y Y 07/01/2025 174.00 121.80 153.12 93.96 93.96 464 498 READ-XR ELBOW COMPLETE 3V RT 4640498 972 C 73080 Y Y 07/01/2025 174.00 121.80 153.12 93.96 93.96 464 554 READ-XR FACIAL BONES 1-2V 4640554 972 C 70140 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 562 READ-XR FACIAL BONES MIN 3V 4640562 972 C 70150 Y Y 07/01/2025 218.00 152.60 191.84 117.72 117.72 464 564 "READ- US, RENAL ARTERIES COMPLETE" 4640564 972 C 93975 Y Y 07/01/2025 577.00 403.90 507.76 311.58 311.58 464 565 "READ- US, RENAL ARTERIES LIMITED " 4640565 972 C 93976 Y Y 07/01/2025 389.00 272.30 342.32 210.06 210.06 464 566 "US, RENAL ARTERIES LIMITED" 4640566 402 C 93976 Y Y 12/23/2020 244.00 170.80 214.72 131.76 131.76 464 567 READ- US OB BIOPHYSICAL PROFILE 4640567 972 C 76818 Y Y 07/01/2025 339.00 237.30 298.32 183.06 183.06 464 568 READ- US TRANSRECTAL 4640568 972 C 76872 Y Y 07/01/2025 277.00 193.90 243.76 149.58 149.58 464 569 READ- US SPINAL CANAL 4640569 972 C 76800 Y Y 07/01/2025 375.00 262.50 330.00 202.50 202.50 464 570 READ- US INFANT HIP 4640570 972 C 76885 Y Y 07/01/2025 300.00 210.00 264.00 162.00 162.00 464 571 READ- US CRANIAL 4640571 972 C 76506 Y Y 07/01/2025 383.00 268.10 337.04 206.82 206.82 464 572 "READ- US, ABI 3 OR MORE LEVELS" 4640572 972 C 93923 Y Y 07/01/2025 322.00 225.40 283.36 173.88 173.88 464 573 "READ- US, CAROTIDS BILAT" 4640573 972 C 93880 Y Y 07/01/2025 577.00 403.90 507.76 311.58 311.58 464 574 READ- US BREAST UNILAT LIMITED 4640574 972 C 76642 Y Y 07/01/2025 204.00 142.80 179.52 110.16 110.16 464 575 READ- US OB (<14 WEEKS) 4640575 972 C 76801 Y Y 07/01/2025 240.00 168.00 211.20 129.60 129.60 464 576 READ- US OB TRANSVAG 4640576 972 C 76817 Y Y 07/01/2025 277.00 193.90 243.76 149.58 149.58 464 577 READ- US OB DETAILED STUDY 4640577 972 C 76811 Y Y 07/01/2025 260.00 182.00 228.80 140.40 140.40 464 578 READ-US OB UMBILICAL DOPPLER 4640578 972 C 76820 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 579 READ-US ARTERIAL LOW EXTREMITY BIL 4640579 972 C 93925 Y Y 07/01/2025 577.00 403.90 507.76 311.58 311.58 464 580 READ-US ARTERIAL LOW EXTREMITY UNI 4640580 972 C 93926 Y Y 07/01/2025 394.00 275.80 346.72 212.76 212.76 464 581 "READ- US, ARTERIAL UPPER EXT UNILA" 4640581 972 C 93931 Y Y 07/01/2025 394.00 275.80 346.72 212.76 212.76 464 582 "READ- US, ARTERIAL UPPER EXT BILAT" 4640582 972 C 93930 Y Y 07/01/2025 577.00 403.90 507.76 311.58 311.58 464 612 "READ-XR FEMUR, AP & LAT, 2V LEFT" 4640612 972 C 73552 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 613 "READ- XR FEMUR, AP & LAT 2V RIGHT" 4640613 972 C 73552 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 616 READ- US ABI 1-2 LEVELS 4640616 972 C 93922 Y Y 07/01/2025 275.00 192.50 242.00 148.50 148.50 464 648 READ-XR FINGER/THUMB 2+VIEWS LEFT 4640648 972 C 73140 Y Y 07/01/2025 132.00 92.40 116.16 71.28 71.28 464 649 READ-XR FINGER/THUMB 2+V RIGHT 4640649 972 C 73140 Y Y 07/01/2025 132.00 92.40 116.16 71.28 71.28 464 650 "READ-1ST FING, MIN 2V LT" 4640650 972 C 73140 Y Y 07/02/2020 217.00 151.90 190.96 117.18 117.18 464 651 READ-1ST FINGER MIN 2V RT 4640651 972 C 73140 Y Y 07/02/2020 217.00 151.90 190.96 117.18 117.18 464 652 READ-2ND FINGER MIN2V LT 4640652 972 C 73140 Y Y 07/02/2020 217.00 151.90 190.96 117.18 117.18 464 653 READ-2ND FINGER MIN2V RT 4640653 972 C 73140 Y Y 07/02/2020 217.00 151.90 190.96 117.18 117.18 464 655 "READ-3RD FINGER,MIN2V LT" 4640655 972 C 73140 Y Y 07/02/2020 217.00 151.90 190.96 117.18 117.18 464 656 "READ-3RD FINGER,MIN2V RT" 4640656 972 C 73140 Y Y 07/02/2020 217.00 151.90 190.96 117.18 117.18 464 657 READ-4TH FINGER MIN2V LT 4640657 972 C 73140 Y Y 07/02/2020 217.00 151.90 190.96 117.18 117.18 464 658 "READ-RADIOLOGIC EXAM,FINGER(S), 2V" 4640658 972 C 73140 Y Y 07/02/2020 45.00 31.50 39.60 24.30 24.30 464 687 READ-XR FOOT 2 VIEWS LT 4640687 972 C 73620 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 688 READ-XR FOOT 2 VIEWS RT 4640688 972 C 73620 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 695 READ-XR FOOT COMPLETE 3V LEFT 4640695 972 C 73630 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 696 READ-XR FOOT COMPLETE 3V RIGHT 4640696 972 C 73630 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 711 READ-FOREARM 2V LT 4640711 972 C 73090 Y Y 07/02/2020 110.00 77.00 96.80 59.40 59.40 464 729 "READ-XR FOREARM, AP & LAT LT" 4640729 972 C 73090 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 464 730 "READ-XR FOREARM,AP&LAT RT" 4640730 972 C 73090 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 464 738 READ-FOREARM 3+VIEWS RIGHT 4640738 972 C 73090 Y Y 07/02/2020 172.00 120.40 151.36 92.88 92.88 464 779 READ-XR HAND RIGHT MIN 3 VIEWS 4640779 972 C 73130 Y Y 07/01/2025 163.00 114.10 143.44 88.02 88.02 464 786 READ-XR HAND LEFT MIN 3 VIEWS 4640786 972 C 73130 Y Y 07/01/2025 163.00 114.10 143.44 88.02 88.02 464 787 READ-XR HAND BILATERAL MIN 3 VIEWS 4640787 972 C 73130 Y Y 07/01/2025 429.00 300.30 377.52 231.66 231.66 464 794 READ-XR HAND 2V LT 4640794 972 C 73120 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 795 READ-XR HAND 2V RT 4640795 972 C 73120 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 810 "READ-XR CALCANEUS, MIN 2V LT" 4640810 972 C 73650 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 811 "READ-XR CALCANEUS,MIN 2V RT" 4640811 972 C 73650 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 836 READ-XR HIPS W/PELVIS 3-4VBILATERA 4640836 972 C 73522 Y Y 07/01/2025 286.00 200.20 251.68 154.44 154.44 464 877 READ-XR HIP W/PELVIS UNILAT 1V 4640877 972 C 73501 Y Y 07/01/2025 108.00 75.60 95.04 58.32 58.32 464 893 "READ-XR HIP COMPLETE 2-3V, UNILAT" 4640893 972 C 73502 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 464 894 "READ-HIP,2-3V, RIGHT" 4640894 972 C 73502 Y Y 07/04/2019 283.00 198.10 249.04 152.82 152.82 464 935 READ-XR HUMERUS 2V LEFT 4640935 972 C 73060 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 936 READ-XR HUMERUS 2V RIGHT 4640936 972 C 73060 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 981 READ-CT UPPER EXTREMITY W/C 4640981 972 C 73201 Y Y 07/01/2025 "1,005.00" 703.50 884.40 542.70 542.70 464 1030 XR- CHEST COMPLETE 4 VIEWS 4641030 972 C 71030 Y Y 07/01/2000 315.16 220.61 277.34 170.19 170.19 464 1081 READ-XR SI JOINTS 1-2VIEWS 4641081 972 C 72200 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 1107 READ-XR KNEE 3V LT 4641107 972 C 73562 Y Y 07/01/2025 180.00 126.00 158.40 97.20 97.20 464 1108 READ-XR KNEE 3V RT 4641108 972 C 73562 Y Y 07/01/2025 180.00 126.00 158.40 97.20 97.20 464 1115 READ-XR KNEE COMPLETE 4+V LT 4641115 972 C 73564 Y Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 464 1116 READ-XR KNEE COMPLETE 4+ V RT 4641116 972 C 73564 Y Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 464 1131 "READ-XR KNEE, 1-2 VIEW LT" 4641131 972 C 73560 Y Y 07/01/2025 160.00 112.00 140.80 86.40 86.40 464 1132 "READ-XR KNEE, 1-2 VIEW RT" 4641132 972 C 73560 Y Y 07/01/2025 160.00 112.00 140.80 86.40 86.40 464 1149 READ-XR LUMBAR SPINE BENDING 2-3 V 4641149 972 C 72120 Y Y 07/01/2025 193.00 135.10 169.84 104.22 104.22 464 1164 "READ-XR LUMBAR SPINE, 2-3 VIEWS" 4641164 972 C 72100 Y Y 07/01/2025 201.00 140.70 176.88 108.54 108.54 464 1172 READ-XR LUMBAR SPINE+BEND 6V 4641172 972 C 72114 Y Y 07/01/2025 298.00 208.60 262.24 160.92 160.92 464 1198 READ-XR LUMBAR SPINE MIN 4V 4641198 972 C 72110 Y Y 07/01/2025 280.00 196.00 246.40 151.20 151.20 464 1200 READ- CT ANGIO BRAIN 4641200 972 C 70496 Y Y 07/01/2025 "1,401.00" 980.70 " 1,232.88 " 756.54 756.54 464 1210 READ- CT NECK (CAROTIDS) 4641210 972 C 70498 Y Y 07/01/2025 "1,503.00" " 1,052.10 " " 1,322.64 " 811.62 811.62 464 1214 READ-XR TIB&FIB BILATERAL 4641214 972 C 73590 Y Y 07/01/2025 189.00 132.30 166.32 102.06 102.06 464 1220 READ-CT ANGIO CHEST (PE) 4641220 972 C 71275 Y Y 07/01/2025 "1,409.00" 986.30 " 1,239.92 " 760.86 760.86 464 1222 READ-XR TIB/FIB 2 VIEWS LEFT 4641222 972 C 73590 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 464 1223 READ-XR TIB&FIB 2 VIEWS RIGHT 4641223 972 C 73590 Y Y 07/01/2025 425.00 297.50 374.00 229.50 229.50 464 1240 READ- CT ANGIO ABD/PELIVS 4641240 972 C 74174 Y Y 07/01/2025 "2,123.00" " 1,486.10 " " 1,868.24 " " 1,146.42 " " 1,146.42 " 464 1271 READ-XR MANDIBLE 1-3VIEWS 4641271 972 C 70100 Y Y 07/01/2025 153.00 107.10 134.64 82.62 82.62 464 1297 READ-XR MANDIBLE MIN 4VIEWS 4641297 972 C 70110 Y Y 07/01/2025 236.00 165.20 207.68 127.44 127.44 464 1310 READ-CT HEAD W/CONTRAST 4641310 972 C 70460 Y Y 07/01/2025 898.00 628.60 790.24 484.92 484.92 464 1320 READ-CT HEAD W& WO CONTRAST 4641320 972 C 70470 Y Y 07/01/2025 "1,273.00" 891.10 " 1,120.24 " 687.42 687.42 464 1330 READ-CT-PARANASAL SINUSES 4641330 972 H 70486 Y Y 07/02/2020 332.00 232.40 292.16 179.28 179.28 464 1362 READ-XR NASAL BONES MIN 3V 4641362 972 C 70160 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 464 1400 READ-CT TEMPORAL/INNER EAR W/O 4641400 972 C 70480 Y Y 07/01/2025 "1,000.00" 700.00 880.00 540.00 540.00 464 1410 READ-CT TEMPORAL/INNER EAR/ORBIT W 4641410 972 C 70481 Y Y 07/01/2025 "1,194.00" 835.80 " 1,050.72 " 644.76 644.76 464 1420 READ-XR NECK SOFT TISSUE 4641420 972 C 70360 Y Y 07/01/2025 141.00 98.70 124.08 76.14 76.14 464 1479 READ-XR ORBITS 4641479 972 C 70200 Y Y 07/01/2025 347.00 242.90 305.36 187.38 187.38 464 1487 READ- ORBITSD 4V 4641487 972 C 70200 Y Y 07/02/2020 229.00 160.30 201.52 123.66 123.66 464 1500 READ-CT FACIAL/SINUS W/O CONTRAST 4641500 972 C 70486 Y Y 07/01/2025 "1,000.00" 700.00 880.00 540.00 540.00 464 1510 READ-CT FACIAL/SINUS W/ CONTRAST 4641510 972 C 70487 Y Y 07/01/2025 "1,056.00" 739.20 929.28 570.24 570.24 464 1511 READ-XR KNEE AP STANDING BILATERAL 4641511 972 C 73565 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 464 1520 READ-CT FACIAL/SINUS W&WO 4641520 972 C 70488 Y Y 07/01/2025 "1,155.00" 808.50 " 1,016.40 " 623.70 623.70 464 1529 XR- PATELLA ADDITIONAL VIEW 4641529 420 C 73560 Y Y 07/02/2020 119.00 83.30 104.72 64.26 64.26 464 1545 "READ-XR PELVIS, 1-2 VIEWS" 4641545 972 C 72170 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 464 1552 "READ-XR PELVIS, MIN 3V" 4641552 972 C 72190 Y Y 07/01/2025 170.00 119.00 149.60 91.80 91.80 464 1600 READ-CT NECK SOFT TISSUE W/O 4641600 972 C 70490 Y Y 07/01/2025 954.00 667.80 839.52 515.16 515.16 464 1610 READ-CT NECK SOFT TISSUE W/C 4641610 972 C 70491 Y Y 07/01/2025 "1,070.00" 749.00 941.60 577.80 577.80 464 1620 READ-CT NECK SOFT TISSUE W&WO 4641620 972 C 70492 Y Y 07/01/2025 "1,273.00" 891.10 " 1,120.24 " 687.42 687.42 464 1630 READ- CT C SPINE W/O 4641630 972 C 72125 Y Y 07/01/2025 "1,137.00" 795.90 " 1,000.56 " 613.98 613.98 464 1640 READ-CT CERVICAL SPINE W/C 4641640 972 C 72126 Y Y 07/01/2025 "1,151.00" 805.70 " 1,012.88 " 621.54 621.54 464 1644 READ-XR RIBS W/CXR MIN 3V 4641644 972 C 71101 Y Y 07/01/2025 218.00 152.60 191.84 117.72 117.72 464 1650 READ-CT CERVICAL SPINE W & WO 4641650 972 C 72127 Y Y 07/01/2025 "1,433.00" " 1,003.10 " " 1,261.04 " 773.82 773.82 464 1669 "READ-XR RIBS BILATERAL, 3 VIEWS" 4641669 972 C 71110 Y Y 07/01/2025 220.00 154.00 193.60 118.80 118.80 464 1677 READ-XR RIBS BILAT 4+V 4641677 972 C 71111 Y Y 07/01/2025 271.00 189.70 238.48 146.34 146.34 464 1693 READ-XR RIBS 2 VIEWS 4641693 972 C 71100 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 1700 READ-CT-CHEST W/O 4641700 972 C 71250 Y Y 07/01/2025 "1,024.00" 716.80 901.12 552.96 552.96 464 1710 READ-CT-CHEST W/C 4641710 972 C 71260 Y Y 07/01/2025 "1,206.00" 844.20 " 1,061.28 " 651.24 651.24 464 1720 READ-CT-CHEST W & WO 4641720 981 C 72127 Y Y 07/02/2020 362.00 253.40 318.56 195.48 195.48 464 1730 READ-CT THORACIC SPINE W/O 4641730 972 C 72128 Y Y 07/01/2025 "1,070.00" 749.00 941.60 577.80 577.80 464 1740 READ-CT THORACIC SPINE W/C 4641740 972 C 72129 Y Y 07/01/2025 "1,206.00" 844.20 " 1,061.28 " 651.24 651.24 464 1743 READ-XR SAC & COCC 2V 4641743 972 C 72220 Y Y 07/01/2025 453.00 317.10 398.64 244.62 244.62 464 1750 READ-CT THORACIC SPINE W & W/O 4641750 972 C 72130 Y Y 07/01/2025 "1,357.00" 949.90 " 1,194.16 " 732.78 732.78 464 1760 READ-CT LUMBAR SPINE W/O 4641760 972 C 72131 Y Y 07/01/2025 "1,107.00" 774.90 974.16 597.78 597.78 464 1770 READ-CT LUMBAR SPINE W/C 4641770 972 C 72132 Y Y 07/01/2025 "1,206.00" 844.20 " 1,061.28 " 651.24 651.24 464 1780 READ-CT LUMBAR SPINE W & WO 4641780 972 C 72133 Y Y 07/01/2025 "1,357.00" 949.90 " 1,194.16 " 732.78 732.78 464 1781 READ-CT CHEST W/WO 4641781 972 C 71270 Y Y 07/01/2025 "1,433.00" " 1,003.10 " " 1,261.04 " 773.82 773.82 464 1800 READ-XR SCAPULA COMPLETE LT 4641800 972 C 73010 Y Y 07/01/2025 92.00 64.40 80.96 49.68 49.68 464 1801 READ-XR SCAPULA COMPLETE RT 4641801 972 C 73010 Y Y 07/01/2025 92.00 64.40 80.96 49.68 49.68 464 1805 READ-CT PELVIS W/O 4641805 972 C 72192 Y Y 07/01/2025 "1,000.00" 700.00 880.00 540.00 540.00 464 1810 READ-CT PELVIS W/CONTRAST 4641810 972 C 72193 Y Y 07/01/2025 "1,194.00" 835.80 " 1,050.72 " 644.76 644.76 464 1820 READ-CT PELVIS W & WO 4641820 972 C 72194 Y Y 07/01/2025 "1,575.00" " 1,102.50 " " 1,386.00 " 850.50 850.50 464 1830 READ-CT ABDOMEN W/O 4641830 972 C 74150 Y Y 07/01/2025 "1,005.00" 703.50 884.40 542.70 542.70 464 1834 READ-XR SHOULDER 1V LT 4641834 972 C 73020 Y Y 07/01/2025 128.00 89.60 112.64 69.12 69.12 464 1835 READ-XR SHOULDER 1V RT 4641835 972 C 73020 Y Y 07/01/2025 128.00 89.60 112.64 69.12 69.12 464 1840 READ-CT ABDOMEN W/C 4641840 972 C 74160 Y Y 07/01/2025 "1,228.00" 859.60 " 1,080.64 " 663.12 663.12 464 1842 READ-XR SHOULDER COMPLETE 2+V LEFT 4641842 972 C 73030 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 464 1843 READ-XR SHOULDER COMPLETE 2+V RIGH 4641843 972 C 73030 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 464 1846 READ-CT ANGIO ABDOMEN 4641846 972 C 74175 Y Y 07/01/2025 "1,655.00" " 1,158.50 " " 1,456.40 " 893.70 893.70 464 1850 READ-CT ABDOMEN W & WO 4641850 972 C 74170 Y Y 07/01/2025 "1,591.00" " 1,113.70 " " 1,400.08 " 859.14 859.14 464 1860 READ- SHOULDER ADDL VIEW 4641860 972 C 93020 Y Y 07/02/2020 97.00 67.90 85.36 52.38 52.38 464 1861 READ-CT ABDOMEN/PELVIS WO 4641861 972 C 74176 Y Y 07/01/2025 "1,791.00" " 1,253.70 " " 1,576.08 " 967.14 967.14 464 1870 READ-CT ABDOMEN/PELVIS W/C 4641870 972 C 74177 Y Y 07/01/2025 "1,984.00" " 1,388.80 " " 1,745.92 " " 1,071.36 " " 1,071.36 " 464 1880 READ-CT ABDOMEN/PELVIS W/WO 4641880 972 C 74178 Y Y 07/01/2025 "2,328.00" " 1,629.60 " " 2,048.64 " " 1,257.12 " " 1,257.12 " 464 1900 READ-CT UPPER EXT W/O 4641900 972 C 73200 Y Y 07/01/2025 906.00 634.20 797.28 489.24 489.24 464 1909 READ-XR SINUSES 1-2V 4641909 972 C 70210 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 464 1917 READ-XR SINUS MIN 3V 4641917 972 C 70220 Y Y 07/01/2025 218.00 152.60 191.84 117.72 117.72 464 1930 READ-CT LOWER EXT W/O 4641930 972 C 73700 Y Y 07/01/2025 978.00 684.60 860.64 528.12 528.12 464 1932 READ-CT LOW DOSE FOR LUNG CA 4641932 972 H 71271 Y N 07/01/2025 729.00 510.30 641.52 393.66 393.66 464 1933 READ-XR SKULL 1-3 VIEWS 4641933 972 C 70250 Y Y 07/01/2025 163.00 114.10 143.44 88.02 88.02 464 1940 READ-CT LOWER EXT W/CONTRAST 4641940 972 C 73701 Y Y 07/01/2025 "1,056.00" 739.20 929.28 570.24 570.24 464 1941 "READ-XR SKULL,COMPLETE, MIN 4V" 4641941 972 C 70260 Y Y 07/01/2025 263.00 184.10 231.44 142.02 142.02 464 1950 READ-CT LOWER EXT W & WO 4641950 972 C 73702 Y Y 07/01/2025 956.00 669.20 841.28 516.24 516.24 464 1980 READ-CT ANGIO LOWER EXT W/CONTRAST 4641980 972 C 73706 Y Y 07/01/2025 "1,384.00" 968.80 " 1,217.92 " 747.36 747.36 464 2022 READ-XR STERNUM 2 VIEWS 4642022 972 C 71120 Y Y 07/01/2025 206.00 144.20 181.28 111.24 111.24 464 2071 READ-XR T-SPINE 2 V 4642071 972 C 72070 Y Y 07/01/2025 174.00 121.80 153.12 93.96 93.96 464 2097 READ-XR T-SPINE 3 V 4642097 972 C 72072 Y Y 07/01/2025 208.00 145.60 183.04 112.32 112.32 464 2139 READ-XR TMJ BILATERAL 4642139 972 C 70330 Y Y 07/01/2025 210.00 147.00 184.80 113.40 113.40 464 2148 XR- READ-GREAT TOE RT 4642148 972 C 73660 Y Y 07/02/2020 258.00 180.60 227.04 139.32 139.32 464 2155 "READ-XR TOE(S), MIN 2V " 4642155 972 C 73660 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 464 2300 READ-CT PEDIATRIC LEG LENGTH 4642300 972 C 77073 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 464 2337 READ-XR WRIST 2 VIEWS LEFT 4642337 972 C 73100 Y Y 07/01/2025 133.00 93.10 117.04 71.82 71.82 464 2338 READ-XR WRIST 2 VIEWS RIGHT 4642338 972 C 73100 Y Y 07/01/2025 133.00 93.10 117.04 71.82 71.82 464 2345 READ-XR WRIST COMPLETE 3V LEFT 4642345 972 C 73110 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 2346 READ-XR WRIST COMPLETE 3V RIGHT 4642346 972 C 73110 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 464 5050 READ-XR ESOPHAGUS 4645050 972 C 74220 Y Y 07/01/2025 201.00 140.70 176.88 108.54 108.54 464 5051 READ-XR THORACOLUMBAR 2V 4645051 320 C 72080 Y Y 07/01/2025 179.00 125.30 157.52 96.66 96.66 464 6001 READ-US ABDOMINAL/LIVER COMP 4646001 972 C 76700 Y Y 07/01/2025 474.00 331.80 417.12 255.96 255.96 464 6019 READ-US ABDMINAL LTD 4646019 972 C 76705 Y Y 07/01/2025 343.00 240.10 301.84 185.22 185.22 464 6027 READ-US RENAL LTD 4646027 972 C 76775 Y Y 07/01/2025 319.00 223.30 280.72 172.26 172.26 464 6091 READ-ECHO AAA SCREENING 4646091 972 H G0389 Y Y 07/02/2020 316.00 221.20 278.08 170.64 170.64 464 6126 READ-US PELVIC NON-OB COMP 4646126 972 C 76856 Y Y 07/01/2025 367.00 256.90 322.96 198.18 198.18 464 6134 READ-US EXTREMITY NON-VASC COMPLET 4646134 972 C 76881 Y Y 07/01/2025 319.00 223.30 280.72 172.26 172.26 464 6142 READ-US RENAL 4646142 972 C 76770 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 464 6167 READ-US OB(>14WEEKS) COMP 4646167 972 C 76805 Y Y 07/01/2025 383.00 268.10 337.04 206.82 206.82 464 6175 READ-US OB LIMITED 4646175 972 C 76815 Y Y 07/01/2025 240.00 168.00 211.20 129.60 129.60 464 6215 READ-US THYROID ST NECK & HEAD 4646215 972 C 76536 Y Y 07/01/2025 319.00 223.30 280.72 172.26 172.26 464 6217 READ-US PELVIC NON-OB LTD 4646217 972 C 76857 Y Y 07/01/2025 240.00 168.00 211.20 129.60 129.60 464 6290 READ-US TRANSVAGINAL 4646290 972 C 76830 Y Y 07/01/2025 319.00 223.30 280.72 172.26 172.26 464 6302 READ-US EXTREMITY VEINS DVT(UNILAT 4646302 972 C 93971 Y Y 07/01/2025 394.00 275.80 346.72 212.76 212.76 464 6303 READ-US EXTREMITY VEINS DVT (BILAT 4646303 972 C 93970 Y Y 07/01/2025 577.00 403.90 507.76 311.58 311.58 464 6556 READ-US SCROTUM & CONTENT 4646556 972 C 76870 Y Y 07/01/2025 343.00 240.10 301.84 185.22 185.22 464 6557 READ US-OPHTHALMIC DX B/A SCAN 4646557 UN 1 972 C 76510 Y Y 10/01/2025 116.00 81.20 102.08 62.64 62.64 467 1 US- ABDOMINAL/LIVER COMPLETE 4670001 402 C 76700 Y Y 07/01/2025 "1,888.00" " 1,321.60 " " 1,661.44 " " 1,019.52 " " 1,019.52 " 467 2 "US,EXTREMITY VEINS DVT (UNILAT)" 4670002 402 C 93971 Y Y 07/01/2025 "1,572.00" " 1,100.40 " " 1,383.36 " 848.88 848.88 467 3 US- DUPLX EXT VEINS UNIL/LTD RIGHT 4670003 402 C 93971 Y Y 07/02/2020 708.00 495.60 623.04 382.32 382.32 467 4 US - ECHO COMPLETE 4670004 UN 1 483 C 93306 Y Y 07/01/2025 "3,014.00" " 2,109.80 " " 2,652.32 " " 1,627.56 " " 1,627.56 " 467 5 US - ECHO LIMITED 4670005 UN 1 483 C 93308 Y Y 07/01/2025 "1,012.00" 708.40 890.56 546.48 546.48 467 19 US- ABDOMINAL LTD 4670019 402 C 76705 Y Y 07/01/2025 "1,367.00" 956.90 " 1,202.96 " 738.18 738.18 467 27 US- RENAL LTD 4670027 402 C 76775 Y Y 07/01/2025 "1,271.00" 889.70 " 1,118.48 " 686.34 686.34 467 70 "US, CAROTIDS BILAT" 4670070 402 C 93880 Y Y 07/01/2025 "2,301.00" " 1,610.70 " " 2,024.88 " " 1,242.54 " " 1,242.54 " 467 90 US- CHEST 4670090 402 C 76604 Y Y 07/01/2025 "1,144.00" 800.80 " 1,006.72 " 617.76 617.76 467 91 US- AAA SCREENING 4670091 402 C 76706 Y Y 07/01/2025 958.00 670.60 843.04 517.32 517.32 467 92 US- BREAST UNI/BILAT COMP 4670092 402 C 76641 Y Y 07/01/2025 "1,065.00" 745.50 937.20 575.10 575.10 467 93 US BREAST UNILATERAL RT COMPLETE 4670092 402 C 76641 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 467 100 "US, RENAL" 4670100 402 C 76770 Y Y 07/02/2020 705.00 493.50 620.40 380.70 380.70 467 126 US- PELVIC NON-OB COMP 4670126 402 C 76856 Y Y 07/01/2025 "1,462.00" " 1,023.40 " " 1,286.56 " 789.48 789.48 467 142 US- RENAL 4670142 402 C 76770 Y Y 07/01/2025 "1,778.00" " 1,244.60 " " 1,564.64 " 960.12 960.12 467 167 US- OB(>14 WEEKS) COMP 4670167 402 C 76805 Y Y 07/01/2025 "1,524.00" " 1,066.80 " " 1,341.12 " 822.96 822.96 467 175 US- OB LIMITED 4670175 402 C 76815 Y Y 07/01/2025 954.00 667.80 839.52 515.16 515.16 467 183 US- OB F/U 4670183 402 C 76816 Y Y 07/01/2025 802.00 561.40 705.76 433.08 433.08 467 215 US- THYROID ST NECK & HEAD 4670215 402 C 76536 Y Y 07/01/2025 "1,271.00" 889.70 " 1,118.48 " 686.34 686.34 467 217 US- PELVIC NON-OB LTD 4670217 402 C 76857 Y Y 07/01/2025 954.00 667.80 839.52 515.16 515.16 467 282 "US, THYROID" 4670282 402 C 76536 Y Y 07/02/2020 585.00 409.50 514.80 315.90 315.90 467 290 US- TRANSVAGINAL 4670290 402 C 76830 Y Y 07/01/2025 "1,271.00" 889.70 " 1,118.48 " 686.34 686.34 467 301 US- US EXTREMITY NON-VASC COMPLETE 4670301 402 C 76881 Y Y 07/01/2025 "1,271.00" 889.70 " 1,118.48 " 686.34 686.34 467 302 US- EXTREMITY NON-VASC LTD 4670302 402 C 76882 Y Y 07/01/2025 860.00 602.00 756.80 464.40 464.40 467 303 "US, EXTREMITY VEINS DVT (BILAT)" 4670303 402 C 93970 Y Y 07/01/2025 "2,646.00" " 1,852.20 " " 2,328.48 " " 1,428.84 " " 1,428.84 " 467 556 US- SCROTUM & CONTENTS 4670556 402 C 76870 Y Y 07/01/2025 "1,367.00" 956.90 " 1,202.96 " 738.18 738.18 467 561 "US, DOPPLER SPECTRAL" 4670561 402 C 93320 Y Y 07/01/2025 690.00 483.00 607.20 372.60 372.60 467 563 US- OB (MULTIPLE GESTATIONS)ADD ON 4670563 402 C 76810 Y Y 07/01/2025 954.00 667.80 839.52 515.16 515.16 467 564 "US, RENAL ARTERIES COMPLETE" 4670564 402 C 93975 Y Y 07/01/2025 "2,301.00" " 1,610.70 " " 2,024.88 " " 1,242.54 " " 1,242.54 " 467 565 "US, RENAL ARTERIES LIMITED" 4670565 402 C 93976 Y Y 07/01/2025 "1,550.00" " 1,085.00 " " 1,364.00 " 837.00 837.00 467 567 US- OB BIOPHYSICAL PROFILE 4670567 402 C 76818 Y Y 07/01/2025 "1,350.00" 945.00 " 1,188.00 " 729.00 729.00 467 568 US- TRANSRECTAL 4670568 402 C 76872 Y Y 07/01/2025 "1,096.00" 767.20 964.48 591.84 591.84 467 569 US- SPINAL CANAL 4670569 402 C 76800 Y Y 07/01/2025 "1,493.00" " 1,045.10 " " 1,313.84 " 806.22 806.22 467 570 US- INFANT HIP 4670570 402 C 76885 Y Y 07/01/2025 "1,191.00" 833.70 " 1,048.08 " 643.14 643.14 467 571 US-CRANIAL 4670571 402 C 76506 Y Y 07/01/2025 "1,524.00" " 1,066.80 " " 1,341.12 " 822.96 822.96 467 572 "US, ABI 3 OR MORE LEVELS" 4670572 402 C 93923 Y Y 07/01/2025 "1,281.00" 896.70 " 1,127.28 " 691.74 691.74 467 574 US- BREAST UNILAT LIMITED 4670574 402 C 76642 Y Y 07/01/2025 810.00 567.00 712.80 437.40 437.40 467 575 US- OB (<14 WEEKS) 4670575 402 C 76801 Y Y 07/01/2025 954.00 667.80 839.52 515.16 515.16 467 576 US- OB TRANSVAG 4670576 402 C 76817 Y Y 07/01/2025 "1,096.00" 767.20 964.48 591.84 591.84 467 577 US- OB DETAILED STUDY 4670577 402 C 76811 Y Y 07/01/2025 "1,033.00" 723.10 909.04 557.82 557.82 467 578 US- OB UMBILICAL DOPPLER 4670578 402 C 76820 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 467 579 "US, ARTERIAL LOWER EXTREMITY BILAT" 4670579 402 C 93925 Y Y 07/01/2025 "2,301.00" " 1,610.70 " " 2,024.88 " " 1,242.54 " " 1,242.54 " 467 580 "US, ARTERIAL LOWER EXTREMITY UNILA" 4670580 402 C 93926 Y Y 07/01/2025 "1,572.00" " 1,100.40 " " 1,383.36 " 848.88 848.88 467 581 "US, ARTERIAL UPPER EXTREMITY UNILA" 4670581 402 C 93931 Y Y 07/01/2025 "1,572.00" " 1,100.40 " " 1,383.36 " 848.88 848.88 467 582 "US, ARTERIAL UPPER EXTREMITY BILAT" 4670582 402 C 93930 Y Y 07/01/2025 "2,301.00" " 1,610.70 " " 2,024.88 " " 1,242.54 " " 1,242.54 " 467 617 "US, ABI 1-2 LEVELS" 4670617 402 C 93922 Y Y 07/01/2025 "1,094.00" 765.80 962.72 590.76 590.76 467 618 US-OPHTHALMIC DX B/A SCAN 4670618 UN 1 402 C 76510 Y Y 10/01/2025 421.00 294.70 370.48 227.34 227.34 467 720 CT - CERVICAL SPINE W&WO CONTRAST 4670720 352 C 72127 Y Y 07/02/2020 "3,610.00" " 2,527.00 " " 3,176.80 " " 1,949.40 " " 1,949.40 " 468 100 CT- ANGIO ABD AORTA & BIL EXT 4680100 350 C 75635 Y Y 07/01/2025 "7,264.00" " 5,084.80 " " 6,392.32 " " 3,922.56 " " 3,922.56 " 468 101 CT-IV INJECTION KIT 4680101 621 Y Y 07/02/2020 216.00 151.20 190.08 116.64 116.64 468 183 READ-US OB F/U 4640577 972 C 76816 Y Y 07/01/2025 202.00 141.40 177.76 109.08 109.08 468 200 CT- ANGIO BRAIN 4680200 350 C 70496 Y Y 07/01/2025 "5,600.00" " 3,920.00 " " 4,928.00 " " 3,024.00 " " 3,024.00 " 468 210 CT-ANGIO NECK (CAROTIDS) 4680210 351 C 70498 Y Y 07/01/2025 "6,008.00" " 4,205.60 " " 5,287.04 " " 3,244.32 " " 3,244.32 " 468 220 CT- ANGIO CHEST (PE) 4680220 350 C 71275 Y Y 07/01/2025 "5,631.00" " 3,941.70 " " 4,955.28 " " 3,040.74 " " 3,040.74 " 468 240 CT- ANGIO ABD/PELVIS 4680240 350 C 74174 Y Y 07/01/2025 "8,484.00" " 5,938.80 " " 7,465.92 " " 4,581.36 " " 4,581.36 " 468 300 CT-HEAD W/O 4680300 351 C 70450 Y Y 07/01/2025 "3,816.00" " 2,671.20 " " 3,358.08 " " 2,060.64 " " 2,060.64 " 468 310 CT-HEAD W/CONTRAST 4680310 351 C 70460 Y Y 07/01/2025 "3,585.00" " 2,509.50 " " 3,154.80 " " 1,935.90 " " 1,935.90 " 468 320 CT-HEAD W& WO CONTRAST 4680320 351 C 70470 Y Y 07/01/2025 "5,085.00" " 3,559.50 " " 4,474.80 " " 2,745.90 " " 2,745.90 " 468 330 CT-MAXILLOFACIAL AREA; W/O CONTRAS 4680330 351 C 70486 Y Y 07/02/2020 "2,519.00" " 1,763.30 " " 2,216.72 " " 1,360.26 " " 1,360.26 " 468 400 "CT-ORBIT, W/O" 4680400 351 C 70480 Y Y 07/02/2020 "2,519.00" " 1,763.30 " " 2,216.72 " " 1,360.26 " " 1,360.26 " 468 419 READ-CT-TEMPORAL/IAC/ORBIT W/WO 4640419 351 C 70482 Y Y 07/02/2020 "3,008.00" " 2,105.60 " " 2,647.04 " " 1,624.32 " " 1,624.32 " 468 425 CT-TEMPORAL/INNER EAR/ORBIT W/O 4680425 351 C 70480 Y Y 07/01/2025 "3,996.00" " 2,797.20 " " 3,516.48 " " 2,157.84 " " 2,157.84 " 468 435 CT- TEMPORAL/INNER EAR/ORBIT W/CON 4680435 351 C 70481 Y Y 07/01/2025 "4,772.00" " 3,340.40 " " 4,199.36 " " 2,576.88 " " 2,576.88 " 468 445 CT- TEMPORAL/INNER EAR/ORBIT W/WO 4680445 351 C 70482 Y Y 07/01/2025 "5,152.00" " 3,606.40 " " 4,533.76 " " 2,782.08 " " 2,782.08 " 468 500 CT-FACIAL/SINUS W/O CONTRAST 4680500 351 C 70486 Y Y 07/01/2025 "3,996.00" " 2,797.20 " " 3,516.48 " " 2,157.84 " " 2,157.84 " 468 510 CT-FACIAL/SINUS W/CONTRAST 4680510 351 C 70487 Y Y 07/01/2025 "4,219.00" " 2,953.30 " " 3,712.72 " " 2,278.26 " " 2,278.26 " 468 520 CT-FACIAL/SINUS W&WO 4680520 351 C 70488 Y Y 07/01/2025 "4,615.00" " 3,230.50 " " 4,061.20 " " 2,492.10 " " 2,492.10 " 468 600 CT-NECK SOFT TISSUE W/O 4680600 352 C 70490 Y Y 07/01/2025 "3,808.00" " 2,665.60 " " 3,351.04 " " 2,056.32 " " 2,056.32 " 468 610 CT-NECK SOFT TISSUE W/ 4680610 352 C 70491 Y Y 07/01/2025 "4,270.00" " 2,989.00 " " 3,757.60 " " 2,305.80 " " 2,305.80 " 468 620 CT-NECK SOFT TISSUE W&WO 4680620 352 C 70492 Y Y 07/01/2025 "5,085.00" " 3,559.50 " " 4,474.80 " " 2,745.90 " " 2,745.90 " 468 630 CT-C SPINE W/O 4680630 350 C 72125 Y Y 07/01/2025 "4,542.00" " 3,179.40 " " 3,996.96 " " 2,452.68 " " 2,452.68 " 468 640 CT-CERVICAL SPINE W/C 4680640 350 C 72126 Y Y 07/01/2025 "4,601.00" " 3,220.70 " " 4,048.88 " " 2,484.54 " " 2,484.54 " 468 650 CT - CERVICAL SPINE W&WO CONTRAST 4680650 352 C 72127 Y Y 07/01/2025 "5,726.00" " 4,008.20 " " 5,038.88 " " 3,092.04 " " 3,092.04 " 468 700 CT-CHEST W/O CONTRAST 4680700 352 C 71250 Y Y 07/01/2025 "4,087.00" " 2,860.90 " " 3,596.56 " " 2,206.98 " " 2,206.98 " 468 710 CT-CHEST W/C 4680710 352 C 71260 Y Y 07/01/2025 "4,822.00" " 3,375.40 " " 4,243.36 " " 2,603.88 " " 2,603.88 " 468 720 CT-THORACIC SPINE W/O 4680720 352 C 72128 Y Y 07/01/2025 "4,270.00" " 2,989.00 " " 3,757.60 " " 2,305.80 " " 2,305.80 " 468 730 CT-THORACIC SPINE W/C 4680730 352 C 72129 Y Y 07/01/2025 "4,822.00" " 3,375.40 " " 4,243.36 " " 2,603.88 " " 2,603.88 " 468 740 CT-THORACIC SPINE W & WO 4680740 352 C 72130 Y Y 07/01/2025 "5,425.00" " 3,797.50 " " 4,774.00 " " 2,929.50 " " 2,929.50 " 468 750 CT-LUMBAR SPINE W/O 4680750 352 C 72131 Y Y 07/01/2025 "4,426.00" " 3,098.20 " " 3,894.88 " " 2,390.04 " " 2,390.04 " 468 760 CT-LUMBAR SPINE W/C 4680760 352 C 72132 Y Y 07/01/2025 "4,822.00" " 3,375.40 " " 4,243.36 " " 2,603.88 " " 2,603.88 " 468 770 CT-LUMBAR SPINE W & WO 4680770 352 C 72133 Y Y 07/01/2025 "5,425.00" " 3,797.50 " " 4,774.00 " " 2,929.50 " " 2,929.50 " 468 780 CT - CHEST W/WO 4680780 350 C 71270 Y Y 07/01/2025 "5,726.00" " 4,008.20 " " 5,038.88 " " 3,092.04 " " 3,092.04 " 468 805 CT-PELVIS W/O 4680805 352 C 72192 Y Y 07/01/2025 "3,996.00" " 2,797.20 " " 3,516.48 " " 2,157.84 " " 2,157.84 " 468 810 CT-PELVIS W/CONTRAST 4680810 352 C 72193 Y Y 07/01/2025 "4,772.00" " 3,340.40 " " 4,199.36 " " 2,576.88 " " 2,576.88 " 468 820 CT-PELVIS W & WO 4680820 352 C 72194 Y Y 07/01/2025 "6,296.00" " 4,407.20 " " 5,540.48 " " 3,399.84 " " 3,399.84 " 468 830 CT-ABDOMEN W/O 4680830 352 C 74150 Y Y 07/01/2025 "4,014.00" " 2,809.80 " " 3,532.32 " " 2,167.56 " " 2,167.56 " 468 840 CT-ABDOMEN W/C 4680840 352 C 74160 Y Y 07/01/2025 "4,905.00" " 3,433.50 " " 4,316.40 " " 2,648.70 " " 2,648.70 " 468 846 CT- ANGIO ABDOMEN 4680846 350 C 74175 Y Y 07/01/2025 "6,619.00" " 4,633.30 " " 5,824.72 " " 3,574.26 " " 3,574.26 " 468 850 CT-ABDOMEN W & WO 4680850 352 C 74170 Y Y 07/01/2025 "6,357.00" " 4,449.90 " " 5,594.16 " " 3,432.78 " " 3,432.78 " 468 860 CT- ABDOMEN/PELVIS WO 4680860 350 C 74176 Y Y 07/01/2025 "7,154.00" " 5,007.80 " " 6,295.52 " " 3,863.16 " " 3,863.16 " 468 870 CT- ABDOMEN/PELVIS W/C 4680870 350 C 74177 Y Y 07/01/2025 "7,928.00" " 5,549.60 " " 6,976.64 " " 4,281.12 " " 4,281.12 " 468 880 CT- ABDOMEN/PELVIS W/WO 4680880 350 C 74178 Y Y 07/01/2025 "9,306.00" " 6,514.20 " " 8,189.28 " " 5,025.24 " " 5,025.24 " 468 900 CT-UPPER EXTREMITY W/O 4680900 350 C 73200 Y Y 07/01/2025 "3,617.00" " 2,531.90 " " 3,182.96 " " 1,953.18 " " 1,953.18 " 468 901 CT-UPPER EXTREMITY RT W/O CONT 4680901 350 C 73200 Y Y 07/02/2020 "2,176.00" " 1,523.20 " " 1,914.88 " " 1,175.04 " " 1,175.04 " 468 930 CT-LOWER EXT W/O 4680930 350 C 73700 Y Y 07/01/2025 "3,908.00" " 2,735.60 " " 3,439.04 " " 2,110.32 " " 2,110.32 " 468 931 CT-LOWER EXT RT W/O CONT 4680931 350 C 73700 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 468 932 CT-LOW DOSE (LDCT) FOR LUNG CA 4680932 350 C 71271 Y Y 07/01/2025 "2,907.00" " 2,034.90 " " 2,558.16 " " 1,569.78 " " 1,569.78 " 468 940 CT-LOWER EXT W/CONTRAST 4680940 350 C 73701 Y Y 07/01/2025 "4,219.00" " 2,953.30 " " 3,712.72 " " 2,278.26 " " 2,278.26 " 468 941 CT-LOWER EXT W/CONTRAST 4680941 350 C 73701 Y Y 07/02/2020 "2,166.00" " 1,516.20 " " 1,906.08 " " 1,169.64 " " 1,169.64 " 468 945 CONTRAST HIGH OSMOLAR 300-349MG/ML 4680945 00270131535 ML 255 H Q9963 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 468 950 CT-LOWER EXT W & WO 4680950 350 C 73702 Y Y 07/01/2025 "3,818.00" " 2,672.60 " " 3,359.84 " " 2,061.72 " " 2,061.72 " 468 951 CT-LOWER EXT RT W & WO CONT 4680950 350 C 73702 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 468 980 CT- ANGIO LOWER EXTREMITY 4680980 350 C 73706 Y Y 07/01/2025 "5,533.00" " 3,873.10 " " 4,869.04 " " 2,987.82 " " 2,987.82 " 468 981 CT- UPPER EXTREMITY W/C 4680981 350 C 73201 Y Y 07/01/2025 "4,014.00" " 2,809.80 " " 3,532.32 " " 2,167.56 " " 2,167.56 " 468 997 ISOVUE 370 MG/ML 4680997 0270131635 ML 1 255 H Q9967 Y Y 07/01/2025 10.00 7.00 8.80 5.40 5.40 468 998 GASTROGRAFIN 30 ML 4680998 00270044535 UN 1 255 H Q9958 Y Y 07/01/2025 82.00 57.40 72.16 44.28 44.28 468 999 ISOVUE 300-399 MG/ML 4680999 00270131535 ML 1 255 H Q9967 Y Y 07/01/2025 10.00 7.00 8.80 5.40 5.40 468 2300 CT- PEDIATRIC LEG LENGTH 4682300 352 C 77073 Y Y 07/01/2025 171.00 119.70 150.48 92.34 92.34 468 2354 3D RENDERING W/ INTER & REPORTING 4682354 359 C 76376 Y Y 07/01/2025 794.00 555.80 698.72 428.76 428.76 471 0 CLINDAMYCIN HYDRO 150MG 4710000 00591570801 UN 1 250 H J8499 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 1 A&D OINTMENT 4710001 00409792609 UN 1 250 H A6250 Y Y 07/04/2019 10.00 7.00 8.80 5.40 5.40 471 2 CEFEPIME INJ PER 500MG(1GM) 4710002 44567024110 ME 2 636 H J0692 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 3 MEROPENEM 100 MG/500 MG VIAL 4710003 55150020720 ME 5 636 H J2185 Y Y 07/01/2025 257.00 179.90 226.16 138.78 138.78 471 4 ACETAZOLAMIDE SOD 500MGIV 4710004 67457085350 ME 1 250 H J1120 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 471 5 FLUCELVAX 4710005 70461041910 252 C 90674 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 471 6 FLUVIRIN (IIV3) 5.0 ML 4710006 7046112010 250 C 90656 Y N 06/07/2018 179.00 125.30 157.52 96.66 96.66 471 7 ARTIFIC TEARS1.4%15ML SOL 4710007 70000001101 UN 1 257 H A6250 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 471 8 ASA ENTERIC/COATED 325MG 4710008 00182044801 UN 1 257 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 9 "ALBUMIN, INFUSION, 25%, 20 ML" 4710009 76125079210 ML 5 258 H P9047 Y Y 07/01/2025 971.00 679.70 854.48 524.34 524.34 471 10 GABAPENTIN 100 MG CAPSULES 4710010 06787722201 ME 1 251 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 11 PROPOFOL 10 MG IV 4710011 80830118807 ME 1 250 H J2704 Y Y 10/07/2025 10.00 7.00 8.80 5.40 5.40 471 12 SUCCINYLCHOLINE (ANECTINE)TO 20 MG 4710012 00409-662902 ME 250 H J0330 Y Y 07/01/2025 260.00 182.00 228.80 140.40 140.40 471 13 CLONIDINE CHL TAB 0.1 MG 4710013 50268019215 UN 1 250 H J8499 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 14 GABAPENTIN 300 MG 4710014 60687059101 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 15 BACTROBAN (MUPIROCIN) 2% OINT 15GM 4710015 51672131201 GR 1 250 H J3490 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 471 16 CYCLOBENZAPRINE TAB 10MG 4710016 00904780961 UN 1 250 H J8499 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 17 CYCLOPENTOLATE HCL OPTH1% 4710017 00065039615 UN 1 250 Y Y 07/01/2025 267.00 186.90 234.96 144.18 144.18 471 18 ELIQUIS (APIXABAN) 5 MG 4710018 00003089431 ME 250 H J3490 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 471 19 ANTIVENOM (CROFAB) 4710019 50633011012 ME 250 H J0840 Y Y 07/01/2025 "15,888.00" " 11,121.60 " " 13,981.44 " " 8,579.52 " " 8,579.52 " 471 20 DIPHENOXYLATE (LOMOTIL) 4710020 59762106101 ME 1 250 H J8499 Y Y 07/01/2025 12.00 8.40 10.56 6.48 6.48 471 21 FAMOTIDINE TAB 20 MG 4710021 67877084205 UN 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 22 FLUMAZENIL 0.5MG/5CC 4710022 63323042410 UN 1 250 H Y Y 07/01/2025 329.00 230.30 289.52 177.66 177.66 471 23 FOLIC ACID IM/IV 5MG/1ML 4710023 63323018410 UN 1 250 Y Y 07/01/2025 205.00 143.50 180.40 110.70 110.70 471 24 GELFOAM 4710024 270 Y Y 07/04/2019 90.00 63.00 79.20 48.60 48.60 471 25 TAMSULOSIN (FLOMAX) 0.4 MG 4710025 00904738361 ME 1 250 H J8499 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 471 26 AZTREONAM 1 GM 4710026 63323040120 ME 2 250 H J0457 Y Y 07/01/2025 503.00 352.10 442.64 271.62 271.62 471 27 HEP B-ADULT 4710027 58160082152 ML 1 252 C 90746 Y Y 07/01/2025 806.00 564.20 709.28 435.24 435.24 471 28 DIMETAPP 4710028 00031223413 ME 257 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 29 ADAPTER PLUG 4710029 270 Y Y 07/04/2019 12.00 8.40 10.56 6.48 6.48 471 30 INFLIXIMAB (INFLECTRA) PER 10 MG 4710030 00069080901 ME 10 636 H Q5103 Y Y 07/01/2025 "1,704.00" " 1,192.80 " " 1,499.52 " 920.16 920.16 471 31 INSULIN HUMULIN PER 5 UNITS 4710031 00002821501 UN 5 250 H J1815 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 32 ZOLPIDEM TARTRATE (AMBIEN) 10 MG 4710032 00904608361 ME 1 250 H J8499 Y Y 07/01/2025 57.00 39.90 50.16 30.78 30.78 471 33 RIFAMPIN 300 MG 4710033 61748001830 ME 1 250 H J8499 Y Y 07/01/2025 88.00 61.60 77.44 47.52 47.52 471 34 OXYBUTYNIN CHLORIDE (DITROPAN)5 MG 4710034 00904702761 UN 1 250 H J8499 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 471 35 METOPROLOL/LOPRESSO 1 MG 4710035 25021030305 ME 1 250 J0616 Y Y 01/16/2026 137.00 95.90 120.56 73.98 73.98 471 36 METOPROLOL TAB 50 MG 4710036 51079080120 UN 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 37 ADENOSINE 6MG/2ML IV PFS 4710037 67457085502 UN 1 250 H J0153 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 471 38 LINEZOLID 600 MG 1 TAB 4710038 ME 1 250 H J8499 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 471 39 "ATROPINE SULFATE, 0.01 MG, INJECT" 4710039 70121170604 UN 100 250 H J0461 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 471 40 QUETIAPINE (SEROQUEL) 25 MG TAB 4710040 00904663861 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 41 NYSTATIN SUSP 5 ML 4710041 00904727692 UN 1 251 H J7599 Y Y 07/01/2025 54.00 37.80 47.52 29.16 29.16 471 42 DULOXETINE (CYMBALTA) 4710042 00904-6453-6 UN 1 250 H J8499 Y Y 07/01/2025 97.00 67.90 85.36 52.38 52.38 471 43 CLONAZEPAM (KLONOPIN) 2 MG 4710043 43547040810 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 44 MIRTAZAPINE (REMERON) 45 MG 4710044 13107003234 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 45 EPINEPHRINE 1:1000 1ML AMP 4710045 00409724101 UN 1 250 H J0171 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 471 46 LANSOPRAZOLE (PREVACID) 30 MG 4710046 64764004613 ME 1 257 H A9150 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 47 BELSOMRA 15MG TABLET 4710047 0000603253 ME 1 250 H J8499 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 471 48 METHOTREXATE 2.5 MG 4710048 51079067005 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 49 PNEUMOCOCCAL VACCINE 4710049 005197102 250 C 90732 Y Y 07/01/2025 306.00 214.20 269.28 165.24 165.24 471 50 FENTANYL PATCH 12 MCG/HR 4710050 0378911998 GR 1 250 H J3010 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 471 51 TERAZOSIN 1 MG CAPSULE 4710051 59746038306 ME 1 250 H J8499 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 52 METHADONE 10 MG TAB 4710052 00904653061 ME 1 250 H J8499 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 53 PREDNISOLONE ACET 1% 4710053 61314063705 UN 1 250 Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 471 54 SPIRIVA RESPIMAT(TIOTROPIUM) 2.5MC 4710054 00597010051 GR 1 250 H J7699 Y Y 07/01/2025 35.00 24.50 30.80 18.90 18.90 471 55 SERTRALINE (ZOLOFT )50 MG 4710055 00904692561 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 56 ETHAMBUTOL HYDROCHLORIDE 400 MG 4710056 6885001201 ME 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 57 AMOX/CLAVULANATE POTASS 875/125MG 4710057 04359802114 ME 1 250 H G9613 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 58 ANTIPYRINE/BENZOCAINE/GLY 4710058 252 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 471 59 HYDROMORPHONE 2MG 4710059 00409131230 UN 1 250 H J1170 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 471 60 HYDROMORPHONE(DILAUDID)0.5MG/0.5ML 4710060 409128305 ME 1 250 H J1170 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 61 CIPROFLOXACIN OTIC 60 MG/ML OTIPRI 4710061 69251020101 ML 1 250 H J7342 Y Y 07/01/2025 597.00 417.90 525.36 322.38 322.38 471 62 AMIODARONE 150MG/3ML 4710062 00143987501 ML 3 636 H J0282 Y Y 07/01/2025 398.00 278.60 350.24 214.92 214.92 471 63 IV D5NS KCL 40MEQ 1L 4710063 00264763500 ML 1 636 H J3480 Y Y 07/01/2025 80.00 56.00 70.40 43.20 43.20 471 64 HYDRALAZINE HCI 20 MG/ML IM/IV 4710064 63323061401 250 H J0360 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 471 65 DEXTROAMPHETAMINE SULFATE 10 MG TA 4710065 10702006601 ME 1 250 H S0160 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 66 METOPROLOL SUCCINATE 25 MG 4710066 05026854015 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 67 BUPIVACAINE 0.5% 10ML 4710067 00074116201 UN 1 250 H J3490 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 68 DEXTROSE 5% 25GM/50ML IN WATER 4710068 00409490234 UN 1 636 H J7060 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 69 CHLORHEXIDINE GLUCONATE 4710069 00234057580 UN 1 270 H A4248 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 471 70 ENOXAPARIN (LOVENOX) 30MG 4710070 00075062430 UN 1 250 H J1650 Y Y 07/01/2025 240.00 168.00 211.20 129.60 129.60 471 71 MELATONIN 3 MG TAB 4710071 96295013723 ME 1 250 H Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 72 LIDOCAINE 2% 4710072 00409427701 UN 1 250 H J3490 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 471 73 LIDOCAINE 2% W/EPI 4710073 00409014701 UN 1 250 H J2004 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 471 74 ATENOLOL 25 MG 4710074 00310010710 UN 1 250 H J8499 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 471 75 AMIODARONE 200MG 4710075 00245014701 UN 1 636 H J0282 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 76 LABETOLOL IV 100MG/20ML 4710076 00409226720 UN 1 250 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 471 77 BUPROPION HCL (WELLBUTRIN SR)150MG 4710077 00904658561 ME 1 250 H J8499 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 471 78 SENNA (SENNOSIDES) 8.6 MG 4710078 309046725596 ME 1 250 H Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 79 NITROGLYCERIN GTT 50MG 4710079 00338104902 UN 1 636 H J2305 Y Y 07/01/2025 171.00 119.70 150.48 92.34 92.34 471 80 CALCIUM CARBONATE TB 4710080 00135018114 UN 1 257 H J3490 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 81 D-AMPHETAMINE SULFATE (DEXEDRINE) 4710081 10702006501 ME 5 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 82 PHENYTOIN/DILANTIN 50 MG 4710082 00641255545 ME 50 636 H J1165 Y Y 07/01/2025 204.00 142.80 179.52 110.16 110.16 471 83 PROCAINAMIDE 1GM/10ML 4710083 00409190201 UN 1 636 H J2690 Y Y 07/01/2025 "1,106.55" 774.59 973.76 597.54 597.54 471 84 FLUZONE QUAD 0.5 ML SINGLE DOSE 4710084 49281042550 UN 1 250 C 90686 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 471 85 TAMIFLU 30MG EACH DOSE 4710085 00402080285 UN 1 250 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 471 86 OSELTAMIVIR- 75MG EACH DOSE 4710086 00402080181 UN 1 250 Y Y 07/01/2025 54.00 37.80 47.52 29.16 29.16 471 87 MEDROXY-PROGSTERONE 1 MG 4710087 00548540000 ME 150 250 H J1050 Y Y 07/01/2025 7.00 4.90 6.16 3.78 3.78 471 88 NORMAL SALINE FLUSH 10ML SYRINGE 4710088 08290306546 ML 10 250 H A4216 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 89 DILTIAZEM XR 240 MG CAPSULE 4710089 6050500166 ME 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 90 DILTIAZEM DRIP 125 MG 4710090 636 H J3490 Y Y 07/01/2025 617.00 431.90 542.96 333.18 333.18 471 91 CLINDAMYCIN/CLEOCI 300 MG IV 4710091 00781328809 ME 300 250 H J0736 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 471 92 REGULAR INSULIN PER 50 UNTS SYRING 4710092 00169300315 UN 50 636 H J1817 Y Y 07/01/2025 752.00 526.40 661.76 406.08 406.08 471 93 CYKLOKAPRON 100 MG/ML (TRANEXAMIC) 4710093 60505616901 ME 100 250 H J3490 Y Y 07/01/2025 126.00 88.20 110.88 68.04 68.04 471 94 "SODIUM CHLORIDE TABLET, USP 1 GM " 4710094 00536134201 GR 1 250 H Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 95 EPOETIN ALFA 1000 UNITS 4710095 55513014810 UN 1 250 H J0885 Y Y 07/01/2025 "1,036.00" 725.20 911.68 559.44 559.44 471 96 GARDASIL-HPV 4710096 000064121202 UN 1 250 C 90651 Y Y 07/01/2025 888.00 621.60 781.44 479.52 479.52 471 97 VITAMIN B COMPLEX CAPSULE 4710097 00536478701 ME 1 257 H A9152 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 98 HEPATITIS A VACCINE 4710098 58160082552 UN 1 250 C 90633 Y Y 07/01/2025 366.00 256.20 322.08 197.64 197.64 471 99 AFLURIA IIV4 SINGLE DOSE SYRINGE 4710099 33332-317-01 UN 1 250 C 90686 Y Y 07/01/2025 54.00 37.80 47.52 29.16 29.16 471 100 AMP/SUBAC/SOD 1.5GM 4710100 44567021010 UN 1 250 H J0295 Y Y 07/01/2025 230.00 161.00 202.40 124.20 124.20 471 101 ACETAMINOPHEN SUPP 650 MG 4710101 51672211602 UN 1 257 H A9150 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 471 102 ZOLPIDEM TARTRATE (AMBIEN) 5 MG 4710102 60687083801 ME 5 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 103 ACIDOPHILUS TABLET 4710103 00536718101 ME 1 257 H A9153 Y Y 07/01/2025 0.00 - - - - 471 104 MECLIZINE/ANTIVERT 25MG 4710104 0536129901 UN 1 250 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 471 105 AMP/SUBAC/SOD PER 1.5 GR ADDV 4710105 44567021010 GR 1.5 250 J0295 Y Y 07/01/2025 395.00 276.50 347.60 213.30 213.30 471 106 DEXTROSE 25% IN WATER 2.5 GM 4710106 0409177510 GR 1 250 H J8499 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 107 PSEUDOEPHEDRINE 30MG 4710107 00781153301 UN 1 250 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 108 TRIAMTERENE/HTCZ 37.5/25M 4710108 62794046488 UN 1 250 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 109 LORATADINE 10MG 4710109 51079013201 UN 1 251 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 110 TRAZADONE 100 MG PO 4710110 00904686861 ME 100 250 H Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 111 OXYCODONE 10MG 4710111 00904709561 ME 10 250 H J3490 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 471 112 OXYCODONE 5MG 4710112 00406051262 ME 5 250 H J3490 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 471 113 NEOMYCIN/POLYMYXIN B/ L 4710113 24208078055 UN 1 257 H Y Y 07/01/2025 248.00 173.60 218.24 133.92 133.92 471 114 NEOMYCIN/POLYMYXIN B/ B 4710114 24208078055 UN 1 257 H A6250 Y Y 07/01/2025 185.00 129.50 162.80 99.90 99.90 471 115 CETACAINE AE 14-2-2% 5GM TOPICAL 4710115 10223020104 GR 1 250 H Y Y 07/01/2025 204.00 142.80 179.52 110.16 110.16 471 116 AMLODIPINE 10MG TAB 4710116 0094637161 ME 10 250 H J8499 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 117 CARBAMIDE PEROXIDE DROPS 4710117 4203701078 UN 1 250 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 118 CEFUROXIME 250MG TAB 4710118 64679092101 UN 1 250 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 471 119 RACEMIC EPINEPHRINE 2.25% 4710119 00487590199 UN 1 251 H J7699 Y Y 07/01/2025 72.00 50.40 63.36 38.88 38.88 471 120 BENZTROPINE MESYLATE 1 MG/(COGENTI 4710120 68382086010 ME 1 250 H J0515 Y Y 07/01/2025 112.00 78.40 98.56 60.48 60.48 471 121 LEVOTHYROXINE 25MCG TAB 4710121 00904694961 UN 1 250 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 122 ISONIAZID 300 MG TABLET 4710122 0555007102 ME 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 123 DOBUTAMINE PREMIX 250MG 4710123 00338107302 UN 1 250 J1250 Y Y 07/02/2020 206.00 144.20 181.28 111.24 111.24 471 124 NEUPOGEN PER MCG 4710124 55513020901 UN 1 636 H J1442 Y Y 07/01/2025 10.00 7.00 8.80 5.40 5.40 471 125 CROTALIDAE (EQUINE)120MG(ANTIVENOM 4710125 66621079002 UN 1 250 H J0841 Y Y 07/01/2025 "2,380.00" " 1,666.00 " " 2,094.40 " " 1,285.20 " " 1,285.20 " 471 126 ISOSORBIDE MONONITR 30 MG #100 4710126 904644961 UN 1 250 H J8499 Y Y 07/01/2025 265.00 185.50 233.20 143.10 143.10 471 127 METHOCARBAM 750 MG 4710127 63739016710 UN 1 250 H J3490 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 128 ESCITALOPRAM OXALATE(LEXAPRO)10 MG 4710128 0904642661 ME 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 129 METHYLERGON .2MG/ML 4710129 51991014417 ME 0.2 636 H J2210 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 130 DIFLUCAN 200 MG IV 4710130 00409468823 UN 1 636 H J1450 Y Y 07/01/2025 480.00 336.00 422.40 259.20 259.20 471 131 PROPYLENE GLYCOL 1.0% ART TEARS 4710131 10119002003 ML 250 H Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 132 CYANOCOBALAMIN/VIT B12 500 MCG TAB 4710132 80681012800 UN 1 250 H Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 133 ENALAPRIL 1.25 MG/ML IV 4710133 00143978710 UN 1 250 H J3490 Y Y 07/01/2025 284.00 198.80 249.92 153.36 153.36 471 134 HYDROCHLOROTHIAZIDE 25MG 4710134 60687059301 UN 1 250 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 135 CARVEDILOL 6.25 MG TABLET 4710135 00007414020 UN 1 250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 136 KETOROLAC 10 MG 4710136 0093031401 ME 1 250 H Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 137 PREVNAR 13 4710137 00005197102 UN 1 252 C 90670 Y Y 07/01/2025 624.00 436.80 549.12 336.96 336.96 471 138 HYDROXYZINE 25MG TABLET 4710138 68084025401 UN 1 250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 139 DEXAMETHASONE ORAL 0.25 MG 4710139 00904726661 ME 16 250 H J8540 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 140 DONEPEZIL 10 MG 4710140 0904647861 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 141 TDAP VACCINE >7 IM 4710141 04928140010 636 C 90715 Y Y 07/01/2025 216.00 151.20 190.08 116.64 116.64 471 142 DTAP VACCINE <7 YEARS 4710142 49281028610 636 C 90700 Y Y 07/01/2025 216.00 151.20 190.08 116.64 116.64 471 143 GLIPIZIDE 5MG 4710143 51079081020 UN 1 250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 144 AMMONIA INHALANT 4710144 64641333334 251 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 145 CIPRO 400 MG IVPB 4710145 00026855463 UN 1 250 H J0744 Y Y 07/01/2025 512.00 358.40 450.56 276.48 276.48 471 146 ATROPINE OPTH SOL 1% 4710146 60219174802 UN 1 250 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 471 147 DUONEB-ALBUT&IPATR2.5MG 4710147 69097084087 UN 1 250 H J7620 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 148 NITROFURANTOIN 100MG 4710148 51079058520 UN 1 250 H J8499 Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 471 149 LEVOTHYROXINE 100MCG TAB 4710149 51079044201 UN 1 250 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 150 SIMVASTATIN 20MG TAB 4710150 00006074061 UN 1 250 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 151 AMOXIL 250MG/150CC BTL 4710151 67253014847 UN 1 250 H J8499 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 471 152 MEDROXYPROGESTERONE ACETATE10MG TA 4710152 60687010521 ME 1 250 H J7999 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 153 REGULAR INSULIN 5 UNITS 4710153 00002821517 250 H J1815 Y Y 07/01/2025 120.44 84.31 105.99 65.04 65.04 471 154 LANTUS INSULIN 5 UNITS 4710154 00088222033 UN 5 250 H J1815 Y Y 07/01/2025 161.00 112.70 141.68 86.94 86.94 471 155 AMINOPHYLLINE 250MG VIAL 4710155 71773005012 ME 1 250 H J0280 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 156 NPH INSULIN 5 UNITS 4710156 00169183411 UN 5 250 H J1815 Y Y 07/01/2025 130.00 91.00 114.40 70.20 70.20 471 157 WARFARIN 1MG TAB 4710157 00056016970 UN 1 250 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 158 WARFARIN 5MG TAB 4710158 00056017270 UN 1 250 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 159 FENTANYL 250MCG/5ML IM.IV 4710159 00409909425 UN 1 636 H J3010 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 471 160 HYDROCOD/ACETA 10/325MG T 4710160 52544053901 UN 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 161 NALOXONE 2MG/2ML IM/IV 4710161 00548146900 UN 1 250 H J2310 Y Y 07/01/2025 424.00 296.80 373.12 228.96 228.96 471 162 OXYMETAZOLINE NASAL 0.05% 4710162 00904571135 UN 1 250 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 163 ANTIVENIN CROTALIDAE VIAL 4710163 50633011012 UN 1 636 H J0840 Y Y 07/01/2025 "15,888.00" " 11,121.60 " " 13,981.44 " " 8,579.52 " " 8,579.52 " 471 164 POLYETHYLENE GLYCOL (MIRALAX) 17 G 4710164 00904693176 GR 1 250 H J3490 Y Y 07/01/2025 69.61 48.73 61.26 37.59 37.59 471 165 FLUCONAZOLE 200 MG TAB 4710165 904650106 ME 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 166 DAKINS SOLUTION 0.25% 4710166 00436093616 UN 1 250 Y Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 471 167 OMEPRAZOLE (PRILOSEC) 4710167 00781223401 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 168 ALTEPLASE 100 MG VIAL 4710168 50242008527 ME 1 250 H J2997 Y Y 07/01/2025 "16,763.00" " 11,734.10 " " 14,751.44 " " 9,052.02 " " 9,052.02 " 471 169 AMOXICILLIN CAP 250MG 4710169 00781202001 UN 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 170 IV SOL SOD CHL.9 1000ML W 4710170 00409711509 UN 1 250 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 171 ASPIRIN 81 MG (ENTERIC COATED) 4710171 6373921210 ME 1 250 H A9150 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 172 IVERMECTIN (STROMECTROL) 3 MG 4710172 42799080601 ME 1 250 H J8499 Y Y 07/01/2025 57.00 39.90 50.16 30.78 30.78 471 173 DOCUSATE SODIUM 100MG 4710173 00904645561 ME 100 636 H A9150 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 174 HYDRALAZINE 25MG TAB 4710174 00904644161 ME 1 251 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 175 AMOX/CLAVULO ACID TAB XR 4710175 6668510010 ME 251 H Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 471 176 METHOCARBAMOL 500MG 4710176 00904705761 UN 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 177 BACLOFEN 10MG TAB 4710177 00904647561 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 178 AMOX/CLAVULO ACID SUSP 4710178 00781187431 ME 1 250 H J8499 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 471 179 FERRIC CARBOXYMALTOSE PER 1 MG 4710179 00517065001 ME 1 636 H J1439 Y Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 471 180 CARBAMAZEPINE 100 MG 4710180 0904385461 ME 1 250 H J8499 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 181 ERAVACYCLINE (XERAVA;50MG VIAL) 1M 4710181 71773-0050-1 ME 1 250 H J0122 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 471 182 MAGNESIUM OXIDE 400 MG 4710182 64980033901 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 183 MORPHINE 30MG TABLET 4710183 0904655861 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 184 BUPRENORPHINE/NALOXONE 4MG/1MG 4710184 12496120403 ME 1 250 H J0573 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 185 BUPRENORPHINE 8MG/2MG 4710185 12496120803 ME 1 250 H J0574 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 186 ALTEPLASE 2MG 4710186 50242004164 ME 1 250 H J2997 Y Y 07/01/2025 172.00 120.40 151.36 92.88 92.88 471 187 LORAZEPAM 0.5MG TAB 4710187 00904600761 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 188 MIDODRINE HCL 10MG TAB 4710188 50268056315 ME 1 250 H J8499 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 471 189 PSYLLIUM (PACKET) 4710189 96295013533 UN 1 251 H J3490 Y Y 07/01/2025 17.00 11.90 14.96 9.18 9.18 471 190 LINEZOLID 600 MG/300 ML IV 4710190 05515024251 ME 1 250 H J2020 Y Y 01/01/2026 84.00 58.80 73.92 45.36 45.36 471 191 CARBAMAZEPINE 200 MG TAB 4710191 00904617261 ME 1 250 H J8499 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 192 BUPRENORPHINE 1 MG 4710192 60687048121 ME 1 250 H J0571 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 193 MIRTAZAPINE 15MG TAB 4710193 00904651961 ME 1 250 H J8499 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 194 ALLOPURINOL 100MG TAB 4710194 00904704161 ME 1 250 H J8499 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 471 195 INDOMETHACIN 50MG TAB 4710195 50268043115 ME 1 250 H J8499 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 471 196 SPIRONOLACTONE 25MG TAB 4710196 00904692761 ME 1 250 H J8499 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 471 197 DILTIAZEM ER 240MG TAB 4710197 60687021701 ME 250 H J8499 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 471 198 OLANZAPINE 1MG (10MG VIAL) 4710198 00517095501 ME 10 250 H J2358 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 199 "PROPOFOL 100ML (SINGLE, 10MG/1ML)" 4710199 63323026978 ML 1 250 H J2704 Y Y 07/01/2025 4.00 2.80 3.52 2.16 2.16 471 200 ETHYL CHLORIDE 103.5ML SPRAY 4710200 00386000111 ML 1 250 H J3490 Y Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 471 201 GENVISC 25MG 4710201 50653000601 GR 1 250 H J7323 Y Y 04/01/2025 675.00 472.50 594.00 364.50 364.50 471 202 OCTREOTIDE INJ. 0.5MG (1MG) 4710202 63323037701 ME 1 636 H J2353 Y Y 07/01/2025 490.00 343.00 431.20 264.60 264.60 471 203 ABATACEPT PER 10MG 4710203 00003218713 ME 1 636 H J0129 Y Y 07/01/2025 96.00 67.20 84.48 51.84 51.84 471 204 EPOETIN ALFA 4000U/ML 4710204 55513014810 UN 1 250 H J0885 Y Y 07/01/2025 377.00 263.90 331.76 203.58 203.58 471 205 FULVESTRANT; FASLODEX 4710205 71288055586 ML 1 250 N Y 07/01/2025 668.00 467.60 587.84 360.72 360.72 471 206 PENICILLIN V POTASSIUM 500MG 4710206 65862017601 UN 1 250 C J8499 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 471 208 BUPRENORPHINE; NALOXONE 2MG 4710208 43598057930 ME 2 250 Y Y 07/01/2025 8.00 5.60 7.04 4.32 4.32 471 210 OPTHALMIC; OCUFLOX 0.3% 5ML 4710210 64980051505 ML 1 250 N Y 07/01/2025 0.00 - - - - 471 212 SODIUM BICARB 650 MG TAB 4710212 00904726161 UN 1 250 N Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 471 214 EPINEPHRINE; EPIPEN ADULT 4710214 49502010202 ME 1 250 Y Y 07/01/2025 882.00 617.40 776.16 476.28 476.28 471 215 BUPRNPH/NALOX 2-0.5MG 4710215 43598057930 250 Y Y 07/01/2025 18.00 12.60 15.84 9.72 9.72 471 216 DEXAMETHASONE 10 MG/ML 4710216 6332350601 UN 1 250 H J1100 N Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 471 217 AMOXICILLIN TRIHYDRATE; 250MG/5ML 4710217 65862070780 250 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 219 DEXTRAN; GENTEAL TEARS DR 0.1-0.3% 4710219 00065930501 UN 250 N Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 471 220 AMOXICILLIN/POTCLVULNT 400-57MG/5M 4710220 65862053450 ML 50 250 Y Y 07/01/2025 166.00 116.20 146.08 89.64 89.64 471 221 PRAXBIND (IDARUCIZUMAB) 2.5 ML 50M 4710221 00597019705 250 H C9399 Y Y 07/01/2025 "7,627.00" " 5,338.90 " " 6,711.76 " " 4,118.58 " " 4,118.58 " 471 222 ETONOGESTREL IMPLNT 4710222 636 H J7307 Y Y 07/04/2019 "1,507.00" " 1,054.90 " " 1,326.16 " 813.78 813.78 471 223 IRRIG SOD CHL .9% 1000ML 4710223 272 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 471 224 LIDOCAINE 2% VISCOUS SOLUTION 4710224 00054350049 UN 250 N Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 471 225 VITAMIN D3; 5000 UNITS 4710225 50268086615 UN 1 257 N Y 08/01/2023 3.00 2.10 2.64 1.62 1.62 471 226 HEP B-PED 0.5ML 4710226 00006498100 UN 1 252 C 90744 Y Y 07/01/2025 383.00 268.10 337.04 206.82 206.82 471 227 CEFAZOLIN SOD 500 MG IM/IV (ANCEF) 4710227 66860000203 ME 1 250 H J0690 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 471 228 CEFAZOLIN PM 2GM 24X50ML (ANCEF) 4710228 0264310511 GR 2 250 H J0690 Y Y 07/01/2025 597.00 417.90 525.36 322.38 322.38 471 229 CARVEDILOL 3.125MG 4710229 00904630061 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 230 A&D OINTMENT TUBE 4710230 95416200027 ME 1 250 H A6250 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 231 FLUDROCORTISONE ACETATE 0.1MG 4710231 50268033015 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 233 PREGABALIN; LYRICA 50 MG 4710233 60687048401 UN 1 250 Y Y 07/01/2025 9.00 6.30 7.92 4.86 4.86 471 235 ALBUTEROL SULFATE 90MCG; 6.7 GR MD 4710235 00054074287 UN 1 250 J7613 N Y 07/01/2025 186.00 130.20 163.68 100.44 100.44 471 237 LORAZEPAM SD 4MG/ML 4710237 00641604525 ME 4 250 N Y 07/01/2025 15.00 10.50 13.20 8.10 8.10 471 239 NYSTATIN; NYAMYC 100MU/GM 4710239 00832046515 UN 1 250 Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 471 240 FE SULFATE 300MG/5ML 4710240 50268033624 UN 1 250 H J3490 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 471 241 NICOTINE PATCH 21MG 4710241 0536589688 ME 1 251 H S4990 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 471 243 GEN EYE DROPS 4710243 00065806301 UN 1 259 Y Y 07/01/2025 3.00 2.10 2.64 1.62 1.62 471 245 GUAIFENESIN 600 MG 4710245 63824000850 UN 1 250 H A9150 N Y 07/01/2025 6.00 4.20 5.28 3.24 3.24 471 248 FUROSEMIDE TAB 40 MG 4710248 00904717861 UN 1 250 Y Y 07/01/2025 6.00 4.20 5.28 3.24 3.24 471 249 KETALAR 4710249 00409205105 ME 100 250 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 471 250 AMLODIPINE 5MG 4710250 69097012705 UN 1 250 Y Y 07/01/2025 9.00 6.30 7.92 4.86 4.86 471 251 FLORASTOR PROBIOTIC; SACCH BOUL 4710251 42037010478 UN 1 250 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 471 255 FARXIGA TB 4710255 00310621039 ME 10 250 N Y 07/01/2025 36.00 25.20 31.68 19.44 19.44 471 257 ISOVUE-M 200 (41%) 4710257 0270141111 ML 10 250 Y Y 07/01/2025 27.00 18.90 23.76 14.58 14.58 471 260 MUCOMYST 20% 4710260 00409330803 ML 1 250 J7608 N Y 07/01/2025 158.00 110.60 139.04 85.32 85.32 471 263 LIDOCAINE HCL SL2% 4710263 00121495040 UN 1 250 N Y 04/20/2024 65.00 45.50 57.20 35.10 35.10 471 268 ANTIVENIN-BLACK WIDOW 4710268 00006542402 UN 1 250 Y Y 07/01/2025 497.00 347.90 437.36 268.38 268.38 471 270 DILTIAZEM 60MG TABLET 4710270 50228048201 ME 1 250 H Y Y 07/01/2025 73.00 51.10 64.24 39.42 39.42 471 271 MICONAZOLE NITRATE 4710271 11701004523 UN 1 250 H Y Y 07/01/2025 32.35 22.65 28.47 17.47 17.47 471 275 FARXIGA TB 4710275 00310621039 ME 10 250 N Y 07/01/2025 35.00 24.50 30.80 18.90 18.90 471 277 JARDIANCE INP 4710277 00597015237 ME 10 250 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 471 285 POTASSIUM CHLORIDE/KLOR-CON 4710285 6021916173 UN 20 250 Y Y 07/01/2025 11.00 7.70 9.68 5.94 5.94 471 292 ASA TAB 325 MG 4710292 0536105429 UN 1 250 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 295 ASA TAB 81MG CHEWABLE 4710295 57896090110 UN 1 250 H Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 300 "ANDEXXA -INJ, COAG, 10MG" 4710300 0031-3200-04 ME 200 MG 632 H J7169 Y Y 07/01/2025 "3,087.00" " 2,160.90 " " 2,716.56 " " 1,666.98 " " 1,666.98 " 471 301 TRAMADOL 50MG TAB 4710301 00045065960 UN 1 250 H J3490 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 305 NICOTINE TP AP 14MG 4710305 70000051101 UN 1 250 C S4990 Y Y 07/01/2025 14.00 9.80 12.32 7.56 7.56 471 310 ACETAMINOPHEN 30ML 4710310 250 H J0132 N Y 07/01/2025 27.00 18.90 23.76 14.58 14.58 471 316 LABETALOL 100MG PO 4710316 00085024404 UN 1 250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 326 LORAZEPAM TAB 1 MG 4710326 00008006402 UN 1 250 H J8499 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 471 330 LORAZEPAM IM/IV 2 MG 4710330 00641604425 UN 1 250 H J2060 Y Y 07/01/2025 179.00 125.30 157.52 96.66 96.66 471 331 HEPARIN0.45% SODIMCHL 250ML 4710331 63323051774 ML 1 250 Y Y 07/01/2025 56.00 39.20 49.28 30.24 30.24 471 340 MAGNESIUM HYDROXIDE 4710340 57237031431 ML 30 250 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 471 369 BACITRACIN OINTMT 1/32 OZ 4710369 45802006070 UN 1 250 J3490 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 379 HYDROMORPHONE (DILAUDID) 0.1 MG 4710379 63323085203 ME 1 250 H J1171 Y Y 07/11/2025 26.00 18.20 22.88 14.04 14.04 471 380 SULFA/TRIMETH SUSP 5ML 4710380 65862049647 ML 250 H S0039 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 381 METRONIDAZOLE 10 MG 4710381 00409015224 ML 50 250 H J1836 Y Y 07/01/2025 13.00 9.10 11.44 7.02 7.02 471 382 VITAMIN B-6 50MG 4710382 77333094010 ME 1 257 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 383 MAGNESIUM CITRATE 1.745 GM 4710383 71399005101 ME 1 257 N Y 07/01/2025 17.00 11.90 14.96 9.18 9.18 471 384 PROMETHAZINE HCC 25 MG 4710384 68084015501 ME 1 257 N Y 07/01/2025 76.00 53.20 66.88 41.04 41.04 471 386 MAX TUSSIN MUCUS; CHST CNGSTN 4710386 71399002408 ML 10 250 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 471 425 DIPHENHYDRAMINE TAB 25MG 4710425 69618002401 ME 1 251 H Q0163 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 433 DIPHENHYDRAMINE IM/IV UP TO 50MG 4710433 25021048101 ME 50 250 H J1200 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 471 434 DIPHENHYDRAMINE LIQUID 25MG/10ML 4710434 6809402459 ML 250 H J1200 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 456 SODIUM CHLORIDE 0.9% 50ML 4710456 63323062353 UN 1 258 H J7050 Y N 07/01/2025 446.00 312.20 392.48 240.84 240.84 471 466 BISACODYL TAB 5 MG 4710466 0904640761 ME 257 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 471 469 BISACODYL SUPP 10 MG 4710469 00713010901 UN 1 257 H A9150 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 480 FENTANYL 100MCG/2ML IV 4710480 00409909422 UN 1 250 H J3010 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 490 VERAPAMIL SR TAB 120MG 4710490 51079089401 UN 1 250 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 491 ACYCLOVIR 200MG CAPSULE 4710491 00904578961 ME 1 251 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 492 LACTULOSE 20GM/30ML 4710492 00121115440 ML 1 251 H J3490 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 493 LOSARTAN POTASSIUM 50MG TABLET 4710493 50268050515 ME 1 251 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 494 BUSPIRONE HCL 5MG TAB 4710494 51079098520 ME 1 250 H J8499 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 471 516 CALCIUM CH 10% IV PFS 4710516 00409163110 UN 1 250 Y Y 07/01/2025 130.00 91.00 114.40 70.20 70.20 471 524 CALCIUM GLU IV 1 GM/10ML 4710524 63323031110 UN 1 250 H J0612 Y Y 07/01/2025 80.00 56.00 70.40 43.20 43.20 471 532 CAPTOPRIL TAB 25 MG 4710532 51079086401 UN 1 250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 550 "DILTIAZEM HCI INJ, 0.5 MG" 4710550 25021031925 UN 250 250 J1163 Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 471 555 "BENZOIN, TINCTURE" 4710555 54162010001 UN 1 257 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 559 NEEDLE-INTRAOSSEOUS 4710559 272 H Y Y 07/01/2025 724.00 506.80 637.12 390.96 390.96 471 561 LIDOCAINE HCL JELLY 2% 4710561 2502167376 ML 1 250 H J3490 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 562 ATORVASTATIN 40 MG TABLET 4710562 00904629206 ME 1 251 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 563 FINASTERIDE 5 MG TABLET 4710563 00904683006 ME 1 251 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 564 TRAZODONE 50 MG TABLET 4710564 00904686861 ME 1 251 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 565 IV CATH/NEEDLE ALL SIZES 4710565 272 H A4300 Y Y 07/04/2019 23.00 16.10 20.24 12.42 12.42 471 566 CHOLECALCIFEROL (VITAMIN D3) 5000I 4710566 05026886615 UN 1 257 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 569 INFLUENZA VIRUS VACCINE (IIV4) 4710569 250 C 90688 N Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 471 600 DONOR BOTTLE W/15G NEEDLE 4710600 272 Y Y 07/04/2019 8.00 5.60 7.04 4.32 4.32 471 618 IV HUBER NEEDLE ALL SIZES 4470618 272 H A4215 Y Y 07/04/2019 47.00 32.90 41.36 25.38 25.38 471 621 IV FILTER SET 4470621 272 H X7700 Y Y 07/04/2019 26.00 18.20 22.88 14.04 14.04 471 625 ONDANSETRON 4 MG ORAL 4710625 68462015713 UN 1 259 H Q0162 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 471 626 NICARDIPINE HCL 4710626 00517-0735-1 UN 1 259 H Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 471 628 ROPIVACAINE HCL 0.5% 4710628 70069006410 ME 1 259 H J2795 Y Y 07/01/2025 8.00 5.60 7.04 4.32 4.32 471 629 LITHIUM CARBONATE TB 450 MG 4710629 680484065501 UN 1 250 H J8499 Y Y 05/01/2025 23.00 16.10 20.24 12.42 12.42 471 637 ATORVASTATIN 10 MG TAB 4710637 0071015523 ME 1 251 H J8499 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 471 680 CIPROFLOXIN TAB 500 MG 4710680 00085175401 ME 1 252 H J8499 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 471 700 CEPHALEXIN SUSP 250MG/5ML 4710700 00093417773 UN 1 250 Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 471 712 TROPICAMIDE 1% OPHTHALMIC DROPS 4710712 17478-0102-1 ML 1 250 H J3490 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 730 DOCUSATE SOD CAP 250 MG 4710730 00781279501 UN 1 251 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 763 PROCHLORPERAZINE UP TO 10MG IM/ 4710763 70069037125 ME 5 250 H J0780 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 471 789 PROCHLORPERAZINE SUPP 25M 4710789 00713013512 ME 250 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 813 NEOMYCIN/POLYMYXIN/ H 4710813 24208083060 250 H J3490 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 471 821 WARFARIN SOD TAB 2.5 MG 4710821 00056017670 UN 1 250 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 840 OFLOXACIN OTIC; FLOXIN OTIC 4710840 60505036301 ML 1 250 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 471 870 IV SOL DEXTROSE 5% 1000ML 4710870 00409792209 UN 1 258 H J7070 Y Y 07/01/2025 304.00 212.80 267.52 164.16 164.16 471 871 DEXTROSE 5% 250 ML 4710871 00409792202 UN 1 636 H J7060 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 872 DEXTROSE 5%-1/2NS-KCL 20MEQ/L 1L 4710872 00264763500 ML 1 250 H J3480 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 471 888 INJEC DEXTROSE 5% 100ML 4710888 00409792337 UN 1 258 H Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 471 896 INJEC DEXTROSE 5% 250ML 4710896 00338001702 ML 258 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 471 900 DAPTOMYCIN PER 500 MG 4710900 43598041311 ME 1 251 H J0878 Y Y 04/07/2025 52.00 36.40 45.76 28.08 28.08 471 901 FEXOFENADINE (ALLEGRA) 180 MG 4710901 00904705060 GR 180 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 904 DEXTROSE 5% & 45% NS 1000 4710904 00990792609 UN 1 636 H J7042 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 915 PIPERACILLIN/TA 3.375GM 4710915 64679005601 GR 1 250 H J2543 Y Y 07/01/2025 328.00 229.60 288.64 177.12 177.12 471 925 "KETAMINE, 10 ML VIAL( 50 MG)" 4710925 00143950810 ML 1 250 H J3490 Y Y 07/01/2025 205.00 143.50 180.40 110.70 110.70 471 946 IV SOL DEX5%/NACL 9 500 ML=1 UNIT 4710946 00990794109 UN 2 636 H J7042 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 995 KINRIX(DTAP-IPV) 4-6 Y/O 4710995 58160081211 UN 1 250 C 90696 Y Y 01/01/2000 157.58 110.31 138.67 85.09 85.09 471 999 POTASSIUM CHLORIDE 20 MEQ POWDER 4710999 6021916173 UN 1 250 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 1000 ZINC; 220 MG 4711000 49035881 ME 1 250 N Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 1010 SODIUM CHLORIDE 100 ML 4711010 00338055318 UN 1 250 H J7050 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 1011 THIAMINE 100MG 4711011 48433010801 ME 1 250 H J8499 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 471 1012 SILVADENE 1% 20GM 4711012 250 H A6250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 1025 DEXAMETHASONE IM/IV 1 MG 4711025 00633230165 ME 1 250 H J1100 Y Y 07/01/2025 93.00 65.10 81.84 50.22 50.22 471 1050 METHYLPRED/ACETA 40MG/1CC 4711050 00703003104 ME 250 H J1030 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 471 1055 INFUSION BUTTERFLY ALL SZ 4711055 270 H A9270 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 471 1068 METHYLPRED/DEPRO 80MG/1ML 4711068 00009347503 UN 1 250 H J1010 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 471 1086 MEDROXY-PROGEST(MEDI-CAL) 4711086 250 H J3490 Y Y 07/01/2025 336.00 235.20 295.68 181.44 181.44 471 1111 DOPAMINE 400MG/250ML 4711111 00143925425 ME 1 250 Y Y 07/01/2025 27.00 18.90 23.76 14.58 14.58 471 1142 IV REGULATOR DIAL-A-FLO 4711142 272 Y Y 07/04/2019 39.00 27.30 34.32 21.06 21.06 471 1183 PHENYTOIN CAP 100 MG 4711183 00071036232 UN 1 250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 1233 BELLADONA ALKA/PHENO ELIX16.2MG/5M 4711233 59212042304 ME 1 251 H J3590 Y Y 07/01/2025 56.00 39.20 49.28 30.24 30.24 471 1266 DOPAMINE HCL PRMX IV400MG 4711266 00409780922 UN 1 258 C 90784 Y Y 07/01/2025 155.00 108.50 136.40 83.70 83.70 471 1276 ONDANSETRON HCL 1MG IM/IV 4711276 00173044202 ME 1 250 H J2405 Y Y 07/01/2025 45.75 32.03 40.26 24.71 24.71 471 1381 EPINEPHRINE 1MG IV 1:10000 4711381 00409490118 UN 1 250 H J0169 Y Y 07/01/2025 157.00 109.90 138.16 84.78 84.78 471 1405 ETOMIDATE 2MG/10ML 4711405 00409669502 UN 1 250 H J3490 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 1407 ERYTHROMYCIN OPTH 3.5GM 4711407 17478007035 UN 1 250 H J3490 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 471 1449 IV EXTENSION SET 4711449 272 H S1015 Y Y 07/04/2019 12.00 8.40 10.56 6.48 6.48 471 1450 DOUBLE LEAD EXT. SET 4711450 272 H S1015 Y Y 07/04/2019 31.00 21.70 27.28 16.74 16.74 471 1456 FERROUS SULFATE 4711456 00143212601 UN 1 251 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 1464 METRONIDAZOLE/FLAGYL 500 4711464 00025183150 ME 1 250 H J3490 Y Y 07/01/2025 350.00 245.00 308.00 189.00 189.00 471 1472 METRONIDAZOLE TAB 250MG 4711472 00904715661 UN 1 250 H J3490 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 1480 FLEETS ENEMA/SOD PHOSPHAT 4711480 00132020140 UN 1 257 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 1485 FLEETS BUFFERED SALINE 4711485 0536741551 ML 257 H Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 1506 FOLIC ACID TAB 1MG 4711506 079854512816 ME 1 251 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 1571 GENTAMYCIN IM/IV 80MG 4711571 00409120703 UN 1 250 H J1580 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 471 1597 GLUCAGON 1MG INJ 4711597 00597026010 UN 1 251 H J0610 Y Y 02/23/2023 422.00 295.40 371.36 227.88 227.88 471 1605 GLYCERINE SUPP ADULT 4711605 00713010126 UN 1 251 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 1639 HALPERIDOL IM/IV 5MG 4711639 00045025501 UN 1 250 H J1630 Y Y 07/01/2025 126.00 88.20 110.88 68.04 68.04 471 1654 HEPARIN SOD FLUSH 100U/ML 4711654 08290306424 UN 1 250 H J1642 Y Y 07/01/2025 59.00 41.30 51.92 31.86 31.86 471 1655 INJ HEPRARIN SOD LOCK FLUSH 10U/ML 4711655 08290306414 UN 1 250 H J1642 Y Y 04/01/2025 3.00 2.10 2.64 1.62 1.62 471 1656 NOREPINEPHRINE SD I MG/ML 4711656 65145013310 ME 1 250 H J3490 Y Y 04/01/2025 27.00 18.90 23.76 14.58 14.58 471 1657 DOPAMINE HCL 40MG/ML 4711657 00143925425 ME 1 250 H J1265 Y N 04/01/2025 28.00 19.60 24.64 15.12 15.12 471 1662 "HEPARIN IV DRIP PER 1,000 UNITS" 4711662 25021040201 UN 1 250 H J1644 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 471 1704 HYDROCORTIZONE CREAM 1% 4711704 00168001531 UN 1 257 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 1705 HYDROCORTISONE 20 MG TABLET 4711705 59762007501 ME 1 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 1712 HYDROCORTISONE 250MG/ML 4711712 00009001305 UN 1 250 H J1720 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 471 1775 PHENTOLAMINE IM/IV 5 MG 4711775 68094010120 ME 1 250 H J2760 Y Y 01/26/2026 744.00 520.80 654.72 401.76 401.76 471 1780 PHENOBARBITAL 30MG TAB 4711780 50268065415 ME 1 250 H J2560 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 1785 XEOMIN - BOTOX 50 UNIT VIAL 4711785 0259160501 UN 1 250 H J0585 Y Y 07/01/2025 "1,072.00" 750.40 943.36 578.88 578.88 471 1795 INFUSION BUTTERFLY ALL SZ 4711795 272 H A4215 Y Y 07/04/2019 12.00 8.40 10.56 6.48 6.48 471 1899 DIPHENHYDRA ELIX DOSE 5ML 4711899 50383058104 ML 1 250 H Q0163 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 1928 IV STARTER KIT 4711928 272 Y Y 07/04/2019 22.00 15.40 19.36 11.88 11.88 471 1930 IV TUBING PEDIATRIC 4711930 272 H X7700 Y Y 07/04/2019 45.00 31.50 39.60 24.30 24.30 471 1931 IV TUBING NON-VENTED 4711931 272 H A4222 Y Y 07/04/2019 38.00 26.60 33.44 20.52 20.52 471 1933 IV TUBING-EXTENSION SET 4711933 272 H S1015 Y Y 07/04/2019 59.00 41.30 51.92 31.86 31.86 471 1936 IV INFUSION SET 4711936 272 H Y Y 07/04/2019 41.00 28.70 36.08 22.14 22.14 471 1940 BLOOD DRAW KIT 4711940 270 Y Y 07/04/2019 45.00 31.50 39.60 24.30 24.30 471 1985 CEPHALEXIN CAP 250 MG 4711985 52959003001 UN 1 250 H J8499 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 1986 CEPHALEXIN (KEFLEX) 500 MG 4711986 50268015215 ME 1 250 H J0690 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 1987 VRAYLAR (CARIPRAZINE) 1.5 MG 4711987 61874-115-30 ME 1 250 H J8499 Y Y 07/01/2025 66.00 46.20 58.08 35.64 35.64 471 1991 AZITHROMYCIN 500MG TAB ZITHROMAZ;G 4711991 00781809131 UN 1 250 H Q0144 Y Y 07/01/2025 86.00 60.20 75.68 46.44 46.44 471 2009 ACETAMINOPHEN LIQUID 325MG/10.15ML 4712009 00904673971 ME 257 H A9150 Y Y 07/01/2025 49.00 34.30 43.12 26.46 26.46 471 2010 ACETAMINOPHEN INFANT DROP 4712010 00904198500 ML 1 257 H A9150 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2025 TRIAMCINOLONE 10 MG 4712025 70121104905 ME 4 250 H J3301 Y Y 07/01/2025 36.00 25.20 31.68 19.44 19.44 471 2058 IV SOL LAC RNGRS 1000 ML 4712058 00409795309 UN 1 258 H J7120 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 2074 DIGOXIN .5MG/2ML 4712074 00173026010 UN 1 250 H J1160 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 471 2082 DIGOXIN TAB 125 MCG 4712082 00081024275 UN 1 250 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 2083 NOREPINEPHRINE 4MG 250 ML IV SOL 4712083 44567064010 UN 1 250 Y Y 07/01/2025 100.00 70.00 88.00 54.00 54.00 471 2090 FUROSEMIDE TAB 20 MG 4712090 00039006710 ME 20 251 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 471 2111 ACTIDOSE-AQUA 4712111 305740121764 250 H Y Y 07/01/2025 193.00 135.10 169.84 104.22 104.22 471 2116 FUROSEMIDE IM/IV 1MG 4712116 03600028225 ME 1 250 H J1938 Y Y 01/16/2026 5.65 3.96 4.97 3.05 3.05 471 2119 LOPERAMIDE 2MG 4712119 00093031101 UN 1 250 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2127 LIDOCAINE 2% 100 MG/ML 4712127 6332348627 ME 250 H J2001 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 2157 MAALOX DOSE 4712157 00904000414 UN 1 257 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 471 2165 CITRATE OF MAGNESIA 4712165 37205011038 UN 1 257 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2173 MAGNESIUM SULF 50% 1GM 4712173 63323006402 GR 1 250 H J3475 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 471 2181 MANNITOL 25% 12.5GM 4712181 00409403101 UN 1 250 H J2150 Y Y 07/01/2025 153.00 107.10 134.64 82.62 82.62 471 2195 BUPIVACAINE HCL .25% IM 10 ML VIAL 4712195 00074115901 UN 1 250 H J3490 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 2250 HYDROGEN PEROXIDE 120ML 4712250 37205087134 UN 1 257 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 471 2272 GLYBURIDE/METFORMIN 5/500 4712272 0904668961 ME 250 H Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 471 2280 MILK OF MAGNESIA DOSE 4712280 00904078816 UN 1 257 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2290 SIMETHICONE 80MG TAB 4712290 51645086001 UN 1 257 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2305 GENTAMYCIN SULFATE OPTH 4712305 17478028312 UN 1 250 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 471 2306 MORPHINE SULF IM/IV 10MG 4712306 00641612725 UN 1 250 H J2270 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 471 2307 PHENOBARBITAL 65MG/ML 4712307 54288013610 UN 1 250 Y Y 07/01/2025 124.00 86.80 109.12 66.96 66.96 471 2308 IRRIG ST H2O 250ML 4712308 272 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2309 THERA M PLUS 4712309 00904549261 UN 1 257 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 2310 SOD CHL .9% 500ML IRRIGATION 4712310 00264220110 272 H A4217 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 2314 IBUPROFEN TAB 200 MG 4712314 00904791461 ME 1 257 H J3490 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2360 IRRIG ST H2O 500ML 4712360 00264210110 UN 1 272 Y Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 471 2397 "NORMAL SALINE SOL, INFUSION 1000 C" 4712397 00409798309 UN 1 250 H J7030 Y Y 07/01/2025 260.00 182.00 228.80 140.40 140.40 471 2405 IV SOL SOD CHL .9% 250 ML 4712405 00409710102 UN 1 250 H J7050 Y Y 07/01/2025 230.00 161.00 202.40 124.20 124.20 471 2413 INJ SOD CHL .45% 1000ML 4712413 00338004304 ML 258 H Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 471 2439 IV SOL SOD CHL .9% 500 ML 4712439 00409798303 UN 1 250 H J7040 Y Y 07/01/2025 241.00 168.70 212.08 130.14 130.14 471 2447 SOD CHL .9% 100ML 4712447 00409798423 ML 1 250 H J7040 Y Y 07/01/2025 140.00 98.00 123.20 75.60 75.60 471 2454 NALOXONE 0.4MG/ML 4712454 00409178269 UN 1 250 H J2310 Y Y 07/01/2025 213.00 149.10 187.44 115.02 115.02 471 2475 DIAZEPAM AMP 10MG/2ML 4712475 00409127332 ME 250 H J3360 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 471 2488 NIFEDIPIN TAB 10MG 4712488 43386044024 ME 1 250 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 2500 CITRACAL-D CAPLET 4712500 016500535072 257 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 2504 NITROGLYCERINE 2% OINT DS 4712504 00281032608 UN 1 250 H Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 471 2512 NITROGLYCERIN TAB 0.4 MG 4712512 59762330403 UN 1 250 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2518 ACETYLCYSTEINE 20% 30ML 4712518 00409330703 ME 1 250 H J7608 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 471 2520 VECURONIUM IV 20 MG 4712520 63323078110 ME 250 H Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 471 2525 SUMATRIPTEN SUCCINATE 6 MG 4712525 00173044902 ME 1 252 H J3030 Y Y 07/01/2025 385.00 269.50 338.80 207.90 207.90 471 2548 PANTOPRAZOLE 40MG IV 4712548 00008092355 UN 1 251 H J2470 Y Y 07/01/2025 366.00 256.20 322.08 197.64 197.64 471 2589 ERTAPENEM 500MG 4712589 60505619604 ME 250 H J1335 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 471 2595 PEDIALYTE 1 BTL 4712595 70074080336 UN 1 257 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 2600 FERROUS SULF/ELIX 1 PINT 4712600 00839537669 UN 1 251 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 471 2629 PENICILLIN VK SUSP BTL 4712629 00182027673 UN 1 250 Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 471 2630 FIBERCON 625 MG TAB 4712630 257 Y Y 07/04/2019 10.00 7.00 8.80 5.40 5.40 471 2635 AZITHROMYCIN 250MG TAB 4712635 59762306003 UN 1 250 H Q0144 Y Y 07/01/2025 65.00 45.50 57.20 35.10 35.10 471 2636 AZITHROMYCIN 500MG IV 4712636 63323039814 UN 1 250 H J0456 Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 471 2637 PENICILLIN V TAB 250 MG 4712637 00781120501 UN 1 250 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 2640 IPOL 4712640 49281086010 UN 1 250 C 90713 Y Y 07/01/2025 153.00 107.10 134.64 82.62 82.62 471 2652 FAMOTIDINE IM/IV 20 MG 4712652 63323073912 UN 1 250 H S0028 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 471 2678 BISMUTH DOSE 4712678 37000003202 UN 1 257 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 2728 PROMETHAZINE IM/IV 25MG 4712728 00641149531 UN 1 250 H J2550 Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 471 2734 PROMETHAZINE SUPP 25MG 4712734 00574723412 UN 1 250 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 2736 PROMETHAZINE W/COD ELIX 4712736 00472162704 UN 1 250 H J8597 Y Y 07/01/2025 57.00 39.90 50.16 30.78 30.78 471 2769 IV SET PRIMARY NON-VENTED 4712769 272 Y Y 07/04/2019 13.00 9.10 11.44 7.02 7.02 471 2777 IV PIGGYBACK SECONDARY 4712777 272 H S1015 Y Y 07/04/2019 12.00 8.40 10.56 6.48 6.48 471 2783 LIDOCAINE 1% W/EPI 4712783 63323048227 UN 1 250 H J3490 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 471 2785 OXYTOCIN 10U/ML 4712785 61570041605 UN 1 250 H J2590 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 2801 TUBERCULIN PURIFD PROTEIN 4712801 42023010401 UN 1 250 C 86580 Y Y 07/01/2025 89.00 62.30 78.32 48.06 48.06 471 2819 PREDNISONE TAB 10MG 4712819 00904692361 ME 10 250 H J7512 Y Y 07/01/2025 30.00 21.00 26.40 16.20 16.20 471 2876 ALBUTEROL INHALER 8 GM 4712876 00173068224 UN 1 250 H J3535 Y Y 07/01/2025 134.00 93.80 117.92 72.36 72.36 471 2884 ALBUTEROL INHAL SOL 1MG AMPULES 4712884 47335070352 UN 1 250 H J7613 Y Y 07/01/2025 21.00 14.70 18.48 11.34 11.34 471 2891 AZITHROMYCIN 30 ML SUSP 4712891 00093202631 UN 1 250 H Q0144 Y Y 07/01/2025 230.00 161.00 202.40 124.20 124.20 471 2892 PHENAZOPYRIDINE TAB 100MG 4712892 68084029201 UN 1 250 H J8499 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 2942 METOCLOPRAMIDE REGLAN 5MG 4712942 63739010310 UN 1 250 H J2765 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 471 2959 METOCLOPRAMIDE REGL 10 MG 4712959 51079028301 UN 1 250 H J2765 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 2983 GUAIFENESIN/DEXTRONETHORP 4712983 71399002408 ME 257 Y Y 07/01/2025 22.00 15.40 19.36 11.88 11.88 471 2985 CEFTRIAXONE IM/IV 250MG 4712985 00409733701 UN 1 250 H J0696 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 471 2991 CEFTRIAXONE SOD PER 250 MG 4712991 00781932895 ME 4 250 H J0696 Y Y 07/01/2025 350.00 245.00 308.00 189.00 189.00 471 2992 OLANZAPINE 2.5 MG TAB 4712992 55111026281 ME 1 250 H J8499 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 3031 SULFA/TRIMETH TAB 800MG 4713031 51079012820 UN 1 250 H J8499 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 471 3051 SILVER SULFADIAZINE 1%/25 GR CREAM 4713051 6157013125 UN 250 J3590 Y Y 07/01/2025 45.00 31.50 39.60 24.30 24.30 471 3052 SILVER SULFADIAZINE 50GM 4713052 08880950540 UN 1 250 H J3590 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 471 3064 SILVER NITRATE STICK 4713064 12870000101 UN 1 250 H J3490 Y Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 471 3080 POTASSIUM CHLOR TAB 20MEQ 4713080 00904729361 UN 1 250 H J3490 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 3120 SOD POLYSTYR SULF/SUS 15G 4713120 00054881611 UN 1 250 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 471 3130 METHYLPRED/SOLUMED 125MG 4713130 43598012925 UN 25 250 H J2919 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 3136 MULTI VITAMIN TAB 4713136 96295012782 UN 1 257 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 3148 METHYLPRED/SOLUMED 1 GM 4713148 00009069801 UN 1 250 H Y Y 07/01/2025 460.00 322.00 404.80 248.40 248.40 471 3171 THREE-WAY STOPCOCK 4713171 270 D 07/04/2019 57.00 39.90 50.16 30.78 30.78 471 3190 ROCURONIUM 50ML/5 ML 4713190 63323042610 ML 1 250 H J0330 Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 471 3211 ACYCLOVIR INJ 5 MG 4713211 55150015410 UN 100 250 H J0133 Y Y 07/01/2025 56.00 39.20 49.28 30.24 30.24 471 3212 SULFACETAMIDE/PRED 10%/.23% BLEPH1 4713212 2420831705 ML 1 250 H J3490 Y Y 07/01/2025 49.00 34.30 43.12 26.46 26.46 471 3213 SULFACETAMIDE OPTH SOL 4713213 24208067004 UN 1 250 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 471 3218 LEVOFLOXACIN IV 500 MG 4713218 00045006801 UN 1 250 H J1956 Y Y 07/01/2025 425.00 297.50 374.00 229.50 229.50 471 3219 LEVAQUIN PREMX 750M/150ML 4713219 00045006601 UN 1 258 Y Y 07/01/2025 596.00 417.20 524.48 321.84 321.84 471 3220 LEVAQUIN 750MG TABS 4713220 50458093010 UN 1 250 H Z7610 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 471 3221 LEVETIRACETAM (KEPPRA) 500 MG TAB 4713221 50474059866 ME 1 251 H J8499 Y Y 07/01/2025 39.00 27.30 34.32 21.06 21.06 471 3222 LEVOFLOXACIN 500MG TABS 4713222 50458092510 UN 1 250 H J8499 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 471 3223 LEVETIRACETAM(KEPPRA)10 ML (500MG) 4713223 39822400001 ML 10 636 H J1953 Y Y 07/01/2025 512.00 358.40 450.56 276.48 276.48 471 3224 LEVETIRACETAM 1000MG/100ML IVPB 4713224 05515024747 ML 1 250 H Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 471 3247 CARBAMAZEPINE TAB 100 MG 4713247 00083002730 UN 1 250 Y Y 07/02/2020 23.00 16.10 20.24 12.42 12.42 471 3254 TERBUTALINE IM/IV 1MG/ML 4713254 00703127104 UN 1 636 H J3105 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 471 3261 ATROPINE SULFATE OPTH SOL 1% 2ML 4713261 60219174802 250 Y Y 12/25/2023 0.00 - - - - 471 3262 DIPTH/TET >7 YRS+ 0.5ML 4713262 13533013101 ML 250 C 90714 Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 471 3290 DILTIAZEM 30 MG TAB 4713290 51079074520 UN 1 250 H Y Y 07/01/2025 87.00 60.90 76.56 46.98 46.98 471 3296 DIPTH/TET->7 YRS 0.5ML 4713296 17478013010 ML 250 C 90702 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 471 3320 THERAPEUTIC-M TAB 4713320 096295127829 257 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 471 3338 THIAMINE IM/IV 100MG/DOSE 4713338 63323001302 UN 1 250 H J3411 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 471 3379 KETOROLAC/TORADOL 15MG/30MG 4713379 00338007225 ME 15 251 H J1885 Y Y 07/01/2025 80.00 56.00 70.40 43.20 43.20 471 3435 FLEETS ENEMA-MINERAL OIL 4713435 00132030140 UN 1 257 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 3437 ACETAMINOPHEN SUPP 120 MG 4713437 45802073232 UN 1 257 H A9150 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 471 3445 ACETAMINOPHEN SUPP 325MG 4713445 00713016412 UN 1 257 H A9150 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 3452 ACETAMINOPHEN TAB 325MG 4713452 00182014101 UN 1 257 H J8499 Y Y 07/01/2025 25.00 17.50 22.00 13.50 13.50 471 3478 ACETAMINOPHEN ELIX 5ML 4713478 00904198500 ML 5 257 H A9150 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 3486 ACETAMINOPHEN W/COD TAB 4713486 00406048462 UN 1 250 H J8499 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 3494 ACETAMINOPHEN W/COD ELIX 4713494 0121050405 ME 1 250 H J8499 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 3502 DIAZEPAM TAB 2 MG 4713502 00140004001 UN 1 250 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 471 3515 ENOXAPARIN LOVENOX 100MG 4713515 00075062300 UN 1 250 H J1650 Y Y 07/01/2025 548.00 383.60 482.24 295.92 295.92 471 3518 ENOXAPARIN LOVENOX 40MG 4713518 00075062040 UN 1 250 H J1650 Y Y 07/01/2025 302.00 211.40 265.76 163.08 163.08 471 3525 PROPRANOLOL IV 1MG AMPS 4713525 00143987201 ME 250 H J1800 Y Y 07/01/2025 130.00 91.00 114.40 70.20 70.20 471 3526 PROPRANOLOL HCL(INDERAL)20 MG TAB A9150 00115-1660-0 ME 1 251 H A9150 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 3535 MEASLES/MUMPS/RUBELLA VAC 4713535 0006468100 ME 250 C 90707 Y Y 07/01/2025 341.00 238.70 300.08 184.14 184.14 471 3541 CLOPIDOGREL PLAVIX 75 MG 4713541 63653117105 ME 75 250 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 3551 VANCOMYCIN 500 MG 4713551 67457034001 ME 2 250 H J3370 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 471 3554 RABIES VACCINE 4713554 250 H X5344 Y Y 07/04/2019 709.00 496.30 623.92 382.86 382.86 471 3555 METFORMIN HYDROCHLO 500MG 4713555 51079097220 UN 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 3569 ENALAPRIL MALEATE TAB 5MG 4713569 51079095101 UN 1 251 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 3577 VENI-GARD IV DRESS ADULT 4713577 272 Y Y 07/04/2019 8.00 5.60 7.04 4.32 4.32 471 3590 NORMAL SALINE IRR 500CC 4713590 250 Y Y 12/08/2023 0.00 - - - - 471 3594 POTASSIUM 20MEQ/100ML 4713594 00338070548 ML 250 H J3480 Y Y 07/01/2025 171.00 119.70 150.48 92.34 92.34 471 3595 POTASSIUM PER2 MEQ/1000ML 4713595 00338080304 ML 250 H J3480 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 3598 NORMAL SALINE 0.45%/1000 CC 4713598 00409798509 ML 1000 250 H J7030 Y Y 07/01/2025 260.00 182.00 228.80 140.40 140.40 471 3619 VERAPAMIL HCL AMP 5 MG 4713619 51754020302 ME 250 H Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 471 3627 DOXYCYCLINE CAP 100 MG 4713627 00143314225 UN 1 250 H J8499 Y Y 07/01/2025 38.00 26.60 33.44 20.52 20.52 471 3668 HYDROXYZINE HCL IM 100MG 4713668 00517560225 ME 250 H Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 471 3684 VITAMIN E CAP 4713684 00904027460 F2 1 257 H A9152 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 3692 PHYTONADIONE VIT/K 10 MG 4713692 00409915801 UN 1 250 H J3430 Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 471 3700 CYANOCOBALAMIN 1000 MCG/ML 4713700 00517003125 UN 1 250 H J3420 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 471 3718 VITAMIN C 4713718 00904052361 UN 1 257 H A9152 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 3719 VITAMIN B12 500 MCG TAB 4713719 40985022309 GR 1 257 H A9152 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 3745 ZOLENDRONIC ACID 1 MG (ZOMETA) 4713745 55150026605 ME 4 250 D J3489 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 471 3746 XOPENEX 1.25MG/0.5ML 4713746 17478017424 ML 250 H J7614 Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 471 3767 LIDOCAINE 1% 20 ML INJECT 4713767 00186011001 UN 1 250 H J2001 Y Y 07/01/2025 104.00 72.80 91.52 56.16 56.16 471 3889 CHLORDIAZEPOXIDE 5 MG TAB (LIBRIUM 4713889 00555015802 250 H J8499 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 3890 HYDROCODONE 5 MG/APAP TAB 4713890 58016066290 UN 1 250 H J8499 Y Y 07/01/2025 42.00 29.40 36.96 22.68 22.68 471 3891 CHLORDIAZEPOXIDE 10 MG TAB(LIBRIUM 4713891 00555003302 ME 250 H J8499 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 3892 CEFTAZIDIME 1 GM (FORTAZ) 4713892 44567-023525 GR 250 H J0713 Y Y 07/01/2025 188.00 131.60 165.44 101.52 101.52 471 3893 ACETAZOLAMIDE TABS 125 MG 4713893 23155-028701 ME 1 250 H J8499 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 471 3894 CHLORDIAZEPOXIDE/LIBRIUM 25 MG 4713894 51079014120 UN 1 250 C J1990 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 471 3908 MIDAZOLOM IM/IV 5 MG 4713908 00409230550 UN 1 250 H J2250 Y Y 07/01/2025 111.00 77.70 97.68 59.94 59.94 471 3916 LIDOCAINE D5W PRMX IV 2GM 4713916 00264959410 UN 1 258 Y Y 07/01/2025 263.00 184.10 231.44 142.02 142.02 471 3918 LIDOCAINE 4% PATCHES 4713918 00536120207 UN 04 250 H C9285 N Y 07/01/2025 3.00 2.10 2.64 1.62 1.62 471 3966 COLLAGENASE (SANTYL) 30 GM 4713966 50484001030 UN 1 250 H J3590 Y Y 07/01/2025 503.00 352.10 442.64 271.62 271.62 471 3967 LIDOCANE TOP/SOL 4% 50ML 4713967 00054350547 UN 1 250 H J3490 Y Y 07/01/2025 98.00 68.60 86.24 52.92 52.92 471 3968 WATER STERILE INJ 10ML 4713968 00074488725 UN 1 250 H A4216 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 471 4002 SODIUM BICARB PFS 4714002 00409663734 UN 1 250 H J3490 Y Y 07/01/2025 233.00 163.10 205.04 125.82 125.82 471 4004 IPRATROPIUM BROMIDE PREPK 4714004 00378797093 UN 1 251 H J7644 Y Y 07/01/2025 97.00 67.90 85.36 52.38 52.38 471 4012 ACTIVATED CHARCOL/SORBTL 4714012 00574012074 UN 1 250 Y Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 471 4024 EYE WASH 4 OZ 4714024 00065053001 UN 1 257 H A4217 Y Y 07/01/2025 77.00 53.90 67.76 41.58 41.58 471 4025 PREDISONE-PEDIATRIC ELIX 1 MG 4714025 50383004004 UN 1 250 H J7684 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 4026 TETRACAINE 4ML 4714026 00065074112 UN 1 250 H J3490 Y Y 07/01/2025 56.00 39.20 49.28 30.24 30.24 471 4045 IBUPROPHEN ELIX 100MG/5ML 4714045 00045046904 UN 1 257 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 471 4050 FLUOR-I-STRIP 4714050 24208039182 ME 1 250 H J3490 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 471 4510 NEULASTA 4714510 636 H J2505 Y Y 07/04/2019 "6,195.00" " 4,336.50 " " 5,451.60 " " 3,345.30 " " 3,345.30 " 471 4695 DTAP-HEPB IPV 4714695 58160081152 UN 1 252 C 90723 Y Y 07/01/2025 306.00 214.20 269.28 165.24 165.24 471 5050 PROTAMINE 10MG/ML 4715050 00002146201 UN 1 250 H J2720 Y Y 07/01/2025 233.00 163.10 205.04 125.82 125.82 471 5065 NITRAZINE PAPER 4715065 259 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 471 5278 BUDESONIDE 1.25 MG NEB 4715278 250 H J7634 Y Y 07/04/2019 57.00 39.90 50.16 30.78 30.78 471 5290 KETOROLAC OPTHAL 5 ML 4715290 00023218103 UN 1 250 Y Y 07/01/2025 252.00 176.40 221.76 136.08 136.08 471 5291 KETOROLAC DR 5% OPHTHALMIC 5 ML 4715291 42571013725 UN 1 251 H J3490 Y Y 10/01/2025 371.00 259.70 326.48 200.34 200.34 471 5656 PHENYTOIN SUSP DOSE 4715656 250 Y Y 07/04/2019 23.00 16.10 20.24 12.42 12.42 471 5695 FUROSEMIDE 20MG/2ML IV/IM 4715695 00186111413 UN 1 250 H J1940 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 471 5978 PNEUMOCOCCAL CONJ 20 (PCV20) IM 4715978 00005200002 UN 1 250 C 90677 N N 07/01/2025 382.00 267.40 336.16 206.28 206.28 471 6200 DILTIAZEM 125MG/25ML VIAL 4716200 0641601501 250 C J3490 Y Y 06/01/2025 580.00 406.00 510.40 313.20 313.20 471 6234 JUVEN NUTRITIONAL SUPPLEMENT 4716234 UN 250 N N 07/01/2025 15.00 10.50 13.20 8.10 8.10 471 6254 MANNITOL 20% 500 ML IV 4716254 00409771503 UN 1 636 Y Y 07/01/2025 386.00 270.20 339.68 208.44 208.44 471 6513 MENACTRA QUADRIVALENT IM 4716513 49281058905 UN 1 250 C 90734 Y Y 07/01/2025 431.00 301.70 379.28 232.74 232.74 471 6525 CALCIUM GLUCONATE 1000MG/100ML IV 4716525 44567062224 250 H J0610 Y Y 07/01/2025 0.00 - - - - 471 6548 CONDOMS 4716548 273 H A4267 Y Y 07/04/2019 10.00 7.00 8.80 5.40 5.40 471 6585 DEXTROSE/H20 10%1000MLINJ 4716585 00409793009 UN 1 250 H J3480 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 471 6859 IV SOL SOD CHL 3% 500ML 4716859 250 H J7040 Y Y 07/01/2025 258.00 180.60 227.04 139.32 139.32 471 8565 SODIUM CHL 0.9% INJ RAD 4718565 00338004938 UN 1 250 Y Y 07/01/2025 241.00 168.70 212.08 130.14 130.14 471 8575 MORPHINE SUL IM/IV 2MG PF 4718575 76045000410 UN 1 250 J2270 Y Y 07/01/2025 93.00 65.10 81.84 50.22 50.22 471 8889 TNK (TENECTEPLASE) 1MG 4718889 50242017601 ME 50 250 H J3101 Y Y 07/01/2025 318.60 223.02 280.37 172.04 172.04 471 8890 VARICELLA-PRIVATE 4718890 00006482700 252 C 90716 Y Y 07/01/2025 431.00 301.70 379.28 232.74 232.74 471 8980 CLINDAMYCIN; PHOS/D5W 4718980 7261163925 UN 1 250 H J0736 Y Y 07/01/2025 134.00 93.80 117.92 72.36 72.36 471 8991 ALPRAZOLAM;XANAX 4718991 60687038801 ME 0.5 250 Y Y 07/01/2025 4.00 2.80 3.52 2.16 2.16 471 9005 ROTAVIRUS ORAL 4719005 00006404741 UN 1 250 C 90680 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 471 9010 NOREINEPHRINE 4MG VIAL 4719010 00574085410 UN 1 250 H J0171 Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 471 9015 PANTOPRAZOLE 40MGTAB 4719015 00008084199 UN 1 250 H J8499 Y Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 471 9500 BUMETANIDE; BUMEX 4719500 68462046954 ME 1 250 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 471 9587 SYNVISC-ONE 4719587 250 H J7325 Y Y 07/04/2019 "1,001.00" 700.70 880.88 540.54 540.54 471 9637 LIDOCAINE VISCOUS 2% 15ML 4719637 00054850016 UN 1 250 Y Y 07/01/2025 69.00 48.30 60.72 37.26 37.26 471 9700 VALACYCLOVIR/ VALTREX 500MG 4719700 00904656561 UN 1 250 Y Y 07/01/2025 8.00 5.60 7.04 4.32 4.32 471 9701 ATROPIN SULFATE INJ 0.01 MG 5ML SY 4719701 70121170507 ME 50 250 H J0461 Y Y 07/01/2025 40.00 28.00 35.20 21.60 21.60 471 9702 OFLOXACIN OPHTHALMIC 4719702 1747871310 UN 1 250 N Y 07/01/2025 46.00 32.20 40.48 24.84 24.84 471 9840 LEUPROLIDE ACETATE/LUPRON 4719840 62935075375 UN 1 250 C J9217 N Y 07/01/2025 300.00 210.00 264.00 162.00 162.00 471 9875 LISINOPRIL 5MG 4719875 00006001958 UN 1 250 H J8499 Y Y 07/01/2025 25.00 17.50 22.00 13.50 13.50 471 9876 BEXSERO-MENINGOCOCCAL 0.5 4719876 46028011401 UN 1 250 C 90620 Y Y 07/01/2025 615.00 430.50 541.20 332.10 332.10 471 9877 REGEN-COV 600MG 4719877 UN 1 250 H J999 Y Y 07/01/2025 0.00 - - - - 471 9878 PRO-STAT 4719878 ML 30 257 H B4155 Y Y 07/01/2025 13.00 9.10 11.44 7.02 7.02 471 9879 ONDANSETRON 4MG 4719879 627524064 ME 1 257 C S0119 Y Y 07/01/2025 0.00 - - - - 471 9880 NORMAL SALINE 0.9% 250 ML 4719880 ML 250 250 H J7050 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 471 9881 MICONAZOLE 2% ANITFUNGAL POWDER 4719881 00316022515 250 Y Y 07/01/2025 0.00 - - - - 471 9882 AMIODARONE HCL 50 MG/18 ML SGL DOS 4719882 67457015318 ME 1 251 H J0282 Y Y 06/01/2021 51.00 35.70 44.88 27.54 27.54 471 9883 DEXTROSE/WATER 5% 500 ML 4719883 00264751010 ME 2 262 H J7060 Y Y 06/01/2017 16.00 11.20 14.08 8.64 8.64 471 9885 RITUXAN INTRAVENOUS 10MG/ 10 ML 4719885 ML 10 250 C J9312 Y Y 07/01/2025 "2,075.00" " 1,452.50 " " 1,826.00 " " 1,120.50 " " 1,120.50 " 471 9887 BENZONATATE 100 MG GELCAP 4719887 68084021401 UN 250 Y Y 07/01/2025 14.00 9.80 12.32 7.56 7.56 471 9888 BALFAXAR POWDER VIAL PER UNIT 4719888 68982026102 UN 1 636 H J7165 Y Y 07/10/2017 4.00 2.80 3.52 2.16 2.16 471 9889 DEXAMETHASONE SOD10MG/ML M/V 4719889 63323051610 ME 1 250 H J1100 Y Y 07/10/2017 7.00 4.90 6.16 3.78 3.78 471 9890 GENTAMICIN S 0.3% 5ML OPHTHALMIC 4719890 61314063305 UN 1 250 H J3490 Y Y 01/01/2017 20.00 14.00 17.60 10.80 10.80 471 9891 DONEPEZIL HC 10 MG 4719891 00904647861 UN 1 251 H J8499 Y Y 07/01/2025 0.36 0.25 0.32 0.19 0.19 471 9892 DAKINS SOL 0.125% 16 OZ WOUND CLEA 4719892 00436067216 UN 1 259 H A6260 Y Y 07/01/2025 72.00 50.40 63.36 38.88 38.88 471 9893 POTASSIUM CHLORIDE PER 2 MEQ/L 4719893 00990711509 ML 1000 636 H J3480 Y Y 01/01/2026 10.00 7.00 8.80 5.40 5.40 471 9894 MORPHINE SF 4 MG/ML S/D PF 4719894 623323045401 ME 4 251 H J2272 Y Y 02/01/2026 17.00 11.90 14.96 9.18 9.18 471 9895 POTASSIUM CL/NS IP 20MEQ/L 1000 4719895 00990711509 ML 1000 636 H J3480 Y Y 01/01/2026 43.00 30.10 37.84 23.22 23.22 471 9999 MISC DRUG 4719999 250 H J8499 Y Y 07/01/2025 0.00 - - - - 472 1 ABG DRAW KIT 4720001 410 Y Y 07/01/2025 284.00 198.80 249.92 153.36 153.36 472 2 NIV ADULT FULL FACE MASK CPAP 4720002 UN 1 270 H A7030 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 472 3 CONT'S INHAL. TRMT AER. MED. 1ST H 4720003 UN 1 412 C 94644 Y Y 07/01/2025 222.00 155.40 195.36 119.88 119.88 472 35 AEROSOL MOUTHPIECE/TUBING 4720035 270 A7016 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 472 43 AEROSOL MASK ADULT 4720043 270 H A4620 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 92 INHALATION TREATMENT 4720092 410 C 94640 Y Y 07/01/2025 308.00 215.60 271.04 166.32 166.32 472 93 INHALATION TX-EA ADDTL HR 4720093 410 C 94645 Y Y 07/01/2025 244.00 170.80 214.72 131.76 131.76 472 100 AEROSOL W02/HR 4720100 410 H A4618 Y Y 07/01/2025 13.00 9.10 11.44 7.02 7.02 472 142 ENDOTRACH TUBE HOLDER 4720142 270 H A7526 Y Y 07/01/2025 97.00 67.90 85.36 52.38 52.38 472 175 NEBULIZER MOUTHPIECE/TUBING 4720175 270 H A7016 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 209 SPIROMTR VOLUM EXERCISER 4720209 410 H A9284 Y Y 07/01/2025 48.00 33.60 42.24 25.92 25.92 472 217 INCEN SPIRO TX 4720217 469 Y Y 04/20/2024 0.00 - - - - 472 218 PLETHYSMOGRAPHY 4720218 469 C 94750 Y Y 07/02/2020 41.00 28.70 36.08 22.14 22.14 472 225 AEROSOL HOLDING CHAMBER 4720225 271 H A4618 Y Y 07/01/2025 113.00 79.10 99.44 61.02 61.02 472 332 MASK NON-REBREATHER ADULT 4720332 270 Y Y 07/01/2025 26.00 18.20 22.88 14.04 14.04 472 334 MASK-PEDS NONREBREATHER 4720334 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 338 "MASK, PARTIAL REBREATHER" 4720338 270 Y Y 07/01/2025 34.00 23.80 29.92 18.36 18.36 472 365 "NASOPHARNAGEAL AIRWAY,ALL" 4720365 410 H A4615 Y Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 472 373 DO NOT USE THIS CODE 4720373 460 C 94760 Y Y 01/01/2000 0.00 - - - - 472 375 OXYGEN SAT -MULTIPLE DETERMINATION 4720375 460 C 94761 Y Y 07/01/2025 54.00 37.80 47.52 29.16 29.16 472 381 "CANNULA, NASAL ADULT" 4720381 270 H A4615 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 385 E-Z WRAP 4720385 271 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 399 OXYGEN SUPPLY TUBING 4720399 271 H A4616 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 407 STERILE H20 INHALER/HUMID 4720407 270 H E0550 Y Y 07/01/2025 32.00 22.40 28.16 17.28 17.28 472 415 OXYGEN MASK ADULT 4720415 270 H A7015 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 423 OXYGEN THERAPY PER DAY 4720423 270 C 99070 Y Y 07/01/2025 503.00 352.10 442.64 271.62 271.62 472 449 PEAK FLOW TX 4720449 460 C 94060 Y Y 07/01/2025 313.00 219.10 275.44 169.02 169.02 472 456 PEAK FLOW METER/ADULT 4720456 271 H A4614 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 472 459 PEAK FLOW METER-PED 4720459 460 C 94250 Y Y 07/02/2020 72.00 50.40 63.36 38.88 38.88 472 472 PERCUSSION-INITIAL 4720472 410 C 94667 Y Y 07/01/2025 155.00 108.50 136.40 83.70 83.70 472 474 PERCUSSION-SUBSEQUENT 4720474 410 C 94668 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 472 498 PFT SIMPLE 4720498 460 C 94010 Y Y 07/01/2025 306.00 214.20 269.28 165.24 165.24 472 550 O2 SAT MILTIPLE DERM 4720550 410 C 94761 Y Y 07/01/2025 205.00 143.50 180.40 110.70 110.70 472 560 RESUSCITATOR-ADULT 4720560 270 Y Y 07/01/2025 162.00 113.40 142.56 87.48 87.48 472 565 RESUSCITATOR-CHILD 4720565 270 Y Y 07/01/2025 267.00 186.90 234.96 144.18 144.18 472 1518 VENTILATOR 4721518 450 C 94002 Y Y 07/01/2025 660.00 462.00 580.80 356.40 356.40 472 2506 "MASK, PARTICULATE" 4722506 270 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 3017 EZ CAP CO2 DETECTOR 4723017 270 Y Y 07/01/2025 134.00 93.80 117.92 72.36 72.36 472 5109 ST. SPUTUM SUCTION 4725109 460 C 94664 Y Y 07/01/2025 134.00 93.80 117.92 72.36 72.36 472 5125 TRACH MASK ADULT 4725125 270 H A7525 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 472 5208 MULTI-VENT AIR ENT MASK 4725208 270 H A4620 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 472 5216 O2 PORTABLE USE 4725216 270 C 99070 Y Y 07/01/2025 124.00 86.80 109.12 66.96 66.96 472 5240 SPECIMEN TRAP 4725240 270 C 94664 Y Y 07/01/2025 134.00 93.80 117.92 72.36 72.36 472 5257 PED TRACH MASK 4725257 270 H A7525 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 472 5265 "CANNULA, NASAL-PED" 4725265 270 H A4615 Y Y 07/01/2025 37.00 25.90 32.56 19.98 19.98 472 5273 PED AEROSOL MASK 4725273 270 H A4620 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 472 5281 PED 02 MASK 4725281 270 H A4620 Y Y 07/01/2025 24.00 16.80 21.12 12.96 12.96 472 6230 CPAP CIRCUIT 4726230 291 C E0601 Y Y 07/01/2025 485.00 339.50 426.80 261.90 261.90 472 6236 NEBULIZER TREATMENT 4726236 412 C 94640 Y Y 07/01/2025 222.00 155.40 195.36 119.88 119.88 472 6242 SOFT-SEAL MASK SM 4726242 450 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 472 6245 SOFT-SEAL MASK LG 4726245 450 Y Y 07/01/2025 140.00 98.00 123.20 75.60 75.60 472 6586 NEBULIZOR W/MASK 4726586 270 Y Y 07/01/2025 29.00 20.30 25.52 15.66 15.66 472 7015 DISPOSABLE TUBING 4727015 270 H A7010 Y Y 07/01/2025 16.00 11.20 14.08 8.64 8.64 476 1 MINOR OP PROCEDURE 4760001 UN 1 761 C 20611 Y Y 07/01/2025 160.00 112.00 140.80 86.40 86.40 476 2 MINOR OP PROCEDURE 4760002 UN 1 761 C 20610 Y Y 04/20/2024 160.00 112.00 140.80 86.40 86.40 476 3 US GUIDANCE NEEDLE PLACEMENT 4760003 UN 1 402 C 76942 Y Y 07/01/2025 617.00 431.90 542.96 333.18 333.18 476 4 SI JOINT INJ ANESTH W/US GUIDANCE 4760004 UN 1 761 C 64451 Y Y 07/01/2025 54.00 37.80 47.52 29.16 29.16 476 5 TRIGGER POINT INJ 3+ MUSCLES 4760005 UN 1 761 C 20553 Y Y 04/20/2024 457.00 319.90 402.16 246.78 246.78 476 6 REGENERATIVE MEDICINE SUPPLIES 4760006 UN 1 272 C 99070 Y Y 07/01/2025 0.00 - - - - 476 7 NITROUS OXIDE 4760007 UN 1 379 H D9230 Y Y 07/01/2025 150.00 105.00 132.00 81.00 81.00 476 8 "TRIGGER PT INJ SNGL TND SH, LG, AP" 4760008 UN 1 761 C 20550 Y Y 07/01/2025 409.00 286.30 359.92 220.86 220.86 476 9 TRIGGER POINT INJ SINGLE TENDON 4760009 UN 1 761 C 20551 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 476 10 "NEW PT, INITIAL VISIT W/*PROC" 4760010 UN 1 761 H 99025 N Y 04/20/2024 109.00 76.30 95.92 58.86 58.86 476 11 "LEVEL 1, BRIEF; 10 MIN" 4760011 UN 1 761 C 99201 N N 04/20/2024 71.00 49.70 62.48 38.34 38.34 476 12 "LEVEL 5, COMPREHENSIVE; 60 MIN" 4760012 UN 1 761 C 99205 Y Y 04/20/2024 424.00 296.80 373.12 228.96 228.96 476 13 EPIDURAL INJ; W/ IMAG GUID LUMBAR 4760013 UN 1 761 C 62323 Y Y 04/20/2024 "2,117.00" " 1,481.90 " " 1,862.96 " " 1,143.18 " " 1,143.18 " 476 14 MANIPULATION OF KNEE JOINT GEN ANE 4760014 UN 1 761 C 27570 Y Y 07/01/2025 303.00 212.10 266.64 163.62 163.62 476 15 TX ROOM TRANSF EPID 4760015 UN 1 761 C 64483 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 476 17 ARTHRO  INTERM W US GUIDANCE 4760017 UN 1 761 C 20606 Y Y 07/01/2025 464.00 324.80 408.32 250.56 250.56 476 18 ARTHRO  GANGLION CYST 4760018 UN 1 761 C 20612 Y Y 08/01/2023 283.00 198.10 249.04 152.82 152.82 476 19 ASP BONE CYST 4760019 761 C 20615 Y Y 07/01/2025 "1,318.00" 922.60 " 1,159.84 " 711.72 711.72 476 20 PRP-PLASMA INJECTIONS 4760020 UN 1 761 C 0232T Y Y 07/01/2025 "1,575.00" " 1,102.50 " " 1,386.00 " 850.50 850.50 476 21 INTRO/INJ. OF ANESTHETIC AGENT NRV 4760021 UN 1 761 C 64480 Y Y 07/01/2025 716.00 501.20 630.08 386.64 386.64 476 22 INJ. OF ANESTHETIC AGENT /STEROID 4760022 UN 1 960 C 64479 Y Y 07/01/2025 "1,411.00" 987.70 " 1,241.68 " 761.94 761.94 476 23 TRANSF EPIDURAL W/ US GUIDA SINGL 4760023 UN 1 761 C 64483 Y Y 04/20/2024 "1,252.00" 876.40 " 1,101.76 " 676.08 676.08 476 24 EPIDURAL W/ US EA ADDITIONAL LEVE 4808161 982 C 64484 Y Y 04/20/2024 565.00 395.50 497.20 305.10 305.10 476 25 INJ PROC FOR SACROILIAC JOINT 4760025 UN 1 761 C 27096 Y Y 07/01/2025 268.00 187.60 235.84 144.72 144.72 476 26 INJ PROC SACROILIAC JOINT; PROVISI 4760026 UN 1 761 C G0260 N Y 07/01/2025 268.00 187.60 235.84 144.72 144.72 476 27 PRP PLASMA INJECTION SELFPAY 4760027 761 C 0232T N N 04/20/2024 530.00 371.00 466.40 286.20 286.20 476 28 TX ROOM MORTON'S INJECTION 4760028 761 C 64455 N Y 03/01/2025 90.00 63.00 79.20 48.60 48.60 476 29 US-EXTREMITY NON-VASC COMPLETE 4760029 402 C 76882 Y Y 07/01/2025 860.00 602.00 756.80 464.40 464.40 476 31 INTRAMUSCULAR INJECTION 4760031 260 C 96372 Y Y 07/01/2025 401.00 280.70 352.88 216.54 216.54 476 33 INT PIDURAL STER INJ CERVIC/THORAC 4760033 761 C 62321 Y Y 07/01/2025 733.00 513.10 645.04 395.82 395.82 476 35 CHEMOTH ADMINISTRATION ANTI-NEOPLA 4760035 UN 1 761 C 96401 Y Y 07/01/2025 730.00 511.00 642.40 394.20 394.20 476 36 ORTHOVISC 30MG 4760036 59676036001 ME 1 250 C J7324 Y Y 04/01/2025 "1,766.68" " 1,236.68 " " 1,554.68 " 954.01 954.01 476 38 INTEGRITY KITS - PRP 4760038 UN 1 761 C 99070 N N 07/01/2025 420.00 294.00 369.60 226.80 226.80 476 39 TX RM TRIGGER POINT INJ 1-2 MUSCL 4760039 UN 1 761 C 20552 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 476 40 TX RM TRIGGER POINT INJ 3+ MUSCLES 4760040 UN 1 761 C 20553 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 476 41 TX RM INJ ANA/STROID INTR CSTAL NR 4760041 UN 1 761 C 64420 Y Y 07/01/2025 175.00 122.50 154.00 94.50 94.50 476 42 TX RM EPID INJ W/IMAG GUID LUMBAR 4760042 UN 1 761 C 62323 Y Y 07/01/2025 814.00 569.80 716.32 439.56 439.56 476 44 F.B RMVL SIMPLE 4760044 UN 1 761 C 10120 Y Y 07/01/2025 322.00 225.40 283.36 173.88 173.88 476 50 XEOMIN-BOTOX 50 UNIT VIAL 4760050 0259160501 UN 1 250 J0585 Y Y 06/23/2025 "1,072.00" 750.40 943.36 578.88 578.88 476 55 BRUXISM INJ - BILATERAL 4760055 UN 1 761 C 64615 Y Y 07/01/2025 280.00 196.00 246.40 151.20 151.20 477 1 THERAPY ADD 15 MINS W/C 4770001 420 C 97145 Y Y 07/02/2020 128.00 89.60 112.64 69.12 69.12 477 2 CANALITH REPOSITION 4770002 420 C 95992 Y Y 07/01/2025 89.00 62.30 78.32 48.06 48.06 477 3 PT EVAL - LOW COMPLEXITY 4770003 424 C 97161 Y Y 07/01/2025 322.00 225.40 283.36 173.88 173.88 477 4 PT EVAL - MOD COMPLEXITY 4770004 424 C 97162 Y Y 07/01/2025 441.00 308.70 388.08 238.14 238.14 477 5 "SELF-CARE HOME MGT TRAIN, EA.15 MI" 4770005 420 C 97535 Y Y 07/01/2025 168.00 117.60 147.84 90.72 90.72 477 6 SINGLE MODALITY 1 AREA; INIT 30 MI 4770006 420 H X3900 N Y 07/01/2025 288.00 201.60 253.44 155.52 155.52 477 7 SINGLE MODALITY 1 AREA; ADTL 15 MI 4770007 420 H X3902 N Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 8 SINGLE PROCEDURE 1 AREA; INIT30 MI 4770008 420 H X3904 N Y 07/01/2025 288.00 201.60 253.44 155.52 155.52 477 9 SINGLE PROC 1 AREA; ADDTL 15 MINS 4770009 420 H X3906 N Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 10 TRT ANY MOD&PROC (1+AREA);30 MINS 4770010 420 H X3908 N Y 07/01/2025 288.00 201.60 253.44 155.52 155.52 477 11 TRT COMBO MOD/PROC; ADDTL 15 MINS 4770011 420 H X3910 N Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 12 CASE CONF & REPORT: INITIAL 30 MIN 4770012 429 H X3926 N Y 07/01/2025 419.00 293.30 368.72 226.26 226.26 477 13 PT - CASE CONFERENCE; ADDTL 15 MIN 4770013 420 H X3930 N Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 477 14 PROSTHETIC ASSESSMENT 4770014 UN 1 420 C 97761 Y Y 07/01/2025 245.00 171.50 215.60 132.30 132.30 477 15 "PROSTHETIC MNGT, SUBS, 15 MINUTES" 4770015 UN 1 420 C 97763 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 477 990 FUNCTIONAL ASSESSMENT PE 4770990 420 CONTR Y Y 07/01/2025 165.00 115.50 145.20 89.10 89.10 477 2656 COLOSTOMY WAFER/SUR-FIT 2 3/4' 4772656 270 H A4414 Y Y 07/01/2025 23.00 16.10 20.24 12.42 12.42 477 2929 HUBBARD TANK EA. 15 MINS 4772929 420 C 97036 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 477 3548 CAST SUPPLIES 4773548 272 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 477 6410 ULTRASOUND TX 15 MIN 4776410 420 C 97035 Y Y 07/01/2025 131.00 91.70 115.28 70.74 70.74 477 6511 WOUND CARE; SELECTIVE 4776511 420 C 97597 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 6512 REM DEVITALIZED TISSUE NONSELECTIV 4776512 761 C 97602 Y Y 07/01/2025 343.00 240.10 301.84 185.22 185.22 477 6513 SEL WOUND CARE<20 CM 4776513 420 C 97597 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 477 6514 SEL WOUND CARE >20 CM 4776514 420 C 97598 Y Y 07/01/2025 245.00 171.50 215.60 132.30 132.30 477 6515 WOUND VAC <50CM 4776515 969 C 97605 Y Y 07/01/2025 240.00 168.00 211.20 129.60 129.60 477 6516 WOUND VAC >50CM 4030017 761 C 97606 Y Y 07/01/2025 409.00 286.30 359.92 220.86 220.86 477 6548 CAST SUPPLIES GAUNTLET 4776548 272 H Q4013 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 477 6565 "PT- THERAPEUT ACTIV;1:1,EA 15" 4776565 420 C 97530 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 477 6572 "ADL TRAIN, 15 MIN" 4776572 420 C 97535 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 477 6580 SELF CARE/HOME MGMT TRAIN 4776580 420 C 97535 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 477 6587 WHEELCHAIR MGT/TRNG/15 MI 4776587 420 C 97542 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 477 6601 APPLY 1+;HOT/COLD PAK 4776601 420 C 97010 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 477 6602 PT EVAL- COMPLEX 4776602 424 C 97163 Y Y 07/01/2025 527.00 368.90 463.76 284.58 284.58 477 6603 NEUROMUSCULAR RE-ED 15 MI 4776603 420 C 97112 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 6606 "IONTOPHORESIS, 15 MIN" 4776606 420 C 97033 Y Y 07/01/2025 89.00 62.30 78.32 48.06 48.06 477 6607 "GAIT TRAINING, 15 MIN" 4776607 420 C 97116 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 6612 "ELEC STIM,MAN,ATTEND 15 M" 4776612 420 C 97032 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 477 6614 PT EDUCATION HEP ECT 4776614 424 C 98960 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 6616 "MASSAGE, 15 MIN" 4776616 420 C 97124 Y Y 07/01/2025 171.00 119.70 150.48 92.34 92.34 477 6618 MASSAGE THERAPY 1/2 HR 4776618 420 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 477 6620 "CONTRAST BATH, EA 15 MIN" 4776620 420 C 97034 Y Y 07/01/2025 105.00 73.50 92.40 56.70 56.70 477 6622 DEBRIDEMENT EA ADD 10% 4776622 420 C 11001 Y Y 07/01/2025 110.00 77.00 96.80 59.40 59.40 477 6623 DEBRID INFC SKIN;10% BS 4776623 420 C 11000 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 477 6625 "DRESSING BURN;WOANES, SM" 4776625 420 C 16020 Y Y 07/01/2025 194.00 135.80 170.72 104.76 104.76 477 6627 DRESSING BURN MEDWOANES 4776627 420 C 16025 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 477 6629 DRESSING BURN-LGWOANES 4776629 420 C 16030 Y Y 07/01/2025 336.00 235.20 295.68 181.44 181.44 477 6630 PT PRELIM EVAL - MEDI-CAL 4776630 424 H X3924 N Y 07/01/2025 457.00 319.90 402.16 246.78 246.78 477 6631 TINETTI/PHYS PERF TEST 4776631 420 C 97750 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 6634 PT RE-EVAULATION 4776634 424 C 97164 Y Y 07/01/2025 166.00 116.20 146.08 89.64 89.64 477 6645 "ELECTRIC STIM, WOUND CARE" 4776645 420 H G0281 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 477 6650 TAPING 4776650 420 C 97139 Y Y 07/01/2025 91.00 63.70 80.08 49.14 49.14 477 6651 PT- THERAPUTIC EX 15 MIN 4776651 420 C 97110 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 477 6652 PATELLA TAPING 4776652 420 C 29530 Y Y 07/01/2025 140.00 98.00 123.20 75.60 75.60 477 6654 ELECTRIC STIM UNATTD 4776654 420 C 97014 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 477 6655 "PHYS MED, 1 AREA, EA 15 M" 4776655 420 C 97110 Y Y 07/04/2019 132.00 92.40 116.16 71.28 71.28 477 6656 "ELECTRIC STIM, UNATT, 1+ AREAS " 477656 420 C 90174 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 477 6659 STRAPPING/UNNA BOOT - PT 4776659 420 C 29580 Y Y 07/01/2025 140.00 98.00 123.20 75.60 75.60 477 6663 PARAFIN BATH 4776663 420 C 97018 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 477 6667 "TRACTION, MECHANICAL 15 M" 4776667 420 C 97012 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 477 6673 WHIRLPOOL 4776673 420 C 97022 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 477 6690 MIST THERAPY 4776690 420 C 97610 Y Y 07/01/2025 518.00 362.60 455.84 279.72 279.72 477 6718 MASSAGE THERAPY 1 HR 4776718 420 Y Y 07/01/2025 117.00 81.90 102.96 63.18 63.18 477 6720 EXERCISE MAINTENCE PROG 4776720 500 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 477 7600 IRRIGATION OF EAR 4777600 999 C 69210 Y Y 07/01/2025 193.00 135.10 169.84 104.22 104.22 477 7810 ACUPUNCTURE 1>MORE W/O 4777810 949 C 97810 Y Y 07/01/2025 147.00 102.90 129.36 79.38 79.38 477 7811 ACUPUCTURE ADDL15 MIN W/O 4777811 949 C 97811 Y Y 07/01/2025 147.00 102.90 129.36 79.38 79.38 477 7813 ACUP 1>MORE W/STIMULATION 4777813 949 C 97813 Y Y 07/01/2025 180.00 126.00 158.40 97.20 97.20 477 7814 ACUPUCT W/STIM ADDTL 15 4777814 949 C 97814 Y Y 07/01/2025 115.00 80.50 101.20 62.10 62.10 477 8000 MYOFACIAL/STM EA 30 MIN 4778000 420 C 97140 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 477 8010 MANUAL THERAPY 4778010 420 C 97140 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 477 8025 COMMUNITY/WORK REINTEGRAT 4778025 420 C 97537 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 477 8033 ORTHOTIC(S) MGT &TRAINING; EA 15 M 4778033 420 C 97760 Y Y 07/01/2025 229.00 160.30 201.52 123.66 123.66 477 8042 "GROUP THER,(2-5 PTS)30MIN" 4778042 420 C 97150 Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 477 8050 VASOPNEUMATIC DEVICE 4778050 420 C 97016 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 477 8083 ORTHOTIC TRAINING 15MIN 4778083 420 C 97763 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 477 8098 POSITION/PERCUSSION TX 4778098 420 C 94668 Y Y 07/01/2025 131.00 91.70 115.28 70.74 70.74 477 8099 POSITION/PERCUSSION INIT 4778099 420 C 94667 Y Y 07/01/2025 161.00 112.70 141.68 86.94 86.94 477 9001 THERA-HONEY GEL 4471009 270 H A4649 Y Y 07/01/2025 44.00 30.80 38.72 23.76 23.76 477 9002 MEPILEX 4779002 272 H A6213 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 477 9003 SACRUM DRESSING 4779003 420 H A4649 Y Y 07/01/2025 19.00 13.30 16.72 10.26 10.26 477 9004 THERA-BAND 4779004 420 H A9300 N N 07/01/2025 21.00 14.70 18.48 11.34 11.34 477 9005 THERA-LOOP DOOR ANCHOR 4779005 420 H A9300 N N 07/01/2025 6.00 4.20 5.28 3.24 3.24 477 9006 INTEGRA BMWD 4779006 420 H Q4104 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 477 9007 TEGADERM THIN HYDROCOLLOID 4779007 420 H A6234 Y Y 07/01/2025 6.00 4.20 5.28 3.24 3.24 477 9013 COBAN COMPRESSION KIT 4471010 272 H Y Y 07/01/2025 189.00 132.30 166.32 102.06 102.06 477 9014 MOBILITY CURRENT STATUS 4779014 420 H G8978 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9015 MOBILITY GOAL STATUS 4779015 420 H G8979 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9016 MOBILITY D/C STATUS 4779016 420 H G8980 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9017 CARRY CURRENT STATUS 4779017 420 H G8984 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9018 CARRY GOAL STATUS 4779018 420 H G8985 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9019 CARRY D/C STATUS 4779019 420 H G8986 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9020 BODY POS CURRENT STATUS 4779020 420 H G8981 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9021 BODY POS GOAL STATUS 4779021 420 H G8982 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9022 BODY POS D/C STATUS 4779022 420 H G8983 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9023 SELF CARE CURRENT STATUS 4779023 420 H G8987 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9024 SELF CARE GOAL STATUS 4779024 420 H G8988 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9025 SELF CARE D/C STATUS 4779025 420 H G8989 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9026 OTHER PT/OT CURRENT STAT 4779026 420 H G8990 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9027 OTHER PT/OT GOAL STATUS 4779027 420 H G8991 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9028 OTHER PT/OT D/C STATUS 4779028 420 H G8992 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9029 SUB PT/OT CURRENT STATUS 4779029 420 H G8993 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9030 SUB PT/OT GOAL STATUS 4779030 420 H G8994 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9031 SUB PT/OT D/C STATUS 4779031 420 H G8995 Y Y 07/01/2025 5.00 3.50 4.40 2.70 2.70 477 9932 TENS UNIT RENTAL 4779932 273 H E0720 Y Y 07/01/2025 850.00 595.00 748.00 459.00 459.00 477 9933 ELECTRODES - C/I 4779933 273 H A4456 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 477 9934 ELECTRODES MEDI/MEDI 4779934 273 H A4595 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 477 9991 NO-SHOW CHARGE NON MEDI-CAL PTS 4779991 UN 1 420 N N 07/01/2025 53.00 37.10 46.64 28.62 28.62 477 9999 INVERSION CHAIR 4779999 420 C 97012 Y Y 07/01/2025 94.00 65.80 82.72 50.76 50.76 478 1 LANGUAGE EVALUATION 4780001 444 H X4300 N Y 07/01/2025 662.00 463.40 582.56 357.48 357.48 478 2 SPEECH/LANGUAGE THERAPY;PER HR 4780002 440 H X4303 N Y 07/01/2025 419.00 293.30 368.72 226.26 226.26 478 3 SPEECH-LANGUAGE THERAPY;IND 1/2 HR 4780003 441 H X4304 N Y 07/01/2025 213.00 149.10 187.44 115.02 115.02 478 16 THERA SVC USE OF SPEECH 4780016 440 C 92609 Y Y 07/01/2025 541.00 378.70 476.08 292.14 292.14 478 17 SPEECH/HEARING THERAPY 4780017 440 C 92507 Y Y 07/01/2025 486.00 340.20 427.68 262.44 262.44 478 18 PROG AND TX SPEECH GEN 4780018 440 C 92609 Y Y 07/01/2025 191.00 133.70 168.08 103.14 103.14 478 19 EX FOR SPEECH DEV RX 1HR 4780019 440 C 92607 Y Y 07/01/2025 359.00 251.30 315.92 193.86 193.86 478 20 EX SPEECH DEVICE RX ADDL 4780020 440 C 92608 Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 478 21 COGNITIVE TEST BY HC PRO 4780021 440 C 96125 Y Y 07/01/2025 554.00 387.80 487.52 299.16 299.16 478 22 COGNITIVE SKILLS DEVELOP 4780022 440 C 97532 Y Y 07/02/2021 368.59 258.01 324.36 199.04 199.04 478 23 FLEXIBLE ENDO SWALLOW EVAL CINE/VI 4780023 440 C 92612 Y Y 07/01/2025 355.00 248.50 312.40 191.70 191.70 478 24 "FLEXIBLE ENDO EVAL,LARYNGEAL SENSO" 4780024 440 C 92614 Y Y 07/01/2025 265.00 185.50 233.20 143.10 143.10 478 25 SPEECH INITIAL EVALUATION 4780025 444 C 92506 Y Y 07/04/2019 422.00 295.40 371.36 227.88 227.88 478 26 INITIAL EVAL SWALLOWING 4780026 440 C 92610 Y Y 07/01/2025 662.00 463.40 582.56 357.48 357.48 478 27 FLEX ENDO EVAL; INTERPRET&REPORT 4780027 440 C 92613 Y Y 07/01/2025 80.00 56.00 70.40 43.20 43.20 478 28 ORAL FUNCTION THERAPY 4780028 440 C 92526 Y Y 07/01/2025 366.00 256.20 322.08 197.64 197.64 478 29 SWALLOW CURRENT STATUS 4780029 441 H G8996 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 30 SWALLOW GOAL STATUS 4780030 441 H G8997 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 31 SWALLOW D/C STATUS 4780031 441 H G8998 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 32 MOTOR SPEECH CURRENT STAT 4780032 441 H G8999 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 33 MOTOR SPEECH GOAL STATUS 4780033 441 H G9186 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 34 MOTOR SPEECH D/C STATUS 4780034 441 H G9158 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 35 LANG COMP CURRENT STATUS 4780035 441 H G9159 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 36 LANG COMP GOAL STATUS 4780036 441 H G9160 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 37 LANG COMP D/C STATUS 4780037 441 H G9161 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 38 LANG EXPRESS CURRENT STAT 4780038 441 H G9162 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 39 LANG EXPRESS GOAL STATUS 4780039 441 H G9163 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 40 LANG EXPRESS D/C STATUS 4780040 441 H G9164 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 41 ATTEN CURRENT STATUS 4780041 441 H G9165 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 42 ATTEN GOAL STATUS 4780042 441 H G9166 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 43 ATTEN D/C STATUS 4780043 441 H G9167 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 44 MEMORY CURRENT STATUS 4780044 441 H G9168 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 45 MEMORY GOAL STATUS 4780045 441 H G9169 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 46 MEMORY D/C STATUS 4780046 441 H G9170 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 47 VOICE CURRENT STATUS 4780047 441 H G9171 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 48 VOICE GOAL STATUS 4780048 441 H G6172 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 49 VOICE D/C STATUS 4780049 441 H G9173 Y Y 07/04/2019 1.00 0.70 0.88 0.54 0.54 478 50 SPEECH LANG CURRENT STAT 4780050 441 H G9174 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 51 SPEECH LANG GOAL STATUS 4780051 441 H G9175 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 52 SPEECH LANG D/C STATUS 4780052 441 H G9176 Y Y 07/04/2019 0.01 0.01 0.01 0.01 0.01 478 53 EVAL RX NONSPEECH GEN DEVICE;1ST H 4780053 440 C 92605 Y Y 07/01/2025 184.00 128.80 161.92 99.36 99.36 478 54 EVAL RX NONSPEECH DEVICE;ADD 30 MI 4780054 440 C 92618 Y Y 07/01/2025 71.00 49.70 62.48 38.34 38.34 478 55 THER SVS NONSP DEVICE; PROGRAM&MOD 4780055 440 C 92606 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 478 57 "TREATMENT SPEECH, LANG/GROUP;2+" 4780057 441 C 92508 Y Y 07/01/2025 55.00 38.50 48.40 29.70 29.70 478 58 THERAPEUTIC SVS;NONSP DEV;PROG&MOD 4780058 440 C 92606 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 478 60 COGNATIVE INTERV SKILLS INI 15 MIN 4780060 441 C 97129 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 478 6323 EVAL SPEECH SOUND PRODUCT 4786323 440 C 92522 Y Y 07/01/2025 215.00 150.50 189.20 116.10 116.10 478 6430 COGNATIVE SKILLS- EA ADDTNL 15 MIN 4786430 440 C 97130 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 478 6540 BEHAVIORAL AND QUALITATE 4786540 440 C 92524 Y Y 07/01/2025 223.00 156.10 196.24 120.42 120.42 478 6541 APHASIA EVAL. PER HOUR 4786541 440 C 96105 Y Y 07/01/2025 233.00 163.10 205.04 125.82 125.82 478 6548 EVALUATION SPEECH FLUENCY 4786548 440 C 92521 Y Y 07/01/2025 263.00 184.10 231.44 142.02 142.02 478 6549 EVAL SPEECH PRODUCTION 4786549 440 C 92523 Y Y 07/01/2025 445.00 311.50 391.60 240.30 240.30 478 6550 STANDARDIZED COGNITIVE PERF. TEST 4786550 441 C 96125 Y Y 07/01/2025 519.00 363.30 456.72 280.26 280.26 478 9991 NO-SHOW CHARGE NON MEDI-CAL PTS 4789991 UN 1 430 N N 07/01/2025 53.00 37.10 46.64 28.62 28.62 479 1 "OT - EVAL, LOW COMPLEXITY, 30 MINS" 4790001 430 C 97165 Y Y 07/01/2025 228.00 159.60 200.64 123.12 123.12 479 2 "OT - EVAL, MOD COMPLEXITY, 45 MINS" 4790002 430 C 97166 Y Y 07/01/2025 380.00 266.00 334.40 205.20 205.20 479 3 "OT - EVAL, HIGH COMPLEXITY, 60 MIN" 4790003 430 C 97167 Y Y 07/01/2025 563.00 394.10 495.44 304.02 304.02 479 4 "OT - RE-EVAULATION, 30 MINS" 4790004 430 C 97168 Y Y 07/01/2025 359.00 251.30 315.92 193.86 193.86 479 5 OCC THER EVAL / ADT 15 MIN+RPT 4790005 430 H X4102 N Y 07/01/2025 107.00 74.90 94.16 57.78 57.78 479 6 "OT - TREATMENT, 30 MINS " 4790006 430 H X4110 N Y 07/01/2025 419.00 293.30 368.72 226.26 226.26 479 7 "OT - COGNITIVE SKILLS, EACH 15 MIN" 4790007 430 C 97129 Y Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 479 8 "OT - SENSORY TECHNIQUES, EA 15 MIN" 4790008 430 C 97533 Y Y 07/01/2025 102.00 71.40 89.76 55.08 55.08 479 9 "OCC THER EVAL INT 30 MIN,PLUS RPT" 4790009 430 H X4110 N Y 07/01/2025 290.00 203.00 255.20 156.60 156.60 479 10 OCC THER TREAT EA ADD 15 MIN 4790010 430 H X4112 N Y 04/01/2020 85.00 59.50 74.80 45.90 45.90 479 11 "OT - TREATMENT, ADDTL 15 MINS" 4790011 430 H X4112 N Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 479 12 OT - HYDOCOLLOID DRESSING-THIN 4790012 272 H A6237 Y Y 07/01/2025 57.00 39.90 50.16 30.78 30.78 479 13 OT - PRELIMINARY EVAL/REHAB/NF 4790013 430 H X4108 N Y 07/01/2025 436.00 305.20 383.68 235.44 235.44 479 14 OT - CASE CONSULT & REPORT 4790014 430 H X4120 N Y 07/01/2025 483.00 338.10 425.04 260.82 260.82 479 15 OT - CASE CONFERENCE & REPORT 4790015 430 H X4104 N Y 07/01/2025 419.00 293.30 368.72 226.26 226.26 479 16 OT -CASE CONFERENCE&REP; ADTL 15MI 4790016 430 H X4104 N Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 479 17 OT- SELF-CARE/HOME MGT TRAIN; 15MI 4790017 430 C 97537 Y Y 07/01/2025 61.00 42.70 53.68 32.94 32.94 479 28 OT - ACTIVITIES 1:1 4790028 431 C 97530 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 479 30 OT - THERAPEUTIC EX 15 MIN 4790030 431 C 97110 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 479 40 "OT - TX 1+, 15M MASSAGE" 4790040 431 C 97124 Y Y 07/01/2025 137.00 95.90 120.56 73.98 73.98 479 6330 COGNATIVE SKILLS- EA ADDTNL 15 MIN 4796330 430 C 97130 Y Y 07/01/2025 63.00 44.10 55.44 34.02 34.02 479 6410 OT - ULTRASOUND TX 15 MIN 4796410 431 C 97035 Y Y 07/01/2025 131.00 91.70 115.28 70.74 70.74 479 6572 OT - ADL TRAINING 4796572 431 C 97535 Y Y 07/01/2025 121.00 84.70 106.48 65.34 65.34 479 6587 OT - WHEELCHAIR TRAINING EA 15 MIN 4796587 430 C 97542 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 479 6601 OT - APPLY 1+;HOT/COLD PAK 4796601 439 C 97010 Y Y 07/01/2025 33.00 23.10 29.04 17.82 17.82 479 6603 "OT - TX 1+,15M,NEUROMUSCULAR" 4796603 431 C 97112 Y Y 07/01/2025 144.00 100.80 126.72 77.76 77.76 479 6606 OT - IONTOPHORESIS 15 MINS 4796606 430 C 97033 Y Y 07/01/2025 89.00 62.30 78.32 48.06 48.06 479 6612 "OT - ELEC XTEM,MAN;ATTED, 15M" 4796612 431 C 97032 Y Y 07/01/2025 152.00 106.40 133.76 82.08 82.08 479 6620 OT - CONTRAST BATH EA 15 MIN 4796620 431 C 97035 Y Y 07/01/2025 65.00 45.50 57.20 35.10 35.10 479 6654 OT - TENS/STIM UNATTENDED 4796654 430 C 97014 Y Y 07/01/2025 147.00 102.90 129.36 79.38 79.38 479 6655 "OT - THER TX, 1 AREA, EA 15 MI" 4796655 431 C 97110 Y Y 07/04/2019 132.00 92.40 116.16 71.28 71.28 479 6663 OT - PARAFIN BATH 4796663 431 C 97018 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 479 8010 OT - MANUAL THERAPY 15 MINS 4798010 430 C 97140 Y Y 07/01/2025 145.00 101.50 127.60 78.30 78.30 479 8033 "OT - ORTHOTIC ASSESS, EA 15 MINS" 4798033 430 C 97760 Y Y 07/01/2025 229.00 160.30 201.52 123.66 123.66 479 8042 OT - GROUP THERAPY (2+) 4798042 433 C 97150 Y Y 07/01/2025 177.00 123.90 155.76 95.58 95.58 479 8083 "OT - ORTHOTIC TRAINING, EA 15 MINS" 4798083 430 C 97763 Y Y 07/01/2025 135.00 94.50 118.80 72.90 72.90 479 8084 NO-SHOW CHARGE NON MEDI-CAL PTS 4798084 UN 1 441 N N 07/01/2025 53.00 37.10 46.64 28.62 28.62 480 1 "E&M, OFF, NEW, LTD." 4800001 UN 1 982 C 99202 Y Y 07/01/2025 277.00 193.90 243.76 149.58 149.58 480 2 "E&M, OFF, NEW, INTERMEDIATE" 4800002 UN 1 982 C 99203 Y Y 07/01/2025 385.00 269.50 338.80 207.90 207.90 480 3 "E&M, OFF, NEW, EXTENDED" 4800003 UN 1 982 C 99204 Y Y 07/01/2025 490.00 343.00 431.20 264.60 264.60 480 4 "E&M, OFF, EST, NO MD" 4800004 UN 1 982 C 99211 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 480 5 "E&M, OFF, EST, BRIEF" 4800005 UN 1 982 C 99212 Y Y 07/01/2025 198.00 138.60 174.24 106.92 106.92 480 6 "E&M, OFF, EST, LTD." 4800006 UN 1 982 C 99213 Y Y 07/01/2025 272.00 190.40 239.36 146.88 146.88 480 7 "E&M, OFF, EST, INTERMEDIATE" 4800007 UN 1 982 C 99214 Y Y 07/01/2025 343.00 240.10 301.84 185.22 185.22 480 8 "ARTHROCENTESIS, ASP. AND/OR INJ US" 4800008 UN 1 982 C 20611 Y Y 07/01/2025 867.00 606.90 762.96 468.18 468.18 480 9 "ARTHROCENTESIS, ASP. AND/OR INJ." 4800009 UN 1 982 C 20610 Y Y 07/01/2025 542.00 379.40 476.96 292.68 292.68 480 10 "NERV BLOCK; PVB, THORACIC; IMAGING" 4800010 UN 1 960 C 64461 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 480 11 NERVE BLOCK; GTR OCCIPITAL NRV 4800011 UN 1 960 C 64405 Y Y 07/01/2025 434.00 303.80 381.92 234.36 234.36 480 12 NERVE BLOCK; VAGUS NERVE 4800012 UN 1 960 C 64408 Y Y 07/01/2025 415.00 290.50 365.20 224.10 224.10 480 13 NERVE BLOCK; BRACHIAL PLEXUS 4800013 UN 1 960 C 64415 Y Y 07/01/2025 309.00 216.30 271.92 166.86 166.86 480 14 NERVE BLOCK; AXILLARY NERVE 4800014 UN 1 960 C 64417 Y Y 07/01/2025 351.00 245.70 308.88 189.54 189.54 480 15 NERVE BLOCK; SUPRASCAPULAR NRV 4800015 UN 1 960 C 64418 Y Y 07/01/2025 434.00 303.80 381.92 234.36 234.36 480 16 NERVE BLOCK; INTERCOSTAL NERVE 4800016 UN 1 960 C 64420 Y Y 07/01/2025 341.00 238.70 300.08 184.14 184.14 480 17 NERVE BLOCK; EACH LVL INTER. NRV 4800017 UN 1 960 C 64421 Y Y 07/01/2025 124.00 86.80 109.12 66.96 66.96 480 18 NERVE BLOCK; ILIOINGUINAL NERVES 4800018 UN 1 960 C 64425 Y Y 07/01/2025 341.00 238.70 300.08 184.14 184.14 480 19 NERVE BLOCK; PUDENDAL NERVE 4800019 UN 1 960 C 64430 Y Y 07/01/2025 310.00 217.00 272.80 167.40 167.40 480 20 NERVE BLOCK; PARACERVICAL NERVE 4800020 UN 1 960 C 64435 Y Y 07/01/2025 248.00 173.60 218.24 133.92 133.92 480 21 NERVE BLOCK; SCIATIC NERVE 4800021 UN 1 960 C 64445 Y Y 07/01/2025 557.00 389.90 490.16 300.78 300.78 480 22 NERVE BLOCK; FEMORAL NERVE 4800022 UN 1 960 C 64447 Y Y 07/01/2025 626.00 438.20 550.88 338.04 338.04 480 23 NERVE BLOCK; LUMBAR OR THORACIC NR 4800023 UN 1 960 C 64520 Y Y 07/01/2025 "1,296.00" 907.20 " 1,140.48 " 699.84 699.84 480 24 INJECTION ANESTHETIC AGENT NRV BLK 4800024 UN 1 960 C 64450 Y Y 07/01/2025 174.00 121.80 153.12 93.96 93.96 480 25 LEVEL 5; MOD-HIGH SEVERITY 4800025 UN 1 988 C 99215 Y Y 07/01/2025 "1,117.00" 781.90 982.96 603.18 603.18 480 27 PROLONGED OFF; OP 15 MIN 4800027 UN 1 982 C 99417 Y Y 07/01/2025 765.00 535.50 673.20 413.10 413.10 480 28 INJECT ANES/STEROID PLANTAR MORTO' 4800028 969 C 64455 Y Y 03/01/2017 150.00 105.00 132.00 81.00 81.00 480 29 ARTHRO; ASP INJ JOINT/BURS W/O GUI 4800029 UN 1 982 C 20600 Y Y 07/01/2025 "1,404.00" 982.80 " 1,235.52 " 758.16 758.16 480 31 READ US-EXTREMITY NON-VASC LTD 4800031 972 C 76882 Y Y 04/20/2024 205.00 143.50 180.40 110.70 110.70 480 33 SPHENOPALATINE NERVE BLOCK 4800033 UN 1 960 C 64405 Y Y 07/01/2025 410.00 287.00 360.80 221.40 221.40 480 300 ARTHROCENTESIS SMALL JOINT W/ GUID 4800300 960 C 20604 Y Y 07/01/2025 928.00 649.60 816.64 501.12 501.12 480 303 F.B RMVL - SUBCUT SIMPLE 4800303 UN 1 982 C 10120 Y Y 07/01/2025 470.00 329.00 413.60 253.80 253.80 480 2011 BRUXISM INJ - UNILATERAL 4802011 UN 1 982 C 64612 Y Y 06/24/2025 360.00 252.00 316.80 194.40 194.40 480 2100 BRUXISM INJ - BILATERAL 4802100 UN 1 982 C 64615 Y Y 06/24/2025 350.00 245.00 308.00 189.00 189.00 480 2625 ARTHROCENTESIS; INTERMPF 4802625 982 C 20605 Y Y 07/01/2025 "1,026.00" 718.20 902.88 554.04 554.04 480 8157 ARTHROCEN; ASPIRATION AND/OR INJEC 4808157 UN 1 982 C 20606 Y Y 07/01/2025 897.00 627.90 789.36 484.38 484.38 480 8158 EPIDURAL INJ;W/IMAG GUID LUMBAR 4808158 UN 1 982 C 62323 N Y 07/01/2025 "2,223.00" " 1,556.10 " " 1,956.24 " " 1,200.42 " " 1,200.42 " 480 8159 TRIGGER POINT INJ 1-2 MUSCLE 4808159 UN 1 971 C 20552 Y Y 07/01/2025 480.00 336.00 422.40 259.20 259.20 480 8160 TRIGGER POINT INJ 3+ MUSCLES 4808160 UN 1 969 C 20553 Y Y 07/01/2025 468.00 327.60 411.84 252.72 252.72 480 8161 TRANSF EPID W/USG LUMB/SACR SINGLE 4808161 UN 1 982 C 64483 Y Y 07/01/2025 "1,315.00" 920.50 " 1,157.20 " 710.10 710.10 480 8162 TRANSF EPID W/USG LUMB/SACR EA ADD 4808162 UN 1 982 C 64484 Y Y 07/01/2025 594.00 415.80 522.72 320.76 320.76 481 1 "EXC., BENIGN LESION 1.1 TO 2.0 CM" 4810001 982 11402 Y Y 07/01/2025 663.00 464.10 583.44 358.02 358.02 481 2 "REPAIR, INTER WD SCALP 2.5 CM/ LES" 4810002 982 12031 Y Y 07/01/2025 "1,131.00" 791.70 995.28 610.74 610.74 481 3 PUNCH BIOPSY OF SKIN 4810003 UN 1 982 C 11104 Y Y 07/01/2025 394.00 275.80 346.72 212.76 212.76 481 4 FINE NDLE ASP BIO W/O IMAG 4810004 UN 1 982 C 10021 Y Y 07/01/2025 289.00 202.30 254.32 156.06 156.06 481 5 ARTHROCENTIS INTERMPF W/O GUID 4810005 982 C 20605 Y Y 07/01/2025 731.00 511.70 643.28 394.74 394.74 481 6 ABDOMINAL PARACENTESIS W/O IMAG GU 4810006 982 C 49082 Y Y 07/01/2025 981.00 686.70 863.28 529.74 529.74 481 7 ABDOMINAL PARACENTESIS W/ IMAGE GU 4810007 982 C 49083 Y Y 07/01/2025 "1,838.00" " 1,286.60 " " 1,617.44 " 992.52 992.52 481 8 "EXCISION, BENIGN LESION 0.5 CM/LES" 4810008 982 C 11400 Y Y 07/01/2025 163.00 114.10 143.44 88.02 88.02 481 9 "EXCISION, BENIGN LESION0.6-1.0CM" 4810009 982 C 11401 Y Y 07/01/2025 279.00 195.30 245.52 150.66 150.66 481 10 "EXCISION, BENIGN LESION 1.1-2.0CM" 4810010 982 C 11402 Y Y 07/01/2025 383.00 268.10 337.04 206.82 206.82 481 11 "EXCISION, BENIGN LESION 2.1-3.0CM" 4810011 982 C 11403 Y Y 07/01/2025 494.00 345.80 434.72 266.76 266.76 481 12 "EXCISION, BENIGN LESION3.1-4.0CM" 4810012 982 C 11404 Y Y 07/01/2025 546.00 382.20 480.48 294.84 294.84 481 13 "EXCISION, BENIGN LESION 4.0 CM" 4810013 982 C 11406 Y Y 07/01/2025 714.00 499.80 628.32 385.56 385.56 481 14 "EXCISION, BENIGN LESION 0.5CM-LESS" 4810014 969 C 11420 Y Y 07/01/2025 284.00 198.80 249.92 153.36 153.36 481 15 "EXCISION, BENIGN LESION 0.6-1.0 CM" 4810015 982 C 11421 Y Y 07/01/2025 372.00 260.40 327.36 200.88 200.88 481 16 "EXCISION, BENIGN LESION 1.1-2.0CM" 4810016 982 C 11422 Y Y 07/01/2025 446.00 312.20 392.48 240.84 240.84 481 17 "EXCISION, BENIGN LESION21.-3.0CM" 4810017 982 C 11423 Y Y 07/01/2025 519.00 363.30 456.72 280.26 280.26 481 18 "EXCISION, BENIGN LESION 3.1-4.0CM" 4810018 982 C 11424 Y Y 07/01/2025 588.00 411.60 517.44 317.52 317.52 481 19 "EXCISION, BEN LESION OVER 4.0 CM" 4810019 982 C 11426 Y Y 07/01/2025 714.00 499.80 628.32 385.56 385.56 481 20 "EXCISION, OTHER BEN LESION-0.5CM" 4810020 982 C 11440 Y Y 07/01/2025 363.00 254.10 319.44 196.02 196.02 481 21 EXCISION OTHER BEN LES 0.6-1-1.0CM 4810021 982 C 11441 Y Y 07/01/2025 436.00 305.20 383.68 235.44 235.44 481 22 "EXCISION, OTHER BEN LES 1.1-2.0CM" 4810022 982 C 11442 Y Y 07/01/2025 510.00 357.00 448.80 275.40 275.40 481 23 "EXCISION, OTHER BEN LES 2.1-3.0CM" 4810023 982 C 11443 Y Y 07/01/2025 583.00 408.10 513.04 314.82 314.82 481 24 "EXCISION, OTHER BENI LES 3.1-4.0CM" 4810024 982 C 11444 Y Y 07/01/2025 657.00 459.90 578.16 354.78 354.78 481 25 "EXCISION, OTHER BEN LES OVER 4.0 C" 4810025 982 C 11446 Y Y 07/01/2025 730.00 511.00 642.40 394.20 394.20 481 26 "EXCISION, OTHER BEN LES OVER 4.0 C" 4810025 982 C 11446 Y Y 01/02/2024 0.00 - - - - 481 27 ASPIRATION AND/OR INJECTION OF GAN 4810027 982 C 20612 Y Y 07/01/2025 237.00 165.90 208.56 127.98 127.98 481 28 "ARTHROCENTESIS, ASP AND INJ W/O I" 4810028 982 C 20600 Y Y 01/02/2024 165.00 115.50 145.20 89.10 89.10 481 29 "ARTHROCENTESIS, ASPIRATION W/ IMAG" 4810029 982 C 20604 Y Y 07/01/2025 300.00 210.00 264.00 162.00 162.00 481 30 "ARTHROCENTESIS, ASPIRATION W/IMGE" 4810030 982 C 20606 Y Y 07/01/2025 594.00 415.80 522.72 320.76 320.76 481 31 "ARTHROCENTESIS, ASPIRATION/INJ W/O" 4810031 982 C 20610 Y Y 07/01/2025 804.00 562.80 707.52 434.16 434.16 481 32 "ARTHROCENTESIS, ASPIRATION INJ W I" 4810032 982 C 20611 Y Y 07/01/2025 852.00 596.40 749.76 460.08 460.08 481 33 TANGENTIAL BIOPSY OF SKIN SINGLE L 4810033 982 C 11102 Y Y 07/01/2025 133.00 93.10 117.04 71.82 71.82 481 34 TANGENTIAL BIOPSY OF SKIN EACH SEP 4810034 982 C 11103 Y Y 07/01/2025 90.00 63.00 79.20 48.60 48.60 481 35 PUNCH BIOPSY OF SKIN (INCLUDING SI 4810035 982 C 11104 Y Y 01/02/2024 375.00 262.50 330.00 202.50 202.50 481 36 PUNCH BIOPSY OF SKIN ADDITIONAL LE 4810036 982 C 11105 Y Y 07/01/2025 173.00 121.10 152.24 93.42 93.42 481 37 INCISIONAL BIOPSY OF SKIN SINGLE L 4810037 982 C 11106 Y Y 07/01/2025 202.00 141.40 177.76 109.08 109.08 481 38 INCISIONAL BIOPSY OF SKIN /ADDITIO 4810038 982 C 11107 Y Y 07/01/2025 107.00 74.90 94.16 57.78 57.78 481 39 "TRIMMING OF NONDYSTROPHIC NAILS, A" 4810039 982 C 11719 Y Y 07/01/2025 62.00 43.40 54.56 33.48 33.48 481 40 "AVULSION OF NAIL PLATE, PARTIAL OR" 4810040 982 C 11730 Y Y 07/01/2025 212.00 148.40 186.56 114.48 114.48 481 41 "AVULSION OF NAIL PLATE, PARTIAL AD" 4810041 982 C 11732 Y Y 07/01/2025 69.00 48.30 60.72 37.26 37.26 481 42 EVACUATION OF SUBUNGUAL HEMATOMA 4810042 982 C 11740 Y Y 07/01/2025 124.00 86.80 109.12 66.96 66.96 481 43 "EXCISION OF NAIL AND NAIL MATRIX, " 4810043 982 C 11750 Y Y 07/01/2025 573.00 401.10 504.24 309.42 309.42 481 44 WEDGE EXCISION OF SKIN OF NAIL FOL 4810044 982 C 11765 Y Y 07/01/2025 300.00 210.00 264.00 162.00 162.00 481 45 DESTRUCTION BENIGN LESIONS 4810045 982 C 17110 Y Y 07/01/2025 482.00 337.40 424.16 260.28 260.28 481 46 DESTRUCTION 15 OR MORE LESIONS 4810046 982 C 17111 Y I 07/01/2025 669.00 468.30 588.72 361.26 361.26 481 47 INCISION AND DRAINAGE OF ABSCESS S 4810047 969 C 46050 Y Y 07/01/2025 "1,025.00" 717.50 902.00 553.50 553.50 481 48 "INCISION AND DRAINAGE, LEG OR ANKL" 4810048 982 C 27603 Y Y 07/01/2025 "3,249.00" " 2,274.30 " " 2,859.12 " " 1,754.46 " " 1,754.46 " 481 49 "INCISION AND DRAINAGE, SHOULDER AR" 4810049 982 C 23030 Y Y 07/01/2025 "3,184.00" " 2,228.80 " " 2,801.92 " " 1,719.36 " " 1,719.36 " 481 50 "INCISION AND DRAINAGE, FOREARM AND" 4810050 982 C 25028 Y Y 07/01/2025 940.00 658.00 827.20 507.60 507.60 481 51 "INCISION AND DRAINAGE, FOREARM AND" 4810051 982 C 25031 Y Y 07/01/2025 814.00 569.80 716.32 439.56 439.56 481 52 "INCISION AND DRAINAGE, UPPER ARM O" 4810052 982 C 23930 Y Y 07/01/2025 716.00 501.20 630.08 386.64 386.64 481 53 "INCISION AND DRAINAGE, UPPER ARM O" 4810053 982 C 23931 Y Y 07/01/2025 470.00 329.00 413.60 253.80 253.80 481 54 "INCISION AND DRAINAGE, PELVIS OR H" 4810054 982 C 26990 Y Y 07/01/2025 "1,709.00" " 1,196.30 " " 1,503.92 " 922.86 922.86 481 55 "INCISION AND DRAINAGE, PELVIS OR H" 4810055 982 C 26991 Y Y 07/01/2025 888.00 621.60 781.44 479.52 479.52 481 56 INCISION AND DRAINAGE THIGH OR KNE 4810056 982 C 27301 Y Y 07/01/2025 "1,392.00" 974.40 " 1,224.96 " 751.68 751.68 481 57 I&D ABSC; SMPL OR SGL 4810057 982 C 10060 Y Y 07/01/2025 345.00 241.50 303.60 186.30 186.30 481 58 I&D ABSCES COMPLEX 4810058 982 C 10061 Y Y 07/01/2025 538.00 376.60 473.44 290.52 290.52 481 59 "FB REMOVAL,COMPLICATED" 4810059 982 C 10121 Y Y 07/01/2025 651.00 455.70 572.88 351.54 351.54 481 60 INCISION AND DRAINAGE OF HEMATOMA 4810060 982 C 10140 Y Y 07/01/2025 398.00 278.60 350.24 214.92 214.92 481 61 PUNCTURE ASP/ABCESS PF 4810061 982 C 10160 Y Y 07/01/2025 309.00 216.30 271.92 166.86 166.86 481 62 INCISION AND DRAINAGE OF BARTHOLIN 4810062 982 C 56420 Y Y 07/01/2025 341.00 238.70 300.08 184.14 184.14 481 64 E&M SERVICE PROVIDED BY NURSE 4810064 UN 1 982 C 99211 Y Y 07/01/2025 156.00 109.20 137.28 84.24 84.24 481 66 E&M OFFICE VISIT 10-19 MINUTES 4810066 UN 1 982 C 99212 Y Y 07/01/2025 198.00 138.60 174.24 106.92 106.92 481 67 E&M OFFICE VISIT 20-29 MINUTES 4810067 UN 1 982 H 99213 Y Y 07/01/2025 272.00 190.40 239.36 146.88 146.88 481 68 E&M OFFICE VISIT 30-39 MINUTES 4810068 UN 1 982 C 99214 Y Y 07/01/2025 346.00 242.20 304.48 186.84 186.84 481 69 E&M OFFICE VISIT HIGH/ 40 MIN 4810069 UN 1 982 C 99215 Y Y 07/01/2025 "1,117.00" 781.90 982.96 603.18 603.18 481 71 SKIN TAG REMOVAL <15 LESIONS 4810071 UN 1 982 C 11200 Y Y 07/01/2025 710.00 497.00 624.80 383.40 383.40 481 73 ADDITIONAL +10 LESIONS 4810073 UN 1 982 C 11201 Y Y 07/01/2025 376.00 263.20 330.88 203.04 203.04 481 75 TREATMENT RM OP HOSP 4810075 UN 1 761 H Z7500 N Y 07/01/2025 75.00 52.50 66.00 40.50 40.50 481 80 INJ SHLDR ARTHROGRAPHY OR ENHANCED 4810080 UN 1 982 C 23350 Y Y 07/01/2025 216.00 151.20 190.08 116.64 116.64 481 85 REMOVAL OF DRUG IMPLANT 4810085 1 982 C 11982 Y Y 07/01/2025 "1,365.00" 955.50 " 1,201.20 " 737.10 737.10 481 87 TX ROOM FB RMVL SIMPLE 4810087 761 C 10120 Y Y 07/01/2025 322.00 225.40 283.36 173.88 173.88 481 89 F.B. – SUBCUT SIMPLE 4810089 982 C 10120 Y Y 07/01/2025 470.00 329.00 413.60 253.80 253.80