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Description of Charge Fine Needle Aspiration Without Imaging Guidance Fine Needle Aspiration With Imaging Guidance I&D Abscess Simple I&D Abscess Complicated/Multiple I&D Pilonidal Cyst Simple Incision & Removal FB Subcutaneous Simple I&D Hematoma/Seroma/Fluid Collection Puncture Aspiration Abscess Hematoma Cyst Debridement Skin/SQ Tissue 1st 20 Skin/SQ CM Biopsy Skin Single Lesion Removal of Skin Tags Up To 15 Shaving <0.5 Lesion Face Ear Excision Benign Lesion Trunk Arm Leg =< 0.5 CM Excision Benign Lesion Trunk Arm Leg 1.1-2.0 CM Excision Benign Lesion FEENLM <= 0.5 CM Debridement of Nails 1-5 Avulsion of Nail Plate Single Avulsion of Nail Plate Each Additional Evacuation Subungual Hematoma Excision of Nail Permanent Repair Simple Nonfacial <=2.5 CM Treatment Superficial Wound Simple Repair Complex Scalp Arm Leg Each Addl 5 CM Repair Complex Forehead Cheek Chin Hand Feet Each Addl 5 CM Repair Complex Eyelids Nose Ears Lips Each Addl 5 CM Burn Treatment 1st Degree Local Dress Debride Partial Thickness Burn Small Dress Debride Partial Thickness Burn Medium Destruction Lesions Up to 14 Pro Fee I&D Abscess Subfascial Explore Penetrating Wound Extremity Remove FB Muscle Simple Arthrocentesis Small Joint w/o US Guid Arthrocentesis Intermediate Joint w/o US Guid Arthrocentesis Major Joint w/o US Guid Cl Tx Temporomandibular Dislocation Injection for Shoulder Arthrography Cl Tx Shoulder Dislocation With Manipulation Without Anesthe Cl Tx Shoulder Dislocation With Manip With Anes Incision/Drainage of Upper Arm/Elbow Area; Bursa Remove FB Upper Arm/Elbow Subcutaneous Cl Tx Elbow Dislocation Without Anesthesia Cl Tx Radial Head Subluxation With Manipulation Injection Procedure for Wrist Arthography Cl Tx Distal Radial Fx With Manipulation Drain Finger Abscess Simple Repair Extensor Tendon Finger Without Graft Each Cl Tx Metacarpophal Dislocation With Manip Without Anes Cl Tx Knuckle Dislocation Single With Manipulation With Anesthesia Cl Tx Phalangeal Shaft Fx With Manipulation Each Cls Tx Articular Fx Phalangeal Joint With Manipulation Cl Tx Distal Phalangeal Fx With Manip Each Cl Tx Interphalangeal Joint Dislocation With Manip Without A Cl Tx Interphalangl Joint Disloc W/Manip With Anes Injection Procedure for Hip Arthrography Without Anesthesia Cl Tx Hip Dislocation Traumatic Without Anesthesia Contrast Injection for Knee Arthrography
Procedure Code 10021 10022 10060 10061 10080 10120 10140 10160 11042 11100 11200 11310 11400 11402 11440 11720 11730 11732 11740 11750 12001 12020 13122 13133 13153 16000 16020 16025 17110 20005 20103 20520 20600 20605 20610 21480 23350 23650 23655 23931 24200 24600 24640 25246 25605 26010 26418 26700 26705 26725 26742 26755 26770 26775 27093 27250 27370
Charge Amount $234.00 $369.00 $169.00 $216.00 $276.00 $106.00 $629.00 $284.00 $151.00 $108.00 $125.00 $59.00 $231.00 $352.00 $152.00 $132.00 $181.00 $54.00 $54.00 $534.00 $162.00 $521.00 $187.00 $213.00 $267.00 $347.00 $347.00 $409.00 $172.00 $754.00 $909.00 $1,067.00 $565.00 $190.00 $190.00 $225.00 $437.00 $329.00 $1,640.00 $1,602.00 $265.00 $189.00 $281.00 $368.00 $1,106.00 $108.00 $891.00 $136.00 $914.00 $175.00 $160.00 $260.00 $159.00 $1,859.00 $723.00 $179.00 $553.00
Cl Tx Patellar Dislocation Without Anesthesia Injection Procedure for Ankle Arthography Cl Tx Distal Fibular Fx With Manipulation Remove FB Foot Subcutaneous Cl Tx Fx Phalanx With Manipulation Each Cl Tx Metatarsophalangl Joint Disloc Without Anes Cl Tx Interphalangeal Joint Dislocation Without Anesthesia Application of Finger Splint Static Removal FB Intranasal Control Nasal Hemorrhage Anterior Simple Control Nasal Hemorrhage Anterior Complex Control Nasal Hemorrhage Posterior Initial Intubation Endotracheal Emergency Tracheotomy Tube Change Catheter Aspiration Nasotracheal Tube Thoracostomy Open Thoracentesis Without Imaging Guidance Pleural Drainage Percutaneous With Indwell Catheter Without Introduction of Needle/Intracatheter Vein Injection Procedure for Extremity Venography Venog Inj Needle or Cath Bilat Introduction of Catheter Vena Cava Left Subclavian 1st Venipunc Difficult Stick 3+ Yrs Routine Venipuncture Specimen Collection Fee Transfusion Blood/Blood Components Insert Non Tunneled Central Venous Catheter 5+ Yrs Insert Tunneled Central Venouse Catheter 5+ Yrs Insert PICC Line Without Port or Pump <5 Yrs Insert PICC Line Without Port or Pump 5+ Yrs Repair Central Venous Catheter Without Port or Pump Replace Non Tunneled CV Catheter Without Port/Pump Same Acce Replace Tunneled CV Catheter Without Port/Pump Same Access Remove Tunneled Central Venous Catheter Without Port/Pump Remove Tunneled Central Venous Catheter With Port/Pump Collect Blood From Porta-Cath Collect Blood From Central/Periph Venous Cath Declotting of Vascular Access Device or Catheter Mechanical Removal of Pericatheter Obstruction CVD Reposition Central Venous Catheter under Fluoro Guidance Contrast Injection for Evaluation of Existing CVAD Arterial Puncture for ABG Arterial Catheter Insertion With Kit Place Needle for Intraosseous Infusion Ligation AV Fistula Repair Laceration Tongue/Floor Mouth <=2.5 CM I&D Tooth Abscess Transendoscopic Tube Placement NG Tube Placement By MD With Fluoroscopy Change Gastrostomy Tube Percutaneous I&D Perianal Abscess Superficial Incision Thrombosed Hemorrhoid External Biopsy Liver Needle Percutaneous Injection Procedure For Cholangiography Replace Duo/Jejun Tube Percutaneous With Fluoro Contrast Injection For Evaluation of Tube Percutaneous Injection Procedure For Pyelography/Nephrostogram
27560 27648 27788 28190 28515 28630 28660 29130 30300 30901 30903 30905 31500 31502 31720 32551 32554 32556 36000 36005 36005 36010 36215 36410 36415 36415 36430 36556 36558 36568 36569 36575 36580 36581 36589 36590 36591 36592 36593 36595 36597 36598 36600 36620 36680 37607 41250 41800 43241 43752 43760 46050 46083 47000 47505 49451 49465 50394
$135.00 $350.00 $406.00 $471.00 $286.00 $298.00 $125.00 $86.00 $108.00 $265.00 $270.00 $167.00 $649.00 $292.00 $148.00 $595.00 $271.00 $927.00 $46.00 $1,202.00 $2,404.00 $1,728.00 $1,869.00 $172.00 $19.00 $19.00 $387.00 $3,649.00 $4,376.00 $1,075.00 $1,755.00 $789.00 $2,091.00 $3,898.00 $1,469.00 $2,090.00 $62.00 $122.00 $251.00 $5,632.00 $1,260.00 $545.00 $120.00 $497.00 $432.00 $3,997.00 $162.00 $188.00 $1,029.00 $229.00 $254.00 $654.00 $118.00 $671.00 $433.00 $2,280.00 $618.00 $582.00
Lithotripsy Unilateral Injection Procedure for Ureterography/Ureteropyleography Loopogram Injection Injection Procedure for Cystography Insert Straight Catheter Private Room Semi Private Room Med/Surg/Gyn LOA Injection Medication IM or SQ Direct Admit To Observation IV Push Initial IV Push Each Additional New Drug IV Infusion Hydration Initial 31 Minutes-1 Hr IV Infusion TPD Initial 16 Minutes-1 Hour IV Infusion TPD Addl Sequential Infusion Up to 1 Hour IV Infusion Hydration Each Addl Hour IV Infusion TPD Each Addl Hour Homatropine 5% Opth Soln 1 ML Hydralazine 10 MG Tab Hydralazine 20 MG/1 ML Inj Hydralazine 25 MG Tab Hydralazine 50 MG Tab Hydrochlorothiazide 25 MG Tab Hydrocort NA Succ 100 MG Inj Hydrocortisone 1% Cr 30 G Hydrocortisone 25 MG Supp Hydromorphone 0.5 MG/ML PCA 20M Hydromorphone 1 MG/1 ML Inj Hydromorphone 2 MG/1 ML Inj Hydroxychloroquine 200 MG Tab Hydroxyurea 500 MG Cap Hydroxyzine 50 Mg/ 1 Ml Inj Hydroxyzine HCL 10 MG Tab Hydroxyzine Hcl 25 MG Tab Hydroxyzine Hcl 50 MG Tab Hyoscyamine 0.125 MG Tab Hyoscyamine 0.125 MG/1 ML Drops Hyoscyamine 0.375 Tab SA Ibuprofen 100 MG/5 ML Susp Ibuprofen 400 MG Tab Ibuprofen 600 MG Tab Ibuprofen 800 MG Tab ICU Room Indigo Carmine 40 MG/5 ML Inj Indomethacin 25 MG Cap In-House Ventilator Transport Instrument Centerline ECTR Disp Instrument Ligasure Impact Insulin Aspart (U-100) Add Insulin Aspart (U-100) Dose Insulin Aspart 70/30 (Dose) Insulin Aspart U-100 10ML Vial Insulin Detemir (U-100) Dose Insulin Hum Reg U-100 10ML Vial Insulin Human 70/30 1 ML Insulin Human NPH (U-100) 1 ML Insulin Human Regular (U-100) Insulin Human Regular Add
50590 50684 50690 51600 51701
96372 G0379 96374 96375 96360 96365 96367 96361 96366
$8,497.00 $151.00 $186.00 $382.00 $192.00 $963.00 $963.00 $0.00 $101.00 $417.00 $290.00 $290.00 $379.00 $379.00 $379.00 $146.00 $146.00 $56.50 $3.62 $142.54 $6.08 $6.08 $6.08 $23.30 $17.22 $6.08 $222.46 $41.41 $43.48 $8.84 $7.09 $23.30 $6.08 $6.08 $5.06 $6.08 $17.22 $6.08 $5.06 $6.08 $6.08 $6.08 $937.00 $109.05 $5.06 $0.00 $600.00 $1,885.00 $17.46 $23.30 $58.42 $546.74 $43.56 $235.83 $45.58 $23.30 $23.30 $202.60
Insulin Lispro 75/25 (Dose) Intermediate Care ICU Room Ipecac Syrup 30 ML Ipratropium 0.02% 2.5 ML Inh So Ipratropium HFA 17 MCG (Dose) Irbesartan 150 MG Tab Iron Sucrose 100 Mg Add Iron Sucrose 100 Mg/5 Ml Inj Irradiation Red Cell Product Each Unit Isoniazid 100 MG Tab Isosorbide Dinitrate 20 MG Tab Isosorbide Mononitrate 30 MG SA Isosorbide Mononitrate 60 MG SA Janumet 50/500 Mg Ketamine 500 MG/10 ML Inj Ketoconazole 2% Cr 15 G Ketorolac 10 MG Tab Ketorolac 30 Mg/1 Ml Inj Ketorolac 60 Mg/2 Ml Inj Kit Advanced Bionics Charging Kit Central Line Dress Dialysis Lg Bore Kit General Laparoscopy CDS Kit Instrument Micro Suture Tak Disposable Kit Mic Transgastric Jejunal Kit Remote Control Boston Sci Kit SCS Programming SC-5532-1 Kit Splitter 2 X 8 30 CM Boston Scientific Kit Thoracic CDS Kit Vac Via 7Day Sys Woundcare Kombiglyze XR 1000 / 2.5 Mg Tab K-Wire 1.1 X 143MM Stryker Labetalol 100 MG Add Labetalol 100 MG Tab Labetalol 100 MG/20 ML Injection Laceration Repair Complex Laceration Repair Intermediate Laceration Repair Simple Lacosamide 50 MG Tab Lacri-Lube Opth Oint 3.5 G Lactobacillus GG Cap Lactobacillus Rhamnosus GG Cap Lactulose 20 G/30 ML Syrup Lamotrigine 100 MG Tab Latanoprost 0.005% Opth Soln 2 Leflunomide 20 MG Tab LETS Topical Soln Levalbuterol Inh 0.63 MG/3 ML Levalbuterol Inh 1.25 MG/3 ML Levalbuterol Resp 1.25 MG/0.5 ML Levetiracetam 500 MG Add Levetiracetam 500 MG Tab Levetiracetam 500 MG/5 ML Liq Levofloxacin 250 MG in 50 ML Dex Levofloxacin 250 MG Tab Levofloxacin 500 MG in 100 ML De Levofloxacin 500 MG Tab Levofloxacin 750 MG/150 ML D5W Levothyroxine 0.025 MG (25 MCG)
$41.53 $868.00 $9.12 $4.05 $3.62 $9.12 $0.00 $0.00 $0.00 $6.08 $6.08 $6.08 $9.12 $28.38 $56.73 $124.60 $5.06 $0.00 $0.00 $6,137.00 $60.00 $473.00 $750.00 $943.00 $3,600.00 $3,600.00 $3,198.00 $1,050.00 $2,172.00 $27.88 $87.00 $394.49 $6.08 $135.74 $856.00 $716.00 $289.00 $16.21 $47.44 $5.06 $3.62 $20.26 $16.21 $463.22 $123.70 $5.95 $32.42 $26.82 $32.42 $397.86 $17.22 $27.35 $100.29 $35.46 $153.98 $40.52 $248.22 $3.62
Levothyroxine 0.05 MG (50 MCG) T Levothyroxine 0.075 MG (75 MCG) Levothyroxine 0.088 MG (88 MCG) Levothyroxine 0.1 MG (100 MCG) T Levothyroxine 0.112 MG (112 MCG) Levothyroxine 0.125 MG (125 MCG) Levothyroxine 0.175 MG Tab Lidocaine 1% Inj 20ML Lidocaine 1% W/Epinephrine 1:1 Lidocaine 100 MG/5 ML Syringe Lidocaine 2 G In Dextrose 5% In Lidocaine 2% Inj 2 mL Lidocaine 2% Inj 20ML Lidocaine 2% Jelly 30G Lidocaine 2% PF Inj 5 ML Lidocaine 5% Patch (Ea) Lidocaine Viscous 2% Soln 20ML Lidocaine-Preservative Free 1% Linaclotide 290 Mcg Cap Linezolid 600 MG Tab Linezolid 600 Mg/D5W 300 Ml IVPB Lisinopril 10 MG Tab Lisinopril 20 MG Tab Lisinopril 5 MG Tab Lithium 300 MG Cap Lomotil (0.025 MG-2.5 MG) Tab Loperamide 2 MG Cap Loratadine 10 MG Tab Lorazepam 0.5 MG Tab Lorazepam 1MG Tab Lorazepam 2MG/1ML Inj Lortab (108 Mg - 2.5 Mg) Elix 5 Ml Lortab (163mg-5mg) elixir 7.5 mL Lortab (167 MG-2.5 MG) Elixir 5M Lortab (216 Mg - 5 Mg) Elixir 10 Ml Losartan 50 MG Tab Lotrel 5/20 Cap Lotrisone Cream 15 G LR 1000 ML Lymph Sub 5-CD19/CD4/CD8 - ARUP Maalox Susp 30 ML Macrobid Cap Mag Sulfate 1 G/D5W 100 ML IVPB Mag Sulfate 2 G/SW 50 ML IVPB Mag Sulfate 4 G/SW100 ML Premix Magic Mouthwash W/Lidocaine Magnesium Chloride 20 % Add Magnesium Chloride 64 MG SA Tab Magnesium Oxide 400 MG Tab Magnesium Sulfate 1 G Add Magnesium Sulfate 1 G/2 ML Inj Mastisol Liq 0.67ML Maxitrol Opth Susp 5 ML Maxzide-25 Tab Meclizine 25 MG Tab Med & Surg Supplies Megestrol 40 MG Tab Megestrol 40 MG/1 ML Susp
$6.08 $6.08 $6.08 $6.08 $6.08 $6.08 $6.08 $23.30 $23.30 $23.30 $247.65 $18.74 $53.69 $82.05 $23.30 $38.60 $32.42 $23.93 $47.56 $480.10 $0.00 $6.08 $6.08 $6.08 $3.80 $8.10 $5.06 $6.08 $8.10 $8.10 $25.32 $10.88 $37.81 $9.12 $24.14 $9.12 $12.16 $100.29 $144.06 $0.00 $5.06 $9.12 $124.68 $124.68 $124.68 $32.42 $73.68 $7.56 $6.08 $19.68 $23.30 $12.20 $188.76 $6.08 $6.08 $0.00 $3.13 $20.26
Megestrol 400mg/10mL susp Melatonin 3 MG Tab Melatonin 5 Mg Tab Meloxicam 15 mg Tab Meloxicam 7.5 MG Tab Memantine 10 MG Tab Memantine 5 MG Tab Memantine 7 Mg SR Cap Meperidine 100 MG/1 ML Inj Meperidine 25 mg/1 mL Inj Meperidine 50 MG Tab Meperidine 50 MG/1 ML Inj Meropenem 1 G in NS 100 Ml IVPB Meropenem 1 G IVPB Meropenem 500 Mg/NS 50 Ml IVPB Mesh Composite Oval 10 X 15CM Mesh Composite Oval 15 X 20CM Mesh Composite Oval 20 X 25CM Mesh Composite Oval 25 X 35CM Metaxalone 800 MG Tab Metformin 500 MG Tab Metformin 500 MG XR Tab Metformin 750 MG XR Tab Metformin 850 MG Tab Methocarbamol 500 MG Tab Methyl Salicylate Patch (Salonpas) 10%-3% Methylene Blue 100 Mg/10 Ml Inj Methylergonovine 0.2 MG/1 ML Inj Methylpred Acet 40 MG/1 ML Inj Methylprednisolone 4 MG Tab Methylprednisolone Na Su 1 G Add Metoclopramide 10 MG Tab Metolazone 5 MG Tab Metoprolol Succ 25 MG XL Tab Metoprolol Succinate 50 MG XL T Metoprolol Tartrate 25 MG Tab Metoprolol Tartrate 5 MG/5 ML In Metoprolol Tartrate 50 MG Tab Metronidazole 500 MG Tab Metronidazole 500 MG/100 ML IVPB Micafungin 100 Mg Add Micropuncture 5 Fr Stiffen Midazolam 10 MG/2 ML Inj Midazolam 2 Mg/ 2 Ml Inj Midazolam 50 Mg Add Midazolam 5MG/1ML Inj Midazolam Inf 100 MG/NS 40 ML Sy Midodrine 5 MG Tab Milk of Magnesia Susp 30ML Minoxidil 2.5 MG Tab Miralax 15 ML (17G) Powder Mirtazapine 15 MG Tab Mirtazapine 30 MG Tab Misoprostol 200 MCG Tab Modafinil 100 MG Tab Montelukast 10 MG Tab Morphine 15 MG SA Tab Morphine 2 Mg/1 Ml Inj
$29.78 $3.62 $3.62 $20.56 $21.27 $11.14 $11.14 $50.95 $25.32 $26.29 $9.51 $25.32 $397.46 $104.58 $219.76 $1,329.00 $2,405.00 $3,242.00 $4,577.00 $18.09 $6.08 $6.08 $7.50 $5.06 $3.04 $4.90 $0.00 $44.18 $46.60 $5.91 $436.31 $6.08 $9.12 $4.83 $6.08 $6.08 $70.35 $6.08 $6.08 $75.98 $0.00 $146.00 $0.00 $0.00 $0.00 $0.00 $85.13 $14.61 $5.06 $6.08 $12.16 $14.18 $15.19 $7.11 $19.25 $14.18 $11.00 $30.44
Morphine 30 Mg / 30 Ml PCA Inj Morphine 30 MG SA Tab Morphine 5 MG/1 ML Inj Morphine 50 MG/50 ML PCA Inj Morphine Oral Conc 20 MG/1 ML Multivitamins Therapeutic Multivitamins w/ Minerals Cap Multivits IV 10 ML Add Multivits W/ Minerals Tab Multivits With Minerals 15 ML Mupirocin 2% Oint 22 G Mycophenolate 500 Mg Tab Nalbuphine 10 MG/1 ML Inj Naloxone 0.4 MG Add Naloxone 0.4 MG/1 ML Inj 10 ML Naloxone 0.4MG/1ML Inj Naloxone 2 MG/2 ML Inj Naproxen 250 MG Tab Nateglinide 120 MG Tab Nebivolol 10 MG Tab Nebivolol 5 MG Tab Needle Percutaneous Entry Cook Neosporin Opth Soln 10 ML Neostigmine 10 MG Add Neostigmine 10 MG/10 ML Inj Nephrocaps Cap Neutra-Phos 250 MG Packet NF Bulk Med NF IVPB NF Med Niacin 500 MG ER Tab Nicardipine Drip 40 MG/200 ML Nicotine 14 MG/24 Hrs Patch Nicotine 21 MG/24 Hrs Patch Nicotine 7 MG/24 Hrs Patch Nifedipine 10 MG Cap Nifedipine 30 MG SA Tab Nifedipine 90 MG SA Tab Nitroglycerin 0.1 MG/Hr Patch Nitroglycerin 0.2 MG/Hr Patch Nitroglycerin 0.4 MG/Hr Patch Nitroglycerin 2% Oint 1G Nitroglycerin 2% Oint 30 G Nitroglycerin 25 Mg/ D5W 250 Ml Nitroglycerine Drip 100 MG Nitroprusside 50 MG Add Norco 10/325 Tab Norco 5/325 Tab Norco 7.5/325 Tab Norepinephrine 4 MG/4 ML Inj Normal Saline 1000 ML IV NS 1000 ML W Kcl 20 MEQ NS 1000 ML W Kcl 40 MEQ NS 500 ML NTG 0.4 MG (1/150 Gr) Tab Bottle Nu-Iron 150 MG Cap Nystatin 500000 Units/5 ML Sus Nystatin Cr 15 G
$102.10 $8.10 $25.32 $344.74 $8.10 $3.62 $3.62 $108.36 $6.08 $5.06 $94.21 $0.00 $23.30 $189.21 $195.16 $38.41 $153.37 $6.08 $7.09 $12.16 $10.74 $17.00 $99.27 $423.21 $418.07 $5.06 $5.06 $0.00 $0.00 $0.00 $13.27 $1,181.80 $32.42 $19.25 $11.14 $5.06 $7.09 $15.19 $17.22 $17.22 $17.22 $17.22 $17.00 $86.33 $221.48 $263.50 $5.06 $8.10 $8.10 $70.56 $122.22 $160.02 $231.18 $80.64 $6.08 $5.06 $5.06 $5.06
Nystatin Powder 15 G Nystatin/Triamcinol Cream 15 G Olanzapine 5 MG Tab Olmesartan 20 MG Tab Omacor 1000 MG Cap Onabotulinumtoxin A (Botox) Inj 200 Units Ondansetron 4 Mg/2 Ml Inj Ondansetron ODT 4 MG Tab Ondansetron ODT 8 MG Tab Opcon-A Ophth Soln 15 Ml Oral Care Oscal D 500 Tab Oseltamivir Phosphate 75 MG Cap Oxacillin 2 G in NS 100 Ml IVPB Oxacillin 2 G IVPB Oxcarbazepine 150 MG Tab Oxybutynin 10 MG XL Tab Oxybutynin 5 MG Tab Oxybutynin 5 MG XL Tab Oxycodone 10 MG SA Tab Oxycodone 15 MG Tab Oxycodone 5 MG Tab Oxygen Therapy Short Stay Oxygen Use/Day Oxymetazoline 0.05% Nasal Spra Oxytocin 10 IU/ML Inj Oxytocin 10 Units/ML Inj Pack Arthroscopy (Disp) Pantoprazole 20 MG EC Tab Pantoprazole 40 MG EC Tab Paroxetine 10 MG Tab Paroxetine 20 MG Tab Paroxetine CR 12.5 MG Tab Patch Pericardial Penicillin G Benzathine 1.2 Mi Penicillin G Benzathine 2.4 Mi Pentosan Polysufate 100 MG Cap Pentoxifylline 400 MG Tab Perform/Document/Complete EKG Permethrin 5% Cr 60 G Phenazopyridine 100 MG Tab Phenazopyridine 200 MG Tab Phenobarbital 130 MG/ML Inj Phenobarbital 32.4 MG Tab Phenobarbital 65 MG IVPB Phenobarbital 65 MG/ML Inj Phentolamine 5 MG Inj Phenylephrine 0.25% Nose Spray Phenylephrine 10 MG Add Phenylephrine 10 MG/1 ML Inj Phenytoin 100 MG/2 ML Inj Phenytoin 100 MG/4 ML Susp Phenytoin 250 MG Add Phenytoin 250 MG/5 ML Inj Phenytoin Extended 100 MG Cap Physostigmine 2 Mg/ 2 Ml Inj Phytonadi Neonat 1 MG/0.5 ML Syr Phytonadione Neonatal 1 MG Add
$160.53 $31.40 $21.27 $8.10 $8.87 $0.00 $0.00 $12.16 $17.22 $22.78 $0.00 $6.08 $25.32 $0.00 $0.00 $9.40 $18.02 $6.08 $17.64 $9.12 $8.10 $7.09 $85.00 $328.00 $22.25 $63.03 $46.58 $611.00 $3.13 $3.17 $14.34 $6.08 $15.02 $765.00 $0.00 $0.00 $31.79 $6.08 $0.00 $128.65 $6.08 $6.08 $55.58 $8.10 $195.56 $43.48 $325.61 $19.25 $24.77 $36.58 $23.30 $5.06 $22.74 $23.30 $5.06 $28.69 $23.30 $197.09
Pioglitazone 15 MG Tab Place/Remove Speaking Valve Plate 2.7 X 16MM Stryker Polysporin Powder 10 G Post Anesthesia Care Each Addl 15 Minutes Post Anesthesia Care Up To 1 Hour 00 Minutes Potassium Chloride 10 MEQ in 10 Potassium Chloride 10 MEQ Tab Potassium Chloride 20 MEQ Add Potassium Chloride 20 MEQ in 10 Potassium Chloride 20 MEQ/15 ML Potassium Chloride 40 MEQ Add Potassium Chloride Bolus 20 mEq in NS 250 Ml Potassium Chloride Bolus 40 mEq in NS 500 Ml Potassium Chloride Bolus 40 Meq/NS 250 Ml Potassium Phosphate 3 MMOL/ML Add Povidone-Iodine 10% Oint 0.9 G Pramipexole 0.25 MG Tab Prasugrel 10 MG Tab Pravastatin 20 MG Tab Prazosin 1 MG Cap Prednisolone 15 MG/5 ML Liq Prednisone 1 MG Tab Prednisone 10 Mg Tab Prednisone 20 Mg Tab Prednisone 5 MG Tab Prednisone 5 MG/1 ML Concentrate Pregabalin 100 MG Cap Pregabalin 25 MG Cap Pregabalin 50 MG Cap Pregabalin 75 MG Cap Prempro 0.3/1.5 Tab Primaxin 500 Mg in NS 100 Ml Primaxin 500 MG IVPB Primidone 50 MG Tab Procainamide 1 G/2 ML Add Prochlorperazine 10 Mg Tab Promethazine 12.5 MG Supp Promethazine 25 MG / 1 ML Inj Promethazine 25 MG Inj Promethazine 25 MG Supp Promethazine 25 Mg Tab Promethazine 50 MG/1 ML Inj Propafenone 150 MG Tab Propofol 10 MG/ML 100 ML Inj Propofol 10 MG/ML 50 ML Propofol 200 MG/20 ML Inj Propranolol 10 MG Tab Propranolol 40 MG Tab Propranolol 60 MG SA Cap Protack Autosuture 5MM Protamine 50 MG Add Protamine 50 MG/5 ML Inj Protection Station Namic Psyllium Powder Packet Pyridostigmine 60 MG Tab Quetiapine 100 MG Tab Quetiapine 25 MG Tab
$21.27 $0.00 $2,430.00 $36.47 $45.00 $1,193.00 $118.74 $6.08 $23.30 $118.74 $5.06 $23.30 $115.15 $161.60 $147.63 $23.30 $17.22 $15.96 $35.81 $10.13 $3.80 $16.21 $5.06 $0.00 $0.00 $6.08 $5.06 $11.30 $10.27 $9.12 $11.45 $20.81 $0.00 $431.79 $3.62 $223.49 $0.00 $25.20 $23.93 $16.08 $26.60 $0.00 $24.17 $6.30 $632.49 $381.89 $147.19 $6.08 $4.83 $7.09 $806.00 $48.87 $50.38 $54.00 $5.06 $4.37 $14.18 $9.12
Rabeprazole 20 Mg EC Tab Racepinephrine 2.25% Inh Soln Radpad Shield Ramipril 2.5 MG Cap Ramipril 5 MG Cap Ranitidine 150 MG/10 ML Syrup Ranolazine 500 MG ER Tab Reload Reticulating 45MM-2.0MM Remove Holter Monitor Respiratory Consult Assessment Respiratory Consult Reassessment Rifampin 150 MG Cap Rifampin 300 MG Cap Risperidone 0.5 MG Tab Risperidone 1 MG Tab Rivaroxaban 10 MG Tab Rivaroxaban 15 MG Tab Rivaroxaban 20 MG Tab Rivastigmine 1.5 MG Cap Rivastigmine 4.6 MG/24 Hr Patch Rocuronium 50 MG/5 ML Inj Rondec DM Drops 30 ML Ropinirole 0.25 MG Tab Ropinirole 1 MG Tab Roxicet (325 MG-5 MG) Tab Scopolamine Patch Screw 2.7 Cortex Stryker Screw Bone T7 Stryker Screw Locking T7 Stryker Sealer-Divider Ligasure Blunt Sennosides 8.6 MG Tab Senokot S Tab Sertraline 50 MG Tab Sevelamer 800 MG Tab Sevelamer Carbonate 800 MG Tab Sheath Brite Tip Silver Nitrate Applicators Silver Sulfadiazine 1% Cr 50 G Simethicone 40 MG/0.6 ML Drops Simethicone 80 MG Chew Tab Sinemet 10/100 Tab Sinemet 25/100 Tab Sinemet CR 50/200 Tab Sitagliptin 50 MG Tab Site Rite Cover Snare Gooseneck Sod Bicarb 50 MEQ/50 ML Syringe Sod Chl 0.45% with KCL 20 Meq/L Sodium Acetate 40 MEQ Add Sodium Bicarbonate 50 MEQ Add Sodium Bicarbonate 650 MG Tab Sodium Chloride 0.45% 1000 ML Sodium Chloride 0.45% 500 ML Sodium Chloride 1 G Tab Sodium Chloride 3% 500 ML Sodium Chloride 4 MEQ/ML Add Sodium Chloride Nasal 45 ML Solifenacin 10 Mg Tab
$49.12 $17.22 $97.00 $8.10 $8.10 $8.10 $22.11 $633.00 $0.00 $0.00 $0.00 $6.08 $13.01 $16.21 $16.21 $42.24 $45.63 $45.63 $12.16 $42.77 $82.05 $257.19 $6.08 $13.27 $8.10 $57.74 $375.00 $338.00 $379.00 $1,396.00 $6.08 $6.08 $12.16 $9.12 $14.61 $93.00 $17.22 $28.36 $50.53 $6.08 $6.08 $6.08 $9.12 $35.40 $35.00 $1,091.00 $172.38 $86.33 $43.22 $44.49 $6.08 $122.22 $131.75 $3.17 $54.70 $41.28 $17.22 $37.96
Solifenacin 5 MG Tab Sorbitol 70% Soln 30 ML Sotalol 80 MG Tab Spinal Procedure Spironolactone 25 MG Tab Splint Sugar Tong S.L. Plaster SPS 15 G/60 ML Susp Stapler Cont Curv Blue CS40B Stapler Cont Curv RL Blue CR40B Stapler EEA Single Use Stapler EGIA 45 Art Med Thick Stapler EGIA 45 Art Vasc Med Stapler EGIA 60 Art Med Thick Stapler EGIA 60 Art Vasc Med Stapler EGIA 60 Art Xtra Thick Stress Formula Vits W/Iron Tab Stress Formula Vits W/Zinc Tab Succinylcholine 200 MG/10 ML Inj Sucralfate 1 G Tab Sucralfate 1 G/10 ML Susp Surgery Each Additional Minute Category 1 Surgery Each Additional Minute Category 2 Surgery Each Additional Minute Category 3 Surgery Each Additional Minute Category 4 Surgery Each Additional Minute Category 5 Surgery Each Additional Minute Category 6 Surgery Each Additional Minute Category 7 Surgery First 30 Minutes Category 1 Surgery First 30 Minutes Category 2 Surgery First 30 Minutes Category 3 Surgery First 30 Minutes Category 4 Surgery First 30 Minutes Category 5 Surgery First 30 Minutes Category 6 Surgery First 30 Minutes Category 7 Surgical Implants Suture Ethilon Suture Monocryl Suture Silk Suture Vicryl Swing Bed Room System Implant CMC Mini Tightrope 1.1 mm Tamoxifen 10 MG Tab Tamsulosin 0.4 MG Cap Telmisartan 40 Mg Tab Telmisartan 80 MG Tab Temazepam 15 MG Cap Terazosin 2 MG Cap Terazosin 5 MG Cap Terbutaline 1 MG/ML Inj Terbutaline 2.5 MG Tab Terconazole-7 Vag Cr 45G Tetracaine 0.5% Opth Soln 15 ML Tetracaine 0.5% Opth Soln 2 ML Tetracycline 500 MG Cap Theophylline 200 MG Tab SA Theophylline 300 MG Tab SA Thyroid 60 MG Tab Thyroid 90 Mg Tab
$41.71 $5.06 $10.13 $1,928.00 $6.08 $93.00 $63.82 $1,544.00 $844.00 $887.00 $550.00 $529.00 $723.00 $693.00 $910.00 $3.62 $6.08 $0.00 $6.08 $6.08 $37.00 $40.00 $45.00 $60.00 $35.00 $47.00 $73.00 $2,891.00 $3,360.00 $3,836.00 $6,146.00 $1,948.00 $5,254.00 $7,017.00 $0.00 $20.00 $20.00 $20.00 $20.00 $675.00 $1,575.00 $6.08 $10.13 $20.69 $9.12 $7.09 $6.08 $6.08 $131.69 $6.08 $187.40 $113.01 $17.22 $5.06 $6.08 $6.08 $3.62 $3.62
Timolol 0.5% Opth Soln 5 ML Tiotropium 18 MCG Inhalation Ca Tiotropium Respimat 2.5 Mg/Inh Tisseel Frozen 4ML Tizanidine 4 MG Tab Tobradex Opth Oint 3.5 G Tobradex Opth Susp 2.5 ML Tobramycin 0.3% Opth Soln 5 ML Tobramycin 40 MG IVPB Tolterodine 2 MG SA Cap Tolterodine 2 MG Tab Tool Tunneling BSC Neuro Topiramate 100 MG Tab Topiramate 25 MG Tab Mammography Diagnostic Digital Unilateral w/ CAD Mammography Diagnostic Digital Bilateral w/ CAD Mammography Screening Digital Bilateral w/ CAD Torque Device Torsemide 10 Mg Tab Torsemide 100 MG Tab Toughy Trace Elements Adult 1 ML Trach Care Tracheostomy Decannulation Tramadol 50 MG Tab Travoprost 0.004% Ophth 2.5 ML Tray Laceration Custom Tray Vascular Trazodone 50 MG Tab Triamcinolone 0.1% Cr 15 G Triamcinolone 0.1% Oint 15 G Trihexyphenidyl 2 MG Tab Triple Antibiotic Oint 0.9 G Pa Triple Antibiotic Oint 15 G Tuberculin 5 Tu/0.1 ML Inj Tussionex Susp 5 ML Tylenol #3 (300 MG-30 MG) Tab Unasyn 1.5 G / NS 50 Ml Unasyn 1.5 G IVPB Unasyn 3 G Inj Unasyn 3 g/NS 100ml Urelle Tab Valacyclovir 500 MG Tab Valproic Acid 250 MG/5 ML Liq Valsartan 160 MG Tab Valsartan 80 MG Tab Vancomycin 1 G Inj Vancomycin 1 G IVPB Vancomycin 1 G/NS 250 Ml Vancomycin 750 MG IVPB Vasopressin 20 Units/1 ML Inj Vecuronium 10 MG Inj Venlafaxine 150 MG SA Cap Venlafaxine 37.5 MG SA Cap Venlafaxine 37.5 MG Tab Venlafaxine 75 MG SA Cap Venlafaxine 75 MG Tab Verapamil 180 MG SA Tab
77065 77066 77067
$146.76 $290.41 $23.35 $641.00 $8.10 $263.38 $194.50 $186.54 $190.92 $14.18 $13.55 $616.00 $37.25 $9.12 $584.00 $612.00 $584.00 $33.00 $3.62 $16.21 $98.00 $23.30 $0.00 $0.00 $6.08 $439.29 $48.00 $211.00 $6.08 $20.84 $15.21 $6.08 $17.22 $21.27 $41.24 $7.09 $8.10 $153.48 $231.01 $128.61 $212.26 $17.81 $40.60 $5.06 $9.12 $9.12 $0.00 $0.00 $0.00 $86.33 $465.70 $185.29 $15.19 $12.47 $9.12 $14.18 $9.12 $7.09
Verapamil 240 MG SA Tab Verapamil 5 MG/2 ML Inj Verapamil 80 MG Tab Vilazodone 40 Mg Tab Vitamin A & D Oint 60 G Vitamin B Complex 100 Mg Add Vitamin B1 100 MG Tab Vitamin B1 100 MG/1 ML Add Vitamin B1 200 MG/2 ML Inj Vitamin B12 1000 MCG Add Vitamin B12 1000 MCG Tab Vitamin B6 100 MG Add Vitamin B6 100 MG/1 ML Inj Vitamin C 500 MG Tab Vitamin C 500 MG/ML Add Vitamin D 400 Units Tab Vitamin D3 1000 Units Tab Vitamin E 400 IU Cap Warfarin 1 MG Tab Warfarin 2 MG Tab Warfarin 2.5 MG Tab Warfarin 3 MG Tab Warfarin 5 MG Tab Warfarin 7.5 MG Tab Wire 1.1 Non Threaded Syn Zerbaxa 1.5 G Add Ziac 10 MG-6.25 MG Tab Clone1 Zinc 220 MG Cap Ziprasidone 20 MG Cap Ziprasidone 20 Mg Inj Ziprasidone 40 MG Cap Zoledronic (Reclast) 5 Mg/100 Ml Zoledronic (Zometa) 4 Mg Add Zolpidem 5 MG Tab Zosyn 2.25 G in NS 50 Ml IVPB Zosyn 2.25 G IVPB Zosyn 3.375 G in NS 50 Ml IVPB Zosyn 3.375 G/100 Ml IVPB Zosyn 4.5 G in NS 100 Ml IVBP
$11.14 $38.41 $6.08 $32.53 $17.22 $210.05 $6.08 $73.61 $99.48 $41.01 $6.08 $51.98 $37.80 $6.08 $28.98 $6.08 $3.62 $5.06 $6.08 $6.08 $6.08 $6.08 $6.08 $6.08 $110.00 $519.57 $7.37 $5.06 $18.23 $0.00 $18.23 $0.00 $0.00 $41.67 $0.00 $0.00 $174.69 $0.00 $186.28
