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Financial Service Staff at 812-801-0161 Monday - Friday 8am - 4:30pm

LOCATION CHARGE# DESCRIPTION CPT CHARGE

HOSPITAL KDH0000017 INSERT FOLEY CATHETER; SIMPLE 51702 141.05$

HOSPITAL KDH0000081 ADMINISTER HEP B VACCINE 90471 39.00$

HOSPITAL 100998 ROOM - PRIVATE 1,056.00$

HOSPITAL 101301 ROOM-HOSPICE RESPITE 1,162.55$

HOSPITAL 101303 ROOM-HOSPICE P/S MGMT 1,162.55$

HOSPITAL 102254 OP NURSE ASSESSMENT 99211 154.40$

HOSPITAL 102263 ARTHROCENTESIS 357.80$

HOSPITAL 603819-B TD ADMINISTRATION - ADULT 90471 39.00$

HOSPITAL 603916-B MMRV VACCINE ADMINISTRATION 90471 39.00$

HOSPITAL 604876-B HEPATITIS B VACCINE ADMIN 39.00$

HOSPITAL 606855-B INFLUENZA ADMINISTRATION G0008 39.00$

HOSPITAL 606856-B ADMIN ANY ROUTE 1ST VACC / TOX 90460 39.00$

HOSPITAL 606945-B PNEUMOCOCCAL VACCINE ADMIN 90471 39.00$

HOSPITAL 607798-B TD ADMINISTRATION - ADULT 90471 39.00$

HOSPITAL KDH0000009 UNNA BOOT APPLICATION 29580 248.30$

HOSPITAL KDH0000011 COLLECT BLOOD IMPLANT PORT 36591 129.55$

HOSPITAL KDH0000012 COLLECT BLOOD FROM PICC 36592 109.65$

HOSPITAL KDH0000013 DECLOT PICC 473.40$

HOSPITAL KDH0000015 BLADDER IRRIGATION 51700 313.75$

HOSPITAL KDH0000016 INSERT BLADDER CATH-STRAIGHT 51701 141.05$

HOSPITAL KDH0000019 BLADDER US NON-IMAGING 51798 221.70$

HOSPITAL KDH0000020 INFUSION HYDRATE OPO 1ST HR 96360 375.20$

HOSPITAL KDH0000021 INFUSION HYDRATION 1ST HR SCH 96360 375.20$

HOSPITAL KDH0000023 INFUSION HYDRATION >90 MIN 96361 29.60$

HOSPITAL KDH0000024 INFUSION HYDRATE > 90 MIN SCH 96361 29.60$

HOSPITAL KDH0000025 INFUSION THER 1ST HR OPO 96365 522.40$

HOSPITAL KDH0000026 INFUSION THER 1ST HR SCHED 96365 522.40$

HOSPITAL KDH0000027 INFUSION THER >90 MIN OPO 96366 23.20$

HOSPITAL KDH0000028 INFUSION THER >90 MIN SCHED 96366 23.20$

HOSPITAL KDH0000029 INFUSION SEQUENTIAL 96367 145.00$

HOSPITAL KDH0000030 INFUSION CONCURRENT 96368 145.00$

HOSPITAL KDH0000031 INJECTION SQ/IM 96372 115.05$

HOSPITAL KDH0000032 INJECTION IV INITIAL 96374 212.25$

HOSPITAL KDH0000033 INJECT IV EA ADD'L DIFF DRUG 96375 192.90$

HOSPITAL KDH0000034 IV INJECT EACH ADD'L SAME DRUG 96376 192.90$

HOSPITAL KDH0000035 PORT FLUSH 96523 118.30$

HOSPITAL KDH0000036 VAC NEG PRESS WND TX<50 CM 97605 408.35$

HOSPITAL KDH0000038 CENTRAL LINE-SUBCLAVIAN INSERT 1,337.35$

HOSPITAL KDH0000039 LUMBAR PUNCTURE (SPINAL TAP) 830.90$

HOSPITAL KDH0000040 OBSERVATION > 1ST HOUR 7.20$

HOSPITAL KDH0000041 OBSERVATION 1ST HOUR 890.40$

HOSPITAL KDH0000043 PICC INSERT ATTEMPT 1,253.70$

HOSPITAL KDH0000044 PICC INSERTION SUCCESSFUL 1,253.70$

HOSPITAL KDH0000045 THORACENTESIS 838.50$

HOSPITAL KDH0000046 APPLY MULTLAY COMPRS LWR LEG 29581 248.30$

HOSPITAL KDH0000047 TRANSCUTANEOUS TEMP PACING 92953 663.25$

HOSPITAL KDH0000048 CARDIOVERSION 854.60$

HOSPITAL KDH0000051 INITIAL VACCINE ADMINISTRATION 90471 39.00$

HOSPITAL KDH0000052 ADMINISTER FLU VACCINE 90471 39.00$

HOSPITAL KDH0000053 ADMINISTER PNEUMONIA VACCINE 90471 39.00$

HOSPITAL KDH0000054 BLOOD TRANSFUSION/DAY 36430 886.85$

HOSPITAL KDH0000055 BLOOD TRANS 1ST HR SCHED 36430 890.40$

HOSPITAL KDH0000056 BLOOD TRANS >1 HR SCHED 36430 7.20$

HOSPITAL KDH0000058 CAPILLARY BLOOD DRAW 36416 14.15$

HOSPITAL KDH0000060 TRANSVENOUS TEMP PACER INSERT 8,560.95$

HOSPITAL KDH0000061 TRANSVENOUS PACER REMOVAL 2,465.75$

HOSPITAL KDH0000064 CAST APPLICATION 335.55$

HOSPITAL KDH0000069 RN ASSESSMENT 99211 154.40$

HOSPITAL KDH0000071 FOLEY CATH SPECIMEN COLLECTION 19.20$

HOSPITAL KDH0000079 GENETIC COUNSELING 96040 45.30$

HOSPITAL KDH0000082 I & D (BEDSIDE) 280.50$

HOSPITAL KDH0000085 IMMUNIZATION ADM; EA ADDTL VAC 90472 39.00$

HOSPITAL KDH0000086 RECOVERY - EXTENDED INITIAL HR 247.65$

HOSPITAL KDH0000087 RECOVERY-EXTENDED EACH ADDL HR 37.65$

HOSPITAL KDH0000092 FRACTURE/DISLOCATION CARE 1,556.90$

HOSPITAL KDH0000094 BLOOD TRANSFUSION 1 UNIT 36430 851.35$

HOSPITAL KDH0000095 BLOOD TRANSFUSION 2 UNITS 36430 1,315.10$


2020-01





HOSPITAL KDH0000098 SPLINT STRAPPING APPLICATION 205.00$

HOSPITAL KDH0000100 REMOVE TNL CV CATH 734.65$

HOSPITAL KDH0000102 RABIES ADMINISTRATION >18 90471 39.00$

HOSPITAL KDH0000103 RABIES ADMINISTRATION <18 90460 39.00$

HOSPITAL 100491 HOSPICE PAIN/SYMPTOM MGMT- 3S 958.70$

HOSPITAL 100492 HOSPICE RESPITE - OP (3S) 971.30$

HOSPITAL 100997 ROOM - PRIVATE 4MSI 1,056.00$

HOSPITAL 101302 ROOM-HOSPICE RESPITE (IP-4MSI) 1,162.55$

HOSPITAL 101304 ROOM-HOSPICE P/S MGMT(IP-4MSI) 1,162.55$

HOSPITAL 606855-B INFLUENZA ADMINISTRATION 39.00$

HOSPITAL 100805 OBSERVATION OB MOD 1HR 890.40$

HOSPITAL 100806 OBSERVATION OB HIGH 1HR 890.40$

HOSPITAL 100811 NEWBORN HEARING SCREEN 92587 312.95$

HOSPITAL 100813 OBSERVATION OB MOD >1HR 7.20$

HOSPITAL 100814 OBSERVATION OB HIGH >1HR 7.20$

HOSPITAL 100815 ULTRASOUND LIMITED (OB) 76815 288.15$

HOSPITAL 100827 NON STRESS TEST - FETAL 59025 363.70$

HOSPITAL 100830 OB ASSESSMENT 1ST HOUR 99211 889.95$

HOSPITAL 100831 OB ASSESSMENT > 1 HR 99211 6.95$

HOSPITAL 100843 VERSION; EXTERNAL 59412 2,778.20$

HOSPITAL 100844 OXYTOCIN CHALLENGE 59020 199.70$

HOSPITAL 100856 ANESTHESIA EPIDURAL OB 1,868.55$

HOSPITAL 100862 CAR SEAT TEST 60 MIN 94780 80.50$

HOSPITAL 100863 CAR SEAT ADD'L 30 MIN 94781 12.00$

HOSPITAL 100864 INSERT CERVICAL DILATOR 59200 356.30$

HOSPITAL 100866 RHOGAM INJECTION 96372 66.05$

HOSPITAL 100999 ROOM - PRIVATE 2MBS 1,056.00$

HOSPITAL 355980 MONITOR FETAL 664.95$

HOSPITAL 356200 MONITOR INTERNAL FETAL 637.40$

HOSPITAL 357010 MONITOR INFANT 466.00$

HOSPITAL 190102 LABOR ROOM INITIAL 24 HOURS 1,981.00$

HOSPITAL 190103 LABOR >24 HRS ea add'l hr 82.50$

HOSPITAL 190104 DELIVERY 2,894.80$

HOSPITAL 190105 DELIVERY OF PLACENTA 59414 2,642.75$

HOSPITAL 100850 NURSERY LEVEL 1 1,305.00$

HOSPITAL 100906 OBSERVATION ICU 1ST HR 1,752.50$

HOSPITAL 100909 OBSERVATION ICU >1HR 13.50$

HOSPITAL 101211 ROOM - PRIVATE ICU 2,063.00$

HOSPITAL 101221 ROOM - PRIVATE DISCHARGED ICU 1,056.00$

HOSPITAL 210016 ARTHROSCOPY, O/P 1,939.45$

HOSPITAL 210017 ORGAN AND/OR TISSUE PROCUREMEN 576.35$

HOSPITAL 210024 SIGMOIDOSCOPY 699.35$

HOSPITAL 210025 LAP CHOLE 5,681.25$

HOSPITAL 210026 MINOR SURGERY 3,548.65$

HOSPITAL 210027 MINOR SURGERY EACH ADDL 1/2 HR 881.30$

HOSPITAL 210028 TRABECULOTOMY 10,133.45$

HOSPITAL 210036 3M ARTHROSCOPY PUMP 297.45$

HOSPITAL 210042 MAJOR SURGERY 5,158.95$

HOSPITAL 210043 MAJOR SURGERY EACH ADDL 1/2 HR 1,791.55$

HOSPITAL 210085 SYNEVAC VACUUM 974.65$

HOSPITAL 210090 OR SCOPE 206.40$

HOSPITAL 210096 CANCELLED PROCEDURE/RN ASSESSM 99201 182.25$

HOSPITAL 210247 CATARACT SURGERY WITHOUT LENS 6,524.55$

HOSPITAL 210576 ASTIMATISM RELAXING INCISION 2,503.00$

HOSPITAL 212035 SPECIAL PROCEDURE 847.10$

HOSPITAL 219500 LITHOTRIPSY - SURGERY 27,412.15$

HOSPITAL 220041 RECOVERY TEE PROCEDURE (SURG) 693.60$

HOSPITAL 309909 STELKAST HEADLESS PIN SC2110-1 972.85$

HOSPITAL 309910 STELKAST HOLD SCREW SC3520-55 972.85$

HOSPITAL 323255 ITS 52MM LOCK CANCELLOUS SCREW 1,494.45$

HOSPITAL 350006 ROD RUSH 456.20$

HOSPITAL 350028 LENS INTEROCULAR +27.5D 012481 755.85$

HOSPITAL 350065 PIN STEINMAN 101.75$

HOSPITAL 350091 DRILL AIR 419.80$

HOSPITAL 350097 CAST, SPICA 1,263.70$

HOSPITAL 350123 MESH FLAT 3X5 000172 305.45$

HOSPITAL 350138 MESH FLAT 14X10 000348 859.70$

2020-01




HOSPITAL 350162 WIRE EYE PRE CUT 803.75$

HOSPITAL 350201 ENDO GIA RELOAD 536.85$

HOSPITAL 350206 LINVATEC ARTHROSCOPY BUR 309.75$

HOSPITAL 350209 SYNTHES SCREW 2.7 576.45$



HOSPITAL 350217 SYN DRILL BIT 2.0 & 2.7 713.00$

HOSPITAL 350219 SYNTHES DRILL BIT 1.8 & 2.4 1,086.40$

HOSPITAL 350220 BEATH PIN 232.10$

HOSPITAL 350226 LINVATEC STAPLE 722.50$

HOSPITAL 350232 SUTURE RETRIEVER 173.65$

HOSPITAL 350234 INTERCEED 1,058.75$

HOSPITAL 350242 ETHICON LIGA CLIP SM/MED/LG 327.55$

HOSPITAL 350245 ETHICON EEA 21,25 1,417.15$

HOSPITAL 350251 ETHICON TX 30 609.65$

HOSPITAL 350252 ETHICON ROTICULATOR 55 994.50$

HOSPITAL 350253 ETHICON ENDOCLIP ML (ER320) 581.80$

HOSPITAL 350254 ETHICON TLH90 626.70$

HOSPITAL 350255 ETHICON TX30V 605.00$

HOSPITAL 350262 ETHICON LAP CHOLE OTKD11 556.05$

HOSPITAL 350266 EHTICON ENDO TLC 55 630.50$

HOSPITAL 350267 NITINOL STONE EXT 1,393.70$

HOSPITAL 350272 ETHICON ENDO SHEAR DC512 882.95$

HOSPITAL 350273 ETHICON TROCAR 5MM 348.95$

HOSPITAL 350280 TROCAR ETHICON HASSON 153.25$

HOSPITAL 350283 CUTTER ENDOPATH 45MM 004869 1,168.55$

HOSPITAL 350284 ETHICON ENDO-GIA LU #TR35W 419.80$

HOSPITAL 350291 ETHICON TA60-3.5 #TX60B 551.05$

HOSPITAL 350294 MEROCEL KENNEDY SINUS PACK 108.50$

HOSPITAL 350299 ETHICON GIA 80 #TLL75 810.25$

HOSPITAL 350300 BARDEEX PIGTAIL STENT 1,178.35$

HOSPITAL 350301 ETHICON GIA 80-3.5 LU #TCR75 432.35$

HOSPITAL 350307 TISSEL 5ML KIT 2,398.55$

HOSPITAL 350308 TISSEL DUOFLO SPRAY SET 627.65$

HOSPITAL 350309 TISSEL DUOCATH 602.25$

HOSPITAL 350310 SILVERSTEIN MONOPOLAR PROBE 548.95$

HOSPITAL 350311 SILVERSTEIN NERVE STIMULATOR 262.90$

HOSPITAL 350314 BARD INLAY URETERAL STENT 826.25$

HOSPITAL 350316 ETHICON TLH 60 551.05$

HOSPITAL 350319 ETHICON ENDO SCISSORS DLS12 448.10$

HOSPITAL 350320 ETHICON RETRIEVAL BAG PRO46 421.50$

HOSPITAL 350326 MEROGEL NASAL DRESSING & STENT 714.00$

HOSPITAL 350327 EPIFILM LAMINA 005003 1,301.75$

HOSPITAL 350367 STRYKER MIXING BOWL (306-553) 398.15$

HOSPITAL 350375 STRYKER 2000 SAW BLADE 508.15$

HOSPITAL 350376 CUTTING LOOP OLYMPUS (A2139) 652.30$

HOSPITAL 350377 CUTTING LOOP OLYMPUS (A22201C) 891.60$

HOSPITAL 350392 STRYKER DENTAL BUR #229100421 52.00$

HOSPITAL 350393 BUR DENTAL 005321 450.85$

HOSPITAL 350394 BOVIE EXTEND VAC 005326 105.05$

HOSPITAL 350396 VENT HERNIA PATCH MD 5950008 1,344.55$

HOSPITAL 350405 SYN COUNTERSINK 3.5 1,197.95$

HOSPITAL 350406 COUNTERSINK 1,445.25$

HOSPITAL 350407 SYN CONTERSINK MALLEOLAR 712.35$

HOSPITAL 350427 COOK OPEN END URET CATH 934.40$

HOSPITAL 350429 HARMONIC SCALPEL DH105 620.05$

HOSPITAL 350430 LAP CHOLE HARMONIC SCAPEL 1,652.30$

HOSPITAL 350431 OPEN HARMONIC SCAPEL 2,359.65$

HOSPITAL 350433 PACEMAKER, ENTITY DR 5326L 19,539.45$

HOSPITAL 350435 PACEMAKER, AFFINITY DR 5330L/R 20,428.65$

HOSPITAL 350438 PACEMAKER,AFFINITY SR, 5130L/R 17,761.10$

HOSPITAL 350439 PACEMAKER,INTEGRITY SR 5142 20,428.65$

HOSPITAL 350440 PACEMAKER, INTEGRITY SR 5136 21,762.25$

HOSPITAL 350444 PACEMAKER,AFFINITY SR 5131M/S 18,138.30$

HOSPITAL 350446 PACEMAKER,TRILOGY DR 2360L-64L 29,575.70$

HOSPITAL 350447 PACEMAKER,ITEGRITY Afx DR 5342 22,676.60$

HOSPITAL 350448 PACEMAKER,INTEGRITY DP 5336 26,652.75$

HOSPITAL 350449 PACEMAKER, AV PLUS DX 1368 4,437.70$

2020-01




HOSPITAL 350451 PACEMAKER LEAD TENDRIL 1346T 3,092.20$

HOSPITAL 350452 PACEMAKER LEAD TENDRIL 1388T 3,092.20$

HOSPITAL 350453 PACEMAKER LEAD TENDRIL SDX1488 3,092.20$

HOSPITAL 350459 ULTRABLATOR 90* ESA-5339 474.75$

HOSPITAL 350460 RANFAC NONSLEEVED XL-11 157.80$

HOSPITAL 350462 SCREW BIOINTERFER 10X23 006001 1,070.85$

HOSPITAL 350466 ARTH TRANSFIX IMPLANT AR1351 1,047.05$

HOSPITAL 350468 EPIDISC 14-17100 479.10$

HOSPITAL 350471 ARTHREX TRANSTIBIAL ACL KIT 609.15$

HOSPITAL 350472 ARTHREX CORING REAMER 1,546.35$

HOSPITAL 350473 ARTHREX PINS/GRAFT PASS WIRE 986.95$

HOSPITAL 350474 LAP CBDE FLURO KIT 1,566.25$

HOSPITAL 350475 LINVATEC 4.2 CUDA C9245 309.00$

HOSPITAL 350481 PACEMAKER, INTEGRITY AFX 5346 24,874.20$

HOSPITAL 350486 LINVATEC 4.8 GATOR C9362 309.00$

HOSPITAL 350498 WIRE GUIDE ROADRUNNER 586.80$

HOSPITAL 350499 DISP TOURNIQUET 34 301.05$

HOSPITAL 350503 ENDO SUCTION/IRRIGATOR STRYKER 561.95$

HOSPITAL 350521 PROLENE 6-0 8706H 43.35$

HOSPITAL 350531 PLDS STAPLER 1,138.00$

HOSPITAL 350584 4.0 CANNULATED SCREW SYNTHES 1,453.35$

HOSPITAL 350585 1.25 THREADED GD WIRE SYNTHES 606.85$

HOSPITAL 350587 2.7 CANNULATED DRILL BIT 2,720.15$

HOSPITAL 350592 COOK CUP BX FORCEP 2,388.30$

HOSPITAL 350593 COOK HELICAL STONE EXTRACTOR 880.65$

HOSPITAL 350653 VICRYL 2-0 REEL J286G 25.45$

HOSPITAL 350740 CHROMIC GUT 3-0 922H 26.55$

HOSPITAL 350799 PLATE LUHR STR 824.90$

HOSPITAL 350812 BONE CEMENT PLAIN 909.30$

HOSPITAL 350820 BONE CEMENT LVC 776.15$

HOSPITAL 350847 RESTRICTOR 981.65$

HOSPITAL 350849 PROLENE 8-0 M8741 418.15$

HOSPITAL 350856 TROCAR 5MM 529.30$

HOSPITAL 350874 TROCAR 10-11MM 722.00$

HOSPITAL 350880 PLATE LUHR T 737.15$

HOSPITAL 350881 SCREW LUHR 2.0 MINI 402.05$

HOSPITAL 350882 PLATE LUHR FRAG 925.90$

HOSPITAL 350884 PLATE LUHR MCS STR 1,471.55$

HOSPITAL 350885 PLATE LUHR L/PL L 17.5-37.0 1,003.20$

HOSPITAL 350886 PLATE LUHR CURVED 785.05$

HOSPITAL 350887 PLATE LUHR DOUBLE T 1,114.95$

HOSPITAL 350888 PLATE LUHR L/PL R 17.5-37.0 1,003.20$

HOSPITAL 350890 LUHR MINI TEMPLATE 529.65$

HOSPITAL 350892 SCREW LUHR 2.7 CORT 10-14 583.55$

HOSPITAL 350897 SCREW LUHR 3.0 CORT 10-14 691.70$

HOSPITAL 350907 PLATE LUHR COVER 30-45 1,471.55$

HOSPITAL 350927 LUHR CURVED TEMPLATE 30-45 467.95$

HOSPITAL 350931 LUHR 1.5 DRIL W/STOP 8-20 819.30$

HOSPITAL 350942 CHROMIC GUT 0 944H 39.85$

HOSPITAL 350956 VICRYL 6-0 J489G 38.65$

HOSPITAL 350959 SYN DRILL BIT 3.2MM (#310.31) 700.00$

HOSPITAL 350961 DENTAL WIRE 218.50$

HOSPITAL 350969 DUALMESH GRAFT 15 X 19 cm 4,066.85$

HOSPITAL 350973 MERSILENE SUTURE 5MM RS22 182.60$

HOSPITAL 350974 TOTAL HIP FEM HEAD 26MM 5-40 2,517.60$

HOSPITAL 350975 CEMENTED HIP #1-#7 10,809.55$

HOSPITAL 350976 DISTAL CENTRALIZER 11-22MM 1,045.70$

HOSPITAL 350981 CLUSTER SHELL 46MM-68MM 5,095.35$

HOSPITAL 350983 TOTAL KNEE BONE SCREW 954.55$

HOSPITAL 350984 ACETUBLAR INSERT 26M P2-7 2,777.65$

HOSPITAL 350988 FEMORAL COMPONENT R&L SM-XXL 18,459.10$

HOSPITAL 350990 INFUSA PORT 7 & 9.6 FR 1,824.10$

HOSPITAL 350991 TIBIA B/P NON P/C S1-L2 7,242.20$

HOSPITAL 350992 TOTAL KNEE STAB BOX S-XXL 1,733.45$

HOSPITAL 350993 DISTAL FEMORAL LOCKING SCREW 756.40$

HOSPITAL 350994 TIBIAL INSERT SM-XL 9-16M 4,049.20$

HOSPITAL 350995 PATELLAR INSERT SM-XL 4,040.65$

HOSPITAL 350996 LIPPED TIBIAL INSERT S-XL 9-19 3,559.35$

2020-01




HOSPITAL 351009 LACRIMAL INBUTATION SET 650.85$

HOSPITAL 351011 TIBAL HUMERAL ROD 2,842.95$

HOSPITAL 351036 DOUBLE BASIN PACK (006818) 327.80$

HOSPITAL 351039 SYN DCP PLATE 11 HOLE #226.61 2,106.05$

HOSPITAL 351040 PACEMAKER IDENTITY XL DR 5376 26,105.75$

HOSPITAL 351051 POLY GIA 75 030775 566.20$

HOSPITAL 351052 ENDO UNIVERSAL 65 733.80$

HOSPITAL 351058 SYN CONDYLAR PLATE 7 HOLE R&L 3,067.00$

HOSPITAL 351059 SYN CONDYLAR PLATE 9 HOLE R&L 3,320.65$

HOSPITAL 351062 KUGEL HERNIA PATCH LG 1,464.85$

HOSPITAL 351066 BILIARY STONE KIT 866.05$

HOSPITAL 351079 ACL INSTRUMENTS 360.65$

HOSPITAL 351080 ACL ARROW 555.50$

HOSPITAL 351096 TUBE ARTHROSCOPY LINVATEC 787.45$

HOSPITAL 351101 YAG LASER VISION SURGICAL 1,975.05$

HOSPITAL 351102 DRILL BIT TK 4 5800-4-125" 950.85$

HOSPITAL 351108 DRILL BIT TK 8 5800-8-125" 950.85$

HOSPITAL 351132 PACEMAKER IDENTITY STJUDE 5172 22,086.20$

HOSPITAL 351133 ENDOLOOP EJ10 (AUTO SUTURE) 546.20$

HOSPITAL 351137 VENT SM CIRCLE PATCH 5950007 2,294.20$

HOSPITAL 351138 GORE-TEX SUTURE CV-0 0N07A 152.30$

HOSPITAL 351144 SERF LAT 3.5M 951.85$

HOSPITAL 351146 SERF 90 3.5 967.80$

HOSPITAL 351147 SYN TEMPLATE SM (329.87) 664.15$

HOSPITAL 351148 ARTH BIOINT SCREW8X28 AR1380TB 665.90$

HOSPITAL 351149 SYN CANNULATED 7.3x16MM SCREW 1,916.85$

HOSPITAL 351154 ENDOCLOSE 79.10$

HOSPITAL 351156 SYN CANNULATED 7.3x32MM SCREW 1,916.85$

HOSPITAL 351158 SYN CORTICAL SCREW 4.5M 478.75$

HOSPITAL 351159 SYN LAG SCREW 12MM 2,435.75$

HOSPITAL 351160 SYN LAG SCREW 14MM 2,707.80$

HOSPITAL 351161 SYN COMPRESSION SCREW 280.99S 913.95$

HOSPITAL 351162 SYN WASHER 13.0M (219.99) 559.65$

HOSPITAL 351163 SYN 2.8 FLUTTED GUIDE WIRE 998.15$

HOSPITAL 351164 SYN 5.0 CAN DRILL BIT (310.63) 2,736.70$

HOSPITAL 351165 SYN 2.8 THREADED GUIDE WIRE 702.95$

HOSPITAL 351166 SYN CAN 7.3 COUNTERSINK 2,753.10$

HOSPITAL 351167 SYN CAN 7.3 TAP (311.68) 2,259.15$

HOSPITAL 351169 SYN 2.5 GUIDE WIRE 900.723 743.35$

HOSPITAL 351170 SYN SIDE PLATE 2-6 HOLES (HIP) 3,643.40$

HOSPITAL 351171 SYN SIDE PL 135* 8-12 HOLES 3,139.50$

HOSPITAL 351172 SYN SIDE PL 135* 14 HOLES 6,085.70$

HOSPITAL 351173 SYN CAN SCREW 4.5 X 20-72 1,506.45$

HOSPITAL 351174 SYN WASHER 10.0M (219.91) 546.20$

HOSPITAL 351175 SYN TAP for 4.5 CAN SCREW 2,865.50$

HOSPITAL 351176 SYN DRILL BIT 1.5M (310.16) 713.00$

HOSPITAL 351177 SYN GUIDE WIRE 150M 603.50$

HOSPITAL 351179 SYN CAN COUNTERSINK 4.5 2,229.70$

HOSPITAL 351180 SYN BONE VOID FILLER 3CC 3,619.80$

HOSPITAL 351184 SYN BONE FILLER DELIVERY NEEDL 618.65$

HOSPITAL 351185 WRAP DURA KNEE COLD 000006 753.95$

HOSPITAL 351187 SYN TROCH STABLE PLATE 3,474.35$

HOSPITAL 351192 DEPUY HIP HEAD 2,960.95$

HOSPITAL 351193 DEPUY HEAD BI POLAR CUP 3,458.65$

HOSPITAL 351194 SYN CERCLAGE BUTTON (298.805S) 1,094.60$

HOSPITAL 351195 SYN CERCLAGE POS PIN (298.839S 1,094.55$

HOSPITAL 351196 SYN CABLE W/CRIMP (298.801.10) 2,975.70$

HOSPITAL 351198 ARTH TWIST IN CANNULA AR-6535 557.90$

HOSPITAL 351199 STRYKER RESECTOR (004539) 344.05$

HOSPITAL 351243 SYN LCP PLATE 6 HOLE 223.561 2,221.05$



HOSPITAL 351251 SYN LCP RECONST 12H 245.121 2,756.55$

HOSPITAL 351252 SYN LCP T PLATE 3X5H 241.151 2,176.15$

HOSPITAL 351253 SYN LCP T PLATE 3X4H 241.361 2,242.05$

HOSPITAL 351254 SYN LCP 1/3 TUBE 6H PL 241.361 1,613.80$

HOSPITAL 351255 SYN LCP 1/3 TUBE 7H PL 241.371 1,226.45$

HOSPITAL 351257 SYN LCP 1/3 TUBE 12HPL 241.421 1,337.50$

2020-01




HOSPITAL 351259 SYN 3.5 LOCKING SCREW 10-60M 1,205.60$


HOSPITAL 351265 SYN DRILL BIT 2.8 (310.288) 888.05$

HOSPITAL 351266 LASER UROLOGY FIBER 4,858.00$

HOSPITAL 351267 LASER UROLOGY STANDBY 1,926.75$

HOSPITAL 351270 WHITTMANN PATCH WP2040 6,352.00$

HOSPITAL 351271 SEPRA FILM GENZYME (4301-02) 652.30$

HOSPITAL 351272 TUNA CARTRIDGE KIT 1900TU 5,098.60$

HOSPITAL 351274 URETHRAL SUPPORT AL R BRD100R 3,768.75$

HOSPITAL 351276 COOK URETERAL ACCESS SHEATH 921.70$

HOSPITAL 351278 DEXON MESH 1,277.20$

HOSPITAL 351279 COOK 2 LUMEN URETH CATH 10FR 538.95$

HOSPITAL 351280 SYN CERCLAGE WIRE 1.5 291.11 803.75$

HOSPITAL 351283 LUHR CUR PLATE 21-50M 831.45$

HOSPITAL 351284 BARD STENT W/ SUTURE 6X22-28 593.05$

HOSPITAL 351289 LASER SHIELD TRACH TUBE 1,287.85$

HOSPITAL 351290 NASAL SPLINT (DOYLE) 432.45$

HOSPITAL 351291 SYN TAP (311.66) 1,878.30$

HOSPITAL 351292 SYN TAP 3.5 (311.32) 1,134.25$

HOSPITAL 351295 SYN 10 HOLE 1/3 TUBE (241.401) 1,294.05$

HOSPITAL 351296 SYN BROAD LC-DCP 226.64 1,727.90$

HOSPITAL 351298 HOWMEDICA 6.5 CANC SCREW16-60M 977.60$

HOSPITAL 351300 BARD GRASPING FORCEP 3F 857.80$

HOSPITAL 351301 BARD STONE BASKET 2.4F 1,222.50$

HOSPITAL 351302 DRILL BIT ZIMMER 4.8 #2318-48 502.20$

HOSPITAL 351304 SYN SAW BLADE (532046) 637.60$

HOSPITAL 351305 SYN DCP PLATE 6 HOLE (224.56) 1,405.05$

HOSPITAL 351306 SYN LCP 1/3 TUBE PL 8H 1,294.05$

HOSPITAL 351307 SYN LCP PL 1/3 TUBE PL 5H 1,613.80$

HOSPITAL 351308 HOWMEDICA TRIDENT INSERT 28 DI 4,894.10$

HOSPITAL 351309 COOK TUOHY-BORST ADAPTER 356.05$

HOSPITAL 351311 LAP DISC HAND ACCESS DEVICE 2,178.80$

HOSPITAL 351312 LAP DISC HAND ACCESS LNG LD112 2,334.45$

HOSPITAL 351318 COOK BX BRUSH 3.2FR 40710 760.55$

HOSPITAL 351321 COOK URET BRUSH BX 30 degree 775.75$

HOSPITAL 351323 TOTAL HIP TRIDENT SHELL 6,646.05$

HOSPITAL 351324 FALOPE RING BAND APPLIER 542.40$

HOSPITAL 351325 PACEMAKER MICRONY 2525T 22,086.20$

HOSPITAL 351326 PACEMAKER TENDRIL 1388K 3,092.20$

HOSPITAL 351327 DEPUY WIRE PASS DRILL 5605-31- 930.50$

HOSPITAL 351328 BUR DENTAL 007522 582.95$

HOSPITAL 351329 MORCELLATOR 2,760.95$

HOSPITAL 351346 SYN 3.5 LCP PLATE 223.571 2,308.00$

HOSPITAL 351347 SYN DCS 95 DGREE PLT 6-10 HOLE 6,079.05$

HOSPITAL 351348 SYN DCS 95 DGREE PLT 12-14 HO 6,825.00$

HOSPITAL 351351 TAUT .035 GUIDEWIRE 337.25$

HOSPITAL 351352 INTERSTIM STIMULATOR 3625 3,534.85$

HOSPITAL 351353 INTERSTIM SNS LEAD KIT 3889 14,671.15$

HOSPITAL 351355 INTERSTIM INTRODUCER KIT 35501 1,454.95$

HOSPITAL 351356 INTERSTIM ACCESSORY KIT 355002 627.65$

HOSPITAL 351361 INTERSTIM PT PROGRAMMER 4,424.00$

HOSPITAL 351362 INTERSTIM ANTENNA 784.25$

HOSPITAL 351363 INTERSTIM PROGRAMMER PKG 2,211.55$

HOSPITAL 351364 INTERSTIM TEST LEAD 3057 1,202.25$

HOSPITAL 351365 INTERSTIM LEAD TEST KIT 3065U 1,597.85$

HOSPITAL 351367 SYN RECON PLATE 7 HOLE 245.071 3,177.55$

HOSPITAL 351368 INTERSTIM CONTROL MAGNET 7452 697.35$

HOSPITAL 351369 SYN COUNTERSINK FOR 2.7 310.87 1,445.35$

HOSPITAL 351371 GYRUS ST BLADE 70138000 411.90$

HOSPITAL 351372 GYRUS CONVERX BL 40* 70138006 513.70$

HOSPITAL 351373 GYRUS CONCAVE BL 40* 70138008 418.90$

HOSPITAL 351374 ZIMMER DRILL BIT 2.7 504.65$

HOSPITAL 351375 HOWMEDICA TOTAL HIP FEM HEAD 3,212.35$

HOSPITAL 351377 BARD COMPOSIX MESH 4X6 2,468.15$

HOSPITAL 351378 BARD COMPOSIX MESH 7X9 5,862.35$

HOSPITAL 351380 BRUSH BIOPSY 3.2F 007617 541.00$

HOSPITAL 351382 ARTH TWIST CANNULA 557.90$

HOSPITAL 351388 SYN K WIRE 2.0X150M (492.20) 1,011.05$

2020-01




HOSPITAL 351389 SYN LC-DCP BROAD PL 4H 224.54 1,245.75$

HOSPITAL 351391 SYN LC-DCP NARROW PL 7H 224.57 2,339.45$



HOSPITAL 351395 SYN LC-DCP NARROW PL 11H224.61 1,825.20$

HOSPITAL 351396 SYN LC-DCP NARROW PL 12H224.62 1,825.20$

HOSPITAL 351397 SYN LC-DCP BOARD PL 6H 226.56 1,907.15$

HOSPITAL 351398 SYN LC-DCP BOARD PL 7H (226.57 2,066.55$



HOSPITAL 351402 SYN LC-DCP BOARD PL 10H 226.60 2,298.25$

HOSPITAL 351403 SYN LC-DCP BROAD PL12H (226.62 2,106.05$

HOSPITAL 351404 SYN T PLATE 4 HOLE (240.14) 2,148.60$

HOSPITAL 351405 SYN T PLATE 6 HOLE (240.16) 2,192.65$

HOSPITAL 351408 BARD OPTIMA STENT 768.45$

HOSPITAL 351412 GIA 60 STAPLER 2,597.75$

HOSPITAL 351419 Syn EX fix 2.5 k wire (292.75) 1,342.35$

HOSPITAL 351420 SYN EX FIX 200M BAR (395.77) 1,130.20$

HOSPITAL 351421 SYN EX FIX 140M BAR (395.74) 553.35$




HOSPITAL 351426 SYN EX FIX SPRING NUTS (395.58 502.75$

HOSPITAL 351427 SYN EX FIX 5.0 SCREW (294.54) 521.75$

HOSPITAL 351428 SYN EX FIX 3.0/4.0 SCRW 294.30 933.35$

HOSPITAL 351429 SYN EX FIX 4.0 CLAMPS (395.54) 2,332.10$

HOSPITAL 351430 SYN EX FIX 4.0 OPN CLMP 395.54 2,130.80$

HOSPITAL 351435 STRYKER INSUFULATION HEAT TUBE 291.75$

HOSPITAL 351436 LASER CO2 2,709.05$

HOSPITAL 351440 SYN DBX PUTTY 5CC 038050 2,864.30$

HOSPITAL 351442 HOWMEDICA HEADLESS PIN76502035 602.50$

HOSPITAL 351444 INDIGO LASER & FIBER 7,150.75$

HOSPITAL 351449 STRYKER EGG BUR 4.0 1607-2-35 624.10$

HOSPITAL 351452 FALOPE-RING BANDS ACMI FRB-30 157.85$

HOSPITAL 351453 TRIPOLAR CUTTING FORCEP TRU532 1,763.95$

HOSPITAL 351458 PACEMAKER VERITY XL 5157 M/S 22,086.20$

HOSPITAL 351460 PACEMAKER IDENTITY DDDR 5370 26,105.75$

HOSPITAL 351461 PACEMAKER ISOFLEX S LEAD 1646T 3,092.20$

HOSPITAL 351463 CRICOTHYROTOMY ANESTH CATH 956.00$

HOSPITAL 351464 COOK AIRWAY EXCHANGE CATHETER 665.60$

HOSPITAL 351472 BARD INLAY STENT 7X26 777726 727.95$

HOSPITAL 351473 SYN DBX PUTTY 2.5CC 2,187.75$

HOSPITAL 351478 CATH HEYMAN FOLLOWER CATH 760.85$

HOSPITAL 351483 SYN 6 HOLE T-PLATE 1,250.60$

HOSPITAL 351484 SYN LCP RECON 5 HOLE PLATE 2,621.25$

HOSPITAL 351485 SYN NUT FOR 4.5 SCREW 219.96 593.35$

HOSPITAL 351491 BARD INLAY STENT 788628 727.95$

HOSPITAL 351494 BARD STONE BASKET 043313 1,158.10$

HOSPITAL 351497 SYN CAN COUNTERSINK 310.86 2,143.15$

HOSPITAL 351504 DEPUY DRILL BIT 5/16 733.10$

HOSPITAL 351506 VERSASTEP 5MM VS101005 009700 589.20$

HOSPITAL 351508 PACEMAKER VERITY 5356 21,052.85$

HOSPITAL 351517 THERMAL ABLATION 007984 3,606.10$

HOSPITAL 351533 PACEMAKER VERITY AD XL SR 5156 33,166.75$

HOSPITAL 351534 INFRAVISION URETERAL KIT 1,260.10$

HOSPITAL 351535 STRYKER COLD KNIFE 0502880502 876.85$

HOSPITAL 351537 STRYKER COLIN KNIFE 0504880800 392.65$

HOSPITAL 351541 STRYKER 30* CUT LOOP 050488040 363.40$

HOSPITAL 351545 STRYKER E KITS 220180540 1,139.90$

HOSPITAL 351546 HARMONIC SCAPLE ACE36E 2,484.05$

HOSPITAL 351547 ENDO CONTOUR STAPLER CS40B BLU 2,060.75$

HOSPITAL 351548 GREEN STAPLER RELOAD CS40G 794.80$

HOSPITAL 351555 TAUT PERITONEAL CATH PL-128 357.00$

HOSPITAL 351556 PACEMAKER IDENTITY DR 5386 26,105.75$

HOSPITAL 351563 SYN SIDE PL 130* 6 H 281.060S 3,643.40$

HOSPITAL 351565 GREEN LIGHT LASER AND FIBER 12,487.95$

HOSPITAL 351566 VENT T TUBES 10-26011 365.10$

HOSPITAL 351567 COLLAGRAFT LARGE 5,077.45$

2020-01




HOSPITAL 351569 VENTRALEX HERNIA PATCH 10301 1,608.05$

HOSPITAL 351570 ENT BLADE DETATCH HOUSE N0522H 528.95$

HOSPITAL 351571 VENTRALEX HERNIA PATCH M 10302 3,199.90$

HOSPITAL 351578 VERSATACK 4.8 000146 1,131.60$

HOSPITAL 351579 STAPE PORP W/ CRADLE 70141014 1,453.50$

HOSPITAL 351588 DORNHOFFER TORP 8.2M 70145843 1,783.35$

HOSPITAL 351590 ENDO CONTOUR STAPLER CS40G GRN 1,570.85$

HOSPITAL 351591 SILICONE SHEET 55X75 20-10680 101.35$

HOSPITAL 351592 SILICONE SHEET 38X51 20-10685 66.75$

HOSPITAL 351595 VASCULAR INTRODUCER 9FR 405116 297.60$

HOSPITAL 351597 NERVE BLOCK CATH KIT AB05060PK 434.05$

HOSPITAL 351602 ESSURE BIRTH CONTROL SYSTEM 6,078.05$

HOSPITAL 351605 U DRAPE ENT 3642089301 62.25$

HOSPITAL 351606 PREMASORB OPEN 0113099 1,199.95$

HOSPITAL 351607 PERMASORB LAPARSCOPIC 0113092 1,244.05$

HOSPITAL 351610 CUTTING LOOP 30* 27F 504884412 346.15$

HOSPITAL 351617 PORT SEAL VALVE 503888001 415.10$

HOSPITAL 351620 RICHARDS BUCKET HANDLE PROSTH 742.30$

HOSPITAL 351622 RICHARDS BUCKET HANDLE PROSTHE 742.30$

HOSPITAL 351623 DORNHOFFER PORP 5M MID EAR PRO 1,698.55$

HOSPITAL 351629 RICHARDS BUCKET HANDLE 4 X.6 1,446.75$

HOSPITAL 351630 RICHARDS BUCKET HANDLE 4.0 x.4 1,446.75$



HOSPITAL 351634 SUTURE PDS II 4-0 Z494G 49.60$

HOSPITAL 351635 SUTURE PDS II 5-0 Z493G 69.90$

HOSPITAL 351637 PACEMAKER VICTORY XL DR 5816 25,620.10$

HOSPITAL 351639 STJUDE TENDRIL LEAD 1488TC 3,368.70$

HOSPITAL 351640 DRAPE ISOLATION W POUCH 527.95$

HOSPITAL 351641 BUR 1MM 008377 731.75$

HOSPITAL 351642 SYN RECON 8 HOLE PLT 245.081 3,313.65$

HOSPITAL 351643 PACEMAKER TENDRILL 1688T/46 SD 4,096.20$

HOSPITAL 351644 ENT DIAMOND BUR 703.70$

HOSPITAL 351646 BUR DIAMOND 1MM 008384 717.80$

HOSPITAL 351647 SYN CAN 4.5 DRILL BIT 310.66 2,720.15$

HOSPITAL 351648 DRILL BIT MITEK GII 211093 832.45$

HOSPITAL 351650 NOVASURE ABLATION CATH NS2000 3,991.15$

HOSPITAL 351651 NOVASURE ABLATION CATH NS2007 5,717.55$

HOSPITAL 351652 TUBE ENDOBRONCHIAL 41F LEFT 633.25$

HOSPITAL 351654 PACEMAKER IDENTITY ADX SR 5180 23,338.80$

HOSPITAL 351655 PACEMAKER LEAD 1688TC/52 3,092.20$

HOSPITAL 351656 BOVIE BIPOLAR TISSUE 231021 1,785.70$

HOSPITAL 351661 STRYKER LIFT HEAD 26MM 3,862.00$

HOSPITAL 351662 STRYKER HIP STEM 6,485.25$

HOSPITAL 351663 STRYKER INTER HEAD (hip comp) 3,183.70$

HOSPITAL 351664 STRYKER BIPOLAR 3,891.20$

HOSPITAL 351665 WAND EVAC XTRA 008467 957.75$

HOSPITAL 351666 COBLATOR ARTHOCARE EIC4845 957.75$

HOSPITAL 351668 VERSASTEP 11MM VS101011P 09699 704.20$

HOSPITAL 351670 LIGASURE ADV 5M LF5544 009703 3,021.70$

HOSPITAL 351671 DEPUY CENTRALIZER 11 127620000 751.70$


HOSPITAL 351676 PACEMAKER STJ UNIFY CD3231-40Q 109,171.30$

HOSPITAL 351677 PACEMAKER LEAD DURATA 7120Q/52 21,305.10$

HOSPITAL 351678 PACEMAKER ACCENT RF PM1210 22,274.55$

HOSPITAL 351706 PACEMAKER TENDRILL 1688TC/58 3,092.20$

HOSPITAL 351707 ACCU-CUT GUIDE 16911 780.70$

HOSPITAL 351708 SYN LCP PLATE 14H 189M 2,707.30$

HOSPITAL 351709 SYN K WIRE 1.6M X 150M 292.71 1,216.80$

HOSPITAL 351710 SYN LCP T PLATE 241.931 2,151.45$

HOSPITAL 351711 SYN LCP T PLATE 3H/4H 241.941 2,250.30$







HOSPITAL 351718 SYN LCP TPLATE 4H/4H 241.141 2,317.55$

2020-01





HOSPITAL 351721 RETRACTOR RINGS 742.40$

HOSPITAL 351724 BARD FILIFORM TIP 2-6F 482.40$

HOSPITAL 351726 BARD PHILLIP THREAD TIP 021524 620.30$

HOSPITAL 351727 SYN LCP DISTAL PL SHORT 5,258.90$

HOSPITAL 351732 MITEK-DEPUY DRILL BIT 211083 696.25$

HOSPITAL 351734 SYN 2.4 LOCK SCREW 6-30M 1,121.35$

HOSPITAL 351736 SYN RADIUS PL ST 242.479 2,691.30$

HOSPITAL 351738 SYN LCP RADIUS PL ST 242.490 2,839.70$

HOSPITAL 351739 SYN LCP L PL 242.500 2,744.85$

HOSPITAL 351740 SYN LCP RADIUS L PL 242.501 2,876.75$


HOSPITAL 351743 PACEMAKER VICTORY DUAL 5810 28,631.90$

HOSPITAL 351744 STRYKER MINI SAW BL 5400031171 795.40$



HOSPITAL 351747 SYN LCP L PL 242.503 2,876.75$

HOSPITAL 351748 SYN DRILL BIT 1.8 310.509 1,464.85$

HOSPITAL 351750 CHOLANGIOGRAM CATH REDDICK 346.80$

HOSPITAL 351751 SYN DRILL BIT 2.0 310.21 803.75$

HOSPITAL 351752 SYN EX FIX PIN 294.769 1,607.35$

HOSPITAL 351753 SYN EX FIX 200M ROD 03304320S 8,593.00$

HOSPITAL 351754 SYN EX FIX 220M ROD 03304322S 8,593.00$









HOSPITAL 351766 SYN LCP RADIUS T PLATE 242.477 2,839.70$

HOSPITAL 351768 SYN LCP VOLAR PLATE 242.458 3,502.35$







HOSPITAL 351776 BAKRI BALLON JSOS100500 1,307.85$

HOSPITAL 351778 PLUG C-AFP-0 0.6X9.5 anal fist 3,579.35$

HOSPITAL 351780 PACK ARTHROSCOPY 433.15$

HOSPITAL 351781 LAP CHOLE AEROSTAT CATH W/TROC 351.60$

HOSPITAL 351783 INTERSTIM PT PROGRAMMER 3037 5,102.50$

HOSPITAL 351784 PACEMAKER TENDRIL ST 1788T 3,789.85$

HOSPITAL 351785 INTERSTIM ANTENNA 37092 832.70$

HOSPITAL 351786 INTERSTIM NEUROSTIMULATOR 3058 48,202.25$

HOSPITAL 351793 FASCIAL CLOSURE DEVIC CTI-512N 463.60$

HOSPITAL 351794 STAPLER ECHELON EC60A 008736 1,383.25$

HOSPITAL 351795 PACEMAKER INTEGRITY ADX 5360 25,263.50$

HOSPITAL 351796 ENT HARMONIC SHEAR 2,624.55$

HOSPITAL 351797 PACEMAKER LEAD; TENDRIL 1782TC 3,789.85$

HOSPITAL 351799 PACK HIP 767.70$

HOSPITAL 351800 DEPUY GUIDE WIRE 3.2x6 141806 424.30$

HOSPITAL 351801 DEPUY SCFE BONE SCREW 55-110 M 1,405.70$

HOSPITAL 351803 LUHR DRILL BIT 1.5 68856120 846.35$




HOSPITAL 351807 PROLENE HERNIA MESH 968255 1,528.90$

HOSPITAL 351809 LIGAMAX 5 ENDO CLIP EL5ML 753.95$

HOSPITAL 351810 SUTURE ANCHOR 008837 5,415.00$

HOSPITAL 351813 ENDO POUCH CD001 008863 298.75$

HOSPITAL 351814 ENDO ENDOCLIP ML CA090 008862 549.75$

HOSPITAL 351816 SHEAR ENDO 5MM 008870 188.05$

HOSPITAL 351817 GRASPER ENDO 5MMX32CM 008871 235.45$

HOSPITAL 351822 SYN HUMERAL PL 3 HOLE 9,236.00$

HOSPITAL 351823 BARD 3DMAX MESH LG 1,363.25$

2020-01




HOSPITAL 351825 ENDO BALLOON OMSPDBS2 1,646.35$

HOSPITAL 351826 ENDO BALLOON TROCAR OMST10SB 860.75$

HOSPITAL 351828 Q PAIN PUMP PM012-A 530.60$

HOSPITAL 351829 PACK SHOULDER (KIMBERLY CLARK) 459.70$

HOSPITAL 351830 SYN EX FIX 140 MM BAR 849.55$

HOSPITAL 351832 MINI ARC SLING AMS 720046-01 4,192.50$

HOSPITAL 351834 KIT TRANSTIBIAL 008945 1,006.00$

HOSPITAL 351839 STRYKER MED SAW BLADE 22963111 514.95$

HOSPITAL 351841 BARD SOFT MESH 3X6 374.80$



HOSPITAL 351844 ETHICON ATS45 RELOAD 339184 537.45$

HOSPITAL 351845 SYN 135*3H SIDE PL 281.530S 2,408.15$

HOSPITAL 351847 PACEMAKER LEAD 1888TC 3,092.20$

HOSPITAL 351848 PACEMAKER VICTORY 5610 26,521.35$

HOSPITAL 351854 BARD 3DMAX MESH MEDIUM 1,276.50$

HOSPITAL 351858 COOK SOFT STENTS 728.50$

HOSPITAL 351859 BARD VENTRALEX HRNA PTCH10303 3,048.10$

HOSPITAL 351865 DORNOFFER FOOTPLATE 7014-3254 2,806.35$

HOSPITAL 351866 INTERSTIM MEDICAL ADHESIVE 416.35$

HOSPITAL 351867 SPLINT,NASAL AQUAPLAST 458.10$

HOSPITAL 351869 ARTHREX 5.5 SCREW W/WIRE SUTUR 594.50$

HOSPITAL 351873 COOK RETRIVAL SAC 8X10 G11327 637.65$

HOSPITAL 351874 ECHELON 60 RELOAD ECR60W 579.05$

HOSPITAL 351875 PACEMAKER ZEPHYR DR 5820 25,620.10$

HOSPITAL 351876 COOK CUTTING LOOP CL241212OL 346.45$

HOSPITAL 351878 PACEMAKER ISOFLEX LEAD 1948/52 3,092.20$

HOSPITAL 351879 GYRUS GYN HANDPIECE 920005 1,852.35$

HOSPITAL 351881 PACEMAKER TENDRIL 1888TC/58 3,975.70$

HOSPITAL 351882 SUTURE FIBERLOP ARTHREX AR7234 185.75$

HOSPITAL 351887 ENDO MULTIFIRE HERNIA 861.75$

HOSPITAL 351889 ETHICON ENDOCLIP EL5ML 004808 791.45$

HOSPITAL 351891 ENDO LAP CHOLE TROCAR's 008892 995.25$

HOSPITAL 351892 CLIP ENDO LIGA 008941 555.10$

HOSPITAL 351900 SYN 2.5 REAMING ROD 351707S 1,127.75$

HOSPITAL 351901 SYN 3.2 GUIDE WIRE 400M 357399 946.40$

HOSPITAL 351902 SYN 3 FLUTE DRILL 260M 357.407 1,477.50$

HOSPITAL 351904 SYN TI END CAP 0mm 456.311s 1,492.00$

HOSPITAL 351905 SYN TI END CAP 5mm 456.312S 1,490.95$

HOSPITAL 351906 PACEMAKER LEAD ISOFLEX 1948/58 3,092.20$

HOSPITAL 351907 SYN 10 x 170 TRO NAIL 456.315S 8,197.50$

HOSPITAL 351908 SYN 11/170TI TROC NAIL 456318S 8,197.50$

HOSPITAL 351909 SYN 11/285TI TROC NAIL 456328S 8,197.50$

HOSPITAL 351910 WOLF CUTTING LOOPS 8424.1310 331.35$

HOSPITAL 351911 WOLF KNIFE ELECTRODE 8423.1905 541.35$

HOSPITAL 351912 WOLF COAFULATING ELE 8423.0205 617.75$

HOSPITAL 351914 SYN 11M TI HELICAL BLADE 2,777.15$

HOSPITAL 351916 SYN TI 5M LOCK SCREW 1,284.40$

HOSPITAL 351917 ST JUDE SAFE SHEATH HLS-1008 442.95$

HOSPITAL 351918 PACEMAKER LEAD 1648T/52 3,092.20$

HOSPITAL 351919 CATH FOLEY DAVIS 0187L 009759 925.60$


HOSPITAL 351922 PACEMAKER ZEPHYR SR 5620 26,503.55$

HOSPITAL 351925 COLLAMEND GRFT 10x15cm 1175112 9,276.35$

HOSPITAL 351930 COLLAMEND GRAFT 6X8CM 1175113 15,570.85$

HOSPITAL 351931 COLLAMEND GRAFT 7x9cm 1175114 21,843.40$

HOSPITAL 351932 COLLAMEND GRAFT 8x10cm 1175115 22,956.50$

HOSPITAL 351933 ALLOMAX GRAFT 1180020 5,035.85$

HOSPITAL 351935 GELPORT W/ALEXIS WND RETRC8XX2 2,370.00$

HOSPITAL 351936 COLPO PNEUMO OCCLUDER CPO-6 311.30$

HOSPITAL 351937 COOPER SURGICAL RUMI TIP 304.60$

HOSPITAL 351946 SUTURE PDS 1 BLUNT PDPB880G 70.50$

HOSPITAL 351947 BLADE SAGITTAL 009380 630.60$

HOSPITAL 351954 ZIMMER DRILL 2.0 2318-020-06 258.05$

HOSPITAL 351958 3DMAX MESH GRAFT LG LEFT 1,296.00$

HOSPITAL 351959 3DMAX MESH GRAFT LG RIGHT 1,270.15$

HOSPITAL 351960 BLUE CONTOUR RELOAD CR40B 1,205.95$

HOSPITAL 351961 SYN VOLAR RADI PLATE L 242.483 3,326.40$

2020-01




HOSPITAL 351962 SYN DORSAL RAD PLATE L 242.482 4,038.20$

HOSPITAL 351963 SYN VOLAR RADI PLATE R 242.473 3,326.40$

HOSPITAL 351964 SYN DORSAL RAD PLATE R 242.472 4,038.20$

HOSPITAL 351965 SYN 1.8M BUTTRESS PINS 940.55$

HOSPITAL 351966 SYN CORTEX SCREW 2.4 12M-30M 728.20$

HOSPITAL 351967 SYN 11/340 R TI TRCH NAIL9528 10,785.60$

HOSPITAL 351970 SYN 11/380 R TI TROCH NAIL9530 10,785.60$

HOSPITAL 351971 SYN 11/400 R TI TRCH NAIL9531 10,785.60$

HOSPITAL 351972 SYN 11/340 L TI TRCH NAIL9532 10,785.60$



HOSPITAL 351976 PACER BIOTRONIK EVIA DR 359524 20,193.20$

HOSPITAL 351978 PACER BIOTRONIK EVIA SR 359531 18,931.05$

HOSPITAL 351979 LEAD, BIOTRONIK SETROX PACER 2,524.25$

HOSPITAL 351980 LEAD, BIOTRONIK AROX PACER 2,524.25$

HOSPITAL 351981 LEAD, BITRONIK SELOX PACER 2,524.25$

HOSPITAL 351982 RD180 RUNNING DEVICE 021100 946.70$

HOSPITAL 351990 INTERSTIM QUAD LEAD KIT 388933 14,671.15$

HOSPITAL 351992 SHEATH URETRAL ACCESS 009688 922.90$

HOSPITAL 351994 PACEMAKER,STJUDE ACC RF PM2210 24,260.35$

HOSPITAL 351995 GORE BIO-A TISSUE GRAFT FS0915 3,065.85$

HOSPITAL 351997 MALYUGAN RING 991.50$

HOSPITAL 352024 PACK ORTHO MINOR 387.15$

HOSPITAL 352025 PIN DRILL 009804 2,219.15$

HOSPITAL 352026 GYRUS MOD ENT T TUBE 70241072 135.85$

HOSPITAL 352028 PUSHER KNOT/SUTURE 009807 843.10$

HOSPITAL 352030 ARTHREX MENISCAL CINC AR-4500 1,437.45$

HOSPITAL 352031 ST JUDE SAFE SHEATH HLS 1006 428.85$

HOSPITAL 352032 ALCON TORIC LENS SN6AT8 755.85$

HOSPITAL 352034 SENSOR GUIDEWIRE ST 316.75$

HOSPITAL 352036 DILATOR URETERAL 009816 1,153.35$

HOSPITAL 352037 DILATOR S CURVE 009817 1,313.55$

HOSPITAL 352045 STENT INLAY 00930 974.85$

HOSPITAL 352046 CATHETER BALLOON DIL 6M 009836 1,602.60$

HOSPITAL 352048 BARD STONE BASKET 042313 1,209.85$

HOSPITAL 352049 CATHETER BALLOON DIL 5M 009836 1,198.50$

HOSPITAL 352050 BS ACTION PUMPING SYSTEM702100 728.20$

HOSPITAL 352052 BARD AQUA GUIDE 55 CM 131155 757.00$

HOSPITAL 352053 CATHETER URETERAL 009858 484.10$

HOSPITAL 352056 ENDOPOUCH 5ML CD003 300.05$

HOSPITAL 352058 GYRUS OTOMIMIX BONE FILLER 1,680.30$

HOSPITAL 352059 DEPUY SUMMIT PF #2-8 4,749.90$

HOSPITAL 352060 DEPUY SUMMIT CEM # 2-8 4,749.90$

HOSPITAL 352061 ZIM PSS TOTAL 6,436.80$

HOSPITAL 352062 ZIM PSS CANCEL 1,639.20$

HOSPITAL 352068 MEPILEX AG 4X4 DRESSING 47.55$

HOSPITAL 352071 WOUND VAC MIN DISP PICO 4X8 2,441.70$

HOSPITAL 352073 WOUND VAC MINI DISP PICO 4X12 1,253.25$

HOSPITAL 352116 VASCULAR INTRODUCER 8 FR 683.35$

HOSPITAL 352117 VASCULAR INTRODUCER SET 292.20$

HOSPITAL 352147 DAVOL/FLAT MESH 1 X 4 337.10$

HOSPITAL 352171 TRAY UMBILICAL ARTERY (002810) 692.80$

HOSPITAL 352174 TRAY CHEST INSERTION ONLY PEDS 1,810.15$

HOSPITAL 352176 TRAY CHEST TUBE INSERTION ONLY 306.00$

HOSPITAL 352272 PLATE 1/3 TUBULAR 6 HOLE 524.70$


HOSPITAL 352275 ZIM SHO LINER 00434903600 5,909.70$

HOSPITAL 352276 DRILL BIT 2MM-4.5MM 700.00$

HOSPITAL 352279 ZIM HUM STEM 00434903611 31,733.20$

HOSPITAL 352282 SYN TAP 4.5MM (311.46) 2,843.55$

HOSPITAL 352284 SYN SCREW CORTEX 3.5MM 488.85$

HOSPITAL 352288 SCREW CANCELLOUS 411.35$

HOSPITAL 352290 SCREW CORTEX 4.5MM 478.75$

HOSPITAL 352292 SCREW CANCELLOUS 3.5 411.35$

HOSPITAL 352296 SCREW CANCELLOUS 32MM THREADED 581.55$

HOSPITAL 352303 SYN CORTEX SCREW 27 X 6 541.10$

HOSPITAL 352304 SCREW MINI CORTEX 1.5MM 536.10$

HOSPITAL 352306 CORTEX SCREW 536.20$

2020-01




HOSPITAL 352312 SYN MINI WASHER 7MM 505.70$

HOSPITAL 352314 PLATE MINI 1/4 TUB 3 HOLE 764.85$





HOSPITAL 352328 PLATE MINI 1/4 TUB 8 HOLE 1,030.55$

HOSPITAL 352340 PLATE MINI L OBL L/R 839.40$

HOSPITAL 352342 PLATE MINI T 930.45$

HOSPITAL 352344 PLATE MINI STR 3 HOLE 839.40$



HOSPITAL 352350 SYNTHES K-WIRE .6MM 758.35$

HOSPITAL 352352 SYNTHES K-WIRE MINI 292.08 758.35$

HOSPITAL 352354 SYN DRILL BIT 1.1 & 1.5 713.00$

HOSPITAL 352358 DRILL BIT 2.0 & 2.7 803.15$

HOSPITAL 352360 TAP 1.5-2.0 MINI 965.75$

HOSPITAL 352362 TAP 2.7 MINI 1,134.25$

HOSPITAL 352456 PLATE SMALL T 4 HOLE 1,879.65$

HOSPITAL 352468 PLATE T BUTTRESS 8 HOLE 2,967.45$

HOSPITAL 352514 PLATE SEMI TUBULAR 5 HOLE 802.35$

HOSPITAL 352518 SCREW CANCELLOUS 16 MMTH 259.35$

HOSPITAL 352520 SCREW MALLOELAR 541.10$

HOSPITAL 352526 PLATE DCP 8 HOLE 97MM 1,112.40$

HOSPITAL 352528 PLATE DCP 10 HOLE 121MM 1,189.70$

HOSPITAL 352536 COVENTRY STAPLES 386.65$

HOSPITAL 352554 BLADES/BURS STRYKER 1,305.75$

HOSPITAL 352653 VISI PORT TROCAR 1,021.55$

HOSPITAL 352689 DRAIN TRIPLE LUMEN 000221 428.55$

HOSPITAL 352690 STRY ACE INSERT 36M 6230036F 6,240.85$

HOSPITAL 352691 STRY ACE 6 HIP STEM 60580637D 8,737.15$

HOSPITAL 352692 STRY ACE UNI SPACER 12 908.50$

HOSPITAL 352693 STRY FEM HEAD 36M 35700436 6,240.85$

HOSPITAL 352694 ITS CAN SCREW 5.9 1,494.45$

HOSPITAL 352696 ITS GUIDEWIRE 3.5X280 768.55$

HOSPITAL 352697 ITS 4.5 CORT LOCK SCREW 16-50M 908.50$

HOSPITAL 352698 ITS 4.5 CORT LOCK SCREW 50-90M 1,077.20$

HOSPITAL 352699 ITS PLATE 4 HOLE LEFT 213224 6,824.65$

HOSPITAL 352700 ETEX EQUIVABONE 766022 19,240.55$

HOSPITAL 352701 STELKAST BIPOLAR HIP 18,154.95$

HOSPITAL 352702 ITS CORT SCREW 4.5 768.55$

HOSPITAL 352703 STRY FEM STEM 5 67200535 13,480.10$

HOSPITAL 352705 SN LOCK SCREW 3.5 73825 1,194.00$

HOSPITAL 352706 SN NONLOCK SCRWE 3.5 73824 461.00$

HOSPITAL 352707 SN DISTAL TIBIAL PL 16 HOLE 11,842.05$

HOSPITAL 352708 SN 2.7 SHORT DRILL 71173502 850.10$

HOSPITAL 352709 SN 2.7 DRILL W/QC 7173503 1,018.80$

HOSPITAL 352710 SN TARGETER K WIRE 2.7 1.6X260 350.80$

HOSPITAL 352711 SN TARGETER 2.7 DRILL BIT 1,096.65$

HOSPITAL 352712 BARD MULTI LENGTH STENT 778400 937.25$

HOSPITAL 352713 PREVENA WOUND SYSTEM 2,487.75$

HOSPITAL 352714 MED 2.5 DRILL BIT A3733 713.80$

HOSPITAL 352715 MED 2.5 NONLOCK CORT SCREW 778.30$

HOSPITAL 352716 MED L RADIAL PLATE 4,105.55$

HOSPITAL 352718 SYN GUIDEWIRE 1.1 606.85$

HOSPITAL 352719 SYN 2.0 DRILL BIT 2,621.25$

HOSPITAL 352720 SYN 3.0 HEADLESS SCREW 2,188.50$

HOSPITAL 352721 ZIM TOT SHO SCREW 4.5 1,014.90$

HOSPITAL 352722 ITS 3.3. DRILL BIT 72442210 1,226.40$

HOSPITAL 352723 ITS 6.5 CANNULATED SCREW 6516 2,123.85$

HOSPITAL 352724 ITS 6.5 GUIDEWIRE 102527 768.55$

HOSPITAL 352725 STRY ACE SHELL 48M 5421148D 6,240.85$

HOSPITAL 352726 STRY ACE LINER 38M 6260038 7,489.00$

HOSPITAL 352727 STRY HIP STEM 2 67210230 13,480.10$

HOSPITAL 352728 STRY FEM HEAD 22.2 +8 62609322 3,063.70$

HOSPITAL 352729 STRY MDM LINER 38D 12362244 7,489.00$

HOSPITAL 352730 SYN TI 13M RETRO FEM NAIL 6,931.65$

HOSPITAL 352731 SYN TI END CAP T40 5003000S 1,525.75$

2020-01




HOSPITAL 352732 SYN 5.0 LOCK SCREW 54M 1,607.90$

HOSPITAL 352733 SYN 4.2 3 DRILL BIT 3010061 1,240.90$

HOSPITAL 352734 SYN 4.2 3 DRILL BIT 3010104 1,738.20$

HOSPITAL 352735 STRY CEMENT HIP STEM NO 5 8,737.15$

HOSPITAL 352736 STRY CLUSTER ACE SHELL5421146D 6,240.85$

HOSPITAL 352737 STRY FEM HEAD 62609136 3,063.70$

HOSPITAL 352738 STRY ACE INSERT 6230036 6,240.85$

HOSPITAL 352739 BUTLERS ORAL ROUND BUR 30068 53.55$

HOSPITAL 352740 STRY TIB INSERT 5530G509 6,240.85$

HOSPITAL 352741 STRY PATELLA A29 551G299 3,494.85$

HOSPITAL 352742 STRY TIB BASPLATE 5520B500 6,240.85$

HOSPITAL 352743 STRY FEM COMP NO 6 5517F602 13,729.65$

HOSPITAL 352744 STRY HIP STEM NO 2 60570230D 8,737.15$

HOSPITAL 352745 STRY FEMORAL HEAD +0 62609122 3,063.70$

HOSPITAL 352746 PARCUS 5.5 SUTURE ANCHOR10356T 1,692.65$

HOSPITAL 352747 ITS CAN SCREW 4.0X60 3140460 2,108.60$

HOSPITAL 352748 ITS CAN SCRW 4.0X30 3140430 1,257.45$

HOSPITAL 352749 ARTHREX TIGHTROPE AR8926SS 3,631.05$

HOSPITAL 352750 ST JUDE ASSURITY PM1240 11,965.80$

HOSPITAL 352757 HICKMAN CATH 9.6 FR 600564 1,544.35$

HOSPITAL 352758 STR ADAPTER SLEEVE 6519T025 1,443.15$

HOSPITAL 352759 STR FEM HEAD 65191036 6,240.85$

HOSPITAL 352760 STR ACE INSERT 6230036G 6,240.85$

HOSPITAL 352761 BIOCOMPOSITE RAPID CURE 620010 7,406.45$

HOSPITAL 352762 DEPUY THREAD PINS 950502303 2,133.25$

HOSPITAL 352763 ST JUDE ASSURITY PM2240 15,060.35$

HOSPITAL 352764 ART SOFT SCREW AR1400H25 924.15$

HOSPITAL 352765 CUTTER FLIP 11M 011316 1,692.65$

HOSPITAL 352766 ART FLIP CUTTER 11M 1,571.75$

HOSPITAL 352767 ART FIBERSNARE AR 7209SN 972.85$

HOSPITAL 352768 ENT DIAMOND BUR 5M S5DC 733.30$

HOSPITAL 352769 ZIM 2.5 DRILL 62631491 1,202.15$

HOSPITAL 352770 ZIM 2.5 PIN 4740902501 1,122.00$

HOSPITAL 352771 ZIM SHO BASE PL 00434901500 11,089.80$

HOSPITAL 352772 ZIM SHO CAN DRILL 47430906115 1,402.50$

HOSPITAL 352773 ZAIM GLENOSPHERE 00434903611 6,930.25$

HOSPITAL 352774 ZIM TOT SHO CANN DRILL 1,692.65$

HOSPITAL 352775 ZIM SHO LINER 434903600 5,909.75$

HOSPITAL 352777 ZIM TOT SHO BASE PL 434902502 13,244.85$

HOSPITAL 352779 STR GAMMA DRILL 13203042S 1,441.20$

HOSPITAL 352780 STR GAMMA K WIRE 12106450S 1,421.05$

HOSPITAL 352781 STR GAMA TI NAIL 31251180S 8,532.90$

HOSPITAL 352782 STR GAMMA LAG SCREW 306000085S 3,482.55$

HOSPITAL 352783 STR GAMMA LOCK SCREW 18965032S 1,525.45$

HOSPITAL 352784 AOS GUIDE PIN 32M 0100 804.60$

HOSPITAL 352786 AOS GALILEO TOOL 0457 933.95$

HOSPITAL 352787 AOS TROCHNAIL R 1067365 9,407.65$

HOSPITAL 352788 AOS GALILEO LAG SCREW 85M 2,607.70$

HOSPITAL 352790 BIT DRILL 4.0 011349 1,373.45$

HOSPITAL 352791 AOS CORT SCREW 5.0X34 8001034 1,528.30$

HOSPITAL 352793 ITS WASHER 6.5 913002 207.55$

HOSPITAL 352794 ART T3 AMZ AR 13217 2,942.00$

HOSPITAL 352795 ART K WIRE AR8941K 220.55$


HOSPITAL 352797 ART4.5 CANNULATED SCREW AR8945 1,304.25$

HOSPITAL 352798 STELKAST TIB INSERT SC34533510 5,776.55$

HOSPITAL 352799 DEPUY TIB INSERT 158124008 5,632.20$

HOSPITAL 352800 STRYKER HIP STEM 60580435D 8,737.15$

HOSPITAL 352801 SYN MATRIX SCREW 2.4M 733.30$

HOSPITAL 352802 SYN MINI PL 2X2 503750 2,203.50$

HOSPITAL 352803 SYN CRESENT PL 503711 2,273.60$

HOSPITAL 352804 SYN MATRIX 1.0 DRILL 503477 1,434.05$

HOSPITAL 352805 SYN MATRIX 2.4 DRILL BIT503481 1,239.35$

HOSPITAL 352806 MYOSURE CLASSIC 10401 5,343.35$

HOSPITAL 352807 STRY HIP STEM 67200635 13,480.10$

HOSPITAL 352808 ART SOFT SCREW 9X25 AR1390H 924.15$

HOSPITAL 352809 ARTHREX DISTAL BICEPS AR2260 4,035.45$

HOSPITAL 352810 ALAMO TISSUE GRAFT PS652FF 9,469.50$

2020-01




HOSPITAL 352811 SYN CLAVICLE PL 7 HOLE02112083 3,907.00$

HOSPITAL 352812 AOS SHORT NAIL 10X130 1040200 8,747.45$

HOSPITAL 352813 ZIM HUMERAL STEM 434811313 18,889.85$

HOSPITAL 352814 ZIM GLENOID COMP 432604046 8,982.00$

HOSPITAL 352815 SYN DISTAL HUMERUS PL02104028S 6,230.80$

HOSPITAL 352816 STRY ACE INSERT TOTAL 6231036E 6,240.85$

HOSPITAL 352817 STRY HIP STEM TOTAL 60203535 13,480.10$

HOSPITAL 352818 STRY FEM HEAD TOTAL 65700536 6,240.85$

HOSPITAL 352819 ZIM HUMERAL HEAD 43004621 7,263.45$

HOSPITAL 352820 STELKAST EXTRA TIBIA 6,189.25$

HOSPITAL 352821 STRYKER BIPOLAR 26X47 UH14726 3,724.55$

HOSPITAL 352822 ZIM REVERSE STEM 434901013 31,733.20$

HOSPITAL 352823 AOS ES NAIL 1066365 9,407.65$

HOSPITAL 352824 MEDA FEM STEM NO2 00118232 13,203.65$

HOSPITAL 352825 CUTTER FLIP 10M 011547 1,571.75$

HOSPITAL 352826 MEDA ACE SHELL 50 M 012650MB 5,157.70$

HOSPITAL 352827 MEDA FEM HEAD 28M 0129201 3,300.90$

HOSPITAL 352828 MEDA ACE LINER 28M 01262850MHC 4,332.45$

HOSPITAL 352829 MED FEM STEM NO4 0118234 13,203.65$

HOSPITAL 352830 MED ACE SHELL 54M 012654MB 5,157.70$

HOSPITAL 352831 MED FEM HEAD 28M 01262854MHC 4,332.45$

HOSPITAL 352832 MED ACE LINER 0128202 3,300.90$

HOSPITAL 352834 ART LASSO 45 AR406845L3 908.50$

HOSPITAL 352835 ZIM NEXGEN FEM COMP 596801752 8,046.00$

HOSPITAL 352836 ZIM NEXGEN ART SUR 596242210 6,249.15$

HOSPITAL 352837 ZIM NEXGEN TIB COMP 59804702 3,245.30$

HOSPITAL 352838 AOS ES NAIL 10X42 1066425 9,407.65$

HOSPITAL 352839 AOS BALL NOSE GUIDE 101900S 1,373.45$

HOSPITAL 352840 AOS ES NAIL RT 11X39 1059395 9,407.65$

HOSPITAL 352842 ZIM NEXGEN PATELLA 59726532 21,212.45$

HOSPITAL 352843 ITS WASHER 4.5X11 36431 671.25$

HOSPITAL 352844 ITS 55M CAN SCREW 31404 1,595.95$

HOSPITAL 352845 ITS DRILL BIT 2.5X180 768.55$

HOSPITAL 352846 MEDACTA FEM STEM 118233 13,203.65$

HOSPITAL 352847 SYN 3.7 LOCK SCREW 1,252.40$

HOSPITAL 352848 SYN HUMERUS PL 2 2123021 6,405.15$

HOSPITAL 352849 MEDECTA FEM HEAD 28M1282848MHC 4,332.45$

HOSPITAL 352850 MEDECTA FEM SHELL 12648MB 5,157.70$

HOSPITAL 352851 MEDA FEM STEM 3 118153 12,378.40$

HOSPITAL 352852 GUIDEWIRE SOLO .035 011616 248.15$


HOSPITAL 352854 MEDA FEM HEAD 125012 0 2,888.35$


HOSPITAL 352860 STRY HIP STEM 2.5 60202530 13,480.10$

HOSPITAL 352861 STRY ACE INSERT 6,240.85$

HOSPITAL 352862 STRY TIB BEARING 6 5530G611 6,240.85$

HOSPITAL 352863 STRY FEM CRUCIATE 6 5517F601 13,729.65$

HOSPITAL 352864 STRY TIB BASEPL 6 5521B600 7,449.00$

HOSPITAL 352865 STRY FEM STEM 12M 5560S112 4,892.00$

HOSPITAL 352866 STR TIB BEARING 6 5530G609 6,240.85$

HOSPITAL 352867 STRY TIB BASE PL 6 5520B600 6,240.85$

HOSPITAL 352868 BIT DRILL CANN 5.0 013679 1,663.60$

HOSPITAL 352869 AOS DRILL 5.0 0209200 1,837.75$

HOSPITAL 352870 AOS FEM NAIL 11X36 1059365 9,407.65$

HOSPITAL 352871 MEDA ACE SHELL 48M 12648MB 5,157.70$

HOSPITAL 352872 MEDA ACE LINER 28M 1262848MHC 4,332.45$


HOSPITAL 352874 STELKAST TIB COMP SC1586112 5,157.70$

HOSPITAL 352877 SYN 2.4 VA-LCP PLATE 02111730 6,058.45$

HOSPITAL 352878 STRY BIOPREP BONE KIT206710000 378.40$

HOSPITAL 352879 ALEXIS C8301 XSMALL 131.50$

HOSPITAL 352880 ALEXIS C8701 SM 324.50$

HOSPITAL 352881 MEDA ACE LINER 12656MB 5,157.70$

HOSPITAL 352882 MEDA ACE LINER 12622856MHC 4,332.45$

HOSPITAL 352885 MED FEM STEM 5 118235 13,203.65$

HOSPITAL 352886 ZIM NEXGEN TOTAL KNEE 23,931.50$

HOSPITAL 352889 MEDA FEM STEM 118230 13,203.65$

HOSPITAL 352891 SUN VA 2.4 LOCK SCREW 2210118 1,302.75$

2020-01




HOSPITAL 352893 MEDACTA FEM HEAD 0125011 2,888.35$

HOSPITAL 352894 ARAT INTER SCREW 7X23M AR1370C 1,305.80$

HOSPITAL 352895 SCREW INTER 9X28 011715 1,305.80$

HOSPITAL 352896 ACL TISSUE GRAFT 116614 9,902.75$

HOSPITAL 352897 ZIM HUM STEM 14X130 434901413 27,706.90$

HOSPITAL 352898 ZIM GLENOID COMP 7,715.90$

HOSPITAL 352899 ZIM HUM HEAD 4305223 7,715.90$

HOSPITAL 352901 ZIM NEXGEN DRILL PIN 590102000 2,471.60$

HOSPITAL 352902 ZIM HUM STEM 434811213 17,886.75$

HOSPITAL 352903 ZIM INVERSE SCREW 1042230 827.35$

HOSPITAL 352904 BARD SOLO FLEX TIP WIRE 247.65$

HOSPITAL 352905 BARD F/C KIT LATEX FREE303416A 139.95$

HOSPITAL 352906 HEMACLEAR MODEL A PRH032MA01A 130.60$

HOSPITAL 352907 PARCUS KNOTLESS ANCHOR 10314 1,620.10$

HOSPITAL 352908 ZIM 2.0 DRILL BIT 236017520 1,450.85$

HOSPITAL 352909 ITS CURVED WASHER 4.5X11 36432 698.05$

HOSPITAL 352910 MEDA ACE SHELL 012558MB 5,157.70$

HOSPITAL 352911 MEDA ACE LINER 012660MB 5,157.70$

HOSPITAL 352912 MEDA FEM HEAD 01262860MHC 4,332.45$

HOSPITAL 352913 MEDA FEM NECK 2 0018152 12,378.40$

HOSPITAL 352914 ZIM CAN SCREW 6.0 472484 1,431.55$

HOSPITAL 352915 ZIM NAIL 10X24 4729424010 12,836.45$

HOSPITAL 352916 ZIM TEAR DROP 3X100 4724900970 1,602.75$

HOSPITAL 352917 ZIM THREAD PIN 3.0M 249004630 953.90$

HOSPITAL 352918 ZIM DRILL 4.9 249003449 2,558.30$

HOSPITAL 352919 ZIM DRILL 4.3 249003443 1,397.70$

HOSPITAL 352920 PARCUS 5.5 PEEK ANCHOR 10324T 1,813.55$

HOSPITAL 352921 MARYLAND JAW LIGASURE LF1737 2,688.85$

HOSPITAL 352922 STRY TIB NAIL 9X360 18220936 9,886.25$

HOSPITAL 352923 MED FEM HEAD 28M 1282858MHC 4,332.45$

HOSPITAL 352924 AOS ES FEM NAIL 1066335 9,407.65$

HOSPITAL 352925 ITS CANN SCREW 35 1,291.35$

HOSPITAL 352926 SUN HUMERUS PL 3.5X160 241919 10,002.55$

HOSPITAL 352927 LITHOTRIPSY STANDBY 576.35$

HOSPITAL 352928 ITS 3 PROLOCK PL 210323 3,507.25$

HOSPITAL 352929 ITS CAN LOCK SCREW 37303 966.90$

HOSPITAL 352930 ITS 2.4 DRILL BIT DB24110 799.20$

HOSPITAL 352931 ITS CORT SCREW 37304 966.90$

HOSPITAL 352932 MED ACE SHELL 012652MB 5,157.70$

HOSPITAL 352933 MED ACE LINER 0126852MHC 4,332.45$

HOSPITAL 352934 MED ACE SHELL 0126450058 4,745.10$

HOSPITAL 352935 MED ACE SHELL 012652MB 5,157.70$

HOSPITAL 352936 MED FEM STEM 00118242 13,203.65$

HOSPITAL 352937 MED ACE LINER 01283648HCT 3,919.90$

HOSPITAL 352938 MED FLAT HEAD SCREW 25M 674.40$

HOSPITAL 352940 MED FEM HEAD 0129209 3,300.90$

HOSPITAL 352942 ART FOAM STAR SLEEVE AR1606V 746.25$

HOSPITAL 352943 TISSEL 10ML SYRINGE 1501263 2,296.35$

HOSPITAL 352944 STEM FEMORAL 3L 016007 13,203.65$

HOSPITAL 352946 MED FEM HEAD 0 129203 3,300.90$

HOSPITAL 352947 COOK FIRM STENT SETG23406 6X26 667.70$

HOSPITAL 352948 SYN 2.4 LOCK SCREW 1,302.75$

HOSPITAL 352949 SYN VOLAR PL 6X2.4 2111631 6,058.45$

HOSPITAL 352950 SYN LCP PL 6X2.4 2111531 4,063.10$

HOSPITAL 352953 BARD VACCESS INFUSAPORT7480000 1,622.20$

HOSPITAL 352954 AOS AR SCREW 8021 1,837.75$





HOSPITAL 352965 DEPUY HUMERUS 3.5MM PL02123027 10,410.55$

HOSPITAL 352966 DEPUY 3.5MM CERCLAGE PIN 1,303.70$

HOSPITAL 352968 STRY 9X345MM TIBIAL NAIL 9,886.25$

HOSPITAL 352969 STRY 8X345 TIBIAL NAIL 9,886.25$

HOSPITAL 352970 STRY 5X425MM LOCKING SCREW 1,421.90$



HOSPITAL 352973 PARCUS 3.2MM ANCHOR SUTURE 1,813.55$

2020-01




HOSPITAL 352974 ITS PROLOCK 3HOLE RIGHT RADIUS 3,507.25$

HOSPITAL 352977 ITS 22MM CANCELLOUS LOCK SCREW 966.90$

HOSPITAL 352978 DEPUY 2.4X16MM CORTEX SCREW 720.35$


HOSPITAL 352981 DEPUY 1.8X125MM DRILL BIT 1,168.00$


HOSPITAL 352983 DEPUY 36MM FEMORAL HEAD 8,132.70$

HOSPITAL 352984 DEPUY PINNACLE 36X60MM LINER 6,884.15$

HOSPITAL 352985 DEPUY PINNACLE 60MM ACET SHELL 10,915.30$

HOSPITAL 352986 DEPUY SUMMIT150MM FEMORAL STEM 20,293.10$

HOSPITAL 352987 ZIM 4.9MM CANNULATED DRILL BIT 3,292.70$

HOSPITAL 352988 ZIM 4.3MM CALIBRATED DRILL BIT 1,397.70$

HOSPITAL 352989 ZIM 11.5MMX20CM RF NAIL 12,836.45$

HOSPITAL 352990 ZIM CANC Z NAIL 6.0X75 SCREW 1,431.55$

HOSPITAL 352991 ZIM 6.0X50 CANC Z NAIL SCREW 1,431.55$

HOSPITAL 352992 COOK 5FR 22-32CM URET STENT 667.70$

HOSPITAL 352993 STRY 10X390MM TIBIA NAIL 9,886.25$

HOSPITAL 352994 ITS 3.5MM DRILL BIT 799.20$

HOSPITAL 352995 ITS 85MM CANCELLOUS SCREW 1,349.35$

HOSPITAL 352996 ITS 4HDE LEFT PROX TIBIAL 6,824.65$

HOSPITAL 352997 ITS 80MM CANCELL LOCKING SCREW 1,494.45$


HOSPITAL 352999 ITS 65MM CORTICAL SCREW 799.20$




HOSPITAL 353004 MEDACTA FEMORAL HIP STEM SZ 2 13,203.65$

HOSPITAL 353005 PARCUS 3.2MM DRILL BIT 1,427.60$

HOSPITAL 353006 ZIMMER HUMERAL STEM 10MMX130MM 15,679.30$

HOSPITAL 353007 ZIMMER HUMERAL HEAD 23MMX46MM 7,055.75$

HOSPITAL 353008 STELK FEMUR PS GENFLEX RIGHT 8,664.95$

HOSPITAL 353009 STELK TIBIA POSTER TRAY INSERT 5,982.95$

HOSPITAL 353015 STELK POSTER TIBIAL TRAY INSER 5,157.70$

HOSPITAL 353022 STELK TIBIAL KNEE SYSTEM TRAY 17,515.45$

HOSPITAL 353024 STELK FEM/TIB STEM CEMENTED 7,303.30$

HOSPITAL 353025 DEPUY CLAVICLE 3.5MM PL 4H15MM 3,191.70$

HOSPITAL 353026 DEPUY 2.4MMX20MM LOCK SCREW 1,302.75$

HOSPITAL 353027 PLATE DISTAL VOLAR 2.4MM 01200 6,058.45$

HOSPITAL 353028 STELK 3 PEG PATELLA SC159126 2,888.35$

HOSPITAL 353029 STELK TIBIA COM SC15841T1F 5,982.95$

HOSPITAL 353030 COOK FIRM STENT 6X24 SET 667.70$

HOSPITAL 353031 T-SCOPE POST-OP KNEE BRACE 847.95$

HOSPITAL 353032 ZIMMER 3.2MM DRILL BIT 1,344.60$

HOSPITAL 353034 AOS 95MM LAG SCREW 2,607.70$

HOSPITAL 353035 DEPUY COMP 3.0X26MM SCREW 2,188.50$

HOSPITAL 353036 DEPUY EX-FIX 4POS CLAMPMR 3,188.10$

HOSPITAL 353037 DEPUY LG ATTCH-MULTPIN CLAMP 2,757.30$

HOSPITAL 353038 DEPUY STEINMANN 5.0X200MM PIN 1,374.05$

HOSPITAL 353039 DEPUY SCHANZ SCREW5.0X60MM/175 1,351.95$

HOSPITAL 353040 DEPUY EXFIX LG CRBN FBRRO100MM 1,728.55$

HOSPITAL 353041 DEPUY EXFIX LG CRBNFBR RO400MM 2,037.55$

HOSPITAL 353042 ARTHREX 10X30MM SOFT SCREW 707.30$

HOSPITAL 353043 STRY V40 FEMORAL HEAD 5,576.60$

HOSPITAL 353044 STRY 14X155MM HIP STEM 13,260.90$

HOSPITAL 353045 STRY 21MM+10 V40 HIP STEM 18,503.25$

HOSPITAL 353046 CABLE SLEEVE BEAD .0MM 012026 1,746.40$

HOSPITAL 353047 AOS 32MM CORTICAL SCREW 1,528.30$

HOSPITAL 353048 AOS LT 130X10X36 ES NAIL 9,407.65$

HOSPITAL 353049 ITS RADIUS SM RT LOCK PLATE 3,507.25$

HOSPITAL 353050 ITS 3.0X14MM LOCKING SCREW 966.90$

HOSPITAL 353051 IRRISEPT SYSTEM CLEANING 1,783.30$

HOSPITAL 353052 COOK URETERAL 5FR 70CM CATH 143.40$

HOSPITAL 353053 AOS 10X39X130 E6 NAIL 9,407.65$

HOSPITAL 353054 COOK 6FR 28CM URETERAL STENT 667.70$

HOSPITAL 353055 COOK .035 NITINOL GWIRE 951.75$

HOSPITAL 353059 SYN DIST/TIB PL 4H 2118002 6,677.45$

HOSPITAL 353060 SYN 3.5X36 CORT SCREW 2206236 430.35$

HOSPITAL 353061 SYN 2.7X56 METAPHYSEAL SCREW 507.50$

2020-01




HOSPITAL 353062 SYN 2.7 VA LOCK SCREW 896.55$

HOSPITAL 353063 SYN 2.0 DRILL BIT 323062 999.35$

HOSPITAL 353064 ITS SL PL 9H 21104-9 4,122.15$

HOSPITAL 353065 MESH VENTRALIGHT 012056 6,334.45$

HOSPITAL 353066 DEP ACE SHELL 121732052 10,915.30$

HOSPITAL 353067 DEP ACE LINER 122136052 6,966.60$

HOSPITAL 353068 DEP FEM STEM 157002110 20,293.10$

HOSPITAL 353069 DEP FEM HEAD 136536320 8,132.70$

HOSPITAL 353070 ITS LG LEFT LOCK RADIUS PLATE 3,507.25$

HOSPITAL 353071 ITS 1.5MM 5 HOLE SL PLATE 3,709.45$

HOSPITAL 353072 ALLERGAN 100 U VIAL BOTOX 2,292.75$

HOSPITAL 353073 ZIMMER KNEE KIT W/SIDE ACCUPOR 13,595.60$

HOSPITAL 353074 ZIMMER ACCUMIX MIXING SYSTEM 973.35$

HOSPITAL 353085 POLY REINFORCED SURGICAL GOWN 22.30$

HOSPITAL 353086 STEM FEMORAL SZ00 012101 13,203.65$

HOSPITAL 353087 ITS 1.5MM SL 7 HOLE STRT PLATE 4,122.15$

HOSPITAL 353088 SCREW CORTICAL 44MM 1,528.30$

HOSPITAL 353089 SCREW ANTI ROTATION 80MM 1,837.75$

HOSPITAL 353090 DRILL BIT SHORT 4.0MM 1,315.45$

HOSPITAL 353091 NAIL ES LEFT 11X39X130 9,407.65$

HOSPITAL 353092 SCREW CORTICAL 46MM 1,528.30$

HOSPITAL 353093 WIRE-K 1.2MM 202.35$

HOSPITAL 353094 PLATE FLS STRAIGHT 5 HOLE 4,023.05$

HOSPITAL 353095 LOCKING CORTICAL 16MM 966.90$

HOSPITAL 353096 SCREW CORTICAL 8MM 596.90$

HOSPITAL 353097 PLATE FLS CURVED 4,167.45$

HOSPITAL 353098 DEPUY PERIARTIC HUMERUS PL 3 6,499.55$

HOSPITAL 353099 DEPUY CORTEX SCREW 2.0X14MM 483.75$

HOSPITAL 353101 DEPUY CORTEX SCREW 2.0X16MM 483.75$

HOSPITAL 353102 ARTHREX BREAKAWAY PIN 499.15$

HOSPITAL 353103 ARTHREX MED BASEPLATE 7,076.35$

HOSPITAL 353104 ARTHREX CUP CAP COATED 7,365.20$

HOSPITAL 353105 ARTHREX STEM SZ 8 10,253.45$

HOSPITAL 353106 ARTHREX HUMERAL INSERT MED 4,188.05$

HOSPITAL 353107 ARTHREX GLENOSPHERE 39+4 LAT 8,664.95$

HOSPITAL 353108 ARTHREX 30MM GLENOID LOCKSCREW 778.70$

HOSPITAL 353109 ARTHREX NONLOCK 6.5X20MM SCREW 1,103.15$

HOSPITAL 353112 SCREW CANNULATED 4.0 012173 1,595.95$

HOSPITAL 353113 SCREW CANNULATED 48MM 012176 1,595.95$

HOSPITAL 353114 ITS 6 HOLE RIGHT FIBULAR PLATE 6,168.65$

HOSPITAL 353115 DEPUY 4.0X50MM LOCK SCREW 1,607.90$


HOSPITAL 353117 DEPUY 4.0X34MM CANNULATE SCREW 1,472.65$

HOSPITAL 353118 DEPUY 4.0X30MM CANNULATE SCREW 1,472.65$

HOSPITAL 353119 COOK 7X26 UNIV FIRM STENT SET 667.70$

HOSPITAL 353120 STRYKER 4.2X340MM DRILL BIT 1,450.85$

HOSPITAL 353121 STRYKER 4.2X180MM DRILL AO SM 1,557.30$

HOSPITAL 353123 STRY 10X380MM SUPRACOND T2NAIL 13,108.75$

HOSPITAL 353124 STRY 5X55MM T2 LOCK SCREW 1,421.90$

HOSPITAL 353125 STRY 5X75MM T2 LOCK SCREW 1,421.90$

HOSPITAL 353126 MEDACTA 46MM SHELL LINER 5,157.70$

HOSPITAL 353127 MEDACTA 22.2MM LINER HEAD 4,332.45$

HOSPITAL 353128 MEDACTA 22.2MM FEMORAL HEAD 2,888.35$

HOSPITAL 353129 STELK TIBIAL TRAY SC2291-3T4F 17,515.45$

HOSPITAL 353130 ITS LG OPEN ROD CLAMP 3,379.40$

HOSPITAL 353131 ITS LG ADJ PIN ROD CLAMP 3,470.15$

HOSPITAL 353132 ITS 30 DEGREE OUTRIGGER 1,135.65$

HOSPITAL 353133 ITS MULTIPIN CLAMP 1,135.65$

HOSPITAL 353134 ITS TITANIUM DRILLING PINS 1,375.65$

HOSPITAL 353135 ITS 11X100 BARS 1,349.35$



HOSPITAL 353138 ARTHREX 4.0 DBL CUT BLADE 596.90$

HOSPITAL 353141 BIOCOMPOSITE RAPID CURE 50CC 10,517.55$

HOSPITAL 353142 ITS 4.0 CANNULATED SCREW 1,257.45$

HOSPITAL 353143 CD MEDICAL 2.8MM PARCUS SUTURE 1,813.55$

HOSPITAL 353144 ARTHREX 4.0MM POWER RASP 922.50$

HOSPITAL 353145 ARTHREX 4.0MM BONE CUTTER 654.65$

2020-01




HOSPITAL 353146 ARTHREX 5.5MM BONE CUTTER 654.65$

HOSPITAL 353147 AOS 5.0X80MM AR SCREW 1,801.70$

HOSPITAL 353148 STELK LEFT KNEE FEMUR 35,314.75$

HOSPITAL 353149 STELK KNEE VALGUS BUSH ASSEMBL 2,447.45$

HOSPITAL 353150 STELK 10MM FEMORAL TIBIAL STEM 7,160.10$

HOSPITAL 353151 STELK KNEE TIBIAL INSERT 11,104.15$

HOSPITAL 353152 STELK 16MM FEMORAL TIBIAL STEM 7,160.10$

HOSPITAL 353153 ITS 4.0X36MM CANNULATED SCREW 1,232.80$


HOSPITAL 353155 ITS 2.5X110MM DRILL BIT 783.60$

HOSPITAL 353161 ITS TEMP PLATE HOLDER 858.85$

HOSPITAL 353165 PARC 5.5MM SUTURE ANCH W/NEEDL 1,825.45$

HOSPITAL 353166 MEDTRONIC INTERSTIM BT TESTKIT 1,991.35$

HOSPITAL 353167 TUBING PNEUMOSURE H 620040690 226.65$

HOSPITAL 353168 ARTHREX 4.0 CURVED DC SHAVER 654.65$

HOSPITAL 353169 ARTHREX 4.0 EXCALIBAR SHAVER 585.15$

HOSPITAL 353170 ARTHREX 4.0 CURVED BONE CUTTER 654.65$

HOSPITAL 353171 ARTHREX 5.5 OVAL BURR 654.65$

HOSPITAL 353172 ARTHREX 5.5 POWER RASP 922.50$

HOSPITAL 353173 ARTHREX 4.0 TORPEDO 642.60$

HOSPITAL 353174 MEDACTA 45X28MM BIPOLAR HEAD 2,831.70$

HOSPITAL 353175 DEPUY SZ 4 TOTAL KNEE 26,293.90$

HOSPITAL 353176 ARTHREX DISP PIN KIT 1,323.25$

HOSPITAL 353177 ARTHREX 7X25MM CANNULAT SCREW 865.20$

HOSPITAL 353178 ARTHREX 4.5X30MM BI-CORT POST 909.75$

HOSPITAL 353179 ARTHREX 14MM SPIKED WASHER 909.75$

HOSPITAL 353180 MEDACTA 3+ LT SPHERE FEM COMP 11,326.60$

HOSPITAL 353181 MEDACTA SZ 2 LT FIX TIB TRAY 6,067.85$

HOSPITAL 353182 MEDACTA SZ2 RESURFAC PATELLA 2,022.65$

HOSPITAL 353183 MEDACTA 2X10MM FLEX TIBIAL INS 4,854.30$

HOSPITAL 353184 MEDACTA SZ3 LT FEMUR CUT BLOCK 1,272.35$

HOSPITAL 353185 MEDACTA LT FEMUR BONE MODEL 1,272.35$

HOSPITAL 353186 MEDACTA SZ3 LT TIB CUT BLOCK 1,272.35$

HOSPITAL 353188 MEDACTA LEFT TIB BONE MODEL 1,297.75$

HOSPITAL 353190 SYNTHES 2.4MM ANGLE LOCK SCREW 1,302.75$

HOSPITAL 353191 ALAMO 2.8CM ACHILLES TENDON FF 10,901.90$

HOSPITAL 353192 STELK 10MM 1/2 TIB BLOCK W/SCR 6,512.85$

HOSPITAL 353193 STELK 14X80MM FEM/TIB STEM 7,160.10$

HOSPITAL 353194 STELK MOD KNEE TIBIAL TRAY 17,171.95$

HOSPITAL 353195 STELK POSTER STAB TIB TRAY 4 5,056.55$

HOSPITAL 353196 STELK POSTERIOR TIB TRAY 3 5,056.55$

HOSPITAL 353197 STELKAST KNEE IMPLANT SC29543 8,495.00$

HOSPITAL 353198 ARTHREX 5.5X14.7MM ANCHOR SUTU 1,540.95$

HOSPITAL 353200 ARTH 4.75X19.1MM ACHILL SPEEDB 7,038.75$

HOSPITAL 353201 STRYKER 10X400MM NAIL 13,365.45$

HOSPITAL 353202 STRYKER 5X65MM LOCK SCREW 1,465.10$


HOSPITAL 353204 JR 9.5X237MM SPEEDGRAFT TEND 9,304.00$

HOSPITAL 353205 ARTHREX RETRO DRILL PIN 922.50$

HOSPITAL 353206 ARTHREX 9MM FLIP CUTTER 1,240.55$

HOSPITAL 353207 ARTHREX 4.75MM SWIVEL LOCK 1,896.50$

HOSPITAL 353208 SYNTHES 2.4x66MM RADIUS PLATE 6,285.10$

HOSPITAL 353212 ENDO PEANUT 406.10$

HOSPITAL 353213 ARTHREX 5.5 DC SHAVER 585.15$

HOSPITAL 353214 STRYKER 3X285MM KWIRE 1,316.90$

HOSPITAL 353215 STRYKER 2X800MM GUIDEWIRE 1,417.65$

HOSPITAL 353216 STRYKER 5X800MM GUIDEWIRE 1,460.35$

HOSPITAL 353217 STRYKER TEFLON TUBE 2,005.65$



HOSPITAL 353220 STRYKER 7X240MM HUMERAL NAIL 10,064.55$





HOSPITAL 353225 DEPUY 3.0X20MM COMP SCREW 2,188.50$

HOSPITAL 353226 DEPUY 1.1X150MM GUIDEWIRE 576.45$

HOSPITAL 353227 STRYKER 5X57.5 LOCK SCREW 1,494.45$

2020-01




HOSPITAL 353228 COOK 6FR 22-32CM STENT 654.65$

HOSPITAL 353229 WRIGHT 20X20MM STAPLE KIT 10,396.25$

HOSPITAL 353230 ITS 3 HOLE SM RIGHT PLATE 3,438.45$

HOSPITAL 353231 STRY 3.0X800MM BALL TIP GWIRE 1,498.30$

HOSPITAL 353232 STR 3.0X800MM SMOOTH TIP GWIRE 1,469.85$


HOSPITAL 353235 STRYKER ANKLE SUPRESSION SCREW 1,465.10$

HOSPITAL 353236 STRY 10X150MM RIGHT ANKLE NAIL 15,566.10$

HOSPITAL 353237 STRY T2 SCN THREADED END CAP 1,522.00$

HOSPITAL 353238 STRYKER 5X40MM SHAFT SCREW 1,583.65$

HOSPITAL 353239 STRYKER 5X70MM LOCKING SCREW 1,465.10$

HOSPITAL 353240 STRYKER 0.8MM KWIRE 545.50$


HOSPITAL 353242 STRY 3.0X32MM CANNULATED SCREW 1,522.00$

HOSPITAL 353243 STRY 3.0X36MM CANNULATED SCREW 1,522.00$

HOSPITAL 353244 STRYKER 1.7MM DRILL BIT 2,029.25$

HOSPITAL 353245 STELK TIB INSERT SC3453-2.5-14 5,769.95$

HOSPITAL 353246 ITS 13 HOLE FEMUR PLATE 7,370.45$

HOSPITAL 353247 ENDO STITCH (POLYSORB/SURGDAC) 226.85$


HOSPITAL 353250 ITS 85MM LOCKING SCREW 1,322.90$

HOSPITAL 353251 ITS 40MM LOCK SCREW 1,322.90$



HOSPITAL 353255 ITS 8HOLE RIGHT TIBIAL PLATE 3,636.75$

HOSPITAL 353257 ITS 3.5X110MM TWIST DRILL BIT 783.60$




HOSPITAL 353263 ITS 1.6MM KWIRE 783.15$

HOSPITAL 353264 STRY 1.5X300MM PRECURVED NAIL 1,891.75$

HOSPITAL 353265 WRIGHT 5 DEGREE MD RIGHT PLATE 9,559.00$

HOSPITAL 353266 WRIGHT 3.5X18MM NONLOCK SCREW 1,113.30$


HOSPITAL 353269 ARTHREX 45 DEGREE POWER PICK 642.60$

HOSPITAL 353270 ARTHREX 3.5X14.8MM SUTURE ANCH 1,896.50$

HOSPITAL 353271 ARTHREX 50 DEGREE ABLATOR 1,113.30$


HOSPITAL 353273 WRIGHT 3.5X16MM LOCK SCREW 1,635.80$



HOSPITAL 353276 WRIGHT 2.5X60MM DRILL BIT 1,240.55$

HOSPITAL 353277 WRIGHT 1.MM OLIVE WIRE 744.35$

HOSPITAL 353278 WRIGHT 1.6X150MM KWIRE 476.15$

HOSPITAL 353279 ITS 5.0X150MM PIN 1,348.70$

HOSPITAL 353280 ITS ANGEL WING 1,336.00$

HOSPITAL 353281 ITS LG OPEN ROD 1701001013 3,313.10$

HOSPITAL 353282 ITS 450X11MM CARBON TIBIAL ROD 1,555.15$

HOSPITAL 353283 ITS 150MMX11MM CARBON TIB ROD 1,322.90$

HOSPITAL 353284 ITS 4.0X150MM PIN W35MM THREAD 1,348.70$

HOSPITAL 353286 ARTH 8.5MM LOW PROFILE REAMER 1,240.55$

HOSPITAL 353287 ARTHREX 6X23MM COMPOSITE SCREW 1,495.00$

HOSPITAL 353288 ARTH 4.5X35MM BICORTICAL SCREW 991.75$

HOSPITAL 353289 STELK TIBIAL TRAYSC1586-2.5-14 5,056.55$

HOSPITAL 353290 JRF SEMI T GRAFT 4,449.75$

HOSPITAL 353291 JRF GRACILIS GRAFT 4,449.75$

HOSPITAL 353292 ARTHREX MPFL KIT 6,015.25$

HOSPITAL 353293 SYNTHES 2.0X65MM DRILL BIT 732.45$

HOSPITAL 353294 EOS 11MMX42CM 130DEG ES NAIL 9,223.15$

HOSPITAL 353295 STRYKER 3.5X14MM LOCK SCREW 1,351.35$




HOSPITAL 353299 STRYKER 3.5X14MM BONE SCREW 935.15$


HOSPITAL 353301 STRYKER 7HOLE LATERAL RT PLATE 8,830.85$

HOSPITAL 353302 STRY AO T10 SCREWDRIVER BLADE 2,342.20$

HOSPITAL 353303 STRYKER 2.6X122MM,WL70MM DRILL 1,199.60$

2020-01




HOSPITAL 353304 ARTHREX 10MM SHORT FLIPCUTTER 1,540.95$

HOSPITAL 353306 AR 5.5X14.7MM CORKSCREW SUTURE 1,612.05$

HOSPITAL 353307 AR 3.5MM RETROBUTTON DRILL PIN 731.65$

HOSPITAL 353308 AR 7X19.5MM TENODESIS SUT ANCH 2,062.50$

HOSPITAL 353310 ARTHREX 7.5MM LOWPRO REAMER 1,240.55$

HOSPITAL 353315 ARTHREX 8X40MM PASSPORT 423.25$

HOSPITAL 353316 AR 8X19.1MM TENODESIS SUT ANCH 2,062.50$

HOSPITAL 353319 AR 4.75X19.1MM SPEEDBRIDGE IMP 7,038.75$

HOSPITAL 353320 AR 6.25X19.1MM TENOD SUT ANCH 1,943.95$

HOSPITAL 353321 AR 4.75X22MM DL SWIVELLOCK SUT 1,977.15$

HOSPITAL 353322 DEPUY TOTAL KNEE SZ 2 26,293.90$

HOSPITAL 353323 PROPEL IMPLANT 2,953.10$

HOSPITAL 353324 ARTHREX FIBERLOOP 383.55$

HOSPITAL 353325 ARTHREX 3MM SHAVER 654.65$

HOSPITAL 353326 ITS MED 8HOLE LOCK FIB PLATE 6,290.40$

HOSPITAL 353327 MEDACTA SZ 1 FEMORAL STEM 12,944.70$

HOSPITAL 353328 STRYKER SAW BLADE 6118-119-090 595.60$

HOSPITAL 353329 DEPUY 2.0X45MM 6HOLE LCP PLATE 1,825.20$







HOSPITAL 353336 SYNTHES 2.4X45MM6HOLE RT PLATE 6,058.45$

HOSPITAL 353337 ALAMO TISSUE GRAFT PS294FF 9,283.80$

HOSPITAL 353338 ARTH QUAD TENDON GRAFT BLADE 1,113.30$

HOSPITAL 353339 STELKAST TOTAL FEM TIB STEM 37,883.45$

HOSPITAL 353340 K-WIRE .86 014232 291.00$

HOSPITAL 353341 ARTHREX 3.5MM PROFILE DRILL 954.25$

HOSPITAL 353342 ARTHREX 2.2MM DRILL BIT 1,240.55$

HOSPITAL 353343 ARTH 3.5X22MM COMPRESS SCREW 1,398.70$

HOSPITAL 353344 ARTHREX TRIPLE DAM CANNULA 363.70$

HOSPITAL 353345 ARTHREX 24 DEG LT LASSO 890.65$

HOSPITAL 353346 ARTH 2.9X12.5MM SHORT PUSHLOCK 1,896.50$

HOSPITAL 353347 ARTHREX LABRAL TAPE 644.70$

HOSPITAL 353348 ARTHREX 2.9MM SHORT DRILL KIT 668.05$

HOSPITAL 353349 ITS 3HOLE LEFT SM PLATE 3,438.45$

HOSPITAL 353350 ITS 1.6X150MM THREADED KWIRE 783.60$

HOSPITAL 353351 ITS 10HOLE FIBULA PLATE 6,533.05$

HOSPITAL 353352 CUTTER FLIP SHORT 9.5MM 012745 1,540.95$

HOSPITAL 353353 DEPUY 3.0X24MM HEADLESS SCREW 2,188.50$

HOSPITAL 353354 WRIGHT .45X5IN KWIRE 515.80$

HOSPITAL 353355 WRIGHT 2.0X12MM SNAP OFF SCREW 1,778.00$

HOSPITAL 353356 WRIGHT 1.0MM KWIRE 476.15$

HOSPITAL 353357 WRIGHT 3.0MM DRILL BIT 1,265.95$

HOSPITAL 353358 WRIGHT 3.0MM CANNUL HEAD DRILL 1,612.05$

HOSPITAL 353359 WRIGHT 3.2X24MM CANN SCREW 1,872.85$

HOSPITAL 353360 WRIGHT 3.2X12MM CANN SCREW 1,872.85$

HOSPITAL 353361 WRIGHT 2.7X12MM SNAP OFF SCREW 1,778.00$

HOSPITAL 353362 WRIGHT 3.2X18MM HEADLESS SCREW 1,872.85$

HOSPITAL 353363 ARTHREX 4-0 FIBER LOOP 674.25$




HOSPITAL 353370 WRIGHT .9X150MM KWIRE 476.15$


HOSPITAL 353372 WRIGHT 2.4MM CANN DRILL BIT 1,463.20$




HOSPITAL 353378 STRYKER 4HOLE EXT MEDIAL PLATE 6,792.00$

HOSPITAL 353379 STRYKER 2.7X20MM CORT SCREW 935.20$

HOSPITAL 353380 STRY 4HOLE RT POST LAT PLATE 6,792.00$

HOSPITAL 353381 STRYKER 2.7MM CANN DRILL BIT 2,365.90$




2020-01







HOSPITAL 353390 STRYKER 1.4MM GUIDEWIRE 801.60$

HOSPITAL 353391 STRYKER 4.0X32MM ASNIS SCREW 1,365.55$


HOSPITAL 353393 STRYKER 2.7X14MM CORT SCREW 935.20$

HOSPITAL 353394 STRYKER 10HOLE RT VOLAR PLATE 6,278.25$

HOSPITAL 353395 STRY 8HOLE RT NARROW VOLAR PL 6,278.25$


HOSPITAL 353397 STRYKER 2.7X18MM CANN SCREW 1,227.85$


HOSPITAL 353399 STRYKER 2.7X14MM LOCK SCREW 935.15$

HOSPITAL 353400 ZIM 4.5x30MM INVREV CANC SCREW 755.55$

HOSPITAL 353401 ARTHREX .045IN DBL END KWIRE 396.80$

HOSPITAL 353402 DEPUY 5HOLE 18MM RT CLAV PLATE 3,275.10$

HOSPITAL 353403 CD MEDICAL 2 PARCUS BRAID 495.90$

HOSPITAL 353404 SYN 2.7x125MM 3FLUT DRILL BIT 1,134.25$

HOSPITAL 353405 ARTHREX 7X28MM COMPRESS SCREW 1,495.00$

HOSPITAL 353406 STRY 3.0x26/6MM ASNIS SCREW 1,522.00$

HOSPITAL 353407 STRY 3.0X34/16MM ASNIS SCREW 1,522.00$



HOSPITAL 353411 STRY2.0X1.7MM ASNIS DRILL COUP 788.90$

HOSPITAL 353412 STRY3.0X2.1MM ASNIS DRILL COUP 2,029.25$


HOSPITAL 353415 WRIGHT 3.2MM CANN DRILL 1,265.95$

HOSPITAL 353416 WRIGHT 5.5X45MM SOLID SCREW 6,775.75$


HOSPITAL 353418 AOS 11MMX34CM RETROGRADE NAIL 9,061.35$


HOSPITAL 353420 AOS 75MM CANCELLOUS SCREW 1,706.90$

HOSPITAL 353421 AOS COMPRESSION SPACER 1,650.05$





HOSPITAL 353426 AOS 4.0MM DRILL BIT 1,289.70$

HOSPITAL 353427 WAND ALATOR 90 DEG 012929 1,113.30$

HOSPITAL 353428 SYNTHES 5HOLE HUMERUS PLATE 6,478.85$

HOSPITAL 353429 DEPUY 12HOLE PLATE 2,936.90$






HOSPITAL 353436 DEPUY 4.3MM DRILL BIT 1,205.60$

HOSPITAL 353437 CANNULA PASSPORT 8X30 012943 423.25$


HOSPITAL 353439 TUBE TRACHEAL SHILEY ADULT 573.15$

HOSPITAL 353440 ART KNOTLESS SYNDESMOSIS REPAI 3,626.85$



HOSPITAL 353443 ARTHREX 3.5X18 COMPRESS SCREW 1,424.35$





HOSPITAL 353448 WRIGHT 2.8MM HDLESS CANN SCREW 1,568.50$

HOSPITAL 353449 WRIGHT .9MM KWIRE 539.40$

HOSPITAL 353450 S&N 6HOLE 45PROX TIBIAL PLATE 4,543.85$

HOSPITAL 353451 S&N 6.5X75MM CANCELLOUS SCREW 328.40$

HOSPITAL 353452 S&N 4.5X74MM LOCK SCREW 987.60$





HOSPITAL 353459 S&N 6HOLE 3.5 1/3 TUBULAR PLAT 735.05$

2020-01




HOSPITAL 353460 S&N 3.5X18MM NON LOCK SCREW 215.80$

HOSPITAL 353461 S&N 3.5X26MM NON LOCK SCREW 215.80$

HOSPITAL 353462 S&N 2.7 SHORT DRILL BIT 596.30$

HOSPITAL 353463 S&N 3.5 LONG DRILL BIT 769.15$

HOSPITAL 353464 S&N 2.0 KWIRE 174.95$

HOSPITAL 353465 S&N 12/14 28MM FEMORAL HEAD 16,196.90$

HOSPITAL 353466 WRIGHT 8X8MM FUSEFORGE IMP KIT 7,851.20$


HOSPITAL 353468 MEDLINE HIP PACK DYNJ50091 967.70$

HOSPITAL 353469 MEDACTA SZ4 TIBIAL CUT BLOCK 1,296.20$

HOSPITAL 353470 MEDACTA RT TIBIAL BONE MODEL 1,296.20$

HOSPITAL 353471 MEDACTA SZ 5 FEMUR CUT BLOCK 1,296.20$

HOSPITAL 353472 MEDACTA RT FEMUR BONE MODEL 1,296.20$

HOSPITAL 353474 DEPUY 9HOLE NARROW LCP PLATE 3,049.85$


HOSPITAL 353476 ARTHREX 45 DEG RT LASSO 907.45$

HOSPITAL 353477 BOSTON 3.5CM FLEX GUIDEWIRE 1,361.45$

HOSPITAL 353478 DEPUY 7HOLE CLAVICLE PLATE 5,629.80$

HOSPITAL 353479 ARTH 3.5X24MM COMPRESS SCREW 1,424.35$

HOSPITAL 353480 ARTHREX MICRO CORKSCREW FT 1,376.10$

HOSPITAL 353481 MEDACTA SZ M 22.2MM FEMOR HEAD 2,885.00$


HOSPITAL 353483 AOS 6.5X75MM CORTICAL SCREW 1,738.20$




HOSPITAL 353487 BOLT COMPRESSION 013037 1,680.30$

HOSPITAL 353488 AOS 12X22CM RETROGRADE NAIL 9,231.85$

HOSPITAL 353489 MEDACTA SZ 6 HIP STEM 12,364.05$

HOSPITAL 353490 LIFENET 9.5 FLEXIGRAFT VAR LEN 9,957.25$

HOSPITAL 353491 ARTH 10X28 INTERFERENCE SCREW 1,523.15$

HOSPITAL 353492 ARTHREX ABS OPEN TIGHTROPE 1,257.45$

HOSPITAL 353493 ARTHREX BTB TIGHTROPE 2,052.05$

HOSPITAL 353494 ART ABS ROUND BUTTON TIGHTROPE 1,387.00$

HOSPITAL 353495 ARTHREX TIGERSTICK 674.25$

HOSPITAL 353496 ARTHREX FIBERSTICK 674.25$



HOSPITAL 353499 WRIGHT 3.5X30MM CANNUL SCREW 1,718.95$


HOSPITAL 353501 WRIGHT 5DEG MTP MED PLATE 10,031.45$



HOSPITAL 353504 AOS 12MMX20CMX130DEG NAIL 8,762.00$

HOSPITAL 353505 ART OSTEOCHONDRAL DART DISPKIT 1,328.65$

HOSPITAL 353506 ARTH 1.3X18MM CHONDRAL DART 784.30$

HOSPITAL 353507 CANNULA ACCUPORT 013064 2,052.05$

HOSPITAL 353508 ZIMMER 5CC ACCUFILL 12,158.00$

HOSPITAL 353509 ZIMMER 36MM REVERSE POLY LINER 4,698.40$

HOSPITAL 353510 STELK TIBIAL TRAY SC2291-4T4F 17,495.15$

HOSPITAL 353512 ARTHREX 10X20 PASSPORT CANNULA 431.55$

HOSPITAL 353513 ART 8X12MM TIGHTROPE BUTTON 926.90$

HOSPITAL 353514 MEDACTA SZ8 FEMORAL STEM 12,364.05$

HOSPITAL 353515 WRIGHT 2.0X14MM SNAPOFF SCREW 1,868.60$





HOSPITAL 353520 WRIGHT 4.0MM CANN SCREW 1,568.50$

HOSPITAL 353521 WRIGHT 5.0MM CANN SCREW 1,568.50$

HOSPITAL 353522 STRY 2.4MM GUIDE PIN 12 IN 939.85$


HOSPITAL 353524 AOS 55M CORTICAL SCREW 1,525.75$

HOSPITAL 353529 ENDO CATCH 539.55$

HOSPITAL 353530 ARTHREX BTB TIGHTROPE 2,148.60$

HOSPITAL 353531 WRIGHT LT MED INFUSION PLATE 11,527.45$

HOSPITAL 353532 WRIGHT TEMP FIX PIN 797.25$


2020-01




HOSPITAL 353534 WRIGHT 3.5X24MM CANNUL SCREW 1,718.95$


HOSPITAL 353537 COUNTERSINK CANN SCREW 013112 1,361.60$







HOSPITAL 353544 WRIGHT 2.7X13MM SNAPOFF SCREW 1,868.60$


HOSPITAL 353546 MEDACT SZ5 LT TIBIAL CUT BLOCK 1,296.20$

HOSPITAL 353547 LIFENET 6.0X240MM TENDON FST 7,336.05$

HOSPITAL 353549 ARTHREX AC REPAIR SYSTEM 4,636.55$

HOSPITAL 353550 ZIMMER 4.3X195MM DRILL BIT 1,056.50$

HOSPITAL 353551 ZIM 5.0X18MM UNICORTICAL SCREW 1,581.50$

HOSPITAL 353552 ZIM 5.0X12MM UNICORTICAL SCREW 1,581.50$

HOSPITAL 353553 ZIMMER 5.0X30MM CORT SCREW 1,289.15$



HOSPITAL 353556 ZIMMER 4.5MM DRILL BIT 1,497.25$



HOSPITAL 353559 ZIMMER NCB LOCKING SCREW CAP 1,581.50$

HOSPITAL 353560 ZIMMER NCB LOCK CAP STERILE 1,581.50$

HOSPITAL 353561 ZIMMER 9HOLE PROX FEM PLATE 8,762.00$

HOSPITAL 353562 DEPUY TOTAL KNEE 26,788.70$

HOSPITAL 353563 DEPUY 8H PERIARTIC HUM PLATE 10,715.50$

HOSPITAL 353564 DEPUY 10H PERIARTIC HUM PLATE 11,107.05$

HOSPITAL 353565 DEPUY 2.7X34MM METAPHYS SCREW 682.65$

HOSPITAL 353566 DEPUY 2.7X36MM METAPHYS SCREW 682.65$

HOSPITAL 353567 DEPUY 4H VA-LCP TIB PLATE SM 9,285.45$




HOSPITAL 353571 SKYF DBM ORTHO CRUNCH 5CC 7,047.55$

HOSPITAL 353572 SKYF DBM ORTHO CRUNCH 10CC 10,385.80$

HOSPITAL 353573 LIFENET PERONEUS LONGUS TENDON 9,038.15$

HOSPITAL 353574 ARTH ACL TIGHTROPE AR1588RTJ 1,786.50$

HOSPITAL 353575 PUTTY DBM 013169 6,305.75$

HOSPITAL 353576 DEPUY 8H 3.5MM RT CLAV PLATE 5,774.05$

HOSPITAL 353577 DEPUY 7H DISTAL RADIUS PLATE 6,058.45$

HOSPITAL 353578 DEPUY 24MM LOCKING SCREW 1,302.75$

HOSPITAL 353579 DEPUY 1.25 PLATE REDUC WIRE 1,221.60$

HOSPITAL 353580 DEPUY GUIDEWIRE 900721 573.15$


HOSPITAL 353582 ARTH LOW PROFILE REAMER AR1407 1,263.90$

HOSPITAL 353583 STRY SM PRESSURIZ CANAL YELLOW 107.05$

HOSPITAL 353584 STRY MED PRESSURIZ CANAL BLUE 107.05$


HOSPITAL 353586 MEDACTA SZ4 LT TIBIAL CUTBLOCK 1,296.20$


HOSPITAL 353588 STELK TIB INSERT SC34533514 5,769.95$

HOSPITAL 353589 CD PARCUS 2 SUTURE TAPE 657.40$

HOSPITAL 353591 WAND 90 DEGREE OPES 013195 1,199.10$

HOSPITAL 353592 ARTH HIP MASTER DISP KIT 6526S 2,172.70$

HOSPITAL 353593 ARTHREX BONE CUTTER 6420BC 667.50$

HOSPITAL 353594 ARTHREX 3X12.7MM SUTURE ANCHOR 1,858.90$

HOSPITAL 353595 ARTHREX 3MM SUTURETAK DISP KIT 1,037.00$

HOSPITAL 353596 ITS 4.0x26MM CANNULATED SCREW 1,255.40$

HOSPITAL 353597 STELK TIBIAL TRAY SC34525214 5,769.95$

HOSPITAL 353598 SMITH-NEP 6H RT TIB PLATE 4,543.85$

HOSPITAL 353599 SMITHNEP 4.5X24MM CORTEX SCREW 198.65$

HOSPITAL 353600 SMITHNEP 4.5X40MM LOCK SCREW 978.50$


HOSPITAL 353602 SMITHNEP 6.5X65MM CANC SCREW 302.20$



2020-01




HOSPITAL 353605 SMITHNEP 3.5MM DRILL BIT LONG 928.40$

HOSPITAL 353606 SMITHNEP 3.5MM SHORT DRILL BIT 823.75$

HOSPITAL 353607 SMITHNEP 4.5MM CANN DRILL BIT 1,490.55$

HOSPITAL 353608 SMITHNEP 2.0X228 PERILOC KWIRE 174.95$

HOSPITAL 353609 ARTHREX 9X23MM INTERF SCREW 1,523.15$

HOSPITAL 353610 KS 27FR MONOPOLAR ANG CUT LOOP 463.10$



HOSPITAL 353613 PARCUS 2.0MM SUTURE ANCHOR 1,907.15$

HOSPITAL 353614 ITS 24MM CANNULATED SCREW 1,255.40$


HOSPITAL 353616 AOS 33X10 TIBIAL NAIL 8,572.45$

HOSPITAL 353617 AOS SPACER 1117 1,699.60$

HOSPITAL 353618 AOS 39X10 TIBIAL NAIL 1110390 8,572.45$

HOSPITAL 353619 AOS 65MM CORTICAL SCREW 800165 1,525.75$


HOSPITAL 353621 MEDACTA 28MM FEMORAL HEAD 2,885.00$

HOSPITAL 353622 SKYF PLACENTAL ALLOGRAFT AM100 10,303.40$


HOSPITAL 353624 WRIGHT 2.8MM COUNTERSINK SCREW 1,568.50$



HOSPITAL 353628 AOS 34.5X9 TIBIAL NAIL 1109345 8,572.45$



HOSPITAL 353631 STELK TIBIAL INSERT SC3453414 5,976.00$

HOSPITAL 353632 ALAMO STRUT GRAFT AT341FD 2,472.85$

HOSPITAL 353633 ARTH 5.5X19.1MM SUTURE ANCHOR 1,810.60$

HOSPITAL 353634 COOK STENT/INTRODUCER G34110 3,717.55$

HOSPITAL 353635 STRYKER 1.6X150MM SS KWIRE 202.30$

HOSPITAL 353636 STRYKER 4.0X40MM CANNUL SCREW 1,390.60$

HOSPITAL 353637 STRY 2.7X18MM T10 LOCK SCREW 1,376.10$

HOSPITAL 353638 STRY 3.8X18MM T10 BONE SCREW 952.75$





HOSPITAL 353643 STRY 4H LT DISTAL POST LAT PL 6,919.80$

HOSPITAL 353644 STRY 4H DIST MEDIAL HUMERUS PL 6,919.80$

HOSPITAL 353645 STRY 6H DIST MEDIAL HUMERUS PL 6,919.80$



HOSPITAL 353648 AOS 10X34.5 TIBIAL NAIL 8,572.45$

HOSPITAL 353649 AOS 5.0X70 CORTICAL SCREW 1,525.75$

HOSPITAL 353650 PROPEL 5.2MM 3,276.50$

HOSPITAL 353652 PROPEL MINI 4.0MM 3,276.50$

HOSPITAL 353653 SKYF PLACENTAL ALLOGRAFT AM200 13,206.10$

HOSPITAL 353654 ARTH 9MM FLIPCUTTER 1204AS90 1,569.25$

HOSPITAL 353655 ZIMMER SZ 29 PATELLA 59726529 2,678.90$

HOSPITAL 353656 ZIM NEXGEN FEM L #E 596801551 15,661.10$

HOSPITAL 353657 ZIMMER SZ 3 TIBIAL STEM 6,264.50$

HOSPITAL 353658 ZIM NEX GEN EF KNEE 59623210 5,285.70$

HOSPITAL 353659 MEDACTA 6.5X35MM FLAT SCREW 674.25$

HOSPITAL 353660 MEDACTA 32MM FEMORAL HEAD 2,885.00$

HOSPITAL 353661 MEDA SZ1 FEMORAL STEM 01120041 12,364.05$

HOSPITAL 353662 ZIMMER 5.0X34MM NCB SCREW 1,240.90$

HOSPITAL 353663 ZIMMER 285MM FEMORAL PLATE 9,231.85$



HOSPITAL 353666 ARTH 3.5X20MM HEADLESS SCREW 1,424.35$

HOSPITAL 353667 SUTURE ANCHOR 4.75X19.1 013739 2,269.30$

HOSPITAL 353668 REAMER LOW PROFILE 6M 013840 1,263.90$

HOSPITAL 353669 MEDA SZ 0 FEMORAL STEM 0112040 12,364.05$

HOSPITAL 353670 WRIGHT 3.0X4.0MM HEADLES SCREW 1,965.15$

HOSPITAL 353671 ARTH L DISTAL CLAVICLE PLATE 2,266.80$

HOSPITAL 353672 SCREW CORTICAL 3.5X12 013339 471.95$

HOSPITAL 353673 ARTHREX 2.7X14 LOCK SCREW 745.40$

HOSPITAL 353674 ARTHREX 2.7X16 LOCK SCREW 745.40$

2020-01




HOSPITAL 353675 ARTHREX 3.5X18 CORTICAL SCREW 471.95$

HOSPITAL 353676 SCREW CORTICAL 3.5X14 013343 471.95$

HOSPITAL 353677 ARTHREX 3.5X16 CORTICAL SCREW 471.95$

HOSPITAL 353678 PLATE CLAVICLE BUTTON 013345 1,689.90$

HOSPITAL 353679 ARTHREX 2.5CC DBM PUTTY 2,172.70$


HOSPITAL 353683 ARTHREX 2.0 DRILL BIT 894316 960.80$

HOSPITAL 353688 TUBE ARTHROSCOPY 720.90$

HOSPITAL 353690 PLATE DISTAL RAD 3H 013352 4,058.45$

HOSPITAL 353691 PARCUS 4.5MM SUTURE ANCHOR 1,738.20$

HOSPITAL 353692 ARTHREX LIGAM AUG AR1678CP 4,018.35$

HOSPITAL 353693 AOS 10X32 RETROGRADE NAIL 9,231.85$




HOSPITAL 353697 ZIMMER FOOT/ANKLE KIT 514503 15,558.05$

HOSPITAL 353698 STRYKER HII 7MM TWRENCH 2,176.15$

HOSPITAL 353699 STRY 5X180 HALF PIN 50 THREAD 1,581.50$

HOSPITAL 353700 STRY 6X200 HALF PIN 70 THREAD 1,581.50$

HOSPITAL 353701 STRY TRIAX DYN TUBE 25MM 8,770.25$

HOSPITAL 353702 STRYKER 25MM PIN CLAMP 8,770.25$

HOSPITAL 353703 STRY 25MM BIOCOMPRESS WRENCH 1,704.40$

HOSPITAL 353704 STRY3.2X180MM DRILL BIT 700356 1,496.80$

HOSPITAL 353705 ZIMMER FOOT/ANKLE KIT 414602 15,558.05$

HOSPITAL 353706 CDMED 32MM PLAT 01263244HCT 3,915.35$

HOSPITAL 353707 CDMED ACETAB SHELL 0126450050 4,739.60$

HOSPITAL 353709 CDMED 32MM FEMOR HEAD 0129204 3,297.10$

HOSPITAL 353710 SUTURE ANCHOR 2.4X6.5 013373 1,569.25$

HOSPITAL 353711 ARTH SUTURE TAK KIT AR1320DSC 1,134.25$

HOSPITAL 353712 ITS 7HOLE PLATE 2160107 4,360.40$


HOSPITAL 353714 DEPUY 1.8X150MM KWIRE 832.15$

HOSPITAL 353715 ITS 3.0X24MM CANCELLOUS SCREW 965.75$

HOSPITAL 353717 INZII RETRIEVAL SYSTEM 12/15MM 1,011.35$

HOSPITAL 353718 AOS 9MMX30CM TIBIAL NAIL 8,572.45$


HOSPITAL 353720 SYNTHES 1.7MM TITANIUM CABLE 2,979.85$

HOSPITAL 353721 MEDA SZ2 FEM STEM 01263648HCT 3,915.35$

HOSPITAL 353722 MEDA56MM ACET SHELL 0126450056 4,739.60$

HOSPITAL 353723 KIT OSTEOCHOND REPAIR 013387 2,143.15$

HOSPITAL 353724 ITS 4.0 CANNULATED DRILL BIT 758.50$

HOSPITAL 353725 CANNULA GEMINI 013390 431.55$

HOSPITAL 353726 ARTHREX CURVED NEEDLE 4502 1,907.15$

HOSPITAL 353727 ITS 5H SM LEFT PLATE 210325 3,503.20$

HOSPITAL 353728 ITS 3.0X10MM CANCELLOUS SCREW 965.75$

HOSPITAL 353729 ZIMMER END PORT CANNULA 307034 1,907.15$



HOSPITAL 353732 STRYKER 7HOLE LT PLATE 628207 8,996.95$


HOSPITAL 353734 SENECA KNEE PACK DYNJ52270 1,096.55$

HOSPITAL 353735 SHAVER DOUBLECUT 013406 333.30$


HOSPITAL 353737 STRY HYDROSET HA BONE 397005 6,382.00$

HOSPITAL 353738 SMITHNEPH 4.5MM CANN DRILL 720.45$

HOSPITAL 353739 SMITHNEPH 4.5X70MM LOCK SCREW 987.60$

HOSPITAL 353740 SMITHNEPH 4.5X50MM LOCK SCREW 987.60$





HOSPITAL 353745 WRIGHT 4.3MM DRILL 1,718.95$


HOSPITAL 353747 WRIGHT 5.0X30MM VALOR SCREW 1,868.60$





2020-01




HOSPITAL 353752 WRIGHT 11.5X260MM LT LG NAIL 16,864.55$

HOSPITAL 353753 WRIGHT VALOR NAIL END CAP 1,704.40$

HOSPITAL 353754 WRIGHT VALOR 4.3X120MM DRILL 1,718.95$

HOSPITAL 353755 WRIGHT 4.3X80MM DRILL 1,718.95$

HOSPITAL 353756 WRIGHT 3.0 BEADED GUIDEWIRE 1,482.35$

HOSPITAL 353757 WRIGHT 3.0MM KWIRE 1,482.35$

HOSPITAL 353758 WRIGHT 9.0X250 STEPPED REAMER 1,651.30$

HOSPITAL 353759 SKYF DBM PURE PUTTY JHG05P 6,305.75$

HOSPITAL 353760 STRYKER 8 HOLE RT FEMUR PLATE 16,044.45$







HOSPITAL 353767 ART 6.0 PILOT REAMER AR1451 1,304.15$

HOSPITAL 353778 STRYKER 4.2MM FIXATOR 4,438.75$

HOSPITAL 353779 STRYKER 2.0X315MM DRILL TIP 738.90$

HOSPITAL 353780 AOS 11X33CMX130 LONG NAIL 8,737.30$

HOSPITAL 353781 ARTH 2.9MM PUSHLOCK DISP KIT 1,134.25$

HOSPITAL 353782 ARTH 5.5X19.1MM SUTURE ANCHOR 1,931.30$

HOSPITAL 353783 MEDACTA SZ5+ LT FEMORAL STEM 11,539.80$

HOSPITAL 353784 MEDACTA SZ4 FIXED TIBIAL TRAY 6,182.10$

HOSPITAL 353785 MEDA SZ4 10MM LT TIBIAL INSERT 4,945.60$

HOSPITAL 353786 MEDA SZ4 LT 10MM TIBIAL INSERT 4,945.60$

HOSPITAL 353787 STRY REST ADMX3 28MM 12362852 10,637.20$

HOSPITAL 353788 STRY 15MM GAP PLATE SCREWS 1,419.40$

HOSPITAL 353789 STRY 20MM GAP PLATE SCREW 1,419.40$



HOSPITAL 353792 STRY TRITAN/REV ACET 5090260F 21,591.75$

HOSPITAL 353793 STRY 46MM F MDM COCR LINER 13,501.50$

HOSPITAL 353794 STRY 60MM CUP BLADE 520960 2,138.20$

HOSPITAL 353795 MEDACTA SZ5 LT FEMORAL STEM 13,188.30$

HOSPITAL 353796 MEDACTA 36MM LT FEMORAL HEAD 3,297.10$

HOSPITAL 353797 ARTHREX 19.5MM SUTURE ANCHOR 2,100.30$

HOSPITAL 353798 SUTURE ANCHOR 19.1MM 013503 2,100.30$

HOSPITAL 353799 AOS 10X36 TROCHATOR NAIL RT 8,737.30$

HOSPITAL 353800 AOS 11X39 TROCH NAIL 1059390 8,737.30$

HOSPITAL 353801 ITS 3.0X22MM LOCK CORT SCREW 965.75$



HOSPITAL 353804 STRYKER 2.7MM DRILL 1,221.60$


HOSPITAL 353807 STRYKER 9H CLAVICLE PLATE 9,631.65$

HOSPITAL 353808 STRYKER 2.6 XL DRILL 703824 1,323.05$



HOSPITAL 353811 STRY TRAUMA FOAMPACK 21022205 6,837.35$

HOSPITAL 353812 ARTH 7X19.5MM SUTURE ANCHOR 2,100.30$

HOSPITAL 353813 STRYKER 2.5 DRILL 705025 2,066.55$

HOSPITAL 353814 STRYKER 3.1 DRILL 705077 1,989.25$

HOSPITAL 353815 STRY SZ 3 TIBIA PLATE 627304 11,082.35$

HOSPITAL 353816 STRY 3.5X32MM CORTICAL SCREW 566.40$

HOSPITAL 353817 STRY 4.0X80MM LOCK SCREW 1,274.75$



HOSPITAL 353820 STRY 4.0X60MM CANCELLOUS SCREW 809.10$

HOSPITAL 353821 STRY 3.5X34MM CORTICAL SCREW 576.35$

HOSPITAL 353822 STRYKER 2.0 KWIRE 816.70$

HOSPITAL 353823 STRY 5.0X60MM CANN SCREW 1,525.75$

HOSPITAL 353824 STRY 3.5 CANN DRILL 702450 2,361.10$

HOSPITAL 353825 STRY 3.0X450MM FLEX NAIL 2,327.25$

HOSPITAL 353826 STRY 3.5X450MM FLEX NAIL 2,394.85$

HOSPITAL 353827 STRY STANDARD RIM PLATE1030302 5,432.00$

HOSPITAL 353828 STRYKER 1.8 DRILL 9051003 579.85$

HOSPITAL 353829 STRY 2.4X22 BONE SCREW 171422 869.75$


2020-01





HOSPITAL 353832 STRY 2.4X16 LOCK SCREW 1732416 946.40$





HOSPITAL 353837 STRY K WIRE 4511045 337.15$

HOSPITAL 353838 ZIMMER GLENOSPHERE IMPACTOR 1,471.25$

HOSPITAL 353839 STRYKER REVOL CEMENT MIXER 1,012.50$

HOSPITAL 353840 STELK TIBIAL STEM 2196114 7,294.85$

HOSPITAL 353841 STELK REV KNEE LT FEMUR 29574 35,979.30$

HOSPITAL 353842 STELK POST FEM AUGMENT 231745 6,635.40$

HOSPITAL 353843 STELK REV TIBIAL INSERT2265412 11,313.15$

HOSPITAL 353844 AOS 8X39.5 TIBIAL NAIL 1108345 8,572.45$

HOSPITAL 353845 AOS 3.2 DRILL BIT 0229 1,525.75$



HOSPITAL 353849 SMITHNEP 6H PLATE LATERAL 2,911.80$

HOSPITAL 353850 SMITHNEP 2.0MM PERILOC KWIRE 295.35$







HOSPITAL 353858 DEPUY 48MM ACET SHELL 10,901.05$

HOSPITAL 353859 DEPUY 32MM ACET LINER 5,633.15$

HOSPITAL 353860 DEPUY SZ 4 FEMORAL STEM 20,269.60$

HOSPITAL 353861 DEPUY 32MM FEMORAL HEAD 7,700.35$

HOSPITAL 353862 AOS 9MMX33.0CM TIBIAL NAIL 8,572.45$

HOSPITAL 353863 AOS 4.0 CALIBRATED DRILL 1,313.30$

HOSPITAL 353864 AOS 5.0MMX50 CORTICAL SCREW 1,525.75$

HOSPITAL 353865 AOS 5.0X36 CORTICAL SCREW 1,525.75$

HOSPITAL 353901 ANTISEPTIC PREOP NASAL/SKIN 56.05$

HOSPITAL 353903 PACEMAKER ACCENT DR PM2110 22,463.35$

HOSPITAL 354009 STELKAST TIBIAL TRAY 22912T2F 17,171.95$

HOSPITAL 354010 STELKAST 3 PEG PATELLA 2,831.70$

HOSPITAL 354016 STEL GENFLEX FEMUR SC295435 8,654.85$

HOSPITAL 354115 ENDO TROCAR 5 MM X 100 CFF03 119.75$

HOSPITAL 354116 ENDO TROCAR 8 MM X 100 C0Q19 119.75$

HOSPITAL 354121 ENDO TROCAR BLADELESS B5XT 266.80$

HOSPITAL 354130 ENDO DISSECT 336.40$

HOSPITAL 354151 SURGICEL ABSORB HEMOSTAT 0274 338.10$

HOSPITAL 354153 WARMING BLANKET 341.15$

HOSPITAL 354250 ANCHOR SUTURE SWIVEL 009911 1,715.20$

HOSPITAL 354251 NEEDLE SCORPION SUREFURE 00991 600.40$

HOSPITAL 354253 ARTH TX ARM SLEEVE AR1635 323.85$

HOSPITAL 354255 ARTH SUSTURE PASSING WIRE AR12 758.80$

HOSPITAL 354256 FIBERWIRE #2 009906 120.10$

HOSPITAL 354257 ITS 6H CLAVICLE LOCK PL 211216 4,283.55$

HOSPITAL 354258 ITS 8H CLAVICLE LOCK PL211218 4,283.55$

HOSPITAL 354259 10H CLAVICLE LOCK PL2112110 4,712.30$

HOSPITAL 354260 ITS 6H CLAV 3.5 LK PL211226 4,283.55$

HOSPITAL 354264 ITS 8H CLAV 3.5 LK PL 211228 4,283.55$

HOSPITAL 354266 ITS 10H CLAV 3.5 LK PL2112210 4,712.30$

HOSPITAL 354267 ITS 4HR CLAV LK PL 211234 4,712.30$

HOSPITAL 354270 ITS 4HL CLAV LK PL 211244 4,712.30$

HOSPITAL 354271 ITS 4H LG PRO HUM LK PL 211314 9,411.65$

HOSPITAL 354272 ITS 5HR DIS HUM LK PL 212415 5,998.65$

HOSPITAL 354273 ITS 3H SM PRO HUM LK PL211323 9,411.65$

HOSPITAL 354309 ITS 4H SM PRO HUM LK PL 211324 9,411.65$

HOSPITAL 354311 ITS 3H LG PRO HUM LK PL 211313 9,411.65$

HOSPITAL 354312 ITS 5HL DIS HUM LK PL 212425 5,998.65$



HOSPITAL 354316 ITS DRILL BIT 3.0X140 6,341.60$



2020-01





HOSPITAL 354321 ITS 5HR/L OLE LK HOOK PL211145 6,427.45$

HOSPITAL 354323 ITS 5HR OLE LK HOOK PL 211137 6,427.45$

HOSPITAL 354324 ITS K WIRE 1.6X150 KW16150 900.50$

HOSPITAL 354325 ITS STEIN PIN 2.0X228 SP20228 900.50$

HOSPITAL 354326 ITS 4HR SM RAD LK PL 210294 4,283.55$

HOSPITAL 354327 ITS 4HL SM RAD LK PL 210304 4,283.55$

HOSPITAL 354329 ITS 4HR LG STY 32M PL210254L 4,283.55$

HOSPITAL 354330 ITS 4HL LG STY 32M PL210264L 4,283.55$

HOSPITAL 354331 ITS 4HR SM STY 25M PL210284L 4,283.55$

HOSPITAL 354332 ITS 4HL SM STY 25M PL210284L 4,283.55$

HOSPITAL 354333 ITS 6HR LG STY 32M PL210256L 4,283.55$

HOSPITAL 354335 ITS 6HR RAD STYPLSM 210276L 4,283.55$

HOSPITAL 354336 ITS 6HL RAD STYPLSM25M 210286L 4,283.55$

HOSPITAL 354337 ITS ST LOCK PL 5H 211015 4,283.55$





HOSPITAL 354342 ITS GUIDEWIRE 3.2X228 35324228 1,001.60$

HOSPITAL 354343 ITS CORT SCREW 2.7X10-24 698.15$

HOSPITAL 354344 ITS CORT SCREW 2.7X40-50 799.30$

HOSPITAL 354345 ITS CAN SCREW L 3X10-30 1,207.35$

HOSPITAL 354346 ITS CORK SCREW 3.5X16-24M 698.15$

HOSPITAL 354347 ITS CORT SCREW 3.5X26-60M 799.30$

HOSPITAL 354352 ITS CORT SCREW L3.5X12-24 1,207.35$

HOSPITAL 354353 ITS CORT SCREW L3.5X28-40 1,416.35$

HOSPITAL 354354 ITS CAN SCREW 4.2X14-60M 1,679.45$

HOSPITAL 354357 ITS DRILL BIT 2.0X100 DB20-100 596.95$





HOSPITAL 354363 CUTTER FLIP 8.5M 013844 1,639.20$

HOSPITAL 354364 FLIPCUT 10.5 009991 1,639.20$

HOSPITAL 354366 ARTH FLIPCUT 8M AR1204AF80 1,639.20$

HOSPITAL 354367 AQUAMANTYS 6.0 BIPOLAR 231121 2,511.85$

HOSPITAL 354369 MONARCH VAG SLING 72403830 5,449.80$

HOSPITAL 354376 MASTISOL 15 ML 64.20$

HOSPITAL 354379 PLEUREX PLEURAL CATH 50-7000B 2,207.00$

HOSPITAL 354380 PLEUREX PT START KIT 500075 1,336.60$

HOSPITAL 354381 ORTHO POLAR PACK SHOULDER10606 1,031.70$

HOSPITAL 354383 FIBERTAPE 2M 010101 407.50$

HOSPITAL 354385 ORTHO POLAR PACK KNEE 10604 959.75$

HOSPITAL 354386 BARD OPTIMA STENT 788726 715.55$

HOSPITAL 354387 ARTH FLIPCUT 9.5 AR1204AF95 1,639.15$

HOSPITAL 354390 ITS WASHER CLAMP 000500 526.15$

HOSPITAL 354391 ITS TWIST DRILL 2.5M 732513 1,342.15$




HOSPITAL 354395 ITS K WIRE 1.2MX150M 001215 269.85$

HOSPITAL 354397 ITS K WIRE 1.6MX150M 001615 798.80$

HOSPITAL 354398 ITS WASHER 4.0M 040700 256.35$

HOSPITAL 354399 ITS WASHER 4.5M 050800 256.35$

HOSPITAL 354400 ITS CANNULATED 4.0 SCREW 2,457.65$

HOSPITAL 354401 ZIM HIP SAW BLADE 25090119TG1 343.15$

HOSPITAL 354402 C-ARMOR DRAPE 5526 175.95$

HOSPITAL 354403 ST JUDE WIRELESS INTERROG1151 4,267.95$

HOSPITAL 354404 ART THREADED CANNULA AR6566 232.55$

HOSPITAL 354405 MEDARTIS 2.5 LOCKING SCREW 2.5 828.15$

HOSPITAL 354406 MEDARTIS COUNTERSINK 1,377.90$

HOSPITAL 354407 MEDATRIS K WIRE 352.25$

HOSPITAL 354408 ZIM PALACOS R&G CEMENT 1,515.30$

HOSPITAL 354409 MONOCRYL 3-0 Y523H 22.25$

HOSPITAL 354410 ARTHREX OUTFLOW TUBE AR6430 201.15$

HOSPITAL 354411 ITS CLAV LOCK PL 6H R 21127-6 4,714.05$

HOSPITAL 354412 ITS CLAV LOCK PL 6HL 21128-6 4,714.05$

2020-01




HOSPITAL 354413 ITS OLE LK HOOK PL 9HL 21112-9 6,429.85$

HOSPITAL 354414 ITS OLE LK HOOK PL 9HR 21113-9 6,429.85$

HOSPITAL 354415 ITS PILON SM 4H PL 210934 8,145.45$



HOSPITAL 354418 ITS PILON LG 4H PL 210914 8,145.45$

HOSPITAL 354419 ITS PILON LG 6H 210916 8,145.45$

HOSPITAL 354420 ITS PILON LG 8H PL 210918 8,145.45$

HOSPITAL 354421 ENDOCLIP CA500 551.45$

HOSPITAL 354423 EXTRACTOR STONE CIRCLE 010310 1,393.70$

HOSPITAL 354424 PDS 2-0 Z317H 26.50$

HOSPITAL 354425 ITS TIBIA R ANT PL 7H 213117 8,145.45$

HOSPITAL 354426 ITS TIBIA L ANT PL 7H 213127 8,145.45$

HOSPITAL 354428 ITS TIBIA R ANT PL 11H 2131111 8,574.45$

HOSPITAL 354429 ITS TIBIA L ANT PL 11H 2131211 8,574.45$

HOSPITAL 354430 ITS FIB R PROLOCK 4H PL 212214 6,000.85$

HOSPITAL 354431 ITS FIB L PROLOCK 4H PL 212224 6,000.85$





HOSPITAL 354436 ZIM TOTAL SAW BLADE 25090119 201.15$

HOSPITAL 354437 ITS K WIRE KW16-120 269.85$

HOSPITAL 354438 BARD U-NITE GUIDEWIRE 250NSS35 256.35$

HOSPITAL 354439 ITS CANNULATED SCREW 3.5 2,457.65$

HOSPITAL 354440 VAPOR CLEAN FILTER 101 310.55$

HOSPITAL 354441 ST JUDE ACCENT PM1110 PACEMAKE 21,661.15$

HOSPITAL 354442 PEDI ANES SP02 SENSOR 112434 70.70$

HOSPITAL 354443 LIGASURE FORCEPS LF1212A 2,540.40$

HOSPITAL 354444 C ARM KIT 83.05$

HOSPITAL 354445 ETHIBOND 4-0 EXCELL x871H 25.20$

HOSPITAL 354446 DEPUY SM CEMENT RESTRICTOR 54 802.60$

HOSPITAL 354447 DEPUY LG CEMENT RESTRICTOR 802.60$

HOSPITAL 354449 ARTHREX PUMP TUBING AR-6410 261.70$

HOSPITAL 354450 AQUACEL DRESSING 3.5 X 6 132.65$

HOSPITAL 354451 VICRYL 5-0 J213H 16.50$

HOSPITAL 354452 EQUIVA BONE GRAFT 76-6021 12,827.95$

HOSPITAL 354454 TOTAL KNEE W STEM 41,529.45$


HOSPITAL 354456 ALAMO TENDON TISSUE GRAFT 9,056.90$

HOSPITAL 354457 ETEX GAMMA BSA 76-6010 12,026.10$

HOSPITAL 354459 ETEX BETA BSM 76-6016 12,026.05$

HOSPITAL 354460 STRYKER ACE INSERT 6250T32E 6,240.85$

HOSPITAL 354461 STRYKER FEM STEM 0 6020-0030 13,480.10$

HOSPITAL 354462 STRYKER FEM HEAD 65650132 6,240.85$

HOSPITAL 354463 WIRE (COIL) 10 METER 674.10$

HOSPITAL 354464 STRYKER ACE INSERT 32M63025115 4,149.25$

HOSPITAL 354465 SCREW CANCELLOUS 6.5 MM 637.20$

HOSPITAL 354466 STRYKER FEM HEAD 32M+0 3,063.70$

HOSPITAL 354467 PARCUS 5.5 SUTURE ANCHOR10253T 1,765.25$

HOSPITAL 354468 STRY ACE SHELL 54M 5020354E 7,449.00$

HOSPITAL 354469 STRY FEM STERM NO4 67200435 13,480.10$

HOSPITAL 354470 STRY FEM HEAD 28MM 65700028 6,240.85$

HOSPITAL 354471 ZIMMER TOTAL KNEE SCREW 856.10$

HOSPITAL 354472 ZIMMER UNI TOTAL KNEE CAP 19,805.40$

HOSPITAL 354474 DRAPE BIL LIMB DYNJP8006 95.80$

HOSPITAL 354475 MESH VENTRALIGHT 010249 1,784.20$

HOSPITAL 354476 BARD VENTRALIGHT MESH 5954680 3,002.70$

HOSPITAL 354477 FILSHIE TUBAL CLIPS AVM0851J 379.40$

HOSPITAL 354478 RUMI II HANDLE 2.5-4.0 452.35$

HOSPITAL 354479 ZIM UNI SAW BLADE 13090119TF1 267.45$

HOSPITAL 354480 ZIM OSS SAW BLADE 19090119TG1 267.45$

HOSPITAL 354481 ZIM RECIP SAW BLADE 13076119SR 240.25$

HOSPITAL 354482 HYDROSET 3ML STRYKER 4,136.15$




HOSPITAL 354496 DORNOCH MANIFOLD 79.40$

2020-01




HOSPITAL 354497 PACEMAKER LD, TENDRIL 2088T/58 2,680.95$

HOSPITAL 354498 HEMACLEAR MODEL F 77.40$

HOSPITAL 354499 STELKAST HI DEMAND TOTAL KNEE 42,148.35$

HOSPITAL 354501 STELKAST LOW DEMAND TOTAL KNEE 22,693.70$

HOSPITAL 354502 STRY ACE INSERT 32M 6230032D 6,240.85$

HOSPITAL 354503 STRY ACE SHELL 48M 5020348C 7,489.00$

HOSPITAL 354504 DEPUY ACE LINER 122032152 7,443.15$

HOSPITAL 354505 DEPUY FEM HEAD +5 101468000 3,886.55$

HOSPITAL 354507 ART SUTURELASSO AR4068C 1,297.75$

HOSPITAL 354508 ABLATOR 90 DEGREE 010981 1,135.65$

HOSPITAL 354509 STRY HIP STEM 60200230 13,480.10$

HOSPITAL 354510 STRY ACE INSERT 32M 3231032E 6,240.85$

HOSPITAL 354511 STRY REAMER 2273000S 2,413.20$

HOSPITAL 354513 STRY DRILL 4.2X130 18064280S 1,315.45$

HOSPITAL 354514 STRY DRILL 4.2X260 18064250S 1,315.45$

HOSPITAL 354515 STRY LOCK SCREW 50M 18965050S 1,525.45$

HOSPITAL 354516 STRY TIBIAL NAIL 14X360 9,415.90$

HOSPITAL 354517 STRY TIBIAL NAIL 12X360 9,415.90$

HOSPITAL 354518 STRY GUIDEWIRE 18060085S 1,595.95$

HOSPITAL 354519 ACUMED HEAD L TRH240LS 13,306.80$

HOSPITAL 354520 ACUMED 10X2 STEM TRS1002S 8,103.80$

HOSPITAL 354521 REAMER COLLAR 014306 1,963.45$

HOSPITAL 354522 ACUMED GUIDEWIRE WS 1607ST 194.55$

HOSPITAL 354523 ACUMED 3.5 SCREW 846.35$

HOSPITAL 354524 ACUMED 3.5 SCREW LOCK 921.45$

HOSPITAL 354525 ACUMED 2.7 LOCK SCREW 921.45$

HOSPITAL 354526 ACUMED OLECRANON PLATE 700302 4,716.25$

HOSPITAL 354527 ZIM 4.3 DRILL BIT 249004443 1,005.80$

HOSPITAL 354528 ZUN FEM NAIL 10X130 7,701.30$

HOSPITAL 354529 ZIM CORT SCREW 5X40 1,577.50$

HOSPITAL 354530 ZIM LAG SCREW 105X105 2,791.80$

HOSPITAL 354531 SON INSTRUMENT PK ST0101 3,300.90$

HOSPITAL 354532 SON FLEX ROD CRXWG24010S 13,409.90$

HOSPITAL 354533 SON BONE SCREW 2.7X20 SC2720 778.30$

HOSPITAL 354534 ZIM 3.2 THREAD PIN 1,168.00$

HOSPITAL 354535 STELKAST FEM HEAD SC1151 28MM0 3,919.90$

HOSPITAL 354536 STRY ACE SHELL 60M 5020360F 7,489.00$

HOSPITAL 354545 BLADE SAW 492.80$

HOSPITAL 354571 ISTENT GTS100 6,989.40$

HOSPITAL 354572 DRESSING AQUACEL 3.5X10 010478 165.80$

HOSPITAL 354658 VENA CAVA FILTER SYSTEM 5,288.85$

HOSPITAL 354789 FILTER REDI FLOW 308.70$

HOSPITAL 355060 INFUSA PORT 8FR (000004) 1,687.10$

HOSPITAL 355100 ARTHREX TENODESIS DISP KIT 1,453.50$

HOSPITAL 355125 STEM FEMORAL SZ00 012144 13,203.65$

HOSPITAL 355126 ZIMMER TOTAL KNEE IMPLANT 23,931.50$

HOSPITAL 355127 MEDTRONIC ENS W/BELT 1,934.45$

HOSPITAL 355128 MEDTRONIC ENS TEST STIM CABLE 539.60$

HOSPITAL 355129 MEDTRONIC TWIST CABLE 25-64CM 809.35$

HOSPITAL 355130 WRIGHT LPL RAYHACH PLATE 6,564.80$

HOSPITAL 355131 WRIGHT 2.7X14MM LOCKING SCREW 1,421.05$

HOSPITAL 355138 WRIGHT 2.7X18MM LOCKING SCREW 1,421.05$

HOSPITAL 355139 WRIGHT SAW BLADE 900.40$

HOSPITAL 355140 WRIGHT 2.0 DRILL BIT 739.80$




HOSPITAL 355193 STITCH ENDO 10MM 009336 1,349.10$

HOSPITAL 355267 LINVATIC REAMER BURR 4.0 5091 639.40$

HOSPITAL 355270 ZIMMER 232/233/242 SAW BL 568.20$

HOSPITAL 355427 CENTRAX BIPOLAR CUP 5,324.90$

HOSPITAL 355493 STAPLER SGL-1 LIGATING LOOP 339.05$

HOSPITAL 355698 FEMORAL HEAD (BIPOLAR) 2,524.25$

HOSPITAL 355812 BONE DRI WICK 530.85$

HOSPITAL 356391 PROBE BILIARY BALLOON 818.50$

HOSPITAL 356448 NEEDLE TRU CUT BIOPSY 349.30$

HOSPITAL 356512 PACK SHOULDER 1,013.35$

HOSPITAL 356513 TUBE ENDOBRONCIAL 35F LF 1,504.65$

2020-01




HOSPITAL 357216 CHOLANGIOCATH RANFAC 384.25$

HOSPITAL 357423 TUBE ENDOBRONCIAL 37 F LF 1,505.00$

HOSPITAL 357487 SYN K-WIRE 875.00$

HOSPITAL 357888 ALTA LAG SCREW 819.60$

HOSPITAL 357895 ANCHORS MITEK 1,743.20$

HOSPITAL 357989 PACK C-SECTION 495.45$

HOSPITAL 358091 EXTRIMITY EXTRACTOR 1,403.00$

HOSPITAL 358092 ENSEAL 38MM JAW CURVED 015572 2,374.30$

HOSPITAL 358183 TIB INSERT FIXED 5,158.65$

HOSPITAL 358317 SCREW LOCKING 4.0x30 013753 1,458.20$

HOSPITAL 358461 URO ELECTRODE 1.9 FRENCH 556.35$

HOSPITAL 358466 SYNTHES SPIKED WASHER 216.85$

HOSPITAL 358471 SPOON PLATE SVN 1,321.60$

HOSPITAL 358472 SYN LAT TIBIAL BUTTRESS PLATE 3,078.30$

HOSPITAL 358520 LUHR T PLATE 37MM 899.65$

HOSPITAL 358521 LUHR STRAIGHT PLATE 739.40$

HOSPITAL 358522 LUHR MINI CURVED PLATE 718.55$

HOSPITAL 358523 LUHR DOUBLE T PLATE 997.60$

HOSPITAL 358524 LUHR FRAGMENTATION PLATE 1,095.10$

HOSPITAL 358525 LUHR MINI CURVED TEMPLATE 489.65$

HOSPITAL 358526 LUHR CURVED TEMPLATE 160.70$

HOSPITAL 358527 LUHR STRAIGHT TEMPLATE 172.35$

HOSPITAL 358530 AMS UROLOOP 593.85$

HOSPITAL 358532 SYNTHES GUIDE PIN DHS/DCS 272.80$

HOSPITAL 358533 FIBULA PLATE 6,408.75$

HOSPITAL 358534 PEG PATELLAR COMPONENT 22,667.40$

HOSPITAL 358535 GUIDEWIRE BULLET TIP 1,101.60$

HOSPITAL 358536 CANCELLOUS LOCKING SCREW 1,737.75$

HOSPITAL 358537 TIBIAL BLOCK WITH SCREW 6,635.50$

HOSPITAL 358538 TIBIAL BUSHING 2,493.55$

HOSPITAL 358539 BLOCK CUTTING 013597 1,296.20$

HOSPITAL 358540 TIBIAL ADAPTER 1,296.20$

HOSPITAL 358541 TIBIAL TRAY 19,122.40$

HOSPITAL 358542 NAIL, LONG 8,737.50$

HOSPITAL 358543 TUBING, SM JOINT & CANNULA SET 814.55$

HOSPITAL 358544 DIGIT TRAP FINGER GRASPING 280.60$

HOSPITAL 358545 DERMIS DECELLUARIZED 013612 9,368.25$

HOSPITAL 358546 TIBIAL TRAY INSTERT 5,769.95$

HOSPITAL 358547 BUR 2.0MM 013619 667.70$

HOSPITAL 358548 SORBAFIX FIXATION 0113115 1,277.80$

HOSPITAL 358549 SORBAFIX 0113116 1,854.10$

HOSPITAL 358550 HUMERAL STEM 24,274.60$

HOSPITAL 358551 SHELL ACETABULR 48MM 2H 013632 4,739.05$

HOSPITAL 358552 FLAT LINER 32mm 3,914.75$

HOSPITAL 358553 HEAD FEMORAL 32MM 013633 3,297.10$

HOSPITAL 358554 PLATE PROLOCK LOCKING 5-HOLE 3,502.65$

HOSPITAL 358555 FIBERLOOP WITH CARVED NEEDLE 674.25$

HOSPITAL 358556 BUTTON GRAFT FIXATION 21x4.4mm 2,052.05$

HOSPITAL 358557 DRILL BIT W/STOP 6mm 926.50$

HOSPITAL 358558 SCREW 3.5 x 32mm 2,018.30$

HOSPITAL 358559 PLATE, LAPIDUS 12,817.50$

HOSPITAL 358560 SCREW, 2.7 X 15mm 1,868.25$

HOSPITAL 358561 K-WIRE, DOUBLE SIDED 1.1mm 539.40$

HOSPITAL 358562 SHELL ACETABULAR SZ52MM 013650 4,739.05$

HOSPITAL 358563 FLAT HEAD SCREW 6.5mm X 20mm 674.25$

HOSPITAL 358564 FLAT LINER HEAD 3,914.75$

HOSPITAL 358565 ENDOPATH ECHELON 60mm (GST60B) 669.85$

HOSPITAL 358566 ENDOPATH ECHELON 60mm (GST60D) 669.85$

HOSPITAL 358567 PEG PATELLA, GEN-FLEX KNEE SNG 2,885.00$

HOSPITAL 358568 PLATE, FIBULA 10 HOLE 6,656.20$

HOSPITAL 358569 NAIL, ANTEGRADE 9,231.85$

HOSPITAL 358570 SCREW, CANCELLOUS 80mm 2,967.45$

HOSPITAL 358571 CANNULA, END DELIVERY 2,220.55$

HOSPITAL 358572 XENMATIX AB 19X35CM 60,980.50$

HOSPITAL 358573 PLATE HUMERUS 8,997.40$

HOSPITAL 358574 SCREW FLAT 674.25$

HOSPITAL 358575 TIBIAL INSERT 22,667.40$


2020-01




HOSPITAL 358577 VANGUARD FEMORAL COMP 70m 30,085.80$

HOSPITAL 358578 VANGUARD TIBIA LOCKING BAR 5,357.80$

HOSPITAL 358579 VANGUARD PATELLA PEG 2,472.85$

HOSPITAL 358580 VANGUARD TIBIAL BEARING KNEE 4,121.35$

HOSPITAL 358581 BIOMET FIN STEM 40m 4,566.55$

HOSPITAL 358582 WRIGHT HEADLESS SCREW 7.0 5,415.40$

HOSPITAL 358583 WRIGHT K WIRE 2.5 539.40$

HOSPITAL 358584 WRIGHT DRILL BIT 5m 1,400.20$

HOSPITAL 358585 WRIGHT COUNTER SINK 7.0 1,665.75$

HOSPITAL 358586 WRIGHT STAPLE 20x20 2,600.60$

HOSPITAL 358587 WRIGHT 4 HOLE PLATE 11,387.35$

HOSPITAL 358588 WRIGHT SHORT SCREW 1,419.55$

HOSPITAL 358589 WRIGHT K WIRE 1.4m 3,236.25$

HOSPITAL 358590 STRYKER HOOK PLATE 5 HOLE 7,937.75$

HOSPITAL 358591 STRYKER CONNECTING ROD 250 2,192.65$



HOSPITAL 358594 STRYKER BAR-BAR CLAMP 4,063.75$

HOSPITAL 358595 STRYKER PIN-BAR INVERTED CLAMP 4,063.75$

HOSPITAL 358597 STRYKER PIN-BAR CLAMP 3,787.60$

HOSPITAL 358598 STRYKER 30* POST 1,134.25$

HOSPITAL 358599 STRYKER SEMI CIRCLE ROD 2,085.45$

HOSPITAL 358600 STRYKER MULTI PIN CLAMP 4,311.05$

HOSPITAL 358601 SUTURE PDS II 0 OS-6 36.80$

HOSPITAL 358602 TURBOVAC 90 IFS 1,134.25$

HOSPITAL 358603 AMBIENT MULTIVAC 50* 1,393.45$

HOSPITAL 358604 STRYKER VARIAX PL 7,805.95$

HOSPITAL 358605 ITS DRILL BIT 2.0 x 110 647.05$

HOSPITAL 358606 ITS 1/3 TUBULAR PLATE 4,360.40$

HOSPITAL 358607 FIBERLOOP 2-0 AR-7232-02 206.10$

HOSPITAL 358608 K WIRE 2.0 705002 910.25$

HOSPITAL 358609 TIBIAL NAIL 10 x 345 10,888.65$

HOSPITAL 358610 GUIDE WIRE 3 x 1000 1,675.45$

HOSPITAL 358611 STELKAST TIBIA INSERT 5,149.55$

HOSPITAL 358612 AOS SUPRACONDYLER NAIL 9,231.85$

HOSPITAL 358613 AOS CONDYLE NUT 1,772.05$

HOSPITAL 358614 AOS NUT WASHER 1,166.65$

HOSPITAL 358616 TIBIAL PLATE 8 HOLE 627308 11,997.30$

HOSPITAL 358617 PERONEUS LONGUS TENDON FPL10 15,389.15$

HOSPITAL 358618 SHUTTLE 90 DEGREE 013809 1,289.15$

HOSPITAL 358622 SKY DBM PURE PETTY 2.5CC 4,100.80$

HOSPITAL 358623 WRIGHT BONE GRAFT K20003010 13,682.90$

HOSPITAL 358624 DISP KIT AR-1322DSC 1,134.25$

HOSPITAL 358625 LIGAMENT AUG REPAIR KIT 4,430.50$

HOSPITAL 358626 KNEE PACK 013797 2,243.40$

HOSPITAL 358627 ART CLAVICLE PL L AR2653CL 2,266.80$

HOSPITAL 358628 BIOPRO ACCU-CUT 19505 713.00$

HOSPITAL 358629 AOS SHORTNAIL 9X130 8,737.30$

HOSPITAL 358630 STRY CLAVICLE PL 10 HOLE 7,805.95$

HOSPITAL 358637 LIFENET SEMITENDINOSUS FSTP 4,352.25$

HOSPITAL 358638 STRY BONE SCREW 3.5 1,101.85$

HOSPITAL 358639 STRY LOCK SCREW 3.5 1,511.30$

HOSPITAL 358640 STRY DRILL BITS 1,342.35$

HOSPITAL 358641 STRY ABONE SCREW 2.7 1,101.85$

HOSPITAL 358643 WRIGHT CUP REAMER 2,143.75$

HOSPITAL 358644 WRIGHT CUP REAMER 1,670.60$

HOSPITAL 358646 WRIGHT CANNULATED 1,348.15$

HOSPITAL 358647 WRIGHT JONES SCREW 7,113.45$

HOSPITAL 358648 WRIGHT SOLID DRILL 1,278.85$

HOSPITAL 358649 ART 5M CANNULATED REAMER 1,391.15$

HOSPITAL 358650 SURGIPORT TROCAR 5MM 811.85$

HOSPITAL 358651 ART DISP INST KIT TENODESIS 1,261.75$

HOSPITAL 358652 ART SUTURE TAPE 3M 708.00$

HOSPITAL 358653 ART DISP KIT FOR SWIVELOCK 1,327.80$

HOSPITAL 358654 ART SWIVELOCK FORKED EYELET 2,052.05$

HOSPITAL 358656 AOS 11X20 FEM NAIL 8,737.30$

HOSPITAL 358657 LIFENET DECELL DERMIS AFLEX301 16,027.95$

HOSPITAL 358658 PDS II 0 Z534 36.80$

2020-01




HOSPITAL 358659 SUTURE ANCHOR 3X14.5 AR1934BCF 1,641.65$

HOSPITAL 358660 BANANA LASSO AR8701 907.45$

HOSPITAL 358661 MEASURING PROBE AR407001 1,296.20$

HOSPITAL 358662 PASSPORT 12X3 AR65921230 606.85$

HOSPITAL 358663 PERC KIT 3MM AR1934PL30 1,263.90$

HOSPITAL 358664 ART DISTAL BICEP REPAIR KIT 4,539.65$

HOSPITAL 358665 STRATAFIX 3-0 SXPP1A410 110.15$

HOSPITAL 358666 STRATAFIX 2-0 SXPP1A409 110.15$

HOSPITAL 358667 STRATAFIX 0 PDS SXPP1A407 124.95$

HOSPITAL 358668 STRATAFIX 3-0 SXPP1B425 116.70$

HOSPITAL 358669 AOS CAN FT SCREW 1,219.20$

HOSPITAL 358670 AOS 5* HUMERAL PLATE 3012-005 8,749.05$

HOSPITAL 358671 AOS CAN LOCK SCREW 1,219.20$

HOSPITAL 358672 AOS CORTICAL SCREW 1,480.45$

HOSPITAL 358673 AOS 2.5 DRILL BIT 0237-100 1,376.50$

HOSPITAL 358678 BIT DRILL CALIBRATED 013963 1,373.95$

HOSPITAL 358679 AOS GUIDE WIRE 2.0 930.20$

HOSPITAL 358680 AOS CALIBRATED DRILL 2.5 BIT 1,428.40$

HOSPITAL 358681 COOK METAL STENT 6X26 G34111 3,722.55$

HOSPITAL 358682 ABSORBATACK 5M ABSTACK30X 2,206.05$

HOSPITAL 358683 SWAN NECK CUR CATH KIT 1,873.70$

HOSPITAL 358684 ZIM SCP KNEE KIT 414.502 14,217.20$

HOSPITAL 358685 ZIM ACCUPORT CANNULA 2,187.30$

HOSPITAL 358686 ITS 3.5 CORT SCREW 697.70$

HOSPITAL 358687 SKYE CAN CHIPS 1-4M OSP132 2,249.20$

HOSPITAL 358688 SKYE CAN CHIPS 4-10M OSP150 2,476.20$

HOSPITAL 358689 WRIGHT DRILL BIT 3.7 1,407.90$

HOSPITAL 358690 WRIGHT DRILL BIT 2.7 1,214.35$

HOSPITAL 358691 WRIGHT GUIDE WIRE 1.9 337.15$

HOSPITAL 358692 WRIGHT LONG THREAD SCREW 5.5 1,862.55$

HOSPITAL 358693 WRIGHT LONG THREAD SCREW 4.0 1,465.85$

HOSPITAL 358694 WRIGHT SHORT THREAD 5.5 SCREW 1,862.55$

HOSPITAL 358695 WRIGHT 4.7 DRILL BIT 1,407.90$

HOSPITAL 358697 WRIGHT 2.3 K WIRE 337.15$

HOSPITAL 358699 STAPLER ECHELON 60 013794 1,629.75$

HOSPITAL 358700 TROCH NAIL 10x130x39 013800 8,737.30$

HOSPITAL 358725 SIMPULSE 948.60$

HOSPITAL 358762 KIT JEJUNOSTOMY 976.15$

HOSPITAL 358800 WRIGHT SHORT THREAD 7.0 SCREW 2,254.45$

HOSPITAL 358801 ART FIBERLOOP/FIBERTAG AR-7264 811.60$

HOSPITAL 358802 STEM RADIAL 014022 12,380.70$

HOSPITAL 358803 HEAD RADIAL 10X22 014741 12,380.70$

HOSPITAL 358804 WRIGHT MTP PLATE 10,350.35$

HOSPITAL 358805 STRY COUNTERSINK 1,480.45$

HOSPITAL 358806 STRYKER COMP PLATE 14 HOLE 5,257.75$

HOSPITAL 358807 ART APOLLORF AR-9811 1,136.25$

HOSPITAL 358808 WRIGHT WASHER 5.5 1,077.85$

HOSPITAL 358809 RETRIEVAL BAG 10MM 278.20$

HOSPITAL 358810 MED FLEX OSTEOTOME 1,011.05$

HOSPITAL 358811 STRY K WIRE 2.0 1,238.65$

HOSPITAL 358812 STRY LAT TIB PLATE 11,303.65$

HOSPITAL 358813 COVIDIEN RELTACK4XDPT 2,272.05$

HOSPITAL 358814 LIFENET ANT TENDON FANT/TIB/T 10,049.05$

HOSPITAL 358815 LIFENET TENDON GRAFT AFLEX101 11,150.95$

HOSPITAL 358816 ITS L DISTAL FEMUR 9* PLATE 7,127.20$

HOSPITAL 358817 ITS 3.5 DRILL BIT 61354280 1,225.45$

HOSPITAL 358818 WRIGHT COTTON/EVANS PL 9,335.10$

HOSPITAL 358819 WRIGHT ALLOPURE 6M WEDGE 10,668.10$

HOSPITAL 358820 WRIGHT ALLOPURE 10M WEDGE 12,979.15$

HOSPITAL 358821 ART LOCK SCREW 727.25$

HOSPITAL 358822 ART SUTURE PL AR14005 9,405.30$

HOSPITAL 358823 ART COA SCREW 455.00$

HOSPITAL 358824 ART KNEE LIG REPAIR KIT 4,931.70$

HOSPITAL 358825 ITS FLS SM H SHAPE 3,920.60$

HOSPITAL 358826 ZIM CROSSFIT MENISCAL REPAIR 2,352.40$

HOSPITAL 358827 ZIM CROSSFIT REPAIR KIT 1,306.20$

HOSPITAL 358828 WRIGHT 4.5X44 FT SCREW 6,153.25$

HOSPITAL 358829 WRIGHT 3.2 DRILL BIT 1,320.75$

2020-01




HOSPITAL 358831 STRY CANN SCREW 6.5 2,322.15$

HOSPITAL 358832 STRY TIBIAL PLATE 6HOLE 10,713.45$

HOSPITAL 358833 STRY DRILL BIT 6.5 3,297.45$

HOSPITAL 358834 STRY GUIDE WIRE 3.2 1,136.90$

HOSPITAL 358835 SYN DISTAL RADIIUS PLATE 5,835.55$

HOSPITAL 358836 ART 2.4 CANN GUIDE WIRE 1,330.40$

HOSPITAL 358837 STRYKER 4.3 DRILL BIT 2,080.25$

HOSPITAL 358838 STRYKER 4.5 CORTICAL SCREW 657.20$

HOSPITAL 358839 STRYKER FEM PLATE 10* 16,218.75$

HOSPITAL 358840 STRYKER VITOSS BB TRAUMA 23,956.70$

HOSPITAL 358841 ART 3.5 LOCK SCREW 859.40$

HOSPITAL 358842 ART 2.4 LOCK SCREW 909.00$

HOSPITAL 358843 1.8 DRILL BIT 798.80$

HOSPITAL 358844 ZIM NONPOR RVS STEM 11X130 22,347.20$

HOSPITAL 358845 ITS 11* FOREARM PL 6,186.30$

HOSPITAL 358846 ITS 9* FOREARM PL 6,186.30$

HOSPITAL 358847 ART 2.9 PUSH LOCK KIT 1,136.25$

HOSPITAL 358848 2.5 DRILL BIT 687.55$

HOSPITAL 358849 K-WIRE 014206 674.25$

HOSPITAL 358850 ITS PROLOCK 5* PLATE 21033-5 3,507.75$

HOSPITAL 358852 ART DIST RAD PL 3,280.95$

HOSPITAL 358853 ART QUICK SET 8,233.20$

HOSPITAL 358854 ART 3.5 CORT SCREW 606.65$

HOSPITAL 358855 ARIS SLING 934400 4,312.65$

HOSPITAL 358857 AOS FRACTURE REDUCTION SCREW 1,296.60$

HOSPITAL 358858 AOS HUMERAL NAIL 8,633.55$

HOSPITAL 358860 AOS CANCELLOUS SCREW 1,103.05$

HOSPITAL 358862 PDSII Z765D 134.00$

HOSPITAL 358863 ART HEADLESS SCREW 1,427.20$


HOSPITAL 358865 STR FEM HEAD 2,738.10$

HOSPITAL 358866 SKYE ORTHOBIOLOGICS 7,057.15$

HOSPITAL 358867 WRIGHT SHORT THREAD SCREW 2,104.75$

HOSPITAL 358868 UNDER BODY WARMING BLANKET 184.15$

HOSPITAL 358869 ART CORKSCREW ANCHOR 2,030.15$

HOSPITAL 358870 ART ALLOGRAFT GRAFTLINK 5,542.50$

HOSPITAL 358871 HOLOGIC MYOSURE XL14H18R 6,462.75$

HOSPITAL 358872 WRIGHT N/C FUSION PLATE 11,980.45$

HOSPITAL 358873 WRIGHT FT SCREW 2,133.50$

HOSPITAL 358874 ITS 4.5 DRILL BIT 471.95$

HOSPITAL 358875 SYN DISTAL RADIUS PL 6,244.10$

HOSPITAL 358876 AOS K WIRE 1.5X150 889.80$

HOSPITAL 358877 AOS 8 HOLE PLATE 4,033.15$

HOSPITAL 358878 AOS 2.5 DRILL BIT 1,428.40$

HOSPITAL 358879 AOS 3.5 CORTICAL LOCKING SCREW 1,506.35$

HOSPITAL 358880 AOS 3.5 CORTICAL NONLOCK SCREW 1,219.20$

HOSPITAL 358881 WRIGHT 4.0 COUNTERSINK 1,214.35$

HOSPITAL 358882 WRIGHT ALLOMATRIX PUTTY 4,663.45$

HOSPITAL 358883 WRIGHT 4.3 COUNTERSINK/DRILL 1,765.80$

HOSPITAL 358884 WRIGHT LONG THREAD SCREWS 4.0 1,465.85$

HOSPITAL 358885 CRTX LCK 4.5 SCREW 134.20$

HOSPITAL 358886 CANN LCK SCREW 1,428.15$

HOSPITAL 358887 S&N 6H LT TIB PLATE 4,952.30$

HOSPITAL 358889 S&N 3.5X40 PIN 762.95$

HOSPITAL 358890 PIIN DRILL TRIMIT 014348 1,363.55$

HOSPITAL 358891 BIT DRILL 5M 014359 1,349.80$

HOSPITAL 358892 ITS 2.4 LCK CORT SCREW 1,731.95$

HOSPITAL 358893 ITS 3 HOLE ULNA PLATE 5,612.65$

HOSPITAL 358894 ZIM RVS TRAY 44 MM 8,666.55$

HOSPITAL 358895 ZIM MINI STEM 11 MM 18,983.80$

HOSPITAL 358896 ZIM ARCOM XL 44-36 STD 3,702.55$

HOSPITAL 358897 STRATTICE 20X20 GRAFT 55,585.30$

HOSPITAL 358898 ZIM 2.7 CORTICAL SCREW 808.90$

HOSPITAL 358900 ZIM LCK SCREW 2.7 935.00$

HOSPITAL 358945 SEPTAL BUTTON 533.35$

HOSPITAL 359010 ZIM SMOOTH PEG 2.2 935.00$

HOSPITAL 359011 ZIM LEFT STANDARD PLATE 4,523.10$

HOSPITAL 359012 ZIM 2.2 DRILL 768.55$

2020-01




HOSPITAL 359013 MENTOR BREAST IMPLANT 3,714.25$

HOSPITAL 359014 ALLODERM MESH 014392 111,347.95$

HOSPITAL 359015 ZIM HYBRID GLEN POST 2,063.45$

HOSPITAL 359016 ZIM HUM HEAD 7,593.55$

HOSPITAL 359017 ZIM VERSA STD TAPER 1,451.35$

HOSPITAL 359018 ZIM GLENOID BASE 5,777.70$

HOSPITAL 359019 ZIM 9 STEINMAN" 928.55$

HOSPITAL 359020 S&N ACCORD CABLE & CLAMP 2,012.60$

HOSPITAL 359021 WRIGHT 1ST RAY PLATE 8,844.00$

HOSPITAL 359022 WRIGHT MEDIAL FUSION PLATE 12,616.00$

HOSPITAL 359023 ART BUTTRESS PLATE 13,858.20$

HOSPITAL 359024 WRIGHT DARCO SCREW 2,740.35$

HOSPITAL 359025 ZIM NCB SCREW 4.0 1,233.65$

HOSPITAL 359026 WRIGHT 5ML ALLOMTRIX PUTTY 6,479.30$

HOSPITAL 359027 ART DISTAL FIB PL 3,280.95$

HOSPITAL 359028 ART 3.5X14 LOCK SCREW 746.70$

HOSPITAL 359029 S&N TIBIAL PL 8* 5,004.40$

HOSPITAL 359030 S&N CAN SCREW 6.5 315.10$

HOSPITAL 359031 S&N CAN LOCK SCREW 5.7 1,428.15$

HOSPITAL 359032 STR 2.7 FT LOCK SCREW 1,514.25$

HOSPITAL 359033 STR HOOK PL 5* RIGHT 7,948.50$

HOSPITAL 359034 STR 2M K-WIRE W/STOP 1,064.90$

HOSPITAL 359035 WRIGHT 4.5 COTICAL SCREW 1,006.45$

HOSPITAL 359036 WRIGHT DARCO 2.5 K WIRE 552.90$

HOSPITAL 359037 WRIGHT FUSION PLATE 15,269.55$

HOSPITAL 359038 WRIGHT DARCO DRILL BIT 1,320.75$

HOSPITAL 359039 S&N CLAVICLE PL 10H R 2,618.55$


HOSPITAL 359042 RELOAD LINEAR CUT ENDO 014542 753.20$

HOSPITAL 359043 ENDO LINEAR CUTTER RELOAD GST6 753.20$

HOSPITAL 359044 ENDO ECHELON LONG PLEE60A 1,789.15$

HOSPITAL 359045 ENDO HARMONIC SHEARS 7LONG 2,659.80$

HOSPITAL 359046 WRIGHT LOCK SCREW 1,775.55$

HOSPITAL 359047 WRIGHT NONLOCKING SCREW 1,006.45$

HOSPITAL 359048 WRIGHT DRILL BITS 1,403.00$

HOSPITAL 359049 WRIGHT 4* PINCH PLATE 7,428.50$

HOSPITAL 359050 ART K WIRE 350.70$

HOSPITAL 359051 SYN DIST/TIB PL 4* 6,678.75$

HOSPITAL 359052 SCREW 6.7X100 014570 1,647.10$


HOSPITAL 359054 ART K WIRE 202.30$

HOSPITAL 359055 ALLODERM TISSUE MATRIX 014585 27,666.80$

HOSPITAL 359056 BREAST IMPLANT MOD+ 3,714.25$

HOSPITAL 359057 ALLODERM MESH 320CM 014393 54,066.55$

HOSPITAL 359058 ITS 4HOLE PL R FIBULA 21225-4 6,169.75$

HOSPITAL 359059 LUHR 2.1 DRILL BIT 893.50$

HOSPITAL 359060 MAXX-REGEN BONE MARROW KIT 10,317.25$

HOSPITAL 359061 AOS 2.5 DRILL BIT 1,315.95$

HOSPITAL 359062 AOS ST CLAVICLE PL 3019-060 3,961.45$

HOSPITAL 359063 AOS CORT SCREW 1,168.70$

HOSPITAL 359064 BREAST TISSUE EXPANDER 6,809.45$

HOSPITAL 359065 VICRYL 3-0 VCP864D 87.50$

HOSPITAL 359066 S&N 12X288 FEM PL 74820512 7,450.75$

HOSPITAL 359067 S&N CABLE SADDLE 74800601 1,149.15$

HOSPITAL 359068 ZIM VOLAR RIM PL 6,272.95$

HOSPITAL 359069 ZIM LK SQ SCREW 1,168.70$

HOSPITAL 359070 ZIM K WIRE 539.40$

HOSPITAL 359071 ZIM NONLK SCREW 1,011.05$

HOSPITAL 359072 ZIM MD SCREW 1,257.85$

HOSPITAL 359073 ART INTERNAL BRACE KIT 4,865.70$

HOSPITAL 359074 AOS FEM ROD 39X12.5X130 11,761.70$

HOSPITAL 359075 WRIGHT KWIRE 1.6 M 310.20$

HOSPITAL 359076 S&N VERILAST TOTAL KNEE 17,745.75$

HOSPITAL 359077 S&N ANKLE STRAP 242.15$

HOSPITAL 359078 AOS ST 6 HOLE PL 3,961.45$

HOSPITAL 359080 GUHL ANKLE DISTRACTOR 72203756 1,011.05$

HOSPITAL 359081 EXTRIMITY TRAY 72203988 1,403.00$

HOSPITAL 359082 EXTRIMITY SCOPE SET 1,623.20$

2020-01




HOSPITAL 359083 SCREW TENODESIS 5.5X8 014701 1,378.80$

HOSPITAL 359084 ART LASSO WIRE AR4068055D 377.60$

HOSPITAL 359085 ART 10X3 CANNULA AR65921030 431.55$

HOSPITAL 359086 AOS CANN 4.0 SCREW 1,312.05$

HOSPITAL 359087 AOS CANN DRILL 2.5 1,548.10$

HOSPITAL 359088 STR CAN 4.0 BONE SCREW 1,350.55$

HOSPITAL 359089 STR POLY INSERT 6,652.65$

HOSPITAL 359090 STR FEM HEAD 5,790.10$

HOSPITAL 359091 STR CROSSFIRE INSERT 9,042.10$

HOSPITAL 359092 MYOSURE XL50-50XL 6,421.50$

HOSPITAL 359093 AOS LK SCREW 2.7 1,350.70$

HOSPITAL 359094 AOS FIB PLATE 3051012 7,329.45$

HOSPITAL 359095 AOS CORT SCREW 3.5 1,329.75$

HOSPITAL 359096 AOS 46 M HEADLESS SCREW 1,312.05$

HOSPITAL 359097 AOS CORT SCREW 2.7 846.85$


HOSPITAL 359099 AOS 2.8 DRILL BIT 4009 1,490.85$

HOSPITAL 359100 STR SELF TAP CORT SCREW 3.5 596.60$

HOSPITAL 359101 STR PELV PLATE 4,713.00$

HOSPITAL 359102 STR 2.5 DRILL BIT 1,765.80$

HOSPITAL 359103 AOS SEMI TUB PLATE 3,625.15$

HOSPITAL 359104 AOS CORT LK SCREW 1,393.30$

HOSPITAL 359105 WRIGHT CORE DECOMPRESSION KIT 32,169.25$

HOSPITAL 359106 S&N ANKLE SCOPE 1,623.20$

HOSPITAL 359107 AOS LOCK SCREW 1,219.20$

HOSPITAL 359108 ZIM 3.2X9 STEINMAN PIN 1,428.40$

HOSPITAL 359109 WRIGHT EXPAND REAMER 2,826.95$

HOSPITAL 359110 S&N GNS REFURF PATELLA 3,415.10$

HOSPITAL 359111 MED CHISEL BLADE 973.95$

HOSPITAL 359112 MED RADIAL BLADE 973.95$

HOSPITAL 359113 AOS DISTAL TIB PLATE 3041009 7,728.95$

HOSPITAL 359114 ITS 9* CURVED PLATE 21604 1,225.35$

HOSPITAL 359115 ZIM QUICK VAC MIXING BOWL 1,168.70$

HOSPITAL 359116 SKYE PLACENTAL ALLOGRAFT AM50 6,190.35$

HOSPITAL 359117 ZIM TIB CONE LG 19,327.35$

HOSPITAL 359118 AOS FIB PLATE 7,332.70$

HOSPITAL 359119 N&S WRIST TOWER 1,623.20$

HOSPITAL 359120 N&S WRIST STABLIZATION KIT 871.55$

HOSPITAL 359121 ART STYLOID HOOK PLATE 5,455.85$

HOSPITAL 359123 ART CORTEX SCREW 2.4 714.20$

HOSPITAL 359124 MEDA TIBIAL AUGMENTATION 5,220.60$

HOSPITAL 359125 MEDA OFFSET CONTECTOR 8,357.05$

HOSPITAL 359126 MEDA FEM DIST AUGMENTATION 5,680.30$

HOSPITAL 359127 MEDA FEM COMPONENT 29,940.75$

HOSPITAL 359128 MEDA FLUTED EXT STEM 6,499.90$

HOSPITAL 359129 MEDA TIBAL TRAY 10,891.85$

HOSPITAL 359130 MEDA TIB INSERT 9,553.85$

HOSPITAL 359131 SHAVER DRILL 3M 014846 808.90$

HOSPITAL 359132 MYOSURE LITE 3,260.30$

HOSPITAL 359133 MYOSURE REACH 6,739.30$

HOSPITAL 359134 MYOSURE XL 6,875.50$

HOSPITAL 359135 AQUILEX IN/OUTFLOW TUBING 565.45$

HOSPITAL 359136 AQUILEX CANISTER KIT 49.50$

HOSPITAL 359137 PROPEL NASAL SPLINT 3,879.30$

HOSPITAL 359138 SKYE AMNIOTIC ALLOGRAFT AC4546 14,444.15$

HOSPITAL 359139 STR IM FLEX NAIL 2,375.40$

HOSPITAL 359140 BOSTON SC ACCOLADE L310 17,333.00$

HOSPITAL 359141 BOSTON SC COMM CONN CFRE 1,011.05$

HOSPITAL 359142 ZIM SM ILIAC WEDGE GRAFT 3,817.40$

HOSPITAL 359143 BOSTON SC INGEVITY 7742 2,063.45$

HOSPITAL 359144 ZIM JUGGERKNOT 2.9 KIT 2,104.75$

HOSPITAL 359145 ZIM QUATTRO ANCHOR 2,600.00$

HOSPITAL 359146 ZIM JGRKNT 2.9M #2 BLUE 2,269.85$

HOSPITAL 359147 LIGASURE LF1944 4,532.60$

HOSPITAL 359148 THUNDERBEAT 5MM 3,507.90$

HOSPITAL 359149 COUNTERSINK 014898 1,650.70$

HOSPITAL 359150 AOS R LG PILON PLATE 9,703.25$

HOSPITAL 359151 ZIM LOCK SCREW 6.5 909.95$

2020-01




HOSPITAL 359152 ZIM COMP SCREW 6.5 909.95$

HOSPITAL 359153 ZIM REV SHOULDER GLEN 5,984.05$

HOSPITAL 359154 ZIM REV SHOULDER ADPTR 8,047.50$

HOSPITAL 359155 SCLERA TRANSPLANT 2,476.20$

HOSPITAL 359156 WRIGHT AUGMENT BONE GRAFT 7,428.50$

HOSPITAL 359157 WRIGHT DRILL BIT 1,364.30$

HOSPITAL 359158 ART KNOTLESS TIGHTROPE 3,631.70$

HOSPITAL 359159 AOS MEDIAL TIB PL 9,703.25$

HOSPITAL 359160 ZIM COMP DRILL BIT 1,220.70$

HOSPITAL 359161 MEDA HEADLESS PINS 1,011.05$

HOSPITAL 359162 STELKAST G-FLEX FEMUR 8,666.55$

HOSPITAL 359163 STELKAST G-FLEX CR INSERT 5,158.65$

HOSPITAL 359164 S&N CEMENT PREP KIT TOTAL HIP 2,063.45$

HOSPITAL 359165 MEDA FEM MINI STEM 13,825.15$

HOSPITAL 359166 LIFENET UCL GRAFT (FGRACILIIS) 6,792.90$

HOSPITAL 359167 WRIGHT HEADED 2.5 K WIRE 579.85$

HOSPITAL 359168 WRIGHT HEADED DRILL BIT 1,364.30$

HOSPITAL 359169 ZIM CABLE ASSY 2,682.55$

HOSPITAL 359170 ZIM NCB CABLE BUTTON 1,403.00$

HOSPITAL 359171 ZIM STEIN PIN 612.10$

HOSPITAL 359172 STRY MATTA PLATE 4,939.95$

HOSPITAL 359173 ART MENI ROOT REPAIR 5,868.50$

HOSPITAL 359174 STRY TIBIAL PL R 12,236.30$

HOSPITAL 359175 STRY DRILL BIT 3.1 1,843.25$

HOSPITAL 359176 ARTHEX POWERPICK AR-8150PX 454.00$

HOSPITAL 359177 WRIGHT VALOR NAIL 17,918.60$

HOSPITAL 359178 STRY TIBIAL PL R 10,907.45$

HOSPITAL 359179 SKYE ALLOGRAFT 10,317.25$

HOSPITAL 359180 AOS WASHER 776.55$

HOSPITAL 359181 AOS CAN SCREW 4.0 1,312.05$

HOSPITAL 359182 AOS FULLY THREADED 1,312.05$

HOSPITAL 359183 SYN DISTAL RAD PL 7* 6,528.85$

HOSPITAL 359184 SCREW SHORT THREAD 4X45 015072 1,087.10$

HOSPITAL 359185 MEDTRONIC ADVISA PACEMAKER 17,745.75$

HOSPITAL 359186 STRY RECIPROCATING BLADE 602.50$

HOSPITAL 359187 MEDTRONIC TEST LEAD 539.40$

HOSPITAL 359188 MEDTRONIC TEST LEAD KIT 808.90$

HOSPITAL 359189 MEDTRONIC ANTIBIOTIC ENVELOPE 8,233.20$

HOSPITAL 359190 MEDTRONIC WRENCH KIT 5873W 485.50$

HOSPITAL 359191 WRIGHT RAYHACK PLATE 6,883.75$

HOSPITAL 359192 MEDA FEM COMP 8,967.30$

HOSPITAL 359193 MEDA TIBIAL TRAY 5,984.05$

HOSPITAL 359194 MEDA TIBIAL INSERT 3,301.60$

HOSPITAL 359195 GUIDESCOPE MAC/LOPRO 193.55$

HOSPITAL 359196 ENDO STITCH 404.15$

HOSPITAL 359197 SUTURE V LOC 3-0 0151 168.90$

HOSPITAL 359198 ART 7M WASHER 432.90$

HOSPITAL 359199 ART 8* 1/3 TUB PL 1,307.35$

HOSPITAL 359201 MESH EPIFIX 4CMX4.5CM 013920 653.55$

HOSPITAL 359202 ENDOLOOP PDS 014613 195.50$

HOSPITAL 359203 ART CANN SCREW LT 1,071.30$

HOSPITAL 359204 BONE BANK 2.5ML DBM PUTTY 4,126.90$

HOSPITAL 359205 ROYAL TROCAR 11G 3,095.20$

HOSPITAL 359206 ROYAL DRILL ADAPTER 1,623.20$

HOSPITAL 359207 S&N UNI KNEE 11,968.05$

HOSPITAL 359208 S&N MIS HEAD SCREW 677.50$

HOSPITAL 359209 ESOPHAGEAL STENT 11,483.20$

HOSPITAL 359211 WRIGHT SHORT THREAD SCREW 1,514.25$

HOSPITAL 359212 VAC DRESSING WHITEFOAM LRG 97.35$

HOSPITAL 359213 WRIGHT MTP FUSION PLATE 10,663.95$

HOSPITAL 359214 WRIGHT REAMER 1,727.10$

HOSPITAL 359215 KINAMED SUPERCABLE 2,297.95$

HOSPITAL 359216 WRIGHT 2.4 SCREW 1,051.85$

HOSPITAL 359217 WRIGHT ISO PLATE 6,710.35$

HOSPITAL 359218 WRIGHT 1.6 DRILL 1,190.15$

HOSPITAL 359219 ART SYNDE TIGHTROPE 8,815.10$

HOSPITAL 359220 WRIGHT ISO COUNTERSINK 1,190.15$

HOSPITAL 359221 WRIGHT EDGELOCK PLATE 7,527.55$

2020-01





HOSPITAL 359223 WRIGHT 3.5 LOCK SCREW 1,296.60$

HOSPITAL 359224 MEDA STRAIGHT PLATE 5 HOLE 1,899.85$

HOSPITAL 359225 MEDA GOLD 2.0 CORTEX SCREW 661.35$

HOSPITAL 359226 STRY HEATED INSUFF TUBING 235.25$

HOSPITAL 359227 STRY SMOKE EVAC TUBING 209.05$

HOSPITAL 359228 MEDA 1.6X25 DRILL BIT 920.45$

HOSPITAL 359229 ART MIX SYRINGE 14ML 973.95$

HOSPITAL 359230 NEEDLE DELIVERY 015293 1,298.60$

HOSPITAL 359231 FCI CONFORMER 471.95$

HOSPITAL 359232 FCI SPHERICAL IMPLANT 606.85$

HOSPITAL 359233 MED GOLD 2.3 CORTEX SCREW 661.35$

HOSPITAL 359234 PUTTY DBM 5CC 015187 4,717.10$

HOSPITAL 359235 BAR TIB LOCKING 015191 1,623.20$

HOSPITAL 359236 ROD TIB 14X71 015192 17,745.75$

HOSPITAL 359237 ITS PROX HUM LK PL 4* 8,295.15$

HOSPITAL 359238 GOLD CORTEX SCREW 2.3*9 661.30$

HOSPITAL 359239 ITS PROLOCK PLATE 5* 210317 3,920.60$

HOSPITAL 359240 ROYAL BIO HUMAN DBM MGP05 5,158.15$

HOSPITAL 359241 AOS TEMP FIX PIN 0121 768.55$

HOSPITAL 359242 ART LOCK CORT SCREW 859.40$

HOSPITAL 359243 ROY BIO RAN FILTER 1,317.70$


HOSPITAL 359245 ART 3.5 CORT LK SCREW 859.40$

HOSPITAL 359246 BOSTON SCIENTIFIC PACE GENERAT 14,444.15$

HOSPITAL 359247 PACEMAKER CELL ADAPTER 1,623.20$

HOSPITAL 359248 GYRUS T TUBE 222.95$

HOSPITAL 359249 ZIM PULSAVAC FAN SPRAY 188.70$

HOSPITAL 359250 ZIM IM SPRAY TIP 101.15$

HOSPITAL 359251 ZIM FEM BRUSH TIP 91.65$

HOSPITAL 359252 WRIGHT M&P PLATE 13,222.70$

HOSPITAL 359253 PARCUS SLIK ANCHOR 2,269.85$

HOSPITAL 359254 AOS HOOK PLATE 7,329.45$

HOSPITAL 359255 ART 12* 1/3 TUBULAR PLATE 1,451.35$

HOSPITAL 359256 ZIM 1/8 DRILL BIT" 405.20$

HOSPITAL 359257 MED ACE 2* SHELL 4,746.00$

HOSPITAL 359258 MEDACTA LINER 36mm 01.32.3644 3,923.80$

HOSPITAL 359259 VICRYL 3-0 22.85$

HOSPITAL 359260 DBM GEL ALLOSYNC 015308 3,301.60$

HOSPITAL 359261 PLATE GRAVITY PLANTAR 6,809.45$

HOSPITAL 359262 NEEDLE DRIVER GRAVITY 1,857.15$

HOSPITAL 359263 H-GENIN PUTTY 5CC 8,212.55$

HOSPITAL 359264 PLATE DISTAL RADIUS 4,863.70$

HOSPITAL 359265 VALOR NAIL 10MMX250MM LT LRG 17,919.10$

HOSPITAL 359266 TFCC FAST FIX 2,756.80$

HOSPITAL 359267 SUTURE SYSTEM TFCC MENDER DISP 881.75$

HOSPITAL 359268 PATELLA RESURFACING 1,451.35$

HOSPITAL 359269 FEMORAL COMPONENT 10,936.35$

HOSPITAL 359270 LARYNGEAL AIRWAY MASK 686.00$


HOSPITAL 359272 FUSEFORCE STAPLE 11,596.65$

HOSPITAL 359273 TIBIAL TRAY RIGHT T3-14 5,365.05$

HOSPITAL 359274 TIBIAL INSERT SIZE 4 RIGHT 5,158.65$

HOSPITAL 359275 LAG GALILEO SCREW 115MM 3,669.20$

HOSPITAL 359276 SCREW LOCKING 3.5MM 14MM 859.40$

HOSPITAL 359277 GUIDE WIRE 3.2 899.85$

HOSPITAL 359278 HUMERAL LOCK RING 9,966.50$


HOSPITAL 359280 ART 5* LEFT L PLATE 3,693.60$

HOSPITAL 359281 ART HAND/WRIST LEGAMENT REPAIR 8,815.10$

HOSPITAL 359282 ITS CORT 2.7 SCREW 596.60$

HOSPITAL 359283 AQUILEX SUCTION TUBING 907.95$

HOSPITAL 359284 AQUILEX IRRIGATE TUBING 495.25$

HOSPITAL 359285 VIVORTE TRABEXUS EB 13,206.10$

HOSPITAL 359286 S&N PF PIN 1,074.85$

HOSPITAL 359287 STRAP ANKLE DIST 015388 606.85$

HOSPITAL 359288 WRIGHT 7 HOLE PLATE 4,250.75$

HOSPITAL 359289 WRIGHT AUGMENT BONE GRAFT 14,275.05$

2020-01




HOSPITAL 359290 ART DIS FIB 5* PL 2,682.55$

HOSPITAL 359291 ITS CORT SCREW 647.25$

HOSPITAL 359292 ANCHOR PARCUS 4.5 TWIST 2,166.70$

HOSPITAL 359293 STELKAST TIB COMP 6,190.35$

HOSPITAL 359294 ART ACL/PCL IMPLANT SYSTEM 4,952.30$

HOSPITAL 359295 MEDA EXT STEM 6,190.35$

HOSPITAL 359296 ITS 8* R CLAV PL 6,648.45$

HOSPITAL 359297 ITS LOCK SCREW 1,493.35$

HOSPITAL 359298 TYRX ANTIBACTERIAL ENVELOPE 8,360.20$

HOSPITAL 359299 ITS SM L 8* PRL PL 3,920.60$

HOSPITAL 359300 RB MAXX-CELL ASP KIT 10,317.25$

HOSPITAL 359301 MEDA 1.2 GOLD CORTEX SCREW 661.35$

HOSPITAL 359302 MED BLUE 2.0 LOCK SCREW 1,070.40$

HOSPITAL 359303 MED BLUE 2.0/2.3 LOCKING PLATE 2,430.80$

HOSPITAL 359304 STELKAST ULTRA CONGRUENT KNEE 6,293.60$

HOSPITAL 359306 ART STAR DRIVER 1,623.20$

HOSPITAL 359307 ART SUTURE KNOTLESS 1,341.30$

HOSPITAL 359308 MED BLUE LOCK PL Y2/5 2,509.00$

HOSPITAL 359309 ART FIBERSTICK 2-0 606.65$

HOSPITAL 359310 ART SUTURE HOOK 1,298.60$

HOSPITAL 359311 ART LASSO STRAIGHT 1,298.60$

HOSPITAL 359312 ART TFCC DISP KIT 2,063.45$

HOSPITAL 359313 AUGMENT WRIGHT K300-015-10 7,820.50$

HOSPITAL 359314 TAUT CHOLANGIOCATH 20018-M55 240.90$

HOSPITAL 359315 STR BIPOLAR FORCEP 50.50$

HOSPITAL 359316 STRY BIPOLAR FORCEP/CABLE 50.30$

HOSPITAL 359320 LOQ CLAV PL 6,219.30$

HOSPITAL 359322 LOQ CORT SCREW 2.7 1,269.45$

HOSPITAL 359323 LOQ CORT SCREW GOLD 647.25$

HOSPITAL 359325 LOQ CORT SCREW 3.5 1,493.35$

HOSPITAL 359326 BARD COMPOSIX L/P MESH 2,311.10$

HOSPITAL 359327 MESH PLUG PREFIX LARGE 015544 711.25$

HOSPITAL 359328 AOS CLAVICLE PLATE 3,961.85$

HOSPITAL 359329 HORIZON GREEN LIGA CLIP 50.60$

HOSPITAL 359330 ZIM CORT SCREW 5.0 1,548.10$

HOSPITAL 359331 ZIM FEM NAIL 14,031.50$

HOSPITAL 359332 ZIM 3.0 PIN 1,233.65$

HOSPITAL 359333 ART FAST THREAD 1,596.45$

HOSPITAL 359334 KINAMED GRIP & PL SYSTEM 6,190.35$

HOSPITAL 359335 MED COMP SCREW 2,123.30$

HOSPITAL 359336 MED SCREW BLADE 2,500.30$

HOSPITAL 359337 MED K-WIRE 1,244.55$

HOSPITAL 359338 ENDO CLOSE 250.75$

HOSPITAL 359339 WRIGHT FUSEFORCE STAPLE 8,344.65$

HOSPITAL 359340 STRY HUMERAL NAIL 12,112.50$

HOSPITAL 359341 SUTURE ANCHOR 4.75 015586 1,572.30$

HOSPITAL 359342 CON AUTOPASS NEEDLE 811.60$

HOSPITAL 359343 CON HI-FI SUTURE 1,572.30$

HOSPITAL 359344 ITS 3.0 CANC LK SCREW 967.50$

HOSPITAL 359345 PASSER SUTURE 015609 909.00$

HOSPITAL 359346 MED GOLD 1.5 CORT SCREW 661.35$

HOSPITAL 359347 MED COUNTERSINK 1,396.90$

HOSPITAL 359348 MED DRILL BIT 920.45$

HOSPITAL 359349 MED K WIRE 495.60$

HOSPITAL 359350 MED BLUE LK SCREW 1,070.40$

HOSPITAL 359351 MED TRILOCK PL 3,033.30$

HOSPITAL 359352 KINMED COMP SCREW 660.75$

HOSPITAL 359353 KINMED LK SCREW 5.0M 1,603.75$

HOSPITAL 359354 LINK EXPANSION BOLT 1,714.20$

HOSPITAL 359355 LINK FEM STEM 19,933.20$

HOSPITAL 359356 LINK PROSTHESIS HEAD 10,737.90$

HOSPITAL 359357 LINK NECK W/O COLLAR 22,733.70$

HOSPITAL 359358 LINK FEM SPACER 1,738.05$

HOSPITAL 359359 MEDA SCREW PACK 1,011.05$

HOSPITAL 359360 MEDA LONG THREADED PIN 1,011.05$

HOSPITAL 359361 SUT MONOCRYL PS-2 4-0 Y496G* 50.60$

HOSPITAL 359362 PACEMAKER INGEVITY MRI IS-1 2,056.05$

HOSPITAL 359363 PACEMAKER DR IS-1 015670 18,571.05$

2020-01




HOSPITAL 359364 SCREW COMPRESSION HEADLESS 40M 1,312.05$

HOSPITAL 359365 NAIL LEFT 11MMX36CM 8,749.05$

HOSPITAL 359366 DRILL BIT CAILBRATED S0289 1,446.50$

HOSPITAL 359367 STEM TIBIAL FEMORAL PRESS FIT 7,304.70$

HOSPITAL 359368 INSERT GENFLEX KNEE CR 5-11 6,293.60$

HOSPITAL 359369 INSERT GENFLEX KNEE CR 2.5-11 6,293.60$

HOSPITAL 359370 SUTURE Y KNOT ANCHOR W/TAPE 1,572.30$

HOSPITAL 359371 SUTURE LASSO MICRO AR-8704 909.00$

HOSPITAL 359372 TIBIAL INSERT FIX 5,158.65$

HOSPITAL 359373 VOLAR DISTAL PLATE 2.4MM 6,293.60$

HOSPITAL 359374 GHIATAS BREAST WIRE ALL SIZES 136.40$

HOSPITAL 359375 BREVERA BREAST BIOPSY NEEDLE 1,052.40$

HOSPITAL 359376 BREVERA SINGLE CHAMBER FILTER 758.30$

HOSPITAL 359377 BREVERA BIOPSY 12 CHAMBER 758.30$

HOSPITAL 359378 FORMALINE 240/120ML 21.25$

HOSPITAL 359379 PLATE PROXIMAL LEFT 2 HOLE 12,698.50$

HOSPITAL 359380 4MM LOCKING SCREW 1,465.80$

HOSPITAL 359381 RADIAL STEM WITH SCREW 8,831.60$

HOSPITAL 359382 FULL THREAD PEG SCREW 973.95$

HOSPITAL 359383 PLATE CORONOID RIGHT 5,034.85$

HOSPITAL 359384 FULL PEG SCREW 973.95$

HOSPITAL 359385 DRILL BIT FAST 1,103.80$

HOSPITAL 359386 PLATE OLECRANON 13 HOLE 6,561.80$

HOSPITAL 359387 SCREW CORTEX 3.5 015698 1,493.35$

HOSPITAL 359388 CORTEX LOW PROFILE SCREW 714.20$

HOSPITAL 359389 WASHER CORTEX 3.5MM 015700 714.20$

HOSPITAL 359390 CORTEX LOCKING SCREW 1,493.35$

HOSPITAL 359391 DRILL BIT 2.7MM CALIBRATED 1,168.70$

HOSPITAL 359392 DRILL BIT 2.5MM 1,103.80$

HOSPITAL 359393 FULL PEG SCREW 973.95$

HOSPITAL 359394 ANCHOR SUTURE PEEK MINI 2,125.35$

HOSPITAL 359395 THREAD HEADLESS SCREW 1,312.05$

HOSPITAL 359396 ALCON IOL TORIC LENS 19.0 1,298.60$

HOSPITAL 359397 FLOSEAL 5ML FULL PREP KIT 971.70$

HOSPITAL 359398 FLOSEAL ENDO APPLICATOR 626.50$

HOSPITAL 359399 CANNULATED SCREW 4.0mm x 18mm 1,312.00$

HOSPITAL 359400 GEN FLEX KNEE CR INSERT ULTRA 6,293.60$

HOSPITAL 359401 BARD XL PERFIX PLUG 841.80$

HOSPITAL 359402 FEMUR CUTTING BLOCK SIZE 4 1,298.60$

HOSPITAL 359403 TIBIAL INSERT FIXED SIZE 4 5,158.65$

HOSPITAL 359404 GOLD CORTEX BONE SCREW 661.30$

HOSPITAL 359405 GEN ULTRA CONGRUENT FLEX INSER 6,293.60$

HOSPITAL 359406 STAPLE NITINOL 15 X 15MM 11,596.65$

HOSPITAL 359407 FUSEFORCE STAPLE SIZER 1,460.90$

HOSPITAL 359408 KELLER FUNNEL 954.40$

HOSPITAL 359409 LINK BOLT MP EXPANSION 1,712.60$

HOSPITAL 359410 HIP ADAPTOR 12/14MM 22,733.70$

HOSPITAL 359411 HIP HEAD 12/14 6,932.65$

HOSPITAL 359412 HIP STEM 21,086.30$

HOSPITAL 359413 HIP STEM 16X14X210 19,438.90$

HOSPITAL 359414 D-FEND PRO WATER TRAP 137.40$

HOSPITAL 359415 MEDA FEM STEM 13,217.00$

HOSPITAL 359417 PLATE LATERAL 7,422.20$

HOSPITAL 359418 STR 8.0 WASHER 778.85$

HOSPITAL 359419 STR CAN SCREW 8X80 2,230.40$

HOSPITAL 359420 ART PERI GLENOID SCREW 778.70$

HOSPITAL 359421 ALIGN RADIAL STEM 9,499.70$

HOSPITAL 359422 ALIGN RADIAL HEAD & SCREW 9,706.25$

HOSPITAL 359423 ALIGN UNI DRIVER 728.30$

HOSPITAL 359425 ART SUTURE KIT 1,001.40$

HOSPITAL 359426 ART GLENIOD BASEPLATE 8,054.10$

HOSPITAL 359427 ART GUIDE WIRE 579.80$

HOSPITAL 359428 ART 3.0 DRILL BIT 1,239.40$

HOSPITAL 359429 ITS PIN TO BAR CLAMP 3,382.75$

HOSPITAL 359430 ITS PIN CENTRAL THREAD 1,375.70$

HOSPITAL 359431 ART MENISCAL CINCH 1,912.20$

HOSPITAL 359432 ART SUTURE CUTTER 1,135.60$

HOSPITAL 359433 VITOSS BB TRAUMA 7,000.90$

2020-01




HOSPITAL 359434 K WIRE 3.2 1,168.05$

HOSPITAL 359435 STR 4.9 DRILL BIT 2,358.40$

HOSPITAL 359436 STR FIXOS 7.0 SCREW 4,613.60$

HOSPITAL 359437 K WIRE 1.4 1,462.00$

HOSPITAL 359438 DRILL BIT FIXOS 2,350.15$

HOSPITAL 359439 K WIRE 2.0 1,070.70$

HOSPITAL 359440 AOS DIS TIB PLATE 7,735.25$

HOSPITAL 359441 STR FIXOS 5.0 SCREW 2,858.25$

HOSPITAL 359442 AOS THREAD K-WIRE 979.15$

HOSPITAL 359443 ART PIN KIT 1,936.40$

HOSPITAL 359444 LOQ TIB PLATE 9,780.60$

HOSPITAL 359445 LOQ 3.5 CORT SCREW 1,343.25$

HOSPITAL 359446 LOQ 2.7 DRILL BIT 869.55$

HOSPITAL 359447 LOQ 2.7 DRILL BIT 960.40$

HOSPITAL 359448 SCREW LOCK 1,376.30$

HOSPITAL 359449 DRILL BIT 1,451.35$

HOSPITAL 359450 INTERSTIM SMART KIT 8,054.10$

HOSPITAL 359451 DRILL TIP WIRE 858.80$

HOSPITAL 359452 PLATE FEMUR 8,772.05$

HOSPITAL 359453 SUTURE POLYSORB 25.05$

HOSPITAL 359454 STR BONE SCREW 3.5 1,219.95$

HOSPITAL 359455 ARTH FIBERWIRE 0 AR725 106.50$

HOSPITAL 359456 ART SUTURETAPE LOOP AR7534 708.05$

HOSPITAL 359457 ART SUTURETAPE FIBERLNK AR7235 859.75$

HOSPITAL 359498 LAPAROSCOPY 645.05$

HOSPITAL 359499 ALPHA PLATE 11,564.85$

HOSPITAL 359500 SCREW HEADLESS 1,312.90$

HOSPITAL 359501 SCREW FIBONACCI 1,329.00$

HOSPITAL 359502 SCREW NON LOCKING 1,232.95$

HOSPITAL 359503 SCREW CORTICAL 1,103.75$

HOSPITAL 359504 SCREW FULLY THREADED 1,219.95$

HOSPITAL 359505 HUMERAL STEM SM 4,192.25$

HOSPITAL 359506 HUMERAL STEM REVERSE SZ 8 10,263.80$

HOSPITAL 359507 SCREW LOCKING PERIPHERAL 778.70$

HOSPITAL 359508 FEMORAL STEM SIZE 2 13,217.00$

HOSPITAL 359509 HUMERAL INSERT COMBO 4,192.25$

HOSPITAL 359510 SPACER 2,372.10$

HOSPITAL 359511 PLATE OLECRANON 4 HOLE 8,182.15$

HOSPITAL 359513 SCREW LOCKING 3.5MM X 30MM 1,670.15$

HOSPITAL 359514 SCREW BONE FULL THREADED 1,219.95$

HOSPITAL 359516 NAIL PROXIMAL HUMERUS CAN LT 16,541.85$

HOSPITAL 359517 SCREW LOCKING 4MM X 28MM 1,820.25$

HOSPITAL 359518 STEM FEMORAL SIZE 00 13,217.00$

HOSPITAL 359519 SCREW NON LOCKING 778.70$

HOSPITAL 359520 STEM CAP COATED 10,263.80$

HOSPITAL 359521 HUMERAL INSERT MED 4,192.25$

HOSPITAL 359522 ART GLENOSPHERE MODULAR 9,499.70$

HOSPITAL 359529 BARD 3DMAX MESH LIGHT 1,226.45$

HOSPITAL 359532 ITS 65MM CANNULATED SCREW 1,529.80$

HOSPITAL 359533 SHORT HOOK PLATE 3 HL 7,338.70$

HOSPITAL 359534 60MM CANCELLOUS LOCK SCREW 1,312.90$

HOSPITAL 359535 18MM CORTICAL SCREW 1,329.00$

HOSPITAL 359544 VASCULAR GRAFT GORE TEX 000116 2,712.30$

HOSPITAL 359587 CATHETER FOGARTY ARTERIAL 3-7 823.15$

HOSPITAL 359595 HEMOVAC LRG TUBE 345.70$

HOSPITAL 359596 ART ABLATOR HOOK 90 AR-9801 882.45$

HOSPITAL 359623 KIT WRIST SMALL 897.80$

HOSPITAL 359624 VALOR NAIL 10MMX200MM LT MED 17,919.10$

HOSPITAL 359625 VALOR NAIL 10MMX250MM LT LRG 17,919.10$

HOSPITAL 359626 VALOR NAIL 10MMX300MM LT XLG 17,919.10$

HOSPITAL 359627 VALOR SCREW 1,988.35$

HOSPITAL 359628 SCREW SHORT THREAD 2,322.15$

HOSPITAL 359629 SCREW LONG THREAD 1,514.20$

HOSPITAL 359878 CEMENT BONE 009751 604.20$

HOSPITAL 359883 SOL SORBITOL 3% 3000ML URO IRR 63.95$

HOSPITAL 359886 DRESSING AQUACEL 3.5X6 010477 132.65$

HOSPITAL 359887 SUTURE ANCHOR 010510 1,362.65$

HOSPITAL 359888 ART 90 LASSO AR406890 908.50$

2020-01




HOSPITAL 359889 ART SUTURE ANCHOR PUSHLOCK 2,113.45$

HOSPITAL 359890 ART FIBERLINK AR7235 1,837.75$

HOSPITAL 359891 ART 45 LASDSO AR406845R 908.50$

HOSPITAL 359893 HEMACLEAR MEDIUM 169.30$

HOSPITAL 359894 HEMACLEAR LARGE ORANGE 203.20$

HOSPITAL 359895 HEMACLEAR XLG B&W 208.05$

HOSPITAL 359896 CANNUFLOW CANNULA ENTREVU 305.05$

HOSPITAL 359897 DEPUY TOTAL KNEE 26,819.85$

HOSPITAL 359898 STELKAST TOTAL HIP IMPLANT 25,169.35$

HOSPITAL 359901 TRANSANAL ACCESS PLATFORM 3,404.15$

HOSPITAL 359902 MEDLINE U DRAPE 23.85$

HOSPITAL 359903 PARCUS V LOX SUTURE ANCHOR 1,741.05$

HOSPITAL 359904 PARCUS MITI SUTURE ANCHOR 1,934.45$

HOSPITAL 359905 PARCUS SUTURE BRAID 2 - 20049 634.75$

HOSPITAL 359906 PARCUS 4.5M PUSHIN ANCHOR10318 1,620.10$

HOSPITAL 359907 PARCUS INFINITY LOOP 2 - 20056 689.05$

HOSPITAL 359908 COOK URETER METAL STENT/INTROD 4,017.90$


HOSPITAL 359910 STELKAST HOLD SCREW SC3520-55 972.85$


HOSPITAL 359912 STELKAST TOTAL KNEE HIGH DEMAN 23,518.95$

HOSPITAL 359913 MEDTRONIC INFLATE FX EL 153B 12,997.35$

HOSPITAL 359915 PARCUS 2 BRAID 20054 486.30$

HOSPITAL 359916 PARCUS KNOTLESS ANCHOR 3.5 1,644.25$

HOSPITAL 359917 PARCUS 5.0 V-LOX W/#2 BRAID 1,668.50$

HOSPITAL 359918 PARCUS 3.5 DRIVER 10344 972.85$

HOSPITAL 359919 PARCUS 4.5 DRIVER 10345 972.85$

HOSPITAL 359920 PARCUS #5 SUTURE 20059 587.85$

HOSPITAL 359921 PARCUS TRACTION KIT 20016 648.40$

HOSPITAL 359922 SYN TI 11/130 NAIL 456.424S 10,785.60$

HOSPITAL 359923 SYN 3.5 DRILL BIT 310.37 803.75$

HOSPITAL 359924 SYN 2.8 DRILL BIT CAL 03113024 1,192.60$

HOSPITAL 359925 SYN DRILL BIT CAL 2.5 03113023 1,192.60$

HOSPITAL 359926 BARD XENMASTER GRAFT 50,516.15$

HOSPITAL 359927 ITS K WIRE KW16-102 259.45$

HOSPITAL 359928 ITS DRILL BIT 2.7 DB27-100 622.45$

HOSPITAL 359929 SYN 3.5 LOCK SCREW 44M 212.134 1,205.60$

HOSPITAL 359930 SYN 3.5 LCP PLATE 10 HOLE 8,667.25$

HOSPITAL 359931 STELKAST LOW DEMAND TOTAL KNEE 22,693.70$

HOSPITAL 359933 GLAUKOS TRAB I STENT GTS100L 5,706.55$

HOSPITAL 359940 ZIMMER PT SPEC INST 4,613.15$

HOSPITAL 359941 BREG SHOULDER SLING BRACE S-XL 610.65$

HOSPITAL 359942 CONMED SAW BLADE 285.45$

HOSPITAL 359943 STRYKER ACE SHELL 5421150E 6,240.85$

HOSPITAL 359945 STRYKER CAN SCREW 6.5 846.15$

HOSPITAL 359946 STRY ACE INSERT 32M 6230032D 6,240.85$

HOSPITAL 359947 STRYKER ACE LINER 7,489.00$

HOSPITAL 359948 STRYKER X3 INSERT 7,489.00$

HOSPITAL 359949 STRYKER DRILL BIT 21073325 908.50$

HOSPITAL 359950 ZIMMER TOTAL HIP 26,819.85$

HOSPITAL 359951 O VICRYL SUTURE J603H 22.05$

HOSPITAL 359952 POWERPORT SLIM 010800 2,176.25$

HOSPITAL 359953 ACUMED GUIDEWIRE .035WS-0906ST 194.55$

HOSPITAL 359954 ACUMED RADIAL HEAD TR-H220L-S 13,709.65$

HOSPITAL 359955 ACUMED RADIAL STEM TR-50804-S 8,348.80$

HOSPITAL 359957 SILK 4-0 1984G 52.20$

HOSPITAL 359958 ITS 2.6X220MM CANN DRILL BIT 1,523.40$

HOSPITAL 359959 ITS 4.0 CAN SCREW 50M 1,595.95$

HOSPITAL 359960 DEPUY 9X330MM CANN TIB NAIL 6,071.05$

HOSPITAL 359961 SYN TI 4X0X42M LOCK SCREW 1,450.40$

HOSPITAL 359962 SYN TI 3.2X330 3FLUT BIT 1,738.20$

HOSPITAL 359963 SYN TI 3.2X145 3FLUT BIT 1,240.90$

HOSPITAL 359964 ZIM UNI KNEE TIBIAL 908.50$

HOSPITAL 359965 DEPUY 4X34MM LOCK SCREW 1,450.40$


HOSPITAL 359967 ZIM UNI KNEE FEM 3,404.15$

HOSPITAL 359968 PARCUS DRILL BIT 3 X300 1,427.60$

HOSPITAL 359969 S&N FAST FIX 360 BRAID 2,176.25$

2020-01




HOSPITAL 359970 S&N FAST FIX 360 PUSHER 876.05$

HOSPITAL 359971 QUILL O SUTURE 130.50$

HOSPITAL 359972 QUILL 2 SUTURE 149.20$

HOSPITAL 359973 QUILL 2-0 SUTURE 149.20$

HOSPITAL 359977 ORTHO KNEE SUPPORT LG 07234 307.00$

HOSPITAL 372714 SYN EX FIX L PIN CLAMP 390002 3,413.25$

HOSPITAL 372715 SYN EX FIX L CLAMP 390.005 3,002.95$

HOSPITAL 372716 SYN EX FIX L ROD 11X350 1,858.90$

HOSPITAL 395504 MED FEM STEM SIZE 4 13,217.00$

HOSPITAL 635116 NEEDLE TIPPED CYTOLOGY BRUSH 254.10$

HOSPITAL 650445 BODY COVER UPPER 42.45$

HOSPITAL 650789 BODY COVER LOWER 331.75$

HOSPITAL 658657 LIFENET DECELL DERMIS AFLEX301 16,027.95$

HOSPITAL KDH0000099 PEAK PRP PLASMA SYSTEM PROCEDU 0232T 359.70$

HOSPITAL 212028 COSMETIC ANESTHESIA 317.25$

HOSPITAL 351598 ANESTHESIA BLOCK NERVE 819.60$

HOSPITAL 650029 ANESTHESIA BLOCK REGIONAL 916.05$

HOSPITAL 650045 ANESTH GENERAL 1ST HOUR 1,828.35$

HOSPITAL 650046 ANESTH GENERAL EA ADDL 1/2 HR 363.15$

HOSPITAL 650061 ARTERIAL MONITORING KIT 377.05$

HOSPITAL 650088 ANESTHESIA SPINAL 1,762.75$

HOSPITAL 650118 ANESTHESIA SPINAL KIT 25 G 356.50$

HOSPITAL 650119 TRAY ANES EPIDURAL BARRON 349.95$

HOSPITAL 650126 ANESTHESIA LOCAL 847.90$

HOSPITAL 650145 ANESTHESIA MAC 1ST HOUR 1,828.35$

HOSPITAL 650146 ANESTHESIA MAC EA ADDL 1/2 HR 308.95$

HOSPITAL 650147 ANESTHESIA MAC 1ST 15 MIN 914.25$

HOSPITAL 650148 ANESTHESIA MAC EA ADDL 15 MIN 308.95$

HOSPITAL 651257 TRAY ANES SPINAL LIDOCAINE 96.60$

HOSPITAL 651258 TRAY ANES SPINAL MARCAINE 98.70$

HOSPITAL 177779 NAVIGATIONAL BRONCHOSCOPY 31627 1,825.90$

HOSPITAL 352941 CAPSULE LAUNCHER 00711144 1,692.65$

HOSPITAL 630002 INJECT IV INITIAL ASU 96374 212.25$

HOSPITAL 630003 INJECT IV add'l diff drug ASU 96375 192.90$

HOSPITAL 630004 MONOPOLAR HEMOSTAT GRASPER 1,295.25$

HOSPITAL 630006 INJECT IV add'l same drug ASU 96376 192.90$

HOSPITAL 630007 PARACENTESIS (ASU) 763.15$

HOSPITAL 630008 THORACENTESIS (ASU) 838.50$

HOSPITAL 630010 ENDOSCOPY 1,609.95$

HOSPITAL 630011 INJECTION SQ/IM (ASU) 96372 115.05$

HOSPITAL 630012 SIGMOIDOSCOPY, FLEXIBLE 1,558.50$

HOSPITAL 630015 SIGMOID,FLEX W/POLYPECTOMY 2,346.50$

HOSPITAL 630020 BRONCHOSCOPY O/P 1,901.20$

HOSPITAL 630021 BRONCHOSCOPY, NAVIGATIONAL 1,722.55$

HOSPITAL 630026 SIGMOIDOSCOPY,RIGID W/POLY 1,289.15$

HOSPITAL 630027 PH MONITOR 91034 1,255.75$

HOSPITAL 630028 MANOMETRY 91010 1,192.60$

HOSPITAL 630041 BRONCH RETRIEVAL BASKET 1,790.40$

HOSPITAL 630042 THERAPEUTIC PHLEBOTOMY 99195 111.65$

HOSPITAL 630051 EGD W/PEG INSERT 1,772.80$

HOSPITAL 630070 SPECIAL PROCEDURE MINOR 402.15$

HOSPITAL 630076 TUBE JEJUNOSTOMY 18FR 1,635.15$

HOSPITAL 630080 SIGMOIDOSCOPY, RIGID O/P 576.80$

HOSPITAL 630120 DILATOR BALLOON EACH 425.50$

HOSPITAL 630122 COLLECT BLOOD IMPLANT PORT ASU 36591 129.55$

HOSPITAL 630123 COLLECT BLOOD FROM PICC ASU 36592 129.55$

HOSPITAL 630140 RECOVERY STEP-DOWN (ASU) 235.80$

HOSPITAL 630141 RECOVERY STEP-DOWN 1/4 HR ASU 58.95$

HOSPITAL 630150 RECOVERY 1ST HOUR (ASU) 981.15$

HOSPITAL 630151 RECOVERY EACH 1/4 HOUR (ASU) 245.75$

HOSPITAL 630204 GASTRO TUBE REPLACEMENT 388.40$

HOSPITAL 630221 SNARE POLYPECTOMY DISP 561.20$

HOSPITAL 630251 TISSEL KIT 1,064.10$

HOSPITAL 630500 REG ANEST SERV OP W/O F 649.40$

HOSPITAL 630501 REG ANEST SERV OP W/F 1,132.30$

HOSPITAL 630515 REG ANEST EPIDURAL OP W/O F 994.00$

HOSPITAL 630516 REG ANEST EPIDURAL OP W/F 1,476.95$

HOSPITAL 630575 REGIONAL CLINIC 99211 138.45$

2020-01




HOSPITAL 630605 CAPSULE ENDOSCOPY 91110 2,825.90$

HOSPITAL 632003 BRONCHOSCOPY W/SPECIMEN IP 2,624.20$

HOSPITAL 632005 BRONCHOSCOPY IP 1,901.20$

HOSPITAL 632007 BRONCHOSCOPY W/SPECIMEN OP 2,624.20$

HOSPITAL 632015 COLONOSCOPY 1,408.45$

HOSPITAL 632017 COLONOSCOPY W/POLYPECTOMY 2,141.95$

HOSPITAL 632021 FOREIGN BODY EXTRACTION EOSPHA 272.05$

HOSPITAL 632035 SPECIAL PROCEDURE MAJOR 878.40$

HOSPITAL 632175 NEEDLE COLON SCLEROTHERAPY 601.60$

HOSPITAL 635000 ASU OP PROC/TX PER HOUR 99211 189.70$

HOSPITAL 635101 KIT EDGE PROC 45 FIRM 010639 4,773.40$



HOSPITAL 635104 EDGE 45 EXT CHAN FIRM TIP EWC 2,109.90$



HOSPITAL 635108 FORCEP BIOPSY PREMARKED 375.60$

HOSPITAL 635109 BRUSH BRONCH CYTOLOGY 010648 146.40$

HOSPITAL 635110 NEEDLE PREMARK ASPR 21G 010649 463.85$

HOSPITAL 635111 BRUSH CYT TRPL NDL 10MM 010651 465.25$

HOSPITAL 635112 TRIPLE NEEDLE CYTO 15MM BRUSH 465.25$

HOSPITAL 635113 COBRA FIDUCIAL MARKERS 638.40$

HOSPITAL 635114 MARKER DELIVER KITS 378.40$

HOSPITAL 635160 BLOOD TRANSFUSION 1 UNIT (ASU) 36430 851.35$

HOSPITAL 635161 BLOOD TRANSFUSION 2 UNITS(ASU) 36430 1,315.10$

HOSPITAL 635162 BLOOD TRANSFUSION 3 UNITS(ASU) 36430 1,972.55$

HOSPITAL 635165 PICC INSERTION SUCCESSFUL ASU 1,102.25$

HOSPITAL 635167 PICC INSERT ATTEMPT (ASU) 1,102.25$

HOSPITAL 635493 INFUSION HYDRATE ASU 1ST HR 96360 375.20$

HOSPITAL 635495 INFUSION THER ASU 1st HR 96365 522.40$

HOSPITAL 635496 INFUSION THER ASU >90 min 96366 23.20$

HOSPITAL 635498 INFUSION SEQUENTIAL ASU 96367 145.00$

HOSPITAL 635499 PORT FLUSH - ASU 96523 111.65$

HOSPITAL 635500 CHEMO IV INFUSION 1 HR (ASU) 96413 617.50$

HOSPITAL 635501 CHEMO IV INFUSION ADDL HR(ASU) 96415 247.60$

HOSPITAL 635809 STENT WALLFLEX 30/25X12 230CM 11,351.80$

HOSPITAL 635810 GUIDEWIRE .035 STIFF 450CM STR 2,012.30$

HOSPITAL 635811 CANNULA TANDEM XL ERCP 796.05$

HOSPITAL 637762 BRUSH MICROBIO SPEC COLLECTION 321.70$

HOSPITAL 637764 FECAL TRANSPLANT PROCEDURE 3,245.80$

HOSPITAL KDH0000089 HEMODIALYSIS TREATMENT IP 90937 1,988.45$

HOSPITAL 220001 RECOVERY ROOM 1,910.55$

HOSPITAL 220002 RECOVERY ROOM EACH ADDL 1/2 HR 310.05$

HOSPITAL 280012 THERAPEUTIC PHLEBOTOMY 99195 232.20$

HOSPITAL 280013 CHEMOTHERAPY BLADDER INSTILL 51720 534.85$

HOSPITAL 280014 INJECT IV add'l same drug ONC 96376 192.90$

HOSPITAL 280050 INJECTION SQ/IM (ONC) 96372 115.05$

HOSPITAL 280051 INJECT IV INITIAL ONC 96374 212.25$

HOSPITAL 280053 INJECT IV ADDL DIFF DRUG ONC 96375 192.90$

HOSPITAL 280054 COLLECT BLOOD FROM PICC ONC 36592 129.55$

HOSPITAL 280159 COLLECT BLOOD IMPLANT PORT ONC 36591 129.55$

HOSPITAL 280161 BONE MARROW BIOPSY - ONCOLOGY 38221 2,008.20$

HOSPITAL 280162 DECLOT PICC (ONC) 36593 394.20$

HOSPITAL 280201 ONC VISIT FACILITY L1 (NEW) 99201 110.50$





HOSPITAL 280211 ONC VISIT FACILITY L1 (EST) 99211 180.05$

HOSPITAL 280211-25 ONC VISIT FACILITY L1 (EST)-25 9921125 180.05$









2020-01




HOSPITAL 280217 CHEMO ADMIN NON-HORMONAL IM/SQ 96401 296.60$

HOSPITAL 280218 CHEMO ADMIN HORMONAL SQ/IM 96402 296.60$

HOSPITAL 280219 CHEMO IV PUSH - INITIAL 96409 377.30$

HOSPITAL 280220 CHEMO IV PUSH -EA ADDITIONAL 96411 377.30$

HOSPITAL 280221 CHEMO INFUSION 1ST HOUR 96413 654.55$

HOSPITAL 280222 CHEMO INFUSION -EACH ADD'L HR 96415 262.45$

HOSPITAL 280223 CHEMO INFUSION SEQUENTIAL 96417 260.95$

HOSPITAL 280409 INFUSION HYDRATE ONC > 90min 96361 29.60$

HOSPITAL 280410 INFUSION THER ONC 1st HR 96365 522.40$

HOSPITAL 280411 INFUSION THER ONC >90 min 96366 23.20$

HOSPITAL 280500 CHEMO ADMIN VIA PORTABLE PUMP 96416 490.50$

HOSPITAL 280505 INFUSION SEQUENTIAL ONC 96367 145.00$

HOSPITAL 280506 INFUSION CONCURRENT ONC 96368 145.00$

HOSPITAL 280771 ADMIN OF INFLUENZA VACCINE-ONC 90471 39.00$

HOSPITAL 280772 ADMIN OF PNEMONCOCCAL VACCINE 90471 39.00$

HOSPITAL 280773 ADMIN IMMUNIZATION - 1 VACCINE 90471 39.00$

HOSPITAL 280774 PORT FLUSH - ONC 96523 118.30$

HOSPITAL 280776 INFUSION HYDRATION 1ST HR SCH 96360 375.20$

HOSPITAL 280778 INFUSION HYDRATION >90 MIN -59 9636159 29.60$

HOSPITAL 280779 FMLA 20.85$

HOSPITAL 280780 BEHAV CHNG SMOKING 3-10 MIN 99406 38.60$

HOSPITAL 280781 BEHAV CHNG SMOKING > 10 MIN 99407 38.60$

HOSPITAL 280787 IMMUNIZATION ADM;EA ADDTL 90472 39.00$

HOSPITAL 280788 ADMINISTER HEP B VACCINE 90471 39.00$

HOSPITAL 280790 INJECTION SQ/IM (ONC) -59 9637259 115.05$

HOSPITAL 280793 CHEMO ADMIN NON-HORM IM/SQ -59 9640159 296.60$

HOSPITAL 280794 CHEMO ADMIN HORMONAL SQ/IM -59 9640259 296.60$

HOSPITAL 280795 INFUSION THER ONC 1st HR -59 9636559 522.40$

HOSPITAL 280803 REFILL/MAINT PORTABLE PUMP 96521 245.45$

HOSPITAL 285270 VENIPUNCTURE ONC 36415 19.45$

HOSPITAL 320159 DEFIB PADS ZOLL ADULT 297.25$

HOSPITAL ED00000001 BURN CARE &/or DEBRIDE,DRESS 210.35$

HOSPITAL ED00000002 NAIL AVULSION/REPAIR 182.65$

HOSPITAL ED00000003 INJECTION SQ/IM (ER) 96372 115.05$

HOSPITAL ED00000004 INJECT IV INITIAL (ER) 96374 212.25$

HOSPITAL ED00000005 INFUSION THER 1ST HOUR (ER) 96365 522.40$

HOSPITAL ED00000006 INFUSION THER > 90 MIN (ER) 96366 23.20$

HOSPITAL ED00000007 COLLECT BLOOD IMPLANT PORT(ER) 36591 129.55$

HOSPITAL ED00000010 PULSE OXIMETER (ER) 94760 85.35$

HOSPITAL ED00000012 VENIPUNCTURE (ER) 36415 19.45$

HOSPITAL ED00000013 AIRWAY SUCTION/ASPIRATION (ER) 31720 212.25$

HOSPITAL ED00000014 CHEST TUBE INSERTION (ER) 685.65$

HOSPITAL ED00000015 SPLINT/STRAPPING APPLICAT (ER) 205.00$

HOSPITAL ED00000016 CAST APPLICATION (ER) 335.55$

HOSPITAL ED00000017 NG TUBE PLACEMENT W/FLOURO(ER) 43752 435.20$

HOSPITAL ED00000018 BURN CARE (SIMPLE) W/O DEBRIDE 167.35$

HOSPITAL ED00000020 FOREIGN BODY REMOVAL-TISSUE ER 438.50$

HOSPITAL ED00000021 LACERATION REPAIR-SUPERFICIAL 328.25$

HOSPITAL ED00000022 ORAL REPAIR <2.5 CM (ER) 546.90$

HOSPITAL ED00000023 TX DISTAL RADIAL FX/SEP W/MAN 1,556.90$

HOSPITAL ED00000024 I & D (ER) 280.50$

HOSPITAL ED00000025 INSERT FOLEY CATHETER;SMPLE ER 51702 141.05$

HOSPITAL ED00000026 NOSE BLEED (EPISTAXIS CONTROL) 229.30$

HOSPITAL ED00000027 FOREIGN BODY REMOVAL -EYE (ER) 270.85$

HOSPITAL ED00000028 LUMBAR PUNCTURE (ER) 830.90$

HOSPITAL ED00000029 INSERT FOLEY CATH; COMPLEX ER 51703 302.95$

HOSPITAL ED00000030 FOREIGN BODY REMOVAL-EAR (ER) 129.55$

HOSPITAL ED00000031 FOREIGN BODY REMOVAL-NOSE (ER) 129.55$

HOSPITAL ED00000033 I & D PERITONSILLAR ABCESS ER 444.40$

HOSPITAL ED00000034 INFUSION HYDRATE 1ST HOUR (ER) 96360 375.20$

HOSPITAL ED00000035 INFUSION HYDRATE > 90 MIN (ER) 96361 29.60$

HOSPITAL ED00000036 INJECT IV ADD'L DIFF DRUG (ER) 96375 192.90$

HOSPITAL ED00000037 INFUSION SEQUENTIAL (ER) 96367 145.00$

HOSPITAL ED00000038 INFUSION CONCURRENT (ER) 96368 145.00$

HOSPITAL ED00000039 CAPILLARY BLOOD COLLECTION(ER) 36416 14.15$

HOSPITAL ED00000040 BLADDER IRRIGATION (ER) 51700 313.75$

HOSPITAL ED00000041 ARTHROCENTESIS (ER) 357.80$

HOSPITAL ED00000042 PICC/PORT FLUSH/IRRIG (ER) 96523 118.30$

2020-01




HOSPITAL ED00000044 BLADDER US NON-IMAGING (ER) 51798 221.70$

HOSPITAL ED00000045 COLLECT BLOOD FROM PICC (ER) 36592 129.55$

HOSPITAL ED00000046 PARACENTESIS (ER) 867.95$

HOSPITAL ED00000047 EVAC -SUBLUNGUAL HEMATOMA (ER) 79.50$

HOSPITAL ED00000048 IV INJECT ADD'L SAME DRUG (ER) 96376 192.90$

HOSPITAL ED00000049 BLOOD TRANSFUSION (ER) 36430 886.85$

HOSPITAL ED00000050 CENTRAL LINE INSERT-SUBCLAV ER 1,337.35$

HOSPITAL ED00000051 INTRAOSSEOUS NEEDLE PLACE (ER) 181.10$

HOSPITAL ED00000052 LEVEL 1 ER VISIT 99281 213.75$

HOSPITAL ED00000053 LEVEL 1 ER VISIT - MOD 25 9928125 213.75$





HOSPITAL ED00000058 LEVEL 4 ER VISIT 99284 1,066.05$

HOSPITAL ED00000059 LEVEL 4 ER VISIT - MOD 25 9928425 1,066.05$

HOSPITAL ED00000060 LEVEL 5 ER VISIT 99285 1,422.20$


HOSPITAL ED00000062 INSERT BLADDER CATH-STRGHT ER 51701 141.05$


HOSPITAL ED00000074 NURSING OBSERVATION (ER) 44.00$

HOSPITAL ED00000075 PICC INSERTION (ER) 1,253.70$

HOSPITAL ED00000077 CAST REMOVAL OR BIVALVING 295.20$

HOSPITAL ED00000078 CHG J TUBE/D TUBE W/FLOURO(ER) 685.65$

HOSPITAL ED00000079 G/J TUBE REPLACE W/FLOURO(ER) 975.60$

HOSPITAL ED00000080 INITIAL VACCINE ADMINISTRATION 90471 39.00$

HOSPITAL ED00000083 INFUSION HYDRATE 1ST HOUR 59 9636059 375.20$

HOSPITAL ED00000084 INFUSION THER 1ST HOUR 59 9636559 522.40$

HOSPITAL ED00000085 INJECT IV INITIAL (ER)/59 MOD 9637459 212.25$

HOSPITAL ED00000086 IMMUNIZATION ADM; EA ADDTL VAC 90472 39.00$

HOSPITAL ED00000087 ADMINISTER FLU VACCINE 90471 39.00$

HOSPITAL ED00000088 ADMINISTER PNEUMONIA VACCINE 90471 39.00$

HOSPITAL ED00000089 ADMINISTER HEP B VACCINE 90471 39.00$

HOSPITAL ED00000090 UROLOGY PROCEDURE 293.40$

HOSPITAL ED00000091 ORAL REPAIR > 2.5 CM (ER) 979.30$

HOSPITAL ED00000093 TENDON REPAIR 2,942.90$

HOSPITAL ED00000094 LACERATION REPAIR-INTERM/COMPL 681.35$

HOSPITAL ED00000095 EXPL PENETRATING WND; EXTREM 1,337.60$

HOSPITAL ED00000096 TRACHEOSTOMY EMERG 979.30$

HOSPITAL ED00000097 I&D OF VULVA/PERINEAL ABSCESS 356.30$

HOSPITAL ED00000098 THROAT SUCTION CAUTERIZATION 2,798.45$

HOSPITAL ED00000099 KNEECAP DISLOCATION REPAIR 244.80$

HOSPITAL ED00000100 DEBRIDE SKIN AT FRACTURE SITE 1,337.60$

HOSPITAL ED00000101 CLOSED TRTMT OF DISLOCATED HIP 1,950.35$

HOSPITAL ED00000102 REMOVE FOREIGN BODY ARM/ELBOW 964.05$

HOSPITAL ED00000103 REVISE ARM/LEG NERVE 2,082.90$

HOSPITAL ED00000104 REPAIR OF LEG TENDON EA 3,401.50$

HOSPITAL ED00000105 DEBRIDE MUSC/FASC 1ST 20CM < 608.75$

HOSPITAL ED00000106 DEBRIDE MUSC/FASC ADD ON <20CM 78.15$

HOSPITAL ED00000107 WOUND DEBRIDE < 20 CM 320.40$

HOSPITAL ED00000108 REPAIR OF DIGIT NERVE 4,823.10$

HOSPITAL ED00000109 REPAIR NERVE ADD-ON 862.15$

HOSPITAL ED00000110 REMOVAL OF NAIL BED 479.95$

HOSPITAL ED00000111 REMOVAL NAIL BED/TIP 2,613.70$

HOSPITAL ED00000112 CHG OF CYSTOSTOMY TUBE;SIMPLE 317.85$

HOSPITAL ED00000113 REPOSITION GASTROSTOMY TUBE 1,058.40$

HOSPITAL ED00000114 SKIN TISSUE PROCEDURE 170.20$

HOSPITAL ED00000115 CARDIOVASCULAR PROCEDURE 184.35$

HOSPITAL ED00000116 TRIM NAIL(S) ANY NUMBER 91.65$

HOSPITAL ED00000117 INCIS THROMBO HEMORRHOID,EXT 317.85$

HOSPITAL ED00000118 ANESTHESIA MAC 1ST 15 MIN 99152 914.25$

HOSPITAL ED00000119 ANETHESIA MAC EA ADDL 15 MIN 99153 308.95$

HOSPITAL ED00000120 CLOSE TRTMT HIP DISLOC WO ANES 337.30$

HOSPITAL ED00000122 REPAIR NAIL BED 608.75$

HOSPITAL ED00000123 TREAT FINGER FRACTURE EA 3,074.45$

HOSPITAL ED00000124 I&D HEMATOMA/FLUID 1,337.60$

HOSPITAL ED00000125 CL TX DISL; WO ANESTH 337.30$

HOSPITAL ED00000126 IRRIG CORP CAVERNOSA PRIAPISM 321.80$

2020-01




HOSPITAL ED00000127 REMOVE EMBEDDED FB EYELID 449.15$

HOSPITAL ED00000128 LARYNGOSCOPY FLEX; DIAGNOSTIC 226.90$

HOSPITAL ED00000129 CL TX PROX TIBIAL FX W SK TRAC 1,975.05$

HOSPITAL ED00000130 REPAIR BLD VESSEL DIR;LWR EXT 1,244.10$

HOSPITAL ED00000131 EXPLORE/TREAT WRIST JOINT 3,916.45$

HOSPITAL ED00000132 OPEN REPAIR WRIST JOINT 5,663.75$

HOSPITAL ED00000133 REPAIR FRACTURE ULNAR STYLOID 7,055.90$

HOSPITAL ED00000134 ESOPHAGOSCOPY FLEXIBLE BRUSH 1,122.20$

HOSPITAL ED00000135 REMOVE TNL CV CATH 734.65$

HOSPITAL ED00000136 REMOVAL OF HEMORRHOID CLOT 2,359.25$

HOSPITAL ED00000137 CLOSED TX SHOULDER W/MANIPULAT 1,731.95$

HOSPITAL ED00000138 UNLIS PROC DENTOALVEOLAR STRUC 195.30$

HOSPITAL ED00000139 PERICARDIOCENTESIS, INITIAL 736.60$

HOSPITAL ED00000140 DEB BONE 20 SQ CM/< 1,337.60$

HOSPITAL ED00000141 REPAIR OF LEG TENDON, EACH 3,916.45$

HOSPITAL ED00000143 EXPLORE/TREAT FINGER JOINT 2,066.40$

HOSPITAL ED00000144 TREAT ELBOW DISLOC W ANESTH 1,731.95$

HOSPITAL ED00000145 INJ ANEST;OTH PERIPH NRV/BRANC 709.55$

HOSPITAL ED00000146 REMOV FOREIGN BODY MUSCLE,SIMP 1,337.60$

HOSPITAL ED00000147 CONTROL OROPHARYN HEMORRH;SIMP 184.30$

HOSPITAL ED00000148 CL TX IP JT D W MANIP; W ANEST 317.10$

HOSPITAL ED00000149 TREAT FRACTURE OF ULNA 240.15$

HOSPITAL ED00000150 DRAINAGE OF MOUTH LESION 979.30$

HOSPITAL ED00000151 TRIGGER POINT INJECTION 323.05$

HOSPITAL ED00000153 LAC REPAIR; COMPLEX ADDL 5CM< 112.85$

HOSPITAL ED00000154 MOD SED OTH PHYS/QHP 5/>YRS 99156 914.25$

HOSPITAL ED00000155 MOD SED DIFF PHYS EA ADDL 15 99157 291.45$

HOSPITAL ED00000156 BEHAV CHNG SMOKING 3-10 MIN 99406 38.60$

HOSPITAL ED00000157 BEHAV CHNG SMOKING > 10 MIN 99407 38.60$

HOSPITAL ED00000158 TREAT FINGER DISLOC W/O ANESTH 254.55$

HOSPITAL ED00000159 COMPOSITE SKIN GRAFT 3,035.05$

HOSPITAL ED00000160 MOD SED SAME PHYS<5YRS1ST15MIN 99151 862.50$

HOSPITAL ED00000161 MOD SED OTH PHYS/QHP <5YRS 99155 862.50$

HOSPITAL ED00000162 REPAIR FINGER/HAND TENDON 3,401.50$

HOSPITAL ED00000163 INJECTION SQ/IM (ER) 59 9637259 115.05$

HOSPITAL ED00000166 INFUSION THER > 90 MIN (ER) 59 9636659 23.20$

HOSPITAL ED00000167 CLSD TX ELBOW DISLOC W/O ANEST 519.80$

HOSPITAL ED00000169 INFUS HYDRATE > 90 MIN (ER) 59 9636159 29.60$

HOSPITAL ED00000170 INJ IV ADD'L DIFF DRUG (ER) 59 9637559 192.90$

HOSPITAL ED00000171 INFUSION SEQUENTIAL (ER) 59 9636759 145.00$

HOSPITAL ED00000172 INFUSION CONCURRENT (ER) 59 9636859 145.00$

HOSPITAL ED00000173 IV INJ ADD'L SAME DRUG (ER) 59 9637659 192.90$

HOSPITAL ED00000174 DEBRIDE SKIN BONE AT FX SITE 2,008.20$

HOSPITAL ED00000175 TX SHOULDER DISLOC W/GT FRACT 1,556.90$

HOSPITAL ED00000176 I&D FINGER ABSCESS 324.20$

HOSPITAL ED00000177 CLOSED TX NASAL FX W/STABILIZ 2,295.90$

HOSPITAL ED00000178 TX SHOULDER DISLOC W/O ANESTH 244.75$

HOSPITAL ED00000179 CL TX TMJ DISLOCATION 183.65$

HOSPITAL ED00000180 SKIN GRFT FACE/GEN=<20sq cm ED 2,036.60$

HOSPITAL ED00000181 REMOVE EAR WAX UNI W/ INSTRMNT 80.80$

HOSPITAL ED00000182 UNLISTED PROC-NERVOUS SYSTEM 323.05$

HOSPITAL ED00000183 HUMERUS OR ELBOW UNLISTED PROC 244.75$

HOSPITAL ED00000184 REMOVE IMPACTED EAR WAX UNI IR 69209 80.80$

HOSPITAL ED00000185 LACERATION REPAIR - VAGINA 2,642.75$

HOSPITAL ED00000186 I&D ABSCESS - COMP or MULTI 409.40$

HOSPITAL ED00000187 INJECT ANESTH; FACIAL NERVE 368.75$

HOSPITAL ED00000188 REMOVE INTRAUTERINE DEVICE 385.80$

HOSPITAL ED00000189 REPAIR BLOOD VESSEL 3,219.85$

HOSPITAL ED00000190 I&D PILONID CYS; SMPL 736.00$

HOSPITAL ED00000191 UNLISTED PROC - NOSE 241.80$

HOSPITAL ED00000192 REM TUNNELED CVAD W PORT/PUMP 934.00$

HOSPITAL ED00000193 REM FB CONJUNCTIVA;SUPERFICIAL 136.65$

HOSPITAL ED00000195 ARTERIAL PUNCTURE BLOOD FOR DX 36600 74.55$

HOSPITAL ED00000196 REMOVE IMP EAR WAX BILAT-IRRIG 6920950 161.65$

HOSPITAL ED00000197 REMOVE IMP EAR WAX BILAT-INSTR 161.65$

HOSPITAL ED00000198 SPLINT/STRAPPING APPLIC BILAT 409.95$

HOSPITAL ED00000199 DEB SUBQ TISSUE 20 SQ CM/< 399.50$

HOSPITAL ED00000200 CL TX FRAC DISLOC W OR W/O MAN 1,662.00$

2020-01




HOSPITAL ED00000201 AMPUTATE TOE; IP JOINT 3,328.70$

HOSPITAL ED00000202 AMPUTATE FING/TH SGL; W DIR CL 3,681.05$

HOSPITAL ED00000203 LCL SURG WND/DEH EXTENS 2,182.65$

HOSPITAL ED00000205 CL TX OF NASAL BONE FX; WO STA 1,583.90$

HOSPITAL ED00000206 BIOPSY OF CERVIX 801.00$

HOSPITAL ED00000207 INJ EPIDURAL BLOOD OR CLOT PAT 756.20$

HOSPITAL ED00000208 PUNCT ASP - ABSC HEMAT CYST 432.55$

HOSPITAL ED00000209 REVISION OF EYELID 2,403.90$

HOSPITAL ED00000210 RPLC GTUBE NO REVJ TRC 303.80$

HOSPITAL ED00000211 RPLC GTUBE REVJ GSTRST TRC 303.80$

HOSPITAL ED00000214 THORACENTESIS NDL/CATH W/IMAGE 32555 775.20$

HOSPITAL 340010 BLS MILEAGE (PER MILE) 18.60$

HOSPITAL 340011 AMBULANCE CONVALESCENCE 266.90$

HOSPITAL 340014 PARAMEDIC INTERCEPT 150.00$

HOSPITAL 340250 ALS MILEAGE (PER MILE) 18.60$

HOSPITAL 340300 AMBULANCE BLS EMERGENCY 838.60$

HOSPITAL 340302 AMBULANCE ALS I EMERGENCY 1,215.85$

HOSPITAL 340305 AMBULANCE ALS II EMERGENCY 1,571.50$

HOSPITAL 340310 AMBULANCE ALS NON-EMERGENCY 1,109.75$

HOSPITAL 340314 AMBULANCE BLS NON-EMERGENCY 469.55$

HOSPITAL 340321 AMBULANCE SPECIALTY CARE TRANS 1,920.85$

HOSPITAL 340322 AMBULANCE MILEAGE PER .10 MILE 1.75$

HOSPITAL 340323 AMBULANCE MILEAGE PER MILE 17.05$

HOSPITAL 340324 CAS MA AMB NON-EMERGENCY 16.05$

HOSPITAL 340325 NAS MA AMB NON-EMERG WHEELCHR 32.00$

HOSPITAL 5259 DRESSING HYDROGEL WOUND 8x8 59.55$

HOSPITAL 344149 NASAL SEPTAL PROSTHESIS 1,750.85$

HOSPITAL 349871 TUBE TRACHEAL SHILEY PED 573.60$

HOSPITAL 350013 CAPNOGRAPHY NASAL ADT CANNU LT 106.20$

HOSPITAL 350014 CATHETER FOLEY 5CC 24FR 72.90$

HOSPITAL 350060 CAPNOGRAPHY NASAL TUBING PED 90.70$

HOSPITAL 350078 LAVAGE GASTRIC-CLOSED SYSTEM 809.75$

HOSPITAL 350119 ORTHO CAST LEG SHORT 327.55$

HOSPITAL 350124 NOZ STOP POSTERIOR PACKING KIT 603.25$

HOSPITAL 350167 VAC CANNISTER (008211) 179.50$

HOSPITAL 350169 VAC DRESSING KIT LARGE (008209 218.65$

HOSPITAL 350179 POST OP SHOE WOMEN LG 009418 107.90$

HOSPITAL 350754 IV FLUID WARMER SET 413.55$

HOSPITAL 350870 EXTRACTOR VACUUM OB 366.80$

HOSPITAL 350980 TUBE TRACHEAL SHILEY ADULT 573.15$

HOSPITAL 351032 HEIMLICH CHEST DRAIN VALVE 290.15$

HOSPITAL 351034 NEEDLE INTRAOSSEOUS 18 2.5 347.65$

HOSPITAL 351035 NEEDLE INTRAOSSEOUS 18 3.0 347.65$

HOSPITAL 351047 SET PNEUMOTHORAX 987.00$

HOSPITAL 351095 DERMABOND 329.05$

HOSPITAL 351106 CATHETER ST ROBNEL 8FR 6.00$

HOSPITAL 351425 SYN EX FIX 2.5 CAPS (392.24) 647.25$

HOSPITAL 351587 KIT PERCUTANEOUS CATH 528.35$

HOSPITAL 351619 SURGISEAL SKIN ADHESIVE 95.20$

HOSPITAL 352169 TRAY PACEMAKER KIT (002795) 2,345.85$

HOSPITAL 352431 KIT UROSTOMY POST OP 544.20$

HOSPITAL 353000 CIRCUMC TRAY W/UNIV CIRC CLAMP 112.45$

HOSPITAL 353285 KIT INTRAUTERINE PRESSURE CATH 625.60$

HOSPITAL 354155 CATHETER TPN 1,398.70$

HOSPITAL 354215 DOUBLE LUMAN CATH 499.70$

HOSPITAL 354537 TRAY TRACHCARE SUCTION 16 288.35$

HOSPITAL 354538 TRAY TRACHCARE SUCTION 14 288.35$

HOSPITAL 354616 TRAY PEDIATRIC 2-LUMEN (002737 207.00$

HOSPITAL 354832 TRAY PLEURAVAC ADULT 1,123.05$

HOSPITAL 354833 TRAY PLEURAVAC INFANT 1,237.80$

HOSPITAL 354852 DRAIN T 10 FR 69.55$

HOSPITAL 354878 ORTHO PILLOW ABDUCTION LEG 421.40$

HOSPITAL 354960 ELECTRODE PACING 663.20$

HOSPITAL 355010 HEEL PROTECTOR-PRESSU (006587) 331.90$

HOSPITAL 355023 DEBRIDEMENT TRAY 291.75$

HOSPITAL 355039 OB DELIVERY TRAY (008118) 391.45$

HOSPITAL 355049 SCD EXPRESS SLEEVE T/LLG008336 499.60$

HOSPITAL 355050 SCD EXPRESS SLEEVE K/LLG008337 313.40$

2020-01




HOSPITAL 355061 ENDO TROCAR BALLOON 008936 189.25$

HOSPITAL 355094 GRAFTJACKET INJECTABLE 008341 5,987.15$

HOSPITAL 355095 GRAFTJACKET 4X4 (008340) 4,319.60$

HOSPITAL 355096 CERVICAL RIPEN BALLOON 008914 517.30$

HOSPITAL 355097 OSTOMY FLEX-SEAL FMS KT 009197 1,384.00$

HOSPITAL 355102 PICC 6FR TRIPLE LUMEN 008401 945.90$

HOSPITAL 355103 POWER PICC 5FR DUAL 008402 941.75$

HOSPITAL 355118 BONE INJECT GUN- ADULT 008701 799.30$

HOSPITAL 355133 LAP TACKER SORAFIX 009432 2,568.35$

HOSPITAL 355151 DRESSING RETAINER 3 457701" 24.60$

HOSPITAL 355161 TRACH TUBE #4 (006159) 496.25$

HOSPITAL 355165 SCD EXPRESS SLEEVE XLG 008828 410.30$

HOSPITAL 355180 TRAY, 3-LUMEN (001776) 488.00$

HOSPITAL 355182 PICC 5FR KIT DOUBLE LUMEN 674.10$

HOSPITAL 355183 CATHETER PERIPHERAL EXT DWELL 440.55$

HOSPITAL 355201 TUBE TRACH CUFF EXT 6 008672 658.55$

HOSPITAL 355202 TUBE TRACH CUFF EXT 8 008673 658.55$

HOSPITAL 355203 TUBE TRACH U/CUFF EXT 6 008674 658.55$

HOSPITAL 355205 TUBE TRACH U/CUFF EXT 8 008675 658.55$

HOSPITAL 355215 KIT CVC PRESS LUMEN 009326 468.35$

HOSPITAL 355216 BONE INJECT GUN- PEDS 008703 610.90$

HOSPITAL 355217 PORT BIOFLO BASV 8 FR VALVED 1,448.50$

HOSPITAL 355410 BLANKETROL BLANKET ADULT 369.30$

HOSPITAL 355433 PASSY MUIR VALVE PMV-20 846.40$

HOSPITAL 355601 COMPRESSION SUPPORT CHIN WRAP 245.05$

HOSPITAL 355604 ARM LIFT COMPRESSION XLG 650.60$

HOSPITAL 355612 COS-MASTECTOMY BRA(ALL SIZES) 53.05$

HOSPITAL 355613 COS-BREAST IMP MOD CLASSIC 1,160.40$

HOSPITAL 355614 COS-BREAST IMP MOD PLUS 1,193.55$

HOSPITAL 355615 COS-BREAST IMP HIGH 1,226.70$

HOSPITAL 355616 COS-BREAST IMP ULTRA HIGH 1,266.50$

HOSPITAL 355617 COS-BREAST IMP SILTEX MOD CL 1,226.70$

HOSPITAL 355618 COS-BREAST IMP SILTEX MOD PLUS 1,266.50$

HOSPITAL 355619 COS-BREAST IMP SILTEX HIGH 1,266.50$

HOSPITAL 355620 COS-BREAST IMP SILTEX ULT HIGH 1,299.60$

HOSPITAL 355621 COS-BREAST IMP ANAT (ALL PROF) 1,810.20$

HOSPITAL 355622 GASTROSTOMY MOSS TUBE 18FR 2,565.40$

HOSPITAL 355776 BAKRI BALLON 008715 1,402.00$

HOSPITAL 355901 NEEDLE KOPANS BREAST BX 20GX7 459.95$




HOSPITAL 355905 SUTURE MONOCRYL PLUS 4.0 82.95$

HOSPITAL 355976 NU TRAKE 2,165.05$

HOSPITAL 356026 TRACK TUBE BIVONE 467.80$

HOSPITAL 356308 BAG BILE MED 76.15$

HOSPITAL 356820 CATHETER FOLEY 10FR W/ 3CC BAG 75.00$

HOSPITAL 357150 AQUACEL SILVER 4X4 (007150) 65.55$

HOSPITAL 357152 AQUACEL SILVER ROPE (007749) 123.65$

HOSPITAL 357290 SUTURE TYPE 7 1,055.85$

HOSPITAL 357312 ELECTRODE TENS POST-OP 303.40$

HOSPITAL 357421 KIT ELECATH PACING 5FR 1,846.65$

HOSPITAL 357422 KIT, GASTROSTOMY 14 FR 2.0 CM 491.45$

HOSPITAL 357702 TUBE BLAKEMORE 2,311.85$

HOSPITAL 358322 INTRA B.I.G.BONE INJ 008703-P 799.30$

HOSPITAL 358631 DRESSING VAC VERAFLOW MED 723.20$

HOSPITAL 358633 DRESSING VAC VERAFLO LRG 1,357.95$

HOSPITAL 358634 CASSETTE VAC VERALINK 539.70$

HOSPITAL 358635 PRONTOSCAN IRRIG SOL 824.30$

HOSPITAL 358698 TRAY CVC 3 LUMEN SAFDWELL 1,156.30$

HOSPITAL 358701 HEADCOVER LG WHITE PAPR 305.15$

HOSPITAL 358702 HEADCOVER REG WHITE PAPR 305.15$

HOSPITAL 358726 SENSORMAT DISPOSABLE 455.85$

HOSPITAL 358861 TRAY CSR 68.20$

HOSPITAL 359321 TRAY PERITONEAL 461.40$

HOSPITAL 359531 TRIMANO BEACH CHAIR KIT 758.60$

HOSPITAL 359546 CATHETER SUPRAPUBIC SET 746.85$

HOSPITAL 359880 RAPID RHINO 5.5 CM ANT 009861 404.85$

2020-01




HOSPITAL 359881 RAPID RHINO 7.5CM ANT/POST9862 425.05$

HOSPITAL 359882 RAPID RHINO 9.0CM ANT/POST9863 607.30$

HOSPITAL 359885 HYDROFIBER SILVER DRESSING9X12 313.40$

HOSPITAL 359980 SOCK STRASSBURG WHITE 12-16 IN 269.10$

HOSPITAL 359981 SOCK STRASSBURG WHITE 16-21 IN 269.10$

HOSPITAL 354422 SOL D5W% 500ML AVIVA CONTAINER 13.75$

HOSPITAL 370007 DEXTROSE 5% LAC RINGER 1000 ML 108.20$

HOSPITAL 370009 SOL BSS 126.65$

HOSPITAL 370015 SOL 5% DEXT 500ML 138.90$

HOSPITAL 370023 SOL D5W 250 66.40$

HOSPITAL 370058 SOL 5% DEXT & 0.9% SC 1000 ML 138.55$

HOSPITAL 370066 SOL D5 & 9% SOD CHLOR 500 66.40$

HOSPITAL 370074 SOL DEXTROSE 10% 1000ML 26.95$

HOSPITAL 370082 SOL D 10%-9% SOD CHLOR 67.05$

HOSPITAL 370090 SOL LACTATE RINGER 1000 103.80$

HOSPITAL 370104 SOL RINGERS 1000ML 26.95$

HOSPITAL 370112 SOL LACTATE RINGER 500 ML 76.20$

HOSPITAL 370120 SOD CHLORIDE 0.9% 1000M 104.55$

HOSPITAL 370125 SOL SODIUM CHLORIDE IRR 3000ML 220.95$

HOSPITAL 370129 SOL ACD A ANTI COAGULANT 90.10$

HOSPITAL 370139 SODIUM CHLORIDE 0.9% 500ML 97.60$

HOSPITAL 370147 SOL 0.45% SOD CHLORIDE 1000ML 129.00$

HOSPITAL 370155 SOL 5% DEXT & LR 500 ML 129.80$

HOSPITAL 370198 SOL POLYONIC M56 33.10$

HOSPITAL 370252 DEXTRA 288.30$

HOSPITAL 370260 SOL D5 & .45% SOD CHLOR 114.70$

HOSPITAL 370279 SOL INERT SUGAR 10% 33.60$

HOSPITAL 370341 SOL SODIUM CHLORIDE 250 66.40$

HOSPITAL 370368 SOL D5W PARTIAL FILL 44.90$

HOSPITAL 370392 SOL SODIUM CHLORIDE 3% 76.20$

HOSPITAL 370406 SOL D 50W 500CC 62.85$

HOSPITAL 370414 SOL ALCOHOL 5 IN D5W 23.45$

HOSPITAL 370422 SOL 5% DEXT & .2% SC 1000 76.20$

HOSPITAL 370449 SOL D2 1/2 WATER 1000 62.65$

HOSPITAL 370511 SOL STERILE WATER 1000ML 26.95$

HOSPITAL 370554 SOL D5 & 2-250 58.10$

HOSPITAL 370555 SOL 5% DEXT & .2% SC 500 ML 64.25$

HOSPITAL 370556 SOL D5 & 45 250 58.10$

HOSPITAL 370557 SOL D5W 250 GLASS 34.60$

HOSPITAL 370558 SOL D5W 20% GLASS 500CC 66.40$

HOSPITAL 370559 SOL DEXTROSE 50% 27.55$

HOSPITAL 370560 SOL SODIUM CHLORIDE 50 66.40$

HOSPITAL 370561 SOL SODIUM CHLORIDE PART. 16S 66.40$

HOSPITAL 371258 SOL STERILE WATER IRR 3000ML 186.40$

HOSPITAL 371567 SOL STERILE H20 IRRG 1000ML 66.60$

HOSPITAL 372320 SOL LACTATE RINGERS 3000ML 174.05$

HOSPITAL 374961 SOL 5% DEXT & 0.45% SC 500 ML 76.20$

HOSPITAL 376235 SOD CHLORIDE IRRIG 0.9 % 1000M 28.00$

HOSPITAL 376871 SOL SODIUM CHLORIDE PARTIAL 66.40$

HOSPITAL 410082 CAPILLARY BLOOD GAS 82805 210.50$

HOSPITAL LAB0000002 BASIC METABOLIC PANEL 80048 76.55$

HOSPITAL LAB0000003 RENAL FUNCTION PANEL 80069 181.40$

HOSPITAL LAB0000004 CATECHOLAMINES UR 82384 382.35$

HOSPITAL LAB0000005 FACTOR VIII ACTIVITY 85240 160.20$

HOSPITAL LAB0000006 COXSACKIE B AB TYPES 1-6 86658 141.25$

HOSPITAL LAB0000009 DERMPATH COMPREHENSIVE EXAM 88325 618.05$

HOSPITAL LAB0000011 HCV GENOTYPE 87902 419.55$

HOSPITAL LAB0000012 HISTOPLASMA AB EA 86698 142.50$

HOSPITAL LAB0000013 HISTOPLASMA AG BY EIA 87385 144.20$

HOSPITAL LAB0000014 HIV WEST BLOT HIV-1 86689 143.90$

HOSPITAL LAB0000015 INFLUENZA A AB EA 86710 66.90$

HOSPITAL LAB0000023 ARTERIAL BLOOD GAS 82805 185.55$

HOSPITAL LAB0000025 AEROBIC ID 87077 185.70$

HOSPITAL LAB0000026 ALPHA FETOPROTEIN;SERUM(81169) 82105 123.15$

HOSPITAL LAB0000027 ACUTE HEPATITIS PROFILE (9022) 80074 481.20$

HOSPITAL LAB0000028 ALDOSTERONE 82088 430.95$

HOSPITAL LAB0000029 RENIN 84244 237.65$

HOSPITAL LAB0000030 AMINO ACIDS QUANT URINE ML9233 82131 267.90$

2020-01




HOSPITAL LAB0000031 AMIODARONE/CHROMATOGRAPHY 9247 80345 252.40$

HOSPITAL LAB0000032 AMYLASE BODY FLUID 82150 82.65$

HOSPITAL LAB0000033 ANCA PANEL FOR VASCULITIS 83516 326.65$

HOSPITAL LAB0000034 ANDROSTENEDIONE (9709) 82157 145.35$

HOSPITAL LAB0000036 ACT PROT C RESISTANCE (81967) 85307 200.25$

HOSPITAL LAB0000037 ANTITHROMBIN III ACTIVITY 9030 85300 250.85$

HOSPITAL LAB0000038 ANTITHROMBIN III AG,P (6475) 85301 158.30$

HOSPITAL LAB0000039 BETA -2 GLYCOPROTEIN AB 86146 96.45$

HOSPITAL LAB0000040 BARBITURATES CONFIRMATION 80345 186.95$

HOSPITAL LAB0000041 BARTONELLA ABS 86611 324.75$

HOSPITAL LAB0000042 BENZODIAZEPINES IMMUNO 1-12 80346 109.50$

HOSPITAL LAB0000043 BLASTOMYCES AB 82607 62.20$

HOSPITAL LAB0000044 BNP (B-NATRIURETIC PEPTIDE) 83880 161.90$

HOSPITAL LAB0000045 BORDETELLA RAPID PCR (80910) 87801 253.30$

HOSPITAL LAB0000046 BRUCELLA AB 86622 261.00$

HOSPITAL LAB0000047 SUBOXONE, U 80361 133.60$

HOSPITAL LAB0000048 CANDIDA ALBICANS AB 86628 221.15$

HOSPITAL LAB0000049 CARNITINE 82379 114.30$

HOSPITAL LAB0000050 CBC AUTO W/PLT & W/O DIFF 85027 43.55$

HOSPITAL LAB0000051 CBC AUTO W/PLT & AUTO DIFF 85025 52.75$

HOSPITAL LAB0000053 CHLAMYDIA AMPLIFIED DNA 81096 87110 145.25$

HOSPITAL LAB0000054 CLOMIPRAMINE (80902) 82542 176.65$

HOSPITAL LAB0000055 CMV BY PCR 87497 442.10$

HOSPITAL LAB0000056 CYTOPLASMIC NEUTRO AB (9441) 86255 314.45$

HOSPITAL LAB0000057 COCAINE CONFIRMATION 80353 100.40$

HOSPITAL LAB0000058 Cortisol (8545) 82533 181.40$

HOSPITAL LAB0000059 CRYPTOCOCCUS AG CSF 87327 166.10$

HOSPITAL LAB0000060 EBV BY PCR 87798 360.35$

HOSPITAL LAB0000062 LYME DISEASE AB CSF 86618 121.10$

HOSPITAL LAB0000063 VARICELLA ZOSTER RAPIDPCR81241 87798 105.10$

HOSPITAL LAB0000064 Cyclosporine (8931) 80158 57.35$

HOSPITAL LAB0000065 CYTOLOGY CONSULTATION (9354) 88321 424.85$

HOSPITAL LAB0000068 DRUG OF ABUSE SCREEN KDH 80307 134.30$

HOSPITAL LAB0000069 DRUG SCREEN OTC (8421) 80307 159.75$

HOSPITAL LAB0000070 EPSTEIN BARR DNA 82987 87799 288.15$

HOSPITAL LAB0000071 EHRLICHIA AB 86666 256.75$

HOSPITAL LAB0000072 ELECTROLYTE PANEL 80051 107.20$

HOSPITAL LAB0000073 AB TO EXTRACTABLE NUCLEAR AG 86235 199.20$

HOSPITAL LAB0000074 ENTEROVIRUS BY RAPID PCR 80066 87498 327.50$

HOSPITAL LAB0000077 FETAL FIBRONECTIN TEST 82731 785.50$

HOSPITAL LAB0000078 FAT,FECES (8310) 82710 225.60$

HOSPITAL LAB0000080 FACTOR V ACTIVITY CHARGE 9054 85220 234.80$

HOSPITAL LAB0000081 GANGLIOSIDE AB 83520 158.65$

HOSPITAL LAB0000082 GASTRIC OCCULT BLOOD 82271 38.75$

HOSPITAL LAB0000083 GENTAMYCIN 80170 143.05$

HOSPITAL LAB0000084 GIARDIA AG, FECES 80231 87329 177.60$

HOSPITAL LAB0000086 GLIADIN IGG/IGA 83516 223.90$

HOSPITAL LAB0000087 GLUCOSE - BODY FLUID 82945 36.00$

HOSPITAL LAB0000089 HCG QUALITATIVE, SERUM 84703 72.15$

HOSPITAL LAB0000090 HCG QUALITATIVE,URINE 81025 78.80$

HOSPITAL LAB0000093 HEMATOPATHOLOGY CONS 5434 88325 469.65$

HOSPITAL LAB0000094 HER 2 IMMUNO 88361 253.45$

HOSPITAL LAB0000095 HSV PCR GENITAL 80575 87529 354.00$

HOSPITAL LAB0000096 HEMOGLOBIN A.1C 83036 71.25$

HOSPITAL LAB0000097 HISTOPLASMA AG, URINE 87385 144.20$

HOSPITAL LAB0000098 HLA-B27 86812 273.20$

HOSPITAL LAB0000100 HELICOBACTER PYLORI ABS KDH 86677 142.55$

HOSPITAL LAB0000101 HTLV I AB 86687 121.70$

HOSPITAL LAB0000102 IONIZED CALCIUM 82330 42.95$

HOSPITAL LAB0000103 KETONE, S QT 82009 40.40$

HOSPITAL LAB0000105 LEAD W/DEMOGRAPHICS 15070 83655 67.90$

HOSPITAL LAB0000106 LIGHT CHAINS, SERUM 83883 210.55$

HOSPITAL LAB0000108 LIVER PANEL (HEPATIC FUNCTION) 80076 39.90$

HOSPITAL LAB0000109 LYME DISEASE IGG/GIM WESTERN B 86617 148.05$

HOSPITAL LAB0000110 MALARIA SMEAR (9240) 87207 177.35$

HOSPITAL LAB0000111 METANEPHRINES, PLASMA 81609 83835 179.70$

HOSPITAL LAB0000112 METANEPHRINE random UR 83005 83835 220.80$

HOSPITAL LAB0000113 METHADONE,CONFIRM 83129 80358 135.65$

2020-01




HOSPITAL LAB0000115 MONO SCRN (HETEROPHILE AB)QUAL 86308 88.40$

HOSPITAL LAB0000118 MUMPS IGG/IGM 86735 134.35$

HOSPITAL LAB0000119 MYCOPLAS PNEU AG IgM (8181) 86738 113.00$

HOSPITAL LAB0000121 MYOGLOBIN,URINE 9274 83874 173.10$

HOSPITAL LAB0000122 NICOTINE;URINE 80323 73.10$

HOSPITAL LAB0000123 NICOTINE, SERUM 80323 130.55$

HOSPITAL LAB0000124 NITRAZINE TEST 83986 51.40$

HOSPITAL LAB0000126 NTX TELOPEPTIDE URINE 81549 82523 196.90$

HOSPITAL LAB0000127 OCCULT BLOOD,FOB1-3SPEC W/O SS 82274 70.35$

HOSPITAL LAB0000128 OCC BLOOD CARD,1-3 SPEC W/SS 82272 34.35$

HOSPITAL LAB0000130 OCCULT BLOOD CARD3 SPEC W/O SS 82270 34.35$

HOSPITAL LAB0000131 OLIGOCLONAL BANDING S & CSF 83916 436.00$

HOSPITAL LAB0000132 OPIATES URINE 8473 80361 175.20$

HOSPITAL LAB0000134 PARASITE ID (9202) 87169 84.55$

HOSPITAL LAB0000135 PARVOVIRUS IGG/IGM 86747 259.45$

HOSPITAL LAB0000136 PROTEIN C ACTIVITY (MAYO 9339) 85303 339.10$

HOSPITAL LAB0000138 PROTEIN ELECTRO BF 8274 84166 128.05$

HOSPITAL LAB0000139 CARDIOLIPIN IgG (82976) 86147 175.55$

HOSPITAL LAB0000140 PLATELET AB 86022 340.05$

HOSPITAL LAB0000141 O2 SATURATION (PO2) 82810 58.80$

HOSPITAL LAB0000144 PROT C AG 85302 399.30$

HOSPITAL LAB0000145 PROTEIN S FREE 85306 263.75$

HOSPITAL LAB0000146 PROTHROMBIN TIME 85610 30.65$

HOSPITAL LAB0000147 PROTHROMBIN TIME ANTICOAG CL 85610 47.50$

HOSPITAL LAB0000148 RBC FOLATE 82747 248.75$

HOSPITAL LAB0000149 RENAL PATHLOGY CONSULT 88501 88325 255.65$

HOSPITAL LAB0000150 RETICULOCYTE/FLOW CYTOMETRY 85045 72.90$

HOSPITAL LAB0000151 ROCKY MOUNTAIN SPOTTED FEVER I 86757 223.75$

HOSPITAL LAB0000153 RUBEOLA IGG/IGM 86765 73.40$

HOSPITAL LAB0000154 STONE ANALYSIS (8596) 82365 135.45$

HOSPITAL LAB0000157 T3 Free 9404 84481 184.90$

HOSPITAL LAB0000158 TACROLIMUS,B (80783) 80197 117.30$

HOSPITAL LAB0000159 TB BY QUANTERIFERON GOLD 86480 143.75$

HOSPITAL LAB0000161 TOBRAMYCIN 80200 140.15$

HOSPITAL LAB0000162 TOTAL PROTEIN BODY FLUID 84157 60.50$

HOSPITAL LAB0000163 THROMBIN TIME,PLASMA 85670 96.05$

HOSPITAL LAB0000164 TISSUE TRANSGLUTAMINASE IGG/IG 83516 298.10$

HOSPITAL LAB0000165 URINALYSIS W/O MICRO 81003 24.65$

HOSPITAL LAB0000166 URINALYSIS MICROSCOPIC ONLY 81015 30.00$

HOSPITAL LAB0000167 URINALYSIS WITH MICROSCOPIC 81001 65.20$

HOSPITAL LAB0000169 VANCOMYCIN 80202 133.00$

HOSPITAL LAB0000170 VIRAL CULTURE 87252 129.85$

HOSPITAL LAB0000171 THIAMINE WHOLE BLOOD 84425 163.35$

HOSPITAL LAB0000172 25 HYDROXY-VITAMIN D2 & D3 82306 132.05$

HOSPITAL LAB0000173 VON WILLENBRAND FACTOR AG 554 85246 208.55$

HOSPITAL LAB0000174 VARICELLA ZOSTER IGG/IGM 86787 206.80$

HOSPITAL LAB0000176 ZINC,SERUM 8620 84630 142.10$

HOSPITAL LAB0000177 LATEX (ALLERGEN SPECIFIC) IGE 86003 42.25$

HOSPITAL LAB0000178 VASOACTIVE INTEST POLYPETIDE 84586 185.15$

HOSPITAL LAB0000179 ANTIDIURETIC HORM (VASOPRESSIN 84588 435.50$

HOSPITAL LAB0000180 AMIKACIN 80150 336.85$

HOSPITAL LAB0000181 CARBON MONOXIDE 82375 122.60$

HOSPITAL LAB0000182 MITOCHONDRIAL AB (NON INF AGT) 83516 156.20$

HOSPITAL LAB0000184 CULTURE SCREEN 87081 99.50$

HOSPITAL LAB0000185 C1Q QUALITATIVE 86160 247.70$

HOSPITAL LAB0000186 C1 ESTERASE INH QUANT 81493 86161 194.55$

HOSPITAL LAB0000187 ETHOSUXIMIDE (ZARONTIN) 80168 236.35$

HOSPITAL LAB0000188 PLATELET FUNCT ANAL-EPINEPHRIN 85576 112.15$

HOSPITAL LAB0000189 PLATELET FUNCT ANALYSIS - ADP 85576 112.15$

HOSPITAL LAB0000190 COAG FACTOR V (PROACCELERIN) 85220 234.80$

HOSPITAL LAB0000191 GGTS 82977 52.00$

HOSPITAL LAB0000193 METHYLMALONIC ACID QUANT/ORG 83921 287.75$

HOSPITAL LAB0000195 DHEA S 82627 233.15$

HOSPITAL LAB0000196 DRUG SCR,MULT CLASS NIDA/DOT 80306 53.05$

HOSPITAL LAB0000197 HALOPERIDOL\HALDOL\CHROMATOG 80173 93.95$

HOSPITAL LAB0000198 MICRO ALBUMIN, RANDOM URINE QT 82043 94.35$

HOSPITAL LAB0000200 SICKLECELL(HGB.S)SCKL/RBC,RED 85660 77.10$

HOSPITAL LAB0000201 NEWBORN SCREEN PROFILE (PKU) 84030 148.35$

2020-01




HOSPITAL LAB0000203 RPR (VDRL) QUAL 86592 70.25$

HOSPITAL LAB0000204 LACTATE ACID 83605 111.45$

HOSPITAL LAB0000205 SELENIUM BLOOD 84255 201.95$

HOSPITAL LAB0000207 CLOSTRIDIUM DIFFICLE, EXOTOXIN 87324 194.95$

HOSPITAL LAB0000208 PROC FEE - DRUGS OF ABUSE COL 99001 25.75$

HOSPITAL LAB0000209 VALPROIC ACID 80164 143.40$

HOSPITAL LAB0000210 SALICYLATE 80329 117.30$

HOSPITAL LAB0000211 ACETAMINOPHEN-SER QUANT 80329 174.85$

HOSPITAL LAB0000213 STREP SCR GROUP A-THROAT 87880 94.30$

HOSPITAL LAB0000214 PSA TOTAL DIAG (KDH) 84153 166.05$

HOSPITAL LAB0000216 PSA TOTAL SCREENING (KDH) 148.55$

HOSPITAL LAB0000219 HDL CHOL-DIRECT MEASURE 83718 76.10$

HOSPITAL LAB0000220 WET MOUNT (TRICHOMANAS SMEAR) 87210 61.45$

HOSPITAL LAB0000223 FERN SMEAR 87210 61.45$

HOSPITAL LAB0000226 ABSOLUTE EOSPINOPHIL COUNT 89190 38.55$

HOSPITAL LAB0000227 CARBAMAZAPINE (TEGRETOL) 80156 131.35$

HOSPITAL LAB0000228 ROTAVIRUS AG EIA 87425 166.75$

HOSPITAL LAB0000229 CULT,ANAER ANY SRC 87075 131.15$

HOSPITAL LAB0000230 CULTURE, STOOL (BACT DEFINITIV 87045 172.60$

HOSPITAL LAB0000231 STOOL CULTURE ADDT'L 87046 97.10$

HOSPITAL LAB0000232 CULT,ANAER ID EA ORG 87076 94.30$

HOSPITAL LAB0000233 BETA LACTAMASE ENZYME DETECT 87185 69.70$

HOSPITAL LAB0000234 CULT,OTHER SRC(BACT DEFINITIVE 87070 147.55$

HOSPITAL LAB0000235 CULTURE, WOUND 87070 142.00$

HOSPITAL LAB0000236 CULT,NOSE,THROAT,(BACT DEFIN) 87070 142.00$

HOSPITAL LAB0000237 INFLUENZA A & B ANTIGEN 87502 283.90$

HOSPITAL LAB0000239 CHLAMYDIA TEST (ANTIGEN) 87810 164.50$

HOSPITAL LAB0000240 GLUCOSE TOL, I HR 82950 49.50$

HOSPITAL LAB0000241 PHENOBARBITAL 80184 107.90$

HOSPITAL LAB0000242 HCG QUANT 84702 160.50$

HOSPITAL LAB0000243 CPK-MB ONLY 82553 101.65$

HOSPITAL LAB0000244 CULTURE, UR (BACT) QUANT W/CC 87086 61.10$

HOSPITAL LAB0000245 FUNGAS SMEAR 87205 62.85$

HOSPITAL LAB0000246 G C CULTURE 87081 91.90$

HOSPITAL LAB0000247 GRAM STAIN 87205 57.15$

HOSPITAL LAB0000248 PARASITE,DRY MOUNT 87220 43.80$

HOSPITAL LAB0000249 MICROTITER MIC SENSITIVITY 87186 119.10$

HOSPITAL LAB0000250 CONCENTRATION 87015 105.40$

HOSPITAL LAB0000251 AFB SMEAR 87206 56.10$

HOSPITAL LAB0000256 VENIPUNCTURE 36415 19.45$

HOSPITAL LAB0000257 CAPILLARY BLOOD COLLECTION 36416 14.15$

HOSPITAL LAB0000258 RSV AG SCREEN 87420 513.10$

HOSPITAL LAB0000259 THEOPHYLLINE 80198 98.75$

HOSPITAL LAB0000261 ALCOHOL,ETHYL NON BREATH SPEC 80320 161.80$

HOSPITAL LAB0000262 CALCIUM,TOT 82310 44.20$

HOSPITAL LAB0000263 CARBON DIOXIDE (CO2) 82374 62.20$

HOSPITAL LAB0000264 CPK,TOT 82550 47.45$

HOSPITAL LAB0000266 DIGOXIN 80162 108.65$

HOSPITAL LAB0000268 DILANTIN TTL 80185 111.55$

HOSPITAL LAB0000269 ALKALINE PHOSPHATASE TOT 84075 46.40$

HOSPITAL LAB0000270 SGOT/AST 84450 55.45$

HOSPITAL LAB0000271 PROTEIN TOTAL; SERUM 84155 55.30$

HOSPITAL LAB0000272 TSH (THYROID STIM HORMONE) 84443 90.20$

HOSPITAL LAB0000273 MEASURED LDL 83721 98.20$

HOSPITAL LAB0000274 TRIGLYCERIDES 84478 43.65$

HOSPITAL LAB0000277 SGPT/ALT 84460 52.40$

HOSPITAL LAB0000278 ALBUMIN,SER 82040 37.25$

HOSPITAL LAB0000281 CHLORIDE,BLOOD 82435 53.45$

HOSPITAL LAB0000284 GLUCOSE, QUANT 82947 41.80$

HOSPITAL LAB0000285 POTASSIUM, SER 84132 41.50$

HOSPITAL LAB0000286 SODIUM,SERUM 84295 30.10$

HOSPITAL LAB0000287 BILIRUBIN TOTAL 82247 51.95$

HOSPITAL LAB0000288 DIFFERENTIAL WBC 85007 26.45$

HOSPITAL LAB0000289 FIBRINOGEN ACTIVITY 85384 132.15$

HOSPITAL LAB0000291 PLT COUNT AUTO 85049 59.80$

HOSPITAL LAB0000292 PTT-PART THROMBO TIME 85730 63.50$

HOSPITAL LAB0000294 WBC (WHITE BLOOD CELL CNT),BLD 85048 40.15$

HOSPITAL LAB0000295 ASO SEMI-QUANT TITER 86060 63.45$

2020-01




HOSPITAL LAB0000298 RUBELLA AB IGG QUAL 86762 70.30$

HOSPITAL LAB0000300 CULTURE, BLOOD INCLUDE ANAER 87040 158.90$

HOSPITAL LAB0000301 LIPID PNL 80061 101.60$

HOSPITAL LAB0000302 GLUCOSE-GLUCOMETER 82962 37.40$

HOSPITAL LAB0000305 FUNGAL SUSCEPT PER DRUG 87186 290.80$

HOSPITAL LAB0000311 GLUCAGON 9358 82943 79.25$

HOSPITAL LAB0000312 ASPERGILLUS ANTIGEN 87305 116.50$

HOSPITAL LAB0000313 C2 COMPLEMENT AG EACH 84141 86160 173.40$

HOSPITAL LAB0000314 CULT REF ID FUNGUS YEAST 50025 87106 171.35$

HOSPITAL LAB0000315 CULT REF ID FUNGUS MOLD 50025 87107 145.25$

HOSPITAL LAB0000316 LIVER/KIDNEY MICROSOM AB 80387 86376 40.20$

HOSPITAL LAB0000319 OXYMORPHONE; ASSAY OF OPIATES 80361 242.75$

HOSPITAL LAB0000322 17 HYDROXYPROGESTERONE (9231) 83498 147.85$

HOSPITAL LAB0000323 TSH SENSITIVE 8939 84443 67.05$

HOSPITAL LAB0000324 Acetocholine Recept AB 83519 374.45$

HOSPITAL LAB0000325 MECONIUM DRUG SCR NON STATE 80307 120.20$

HOSPITAL LAB0000326 ACTH (8411) 82024 451.85$

HOSPITAL LAB0000327 ALDOLASE (8363) 82085 89.50$

HOSPITAL LAB0000328 ALPHA 1 ANTITRYPSIN (8161) 82103 200.80$

HOSPITAL LAB0000329 GLOMERULAR BASEMENT MEMBRANE 83520 95.00$

HOSPITAL LAB0000330 TRILEPTAL LEVEL 81030 80183 132.80$

HOSPITAL LAB0000331 ANGIOTENSIN CONV ENZYME (8285) 82164 168.60$

HOSPITAL LAB0000332 LYME DISEASE SEROLOGY 82516 86618 47.50$

HOSPITAL LAB0000333 ASPERGILLUS,FUNIGATUS IgG 9678 86606 105.85$

HOSPITAL LAB0000334 HEP A IgM ONLY 8342 86709 132.20$

HOSPITAL LAB0000335 BETA 2 MICROGLOBULIN (9234) 82232 187.60$

HOSPITAL LAB0000337 CANCER AG 125 (CA125 9289) 86304 212.80$

HOSPITAL LAB0000338 CA 15-3 (81607) 86300 185.35$

HOSPITAL LAB0000339 CA 19-9 (9288) 86301 193.60$

HOSPITAL LAB0000340 CA 27-29 (81413) 86300 271.70$

HOSPITAL LAB0000343 CALCITONIN,P (9160) 82308 301.20$

HOSPITAL LAB0000344 CAROTENE,S (8288) 82380 94.30$

HOSPITAL LAB0000345 CEA (8521) 82378 222.05$

HOSPITAL LAB0000348 CERULOPLASMIN (8364) 82390 110.95$

HOSPITAL LAB0000349 MANGANESE S 83785 88.50$

HOSPITAL LAB0000350 CLONAZEPAM (8385) 80346 157.95$

HOSPITAL LAB0000351 COAG FACTOR IX (9065) 85250 342.30$

HOSPITAL LAB0000352 COAG FACTOR VII (9055) 85230 200.95$

HOSPITAL LAB0000353 COAG FACTOR X (9066) 85260 387.50$

HOSPITAL LAB0000354 COAG FACTOR XI (9067) 85270 253.35$

HOSPITAL LAB0000355 COAG FACTOR II 9121 85210 297.75$

HOSPITAL LAB0000358 C3 COMPLEMENT (8174) 86160 128.30$

HOSPITAL LAB0000359 C4 COMPLEMENT (8171) 86160 193.15$

HOSPITAL LAB0000360 COMPLEMENT TOTAL (CH50 8167) 86162 312.25$

HOSPITAL LAB0000361 COPPER,SER (8612) 82525 132.05$

HOSPITAL LAB0000362 PREGNENOLENE 84140 133.60$

HOSPITAL LAB0000364 HEPATITIS Bc IgG/IgM (8347) 86704 140.55$

HOSPITAL LAB0000366 17 OH PREGNENOLONE 84143 80.40$

HOSPITAL LAB0000367 TOPIRMATE (TOPAMAX) (81546) 80201 158.05$

HOSPITAL LAB0000369 DRUG SCREEN P (8421) 80307 159.75$

HOSPITAL LAB0000370 EBV IgG EARLY AG (8890) 86663 103.35$

HOSPITAL LAB0000372 ENDOMYSIAL ABS (9360) 86256 153.00$

HOSPITAL LAB0000373 ERYTHROPOIETIN (80173) 82668 194.10$

HOSPITAL LAB0000374 LEVETIRACETAM kEPPRA 80177 112.45$

HOSPITAL LAB0000375 FSH S (8670) 83001 207.30$

HOSPITAL LAB0000377 CRP CARDIAC (82047) 86141 96.90$

HOSPITAL LAB0000378 G-6 PD (8368) 82955 97.90$

HOSPITAL LAB0000379 C1 ESTERASE INHIBITOR 8198 86160 123.70$

HOSPITAL LAB0000380 GAD65 AB ASSAY (81596) 86341 198.65$

HOSPITAL LAB0000381 HEPARIN ANTI-XA ASSAY (80609) 85520 166.15$

HOSPITAL LAB0000382 GASTRIN S (8512) 82941 185.40$

HOSPITAL LAB0000384 ZONISAMIDE (ZONEGRAN) 80203 61.30$

HOSPITAL LAB0000385 HUMAN PAPILLOMA VIRUS DNA 87624 210.00$

HOSPITAL LAB0000386 HAPTOGLOBIN (9168) 83010 108.50$

HOSPITAL LAB0000390 HEPATITIS BsAG S (9013) 87340 170.75$

HOSPITAL LAB0000391 HEPATITIS Be AG (80510) 87350 120.85$

HOSPITAL LAB0000393 HOMOCYSTEINE,TOTAL P (80379) 83090 179.90$

HOSPITAL LAB0000394 UREA, URINE 84540 26.00$

2020-01




HOSPITAL LAB0000395 IMMUNOGLOBULIN A IgA (8157) 82784 61.05$

HOSPITAL LAB0000396 PROTEIN S, FREE 85306 223.95$

HOSPITAL LAB0000397 IMMUNOGLOBULIN E IgE (8159) 82785 194.05$

HOSPITAL LAB0000398 INSULIN-LIKE GROWTH 1 84305 174.85$

HOSPITAL LAB0000399 IMMUNOGLOBULIN G IgG (8160) 82784 218.40$

HOSPITAL LAB0000401 CREATINE 82540 89.85$

HOSPITAL LAB0000402 BIOTINIDASE, BLOOD 82261 131.85$

HOSPITAL LAB0000403 INSULIN TTL 83525 145.65$

HOSPITAL LAB0000404 LEGIONELLA PNEU AB (8122) 86713 122.75$

HOSPITAL LAB0000405 LEGIONELLA AG URINE (81268) 87449 288.70$

HOSPITAL LAB0000407 LUTEINIZING HORMONE,S (8663) 83002 201.50$

HOSPITAL LAB0000408 LIPASE 83690 87.95$

HOSPITAL LAB0000409 SENSITIVITY 87186 124.60$

HOSPITAL LAB0000411 MERCURY, BLOOD 83825 201.25$

HOSPITAL LAB0000413 VARICELLA ZOSTER IGM 80964 86787 118.20$

HOSPITAL LAB0000414 VITAMIN K1 S 84597 93.15$

HOSPITAL LAB0000415 GABAPENTIN,P (80826) 80171 142.85$

HOSPITAL LAB0000416 SYPHILLIS IgG 86780 34.00$

HOSPITAL LAB0000418 OSMOLALITY;URINE 83935 62.40$

HOSPITAL LAB0000419 OSMOLALITY;SERUM 83930 85.85$

HOSPITAL LAB0000420 OCC BLOOD FOB 1-3 SPEC W/SS 82274 70.35$

HOSPITAL LAB0000422 HANSON'S RAST CHARGE 86003 12.50$

HOSPITAL LAB0000423 PREALBUMIN (9005) 84134 111.00$

HOSPITAL LAB0000424 PROGESTERONE (8141) 84144 218.75$

HOSPITAL LAB0000425 PROLACTIN (8690) 84146 244.00$

HOSPITAL LAB0000426 RENAL BX ELECTRON MICROSCOPY ( 88348TC 676.05$

HOSPITAL LAB0000427 HUMAN ANTI MOUSE ANTIBODY 83520 301.10$

HOSPITAL LAB0000428 FLOW CYT INTERPRETATION 9-15 88188 141.85$

HOSPITAL LAB0000429 FLOW CYT INTERPRETATION >16 88189 170.20$

HOSPITAL LAB0000431 SURGICAL PATH CONSULT 88321 88321 476.45$

HOSPITAL LAB0000432 SURGICAL PATH CONSULT 88323 88323 476.45$

HOSPITAL LAB0000433 LYME DISEASE AB;SPINAL FLUID 86617 79.85$

HOSPITAL LAB0000435 FLOW CYTOMETRY INT 2-8 MARKERS 88187 129.25$

HOSPITAL LAB0000437 HPV TYPING FISH (80172) 88365 520.25$

HOSPITAL LAB0000438 SEROTONIN 84260 316.30$

HOSPITAL LAB0000441 T UPTAKE 81792 84479 97.25$

HOSPITAL LAB0000442 Thyroxine (T4) Total 84436 79.55$

HOSPITAL LAB0000443 Testosterone Total 84403 144.20$

HOSPITAL LAB0000444 VARICELLA ZOSTER IGG 86787 96.20$

HOSPITAL LAB0000445 THYROID STIM IMMUNOGLOB 8634 84445 391.40$

HOSPITAL LAB0000447 TRANSFERRIN,S 8829 84466 124.55$

HOSPITAL LAB0000449 PLASMINOGEN ACTIVITY 550 85420 110.50$

HOSPITAL LAB0000450 VITAMIN D 1.25 DIHYDROXY 8822 82652 471.00$

HOSPITAL LAB0000451 VITAMIN E 84446 151.50$

HOSPITAL LAB0000452 AMYLASE,ISOENZYMES 82150 80.30$

HOSPITAL LAB0000453 GROWTH HORMONE (8688) 83003 176.65$

HOSPITAL LAB0000454 ANTI SMOOTH MUSCLE AB (6284) 86255 64.05$

HOSPITAL LAB0000455 VDRL,CSF (9028) 86592 29.40$

HOSPITAL LAB0000456 LAMOTRIGINE (80999) 80175 206.65$

HOSPITAL LAB0000457 HEP C VIRUS bDNA (8113) 87522 350.65$

HOSPITAL LAB0000458 ADENOVIRUS AB S (8152) 86603 141.70$

HOSPITAL LAB0000462 SIROLIMUS (RAPAMYCIN) 80195 126.95$

HOSPITAL LAB0000464 CRYPTOSPORIDIUM AG FECES 87328 118.35$

HOSPITAL LAB0000465 ESTRADIOL,ENHANCED 82670 185.35$

HOSPITAL LAB0000466 BILE ACIDS; TOTAL 82239 59.25$

HOSPITAL LAB0000467 ASCORBIC ACID - VIT C 82180 186.90$

HOSPITAL LAB0000468 SEX HORMONE BINDING GLOBULIN 84270 56.05$

HOSPITAL LAB0000469 ACYLCARNITINE QUANT PLASMA 82017 180.50$

HOSPITAL LAB0000470 ECHINOCOCCUS AB IgG 86682 63.25$

HOSPITAL LAB0000471 INTRINSIC FACTOR BLOCKING AB 86340 159.80$

HOSPITAL LAB0000473 HLA DQ TYPE CELIAC (88906) 86812 314.50$

HOSPITAL LAB0000476 THYROGLOBULIN AB SCREEN 86800 81.95$

HOSPITAL LAB0000480 IMMUNOGLOBULIN M (IGM) 82784 63.15$

HOSPITAL LAB0000481 CLOZAPINE 80159 86.35$

HOSPITAL LAB0000482 OSTEOCALCIN 83937 73.00$

HOSPITAL LAB0000483 HIV TYPE I AB 86689 146.90$

HOSPITAL LAB0000486 PYRUVATE 84210 126.35$

HOSPITAL LAB0000487 PROINSULIN 84206 184.85$

2020-01




HOSPITAL LAB0000488 INSULIN ANTIBODY 86337 193.10$

HOSPITAL LAB0000489 TRYPTASE, SERUM 83520 121.40$

HOSPITAL LAB0000490 REPTILASE TIME 85635 54.35$

HOSPITAL LAB0000491 CREATININE, URINE CHG 82570 21.40$

HOSPITAL LAB0000492 RA BODY FLUID QT 86431 64.95$

HOSPITAL LAB0000493 HIV-1, NA QUAN 87536 511.10$

HOSPITAL LAB0000494 HEPATITIS B SURF AG CONFIRM 87341 140.80$

HOSPITAL LAB0000496 CELLCEPT (MYOPHENOLIC ACID) 80180 181.65$

HOSPITAL LAB0000497 VIRUS ISOLATE; ADDTL OR ID 87253 47.05$

HOSPITAL LAB0000499 FRANCISELLA TULARENSIS AB 9115 86000 104.80$

HOSPITAL LAB0000502 OXYCODONE 80365 85.65$

HOSPITAL LAB0000507 HEP B VIRAL DNA QUANT 87517 221.70$

HOSPITAL LAB0000508 VITAMIN B3 84591 127.35$

HOSPITAL LAB0000511 VITAMIN B6 84207 57.50$

HOSPITAL LAB0000512 HEPATITIS E AB 86790 84.25$

HOSPITAL LAB0000514 CYSTATIN C 82610 72.60$

HOSPITAL LAB0000515 HSV 2 IGM 86694 32.70$

HOSPITAL LAB0000519 ELASTASE 83519 339.90$

HOSPITAL LAB0000520 WHIPPLE'S DISEASE 87798 186.00$

HOSPITAL LAB0000522 CALPROTECTIN STOOL 91597 83993 225.20$

HOSPITAL LAB0000524 DIHYDROTESTOSTERONE 81479 80327 79.25$

HOSPITAL LAB0000527 CHOLINESTERASE; RBC 82482 101.60$

HOSPITAL LAB0000529 PHOSPHOLIPID PLTLT NEUTRALIZ 85597 83.55$

HOSPITAL LAB0000531 LACTOFERRIN, FECAL (QUAL)91560 83630 153.05$

HOSPITAL LAB0000533 EBV INSITU HYBRID 88365 245.25$

HOSPITAL LAB0000535 LACOSAMIDE QUAN MASS SPECT, EA 83789 201.35$

HOSPITAL LAB0000536 E. COLI (SHIGA) TOXIN 87798 324.85$

HOSPITAL LAB0000537 H PYLORI IGM AB 86677 70.25$

HOSPITAL LAB0000538 BILIRUBIN; BODY FLUID 8038 82247 111.85$

HOSPITAL LAB0000541 BK VIRUS, PCR, URINE (87859) 87799 170.25$

HOSPITAL LAB0000544 HEP INDUCED AB (HIT) PF4 81904 86022 106.70$

HOSPITAL LAB0000546 H PYLORI BREATH TEST 81590 83013 128.15$

HOSPITAL LAB0000547 CORTISOL; SALIVA 84225 82533 89.75$

HOSPITAL LAB0000549 BETA-HYDROXYBUTYRATE 9251 82010 52.05$

HOSPITAL LAB0000550 MTB COMPLEX SUSCEPT 56032 87188 32,940.95$

HOSPITAL LAB0000551 CREATININE, BODY FLUID 8037 82570 52.75$

HOSPITAL LAB0000555 ANTI MULERIAN HORMONE 91691 83516 151.55$

HOSPITAL LAB0000556 CTX C -TELOPEPTIDE 82523 82523 155.25$

HOSPITAL LAB0000559 CHROMIUM, S (8638) 82495 36.85$

HOSPITAL LAB0000560 COBALT, S (80084) 83018 89.25$

HOSPITAL LAB0000561 COENZYME Q10 (87853) 82542 165.30$

HOSPITAL LAB0000562 BORDETELLA AB IgA/IgG 86615 136.75$

HOSPITAL LAB0000563 PROTEINASE 3 (PR-3) AB 82965 83516 64.55$

HOSPITAL LAB0000565 MALARIA BY PCR 87860 87798 169.35$

HOSPITAL LAB0000567 FLOW CYTOMETRY B-CELL PANEL 88185 391.65$

HOSPITAL LAB0000568 FLOW CYTOMETRY ACUTE PANEL 88185 347.25$

HOSPITAL LAB0000570 H. PYLORI SCREEN 87077 65.60$

HOSPITAL LAB0000572 MAGNESIUM 83735 66.85$

HOSPITAL LAB0000573 LITHIUM 80178 71.50$

HOSPITAL LAB0000574 AMMONIA 82140 111.45$

HOSPITAL LAB0000576 CULT,FUNG,BLD 87103 36.90$

HOSPITAL LAB0000577 ID, BACTERIAL BY KIT 87077 67.00$

HOSPITAL LAB0000578 CULT,GROUP B STREP SCR (1 ORG) 87081 101.35$

HOSPITAL LAB0000579 CULTURE FUNG OTHER SOURCE 87102 153.30$

HOSPITAL LAB0000580 ACID FAST CULTURE 87116 143.90$

HOSPITAL LAB0000581 POTASSIUM RANDOM URINE 84133 55.60$

HOSPITAL LAB0000582 SODIUM RANDOM URINE 84300 55.60$

HOSPITAL LAB0000584 CHOLESTEROL 82465 52.20$

HOSPITAL LAB0000585 AMYLASE 82150 82.65$

HOSPITAL LAB0000586 PHOSPHOROUS 84100 38.30$

HOSPITAL LAB0000587 FERRITIN 82728 144.30$

HOSPITAL LAB0000590 TRANSCUTANEOUS BILI OB 88720 36.15$

HOSPITAL LAB0000591 PARATHYROID KDH 83970 241.40$

HOSPITAL LAB0000592 HEMOGLOBIN 85018 45.50$

HOSPITAL LAB0000593 HEMATOCRIT 85014 37.30$

HOSPITAL LAB0000594 PH BODY FLUID 83986 51.40$

HOSPITAL LAB0000595 D-DIMER 85379 168.10$

HOSPITAL LAB0000597 DAT WELLNESS PROFILE 35.00$

2020-01




HOSPITAL LAB0000602 VWF MULTIMERIC CHG 85247 272.40$

HOSPITAL LAB0000603 PSA ULTRASENSITIVE TTL 84153 94.20$

HOSPITAL LAB0000607 VITAMIN A CHG ONLY 84590 48.45$

HOSPITAL LAB0000609 FTA ABS CHG 86780 77.65$

HOSPITAL LAB0000610 MAGNESIUM RANDOM URINE CHG 83735 132.00$

HOSPITAL LAB0000611 ISLET CELL AB CHG 86341 45.35$

HOSPITAL LAB0000612 HEPATITIS A IGG/IGM 86708 154.25$

HOSPITAL LAB0000614 CRYPTOCOCCUS AG, S 86403 47.50$

HOSPITAL LAB0000615 COCCIDIOIDES AB 86635 83.15$

HOSPITAL LAB0000616 AMPHETAMINES, URINE 80324 130.10$

HOSPITAL LAB0000617 MYELOPEROXIDASE 83516 100.40$

HOSPITAL LAB0000618 ESTRONE 82679 169.80$

HOSPITAL LAB0000619 H. PYLORI AG FECES 87338 205.80$

HOSPITAL LAB0000620 CYCLIC CIT PEPTIDE 86200 127.00$

HOSPITAL LAB0000621 LDH BODY FLUID, MAYO 83615 53.35$

HOSPITAL LAB0000622 CHLORIDE RANDOM URINE 82435 54.75$

HOSPITAL LAB0000623 DIPTHERIA IGG 86317 302.80$

HOSPITAL LAB0000624 PROTEIN S ACTIVITY FREE 85306 223.95$

HOSPITAL LAB0000625 PARIETAL CELL AB 83516 44.95$

HOSPITAL LAB0000626 TISSUE TRANSGLUTAMINASE IGA 83516 149.15$

HOSPITAL LAB0000627 TISSUE TRANSGLUTAMINASE IGG 83516 129.40$

HOSPITAL LAB0000628 CHROMOGRANIN A 86316 136.70$

HOSPITAL LAB0000630 STRONGYLOIDES AB 86682 95.15$

HOSPITAL LAB0000633 BONE ALKALINE PHOS (BAP) ISO 84080 97.75$

HOSPITAL LAB0000634 BORDETELLA;IgG, IgA, IgM(FBPA) 86615 186.30$

HOSPITAL LAB0000635 TETANUS TOXOID IgG (TTIG) 86317 51.95$

HOSPITAL LAB0000637 CHRONIC UTICARIA (FCUI) 86352 289.10$

HOSPITAL LAB0000638 T3 REVERSE (MISCARUP) 84482 116.40$

HOSPITAL LAB0000640 URIC ACID URINE; RANDOM 84560 85.20$

HOSPITAL LAB0000643 CMV PCR CSF (LCMV) 87496 129.00$

HOSPITAL LAB0000651 DRUG SCREEN NON-DOT W/O KIT 80305 37.15$

HOSPITAL LAB0000654 MANNOSE BINDING LECTHIN 83520 188.25$

HOSPITAL LAB0000661 BK VIRUS PLASMA 87799 148.45$

HOSPITAL LAB0000665 ANA MULT SERUM; TITER 110099 86039 45.20$

HOSPITAL LAB0000666 RPOU-PHOSPHOROUS RANDOM URINE 84105 64.85$

HOSPITAL LAB0000667 ASPERGILLUS IgG 86001 69.80$

HOSPITAL LAB0000668 RIA NONANTIBODY 83519 116.60$

HOSPITAL LAB0000695 IMMUNOGLOBULIN IgG/IgA/IgM 82784 64.30$

HOSPITAL LAB0000698 MYCOPLASMA PNEUM IgM Ab BY IFA 86738 86.60$

HOSPITAL LAB0000700 HEPATITIS C QUANT RNA (QHCV) 87522 209.30$

HOSPITAL LAB0000702 ETHANOL, URINE (ETOHU) 80320 82.65$

HOSPITAL LAB0000703 ITRACONAZOLE (ITCON) 80299 65.35$

HOSPITAL LAB0000704 VDRL, SERUM (VDRL), QL 86592 82.70$

HOSPITAL LAB0000706 FATTY ACID PROFILE (FAPCP) 82542 151.75$

HOSPITAL LAB0000707 CONFIRMATION DRUG SCREEN(CDAU) 80307 50.95$

HOSPITAL LAB0000708 DRUGS OF ABUSE 9 PANEL (FDA9P) 80307 143.15$

HOSPITAL LAB0000709 PROSTATE BX 5-20 SPECIMENS 450.15$

HOSPITAL LAB0000710 6-MAMU 80356 153.05$

HOSPITAL LAB0000711 ALBUMIN, BODY FLUID 82042 66.85$

HOSPITAL LAB0000713 ALPHA 1 ANTITRYPSIN, FECES 82103 59.65$

HOSPITAL LAB0000714 REDUCIN SUBST - FECES 84376 85.90$

HOSPITAL LAB0000719 DAT DIABETIC PANEL 80061 75.00$

HOSPITAL LAB0000720 CADMIUM, BLOOD (CDB) 82300 61.40$

HOSPITAL LAB0000721 TRIGLYCERIDES BODY FLUID TGLBF 84478 192.90$

HOSPITAL LAB0000725 RIBOFLAVIN (VITAMIN B-2) 84252 176.20$

HOSPITAL LAB0000727 MARIJUANA CONFIRM 80349 117.00$

HOSPITAL LAB0000731 IMMUNOFIXATION, SERUM 86334 91.55$

HOSPITAL LAB0000733 CYP2D6 GENE COM VARIANTS 81226 533.65$

HOSPITAL LAB0000734 CYP2C19 GENE COM VARIANTS 81225 587.75$

HOSPITAL LAB0000735 DPD GEN HLA II TYPING ALLELE H 81400 321.45$

HOSPITAL LAB0000736 HUNTINGTONS MOPATH PROC LEV 2 81271 317.00$

HOSPITAL LAB0000737 MTHFR GENE ANALYSIS 81291 127.95$

HOSPITAL LAB0000740 CYSTIC FIBROSIS CFTR GENE COMM 81220 649.60$

HOSPITAL LAB0000741 FACTOR V LEIDEN F5 GENE 81241 84.25$

HOSPITAL LAB0000742 FRAGILE X FMR1 GENE DETECTION 81243 311.50$

HOSPITAL LAB0000743 PT G20210A F2 GENE 81240 118.75$

HOSPITAL LAB0000744 JAK2 GENE 81270 396.35$

HOSPITAL LAB0000747 BCR/ABL ASPE MOPATH PROC LEVEL 81403 560.75$

2020-01




HOSPITAL LAB0000752 HLA-A UNLISTED MOL PATH 81380 446.95$

HOSPITAL LAB0000753 BCR/ABL1 GENE MAJOR BP 81206 488.20$

HOSPITAL LAB0000754 CGH CHROMOSOMAL MICROARRAY BLO 81229 1,471.00$

HOSPITAL LAB0000755 HAV RNA QUAL PCR 84999 245.45$

HOSPITAL LAB0000756 ARSENIC BLOOD 82175 181.90$

HOSPITAL LAB0000758 PROTEIN S TOTAL 85305 36.60$

HOSPITAL LAB0000759 HEPATITIS B CORE IgM Ab 86705 43.30$

HOSPITAL LAB0000760 HELICOBACTER PYLORI IgM Ab 86677 61.90$

HOSPITAL LAB0000761 HELICOBACTER PYLORI IgA Ab 86677 61.90$

HOSPITAL LAB0000763 PANCREATIC ELASTASE FECAL 82656 162.90$

HOSPITAL LAB0000767 SEMEN ANALYSIS-POST VAS 89321 50.15$

HOSPITAL LAB0000768 BARBITURATES CONFIRM 80345 113.90$

HOSPITAL LAB0000770 GABAPENTIN 80171 113.90$

HOSPITAL LAB0000771 TRAMADOL QUANT 80373 111.05$

HOSPITAL LAB0000772 QUEST PREGABALIN 80366 113.90$

HOSPITAL LAB0000777 BUPRENORPHINE - CONFIRM 80348 113.90$

HOSPITAL LAB0000779 HEROIN METABOLITE (REFLEX) 80356 305.05$

HOSPITAL LAB0000787 COLLECT BLOOD IMPLANT PORT 36591 129.55$

HOSPITAL LAB0000788 RBC (RED BLD CELL CNT) 85041 21.40$

HOSPITAL LAB0000791 RENAL BX; IMMUNOHISTOLOGY 8104 88346 297.45$

HOSPITAL LAB0000792 HPV DNA GENOTYPES 16 & 18 87625 131.85$

HOSPITAL LAB0000793 LACTOFERRIN FECAL (QUAL) 83630 24.65$

HOSPITAL LAB0000794 ALCOHOL,ETHYL BREATH ONLY 82075 39.20$

HOSPITAL LAB0000795 DRUG SCREEN NON-DOT EMPLOYMENT 80306 53.05$

HOSPITAL LAB0000798 TRICHOMONAS 87661 136.95$

HOSPITAL LAB0000800 PAP PHYS INTERP 88141 53.60$

HOSPITAL LAB0000801 DAT VITAMIN D 82306 45.00$

HOSPITAL LAB0000802 SYN CANNABINOIDS CONFIRM > 7 80352 120.75$

HOSPITAL LAB0000810 BULLOUS PEMPHIGOID AB 83516 149.10$

HOSPITAL LAB0000812 HEAT SHOCK UNLISTED MOLE PATH 81479 695.35$

HOSPITAL LAB0000813 PML RARA 81315 704.05$

HOSPITAL LAB0000815 BETA-2 TRANSFERRIN CSF 86335 129.80$

HOSPITAL LAB0000816 JAK-XB MOPATH PROC LEVEL 4 81403 428.30$

HOSPITAL LAB0000817 ACTINOMYCES SCREEN 87081 232.80$

HOSPITAL LAB0000818 COPPER, URINE 82525 66.20$

HOSPITAL LAB0000819 CD8 IMMUNE 86356 521.10$

HOSPITAL LAB000081B PROTEIN ELECTRO U 84156 107.05$

HOSPITAL LAB0000820 HISTONE AB 83516 41.25$

HOSPITAL LAB0000822 STREP PNEUM IgG Ab 12 SEROTYPE 86317 310.30$

HOSPITAL LAB0000823 STREP PNEUM IgG AB 23 SEROTYPE 86317 547.10$

HOSPITAL LAB0000824 COAG FACTOR VIII ACTIVITY 554 85240 87.30$

HOSPITAL LAB0000825 SPEC COAG INTERP 85390 63.80$

HOSPITAL LAB0000826 COAG FACTOR VIII INHIBITOR SCR 85335 264.05$

HOSPITAL LAB0000827 ER/PR MANUAL MAYO 88360 297.45$

HOSPITAL LAB0000828 VMA U RANDOM 84585 36.30$

HOSPITAL LAB0000829 JC VIRUS, PCR PLASMA 87799 329.50$

HOSPITAL LAB0000830 ALLERGAN AMERICAN COCKROACHIgE 86003 56.65$

HOSPITAL LAB0000833 IODINE 83018 76.45$

HOSPITAL LAB0000834 DIS2 HLA-DR0405 81375 350.20$

HOSPITAL LAB0000835 DISI HLA-A29/HLA B0501 81374 350.55$

HOSPITAL LAB0000836 CAL RETICULIN MUTATION ASSAY 81219 622.45$

HOSPITAL LAB0000837 EVEROLIMUS, BLD 80169 228.85$

HOSPITAL LAB0000838 IGFBP-2 83519 132.00$

HOSPITAL LAB0000839 HB VARIANT BY MASS SPEC 83789 139.55$

HOSPITAL LAB0000842 C-PEPTIDE 84681 50.35$

HOSPITAL LAB0000843 PATERNITY TEST COLLECTION 25.00$

HOSPITAL LAB0000844 PRO-BNP(B-NATRIURETIC PEPTIDE) 83880 102.80$

HOSPITAL LAB0000845 GALACTOSE-ALPHA 1,3 IGE 86003 86.50$

HOSPITAL LAB0000846 DES GAMMA CARBOXY PROTHROMB,S 83951 169.20$

HOSPITAL LAB0000847 SULFATE, URINE 84392 96.60$

HOSPITAL LAB0000848 FRUCTOSAMINE, SERUM 82985 50.65$

HOSPITAL LAB0000850 DRVVT 85613 129.55$

HOSPITAL LAB0000852 MaTa ANTIBODY, WESTERN BLOT 84182 662.00$

HOSPITAL LAB0000853 HEMOCHROMATOSIS GENE ANALYSIS 81256 272.95$

HOSPITAL LAB0000854 THYROXINE BINDING GLOBULIN, S 84442 54.35$

HOSPITAL LAB0000855 MYCOBACT TB PCR (MTBRP) 87556 258.65$

HOSPITAL LAB0000857 BISMUTH, BLOOD 83018 102.00$

HOSPITAL LAB0000858 BERYLLIUM, BLOOD 83018 120.40$

2020-01




HOSPITAL LAB0000859 BARIUM, SERUM 83018 135.40$

HOSPITAL LAB0000860 LYMPHOCYTE PROLIFERATION,MITOG 86353 364.50$

HOSPITAL LAB0000861 ANTIMONY, BLOOD 83018 122.95$

HOSPITAL LAB0000862 HIV 1/2 AG & AB SCRN 87389 56.60$

HOSPITAL LAB0000864 HIV-2 DIFF 86702 109.05$

HOSPITAL LAB0000865 HIV-1 AB DIFF 86701 71.75$

HOSPITAL LAB0000868 IMMUNE COMPLEX 86332 232.80$

HOSPITAL LAB0000869 TYPE II COLAGEN AB 83520 179.10$

HOSPITAL LAB0000870 CARDIOLIPIN IgA 86147 41.95$

HOSPITAL LAB0000871 68 KD ANTIBODIES 84182 240.25$

HOSPITAL LAB0000872 ACUTE PROHPYRIA,MULTIGENE PANE 81479 2,145.60$

HOSPITAL LAB0000874 CARBOHYDRATE DEFIC TRANSFERRIN 82373 81.00$

HOSPITAL LAB0000877 BATH SALTS FMMM 80307 142.25$

HOSPITAL LAB0000878 CRMP-5-IGG WB 84182 148.40$

HOSPITAL LAB0000879 AChR GANGLIONIC NEURONAL AB 83519 129.15$

HOSPITAL LAB0000880 MuSK AUTOANTIBODY, S 83519 578.50$

HOSPITAL LAB0000881 PROLACTIN, PITUIT MACROADENOMA 84146 97.25$

HOSPITAL LAB0000882 UREAPLASMA PCR 87798 137.55$

HOSPITAL LAB0000883 MYELIN ASSOC GLYCOPROTEIN(MAG) 83516 158.05$

HOSPITAL LAB0000884 PEANUT COMPONENT PANEL 86003 319.85$

HOSPITAL LAB0000885 MICROSPORIDIA PCR 87798 306.75$

HOSPITAL LAB0000887 PROBE +2 PBCT 88271 70.85$

HOSPITAL LAB0000888 PROBE, +1 PADD 88271 35.45$

HOSPITAL LAB0000892 INTERPHASES, 25-99 88274 83.90$

HOSPITAL LAB0000893 INTERPHASES >=100 88275 82.95$

HOSPITAL LAB0000894 SOLUBLE TRANSFER RECEPTOR 84238 88.15$

HOSPITAL LAB0000896 APOLIPOPROTEIN A1, & B,P 82172 105.85$

HOSPITAL LAB0000897 CHROMOSOMES CONGENITAL BLOOD 88291 235.60$

HOSPITAL LAB0000898 CULTURE 01 88230 158.05$

HOSPITAL LAB0000899 KARYOTYPES >2 88280 60.50$

HOSPITAL LAB0000900 AG-NOR/CBL STAIN 88283 94.45$

HOSPITAL LAB0000901 CHROMO BM 88291 405.70$

HOSPITAL LAB0000903 METAPHASES 15-20 88262 214.50$


HOSPITAL LAB0000906 METAPHASES 20-25 88264 214.50$

HOSPITAL LAB0000908 MOLD PANEL 86003 64.90$

HOSPITAL LAB0000909 PAP SMEAR W/IMAGING SCREENING 88142 150.95$

HOSPITAL LAB0000910 PAP SMEAR W IMAGING DIAGNOSTIC 88142 156.50$

HOSPITAL LAB0000911 PAP PHYS INTERP 88141 112.60$

HOSPITAL LAB0000912 CLOSTRIDIUM DIFFICLE PCR, MAYO 87493 143.80$


HOSPITAL LAB0000914 RABIES ANTIBODY ENDPOINT 86382 146.85$

HOSPITAL LAB0000915 PM DRUG SCREE ARUP 80307 171.40$

HOSPITAL LAB0000916 SUBOXONE EMPLOYMENT 80348 27.25$

HOSPITAL LAB0000918 LYSOZYME, SERUM 85549 87.50$

HOSPITAL LAB0000920 C2 COMPLEMENT FUNCTIONAL W/ RE 86161 84.85$

HOSPITAL LAB0000922 FAMILIAL MUTATION, TARGETED TE 81479 625.35$

HOSPITAL LAB0000923 DEXAMETHASONE 80375 168.65$

HOSPITAL LAB0000924 PM-SCL ANTIBODY 86235 146.85$

HOSPITAL LAB0000925 HEMOGLOBIN, PLASMA 83051 71.40$

HOSPITAL LAB0000927 ANTI-DNASE B TITER 86215 146.85$

HOSPITAL LAB0000928 THIOPURINE METHYLTRANSFERASE 82657 371.95$

HOSPITAL LAB0000929 BENZODIAZEPINE QUANT> 13 ARUP 80347 106.05$

HOSPITAL LAB0000930 OXYGEN DISS P50 WB 82820 203.85$

HOSPITAL LAB0000933 DAT MICROALB/CREAT RATIO RANDO 49.00$

HOSPITAL LAB0000934 AFP-L3% AND TOTAL AFP, S 82107 175.75$

HOSPITAL LAB0000935 PT 1:1 MIX 85611 101.20$

HOSPITAL LAB0000936 PALIPERIDONE (INVEGA) 80342 183.55$

HOSPITAL LAB0000937 CLOBAZAM (ONFI) 80339 167.15$

HOSPITAL LAB0000938 DAT MICROALB/CREAT RATIO RANDO 82570 45.00$

HOSPITAL LAB0000939 LISTERIA ANTIBODY, CF, S 86609 160.80$

HOSPITAL LAB0000940 PARVOVIRUS B19 PCR 87798 163.00$

HOSPITAL LAB0000942 HSV PCR BLOOD 87529 91.00$

HOSPITAL LAB0000943 HCV GENOTYPE RESOLUTION 87902 674.35$

HOSPITAL LAB0000944 NEUROFIBROMATOSIS GENE SEQ 81408 2,805.05$

HOSPITAL LAB0000945 CELIAC HLA DQ TYPING 81376 362.15$

HOSPITAL LAB0000946 SISIC-BMP 80048 4.40$

HOSPITAL LAB0000947 SISIC - CBC AUTO W/PLT & AUTO 85025 4.40$

2020-01




HOSPITAL LAB0000948 SISIC - CMP (CHEM 14) 80053 5.50$

HOSPITAL LAB0000949 SISIC - IRON AND TIBC 83550 10.95$

HOSPITAL LAB0000950 SISIC - FERRITIN 82728 5.50$

HOSPITAL LAB0000951 SISIC - GLUCOSE, QUANT 82947 5.50$

HOSPITAL LAB0000952 SISIC - FREE T4 84439 5.50$

HOSPITAL LAB0000953 SISIC - HEMOGLOBIN A.1C 83036 10.95$

HOSPITAL LAB0000954 SISIC - INR 85610 4.40$

HOSPITAL LAB0000955 SISIC - LIPID PNL 80061 8.70$

HOSPITAL LAB0000956 SISIC-LIVER PANEL HEPATIC FUNC 80076 5.50$

HOSPITAL LAB0000957 SISIC - MICRO ALBUMIN, RNDM QT 82043 8.70$

HOSPITAL LAB0000958 SISIC - MONO SCRN 86308 10.95$

HOSPITAL LAB0000959 SISIC - HCG QUAL, URINE 81025 10.95$

HOSPITAL LAB0000960 SISIC - PSA TOTAL 84153 27.25$

HOSPITAL LAB0000961 SISIC - RENAL FUNCTION PANEL 80069 5.50$

HOSPITAL LAB0000962 SISIC - RHEUMATOID FACTOR QT 86431 8.70$

HOSPITAL LAB0000963 ESTRIOL, UNCONJ 82677 62.75$

HOSPITAL LAB0000964 SISIC - SED RATE 85652 8.70$

HOSPITAL LAB0000965 SISIC - TSH 84443 8.70$

HOSPITAL LAB0000966 SISIC - URINALYSIS 81003 5.50$

HOSPITAL LAB0000967 SISIC - URIC ACID BLOOD 84550 5.50$

HOSPITAL LAB0000970 SISIC - 25 HYDROXY-VITAMIN D2 82306 32.65$

HOSPITAL LAB0000971 SISIC - CULTURE, UR (BACT) QUA 87086 21.80$

HOSPITAL LAB0000973 MTHP: MTHFR 2 MUTATIONS ANALYS 81291 286.05$

HOSPITAL LAB0000976 PD-L1 SEMI-QUANT IHC MAYO 88360 359.95$

HOSPITAL LAB0000977 SISIC - INFLUENZA A & B ANTIGE 87502 21.80$

HOSPITAL LAB0000978 SISIC - STREP SCR GROUP A-THRO 87880 5.50$

HOSPITAL LAB0000979 SISIC - VENIPUNCTURE 36415 2.25$

HOSPITAL LAB0000982 ADAMTS13 ACTIVITY AND INHIBITO 85397 251.70$

HOSPITAL LAB0000983 ARIXTRA LEVEL 85130 153.65$

HOSPITAL LAB0000984 ANTI-RETINAL AUTO AB, IHC 88342 406.45$

HOSPITAL LAB0000985 EASTERN EQUINE ENCEPHALITIA AB 86652 96.45$

HOSPITAL LAB0000986 PROPYLENE GLYCOL 84600 176.75$

HOSPITAL LAB0000987 OXCARBAZEPINE METABOLITE 80183 40.45$

HOSPITAL LAB0000988 THROMBOPOIETIN (TPO) 83520 212.45$

HOSPITAL LAB0000989 GLIADIN IGA ONLY 83516 63.25$

HOSPITAL LAB0000991 PROCALCITONIN 84145 173.85$

HOSPITAL LAB0000992 R TYPHI IGG TITER 86757 149.20$

HOSPITAL LAB0000993 R TYPHI IGM TITER 86757 162.75$

HOSPITAL LAB0000994 RMSF IGG TITER 86757 142.15$

HOSPITAL LAB0000995 RMSF IGM TITER 86757 155.05$

HOSPITAL LAB0000996 Q FEVER IGG PHASE I TITER 86638 126.20$

HOSPITAL LAB0000997 Q FEVER IGG PHASE II TITER 86638 126.20$

HOSPITAL LAB0000998 Q FEVER IGM PHASE I TITER 86638 126.20$

HOSPITAL LAB0000999 Q FEVER IGM PHASE II TITER 86638 126.20$

HOSPITAL LAB0001000 COPPER CREATININE RATIO URINE 82525 167.35$

HOSPITAL LAB0001001 7-DEHYDROCHOLESTEROL 82542 237.95$

HOSPITAL LAB0001003 LYMPHOCYTE PROLIFERATION, ANTI 86353 786.25$

HOSPITAL LAB0001006 RESPIRATORY VIRUS PROFILE 87633 738.15$

HOSPITAL LAB0001007 GANGLIOSIDE AB FGAGM 83516 276.25$

HOSPITAL LAB0001009 NICKEL, SERUM 83885 92.10$

HOSPITAL LAB0001010 TESTOSTERONE TOTAL, URINE 84403 339.90$

HOSPITAL LAB0001011 PROGESTERONE, URINE 84144 339.90$

HOSPITAL LAB0001012 HYDROXYPROGESTERONE 17-D, URIN 83498 271.90$

HOSPITAL LAB0001013 FLU A&B, RSV PCR 87631 321.15$

HOSPITAL LAB0001015 ZOLPIDEM (AMBIEN), SERUM 80368 154.30$

HOSPITAL LAB0001016 ZIKA VIRUS, PCR 87662 203.95$

HOSPITAL LAB0001017 FAMILIAL MUTATION GENE RET 81403 606.90$

HOSPITAL LAB0001018 TRANSFORMING GROWTH FACTOR 83520 245.35$

HOSPITAL LAB0001019 MELANOCYTE STIMULATING HORMONE 83519 265.25$

HOSPITAL LAB0001020 VASC ENDOTHELIAL GROWTH FACTOR 83520 272.65$

HOSPITAL LAB0001021 INFLIXIMAB QN 80299 298.40$

HOSPITAL LAB0001022 IF, EA ADDITIONAL 88350 54.40$

HOSPITAL LAB0001023 NICOTINE, UR KDH 80323 21.25$

HOSPITAL LAB0001051 HEPATITIS B SURFACE AB 86317 38.25$

HOSPITAL LAB0001052 HEXAGONAL PHOSPHOLIPID NEUTRAL 85598 122.60$

HOSPITAL LAB0001053 VWF ACTIVITY 85245 58.45$

HOSPITAL LAB0001060 BLASTOMYCES AB 86612 26.10$

HOSPITAL LAB0001061 HSV 1&2 AB, IgG 86694 36.70$

2020-01




HOSPITAL LAB0001062 ENA ABS 86235 163.15$

HOSPITAL LAB0001065 KAPPA/LAMBDA FREE LIGHT CHAINS 83883 66.85$

HOSPITAL LAB0001066 F ACTIN (SMOOTH MUSCLE) AB 83516 29.45$

HOSPITAL LAB0001067 BORDETELLA PERTUSSIS BY PCR 87798 153.25$

HOSPITAL LAB0001069 MATERNAL QUAD SCREEN 81511 78.95$

HOSPITAL LAB0001070 PANCREATIC ELASTASE 83520 177.15$

HOSPITAL LAB0001071 CORTISOL, SALIVA 82533 82.25$

HOSPITAL LAB0001072 ESTROGENS FRACTIONATED 82671 79.20$

HOSPITAL LAB0001073 GONAD RELEASING HORMONE 83727 305.05$

HOSPITAL LAB0001074 HEP C ANTIBODY SCREENING 86803 178.25$

HOSPITAL LAB0001076 ALLERGEN, YELLOW DYE IGE 86003 75.25$

HOSPITAL LAB0001079 LACOSIMIDE, SERUM 80339 150.60$

HOSPITAL LAB0001084 ERBB2 88377 597.90$

HOSPITAL LAB0001085 PTH RELATED PEPTIDE 82542 115.45$

HOSPITAL LAB0001090 PTT-D 1:1 MIX REFLEX 85732 23.30$

HOSPITAL LAB0001091 VDRL CSF TITER REFLEX 86593 45.55$

HOSPITAL LAB0001092 DS DNA IFA REFLEX 86256 53.90$

HOSPITAL LAB0001093 ANCA TITER REFLEX 86256 77.05$

HOSPITAL LAB0001094 GLIADIN IGA REFLEX 83516 29.45$

HOSPITAL LAB0001095 TTG AB IGG REFLEX 83516 29.45$

HOSPITAL LAB0001096 CELIAC DISEASE SCREEN REFLEX 83516 89.15$

HOSPITAL LAB0001098 BUPRENORPHINE SCREEN W/ REFLEX 80307 127.00$

HOSPITAL LAB0001100 AMIODARONE & METABOLITES 80299 36.20$

HOSPITAL LAB0001101 FAT, FECAL 82705 36.05$

HOSPITAL LAB0001102 ZYPREXA (OLANZAPINE) 80342 150.60$

HOSPITAL LAB0001103 BATH SALTS PANEL, URINE 80371 172.45$

HOSPITAL LAB0001106 THC CONFIRMATION, URINE 80349 37.15$

HOSPITAL LAB0001108 STRIATED MUSCLE REFLEX 86256 90.05$

HOSPITAL LAB0001109 ACHR MODULATING AB TITER REFLE 83516 81.75$

HOSPITAL LAB0001110 NEURONAL NUCLEAR AB TITER REFL 86256 153.85$

HOSPITAL LAB0001111 PURKINJE CELL AB TITER REFLEX 86256 153.85$

HOSPITAL LAB0001112 NEURONAL NUCLEAR AB, IGG IMMUN 83516 153.85$

HOSPITAL LAB0001113 CV2.1 AB IGG TITER, REFLEX 86256 335.55$

HOSPITAL LAB0001114 HEMOGLOBIN S EVALUATION 83021 54.60$

HOSPITAL LAB0001115 SICKLE SOLUBILITY REFLEX 85660 51.05$

HOSPITAL LAB0001116 JC VIRUS PCR, CSF 87798 155.20$

HOSPITAL LAB0001117 WEST NILE VIRUS RNA, PCR, CSF 87798 220.20$

HOSPITAL LAB0001118 GLIADIN IGG REFLEX 83516 29.45$

HOSPITAL LAB0001119 TTG AB IGA REFLEX 83516 29.45$

HOSPITAL LAB0001120 RNA POLYMERASE III AB, IGG 83516 104.75$

HOSPITAL LAB0001122 HSV TYPING REFLEX 87140 81.75$

HOSPITAL LAB0001123 SMOOTH MUSCLE AB TITER 86256 75.25$

HOSPITAL LAB0001130 ADMARK PHOSPHO-TAU/AB42 83520 1,476.25$

HOSPITAL LAB0001131 OPRM1 GENOTYPE, 1 VARIANT 81479 259.95$

HOSPITAL LAB0001132 HEAT SHOCK PROTEIN 70, IGG 83516 189.95$

HOSPITAL LAB0001133 HSV BY PCR SUBTYPING REFLEX 198.95$

HOSPITAL LAB0001134 BRCA1 & BRCA2 SEQUENCING 81211 2,561.60$

HOSPITAL LAB0001135 FLOW FIRST MARKER 88184 251.25$

HOSPITAL LAB0001136 FLOW EACH ADDITIONAL MARKER 88185 64.40$

HOSPITAL LAB0001137 HLA-B*15:02 CARBAMASEPINE HYPE 81380 322.45$

HOSPITAL LAB0001138 IGF BINDING PROTEIN 3 82397 36.20$

HOSPITAL LAB0001140 FACTOR V R2 MUTATION DETECTION 81400 494.15$

HOSPITAL LAB0001141 LR, GI PROTEIN 1 AB REFLEX 86255 311.10$

HOSPITAL LAB0001142 UNLISTED MOLECULAR PATH PROC 81479 351.25$

HOSPITAL LAB0001143 PROSTATE SPECIFIC KALLIKREIN 81539 898.65$

HOSPITAL LAB0001144 SIGNAL RECOGNITION PARTICLE 83516 119.40$

HOSPITAL LAB0001145 C. BURNETII IGG/IGM 86638 111.40$

HOSPITAL LAB0001146 CYSTINE 82131 110.50$

HOSPITAL LAB0001147 HEPATITIS D QUANTITATIVE 87799 335.55$

HOSPITAL LAB0001148 MYELOID CMA AND NGS 81455 3,693.55$

HOSPITAL LAB0001149 RUNXI QUANTITATIVE 81401 603.95$

HOSPITAL LAB0001150 IMMUNOFIXATION, IGD AND IGE 86334 155.20$

HOSPITAL LAB0001151 BARTONELLA BY PCR 87471 291.75$

HOSPITAL LAB0001152 BABESIA BY PCR 87798 192.30$

HOSPITAL LAB0001153 PLATELET ASSOC ABS 86023 100.90$

HOSPITAL LAB0001156 ORGANIC ACIDS URINE TTL 83918 179.10$

HOSPITAL LAB0001157 VIRAL CULTURE, RAPID 87254 116.20$

HOSPITAL LAB0001158 THIOPURINE METABOLITE 80299 171.95$

2020-01




HOSPITAL LAB0001159 CCT 84999 147.70$

HOSPITAL LAB0001160 LEPTIN, QUANT 83520 111.40$

HOSPITAL LAB0001161 HEPTATITIS B GENO BY SEQUENCE 87912 430.85$

HOSPITAL LAB0001162 MYCOPLAS PNEU DNA AMP 87581 89.40$

HOSPITAL LAB0001163 HEPATITIS Be ANTIBODY 86707 32.70$

HOSPITAL LAB0001164 FETAL HEMOGLOBIN 86356 225.50$

HOSPITAL LAB0001165 ABSOLUTE CD4 86361 80.80$

HOSPITAL LAB0001166 ANTI-MULLERIAN HORMONE 83520 116.20$

HOSPITAL LAB0001167 MMP-9 83520 158.35$

HOSPITAL LAB0001168 TICK BORNE DISEASE PNL BY PCR 87798 434.35$

HOSPITAL LAB0001169 MENINGITIS ENCEPHALITIS PNL 87483 667.25$

HOSPITAL LAB0001170 HLA-DR GENOTYPING 81382 433.15$

HOSPITAL LAB0001171 NOROVIRUS 1 AND 2 PCR 87798 257.30$

HOSPITAL LAB0001172 NEURON SPECIFIC ENOLASE 86316 64.85$

HOSPITAL LAB0001173 SNP MICROARROY, PROD OF CONCEP 81229 1,768.00$

HOSPITAL LAB0001174 BARTONELLA IGG & IGM 86611 46.75$

HOSPITAL LAB0001175 LIPOPROTEIN 83695 39.00$

HOSPITAL LAB0001176 CANDIDA SURESWAB 87481 97.90$

HOSPITAL LAB0001177 VOLTAGE GATED CALCIUM CHNL AB 83519 257.30$

HOSPITAL LAB0001178 ALLG SPEC IGE RECOMB EA 86008 41.15$

HOSPITAL LAB0001179 POLIO VIRUS TYPES 1,3 AB 86658 136.90$

HOSPITAL LAB0001180 MPL CODON 515 MUTATION 81402 473.40$

HOSPITAL LAB0001181 CHARCOT-MARIE-TOOTH TYPE 1A 81324 885.05$

HOSPITAL LAB0001182 PNH, HIGH SENSITIVITY, WBC 86356 339.20$

HOSPITAL LAB0001183 CLOSTRIDIUM DIFFICLE CYTOTOXIN 87230 54.60$

HOSPITAL LAB0001184 GABAPENTIN, URINE 80355 87.55$

HOSPITAL LAB0001185 BRUCELLA AB 86622 25.10$

HOSPITAL LAB0001186 BETA GLOBULIN FULL GENE SEQ 81364 603.95$

HOSPITAL LAB0001187 NATURAL KILLER CELLS ENUMERAT 86357 168.50$

HOSPITAL LAB0001188 ALLERGEN SPECIFIC IGE RECOMB 86008 41.15$

HOSPITAL LAB0001189 DHEA BY TMS 82626 57.95$

HOSPITAL LAB0001190 ISH TECH ONLY 88365TC 179.80$

HOSPITAL LAB0001191 TITANIUM QUANT 83018 160.50$

HOSPITAL LAB0001192 FMR1 GENE CHARACTERIZE REFLEX 81244 561.25$

HOSPITAL LAB0001193 PROSTAGLANDIN D2 84150 384.35$

HOSPITAL LAB0001194 ETHYL GLUCURONIDE/SULFATE 80321 76.75$

HOSPITAL LAB0001195 KLEIHAUER-BETKE 85460 40.15$

HOSPITAL LAB0001196 STREP B DNA AMPLIFICATION 87653 80.45$

HOSPITAL LAB0001197 ROS-1 BY FISH 88366 649.50$

HOSPITAL LAB0001198 ALPHA GLOBIN DELETION/DUP 81269 548.95$

HOSPITAL LAB0001199 LEPTOSPIRA AB, IGM 86720 85.95$

HOSPITAL LAB0001200 GADOLINIUM, URINE 83018 314.60$

HOSPITAL LAB0001201 BABESIA MICROTI IGG/IGM 86753 67.25$

HOSPITAL LAB0001202 ANAPLASMA PHAGOCTOPHILM (HGA) 86666 119.40$

HOSPITAL LAB0001203 POC PLOIDY BY FLOW CYTOMETRY 88182 169.10$

HOSPITAL LAB0001204 HLA II TYPING 81383 291.75$

HOSPITAL LAB0001205 FUNGAL ID MALDI-TOF MS 87158 118.95$

HOSPITAL LAB0001206 CULTURE TYPING 87158 119.40$

HOSPITAL LAB0001207 AGGRESSIVE B-CELL LYMPHOMA 88366 463.65$

HOSPITAL LAB0001208 TOXOPLASMA AB IGA 86677 224.15$

HOSPITAL LAB0001209 HIV-1 QUANT 87536 139.40$

HOSPITAL LAB0001210 HIV-1 GENOTYPING 87901 419.75$

HOSPITAL LAB0001211 MYCOBACTERIUM TUBERC DNA PROBE 87149 132.65$

HOSPITAL LAB0001212 HEREDITARY HEMOLYTIC ANEMIA 81443 2,774.20$

HOSPITAL LAB0001214 GASTROINTESTINAL VIRAL PANEL 87506 311.55$

HOSPITAL LAB0001215 ALUMINUM, SERUM 82108 51.05$

HOSPITAL LABE00005B A1A ALPHA 1 ANTITRYPSIN TTL 82103 33.45$

HOSPITAL LABE00005C A1A MOLECULAR ISOL 81332 9.65$

HOSPITAL LABE00005D A1A NUCLEIC ACID PROBE 81332 19.20$

HOSPITAL LABE00005E A1A MOLECULAR AMPLIFICATION 81332 85.95$

HOSPITAL LABE00005F A1A INT/RPT 82104 9.65$

HOSPITAL LABE00009B B-CELL LYMPH DNA PRB 88271 117.95$

HOSPITAL LABE00009C B-CELL LYMPH INSITU 100-300 88275 143.70$

HOSPITAL LABE00009D B-CELL LYMPH INTERP 88291 52.85$

HOSPITAL LABE00014B HCV FIBROSURE NEPHELOMETRY 83883 87.40$

HOSPITAL LABE00014C HCV FIBROSURE HAPTOGLOBIN QT 83010 80.65$

HOSPITAL LABE00014D HCV FIBROSURE APOLIPOPROTEIN 82172 89.30$

HOSPITAL LABE00014E HCV FIBROSURE GGT 82977 14.25$

2020-01




HOSPITAL LABE00014F HCV FIBROSURE BILIRUBIN TOTAL 82247 14.25$

HOSPITAL LABE00014G HCV FIBROSURE ALT 84460 14.25$

HOSPITAL LABE00017B MS OLIGOCLONAL BAND S & CSF 83916 78.10$

HOSPITAL LABE00017C MS IGG S & CSF 82784 36.20$

HOSPITAL LABE00017D MS ALBUMIN S 82040 9.75$

HOSPITAL LABE00017E MS ALBUMIN CSF 82042 10.10$

HOSPITAL LABE00019B PLASMA CELL DNA PRB 88271 279.70$

HOSPITAL LABE00019C PLASMA CELL INSIT HYB 100-300 88275 118.15$

HOSPITAL LABE00019D PLASMA CELL CRYOPRESERVE 88240 17.15$

HOSPITAL LABE00019E PLASMA CELL INTERP 88291 29.70$

HOSPITAL LABE00025B CHL/GC DNA CHLAMYDIA 87491 130.20$

HOSPITAL LABE00025C CHL/GC DNA GC 87591 172.35$

HOSPITAL LABE00026B CHROMO AUTOPSY INTERP 88291 34.70$

HOSPITAL LABE00026C CHROMO AUTOPSY TISS CULTURE 88233 255.80$

HOSPITAL LABE00026D CHROMO AUTOPSY CYTOGEN STUDY 88299 226.35$

HOSPITAL LABE00027B CHROMO CONG BLD INTERP 88291 28.45$

HOSPITAL LABE00027C CHROMO CONG BLD TISS CULTURE 88230 198.55$

HOSPITAL LABE00028B CHROMO HEMA INTERP 88291 41.05$

HOSPITAL LABE00028C CHROMO HEMA TISS CULTURE 88237 270.40$

HOSPITAL LABE00028D CHROMO HEMA CYTOGEN 20-25 CELL 88264 266.30$

HOSPITAL LABE00029B VW PROFILE VW FACTOR AG 85246 177.75$

HOSPITAL LABE00029C VW PROFILE VW FACTOR ACTIVITY 85397 177.75$

HOSPITAL LABE00029D VW PROFILE FACTOR VIII ASSAY 85240 138.10$

HOSPITAL LABE00032B CHROMO BM INTERP 88291 42.60$

HOSPITAL LABE00032C CHROMO BM TISSUE CULT 88237 280.60$

HOSPITAL LABE00032D CHROMO BM CYTOGEN 100-300 88264 276.35$

HOSPITAL LABE00035B SEMEN ANALYSIS MOTILITY & COUN 89310 193.20$

HOSPITAL LABE00035C SEMEN ANALYSIS WHO MORPH 89398 67.90$

HOSPITAL LABE00037B BCR/ABL DNA PRB 88271 122.70$

HOSPITAL LABE00037C BCR/ABL INSIT HYBRID 100-300 88275 149.40$

HOSPITAL LABE00037D BCR/ABL INTERP 88291 54.95$

HOSPITAL LABE00039B HEMOCHROM NA PRB 81256 46.85$

HOSPITAL LABE00039C HEMOCHROM MOL ISOL 81256 46.90$

HOSPITAL LABE00039D HEMOCHROM AMPLIFICATION 81256 195.15$

HOSPITAL LABE00039E HEMOCHROM INTERP 81256 23.50$

HOSPITAL LABE00040B HER2NEU FISH EA PRB 88271 234.15$

HOSPITAL LABE00040C HER2NEU INSIT HYBRID 25-99 88274 147.75$

HOSPITAL LABE00040D HER2NEU FISH INTERP 88291 122.90$

HOSPITAL LABE00041B HGB ELECT QUANT BY HPLC 83021 44.20$

HOSPITAL LABE00041C HGB ELECT QUANT BY ELECTRO 83020 32.70$

HOSPITAL LABE00042B PATH LEVEL IV HISTOCHEM MUSCLE 88305TC 144.75$

HOSPITAL LABE00042C HISTOCHEM MUSCLE HISTOCHEM STA 88314 1,099.65$

HOSPITAL LABE00042D HISTOCHEM MUSCLE HISTOCHEM ENZ 88319TC 1,386.35$

HOSPITAL LABE00045B INFLUENZA B AB EA 86710 66.90$

HOSPITAL LABE00049B PI LINK FLOW RBC&WBC 1ST MARK 88184 297.45$

HOSPITAL LABE00049C PI LINK FLOW ADD MARKER EA 88185 167.10$

HOSPITAL LABE00052B RICKETTSIA SPOTTED FEVER AB EA 86757 68.35$

HOSPITAL LABE00052C RICKETTSIA TYPHUS AB EA 86757 68.35$

HOSPITAL LABE00052D RICKESSIA Q FEVER AB EA 86638 38.00$

HOSPITAL LABE00054B T&B CELL B CELL TOTAL 86355 61.30$

HOSPITAL LABE00054C T&B CELL NK CELLS TOTAL 86357 61.30$

HOSPITAL LABE00054D T&B CELL T CELL TOTAL 86359 61.30$

HOSPITAL LABE00054E T&B CELL ABS CD4/CD8 86360 76.05$

HOSPITAL LABE00056B TORCH RUBELLA IGG 86762 25.50$

HOSPITAL LABE00056C TORCH TOXOPLASMA IGG 86777 25.50$

HOSPITAL LABE00056D TORCH CMV IGG 86644 25.50$

HOSPITAL LABE00056E TORCH HSV2 IGG 86696 59.55$

HOSPITAL LABE00056F TORCH HSV1 IGM 86695 20.00$

HOSPITAL LABE00057B TOXOPLASMA IGG/IGM IGG 86777 35.60$

HOSPITAL LABE00057C TOXOPLASMA IGG/IGM IGM 86778 25.50$

HOSPITAL LABE00058B VIRAL ENCEPH VARICELLA AB EA 86787 104.30$

HOSPITAL LABE00058C VIRAL ENCEPH HSV 1 AB EA 86695 106.35$

HOSPITAL LABE00058D VIRAL ENCEPH HSV 2 AB EA 86696 156.75$

HOSPITAL LABE00058E VIRAL ENCEPH LYMPH CHORIO AB E 86727 104.30$

HOSPITAL LABE00058F VIRAL ENCEPH MUMPS AB EA 86735 105.65$

HOSPITAL LABE00058G VIRAL ENCEPH RUBEOLA AB EA 86765 104.30$

HOSPITAL LABE00061B 5HIAA U 83497 149.95$

HOSPITAL LABE00063B ALDOSTERONE U 82088 155.05$

2020-01




HOSPITAL LABE00064B AMYLASE U 82150 89.20$

HOSPITAL LABE00067B CALCIUM UR 82340 60.65$

HOSPITAL LABE00068B CATECHOLAMINES FRACTION UR 82384 200.40$

HOSPITAL LABE00069B CITRIC ACID U 82507 206.15$

HOSPITAL LABE00070B CHLORIDE URINE 82436 54.75$

HOSPITAL LABE00071B CREATININE CLEARANCE 82575 110.10$

HOSPITAL LABE00072B CREATININE U 82570 65.45$

HOSPITAL LABE00074B PROTEIN TOTAL U 84156 14.85$

HOSPITAL LABE00074C PROTEIN ELECTRO U 84166 45.60$

HOSPITAL LABE00074D IMMUNOFIXATION U 86335 103.40$

HOSPITAL LABE00076B MAGNESIUM U 83735 132.00$

HOSPITAL LABE00077B MERCURY QT URINE 83825 119.55$

HOSPITAL LABE00078B METANEPHRINES U 83835 232.60$

HOSPITAL LABE00080B OXALATE U 83945 62.60$

HOSPITAL LABE00081C PROTEIN E-PHORESIS URINE 84166 45.60$

HOSPITAL LABE00082B PHOSPHOROUS U 84105 77.50$

HOSPITAL LABE00083B PORPHYRINS QUANT U 84120 80.30$

HOSPITAL LABE00083C PORPHOBILINOGEN QUANT U 84110 40.30$

HOSPITAL LABE00084B POTASSIUM U 84133 57.45$

HOSPITAL LABE00085B SODIUM U 84300 55.60$

HOSPITAL LABE00086B URIC ACID U 84560 85.20$

HOSPITAL LABE00087B PROTEIN E-PHORESIS URINE 84166 66.35$

HOSPITAL LABE00088B VMA U 84585 203.30$

HOSPITAL LABE00091B ANEUPLOIDY INST HYBRID 100-300 88275 70.45$

HOSPITAL LABE00091C ANEUPLOIDY DETECT POC FISH 88271 682.30$

HOSPITAL LABE00091D ANEUPLOIDY DETECT POC FISH 88291 52.30$

HOSPITAL LABE00092B ALK PHOS ISOENZYMES 84080 91.05$

HOSPITAL LABE00092C ALK PHOS ISOENZYMES 84075 91.05$

HOSPITAL LABE00097B BF CELL COUNT 89051 75.55$

HOSPITAL LABE00097C BF RBC AUTO 85041 26.00$

HOSPITAL LABE00097D BF PH 83986 51.40$

HOSPITAL LABE00102B T-CELL ABS CD4 & CD8 86360 86.95$

HOSPITAL LABE00102C T-CELLS TTL 86359 69.75$

HOSPITAL LABE00104B GC BY THIN PREP 87591 135.25$

HOSPITAL LABE00104C CHLAMYDIA BY THIN PREP 87491 135.25$

HOSPITAL LABE00105B CHLAMYDIA ANTIBODIES IGM 86632 430.50$

HOSPITAL LABE00105C CHLAMYDIA ANTIBODIES 86631 430.50$

HOSPITAL LABE00107B CHRONIC HEPATITIS PROFILE 87340 30.30$

HOSPITAL LABE00107C HEP C AB 86803 60.60$

HOSPITAL LABE00107D HEP B CORE AB 86705 43.30$

HOSPITAL LABE00107E HEP B SURFACE AB 86706 155.45$

HOSPITAL LABE00108B CPK ISOENZYMES 82552 113.40$

HOSPITAL LABE00108C CPK TTL 82550 90.00$

HOSPITAL LABE00109B CCP ANTIBODY 86200 127.00$

HOSPITAL LABE00109C ANTINUCLEAR ANTIBODIES ANA 86038 117.90$

HOSPITAL LABE00110B CORTISOL FREE URINE 82530 273.70$

HOSPITAL LABE00111B CRYOGLOBULINS QL & SEMI-QT 82595 42.10$

HOSPITAL LABE00111C CRYOFIBRINOGEN 82585 42.10$

HOSPITAL LABE00112B CSF CELL COUNT 89051 43.80$

HOSPITAL LABE00112C CSF RBC AUTO 85041 26.00$

HOSPITAL LABE00112D CSF PROTEIN TTL 84157 60.50$

HOSPITAL LABE00112E CSF GLUCOSE 82945 36.00$

HOSPITAL LABE00113B WEST NILE VIRUS AB, CSF 86789 113.10$

HOSPITAL LABE00113C WEST NILE VIRUS AB CSF IGM 86788 113.10$

HOSPITAL LABE00114B CYCLOSPORA STAIN 87207 58.10$

HOSPITAL LABE00114C CYCLOSPORA CONCENTRATION 87015 63.10$

HOSPITAL LABE00115B CMV IGM 86645 96.55$

HOSPITAL LABE00115C CMV IGG 86644 97.70$

HOSPITAL LABE00117B DIPTHERIA/TETANUS IMMUNO AB 86317 84.05$

HOSPITAL LABE00117C DIPTHERIA/TETANUS AB 86648 84.05$

HOSPITAL LABE00118B EPSTEIN BARR AB VIRAL CAPSID 86665 90.25$

HOSPITAL LABE00118C EPSTEIN BARR AB NUCLEAR AG 86664 63.65$

HOSPITAL LABE00118D EPSTEIN BARR AB VIRAL CAPSID 86665 90.25$

HOSPITAL LABE00119C FECES SODIUM 84302 31.30$

HOSPITAL LABE00119D FECES MAGNESIUM 83735 42.85$

HOSPITAL LABE00119E FECES CHLORIDE 82438 31.30$

HOSPITAL LABE00119F FECES PHOSPHORUS 84100 30.40$

HOSPITAL LABE00122B T3 UPTAKE 84479 35.20$

2020-01




HOSPITAL LABE00122C THYROXINE TTL 84436 35.20$

HOSPITAL LABE00124B HEAVY METAL MERCURY QT 83825 64.50$

HOSPITAL LABE00124C HEAVY METAL LEAD 83655 48.45$

HOSPITAL LABE00124D HEAVY METAL CADMIUM 82300 83.20$

HOSPITAL LABE00124E HEAVY METAL ARSENIC 82175 75.05$

HOSPITAL LABE00124F HEAVY METAL TIMED COLLECT 81050 22.40$

HOSPITAL LABE00125B MERCURY QT 83825 63.40$

HOSPITAL LABE00125C LEAD 83655 63.40$

HOSPITAL LABE00125D CADMIUM 82300 58.15$

HOSPITAL LABE00125E ARSENIC 82175 181.90$

HOSPITAL LABE00126B HEPATITIS B SURFACE AG IA 87340 37.45$

HOSPITAL LABE00126C HEPATITIS B SURFACE AB 86706 34.05$

HOSPITAL LABE00126D HEPATITIS B AB TOTAL 86704 34.05$

HOSPITAL LABE00127B HSV TYPE 2 AB 86696 77.60$

HOSPITAL LABE00127C HSV TYPE 1 AB 86695 75.40$

HOSPITAL LABE00127D HSV 1-2 AB 86694 56.30$

HOSPITAL LABE00128B VARICELLA ZOSTER DERMA PROBE 87798 180.00$

HOSPITAL LABE00128C HSV ZOSTER DERMA PROBE 87529 189.10$

HOSPITAL LABE00129B HISTAMINE, URINE 83088 201.35$

HOSPITAL LABE00129C HISTAMINE URINE TIME COLLECT 81050 22.40$

HOSPITAL LABE00130B HSV TYPE 2 IGG ONLY 86696 77.60$

HOSPITAL LABE00130C HSV TYPE 1 IGG ONLY 86695 75.40$

HOSPITAL LABE00132B HEMOGLOBIN 85018 45.50$

HOSPITAL LABE00132C HEMATOCRIT 85014 38.30$

HOSPITAL LABE00135B IGG INDEX CSF AND SERUM 82784 34.05$

HOSPITAL LABE00135C ALBUMIN OTHER 82042 17.00$

HOSPITAL LABE00135D ALBUMIN SERUM 82040 17.00$

HOSPITAL LABE00136B IGG SUBCLASSES 82787 95.15$

HOSPITAL LABE00136C GAMMAGLOBULIN SUBCLASSES EA 82784 94.40$

HOSPITAL LABE00143B LEUKEMIA/LYMPHOMA FLOW 1ST 88185 377.05$

HOSPITAL LABE00143C LEUKEMIA/LYMPHOMA FLOW EA ADD 88184 297.45$

HOSPITAL LABE00146B CREAT RATIO RANDOM UR 82570 65.45$

HOSPITAL LABE00146C MICROALB RATIO RANDOM UR 82043 84.35$

HOSPITAL LABE00149B SMEAR OVA AND PARASITE 87209 127.10$

HOSPITAL LABE00149C OVA AND PARASITE CONCENTRATION 87015 127.10$

HOSPITAL LABE00150B PROTEIN E-PHORESIS SERUM 84165 113.05$

HOSPITAL LABE00150C PROTEIN SERUM TTL 84155 48.95$

HOSPITAL LABE00151C HEP A AB 86708 30.80$

HOSPITAL LABE00151D HEB B AD 86803 35.40$

HOSPITAL LABE00151E HEP B SURFACE AB 86706 26.85$

HOSPITAL LABE00151F HEP B CORE AB 86704 30.00$

HOSPITAL LABE00152B PRIMIDONE 80188 72.65$

HOSPITAL LABE00152C PHENOBARBITAL 80184 36.50$

HOSPITAL LABE00154B PROTEIN TTL URINE 84156 21.55$

HOSPITAL LABE00154C CREATININE RATIO URINE 82570 21.40$

HOSPITAL LABE00156B PROSTATE SPECIFIC AG FREE 84154 76.75$

HOSPITAL LABE00156C PROSTATE SPECIFIC AG TTL 84153 79.10$

HOSPITAL LABE00157B PHENYTOIN FREE 80186 48.35$

HOSPITAL LABE00157C PHENYTOIN TTL 80185 53.15$

HOSPITAL LABE00159B DEOXYRIBONUCLEASE ANTIBODY 86215 88.35$

HOSPITAL LABE00159C ANTISTREPTOLYSIN O TITER 86060 44.30$

HOSPITAL LABE00160B URIC ACID URINE 84560 38.30$

HOSPITAL LABE00160C SULFATE URINE 84392 38.30$

HOSPITAL LABE00160D SODIUM URINE 84300 38.30$

HOSPITAL LABE00160E POTASSIUM URINE 84133 38.30$

HOSPITAL LABE00160F PHOSPHORUS URINE 84105 38.30$

HOSPITAL LABE00160G PH URINE 83986 38.30$

HOSPITAL LABE00160H OXALATE URINE 83945 38.30$

HOSPITAL LABE00160I OSMOLATITY URINE 83935 38.30$

HOSPITAL LABE00160J MAGNESIUM URINE 83735 38.30$

HOSPITAL LABE00160K CREATININE URINE 82570 38.30$

HOSPITAL LABE00160L CITRATE URINE 82507 38.30$

HOSPITAL LABE00160M CHLORIDE URINE 82436 38.30$

HOSPITAL LABE00160N CALCIUM URINE 82340 38.30$

HOSPITAL LABE00161B CRYSTAL ID LIGHT MICROSCOPY 89060 71.35$

HOSPITAL LABE00161C CELL COUNT 89051 75.55$

HOSPITAL LABE00161D RBC AUTO 85041 26.00$

HOSPITAL LABE00162B TESTOSTERONE TTL 84403 105.20$

2020-01




HOSPITAL LABE00162C TESTOSTERONE FREE 84402 94.50$

HOSPITAL LABE00163B HEMOGLOBIN CHROMOTOGRAPHY 83021 105.15$

HOSPITAL LABE00163C HEMOGLOBIN ELECTROPHORESIS 83020 123.25$

HOSPITAL LABE00163D FERRITIN 82728 144.30$

HOSPITAL LABE00164B THYROGLOBULIN AB 86800 200.55$

HOSPITAL LABE00164C THYROGLOBULIN TUMOR MARKER 84432 194.60$

HOSPITAL LABE00167B INHIBIN A 86336 108.40$

HOSPITAL LABE00167C GONADOTROPIN CHORIONIC QT 84702 117.60$

HOSPITAL LABE00167D ESTRIOL 82677 106.15$

HOSPITAL LABE00167E AFP QUAD SCREEN 82105 88.10$

HOSPITAL LABE00169B VITAMIN A 84590 48.45$

HOSPITAL LABE00169C VITAMIN E 84446 60.55$

HOSPITAL LABE00170B LIPOPROTEIN DIRECT MEASURE 83718 17.80$

HOSPITAL LABE00170C TRIGLYCERIDES 84478 12.70$

HOSPITAL LABE00170D CHOLESTEROL SERUM/WB TTL 82465 9.60$

HOSPITAL LABE00170E ELECTROPHORETIC TEST 82664 63.20$

HOSPITAL LABE00170F APOLIPOPROTEIN EACH 82172 24.90$

HOSPITAL LABE00173B AML FISH 88291 67.60$

HOSPITAL LABE00173C AML FISH IN SITU 100-300 CELL 88275 87.90$

HOSPITAL LABE00173D AML FISH PROBE EA 88271 74.40$

HOSPITAL LABE00174B AML FISH 4 INSITU 100-300 CELL 88275 67.60$

HOSPITAL LABE00174C AML FISH 4 PROBE EA 88271 107.45$

HOSPITAL LABE00175B AML FISH INSITU 100-300 CELL 88275 297.25$

HOSPITAL LABE00175C AML FISH 20 PROBE EA 88271 669.05$

HOSPITAL LABE00186B MYELOMA BY FISH CHG 88271 223.65$

HOSPITAL LABE00186C MYELOMA IN SITU 100-300 CELLS 88275 621.45$

HOSPITAL LABE00186D MYELOMA BY FISH CHG 88291 355.85$

HOSPITAL LABE00188B WEST NILE VIRUS IGG 86789 113.10$

HOSPITAL LABE00188C WEST NILE VIRUS IGM 86788 113.10$

HOSPITAL LABE00196B PROTEIN ELCTRO RU;TOTAL (REPU) 84156 10.55$

HOSPITAL LABE00196C PROTEIN ELCTRO ;PHORESIS(REPU) 84166 50.85$

HOSPITAL LABE00197C VIT B6-PYRODOXL 5 PHOS (B6PRO) 84207 120.15$

HOSPITAL LABE00198B HEAVY METALS RU;ARSENIC(HMSRU) 82175 41.75$

HOSPITAL LABE00198C HEAVY METALS RU;LEAD (HMSRU) 83655 26.60$

HOSPITAL LABE00198D HEAVY METALS RU;CADMIUM(HMSRU) 82300 35.60$

HOSPITAL LABE00198E HEAVY METAL; MERCURY(HMSRU) QT 83825 35.60$

HOSPITAL LABE00200D LUNG CA INT & RPT (FLCA) 88291 105.30$

HOSPITAL LABE00202B HSV1 BY PCR 87529 82.25$

HOSPITAL LABE00202C HSV2 BY PCR 87529 82.25$

HOSPITAL LABE00203B PORPHYRINS QUANT UA 84110 23.55$

HOSPITAL LABE00203C PORPHYRINS QUAN & FRACT UA 84120 40.95$

HOSPITAL LABE00204B IgA NEPHELOMETRY 83883 210.20$

HOSPITAL LABE00204C IgA GAMMAGLOBULIN 82784 71.95$

HOSPITAL LABE00209B IFIX RAND - TP 84156 9.50$

HOSPITAL LABE00209C IFIX RAND - PROT ELECT 84166 45.60$

HOSPITAL LABE00209D IFIX RAND - IFIX UR 86335 72.95$

HOSPITAL LABE00212B ACTIVATED PTT - LUPPR 85730 24.35$

HOSPITAL LABE00212C PROTIME - LUPPR 85610 16.05$

HOSPITAL LABE00212D DRVVT - LUPPR 85613 33.85$

HOSPITAL LABE00213B TOXOPLASMA IGG 86777 56.60$

HOSPITAL LABE00213C TOXOPLASMA IGM 86778 58.05$

HOSPITAL LABE00215B CREATININE UR 82570 41.80$

HOSPITAL LABE00215C 5HIAA UR 83497 89.75$

HOSPITAL LABE00217B THYROPEROXIDASE Ab 86376 36.30$

HOSPITAL LABE00217C THYROGLOBULIN Ab 86800 39.55$

HOSPITAL LABE00219B COLD AGGLUTININ TITER 86157 46.60$

HOSPITAL LABE00219C COLD AGGLUTININ SCREEN 86156 31.50$

HOSPITAL LABE00222B ALPHA-1-ANTITRYPSIN; TOTAL 82103 40.45$

HOSPITAL LABE00222C SERPINA1 GENE 81332 42.05$

HOSPITAL LABE00223B ASPA GENE 81200 67.00$

HOSPITAL LABE00223C SMPD1 GENE COMMON VARIANTS 81330 67.00$

HOSPITAL LABE00223D MCOLN1 GENE 81290 67.00$

HOSPITAL LABE00223E IKBKAP GENE 81260 67.00$

HOSPITAL LABE00223F HEXA GENE 81255 67.00$

HOSPITAL LABE00223G GBA GENE 81251 67.00$

HOSPITAL LABE00223H FANCC GENE 81242 67.00$

HOSPITAL LABE00223I BLM GENE 81209 67.00$

HOSPITAL LABE00223J B-HEXOSAMINIDASE EA ASSAY 83080 123.05$

2020-01




HOSPITAL LABE00224B KRAS MUTATION ANALYSIS 81275 654.75$

HOSPITAL LABE00224C KRAS SLIDE REVIEW 88381 81.90$

HOSPITAL LABE00226B EGFR GENE COM VARIANTS 81235 1,147.55$

HOSPITAL LABE00226C EGFR SLIDE REVIEW 88381 82.50$

HOSPITAL LABE00227B HPNCC MICROSTAT INSTABILITY 81301 385.55$

HOSPITAL LABE00227C HPNCC MLH-1 88341 297.45$

HOSPITAL LABE00227D HPNCC MLH-2 88341 297.45$

HOSPITAL LABE00227E HPNCC MLH-6 88341 297.45$

HOSPITAL LABE00227F HPNCC PMS-2 88342 297.45$

HOSPITAL LABE00227G HPNCC SLIDE REVIEW 88381 81.35$

HOSPITAL LABE00228B T-CELL RECEPTOR TRB GENE REARR 81340 270.85$

HOSPITAL LABE00228C T-CELL RECEPTOR TRG GENE REARR 81342 270.85$

HOSPITAL LABE00229B BRAF GENE 81210 529.55$

HOSPITAL LABE00229C BRAF SLIDE REVIEW 88381 80.60$

HOSPITAL LABE00230B THROMB AT ACTIVITY 85300 83.15$

HOSPITAL LABE00230C THROMB THROMBIN TIME 85670 40.55$

HOSPITAL LABE00230D THROMB APTT 85730 42.15$

HOSPITAL LABE00230E THROMB PT 85610 17.80$

HOSPITAL LABE00230F THROMB D DIMER 85379 71.40$

HOSPITAL LABE00230G THROMB PROT C ACTIVITY 85303 97.00$

HOSPITAL LABE00230H THROMB APC RESISTANCE 85307 107.45$

HOSPITAL LABE00230I CLOTTING INHIBITOR PROTEIN S F 85306 107.45$

HOSPITAL LABE00230J THROMB DRVVT 85613 58.45$

HOSPITAL LABE00230L THROMB SPEC COAG INTERP 8539026 36.30$

HOSPITAL LABE00230N THROMB F2 GENE 81240 69.75$

HOSPITAL LABE00232B IGH GENE REARRANG DIRECT PROBE 81262 179.20$

HOSPITAL LABE00232C IGK REARRANGE ABN CLONAL POP 81264 179.20$

HOSPITAL LABE00233B AMITRIPTYLINE 80335 57.00$

HOSPITAL LABE00233C NORTRIPTYLINE 80335 57.00$

HOSPITAL LABE00236B CRYPTOSPORIDIUM 87328 26.40$

HOSPITAL LABE00236C GIARDIA STOOL 87329 26.40$

HOSPITAL LABE00240C PM 10 SPECTROPHOTOMETRY 84311 37.70$

HOSPITAL LABE00240D PM 10 CREATININE URINE 82570 27.90$

HOSPITAL LABE00240E PM 10 PH URINE 83986 15.70$

HOSPITAL LABE00241C PM BASE 4 SPECTROPHOTOMETRY 84311 27.85$

HOSPITAL LABE00241D PM BASE 4 CREATININE URINE 82570 20.65$

HOSPITAL LABE00241E PM BASE 4 PH URINE 83986 11.60$

HOSPITAL LABE00242B BV-GARDNERELLA 87512 66.20$

HOSPITAL LABE00242C BV-LACTOBACILLUS 87799 66.20$

HOSPITAL LABE00242D BV-ATOPOBIUM 87799 66.20$

HOSPITAL LABE00242E BV-MEGASPHAERA 87799 66.20$

HOSPITAL LABE00243B HSV1 BY PCR 87529 65.35$

HOSPITAL LABE00243C HSV2 BY PCR 87529 65.35$

HOSPITAL LABE00246B PENTA SCREEN INHIBIN A 86336 31.75$

HOSPITAL LABE00246C PENTA SCREN HCG QUANT 84702 14.80$

HOSPITAL LABE00246D PENTA SCREEN ESTRIOL 82677 51.00$

HOSPITAL LABE00246E PENTA SCREEN AFP 82105 35.40$

HOSPITAL LABE00247B HER2NUE FISH GE DNA PRB 88271 317.60$

HOSPITAL LABE00247C HER2NEU FISH INSITU HYBRID 88274 193.10$

HOSPITAL LABE00247D HER2NEU FISH INTERP 88291 166.60$

HOSPITAL LABE00248B PAP SMEAR W/IMAGING SCREENING 155.95$

HOSPITAL LABE00248C HUMAN PAPILLOMA VIRUS DNA 87624 233.30$

HOSPITAL LABE00251B FIBROSPECT IMMUNOASSAY QUANT 83520 407.85$

HOSPITAL LABE00251C FIBROSURE II NEPHELOMETRY 83883 130.15$

HOSPITAL LABE00252B CLL FISH INTERP 88291 82.05$

HOSPITAL LABE00252C CLL FISH DNA PRB 88271 156.10$

HOSPITAL LABE00253C SDH GENE ANALYSIS MOPATH LEV 6 81405 618.10$

HOSPITAL LABE00254B B CELL IMMUNE TOTAL B CELL 86355 60.10$

HOSPITAL LABE00254C B CELL IMMUNE ASSESS NK CELLS 86357 60.10$

HOSPITAL LABE00254D B CELL IMM ASSESS TOTAL T CELL 86359 60.10$

HOSPITAL LABE00254E B CELL IMMUNE ASSESS CD/CD 8 86360 74.60$

HOSPITAL LABE00254F B CELL IMM ASSESS FLOW 1STMARK 88184 297.45$

HOSPITAL LABE00254G B CELL IMM ASSESS EA ADD MARKE 88185 195.65$

HOSPITAL LABE00256B INHIBIN A 86336 83.40$

HOSPITAL LABE00256C INHIBIN B 83520 68.20$

HOSPITAL LABE00257B VALPROIC ACID FREE 80165 51.60$

HOSPITAL LABE00257C VALPROIC ACID TOTAL 80164 51.60$

HOSPITAL LABE00258B AMPHET - AMPHET 1/2 80324 65.05$

2020-01




HOSPITAL LABE00258C AMPHETMAMINES-METHYLENEDIOXYAM 80359 65.05$

HOSPITAL LABE00259B HPV TYPING FISH INITIAL 88365 321.50$

HOSPITAL LABE00259C HPV TYPING FISH ADDITIONAL 88364 198.80$

HOSPITAL LABE00260B CUT IMMUNO FLUOR CONSULT 88323 204.85$

HOSPITAL LABE00260C CUTANEOUS IMMUNO AB 88346 928.85$

HOSPITAL LABE00261B OPIATES CONF 80361 58.45$

HOSPITAL LABE00261C OPIATES OXYCODONE 80365 58.45$

HOSPITAL LABE00262B HISTO/BLASTO PNL HISTOPLASMA 86698 32.20$

HOSPITAL LABE00262C HISTO/BLASTO PANEL BLASTO 86612 68.60$

HOSPITAL LABE00263B MELANOMA FISH INTERP 88291 151.15$

HOSPITAL LABE00263C MELANOMA FISH DNA PRB 88271 1,118.10$

HOSPITAL LABE00263D MELANOMA FISH CYTO 100-300 88275 169.80$

HOSPITAL LABE00264B CD 4 T CELL TOTAL 86359 77.85$

HOSPITAL LABE00264C CD 4 T CELL ABS CD4/CD8 86360 97.10$

HOSPITAL LABE00266B BCR/ABL GENE MAJOR BP 81206 248.90$

HOSPITAL LABE00266C BCR/ABL1 GENE MINOR BP 81207 220.50$

HOSPITAL LABE00268B ASSAY IgA (HLCA) 82784 104.15$

HOSPITAL LABE00268C NEPHELOMETERY (HLCA) 83883 312.40$

HOSPITAL LABE00269B MDS BY FLOW ADD MARKER 88185 300.75$

HOSPITAL LABE00269C MDS BY FLOW 1ST MARKER 88184 297.45$

HOSPITAL LABE00269D FLOW CYT INTERPRETATION >16 88189 170.20$

HOSPITAL LABE00270B ALLERGEN SPECIFIC IGG 86001 34.95$

HOSPITAL LABE00270C ALLEGEN SPECIFIC IGE 86003 34.95$

HOSPITAL LABE00270D IA QUANT NOS NONAB 83520 85.25$

HOSPITAL LABE00271B CORTISOL FREE 82530 114.95$

HOSPITAL LABE00271C CORTISOL TOTAL 82533 110.50$

HOSPITAL LABE00272C CHROM ANAL ADD COUNTS 88285 33.00$

HOSPITAL LABE00274B METAPHASES 20-25 88264 214.50$

HOSPITAL LABE00274C CHROMO ANALY ADDL CELL COUNTS 88285 33.00$

HOSPITAL LABE00275B PMS2 GENE FULL SEQ 81317 933.50$

HOSPITAL LABE00275C PMS2 GENE DUP/DELET VARIANTS 81319 263.30$

HOSPITAL LABE00276B ADALIMUMAB QUANT 80299 313.80$

HOSPITAL LABE00276C ADALIMUMAB CHEMILUMINESCENT AS 82397 246.60$

HOSPITAL LABE00278B ALLEGEN SPECIFIC IGE 86003 29.10$

HOSPITAL LABE00278C IMMUNODIFFUSION OUCHTERLONY 86331 155.40$

HOSPITAL LABE00278D ASPERGILLUS ANTIBODY 86606 94.65$

HOSPITAL LABE00278E ALLERGEN SPECIFIC IGE 86005 14.75$

HOSPITAL LABE00279B SISIC - FOLATE 82746 4.40$

HOSPITAL LABE00279C SISIC - B12 82607 4.40$

HOSPITAL LABE00280B WET MOUNT (SALINE/INK) 87210 20.65$

HOSPITAL LABE00281B ZIKA IGM 86790 132.00$

HOSPITAL LABE00281C DENGUE AB, IGM 86790 132.00$

HOSPITAL LABE00282B HSPP MOPATH LEVEL 5 81404 231.65$

HOSPITAL LABE00282C MOPATH LEVEL 6 81405 462.25$

HOSPITAL LABE00282D MOPATH LEVEL 7 81406 717.70$

HOSPITAL LABE00282E MOPATH LEVEL 8 81407 462.25$

HOSPITAL LABE00282F HSPP UNLISTED MOPATH 81479 231.65$

HOSPITAL LABE00283B ASIALO-GM1 IgG and IgM 83516 92.20$

HOSPITAL LABE00283C GM1 IgG 83516 46.10$

HOSPITAL LABE00283D GM1 IgM 83516 46.10$

HOSPITAL LABE00283E GD1b IgG 83516 46.10$

HOSPITAL LABE00283F GD1b IgM 83516 46.10$

HOSPITAL LABE00290B PMP22 GENE FULL SEQUENCE 81325 217.50$

HOSPITAL LABE00290C MOPATH LEVEL 4 81403 217.50$

HOSPITAL LABE00290D MOPATH LEVEL 5 (#1) 81404 217.50$

HOSPITAL LABE00290E MOPATH LEVEL 5 (#2) 81404 217.50$

HOSPITAL LABE00290F MOPATH LEVEL 5 (#3) 81404 217.50$

HOSPITAL LABE00290G MOPATH LEVEL 6 (#1) 81405 217.50$

HOSPITAL LABE00290H MOPATH LEVEL 6 (#2) 81405 217.50$

HOSPITAL LABE00290I MOPATH LEVEL 7 (#1) 81406 217.50$

HOSPITAL LABE00290J MOPATH LEVEL 7 (#2) 81406 217.50$

HOSPITAL LABE00290K MOPATH LEVEL 7 (#3) 81406 217.50$

HOSPITAL LABE00291B CYTO/MOLECULAR REPORT 88291 190.15$

HOSPITAL LABE00291C CYTOGENETICS DNA PROBE 88271 190.15$

HOSPITAL LABE00291D CYTOGENETICS DNA PROBE 88271-91 190.15$

HOSPITAL LABE00292B KAPPA LAMBDA IN SITU HYBRID 88365 170.80$

HOSPITAL LABE00292C KAPPA LAMBDA SITU HYB (FISH) 88364 170.80$

HOSPITAL LABE00293B DRUG SCREENING OXYCODONE 80365 150.55$

2020-01




HOSPITAL LABE00293C DRUG TEST PRSMV CHEM ANLYZR 80307 105.85$

HOSPITAL LABE00294B CG MCG; INT & REP 88291 223.50$

HOSPITAL LABE00294C MCG; DNA PROBE EA 88271 400.70$

HOSPITAL LABE00300B MICRODISSECTION MANUAL 88381 30.95$

HOSPITAL LABE00300C KRAS GENE VARIANTS EXON 2 81275 242.40$

HOSPITAL LABE00300D KRAS GENE ADDL VARIANTS 81276 242.40$

HOSPITAL LABE00302B URINE TOTAL PROTEIN 84156 9.30$

HOSPITAL LABE00302C IMMUNFIX E-PHORSIS/URINE/CSF 86335 74.85$

HOSPITAL LABE00303B URINE TOTAL PROTEIN 84156 8.80$

HOSPITAL LABE00303C IMMUNFIX E-PHORSIS/URINE/CSF 86335 63.65$

HOSPITAL LABE00303D NEPHELOMETRY EA ANALYTES NES 83883 26.30$

HOSPITAL LABE00303E NEPHELOMETRY EA ANALYTE NES 83883 26.30$

HOSPITAL LABE00305B TESTOSTERONE; TOTAL 84403 56.10$

HOSPITAL LABE00305C SEX HORMONE BINDING GLOBULIN 84270 47.80$

HOSPITAL LABE00306B ALPHA-1-ANTITRYPSIN; PHENOTYPE 82104 36.95$

HOSPITAL LABE00306C ALPHA-1-ANTITRYPSIN; TOTAL 82103 34.10$

HOSPITAL LABE00307B B CELLS TOTAL COUNT 86355 68.50$

HOSPITAL LABE00307C NK CELLS TOTAL COUNT 86357 68.50$

HOSPITAL LABE00307D T CELLS; TOTAL COUNT 86359 69.95$

HOSPITAL LABE00307E T CELLS; ABSOL CD4 AND CD8 86360 84.55$

HOSPITAL LABE00309B NEPHELOMETRY EA ANALYTE NES 83883 85.95$

HOSPITAL LABE00309C AST OR SGOT 84450 35.85$

HOSPITAL LABE00309D TRANSFERASE; ALANINE AMINO 84460 38.25$

HOSPITAL LABE00309E UREA NITROGEN; QUAN 84520 28.70$

HOSPITAL LABE00309F GLUTAMYLTRANSFERASE GAMMA 82977 50.20$

HOSPITAL LABE00310B IMMUNOASSAY NONANTIBODY 83516 54.60$

HOSPITAL LABE00310C FLUORESCENT AB; SCRN EA AB 86255 56.90$

HOSPITAL LABE00311B LIPOPROTEIN BLD QUAN PART 83704 61.25$

HOSPITAL LABE00311C LIPID PANEL 80061 28.85$

HOSPITAL LABE00312B PROTHROMBIN TIME 85610 17.15$

HOSPITAL LABE00312C PTT; PLASMA OR WHOLE BLOOD 85730 26.10$

HOSPITAL LABE00312D RUSSELL VIPER VENOM TIME; DILU 85613 25.40$

HOSPITAL LABE00313B PTT-PLASMA PR WHOLE BLOOD 85730 31.05$

HOSPITAL LABE00313C HEPARIN NEUTRALIZATION 85525 50.70$

HOSPITAL LABE00315B AB; FUNGUS NES 86671 26.15$

HOSPITAL LABE00315C AB; FUNGUS NES 86671 26.15$

HOSPITAL LABE00315D FLUORESCENT AB; SCRN EA AB 86255 30.70$

HOSPITAL LABE00317B RIA NON ANTIBODY 83519 79.95$

HOSPITAL LABE00317C IMMUNOASSAY NON-ANTIBODY 83516 67.10$

HOSPITAL LABE00317D IMMUNOASSY NON-ANTIBODY 83516 67.10$

HOSPITAL LABE00317E FLUORESCENT AB; SCRN EA AB 86225 71.40$

HOSPITAL LABE00318B FLUORESCENT AB; SCREEN EA AB 86255 78.90$

HOSPITAL LABE00318C FLUORESCENT AB; SCRN EA AB 86255 78.95$

HOSPITAL LABE00318D IMMUNOASSAY NON-ANTIBODY 83516 74.30$

HOSPITAL LABE00319B MONONUCLEAR CELL ANTIGEN (#1) 86356 44.90$

HOSPITAL LABE00319C MONONUCLEAR CELL ANTIGEN (#2) 86356 44.90$

HOSPITAL LABE00319D MONONUCLEAR CELL ANTIGEN (#3) 86356 44.90$

HOSPITAL LABE00319E MONONUCLEAR CELL ANTIGEN (#4) 86356 44.90$

HOSPITAL LABE00319F MONONUCLEAR CELL ANTIGEN (#5) 86356 44.90$

HOSPITAL LABE00319G MONONUCLEAR CELL ANTIGEN (#6) 86356 44.90$

HOSPITAL LABE00319H MONONUCLEAR CELL ANTIGEN (#7) 86356 44.90$

HOSPITAL LABE00320B ENA ANY METHOD (#1) 86235 32.90$

HOSPITAL LABE00320C ENA ANY METHOD (#2) 86235 32.90$

HOSPITAL LABE00320D ENA ANY METHOD (#3) 86235 32.90$

HOSPITAL LABE00320E ENA ANY METHOD (#4) 86235 32.90$

HOSPITAL LABE00320F ENA ANY METHOD (#5) 86235 32.90$

HOSPITAL LABE00320G ENA ANY METHOD (#6) 86235 32.90$

HOSPITAL LABE00320H ENA ANY METHOD (#7) 86235 32.90$

HOSPITAL LABE00320I IMMUNOASSAY NONANTIBODY 83516 20.30$

HOSPITAL LABE00320J IMMUNOASSAY NONANTIBODY 83516 20.30$

HOSPITAL LABE00322D MCG; DNA PROBE EA (#3) 88271 53.45$

HOSPITAL LABE00323B ASSAY IGA/IGD/IGG/IGM EACH (1) 82784 15.45$

HOSPITAL LABE00323C ASSAY IGA/IGD/IGG/IGM EACH (2) 82784 15.45$

HOSPITAL LABE00323D ASSAY IGA/IGD/IGG/IGM EACH (3) 82784 15.40$

HOSPITAL LABE00323E PROTEIN; EP, FRACT & QUAN 84165 19.15$

HOSPITAL LABE00323F SERUM IMMUNOFIXATION 86334 39.95$

HOSPITAL LABE00323J NEPHELOMETRY EA ANALYTE NES 1 83883 22.35$

HOSPITAL LABE00325B IMMUNOASSAY NONANTIBODY 83516 46.20$

2020-01




HOSPITAL LABE00325C IMMUNOASSAY NONANTIBODY 83516 46.20$

HOSPITAL LABE00326B ALLERG SP IGE; QUAN OR SEMIQUA 86003 13.35$

HOSPITAL LABE00326C ALLERG SP IGE; QUAN OR SEMIQUA 86003 13.35$

HOSPITAL LABE00326D ALLERG SP IGE; QUAN OR SEMIQUA 86003 13.35$

HOSPITAL LABE00326E ALLERG SP IGE; QUAN OR SEMIQUA 86003 13.35$

HOSPITAL LABE00326F ALLERG SP IGE; QUAN OR SEMIQUA 86003 13.35$

HOSPITAL LABE00327B ENA ANY METHOD 86235 45.70$

HOSPITAL LABE00327C ENA ANY METHOD 86235 45.70$

HOSPITAL LABE00328B HSV1 IF 87274 46.60$

HOSPITAL LABE00328C HSV2 IF 87273 46.60$

HOSPITAL LABE00340B DNA SEQUENCING 87153 225.90$

HOSPITAL LABE00340C MIC SENSITIVITY 87186 142.60$

HOSPITAL LABE00341B LUNG CA MICRODISSECTION 88381 133.15$

HOSPITAL LABE00341C LUNG CA PMP 22 FULL GENE SEQ 81235 387.55$

HOSPITAL LABE00341D LUNG CA IHC 1ST STAIN 88342 220.75$

HOSPITAL LABE00341E LUNG CA IHC EA ADDL 88341 101.15$

HOSPITAL LABE00343B RIA ANTIBODY 83519 414.05$

HOSPITAL LABE00343C IMMUNOASSAY NON-ANTIBODY 83516 230.00$

HOSPITAL LABE00343D FLUORESCENT AB; SCRN EA AB 86255 122.70$

HOSPITAL LABE00344B TISSUE CULTURE, LYMPHOCYTE 88230 357.50$

HOSPITAL LABE00344C CHROMOSOME ANALYSIS, 100 CELLS 88249 1,131.95$

HOSPITAL LABE00345B HERED BREAST CA REL 10 GENE 81432 2,605.45$

HOSPITAL LABE00345C HERED BREAST CA REL DUP/DEL 81433 1,665.80$

HOSPITAL LABE00346B NRAS MICRODISSECTION 88381 133.30$

HOSPITAL LABE00346C NRAS 81311 347.80$

HOSPITAL LABE00347B COLON CA MICRODISSECTION 88381 133.90$

HOSPITAL LABE00347C COLON CA BRAF GENE 81210 210.10$

HOSPITAL LABE00347D COLON CA KRAS2 MUTATION ANALYS 81275 232.05$

HOSPITAL LABE00347E COLON CA KRAS GENE ADDL VARIAN 81276 232.05$

HOSPITAL LABE00347F COLON CA NRAS 81311 346.25$

HOSPITAL LABE00348B CYTOGENOMIC MIP ARRAY MICRODIS 88381 2,015.75$

HOSPITAL LABE00349B MOLAR PREGNANCY, STR MARKERS 81265 420.95$

HOSPITAL LABE00349C MICRODISSECTION, MANUAL 88381 36.65$

HOSPITAL LABE00350B MCG DNA PROBE 88271 203.10$

HOSPITAL LABE00350C MCG IP SITU 100-300 CELLS 88275 558.45$

HOSPITAL LABE00350D CG & MCG INTERP 88291 84.65$

HOSPITAL LABE00352B DNA PROBE EA (#3) 88271 203.10$

HOSPITAL LABE00352C INSITU 100/300 88275 562.70$

HOSPITAL LABE00352D INTERP & RPT 88291 81.45$

HOSPITAL LABE00353B MOPATH PROCEDURE LEVEL 2 8140190 710.70$

HOSPITAL LABE00353C MOPATH PROCEDURE LEVEL 5 8140490 1,066.05$

HOSPITAL LABE00353D MOPATH PROCEDURE LEVEL 7 8140690 1,421.40$

HOSPITAL LABE00353E UNLISTED MOLECULAR PATHOLOGY 8147990 355.35$

HOSPITAL LABE00354C PL CELL FISH MORPH ONLY 88373 1,112.70$

HOSPITAL LABE00354D PL CELL FISH MORPH EA MULTIPLE 88374 1,112.70$

HOSPITAL LABE00355B APC/GENE DUP/DEL 81203 319.35$

HOSPITAL LABE00355C APC GENE FULL SEQUENCE 81201 1,241.25$

HOSPITAL LABE00355D MOPATH LEVEL 2 81401 213.30$

HOSPITAL LABE00356B CFTR GENE COM VARIANTS 81220 657.05$

HOSPITAL LABE00356C MOPATH PROCEDURE LEVEL 2 81329 157.70$

HOSPITAL LABE00356D FMR1 GENE DETECTION 81243 61.35$

HOSPITAL LABE00357B ALLERGEN SPECIFIC IGE 86003 17.20$

HOSPITAL LABE00357C ALLERGEN SPECIFIC IGE, RECOMB 86008 326.90$

HOSPITAL LABE00358B IA INFECTIOUS AGENT 86317 64.25$

HOSPITAL LABE00358C PROTEIN WESTERN BLOT 84182 80.35$

HOSPITAL LABE00358D NEURO CSF PRIO PROTEIN 0035U 16.00$

HOSPITAL LABE00359B ASPA GENE 81200 57.40$

HOSPITAL LABE00359C BLM GENE 81209 49.20$

HOSPITAL LABE00359D FANCC GENE 81242 41.00$

HOSPITAL LABE00359E GBA GENE 81251 53.25$

HOSPITAL LABE00359F HEXA GENE 81255 57.40$

HOSPITAL LABE00359G IKBKAP GENE 81260 45.10$

HOSPITAL LABE00359H MCOLN1 GENE 81290 49.20$

HOSPITAL LABE00359I SPMD1 GENE VARIANTS 81330 53.25$

HOSPITAL LABE00359J BCKDHB GENE 81205 106.50$

HOSPITAL LABE00359K G6PC GENE 81250 65.60$

HOSPITAL LABE00359L MOPATH PROC 1 81400 73.75$

HOSPITAL LABE00359M MOPATH PROC LEVEL 2 81401 159.75$

2020-01




HOSPITAL LABE00359N UNLISTED MOPATH 81479 8.20$

HOSPITAL LABE00360B ALL FISH INTERP 88291 78.95$

HOSPITAL LABE00360C ALL FISH DNA PRB 88271 321.95$

HOSPITAL LABE00360D ALL FISH INSITU HYBRID 100-300 88275 624.40$

HOSPITAL LABE00362B FLT3 GENE 81245 406.60$

HOSPITAL LABE00362C FTL3 GENE ANALYSIS 81246 200.30$

HOSPITAL LABE00363B ANTI-PHOSPHA TIDYLSERINE 86148 192.55$

HOSPITAL LABE00363C IMMUNOASSAY NON-AB 83516 136.10$

HOSPITAL LABE00363D UNLISTED IMMUNOLOGY 86849 3.35$

HOSPITAL LABE00364B C-REACTIVE PROTEIN SYNOVIAL 86140 17.90$

HOSPITAL LABE00364C SPECTROPHOTOMETRY ANALYTE 84311 23.55$

HOSPITAL LABE00364D IMMUNOASSAY NON-ANTIBODY 83516 39.80$

HOSPITAL LABE00365B KIT GENE TARGETED SEQ ANALYSIS 81272 386.90$

HOSPITAL LABE00365C MICRO DISSECTION MANUAL 88381 136.60$

HOSPITAL LABE00365D PDGFRA GENE 81314 386.90$

HOSPITAL LABE00366B INFLUENZA A AG BY DFA 87276 20.50$

HOSPITAL LABE00366C INFLUENZA B AG BY IF 87275 17.45$

HOSPITAL LABE00366D PARAINFLUENZA AG BY DFA 87279 50.80$

HOSPITAL LABE00366E RSV AG BY IF 87280 17.45$

HOSPITAL LABE00366F ADENOVIRUS AG BY IF 87260 18.95$

HOSPITAL LABE00366G NOS INFECTIOUS AGENT BY IF 87299 20.50$

HOSPITAL LABEP0146B MICROALB/CREAT RATIO RANDOM UR 82570QW 65.45$

HOSPITAL LABEP0146C MICROALB/CREAT RATIO RANDOM UR 82043QW 84.35$

HOSPITAL LABP000002 CHEM 8 (BMP) 80048 76.55$

HOSPITAL LABP000050 CBC AUTO W/PLT & W/O DIFF 85027 43.55$

HOSPITAL LABP000051 CBC AUTO W/PLT & AUTO DIFF 85025 52.75$

HOSPITAL LABP000068 DRUG OF ABUSE SCREEN KDH 80307 134.30$

HOSPITAL LABP000090 HCG QUALITATIVE,URINE 81025QW 78.80$

HOSPITAL LABP000096 HEMOGLOBIN A.1C 83036QW 71.25$

HOSPITAL LABP000107 LIPID PNL 80061QW 55.90$

HOSPITAL LABP000108 LIVER PANEL (HEPATIC FUNCTION) 80076 39.90$

HOSPITAL LABP000115 MONO SCRN (HETEROPHILE AB)QUAL 86308QW 88.40$

HOSPITAL LABP000147 PROTHROMBIN TIME-ACC/PHY OFFIC 85610QW 30.65$

HOSPITAL LABP000165 URINALYSIS 81003QW 24.65$

HOSPITAL LABP000166 URINALYSIS MICROSCOPIC ONLY 81015 30.00$

HOSPITAL LABP000167 URINALYSIS WITH MICROSCOPIC 81001 65.20$

HOSPITAL LABP000198 MICRO ALBUMIN, RANDOM URINE 82043QW 94.35$

HOSPITAL LABP000213 STREP SC GROUP A-THROAT 87880QW 94.30$

HOSPITAL LABP000219 HDL CHOL-DIRECT MEASURE 83718QW 76.10$

HOSPITAL LABP000237 INFLUENZA A & B ANTIGEN 87502QW 283.90$

HOSPITAL LABP000238 INFLUENZA B ANTIGEN 87804QW 132.00$

HOSPITAL LABP000240 GLUCOSE TOL, I HR 82950QW 49.50$

HOSPITAL LABP000256 VENIPUNCTURE 36415 19.45$

HOSPITAL LABP000257 CAPILLARY BLOOD COLLECTION 36416 14.15$

HOSPITAL LABP000262 CALCIUM,TOT 82310QW 44.20$

HOSPITAL LABP000270 SGOT/AST 84450QW 55.45$

HOSPITAL LABP000271 PROTEIN TOTAL; SERUM 84155QW 55.30$

HOSPITAL LABP000274 TRIGLYCERIDES 84478QW 43.65$

HOSPITAL LABP000277 SGPT/ALT 84460QW 52.40$

HOSPITAL LABP000278 ALBUMIN,SER 82040QW 37.25$

HOSPITAL LABP000284 GLUCOSE, QUANT 82947QW 41.80$

HOSPITAL LABP000285 POTASSIUM, SER 84132QW 41.50$

HOSPITAL LABP000286 SODIUM,SERUM 84295QW 30.10$

HOSPITAL LABP000287 BILIRUBIN TOTAL 82247 50.60$

HOSPITAL LABP000291 PLT COUNT AUTO 85049 59.80$

HOSPITAL LABP000294 WBC (WHITE BLOOD CELL CNT),BLD 85048 40.15$

HOSPITAL LABP000301 LIPID PNL 80061QW 101.60$

HOSPITAL LABP000302 GLUCOSE-GLUCOMETER 82962 37.40$

HOSPITAL LABP000491 CREATININE, URINE CHG 82570QW 21.40$

HOSPITAL LABP000584 CHOLESTEROL 82465QW 52.20$

HOSPITAL LABP000586 PHOSPHOROUS 84100 38.30$

HOSPITAL LABP000592 HEMOGLOBIN 85018QW 45.50$

HOSPITAL LABZ000001 MYOGLOBIN 83874 121.05$

HOSPITAL LABZ000002 TROPONIN QT 84484 123.20$

HOSPITAL LABZ000003 CHEM 14 80053 105.25$

HOSPITAL LABZ000004 BILIRUBIN -CONJUGATED 82248 56.50$

HOSPITAL LABZ000005 LDH 83615 53.35$

HOSPITAL LABZ000006 URIC ACID BLOOD 84550 61.00$

2020-01




HOSPITAL LABZ000007 HIV 1-2 86703 139.30$

HOSPITAL LABZ000008 HEPATITIS C AB 86803 178.25$

HOSPITAL LABZ000009 HEPATITIS B SURF AG 87340 170.75$

HOSPITAL LABZ000010 HEPATITIS B SURF AB 86706 155.45$

HOSPITAL LABZ000011 AFP TUMOR MARKER 82105 213.65$

HOSPITAL LABZ000012 HCG TUMOR MARKER 84702 75.95$

HOSPITAL LABZ000013 CENTROMERE AB 83516 100.00$

HOSPITAL LABZ000015 DS DNA IGG 86225 196.10$

HOSPITAL LABZ000016 ANTI JO AB 86235 130.50$

HOSPITAL LABZ000017 RNP AB 86235 242.90$

HOSPITAL LABZ000018 SCL-70 AB 86235 277.75$

HOSPITAL LABZ000019 SMITH'S AB 86235 304.80$

HOSPITAL LABZ000020 SSA AB 86235 127.60$

HOSPITAL LABZ000021 SSB AB 86235 127.60$

HOSPITAL LABZ000022 MUMPS IGG 86735 67.25$

HOSPITAL LABZ000023 RUBELLA IGG 86765 72.80$

HOSPITAL LABZ000024 RUBEOLA IGG 86765 82.85$

HOSPITAL LABZ000025 INFLUENZA A IGM 86710 33.55$

HOSPITAL LABZ000026 INFLUENZA B IGG/IGM 86710 66.90$

HOSPITAL LABZ000027 MYCOPLASMA IGG/IGM 86738 65.35$

HOSPITAL LABZ000028 RSV IGG/IGM 86756 320.90$

HOSPITAL LABZ000030 FREE T4 84439 129.75$

HOSPITAL LABZ000031 T3 TOTAL 84480 70.45$

HOSPITAL LABZ000032 THYROPEROXIDASE (TPO) 86376 98.95$

HOSPITAL LABZ000038 C-REACTIVE PROTEIN 86140 103.25$

HOSPITAL LABZ000039 RHEUMATOID FACTOR QT 86431 101.40$

HOSPITAL LABZ000040 ANTINUCLEAR ANTIBODY 86038 104.60$

HOSPITAL LABZ000041 SED RATE 85652 41.30$

HOSPITAL LABZ000042 24 HOUR URINE VOLUME CHG 81050 22.40$

HOSPITAL LABZ000043 B12/FOLATE 82607 103.95$

HOSPITAL LABZ000044 B12/FOLATE 82746 91.40$

HOSPITAL LABZ000045 BILIRUBIN PROFILE NEONATE 82247 51.95$

HOSPITAL LABZ000046 BILIRUBIN PROFILE NEONATE 82248 56.50$

HOSPITAL LABZ000047 BUN (UREA NITROGEN,BLD) QUANT 84520 37.05$

HOSPITAL LABZ000048 CREATININE BLD 82565 44.75$

HOSPITAL LABZ000050 IRON AND TIBC 83550 85.00$

HOSPITAL LABZ000051 IRON FE 83540 64.70$

HOSPITAL LABZ000052 TORCH PROFILE IGG 86778 102.90$

HOSPITAL LABZ000053 TORCH PROFILE IGG 86694 56.30$

HOSPITAL LABZ000054 CMV IGG 86645 96.55$

HOSPITAL LABZ000055 GLUCOSE TOL 4HR EA ADDL BEYOND 82952 20.15$

HOSPITAL LABZ000056 GLUCOSE TOL 3 HR 82951 137.75$

HOSPITAL LABZ000057 IMMUN STATUS PANEL VARIC IgG 86787 24.55$

HOSPITAL LABZ000058 MYCOPLASMA HOMINIS 87798 136.20$

HOSPITAL LABZ000059 MYCOPLASMA GENITALIUM 87798 136.20$

HOSPITAL LABZ000060 U PARVUM 87798 65.35$

HOSPITAL LABZ000061 U UREALYTICUM 87798 65.35$

HOSPITAL LABZP00003 CHEM 14 (CMP) 80053 105.25$

HOSPITAL LABZP00004 CHEM 14 (CMP) + LIVER PNL 82248 56.50$

HOSPITAL LABZP00045 BILIRUBIN PROFILE NEONATE 82247 51.95$

HOSPITAL LABZP00046 BILIRUBIN PROFILE NEONATE 82248 56.50$

HOSPITAL LABZP00047 BUN (UREA NITROGEN,BLD) QUANT 84520QW 37.05$

HOSPITAL LABZP00048 CREATININE BLD 82565QW 44.75$

HOSPITAL LABZP00056 GLUCOSE TOL 3 HR 82951QW 137.75$

HOSPITAL LAB0000764 MANUAL TUMOR IM HISTOCHEM EA A 88360 297.45$

HOSPITAL LAB0000876 DRUG SCREEN, UMBILICAL CORD 80307 221.30$

HOSPITAL LAB0001055 HER2/NEU WITH INTERPRETATION 88360 206.90$

HOSPITAL LAB0001056 REFLEX ERBB2 88377 510.00$

HOSPITAL LAB0001082 ALK BY FISH, LUNG 88366 597.90$

HOSPITAL LAB0001139 FISH PER SPEC EA STAIN PROC 88366 488.05$

HOSPITAL LAB0001154 HER2 BY FISH TC 88374TC 457.55$

HOSPITAL LABE00200B LUNG CA DNA PROBE (FLCA) 88271 110.85$

HOSPITAL LABE00200C LUNG CA IN SITU HYBRID (FLCA) 88274 134.80$

HOSPITAL LABE00301B IMMUNOHISTO ANTB 1ST STAIN 88342 75.40$

HOSPITAL LABE00301C IMMUNOHISTO ANTIBDY ADD SLID 88341 61.55$

HOSPITAL LABE00301D IMMUNOHISTO ANTIBODY ADDL SLID 88341 61.55$

HOSPITAL LABE00301E IMMUNOHISTO ANTIBODY ADDL SLID 88341 61.55$

HOSPITAL LABE00308B TISSUE CULTURE; BM BLD CELLS 88237 119.00$

2020-01




HOSPITAL LABE00308C CHROM ANALY; 20-25 CELLS 88264 234.00$

HOSPITAL LABE00308D CG MCG; INT & REP 88291 43.70$

HOSPITAL LABE00321B MCG; DNA PROBE EA 88271 36.80$

HOSPITAL LABE00321C MCG DNA PROBE EA (#2) 88271 36.80$

HOSPITAL LABE00321D MCH; DNA PROBE EA (#3) 88271 36.80$

HOSPITAL LABE00321E MCG DNA PROBE EA (#4) 88271 36.80$

HOSPITAL LABE00321F MCG IP SITU 100-300 CELLS (#1) 88275 101.10$

HOSPITAL LABE00321G MCG IP SITU 100-300 CELLS (#2) 88275 101.10$

HOSPITAL LABE00321H MCG IP SITU 100-300 CELLS (#3) 88275 101.10$

HOSPITAL LABE00321J MCG IP SITU 100-300 CELLS (#4) 88275 101.10$

HOSPITAL LABE00321K CG MCG; INT & REP 88291 61.30$

HOSPITAL LABE00322B MCG; DNA PROBE EA (#1) 88271 53.45$

HOSPITAL LABE00322C MCG; DNA PROBE EA (#2) 88271 53.45$

HOSPITAL LABE00322E MCG; DNA PROBE EA (#4) 88271 53.45$

HOSPITAL LABE00322F MCG; DNA PROBE EA (#5) 88271 53.45$

HOSPITAL LABE00322G MCG; DNA PROBE EA (#6) 88271 53.45$

HOSPITAL LABE00322H MCG;IP SITU 100-300 CELLS (#1) 88275 147.40$

HOSPITAL LABE00322J MCG;IP SITU 100-300 CELLS (#2) 88275 147.40$

HOSPITAL LABE00322K MCG;IP SITU 100-300 CELLS (#3) 88275 147.40$

HOSPITAL LABE00322L MCG;IP SITU 100-300 CELLS (#4) 88275 147.40$

HOSPITAL LABE00322M MCG;IP SITU 100-300 CELLS (#5) 88275 147.40$

HOSPITAL LABE00322N MCG;IP SITU 100-300 CELLS (#6) 88275 147.40$

HOSPITAL LABE00322P CG MCG; INT & REP 88291 76.95$

HOSPITAL LABE00324B ROS-1 DNA PROBE EACH 88271 498.70$

HOSPITAL LABE00324C ROS-1 INT & RPT 88291 280.55$

HOSPITAL LABE00342B KID BX LEVEL IV 88305 91.25$

HOSPITAL LABE00342C KID BX SS TRICHROME 88313 57.65$

HOSPITAL LABE00342D KID BX SS JONES 88313 57.65$

HOSPITAL LABE00342E KID BX SS PAS 88313 57.65$

HOSPITAL LABE00342F KID BX IF ALBUMIN 88350 55.65$

HOSPITAL LABE00342G KID BX IF FIBRINOGEN 88350 55.65$

HOSPITAL LABE00342H KID BX IF C1Q 88350 55.65$

HOSPITAL LABE00342I KID BX IF C3 88350 55.65$

HOSPITAL LABE00342J KID BX IF IGG 88346 429.95$

HOSPITAL LABE00342K KID BX IF IGM 88350 55.65$

HOSPITAL LABE00342L KID BX IF IGA 88350 55.65$

HOSPITAL LABE00342M KID BX ELECTRON MICRO 88348 838.25$

HOSPITAL LABE00351B MUSCLE BX-TISSUE EXAM BY PTH 88305 85.40$

HOSPITAL LABE00351C MUSCLE BX EVAL-SPEC STAIN GRP2 88313 85.40$

HOSPITAL LABE00351D MUSCLE BX EVAL HISTOCHEM ADD 88314 288.10$

HOSPITAL LABE00351E MUSCLE BX EVAL-SPEC STAIN GRP3 88319 875.05$

HOSPITAL LABE00361B TISSUE CULTURE,PERIPH BLD 88237 174.60$

HOSPITAL LABE00361C CHROM ANALY;20-25 CELLS PERIPH 88264 248.90$

HOSPITAL LABE00361D CG MCG;INT & REP PERIPH BLD 88291 52.40$

HOSPITAL PATH000001 AUTOPSY (FORENSIC EXAM) 281.10$

HOSPITAL PATH000002 DECALCIFICATION 88311TC 51.15$

HOSPITAL PATH000003 FINE NEEDLE ASPIRATION (ASPRI) 88172TC 145.15$

HOSPITAL PATH000004 FNA SPECIMEN ADEQUACY - ADD'L 88177TC 56.60$

HOSPITAL PATH000005 BODY FLUID CYTOLOGY 88104TC 126.70$

HOSPITAL PATH000006 CYTOPATHOLOGY CENTRIFUGE TECH 88108TC 185.00$

HOSPITAL PATH000008 BONE MARROW INTERP 85097 625.60$

HOSPITAL PATH000010 FNA EVAL W/INTERP & REPORT 88173TC 218.30$

HOSPITAL PATH000011 IMMUNOCYTOCHEM EA ANTIBOD/SLID 88342TC 297.45$

HOSPITAL PATH000012 CONSULTATION 88321 362.30$

HOSPITAL PATH000013 SURG PATH LEVEL 1 GROSS ONLY 88300TC 73.00$

HOSPITAL PATH000014 SURG PATH LEVEL II 88302TC 152.75$

HOSPITAL PATH000015 TISSUE EXAM LEVEL III 88304TC 213.00$

HOSPITAL PATH000016 TISSUE GROSS/MICRO #4 88305TC 286.60$

HOSPITAL PATH000017 TISSUE EXAM BY PATH LEVEL V 88307 428.25$

HOSPITAL PATH000018 TISSUE PATH LEVEL VI 88309 625.60$

HOSPITAL PATH000019 SPECIAL STAINGRP 1 MICRO-ORG 88312TC 171.25$

HOSPITAL PATH000020 SPECIAL STAIN GROUP II 88313TC 167.15$

HOSPITAL PATH000021 TIS G/M#3 SKIN:CYSTTAGLIPOMA 88304TC 193.95$

HOSPITAL PATH000022 TISSUE EXAM BY PATH LEVEL IV 88305TC 260.55$

HOSPITAL PATH000023 FROZEN SECTION EXAM 88331TC 180.85$

HOSPITAL PATH000024 FROZEN SECTION ADD. BLOCK 88332TC 125.70$

HOSPITAL PATH000025 CYTOLOGY TOUCH PREP SCREEN/INT 88160TC 95.00$

HOSPITAL PATH000026 CYTOLOGY TCH PREP-PREP/SCR/INT 88161TC 121.70$

2020-01




HOSPITAL PATH000028 TOUCH PREP SURGERY INITIAL 88333TC 625.60$

HOSPITAL PATH000029 TOUCH PREP SURGERY ADDITIONAL 88334TC 146.70$

HOSPITAL PATH000030 INTRAOPERATIVE CONSULTATION 88329 66.15$

HOSPITAL PATH000033 PAP SMEAR SCREENING BY TECH 76.65$

HOSPITAL PATH000040 IMMUNOCYTOCHEM AB - ADDITIONAL 88341TC 63.85$

HOSPITAL BBK0000001 THERAPEUTIC PHLEBETOMY-LAB/ASU 99195 232.20$

HOSPITAL BBK0000002 AB ID EACH PANEL 86870 297.45$

HOSPITAL BBK0000005 BLOOD TYPE (ABO) 86900 79.50$

HOSPITAL BBK0000006 RH TYPE 86901 43.40$

HOSPITAL BBK0000007 RBC AG (OTHER THAN ABO/RH) 86905 146.40$

HOSPITAL BBK0000008 RH PHENOTYPEING COMP 86906 150.95$

HOSPITAL BBK0000009 DIRECT COOMBS 86880 79.50$

HOSPITAL BBK0000010 AB ELUTION RBC 86860 146.40$

HOSPITAL BBK0000011 AB ID PNL 86870 297.45$

HOSPITAL BBK0000012 RBC PRETREAT W/ENZ 86971 146.40$

HOSPITAL BBK0000013 RBC PRETREAT W/CHEM/DRUGS 86970 110.00$

HOSPITAL BBK0000014 SERUM PRETREAT W/DRUGS 86975 205.35$

HOSPITAL BBK0000015 RBC ADSORPTION 86978 120.70$

HOSPITAL BBK0000016 SERUM PRETREAT INCUB W/INH 86977 146.40$

HOSPITAL BBK0000017 SERUM PRETREAT B/DIL 86976 43.40$

HOSPITAL BBK0000018 RBC PRETREAT B/DENS GRAD S 86972 146.40$

HOSPITAL BBK0000019 HEMOLYSIN AGG AUTO 86940 67.60$

HOSPITAL BBK0000020 HEMOLYSIN AGG AUTO INCUB 86941 67.60$

HOSPITAL BBK0000021 AG TYPE PER AG PER UNIT 86902 146.40$

HOSPITAL BBK0000022 PRE SELECTED UNIT 86904 174.00$

HOSPITAL BBK0000023 PLT CROSSMATCH 86022 291.50$

HOSPITAL BBK0000025 ANTI-A 86900 79.50$

HOSPITAL BBK0000027 ANTI-B 86900 79.50$

HOSPITAL BBK0000028 ANTI-D 86901 43.40$

HOSPITAL BBK0000029 ANTIGEN IDENTIFICATION PATIENT 86905 146.40$

HOSPITAL BBK0000031 FETAL BLEED SCREEN 85461 80.30$

HOSPITAL BBK0000032 FROZEN BLOOD PREP 86930 146.40$

HOSPITAL BBK0000035 CROSSMATCH AHG 86921 146.40$

HOSPITAL BBK0000036 ANTI-DU 86905 146.40$

HOSPITAL BBK0000037 DAT POLYSPECIFIC AHG 86880 79.50$

HOSPITAL BBK0000038 DIRECT COOMB TRANSF REACTION 86880 79.50$

HOSPITAL BBK0000039 THAWING EACH UNIT FFP 86927 297.45$

HOSPITAL BBK0000040 ANTIBODY SCREEN EA TECHNIQUE 86850 71.65$

HOSPITAL BBK0000041 COOMBS TEST INDIRECT QUAL EA 86885 146.40$

HOSPITAL BBK0000042 AGID-UNIT CHARGE 86902 146.40$

HOSPITAL BBK0000046 RHOGAM 90384 255.25$

HOSPITAL BBK0000049 GRANULOCYTE PHERESIS 4,065.75$

HOSPITAL BBK0000050 PLT APH/PHER LEUCORED 1,105.20$

HOSPITAL BBK0000051 RED CELLSWASHED 584.30$

HOSPITAL BBK0000052 RED CELLSLEUCOREDUCDCMVN 382.20$

HOSPITAL BBK0000053 PLTAPH/PHER LEUCORED IRRA 1,116.35$

HOSPITAL BBK0000054 DEGLYCEROLIZATION 648.40$

HOSPITAL BBK0000055 RED CELLSLEUCOREDUCEDIRR 524.80$

HOSPITAL BBK0000056 RED CELLS LEUCOREDUCED 410.75$

HOSPITAL BBK0000057 PLTAPH/PHER LEUCORED CMVN 1,033.40$

HOSPITAL BBK0000058 PLTLEUCOREDUCED IRRAD P/U 268.60$

HOSPITAL BBK0000059 PLT PHER LR IRR CMV NEG 1,554.10$

HOSPITAL BBK0000061 CMV NEGATIVE 400.60$

HOSPITAL BBK0000062 CRYOPRECEPITATE 331.65$

HOSPITAL BBK0000063 FRESH FROZEN PLASMA 132.70$

HOSPITAL BBK0000064 PLATELETS LEUKOCYTE REDUCED 169.40$

HOSPITAL BBK0000065 CRYOPRECIPITATE AHF POOLED E 331.65$

HOSPITAL BBK0000066 FRESH FROZE PLASMA 8-24HR COLL 121.45$

HOSPITAL BBK0000067 PACK CELL-DEGLYCERIZED EA UNIT 615.40$

HOSPITAL BBK0000068 RBC, LEUKOCYTE POOR EA UNIT 410.75$

HOSPITAL BBK0000069 RBC LR IRRADIATED EACH UNIT 524.80$

HOSPITAL BBK0000070 RBC, WASHED EA UNIT 584.30$

HOSPITAL BBK0000071 RED BLOOD CELLS, FROZEN EA UN 479.95$

HOSPITAL BBK0000072 RBC DEGLYCEROLIZED EACH UNIT 648.40$

HOSPITAL BBK0000073 CRYOPRECIPITATE EA UNIT 331.65$

HOSPITAL BBK0000074 PLATELETS PHERESIS LR EA UNIT 1,105.20$

HOSPITAL BBK0000075 PLATELETS PHERESIS LR IRRAD EA 1,116.35$

HOSPITAL BBK0000076 GRANULOCYTES PHERESIS UNIT 4,065.75$

2020-01




HOSPITAL BBK0000077 PLASMA 1 DONOR FRZ W/IN 8 HR 132.70$

HOSPITAL BBK0000078 ANTIBODY SCREEN 86850 72.10$

HOSPITAL BBK0000079 COOMBS INDIRECT 86886 145.15$

HOSPITAL BBK0000081 FACTOR XII ASSAY (F-12) 85280 111.05$

HOSPITAL BBK0000082 CROSSMATCH - IMMED SPIN 86920 180.65$

HOSPITAL BBK0000083 CROSSMATCH - ELECTRONIC 86923 180.65$

HOSPITAL BBK0000084 ARC-COMP AHG ADSORPTION 86922 146.40$

HOSPITAL BBK0000085 ANTIBODY ID 86870 251.25$

HOSPITAL BBK0000086 EGA TRT RED CELLS 86860 185.70$

HOSPITAL BBK0000087 COMPATIBILITY SCREEN 86922 141.85$

HOSPITAL BBK0000089 DIRECT ANTIGLOBULIN 86880 83.60$

HOSPITAL BBK0000090 DTT TREATMENT 86970 111.40$

HOSPITAL BBK0000091 ELUATE 86860 172.45$

HOSPITAL BBK0000092 ENZYME TRT OF PNL 86971 251.25$

HOSPITAL BBK0000093 HGB SCREENING 85660 83.60$

HOSPITAL BBK0000094 MICROHCT/HYPO CELL SEPARATION 86972 172.45$

HOSPITAL BBK0000095 NEUTRALIZATION, (HPC/PLASMA/LE 86977 172.45$

HOSPITAL BBK0000096 PATIENT RH PHENOTYPE 86906 167.15$

HOSPITAL BBK0000097 PATIENT AG Cecek (INDIV AG) 86905 89.15$

HOSPITAL BBK0000098 PT AG AHG 86905 113.00$

HOSPITAL BBK0000099 PT AG DIRECT 86905 124.20$

HOSPITAL BBK0000100 PT AG RARE LOW 86905 124.20$

HOSPITAL BBK0000101 PT AG RARE HIGH 86905 153.85$

HOSPITAL BBK0000102 PRE-WARM 86940 92.85$

HOSPITAL BBK0000103 SALINE REPLACEMENT 86977 172.45$

HOSPITAL BBK0000104 TITRATION 86886 103.50$

HOSPITAL BBK0000105 RBC MOL TYPING (PT) 81403 530.45$

HOSPITAL BBK0000106 DONOR AG CeceK 86902 89.15$

HOSPITAL BBK0000107 DONOR AG AHG 86902 113.00$

HOSPITAL BBK0000108 DONOR AG DIRECT 86902 124.20$

HOSPITAL BBK0000109 DONOR AG RARE LOW 86902 124.20$

HOSPITAL BBK0000110 DONOR AG RARE HIGH 86902 153.85$

HOSPITAL BBK0000111 STAT SPECIMEN 86999 610.05$

HOSPITAL BBK0000112 MONDAY-FRIDAY FEE 86999 331.20$

HOSPITAL BBK0000113 CONSULT FEE 86999 84.90$

HOSPITAL BBKE00001B BLOOD TYPING SEROLOGIC ABO 86900 32.50$

HOSPITAL BBKE00001C BLOOD TYPING SEROLOGIC RH(D) 86901 32.50$

HOSPITAL BBKE00002B PRETREAT RBC; ENZYMES 86971 248.30$

HOSPITAL BBKE00002C SERUM PRETX; RC ABSORPT 86978 17.00$

HOSPITAL BBKE00003B PRETREAT RBC; ENZYMES 86971 248.30$

HOSPITAL BBKE00003C SERUM PRETX; RC ABSORPT 86978 17.00$

HOSPITAL BK0000072 RBC DEGLYCEROLIZED EACH UNIT 648.40$

HOSPITAL 175817 SLEEP STUDY UNATT&RESP EFFT 605.60$

HOSPITAL 500001 ECG 12 LEAD 93005 167.60$

HOSPITAL 500007 COLOR FLOW 93325 667.10$

HOSPITAL 500009 VENOUS IMAGING LIMITED 93971 863.20$

HOSPITAL 500010 CAROTID IMAGING BILATERAL 93880 1,093.90$

HOSPITAL 500011 CAROTID IMAGING FOLLOWUP 93882 680.35$

HOSPITAL 500012 VENOUS IMAGING COMP BILATERAL 93970 1,259.05$

HOSPITAL 500013 ARTERIAL IMAGING LOWER BILAT 93925 1,064.05$

HOSPITAL 500014 ARTERIAL IMAGING FOLLOWUP LOWR 93926 683.60$

HOSPITAL 500015 ARTERIAL IMAGING UPPER BILAT 93930 959.00$

HOSPITAL 500016 ARTERIAL IMAGING FOLLOWUP UPPR 93931 1,002.35$

HOSPITAL 500022 TTE ECHO COMPLETE W/O CONTRST 93306 2,536.40$

HOSPITAL 500025 SEGMENTAL PRESSURES LOWER BIL 93923 1,009.05$

HOSPITAL 500026 SEGMENTAL PRESSURES UPPER BIL 93923 1,009.05$

HOSPITAL 500027 STRESS ECG 93017 994.10$

HOSPITAL 500028 PHARMOLOGICAL STRESS WO/INTERP 93017 994.10$

HOSPITAL 500043 RHYTHM STRP 1-3 LEAD W/REPORT 93041 90.50$

HOSPITAL 500060 TRANSESOPHAGEAL ECHO 93312 1,659.45$

HOSPITAL 500065 TREADMILL 93924 1,067.55$

HOSPITAL 500081 ANKLE INDEX PRESSURE 93922 513.40$

HOSPITAL 500082 ECHO DOPPLER FOLLOWUP 93321 481.45$

HOSPITAL 500087 EEG AWAKE & DROWSY 95816 1,037.35$

HOSPITAL 500105 VEIN MAP/HEMODIALYSIS ACCESS 659.65$

HOSPITAL 500140 ECHO 2-D W/WO M-MODE FOLLOWUP 93308 360.85$

HOSPITAL 500150 ECHO DOPPLER COMP 93320 708.15$

HOSPITAL 500151 STRESS ECHO 93350 1,407.70$

2020-01




HOSPITAL 500280 HOLTER MONITOR UP TO 48 HOURS 93225 625.25$

HOSPITAL 500281 HOLTER MONITORING SCANNING 93226 870.75$

HOSPITAL 500286 HOLTER MONITOR UP TO 48HRS 93225 1,250.45$

HOSPITAL 503001 NUCLEAR STRESS 93017 994.10$

HOSPITAL 503002 TTE ECHO COMPLETE W/CONTRAST 3,038.45$

HOSPITAL 511080 TILT TABLE TESTING 93660 1,337.35$

HOSPITAL 511103 IMPLANT LINQ RECORDER 33285 9,508.90$

HOSPITAL 511122 REMOVE LINQ RECORDER 2,378.50$

HOSPITAL 511160 LINQ RECORDER 21,847.85$

HOSPITAL CAR00001TC ECG 12 LEAD 93005 167.60$

HOSPITAL 510001 CARDIAC INIT ASSESS W/ECG (P2) 93798 268.85$

HOSPITAL 510002 CARDIAC REHAB PHASE II 93798 268.85$

HOSPITAL 510012 MONITORING 1-3 LEAD W/O INTERP 93041 90.50$

HOSPITAL 510018 ASSESSMENT/(RE) & EVAL (P-P2/3 99211 253.65$

HOSPITAL 510019 ASSESSMENT/(RE) & EVAL (C-P3) 99211 169.70$

HOSPITAL 510020 PULMONARY REHAB PHASE II/15min 79.50$

HOSPITAL 510024 6 MINUTE WALK 94618 245.15$

HOSPITAL 510027 CARDIAC REH PH III 1-7 VISITS 93797 52.25$

HOSPITAL 510028 CARDIAC REH PH III 8-12 VISITS 93797 75.50$

HOSPITAL 510029 PULM REH PH III 1-7 VISITS 94761 53.20$

HOSPITAL 510030 PULM REH PH III 8-12 VISITS 94761 75.50$

HOSPITAL 510031 PULMONARY REHAB PHASE II/COPD 268.85$

HOSPITAL 170000 ASTHMA TEACHING 99211 104.10$

HOSPITAL 170002 BIPAP (CPAP) 94660 329.50$

HOSPITAL 170008 ARTERIAL PUNCTURE 36600 141.05$

HOSPITAL 170010 CPAP - ARABELLA 94660 329.50$

HOSPITAL 170096 ABG 82803 156.85$

HOSPITAL 170100 ACAPELLA THERAPY, INITIAL 94664 212.25$

HOSPITAL 170101 ACAPELLA THERAPY, SUBQUENTIAL 94667 129.55$

HOSPITAL 170102 EZ-PAP THERAPY, INITIAL 94664 212.25$

HOSPITAL 170103 EZ-PAP THERAPY, SUBQUENTIAL 94664 212.25$

HOSPITAL 170104 FLO-MIST CONTINUOUS NEB 1ST HR 94640 212.25$

HOSPITAL 170105 FLO-MIST CONTINUOUS NEB (SUBQ) 94640 212.25$

HOSPITAL 170106 ALBUTEROL BOTTLE 94.40$

HOSPITAL 170125 PFT PRE & POST 94060 618.30$

HOSPITAL 170158 PEAK FLOW INIT 99211 206.50$

HOSPITAL 170177 CPR-CARDIOPULM RESUCITATION 92950 658.25$

HOSPITAL 170185 CPT W/POST DRAINAGE INITIAL 94667 129.55$

HOSPITAL 170190 CPT W/POST DRAINAGE SUB 94668 79.50$

HOSPITAL 170196 LUNG VOLUMES 94726 312.95$

HOSPITAL 170356 PULSE OXIMETRY SINGLE 94760 85.35$

HOSPITAL 170375 SLEEP STUDY Sa02 94762 301.00$

HOSPITAL 170469 METER DOSE INHALER SUBQ 94640 212.25$

HOSPITAL 170500 RESPIRATORY ASSESSMENT 94799 184.35$

HOSPITAL 170511 NEBULIZER THERAPY INIT 94640 212.25$

HOSPITAL 170513 NEBULIZER THERAPY SUBSQ 94640 212.25$

HOSPITAL 170520 PEAK FLOW SUBQ 94726 312.95$

HOSPITAL 170552 NASOTRACHEAL SUCTION 31720 212.25$

HOSPITAL 170568 CONTINUOUS VENT INIT 1ST DAY 94002 649.20$

HOSPITAL 170569 CONTINUOUS VENT SUBQ DAY(S) 94003 649.20$

HOSPITAL 170592 NORMAL SALINE 10% SOLUTION 2.70$

HOSPITAL 170607 ALBUTEROL 5.0mg 5.95$

HOSPITAL 170658 PFT 94010 221.15$

HOSPITAL 170741 SPUTUM SPEC COLLECT (INDUCED) 89220 145.15$

HOSPITAL 170800 O2 PER HR 9.40$

HOSPITAL 170802 O2 BY CANNULA - 1st 15 MIN 13.70$

HOSPITAL 170851 O2 PER DAY 221.90$

HOSPITAL 170886 O2 BY CANNULA - 1ST HOUR 54.45$

HOSPITAL 170897 LUNG DIFFUSION 94729 299.70$

HOSPITAL 170898 CO EXPIRED GAS BY IR 94770 355.90$

HOSPITAL 171165 METER DOSE INHALER INIT 94640 212.25$

HOSPITAL 177770 INCENTIVE SPIROMETRY INIT 94010 184.35$

HOSPITAL 177773 MONIT DURING C-SEC (NEONATE) 99464 36.10$

HOSPITAL 177776 EVALUATE PT USE OF INHALER 94664 212.25$

HOSPITAL 177777 MECHANICAL CHEST WALL OSCILL 94669 212.25$

HOSPITAL 177778 NB RESUSCITATION 99465 663.25$

HOSPITAL 177780 INTUBATION ET EMERGENT 31500 240.35$

HOSPITAL 177783 VAPOTHERM THERAPY 94799 184.35$

2020-01




HOSPITAL 510009 PULMONARY REHAB PHASE I 182.25$

HOSPITAL 175805 MULT SLEEP LATENCY-MSLT or MWT 95805 4,534.95$

HOSPITAL 175810 POLYSOMNOGRAPY 4/> PARAMETERS 95810 4,981.40$

HOSPITAL 175811 POLYSOMNOGRAPHY w/CPAP or VENT 95811 5,227.15$

HOSPITAL 175812 POLY w/CPAP or VENT DISCONTINU 9581152 5,227.15$

HOSPITAL 175813 POLY 4/> PARAMETERS DISCONTINU 9581052 4,981.40$

HOSPITAL 175818 PAP-NAP <6 HOURS 9580752 621.20$

HOSPITAL XDX00002TC KNEE 1 OR 2 VIEWS LEFT 73560LT 332.35$

HOSPITAL XDX00003TC KNEE 1 OR 2 VIEWS RIGHT 73560RT 332.35$

HOSPITAL XDX00004TC KNEE LEFT 3 VIEWS 73562LT 363.95$

HOSPITAL XDX00005TC KNEE RIGHT 3 VIEWS 73562RT 363.95$

HOSPITAL XDX00006TC KNEE COMP 4/> VIEWS LEFT 73564LT 544.25$

HOSPITAL XDX00007TC KNEE COMP 4/> VIEWS RIGHT 73564RT 544.25$

HOSPITAL XDX00011TC FEMUR 2 VIEWS LEFT 73552LT 352.70$

HOSPITAL XDX00012TC FEMUR 2 VIEWS RIGHT 73552RT 352.70$

HOSPITAL XDX00013TC ANKLE 3 VIEWS LEFT 73610LT 334.90$

HOSPITAL XDX00014TC ANKLE 3 VIEWS RIGHT 73610RT 334.90$

HOSPITAL XDX00015TC FOOT 2 VIEWS LEFT 73620LT 284.20$

HOSPITAL XDX00016TC FOOT 2 VIEWS RIGHT 73620RT 284.20$

HOSPITAL XDX00017TC FOOT COMPLETE MIN 3 VIEWS LEFT 73630LT 331.55$

HOSPITAL XDX00018TC FOOT COMPLETE MIN 3 VIEWS RT 73630RT 331.55$

HOSPITAL XDX00019TC CALCANEUS MIN 2 VIEWS LEFT 73650LT 269.80$

HOSPITAL XDX00020TC CALCANEUS MIN 2 VIEWS RIGHT 73650RT 269.80$

HOSPITAL XDX00021TC HIP 2 VIEWS LT W/PELV IF PERF 73502LT 374.60$

HOSPITAL XDX00022TC HIP 2 VIEWS RT W/PELV IF PERF 73502RT 374.60$

HOSPITAL XDX00024TC HIP 1 VIEW LEFT W/PELV IF PERF 73501LT 224.95$

HOSPITAL XDX00025TC HIP 1 VIEW RT W/PELV IF PERF 73501RT 224.95$

HOSPITAL XDX00026TC ANKLE 2 VIEWS LEFT 73600LT 287.20$

HOSPITAL XDX00027TC ANKLE 2 VIEWS RIGHT 73600RT 287.20$

HOSPITAL XDX00028TC HAND 3 VIEWS LEFT 73130LT 324.25$

HOSPITAL XDX00029TC HAND 3 VIEWS RIGHT 73130RT 324.25$

HOSPITAL XDX00030TC HAND 2 VIEWS LEFT 73120LT 264.50$

HOSPITAL XDX00031TC HAND 2 VIEWS RIGHT 73120RT 264.50$

HOSPITAL XDX00032TC WRIST 2 VIEWS LEFT 73100LT 246.90$

HOSPITAL XDX00033TC WRIST 2 VIEWS RIGHT 73100RT 246.90$

HOSPITAL XDX00034TC WRIST 3 VIEWS LEFT 73110LT 414.35$

HOSPITAL XDX00035TC WRIST 3 VIEWS RIGHT 73110RT 414.35$

HOSPITAL XDX00036TC FOREARM 2 VIEWS LEFT 73090LT 414.35$

HOSPITAL XDX00037TC FOREARM 2 VIEWS RIGHT 73090RT 414.35$

HOSPITAL XDX00038TC ELBOW 2 VIEWS LEFT 73070LT 332.25$

HOSPITAL XDX00039TC ELBOW 2 VIEWS RIGHT 73070RT 332.25$

HOSPITAL XDX00040TC ELBOW 3 VIEWS LEFT 73080LT 332.25$

HOSPITAL XDX00041TC ELBOW 3 VIEWS RIGHT 73080RT 332.25$

HOSPITAL XDX00042TC HUMERUS 2 VIEWS LEFT 73060LT 310.60$

HOSPITAL XDX00043TC HUMERUS 2 VIEWS RIGHT 73060RT 310.60$

HOSPITAL XDX00044TC SHOULDER 2 VIEWS LEFT 73030LT 387.90$

HOSPITAL XDX00045TC SHOULDER 2 VIEWS RIGHT 73030RT 387.90$

HOSPITAL XDX00048TC CLAVICLE COMPLETE LEFT 73000LT 286.40$

HOSPITAL XDX00049TC CLAVICAL COMPLETE RIGHT 73000RT 286.40$

HOSPITAL XDX00050TC ACROMIOCLAVICULAR JOINTS BILAT 73050 326.65$

HOSPITAL XDX00051TC SCAPULA COMPLETE LEFT 73010LT 297.55$

HOSPITAL XDX00052TC SCAPULA COMPLETE RIGHT 73010RT 297.55$

HOSPITAL XDX00053TC STERNOCLAVICULAR JOINT MIN 3 V 71130 326.20$

HOSPITAL XDX00054TC BONE AGE STUDY 77072 151.55$

HOSPITAL XDX00055TC KNEE COMPLETE 4 VIEWS 73564LT 544.25$

HOSPITAL XDX00056TC KNEE COMPLETE 4 VIEWS 73564RT 544.25$

HOSPITAL XDX00059TC PELVIS W/RT HIP 1 VIEW 73501RT 344.80$

HOSPITAL XDX00060TC CHANGE GASTROSTOMY TUBE - S 49450 974.65$

HOSPITAL XDX00062TC INSERT DUOD/JEJ TUBE - R 49441 1,544.90$

HOSPITAL XDX00063TC INSERT DUOD/JEJ TUBE - S 49441 1,544.90$

HOSPITAL XDX00064TC NG TUBE PLACEMENT W/FLUORO 43752 435.20$

HOSPITAL XDX00067TC NECK SOFT TISSUE 70360 320.35$

HOSPITAL XDX00068TC SKULL LESS THAN 4 VIEWS 70250 374.60$

HOSPITAL XDX00069TC SKULL COMPLETE MIN 4 VIEWS 70260 568.30$

HOSPITAL XDX00071TC PARANASAL SINUS < 3 VIEWS 70210 264.50$

HOSPITAL XDX00072TC PARANASAL SINUS MIN 3 VIEWS 70220 476.00$

HOSPITAL XDX00073TC NASAL BONES COMPL MIN 3 VIEWS 70160TC52 384.30$

HOSPITAL XDX00075TC EYE DETECTION OF FOREIGN BODY 70030 328.55$

2020-01




HOSPITAL XDX00077TC UPPER GI 74240 579.85$

HOSPITAL XDX00078TC MANDIBLE PARTIAL < 4 VIEWS 70100 389.40$

HOSPITAL XDX00079TC MANDIBLE COMPLETE MIN 4 VIEWS 70110 445.15$

HOSPITAL XDX00081TC TM JOINTS BILATERAL 70330 489.05$

HOSPITAL XDX00083TC ORBITS COMPLETE MIN 4 VIEWS 70200 472.40$

HOSPITAL XDX00084TC FACIAL BONES LESS THAN 3 VIEWS 70140 413.00$

HOSPITAL XDX00085TC FACIAL BONES COMP MIN 3 VIEWS 70150 488.15$

HOSPITAL XDX00086TC CERVICAL SPINE 1 VIEW 72020 291.55$

HOSPITAL XDX00087TC CERVICAL SPINE 2 OR 3 VIEWS 72040 377.35$

HOSPITAL XDX00088TC CERVICAL SPINE MIN 4 VIEWS 72050 503.30$

HOSPITAL XDX00089TC CERVICAL SPINE COMP W FLEX/EXT 72052 585.70$

HOSPITAL XDX00090TC THORACIC SPINE 2 VIEWS 72070 315.70$

HOSPITAL XDX00091TC SACRUM AND COCCYX MIN 2 VIEWS 72220 351.55$

HOSPITAL XDX00092TC THORACIC SPINE 3 VIEWS 72072 506.35$

HOSPITAL XDX00094TC THORACOLUMBAR SPINE 2 VIEWS 72080 499.25$

HOSPITAL XDX00095TC LUMBOSACRAL 2 OR 3 VIEWS 72100 473.55$

HOSPITAL XDX00097TC LUMBAR W/FLEXION/EXT MIN 4 VW 72110 564.15$

HOSPITAL XDX00098TC SPINE SURVEY AP/LAT ENTIRE 72082 629.15$

HOSPITAL XDX00101TC RIBS UNILATERAL 2 VIEWS LEFT 71100LT 372.55$

HOSPITAL XDX00102TC RIBS UNILATERAL 2 VIEWS RIGHT 71100RT 372.55$

HOSPITAL XDX00103TC RIBS LT W/PA CHEST MIN 3 VIEW 71101LT 388.90$

HOSPITAL XDX00104TC RIBS RIGHT W/PA CHEST MIN 3 71101RT 388.90$

HOSPITAL XDX00105TC LUMBOSACRAL 2/3 VIEWS REDUCED 7210052 473.55$

HOSPITAL XDX00106TC RIBS MIN 3 VIEWS BILATERAL 71110 407.35$

HOSPITAL XDX00107TC RIBS BILAT W/PA CHEST MIN 4 71111 462.15$

HOSPITAL XDX00108TC STERNUM MIN 2 VIEWS 71120 324.45$

HOSPITAL XDX00109TC PELVIS 1 OR 2 VIEWS 72170 325.00$

HOSPITAL XDX00110TC PELVIS COMPLETE MIN 3 VIEWS 72190 415.30$

HOSPITAL XDX00112TC SACROILIAC JOINTS 3 OR MORE 72202 351.70$

HOSPITAL XDX00113TC ABDOMEN SINGLE AP VIEW 74018 327.45$

HOSPITAL XDX00116TC ACUTE ABD SERIES W/CHEST XRAY 74022 595.00$

HOSPITAL XDX00118TC ESOPHAGUS 74220 540.20$

HOSPITAL XDX00121TC UPPER GI w/o KUB w/AIR 74246 847.80$

HOSPITAL XDX00122TC UPPER GI w/SMALL BOWEL w/AIR 74249 1,029.90$

HOSPITAL XDX00123TC SM BOWEL INCLUDE MULTI SERIAL 74250 521.20$

HOSPITAL XDX00125TC BARIUM ENEMA 74270 689.85$

HOSPITAL XDX00126TC BARIUM ENEMA AIR CONTRAST 74280 944.40$

HOSPITAL XDX00131TC RETROGRADE PYELOGRAM LEFT 74420 756.70$

HOSPITAL XDX00132TC RETROGRADE PYELOGRAM RIGHT 74420 756.70$

HOSPITAL XDX00140TC FLUOROSCOPY UP TO 1 HR (R) 76000 450.35$

HOSPITAL XDX00141TC FLUORO GUIDANCE NEEDLE PLAC 77002 595.65$

HOSPITAL XDX00143TC TOMOGRAPHY SINGLE PLANE 76100 439.20$

HOSPITAL XDX00145TC CHEST DECUBITIS/SPECIAL VIEW 71045 312.15$

HOSPITAL XDX00147TC ANKLE 1 VIEW LEFT 7360052LT 287.20$

HOSPITAL XDX00151TC ARTHROCENTESIS (RADIOLOGY) 20610 317.85$

HOSPITAL XDX00153TC TIBIA FIBULA 2 VIEWS LEFT 73590LT 344.80$

HOSPITAL XDX00154TC TIBIA FIBULA 2 VIEWS RIGHT 73590RT 344.80$

HOSPITAL XDX00155TC CARPAL SERIES LEFT 73110LT 414.35$

HOSPITAL XDX00156TC CARPAL SERIES RIGHT 73110RT 414.35$

HOSPITAL XDX00157TC THORACENTESIS W/TUBE INSERT 32555 778.90$

HOSPITAL XDX00162TC NEPHROSTOGRAM 74425 571.50$

HOSPITAL XDX00163TC ANKLE 1 VIEW RIGHT 7360052RT 287.20$

HOSPITAL XDX00165TC HAND 1 VIEW - LEFT 7312052LT 264.50$

HOSPITAL XDX00166TC HAND 1 VIEW - RIGHT 7312052RT 264.50$

HOSPITAL XDX00173TC INJECTION FOR CYSTOGRAPHY 51600 101.20$

HOSPITAL XDX00174TC CHANGE GASTROSTOMY TUBE - R 49450 974.65$

HOSPITAL XDX00175TC GASTROSTOMY TUBE INSERT - R 49440 1,544.90$

HOSPITAL XDX00188TC ARTHROGRAM SHOULDER LEFT 73040LT 754.55$

HOSPITAL XDX00189TC ARTHROGRAM SHOULDER RIGHT 73040RT 754.55$

HOSPITAL XDX00194TC ABSCESS FISTULA/SINUS TRACT 76080 499.45$

HOSPITAL XDX00195TC VOIDING URETHROCYSTOGRAM 74455 747.35$

HOSPITAL XDX00196TC UROGRAPHY IVP/TOMOGRAPHY 74415 1,158.60$

HOSPITAL XDX00199TC EXCRETORY UROGRAPHY/IVP 74410 1,154.15$

HOSPITAL XDX00201TC FINGER HAND THUMB LT 73140LT 241.85$

HOSPITAL XDX00202TC FINGER HAND 2ND DIGIT LT 73140LT 241.85$

HOSPITAL XDX00203TC FINGER HAND 3RD DIGIT LT 73140LT 241.85$

HOSPITAL XDX00204TC FINGER HAND 4TH DIGIT LT 73140LT 241.85$

HOSPITAL XDX00205TC FINGER HAND 5TH DIGIT LT 73140LT 241.85$

2020-01




HOSPITAL XDX00206TC FINGER RT HAND THUMB 73140RT 241.85$

HOSPITAL XDX00207TC FINGER RT HAND 2ND DIGIT 73140RT 241.85$

HOSPITAL XDX00208TC FINGER RT HAND 3RD DIGIT 73140RT 241.85$

HOSPITAL XDX00209TC FINGER RT HAND 4TH DIGIT 73140RT 241.85$

HOSPITAL XDX00210TC FINGER RT HAND 5TH DIGIT 73140RT 241.85$

HOSPITAL XDX00211TC TOE LT FOOT GREAT TOE 73660LT 241.85$

HOSPITAL XDX00212TC TOE LT FOOT 2ND DIGIT 73660LT 241.85$

HOSPITAL XDX00213TC TOE LT FOOT 3RD DIGIT 73660LT 241.85$

HOSPITAL XDX00214TC TOE LT FOOT 4TH DIGIT 73660LT 241.85$

HOSPITAL XDX00215TC TOE LT FOOT 5TH DIGIT 73660LT 241.85$

HOSPITAL XDX00216TC TOE FOOT GREAT TOE RT 73660RT 241.85$

HOSPITAL XDX00217TC TOE RT FOOT 2ND DIGIT 73660RT 241.85$

HOSPITAL XDX00218TC TOE RT FOOT 3RD DIGIT 73660RT 241.85$

HOSPITAL XDX00219TC TOE RT FOOT 4TH DIGIT 73660RT 241.85$

HOSPITAL XDX00220TC TOE RT FOOT 5TH DIGIT 73660RT 241.85$

HOSPITAL XDX00221TC SCOLIOSIS SURVEY 72081 416.55$

HOSPITAL XDX00222TC HYSTEROSALPINGOGRAM 74740 1,313.90$

HOSPITAL XDX00225TC OSSEOUS SURVEY COMPLETE 77075 794.80$

HOSPITAL XDX00227TC FOOT 1 VIEW LEFT 7362052LT 284.20$

HOSPITAL XDX00228TC FOOT 1 VIEW RIGHT 7362052RT 284.20$

HOSPITAL XDX00229TC HUMERUS 1 VIEW LEFT 7306052 310.60$

HOSPITAL XDX00230TC HUMERUS 1 VIEW RIGHT 7306052 310.60$

HOSPITAL XDX00231TC ELBOW 1 VIEW RIGHT 7307052RT 332.25$

HOSPITAL XDX00232TC ELBOW 1 VIEW LEFT 7307052LT 332.25$

HOSPITAL XDX00333TC CHEST SINGLE VIEW FRONTAL 71045 309.15$

HOSPITAL XDX00334TC CHEST PA & LATERAL 2 VIEWS 71046 403.15$

HOSPITAL XDX00335TC CHEST 2 VIEW W/APICAL LORDOTIC 71045 365.00$

HOSPITAL XDX00336TC PHARYNGEAL/SPEECH EVAL RECORD 74230 717.90$

HOSPITAL XDX00337TC CHOLANGIOGRAPHY INTRAOPERATIVE 74300 620.00$

HOSPITAL XDX00338TC CHOLANGIOGRAM POSTOPERATIVE 47531 862.30$

HOSPITAL XDX00339TC FINGER RT HAND THUMB 1 VIEW 7314052 241.85$

HOSPITAL XDX00344TC FLUORO NDL LOC-SPINAL INJ (S) 77003 483.00$

HOSPITAL XDX00345TC CATH INTRO HYSTEROSALPINGOGRAM 31.75$

HOSPITAL XDX00346TC URETHROGRAM RETROGRADE 74430 616.00$

HOSPITAL XDX00351TC PERCUTANEOUS ABCESS DRAINAGE 75989 255.25$

HOSPITAL XDX00352TC FINGER LT HAND THUMB 1 VIEW 7314052 241.85$

HOSPITAL XDX00360TC BX ABD/RETROPERITONEAL MASS 1,602.05$

HOSPITAL XDX00361TC ARTHROGRAM SHOULDER INJ 524.45$

HOSPITAL XDX00362TC CHEST TUBE INSERTION 685.65$

HOSPITAL XDX00363TC CYSTOGRAM - SURGEON 74430 616.00$

HOSPITAL XDX00366TC D/J TUBE REPLACEMENT - RAD 49451 974.65$

HOSPITAL XDX00367TC ARTHROGRAM KNEE INJ - RIGHT 27369RT 508.85$

HOSPITAL XDX00368TC ARTHROGRAM KNEE INJ - LEFT 27369LT 508.85$

HOSPITAL XDX00378TC EVALUATE D/G/J TUBE - RAD 187.85$

HOSPITAL XDX00381TC FLUOROSCOPY UP TO 1HOUR - SURG 76000 387.90$

HOSPITAL XDX00384TC ABCESS,HEMATOMA,CYST ASPIRATIO 477.20$

HOSPITAL XDX00385TC CATH INTRO HYSTOSALPINGRAM-RAD 41.95$

HOSPITAL XDX00386TC LUMBAR W/OBLIQUES 5 VIEWS 72110 564.15$

HOSPITAL XDX00387TC LUMBAR COMPL,INC BEND 6 VW 72114 723.45$

HOSPITAL XDX00389TC NEPHROSTOGRAM INJ; NEW ACCESS 450.90$

HOSPITAL XDX00393TC REPOSITION NG/G TUBE - RAD 1,291.95$

HOSPITAL XDX00395TC RETROGRADE URETHROGRAM 74450 598.00$

HOSPITAL XDX00396TC SMALL BOWEL THRU G TUBE 74251 876.65$

HOSPITAL XDX00397TC SPINAL LUMBAR PUNCT W/WO FLURO 830.90$

HOSPITAL XDX00400TC INJECT FOR CYSTOGRAPHY or VCU 51600 101.20$

HOSPITAL XDX00401TC CYSTO CONRAY 250 ML BOTTLE 16.60$

HOSPITAL XDX00402TC GASTROGRAFIN 120ML 242.65$

HOSPITAL XDX00403TC OMNIPAQUE 350mg/100ml 58.35$



HOSPITAL XDX00407TC BONE SURVEY (METS) LIMITED 77074 884.35$

HOSPITAL XDX00408TC HIP ARTHROGRAM 73525 515.30$

HOSPITAL XDX00409TC FLOURO SPINE NDL LOC (R) 77003 483.00$

HOSPITAL XDX00410TC HIP ARTHROGRAPHY INJ WO ANESTH 27093 363.65$

HOSPITAL XDX00411TC SCANOGRAM BONE LENGTH 77073 361.80$

HOSPITAL XDX00412TC VISIPAQUE 320MG/50 ML BOTTLE 92.80$

HOSPITAL XDX00414TC KNEE 1 OR 2 VIEWS BILATERAL 7356050 664.70$

HOSPITAL XDX00415TC PICC INSERTION 36569 1,232.05$

2020-01




HOSPITAL XDX00418TC LOOPOGRAM 74425 1,228.60$

HOSPITAL XDX00419TC PELVIS W/RT & LT HIP ADULT 73523 1,483.90$

HOSPITAL XDX00420TC INJECTION URETER ILEAL CONT 50690 313.95$

HOSPITAL XDX00421TC INJ W/FLUOR EVAL CV DEVICE 36598 283.80$

HOSPITAL XDX00422TC RETROGRADE URETHROGRAM INJ 51610 476.05$

HOSPITAL XDX00424TC DIAGNOSTIC SPECIMEN XRAY 76098 824.10$

HOSPITAL XDX00450TC X-RAY PELVIS/HIPS 2+VIEW CHILD 73521 1,483.90$

HOSPITAL XDX00451TC SHOULDER 1 VIEW 73020 86.40$

HOSPITAL XDX00452TC DILATE FOR STRICTURE/OBSTR 74360 726.45$

HOSPITAL XDX00453TC CHANGE NEPHROSTOMY TUBE 50435 2,159.55$

HOSPITAL XDX00455TC KNEES BILATERAL STANDING AP 73565 86.40$

HOSPITAL XDX00456TC JOINT SURVEY SINGLE 2+ JOINTS 77077 143.05$

HOSPITAL XDX00458TC PLACEMENT NEPHROURETERAL CATH 2,139.00$

HOSPITAL XDX00459TC NEPHROSTOGRAM INJ;EXIST ACCESS 744.80$

HOSPITAL XDX00460TC HIPS 2 VIEWS, W/PELVIS IF PERF 73521 777.80$

HOSPITAL XDX00461TC HIPS BIL 3-4 VIEW PELV IF PERF 73522 777.80$

HOSPITAL XDX00462TC SINUS TRACT INJ; DX 20501 101.20$

HOSPITAL XDX00463TC TIBIA FIBULA 1 VIEW RIGHT 7359052RT 344.80$

HOSPITAL XDX00464TC FEMUR 1 VIEW LEFT 73551 82.80$

HOSPITAL XDX00465TC FEMUR 1 VIEW RIGHT 73551 82.80$

HOSPITAL XDX00466TC ABDOMEN 2 VIEWS 74019 373.10$

HOSPITAL XDX00467TC ABDOMEN 3 OR MORE VIEWS 74021 352.90$

HOSPITAL XDX00468TC PELVIS W/RT HIP 1 VIEW 73501RT 344.80$

HOSPITAL XDX00469TC HIP W/PELVIS 1 VIEW LT 73501LT 344.80$

HOSPITAL XDX00470TC JOINT SURVEY SNGL VW 2+ JOINTS 77077 360.75$

HOSPITAL XDX00471TC JOINT SURVEY SINGLE < 2 JOINTS 7707752 360.75$

HOSPITAL XDX00P18TC FOOT COMPLETE MIN 3 VIEWS RT 3 73630RT 331.55$

HOSPITAL XDX00P88TC CERVICAL SPINE MIN 4 VIEWS 3DA 72050 503.30$

HOSPITAL XDX0P101TC RIBS UNILATERAL 2 VIEWS LT 3DA 71100LT 372.55$

HOSPITAL XMG00001TC MAMMO SCREEN UNIL RT 77067TC52 174.75$

HOSPITAL XMG00002TC MAMMO SAME DAY AS SCR RT W/IMP 77065GGRT 174.75$

HOSPITAL XMG00003TC MAMMO SAME DAY AS SCR LT W/IMP 77065GG 174.75$

HOSPITAL XMG00004TC MAMMO SAME DAY AS SCR LT 77065GG 174.75$

HOSPITAL XMG00005TC MAMMO SAME DAY AS SCR RT 77065GG 174.75$

HOSPITAL XMG00006TC MAMMO DIGITAL SCREEN BILATERAL 77067 255.35$

HOSPITAL XMG00007TC MAMMO DIAGNOSTIC BILATERAL 77066 368.25$

HOSPITAL XMG00009TC MAMMO DIAGNOSTIC UNIL LT 77065LT 231.25$

HOSPITAL XMG00010TC MAMMO DIAGNOSTIC UNIL RT 77065RT 231.25$

HOSPITAL XMG00011TC MAMMO SCREEN UNIL LT 7706752 174.75$

HOSPITAL XMG00012TC MAMMO SCREEN UNIL RT W/IMP 7706752RT 174.75$

HOSPITAL XMG00013TC MAMMO SCREEN UNIL LT W/IMP 7706752LT 174.75$

HOSPITAL XMG00014TC MAMMO DIAG UNIL LT W/IMPL 77065 231.25$

HOSPITAL XMG00015TC MAMMO DIAG UNIL RT W/IMPL 77065 231.25$

HOSPITAL XMG00016TC MAMMO SCREEN BILATERAL W/IMPL 77067 255.35$

HOSPITAL XMG00018TC BREAST PERC-VAC W/IMG-LT S 1,731.05$

HOSPITAL XMG00020TC PREOP PLCMT NEEDLE WIRE-LEFT 2,504.45$

HOSPITAL XMG00021TC PREOP PLCMT NEEDLE WIRE-RIGHT 2,504.45$

HOSPITAL XMG00022TC PREOP PLCMT NDLE WIRE EA ADD'L 654.60$

HOSPITAL XMG00023TC COMPUTER-AIDED DETECTION DIAG 77065 56.50$

HOSPITAL XMG00026TC STEREOTACTIC BIOPSY 19081 2,474.25$

HOSPITAL XMG00031TC MAMMO DIAG BILATERAL w/IMPL 77066 368.25$

HOSPITAL XMG00033TC STEREOTACTIC LOCALIZ EA ADDL 606.95$

HOSPITAL XMG00034TC MAMMO SAME DAY AS SCREEN BIL 77066GG 302.70$

HOSPITAL XMG00036TC DIAGNOSTIC SPECIMEN 76098 824.10$

HOSPITAL XMG00037TC BREAST TOMOSYNTHESIS BI SCREEN 77063 53.05$

HOSPITAL XMG00038TC TOMOSYNTH BREAST UNI SCRN 7706352 53.05$

HOSPITAL XMG00042TC TOMOSYNTH DIAG BREAST UNI 77061 53.05$

HOSPITAL XMG00043TC TOMOSYNTH DIAG BREAST BI 77062 53.05$

HOSPITAL XPT00001TC PET BRAIN IMAGING METABOLIC 78608PI 4,726.90$

HOSPITAL XPT00002TC PET W/CONCUR CT;LIMITED AREA 78814PI 3,121.35$

HOSPITAL XPT00003TC PET W/CONCUR CT;SKULL-THIGH 78815PI 3,121.35$

HOSPITAL XPT00004TC PET W/CONCUR CT;WHOLE BODY 78816PI 3,121.35$

HOSPITAL XPT00005TC PET BRAIN IMAGING METABOLIC 78608PS 4,726.90$

HOSPITAL XPT00006TC PET W/CONCUR CT;LIMITED ARE 78814PS 3,121.35$

HOSPITAL XPT00007TC PET W/CONCUR CT;SKULL-THIGH 78815PS 3,121.35$

HOSPITAL XPT00008TC PET W/CONCUR CT;WHOLE BODY 78816PS 3,121.35$

HOSPITAL XPT00009TC FDG - up to 45 MILLICURIES 614.40$

HOSPITAL XCT00001RN RECOVERY PER 1/4 HR - RAD 57.20$

2020-01




HOSPITAL XCT00002TC NEPHROSTOMY CATHETER KIT 786.90$

HOSPITAL XCT00003TC CT ABDOMEN & PELVIS W/O CNTR 74176 2,221.30$

HOSPITAL XCT00004TC CT ABDOMEN & PELVIS W/CNTR 74177 2,423.55$

HOSPITAL XCT00005TC CT ABDOMEN & PELVIS WO/W CNTR 74178 3,091.20$

HOSPITAL XCT00006TC CT RENAL PROTOCOL W/O CNTR 74176 2,221.30$

HOSPITAL XCT00009TC VISIPAQUE 270mg/100ml 182.70$

HOSPITAL XCT00010TC CT ABDOMEN W/O CONTRAST 74150 1,146.15$

HOSPITAL XCT00011TC VISIPAQUE 320mg/100ml BOTTLE 203.00$

HOSPITAL XCT00012TC CT ABDOMEN WO/W CONTRAST 74170 1,561.75$

HOSPITAL XCT00013TC CT CHEST/THORAX W/O CONTRAST 71250 1,124.35$

HOSPITAL XCT00014TC CT CHEST/THORAX W/CONTRAST 71260 1,197.70$

HOSPITAL XCT00015TC CT CHEST/THORAX WO/W CONTRAST 71270 1,413.60$

HOSPITAL XCT00016TC CT PELVIS W/O CONTRAST 72192 1,075.15$

HOSPITAL XCT00017TC CT PELVIS WO/W CONTRAST 72194 1,529.50$

HOSPITAL XCT00018TC PC-CT SOFT TISSUE NECK W/CNTR 70490 1,150.55$

HOSPITAL XCT00019TC CT SOFT TISSUE NECK W/CONTRAST 70491 1,211.75$

HOSPITAL XCT00020TC CT SOFT TISSUE NECK WO/W CNTR 70492 1,430.40$

HOSPITAL XCT00021TC CT SINUS/FACIAL BONES WO CNTR 70486 898.70$

HOSPITAL XCT00022TC CT MAXILLOFACIAL W/CONTRAST 70487 1,129.70$

HOSPITAL XCT00023TC CT MAXILLOFACIAL WO/W CONTRAST 70488 1,441.60$

HOSPITAL XCT00024TC CT HEAD OR BRAIN W/O CONTRAST 70450 1,094.40$

HOSPITAL XCT00025TC CT HEAD OR BRAIN W/CONTRAST 70460 1,117.30$

HOSPITAL XCT00026TC CT HEAD OR BRAIN WO/W CONTRAST 70470 1,451.30$

HOSPITAL XCT00027TC CT ORBITS W/O CONTRAST 70480 1,162.15$

HOSPITAL XCT00028TC CT ORBIT W/CONTRAST 70481 1,214.40$

HOSPITAL XCT00029TC CT ORBITS WO/W CONTRAST 70482 1,322.50$

HOSPITAL XCT00030TC CT TEMPORAL BONES W/O CONTRAST 70480 1,162.15$

HOSPITAL XCT00031TC CT TEMPORAL BONE WO/W CONTRAST 70482 1,322.50$

HOSPITAL XCT00032TC CT CERVICAL SPINE W/O CONTRAST 72125 1,230.15$

HOSPITAL XCT00033TC CT CERVICAL SPINE W/CONTRAST 72126 1,247.65$

HOSPITAL XCT00034TC CT TEMPORAL BONES W/CONTRAST 70481 1,214.40$

HOSPITAL XCT00035TC CT CERVICAL SPINE WO/W CNTR 72127 1,405.30$

HOSPITAL XCT00036TC CT THORACIC SPINE W/O CONTRAST 72128 1,139.40$

HOSPITAL XCT00037TC CT THORACIC SPINE W/CONTRAST 72129 1,157.40$

HOSPITAL XCT00038TC CT THORACIC SPINE WO/W CNTR 72130 1,405.30$

HOSPITAL XCT00039TC CT LUMBAR SPINE W/O CONTRAST 72131 1,208.45$

HOSPITAL XCT00040TC CT LUMBAR SPINE W/CONTRAST 72132 1,303.40$

HOSPITAL XCT00041TC CT LUMBAR SPINE WO/W CONTRAST 72133 1,728.05$

HOSPITAL XCT00044TC CTA ABDOMEN 74175 1,575.60$

HOSPITAL XCT00045TC CTA HEAD 70496 1,609.05$

HOSPITAL XCT00046TC CTA NECK 70498 1,577.15$

HOSPITAL XCT00047TC CTA CHEST 71275 1,678.05$

HOSPITAL XCT00048TC CTA PELVIS 72191 1,677.00$

HOSPITAL XCT00049TC CTA LOWER EXTREMITY 73706 1,255.95$

HOSPITAL XCT00051TC CTA ABD ARTERIES W/RUNOFF 75635 1,783.30$

HOSPITAL XCT00053TC CT UPPER EXT LEFT W/O CNTR 73200LT 865.50$

HOSPITAL XCT00054TC CT UPPER EXT RIGHT W/O CNTR 73200RT 865.50$

HOSPITAL XCT00055TC CT UPPER EXT LEFT W/CONTRAST 73201LT 980.15$

HOSPITAL XCT00056TC CT UPPER EXT RIGHT W/CONTRAST 73201RT 980.15$

HOSPITAL XCT00057TC CT UPPER EXT LEFT WO/W CNTR 73202LT 1,544.25$

HOSPITAL XCT00058TC CT UPPER EXT RIGHT WO/W CNTR 73202RT 1,544.25$

HOSPITAL XCT00059TC CT LOWER EXT LEFT W/O CONTRAST 73700LT 999.00$

HOSPITAL XCT00060TC CT LOWER EXT RIGHT W/O CNTR 73700RT 999.00$

HOSPITAL XCT00061TC CT LOWER EXT LEFT W/CONTRAST 73701LT 1,161.95$

HOSPITAL XCT00062TC CT LOWER EXT RIGHT W/CONTRAST 73701RT 1,161.95$

HOSPITAL XCT00063TC CT LOWER EXT LEFT WO/W CNTR 73702LT 1,407.95$

HOSPITAL XCT00064TC CT LOWER EXT RIGHT WO/W CNTR 73702RT 1,407.95$

HOSPITAL XCT00067TC 3D RENDERING W/POSTPROCESS 76377 579.85$

HOSPITAL XCT00069TC BIOPSY BONE MARROW NDL/TROCAR 38221 2,008.20$

HOSPITAL XCT00070TC BONE MARROW ASP WITH BX 38222 457.45$

HOSPITAL XCT00071TC PARACENTESIS ABDOMINAL 765.30$

HOSPITAL XCT00074TC NEEDLE BIOPSY, LYMPH NODES 701.55$

HOSPITAL XCT00076TC CT GUIDANCE NEEDLE PLACEMENT 77012 2,318.75$

HOSPITAL XCT00077TC CT ABDOMEN W/CONTRAST 74160 1,266.70$

HOSPITAL XCT00078TC CT PELVIS W/CONTRAST 72193 1,156.90$

HOSPITAL XCT00080TC BX ABD/RETROPERITONEAL MASS 1,483.30$

HOSPITAL XCT00081TC ARTHROCENTESIS 317.85$

HOSPITAL XCT00082TC BIOPSY BONE TROCAR/NEEDLE DEEP 2,008.20$

2020-01




HOSPITAL XCT00083TC BIOPSY BONE SUPERFICIAL 1,337.60$

HOSPITAL XCT00084TC CHEST TUBE INSERTION 685.65$

HOSPITAL XCT00085TC FNA BX W/CT GDN 1ST LES 713.55$

HOSPITAL XCT00086TC PERCUTANEOUS ABCESS DRAINAGE 75989 255.25$

HOSPITAL XCT00087TC BIOPSY/NEEDLE OF LIVER 1,337.60$

HOSPITAL XCT00088TC DRAIN PERCUT LIVER LESION 1,909.65$

HOSPITAL XCT00089TC BIOPSY LUNG OR MEDIASTINIUM 1,337.60$

HOSPITAL XCT00090TC BIOPSY MUSCLE, PERCUTAN NEEDLE 1,337.60$

HOSPITAL XCT00091TC BIOPSY OF NECK/CHEST 1,602.15$

HOSPITAL XCT00092TC CHANGE NEPHROSTOMY TUBE 2,159.55$

HOSPITAL XCT00093TC NEPHROSTOMY TUBE REMOVAL 50389 850.45$

HOSPITAL XCT00094TC BIOPSY NEEDLE PANCREAS 1,337.60$

HOSPITAL XCT00095TC DRAIN PERITONEAL ABSCESS PERCU 2,008.20$

HOSPITAL XCT00096TC BIOPSY PLEURA PERCUTAN NEEDLE 1,337.60$

HOSPITAL XCT00097TC PNEUMONOCENTESIS PUNC LUNG ASP 1,337.60$

HOSPITAL XCT00099TC DRAINAGE ABCESS PERCUTAN 1,337.60$

HOSPITAL XCT00100TC PERCUTDRAIN RETROPER ABSCESS 2,008.20$

HOSPITAL XCT00101TC THORACENTESIS 866.15$

HOSPITAL XCT00102TC THORACENTESIS W/TUBE INSERT 866.15$

HOSPITAL XCT00104TC SHOULDER CT W/CONTRAST 73201 980.15$

HOSPITAL XCT00105TC SHOULDER CT W/WO CONTRAST 73202 1,544.25$

HOSPITAL XCT00106TC BIOPSY RENAL TROCAR/NDLE PERCU 50200 2,008.20$

HOSPITAL XCT00107TC SHOULDER ARTHROGRAM INJ 23350 363.65$

HOSPITAL XCT00108TC CT ANGIO ABD/PELV W/O & W DYE 74174 2,702.00$

HOSPITAL XCT00109TC BX LYMPH NODES NEEDLE 38505 1,337.60$

HOSPITAL XCT00115TC PERCUTANEOUS CHOLECYSTOSTOMY 47490 3,091.35$

HOSPITAL XCT00116TC LUNG CANCER SCREENING-DAT 88.00$

HOSPITAL XCT00119TC OMNIPAQUE 300MG/200ML 122.85$

HOSPITAL XCT00120TC BONE MARROW ASPIRATION ONLY 38220 1,337.60$

HOSPITAL XCT00121TC LDCT FOR LUNG CANCER SCREEN 128.75$

HOSPITAL XCT00125TC OMNIPAQUE 300/100ML BOTTLE 99.00$

HOSPITAL XCT00126TC PLACEMENT NEPHROURETERAL CATH 2,139.00$

HOSPITAL XCT00130TC OMNIPAQUE 300/75ML BOTTLE 82.70$

HOSPITAL XCT00131TC CTA CHEST REDUCED 7127552 1,678.05$

HOSPITAL XCT00132TC RENAL CYST ASPIRATION 1,418.35$

HOSPITAL XCT00133TC RENAL CYST ASPIRATE EACH ADD'L 1,418.35$

HOSPITAL XCT00136TC DX BONE MARROW BX & ASPIR 38222 2,917.50$

HOSPITAL XCT00137TC CT LIMITED 76380 366.05$

HOSPITAL XCT00138TC FNA BX W/CT GDN EA ADDL 104.15$

HOSPITAL XUS00001TC BLADDER ULTRASOUND 76857 592.85$

HOSPITAL XUS00002TC PAROTID ULTRASOUND 76536 777.95$

HOSPITAL XUS00003TC ABDOMEN SONOGRAM LTD <6 ORGANS 76705 984.70$

HOSPITAL XUS00004TC ABDOMEN SONOGRAM COMPLETE 76700 1,261.35$

HOSPITAL XUS00005TC TRANSRECTAL PROSTATE SONOGRAM 76872 752.90$

HOSPITAL XUS00006TC US GUIDANCE FOR NEEDLE PLCMENT 76942 662.35$

HOSPITAL XUS00007TC HEAD SONOGRAM 76506 725.30$

HOSPITAL XUS00008TC ULTRASOUND 76999 580.50$

HOSPITAL XUS00010TC RETROPERITONEAL SONOGRAM LIMIT 76775 891.75$

HOSPITAL XUS00011TC RETROPERITONEAL SONOGRAM COMP 76770 1,194.95$

HOSPITAL XUS00012TC SPINAL CANAL AND CONTENTS 76800 790.45$

HOSPITAL XUS00013TC US BLADDER WITH PVR 76857 592.85$

HOSPITAL XUS00014TC US ADD'L GESTATION EACH 76802 953.90$

HOSPITAL XUS00015TC PELVIC LIMITED SONOGRAM 76857 592.85$

HOSPITAL XUS00016TC PELVIC COMPLETE SONOGRAM 76856 859.90$

HOSPITAL XUS00017TC ABD AORTA SONOGRAM 76775 891.75$

HOSPITAL XUS00018TC BREAST SONOGRAM LIMITED 76642 717.10$

HOSPITAL XUS00019TC TESTICULAR SONOGRAM 76870 729.50$

HOSPITAL XUS00020TC TRANSVAGINAL SONOGRAM NON-OB 76830 753.65$

HOSPITAL XUS00021TC TRANSVAGINAL U/S PREGNANT 76817 722.80$

HOSPITAL XUS00022TC OB US < 14 WKS SINGLE FETUS 76801 750.00$

HOSPITAL XUS00023TC INFANT HIPS U/S LIMITED STATIC 76886 867.60$

HOSPITAL XUS00025TC US EXTREMITY NON VASC LIMITED 76882 351.30$

HOSPITAL XUS00026TC BIOPSY OF THYROID 682.50$

HOSPITAL XUS00027TC BIOPSY SALIVARY GLAND NEEDLE 1,337.60$

HOSPITAL XUS00028TC OB COMPLETE ADD'L GEST >1 TRI 76810 896.50$

HOSPITAL XUS00029TC OB COMPLETE > 1st TRIMESTER 76805 959.85$

HOSPITAL XUS00034TC ABD AORTIC ANEURYSM SCREEN 76706 912.25$

HOSPITAL XUS00035TC 4D OB ULTRASOUND 125.00$

2020-01




HOSPITAL XUS00036TC BX ABD/RETROPERITONEAL MASS 1,602.05$

HOSPITAL XUS00037TC ARTHROCENTESIS 340.75$

HOSPITAL XUS00038TC ASPIRATION CYST BREAST 682.50$

HOSPITAL XUS00039TC ASPIRATION CYST BREAST, EA ADD 470.15$

HOSPITAL XUS00040TC PREOP PLCMT NEEDLE WIRE 2,504.45$

HOSPITAL XUS00041TC PREOP PLCMT NDLE WIRE EA ADD'L 654.60$

HOSPITAL XUS00043TC BX BREAST W/IMAGING-RAD 1,337.60$

HOSPITAL XUS00044TC BX BREAST W/IMAG-ADD'L LSN R 1,019.75$

HOSPITAL XUS00046TC FINE NEEDLE ASP DEEP TISSUE 770.65$

HOSPITAL XUS00048TC BIOPSY/NEEDLE OF LIVER 1,418.35$

HOSPITAL XUS00049TC DRAIN PERCUT LIVER LESION 2,062.45$

HOSPITAL XUS00050TC DRAINAGE LYMPH NODE SIMPLE 3,199.50$

HOSPITAL XUS00051TC BIOPSY MUSCLE, PERCUTAN NEEDLE 1,337.60$

HOSPITAL XUS00052TC BIOPSY OF NECK/CHEST 1,730.35$

HOSPITAL XUS00053TC BIOPSY NEEDLE PANCREAS 1,418.35$

HOSPITAL XUS00054TC PARACENTESIS ABDOMINAL 851.35$

HOSPITAL XUS00055TC PERITIONEAL ABSCESS DRAINAGE 2,062.45$

HOSPITAL XUS00056TC PYLORUS 76705 984.70$

HOSPITAL XUS00057TC RENAL ABSCESS DRAINAGE 1,337.60$

HOSPITAL XUS00058TC RENAL BIOPSY 2,008.20$

HOSPITAL XUS00059TC RENAL CYST ASPIRATION 1,418.35$

HOSPITAL XUS00060TC RENAL CYST ASPIRATE EACH ADD'L 1,418.35$

HOSPITAL XUS00061TC THORACENTSIS W/O IMAGING GUIDE 935.45$

HOSPITAL XUS00062TC THORACENTESIS W/TUBE INSERT 935.45$

HOSPITAL XUS00063TC THYROID CYST ASPIRATION 714.85$

HOSPITAL XUS00064TC THYROGLOSSAL DUCT CYST DRAIN 5,681.25$

HOSPITAL XUS00067TC BX LYMPH NODES NEEDLE 1,337.60$

HOSPITAL XUS00070TC PICC INSERTION 36569 1,232.05$

HOSPITAL XUS00071TC ABCESS,HEMATOMA,CYST,ASPIRAT 10160 417.15$

HOSPITAL XUS00073TC DUPLEX RENAL ULTRASOUND 93975 1,191.35$

HOSPITAL XUS00074TC DUPLEX RENAL ULTRASOUND LIMITE 93976 816.50$

HOSPITAL XUS00075TC US EXAM CHEST 76604 689.15$

HOSPITAL XUS00076TC OB LIMITED ULTRASOUND 76815 288.15$

HOSPITAL XUS00077TC BREAST SONOGRAM COMPLETE 76641 130.85$

HOSPITAL XUS00078TC US HEAD/NECK SOFT TISSUE 76536 777.95$

HOSPITAL XUS00079TC US GUIDED NEEDLE LOC AXILLARY 38999 495.80$

HOSPITAL XUS00080TC US GUIDANCE FOR VEIN 76937 662.35$

HOSPITAL XUS00081TC US TRANS KIDNEY W/DUPL DOPPLER 76776 218.15$

HOSPITAL XUS00082TC OB US FOLLOW-UP PER FETUS 76816 959.85$

HOSPITAL XUS00083TC OB US ADDT'L GEST FOLLOW UP 76816 822.20$

HOSPITAL XUS00094TC FNA BX W/US GDN EA ADDL 74.25$

HOSPITAL XNM00001TC BONE SCAN LIMITED AREA 78300 1,296.70$

HOSPITAL XNM00003TC BONE SCAN WHOLE BODY 78306 1,711.40$

HOSPITAL XNM00005TC PULMONARY PERFUSION IMAGING 78580 1,462.40$

HOSPITAL XNM00006TC LIVER & SPLEEN IMAGING-STATIC 78215 1,328.60$

HOSPITAL XNM00007TC KIDNEY IMAGING W/VASCULAR FLOW 78707 1,320.35$

HOSPITAL XNM00008TC KIDNEY IMAGING W/PHARMACOLOGIC 78708 1,456.20$

HOSPITAL XNM00009TC KIDNEY IMAGING MULTIPLE WO/W 78709 1,344.05$

HOSPITAL XNM00010TC THYROID IMAGING W/UPTAKE-SINGL 78014 1,203.40$

HOSPITAL XNM00011TC THYROID IMAGING UPTAKE-MULTIPL 78014 1,203.40$

HOSPITAL XNM00012TC LIVER IMAGING (SPECT) 78205 1,812.80$

HOSPITAL XNM00013TC THYROID THERAPY-ORAL ADMIN 79005 1,395.70$

HOSPITAL XNM00014TC ACUTE GI BLOOD LOSS IMAGING 78278 1,295.35$

HOSPITAL XNM00015TC TUMOR LOCALIZATION WHOLE BODY 78804 2,481.80$

HOSPITAL XNM00016TC MYOCARDIAL STRSS &/OR RST MULT 78452 4,887.45$

HOSPITAL XNM00017TC MYOCARDIAL STRESS OR REST SNGL 78451 3,802.50$

HOSPITAL XNM00018TC HIDA 78226 1,634.55$

HOSPITAL XNM00019TC HIDA SCAN WITH CCK 78227 1,671.35$

HOSPITAL XNM00021TC GASTRIC EMPTYING 78264 1,529.25$

HOSPITAL XNM00023TC EJECTION FRACTION MUGA 78494 1,923.10$

HOSPITAL XNM00024TC TECHNETIUM SESTAMIBI-CARDIOLYT 322.85$

HOSPITAL XNM00025TC TECHNETIUM TETROFOSMIN MYOVIEW 271.05$

HOSPITAL XNM00026TC BONE &/OR JOINT W/SPECT 78320 1,601.30$

HOSPITAL XNM00027TC BONE SCAN WITH FLOW 3 PHASE 78315 1,752.10$

HOSPITAL XNM00028TC LIVER/SPLEEN SCAN W/FLOW STATI 78216 2,325.65$

HOSPITAL XNM00029TC THYROID CA METS IMAGING-WHOLE 78018 1,747.30$

HOSPITAL XNM00030TC LOCALIZE OF ABSCESS WHOLE BODY 78806 2,297.95$

HOSPITAL XNM00032TC SENTINEL NODE INJECT IDENTIFY 38792 670.15$

2020-01




HOSPITAL XNM00034TC VASOTEC 2.5MG/2ML VIAL 19.50$

HOSPITAL XNM00038TC LASIX 20mg 6.00$

HOSPITAL XNM00039TC BOWEL IMAGING-MECKELS LOCALIZ 78290 909.65$

HOSPITAL XNM00040TC PULMONARY VENT MULT PROJECTION 78579 1,228.45$

HOSPITAL XNM00041TC SENTINEL NODE WITH IMAGES 78195 1,641.80$

HOSPITAL XNM00042TC TECHNETIUM Tc 99M MEDRON 30mCi 179.00$

HOSPITAL XNM00043TC TC99M MEBROFENIN =< 15 MCI 266.20$

HOSPITAL XNM00044TC TECHNETIUM PENTETATE/mci MAG 3 760.95$

HOSPITAL XNM00045TC I-123 SOD IODIDE CAP per100uci 406.90$

HOSPITAL XNM00046TC I-131 IODIDE CAP per mCi DIAG 84.20$

HOSPITAL XNM00047TC TC99 MAA 460.45$

HOSPITAL XNM00048TC TECHNETIUM SULFUR COLLOID 324.45$

HOSPITAL XNM00049TC GALLIUM Ga 67 per mci 225.80$

HOSPITAL XNM00050TC TECHNETIUM AEROSOL (DTPA) 408.45$

HOSPITAL XNM00051TC TECHNETIUM PYROPHOSPHATE (PYP) 297.35$

HOSPITAL XNM00052TC TECHNETIUM EXAMETAZIME CERETEC 2,245.50$

HOSPITAL XNM00053TC I-131 IODIDE - Thereapeutic 433.70$

HOSPITAL XNM00054TC Tc99 FILTER SULFUR COLLOID UD 779.10$

HOSPITAL XNM00055TC TC99M PERTECHNETATE PER 1 MCI 536.50$

HOSPITAL XNM00056TC SUCCIMER MD (DMSA) 1,352.60$

HOSPITAL XNM00057TC KIDNEY IMAGING MORPHOLOGY 78701 724.35$

HOSPITAL XNM00059TC NON-IMAGING INJECTION PROCEDUR 78808 638.55$

HOSPITAL XNM00065TC PARATHYROID IMAGING 78070 1,042.90$

HOSPITAL XNM00067TC KINEVAC (CCK) 5 MCG VIAL 211.10$

HOSPITAL XNM00068TC BRAIN SCAN FOR VIABILITY 78607 1,554.90$

HOSPITAL XBD00001TC BONE DENSITY 1 OR MORE SITES 77080 649.50$

HOSPITAL XBD00003TC BONE DENSITY FOREARM/WRST/HEEL 77081 330.95$

HOSPITAL XBD00004TC HIP SPINE PELV W/VERT FX ASSES 77085 143.05$

HOSPITAL XBD000P1TC BONE DENSITY 1 OR > SITES 3DA 77080 649.50$

HOSPITAL XMR00001TC MRI BRAIN INC STEM WO/W CONT 70553 2,313.85$

HOSPITAL XMR00002TC MRI BRAIN INC STEM W/O CONT 70551 1,807.35$

HOSPITAL XMR00003TC MRI BRAIN INC STEM W/ CONT 70552 1,988.15$

HOSPITAL XMR00004TC GADOLINIUM 15ML 182.30$

HOSPITAL XMR00005TC GADOLINIUM 20ML 240.20$

HOSPITAL XMR00006TC PROHANCE 20 ML BOTTLE - MRI 351.55$

HOSPITAL XMR00007TC MRI CERVICAL SPINE W/O CONT 72141 1,807.35$

HOSPITAL XMR00008TC MRI CERVICAL SPINE WO/W CONT 72156 2,300.65$

HOSPITAL XMR00009TC MRI LUMBAR SPINE W/O CONTRAST 72148 1,620.00$

HOSPITAL XMR00010TC MRI LUMBAR SPINE WO/W CONT 72158 2,500.05$

HOSPITAL XMR00011TC MRI THORACIC SPINE W/O CONT 72146 1,878.50$

HOSPITAL XMR00014TC MRV - HEAD W/O CONTRAST 70544 1,560.30$

HOSPITAL XMR00015TC MRI CHEST W/O CONTRAST 71550 1,995.65$

HOSPITAL XMR00016TC MRI CHEST W/CONTRAST 71551 2,195.20$

HOSPITAL XMR00017TC MRI ABDOMEN W/O CONTRAST 74181 1,886.90$

HOSPITAL XMR00018TC MRI PELVIS W/O CONTRAST 72195 1,840.55$

HOSPITAL XMR00019TC MRI PELVIS W/CONTRAST 72196 2,024.55$

HOSPITAL XMR00021TC MRI ORBITFACE & NECK W/O CONT 70540 1,743.85$

HOSPITAL XMR00022TC MRI ORBITFACE & NECK W/ CONT 70542 1,918.25$

HOSPITAL XMR00023TC MRI ORBITFACE & NECK WO/W CON 70543 2,402.15$

HOSPITAL XMR00024TC MRA HEAD W/O CONTRAST 70544 1,560.30$

HOSPITAL XMR00025TC MRA NECK W/O CONTRAST 70547 1,121.50$

HOSPITAL XMR00026TC MRI CHEST WO/W CONTRAST 71552 2,793.95$

HOSPITAL XMR00027TC MRI CERVICAL SPINE W/ CONT 72142 1,988.15$

HOSPITAL XMR00028TC MRI THORACIC SPINE W/ CONT 72147 2,066.30$

HOSPITAL XMR00029TC MRI LUMBAR SPINE W/ CONTRAST 72149 1,901.40$

HOSPITAL XMR00030TC MRI PELVIS WO/W CONTRAST 72197 2,500.05$

HOSPITAL XMR00031TC UPPER EXT LT NO JNT W/O CONT 73218LT 1,614.85$

HOSPITAL XMR00032TC UPPER EXT RT NO JNT W/O CONT 73218RT 1,614.85$

HOSPITAL XMR00033TC UPPER EXT NO JOINT W/CONT 73219LT 1,776.35$

HOSPITAL XMR00034TC UPPER EXT NO JNT W/CONT 73219RT 1,776.35$

HOSPITAL XMR00035TC UPPER EXT NO JNT WO/W CONT 73220LT 2,100.20$

HOSPITAL XMR00036TC UPPER EXT NO JNT WO/W CONT 73220RT 2,100.20$

HOSPITAL XMR00037TC MRI UPPER ANY JNT W/O CONT LT 73221LT 1,826.90$

HOSPITAL XMR00038TC MRI UPPER ANY JNT W/O CONT RT 73221RT 1,826.90$

HOSPITAL XMR00039TC MRI UPPER EXT ANY JNT W/CNT LT 73222LT 2,009.55$

HOSPITAL XMR00040TC MRI UPPER EXT ANY JNT W/CNT RT 73222RT 2,009.55$

HOSPITAL XMR00041TC MRI UPPER EXT ANY JNT WO/W LT 73223LT 2,374.95$

HOSPITAL XMR00042TC MRI UPPER EXT ANY JNT WO/W RT 73223RT 2,374.95$

2020-01




HOSPITAL XMR00043TC MRI LOWER EXT NO JOINT W/O CON 73718LT 1,824.05$

HOSPITAL XMR00044TC MRI LOWER EXT NO JNT W/O RT 73718RT 1,824.05$

HOSPITAL XMR00045TC MRI LOWER EXT NO JOINT W/CONT 73719LT 2,006.50$

HOSPITAL XMR00046TC MRI LOWER EXT NO JNT W/CONT RT 73719RT 2,006.50$

HOSPITAL XMR00047TC MRI LOWER EXT NO JNT WO/W CONT 73720LT 2,371.30$

HOSPITAL XMR00048TC MRI LOWER EXT NO JNT WO/W RT 73720RT 2,371.30$

HOSPITAL XMR00049TC MRI LOWER EXT ANY JNT W/O CONT 73721LT 1,827.80$

HOSPITAL XMR00050TC MRI LOWER EXT ANY JNT W/O CONT 73721RT 1,827.80$

HOSPITAL XMR00051TC MRI LOWER EXT ANY JNT WO/W CON 73723LT 2,376.15$

HOSPITAL XMR00052TC MRI LOWER EXT ANY JNT WO/W CON 73723RT 2,376.15$

HOSPITAL XMR00053TC MRA CHEST WO/W CONTRAST 71555 1,992.95$

HOSPITAL XMR00054TC MRA PELVIS WO/W CONTRAST 72198 1,864.25$

HOSPITAL XMR00055TC MRA ABDOMEN WO/W CONTRAST 74185 1,737.85$

HOSPITAL XMR00056TC MRA UPPER EXTREMITY WO/W CONT 73225 1,992.95$

HOSPITAL XMR00057TC MRI THORACIC SPINE WO/W CONT 72157 2,368.70$

HOSPITAL XMR00059TC MRI ABDOMEN W/CONTRAST 74182 2,075.50$

HOSPITAL XMR00060TC MRA HEAD W/CONTRAST 70545 1,716.35$

HOSPITAL XMR00062TC MRA NECK W/CONTRAST 70548 1,233.65$

HOSPITAL XMR00063TC MRA NECK WO/W CONTRAST 70549 1,527.35$

HOSPITAL XMR00064TC MRI LOWER EXT ANY JNT W/CONT 73722LT 2,010.60$

HOSPITAL XMR00065TC MRI LOWER EXT ANY JNT W/CONT 73722RT 2,010.60$

HOSPITAL XMR00066TC MRI ABD WO/W CONTRAST 74183 2,500.30$

HOSPITAL XMR00067TC MRA LOWER EXTREMITY WO/W CONT 73725 1,742.90$

HOSPITAL XMR00069TC MRA PELVIS W/O CONTRAST 72198 1,864.25$

HOSPITAL XMR00070TC MRA ABDOMEN W/CONTRAST 74185 1,737.85$

HOSPITAL XMR00071TC MRA ABDOMEN W/O CONTRAST 74185 1,737.85$

HOSPITAL XMR00072TC MRA UPPER EXTREMITY WO CONT 1,992.95$

HOSPITAL XMR00073TC MRA LOWER EXTREMITY WO CONT 1,742.90$

HOSPITAL XMR00074TC MRA/MRV HEAD W/O CONTRAST 70544 1,560.30$

HOSPITAL XMR00075TC PROHANCE 15 ML BOTTLE - MRI 325.40$

HOSPITAL XMR00079TC BRACHIAL PLEXUS MRI W/O CONTRA 73218 394.60$

HOSPITAL XMR00080TC BRACHIAL PLEXUS MRI W CONTRAST 73219 588.60$

HOSPITAL XMR00081TC BRACHIAL PLEXUS MRI W&WO CONTR 73220 665.60$

HOSPITAL 580002 SIMULATION: SIMPLE 77280 784.85$

HOSPITAL 580003 SIMULATION:COMPLEX 77290 1,560.30$

HOSPITAL 580004 RTX DOSIMETRY CALCULATE BASIC 77300 396.45$

HOSPITAL 580008 MICRO/DOSIMETRY (e.g TLD) 77331 446.85$

HOSPITAL 580009 TREATMENT DEVICE:SIMPLE 77332 480.35$

HOSPITAL 580010 TREATMENT DEVICE:INTERMEDIATE 77333 524.45$

HOSPITAL 580011 TREATMENT DEVICE:COMPLEX 77334 1,022.15$

HOSPITAL 580012 SPECIAL TREATMENT PROCEDURE 77470 1,581.95$

HOSPITAL 580030 MEDICAL PHYSICS CONSULT 77336 572.10$

HOSPITAL 580031 MEDICAL PHYSICS CONSULT SPECIA 77370 867.20$

HOSPITAL 580035 PORT VERIFICATION FILM(S) 77417 267.40$

HOSPITAL 580038 SIMULATION: INTERMEDIATE 77285 794.30$

HOSPITAL 580045 3-D SIMULATION (RTX ONC) 77295 3,360.95$

HOSPITAL 580063 IMRT - PLANNING 77301 2,279.65$

HOSPITAL 580094 IMAGE FUSION BY DOSIMETRIST 77399 867.20$

HOSPITAL 580097 ISODOSE PLAN; SIMPLE 77306 236.65$

HOSPITAL 580098 ISODOSE PLAN; COMPLEX 77307 414.40$

HOSPITAL 580099 RADIATION TRTMT DELIV;SIMPLE 77402 156.75$

HOSPITAL 580107 RADIATION TRTMT DELIV;INTERMED 77407 156.75$

HOSPITAL 580108 RADIATION TRTMT DELIV;COMPLEX 77412 278.45$

HOSPITAL 580109 IMRT SIMPLE 77385 1,683.35$

HOSPITAL 580110 IMRT COMPLEX 77386 1,850.85$

HOSPITAL 580111 IGRT 77387 144.15$

HOSPITAL 580113 OFFICE CONSULT L1 99241 107.30$





HOSPITAL 580118 IMRT MLC 77338 473.50$

HOSPITAL 580119 RESP MOTION MANAGEMENT SIM 77293 3,360.95$

HOSPITAL 580121 SPECIAL TELETHERAPY 77321 473.50$

HOSPITAL 580122 LARYNGOSCOPY FLEX; DIAGNOSTIC 31575 214.00$

HOSPITAL 580123 OMNIPAQUE 300MG PER ML 0.75$

HOSPITAL 580124 OFFICE/OP VISIT, NEW L1 99201 110.50$


2020-01






HOSPITAL 580129 OFFICE/OP VISIT, EST L1 99211 110.50$






HOSPITAL 580135 VISIPAQUE 270MG/100 ML 182.70$

HOSPITAL 580136 SBRT DELIVERY PER FRACTION 77373 5,865.60$

HOSPITAL 580140 PORT FLUSH - RADONC 96523 118.30$

HOSPITAL 580141 ADMIN OF INFLUENZA VACCINE 90471 39.00$

HOSPITAL 580142 ADMIN OF PNEMONCOCCAL VACCINE 90471 39.00$

HOSPITAL 600005 PCA-MORPHINE 150MG/30CC 123.90$

HOSPITAL 600008 AMOXICIL/CLAV SUS 125/5 68.75$

HOSPITAL 600009 AMOXICIL/CLAV SUS 250MG/5 134.35$

HOSPITAL 600015 AUGMENTIN 500MG T 17.20$

HOSPITAL 600020 AMIKIN 500MG IV/SOLUTION 335.30$

HOSPITAL 600022 AMOXICILLIN 250MG 6.55$


HOSPITAL 600024 AMOXILCILLIN 125/5 100 24.90$

HOSPITAL 600025 AMOXICILLIN 250/5 100 20.45$

HOSPITAL 600026 AMPICILLIN 1GM IV/SOLUTION 39.25$

HOSPITAL 600027 AMPICILLIN 2GM VIAL 47.70$

HOSPITAL 600030 AMPICILLIN 250/5 100S 13.80$

HOSPITAL 600032 AMPICILLIN 500MG C 6.55$

HOSPITAL 600033 AMPICILLIN 125MG IV/SOLUTION 23.40$



HOSPITAL 600036 STADOL 2MG VIAL 46.05$

HOSPITAL 600040 BACID CAPS 6.55$

HOSPITAL 600042 AZECTAM 1GM/ SOLUTION 105.85$

HOSPITAL 600043 AZECTAM 2GM/SOLUTION 202.05$

HOSPITAL 600049 BUPROPION SR 150MG T 7.95$

HOSPITAL 600051 CODEINE SULFATE 15MG 7.75$

HOSPITAL 600060 BIAXIN 500MG 17.85$

HOSPITAL 600063 BICILLIN C-R 600,000 UNIT SYR 38.85$

HOSPITAL 600067 BI-CILLIN LA 600,000 41.35$

HOSPITAL 600092 SOD CHLORIDE .9% 100ML IV SOLN 14.90$

HOSPITAL 600095 CEFTIN 250 MG T 18.75$

HOSPITAL 600096 CIPROFLOXACIN 500MG TABLET 19.50$

HOSPITAL 600098 CEFOTAXIME 1GM IV/SOLN 83.10$

HOSPITAL 600104 CLEOCIN 900MG IV 123.05$

HOSPITAL 600105 CLEOCIN PED 100 ML BOTTLE 82.15$

HOSPITAL 600106 CLEOCIN 300MG IV/SOLUTION 60.00$


HOSPITAL 600109 CLEOCIN 150MG C 7.60$

HOSPITAL 600115 DIFLUCAN 200MG TAB 71.80$

HOSPITAL 600116 DIFLUCAN 100MG 43.95$

HOSPITAL 600117 DECLOMYCIN 150MG C 19.00$

HOSPITAL 600132 ERYTHROMYCIN 500MG IV/SOLUTION 67.10$

HOSPITAL 600137 COREG 6.25MG T 8.70$

HOSPITAL 600139 ERYC 250MG C (ABBOTT) 6.55$

HOSPITAL 600141 FORTAZ 1GM IV/TAZIDIME/SOLUTIO 107.25$


HOSPITAL 600148 FLAGYL 500MG IV/SOLUTION 112.80$

HOSPITAL 600153 ATROVENT UD 6.55$

HOSPITAL 600155 SULFAMETHOXAZOLE/TRIMETHOPRIM 30.55$

HOSPITAL 600161 ALBUTEROL SOL 5MG/ML 20ML BOTT 30.95$

HOSPITAL 600162 BUSPIRONE 15MG 9.45$

HOSPITAL 600164 GENTAMYCIN 10MG/ML 2ML 27.80$

HOSPITAL 600191 CEPHALEXIN 250MG CAP 8.20$


HOSPITAL 600193 CEPHALEXIN 125MG/5 S 100 70.75$

HOSPITAL 600194 CEPHALEXIN 250MG/5ML BOTTLE 58.95$

HOSPITAL 600203 PRAMIPEXOLE 0.25MG TAB 6.55$

HOSPITAL 600204 KEFZOL 500MG IV 28.80$

HOSPITAL 600207 LIORESAL 20MG TAB 6.60$

2020-01




HOSPITAL 600208 PLAVIX 75MG TAB 16.75$

HOSPITAL 600211 IRBESARTAN 150MG TAB 7.45$

HOSPITAL 600215 MACRODANTIN 50MG 6.55$

HOSPITAL 600224 MONTELUKAST 10MG TAB 12.95$

HOSPITAL 600225 GENTAMYCIN 80 MG VIAL 6.55$

HOSPITAL 600246 MINOCIN 100MG C. 12.95$

HOSPITAL 600256 MYCELEX 10 MG TROCHE 6.55$

HOSPITAL 600258 NAFCILLIN 1GM IV/SOLUTION 50.15$

HOSPITAL 600259 NAFCILLIN 2GM IV/SOLUTION 88.25$

HOSPITAL 600264 SYNVISC DISP. SYRINGE 2ML 567.95$

HOSPITAL 600265 VALPROATE SOD 500MG/5ML VIAL 52.00$

HOSPITAL 600270 NEOMYCIN 500MG T 11.35$

HOSPITAL 600274 NEOSPORIN GU IRR 1ML 35.70$

HOSPITAL 600291 PENICILLIN G 5 MIL IV/SOLUTION 46.70$

HOSPITAL 600301 PENICILLIN V POTASS 500MG TAB 6.55$

HOSPITAL 600310 ROCEPHIN 1GM/SOLUTION 209.70$


HOSPITAL 600312 ROCEPHIN 250MG IV/SOLUTION 73.05$


HOSPITAL 600315 ROCALTROLO .25MG CAPS 6.55$

HOSPITAL 600318 DENOSUMAB 60 MG SYRINGE 855.90$

HOSPITAL 600322 RIFADIN 300MG 11.75$

HOSPITAL 600351 TETRACYCLINE 250 MG C 6.55$

HOSPITAL 600352 TETRACYCLINE 500 MG C 6.55$

HOSPITAL 600366 TOBRAMYCIN 40MG/ML 2ML VIAL 61.50$

HOSPITAL 600372 TRIMPEX 100 MG T 6.55$

HOSPITAL 600385 VANCOMYCIN 500MG IV/SOLUTION 64.25$

HOSPITAL 600386 VANCOMYCIN 1GM IV/SOLUTION 112.75$

HOSPITAL 600400 VIBRATABS 100 MG T/DOXYCY 9.55$

HOSPITAL 600403 VIBRAMYCIN 100MG IV/SOLUTION 101.85$

HOSPITAL 600410 ZOVIRAX 200 MG CAPSULE 6.55$

HOSPITAL 600411 ZOVIRAX 500 MG IV 300.70$

HOSPITAL 600485 AVITENE 1 G 618.65$

HOSPITAL 600490 GELFOAM 100MM 143.90$

HOSPITAL 600491 GELFOAM DENTAL PAK 141.50$

HOSPITAL 600492 GELFOAM 12-7 EACH 26.95$

HOSPITAL 600505 THROMBIN 5000 UNIT 179.50$

HOSPITAL 600575 B & O SUPPOSITORY (EA) 15.05$

HOSPITAL 600645 MEPERIDINE 100 MG INJ. 8.90$

HOSPITAL 600680 DILAUDID 2MG 6.55$

HOSPITAL 600683 DILAUDID 4 MG T. 6.55$

HOSPITAL 600692 DURAGESIC 25 MCG PATCH 61.20$



HOSPITAL 600695 DURAGESIC 100MG 174.30$

HOSPITAL 600720 MORPHINE 15 MG TABLET 6.55$

HOSPITAL 600735 MORPHINE 10MG SYR. 6.55$

HOSPITAL 600737 MS CONTIN 15MG TAB 6.55$

HOSPITAL 600739 MS CONTIN 30MG TABLET 8.60$

HOSPITAL 600770 PERCOCET-5 325MG TAB 6.55$

HOSPITAL 600775 RITALIN 5 MG T. 6.55$


HOSPITAL 600780 ROXICET PER OZ 9.10$

HOSPITAL 600840 ATIVAN 2 MG/ML 1ML VIAL 55.65$

HOSPITAL 600934 RALOXIEFENE 60MG TAB 6.55$

HOSPITAL 600952 FIORICET TAB 6.55$

HOSPITAL 600970 IMMODIUM 2 MG CAPSULE 6.55$

HOSPITAL 600980 CHLORDIAZEPOXIDE 5MG C 6.55$


HOSPITAL 600982 LIBRIUM 25 MG. C. 6.55$

HOSPITAL 600996 LOMOTIL T. 6.55$

HOSPITAL 600997 DIPHENOX/ATROP LIQ/DOSE 16.95$

HOSPITAL 601085 PHENOBARBITAL 1/4 GR. T. 6.55$

HOSPITAL 601086 PHENOBARBITAL 30 MG BULK TAB 6.55$

HOSPITAL 601088 PHENOBARBITAL 1 GR. T. 6.55$

HOSPITAL 601090 PHENOBARBITAL 1-1/2 GR. T. 6.55$

HOSPITAL 601095 PHENOBARBITAL 65MG/1ML 6.55$

HOSPITAL 601096 PHENOBARBITAL 130 MG/1ML 14.50$

2020-01




HOSPITAL 601110 TEMAZEPAM 15MG C 6.55$


HOSPITAL 601117 DIFLUCAN 200MG IV 518.10$

HOSPITAL 601118 HUMIBID LA-GUAIFENESIN/MUCINEX 6.55$

HOSPITAL 601125 OXAZEPAM 10MG C 6.55$


HOSPITAL 601185 DIAZEPAM 2MG T 6.55$


HOSPITAL 601200 DIAZEPAM 10MG INJ 18.80$

HOSPITAL 601233 NEO-SYNEPHRINE 10% OPTH 111.05$

HOSPITAL 601235 XANAX 0.25 MG TAB 6.55$

HOSPITAL 601240 XANAX 0.5 MG TABLET 6.55$

HOSPITAL 601243 XANAX 1 MG TAB 6.55$

HOSPITAL 601246 BSS 15 ML 38.75$

HOSPITAL 601250 ATROPINE SULFATE OPH OINT 7.55$

HOSPITAL 601251 ATROPINE OPH 5CC 28.90$

HOSPITAL 601252 METHERGINE 0.2MG TAB 6.55$

HOSPITAL 601260 ALCAINE OPTH 15 CC 36.40$

HOSPITAL 601270 BACITRACIN OINT 3.5 GM TUBE 15.80$

HOSPITAL 601283 BLEPH-10 OPH SOL -5CC- 78.75$

HOSPITAL 601286 BLEPHAMIDE 10 ML 56.70$

HOSPITAL 601294 GARAMYCIN OINT 1% 74.55$

HOSPITAL 601297 TIMOPTIC OPTH O.5% 5ML BOTTLE 104.30$

HOSPITAL 601298 CORTISPORIN OPH SOL 5CC 94.20$

HOSPITAL 601305 CYCLOGYL 1% OPTH SOLN 15 ML BT 73.15$

HOSPITAL 601310 DACRIOSE 1 OZ SOL. 27.75$

HOSPITAL 601350 FLUOROMETHALONE OPTH SOL 6.60$

HOSPITAL 601360 GARAMYCIN OPTH OINT. 18.25$

HOSPITAL 601361 GENTAMYCIN OPTH SOL 5ML BOT 47.65$

HOSPITAL 601375 ERYTHROMYCIN OPTH OINT 1GM TU 24.30$

HOSPITAL 601387 PILOCARPINE 1% 15CC 71.55$

HOSPITAL 601389 PILOCARPINE 2% 15ML BOTTLE 73.00$

HOSPITAL 601393 PILOCARPINE 4% 15CC 78.20$

HOSPITAL 601405 IMMODUM 4 OZ LIQ 35.50$

HOSPITAL 601451 PRED FORTE 1% Opth Susp 5ML 89.75$

HOSPITAL 601460 ISOPTO - HOMATROPINE 5% 5CC 71.55$

HOSPITAL 601470 ISOPTO-TEARS 15CC 23.50$

HOSPITAL 601475 LACRI-LUBE 3.5GM 48.30$

HOSPITAL 601485 MAXITROL OPTH GTTS 5 ML 109.70$

HOSPITAL 601490 MAXITROL OPTH OINT. 3.5GM 107.05$

HOSPITAL 601495 MIOCHOL OPTH SOL. 2ML 127.70$

HOSPITAL 601530 PITOCIN --1 UNIT 6.55$

HOSPITAL 601552 VICOPROFEN 7.5MG/200MG TAB 6.55$

HOSPITAL 602214 IBUPROFEN 200MG T 6.55$

HOSPITAL 602220 SPIRONOLACTONE/HCTZ 25/25 6.55$

HOSPITAL 602224 SPIRONOLACTONE 50MG 6.55$

HOSPITAL 602225 SPIRONOLACTONE 25MG TABLET 6.55$

HOSPITAL 602226 SPIRONOLECTONE 100MG 7.20$

HOSPITAL 602235 METHYLDOPA 250MG T 6.55$


HOSPITAL 602275 ALTACE 5MG TAB 6.55$

HOSPITAL 602296 ALTACE 2.5MG CAP 6.55$

HOSPITAL 602350 MECLIZINE 12.5MG T 6.55$

HOSPITAL 602355 MECLIZINE 25MG T 6.55$

HOSPITAL 602365 HYDRALAZINE 10MG T 6.55$

HOSPITAL 602395 HYDRALAZINE 25MG TABLET 6.55$

HOSPITAL 602410 TRIHEXYPHENIDYL 2MG 6.55$

HOSPITAL 602415 TRIHEXYPHENIDYL 5MG 6.55$

HOSPITAL 602425 ASPIRIN 325MG TAB 6.55$

HOSPITAL 602429-A TD TOXOID - PEDIATRIC 90715 230.00$

HOSPITAL 602430 ASA 5 GR ENTERIC 6.55$

HOSPITAL 602435 ASA 5 GR T. 6.55$

HOSPITAL 602445 ASCRIPTIN 325 MG TABLET 6.55$

HOSPITAL 602467 ACTIGALL 300MG CAP 12.35$

HOSPITAL 602468 ASPERCREME 1.25 OZ 13.40$

HOSPITAL 602470 ASPIRIN 81MG TAB *CHEWABLE* 6.55$

HOSPITAL 602479 HYDROXYZINE 10MG T 6.55$

HOSPITAL 602480 HYDROXYZINE 25MG TAB 6.55$

2020-01





HOSPITAL 602500 AVENTYL 25 MG C 6.55$

HOSPITAL 602520 AZULFIDINE 500MG T. 6.55$

HOSPITAL 602540 BENADRYL 25MG C 6.55$


HOSPITAL 602542 BENADRYL CREAM 15GR 13.60$

HOSPITAL 602545 PROBENECID 0.5GM T 6.55$

HOSPITAL 602550 DICYCLOMINE 10MG C 6.55$

HOSPITAL 602553 BUDESONIDE 0.5MG/2ML NEB 18.15$

HOSPITAL 602554 BROVANA 15MCG/2ML NEB 14.55$

HOSPITAL 602555 DICYCLOMINE 20MG T 6.55$

HOSPITAL 602590 BRETHINE 2.5MG T. 6.55$

HOSPITAL 602610 BUMEX 1 MG T. 6.55$

HOSPITAL 602612 BUSPAR 10MG T 6.55$

HOSPITAL 602616 PLAQUENIL 200MG 6.55$

HOSPITAL 602625 CALAN 80 MG T. 6.55$

HOSPITAL 602630 CALAN 120MG T. 6.55$

HOSPITAL 602631 CALAN SR 240MG 8.05$

HOSPITAL 602632 CALAN SR 180MG TAB 7.10$

HOSPITAL 602646 CALTRATE 600 MG 6.55$

HOSPITAL 602650 CARAFATE 1 GM TAB 6.55$

HOSPITAL 602654 CAPOTEN 12.5 MG T 6.55$

HOSPITAL 602655 CAPOTEN 25 MG T 6.55$

HOSPITAL 602658 CARDIZEM SR 60MG CAP 6.55$

HOSPITAL 602662 CAPOZIDE 25/15 6.55$

HOSPITAL 602665 CARDIZEM 30 MG T. 6.55$

HOSPITAL 602666 CARDIZEM 60 MG 6.55$



HOSPITAL 602669 CARDIZEM 120 SR 7.85$

HOSPITAL 602670 CATAPRES 0.1 MG T. 6.55$

HOSPITAL 602671 CARDURA 2MG TAB 6.55$

HOSPITAL 602672 CARDIZEM CD 240MG CAP 12.80$

HOSPITAL 602674 CATOPRES 0.3MG T 6.55$

HOSPITAL 602675 CATAPRES 0.2 MG TAB 6.55$

HOSPITAL 602676 CATAPRES TTS-2 PATCH 72.75$

HOSPITAL 602677 cloNIDine HCL TTS-1 PATCH 43.20$


HOSPITAL 602684 THERA-M VITAMIN TAB 6.55$

HOSPITAL 602686 CETACAINE-1 SPRAY- 6.55$

HOSPITAL 602705 CEPACOL THROAT LOZENGE BX 6.55$

HOSPITAL 602706 CEPASTAT LOZENGE -BOX- 7.60$

HOSPITAL 602708 CHARCOCAPS 6.55$

HOSPITAL 602718 PERIDEX ORAL RINSE -OZ- 6.55$

HOSPITAL 602746 CILOXAN OPTH SOL 25ML 116.40$

HOSPITAL 602750 SULINDAC 150MG T 6.55$

HOSPITAL 602755 SULINDAC 200MG T 7.55$

HOSPITAL 602765 BENZTROPINE 2MG T 6.55$

HOSPITAL 602770 COGENTIN 2 MG T. 6.55$

HOSPITAL 602780 COLCHICINE 0.6 MG TAB 6.55$

HOSPITAL 602790 DOCUSATE SOD 100MG C 6.55$

HOSPITAL 602810 PROCHLORPERAZINE 5MG T 6.55$

HOSPITAL 602815 COMPAZINE 10 MG T. 6.55$

HOSPITAL 602823 CORDARONE 200MG 15.20$

HOSPITAL 602824 CORGARD 20MG TAB 6.55$

HOSPITAL 602825 CORGARD 40MG T. 6.55$

HOSPITAL 602880 COUMADIN 2MG T. 6.55$

HOSPITAL 602885 COUMADIN 2 1/2 MG T. 6.55$

HOSPITAL 602890 COUMADIN 5 MG T. 6.55$

HOSPITAL 602892 CHROMAGEN CAP 6.55$

HOSPITAL 602929 CYTOTEC 100MG TAB 6.55$

HOSPITAL 602930 CYTOMEL 25MG T. 6.55$

HOSPITAL 602935 DANTRIUM 25 MG C. 6.55$

HOSPITAL 602936 DAPSONE 25MG TAB 6.55$

HOSPITAL 602940 DEXAMETHASONE 0.5MG T 6.55$

HOSPITAL 602955 DEXAMETHASONE 4MG TAB 9.95$

HOSPITAL 602961 DEPAKENE 250MG/5ML OZ 37.90$

HOSPITAL 602963 DEPA KOTE 250MG 6.55$

2020-01




HOSPITAL 602964 DEPAKOTE 500MG TABLET 6.60$

HOSPITAL 602965 DESYREL 50MG T. 7.60$

HOSPITAL 602970 DESYREL 100MG TAB 9.45$


HOSPITAL 602972 DIABETA 2.5 6.55$

HOSPITAL 602973 DIABETA 5MG T 6.55$

HOSPITAL 602980 CHLORPROPAMIDE 250MG T 6.55$

HOSPITAL 602981 GLYNASE 3MG 6.55$

HOSPITAL 602993 ZIDOVUDINE 10MG/ML 20ML 94.10$

HOSPITAL 602999 DIAMOX 250 MG T. 6.55$

HOSPITAL 603000 DIAMOX 500MG C. 6.55$

HOSPITAL 603002 NEPTAZANE 50MG 6.55$

HOSPITAL 603030 DILANTIN 50MG T 6.55$

HOSPITAL 603035 DILANTIN 100MG C. 6.55$

HOSPITAL 603041 DILANTIN 30MG 6.55$

HOSPITAL 603060 OXYBUTYNIN 5MG 6.55$

HOSPITAL 603075 CHLOROTHIAZIDE 500MG T 6.55$

HOSPITAL 603105 DONNATAL T. 6.55$

HOSPITAL 603135 BISACODYL 5 MG TABLET 6.55$

HOSPITAL 603145 DYAZIDE C. 6.55$

HOSPITAL 603161 ELDEPRYL 5MG 14.00$

HOSPITAL 603175 EDECRIN 50 MG T. 6.55$

HOSPITAL 603179 THROMBOSTAT SPR 10,000U 282.70$

HOSPITAL 603180 AMITRIPTYLINE 10MG T 6.55$

HOSPITAL 603185 AMITRIPYLINE 25MG T 6.55$




HOSPITAL 603256 EPOGEN 10 000 UNIT /1CC 593.05$

HOSPITAL 603312 SILVER NITRATE STICK EA 6.55$

HOSPITAL 603316 CETACAINE SPRAY 137.20$

HOSPITAL 603317 FER-IN-SOL DROP 50ML EA 29.25$

HOSPITAL 603319 VITAMIN E 200 IU 6.55$

HOSPITAL 603321 DISULFURAM 250MG 6.55$

HOSPITAL 603322 MYSOLINE 50MG TAB 6.55$

HOSPITAL 603324 FELDENE 10 MG C 8.60$

HOSPITAL 603325 FELDENE 20 MG C. 15.20$

HOSPITAL 603346 QUETIAPINE 100MG TAB 13.25$

HOSPITAL 603350 FERROUS GLUCONATE 5GR. C. 6.55$

HOSPITAL 603355 FERROUS SULFATE 325 MG TABLET 6.55$

HOSPITAL 603357 FIBERCON TABS 6.55$

HOSPITAL 603360 CYCLOBENZAPRINE 10MG T 6.55$

HOSPITAL 603362 METRONIDAZOLE 250MG TAB 6.85$

HOSPITAL 603363 METRONIDAZOLE 500MG T 12.25$

HOSPITAL 603365 FLORINEF 0.1MG T. 6.55$

HOSPITAL 603370 FOLIC ACID 1MG TAB 6.55$

HOSPITAL 603382 GLUCOTROL 10 MG T 6.55$

HOSPITAL 603384 GLUCOTROL 5 MG TAB 6.55$

HOSPITAL 603385 HALOPERIDOL 1/2MG T 6.55$

HOSPITAL 603386 NICOTINE 21MG PATCH 11.85$



HOSPITAL 603395 HALOPERIDOL 2MG T 6.55$

HOSPITAL 603396 FLOVENT 44MCG INHALER 13GM 187.75$


HOSPITAL 603405 HALOPERIDOL 10 MG T 8.05$

HOSPITAL 603434 HYDREA 500MG 8.80$

HOSPITAL 603445 HYDROCHLOROTHIAZIDE 25MG TAB 6.55$

HOSPITAL 603450 HYDROCHLOROTHIAZIDE 50MG T. 6.55$

HOSPITAL 603482 HYTRIN 2MG TABLET 6.60$

HOSPITAL 603483 HYTRIN 5MG CAPSULE 6.60$

HOSPITAL 603485 IMURAN 50MG T 6.85$

HOSPITAL 603490 PROPRANOLOL 10MG T 6.55$



HOSPITAL 603505 PROPRANOLOL LA 80MG C 6.55$


HOSPITAL 603525 INDOMETHACIN 25MG C 6.55$

2020-01





HOSPITAL 603535 INDOMETHACIN SR 75MG C 9.10$

HOSPITAL 603539 LODINE 300MG 6.85$

HOSPITAL 603550 ISONIAZID 300MG TAB 6.55$

HOSPITAL 603560 ISOSORBIDE 5MG S T. 6.55$

HOSPITAL 603565 ISOSORBIDE 5MG O T. 6.55$


HOSPITAL 603580 ISOSORBIDE 20MG T 6.55$

HOSPITAL 603605 KAOCHLOR S-F 20MEQ/15ML/PER ML 13.40$

HOSPITAL 603616 KLONOPIN 0.5 TABLET 6.55$

HOSPITAL 603625 LANOXIN 0.125MG T. 6.55$

HOSPITAL 603630 LANOXIN 0.25 MG T. 6.55$

HOSPITAL 603640 FUROSEMIDE 20MG TABLET 6.55$

HOSPITAL 603645 LASIX 40MG TABLET 6.55$

HOSPITAL 603655 CHLORDIAZEPOXIDE/CLIDINIU 6.55$


HOSPITAL 603660 LITHANE 300 MG T. 6.55$

HOSPITAL 603670 LONITEN 2.5 MG T. 6.55$

HOSPITAL 603675 LONITEN 10 MG T. 6.55$

HOSPITAL 603681 LOPID 600MG TABLET 7.10$

HOSPITAL 603685 LOPRESSOR 50MG T. 6.55$

HOSPITAL 603690 LOPRESSOR 100MG TABLET 6.55$

HOSPITAL 603693 PRILOSEC 20MG CAPSULE 23.05$

HOSPITAL 603701 ENOXAPARIN 40MG/0.4ML SYRINGE 92.55$

HOSPITAL 603702 LAMOTRIGINE 25MG TAB 10.05$

HOSPITAL 603703 FAMOTIDINE 20 MG/2 ML VIAL 16.80$

HOSPITAL 603704 CARVEDILOL 3.12 MG TAB 8.40$

HOSPITAL 603705 ICY HOT (ANY SIZE) 31.65$

HOSPITAL 603708 MIDODRINE 5 MG 8.30$


HOSPITAL 603712 TOPIRANATE 100 MG TAB 14.80$

HOSPITAL 603714 ANASTROZOLE 1 MG TAB 34.45$

HOSPITAL 603731 LUBRIDERM LOTION bottle 6.55$

HOSPITAL 603736 ADENOSINE 90MG 585.90$

HOSPITAL 603737 DOCETAXEL 80MG VIAL 2,126.95$

HOSPITAL 603741 MAXAIR INHALER 129.90$

HOSPITAL 603747 MAXZIDE T 6.55$

HOSPITAL 603748 MAXZIDE - 25 6.55$

HOSPITAL 603753 ALBUTEROL 2.5 MG NEB 10.55$

HOSPITAL 603754 ALBUTEROL 1.25MG NEB 6.55$

HOSPITAL 603757 MEGACE 40MG T 7.60$

HOSPITAL 603760 MEDROL 4MG TABLET 6.55$

HOSPITAL 603766 VENLAFAXINE XR 37.5MG 9.90$

HOSPITAL 603770 MEGACE 20MG T. 6.55$

HOSPITAL 603775 MELLARIL 10MG T. 6.55$



HOSPITAL 603819-A DIPTH,PERTUSS TETANUS (ACELL) 90715 436.25$

HOSPITAL 603825 PHYTONADIONE 5 MG TABLET 6.55$

HOSPITAL 603840 METHOTREXATE 2.5MG T. 22.80$

HOSPITAL 603845 MEVACOR T 12.65$

HOSPITAL 603855 MICRO-K EXTEN C. 6.55$

HOSPITAL 603856 POTASSIUM CHLORIDE 10MEQ CAPS 6.55$

HOSPITAL 603860 MIDRIN CAP 6.55$

HOSPITAL 603865 PRAZOSIN 1MG C 6.55$

HOSPITAL 603904 ELIMITE CREAM 60GM TUBE 96.35$

HOSPITAL 603908 CHLOROTHIAZIDE 500MG VIAL 58.65$

HOSPITAL 603910 VICKS 2 OZ SALVE 10.70$

HOSPITAL 603913 ETHAMBUTOL 400MG 8.00$

HOSPITAL 603914 CORTEF 10MG 6.55$

HOSPITAL 603915 ZOLOFT 100MG TAB 11.95$

HOSPITAL 603916-A MMRV VACCINE 90710 113.00$

HOSPITAL 603917 TETRACAINE O.5% OPTH SOL 68.15$

HOSPITAL 603924 BETOPTIC S OPTH. SOLN. 102.90$

HOSPITAL 603933 MONOPRIL 10MG TAB 6.55$



HOSPITAL 603947 MULTI-VITAMIN 6.55$

2020-01




HOSPITAL 603948 MULTIVITAMIN LIQ OZ ADULT 6.55$

HOSPITAL 603949 PHOSLO 667 MG (CA AC) 6.55$

HOSPITAL 603950 VERSED 5MG/ML VIAL 331.55$

HOSPITAL 603953 HYGROTON 25MG T 6.55$

HOSPITAL 603956 PROCHLORPERAZINE 25MG SUP 17.80$


HOSPITAL 603985 NAPROSYN 250MG T. 6.55$


HOSPITAL 603991 NAPROSYN 500 MG TABLET 6.55$

HOSPITAL 604001 FUROSEMIDE 80MG T 6.55$

HOSPITAL 604009 DTIC 200 MG VIAL 91.95$

HOSPITAL 604012 PROZAC 10MG C 11.55$


HOSPITAL 604020 PREMARIN O.9MG 6.55$

HOSPITAL 604021 NORVASC 10MG T 10.70$

HOSPITAL 604031 MEPERIDINE 50 MG T 6.55$

HOSPITAL 604034 HYDROCORTISONE 2.5% 30GM TUBE 39.85$

HOSPITAL 604036 PAXIL 20MG T 10.35$

HOSPITAL 604041 PRELONE 15MG/5CC per ml 50.25$

HOSPITAL 604042 THEODUR 450 MG 3.05$

HOSPITAL 604043 DEPO-PROVERA 150MG SYRINGE 205.50$

HOSPITAL 604046 SPORANOX 100MG 28.70$

HOSPITAL 604047 TOPROL XL 50MG 6.55$

HOSPITAL 604049 IMITREX 6 MG/0.5 ML VIAL 197.80$

HOSPITAL 604051 CIPROFLOXACIN 200MG IV 90.70$

HOSPITAL 604053 DAYPRO 600MG 7.25$

HOSPITAL 604055 NIACIN 100MG T. 6.55$

HOSPITAL 604056 NEW SKIN 19.20$

HOSPITAL 604059 DISALCID 500MG TAB 6.55$

HOSPITAL 604069 NIFEREX 150 C 6.55$

HOSPITAL 604070 NITRO-BID 2.5MG CAP 6.55$

HOSPITAL 604074 L-THYROXINE O.112MG 6.55$

HOSPITAL 604075 NITRO-BID 6.5 C 1.65$

HOSPITAL 604076 BUMEX 0.5MG T 6.55$

HOSPITAL 604078 BETAPACE 80MG TABS 8.90$

HOSPITAL 604079 NITROLINGUAL SPRAY 130.90$

HOSPITAL 604081 NITROGLYCERIN 0.4 MG PATCH 8.40$

HOSPITAL 604082 NITRO PATCH O.6 MG PATCH 8.05$

HOSPITAL 604083 NITRO PATCH O.1MG/H(5CM) 7.60$

HOSPITAL 604084 NITRO PATCH 0.2MG/H(10CM) 9.90$

HOSPITAL 604095 NITROSTAT 1/150 (.4MG)25S 36.10$

HOSPITAL 604097 LOTENSIN 20MG TABLET 6.55$

HOSPITAL 604104 PYRAZINAMIDE 500MG 6.55$

HOSPITAL 604108 SANDOSTATIN 100MCG/ML AMP IM 44.45$

HOSPITAL 604112 ESTRATEST H.S. 3.35$

HOSPITAL 604131 LEVSINEX TIMECAPS 0.375 MG 6.55$

HOSPITAL 604132 LEVSIN SL 6.55$

HOSPITAL 604138 DILANTIN 100MG/4ML CUP 14.70$

HOSPITAL 604139 CLOZARIL 100 MG T 20.05$

HOSPITAL 604140 NOLVADEX 10 MG T 9.20$

HOSPITAL 604141 HALOPERIDOL DEC. 50 MG/CC 121.70$

HOSPITAL 604143 PROPRANOLOL LA 60MG 6.55$

HOSPITAL 604145 NORPACE 100 MG C 6.55$

HOSPITAL 604147 NORMODYNE 100 MG 6.55$

HOSPITAL 604150 NORPACE CR 150 MG C. 6.55$

HOSPITAL 604151 NORPACE CR 100 MG 6.55$

HOSPITAL 604155 NORPACD 150 MG C. 6.55$

HOSPITAL 604158 CYANOCOBALAMIN 500 MCG 6.55$

HOSPITAL 604159 LORATADINE 10 MG TABLET 10.05$

HOSPITAL 604160 ESTRADIOL 2 MG 6.55$

HOSPITAL 604162 FLUPHENAZINE 5MG 6.55$

HOSPITAL 604165 DESIPRAMINE 25MG T 6.55$

HOSPITAL 604166 ZINC 50 MG TABLET 6.55$

HOSPITAL 604167 ESTRADIOL 1MG TAB 6.55$

HOSPITAL 604169 ENALAPRIL 2.5MG 6.55$

HOSPITAL 604170 DESIPRAMINE 50MG T 6.55$

HOSPITAL 604172 COLAGENASE SANTLY 2,449.90$

HOSPITAL 604180 DESIPRAMINE 100MG TABLET 8.60$

2020-01




HOSPITAL 604181 SUCRALFATE SUSP 1GM/10CC 11.70$

HOSPITAL 604183 PEPTAMEN 240 ML CAN 11.20$

HOSPITAL 604185 DESIPRAMINE 150 MG T 11.80$

HOSPITAL 604186 ZOLPIDEM 10MG 8.60$

HOSPITAL 604192 KETOCONAZOLE SHAMPOO 2% 88.30$

HOSPITAL 604193 HYDROXYZINE 50 MG INJ 6.55$

HOSPITAL 604194 LIDOCAINE 2.5% PRILOCAINE 7.70$

HOSPITAL 604197 GLUCERNA 1000 ML RTH 38.80$

HOSPITAL 604200 OGEN .625MG T 6.55$

HOSPITAL 604205 LITHIUM CARBONATE 450 MG 18.85$

HOSPITAL 604207 DROPERIDOL 2CC AMP 45.95$

HOSPITAL 604208 DOXYLAMINE 25MG T 6.55$

HOSPITAL 604209 ONDANSETRON 2MG/ML 2ML VIAL 120.55$

HOSPITAL 604211 METHYL SALICYLATE OIL OZ 3.05$

HOSPITAL 604219 PIPERACILLIN/TAZOB 3.37GM VIAL 79.50$

HOSPITAL 604223 INDAPAMIDE 1.25MG T 6.55$

HOSPITAL 604225 OGEN 1.25 MG T 6.55$

HOSPITAL 604251 BETADINE SOLN 8 OZ 15.15$

HOSPITAL 604255 ORINASE 500 MG TABLET 6.55$


HOSPITAL 604261 CALMOSEPTINE 22.25$

HOSPITAL 604267 KETOPROFEN 75MG C 7.25$

HOSPITAL 604270 OS-CAL 250MG T 6.55$

HOSPITAL 604271 OS CAL 500MG T 6.55$

HOSPITAL 604276 NULYTELY 4000 ML BOTTLE 99.40$

HOSPITAL 604290 PAMELOR 10MG C 6.55$

HOSPITAL 604291 VENLAFAXINE 37.5 MG 6.55$

HOSPITAL 604294 IMDUR 60MG TABS 6.90$

HOSPITAL 604295 PAMELOR 25MG C 6.55$

HOSPITAL 604296 PAMELOR 50 MG T 9.80$

HOSPITAL 604297 AMYLASE/LIPASE/PROTEASE 1 COMB 6.55$

HOSPITAL 604301 PARAFON FORTE DSC 6.55$

HOSPITAL 604302 ONDANSETRON 8MG TABS 32.55$

HOSPITAL 604304 ZAROXOLYN 10MG T 6.55$

HOSPITAL 604305 LACTAID CAPLET 6.55$

HOSPITAL 604313 POT. CL. 20MEQ/15CC (UD) 6.55$

HOSPITAL 604318 STADOL SPRAY 335.55$

HOSPITAL 604320 ASACOL 400MG 6.55$

HOSPITAL 604323 BLISTEX LIP OINT 6.55$

HOSPITAL 604324 PARLODEL 2.5MG TABLET 8.90$

HOSPITAL 604336 ISOSORBIDE MONONIT. 10MG 6.55$

HOSPITAL 604338 MIDAZOLAM 5MG/CC 50.20$

HOSPITAL 604352 PCE 500MG 9.00$

HOSPITAL 604353 PEPCID 20MG TABLET 9.10$

HOSPITAL 604354 PEPTO-BISMOL TAB 6.55$

HOSPITAL 604360 PERIACTIN 4MG T 6.55$

HOSPITAL 604371 CORTISONE 25MG T 6.55$

HOSPITAL 604380 DIPYRIDAMOLE 25MG T 6.55$



HOSPITAL 604386 HYDROGEN PEROXIDE 120 ML BTL 6.55$

HOSPITAL 604387 PEROXIDE 16 OZ 6.55$

HOSPITAL 604394 PROMETHAZINE 12.5MG T 6.55$

HOSPITAL 604399 PLENDIL 5MG 6.55$

HOSPITAL 604404 DOMEBORO PKTS 12'S 48.35$

HOSPITAL 604405 WELLBUTRIN 75MG 6.55$

HOSPITAL 604407 DEBROX DROPS 15ML 16.30$

HOSPITAL 604408 LISINOPRIL/HCTZ 20/12.5 TABLET 6.55$

HOSPITAL 604416 POLYSPORIN OPHTH OINTMENT 19.30$

HOSPITAL 604426 ZESTORETIC 20/25 TABLET 6.55$

HOSPITAL 604433 PRAVACOL 20MG TAB 11.20$

HOSPITAL 604435 PREDNISONE 1MG T 6.55$





HOSPITAL 604451 NITRO PATCH 0.3MG/H (15CM) 9.10$

HOSPITAL 604452 TRIAMCINOLONE ORABASE 5GM 66.60$

2020-01




HOSPITAL 604453 DOXAZOSIN MESYLATE 4 MG TAB 6.55$

HOSPITAL 604454 VOSOL-HC OTIC 172.05$

HOSPITAL 604455 PREMARIN 0.3MG T 6.55$




HOSPITAL 604467 PRE-NATAL VITAMIN 6.55$

HOSPITAL 604469 PRINIVIL 10MG T 6.55$



HOSPITAL 604482 NIFEDIPINE XL 30MG T 15.05$



HOSPITAL 604485 NIFEDIPINE 10MG C 6.55$

HOSPITAL 604487 PROTOPAM 1GM/20ML 159.90$

HOSPITAL 604489 PROVERA 2.5MG T 6.55$

HOSPITAL 604508 NEPHROCAPS 6.55$

HOSPITAL 604509 LIDOCAINE 4% TOP SOL/ML 1.80$

HOSPITAL 604510 BUMEX 2MG T 6.55$

HOSPITAL 604511 LAC-HYDRIN 12% LOTION 158.75$

HOSPITAL 604514 HYTRIN 1MG 7.45$

HOSPITAL 604515 PROVERA 5MG 6.55$


HOSPITAL 604518 ESTRATEST TABLET 6.55$

HOSPITAL 604527 ISOSORBIDE TEMBIDS 40MG T 6.55$

HOSPITAL 604528 KLONOPIN 1MG 6.55$

HOSPITAL 604534 ADRENALIN 1MG/ML 30ML 57.90$

HOSPITAL 604543 PROPYLTHIOURACIL 50 MG TAB 6.55$

HOSPITAL 604545 ALBUTEROL 2MG T 6.55$

HOSPITAL 604548 SLOW-MAG 64 MG TAB 6.55$

HOSPITAL 604549-A HEPATITIS B VAC 10MCG/0.5ML 90744 267.25$

HOSPITAL 604551 ALBUTEROL 4MG REPTABU 6.55$

HOSPITAL 604552 TOBREX OPH OINT 3.5 GM 103.05$

HOSPITAL 604553 PROSCAR 5MG T 11.35$

HOSPITAL 604555 PROVERA 10MG TAB 6.55$

HOSPITAL 604558 PROZAC 20MG 13.15$

HOSPITAL 604565 PYRIDIUM 100MG T 6.55$


HOSPITAL 604572 PYRIDOXINE 25MG B-6 6.55$

HOSPITAL 604573 PYRIDOXINE 50MG 6.55$

HOSPITAL 604581 ACETYLCYSTEINE 200 MG/ML VIAL 23.90$

HOSPITAL 604585 QUINAGLUTE 324MG T 6.55$

HOSPITAL 604587 NITROGLYCERIN .4MG T 6.55$

HOSPITAL 604591 DEXTROSE 25% 10ML PED SYR 20.10$

HOSPITAL 604593 NARCAN 1MG AMP 38.10$

HOSPITAL 604597 MACROBID 100MG C 8.00$

HOSPITAL 604603 PROMETHAZINE 12.5MG SUPP 11.90$

HOSPITAL 604604 T-STAT 2% SOL 86.60$

HOSPITAL 604615 LIDOCAINE 2% W/EPI 20CC 13.55$

HOSPITAL 604621 CARDIZEM CD 120MG 19.90$

HOSPITAL 604625 QUININE SULFATE 325MG C 6.55$

HOSPITAL 604630 RELAFEN 500MG 6.55$

HOSPITAL 604637 ESTRADERM 0.1 PATCH 13.75$

HOSPITAL 604639 METOCLOPRAMIDE 5MG T 6.55$


HOSPITAL 604641 ESTRADERM 0.05MG PATCH 11.65$

HOSPITAL 604643 BISOPROLOL 2.5/HCTZ 6.25MG 6.55$

HOSPITAL 604655 METHOCARBAMOL 500MG T 6.55$

HOSPITAL 604658 NORVASC 5MG 6.70$


HOSPITAL 604662 ZINC SULFATE 220MG 6.55$

HOSPITAL 604668 TORSEMIDE 10MG TABLET 6.55$

HOSPITAL 604671 SECTRAL 200MG 6.55$

HOSPITAL 604674 SIMVASTATIN 10MG T 9.45$

HOSPITAL 604679 METIPRANOLOL OPTH SOL 10M 100.15$

HOSPITAL 604680 SENOKOT TABLET 6.55$

HOSPITAL 604683 RISPRIDONE 1 MG TABLET 11.10$

HOSPITAL 604692 WARFARIN 1MG T 6.55$

2020-01




HOSPITAL 604693 METRONIDAZOLE VAG GEL 138.45$

HOSPITAL 604694 FAMCICLOVIR 500 MG TABLET 35.70$

HOSPITAL 604698 MEGACE SUSP 40MG/ML EA CC 6.55$

HOSPITAL 604701 LOSARTAN POTASSIUM 25MG TAB 6.55$


HOSPITAL 604704 PYRIDOSTIGMINE 180MG T 6.55$

HOSPITAL 604708 LIDOCAINE JELLY 2% 5ML TUBE/ML 17.40$

HOSPITAL 604709 SUMATRIPTAN SUCCINATE 25MG TAB 56.40$

HOSPITAL 604710 SINEMET 10/100 T 6.55$

HOSPITAL 604711 METRONIDAZOLE .75% CREAM 131.60$

HOSPITAL 604712 HEPARIN 1000U/CC MDV 9.10$

HOSPITAL 604713 GABAPENTIN 400MG C 7.70$

HOSPITAL 604714 CEFTRIAXONE 1 GM VI 199.65$


HOSPITAL 604717 DORZOLAMIDE HCL 2% 111.00$


HOSPITAL 604721 SINEMET CR 8.65$

HOSPITAL 604722 HEPARIN 1000U/CC 10CC MDV 8.45$

HOSPITAL 604725 SINEQUAN 10MG C 6.55$

HOSPITAL 604727 HEPARIN 100 UNITS/ML IV SOLN 29.90$


HOSPITAL 604732 CLARITHROMYCIN 250MG SUSP. 142.20$

HOSPITAL 604734 CASODEX 50MG TABLET 59.20$


HOSPITAL 604736 AZITHROMYCIN 200mg/5ml 15mlBTL 135.00$

HOSPITAL 604737 FRAGMIN 2500 IU/0.2ML 77.35$

HOSPITAL 604739 HYZAAR 50/12.5MG TABLET 6.55$


HOSPITAL 604742 DILTIAZEM 5MG/ML 10 ML VIAL 125.85$

HOSPITAL 604746 HYDROCODONE/APAP 7.5/500 1 ML 6.55$

HOSPITAL 604748 MOEXIPRIL 15MG TAB 6.55$

HOSPITAL 604757 VITAMIN A 10,000 UNITS 6.55$

HOSPITAL 604758 CALCITONIN NASAL 30 SPRAY BTL 131.20$

HOSPITAL 604759 CARTEOLOL 1% OPHTH SOL 5ML BOT 88.15$

HOSPITAL 604761 MESNEX 1000 MG 40.45$

HOSPITAL 604763 DINOSPROSTONE 10MG 504.05$


HOSPITAL 604768 DOPAMINE 400MG PREMIX 78.65$

HOSPITAL 604769 CETIRIZINE 10MG T 9.70$

HOSPITAL 604771 GLUCOPHAGE 850 MG TABLET 6.55$

HOSPITAL 604773 OXYCODONE 10MG T 6.55$

HOSPITAL 604777 DOBUTAMINE 250MG/250CC D5 367.70$

HOSPITAL 604778 FOSAMAX 10MG T 13.20$


HOSPITAL 604784 OXYCODONE 20MG TAB 12.25$

HOSPITAL 604787 MENINGOCOCCAL VACCINE 90733 332.10$

HOSPITAL 604790 CARISOPRODOL 350MG T 6.55$

HOSPITAL 604792 CALCIUM CITRATE 6.55$


HOSPITAL 604801 OXYCODONE 5MG CAP 6.55$

HOSPITAL 604803 TIMOPTIC XE 0.5% OPH 5ML 154.90$

HOSPITAL 604805 GABAPENTIN 100MG CAP 6.55$

HOSPITAL 604807 GLIMEPIRIDE 4 MG TABLET 6.55$

HOSPITAL 604809 DIVALPROEX 125MG T 6.55$



HOSPITAL 604818 LORATADINE/PSEUOEP 5/120 6.55$

HOSPITAL 604819 AMOXICILLIN/CLAV 875MG T 25.00$

HOSPITAL 604820 SINEMET CR 25/100 TAB 6.55$

HOSPITAL 604821 MAG SULFATE 40GM/L PREMIX 36.20$

HOSPITAL 604823 GEMCITABINE 1GM VIAL 660.20$

HOSPITAL 604824 MAGNESIUM OXIDE 400MG TABLET 6.55$

HOSPITAL 604826 CONJ. EXTROGEN/MEDROXPROG PKG 10.45$

HOSPITAL 604830 FLUTICASONE 220MCG INHALER 311.15$

HOSPITAL 604831 NASACORT AQ NASAL SPRAY 183.65$

HOSPITAL 604832 SORBITOL 70% SOL PER ML 6.55$

HOSPITAL 604834 LATANOPROST OPH 0.005% 2.5ml 209.30$

HOSPITAL 604836 PLACEBO 6.55$

2020-01




HOSPITAL 604837 SPECTAZOLE CR 15GR 67.05$

HOSPITAL 604845 STELEZINE 2 MG T. 6.55$

HOSPITAL 604860 STESSTABS 600 T. 6.55$

HOSPITAL 604870 SUDAFED 30 MG T./PSEUDOEP 6.55$

HOSPITAL 604875 SUDAFED 60 MG /PSEUDOEPHE 6.55$

HOSPITAL 604888 MIRTAZAPINE 30MG TAB 12.90$

HOSPITAL 604890 DOCUSATE CALCIUM 240 MG C 6.55$

HOSPITAL 604891 FOSPHENYTOIN NA 50 MG/ML 2 ML 103.80$

HOSPITAL 604895 ZAFIRLUKAST 20MG T. 6.55$

HOSPITAL 604901 FENTANYL EPIDURAL MIXTURE 86.55$

HOSPITAL 604904 PETROLATUM OPTH.OINT 16.65$

HOSPITAL 604905 SYMMETREL 100 MG C. 6.55$

HOSPITAL 604906 REMIFENTANIL 1MG VIAL 67.50$

HOSPITAL 604909 FLUTICASONE 110MCG 289.30$

HOSPITAL 604910 TOBRAMYCIN 40MG/1ML 108.55$

HOSPITAL 604913 PANCURONIUM 2MG/ML 33.10$

HOSPITAL 604915 L-THYROXINE 0.O25 MG T 6.55$

HOSPITAL 604920 L-THROXINE 0.1 MG TABLET 6.55$

HOSPITAL 604921 L-THROXINE 0.125 MG T 6.55$

HOSPITAL 604922 L-THYROXINE 0.075 MG TAB 6.55$

HOSPITAL 604925 L-THYROXINE 0.05 MG T 6.55$

HOSPITAL 604930 L-THYRXINE 0.15 MG T 6.55$


HOSPITAL 604938 AZITHROMYCIN 100MG/5CC 15CC 141.75$

HOSPITAL 605003 CARBAMAZEPINE 100MG/5ML ML SUS 9.10$

HOSPITAL 605005 CARBAMAZEPHINE 200 MG TAB 6.55$

HOSPITAL 605006 TEMOVATE CREAM 30 GM 175.50$

HOSPITAL 605007 TENEX 1 MG 6.55$

HOSPITAL 605025 ATENOLOL 50 MG T 6.55$


HOSPITAL 605028 CARBOXYMETHYLCELLULOSE 39.70$

HOSPITAL 605030 TESSALON 100 MG PERLES 6.55$

HOSPITAL 605032 CARDIZEM CD 180 MG CAPSULE 7.20$

HOSPITAL 605033 THEO-DUR 100 MG 6.55$

HOSPITAL 605034 ASPIRIN 81 MG ENTERIC T 6.55$

HOSPITAL 605035 THEO-DUR 200 MG T 6.55$

HOSPITAL 605036 TRAMADOL 50 MG TABLET 6.55$

HOSPITAL 605037 FLUTICASONE NASAL INHALER 233.40$

HOSPITAL 605038 FLUVOXAMINE 100 MG 20.05$

HOSPITAL 605040 THEO-DUR 300 MG T 6.55$

HOSPITAL 605043 DICLOFENAC 0.1% OPTH 5ML 155.60$

HOSPITAL 605052 LIDOCAINE VIS PER DOSE 6.55$

HOSPITAL 605055 OFLOXACIN 0.3% OPH SOLN 132.65$

HOSPITAL 605057 MORPHINE 30 MG T 6.55$

HOSPITAL 605060 FLUVOXAMINE 50 MG TABLET 12.65$

HOSPITAL 605062 CAFFEINE/SOD BENZOATE AMP 141.05$

HOSPITAL 605063 EPSOM SALT 4OZ 6.55$

HOSPITAL 605064 GLUCOPHAGE 500 MG 6.55$

HOSPITAL 605067 KETOROLAC .5% O.S. 160.20$


HOSPITAL 605070 LANSOPRAZOLE 30 MG CAPSULE 18.55$

HOSPITAL 605073 VINORELBINE 10 MG/1CC VIAL 184.30$

HOSPITAL 605078 THIAMINE 100 MG T 6.55$

HOSPITAL 605085 CHOLRPROMAZINE 25 MG T 6.55$

HOSPITAL 605090 CHLORPROMAZINME 50 MG T 6.55$

HOSPITAL 605095 CHLORPROMAZINE 100 MG T 6.55$

HOSPITAL 605105 THROID ARMOUR 1/2 GR 30 MG 6.55$

HOSPITAL 605110 THYROID 60mg TAB 6.55$

HOSPITAL 605115 THYROID ARMOUR 2 GR 6.55$

HOSPITAL 605117 THYROID 3 GR 6.55$

HOSPITAL 605122 TICLID 250 MG TAB 8.85$

HOSPITAL 605124-A ZOSTAVAX LIVE VACCINE 90736 232.75$

HOSPITAL 605136 LEVOTHYROXINE 0.3MG TAB 6.55$

HOSPITAL 605140 IMIPRAMINE 10 MG T 6.55$


HOSPITAL 605188 TRANDATE 200 T 6.55$

HOSPITAL 605191 TRANSDERM SCOP 22.30$

HOSPITAL 605198 TRENTAL 400 MG 6.55$

2020-01




HOSPITAL 605225 TRILAFON 2 MG T 6.55$

HOSPITAL 605250 TUMS TABLET 6.55$

HOSPITAL 605260 ACETAMINOPHEN 325 MG TAB 6.55$

HOSPITAL 605275 ACETAMINOPHEN CH CHEW TAB 6.55$

HOSPITAL 605290 URECHOLINE 10 MG T 6.55$

HOSPITAL 605295 URECHOLINE 25 MG T 6.55$

HOSPITAL 605300 URISED T 6.55$

HOSPITAL 605305 URISPAS 100 MG T 6.55$

HOSPITAL 605317 VASOTEC 5 MG T 6.55$



HOSPITAL 605321 VERMOX 100MG CHEW TAB 27.80$

HOSPITAL 605345 VISKEN 5 MG T 6.55$

HOSPITAL 605355 HYDROXYZINE 25 MG C 6.55$


HOSPITAL 605373 ASCORBIC ACID 250 MG 6.55$


HOSPITAL 605375 VITAMIN E 400 I.U.C 6.55$

HOSPITAL 605386 VOLTAREN 50 MG T 6.55$


HOSPITAL 605393 WELLBUTRIN 100 MG TAB 6.55$

HOSPITAL 605400 ETODOLAC 500MG TAB 8.30$

HOSPITAL 605410 ZAROXOLYN 2 1/2 MG T 6.55$

HOSPITAL 605413 ZOVIRAX 800 MG TABLET 22.20$

HOSPITAL 605415 ZAROXOLYN 5 MG T 6.55$

HOSPITAL 605416 PRINIVIL 5 MG TAB 6.55$

HOSPITAL 605420 ALLOPURINOL 100 MG T 6.55$

HOSPITAL 605421 LEVOBUNOLOL .5% O.S. 100.25$


HOSPITAL 605511 ADENOSINE 3 MG/ML 2ML VI 172.45$

HOSPITAL 605513 ALBUMIN 12.5gm/50ml (50ml bag) 528.00$

HOSPITAL 605515 METHYLDOPA/ALDOMET 250 IV 62.05$

HOSPITAL 605525 AMINOPHYLLINE 250 MG/10 ML 18.25$

HOSPITAL 605541 AQUOSOL A 50,000 IV 73.05$

HOSPITAL 605542 VITAMIN K INJ 10MG/CC 27.60$

HOSPITAL 605543 VITAMIN K INJ 1 MG/0.5ML PED 14.15$

HOSPITAL 605556 TRIAMCINOLONE CR. 0.5% 24.35$

HOSPITAL 605565 BACTRIM 5 ML AMP IV 48.80$

HOSPITAL 605585 DICYCLOMINE 10MG/ML 2ML AMP 18.95$

HOSPITAL 605595 BRETHINE 1 MG/1ML AMP IV 11.05$

HOSPITAL 605605 CALAN 5MG/2ML VIAL 87.05$

HOSPITAL 605610 CARBOCAINE 1% 30 ML VIAL 59.90$

HOSPITAL 605617 CALCIMAR 200 U ML 160.75$

HOSPITAL 605620 CALCIUM GLUC 1000 MG/10ML VIAL 16.10$

HOSPITAL 605625 CALCIUM CHLORIDE 100 MG IV 74.35$

HOSPITAL 605635 CELESTONE SOLUS 6MG/ML 5ML IV 109.30$

HOSPITAL 605645 BENZTROPINE 2MG/2CC 41.35$

HOSPITAL 605655 COMPAZINE 10MG/2ML IV 32.40$

HOSPITAL 605670 CYANOCOLBALMIN 1000MCG/ML VIAL 12.10$

HOSPITAL 605680 CYCLOPHOSPHAMIDE 500 MG IV 197.10$

HOSPITAL 605682 DDAVP INJ 4MCG/1ML AMP 141.25$

HOSPITAL 605683 DDAVP NASAL SPRAY 622.90$

HOSPITAL 605725 DEPO-MEDROL 40MG/1ML 1CC 36.95$

HOSPITAL 605730 DEPO-MEDROL 80MG VIAL 67.95$

HOSPITAL 605735 D.H.E 45 AMP 1MG/ML 56.95$

HOSPITAL 605740 DIAMOX 500MG INJ 199.00$

HOSPITAL 605745 DILANTIN 100 MG VIAL 40.75$


HOSPITAL 605755 DOPRAM 20 MG/ML 20 ML 269.00$

HOSPITAL 605785 FLUOROURACIL 500 MG AMP 12.55$

HOSPITAL 605790 FOLVITE 5MG/CC 10ML IV 81.40$

HOSPITAL 605794 FUROSEMIDE 100 MG IV 40.35$

HOSPITAL 605795 HALOPERIDOL 5MG/CC INJ 34.45$

HOSPITAL 605800 HEPARIN 5,000 UNIT 13.75$

HOSPITAL 605830 INFED 100MG/2ML AMP 83.65$

HOSPITAL 605860 TRIAMCINOLONE 40MG/CC 1CC 31.70$

HOSPITAL 605866 BLENOXANE 15 U VIAL 777.90$

HOSPITAL 605870 LANOXIN 0.5 MG/2CC AMP 10.35$

2020-01




HOSPITAL 605879 LUPRON 7.5 MG 996.20$

HOSPITAL 605880 CISPLATIN 1MG/ML 696.70$

HOSPITAL 605882 EPOGEN 3000 U/ML 249.15$

HOSPITAL 605887 LEVOPHED 1MG/Ml 4ML 57.85$

HOSPITAL 605890 MAGNESIUM SULFATE 50% 1GM/2ML 31.35$

HOSPITAL 605895 BUPIVACAINE .25% 30 ML 41.75$


HOSPITAL 605908 METHYLENE BLUE 10MG/1ML AMP 78.20$

HOSPITAL 605910 METHOTREXATE 50 MG IV 28.90$

HOSPITAL 605939 VECURONIUM BROMIDE 1MG/ML 10ml 138.30$

HOSPITAL 605940 NUBAIN 10 MG 1 ML 18.25$

HOSPITAL 605980 PONTOCAINE 2% TOP 30ML 116.15$

HOSPITAL 606005 PRONESTYL 1GM/2ML 113.05$

HOSPITAL 606025 REGLAN 10MG/2ML 16.75$

HOSPITAL 606045 SOLU-CORTEF 100 MG 28.85$


HOSPITAL 606055 SOLU-MEDROL 40 MG VIAL 20.55$



HOSPITAL 606088 TPA 100MG VIAL 6,522.05$

HOSPITAL 606092 L-THYROXINE 0.2 MG IV 221.00$

HOSPITAL 606110 THIAMINE 100MG/2ML VIAL 4.35$

HOSPITAL 606120 CHLORPROMAZINE 50MG/2ML VL 99.70$

HOSPITAL 606136 TORADOL 60 MG IM 47.40$

HOSPITAL 606137 TORADOL 10 MG TABS 7.40$

HOSPITAL 606168 ZOLOFT 50 MG 12.65$


HOSPITAL 606185 METAMUCIL PACKET 6.55$

HOSPITAL 606195 K-LYTE 25MEQ 6.55$

HOSPITAL 606200 QUESTRAN 50M PACK 7.75$

HOSPITAL 606215 CORTENEMA 100 MG ENEMA 34.60$

HOSPITAL 606245 CASTOR OIL 60 ML BOTTLE 13.00$

HOSPITAL 606260 DERMOPLAST SPRAY 60ML 24.80$

HOSPITAL 606286 L-THYROXIN 0.088MG 6.55$

HOSPITAL 606287 DONEPEZIL 5MG TAB 23.90$

HOSPITAL 606292 SORBITOL SOLUTION 30 ML CUP 6.55$

HOSPITAL 606293 OLANZAPINE 10MG T 42.80$

HOSPITAL 606296 ALPHAGAN 0.2% OPH SOL 125.40$

HOSPITAL 606297 RELAFEN 750 MG TAB 6.95$

HOSPITAL 606298 CLARITIN-D 24 HR T 6.55$

HOSPITAL 606300 MIDAZOLAM 10MG/10CC 100.55$

HOSPITAL 606302 GUAIFENESIN-DM T. 6.55$

HOSPITAL 606303 FLUCONAZOLE 40MG/ML 35ML 294.30$

HOSPITAL 606309 MESALAMINE 250 MG 6.55$

HOSPITAL 606311 ASTELIN 137mcg NASAL SPRAY 245.45$

HOSPITAL 606340 XOPENEX 1.25MG/3ML MINI NEBS 10.90$

HOSPITAL 606341 XOPENEX 0.63mg/3ml NEB 10.10$

HOSPITAL 606346 LOTENSIN 10 MG TAB 6.55$

HOSPITAL 606348 CITRUCIL PKT 6.55$

HOSPITAL 606395 MINERAL OIL 6.55$

HOSPITAL 606405 SIMETHICONE 80 MG CHEW TABLET 6.55$

HOSPITAL 606415 PEPTO-BISMOL OZ 6.55$

HOSPITAL 606450 SOD BICARB 10GR T 6.55$

HOSPITAL 606461 IBUPROFEN SUSP PER ML 6.55$

HOSPITAL 606480 HYDROXZINE 10 MG/5CC OZ 15.70$

HOSPITAL 606490 DICYCLOMINE SYRUP OX 9.10$

HOSPITAL 606497 TORESEMIDE 20 MG TAB 6.55$

HOSPITAL 606516 CHARCHOL BT 39.05$

HOSPITAL 606520 CHERRY SYR OZ 6.55$

HOSPITAL 606535 CHLOROSEPTIC SPRAY OZ 18.25$

HOSPITAL 606555 DOCUSATE SOD 20MG/5CC OZ 6.55$

HOSPITAL 606575 DEXAMETHASONE .50MG/5CC OZ 22.30$

HOSPITAL 606585 DILANTIN 125MG/5CC EA OZ 20.00$

HOSPITAL 606598 FLUDARA 50 MG 304.20$

HOSPITAL 606605 DONNATAL OZ 8.00$

HOSPITAL 606616 DILTIAZEM 5MG/ML VIAL 69.10$

HOSPITAL 606619 GLIPIZIDE 5MG EXT RELEASE 6.55$

HOSPITAL 606620 FEOSOL ELIXIR (PER CC) 6.55$

2020-01




HOSPITAL 606629 GLYCERIN PEDIATRIC SUPP 6.55$

HOSPITAL 606637 GI COCKTAIL 11.25$

HOSPITAL 606644 NITROGLYCERIN PREMIX 50 MG BTL 78.15$

HOSPITAL 606645 HALOPERIDOL 2 MG/CC 15CC 105.90$

HOSPITAL 606646 BOTULINUM TOXIN A 100 UNITS/VI 905.55$

HOSPITAL 606650 NITROGLYCERIN SPRAY/DOSE 6.55$

HOSPITAL 606661 ISMO 20 MG 6.55$

HOSPITAL 606671 JEVITY 1000ML 28.65$

HOSPITAL 606673 ENSURE PLUS 1000ML 28.65$

HOSPITAL 606676 SOD POLYSTYRENE SLF 30GM/120ML 107.35$

HOSPITAL 606682 CYCLOSPORINE 100 MG CAP 29.15$

HOSPITAL 606684 TOBRAMYCIN 1.2 GM POWDER 603.70$

HOSPITAL 606685 LANOXIN .05MG/ICC 60 ML3 98.90$

HOSPITAL 606686 LABETALOL HCL 5 MG/ML VIAL 179.20$

HOSPITAL 606687 GABAPENTIN 300 MG C 6.55$

HOSPITAL 606690 TERBINAFIN HCL CR 1% 111.70$

HOSPITAL 606691 ETOOLAC 400 MG T 6.85$

HOSPITAL 606698 POLYCITRA -OZ- 6.55$

HOSPITAL 606701 NIFERIX LIQ OZ 8.40$

HOSPITAL 606703 PREDNISONE 5MG/5ML CUP 25.80$

HOSPITAL 606704 METOCLOPRAMIDE SYR OZ 11.20$

HOSPITAL 606724 ANTIFUNGAL CRM 5OZ 33.95$

HOSPITAL 606730 SYMMETREL 50MG/5ML ML 30.75$

HOSPITAL 606743 LIDOCAINE GARGLE 7.10$

HOSPITAL 606745 ZANTAC 15MG/1CC SYR -OZ- 69.30$

HOSPITAL 606770 TB VACCINE-TUBERSOL 0.1ML DOSE 86580 10.80$

HOSPITAL 606775 ANTI-VENOM SPIDER -R- 128.90$

HOSPITAL 606781 DIGIBIND 40MG VIAL 828.15$

HOSPITAL 606798 ALBUTEROL 2MG/5CC LIQ 12.25$

HOSPITAL 606855-A INFLUENZA VIRUS VACCINE 90658 39.45$

HOSPITAL 606856-A FLUZONE PED FLU VACCINE 90658 18.70$

HOSPITAL 606859 FLULAVAL 0.5ML SYRINGE 90658 23.95$

HOSPITAL 606890 LASIX ORAL SOL 60ML -R- 52.75$

HOSPITAL 606905 MAGNESIUM CITRATE 300 ML BOT 6.55$

HOSPITAL 606910 MVI 12 VIAL 10 ML 16.25$

HOSPITAL 606945-A PNEUMOVAX-23 .5ML -R- 90732 136.00$

HOSPITAL 606946 PREVNAR 13VALANT CONJUG 0.5ML 90670 261.00$

HOSPITAL 606950 PREMARIN INJECT 25 MG VIAL 187.95$

HOSPITAL 606960 PROTAMINE SULFATE 10MG/ML 25ML 127.95$

HOSPITAL 606969 RABIES VACCINE (IMOVAX) 90675 346.45$

HOSPITAL 606970 RABIES IMMUNE GLOB 150U/ML 2ML 90375 606.50$

HOSPITAL 606990-A TETANUS TOXOID,ADSORBED/PF 90714 221.25$

HOSPITAL 607013 HETASTARCH 6% / NS 500 ML BAG 440.75$

HOSPITAL 607015 MANNITOL 25% 50ML 22.95$

HOSPITAL 607040 POT CHLORIDE PREMIX 10MEQ 22.15$

HOSPITAL 607042 POT CHORIDE PREMIX 20MEQ 22.15$

HOSPITAL 607045 POTASSIUM CHLOR 2MEQ/ML 20ML V 26.10$

HOSPITAL 607050 POT PHOSPHATE 15MM/5ML VIAL 21.10$

HOSPITAL 607058 SOD CHLOR 250CC ADV. 35.20$


HOSPITAL 607060 SOD CHLORIDE 4MEQ/ML 30ML VL 14.95$

HOSPITAL 607062 SODIUM PHOSPHATE 15CC 29.80$

HOSPITAL 607103 ANTIPYR/B-CAINE/GLY EAR DROPS 26.30$

HOSPITAL 607106 IPRATROPIUM INHALER 98.90$

HOSPITAL 607107 AZMACORT INHALER 232.30$

HOSPITAL 607110 AMMONIA INHALENTS EA 6.55$

HOSPITAL 607140 NEO-SYNEPHRINE 0.25% 22.45$

HOSPITAL 607155 OCEAN SPRAY 6.85$

HOSPITAL 607185 EPINEPHrine 2.25% INHALANT NEB 6.55$

HOSPITAL 607243 LORATADINE SYRUP -PER CC- 6.55$

HOSPITAL 607564 ELEVIEW 85.95$

HOSPITAL 607798-A TETANUS, DIPHTHERIA TOX 90715 230.60$

HOSPITAL 608017 CETAPHIL CLEANSING LOTION BTL 53.30$

HOSPITAL 608048 BUSPAR 5MG 6.55$

HOSPITAL 608055 EFFERDENT 1 BOX 8.05$

HOSPITAL 608067 HIBICLENS 39.15$

HOSPITAL 608135 TUCKS BOX OF 40 12.00$

HOSPITAL 608140 PETROLEUM JELLY OZ 6.55$

2020-01




HOSPITAL 608180 OLANZAPINE 5MG TAB 31.30$

HOSPITAL 608181 OLANZAPINE 2.5MG T 23.95$

HOSPITAL 608202 ADRENALIN TOPICAL 57.90$

HOSPITAL 608225 ANUSOL HC CR 1 OZ 62.80$

HOSPITAL 608235 TRIAMCINOLONE OI 0.1% 15G 51.50$

HOSPITAL 608290 CALADRYL LOT 2 1/2 OZ 8.55$

HOSPITAL 608295 CALAMINE 4 OZ 6.55$

HOSPITAL 608395 BETAMETHASONE DIP 15G CR 93.50$

HOSPITAL 608432 ELOCON CREAM 0.1% 15GM TUBE 83.15$

HOSPITAL 608460 GYNE-LOTRIMIN CREAM 45 GM TUBE 104.85$

HOSPITAL 608461 ZEMURON -MG- 6.55$

HOSPITAL 608471 HYDROCORTISONE .5% CR 12.55$

HOSPITAL 608472 HYDROCORTISONE 1% 6.60$

HOSPITAL 608475 HYDROCORTISONE 1% LOTION 36.55$

HOSPITAL 608505 FLUOCINONIDE CR 15GM 33.35$

HOSPITAL 608515 LOPROX 1% CR 30G 106.50$

HOSPITAL 608520 LOTRIMIN 1% 15G CR 64.35$


HOSPITAL 608531 LOTRISONE CR 15GM 99.40$


HOSPITAL 608545 MONISTAT CR 90.25$

HOSPITAL 608550 MICONAZOLE VAG SUPP -EA- 15.20$

HOSPITAL 608555 MONISTAT-DERM 30G 113.60$

HOSPITAL 608565 MYCELEX 15G CR 54.55$

HOSPITAL 608570 MYCOLOG CR 15G 16.10$

HOSPITAL 608575 MYCOLOG CR 30G 29.50$

HOSPITAL 608580 MYCOLOG OINT 15 16.10$

HOSPITAL 608585 MYCOLOG OINT 30G 29.50$

HOSPITAL 608592 MYCOSTATIN POWDER 125.05$

HOSPITAL 608595 MYOFLEX 2 OZ 21.25$


HOSPITAL 608630 NEOSPORIN OINT 1/2 OZ 30.50$

HOSPITAL 608640 NILSTAT CR 15G 42.35$

HOSPITAL 608645 NITROGLYCERIN OINT 30 GM TUBE 32.55$

HOSPITAL 608648 NIZORAL 2% CREAM 15GM 78.15$

HOSPITAL 608655 POLYSPORIN OINT 20.40$

HOSPITAL 608660 PREPARATION H OZ 40.50$

HOSPITAL 608665 PREMARIN CR 186.45$

HOSPITAL 608670 PROCTOFOAM - HC 116.10$

HOSPITAL 608673 MARINOL 2.5MG C 18.90$

HOSPITAL 608675 PROCTOCORT 92.95$

HOSPITAL 608685 SILVADENE 50 GM JAR 30.20$

HOSPITAL 608695 SELSUN LOTION 4 OZ 64.30$

HOSPITAL 608715 TINACTIN CREAM 15GM 32.25$

HOSPITAL 608721 TOBRADEX OPH SOL 5ML 72.95$

HOSPITAL 608722 TOBRADEX OPH OINT 123.05$

HOSPITAL 608723 TOBREX OPTH SOLN 0.3% 103.05$

HOSPITAL 608775 LIDOCAINE 2% JELLY 79.40$

HOSPITAL 608785 LIDOCAINE 5% OINTMENT 67.60$

HOSPITAL 608790 LIDOCAINE VISCOUS 100CC 28.00$

HOSPITAL 608795 ZINC PASTE OZ 7.10$

HOSPITAL 608797 AZITHROMYCIN 250MG TABLET 26.30$

HOSPITAL 608800 ZOVIRAX OINT 15G 205.25$

HOSPITAL 608804 OLANZAPINE 7.5MG TAB 30.35$

HOSPITAL 608915 DOPAMINE 200 CRASH 62.15$

HOSPITAL 608916 DOPAMINE 400MG 87.15$

HOSPITAL 608940 LIDOCAINE CRASH 20MG/5ML SYRIN 14.00$

HOSPITAL 608950 LIDOCAINE 2G CRASH 36.60$

HOSPITAL 608965 NITROGLYCERINE 50 MG CRASH 78.80$

HOSPITAL 608966 PRO MOD POWDER 275 GM 40.00$

HOSPITAL 608970 REGITINE 5 MG CRASH 342.45$

HOSPITAL 608975 SOD. BICARB 8.4% CRASH 74.30$

HOSPITAL 608980 SOD. BICARB PED CRASH 54.90$

HOSPITAL 608981 LIDOCAINE 4% - EA CC- 6.55$

HOSPITAL 608988 TEMAZEPAM 7.5MG CAPSULES 6.55$

HOSPITAL 608989 BIAFINE WOUND DRESSING 50.00$

HOSPITAL 608994 ALBUTEROL/IPRATROPIUM INHALER 153.65$

HOSPITAL 609002 NA BIPHOS/POTA PHOSPH 1 EA PKT 6.55$

2020-01




HOSPITAL 609004 GLIMEPIRIDE 2 MG TABLETS 6.55$

HOSPITAL 609006 DEFEROXAMINE MESY. 500 MG 62.20$

HOSPITAL 609007 VALSARTAN 80 MG CAPS 6.55$

HOSPITAL 609008 AZITHROMYCIN 500 MG ADD VANT 124.55$

HOSPITAL 609010 WARFARIN 4 MG TAB 6.55$

HOSPITAL 609011 PENTOSAN 100 MG CAP 8.55$

HOSPITAL 609013 VALACYCLOVIR HCL 500MG TAB 11.05$

HOSPITAL 609016 ZANAFLEX 4 MG TAB 7.90$

HOSPITAL 609017 GLIPIZIDE XL 10 MG 6.55$

HOSPITAL 609018 AMOXICILLIN/CLAVULANTE 163.60$

HOSPITAL 609019 WARFARIN 3 MG T 6.55$


HOSPITAL 609021 LUPRON DEPOT 22.5MG KIT 2,400.50$

HOSPITAL 609023 FOSFOMYCIN TROMETHAMINE 3GM PK 132.30$

HOSPITAL 609024 TERBINAFINE 250 MG TAB 32.70$

HOSPITAL 609026 MAGNESIUM GLUCONATE 500 MG 6.55$

HOSPITAL 609110 PROMETHAZINE LIQ PER ML 6.55$

HOSPITAL 609125 ROBITUSSIN LIQUID 4 OZ 6.55$

HOSPITAL 609135 ROBITUSSIN DM 4 OZ 11.20$

HOSPITAL 609143 RYTHMOL 150MG TAB 6.55$

HOSPITAL 609150 DOXEPIN 10MG/ML 120ML BOTTLE 154.40$

HOSPITAL 609187 TUSSIONEX 5ML 27.45$

HOSPITAL 609215 VI-DAYLIN -IRON DROP 57.15$

HOSPITAL 609305 ASPIRIN 5 GR SUPPOS 6.55$


HOSPITAL 609320 ACETAMINOPHEN 325mg (5GR) SUPP 6.55$

HOSPITAL 609345 ANUSOL-HC 25MG SUPP 10.90$

HOSPITAL 609361 ALBUTEROL/IPRATROPIUM SOLN 9.55$

HOSPITAL 609362 PENTAMIDINE INH SOL/ 300 MG 111.30$

HOSPITAL 609380 GLYCERIN SUPPOS 6.55$

HOSPITAL 609385 PROMETHAZINE 25MG SUPP 13.80$

HOSPITAL 609394 CARBAMAZEPINE 100MG TAB 6.55$

HOSPITAL 609601 FLU-SANOFI 90658 32.65$

HOSPITAL 609609 FLUZONE QUADRIVALENT 90686 19.70$

HOSPITAL 609982 HIGH DOSE FLU VACC 90662 54.40$

HOSPITAL 609986 FLUARIX QUADRIVALENT 0.5ML SYR 90686 18.70$

HOSPITAL 615478 FISH OIL 100MG CAPSULE 6.55$

HOSPITAL 611222 ANTI-COAGULATION CLINIC 99211 120.25$

HOSPITAL LAB0000652 PROTHROMBIN TIME PHAR ACOAG CL 85610 30.65$

HOSPITAL LAB0000653 CAPILL BLOOD COLL PHAR ACOAGCL 36416 14.15$

HOSPITAL 690000 NO SHOW PHYSICAL THERAPY 51.50$

HOSPITAL 690007 PARAFFIN BATH 97018GP 138.75$

HOSPITAL 690007PTA PARAFFIN BATH PTA 134.70$

HOSPITAL 690024 CERVICAL TRACT MECH 97012GP 138.75$

HOSPITAL 690024PTA CERVICAL TRACT MECH PTA 134.70$

HOSPITAL 690032 LUMBAR TRACT MECH DRS 97012GP 138.75$

HOSPITAL 690032PTA LUMBAR TRACT MECH DRS PTA 134.70$

HOSPITAL 690036 IONTOPHORESIS/PATCH/15 min 97033GP 42.30$

HOSPITAL 690036PTA IONTOPHORESIS/PATCH/15MIN PTA 41.05$

HOSPITAL 690067 WHIRLPOOL 97022GP 196.80$

HOSPITAL 690067PTA WHIRLPOOL PTA 191.05$

HOSPITAL 690091 MASSAGE/15 MIN 97124GP 123.10$

HOSPITAL 690091PTA MASSAGE/15 MIN PTA 119.50$

HOSPITAL 690093 PT GROUP THERAPY 97150GP 58.20$

HOSPITAL 690093PTA PT GROUP THERAPY PTA 56.50$

HOSPITAL 690094 FLUIDOTHERAPY/WP 97022GP 196.80$

HOSPITAL 690094PTA FLUIDOTHERAPY/WP PTA 191.05$

HOSPITAL 690111 AQUATIC THERAPY/15 MIN 97113GP 126.50$

HOSPITAL 690111PTA AQUATIC THERAPY/15 MIN PTA 122.80$

HOSPITAL 690121 NEUROMUSCULAR RE-ED/15 MIN 97112GP 123.10$

HOSPITAL 690121PTA NEUROMUSCULAR RE-ED/15 MIN PTA 119.50$

HOSPITAL 690125 BIOFEEDBACK TRAINING 90901GP 380.80$

HOSPITAL 690125PTA BIOFEEDBACK TRAINING PTA 369.70$

HOSPITAL 690151 THER EX/15 MINUTES 97110GP 160.15$

HOSPITAL 690151PTA THER EX/15 MINUTES PTA 155.45$

HOSPITAL 690152 ULTRASOUND/15 MIN 97035GP 126.10$

HOSPITAL 690152PTA ULTRASOUND/15 MIN PTA 122.40$

HOSPITAL 690153 ULTRASOUND/WOUNDS/15 MIN 97035GP 126.10$

2020-01




HOSPITAL 690153PTA ULTRASOUND/WOUNDS/15 MIN PTA 122.40$

HOSPITAL 690156 GAIT TRAINING/15 MIN 97116GP 147.10$

HOSPITAL 690156PTA GAIT TRAINING/15 MIN PTA 142.80$

HOSPITAL 690199 ORTHO FITTING/TRAINING/15 97760GP 148.20$

HOSPITAL 690199PTA ORTHO FITTING/TRAINING/15 PTA 143.85$

HOSPITAL 690203 THERAPEUTIC ACT/FUNCT/15 MIN 97530GP 150.00$

HOSPITAL 690203PTA THERAPEUTIC ACT/FUNCT 15MN PTA 145.60$

HOSPITAL 690204 HIGH VOLT ULTRASOUND/15 MIN 97035GP 126.10$

HOSPITAL 690204PTA HIGH VOLT ULTRASOUND/15MIN PTA 122.40$

HOSPITAL 690206 INTERFERENTIAL/EMS TENS/15 MIN 97032GP 128.40$

HOSPITAL 690206PTA INTERFERENTIAL/EMS TENS/15 PTA 124.64$

HOSPITAL 690207 IONTOPHORESIS/15 MIN 97033GP 42.30$

HOSPITAL 690207PTA IONTOPHORESIS/15 MIN PTA 41.05$

HOSPITAL 690208 PHYSICAL PERF TEST/15 MIN 97750GP 134.40$

HOSPITAL 690208PTA PHYSICAL PERF TEST/15 MIN PTA 130.45$

HOSPITAL 690209 PHONOPHORESIS/US/15 MIN 97035GP 126.10$

HOSPITAL 690209PTA PHONOPHORESIS/US/15 MIN PTA 122.40$

HOSPITAL 690215 MANUAL THERAPY/15 MIN 97140GP 158.00$

HOSPITAL 690215PTA MANUAL THERAPY/15 MIN PTA 153.40$

HOSPITAL 690216 PROSTHETIC TRAINING/15 MIN 97761GP 90.60$

HOSPITAL 690216PTA PROSTHETIC TRAINING/15 MIN PTA 87.95$

HOSPITAL 690220 SLCTV WND DEBRIDEM 20 CM OR < 97597GP 320.40$

HOSPITAL 690220PTA SLCTV WND DEBRIDE 20CMOR< PTA 311.05$

HOSPITAL 690221 NSW DEBRIDEM WO A/SESSION 97602GP 167.35$

HOSPITAL 690221PTA NSW DEBRIDEM WO A/SESSION PTA 162.45$

HOSPITAL 690322 IFT/EMS/TENS UNATTENDED 97014GP 125.15$

HOSPITAL 690322PTA IFT/EMS/TENS UNATTENDED PTA 121.50$

HOSPITAL 690326 CANALITH REPOSITIONING PER DAY 95992 129.10$

HOSPITAL 690326PTA CANALITH REPOSITIONING DAY PTA 125.30$

HOSPITAL 690415 SLCTV WND DEBRIDEM ADDL 20 CM/ 97598GP 311.35$

HOSPITAL 690415PTA SLCTV WND DEBRIDE ADD 20CM PTA 302.25$

HOSPITAL 690611 INFRARED 97026GP 105.75$

HOSPITAL 690611PTA INFRARED PTA 102.65$

HOSPITAL 690772 COMM/WORK REINTERGRATION15MIN 97537GP 158.75$

HOSPITAL 690772PTA COMM/WORK REINTERGR 15MIN PTA 154.10$

HOSPITAL 690774 WHIRLPOOL EXTENDED 97022GP 217.50$

HOSPITAL 690774PTA WHIRLPOOL EXTENDED PTA 211.15$

HOSPITAL 690781 MANUAL THERAPY DN 15 MIN 97140GP 158.00$

HOSPITAL 690781PTA MANUAL THERAPY DN 15 MIN PTA 153.40$

HOSPITAL 690782 APPLY MULTLAY COMPRS LWR LEG 29581GP 169.35$

HOSPITAL 690786 APPL MULTLAY COMPRS ARM/HAND 29584GP 169.35$

HOSPITAL 690787 MULTILAY COMPR LOW LEG BILAT 2958150GP 284.60$

HOSPITAL 690790 MULTLAY COMPRS ARM/HAND BILAT 2958450GP 169.35$

HOSPITAL 690791 PT EVAL LOW COMPLEXITY 97161GP 248.00$

HOSPITAL 690792 PT EVAL MOD COMPLEXITY 97162GP 384.35$

HOSPITAL 690793 PT EVAL HIGH COMPLEXITY 97163GP 495.90$

HOSPITAL 690794 PT RE-EVALUATION 97164GP 200.95$

HOSPITAL 690795 ORTH/PROST MGMT SBSQ 15MIN 97763GP 87.05$

HOSPITAL 690795PTA ORTH/PROST MGMT SBSQ 15MIN PTA 84.50$

HOSPITAL 690796 TK-PT EVAL LOW COMPLEXITY 248.00$

HOSPITAL 690797 TJ-PT EVAL MOD COMPLEXITY 384.35$

HOSPITAL 690798 TJ-PT EVAL HIGH COMPLEXITY 495.90$

HOSPITAL 690799 TJ-THER EX/15 MINUTES 160.15$

HOSPITAL 690800 TJ-GAIT TRAINING/15 MIN 147.10$

HOSPITAL 690801 TJ-THERAPEUTIC ACT/FUNCT/15MIN 150.00$

HOSPITAL 690605 COMM/WORK REINTEGR PER 15 MIN 97537GO 173.30$

HOSPITAL 691100 NO SHOW OCCUPATIONAL THERAPY 51.50$

HOSPITAL 691178 FLUIDOTHERAPY 97022GO 196.80$

HOSPITAL 691231 SELF CARE/HOME MGNT/ADL/15 MIN 97535GO 60.30$

HOSPITAL 691233 PARAFFIN BATH 97018GO 138.75$

HOSPITAL 691301 SENSORY INTEGRATION/15 MIN 97533GO 95.75$

HOSPITAL 691302 DEVELOP COGNITIVE SKILLS/15MIN 95.30$

HOSPITAL 691508 INTERFERENTIAL/EMS/15 MIN 97032GO 128.40$

HOSPITAL 691509 OT GROUP THERAPY 97150GO 58.20$

HOSPITAL 691511 MANUAL THERAPY/15 MIN 97140GO 158.00$

HOSPITAL 691512 MASSAGE/15 MIN 97124GO 123.10$

HOSPITAL 691514 THERAPEUTIC ACT/FUNCT/15 MIN 97530GO 150.00$

HOSPITAL 691521 INTERFERENTIAL UNATTENDED 126.85$

2020-01




HOSPITAL 691529 IONTOPHORESIS/15 MIN 97033GO 42.30$

HOSPITAL 691531 ULTRASOUND/15 MIN 97035GO 126.10$

HOSPITAL 691535 ORTHO FITTING/TRAINING/15 MIN 97760GO 148.20$

HOSPITAL 691539 NEUROMUSCULAR RE-ED PER/15 MIN 97112GO 123.10$

HOSPITAL 691548 THER EXERCISE/15 MINUTES 97110GO 160.15$

HOSPITAL 691558 IONTOPHORESIS/PATCH/15 min 97033GO 42.30$

HOSPITAL 691570 WHEELCHAIR ASSESS/15 MIN 97542GO 89.25$

HOSPITAL 691573 PHYSICAL PERF TEST/15 MIN 97750GO 134.40$

HOSPITAL 691586 WHFO,WRIST GAUNTLET,CUSTOM 297.75$

HOSPITAL 691723 APPLY MULTLAY COMPRS LWR LEG 29581GO 169.35$

HOSPITAL 691726 APPL MULTLAY COMPRS ARM/HAND 29584GO 169.35$

HOSPITAL 691728 MULTLAY COMPRS LWR LEG BILAT 2958150GO 284.60$

HOSPITAL 691731 MULTLAY COMPRS ARM/HAND BILAT 2958450GO 169.35$

HOSPITAL 691732 OT EVAL LOW COMPLEXITY 97165GO 248.00$

HOSPITAL 691733 OT EVAL MOD COMPLEXITY 97166GO 384.35$

HOSPITAL 691734 OT EVAL HIGH COMPLEXITY 97167GO 495.90$

HOSPITAL 691735 OT RE-EVALUATION 97168GO 200.95$

HOSPITAL 691736 THER IVNTJ W/FOCUS COG FUNCJ 97127GO 95.30$

HOSPITAL 691737 ORTHC/PROSTC MGMT SBSQ 15MIN 97763GO 87.05$

HOSPITAL 691738 TJ-OT EVAL LOW COMPLEXITY 248.00$

HOSPITAL 691739 TJ-OT EVAL MOD COMPLEXITY 384.35$

HOSPITAL 691740 TJ-OT EVAL HIGH COMPLEXITY 495.90$

HOSPITAL 691741 TJ-THER EXERCISE/15 MINUTES 160.15$

HOSPITAL 691742 TJ-THERAPEUTIC ACT/FUNCT/15MIN 150.00$

HOSPITAL 730000 NO SHOW SPEECH THERAPY 51.50$

HOSPITAL 730003 SP GENRATNG DEVCE EVAL 1st hr 92607GN 498.75$

HOSPITAL 730006 SP GENERATING DEVICE TX 92609GN 363.85$

HOSPITAL 730008 SENSORY INTEGRATION PER 15 MIN 97533GN 101.55$

HOSPITAL 730011 APHASIA ASSESSMENT PER HOUR 96105GN 464.50$

HOSPITAL 730029 DEVELOP COGNITIVE SKILL/15 MIN 101.05$

HOSPITAL 730033-O DYSPHAGIA BEDSIDE EVAL 92610GN 453.25$

HOSPITAL 730034-O DYSPHAGIA BED EVALUATION 92610GN 453.25$

HOSPITAL 730043 SPEECH TREAT LEVEL ONE 92507GN 268.65$

HOSPITAL 730044 SPEECH TREAT LEVEL 2 92507GN 403.05$

HOSPITAL 730046 SP,LANG GP THERAPY 92508GN 79.75$

HOSPITAL 730049 SP GENRTNG DEV EVAL EA ADDL 30 92608GN 80.00$

HOSPITAL 730052 DYSPHAGIA THERAPY 92526GN 434.10$

HOSPITAL 730067 NON SPEECH DEVICE EVAL/1ST HR 92605GN 422.45$

HOSPITAL 730079 MODIF BARIUM SWAL EVAL 92611GN 462.70$

HOSPITAL 730081 SPEECH LANGUAGE RE-EVAL 92521GN 273.90$

HOSPITAL 730094 DYSPH W/VITAL STIM TX 92526GN 434.10$

HOSPITAL 730096 COGNITIVE TESTING/hour 96125GN 314.85$

HOSPITAL 730097 FSSA - SPEECH FLUENCY 92521 164.80$

HOSPITAL 730098 DSS - SPEECH THERAPIST/HOUR 100.85$

HOSPITAL 730272 EVALUATION OF SPEECH FLUENCY 92521GN 424.65$

HOSPITAL 730273 ST EVAL ARTIC;APRIXIA/DYSARTHR 92522GN 424.65$

HOSPITAL 730274 ST EVAL ARTIC & REC/EXP 92523GN 424.65$

HOSPITAL 730275 BEHAVRAL QUALIT ANALYS VOICE 92524GN 424.65$

HOSPITAL 730276 NONSPEECH DEV EVAL ADDL 30 MIN 92618GN 224.55$

HOSPITAL 730277 PTA AIR THRES ONLY 92552 177.60$

HOSPITAL 730278 THER IVNTJ W/FOCUS COG FUNCJ 97127GN 101.05$

HOSPITAL 700001 WORK HARDENING INITIAL 2 HR 97545 448.20$

HOSPITAL 700001PTA WORK HARDENING INITIAL 2HR PTA 435.15$

HOSPITAL 700002 WORK HARDENING ADDT'L HOUR EA. 97546 150.05$

HOSPITAL 700002PTA WORK HARDENING ADDT'L HR PTA 145.65$

HOSPITAL 700101 FUNCTIONAL CAPACITY/15 MIN 97750 142.45$

HOSPITAL 760024 DEBRIDEMENT, NON-SELECT WOCRN 141.90$

HOSPITAL 760030 OP OSTOMY TX >30 MIN (NEW) 99203 143.00$

HOSPITAL 760031 OP WOUND ASSESSMENT 10 MIN 99211 142.95$

HOSPITAL 760035 OP OSTOMY TX <30 MIN (NEW) 99202 107.40$

HOSPITAL 760060 OP WOUND TX >30 MIN (NEW) 99203 143.00$

HOSPITAL 760065 OP WOUND TX <30 MIN (NEW) 99202 112.55$

HOSPITAL 760082 DEBRIDEMENT INFECTED SKIN 10% 232.75$

HOSPITAL 760083 EDUCATION/TRAINING 1 PT 98960 142.55$

HOSPITAL 760105 OP OSTOMY TX >30 MIN (EST) 99213 139.35$

HOSPITAL 760109 OP OSTOMY CARE 10 MIN 99211 142.95$

HOSPITAL 760110 OP OSTOMY TX <30 MIN (EST) 99212 112.55$

HOSPITAL 760115 OP WOUND TX >30 MIN (EST) 99213 163.45$

2020-01




HOSPITAL 760120 OP WOUND TX <30 MIN (EST) 99212 112.55$

HOSPITAL 760137 REMOVE BENIGN LESION; SINGLE 167.35$

HOSPITAL 760138 REMOVE BENIGN LESIONS; 2-4 LSN 154.00$

HOSPITAL 760139 REMOVE BENIGN LESION; >4 LSNS 192.55$

HOSPITAL 770024 DIABETES EDUCATION-N CERT INST 99211 127.50$

HOSPITAL DS00000001 DIAB SELF-MNGT IND PER 30 MIN 98.45$

HOSPITAL DS00000002 DIAB SELF-MNGT-GRP PER 30 MIN 73.00$

HOSPITAL DS00000003 GLUCOSE MONITORING CONT 72+ HR 95250 305.00$

HOSPITAL 790002 BILIRUBIN LIGHT 228.45$

HOSPITAL 90702 DT VACCINE < 7 YRS 90702 36.90$

HOSPITAL 90714 TD VACCINE >/= 7 YR NO PRESERV 90714 31.70$

HOSPITAL 93000-CC 12 LEAD EKG; GLOBAL (CC) 93000 205.60$

HOSPITAL 94640-CC AIRWAY INHALATION TREATMENT-CC 94640 212.25$

HOSPITAL A4565-CR CRADLE ARM SLING 49.50$

HOSPITAL J2930 CC SOLU-MEDROL 125MG (CONV CARE) 57.15$

HOSPITAL J7613 ALBUTEROL INHALER SOLN 1mg 21.40$

HOSPITAL J7613 CC ALBUTEROL INH SOLN 1mg(CONVCA) 21.40$

HOSPITAL L1810 BRACE, HINGED KNEE 191.95$

HOSPITAL L1820 HINGED KNEE BRACE 267.50$

HOSPITAL L3260 SURGICAL BOOT 69.90$

HOSPITAL L3702 ELBOW CHO-PAT ORTHO SPLINT 64.10$

HOSPITAL L4360 PNEUMATI WALKING BOOT PREFAB 284.95$

HOSPITAL 850050 NUTRITION THERAPY 57.30$

HOSPITAL 850051 MNT INIT ASSESSMENT/15 min 97802 47.20$

HOSPITAL 850052 MNT RE-ASSESSMENT 15/MIN 97803 47.20$

HOSPITAL 850053 MNT GROUP THERAPY/30 MIN 97804 47.20$

HOSPITAL 602902 DEXAMETHASONE 4MG/ML 30ML VIAL 1.52$

HOSPITAL 600197 SIMPLE SYRUP 2.17$ Average Charge 2019 Average Charge

HOSPITAL 604853 DIPHENHYDRAMINE LIQ 12.5MG/5ML 3.13$

HOSPITAL 601988 NYSTATIN 100,000 U/ML SUSP 3.54$

HOSPITAL 600194 CEPHALEXIN 250MG/5ML BOTTLE 3.73$

HOSPITAL 600025 AMOXICILLIN 250/5 100 3.85$

HOSPITAL 608137 TRIAMCINOLONE 0.1% CREAM/OINT 4.63$

HOSPITAL 601206 MORPHINE IR 15MG TAB 4.88$

HOSPITAL 605509 FLECAINIDE 50MG TAB 4.88$

HOSPITAL 621457 DOXORUBICIN 2 MG/ML 4.92$

HOSPITAL 600226 DIPHENHYDRAMINE ELIX (/CC) 5.30$

HOSPITAL 608158 SODIUM CHLORIDE 0.9% 10ML VIAL 5.54$

HOSPITAL 604467 PRE-NATAL VITAMIN 5.59$

HOSPITAL 609150 DOXEPIN 10MG/ML 120ML BOTTLE 6.00$

HOSPITAL 604217 ZOLPIDEM TARTRATE 5MG TAB 6.04$



HOSPITAL 600083 CITALOPRAM HYDROBROM 20MG TAB 6.09$

HOSPITAL 604558 PROZAC 20MG 6.14$

HOSPITAL 603445 HYDROCHLOROTHIAZIDE 25MG TAB 6.16$

HOSPITAL 604713 GABAPENTIN 400MG C 6.19$

HOSPITAL 606287 DONEPEZIL 5MG TAB 6.21$

HOSPITAL 602395 HYDRALAZINE 25MG TABLET 6.23$

HOSPITAL 603485 IMURAN 50MG T 6.25$

HOSPITAL 606687 GABAPENTIN 300 MG C 6.31$

HOSPITAL 603712 TOPIRANATE 100 MG TAB 6.32$

HOSPITAL 603355 FERROUS SULFATE 325 MG TABLET 6.34$

HOSPITAL 602684 THERA-M VITAMIN TAB 6.34$

HOSPITAL 604446 VITAMIN D 1000 U Cap 6.35$

HOSPITAL 601204 OXYCODONE 5MG TABLET 6.36$

HOSPITAL 604012 PROZAC 10MG C 6.37$

HOSPITAL 603947 MULTI-VITAMIN 6.38$

HOSPITAL 603690 LOPRESSOR 100MG TABLET 6.39$

HOSPITAL 602156 ESCITALOPRAM 10MG TAB 6.42$

HOSPITAL 615478 FISH OIL 100MG CAPSULE 6.42$

HOSPITAL 604528 KLONOPIN 1MG 6.42$

HOSPITAL 604353 PEPCID 20MG TABLET 6.43$

HOSPITAL 601235 XANAX 0.25 MG TAB 6.43$

HOSPITAL 600737 MS CONTIN 15MG TAB 6.44$

HOSPITAL 603660 LITHANE 300 MG T. 6.44$

HOSPITAL 603135 BISACODYL 5 MG TABLET 6.44$

HOSPITAL 604824 MAGNESIUM OXIDE 400MG TABLET 6.44$

2020-01





HOSPITAL 603685 LOPRESSOR 50MG T. 6.46$


HOSPITAL 605034 ASPIRIN 81 MG ENTERIC T 6.48$

HOSPITAL 605250 TUMS TABLET 6.48$

HOSPITAL 607898 VITAMIN B12 1000 MCG 6.48$


HOSPITAL 603645 LASIX 40MG TABLET 6.49$

HOSPITAL 603360 CYCLOBENZAPRINE 10MG T 6.49$


HOSPITAL 603616 KLONOPIN 0.5 TABLET 6.50$

HOSPITAL 602216 ONDANSETRON 4MG TABLET 6.50$

HOSPITAL 604658 NORVASC 5MG 6.50$

HOSPITAL 603312 SILVER NITRATE STICK EA 6.50$

HOSPITAL 600040 BACID CAPS 6.50$


HOSPITAL 605198 TRENTAL 400 MG 6.50$

HOSPITAL 605064 GLUCOPHAGE 500 MG 6.51$

HOSPITAL 604680 SENOKOT TABLET 6.51$

HOSPITAL 603123 SERTRALINE 25MG TAB 6.51$



HOSPITAL 602225 SPIRONOLACTONE 25MG TABLET 6.51$

HOSPITAL 602665 CARDIZEM 30 MG T. 6.51$


HOSPITAL 601240 XANAX 0.5 MG TABLET 6.51$

HOSPITAL 600825 ATIVAN 0.5 MG T. 6.51$

HOSPITAL 602425 ASPIRIN 325MG TAB 6.51$

HOSPITAL 603391 METOPROLOL TARTRATE 25MG TAB 6.51$

HOSPITAL 605036 TRAMADOL 50 MG TABLET 6.51$

HOSPITAL 600032 AMPICILLIN 500MG C 6.51$

HOSPITAL 600049 BUPROPION SR 150MG T 6.51$

HOSPITAL 600137 COREG 6.25MG T 6.51$

HOSPITAL 600188 MAALOX SUSP UD 30 ML CUP 6.51$

HOSPITAL 600444 ROBITUSSIN 10ML CUP 6.51$


HOSPITAL 601086 PHENOBARBITAL 30 MG BULK TAB 6.51$

HOSPITAL 601243 XANAX 1 MG TAB 6.51$

HOSPITAL 601682 TRIPLE ANTIBIOTIC OINT 0.9GM 6.51$

HOSPITAL 602430 ASA 5 GR ENTERIC 6.51$



HOSPITAL 602625 CALAN 80 MG T. 6.51$

HOSPITAL 602765 BENZTROPINE 2MG T 6.51$


HOSPITAL 603185 AMITRIPYLINE 25MG T 6.51$

HOSPITAL 603332 HEPARIN LOCK FLUSH 100U/ML 3ML 6.51$

HOSPITAL 603370 FOLIC ACID 1MG TAB 6.51$


HOSPITAL 603855 MICRO-K EXTEN C. 6.51$

HOSPITAL 604069 NIFEREX 150 C 6.51$

HOSPITAL 604238 ONDANSETRON 40 MG/VIAL 6.51$

HOSPITAL 604354 PEPTO-BISMOL TAB 6.51$

HOSPITAL 604448 GUIFENESIN SYR W DEXTR 5ML CUP 6.51$

HOSPITAL 604662 ZINC SULFATE 220MG 6.51$


HOSPITAL 605078 THIAMINE 100 MG T 6.51$

HOSPITAL 605179 LITHIUM CARBONATE ER 450MG TAB 6.51$

HOSPITAL 605207 CETIRIZINE SYRUP 6.51$

HOSPITAL 605224 SODIUM CHLORIDE TABLET 1GM 6.51$


HOSPITAL 606450 SOD BICARB 10GR T 6.51$

HOSPITAL 606520 CHERRY SYR OZ 6.51$

HOSPITAL 606698 POLYCITRA -OZ- 6.51$

HOSPITAL 606805 BISACODYL 10 MG SUPP 6.51$

HOSPITAL 608011 NORCO 7.5 6.51$

HOSPITAL 609315 ACETAMINOPHEN 2 GR SUPPOS 6.51$


2020-01





HOSPITAL 600198 BLEACH 6.51$

HOSPITAL 600199 SOD BICARB POWDER 6.51$

HOSPITAL 600224 MONTELUKAST 10MG TAB 6.51$

HOSPITAL 600232 FLUOR I STRIP (EA) 6.51$

HOSPITAL 600251 NAPROXEN 220MG TABLET 6.51$

HOSPITAL 600252 CALCIUM CARBONATE/VIT D 500MG 6.51$

HOSPITAL 600683 DILAUDID 4 MG T. 6.51$

HOSPITAL 600753 MORPHINE SOL 0.2 MG/ML0.5MLSYR 6.51$

HOSPITAL 600970 IMMODIUM 2 MG CAPSULE 6.51$




HOSPITAL 601868 LIDOCAINE 2% 10ML MD VIAL 6.51$

HOSPITAL 602131 GLYCOPYRROLATE 1 MG TAB 6.51$


HOSPITAL 602350 MECLIZINE 12.5MG T 6.51$

HOSPITAL 602365 HYDRALAZINE 10MG T 6.51$


HOSPITAL 602520 AZULFIDINE 500MG T. 6.51$


HOSPITAL 602612 BUSPAR 10MG T 6.51$

HOSPITAL 602646 CALTRATE 600 MG 6.51$


HOSPITAL 602670 CATAPRES 0.1 MG T. 6.51$

HOSPITAL 602675 CATAPRES 0.2 MG TAB 6.51$

HOSPITAL 602790 DOCUSATE SOD 100MG C 6.51$

HOSPITAL 602936 DAPSONE 25MG TAB 6.51$


HOSPITAL 602970 DESYREL 100MG TAB 6.51$

HOSPITAL 603145 DYAZIDE C. 6.51$





HOSPITAL 603238 LIDOCAINE 1% 30ML STERILE VIAL 6.51$

HOSPITAL 603357 FIBERCON TABS 6.51$

HOSPITAL 603362 METRONIDAZOLE 250MG TAB 6.51$

HOSPITAL 603382 GLUCOTROL 10 MG T 6.51$

HOSPITAL 603390 HALOPERIDOL 1 MG T 6.51$

HOSPITAL 603401 CALCIUM 600MG/VIT D 6.51$

HOSPITAL 603482 HYTRIN 2MG TABLET 6.51$

HOSPITAL 603483 HYTRIN 5MG CAPSULE 6.51$



HOSPITAL 603550 ISONIAZID 300MG TAB 6.51$

HOSPITAL 603630 LANOXIN 0.25 MG T. 6.51$

HOSPITAL 603640 FUROSEMIDE 20MG TABLET 6.51$

HOSPITAL 603655 CHLORDIAZEPOXIDE/CLIDINIU 6.51$


HOSPITAL 603747 MAXZIDE T 6.51$

HOSPITAL 603766 VENLAFAXINE XR 37.5MG 6.51$

HOSPITAL 603861 APAP/DIPHENHYDRAMINE 6.51$

HOSPITAL 603865 PRAZOSIN 1MG C 6.51$

HOSPITAL 603917 TETRACAINE O.5% OPTH SOL 6.51$


HOSPITAL 603991 NAPROSYN 500 MG TABLET 6.51$

HOSPITAL 604132 LEVSIN SL 6.51$

HOSPITAL 604148 EXCEDRIN TABLET 6.51$

HOSPITAL 604153 DOCUSATE NA 100 MG/10 ML CUP 6.51$

HOSPITAL 604158 CYANOCOBALAMIN 500 MCG 6.51$

HOSPITAL 604160 ESTRADIOL 2 MG 6.51$

HOSPITAL 604166 ZINC 50 MG TABLET 6.51$

HOSPITAL 604271 OS CAL 500MG T 6.51$

HOSPITAL 604296 PAMELOR 50 MG T 6.51$

HOSPITAL 604301 PARAFON FORTE DSC 6.51$

HOSPITAL 604305 LACTAID CAPLET 6.51$

HOSPITAL 604405 WELLBUTRIN 75MG 6.51$

2020-01






HOSPITAL 604449 VITAMIN D3 50,000 UNIT CAPSULE 6.51$

HOSPITAL 604489 PROVERA 2.5MG T 6.51$

HOSPITAL 604514 HYTRIN 1MG 6.51$

HOSPITAL 604548 SLOW-MAG 64 MG TAB 6.51$

HOSPITAL 604555 PROVERA 10MG TAB 6.51$

HOSPITAL 604573 PYRIDOXINE 50MG 6.51$







HOSPITAL 604757 VITAMIN A 10,000 UNITS 6.51$

HOSPITAL 604792 CALCIUM CITRATE 6.51$

HOSPITAL 604805 GABAPENTIN 100MG CAP 6.51$

HOSPITAL 604843 HCTZ/BISPROLOL FUMARATE 1 TAB 6.51$

HOSPITAL 604870 SUDAFED 30 MG T./PSEUDOEP 6.51$


HOSPITAL 604921 L-THROXINE 0.125 MG T 6.51$

HOSPITAL 604992 METFORMIN 500MG XR 6.51$


HOSPITAL 605115 THYROID ARMOUR 2 GR 6.51$



HOSPITAL 605275 ACETAMINOPHEN CH CHEW TAB 6.51$




HOSPITAL 605393 WELLBUTRIN 100 MG TAB 6.51$

HOSPITAL 605553 SOTALOL 120MG TAB 6.51$

HOSPITAL 605686 MIRAPEX 1 MG TABLET 6.51$

HOSPITAL 605806 PILOCARPINE 5MG TAB 6.51$

HOSPITAL 606004 VITAMIN-D 5000 UNIT CAP 6.51$

HOSPITAL 606137 TORADOL 10 MG TABS 6.51$

HOSPITAL 606286 L-THYROXIN 0.088MG 6.51$

HOSPITAL 606314 GAVISCON TABLET 6.51$

HOSPITAL 606405 SIMETHICONE 80 MG CHEW TABLET 6.51$

HOSPITAL 606497 TORESEMIDE 20 MG TAB 6.51$

HOSPITAL 606629 GLYCERIN PEDIATRIC SUPP 6.51$

HOSPITAL 607110 AMMONIA INHALENTS EA 6.51$

HOSPITAL 607316 PROMETHAZINE/CODEINE 5ML CUP 6.51$

HOSPITAL 608055 EFFERDENT 1 BOX 6.51$

HOSPITAL 608253 FOLIC ACID 400MCG 6.51$

HOSPITAL 608426 VENLAFAXINE 100MG TABLET 6.51$

HOSPITAL 608555 MONISTAT-DERM 30G 6.51$

HOSPITAL 608578 TOPICAL LIGHT MINERAL OIL 30ML 6.51$

HOSPITAL 608850 DEXTROSE 50 ML IV BAG 6.51$

HOSPITAL 609004 GLIMEPIRIDE 2 MG TABLETS 6.51$

HOSPITAL 609110 PROMETHAZINE LIQ PER ML 6.51$


HOSPITAL 609380 GLYCERIN SUPPOS 6.51$

HOSPITAL 609394 CARBAMAZEPINE 100MG TAB 6.51$

HOSPITAL 609604 CHEWABLE MULTIVITAMIN TAB 6.51$

HOSPITAL 609676 FLU GLO 0.6MG OPTH STRIPS 6.51$

HOSPITAL 609960 CHLORHEXDINE 15ML CUP 6.51$

HOSPITAL 684215 VITAMIN E 1000U CAPS 6.51$



HOSPITAL 604621 CARDIZEM CD 120MG 6.52$

HOSPITAL 602470 ASPIRIN 81MG TAB *CHEWABLE* 6.53$

HOSPITAL 600153 ATROVENT UD 6.54$

HOSPITAL 603754 ALBUTEROL 1.25MG NEB 6.54$

HOSPITAL 607185 EPINEPHrine 2.25% INHALANT NEB 6.54$

HOSPITAL 600996 LOMOTIL T. 6.55$

HOSPITAL 606461 IBUPROFEN SUSP PER ML 6.61$

HOSPITAL 603129 MAG HYD/ALUM HYD SIME 30ML CUP 6.61$

2020-01




HOSPITAL 604050 PREDNISOLONE SYRUP 5MG 5C 6.61$

HOSPITAL 604036 PAXIL 20MG T 6.66$


HOSPITAL 604159 LORATADINE 10 MG TABLET 6.81$

HOSPITAL 600701 ACETAMINOPHEN ELIX 325MG/12.5C 6.82$


HOSPITAL 603171 METOCLOPRAMIDE 10MG/10ML CUP 6.90$

HOSPITAL 604167 ESTRADIOL 1MG TAB 6.90$

HOSPITAL 603030 DILANTIN 50MG T 6.92$

HOSPITAL 602650 CARAFATE 1 GM TAB 7.00$

HOSPITAL 603060 OXYBUTYNIN 5MG 7.03$

HOSPITAL 608012 NORCO 5 7.04$

HOSPITAL 603216 OXCARBAZEPINE 150MG TAB 7.10$

HOSPITAL 600239 PHENERGAN 25 MG TAB 7.17$

HOSPITAL 602674 CATOPRES 0.3MG T 7.17$

HOSPITAL 600208 PLAVIX 75MG TAB 7.18$

HOSPITAL 608181 OLANZAPINE 2.5MG T 7.19$


HOSPITAL 601552 VICOPROFEN 7.5MG/200MG TAB 7.19$

HOSPITAL 602632 CALAN SR 180MG TAB 7.19$

HOSPITAL 603384 GLUCOTROL 5 MG TAB 7.19$


HOSPITAL 608013 NORCO 10 7.20$

HOSPITAL 600109 CLEOCIN 150MG C 7.37$

HOSPITAL 609325 ACETAMINOPHEN 650MG SUP (10GR) 7.41$

HOSPITAL 605413 ZOVIRAX 800 MG TABLET 7.47$

HOSPITAL 600301 PENICILLIN V POTASS 500MG TAB 7.57$

HOSPITAL 600220 NYSTATIN SUSP (/CC) 7.57$

HOSPITAL 602996 LORAZEPAM 1MG TAB 7.57$


HOSPITAL 602964 DEPAKOTE 500MG TABLET 7.57$

HOSPITAL 603915 ZOLOFT 100MG TAB 7.57$

HOSPITAL 606168 ZOLOFT 50 MG 7.77$

HOSPITAL 605958 BUPROPION 150MG LX TAB 7.85$

HOSPITAL 602480 HYDROXYZINE 25MG TAB 7.85$


HOSPITAL 609035 LORATIDINE 10MG TAB 7.85$

HOSPITAL 608981 LIDOCAINE 4% - EA CC- 7.90$

HOSPITAL 608007 BEER 7.93$

HOSPITAL 603547 MAALOX 15ML CUP 7.93$

HOSPITAL 605032 CARDIZEM CD 180 MG CAPSULE 7.97$

HOSPITAL 603914 CORTEF 10MG 7.97$

HOSPITAL 602555 DICYCLOMINE 20MG T 8.12$

HOSPITAL 602545 PROBENECID 0.5GM T 8.20$

HOSPITAL 607889 AMOXICILLIN 250MG TAB 8.21$

HOSPITAL 601010 QUETIAPINE FUMARATE 8.30$

HOSPITAL 603169 SENNA/DOUCSATE TABLET 8.30$

HOSPITAL 605101 METHYLPHENIDATE 5MG TAB 8.37$

HOSPITAL 603346 QUETIAPINE 100MG TAB 8.38$

HOSPITAL 603757 MEGACE 40MG T 8.38$

HOSPITAL 604868 TAPAZOLE 10MG TAB 8.38$

HOSPITAL 602914 LACTOSE FREE FOOD 8.38$

HOSPITAL 606381 VENLAFAXINE 75MG TAB 8.41$

HOSPITAL 605271 MAGNESIUM HYDROXIDE CONCENTRAT 8.58$

HOSPITAL 604630 RELAFEN 500MG 8.65$

HOSPITAL 602823 CORDARONE 200MG 8.89$

HOSPITAL 603693 PRILOSEC 20MG CAPSULE 8.91$

HOSPITAL 604508 NEPHROCAPS 8.93$

HOSPITAL 603670 LONITEN 2.5 MG T. 9.20$


HOSPITAL 608096 NO-RINSE SHAMPOO 9.25$

HOSPITAL 609013 VALACYCLOVIR HCL 500MG TAB 9.38$

HOSPITAL 600021 MIDAMOR 5MG TAB 9.47$

HOSPITAL 600680 DILAUDID 2MG 9.47$

HOSPITAL 604915 L-THYROXINE 0.O25 MG T 9.47$

HOSPITAL 606297 RELAFEN 750 MG TAB 9.47$

HOSPITAL 600770 PERCOCET-5 325MG TAB 9.47$

HOSPITAL 609361 ALBUTEROL/IPRATROPIUM SOLN 9.51$

2020-01




HOSPITAL 604892 ROPINIROLE 1MG TAB 9.59$

HOSPITAL 600162 BUSPIRONE 15MG 9.72$

HOSPITAL 604074 L-THYROXINE O.112MG 9.72$

HOSPITAL 602972 DIABETA 2.5 9.73$


HOSPITAL 605880 CISPLATIN 1MG/ML 9.77$


HOSPITAL 602550 DICYCLOMINE 10MG C 9.94$

HOSPITAL 603246 LEVTIRACETAM 250MG TAB 9.94$

HOSPITAL 606341 XOPENEX 0.63mg/3ml NEB 10.09$

HOSPITAL 603198 LIPITOR 40MG TAB 10.15$

HOSPITAL 601299 MORPHINE IMMED RELEASE 15MG T 10.21$

HOSPITAL 603349 LEVOTHYROXINE 137 mcg tab 10.25$

HOSPITAL 600408 CLOZARIL 25MG TABLET 10.28$

HOSPITAL 601216 GUAIFENESIN W/CODIEN 10 ML CUP 10.28$



HOSPITAL 603753 ALBUTEROL 2.5 MG NEB 10.41$


HOSPITAL 601598 NATEGLINIDE 60MG TABLET 10.42$

HOSPITAL 609876 TRIHEXYPHENIDYL HCL 10.44$


HOSPITAL 606302 GUAIFENESIN-DM T. 10.55$

HOSPITAL 608276 BACITRACIN 0.9 GRAM PACKET 10.58$

HOSPITAL 600930 ACETAMINOPHEN W/CODEINE #3 TAB 10.59$

HOSPITAL 603681 LOPID 600MG TABLET 10.75$

HOSPITAL 604431 GABAPENTIN 50MG/ML SOLUTION 10.82$

HOSPITAL 603242 MORPHINE 30MG IMM. REL. TAB 10.82$


HOSPITAL 605162 MORPHINE 60MG TAB 10.86$

HOSPITAL 606340 XOPENEX 1.25MG/3ML MINI NEBS 10.87$

HOSPITAL 608790 LIDOCAINE VISCOUS 100CC 10.88$

HOSPITAL 608032 SODIUM CHLORIDE 10ML SYRINGE 11.09$

HOSPITAL 604596 VERSED 2MG/2CC VIAL 11.10$

HOSPITAL 601987 NALTREXONE 50MG TAB 11.11$

HOSPITAL 600399 VANCOMYCIN 25MG/ML 300 ML BOTT 11.12$

HOSPITAL 603131 MEMANTINE 5MG TAB 11.21$

HOSPITAL 604709 SUMATRIPTAN SUCCINATE 25MG TAB 11.36$

HOSPITAL 600410 ZOVIRAX 200 MG CAPSULE 11.58$


HOSPITAL 605790 FOLVITE 5MG/CC 10ML IV 11.62$

HOSPITAL 608295 CALAMINE 4 OZ 11.63$

HOSPITAL 601544 METHADONE 10MG TAB 11.63$

HOSPITAL 604809 DIVALPROEX 125MG T 11.71$

HOSPITAL 600102 SODIUM CHLORIDE 20ML VIAL 11.73$

HOSPITAL 604294 IMDUR 60MG TABS 11.74$

HOSPITAL 607144 VANCOMYCIN 50MG/ML SUSPENSION 11.75$

HOSPITAL 605410 ZAROXOLYN 2 1/2 MG T 11.90$

HOSPITAL 600982 LIBRIUM 25 MG. C. 11.90$

HOSPITAL 603035 DILANTIN 100MG C. 11.90$

HOSPITAL 606185 METAMUCIL PACKET 11.99$

HOSPITAL 605914 CILOSTAZOL 100 MG TAB 12.11$

HOSPITAL 600952 FIORICET TAB 12.17$

HOSPITAL 605105 THROID ARMOUR 1/2 GR 30 MG 12.31$

HOSPITAL 603264 DULOXETINE 60MG CAP 12.41$

HOSPITAL 603573 NAROPIN 2MG/ML 20ML VIAL 12.44$

HOSPITAL 603572 ROPIVACAINE HCL 2 MG/ML ML 12.44$

HOSPITAL 603748 MAXZIDE - 25 12.98$

HOSPITAL 605188 TRANDATE 200 T 13.16$

HOSPITAL 602224 SPIRONOLACTONE 50MG 13.25$

HOSPITAL 604922 L-THYROXINE 0.075 MG TAB 13.25$

HOSPITAL 606987 CYTOMEL 5MCG TAB 13.40$


HOSPITAL 604131 LEVSINEX TIMECAPS 0.375 MG 13.52$

HOSPITAL 605897 DEMADEX 100MG TABLETS 13.52$

HOSPITAL 603856 POTASSIUM CHLORIDE 10MEQ CAPS 13.79$

HOSPITAL 604147 NORMODYNE 100 MG 13.79$

HOSPITAL 609991 FLORASTOR 250MG CAPSULE 13.90$

2020-01




HOSPITAL 604683 RISPRIDONE 1 MG TABLET 14.20$

HOSPITAL 600697 HALCION O.25MG TAB 14.32$

HOSPITAL 603353 ROPIVACAINE HCL 5 MG/ML ML 14.34$

HOSPITAL 609187 TUSSIONEX 5ML 14.34$

HOSPITAL 609016 ZANAFLEX 4 MG TAB 14.55$

HOSPITAL 602355 MECLIZINE 25MG T 14.60$

HOSPITAL 603675 LONITEN 10 MG T. 14.61$

HOSPITAL 602630 CALAN 120MG T. 14.87$

HOSPITAL 604140 NOLVADEX 10 MG T 14.88$

HOSPITAL 603363 METRONIDAZOLE 500MG T 15.15$

HOSPITAL 603344 LEVOTHYROXINE 0.175MG TABLET 15.22$

HOSPITAL 602659 ACETAMINOPHEN/CODEINE LIQ 10ML 15.33$

HOSPITAL 606159 ETOPOSIDE INJECTION 20MG 15.33$

HOSPITAL 606111 FENOFIBRATE 54MG TAB 15.34$

HOSPITAL 606686 LABETALOL HCL 5 MG/ML VIAL 15.34$


HOSPITAL 602423 DIVALPROEX 125MG CAPSULE 15.42$

HOSPITAL 602554 BROVANA 15MCG/2ML NEB 15.46$



HOSPITAL 605005 CARBAMAZEPHINE 200 MG TAB 15.69$

HOSPITAL 606999 LIDOCAINE 2% JELLY 6ML SYRINGE 15.79$

HOSPITAL 604081 NITROGLYCERIN 0.4 MG PATCH 16.23$


HOSPITAL 605575 BENADRYL 50 MG/ML VIAL 16.50$

HOSPITAL 603743 BATERIOSTATIC NACL 30 ML 16.51$

HOSPITAL 604302 ONDANSETRON 8MG TABS 16.64$

HOSPITAL 604930 L-THYRXINE 0.15 MG T 16.77$


HOSPITAL 603789 VALPROATE SOD 250 MG/5 ML CUP 16.77$

HOSPITAL 606517 IMITREX 100 MG TAB 16.92$


HOSPITAL 601289 RISPERIDONE 0.5 MG TABLET 17.04$

HOSPITAL 602810 PROCHLORPERAZINE 5MG T 17.04$


HOSPITAL 602610 BUMEX 1 MG T. 17.85$

HOSPITAL 601263 LEVETRIACETAM 500MG TAB 18.00$

HOSPITAL 600772 PERCOCET-7.5 325 MG TABLET 18.12$

HOSPITAL 602815 COMPAZINE 10 MG T. 18.40$

HOSPITAL 604722 HEPARIN 1000U/CC 10CC MDV 18.40$

HOSPITAL 608362 TEGRETOL XR 200 MG TAB 18.63$

HOSPITAL 607014 MIDAZOLAM 50MG/10ML VIAL 18.66$


HOSPITAL 605345 VISKEN 5 MG T 18.66$


HOSPITAL 608048 BUSPAR 5MG 19.13$

HOSPITAL 604336 ISOSORBIDE MONONIT. 10MG 19.20$


HOSPITAL 605110 THYROID 60mg TAB 19.43$

HOSPITAL 604433 PRAVACOL 20MG TAB 19.65$




HOSPITAL 609007 VALSARTAN 80 MG CAPS 20.24$

HOSPITAL 602117 COLESTIPOL HCL 1GM TAB 20.24$

HOSPITAL 606616 DILTIAZEM 5MG/ML VIAL 20.28$

HOSPITAL 604485 NIFEDIPINE 10MG C 20.52$

HOSPITAL 604820 SINEMET CR 25/100 TAB 20.56$

HOSPITAL 601246 BSS 15 ML 20.67$

HOSPITAL 609320 ACETAMINOPHEN 325mg (5GR) SUPP 20.71$

HOSPITAL 600014 SOD CITRATE/CIT ACID 30ML CUP 20.73$

HOSPITAL 600139 ERYC 250MG C (ABBOTT) 20.84$

HOSPITAL 602929 CYTOTEC 100MG TAB 20.95$

HOSPITAL 602833 MORPHINE 2MG CARPUJECT 21.04$

HOSPITAL 603365 FLORINEF 0.1MG T. 21.21$

HOSPITAL 606139 TORADOL 15MG IM/IV 21.37$

HOSPITAL 606661 ISMO 20 MG 21.37$


2020-01





HOSPITAL 606025 REGLAN 10MG/2ML 21.64$

HOSPITAL 605685 DEXAMETHASONE 4 MG/1ML 21.91$

HOSPITAL 602861 FENOFIBRATE, MICR. 160MG TABLE 22.12$

HOSPITAL 604082 NITRO PATCH O.6 MG PATCH 22.18$

HOSPITAL 602824 CORGARD 20MG TAB 22.45$

HOSPITAL 606047 AMOXICILLIN 875 MG TAB 22.45$

HOSPITAL 605690 DEXAMETHASONE 4 MG/ML 5ML 22.45$


HOSPITAL 602706 CEPASTAT LOZENGE -BOX- 22.47$

HOSPITAL 608225 ANUSOL HC CR 1 OZ 22.47$

HOSPITAL 603587 MINIPRES 5 MG CAPSULE 22.72$

HOSPITAL 603953 HYGROTON 25MG T 22.72$

HOSPITAL 602655 CAPOTEN 25 MG T 22.99$

HOSPITAL 609314 ACETAMINOPHEN 80MG SUPP 22.99$

HOSPITAL 604047 TOPROL XL 50MG 23.16$

HOSPITAL 604143 PROPRANOLOL LA 60MG 23.47$


HOSPITAL 604386 HYDROGEN PEROXIDE 120 ML BTL 23.80$


HOSPITAL 606131 TIMOLOL 0.25% 5 ML BOTTLE 23.80$

HOSPITAL 601208 CYANOCOBALAMIN/FA/PYRIDOXINE T 23.96$

HOSPITAL 605030 TESSALON 100 MG PERLES 24.07$

HOSPITAL 605095 CHLORPROMAZINE 100 MG T 24.07$

HOSPITAL 604587 NITROGLYCERIN .4MG T 24.34$



HOSPITAL 604404 DOMEBORO PKTS 12'S 24.62$

HOSPITAL 607615 HUM INSULIN NPH/REG 3ML 100U 24.68$

HOSPITAL 603142 LACTULOSE SYRUP 20GM/30ML ML 24.68$

HOSPITAL 604694 FAMCICLOVIR 500 MG TABLET 25.15$

HOSPITAL 602500 AVENTYL 25 MG C 25.15$

HOSPITAL 604673 NYSTATIN 5ML CUP 25.16$

HOSPITAL 604920 L-THROXINE 0.1 MG TABLET 25.19$

HOSPITAL 607101 CEFDINVIR 300MG CAP 25.40$


HOSPITAL 601118 HUMIBID LA-GUAIFENESIN/MUCINEX 25.70$

HOSPITAL 600256 MYCELEX 10 MG TROCHE 25.70$

HOSPITAL 601861 METOPROLOL SUCCINATE 25MG TAB 25.74$

HOSPITAL 602213 SCOPOLAMINE 2.5MG TAB 25.96$

HOSPITAL 603434 HYDREA 500MG 25.97$

HOSPITAL 604938 AZITHROMYCIN 100MG/5CC 15CC 25.99$

HOSPITAL 604739 HYZAAR 50/12.5MG TABLET 26.03$


HOSPITAL 605416 PRINIVIL 5 MG TAB 26.18$

HOSPITAL 609040 ADDERAL 5 MG TAB 26.19$

HOSPITAL 600015 AUGMENTIN 500MG T 26.23$

HOSPITAL 604447 VITAMIN D 50,000 UNIT CAPSULE 26.23$


HOSPITAL 605226 AYR SALINE NASAL GEL 26.44$

HOSPITAL 608795 ZINC PASTE OZ 26.50$

HOSPITAL 604510 BUMEX 2MG T 26.50$

HOSPITAL 606136 TORADOL 60 MG IM 26.54$

HOSPITAL 604453 DOXAZOSIN MESYLATE 4 MG TAB 26.78$

HOSPITAL 609745 BUPROPION SR 100MG TAB 26.78$

HOSPITAL 604181 SUCRALFATE SUSP 1GM/10CC 26.89$


HOSPITAL 604209 ONDANSETRON 2MG/ML 2ML VIAL 27.05$

HOSPITAL 603703 FAMOTIDINE 20 MG/2 ML VIAL 27.05$

HOSPITAL 602880 COUMADIN 2MG T. 27.05$

HOSPITAL 604692 WARFARIN 1MG T 27.05$

HOSPITAL 606014 LISINOPRIL/HCTZ 10-12.5 27.05$

HOSPITAL 606575 DEXAMETHASONE .50MG/5CC OZ 27.05$


HOSPITAL 600445 METHOHEXITAL SOD 10 MG/ML 27.05$


HOSPITAL 602885 COUMADIN 2 1/2 MG T. 27.05$

HOSPITAL 602890 COUMADIN 5 MG T. 27.05$

2020-01




HOSPITAL 604426 ZESTORETIC 20/25 TABLET 27.05$


HOSPITAL 604643 BISOPROLOL 2.5/HCTZ 6.25MG 27.05$

HOSPITAL 604819 AMOXICILLIN/CLAV 875MG T 27.05$

HOSPITAL 606195 K-LYTE 25MEQ 27.05$

HOSPITAL 607788 AVEENO 27.05$

HOSPITAL 609010 WARFARIN 4 MG TAB 27.05$


HOSPITAL 609143 RYTHMOL 150MG TAB 27.05$

HOSPITAL 606733 LABETALOL HCL 27.10$

HOSPITAL 603949 PHOSLO 667 MG (CA AC) 27.29$

HOSPITAL 600054 TOPROL XL 100 MG 27.46$

HOSPITAL 604078 BETAPACE 80MG TABS 27.54$

HOSPITAL 602686 CETACAINE-1 SPRAY- 28.06$

HOSPITAL 606410 SIMETHICONE DROPS 30ML BOTTLE 28.16$

HOSPITAL 608519 ALPRAZOLAM 0.5MG ODT TABLET 28.40$


HOSPITAL 605940 NUBAIN 10 MG 1 ML 28.77$

HOSPITAL 606905 MAGNESIUM CITRATE 300 ML BOT 28.82$

HOSPITAL 604408 LISINOPRIL/HCTZ 20/12.5 TABLET 29.33$

HOSPITAL 608951 LIDOCAINE 1% 20ml VIAL 29.58$

HOSPITAL 604291 VENLAFAXINE 37.5 MG 29.62$

HOSPITAL 608971 BUPIVICANE 0.75% (SPINAL)/CC- 29.63$


HOSPITAL 604104 PYRAZINAMIDE 500MG 30.10$

HOSPITAL 607140 NEO-SYNEPHRINE 0.25% 30.10$


HOSPITAL 603625 LANOXIN 0.125MG T. 30.12$

HOSPITAL 600315 ROCALTROLO .25MG CAPS 30.35$

HOSPITAL 605800 HEPARIN 5,000 UNIT 30.35$

HOSPITAL 608986 ETHINYK ESTRADIOL 0.5MG 30.35$

HOSPITAL 607234 ONDANSETRON ODT 4MG TABLET 30.61$

HOSPITAL 604553 PROSCAR 5MG T 30.64$

HOSPITAL 600270 NEOMYCIN 500MG T 30.86$

HOSPITAL 600161 ALBUTEROL SOL 5MG/ML 20ML BOTT 30.95$

HOSPITAL 600322 RIFADIN 300MG 31.17$

HOSPITAL 605839 GALANTAMINE 4MG TAB 31.44$

HOSPITAL 606096 SUBUTEX 2 MG TAB 31.57$

HOSPITAL 604592 METOPROLOL TARTRATE 1MG/ML 5ML 31.63$

HOSPITAL 609559 SEROQUEL 200MG TAB 31.67$

HOSPITAL 603708 MIDODRINE 5 MG 31.69$

HOSPITAL 608961 LIDOCAINE 1% 10MG/ML 10ML VIAL 31.88$

HOSPITAL 600507 XYLOCAINE 1% 5ML VIAL (PF) 31.88$

HOSPITAL 607243 LORATADINE SYRUP -PER CC- 31.88$

HOSPITAL 600092 SOD CHLORIDE .9% 100ML IV SOLN 31.89$

HOSPITAL 605157 MSO 20MG/5ML SYRINGE 32.03$

HOSPITAL 600176 DEXTROSE 5% 100ML 32.03$

HOSPITAL 600178 SODIUM CHLORIDE 0.9% 50ML 32.09$

HOSPITAL 603183 BUPIVICAINE 0.25% 10ML VIAL 32.13$

HOSPITAL 600508 XYLOCAINE 2% 5 ML VIAL (PF) 32.14$

HOSPITAL 600739 MS CONTIN 30MG TABLET 32.39$

HOSPITAL 601213 OXYCODONE 30 MG TABLET 32.39$

HOSPITAL 605415 ZAROXOLYN 5 MG T 32.39$

HOSPITAL 608201 A & D OINTMENT 1/2 OZ 32.39$

HOSPITAL 602863 BISOPROLOL FUMARATE 5MG TAB 33.48$

HOSPITAL 602399 CEFDNIR 250MG/5ML 100ML BOTTLE 34.20$

HOSPITAL 607155 OCEAN SPRAY 34.31$


HOSPITAL 603724 FAMOTIDINE 20 MG/50 ML BAG 34.45$

HOSPITAL 604556 PROMETRIUM 100MG TAB 34.69$

HOSPITAL 600670 DILAUDID 2 MG SYRINGE 34.72$

HOSPITAL 609609 FLUZONE QUADRIVALENT 35.02$

HOSPITAL 603172 DULOXETINE 30MG CAP 35.20$

HOSPITAL 603011 DIVALPROEX ER 250MG 35.45$


HOSPITAL 602616 PLAQUENIL 200MG 35.97$


HOSPITAL 605518 PANTOPRAZOLE 40MG TABLET 36.43$

2020-01





HOSPITAL 604084 NITRO PATCH 0.2MG/H(10CM) 36.99$

HOSPITAL 601557 ROPINIROLE HCL 0.25 MG TAB 37.08$

HOSPITAL 605791 FUROSEMIDE 20 MG VIAL 37.24$

HOSPITAL 626110 ACETIC ACID IRRIGATION 37.32$

HOSPITAL 604338 MIDAZOLAM 5MG/CC 37.49$

HOSPITAL 608625 BUTORPHANOL TARTRATE 1MG/ML VI 37.49$

HOSPITAL 608794 GENTAMICIN CREAM 15GM TUBE 37.95$

HOSPITAL 604021 NORVASC 10MG T 37.99$

HOSPITAL 607568 ZONISAMIDE 100MG CAP 38.32$

HOSPITAL 600144 EFFEXOR 75MG TAB 38.51$

HOSPITAL 602542 BENADRYL CREAM 15GR 38.77$

HOSPITAL 607891 MIDAZOLAM SYRUP 38.77$


HOSPITAL 600204 KEFZOL 500MG IV 39.27$

HOSPITAL 600273 DEXTROSE 10% 250ML 39.32$

HOSPITAL 607658 INSULIN ASPR 100 U/ML PEN HIGH 39.42$

HOSPITAL 604507 ACETAMINOPHEN (ANY) 1 DOSE 39.60$

HOSPITAL 606535 CHLOROSEPTIC SPRAY OZ 39.66$

HOSPITAL 608901 AQUAPHOR 39.66$

HOSPITAL 605033 THEO-DUR 100 MG 39.94$

HOSPITAL 605052 LIDOCAINE VIS PER DOSE 40.04$

HOSPITAL 601317 OXYMETAZOLINE NASAL SPRAY 40.08$

HOSPITAL 605689 DEXAMETHASONE 10MG VIAL W/PRES 40.55$

HOSPITAL 605688 DEXAMETHASONE 10mg/ml 40.55$

HOSPITAL 602593 POLYETHYLENE GLYCOL 17GM PACK 40.66$

HOSPITAL 600115 DIFLUCAN 200MG TAB 40.81$

HOSPITAL 606671 JEVITY 1000ML 41.07$

HOSPITAL 606683 JEVITY 1.2 CAL RTH 1 LITER 41.07$

HOSPITAL 600011 RANITIDINE 150 MG/10ML CUP 41.28$

HOSPITAL 604083 NITRO PATCH O.1MG/H(5CM) 41.32$


HOSPITAL 652314 VISINE OPTH SOL 15 ML 41.57$

HOSPITAL 608009 INSULIN REGULAR 300U/ML 3ML VI 41.64$

HOSPITAL 606396 TOPIRAMATE 25MG TAB 41.73$


HOSPITAL 608605 PAROXETINE 10MG TAB 41.83$


HOSPITAL 606300 MIDAZOLAM 10MG/10CC 42.09$

HOSPITAL 602197 CELECOXIB 100MG CAP 42.32$

HOSPITAL 600203 PRAMIPEXOLE 0.25MG TAB 43.36$

HOSPITAL 604742 DILTIAZEM 5MG/ML 10 ML VIAL 43.36$






HOSPITAL 605432 MILK OF MAGNESIA 30ML CUP 44.80$

HOSPITAL 603202 BUPIVICAINE 0.5% 10ML VIAL 44.85$

HOSPITAL 605060 FLUVOXAMINE 50 MG TABLET 45.10$

HOSPITAL 601370 ARTIFCIAL TEARS 15 ML BOTTLE 45.44$

HOSPITAL 602963 DEPA KOTE 250MG 45.65$

HOSPITAL 603913 ETHAMBUTOL 400MG 45.65$

HOSPITAL 607126 DIVALPROLEX 500MG TAB 45.90$

HOSPITAL 605191 TRANSDERM SCOP 46.14$

HOSPITAL 604905 SYMMETREL 100 MG C. 46.24$

HOSPITAL 608550 MICONAZOLE VAG SUPP -EA- 46.93$

HOSPITAL 608797 AZITHROMYCIN 250MG TABLET 47.26$

HOSPITAL 604538 XYLOCAINE 1% 2.1ML SYRINGE 47.37$

HOSPITAL 603201 BUPIVICAINE/EPI 0.5% 10ML VIAL 48.20$

HOSPITAL 604292 PROPANOLOL SOLUTION 20MG/5ML 48.21$

HOSPITAL 608275 BACITRACIN OINT 30GM TUBE 48.63$

HOSPITAL 625127 LEVOFLOXACIN 250 MG TAB 48.72$

HOSPITAL 608647 NITROGLYCERIN OINT 2% 1 PKT 48.72$

HOSPITAL 605792 FUROSEMIDE 40 MG VIAL 49.21$

HOSPITAL 608472 HYDROCORTISONE 1% 49.99$

HOSPITAL 605601 BUMEX 1MG/4ML VIAL 49.99$

HOSPITAL 602592 AMOXICILLIN 400MG/5ML 100ML BT 50.24$

2020-01




HOSPITAL 602999 DIAMOX 250 MG T. 50.50$

HOSPITAL 608940 LIDOCAINE CRASH 20MG/5ML SYRIN 50.76$

HOSPITAL 606673 ENSURE PLUS 1000ML 50.99$

HOSPITAL 600400 VIBRATABS 100 MG T/DOXYCY 51.03$


HOSPITAL 600509 XYLOCAINE 1% 2ML PRESERV FREE 51.83$

HOSPITAL 601734 OXYBUTYNIN XL 5 MG TAB 52.39$

HOSPITAL 602831 TAMSULOSIN 0.4MG CAP 52.54$


HOSPITAL 606134 TORADOL 30 MG IM/IV 52.80$

HOSPITAL 608860 ASCORBIC ACID 500MG/ML 52.95$

HOSPITAL 603159 MEGESTREL 400MG/10ML CUP 53.31$

HOSPITAL 602579 LANOLIN 7 GM TUBE 53.81$

HOSPITAL 604597 MACROBID 100MG C 54.32$

HOSPITAL 606743 LIDOCAINE GARGLE 54.79$

HOSPITAL 603612 BUPROPION XL 300MG TAB 54.84$

HOSPITAL 603508 ENALAPRILAT 1.25MG/VIAL 55.09$

HOSPITAL 603000 DIAMOX 500MG C. 55.09$

HOSPITAL 600771 PERCOCET-10 325 MG TABLET 55.60$

HOSPITAL 605794 FUROSEMIDE 100 MG IV 55.60$


HOSPITAL 605890 MAGNESIUM SULFATE 50% 1GM/2ML 56.60$

HOSPITAL 608545 MONISTAT CR 56.62$

HOSPITAL 607015 MANNITOL 25% 50ML 57.39$

HOSPITAL 600268 DEXTROSE 5% IN H20 250CC IV SO 57.50$


HOSPITAL 601260 ALCAINE OPTH 15 CC 60.31$

HOSPITAL 608779 GENTAMICIN 80MG/50ML 60.33$

HOSPITAL 608140 PETROLEUM JELLY OZ 60.45$

HOSPITAL 608980 SOD. BICARB PED CRASH 60.96$


HOSPITAL 608159 LIDOCAINE W/EPI 50ML VIAL 63.10$

HOSPITAL 600729 MORPHINE 4 MG 63.27$

HOSPITAL 605939 VECURONIUM BROMIDE 1MG/ML 10ml 63.51$

HOSPITAL 605511 ADENOSINE 3 MG/ML 2ML VI 63.51$

HOSPITAL 600452 BYSTOLIC 2.5mg TABLET 63.59$

HOSPITAL 606818 PACLITAXEL 6MG/ML 63.73$

HOSPITAL 600731 MORPHINE 5MG/1ML VIAL 63.77$

HOSPITAL 603141 BUPIVICAINE/EPINEPHRINE 0.25% 64.02$

HOSPITAL 600732 MORPHINE 8MG/ML 65.04$

HOSPITAL 608640 NILSTAT CR 15G 66.05$

HOSPITAL 600472 XYLOCAINE MPF 2% VIALS 66.40$

HOSPITAL 600934 RALOXIEFENE 60MG TAB 66.83$

HOSPITAL 605540 HYDRALAZINE 20 MG/AMP IV 67.22$

HOSPITAL 604251 BETADINE SOLN 8 OZ 67.59$

HOSPITAL 603910 VICKS 2 OZ SALVE 67.69$

HOSPITAL 607150 NEO-SYNEPHRINE 1% 69.61$

HOSPITAL 608959 FLOURESCITE 10%5ML SINGLE USE 69.63$


HOSPITAL 605972 MELOXICAM 7.5MG TAB 71.31$

HOSPITAL 602587 FIXODENT 2oz TUBE 72.43$

HOSPITAL 608135 TUCKS BOX OF 40 72.54$


HOSPITAL 607946 VALSARTAN/HCTZ 80MG/12.5MG TAB 72.69$

HOSPITAL 604591 DEXTROSE 25% 10ML PED SYR 73.71$


HOSPITAL 605349 VALSARTAN/HCTZ 160/12.5 TAB 74.48$

HOSPITAL 601096 PHENOBARBITAL 130 MG/1ML 74.73$

HOSPITAL 601489 CHLORHEXIDINE GLUCONATE 118ML 74.98$

HOSPITAL 607803 ENTACAPONE 200MG TAB 75.24$

HOSPITAL 600392 SEVELAMER 403 MG CAP 75.74$

HOSPITAL 600060 BIAXIN 500MG 75.75$

HOSPITAL 602997 COLESEVELAM 625MG TAB 75.75$

HOSPITAL 600038 ANCEF 1GM IV/SOLUTION 76.38$

HOSPITAL 607880 VITAL 1.5 CAL ELEMENTAL NUTRI 76.52$

HOSPITAL 600963 CIPRO OPHTHALMIC SOL 0.3 BOT 76.52$

HOSPITAL 608595 MYOFLEX 2 OZ 76.52$


2020-01




HOSPITAL 600225 GENTAMYCIN 80 MG VIAL 77.79$

HOSPITAL 603556 AZTREONAM 500MG IV PUSH 77.89$


HOSPITAL 600044 DEXTROSE 10% WATER 1000ML 78.38$

HOSPITAL 658749 NORFLURANE/HFC 245FA AEROSOL 79.31$

HOSPITAL 600840 ATIVAN 2 MG/ML 1ML VIAL 79.69$

HOSPITAL 603950 VERSED 5MG/ML VIAL 79.70$

HOSPITAL 604527 ISOSORBIDE TEMBIDS 40MG T 79.84$

HOSPITAL 607010 VELBAN 1 MG 79.96$

HOSPITAL 605870 LANOXIN 0.5 MG/2CC AMP 80.08$

HOSPITAL 606154 GLUTOSE-15 GEL 80.08$

HOSPITAL 605085 CHOLRPROMAZINE 25 MG T 80.34$

HOSPITAL 606397 TOPAMAX 25mg SPRINKLE capsule 81.24$

HOSPITAL 606189 MIDAZOLAM 5MG/5ML VIAL 82.13$



HOSPITAL 600590 DABIGATRAN 75MG CAPSULE 83.09$

HOSPITAL 601475 LACRI-LUBE 3.5GM 83.40$

HOSPITAL 606200 QUESTRAN 50M PACK 84.17$

HOSPITAL 606201 CHOLESTYRAMINE LITE PACKET 84.17$

HOSPITAL 605328 CEFAZOLIN 1GM PREMIX D5W 50ML 84.61$

HOSPITAL 604222 FENTANYL CIT 100 MCG VIAL 84.68$

HOSPITAL 606453 LORTAB ELIXIR 7.5/325MG/15ML 84.93$

HOSPITAL 607312 VARENICLINE 0.5MG TABLET 85.95$


HOSPITAL 600266 SOD CHLORIDE 250CC IV SOL 86.75$

HOSPITAL 606644 NITROGLYCERIN PREMIX 50 MG BTL 86.95$

HOSPITAL 654872 XYLOCAINE 1.5%/EPI 1:200,000 87.74$

HOSPITAL 608067 HIBICLENS 91.31$

HOSPITAL 603273 METAXALONE 800MG TABLET 91.31$

HOSPITAL 603193 ACETYLCYSTEINE 600MG CAPSULE 91.72$

HOSPITAL 607050 POT PHOSPHATE 15MM/5ML VIAL 91.93$

HOSPITAL 605628 BUPIVIC/EPINEPH .25% 50ML VIAL 93.91$

HOSPITAL 600542 LET SOLUTION 93.92$

HOSPITAL 604837 SPECTAZOLE CR 15GR 94.37$


HOSPITAL 602467 ACTIGALL 300MG CAP 96.92$

HOSPITAL 608317 LIDOCAINE TOPICAL PATCH 96.92$

HOSPITAL 600030 AMPICILLIN 250/5 100S 97.18$

HOSPITAL 604297 AMYLASE/LIPASE/PROTEASE 1 COMB 97.59$

HOSPITAL 604342 TOLTERODINE 4M CAP 97.94$

HOSPITAL 600193 CEPHALEXIN 125MG/5 S 100 98.20$

HOSPITAL 604634 BUPIVACAINE .25% EPI 30ML 98.20$

HOSPITAL 606267 TACROLIMUS 1MG CAP 98.70$

HOSPITAL 608746 VASOTEC IV 2ML 98.78$

HOSPITAL 602556 VIMPAT 50 MG TAB 100.12$

HOSPITAL 604279 BUMEX 0.5 MG/2 ML VIAL 100.44$

HOSPITAL 606095 SYNTOCINON 10 UNIT 100.49$

HOSPITAL 603072 PANTOPRAZOLE 40MG VIAL 101.62$

HOSPITAL 606100 ASACOL HD 800 MG 102.32$

HOSPITAL 608791 Lidocaine 1%-EPI 1:200,000 102.54$

HOSPITAL 600387 BYSTOLIC 10mg TABLET 102.69$

HOSPITAL 601111 DEXTROSE 31 GM/TUBE 102.78$

HOSPITAL 602589 TRIMETHOPRIM O.S. 103.04$

HOSPITAL 605892 MAGNESIUM SULF 4GM/100ML BAG 103.91$

HOSPITAL 606770 TB VACCINE-TUBERSOL 0.1ML DOSE 104.06$

HOSPITAL 605620 CALCIUM GLUC 1000 MG/10ML VIAL 105.19$

HOSPITAL 605147 CEFIPIME 1GM VIAL 105.34$

HOSPITAL 609923 LIDOCAINE TOPICAL 4% UROJECT 105.60$

HOSPITAL 654123 AMIODARONE 450 MG/9 ML VIAL 106.10$

HOSPITAL 600036 STADOL 2MG VIAL 106.62$

HOSPITAL 605670 CYANOCOLBALMIN 1000MCG/ML VIAL 108.91$

HOSPITAL 605935 NEO-SYNEPHRINE 1% 10MG/ML 109.93$

HOSPITAL 609060 VALSARTAN 160 MG TABLET 109.96$

HOSPITAL 605565 BACTRIM 5 ML AMP IV 110.18$

HOSPITAL 600238 FLAGYL 500 PREMIX 110.46$

HOSPITAL 606367 PROPOFOL 10MG/ML VIAL 111.71$

HOSPITAL 607045 POTASSIUM CHLOR 2MEQ/ML 20ML V 111.79$

2020-01




HOSPITAL 603916-A MMRV VACCINE 113.07$

HOSPITAL 606913 DUTASTERIDE 0.5MG CAPSULE 113.50$

HOSPITAL 605891 MAGNESIUM SULFATE 1GM/100ML 113.79$

HOSPITAL 604534 ADRENALIN 1MG/ML 30ML 114.77$

HOSPITAL 609835 NIACIN SUST RELEASE 500MG TAB 115.54$

HOSPITAL 608660 PREPARATION H OZ 116.81$

HOSPITAL 605595 BRETHINE 1 MG/1ML AMP IV 117.15$

HOSPITAL 600024 AMOXILCILLIN 125/5 100 117.45$

HOSPITAL 603186 SUCRALFATE 1GM/10CC CUP 117.48$

HOSPITAL 606945-A PNEUMOVAX-23 .5ML -R- 117.50$

HOSPITAL 602780 COLCHICINE 0.6 MG TAB 117.71$

HOSPITAL 605321 VERMOX 100MG CHEW TAB 117.83$

HOSPITAL 607616 HUM INSULIN NPH 3ML PEN 100U 118.29$

HOSPITAL 604219 PIPERACILLIN/TAZOB 3.37GM VIAL 118.79$

HOSPITAL 600625 DEMEROL 50 MG. INJ. 119.68$

HOSPITAL 604261 CALMOSEPTINE 120.39$


HOSPITAL 605172 MORPHINE SUST REL 100 MG TAB 122.43$


HOSPITAL 654124 AMIODARONE 900MG VIAL 124.21$

HOSPITAL 601306 CYCLOPENTOLATE 2% 15 ML BOT 124.47$

HOSPITAL 603998 D5 1/2 NS W/10MEQ KCL/L 125.01$

HOSPITAL 603986 D5/NS W/20MEQ KCL/1000 ML BAG 125.06$


HOSPITAL 602746 CILOXAN OPTH SOL 25ML 125.62$

HOSPITAL 603999 D5W W/40 MEQ KCL/L 125.67$

HOSPITAL 601512 ELIQUIS 5MG TABLET 125.83$

HOSPITAL 603997 D5W W/20MEQ KCL/L 125.93$

HOSPITAL 600520 ATROPINE 0.4 MG IV 126.25$

HOSPITAL 605625 CALCIUM CHLORIDE 100 MG IV 126.40$

HOSPITAL 603992 NS W/40MEQ KCL/L 126.41$


HOSPITAL 601224 BRILINTA 90MG TAB 126.81$

HOSPITAL 606910 MVI 12 VIAL 10 ML 127.16$

HOSPITAL 603989 NS W/20MEQ KCL/L 127.31$

HOSPITAL 604957 DILTIAZEM 125MG/ML 25ML VIAL 127.51$

HOSPITAL 603236 DULOXETINE 20MG CAPSULE 127.52$

HOSPITAL 608081 AMIODARONE 150MG AMP 127.52$

HOSPITAL 608235 TRIAMCINOLONE OI 0.1% 15G 127.52$

HOSPITAL 603089 MEROPENEM 500MG VIAL 127.52$


HOSPITAL 604407 DEBROX DROPS 15ML 127.52$


HOSPITAL 605780 ETOMIDATE 20MG/10ML AMP 127.52$

HOSPITAL 605936 PHENYLEPHRINE 400MCG/10ML SYR 127.52$

HOSPITAL 607566 PIPERCILLIN/TAZOBACTAM 2.25 GM 127.52$

HOSPITAL 603143 ZIPRASIDONE 20MG CAP 127.52$

HOSPITAL 605037 FLUTICASONE NASAL INHALER 127.98$

HOSPITAL 605981 PARAPLATINUM 10MG/ML 60ML VIAL 129.12$

HOSPITAL 606015 CLINDAMYCIN 600MG IN 50ML D5W 130.05$

HOSPITAL 607412 PREGABALIN 25MG CAPSULE 130.35$

HOSPITAL 604784 OXYCODONE 20MG TAB 130.52$

HOSPITAL 602196 CELECOXIB 200MG CAP 130.76$

HOSPITAL 605993 1/2NS w/20 meq KCL/L 131.54$

HOSPITAL 684352 GAVILAX 238GM BOTTLE 131.72$

HOSPITAL 605943 RANOLAZINE 500MG TAB 133.24$

HOSPITAL 608673 MARINOL 2.5MG C 133.59$

HOSPITAL 602732 LAMOTRIGINE 200 MG TABLET 134.12$

HOSPITAL 606260 DERMOPLAST SPRAY 60ML 134.32$

HOSPITAL 604727 HEPARIN 100 UNITS/ML IV SOLN 135.18$

HOSPITAL 607802 LETROZOLE 2.5MG TAB 135.31$

HOSPITAL 609385 PROMETHAZINE 25MG SUPP 136.51$

HOSPITAL 605795 HALOPERIDOL 5MG/CC INJ 136.51$


HOSPITAL 604999 MORPHINE 1MG/ML PF 10MG/10ML V 138.14$

HOSPITAL 603294 LUBIPROSTONE 24MCG CAPSULE 138.67$

HOSPITAL 603297 AMITIZA 8MCG CAPSULES 138.79$

HOSPITAL 604910 TOBRAMYCIN 40MG/1ML 139.59$

2020-01




HOSPITAL 608670 PROCTOFOAM - HC 141.54$

HOSPITAL 604046 SPORANOX 100MG 143.25$

HOSPITAL 606752 LEVETIRACETAM 100MG/ML ML 144.41$

HOSPITAL 643512 HYDROCORTISONE 1% LOTION 144.42$

HOSPITAL 605782 AMIDATE 40 MG/20 ML SYRINGE 146.23$

HOSPITAL 604708 LIDOCAINE JELLY 2% 5ML TUBE/ML 147.96$

HOSPITAL 603987 D5/NS W/40MEQ KCL/L 150.29$

HOSPITAL 608180 OLANZAPINE 5MG TAB 150.64$

HOSPITAL 605912 METHERGINE 0.2 MG/1CC INJ 152.32$

HOSPITAL 602991 LIDOCAINE 400MG/20ML UROJECT 152.79$

HOSPITAL 606016 CLINDAMYCIN 900MG IN 50ML D5W 153.75$

HOSPITAL 608775 LIDOCAINE 2% JELLY 154.00$

HOSPITAL 606676 SOD POLYSTYRENE SLF 30GM/120ML 154.15$

HOSPITAL 601551 VIIBRYD 40MG 154.95$

HOSPITAL 606110 THIAMINE 100MG/2ML VIAL 156.38$

HOSPITAL 604108 SANDOSTATIN 100MCG/ML AMP IM 156.62$

HOSPITAL 600735 MORPHINE 10MG SYR. 159.14$

HOSPITAL 601297 TIMOPTIC OPTH O.5% 5ML BOTTLE 161.12$

HOSPITAL 605327 CEFAZOLIN 2GM/100ML PREMIX 161.18$



HOSPITAL 604635 BUPIVACAINE .5% EPI 30ML 165.49$

HOSPITAL 607611 INSULIN ASPART 300 UNIT PEN 166.55$

HOSPITAL 609605 ENTRESTO 24MG 167.00$

HOSPITAL 608685 SILVADENE 50 GM JAR 167.76$

HOSPITAL 608648 NIZORAL 2% CREAM 15GM 168.84$

HOSPITAL 602312 PIOGLITAZONE 30 MG TAB 170.27$

HOSPITAL 603714 ANASTROZOLE 1 MG TAB 170.28$


HOSPITAL 604444 OXYCODONE 40MG TAB U/D 171.47$

HOSPITAL 603907 ATROPINE 1MG/10CC SYRINGE 172.43$

HOSPITAL 601361 GENTAMYCIN OPTH SOL 5ML BOT 173.87$

HOSPITAL 600492 GELFOAM 12-7 EACH 174.65$

HOSPITAL 603956 PROCHLORPERAZINE 25MG SUP 176.03$


HOSPITAL 604768 DOPAMINE 400MG PREMIX 179.53$


HOSPITAL 605789 LYTES/CMC 120CC 179.62$

HOSPITAL 603769 ATROVENT NASAL SPRAY 15 ML ML 180.09$

HOSPITAL 606998 HYSEPT 0.25% SOLUTION 180.10$

HOSPITAL 604603 PROMETHAZINE 12.5MG SUPP 181.30$


HOSPITAL 608556 CALCIUM CHLOR 1000 MG/10 ML VI 181.54$

HOSPITAL 608975 SOD. BICARB 8.4% CRASH 184.35$

HOSPITAL 606030 ROBINUL 0.2 MG 1ML 190.99$

HOSPITAL 606679 KAYEXALATE UNIT 15GM/60ML BOTT 193.67$

HOSPITAL 600063 BICILLIN C-R 600,000 UNIT SYR 195.23$

HOSPITAL 607311 INSULIN DET 100u/ML 3ML PEN 197.39$

HOSPITAL 602551 BACITRACIN 50000 UNIT VIAL 197.53$

HOSPITAL 607748 MYCOPHENOLATE 500MG TAB 199.02$

HOSPITAL 605500 EPINEPHRINE 1 MG/ML VIAL 199.73$

HOSPITAL 605541 AQUOSOL A 50,000 IV 199.97$

HOSPITAL 606144 D5W 50ML SYRINGE 201.44$

HOSPITAL 600052 SUBLIMAZE 250 MCG/5 ML VIAL 203.33$


HOSPITAL 602068 PIPERACILLIN/TAZOBACTAM 4.5GM 204.76$

HOSPITAL 605860 TRIAMCINOLONE 40MG/CC 1CC 208.02$

HOSPITAL 600043 AZECTAM 2GM/SOLUTION 208.81$

HOSPITAL 600067 BI-CILLIN LA 600,000 208.83$

HOSPITAL 600403 VIBRAMYCIN 100MG IV/SOLUTION 208.97$

HOSPITAL 603763 EMLA CREAM 30 GM 210.03$

HOSPITAL 604274 PENICILLIN G POT 3MMU/50ML DEX 211.79$

HOSPITAL 606615 XARELTO 10 MG 213.14$


HOSPITAL 605254 MUPIROCIN 2% OINTMENT TUBE 213.62$

HOSPITAL 604777 DOBUTAMINE 250MG/250CC D5 214.34$

HOSPITAL 604194 LIDOCAINE 2.5% PRILOCAINE 216.74$

HOSPITAL 605725 DEPO-MEDROL 40MG/1ML 1CC 218.58$

2020-01




HOSPITAL 604139 CLOZARIL 100 MG T 219.13$


HOSPITAL 602826 MULTAQ 400MG TABLET 220.70$


HOSPITAL 607041 POTASSIUM CHLORIDE 10MEQ-LIDOC 223.92$

HOSPITAL 603376 OXYTOCIN 20 U/D5 LR 1000ML BAG 225.86$

HOSPITAL 601375 ERYTHROMYCIN OPTH OINT 1GM TU 226.32$

HOSPITAL 600698 FENTANYL 12mcg PATCH 229.20$

HOSPITAL 604110 ROMAZICON 0.5 MG/5 ML VIAL 229.20$

HOSPITAL 602429-A TD TOXOID - PEDIATRIC 230.00$

HOSPITAL 607798-A TETANUS, DIPHTHERIA TOX 230.57$

HOSPITAL 608008 OSELTAMIVIR 75MG CAP 231.82$

HOSPITAL 609345 ANUSOL-HC 25MG SUPP 234.50$

HOSPITAL 601203 EZETIMIBE 10MG TAB 237.10$

HOSPITAL 603756 ATROPINE 0.05MG/ML 5ML 239.01$

HOSPITAL 603088 BIMATOPROST OPTH. SOLN. 239.49$

HOSPITAL 603090 MERREM 1 GM VIAL 239.49$

HOSPITAL 605525 AMINOPHYLLINE 250 MG/10 ML 239.49$

HOSPITAL 606196 ULORIC 40 MG TAB 239.49$

HOSPITAL 606293 OLANZAPINE 10MG T 239.49$

HOSPITAL 609018 AMOXICILLIN/CLAVULANTE 239.49$


HOSPITAL 606102 TAMIFLU 30MG CAP 239.49$

HOSPITAL 605663 RIVASTIGMINE 4.6MG/24 HR PATCH 241.79$

HOSPITAL 600104 CLEOCIN 900MG IV 243.70$


HOSPITAL 600291 PENICILLIN G 5 MIL IV/SOLUTION 246.41$

HOSPITAL 601896 XYLOCAINE 2%/EPI 1:2000,000 246.47$

HOSPITAL 604736 AZITHROMYCIN 200mg/5ml 15mlBTL 247.81$

HOSPITAL 604834 LATANOPROST OPH 0.005% 2.5ml 248.20$

HOSPITAL 603147 BUDESONIDE 3MG CAPSULE 249.38$

HOSPITAL 605585 DICYCLOMINE 10MG/ML 2ML AMP 251.71$

HOSPITAL 609558 DAKINS FULL STRENGTH SOLTUION 253.64$

HOSPITAL 605655 COMPAZINE 10MG/2ML IV 253.93$

HOSPITAL 604276 NULYTELY 4000 ML BOTTLE 254.77$

HOSPITAL 602718 PERIDEX ORAL RINSE -OZ- 260.06$

HOSPITAL 601251 ATROPINE OPH 5CC 260.59$

HOSPITAL 601095 PHENOBARBITAL 65MG/1ML 263.28$

HOSPITAL 608462 SUMATRIPTAN 50MG TAB 265.52$

HOSPITAL 604549-A HEPATITIS B VAC 10MCG/0.5ML 267.23$

HOSPITAL 600366 TOBRAMYCIN 40MG/ML 2ML VIAL 268.43$

HOSPITAL 603636 CEFEPIME 2GM VIAL 268.88$

HOSPITAL 607040 POT CHLORIDE PREMIX 10MEQ 273.16$

HOSPITAL 608003 CEREBYX 500 MG/10 ML VIAL 273.36$

HOSPITAL 606613 XARELTO 15MG TAB 274.30$

HOSPITAL 608950 LIDOCAINE 2G CRASH 274.48$

HOSPITAL 604856 SITAGLIPITIN 50MG TAB 274.78$

HOSPITAL 607042 POT CHORIDE PREMIX 20MEQ 275.63$

HOSPITAL 609089 FLUCONAZOLE 400 MG IV 276.61$

HOSPITAL 602221 LIDOCAINE 2000MG/500ML D5W 279.98$

HOSPITAL 608723 TOBREX OPTH SOLN 0.3% 283.66$

HOSPITAL 600164 GENTAMYCIN 10MG/ML 2ML 287.88$


HOSPITAL 606690 TERBINAFIN HCL CR 1% 290.84$

HOSPITAL 605475 XARELTO 20 MG TAB 296.25$

HOSPITAL 600202 NYSTATIN CREAM 30GM 297.33$

HOSPITAL 608823 INVEGA TAB 299.10$

HOSPITAL 608881 PREDNISOLONE 15MG/5ML 60ML BTL 299.58$

HOSPITAL 606402 SPIRIVIA INHALER 30 PUFF 300.52$

HOSPITAL 608429 KETAMINE 50MG/1ML SYRINGE 301.37$

HOSPITAL 605925 NARCAN 0.4 MG AMP 307.35$


HOSPITAL 600589 PRASUGREL 5MG TABLET 307.81$

HOSPITAL 605687 ERYTHROMYCIN FILMTAB 500 MG 309.66$

HOSPITAL 608592 MYCOSTATIN POWDER 311.00$

HOSPITAL 603347 SEROQUEL XR 200mg 311.19$

HOSPITAL 608957 NEOSTIGMINE 1MG/ML 5ML SYR 313.70$

HOSPITAL 604452 TRIAMCINOLONE ORABASE 5GM 317.28$

2020-01




HOSPITAL 604714 CEFTRIAXONE 1 GM VI 319.25$

HOSPITAL 605843 INTRALIPID 20% 250ML BAG 321.09$


HOSPITAL 604852 LEUCOVORIN CALCIUM 200 MG VIAL 331.19$

HOSPITAL 604500 OXEPA 1000 ML BOTTLE 332.59$

HOSPITAL 608925 EPINEPHRINE 1MG 10000 CRASH 335.65$

HOSPITAL 608533 LEVTRIACETAM 500MG/VIAL 336.04$

HOSPITAL 603696 ENOXAPARIN 100MG SYRINGE 336.10$

HOSPITAL 604441 HYDROMORPHONE 20CC MDV 336.10$

HOSPITAL 600042 AZECTAM 1GM/ SOLUTION 336.25$

HOSPITAL 625126 LEVOFLOXACIN 250 MG IV SOL 338.01$

HOSPITAL 605485 LEUCOVORIN 350mg vial 339.95$

HOSPITAL 609961 PROVAYBLUE 50MG/10ML AMP 341.74$

HOSPITAL 609346 ELOCON 0.1% OIN 15 GM 342.81$

HOSPITAL 609506 OCTREOTIDE ACETAT INJ 1 ML AMP 352.46$

HOSPITAL 607614 NOVOLOG 70/30 300U/3ML PEN 357.83$

HOSPITAL 606120 CHLORPROMAZINE 50MG/2ML VL 362.54$

HOSPITAL 608880 VIMPAT 200 MG/20 ML VIAL 363.21$

HOSPITAL 603456 REVATIO 20 MG TAB 367.24$

HOSPITAL 600447 BREVITAL 100 MG/10ML SYRINGE 370.75$

HOSPITAL 608487 LEFLUNOMIDE 20MG TAB 376.21$

HOSPITAL 608969 PROTEIN SUPPLEMENT 946ml BOTT 376.65$

HOSPITAL 605055 OFLOXACIN 0.3% OPH SOLN 379.12$

HOSPITAL 606184 INCRUSE ELLIPTA INHALER 379.89$

HOSPITAL 607161 ALBUTEROL INHALER 8.5GM 384.51$

HOSPITAL 606984 OLANZAPINE 10MG ODT TABLET 385.99$

HOSPITAL 601119 FLUCONAZOLE 100 MG/50 ML 386.19$

HOSPITAL 605516 TRANEXAMIC ACID 100MG/ML 388.06$

HOSPITAL 605730 DEPO-MEDROL 80MG VIAL 388.98$

HOSPITAL 600424 ABILIFY 2 MG TAB 389.82$

HOSPITAL 609955 LATUDA 40MG TABLET 390.80$

HOSPITAL 605887 LEVOPHED 1MG/Ml 4ML 395.84$

HOSPITAL 601201 LINEZOLID 600MG TAB 396.57$

HOSPITAL 605486 LEUCOVORIN 100mg vial 412.84$

HOSPITAL 601200 DIAZEPAM 10MG INJ 413.59$

HOSPITAL 600265 VALPROATE SOD 500MG/5ML VIAL 417.44$

HOSPITAL 602047 INSULIN ASPART 1000 UNITS/10ML 420.95$

HOSPITAL 605523 CYCLOSPORINE DROPPERETTES 32/B 431.78$

HOSPITAL 603819-A DIPTH,PERTUSS TETANUS (ACELL) 436.21$

HOSPITAL 602727 LEVEMIR 1000U/10ML INSULIN 438.56$

HOSPITAL 602728 PAMIDRONATE DISODIUM 90MG VIAL 438.91$

HOSPITAL 606637 GI COCKTAIL 444.59$

HOSPITAL 600411 ZOVIRAX 500 MG IV 448.13$

HOSPITAL 600490 GELFOAM 100MM 448.13$



HOSPITAL 603301 VINCRISTINE 2MG VIAL 448.13$

HOSPITAL 605512 ADENOCARD 3MG/ML 4ML VIAL 448.13$

HOSPITAL 605517 ADENOSINE 3MG/ML 4 ML VIAL 448.13$

HOSPITAL 606041 PHENYLEPHRINE 0.5% 15ML SPRAY 448.13$

HOSPITAL 606067 CEFDINIR 125MG/5ML 60ML BOTTLE 448.13$

HOSPITAL 604901 FENTANYL EPIDURAL MIXTURE 448.33$

HOSPITAL 609008 AZITHROMYCIN 500 MG ADD VANT 448.86$

HOSPITAL 603904 ELIMITE CREAM 60GM TUBE 457.28$

HOSPITAL 603083 ARIPIPRAZOLE 10MG TAB 458.15$

HOSPITAL 600027 AMPICILLIN 2GM VIAL 458.31$


HOSPITAL 658234 DOCETAXEL INJECTION 10 MG/ML 477.80$

HOSPITAL 600695 DURAGESIC 100MG 479.37$

HOSPITAL 608893 PAMIDRONATE 60MG/10ML 486.69$

HOSPITAL 602913 ARIPIPRAZOLE 5 MG TABLET 502.83$

HOSPITAL 625125 LEVOFLOXACIN 500 MG IV SOL 503.68$

HOSPITAL 607884 ANORO ELLIPTA INHALER 511.95$

HOSPITAL 606684 TOBRAMYCIN 1.2 GM POWDER 524.99$

HOSPITAL 608562 ENOXAPARIN SOD 150MG/ML SYR 533.01$

HOSPITAL 605236 BREO ELLIPTA INHALER 549.74$

HOSPITAL 603356 NAROPIN 0.5% 150MG VIAL 553.16$


2020-01




HOSPITAL 602324 TEMOVATE 0.05% CREAM 15GM 566.21$

HOSPITAL 603459 MODAFINIL 200MG TAB 568.08$

HOSPITAL 600575 B & O SUPPOSITORY (EA) 570.15$

HOSPITAL 601117 DIFLUCAN 200MG IV 582.65$

HOSPITAL 609602 MAGNESIUM 50gram/500ml LR 584.02$

HOSPITAL 604593 NARCAN 1MG AMP 593.34$

HOSPITAL 606591 CLINIMIX 4.25-10 2,000ML PRMIX 602.97$

HOSPITAL 609565 NEXTERONE 150MG/100ML 617.83$

HOSPITAL 602677 cloNIDine HCL TTS-1 PATCH 621.30$

HOSPITAL 602731 CARDENE(NICARDIPINE) 25MG AMP 621.30$

HOSPITAL 601360 GARAMYCIN OPTH OINT. 623.33$

HOSPITAL 608690 SILVER SULFADIAZINE 400GM 626.79$

HOSPITAL 602994 OXALIPLATIN 100MG/20ML VIAL 635.02$

HOSPITAL 605635 CELESTONE SOLUS 6MG/ML 5ML IV 635.03$

HOSPITAL 623456 RIFAXIMIN 550 MG TAB 651.01$

HOSPITAL 603734 BREVIBLOC 10 CC 655.34$

HOSPITAL 605740 DIAMOX 500MG INJ 655.34$

HOSPITAL 625124 LEVOFLOXACIN 750 IV SOLUTION 668.35$

HOSPITAL 604909 FLUTICASONE 110MCG 668.96$

HOSPITAL 600385 VANCOMYCIN 500MG IV/SOLUTION 670.87$

HOSPITAL 608990 IRINOTECAN HCL 20 MG/ML 5ML VI 682.75$

HOSPITAL 605451 ATIVAN 2mg/ml Oral 30ml btl 693.67$

HOSPITAL 603206 OLANZAPINE 10MG VIAL 708.63$

HOSPITAL 609101 VANCOMYCIN HCL 750 MG INJ 728.36$

HOSPITAL 600422 ACETAMINOPHEN 1000MG/100MLVIAL 742.55$

HOSPITAL 600416 SUCCINYLCHOLINE 200mg/vial 748.82$

HOSPITAL 606875 BLEOMYCIN SULFATE 30UNITS/VIAL 758.45$

HOSPITAL 605543 VITAMIN K INJ 1 MG/0.5ML PED 766.70$

HOSPITAL 601867 AK-DILATE 10% OPTH SOL 5 ML 766.70$

HOSPITAL 602903 VORICONAZOLE 200MG TAB 766.70$

HOSPITAL 604511 LAC-HYDRIN 12% LOTION 766.70$

HOSPITAL 605513 ALBUMIN 12.5gm/50ml (50ml bag) 766.70$

HOSPITAL 605542 VITAMIN K INJ 10MG/CC 766.70$

HOSPITAL 600386 VANCOMYCIN 1GM IV/SOLUTION 767.32$

HOSPITAL 605521 BUDESONIDE TURBUHALER 767.48$

HOSPITAL 602954 ZIPRASIDONE 20MG VIAL 779.24$

HOSPITAL 601252 METHERGINE 0.2MG TAB 783.70$

HOSPITAL 604823 GEMCITABINE 1GM VIAL 791.80$

HOSPITAL 609567 NEXTERONE 360MG/200ML PREMIX 794.86$

HOSPITAL 679433 BI-CILLIN C-R 1.2M U/2ML SYRIN 797.52$


HOSPITAL 605786 FLOUROURACIL 1GM/20ML 813.07$

HOSPITAL 604891 FOSPHENYTOIN NA 50 MG/ML 2 ML 829.48$


HOSPITAL 606311 ASTELIN 137mcg NASAL SPRAY 856.71$

HOSPITAL 600105 CLEOCIN PED 100 ML BOTTLE 860.83$

HOSPITAL 608479 ROCURONIUM BROM 50 MG 861.15$

HOSPITAL 603546 FLUOROURACIL 50MG/ML 100ML VL 880.56$

HOSPITAL 605645 BENZTROPINE 2MG/2CC 880.56$

HOSPITAL 606061 THROMBIN 5000 UNIT SPRAY KIT 880.56$

HOSPITAL 608851 AMOX TR/POT CLAV 600MG/5ML ML 880.56$

HOSPITAL 604533 EPHEDRINE SULF 50MG/1ML VIAL 880.56$

HOSPITAL 604967 ROPIVACAINE EPI 2MG/ML 200ML 880.56$

HOSPITAL 604758 CALCITONIN NASAL 30 SPRAY BTL 883.31$

HOSPITAL 604049 IMITREX 6 MG/0.5 ML VIAL 935.39$

HOSPITAL 604966 ROPIVACAINE EPI 2MG/ML 100ML 952.63$

HOSPITAL 600380 VENOFER 200MG/10ML SDV 973.61$

HOSPITAL 603069 IRON SUCROSE 20MG/1ML 5ML VIAL 973.61$

HOSPITAL 634875 ZYVOX 600 MG/300 ML SOLUTION 982.43$

HOSPITAL 606363 PROPOFOL 1000MG/100ML VI 988.33$

HOSPITAL 605067 KETOROLAC .5% O.S. 1,003.82$

HOSPITAL 609204 PATADAY 3ML BOTTLE (EYE DROP) 1,005.59$

HOSPITAL 609023 FOSFOMYCIN TROMETHAMINE 3GM PK 1,011.37$

HOSPITAL 602749 CILOXIN OPTH OINT 3GM 1,033.22$

HOSPITAL 608724 TOBRADEX EYE DROPS 2.5 ML BOT 1,059.58$

HOSPITAL 679432 BI-CILLIN LA 1200000 UNITS 1,078.28$

HOSPITAL 602992 OXALIPLATIN 50MG/10ML VIAL 1,086.90$

HOSPITAL 609941 ERAXIS 100MG VIAL 1,102.81$

2020-01




HOSPITAL 603203 ACETYLCYSTEINE 200 MG/ML VI 1,111.16$

HOSPITAL 602094 VORICONAZOLE 200MG VIAL 1,126.65$

HOSPITAL 600062 OTOCORT EAR SOLN 1,157.60$

HOSPITAL 609650 RHOPHYLAC 1500 U/2ML SYRINGE 1,186.05$

HOSPITAL 606755 GAMMAGARD 1GM VIAL 1,187.49$

HOSPITAL 604043 DEPO-PROVERA 150MG SYRINGE 1,198.73$

HOSPITAL 608202 ADRENALIN TOPICAL 1,208.38$

HOSPITAL 605594 AMPHOTERICIN B LIPOSOME 50MG 1,372.76$

HOSPITAL 604009 DTIC 200 MG VIAL 1,408.27$

HOSPITAL 602008 RETACRIT 10000 UNITS/ML 1,429.31$

HOSPITAL 601270 BACITRACIN OINT 3.5 GM TUBE 1,440.25$

HOSPITAL 606093 SYNTHROID 100 MCG VIAL 1,513.33$

HOSPITAL 604787 MENINGOCOCCAL VACCINE 1,576.51$

HOSPITAL 601352 GEMCITIBINE 200MG VIAL 1,606.88$

HOSPITAL 605735 D.H.E 45 AMP 1MG/ML 1,606.88$

HOSPITAL 606650 NITROGLYCERIN SPRAY/DOSE 1,606.88$

HOSPITAL 605000 RELISTOR 12 MG/ 0.6 ML 1,606.88$

HOSPITAL 609606 DEFINITY INJ CONTRAST SUSP 1,609.43$

HOSPITAL 603188 LANSOPRAZOLE 30MG SOLU-TAB 1,627.28$

HOSPITAL 605146 DORZOLAMIDE/TIMOLOL 1,635.27$

HOSPITAL 603255 PROCRIT 10,000 UNITS ESRD 1,724.66$

HOSPITAL 603256 EPOGEN 10 000 UNIT /1CC 1,724.66$

HOSPITAL 605668 COSYNTROPIN 0.25mg/1ml vial 1,753.41$

HOSPITAL 606584 CLINIMIX 4.25/10 TPN 1,756.86$

HOSPITAL 606831 ERTAPENUM 1GM VIAL 1,760.40$

HOSPITAL 606296 ALPHAGAN 0.2% OPH SOL 1,776.27$

HOSPITAL 606583 CLINIMIX E 4.25/10 TPN 1,784.96$

HOSPITAL 606587 CLINIMIX E 5/15 TPN 1,785.31$

HOSPITAL 603258 PRAMLINTIDE 0.6MG/ML 5ML VIAL 1,788.19$

HOSPITAL 608053 DIAZEPAM 2.5 MG SUPP 1,798.53$

HOSPITAL 603149 CINCALCET 30MG TAB 1,848.55$

HOSPITAL 607679 MUPIROCIN CREAM 15GM TUBE/ GM 1,913.41$

HOSPITAL 609580 LEVOLEUCOVORIN 250MG/25ML VIAL 1,940.24$

HOSPITAL 601394 BEXSERO 0.5ML SYR MENG B VACC 1,948.58$

HOSPITAL 604598 PITRESSIN 20 UNITS/ML AMP 1,951.17$

HOSPITAL 601298 CORTISPORIN OPH SOL 5CC 2,039.70$

HOSPITAL 606582 CLINIMIX 5/15 TPN 2,082.48$

HOSPITAL 602733 ENTEREG 12 MG CAPSULE 2,084.54$

HOSPITAL 606419 ALTEPLASE 2MG VIAL 2,093.17$

HOSPITAL 600165 GLUCAGON 1 MG VIAL 2,155.82$

HOSPITAL 606565 RECLAST ZOLEDRO ACID 5MG/100ML 2,181.07$

HOSPITAL 602821 TRAVOPROST 2.5ML/BOTTLE 2,221.73$

HOSPITAL 606946 PREVNAR 13VALANT CONJUG 0.5ML 2,269.50$

HOSPITAL 608882 CIPROFLOXACIN/DEXAMETHASONE OS 2,341.82$

HOSPITAL 600581 COCAINE 4% 4ML BOTTLE 2,375.19$

HOSPITAL 604172 COLAGENASE SANTLY 2,449.84$

HOSPITAL 600388 ARANESP 40 MCG/1MLVIAL NONESRD 2,477.43$

HOSPITAL 601548 FILGRASTIM-SNDZ 300MCG/0.5ML 2,493.86$

HOSPITAL 600264 SYNVISC DISP. SYRINGE 2ML 2,510.92$

HOSPITAL 600318 DENOSUMAB 60 MG SYRINGE 2,600.44$

HOSPITAL 609445 REGADENOSON 0.4mg/5ml vial 2,744.01$

HOSPITAL 600302 HYALGAN/SUPARTZ INJ PER DOSE 2,796.64$

HOSPITAL 602848 EPIRUBICIN 50MG VIAL 2,886.70$

HOSPITAL 606451 GRANIX 300 MCG SYRINGE 3,201.55$

HOSPITAL 603179 THROMBOSTAT SPR 10,000U 3,207.45$

HOSPITAL 602006 CINVANTI 130MG/18ML 3,207.45$

HOSPITAL 603267 EPOGEN 20MU/VIAL 3,207.45$

HOSPITAL 605552 FILGRASTIM 300 MCG VIAL 3,207.45$

HOSPITAL 607334 ZARXIO 480MCG SYRINGE 3,207.45$

HOSPITAL 607777 FOSAPREPITANT INJECTION 150MG 3,207.45$

HOSPITAL 608806 ACYCLOVIR 15GR OINT 3,207.45$

HOSPITAL 624517 SKLICE LOTION 3,207.45$

HOSPITAL 608665 PREMARIN CR 3,224.87$

HOSPITAL 601214 EPINEPHRINE 0.3MG/SYRINGE 3,264.23$

HOSPITAL 606969 RABIES VACCINE (IMOVAX) 3,282.26$

HOSPITAL 604023 HEMABATE 250MCG/ML 3,394.09$

HOSPITAL 603157 ALIMTA 100mg VIAL 3,443.70$

HOSPITAL 606551 PRIVIGEN 5GM VIAL 3,610.81$

2020-01




HOSPITAL 604763 DINOSPROSTONE 10MG 3,679.89$

HOSPITAL 609458 KYROLIS 10 MG 3,705.62$

HOSPITAL 609940 ELIGARD 7.5 MG SYRINGE 3,754.94$

HOSPITAL 606549 GAMUNEX LIQUID 5G 3,917.77$

HOSPITAL 603080 ARANESP 60MCG/0.3Ml SYR N.ESRD 3,972.46$

HOSPITAL 603163 DAPTOMYCIN 500MG VIAL 4,038.13$

HOSPITAL 603091 PALONOSETRON 25mcg 4,106.12$

HOSPITAL 609993 LILETTA, 52 MG 4,194.61$

HOSPITAL 605680 CYCLOPHOSPHAMIDE 500 MG IV 4,251.50$

HOSPITAL 609566 FIRMAGON 80MG PFS KIT SNGL USE 4,427.52$

HOSPITAL 608566 ZOLEDRONIC ACID 4MG 4,506.72$

HOSPITAL 603873 AZACITIDINE 100MG VIAL 4,545.94$

HOSPITAL 603062 ARANESP 100 MCG NONESRD 4,623.27$

HOSPITAL 608785 LIDOCAINE 5% OINTMENT 4,645.67$

HOSPITAL 605617 CALCIMAR 200 U ML 4,683.28$

HOSPITAL 603192 BEVACIZUMAB 100MG/4ML VIAL ML 4,787.12$

HOSPITAL 600485 AVITENE 1 G 4,788.39$

HOSPITAL 601254 INFLIXIMAB-DYYB 100MG VIAL 4,788.39$

HOSPITAL 606094 OMALIZUMAB 5MG INJECTION 4,788.39$

HOSPITAL 606861 MITOMYCIN 40 MG VIAL 4,788.39$


HOSPITAL 606996 DARZALEX 100MG/5ML SINGLE DOSE 4,788.39$

HOSPITAL 608796 ZILRETTA 32MG 4,788.39$

HOSPITAL 609988 Mirena IUD 4,788.39$

HOSPITAL 601891 IMFINZI 120MG 4,797.16$

HOSPITAL 605831 FERAHEME 510MG/17ML ELEM IRON 4,819.98$

HOSPITAL 604278 ZOMETA 4MG/100 ML PREMIX 4,849.03$

HOSPITAL 604395 CYCLOPHOSPHAMIDE 1000 MG VIAL 4,929.97$

HOSPITAL 609106 NULOJIX 250MG INJ 4,991.22$

HOSPITAL 607821 INJECTAFER 750MG/15ML 5,065.34$

HOSPITAL 609648 RITUXIMAB 100MG/10ML VIAL 5,115.58$

HOSPITAL 608887 KCENTRA 5,163.18$

HOSPITAL 602818 VECTIBIX 100MG/5ML INJECTION 5,321.80$


HOSPITAL 606089 XOLAIR 150 MG VIAL 5,510.73$

HOSPITAL 603744 DOCETAXEL 80 MG/8 ML VIAL 5,552.57$

HOSPITAL 604397 CYCLOPHOSPHAMIDE 2GM 5,552.57$

HOSPITAL 604872 GEMCITABINE 2GM VIAL 5,552.57$

HOSPITAL 606011 KYPROLIS 30MG VIAL SINGLE USE 5,552.57$

HOSPITAL 609508 OPDIVO 40MG VIAL 5,552.57$

HOSPITAL 606980 INFLIXIMAB 100MG VIAL 5,555.89$

HOSPITAL 614679 FIRMAGON 240MG (120MG X 2) SYR 5,924.82$

HOSPITAL 606546 GAMMAGARD 10GM VIAL 6,029.88$

HOSPITAL 606559 OCTAGAM INJECTION 10 GM 6,029.88$

HOSPITAL 608903 ELIGARD 22.5MG SYRINGE 6,181.06$

HOSPITAL 606617 ABRAXANE 100mg VIAL 6,204.92$



HOSPITAL 609603 HERCEPTIN 150MG VIAL 7,172.07$

HOSPITAL 603237 BORTEZOMIB 3.5MG VIAL 7,172.07$

HOSPITAL 606534 ELIGARD 30 MG SYRINGE 7,172.07$

HOSPITAL 607219 DECITABINE 50MG VIAL 7,172.07$

HOSPITAL 609494 SIMPONI ARIA 50MG/4ML VIAL 7,172.07$

HOSPITAL 602583 FASLODEX 500 MG 2 SYRINGE PKG 7,271.84$

HOSPITAL 602557 CIMZIA KIT 7,530.72$

HOSPITAL 609044 TRISENOX 10MG/10ML AMP CHEMO 7,884.17$

HOSPITAL 606995 DARZALEX 400MG/20ML SINGLE DOS 8,178.24$

HOSPITAL 601651 IRINOTECAN LIPOSOMAL 43MG 8,457.07$

HOSPITAL 600317 DENOSUMAB 120 MG/1.7 VIAL 8,505.64$

HOSPITAL 608801 KYPROLIS INJ 60 MG VIAL 9,285.67$


HOSPITAL 608904 ELIGARD 45MG SYRINGE 9,969.44$

HOSPITAL 606554 GAMMAGARD LIQUID 20GM VIAL 10,114.65$

HOSPITAL 606566 OCTAGAM INJECTION 20 GM 10,114.65$


HOSPITAL 606553 GAMMAGARD 30 GM 10,454.07$

HOSPITAL 603542 DOXORUBICIN LIPO 50 MG VIAL 10,476.90$

HOSPITAL 606003 NUCALA 100MG VIAL 10,672.13$

2020-01




HOSPITAL 603158 PEMETREXED 500MG VIAL 11,081.48$

HOSPITAL 603494 BEVACIZUMAB 400MG/16ML VIAL 12,618.78$

HOSPITAL 601890 IMFINZI 500MG 14,210.90$

HOSPITAL 605799 OCTREOTIDE ACET. 20 MG SYRINGE 15,490.41$

HOSPITAL 602005 UDENYCA 6MG/0.6ML 15,688.34$

HOSPITAL 609950 KETRUDA 100MG/4 ML VIAL 17,091.71$

HOSPITAL 609021 LUPRON DEPOT 22.5MG KIT 17,130.12$

HOSPITAL 603036 LEUPROLIDE 30MG 4-MONTH 17,860.60$

HOSPITAL 604858 RITUXIMAB 500MG/50ML VIAL 18,336.41$

HOSPITAL 609505 PERJETA 420MG/14ML VIAL 18,450.16$

HOSPITAL 606974 RABIES IMM GLOB 300 UN/ML 5ML 18,565.15$

HOSPITAL 602819 VECTIBIX 400MG/20ML INJECTION 18,690.14$

HOSPITAL 608652 FASENRA 30MG/ML (BENRALIZUMAB) 19,342.77$

HOSPITAL 609800 NEULASTA ONPRO KIT 6MG 19,488.38$

HOSPITAL 603824 TENECTEPLASE 50 MG KIT 20,520.84$


HOSPITAL 602858 PEGFILGRASTIM 6MG SYRINGE 23,903.37$

HOSPITAL 609569 TYSABRI 300MG/15ML INJ 24,783.05$

HOSPITAL 601019 YERVOY 50MG/10ML VIAL 26,449.73$

HOSPITAL 606234 Tecentriq 1200mg/20ml Vial 27,423.21$

HOSPITAL 606088 TPA 100MG VIAL 33,403.14$

HOSPITAL 603548 CEMIPLIMAB-RWLC 350MG/7ML 36,492.84$

HOSPITAL 600905 OCREVUS 300MG/10ML INJ 43,443.86$

HOSPITAL 601020 YERVOY 200MG/40ML VIAL 99,999.99$

PROFESSIONAL 00100 ANESTH, SALIVARY GLAND 00100 155.00$

PROFESSIONAL 00102 ANESTH, REPAIR OF CLEFT LIP 00102 155.00$

PROFESSIONAL 00103 ANESTH - RECONSTRUCT EYELID 00103 155.00$

PROFESSIONAL 00104 ANESTH ELECTROSHOCK 00104 155.00$

PROFESSIONAL 00120 ANESTH EAR SURGERY 00120 155.00$

PROFESSIONAL 00124 ANESTH EAR EXAM 00124 155.00$

PROFESSIONAL 00126 ANESTH TYMPANOTOMY 00126 155.00$

PROFESSIONAL 00140 ANESTHESIA PROCEDURES ON EYE 00140 155.00$

PROFESSIONAL 00142 ANESTH LENS SURGERY 00142 155.00$

PROFESSIONAL 00144 ANESTH CORNEAL TRANSPLANT 00144 155.00$

PROFESSIONAL 00145 ANESTH VITREORETINAL SURG 00145 155.00$

PROFESSIONAL 00147 ANESTH IRIDECTOMY 00147 155.00$

PROFESSIONAL 00148 ANESTH EYE EXAM 00148 155.00$

PROFESSIONAL 00160 ANESTH NOSE/SINUS SURGERY NOS 00160 155.00$

PROFESSIONAL 00162 ANESTH NOSE/SINUS SURGERY RADICAL 00162 155.00$

PROFESSIONAL 00164 ANESTH BIOPSY OF NOSE 00164 155.00$

PROFESSIONAL 00170 ANESTH PROCEDURE ON MOUTH 00170 155.00$

PROFESSIONAL 00172 ANESTH CLEFT PALATE REPAIR 00172 155.00$

PROFESSIONAL 00174 ANESTH PHARYNGEAL SURG EXCISION 00174 155.00$

PROFESSIONAL 00176 ANESTH PHARYNGEAL SURG RADICAL 00176 155.00$

PROFESSIONAL 00190 ANESTH FACE/SKULL BONE SURG 00190 155.00$

PROFESSIONAL 00192 ANESTH FACIAL BONE SURGERY 00192 155.00$

PROFESSIONAL 00210 ANESTH CRANIAL SURG NOS 00210 155.00$

PROFESSIONAL 00211 ANESTH CRAN SURG HEMOTOMA 00211 155.00$

PROFESSIONAL 00212 ANESTH SKULL DRAINAGE SUBDURAL TAPS 00212 155.00$

PROFESSIONAL 00214 ANESTH SKULL DRAINAGE BURR HOLES 00214 155.00$

PROFESSIONAL 00215 ANESTH SKULL REPAIR/FRACT 00215 155.00$

PROFESSIONAL 00216 ANESTH HEAD VESSEL SURGERY 00216 155.00$

PROFESSIONAL 00218 ANESTH SPECIAL HEAD SURGERY 00218 155.00$

PROFESSIONAL 00220 ANESTH INTRCRN NERVE 00220 155.00$

PROFESSIONAL 00222 ANESTH HEAD NERVE SURGERY 00222 155.00$

PROFESSIONAL 00300 ANESTH HEAD/NECK/PTRUNK 00300 155.00$

PROFESSIONAL 00320 ANESTH NECK ORGAN 1YR/> 00320 155.00$

PROFESSIONAL 00322 ANESTH BIOPSY OF THYROID 00322 155.00$

PROFESSIONAL 00326 ANESTH LARYNX/TRACH < 1 YR 00326 155.00$

PROFESSIONAL 00350 ANESTH NECK VESSEL SURGERY NOS 00350 155.00$

PROFESSIONAL 00352 ANESTH NECK VESSEL SURG SIMPLE LIGATION 00352 155.00$

PROFESSIONAL 00400 ANESTH SKIN, EXT/PER/ATRUNK 00400 155.00$

PROFESSIONAL 00402 ANESTH SURGERY OF BREAST RECONSTRUCT 00402 155.00$

PROFESSIONAL 00404 ANESTH SURGERY OF BREAST RADICAL 00404 155.00$

PROFESSIONAL 00406 ANESTH SURGERY OF BREAST RAD W IMND 00406 155.00$

PROFESSIONAL 00410 ANESTH CORRECT HEART RHYTHM 00410 155.00$

PROFESSIONAL 00450 ANESTH CLAVICLE SCAPULA NOS 00450 155.00$

PROFESSIONAL 00454 ANESTH COLLAR BONE BIOPSY 00454 155.00$

2020-01




PROFESSIONAL 00470 ANESTH REMOVAL OF RIB 00470 155.00$

PROFESSIONAL 00472 ANESTH CHEST WALL REPAIR 00472 155.00$

PROFESSIONAL 00474 ANESTH SURGERY OF RIB 00474 155.00$

PROFESSIONAL 00500 ANESTH ESOPHAGEAL SURGERY 00500 155.00$

PROFESSIONAL 00520 ANESTH CHEST PROCEDURE 00520 155.00$

PROFESSIONAL 00522 ANESTH CHEST LINING BIOPSY 00522 155.00$

PROFESSIONAL 00524 ANESTH CHEST DRAINAGE 00524 155.00$

PROFESSIONAL 00528 ANES MEDIASCPY & DX THORSCPY 00528 155.00$

PROFESSIONAL 00529 ANES MEDSCPY&THORSCPY 1 LUNG 00529 155.00$

PROFESSIONAL 00530 ANESTH PACEMAKER INSERTION 00530 155.00$

PROFESSIONAL 00532 ANESTH VASCULAR ACCESS 00532 155.00$

PROFESSIONAL 00534 ANESTH CARDIOVERTER/DEFIB 00534 155.00$

PROFESSIONAL 00537 ANESTH CARDIAC ELECTROPHY 00537 155.00$

PROFESSIONAL 00539 ANESTH TRACH-BRONCH RECONST 00539 155.00$

PROFESSIONAL 00540 ANESTH CHEST SURGERY 00540 155.00$

PROFESSIONAL 00541 ANESTH THORACOTOMY W 1 LUNG VENT 00541 155.00$

PROFESSIONAL 00542 ANESTH REMVL PLEURA 00542 155.00$

PROFESSIONAL 00546 ANESTH LUNG CHEST WALL SURG 00546 155.00$

PROFESSIONAL 00548 ANESTH TRACHEA BRONCHI SURG 00548 155.00$

PROFESSIONAL 00550 ANESTH STERNAL DEBRIDEMENT 00550 155.00$

PROFESSIONAL 00560 ANESTH HEART SURG W/O PUMP 00560 155.00$

PROFESSIONAL 00561 ANESTH HEART SURG < 1 YR 00561 155.00$

PROFESSIONAL 00562 ANESTH HRT SURG W/PMP AGE 1 00562 155.00$

PROFESSIONAL 00563 ANESTH HEART SURG W/ARREST 00563 155.00$

PROFESSIONAL 00566 ANESTH CABG W/O PUMP 00566 155.00$

PROFESSIONAL 00567 ANESTH CABG W/PUMP 00567 155.00$

PROFESSIONAL 00580 ANESTH HEART/LUNG TRANSPLANT 00580 155.00$

PROFESSIONAL 00600 ANESTH CERV SPINE CORD SURGERY 00600 155.00$

PROFESSIONAL 00604 ANESTH SITTING PROCEDURE 00604 155.00$

PROFESSIONAL 00620 ANESTH THORACIC SPINE CORD SURGERY 00620 155.00$

PROFESSIONAL 00625 ANES SPINE TRANTHOR W/O VENT 00625 155.00$

PROFESSIONAL 00626 ANES SPINE TRANSTHOR W/VENT 00626 155.00$

PROFESSIONAL 00630 ANESTH LUMBAR SPINE CORD SURGERY 00630 155.00$

PROFESSIONAL 00632 ANESTH LUMBAR REMOVAL OF NERVES 00632 155.00$

PROFESSIONAL 00635 ANESTH LUMBAR PUNCTURE 00635 155.00$

PROFESSIONAL 00640 ANESTH SPINE MANIPULATION 00640 155.00$

PROFESSIONAL 00670 ANSTH EXT SPINE CORD SURGERY 00670 155.00$

PROFESSIONAL 00700 ANESTH ABDO WALL SURG UPPER ANT NOS 00700 155.00$

PROFESSIONAL 00702 ANESTH FOR LIVER BIOPSY 00702 155.00$

PROFESSIONAL 00730 ANESTH ABDOMINAL WALL SURG UPPER POST 00730 155.00$

PROFESSIONAL 00731 ANES UPR GI NDSC PX NOS 00731 143.00$

PROFESSIONAL 00750 ANESTH REPAIR OF HERNIA UPPER NOS 00750 155.00$

PROFESSIONAL 00752 ANESTH REPAIR OF HERNIA 00752 155.00$

PROFESSIONAL 00754 ANESTH RPR HERNIA OMPHALOCELE 00754 155.00$

PROFESSIONAL 00756 ANESTH REPAIR OF HERNIA TRANSABDO 00756 155.00$

PROFESSIONAL 00770 ANESTH BLOOD VESSEL REPAIR 00770 155.00$

PROFESSIONAL 00790 ANESTH SURG UPPER ABDOMEN 00790 155.00$

PROFESSIONAL 00792 ANESTH HEMORR/EXCISE LIVER 00792 155.00$

PROFESSIONAL 00794 ANESTH PANCREAS REMOVAL 00794 155.00$

PROFESSIONAL 00796 ANESTH FOR LIVER TRANSPLANT 00796 155.00$

PROFESSIONAL 00797 ANESTH SURGERY FOR OBESITY 00797 155.00$

PROFESSIONAL 00800 ANESTH ABDO WALL SURG LOWER ANT NOS 00800 155.00$

PROFESSIONAL 00802 ANESTH FAT LAYER REMOVAL 00802 155.00$

PROFESSIONAL 00812 ANES LWR INTST SCR COLSC 00812 143.00$

PROFESSIONAL 00820 ANESTH ABDOMINAL WALL SURG LOWER POST 00820 155.00$

PROFESSIONAL 00830 ANESTH REPAIR OF HERNIA LOWER NOS 00830 155.00$

PROFESSIONAL 00832 ANESTH REPAIR OF HERNIA V&A 00832 155.00$

PROFESSIONAL 00834 ANESTH HERNIA REPAIR < 1 YR 00834 155.00$

PROFESSIONAL 00836 ANESTH HERNIA REP <50 WKS GEST AGE 00836 155.00$

PROFESSIONAL 00840 ANESTH SURG LOWER ABDOMEN 00840 155.00$

PROFESSIONAL 00842 ANESTH AMNIOCENTESIS 00842 155.00$

PROFESSIONAL 00844 ANESTH PELVIS SURGERY 00844 155.00$

PROFESSIONAL 00846 ANESTH HYSTERECTOMY 00846 155.00$

PROFESSIONAL 00848 ANESTH PELVIC ORGAN SURG 00848 155.00$

PROFESSIONAL 00851 ANESTH TUBAL LIGATION 00851 155.00$

PROFESSIONAL 00860 ANESTH SURGERY OF ABDOMEN 00860 155.00$

PROFESSIONAL 00862 ANESTH KIDNEY/URETER SURG 00862 155.00$

PROFESSIONAL 00864 ANESTH REMOVAL OF BLADDER 00864 155.00$

2020-01




PROFESSIONAL 00865 ANESTH REMOVAL OF PROSTATE RADICAL 00865 155.00$

PROFESSIONAL 00866 ANESTH REMOVAL OF ADRENAL 00866 155.00$

PROFESSIONAL 00868 ANESTH KIDNEY TRANSPLANT 00868 155.00$

PROFESSIONAL 00870 ANESTH BLADDER STONE SURG 00870 155.00$

PROFESSIONAL 00872 ANESTH KIDNEY STONE DESTR W H20 BATH 00872 155.00$

PROFESSIONAL 00873 ANESTH KIDNEY STONE DESTRO WO H20 BATH 00873 155.00$

PROFESSIONAL 00880 ANESTH ABDOMEN VESSEL SURG 00880 155.00$

PROFESSIONAL 00882 ANESTH MAJOR VEIN LIGATION 00882 155.00$

PROFESSIONAL 00902 ANESTH ANORECTAL SURGERY 00902 155.00$

PROFESSIONAL 00904 ANESTH PERINEAL SURGERY 00904 155.00$

PROFESSIONAL 00906 ANESTH REMOVAL OF VULVA 00906 155.00$

PROFESSIONAL 00908 ANESTH REMOVAL OF PROSTATE PERINEAL 00908 155.00$

PROFESSIONAL 00910 ANESTH BLADDER SURGERY 00910 155.00$

PROFESSIONAL 00912 ANESTH BLADDER TUMOR SURG 00912 155.00$

PROFESSIONAL 00914 ANESTH REMOVAL OF PROSTATE RESECTION 00914 155.00$

PROFESSIONAL 00916 ANESTH BLEEDING CONTROL 00916 155.00$

PROFESSIONAL 00918 ANESTH STONE REMOVAL 00918 155.00$

PROFESSIONAL 00920 ANESTH GENITALIA SURGERY 00920 155.00$

PROFESSIONAL 00921 ANESTH VASECTOMY 00921 155.00$

PROFESSIONAL 00922 ANESTH SPERM DUCT SURGERY 00922 155.00$

PROFESSIONAL 00924 ANESTH TESTIS EXPLORATION 00924 155.00$

PROFESSIONAL 00926 ANESTH REMOVAL OF TESTIS INGUINAL 00926 155.00$

PROFESSIONAL 00928 ANESTH REMOVAL OF TESTIS ABDOMINAL 00928 155.00$

PROFESSIONAL 00930 ANESTH TESTIS SUSPENSION 00930 155.00$

PROFESSIONAL 00932 ANESTH AMPUTATION OF PENIS 00932 155.00$

PROFESSIONAL 00934 ANES RAD AMP PNS W/BI INGUINAL NODE OPN 00934 155.00$

PROFESSIONAL 00936 ANES RAD AMP PNS W/BI INGUN&ILIAC INCL O 00936 155.00$

PROFESSIONAL 00938 ANESTH INSERT PENIS DEVICE 00938 155.00$

PROFESSIONAL 00940 ANESTH VAGINAL PROCEDURES 00940 155.00$

PROFESSIONAL 00942 ANESTH SURG ON VAG/URETHRAL 00942 155.00$

PROFESSIONAL 00944 ANESTH VAGINAL HYSTERECTOMY 00944 155.00$

PROFESSIONAL 00948 ANESTH REPAIR OF CERVIX 00948 155.00$

PROFESSIONAL 00950 ANESTH VAGINAL ENDOSCOPY 00950 155.00$

PROFESSIONAL 00952 ANESTH HYSTEROSCOPE/GRAPH 00952 155.00$

PROFESSIONAL 01112 ANESTH BONE ASPIRATE/BX 01112 155.00$

PROFESSIONAL 01120 ANESTH PELVIS SURGERY BONY 01120 155.00$

PROFESSIONAL 01130 ANESTH BODY CAST PROCEDURE 01130 155.00$

PROFESSIONAL 01140 ANESTH AMPUTATION AT PELVIS 01140 155.00$

PROFESSIONAL 01150 ANESTH PELVIC TUMOR SURGERY 01150 155.00$

PROFESSIONAL 01160 ANESTH PELVIS PROCEDURE 01160 155.00$

PROFESSIONAL 01170 ANESTH PELVIS SURGERY SYMP PUB OR SACRO 01170 155.00$

PROFESSIONAL 01173 ANESTH FX REPAIR PELVIS 01173 155.00$

PROFESSIONAL 01200 ANESTH HIP JOINT PROCEDURE 01200 155.00$

PROFESSIONAL 01202 ANESTH ARTHROSCOPY OF HIP 01202 155.00$

PROFESSIONAL 01210 ANESTH HIP JOINT SURGERY 01210 155.00$

PROFESSIONAL 01212 ANESTH HIP DISARTICULATION 01212 155.00$

PROFESSIONAL 01214 ANESTH HIP ARTHROPLASTY 01214 155.00$

PROFESSIONAL 01215 ANESTH REVISE HIP REPAIR 01215 155.00$

PROFESSIONAL 01220 ANESTH PROCEDURE ON FEMUR 01220 155.00$

PROFESSIONAL 01230 ANESTH SURGERY OF FEMUR 01230 155.00$

PROFESSIONAL 01232 ANESTH AMPUTATION OF FEMUR 01232 155.00$

PROFESSIONAL 01234 ANESTH RADICAL FEMUR SURG 01234 155.00$

PROFESSIONAL 01250 ANESTH UPPER LEG SURGERY 01250 155.00$

PROFESSIONAL 01260 ANESTH UPPER LEG VEINS SURG 01260 155.00$

PROFESSIONAL 01270 ANESTH THIGH ARTERIES SURG 01270 155.00$

PROFESSIONAL 01272 ANESTH FEMORAL ARTERY SURG 01272 155.00$

PROFESSIONAL 01274 ANESTH FEMORAL EMBOLECTOMY 01274 155.00$

PROFESSIONAL 01320 ANESTH KNEE AREA SURGERY 01320 155.00$

PROFESSIONAL 01340 ANESTH KNEE AREA PROC LWR CLSD 01340 155.00$

PROFESSIONAL 01360 ANESTH KNEE AREA PROC LWR OPEN 01360 155.00$

PROFESSIONAL 01380 ANESTH KNEE JOINT PROCEDURE 01380 155.00$

PROFESSIONAL 01382 ANESTH DX KNEE ARTHROSCOPY 01382 155.00$

PROFESSIONAL 01390 ANESTH KNEE PROC UPPER CLSD 01390 155.00$

PROFESSIONAL 01392 ANESTH KNEE PROC UPPER OPEN 01392 155.00$

PROFESSIONAL 01400 ANESTH KNEE JOINT SURGERY 01400 155.00$

PROFESSIONAL 01402 ANESTH KNEE ARTHROPLASTY 01402 155.00$

PROFESSIONAL 01404 ANESTH AMPUTATION AT KNEE 01404 155.00$

PROFESSIONAL 01420 ANESTH KNEE JOINT CASTING 01420 155.00$

2020-01




PROFESSIONAL 01430 ANESTH KNEE VEINS SURGERY 01430 155.00$

PROFESSIONAL 01432 ANESTH KNEE VESSEL SURG 01432 155.00$

PROFESSIONAL 01440 ANESTH KNEE ARTERIES SURG 01440 155.00$

PROFESSIONAL 01442 ANESTH KNEE ARTERY SURG 01442 155.00$

PROFESSIONAL 01444 ANESTH KNEE ARTERY REPAIR 01444 155.00$

PROFESSIONAL 01462 ANESTH LOWER LEG PROCEDURE 01462 155.00$

PROFESSIONAL 01464 ANESTH ANKLE/FT ARTHROSCOPY 01464 155.00$

PROFESSIONAL 01470 ANESTH LOWER LEG SURGERY NOS 01470 155.00$

PROFESSIONAL 01472 ANESTH ACHILLES TENDON SURG 01472 155.00$

PROFESSIONAL 01474 ANESTH LOWER LEG SURGERY 01474 155.00$

PROFESSIONAL 01480 ANESTH LOWER LEG BONE SURG 01480 155.00$

PROFESSIONAL 01482 ANESTH RADICAL LEG SURGERY 01482 155.00$

PROFESSIONAL 01484 ANESTH LOWER LEG REVISION 01484 155.00$

PROFESSIONAL 01486 ANESTH ANKLE REPLACEMENT 01486 155.00$

PROFESSIONAL 01490 ANESTH LOWER LEG CASTING 01490 155.00$

PROFESSIONAL 01500 ANESTH LEG ARTERIES SURG 01500 155.00$

PROFESSIONAL 01502 ANESTH LWR LEG EMBOLECTOMY 01502 155.00$

PROFESSIONAL 01520 ANESTH LOWER LEG VEIN SURG NOS 01520 155.00$

PROFESSIONAL 01522 ANESTH LOWER LEG VEIN SURG 01522 155.00$

PROFESSIONAL 01610 ANESTH SURGERY OF SHOULDER 01610 155.00$

PROFESSIONAL 01620 ANESTH SHOULDER PROCEDURE 01620 155.00$

PROFESSIONAL 01622 ANES DX SHOULDER ARTHROSCOPY 01622 155.00$

PROFESSIONAL 01630 ANESTH SURGERY OF SHOULDER NOS 01630 155.00$

PROFESSIONAL 01634 ANESTH SHOULDER JOINT AMPUT 01634 155.00$

PROFESSIONAL 01636 ANESTH FOREQUARTER AMPUT 01636 155.00$

PROFESSIONAL 01638 ANESTH SHOULDER REPLACEMENT 01638 155.00$

PROFESSIONAL 01650 ANESTH SHOULDER ARTERY SURG 01650 155.00$

PROFESSIONAL 01652 ANESTH SHOULDER VESSEL SURG 01652 155.00$

PROFESSIONAL 01654 ANESTH SHOULDER VESSEL SURG BYPASS GR 01654 155.00$

PROFESSIONAL 01656 ANESTH ARM-LEG VESSEL SURG 01656 155.00$

PROFESSIONAL 01670 ANESTH SHOULDER VEIN SURG 01670 155.00$

PROFESSIONAL 01680 ANESTH SHOULDER CASTING 01680 155.00$

PROFESSIONAL 01710 ANESTH ELBOW AREA SURGERY 01710 155.00$

PROFESSIONAL 01712 ANESTH UPPR ARM TENDON SURG OPEN 01712 155.00$

PROFESSIONAL 01714 ANESTH UPPR ARM TENDON SURG 01714 155.00$

PROFESSIONAL 01716 ANESTH BICEPS TENDON REPAIR 01716 155.00$

PROFESSIONAL 01730 ANESTH UPPR ARM PROCEDURE 01730 155.00$

PROFESSIONAL 01732 ANESTH DX ELBOW ARTHROSCOPY 01732 155.00$

PROFESSIONAL 01740 ANESTH UPPER ARM SURGERY 01740 155.00$

PROFESSIONAL 01742 ANESTH HUMERUS SURGERY 01742 155.00$

PROFESSIONAL 01744 ANESTH HUMERUS REPAIR 01744 155.00$

PROFESSIONAL 01756 ANESTH RADICAL HUMERUS SURG 01756 155.00$

PROFESSIONAL 01758 ANESTH HUMERAL LESION SURG 01758 155.00$

PROFESSIONAL 01760 ANESTH ELBOW REPLACEMENT 01760 155.00$

PROFESSIONAL 01770 ANESTH UPPR ARM ARTERY SURG 01770 155.00$

PROFESSIONAL 01772 ANESTH UPPR ARM EMBOLECTOMY 01772 155.00$

PROFESSIONAL 01780 ANESTH UPPER ARM VEIN SURG 01780 155.00$

PROFESSIONAL 01782 ANESTH UPPR ARM VEIN REPAIR 01782 155.00$

PROFESSIONAL 01810 ANESTH LOWER ARM SURGERY 01810 155.00$

PROFESSIONAL 01820 ANESTH LOWER ARM PROCEDURE 01820 155.00$

PROFESSIONAL 01829 ANESTH DX WRIST ARTHROSCOPY 01829 155.00$

PROFESSIONAL 01830 ANESTH LOWER ARM SURGERY NOS 01830 155.00$

PROFESSIONAL 01832 ANESTH WRIST REPLACEMENT 01832 155.00$

PROFESSIONAL 01840 ANESTH LWR ARM ARTERY SURG 01840 155.00$

PROFESSIONAL 01842 ANESTH LWR ARM EMBOLECTOMY 01842 155.00$

PROFESSIONAL 01844 ANESTH VASCULAR SHUNT SURG 01844 155.00$

PROFESSIONAL 01850 ANESTH LOWER ARM VEIN SURG 01850 155.00$

PROFESSIONAL 01852 ANESTH LWR ARM VEIN REPAIR 01852 155.00$

PROFESSIONAL 01860 ANESTH LOWER ARM CASTING 01860 155.00$

PROFESSIONAL 01916 ANESTH DX ARTERIOGRAPHY 01916 155.00$

PROFESSIONAL 01920 ANESTH CATHETERIZE HEART 01920 155.00$

PROFESSIONAL 01922 ANESTH CAT OR MRI SCAN 01922 155.00$

PROFESSIONAL 01924 ANES THER INTERVEN RAD ART 01924 155.00$

PROFESSIONAL 01925 ANES THER INTERVEN RAD CAR 01925 155.00$

PROFESSIONAL 01926 ANES TX INTERV RAD HRT/CRAN 01926 155.00$

PROFESSIONAL 01930 ANES THER INTERVEN RAD VEI 01930 155.00$

PROFESSIONAL 01931 ANES THER INTERVEN RAD TIP 01931 155.00$

PROFESSIONAL 01932 ANES TX INTERV RAD TH VEIN 01932 155.00$

2020-01




PROFESSIONAL 01933 ANES TX INTERV RAD CRAN VEIN 01933 155.00$

PROFESSIONAL 01935 ANESTH PERC IMG DX SP PROC 01935 155.00$

PROFESSIONAL 01936 ANESTH PERC IMG TX SP PROC 01936 155.00$

PROFESSIONAL 01951 ANESTH BURN LESS 4 PERCENT 01951 155.00$

PROFESSIONAL 01952 ANESTH BURN 4-9 PERCENT 01952 155.00$

PROFESSIONAL 01953 ANESTH BURN EACH 9 PERCENT 01953 155.00$

PROFESSIONAL 01958 ANESTH ANTEPARTUM MANIPUL 01958 155.00$

PROFESSIONAL 01960 ANEST VAGINAL DELIVERY 01960 155.00$

PROFESSIONAL 01961 ANESTH CS DELIVERY 01961 155.00$

PROFESSIONAL 01962 ANESTH EMER HYSTERECTOMY 01962 155.00$

PROFESSIONAL 01963 ANESTH CS HYSTERECTOMY 01963 155.00$

PROFESSIONAL 01965 ANESTH INC/MISSED AB PROC 01965 155.00$

PROFESSIONAL 01966 ANESTH INDUCED AB PROCEDURE 01966 155.00$

PROFESSIONAL 01967 ANESTH/ANALG VAG DELIVERY 01967 155.00$

PROFESSIONAL 01968 ANES/ANALG CS DELIVER ADD-ON 01968 155.00$

PROFESSIONAL 01969 ANESTH/ANALG CS HYST ADD-ON 01969 155.00$

PROFESSIONAL 01990 SUPPORT FOR ORGAN DONOR 01990 155.00$

PROFESSIONAL 01991 ANESTH NERVE BLOCK/INJ 01991 155.00$

PROFESSIONAL 01992 ANESTH N BLOCK/INJ PRONE 01992 155.00$

PROFESSIONAL 01996 MANAGE DAILY DRUG THERAPY 01996 401.00$

PROFESSIONAL 01999 UNLISTED ANESTH PROCEDURE 01999 155.00$

PROFESSIONAL 62322 NJX INTERLAMINAR LMBR/SAC 62322 197.00$

PROFESSIONAL 62326 NJX INTERLAMINAR LMBR/SAC 62326 935.00$

PROFESSIONAL 64486 TAP BLOCK UNIL BY INJECTION 64486 385.00$

PROFESSIONAL 99100 SPECIAL ANESTHESIA SERVICE 99100 150.00$

PROFESSIONAL 99140 EMERGENCY ANESTHESIA 99140 283.00$

PROFESSIONAL 99152 MOD SED SAME PHYS/QHP 5/>YRS 99152 386.00$

PROFESSIONAL 99153 MOD SED SAME PHYS/QHP EA 99153 309.00$

PROFESSIONAL 92950 HEART/LUNG RESUSCITATION CPR 92950 1,241.15$

PROFESSIONAL 92960 CARDIOVERSION ELECTRIC, EXT 92960 1,115.50$

PROFESSIONAL 92977 DISSOLVE CLOT, HEART VESSEL 92977 1,990.00$

PROFESSIONAL 93000 ELECTROCARDIOGRAM, COMPLETE 93000 177.20$

PROFESSIONAL 93005 ELECTROCARDIOGRAM, TRACING 93005 167.60$

PROFESSIONAL 93005hpsa ELECTROCARDIOGRAM, TRACING 93005 167.60$

PROFESSIONAL 93005hspa ELECTROCARDIOGRAM, TRACING 93005 167.60$

PROFESSIONAL 93010 ELECTROCARDIOGRAM REPORT 93010 89.65$

PROFESSIONAL 93010hpsa ELECTROCARDIOGRAM REPORT 93010 89.65$

PROFESSIONAL 93015 CARDIOVASCULAR STRESS TEST 93015 759.15$

PROFESSIONAL 93016 CARDIOVASCULAR STRESS TEST - SUPERVISON 93016 244.15$

PROFESSIONAL 93018 CARDIOVASCULAR STRESS TEST - INTERP/REP 93018 411.00$

PROFESSIONAL 93041 RHYTHM ECG, TRACING 93041 45.35$

PROFESSIONAL 93042 RHYTHM ECG, REPORT 93042 72.10$

PROFESSIONAL 93224 ECG UP TO 48 HRS RECORD SCAN STOR W R&I 93224 415.10$

PROFESSIONAL 93227 ECG MONIT/REPRT UP TO 48 HRS 93227 232.80$

PROFESSIONAL 93270 ECG RECORDING 93270 180.25$

PROFESSIONAL 93303 TTE CONG ABN; COMPLETE 93303 249.30$

PROFESSIONAL 93307 TTE W/O DOPPLER COMPLETE 93307-26 621.10$

PROFESSIONAL 93308 ECHO EXAM OF HEART 93308 296.65$

PROFESSIONAL 93320 DOPPLER ECHO EXAM, HEART 93320-26 452.20$

PROFESSIONAL 93321 DOPPLER ECHO EXAM, HEART 93321 224.55$

PROFESSIONAL 93325 DOPPLER COLOR FLOW ADD-ON 93325 193.65$

PROFESSIONAL 93350 STRESS TTE ONLY 93350-26 240.00$

PROFESSIONAL 93610 INTRA-ATRIAL PACING 93610 491.35$

PROFESSIONAL 93612 INTRAVENTRICULAR PACING 93612 1,104.20$

PROFESSIONAL 93784 AMBULATORY BLOOD PRESSURE MONITORING 93784 720.00$

PROFESSIONAL 93790 REVIEW/REPORT BP RECORDING 93790 164.80$

PROFESSIONAL 93792 PT/CAREGIVER TRAIN HOME INR 93792 150.00$

PROFESSIONAL 93793 ANTICOAG MGMT PT WARFARIN 93793 33.00$

PROFESSIONAL 93880 EXTRACRANIAL BILAT STUDY 93880 1,093.90$

PROFESSIONAL 93880-26 EXTRACRANIAL BILAT STUDY 93880-26 86.55$

PROFESSIONAL 93882 EXTRACRANIAL UNI/LTD STUDY 93882 680.35$

PROFESSIONAL 93882-26 EXTRACRANIAL UNI/LTD STUDY 93882-26 54.60$

PROFESSIONAL 93922 UPR/L XTREMITY ART 2 LEVELS 93922 513.40$

PROFESSIONAL 93922-26 UPR/L XTREMITY ART 2 LEVELS 93922-26 30.90$

PROFESSIONAL 93923 UPR/LXTR ART STDY 3+ LVLS 93923 1,009.05$

PROFESSIONAL 93923-26 UPR/LXTR ART STDY 3+ LVLS 93923-26 53.60$

PROFESSIONAL 93924 LWR XTR VASC STDY BILAT 93924 1,067.55$

PROFESSIONAL 93924-26 LWR XTR VASC STDY BILAT 93924-26 55.65$

2020-01




PROFESSIONAL 93925 LOWER EXTREMITY STUDY 93925 1,064.05$

PROFESSIONAL 93925-26 LOWER EXTREMITY STUDY 93925-26 127.75$

PROFESSIONAL 93926-26 DUPLEX LE ART/BPG; UNIL/LIMIT (P/C) 93926-26 200.85$

PROFESSIONAL 93930 UPPER EXTREMITY STUDY BIL 93930 959.00$

PROFESSIONAL 93930-26 UPPER EXTREMITY STUDY BIL 93930-26 108.00$

PROFESSIONAL 93931-26 DUPLEX UE ART/BPG; UNIL/LIMIT 93931-26 60.80$

PROFESSIONAL 93970 EXTREMITY STUDY BIL 93970 1,259.05$

PROFESSIONAL 93970-26 EXTREMITY STUDY BIL 93970-26 77.25$

PROFESSIONAL 93971 EXTREMITY STUDY UNI OR LIMITED 93971 863.20$

PROFESSIONAL 93971-26 EXTREMITY STUDY UNI OR LIMITED 93971-26 60.80$

PROFESSIONAL 94010 BREATHING CAPACITY TEST 94010 85.60$

PROFESSIONAL 94010-26 BREATHING CAPACITY TEST REVIEW & INTERP. 94010-26 95.80$

PROFESSIONAL 94010-GFT BREATHING CAPACITY TEST 94010 150.00$

PROFESSIONAL 94010TCZP BREATHING CAPACITY TEST - TECHNICAL ONLY 94010TCZP 118.45$

PROFESSIONAL 94016 SPIROMETRY,PHYSICIAN REVIEW & INTER ONLY 94016 72.10$

PROFESSIONAL 94060 EVALUATION OF WHEEZING 94060 618.30$

PROFESSIONAL 94060-26 EVALUATION OF WHEEZING 94060-26 25.75$

PROFESSIONAL 94150 VITAL CAPACITY TEST 94150 73.15$

PROFESSIONAL 94200 LUNG FUNCTION TEST (MBC/MVV) 94200-26 70.05$

PROFESSIONAL 94250 EXPIRED GAS COLLECTION 94250-26 62.85$

PROFESSIONAL 94375 RESPIRATORY FLOW VOLUME LOOP 94375-26 89.65$

PROFESSIONAL 94621 PULM STRESS TEST/COMPLEX 94621-26 411.00$

PROFESSIONAL 94640 AIRWAY INHALATION TREATMENT 94640 82.40$

PROFESSIONAL 94664 AEROSOL OR VAPOR INHALATIONS 94664 95.80$

PROFESSIONAL 94726 PULM FUNCT TST PLETHYSMOGRAP 94726 312.95$

PROFESSIONAL 94726-26 PULM FUNCT TST PLETHYSMOGRAPHY 94726-26 26.80$

PROFESSIONAL 94729 CO/MEMBANE DIFFUSE CAPACITY 94729 299.70$

PROFESSIONAL 94729-26 CO/MEMBANE DIFFUSE CAPACITY 94729-26 92.70$

PROFESSIONAL 94760 PULSE OX - MEASURE BLOOD OXYGEN LEVEL 94760 58.75$

PROFESSIONAL 94761 MEASURE BLOOD OXYGEN LEVEL 94761 83.45$

PROFESSIONAL 94762 OVERNIGHT PULSE OXIMETRY MONITORING 94762 122.60$

PROFESSIONAL 95822-26 EEG COMA OR SLEEP ONLY 95822-26 449.10$

PROFESSIONAL 95824-26 CEREBRAL DEATH EVALUATION ONLY 95824-26 60.00$

PROFESSIONAL G0248 DEMO USE HOME INR MONITOR G0248 99.80$

PROFESSIONAL G0249 PROVIDE INR TEST MATER/EQUIP G0249 100.60$

PROFESSIONAL G0365-26 VEIN MAP/HEMODIALYSIS ACCESS G0365-26 70.05$

PROFESSIONAL 95250 GLUCOSE MONITORING CONT 72+ HRS 95250 305.00$

PROFESSIONAL 95251 GLUC MONITOR CONT PHYS I&R 72+ HRS 95251 82.00$

PROFESSIONAL 99241 OFFICE CONSULTATION 99241 272.00$





PROFESSIONAL 99251 INITIAL INPATIENT CONSULT 99251 281.00$





PROFESSIONAL G0250 MD INR TEST REV INTER MGMT, 1 TST/WK G0250 68.00$

PROFESSIONAL 92502 EAR AND THROAT EXAMINATION 92502 661.00$

PROFESSIONAL 92504 EAR MICROSCOPY EXAMINATION 92504 108.00$

PROFESSIONAL 92511 NASOPHARYNGOSCOPY 92511 352.00$

PROFESSIONAL 92516 FACIAL NERVE FUNCTION TEST 92516 313.00$

PROFESSIONAL 92520 LARYNGEAL FUNCTION STUDIES 92520 595.00$

PROFESSIONAL 92533 CALORIC VESTIBULAR TEST 92533 177.00$

PROFESSIONAL 92552 PURE TONE AUDIOMETRY, AIR 92552 93.00$

PROFESSIONAL 92553 AUDIOMETRY, AIR & BONE 92553 94.00$

PROFESSIONAL 92555 SPEECH THRESHOLD AUDIOMETRY 92555 73.00$

PROFESSIONAL 92557 COMPREHENSIVE HEARING TEST 92557 161.00$

PROFESSIONAL 92565 STENGER TEST, PURE TONE 92565 65.00$

PROFESSIONAL 92567 TYMPANOMETRY 92567 82.00$

PROFESSIONAL 92585 AUDITORY EP - COMPREHENSIVE 92585 290.00$

PROFESSIONAL 92590 HEARING AID EXAM, ONE EAR 92590 158.00$

PROFESSIONAL 92591 HEARING AID EXAM, BOTH EARS 92591 234.00$

PROFESSIONAL 92592 HEARING AID CHECK, ONE EAR 92592 114.00$

PROFESSIONAL 92593 HEARING AID CHECK, BOTH EARS 92593 161.00$

PROFESSIONAL 92597 EVAL TU USE/FIT VOICE PROSTH 92597 166.00$

PROFESSIONAL 99080 INIT NON MEDICARE INITIAL CERTIFICATION 99080 145.00$

2020-01




PROFESSIONAL 99080 INS SPECIAL REPORTS OR FORMS 99080 84.00$

PROFESSIONAL 99080RECER NON MEDICARE RECERTIFICATION 99080 123.00$

PROFESSIONAL AFLAC AFLAC FORM COMPLETION 99080 20.00$

PROFESSIONAL DISCONT DISABILITY CONTINUATION FORM COMPLETION 99080 26.00$

PROFESSIONAL FMLA FMLA FORM COMPLETION 99080 20.00$

PROFESSIONAL HANDI HANDICAP LICENSE PLATE FORM COMPLETION 99080 20.00$

PROFESSIONAL LIFE LIFE INS. POLICY FORM COMPETION 99080 26.00$

PROFESSIONAL MISC MISCELLANEOUS FORMS COMPLETION 99080 20.00$

PROFESSIONAL PDF PERSONAL DISABILITY FORM COMPLETION 99080 38.00$

PROFESSIONAL WCF WORKERS COMPENSATION FORM COMPLETION 99080 20.00$

PROFESSIONAL 99217 OBSERVATION CARE DISCHARGE 99217 294.00$

PROFESSIONAL 99218 OBSERVATION CARE 99218 348.00$



PROFESSIONAL 99221 INITIAL HOSPITAL CARE, L1 99221 341.00$

PROFESSIONAL 99222 INITIAL HOSPITAL CARE L2 99222 427.00$

PROFESSIONAL 99223 INITIAL HOSPITAL CARE L3 99223 505.00$




PROFESSIONAL 99231 SUBSEQUENT HOSPITAL CARE L1 99231 180.00$



PROFESSIONAL 99234 OBSERV/HOSP SAME DATE 99234 488.00$



PROFESSIONAL 99238 HOSPITAL DISCHARGE DAY 30 OR < 99238 253.00$

PROFESSIONAL 99239 HOSPITAL DISCHARGE DAY >30 99239 358.00$

PROFESSIONAL 99281 EMERGENCY DEPT VISIT 99281 180.00$

PROFESSIONAL 99282 EMERGENCY DEPT VISIT L2 99282 235.00$




PROFESSIONAL 99291 CRITICAL CARE, FIRST HOUR 99291 694.00$

PROFESSIONAL 99292 CRITICAL CARE, ADDL 30 MIN 99292 353.00$

PROFESSIONAL 99356 PROLONGED SERVICE, INP 1ST HOUR 99356 574.00$

PROFESSIONAL 99357 PROLONGED SERVICE, INP EA ADDL 30 MIN 99357 342.00$

PROFESSIONAL 99360 PHYSICIAN STANDBY SERVICES 99360 311.00$

PROFESSIONAL 99460 INIT NB EM PER DAY, HOSP 99460 430.00$

PROFESSIONAL 99462 SBSQ NB EM PER DAY, HOSP 99462 170.00$

PROFESSIONAL 99463 SAME DAY NB DISCHARGE 99463 561.00$

PROFESSIONAL 99464 ATTENDANCE AT DELIVERY 99464 574.00$

PROFESSIONAL 99465 NB RESUSCITATION 99465 651.00$

PROFESSIONAL 99468 NEONATE CRIT CARE, INITIAL 99468 1,933.00$

PROFESSIONAL 99469 NEONATE CRIT CARE, SUBSQ 99469 1,103.00$

PROFESSIONAL 99477 INIT DAY HOSP NEONATE CARE 99477 1,295.00$

PROFESSIONAL 99479 IC LBW INF 1500-2500 G SUBSQ 99479 362.00$

PROFESSIONAL 99480 IC INF PBW 2501-5000 G SUBSQ 99480 349.00$

PROFESSIONAL 90378 PALIVIZUMAB,PER 50 MG 90378 1,806.25$

PROFESSIONAL DEGAR 80MG DEGARELIX INJECTION 80MG J9155 503.50$

PROFESSIONAL DELESTROG DELESTROGEN PER 1CC J1000 165.25$

PROFESSIONAL DEPOSUBQ DEPO-SUBQ-PROVERA 104MG/65ML J3490 287.05$

PROFESSIONAL DEXAMETH10 DEXAMETHASONE 10 MG VIAL J1100 12.00$

PROFESSIONAL DMSO DMSO J1212 361.00$

PROFESSIONAL EPIPEN .15 ADRENALIN EPINEPHR 0.15MG AUTO INJ PEN J3490 132.65$

PROFESSIONAL EPIPEN .3 ADRENALIN EPINEPHR 0.3MG AUTO INJ PEN J3490 132.65$

PROFESSIONAL GLUCOSEGEL ORAL GLUCOSE GEL J3490 8.75$

PROFESSIONAL J0120 TERRAMYCIN INJ TO 250 MG J0120 60.85$

PROFESSIONAL J0153 ADENOSINE INJECTION J0153 116.40$

PROFESSIONAL J0171-AMP AMPULE-EPI 1MG J0171 4.40$

PROFESSIONAL J0180 ADRENOSEN INJECTION J0180 109.85$

PROFESSIONAL J0280 AMINOPHYLLIN INJ 250 MG J0280 23.70$

PROFESSIONAL J0290 AMPICILLIN INJ UP TO 500 J0290 72.85$

PROFESSIONAL J0360 APRESOLINE INJ/HYDRALAZIN J0360 46.75$

PROFESSIONAL J0500 INJ,DICYCLOMINE HCl, UP TO 20mg (BENTYL) J0500 26.50$

PROFESSIONAL J0515 COGENTIN MESYLATE INJ 1MG J0515 45.70$

PROFESSIONAL J0558 PEN BENZATHINE INJ 100000 U (1.2M) J0558 94.65$

PROFESSIONAL J0561 1.2M PENICILLIN G BENZATHINE INJ 100,000 UNIT J0561 279.65$

2020-01




PROFESSIONAL J0585 INJ ONABOTULINUMTOXINA 1 VIAL J0585 13.55$

PROFESSIONAL J0585-200 INJ ONABOTULINUMTOXINA 1 VIAL J0585 13.05$

PROFESSIONAL J0585-COS INJECTION ONABOTULINUMTOXINA 1 UNIT-COS 744.50$

PROFESSIONAL J0587 INJ RIMABOTULINUMTOXINB 100 UNITS J0587 2,751.20$

PROFESSIONAL J0587-25 MYOBLOC (RIMABOTULINUMTOXINB) J0587 939.50$

PROFESSIONAL J0595 BUTORPHANOL TARTRATE 1 MG (Stadol) J0595 18.50$

PROFESSIONAL J0630 CALCIMAR INJECTION J0630 109.85$

PROFESSIONAL J0670 INJ,MEPIVACAINE HCL (CARBOMAINE PER 10ML J0670 46.75$

PROFESSIONAL J0690 ANCEF J0690 57.70$

PROFESSIONAL J0696 CEFTRIAXONE FOR INJECTION 250 MG J0696 7.60$

PROFESSIONAL J0696-1GM CEFTRIAXONE FOR INJECTION 1GM J0696 3.40$

PROFESSIONAL J0696-CAR ROCEPHIN 500MG J0696 85.95$

PROFESSIONAL J0697 ZINACEF INJECTION J0697 64.15$

PROFESSIONAL J0702 CELESTON SOLUSPAN 6 MG/ML 5ML J0702 64.15$

PROFESSIONAL J0717 CIMZIA KIT J0717 1,462.60$

PROFESSIONAL J0725 CHORINOIC GONADOT INJ PER 1000 USP UNITS J0725 427.40$

PROFESSIONAL J0735 CLONIDINE 1 MG J0735 29.40$

PROFESSIONAL J0775 COLLAGENASE CLOST HIST INJ 0.01MG J0775 91.10$

PROFESSIONAL J0780 COMPAZINE 10mg/2ml IM J0780 28.25$

PROFESSIONAL J0800 CORTICOTROPIN INJ, UP TO 40 UNITS - ACTH J0800 3,659.20$

PROFESSIONAL J0834 COSYNTROPIN CORTROSYN INJ 0.25 J0834 92.45$

PROFESSIONAL J0881 ARANESP 1 MCG (NON ERSD USE) J0881 15.25$

PROFESSIONAL J0882 DARBEPOETIN ALFA ESRD USE 1 MICROGRAM J0882 15.25$

PROFESSIONAL J0885 EPO(PROCRIT) 1000U NONESRD INJ J0885 45.70$

PROFESSIONAL J0897 PROLIA 60 MG/ML J0897 2,546.40$

PROFESSIONAL J1000 DEPO-ESTRADIOL J1000 50.00$

PROFESSIONAL J1020 DEPO-MEDROL 20 MG J1020 27.20$

PROFESSIONAL J1030 DEPO-MEDROL 40 MG INJECTION J1030 8.70$

PROFESSIONAL J1040 DEPO-MEDROL 80 MG INJECTION J1040 16.35$

PROFESSIONAL J1050 PROVERA 150MG SINGLE DOSE VIAL J1050 146.85$

PROFESSIONAL J1050-104 PROVERA 104MG SINGLE DOSE VIAL J1050 240.65$

PROFESSIONAL J1071 1MG DEPO TESTOSTERONE 1MG J1071 21.75$

PROFESSIONAL J1071-1 DEPO-TESTOSTERONE 10ML MULTI USE J1071 0.05$

PROFESSIONAL J1100 DECADRON 10 MG INJECTION J1100 0.25$

PROFESSIONAL J1100-4MG DECADRON 4 MG INJECTION J1100 1.50$

PROFESSIONAL J1110 DIHYDROERGOTAMINE MESYLATE 1MG/1ML VIAL J1110 241.45$

PROFESSIONAL J1160 DIGOXIN INJECTION J1160 34.80$

PROFESSIONAL J1165 DILANTIN INJECTION PER 50MG J1165 65.25$

PROFESSIONAL J1170 INJECTION, HYDROMORPHONE, UP TO 4 MG. J1170 12.00$

PROFESSIONAL J1200 BENADRYL/DIPHENIDRINE 50 MG INJECTION J1200 2.15$

PROFESSIONAL J1240 DRAMAMINE 50 MG J1240 39.15$

PROFESSIONAL J1250 DOBUTAMINE PER 250MG J1250 52.20$

PROFESSIONAL J1335 ERTAPENEM SODIUM, 500MG/2ML VIAL J1335 84.80$

PROFESSIONAL J1380 ESTRADIOL VALERATE INJ TO 10 MG J1380 152.25$

PROFESSIONAL J1438 ETANERCEPT, 25 MG (ENBREL) J1438 536.10$

PROFESSIONAL J1442FILG FILGASTIM 300 MCG VIAL J1442 717.70$

PROFESSIONAL J1442NEUP NEUPOGEN, 480 MCG INJECTION J1442 1,260.35$

PROFESSIONAL J1460 GAMMA GLOBULIN, INTRAMUSCULAR, 1CC J1460 118.55$

PROFESSIONAL J1571 HEPAGAM B IM INJECTION 0.5 ML J1571 1,668.70$

PROFESSIONAL J1580 GENTAMICIN/GARAMYCIN INJ J1580 34.80$

PROFESSIONAL J1600 MYOCHRISINE SOD THIOMALEATE) 50MG/ML J1600 72.85$

PROFESSIONAL J1610 GLUCAGON J1610 141.35$

PROFESSIONAL J1630 HALDOL INJ 5 MG (RAPID ONSET) J1630 152.25$

PROFESSIONAL J1631 HALDOL DECANOATE-50 (SLOW ONSET) J1631 152.25$

PROFESSIONAL J1631-100 HALDOL DECONOATE 100MG/1ML J1631 16.35$

PROFESSIONAL J1642 HEP FLUSH 100UNITS/ML 3ML SYRINGE J1642 3.30$

PROFESSIONAL J1644 HEPARIN SODIUM PER 1000 UNITS INJECTION J1644 12.00$

PROFESSIONAL J1650 ENOXAPARIN SODIUM 10 MG J1650 77.25$

PROFESSIONAL J1650-150A LOVENOX 150MG J1650 28.65$

PROFESSIONAL J1650-150M LOVENOX 150MG J1650 28.65$

PROFESSIONAL J1650-60MG LOVENOX 60MG J1650 12.70$

PROFESSIONAL J1652 INJ ATRIXTRA 0.5 MG J1652 65.25$

PROFESSIONAL J1652 10MG INJ ARIXTRA 0.5 MG J1652 10.85$

PROFESSIONAL J1720 SOLU-CORTEF J1720 39.15$

PROFESSIONAL J1740 INJECTION, IBANDRONATE SODIUM, 1 MG x 3 J1740 1,304.90$

PROFESSIONAL J1750 IRON DEXTRAN 50 MG J1750 107.70$

PROFESSIONAL J1815 INSULIN INJECTION 5 UNITS J1815 34.80$

PROFESSIONAL J1830 INTERFERON BETA-1b (BETASERON) J1830 627.50$

2020-01




PROFESSIONAL J1885 TORADOL PER 15 MG J1885 51.15$

PROFESSIONAL J1885-60MG TORADOL PER 60 MG J1885 51.15$

PROFESSIONAL J1940 LASIX UP TO 20MG J1940 39.15$

PROFESSIONAL J1950 LEUPROLIDE ACETATE, PER 3.75 MG INJ. J1950 1,923.70$

PROFESSIONAL J1950-11MG LEUPROLIDE ACETATE 11.25MG J1950 14,603.65$

PROFESSIONAL J2001 LIDOCAINE HCL INJ FOR IV 10 MG J2001 6.50$

PROFESSIONAL J2010 LINCOCIN UP TO 300 MG J2010 54.40$

PROFESSIONAL J2060 ATIVAN J2060 27.20$

PROFESSIONAL J2175 DEMEROL PER 100MG J2175 39.15$

PROFESSIONAL J2270 MORPHINE UP TO 10 MG J2270 39.15$

PROFESSIONAL J2300 NUBAIN INJECTION PER 10 MG J2300 39.15$

PROFESSIONAL J2310 NALOXONE HCI PER 1 MG J2310 60.85$

PROFESSIONAL J2323 NATALIZUMAB INJECTION 1 MG J2323 6,755.05$

PROFESSIONAL J2353 SANDOSTATIN LAR DEPOT 1 MG J2353 306.65$

PROFESSIONAL J2370 EO-SYNEPHRINE INJ TO 1 ML J2370 9.35$

PROFESSIONAL J2405 ZOFRAN, PER 1 MG J2405 28.25$

PROFESSIONAL J2440 PAPAVERINE 60 MG/2 ML SINGLE DOSE VIAL J2440 12.00$

PROFESSIONAL J2505 PEGFILGRASTIM, 6 MG INJ (NEULASTA) J2505 9,690.05$

PROFESSIONAL J2550 PHENERGAN UP TO 50MG J2550 39.15$

PROFESSIONAL J2675 PROGESTERONE J2675 39.15$

PROFESSIONAL J2680 PROLIXIN J2680 141.35$

PROFESSIONAL J2791 RHOPHYLAC 300mcg/2ml (1500 IU) J2791 230.50$

PROFESSIONAL J2795 ROPIVACAINE 30ML SINGLE DOSE VIAL J2795 12.95$

PROFESSIONAL J2910 SOLGANAL,UP TO 50MG J2910 60.85$

PROFESSIONAL J2920 SOLU-MEDROL UP TO 40MG J2920 37.00$

PROFESSIONAL J2930 SOLU-MEDROL UP TO 125MG J2930 65.25$

PROFESSIONAL J2997 INJECTION, ALTEPLASE RECOMBINANT, 1MG J2997 179.45$

PROFESSIONAL J3000 STREPTOMYCIN INJECTION J3000 34.80$

PROFESSIONAL J3030 IMITREX 6 MG INJECTION J3030 176.20$

PROFESSIONAL J3105 TERBUTALINE SULFATE INJ J3105 42.45$

PROFESSIONAL J3121 TESTOSTERONE ENAN INJ 200 MG/ML J3121 88.10$

PROFESSIONAL J3250 TIGAN UP TO 200 MG J3250 15.25$

PROFESSIONAL J3260 TOBRAMYCIN SULFATE INJ, 80mg/2ml J3260 18.50$

PROFESSIONAL J3301-40 KENALOG 40 MG J3301 19.35$

PROFESSIONAL J3315 INJ TRIPTORELIN PAMOATE 3.75 MG J3315 822.10$

PROFESSIONAL J3360 VALIUM J3360 46.75$

PROFESSIONAL J3370 VANCOMYCIN HCL 500 MG VIAL J3370 16.35$

PROFESSIONAL J3370-1GM VANCOMYCIN HCL 1GM VIAL J3370 27.65$

PROFESSIONAL J3410 VISTARIL J3410 34.80$

PROFESSIONAL J3420 B-12 1000 mcg/ml J3420 28.00$

PROFESSIONAL J3430 AQUAMEPHYTON (VIT. K 1mg) J3430 8.70$

PROFESSIONAL J3430 10MG AQUAMEPHYTON (VITAMIN K) 1MG J3430 44.60$

PROFESSIONAL J3430 20MG AQUAMEPHYTON (VITAMIN K) 1MG J3430 88.10$

PROFESSIONAL J3490CAND CANDIDA ALBICANS ANTIGEN PER ML J3490 35.90$

PROFESSIONAL J3490HPC HYDROXYPROGESTERONE CAPROATE 250 MG J3490 67.40$

PROFESSIONAL J3490TESTO TESTOPEL J3490 207.65$

PROFESSIONAL J7030 NORMAL SALINE 1000CC J7030 18.50$

PROFESSIONAL J7060 DEXTROSE 50% 50CC J7060 84.80$

PROFESSIONAL J7321 HYALGAN/SUPARTZ INJ PER DOSE J7321 470.85$

PROFESSIONAL J7323 EUFLEXXA J7323 438.25$

PROFESSIONAL J7324 ORTHOVISC 2ML SYRINGE J7324 237.05$

PROFESSIONAL J7325 SYNVISC OR SYNVISC-ONE 1 MG J7325 1,324.00$

PROFESSIONAL J7327 MONOVISC 4ML SYRINGE J7327 1,337.50$

PROFESSIONAL J9155 DEGARELIX (FIRMAGON) INJ 1 MG J9155 1,065.70$

PROFESSIONAL J9155-120 DEGARELIX (FIRMAGON) INJ 1 MG J9155 3,244.65$

PROFESSIONAL J9155-80 DEGARELIX (FIRMAGON) INJ 1 MG J9155 1,135.60$

PROFESSIONAL J9201 GEMCITABINE HCL INJ 200 MG J9201 419.75$

PROFESSIONAL J9213 INTERFERON ALPHA 3 MIL IV J9213 362.15$

PROFESSIONAL J9214 INTERFERON ALFA-2B 1 MILLION UNITS J9214 116.40$

PROFESSIONAL J9217 LUPRON (LEIPROLIDE ACETATE) 7.5 MG J9217 1,901.95$

PROFESSIONAL J9217 30MG LUPRON (LEIPROLIDE ACETATE) 7.5 MG J9217 7,597.85$

PROFESSIONAL J9217 ELIG LUPRON (LEIPROLIDE ACETATE) 7.5 MG J9217 11,396.20$

PROFESSIONAL J9217-30 ELIGARD 30MG J9217 2,343.40$

PROFESSIONAL J9218 LUPRON PER 1 MG J9218 2,846.85$

PROFESSIONAL J9260 METHOTREXATE SODIUM,50 MG J9260 22.85$

PROFESSIONAL METHACORT METHACORT INJECTION J2920 41.30$

PROFESSIONAL OMNIPEN500 OMNIPEN UP TO 500MG J0290 70.70$

PROFESSIONAL S0020 INJECTION, BUPIVICAINE HCI, 30ML J3490 76.10$

2020-01




PROFESSIONAL S0077 CLINDAMYCIN PHOSPATE 300 MG S0077 8.10$

PROFESSIONAL S0171 BUMEX INJECTION J3490 34.80$

PROFESSIONAL S0189 TESTOSTERONE PELLET 75 MG S0189 201.20$

PROFESSIONAL TRIPLEMIX TRIPLEMIX J3490 293.60$

PROFESSIONAL VITRASE VITRASE, 200 UNIT VIAL J3490 134.85$

PROFESSIONAL 36415 VENOUS COLLECTION FEE - DRAWING BLOOD 36415 19.45$

PROFESSIONAL 36416 FINGER, HEEL, OR EAR STICK 36416 14.15$

PROFESSIONAL 80048 BASIC METABOLIC PANEL (CHEM 8) 80048 76.50$

PROFESSIONAL 80171 DRUG SCREEN QUANT GABAPENTIN 80171 113.85$

PROFESSIONAL 81003 UA AUTO W/O MICROSCOPIC 81003-QW 24.65$

PROFESSIONAL 81025 URINE PREGNANCY TEST 81025 78.80$

PROFESSIONAL 82103 ALPHA 1 ANTITRYPSIN TOT (8161) 82103 24.70$

PROFESSIONAL 82270 OCCULT BLD 1-3 SPEC W/SINGLE DETERMINATI 82270 34.30$

PROFESSIONAL 82272 OCCULT BLD,PERIOXIDASE,SGL/RECTAL EXAM 82272 34.30$

PROFESSIONAL 82947 GLUCOSE, QUANT 82947 41.80$

PROFESSIONAL 83880 B-TYPE NATRIURETIC PEPTIDE KDH 83880 102.75$

PROFESSIONAL 83986 PH TEST/ BODY FLUID ACIDITY 83986 11.60$

PROFESSIONAL 85027CA CBC AUTO W/PLT W/O DIFF 85027 43.55$

PROFESSIONAL 85060 BLOOD SMEAR, PERIPHERAL, INTER/REPORT 85060 151.75$

PROFESSIONAL 86308 MONO SCRN (HETEROPHILE AB)QUAL 86308 88.40$

PROFESSIONAL 86580 TB INTRADERMAL TEST 86580 28.65$

PROFESSIONAL 86580M TB INTRADERMAL TEST 86580 9.55$

PROFESSIONAL 86689B AB; HTLV OR HIV WESTERN BLOT (20550) 86689 91.75$

PROFESSIONAL 87220 KOH WET PREP 87220 43.80$

PROFESSIONAL 87502 SISIC - INFLUENZA A&B ANTIGEN 87502 21.75$

PROFESSIONAL 87880 STREP SCR GROUP A-THROAT 87880 94.25$

PROFESSIONAL 99000 SPECIMEN HANDLING 99000 17.45$

PROFESSIONAL 410024 INFLUENZA A AG SCR 87899 172.95$

PROFESSIONAL G0452 MOLECULAR PATHOLOGY INTERPR G0452 9.85$

PROFESSIONAL Q0091 SCREENING PAP SMEAR OBTAINED PELVIC EXAM Q0091 84.00$

PROFESSIONAL 36415W DRAWING BLOOD 36415 19.45$

PROFESSIONAL 80048W BASIC METABOLIC PANEL (CHEM 8) WAIVE 80048 76.50$

PROFESSIONAL 80051W ELECTROLYTE PANEL WAIVE 80051 107.20$

PROFESSIONAL 80095W COLLECT-DOT DRUG SCREEN DRUG SCREEN 81.60$

PROFESSIONAL 80096W DRUG SCREEN; NON DOT /COMPANY ACCOUNTS"" 80096 115.30$

PROFESSIONAL 80097W DRUG SCREEN, DOT (COMPANY ACCTS. ONLY) 80097 194.70$

PROFESSIONAL 81003W UR AUTO W/O MICROSCOPIC 81003 24.65$

PROFESSIONAL 81025QW HCG URINE SCREEN 81025-QW 78.80$

PROFESSIONAL 82104 ALPHA 1 ANTITRYPSIN PHENOTYPE (8161) 82104 51.40$

PROFESSIONAL 82247W BILIRUBIN TOTAL WAIVE 82247 51.90$

PROFESSIONAL 82248 BILIRUBIN, DIRECT - WAIVE 82248 56.50$

PROFESSIONAL 82248W BILIRUBIN, DIRECT WAIVE 82248 56.50$

PROFESSIONAL 82270W OCCULT BLD 1-3 SPEC-DIAG 82270 34.30$

PROFESSIONAL 82310W CALCIUM, TOT - WAIVE 82310 44.20$

PROFESSIONAL 82374W CARBON DIOXIDE (CO2) - WAIVE 82374 62.15$

PROFESSIONAL 82435W CHLORIDE, BLOOD - WAIVE 82435 54.75$

PROFESSIONAL 82565W CREATININE BLD WAIVE 82565 44.70$

PROFESSIONAL 82570QW CREATININE; URINE 82570-QW 65.45$

PROFESSIONAL 84132W POTASSIUM, SER 84132 41.45$

PROFESSIONAL 84295W SODIUM, SER 84295 30.10$

PROFESSIONAL 84520W BUN (UREA NITROGEN, BLD) QUANT - WAIVE 84520 37.05$

PROFESSIONAL 84703W HCG QUALITATIVE, BLOOD - WAIVE 84703 72.15$

PROFESSIONAL 85007W DIFFERENTIAL WBC - WAIVE 85007 26.45$

PROFESSIONAL 85008W SMEAR EXAM W/OUT DIFF, BLOOD - WAIVE 85008 16.35$

PROFESSIONAL 85014W HEMATOCRIT (NON SPUN) WAIVE 85014 38.30$

PROFESSIONAL 85018QW HEMOGLOBIN WAIVED 85018-QW 45.50$

PROFESSIONAL 85652 ARTH AUTOM ERYTHROCYTE SED RATE 85652 41.25$

PROFESSIONAL 85652W SEDIMENTATION RATE, ESR-AUTO 85652 41.25$

PROFESSIONAL 86651 ARBOVIRUS AB PANEL; ENCEPH CALIF 86651 31.90$

PROFESSIONAL 86652 ARBOVIRUS AB PANEL; ENCEPH E EQUINE 86652 31.90$

PROFESSIONAL 86653 ARBOVIRUS AB PANEL; ENCEPH ST LOUIS 86653 31.90$

PROFESSIONAL 86654 ARBOVIRUS AB PANEL; ENCEPH W EQUINE 86654 31.90$

PROFESSIONAL 87220W KOH WET PREP - WAIVE 87220 43.80$

PROFESSIONAL 87880W STREP SCR GROUP A- THROAT 87880 94.25$

PROFESSIONAL Q0111 WET MOUNTS - WAIVED Q0111 67.45$

PROFESSIONAL Q0112 KOH PREPS - WAIVED Q0112 67.45$

PROFESSIONAL Q0114 FERN TEST Q0114 50.05$

PROFESSIONAL 81003P UR AUTO W/O MICROSCOPIC (BY PHYSICIAN) 81003-QW 38.25$

2020-01




PROFESSIONAL 82270P OCCULT BLD 1-3 SPEC-DIAG 82270 34.30$

PROFESSIONAL 82731P FETAL FIBRONECTIN TEST 82731 785.45$

PROFESSIONAL 87220P KDH WET PREP 87220 43.80$

PROFESSIONAL 87804P INFLUENZA 87804 132.00$

PROFESSIONAL 87804PA INFLUENZA A ANTIGEN 87804 132.00$

PROFESSIONAL 87880P STREP A RAPID 87880 94.25$

PROFESSIONAL Q0111P WET MOUNTS - WAIVED Q0111 66.40$

PROFESSIONAL Q0112P KOH PREPS - WAIVED Q0112 47.85$

PROFESSIONAL 5 ANTIGEN THERAPY, 5 UNITS, SINGLE VIAL 95165 100.05$

PROFESSIONAL 10 ANTIGEN THERAPY, 10 UNITS, SINGLE VIAL 95165 193.55$

PROFESSIONAL 20 ANTIGEN THERAPY, 20 UNITS, MULTIPLE VIAL 95165 284.90$

PROFESSIONAL 52 ANTIGEN THERAPY, 5 UNITS, MULTIPLE VIAL 95165 77.25$

PROFESSIONAL 102 ANTIGEN THER.10U, SING. VL/MULTI MEMBERS 95165 97.85$

PROFESSIONAL 202 ANTIGEN THER.20 UNITS,MULTI VIAL&MEMBERS 95165 144.65$

PROFESSIONAL 90460 IMMUNE ADM, <18 YRS, 1ST VAC 90460 39.00$

PROFESSIONAL 90460-26 IMMUNE ADM, <18 YRS, 1ST VAC 90460 39.00$

PROFESSIONAL 90461 IMMUNE ADM, <18 YRS, EA ADD'L VAC 90461 35.00$

PROFESSIONAL 90461-26 IMMUNE ADM, <18 YRS, EA ADD'L VAC 90461 35.00$

PROFESSIONAL 90471 IMMUNIZATION ADMIN 90471 39.00$

PROFESSIONAL 90471-26 IMMUNIZATION ADMIN 90471 39.00$

PROFESSIONAL 90472 IMMUNIZATION ADMIN, EACH ADD 90472 35.00$

PROFESSIONAL 90472-26 IMMUNIZATION ADMIN; EA ADD'L 90472 35.00$

PROFESSIONAL 90473 IMMUNE ADMIN ORAL/NASAL 90473 35.00$

PROFESSIONAL 90473-26 IMMUNE ADMIN ORAL/NASAL 90473 35.00$

PROFESSIONAL 90474 IMMUNE ADMIN ORAL/NASAL ADDL 90474 35.00$

PROFESSIONAL 90474-26 IMMUNE ADMIN ORAL/NASAL ADDL 90474 35.00$

PROFESSIONAL 91010 ESOPHAGUS MOTILITY STUDY 91010 450.20$

PROFESSIONAL 91010-26 ESOPHAGEAL MOTILITY (MANOMETRIC) 91010-26 450.20$

PROFESSIONAL 91034 GASTROESOPH REFLUX W NASAL PH 91034 199.05$

PROFESSIONAL 91034-26 ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST 91034-26 199.05$

PROFESSIONAL 91038 ESOPH IMPED FUNCT TEST > 1H 91038 469.80$

PROFESSIONAL 91110-26 CAPSULE ENDOSCOPY (P/C) 91110-26 1,053.75$

PROFESSIONAL 92081 VISUAL FIELD EXAM W/INTERPRETATION & RPT 92081 202.25$

PROFESSIONAL 92270 ELECTRO-OCULOGRAPHY 92270 255.60$

PROFESSIONAL 92568 ACOUSTIC REFL THRESHOLD TST 92568 46.75$

PROFESSIONAL 93272 ECG/REVIEW INTERPRET ONLY 93272 132.65$

PROFESSIONAL 93279 PM DEVICE PROGR EVAL, SNGL 93279 239.20$

PROFESSIONAL 93280 PM DEVICE PROGR EVAL DUAL 93280 286.05$

PROFESSIONAL 93284 PRGRMG EVAL IMPLANTABLE DFB 93284 239.20$

PROFESSIONAL 93288 PM DEVICE EVAL IN PERSON 93288 286.05$

PROFESSIONAL 93294 PM DEVICE INTERROGATE REMOTE =<90 DAYS 93294 113.10$

PROFESSIONAL 93306-26 TTE W/DOPPLER, COMPLETE 93306-26 325.15$

PROFESSIONAL 94002 VENT MGMT INPAT, INIT DAY 94002 387.15$

PROFESSIONAL 94003 VENT MGMT INPAT, SUBQ DAY 94003 284.90$

PROFESSIONAL 94618 PULMONARY STRESS TESTING 94618 396.90$

PROFESSIONAL 94618-26 PULMONARY STRESS TESTING 94618-26 55.15$

PROFESSIONAL 95004 SCRATCH TEST, IMMEDIATE REACTION 95004 17.40$

PROFESSIONAL 95018 PERQ&IC ALLG TEST DRUGS/BIOL 95018 57.70$

PROFESSIONAL 95024 ALLERGY SKIN TESTS 95024 23.95$

PROFESSIONAL 95027 IDT 95027 23.95$

PROFESSIONAL 95028 ALLERGY TESTS,DELAYED REACTION W/READING 95028 37.00$

PROFESSIONAL 95076 INGEST CHALLENGE INI 120 MIN 95076 314.30$

PROFESSIONAL 95115 IMMUNOTHER. INJ. 1/MULTI. FAMILY MEMBERS 95115 37.00$

PROFESSIONAL 95115M IMMUNOTHER. INJ. 1/MULTI. FAMILY MEMBERS 95115 32.60$

PROFESSIONAL 95117 IMMUNOTHERAPY INJECTIONS 2 OR MORE 95117 40.25$

PROFESSIONAL 95117-3 ALLERGY INJECTION 3 INJECTIONS 95117 44.60$

PROFESSIONAL 95117-4 ALLERGY INJECTION 4 INJECTIONS 95117 50.00$

PROFESSIONAL 95117M IMMUNOTHER. 2 INJ./MULTI. FAMILY MEMBERS 95117 34.80$

PROFESSIONAL 95120 IMMUNOTHERAPY, ONE INJ./INCLUDING EXTRAC 95120 47.85$

PROFESSIONAL 95165 ANTIGEN THERAPY SERVICE 95165 176.20$

PROFESSIONAL 95805-26 MSLT/MWT 95805-26 434.95$

PROFESSIONAL 95810-26 PSS W 4/> PARAM W TECH 95810-26 556.75$

PROFESSIONAL 95811-26 PSS W 4/> P W CPAP/BIPAP 95811-26 588.35$

PROFESSIONAL 95812 EEG 41-60 MINUTES 95812 577.10$

PROFESSIONAL 95816 EEG AWAKE & DROWSY 95816 416.55$

PROFESSIONAL 95819 EEG AWAKE & ASLEEP 95819 478.50$

PROFESSIONAL 95860 MUSCLE TEST, ONE LIMB 95860 336.05$

PROFESSIONAL 95861 MUSCLE TEST, TWO LIMBS 95861 659.00$

2020-01




PROFESSIONAL 95863 MUSCLE TEST, 3 LIMBS 95863 855.85$

PROFESSIONAL 95864 MUSCLE TEST, 4 LIMBS 95864 921.10$

PROFESSIONAL 95870 MUSCLE TEST NONPARASPINAL 1 EX 95870 164.25$

PROFESSIONAL 95874 GUIDE NERVE DESTR NEEDLE EMG 95874 78.30$

PROFESSIONAL 95930 VEP TEST CNS; CHECKERBD/FLASH 95930 139.20$

PROFESSIONAL 95933 BLINK REFLEX TEST 95933 88.10$

PROFESSIONAL 95937 NEUROMUSCU JUNCT TEST EA NERVE 95937 113.10$

PROFESSIONAL 95953 CER SEIZURE PORT 16CH EA 24HRS 95953 471.95$

PROFESSIONAL 95953-26 CER SEIZURE PORT 16CH EA 24 HRS 95953-26 449.15$

PROFESSIONAL 95970 EA NS PGS; S/CPLX WO REPR 95970 128.35$

PROFESSIONAL 95972 ELECT ANALYSIS,IMPLANTED NEUROSTIMULATOR 95972 345.80$

PROFESSIONAL 95992 CANALITH REPOSITIONING PROC 95992 84.80$

PROFESSIONAL 96110 DEVELOPMENTAL TESTING, LIMITED 96110 52.20$

PROFESSIONAL 96127 BRIEF EMOTIONAL/BEHAV ASSMT 96127 16.35$

PROFESSIONAL 96146 PSYCHO/NEURO TEST ADMIN W/SINGLE INSTR 96146 108.75$

PROFESSIONAL 96360 HYDRATION IV INFUSION, INIT 96360 208.80$

PROFESSIONAL 96361 HYDRATE IV INFUSION, ADD-ON 96361 71.80$

PROFESSIONAL 96372 THER/PROPH/DIAG INJ, SC/IM 96372 46.00$

PROFESSIONAL 96372-26 THER/PROPH/DIAG INJ, SC/IM 96372 45.70$

PROFESSIONAL 96374 THER/PROPH/DIAG INJ, IV PUSH 96374 165.25$

PROFESSIONAL 96401 CHEMO ADMIN,SQ OR IM, NON-HORMONAL 96401 224.05$

PROFESSIONAL 96402 CHEMO ADMIN,SQ OR IM, HORMONAL 96402 125.10$

PROFESSIONAL 96523 IRRIG DRUG DELIVERY DEVICE 96523 52.20$

PROFESSIONAL 97014 APP/MODALITY 1/MORE AREAS;H&C ELEC STIM 97014 77.25$

PROFESSIONAL 97032 ELECTRICAL STIMULATION PER 15 MINUTES 97032 92.45$

PROFESSIONAL 97035 ULTRASOUND THERAPY 97035 121.80$

PROFESSIONAL 97110 THERAPEUTIC EXERCISES EA 15 MINS 97110 78.30$

PROFESSIONAL 97140 MANUALTHRPY 1OR MORE REGIONS/EA 15 MIN 97140 93.50$

PROFESSIONAL 97597 REMOVAL DEAD TISSUE WOUND(S) <= 20 CM 97597 294.75$

PROFESSIONAL 97602 REMOVAL OF DEVITALIZED TISSUE FROM WOUND 97602 70.70$

PROFESSIONAL 97605 NEG PRESS WOUND TX, < 50 CM 97605 207.70$

PROFESSIONAL 97607 NEG PRESS WND TX <=50 SQ CM 97607 82.65$

PROFESSIONAL 97802 MEDICAL NUTRITION THERAPY, INDIV 15M 97802 50.95$

PROFESSIONAL 97803 RE-ASSESS NUTRITION THER; EA 15M 97803 46.65$

PROFESSIONAL 97804 MEDICAL NUTRITION THERAPY, INDIV 97804 45.65$

PROFESSIONAL 97810 ACUPUNCTURE W/O STIMUL/15 MIN 97810 59.85$

PROFESSIONAL 97813 ACUPUNCT W/STIMUL 15 MIN 97813 64.15$

PROFESSIONAL 98925 OSTEOPATHIC MANIPULATION 1-2 BODY REGION 98925 160.95$




PROFESSIONAL 98929 OSTEOPATHIC MANIPULATION 9-10 BODY REGIO 98929 346.90$

PROFESSIONAL 99002 DEVICE HANDLING 99002 141.35$

PROFESSIONAL 99173 VISUAL ACUITY SCREEN-BILATERAL QUAN 99173 33.75$

PROFESSIONAL A4648 GOLD FIDUCIAL MARKERS PACK OF 3 A4648 179.45$

PROFESSIONAL G0008 ADM OF FLU VACCINE G0008 39.00$

PROFESSIONAL G0009 INJ ADM FEE PNEUMOVAX VAC G0009 39.00$

PROFESSIONAL G0010 HEPATITIS B INJ ADM FEE G0010 40.00$

PROFESSIONAL G0283 ELECT STIM (UNATT) 1/MORE AREAS G0283 69.60$

PROFESSIONAL G0403 EKG FOR INITIAL PREVENT EXAM G0403 176.20$

PROFESSIONAL G0404 EKG TRACING FOR INITIAL PREV G0404 137.00$

PROFESSIONAL G0405 EKG INTERPRET & REPORT PREVE G0405 88.10$

PROFESSIONAL G0500 MOD SEDAT ENDO SERVICE >5YRS G0500 72.25$

PROFESSIONAL J0171 ADRENALIN EPINEPHRINE INJ 1 VIAL J0171 5.45$

PROFESSIONAL J0561 600 BICILLIN L-A 600,000 UNITS/VIAL J0561 161.45$

PROFESSIONAL J2765 METOCLOPRAMIDE HCL TO 10 MG J2765 2.15$

PROFESSIONAL J7296 KYLEENA IUD 19.5MG J7296 2,044.40$

PROFESSIONAL J7297 LILETTA IU 52MG 3 YR J7297 985.10$

PROFESSIONAL J7298 MIRENA IU 52MG 5 YR J7298 1,907.35$

PROFESSIONAL J7307NEX NEXPLANON / etonogestrel J7307 1,980.10$

PROFESSIONAL J7323 20MG HYALURONIC ACID 20mg +LIDOCAINE 1% 2ml J7323 110.95$

PROFESSIONAL J7323 60MG HYALURONIC ACID 60mg +LIDOCAINE 1% 6ml J7323 532.80$

PROFESSIONAL J7336 QUTENZA 8% PATCH J7336 992.85$

PROFESSIONAL J7644 ATROVENT UNIT DOSE J7644 6.55$

PROFESSIONAL S0090 SILDENAFIL 20MG TAB S0090 7.60$

PROFESSIONAL 00025 METHYLERGONOVINE MALEATE TABLET 0.2MG 44.60$

PROFESSIONAL 00029 SILVER NITRATE 0.5% SOLUTION J3490 134.85$

PROFESSIONAL 00031 SILDENAFIL 20MG TABS BOTTLE OF 30 38.10$

2020-01




PROFESSIONAL 00032 SILDENAFIL BOTTLE 30 TABS 34.80$

PROFESSIONAL 00033 NITROSTAT 0.4MG TABLET EA A9270 0.60$

PROFESSIONAL 00034 PROCARDIA 10MG CAP EA A9270 2.15$

PROFESSIONAL 00035 ASPIRIN 80MG TAB EA A9270 0.05$

PROFESSIONAL 00036 ASPIRIN 325MG TAB EA A9270 0.05$

PROFESSIONAL 00037 CUREX OINTMENT 45GM TUBE A9270 115.25$

PROFESSIONAL 00038 DEXAMETHASONE POWDER A9270 7.60$

PROFESSIONAL 00039 KETOROLAC TAB A9270 3.30$

PROFESSIONAL 00040 CLONIDINE 0.1MG A9270 0.10$

PROFESSIONAL 00041 TYLENOL 325MG A9270 0.05$

PROFESSIONAL 00042 IMITREX 25MG A9270 0.10$

PROFESSIONAL 00043 HALCION 0.25MG A9270 2.15$

PROFESSIONAL 00044 TYLENOL LIQUID A9270 3.30$

PROFESSIONAL 00045 XANAX 0.5MG TAB A9270 2.10$

PROFESSIONAL 00046 BACTRIM DS A9270 2.50$

PROFESSIONAL 00054 IBUPROFEN LIQUID 100MG/5ML 00054 8.15$

PROFESSIONAL 99070-TSV TRIMO-SAN VAGINAL JELLY KIT 99070 44.60$

PROFESSIONAL DIASTAT 10 DIASTAT ACUDIAL 10MG KIT J3490 780.80$

PROFESSIONAL J0275 ALPROSTADIL URETHRAL SUPPOSITORY, NOF SA J0275 81.60$

PROFESSIONAL J3490CHLO CHLORAL HYDRATE 30 ML J3490 15.25$

PROFESSIONAL J3490EMLA EMLA CREAM 30 GRAM TUBE J3490 35.90$

PROFESSIONAL J7300 IUD - PARAGARD J7300 1,407.15$

PROFESSIONAL J7303 NUVARING VAGINAL RING J7303 679.65$

PROFESSIONAL J7510 PREDNISOLONE ORAL, (ORAPRED) J7510 50.00$

PROFESSIONAL J7510-15 ORAPRED 15MG ODT J7510 29.40$

PROFESSIONAL J7610 ALBUTEROL COMP CON J7610 25.05$

PROFESSIONAL J7613 ALBUTEROL NEB PREMIX 2.5MG/3ML J7613 30.45$

PROFESSIONAL J7614-125 LEVALBUTEROL 1.25MG J7614 9.85$

PROFESSIONAL J7614-63 LEVALBLEVALBUTEROL 0.63MGUTEROL 0.63MG J7614 9.85$

PROFESSIONAL J8540-LIQ DEXAMETHASONE 0.25 MG LIQUID J8540 2.15$

PROFESSIONAL J8540-LIQ4 DEXAMETHASONE 0.25MG LIQUID J8540 2.15$

PROFESSIONAL J8540-TAB4 DEXAMETHASONE 0.25 MG ORAL J8540 4.35$

PROFESSIONAL J8540-TAB8 DEXAMETHASONE 0.25 MG ORAL J8540 4.35$

PROFESSIONAL J9031 BCG LIVE (INTRAVESICAL), PER INSTILLATIO J9031 457.85$

PROFESSIONAL J9219 LEUPROLIDE ACETATE IMPL, 65 MG J9219 5,013.00$

PROFESSIONAL J9225 VANTAS IMPLANT 50 MG J9225 5,013.00$

PROFESSIONAL PROCARDIA PROCARDIA 10mg (Nifedipine) J8499 10.85$

PROFESSIONAL Q0144 ZITHROMAX ORAL CAPSUL/POWDER, 1 GRAM Q0144 123.95$

PROFESSIONAL Q0162-LIQ ZOFRAN LIQUID Q0162 2.15$

PROFESSIONAL Q0162-TAB4 ZOFRAN 4 MG TAB ORAL Q0162 0.65$

PROFESSIONAL Q0162-TAB8 ZOFRAN 8 MG TAB ORAL Q0162 0.65$

PROFESSIONAL Q0163-CAP BENADRYL 25MG CAP Q0163 0.35$

PROFESSIONAL Q0163-LIQ BENADRYL LIQUID Q0163 2.15$

PROFESSIONAL Q0169 PROMETHAZINE HCL 12.5 MG ORAL Q0169 0.50$

PROFESSIONAL S0191 MISOPROSTOL, ORAL 200 MCG J8499 13.05$

PROFESSIONAL ZOF4MGTAB ZOFRAN 4 MG TABLET Q0162 0.65$

PROFESSIONAL 94004 VENT MGMT NF PER DAY 94004 208.00$

PROFESSIONAL 99304 INITIAL NURSING HOME CARE, PER DAY 99304 188.00$



PROFESSIONAL 99307 SUBSEQUENT NURSING HOME CARE 99307 139.00$




PROFESSIONAL 99315 NURSING FAC DISCHARGE DAY 99315 238.00$

PROFESSIONAL 99316 NURSING FAC DISCHARGE DAY 99316 297.00$

PROFESSIONAL 99318 ANNUAL NURSING FACILITY ASSESSMENT 99318 188.00$

PROFESSIONAL 99324 DOMICILIARY OR REST HOME VISIT, NEW PT. 99324 191.00$

PROFESSIONAL 99325 DOMICILARY OR REST HOME VISIT, NEW PT. 99325 296.00$




PROFESSIONAL 99334 DOMICILIARY OR REST HOME VISIT, ESTAB PT 99334 157.00$




PROFESSIONAL 56405 I & D OF VULVA/PERINEUM 56405 694.00$

PROFESSIONAL 56420 DRAINAGE OF GLAND ABSCESS 56420 535.00$

2020-01




PROFESSIONAL 56440 SURGERY FOR VULVA LESION 56440 1,809.00$

PROFESSIONAL 56442 HYMENOTOMY 56442 535.00$

PROFESSIONAL 56501 DESTRUCTION, VULVA LESION(S) 56501 535.00$

PROFESSIONAL 56515 DESTRUCTION, VULVA LESION(S) 56515 1,799.00$

PROFESSIONAL 56605 BIOPSY OF VULVA/PERINEUM 56605 417.00$

PROFESSIONAL 56606 BIOPSY OF VULVA, EA ADDL LESION 56606 210.00$

PROFESSIONAL 56620 PARTIAL REMOVAL OF VULVA 56620 4,205.00$

PROFESSIONAL 56625 COMPLETE REMOVAL OF VULVA 56625 4,817.00$

PROFESSIONAL 56630 EXTENSIVE VULVA SURGERY 56630 8,408.00$

PROFESSIONAL 56640 EXTENSIVE VULVA SURGERY 56640 9,563.00$

PROFESSIONAL 56700 PARTIAL REMOVAL OF HYMEN 56700 1,242.00$

PROFESSIONAL 56740 REMOVE VAGINA GLAND LESION 56740 2,086.00$

PROFESSIONAL 56800 REPAIR OF VAGINA 56800 1,984.00$

PROFESSIONAL 56810 REPAIR OF PERINEUM 56810 2,012.00$

PROFESSIONAL 57000 EXPLORATION OF VAGINA 57000 1,861.00$

PROFESSIONAL 57010 DRAINAGE OF PELVIC ABSCESS 57010 1,653.00$

PROFESSIONAL 57023 NON OBSTERICAL SPONTANEOUS BLEEDING 57023 565.00$

PROFESSIONAL 57061 DESTRUCTION VAGINA LESION(S) 57061 347.00$

PROFESSIONAL 57065 DESTRUCTION VAGINA LESION(S) 57065 1,803.00$

PROFESSIONAL 57100 BIOPSY OF VAGINA 57100 367.00$

PROFESSIONAL 57105 BIOPSY OF VAGINA 57105 891.00$

PROFESSIONAL 57120 CLOSURE OF VAGINA 57120 3,473.00$

PROFESSIONAL 57130 REMOVE VAGINA LESION 57130 1,920.00$

PROFESSIONAL 57135 REMOVE VAGINA LESION 57135 1,203.00$

PROFESSIONAL 57160 INSERT PESSARY/OTHER DEVICE 57160 225.00$

PROFESSIONAL 57170 FITTING OF DIAPHRAGM/CAP 57170 233.00$

PROFESSIONAL 57180 TREAT VAGINAL BLEEDING 57180 545.00$


PROFESSIONAL 57210 REPAIR VAGINA/PERINEUM 57210 2,685.00$

PROFESSIONAL 57220 REVISION OF URETHRA 57220 3,099.00$

PROFESSIONAL 57240 REPAIR BLADDER & VAGINA 57240 3,895.00$

PROFESSIONAL 57250 REPAIR RECTUM & VAGINA 57250 3,871.00$


PROFESSIONAL 57265 EXTENSIVE REPAIR OF VAGINA 57265 5,976.00$

PROFESSIONAL 57267 INSERT MESH/PELVIC FLR ADDON 57267 1,614.00$

PROFESSIONAL 57268 REPAIR OF BOWEL BULGE 57268 4,126.00$

PROFESSIONAL 57270 REPAIR OF BOWEL POUCH 57270 4,782.00$

PROFESSIONAL 57280 SUSPENSION OF VAGINA 57280 5,763.00$

PROFESSIONAL 57282 COLPOPEXY,VAGINAL 57282 5,196.00$

PROFESSIONAL 57287 REV/REP STRESS INCONT SLING 57287 2,987.00$

PROFESSIONAL 57288 REPAIR BLADDER DEFECT 57288 5,773.00$

PROFESSIONAL 57289 REPAIR BLADDER & VAGINA 57289 5,151.00$

PROFESSIONAL 57295 REVISE VAG GRAFT VIA VAGINA 57295 2,230.00$

PROFESSIONAL 57300 REPAIR RECTUM-VAGINA FISTULA 57300 5,151.00$

PROFESSIONAL 57305 REPAIR RECTUM-VAGINA FISTULA 57305 6,687.00$

PROFESSIONAL 57307 FISTULA REPAIR & COLOSTOMY 57307 7,453.00$

PROFESSIONAL 57320 REPAIR BLADDER-VAGINA LESION 57320 5,551.00$

PROFESSIONAL 57400 DILATION OF VAGINA 57400 822.00$

PROFESSIONAL 57410 PELVIC EXAMINATION UNDER ANESTHESIA 57410 685.00$

PROFESSIONAL 57415 REMOVAL IMPACTED VAGINAL FB UNDER ANESTH 57415 888.00$

PROFESSIONAL 57420 COLPOSCOPY OF VAGINA W/CERVIX 57420 300.00$

PROFESSIONAL 57452 EXAMINATION OF VAGINA 57452 383.00$

PROFESSIONAL 57454 VAGINA EXAMINATION & BIOPSY 57454 613.00$

PROFESSIONAL 57455 COLPOSCOPY W/BIOPSY CERVIX W/SCOPE 57455 545.00$

PROFESSIONAL 57456 COLPOSCOPY W/ENDOCERVICAL CURETTAGE 57456 458.00$

PROFESSIONAL 57460 CERVIX EXCISION 57460 2,019.00$

PROFESSIONAL 57500 BIOPSY OF CERVIX 57500 452.00$

PROFESSIONAL 57505 ENDOCERVICAL CURETTAGE 57505 314.00$

PROFESSIONAL 57510 CAUTERIZATION OF CERVIX 57510 481.00$

PROFESSIONAL 57511 CRYOCAUTERY OF CERVIX 57511 518.00$

PROFESSIONAL 57520 CONIZATION OF CERVIX 57520 2,192.00$

PROFESSIONAL 57522 CONIZATION OF CERVIX 57522 1,894.00$

PROFESSIONAL 57530 REMOVAL OF CERVIX 57530 2,066.00$

PROFESSIONAL 57540 REMOVAL OF RESIDUAL CERVIX 57540 3,159.00$

PROFESSIONAL 57550 REMOVAL OF RESIDUAL CERVIX 57550 2,469.00$

PROFESSIONAL 57555 REMOVE CERVIX/REPAIR VAGINA 57555 3,281.00$

PROFESSIONAL 57556 REMOVE CERVIX, REPAIR BOWEL 57556 5,736.00$

PROFESSIONAL 57558 D&C OF CERVICAL STUMP 57558 1,539.00$

2020-01




PROFESSIONAL 57700 REVISION OF CERVIX 57700 1,552.00$


PROFESSIONAL 57800 DILATION OF CERVICAL CANAL 57800 284.00$

PROFESSIONAL 58100 BIOPSY OF UTERUS LINING 58100 431.00$

PROFESSIONAL 58120 DILATION AND CURETTAGE 58120 1,672.00$

PROFESSIONAL 58140 REMOVAL OF UTERUS LESION 58140 3,551.00$

PROFESSIONAL 58145 REMOVAL OF UTERUS LESION 58145 3,644.00$

PROFESSIONAL 58150 TOTAL HYSTERECTOMY 58150 6,500.00$

PROFESSIONAL 58152 TOTAL HYSTERECTOMY 58152 7,692.00$

PROFESSIONAL 58180 SUPRACERV ABD HYSTERECTOMY W/WO REMOVAL 58180 6,762.00$

PROFESSIONAL 58200 EXTENSIVE HYSTERECTOMY 58200 7,859.00$

PROFESSIONAL 58210 EXTENSIVE HYSTERECTOMY 58210 12,303.00$

PROFESSIONAL 58260 VAGINAL HYSTERECTOMY 58260 3,186.00$



PROFESSIONAL 58267 HYSTERECTOMY & VAGINA REPAIR 58267 7,646.00$

PROFESSIONAL 58270 HYSTERECTOMY & VAGINA REPAIR 58270 6,954.00$

PROFESSIONAL 58275 HYSTERECTOMY/REVISE VAGINA 58275 6,436.00$

PROFESSIONAL 58280 HYSTERECTOMY/REVISE VAGINA 58280 6,914.00$

PROFESSIONAL 58290 VAG HYST COMPLEX 58290 6,003.00$

PROFESSIONAL 58291 VAG HYSTERECTOMY W/REMOVAL OF TUBE/OVARY 58291 7,010.00$

PROFESSIONAL 58294 VAGINAL HYSTERECTOMY W/REPAIR ENTEROCELE 58294 6,135.00$

PROFESSIONAL 58300 INSERT INTRAUTERINE DEVICE 58300 445.00$

PROFESSIONAL 58301 REMOVE INTRAUTERINE DEVICE 58301 290.00$

PROFESSIONAL 58340 HYSTEROGR/SIS CONTR/SALINE INJ 58340 521.00$

PROFESSIONAL 58345 TRANSCERV FALLOPIAN TUBE CATH FOR DX 58345 1,527.00$

PROFESSIONAL 58350 CHROMOTUBATION OF OVIDUCT 58350 469.00$

PROFESSIONAL 58350-50 BILATERAL CHROMOTUBATION OF OVIDUCT 58350-50 936.00$

PROFESSIONAL 58353 ENDOMETRIAL ABLATION,THERMAL,W/O HYSTERO 58353 3,507.00$

PROFESSIONAL 58400 SUSPENSION OF UTERUS 58400 4,197.00$

PROFESSIONAL 58410 SUSPENSION OF UTERUS 58410 4,848.00$

PROFESSIONAL 58540 REVISION OF UTERUS 58540 5,563.00$

PROFESSIONAL 58545 LAPAROSCOPIC MYOMECTOMY 58545 2,956.00$

PROFESSIONAL 58550 LAPAROSCOPIC ASST VAGINAL HYSTERECTOMY 58550 4,609.00$

PROFESSIONAL 58552 LAP VAG HYST W REM TB/OVARY 58552 4,498.00$

PROFESSIONAL 58554 LAPARO-VAG HSYT W/T/O COMPL>250 GM 58554 3,573.00$

PROFESSIONAL 58555 HYSTEROSCOPY, DX, SEP PROC 58555 1,799.00$

PROFESSIONAL 58558 HYSTEROSCOPY, BIOPSY 58558 2,904.00$

PROFESSIONAL 58559 HYSTEROSCOPY, BIOPSY 58559 2,904.00$

PROFESSIONAL 58561 HYSTEROSCOPY; W REM LEIOMYOMATA 58561 3,153.00$

PROFESSIONAL 58563 HYSTEROSCOPY,SURG W/ENDOMETRIAL ABLAT 58563 3,409.00$

PROFESSIONAL 58565 HYSTEROSCOPY W FALLOPIAN IMPLANTS 58565 3,123.00$

PROFESSIONAL 58600 DIVISION OF FALLOPIAN TUBE 58600 2,899.00$

PROFESSIONAL 58605 DIVISION OF FALLOPIAN TUBE 58605 2,724.00$

PROFESSIONAL 58611 LIGATE OVIDUCT(S) ADD-ON 58611 1,657.00$

PROFESSIONAL 58615 OCCLUDE FALLOPIAN TUBE(S) 58615 2,606.00$

PROFESSIONAL 58660 LAPAROSCOPY, LYSIS 58660 4,323.00$

PROFESSIONAL 58661 LAPAROSCOPY, REMOVE ADNEXA 58661 5,430.00$

PROFESSIONAL 58662 LAPAROSCOPY, EXCISE LESIONS 58662 4,323.00$

PROFESSIONAL 58670 LAPAROSCOPY, TUBAL CAUTERY 58670 3,758.00$

PROFESSIONAL 58671 LAPAROSCOPY, TUBAL BLOCK 58671 3,758.00$

PROFESSIONAL 58673 LAPAROSCOPY, SALPINGOSTOMY 58673 4,759.00$

PROFESSIONAL 58679 EXPLORATORY LAPAROSCOPY 58679 3,411.00$

PROFESSIONAL 58700 REMOVAL OF FALLOPIAN TUBE 58700 3,772.00$

PROFESSIONAL 58720 SALPINGO-OOPHORECTOMY,comp/part, un/bi 58720 3,175.00$

PROFESSIONAL 58740 REVISE FALLOPIAN TUBE(S) 58740 4,111.00$

PROFESSIONAL 58750 REPAIR OVIDUCT 58750 7,836.00$

PROFESSIONAL 58752 REVISE OVARIAN TUBE(S) 58752 6,773.00$

PROFESSIONAL 58760 REMOVE TUBAL OBSTRUCTION 58760 7,008.00$

PROFESSIONAL 58770 CREATE NEW TUBAL OPENING 58770 6,441.00$

PROFESSIONAL 58800 DRAINAGE OF OVARIAN CYST(S) 58800 3,523.00$

PROFESSIONAL 58805 DRAINAGE OF OVARIAN CYST(S) 58805 2,440.00$

PROFESSIONAL 58820 DRAIN OVARY ABSCESS, OPEN 58820 2,639.00$

PROFESSIONAL 58822 DRAIN OVARY ABSCESS, PERCUT 58822 3,830.00$

PROFESSIONAL 58900 BIOPSY OF OVARY(S) 58900 3,657.00$

PROFESSIONAL 58920 PARTIAL REMOVAL OF OVARY(S) 58920 4,654.00$

PROFESSIONAL 58925 REMOVAL OF OVARIAN CYST(S) 58925 3,991.00$

PROFESSIONAL 58940 REMOVAL OF OVARY(S) 58940 4,192.00$

2020-01




PROFESSIONAL 58943 REMOVAL OF OVARY(S) 58943 7,068.00$

PROFESSIONAL 58950 RESECT OVARIAN MALIGNANCY 58950 5,798.00$

PROFESSIONAL 58952 RESECT OVARIAN MALIGNANCY 58952 14,055.00$

PROFESSIONAL 58953 BIL SALPINGO-OOPHORECTOMY W/OMENTECTOMY 58953 16,858.00$

PROFESSIONAL 58956 BIL SALPINGO-OOPHORECTOMY W/TOTAL OMENTE 58956 4,183.00$

PROFESSIONAL 58957 RESECT RECURRENT GYN MAL 58957 4,095.00$

PROFESSIONAL 58960 EXPLORATION OF ABDOMEN 58960 6,648.00$

PROFESSIONAL 59000 AMNIOCENTESIS 59000 486.00$

PROFESSIONAL 59020 FETAL CONTRACT STRESS TEST 59020 316.00$

PROFESSIONAL 59025 FETAL NON-STRESS TEST 59025 338.00$

PROFESSIONAL 59025-26 FETAL NON-STRESS TEST 59025-26 188.00$

PROFESSIONAL 59050 FETAL MONITOR W/REPORT 59050 450.00$

PROFESSIONAL 59100 REMOVE UTERUS LESION 59100 3,391.00$

PROFESSIONAL 59120 TREAT ECTOPIC PREGNANCY 59120 4,869.00$







PROFESSIONAL 59160 D & C AFTER DELIVERY 59160 1,582.00$

PROFESSIONAL 59200 INSERT CERVICAL DILATOR 59200 456.00$

PROFESSIONAL 59300 EPISIOTOMY OR VAGINAL REPAIR 59300 1,036.00$


PROFESSIONAL 59350 REPAIR OF UTERUS 59350 3,110.00$

PROFESSIONAL 59400 OBSTETRICAL CARE 59400 4,748.00$



PROFESSIONAL 59412 ANTEPARTUM MANIPULATION 59412 862.00$

PROFESSIONAL 59414 DELIVER PLACENTA 59414 720.00$

PROFESSIONAL 59510 CESAREAN DELIVERY 59510 5,661.00$

PROFESSIONAL 59514 CESAREAN DELIVERY ONLY 59514 4,616.00$

PROFESSIONAL 59515 CESAREAN DELIVERY 59515 4,626.00$

PROFESSIONAL 59525 REMOVE UTERUS AFTER CESAREAN 59525 2,631.00$

PROFESSIONAL 59610 VBAC DELIVERY 59610 5,450.00$

PROFESSIONAL 59614 VBAC CARE AFTER DELIVERY 59614 3,786.00$

PROFESSIONAL 59618 ATTEMPTED VBAC DELIVERY 59618 5,903.00$

PROFESSIONAL 59622 ATTEMPTED VBAC AFTER CARE 59622 3,748.00$

PROFESSIONAL 59812 TREATMENT OF MISCARRIAGE 59812 1,669.00$

PROFESSIONAL 59820 CARE OF MISCARRIAGE 59820 1,693.00$

PROFESSIONAL 59821 TREATMENT OF MISCARRIAGE 59821 1,922.00$

PROFESSIONAL 59840 INDUCED ABORTION BY DILATION CURETTAGE 59840 4,192.00$

PROFESSIONAL 59841 ABORTION BY DILATION & EVACUAT 59841 2,015.00$

PROFESSIONAL 59850 ABORTION BY AMNIO INJECTION(S) 59850 2,898.00$

PROFESSIONAL 59851 ABORTION BY AMNIO INJECTION(S) 59851 3,644.00$

PROFESSIONAL 59855 INDUCED ABOR BY VAGINAL SUPPOSITORIES 59855 2,103.00$

PROFESSIONAL 59856 INDUCED ABORTION W/DILATION & CURETTAGE 59856 2,272.00$

PROFESSIONAL 59870 EVACUATE MOLE OF UTERUS 59870 1,895.00$

PROFESSIONAL 59871 REMOVE CERCLAGE SUTURE UNDER ANESTH 59871 843.00$

PROFESSIONAL 99341 HOME VISIT, NEW PATIENT 99341 179.00$





PROFESSIONAL 99347 HOME VISIT, EST PATIENT 99347 145.00$

PROFESSIONAL 99348 HOME SERVICES EST PT EXPA 99348 179.00$



PROFESSIONAL 99374 HOME HEALTH CARE SUPERVISION 15-29 MINS 99374 220.00$

PROFESSIONAL 99375 HOME HEALTH CARE SUPERVISION 30 MIN + 99375 327.00$

PROFESSIONAL 99378 HOSPICE CARE SUPERVISION 99378 219.00$

PROFESSIONAL G0179 MEDICARE HOME HEALTH RECERTIFICATION G0179 138.00$

PROFESSIONAL G0180 MEDICARE HOME HEALTH CERTIFICATION G0180 162.00$

PROFESSIONAL G0181 HOME CARE SUPERVISION 30 MIN + G0181 244.00$

PROFESSIONAL G0182 HOSPICE CARE SUPERVISION 30 MIN + G0182 252.00$

PROFESSIONAL 13014 TELEMEDICINE - FACILITY FEE Q3014 74.00$

PROFESSIONAL 59425 ANTEPARTUM CARE ONLY 4-6 VISITS 59425 1,046.00$

PROFESSIONAL 59426 ANTEPARTUM CARE ONLY 7 OR MORE VISITS 59426 1,864.00$

2020-01




PROFESSIONAL 59430 CARE AFTER DELIVERY 59430 415.00$

PROFESSIONAL 95012 EXHALED NITRIC OXIDE MEAS 95012 37.00$

PROFESSIONAL 99201 OFFICE/OP VISIT,NEW L1 99201 136.00$





PROFESSIONAL 99211 OFFICE/OP VISIT,EST L1 99211 83.00$





PROFESSIONAL 99381 PREV VISIT, NEW, INFANT 99381 216.00$

PROFESSIONAL 99382 PREV VISIT, NEW, AGE 1-4 99382 238.00$





PROFESSIONAL 99387 PREV VISIT, NEW, 65 & OVER 99387 330.00$

PROFESSIONAL 99391 PREV VISIT, EST, INFANT 99391 172.00$

PROFESSIONAL 99392 PREV VISIT, EST, AGE 1-4 99392 198.00$





PROFESSIONAL 99397 PREV VISIT, EST, 65 & OVER 99397 278.00$

PROFESSIONAL 99401 PREVENTATIVE COUNSELING, INDIV 15 MIN 99401 87.00$



PROFESSIONAL 99412 PREVENTIVE COUNSELING, GROUP 60 MIN 99412 190.00$

PROFESSIONAL 99450 BASIC LIFE DISABILITY EXAM 99450 192.00$

PROFESSIONAL 99455 WORK RELATED OR DISABILITY EVALUATION 99455 202.00$

PROFESSIONAL 99456 DISABILITY EXAMINATION 99456 686.00$

PROFESSIONAL 99461 INIT NB EM PER DAY, NON-FAC 99461 199.00$

PROFESSIONAL 99471 PED CRITICAL CARE, INITIAL 99471 2,116.00$

PROFESSIONAL 99475 PED CRIT CARE AGE 2-5, INIT 99475 1,167.00$

PROFESSIONAL 99487 COMPLEX CCM 99487 101.00$

PROFESSIONAL 99489 COMPLEX CCM ADD ON 99489 71.00$

PROFESSIONAL 99490 CHRONIC CARE MANAGEMENT 20 MIN 99490 54.00$

PROFESSIONAL 99497 ADVNCD CARE PLAN 30 MIN 99497 291.00$

PROFESSIONAL 99498 ADVNCD CARE PLAN ADDL 30 MIN 99498 282.00$

PROFESSIONAL G0101 EXAM,BREAST AND PELVIC G0101 91.00$

PROFESSIONAL G0102 PROSTATE CA SCREENING; DIGITAL RECTAL EX G0102 63.00$

PROFESSIONAL G0296 VISIT TO DETERM LDCT ELIG G0296 65.00$

PROFESSIONAL G0402 INITIAL PREVENTIVE EXAM G0402 212.00$

PROFESSIONAL G0438 ANNUAL WELLNESS INIT VISIT G0438 220.00$

PROFESSIONAL G0439 ANNUAL WELLNESS SUBSQ VISIT G0439 139.00$

PROFESSIONAL G0444 SCREENING FOR DEPRESSION G0444 25.00$

PROFESSIONAL G0447 BEHAVIOR COUNSEL OBESITY 15M G0447 156.00$

PROFESSIONAL MROEXAM MRO EXAM 99499 153.00$

PROFESSIONAL PXADM-NH NURSING HOME PHYSICAL 99499 185.00$

PROFESSIONAL PXCDL CDL PHYSICAL 99499 90.00$

PROFESSIONAL PXEMPM PRE-EMPLOYMENT PHYSICAL - MODERATE 99499 125.00$

PROFESSIONAL PXEMPS PRE-EMPLOYMENT PHYSICAL - SIMP 99499 65.00$

PROFESSIONAL PXPP PUBLIC PASSENGER/CHAUFFEUR LICENSE PX 99499 41.00$

PROFESSIONAL PXSCHLCOM SCHL PHYSICAL - CMPLX 99499 30.00$

PROFESSIONAL PXSCHLSIM SCHL PHYSICAL-SMPLE 99499 30.00$

PROFESSIONAL PXSPRTCOM SPORTS PHYSICAL - COMPLEX 99499 30.00$

PROFESSIONAL PXSPRTSIM SPORTS PHYSICAL - SIMPLE 99499 30.00$

PROFESSIONAL PXWELL PHYSICAL - WELLNESS 99499 65.00$

PROFESSIONAL Q3014 TELEMEDICINE - FACILITY FEE Q3014 75.00$

PROFESSIONAL 74420 UROGRAPHY,RETROGRADE W/WO KUB 74420 532.50$

PROFESSIONAL 76536 US EXAM OF HEAD AND NECK 76536 228.00$

PROFESSIONAL 76705 ECHO EXAM OF ABDOMEN 76705-TC 266.00$

PROFESSIONAL 76770 ULTRASOUND, RENAL 76770 438.80$

PROFESSIONAL 76775 ECHO EXAM ABDOMEN BACK WALL 76775 207.00$

PROFESSIONAL 76801 ULTRASOUND 1ST TRIMESTER 1ST GESTATION 76801 409.95$

PROFESSIONAL 76802 ULTRASND,1ST TRI,EA ADD'L GESTATION 76802 229.70$

2020-01




PROFESSIONAL 76805 ECHO EXAM OF PREGNANT UTERUS 76805 529.40$


PROFESSIONAL 76811 ULTRASOUND,PREG UTERUS, REAL TIME W/IMAG 76811 338.85$


PROFESSIONAL 76816 ECHO EXAM FOLLOW-UP/REPEAT 76816 346.10$

PROFESSIONAL 76817 ULTRASOUND,PREGNANT UTERUS,TRANSVAGINAL 76817 375.95$

PROFESSIONAL 76818 FETAL BIOPHYSICAL PROF;W/NON STRESS TEST 76818 410.95$

PROFESSIONAL 76819 FETAL BIOPHYSICAL PROF;W/O NON STRESS TE 76819 455.25$

PROFESSIONAL 76830 ECHO EXAM, TRANSVAGINAL 76830 531.50$

PROFESSIONAL 76831 SALINE INFUSED SONOHYSTEROGRAPHY 76831 450.10$

PROFESSIONAL 76831-26 SALINE INFUSED SONOHYSTEROGRAPHY 76831-26 450.10$

PROFESSIONAL 76856 ECHO EXAM OF PELVIS 76856 478.95$

PROFESSIONAL 76857 ULTRASOUND, PELVIC/BLADDER LIMITED 76857 252.35$

PROFESSIONAL 76870 ULTRASOUND / SCROTUM AND CONTENTS 76870 712.75$

PROFESSIONAL 76872 ULTRASOUND, TRANSRECTAL (PROSTATE) 76872 771.45$

PROFESSIONAL 76881 US XTR NON-VASC COMPLETE 76881 240.00$

PROFESSIONAL 76882 US XTR NON VASC LMTD 76882 66.95$

PROFESSIONAL 76937 US GUIDE, VASCULAR ACCESS 76937 175.10$

PROFESSIONAL 76942 ULTRASOUND GUIDED NEEDLE PLACEMENT (PC) 76942 486.15$

PROFESSIONAL 77002 NEEDLE LOCALIZATION BY XRAY 77002 391.40$

PROFESSIONAL 10021-26 FNA BX W/O IMG GDN 1ST LES 10021 317.00$

PROFESSIONAL 10160-26 PUNCT ASP - ABSC,HEMAT,CYST (P/C) 10160 234.00$

PROFESSIONAL 19001-26 BREAST CYST ASPIRATION, EA ADD (P/C) 19001 125.00$

PROFESSIONAL 19120-2650 EXCISION BREAST LESION-BIL (P/C) 19120-50 2,987.00$

PROFESSIONAL 19120-26LT EXCISION BREAST LESION-LEFT (P/C) 19120-LT 1,494.00$

PROFESSIONAL 19120-26RT EXCISION BREAST LESION-RIGHT (P/C) 19120-RT 1,494.00$

PROFESSIONAL 20206-26 BX,MUSCLE,PERCUTANEOUS NEEDLE (P/C) 20206 456.00$

PROFESSIONAL 20220-26 BONE BIOPSY TROCAR/NEEDLE SPRFCL (PC) 20220 594.00$

PROFESSIONAL 20225-26 BONE BIOPSY TROCHAR/NEEDLE DEEP (PC) 20225 3,670.00$

PROFESSIONAL 21550-26 BIOPSY OF NECK/CHEST (P/C) 21550 666.00$

PROFESSIONAL 23350-2650 INJECT SHOULDER ARTHROGRAM-BIL (P/C) 23350-50 786.00$

PROFESSIONAL 23350-26LT INJECT SHOULDER ARTHROGRAM-LT (P/C) 23350-LT 393.00$

PROFESSIONAL 23350-26RT INJECT SHOULDER ARTHROGRAM-RT (P/C) 23350-RT 393.00$

PROFESSIONAL 27369-LT INJECTION KNEE ARTHROGRAM-LT (P/C) 27369-LT 267.00$

PROFESSIONAL 27369-RT INJECTION KNEE ARTHROGRAM-RT (P/C) 267.00$

PROFESSIONAL 32400-26 NEEDLE BIOPSY OF CHEST LINING (P/C) 32400 626.00$

PROFESSIONAL 32405-26 BX LUNG OR MEDIASTINIUM (P/C) 32405 1,141.00$

PROFESSIONAL 32554-26 THORACENTESIS FOR ASPIRATION (P/C) 32554 489.00$

PROFESSIONAL 36000-26 PLACE NEEDLE IN VEIN (P/C) 36000 152.00$

PROFESSIONAL 36005-26 INJECTION CONTRAST VENOGRAPHY (P/C) 36005 350.00$

PROFESSIONAL 36100-2650 ESTAB ACCESS TO CAROTID-BIL (P/C) 36100-50 2,201.00$

PROFESSIONAL 36100-26LT ESTAB ACCESS TO CAROTID-LEFT (P/C) 36100-LT 1,103.00$

PROFESSIONAL 36100-26RT ESTAB ACCESS TO CAROTID-RIGHT (P/C) 36100-RT 1,103.00$

PROFESSIONAL 36140-26 ESTABLISH ACCESS TO AORTA (P/C) 36140 900.00$

PROFESSIONAL 36245-26 CATH 1ST ORDER ABD/PELVIC/LE (P/C) 36245 1,488.00$

PROFESSIONAL 36568-26 PC-INSERT PICC CATH <5 YRS 36568-26 229.00$

PROFESSIONAL 36569-26 PC-INS PICC AGE 5 YRS/> 36569 423.00$

PROFESSIONAL 37191-26 PC-INS ENDOVAS VENA CAVA FILTR 37191-26 411.00$

PROFESSIONAL 37197-26 PC-REMOVE INTRVAS FOREIGN BODY 37197 713.00$

PROFESSIONAL 38220-26 BONE MARROW ASPIRATION (P/C) 38220 99.00$

PROFESSIONAL 38221-26 BONE MARROW BX,NEEDLE/TROCAR (P/C) 38221 649.00$

PROFESSIONAL 38222-26 DX BONE MARROW BX & ASPIR 38222 748.00$

PROFESSIONAL 38300-26 DRAINAGE,LYMPH NODE LESION (P/C) 38300 440.00$

PROFESSIONAL 38790-26 INJECTION FOR LYMPHANGIOGRAPHY (RAD P/C) 38790 824.00$

PROFESSIONAL 38999-26 PC-US GUIDED NEEDLE LOC AXILLA 38999-26 295.00$

PROFESSIONAL 42400-26 BIOPSY SALIVARY GLAND;NEEDLE (PC) 42400 351.00$

PROFESSIONAL 43752-26 NASAL/OROGASTRIC TUBE PLMT (RAD P/C) 43752 730.00$

PROFESSIONAL 43761-26 REPOSITION GASTROSTOMY TUBE (P/C) 43761 534.00$

PROFESSIONAL 47000-26 NEEDLE BIOPSY OF LIVER (P/C) 47000 705.00$

PROFESSIONAL 47490 PERCUTANEOUS CHOLECYSTOSTOMY 47490 1,462.00$

PROFESSIONAL 47531-26 T-TUBE CHOLANGIOGRAM POST-OP (P/C) 47531 130.00$

PROFESSIONAL 47532-26 PC-VENOGRAM EXTRIMITY;UNILATER 47532-26 105.00$

PROFESSIONAL 48102-26 NEEDLE BIOPSY PANCREAS (P/C) 48102 1,204.00$

PROFESSIONAL 49180-26 BIOPSY ABDOMINAL MASS (P/C) 49180 959.00$

PROFESSIONAL 49421-26 PC-INS TUN IP CATH FOR DIALOPN 49421-26 381.00$

PROFESSIONAL 49424-26 CONTRAST INJ ABSCESS/CYST ASSES (P/C) 49424 245.00$

PROFESSIONAL 49440-26 PLACE GASTROSTOMY TUBE PERC (P/C) 49440 2,169.00$

PROFESSIONAL 49441-26 PLACE DUOD/JEJ TUBE PERC (P/C) 49441 1,037.00$

2020-01




PROFESSIONAL 49450-26 REPLACE G/C TUBE PERC (P/C) 49450 2,870.00$

PROFESSIONAL 49451-26 REPLACE DUOD/JEJ TUBE PERC (P/C) 49451 403.00$

PROFESSIONAL 49465-26 EVALUATION OF D,G,or J TUBE- (P/C) 49465 138.00$

PROFESSIONAL 50200-26 RENAL BX;PERCUT;TROCAR/NEEDLE (P/C) 50200 935.00$

PROFESSIONAL 50389-26 NEPHROSTOMY TUBE REMOVAL (P/C) 50389-26 2,013.00$

PROFESSIONAL 50390-2650 DRAINAGE OF KIDNEY LESION-BIL (P/C) 50390-50 1,943.00$

PROFESSIONAL 50390-26LT DRAINAGE OF KIDNEY LESION-LT (P/C) 50390-LT 971.00$

PROFESSIONAL 50390-26RT DRAINAGE OF KIDNEY LESION-RT (P/C) 50390-RT 971.00$

PROFESSIONAL 50430-26 INJECTION FOR KIDNEY X-RAY 50340-26 379.00$

PROFESSIONAL 50431-26 NJX PX NFROSGRM &/URTRGRM 50431 209.00$

PROFESSIONAL 50432-26 PC-NEPHROSTOMY TUBE PLACEMENT 50432-26 600.00$

PROFESSIONAL 50435-26 PC-CHANGE NEPHROSTOMY TUBE 50435 2,160.00$

PROFESSIONAL 50684-2650 INJECTION URETER X-RAY-BIL (P/C) 50684-50 472.00$

PROFESSIONAL 50684-26LT INJECTION URETER X-RAY-LEFT (P/C) 50684-LT 238.00$

PROFESSIONAL 50684-26RT INJECTION URETER X-RAY-RIGHT (P/C) 50684-RT 238.00$

PROFESSIONAL 50690 INJECTION URETER ILEAL CONT (P/C) 50690 315.00$

PROFESSIONAL 51610-26 INJECTION FOR RETROGRADE CYSTO (P/C) 51610 300.00$

PROFESSIONAL 51798-26 US PV RESIDUAL URINE (P/C) 51798 101.00$

PROFESSIONAL 55700-26 PROSTATE NEEDLE PUNCH BX (P/C) 55700 647.00$

PROFESSIONAL 58340-26 CATH INTRO HYSTEROSONOGRAM (P/C) 58340 311.00$

PROFESSIONAL 60000-26 I&D THYROGLOSSAL DUCT CYST (PC) 60000 439.00$

PROFESSIONAL 60100-26 BIOPSY OF THYROID (P/C) 60100 512.00$

PROFESSIONAL 60300-26 ASPIR/INJ THYROID CYST (P/C) 60300 363.00$

PROFESSIONAL 70030-26 EYE DETECTION OF FOREIGN BODY (P/C) 70030-26 62.00$

PROFESSIONAL 70100-26 MANDIBLE PARTIAL < 4 VIEWS (P/C) 70100-26 67.00$

PROFESSIONAL 70110-26 MANDIBLE COMPLETE MIN 4 VIEWS (P/C) 70110-26 79.00$

PROFESSIONAL 70130-26 MASTOIDS COMP MIN 3 PER SIDE (P/C) 70130-26 55.00$

PROFESSIONAL 70140-26 FACIAL BONES < 3 VIEWS (P/C) 70140-26 55.00$

PROFESSIONAL 70150-26 FACIAL BONES COMP MIN 3 VIEWS (P/C) 70150-26 83.00$

PROFESSIONAL 70190-26 OPTICAL FORAMINA (P/C) 70190-26 55.00$

PROFESSIONAL 70200-26 ORBITS COMP MIN 4 VIEWS (P/C) 70200-26 75.00$

PROFESSIONAL 70210-26 PARANASAL SINUS < 3 VIEWS (P/C) 70210-26 62.00$

PROFESSIONAL 70220-26 PARANASAL SINUS MIN 3 VIEWS (P/C) 70220-26 84.00$

PROFESSIONAL 70240-26 SELLA TURCICA/PITUITARY (P/C) 70240-26 55.00$

PROFESSIONAL 70250-26 SKULL < 4 VIEWS (P/C) 70250-26 62.00$

PROFESSIONAL 70260-26 SKULL COMPLETE MIN 4 VIEWS (P/C) 70260-26 84.00$

PROFESSIONAL 70328-26 TM JOINTS UNILATERAL (P/C) 70328-26 79.00$

PROFESSIONAL 70330-26 TM JOINTS BILATERAL (P/C) 70330-26 84.00$

PROFESSIONAL 70332-26 TMJ ARTHROGRAM 70332-26 158.00$

PROFESSIONAL 70336-26 TMJ IMAGING (P/C) 70336-26 563.00$

PROFESSIONAL 70360-26 NECK SOFT TISSUE (P/C) 70360-26 55.00$

PROFESSIONAL 70371-26 MODIFIED BARIUM SWALLOW (P/C) 70371-26 208.00$

PROFESSIONAL 70450-26 HEAD OR BRAIN W/O CONTRAST (P/C) 70450-26 321.00$

PROFESSIONAL 70460-26 HEAD OR BRAIN W/CONTRAST (P/C) 70460-26 370.00$

PROFESSIONAL 70470-26 HEAD OR BRAIN WO/W CONTRAST (P/C) 70470-26 471.00$

PROFESSIONAL 70480-26 ORBITS W/O CONTRAST (P/C) 70480-26 321.00$

PROFESSIONAL 70480-26WO TEMPORAL BONES W/O CONTRAST 70480-26 321.00$

PROFESSIONAL 70481-26 ORBIT W/CONTRAST (P/C) 70481-26 370.00$

PROFESSIONAL 70482-26 ORBITS WO/W CONTRAST (P/C) 70482-26 461.00$

PROFESSIONAL 70482-26WW TEMPORAL BONES WO/W CONTRAST 70482-26 461.00$

PROFESSIONAL 70486-26 MAXILLOFACIAL W/O CONTRAST (P/C) 70486-26 337.00$

PROFESSIONAL 70487-26 MAXILLOFACIAL W/CONTRAST (P/C) 70487-26 370.00$

PROFESSIONAL 70488-26 MAXILLOFACIAL WO/W CONTRAST (P/C) 70488-26 466.00$

PROFESSIONAL 70490-26 SOFT TISSUE NECK W/O CONTRAST (P/C) 70490-26 344.00$

PROFESSIONAL 70491-26 SOFT TISSUE NECK W/CONTRAST (P/C) 70491-26 378.00$

PROFESSIONAL 70492-26 SOFT TISSUE NECK WO/W CONTRAST (P/C) 70492-26 508.00$

PROFESSIONAL 70496-26 CT ANGIOGRAPHY; HEAD (P/C) 70496-26 380.00$

PROFESSIONAL 70498-26 CT ANGIOGRAPHY; NECK (P/C) 70498-26 382.00$

PROFESSIONAL 70540-26 ORBIT, FACE, NECK (P/C) 70540-26 563.00$

PROFESSIONAL 70540-26OF ORBIT,FACE W/O CONTRAST (P/C) 70540-26 563.00$

PROFESSIONAL 70542-26 ORBIT,FACE W/CONT (P/C) 70542-26 671.00$

PROFESSIONAL 70543-26 ORBIT,FACE WO/W CONT W/ADD FLM (P/C) 70543-26 716.00$

PROFESSIONAL 70544-26 MRA HEAD W/O CONTRAST (P/C) 70544-26 759.00$

PROFESSIONAL 70545-26 MRA HEAD W/CONT (P/C) 70545-26 671.00$

PROFESSIONAL 70546-26 MRA HEAD WO/W CONT W/ADD FILMS (P/C) 70546-26 671.00$

PROFESSIONAL 70547-26 MRA NECK W/O CONT (P/C) 70547-26 671.00$

PROFESSIONAL 70548-26 MRA NECK W/CONT (P/C) 70548-26 671.00$

PROFESSIONAL 70549-26 MRA NECK WO/W CONT W/ADD FILMS (P/C) 70549-26 671.00$

2020-01




PROFESSIONAL 70551-26 BRAIN INC STEM W/O CONTRAST (P/C) 70551-26 674.00$

PROFESSIONAL 70552-26 BRAIN INC STEM W/CONTRAST (P/C) 70552-26 712.00$

PROFESSIONAL 70553-26 BRAIN INCL STEM WO/W CONTRAST (P/C) 70553-26 757.00$

PROFESSIONAL 71045-26 CHEST 1 VIEW 71045-26 79.00$

PROFESSIONAL 71046-26 X-RAY EXAM CHEST 2 VIEWS 71046-26 66.00$

PROFESSIONAL 71100-26 RIBS UNILATERAL 2 VIEWS (P/C) 71100-26 60.00$

PROFESSIONAL 71101-26 RIBS LT W/PA CHEST MIN 3 VIEWS (P/C) 71101-26 79.00$

PROFESSIONAL 71110-26 RIBS BILATERAL MIN 3 VIEWS (P/C) 71110-26 77.00$

PROFESSIONAL 71111-26 RIBS BILAT W/PA CHEST MIN 4 (P/C) 71111-26 91.00$

PROFESSIONAL 71120-26 STERNUM MIN 2 VIEWS (P/C) 71120-26 66.00$

PROFESSIONAL 71130-26 STERNOCLAVICULAR JOINT MIN 2 (P/C) 71130-26 66.00$

PROFESSIONAL 71250-26 CHEST/THORAX W/O CONTRAST (P/C) 71250-26 321.00$

PROFESSIONAL 71260-26 CHEST/THORAX W/CONTRAST (P/C) 71260-26 370.00$

PROFESSIONAL 71270-26 CHEST/THORAX WO/W CONTRAST (P/C) 71270-26 398.00$

PROFESSIONAL 71275-26 CT ANGIOGRAPHY; CHEST (P/C) 71275-26 426.00$

PROFESSIONAL 71550-26 CHEST W/O CONTRAST (P/C) 71550-26 712.00$

PROFESSIONAL 71551-26 CHEST W/CONTRAST 71551-26 712.00$

PROFESSIONAL 71552-26 CHEST WO/W CONT W/ADD FILMS (P/C) 71552-26 768.00$

PROFESSIONAL 71555-26 MRA CHEST WO/W CONTRAST (P/C) 71555-26 788.00$

PROFESSIONAL 72020-26 SPINE 1 VIEW ANY LEVEL (P/C) 72020-26 55.00$

PROFESSIONAL 72040-26 CERVICAL SPINE 2 OR 3 VIEWS (P/C) 72040-26 70.00$

PROFESSIONAL 72050-26 CERVICAL SPINE MIN 4 VIEWS (P/C) 72050-26 84.00$

PROFESSIONAL 72052-26 CERVICAL SPINE COMPLETE (P/C) 72052-26 109.00$

PROFESSIONAL 72070-26 THORACIC SPINE 2 VIEWS (P/C) 72070-26 66.00$

PROFESSIONAL 72072-26 THORACIC SPINE 3 VIEWS (P/C) 72072-26 73.00$

PROFESSIONAL 72080-26 THORACOLUMBAR 2 VIEWS (P/C) 72080-26 69.00$

PROFESSIONAL 72081-26 SCOLIOSIS SURVEY (P/C) 72081-26 35.00$

PROFESSIONAL 72082-26 ENTIRE SPINE SURVEY AP/LAT (P/C) 72082-26 127.00$

PROFESSIONAL 72100-26 LUMBOSACRAL 2 OR 3 VIEWS (P/C) 72100-26 67.00$

PROFESSIONAL 72110-26 X-RAY EXAM OF LOWER SPINE 4+ VIEWS 72110-26 91.00$

PROFESSIONAL 72114-26 LUMBAR COMPL,INCL BEND VIEW,MIN 6 (P/C) 72114-26 119.00$

PROFESSIONAL 72120-26 LUMBAR BENDING ONLY, 2 OR 3 VIEWS (P/C) 72120-26 67.00$

PROFESSIONAL 72125-26 CERVICAL SPINE W/O CONTRAST (P/C) 72125-26 321.00$

PROFESSIONAL 72126-26 CERVICAL SPINE W/CONTRAST (P/C) 72126-26 370.00$

PROFESSIONAL 72127-26 CERVICAL SPINE WO/W CONTRAST (P/C) 72127-26 398.00$

PROFESSIONAL 72128-26 THORACIC SPINE W/O CONTRAST (P/C) 72128-26 321.00$

PROFESSIONAL 72129-26 THORACIC SPINE W/CONTRAST (P/C) 72129-26 358.00$

PROFESSIONAL 72130-26 THORACIC SPINE WO/W CONTRAST (P/C) 72130-26 398.00$

PROFESSIONAL 72131-26 LUMBAR SPINE W/O CONTRAST (P/C) 72131-26 321.00$

PROFESSIONAL 72132-26 LUMBAR SPINE W/CONTRAST (P/C) 72132-26 358.00$

PROFESSIONAL 72133-26 LUMBAR SPINE WO/W CONTRAST (P/C) 72133-26 674.00$

PROFESSIONAL 72141-26 CERVICAL SPINE W/O CONTRAST (P/C) 72141-26 674.00$

PROFESSIONAL 72142-26 CERVICAL SPINE W/CONTRAST (P/C) 72142-26 701.00$

PROFESSIONAL 72146-26 THORACIC SPINE W/O CONTRAST (P/C) 72146-26 674.00$

PROFESSIONAL 72147-26 THORACIC SPINE W/CONT (P/C) 72147-26 764.00$

PROFESSIONAL 72148-26 LUMBAR SPINE W/O CONTRAST (P/C) 72148-26 674.00$

PROFESSIONAL 72149-26 LUMBAR SPINE W/CONT (P/C) 72149-26 724.00$

PROFESSIONAL 72156-26 CERVICAL SPINE WO/W CONTRAST (P/C) 72156-26 749.00$

PROFESSIONAL 72157-26 THORACIC SPINE WO/W CONTRAST (P/C) 72157-26 749.00$

PROFESSIONAL 72158-26 LUMBAR SPINE WO/W CONTRAST (P/C) 72158-26 749.00$

PROFESSIONAL 72170-26 PELVIS 1 OR 2 VIEWS (P/C) 72170-26 55.00$

PROFESSIONAL 72190-26 PELVIS COMPLETE MIN 3 VIEWS (P/C) 72190-26 76.00$

PROFESSIONAL 72191-26 CT ANGIOGRAPH PELV W/O&W/DYE 72191-26 400.00$

PROFESSIONAL 72192-26 PELVIS W/O CONTRAST (P/C) 72192-26 321.00$

PROFESSIONAL 72193-26 PELVIS W/CONTRAST (P/C) 72193-26 378.00$

PROFESSIONAL 72194-26 PELVIS WO/W CONTRAST (P/C) 72194-26 412.00$

PROFESSIONAL 72194-26WF PELVIS WO/W CONTRAST W/ADD FILMS (P/C) 72194-26 411.00$

PROFESSIONAL 72195-26 PELVIS W/O CONTRAST (P/C) 72195-26 712.00$

PROFESSIONAL 72196-26 PELVIS W/CONTRAST (P/C) 72196-26 712.00$

PROFESSIONAL 72197-26 PELVIS WO/W CONT W/ADD FILMS (P/C) 72197-26 626.00$

PROFESSIONAL 72198-26 MRA PELVIS WO/W CONT (P/C) 72198-26 634.00$

PROFESSIONAL 72200-26 SACROILIAC JOINTS <3 VIEWS (P/C) 72200-26 45.00$

PROFESSIONAL 72202-26 SACROILIAC JOINTS 3 OR MORE (P/C) 72202-26 66.00$

PROFESSIONAL 72220-26 SACRUM AND COCCYX MIN 2 VIEWS (P/C) 72220-26 62.00$

PROFESSIONAL 72265-26 LUMBAR MYELOGRAM (P/C) 72265-26 388.00$

PROFESSIONAL 73000-26LT CLAVICAL LEFT COMPLETE (P/C) 73000-26LT 50.00$

PROFESSIONAL 73000-26RT CLAVICAL RIGHT COMPLETE (P/C) 73000-26RT 50.00$

PROFESSIONAL 73010-26LT SCAPULA LEFT COMPLETE (P/C) 73010-26LT 59.00$

2020-01




PROFESSIONAL 73010-26RT SCAPULA RIGHT COMPLETE (P/C) 73010-26RT 59.00$

PROFESSIONAL 73020-26LT SHOULDER LEFT 1 VIEW (P/C) 73020-26LT 46.00$

PROFESSIONAL 73020-26RT SHOULDER RIGHT 1 VIEW (P/C) 73020-26RT 46.00$

PROFESSIONAL 73030-26LT SHOULDER COMP LT MIN 2 VIEWS (P/C) 73030-26LT 62.00$

PROFESSIONAL 73030-26RT SHOULDER COMP RT MIN 2 VIEWS (P/C) 73030-26RT 62.00$

PROFESSIONAL 73040-26LT SHOULDER LEFT ARTHROGRAM (P/C) 73040-26LT 304.00$

PROFESSIONAL 73040-26RT SHOULDER RIGHT ARTHROGRAM (P/C) 73040-26RT 304.00$

PROFESSIONAL 73050-26 AC JOINT BILATERAL (P/C) 73050-26 57.00$

PROFESSIONAL 73060-26LT HUMERUS LEFT MIN 2 VIEWS (P/C) 73060-26LT 55.00$

PROFESSIONAL 73060-26RT HUMERUS RIGHT MIN 2 VIEWS (P/C) 73060-26RT 55.00$

PROFESSIONAL 73070-26LT ELBOW LEFT 2 VIEWS (P/C) 73070-26LT 55.00$

PROFESSIONAL 73070-26RT ELBOW RIGHT 2 VIEWS (P/C) 73070-26RT 55.00$

PROFESSIONAL 73080-26LT ELBOW COMP LEFT MIN 3 VIEWS (P/C) 73080-26LT 67.00$

PROFESSIONAL 73080-26RT ELBOW COMP RIGHT MIN 3 VIEWS (P/C) 73080-26RT 67.00$

PROFESSIONAL 73090-26LT FOREARM LEFT 2 VIEWS (P/C) 73090-26LT 55.00$

PROFESSIONAL 73090-26RT FOREARM RIGHT 2 VIEWS (P/C) 73090-26RT 55.00$

PROFESSIONAL 73100-26LT WRIST LEFT 2 VIEWS (P/C) 73100-26LT 55.00$

PROFESSIONAL 73100-26RT WRIST RIGHT 2 VIEWS (P/C) 73100-26RT 55.00$

PROFESSIONAL 73110-26BC CARPAL SERIES, BILATERAL (P/C) 73110-2650 227.00$

PROFESSIONAL 73110-26LC CARPAL SERIES, LEFT (P/C) 73110-26LT 116.00$

PROFESSIONAL 73110-26LT WRIST LEFT MIN 3 VIEWS (P/C) 73110-26LT 67.00$

PROFESSIONAL 73110-26RC CARPAL SERIES, RIGHT (P/C) 73110-26RT 116.00$

PROFESSIONAL 73110-26RT WRIST RIGHT MIN 3 VIEWS (P/C) 73110-26RT 67.00$

PROFESSIONAL 73120-26LT HAND LEFT MIN 2 VIEWS (P/C) 73120-26LT 55.00$

PROFESSIONAL 73120-26RT HAND RIGHT MIN 2 VIEWS (P/C) 73120-26RT 55.00$

PROFESSIONAL 73130-26LT HAND LEFT MIN 3 VIEWS (P/C) 73130-26LT 67.00$

PROFESSIONAL 73130-26RT HAND RIGHT MIN 3 VIEWS (P/C) 73130-26RT 67.00$

PROFESSIONAL 73140-26LT X-RAY EXAM OF FINGER(S) 2+VIEWS LT (P/C) 73140-26LT 46.00$

PROFESSIONAL 73140-26RT X-RAY EXAM OF FINGER(S) 2+VIEWS RT (P/C) 73140-26RT 46.00$

PROFESSIONAL 73200-26LT UPPER EXTREMITY LEFT W/O CONT (P/C) 73200-26LT 321.00$

PROFESSIONAL 73200-26RT UPPER EXTREMITY RIGHT W/O CONT (P/C) 73200-26RT 321.00$

PROFESSIONAL 73201-26 CT; U EXTR W CONTRAST 73201-26 226.00$

PROFESSIONAL 73201-26LT UPPER EXT LEFT W/CONTRAST (P/C) 73201-26LT 358.00$

PROFESSIONAL 73201-26RT UPPER EXT RIGHT W/CONTRAST (P/C) 73201-26RT 358.00$

PROFESSIONAL 73202-26 CT: U EXTR W AND WO CONTRAST 73202-26 201.00$

PROFESSIONAL 73202-26LT UPPER EXT LEFT WO/W CONTRAST (P/C) 73202-26LT 398.00$

PROFESSIONAL 73202-26RT UPPER EXT RIGHT WO/W CONTRAST (P/C) 73202-26RT 398.00$

PROFESSIONAL 73206-26 CT ANGIO UPR EXTRM W/O&W/DYE (PC) 73206-26 400.00$

PROFESSIONAL 73218-26 BRACHIAL PLEXUS MRI W/O CONTRAST (P/C) 73218-26 229.00$

PROFESSIONAL 73218-26LT UPPER EXT LT NO JNT W/O CONT (P/C) 73218-26LT 574.00$

PROFESSIONAL 73218-26RT UPPER EXT RT NO JNT W/O CONT (P/C) 73218-26RT 574.00$

PROFESSIONAL 73219-26 BRACHIAL PLEXUS MRI W CONTRAST (P/C) 73219-26 273.00$

PROFESSIONAL 73219-26LT UPPER EXT LT NO JNT W/CONT (P/C) 73219-26LT 574.00$

PROFESSIONAL 73219-26RT UPPER EXT RT NO JNT W/CONT (P/C) 73219-26RT 574.00$

PROFESSIONAL 73220-26 BRACHIAL PLEXUS MRI W&WO CONTRAST (P/C) 73220-26 404.00$

PROFESSIONAL 73220-26LT UPPER EXT LT NO JNT WO/W CONTRAST (P/C) 73220-26LT 591.00$

PROFESSIONAL 73220-26RT UPPER EXT RT NO JNT WO/W CONTRAST (P/C) 73220-26RT 591.00$

PROFESSIONAL 73221-26LT UPPER EXT LT ANY JNT W/O CONTRAST (P/C) 73221-26LT 664.00$

PROFESSIONAL 73221-26RT UPPER EXT RT ANY JNT W/O CONTRAST (P/C) 73221-26RT 664.00$

PROFESSIONAL 73222-26LT UPPER EXT LT ANY JNT W/CONT (P/C) 73222-26LT 562.00$

PROFESSIONAL 73222-26RT UPPER EXT RT ANY JNT W/CONT (P/C) 73222-26RT 562.00$

PROFESSIONAL 73223-26LT UPPER EXT LT ANY JNT WO/W CONT (P/C) 73223-26LT 660.00$

PROFESSIONAL 73223-26RT UPPER EXT RT ANY JNT WO/W CONT (P/C) 73223-26RT 660.00$

PROFESSIONAL 73225-26 MRA UPPER EXTREMITY WO/W CONTRAST (P/C) 73225-26 589.00$

PROFESSIONAL 73501-26LT HIP LEFT VIEW W/PELV IF PERF (P/C) 73501-26LT 67.00$

PROFESSIONAL 73501-26RT HIP RIGHT VIEW W/PELV IF PERF (P/C) 73501-26RT 67.00$

PROFESSIONAL 73502-26 HIP LEFT 2-3 VIEWS W/PELV IF PERF (P/C) 73502-26 77.00$

PROFESSIONAL 73502-26LT HIP LEFT 2-3 VIEWS W/PELV IF PERF (P/C) 73502-26LT 77.00$

PROFESSIONAL 73502-26RT HIP RIGHT 2-3 VIEWS W/PELV IF PERF (P/C) 73502-26RT 77.00$

PROFESSIONAL 73521-26 PC-PC-HIP 2 VIEWS, W/PELV IF PERF 73521-26 66.00$

PROFESSIONAL 73522-26 PC-HIP BI3-4 VIEW PELV IF PERF 73522-26 74.00$

PROFESSIONAL 73523-26 X-RAY EXAM HIPS BI 5/> VIEWS (P/C) 73523-26 116.00$

PROFESSIONAL 73525-26 HIP ARTHROGRAM,RAD EXAM 73525-26 113.00$

PROFESSIONAL 73551-26 FEMUR 1 VIEW (P/C) 73551-26 31.00$

PROFESSIONAL 73551-26RT 1 VIEW FEMUR RIGHT 73551-26RT 175.00$

PROFESSIONAL 73552-26LT X-RAY EXAM OF LEFT FEMUR 2/> (P/C) 73552-26LT 59.00$

PROFESSIONAL 73552-26RT X-RAY EXAM OF RIGHT FEMUR 2/> (P/C) 73552-26RT 59.00$

PROFESSIONAL 73560-2650 KNEE BILATERAL 1 OR 2 VIEWS (P/C) 73560-2650 93.00$

2020-01




PROFESSIONAL 73560-26LT KNEE LEFT 1 OR 2 VIEWS (P/C) 73560-26LT 55.00$

PROFESSIONAL 73560-26RT KNEE RIGHT 1 OR 2 VIEWS (P/C) 73560-26RT 55.00$

PROFESSIONAL 73562-26LT KNEE LEFT 3 VIEWS (P/C) 73562-26LT 79.00$

PROFESSIONAL 73562-26RT KNEE RIGHT 3 VIEWS (P/C) 73562-26RT 79.00$

PROFESSIONAL 73564-26LT KNEE COMP LEFT 4 OR MORE VIEWS (P/C) 73564-26LT 99.00$

PROFESSIONAL 73564-26RT KNEE COMP RIGHT 4 OR MORE VIEWS (P/C) 73564-26RT 99.00$

PROFESSIONAL 73565-26 KNEES BILATERAL STANDING AP (P/C) 73565-26 73.00$

PROFESSIONAL 73565-TC KNEES BILATERAL STANDING AP 73565-TC 87.00$

PROFESSIONAL 73590-26LT TIBIA AND FIBULA 2 VIEW LEFT (P/C) 73590-26LT 57.00$

PROFESSIONAL 73590-26RT TIBIA AND FIBULA 2 VIEW RIGHT (P/C) 73590-26RT 57.00$

PROFESSIONAL 73600-26LT ANKLE LEFT 2 VIEWS (P/C) 73600-26LT 55.00$

PROFESSIONAL 73600-26RT ANKLE RIGHT 2 VIEWS (P/C) 73600-26RT 55.00$

PROFESSIONAL 73610-26LT ANKLE COMPLETE LT MIN 3 VIEWS (P/C) 73610-26LT 67.00$

PROFESSIONAL 73610-26RT ANKLE COMPLETE RT MIN 3 VIEWS (P/C) 73610-26RT 67.00$

PROFESSIONAL 73620-26LT FOOT LEFT 2 VIEWS (P/C) 73620-26LT 55.00$

PROFESSIONAL 73620-26RT FOOT RIGHT 2 VIEWS (P/C) 73620-26RT 55.00$

PROFESSIONAL 73630-26LT FOOT COMPLETE LEFT MIN 3 VIEWS (P/C) 73630-26LT 67.00$

PROFESSIONAL 73630-26RT FOOT COMPLETE RIGHT MIN 3 VIEW (P/C) 73630-26RT 67.00$

PROFESSIONAL 73650-26LT OS CALCIS LEFT MIN 2 VIEWS (P/C) 73650-26LT 55.00$

PROFESSIONAL 73650-26RT OS CALCIS RIGHT MIN 2 VIEWS (P/C) 73650-26RT 55.00$

PROFESSIONAL 73660-26LT X-RAY EXAM OF TOE(S) 2+VIEWS LT (P/C) 73660-26LT 46.00$

PROFESSIONAL 73660-26RT X-RAY EXAM OF TOE(S) 2+VIEWS RT (P/C) 73660-26RT 46.00$

PROFESSIONAL 73700-26LT LOWER EXT LEFT W/O CONTRAST (P/C) 73700-26LT 347.00$

PROFESSIONAL 73700-26RT LOWER EXT RIGHT W/O CONTRAST (P/C) 73700-26RT 347.00$

PROFESSIONAL 73701-26LT LOWER EXT LEFT W/CONTRAST (P/C) 73701-26LT 358.00$

PROFESSIONAL 73701-26RT LOWER EXT RIGHT W/CONTRAST (P/C) 73701-26RT 358.00$

PROFESSIONAL 73702-26LT LOWER EXT LEFT WO/W CONTRAST (P/C) 73702-26LT 398.00$

PROFESSIONAL 73702-26RT LOWER EXT RIGHT WO/W CONTRAST (P/C) 73702-26RT 398.00$

PROFESSIONAL 73706-26 CT ANGIO LWR EXTR W/O&W/DYE (PC) 73706-26 424.00$

PROFESSIONAL 73718-26LT LOWER EXT LT NO JNT W/O CONT (P/C) 73718-26LT 563.00$

PROFESSIONAL 73718-26RT LOWER EXT RT NO JNT W/O CONT (P/C) 73718-26RT 563.00$

PROFESSIONAL 73719-26LT LOWER EXT LT NO JNT W/CONT (P/C) 73719-26LT 563.00$

PROFESSIONAL 73719-26RT LOWER EXT RT NO JNT W/CONT (P/C) 73719-26RT 563.00$

PROFESSIONAL 73720-26LT LOWER EXT LT NO JNT WO/W CONTRAST (P/C) 73720-26LT 598.00$

PROFESSIONAL 73720-26RT LOWER EXT RT NO JNT WO/W CONTRAST (P/C) 73720-26RT 598.00$

PROFESSIONAL 73721-26LT LOWER EXT LT ANY JNT W/O CONTRAST (P/C) 73721-26LT 664.00$

PROFESSIONAL 73721-26RT LOWER EXT RT ANY JNT W/O CONTRAST (P/C) 73721-26RT 664.00$

PROFESSIONAL 73722-26LT LOWER EXT LT ANY JNT W/CONT (P/C) 73722-26LT 549.00$

PROFESSIONAL 73722-26RT LOWER EXT RT ANY JNT W/CONT (P/C) 73722-26RT 549.00$

PROFESSIONAL 73723-26LT LOWER EXT LT ANY JNT WO/W CONT (P/C) 73723-26LT 690.00$

PROFESSIONAL 73723-26RT LOWER EXT RT ANY JNT WO/W CONT (P/C) 73723-26RT 690.00$

PROFESSIONAL 73725-26 MRA LOWER EXTREMITY WO/W CONTRAST (P/C) 73725-26 574.00$

PROFESSIONAL 74018-26 ABDOMEN 1 VIEW 74018-26 55.00$

PROFESSIONAL 74019-26 ABDOMEN 2 VIEWS 74019-26 101.00$

PROFESSIONAL 74021-26 ABDOMEN 3 OR MORE VIEWS (P/C) 74021-26 85.00$

PROFESSIONAL 74022-26 ACUTE ABD SERIES W/CHEST XRAY (P/C) 74022-26 127.00$

PROFESSIONAL 74150-26 CT ABDOMEN W/O CONTRAST (P/C) 74150-26 321.00$

PROFESSIONAL 74160-26 CT ABDOMEN W/CONTRAST (P/C) 74160-26 370.00$

PROFESSIONAL 74170-26 ABDOMEN WO/W CONTRAST (P/C) 74170-26 398.00$

PROFESSIONAL 74174-26 CT ANGIO ABD&PELV W/O & W/DYE 74174-26 404.00$

PROFESSIONAL 74175-26 CT ANGIOGRAPHY; ABDOMEN (P/C) 74175-26 421.00$

PROFESSIONAL 74176-26 CT ABDOMEN & PELVIS W/O CONTRAST (PC) 74176-26 490.00$

PROFESSIONAL 74177-26 CT ABDOMEN & PELVIS W/CONTRAST (PC) 74177-26 445.00$

PROFESSIONAL 74178-26 CT ABDOMEN & PELVIS WO/W CONTRACT (PC) 74178-26 424.00$

PROFESSIONAL 74181-26 MRI ABDOMEN W/O CONTRAST (P/C) 74181-26 712.00$

PROFESSIONAL 74182-26 MRI ABDOMEN W/CONTRAST (P/C) 74182-26 712.00$

PROFESSIONAL 74183-26 ABDOMEN WO/W CONT W/ADD FILMS (P/C) 74183-26 679.00$

PROFESSIONAL 74185-26 MRA ABDOMEN WO/W CONTRAST (P/C) 74185-26 598.00$

PROFESSIONAL 74220-26 ESOPHAGUS (P/C) 74220-26 119.00$

PROFESSIONAL 74230-26 SWALLOW FUNCTION w/cine,videoradiography 74230-26 104.00$

PROFESSIONAL 74240-26 UPPER GI 74240-26 147.00$

PROFESSIONAL 74245-26 UGI W SM BOWEL (P/C) 74245-26 180.00$

PROFESSIONAL 74246-26 UPPER GI W/O KUB (P/C) 74246-26 152.00$

PROFESSIONAL 74247-26 UPPER GI W/KUB W/AIR (P/C) 74247-26 144.00$

PROFESSIONAL 74249-26 UGI w/SMALL BOWEL w/AIR (P/C) 74249-26 258.00$

PROFESSIONAL 74250-26 SMALL BOWEL (P/C) 74250-26 119.00$

PROFESSIONAL 74251-26 SMALL BOWEL/GI TUBE (P/C) 74251-26 464.00$

PROFESSIONAL 74270-26 BARIUM ENEMA/COLON (P/C) 74270-26 178.00$

2020-01




PROFESSIONAL 74280-26 BARIUM ENEMA/AIR CONTR COLON (P/C) 74280-26 231.00$

PROFESSIONAL 74290-26 GALLBLADDER CHOLECYSTOGRAM (P/C) 74290-26 79.00$

PROFESSIONAL 74300-26 GALLBLADDER OPERATIVE (P/C) 74300-26 101.00$

PROFESSIONAL 74301-26 GALLBLADDER OPERATE ADDT'L SET (P/C) 74301-26 67.00$

PROFESSIONAL 74330-26 ERCP (P/C) 74330-26 258.00$

PROFESSIONAL 74360-26 DILATE FOR STRICTURE/OBSTR (P/C) 74360-26 126.00$

PROFESSIONAL 74410-26 IVP (P/C) 74410-26 144.00$

PROFESSIONAL 74415-26 IVP WITH TOMOGRAMS (P/C) 74415-26 148.00$

PROFESSIONAL 74420-26 RETROGRADE PYELOGRAM (P/C) 74420-26 123.00$

PROFESSIONAL 74425-26 CONTRST X-RAY, URINARY TRACT 74425-26 83.00$

PROFESSIONAL 74430-26 CONTRAST X-RAY, BLADDER 74430-26 77.00$

PROFESSIONAL 74450-26 URETHROGRAM, RETROGRADE (P/C) 74450-26 105.00$

PROFESSIONAL 74455-26 VOIDING CYSTOGRAM (P/C) 74455-26 127.00$

PROFESSIONAL 74470-26 RENAL CYST STUDY (P/C) 74470-26 235.00$

PROFESSIONAL 74710-26 PELVIMETRY (P/C) 74710-26 137.00$

PROFESSIONAL 74740-26 HYSTEROSALPINGOGRAM (P/C) 74740-26 119.00$

PROFESSIONAL 75571-26 CT HRT W/O DYE W/CA TEST (P/C) 75571-26 288.00$

PROFESSIONAL 75600-26 ARTERIOGRAM THORACIC AORTA (P/C) 75600-26 158.00$

PROFESSIONAL 75625-26 AORTOGRAM ABD W/RUNOFF-PANEL (P/C) 75625-26 649.00$

PROFESSIONAL 75630-26 ARTERIOGRAM FEMORAL W/RUNOFF (P/C) 75630-26 492.00$

PROFESSIONAL 75635-26 CT ANGIO ABDOMINAL ARTERIES w/RUNOFF(PC) 75635-26 537.00$

PROFESSIONAL 75710-26 ANGIOGRAM EXTREMITY (P/C) 75710-26 520.00$

PROFESSIONAL 75726-26 ABDOMINAL AORTA & VISCERAL (P/C) 75726-26 649.00$

PROFESSIONAL 75774-26 ARTERIOGRAM ADDITIONAL VESSEL (P/C) 75774-26 176.00$

PROFESSIONAL 75809-26 SHUNTOGRAM FOR NV SHUNT (PC) 75809-26 61.00$

PROFESSIONAL 75820-26LT VENOGRAM EXTREMITY LEFT (P/C) 75820-26LT 325.00$

PROFESSIONAL 75820-26RT VENOGRAM EXTREMITY RIGHT (P/C) 75820-26RT 325.00$

PROFESSIONAL 75822-26 VENOGRAM EXTREMITY BILATERAL (P/C) 75822-26 558.00$

PROFESSIONAL 75831-26 PC-UNIL SELCTV RENAL VENOGRAM 75831-26 190.00$

PROFESSIONAL 75840-26 PC-UNIL SELCTV ADRENAL VENOGRA 75840-26 190.00$

PROFESSIONAL 75889-26 PC-HEPATIC VENOGRAM W HDM 75889-26 190.00$

PROFESSIONAL 75893-26 RENAL VEIN RENIN (P/C) 75893-26 204.00$

PROFESSIONAL 75984-26 CHANGE TUBE W/RAD SUPERVISION (P/C) 75984-26 209.00$

PROFESSIONAL 75989-26 RAD.GUIDANCE/PERCUTANEOUS DRAINAGE ABCS 75989-26 203.00$

PROFESSIONAL 76000-26 FLUOROSCOPY UP TO 1 HR-RADIOLOGIST (P/C) 76000-26 116.00$

PROFESSIONAL 76080-26 FISTULA (P/C) 76080-26 158.00$

PROFESSIONAL 76098-26 DIAGNOSTIC SPECIMEN (P/C) 76098-26 83.00$

PROFESSIONAL 76100-26 TOMOGRAPHY SINGLE PLANE SECT (P/C) 76100-26 184.00$

PROFESSIONAL 76376-26 3D NOT REQUIRING IMAGE 76376-26 82.00$

PROFESSIONAL 76377-26 3D REQUIRING IMAGING 76377-26 299.00$

PROFESSIONAL 76380-26 CT LIMITED (PC) 76380-26 359.00$

PROFESSIONAL 76498-26 MRV - HEAD W/O CONTRAST UNLISTED MRI 76498-26 759.00$

PROFESSIONAL 76506-26 HEAD SONOGRAM (P/C) 76506-26 286.00$

PROFESSIONAL 76536-26 US HEAD/NECK SOFT TISSUE (P/C) 76536-26 237.00$

PROFESSIONAL 76604-26 US EXAM CHEST 76604-26 69.00$

PROFESSIONAL 76604-TC US EXAM CHEST 76604 683.00$

PROFESSIONAL 76641-26 BREAST SONOGRAM COMPLETE (P/C) 76641-26 60.00$

PROFESSIONAL 76642-26 ULTRASOUND BREAST LIMITED (P/C) 76642-26 54.00$

PROFESSIONAL 76700-26 ABDOMEN SONOGRAM COMPLETE (P/C) 76700-26 351.00$

PROFESSIONAL 76705-26 ABDOMEN SONOGRAM LTD <6 ORGANS (P/C) 76705-26 220.00$

PROFESSIONAL 76706-26 ULTRASOUND EXAM AAA SCREEN (P/C) 76706-26 126.00$

PROFESSIONAL 76770-26 KIDNEY SONOGRAM COMPLETE (P/C) 76770-26 351.00$

PROFESSIONAL 76775-26 ULTRASOUND RETROPERITONEAL LIMITED (P/C) 76775-26 237.00$

PROFESSIONAL 76800-26 SPINAL ULTRASOUND (PC) 76800-26 254.00$

PROFESSIONAL 76801-26 OB ULTRASOUND < 14WKS SINGLE FETUS (P/C) 76801-26 202.00$

PROFESSIONAL 76802-26 OB US < 14WKS, ADDL FETUS (P/C) 76802-26 125.00$

PROFESSIONAL 76805-26 OB COMPLETE (P/C) 76805-26 237.00$

PROFESSIONAL 76810-26 OB COMPLETE MULT GESTATION (P/C) 76810-26 351.00$

PROFESSIONAL 76815-26 OB ULTRASOUND LIMITED (P/C) 76815-26 87.00$

PROFESSIONAL 76816-26 OB US FOLLOW-UP PER FETUS (P/C) 76816-26 237.00$

PROFESSIONAL 76817-26 PREGNANT UTERUS TRANSVAG U/S 76817-26 210.00$

PROFESSIONAL 76826-26 FETAL GROWTH SERIES (P/C) 76826-26 303.00$

PROFESSIONAL 76830-26 TRANSVAGINAL SONOGRAM (P/C) 76830-26 214.00$

PROFESSIONAL 76856-26 PELVIC COMPLETE SONOGRAM 76856-26 237.00$

PROFESSIONAL 76857-26 BLADDER US (PELVIC US LIMITED) (P/C) 76857-26 173.00$

PROFESSIONAL 76857-26P PELVIC LIMITED SONOGRAM (P/C) 76857-26 173.00$

PROFESSIONAL 76870-26 TESTICULAR SONOGRAM (P/C) 76870-26 209.00$

PROFESSIONAL 76872-26 TRANSRECTAL PROSTATE SONOGRAM (P/C) 76872-26 286.00$

2020-01




PROFESSIONAL 76881-26 US EXTREMETY NON VASC COMPLETE 76881-26 295.00$

PROFESSIONAL 76882-26 US EXTREMETY NON VASC LIMITED 76882-26 205.00$

PROFESSIONAL 76885-26 INFANT HIPS SONOGRAM (P/C) 76885-26 209.00$

PROFESSIONAL 76886-26 INFANT HIPS SONOGRAM (P/C) 76886-26 185.00$

PROFESSIONAL 76937-26 PC-US GUIDANCE FOR VEIN 76937-26 45.00$

PROFESSIONAL 76942-26 ULTRASOUND GUIDED NEEDLE PLACEMENT (PC) 76942-26 220.00$

PROFESSIONAL 76946-26 US GUIDED AMNIOCENTESIS 76946-26 123.00$

PROFESSIONAL 76946-26S US GUIDANCE;AMNIOCENTESIS IMGING S&I 76946-26 123.00$

PROFESSIONAL 76998-26 US GUIDE, INTRAOP 76998-26 315.00$

PROFESSIONAL 76998-26S US GUIDE, INTRAOP 76998-26 315.00$

PROFESSIONAL 76999-26 UNLISTED ULTRASOUND 76999-26 222.00$

PROFESSIONAL 77001-26 PC-FLOURO GUIDANCE 77001-26 78.00$

PROFESSIONAL 77002-26 NEEDLE LOCALIZATION BY XRAY 77002-26 171.00$

PROFESSIONAL 77003-26 FLUOROGUIDE FOR SPINE INJECT 77003-26 191.00$

PROFESSIONAL 77012-26 CT SCAN FOR NEEDLE BIOPSY (PC) 77012-26 235.00$

PROFESSIONAL 77061-26 TOMOSYNTHESIS DIAG BREAST UNI (PC) 77061-26 54.00$

PROFESSIONAL 77062-26 TOMOSYNTH DIAG BREAST BI (P/C) 77062-26 54.00$

PROFESSIONAL 77063-26 TOMOSYNTH BREAST BI SCREEN 77063-26 54.00$

PROFESSIONAL 77065-26 MAMMO DIAGNOSTIC UNIL 77065-26 174.00$

PROFESSIONAL 77065-26GG MAMMO DIAGNOSTIC UNIL 77065-26GG 174.00$

PROFESSIONAL 77066-26 DX MAMMO INCL CAD BI 77066-26 200.00$

PROFESSIONAL 77067-26 MAMMO DIGITAL SCREEN - BILATERAL 77067-26 174.00$

PROFESSIONAL 77071 X-RAY STRESS VIEW 77071 111.00$

PROFESSIONAL 77072-26 X-RAYS FOR BONE AGE 77072-26 59.00$

PROFESSIONAL 77073-26 X-RAYS, BONE LENGTH STUDIES 77073-26 78.00$

PROFESSIONAL 77074-26 X-RAYS, BONE SURVEY, LIMITED 77074-26 194.00$

PROFESSIONAL 77075-26 X-RAYS, BONE SURVEY COMPLETE 77075-26 192.00$

PROFESSIONAL 77076-26 X-RAYS, BONE SURVEY, INFANT 77076-26 94.00$

PROFESSIONAL 77077-26 PC-JOINT SURVEY SINGLE 2+VIEWS 77077-26 57.00$

PROFESSIONAL 77080-26 BONE DENSITY, AXIAL (DXA) (PC) 77080-26 91.00$

PROFESSIONAL 77085-26 HIP SPINE PELV W/VERT FX ASSES 77085-26 67.00$

PROFESSIONAL 77261 CLINICAL TX PLAN: SIMPLE (P/C-RAD) 77261 644.00$

PROFESSIONAL 77262 CLINICAL TX PLAN:INTERMEDIATE (PC-RAD) 77262 909.00$

PROFESSIONAL 77263 CLINICAL TX PLAN:COMPLEX (P/C-RAD) 77263 1,203.00$

PROFESSIONAL 77280-26 SIMULATION:SIMPLE (P/C-RADIATION) 77280-26 273.00$

PROFESSIONAL 77285-26 SIMULATION:INTERMEDIATE (P/C-RADIATION) 77285-26 420.00$

PROFESSIONAL 77290-26 SIMULATION:COMPLEX (P/C-RADIATION) 77290-26 553.00$

PROFESSIONAL 77295-26 3-D SIMULATION (P/C RADIATION ONCOLOGY) 77295-26 1,456.00$

PROFESSIONAL 77300-26 RTX DOSIMETRY CALCULATE BASIC (P/C-RAD) 77300-26 311.00$

PROFESSIONAL 77301-26 IMRT/CONFORMAL RTH PLAN (P/C-RAD ONC) 77301-26 1,870.00$

PROFESSIONAL 77307-26 ISODOSE PLAN:COMPLEX (P/C-RADIATION) 77307-26 372.00$

PROFESSIONAL 77331-26 MICRO/DOSIMETRY (e.g TLD) (P/C-RADIATIO) 77331-26 364.00$

PROFESSIONAL 77332-26 TREATMENT DEVICE:SIMPLE (P/C-RADIATION) 77332-26 297.00$

PROFESSIONAL 77333-26 TREATMENT DEVICE:INTERMEDIATE (P/C-RAD) 77333-26 410.00$

PROFESSIONAL 77334-26 TREATMENT DEVICE:COMPLEX (P/C-RADIATION) 77334-26 593.00$

PROFESSIONAL 77387-26 CT GUIDANCE-IGRT 77387-26 179.00$

PROFESSIONAL 77427 RADIATION TX MGMT:TX'S (P/C-RAD) 77427 1,643.00$

PROFESSIONAL 77431 RADIATION TX MGMT: 1 FRACTION 77431 475.00$

PROFESSIONAL 77435 SBRT MANAGEMENT =< 5 FRACTIONS 77435 2,031.00$

PROFESSIONAL 77470-26 SPECIAL TREATMENT PROCEDURE (P/C-RAD) 77470-26 530.00$

PROFESSIONAL 78012-26 THYROID IMAGING W/UPTAKE-SINGLE (P/C) 78012-26 176.00$

PROFESSIONAL 78014-26 THYROID IMAGING W/BLOOD FLOW 78014-26 557.00$

PROFESSIONAL 78018-26 I-131 WHOLE BODY (P/C) 78018-26 260.00$

PROFESSIONAL 78070-26 PARATHYROID IMAGING 78070-26 479.00$

PROFESSIONAL 78195-26 SENTINEL NODE WITH IMAGES (P/C) 78195-26 280.00$

PROFESSIONAL 78205-26 LIVER SPECT (RAD P/C) 78205-26 335.00$

PROFESSIONAL 78215-26 LIVER & SPLEEN IMAGING (P/C) 78215-26 163.00$

PROFESSIONAL 78216-26 LIVER/SPLEEN SCAN WITH FLOW (P/C) 78216-26 174.00$

PROFESSIONAL 78226-26 HIDA (P/C) 78226-26 755.00$

PROFESSIONAL 78227-26 HIDA SCAN WITH CCK (P/C) 78227-26 1,031.00$

PROFESSIONAL 78264-26 GASTRIC EMPTYING (P/C) 78264-26 644.00$

PROFESSIONAL 78278-26 GI BLEED (P/C) 78278-26 250.00$

PROFESSIONAL 78290-26 BOWEL IMAGING-MECKELS LOCALIZ (P/C) 78290-26 231.00$

PROFESSIONAL 78300-26 BONE SCAN LIMITED AREA (P/C) 78300-26 194.00$

PROFESSIONAL 78305-26 BONE SCAN MULTIPLE AREAS (P/C) 78305-26 181.00$

PROFESSIONAL 78306-26 BONE SCAN WHOLE BODY (P/C) 78306-26 285.00$

PROFESSIONAL 78315-26 BONE SCAN WITH FLOW (P/C) 78315-26 766.00$

PROFESSIONAL 78320-26 BONE SPECT (P/C) 78320-26 309.00$

2020-01




PROFESSIONAL 78451-26 HT MUSCLE IMAGE SPECT, SINGLE (P/C) 78451-26 572.00$

PROFESSIONAL 78452-26 HT MUSCLE IMAGE SPECT, MULT (P/C) 78452-26 600.00$

PROFESSIONAL 78457-26 PC-PLACE CATH SUBCLAVIAN ART 78457-26 79.00$

PROFESSIONAL 78472-26 CARDIAC BLOOD POOL IMAGING SNG (P/C) 78472-26 243.00$

PROFESSIONAL 78473-26 CARDIAC BLOOD POOL IMAGNG MULT (P/C) 78473-26 354.00$

PROFESSIONAL 78494-26 EJECTION FRACTION W/WALL MOTION (P/C) 78494-26 448.00$

PROFESSIONAL 78579 LUNG VENTILATION IMAGING 78579 198.00$

PROFESSIONAL 78579-26 LUNG VENTILATION IMAGING (P/C) 78579-26 167.00$

PROFESSIONAL 78580-26 PULMONARY PERFUSION IMAGING (P/C) 78580-26 553.00$

PROFESSIONAL 78607-26 BRAIN IMAGING 78607-26 127.00$

PROFESSIONAL 78608-26 BRAIN PET; METABOLIC EVAL PI (P/C) 78608-26PI 329.00$

PROFESSIONAL 78608-26PS BRAIN PET; METABOLIC EVAL PS (P/C) 78608-26PS 329.00$

PROFESSIONAL 78701-26 KIDNEY IMAGING MORPHOLOGY (P/C) 78701-26 116.00$

PROFESSIONAL 78707-26 KIDNEY IMAGING W/VASCULAR FLOW (P/C) 78707-26 345.00$

PROFESSIONAL 78708-26 KIDNEY IMAGING W/PHARM INTERVE (P/C) 78708-26 321.00$

PROFESSIONAL 78709-26 KIDNEY SCAN MULTIPLE WO/W (P/C) 78709-26 298.00$

PROFESSIONAL 78740-26 CYSTOGRAM-VOIDING (P/C) 78740-26 243.00$

PROFESSIONAL 78761-26 TESTICULAR SCAN W/VASCULAR FLOW (P/C) 78761-26 163.00$

PROFESSIONAL 78802-26 TUMOR LOCALIZATION WHOLE BODY (P/C) 78802-26 243.00$

PROFESSIONAL 78804-26 TUMOR LOCALIZATION WHOLE BODY 78804-26 311.00$

PROFESSIONAL 78806-26 LOCALIZ OF ABSCESS WHOLE BODY (P/C) 78806-26 287.00$

PROFESSIONAL 78808-26 INJ RADIPHARM DRUG DX STUDY (P/C) 78808-26 63.00$

PROFESSIONAL 78814-26 PET IMAGE W/CT, LMTD PI (P/C) 78814-26PI 471.00$

PROFESSIONAL 78814-26PS PET IMAGE W/CT, LMTD PS (P/C) 78814-26PS 471.00$

PROFESSIONAL 78815-26 PET IMAGE W/CT, SKULL-THIGH PI (P/C) 78815-26PI 521.00$

PROFESSIONAL 78815-26PS PET IMAGE W/CT, SKULL-THIGH PS (P/C) 78815-26PS 521.00$

PROFESSIONAL 78816-26 PET IMAGE W/CT, FULL BODY PI (P/C) 78816-26PI 536.00$

PROFESSIONAL 78816-26PS PET IMAGE W/CT, FULL BODY PS (P/C) 78816-26PS 536.00$

PROFESSIONAL 79005-26 THYROID THERAPY I-131 (P/C) 79005-26 510.00$

PROFESSIONAL 93888-26 LTD DOPPLER INTRACRANAL ARTERY (P/C) 93888-26 197.00$

PROFESSIONAL 93975-26 DUPLEX RENAL ULTRASOUND (P/C) 93975-26 158.00$

PROFESSIONAL 93976-26 DUPLEX ARTERIAL FLOW; LIMITED 93976-26 134.00$

PROFESSIONAL 95956-26 CEREBR SEIZURE EEG EA 24 HRS (P/C) 95956-26 2,590.00$

PROFESSIONAL G0279-26 TOMOSYNTHESIS DIAG BREAST UNI (PC) G0279-26 54.00$

PROFESSIONAL G0297-26 LDCT FOR LUNG CANCER SCREEN G0297-26 56.00$

PROFESSIONAL GO2022652R MAMMO DIGITAL SCREEN - UNIL RT (P/C) G02022652RT 104.00$

PROFESSIONAL 75989-26S RAD.GUIDANCE/PERCUTANEOUS DRAINAGE ABCS 75989-26 184.00$

PROFESSIONAL 76000-26S FLUOROSCOPY UP TO 1 HR (SURGEON) (P/C) 76000-26 151.00$

PROFESSIONAL 76815-26S OB US, LIMITED STUDY (SURGEON) (PC) 76815-26 125.00$

PROFESSIONAL 76818-26S FBP W NON-STRESS TEST (I&R by OB/GYN) 76818-26 177.00$

PROFESSIONAL 76872-26S TRANSRECTAL PROSTATE SONOGRAM (SURGEON) 76872-26 287.00$

PROFESSIONAL 76937-26S US GUIDE, VASCULAR ACCESS (SURGEON) 76937-26 67.00$

PROFESSIONAL 76942-26S NEEDLE PLACEMENT (BIOPSY) (SURGEON) 76942-26 220.00$

PROFESSIONAL 77001-26S FLUOROGUIDE FOR VEIN DEVICE (SURGEON) 77001-26 130.00$

PROFESSIONAL 77002-26S NEEDLE LOCALIZATION BY XRAY (SURGEON) 77002-26 130.00$

PROFESSIONAL 77003-26S FLUOROGUIDE FOR SPINE INJECT 77003-26 191.00$

PROFESSIONAL 4DOBUS 4D OB ULTRASOUND 4DOBUS 125.00$

PROFESSIONAL 43752-TC NASAL/OROGASTRIC TUBE PLMT W/FLUORO 43752-TC 435.20$

PROFESSIONAL 49440-TC GASTROSTOMY TUBE INSERT - S 49440-TC 827.55$

PROFESSIONAL 49441-TC INSERT DUOD/JEJ TUBE 49441-TC 827.55$

PROFESSIONAL 49450-TC CHANGE GASTROSTOMY 49450-TC 919.40$

PROFESSIONAL 51798-TC POST-VOIDING RESIDUAL 51798-TC 95.70$

PROFESSIONAL 70030-TC EYE DETECTION OF FOREIGN BODY 70030-TC 328.55$

PROFESSIONAL 70100-TC MANDIBLE PARTIAL < 4 VIEWS 70100-TC 389.40$

PROFESSIONAL 70110-TC MANDIBLE COMPLETE MIN 4 VIEWS 70110-TC 445.15$

PROFESSIONAL 70140-TC FACIAL BONES LESS THAN 3 VIEWS 70140-TC 413.00$

PROFESSIONAL 70150-TC FACIAL BONES COMP MIN 3 VIEWS 70150-TC 488.15$

PROFESSIONAL 70200-TC ORBITS COMPLETE MIN 4 VIEWS 70200-TC 472.40$

PROFESSIONAL 70210-TC PARANASAL SINUS < 3 VIEWS 70210-TC 264.50$

PROFESSIONAL 70220-TC PARANASAL SINUS MIN 3 VIEWS 70220-TC 476.00$

PROFESSIONAL 70250-TC SKULL LESS THAN 4 VIEWS 70250-TC 374.60$

PROFESSIONAL 70260-TC SKULL COMPLETE MIN 4 VIEWS 70260-TC 568.30$

PROFESSIONAL 70330-TC TM JOINTS BILATERAL 70330-TC 489.05$

PROFESSIONAL 70360-TC NECK SOFT TISSUE 70360-TC 320.35$

PROFESSIONAL 71045-TC CHEST 1 VIEW 71045-TC 312.15$

PROFESSIONAL 71046-TC X-RAY EXAM CHEST 2 VIEWS 71046-TC 403.15$

PROFESSIONAL 71100-TC RIBS UNILATERAL 2 VIEWS 71100-TC 372.55$

PROFESSIONAL 71101-TC X-RAY EXAM OF RIBS/CHEST 3+ VIEW UNILAT 71101-TC 388.90$

2020-01




PROFESSIONAL 71110-TC RIBS BILATERAL MINIMUM 3 VIEWS 71110-TC 407.35$

PROFESSIONAL 71111-TC RIBS BILAT W/PA CHEST MIN 4 71111-TC 462.15$

PROFESSIONAL 71120-TC STERNUM MIN 2 VIEWS 71120-TC 324.45$

PROFESSIONAL 71130-TC STERNOCLAVICULAR JOINT MIN 3 VIEWS 71130-TC 326.20$

PROFESSIONAL 72020-TC SPINE 1 VIEW ANY LEVEL 72020-TC 291.55$

PROFESSIONAL 72040-TC CERVICAL SPINE 2 OR 3 VIEWS 72040-TC 377.35$

PROFESSIONAL 72050-TC CERVICAL SPINE MIN 4 VIEWS 72050-TC 503.30$

PROFESSIONAL 72052-TC CERVICAL SPINE COMP W FLEX/EXT 72052-TC 585.70$

PROFESSIONAL 72072-TC THORACIC SPINE 3 VIEWS 72072-TC 506.35$

PROFESSIONAL 72080-TC THORACOLUMBAR SPINE 2 VIEWS 72080-TC 499.25$

PROFESSIONAL 72081-TC SCOLIOSIS SURVEY 72081-TC 416.55$

PROFESSIONAL 72082-TC SPINE SURVEY AP/LAT ENTIRE 72082-TC 629.15$

PROFESSIONAL 72100-TC LUMBOSACRAL 2 OR 3 VIEWS 72100-TC 473.55$

PROFESSIONAL 72110-TC LUMBAR W/OBLIQUES 5 VIEWS 72110-TC 564.15$

PROFESSIONAL 72114-TC LUMBAR W/FLEXION & EXTENSION 72114-TC 723.45$

PROFESSIONAL 72170-TC PELVIS 1 OR 2 VIEWS 72170-TC 325.00$

PROFESSIONAL 72190-TC PELVIS COMPLETE MIN 3 VIEWS 72190-TC 415.30$

PROFESSIONAL 72202-TC SACROILIAC JOINTS 3 OR MORE 72202-TC 351.70$

PROFESSIONAL 72220-TC SACRUM AND COCCYX MIN 2 VIEWS 72220-TC 351.55$

PROFESSIONAL 73000-TCLT CLAVICLE COMPLETE LEFT 73000-TCLT 286.40$

PROFESSIONAL 73000-TCRT CLAVICAL COMPLETE RIGHT 73000-TCRT 286.40$

PROFESSIONAL 73010-TCLT SCAPULA COMPLETE LEFT 73010-TCLT 297.55$

PROFESSIONAL 73010-TCRT SCAPULA COMPLETE RIGHT 73010-TCRT 297.55$

PROFESSIONAL 73020-TC SHOULDER 1 VIEW 73020-TC 86.40$

PROFESSIONAL 73030-TCLT SHOULDER 2 VIEWS LEFT 73030-TCLT 387.90$

PROFESSIONAL 73030-TCRT SHOULDER 2 VIEWS RIGHT 73030-TCRT 387.90$

PROFESSIONAL 73040-TCLT ARTHROGRAM SHOULDER LEFT 73040-TCLT 754.55$

PROFESSIONAL 73040-TCRT ARTHROGRAM SHOULDER RIGHT 73040-TCRT 754.55$

PROFESSIONAL 73050-TC ACROMIOCLAVICULAR JOINTS BILAT 73050-TC 326.65$

PROFESSIONAL 73060-TCLT HUMERUS 2 VIEWS 73060-TCLT 310.60$

PROFESSIONAL 73060-TCRT HUMERUS 2 VIEWS RIGHT 73060-TCRT 310.60$

PROFESSIONAL 73070-TCLT ELBOW 2 VIEWS LEFT 73070-TCLT 332.25$

PROFESSIONAL 73070-TCRT ELBOW 2 VIEWS RIGHT 73070-TCRT 332.25$

PROFESSIONAL 73080-TCLT ELBOW 3 VIEWS LEFT 73080-TCLT 332.25$

PROFESSIONAL 73080-TCRT ELBOW 3 VIEWS RIGHT 73080-TCRT 332.25$

PROFESSIONAL 73090-TCLT FOREARM 2 VIEWS LEFT 73090-TCLT 414.35$

PROFESSIONAL 73090-TCRT FOREARM 2 VIEWS RIGHT 73090-TCRT 414.35$

PROFESSIONAL 73100-TCLT WRIST 2 VIEWS LEFT 73100-TCLT 246.90$

PROFESSIONAL 73100-TCRT WRIST 2 VIEWS RIGHT 73100-TCRT 246.90$

PROFESSIONAL 73110-TCLT WRIST 3 VIEWS LEFT 73110-TCLT 414.35$

PROFESSIONAL 73110-TCRT WRIST 3 VIEWS RIGHT 73110-TCRT 414.35$

PROFESSIONAL 73110TC WRIST LEFT MIN 3 VIEWS (T/C) 73110TC 414.30$

PROFESSIONAL 73120-TCLT HAND 2 VIEWS LEFT 73120-TCLT 264.50$

PROFESSIONAL 73120-TCRT HAND 2 VIEWS RIGHT 73120-TCRT 264.50$

PROFESSIONAL 73130-TCLT HAND 3 VIEWS LEFT 73130-TCLT 324.25$

PROFESSIONAL 73130-TCRT HAND 3 VIEWS RIGHT 73130-TCRT 324.25$

PROFESSIONAL 73140-TCLT XRAY EXAM OF FINGER(S) 2+VIEWS LT 73140-TCLT 241.85$

PROFESSIONAL 73140-TCRT XRAY EXAM OF FINGER(S) 2+VIEWS RT 73140-TCRT 241.85$

PROFESSIONAL 73501-TCLT HIP 1 VIEW LEFT W/PELV IF PERF 73501-TCLT 224.95$

PROFESSIONAL 73501-TCRT HIP 1 VIEW RIGHT W/PELV IF PERF 73501-TCRT 224.95$

PROFESSIONAL 73502-TC HIP 2 VIEWS W/PELV IF PERF 73502-TC 374.60$

PROFESSIONAL 73521-TC HIP 2 VIEWS, W/PELV IF PERF 73521-TC 777.80$

PROFESSIONAL 73522-TC HIP BI3-4 VIEW PELV IF PERF 73522-TC 777.80$

PROFESSIONAL 73523-TC PELVIS W/RT & LT HIP 73523-TC 1,483.85$

PROFESSIONAL 73551-TCLT FEMUR 1 VIEW LEFT 73551-TCLT 175.05$

PROFESSIONAL 73551-TCRT FEMUR 1 VIEW RIGHT 73551-TCRT 175.05$

PROFESSIONAL 73552-TCLT FEMUR 2 VIEWS LEFT 73552-TCLT 352.70$

PROFESSIONAL 73552-TCRT FEMUR 2 VIEWS RIGHT 73552-TCRT 352.70$

PROFESSIONAL 73560-TC50 X-RAY EXAM OF KNEE 1 OR 2 73560-TC50 102.25$

PROFESSIONAL 73560-TCLT KNEE 1 OR 2 VIEWS LEFT 73560-TCLT 332.35$

PROFESSIONAL 73560-TCRT KNEE 1 OR 2 VIEWS RIGHT 73560-TCRT 332.35$

PROFESSIONAL 73562-TCLT KNEE LEFT 3 VIEWS 73562-TCLT 363.95$

PROFESSIONAL 73562-TCRT KNEE RIGHT 3 VIEWS 73562-TCRT 363.95$

PROFESSIONAL 73564-TCLT KNEE COMP 4/> VIEWS LEFT 73564-TCLT 544.25$

PROFESSIONAL 73564-TCRT KNEE COMP 4/> VIEWS RIGHT 73564-TCRT 544.25$

PROFESSIONAL 73590-TCLT TIBIA FIBULA 2 VIEWS 73590-TCLT 344.80$

PROFESSIONAL 73590-TCRT TIBIA FIBULA 2 VIEWS RIGHT 73590-TCRT 344.80$

PROFESSIONAL 73600-TCLT ANKLE 2 VIEWS LEFT 73600-TCLT 287.20$

2020-01




PROFESSIONAL 73600-TCRT ANKLE 2 VIEWS RIGHT 73600-TCRT 287.20$

PROFESSIONAL 73610-TCLT ANKLE 3 VIEWS LEFT 73610-TCLT 334.90$

PROFESSIONAL 73610-TCRT ANKLE 3 VIEWS RIGHT 73610-TCRT 334.90$

PROFESSIONAL 73620-TCLT FOOT 2 VIEWS LEFT 73620-TCLT 284.20$

PROFESSIONAL 73620-TCRT FOOT 2 VIEWS RIGHT 73620-TCRT 284.20$

PROFESSIONAL 73630-TCLT FOOT COMPLETE MIN 3 VIEWS LEFT 73630-TCLT 331.55$

PROFESSIONAL 73630-TCRT FOOT COMPLETE MIN 3 VIEWS RT 73630-TCRT 331.55$

PROFESSIONAL 73650-TCLT CALCANEUS MIN 2 VIEWS LEFT 73650-TCLT 269.80$

PROFESSIONAL 73650-TCRT CALCANEUS 73650-TCRT 269.80$

PROFESSIONAL 73660-TCLT X-RAY EXAM OF TOE(S) 2+VIEWS LT 73660-TCLT 241.85$

PROFESSIONAL 73660-TCRT X-RAY EXAM OF TOE(S) 2+VIEWS RT 73660-TCRT 241.85$

PROFESSIONAL 74018-TC ABDOMEN 1 VIEW 74018-TC 327.45$

PROFESSIONAL 74019-TC ABDOMEN 2 VIEWS 74019-TC 373.10$

PROFESSIONAL 74021-TC ABDOMEN 3 OR MORE VIEWS 74021-TC 352.90$

PROFESSIONAL 74022-TC ACUTE ABDOMEN SERIES 74022-TC 595.00$

PROFESSIONAL 74220-TC ESOPHAGUS 74220-TC 540.20$

PROFESSIONAL 74230-TC PHARYNGEAL/SPEECH EVAL RECORD 74230-TC 717.90$

PROFESSIONAL 74240-TC UPPER GI 74240-TC 579.85$

PROFESSIONAL 74245-TC UPPER GI W/SMALL BOWEL W/O AIR 74245-TC 831.25$

PROFESSIONAL 74246-TC UPPER GI W/O KUB W/AIR 74246-TC 847.80$

PROFESSIONAL 74247-TC UPPER GI W/KUB W/AIR 74247-TC 1,009.75$

PROFESSIONAL 74249-TC UPPER GI W/SMALL BOWEL W/AIR 74249-TC 1,029.90$

PROFESSIONAL 74250-TC SM BOWEL INCLUDE MULTI SERIAL 74250-TC 521.20$

PROFESSIONAL 74270-TC BARIUM ENEMA 74270-TC 689.85$

PROFESSIONAL 74280-TC BARIUM ENEMA AIR CONTRAST 74280-TC 944.40$

PROFESSIONAL 74300-TC CHOLANGIOGRAPHY INTRAOPERATIVE 74300-TC 620.00$

PROFESSIONAL 74410-TC EXCRETORY UROGRAPHY/IVP 74410-TC 1,154.15$

PROFESSIONAL 74415-TC UROGRAPHY IVP/TOMOGRAPHY 74415-TC 1,158.60$

PROFESSIONAL 74420-TC RETROGRADE PYELOGRAM 74420-TC 756.70$

PROFESSIONAL 74425-TC NEPHROSTOGRAM 74425-TC 571.50$

PROFESSIONAL 74455-TC VOIDING URETHROCYSTOGRAM 74455-TC 747.35$

PROFESSIONAL 74740-TC HYSTEROSALPINGOGRAM 74740-TC 1,313.90$

PROFESSIONAL 75820-TCLT VENOGRAM EXTREMITY LEFT 75820-TCLT 1,174.45$

PROFESSIONAL 75820-TCRT VENOGRAM EXTREMITY RIGHT 75820-TCRT 1,174.45$

PROFESSIONAL 75989-TC PERCUTANEOU ABCESS DRAINAGE 75989-TC 255.25$

PROFESSIONAL 76000-TC FLUOROSCOPY UP TO 1 HR (R) 76000-TC 450.35$

PROFESSIONAL 76080-TC ABSCESS FISTULA/SINUS TRACT 76080-TC 499.45$

PROFESSIONAL 76098-TC DIAGNOSTIC SPECIMEN XRAY 76098-TC 478.60$

PROFESSIONAL 76100-TC TOMOGRAPHY SINGLE PLANE 76100-TC 439.20$

PROFESSIONAL 76506-TC HEAD SONOGRAM 76506-TC 725.30$

PROFESSIONAL 76536-TC US HEAD/NECK SOFT TISSUE 76536-TC 777.95$

PROFESSIONAL 76642-TC ULTRASOUND BREAST LIMITED 76642-TC 331.45$

PROFESSIONAL 76700-TC ABDOMEN SONOGRAM COMPLETE 76700-TC 1,261.35$

PROFESSIONAL 76705-TC ABDOMEN SONOGRAM LTD <6 ORGANS 76705-TC 984.70$

PROFESSIONAL 76706-TC ULTRASOUND EXAM AAA SCREEN 76706-TC 912.25$

PROFESSIONAL 76770-TC RETROPERITONEAL SONOGRAM COMP 76770-TC 1,194.95$

PROFESSIONAL 76775-TC ULTRASOUND RETROPERITONEAL LIMITED 76775-TC 891.75$

PROFESSIONAL 76776-26 PC-US TRANS KIDNEY W/DUPL DOPP 76776-26 100.10$

PROFESSIONAL 76800-TC SPINAL CANAL AND CONTENTS 76800-TC 790.45$

PROFESSIONAL 76801-TC OB US<14 WKS SINGLE FETUS 76801-TC 750.00$

PROFESSIONAL 76802-TC US ADD'L GESTATION EACH 76802-TC 953.90$

PROFESSIONAL 76805-TC OB COMPLETE >1ST TRIMESTER 76805-TC 959.85$

PROFESSIONAL 76810-TC OB COMPLETE ADD'L GEST>1 TRI 76810-TC 1,046.90$

PROFESSIONAL 76815-TC OB ULTRASOUND LIMITED 76815-TC 288.15$

PROFESSIONAL 76816-TC OB US FOLLOW-UP PER FETUS 76816-TC 959.85$

PROFESSIONAL 76817-TC TRANSVAGINAL U/S PREGNANT 76817-TC 722.80$

PROFESSIONAL 76830-TC TRANSVAGINAL SONOGRAM NON-OB 76830-TC 753.65$

PROFESSIONAL 76856-TC PELVIC COMPLETE SONOGRAM 76856-TC 859.90$

PROFESSIONAL 76857-TC BLADDER ULTRASOUND 76857-TC 592.85$

PROFESSIONAL 76870-TC TESTICULAR SONOGRAM 76870-TC 729.50$

PROFESSIONAL 76872-TC TRANSRECTAL PROSTATE SONOGRAM 76872-TC 752.90$

PROFESSIONAL 76881-TC US EXTREMITY NON VASC COMPLETE 76881-TC 639.45$

PROFESSIONAL 76882-TC US EXTREMITY NON VASC LIMITED 76882-TC 351.30$

PROFESSIONAL 76886-TC INFANT HIPS U/S LIMITED STATIC 76886-TC 867.60$

PROFESSIONAL 76999-TC ULTRASOUND 76999-TC 580.50$

PROFESSIONAL 77002-TC FLUORO GUIDANCE NEEDLE PLACEMENT 77002-TC 595.65$

PROFESSIONAL 77003-TC FLUORO NDL LOC-SPINAL INJ 77003-TC 483.00$

PROFESSIONAL 77061-TC TOMOSYNTHESIS DIAG BREAST UNI 77061-TC 53.05$

2020-01




PROFESSIONAL 77062-TC TOMOSYNTHESIS DIAG BREAST BI 77062-TC 53.05$

PROFESSIONAL 77063-TC TOMOSYNTH BREAST BI SCREEN 77063-TC 53.05$

PROFESSIONAL 77065-TC MAMMO DIAGNOSTIC UNIL 77065-TC 231.25$

PROFESSIONAL 77065-TCGG DX MAMMO INCL CAD UNI 77065-TCGG 231.25$

PROFESSIONAL 77066-TC DX MAMMO INCL CAD BI 77066-TC 368.25$

PROFESSIONAL 77067-TC MAMMO DIGITAL SCREEN - BILATERAL 77067-TC 255.35$

PROFESSIONAL 77072-TC BONE AGE STUDY 77072-TC 151.55$

PROFESSIONAL 77073-TC X-RAY,BONE LENGTH STUDIES 77073-TC 361.80$

PROFESSIONAL 77074-TC OSSEOUS SURVEY-METASTASES 77074-TC 884.35$

PROFESSIONAL 77075-TC OSSEOUS SURVEY COMPLETE 77075-TC 794.80$

PROFESSIONAL 77077-TC JOINT SURVEY SINGLE 2+VIEWS 77077-TC 143.05$

PROFESSIONAL 77080-TC BONE DENSITY AXIAL 1 OR MORE SITES (DXA) 77080-TC 649.50$

PROFESSIONAL 77081-TC BONE DENSITY 77081-TC 330.95$

PROFESSIONAL 77085-TC HIP SPINE PELV W/VERT FX ASSES 77085-TC 143.05$

PROFESSIONAL 77086-TC BONE DENSITY VERTEBRAL FX ASSESS 77086-TC 418.70$

PROFESSIONAL 93975-TC DUPLEX RENAL ULTRASOUND 93975-TC 1,191.35$

PROFESSIONAL 93976-TC DUPLEX RENAL ULTRASOUND LIMITED 93976-TC 816.50$

PROFESSIONAL 530011TC KNEE LEFT ARTHROGRAM 73580-TCLT 691.60$

PROFESSIONAL 530012TC KNEE RIGHT ARTHROGRAM 73580-TCRT 691.60$

PROFESSIONAL 530047TC WRIST RIGHT 2 VIEWS (POV) 73100-TCRT 246.90$

PROFESSIONAL 530067TC SHOULDER COMP RT MIN 2 VIEWS 73030-TCRT 387.90$

PROFESSIONAL 530078TC CHANGE G/J TUBE W/RAD SUPERVISION 75984-TC 643.75$

PROFESSIONAL 530083TC BONE AGE STUDY 77072-TC 151.55$

PROFESSIONAL 530102TC SELLA TURCICA/PITUITARY 70240-TC 323.05$

PROFESSIONAL 530107TC EYE DETECTION OF FOREIGN BODY 70030-TC 328.55$

PROFESSIONAL 530132TC LUMBOSACRAL 2 OR 3 VIEWS 72100-TC 473.55$

PROFESSIONAL 530134TC LUMBAR W/FLEXION & EXTENSION 72114-TC 723.45$

PROFESSIONAL 530136TC LUMBAR MYELOGRAM 72265-TC 1,317.95$

PROFESSIONAL 530150TC RIBS LT W/PA CHEST MIN 3 VIEWS 71101-TCLT 388.90$

PROFESSIONAL 530151TC RIBS RIGHT W/PA CHEST MIN 3 71101-TCRT 388.90$

PROFESSIONAL 530154TC RIBS BILAT W/PA CHEST MIN 4 71111-TC 462.15$

PROFESSIONAL 530165TC ESOPHAGUS 74220-TC 540.20$

PROFESSIONAL 530168TC UPPER GI W/O KUB 74246-TC 847.80$

PROFESSIONAL 530246TC BONE DENSITY, AXIAL (DXA) 77080-TC 649.50$

PROFESSIONAL 531585TC LUMBAR BENDING MIN 4 VIEWS 72120-TC 556.80$

PROFESSIONAL 531949TC PELVIMETRY 74710-TC 554.60$

PROFESSIONAL G0279-TC TOMOSYNTH DIAG BREAST UNI G0279-TC 65.80$

PROFESSIONAL 98966 HC PRO PHONE CALL 5-10 MIN 98966 42.00$



PROFESSIONAL 99050 SERVICES IN THE OFFICE AFTER HOURS 99050 76.00$

PROFESSIONAL 99051 MED SERV, EVE/WKEND/HOLIDAY 99051 46.00$

PROFESSIONAL 99053 MED SERV 10PM-8AM 24 HR FAC 99053 71.00$

PROFESSIONAL 99056 MED SERVICE OUT OF OFFICE 99056 99.00$

PROFESSIONAL 99058 OFFICE SERVCS PROVIDED ON EMERG BASIS 99058 140.00$

PROFESSIONAL 99060 OUT OF OFFICE EMERG MED SERV 99060 114.00$

PROFESSIONAL 99075 MEDICAL TESTIMONY 99075 471.00$

PROFESSIONAL 99199 MA UNLISTED SPECIAL SERVICE OR REPORT 99199 129.00$

PROFESSIONAL 99354 PROLONGED SERVICE, OFFICE, 1ST HOUR 99354 413.00$

PROFESSIONAL 99354-26 PROLONGED SERVICE 1 HR (P/C MED/RAD ONC) 99354 413.00$

PROFESSIONAL 99355 PROLONGED SERVICE,OFFICE,EA ADDL 30 MIN 99355 249.00$

PROFESSIONAL 99355-26 PROLONGED SERV EA ADD'L(P/C MED/RAD ONC) 99355 249.00$

PROFESSIONAL 99358 PROLONGED SERV, W/O CONTACT, 1ST HOUR 99358 378.00$

PROFESSIONAL 99359 PROLONGED SERV, W/O CONTACT ADD 99359 197.00$

PROFESSIONAL 99404 PREVENTIVE COUNSELING, INDIV 99404 240.00$

PROFESSIONAL 99406 BEHAV CHNG SMOKING 3-10 MIN 99406 35.00$

PROFESSIONAL 99407 BEHAV CHNG SMOKING > 10 MIN 99407 65.00$

PROFESSIONAL 99408 ETOH/DRUG ABUSE CNSLNG/INTRVNTN 15-30MIN 99408 125.00$

PROFESSIONAL 99441 PHONE E/M BY PHYS 5-10 MIN 99441 42.00$



PROFESSIONAL G0372 MD SERVICE REQUIRED FOR PMD G0372 79.00$

PROFESSIONAL G0396 ALCOHOL/SUBS INTERV 15-30MN G0396 43.00$

PROFESSIONAL G0397 ALCOHOL/SUBS INTERV >30 MIN G0397 82.00$

PROFESSIONAL 0-01476 KERLIX 4 1/2X4 YD 352337 A6216 6.55$

PROFESSIONAL 0-09651 MEDIHONEY DRESSING 4X5 A6197 33.75$

PROFESSIONAL 0-10140 ORTHO POLAR PACK KNEE A9273 401.05$

PROFESSIONAL 00030 LIDOCAINE 5% PATCH J3490 15.25$

2020-01




PROFESSIONAL 06008 ZIMFOAM FINGER SPLINT A4570 41.30$

PROFESSIONAL 06009 STACK FINGER SPLINT A4570 27.20$

PROFESSIONAL 06014 PADDED FOREARM SPLINT A4570 92.45$

PROFESSIONAL 06031 BACTOBAN OINTMENT 99070 64.15$

PROFESSIONAL 06033 MEDIPLAST 99070 17.40$

PROFESSIONAL 06036 NASAL SHIELD 99070 70.70$

PROFESSIONAL 06037 CALMOSEPTIN CREAM 99070 27.20$

PROFESSIONAL 06038 GI COCKTAIL 99070 39.15$

PROFESSIONAL 06040 TUBULAR STOCKINETTE 06040 46.75$

PROFESSIONAL 06055 BETA VAL OINTMENT 06055 23.95$

PROFESSIONAL 10093 NEOPRENE TENNIS ELBOW SLEEVE 26.50$

PROFESSIONAL 14252 CHIN FACIAL COMPRESSION SUPPORT A6502 28.90$

PROFESSIONAL 14253 ARM LIFT COMPRESSION (VARIOUS SIZES) 76.80$

PROFESSIONAL 14258 POST OP BRAS (VARIOUS SIZES) 103.45$

PROFESSIONAL 99070-POLY POLYMIXIN/BACITRACIN ZINC OPT OINT 99070 99070 18.50$

PROFESSIONAL 99070-TS TOE SPREADER 99070 21.75$

PROFESSIONAL 99070PN PERCUTANEOUS NEEDLE, NEPHROSTOMY KIT 99070 514.40$

PROFESSIONAL 99070SIL SILVADENE CREME 50 GRAM (1.75 OZ) 99070 27.20$

PROFESSIONAL 000274 HEMOSTAT ABSORB 4X8 SURGICEL E1637 233.80$

PROFESSIONAL 000275 SURGICEL HEMOSTAT ABSORB 2X3 A6402 128.35$

PROFESSIONAL 000309 JACKSON PRATT DRAIN 7 MM 30.45$

PROFESSIONAL 000311 JACKSON PRATT BULB RESERVOIR 44.80$

PROFESSIONAL 000714 PNEUMOTHORAX 8 FR AD-1500 KIT 000714 C1729 235.95$

PROFESSIONAL 000715 PERITONEAL LAVAGE KIT 51.15$

PROFESSIONAL 000840 ACE BANDAGE 6 IN VELCRO A6450 15.25$

PROFESSIONAL 000858 COBAN 2 IN ROLL A6453 18.50$

PROFESSIONAL 000859 COBAN BANDAGE 3 IN 1583 A6453 18.50$

PROFESSIONAL 000860 COBAN BANDAGE 4 IN 1584 A6453 18.50$

PROFESSIONAL 000931 IODOFORM PACKING DRESSING 1/4 IN A6266 5.45$

PROFESSIONAL 000932 PLAIN PACKING STRIP 1/2 IN A6407 4.35$

PROFESSIONAL 000933 PLAIN PACKING STRIP 1/4 IN A6407 4.35$

PROFESSIONAL 000940 POLY II DRESSING 4X8 6647 A6258 5.45$

PROFESSIONAL 001031 OSTOMY PASTE 183910 A4405 10.85$

PROFESSIONAL 001033 OSTOMY POWDER 1 OZ BOTTLE 025510 A4371 8.70$

PROFESSIONAL 001043 OSTOMY POUCH LG 413354 A4375 5.45$

PROFESSIONAL 001055 OSTOMY WAFER LG 405458 A4414 5.45$

PROFESSIONAL 001057 OSTOMY WAFER MD 405457 A4414 5.45$

PROFESSIONAL 001074 OSTOMY KIT XL 4 IN 409275 A4416 14.15$

PROFESSIONAL 001076 OSTOMY CONVEX MD 409269 A4416 10.85$

PROFESSIONAL 001123 OSTOMY CONVEX LG 409270 A4416 10.85$

PROFESSIONAL 001127 OSTOMY POUCH MD 413353 A4375 5.45$

PROFESSIONAL 001396 PAD ATTENDS 2.70$

PROFESSIONAL 001475 ABDOMINAL PAD 7-1 2/8 9192 A6253 5.45$

PROFESSIONAL 001476 KERLIX BANDAGE 4 1/2X4 YD A6446 7.40$

PROFESSIONAL 001569 MED LEG BAG 50102 A4358 4.35$

PROFESSIONAL 001572 CATH BAG 2000CC 154004A A4358 8.70$

PROFESSIONAL 001573 URINARY DRAIN BAG CLOSED 4000CC A4358 8.70$

PROFESSIONAL 001575 URO CATH TRAY W/O CATH 82100 A4310 5.45$

PROFESSIONAL 001606 PLEUR EVAC ADULT TRAY 001606 99.00$

PROFESSIONAL 002054 OSTOMY SEAL 839002 A4385 8.70$

PROFESSIONAL 002459 HOSE ANTI-EMB ALL SIZES 15.20$

PROFESSIONAL 002479 THIEMANN COUDE CATHETER 18 FR 120618 A4340 51.15$

PROFESSIONAL 002483 CATH FOLEY 16 FR 30 CC SILVER A4344 22.85$

PROFESSIONAL 002650 SPLINT FINGER 1 1/4 A4570 A4570 6.40$

PROFESSIONAL 002651 SPLINT FINGER ZIM 2 A4570" A4570 9.85$

PROFESSIONAL 002652 SPLINT FINGER ZIM 2 5/8 A4570" A4570 9.85$


PROFESSIONAL 002654 SPLINT FINGER ZIM 3 1/2 A4570" A4570 9.85$

PROFESSIONAL 002655 SPLINT FINGER 4 5/8 A4570" A4570 10.30$


PROFESSIONAL 002684 ORTHO UNIVERSAL ABDOMINAL BINDER A4467 21.75$

PROFESSIONAL 003108 SPLINT FINGER STRIP 1/2*9 A4570 43.85$

PROFESSIONAL 003109 FINGER SPLINT STRIP 1/2*18 A4570 19.10$

PROFESSIONAL 003110 FINGER SPLINT STRIP 1*18 A4570 43.85$

PROFESSIONAL 005195 CLOSED DRAINAGE BEDSIDE BAG 2000CC A4357 9.85$

PROFESSIONAL 005259 CARRADRES HYDRO DRESSING 4X4 A6242 8.70$

PROFESSIONAL 005523 KNEE SUPPORT XS 131012 HS A4467 A4467 49.00$

PROFESSIONAL 005524 KNEE SUPPORT SM 131013 HS A4467 A4467 49.00$

2020-01




PROFESSIONAL 005525 KNEE SUPPORT MD 131014 HS A4467 A4467 49.85$

PROFESSIONAL 005526 KNEE SUPPORT LG 131015 HS A4467 A4467 49.00$

PROFESSIONAL 005527 KNEE SUPPORT XL 131016 HS A4467 A4467 49.00$

PROFESSIONAL 005528 KNEE SUPPORT XXLG 131017 A4467 A4467 49.00$

PROFESSIONAL 005627 SLING XSM PED 301501 A4565 A4565 19.55$

PROFESSIONAL 005628 SLING CHILD 301502 A4565 A4565 19.55$

PROFESSIONAL 005630 SLING SMALL 301503 A4565 A4565 19.55$

PROFESSIONAL 005631 SLING MED 301504 A4565 A4565 20.15$

PROFESSIONAL 005632 SLING LARGE 301505 A4565 A4565 9.85$

PROFESSIONAL 005633 SLING XL 301506 A4565 A4565 19.55$

PROFESSIONAL 005658 HIBICLENS 4 OZ A4248 10.85$

PROFESSIONAL 005688 MASTISOL ADHESIVE 2/3CC A4364 5.45$

PROFESSIONAL 005708 GELOCAST BANDAGE 4 IN 50171 A6456 14.15$

PROFESSIONAL 005881 KNEE STRAP X-SM CP13 A9270 A9270 49.00$

PROFESSIONAL 005882 KNEE STRAP SM CP15 A9270 A9270 49.00$

PROFESSIONAL 005883 KNEE STRAP MED CP17 A9270 A9270 49.00$

PROFESSIONAL 005884 KNEE STRAP LG A9270 A9270 49.00$

PROFESSIONAL 005885 KNEE STRAP XLG A9270 A9270 49.00$

PROFESSIONAL 006140 MEDIPORE 3.5X6 3569 A4452 6.55$

PROFESSIONAL 006646 ORTHO TOE SPREADERS LG PKG OF 12 A9270 35.90$

PROFESSIONAL 007150 AQUACEL SILVER 4X4 DRESSING A6196 23.95$

PROFESSIONAL 007749 AQUACEL SILVER ROPE DRESSING A6196 28.25$

PROFESSIONAL 007813 CHLORHEXIDINE GLUCONATE 4% 4 OZ A4248 6.55$

PROFESSIONAL 008210 VERSAFOAM A6211 231.65$

PROFESSIONAL 008967 BOVIE PAD A4649 6.55$

PROFESSIONAL 008968 BOVIE PENCIL CAUTERY A4649 12.00$

PROFESSIONAL 009105 MEPILEX 4X4 A6209 21.75$

PROFESSIONAL 009106 MEPILEX BORDER DRESSING 6X6 A6213 16.35$

PROFESSIONAL 009107 MEPILEX SACRUM DRESSING 7X7 A6213 20.70$

PROFESSIONAL 009108 MEPILEX BORDER 4X4 A6212 10.85$

PROFESSIONAL 009268 CONVATEC 1 PC OSTOMY A4424 10.85$

PROFESSIONAL 009301 MARATHON SKIN PROTECTAN LIQUID A6250 17.40$

PROFESSIONAL 009314 OCTYSEAL SKIN ADHESIVE A6250 25.05$

PROFESSIONAL 009460 COMPRESSION DRESSING 2 LAYER 2094 A6449 113.10$

PROFESSIONAL 009461 COMPRESS DRESSING 2 LAY LITE A6448 33.75$

PROFESSIONAL 009498 ARGLAES POWDER DRESSING 5 GM A6262 29.40$

PROFESSIONAL 009557 ORTHO K LITE KNEE SLEEVE A9270 72.15$

PROFESSIONAL 009651 HYDROCOLLD DRG >16<=48 W/O B A6235 20.70$

PROFESSIONAL 009886 MEPILEX AG 3X3 DRESSING A6209 18.50$



PROFESSIONAL 010477 AQUACEL AG 3 1/2 X 6 A6197 70.70$

PROFESSIONAL 010478 AQUACEL AG 3 1/2 X 10 A6197 88.10$

PROFESSIONAL 010505 ORTHO SLING SHOT BRACE A4565 113.50$

PROFESSIONAL 010773 QUICK CORE BIOPSY NEEDLE SET A4649 153.35$

PROFESSIONAL 011385 SEROMA 14G 2IN DRAINAGE CATHETER A4338 115.25$

PROFESSIONAL 011697 GEL DIGITAL CAPS L/XL A9900 78.30$

PROFESSIONAL 011892 HOSE ANTI-EMB KNEE SHORT 33.30$

PROFESSIONAL 013330 TENNIS ELBOW STRAP REGULAR A4467 32.60$

PROFESSIONAL 013331 TENNIS ELBOW STRAP XLONG A4467 32.60$

PROFESSIONAL 013590 BINDER ABDOMINAL 15 82-94"" A4467 78.90$

PROFESSIONAL 013724 BINDER ABDOMINAL 12 46-62" 4" A4467 38.10$

PROFESSIONAL 014178 DRESSING MEDIHONEY 2X2 A4649 51.10$

PROFESSIONAL 015265 SILICONE GEL SHEET 4 3/4 X 6 81.85$

PROFESSIONAL 136614 BIOMET ANKLET BRACE MED A4467 20.15$

PROFESSIONAL 350635 MULTIDEX GEL 99070 30.45$

PROFESSIONAL 350636 MULTIDES POWDER 99070 107.70$

PROFESSIONAL A4215 SYRINGE A4215 34.80$

PROFESSIONAL A4266 DIAPHRAGM A4266 137.90$

PROFESSIONAL A4310 INSERTION TRAY (4X4 BETADINE KY) A4310 44.60$

PROFESSIONAL A4322 IRRIGATION SYRINGE, EACH A4322 34.80$

PROFESSIONAL A4327 FEMALE EXT URINARY COLL DEVICE,MEATAL CU A4327 45.70$

PROFESSIONAL A4333 URINARY CATH ANCHOR DEVICE A4333 17.40$

PROFESSIONAL A4338 INDWELLING CATHETER; 2-WAY LATEX A4338 60.85$

PROFESSIONAL A4340 INDWELLING CATHETER; COUDE A4340 80.50$

PROFESSIONAL A4344 INDWELLING CATHETER, FOLEY TYPE A4344 45.70$

PROFESSIONAL A4346 3 WAY FOLEY CATH FOR IRRIGATION A4346 91.35$

PROFESSIONAL A4349 DISP MALE EXTERNAL CATH A4349 13.05$

2020-01




PROFESSIONAL A4351 INTERMITTENT STRAIGHT CATHETER A4351 14.15$

PROFESSIONAL A4353 INTERMITTENT URIN CATHETER W/INSERT SUPP A4353 25.05$

PROFESSIONAL A4358 LEG BAG (URINARY) A4358 45.70$

PROFESSIONAL A4385 OST SKN BARRIER SLD EXT WEAR A4385 17.40$

PROFESSIONAL A4405 OSTOMY SKIN BARRIER, NON-PECTIN PASTE A4405 21.75$

PROFESSIONAL A4424 OST PCH DRAIN W BAR & FILTER A4424 9.85$

PROFESSIONAL A4452 WATERPROOF TAPE A4452 23.95$

PROFESSIONAL A4463 SURGICAL DRESS HOLDER REUSE A4463 107.70$

PROFESSIONAL A4467 BELT STRAP SLEEV GRMNT COVER A4467 78.90$

PROFESSIONAL A4550 SURGICAL TRAY A4550 104.40$

PROFESSIONAL A4561 PESSARY, RUBBER, ANY TYPE A4561 188.85$

PROFESSIONAL A4562 PESSARY, NON RUBBER, ANY TYPE A4562 188.15$

PROFESSIONAL A4565-CR CRADLE ARM SLING A4565 45.70$

PROFESSIONAL A4570 SPLINT A4570 45.70$

PROFESSIONAL A4570TE TENNIS ELBOW AIRCAST PNEUMATIC ARM BAND A4570 55.45$

PROFESSIONAL A4590 SPECIAL CASTING MATERIAL PER ROLL A4590 30.45$

PROFESSIONAL A4614 PEAK FLOW METER A4614 65.75$

PROFESSIONAL A4649 DRESSING SUPPLIES, MISC A4649 21.20$

PROFESSIONAL A5112 URINARY LEG BAG: LATEX A5112 80.50$

PROFESSIONAL A6021 PROMOGRAN PRISMA 28 CM A6021 82.65$

PROFESSIONAL A6196 CARRASORB ALGINATE DRESSING 4X4 A6196 34.80$

PROFESSIONAL A6197 AQUACEL Ag with Hydrofiber 4x4.7 A6197 38.10$

PROFESSIONAL A6198 AQUACEL ALGINATE BURN DRESSING 9X12 A6198 151.20$

PROFESSIONAL A6199 CALCIUM ALGINATE DRESSING ROPE A6199 34.80$

PROFESSIONAL A6203 COMPOSITE DRESSING 16 SQ IN OR < 000985 A6203 18.50$

PROFESSIONAL A6204 COMPOSITE DRESSING >16 SQ < OR = 48 SQ A6204 21.75$

PROFESSIONAL A6206 NU GAUZE A6206 18.50$

PROFESSIONAL A6209 CARRASMART FOAM DRESSING A6209 34.80$

PROFESSIONAL A6211 FOAM DRESSING, >48 SQ IN WO ADHESIVE BOR A6211 55.45$

PROFESSIONAL A6216 GAUZE,NON-IMPREG,NON-STER,PAD SZ>16 SQIN A6216 13.05$

PROFESSIONAL A6219 GAUZE,NON-IMPREG,W/ADHESIVE PAD SZ>16SQ A6219 15.25$

PROFESSIONAL A6222 GAUZE, IMPREG, NOT WATER/NS, </=16 A6222 12.00$

PROFESSIONAL A6242 DUODERM DRESSING A6242 19.55$

PROFESSIONAL A6250 SKIN SEALANTS, PROTECTANTS, MOISTURIZERS A6250 25.05$

PROFESSIONAL A6251SIL ABSORPT DRG <=16 SQ IN (MEPILE A6251 42.45$

PROFESSIONAL A6252 ABSORPT DRG >16 <=48 (MEPILEX A6252 30.45$

PROFESSIONAL A6253 ABSORPT DRG > 48 SQ IN (MEPILE A6253 38.10$

PROFESSIONAL A6257 TEGADERM DRESSING A6257 17.40$

PROFESSIONAL A6260 PURACYN PLUS SOLUTION 4OZ A6260 30.45$

PROFESSIONAL A6261 NU GEL HYDROGEL A6261 30.45$

PROFESSIONAL A6402 GAUZE, NON-IMPREG, STERILE, 16 IN/<, WO A6402 9.85$

PROFESSIONAL A6410 EYE PATCH, STERILE A6410 15.25$

PROFESSIONAL A6442 CONFORMING BANDAGE < 3 IN A6442 17.40$

PROFESSIONAL A6443 CONFORMING BANDAGE > 3 < 5"" A6443 17.40$

PROFESSIONAL A6444 CONFORM BAND N/S W>=5/YD 000907" A6444 17.40$

PROFESSIONAL A6445 CONFORM BAND S W <3/YD" A6445 10.60$

PROFESSIONAL A6448 ACE BANDAGE LESS THAN 3 IN A6448 14.15$

PROFESSIONAL A6449 ACE BANDAGE 3 OR 4 INCHES 000819 A6449 17.40$

PROFESSIONAL A6450 ACE BANDAGE 5 INCHES OR MORE A6450 19.55$

PROFESSIONAL A6456 VICOPASTE PB7 EA A6456 14.15$

PROFESSIONAL A6539 GC STOCKING WAISTLNGTH 18-30 A6539 448.00$

PROFESSIONAL A6545 MULTILAYER COMPRESSION DRESSING 30-50MM A6545 272.95$

PROFESSIONAL A6550 NEG PRES WOUND THER DRSG SET (VERSAFOAM) A6550 140.05$

PROFESSIONAL A9272-4X11 PICO DISP WOUND SUCT, DRSG/ACCESS 4X11 A9272 683.50$

PROFESSIONAL A9272-4X8 PICO DISP WOUND SUCT, DRSG/ACCESS 4X8 A9272 419.10$

PROFESSIONAL A9284 INCENTIVE SPIROMETER A9284 8.70$

PROFESSIONAL A9300 EAR PLUGS A9300 27.20$

PROFESSIONAL ACTICOAT ACTICOAT DRESSING A4649 266.45$

PROFESSIONAL ALLEVYN ALLEVYN DRESSING 4X4 A6209 52.20$

PROFESSIONAL BIAFINE BIAFINE OINTMENT A4649 22.85$

PROFESSIONAL BUNIONCUSH BUNION CUSHION - PEDIFIX 99070 67.40$

PROFESSIONAL DILATOR DILATOR FOR VAGINAL OR RECTAL (SET OF 4) 99070 31.85$

PROFESSIONAL E1637 HEMOSTATS EACH 000275 E1637 70.70$

PROFESSIONAL EAR SEEDS Ear Seeds - 24kt Gold Plated (Each) 99070 1.30$

PROFESSIONAL FEVERALL FEVERALL SUPPOSITORIES 120 MG 99070 22.85$

PROFESSIONAL J7301 SKYLA IUD J7301 1,561.55$

PROFESSIONAL P9612 CATHERIZATION FOR COLLECTION OF SPECIMEN P9612 25.05$

PROFESSIONAL PORT SUPPLIES USED FOR DRESSING CHANGE 99070 51.15$

2020-01




PROFESSIONAL Q4006 CAST SUPPLIES,LONG ARM 11YRS+, FIBERGLAS Q4006 216.40$

PROFESSIONAL Q4008 CAST SUP LONG ARM PED FIBERGLASS Q4008 65.25$

PROFESSIONAL Q4010 CAST SUPP,SHORT ARM CAST,11YRS+ FIBERGLA Q4010 143.55$

PROFESSIONAL Q4012 CAST SUP SHORT ARM PEDIATRIC FIBERGLASS Q4012 57.70$

PROFESSIONAL Q4016 CAST SUP GAUNTLET PED FBRGLS Q4016 70.70$

PROFESSIONAL Q4018 CAST SUP LNG ARM SPLINT ADULT FBRG Q4018 70.70$

PROFESSIONAL Q4021 CAST SUP,SHORT ARM SPLINT 11YRS+,PLASTER Q4021 92.45$

PROFESSIONAL Q4022 CAST SUP SHT ARM SPLINT FBRG (ADULT) Q4022 47.85$

PROFESSIONAL Q4024 CAST SUPP,SHRT ARM,PED.(0-10)FIBERGLASS Q4024 43.50$

PROFESSIONAL Q4030 CAST SUPPLIES,LONG LEG CAST,ADULT 11YR+ Q4030 289.30$

PROFESSIONAL Q4032 CAST SUPPLY LONG LEG PED FIBERGLASS Q4032 139.20$

PROFESSIONAL Q4036 CAST SUPPLY LONG LEG CYL PED FIBERGLASS Q4036 119.65$

PROFESSIONAL Q4037 CAST SUPPLIES,SHORT LEG CAST, ADULT 11+ Q4037 129.40$

PROFESSIONAL Q4038 CAST SUP SHRT LEG FIBERGLASS Q4038 84.80$

PROFESSIONAL Q4040 CAST SHRT LEG FIBERGLASS; PEDS Q4040 84.80$

PROFESSIONAL Q4046 CAST SUPP,SHORT LEG SPLINT,11YRS+(FIBERG Q4046 175.10$

PROFESSIONAL Q4048 CAST SUPPLIES,SHORT LEG SPLINT,0-10 YRS Q4048 129.40$

PROFESSIONAL Q4051 SPLINT SUPPLIES, MISCELLANEOUS Q4051 67.40$

PROFESSIONAL Q4107 GRAFTJACKET PER 1 SQ CM 008340 Q4107 3,262.25$

PROFESSIONAL Q4113 GRAFTJACKET XPRESS 1 CC 008341 Q4113 4,306.15$

PROFESSIONAL Q4163 WOUNDEX BIOSKIN PER SQ CM Q4163 3,373.65$

PROFESSIONAL S8265 HABERMAN FEED FOR CLEFT LIP/PALATE S8265 69.60$

PROFESSIONAL SLING SLING A4565 39.15$

PROFESSIONAL SURG TRAY SURGICAL TRAY - SUPPLIES USED 99070 116.40$

PROFESSIONAL TALCPW STERILE TALC POWDER 112.50$

PROFESSIONAL V5264 EAR MOLD/INSERT V5264 27.20$

PROFESSIONAL WBGCATH WORD BARTHOLIAN GLAND CATHETER 99070 576.35$

PROFESSIONAL 0232T PEAK PRP PLASMA SYSTEM PROCEDURE 0232T 273.00$

PROFESSIONAL 0232T-BIL PEAK PRP PLASMA SYSTEM PROCEDURE 0232T 545.00$

PROFESSIONAL 0437T IMPLTJ SYNTH RNFCMT ABDL WAL 0437T 675.00$

PROFESSIONAL 10004 FNA BX W/O IMG GDN EA ADDL 10004 54.00$

PROFESSIONAL 10005 FNA BX W/US GDN 1ST LES 10005 91.00$

PROFESSIONAL 10006 FNA BX W/US GDN EA ADDL 10006 62.00$

PROFESSIONAL 10007 FNA BX W/FLUOR GDN 1ST LES 10007 117.00$

PROFESSIONAL 10008 FNA BX W/FLUOR GDN EA ADDL 10008 76.00$

PROFESSIONAL 10009 FNA BX W/CT GDN 1ST LES 10009 142.00$

PROFESSIONAL 10010 FNA BX W/CT GDN EA ADDL 10010 104.00$

PROFESSIONAL 10021 FNA BX W/O IMG GDN 1ST LES 10021 317.00$

PROFESSIONAL 10030 GUIDE CATHET FLUID DRAINAGE 10030 1,433.00$

PROFESSIONAL 10040 ACNE SUGERY (OPEN. & REMOV. CYSTS, PUSTU 10040 225.00$

PROFESSIONAL 10060 DRAINAGE OF SKIN ABSCESS SMPL 10060 226.00$

PROFESSIONAL 10061 DRAINAGE OF SKIN ABSCESS CMPLX 10061 623.00$

PROFESSIONAL 10080 DRAIN OF PILONIDAL CYST SMPL 10080 276.00$

PROFESSIONAL 10081 DRAIN OF PILONIDAL CYST CMPLX 10081 683.00$

PROFESSIONAL 10120 REMOVE FOREIGN BODY SIMPLE 10120 383.00$

PROFESSIONAL 10121 REMOVE FOREIGN BODY COMPLEX 10121 677.00$

PROFESSIONAL 10140 DRAINAGE OF HEMATOMA/FLUID 10140 388.00$

PROFESSIONAL 10160 PUNCT ASP - ABSC,HEMAT,CYST 10160 233.00$

PROFESSIONAL 10180 COMPLEX DRAINAGE, WOUND 10180 1,009.00$

PROFESSIONAL 11000 DEBR EXZ/INF SKIN; 10% BS 11000 178.00$

PROFESSIONAL 11004 DEBRIDE NECROTIZING INF EXT GENITALIA 11004 2,042.00$

PROFESSIONAL 11005 DEBRIDE NECROTIZING INF ABD WALL 11005 2,782.00$

PROFESSIONAL 11006 DEBRIDE NECROTIC INF GENITALIA,PERI,ABD 11006 2,715.00$

PROFESSIONAL 11008 REMOVAL PROSTHETIC MESH ABD WALL(ADD ON) 11008 1,153.00$

PROFESSIONAL 11010 DEBRIDE SKIN, FX 11010 1,194.00$

PROFESSIONAL 11011 DEBRIDE SKIN/MUSCLE, FX 11011 1,311.00$

PROFESSIONAL 11012 DEBRIDE SKIN/MUSCLE/BONE, FX 11012 2,062.00$

PROFESSIONAL 11042 DEBRIDE; SKIN TO SQ TISS 11042 378.00$

PROFESSIONAL 11043 DEBRIDE; SKIN TO MUSCLE 11043 701.00$

PROFESSIONAL 11044 DEBRIDE; SKIN TO BONE 11044 997.00$

PROFESSIONAL 11045 DEB SUBQ TISSUE ADD-ON =<20 SQ CM 11045 87.00$

PROFESSIONAL 11046 DEB MUSC/FASCIA ADD-ON =<20 SQ CM 11046 156.00$

PROFESSIONAL 11047 DEB BONE ADD-ON =<20 SQ CM 11047 273.00$

PROFESSIONAL 11055 PARE BENIGN LES; SGL 11055 93.00$

PROFESSIONAL 11056 PARING OR CUTTING TWO TO FOUR 11056 109.00$

PROFESSIONAL 11057 PARING BENIGN LESSION MORE THAN 4 11057 136.00$

PROFESSIONAL 11102 TANGNTL BX SKIN SINGLE LES 11102 120.00$

PROFESSIONAL 11103 TANGNTL BX SKIN EA SEP/ADDL 11103 65.00$

2020-01




PROFESSIONAL 11104 PUNCH BX SKIN SINGLE LESION 11104 150.00$

PROFESSIONAL 11105 PUNCH BX SKIN EA SEP/ADDL 11105 74.00$

PROFESSIONAL 11106 INCAL BX SKN SINGLE LES 11106 182.00$

PROFESSIONAL 11107 INCAL BX SKN EA SEP/ADDL 11107 87.00$

PROFESSIONAL 11200 REMOVAL OF SKIN TAGS 11200 196.00$

PROFESSIONAL 11201 REMOVE SKIN TAGS ADD-ON 11201 102.00$

PROFESSIONAL 11300 SHAVE LES,T/A/L; 0.5CM/< 11300 156.00$

PROFESSIONAL 11301 SHAVE LES,T/A/L; 0.6-1.0CM 11301 194.00$

PROFESSIONAL 11302 SHAVE LES,T/A/L; 1.1-2.0CM 11302 249.00$

PROFESSIONAL 11303 SHAVE LES,T/A/L; > 2.0CM 11303 290.00$

PROFESSIONAL 11305 SHAVE SKIN LESION 11305 173.00$

PROFESSIONAL 11306 SHAVE LES,S/N/H/F/G;0.6-1.0 11306 211.00$

PROFESSIONAL 11307 SHAVE LES,S/N/H/F/G;1.1-2.0 11307 287.00$

PROFESSIONAL 11308 SHAVE LES,S/N/H/F/G;> 2.0CM 11308 350.00$

PROFESSIONAL 11310 SHAVE LES,F/E/N/L; 0.5CM/< 11310 182.00$

PROFESSIONAL 11311 SHAVE LES,F/E/N/L;0.6-1.0CM 11311 246.00$

PROFESSIONAL 11312 SHAVE LES,F/E/N/L; 1.1-2.0C 11312 284.00$

PROFESSIONAL 11313 SHAVE LES,F/E/N/L;>2.0CM 11313 353.00$

PROFESSIONAL 11400 EXC TR-EXT B9+MARG 0.5 < CM 11400 235.00$

PROFESSIONAL 11401 EXC, BEN LES,T/A/L; 0.6-1.0CM 11401 290.00$



PROFESSIONAL 11404 EXC, BEN LES,T/A/L;3.1-4.0CM 11404 542.00$

PROFESSIONAL 11406 EXC, BEN LES,T/A/L; >4.0CM 11406 775.00$

PROFESSIONAL 11420 EXC, BLES,S/N/EX,G;0.5CM/< 11420 250.00$

PROFESSIONAL 11421 EXC, BLES,S/N/EX,G;0.6-1.0CM 11421 313.00$




PROFESSIONAL 11426 EXC, BLES,S/N/EX,G;> 4.0CM 11426 920.00$

PROFESSIONAL 11440 EXC FACE-MM B9+MARG 0.5 < CM 11440 283.00$

PROFESSIONAL 11441 EXC FACE-MM B9+MARG 0.6-1 CM 11441 370.00$




PROFESSIONAL 11446 EXC FACE-MM B9+MARG > 4 CM 11446 971.00$

PROFESSIONAL 11450 REMOVAL, SWEAT GLAND LESION 11450 1,423.00$

PROFESSIONAL 11451 EXC HIDRAD AXIL; CPLX REP 11451 849.00$

PROFESSIONAL 11462 REMOVAL, SWEAT GLAND LESION 11462 1,264.00$

PROFESSIONAL 11470 EXC HIDRAD UMBIL; S/I REP 11470 856.00$

PROFESSIONAL 11600 REMOVAL OF SKIN LESION 11600 333.00$











PROFESSIONAL 11626 REMOVAL OF SKIN LESION 11626 1,059.00$







PROFESSIONAL 11719 TRIM NAIL(S) 11719 103.00$

PROFESSIONAL 11720 DEBRIDEMENT OF NAIL(S),ONE TO FIVE 11720 110.00$

PROFESSIONAL 11721 DEBRIDE NAIL(S); 6/> 11721 164.00$

PROFESSIONAL 11730 REMOVAL OF NAIL PLATE 11730 385.00$

PROFESSIONAL 11732 ADDITIONAL NAIL PLATE REMOVAL 11732 158.00$

PROFESSIONAL 11740 DRAIN BLOOD FROM UNDER NAIL 11740 194.00$

PROFESSIONAL 11750 REMOVAL OF NAIL BED 11750 631.00$

PROFESSIONAL 11755 BIOPSY OF NAIL UNIT 11755 535.00$

PROFESSIONAL 11760 REPAIR OF NAIL BED 11760 1,321.00$

PROFESSIONAL 11762 RECONSTRUCTION OF NAIL BED 11762 2,025.00$

2020-01




PROFESSIONAL 11765 WEDGE EXCISION OF SKIN OF NAIL FOLD 11765 273.00$

PROFESSIONAL 11770 REMOVAL OF PILONIDAL LESION 11770 1,403.00$

PROFESSIONAL 11771 REMOVAL OF PILONIDAL LESION 11771 2,415.00$

PROFESSIONAL 11772 EXCISION,PILONDIAL CYST COMPLICATED 11772 2,536.00$

PROFESSIONAL 11900 INJECTION INTO SKIN LESIONS 11900 131.00$

PROFESSIONAL 11976 REM IMPL CONTRACEP CAPS 11976 503.00$

PROFESSIONAL 11980 SQ HORMONE PELLET IMPL 11980 225.00$

PROFESSIONAL 11981 INSERT,NON-BIODEGRAD DRUG DELIVERY IMPLA 11981 372.00$

PROFESSIONAL 11982 REMOVE DRUG DELIVERY IMPLANT 11982 390.00$

PROFESSIONAL 11983 REMOVAL W/REINSERT-NON-BIODEGRAGE DRUG D 11983 798.00$

PROFESSIONAL 12001 REPAIR SUPERFICIAL WOUND(S) 12001 357.00$










PROFESSIONAL 12016 REPAIR SUPERFICIAL WOUND(S) 12016 1,171.00$

PROFESSIONAL 12017 REPAIR SUPERFICIAL WOUND(S) 12017 2,421.00$

PROFESSIONAL 12020 CLOSURE OF SPLIT WOUND 12020 716.00$

PROFESSIONAL 12021 CLOSURE OF SPLIT WOUND 12021 748.00$

PROFESSIONAL 12031 LAYER CLOSURE OF WOUND(S) 12031 459.00$



PROFESSIONAL 12035 LAYER CLOSURE OF WOUND(S) 12035 1,025.00$
















PROFESSIONAL 13100 REPAIR OF WOUND OR LESION 13100 708.00$

PROFESSIONAL 13101 REPAIR OF WOUND OR LESION 13101 1,130.00$

PROFESSIONAL 13102 C REP TRUNK; EA ADDTL 5 CM/< 13102 316.00$

PROFESSIONAL 13120 REPAIR OF WOUND OR LESION 13120 951.00$


PROFESSIONAL 13122 REPAIR WOUND/LESION ADD-ON 13122 406.00$



PROFESSIONAL 13133 REPAIR WOUND/LESION ADD-ON 13133 543.00$



PROFESSIONAL 13153 CREP E/N/E/L; EA ADDTL 5 CM/< 13153 670.00$

PROFESSIONAL 13160 LATE CLOSURE OF WOUND 13160 1,719.00$

PROFESSIONAL 14000 SKIN TISSUE REARRANGEMENT 14000 1,953.00$






PROFESSIONAL 14060 SKIN TISSUE REARRANGEMENT 10 CM OR LESS 14060 3,541.00$

PROFESSIONAL 14061 TISSUE TRANSFR/EYELID,E,N,LIP 10.1-30 CM 14061 4,045.00$


PROFESSIONAL 14302 SKIN TISSUE REARRANGE ADDL 30.0 SQ CM 14302 483.00$


PROFESSIONAL 15002 WND PREP, CH/INF, TRK/ARM/LG 15002 1,396.00$

2020-01




PROFESSIONAL 15003 WND PREP, CH/INF ADDL 100 CM 15003 275.00$

PROFESSIONAL 15004 WND PREP CH/INF, F/N/HF/G 15004 1,347.00$

PROFESSIONAL 15005 WND PREP, F/N/HF/G, ADDL CM 15005 467.00$

PROFESSIONAL 15040 HARVEST CULTURED SKIN GRAFT 15040 1,030.00$

PROFESSIONAL 15050 SKIN PINCH GRAFT 15050 1,805.00$

PROFESSIONAL 15100 SPLT THCK AUTOGRFT TO 100 SQCM TRNK,EXT 15100 2,422.00$

PROFESSIONAL 15101 SKIN SPLIT GRAFT ADD-ON 15101 1,351.00$

PROFESSIONAL 15115 EPIDRM A-GRFT FACE/NCK/HF/G 100 SQ CM/1% 15115 1,526.00$

PROFESSIONAL 15116 EPIDRM A-GRFT F/N/HF/G ADDL 100 SQ CM/1% 15116 362.00$

PROFESSIONAL 15120 SPLT THCK AUTOGRFT T0 100 SQCM,FACE,DIGI 15120 3,777.00$

PROFESSIONAL 15121 SKN SPLT A-GRFT F/N/HF/G ADDL 100 SQ CM 15121 805.00$

PROFESSIONAL 15130 DERM AUTOGRAFT, TRNK/ARM/LEG 15130 1,899.00$

PROFESSIONAL 15131 DERM AUTOGRAFT T/A/L ADD-ON 15131 322.00$

PROFESSIONAL 15135 DERM AUTOGRAFT FACE/NCK/HF/G100SQCM/1%BA 15135 2,029.00$

PROFESSIONAL 15200 SKIN FULL GRAFT 15200 2,019.00$

PROFESSIONAL 15201 FULL SKIN GRAFT,EA ADDITIONAL 20 SQ CM 15201 1,057.00$


PROFESSIONAL 15221 FTG S/A/L; EA ADDTL 20 SQ CM 15221 996.00$


PROFESSIONAL 15241 SKIN FULL GRAFT ADDL =<20 SQ CM 15241 426.00$


PROFESSIONAL 15271 SKIN SUB GRAFT TRNK/ARM/LEG 15271 259.00$

PROFESSIONAL 15272 SKIN SUB GRAFT T/A/L ADD-ON 15272 61.00$

PROFESSIONAL 15273 SKIN SUB GRFT T/ARM/LG CHILD 15273 519.00$

PROFESSIONAL 15274 SKN SUB GRFT T/A/L CHILD ADD 15274 166.00$

PROFESSIONAL 15275 SKIN SUB GRAFT FACE/NK/HF/G 15275 272.00$

PROFESSIONAL 15276 SKIN SUB GRAFT F/N/HF/G ADDL 15276 76.00$

PROFESSIONAL 15277 SKN SUB GRFT F/N/HF/G CHILD 15277 522.00$

PROFESSIONAL 15572 PEDICLE FLAP; SCALP/ARM/LEG 15572 1,779.00$

PROFESSIONAL 15574 FORM SKIN PEDICLE FLAP 15574 4,099.00$

PROFESSIONAL 15576 FORM SKIN PEDICLE FLAP 15576 3,804.00$

PROFESSIONAL 15610 DELAY FLAP; SCALP/ARM/LEG 15610 822.00$

PROFESSIONAL 15630 DELAY FLAP; EL/NS/ER/LIP 15630 1,992.00$

PROFESSIONAL 15650 TRANSFER SKIN PEDICLE FLAP 15650 2,946.00$

PROFESSIONAL 15731 FOREHEAD FLAP W/VASC PEDICLE 15731 3,668.00$

PROFESSIONAL 15733 MUSC MYOQ/FSCQ FLP H&N PEDCL 15733 6,651.00$

PROFESSIONAL 15734 MUSCLE-SKIN GRAFT, TRUNK 15734 8,344.00$

PROFESSIONAL 15736 MUSCLE-SKIN GRAFT, ARM 15736 7,231.00$

PROFESSIONAL 15738 MUSCLE-SKIN GRAFT, LEG 15738 7,231.00$

PROFESSIONAL 15757 FREE SKIN FLAP W ANAST 15757 8,451.00$

PROFESSIONAL 15760 COMPOSITE SKIN GRAFT 15760 3,968.00$

PROFESSIONAL 15777 ACELLULAR DERM MATRIX IMPLT 15777 557.00$

PROFESSIONAL 15780 ABRASION TREATMENT OF SKIN 15780 4,079.00$

PROFESSIONAL 15820 REVISION OF LOWER EYELID 15820 2,157.00$

PROFESSIONAL 15821 REVISION OF LOWER EYELID 15821 2,205.00$

PROFESSIONAL 15823 REVISION OF UPPER EYELID 15823 3,036.00$

PROFESSIONAL 15823-50 REVISION OF UPPER EYELID 15823-50 6,073.00$

PROFESSIONAL 15824 REMOVAL OF FOREHEAD WRINKLES 15824 4,079.00$

PROFESSIONAL 15828 REMOVAL OF FACE WRINKLES 15828 10,767.00$

PROFESSIONAL 15830 EXC SKIN ABD 15830 6,458.00$

PROFESSIONAL 15838 EXCISE EXCESSIVE SKIN TISSUE 15838 2,123.00$

PROFESSIONAL 15839 EXCISE EXCESSIVE SKIN TISSUE 15839 2,296.00$

PROFESSIONAL 15840 FFG - FACE NRV PARALYSIS 15840 3,256.00$

PROFESSIONAL 15845 REGION MT - FACE NRV PARALYSIS 15845 7,278.00$

PROFESSIONAL 15847 EXC SKIN ABD ADD ON 15847 1,576.00$

PROFESSIONAL 15850 REM SUTURE W AN; SS 15850 157.00$

PROFESSIONAL 15851 REMOVAL OF SUTURES 15851 303.00$

PROFESSIONAL 15852 DRESSING CHANGE,NOT FOR BURN 15852 434.00$

PROFESSIONAL 15877 SUCTION LIPECTOMY; TRUNK 15877 2,062.00$

PROFESSIONAL 15920 REMOVAL OF TAIL BONE ULCER 15920 3,287.00$

PROFESSIONAL 15931 EXCISION,SACRAL PRESSURE ULCER,W/PRI SUT 15931 2,073.00$

PROFESSIONAL 15933 REMOVE SACRUM PRESSURE SORE 15933 5,028.00$


PROFESSIONAL 15935 EXCISE SAC PRESS ULCER W SF OS 15935 2,927.00$


PROFESSIONAL 15940 REMOVE HIP PRESSURE SORE 15940 2,059.00$


PROFESSIONAL 15945 EXC I P ULCER, W OSTECTOMY 15945 3,580.00$

2020-01





PROFESSIONAL 15950 REMOVE THIGH PRESSURE SORE 15950 887.00$

PROFESSIONAL 15951 REMOVE THIGH PRESSURE SORE 15951 4,266.00$

PROFESSIONAL 15999WNDVC DEBRIDE; SKIN - WOUND VACCUM 15999 779.00$

PROFESSIONAL 16000 INIT TX 1ST DEGREE BURN, LOCAL TX 16000 194.00$

PROFESSIONAL 16020 TRTMT PARTIAL THICKNESS BURNS < 5% TBSA 16020 219.00$

PROFESSIONAL 16025 TRTMT BURNS 5%-10% TBSA 16025 370.00$

PROFESSIONAL 16030 TRTMNT BURNS LARGE >10% TBSA 16030 595.00$

PROFESSIONAL 16035 ESCHAROTOMY; INIT INC 16035 1,686.00$

PROFESSIONAL 17000 DESTROY BENIGN/PREMAL LESION 17000 146.00$

PROFESSIONAL 17003 DESTROY LESIONS, 2-14 17003 72.00$

PROFESSIONAL 17004 DESTROY LESIONS, 15 OR MORE 17004 646.00$

PROFESSIONAL 17107 DESTRUCT. VAS. LESION 10.0-50.0 SQ CM 17107 1,970.00$

PROFESSIONAL 17110 DESTRUCT LESION, 1-14 17110 192.00$

PROFESSIONAL 17111 DESTRUCT LESION, 15 OR MORE 17111 280.00$

PROFESSIONAL 17250 CHEMICAL CAUTERY, TISSUE 17250 152.00$

PROFESSIONAL 17260 DESTRUCTION OF SKIN LESIONS 17260 272.00$





PROFESSIONAL 17266 DESTROY MAL.LESION,TRUNK,ARM,LEG >4.0 CM 17266 714.00$













PROFESSIONAL 17340 CRYOTHERAPY OF SKIN 17340 209.00$

PROFESSIONAL 17380 HAIR REMOVAL BY ELECTROLYSIS 17380 270.00$

PROFESSIONAL 17999-KNEE KNEE BIOLOGIC IMPLANT FOR SOFT TISSUE 17999 557.00$

PROFESSIONAL 17999KNE50 KNEE BIOLOGIC IMPLANT FOR SOFT TISSUE 17999-50 1,114.00$

PROFESSIONAL 19000 PUNCT ASP BRST CYST - INITIAL 19000 234.00$

PROFESSIONAL 19001 DRAIN BREAST LESION ADD-ON 19001 181.00$

PROFESSIONAL 19020 INCISION OF BREAST LESION 19020 980.00$

PROFESSIONAL 19020-50 INCISION OF BREAST LESION 19020-50 1,958.00$

PROFESSIONAL 19081 BX BREAST 1ST LESION STRTCTC 19081 1,442.00$

PROFESSIONAL 19081-LT BX BREAST 1ST LESION STRTCTC (LEFT) 19081-LT 1,442.00$

PROFESSIONAL 19081-RT BX BREAST 1ST LESION STRTCTC (RIGHT) 19081-RT 1,442.00$

PROFESSIONAL 19082 BX BREAST ADD LESION STRTCTC 19082 1,164.00$

PROFESSIONAL 19082-26 STEREOTACTIC EA ADDL LESION 19082 1,164.00$

PROFESSIONAL 19083 BX BREAST 1ST LESION US IMAG 19083 1,433.00$

PROFESSIONAL 19083-LT BX BREAST 1ST LESION US IMAG (LEFT) 19083-LT 1,433.00$

PROFESSIONAL 19083-RT BX BREAST 1ST LESION US IMAG (RIGHT) 19083-RT 1,433.00$

PROFESSIONAL 19084 BX BREAST ADD LESION US IMAG 19084 1,148.00$

PROFESSIONAL 19085 BX BREAST 1ST LESION MR IMAG 19085 2,168.00$

PROFESSIONAL 19085-LT BX BREAST 1ST LESION MR IMAG (LEFT) 19085-LT 2,168.00$

PROFESSIONAL 19085-RT BX BREAST 1ST LESION MR IMAG (RIGHT) 19085-RT 2,168.00$

PROFESSIONAL 19086 BX BREAST ADD LESION MR IMAG 19086 1,728.00$

PROFESSIONAL 19100 BIOPSY OF BREAST 19100 747.00$

PROFESSIONAL 19101 BIOPSY OF BREAST 19101 1,571.00$

PROFESSIONAL 19110 NIPPLE EXPLORATION,W/WO EXCISION OF DUCT 19110 1,501.00$

PROFESSIONAL 19120 REMOVAL OF BREAST LESION 19120 1,494.00$

PROFESSIONAL 19120-50 EXCISION OF BREAST LESION BIL 19120-50 2,987.00$

PROFESSIONAL 19125 EXCISION, BREAST LESION 19125 1,552.00$

PROFESSIONAL 19126 EXCISION BREAST EA ADD LESION SEPARATELY 19126 796.00$

PROFESSIONAL 19260 REMOVAL OF CHEST WALL LESION 19260 4,111.00$

PROFESSIONAL 19281 PERQ DEVICE BREAST 1ST IMAG 19281 348.00$

PROFESSIONAL 19282 PERQ DEVICE BREAST EA IMAG 19282 176.00$

PROFESSIONAL 19283 PERQ DEV BREAST 1ST STRTCTC 19283 348.00$

PROFESSIONAL 19284 PERQ DEV BREAST ADD STRTCTC 19284 348.00$

PROFESSIONAL 19284-26 PERQ DEV BREAST ADD STRTCTC 19284-26 341.00$

2020-01




PROFESSIONAL 19285 PERQ DEV BREAST 1ST US IMAG 19285 311.00$

PROFESSIONAL 19286 PERQ DEV BREAST ADD US IMAG 19286 273.00$

PROFESSIONAL 19287 PERQ DEV BREAST 1ST MR GUIDE 19287 564.00$

PROFESSIONAL 19288 PERQ DEV BREAST ADD MR GUIDE 19288 215.00$

PROFESSIONAL 19300 MASTECTOMY FOR GYNECOMASTIA 19300 2,863.00$

PROFESSIONAL 19301 MASTECTOMY, PARTIAL 19301 2,219.00$

PROFESSIONAL 19301-50 PARTIAL MASTECTOMY 19301-50 4,437.00$

PROFESSIONAL 19302 MASTECTOMY, PARTIAL W AXILLARY LYMPHADEN 19302 5,531.00$

PROFESSIONAL 19303 MASTECTOMY, SIMPLE, COMPLETE 19303 3,357.00$

PROFESSIONAL 19303-50 MASTECTOMY, SIMPLE, COMPLETE 19303-50 3,357.00$

PROFESSIONAL 19304 MASTECTOMY, SUBCUTANEOUS 19304 3,570.00$

PROFESSIONAL 19305 MAST, RADICAL 19305 4,628.00$

PROFESSIONAL 19307 MAST, MOD RAD 19307 4,692.00$

PROFESSIONAL 19316 MASTOPEXY 19316 2,377.00$

PROFESSIONAL 19316-50 MASTOPEXY 19316-50 2,377.00$

PROFESSIONAL 19318 REDUCTION MAMMAPLASTY 19318 3,579.00$

PROFESSIONAL 19318-50 REDUCTION MAMMAPLASTY 19318-50 6,951.00$

PROFESSIONAL 19328 REM MAMMARY IMPLANT 19328 2,350.00$

PROFESSIONAL 19328-50 REM MAMMARY IMPLANT 19328-50 3,527.00$

PROFESSIONAL 19330 REM MAMMARY IMPL MATERIAL 19330 1,694.00$

PROFESSIONAL 19340 IM INS BREAST PROSTH S/P M 19340 2,349.00$

PROFESSIONAL 19340-50 IM INS BREAST PROSTH S/P M 19340-50 2,349.00$

PROFESSIONAL 19342 DLY INS BREAST PROSTH S/P M 19342 2,259.00$

PROFESSIONAL 19342-50 DLY INS BREAST PROSTH S/P M 19342-50 3,388.00$

PROFESSIONAL 19357 BREAST RECONST W TISS EXP 19357 4,149.00$

PROFESSIONAL 19357-50 BREAST RECONST W TISS EXP 19357-50 8,299.00$

PROFESSIONAL 19371 PERIPROSTH CAPSULECT BREAST 19371 2,303.00$

PROFESSIONAL 19371-50 PERIPROSTH CAPSULECT BREAST 19371-50 4,425.00$

PROFESSIONAL 19380 REVISE RECONSTR BREAST 19380 2,436.00$

PROFESSIONAL 19380-50 REVISE RECONSTR BREAST 19380-50 4,640.00$

PROFESSIONAL 19499 BREAST SURGERY PROCEDURE 19499 1,561.00$

PROFESSIONAL 20100 EXPLORE WOUND, NECK 20100 3,715.00$

PROFESSIONAL 20101 EXPL PENETRATING WND; CHEST 20101 1,585.00$

PROFESSIONAL 20102 WOUND EXPLORATION ABDOMEN FLANK BACK 20102 1,622.00$

PROFESSIONAL 20103 EXPL P WND; EXTREM 20103 1,686.00$

PROFESSIONAL 20200 MUSCLE BIOPSY 20200 663.00$

PROFESSIONAL 20205 DEEP MUSCLE BIOPSY 20205 1,022.00$

PROFESSIONAL 20206 NEEDLE BIOPSY, MUSCLE 20206 453.00$

PROFESSIONAL 20220 BONE BIOPSY, TROCAR/NEEDLE 20220 593.00$

PROFESSIONAL 20225 BONE BIOPSY, TROCAR/NEEDLE, DEEP 20225 1,203.00$

PROFESSIONAL 20240 BONE BIOPSY OPEN SUPERFICIAL 20240 1,389.00$

PROFESSIONAL 20245 BONE BIOPSY OPEN DEEP 20245 2,099.00$

PROFESSIONAL 20501 SINUS TRACT INJ;DX 20501 180.00$

PROFESSIONAL 20520 REMOVAL FOREIGN BODY SIMPLE 20520 585.00$

PROFESSIONAL 20525 REMOVAL FOREIGN BODY COMPLEX 20525 1,324.00$

PROFESSIONAL 20526 INJECTION, THERAPEUTIC, CARPAL TUNNEL 20526 254.00$

PROFESSIONAL 20526-50 INJ,THERAPEUTIC, CARPAL TUNNEL BILATERAL 20526-50 509.00$

PROFESSIONAL 20527 INJ DUPUYTREN CORD W/ENZYME 20527 193.00$

PROFESSIONAL 20527-50 INJ DUPUYTREN CORD W/ENZYME BILATERAL 20527-50 382.00$

PROFESSIONAL 20550 INJECT TENDON/LIGAMENT/CYST 20550 243.00$

PROFESSIONAL 20550-50 INJECT TENDON/LIGAMENT/CYST BILATERAL 20550-50 485.00$

PROFESSIONAL 20551 INJECTION, TENDON ORIGIN/INSERTION 20551 215.00$

PROFESSIONAL 20552 INJ, SING/MULT TRIGGER POINT(S) 1/2 GRPS 20552 215.00$

PROFESSIONAL 20553 INJ, SING/MULT TRIGGER POINT(S) 3+ GRPS 20553 215.00$

PROFESSIONAL 20600 DRAIN/INJECT, JOINT/BURSA 20600 199.00$

PROFESSIONAL 20600-50 DRAIN/INJ JOINT/BURSA W/O US BILATERAL 20600-50 397.00$

PROFESSIONAL 20604 DRAIN/INJ JOINT/BURSA W/US 20604 194.00$

PROFESSIONAL 20604-50 DRAIN/INJ JOINT/BURSA W/US BILATERAL 20604-50 387.00$


PROFESSIONAL 20605-50 DRAIN/INJECT, JOINT/BURSA BILATERAL 20605-50 416.00$

PROFESSIONAL 20606 DRAIN/INJ JOINT BURSA W/US 20606 251.00$

PROFESSIONAL 20606-50 DRAIN/INJ JOINT/BURSA W/US BILATERAL 20606-50 503.00$


PROFESSIONAL 20610-50 DRAIN/INJECT, JOINT/BURSA, BILATERAL 20610-50 493.00$

PROFESSIONAL 20611 DRAIN/INJ JOINT/BURSA W/US 20611 379.00$

PROFESSIONAL 20611-50 DRAIN/INJ JOINT/BURSA W/US 20611-50 757.00$

PROFESSIONAL 20612 ASPIRATION AND/OR INJ OF GANGLION CYST 20612 207.00$

PROFESSIONAL 20615 TREATMENT OF BONE CYST 20615 728.00$

2020-01




PROFESSIONAL 20650 INSERT AND REMOVE BONE PIN 20650 634.00$

PROFESSIONAL 20660 APPLY,REMOVE FIXATION DEVICE 20660 1,626.00$

PROFESSIONAL 20661 APPLICATION OF HEAD BRACE 20661 2,069.00$

PROFESSIONAL 20663 APPLICATION OF THIGH BRACE 20663 1,385.00$

PROFESSIONAL 20670 REMOVAL OF SUPPORT IMPLANT 20670 1,544.00$

PROFESSIONAL 20680 REMOVAL OF SUPPORT IMPLANT;DEEP 20680 1,514.00$

PROFESSIONAL 20690 APPLY BONE FIXATION DEVICE 20690 3,631.00$

PROFESSIONAL 20692 APPLY BONE FIXATION DEVICE >1 PLANE 20692 2,443.00$

PROFESSIONAL 20694 REMOVAL,U/ANESTH,OF EXT FIXATION SYSTEM 20694 1,555.00$

PROFESSIONAL 20900 REMOVAL OF BONE FOR GRAFT 20900 1,146.00$

PROFESSIONAL 20902 REMOVAL OF BONE FOR GRAFT 20902 2,978.00$

PROFESSIONAL 20912 CARTILAGE FRAFT; N SEPTUM 20912 1,894.00$

PROFESSIONAL 20924 DISTANCE TENDON GRAFT 20924 1,702.00$

PROFESSIONAL 20926 TISSUE GRAFTS, OTHER 20926 1,553.00$

PROFESSIONAL 20950 FLUID PRESSURE, MUSCLE 20950 432.00$

PROFESSIONAL 20974 ELECTRICAL BONE STIMULATION 20974 1,354.00$

PROFESSIONAL 20975 ELECTRICAL BONE STIMULATION 20975 2,402.00$

PROFESSIONAL 20999-BMA BONE MARROW ASPIRATION 20999 87.00$

PROFESSIONAL 20999BMA50 BONE MARROW ASPIRATION BIL 20999-50 174.00$

PROFESSIONAL 21011 EXC FACE LES SC < 2 CM 21011 846.00$

PROFESSIONAL 21012 EXC FACE FACE LES SC = 2 CM 21012 1,188.00$

PROFESSIONAL 21013 EXC FACE TUM DEEP < 2 CM 21013 1,722.00$

PROFESSIONAL 21014 EXC FACE TUM DEEP = 2 cm 21014 1,648.00$

PROFESSIONAL 21029 CONTOUR B TUMOR FACE 21029 1,939.00$

PROFESSIONAL 21141 RECONSTRUCT MIDFACE, LEFORT 21141 9,133.00$

PROFESSIONAL 21181 RECONSTRUCT CONTOUR BENIGN TUMOR CRANIAL 21181 2,616.00$

PROFESSIONAL 21196 RECONSTRUCT LOWER JAW BONE 21196 11,555.00$

PROFESSIONAL 21235 EAR CARTILAGE GRAFT 21235 3,760.00$

PROFESSIONAL 21310 TREATMENT OF NOSE FRACTURE 21310 589.00$

PROFESSIONAL 21315 TREATMENT OF NOSE FRACTURE 21315 946.00$

PROFESSIONAL 21320 TREATMENT OF NOSE FRACTURE 21320 1,635.00$




PROFESSIONAL 21336 TREAT NASAL SEPTAL FRACTURE 21336 2,876.00$

PROFESSIONAL 21337 TREAT NASAL SEPTAL FRACTURE 21337 1,629.00$

PROFESSIONAL 21338 TREAT NASOETHMOID FRACTURE 21338 4,889.00$

PROFESSIONAL 21339 TREAT NASOETHMOID FRACTURE 21339 5,599.00$

PROFESSIONAL 21346 TREAT NOSE/JAW FRACTURE 21346 6,953.00$

PROFESSIONAL 21356 TREAT CHEEK BONE FRACTURE 21356 3,272.00$



PROFESSIONAL 21385 TREAT EYE SOCKET FRACTURE 21385 6,895.00$





PROFESSIONAL 21421 TREAT MOUTH ROOF FRACTURE 21421 3,477.00$

PROFESSIONAL 21422 TREAT MOUTH ROOF FRACTURE 21422 4,637.00$

PROFESSIONAL 21432 TREAT CRANIOFACIAL FRACTURE 21432 5,487.00$



PROFESSIONAL 21440 TREAT DENTAL RIDGE FRACTURE 21440 1,918.00$

PROFESSIONAL 21450 TREAT LOWER JAW FRACTURE 21450 1,918.00$

PROFESSIONAL 21470 TREAT LOWER JAW FRACTURE 21470 7,875.00$

PROFESSIONAL 21501 DRAIN NECK/CHEST LESION 21501 1,384.00$

PROFESSIONAL 21510 DRAINAGE OF BONE LESION 21510 1,657.00$

PROFESSIONAL 21550 BIOPSY OF NECK/CHEST 21550 561.00$

PROFESSIONAL 21552 EXC NECK LES SC = 3 CM 21552 1,186.00$

PROFESSIONAL 21554 EXC NECK TUM DEEP = 5 CM 21554 2,601.00$

PROFESSIONAL 21555 REMOVE LESION, NECK/CHEST 21555 1,137.00$

PROFESSIONAL 21556 REMOVE LESION, NECK/CHEST 21556 1,826.00$

PROFESSIONAL 21600 PARTIAL REMOVAL OF RIB 21600 2,311.00$

PROFESSIONAL 21627 STERNAL DEBRIDEMENT 21627 4,679.00$

PROFESSIONAL 21720 DIVIDE SCM; W/O CAST 21720 2,045.00$

PROFESSIONAL 21725 REVISION OF NECK MUSCLE 21725 2,952.00$

PROFESSIONAL 21820 TREAT STERNUM FRACTURE 21820 861.00$

PROFESSIONAL 21825 TREAT STERNUM FRACTURE 21825 4,194.00$

2020-01




PROFESSIONAL 21920 BIOPSY SOFT TISSUE OF BACK 21920 380.00$

PROFESSIONAL 21930 REMOVE LESION, BACK OR FLANK 21930 1,890.00$

PROFESSIONAL 21931 EXC BACK LES SC = 3 CM 21931 1,521.00$

PROFESSIONAL 21932 EXC BACK TUM DEEP < 5 CM 21932 1,986.00$

PROFESSIONAL 21933 EXC BACK TUM DEEP = 5 CM 21933 2,410.00$

PROFESSIONAL 21936 RESECT BACK TUM 5CM/> 21936 4,128.00$

PROFESSIONAL 22015 I&D P-SPINE L/S/LS 22015 2,380.00$

PROFESSIONAL 22310 TREATMENT OF VERT FX CLSD 22310 2,281.00$

PROFESSIONAL 22315 TREAT SPINE FRACTURE 22315 3,105.00$

PROFESSIONAL 22325 TREAT SPINE FRACTURE 22325 7,703.00$

PROFESSIONAL 22326 TREAT NECK SPINE FRACTURE 22326 9,275.00$

PROFESSIONAL 22612 LUMBAR SPINE FUSION 22612 9,932.00$

PROFESSIONAL 22855 REMOVE SPINE FIXATION DEVICE 22855 9,624.00$

PROFESSIONAL 22900 REMOVE ABDOMINAL WALL LESION 22900 2,160.00$

PROFESSIONAL 22901 EXC ABDL TUM DEEP 5 CM/> 22901 1,635.00$

PROFESSIONAL 22902 EXC ABD LES SC < 3 CM 22902 1,041.00$

PROFESSIONAL 22903 EXC ABD LES SC > 3 CM 22903 1,250.00$

PROFESSIONAL 22905 RAD RESECT ABD TUMOR 5 CM/> 22905 3,159.00$

PROFESSIONAL 22999-EXPL UNLISTED ABD,MUSCULOSKEL EXPLORATION 22999 1,622.00$

PROFESSIONAL 23000 REMOVAL OF CALCIUM DEPOSITS 23000 2,740.00$

PROFESSIONAL 23020 RELEASE SHOULDER JOINT 23020 4,777.00$

PROFESSIONAL 23030 DRAIN SHOULDER LESION 23030 1,317.00$

PROFESSIONAL 23035 INCISION, BONE CORTEX, SHOULDER AREA 23035 2,964.00$

PROFESSIONAL 23040 EXPLORATORY SHOULDER SURGERY 23040 4,777.00$

PROFESSIONAL 23044 EXPLORATORY SHOULDER SURGERY 23044 3,406.00$

PROFESSIONAL 23065 BIOPSY SHOULDER TISSUES 23065 587.00$

PROFESSIONAL 23066 BIOPSY SHOULDER TISSUES 23066 1,384.00$

PROFESSIONAL 23071 EXC SHOULDER LES SC > 3 CM 23071 1,578.00$

PROFESSIONAL 23073 EXC SHOULDER TUM DEEP > 5 CM 23073 2,581.00$

PROFESSIONAL 23075 REMOVAL OF SHOULDER LESION 23075 890.00$

PROFESSIONAL 23076 REMOVAL OF SHOULDER LESION 23076 2,233.00$

PROFESSIONAL 23100 BIOPSY OF SHOULDER JOINT 23100 4,777.00$

PROFESSIONAL 23101 SHOULDER JOINT SURGERY 23101 4,777.00$

PROFESSIONAL 23105 REMOVE SHOULDER JOINT LINING 23105 7,532.00$

PROFESSIONAL 23106 INCISION OF COLLARBONE JOINT 23106 5,028.00$

PROFESSIONAL 23120 PARTIAL REMOVAL, COLLAR BONE 23120 2,268.00$

PROFESSIONAL 23125 REMOVAL OF COLLAR BONE 23125 6,694.00$

PROFESSIONAL 23130 REMOVE SHOULDER BONE, PART 23130 3,348.00$

PROFESSIONAL 23140 REMOVAL OF BONE LESION 23140 3,131.00$

PROFESSIONAL 23145 REMOVAL OF BONE LESION 23145 4,691.00$

PROFESSIONAL 23150 REMOVAL OF HUMERUS LESION 23150 5,028.00$

PROFESSIONAL 23155 REMOVAL OF HUMERUS LESION 23155 6,281.00$

PROFESSIONAL 23170 REMOVE COLLAR BONE LESION 23170 3,771.00$

PROFESSIONAL 23180 REMOVE COLLAR BONE LESION 23180 3,144.00$

PROFESSIONAL 23182 REMOVE SHOULDER BLADE LESION 23182 2,624.00$

PROFESSIONAL 23184 REMOVE HUMERUS LESION 23184 4,045.00$

PROFESSIONAL 23195 REMOVAL OF HEAD OF HUMERUS 23195 6,281.00$

PROFESSIONAL 23200 REMOVAL OF COLLAR BONE 23200 5,028.00$

PROFESSIONAL 23210 REMOVAL OF SHOULDER BLADE 23210 6,694.00$

PROFESSIONAL 23220 PARTIAL REMOVAL OF HUMERUS 23220 6,694.00$

PROFESSIONAL 23330 REMOVE SHOULDER FOREIGN BODY 23330 1,052.00$

PROFESSIONAL 23350 SHOULDER ARTHROGRAM INJ 23350 393.00$

PROFESSIONAL 23405 TENOMYOTOMY SHOULDER; SINGLE 23405 1,797.00$

PROFESSIONAL 23410 REPAIR OF TENDON(S) 23410 5,865.00$

PROFESSIONAL 23412 REPAIR OF TENDON(S) 23412 6,152.00$

PROFESSIONAL 23415 RELEASE OF SHOULDER LIGAMENT 23415 4,738.00$

PROFESSIONAL 23420 REPAIR OF SHOULDER 23420 7,919.00$

PROFESSIONAL 23430 REPAIR BICEPS TENDON 23430 5,902.00$

PROFESSIONAL 23440 REMOVE/TRANSPLANT TENDON 23440 5,902.00$

PROFESSIONAL 23450 REPAIR SHOULDER CAPSULE 23450 5,983.00$






PROFESSIONAL 23470 RECONSTRUCT SHOULDER JOINT 23470 8,370.00$

PROFESSIONAL 23472 RECONSTRUCT SHOULDER JOINT 23472 12,261.00$

PROFESSIONAL 23473 REVIS RECONST SHOULDER JOINT 23473 4,387.00$

2020-01




PROFESSIONAL 23474 REVIS RECONST SHOULDER JOINT 23474 4,608.00$

PROFESSIONAL 23480 REVISION OF COLLAR BONE 23480 4,194.00$

PROFESSIONAL 23485 REVISION OF COLLAR BONE 23485 4,582.00$

PROFESSIONAL 23500 TREAT CLAVICLE FRACTURE 23500 785.00$

PROFESSIONAL 23505 TREAT CLAVICLE FRACTURE 23505 1,198.00$

PROFESSIONAL 23515 TREAT CLAVICLE FRACTURE 23515 4,246.00$

PROFESSIONAL 23520 TREAT CLAVICLE DISLOCATION 23520 1,015.00$



PROFESSIONAL 23540 TREAT CLAVICLE DISLOCATION 23540 632.00$



PROFESSIONAL 23552 OP TX ACLAV DISLOC W GRAFT 23552 2,243.00$

PROFESSIONAL 23570 TREAT SHOULDER BLADE FX 23570 818.00$

PROFESSIONAL 23575 TREAT SHOULDER BLADE FX 23575 1,265.00$

PROFESSIONAL 23585 TREAT SCAPULA FRACTURE 23585 5,041.00$

PROFESSIONAL 23600 TREAT HUMERUS FRACTURE 23600 1,044.00$




PROFESSIONAL 23620 TREAT HUMERUS FRACTURE 23620 981.00$



PROFESSIONAL 23650 TREAT SHOULDER DISLOCATION 23650 995.00$

PROFESSIONAL 23655 TREAT SHOULDER DISLOCATION 23655 1,592.00$

PROFESSIONAL 23660 TREAT SHOULDER DISLOCATION 23660 4,817.00$

PROFESSIONAL 23665 TREAT DISLOCATION/FRACTURE 23665 1,683.00$




PROFESSIONAL 23700 FIXATION OF SHOULDER 23700 1,557.00$

PROFESSIONAL 23800 FUSION OF SHOULDER JOINT 23800 8,370.00$

PROFESSIONAL 23802 FUSION OF SHOULDER JOINT 23802 9,560.00$

PROFESSIONAL 23900 AMPUTATION OF ARM & GIRDLE 23900 10,673.00$

PROFESSIONAL 23920 AMPUTATION AT SHOULDER JOINT 23920 7,953.00$

PROFESSIONAL 23930 DRAINAGE OF ARM LESION 23930 1,421.00$

PROFESSIONAL 23931 DRAINAGE OF ARM BURSA 23931 1,280.00$

PROFESSIONAL 23935 DRAIN ARM/ELBOW BONE LESION 23935 2,835.00$

PROFESSIONAL 24000 EXPLORATORY ELBOW SURGERY 24000 3,929.00$

PROFESSIONAL 24006 CAPSULAR RELEASE - ELBOW 24006 2,009.00$

PROFESSIONAL 24065 BIOPSY ARM/ELBOW SOFT TISSUE 24065 432.00$

PROFESSIONAL 24066 BIOPSY ARM/ELBOW SOFT TISSUE 24066 1,683.00$

PROFESSIONAL 24071 EXC ARM/ELBOW LES SC = 3 CM 24071 1,176.00$

PROFESSIONAL 24073 EX ARM/ELBOW TUM DEEP > 5 CM 24073 2,476.00$

PROFESSIONAL 24075 REMOVE ARM/ELBOW LESION 24075 1,248.00$

PROFESSIONAL 24076 REMOVE ARM/ELBOW LESION 24076 2,268.00$

PROFESSIONAL 24100 BIOPSY ELBOW JOINT LINING 24100 3,014.00$

PROFESSIONAL 24101 EXPLORE/TREAT ELBOW JOINT 24101 3,891.00$

PROFESSIONAL 24102 REMOVE ELBOW JOINT LINING 24102 2,091.00$

PROFESSIONAL 24105 REMOVAL OF ELBOW BURSA 24105 2,312.00$

PROFESSIONAL 24110 REMOVE HUMERUS LESION 24110 4,246.00$

PROFESSIONAL 24115 REMOVE/GRAFT BONE LESION 24115 5,669.00$

PROFESSIONAL 24120 REMOVE ELBOW LESION 24120 3,886.00$


PROFESSIONAL 24130 REMOVAL OF HEAD OF RADIUS 24130 3,561.00$

PROFESSIONAL 24134 REMOVAL OF ARM BONE LESION 24134 5,028.00$

PROFESSIONAL 24138 REMOVE ELBOW BONE LESION 24138 4,246.00$

PROFESSIONAL 24140 PARTIAL REMOVAL OF ARM BONE 24140 4,246.00$

PROFESSIONAL 24147 PARTIAL REMOVAL OF ELBOW 24147 2,835.00$

PROFESSIONAL 24149 RADICAL RESECTION OF ELBOW 24149 5,444.00$

PROFESSIONAL 24150 EXTENSIVE HUMERUS SURGERY 24150 7,116.00$

PROFESSIONAL 24152 EXTENSIVE RADIUS SURGERY 24152 7,774.00$

PROFESSIONAL 24160 REMOVE ELBOW JOINT IMPLANT 24160 3,891.00$

PROFESSIONAL 24164 REMOVE RADIUS HEAD IMPLANT 24164 3,537.00$

PROFESSIONAL 24200 REMOVAL OF ARM FOREIGN BODY 24200 661.00$

PROFESSIONAL 24201 DEEP REM FB FROM UA/ELBOW 24201 1,092.00$

PROFESSIONAL 24301 MUSCLE/TENDON TRANSFER 24301 5,865.00$

PROFESSIONAL 24305 ARM TENDON LENGTHENING 24305 2,126.00$

2020-01




PROFESSIONAL 24330 REVISION OF ARM MUSCLES 24330 4,246.00$

PROFESSIONAL 24340 REPAIR OF BICEPS TENDON 24340 5,865.00$

PROFESSIONAL 24341 REPAIR ARM TENDON/MUSCLE 24341 4,811.00$

PROFESSIONAL 24342 REPAIR OF RUPTURED TENDON 24342 5,865.00$

PROFESSIONAL 24343 REPR ELBOW LAT LIGMNT W/TISS 24343 2,128.00$

PROFESSIONAL 24345 REPR ELBW MED LIGMNT W LCL TISS 24345 1,983.00$

PROFESSIONAL 24357 REPAIR ELBOW, PERC 24357 1,483.00$

PROFESSIONAL 24358 REPAIR ELBOW W/DEB, OPEN 24358 1,739.00$

PROFESSIONAL 24359 REPAIR ELBOW DEB/ATTCH OPEN 24359 2,131.00$

PROFESSIONAL 24360 RECONSTRUCT ELBOW JOINT 24360 9,206.00$

PROFESSIONAL 24365 RECONSTRUCT HEAD OF RADIUS 24365 3,289.00$

PROFESSIONAL 24366 RECONSTRUCT HEAD OF RADIUS 24366 4,607.00$

PROFESSIONAL 24400 REVISION OF HUMERUS 24400 5,696.00$



PROFESSIONAL 24430 REPAIR OF HUMERUS 24430 7,116.00$

PROFESSIONAL 24435 REPAIR HUMERUS WITH GRAFT 24435 8,368.00$

PROFESSIONAL 24470 REVISION OF ELBOW JOINT 24470 5,516.00$

PROFESSIONAL 24495 DECOMPRESSION OF FOREARM 24495 5,028.00$

PROFESSIONAL 24498 NAIL, PIN OR WIRE HUMERUS 24498 2,728.00$












PROFESSIONAL 24566 PERC FIX EP HUMERUS FX W MANIP 24566 1,597.00$





PROFESSIONAL 24582 PERC SK FIX HUMERAL C FX; W MANIP 24582 1,661.00$

PROFESSIONAL 24586 OP TX ELBOW PA FX/DISLOC 24586 2,990.00$

PROFESSIONAL 24587 TREAT ELBOW FRACTURE 24587 6,685.00$

PROFESSIONAL 24600 TREAT ELBOW DISLOCATION 24600 1,083.00$





PROFESSIONAL 24640 TREAT ELBOW DISLOCATION 24640 773.00$

PROFESSIONAL 24650 TREAT RADIUS FRACTURE 24650 696.00$

PROFESSIONAL 24650-50 TREAT RADIUS FRACTURE 24650-50 696.00$

PROFESSIONAL 24655 TREAT RADIUS FRACTURE 24655 1,252.00$



PROFESSIONAL 24670 TREAT ULNAR FRACTURE 24670 845.00$

PROFESSIONAL 24675 TREAT ULNAR FRACTURE 24675 1,403.00$

PROFESSIONAL 24685 TREAT ULNAR FRACTURE 24685 4,258.00$

PROFESSIONAL 24900 AMPUTATION OF UPPER ARM 24900 4,194.00$

PROFESSIONAL 24920 AMPUTATION OF UPPER ARM 24920 3,815.00$

PROFESSIONAL 24925 AMPUTATION FOLLOW-UP SURGERY 24925 1,304.00$

PROFESSIONAL 25000 INCISION OF TENDON SHEATH 25000 1,703.00$

PROFESSIONAL 25001 INC FTS WRIST 25001 1,058.00$



PROFESSIONAL 25024 DECOMPR FARM/WRIST, FLEX & EXT 25024 2,521.00$

PROFESSIONAL 25028 DEEP I&D ABSC - FARM/WRIST 25028 1,683.00$

PROFESSIONAL 25035 TREAT FOREARM BONE LESION 25035 1,831.00$

PROFESSIONAL 25040 EXPLORE/TREAT WRIST JOINT 25040 2,712.00$

PROFESSIONAL 25065 BIOPSY FOREARM SOFT TISSUES 25065 550.00$

PROFESSIONAL 25066 BIOPSY FOREARM SOFT TISSUES 25066 1,304.00$

PROFESSIONAL 25071 EXC FOREARM LES SC > 3 CM 25071 1,188.00$

PROFESSIONAL 25073 EXC FOREARM TUM DEEP = 3 CM 25073 1,521.00$

2020-01




PROFESSIONAL 25075 REMOVAL OF FOREARM LESION 25075 1,203.00$

PROFESSIONAL 25075-50 REMOVAL OF FOREARM LESION 25075-50 1,203.00$


PROFESSIONAL 25077 RESECT FOREARM/WRIST TUM<3CM 25077 2,277.00$

PROFESSIONAL 25085 INCISION OF WRIST CAPSULE 25085 3,531.00$

PROFESSIONAL 25101 EXPLORE/TREAT WRIST JOINT 25101 3,064.00$

PROFESSIONAL 25105 REMOVE WRIST JOINT LINING 25105 3,358.00$

PROFESSIONAL 25107 REMOVE WRIST JOINT CARTILAGE 25107 3,357.00$

PROFESSIONAL 25110 REMOVE WRIST TENDON LESION 25110 1,358.00$

PROFESSIONAL 25111 REMOVE WRIST TENDON LESION 25111 1,771.00$

PROFESSIONAL 25112 REREMOVE WRIST TENDON LESION 25112 2,148.00$

PROFESSIONAL 25115 REMOVE WRIST/FOREARM LESION 25115 4,194.00$

PROFESSIONAL 25115-50 REMOVE WRIST/FOREARM LESION BILATERAL 25115-50 8,386.00$

PROFESSIONAL 25116 RAD EXC WRIST/FARM EXTENSORS 25116 2,211.00$

PROFESSIONAL 25118 EXCISE WRIST TENDON SHEATH 25118 3,951.00$


PROFESSIONAL 25130 REMOVAL OF WRIST LESION 25130 2,947.00$

PROFESSIONAL 25135 REMOVE & GRAFT WRIST LESION 25135 3,531.00$

PROFESSIONAL 25145 REMOVE FOREARM BONE LESION 25145 5,028.00$

PROFESSIONAL 25151 PARTIAL EXC OF RADIUS BONE 25151 1,775.00$

PROFESSIONAL 25210 REMOVAL OF WRIST BONE 25210 2,359.00$

PROFESSIONAL 25230 PARTIAL REMOVAL OF RADIUS 25230 2,268.00$

PROFESSIONAL 25240 PARTIAL REMOVAL OF ULNA 25240 3,137.00$

PROFESSIONAL 25246 INJECTION FOR WRIST X-RAY 25246 379.00$

PROFESSIONAL 25248 REMOVE FOREARM FOREIGN BODY 25248 1,725.00$

PROFESSIONAL 25250 REMOVAL OF WRIST PROSTHESIS 25250 1,478.00$

PROFESSIONAL 25259 MANIPULATE WRIST W ANESTH 25259 1,151.00$

PROFESSIONAL 25260 REPAIR FOREARM TENDON/MUSCLE 25260 3,571.00$

PROFESSIONAL 25263 REP T/M, FLEXOR, FA/WRIST; 2' EA 25263 2,361.00$



PROFESSIONAL 25272 REP T/M, EXTENSOR, FA/W; 2' EA 25272 2,125.00$


PROFESSIONAL 25295 RELEASE WRIST/FOREARM TENDON 25295 2,123.00$

PROFESSIONAL 25301 FUSION OF TENDONS AT WRIST 25301 3,531.00$

PROFESSIONAL 25310 TRANSPLANT FOREARM TENDON 25310 4,108.00$

PROFESSIONAL 25320 OPEN REPAIR OF WRIST JOINT 25320 2,535.00$

PROFESSIONAL 25332 ARTHROPLASTY,WRIST W/ W/O INTERPOSITION 25332 3,619.00$

PROFESSIONAL 25337 RECONSTR ULNA/RADIOULNAR JNT 25337 2,518.00$

PROFESSIONAL 25355 REVISION OF RADIUS 25355 4,626.00$

PROFESSIONAL 25360 REVISION OF ULNA 25360 3,639.00$

PROFESSIONAL 25365 REVISE RADIUS & ULNA 25365 5,288.00$

PROFESSIONAL 25390 SHORTEN RADIUS OR ULNA 25390 4,626.00$

PROFESSIONAL 25400 REPAIR RADIUS OR ULNA 25400 4,295.00$

PROFESSIONAL 25405 REPAIR/GRAFT RADIUS OR ULNA 25405 5,288.00$

PROFESSIONAL 25415 REPAIR RADIUS & ULNA 25415 5,288.00$

PROFESSIONAL 25420 REPAIR/GRAFT RADIUS & ULNA 25420 6,273.00$

PROFESSIONAL 25425 REPAIR RADIUS OR ULNA W AUTOGRAFT 25425 3,552.00$

PROFESSIONAL 25440 REPAIR/GRAFT WRIST BONE 25440 5,652.00$

PROFESSIONAL 25441 RECONSTRUCT WRIST JOINT 25441 5,865.00$

PROFESSIONAL 25445 RECONSTRUCT WRIST JOINT 25445 5,584.00$

PROFESSIONAL 25446 WRIST REPLACEMENT 25446 9,673.00$

PROFESSIONAL 25447 REPAIR WRIST JOINT(S) 25447 4,411.00$

PROFESSIONAL 25500 TREAT FRACTURE OF RADIUS 25500 855.00$

PROFESSIONAL 25505 TREAT FRACTURE OF RADIUS 25505 1,693.00$

PROFESSIONAL 25515 TREAT FRACTURE OF RADIUS 25515 4,371.00$

PROFESSIONAL 25520 GALEAZZI FX/DISLOC 25520 1,490.00$

PROFESSIONAL 25525 OPEN TREAT RADIAL SHAF 25525 3,431.00$

PROFESSIONAL 25526 OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLC 25526 2,566.00$

PROFESSIONAL 25530 TREAT FRACTURE OF ULNA 25530 1,025.00$



PROFESSIONAL 25560 TREAT FRACTURE RADIUS & ULNA 25560 1,138.00$

PROFESSIONAL 25565 TREAT FRACTURE RADIUS & ULNA 25565 2,401.00$

PROFESSIONAL 25574 OPEN TREATMENT RADIUS & ULNA 25574 3,457.00$

PROFESSIONAL 25575 TREAT FRACTURE RADIUS/ULNA 25575 5,450.00$


PROFESSIONAL 25600-50 TREAT FRACTURE RADIUS/ULNA 25600-50 1,135.00$

2020-01





PROFESSIONAL 25606 TREAT FX DISTAL RADIAL 25606 3,343.00$

PROFESSIONAL 25607 TREAT FX RAD EXTRA-ARTICUL 25607 3,369.00$

PROFESSIONAL 25608 TREAT FX RAD INTRA-ARTICUL 25608 3,830.00$

PROFESSIONAL 25609 TREAT FX RADIAL 3+ FRAG 25609 4,884.00$

PROFESSIONAL 25609-50 TREAT FX RADIAL 3+ FRAG 25609-50 9,769.00$

PROFESSIONAL 25622 TREAT WRIST BONE FRACTURE 25622 1,195.00$



PROFESSIONAL 25630 TREAT WRIST BONE FRACTURE 25630 981.00$



PROFESSIONAL 25651 PIN ULNAR STYLOID FX 25651 1,091.00$

PROFESSIONAL 25652 ULNAR STYLOID FRACTURE 25652 1,942.00$

PROFESSIONAL 25660 TREAT WRIST DISLOCATION 25660 1,581.00$


PROFESSIONAL 25671 PIN RADIOULNAR DISLOC 25671 1,230.00$


PROFESSIONAL 25676 OP TX DSTL RADIOULNAR DISLOCATION 25676 1,613.00$

PROFESSIONAL 25680 TREAT WRIST FRACTURE 25680 2,560.00$

PROFESSIONAL 25685 TREAT WRIST FRACTURE 25685 4,732.00$

PROFESSIONAL 25690 CL TX LUNATE DISLOC W MANIP 25690 1,016.00$


PROFESSIONAL 25800 FUSION OF WRIST JOINT 25800 5,237.00$

PROFESSIONAL 25810 FUSION/GRAFT OF WRIST JOINT 25810 6,309.00$

PROFESSIONAL 25820 FUSION OF HAND BONES 25820 4,535.00$

PROFESSIONAL 25825 FUSE HAND BONES WITH GRAFT 25825 6,165.00$

PROFESSIONAL 25900 AMPUTATION OF FOREARM 25900 3,898.00$

PROFESSIONAL 25905 AMPUTATION OF FOREARM 25905 3,358.00$


PROFESSIONAL 25920 AMPUTATE HAND AT WRIST 25920 3,781.00$

PROFESSIONAL 25927 AMPUTATION OF HAND 25927 4,194.00$

PROFESSIONAL 26010 DRAINAGE OF FINGER ABSCESS 26010 394.00$

PROFESSIONAL 26011 DRAINAGE OF FINGER ABSCESS 26011 1,305.00$

PROFESSIONAL 26020 DRAIN HAND TENDON SHEATH 26020 2,148.00$

PROFESSIONAL 26025 DRAINAGE OF PALM BURSA 26025 1,916.00$

PROFESSIONAL 26030 DRAINAGE OF PALM BURSA(S) 26030 4,456.00$

PROFESSIONAL 26034 TREAT HAND BONE LESION 26034 2,045.00$

PROFESSIONAL 26035 DECOMPRESS FINGERS/HAND 26035 6,073.00$

PROFESSIONAL 26040 RELEASE PALM CONTRACTURE 26040 1,209.00$

PROFESSIONAL 26045 RELEASE DUPUYTREN'S CONTRACTURE 26045 1,518.00$

PROFESSIONAL 26055 INCISE FINGER TENDON SHEATH 26055 1,443.00$

PROFESSIONAL 26060 INCISION OF FINGER TENDON 26060 837.00$

PROFESSIONAL 26070 EXPLORE/TREAT HAND JOINT 26070 2,126.00$

PROFESSIONAL 26075 EXPLORE/TREAT FINGER JOINT 26075 2,099.00$

PROFESSIONAL 26080 EXPLORE/TREAT FINGER JOINT 26080 1,683.00$

PROFESSIONAL 26100 BIOPSY HAND JOINT LINING 26100 2,148.00$

PROFESSIONAL 26105 BIOPSY FINGER JOINT LINING 26105 1,599.00$

PROFESSIONAL 26110 BIOPSY FINGER JOINT LINING 26110 1,344.00$

PROFESSIONAL 26111 EXC HAND LES SC > 1.5 CM 26111 1,295.00$

PROFESSIONAL 26113 EXC HAND TUM DEEP . 1.5 CM 26113 2,224.00$

PROFESSIONAL 26115 REMOVAL OF HAND LESION 26115 1,337.00$

PROFESSIONAL 26116 REMOVAL OF HAND LESION 26116 2,188.00$

PROFESSIONAL 26118 RAD RESECT HAND TUMOR 3 CM/> 26118 3,008.00$



PROFESSIONAL 26125 FASCIECTOMY,EACH ADD DIGIT 26125 1,173.00$

PROFESSIONAL 26130 SYNOVECTOMY CMC JOINT 26130 1,636.00$

PROFESSIONAL 26135 REVISE FINGER JOINT, EACH 26135 2,946.00$

PROFESSIONAL 26140 REVISE FINGER JOINT, EACH 26140 2,235.00$

PROFESSIONAL 26145 SYNOVECTOMY TENDON SHEATH 26145 4,194.00$

PROFESSIONAL 26160 EXCISION OF LESION OF TEN 26160 1,630.00$

PROFESSIONAL 26170 REMOVAL OF PALM TENDON, EACH 26170 1,790.00$

PROFESSIONAL 26180 REMOVAL OF FINGER TENDON 26180 1,599.00$

PROFESSIONAL 26185 REMOVE FINGER BONE 26185 1,740.00$

PROFESSIONAL 26200 REMOVE HAND BONE LESION 26200 2,126.00$


PROFESSIONAL 26210 REMOVAL OF FINGER LESION 26210 2,268.00$

2020-01




PROFESSIONAL 26215 REMOVE/GRAFT FINGER LESION 26215 2,860.00$

PROFESSIONAL 26230 PARTIAL REMOVAL OF HAND BONE 26230 2,311.00$

PROFESSIONAL 26235 PARTIAL REMOVAL, FINGER BONE 26235 2,099.00$

PROFESSIONAL 26236 PARTIAL REMOVAL, FINGER BONE 26236 2,099.00$

PROFESSIONAL 26250 EXTENSIVE HAND SURGERY 26250 3,189.00$

PROFESSIONAL 26262 RESECT DISTAL FINGER TUMOR 26262 1,561.00$

PROFESSIONAL 26320 REMOVAL OF IMPLANT FROM HAND 26320 1,389.00$

PROFESSIONAL 26340 MANIP FING JNT W AN EA 26340 819.00$

PROFESSIONAL 26341 MANIPULAT PALM CORD POST INJ 26341 261.00$

PROFESSIONAL 26350 REPAIR FINGER/HAND TENDON 26350 3,358.00$


PROFESSIONAL 26358 REPAIR/GRAFT HAND TENDON 26358 5,702.00$


PROFESSIONAL 26390 REVISE HAND/FINGER TENDON 26390 3,607.00$


PROFESSIONAL 26410 REPAIR HAND TENDON 26410 1,979.00$


PROFESSIONAL 26415 EXC ET W ROD H/F EA 26415 1,955.00$

PROFESSIONAL 26418 REPAIR FINGER TENDON 26418 2,099.00$

PROFESSIONAL 26420 REPAIR/GRAFT FINGER TENDON 26420 2,704.00$




PROFESSIONAL 26434 REPAIR/GRAFT FINGER TENDON 26434 2,704.00$

PROFESSIONAL 26437 EXTENSOR TENDON REALIGNMENT 26437 1,582.00$

PROFESSIONAL 26440 RELEASE PALM/FINGER TENDON 26440 2,148.00$

PROFESSIONAL 26445 RELEASE EXTENSOR TENDON HAND/FINGER 26445 2,035.00$

PROFESSIONAL 26449 RELEASE FOREARM/HAND TENDON 26449 2,948.00$

PROFESSIONAL 26450 INCISION OF PALM TENDON 26450 1,506.00$

PROFESSIONAL 26455 TENOTOMY, FLEXOR, FINGER, OPEN, EACH 26455 1,588.00$

PROFESSIONAL 26460 INCISE HAND/FINGER TENDON 26460 1,506.00$

PROFESSIONAL 26471 FUSION OF FINGER TENDONS 26471 3,008.00$

PROFESSIONAL 26474 FUSION OF FINGER TENDONS 26474 2,188.00$

PROFESSIONAL 26480 TRANSPLANT HAND TENDON 26480 3,771.00$

PROFESSIONAL 26483 TRANSPLANT/GRAFT HAND TENDON 26483 5,028.00$

PROFESSIONAL 26490 REVISE THUMB TENDON 26490 4,284.00$

PROFESSIONAL 26492 TENDON TRANSFER WITH GRAFT 26492 4,724.00$

PROFESSIONAL 26494 HAND TENDON/MUSCLE TRANSFER 26494 4,804.00$

PROFESSIONAL 26497 FINGER TENDON TRANSFER 26497 5,045.00$

PROFESSIONAL 26498 FINGER TENDON TRANSFER 26498 6,908.00$

PROFESSIONAL 26500 HAND TENDON RECONSTRUCTION 26500 2,639.00$

PROFESSIONAL 26500-50 HAND TENDON RECONSTRUCTION 26500-50 2,639.00$

PROFESSIONAL 26508 RELEASE THUMB CONTRACTURE 26508 3,036.00$

PROFESSIONAL 26516 FUSION OF KNUCKLE JOINT 26516 3,144.00$

PROFESSIONAL 26520 RELEASE KNUCKLE CONTRACTURE 26520 3,037.00$

PROFESSIONAL 26525 RELEASE FINGER CONTRACTURE 26525 2,859.00$

PROFESSIONAL 26530 REVISE KNUCKLE JOINT 26530 3,358.00$

PROFESSIONAL 26531 REVISE KNUCKLE WITH IMPLANT 26531 4,194.00$

PROFESSIONAL 26535 REVISE FINGER JOINT 26535 3,358.00$

PROFESSIONAL 26536 REVISE/IMPLANT FINGER JOINT 26536 5,028.00$

PROFESSIONAL 26540 REPAIR HAND JOINT 26540 4,536.00$

PROFESSIONAL 26541 REPAIR HAND JOINT WITH GRAFT 26541 4,817.00$

PROFESSIONAL 26542 RECONSTR MCP JNT COLL LIGAM W LTISS GRAF 26542 2,067.00$

PROFESSIONAL 26545 RECONSTRUCT FINGER JOINT 26545 3,144.00$

PROFESSIONAL 26546 REPAIR NONUNION HAND 26546 3,189.00$

PROFESSIONAL 26548 REP & RECONSTR FINGER VP IP JNT 26548 2,358.00$

PROFESSIONAL 26550 CONSTRUCT THUMB REPLACEMENT 26550 7,201.00$

PROFESSIONAL 26560 REPAIR OF WEB FINGER 26560 4,194.00$

PROFESSIONAL 26561 REPAIR OF WEB FINGER 26561 3,607.00$

PROFESSIONAL 26565 OSTEOTOMY CORRECT DEFORMITY; MCP 26565 1,847.00$

PROFESSIONAL 26567 OSTEOTOMY CORRECT DEFORMITY; PHALANX 26567 1,771.00$

PROFESSIONAL 26591 REPAIR MUSCLES OF HAND 26591 1,764.00$

PROFESSIONAL 26593 RELEASE,INTRINSIC MUSCLES OF HAND,EA MUS 26593 2,449.00$

PROFESSIONAL 26600 TREAT METACARPAL FRACTURE 26600 752.00$

PROFESSIONAL 26605 TREAT METACARPAL FRACTURE 26605 1,121.00$


PROFESSIONAL 26608 PERCUT. SKELETAL FIX. METACARPAL FX. EA. 26608 2,404.00$


2020-01




PROFESSIONAL 26641 TREAT THUMB DISLOCATION 26641 917.00$

PROFESSIONAL 26645 TREAT THUMB FRACTURE 26645 1,683.00$



PROFESSIONAL 26670 TREAT HAND DISLOCATION 26670 752.00$

PROFESSIONAL 26675 TREAT HAND DISLOCATION 26675 1,121.00$

PROFESSIONAL 26676 PIN HAND DISLOCATION 26676 1,762.00$

PROFESSIONAL 26685 TREAT HAND DISLOCATION 26685 2,766.00$

PROFESSIONAL 26686 OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLY 26686 1,704.00$

PROFESSIONAL 26700 TREAT KNUCKLE DISLOCATION 26700 682.00$

PROFESSIONAL 26705 TREAT KNUCKLE DISLOCATION 26705 1,017.00$

PROFESSIONAL 26706 PIN KNUCKLE DISLOCATION 26706 1,590.00$

PROFESSIONAL 26715 TREAT KNUCKLE DISLOCATION 26715 2,534.00$

PROFESSIONAL 26720 TREAT FINGER FRACTURE, EACH 26720 517.00$


PROFESSIONAL 26727 TREAT FINGER FRACTURE, EACH 26727 1,626.00$







PROFESSIONAL 26756 PIN FINGER FRACTURE, EACH 26756 1,353.00$


PROFESSIONAL 26770 TREAT FINGER DISLOCATION 26770 723.00$

PROFESSIONAL 26775 TREAT FINGER DISLOCATION 26775 716.00$

PROFESSIONAL 26776 PIN FINGER DISLOCATION 26776 1,483.00$

PROFESSIONAL 26785 TREAT FINGER DISLOCATION 26785 1,894.00$

PROFESSIONAL 26820 THUMB FUSION WITH GRAFT 26820 5,130.00$

PROFESSIONAL 26841 FUSION OF THUMB 26841 3,370.00$

PROFESSIONAL 26842 THUMB FUSION WITH GRAFT 26842 4,233.00$

PROFESSIONAL 26843 FUSION OF HAND JOINT 26843 3,370.00$

PROFESSIONAL 26850 FUSION OF KNUCKLE 26850 3,226.00$

PROFESSIONAL 26852 FUSION OF KNUCKLE WITH GRAFT 26852 3,771.00$

PROFESSIONAL 26860 FUSION OF FINGER JOINT 26860 2,534.00$

PROFESSIONAL 26861 FUSION OF FINGER JNT, ADD-ON 26861 1,266.00$

PROFESSIONAL 26862 FUSION/GRAFT OF FINGER JOINT 26862 3,226.00$

PROFESSIONAL 26910 AMPUTATE METACARPAL BONE 26910 3,358.00$

PROFESSIONAL 26951 AMPUTATION OF FINGER/THUMB 26951 2,026.00$

PROFESSIONAL 26952 AMPUTATION OF FINGER/THUMB 26952 2,700.00$

PROFESSIONAL 26990 DRAINAGE OF PELVIS LESION 26990 1,483.00$


PROFESSIONAL 27000 INCISION OF HIP TENDON 27000 928.00$

PROFESSIONAL 27001 INCISION OF HIP TENDON 27001 1,852.00$

PROFESSIONAL 27005 INCISION OF HIP TENDON 27005 2,549.00$

PROFESSIONAL 27006 TENOTOMY, HIP ABD/EXT, OPEN 27006 2,124.00$

PROFESSIONAL 27025 INCISION OF HIP/THIGH FASCIA 27025 4,233.00$

PROFESSIONAL 27030 DRAINAGE OF HIP JOINT 27030 4,744.00$

PROFESSIONAL 27033 EXPL/REM FB FROM HIP 27033 2,486.00$

PROFESSIONAL 27033-50 EXPL/REM FB FROM HIP BILATERAL 27033-50 4,963.00$

PROFESSIONAL 27035 DENERVATION OF HIP JOINT 27035 7,201.00$

PROFESSIONAL 27036 EXCISION OF HIP JOINT/MUSCLE 27036 4,460.00$

PROFESSIONAL 27040 BIOPSY OF SOFT TISSUES 27040 492.00$

PROFESSIONAL 27041 BIOPSY OF SOFT TISSUES 27041 2,113.00$

PROFESSIONAL 27043 EXC HIP PELVIS LES SC > 3 CM 27043 1,345.00$

PROFESSIONAL 27045 EXC HIP/PELV TUM DEEP 5cm/> 27045 1,815.00$

PROFESSIONAL 27047 REMOVE HIP/PELVIS LESION 27047 1,811.00$

PROFESSIONAL 27048 REMOVE HIP/PELVIS LESION 27048 3,381.00$

PROFESSIONAL 27049 RADICAL RESECTION OF TUMOR, SOFT TISSUE 27049 6,848.00$

PROFESSIONAL 27050 BIOPSY OF SACROILIAC JOINT 27050 2,519.00$

PROFESSIONAL 27052 BIOPSY OF HIP JOINT 27052 5,652.00$

PROFESSIONAL 27054 REMOVAL OF HIP JOINT LINING 27054 7,723.00$

PROFESSIONAL 27060 REMOVAL OF ISCHIAL BURSA 27060 1,852.00$

PROFESSIONAL 27062 EXC TROCHANTERIC BURSA/CALCIFICAT 27062 1,126.00$

PROFESSIONAL 27065 REMOVAL OF HIP BONE LESION 27065 2,465.00$

PROFESSIONAL 27066 REMOVAL OF HIP BONE LESION 27066 4,114.00$

PROFESSIONAL 27070 PARTIAL REMOVAL OF HIP BONE 27070 2,519.00$

PROFESSIONAL 27071 PARTIAL REMOVAL OF HIP BONE 27071 5,028.00$

2020-01




PROFESSIONAL 27075 RADICAL RESECTION OF TUMOR/INFECTION 27075 5,902.00$

PROFESSIONAL 27080 REMOVAL OF TAIL BONE 27080 2,519.00$

PROFESSIONAL 27086 REMOVE HIP FOREIGN BODY 27086 510.00$

PROFESSIONAL 27087 REMOVAL OF FB, PELVIS OR HIP; DEEP 27087 1,801.00$

PROFESSIONAL 27090 REMOVAL OF HIP PROSTHESIS 27090 3,621.00$

PROFESSIONAL 27091 REMOVAL OF HIP PROSTHESIS 27091 9,508.00$

PROFESSIONAL 27093 INJECTION FOR HIP X-RAY 27093 528.00$

PROFESSIONAL 27093-26 HIP ARTHROGRAPHY INJ WO ANESTH 27093 180.00$

PROFESSIONAL 27095 INJECTION FOR HIP X-RAY 27095 1,683.00$

PROFESSIONAL 27096 INJECT SACROILIAC JOINT 27096 614.00$

PROFESSIONAL 27100 TRANSFER OF ABDOMINAL MUSCLE 27100 6,140.00$

PROFESSIONAL 27120 RECONSTRUCTION OF HIP SOCKET 27120 7,366.00$

PROFESSIONAL 27122 RECONSTRUCTION OF HIP SOCKET 27122 6,140.00$

PROFESSIONAL 27125 PARTIAL HIP REPLACEMENT 27125 8,284.00$

PROFESSIONAL 27125-50 PARTIAL HIP REPLACEMENT 27125-50 16,570.00$

PROFESSIONAL 27130 TOTAL HIP REPLACEMENT 27130 11,076.00$

PROFESSIONAL 27130-50 TOTAL HIP REPLACEMENT BILATERAL 27130-50 22,151.00$

PROFESSIONAL 27132 TOTAL HIP REPLACEMENT 27132 13,800.00$

PROFESSIONAL 27134 REVISE HIP JOINT REPLACEMENT 27134 15,025.00$



PROFESSIONAL 27140 TRANSPLANT FEMUR RIDGE 27140 5,006.00$

PROFESSIONAL 27146 INCISION OF HIP BONE 27146 6,140.00$

PROFESSIONAL 27147 REVISION OF HIP BONE 27147 7,975.00$

PROFESSIONAL 27151 INCISION OF HIP BONES 27151 7,975.00$

PROFESSIONAL 27161 INCISION OF NECK OF FEMUR 27161 7,105.00$

PROFESSIONAL 27165 INCISION/FIXATION OF FEMUR 27165 9,162.00$

PROFESSIONAL 27170 REPAIR/GRAFT FEMUR HEAD/NECK 27170 7,443.00$

PROFESSIONAL 27176 TREAT SLIPPED EPIPHYSIS 27176 6,690.00$



PROFESSIONAL 27179 REVISE HEAD/NECK OF FEMUR 27179 5,220.00$


PROFESSIONAL 27185 REVISION OF FEMUR EPIPHYSIS 27185 3,428.00$

PROFESSIONAL 27187 REINFORCE HIP BONES 27187 6,754.00$

PROFESSIONAL 27197 CLSD TX PELVIC RING FX 27197 302.00$

PROFESSIONAL 27200 TREAT TAIL BONE FRACTURE 27200 791.00$

PROFESSIONAL 27215 TREAT PELVIC FRACTURE(S) 27215 6,122.00$

PROFESSIONAL 27220 TREAT HIP SOCKET FRACTURE 27220 1,502.00$

PROFESSIONAL 27222 TREAT HIP SOCKET FRACTURE 27222 3,657.00$

PROFESSIONAL 27226 TREAT HIP WALL FRACTURE 27226 5,514.00$

PROFESSIONAL 27230 TREAT THIGH FRACTURE 27230 1,603.00$










PROFESSIONAL 27250 TREAT HIP DISLOCATION 27250 1,669.00$









PROFESSIONAL 27267 CLTX THIGH FX 27267 1,105.00$

PROFESSIONAL 27269 OPTX THIGH FX 27269 7,783.00$

PROFESSIONAL 27275 MANIPULATION OF HIP JOINT 27275 1,400.00$

PROFESSIONAL 27280 FUSION OF SACROILIAC JOINT 27280 6,172.00$

PROFESSIONAL 27284 FUSION OF HIP JOINT 27284 9,869.00$

PROFESSIONAL 27290 AMPUTATION OF LEG AT HIP 27290 13,814.00$

PROFESSIONAL 27295 AMPUTATION OF LEG AT HIP 27295 10,664.00$

PROFESSIONAL 27299-GAT OPEN REPAIR GLUT MED ABDUCT TENDON 27299 1,746.00$

2020-01




PROFESSIONAL 27299-HAD OPEN TRTMNT POST HIP ATHRO DISLOCATION 27299 3,767.00$

PROFESSIONAL 27299-HCD HIP CORE DECOMPRESSION 27299 2,499.00$

PROFESSIONAL 27299-REIN REINSERT SCREW DUE TO UNHEALED FX 27299 499.00$

PROFESSIONAL 27299-SPH1 SUBCHONDROPLASTY PELVIS/HIP 1 SITE 27299-SPH1 2,497.00$

PROFESSIONAL 27299-SPH2 SUBCHONDROPLASTY PELVIS/HIP 2 SITE 27299-SPH2 3,197.00$

PROFESSIONAL 27301 DRAIN THIGH/KNEE LESION 27301 1,901.00$


PROFESSIONAL 27305 INCISE THIGH TENDON & FASCIA 27305 2,519.00$

PROFESSIONAL 27306 INCISION OF THIGH TENDON 27306 1,346.00$

PROFESSIONAL 27307 INCISION OF THIGH TENDONS 27307 2,020.00$

PROFESSIONAL 27310 EXPLORATION OF KNEE JOINT 27310 4,249.00$

PROFESSIONAL 27323 BIOPSY,SOFT TISSUE THIGH KNEE 27323 425.00$

PROFESSIONAL 27324 BIOPSY, THIGH SOFT TISSUES 27324 1,683.00$

PROFESSIONAL 27325 NEURECTOMY, HAMSTRING 27325 4,214.00$

PROFESSIONAL 27327 REMOVAL OF THIGH LESION 27327 1,342.00$

PROFESSIONAL 27328 REMOVAL OF THIGH LESION 27328 2,290.00$

PROFESSIONAL 27329 REMOVE TUMOR, THIGH/KNEE 27329 9,726.00$

PROFESSIONAL 27330 BIOPSY, KNEE JOINT LINING 27330 3,692.00$

PROFESSIONAL 27330-50 BIOPSY, KNEE JOINT LINING 27330-50 3,692.00$

PROFESSIONAL 27331 EXPLORE/TREAT KNEE JOINT 27331 5,487.00$

PROFESSIONAL 27331-50 EXPLORE/TREAT KNEE JOINT 27331-50 10,974.00$

PROFESSIONAL 27332 REMOVAL OF KNEE CARTILAGE 27332 5,832.00$

PROFESSIONAL 27333 REMOVAL OF KNEE CARTILAGE 27333 7,377.00$

PROFESSIONAL 27334 REMOVE KNEE JOINT LINING 27334 6,829.00$

PROFESSIONAL 27335 REMOVE KNEE JOINT LINING 27335 6,169.00$

PROFESSIONAL 27337 EXCISE THIGH/KNEE LESION SUBCU =>3 CM 27337 1,526.00$

PROFESSIONAL 27339 EXC THIGH/KNEE TUM DEEP >5CM 27339 2,639.00$

PROFESSIONAL 27340 REMOVAL OF KNEECAP BURSA 27340 2,586.00$

PROFESSIONAL 27345 REMOVAL OF KNEE CYST 27345 3,771.00$

PROFESSIONAL 27347 EXC LESION MENISCUS OR CAPSULE KNEE 27347 1,714.00$

PROFESSIONAL 27350 REMOVAL OF KNEECAP 27350 5,096.00$

PROFESSIONAL 27355 REMOVE FEMUR LESION 27355 3,886.00$

PROFESSIONAL 27357 REMOVE FEMUR LESION/GRAFT 27357 6,281.00$

PROFESSIONAL 27358 REMOVE FEMUR LESION/FIXATION 27358 2,521.00$

PROFESSIONAL 27360 PARTIAL REMOVAL, LEG BONE(S) 27360 4,045.00$

PROFESSIONAL 27360-50 PARTIAL REMOVAL, LEG BONE(S) 27360-50 4,045.00$

PROFESSIONAL 27372 REMOVAL FOREIGN BDY DEEP THIGH 27372 1,683.00$

PROFESSIONAL 27380 REPAIR OF KNEECAP TENDON 27380 5,094.00$

PROFESSIONAL 27381 REPAIR/GRAFT KNEECAP TENDON 27381 5,149.00$

PROFESSIONAL 27385 REPAIR OF THIGH MUSCLE 27385 4,654.00$

PROFESSIONAL 27386 REPAIR/GRAFT OF THIGH MUSCLE 27386 5,115.00$

PROFESSIONAL 27390 INCISION OF THIGH TENDON 27390 2,519.00$

PROFESSIONAL 27391 TENOTOMY,OPEN, HAMSTRING KNEE TO HIP 27391 1,399.00$

PROFESSIONAL 27393 LENGTHENING OF THIGH TENDON 27393 2,572.00$

PROFESSIONAL 27397 TRANSPLANTS OF THIGH TENDONS 27397 4,481.00$

PROFESSIONAL 27400 REVISE THIGH MUSCLES/TENDONS 27400 3,840.00$

PROFESSIONAL 27403 REPAIR OF KNEE CARTILAGE 27403 6,378.00$

PROFESSIONAL 27405 REPAIR OF KNEE LIGAMENT 27405 5,865.00$

PROFESSIONAL 27407 REPAIR OF KNEE LIGAMENT 27407 7,116.00$

PROFESSIONAL 27409 REPAIR OF KNEE LIGAMENTS 27409 8,370.00$

PROFESSIONAL 27415 OPEN OSTEOCHONDRAL KNEE ALLOGRAFT 27415 7,175.00$

PROFESSIONAL 27418 REPAIR DEGENERATED KNEECAP 27418 6,714.00$

PROFESSIONAL 27420 REVISION OF UNSTABLE KNEECAP 27420 6,493.00$

PROFESSIONAL 27422 REVISION OF UNSTABLE KNEECAP 27422 6,464.00$

PROFESSIONAL 27424 REVISION/REMOVAL OF KNEECAP 27424 5,756.00$

PROFESSIONAL 27425 LATERAL RETINACULAR RELEASE 27425 4,798.00$

PROFESSIONAL 27427 RECONSTRUCTION, KNEE 27427 7,670.00$

PROFESSIONAL 27430 REVISION OF THIGH MUSCLES 27430 6,387.00$

PROFESSIONAL 27437 REVISE KNEECAP 27437 4,481.00$

PROFESSIONAL 27438 REVISE KNEECAP WITH IMPLANT 27438 5,115.00$

PROFESSIONAL 27440 REVISION OF KNEE JOINT 27440 5,431.00$


PROFESSIONAL 27445 ARTHROPLASTY KNEE HINGE PROSTH 27445 3,816.00$


PROFESSIONAL 27447 TOTAL KNEE REPLACEMENT 27447 11,076.00$

PROFESSIONAL 27447-50 TOTAL KNEE REPLACEMENT BILATERAL 27447-50 22,151.00$

PROFESSIONAL 27448 OSTEOT FEMUR, SHAFT/SCONDY WO FIX 27448 3,964.00$

PROFESSIONAL 27450 INCISION OF THIGH 27450 5,756.00$

2020-01




PROFESSIONAL 27454 REALIGNMENT OF THIGH BONE 27454 6,396.00$

PROFESSIONAL 27455 REALIGNMENT OF KNEE 27455 5,141.00$

PROFESSIONAL 27457 REALIGNMENT OF KNEE 27457 6,351.00$

PROFESSIONAL 27465 SHORTENING OF THIGH BONE 27465 6,552.00$

PROFESSIONAL 27466 OSTEOPLASTY FEMUR; LENGTHEN 27466 3,703.00$

PROFESSIONAL 27470 REPAIR OF THIGH 27470 6,802.00$

PROFESSIONAL 27472 REPAIR/GRAFT OF THIGH 27472 7,828.00$

PROFESSIONAL 27475 SURGERY TO STOP LEG GROWTH 27475 6,073.00$



PROFESSIONAL 27486 REVISION OF TOTAL KNEE ARTHROPLASTY 27486 9,323.00$

PROFESSIONAL 27487 REVISE/REPLACE KNEE JOINT 27487 14,290.00$

PROFESSIONAL 27488 REMOVAL OF KNEE PROSTHESIS 27488 7,670.00$

PROFESSIONAL 27495 PROPHYL TX; FEMUR 27495 5,796.00$

PROFESSIONAL 27496 DECOMPRESSION OF THIGH/KNEE 27496 2,562.00$

PROFESSIONAL 27500 TREATMENT OF THIGH FRACTURE 27500 3,021.00$












PROFESSIONAL 27516 TREAT THIGH FX GROWTH PLATE 27516 2,946.00$

PROFESSIONAL 27517 TREAT THIGH FX GROWTH PLATE 27517 3,941.00$

PROFESSIONAL 27520 CLOSED TX PATELLAR FX WO MANIP 27520 1,068.00$

PROFESSIONAL 27520-50 CLOSED TX PATELLAR FX WO MANIP 27520-50 1,068.00$

PROFESSIONAL 27524 TREAT KNEECAP FRACTURE 27524 5,028.00$

PROFESSIONAL 27530 TREAT KNEE FRACTURE 27530 1,382.00$

PROFESSIONAL 27530-50 TREAT KNEE FRACTURE 27530-50 2,765.00$




PROFESSIONAL 27538 TREAT KNEE FRACTURE(S) 27538 1,738.00$


PROFESSIONAL 27550 TREAT KNEE DISLOCATION 27550 1,370.00$



PROFESSIONAL 27560 TREAT KNEECAP DISLOCATION 27560 971.00$

PROFESSIONAL 27562 TX PATELLAR DISLOCATION, REQ ANESTHESIA 27562 1,366.00$

PROFESSIONAL 27566 TREAT KNEECAP DISLOCATION 27566 5,069.00$

PROFESSIONAL 27570 FIXATION OF KNEE JOINT 27570 1,261.00$

PROFESSIONAL 27580 FUSION OF KNEE 27580 8,363.00$

PROFESSIONAL 27590 AMPUTATE LEG AT THIGH 27590 6,073.00$



PROFESSIONAL 27598 AMPUTATE LOWER LEG AT KNEE 27598 5,834.00$

PROFESSIONAL 27599 LEG SURGERY PROCEDURE 27599 5,649.00$

PROFESSIONAL 27599-FEM UNLISTED PROC FEMUR OR KNEE 27599 2,498.00$

PROFESSIONAL 27599-PAT EXCISION OSSICLE PATELLA TENDON 27599 2,290.00$

PROFESSIONAL 27599-TIB TIBIA EXCISION BONY OSSICLES 27599 915.00$

PROFESSIONAL 27600 DECOMPRESSION OF LOWER LEG 27600 2,188.00$

PROFESSIONAL 27601 LEG DECOMPRESSION, LWR COMPARTM 27601 1,309.00$

PROFESSIONAL 27602 DECOMPRESSION OF LOWER LEG 27602 2,895.00$

PROFESSIONAL 27603 DRAIN LOWER LEG LESION 27603 1,694.00$

PROFESSIONAL 27605 INCISION OF ACHILLES TENDON 27605 1,057.00$

PROFESSIONAL 27606 INCISION OF ACHILLES TENDON 27606 1,573.00$

PROFESSIONAL 27607 TREAT LOWER LEG BONE LESION 27607 2,492.00$

PROFESSIONAL 27610 EXPLORE/TREAT ANKLE JOINT 27610 3,815.00$

PROFESSIONAL 27612 EXPLORATION OF ANKLE JOINT 27612 4,194.00$

PROFESSIONAL 27613 BIOPSY LOWER LEG SOFT TISSUE 27613 785.00$

PROFESSIONAL 27614 DEEP SFT TISS BX, LEG/ANKLE 27614 1,358.00$

PROFESSIONAL 27618 REMOVE LOWER LEG LESION 27618 1,502.00$

PROFESSIONAL 27619 REMOVE LOWER LEG LESION 27619 2,232.00$

2020-01




PROFESSIONAL 27620 EXPLORE/TREAT ANKLE JOINT 27620 3,360.00$

PROFESSIONAL 27625 REMOVE ANKLE JOINT LINING 27625 4,353.00$

PROFESSIONAL 27626 ARTHROT ANKLE W SYNOVECT; W TENOSY 27626 2,206.00$

PROFESSIONAL 27630 REMOVAL OF TENDON LESION 27630 1,590.00$

PROFESSIONAL 27632 EXC LEG/ANKLE LES SC > 3 CM 27632 1,549.00$

PROFESSIONAL 27634 EXC LEG/ANKLE TUM DEP 5 CM> 27634 1,906.00$

PROFESSIONAL 27635 REMOVE LOWER LEG BONE LESION 27635 4,149.00$

PROFESSIONAL 27637 REMOVE/GRAFT LEG BONE LESION 27637 5,450.00$

PROFESSIONAL 27638 EXC TIB/FIB CYST/TUMOR W ALLOGRFT 27638 2,416.00$

PROFESSIONAL 27640 PARTIAL REMOVAL OF TIBIA 27640 5,450.00$

PROFESSIONAL 27641 PARTIAL REMOVAL OF FIBULA 27641 3,735.00$

PROFESSIONAL 27645 RESECT TIBIA TUMOR 27645 4,407.00$

PROFESSIONAL 27650 REPAIR ACHILLES TENDON 27650 3,031.00$

PROFESSIONAL 27652 REPAIR/GRAFT ACHILLES TENDON 27652 5,865.00$

PROFESSIONAL 27654 REPAIR OF ACHILLES TENDON 27654 4,353.00$

PROFESSIONAL 27656 REPAIR LEG FASCIA DEFECT 27656 1,870.00$

PROFESSIONAL 27658 REPAIR OF LEG TENDON, EACH 27658 2,519.00$




PROFESSIONAL 27675 REPAIR LOWER LEG TENDONS 27675 1,870.00$

PROFESSIONAL 27676 REPR DISL PERONEAL TENDON W FIB INC 27676 1,561.00$

PROFESSIONAL 27680 RELEASE OF LOWER LEG TENDON 27680 2,099.00$

PROFESSIONAL 27681 RELEASE MULTIP TIB FIB ANKLE FLEXOR 27681 1,496.00$

PROFESSIONAL 27685 REVISION OF LOWER LEG TENDON 27685 2,051.00$

PROFESSIONAL 27685-50 REVISION OF LOWER LET TENDON 27685-50 4,100.00$

PROFESSIONAL 27687 REVISION OF CALF TENDON 27687 2,183.00$

PROFESSIONAL 27690 REVISE LOWER LEG TENDON 27690 3,392.00$

PROFESSIONAL 27691 REVISE LOWER LEG TENDON 27691 4,142.00$

PROFESSIONAL 27692 REVISE ADDITIONAL LEG TENDON 27692 845.00$

PROFESSIONAL 27695 REPAIR OF ANKLE LIGAMENT 27695 4,306.00$

PROFESSIONAL 27696 REPAIR OF ANKLE LIGAMENTS 27696 5,865.00$

PROFESSIONAL 27698 REPAIR OF ANKLE LIGAMENT 27698 4,667.00$

PROFESSIONAL 27704 REMOVAL OF ANKLE IMPLANT 27704 3,425.00$

PROFESSIONAL 27705 INCISION OF TIBIA 27705 5,237.00$

PROFESSIONAL 27707 INCISION OF FIBULA 27707 2,946.00$

PROFESSIONAL 27709 INCISION OF TIBIA & FIBULA 27709 6,281.00$

PROFESSIONAL 27712 REALIGNMENT OF LOWER LEG 27712 5,592.00$

PROFESSIONAL 27715 REVISION OF LOWER LEG 27715 8,898.00$

PROFESSIONAL 27720 REPAIR OF TIBIA 27720 7,532.00$

PROFESSIONAL 27722 REPAIR/GRAFT OF TIBIA 27722 5,903.00$

PROFESSIONAL 27724 REPAIR/GRAFT OF TIBIA 27724 8,314.00$

PROFESSIONAL 27726 REPAIR FIBULA NONUNION 27726 2,527.00$

PROFESSIONAL 27730-50 OPEN EPIPHYS AR DIST TIB 27730-50 1,560.00$

PROFESSIONAL 27734 REPAIR LOWER LEG EPIPHYSES 27734 5,305.00$

PROFESSIONAL 27740 REPAIR OF LEG EPIPHYSES 27740 5,592.00$

PROFESSIONAL 27750 TREATMENT OF TIBIA FRACTURE 27750 1,428.00$





PROFESSIONAL 27760 TREATMENT OF ANKLE FRACTURE 27760 1,065.00$



PROFESSIONAL 27767 CLTX POST ANKLE FX 27767 730.00$

PROFESSIONAL 27768 CLTX POST ANKLE FX W/MNPJ 27768 858.00$

PROFESSIONAL 27769 OPTX POST ANKLE FX 27769 3,021.00$

PROFESSIONAL 27780 TREATMENT OF FIBULA FRACTURE 27780 876.00$

PROFESSIONAL 27780-50 TREATMENT OF FIBULA FRACTURE BIL 27780-50 876.00$

PROFESSIONAL 27781 TREATMENT OF FIBULA FRACTURE 27781 1,272.00$

PROFESSIONAL 27784 TREATMENT OF FIBULA FRACTURE 27784 3,903.00$

PROFESSIONAL 27786 TREATMENT OF ANKLE FRACTURE 27786 993.00$

PROFESSIONAL 27786-50 TREATMENT OF ANKLE FRACTURE 27786-50 1,986.00$






2020-01








PROFESSIONAL 27824 TREAT LOWER LEG FRACTURE 27824 1,195.00$





PROFESSIONAL 27829 TREAT LOWER LEG JOINT 27829 3,344.00$

PROFESSIONAL 27830 TREAT LOWER LEG DISLOCATION 27830 922.00$

PROFESSIONAL 27831 TREAT LOWER LEG DISLOCATION 27831 1,379.00$

PROFESSIONAL 27832 TREAT LOWER LEG DISLOCATION 27832 2,816.00$

PROFESSIONAL 27840 TREAT ANKLE DISLOCATION 27840 1,135.00$




PROFESSIONAL 27860 FIXATION OF ANKLE JOINT 27860 959.00$

PROFESSIONAL 27870 FUSION OF ANKLE JOINT 27870 7,284.00$

PROFESSIONAL 27880 AMPUTATION OF LOWER LEG 27880 4,671.00$

PROFESSIONAL 27882 AMPUTATION OF LOWER LEG 27882 4,400.00$



PROFESSIONAL 27888 AMPUTATION OF FOOT AT ANKLE 27888 4,921.00$

PROFESSIONAL 27889 AMPUTATION OF FOOT AT ANKLE 27889 4,921.00$

PROFESSIONAL 27892 DECOMPRESS ANT/LAT CMPRT LEG W DEBR 27892 2,216.00$

PROFESSIONAL 28001 DRAINAGE OF BURSA OF FOOT 28001 500.00$

PROFESSIONAL 28002 TREATMENT OF FOOT INFECTION 28002 1,412.00$

PROFESSIONAL 28003 TREATMENT OF FOOT INFECTION 28003 2,115.00$

PROFESSIONAL 28005 TREAT FOOT BONE LESION 28005 2,256.00$

PROFESSIONAL 28008 INCISION OF FOOT FASCIA 28008 1,765.00$

PROFESSIONAL 28010 TENOTOMY SQ TOE; SINGLE 28010 485.00$

PROFESSIONAL 28020 EXPLORATION OF FOOT JOINT 28020 2,601.00$

PROFESSIONAL 28022 EXPLORATION OF FOOT JOINT 28022 1,972.00$

PROFESSIONAL 28024 EXPLORATION OF TOE JOINT 28024 1,626.00$

PROFESSIONAL 28035 DECOMPRESSION OF TIBIA NERVE 28035 3,523.00$

PROFESSIONAL 28039 EXC FOOT/TOE TUM SC 1.5 CM/> 28039 1,222.00$

PROFESSIONAL 28041 EXC FOOT/TOE TUM DEEP 1.5+ CM 28041 1,348.00$

PROFESSIONAL 28043 EXCISION OF FOOT LESION 28043 1,272.00$

PROFESSIONAL 28043-50 EXCISION OF FOOT LESION 28043-50 2,544.00$

PROFESSIONAL 28045 EXCISION OF FOOT LESION 28045 1,972.00$

PROFESSIONAL 28050 BIOPSY OF FOOT JOINT LINING 28050 2,126.00$

PROFESSIONAL 28052 BIOPSY OF FOOT JOINT LINING 28052 1,765.00$

PROFESSIONAL 28055 NEURECTOMY, FOOT 28055 2,466.00$

PROFESSIONAL 28060 PARTIAL REMOVAL, FOOT FASCIA 28060 2,431.00$

PROFESSIONAL 28062 REMOVAL OF FOOT FASCIA 28062 4,254.00$

PROFESSIONAL 28070 REMOVAL OF FOOT JOINT LINING 28070 2,601.00$

PROFESSIONAL 28072 REMOVAL OF FOOT JOINT LINING 28072 1,555.00$

PROFESSIONAL 28080 REMOVAL OF FOOT LESION 28080 1,902.00$

PROFESSIONAL 28086 EXC FOOT FLEXOR TENDON SHTH 28086 1,234.00$

PROFESSIONAL 28088 EXC FOOT EXTNSR TENDON SHTH 28088 1,053.00$


PROFESSIONAL 28092 REMOVAL OF TOE LESIONS 28092 1,202.00$

PROFESSIONAL 28100 REMOVAL OF ANKLE/HEEL LESION 28100 3,167.00$

PROFESSIONAL 28102 REMOVE/GRAFT FOOT LESION 28102 4,572.00$


PROFESSIONAL 28106 REMOVE/GRAFT FOOT LESION 28106 3,523.00$

PROFESSIONAL 28108 REMOVAL OF TOE LESIONS 28108 1,765.00$

PROFESSIONAL 28110 PART REMOVAL OF METATARSAL 28110 2,115.00$




PROFESSIONAL 28114 REMOVAL OF METATARSAL HEADS 28114 5,028.00$

PROFESSIONAL 28116 REVISION OF FOOT 28116 3,523.00$

PROFESSIONAL 28118 REMOVAL OF HEEL BONE 28118 2,956.00$

PROFESSIONAL 28119 REMOVAL OF HEEL SPUR 28119 2,815.00$

PROFESSIONAL 28120 PART REMOVAL OF ANKLE/HEEL 28120 2,762.00$

PROFESSIONAL 28122 PARTIAL REMOVAL OF FOOT BONE 28122 2,400.00$

2020-01




PROFESSIONAL 28124 PARTIAL REMOVAL OF TOE 28124 1,765.00$


PROFESSIONAL 28130 REMOVAL OF ANKLE BONE 28130 4,221.00$

PROFESSIONAL 28140 REMOVAL OF METATARSAL 28140 2,815.00$

PROFESSIONAL 28150 REMOVAL OF TOE 28150 1,972.00$



PROFESSIONAL 28173 EXTENSIVE FOOT SURGERY 28173 2,815.00$

PROFESSIONAL 28190 REMOVAL OF FOOT FOREIGN BODY 28190 862.00$

PROFESSIONAL 28192 REMOVAL OF FOOT FOREIGN BODY 28192 1,626.00$

PROFESSIONAL 28193 REMOVAL OF FOOT FOREIGN BODY 28193 2,327.00$

PROFESSIONAL 28200 REPAIR OF FOOT TENDON 28200 2,328.00$

PROFESSIONAL 28202 REPAIR/GRAFT OF FOOT TENDON 28202 3,358.00$

PROFESSIONAL 28208 REPAIR OF FOOT TENDON 28208 1,295.00$

PROFESSIONAL 28210 REPAIR/GRAFT OF FOOT TENDON 28210 2,582.00$

PROFESSIONAL 28220 TENOLYSIS FOOT FLEXOR; SINGLE 28220 865.00$

PROFESSIONAL 28225 RELEASE OF FOOT TENDON 28225 1,177.00$

PROFESSIONAL 28226 RELEASE FOOT EXTNSOR TENDON MULTI 28226 850.00$

PROFESSIONAL 28230 INCISION OF FOOT TENDON(S) 28230 1,261.00$

PROFESSIONAL 28232 INCISION OF TOE TENDON 28232 593.00$

PROFESSIONAL 28234 INCISION OF FOOT TENDON 28234 712.00$

PROFESSIONAL 28238 REVISION OF FOOT TENDON 28238 2,755.00$

PROFESSIONAL 28240 RELEASE OF BIG TOE 28240 1,512.00$

PROFESSIONAL 28250 REVISION OF FOOT FASCIA 28250 2,519.00$

PROFESSIONAL 28260 RELEASE OF MIDFOOT JOINT 28260 3,940.00$

PROFESSIONAL 28261 REVISION OF FOOT TENDON 28261 4,485.00$

PROFESSIONAL 28262 REVISION OF FOOT AND ANKLE 28262 5,466.00$

PROFESSIONAL 28264 RELEASE OF MIDFOOT JOINT 28264 5,069.00$

PROFESSIONAL 28270 RELEASE OF FOOT CONTRACTURE 28270 1,229.00$

PROFESSIONAL 28272 RELEASE OF TOE JOINT, EACH 28272 923.00$

PROFESSIONAL 28280 FUSION OF TOES 28280 1,536.00$

PROFESSIONAL 28285 REPAIR OF HAMMERTOE 28285 2,019.00$

PROFESSIONAL 28286 REPAIR OF HAMMERTOE 28286 1,838.00$

PROFESSIONAL 28288 PARTIAL REMOVAL OF FOOT BONE 28288 1,838.00$

PROFESSIONAL 28288-50 PARTIAL REMOVAL OF FOOT BONE 28288-50 3,675.00$

PROFESSIONAL 28289 HALLUX RIGIDUS CORRECTION W/CHEILECTOMY 28289 2,436.00$

PROFESSIONAL 28292 CORRECTION OF BUNION 28292 3,300.00$

PROFESSIONAL 28295 CORRECTION HALLUX VALGUS 28295 1,561.00$


PROFESSIONAL 28297 CORRECTION, HALLUX VALGUS (BUNION) 28297 1,668.00$


PROFESSIONAL 28299 DBL OST BUNION CORRECT 28299 1,833.00$

PROFESSIONAL 28300 INCISION OF HEEL BONE 28300 4,022.00$

PROFESSIONAL 28302 INCISION OF ANKLE BONE 28302 3,771.00$

PROFESSIONAL 28304 OSTEOTOMY MIDT BONE 28304 1,758.00$

PROFESSIONAL 28306 INCISION OF METATARSAL 28306 3,017.00$

PROFESSIONAL 28308 INCISION OF METATARSAL 28308 2,328.00$

PROFESSIONAL 28308-50 INCISION OF METATARSAL 28308-50 2,328.00$

PROFESSIONAL 28309 MT MULTIPL FOR CAVUS FOOT 28309 2,044.00$

PROFESSIONAL 28310 REVISION OF BIG TOE 28310 1,777.00$

PROFESSIONAL 28312 SHORTEN, CORRECT; P, OTHR TOE 28312 1,471.00$

PROFESSIONAL 28313 RECONSTRUCTION,ANGULAR DEFORMITY OF TOE 28313 1,552.00$

PROFESSIONAL 28315 REMOVAL OF SESAMOID BONE 28315 1,656.00$

PROFESSIONAL 28320 REPAIR OF FOOT BONES 28320 3,392.00$

PROFESSIONAL 28322 REPAIR OF FOOT BONES 28322 2,814.00$

PROFESSIONAL 28400 TREATMENT OF HEEL FRACTURE 28400 993.00$

PROFESSIONAL 28400-50 TREATMENT OF HEEL FRACTURE (BILATERAL) 28400-50 1,986.00$

PROFESSIONAL 28405 TREATMENT OF HEEL FRACTURE 28405 1,766.00$

PROFESSIONAL 28406 TREATMENT OF HEEL FRACTURE 28406 2,313.00$

PROFESSIONAL 28415 TREAT HEEL FRACTURE 28415 4,276.00$

PROFESSIONAL 28420 TREAT/GRAFT HEEL FRACTURE 28420 5,865.00$



PROFESSIONAL 28436 PERC SKELETAL FIXATION OF TALUS FX 28436 1,123.00$

PROFESSIONAL 28445 TREAT ANKLE FRACTURE 28445 4,276.00$

PROFESSIONAL 28450 TREAT MIDFOOT FRACTURE, EACH 28450 1,009.00$



2020-01




PROFESSIONAL 28470 TREAT METATARSAL FRACTURE 28470 840.00$

PROFESSIONAL 28475 TREAT METATARSAL FRACTURE 28475 985.00$

PROFESSIONAL 28476 TREAT METATARSAL FRACTURE 28476 1,656.00$

PROFESSIONAL 28485 TREAT METATARSAL FRACTURE 28485 2,579.00$

PROFESSIONAL 28490 TREAT BIG TOE FRACTURE 28490 452.00$

PROFESSIONAL 28495 TREAT BIG TOE FRACTURE 28495 730.00$

PROFESSIONAL 28505 TREAT BIG TOE FRACTURE 28505 1,708.00$

PROFESSIONAL 28510 TREATMENT OF TOE FRACTURE 28510 372.00$

PROFESSIONAL 28515 TREATMENT OF TOE FRACTURE 28515 555.00$

PROFESSIONAL 28525 TREAT TOE FRACTURE 28525 1,392.00$

PROFESSIONAL 28530 CL TX SESAMOID FRACTURE 28530 533.00$

PROFESSIONAL 28540 TREAT FOOT DISLOCATION 28540 593.00$


PROFESSIONAL 28546 TREAT FOOT DISLOCATION 28546 1,573.00$

PROFESSIONAL 28555 REPAIR FOOT DISLOCATION 28555 2,543.00$


PROFESSIONAL 28575 TREATMENT OF TALO JOINT DISLOC W/ANESTHE 28575 1,121.00$






PROFESSIONAL 28630 TREAT TOE DISLOCATION 28630 537.00$


PROFESSIONAL 28636 PERC SK FIX MTP JNT DISL; W MANIP 28636 677.00$

PROFESSIONAL 28645 REPAIR TOE DISLOCATION 28645 1,765.00$



PROFESSIONAL 28675 REPAIR OF TOE DISLOCATION 28675 1,259.00$

PROFESSIONAL 28705 FUSION OF FOOT BONES 28705 7,532.00$






PROFESSIONAL 28750 FUSION OF BIG TOE JOINT 28750 2,966.00$



PROFESSIONAL 28800 AMPUTATION OF MIDFOOT 28800 4,246.00$

PROFESSIONAL 28805 AMPUTATION THRU METATARSAL 28805 4,246.00$

PROFESSIONAL 28810 AMPUTATION TOE & METATARSAL 28810 2,601.00$

PROFESSIONAL 28820 AMPUTATION OF TOE 28820 1,720.00$

PROFESSIONAL 28825 PARTIAL AMPUTATION OF TOE 28825 1,526.00$

PROFESSIONAL 28899-PIN PERCUTANEOUS PIN CURLY TOE 28899 909.00$

PROFESSIONAL 29000 APPLICATION OF BODY CAST 29000 2,099.00$



PROFESSIONAL 29035 APPLICATION OF BODY CAST 29035 759.00$


PROFESSIONAL 29046 APPLICATION OF BODY CAST 29046 797.00$

PROFESSIONAL 29049 APPLICATION OF FIGURE EIGHT 29049 289.00$

PROFESSIONAL 29055 APPLICATION OF SHOULDER CAST 29055 845.00$

PROFESSIONAL 29058 APPLICATION OF SHOULDER CAST 29058 531.00$

PROFESSIONAL 29065 APPLICATION OF LONG ARM CAST 29065 365.00$

PROFESSIONAL 29075 APPLICATION OF FOREARM CAST 29075 313.00$

PROFESSIONAL 29085 APPLY HAND/WRIST CAST 29085 313.00$

PROFESSIONAL 29105 APPLY LONG ARM SPLINT 29105 246.00$

PROFESSIONAL 29125 APPLY FOREARM SPLINT 29125 205.00$

PROFESSIONAL 29125-50 APPLY FOREARM SPLINT BILATERAL 29125-50 410.00$

PROFESSIONAL 29126 APPLY FOREARM SPLINT 29126 255.00$

PROFESSIONAL 29130 APPLICATION OF FINGER SPLINT 29130 127.00$

PROFESSIONAL 29131 APPLICATION OF FINGER SPLINT 29131 214.00$

PROFESSIONAL 29240 STRAPPING OF SHOULDER 29240 187.00$

PROFESSIONAL 29260 STRAPPING OF ELBOW OR WRIST 29260 110.00$

PROFESSIONAL 29280 FINGER SPLINT APPLICATION 29280 80.00$

PROFESSIONAL 29305 APPLICATION OF HIP CAST 29305 837.00$

PROFESSIONAL 29325 APPLICATION OF HIP CASTS 29325 966.00$

PROFESSIONAL 29345 APPLICATION OF LONG LEG CAST 29345 495.00$

2020-01





PROFESSIONAL 29358 APPLY LONG LEG CAST BRACE 29358 797.00$


PROFESSIONAL 29405 APPLY SHORT LEG CAST 29405 387.00$

PROFESSIONAL 29405-50 APPLY SHORT LEG CAST, BILATERAL 29405-50 775.00$



PROFESSIONAL 29445 APPLY RIGID LEG CAST 29445 665.00$

PROFESSIONAL 29450 APPLICATION OF LEG CAST 29450 249.00$

PROFESSIONAL 29505 APPLICATION, LONG LEG SPLINT 29505 289.00$

PROFESSIONAL 29515 APPLICATION LOWER LEG SPLINT 29515 233.00$

PROFESSIONAL 29515-50 APPLICATION LOWER LEG SPLINT (BILATERAL) 29515-50 466.00$

PROFESSIONAL 29530 APPLICATION OF KNEE STRAPPING 29530 180.00$

PROFESSIONAL 29530-50 APPLICATION OF KNEE STRAPPING BILAT 29530-50 358.00$

PROFESSIONAL 29530-LT APPLICATION OF LT KNEE STRAPPING 29530-LT 180.00$

PROFESSIONAL 29530-RT APPLICATION OF RT KNEE STRAPPING 29530-RT 180.00$

PROFESSIONAL 29540 APPLICATION OF ANKLE STRAPPING 29540 123.00$

PROFESSIONAL 29540-50 APPLICATION OF ANKLE STRAPPING 29540-50 123.00$

PROFESSIONAL 29550 STRAPPING OF TOES 29550 56.00$

PROFESSIONAL 29580 APPLICATION OF PASTE BOOT 29580 194.00$

PROFESSIONAL 29580-50 APPLICATION OF PASTE BOOT, BILATERAL 29580-50 387.00$

PROFESSIONAL 29581 APPLICATION MULTI-LAYER COMPRESSION 29581 235.00$

PROFESSIONAL 29700 REMOVAL/REVISION OF CAST 29700 118.00$



PROFESSIONAL 29730 WINDOWING OF CAST 29730 109.00$

PROFESSIONAL 29740 WEDGING OF CAST 29740 161.00$

PROFESSIONAL 29805 ARTHROSCOPY, SHOULDER, DIAG W/WO SYNOVIA 29805 2,596.00$

PROFESSIONAL 29806 ARTHROSCOPY SHOULDER,SURGICAL CAPSULORRH 29806 7,981.00$

PROFESSIONAL 29807 ARTHROSCOPY SHOULDER,SURG REPAIR/SLAP LE 29807 7,981.00$

PROFESSIONAL 29819 SHOULDER ARTHROSCOPY/SURGERY 29819 4,281.00$




PROFESSIONAL 29823 SHOULDER ARTHROSCOPY/SURGERY,DEBRIDEMENT 29823 7,009.00$

PROFESSIONAL 29824 SHOULDER ARTHROSCOPY/SURGERY,DISTAL CALV 29824 6,583.00$



PROFESSIONAL 29827 SHOULDER ARTHROSCOPY,W/ROTATOR CUFF REPA 29827 8,751.00$

PROFESSIONAL 29828 ARTHROSCOPY BICEPS TENODESIS 29828 2,904.00$

PROFESSIONAL 29834 ARTHROSCOPY,ELBOW,SURG,W/REMOVAL FB 29834 4,900.00$

PROFESSIONAL 29835 ARTHROSCOPY,ELBOW,SURG,SYNOVECTOMY,PARTI 29835 5,367.00$

PROFESSIONAL 29837 ARTHROSCOPY,ELBOW,SURG,DEBRIDEMENT,LIMIT 29837 5,566.00$

PROFESSIONAL 29844 ARTHROSCOPY WRIST; P SYNOVECTOMY 29844 1,862.00$

PROFESSIONAL 29846 ARTHROSCOPY WRIST;EXC/REP CARTIL 29846 2,014.00$

PROFESSIONAL 29850 KNEE ARTHROSCOPY/SURGERY 29850 4,765.00$


PROFESSIONAL 29855 TIBIAL ARTHROSCOPY/SURGERY 29855 5,296.00$

PROFESSIONAL 29856 ARTHRS AID TIBIAL FX PROX UNICONDYLAR BI 29856 3,197.00$

PROFESSIONAL 29863 ARTHROSC HIP; W REM FB W SYNOVECT 29863 2,431.00$

PROFESSIONAL 29866 REMOVE LUNG CATHETER 29866 3,922.00$

PROFESSIONAL 29867 ARTHSCPY,KNEE,OSTEOCHONDRAL ALLOGRAFT 29867 5,473.00$

PROFESSIONAL 29870 KNEE ARTHROSCOPY, DX 29870 2,435.00$

PROFESSIONAL 29871 ARTHROSCOPY,KNEE,SURGICAL FOR INFECTION 29871 4,030.00$





PROFESSIONAL 29877 ARTHROSCOPY, KNEE; DEBRID/SHV AC 29877 5,234.00$

PROFESSIONAL 29879 ARTHROSCOPY, KNEE; ABRAS RTHROPL 29879 5,960.00$

PROFESSIONAL 29880 ARTHROSC, KNEE; W MENISC-MED & LAT 29880 7,122.00$

PROFESSIONAL 29881 ARTHROSC, KNEE; W MENISC-MED/LAT 29881 5,309.00$

PROFESSIONAL 29882 ARTHROSC, KNEE; W MEN REP-MED/LAT 29882 6,925.00$

PROFESSIONAL 29883 ARTHROSC, KNEE; W MEN REPAIR-MED&LAT 29883 8,050.00$

PROFESSIONAL 29884 ARTHROSC, KNEE; W LYSIS OF ADHES 29884 4,857.00$

PROFESSIONAL 29885 ARTHROSC, KNEE; DRILL FOR OSTEOCHONDRITI 29885 7,122.00$

PROFESSIONAL 29886 ARTHROSC, KNEE; DRILL FOR O.D. LESION 29886 6,005.00$

PROFESSIONAL 29887 ARTHROSC, KNEE; DRILL FOR OD LES W FIXAT 29887 6,930.00$

2020-01




PROFESSIONAL 29888 ARTHROSC; ANT CRUCIATE LIG REP/AUGM 29888 10,424.00$

PROFESSIONAL 29891 ARTHROSCOPY,ANKLE 29891 6,777.00$

PROFESSIONAL 29892 ARTHROSCOP. AIDED REPAIR OF LG OSTEOCHON 29892 7,484.00$

PROFESSIONAL 29894 ANKLE ARTHROSCOPY/SURGERY 29894 4,989.00$




PROFESSIONAL 29899 ANKLE ARTHROSCOPY W FUSION 29899 3,648.00$

PROFESSIONAL 29999-ARBT ARTHROSCOPIC BICEP TENOTOMY 29999-ARBT 2,154.00$

PROFESSIONAL 29999-ILBA ARTHROSCOPIC ILIOTIBIAL BAND TENOTOMY 29999 1,775.00$

PROFESSIONAL 29999SCAP UNLISTED PROC, OPEN TXT OF SCAPULAR FX 29999SCAP 2,324.00$

PROFESSIONAL 30000 DRAINAGE OF NOSE LESION 30000 484.00$

PROFESSIONAL 30020 DRAINAGE OF NOSE LESION 30020 518.00$

PROFESSIONAL 30100 INTRANASAL BIOPSY 30100 361.00$

PROFESSIONAL 30110 REMOVAL OF NOSE POLYP(S) 30110 877.00$

PROFESSIONAL 30115 REMOVAL OF NOSE POLYP(S) 30115 1,858.00$

PROFESSIONAL 30115-50 REMOVAL OF NOSE POLYP(S) BILATERAL 30115-50 3,715.00$

PROFESSIONAL 30117 REMOVAL OF INTRANASAL LESION 30117 1,278.00$

PROFESSIONAL 30118 REMOVAL OF INTRANASAL LESION 30118 3,531.00$

PROFESSIONAL 30120 REVISION OF NOSE 30120 3,886.00$

PROFESSIONAL 30124 REMOVAL OF NOSE LESION 30124 1,299.00$

PROFESSIONAL 30130 REMOVAL OF TURBINATE BONES 30130 1,692.00$

PROFESSIONAL 30140 REMOVAL OF TURBINATE BONES 30140 2,619.00$

PROFESSIONAL 30140-50 RESECT INFERIOR TURBINATE BILATERAL 30140-50 5,237.00$

PROFESSIONAL 30150 RHINECTOMY; PARTIAL 30150 2,819.00$

PROFESSIONAL 30200 INJECTION TREATMENT OF NOSE 30200 208.00$

PROFESSIONAL 30220 INSERT NASAL SEPTAL BUTTON 30220 1,104.00$

PROFESSIONAL 30300 REMOVE NASAL FOREIGN BODY 30300 372.00$

PROFESSIONAL 30310 REMOVE NASAL FOREIGN BODY 30310 1,346.00$

PROFESSIONAL 30400 RECONSTRUCTION OF NOSE 30400 5,695.00$






PROFESSIONAL 30465 REPAIR NASAL STENOSIS 30465 2,518.00$

PROFESSIONAL 30520 REPAIR OF NASAL SEPTUM 30520 4,462.00$

PROFESSIONAL 30540 REPAIR NASAL DEFECT 30540 4,135.00$

PROFESSIONAL 30545 REPAIR NASAL DEFECT 30545 7,068.00$

PROFESSIONAL 30560 RELEASE OF NASAL ADHESIONS 30560 510.00$

PROFESSIONAL 30620 INTRANASAL RECONSTRUCTION 30620 5,743.00$

PROFESSIONAL 30630 REPAIR NASAL SEPTUM DEFECT 30630 3,991.00$

PROFESSIONAL 30801 CAUTERY&/OR ABLATION MUCOS INF TURBNTES 30801 599.00$

PROFESSIONAL 30802 CAUTERIZATION, INNER NOSE 30802 1,022.00$

PROFESSIONAL 30901 CONTROL OF NOSEBLEED 30901 335.00$

PROFESSIONAL 30901-50 CONTROL OF NOSEBLEED 30901-50 671.00$


PROFESSIONAL 30903-50 CONTROL OF NOSEBLEED 30903-50 991.00$


PROFESSIONAL 30906 REPEAT CONTROL OF NOSEBLEED 30906 824.00$

PROFESSIONAL 30915 LIGATION, NASAL SINUS ARTERY 30915 4,408.00$

PROFESSIONAL 30920 LIGATION, UPPER JAW ARTERY 30920 5,618.00$

PROFESSIONAL 30930 THERAPY, FX INF NASAL TURBINATE(S) 30930 572.00$

PROFESSIONAL 31000 IRRIGATION, MAXILLARY SINUS 31000 372.00$

PROFESSIONAL 31020 EXPLORATION, MAXILLARY SINUS 31020 1,996.00$

PROFESSIONAL 31030 EXPLORATION, MAXILLARY SINUS 31030 3,435.00$

PROFESSIONAL 31032 EXPLORE SINUS,REMOVE POLYPS 31032 5,074.00$

PROFESSIONAL 31040 EXPLORATION BEHIND UPPER JAW 31040 7,390.00$

PROFESSIONAL 31050 EXPLORATION, SPHENOID SINUS 31050 6,717.00$

PROFESSIONAL 31070 EXPLORATION OF FRONTAL SINUS 31070 3,812.00$

PROFESSIONAL 31075 EXPLORATION OF FRONTAL SINUS 31075 5,803.00$

PROFESSIONAL 31081 REMOVAL OF FRONTAL SINUS 31081 6,716.00$





PROFESSIONAL 31090 EXPLORATION OF SINUSES 31090 7,917.00$

PROFESSIONAL 31200 REMOVAL OF ETHMOID SINUS 31200 2,779.00$

2020-01






PROFESSIONAL 31225 REMOVAL OF UPPER JAW 31225 8,180.00$

PROFESSIONAL 31230 REMOVAL OF UPPER JAW 31230 9,598.00$

PROFESSIONAL 31231 NASAL ENDOSCOPY, DX 31231 800.00$

PROFESSIONAL 31233 NASAL/SINUS ENDOSCOPY, DX 31233 1,589.00$

PROFESSIONAL 31235 NASAL ENDO, DX W SPHEN SINUTSOT 31235 927.00$

PROFESSIONAL 31237 NASAL/SINUS ENDOSCOPY, SURG 31237 1,760.00$

PROFESSIONAL 31237-50 NASAL/SINUS ENDOSCOPY, BILATERAL 31237-50 3,520.00$



PROFESSIONAL 31240-50 NASAL/SINUS ENDOSCOPY, SURG 31240-50 2,116.00$

PROFESSIONAL 31253 NSL/SINS NDSC TOTAL 31253 619.00$

PROFESSIONAL 31253-50 NSL/SINS NDSC TOTAL 31253-50 1,238.00$

PROFESSIONAL 31254 REVISION OF ETHMOID SINUS 31254 4,101.00$

PROFESSIONAL 31254-50 REVISION OF ETHMOID SINUS, BILATERAL 31254-50 8,202.00$


PROFESSIONAL 31255-50 REMOVAL OF ETHMOID SINUS BILATERAL 31255-50 13,683.00$

PROFESSIONAL 31256 EXPLORATION MAXILLARY SINUS 31256 3,287.00$

PROFESSIONAL 31256-50 EXPLORATION MAXILLARY SINUS BILATERAL 31256-50 6,573.00$

PROFESSIONAL 31257 NSL/SINS NDSC TOT W/SPHENDT 31257 551.00$

PROFESSIONAL 31257-50 NSL/SINS NDSC TOT W/SPHENDT 31257-50 1,103.00$

PROFESSIONAL 31259 NSL/SINS NDSC SPHN TISS RMVL 31259 584.00$

PROFESSIONAL 31259-50 NSL/SINS NDSC SPHN TISS RMVL 31259-50 1,168.00$

PROFESSIONAL 31267 ENDOSCOPY, MAXILLARY SINUS 31267 4,921.00$

PROFESSIONAL 31267-50 ENDOSCOPY, MAXILLARY SINUS BILATERAL 31267-50 9,842.00$

PROFESSIONAL 31276 NASAL/SINUS ENDOS W/FRONTAL SINUS EXP 31276 3,021.00$

PROFESSIONAL 31276-50 NASAL/SINUS ENDOS W/FRONT SINUS EXP BIL 31276-50 6,042.00$

PROFESSIONAL 31287 NASAL/SINUE ENDOSCOPY,W/SPHENOIDOTOMY 31287 2,006.00$

PROFESSIONAL 31287-50 NASAL/SINUE ENDO,W/SPHENOIDOTOMY BILAT 31287-50 4,011.00$

PROFESSIONAL 31288 NASAL ENDOSCOPY W/TISS.REMOVAL SPHENOID 31288 2,532.00$

PROFESSIONAL 31300 REMOVAL OF LARYNX LESION 31300 6,730.00$

PROFESSIONAL 31360 REMOVAL OF LARYNX 31360 9,086.00$

PROFESSIONAL 31365 REMOVAL OF LARYNX 31365 13,452.00$

PROFESSIONAL 31367 PARTIAL REMOVAL OF LARYNX 31367 9,086.00$






PROFESSIONAL 31390 REMOVAL OF LARYNX & PHARYNX 31390 11,772.00$

PROFESSIONAL 31395 RECONSTRUCT LARYNX & PHARYNX 31395 15,471.00$

PROFESSIONAL 31400 REVISION OF LARYNX 31400 6,059.00$

PROFESSIONAL 31420 REMOVAL OF EPIGLOTTIS 31420 5,055.00$

PROFESSIONAL 31500 INSERT EMERGENCY AIRWAY 31500 615.00$

PROFESSIONAL 31502 CHANGE OF WINDPIPE AIRWAY 31502 536.00$

PROFESSIONAL 31505 DIAGNOSTIC LARYNGOSCOPY 31505 469.00$

PROFESSIONAL 31510 LARYNGOSCOPY WITH BIOPSY 31510 1,198.00$

PROFESSIONAL 31511 REMOVE FOREIGN BODY, LARYNX 31511 1,358.00$

PROFESSIONAL 31512 REMOVAL OF LARYNX LESION 31512 403.00$


PROFESSIONAL 31525 DIAGNOSTIC LARYNGOSCOPY EXCEPT NEWBORN 31525 1,242.00$

PROFESSIONAL 31526 DIAGNOSTIC W/OPER MICROSCOPE OR TELESCOP 31526 1,751.00$

PROFESSIONAL 31530 LARYNGSCOPY W/FOREIGN BODY REMOVAL 31530 2,183.00$

PROFESSIONAL 31531 WITH OPERATING MICROSCOPE OR TELESCOPE 31531 2,724.00$

PROFESSIONAL 31535 OPERATIVE LARYNGOSCOPY 31535 1,961.00$

PROFESSIONAL 31536 LARYNGSCPY W/OPER MICROSCOPE OR TELESCOP 31536 2,213.00$

PROFESSIONAL 31540 LARYNGSCPY W/EXC TUMOR &/OR STRP VCL CRD 31540 2,256.00$

PROFESSIONAL 31541 WITH OPERATING MICROSCOPY OR TELESCOPE 31541 2,795.00$

PROFESSIONAL 31545 LARYNGOSCOPY,W/LESION REMOVAL,RECONSTRU 31545 2,543.00$

PROFESSIONAL 31545-50 LARYNGOSCOPY,W/LESION REMOVAL,RECONSTRU 31545-50 2,543.00$

PROFESSIONAL 31560 LARYNGOSCOPY W/ARYTENOIDECTOMY 31560 3,498.00$

PROFESSIONAL 31561 WITH OPERATING MICROSCOPE OR TELESCOPE 31561 4,112.00$

PROFESSIONAL 31570 LARYNGOSCOPY W/INJ VOCAL CORDS,THERAPY 31570 2,195.00$

PROFESSIONAL 31571 WITH OERATING MICROSCOPE OR TELESCOPE 31571 2,468.00$


PROFESSIONAL 31579 DIAGNOSTIC LARYNGOSCOPY 31579 1,318.00$

PROFESSIONAL 31580 REVISION OF LARYNX 31580 7,855.00$

2020-01




PROFESSIONAL 31584 TREAT LARYNX FRACTURE 31584 5,199.00$

PROFESSIONAL 31600 INCISION OF WINDPIPE 31600 1,935.00$




PROFESSIONAL 31613 REPAIR WINDPIPE OPENING 31613 1,844.00$

PROFESSIONAL 31614 REPAIR WINDPIPE OPENING 31614 3,680.00$

PROFESSIONAL 31615 VISUALIZATION OF WINDPIPE 31615 1,106.00$

PROFESSIONAL 31622 DX BRONCHOSCOPE/WASH 31622 1,491.00$

PROFESSIONAL 31623 BRONCH; W BRUSHINGS 31623 1,002.00$

PROFESSIONAL 31624 BRONCH W/BRONCHIAL ALVELOAR LAVAGE 31624 1,066.00$

PROFESSIONAL 31625 BRONCHOSCOPY WITH BIOPSY 31625 1,838.00$

PROFESSIONAL 31627 NAVIGATIONAL BRONCHOSCOPY 31627 1,749.00$

PROFESSIONAL 31628 BRONCHOSCOPY WITH BIOPSY 31628 1,844.00$

PROFESSIONAL 31629 BRONCHOSCOPY/NEEDLE BX EACH 31629 1,131.00$

PROFESSIONAL 31632 BRONCHOSCOPY/LUNG BX ADDL 31632 228.00$

PROFESSIONAL 31633 BRONCHOSCOPY/NEEDLE BX ADDL 31633 256.00$

PROFESSIONAL 31635 REMOVE FOREIGN BODY, AIRWAY 31635 3,067.00$

PROFESSIONAL 31645 BRONCH W TX ASP TRACHEOBR TR , INIT 31645 1,661.00$

PROFESSIONAL 31646 BRONCH W TX ASP TRACHEOBR; SUBSEQ 31646 1,661.00$

PROFESSIONAL 31750 REPAIR OF WINDPIPE 31750 6,127.00$

PROFESSIONAL 31755 REPAIR OF WINDPIPE 31755 7,350.00$

PROFESSIONAL 31780 RECONSTRUCT WINDPIPE 31780 7,658.00$

PROFESSIONAL 31781 RECONSTRUCT WINDPIPE 31781 8,573.00$

PROFESSIONAL 31785 REMOVE WINDPIPE LESION 31785 7,045.00$

PROFESSIONAL 31800 REPAIR OF WINDPIPE INJURY 31800 3,987.00$

PROFESSIONAL 31805 REPAIR OF WINDPIPE INJURY 31805 5,761.00$

PROFESSIONAL 31820 SURG CLOSE TRACHEOSTOMY/FISTULA 31820 1,177.00$

PROFESSIONAL 31830 REVISE WINDPIPE SCAR 31830 1,172.00$

PROFESSIONAL 32098 OPEN BIOPSY OF LUNG PLEURA 32098 2,023.00$

PROFESSIONAL 32100 EXPLORATION/BIOPSY OF CHEST 32100 5,109.00$

PROFESSIONAL 32110 EXPLORE/REPAIR CHEST 32110 5,878.00$

PROFESSIONAL 32140 REMOVAL OF LUNG LESION(S) 32140 6,387.00$

PROFESSIONAL 32141 REMOVE/TREAT LUNG LESIONS 32141 6,387.00$

PROFESSIONAL 32215 TREAT CHEST LINING 32215 5,625.00$

PROFESSIONAL 32220 RELEASE OF LUNG 32220 6,553.00$

PROFESSIONAL 32225 PARTIAL RELEASE OF LUNG 32225 4,797.00$

PROFESSIONAL 32320 FREE/REMOVE CHEST LINING 32320 7,802.00$

PROFESSIONAL 32400 NEEDLE BIOPSY CHEST LINING 32400 624.00$

PROFESSIONAL 32405 BIOPSY, LUNG OR MEDIASTINUM 32405 1,138.00$

PROFESSIONAL 32440 REMOVAL OF LUNG 32440 9,899.00$

PROFESSIONAL 32480 PARTIAL REMOVAL OF LUNG 32480 8,694.00$

PROFESSIONAL 32505 WEDGE RESECT OF LUNG INITIAL 32505 2,432.00$

PROFESSIONAL 32550 INSERT PLEURAL CATH 32550 3,640.00$

PROFESSIONAL 32551 INSERTION OF CHEST TUBE 32551 917.00$

PROFESSIONAL 32551-26 INSERTION OF CHEST TUBE (PC) 32551-26 916.00$

PROFESSIONAL 32552 REMOVE LUNG CATHETER 32552 1,986.00$

PROFESSIONAL 32554 THORACENTESIS FOR ASPIRATION 32554 372.00$

PROFESSIONAL 32555 THORACENTESIS W/TUBE INSERT 32555 488.00$

PROFESSIONAL 32557 INSERT CATH PLEURA W/ IMAGE 32557 572.00$

PROFESSIONAL 32560 TREAT LUNG LINING CHEMICALLY 32560 616.00$

PROFESSIONAL 32601 THORACOSCOPY, DIAGNOSTIC 32601 1,920.00$

PROFESSIONAL 32607 THORACOSCOPY W/BX INFILTRATE 32607 986.00$

PROFESSIONAL 32609 THORACOSCOPY W/BX PLEURA 32609 856.00$

PROFESSIONAL 32650 THORACOSCOPY, SURGICAL 32650 3,531.00$

PROFESSIONAL 32651 THORACOSCOPY W/PART. PULM. DECORTICATION 32651 5,516.00$

PROFESSIONAL 32653 THORACOSCOPY,SURG; W REM INTRAPLEURAL FB 32653 3,957.00$

PROFESSIONAL 32655 THORACOSCOPY; W EXC -PLICATION BULLAE 32655 4,460.00$

PROFESSIONAL 32666 THORACOSCOPY W/WEDGE RESECT 32666 3,232.00$

PROFESSIONAL 32820 MAJOR RECONSTRUCTION, CHEST WALL 32820 3,771.00$

PROFESSIONAL 32900 REMOVAL OF RIB(S) 32900 4,478.00$

PROFESSIONAL 32960 THERAPEUTIC PNEUMOTHORAX 32960 488.00$

PROFESSIONAL 32999 UNLISTED PROCEDURE, LUNGS AND PLEURA 32999 2,064.00$

PROFESSIONAL 33010 DRAINAGE OF HEART SAC 33010 797.00$

PROFESSIONAL 33015 INCISION OF HEART SAC 33015 1,296.00$

PROFESSIONAL 33025 PERICARDIAL WINDOW FOR DRAINAGE 33025 5,925.00$

PROFESSIONAL 33206 INSERTION OF HEART PACEMAKER 33206 4,949.00$


2020-01





PROFESSIONAL 33210 INSERTION OF HEART ELECTRODE 33210 2,314.00$

PROFESSIONAL 33211 INSERT CARD ELECTRODES DUAL 33211 728.00$

PROFESSIONAL 33212 INSERTION OF PULSE GENERATOR 33212 2,510.00$

PROFESSIONAL 33213 INSERTION OF PULSE GENERATOR 33213 1,290.00$

PROFESSIONAL 33214 UPGRADE OF PACEMAKER SYSTEM 33214 4,949.00$

PROFESSIONAL 33215 REPOSITION PACING-DEFIB LEAD 33215 1,608.00$

PROFESSIONAL 33216 REVISE ELTRD PACING-DEFIB 33216 2,071.00$

PROFESSIONAL 33217 INS/REP TV ELECTRODE; DC PMKR/CD 33217 2,163.00$

PROFESSIONAL 33218 REVISE ELTRD PACING-DEFIB 33218 1,751.00$

PROFESSIONAL 33222 REVISE POCKET, PACEMAKER 33222 2,334.00$

PROFESSIONAL 33226 REPOSITION L VENTRIC LEAD 33226 1,244.00$

PROFESSIONAL 33227 REMOVE&REPLACE PM GEN SINGL 33227 984.00$

PROFESSIONAL 33228 REMV&REPLC PM GEN DUAL LEAD 33228 1,027.00$

PROFESSIONAL 33229 REMV&REPLC PM GEN MULT LEADS 33229 1,067.00$

PROFESSIONAL 33233 REM OF PERM PACEMAKER PULSE GENERATOR 33233 1,321.00$

PROFESSIONAL 33234 REMOVE 1-PACER LEAD ONLY 33234 1,578.00$

PROFESSIONAL 33235 REMOVE 2-PACER LEAD ONLY 33235 1,535.00$

PROFESSIONAL 33241 REMOVE PULSE GENERATOR 33241 698.00$

PROFESSIONAL 33300 REPAIR OF HEART WOUND 33300 8,205.00$

PROFESSIONAL 33305 REPAIR OF HEART WOUND 33305 9,592.00$

PROFESSIONAL 33330 INSERT MAJOR VESSEL GRAFT 33330 6,400.00$

PROFESSIONAL 33702 REPAIR OF HEART DEFECTS 33702 12,588.00$

PROFESSIONAL 33967 INTRA AORTIC BALLOON PUMP INSERTION 33967 1,502.00$

PROFESSIONAL 34001 REMOVAL OF ARTERY CLOT 34001 4,352.00$



PROFESSIONAL 34203 REMOVAL OF LEG ARTERY CLOT 34203 5,803.00$

PROFESSIONAL 35081 REPAIR DEFECT OF ARTERY 35081 10,998.00$

PROFESSIONAL 35082 REPAIR ARTERY RUPTURE, AORTA 35082 10,251.00$


PROFESSIONAL 35103 REPAIR ARTERY RUPTURE, GROIN 35103 10,703.00$





PROFESSIONAL 35206 REPAIR BLOOD VESSEL, DIRECT; UPR EXTREM 35206 3,983.00$

PROFESSIONAL 35216 REPAIR BLOOD VESSEL LESION 35216 8,696.00$

PROFESSIONAL 35221 REPAIR BLD VESSEL DIRECT; INTRA-ABDOM 35221 4,080.00$

PROFESSIONAL 35226 REPAIR BLOOD VESSEL LESION 35226 5,721.00$

PROFESSIONAL 35301 RECHANNELING OF ARTERY 35301 8,116.00$

PROFESSIONAL 35302 RECHANNELING OF ARTERY, FEMORAL 35302 5,462.00$

PROFESSIONAL 35303 RECHANNELING OF ARTERY, POPLITEAL 35303 6,006.00$

PROFESSIONAL 35304 RECHANNELING OF ARTERY,TIBIOPERONEAL TRU 35304 6,248.00$

PROFESSIONAL 35305 RECHANNEL ARTERY,TIBIAL OR PERONEAL,INIT 35305 6,006.00$

PROFESSIONAL 35306 RECHANNEL ARTERY,TIBIAL OR PERONEAL,EA A 35306 2,246.00$

PROFESSIONAL 35361 RECHANNELING OF ARTERY 35361 9,006.00$

PROFESSIONAL 35531 ARTERY BYPASS GRAFT 35531 10,543.00$



PROFESSIONAL 35583 VEIN BYPASS GRAFT 35583 10,469.00$

PROFESSIONAL 35585 VEIN BYPASS GRAFT 35585 12,000.00$



PROFESSIONAL 35637 BYPASS GRAFT, WITH OTHER THAN VEIN; AORT 35637 6,839.00$

PROFESSIONAL 35638 BYPASS GRAFT, WITH OTHER THAN VEIN; AORT 35638 6,963.00$








PROFESSIONAL 35721 EXPLORATION, FEMORAL ARTERY 35721 3,446.00$

PROFESSIONAL 35741 EXPLORATION POPLITEAL ARTERY 35741 3,446.00$

PROFESSIONAL 35761 EXPLORATION OF ARTERY/VEIN 35761 3,830.00$

PROFESSIONAL 35800 EXPL POSTOP HEMOR/THROMB/INF; NECK 35800 2,051.00$

PROFESSIONAL 35820 EXPL POSTOP HEMOR/THROMB/INF; 35820 3,697.00$

2020-01




PROFESSIONAL 35840 EXPLORE ABDOMINAL VESSELS 35840 4,973.00$

PROFESSIONAL 35860 EXPLORE LIMB VESSELS 35860 4,057.00$

PROFESSIONAL 35907 EXCISION OF INFECTED GRAFT; ABDOMEN 35907 5,301.00$

PROFESSIONAL 36000 PLACE NEEDLE IN VEIN 36000 188.00$

PROFESSIONAL 36010 PLACE CATHETER IN VEIN 36010 1,449.00$

PROFESSIONAL 36011 PLACE CATHETER IN VEIN 36011 1,652.00$

PROFESSIONAL 36100 INTRODUCTION OF NEEDLE OR INTRACATHETER 36100 2,366.00$

PROFESSIONAL 36140 ESTABLISH ACCESS TO ARTERY 36140 923.00$

PROFESSIONAL 36252 INS CATH REN ART 1ST BILAT 36252 1,642.00$

PROFESSIONAL 36260 INSERTION OF INFUSION PUMP 36260 3,396.00$

PROFESSIONAL 36262 REMOVAL OF INFUSION PUMP 36262 1,421.00$

PROFESSIONAL 36400 DRAWING BLOOD 36400 152.00$




PROFESSIONAL 36420 ESTABLISH ACCESS TO VEIN 36420 337.00$

PROFESSIONAL 36468 SING/MULT INJ SCLRSNG SOLN VEINS 36468 432.00$

PROFESSIONAL 36471 INJECTION THERAPY OF VEINS 36471 479.00$

PROFESSIONAL 36500 INSERTION OF CATHETER, VEIN 36500 1,036.00$

PROFESSIONAL 36510 INSERTION OF CATHETER, VEIN 36510 435.00$

PROFESSIONAL 36556 INSERTION NON-TUNNEL CATHETER, AGE 5+ 36556 1,347.00$

PROFESSIONAL 36558 INSERT TUNN CTRAL VENOUS W/O SUB PORT 5+ 36558 1,979.00$

PROFESSIONAL 36561 INSERT TUNN CTRAL VENOUS W/SUB PORT 5-UP 36561 2,770.00$

PROFESSIONAL 36569 INSERT PERI CTRAL VENOUS W/SUB PORT>AGE5 36569 1,057.00$

PROFESSIONAL 36576 REPAIR OF CENTRAL VENOUS ACCESS DEVICE 36576 2,562.00$

PROFESSIONAL 36578 REPLACE CATH ONLY OF VAD 36578 1,034.00$

PROFESSIONAL 36580 REPLACE NON-TUNNELED CV CATH 36580 1,676.00$

PROFESSIONAL 36581 REPLACE TUNNELED CV CATH 36581 805.00$

PROFESSIONAL 36582 REPLACEMENT/CENTRAL VENOUS ACCESS DEVICE 36582 3,958.00$

PROFESSIONAL 36589 REMOVAL OF ACCESS DEVICE 36589 1,087.00$

PROFESSIONAL 36590 REMOVAL,TUNNELED CENTRAL VENOUS ACCESS 36590 575.00$

PROFESSIONAL 36593 DECLOT VASCULAR DEVICE 36593 90.00$

PROFESSIONAL 36595 SA MECH REM OBSTR CVAD 36595 2,448.00$

PROFESSIONAL 36597 REPOSIT CVC W FLUORO 36597 618.00$

PROFESSIONAL 36598 INJ W/FLUORO, EVAL CV DEVICE 36598 658.00$

PROFESSIONAL 36598-26 INJ W/FLUOR EVAL CV DEVICE 36598 261.00$

PROFESSIONAL 36600 WITHDRAWAL OF ARTERIAL BLOOD 36600 182.00$

PROFESSIONAL 36620 INSERTION CATHETER, ARTERY 36620 403.00$



PROFESSIONAL 37180 REVISION OF CIRCULATION 37180 7,426.00$

PROFESSIONAL 37191 INS ENDOVAS VENA CAVA FILTR 37191 1,015.00$

PROFESSIONAL 37565 LIGATION OF NECK VEIN 37565 2,402.00$

PROFESSIONAL 37600 LIGATION OF NECK ARTERY 37600 2,615.00$


PROFESSIONAL 37609 TEMPORAL ARTERY PROCEDURE 37609 1,049.00$

PROFESSIONAL 37609-50 TEMPORAL ARTERY PROCEDURE 37609-50 2,096.00$


PROFESSIONAL 37616 LIGATION, MAJOR ARTERY; CHEST 37616 3,996.00$

PROFESSIONAL 37700 REVISE LEG VEIN 37700 1,727.00$

PROFESSIONAL 37722 LIGATE/STRIP LONG LEG VEIN 37722 1,496.00$

PROFESSIONAL 37760 LIGATION PERFORATOR VEINS,(LINTON TYPE) 37760 4,047.00$

PROFESSIONAL 37780 REVISION OF LEG VEIN 37780 488.00$

PROFESSIONAL 37785 REVISE SECONDARY VARICOSITY 37785 1,169.00$

PROFESSIONAL 37788 PENILE REVASCULARIZATION, W,W/O VEIN GRA 37788 6,353.00$

PROFESSIONAL 38100 REMOVAL OF SPLEEN, TOTAL 38100 5,154.00$

PROFESSIONAL 38102 SPLENECTOMY;TOTAL, IN CONJ W/OTHER PROC 38102 2,723.00$

PROFESSIONAL 38115 REPAIR OF RUPTURED SPLEEN 38115 5,637.00$

PROFESSIONAL 38120 LAPAROSCOPY,SURGICAL,SPLENECTOMY 38120 4,471.00$

PROFESSIONAL 38129 UNLISTED LAPAROSCOPY PROCEDURE SPLEEN 38129 1,140.00$

PROFESSIONAL 38220 BONE MARROW; ASPIRATION ONLY 38220 466.00$

PROFESSIONAL 38221 BONE MARROW;BIOPSY, NEEDLE or TROCAR 38221 588.00$

PROFESSIONAL 38300 DRAINAGE, LYMPH NODE LESION 38300 439.00$

PROFESSIONAL 38500 BIOPSY/REMOVAL, LYMPH NODES 38500 905.00$

PROFESSIONAL 38500-50 BIOPSY/REMOVAL, LYMPH NODES 38500-50 1,810.00$

PROFESSIONAL 38505 NEEDLE BIOPSY, LYMPH NODES 38505 529.00$

PROFESSIONAL 38510 BIOPSY/REMOVAL, LYMPH NODES 38510 1,720.00$


2020-01





PROFESSIONAL 38525-50 BIOPSY/REMOVAL, LYMPH NODES 38525-50 1,793.00$

PROFESSIONAL 38530 BIOPSY/EXCISION LYMPH NODE INT MAMMARY 38530 1,866.00$

PROFESSIONAL 38531 OPEN BX/EXC INGUINOFEMORAL NODE(S) 38531 1,042.00$

PROFESSIONAL 38542 EXPLORE DEEP NODE(S), NECK 38542 2,183.00$

PROFESSIONAL 38555 REMOVAL, NECK/ARMPIT LESION 38555 4,599.00$

PROFESSIONAL 38562 REMOVAL, PELVIC LYMPH NODES 38562 4,201.00$

PROFESSIONAL 38571 LAPAROSCOPY;W/BIL TOTAL PELVIC LYMPHADNE 38571 4,061.00$

PROFESSIONAL 38589 UNLISTED LAPAROSCOPY, LYMPHATIC 38589 2,763.00$

PROFESSIONAL 38700 REMOVAL OF LYMPH NODES, NECK 38700 3,915.00$



PROFESSIONAL 38740 REMOVE ARMPIT LYMPH NODES 38740 2,388.00$

PROFESSIONAL 38745 AXILLARY LYMPHADENECTOMY;COMPLETE 38745 4,371.00$

PROFESSIONAL 38760 INGUINOFEMORAL LYMPHADENECTOMY,SUPERFACI 38760 2,716.00$

PROFESSIONAL 38780 REMOVE ABDOMEN LYMPH NODES 38780 8,302.00$

PROFESSIONAL 38792 INJECT PROC IDENTIFICATION SENTINEL NODE 38792 754.00$

PROFESSIONAL 38900 IO MAP OF SENT LYMPH NODE 38900 728.00$

PROFESSIONAL 38900-50 IO MAP OF SENT LYMPH NODE 38900-50 728.00$

PROFESSIONAL 39000 MEDIASTINOTOMY; CERVICAL APPRO 39000 2,020.00$

PROFESSIONAL 39010 TRANSTHORACIC APPROACH,MEDIASTINUM INCIS 39010 5,735.00$

PROFESSIONAL 39220 REMOVAL CHEST LESION 39220 6,091.00$

PROFESSIONAL 39501 REPAIR DIAPHRAGM LACERATION 39501 4,986.00$

PROFESSIONAL 39540 REPAIR DIAPHR HERNIA,NON NEONATAL,ACUTE 39540 4,909.00$

PROFESSIONAL 39545 IMBRICATION OF DIAPHRAGM 39545 3,917.00$

PROFESSIONAL 39599 UNLISTED PROCEDURE;DIAPHRAGM 39599 5,207.00$

PROFESSIONAL 40490 BIOPSY OF LIP 40490 282.00$

PROFESSIONAL 40500 PARTIAL EXCISION OF LIP 40500 2,976.00$



PROFESSIONAL 40525 RECONSTRUCT LIP WITH FLAP 40525 4,408.00$

PROFESSIONAL 40527 RECONSTRUCT LIP WITH FLAP 40527 5,176.00$

PROFESSIONAL 40530 PARTIAL REMOVAL OF LIP 40530 2,208.00$

PROFESSIONAL 40650 REPAIR LIP 40650 1,385.00$



PROFESSIONAL 40800 DRAINAGE OF MOUTH LESION, SIMPLE 40800 354.00$

PROFESSIONAL 40801 DRAINAGE,MOUTH LESION, COMPLICATED 40801 877.00$

PROFESSIONAL 40804 REMOVAL, FOREIGN BODY, MOUTH 40804 449.00$

PROFESSIONAL 40806 INCISION OF LIP FOLD 40806 679.00$

PROFESSIONAL 40808 BIOPSY OF MOUTH LESION 40808 406.00$

PROFESSIONAL 40810 EXCISION OF MOUTH LESION 40810 507.00$

PROFESSIONAL 40812 EXCISE/REPAIR MOUTH LESION 40812 633.00$

PROFESSIONAL 40814 EXCISE/REPAIR MOUTH LESION 40814 1,677.00$

PROFESSIONAL 40816 EXCISION OF MOUTH LESION 40816 2,179.00$

PROFESSIONAL 40819 EXCISE LIP OR CHEEK FOLD 40819 790.00$

PROFESSIONAL 40830 REPAIR MOUTH LACERATION 40830 452.00$

PROFESSIONAL 40831 REPAIR MOUTH LACERATION 40831 1,121.00$

PROFESSIONAL 41006 I&D ABS/CYST, FOM; SUBLING 41006 1,103.00$

PROFESSIONAL 41008 DRAINAGE OF MOUTH LESION 41008 1,327.00$


PROFESSIONAL 41010 INCISION OF TONGUE FOLD 41010 645.00$





PROFESSIONAL 41100 BIOPSY OF TONGUE 41100 431.00$

PROFESSIONAL 41105 BIOPSY OF TONGUE 41105 537.00$

PROFESSIONAL 41108 BIOPSY OF FLOOR OF MOUTH 41108 379.00$

PROFESSIONAL 41110 EXCISION OF TONGUE LESION 41110 484.00$

PROFESSIONAL 41112 EXCISION OF TONGUE LESION 41112 1,054.00$



PROFESSIONAL 41115 EXCISION OF TONGUE FOLD 41115 854.00$

PROFESSIONAL 41116 EXCISION OF MOUTH LESION 41116 1,431.00$

PROFESSIONAL 41120 PARTIAL REMOVAL OF TONGUE 41120 3,272.00$

PROFESSIONAL 41130 PARTIAL REMOVAL OF TONGUE 41130 4,435.00$

PROFESSIONAL 41135 TONGUE AND NECK SURGERY 41135 7,971.00$

2020-01




PROFESSIONAL 41140 REMOVAL OF TONGUE 41140 6,340.00$

PROFESSIONAL 41145 TONGUE REMOVAL, NECK SURGERY 41145 10,144.00$

PROFESSIONAL 41150 TONGUE, MOUTH, JAW SURGERY 41150 8,180.00$

PROFESSIONAL 41153 TONGUE, MOUTH, NECK SURGERY 41153 10,144.00$

PROFESSIONAL 41155 TONGUE, JAW, & NECK SURGERY 41155 10,869.00$

PROFESSIONAL 41250 REPAIR TONGUE LACERATION 41250 484.00$

PROFESSIONAL 41251 REPAIR TONGUE LACERATION 41251 550.00$

PROFESSIONAL 41252 REPAIR TONGUE LACERATION 41252 1,866.00$

PROFESSIONAL 41520 RECONSTRUCTION, TONGUE FOLD 41520 1,275.00$

PROFESSIONAL 41800 DR ABSC, CYST, HEMATOM - DENTOALVEOLAR 41800 377.00$

PROFESSIONAL 41806 REMOVAL FOREIGN BODY,JAWBONE 41806 537.00$

PROFESSIONAL 41826 EXCISION OF GUM LESION 41826 932.00$

PROFESSIONAL 42000 DRAINAGE OF ABSCESS OF PALATE, UVULA 42000 363.00$

PROFESSIONAL 42100 BIOPSY ROOF OF MOUTH 42100 527.00$

PROFESSIONAL 42104 EXCISION LESION, MOUTH ROOF 42104 754.00$

PROFESSIONAL 42106 EXCISION LESION, MOUTH ROOF 42106 1,065.00$

PROFESSIONAL 42107 EXCISION LESION, MOUTH ROOF 42107 1,895.00$

PROFESSIONAL 42120 REMOVE PALATE/LESION 42120 3,042.00$

PROFESSIONAL 42140 EXCISION OF UVULA 42140 1,204.00$

PROFESSIONAL 42145 REPAIR PALATE, PHARYNX/UVULA 42145 4,780.00$

PROFESSIONAL 42160 TREATMENT MOUTH ROOF LESION 42160 6,215.00$

PROFESSIONAL 42180 REPAIR PALATE 42180 724.00$

PROFESSIONAL 42182 REPAIR PALATE 42182 1,505.00$

PROFESSIONAL 42226 LENGTHENING OF PALATE 42226 6,596.00$

PROFESSIONAL 42300 DRAINAGE OF SALIVARY GLAND 42300 379.00$




PROFESSIONAL 42330 REMOVAL OF SALIVARY STONE 42330 718.00$

PROFESSIONAL 42335 REMOVAL OF SALIVARY STONE 42335 1,747.00$

PROFESSIONAL 42340 REMOVAL OF SALIVARY STONE 42340 2,646.00$

PROFESSIONAL 42400 BIOPSY SALIVARY GLAND;NEEDLE 42400 350.00$

PROFESSIONAL 42405 BIOPSY, SALIVARY GLAND; INCISIONAL 42405 823.00$

PROFESSIONAL 42408 EXCISION OF SALIVARY CYST 42408 1,634.00$

PROFESSIONAL 42409 DRAINAGE OF SALIVARY CYST 42409 1,634.00$

PROFESSIONAL 42410 EXCISE PAROTID GLAND/LESION 42410 2,169.00$





PROFESSIONAL 42440 EXCISE SUBMAXILLARY GLAND 42440 4,983.00$

PROFESSIONAL 42450 EXCISE SUBLINGUAL GLAND 42450 2,289.00$

PROFESSIONAL 42500 REPAIR SALIVARY DUCT 42500 2,615.00$

PROFESSIONAL 42650 DILATION OF SALIVARY DUCT 42650 190.00$

PROFESSIONAL 42660 DILATION OF SALIVARY DUCT 42660 270.00$

PROFESSIONAL 42700 DRAINAGE OF TONSIL ABSCESS 42700 618.00$

PROFESSIONAL 42720 I&D ABSCESS, RETROPHARYNGEAL INTRAORAL 42720 1,048.00$

PROFESSIONAL 42725 I&D ABSCESS;RETROPHARYNGEAL;EXTERNAL 42725 1,440.00$

PROFESSIONAL 42800 BIOPSY OF THROAT 42800 439.00$

PROFESSIONAL 42804 BIOPSY OF UPPER NOSE/THROAT 42804 415.00$

PROFESSIONAL 42806 BIOPSY OF UPPER NOSE/THROAT 42806 873.00$

PROFESSIONAL 42808 EXCISE PHARYNX LESION 42808 1,098.00$

PROFESSIONAL 42809 REMOVE PHARYNX FOREIGN BODY 42809 861.00$

PROFESSIONAL 42810 EXCISION OF NECK CYST 42810 1,343.00$

PROFESSIONAL 42815 EXCISION OF NECK CYST 42815 3,738.00$

PROFESSIONAL 42820 REMOVE TONSILS AND ADENOIDS 42820 1,858.00$

PROFESSIONAL 42821 REMOVE TONSILS AND ADENOIDS 42821 1,996.00$

PROFESSIONAL 42825 REMOVAL OF TONSILS 42825 1,771.00$

PROFESSIONAL 42826 REMOVAL OF TONSILS 42826 1,926.00$

PROFESSIONAL 42830 REMOVAL OF ADENOIDS 42830 1,304.00$




PROFESSIONAL 42842 EXTENSIVE SURGERY OF THROAT 42842 9,260.00$



PROFESSIONAL 42860 EXCISION OF TONSIL TAGS 42860 1,098.00$

PROFESSIONAL 42870 EXCISION OF LINGUAL TONSIL 42870 1,891.00$

2020-01




PROFESSIONAL 42890 PARTIAL REMOVAL OF PHARYNX 42890 4,353.00$

PROFESSIONAL 42892 REVISION OF PHARYNGEAL WALLS 42892 6,176.00$

PROFESSIONAL 42894 REVISION OF PHARYNGEAL WALLS 42894 9,880.00$

PROFESSIONAL 42900 REPAIR THROAT WOUND 42900 2,233.00$

PROFESSIONAL 42950 RECONSTRUCTION OF THROAT 42950 4,534.00$

PROFESSIONAL 42953 REPAIR THROAT, ESOPHAGUS 42953 5,433.00$

PROFESSIONAL 42960 CONTROL THROAT BLEEDING 42960 649.00$

PROFESSIONAL 42961 CONTROL THROAT BLEEDING 42961 1,090.00$

PROFESSIONAL 42962 CONTROL THROAT BLEEDING 42962 1,304.00$

PROFESSIONAL 42970 CONTROL NOSE/THROAT BLEEDING 42970 934.00$

PROFESSIONAL 42971 CONTROL NOSE/THROAT BLEEDING 42971 1,208.00$

PROFESSIONAL 42972 CONTROL NOSE/THROAT BLEEDING 42972 1,367.00$

PROFESSIONAL 43030 THROAT MUSCLE SURGERY 43030 4,361.00$

PROFESSIONAL 43100 EXCISION OF ESOPHAGUS LESION 43100 5,443.00$

PROFESSIONAL 43117 PARTIAL REMOVAL OF ESOPHAGUS 43117 12,139.00$

PROFESSIONAL 43130 REMOVAL OF ESOPHAGUS POUCH 43130 4,674.00$

PROFESSIONAL 43180 ESOPHAGOSCOPY, RIGID TRANS W/DIVERTICUL 43180 1,195.00$

PROFESSIONAL 43191 ESOPHAGOSCOPY RIGID TRNSO DX 43191 307.00$

PROFESSIONAL 43200 ESOPHAGUS ENDOSCOPY 43200 1,242.00$

PROFESSIONAL 43202 ESOPHAGUS ENDOSCOPY, BIOPSY 43202 1,443.00$

PROFESSIONAL 43204 ESOPHAGUS ENDOSCOPY & INJECT 43204 1,515.00$

PROFESSIONAL 43215 ESOPHAGUS ENDOSCOPY 43215 2,101.00$

PROFESSIONAL 43220 ESOPH ENDOSCOPY, DILATION 43220 1,692.00$

PROFESSIONAL 43227 ESOPH ENDOSCOPY, REPAIR 43227 1,378.00$

PROFESSIONAL 43235 UPPR GI ENDOSCOPY, DIAGNOSIS 43235 1,399.00$

PROFESSIONAL 43236 UGI W SUBMUCOS INJ 43236 1,381.00$

PROFESSIONAL 43239 UPPER GI ENDOSCOPY, BIOPSY 43239 1,438.00$

PROFESSIONAL 43241 UPPER GI ENDOSCOPY WITH TUBE 43241 1,749.00$

PROFESSIONAL 43245 OPERATIVE UPPER GI ENDOSCOPY 43245 1,877.00$

PROFESSIONAL 43246 PLACE GASTROSTOMY TUBE 43246 1,019.00$


PROFESSIONAL 43248 UPPR GI ENDOSCOPY/GUIDE WIRE 43248 1,471.00$

PROFESSIONAL 43249 ESOPH ENDOSCOPY, DILATION 43249 1,374.00$

PROFESSIONAL 43250 UPPER GI ENDOSCOPY/TUMOR 43250 1,573.00$



PROFESSIONAL 43260 ENDO CHOLANGIOPANCREATOGRAPH 43260 2,235.00$

PROFESSIONAL 43262 ENDO CHOLANGIOPANCREATOGRAPH 43262 3,147.00$

PROFESSIONAL 43266 EGD ENDOSCOPIC STENT PLACE 43266 645.00$

PROFESSIONAL 43279 LAP MYOTOMY, HELLER 43279 4,741.00$

PROFESSIONAL 43280 LAPAROSCOPY,SURG,ESOPHAGOGASTRIC FUNDOPL 43280 4,772.00$

PROFESSIONAL 43281 LAP PARAESOPHAG HERNIA REPAIR 43281 5,451.00$

PROFESSIONAL 43282 LAP PARAESOPHAGEAL HERNIA REPAIR W/MESH 43282 6,129.00$

PROFESSIONAL 43289 UNLISTED LAPAROSCOPY, ESOPHAGUS 43289 4,772.00$

PROFESSIONAL 43320 FUSE ESOPHAGUS & STOMACH 43320 6,195.00$

PROFESSIONAL 43327 ESOPH FUNDO PART/COMPL;LAPAROTOMY 43327 2,175.00$

PROFESSIONAL 43332 TRANSAB ESOPH HIAT HERN RPR WO MESH 43332 2,868.00$

PROFESSIONAL 43352 SURGICAL OPENING, ESOPHAGUS 43352 4,512.00$

PROFESSIONAL 43410 REPAIR ESOPHAGUS WOUND 43410 3,915.00$

PROFESSIONAL 43415 REPAIR ESOPHAGUS WOUND 43415 6,188.00$

PROFESSIONAL 43420 REPAIR ESOPHAGUS OPENING 43420 3,724.00$

PROFESSIONAL 43450 DILATE ESOPHAGUS 43450 609.00$

PROFESSIONAL 43453 DILATE ESOPHAGUS 43453 1,018.00$

PROFESSIONAL 43460 PRESSURE TREATMENT ESOPHAGUS 43460 467.00$

PROFESSIONAL 43499 UNLISTED PROCEDURE, ESOPHAGUS 43499 1,290.00$

PROFESSIONAL 43500 SURGICAL OPENING OF STOMACH 43500 4,354.00$

PROFESSIONAL 43501 SURGICAL REPAIR OF STOMACH 43501 6,159.00$

PROFESSIONAL 43520 INCISION OF PYLORIC MUSCLE 43520 3,203.00$

PROFESSIONAL 43610 EXCISION OF STOMACH LESION 43610 5,551.00$

PROFESSIONAL 43621 GASTRECTOMY,TOTAL W/ESOPHAG W/ROUX-EN Y 43621 9,677.00$

PROFESSIONAL 43631 REMOVAL OF STOMACH, PARTIAL 43631 5,337.00$



PROFESSIONAL 43640 VAGOTOMY & PYLORUS REPAIR 43640 6,052.00$

PROFESSIONAL 43641 VAGOTOMY & PYLORUS REPAIR 43641 6,135.00$

PROFESSIONAL 43752 NASAL/OROGASTRIC TUBE PLMT 43752 435.20$

PROFESSIONAL 43753 TX GASTRO INTUB W/ASP 43753 82.00$

PROFESSIONAL 43761 GASTRIC FEEDING TUBE REPL-DUODENUM 43761 444.00$

2020-01




PROFESSIONAL 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTR 43762 323.00$

PROFESSIONAL 43771 LAP REVISE GASTR ADJ DEVICE 43771 3,228.00$

PROFESSIONAL 43774 LAP GASTRIC RESTRICT PX REMOVE DEVICE 43774 2,680.00$

PROFESSIONAL 43775 LAP SLEEVE GASTRECTOMY 43775 4,314.00$

PROFESSIONAL 43800 RECONSTRUCTION OF PYLORUS 43800 4,963.00$

PROFESSIONAL 43820 FUSION OF STOMACH AND BOWEL 43820 4,030.00$

PROFESSIONAL 43830 PLACE GASTROSTOMY TUBE 43830 3,961.00$

PROFESSIONAL 43832 GASTROSTOMY OPEN; CREATE G TUBE 43832 3,246.00$

PROFESSIONAL 43840 REPAIR OF STOMACH LESION 43840 4,577.00$

PROFESSIONAL 43848 REVISION GASTROPLASTY 43848 7,201.00$

PROFESSIONAL 43860 REVISE STOMACH-BOWEL FUSION 43860 6,441.00$

PROFESSIONAL 43870 CLOSURE OF GASTROSTOMY SURGICAL 43870 1,531.00$

PROFESSIONAL 43880 CLOSURE OF GASTROCOLIC FISTULA 43880 4,535.00$

PROFESSIONAL 44005 FREEING OF BOWEL ADHESION 44005 3,457.00$

PROFESSIONAL 44015 INSERT NEEDLE CATH BOWEL 44015 2,019.00$

PROFESSIONAL 44020 ENTEROTOMY,SM.INTESTINE,EXP,BX,FB REMVL 44020 3,774.00$

PROFESSIONAL 44021 DECOMPRESS SMALL BOWEL 44021 3,798.00$

PROFESSIONAL 44025 INCISION OF LARGE BOWEL 44025 4,375.00$

PROFESSIONAL 44050 REDUCE BOWEL OBSTRUCTION 44050 3,798.00$

PROFESSIONAL 44055 LYSIS DUODENAL BANDS (LADD PROC.) 44055 3,949.00$

PROFESSIONAL 44100 BIOPSY OF BOWEL 44100 724.00$

PROFESSIONAL 44110 EXCISION OF BOWEL LESION(S) 44110 5,065.00$

PROFESSIONAL 44111 EXCISION OF BOWEL LESION(S) 44111 5,835.00$

PROFESSIONAL 44120 REMOVAL OF SMALL INTESTINE 44120 5,369.00$



PROFESSIONAL 44130 BOWEL TO BOWEL FUSION 44130 5,137.00$

PROFESSIONAL 44139 MOBILIZATION OF SPLENIC FLEXURE 44139 475.00$

PROFESSIONAL 44140 PARTIAL REMOVAL OF COLON 44140 6,597.00$







PROFESSIONAL 44150 REMOVAL OF COLON 44150 7,289.00$

PROFESSIONAL 44151 COLECTOMY TOT ABD;W CONTINENT ILEOSTOMY 44151 5,112.00$

PROFESSIONAL 44155 REMOVAL OF COLON/ILEOSTOMY 44155 9,890.00$

PROFESSIONAL 44160 COLECTOMY,PARTIAL,W/REMOVAL ILEUM/ILEOCO 44160 6,235.00$

PROFESSIONAL 44180 LAPAROSCOPY,SURGICAL, ENTEROLYSIS 44180 4,936.00$

PROFESSIONAL 44186 LAP JEJUNOSTOMY 44186 1,713.00$

PROFESSIONAL 44187 LAP, ILEO/JEJUNO-STOMY 44187 5,652.00$

PROFESSIONAL 44188 LAP, COLOSTOMY 44188 4,577.00$

PROFESSIONAL 44202 LAP, ENTERECTOMY 44202 5,141.00$

PROFESSIONAL 44204 LAP,COLECTOMY PARTIAL W/ANASTOMOSIS 44204 6,700.00$

PROFESSIONAL 44205 LAP P COLECTOMY W REM ILEUM 44205 4,976.00$

PROFESSIONAL 44207 COLECTOMY,PAR,W/ANAST,W/COLOPROCTSTMY 44207 10,511.00$

PROFESSIONAL 44208 L COLECTOMY/COLOPROCTOSTOMY 44208 8,626.00$

PROFESSIONAL 44213 LAP, MOBIL SPLENIC FL ADD-ON 44213 587.00$

PROFESSIONAL 44238 UNLISTED LAPAROSCOPY PROCEDURE;INTESTINE 44238 10,359.00$

PROFESSIONAL 44300 OPEN BOWEL TO SKIN 44300 3,580.00$

PROFESSIONAL 44310 ILEOSTOMY/JEJUNOSTOMY, NON-TUBE 44310 4,688.00$

PROFESSIONAL 44312 REVISION OF ILEOSTOMY 44312 1,422.00$

PROFESSIONAL 44314 REVISION OF ILEOSTOMY 44314 4,588.00$

PROFESSIONAL 44320 COLOSTOMY OR SKIN LEVEL CECOSTOMY 44320 4,108.00$

PROFESSIONAL 44322 COLOSTOMY WITH BIOPSIES 44322 4,951.00$

PROFESSIONAL 44340 REVISION OF COLOSTOMY 44340 1,396.00$



PROFESSIONAL 44360 SMALL BOWEL ENDOSCOPY 44360 1,505.00$

PROFESSIONAL 44373 ENDOSCOPY W/COVERSION OF PEG 44373 1,628.00$

PROFESSIONAL 44376 SM INT ENDO W ILEUM;DX 44376 859.00$

PROFESSIONAL 44380 ILEOSCOPY, THRU STOMA; DX 44380 812.00$

PROFESSIONAL 44385 ENDO EVAL SM INTEST POUCH;DX 44385 448.00$

PROFESSIONAL 44386 ENDO EVAL SM INTEST POUCH W BX 44386 863.00$

PROFESSIONAL 44388 COLON ENDOSCOPY 44388 1,621.00$

PROFESSIONAL 44389 COLONOSCOPY W/BIOPSY,SINGLE OR MULTIPLE 44389 1,861.00$

PROFESSIONAL 44391 COLONOSCOPY FOR BLEEDING 44391 1,181.00$

2020-01




PROFESSIONAL 44392 COLONOSCOPY, STOMA; W REM BY HBF/BPC 44392 1,684.00$

PROFESSIONAL 44394 COLONOSCOPY THRU STOMA, W/REMOVAL 44394 1,539.00$

PROFESSIONAL 44602 SUTURE, SMALL INTESTINE 44602 5,007.00$

PROFESSIONAL 44603 SUTURE, SMALL INTESTINE 44603 5,637.00$

PROFESSIONAL 44604 SUTURE, LARGE INTESTINE 44604 4,408.00$

PROFESSIONAL 44605 REPAIR OF BOWEL LESION 44605 4,637.00$

PROFESSIONAL 44615 INTESTINAL STRICTUROPLASTY W/WO DILATION 44615 5,202.00$

PROFESSIONAL 44620 REPAIR BOWEL OPENING 44620 3,472.00$



PROFESSIONAL 44640 CLOSURE OF INTESTINAL CUTANEOUS FISTULA 44640 5,007.00$

PROFESSIONAL 44650 REPAIR BOWEL FISTULA 44650 3,822.00$

PROFESSIONAL 44660 CLOSE ENTEROVES FIST; WO INT/BLDR RESECT 44660 3,651.00$

PROFESSIONAL 44661 CL EV FISTULA W INT RESECT 44661 3,270.00$

PROFESSIONAL 44680 INTESTINAL PLICATION 44680 3,173.00$

PROFESSIONAL 44800 EXCISION OF BOWEL POUCH 44800 3,871.00$

PROFESSIONAL 44820 EXCISION OF MESENTERY LESION 44820 2,730.00$

PROFESSIONAL 44850 REPAIR OF MESENTERY 44850 3,464.00$

PROFESSIONAL 44900 DRAIN APP ABSCESS, OPEN 44900 2,444.00$

PROFESSIONAL 44950 APPENDECTOMY 44950 3,226.00$

PROFESSIONAL 44955 APPENDECTOMY ADD-ON 44955 1,443.00$

PROFESSIONAL 44960 APPENDECTOMY 44960 3,551.00$

PROFESSIONAL 44970 LAPAROSCOPY, APPENDECTOMY 44970 2,807.00$

PROFESSIONAL 44979 UNLISTED LAPAROSCOPY, APPENDIX 44979 2,807.00$

PROFESSIONAL 45000 DRAINAGE OF PELVIC ABSCESS 45000 761.00$

PROFESSIONAL 45005 I&D OF SUBMUCOSAL ABSCESS;RECTUM 45005 504.00$

PROFESSIONAL 45020 I&D SUPRALEVATOR,PELVIRECTAL, ABSCESS 45020 1,336.00$

PROFESSIONAL 45100 BIOPSY OF RECTUM 45100 1,235.00$

PROFESSIONAL 45110 REMOVAL OF RECTUM 45110 9,018.00$

PROFESSIONAL 45130 EXC RECTAL PROCIDENTIA; PERINE 45130 3,859.00$

PROFESSIONAL 45150 DIVISION STRICTURE RECTUM 45150 1,787.00$

PROFESSIONAL 45171 EXC RECTAL TUMOR TRANSANAL PART 45171 1,745.00$

PROFESSIONAL 45172 EXC RCT TUM INCL MUSCULARIS PROPRIA 45172 1,988.00$

PROFESSIONAL 45190 DESTRUCTION OF RECTAL TUMOR 45190 1,598.00$

PROFESSIONAL 45300 PROCTOSIGMOIDOSCOPY 45300 285.00$

PROFESSIONAL 45303 PROCTOSIGMOIDOSCOPY WITH DILATION 45303 1,196.00$

PROFESSIONAL 45305 PROCTOSIGMOIDOSCOPY & BIOPSY 45305 450.00$

PROFESSIONAL 45307 PROCTOSIGMOIDOSCOPY W/REMOVAL OF FB 45307 450.00$

PROFESSIONAL 45308 PROCTOSIGMOIDOSCOPY W/REMOVAL BY BX FORC 45308 481.00$

PROFESSIONAL 45309 PROCTOSIGMOIDOSCOPY W/REMOVAL BY SNARE 45309 481.00$


PROFESSIONAL 45317 PROCTOSIG W BLEED CNTRL 45317 565.00$


PROFESSIONAL 45321 PROCTOSIGMOISCOPY, RIGID,W/DECOMPRESSION 45321 504.00$

PROFESSIONAL 45330 DIAGNOSTIC SIGMOIDOSCOPY 45330 552.00$

PROFESSIONAL 45331 SIGMOIDOSCOPY AND BIOPSY 45331 678.00$

PROFESSIONAL 45332 SIGMOIDOSCOPY 45332 1,095.00$

PROFESSIONAL 45333 SIGMOIDOSCOPY & POLYPECTOMY 45333 1,614.00$

PROFESSIONAL 45334 SIGMOIDOSCOPY FOR BLEEDING 45334 529.00$

PROFESSIONAL 45335 SIGMOIDOSCOPY,FLEX DIAG W OR W/O COLLECT 45335 659.00$

PROFESSIONAL 45337 SIGMOIDOSCOPY W/DECOMPRESSION OF VOLVULU 45337 1,269.00$

PROFESSIONAL 45338 SIGMOIDOSCOPY 45338 1,614.00$

PROFESSIONAL 45340 SIG W/BALLOON DILATION 45340 948.00$

PROFESSIONAL 45378 DIAGNOSTIC COLONOSCOPY 45378 1,703.00$

PROFESSIONAL 45379 COLONOSCOPY 45379 1,979.00$

PROFESSIONAL 45380 COLONOSCOPY AND BIOPSY 45380 1,869.00$

PROFESSIONAL 45381 COLONOSCOPY W/DIRECTED SUBMUCOSAL INJECT 45381 1,728.00$

PROFESSIONAL 45382 COLONOSCOPY/CONTROL BLEEDING 45382 1,766.00$

PROFESSIONAL 45384 COLONOSCOPY 45384 2,382.00$

PROFESSIONAL 45385 COLONOSCOPY FLEX W REM LESION BY SNARE 45385 2,407.00$

PROFESSIONAL 45386 COLONOSCOPY W B DIL STRICTURE(S) 45386 2,889.00$

PROFESSIONAL 45505 REPAIR OF RECTUM 45505 3,864.00$

PROFESSIONAL 45520 TREATMENT OF RECTAL PROLAPSE 45520 205.00$

PROFESSIONAL 45540 PROCTOPEXY (FOR PROLAPSE) ABD APPROACH 45540 4,492.00$

PROFESSIONAL 45550 REPAIR RECTUM/REMOVE SIGMOID 45550 3,874.00$

PROFESSIONAL 45560 REPAIR OF RECTOCELE 45560 2,262.00$

PROFESSIONAL 45562 EXPL, REPAIR, AND PS DRAIN FOR INJURY 45562 3,438.00$

PROFESSIONAL 45563 REPAIR RECTAL INJURY; W/COLOSTOMY 45563 4,121.00$

2020-01




PROFESSIONAL 45905 DILATE ANAL SPHINCTER UNDER ANESTHESIA 45905 450.00$

PROFESSIONAL 45910 DILATE RECTAL STRICTURE UNDER ANEST 45910 595.00$

PROFESSIONAL 45915 REMOVE RECTAL OBSTRUCTION 45915 856.00$

PROFESSIONAL 45990 SURG DX EXAM, ANORECTAL 45990 213.00$

PROFESSIONAL 45999 UNLISTED PROCEDURE RECTUM 45999 1,936.00$

PROFESSIONAL 45999-RTP RECTAL TUBE PLACEMENT 45999 260.00$

PROFESSIONAL 46020 INCISION, PLACEMENT OF SETON 46020 877.00$

PROFESSIONAL 46030 REMOVE ANAL SETON, OTHER MARKER 46030 402.00$

PROFESSIONAL 46040 INCISION OF RECTAL ABSCESS 46040 1,128.00$

PROFESSIONAL 46045 I&D; SUPERF ABSCESS PERI/ISCHEAL 46045 906.00$

PROFESSIONAL 46050 INCISION OF ANAL ABSCESS 46050 450.00$

PROFESSIONAL 46060 INCISION OF RECTAL ABSCESS 46060 1,886.00$

PROFESSIONAL 46083 INCISE EXTERNAL HEMORRHOID 46083 482.00$

PROFESSIONAL 46200 REMOVAL OF ANAL FISSURE 46200 1,692.00$

PROFESSIONAL 46220 REMOVAL OF ANAL TAB 46220 337.00$

PROFESSIONAL 46221 LIGATION OF HEMORRHOID(S) 46221 495.00$

PROFESSIONAL 46230 REMOVAL OF ANAL TABS 46230 576.00$

PROFESSIONAL 46250 HEMORRHOIDECTOMY 46250 1,947.00$

PROFESSIONAL 46255 HEMORRHOIDECTOMY 46255 2,586.00$

PROFESSIONAL 46257 REMOVE IN/EX HEM GRP & FISS 46257 948.00$

PROFESSIONAL 46260 HEMORRHOIDECTOMY,INT/EXT,COMPLEX/EXTENSI 46260 2,767.00$

PROFESSIONAL 46261 REMOVE INT/EXT HEMORR 2+ GRPS & FISSURE 46261 1,747.00$

PROFESSIONAL 46262 HEMORRHOIDECTOMY W/FISTULECTOMY 46262 1,207.00$

PROFESSIONAL 46270 REMOVAL OF ANAL FISTULA 46270 1,634.00$

PROFESSIONAL 46275 SURG TX ANAL FISTULA; SUBMUSCU 46275 1,866.00$

PROFESSIONAL 46280 REMOVAL OF ANAL FISTULA 46280 2,770.00$

PROFESSIONAL 46288 CLOSE ANAL FISTULA W RECTAL ADVANCEM 46288 2,137.00$

PROFESSIONAL 46320 REMOVAL OF HEMORRHOID CLOT 46320 456.00$

PROFESSIONAL 46600 DIAGNOSTIC ANOSCOPY 46600 153.00$

PROFESSIONAL 46606 ANOSCOPY AND BIOPSY 46606 272.00$

PROFESSIONAL 46610 ANOSCOPY/REMOVE LESION 46610 504.00$

PROFESSIONAL 46614 ANOSCOPY; CONTROL BLEEDING 46614 400.00$

PROFESSIONAL 46615 ANOSCOPY 46615 859.00$

PROFESSIONAL 46700 REPAIR OF ANAL STRICTURE 46700 2,311.00$

PROFESSIONAL 46706 REPR OF ANAL FISTULA W/GLUE 46706 605.00$

PROFESSIONAL 46753 RECONSTRUCTION OF ANUS 46753 1,970.00$

PROFESSIONAL 46900 DESTRUCTION, ANAL LESION(S) 46900 419.00$

PROFESSIONAL 46910 DESTRUCTION, ANAL LESION(S) 46910 518.00$

PROFESSIONAL 46922 EXCISION OF ANAL LESION(S) 46922 791.00$

PROFESSIONAL 46924 DESTRUCTION, ANAL LESION(S) 46924 1,744.00$

PROFESSIONAL 46940 TREATMENT OF ANAL FISSURE 46940 299.00$

PROFESSIONAL 46945 LIGATE INTERNAL HEMORRHOIDS; SINGLE 46945 520.00$

PROFESSIONAL 46946 LIGATE INTERNAL HEMORRHOIDS; MULTIP 46946 663.00$

PROFESSIONAL 46947 HEMORRHOIDOPEXY BY STAPLING 46947 932.00$

PROFESSIONAL 47000 NEEDLE BIOPSY OF LIVER 47000 703.00$

PROFESSIONAL 47001 NEEDLE BIOPSY, LIVER ADD-ON 47001 456.00$

PROFESSIONAL 47010 OPEN DRAINAGE, LIVER LESION 47010 3,102.00$

PROFESSIONAL 47100 WEDGE BIOPSY OF LIVER 47100 3,580.00$

PROFESSIONAL 47300 SURGERY FOR LIVER LESION 47300 5,174.00$

PROFESSIONAL 47350 REPAIR LIVER WOUND 47350 5,065.00$

PROFESSIONAL 47360 REPAIR LIVER WOUND 47360 6,022.00$

PROFESSIONAL 47379 LAPAROSCOPE PROCEDURE, LIVER 47379 456.00$

PROFESSIONAL 47399 UNLISTED PROCEDURE, LIVER 47399 456.00$

PROFESSIONAL 47420 INCISION OF BILE DUCT 47420 5,559.00$

PROFESSIONAL 47460 INCISE BILE DUCT SPHINCTER 47460 6,881.00$

PROFESSIONAL 47480 INCISION OF GALLBLADDER 47480 4,449.00$

PROFESSIONAL 47550 BILE DUCT ENDOSCOPY ADD-ON 47550 989.00$

PROFESSIONAL 47552 BILIARY ENDOSCOPY THRU SKIN 47552 1,317.00$

PROFESSIONAL 47554 BILIARY ENDOSCOPY THRU SKIN 47554 1,578.00$

PROFESSIONAL 47562 LAPAROSCOPIC CHOLECYSTECTOMY 47562 4,516.00$

PROFESSIONAL 47563 LAPARO CHOLECYSTECTOMY/GRAPH 47563 4,820.00$

PROFESSIONAL 47564 LAPARO CHOLECYSTECTOMY/EXP-COMMON DUCT 47564 4,865.00$

PROFESSIONAL 47600 REMOVAL OF GALLBLADDER 47600 4,906.00$





PROFESSIONAL 47720 FUSE GALLBLADDER & BOWEL 47720 5,174.00$

2020-01




PROFESSIONAL 47721 FUSE UPPER GI STRUCTURES 47721 6,215.00$

PROFESSIONAL 47760 FUSE BILE DUCTS AND BOWEL 47760 7,159.00$

PROFESSIONAL 47780 FUSE BILE DUCTS AND BOWEL 47780 8,825.00$

PROFESSIONAL 47800 RECONSTRUCTION OF BILE DUCTS 47800 8,205.00$

PROFESSIONAL 47801 PLACEMENT, BILE DUCT SUPPORT 47801 4,165.00$

PROFESSIONAL 48000 DRAINAGE OF ABDOMEN 48000 4,577.00$

PROFESSIONAL 48100 BIOPSY OF PANCREAS 48100 5,065.00$

PROFESSIONAL 48105 RESECT/DEBRIDE PANCREAS 48105 5,814.00$

PROFESSIONAL 48140 PARTIAL REMOVAL OF PANCREAS 48140 7,159.00$

PROFESSIONAL 48150 PARTIAL REMOVAL OF PANCREAS 48150 12,054.00$

PROFESSIONAL 48520 FUSE PANCREAS CYST AND BOWEL 48520 6,058.00$

PROFESSIONAL 49000 EXPLORATION OF ABDOMEN 49000 2,904.00$

PROFESSIONAL 49002 REOPENING OF ABDOMEN 49002 3,135.00$

PROFESSIONAL 49010 EXPLORATION BEHIND ABDOMEN 49010 3,970.00$

PROFESSIONAL 49020 DRAIN ABDOMINAL ABSCESS 49020 3,746.00$

PROFESSIONAL 49040 DRAIN, OPEN, ABDOM ABSCESS 49040 4,445.00$

PROFESSIONAL 49060 DRAIN, OPEN, RETROP ABSCESS 49060 3,864.00$

PROFESSIONAL 49082 ABD PARACENTESIS 49082 468.00$

PROFESSIONAL 49083 ABD PARACENTESIS W/IMAGING 49083 732.00$

PROFESSIONAL 49084 PERITONEAL LAVAGE 49084 235.00$

PROFESSIONAL 49203 EXC ABD TUM 5 CM OR LESS 49203 3,181.00$

PROFESSIONAL 49204 EXC ABD TUM OVER 5 CM 49204 4,054.00$

PROFESSIONAL 49205 EXC ABD TUM OVER 10 CM 49205 4,636.00$

PROFESSIONAL 49220 MULTIPLE SURGERY, ABDOMEN 49220 8,250.00$

PROFESSIONAL 49250 EXCISION OF UMBILICUS 49250 2,586.00$

PROFESSIONAL 49255 REMOVAL OF OMENTUM 49255 3,539.00$

PROFESSIONAL 49320 DIAG LAPARO SEPARATE PROC 49320 2,666.00$

PROFESSIONAL 49321 LAPAROSCOPY, BIOPSY 49321 2,966.00$

PROFESSIONAL 49322 LAPAROSCOPY, ASPIRATION 49322 3,758.00$

PROFESSIONAL 49329 UNLISTED LAPAROSCOPY PROCEDURE,ABDOMEN 49329 3,138.00$

PROFESSIONAL 49329-APO LAPAROSCOPIC LIGATION W/ENDOLOOPS 49329 3,138.00$

PROFESSIONAL 49402 REMOVE FOREIGN BODY, ADBOMEN 49402 2,639.00$

PROFESSIONAL 49405 IMAGE CATH FLUID COLXN VISC 49405 898.00$

PROFESSIONAL 49406 IMAGE CATH FLUID PERI/RETRO 49406 898.00$

PROFESSIONAL 49406-26 IMAGE CATH FLUID PERI/RETRO 49406-26 898.00$

PROFESSIONAL 49421 INS TUN IP CATH FOR DIALOPN 49421 381.00$

PROFESSIONAL 49422 REMOVE PERM INTRPERITONEAL CANNULA/CATH 49422 1,764.00$

PROFESSIONAL 49440 PLACE GASTROSTOMY TUBE PERC 49440 2,163.00$

PROFESSIONAL 49441 PLACE DUOD/JEJ TUBE PERC 49441 1,236.00$

PROFESSIONAL 49446 CHANGE G-TUBE TO G-J PERC 49446 1,048.00$

PROFESSIONAL 49450 REPLACE G/C TUBE PERC 49450 2,863.00$

PROFESSIONAL 49451 REPLACE DUOD/JEJ TUBE PERC 49451 764.00$

PROFESSIONAL 49452 REPLACE G-J TUBE PERC 49452 943.00$

PROFESSIONAL 49460 FIX G/COLON TUBE W/DEVICE 49460 181.00$

PROFESSIONAL 49465 FLUORO EXAM OF G/COLON TUBE 49465 178.00$

PROFESSIONAL 49495 REPAIR INGUINAL HERNIA, INIT 49495 2,835.00$

PROFESSIONAL 49496 REPAIR INGUINAL HERNIA, INCAR OR STRANG 49496 3,452.00$

PROFESSIONAL 49500 REPAIR INGUINAL HERNIA 6mo - < 5yr old 49500 2,863.00$

PROFESSIONAL 49505 REPAIR INGUINAL HERNIA 49505 3,084.00$

PROFESSIONAL 49505-50 REPAIR INGUINAL HERNIA 49505-50 3,084.00$

PROFESSIONAL 49507 REPAIR INGUINAL HERNIA 49507 3,627.00$

PROFESSIONAL 49520 REREPAIR INGUINAL HERNIA 49520 3,580.00$

PROFESSIONAL 49521 REPAIR INGUINAL HERNIA, REC 49521 3,740.00$

PROFESSIONAL 49525 REPAIR INGUINAL HERNIA, SLIDING, ANY AGE 49525 3,400.00$

PROFESSIONAL 49540 REPAIR LUMBAR HERNIA 49540 3,045.00$

PROFESSIONAL 49550 REPAIR FEMORAL HERNIA 49550 3,036.00$

PROFESSIONAL 49553 REPAIR FEMORAL HERNIA, INIT 49553 2,989.00$

PROFESSIONAL 49555 REPAIR RECURRENT FEMORAL HERNIA; REDUCIB 49555 2,466.00$

PROFESSIONAL 49557 REPAIR FEMORAL HERNIA, RECUR 49557 3,918.00$

PROFESSIONAL 49560 REPAIR ABDOMINAL HERNIA 49560 3,421.00$

PROFESSIONAL 49561 REPAIR INCISIONAL HERNIA 49561 4,072.00$

PROFESSIONAL 49565 REREPAIR ABDOMINAL HERNIA 49565 4,298.00$

PROFESSIONAL 49566 REPAIR INCISIONAL HERNIA 49566 4,684.00$

PROFESSIONAL 49568 HERNIA REPAIR W/MESH 49568 913.00$

PROFESSIONAL 49570 REPAIR EPIGASTRIC HERNIA 49570 1,963.00$

PROFESSIONAL 49572 REPAIR EPIGASTRIC HERNIA 49572 2,451.00$

PROFESSIONAL 49580 REPAIR UMBILICAL HERNIA 49580 2,191.00$

PROFESSIONAL 49582 REPAIR UMB HERNIA, < 5 YEARS; INCARCERAT 49582 2,206.00$

2020-01




PROFESSIONAL 49585 REPAIR UMBILICAL HERNIA 49585 3,037.00$

PROFESSIONAL 49587 REPAIR UMB HERNIA,> 5; INCARCERATED 49587 3,287.00$

PROFESSIONAL 49590 REPAIR ABDOMINAL HERNIA 49590 3,197.00$

PROFESSIONAL 49650 LAPARO HERNIA REPAIR INITIAL 49650 2,966.00$

PROFESSIONAL 49650-50 LAPARO HERNIA REPAIR INITIAL 49650-50 2,966.00$

PROFESSIONAL 49651 LAPAROSCOPY; REPAIR RECURRENT ING HERNIA 49651 2,242.00$

PROFESSIONAL 49651-50 LAPAROSCOPY; REPAIR RECURRENT ING HERNIA 49651-50 2,242.00$

PROFESSIONAL 49652 LAP VENT/ABD HERNIA REPAIR 49652 2,768.00$

PROFESSIONAL 49653 LAP VENT/ABD HERN PROC COMP 49653 3,470.00$

PROFESSIONAL 49654 LAP INC HERNIA REPAIR 49654 3,224.00$

PROFESSIONAL 49655 LAP INC HERN REPAIR COMP 49655 3,881.00$

PROFESSIONAL 49656 LAP INC HERNIA REPAIR RECUR 49656 3,236.00$

PROFESSIONAL 49657 LAP INC HERN RECUR COMP 49657 4,741.00$

PROFESSIONAL 49900 REPAIR OF ABDOMINAL WALL 49900 2,801.00$

PROFESSIONAL 49905 INTRA-ABDOMINAL OMENTAL FLAP 49905 1,242.00$

PROFESSIONAL 50080 PERC NEPHROSTOLITHOTOMY; TO 2 CM 50080 3,001.00$

PROFESSIONAL 50081 PERC NEPHROSTOLITHOTOY;> 2 CM 50081 3,651.00$

PROFESSIONAL 50220 NEPROURETERECTERY WITH BLADDER CUFF 50220 5,650.00$

PROFESSIONAL 50230 REMOVAL OF KIDNEY 50230 8,146.00$

PROFESSIONAL 50234 REMOVAL OF KIDNEY & URETER 50234 6,265.00$

PROFESSIONAL 50384 REMOVE URETER STENT, PERCUT 50384 5,974.00$

PROFESSIONAL 50433 PLMT NEPHROURETERAL CATHETER 50433 2,334.00$

PROFESSIONAL 50545 LAP - RADICAL NEPHRECTOMY 50545 3,411.00$

PROFESSIONAL 50561 RENAL ENDO EST OSTOMY; W REM FB/STONE 50561 1,515.00$

PROFESSIONAL 50590 FRAGMENTING OF KIDNEY STONE 50590 5,701.00$

PROFESSIONAL 50660 REMOVAL OF URETER 50660 7,393.00$

PROFESSIONAL 50693 PLMT URETERAL STENT PRQ 50693 668.00$

PROFESSIONAL 50693-26 PC-PERC DR OR STENT PLCMT URETER 50693-26 1,264.00$

PROFESSIONAL 50700 REVISION OF URETER 50700 6,337.00$

PROFESSIONAL 50715 RELEASE OF URETER 50715 6,337.00$

PROFESSIONAL 50760 FUSION OF URETERS 50760 2,995.00$

PROFESSIONAL 50780 URETERONEOCYSTOSTOMY; SGL URET TO BLDR 50780 3,247.00$

PROFESSIONAL 50953 URETERAL CATHETERIZATION W/WO DILATION 50953 3,479.00$

PROFESSIONAL 50955 URETERAL CATHETERIZATION W/BIOPSY 50955 4,114.00$

PROFESSIONAL 51040 INCISE & DRAIN BLADDER 51040 3,338.00$

PROFESSIONAL 51045 INCISE BLADDER/DRAIN URETER 51045 3,674.00$

PROFESSIONAL 51100 DRAIN BLADDER BY NEEDLE 51100 194.00$

PROFESSIONAL 51102 DRAIN BL W/CATH INSERTION 51102 651.00$

PROFESSIONAL 51500 EXCISION URACHAL CYST 51500 3,093.00$

PROFESSIONAL 51535 CYSTOTOMY FOR EXC,INC,REPAIR URETEROCELE 51535 2,881.00$

PROFESSIONAL 51550 PARTIAL REMOVAL OF BLADDER 51550 4,672.00$

PROFESSIONAL 51570 REMOVAL OF BLADDER 51570 8,005.00$

PROFESSIONAL 51600 INJECTION FOR CYSTOGRAPHY 51600 519.00$

PROFESSIONAL 51610 INJECT CONTRAST THROUGH URETHRAL CATH 51610 299.00$

PROFESSIONAL 51700 BLADDER IRRIGATION,SIMPLE,LAVAGE &/OR IN 51700 357.00$

PROFESSIONAL 51701 INSERTION OF NON-INDWELLING BLADDER CATH 51701 221.00$

PROFESSIONAL 51702 INSERTION TEMP/INDWELLING BLADDER CATH 51702 260.00$

PROFESSIONAL 51703 INSERTION OF TEMP INDWELLING CATH, COMPL 51703 432.00$

PROFESSIONAL 51705 CHANGE OF BLADDER TUBE 51705 205.00$

PROFESSIONAL 51710 CHANGE OF BLADDER TUBE 51710 729.00$

PROFESSIONAL 51715 ENDOS INJ IMPLNT MATRL URETHRA/BLDR NCK 51715 1,275.00$

PROFESSIONAL 51720 BLADDER INSTILLATION OF ANTICARCINOGENIC 51720 487.00$

PROFESSIONAL 51725 SIMPLE CYSTOMETROGRAM 51725 537.00$

PROFESSIONAL 51725-26 SIMPLE CYSTOMETROGRAM 51725-26 182.00$

PROFESSIONAL 51726 COMPLEX CYSTOMETROGRAM 51726 747.00$

PROFESSIONAL 51727 COMPLEX CYSTOMETROGRAM w/URETHRAL PRESS 51727 727.00$

PROFESSIONAL 51728 COMPLEX CYSTOMETROGRAM w/VOIDING PRESS 51728 727.00$

PROFESSIONAL 51728-26 COMPLEX CYSTOMETROGRAM w/VOIDING PRESS 51728-26 588.00$

PROFESSIONAL 51728-TC COMPLEX CYSTOMETROGRAM w/VOIDING PRESS 51728-TC 490.00$

PROFESSIONAL 51729 COMPLEX CYSTOMETROGRAM w/VOID & URETHRAL 51729 641.00$

PROFESSIONAL 51729-26 COMPLEX CYSTOMETRO w/VOID&URETHRAL(P/C) 51729-26 256.00$

PROFESSIONAL 51729-TC COMPLEX CYSTOMETROGRAM w/VOID & URETHRAL 51729-TC 384.00$

PROFESSIONAL 51736 SIMPLE UROFLOWMETRY 51736 114.00$

PROFESSIONAL 51741 COMPLEX UROFLOWMETRY 51741 293.00$

PROFESSIONAL 51741-26 COMPLEX UROFLOWMETRY 51741-26 110.00$

PROFESSIONAL 51741-TC COMPLEX UROFLOWMETRY 51741-TC 214.00$

PROFESSIONAL 51784 EMG OF ANAL/URETHRAL, OTHER THAN NEEDLE 51784 564.00$

PROFESSIONAL 51784-26 EMG OF ANAL/URETHRAL, OTHER THAN NEEDLE 51784-26 454.00$

2020-01




PROFESSIONAL 51784-TC EMG OF ANAL/URETHRAL, OTHER THAN NEEDLE 51784-TC 462.00$

PROFESSIONAL 51797 VOIDING PRESSURE STUDIES,INTRA-ABD 51797 503.00$

PROFESSIONAL 51797-26 INTRAABDOMINAL PRESSURE TEST 51797-26 149.00$

PROFESSIONAL 51797-TC INTRAABDOMINAL PRESSURE TEST 51797-TC 411.00$

PROFESSIONAL 51798 POST-VOIDING RESIDUAL 51798 101.00$

PROFESSIONAL 51840 ATTACH BLADDER/URETHRA 51840 6,184.00$

PROFESSIONAL 51841 ATTACH BLADDER/URETHRA 51841 5,542.00$

PROFESSIONAL 51860 REPAIR OF BLADDER WOUND 51860 4,411.00$

PROFESSIONAL 51865 SUTURE BLADDER WOUND, INJURY; 51865 4,036.00$

PROFESSIONAL 51880 REPAIR OF BLADDER OPENING 51880 2,839.00$

PROFESSIONAL 51960 REVISION OF BLADDER & BOWEL 51960 10,068.00$

PROFESSIONAL 52000 CYSTOSCOPY 52000 821.00$

PROFESSIONAL 52001 CYSTOSCOPY, URETHRAL WASHINGS 52001 2,125.00$

PROFESSIONAL 52005 CYSTOSCOPY & URETER CATHETER 52005 1,128.00$

PROFESSIONAL 52005-50 CYSTOSCOPY & URETER CATHETER 52005-50 2,256.00$

PROFESSIONAL 52007 CYSTOSCOPY W/BRUSH BIOSPY 52007 971.00$

PROFESSIONAL 52204 CYSTOSCOPY 52204 1,095.00$

PROFESSIONAL 52214 CYSTOURETHROSCOPY WITH FULGURATION 52214 4,317.00$

PROFESSIONAL 52224 CYSTO W FULG OF MINOR LESIONS 52224 4,052.00$

PROFESSIONAL 52234 CYSTOURETHROSCOPY W/TREATMENT 52234 1,592.00$

PROFESSIONAL 52235 CYSTOSCOPY AND TREATMENT 52235 2,625.00$



PROFESSIONAL 52265 CYSTOSCOPY AND TREATMENT W/LOCAL ANESTH 52265 1,017.00$

PROFESSIONAL 52275 CYSTO W/INTERNAL URETHROTOMY;MALE 52275 1,314.00$

PROFESSIONAL 52276 CYSTOURETHROSCOPY W/URETHROTOMY 52276 1,811.00$

PROFESSIONAL 52277 CYSTOURETHROSCOPY W/RES OF EXT SPHINCTER 52277 1,317.00$




PROFESSIONAL 52287 CYSTOSCOPY CHEMODENERVATION 52287 1,057.00$

PROFESSIONAL 52290 CYSTOSCOPY AND TREATMENT 52290 604.00$



PROFESSIONAL 52315 CYSTO W REM FB/STNT, URETH/BLD;COMPL 52315 1,744.00$

PROFESSIONAL 52317 LITHOLAPAXY, SIMPLE 52317 2,908.00$

PROFESSIONAL 52318 LITHOLAPAXY, COMPLICATED OR LARGE 52318 3,564.00$


PROFESSIONAL 52325 CYSTOSCOPY AND TREATMENT W/FRAGMENTATION 52325 2,816.00$


PROFESSIONAL 52332 CYSTOURETHROSCOPY W/INSERTION STENT 52332 756.00$

PROFESSIONAL 52332-50 CYSTOURETHROSCOPY W/INSERT STENT BILAT 52332-50 1,512.00$

PROFESSIONAL 52341 CYSTOSCOPY AND TREATMENT OF URETERAL STR 52341 1,237.00$

PROFESSIONAL 52344 CYSTOSCOPY W/INSERTION OF URETERAL GUIDE 52344 1,585.00$

PROFESSIONAL 52345 CYSTO W/TX URETEROPELVIC JUNCT STRICTURE 52345 2,634.00$

PROFESSIONAL 52351 CYSTO W/URETEROSCOPY &/OR PYELOSCOPY DX 52351 2,127.00$

PROFESSIONAL 52352 CYSTOSCOPY AND TREATMENT W/REMOVAL 52352 1,787.00$

PROFESSIONAL 52353 CYSTOSCOPY AND TREATMENT W/LITHO 52353 1,810.00$

PROFESSIONAL 52354 CYSTO W BIOPSY OR LES FULG 52354 1,585.00$

PROFESSIONAL 52354-50 CYSTO W BIOPSY OR LES FULG 52354-50 1,585.00$

PROFESSIONAL 52355 CYSTO W TUMOR RESECT 52355 1,369.00$

PROFESSIONAL 52356 CYSTO/URETERO W/LITHOTRIPSY 52356 3,889.00$

PROFESSIONAL 52356-50 CYSTO/URETERO W/LITHOTRIPSY BILATERAL 52356-50 7,777.00$

PROFESSIONAL 52450 INCISION OF PROSTATE 52450 1,879.00$

PROFESSIONAL 52500 TRANSURETHRAL RESECTION BLADDER NECK 52500 2,466.00$

PROFESSIONAL 52601 PROSTATECTOMY (TURP) 52601 4,967.00$

PROFESSIONAL 52630 REMOVE PROSTATE REGROWTH 52630 1,707.00$

PROFESSIONAL 52640 TRANSURETHRAL RESECT BLADDER NECK 52640 2,904.00$

PROFESSIONAL 52648 LASER VAPORZTN PROSTATE, COMPLETE 52648 4,403.00$

PROFESSIONAL 52649 PROSTATE LASER ENUCLEATION 52649 2,486.00$

PROFESSIONAL 53020 INCISION OF URETHRA 53020 400.00$

PROFESSIONAL 53060 DRAINAGE OF URETHRA ABSCESS 53060 660.00$

PROFESSIONAL 53200 BIOPSY OF URETHRA 53200 1,100.00$

PROFESSIONAL 53265 TREATMENT OF URETHRA LESION 53265 996.00$

PROFESSIONAL 53270 REMOVAL OF URETHRA GLAND 53270 767.00$

PROFESSIONAL 53450 Urethromeatoplasty, with mucosal advance 53450 1,249.00$

PROFESSIONAL 53500 URETHROLYSIS,TRANSVAGINAL 53500 2,453.00$

PROFESSIONAL 53510 REPAIR OF URETHRA INJURY 53510 1,656.00$

2020-01




PROFESSIONAL 53600 DILATION OF URETHRAL STRICTURE, MALE INT 53600 307.00$

PROFESSIONAL 53601 DILATION OF URETHRAL STRICTURE 53601 174.00$

PROFESSIONAL 53605 DIL URETH STRICT/VN - SOUND OR DIL, MALE 53605 322.00$

PROFESSIONAL 53620 DILATION OF URETHRAL;MALE;INITIAL 53620 447.00$

PROFESSIONAL 53621 DILAT URETHRAL STRICTURE MALE SUBSEQUENT 53621 320.00$

PROFESSIONAL 53660 DILATION OF URETHRA 53660 246.00$

PROFESSIONAL 53661 URETHRAL DILATION SOUNDS FEMALE 53661 219.00$

PROFESSIONAL 53665 DILATE FEMALE URETHRA; GEN ANESTHESIA 53665 299.00$

PROFESSIONAL 53852 TRANSURETHRAL DESTRUCT-RADIO THERMOTHERA 53852 7,676.00$

PROFESSIONAL 54000 SLIT PREPUCE DORSAL OR LATERAL; NEWBORN 54000 534.00$

PROFESSIONAL 54001 INCISION PENIS, EXCEPT NEWBORN 54001 747.00$

PROFESSIONAL 54015 INCISION AND DRAINAGE OF PENIS, DEEP 54015 587.00$

PROFESSIONAL 54050 DESTRUCTION, PENIS LESION(S) 54050 361.00$

PROFESSIONAL 54055 ELECTRODESICCATION, PENIS LESION(S) 54055 928.00$

PROFESSIONAL 54056 CRYOSURGERY, PENIS LESION(S) 54056 353.00$

PROFESSIONAL 54057 DESTR LESION(S), PENIS, SIMPLE; LASER 54057 859.00$

PROFESSIONAL 54060 EXCISION OF PENIS LESION(S) 54060 959.00$

PROFESSIONAL 54065 DESTRUCTION, PENIS LESION(S) 54065 876.00$

PROFESSIONAL 54100 BIOPSY OF PENIS (SEPARATE PROCEDURE) 54100 469.00$

PROFESSIONAL 54105 BIOPSY OF PENIS,DEEP STRUCTURE-(SEP PROC 54105 1,354.00$

PROFESSIONAL 54115 TREATMENT OF PENIS LESION 54115 1,512.00$

PROFESSIONAL 54120 AMPUTATE PENIS; PARTIAL 54120 1,805.00$

PROFESSIONAL 54150 CIRCUMCISION W/REGIONL BLOCK 54150 525.00$

PROFESSIONAL 54160 CIRCUMCISION 54160 898.00$

PROFESSIONAL 54161 CIRCUM 28 DAYS OR OLDER 54161 802.00$

PROFESSIONAL 54162 LYSIS OR EXC OF PENILE POST-CIRCUMCISION 54162 810.00$

PROFESSIONAL 54163 REPAIR INCOMPLETE CIRCUMCISION 54163 727.00$

PROFESSIONAL 54164 FRENULOTOMYJ OF PENIS 54164 646.00$

PROFESSIONAL 54200 INJECTION PROC FOR PEYRONIE DISEASE 54200 521.00$

PROFESSIONAL 54220 TREATMENT OF PENIS LESION 54220 687.00$

PROFESSIONAL 54235 INJ CORPORA CAVERNOSA W PHARM AGENTS 54235 312.00$

PROFESSIONAL 54240 PENIS STUDY 54240 361.00$

PROFESSIONAL 54405 INSERT MULTI-COMP PROSTHESIS 54405 3,334.00$

PROFESSIONAL 54406 REMOVE MULTI-COMP INFLAT PENILE PROSTHES 54406 3,080.00$

PROFESSIONAL 54415 REMOVE SELF-CONTD PENIS PROS 54415 1,431.00$

PROFESSIONAL 54416 REMOVAL/REPLACEMENT OF PENILE PROSTHESIS 54416 2,557.00$

PROFESSIONAL 54440 PLASTIC OPERATION OF PENIS FOR INJURY 54440 2,121.00$

PROFESSIONAL 54450 PREPUTIAL STRETCHING 54450 415.00$

PROFESSIONAL 54505 BIOPSY TESTIS, INCISIONAL 54505 994.00$

PROFESSIONAL 54512 EXCISE EP TESTIS LESION 54512 1,121.00$

PROFESSIONAL 54520 REMOVAL OF TESTIS 54520 2,237.00$

PROFESSIONAL 54520-50 REMOVAL OF TESTIS, BILATERAL 54520-50 4,474.00$

PROFESSIONAL 54530 ORCHIECTOMY,RADICAL,INGUINAL APPROACH 54530 2,601.00$

PROFESSIONAL 54600 REDUCE TESTIS TORSION 54600 2,059.00$

PROFESSIONAL 54640 SUSPENSION OF TESTIS 54640 2,445.00$

PROFESSIONAL 54700 DRAINAGE OF SCROTUM 54700 1,032.00$

PROFESSIONAL 54830 EXCISION OF LOCAL LESION OF EPIDIDYMIS 54830 1,029.00$

PROFESSIONAL 54840 EXC. SPERMATOCELE, W/WO EPIDIDYMECTOMY 54840 1,993.00$

PROFESSIONAL 54860 REMOVAL OF EPIDIDYMIS 54860 1,290.00$

PROFESSIONAL 55000 DRAINAGE OF HYDROCELE 55000 361.00$

PROFESSIONAL 55040 REMOVAL OF HYDROCELE 55040 2,586.00$

PROFESSIONAL 55041 REMOVAL OF HYDROCELES 55041 3,970.00$

PROFESSIONAL 55100 DRAINAGE OF SCROTUM ABSCESS 55100 614.00$

PROFESSIONAL 55110 SCROTAL EXPLORATION 55110 1,645.00$

PROFESSIONAL 55250 REMOVAL OF SPERM DUCT(S) (VASECTOMY) 55250 1,669.00$

PROFESSIONAL 55500 SPERMATOCELECTERY 55500 1,328.00$

PROFESSIONAL 55520 EXCISION OF LESION OF SP 55520 1,931.00$

PROFESSIONAL 55530 EXC.VARICOCELE OR LIGATION SPERM.VEIN 55530 2,169.00$

PROFESSIONAL 55535 REVISE SPERMATIC CORD VEINS 55535 1,587.00$

PROFESSIONAL 55540 EXC VARICOCEL/LIG SPERM VEINS ; W HYDORC 55540 2,293.00$

PROFESSIONAL 55559 UNLISTED LAPAROSCOPY, SPERMATI 55559 1,669.00$

PROFESSIONAL 55700 BIOPSY,PROSTATE; NEEDLE OR PUNCH 55700 646.00$

PROFESSIONAL 55706 PROSTATE SATURATION SAMPLING 55706 981.00$

PROFESSIONAL 55831 REMOVAL OF PROSTATE 55831 6,102.00$

PROFESSIONAL 55840 PROSTATECTOMY RETROPUBIC RADIAL,W W/O NE 55840 6,877.00$

PROFESSIONAL 55842 PROSTATECTOMY WITH LYMPH NODE BIOPSY 55842 4,884.00$

PROFESSIONAL 55845 EXTENSIVE PROSTATE SURGERY 55845 7,990.00$

PROFESSIONAL 55876 PLACE RT DEVICE/MARKER PROS 55876 363.00$

2020-01




PROFESSIONAL 55899 UNLISTED PROCEDURE MALE GENITAL SYSTEM 55899 501.00$

PROFESSIONAL 56441 LYSIS OF LABIAL ADHESIONS 56441 331.00$

PROFESSIONAL 56820 COLPOSCOPY OF VULVA 56820 260.00$

PROFESSIONAL 57022 I & D VAGINAL HEMATOMA PP 57022 358.00$

PROFESSIONAL 57106 VAGINECTOMY W P REM OF VAG WALL 57106 1,286.00$

PROFESSIONAL 57283 COLPOPEXY, INTRAPERITONEAL 57283 2,766.00$

PROFESSIONAL 57421 EXAM/BIOPSY OF VAG W/SCOPE 57421 366.00$

PROFESSIONAL 58110 BX DONE W/COLPOSCOPY ADD-ON 58110 243.00$

PROFESSIONAL 58542 LAP SURG HYSTER W/T/O UT 250 G OR LESS 58542 3,295.00$

PROFESSIONAL 58546 LAPARO-MYOMECTOMY, COMPLEX 58546 5,252.00$

PROFESSIONAL 58553 LAPARO-VAG HYST,COMPLEX 58553 4,180.00$

PROFESSIONAL 58562 HYSTEROSCOPY; W REM IMPACTED F 58562 1,621.00$

PROFESSIONAL 58570 TLH, UTERUS 250 G OR LESS 58570 3,552.00$

PROFESSIONAL 58571 LAP SURG TOT HYSTER W/T/O 250 G or LESS 58571 3,930.00$

PROFESSIONAL 58572 TLH UTERUS OVER 250 G 58572 3,391.00$

PROFESSIONAL 58573 LAP SURG TOT HYSTER W/T/O > 25 58573 3,585.00$

PROFESSIONAL 58579 UNLISTED HYSTEROSCOPY UTERUS 58579 1,327.00$

PROFESSIONAL 58970 FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL 58970 1,559.00$

PROFESSIONAL 58999 GENITAL SURGERY PROCEDURE, FEMALE 58999 2,476.00$

PROFESSIONAL 58999REP REPAIR/SUT TUBAL/MESOSALPINX W/HEMORRHAG 58999 2,801.00$

PROFESSIONAL 59830 SURG TX SEPTIC ABORTION 59830 1,090.00$

PROFESSIONAL 60000 DRAIN THYROID/TONGUE CYST 60000 438.00$

PROFESSIONAL 60100 BIOPSY OF THYROID 60100 510.00$

PROFESSIONAL 60200 REMOVE THYROID LESION 60200 3,449.00$

PROFESSIONAL 60210 PARTIAL THYROID EXCISION 60210 5,480.00$

PROFESSIONAL 60220 TOTAL THYROID LOBECTOMY, UNILATERAL 60220 3,403.00$

PROFESSIONAL 60225 PARTIAL REMOVAL OF THYROID 60225 5,696.00$

PROFESSIONAL 60240 REMOVAL OF THYROID 60240 4,248.00$

PROFESSIONAL 60252 REMOVAL OF THYROID 60252 8,134.00$

PROFESSIONAL 60254 EXTENSIVE THYROID SURGERY 60254 10,006.00$

PROFESSIONAL 60260 REPEAT THYROID SURGERY 60260 5,196.00$

PROFESSIONAL 60270 TT REM OF THYROID 60270 5,457.00$

PROFESSIONAL 60271 THYROIDECTOMY; CERVICAL 60271 4,588.00$

PROFESSIONAL 60280 REMOVE THYROID DUCT LESION 60280 3,761.00$

PROFESSIONAL 60281 REMOVE THYROID DUCT LESION 60281 3,946.00$

PROFESSIONAL 60300 ASPIR/INJ THYROID CYST 60300 363.00$

PROFESSIONAL 60500 EXPLORE PARATHYROID GLANDS 60500 5,760.00$

PROFESSIONAL 60502 PARATHYROID,THYMUS REXPLORATION 60502 5,892.00$

PROFESSIONAL 60512 PARATHYROID AUTOTRANSPLANTATION 60512 1,057.00$

PROFESSIONAL 60540 EXPLORE ADRENAL GLAND 60540 6,881.00$

PROFESSIONAL 60600 REMOVE CAROTID BODY LESION 60600 6,255.00$

PROFESSIONAL 61500 CRANIECTOMY; W EXC TUMOR / BONE LESION 61500 3,833.00$

PROFESSIONAL 62000 TREAT SKULL FRACTURE 62000 7,443.00$

PROFESSIONAL 62005 TREAT SKULL FRACTURE 62005 9,824.00$

PROFESSIONAL 62010 TREATMENT OF HEAD INJURY 62010 11,506.00$

PROFESSIONAL 62100 REPAIR BRAIN FLUID LEAKAGE 62100 12,276.00$

PROFESSIONAL 62270 SPINAL FLUID TAP, DIAGNOSTIC 62270 402.00$

PROFESSIONAL 62272 SPINAL TAP DRAINAGE OF FLUID 62272 388.00$

PROFESSIONAL 62273 INJ EPIDURAL, BLOOD OR CLOT PATCH 62273 1,011.00$

PROFESSIONAL 63005 REMOVE SPINE LAMINA 1/2 LMBR 63005 9,357.00$

PROFESSIONAL 63015 REMOVE SPINE LAMINA >2 CRVCL 63015 12,667.00$

PROFESSIONAL 63017 REMOVE SPINE LAMINA >2 LMBR 63017 11,921.00$

PROFESSIONAL 63020 NECK SPINE DISK SURGERY 63020 10,949.00$

PROFESSIONAL 63030 LOW BACK DISK SURGERY 63030 10,604.00$

PROFESSIONAL 63035 SPINAL DISK SURGERY ADD-ON 63035 3,472.00$

PROFESSIONAL 63040 LAMINOTOMY SINGLE CERVICAL 63040 11,921.00$

PROFESSIONAL 63042 LAMINOTOMY SINGLE LUMBAR 63042 13,814.00$

PROFESSIONAL 64405 INJ,ANEST AGENT OCCIPITAL 64405 438.00$

PROFESSIONAL 64415 SGL NBI BRACHIAL PLEXUS 64415 432.00$

PROFESSIONAL 64416 NB CONT INFUSE, B PLEXUS 64416 503.00$

PROFESSIONAL 64417 INJ ANESTH; AXILLARY NERVE 64417 503.00$

PROFESSIONAL 64418 INJ ANESTH; SUPRASCAPULAR NERVE 64418 439.00$

PROFESSIONAL 64420 INJECTION FOR NERVE BLOCK 64420 500.00$

PROFESSIONAL 64421 INJ ANEST AGENT;INTERCOST 64421 776.00$

PROFESSIONAL 64425 INJECTION FOR NERVE BLOCK 64425 478.00$

PROFESSIONAL 64445 N BLOCK, SGL SCIATIC NRV 64445 467.00$

PROFESSIONAL 64446 N BLK SCIATIC, CONT INF 64446 486.00$

PROFESSIONAL 64447 FEMORAL N BLOCK, SGL 64447 316.00$

2020-01




PROFESSIONAL 64448 FEM N BLOCK BY CONT INF 64448 435.00$

PROFESSIONAL 64449 NB INJ, LUMB PLEXUS, POST APPR 64449 449.00$

PROFESSIONAL 64450 INJ, ANEST AGENT OTH PERIPHERAL NERVE OR 64450 343.00$

PROFESSIONAL 64450-50 INJ, ANEST AGENT OTH PERIPHERAL NERVE OR 64450-50 685.00$

PROFESSIONAL 64455 INJ, NERVE BLOCK, PLANTAR DIGI 64455 203.00$

PROFESSIONAL 64455-50 INJ, NERVE BLOCK,PLANTAR DIGI BIL 64455-50 405.00$

PROFESSIONAL 64488 TAP BLOCK BI INJECTION 64488 472.00$

PROFESSIONAL 64553 IMPLANT NEUROELECTRODES 64553 383.00$

PROFESSIONAL 64555 IMPLANT NEUROELECTRODES 64555 414.00$

PROFESSIONAL 64561 PERCUT IMPLANT NEUROSTIM/SACRAL NERVE 64561 3,650.00$

PROFESSIONAL 64561-50 PERCUT IMPLANT NEUROSTIM/SACRAL NERVE 64561-50 7,088.00$

PROFESSIONAL 64566 IMPLANT NEUROSTIM PERCUT TIBIAL NERVE 64566 253.00$

PROFESSIONAL 64581 INC/IMPLANT NEUROSTIM ELECTRODE;SACRAL N 64581 4,227.00$

PROFESSIONAL 64585 REV/REM PERIPHERAL NS ELECTECTRODES 64585 1,188.00$

PROFESSIONAL 64590 IMPLANT NEURORECEIVER 64590 757.00$

PROFESSIONAL 64595 REVISE/RMV PN/GASTR STIMUL 64595 1,098.00$

PROFESSIONAL 64612 CHEMODENERV;FACE NERVE MUSCLES 64612 421.00$

PROFESSIONAL 64615 CHEMODENERV MUSC MIGRAINE 64615 546.00$

PROFESSIONAL 64616 CHEMODENERV MUSC NECK DYSTON 64616 339.00$

PROFESSIONAL 64616-50 CHEMODENERV MUSC NEC DYSTON BILATERAL 64616-50 676.00$

PROFESSIONAL 64642 CHEMODENERV 1 EXTREMITY 1-4 64642 479.00$

PROFESSIONAL 64643 CHEMODENERV 1 EXTREM 1-4 EA 64643 295.00$

PROFESSIONAL 64644 CHEMODENERV 1 EXTREM 5/> MUS 64644 450.00$

PROFESSIONAL 64645 CHEMODENERV 1 EXTREM 5/> EA 64645 352.00$

PROFESSIONAL 64646 CHEMODENERV TRUNK MUSC 1-5 64646 410.00$

PROFESSIONAL 64647 CHEMODENERV TRUNKK MUSC 6/> 64647 478.00$

PROFESSIONAL 64650 CHEMODENERV ECCRINE GLANDS BOTH AXILLAE 64650 173.00$

PROFESSIONAL 64702 REVISE FINGER/TOE NERVE 64702 3,040.00$

PROFESSIONAL 64704 REVISE HAND/FOOT NERVE 64704 3,338.00$

PROFESSIONAL 64708 REVISE ARM/LEG NERVE 64708 3,891.00$

PROFESSIONAL 64712 REVISION OF SCIATIC NERVE 64712 4,883.00$

PROFESSIONAL 64713 NEUROPLASTY;BRACHIAL PLEXUS 64713 2,022.00$

PROFESSIONAL 64718 REVISE ULNAR NERVE AT ELBOW 64718 4,677.00$

PROFESSIONAL 64718-50 REVISE ULNAR NERVE AT ELBOW BILATERAL 64718-50 9,355.00$

PROFESSIONAL 64719 REVISE ULNAR NERVE AT WRIST 64719 2,375.00$

PROFESSIONAL 64721 CARPAL TUNNEL SURGERY 64721 2,353.00$

PROFESSIONAL 64721-50 NEUROPLASTY;MEDIAN NERVE CARP TUNNEL BIL 64721-50 4,703.00$

PROFESSIONAL 64722 RELIEVE PRESSURE ON NERVE(S) 64722 2,987.00$

PROFESSIONAL 64726 DECOMPRESS; PLANTAR DIGITAL NE 64726 1,017.00$

PROFESSIONAL 64760 INCISION OF VAGUS NERVE 64760 4,536.00$

PROFESSIONAL 64772 TRANSECT OR AVULSE OTHER SPINAL NERVE 64772 1,462.00$

PROFESSIONAL 64774 EXCISION OF NEUROMA;CUTANEOUS NERVE,SURG 64774 1,487.00$

PROFESSIONAL 64776 REMOVE DIGIT NERVE LESION 64776 1,561.00$

PROFESSIONAL 64782 REMOVE LIMB NERVE LESION 64782 2,080.00$

PROFESSIONAL 64787 IMPL NERVE END INTO BONE OR MUSCLE 64787 830.00$

PROFESSIONAL 64788 REMOVE SKIN NERVE LESION 64788 2,519.00$

PROFESSIONAL 64790 REMOVAL OF NERVE LESION 64790 3,771.00$

PROFESSIONAL 64792 REMOVAL OF NERVE LESION 64792 4,607.00$

PROFESSIONAL 64831 REPAIR OF DIGIT NERVE 64831 2,439.00$

PROFESSIONAL 64832 REPAIR NERVE ADD-ON 64832 1,629.00$

PROFESSIONAL 64834 REPAIR OF HAND OR FOOT NERVE 64834 3,358.00$

PROFESSIONAL 64835 REPAIR OF HAND OR FOOT NERVE 64835 4,194.00$

PROFESSIONAL 64836 REPAIR OF HAND OR FOOT NERVE,ULNAR MOTOR 64836 3,223.00$

PROFESSIONAL 64864 REPAIR OF FACIAL NERVE 64864 4,408.00$

PROFESSIONAL 64999DNF UNLIST PROC NERVOUS,DIGITAL NERVE FINGER 64999 1,238.00$

PROFESSIONAL 64999INEB IMPLANTATION NERVE END INTO BONE OTHER 64999 830.00$

PROFESSIONAL 64999PTNS IMPLANT NEUROSTIM PERCUT TIBIAL NERVE 64999 660.00$

PROFESSIONAL 65205 REMOVE FOREIGN BODY EYE SPFL 65205 197.00$

PROFESSIONAL 65210 REMOVE FORGN BDY EYE EMBEDDED 65210 244.00$

PROFESSIONAL 65220 REMOVE FOREIGN BDY EYE NO LAMP 65220 237.00$

PROFESSIONAL 65275 REPAIR OF EYE WOUND 65275 934.00$

PROFESSIONAL 67345 CHEMODENERVATION - EXTRAOCULAR MUSCLE 67345 606.00$

PROFESSIONAL 67405 ORBITOTOMY WO BONE FLAP; W DRAIN ONLY 67405 2,303.00$

PROFESSIONAL 67800 REMOVE EYELID LESION 67800 335.00$

PROFESSIONAL 67810 BIOPSY OF EYELID 67810 310.00$

PROFESSIONAL 67850 TREAT EYELID LESION 67850 380.00$

PROFESSIONAL 67901 REPAIR BLEPHAROPTOSOS,W/SUT.OTH.MATERIAL 67901 3,541.00$

PROFESSIONAL 67930 REPAIR EYELID WOUND 67930 1,446.00$

2020-01




PROFESSIONAL 67935 REPAIR EYELID WOUND 67935 2,157.00$

PROFESSIONAL 67950 REVISION OF EYELID 67950 2,673.00$

PROFESSIONAL 68020 INC CONJUNCTIVA, DRAINAGE OF CYST 68020 242.00$

PROFESSIONAL 69000 DRAIN EXTERNAL EAR LESION 69000 372.00$

PROFESSIONAL 69005 DRAIN EXTERNAL EAR LESION 69005 1,084.00$

PROFESSIONAL 69020 DRAIN OUTER EAR CANAL LESION 69020 550.00$

PROFESSIONAL 69090 PIERCE EARLOBES 69090 155.00$

PROFESSIONAL 69100 BIOPSY OF EXTERNAL EAR 69100 397.00$

PROFESSIONAL 69105 BIOPSY OF EXTERNAL EAR CANAL 69105 397.00$

PROFESSIONAL 69110 REMOVE EXTERNAL EAR, PARTIAL 69110 1,566.00$

PROFESSIONAL 69120 REMOVAL OF EXTERNAL EAR 69120 4,062.00$

PROFESSIONAL 69140 EXC EXOSTOSIS(ES) EXTERN AUDITORY CANAL 69140 2,356.00$

PROFESSIONAL 69145 REMOVE EAR CANAL LESION(S) 69145 1,044.00$

PROFESSIONAL 69150 EXTENSIVE EAR CANAL SURGERY 69150 4,336.00$

PROFESSIONAL 69155 EXTENSIVE EAR/NECK SURGERY 69155 6,356.00$

PROFESSIONAL 69200 CLEAR OUTER EAR CANAL 69200 269.00$

PROFESSIONAL 69200-50 CLEAR OUTER EAR CANAL 69200-50 537.00$

PROFESSIONAL 69205 CLEAR OUTER EAR CANAL 69205 1,280.00$

PROFESSIONAL 69209 REMOVE IMPACTED EAR WAX UNI 69209 76.00$

PROFESSIONAL 69209-50 REMOVE IMPACTED EAR WAX BILATERAL 69209-50 114.00$

PROFESSIONAL 69210 REMOVE IMPACTED EAR WAX 69210 93.00$

PROFESSIONAL 69210-50 REMOVE IMPACTED EAR WAX BIL 69210-50 138.00$

PROFESSIONAL 69220 CLEAN OUT MASTOID CAVITY 69220 233.00$

PROFESSIONAL 69220-50 CLEAN OUT MASTOID CAVITY 69220-50 233.00$

PROFESSIONAL 69222 CLEAN OUT MASTOID CAVITY 69222 755.00$

PROFESSIONAL 69300 REVISE EXTERNAL EAR 69300 3,761.00$

PROFESSIONAL 69310 REBUILD OUTER EAR CANAL 69310 5,487.00$

PROFESSIONAL 69320 REBUILD OUTER EAR CANAL 69320 5,487.00$

PROFESSIONAL 69399 OUTER EAR SURGERY PROCEDURE 69399 4,967.00$

PROFESSIONAL 69420 INCISION OF EARDRUM 69420 691.00$

PROFESSIONAL 69420-50 INCISION OF EARDRUM BIL 69420-50 1,382.00$

PROFESSIONAL 69421 INCISION OF EARDRUM 69421 938.00$

PROFESSIONAL 69424 REMOVE VENTILATING TUBE 69424 629.00$

PROFESSIONAL 69424-50 REMOVE VENTILATING TUBE, BILATERAL 69424-50 1,258.00$

PROFESSIONAL 69433 CREATE EARDRUM OPENING 69433 846.00$

PROFESSIONAL 69433-50 TYMPANOSTOMY LOCAL; BILATERAL 69433-50 1,689.00$

PROFESSIONAL 69436 TYMPANOSTOMY, GEN ANESTHESIA 69436 765.00$

PROFESSIONAL 69436-50 TYMPANOSTOMY GEN ANESTHESIA BILATERAL 69436-50 1,530.00$

PROFESSIONAL 69440 EXPLORATION OF MIDDLE EAR 69440 4,043.00$

PROFESSIONAL 69450 TYMPANOLYSIS, TRANSCANAL 69450 2,407.00$

PROFESSIONAL 69501 MASTOIDECTOMY 69501 4,496.00$

PROFESSIONAL 69502 MASTOIDECTOMY 69502 5,774.00$

PROFESSIONAL 69505 REMOVE MASTOID STRUCTURES 69505 6,273.00$

PROFESSIONAL 69511 EXTENSIVE MASTOID SURGERY 69511 7,166.00$

PROFESSIONAL 69540 REMOVE EAR LESION 69540 755.00$

PROFESSIONAL 69550 REMOVE EAR LESION 69550 7,470.00$



PROFESSIONAL 69601 MASTOID SURGERY REVISION 69601 5,625.00$




PROFESSIONAL 69610 TYMPANIC MEMBRANE REPAIR 69610 1,775.00$

PROFESSIONAL 69610-50 TYMPANIC MEMBRANE REPAIR 69610-50 3,549.00$

PROFESSIONAL 69620 REPAIR OF EARDRUM 69620 4,967.00$

PROFESSIONAL 69631 REPAIR EARDRUM STRUCTURES 69631 4,543.00$

PROFESSIONAL 69632 REBUILD EARDRUM STRUCTURES 69632 7,285.00$



PROFESSIONAL 69641 REVISE MIDDLE EAR & MASTOID 69641 8,060.00$




PROFESSIONAL 69650 RELEASE MIDDLE EAR BONE 69650 4,895.00$

PROFESSIONAL 69660 REVISE MIDDLE EAR BONE 69660 6,688.00$

PROFESSIONAL 69661 REVISE MIDDLE EAR BONE 69661 7,252.00$

PROFESSIONAL 69666 REPAIR MIDDLE EAR STRUCTURES 69666 7,252.00$

PROFESSIONAL 69667 REPAIR MIDDLE EAR STRUCTURES 69667 5,973.00$

2020-01




PROFESSIONAL 69720 RELEASE FACIAL NERVE 69720 7,166.00$


PROFESSIONAL 69740 REPAIR FACIAL NERVE 69740 8,358.00$

PROFESSIONAL 69745 REPAIR FACIAL NERVE 69745 11,940.00$

PROFESSIONAL 69799DRUM MIDDLE EAR SURGERY PROCEDURE 69799DRUM 1,667.00$

PROFESSIONAL 69806 EXPLORE INNER EAR 69806 8,595.00$

PROFESSIONAL 69910 REMOVE INNER EAR & MASTOID 69910 8,075.00$


PROFESSIONAL 70030-2650 XR FB IN EYE 70030-2650 93.00$

PROFESSIONAL 70030-50 XR FB IN EYE 70030-50 483.00$

PROFESSIONAL 76098 SURGICAL SPECIMEN XR 76098 75.00$

PROFESSIONAL 76641 ULTRASOUND BREAST COMPLETE 76641 233.00$

PROFESSIONAL 76642 ULTRASOUND BREAST LIMITED 76642 208.00$

PROFESSIONAL 92265 EYE MUSCLE EVAL 1 MUSC, 1-2 EYES 92265 178.00$

PROFESSIONAL 93293-26 PM PHONE R-STRIP DEVICE EVAL =<90 DAYS 93293-26 43.00$

PROFESSIONAL 93296 PM/ICD REMOTE TECH SERV =<90 DAYS 93296 80.00$

PROFESSIONAL 93799 UNLISTED CARDIOVASCULAR SERVICE 93799 87.00$

PROFESSIONAL 94727-26 PULM FUNCTION TEST BY GAS 94727-26 83.00$

PROFESSIONAL 95813-26 EEG OVER 1 HOUR 95813-26 145.00$

PROFESSIONAL 95873 GUIDE NERV DESTR ELEC STIM 95873 103.00$

PROFESSIONAL 95885 MUSC TST DONE W/NERV TST LIM 95885 157.00$

PROFESSIONAL 95885-50 MUSC TST DONE W/NERV TST LIM BILAT 95885-50 314.00$

PROFESSIONAL 95886 MUSC TEST DONE W/N TEST COMP 95886 293.00$

PROFESSIONAL 95886-50 MUSC TEST DONE W/N TEST COMP BILAT 95886-50 585.00$

PROFESSIONAL 95887 MUSC TST DONE W/N TST NONEXT 95887 182.00$

PROFESSIONAL 95907 NVR CNDJ TST 1-2 STUDIES 95907 251.00$

PROFESSIONAL 95908 NRV CNDJ TST 3-4 STUDIES 95908 883.00$

PROFESSIONAL 95909 NRV CNDJ TST 5-6 STUDIES 95909 1,104.00$

PROFESSIONAL 95910 NRV CNDJ TEST 7-8 STUDIES 95910 499.00$



PROFESSIONAL 95913 NRV CNDJ TEST 13/> STUDIES 95913 819.00$

PROFESSIONAL 95951-26 CEREBR SEIZURE 16/> CH; EA 24 HRS 95951-26 485.00$

PROFESSIONAL 95971 ANALYZE NEUROSTIM SIMPLE 95971 129.00$

PROFESSIONAL 95976 ALYS SMPL CN NPGT PRGRMG 95976 50.00$

PROFESSIONAL 95977 ALYS CPLX CN NPGT PRGRMG 95977 67.00$

PROFESSIONAL 95983 ALYS BRN NPGT PRGRMG 15 MIN 95983 63.00$

PROFESSIONAL 95984 ALYS BRN NPGT PRGRMG ADDL 15 95984 55.00$

PROFESSIONAL 96365 THER/PROPH/DIAG IV INF INIT =<1 HR 96365 163.00$

PROFESSIONAL 97606 NEG PRESS WOUND TX >50 CM 97606 96.00$

PROFESSIONAL 97608 NEG PRESS WOUND TX >50 CM 97608 398.00$

PROFESSIONAL 99495 TCM 14 DAY DISCH MODERATE 99495 288.00$

PROFESSIONAL 99496 TCM 7 DAY DISCH COMPLEX 99496 406.00$

PROFESSIONAL 003111 FINGER SPLINT STRIP 1 1/2*18 A4570 30.00$

PROFESSIONAL 3625126 INS CATH REN ART 1ST UNILAT 3625126 1,127.00$

PROFESSIONAL 3625226 INS CATH REN ART 1ST BILAT 3625226 1,233.00$

PROFESSIONAL G0104 FLEXIBLE SIGMOIDOSCOPY, SCREENING G0104 552.00$

PROFESSIONAL G0105 COLONSCOPY, SCREENING G0105 1,703.00$

PROFESSIONAL G0121 COLONOSCOPY, SCREENING (NON HIGH RISK) G0121 1,703.00$

PROFESSIONAL G0127 TRIMMING OF DYSTROPHIC NAILS G0127 103.00$

PROFESSIONAL G0168 WOUND CLOSURE UTILIZING TISSUE ADHESIVE( G0168 231.00$

PROFESSIONAL G0289 ARTHROSCOPY, KNEE, SURGICAL G0289 491.00$

PROFESSIONAL G0455 FECAL MICROBIOTA PREP INSTIL G0455 162.00$

PROFESSIONAL 90281 IMMUNE GLOBIN (LG) HUMAN FOR INTRAMUSC 90281 55.20$

PROFESSIONAL 90375 RABIES, IMMUNE GLOBULIN (RIg), HUMAN IM 90375 544.85$

PROFESSIONAL 90389 TETANUS IMMUNE GLOBULIN HUMAN IM 90389 194.70$

PROFESSIONAL 90620 MENINGOCOCCAL RECOMBINANT PROTEIN 90620 326.25$

PROFESSIONAL 90632 HEP A VACCINE, ADULT IM 90632 158.05$

PROFESSIONAL 90633 HEP A VACCINE, PEDIATRIC IM 2 DOSE 90633 339.50$

PROFESSIONAL 90634 HEP A VACCINE, PEDIATRIC IM 3 DOSE 90634 261.00$

PROFESSIONAL 90636 IM ADULT HEPA-HEPB (TWINRIX) 90636 233.40$

PROFESSIONAL 90648 Hib, PRP-T CONJUGATE 90648 124.00$

PROFESSIONAL 90649 H PAPILLOMA VACC 3 DOSE IM (GARDASIL) 90649 318.65$

PROFESSIONAL 90651 GARDASIL 9 90651 237.05$

PROFESSIONAL 90654 FLU VACCINE NO PRESERV ID 90654 18.70$

PROFESSIONAL 90655 FLUZONE 6-35 MONTHS 0.25 ML PRESERV FREE 90655 18.70$

PROFESSIONAL 90656 FLUARIX 90656 18.70$

PROFESSIONAL 90657 FLU VACCINE, 6-35 MO, IM (0.25ML) 90657 18.70$

2020-01




PROFESSIONAL 90658 FLU VACCINE, 3 YRS, IM (0.5ML) 90658 18.70$

PROFESSIONAL 90660 INTRANASAL LIVE FLU VACCINE 90660 31.60$

PROFESSIONAL 90662 FLUZONE HIGH DOXE 65 Y/O> 90662 75.00$

PROFESSIONAL 90670 PNEUMOCOCCAL VACC, 13 VAL IM 90670 261.00$

PROFESSIONAL 90672 FLUMIST INTRANASAL 90672 32.60$

PROFESSIONAL 90673 FLU VACC RIV3 NO PRESERV 90673 18.70$

PROFESSIONAL 90675 RABIES VACCINE, IM 90675 396.95$

PROFESSIONAL 90680 ROTATEQ (ROTAVIRUS VACC) ORAL 3 DOSE 90680 290.70$

PROFESSIONAL 90681 ROTAVIRUS VACCINE, HUMAN, ATTE 90681 198.40$

PROFESSIONAL 90682 RIV4 VACC RECOMBINANT DNA IM 90682 74.00$

PROFESSIONAL 90685 FLUZONE QUAD (0.25ML PEDS) 90685 18.70$

PROFESSIONAL 90686 FLUZONE/FLUARIX QUAD PRESERV FREE 90686 19.70$

PROFESSIONAL 90687 FLU VACCINE 4 VAL 6-35 MO IM 90687 18.70$

PROFESSIONAL 90688 FLU VACC 4 VAL 3 YRS PLUS IM 90688 18.70$

PROFESSIONAL 90690 TYPHOID VACC LIVE ATTENUATED 90690 134.75$

PROFESSIONAL 90691 TYPHOID VACCINE, IM 90691 142.15$

PROFESSIONAL 90696 DTAP-IPV VACC KINRIX 4-6 YR IM 90696 91.30$

PROFESSIONAL 90698 DTAP-HIB-IP VACCINE, IM 90698 69.00$

PROFESSIONAL 90700 DTAP VACCINE, IM - INFANRIX 90700 104.00$

PROFESSIONAL 90702 DT VACCINE, IM-PEDIATRIC 90702 42.45$

PROFESSIONAL 90707 MMR II (DILUENT) VACCINE, SC 90707 127.35$

PROFESSIONAL 90710 MMR & VARICELLA (PROQUAD) VACCINE 90710 357.55$

PROFESSIONAL 90713 POLIOVIRUS, IPV, SC OR IM 90713 89.10$

PROFESSIONAL 90714 TD VACCINE NO PRSRV >/= 7 IM 90714 37.15$

PROFESSIONAL 90715 TETANUS DIPTHERIA >7 IM 90715 72.00$

PROFESSIONAL 90716 CHICKEN POX (VARIVAX) VACCINE, SC 90716 181.45$

PROFESSIONAL 90723 DTAP/HEPV/IPV VACCINE, IM (PEDIARIX) 90723 126.25$

PROFESSIONAL 90732 PNEUMOCOCCAL VACCINE, ADULT 90732 136.00$

PROFESSIONAL 90733 MENINGOCOCCAL VACCINE, SC 90733 233.40$

PROFESSIONAL 90734 MENINGOCCOCAL VACCINE (MENACTRA) 90734 301.30$

PROFESSIONAL 90736 ZOSTER VACC, SC (ZOSTAVAX) (SHINGLES) 90736 238.20$

PROFESSIONAL 90744 HEP B VACCINE, PED/ADOL, IM 90744 129.45$

PROFESSIONAL 90746 HEP B VACCINE, ADULT, IM 90746 218.60$

PROFESSIONAL 90748 HEP B/HIB VACCINE, IM 90748 195.20$

PROFESSIONAL 90750 SHINGRIX 90750 292.10$

PROFESSIONAL J1670 HUMAN TETANUS J1670 380.60$

PROFESSIONAL Q2036 FLULAVAL VACC 3 YRS & > IM Q2036 18.70$

PROFESSIONAL Q2036B FLULAVAL VACC 3 YRS & > IM MEDICARE ONLY Q2036 18.70$

PROFESSIONAL Q2038 FLUZONE 0.50 ML (MEDICARE) Q2038 18.70$

2020-01

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