Standard charges listing

Jerold Phelps Community Hospital Standard Charges Listing - April 2020
ABO BLOOD TYPE	BB	79.10
ANTIBODY DETECTION /SO	BB	25.60
ANTIGEN SCREENING OF DONOR BLOOD, RH (D)	BB	98.00
ANTIGEN SCREENING OF PATIENT BLOOD, ABO	BB	98.00
INVESTIGATION OF TRANSFSION REACTION /SO	BB	339.10
PLATELETS PHERESIS	BB	1,371.30
Rbc leukoreduced irradiated	BB	878.70
RED BLOOD CELLS LEUKOREDUCED	BB	567.30
RH FACTOR	BB	121.65
DMV PHYSICAL CASH ON DOS	CL	105.00
EX BEN SCP/NK/HD/FT <.5CM	CL	228.30
GLUCOSE BY REAGENT STRIP	CL	26.05
HEMOGLOBIN	CL	40.20
HOME VISIT EST PT LIMITED	CL	129.80
HOME VISIT EST PT LOW-MOD	CL	198.25
HOME VISIT EST PT MOD-HI	CL	304.40
HOME VISIT NEW PT HI UNSTABLE	CL	654.80
HOME VISIT NEW PT HIGH	CL	539.25
HOME VISIT NEW PT LOW	CL	162.90
HOME VISIT NEW PT MOD-HI	CL	385.80
HOME VISIT NEW PT MODERATE	CL	234.95
IMMUN ADMIN 1ST EA/COMBO	CL	116.90
IMMUN ADMIN ADDL EA/COMBO	CL	41.40
IMMUN ADMIN INFLUENZA	CL	99.10
IMMUN ADMIN PNEUMOVAX	CL	36.65
IMMUN ADMIN VACCINE FOR CHILDREN	CL	27.35
INJ SC/SQ/IM FLU VAC SPLIT 3+ YRS	CL	64.95
INJ THER/PRO/DX INTRA-ART	CL	92.10
INJECTION-SC/SQ OR IM	CL	64.95
INSURANCE EXAM	CL	260.80
KOH PREP WET MOUNT FUNGUS	CL	47.20
NO CHARGE	CL	0.00
NO SHOW CHARGE	CL	42.00
OCCULT BLOOD FECES	CL	82.60
PREGNANCY TEST URINE	CL	98.80
PRO SVC ALLERGEN > 2	CL	42.60
PRO SVC ALLERGN TX WO EXT	CL	42.60
RAPID STREP SCREEN	CL	173.50
REMOVE FB FROM EYE PRO FEE	CL	123.90
RESPIRATORY FIT TEST NURSE ONLY	CL	79.80
SKIN TEST TUBERCULOSIS	CL	52.05
SPORTS PHYS/CASH DOS ONLY	CL	21.00
SVN INITIAL TREATMENT	CL	234.95
SVN SUBSEQUENT (EA)	CL	57.90
TELEHEALTH FACILITY FEE	CL	52.50
UA DIP WO/MICRO	CL	28.40
VACCINE SCHOOL SPECIAL	CL	29.60
VISITING NURSE EST PT UNSTABLE	CL	422.50
ANOSCOPY DIAG	CLMD	234.95
APPL CAST SHRT ARM EBW/FN	CLMD	243.15
APPL SPLINT SHT ARM	CLMD	171.20
APPL SPLINT SHT LEG	CLMD	157.05
ARTHRO ASP/INJ INTRMD JNT	CLMD	173.50
ARTHRO ASP/INJ MAJ JNT/BR	CLMD	205.35
ARTHROCENT ASP/INJ SM JNT	CLMD	167.60
AUDIOLGC FNCTN SCRNG AIR	CLMD	40.20
AVULS NAILPLT PART/COMP S	CLMD	185.20
BIOPSY CERVIX SINGLE/MULT	CLMD	290.35
BX SKN/SQ/MUC MEMB ADL10%	CLMD	89.80
BX SKN/SQ/MUC MEMB SINGLE	CLMD	178.20
CATH INSRT BLADDR NONINDW	CLMD	154.60
CATH INSRT FOLEY SIMPLE	CLMD	177.00
CD TRT FX METACARP EA WOM	CLMD	736.20
CLSD TRT METAC FX SG W/MN	CLMD	863.65
CLSD TX DIST RAD FX WO M	CLMD	847.10
COLPO W/BX CERVIX/ECC	CLMD	706.80
COLPOSCOPY/VAGINOSCOPY	CLMD	494.40
CTL HEMOR NASL POST INI	CLMD	613.50
DEBR SKIN	CLMD	106.20
DEBRIDE SKIN	CLMD	161.65
DEBRIDE SKIN/SUB TISSUE	CLMD	219.60
DEBRIDEMENT OF NAIL 1 - 5	CLMD	50.85
DEBRIDEMNT NAIL 6 OR MORE	CLMD	125.80
DEST LESION /VULVA	CLMD	369.45
DEST LESION 15 OR MORE	CLMD	181.70
DEST LESION 2-14 EACH	CLMD	31.90
DEST LESION ANY METH 15+	CLMD	566.30
DEST LESION ANY METH 1ST	CLMD	137.00
DEST WART ANY METH 1-14	CLMD	153.50
DMV 2ND VISIT CASH ON DOS	CLMD	52.50
DRAIN EXTERNAL EAR LESION	CLMD	562.75
DRAINGE OF PILONIDAL CYST	CLMD	620.60
DRX/DBD BURN W/O ANS SML	CLMD	252.60
E/M EST PT COMPREHNS	CLMD	330.35
E/M EST PT DETAILED	CLMD	206.55
E/M EST PT EXPANDED	CLMD	142.80
E/M EST PT LIMITED	CLMD	110.95
E/M EST PT MINIMAL	CLMD	78.00
E/M NEW PT COMP/COMPLEX	CLMD	509.70
E/M NEW PT COMP/MOD	CLMD	377.55
E/M NEW PT DETAILED	CLMD	264.30
E/M NEW PT EXPANDED	CLMD	203.00
E/M NEW PT LIMITED	CLMD	162.90
EMPLOYEE PHYSICAL	CLMD	142.80
ENDOMETRIAL BIOPSY	CLMD	467.30
EST PT PRE EXAM/UNDR 1 YR	CLMD	166.40
EST PT PREV EXAM/ 1-4 YRS	CLMD	206.55
EST PT PREV EXAM/ 5-11 YR	CLMD	217.10
EST PT PREV EXAM/12-17 YR	CLMD	234.95
EST PT PREV EXAM/18-39 YR	CLMD	316.20
EST PT PREV EXAM/40-64 YR	CLMD	358.70
EST PT PREV EXAM/65 & OVR	CLMD	393.00
EVAC SUBUNGUAL HEMATOMA	CLMD	85.10
EX BEN SCP/NK/HD/FT <.5CM	CLMD	240.70
EX BEN SCP/NK/HD/FT 1.1-2	CLMD	390.55
EX BEN SCP/NK/HD/FT0.6-1.	CLMD	378.75
EX BN L/FCE/MU MEM 1.1-2	CLMD	464.85
EX BN LS FCE/MUC MEM <0.5	CLMD	352.80
EX BN LS/FCE/MU MEM 2.1-3	CLMD	586.30
EX BN LS/TRK/ARM/LEG .6-1	CLMD	361.10
EX BN LS/TRK/ARM/LEG >4.0	CLMD	623.00
EX BN LS/TRK/ARM/LG <0.5C	CLMD	259.60
EX BN LS/TRK/ARM/LG 1.1-2	CLMD	366.90
EX BN LS/TRK/ARM/LG 2.1-3	CLMD	470.90
EX BN LS/TRK/ARM/LG 3.1-4	CLMD	520.30
EX ML LES/FACE 1.1-2CM	CLMD	632.40
EX ML TRK/ARM/LEG 3.1-4CM	CLMD	608.85
EX ML TRK/ARM/LG 1.1-2C	CLMD	501.45
EX ML/SC/NK/HD/FT/GN .6-1	CLMD	483.70
EX NAL/MTRX PRT/CMPL PERM	CLMD	394.10
EXC MLG LES FACE 2.1-3CM	CLMD	778.65
EXPL PENTRT WND EXTREMITY	CLMD	1,025.20
FOLLOW-UP GLOBAL SVC	CLMD	0.00
HSP ADM/DIS SAME DAY/LOW	CLMD	351.60
HSP CARE INI/COMPREHN/CPX	CLMD	411.80
HSP CARE INI/COMPREHN/MOD	CLMD	335.10
HSP CARE INI/DETAILED/LOW	CLMD	249.00
HSP CARE SUBQ/DETAILED/HI	CLMD	241.90
HSP CARE SUBQ/EXPNDED/MOD	CLMD	178.20
HSP CARE SUBQ/FOCUSED/LOW	CLMD	125.20
HSP DISCHARG MGMT/MD/<30	CLMD	211.30
HSP DISCHARG MGMT/MD/>31	CLMD	264.30
HSP OBS SUBSEQ MOD	CLMD	142.80
HSP OBSRV DSCRG DIFF DAY	CLMD	160.55
HSP OBSRV H&P LOW CMPLX	CLMD	200.60
HSP OBSRV H&P MOD CMPLX	CLMD	272.60
I&D ABCS VULVA/PERINEAL	CLMD	378.75
I&D ABSCESS SIMPLE/SINGLE	CLMD	259.60
I&D ABSCESS;CMPLCTD/MULTP	CLMD	468.30
INC/REM FB SUBCUT TISSUE	CLMD	361.10
INCISIONAL BX SKIN EA ADDL	CLMD	193.20
INCISIONAL BX SKIN SINGLE LES	CLMD	403.20
INCS THROMBOSED HEMOR EXT	CLMD	493.90
INJ TEND SHTH/LIG/APNEURO	CLMD	263.20
INJ TRIG PNT 1 OR 2 MUSCL	CLMD	263.20
INJ TRIG PNT 3+ MUS GRP	CLMD	263.20
IUD INSERTION	CLMD	199.50
MCARE 1ST YEARLY WELLNESS	CLMD	393.00
MCARE EA AD YEARLY EXAM	CLMD	414.55
MCARE INT IST 12 MONTH	CLMD	284.35
Medicare RHC AIR	CLMD	0.00
NP INT PREV EXAM 12-17 YR	CLMD	331.55
NP INT PREV EXAM 18-39 YR	CLMD	381.20
NP INT PREV EXAM 40-64 YR	CLMD	431.90
NP INT PREV EXAM 5-11 YRS	CLMD	302.10
NP INT PREV EXAM 65 & OVR	CLMD	421.20
NP INT PREV EXAM/UNDR 1 YR	CLMD	307.70
NP INT PREVENT EXAM 1-4YR	CLMD	246.65
OBSRV H&P HIGH CMPLX	CLMD	341.05
PARING/CUT BEN LESION SGL	CLMD	63.75
PHLEBOTOMY THERAPEUTIC	CLMD	90.90
PRE-EMPLOYMENT PHYSICAL CONTRACTED	CLMD	157.50
PROC UNLT/SKN/MU ME/SQ TS	CLMD	226.60
PUNCH BX SKIN EA ADDL	CLMD	163.80
PUNCH BX SKIN SINGLE LES	CLMD	332.90
PUNCT/ASP ABCS/HEM/BUL/CY	CLMD	291.10
REM FB CORNEAL WO SL	CLMD	613.50
REM FB EAR CABAK WO/ANEST	CLMD	279.30
REM FB EYE CON/SBCN EMBED	CLMD	520.30
REM IMPAC CERUM/UNL/BILAT	CLMD	128.70
REM IUD	CLMD	409.40
REM SHORT ARM/LEG CAST	CLMD	188.80
REM SKN TGS MULT FIBR 15<	CLMD	167.60
REMOV IMPACTED EAR WAX IRRIGATION UNILAT	CLMD	39.10
REP SC/TRK/AX/NK/E2.6-7.5	CLMD	494.40
REP SC/TRK/AX/NK/EX <2.5	CLMD	409.40
REP WND FCE/MU 2.6-5.0 CM	CLMD	457.80
REP WND FCE/MUC 2.5<	CLMD	410.60
SHV EP/DM FC/MUC 0.6-1	CLMD	240.70
SHV EP/DM FC/MUC MEM <0.5	CLMD	158.15
SHV EP/DM LS/TR/AR/LG<0.5	CLMD	176.40
SHV EP/DM SC/NK/HD/FT<0.5	CLMD	138.10
Single tendon origin/insertion	CLMD	263.40
SKIN FULL GRFT FACE/GEN/HF PRO FEE	CLMD	2,175.60
SNF ANNUAL ASSESSMENT	CLMD	161.65
SNF DISCHARG MGMNT <30MIN	CLMD	152.30
SNF DISCHARG MGMNT >30MIN	CLMD	190.00
SNF E/M H&E SUBQ DETAILED	CLMD	161.65
SNF E/M H&E SUBQ LOW	CLMD	81.50
SNF E/M H&E SUBQ MODER	CLMD	110.95
SNF E/M INITIAL HI CMPLX	CLMD	249.00
SNF E/M INITIAL LOW CMPLX	CLMD	146.30
SNF E/M INITIAL MOD CMPLX	CLMD	205.35
SNF SUBSEQUENT HI CMPLX	CLMD	219.60
TANGNTL BX SKIN EA ADDL	CLMD	142.80
TANGNTL BX SKIN SINGLE LES	CLMD	264.60
THORACENTESIS W/ IMAGING GUIDANCE	CLMD	802.20
THORACENTESIS W/O IMAGING GUIDANCE	CLMD	703.20
TRIM NONDYSTROPHIC NAILS	CLMD	57.90
TYMPANOMETRY	CLMD	61.45
WEDGE EXCISION SKN/NAL FO	CLMD	168.90
WELCOME TO MEDICARE EXAM	CLMD	485.00
CT ABD &/OR PELV W W/O CONTRAST	CT	3,024.00
CT ABD PELV W/CONTRAST	CT	1,890.00
CT ABD PELV W/O CONTRAST	CT	1,890.00
CT ABDOMEN W W/O CONTRAST	CT	1,890.00
CT ABDOMEN W/CONTRAST	CT	1,890.00
CT ABDOMEN W/O CONTRAST	CT	850.50
CT ANGIO ABD ARTERIES	CT	1,890.00
CT ANGIO ABD/PELV W W/O CONTRAST	CT	1,890.00
CT ANGIO CHEST	CT	1,890.00
CT ANGIO HEAD	CT	1,890.00
CT ANGIO NECK	CT	1,890.00
CT BODY 3D ADDL	CT	0.00
CT BONE DENSITY PERIPHERAL	CT	472.50
CT C-SPINE W W/O CONTRAST	CT	3,024.00
CT C-SPINE W/CONTRAST	CT	1,974.00
CT C-SPINE W/O CONTRAST	CT	850.50
CT EYE/EAR/FOSSA W W/O CONTRAST	CT	1,890.00
CT EYE/EAR/FOSSA W/CONTRAST	CT	1,890.00
CT EYE/EAR/FOSSA W/O CONTRAST	CT	850.50
CT GUIDE NEEDLE PLACE	CT	0.00
CT HEAD W W/O CONTRAST	CT	1,890.00
CT HEAD W/CONTRAST	CT	1,890.00
CT HEAD W/O CONTRAST	CT	850.50
CT HEAD/NECK 3D ADDL	CT	0.00
CT HEART W/O CONTRAST W/CA TEST	CT	472.50
CT L-SPINE W W/O CONTRAST	CT	3,024.00
CT L-SPINE W/CONTRAST	CT	1,890.00
CT L-SPINE W/O CONTRAST	CT	850.50
CT LOW DOSE CANCER SCREEN	CT	472.50
CT LOWER EXT W W/O CONTRAST	CT	1,890.00
CT LOWER EXT W/O CONTRAST	CT	850.50
CT LOWER EXTREM W/CONT	CT	1,890.00
CT LTD F/U HEAD/NECK	CT	472.50
CT LTD F/U OTHR THAN HEAD/NECK	CT	472.50
CT MAXILLOFACIAL W W/O CONT	CT	1,890.00
CT MAXILLOFACIAL W/CONTRAST	CT	1,890.00
CT MAXILLOFACIAL W/O CONTRAST	CT	850.50
CT PELVIS W W/O CONTRAST	CT	1,890.00
CT PELVIS W/CONTRAST	CT	1,890.00
CT PELVIS W/O CONTRAST	CT	850.50
CT SINUS W W/O CONTRAST	CT	1,890.00
CT SINUS W/CONTRAST	CT	1,890.00
CT SINUS W/O CONTRAST	CT	850.50
CT SOFT TISS NECK W W/O CONTRAST	CT	1,890.00
CT SOFT TISS NECK W/CONTRAST	CT	1,890.00
CT SOFT TISS NECK W/O CONTRAST	CT	850.50
CT T-SPINE W W/O CONTRAST	CT	1,890.00
CT T-SPINE W/CONTRAST	CT	1,890.00
CT T-SPINE W/O CONTRAST	CT	850.50
CT THORAX W W/O CONTRAST	CT	1,890.00
CT THORAX W/CONTRAST	CT	1,890.00
CT THORAX W/O CONTRAST	CT	850.50
CT UPPER EXT W W/O CONTRAST	CT	1,890.00
CT UPPER EXT W/CONTRAST	CT	1,890.00
CT UPPER EXT W/O CONTRAST	CT	850.50
CT ABD &/OR PELV W W/O CONTRAST PRO FEE	CTMD	939.80
CT ABD PELV W/CONTRAST PRO FEE	CTMD	826.90
CT ABD PELV W/O CONTRAST PRO FEE	CTMD	535.50
CT ABDOMEN W W/O CONTRAST PRO FEE	CTMD	698.30
CT ABDOMEN W/CONTRAST PRO FEE	CTMD	614.30
CT ABDOMEN W/O CONTRAST PRO FEE	CTMD	399.00
CT ANGIO ABD ARTERIES PRO FEE	CTMD	1,015.90
CT ANGIO ABD/PELV W W/O CONTRAST PRO FEE	CTMD	1,034.30
CT ANGIO CHEST PRO FEE	CTMD	798.00
CT ANGIO HEAD PRO FEE	CTMD	779.65
CT ANGIO NECK PRO FEE	CTMD	777.00
CT BONE DENSITY PERIPHERAL PRO FEE	CTMD	301.90
CT C-SPINE W W/O CONTRAST PRO FEE	CTMD	716.65
CT C-SPINE W/CONTRAST PRO FEE	CTMD	606.50
CT C-SPINE W/O CONTRAST PRO FEE	CTMD	490.90
CT EYE/EAR/FOSSA W W/O CONTRAST PRO FEE	CTMD	798.00
CT EYE/EAR/FOSSA W/CONTRAST PRO FEE	CTMD	732.40
CT EYE/EAR/FOSSA W/O CONTRAST PRO FEE	CTMD	619.50
CT GUIDE NEEDLE PLACE PRO FEE	CTMD	330.80
CT HEAD W W/O CONTRAST PRO FEE	CTMD	511.90
CT HEAD W/CONTRAST PRO FEE	CTMD	431.60
CT HEAD W/O CONTRAST PRO FEE	CTMD	307.15
CT HEAD/NECK 3D ADDL PRO FEE	CTMD	63.00
CT HEART W/O CONTRAST W/CA TEST PRO FEE	CTMD	267.80
CT L-SPINE W W/O CONTRAST PRO FEE	CTMD	716.65
CT L-SPINE W/CONTRAST PRO FEE	CTMD	606.40
CT L-SPINE W/O CONTRAST PRO FEE	CTMD	477.80
CT LOW DOSE CANCER SCREEN PRO FEE	CTMD	672.00
CT LOWER EXT W W/O CONTRAST PRO FEE	CTMD	727.15
CT LOWER EXT W/CONTRAST PRO FEE	CTMD	601.15
CT LOWER EXT W/O CONTRAST PRO FEE	CTMD	480.90
CT LTD F/U HEAD/NECK PRO FEE	CTMD	388.50
CT LTD F/U OTHR THAN HEAD/NECK PRO FEE	CTMD	388.50
CT MAXILLOFACIAL W W/O CONTRAST PRO FEE	CTMD	543.40
CT MAXILLOFACIAL W/CONTRAST PRO FEE	CTMD	446.30
CT MAXILLOFACIAL W/O CONTRAST PRO FEE	CTMD	370.15
CT PELVIS W W/O CONTRAST PRO FEE	CTMD	690.40
CT PELVIS W/CONTRAST PRO FEE	CTMD	601.15
CT PELVIS W/O CONTRAST PRO FEE	CTMD	388.50
CT SINUS W W/O CONTRAST PRO FEE	CTMD	543.40
CT SINUS W/CONTRAST PRO FEE	CTMD	446.30
CT SINUS W/O CONTRAST PRO FEE	CTMD	370.15
CT SOFT TISS NECK W W/O CONTRAST PRO FEE	CTMD	737.65
CT SOFT TISS NECK W/CONTRAST PRO FEE	CTMD	627.40
CT SOFT TISS NECK W/O CONTRAST PRO FEE	CTMD	514.50
CT T-SPINE W W/O CONTRAST PRO FEE	CTMD	721.90
CT T-SPINE W/CONTRAST PRO FEE	CTMD	611.65
CT T-SPINE W/O CONTRAST PRO FEE	CTMD	480.40
CT THORAX W W/O CONTRAST PRO FEE	CTMD	732.40
CT THORAX W/CONTRAST PRO FEE	CTMD	611.65
CT THORAX W/O CONTRAST PRO FEE	CTMD	480.40
CT UPPER EXT W W/O CONTRAST PRO FEE	CTMD	737.65
CT UPPER EXT W/CONTRAST PRO FEE	CTMD	590.65
CT UPPER EXT W/O CONTRAST PRO FEE	CTMD	477.80
ABD PARACENTESIS W/IMAGING	ED	1,560.30
AMPUTATION OF FINGER/THUMB	ED	2,126.85
ANOSCOPY W/REMVL FOREIGN BODY	ED	1,653.80
APPL SPLINT FNGR STATIC	ED	188.80
APPL SPLINT LONG ARM	ED	288.00
APPL SPLINT LONG LEG	ED	584.00
APPL SPLINT SHT ARM STATI	ED	384.70
APPL SPLINT SHT LEG	ED	384.70
ARTERIAL PUNCT DX BLD DRW	ED	98.00
ARTHR/ASP/INJ INT JNT/BRS	ED	616.40
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA	ED	621.70
AVUL NAIL PRTL/COMPLT SING	ED	325.35
BX SKIN SUBQ MUC MEMB 1 LESION	ED	621.70
CARDIOPULMONARY RESUS	ED	855.35
CARDIOVERSION ELECTIVE EX	ED	790.40
CATH INSERT FOLEY SIMPLE	ED	549.85
CATH INSRT BLADDR NONINDW	ED	265.50
CATH INSRT FOLEY COMPLEX	ED	188.80
CD TRT DSL HIP TRAUM W/A	ED	1,792.05
CD TRT DSL IPJNT W/M WO/A	ED	672.40
CD TRT DSL SHLDR W/M W/A	ED	2,732.30
CD TRT DSL SHLDR W/M WO/A	ED	1,025.20
CD TRT FX BIMALLEO WO/M	ED	378.75
CD TRT FX DIS RAD/EP WO/M	ED	577.00
CD TRT FX HUM CONDYL W/MANIP	ED	627.70
CD TRT FX LAT MAL W/M	ED	564.10
CD TRT FX METACARP EA WOM	ED	590.10
CD TRT FX METACP W/M EA	ED	634.05
CD TRT FX NAS BN W/O STBN	ED	2,166.00
CD TRT FX PHLNG SHFT W/M	ED	1,025.20
CD TRT FX PHLNX/NG W/M	ED	672.40
CD TRT FX RADIUS/ULNA	ED	530.90
CD TRT FX SHOULDER DISL W/MANIP	ED	3,022.10
CD TRT FX TOE DISLOC W/O ANESTH	ED	627.70
CD TRT FX TRIMALLEOAR	ED	437.20
CD TRT SUBLX RAD HEAD W/M	ED	678.40
CENTRAL LINE PLACEMENT>5	ED	2,637.90
CHANGE OF BLADDER TUBE	ED	441.00
CL TX FINGER FX W MANIP	ED	436.60
CL TX SCAPULAR FX W/MANIP	ED	3,446.10
CLOSD MOUTH LAC RPR >2.5CM	ED	1,218.40
CLOSED TX ANKLE DISLOC W/O ANES	ED	564.10
CLOSED TX ANKLE FX W/MANIP	ED	2,555.70
CLS TX FEM FX PROX END NECK W/MANIP	ED	1,907.35
CLSD TX CLAVICLE FX W/MANIP	ED	659.40
CLSD TX FX ULNAR STYLOID	ED	550.85
CLSD TX FX ULNAR STYLOID	ED	550.85
CLSD TX PST HIP DISCLOC W/O ANES	ED	551.30
CLSD TX RESET DISLOCATED JAW	ED	591.20
CLSD TX TIBIAL FX W/MANIP	ED	437.20
CLSD TX TOE DISLOC WO ANES	ED	628.45
CLTX PROX FIBULA SHAFT FX W MANIJ PRO FE	ED	3,387.00
CLTX SHLDR DISLOC W MANIP	ED	2,556.55
CLTX TIBIAL FX W/WO MANI SKELETAL TRACJ	ED	6,843.00
CONTROL OF NOSEBLEED	ED	271.35
CONTROL OF NOSEBLEED	ED	381.20
CONTROL THROAT BLEEDING SIMPLE	ED	469.60
CRITICAL CARE IN ED, MARKER CHG	ED	0.00
DEBR ECZEM/INFCT SKN 10%	ED	483.70
DEBR SKN & SUBQ TISSUE	ED	798.70
DEBR SKN/SQ TISSUE/MUSCLE	ED	460.10
DEBR/REM FB SKIN/SQ/MUS/BONE	ED	2,462.10
DESTRUCTION B9 LESION UP TO 14	ED	422.05
DRAIINAGE OF MOUTH LESION, SIMPLE	ED	672.40
DRAIN BLADDER BY NEEDLE	ED	1,484.70
DRAIN EXTERNAL EAR LESION	ED	629.65
DRAIN OUTER EAR CANAL LESION	ED	629.65
DRAIN/INJ JOINT/BURSA W ULTRASOUND GUIDE	ED	657.10
DRAINAGE ABCESS FINGER SIMPLE	ED	764.15
DRAINAGE EYELID ABSCESS	ED	710.90
DRAINAGE OF ARM BURSA	ED	3,538.50
DRAINAGE OF GUM LESION	ED	618.20
DRESS/DEBRID BURN W/O ANESTH	ED	241.90
DRESS/DEBRID PT-THICK BURN LG	ED	652.10
DRIANAGE OF GLAND ABCESS	ED	412.90
DRS/DBD BURN W/O ANS SML	ED	346.90
DX LARYNGOSCOPY EXCL NB	ED	2,667.00
ECG-1-3 LEAD TRACING ONLY	ED	96.80
ECG-12 LEADS TRACING ONLY	ED	689.00
ED NURSE ONLY - NO CHG	ED	0.00
ED VISIT CC SVCS ADL 30MN	ED	853.00
ED VISIT LEVEL 1	ED	369.45
ED VISIT LEVEL 2	ED	1,160.85
ED VISIT LEVEL 3	ED	2,170.60
ED VISIT LEVEL 4	ED	3,159.25
ED VISIT LEVEL 5	ED	5,720.35
ED VISIT LEVEL 6 CC SVCS	ED	9,908.30
EVAC SUBUNGUAL HEMATOMA	ED	171.20
EXC B9 LESION MRGN S,N,H,F,G 2.1-3 PR F	ED	2,888.60
EXC BEN LES INC MAR HEAD/FT/GENIT <.5CM	ED	882.00
EXC TR EXT B9+MARG 1.1-2 CM	ED	1,131.90
EXCISION OLECRANON BURSA	ED	6,884.90
EXPL PENETRATING WOUND ABD/BACK	ED	3,934.95
EXPLOR PENETRATING WOUND EXTREMITY	ED	1,188.50
FRACTURE TREATMENT IN ED, MARKER CHG	ED	0.00
GLUCOSE BY REAGENT STRIP	ED	26.05
I&D ABCESS PERITONSILLAR	ED	442.50
I&D ABSCESS SIMPLE/SINGLE	ED	384.70
I&D ABSCESS/CYST COMPLEX	ED	482.60
I&D DEEP ABSC BURSA THIGH/KNEE	ED	6,242.30
I&D HEMAT/SEROMA/FLD	ED	1,541.90
I&D PILONIDAL CYST SIMPLE	ED	716.40
I&D PILONIDAL CYST SIMPLE	ED	716.40
I&D VULVA/PERINEAL ABSCESS	ED	415.75
IMMUN ADMIN ADDL EA COMBO	ED	63.75
INC/REM FB SUBCUT COMPLEX	ED	1,810.90
INC/REM FB SUBCUT SIMPLE	ED	500.20
INCISION ANAL ABCESS	ED	950.95
INCISIONAL BX SKIN EA ADDL	ED	436.80
INCISIONAL BX SKIN SINGLE LES	ED	824.30
INCS THROMBOSED HEMOR EXT	ED	567.90
INFUSION 2ND LINE <1 HR	ED	144.00
INFUSION CONCURRENT LINE >1 HR	ED	249.85
INFUSION HYDRATION < 1 HR	ED	1,330.80
INFUSION HYDRATION > 1 HR	ED	685.45
INFUSION THER/DX <1 HOUR	ED	614.70
INFUSION THER/DX 1-8HR EA	ED	451.90
INJ THER-PROP-DX SQ-IM	ED	230.10
INJ TRIG PNT 1 OR 2 MUSCL	ED	660.70
INJ/ANES OTHR PERIPHERAL	ED	614.20
INJECT TRIGGER POINTS 3+ MUSCLES	ED	614.20
INS NON-TUNNEL CATH VENOUS <5Y	ED	2,870.70
INSERT PICC CATH	ED	2,063.30
INSERT TUNNELED CV CATH	ED	6,506.00
INTRAOSSEOUS NEEDLE PLACE	ED	988.65
INTUBATE ET EMERGENT	ED	2,208.50
IV PLC OF NDL W/CAP ONLY	ED	207.75
IV PUSH ADDL-NEW DRUG	ED	221.90
IV PUSH ADDL-SAME DRUG	ED	204.25
IV PUSH SINGLE-INIT DRUG	ED	285.70
IV PUSH/INF/HYDRATION IN ED, MARKER CHG	ED	0.00
LACERATION REPAIR IN ED, MARKER CHG	ED	0.00
LAV PERITON/ABD PARA INTL	ED	1,998.20
LAY CLS FC/MUC 736-12.5 CM	ED	404.85
LAY CLS FC/MUC<2.5CM	ED	525.10
LAY CLS FC/MUC2.6-5.0CM	ED	525.10
LAY CLS FC/MUC20.1-30 CM	ED	525.10
LAY CLS FC/MUC5.1-7.5 CM	ED	634.05
LAY CLS NK/HND/FT<2.5CM	ED	525.10
LAY CLS NK/HND/FT2.6-7.5CM	ED	606.10
LAY CLS TK/EXT <2.5 CM	ED	618.20
LAY CLS TK/EXT 12.6-20 CM	ED	577.70
LAY CLS TK/EXT 2.6-7.5 CM	ED	618.20
LAY CLS TK/EXT 7.6-12.5CM	ED	617.10
LEG SURGERY PROCEDURE	ED	524.55
MOD SED SAME PHYS >5 YRS 1st 30M	ED	220.50
MOD SED SAME PHYS>5 YRS EA ADDL 15M	ED	110.30
NERVE BLOCK INJ OCCIPITAL	ED	657.10
NERVE BLOCK INJ OCCIPITAL	ED	657.10
NERVE BLOCK INJ TRIGEMINAL	ED	621.70
NG TUBE INSERTION	ED	1,177.40
O2 SAT MEAS SNGL READ	ED	56.70
OCCULT BLOOD FECES	ED	82.60
OPN TRT FX DIST PHLNG EA	ED	3,519.10
PEAK FLOW MEASURE	ED	113.35
PHLEBOTOMY THERAPUETIC	ED	90.90
POS AIRWAY PRESSURE CPAP	ED	488.30
PREGNANCY TEST	ED	79.10
PUNCH BX SKIN EA ADDL	ED	245.70
PUNCH BX SKIN SINGLE LES	ED	463.10
PUNCT/ASP ABCS/HEM/BUL/CY	ED	190.00
RAPID STREP SCREEN	ED	109.85
REM FB CORNEAL WO/SLITLMP	ED	564.00
REM FB EAR CABAK WO/ANEST	ED	222.70
REM FB EYE EXT CNJT SUPER	ED	275.75
REM FB INTRANASAL	ED	275.75
REM IMPACT CERUMEN UN/BIL	ED	118.10
REM OF FOREIGN BODY FR PHARYNX	ED	866.30
REMOV FB EYE CORNEA W SLIT LAMP	ED	726.70
REMOVAL OF NAIL BED	ED	672.40
REMOVAL OF SKIN TAGS	ED	324.15
REMOVE FOREARM FB	ED	3,189.90
REMOVE IMPACTED EAR WAX UNI	ED	161.65
REP CMLX FC/HND/GN AD<5CM	ED	593.30
REP CMLX FC/HND/GN1.1-2.5	ED	652.10
REP CMLX FC/HND/GN2.6-7.5	ED	593.30
REP LAC FAC/MUC <2.5CM	ED	623.00
REP LAC FAC/MUC 5.1-7.5CM	ED	344.60
REP LAC FAC/MUC 7.6-12.5C	ED	525.10
REP LAC SCP/NK 7.6-12.5CM	ED	525.10
REP LAC SCP/NK/TNK <2.5CM	ED	870.70
REP LAC SCP/NK/TNK2.5-7.5	ED	965.10
REP LAC SIMPLE 12.6-20 CM	ED	884.80
REP LAC SIMPLE 20.1-30 CM	ED	793.80
REPAIR COMPLEX TRUNK 2.6-7.5 CM	ED	1,281.55
REPAIR COMPX SCALP/ARM/LEG 2.6-7.5CM	ED	923.80
REPAIR FINGER TENDON	ED	2,831.20
REPAIR LAC TONGUE FLOOR MOUTH >2.6CM	ED	1,898.50
REPAIR NAIL BED EA	ED	1,181.90
REPAIR OF VAGINA	ED	4,771.20
REPAIR SIMPLE F/E/E/N/L 2.6-5CM	ED	354.00
REPAIR TONGUE LACERATION <2.5CM	ED	251.40
REPR INTERM SCALP/AX/TRNK/EXT	ED	1,267.40
RMVL DEVITAL TIS 20CM<	ED	1,021.70
RN AMBULANCE ESCORT/HOUR	ED	127.50
RPLC GASTRO TUBE NO REV/GUID	ED	608.00
RPR WOUND, LESION EA ADDL <5CM	ED	906.30
SHV EP/DM LS/TR/AR/LG<0.5	ED	321.95
SHV EP/DM LS/TR/AR/LG<0.5	ED	321.95
SPINAL PUNCT LUMBAR DX	ED	1,298.75
SVN INITIAL TREATMENT	ED	343.40
SVN SUBSEQUENT (EA)	ED	259.60
TANGNTL BX SKIN EA ADDL	ED	245.70
TANGNTL BX SKIN SINGLE LES (SHV,SCOOP)	ED	463.10
THORACENTESIS	ED	1,669.30
THORACENTESIS PUNCT ASPIR	ED	569.90
THORACENTESIS W/IMAGING GUIDANCE	ED	1,286.30
THOROCOSTOMY TUBE PLACED	ED	953.80
THROAT SURGERY PROCEDURE UNSPEC	ED	824.30
THROMBOLYSIS TX CORONARY	ED	497.90
TRANSFUSE BLOOD/BLD PROD	ED	2,131.70
TREAT LOWER LEG FRACTURE	ED	3,022.10
TREAT WRIST BONE FX	ED	2,555.70
TREAT WRIST BONE FX	ED	2,555.70
TX BIG TOE FRACTURE	ED	2,561.00
TX CLOSED HEEL FX	ED	564.10
TX FX RADIUS & ULNA	ED	1,461.60
UA DIP WO/MICRO	ED	28.40
UPPER ARM ELBOW SURG UNLISTED	ED	567.00
VAGINAL DELIVERY ONLY	ED	979.00
VENIPUNCTURE, ED	ED	40.20
ABD PARACENTESIS W/IMAGING PRO FEE	EDMD	296.10
AMPUTATION OF FINGER/THUMB PRO FEE	EDMD	1,820.10
ANOSCOPY W/REMVL FOREIGN BODY PRO FEE	EDMD	231.55
APPL CAST LONG ARM	EDMD	230.10
APPL CAST SHT LEG	EDMD	221.90
APPL SPLINT FNGR STATIC	EDMD	113.35
APPL SPLINT LONG ARM	EDMD	200.60
APPL SPLINT LONG LEG	EDMD	256.05
APPL SPLINT SHT ARM DYNAM	EDMD	249.00
APPL SPLINT SHT ARM STATI	EDMD	171.20
APPL SPLINT SHT LEG	EDMD	166.40
ARTERIAL CATH PERCUTANEOU	EDMD	154.60
ARTHR/ASP/INJ INT JNT/BRS	EDMD	223.10
ARTHR/ASP/INJ MJR JNT/BRS	EDMD	205.35
ARTHR/ASP/INJ SM JNT/BRS	EDMD	195.95
AVUL NAIL PRTL/CMPLT SING	EDMD	185.20
BX SKN/SQ/MUC MEMB SINGLE	EDMD	226.60
CARDIOPULMONARY RESUS	EDMD	619.40
CARDIOVERSION ELECTIVE EX	EDMD	471.90
CAST REM FULL ARM/LEG	EDMD	178.20
CD TRT DSL ELBOW W/A	EDMD	1,710.60
CD TRT DSL ELBOW WO/A	EDMD	1,087.75
CD TRT DSL HIP TRAUM W/A	EDMD	1,984.30
CD TRT DSL IPJNT W/M WO/A	EDMD	722.05
CD TRT DSL PATELLAR WO/A	EDMD	948.50
CD TRT DSL PATTELLAR W/A	EDMD	1,254.10
CD TRT DSL SHLDR W/M W/A	EDMD	1,217.55
CD TRT DSL SHLDR W/M WO/A	EDMD	752.70
CD TRT FX BIMALLEO WO/M	EDMD	1,597.30
CD TRT FX CLAVIC W/O MAN	EDMD	573.40
CD TRT FX DIS RAD/EP W/M	EDMD	1,559.60
CD TRT FX DIS RAD/EP WO/M	EDMD	847.10
CD TRT FX DIST PHLNG WO/M	EDMD	923.80
CD TRT FX HUM CONDYLAR W/MANIP	EDMD	1,527.80
CD TRT FX HUM SHFT WO/M	EDMD	848.30
CD TRT FX HUM/PROX W/MAN	EDMD	1,362.60
CD TRT FX LAT MAL W/M PRO FEE	EDMD	1,477.05
CD TRT FX LAT MAL WO/M	EDMD	825.90
CD TRT FX MED MALLOS WO/M	EDMD	849.40
CD TRT FX METACARP EA WOM PRO FEE	EDMD	750.80
CD TRT FX METACP W/M EA PRO FEE	EDMD	1,000.45
CD TRT FX NAS BN W/O STBN	EDMD	559.25
CD TRT FX PHL SHFT WOM EA	EDMD	450.70
CD TRT FX PHLNG SHFT W/M	EDMD	1,000.45
CD TRT FX PHLNX/NG W/M	EDMD	408.30
CD TRT FX RAD SHFT WO/M	EDMD	1,425.10
CD TRT FX RADIUS/ULNA	EDMD	1,545.40
CD TRT FX SHOULDER DISL W/MANIP PRO FEE	EDMD	1,397.00
CD TRT FX TIB SHFT WO/M	EDMD	946.20
CD TRT FX TOE DISLOC W/O ANESTH	EDMD	330.35
CD TRT FX TRIMALLEOAR W/M PRO FEE	EDMD	1,742.40
CD TRT SUBLX RAD HEAD W/M	EDMD	350.40
CD TX DISTAL FINGER FX PRO FEE	EDMD	735.00
CENTRAL LINE PLCMT > 5 YR	EDMD	707.80
CHANGE OF BLADDER TUBE PRO FEE	EDMD	146.75
CHEMODENERVATE MUSC MIGRAIN	EDMD	339.20
CL TX FINGER FX W MANIP PRO FEE	EDMD	1,283.30
CL TX SCAPULAR FX W/MANIP PRO FEE	EDMD	1,022.70
CLOSD MOUTH LAC RPR >2.5CM PRO FEE	EDMD	650.50
CLOSED TX ANKLE DISLOC W/O ANES PRO FEE	EDMD	1,003.60
CLOSED TX ANKLE FX W/MANIP PRO FEE	EDMD	693.55
CLS TX FEM FX PROX END NECK W/MANIP PRO	EDMD	2,136.65
CLSD TX CLAVICLE FX W/MANIP PRO FEE	EDMD	1,135.10
CLSD TX FX ULNAR STYLOID PRO FEE	EDMD	842.30
CLSD TX PST HIP DISCLOC W/O ANES PRO FEE	EDMD	1,125.80
CLSD TX RESET DISLOCATED JAW PRO FEE	EDMD	86.10
CLSD TX TIBIAL FX W/MANIP PRO FEE	EDMD	1,807.10
CLSD TX TOE DISLOC WO ANES PRO FEE	EDMD	360.60
CLTX PROX FIBULA SHAFT FX W MANIJ	EDMD	1,034.00
CLTX SHLDR DISLOC W MANIP PRO FEE	EDMD	1,063.70
CLTX TIBIAL FX W/WO MANI SKEL TRAC PR FE	EDMD	1,500.00
CONTROL THROAT BLEEDING SIMPLE	EDMD	749.20
CTL HEMORR NAS POST PACKS	EDMD	613.50
CTL HEMORRAGE NASAL ANTER	EDMD	271.35
CTL HEMORRHAGIC NASAL POSTERIOR	EDMD	394.10
DEBR ECZEM/INFCT SKN 10%	EDMD	109.85
DEBR SKN & SUBQ TISSUE	EDMD	219.60
DEBR/REM FB SKIN/SQ/MUS/BONE	EDMD	1,490.10
DESTRUCTION B9 LESION UP TO 14 PRO FEE	EDMD	310.65
DRAIINAGE OF MOUTH LESION, SIMPLE	EDMD	407.10
DRAIN BLADDER BY NEEDLE PRO FEE	EDMD	105.85
DRAIN EXTERNAL EAR LESION	EDMD	562.75
DRAIN OUTER EAR CANAL LESION PRO FEE	EDMD	619.50
DRAIN/INJ JOINT/BURSA W ULTRASOUND GUIDE	EDMD	185.20
DRAINAGE ABCESS FINGER SIMPLE PRO FEE	EDMD	402.30
DRAINAGE EYELID ABSCESS PRO FEE	EDMD	310.80
DRAINAGE OF ARM BURSA PRO FEE	EDMD	433.70
DRAINAGE OF GLAND ABCESS	EDMD	273.80
DRAINAGE OF GUM LESION	EDMD	526.30
DRESS/DEBRID BURN W/O ANESTH	EDMD	477.90
DRESS/DEBRID PT-THICK BURN LG PRO FEE	EDMD	441.00
DRS/DED BURN W/O ANS SML	EDMD	252.60
DX LARYNGOSCOPY EXCL NB PRO FEE	EDMD	542.35
ECG-12 LEAD INTP REPORT ONLY	EDMD	66.20
ED CC SVCS 30-74 MIN	EDMD	733.85
ED CC SVCS ADDL 30 MIN ++	EDMD	366.90
ED MD EMS DIRECTED ALS	EDMD	459.00
ED VISIT COMPREHENSIVE	EDMD	736.20
ED VISIT DETAILED	EDMD	494.40
ED VISIT EXPANDED	EDMD	220.60
ED VISIT EXPANDED/MODER	EDMD	330.35
ED VISIT PROBLEM FOCUSED	EDMD	162.90
EVAC SUBUNGUAL HEMATOMA	EDMD	85.10
EX BN LS/TRK/ARM/LG 3.1-4	EDMD	520.30
EXC B9 LESION MRGN S,N,H,F,G 2.1-3	EDMD	423.85
EXC BEN LES HEAD/FT/GENIT <.5CM PRO FEE	EDMD	224.90
EXC TR EXT B9+MARG 1.1-2 CM PRO FEE	EDMD	443.10
EXCISION OLECRANON BURSA PRO FEE	EDMD	957.40
EXPL PENETRATING WOUND ABD/BACK PRO FEE	EDMD	1,370.05
EXPLOR PENETRATING WOUND EXTRMTY PRO FEE	EDMD	991.30
HSP CARE INITIAL / HIGH	EDMD	411.80
HSP CARE INITIAL / MODERATE	EDMD	335.10
HSP CARE INITIAL LOW	EDMD	249.00
HSP CARE SUBQ / HIGH	EDMD	241.90
HSP CARE SUBQ/EXPNDED/MOD	EDMD	178.20
HSP CARE SUBQ/FOCUSED/LOW	EDMD	125.20
HSP DISCHARG MGMT/MD/<30	EDMD	211.30
HSP DISCHARG MGMT/MD/>31	EDMD	264.30
I&D ABCESS PERITONSILLAR	EDMD	514.45
I&D ABSCESS SIMPLE/SINGLE	EDMD	270.30
I&D ABSCESS/CYST COMPLEX	EDMD	541.60
I&D DEEP ABSC BURSA THIGH/KNEE PRO FEE	EDMD	1,371.30
I&D HEMAT/SEROMA/FLD	EDMD	446.00
I&D PILONIDAL CYST SIMPLE PRO FEE	EDMD	413.30
I&D VULVA/PERINEAL ABSCESS PRO FEE	EDMD	371.65
INC/REM FB SUBCUT COMPLEX	EDMD	825.90
INC/REM FB SUBCUT SIMPLE	EDMD	381.20
INCISION ANAL ABCESS PRO FEE	EDMD	494.35
INCISIONAL BX SKIN EA ADDL PRO FEE	EDMD	88.20
INCISIONAL BX SKIN SINGLE LES PRO FEE	EDMD	164.90
INCS THROMBOSED HEMOR EXT PRO FEE	EDMD	301.10
INJ TEND SHTH/LIG/APNEURO	EDMD	263.20
INJ TRIG PNT 1 OR 2 MUSCL	EDMD	263.20
INJ/ANES OTHR PERIPHERAL PRO FEE	EDMD	291.45
INJECT TRIGGER POINTS 3+ MUSCLES PRO FEE	EDMD	178.60
INJECTION THERAPEUTIC	EDMD	139.30
INS NON-TUNNEL CATH VENOUS <5Y PRO FEE	EDMD	233.10
INSERT PICC CATH PRO FEE	EDMD	232.50
INSERT TUNNELED CV CATH PRO FEE	EDMD	755.30
INTL TRMT 1DEG BURN/LOCAL	EDMD	188.80
INTRAOSSEOUS NEEDLE PLACE	EDMD	440.20
INTUBATE ET EMERGENT	EDMD	422.50
LAV PERITON/ABD PARA INTL	EDMD	407.10
LAY CLS FC/MUC 7.6-12.5 CM	EDMD	1,037.05
LAY CLS FC/MUC<2.5 CM	EDMD	588.75
LAY CLS FC/MUC2.6-5.0 CM	EDMD	552.15
LAY CLS FC/MUC5.1-7.5 CM PRO FEE	EDMD	650.10
LAY CLS NK/HND/FT<2.5 CM	EDMD	495.50
LAY CLS NK/HND/FT2.6-7.5C	EDMD	588.75
LAY CLS NK/HND/FT7.6-12.5	EDMD	656.10
LAY CLS TK/EXT <2.5 CM	EDMD	447.20
LAY CLS TK/EXT 12.6-20 CM PRO FEE	EDMD	821.50
LAY CLS TK/EXT 2.6-7.5 CM	EDMD	575.80
LAY CLS TK/EXT 7.6-12.5CM	EDMD	648.85
LEG SURGERY PROCEDURE PRO FEE	EDMD	367.50
MEDICAL SCREENING EXAM	EDMD	70.80
MOD SED SAME PHYS <5 YRS	EDMD	181.70
MOD SED SAME PHYS >5 YRS 1st 30M PRO FEE	EDMD	151.15
MOD SED SAME PHYS>5 YR EA AD 15M PRO FE	EDMD	76.20
NERVE BLOCK INJ OCCIPITAL	EDMD	191.20
NERVE BLOCK INJ TRIGEMINAL	EDMD	216.00
NERVE BLOCK INJECTION FACIAL	EDMD	547.40
NG TUBE INSERTION	EDMD	346.90
OBS/ HSP ADM/DIS SAME DAY HIGH	EDMD	535.60
OBS/ HSP ADM/DIS SAME DAY HIGH	EDMD	535.60
OBS/ HSP ADM/DIS SAME DAY LOW	EDMD	351.60
OBS/ HSP ADM/DIS SAME DAY MOD	EDMD	477.90
OBS/ HSP ADM/DIS SAME DAY MOD	EDMD	477.90
OBSERV DISCH DIFF DAY	EDMD	160.55
OBSERVATION SUBS HIGH	EDMD	247.75
OBSERVATION SUBS HIGH	EDMD	247.75
OBSERVATION SUBS LOW	EDMD	109.85
OBSERVATION SUBS LOW	EDMD	109.85
OBSERVATION SUBS MODERATE	EDMD	167.60
OBSRV H&P HIGH CMPLX	EDMD	341.05
OBSRV H&P LOW CMPLX	EDMD	200.60
OBSRV H&P MOD CMPLX	EDMD	272.60
OPN TRT FX DIST PHLNG EA	EDMD	1,136.20
PARTIAL AMPUTATION OF TOE	EDMD	1,714.20
PESSARY	EDMD	178.20
PUNCH BX SKIN EA ADDL PRO FEE	EDMD	73.50
PUNCH BX SKIN SINGLE LES PRO FEE	EDMD	135.50
PUNCT/ASP ABCS/HEM/BUL/CY	EDMD	326.80
REM FB CORNEAL WO/SLITLMP	EDMD	284.35
REM FB EAR CABAK WO/ANEST PRO FEE	EDMD	326.80
REM FB EYE EXT CNJT SUPER	EDMD	244.25
REM FB EYE EXT CONJ EMBED	EDMD	264.30
REM FB INTRANASAL PRO FEE	EDMD	368.15
REM IMPACT CERUMEN UN/BIL PRO FEE	EDMD	128.70
REM OF FOREIGN BODY FR PHARYNX PRO FEE	EDMD	329.80
REMOV FB EYE CORNEA W SLIT LAMP PRO FEE	EDMD	163.20
REMOVAL OF NAIL BED PRO FEE	EDMD	471.90
REMOVAL OF SKIN TAGS	EDMD	206.30
REMOVE FOREARM FB PRO FEE	EDMD	1,110.90
REMOVE IMPACTED EAR WAX UNI	EDMD	39.10
REP CMLX FC/HND/GN AD<5CM PRO FEE	EDMD	349.30
REP CMLX FC/HND/GN1.1-2.5 PRO FEE	EDMD	689.00
REP CMLX FC/HND/GN2.6-7.5 PRO FEE	EDMD	1,068.90
REP CMLX LD/N/E/L1.1-2.5	EDMD	867.15
REP CMLX LD/N/E/L2.6-7.5	EDMD	1,692.90
REP CMLX SCLP/LIMB2.6-7.5	EDMD	904.85
REP LAC FAC/MUC <2.5CM	EDMD	494.40
REP LAC FAC/MUC 2.6-5.0CM	EDMD	579.30
REP LAC FAC/MUC 5.1-7.5CM	EDMD	538.00
REP LAC FAC/MUC 7.6-12.5C PRO FEE	EDMD	749.20
REP LAC SCP/NK 7.6-12.5CM	EDMD	612.40
REP LAC SCP/NK/TNK <2.5CM	EDMD	409.40
REP LAC SCP/NK/TNK2.5-7.5	EDMD	494.40
REP LAC SIMPLE 12.6-20 CM	EDMD	646.55
REP LAC SIMPLE 20.1-30 CM PRO FEE	EDMD	674.75
REPAIR COMPLEX TRUNK 2.6-7.5 CM PRO FEE	EDMD	689.90
REPAIR FINGER TENDON	EDMD	1,415.60
REPAIR NAIL BED EA	EDMD	343.40
REPAIR OF VAGINA	EDMD	863.10
REPAIR TONGUE LACERATION <2.5CM PRO FEE	EDMD	920.20
REPR INTERM SCALP/AX/TRNK/EXT PRO FEE	EDMD	761.30
RMVL DEVITAL TIS 20CM<	EDMD	131.00
RPLC GASTRO TUBE NO REV/GUID PRO FEE	EDMD	105.00
RPR LAC TONGUE FLOOR MOUTH >2.6CM PRO FE	EDMD	904.10
RPR WOUND, LESION EA ADDL <5CM PRO FEE	EDMD	402.30
SHV EP/DM LS/TR/AR/LG<0.5 PRO FEE	EDMD	99.25
SPINAL PUNCT LUMBAR DX PRO FEE	EDMD	789.30
TANGNTL BX SKIN EA ADDL PRO FEE	EDMD	62.00
TANGNTL BX SKIN SINGLE LES PRO FEE	EDMD	108.20
THORACENTESIS	EDMD	428.35
THORACENTESIS W/IMAGING GUIDANCE PRO FEE	EDMD	304.50
THORACENTESIS W/O IMAGING GUIDANCE	EDMD	703.20
THOROCOSTOMY TUBE PLACED PRO FEE	EDMD	661.90
THROAT SURGERY PROCEDURE UNSPEC PRO FEE	EDMD	257.30
TREAT LOWER LEG FRACTURE	EDMD	1,397.00
TREAT WRIST BONE FX PRO FEE	EDMD	1,278.40
TX BIG TOE FRACTURE PRO FEE	EDMD	1,085.70
TX CLOSED HEEL FRACTURE PRO FEE	EDMD	960.10
TX FX RADIUS & ULNA PRO FEE	EDMD	1,108.80
UPPER ARM ELBOW SURGERY UNLISTED PRO FEE	EDMD	357.00
VAGINAL DELIVERY ONLY	EDMD	3,883.60
HISTORICAL CHARGES	HIST	0.00
MIGRATION BALANCING ADJUSTMENT	HIST	0.00
MIGRATION DEFAULT	HIST	0.00
17-HYDROXYPREGNENOLONE LEVEL /SO	LAB	73.90
5 HIAA URINE /SO	LAB	41.80
A1C /SO	LAB	185.20
AB CANDIDA /SO	LAB	38.90
AB COXIELLA BURNET II Q FEVER /SO	LAB	39.90
AB CYTOMEGALOVIRUS /SO	LAB	46.60
AB CYTOMEGALOVIRUS IGM /SO	LAB	54.60
AB EPSTEIN BARR NUCLEAR AG /SO	LAB	49.60
AB EPSTEIN-BARR VIRAL CAPSID /SO	LAB	58.80
AB HEP DELTA AGENT /SO	LAB	55.60
AB VIRUS NOT ELSEWHERE CLASSIFIED /SO	LAB	41.75
ACETOMINOPHEN	LAB	390.55
ACTH /SO	LAB	125.20
AFP /SO	LAB	54.35
ALBUMIN	LAB	89.80
ALCOHOL BLOOD	LAB	207.75
ALDOLASE /SO	LAB	31.45
ALDOSTERONE ASSAY /SO	LAB	132.05
ALK PHOS ISOENZYMES /SO	LAB	83.80
ALKALOIDS NOS /SO	LAB	30.70
ALLERGEN IGE, EA ALLERGEN /SO	LAB	16.90
ALLERGEN SPEC IGG QUAN/SEMIQUAN EA /SO	LAB	20.55
ALPHA 1 ANTITRUPSIN /SO	LAB	43.20
ALPHA 1 ANTITRYPSIN PHENOTYPE /SO	LAB	46.90
AMH /SO	LAB	45.30
AMINO ACID ANALYSIS /SO	LAB	54.70
AMMONIA /SO	LAB	214.80
AMMONIA- BLOOD	LAB	214.80
AMYLASE	LAB	186.55
AMYLASE /SO	LAB	186.55
ANA LYZER /SO	LAB	39.20
ANA TITER /SO	LAB	36.20
ANCA SCREEN /SO	LAB	48.80
ANGIOTENSION CONV ENZY/SO	LAB	47.30
ANIBODY FUNGUS /SO	LAB	39.70
Anti human globulin RBC titer	LAB	13.60
ANTI-DNA /SO	LAB	44.50
ANTIBODY COCCIDIOIDES S/O	LAB	33.60
ANTIBODY DETECTION NOS IF /SO	LAB	42.30
ANTIEPILEPTIC LEVEL ETHOSUXIMIDE /SO	LAB	13.00
ANTINUCLEAR ANTIBODY/SO	LAB	39.20
ANTITHROMBIN III ANTIGEN /SO	LAB	35.00
ANTITHROMBIN III PAN /SO	LAB	38.40
APOLIPOPROTEIN A-1 /SO	LAB	55.35
ARSENIC /SO	LAB	61.50
ARTERIAL PUNC/BLOOD WTHDR	LAB	88.60
ASO TITER /SO	LAB	23.65
ASPERGILLUS AG IA S/O	LAB	35.00
Aspergillus antibody screen S/O	LAB	43.90
ASSAY LIPOPROTEIN PLA2 /SO	LAB	122.20
ASSAY OF ANDROSTENEDIONE /SO	LAB	105.40
ASSAY OF CALCITONIN /SO	LAB	86.85
ASSAY OF CALPROTECTIN FECAL /SO	LAB	63.10
ASSAY OF CRYOFIBRINOGEN /SO	LAB	37.10
ASSAY OF CRYOGLOBULIN SEMI QUANT /SO	LAB	20.95
ASSAY OF G6PD ENZYME /SO	LAB	31.35
ASSAY OF GLYCATED PROTEIN /SO	LAB	48.85
ASSAY OF HISTAMINE /SO	LAB	96.60
ASSAY OF LDH ENZYMES /SO	LAB	41.50
ASSAY OF LIPOPROTEIN (A) /SO	LAB	41.95
ASSAY OF PREGNENOLONE /SO	LAB	67.00
ASSAY OF PROSTAGLNDIN EACH /SO	LAB	110.30
ASSAY OF PROTEIN SERUM INHOUSE	LAB	14.80
ASSAY OF SELENIUM /SO	LAB	82.75
ASSAY OF URINE, UREA NIT /SO	LAB	15.40
ASSAY OF VASOPRESSIN /SO	LAB	110.00
ASSAY OF VIT E TOCOPHEROL ALPHA /SO	LAB	46.00
ASSAY OF VITAMIN NOS /SO	LAB	44.80
ASSAY PH BODY FLUID NOS /SO	LAB	11.60
B-2 GLYCOPROTEIN /SO	LAB	82.50
B-2 MICROGLOBULIN /SO	LAB	52.40
BACTERIUM ANTIBODY S/O	LAB	37.55
BARTONELLA HENSELEA /SO	LAB	33.00
BASIC METABOLIC PANEL	LAB	188.80
BENZODIAZEPINES /SO	LAB	17.80
BETA 2 MICROGLOBULIN /SO	LAB	52.40
BETA STREP SCREEN/Q	LAB	10.15
BILE ACID /SO	LAB	55.50
BILIRUBIN TOTAL	LAB	88.60
BILIRUBIN- DIRECT	LAB	90.90
BLASTOMYCES ANTIBODY S/O	LAB	37.65
BLOOD CLOTTING FACTOR X /SO	LAB	69.60
BLOOD FUNGUS CULTURE S/O	LAB	53.70
BLOOD OCCULT FECAL HGB IA QUAL 1-3	LAB	59.75
BLOOD OCCULT FECAL HGB IA QUAL 1-3 /S0	LAB	59.75
BLOOD SMEAR INTERPRETATION /SO	LAB	67.10
Blood typing, RBC Ag not ABO/Rh ea.	LAB	10.10
BMP /SO	LAB	4.90
BRCA1&2 SEQ & FULL DUP/DEL /SO	LAB	5,913.60
C PEPTIDE /SO	LAB	67.50
C REACTIVE PROTEIN /SO	LAB	20.85
C-REACTIVE PROTEIN HS /SO	LAB	250.20
C-REACTIVE PROTEIN INHOUSE	LAB	20.85
C. DIFF TOXIN, EIA/SO	LAB	38.90
CA 125 /SO	LAB	67.50
CA 15-3 /SO	LAB	67.50
CA 27.29 (BR27.29) /SO	LAB	67.50
CA19-9 /SO	LAB	67.50
CADMIUM ASSAY /SO	LAB	75.00
CALCIUM /SO	LAB	68.50
CALCIUM IONIZED /SO	LAB	44.30
CALCIUM URINE QUANT TIMED SPECIMEN /SO	LAB	19.55
CALCIUM- BLOOD	LAB	68.50
CALCULUS INFRARED SPECTROSCOPY /SO	LAB	41.80
CANDIDA DNA AMP PROBE /SO	LAB	113.70
CANDIDA DNA DIR PROBE /SO	LAB	65.00
CARBON DIOXIDE BLOOD ASSAY /SO	LAB	15.80
CARBOXYHEMOGLOBIN /SO	LAB	39.90
CARDIO IQ (TM) HDL CHOL /SO	LAB	26.60
CARDIO IQ (TM) LIPO, ION /SO	LAB	102.20
CARDIOLIPIN AB SCREEN /SO	LAB	82.50
CATECHOLAMINES /SO	LAB	81.85
CBC W/AUTO DIFF	LAB	171.20
CBC W/MANUAL DIFF	LAB	121.65
CBC W/O DIFFERENTIAL	LAB	135.80
CEA /SO	LAB	61.45
CELIAC DIAGNOSTIC PNL /SO	LAB	37.40
CELL COUNT (BODY FLUID) /SO	LAB	17.90
CELL CT ONLY SN FLD/CSF /SO	LAB	106.20
CENTRAL LINE BLOOD DRAW	LAB	37.90
CERULOPLASMIN /SO	LAB	34.80
CHEMILUMINESCENT ASSAY /SO	LAB	45.80
CHLAMYDIA ANTIBODY /SO	LAB	38.35
CHLAMYDIA CULTURE ANY SOURCE /SO	LAB	63.50
CHLAMYDIA DNA,SDA /SO	LAB	113.70
CHLAMYDIA IGM ANTIBODY /SO	LAB	20.10
CHLAMYDIA PENUMONIAE /SO	LAB	113.70
CHLORIDE, BLOOD /SO	LAB	14.90
CHLORIDE,URINE /SO	LAB	16.30
CHOLESTEROL- TOTAL	LAB	47.20
CHP BLOOD DRAW	LAB	36.80
CHROMIUM,PLASMA /SO	LAB	65.75
CHROMOGRANIN A /SO	LAB	67.50
CHROMOSOME ANALYSIS /SO	LAB	253.70
CITRATE URINE /SO	LAB	11.80
CKMB - CREATINE KINASE MB FRACTION /SO	LAB	37.45
CLINICAL MONITORING II /SO	LAB	56.70
CLOSTRIDIUM DIFF AMPLIFIED PROBE /SO	LAB	113.70
CLOTTING FACTOR VIII AHG 1 STAGE /SO	LAB	58.00
CLOTTING FACTOR VIII VW FACTOR ANTGN /SO	LAB	74.35
CLOTTING FACTOR VIII VW MEASURE /SO	LAB	74.35
CLOTTING FACTR VIII VW MULTIMETRIC /SO	LAB	74.35
CMP /SO	LAB	224.20
COBALT,BLOOD /SO	LAB	92.20
COL CHROMOTOGRAPHY QUAL/QUAN /SO	LAB	67.85
COLLAGEN CROSSLINKS NTX /SO	LAB	60.55
COMPLEMENT C3C /SO	LAB	38.90
COMPLEMENT C4 /SO	LAB	56.10
COMPLEMENT CH50 /SO	LAB	65.85
COMPREHENSIVE METAB PANEL	LAB	224.20
COPPER SERUM /SO	LAB	40.20
CORTISOL 24 URINE /SO	LAB	54.15
CORTISOL TOTAL /SO	LAB	52.80
COXSACKIE AB /SO	LAB	42.20
CP AB /SO	LAB	41.95
CPK	LAB	151.15
CPK /SO	LAB	151.15
CPK ISOENZYMES	LAB	161.65
CPK ISOENZYMES /SO	LAB	161.65
CREATININE	LAB	99.10
CREATININE CLEARANCE 24 /SO	LAB	30.60
CREATININE URINE	LAB	18.65
CREATININE/ URINE /SO	LAB	18.65
CROSS MATCH EACH UNIT	LAB	507.30
CRP-HS	LAB	250.20
CRYOGLOBULIN QUAL SEMI-QUANT /SO	LAB	20.95
CRYPTOCOCCUS ANTIBODY / SO	LAB	42.00
CRYPTOSPORIDIUM AG IF /SO	LAB	38.90
CRYPTOSPORIDIUM OR INFECTIOUS AGENT /SO	LAB	21.65
CRYSTALS- SYNOVIAL FLUI /SO	LAB	23.20
CULT TYPE IMMUNOFLUORESC EA ANTISERM /SO	LAB	18.10
CULTURE AEROBIC /SO	LAB	27.95
CULTURE BACT ANAEROBIC EXCEPT BLOOD /SO	LAB	30.70
CULTURE SCREEN /SO	LAB	21.50
CULTURE STOOL /SO	LAB	30.60
CULTURE THROAT /SO	LAB	27.95
CULTURE TYPE IMMUN NOT FLUORES /SO	LAB	19.60
CULTURE TYPING GLC/HPLC /SO	LAB	40.60
CULTURE URINE /SO	LAB	26.15
CULTURE, BLOOD /SO	LAB	33.45
CULTURE-FUNGUS /SO	LAB	27.25
CYSTATIN C /SO	LAB	48.60
CYSTIC FIBROSIS SCREEN /SO	LAB	1,461.10
CYSTIC FIBROSIS SCREEN /SO	LAB	118.10
CYSTIEN URINE /SO	LAB	11.80
CYTOLOGY URINE /SO	LAB	83.50
CYTOMEGALOVIRUS DNA /SO	LAB	138.80
CYTOPATH C/V THIN LAYER /SO	LAB	65.65
CYTOPATH C/V THIN LAYER RESCREEN /SO	LAB	85.85
CYTOPATH CELL ENHANCE TECHNIQ SLCTV /SO	LAB	73.80
D DIMER	LAB	322.20
D DIMER / Q	LAB	47.20
DETECT AGNT MULT DNA AMPLI	LAB	204.80
DETECT DNA /SO	LAB	138.80
DHEA /SO	LAB	81.90
DHEA SULFATE /SO	LAB	72.05
DIGOXIN	LAB	256.05
Dihydrotestosterone, LC/MS/MS Q	LAB	38.40
DILANTIN (PHENYTOIN)	LAB	256.05
DIRECT ANTIGLOBULIN TEST /SO	LAB	17.45
DNA ANTIBODY SINGLE STRAND /SO	LAB	39.20
DOT Drug Testing - DATCO	LAB	94.50
DRUG ASSAY CYCLOSPORINE /SO	LAB	58.50
DRUG ASSAY EVEROLIMUS /SO	LAB	44.50
DRUG SCREEN CLINICAL /SO	LAB	424.75
DRUG SCREEN PRESUMPTIVE OPT INST	LAB	80.30
DRUG SCREEN PRESUMPTIVE OPT INST	LAB	80.30
DRUG SCREEN QUAN LAMOTRIGINE /SO	LAB	42.90
DRUG SCREEN QUANT MYCOPHENOLATE /SO	LAB	58.50
DRUG SCREEN V /SO	LAB	276.10
DRUG SCREEN/MULTI DRG CLS	LAB	276.10
DRUG SCRN QUANT OXCARBAZEPIN /SO	LAB	42.95
DRUG TEST DEF 1-7 CLASSES /SO	LAB	300.40
EHRLICA CANIS AB /SO	LAB	39.10
EHRLICHIA ABS /SO	LAB	33.00
ELASTASE PANCREATIC FECAL QUAL /SO	LAB	37.40
ELECTROLYTE PANEL	LAB	133.50
ENTAMOEB HIST GRP AG IA /SO	LAB	38.90
ERYTHROPOIETIN /SO	LAB	60.90
ESR	LAB	76.80
ESTRADIOL (E2) /SO	LAB	90.50
ESTROGEN TOT /SO	LAB	70.30
ESTRONE /SO	LAB	80.90
FACTOR V LEIDEN /SO	LAB	198.05
FECAL FAT /SO	LAB	16.50
FERRITIN /SO	LAB	44.20
FIBRIN DEGRADATION PRODUCTS /SO	LAB	23.10
FIBRIROGEN /SO	LAB	38.00
FLOW CYTOMETRY EA ADDL MARKER /SO	LAB	9.80
FLOW CYTOMETRY INTERP 16/> MARKERS /SO	LAB	233.40
FLOW CYTOMETRY TC 1 MARKER /SO	LAB	37.75
FLUORESCENT ANTIBODY SCREEN /SO	LAB	39.10
FOLATES RBC /SO	LAB	150.40
FOLIC ACID /SO	LAB	47.60
FOLIC ACID RBC	LAB	150.40
Food Allery Profile	LAB	11.80
FRAGILE X /SO	LAB	110.95
FSH /SO	LAB	60.20
FTA /SO	LAB	8.30
FUNGI IDENT MOLD /SO	LAB	33.45
GARDNER VAG DNA DIR PROBE /SO	LAB	65.00
GARDNER VAG DNA QUANT /SO	LAB	135.35
GASES-PH PCO2 PO2 & SAT	LAB	690.20
GASTRIN /SO	LAB	57.15
GC DNA,SDA /SO	LAB	113.70
GENE ANALYSIS HEMOCHROMATOSIS /SO	LAB	211.80
GENTAMICIN ASSAY PEAK /SO	LAB	53.10
GENTAMICIN ASSAY TROUGH /SO	LAB	53.10
GGT /SO	LAB	23.30
GIARDIA AG STOOL /SO	LAB	38.90
GIARDIA ANTIGEN /SO	LAB	38.90
GIARDIA LAMBLIA AB /SO	LAB	47.70
GLIADIN AB IgG IgA /SO	LAB	37.40
GLIADIN AB IgG IgA 2nd test /SO	LAB	37.40
GLUCOSE POST GLUCOSE DOSE	LAB	68.50
GLUCOSE QUANT	LAB	64.95
GLUCOSE TOL 3 SPECIMENS	LAB	247.75
GLUCOSE TOLERANCE EA ADDL AFTER 3 SPECIM	LAB	18.30
GLUCOSE,SYNOVIAL FLUID /SO	LAB	12.80
GRAM STAIN /SO	LAB	13.80
H PLORI IGA AAB /SO	LAB	47.00
H PYLORI BREATH ANAL UREASE /SO	LAB	218.30
H. PYLORI AB /SO	LAB	48.90
H. PYLORI ANTIGEN /SO	LAB	46.60
HAPTOGLOBIN /SO	LAB	40.75
HCG, QUANTITATIVE	LAB	54.60
HCV RNA QUAL /SO	LAB	113.70
HCV RNA QUANT R-T PCR /SO	LAB	138.80
HEATITIS B IADNA QUANT /SO	LAB	138.80
HEMATOCRIT	LAB	69.70
HEMOGLOBIN	LAB	79.10
HEMOGLOBIN CHROMOTOGRAPHY /SO	LAB	58.55
HEP B CORE ANTI IGM /SO	LAB	38.20
HEP B CORE TOTAL/HBC IG /SO	LAB	39.10
HEP B DNA/QUAL / Q	LAB	135.80
HEP B GENOTYPE DNA /SO	LAB	834.35
HEP B SURFACE ANTIB /SO	LAB	34.80
HEP C GENOTYPE LIPA /SO	LAB	834.35
HEP C RNA QUANT /SO	LAB	138.80
HEP DELTA AGENT ANTIBODY /SO	LAB	55.60
HEPATIC PANEL	LAB	159.35
HEPATIC PANEL /SO	LAB	159.35
HEPATITIS A ANTIB IGM /SO	LAB	36.50
HEPATITIS A, TOTAL /SO	LAB	40.10
HEPATITIS B SURF AG /SO	LAB	33.45
HEPATITIS Be AG EIA /SO	LAB	37.35
HEPATITIS BE ANTIBODY /SO	LAB	37.50
HEPATITIS C ANTIBODY /SO	LAB	46.20
HEPATITIS C BY RIBA /SO	LAB	50.20
HEPATITIS PANEL/SO	LAB	153.60
HERPES CULTURE /SO	LAB	48.90
HERPES SIMPLEX NES ANTBDY /SO	LAB	46.60
HGB A1C	LAB	185.20
HISTOPLASMA ANTIBODY S/O	LAB	36.45
HISTOPLASMA CAPSUL AG IA / SO	LAB	35.00
HIV 1\2 AB SCREEN /SO	LAB	44.40
HIV-1 RNA QUANT BDNA /SO	LAB	275.80
HIV-1&2, AG & ANTIBODY /SO	LAB	78.00
HLA B27 /SO	LAB	83.65
HLA CLASS II LOW RES /SO	LAB	396.10
HLA I LOW RES ONE ANTIGEN EQUIV EACH /SO	LAB	235.75
HLA II TYPING 1 LOC HR /SO	LAB	400.80
HLA TYPING CELIAC/Q	LAB	147.10
HOMOCYSTINE TOTAL /SO	LAB	54.70
HPV IADNA HIGH RISK TYPES /SO	LAB	113.70
HPV TYPES 16 & 18 ONLY /SO	LAB	113.70
HS-CRP /SO	LAB	250.20
HSV 1/2 DNA PCR /SO	LAB	113.70
HSV 1/2 IGG /SO	LAB	42.75
HSV CULTURE,SOFP /SO	LAB	109.75
HSV I IGG /SO	LAB	42.75
HSV II IGG /SO	LAB	62.75
HUMAN EPIDIDYMIS PROTEIN 4 HE4 /SO	LAB	67.50
IADNA AMP PROBE TQ EACH NOT SPECIFD /SO	LAB	113.70
IADNA BARTONELLA AMP PROBE TECHNIQ /SO	LAB	113.70
IGA /SO	LAB	30.15
IGE /SO	LAB	53.35
IGF1 /SO	LAB	68.90
IGFBP3 /SO	LAB	48.30
IGG /SO	LAB	30.15
IgG ANTIBODY NOS /SO	LAB	40.10
IGM /SO	LAB	30.15
IMMUNFIX ELEC SERUM /SO	LAB	78.55
IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOA	LAB	50.40
IMMUNODIFFUSION NES /SO	LAB	45.50
IMMUNOFIXATION ELECTROPHORESIS SERUM /SO	LAB	72.50
IMMUNOFIXATN ELEC URIN /SO	LAB	95.10
INFECTIOUS AGENT, CORONOVIRUS, AMP PROBE	LAB	127.50
INFLUENZA	LAB	94.40
INFLUENZA A&B AG,EIA /SO	LAB	38.90
INFLUENZA DNA AMP PROBE	LAB	251.50
INSULIN /SO	LAB	37.00
INTRINSIC FACTOR /SO	LAB	48.85
IRON TOTAL /SO	LAB	21.00
IRON TOTAL/IRON BIND /SO	LAB	28.40
ISLET CELL ANTIBODY /SO	LAB	64.10
JAK2 GENE /SO	LAB	303.30
JAK2 MUTATION /SO	LAB	303.30
KAPPA LAMBDA LIT CHN /SO	LAB	44.05
KETONES PANEL /SO	LAB	14.25
KIT - URINE COLLECTION	LAB	56.00
KIT DRAW FROM EMPLOYEE	LAB	0.00
KIT DRAW FROM PATIENT	LAB	56.00
KOH PREP WET MOUNT FUNGUS	LAB	44.90
LACTIC ACID/LACTATE	LAB	206.55
LAMOTRIGINE LEVEL /Q	LAB	37.90
LDH /SO	LAB	23.65
LDL DIRECT	LAB	179.40
LEAD BLOOD /SO	LAB	39.20
LEISHMANIA AB /SO	LAB	46.00
LEUKOCYTE ALK PHOS /SO	LAB	27.90
LEVETIRACETAM DRUG SCREEN /SO	LAB	49.80
LIPASE	LAB	133.50
LIPASE /SO	LAB	133.50
LIPID PANEL	LAB	244.25
LIPID PANEL /Q	LAB	9.50
LIPO PROFILE TEST /SO	LAB	55.35
LITHIUM /SO	LAB	21.40
Liver Fibrosis Panel / SO	LAB	189.55
LUPUS ANTICOAG EVAL /SO	LAB	31.05
LUTEINIZING HORMONE(LH) /SO	LAB	60.00
LYME DISEAS ANTIBDY IGM /SO	LAB	50.20
LYME DISEASE ANTIBODY /SO	LAB	55.20
LYME WEST BLOT /SO	LAB	227.50
M. TUBERCULO DNAAMP PROBE /SO	LAB	113.70
MACROSCOPIC EXAM PARASITE /SO	LAB	13.80
MAGNESIUM	LAB	127.50
MAGNESIUM RBC /SO	LAB	127.50
MAGNESIUM URINE	LAB	11.80
MALARIA SMEAR /SO	LAB	19.45
MASS SPECTROMETRY QUAL/QUAN /SO	LAB	63.30
MCARE SCREENING PSA	LAB	230.10
MERCURY /SO	LAB	52.70
METANEPHRINES TOTAL /SO	LAB	54.90
METHYLMALONIC ACID /SO	LAB	55.50
MICOBACTERIA CULTURE ACID FAST /SO	LAB	35.00
MICRO ALBUMIN /SO	LAB	18.75
MICROALBUMIN URINE /SO	LAB	18.75
MICROBE SUSCEPTIBLE DIFFUSE /SO	LAB	15.40
MICROBE SUSCEPTIBLE DISK /SO	LAB	22.30
MICROBE SUSCEPTIBLE ENZYME /SO	LAB	18.00
MITOCHONDRIAL AB / Q	LAB	9.50
MOLECULAR PATH 2 HUNTINGTON'S /SO	LAB	359.10
MONONUCLEOSIS TEST	LAB	100.45
MRSA SCREEN RT PCR /SO	LAB	113.70
MTHFR GENE ANALYSIS /SO	LAB	171.50
MUCIN SYNOVIA FLUID ROPES TEST /SO	LAB	19.00
MUMPS /SO	LAB	42.30
MYCOPLASMA PNEUMONIAE /SO	LAB	42.90
MYELIN BASIC PROTEIN CSF ANALYSIS /SO	LAB	55.80
MYOGLOBIN, URINE /SO	LAB	4.80
NEUTRALIZATION TEST VIRAL /SO	LAB	54.80
NK CELLS TOTAL CT /SO	LAB	122.30
NO CHARGE	LAB	0.00
NT-PRO BNP	LAB	654.80
NUCLEAR ANTIGEN ANTIBODY /SO	LAB	58.10
OB PANEL	LAB	376.45
OB PANEL /SO	LAB	242.60
OCCULT BLOOD FECES	LAB	39.10
OLIGOCLONAL IMMUNE BANDS /SO	LAB	71.90
ONCO OVARIAN BIOCHEM ASSAY 2 PROTEIN /SO	LAB	683.80
ORGANISM ID AEROBIC EACH /SO	LAB	30.60
ORGANISM ID ANAEROBIC EACH /SO	LAB	30.60
OSMOLALITY (URINE) /SO	LAB	22.10
OSMOLALITY(SERUM) /SO	LAB	21.40
OVA & PARASITES /SO	LAB	28.80
OXALATE URINE /SO	LAB	11.80
OXCARBAZEPINE METABOLIT/Q	LAB	14.25
P.T.T	LAB	205.35
PARATHYROID HORMON INT /SO	LAB	79.10
PARTICLE AGGLUT ANTBDY SCRN / SO	LAB	30.30
PCR AG DETECT NOS IIA MULT /SO	LAB	38.90
PHENOBARBITAL /SO	LAB	40.20
PHOSPHATASE ALKALINE	LAB	83.80
PHOSPHATE INORGANIC	LAB	93.30
PHOSPHOLIPID ANTIBODY /SO	LAB	52.10
PHOSPHORUS URINE /SO	LAB	16.80
PHOSPHORUS/PHOSPHATE /SO	LAB	93.30
PINWORM EXAM /SO	LAB	13.80
PLATELET CT SEPARATE PROC	LAB	205.35
PORPHOBILINOGEN ASSAY, RANDOM /SO	LAB	27.40
POTASSIUM	LAB	93.30
POTASSIUM 24 URINE /SO	LAB	14.00
POTASSIUM,URINE /SO	LAB	14.00
PREALBUMIN /SO	LAB	47.30
PREGNANCY TEST SERUM QUAL	LAB	145.20
PREGNANCY TEST URINE	LAB	99.10
PROCALCITONIN (PCT) /SO	LAB	86.85
PROGESTERONE /SO	LAB	67.60
PROLACTIN /SO	LAB	62.80
PROTEIN C /SO	LAB	50.85
PROTEIN C INHIBIT /SO	LAB	44.85
PROTEIN E-PHORESIS/URINE/CSF /SO	LAB	57.80
PROTEIN ELECTRO SERUM /SO	LAB	34.80
PROTEIN S CLOT INHIBIT /SO	LAB	49.70
PROTEIN TOTAL 24HR URIN /SO	LAB	11.90
PROTEIN TOTAL XCPT REFRACTOMETRY / SO	LAB	11.90
PROTEIN TOTAL/ SERUM /SO	LAB	14.80
PROTEIN/CREAT RATIO /SO	LAB	11.90
PROTHROMBIN GENE /SO	LAB	172.40
PROTHROMBIN TIME	LAB	180.60
PROTIME W/INR /SO	LAB	180.60
PSA FREE RATIO /SO	LAB	59.60
PSA TOTAL	LAB	230.10
PTH /SO	LAB	133.80
PTH BIOINTACT /SO	LAB	133.80
QUANTIFERON GOLD /SO	LAB	200.90
QUANTITATION OF TX DRUG NES /SO	LAB	48.95
QUEST MISC LIVER FIBROSIS TEST /SO	LAB	0.00
RAPID STREP SCREEN	LAB	173.50
RAY'S MARKET DRUG SCREEN	LAB	46.10
RBC AUTOMATED /SO	LAB	9.80
RBC SICKLE CELL TEST /SO	LAB	17.90
RENAL PANEL	LAB	225.40
RENIN /SO	LAB	71.25
RETICULOCYTE COUNT	LAB	193.50
RETICULOCYTE/SO	LAB	193.50
RHEUMATOID FACTOR /SO	LAB	18.40
RICKETTSIA ANTIBODY /SO	LAB	63.00
RPR /SO	LAB	13.80
RUBELLA /SO	LAB	46.60
RUBEOLOA TITER /SO	LAB	41.75
SALICYLATES(ASPIRIN)/Q	LAB	9.50
SALYCILATES	LAB	235.95
SEMEN ANALYSIS POST /SO	LAB	39.10
Semen Count Not Billable /SO	LAB	0.00
SENSITIVITY/SUSCEPTIBILTY ON CULTURE /SO	LAB	32.70
SGOT	LAB	40.20
SGPT	LAB	44.90
SHBG /SO	LAB	70.40
SHIGA LIKE TOXIN IAAD EIA /SO	LAB	38.90
SIROLIMUS/RAPAMYCIN /SO	LAB	44.50
SJOGREN'S ANTIBODY-SS-A /SO	LAB	58.10
SKIN FUNGI CULT MOLD, YEAST /SO	LAB	24.95
SKIN TEST TUBERCULOSIS	LAB	52.05
SM ANTIBODY NUCLEAR ANTIGEN /SO	LAB	58.10
SMEAR COMPLX STAIN OVA PARASIT /SO	LAB	58.20
SMOOTH MUSCLE AB / Q	LAB	9.50
SMR PRIM SRC FLUORESC&/AFS BCT FNGI /SO	LAB	17.45
SNRPN METHYLATION GENE ANALYSIS S/O	LAB	134.10
SODIUM 24 URINE /SO	LAB	15.80
SODIUM SERUM	LAB	87.40
SSA, SSB(SJOGRENS AB) /SO	LAB	55.50
STONE ANALYSIS /SO	LAB	37.50
STOOL CULTR AEROBIC BACT EACH /SO	LAB	30.60
STREP A DNA AMP PROBE	LAB	102.40
STREPTOCOCCUS PNEUMONIAE IgG AB /SO	LAB	48.60
SUGARS SINGLE QUAL /SO	LAB	17.90
SULFATE URINE /SO	LAB	15.40
T LYMPHOCYTE CD4 /SO	LAB	86.80
T3 BY RIA /SO	LAB	45.95
T3 FREE /SO	LAB	54.90
T3 REVERSE / Q	LAB	51.10
T3 UPTAKE /SO	LAB	20.95
T4 /SO	LAB	22.30
T4 FREE BY DIALYSIS /SO	LAB	185.20
T4, FREE	LAB	185.20
TACROLIMUS /SO	LAB	44.50
TEGRETOL- CARBAMAZEPHN /SO	LAB	47.20
TESTOSTERONE FREE /SO	LAB	82.55
TESTOSTERONE TOTAL ADULT MALE /SO	LAB	83.65
TESTOSTERONE TOTAL LC/MS/MS /SO	LAB	83.65
TETANUS ANTITOXID /SO	LAB	48.70
THYROGLOBULIN AB /SO	LAB	51.60
THYROGLOBULIN W/O TGAB /SO	LAB	52.05
THYROID PEROXIDASE AB /SO	LAB	47.15
THYROID STIMUL IMM /SO	LAB	164.80
THYROXINE FREE /SO	LAB	185.20
TISSUE EXAM BY PATHOLOGIST LVL IV /SO	LAB	117.35
TISSUE EXAM BY PATHOLOGIST LVL 1 /SO	LAB	45.85
TISSUE EXAM BY PATHOLOGIST LVL II /SO	LAB	83.50
TISSUE EXAM BY PATHOLOGIST LVL III /SO	LAB	117.35
TISSUE EXAM BY PATHOLOGIST LVL V /SO	LAB	565.50
TISSUE EXAM BY PATHOLOGIST LVL VI /SO	LAB	1,420.00
TISSUE KOH FOR FUNGI /SO	LAB	44.90
TISSUE TRANSGLUTAM ABS /SO	LAB	37.40
TOTAL PSA /SO	LAB	230.10
TOTAL/DIRECT BILI FXNTD /SO	LAB	88.60
TOXICOLOGY DRUG SCREEN, MULT CLASSES, /S	LAB	648.20
TOXIN/ANTITOXIN ASSAY TISSUE /SO	LAB	63.95
TOXOPLASMA ANTIBODY /SO	LAB	46.60
TOXOPLASMA ANTIBODY IGM /SO	LAB	46.70
TRANSFERRIN /SO	LAB	41.40
TRICHOMMONAS AMP PROBE /SO	LAB	107.20
TRICHOMONAS VAGIN DIR PROBE /SO	LAB	65.00
TRIGLYCERIDES	LAB	62.65
TROPONIN QUANTITATIVE	LAB	368.15
TSH	LAB	324.50
TSH /SO	LAB	324.50
UA AUTO WO/MICRO	LAB	120.45
UA DIP W/O MICROSCOPIC	LAB	28.40
UA MICRO ONLY	LAB	44.90
UA W/ MICROSCOPIC	LAB	140.50
UREA NITROGEN (BUN) QUANT	LAB	83.80
URIC ACID /SO	LAB	14.65
URIC ACID 24 URINE /SO	LAB	15.40
URINE BACTERIA CULTURE /SO	LAB	30.60
URINE PORPHYRINS, FRACT, /SO	LAB	47.70
URINE, DIP STICK W/MICRO, NON-AUTO	LAB	64.95
VALPROIC ACID /SO	LAB	43.90
VANCOMYCIN /SO	LAB	43.90
VANCOMYCIN In-House	LAB	79.00
VAP IM CHOLESTEROL /SO	LAB	88.90
VARICELLA ZOSTER AG IF /SO	LAB	38.90
VARICELLA ZOSTER IGG /SO	LAB	41.75
VARICELLA ZOSTER VIRUS DNA QUAL /SO	LAB	70.25
VENIPUNCTURE	LAB	40.20
VIRUS INOCULATION SHELL STAIN /SO	LAB	63.40
VIRUS TISSUE INOCULATION /SO	LAB	84.50
VISCOSITY,SERUM /SO	LAB	37.90
VIT B1 THIAMINE /SO	LAB	68.80
VIT D 25-HYDROXY	LAB	95.90
VITAMIN A /SO	LAB	37.60
VITAMIN B12	LAB	49.05
VITAMIN B12 /SO	LAB	48.85
VITAMIN B6 /SO	LAB	91.05
VITAMIN D 1 25-DIHYDROXY /SO	LAB	124.75
VITAMIN K LEVEL /SO	LAB	44.50
VMA /SO	LAB	50.20
WBC SMEAR STOOL / Q	LAB	13.80
WESTERN BLOT TEST /SO	LAB	55.25
WET MOUNT	LAB	54.40
ZINC /SO	LAB	36.90
ZONISAMIDE(ZONEGRAN) /SO	LAB	42.95
MAMM DX UNILATERAL	MAMM	346.50
MAMM DX UNILATERAL	MAMM	346.50
MAMM SCREENING CAD	MAMM	58.55
MAMMOGRAPHY SCREENING	MAMM	291.45
MAMMOGRAPHY SCREENING	MAMM	291.45
MAMMOGRAPHY SCREENING BILAT W/CAD	MAMM	349.90
ADHESIVE-SKIN	MM	94.40
ARM SLING LG	MM	21.60
ARM SLING MD	MM	20.20
BAG- FOLEY 2000ML	MM	35.40
BAG-LEG URINARY	MM	56.70
BANDG- ACE ELASTIC 2"	MM	24.85
BANDG- ACE ELASTIC 3"	MM	24.85
BANDG- ACE ELASTIC 4"	MM	34.40
BANDG- ACE ELASTIC 6"	MM	24.85
BANDG-CONFORM 2" PER YARD	MM	10.70
BANDG-CONFORM 3" PER YARD	MM	10.70
BANDG-CONFORM 4" PER YARD	MM	10.70
BANDG-ROLL GAUZE 2" STL	MM	8.30
BANDG-ROLL GAUZE 4" STL	MM	21.30
BANDG-TRIANGLE	MM	23.65
BANDG-TUBULAR GZ SZ 1/YD	MM	10.70
BANDG-TUBULAR GZ SZ2 /YD	MM	4.80
BANDG-TUBULAR GZ SZ3/YD	MM	13.00
BANDG-TUBULAR GZ SZ4 /YD	MM	11.80
BANGAGE-TUBULAR GZ	MM	13.00
BELT-RIB	MM	67.40
BELT-RIB MALE	MM	50.85
BIOPATCH DISK	MM	48.40
BLANKET-BAIR HUGGER	MM	36.80
CAST ARM LONG FBRGL >11YO	MM	142.80
CAST ARM SHRT FBRGL <11YO	MM	128.70
CAST ARM SHRT FBRGL >11YO	MM	88.60
CAST LEG SHRT FBRGL >10YO	MM	149.85
CAST LEG SHRT PLSTR >11YO	MM	76.80
CAST- FIBERGLASS 4"	MM	63.75
CAST- SANDAL, SM	MM	101.55
CATH FOLEY 14F 05CC	MM	76.80
CATH- FEMALE KIT	MM	35.40
CATH- MALE EXTERNAL	MM	8.30
CATH-FOLEY SILICONE COUDE TIP 14FR	MM	76.80
CATH-FOLEY, 12FR, 05CC	MM	76.80
CATH-FOLEY, 16FR, 05CC	MM	76.80
CATH-FOLEY, 18FR, 05CC	MM	76.80
CATH-FOLEY, 18FR, 30CC	MM	76.80
CATH-FOLEY, 8FR, 03CC	MM	76.80
CERVICAL COLLAR STANDARD SIZE	MM	31.50
CERVICAL COLLAR, M	MM	37.10
CLAVICAL SM	MM	29.40
CLAVICAL SPLINT XL	MM	29.40
CLAVICLE SPLINT LG	MM	29.40
CRUTCH- ADULT ADJ	MM	187.70
CRUTCH- ADULT TALL ADJ	MM	187.70
CRUTCH- YOUTH ADJ	MM	187.70
cv plus catheter stablilization device	MM	77.70
DERMADOND	MM	52.50
DRESS- COBAN 1" /ROLL	MM	13.00
DRESS- TELFA 2"X3"	MM	8.30
DRESS- TELFA 3"X8"	MM	8.30
DRESS- XEROFORM 1"X8"	MM	9.50
DRESS- XEROFORM 5"X9"	MM	15.45
DRESS- XSPAN SIZE 4/YD	MM	8.30
DRESS-DUODERM CGF 2.5X2.5	MM	37.90
DRESS-DUODERM CGF 4X4	MM	61.45
DRESS-NONADHEARING 3"X8"	MM	13.00
DRESS-NONADHERING 3"X16"	MM	10.70
DRESS-NONADHERING 3"X3"	MM	8.30
DRESS-TELFA 3X4	MM	21.30
DRESS-TRANS 10CMX14CM	MM	15.45
DRESS-TRANSPARENT 2X3	MM	21.30
DRESSING - MEPILEX 9.2X9.2	MM	26.30
DRESSING-ALLEVYN SAC 12.5X12.5	MM	36.80
DRESSING-NONADHEARING	MM	21.30
DRESSING-TELFA	MM	21.30
DRESSING-XPAND	MM	8.30
DUODERM CGF BORDER 2.5 X 2.5	MM	20.00
ELECTRODE- ZOLL ONE STEP	MM	236.30
FINGER SPLINT	MM	7.65
HYDROCOLLOID-DRESSING 6X6	MM	29.40
IMMOBILIZER-SHOULDER MESH	MM	69.70
IMMUN ADMIN 1ST EA COMBO	MM	116.90
MEDIPORE TAPE 2"	MM	30.50
MEDIPORE TAPE 4"	MM	42.00
NACL FLUSH 10ML	MM	6.30
OCULAR IRRIG LENS MORGAN	MM	185.20
PACKING	MM	50.85
PACKING- IODOFORM 1"	MM	31.90
PACKING- IODOFORM 1/4"	MM	50.85
PACKING- PLAIN 1"	MM	50.85
PACKING- PLAIN 1/2"	MM	24.85
PADDING- CAST SYNTHETC 2"	MM	11.80
PADDING-CAST	MM	19.00
PARACENTESIS KIT	MM	105.00
PEDIALYTE	MM	26.30
PLASTER SPLINT	MM	27.25
PLEUR- EVAC	MM	766.80
QUICK TRACH 4.0	MM	204.80
QUICK TRACH PEDS 2.0	MM	204.80
RIB BELT FEMALE XL	MM	29.40
RIB BELT MENS XL	MM	36.80
RIB BELT UNISEX L	MM	36.80
RIB BELT UNIVERSAL	MM	25.20
SALINE SOL 10CC FOR MDI	MM	13.00
SANDAL- CAST MED	MM	101.55
SANDAL-CAST	MM	101.55
SANDAL-CAST, LG	MM	101.55
SLING CHILD	MM	18.90
SLING-ARM UNIVERSAL	MM	63.75
SOL- IV, 3% NACL, 500ML	MM	22.10
SOL- IV, 9% NACL, 1000ML	MM	42.00
SOL- IV, 9% NACL, 100ML	MM	31.50
SOL- IV, 9% NACL, 250ML	MM	35.70
SOL- IV, 9% NACL, 500ML	MM	52.50
SOL- IV, D5, 1000ML	MM	29.40
SOL- IV, D5, 100ML	MM	31.50
SOL- IV, D5, 500ML	MM	11.60
SOL-IRRIGATION H2O STL 1L	MM	13.00
SOL-IRRIGATION NACL 500ML	MM	24.20
SOL-IRRIGATION STL NACL1L	MM	13.00
SOL-IV D10W 250ML	MM	8.30
SOL-IV, 45% NACL, 1000ML	MM	85.10
SOL-IV, D5, LR, 1000ML	MM	36.80
SOL-IV, D5,.45NACL 1000ML	MM	26.05
SOL-IV, LR, 1000ML	MM	43.60
SOL-IV,D5/.9NACL EA 1L	MM	26.05
SPLINT ARM LONG FBRGL <11	MM	67.40
SPLINT ARM LONG FBRGL >11	MM	179.40
SPLINT ARM SHRT FBRGL <11	MM	99.10
SPLINT ARM SHRT FBRGL >11	MM	93.30
SPLINT ARM SHRT PLSTR >11	MM	44.90
SPLINT LEG LONG FBRGL <11	MM	158.15
SPLINT LEG LONG FBRGL >11	MM	109.85
SPLINT LEG LONG PLSTR >11	MM	55.50
SPLINT LEG SHRT FBRGL <11	MM	120.45
SPLINT LEG SHRT FBRGL >11	MM	137.00
SPLINT LEG SHRT PLSTR <11	MM	61.45
SPLINT LEG SHRT PLSTR >11	MM	39.10
SPLINT-ANKLE SUPPORT STRP	MM	204.25
SPLINT-CLAVICAL MD	MM	50.85
SPLINT-COLLES LG L	MM	53.20
SPLINT-CRDBD/FOAM 12"	MM	13.00
SPLINT-FINGER	MM	19.00
SPLINT-FNGR PLN END 4.25	MM	10.70
SPLINT-WRIST	MM	94.40
SPLINT-WRIST UNIVERSAL	MM	103.90
SPLINT-WRIST,UNIV,R	MM	103.90
SPLNT-COLLES,LARGE,R	MM	94.40
SPLNT-COLLES,MEDIUM,L	MM	94.40
SPLNT-COLLES,MEDIUM,R	MM	94.40
SPLNT-COLLES,SMALL,L	MM	94.40
SPLNT-COLLES,SMALL,R	MM	94.40
SPONGE-GAUZE 4X4 TRAY	MM	10.50
STAPLER- SKIN 15 DSP	MM	152.30
STOCKINETTE	MM	13.00
STRAP-CATH LEG	MM	93.30
SUTURE-5.0 PROLENE	MM	74.45
SUTURE-6.0 ETHILON	MM	64.95
TEGADERM 3.5 X 4.5	MM	20.00
TEGADERM 4X4	MM	7.40
TEGADERM DRESSING	MM	16.90
TRAY- LUMBAR PUNCTURE ADU	MM	137.00
TRAY- THORENCENT PARACENT	MM	402.30
TRAY- URINE METER FOLEY	MM	109.85
TRAY-CATH 'ADD A FOLEY'	MM	109.85
TRAY-CENTRAL LINE DRESS	MM	31.90
TRAY-CV CATH MULTI LUMEN	MM	332.75
TRAY-CV CATH,PED 22G	MM	294.00
TRAY-URETHRAL CATH	MM	34.40
U SHAPED CALLUS CUSHION	MM	13.15
UNIVERSAL STIRRUP ANKLE BRACE	MM	48.10
WALKING BOOT LG	MM	131.30
WALKING BOOT MED	MM	131.30
WALKING BOOT SM	MM	131.30
GLUCOSE BY REAGENT STRIP	NUR	26.05
SEMI PVT BED ACUITY LVL 1	NUR	3,247.80
SEMI PVT BED ACUITY LVL 2	NUR	4,871.65
OBS BED CHARGE PER HOUR	OBS	205.35
E/M EST PT COMPREHNS	OPMD	330.35
E/M EST PT DETAILED	OPMD	206.55
E/M EST PT EXPANDED	OPMD	142.80
E/M EST PT LIMITED	OPMD	110.95
E/M NEW PT COMP/COMPLEX	OPMD	509.70
E/M NEW PT COMP/MOD	OPMD	377.55
E/M NEW PT DETAILED	OPMD	264.30
E/M NEW PT EXPANDED	OPMD	203.00
E/M NEW PT LIMITED	OPMD	162.90
APPL SPLINT LONG LEG	OPPR	241.90
ARTHR/ASP/INJ INT JNT/BRS	OPPR	223.10
E/M HBC DETAILED-MODERATE	OPPR	227.80
E/M HBC EXPANDED-MODERATE	OPPR	254.95
E/M HBC FOCUSED-MINOR	OPPR	266.70
E/M HBC NURSE ONLY	OPPR	368.15
ECG-1-3 LEAD TRACING ONLY	OPPR	34.40
ECG-12 LEADS TRACING ONLY	OPPR	689.00
HBC NURSING MARKER	OPPR	0.00
I&D ABSCESS SIMPLE/SINGLE	OPPR	361.10
IMMUN ADMIN 1ST EA/COMBO	OPPR	99.10
IMMUN ADMIN ADDL EA/COMBO	OPPR	37.90
INC/REM FB SUBCUT SIMPLE	OPPR	361.10
INFUSION THER/DX <1 HOUR	OPPR	614.70
INFUSION THER/DX >1HR-8HR	OPPR	451.90
INFUSION/HYDRATE <1HOUR	OPPR	665.40
INFUSION/HYDRATE >1 HR	OPPR	133.50
INJ THER/PROP/DX SQ/IM	OPPR	230.10
IV PUSH-SNGL OR INTL DRUG	OPPR	221.90
SKIN FULL GRFT FACE/GEN/HF	OPPR	4,063.50
THORACENTESIS	OPPR	1,020.50
TRANSFUSE BLOOD/BLD PROD	OPPR	2,131.70
ACETAMINOPHEM 120MG SUPP	PHAR	4.30
ACETAMINOPHEN 300MG SUPP	PHAR	7.50
ACETAMINOPHEN 500MG TAB	PHAR	4.30
ACETAMINOPHEN SUPP 650 MG	PHAR	10.00
ACETYLCYSTEINE INH	PHAR	50.00
ACETYLCYSTEINE INH SOL	PHAR	49.00
ACETYLCYSTEINE INJ 200MG/ML	PHAR	165.00
ActHIB	PHAR	54.00
ACYCLOVIR 200MG CAP	PHAR	9.00
ADENOSINE 6MG INJ	PHAR	34.00
AFRIN	PHAR	18.00
ALBUTERAL/IPRATROPIUM NEB	PHAR	0.00
ALBUTEROL INHALER	PHAR	182.00
ALBUTEROL UD / MG INH SOL	PHAR	21.00
ALCAINE O/S 4 DROPS	PHAR	14.00
AMIODARONE 150MG/3ML	PHAR	26.00
AMIODARONE HCL 200MG TAB	PHAR	9.00
AMIODARONE HCL 30MG INJ	PHAR	4.30
AMITRIPYLINE HCI	PHAR	4.30
Ammonia Inhalants	PHAR	10.00
AMOXICILIN 125MG/5CC SUS	PHAR	3.00
AMOXICILLIN 250MG CAP	PHAR	5.00
AMOXICILLIN 250MG/5CC SUS	PHAR	4.00
AMOXICILLIN 500MG CAP	PHAR	8.00
AMOXICILLIN 875 MG	PHAR	4.30
AMOXICILLIN LIQUID	PHAR	22.50
AMOXICILLIN POT CLAV 400 MG	PHAR	22.50
AMPICILLIN 1GM IM	PHAR	43.00
AMPICILLIN SOD 1 GM IVP	PHAR	43.00
	PHAR	43.00
AMPICILLIN/SULBACTAM 1.5 GM IM	PHAR	53.00
AMPICILLIN/SULBACTAM 1.5 GM IVPB	PHAR	53.00
	PHAR	53.00
AMPICILLIN/SULBACTAM 3 GM	PHAR	94.00
ARANESP NON-ERSD 1MCG INJ	PHAR	10.70
ARISTADA 1064MG	PHAR	4,194.33
ARTIFICIAL TEARS	PHAR	28.00
ASA 325MG TAB	PHAR	4.30
ASA 81MG TAB	PHAR	4.00
ASA SUPPOSITOR 600 MG	PHAR	17.00
ASCORBIC ACID	PHAR	3.00
ATENOLOL 50MG TAB	PHAR	12.00
ATORVASTATIN 10 MG TAB	PHAR	6.00
ATROPINE 0.1MG INJ	PHAR	9.00
AUGMENTIN 125MG SUSP	PHAR	40.70
AUGMENTIN 200MG SUSP	PHAR	52.00
AUGMENTIN 500MG TAB	PHAR	29.00
AUGMENTIN 875MG TAB	PHAR	28.00
AZITHROMICIN 750MG IV	PHAR	134.00
Azithromycin 200m/5ml	PHAR	75.00
AZITHROMYCIN 250MG TAB	PHAR	8.00
AZITHROMYCIN 250MG Z-PAC	PHAR	42.00
AZITHROMYCIN 500MG IV	PHAR	33.00
AZITROMYCIN SUS 200MG/5ML	PHAR	147.70
BACITRACIN TOPICAL	PHAR	6.00
BACLOFEN	PHAR	29.00
BACLOFEN 10MG TAB	PHAR	8.00
BACTERIOSTATIC H20	PHAR	8.00
BACTERIOSTATIC SODIUM CHLORIDE	PHAR	8.00
BENAZEPRIL 5MG	PHAR	3.50
BENZOCAINE SPRAY	PHAR	5.00
BENZTROPINE 1 MG TAB	PHAR	5.00
BEXSERO	PHAR	622.00
BISACODYL 10MG SUPP	PHAR	11.00
BISACODYL TAB 5 MG	PHAR	5.00
BOTOX	PHAR	1,803.00
BUDESONIDE 1 MG	PHAR	0.00
BUMETANIDE .25 <2.5MG INJ	PHAR	20.00
BUMETANIDE 1 MG	PHAR	6.00
BUMETANIDE 2.5 MG IM/IVP	PHAR	34.00
BUPIVACAINE INJ 5 %	PHAR	40.00
BUPIVICAINE .5% 1CC INJ	PHAR	19.00
CALCIUM 500 MG TAB	PHAR	4.00
CALCIUM CHLR 10%<10ML INJ	PHAR	10.00
CALCIUM GLUC PER 10ML INJ	PHAR	17.00
CALMOSEPTINE OINTMENT	PHAR	27.60
CAPTOPRIL 25MG TAB	PHAR	20.00
Caspofungin 5mg	PHAR	19.00
CATHFLO ACTIVASE	PHAR	283.00
CEFAZOLIN 1 GM IM	PHAR	19.00
CEFAZOLIN 1 GM IVPB	PHAR	19.00
	PHAR	19.00
CEFEPIME 2 GM IVPB	PHAR	36.00
CEFEPIME 2GM IVP	PHAR	36.00
CEFOTETAN IM 2 GM	PHAR	108.00
CEFOTETAN IM 2 GM	PHAR	108.00
Ceftaroline 600mg vial	PHAR	270.00
CEFTAZIDIME 1 GM IM	PHAR	33.00
CEFTAZIDIME 1GM IVPB	PHAR	33.00
CEFTAZIDIME 500MG	PHAR	55.00
CEFTRIAXONE 1 GM	PHAR	145.00
	PHAR	145.00
CEFTRIAXONE 2 GM	PHAR	93.00
CEFTRIAXONE IM 2000 MG	PHAR	93.00
CEFTRIAXONE SOD 250MG	PHAR	82.00
CEFTRIAZONE IM 1000 MG	PHAR	145.00
CEFUROXIME TAB 500 MG	PHAR	10.50
CELESTONE INJ PER 3MG	PHAR	52.00
CEPHALEXIN 250 MG	PHAR	10.00
CEPHALEXIN 250MG/100ML PO	PHAR	18.00
CEPHALEXIN 250MG/5ML PO	PHAR	3.30
CHARCOAL ACIVT 50GM 8OZ	PHAR	109.00
CHARCOAL ACT WITH SORBITAL 50GM 8OZ	PHAR	109.00
CHLORPROMAZINE 50 MG	PHAR	134.00
CIMETIDINE 300MG INJ	PHAR	28.90
CIPROFLOXACIN 500MG TAB	PHAR	6.00
CLINDAMYCIN 150MG PO	PHAR	13.00
CLINDAMYCIN 300MG INJ	PHAR	21.00
	PHAR	21.00
CLINDAMYCIN IM 600 MG	PHAR	17.00
CLINDAMYCN 600MG IVPB	PHAR	17.00
CLONAXEP/KLONOPN TAB 1MG	PHAR	5.40
CLONIDINE HCL/CAP .1MG TB	PHAR	5.00
CLOPIDOGRE/PLAIV 75MG TAB	PHAR	29.00
CLOVE OIL	PHAR	18.00
CORTISPORIN 1 SQUIRT	PHAR	6.50
CORTISPORIN OINTMENT 15GM	PHAR	96.00
CORTROSYN IM,IV	PHAR	215.10
Crotalidae Crofab	PHAR	5,772.00
CYANOBALAMIN <=1000 MCG I	PHAR	49.00
CYCLOBENZAPRINE 10 MG	PHAR	6.00
CYCLOPENTOLATE HCL OPTH SOL 2%	PHAR	32.00
Daptomycin 750 MG	PHAR	1,040.00
DECAVAC INJ	PHAR	169.00
DEPO MEDROL 20MG INJ	PHAR	7.50
DEPO MEDROL 40MG INJ	PHAR	42.00
DEPO MEDROL 80MG INJ	PHAR	71.00
DEXAMETH/DECRON 4 MG TAB	PHAR	4.30
DEXAMETHASONE 10MG INJ	PHAR	31.00
	PHAR	31.00
DEXAMETHASONE PER 1MG INJ	PHAR	4.30
DEXAMTH <4MG/ML INJ	PHAR	14.00
DEXTROSE 50% <25GM INJ	PHAR	9.00
DIAZEPAM <=5MG INJ	PHAR	139.00
DIAZEPAM 10MG TAB	PHAR	6.50
DICLOXACILLIN 250MG	PHAR	15.00
Dicyclomine 20mg	PHAR	7.00
DIGOXIN .125MG TAB	PHAR	21.00
DIGOXIN .25MG TAB	PHAR	21.00
DIGOXIN .5MG TAB	PHAR	4.30
DIGOXIN <.5MG INJ	PHAR	31.00
	PHAR	31.00
DIHYDROERGOTAMINE 1 MG INJ	PHAR	315.00
DILAUDID 2MG TAB	PHAR	4.30
DILTIAZEM 5 MG/ML IVPB	PHAR	26.00
DILTIAZEM 5MG INJ IVP	PHAR	9.00
DILTIAZEM HCL/CARD 30MG T	PHAR	13.00
DILTIAZEM HCL/CARD 90MG T	PHAR	5.40
DIPHENHYDRAMIN 50MG	PHAR	31.00
	PHAR	31.00
DIPHENHYDRAMINE 50MG ELIX	PHAR	10.00
DIPHENHYDRAMN HCL ELX 1OZ	PHAR	4.30
DIPHENHYDRMN HCL 25MG CAP	PHAR	3.00
DIPTHERIA & TETNS TXD INJ >7 PRESERV FRE	PHAR	96.30
DIVALPROEX SODIUM	PHAR	19.00
DOBUTAMINE 250 MG	PHAR	11.00
	PHAR	11.00
DOCUSATE SOD/COL 100MG TB	PHAR	5.00
DOCUSATE SODIUM 250MG	PHAR	4.00
DOCUSATE TAB 100 MG	PHAR	0.00
DONNATAL ELIXIR 5CC	PHAR	45.00
DOPAMINE 400MG INJ	PHAR	8.00
DOXAZOSIN 4MG TAB	PHAR	16.00
DOXYCYCLINE 100MG	PHAR	101.00
DOXYCYCLINE 100MG TAB	PHAR	22.00
DTAP	PHAR	198.00
DTAP-IPV	PHAR	260.00
ELIGARD 3.75MG SQ	PHAR	143.40
EMLA 2.5% CREAM	PHAR	17.00
ENALAPRIL	PHAR	20.00
ENALAPRILAT 1.25 MG	PHAR	33.00
ENEMA	PHAR	11.80
ENEMA MINERAL OIL	PHAR	3.00
ENOXAPARIN 10MG INJ	PHAR	68.00
EPINEPHRINE .4 UD INH SOL	PHAR	7.00
EPINEPHRINE 1-10000MINIJT	PHAR	97.00
EPINEPHRINE 1MG/ML	PHAR	13.00
EPINEPHRINE 1ML INJ 1:1K	PHAR	97.00
EPINEPHRINE IM 1 MG/ML	PHAR	97.00
Ertapenem 1GM IM/IVP	PHAR	178.00
Ertapenem 1GM IVPB	PHAR	178.00
ERYTHROMYCIN 250MG TAB	PHAR	69.00
ERYTHROMYCIN OPTH OINT 4G	PHAR	13.00
ERYTHROMYCIN SULF 2-600MG	PHAR	83.50
ESTROGEN/PREMARIN	PHAR	851.00
Ethyl Chloride fine stream	PHAR	12.00
ETOMIDATE 2MG >10ML	PHAR	11.00
eye wash	PHAR	3.00
FENTANYL 250 MCG	PHAR	3,517.00
FENTANYL CIT <100MCG INJ	PHAR	357.00
FENTANYL CITRATE 50 MCG IM/IVP	PHAR	28.00
FENTANYL CITRATE 50 MCG IVPB	PHAR	28.00
FERRLECIT 12.5 MG	PHAR	54.00
FERROUS SULFT/FE SUF 325M	PHAR	4.00
FLU VACCINE CASH	PHAR	25.00
FLU VACCINE HI DOSE INJ MDCR	PHAR	0.00
FLU VACCINE INJ	PHAR	128.00
FLU VACCINE INJ MEDICARE	PHAR	0.00
FLUCONAZOLE 100 MG	PHAR	12.00
FLUCONAZOLE 150MG	PHAR	19.00
FLUMAZENIL .5 MG	PHAR	18.00
FLUORESCEIN SODIUM STRIP	PHAR	4.00
FLUOXETINE	PHAR	24.00
	PHAR	24.00
FOLIC ACID 1MG TAB	PHAR	3.00
FOSPHENYOIN IM 50 PE/ML	PHAR	34.00
FOSPHENYTOIN SOD 100MG INJ	PHAR	34.00
FUROSEMIDE <20MG IM/IVP	PHAR	17.00
FUROSEMIDE <20MG IVPB	PHAR	17.00
	PHAR	17.00
FUROSEMIDE 40 MG	PHAR	5.00
GABAPENTIN 100 MG CAP	PHAR	6.00
GABAPENTIN 300MG	PHAR	10.00
GENTAMICIN 0.3% OPTH OINNT	PHAR	138.00
GENTAMICIN SULF <80MG IM/IVP	PHAR	13.00
GENTAMICIN SULF <80MG IVPB	PHAR	13.00
GENTAMICIN SULF OPTH <5ML	PHAR	75.00
GENTAMYCIN 0.3% OINT	PHAR	38.00
GEODON 20MG	PHAR	186.00
GLUCAGON 1MG INJ	PHAR	316.00
GLUCOPHAGE 500MG TAB	PHAR	5.40
GLUCOSE <15GM PO	PHAR	31.10
GLUCOTROL 10 MG	PHAR	9.00
Glutose 15gms	PHAR	24.00
GUAIFENESIN 118ML SUS	PHAR	7.50
GUAIFENESIN AC 30ML SUS	PHAR	9.70
GUAIFENESIN AC 5ML SUS	PHAR	3.00
GUAIFENESIN DM 5ML SUS	PHAR	4.00
HALDOL 2MG TAB	PHAR	9.00
HALOPERIDOL LACTAT<5MGINJ	PHAR	20.00
HCTZ 25MG	PHAR	4.00
HCTZ 50MG TAB	PHAR	4.30
HEP A VACCINE	PHAR	171.00
HEPARIN 10000 UNITS	PHAR	36.00
HEPARIN 5,000	PHAR	29.00
HEPARIN 5000U INJ	PHAR	17.00
HEPARIN FLUSH	PHAR	9.00
HEPARIN SOD PER 5000 INJ	PHAR	36.00
HEPATITIS A PED/ADOLESCENT	PHAR	29.00
HEPATITUS B ADULT INJ	PHAR	238.70
HEPATITUS B CHILD INJ	PHAR	177.00
HPV VACCINE	PHAR	246.10
HPV-GARDASIL	PHAR	789.00
HYDROcodone/Apap 10/325	PHAR	20.00
Hydrocortisone Supp 25mg	PHAR	55.00
HYDROMORPHONE 1MG/ML	PHAR	31.00
HYDROMORPHONE 2MG TAB	PHAR	5.00
HYDROMORPHONE 2MG/ML	PHAR	31.00
HYDROMORPHONE HCL 0.5 MG/ML	PHAR	33.00
HYDROXYZIN HCL CAP 25MG	PHAR	6.00
HYDROXYZINE 50MG/ML	PHAR	92.00
HYDROXYZINE HCL<=25MG INJ	PHAR	41.80
IBUPROFEN 100MG/ML 5ML	PHAR	5.00
IBUPROFEN 400MG TAB	PHAR	5.00
IBUPROFEN 600MG TAB	PHAR	7.00
IMODIUM 2MG TAB	PHAR	6.00
INDERAL 10MG TAB	PHAR	4.30
INDERAL 10MG TAB	PHAR	9.00
INDOCIN 25MG CAP	PHAR	7.00
INFED 50MG	PHAR	91.00
INFLUENZA (HIGH DOSE)	PHAR	140.00
INSULIN LANTUS PER 5 UNITS	PHAR	23.00
INSULIN N 100U/ML 10ML VL	PHAR	68.50
INSULIN N PER 5 UNITS	PHAR	97.00
INSULIN R 100U/ML 10ML VL	PHAR	68.50
INSULIN R PER 5 UNITS	PHAR	9.00
IPOL Polio Vaccine	PHAR	130.00
IPRATROPIUM BROMIDE UD	PHAR	0.00
IRON SUCROSE 200MG	PHAR	33.00
ISOSORBIDE 10MG	PHAR	10.00
KEFLEX 125MG 100CC LIQUID	PHAR	33.20
KEFLEX 250MG TAB	PHAR	4.30
KEFLEX 250MG/5CC 100CC LQ	PHAR	6.00
KEFLEX 500MG TAB	PHAR	15.00
KENALOG 0.1% CREAM	PHAR	30.00
KETAMINE 50 MG/ML IVPB	PHAR	42.00
KETAMINE 500MG INJ	PHAR	42.00
KETORLAC 30 MG/ML	PHAR	17.00
KETORLAC 60MG	PHAR	23.00
KETOROLAC TROMTH 15MG INJ	PHAR	49.00
LABETALOL HCL 5MG INJ	PHAR	22.00
LACTULOSE 15 ML SOL	PHAR	4.00
LANSOPRAZOL/PREVACD 30MG	PHAR	10.00
LASIX 40MG TAB	PHAR	4.00
LASIX 80MG TAB	PHAR	4.30
LEVAQUIN PER 250MG IV	PHAR	17.00
	PHAR	17.00
LEVETIRACETAM 50O MG	PHAR	5.00
LEVETIRACETAM IVP 500 MG/ 5 ML	PHAR	18.00
LEVETIRACETAM IVPB 500 MG/ 5 ML	PHAR	26.00
LEVOFLOXACIN 500 MG	PHAR	16.00
LEVOFLOXACIN 500MG TAB	PHAR	87.00
LEVOTHYROXINE 100MG	PHAR	16.00
LEVOTHYROXINE SODIUM TAB	PHAR	4.30
LIDOCAINE 2% (SYRING)	PHAR	15.00
LIDOCAINE 50CC INJ	PHAR	24.70
LIDOCAINE LOCAL 1-2CC INJ	PHAR	17.00
LIDOCAINE SYRINGE 1%	PHAR	0.00
LIDOCAINE W/D5W	PHAR	16.00
LIDOCAINE/EPI 2%	PHAR	26.00
LILETTA IUD 52MG	PHAR	1,030.00
LISINOPRIL 10MG TAB	PHAR	4.30
LISINOPRIL 5MG TAB	PHAR	5.00
LITHIUM 300MG	PHAR	15.00
LOMOTIL 2.5MG TAB	PHAR	12.00
LOPERAMIDE 2MG	PHAR	12.00
LORATADINE TAB 10 MG	PHAR	0.00
LORAZEPAM 1MG IVPB	PHAR	10.00
LORAZEPAM IM/IVP 2 MG/ML	PHAR	10.00
LORAZEPAM/ATIVAN 1MG TAB	PHAR	4.00
LOTENSION 10MG TAB	PHAR	12.00
LUPRON 7.5 MG INJ	PHAR	2,797.00
MAALOX 30CC LIQUID	PHAR	5.00
MACROBID 100MG TAB	PHAR	27.00
MAG CITRATE 10 OZ LIQUID	PHAR	11.80
MAGNESIUM 300MG TAB	PHAR	4.30
MAGNESIUM CITRATE	PHAR	5.00
MAGNESIUM SULF 500MG INJ	PHAR	8.00
	PHAR	8.00
MAGNESIUM SULFATE IM/IVP 5 GM	PHAR	8.00
MANNITOL	PHAR	9.00
MECLIZINE HCL 25MG TAB	PHAR	4.30
MEDROXYPROGESTERONE TAB 5MG	PHAR	6.00
MEDROXYPROGSTRNE 1 MG	PHAR	205.00
MELATONIN	PHAR	5.00
MENINGOCOCCAL MPSV4	PHAR	230.00
MEPERIDINE PER 100MG INJ	PHAR	55.70
MEROPENEM 100 MG IV	PHAR	87.00
MEROPENEM IVP 500 MG	PHAR	42.00
METAPROTERENOL <10MG INJ	PHAR	31.10
METFROMIN 500MG	PHAR	11.00
METOCLOPRAMIDE <=10MG INJ	PHAR	14.00
	PHAR	14.00
METOCLOPRAMIDE 5MG	PHAR	6.00
METOLAZONE 2.5MG TAB	PHAR	11.00
METOPROLOL <5MG IV	PHAR	14.00
METOPROLOL TARTRATE TAB	PHAR	9.00
METRONIDAZOLE 500 MG	PHAR	16.00
METRONIDAZOLE 500MG TAB	PHAR	11.00
METRONIDZLE/FLGYL 1GM IV	PHAR	66.40
MICONAZOLE NITRATE 2% CREAM	PHAR	10.00
MIDAZOLAM IM/IVP 1 MG	PHAR	10.00
MIDAZOLAM IM/IVP 5 MG	PHAR	10.00
MIDAZOLAM IVPB 1 MG	PHAR	10.00
MIDAZOLAM PER 5 MG INJ	PHAR	10.00
MILK OF MAGNESA 30ML LQUD	PHAR	6.00
MMR VACCINE	PHAR	187.00
MORPHINE SULFATE 30MG TAB	PHAR	4.30
MORPHINE SULFATE IM/IVP 10 MG/ML	PHAR	33.00
MORPHINE SULFATE IM/IVP 4MG/ML	PHAR	33.00
MORPHINE SULFATE IVPB 10 MG/ML	PHAR	33.00
MORPHINE SULFATE IVPB 4 MG	PHAR	33.00
MULTI VIT TAB	PHAR	4.00
MULTI-VIT	PHAR	3.50
MULTIVITAMIN CONCRTE INJ	PHAR	35.00
MUPIROCIN 2% OINT	PHAR	25.00
MYLANTA <30CC	PHAR	3.00
NAFCILIIN	PHAR	80.00
NALOXONE 0.4MG IVPB	PHAR	80.00
NALOXONE 1 MG IVPB	PHAR	102.00
	PHAR	102.00
NALOXONE IM/IVP 0.4 MG	PHAR	80.00
NAPROSYN 250MG TAB	PHAR	11.00
Naproxen 500mg	PHAR	11.00
NASAL SPRAY	PHAR	8.60
Neo/Poly/Bac Ointment	PHAR	32.00
Neo/Poly/HC Suspension	PHAR	53.00
NEOSPORIN 1/32 OZ TOPICAL	PHAR	4.30
NEOSPORIN OPTH SOL	PHAR	147.00
NEULASTA 6MG INJ	PHAR	4,983.00
NEUPOGEN 300MCG	PHAR	574.00
NEXPLANON	PHAR	940.00
NICOTINE PATCH 14 MH	PHAR	0.00
NICOTINE PATCH 21MG	PHAR	20.00
NIFEDIPINE CAP 30MG	PHAR	17.00
NITRO 25MG/250ML	PHAR	90.00
NITROGLYCERIN	PHAR	12.00
NITROGLYCERIN 2% OINTMENT	PHAR	10.00
NITROGLYCERIN 50MG INJ	PHAR	49.30
NITROGLYCERIN SPRAY	PHAR	140.00
NITROGLYCERIN TAB	PHAR	4.30
NORCO	PHAR	7.00
NOREPINEPHRINE 4 MG	PHAR	105.00
NORVASC 5MG TAB	PHAR	27.00
NYSTATIN CREAM	PHAR	13.00
NYSTATIN CREAM 1M	PHAR	24.70
OFLOXAXIN	PHAR	209.00
OLANZAPINE 5 MG	PHAR	6.00
OMEPRAZOLE 20MG CAP	PHAR	25.00
OMNIPAQUE CT CONTRAST ZERO CHARGE 340B	PHAR	0.00
ONDANSETRON HCL IV PER MG	PHAR	8.00
	PHAR	8.00
ONDANSETRON HCL TAB 4MG	PHAR	6.00
ONDANSETRON ODT 8MG	PHAR	6.00
OPTHAINE OPTHAMALIC 15ML	PHAR	128.00
ORAJEL	PHAR	0.00
ORPHENADRINE CIT<=60MG IN	PHAR	63.00
	PHAR	63.00
Oseltamivir 30MG	PHAR	34.00
Oseltamivir 75mg	PHAR	87.00
OTIC SOL/AURALGAN GTTS	PHAR	3.00
OXYTOCIN <=10 UN INJ	PHAR	19.00
OYSTER SHELL CALCIUM	PHAR	0.00
PANTOPRAZOLE TAB 40 MG	PHAR	5.00
PARAGUARD IUD	PHAR	125.00
Paroxetine 20mg	PHAR	26.00
PEDIA-LAX	PHAR	0.00
PEN G 5 MILLION	PHAR	83.00
	PHAR	83.00
PEN G BENZ/LA 100,000 units	PHAR	196.00
PEN VK 250MG	PHAR	5.00
PEN VK 250MG/5CC 100ML	PHAR	4.00
PEN VK 500MG TAB	PHAR	11.00
PEN VK SUSP 125MG	PHAR	4.00
PENICILLIN VK 250MG	PHAR	11.00
PEPCID 20MG TAB	PHAR	17.00
PERCOCET -5 TAB	PHAR	15.00
PERMETHRIN 5% CREAM	PHAR	8.00
PERMETHRIN CREAM	PHAR	7.00
PEROXYL	PHAR	0.00
PHENERGAN 25MG SUPPOSITOR	PHAR	12.90
PHENERGAN 25MG TAB	PHAR	4.30
PHENYTOIN SODIUM 100MG TB	PHAR	10.00
PHENYTOIN SUSP 125MG	PHAR	11.00
PHYSOSTGMINE	PHAR	105.00
PHYTONADIONE IM 1 MG/0.5ML	PHAR	58.00
PILOCARPINE 1%	PHAR	36.00
PIPERACILLIN IVPB 3.375 GM	PHAR	77.00
PIPERACILLIN/TAZOBACTAM 2.25 MG IVPB	PHAR	77.00
PITOCIN	PHAR	17.00
PITOCIN 10UN/ML	PHAR	17.00
PNEUMO 13 VACC INJ MEDICARE	PHAR	0.00
PNEUMO 23 VACCINE INJ MEDICARE	PHAR	0.00
PNEUMOCOCCAL VAC INJ	PHAR	368.00
POLY B/SULF/TRI	PHAR	46.00
PONTOCAINE .5% 4 DROPS	PHAR	4.30
POTASIUM CHLORIDE 10MEG/100ML	PHAR	36.40
POTASIUM CHLORIDE 10MEQ/50ML	PHAR	16.00
POTASSIUM 20MEQ/15ML	PHAR	11.00
POTASSIUM CHLORIDE 10% 30	PHAR	4.30
POTASSIUM CHLORIDE IVPB 10 MEQ PREMIX	PHAR	16.00
POTASSIUM CHLORIDE ORAL SOLUTION 20MEQ	PHAR	15.00
POTASSIUM CL 10MEQ TAB	PHAR	7.00
POTASSIUM CL 20 MEQ	PHAR	3.00
POTASSIUM CL EA 2 MEQ INJ	PHAR	16.00
	PHAR	16.00
Prednisilone 15mg/5ml	PHAR	8.00
PREDNISOLONE 1%	PHAR	58.00
PREDNISONE 10MG TAB	PHAR	4.30
PREDNISONE 20MG TAB	PHAR	9.00
PREDNISONE 30 CC ELIX	PHAR	5.40
PREDNISONE 5CC ELIX	PHAR	11.00
PREDNISONE 5MG TAB	PHAR	5.00
PREVNAR 13	PHAR	373.00
PRILOSEC 20MG TAB	PHAR	11.80
PRIMAXIN 500MG	PHAR	164.00
PROAIR	PHAR	195.00
PROBIOTIC	PHAR	0.00
PROCAINAMIDE 100MG/ML INJ	PHAR	58.00
PROCARDIA 30MG TAB	PHAR	12.00
PROCHLORPERAZINE <=10MG I	PHAR	63.00
	PHAR	63.00
PROCHLORPERAZINE 10MG TAB	PHAR	12.00
PROCHLORPERAZINE IM/IVP 5 MG/ML	PHAR	63.00
PROCHLORPRZN/COMPZ SUP 25	PHAR	30.00
PROLIA 60 MG INJ	PHAR	1,372.90
PROMETHAZINE 25MG IM	PHAR	15.00
PROMETHAZINE HCL<50MG IVPB	PHAR	17.00
PROMETHAZINE TAB 25 MG	PHAR	13.00
PROMTHAZINE SUPP 25MG	PHAR	92.00
PROPOFOL 10 ML INJ	PHAR	2.25
PROPOFOL 100ML	PHAR	73.00
PROPRANOLOL 10MG	PHAR	7.00
PROTAMINE SULFATE 250MG/25ML	PHAR	23.00
PROTONIX 40MG IV	PHAR	157.00
PROVENTIL 2.5 MG	PHAR	0.00
PROVENTIL INHAL 5 MG	PHAR	0.00
PROZAC 20MG TAB	PHAR	15.00
PSEUDOEPHEDRN HCL/ACTF TB	PHAR	4.30
PULMICORT/BUDESONIDE NEB	PHAR	312.50
PYRIDIUM 100MG TAB	PHAR	4.30
PYRIDIUM 200MG TAB	PHAR	22.00
RABIES IMM GLOB (Rig=HT)	PHAR	1,104.00
RABIES VACC POST EXPOSURE	PHAR	264.00
RANITIDINE 150MG TAB	PHAR	5.00
RANITIDINE HCL 50MG INJ	PHAR	35.00
	PHAR	35.00
RANITIDINE IM/IVP 25 MG	PHAR	35.00
REGLAN 10MG TAB	PHAR	4.30
RESTORIL 15MG TAB	PHAR	10.00
RESTORIL 30MG TAB	PHAR	4.30
RhoGam	PHAR	255.00
ROCURONIUM 10 MG	PHAR	9.00
SENNA	PHAR	0.00
SERTRALIN HCL/ZOLOFT 25MG	PHAR	11.80
SILVADENE 1%<50GM TOPICAL	PHAR	6.00
SILVADENE CREAM	PHAR	65.00
SILVER NITRATE STICK	PHAR	0.00
Simethicone 80mg tablet	PHAR	4.00
SODIUM BICARB 4%	PHAR	25.00
SODIUM BICARB 4.2	PHAR	45.00
SODIUM BICARB 8.4%	PHAR	50.00
SODIUM BICARBONATE 84	PHAR	17.00
SODIUM CHLORIDE INHAL 3%	PHAR	0.00
SODIUM CHLORIDE INHAL 9%	PHAR	0.00
SODIUM POLY SULF 15GM SUS	PHAR	38.50
SOLU-CORTEF 100 MG IM/IVP	PHAR	67.00
SOLU-CORTEF 100 MG IVPB	PHAR	67.00
	PHAR	67.00
SOLU-CORTEF 250 MG	PHAR	74.90
SOLU-MEDROL <=125MG INJ	PHAR	66.00
	PHAR	66.00
SOLU-MEDROL <=40MG INJ	PHAR	69.60
SOLU-MEDROL 1 GRAM	PHAR	158.00
SOLU-MEDROL 500 MG	PHAR	126.00
SPIRIVA	PHAR	376.70
SPIRONOLCTN/ADLACTONE TB	PHAR	8.00
STERILE WATER	PHAR	9.00
SUCCINYLCHNE 20MG INJ	PHAR	26.00
	PHAR	26.00
SUDOGEST	PHAR	4.00
SULF/TRIM 200/40MG/5MLSUS	PHAR	8.00
SULF/TRIM 800/160MG TAB	PHAR	5.00
SULFACETAMD SOD 10%	PHAR	136.00
SUMATRIPTAN SUCC 6MG INJ	PHAR	262.00
TAMSULOSIN 0.4MG	PHAR	6.00
TD VACC PRSV FREE 7 YRS & OLDER	PHAR	169.00
TDAP VACCINE	PHAR	203.00
TEGRETOL 200MG TAB	PHAR	13.00
TENECTEPLASE (TNK) 50MGIV	PHAR	8,173.00
TH CLINDAMYCIN 6 PK	PHAR	12.90
THERA-TAB (MULTI-VIT0	PHAR	0.00
THIAMINE 100MG INJ	PHAR	32.00
THYROID 120MG TAB	PHAR	4.30
THYROID 60MG TAB	PHAR	4.30
TRANEXAMIC ACID	PHAR	19.00
TRAZODONE HCL 50MG	PHAR	7.00
TRIAMCINOLONE /10MG INJ	PHAR	64.00
TRIAMCINOLONE CREAM <15GM	PHAR	4.30
TRUVADA	PHAR	204.00
TYLENOL 325MG TAB	PHAR	4.00
TYLENOL 5CC LIQUID	PHAR	5.00
TYLENOL 650MG TAB	PHAR	4.30
TYLENOL ELIXIR 4 OZ	PHAR	11.80
TYLENOL W/CODEINE 30CC LQ	PHAR	12.90
TYLENOL W/CODEINE 30MG TB	PHAR	7.00
VALIUM 10MG TAB	PHAR	7.00
VALIUM 5MG TAB	PHAR	5.40
VALPROIC ACID/DEPKN 250MG	PHAR	4.30
VANCOMYCIN 1.5 GM	PHAR	164.00
VANCOMYCIN 1GM	PHAR	43.00
VANCOMYCIN INJ 750 MG	PHAR	80.00
VANCOMYCIN IVPB 250-1000 MG	PHAR	43.00
VARICELLA VACC-PT > 19Y/O	PHAR	190.00
VECURONIUM BROMIDE IV	PHAR	56.80
VERAPAMIL 2.5MG INJ	PHAR	51.00
VERAPAMIL 80MG	PHAR	6.00
VFC- ACTHIB DTAP-IPV-HIB	PHAR	0.00
VFC- ACTHIB- HAEMOPHILUS B (HIB)	PHAR	0.00
VFC- BOOSTRIX	PHAR	0.00
VFC- HEPATITIS A	PHAR	0.00
VFC- HEPATITIS B	PHAR	0.00
VFC- HEPATITITS B	PHAR	0.00
VFC- INFANRIX PED	PHAR	0.00
VFC- INFLUENZA VAC	PHAR	0.00
VFC- KINRIX	PHAR	0.00
VFC- M-M-R	PHAR	0.00
VFC- MENACTRA	PHAR	0.00
VFC- MENINGOCOCCAL B	PHAR	0.00
VFC- PENTACEL	PHAR	0.00
VFC- POLIOMYELITIS	PHAR	0.00
VFC- PREVNAR 13	PHAR	0.00
VFC- ROTAVIRUS	PHAR	0.00
VFC- VARICELLA	PHAR	0.00
VFC-GARDASIL 9	PHAR	0.00
VFC-KINRIX	PHAR	0.00
VFC-PEDIARIX	PHAR	0.00
VICODIN PO	PHAR	4.30
VISIPAQUE CT CONTRAST ZERO CHARGE 340B	PHAR	0.00
VITAMIN B-CMPLX 100MG INJ	PHAR	39.60
VITAMIN D3 2000IU	PHAR	0.00
VITAMIN D3 5000IU	PHAR	0.00
VITAMIN K PER MG INJ	PHAR	58.00
	PHAR	58.00
WARFARIN 5MG	PHAR	9.00
WARFARIN 5MG	PHAR	5.25
XOLAIR 225MG SQ	PHAR	2,936.00
XOPENEX UD INHL	PHAR	0.00
XYLOCAINE 1% 1CC INJ	PHAR	0.00
XYLOCAINE 1% W/EPI	PHAR	19.00
XYLOCAINE 2% 1CC INJ	PHAR	0.00
XYLOCAINE 2% W/EPI 1CC IN	PHAR	0.00
XYLOCAINE JELLY 1GM	PHAR	11.00
XYLOCAINE JELLY 30GM	PHAR	20.40
XYLOCAINE VISC	PHAR	3.00
XYLOCAINE VISC BOTTLE	PHAR	32.10
XYLOCAINE/W EPI 1%	PHAR	0.00
Zinc 50mg	PHAR	3.00
ZOLEDRONIC EA 5MG INJ	PHAR	187.00
ZOSYN 1G/0.125G 1.125 IV	PHAR	77.00
CURRENT MOBIL STAT CJ	PT	0.00
MAN THERAPY 1+ REGIONS, EA 15 MIN	PT	83.00
MOBILITY CURRENT STATU CM	PT	0.00
MOBILITY GOAL STATUS CI	PT	0.00
MOBILITY GOAL STATUS CK	PT	0.00
MOBILITY GOAL STATUS CL	PT	0.00
PT ELEC STIM ATTN / 15MIN	PT	87.40
PT EVAL FOLLOW-UP	PT	139.30
PT EVAL HIGH COMPLEX 45MIN	PT	385.90
PT EVAL INITIAL	PT	429.50
PT EVAL LOW COMPLEX 20MIN	PT	248.20
PT EVAL MOD COMPLEX 30MIN	PT	303.30
PT GAIT TRNG/STAIR /15MIN	PT	86.30
PT NEURO MSCL RE-ED /15MI	PT	98.00
PT RE-EVAL EST PLAN CARE	PT	154.40
PT THERAPU EX /15MIN	PT	98.00
PT ULTRASOUND ATTN / 15MI	PT	47.20
Self Care / Home Mngmt Training	PT	68.50
ST DYSPHAGIA INDIVID	PT	235.95
ST EVAL DYSPHAGIA	PT	381.20
THERAPEUTIC ACTV EA 15MIN	PT	68.50
Family psychotherapy w/ patient present	SLS	375.00
Family psychotherapy w/o patient present	SLS	375.00
Group Psychotherapy	SLS	295.00
Individual Psychotherapy 16-37 mins	SLS	325.00
Individual Psychotherapy 38-52 mins	SLS	350.00
Individual Psychotherapy 53-67 mins	SLS	375.00
Telehealth Fee SLS	SLS	50.00
GLUCOSE BY REAGENT STRIP	SNF	22.00
SKILLED NURSING BED CHG	SNF	499.53
SNF BED HOLD / LOA	SNF	499.53
SNF BED HOLD/M-CAL	SNF	370.00
BEHAVRAL & QUALIT ANALYS VOICE	ST	267.80
COGNITIVE SKILLS DEVELOPMENT	ST	79.10
CONGITIVE TEST BY HC PRO	ST	350.40
EVAL FOR NONSPEECH DEV RX ADD 30 MIN	ST	96.80
EVAL FOR NONSPEECH DEVICE RX	ST	265.50
EVAL FOR SPEECH DEVICE RX 1ST HR	ST	377.55
EVAL FOR SPEECH DEVICE RX EA ADDL 30 MIN	ST	155.80
EVAL SWALLOWING FUNCTION	ST	218.30
Medical team conf w/ nonphys, 30min more	ST	103.55
ORAL SPEECH DEVICE EVAL	ST	214.80
SPEECH SOUND LANG COMPREHENSION	ST	578.10
ST EVAL SPEECH	ST	443.70
ST LANGUAGE INDIV	ST	280.80
ST SPEECH INDIV	ST	280.80
TEAM CONFERENCE FACE-TO-FACE NON PHYS	ST	113.40
THER SERV NONSPEECH DEVICE	ST	212.40
TX SWALLOWING DYSFUNCTION	ST	256.05
USE OF SPEECH DEVICE SERVICE	ST	330.35
GLUCOSE, BY REAGENT STRIP	SWB	26.05
OCCULT BLOOD FECES	SWB	82.60
Other Facility CT - Part A Stay	SWB	2,096.90
SWB BED HOLD / LOA	SWB	707.80
SWING BED CHARGE	SWB	707.80
ABD COMP INCL DECUB/ERECT	XR	726.90
ABD COMP W/PA CHEST	XR	311.70
ABD SINGLE AP VIEW (KUB)	XR	630.30
ABDOMEN 1 VW	XR	163.10
ABDOMEN 2 VW	XR	311.75
ABDOMEN 3 OR MORE VW	XR	311.75
ACROMIOCLAVICULAR JTS/BIL	XR	163.10
ANKLE COMP 3V+ BILAT	XR	326.15
ANKLE COMP 3V+ L	XR	163.10
ANKLE COMP 3V+ R	XR	163.10
ANKLE LTD 2V BILAT	XR	326.15
ANKLE LTD 2V BILAT	XR	326.15
ANKLE LTD 2V L	XR	163.10
ANKLE LTD 2V R	XR	163.10
BONE AGE STUDIES	XR	311.70
BONE SURVEY COMP W/LNG BO	XR	311.70
BONE SURVEY INFANT	XR	132.60
C-SPINE FLEXION / EXTENSION ONLY	XR	163.10
CALCANEUS 2V BILAT	XR	326.15
CALCANEUS 2V+ L	XR	163.10
CALCANEUS 2V+ R	XR	163.10
CHEST 1 VW	XR	163.10
CHEST 1V FRONTAL	XR	578.70
CHEST 2 VW	XR	163.10
CHEST 2 VW	XR	163.10
CHEST 2V FRONTAL/LAT	XR	749.40
CHEST 2V W/LORDOTIC	XR	373.10
CHEST 3 VW	XR	163.10
CHEST 4 OR MORE VW	XR	311.75
CHEST SP VW DECUB/BUCKY	XR	133.80
CLAVICLE COMP L	XR	163.10
CLAVICLE COMP R	XR	163.10
ELBOW 2VW BILATERAL	XR	326.15
ELBOW COMP 3V BILAT	XR	326.15
ELBOW COMP 3V+ L	XR	163.10
ELBOW COMP 3V+ R	XR	163.10
ELBOW LTD 2V L	XR	163.10
ELBOW LTD 2V R	XR	163.10
FACIAL BONES 1 OR 2 VIEWS	XR	163.10
FACIAL BONES COMPL/3V MIN	XR	311.70
FEMUR 2V L	XR	678.60
FEMUR 2V R	XR	678.60
FEMUR MIN 2 V LT	XR	163.10
FEMUR MIN 2 V RT	XR	163.10
FINGER 2ND DIGIT L	XR	163.10
FINGER 2ND DIGIT R	XR	163.10
FINGER 3RD DIGIT L	XR	163.10
FINGER 3RD DIGIT R	XR	163.10
FINGER 4TH DIGIT L	XR	163.10
FINGER 4TH DIGIT R	XR	163.10
FINGER 5TH DIGIT L	XR	163.10
FINGER 5TH DIGIT R	XR	163.10
FINGER THUMB L	XR	163.10
FINGER THUMB R	XR	163.10
FINGERS 2V+ L	XR	163.10
FINGERS 2V+ R	XR	163.10
FOOT 2V BILATERAL	XR	326.15
FOOT 2V L	XR	163.10
FOOT 2V R	XR	163.10
FOOT 3V BILATERAL	XR	326.15
FOOT COMP 3V+ L	XR	163.10
FOOT COMP 3V+ R	XR	163.10
FOREARM 2V BILAT	XR	326.15
FOREARM 2V L	XR	163.10
FOREARM 2V R	XR	163.10
FOREIGN BODY CHILD 1 V	XR	163.10
HAND 2V BILATERAL	XR	623.40
HAND 2V L	XR	311.70
HAND 2V R	XR	311.70
HAND 3V+ BILATERAL	XR	326.15
HAND 3V+ L	XR	163.10
HAND 3V+ R	XR	163.10
HIP & PELVIS UNILAT 1 VW L	XR	477.55
HIP & PELVIS UNILAT 1 VW L	XR	163.10
HIP & PELVIS UNILAT 1 VW R	XR	163.10
HIP BILAT INC PELVIS	XR	906.70
HIP UNILAT 1V L	XR	477.55
HIP UNILAT 1V R	XR	477.55
HIP UNILAT 2-3 V LT	XR	163.10
HIP UNILAT 2-3 V RT	XR	163.10
HIP UNILAT COMP 2-3V+ L	XR	669.70
HIP UNILAT COMP 2-3V+ R	XR	669.70
HIPS BILAT W PELVIS 2 V	XR	311.70
HIPS BILAT W PELVIS 3-4 V	XR	311.70
HUMERUS 2V+ L	XR	163.10
HUMERUS 2V+ R	XR	163.10
KNEE 1-2V BILATERAL	XR	326.15
KNEE 1-2V R	XR	163.10
KNEE 3V BILATERAL	XR	326.15
KNEE 3V L	XR	163.10
KNEE 3V R	XR	163.10
KNEE BILAT STANDING AP	XR	163.10
KNEE COMP 4V BILATERAL	XR	623.30
KNEE COMP 4V L	XR	311.70
KNEE COMP 4V R	XR	311.70
KNEE/PATELLA 1-2V L	XR	163.10
KNEE/PATELLA 1-2V L	XR	163.10
KNEE/PATELLA 1-2V R	XR	712.30
KNEE/PATELLA 1-2V R	XR	163.10
LOWER EXTREM-INFANT L	XR	163.10
LOWER EXTREM-INFANT R	XR	163.10
LOWER EXTREMITY INFANT L	XR	111.30
MANDIBLE PRTL 1-3V BILAT	XR	326.15
MANDIBLE PRTL 1-3V R	XR	163.10
MANDIBLE PRTL/1-3V L	XR	163.10
NASAL BONES/3V MIN	XR	163.10
NECK/SOFT TISSUE	XR	163.10
ORBITS/4V MIN	XR	311.70
PELVIS AP 1-2V	XR	311.70
PELVIS COMP 3 VW MIN	XR	297.80
POST PROCEDURE PLACEMENT XRAY	XR	0.00
RIBS BILAT MIN 3V	XR	311.70
RIBS BILAT W/PA CHEST 4V	XR	311.70
RIBS UNILAT 2V MIN L	XR	163.10
RIBS UNILAT 2V+ R	XR	163.10
RIBS UNILAT W/PA CXR 3V L	XR	311.70
RIBS UNILAT W/PA CXR 3V R	XR	311.70
SACROILIAC JNTS MIN 3V	XR	311.70
SACRUM/COCCYX MIN 2V	XR	163.10
SCAPULA COMP L	XR	311.70
SCAPULA COMP R	XR	311.70
SHOULDER COMP 2V+ L	XR	163.10
SHOULDER COMP 2V+ R	XR	163.10
SHOULDER LTD 1V L	XR	163.10
SHOULDER LTD 1V R	XR	163.10
SHOULDERS 2V+ BILAT	XR	326.15
SI JOINTS LESS THAN 3 VWS	XR	311.70
SINUSES/PARANASAL 1 OR 2V	XR	163.10
SINUSES/PARANASAL 3V MIN	XR	163.10
SKULL COMP 4V	XR	311.70
SKULL LTD/1-3V	XR	311.70
SPINE CERVICAL AP/LAT	XR	163.10
SPINE CERVICAL COMP 4V+	XR	311.70
SPINE CERVICAL W/FLEX EXT	XR	311.70
SPINE LUMBOSACRAL AP/LAT	XR	311.70
SPINE LUMBOSACRAL BEND ONLY	XR	300.50
SPINE LUMBOSACRAL W/BEND	XR	311.70
SPINE LUMBOSACRAL W/OBL	XR	311.70
SPINE SCOLIOSIS ERECT	XR	512.40
SPINE SINGLE VIEW	XR	163.10
SPINE THORACIC AP/LAT	XR	311.70
SPINE THORACIC W/SWIMMER	XR	311.70
SPINE THORACOLUMBAR 2V	XR	163.10
SPINE, ENTIRE, 1VW	XR	163.10
STERNUM MIN 2V	XR	163.10
TIBIA/FIBULA 2V BILAT	XR	326.15
TIBIA/FIBULA 2V L	XR	163.10
TIBIA/FIBULA 2V R	XR	163.10
TMJ JOINTS BILATERAL	XR	163.10
TOE 2V BIG DIGIT L	XR	163.10
TOE 2V BIG DIGIT R	XR	163.10
TOES 2V+ BILAT	XR	326.15
TOES 2V+ L	XR	163.10
TOES 2V+ R	XR	163.10
UPPER EXTREMITY INFANT L	XR	311.70
UPPER EXTREMITY INFANT R	XR	311.70
WRIST COMP 3V+ BILATERAL	XR	326.15
WRIST COMP 3V+ L	XR	163.10
WRIST COMP 3V+ R	XR	163.10
WRIST LTD 2V BILAT	XR	326.15
WRIST LTD 2V L	XR	163.10
WRIST LTD 2V R	XR	163.10
WRIST NAVICULAR 2V L	XR	163.10
WRIST NAVICULAR 2V R	XR	163.10
ABD COMP W/PA CHEST PRO FEE	XRMD	43.50
ABDOMEN 1 VW PRO FEE	XRMD	31.50
ABDOMEN 2 VW PRO FEE	XRMD	31.50
ABDOMEN 3 OR MORE VW PRO FEE	XRMD	36.90
ACROMIOCLAVICULAR JTS/BIL PRO FEE	XRMD	31.50
ANKLE COMP 3V LT PRO FEE	XRMD	31.50
ANKLE COMP 3V+ BILAT PRO FEE	XRMD	94.50
ANKLE COMP 3V+ RT PRO FEE	XRMD	31.50
ANKLE LTD 2V BILAT PRO FEE	XRMD	63.00
ANKLE LTD 2V LT PRO FEE	XRMD	31.50
ANKLE LTD 2V RT PRO FEE	XRMD	31.50
BONE AGE STUDIES PRO	XRMD	31.50
BONE SURVEY SOMP W/LNG BO PRO FEE	XRMD	72.80
C-SPINE FLEXION / EXTENSION ONLY PRO FEE	XRMD	31.50
CALCANEUS 2V BILAT PRO FEE	XRMD	86.95
CALCANEUS 2V+ LT PRO FEE	XRMD	31.50
CALCANEUS 2V+ RT PRO FEE	XRMD	31.50
CHEST 1 VW PRO FEE	XRMD	31.50
CHEST 2 VW PRO FEE	XRMD	31.50
CHEST 3 VW PRO FEE	XRMD	37.80
CHEST 4 OR MORE VW PRO FEE	XRMD	43.50
CLAVICLE COMP LT PRO FEE	XRMD	31.50
CLAVICLE COMP RT PRO FEE	XRMD	31.50
ELBOW 2VW BILATERAL PRO FEE	XRMD	43.50
ELBOW COMP 3V BILAT PRO FEE	XRMD	47.30
ELBOW COMP 3V+ LT PRO FEE	XRMD	31.50
ELBOW COMP 3V+ RT PRO FEE	XRMD	31.50
ELBOW LTD 2V LT PRO FEE	XRMD	31.50
ELBOW LTD 2V RT PRO FEE	XRMD	31.50
FACIAL BONES 1 OR 2 VIEWS PRO FEE	XRMD	31.50
FACIAL BONES COMPL/3V MIN PRO FEE	XRMD	35.90
FEMUR MIN 2 V LT PRO FEE	XRMD	31.50
FEMUR MIN 2 V RT PRO FEE	XRMD	31.50
FINGER 2ND DIGIT L PRO FEE	XRMD	31.50
FINGER 2ND DIGIT R PRO FEE	XRMD	31.50
FINGER 3RD DIGIT L PRO FEE	XRMD	31.50
FINGER 3RD DIGIT R PRO FEE	XRMD	31.50
FINGER 4TH DIGIT L PRO FEE	XRMD	31.50
FINGER 4TH DIGIT R PRO FEE	XRMD	31.50
FINGER 5TH DIGIT L PRO FEE	XRMD	31.50
FINGER 5TH DIGIT R PRO FEE	XRMD	31.50
FINGER THUMB L PRO FEE	XRMD	31.50
FINGER THUMB R PRO FEE	XRMD	31.50
FINGERS 2V+ L PRO FEE	XRMD	31.50
FINGERS 2V+ R PRO FEE	XRMD	31.50
FOOT 2V BILATERAL PRO FEE	XRMD	83.20
FOOT 2V LT PRO FEE	XRMD	31.50
FOOT 2V RT PRO FEE	XRMD	31.50
FOOT 3V BILATERAL PRO FEE	XRMD	90.70
FOOT COMP 3V+ L PRO FEE	XRMD	31.50
FOOT COMP 3V+ R PRO FEE	XRMD	31.50
FOREARM 2V BILAT PRO FEE	XRMD	45.40
FOREARM 2V LT PRO FEE	XRMD	31.50
FOREARM 2V RT PRO FEE	XRMD	31.50
FOREIGN BODY CHILD 1V PRO	XRMD	31.50
HAND 2V BILATERAL PRO FEE	XRMD	45.40
HAND 2V LT PRO FEE	XRMD	31.50
HAND 2V R PRO	XRMD	31.50
HAND 3V+ BILATERAL PRO FEE	XRMD	47.30
HAND 3V+ LT PRO FEE	XRMD	31.50
HAND 3V+ RT PRO FEE	XRMD	31.50
HIP & PELVIS UNILAT 1 VW LT PRO FEE	XRMD	31.50
HIP & PELVIS UNILAT 1 VW RT PRO FEE	XRMD	31.50
HIP BILAT INC PELVIS PRO	XRMD	60.70
HIP UNILAT 2-3 V LT PRO FEE	XRMD	31.50
HIP UNILAT 2-3 V RT PRO FEE	XRMD	31.50
HIPS BILAT W PELVIS 2 V PRO FEE	XRMD	63.00
HIPS BILAT W PELVIS 3-4 V PRO FEE	XRMD	40.65
HUMERUS 2V+ LT PRO FEE	XRMD	31.50
HUMERUS 2V+ RT PRO FEE	XRMD	31.50
KNEE 1-2V BILATERAL PRO FEE	XRMD	90.70
KNEE 1-2V L PRO	XRMD	31.50
KNEE 3V BILATERAL PRO FEE	XRMD	102.10
KNEE 3V LT PRO FEE	XRMD	31.50
KNEE 3V RT PRO FEE	XRMD	31.50
KNEE BILAT STANDING AP PRO FEE	XRMD	63.00
KNEE COMP 4V BILATERAL PRO FEE	XRMD	63.00
KNEE COMP 4V LT PRO FEE	XRMD	31.50
KNEE COMP 4V RT PRO FEE	XRMD	31.50
KNEE/PATELLA 1-2V LT PRO-FEE	XRMD	31.50
KNEE/PATELLA 1-2V R PRO	XRMD	31.50
KNEE/PATELLA 1-2V RT	XRMD	31.50
LOWER EXTREM-INFANT L PRO FEE	XRMD	31.50
LOWER EXTREM-INFANT R PRO FEE	XRMD	31.50
MAMM DX UNILATERAL PRO FEE	XRMD	115.50
MAMM SCREENING CAD PRO FEE	XRMD	21.55
MAMMOGRAPHY SCREEN BILAT W/CAD PRO FEE	XRMD	122.65
MAMMOGRAPHY SCREENING PRO FEE	XRMD	101.10
MANDIBLE PRTL 1-3V BILAT PRO FEE	XRMD	49.15
MANDIBLE PRTL 1-3V L PRO FEE	XRMD	31.50
MANDIBLE PRTL 1-3V R PRO FEE	XRMD	31.50
NASAL BONES/3V MIN PRO FEE	XRMD	31.50
NECK/SOFT TISSUE PRO FEE	XRMD	31.50
ORBITS 4V MIN PRO	XRMD	38.75
PELVIS AP 1-2V PRO FEE	XRMD	31.50
POST PROCEDURE PLACEMENT XRAY PRO FEE	XRMD	0.00
RADIOLOGIST FEE 71010	XRMD	39.40
RADIOLOGIST FEE 71020	XRMD	47.30
RADIOLOGIST FEE 71021	XRMD	59.65
RADIOLOGIST FEE 71035	XRMD	61.85
RADIOLOGIST FEE 72069	XRMD	64.10
RADIOLOGIST FEE 73500	XRMD	40.55
RADIOLOGIST FEE 73500	XRMD	55.15
RADIOLOGIST FEE 73510	XRMD	48.40
RADIOLOGIST FEE 73510	XRMD	48.40
RADIOLOGIST FEE 73550	XRMD	40.55
RADIOLOGIST FEE 73550	XRMD	40.55
RADIOLOGIST FEE 74000	XRMD	47.30
RADIOLOGIST FEE 74020	XRMD	55.15
RIBS BILAT MIN 3V PRO	XRMD	39.70
RIBS BILAT W/PA CHEST 4VN PRO FEE	XRMD	44.40
RIBS UNILAT 2V MIN RT PRO FEE	XRMD	31.50
RIBS UNILAT W/PA CXR 3V LT PRO FEE	XRMD	36.80
RIBS UNILAT W/PA CXR 3V RT PRO FEE	XRMD	36.80
RIBS UNILATERAL 2V MIN LT PRO FEE	XRMD	31.50
SACROILIAC JNTS MIN 3V PRO FEE	XRMD	31.50
SACRUM/COCCYX MIN 2V PRO FEE	XRMD	31.50
SCAPULA COMP LT PRO FEE	XRMD	56.20
SCAPULA COMP R PRO	XRMD	31.50
SHOULDER LTD 1V LT PRO FEE	XRMD	31.50
SHOULDER LTD 1V RT PRO FEE	XRMD	31.50
SHOULDERS 2V+ LT PRO FEE	XRMD	31.50
SHOULDERS 2V+ BILAT PRO FEE	XRMD	51.05
SHOULDERS 2V+ RT PRO FEE	XRMD	31.50
SI JOINTS LESS THAN 3 VWS PRO FEE	XRMD	31.50
SINUSES/PARANASAL 1 OR 2V PRO FEE	XRMD	31.50
SINUSES/PARANASAL 3V MIN PRO FEE	XRMD	34.00
SKULL COMP 4V PRO	XRMD	47.30
SKULL LTD/1-3V PRO FEE	XRMD	34.00
SPINE CERVICAL AP/LAT PRO FEE	XRMD	31.50
SPINE CERVICAL COMP 4V+ PRO FEE	XRMD	42.55
SPINE CERVICAL W/FLEX EXT PRO	XRMD	49.15
SPINE LUMBOSACRAL AP/LAT PRO FEE	XRMD	31.50
SPINE LUMBOSACRAL BEND ONLY PRO FEE	XRMD	108.70
SPINE LUMBOSACRAL W/BEND PRO FEE	XRMD	44.40
SPINE LUMBOSACRAL W/OBL PRO FEE	XRMD	42.55
SPINE SINGLE VIEW PRO FEE	XRMD	31.50
SPINE THORACIC AP/LAT PRO FEE	XRMD	31.50
SPINE THORACIC W/SWIMMER PRO FEE	XRMD	31.50
SPINE THORACOLUMBAR 2V PRO FEE	XRMD	31.50
SPINE, ENTIRE, 1VW PRO FEE	XRMD	35.90
STERNUM MIN 2V PRO FEE	XRMD	31.50
TIBIA/FIBULA 2 V BILAT PRO FEE	XRMD	90.70
TIBIA/FIBULA 2V LT PRO FEE	XRMD	31.50
TIBIA/FIBULA 2V RT PRO FEE	XRMD	31.50
TMJ JOINTS BILATERAL PRO FEE	XRMD	33.10
TOE 2V BIG DIGIT L PRO FEE	XRMD	31.50
TOE 2V BIG DIGIT R PRO FEE	XRMD	31.50
TOES 2V+ BILAT PRO FEE	XRMD	63.00
TOES 2V+ L PRO FEE	XRMD	31.50
TOES 2V+ R PRO FEE	XRMD	31.50
UPPER EXTREM INFANT L PRO	XRMD	31.50
UPPER EXTREM INFANT R PRO	XRMD	31.50
WRIST 2 VW LT PRO FEE	XRMD	31.50
WRIST 2V RT PRO FEE	XRMD	31.50
WRIST COMP 3V+ BILAT PRO FEE	XRMD	47.30
WRIST COMP 3V+ LT PRO FEE	XRMD	31.50
WRIST COMP 3V+ RT PRO FEE	XRMD	31.50
WRIST LTD 2V BILAT PRO FEE	XRMD	47.30
WRIST LTD 2V L PRO FEE	XRMD	31.50
WRIST LTD 2V R PRO	XRMD	31.50

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