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Patient Pricing - Riceland Healthcare

Riceland Medical Center determines its standard charges for patient services with the use of a chargemaster, similar to the manufacturer’s suggested retail price (MSRP). These are the baseline rates for services provided by the hospital. https://www.ricelandhealthcare.com/patient-pricing/

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Patient Pricing - Riceland Healthcare

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  1. CHARGE CODE DESCRIPTION ROOM BOARD/PVT ROOM BOARD/SEMI ROOM BOARD/ISOLATION ROOM BOARD/ISOLATION W/MONITOR ROOM BOARD/PVT W/MONITOR ROOM BOARD/SEMI W/MONITOR INFUSION THRPY EA ADDNTL HR IV INFUSION THERAPY 1ST HR IV INFUSION THERAPY PER HR IV PUSH ADDITIONAL MEDS IV PUSH MEDS INITIAL HYDRTION IV INIT 31-60 MINS PARING/CURETTEMENT B9 LESION 1 PAR/CUTT B9 LESION 2-4 SKIN SUBGRAFT F/H/H/F <100 SQCM-1ST 25CM SKIN SUBGRFT F/H/H/F<100 SCM-EA ADD 25CM TENOTOMY PERCUTANEOUS TOE SINGLE TENDON STRAPPING OF ANKLE AND/OR FOOT STRAPPING UNNA BOOT BX BONE OPEN SUPERFICIAL ENDOTRACHEAL INTUB CVP INSERTION CATHETERIZATION, VENOUS INSERT PICC LINE WO SUBQ PORT/PUMP AGE5+ ABD PARACENTESIS W/OUT IMG GUIDE IRRIGATION OF BLADDER SIMPLE CATHETER BLADDER, SIMPLE INSERTION OF PICC INJ FORAMEN EPIDURAL L/S INJ FORAMEN EPIDURAL ADD-ON TRIM NAIL(S) DYSTROPHIC, ANY NUMBER I&D ABSCESS COMPLICATED/MULTI UNLISTED PROCEDURE, RECTUM SURGERY FOR VULVA LESION TRANSFUSION OF PACKED CELLS HOT-COLD THERAPY 1/> AREAS TREATMENT ROOM INJECTION ADMINISTRATION COOMBS INDIRECT EACH COOMBS DIRECT EACH ABO GROUP BLOOD TYPING BLOOD TYPING RH RED BLOOD CELLS EACH UNIT PLASMA FRESH FROZEN EACH UNIT ANTIMITOCHONDRIAL, AB AUTOLOGOUS BLOOD PROCESS/STORE STD PRICE ( 1,184.00) ( 1,109.00) ( 1,627.00) ( 1,922.00) ( 1,441.00) ( 1,441.00) ( ( ( ( ( ( ( ( ( 4,722.00) ( 1,559.00) ( ( ( ( ( ( 1,018.00) ( ( 1,019.00) ( ( ( ( 1,170.00) ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 172.00) 327.00) 109.00) 117.00) 67.00) 114.00) 261.00) 304.00) 361.00) 81.00) 84.00) 478.00) 465.00) 578.00) 271.00) 395.00) 135.00) 419.00) 201.00) 72.00) 580.00) 647.00) 735.00) 226.00) 47.00) 131.00) 38.00) 238.00) 91.00) 164.00) 280.00) 235.00) 112.00) 78.00) 93.00)

  2. THAWING FRESH FROZEN PLASMA IMMEDIATE SPIN INCUBATION TECHNIQUE ANTIGLOBULIN TECHNIQUE LEUKOCYTE EACH UNIT LEUKOCYTE PROCESS/HANDLE FRESH FROZEN PLASMA PROCESSING RED BLOOD CELLS PROCESS/HANDLE PSYCHOTHERAPY, 30 MINS W/ PATIENT PSYCHOTHERAPY, 45 MINS W/ PATIENT PSYCHOTHERAPY, 60 MINS W/ PATIENT GROUP PSYCHOTHERAPY 45-50 MIN FAMILY PSHCHOTHERAPY W/OUT PATIENT FAMILY PSYCHOTHERAPY W/ PATIENT EDU. SERVICES TX OF PTS MH PROBLEMS PSYCH DIAG EVAL PSYCH DIAG EVAL W/ MEDICAL SVCS PSYCHOTHERAPY 30 MIN SUBQ VISIT PSYCHOTHERAPY 45 MIN SUBQ VISIT PSYCHOTHERAPY 60MIN SUBQ VISIT PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN PSYCHOTHERAPY FOR CRISIS EA ADDTL 30 MIN BX BREAST WITH PLACEMENTOF LOCAL DEV BX BREAST WITH PLACE LOCAL DEVICE EA ADD BX BREAST W/PLACEMENT US GUIDANCE BX BREAST W/PLACEMENT US GUIDANCE ADDL L BX BONE BIOPSY TROCAR/NEEDLE BX OF NECK/CHEST BIOPSY LUNG OR MEDIASTINUM PERC NEEDLE BIOPSY OF LIVER/NEEDLE PERC BIOPSY ABD MASS PERC NEEDLE BX MUSCLE PERCUTANEUS NEEDLE BX/EXC LYMPH NODE NEEDLE SUPERFICIAL BX THYROID, PERCUTANEOUS CORE NEEDLE SUCTION CANISTER 800CC DENTURE CREAM DENTURE CLEANSER BED PAN FRACTURE NEBULIZER MASK ADULT NEBULIZER T-UP ICE PACK STAY DRY SM ICE PACK STAY DRY LG SCRUBBRUSH W/O DETERGENT SCRUBBRUSH W/PVP BRN PAD DEFIB ADULT BARRIER CREAM WIPES (TUB) OTOSCOPE DISP ADULT 4MM ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 27.00) 184.00) 225.00) 225.00) 821.00) 275.00) 139.00) 238.00) 410.00) 546.00) 808.00) 546.00) 661.00) 681.00) 546.00) 420.00) 471.00) 410.00) 546.00) 809.00) 843.00) 404.00) 1,405.00) 1,405.00) 1,405.00) 1,405.00) 3,794.00) 1,531.00) 1,531.00) 2,808.00) 1,531.00) 3,794.00) 1,531.00) 1,531.00) 52.00) 35.00) 25.00) 10.00) 17.00) 45.00) 15.00) 15.00) 8.00) 8.00) 249.00) 76.00) 7.00)

  3. JAR SUNDRY LABLED (ER) TEMPERATURE INDICATORS TRAY GASTRIC LAVAGE LG 34 FR TUBE TRACH HOLDER DRAPE PAPER CREPE PAPER TABLE CREPE PROBE PEDI DISPOSABLE AIR MATTRESS & MODULE RENTAL WOUND VAC, DAILY SUCTION SETUP DISP BP CUFF SMALL STOCKING KNEE XL BP CUFF NEONATE DISP AMBU BAG INFANT SPLINT J-ORTHOGLASS 2" PER FOOT SPLINT J-ORTHOGLASS 4" PER FOOT SPLINT J-ORTHOGLASS 6" PER FOOT SUCTION TUBING KIT 13" & 72" PCS CO2 DETECTOR PEDI ORTHO-SPLINT CLAVICLE W/ PAD MED ORTHO-BRACE ANKLE SMALL ORTHO-BRACE ANKLE MED ORTHO-SPLINT FOREARM LT MED ORTHO-SPLINT WRIST/FOREARM LT SMALL ORTHO-SPLINT WRIST/FOREARM RT MED ORTHO-SPLINT WRIST/FOREARM LT LARGE ORTHO-SHOE POST OP WOMENS MED ORTHO-SHOE POST OP WOMENS LARGE ORTHO-SHOE POST OP MENS LARGE ORTHO-SHOE POST OP MENS XL ORTHO-SHOE POST OP WOMENS SMALL ORTHO-SUPPORT WRIST RT MED ORTHO-SPLINT THUMB SPICA RT UNIVERSAL ORTHO-SPLINT THUMB SPICA LT UNIVERSAL ORTHO-SPLINT WRIST/FOREARM RT LARGE UNDERPADS SITZ BATH BED PAN BAG LEG URINARY W/STRAPS 19OZ BANDAGE ELASTIC 2" EACH BANDAGE ELASTIC 4" EACH BANDAGE ELASTIC 6" EACH TAPE TRANSPORE 1"X10YDS IMMOBILIZER SHOULDER FOAM TUBE ENDOTRACH 7.0MM TUBE ENDOTRACH 8.0MM GLOVES L/F MEDIUM ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 68.00) 12.00) 71.00) 44.00) 7.00) 17.00) 178.00) 128.00) 693.00) 119.00) 62.00) 31.00) 49.00) 152.00) 32.00) 52.00) 79.00) 51.00) 81.00) 39.00) 124.00) 124.00) 35.00) 38.00) 38.00) 38.00) 44.00) 44.00) 44.00) 44.00) 44.00) 65.00) 62.00) 66.00) 38.00) 7.00) 21.00) 10.00) 36.00) 7.00) 9.00) 12.00) 10.00) 178.00) 44.00) 45.00) 8.00)

  4. SLING ARM LG AIRWAY DUAL CHANNEL 60MM DISP ARMBOARD IV ADULT DISP EA RESUSCITATOR ADULT DISP EA RESUSCITATOR PEDI DISP EA BAG EMESIS DISP EXERCISER VOLUMETRIC 4000ML MASK MULTI VENT AIR W/TUBING MASK FACE TENT AEROSOL DISP THERMOMETER DIGITAL ORAL CAST PADDING POLYESTER 4" ECH IMMOBILIZER KNEE UNIV TRIM BETADINE 4OZ CLEANSER APPLICATOR CTN TIP 6' BANDAGE ADHSV STRIP 1X3' BLADE TONGUE SR STR 6' AIRWAY BERMAN PLASTIC 100MM AIRWAY BERMAN PLASTIC 80MM ALCOHOL 16OZ BALL COTTON MEDIUM KERLIX LITE GAUZE 2" ST BANDAGE KERLIX RL STR 4 1/2 BASIN OR RND STR TONGUE BLADE NON STERILE CANISTER SCTN 120CC CANNULA NASAL CRUV TIP W/7' P CANNULA SOFTECH ADLT 7' TU CATHETER IV JELCO 16GX11/4 CATHETER IV JELCO 22GX1 CATHETER LEG STRAP HOLDER CATHETER SCTN N/SLV 18FR 22' IV CATHETER 18X1 1/4 PROTECT IV CATHETER 20 X 1 1/4 SAFETY CATHETER IV 22GX1 SAFETY CATHETER IV 24X5/8 SAFETY COLLAR CERVICAL FORM FIT LG COLLAR CERVICAL FORM FIT SM CONTAINER SHARPS 5QT CONTAINER SPCMN W/CAP 8OZ CUP MEDICINE 1OZ CUP PORTION PAPER 3/4 OZ ENEMA BAG 150CC GEL ELECTRODE DERMA 4OZ TU GLOVES EXAM VNYL PWDRFR LG GLOVES EXM VNYL PWDRFR MED BELT GAIT W/NICKEL BUCKLE WHT SLING & SWATHE LG ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 68.00) 23.00) 67.00) 179.00) 192.00) 19.00) 63.00) 25.00) 13.00) 61.00) 21.00) 175.00) 9.00) 8.00) 7.00) 7.00) 8.00) 8.00) 8.00) 7.00) 8.00) 15.00) 9.00) 7.00) 35.00) 20.00) 9.00) 12.00) 12.00) 41.00) 34.00) 29.00) 32.00) 28.00) 32.00) 54.00) 54.00) 51.00) 7.00) 7.00) 7.00) 7.00) 23.00) 7.00) 7.00) 72.00) 119.00)

  5. SLING & SWATHE MED SLING & SWATHE SM SLING ARM PRO FIT MED KIT SPILL EMERGENCY MASK ISO HI FILTRATION PADS DEFIB PEDI GLOVES EXM VNYL PWDRFR SM GOGGLES PROTECTIVE CAST PADDIING SYN 2X4YDS PLEUR-EVAC W/DBL CHAM POUCH SELFSEAL 3 1/2X9 POUCH TELEMETRY PUMP SET KANGAROO 1200ML SOLIDIFIER RED-Z 1OZ SCRUBBRUSH W/HIBICLENS SHIELD EYE FOX SPONGE GZE 12 PLY 4X4 ST10S EA SPONGE GZE 16 PLY 4X4 SPONGE GZE CUREX 12 PLY 2X2 SPONGE GZE 8 PLY STR 4X4 CLAVICLE STRAP MEDIUM CLAVICLE STRAP LARGE RHINO ROCKET SLIMLINE SMGL ME SLING ARM UNIV LG SLING ARM UNIV SM TAPE ADHSV FOAM 3X5 1/2 TAPE ADHSV MICRSPORE PAPER 1/2 TAPE ADHSV MICRSPORE PAPER 2X1 TAPE ADHSV PAPER MICROPORE TAPE ADHSV DURAPORE 2X10 TAPE INDICATOR STEAM 1" TAPE PAD ADHSV REMOVER URINAL MALE W/LID WALKER SHORT LEG LG WALKER SHORT LEG MED WALKER SHORT LEG SM TAPE ADHSV DURAPORE 1X10 ARMBOARD FOAM DISP ADLT 3X18 CAST PADDING SYNTHETIC 2X4 CAST PADDING SYNTH 3X4 CAST PADDING SYN 4X4 CAST STOCKINETTE SYN 2X25 CAST STOCKINETTE SYN 3X25YDS CAST TAPE WHITE 2X4 YDS CATH TRAY URETH RED RBR 14FR CAST STOCKINETTE SYNTH 6X25 CONNECTOR TUBING 5 IN 1 N/S ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 122.00) 122.00) 25.00) 73.00) 7.00) 264.00) 7.00) 20.00) 12.00) 1,375.00) 7.00) 13.00) 56.00) 23.00) 9.00) 48.00) 12.00) 12.00) 7.00) 7.00) 161.00) 161.00) 112.00) 113.00) 44.00) 61.00) 7.00) 13.00) 15.00) 17.00) 45.00) 7.00) 8.00) 412.00) 427.00) 412.00) 10.00) 8.00) 12.00) 17.00) 23.00) 15.00) 18.00) 88.00) 17.00) 31.00) 9.00)

  6. GLOVES PW FR LG GLOVES PW FR MED GLOVES PW FR SM SPLINT J 3"ROLL PER FOOT CAST TAPE STD 3X4 YDS COLLECTOR URINE (HAT) K-Y JELLY LUBRICANT 4 OZ TUBE EAR CURETTE PEDI EAR CURETTE ADULT SPLINT J 5" ROLL PER FOOT CANNULA NASAL PEDI 7' TUBE RESTRAINT VEST LARGE STRAINER URINE STETHASCOPE DISPOSABLE OTOSCOPE DISP 2.5MM PEDI TUBE OXYGEN EXT 7' MASK OXYGEN (PEDI) EMESIS BASIN CATHETER CADDI,STOMACH BNDR MD SLING ARM PRO FIT LGE SLING ARM PRO FIT SMALL PROTECTORS, HEEL/ELBOW FOAM SPLINT FINGER LMA SIZE 3 LMA SIZE 4 LMA SIZE 5 TUMBLER PATIENT 9 OZ PERSONAL BELONGINGS BAG SLING AND SWATHE XL TAPE MEDIPORE SURGERY 2" SPLINT J 4" ROLL PER FOOT TAPE MEDIPORE SURGERY 4" TAPE ADHSV FOAM 4X5 1/2 PADS HEATING DISPOSABLE EASY FEED ENTERAL NUT BAG DENTAL MIRROR DISP WICK EAR MASK TRACH ADLT W/O TUBING SLING TRIANGULAR BANDAGE CONTAINER SPCMN NONSTER 4 OZ SPLINT J 6" ROLL PER FOOT SPLASH SHIELD SPLINT J2" ROLL PER FOOT TUBE HOLDERS FINGER PROTECTOR BASEBALL SPLINT FINGER COTS ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 7.00) 7.00) 7.00) 71.00) 88.00) 10.00) 15.00) 8.00) 10.00) 94.00) 17.00) 119.00) 21.00) 27.00) 7.00) 8.00) 12.00) 7.00) 194.00) 25.00) 25.00) 71.00) 19.00) 921.00) 921.00) 921.00) 15.00) 7.00) 119.00) 29.00) 79.00) 29.00) 68.00) 19.00) 54.00) 8.00) 8.00) 13.00) 9.00) 27.00) 107.00) 21.00) 60.00) 7.00) 7.00) 9.00) 8.00)

  7. CURVED FINGER SPLINTS FROG SPLINTS STOCKING THIGH HIGH LARGE STOCKING THIGH HIGH MEDIUM PADZ STAT ADULT ELECTRODE PEDI PADZ POUCH DRAINABLE COLOSTOMY STOCKING THIGH HIGH XL CUFF BLOOD PRESSURE DISP COLLAR STIFF NECK ADULT COLLAR STIFF NECK PEDI TAPE SILK COLLECTOR PEDI URINE PAD EKG DIAPHORETIC -3 PADS PNEUMOTHORACIC KIT BAG RESP SETUP BETADINE PREP PAD GAUZE TUBE 5/8 PER YARD GLOVES NITRO CAST STOCKINETTE SYN 4 X 25 CATHETER SCTN N/SLV 8FR PEDI HEEL WARMER MASK OXYGEN PEDI W/ NEB & TUBE GAUZE TUBE #1 PER YARD GAUZE TUBE #3 PER YARD RESTRAINT LIMB ADJ RESTRAINT VEST MED LIGHT HANDLE COVER SPONGE GAUZE 2X2X8 PLY STERILE PEDI DISP PULSE OX PROBE COMBITUBE COMBITUBE 41 FRENCH PICC SUPPLIES AND KIT CO2 DETECTOR - EASY CAP II FINGER SPLINT ALUM XL STRYKER T-PAD T-BLANKET PEAK FLOW METER WRIST SUPPORT W/ABDCTED THUMB LFT LRG SPLINT WRIST/FOREARM RGHT SMALL BRACE ANKLE AIRGEL LG 10" WALKER LOWER LEG, MED TELFA ADHESIVE PAD 3X4 MIDLINE SUPPLIES AND KIT SUTURE 4-0 GUT PL C-6 SUTURE 4-0 VICRYL CTD P-3 SUTURE 2-0 SOF SILK GS-21 ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 7.00) 7.00) 72.00) 72.00) 384.00) 392.00) 20.00) 68.00) 125.00) 100.00) 60.00) 12.00) 10.00) 12.00) 1,287.00) 7.00) 7.00) 7.00) 7.00) 19.00) 17.00) 67.00) 23.00) 7.00) 7.00) 58.00) 137.00) 9.00) 7.00) 119.00) 616.00) 591.00) 214.00) 114.00) 23.00) 82.00) 372.00) 62.00) 162.00) 42.00) 101.00) 245.00) 7.00) 158.00) 25.00) 131.00) 31.00)

  8. SUCTION CONNECTING TUBING 6' X 1/4" PORT ACCESS KIT SUTURE BLUE MONO. 4-0 DSM18 SUTURE BLUE MONO. 5-0 DSM13 SUTURE BLUE MONO. 6.0 DSM13 CATH FOLEY 3 WAY 16FR SILICONE STAPLER SKIN 35W SUTURE CHROMIC GUT 6-0 ALCOHOL PREP MED GLOVES STERILE SZ 7 TRAY IRRIG W/60CC BULB SYRINGE PAD EYE OVAL SMALL BANDAGE ADHSV XLG 2X4 KERLIX LITE GAUZE 2" STERI STRIP 1/4IN STERI STRIP 1/2IN PACKING STRIP IODO 1/4" DRESSING ADAPTIC 3X3 EACH GOWN ISOLATION DISP KIT IV START W/TEGADERM DRESS KIT SUCTION MED 100CC DISP EA K-Y JELLY STERILE FOIL PK PACKING NUG IODO 1/2"X5' SUT GUT CHR 3-0 27" SH SUT ETH MONO BLK 4-0 18" FS-2 SUT ETH MONO BLK 6-0 18" P-1 SUT ETH MONO BLK 5-0 18" FS-2 GLOVES STERILE LTX SZ 8 BLADE #15 DISP EA BLADE #10 DISP EA BLADE #11 DISP EA TUBE GASTROSTOMY TRIFNL 20" SWABSTICK LEMON GLYCERINE EACH CATH KIT FEMALE 8 FR DISP EA DRESSING TEGADERM 4X4 GLOVES STERILE SZ 6 1/2 BETADINE SWAB STICKS EACH NEEDLE HUBER 20X1 GLOVES STERILE SZ 6 SYRINGE LL 10CC CATH FOLEY 2 WAY 8FR CLOROX WIPES FRESH SCENT CATHETER FOLEY 16FR 5CC CATHETER FOLEY 18FR 5CC 2 WAY CATHETER FOLEY 20FR 5CC AIRWAY NASO DISP 30FR CATHETER PLUG W/CAP STR ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 9.00) 103.00) 58.00) 51.00) 52.00) 94.00) 83.00) 214.00) 7.00) 8.00) 17.00) 7.00) 7.00) 9.00) 7.00) 15.00) 23.00) 8.00) 15.00) 10.00) 114.00) 7.00) 27.00) 44.00) 108.00) 72.00) 62.00) 8.00) 10.00) 12.00) 10.00) 331.00) 7.00) 54.00) 17.00) 8.00) 7.00) 35.00) 8.00) 7.00) 109.00) 7.00) 59.00) 63.00) 131.00) 38.00) 9.00)

  9. CATHETER TRAY FOLEY W/O CATH CATHETER EXTERNAL MALE CATHETER STR SUCTION KIT 14FR CATH N GLOVE SET 14FR CATHETER THORACIC STRT 28FR CATHETER THORACIC STRT 36FR CATHETER W/SOFT TIP 14FR W/FU CONTAINER SPCMN STR 4OZ CULTURETTE, EZ ANGL SWAB DRAIN PENROSE STR 1/2'X18' DRAIN PENROSE STR 1/4'X18' DRESSING COMBINE STR 8X10 DRESSING RELEASE 9'X3' NON ADHERENT NS PAD 3X4 DRESSING TEGADERM 8X12 DRESSING TEGADERM 2X2 DRESSING VASELINE FOIL PK STR FILTER HYDRO ASPRTR SUCTION CANNULA INTERLINK VL ACC PERIWASH 8OZ SYRINGE LL 5CC MASK NONBREATHING ADULT KIT CATCH MIDSTREAM W/FNL AQUAPAK/HUMIDIFIER KIT, TEST HEMOCULT SNG 2 HOLE LANCET SINGLE USE MASK OXY ADULT NON-REBREA MASK RESPIRATOR (N-95) SN NEEDLE FILTER 19GX11/2 NEEDLE HYPO 18GX1 NEEDLE HYPO 20GX11/2 NEEDLE HYPO 22GX1 NEEDLE HYPO 25GX11/4 NEEDLE HYPO 27GX11/4 NEEDLE SAFE 27GX1/2 NEEDLE SPINAL STR 18GX31/2 NEEDLE SPINAL STR 20GX31/2 PACKING NUG IODO 1X5 PACKING NUG IODO 2X5 PACKING NUG PL STR 1/2 X 5 PAD ELECTRODE EKG FASTRACE PROBE COVERS IVAC PROBE COVERS WELCH ALLYN STAPLE REMOVER SKIN DISP SUCTION YANKAUER BULB TIP STR SUTURE ETHILON BLK MONO 7-0 SUTURE GUT CHR 4-0 FS-2 27 ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 75.00) 10.00) 10.00) 10.00) 67.00) 67.00) 54.00) 9.00) 18.00) 12.00) 12.00) 8.00) 7.00) 7.00) 56.00) 8.00) 10.00) 67.00) 7.00) 25.00) 7.00) 17.00) 19.00) 21.00) 8.00) 7.00) 17.00) 15.00) 7.00) 7.00) 7.00) 7.00) 7.00) 7.00) 8.00) 36.00) 36.00) 54.00) 75.00) 23.00) 56.00) 17.00) 7.00) 13.00) 15.00) 84.00) 23.00)

  10. SYRINGE EAR 3 OZ SYRINGE INSULIN 1CC 28G SYRINGE SL LL 20CC SPECULUM VAG ILLUM DISP MED TRAY IRRIGATION PISTON LACERATION TRAY SUTURE REMOVAL TRAY TRAY THORACENTESIS/PARECENT TUBE CHEST 28FR TUBE ENDOTRACH CUFFED TUBE ENDOTRACH CUFFED 7 TUBE ENDOTRACH CUFFED 71/2 TUBE ENDOTRACH CUFFED 8 TUBE ENDOTRACH CUFFED 81/2 TUBE NASOGASTRIC 10FR TUBE NASOGASTRIC 14FR TUBE NASOGASTRIC 16FR TUBE NASOGASTRIC 18FR TUBE SALEM SUMP STR 16FR 48' TUBE TRACH CUFF 61/2MM TUBE TRACH CUFF 7 TUBE TRACH CUFF 8MM TUBE TRACH UNCUFFED 2 TUBE TRACH UNCUFED 3 TUBE TRACH UNCUFFED 4 SUTURE 3-0 PROLENE SCALPEL DISP 15 APPLICATOR CTNTP 6'STR 2/PK BANDAGE ELAS ECON 3 BANDAGE GZE KLING STR 3 CATH KIT SUCTION 14FR CATH KIT STR INF 5FR CATHETER FOLEY 12FR 5CC CATHETER FOLEY 14FR 5CC CATHETER FOLEY 16FR 30CC CATHETER FOLEY 18FR 30CC CATHETER FOLEY 24FR 5CC CATHETER FOLEY 2WAY STR 16FR CATHETER FOLEY 3WAY 16FR 30CC CATH FOLEY 3 WAY 24FR 30CC CATH FOLEY ALL SIL 12FR 5CC CATH FOLEY ALL SIL 22FR 5CC LS CLV MICRB T LS MICRO EITN CLV LS CNV3CLAVES OL LS CNV2CLAVES OL LS LTF CVN BCK CL ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 25.00) 7.00) 8.00) 21.00) 12.00) 62.00) 9.00) 450.00) 425.00) 48.00) 60.00) 62.00) 48.00) 62.00) 35.00) 36.00) 23.00) 23.00) 67.00) 68.00) 62.00) 68.00) 25.00) 58.00) 25.00) 59.00) 38.00) 7.00) 12.00) 8.00) 8.00) 59.00) 45.00) 87.00) 53.00) 104.00) 45.00) 113.00) 176.00) 104.00) 54.00) 75.00) 21.00) 23.00) 40.00) 36.00) 37.00)

  11. LS EXTN OL CLAVE LS LFREE PPR ADPT LS CLV TWINSITE GLOVES L/F STR SIZE 7 CATH FOLEY 16FR LTX FREE CATHETER WNGD PROT L/F 22GX1 SUT VICRYL UD BR CT O 27' CT1 SUT VICRYL VIO BR CT 2-0 27' S SUT VICRYL UD BR CT 3-0 27' SH SUT VICRYL UD BR CT 4-0 27' FS SUT ETH SILK BLK BR 2-0 18" CATH FOLEY 3 WAY 16FR 5CC CATH FOLEY 3 WAY 22FR 5CC CATHETER STR SCTN 8FR W/TRAP CATHETER TRAY W/16FR CATH STAPLER SKIN MULTI SHOT 5 STAPLER SKIN MULTI SHOT 15 CANNULA INTERLINK BLUNT 17G PACKING NUG PL STR 1/4 CENTRAL LINE TRAY INSERSTION CENTRAL LINE DRESSING KIT LS MICROBOR EXT SET, 7" NEEDLE SAFETY 18G CATHETER RED RUBBER 12 FR CATHETER RED RUBBER 14FR DRESSING ADAPTIC 3X16 EACH TUBE CONN 3/ 16 X 18 TUBE CONN/NON CONN STR NEEDLE 25X1 SAFETY GLIDE TRAY LUMBAR PUNCTURE PEDI TRAY LUMBAR PUNCTURE ADULT 20G SUT ETH PRO MONO 4-0 18" PS-2 GLOVES STERILE SZ 7 1/2 PACKING STRIP PLN 1/4" PER YRD GLOVES STERILE SZ 8 1/2 TRAY I & D LARGE TRAY I & D SMALL SUT ETH SILK BLK BR 3-0 30" SH SUT ETH SILK BLK 3-0 30" BR SUT ETH GUT PL 3-0 27" CT SUT ETH MONO BLK 3-0 18" FS-1 SUT ETH MER BR O 30" CT-1 SUT ETH MONO BLK 2-0 30" FSLX SUT ETH MONO BLK 5-0 18" P-3 SUT 4-0 ETHIL FS-2 SUT ETH GUT PL 3-0 27" CTX TUBE GASTROSTOMY TRIFNL 12 FR ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 25.00) 9.00) 28.00) 37.00) 86.00) 28.00) 37.00) 48.00) 40.00) 45.00) 63.00) 205.00) 180.00) 17.00) 103.00) 113.00) 138.00) 7.00) 48.00) 51.00) 38.00) 40.00) 7.00) 9.00) 13.00) 21.00) 9.00) 15.00) 7.00) 166.00) 198.00) 91.00) 7.00) 23.00) 10.00) 132.00) 201.00) 44.00) 44.00) 87.00) 95.00) 40.00) 40.00) 75.00) 38.00) 41.00) 36.00)

  12. CATHETE FOLEY 3WAY 18FR 30CC SYRINGE 60CC CATH TIP SYRINGE 60CC LL SWAB MOUTH W/ DENTIFRICE VACUTAINER BLOOD COLLECTION STERI STRIP 1/8 INCH CATHETER FOLEY 3WAY 20FR 30CC SPONGE GZE 6PLY STR 4X4 SPLIT DRESSING TEGADERM 6X8 SWABS BENZOIN TINCTURE TUBE ENDOTRACH CUFFED 9.0 MM TUBE ENDOTRACH CUFFED 6.5 MM TUBE ENDOTRACH UNCUFFED 4.0 MM TUBE GASTROSTOMY TRIFNL 16 FR SUTURE 5-0 PROLENE FS-2 TUBE TRACH UNCUFFED 2.5MM TUBE TRACH UNCUFFED 3.5 NEEDLE INLET CLOSE SURE SPONGE GZE 12PLY STR 4X4 2PK COVER LIGHT HANDLE STR AIRWAY NASO DISP 28FR AIRWAY NASO DISP 32FR WIPES DISINFECTING TRAY CHEST TUBE INSERTION CHEST TUBE 24 FR SUCTION CATHETER 8 FR SUTURE ETHILON BLK NYLON 6-0 SUTURE ETHILON BLK NYLON 5-0 SUTURE ETHILON BLK NYLON 4-0 SUT PRO 5-0 PC 5 CUTTING TRACH CARE TRAY TRAY QUICK TRACH 4.0 MM TRAY QUICK TRACH 2.0 MM LENSES MORGAN MID FLOW PROBE COVER EAR PC 200 SUTURE 4-0 ETHILON PC-3 NEEDLE SAFETY GLIDE 25X5/8 PROBE COVER DIGITAL ORAL TUBING COMM 3/16X1 1/2 ST 50 TUBING CONN 3/16 X 10 5MM NEEDLE SAFETY COMBO 27 X 1/2 NEEDLE SAFETY COMBO 22 X 1 1/2 SUT ETH BR 3-0 30" SH CATHETER FOLEY 10FR 3CC TUBING 6' CORR-A-FLEX CATHETER FOLEY 3WAY 20FR 5CC CATHETER FOLEY 3WAY 18FR 5CC ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 227.00) 8.00) 8.00) 7.00) 10.00) 12.00) 227.00) 8.00) 40.00) 7.00) 62.00) 62.00) 58.00) 36.00) 60.00) 58.00) 58.00) 1,151.00) 7.00) 23.00) 38.00) 38.00) 7.00) 53.00) 68.00) 23.00) 108.00) 80.00) 107.00) 144.00) 34.00) 1,707.00) 1,707.00) 189.00) 7.00) 122.00) 7.00) 7.00) 8.00) 12.00) 7.00) 7.00) 75.00) 102.00) 10.00) 227.00) 180.00)

  13. TUBE FEEDING 12FR 45" NEEDLE SAFETY 23GX1.5 OTOSCOPE KLEEN SCOOP SUT ETH MONO BLK 4.0 18" PC-3 TUBE CONN N/C STR 3/16 X 16 TUBE CONN N/C STR 9/32X20 PACK OB TUBE RECTAL SPONGE GZE COVER 4X4 NEEDLE SAFETY 25 X 1.5 STYLET INTUBATION 2.5-4.0 MM STYLET INTUBATION 7.5-10.0 MM STYLET INTUBATION 5.0-7.0 MM LS CLAVE ADAPTOR TUBE TRACH UNCUFFED 4.5 TUBE TRACH UNCUFFED 5.0 TUBE TRACH UNCUFFED 5.5 SEXUAL ASSAULT KIT DRESSING VASELINE 3X36 WOUND VAC DRESSING WOUND VAC CANNISTER W/ISO TUBE SALEM SUMP 18 FR NEEDLE SAFETY COMBO INSULIN NEEDLE SAFETY COMBO 21 X 1 1/2 BANDAGE COHESIVE RNBOW DERMABLADE INTROSSEOUS NEEDLE CATHETER FOLEY 22FR 30CC NEEDLE SPINAL STR 25G TUBE ENDOTRACH NASAL 8.5 TUBE ENDOTRACH NASAL 8.0 TUBE ENDOTRACH NASAL 7.5 TUBE ENDOTRACH NASAL 7.0 TUBE ENDOTRACH NASAL 6.5 POUCH SELF SEAL 51/ 4 X 10 POUCH SELF SEAL 12 X 18 POUCH SELF SEAL 8 X 16 DRESSING ADAPTIC 3 X 8 DRAPE LARGE SYRINGE LL 3CC TRAY VAGINAL IRRIGATION SUCTION CATHETER 10 FR TUBE FEEDING 5FR PEDI FEEDING TUBE LEVINE 12FR LS SECOND PGBK OL PATIENT CIRCUIT TARAPAC SUTURE 3-0 ETHILON PC-5 ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 497.00) 7.00) 8.00) 91.00) 10.00) 38.00) 207.00) 82.00) 7.00) 7.00) 40.00) 40.00) 40.00) 21.00) 25.00) 62.00) 62.00) 617.00) 28.00) 305.00) 349.00) 23.00) 7.00) 7.00) 31.00) 18.00) 200.00) 73.00) 27.00) 21.00) 62.00) 21.00) 21.00) 62.00) 7.00) 7.00) 7.00) 15.00) 40.00) 7.00) 13.00) 20.00) 15.00) 18.00) 10.00) 288.00) 95.00)

  14. SUTURE 7-0 ETHILON P1 INNER CANNULA GLOVES L/F STR SIZE 6 1/2 LS BURETTE LS DIAL A FLOW EXT SET LS BLOOD SET LS FILTER SET LS CNV 3 CLAVES OL LSPLM CNVTP CLV (PRIMARY) SUT ETH SUTURES 18" BOVIE DISPOSABLE CATH KIT SUCTION 8FR CATH, FOLEY 2 WAY COUDE 16FR CATH, FOLEY 2 WAY COUDE 18FR CATH FOLEY COUDE 12FR AIRWAY KING SZ 3 AIRWAY KING SZ 4 AIRWAY KING SZ 5 FEN IV TUBING BLOOD SET FEN IV TUBING SECONARY SET FEB IV TUBING PRIMARY SET FEN IV TUBING BURETTE SET TUBE ENDOTRACH CUFFED 6.0 FEN IV TUBING PVC FREE SET DIAPER ADULT XL PULL UPS XL - EACH PULL UPS LARGE - EACH PULL UPS MED - EACH PULL UPS SMALL - EACH DIAPER XXL CRUTCHES ALUMINUM YOUTH CRUTCH ALUMINUM ADJ ADLT DIAPER ADLT LARGE CRUTCH ALUMINUM TALL ADLT DIAPER TODDLER SIZE 4 & 5 DIAPER NEWBORN CRUTCH ALUMINUM CHILD DEODORANT ORTHO-SLING & SWATHE DELUXE UNIVERSAL ORTHO-WALKER BOOT TALL MED FACIAL TISSUES DENTURE CUP PILLOW DISPOSABLE LOTION SKIN INTEN CARE 4OZ PERSONAL TOOTHBRUSH PERSONAL TOOTHPASTE PERSONAL COMB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 125.00) 179.00) 37.00) 200.00) 60.00) 178.00) 40.00) 59.00) 66.00) 45.00) 63.00) 12.00) 30.00) 30.00) 30.00) 359.00) 359.00) 359.00) 25.00) 8.00) 26.00) 45.00) 21.00) 26.00) 9.00) 10.00) 8.00) 7.00) 9.00) 6.00) 130.00) 126.00) 9.00) 160.00) 7.00) 7.00) 126.00) 7.00) 52.00) 255.00) 10.00) 7.00) 48.00) 8.00) 7.00) 7.00) 7.00)

  15. PERSONAL BABY POWDER 4OZ SHAMPOO/BODY WASH 4 OZ PERSONAL RAZOR PAD NAIL POLISH REMOVER PAD OB W/MOIST GUARD PILLOW NON-DISPOSABLE PERSONAL ANTIBACTERIAL SOAP PERSONAL PATIENT SOCKS PERSONAL SHAVE CREAM PERSONAL PITCHER PERSONAL SHAMPOO NO RINSE PERSONAL PATIENT SOCKS - LARGE PERSONAL PATIENT SOCKS - XL PERSONAL ADMISSION KIT INJ MIDAZOLAM HYDROCHLORIDE PER 1MG LOCM 300-399 MG/ML IODINE, 1ML CT FINE NEEDLE ASPIRATION WITH IMG GUIDE CT PLACEMENT OF BREAST LOC STEREO GUIDE CT SINUSES W&WO CONTRAST CT CHEST W/O CONTRAST CT CHEST W/CONTRAST CT CHEST W W/O CONTRAST CT SPINE CERVICAL W/O CONTRAST CT SPINE CERVICAL W & W/O CONTRST CT SPINE THORACIC W/O CONTRAST CT THORACIC SPINE W/CONTRAST MATERIAL CT SPINE LUMBAR W/O CONTRAST CT LUMBAR SPINE W/CONTRAST CTA PELVIS CT PELVIS W/O CONTRAST CT PELVIS W/CONTRAST CT PELVIS W W/O CONTRAST CT CONTRAST X-RAY, LOWER SPINE CT EXTREMITY UPPER W/O CONTRAST CT EXTREMITY UPPER W / CONTRAST CT EXTREMITY UPPER W W/O CONTRAST CT UPPER EXTREMITY CONT W/WO CT EXTREMITY LOWER W/O CONTRAST CT EXTREMITY LOWER W/CONTRAST CT EXTREMITY LOWER W W/O CONTRAST CTA LOWER EXTREMITY CT ABDOMEN W/O CONTRAST CT ABDOMEN W/CONTRAST CT ABDOMEN W W/O CONTRAST CT ANGIO ABD/PLVS CNTRST MITRL W/WO CONT CTA ABDOMEN CT ABD & PELVIS W/O CONTRAST ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 10.00) 10.00) 7.00) 7.00) 17.00) 61.00) 7.00) 7.00) 10.00) 8.00) 10.00) 12.00) 12.00) 44.00) 10.00) 7.00) 653.00) 577.00) 3,574.00) 2,808.00) 3,063.00) 3,574.00) 2,808.00) 3,574.00) 2,808.00) 3,063.00) 2,808.00) 3,063.00) 3,574.00) 2,808.00) 3,063.00) 3,574.00) 3,063.00) 2,808.00) 3,063.00) 3,574.00) 3,574.00) 2,808.00) 3,063.00) 3,574.00) 3,574.00) 2,808.00) 3,063.00) 3,574.00) 4,468.00) 3,574.00) 4,084.00)

  16. CT ABDOMEN&PELVIS W/CONTRAST CT ABD&PELV 1+ SECTION/REGNS CT ANGIO ABD AORTA RUNOFF CT GUIDANCE PLCMENT RADIATION CT 3D RENDERING W/ INTERP & POSTPRO CT GUIDE FOR NEEDLE PLACEMENT CT LOW DOSE FOR LUNG CANCER SCREENING CT LOW DOSE FOR LUNG CANCER SCREEN CT HEAD BRAIN W/O CONTRAST CT HEAD BRAIN W/CONTRAST CT HEAD BRAIN W W/O CONTRAST CT HEAD(ORBIT,STELLA,EAR)W/O CONT CT HEAD (SPECIFY AREA) W/CONTRAST CT ORBIT/SELLA/EAR W/WO CT MAXILLOFACIAL W/O CONTRAST CT MAXILLOFACIAL W/CONTRAST CT SOFT TISSUE NECK W/O CONTRAST CT SOFT TISSUE NECK W/CONTRAST CT SOFT TISSUE NECK W W/O CONTRST CTA HEAD CTA NECK CTA CHEST CT SPINE CERVICAL W/CONTRAST CT SPINE THORACIC W W/O CONTRAST CT SPINE LUMBAR W W/O CONTRAST THORACENTESIS NEEDLE/CATH PLEURA W/IMAGI INFUSION THRPY EACH ADDNTL HR IV PUSH SAME MED EA ADDITIONAL IV INFUSION THERAPY 1ST HR IV INFUSION THERAPY PER HR HYDRTION IV INITIAL 31-60 MINS TRANSFUSION OF PACKED CELLS EMERGENCY ROOM L-1 EMERGENCY ROOM L-2 EMERGENCY ROOM L-3 EMERGENCY ROOM L-4 EMERGENCY ROOM L-5 FINE NEEDLE ASPIRATION W/O IMAGING GUIDA I&D ABSCESS SIMPLE SINGLE* I&D ABSCESS COMPLICATED/MULTI I&D PILONIDAL SIMPLE I&D PILONIDAL COMPLEX FB RMVE SUBCTNEOUS TISSUE SAMP FB RMVE COMPLEX I&D HEMATOMA SEROMA* PUNCTURE/ASP ABSCESS SMALL I&D POST OP WOUND INF ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 4,468.00) 4,468.00) 2,808.00) 2,808.00) 973.00) 2,808.00) 1,648.00) 1,648.00) 2,808.00) 3,063.00) 3,574.00) 2,808.00) 3,063.00) 3,574.00) 2,808.00) 3,063.00) 2,808.00) 3,063.00) 3,574.00) 2,808.00) 2,808.00) 2,808.00) 3,063.00) 3,574.00) 3,574.00) 2,502.00) 177.00) 192.00) 336.00) 111.00) 117.00) 234.00) 304.00) 488.00) 800.00) 1,212.00) 1,795.00) 296.00) 341.00) 597.00) 296.00) 627.00) 166.00) 700.00) 385.00) 265.00) 572.00)

  17. DEBRIDEMENT OF EXT INF SKIN DEBRIDEMENT SKIN PARTIAL THICK DEBRIDEMENT SKIN FULL THICKNES DEBRIDEMENT SKIN &SBCTS TISSUE DEBRIDEMENT WOUND DEEP EXC SKIN TAGS UP TO 15* DEBRIDEMENT OF NAIL 1-5 AVULSION ON NAIL PLATE AVULSION NAIL PLATE,PRTL/CMPLT EXC NAIL EVACUATION EXC NAIL/NAIL MATRIX PERMANENT NAIL BED REPAIR SIMPLE NAIL BED REPAIR COMPLEX EXCISE INGROWN NAIL RPR SMPLE SCLP NCK TRNK EXT* RPR SMPLE SCLP NCK TRNK EXT* RPR SMPLE SCLP NCK TRNK EXT* RPR SMPLE SCLP NCK TRNK EXT RPR SMPLE SCLP NCK TRNK EXT RPR SMPLE FCE EAR ELID NSE LP 2.5CM/< RPR SMPLE FCE EAR ELID NSE LP* RPR SMPLE FCE EAR ELID NSE LP RPR SMPLE FCE EAR ELID NSE LIP RPR SMPLE FCE EAR ELID NSE LIP RPR SMPLE FCE EAR ELID NSE LIP RPR SMPLE FCE EAR ELID NSE LIP SECONDARY CLOSURE RPR SMPLE FACE W/ PACKING RPR INT SCLP TRNK EXT 0-2.5CM RPR INT SCLP TRNK EXT 2.6-7.5 RPR SCLP TRNK EXT 7.6-12.5CM RPR INT SCLP TRNK EXT 12.6-20 RPR INT SCLP TRNK EXT 20.1-30 RPR INT SCLP TRNK EXT 30+CM RPR INT NCK HND FEET GEN 2.5 RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GENT RPR INT FACE/EARS/LIPS 0-2.5CM RPR INT FACE/EARS/LIPS 2.6-5.0 RPR INT FACE/EARS/LIPS5.1-7.5 RPR INT FACE/EARS/LIPS7.6-12.5 RPR INT FACE/EARS/LIPS 12.6-20 RPR INT FACE/EARS/LIPS 30+CM RPR CMPLX TRUNK 1.1 - 2.5 CM ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 285.00) 163.00) 183.00) 339.00) 597.00) 175.00) 69.00) 352.00) 170.00) 179.00) 422.00) 443.00) 759.00) 315.00) 344.00) 440.00) 517.00) 645.00) 833.00) 413.00) 468.00) 560.00) 819.00) 873.00) 1,046.00) 1,222.00) 640.00) 458.00) 466.00) 680.00) 804.00) 811.00) 1,197.00) 1,187.00) 597.00) 654.00) 754.00) 1,019.00) 1,077.00) 1,363.00) 613.00) 654.00) 734.00) 809.00) 1,358.00) 1,895.00) 781.00)

  18. RPR CMPLX TRUNK 2.6-7.5CM RPR CMPLX TRNK ADDTL 5CM>7.5CM RPR COMPLX SCALP/ARMS/LEGS RPR CMPLX SCALP/ARMS/LEGS RPR CMPLX HED/ARM/LEG ADDTL5CM RPR CMPLX FACE/HAND/FT/GEN RPR CMPLX FACE/HAND/FT/GEN RPR CMPLX FACE/HAND/FT/GEN RPR CMPLX EYELID/NOSE/EARS/LIP RPR CMPLX EYELID/NOSE/EARS/LIP BURN TREAT 1ST DGR LOCAL ONLY BURN SM DRESS/DEBRID BURN MED DRESS/DEBRID BURN LG DRESS/DEBRID FB RMVE MUSCLE SIMPLE FB REMOVAL MUSCLE COMPLEX Inj trigger point 1/2 muscle ARTHROCENTESIS INJ SM JT ARTHROCENTESIS INJ INTERMED ARTHROCENTESIS FRACTURE NOSE BONE FX W/O MNP FX MANDIBULAR DISLOCATED TEMPOROMANDIBULAR FRACTURE RIB FX RIB W/FLAIL CHEST FX SPINE VERT BODY FRACTURE CLAVICLE CLOSED REDUCTION TRACTN/MANIP AC INT REDUCTION FX SCAPULAR FX HUMERAL NECK DISLOCATED SHOULDER CLSD TX SHLDR DISLOCATE W/MAN FB RMVE UPPER ARM/ELB SUBCUTNS FRACTURE HUMERUS FX SUPRACONDYLAR DISLOCATED ELBOW TRT CLSD FRACTURE ELBOW CLOSED DISLOCATED NURSEMAID ELBOW FX RADIAL HD/NECK CLSD TRTMNT ULNAR W/O MAN FX RADIAL SHAFT FX ULNAR SHAFT FRACTURE RADIUS/ULNA FX RADIAL DISTAL WRIST FRACTURE REDUCTION FX NAVICULAR ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 1,131.00) 317.00) 811.00) 1,235.00) 500.00) 939.00) 1,593.00) 822.00) 1,167.00) 1,831.00) 185.00) 175.00) 579.00) 814.00) 807.00) 1,205.00) 206.00) 236.00) 166.00) 193.00) 122.00) 889.00) 130.00) 315.00) 2,169.00) 941.00) 718.00) 1,015.00) 1,148.00) 758.00) 1,017.00) 1,250.00) 1,652.00) 784.00) 1,024.00) 1,275.00) 1,433.00) 2,470.00) 466.00) 772.00) 1,011.00) 819.00) 758.00) 996.00) 362.00) 1,713.00) 874.00)

  19. FX CARPAL CLSD TRTMNT DISLCTN W/MANIP CLSD TRTMNT DSLOCTN W/MANIP I&D FINGER ABSCESS SIMPLE I&D FINGER ABSCESS COMP(FELON) FB RMVE CARPOMETACARPAL JOINT FB RMVE METACARPOPHALANGEAL JT FB RMVE INTERPHALANGEAL JOINT RPR EXT TNDN FINGER W/O GRF REDUCTION FINGER DISLOCATION DISLOCATED TOE DISLOCATED FINGER FRACTURE FINGER/THUMB FX PHALANGEAL W/MANIPULATION FX CLOSED DISTAL PHALANGEAL FRACTURE DISTAL PHALANGE DISLOCATED I P JOINT FINGER DISLOCATED I P JNT FNGR W/ANES FX COCCYX FRACTURE FEMORAL CLOSED FX W/O DISLOCATED HIP W/O ANESTHESIA FRACTURE KNEE FRACTURE TIBIA KNEE DISLOCATION, CLOSED FX DISLOCATED PATELLA FX TIBIAL SHAFT FRACTURE FIBULA CLSD TRTMNT FIBLR DSTL W/O MAN FX ANKLE BIMALLEOLAR FRACTURE ANKLE ANKLE FX, W/MANIPULATION DISLOCATED ANKLE ARTHROTOMY OF INTERPHAL JOINT FB RMVE FOOT SUBCUTANEOUS FB RMVE FOOT DEEP FB RMVE FOOT COMPLICATED RPR TENDON FLEX FT PRM W/O GRF FX CALCANEAL FX TALUS FX TARSAL FX METATARSAL FX GREAT TOE W/O MANIP FX GREAT TOE W/MANIP FRACTURE TOE DISLOCATED GREAT TOE DISLOCATED METATARSAL TREAT TOE DISLOCATION ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 936.00) 1,483.00) 1,449.00) 323.00) 519.00) 2,243.00) 2,362.00) 2,529.00) 3,174.00) 1,604.00) 1,308.00) 1,524.00) 524.00) 1,021.00) 632.00) 1,414.00) 969.00) 1,340.00) 570.00) 1,830.00) 2,066.00) 1,028.00) 1,259.00) 1,953.00) 1,403.00) 1,104.00) 970.00) 1,115.00) 1,111.00) 1,315.00) 1,882.00) 1,635.00) 1,707.00) 817.00) 1,544.00) 1,897.00) 1,920.00) 1,028.00) 283.00) 891.00) 814.00) 492.00) 587.00) 662.00) 131.00) 611.00) 517.00)

  20. CLTX INTERPHALANGEAL JT DSLOC W/ ANESTHI FRACTURE PHALANGES FT OPEN 1+ SPLINT ARM LONG APPLY SPLINT ARM SHRT STATIC APPLY SPLINT FINGER SPLINT LEG LONG APPLICATION SPLINT LEG SHORT APPLICATION DENIS-BROWNE SPLINT STRAPPING FB RMVE INTERNASAL NOSEBLEED ROUNTINE SMPLE* NOSEBLEED ANTERIOR PACK NOSEBLEED POSTIER PACK ENDOTRACHEAL INTUB DIRECT LARYNGOSCOPY TRACHEOSTOMY EMERGENCY THORACENTESIS CHEST TUBE THORACOSTOMY CHEST TUBE IND W/WO DRAIN PERICARDIOCENTESIS CVP INSERTION CUT DOWN CATHETERIZATION, VENOUS INSERT PICC LINE WO SUBQ PORT/PUMP AGE5+ INTRAOSSEOUS INFUSION ARTERIAL CATH OR CANULATION REMOVAL FOREIGN BODY MOUTH I&D ABSCESS DENTAL FB RMVE THROAT NASO-/ORO-GASTRC TUBE PLCMENT CHANGE OF GASTROSTOMY TUBE FECAL IMPACTION REMOVAL Unlisted Procedure, Rectum I&D THROMBOSED HEMMORRHOID EXCISION OF THROMBOSD HEM EXT PERITONEAL LAVAGE/PARACENTESIS IRRIGATION OF BLADDER SIMPLE CATHETER BLADDER, SIMPLE CATHETER BLADDER, COMPLEX CYSTOSTOMY TUBE CHANGE MEATOTOMY MEATOTOMY INFANT CATHERIZATION, URETHRA INSERTION OF PICC ER I&D OF VULVA/PERINAL ABCESS I&D BARTHOLIN'S GLAND ABSCESS REMOVAL IUD VAGINAL DELIVERY ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 550.00) 2,212.00) 227.00) 159.00) 117.00) 227.00) 183.00) 266.00) 227.00) 247.00) 330.00) 437.00) 478.00) 615.00) 908.00) 315.00) 873.00) 525.00) 502.00) 1,046.00) 344.00) 578.00) 1,019.00) 302.00) 428.00) 530.00) 391.00) 458.00) 178.00) 1,189.00) 666.00) 666.00) 607.00) 419.00) 271.00) 406.00) 138.00) 376.00) 256.00) 377.00) 243.00) 377.00) 1,204.00) 445.00) 415.00) 292.00) 3,184.00)

  21. SPINAL TAP W/OUT INJECTION SPINAL TAP W/ INJECTION SKULL FX SIMPLE SPINAL PUNCTURE LUMBAR DIAG LOCAL BLOCK (NERVE) CERVICAL PLEXUS DIGITAL NERVE BLOCK INJ ANES AGNT/STERD FACET JNT FB RMVE EYE EXTERNAL FB RMVE EYE EMBEDDED FB RMVE CORNEA W/O LAMP FB RMVE CORNEA SLIT LAMP FB RMVE EAR CANAL W/O ANS FB RMVE IMPACTED CERUMEN IV PUSH ADDITIONAL MEDS INJECTION ADMINISTRATION IV PUSH MEDS INITIAL GASTRIC INTUBATION ASP LAVAGE TEMPORARY TRANSCUT. PACEMAKER CARDIOVERSION THROMBOLYSIS INFUSION RMVL DEVITAL TIS 20 CM/< MOD SEDATION 5YRS + 1ST 30 MIN MOD SEDATION 5YRS + ADDT'L 15 IPECAC & OBS RESUSITATE NEWBORN FX METACARPAL W/O MANIP FX METACARPAL W/MANIP. ER CRITICAL CARE 1ST HOUR ER PHYS CRIT. EA ADD 30 MIN ER PROFESSIONAL FEE LEVEL I BRIEF ER PROFESSIONAL FEE LEVEL-II LIMITED ER PROFESSIONAL FEE LEVEL III INTERM. ER PROFESSIONAL FEE LEVEL IV EXTENDED ER PROFESSIONAL FEE LEVEL V COMPREHEN FINE NEEDLE ASPIRATION W/O IMAGING GUIDA I&D ABSCESS SIMPLE SINGLE* I&D ABSCESS COMPLICATED/MULTI I&D PILONIDAL SIMPLE I&D PILONIDAL COMPLEX FB RMVE SUBCTNEOUS TISSUE SAMP FB RMVE COMPLEX I&D HEMATOMA SEROMA* PUNCTURE/ASP ABSCESS SMALL I&D POST OP WOUND INF DEBRIDEMENT OF EXT INF SKIN DEBRIDEMENT SKIN PARTIAL THICK ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 490.00) 597.00) 3,564.00) 293.00) 226.00) 324.00) 252.00) 437.00) 142.00) 180.00) 177.00) 177.00) 271.00) 144.00) 120.00) 39.00) 69.00) 109.00) 70.00) 488.00) 1,118.00) 102.00) 149.00) 41.00) 198.00) 627.00) 730.00) 1,084.00) 944.00) 475.00) 220.00) 293.00) 415.00) 604.00) 804.00) 296.00) 341.00) 597.00) 296.00) 627.00) 166.00) 700.00) 385.00) 265.00) 572.00) 285.00) 163.00)

  22. DEBRIDEMENT SKIN FULL THICKNES DEBRIDEMENT SKIN &SBCTS TISSUE DEBRIDEMENT WOUND DEEP EXC SKIN TAGS UP TO 15* DEBRIDEMENT OF NAIL 1-5 AVULSION ON NAIL PLATE AVULSION NAIL PLATE,PRTL/CMPLT EXC NAIL EVACUATION EXC NAIL/NAIL MATRIX PERMANENT NAIL BED REPAIR SIMPLE NAIL BED REPAIR COMPLEX EXCISE INGROWN NAIL RPR SMPLE SCLP NCK TRNK EXT* RPR SMPLE SCLP NCK TRNK EXT* RPR SMPLE SCLP NCK TRNK EXT* RPR SMPLE SCLP NCK TRNK EXT RPR SMPLE SCLP NCK TRNK EXT RPR SMPLE FCE EAR ELID NSE LP 2.5CM/< RPR SMPLE FCE EAR ELID NSE LP* RPR SMPLE FCE EAR ELID NSE LP RPR SMPLE FCE EAR ELID NSE LIP RPR SMPLE FCE EAR ELID NSE LIP RPR SMPLE FCE EAR ELID NSE LIP RPR SMPLE FCE EAR ELID NSE LIP SECONDARY CLOSURE RPR SMPLE FACE W/ PACKING RPR INT SCLP TRNK EXT 0-2.5CM RPR INT SCLP TRNK EXT 2.6-7.5 RPR SCLP TRNK EXT 7.6-12.5CM RPR INT SCLP TRNK EXT 12.6-20 RPR INT SCLP TRNK EXT 20.1-30 RPR INT SCLP TRNK EXT 30+CM RPR INT NCK HND FEET GEN 2.5 RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GEN RPR INT NECK HAND FEET GENT RPR INT FACE/EARS/LIPS 0-2.5CM RPR INT FACE/EARS/LIPS 2.6-5.0 RPR INT FACE/EARS/LIPS5.1-7.5 RPR INT FACE/EARS/LIPS7.6-12.5 RPR INT FACE/EARS/LIPS 12.6-20 RPR INT FACE/EARS/LIPS 30+CM RPR CMPLX TRUNK 1.1 - 2.5 CM RPR CMPLX TRUNK 2.6-7.5CM RPR CMPLX TRNK ADDTL 5CM>7.5CM ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 183.00) 339.00) 597.00) 175.00) 69.00) 352.00) 170.00) 179.00) 422.00) 443.00) 759.00) 315.00) 344.00) 440.00) 517.00) 645.00) 833.00) 413.00) 468.00) 560.00) 819.00) 873.00) 1,046.00) 1,222.00) 640.00) 458.00) 466.00) 680.00) 804.00) 811.00) 1,197.00) 1,187.00) 597.00) 654.00) 754.00) 1,019.00) 1,077.00) 1,363.00) 613.00) 654.00) 734.00) 809.00) 1,358.00) 1,895.00) 781.00) 1,131.00) 317.00)

  23. RPR COMPLX SCALP/ARMS/LEGS RPR CMPLX SCALP/ARMS/LEGS RPR CMPLX HED/ARM/LEG ADDTL5CM RPR CMPLX FACE/HAND/FT/GEN RPR CMPLX FACE/HAND/FT/GEN RPR CMPLX FACE/HAND/FT/GEN RPR CMPLX EYELID/NOSE/EARS/LIP RPR CMPLX EYELID/NOSE/EARS/LIP BURN TREAT 1ST DGR LOCAL ONLY BURN SM DRESS/DEBRID BURN MED DRESS/DEBRID BURN LG DRESS/DEBRID FB RMVE MUSCLE SIMPLE FB REMOVAL MUSCLE COMPLEX Inj trigger point 1/2 muscle ARTHROCENTESIS INJ SM JT ARTHROCENTESIS INJ INTERMED ARTHROCENTESIS FRACTURE NOSE BONE FX W/O MNP FX MANDIBULAR DISLOCATED TEMPOROMANDIBULAR FRACTURE RIB FX RIB W/FLAIL CHEST FX SPINE VERT BODY FRACTURE CLAVICLE CLOSED REDUCTION TRACTN/MANIP AC INT REDUCTION FX SCAPULAR FX HUMERAL NECK DISLOCATED SHOULDER CLSD TX SHLDR DISLOCATE W/MAN FB RMVE UPPER ARM/ELB SUBCUTNS FRACTURE HUMERUS FX SUPRACONDYLAR DISLOCATED ELBOW TRT CLSD FRACTURE ELBOW CLOSED DISLOCATED NURSEMAID ELBOW FX RADIAL HD/NECK CLSD TRTMNT ULNAR W/O MAN FX RADIAL SHAFT FX ULNAR SHAFT FRACTURE RADIUS/ULNA FX RADIAL DISTAL WRIST FRACTURE REDUCTION FX NAVICULAR FX CARPAL CLSD TRTMNT DISLCTN W/MANIP ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 811.00) 1,235.00) 500.00) 939.00) 1,593.00) 822.00) 1,167.00) 1,831.00) 185.00) 175.00) 579.00) 814.00) 807.00) 1,205.00) 206.00) 236.00) 166.00) 193.00) 122.00) 889.00) 130.00) 315.00) 2,169.00) 941.00) 718.00) 1,015.00) 1,148.00) 758.00) 1,017.00) 1,250.00) 4,700.00) 784.00) 1,024.00) 1,275.00) 1,433.00) 247.00) 466.00) 772.00) 1,011.00) 819.00) 758.00) 996.00) 362.00) 1,713.00) 874.00) 936.00) 1,483.00)

  24. CLSD TRTMNT DSLOCTN W/MANIP I&D FINGER ABSCESS SIMPLE I&D FINGER ABSCESS COMP(FELON) FB RMVE CARPOMETACARPAL JOINT FB RMVE METACARPOPHALANGEAL JT FB RMVE INTERPHALANGEAL JOINT RPR EXT TNDN FINGER W/O GRF FX METACARPAL W/O MANIP FX METACARPAL W/MANIP. REDUCTION FINGER DISLOCATION DISLOCATED TOE DISLOCATED FINGER FRACTURE FINGER/THUMB FX PHALANGEAL W/MANIPULATION FX CLOSED DISTAL PHALANGEAL FRACTURE DISTAL PHALANGE DISLOCATED I P JOINT FINGER DISLOCATED I P JNT FNGR W/ANES FX COCCYX FRACTURE FEMORAL CLOSED FX W/O DISLOCATED HIP W/O ANESTHESIA FRACTURE KNEE FRACTURE TIBIA KNEE DISLOCATION, CLOSED FX DISLOCATED PATELLA FX TIBIAL SHAFT FRACTURE FIBULA CLSD TRTMNT FIBLR DSTL W/O MAN FX ANKLE BIMALLEOLAR FRACTURE ANKLE ANKLE FX, W/MANIPULATION DISLOCATED ANKLE ARTHROTOMY OF INTERPHAL JOINT FB RMVE FOOT SUBCUTANEOUS FB RMVE FOOT DEEP FB RMVE FOOT COMPLICATED RPR TENDON FLEX FT PRM W/O GRF FX CALCANEAL FX TALUS FX TARSAL FX METATARSAL FX GREAT TOE W/O MANIP FX GREAT TOE W/MANIP FRACTURE TOE DISLOCATED GREAT TOE DISLOCATED METATARSAL TREAT TOE DISLOCATION ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 1,449.00) 323.00) 519.00) 2,243.00) 2,362.00) 2,529.00) 3,174.00) 730.00) 1,084.00) 1,604.00) 1,308.00) 1,524.00) 524.00) 1,021.00) 632.00) 1,414.00) 227.00) 1,340.00) 570.00) 1,830.00) 2,066.00) 1,028.00) 1,259.00) 1,953.00) 1,403.00) 1,104.00) 970.00) 1,115.00) 1,111.00) 1,315.00) 1,882.00) 1,635.00) 1,707.00) 817.00) 1,544.00) 1,897.00) 1,920.00) 1,028.00) 283.00) 891.00) 814.00) 492.00) 587.00) 662.00) 131.00) 611.00) 517.00)

  25. CLTX INTERPHALANGEAL JT DSLOC W/ ANESTH FRACTURE PHALANGES FT OPEN 1+ SPLINT ARM LONG APPLY SPLINT ARM SHRT STATIC APPLY SPLINT FINGER SPLINT LEG LONG APPLICATION SPLINT LEG SHORT APPLICATION FB RMVE INTERNASAL NOSEBLEED ROUNTINE SMPLE* NOSEBLEED ANTERIOR PACK NOSEBLEED POSTIER PACK ENDOTRACHEAL INTUB DIRECT LARYNGOSCOPY TRACHEOSTOMY EMERGENCY THORACENTESIS CHEST TUBE THORACOSTOMY CHEST TUBE IND W/WO DRAIN PERICARDIOCENTESIS CVP INSERTION CUT DOWN CATHETERIZATION, VENOUS INTRAOSSEOUS INFUSION ARTERIAL CATH OR CANULATION REMOVAL FOREIGN BODY MOUTH I&D ABSCESS DENTAL FB RMVE THROAT NASO-/ORO-GASTRC TUBE PLCMENT CHANGE OF GASTROSTOMY TUBE FECAL IMPACTION REMOVAL I&D THROMBOSED HEMMORRHOID EXCISION OF THROMBOSD HEM EXT PERITONEAL LAVAGE/PARACENTESIS CATHETER BLADDER, SIMPLE CATHETER BLADDER, COMPLEX CYSTOSTOMY TUBE CHANGE MEATOTOMY MEATOTOMY INFANT CATHERIZATION, URETHRA I&D OF VUVLA/PERINAL ABCESS I&D BARTHOLIN'S GLAND ABSCESS REMOVAL IUD VAGINAL DELIVERY SPINAL TAP W/OUT INJECTION SPINAL TAP W/ INJECTION SKULL FX SIMPLE SPINAL PUNCTURE LUMBAR DIAG LOCAL BLOCK (NERVE) ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 550.00) 2,212.00) 227.00) 159.00) 117.00) 227.00) 183.00) 227.00) 247.00) 330.00) 437.00) 478.00) 615.00) 908.00) 315.00) 873.00) 525.00) 502.00) 1,046.00) 344.00) 604.00) 302.00) 428.00) 530.00) 391.00) 458.00) 178.00) 1,189.00) 666.00) 607.00) 419.00) 271.00) 138.00) 376.00) 256.00) 377.00) 243.00) 377.00) 445.00) 415.00) 292.00) 3,184.00) 490.00) 597.00) 3,564.00) 293.00) 226.00)

  26. DIGITAL NERVE BLOCK INJ ANES AGNT/STERD FACET JNT FB RMVE EYE EXTERNAL FB RMVE EYE EMBEDDED FB RMVE CORNEA W/O LAMP FB RMVE CORNEA SLIT LAMP FB RMVE EAR CANAL W/O ANS FB RMVE IMPACTED CERUMEN GASTRIC INTUBATION ASP LAVAGE CPR TEMPORARY TRANSCUT. PACEMAKER CARDIOVERSION THROMBOLYSIS INFUSION RMVL DEVITAL TIS 20 CM/< MOD SEDATION 5YRS + 1ST 30 MIN MOD SEDATION 5YRS + ADDTL 15 IPECAC & OBS Tobacco Use Cessation 3-10 minutes Tobacco Use Cessation > 10 minutes RESUSITATE NEWBORN ELECTRODES, PAIR CONDUCTIVE GEL OR PASTE EKG/ECG 12LD TRACNG&INTERPRTN EKG/ECG 12 LD TRACING ONLY EKG/ECG 3 LEAD TRACING ONLY ELECTROCARDIOGRAPHY EKG INTERPRET NEEDLE EMG; 2 EXT W/WO REL PARSPINL AREA NEEDLE EMG EACH EXT W/PARSPNL AREA LMTD NDL EMG EA XTR W/PARASPINL AREA COMPLETE EMG NON-EXTREMITY W/ NERVE CONDUCTION NERVE CONDUCTION STUDIES; 7-8 STUDIES NERVE CONDUCTION STUDIES; 9-10 STUDIES NERVE CONDUCTION STUDIES; 11-12 STUDIES NERVE CONDUCTION STUDIES; 13 OR MORE EKG INTERPRET INJECTIION FOR MYELOGRAM NEEDLE LOCALIZATION BY X-RAY FLOUROGUIDE FOR SPINE INJECT EPIDUROGRAPHY, DIAGNOSTIC D.P.S. BLOOD DRAW MISC COLLECTION FEE VENIPUNCTURE GLUCOSE-FINGER STICK BASIC METABOLIC PANEL ELECTROLYTE PANEL COMPREHENSIVE METABOLIC PANEL ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 252.00) 437.00) 142.00) 180.00) 177.00) 177.00) 271.00) 144.00) 109.00) 1,285.00) 70.00) 488.00) 1,118.00) 102.00) 149.00) 41.00) 198.00) 56.00) 91.00) 627.00) 69.00) 69.00) 200.00) 125.00) 44.00) 714.00) 133.00) 1,628.00) 598.00) 1,014.00) 848.00) 2,145.00) 2,611.00) 3,073.00) 3,578.00) 93.00) 1,191.00) 640.00) 282.00) 366.00) 84.00) 34.00) 36.00) 36.00) 301.00) 112.00) 449.00)

  27. PROFILE LIPID RENAL FUNCTION PANET HEPATITIS PANEL ACUTE PANEL HEPATIC FUNCTION DRUG SCREEN 8 PANEL AMIKACIN - PEAK & TROUGH DRUG SCREEN DIGOXIN; TOTAL DRUG SCREEN DIGOXIN; FREE VALPROIC ACID DRUG SCREEN VALPROIC ACID; FREE GENTAMICIN LEVETIRACETAM, SERUM LITHIUM OXCARBAZEPINE, SERUM PHENOBARBITAL DILANTIN PHENYTOIN TOTAL PRIMIDONE MYSOLINE QUINIDINE SALICYLATES TACROLIMUS BLOOD (FK506) THEOPHYLLINE VANCOMYCIN METHLYPHENIDATE (RITALIN) SERUM URINALYSIS NON-AUTOMATED W/ MICRO UA AUTO WITH MICRO URINALYSIS (DIP STICK) UA AUTO WO MICRO UA MICRO ONLY PREGNANCY TEST URINE COLOR CYP2C19 Genotype (*2 *3 *17) – Plavix® r CYP2C9 GENE COM VARIANTS Prothrombin G20210A Mutation (Factor II) FACTOR V LEIDEN MUTATION ANALYSIS HFE HEMOCHROMATOSIS DNA ANA COMMON VARI MTHFR Genotype (C677T & A1298C Mutations ACETAMINOPHEN SERUM ACETONE ACETONE(B)/KETONE QUANTITATIVE ADRENOCORTICOTROPIC HORMONE ACTH PLASMA ALBUMIN SERUM ALBUMIN, PERITONEAL FLUID MICROALBUMIN, URINE ALCOHOL ANY EXCEPT BREATH ALCOHOL BREATH A1 ANTITRYPSIN A1 ANTITRYP PHENO APF (ALPHA FETOPROTEIN) ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 212.00) 137.00) 751.00) 130.00) 663.00) 238.00) 210.00) 210.00) 215.00) 215.00) 259.00) 210.00) 105.00) 210.00) 181.00) 210.00) 262.00) 230.00) 380.00) 217.00) 224.00) 215.00) 285.00) 50.00) 154.00) 41.00) 37.00) 49.00) 100.00) 3,374.00) 2,024.00) 776.00) 964.00) 848.00) 689.00) 291.00) 70.00) 116.00) 585.00) 78.00) 83.00) 89.00) 198.00) 191.00) 213.00) 228.00) 265.00)

  28. AMINO ACIDS SINGLE QUANT AMINO ACIDS QUANT 2-5 AMMONIA AMYLASE ACE - ANGIOTENSIN I CONV ENZYM Apolipoprotein A-I (ApoA-I) ARSENIC VITAMIN C BILE ACIDS TOTAL BILIRUBIN TOTAL BILIRUBIN DIRECT OCCULT BLOOD, BY PEROXIDASE BLOOD OCCULT (GUAIAC) CADMIUM; URINE CALCIFEDIOL (25-OH VITAMIN D) CALCIUM TOTAL 82310 CALCIUM IONIZED CALCIUM URINE 24HR CALCULI, URINARY RENAL STONE ANALYSIS TEGRETOL CARBAMAZEPIN TOTAL CO2 CARBON MONOXIDE QUANTITATIVE CEA CERULOPLASMIN CHLORIDE BLOOD CHLORIDE URINE CHOLESTEROL SERUM TOTAL PSEUDOCHOLINESTERASE CITRIC ACID (CIRTARE) 24 HR URINE COLLAGEN CROSS LINKS ANY METHOD COPPER CORTISOL TOTAL CREATINE, URINE LEVETIRACETAM CPK TOTAL CKMB-MB FRACTION ONLY CREATININE BLOOD 82565 CREATININE URINE CREATININE CLEARANCE CRYOGLOBULIN,QUAL OR SEMIQUAL VITAMIN B-12 CYSTATIN C (INCL eGFR) Dehydroepiandrosterone Sulfate (DHEA-S) VITAMIN D COMPLETE ELATASE PANCREATIC FECAL QUAL/SEMI-QUANT Electrophoretic test ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 267.00) 158.00) 230.00) 102.00) 230.00) 245.00) 300.00) 157.00) 270.00) 79.00) 79.00) 51.00) 51.00) 366.00) 429.00) 82.00) 216.00) 95.00) 203.00) 204.00) 229.00) 78.00) 195.00) 300.00) 170.00) 73.00) 80.00) 69.00) 124.00) 439.00) 296.00) 196.00) 258.00) 73.00) 285.00) 179.00) 375.00) 82.00) 83.00) 150.00) 102.00) 238.00) 215.00) 351.00) 607.00) 315.00) 413.00)

  29. ERYTHROPOIETIN ESTRADIOL ESTROGENS FRACTIONATED ESTROGEN, TOTAL ESTRONE FECAL FAT QUALITATIVE FAT FECES QUANTITATIVE Free Fatty Acids (FFA) FERRITIN FIBRINOGEN ACTIVITY FOLATE SERUM ASSAY OF FOLIC ACID RBC Galectin-3 IMMUNOGLOBULIN G IGG GAMMA IMMUNOGLOBULINS E IgG SUBCLASSES 1-4 EACH GASTRIN SERUM GLUCOSE QUANT GLUCOSE POST DOSE GLUCOSE TOLERANCE 3 SPECIMENS GLUCOSE TOLERANCE ECH OVER 3 G6PD-GLUCOSE-6-PHOSPIATE DEHYD BLOOD GLUCOSE BY HOME MONITOR GAMMA GT 82977 Fructosamine FSH LEUTEINIZING HORMONE GROWTH HORMONE SINGLE SERUM HEAVY METAL QUANTITATIVE EACH HGB ELECTROPHORESIS HEMGLBNPTHY FRCTNTN CHRMTGRPHY HGB A1C EA NUC ACID SEQU HOMOCYSTEINE RANDOM URINE 5HIAA IMMUNOASSAY ANAL QUANT NOS INSULIN RIA TOTAL IRON IRON BINDING TOTAL LACTIC ACID, PLASMA LDH TOTAL LDH ISOENZYMES LACTOFERRIN, FECAL, QUANT LEAD LEVEL LIPASE LIPOPROTEIN A Lipoprotein-Associated Phospholipase A2 LIPOPROTEIN BLOOD ELCTROPHRTIC SEP/QUANT ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 297.00) 441.00) 510.00) 138.00) 394.00) 80.00) 265.00) 210.00) 216.00) 135.00) 233.00) 273.00) 348.00) 147.00) 260.00) 67.00) 279.00) 63.00) 75.00) 203.00) 62.00) 138.00) 38.00) 114.00) 238.00) 293.00) 292.00) 263.00) 347.00) 203.00) 285.00) 154.00) 267.00) 96.00) 204.00) 181.00) 102.00) 138.00) 170.00) 95.00) 202.00) 418.00) 192.00) 110.00) 204.00) 535.00) 240.00)

  30. LDL Particle Number (LDL-P) & HDL Partic HDL CHOLESTEROL LDL CHOLESTEROL MAGNESIUM MASS SPECTROMETRY QUANT MERCURY MUCIN CLOT MYOGLOBIN Myeloperoxidase (MPO) ASSAY OF NEPHELOMETRY NOT SPEC ORGANIC ACIDS TOTAL QUANT METHYLMALONIC ACID OSMOLALITY SERUM OSMOLALITY URINE Osteocalcin OXALATE 24 HOUR URINE PTH LEVEL PHOSPHATASE ACID TOTAL PHOSPHATASE ALKAL PHOSPHORUS INORG PHOSPHORUS 24 HOUR URINE PORPHYRINS 24 HR URINE POTASSIUM 84132 POTASSIUM URINE PREALBUMIN Pregnenolone PROGESTERONE PROLACTIN PSA PROSTATIC SPECIFIC ANTIGEN Prostate-Specific Antigen (PSA), free PROTEIN TOTAL SERUM 24 HR URINE, TOTAL PROTEIN PROTIEN TOTAL - PLEURAL FLUID PROTEIN ELECTRO, SERUM ELECTROPHORETIC FRACTIONATION PROTOPORPHYRIN, RBC, QUANTITATIVE Proinsulin VITAMIN B-6 SOLUBLE TRANSFERRIN RECEPTOR RENIN Human Sex Hormone-Binding Globulin (SHBG SODIUM SERUM URINE SODIUM ASSAY SOMATOMEDIN HDL2-C Subclass 1,5 Anhydroglucitol (Glycomark®) FREE TESTOSTERONE SERUM ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 535.00) 131.00) 152.00) 107.00) 285.00) 205.00) 93.00) 368.00) 535.00) 215.00) 260.00) 260.00) 78.00) 78.00) 449.00) 203.00) 651.00) 117.00) 83.00) 75.00) 83.00) 233.00) 73.00) 69.00) 134.00) 327.00) 329.00) 306.00) 291.00) 291.00) 59.00) 59.00) 59.00) 170.00) 282.00) 139.00) 282.00) 444.00) 577.00) 348.00) 344.00) 76.00) 76.00) 336.00) 111.00) 46.00) 402.00)

  31. TESTOSTERONE TOTAL VITAMIN B1 THROMBOXANE URINE THYROXINE TOTAL T4 FREE TBG TSH THYROID STMULTNG IMMNE GLBLN VITAMIN A SGOT AST SGPT ALT TRANFERRIN TRIGLYCERIDES T UPTAKE TRI-IODOTHYRONINE T3; TOTAL T-3 FREE T3, reverse TROPONIN QUANTATIVE TROPONIN QUALITATIVE BUN QUANTITATIVE URIC ACID BLOOD URIC ACID URINE VMA/URINE VITAMIN E VITAMIN K 1 ZINC, SERUM C-PEPTIDE SERUM PREGNANCY QUANT. HCG QUALITATIVE HCG WBC W/DIFF AUTOMATED BLOOD SMEAR W MANUAL DIFF HCT (HEMATOCRIT) CBC WITH DIFFERENTIAL CBC W/MANUAL DIFF RETICULOCYTE COUNT MANUAL WBC BLOOD COUNT, PLATELET AUTOMATED D-DIMER QA FDP,D-DIMER, QUANTITATIVE Fibrinogen, mass PROTHROMBIN TIME SED RATE WESTGREN NONAUTOMATED Erythrocyte Sedimentation Rate (ESR) HEMOGLOBIN SOLUBILITY HGB THROMBIN TIME PLASMA THROMBOPLASTIN INHIBITN,TISSUE PTT ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 409.00) 109.00) 265.00) 110.00) 142.00) 234.00) 265.00) 803.00) 224.00) 83.00) 84.00) 145.00) 91.00) 102.00) 224.00) 268.00) 122.00) 426.00) 117.00) 63.00) 72.00) 75.00) 245.00) 183.00) 109.00) 180.00) 329.00) 138.00) 118.00) 102.00) 139.00) 38.00) 179.00) 214.00) 65.00) 41.00) 95.00) 113.00) 147.00) 135.00) 176.00) 56.00) 44.00) 88.00) 92.00) 135.00) 95.00)

  32. FEBRILE AGGLUTINUS EACH ALLERGEN SPECIFIC IgG QUAN/SEMIQUAN EACH ALLERGEN SPECIFIC IgE QUAN/SEMIQUAN EACH ALLERGEN SPECIFIC Ige QUAL MULTIALLERGEN ANCA ANA (ANTINUCLEAR ANTIBODIES) ANA TITER ASO TITER C-REACTIVE PROTEIN (CRP) C-REACTVE PROTN HI SNSITIVITY Anti-Beta-2 Glycoprotein I Antibodies (A ACA, QUANTITATIVE,IGA,IGG,IGM COLD AGGLUTININ TITER QUANTITATIVE DNASE ANTIBODY ANTI DNA ANTIBODIED BY EIA NUCLEAR ANTIGEN ANTIBODY CANCER ANTIGEN CA - 19 -9 CA 125 II MONO SPOT CHROMOGRANIN A-IMMUNOASSY TMR QUANT IMMUNOASSAY INFECT AGNT ANTBDY QUANT NOS IMMUNOFIXATION ELECTROPHRSIS IMMUNOFIXATION UA INTRINSIC FACTOR BLOCKING ANTIBODIES ANTIPANCREATIC ISLET CELLS LIVER KIDNEY MICROSOMAL AB HEPATITIS B SURF ANT W/CONF RHEUMATOID FACTOR RHEUMATOID FACTOR RPR BARTONELLA ANTIBODY PANEL LYMES DISEASE WESTERN BLOT LYME DISEASE TTL ANTIBODIES CYTOMEGALOVIRUS (CMV), IGM EB VIRUS, EARLY ANTIGEN EPSTEIN-BARR NUC ANTGN ANTIBODIES IsG EB VIRUS, VIRAL CAPSID HELICOBACTER PYLORI, ANY HIV HERPES SIMPLEX NON-SPECIFIC TYPE TEST HEPRES SIMPLEX TYPE 1 HERPES SIMPLEX TYPE 2 HIV 1 HIV 2 HIV 1 AND HIV 2, SINGLE RESULT HEP B CORE ANTIBODY TOTAL ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 111.00) 75.00) 75.00) 126.00) 238.00) 192.00) 177.00) 116.00) 83.00) 204.00) 124.00) 124.00) 107.00) 173.00) 217.00) 283.00) 329.00) 329.00) 329.00) 83.00) 426.00) 237.00) 352.00) 464.00) 196.00) 273.00) 229.00) 267.00) 90.00) 90.00) 68.00) 130.00) 245.00) 269.00) 130.00) 207.00) 241.00) 286.00) 130.00) 306.00) 227.00) 208.00) 306.00) 140.00) 167.00) 217.00) 191.00)

  33. HEP B CORE IGM ANTIBODY HEP B SURFACE ANTIBODY HEPATITIS A ANTIODY IGM INFLUENZA TITER LEGIONELLA IGM ROCKY MNTN FEVER TITRE RUBELLA TITER TREPONEMA PALLIDUM ANTIBODIES (FTA-ABS) VARICELLA ZOSTER VIRUS AB,IGM WEST NICE VIRUS, IGM WEST NILE VIRUS WEST NILE VIRUS TITER Anti-Thyroglobulin Antibodies (Anti-Tg) HEPATITIS C ANTIBODY HEP C ANTIBODY AB ID STD COM PANEL ABO ANTIBODY TITER (COOMBS) CONCENTRATION INFECTIOUS AGENTS CULTURE BLOOD AEROBIC CULTURE STOOL AEROVIC CULTURE STOOL + PATHOGENS CULTURE SPUTUM OTHER SOURCE CULTURE BACTERIAL ANY ANAEROBIC ISOID AEROBIC BACTERIUM ID MRSA CULTURE URINE QUANT CLNY CULTURE FUNGUS CULTURE FUNGAL DEF ID CULTURE CHLAMYDIA CULTURE AFB (MYCOBACTERIA) PINWORM PREPARATION SMEAR OVA & PARASITES DIRECT SENSITIVITY ORGANISM GRAM STAIN SMEAR AFB OVA & PARASITE SMEAR WET MOUNT KOH PREP CLOSTRIDIUM DIFFICILE TOXIN RSV ASPERGILLUS GALACTOMANNAN EIA CLOSTRIDIUM DIFF TOXINS IAAD EIA CRYPTOSPORIDIUM IAAD EIA GIARDIA H. PYLORI STOOL AG EIA HEP B SURFACE ANTIGEN HEP BE ANTIGEN ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 185.00) 170.00) 178.00) 215.00) 242.00) 306.00) 227.00) 138.00) 130.00) 130.00) 227.00) 130.00) 251.00) 225.00) 245.00) 527.00) 83.00) 137.00) 163.00) 150.00) 150.00) 136.00) 197.00) 129.00) 105.00) 129.00) 134.00) 163.00) 309.00) 171.00) 68.00) 138.00) 137.00) 68.00) 86.00) 284.00) 68.00) 68.00) 311.00) 189.00) 189.00) 189.00) 245.00) 245.00) 227.00) 163.00) 182.00)

  34. RAPID STREP INFECT AGNT-DNA/RNA-BORRELIA BURGDORFERI IADNA CANDIDA SP AMP PROBE TQ CHLAMYDIA DNA PROBE CHLAMYDIA NUCLEIC AAA CYTOMEGALOVIRUS (CMV) QUANT, PLASMA INLFUENZA VIRUS REVERSE TRANSCRIPTION INFLUENZA VIRUS FOR MULT TYPES/SUB TYPES HEP B VIRUS DNA HEP C, QUAL DNA OR RNA, NNA AMP PROBEREV HEP C RNA PCR QUANT HIV-1 QUANT, REALTIME PCR GONORRHOEAE GEN PROBE GONORRHOEAE DNA PROBE TRICHOMONAS VAG DNA/RNA AMP PROB CANDIDA SP DNA OR RNA AMP PROBE INFECTIOUS AGNT DETCT (DNA/RNA) QUANT EA INFLUENZA ANTIGEN (CHG X2) HEPATITIS C VIRUS CYTOPTHLGY,CERV,VAG PAP W/RFLX LEUKEMIA FLOW MARKER-1ST MARKER-TC ONLY LEUKEMIA FLOW MARKER-EA ADDTL-TECH ONLY LEUKEMIA FLOW MARKER-16 OR > MARKERS OVA AND PARASITES WITH DIFFERENTIAL COUNT WBC STOOL CRYSTAL ID BY LIGHT PSA SCREENING,TOTAL MUMPS ANTIBODIES IgG MUMPS ANTIBODIES IgM PSA SCREENING CMV ALDOSTERONE URINE CATECHOLAMINES FRACTIONATED HAPTOGLOBIN ANTIGLIADIN AB PANEL ACHR RECEPTOR BINDING ANTIBODY METANEPHRINES BNP PLATELET ANTIBODY COMPLEMENT ANTIGEN EACH COMPONENT COMPLEMENT FUNCTIONAL EACH COMPONENT CYCLIC CITRULLINATED PEPTIDE #TB SKIN TEST INTRADERMAL ALDOLASE HEMOGLOBIN PERIPHERAL SMEAR ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 189.00) 455.00) 531.00) 317.00) 554.00) 487.00) 810.00) 1,342.00) 554.00) 554.00) 448.00) 1,287.00) 317.00) 554.00) 531.00) 531.00) 876.00) 95.00) 2,891.00) 321.00) 235.00) 135.00) 235.00) 91.00) 88.00) 68.00) 114.00) 291.00) 206.00) 206.00) 291.00) 291.00) 643.00) 328.00) 199.00) 182.00) 214.00) 268.00) 535.00) 155.00) 191.00) 156.00) 204.00) 36.00) 154.00) 38.00) 265.00)

  35. MURAMIDASE / LYSOZYME SERUM HEP A TOTAL CULTURE URINE HANDLING FEE CLINICAL PATH CONSULT LIMITED LEVEL I SURG PATH GROSS ONLY LEVEL II SURG PATH GROSS&MICRO LEVEL III SURG PATH GROSS&MICR LEVEL IV SURG PATH GROSS&MICRO LEVEL V SURG PATH GROSS&MICRO LEVEL VI SURG PATH GROSS&MICRO CYTOPATH. SMEARS,SCREEN,INTPRT CYTOPATHOLOGY INTERPRET&REPORT PLACEMENT BREAST LOCALIZATION DEVICE DX BREAST TOMOSYNTHESIS UNILATERAL DX BREAST TOMOSHYTHESIS BILATERAL DX UNILAT MAMMO W/ CAD DX BILAT MAMMO W/ CAD MAMMO BILATERAL DIGITAL DIAGNOSTIC MAMMO DIGITAL BREAST TOMOSYNTHESIS UNILAT DX BREAST TOMOSYNTHESIS BILAT SCREENING MAMMO SCREENING W/ CAD MAMMO SCREENING BILATERAL DIGITAL GAD-BASE MR CONTRAST NOS,1ML MRI TEMPOROMANDIBULAR JOINT MRI ORBIT/FACE/NECK - PLAIN MRI ORBIT/FACE/NECK W/CONTRAST MRI ORBIT/FACE/NECK - W/WO MRA HEAD MRA ANGIOGRAPHY HEAD W/DYE MRA HEAD W/WO MRA NECK MRA NECK W/ CONTRAST MRA NECK W W/O CONTRAST MRI BRAIN - PLAIN MRI BRAIN W/C MRI HEAD W/ AND W/O CONTRAST MRI CHEST W/O CONTRAST MRI CHEST W W/O CONTRAST MRA CHEST W/O & W/CONTRAST MATERIAL MRI CERVICAL SPINE - PLAIN MRI SPNL CNL/CNT,CRV W/CONT MRI THORACIC SPINE MRI THORACIC SPINE W/CONTRAST MRI LUMBAR SPINE - PLAIN MRI LUMBAR SPINE W/CONTRAST ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 244.00) 196.00) 129.00) 24.00) 193.00) 76.00) 131.00) 205.00) 349.00) 343.00) 425.00) 126.00) 419.00) 641.00) 366.00) 366.00) 840.00) 839.00) 839.00) 840.00) 366.00) 366.00) 578.00) 578.00) 29.00) 3,404.00) 3,320.00) 3,574.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,320.00) 3,830.00) 3,830.00) 3,320.00) 3,320.00) 3,320.00) 3,574.00) 3,320.00) 3,574.00)

  36. MRI CERVICAL SPINE WI & W/OI MRI CHEST W/WO DYE MRI LUMBAR SPINE W/WO DYE MRI PELVIS - PLAIN MRI PEVLIS W/DYE MRI PELVIS - W/WO DYE MRA PELVIS W/WO CONTRAST MATERIAL MRI UPPER EXTREME - PLAIN MRI UPPER EXTREMITY OTH THAN JT W/CONTR MRI UPPER EXTREM - W/WO DYE MRI JOINT UPR EXTREM - PLAIN MRI UPPER EXTREMITY W/CON MRI JOINT UPR EXTRM - W/WO DYE MRI LWR EXTREM (LEG) - PLAIN MRI LOWER EXTREMITY W/DYE MRI LWR EXTREM (LEG) W/WO DYE MRI JOINT LWR EXTREM - PLAIN MRI LOW EXTREMITY JT; W/CM MRI JOINT LWR EXTREM W/WO DYE MRA LOWER EXTREMITY W/WO CONTRAST MRI ABODMEN W/O DYE MRI ABDOMEN W/ CONTRAST MRI ABDOMEN - W/WO DYE MRI ANGIO, ADDOM W W/O DYE MR GUIDANCE FOR NEEDLE PLACE MRI BREAST UNILATERAL W/WO DYE MRI BREAST BILATERAL W/WO DYE HEPARIN 2 UNITS SINCALIDE INJ / KINEVAC SMCG MYOVIEW 40MCI UREA BREATH TEST C14 UREA BREATH TEST ANALY PARATHYROID NUCLEAR IMAGING LYMPH & LYMPH NODE IMA THYROID IMAGE UPDATE THYROID UPTAKE W/BLOOD FLOW S/M QUANT LIVER/SPLEEN/W/VASCULAR HEPATOBILIARY DUCT IMA HEPATOBILIARY SYSTEM IMAGING W/DRUG GASTRIC EMPTYING STUDY BONE &/JOINT IMAGING LIMITED AREA BONE &/OR JNT MULTIPLE BONE & JOINT IMAGING, WHOLE BODY BONE & JOINT IMAGING, 3 PHASE STUDY MYOCARDIAL SPECT SINGLE MYOCARDIAL SPECT MULT BLOOD POOL IMAGE MULT ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 3,830.00) 3,830.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,830.00) 3,320.00) 3,574.00) 3,830.00) 3,830.00) 3,830.00) 3,830.00) 3,830.00) 219.00) 275.00) 950.00) 153.00) 1,530.00) 659.00) 1,754.00) 1,822.00) 2,076.00) 1,764.00) 1,822.00) 2,085.00) 2,085.00) 1,531.00) 1,922.00) 2,738.00) 2,410.00) 3,292.00) 5,478.00) 4,715.00)

  37. CARDIAC BLOOD POOL FIR CARDIAC BLOOD POOL MUL LUNG PERFUSION PARTICU BRAIN IMAGING TOMOGRAPHIC SPECT CEREBROSPINAL FLUID FL GALLIUM SCAN WHOLE BODY KIT LABELED RBC DISP TC99M SESTAMIBI TC-99M PER STUDY DOSE MDP UP TO 30 MCI TL-201 THALLOUS CHLOR I-123 200MCI CAP EA TC99M EXAMETAZIME CHOLETEC UP TO 15 MCI MAA UP TO 10MCI EA TC99M SULFUR COLLOID UP TO 2 IN-111 PENTETREOTIDE DTPA UP TO 75 MCI INH OBS ROOM 1ST HR-NO TELEM. OBSRV ROOM W/MON 1ST HR OBSRV ROOM W/MON EA ADD HR OBSERVATION CHF PATNT 8-48 HRS OBS ROOM / EACH ADD HR-NO TELE TENS APPLICATION HOT-COLD THERAPY 1/> AREAS TRACTION MECH 1/> AREAS ELECTRICAL STIM UNATTENDED 1/> AREAS VASOPNEUMATIC DEVICE THERAPY 1/> AREAS PARAFFIN BATH 1/> AREAS WHIRLPOOL 1/> AREAS ELECTRICAL STIM MAN EACH 15 MIN IONTOPHORESIS EA 15 MIN 1/> AREAS CONTRAST BATHS EA 15 MIN 1/> AREAS ULTRASOUND EA 15 MIN 1/> AREAS UNLISTED MOD SPEC TYPE/TIME CONSTANT ATT THERAPEUTIC EXERCISES EA 15MIN 1/> AREAS NEUROMUSC RE-EDU EA 15 MIN 1/> AREAS GAIT TRAINING EACH 15 MIN (INC STAIRS) MASSAGE EA 15 MIN 1.+ AREAS MAN THRPY TQS EA 15 MIN, 1/> REGIONS THERAPEUTIC PROC GROUP 2/> INDIVIDUALS THERAPEUTIC ACT DIR PT CONTACT EA 15 MIN COGNITIVE SKILLS DEVELOPMENT EA 15 MIN SELF CARE/HOME MGMT TRAIN EACH 15 MIN COMMUNITY/WORK REINTEGRATION EA 15 MIN WHEELCHAIR MANAGEMENT EACH 15MIN DEBRIDEMENT OPEN WOUND EA ADDTL 20 SQCM ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 1,987.00) 2,753.00) 1,747.00) 3,647.00) 3,145.00) 2,480.00) 393.00) 840.00) 93.00) 88.00) 164.00) 132.00) 2,808.00) 176.00) 117.00) 125.00) 7,314.00) 210.00) 481.00) 564.00) 188.00) 675.00) 152.00) 124.00) 47.00) 126.00) 52.00) 149.00) 84.00) 180.00) 150.00) 204.00) 141.00) 101.00) 152.00) 252.00) 264.00) 223.00) 205.00) 235.00) 138.00) 256.00) 212.00) 275.00) 238.00) 242.00) 191.00)

  38. ORTHOTICS TRAINING, 15 MIN ECH PROSTHETIC TRAINING EA 15 MIN UPPR/LWR ORTHOTIC/PROST CHECK OUT EST PT EA 15 MI MOBILITY-WALK/MOVING CURRENT STS MOBILITY-WALK/MOVING GOAL MOBILITY-WALKING/MOVING DC STS CHG/MAINT BODY POS CURRENT STS CHG/MAINT BODY POS GOAL CHG/MAINT BODY POS DC STATUS CARRY/MV/HAND OBJECTS CURRENT STS CARRY/MV/HAND OBJECTS GOAL CARRY/MV/HAND OBJECTS DC STATUS SELF CARE CURRENT STS SELF CARE GOAL SELF CARE DC STATUS OTHER PT/OT PRIM FCT LMT CURRENT STS OTHER PT/OT PRIM FCT LMT GOAL OTHER PT/OT PRIM FCT LMT DC STATUS OTHER PT/OT SUBSQ FUNCT LMT CURRENT STS OTHER PT/OT SUBSQ FUNCT LMT GOAL OTHER PT/OT SUBSQ FUNCT LMT DC STS PHYSICAL PERFORM TEST W/ RPT EA 15 MIN PT EVAL LOW COMPLEX PT EVAL MOD COMPLEX PT EVAL HIGH COMPLEX PT RE-EVAL EST PLAN CARE RADIOPHARM DX AGENT MEPERIDINE HYDROCHL / 50MG LIDOCAINE INJ SURGICAL TRAY STERILE NEEDLE XR INJECTION FOR WRIST X-RAY INJECTION KNEE ARTHROGRAPHY HYSTEROSALPINGOGRAM CATH MYELOGRAPHY LUMBAR INJ 2> REGIONS RADIOLOGIC EXAMINATION EYE DETECT FB XR MANDIBLE 1-3 VIEWS XR MANDIBULAR SERIES MIN 4VIEWS XR MASTOID PARTIAL XR MASTOID CMPLETE MIN 3V ECH SDE XR FACIAL BONES LIMITED XR FACIAL BONE SERIES MIN 3VIEWS XR NASAL BONE SERIES MIN 3VIEWS XR ORBIT CMPLETE MIN 4VIEWS XR SINUSES <THAN 3VIEWS XR SINUSES CMPLETE MIN 3VIEWS XR SKULL <THAN 4 VIEWS ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 296.00) 259.00) 365.00) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 0.01) 259.00) 605.00) 662.00) 718.00) 411.00) 129.00) 25.00) 129.00) 66.00) 191.00) 705.00) 129.00) 613.00) 1,333.00) 326.00) 326.00) 326.00) 216.00) 229.00) 344.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00)

  39. XR SKULL MIN 4VIEWS XR T M JOINTS UNILATERAL XR T-M JOINT BILATERAL XR SOFT TISSUES OF NECK XR CHEST 1 VIEW XR CHEST XRAY STEREO FRONTAL XR CHEST 3 VIEWS W/LORDOTIC XR CHEST CMPLETE MIN 4 VIEWS XR CHEST 1 VIEW XR CHEST 2 VIEWS XR CHEST 3 VIEWS XR CHEST 4 VIEWS XR RIBS UNILAT 2VIEWS XR RIBS W/PA CHEST MIN 3VIEWS XR RIBS BILATERAL XR RIBS BILAT W/PA CHEST MIN 4V XR STERNUM MIN 2VIEWS XR STEMOCIAVICULAR JOINT XR SPINE 1VIEW XR CERVICAL SPINE 2/3 VIEWS XR SPINE CERVICAL MIN 4 VIEWS XR CERVICAL SPINE CMPLETE & FLEX XR SCOLIOSIS SERIES scoliosis evalu XR SPINE THORACIC 2VIEWS XR SPINE THORACIC 3VIEWS XR THORACIC 4 VIEW RADEX SPINE THORACOLUMBAR 2 VIEWS XR SCOLIOSIS EVAL 1 VIEW XR SCOLIOSIS EVAL 2-3 VIEWS XR SCOLIOSIS EVAL 4-5 VIEWS XR SCOLIOSIS EVAL 6+ VIEWS XR SPINE THORACIC SCOLIOSIS STUDY XR SPINE LS 2/3VIEWS XR SPINE LS MIN 4VIEWS XR SPINE LS CMPLETE W/BENDING XR LUMBAR SPINE BENDING XR PELVIS 1/2VIEWS X-RAY EXAM OF PELVIS XR SACROILIAC JOINTS COMPLETE XR EXAM SACROILIAC JOINTS XR SACRUM & COCCYX MIN 2VIEWS MYELOGRAPY CERVICAL RS&I MYELOGRAPY THORACIC RS&I MYELOGRAPY 2/MORE REGIONS RS&I XR CLAVICLE COMPLETE XR SCAPULA COMPLETE XR SHOULDER 1VIEW ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 543.00) 216.00) 361.00) 229.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 543.00) 543.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 471.00) 326.00) 543.00) 543.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 2,681.00) 2,681.00) 2,681.00) 326.00) 326.00) 326.00)

  40. XR SHOULDER CMPLETE MIN 2VIEWS XR CONTRAST X-RAY OF SHOULDER XR ACROMIOCLAVICULAR JOINTS XR HUMERUS MIN 2VIEWS XR ELBOW 2VIEWS XR ELBOW CMPLETE MIN 3VIEWS XR CONTRAST X-RAY OF ELBOW LI XR FOREARM 2VIEWS XR UPPER EXTREMITY, INFANT XR WRIST 2VIEWS XR WRIST CMPLETE MIN 3VIEWS XR WRIST W/CONTRAST XR HAND 2 VIEWS XR HAND CMPLETE MIN 3VIEWS XR FINGER (S) MIN 2VIEWS XR HIP UNILAT 1 VIEW XR HIP UNILATERAL 1 VIEW XR HIP UNILAT CMPLT MIN 2 VIEWS XR HIP UNILAT W/ PELVIS 4 VIEWS XR HIP UNILAT CMPLETE MIN 2VIEWS XR HIPS BILAT W/ PELVIS MIN 2 VIEWS XR HIPS BILAT W/ PELVIS 3-4 VIEWS XR HIPS BILAT W/ PELVIS MIN 5 VIEWS XR CONTRAST X-RAY OF HIP XR PELVIS/HIPS MIN 2VIEWS XR FEMUR 2 VIEWS XR KNEE 1/2VIEWS XR KNEE MIN 3VIEWS XR KNEE CMPLETE 4VIEWS XR KNEE BOTH STANDING AP RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I XR TIB FIB 2VIEWS XR LOWER EXTREMITY INFANT MIN 2V XR ANKLE 2VIEWS XR ANKLE CMPLETE MIN 3VIEWS XR FOOT 2VIEWS XR FOOT CMPLETE MIN 3VIEWS XR OS CALCIS MIN 2VIEWS XR TOE (S) MIN 2VIEWS XR ABDOMEN AP & LATERAL XR ABDOMEN 1 VIEW XR ABDOMEN 2 VIEWS XR ABDOMEN 3+ VIEWS XR ABDOMEN ACUTE SERIES W/CHEST XR RAD EXAM ESOPHAGUS XRCONTRST X-RAY UPPR GI TRACT XR UGI W/AIR, W/KUB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 326.00) 2,011.00) 326.00) 326.00) 326.00) 326.00) 2,011.00) 326.00) 326.00) 326.00) 326.00) 2,011.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 2,011.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 1,237.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 326.00) 302.00) 621.00) 621.00) 621.00)

  41. XR UGI/SBFT XR SBFT UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY XR IVP W/O TOMO XR IVP W/TOMO X-RAY, FEMALE GENITAL TRACT XR PEDI FOREIGN BODY XR BONE DENSITY (HIPS SPINE) DXA XR EXAM BREAST SPECIMEN XR OF MAMMARY DUCT XR STRESS VIEW XR BONE AGE STUDY XR BONE LENGTH STUDY XR BONE SURVEY COMPLETE XR BONE DENSITY (HIPS SPINE) DXA K FLOW/FUNCT IMAGE, MULTIPLE XR CHEST 3 VIEWS PLCMNT OF SFT TISS LOCAL DEVICE 1ST LESI MYELOGRAPHY VIA LUMBAR INJ CERVICAL MYELOGRAM INJ LUMBAR THORACIC MYELOGRAPHY LMBR INJ INC RX SUPER/INTPRE EKG/ECG 12 LD TRACING ONLY EMG NEEDLE 1 EXTREMITY W/WO PARASPINAL XR INJECTION FOR SHOULDER X-RAY INJ PROC ELBOW ARTHROGRAPHY INJ FOR HIP ARTHRGRPHY W/O ANE MOD SEDATION INIT 15 MIN AGE 5+ VIP-DO NOT BALANCE BILL OXYGEN USE PER DAY OXYGEN EACH HOUR ABG DRAWING FEE ARTERIAL BLOOD GAS SPUTUM COLLECTION CPAP VENT INIT & MGMT NEBULIZER DEMO/EVALUTAION NEBULIZER TREATMENT PD & CP COMBO TX ULTRA SONIC NEBULIZER HEAT MIST W/OXY PER HOUR INCENTIVE SPIROMETRY POSTURAL DRAINAGE TREATMENT PERCUSSION TREATMENT SUCTION DAILY CHECK OXI HOOD SET UP OXI HOOD W/OXY PER HOUR ROOM HUMIDIFIER SETUP/MONITOR CONT ULTRA SONIC W/OXY PER HR ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 1,021.00) 621.00) 955.00) 424.00) 970.00) 1,820.00) 229.00) 855.00) 2,011.00) 423.00) 326.00) 326.00) 326.00) 543.00) 511.00) 1,143.00) 229.00) 592.00) 1,251.00) 1,251.00) 1,333.00) 161.00) 1,550.00) 509.00) 511.00) 1,277.00) 149.00) 662.00) 287.00) 132.00) 160.00) -  ) 27.00) 50.00) 86.00) 78.00) 92.00) 98.00) 71.00) 38.00) 34.00) 74.00) 74.00) 74.00) 38.00) 93.00) 24.00)

  42. CROUP TENT SET UP CROUP TENT OHIO W/OXY PER HOUR COOL MIST W/OXY PER HOUR PEAK FLOW MONITOR SUCTION TREATMENT STERILE RSV WASH COLLECTION PEP THERAPY/TRAINING PULSE-OX DISP. PEDI PULSE-OX DISP. ADULT PULMONARY FUNCTION SPIROMETRY PULMONARY FUNCTION COMPLETE PULSE OX PRIVATE SINGLE USE PULSE OX SEMI RM SINGLE USE PULSE OX SINGLE DETERMINATION PULSE OX MULTIPLE DETERMINATIN DEEP BREATHING EXERCISES EMERGENCY RESUSCITATION HOLTER MONITOR 24HR RECORD CPR HEPARIN FLUSH KIT 100 U PANTOPRAZOLE 40MG TAB VERAPAMIL 120MG TAB DERMABOND AMMONIA INHALANT .33CC INSULIN-NOVOLOG 70/30 1/1000 U SPIRONOLACTONE 25MG TAB AMOXICILLIN 250MG CAP MECLIZINE 25MG TAB PROCAINAMIDE IV 100MG/ML HYDRALAZINE 25MG TAB HYDROXYZINE 25MG TAB ATORVASTATIN 10MG TAB SULFAMETHOXAZOLE/TRIMETHPRM DS DONEPEZIL HYDROCHLORIDE 5MGTAB DIPHENHYDRAMINE 25 MG TAB FEXOFENADINE HYD.CHLO.60MG TAB VERAPAMIL 180MG TAB CAPTOPRIL 25MG TAB DILTIAZEM 30MG TAB DILTIAZEM 60MG TAB CLONIDINE 0.1MG TAB DILTIAZEM CD 180MG CAP DOCUSATE SODIUM 100MG TAB WARFARIN 1MG TAB PHENYTOIN 100MG TAB FLUMAZENIL IV 5ML OXYBUTYNIN 5MG TAB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 86.00) 36.00) 26.00) 71.00) 86.00) 86.00) 76.00) 175.00) 175.00) 374.00) 569.00) 175.00) 175.00) 175.00) 175.00) 76.00) 425.00) 510.00) 1,250.00) 7.00) 21.00) 8.00) 309.00) 7.00) 7.00) 7.00) 7.00) 7.00) 12.00) 7.00) 7.00) 23.00) 15.00) 45.00) 7.00) 12.00) 8.00) 7.00) 7.00) 7.00) 7.00) 9.00) 7.00) 7.00) 7.00) 569.00) 7.00)

  43. GUAIFENESIN 600MG TAB TRAZADONE 50MG TAB AMITRIPTYLINE 25MG TAB METRONIDAZOLE 250MG TAB CYCLOBENZAPRINE 10MG TAB DOXAZOSIN MESYLATE 2MG TAB FLUDOCORTISONE 0.1 MG TAB EPINEPHRINE AMP 0.1 MG GLIPIZIDE 5MG TAB METOLAZONE 2.5MG TAB NITROGLYCERIN 0.2MG/HR PATCH PHENAZOPYRIDINE 100MG TAB LOPERAMIDE 2MG TAB PROPRANOLOL 20MG TAB CEPHALEXIN 250MG TAB DIGOXIN 0.125MG TAB FUROSEMIDE 20MG TAB FUROSEMIDE 40MG TAB METOPROLOL TARTRATE 50MG TAB PROMETHAZINE DM SYRUP 5ML FENTANYL 25 MCG TRANSDERMAL THIORIDAZINE 10MG TAB ASPIRIN 81MG TAB GEMFIBROZIL 600MG TAB NITROGLYCERIN SL 0.4MG TAB MONTELUKAST 10MG TAB AMLODIPINE 5MG TAB PROMETHAZINE 25MG TAB PREDNISONE 5MG TAB PREDNISONE 10MG TABLET EACH SIMVASTATIN 10MG TAB ISOSORBIDE MONONITRATE 60MG TB NIFEDIPINE 30MG TAB FLUCONAZOLE 150MG TAB METHOCARBAMOL 750MG TAB CARBIDOPA/LEVADOPA 25/100MG CARBIDOPA/LEVADOPA 25/250 MG TAB TRAMADOL 50MG TAB NORMAL SALINE 3ML IPRATROPIUM BROMIDE .02 PERCENT SOL CARBAMAZEPINE 200MG TAB PENTOXIFYLLINE 400MG TAB LEVOTHYROXIN 0.025MG TAB 25MC LEVOTHYROXIN 0.088MG TAB/88MC LEVOTHYROXIN 0.075MG TAB 75MC ENALAPRIL 5MG TAB DICLOFENAC SODIUM 50MG TAB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 7.00) 7.00) 7.00) 7.00) 7.00) 7.00) 9.00) 8.00) 7.00) 12.00) 8.00) 7.00) 7.00) 8.00) 7.00) 20.00) 7.00) 7.00) 7.00) 7.00) 128.00) 7.00) 7.00) 7.00) 119.00) 27.00) 13.00) 7.00) 7.00) 7.00) 23.00) 8.00) 13.00) 119.00) 7.00) 7.00) 7.00) 10.00) 21.00) 8.00) 7.00) 7.00) 7.00) 7.00) 7.00) 7.00) 7.00)

  44. RANITIDINE 150MG TAB ACYCLOVIR 400MG CAP AMOXICILLIN 250MG SUSP 5ML SULFAMETHOXAZOLE/TRIMETH PEDS PHENYTOIN 125MG/5ML SUSP 8OZ THEOPHYLLINE ELIX 80MG/15ML LIDOCAINE VISCOUS 2 PERCENT 20ML GENTAMICIN OPHTH OINT 3.5GM TIMOLOL 0.5 PERCENT OPHTH 2.5ML DEXAMETHASONE 1MG/ML IM/IV MEPERIDINE IM/IV 100MG/ML MEPERIDINE IM/IV 25MG/ML PHENYLEPHRINE 1/4 PERCENT SOL 15ML NEOMYCIN/POLYB/HYDRO OTIC 10CC LISINOPRIL 10MG TAB FLUOXETINE 20 MG TAB DUODERM 4X4 DRESSING GENTAMICIN 0.1 PERCENT OINT 15 GM TERBINAFINE CREAM 12GM NIZORAL 2% CREAM CLOTRIMAZOLE/BETAMET 15GM CR SILVER SULFADIAZINE CREAM 25GM NAPROXEN 500MG TAB IPRATROPIUM BROMIDE/ALBUT. INH TETRACAINE 0.5 PERCENT TOLTERODINE 2MG TAB ZOLPIDEM TARTRATE 5MG TAB RESPERIDONE 1MG TAB VITAMIN B-12 1000MCG/ML DIPHENHYDRAMINE IM/IV 50MG/ML METHYLPREDNISOLONE IM/IV 80MG SOTALOL 80MG TAB HALOPERIDOL IM/IV 5MG/ML PROPRANOLOL IM/IV 1MG/ML SULCRALFATE 1GM SUSP FUROSEMIDE IV 20MG LORATADINE 10MG TAB LIDOCAINE 2 PERCENT MDV 2 PERCENT 50ML METOPROLOL IV 5MG/5ML BUPIVACAINE .5 PERCENT 30 ML BUPIVACAINE .75 PERCENT 30ML BUPIVACAINE .25 PERCENT 30ML LEVOTHYROXIN .01MG (100MC) TAB PROMETHAZINE IM/IV 25MG/ML METHYLPREDNISOLONE IM/IV 40MG METHYLPREDNISOLONE IM/IV 125MG LEVOFLOXACIN IM/IV 500MG ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 7.00) 6.00) 17.00) 7.00) 8.00) 28.00) 9.00) 188.00) 126.00) 12.00) 8.00) 8.00) 38.00) 308.00) 10.00) 7.00) 41.00) 13.00) 78.00) 166.00) 135.00) 25.00) 7.00) 449.00) 53.00) 27.00) 21.00) 28.00) 44.00) 44.00) 84.00) 28.00) 40.00) 171.00) 21.00) 9.00) 27.00) 9.00) 28.00) 20.00) 41.00) 27.00) 7.00) 45.00) 20.00) 36.00) 186.00)

  45. VANCOMYCIN IM/IV 500GM DOXYCYCLINE 100MG TAB LIDOCAINE 1 PERCENT MDV 50ML MUPIROCIN CREAM 2 PERCENT 15GM TUBE DIGOXIN IV .25MG/ML CLOPIDROGREL 75MG TAB CHLORDIAZEPOXIDE 10MG TAB FLUOR STRIP TEMAZEPAM 15MG TAB DIAZEPAM 5MG TAB CIPROFLAXACIN 500MG TAB NALBUPHINE IM/IV 10MG/ML AMIODARONE 200MG TAB VALPORIC ACID 250MG TAB ACETAMINOPHEN/CODEINE ELXR 5ML GLYBURIDE 5MG TAB MIDAZOLAM IM/IV 5MG/ML BUTORPHANOL IM/IV 2MG/ML DIAZEPAM IM/IV 5MG/ML METFORMIN 500MG TAB LORAZEPAM IM/IV 2MG/ML GLIPIZIDE XL 5MG TAB POTASSIUM CHLORIDE 10 MEQ TAB HYOSCYAMINE SULFATE 0.125 MG INSULIN-HUMULIN R 1/1000 UNITS INSULIN-HUMULIN N 1/1000 UNITS PENICILLIN G CR 100,000 UNITS PENICILLIN G LA 100,000 UNITS PROMETHAZINE SUP 12.5MG PROMETHAZINE SUP 25MG ALTEPLASE 50MG SINGLE DOSE LIDOCAINE 0.4 PERCENT /D5W 500ML NALBUPHINE IM/IV 20MG/ML IV-D5W 1000ML FAMOTIDINE 20 MG TAB SERTRALINE 50MG TAB PROCHLORPERAZINE 10MG TAB FUROSEMIDE IV 40MG IV - NORMAL SALINE 10ML BACITRACIN OPHTH ONIT 3.5GM TORSEMIDE 20MG TAB LIDOCAINE W/EPI 1 PERCENT 30ML DILTIAZEM IV 5MG/ML METOCLOPRAMIDE 10MG TAB LEVOTHYROXIN 0.05MG TAB 50MC NITROGLYCERIN 2 PERCENT OINT 1GM ATENOLOL 25MG TAB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 66.00) 7.00) 10.00) 272.00) 23.00) 38.00) 7.00) 7.00) 7.00) 7.00) 53.00) 10.00) 13.00) 7.00) 7.00) 7.00) 13.00) 73.00) 8.00) 8.00) 36.00) 7.00) 7.00) 7.00) 7.00) 7.00) 200.00) 249.00) 38.00) 29.00) 7,786.00) 61.00) 13.00) 13.00) 7.00) 23.00) 7.00) 32.00) 12.00) 20.00) 10.00) 13.00) 71.00) 7.00) 7.00) 41.00) 7.00)

  46. IRBESARTAN 150MG TAB MELOXICAM 7.5MG TAB GABAPENTIN 100MG TAB AZITHROMYCIN IM/IV 500MG CHLORDIAZEPOXIDE 25MG TAB TAMSULOSIN 0.4MG TAB BUPROPION 150MG TAB NICARDIPINE I.V. 20MG IN 200ML HYDROXYZINE 10MG TAB ALBUTEROL INHAL.KIT 1MG VENT PHENYLEPHRINE 1 PERCENT NASAL DROPS CELECOXIB 100MG TAB VALSARTAN 80MG TAB ISOSORBIDE DINITRATE ORL 10MG LISINOPRIL 5MG TAB POTASSIUM CHLORIDE 10 PERCENT LIQ NALOXONE IM/IV .4MG/ML LACTULOSE SOL 30ML PRIMIDONE 50MG TAB OXYCARBAZEPINE 150MG TAB CETIRIZINE SYRUP 5 ML LEVETIRACETAM 500MG TAB TRIAMTERENE/HCTZ 37.5/25 MG T TELMISARTAN 40MG TAB GLIMEPIRIDE 2MG TAB VITAMIN K1 IM/IV 10MG FOSPHENYTOIN GLIPIZIDE ER 2.5MG TAB FLUCONAZOLE IM/IV 200MG/ML ALPRAZOLAM 0.5MG TAB VERAPAMIL IM/IV 2.5MG/ML NIFEDIPINE 10MG TAB ALLOPURINOL 300MG TAB DIBUCAINE OINT 1OZ. BACLOFEN 10MG TAB NYSTATIN SUSP 5ML MIRTAZAPINE 15MG TAB HYDROCHLOROTHIAZIDE 25 MG TAB VECURONIUM BROMIDE 10MG INJ IV ROPINIROLE HCL 1 MG TAB ALLOPURINOL 100MG TAB LACTOBACILLUS ACID SPRINKLES BUSPIRONE HCL 5 MG TAB CITALOPRAM HYDROBROMDE 20MG TB AZITHROMYCIN 250MG TAB DIPHENHYDRAMINE 12.5MG/5ML LIDOCAINE JELLY 2% 30ML ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 13.00) 21.00) 8.00) 216.00) 7.00) 17.00) 17.00) 404.00) 7.00) 104.00) 41.00) 15.00) 13.00) 7.00) 10.00) 7.00) 12.00) 12.00) 7.00) 10.00) 17.00) 20.00) 7.00) 13.00) 7.00) 51.00) 214.00) 8.00) 865.00) 7.00) 25.00) 7.00) 7.00) 21.00) 7.00) 9.00) 27.00) 7.00) 29.00) 8.00) 7.00) 10.00) 7.00) 7.00) 72.00) 7.00) 126.00)

  47. METOCLOPRAMIDE IV 10MG HYDRALAZINE 20MG/ML INJ IM/IV PANTOPRAZOLE SODIUM IV 40MG SUCINYLCHLNE CHL IM/IV 20MG/ML CEFAZOLIN IM/IV 500 MG ACETAMINOPHEN/CODEINE TB 300MG FLUTICASONE PRPNTE/SLMTRL INH FLUTICASONE PRPNTE 50MCG N SPY ISOSORBIDE MONONITRATE 20MG TB RAMIPRIL 2.5 MG TAB SUCRALFATE 1GM TAB PENICILLIN V POTSSM 250MG TAB VITAMIN-MULTI IV 10ML FOLIC ACID IM/IV, SC 5MG/ML GENTAMICIN 80MG IVPB FINASTERIDE 5 MG TAB PIOGLITAZONE HCL 15MG TAB LOSARTAN POTASSIUM 50MG TAB LEVOTHYROXINE 112 MCG TAB DOPAMINE HCL IV 400MG PREDNISONE 20MG TAB FUROSEMIDE IM/IV 100 MG GENTAMICIN OPTH SOL 5ML AMPICILLIN IM/IV 500MG POTASSIUM CHLORIDE 20MEQ TAB PREDNSLNE ACETATE OPTH SUSP 1 PERCENT NIACIN SR 250MG TAB POLYSACCHARID IRON CMPLX 150MG RIVASTIGMINE 1.5MG TAB HYDROXYZINE IM/IV 50MG/ML STERILE WATER EYE WASH SOL 4OZ NEOMYCIN,POLYMIXIN GU IRR 10X1 ADENOSINE IV 6MG/2ML GABAPENTIN 300 MG TAB PHENYLEPHRINE 1 PERCENT NASAL SPRAY PRAMIPEXOLE 0.125MG TAB VASOPRESSIN 10 UNITS/.5 ML INJ NORMAL SALINE 1000ML BAG IRR BIMATOPROST OPTH .03 PERCENT 2.5ML SL ACTVTD CHARCOAL W/SORBITAL 50G FELODIPINE 5MG TAB KETOROLAC 30MG/ML INJ 30MG GETNAMICIN 80MG/2ML INJ LYRICA 50MG CAPSULE NAMENDA 10MG TAB WARFARIN 2.5MG TAB QUINAPRIL 5MG TAB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 8.00) 44.00) 228.00) 10.00) 32.00) 8.00) 738.00) 564.00) 7.00) 13.00) 9.00) 7.00) 81.00) 82.00) 40.00) 25.00) 36.00) 7.00) 7.00) 112.00) 7.00) 8.00) 27.00) 44.00) 8.00) 40.00) 7.00) 8.00) 23.00) 12.00) 23.00) 118.00) 360.00) 13.00) 41.00) 9.00) 25.00) 27.00) 290.00) 175.00) 12.00) 15.00) 15.00) 25.00) 40.00) 9.00) 7.00)

  48. DIVALPROEX SODIUM ER 250MG TAB TRIAMCNLNE ACTNDE NSE SPRY16.5 LIDOCAINE 0.5 PERCENT 50ML SDV FUROSEMIDE 20MG-INHALATION DEXAMTHASONE 1MG/ML-INHALATION POTASSIUM CHLORIDE 8 MEQ TAB ALBUTEROL .5 PERCENT 20ML DICYCLOMINE 10MG TAB NYSTATIN CREAM 15GM VANCOMYCIN IM/IV 1GM BRIMONIDINE OPTH SOL 0.15% BRIMONIDINE OPTH SOL 0.2% VERAPAMIL ER 180MG CAPS PRAVASTATIN SODIUM 20MG TAB LEVALBUTEROL HCL 0.5MG INH POTASSIUM CHLORIDE IV 20MEQ TETANUS .5ML INJ TETANUS/DIPTHERIA 0.5ML INJ DOCUSATE SODIUM 100MG/10ML HYDROCORTISONE SOD IM/IV 100MG GENTAMICIN 60MG IV PAROXETINE 20MG TAB SANTYL OINTMENT 15 GM IMIPENEM-CILASTATIN VL 250MG MUPIROCIN OINTMENT 22 GM NICOTINE TRANSDERMAL PTCH 21MG SALINE NASAL SPRAY 1.5 OZ NITROPRUSSIDE SODIUM 50MG IV PROPYLTHIOURACIL 50MG. TAB LABETALOL HCL 5MG/ML 4ML CLINDAMYCIN 600MG INJ CLONAZEPAM .5 MG TAB SOD.BICARBONATE 8.4 PERCENT 10ML PED LATANOPROST EYE DROP .005 PERCENT SOL ENALAPRILAT 1.25 MG VL FOLIC ACID 1MG TAB QUETIAPINE FUMARATE 25MG TAB SIMETHICONE 80 MG TAB BUMETANIDE 2 MG TAB METRONIDAZOLE 500MG IVPB DIVALPROEX SODIUM 500MG TAB BENZONATATE 100MG CAPS KETAMINE HCL IM/IV 50MG/ML PROPOFOL SDV IM/IV 10MG/ML LIDOCAINE 2 PERCENT IV 100MG/5ML TRIAMCINOLNE ACTNDE IM/IV 10MG METOPROLOL SUCCINATE 50MG TAB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 17.00) 529.00) 119.00) 10.00) 12.00) 7.00) 40.00) 7.00) 10.00) 419.00) 395.00) 130.00) 8.00) 9.00) 21.00) 8.00) 75.00) 192.00) 7.00) 20.00) 38.00) 27.00) 858.00) 159.00) 131.00) 25.00) 15.00) 15.00) 7.00) 44.00) 71.00) 7.00) 27.00) 479.00) 41.00) 7.00) 15.00) 7.00) 7.00) 27.00) 17.00) 7.00) 68.00) 122.00) 21.00) 61.00) 9.00)

  49. HYDROXYZINE HCL 10MG/5ML ELIX INDOMETHACIN SA 75MG CAPS CLINDAMYCIN HCL 150MG CAPS MIDAZOLAM IM/IV 1MG/ML 2ML BTL VITAMIN B 1 IM/IV 100MG PIPERACILLIN/TAZBCTM IV 3.375G CLONIDINE TTS PATCH - 1 VERAPAMIL 40MG TAB ACYCLOVIR IV 500MG CARBAMAZEPINE 5ML ELIX CILOSTAZOL 50MG TAB BUMETANIDE 1 MG TAB TERAZOSIN 5MG CAP CARVEDILOL 12.5 MG TAB DULOXETINE HCL 30 MG CAP DIVALPROEX SODIUM 250MG TAB TIZANIDINE 4MG TAB LIDOCAINE 2 PERCENT W/EPI 20ML NYSTATIN POWDER 50MU 10GM CETIRIZINE HCL 10 MG TAB GUIAFNSN 600/DEXTROMTH 30MG TB VALPROIC ACID 250MG/5ML SYRUP AMITRIPTYLINE HCL 10 MG TAB RIVASTIGMINE PATCH 4.6MG/24HRS BETAXOLOL 10MG TAB SULFACETAMIDE 10 PERCENT OPTH SOL15ML LOVASTATIN 10MG TAB CEFDINIR 125MG/5ML SUSP CYPROHEPTADINE 2MG/5ML SYRUP PIPERACILLIN/TAZOBCTM IV 2.25G SODIUM CHLORIDE 1GM TAB CARISOPRODOL 350 MG TAB METOPROLOL TARTRATE 25MG TAB HETASTARCH IV 6 PERCENT 500ML NS CARDIZEM CD 300MG CAP CIPROFLOXACIN 200 MG IV SILVER NITRATE APPLICATOR SIMVASTATIN 40MG TAB RANITIDINE IV 25MG/ML RANITIDINE IV 75MG/ 5ML LORAZEPAM 0.5MG TAB LANSOPRAZOLE 15MG TAB DIGOXIN IV 500MCG/ML BENAZEPRIL 10 MG TAB BETAXOLOL HCL .25 PERCENT 2.5ML EYEDR ZIPRASIDONE MESYLATE 10 MG INJ BRINZOLAMIDE 5ML OPTH SOL ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 7.00) 8.00) 8.00) 9.00) 21.00) 153.00) 113.00) 7.00) 45.00) 7.00) 9.00) 7.00) 7.00) 100.00) 41.00) 20.00) 7.00) 20.00) 286.00) 21.00) 7.00) 7.00) 7.00) 67.00) 9.00) 17.00) 8.00) 37.00) 6.00) 104.00) 7.00) 8.00) 7.00) 186.00) 27.00) 15.00) 7.00) 7.00) 40.00) 6.00) 7.00) 7.00) 12.00) 7.00) 200.00) 119.00) 303.00)

  50. DOBUTAMINE IV 250MG/20ML MEGESTROL ACETATE 40MG/ML SUSP SODIUM POLYSTRYENE SULF 15GM AZITHROMYCIN SOL 100MG/5ML LEVALBUTEROL HCL 0.5MG UD INH CEPHALEXIN 125MG/5ML SUSP 100M CARVEDILOL 3.125 MG TAB DOXEPIN HCL 10MG TAB DIVALPROEX SOD SPRINKLE CAPS ONDANSETRON 1MG ORAL FLUOXETINE 10 MG CAP BENZTROPINE MESYLATE 0.5 MG TB CLINDAMYCIN PALM HCL 100ML SOL FLUTCASNE/SALMTRL 100/50MCG IN ACETYLCYSTEINE 20 PERCENT 30ML IHH/OR DAKINS SOLUTION .25% 16 OZ TERAZOSIN 1 MG TAB LIDOCAINE PATCH 5 PERCENT DILTIAZEM ER 120MG CAPS NORMAL SALINE 1000ML BTL IRRG AMOXICILLIN/CLAV POT 400MG/5ML CEFOXITIN IV 1GM 20 ML ASPIRIN/EXTENDED REL 25/200MG TIOTROPIUM 18MCG INH POWDER PHENTOLAMINE IM/IV 5MG POLYETHYLENE 17GM PCKT TRIAMICINOLONE .1 PERCENT 15GM CREAM CLINDAMYCIN IV 300MG 2ML METFORMIN ER 500MG TAB MORPHINE 2MG/ML INJ LEVOFLOXACIN IV 750MG LINEZOLID IV 600MG/300ML HYDROMORPHONE HCL 2MG INJ ZINC SULFATE 50MG CAP SALMETEROL/FLUTICSN 250/50 INH ZIPRASIDONE 20 MG CAPS RESPERIDONE .25 MG TAB PHENYTOIN 100MG/4ML SUSP FLECAINIDE ACETATE 50MG TAB INSULIN DETERMIR PER UNIT CLARITHROMYCIN 500MG TAB LEVALBUTEROL 0.5 MG UB INHLTN HEP B VACCINE ADULT INJ LAMOTRIGINE 25MG TAB NITROFURANTOIN 100MG CAP ZAFIRLUKAST 10MG TAB RACEPHINEPHRINE .5ML INHL SOL ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 36.00) 56.00) 40.00) 189.00) 25.00) 61.00) 21.00) 7.00) 10.00) 9.00) 7.00) 7.00) 289.00) 576.00) 173.00) 89.00) 7.00) 58.00) 9.00) 12.00) 101.00) 88.00) 21.00) 349.00) 306.00) 21.00) 9.00) 25.00) 9.00) 10.00) 189.00) 482.00) 13.00) 7.00) 766.00) 51.00) 7.00) 20.00) 9.00) 7.00) 45.00) 32.00) 249.00) 7.00) 23.00) 20.00) 13.00)

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