Acute Care Hospitals

Spring Valley Hospital Medical Center

3.0

5400 S Rainbow Blvd
Las Vegas, NV 89118

(702) 853-3000 springvalleyhospital.com

CCN 290034

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All Procedure Prices

Insurance:

Procedure	CPT	Price
ROD LEGACY 5.5MM X 500MM	27130	$21,506
APPLY FOREARM SPLINT	29125	$276
PLATE VARIAX CLAV SUP MIDSHAFT TI STD 10H 122MM RT	29881	$4,711
Intubation, endotracheal, emergency procedure	31500	$1,131
Tracheotomy tube change prior to establishment of fistula tract	31502	$484
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate pr	31622	$2,035
STENT PROTEGE GPS 6F .035 14X30 80CM	31720	$294
HC ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX	36600	$159
CATH PACIFIC EXTREME PTA BLN 130CM 5X200MM	36620	$396
CEFOTAXIME PER 1GM	54014774	$247
CEFOTAXIME PER 1GM	54014790	$426
CEFTRIAXONE PER 250MG	54015896	$1,082
DOPAMINE HCL PER 40MG	54029079	$781
DOPAMINE HCL PER 40MG	54029111	$228
DOPAMINE HCL PER 40MG INJ	54029152	$239
FLUCONAZOLE 200MG INJ	54035670	$3,558
FLUCONAZOLE 200MG INJ	54035696	$2,570
GENTAMICIN SULF UP TO 80MG	54038179	$189
GENTAMICIN SULF UP TO 80MG	54038211	$215
GENTAMICIN SULF UP TO 80MG	54038237	$206
GENTAMICIN SULF UP TO 80MG	54038252	$90
GENTAMICIN SULF UP TO 80MG	54038278	$236
LEVOFLOXACIN PER 250MG	54051354	$742
LINEZOLID PER 200MG	54052816	$1,622
MAG SULPHATE PER 500MG INJ	54055272	$80
DEXTRAN 40/D5W 10% 500ML BAG	54101506	$2,423
DEXTRAN 40/NS 10-0.9% 500ML BA	54101555	$2,423
D5NS PER 500ML	54102751	$291
D5NS 500ML BAG	54102801	$188
D5W 1000ML BAG	54103155	$270
D5W 500ML BAG	54103205	$250
DOBUTAMINE PER 250MG INJ	54104005	$2,052
DOBUTAMINE PER 250MG INJ 636	54104054	$2,189
HEPARIN PER 1000UNITS	54105507	$275
HEPARIN PER 1000 UNITS	54105655	$23
HEPARIN PER 1000 UNITS	54105705	$779
HEPARIN PER 1000 UNITS	54105754	$158
HEPARIN SOD PER 1000 UNITS	54105804	$434
POT CHL PER 2MEQ INJ	54107206	$628
POT CHL PER 2MEQ INJ	54107354	$506
RINGERS LACTATED 1000ML BAG	54107503	$304
RINGERS LACTATED 500 ML BAG	54107552	$250
SODIUM CHL 0.9% 1000ML BAG	54108055	$318
SODIUM CHL 0.9% 500ML BAG	54108105	$319
SODIUM CHL 0.9% 250ML BAG	54108154	$220
RINGERS LACTATED 250ML BAG	54109756	$194
DOPAMINE HCL PER 40MG	54110150	$260
DEXTROSE 5%-WATER 500ML BAG	54111182	$170
PIPERACIL/TAZO PER 1.125GM	54111497	$265
POT CHL PER 2MEQ INJ	54111521	$265
MOXIFLOXACIN PER 100MG	54111661	$562
VWF PER UNIT (HUMATE-P)>600 VL	54111711	$8
VORICONAZOLE PER 10MG	54111729	$368
POTASSIUM CHL PER 2MEQ	54111760	$619
RASBURICASE PER 0.5MG	54111778	$6,151
AMIODARONE HCL PER 30MG	54111893	$198
PAMIDRONATE DISOD 30MG VL/GN	54111950	$898
ARSENIC TRIOXIDE PER 1MG	54111968	$944
VANCOMYCIN HCL PER 500MG	54111984	$84
VANCOMYCIN HCL PER 500MG INJ	54111992	$87
LEVOFLOXACIN PER 250MG	54112024	$979
CEFTAZIDIME PER 500MG	54112032	$96
DAPTOMYCIN PER 1MG	54112149	$3,479
AZITHROMYCIN 500MG/NS 250ML BD	54112206	$81
AZITHROMYCIN PER 500MG	54112214	$95
VANCOMYCIN PER 500MG	54112222	$222
VANCOMYCIN PER 500MG	54112230	$222
IBUTILIDE FUM PER 1MG	54112248	$686
CILASTATIN IMIP PER 250MG	54112255	$146
VANCOMYCIN PER 500MG	54112289	$84
VANCOMYCIN PER 500MG	54112297	$76
AMPICILLIN SOD PER 500MG INJ	54112305	$100
AMPICILLIN SOD PER 500MG INJ	54112313	$102
AMPICILLIN/SULBACTAM PER 1.5G	54112321	$116
AMPICILLIN/SULBACTAM PER 1.5G	54112339	$152
CEFTAZIDIME PER 500MG	54112362	$128
CEFTRIAXONE SOD 250MG INJ	54112370	$180
CEFTRIAXONE PER 250MG	54112388	$295
CEFUROXIME 750MG/NS 50ML	54112396	$81
PEN G POT UP TO 600MU	54112438	$148
AMPICILLIN SOD 500MG INJ	54112446	$172
CEFOTAXIME PER 1GM	54112453	$174
CEFOTAXIME PER 1GM	54112461	$228
CEFEPIME HCL PER 500MG	54112479	$212
IMIPEN/CILAS PER 250MG	54112487	$208
CEFTAZIDIME PER 500MG	54112495	$211
CEFOXITIN PER 1GM	54112503	$193
PIPERACIL/TAZO PER 1.125G	54112511	$189
PIPERAC/TAZO PER 1.125GM	54112529	$224
OXACILLIN SODIUM UP TO 250MG	54112545	$190
CEFTRIAXONE PER 250MG	54112552	$313
CEFAZOLIN SOD 500MG INJ	54112560	$110
CEFEPIME HCL PER 500MG	54112586	$361
PIPERACIL/TAZO PER 1.125GM	54112602	$212
AMP SOD/SULBACT PER 1.5GM	54112610	$162
PIPERACIL/TAZO PER 1.125GM	54112651	$189
CEFTAZIDIME PER 500MG	54112677	$123
CEFTAZIDIME PER 500MG	54112685	$295
CEFEPIME HCL PER 500MG	54112693	$219
CEFEPIME HCL PER 500MG	54112701	$394
MEROPENEM PER 100MG	54112719	$324
MEROPENEM PER 100MG	54112727	$593
OXACILLIN SODIUM UP TO 250MG	54112974	$167
MORPHINE SULF UP TO 10MG	54113014	$92
OXYTOCIN UP TO 10 UNITS	54113063	$136
OXYTOCIN UP TO 10 UNITS	54113071	$108
AMIODARONE HCL PER 30MG	54113147	$253
AMIODARONE HCL PER 30MG	54113154	$132
FLUCONAZOLE PER 200MG	54113162	$1,610
PAMIDRONATE DISOD PER 30MG GN	54113188	$5,187
OXYTOCIN UP TO 10 UNITS	54113220	$76
OXYTOCIN UP TO 10 UNITS	54113238	$76
MEPERIDINE HCL PER 100MG	54113253	$352
MIDAZOLAM PER 1MG	54113287	$188
LARONIDASE PER 0.1MG	54113303	$3,731
CEFOTAXIME PER 1G 636	54113337	$212
CEFUROXIME PER 750MG	54113352	$316
MAGNESIUM SULPHATE PER 500MG	54113360	$47
AMPICILLIN/NS 500MG/50ML IVPB	54113428	$47
METOCLOPRAMIDE 10MG/NS 50ML PB	54113436	$58
CEFTRIAXONE PER 250MG	54113444	$150
ERTAPENEM SOD PER 500MG	54113451	$390
ONDANSETRON PER 1MG	54113469	$206
PHENYTOIN PER 50MG	54113477	$30
PIPERACIL/TAZO PER 1.125G	54113550	$292
LORAZEPAM PER 2MG	54113600	$640
LORAZEPAM PER 2MG	54113618	$637
MIDAZOLAM PER 1MG INJ	54113626	$304
DOPAMINE HCL PER 40MG	54113642	$152
OXYTOCIN UP TO 10 UNITS	54113675	$135
OXYTOCIN UP TO 10 UNITS	54113683	$422
OXYTOCIN UP TO 10 UNITS	54113741	$176
MEROPENEM PER 100MG	54113824	$393
CEFOXITIN SODIUM PER 1GM	54113832	$244
LORAZEPAM PER 2MG	54113865	$187
MIDAZOLAM PER 1MG	54113881	$100
AMIODARONE PER 30MG	54113907	$256
CEFTRIAXONE SOD PER 250MG	54113915	$828
CEFTRIAXONE SOD PER 250MG	54113923	$43
OXYTOCIN UP TO 10 UNITS	54114012	$493
FENTANYL CITRATE PER 0.1MG	54114095	$115
HEPARIN PER 1000 UNITS	54114269	$66
LORAZEPAM PER 2MG	54114335	$548
AZITHROMYCIN/NS 500MG/250ML GN	54114368	$239
AZITHROMYCN/D5W 500MG/250ML GN	54114376	$263
CEFOXITIN DUPLEX 1GM/50ML IVPB	54114590	$185
CEFOXITIN SODIUM PER 1GM	54114616	$230
VANCOMYCIN PER 500MG	54114632	$146
MAG SULFATE PER 500MG	54114699	$65
HEPARIN PER 1000 UNITS	54114715	$65
MIDAZOLAM PER 1MG	54114723	$212
OXYTOCIN UP TO 10 UNITS	54114772	$60
POTASSIUM CHL PER 2MEQ	54114806	$87
POTASSIUM CHL PER 2MEQ	54114814	$87
MAG SULFATE PER 500MG	54114871	$128
ACYCLOVIR PER 5MG	54114889	$169
CEFAZOLIN PER 500MG	54114905	$136
MAG SULFATE PER 500MG	54114947	$60
AMIODARONE HCL PER 30MG	54114988	$150
CASPOFUNGIN ACET PER 5MG	54114996	$2,472
CASPOFUNGIN ACET PER 5MG	54115001	$1,931
CEFAZOLIN SOD PER 500MG	54115027	$118
FLUCONAZOLE PER 200MG	54115043	$1,622
OXYTOCIN UP TO 10 UNITS	54115050	$140
CEFTRIAXONE SOD PER 250MG	54115076	$242
CEFAZOLIN PER 500MG	54115084	$159
LORAZEPAM PER 2MG	54115100	$292
MIDAZOLAM PER 1MG	54115118	$361
SOD CHL 0.9% ADD-VANT 250ML	54115126	$60
DAPTOMYCIN PER 1MG	54115159	$60
PEN G POT UP TO 600MU	54115167	$124
ZOLEDRONC ACID/RECLAST PER 1MG	54115175	$5,952
PITOCIN/NS 10UNITS/500ML	54115183	$86
DOPAMINE HCL PER 40MG	54115217	$71
INSULIN PER 5 UNITS	54115233	$68
ONDANSETRON PER 1MG	54115241	$172
MILRINONE LACT PER 5MG	54115266	$1,351
CALCIUM GLUC INJ PER 10MG	54115274	$84
OXYTOCIN UP TO 10 UNITS	54115282	$110
CIPROFLOXACIN 200MG/100ML FLEX	54115308	$358
CIPROFLAXACIN PER 200MG	54115316	$188
DOBUTAMINE PER 250MG INJ	54115332	$601
DOPAMINE HCL PER 40MG	54115340	$285
GENTAMICIN SULF UP TO 80MG	54115373	$70
HEPARIN PER 1000 UNITS	54115381	$70
HEPARIN/NS 1000U/500ML PF	54115399	$60
POTASSIUM CHL PER 2MEQ	54115456	$100
POTASSIUM CHL PER 2MEQ	54115464	$100
DEXTRAN/NS 10% 500ML	54115514	$2,665
FENTANYL CITRATE PER 0.1MG	54115563	$84
FENTANYL CITRATE PER 0.1MG	54115571	$86
FENTANYL CITRATE PER 0.1MG	54115589	$87
FENTANYL CITRATE PER 0.1MG	54115597	$92
MORPHINE SULF PF PER 10 MG	54115605	$98
MORPHINE SULF PF PER 10MG	54115613	$98
CALCIUM GLUC INJ PER 10MG	54115639	$98
HEPARIN PER 10 UNITS	54116108	$95
IMIPENEM/CILAS PER 250MG	54116132	$579
LEVETIRACETAM PER 10MG	54116140	$688
ERTAPENEM SOD PER 500MG	54116157	$844
PEN G POT UP TO 600MU	54116199	$123
ONDANSETRON PER 1MG	54116223	$95
FENTANYL CITRATE PER 0.1MG	54116249	$70
ROPIVACAINE PER 1MG	54116272	$180
ROPIVACAINE PER 1MG	54116348	$275
CEFTAZIDIME PER 500MG	54116355	$324
ROPIVACAINE PER 1MG	54116363	$271
OXYTOCIN UP TO 10 UNITS	54116413	$60
CEFTRIAXONE PER 250MG	54116421	$54
BIVALIRUDIN PER 1MG	54116439	$3,262
FLUCONAZOLE PER 200MG	54116462	$373
DOPAMINE HCL PER 40MG	54116512	$134
AMIKACIN SULF PER 100MG	54116520	$146
MAG SULFATE PER 500MG	54116546	$36
TIGECYCLINE PER 1MG	54116678	$751
CEFEPIME PER 500MG	54116686	$441
BIVALIRUDIN PER 1MG	54116694	$2,817
OCTREOTIDE ACET PER 25 MCG	54116728	$1,332
FOSPHENYTOIN PER 50MG	54116736	$84
OXYTOCIN UP TO 10 UNITS	54116777	$358
IRINOTECAN PER 20MG	54116827	$141
IRINOTECAN PER 20MG	54116835	$318
IRINOTECAN PER 20MG	54116843	$1,263
MIDAZOLAM INJ PER 1MG	54116900	$355
INSULIN PER 5 UNITS	54116918	$100
PROMETHAZINE/NS 25MG/50ML	54116926	$60
HEPARIN PER 10 UNITS	54116959	$62
HEPARIN PER 10 UNITS	54116967	$58
MAG SULFATE PER 500MG	54116975	$105
MORPHINE SULF UP TO 10MG	54116991	$58
CEFAZOLIN PER 500MG	54117007	$168
MICAFUNGIN SOD PER 1MG	54117031	$458
MICAFUNGIN SOD PER 1MG	54117049	$1,122
TIGECYCLINE PER 1MG	54117056	$437
CEFAZOLIN PER 500MG	54117064	$71
CEFOXITIN/NS 1GM/100ML	54117072	$136
ONDANSETRON PER 1MG	54117114	$194
LORAZEPAM PER 2MG	54117130	$304
HEPARIN LOC PER 10 UNITS	54117163	$65
BANANA BAG ER 1000ML	54117189	$430
FENTANYL CITRATE PER 0.1MG	54117205	$76
FENTANYL CITRATE PER 0.1MG	54117213	$132
ADRENAL EPINEPH INJ PER 0.1MG	54117221	$71
HEPARIN LOC PER 10 UNITS	54117239	$110
HEPARIN LOC PER 10 UNITS	54117247	$110
PIPER/TAZO PER 1.125GM	54117254	$88
PIPER/TAZO PER 1.125GM	54117262	$116
PIPER/TAZO PER 1.125GM	54117270	$146
DOBUTAMINE PER 250MG INJ	54117288	$118
CEFUROXIME SOD PER 750MG	54117346	$136
LORAZEPAM PER 2MG	54117387	$331
MAG SULFATE PER 500MG	54117429	$27
CEFAZOLIN/D5W 500MG/50ML	54117460	$42
CEFAZOLIN SOD PER 500MG	54117551	$49
FENTANYL CITRATE PER 0.1MG	54117585	$50
MIDAZOLAM PER 1MG	54117593	$38
MIDAZOLAM PER 1MG	54117601	$43
FENTANYL CITRATE PER 0.1MG	54117619	$34
VANCOMYCIN PER 500MG	54117791	$18
TIROFIBAN HCL INJ PER 0.25MG	54117981	$2,232
VANCOMYCIN PER 500MG	54118013	$198
CEFAZOLIN PER 500MG	54118047	$15
MORPHINE SULF PER 10MG INJ	54118054	$27
MORPHINE SULF PER 10MG INJ	54118062	$118
MORPHINE SULF PER 10MG INJ	54118070	$242
MORPHINE SULF PER 10MG INJ	54118088	$286
MORPHINE SULF PER 10MG INJ	54118096	$62
CEFTRIAXONE PER 250MG	54118195	$26
CEFTRIAXONE PER 250MG	54118203	$42
VANCOMYCIN HCL 500MG INJ	54118302	$276
VANCOMYCIN PER 500MG	54118369	$263
LEVETIRACETAM PER 10MG	54118385	$35
LEVETIRACETAM PER 10MG	54118393	$227
LEVETIRACETAM PER 10MG	54118401	$325
VANCOMYCIN PER 500MG	54118534	$36
LINEZOLID PER 200MG	54118708	$283
VANCOMYCIN PER 500MG	54118740	$45
VANCOMYCIN PER 500MG	54118765	$43
VANCOMYCIN PER 500MG	54118872	$20
VANCOMYCIN PER 500MG	54118880	$22
CONIVAPTAN PER 1MG	54118948	$2,383
CANGRELOR PER 1MG	54118963	$3,148
AMIODARONE HCL PER 30MG	54119029	$160
ARGATROBAN PER 1MG ESRD	54119300	$2,273
CEFAZOLIN PER 500MG	54324777	$136
CEFAZOLIN PER 500MG	54325568	$171
FERUMOXYTOL PER 1MG NONESRD	54344288	$1,811
EPOPROSTENOL PER 0.5MG	54344379	$213
EPOPROSTENOL 0.5MG VIAL	54344395	$79
FACTOR IX COMPLEX PER UNIT	54344403	$2
DACLIZUMAB PER 25MG	54344437	$2,267
DIMERCAPROL PER 100MG	54344478	$456
HEP A VACC 1440 UNITS/1ML VIAL	54344486	$360
TETANUS/DIPTH/PERT 0.5ML SYR	54344668	$268
CYTOMEGALOVIRUS PER VIAL	54344684	$4,829
DEXAMETHASONE 0.5MG/5ML	54344924	$16
MORPHINE SULF UP TO 10MG	54344999	$15
CLOFARABINE PER 1MG	54345046	$8,810
MINOCYCLINE PER 1MG	54345111	$560
CLONIDINE 1MG/10ML VIAL	54345160	$265
INSULIN PER 5 UNITS	54345343	$30
MORPHINE SULF UP TO 10MG	54345467	$126
TRIAMCINOLONE ACET PER 1MG	54345509	$516
ADRENAL EPINEPH INJ PER 0.1MG	54345673	$613
ADRENAL EPINEPH INJ PER 0.1MG	54345681	$503
ADRENAL EPINEPH INJ PER 0.1MG	54345731	$306
ADRENAL EPINEPH INJ PER 0.1MG	54345756	$738
ADRENAL EPINEPH INJ PER 0.1MG	54345764	$1
PEN G BENZ/PROC PER 100000	54345772	$269
PEN G BENZ INJ PER 100000U	54345806	$208
PEN G BENZ INJ PER 100000U	54345814	$797
PEN G BENZ INJ PER 100000U	54345822	$886
ESTADIOL VALERATE PER 10MG	54345830	$1,167
TOPOTECAN PER 0.1MG	54345848	$7,526
ANTITHROMBIN RECOM PER 50IU	54345855	$15,578
CROTALIDAE IMMUNE FAB TO 1MG	54345863	$13,166
IMMUNE GLOB/HIZENTRA PER 100MG	54345939	$2,091
EPOETIN ALFA PER 1000U NONESRD	54345954	$1,060
EPOETIN ALFA PER 100UNITS ESRD	54345962	$1,060
DOCETAXEL PER 1MG	54345970	$5,972
DOCETAXEL PER 1MG	54345988	$1,583
IRON SUCROSE CPLX PER 1MG	54346028	$422
PROMETHAZINE 25MG/1ML VIAL	54346051	$14
OCTREOTIDE NONDEP PER 25MCG	54346093	$29
CEFTAROLINE FOSAMIL PER 10MG	54346127	$262
DORIPENEM PER 10MG	54346143	$106
RHO(D) IMM GLOB 50MCG MINI SYR	54346184	$164
INTERFERON A2B PER 1 MILL UNIT	54346267	$594
MIDAZOLAM PER 1MG	54346283	$14
MIDAZOLAM PER 1MG	54346291	$2
IBUPROFEN INJ PER 100MG	54346325	$42
FLUOROURACIL INJ PER 500MG	54346333	$35
LEVOFLOXACIN PER 250MG	54346366	$236
PLERIXAFOR INJ PER 1MG	54346416	$25,219
BENZTROPINE MESYL PER 1MG	54346499	$702
IMIGLUCERASE PER 10 UNITS	54346531	$6,094
PLASMA PROT (HUMAN) 5% 250ML	54346549	$185
SUCCINYLCHOLIN CHL UP TO 20MG	54346887	$95
NEOSTIGMINE METHY UP TO 0.5MG	54346895	$61
IVIG NONLYOPHILIZED PER 500MG	54346945	$3,098
IVIG NONLYOPHILIZED PER 500MG	54346952	$1,550
OXYMORPHONE 1MG/1ML AMP	54346994	$15
BUPRENORPHINE PER 0.1MG	54347075	$23
RETEPLASE PER 18.1MG	54347083	$16,690
HYDROCORT SOD SUC PF 100MG/2ML	54347109	$24
DENOSUMAB PER 1MG	54347257	$3,172
CEFTAROLINE FOSAMIL PER 10MG	54347265	$262
ECALLANTIDE PER 1MG	54347281	$32,087
GEMCITABINE HCL PER 200MG	54347315	$2,062
GEMCITABINE 200MG/5.26ML VIAL	54347323	$412
DOCETAXEL PER 1MG	54347331	$4,586
DOCETAXEL PER 1MG	54347349	$1,217
FOSAPREPITANT PER 1MG	54347414	$984
ACETAMINOPHEN INJ PER 10MG	54347539	$83
LIDOCAINE/TETRA 70-70MG PATCH	54347547	$101
ROTAVIRUS VACCINE SUSP 1ML	54347588	$392
KINRIX VACCINE 0.5ML SYRINGE	54347596	$218
HUMAN PAPILOMVIRUS VACC 0.5ML	54347604	$504
MIDAZOLAM INJ PER 1MG	54347638	$19
RASBURICASE PER 0.5MG	54347695	$11,088
HYDROCORTISONE PF TO 100MG	54347802	$66
HPV VACCINE 2-VALENT 0.5ML	54347836	$492
DIMENHYDRINATE 50MG/1ML VIAL	54347893	$28
HYDRO SOD SUCC PER 100MG	54348057	$110
ROPIVACAINE PER 1MG	54348081	$306
ROPIVACAINE PER 1MG	54348099	$1,756
FENTANYL CITRATE PER 0.1MG	54348115	$23
MORPHINE SULF PF PER 10MG	54348156	$63
TRASTUZUMAB PER 10MG	54348271	$574
PAMIDRONATE DISORD PER 30MG	54348297	$122
TRASTUZUMAB PER 10MG	54348339	$331
NULECIT 12.5MG/5ML	54348354	$14
MELPHALAN 2MG TAB	54348388	$28
ROPIVACAINE HCL PER 1MG	54348412	$39
SIROLIMUS ORAL PER 1 MG	54348479	$49
BRENTUXIMAB VEDOTIN PER 1MG	54348628	$15,720
ANASCORP UP TO 120MG	54348669	$13,946
ACYCLOVIR PER 5MG INJ	54348727	$66
ALBUMIN HUMAN 5% PER 50ML	54348735	$120
GENTAMICIN UP TO 80MG	54348784	$15
HYDROCORTISONE UP TO 100MG	54348792	$23
IVIG NONLYOPHILIZED PER 500MG	54348982	$7,005
IVIG NONLYOPHILIZED PER 500MG	54349089	$464
IVIG NONLYOPHILIZED PER 500MG	54349097	$1,018
BUPIVACAINE LIPOSOME PER 1MG	54349311	$1,468
CYCLOSPORINE ORAL PER 100MG	54349360	$17
METHYLNAL TREXONE PER 0.1 MG	54349618	$472
EVEROLIMUS PER 0.25 MG	54349626	$933
PEN G POT UP TO 600000U INJ	54350947	$23
TOCILIZUMAB INJ PER 1MG	54351234	$5,587
ICATIBANT INJ PER 1MG	54351283	$9,782
INFLUENZA QUAD 60MCG/0.5ML SYR	54351291	$116
INJ FILGRASTIM G-CSF PER 1MCG	54351549	$3,222
INJ FILGRASTIM G-CSF PER 1MCG	54351556	$1,117
INJ FILGRASTIM G-CSF PER 1MCG	54351564	$5,831
INJ BETA INTERFERON PER 1MCG	54351580	$2,736
INJ BETA INTERFERON PER 1MCG	54351598	$2,021
NEOSTIGMINE METHY UP TO 0.5MG	54351804	$62
DENOSUMAB PER 1MG	54351838	$7,290
DEFINITY RT PER 1ML	54352141	$816
POTASSIUM CHL PER 2MEQ	54352372	$18
IVIG NONLYOPHILIZED PER 500MG	54352471	$3,134
MORPHINE SULF PER 10MG INJ	54352786	$263
TESTOSTERON CYP PER 1MG INJ	54352794	$398
TESTOSTERONE ENANTH PER 1MG	54352802	$1,151
PACLITAXEL PER 1MG INJ	54352810	$3,838
PACLITAXEL PER 1MG INJ	54352828	$8,176
MORPHINE SULF PER 10MG INJ	54352836	$438
PACLITAXEL PER 1MG INJ	54352844	$1,966
PACLITAXEL PER 1MG INJ	54352851	$9,694
PROPOFOL INJ PER 10MG	54352869	$357
PROPOFOL INJ PER 10MG	54352877	$432
PROPOFOL INJ PER 10MG	54352885	$86
PACLITAXEL PER 1MG INJ	54352901	$715
PACLITAXEL PER 1MG INJ	54352919	$2,001
PROPOFOL INJ PER 10MG	54352927	$21
PROPOFOL INJ PER 10MG	54352935	$52
PROPOFOL INJ PER 10MG	54352943	$118
PROPOFOL INJ PER 10MG	54352950	$21
PROPOFOL INJ PER 10MG	54352968	$14
PROPOFOL INJ PER 10MG	54352976	$36
PROPOFOL INJ PER 10MG	54352984	$58
PROPOFOL INJ PER 10MG	54352992	$33
PROPOFOL INJ PER 10MG	54353008	$81
PROPOFOL INJ PER 10MG	54353016	$140
PROPOFOL INJ PER 10MG	54353024	$109
PROPOFOL INJ PER 10MG	54353032	$66
PROPOFOL INJ PER 10MG	54353040	$519
ADENOSINE PER 1MG INJ	54353065	$546
ADENOSINE PER 1MG INJ	54353073	$1,112
ADENOSINE PER 1MG INJ	54353198	$183
ADENOSINE PER 1MG INJ	54353206	$661
ADENOSINE PER 1MG INJ	54353214	$50
ADENOSINE PER 1MG INJ	54353222	$846
PROTHROMBIN CMPLEX PER IU	54353230	$10
CYCLOPHOSPHAMIDE ORAL PER 25MG	54353263	$23
CYCLOPHOSPHAMIDE ORAL PER 25MG	54353271	$102
FACTOR VIIA PER 1MCG	54353404	$12
FACTOR VIIA PER 1MCG	54353412	$12
FACTOR VIIA PER 1MCG	54353420	$12
FACTOR IX(PROFILNINE)PER UNIT	54353446	$4
FACTOR IX(BENEFIX)PER UNIT	54353479	$8
ANTITHROMBIN III PER IU	54353495	$22
SUMATRIPTAN 6MG/0.5ML INJ	54353644	$1,294
LORAZEPAM PER 2MG	54353800	$39
CEFTOLOZANE/TAZOBACTAM 50/25MG	54353842	$530
RHO(D) IMMUNE GLOB 300MCG SYR	54353909	$1,790
TBO-FILGRASTIM PER 1MCG	54354089	$1,839
TBO-FILGRASTIM PER 1MCG	54354097	$2,928
ALEMTUZUMAB PER 1MG	54354105	$7,960
PREDNISONE IR ORAL PER 1MG	54354295	$1
PREDNISONE IR ORAL 1MG	54354303	$1
PREDNISONE IR ORAL 1MG	54354311	$1
PREDNISONE IR ORAL 1MG	54354329	$24
PREDNISONE IR ORAL 1MG	54354345	$1
PREDNISONE IR ORAL 1MG	54354352	$81
FILGRASTIM G-CSF BIO PER 1MCG	54354659	$876
NEOSTIGMINE METHY UP TO 0.5MG	54354733	$190
PERAMIVIR PER 1MG	54354824	$1,157
GENTAMICIN SULF UP TO 80MG	54354857	$12
GENTAMICIN SULF UP TO 80MG	54354865	$1
GENTAMICIN UP TO 80MG	54354873	$176
GENTAMICIN UP TO 80MG	54354881	$237
ORITAVANCIN PER 10MG	54355359	$8,289
ISAVUCONAZONIUM PER 1MG	54355391	$1,224
BELATACEPT PER 1MG	54355433	$2,358
ARGATROBAN PER 1MG NONESRD	54355607	$13,008
ARGATROBAN PER 1MG ESRD	54355615	$11,825
METHYLENE BLUE PER 1MG	54355847	$834
IVIG NONLYOPHILIZED PER 500MG	54356076	$3,210
CANGRELOR PER 1MG	54356092	$3,206
CONIVAPTAN PER 1MG	54356100	$504
HEMIN PER 1MG	54356761	$21,461
INSULIN PER 5 UNITS	54356993	$12
DALBAVANCIN PER 5MG	54357009	$3,616
SUCCINYLCHOLIN CHL UP TO 20MG	54357090	$56
CEFAZOLIN PER 500MG	54357116	$16
CEFEPIME HCL PER 500MG	54357124	$37
CEFEPIME HCL PER 500MG	54357132	$69
CEFOXITIN SODIUM PER 1GM	54357157	$34
CEFTAZIDIME PER 500MG	54357165	$32
CEFTRIAXONE PER 250MG	54357173	$16
CEFTRIAXONE PER 250MG	54357181	$26
CEFUROXIME SOD PER 750MG	54357199	$16
MEROPENEM PER 100MG	54357207	$118
CEFAZOLIN PER 500MG	54357280	$23
MEROPENEM PER 100MG	54357314	$34
AMPICILLIN SOD PER 500MG	54357322	$34
AMPICILLIN SOD PER 500MG	54357330	$73
OXACILLIN SODIUM UP TO 250MG	54357348	$53
OXACILLIN SODIUM UP TO 250MG	54357355	$122
DAPTOMYCIN PER 1MG	54357371	$251
ERTAPENEM SOD PER 500MG	54357553	$90
DAPTOMYCIN PER 1MG	54357785	$2,081
FACTOR VIII(WILATE1000)PERUNIT	54357819	$6
C1 ESTERASE BERINERT PER 10U	54357868	$7,158
GLIADEL WAFER 7.7-192.3	54357900	$14,824
IVIG NONLYOPHILIZED PER 500MG	54357975	$1,266
ARGATROBAN PER 1MG NONESRD	54358171	$606
RABIES IG PER 150IU	54358247	$10,893
INJ FILGRASTIM G-CSF PER 1MCG	54358502	$1,109
RITUXIMAB PER 10 MG	54358775	$28,318
RITUXIMAB PER 10 MG	54358783	$6,920
MEROPENEM/VABOR PER 10MG/10MG	54358916	$644
VANCOMYCIN PER 500MG	54358924	$95
EPO ALFA EPBX PER 1000U	54359005	$384
EPO ALFA EPBX PER 100U ESRD	54359047	$384
VANCOMYCIN PER 500MG	54359070	$66
METHYLNAL TREXONE PER 0.1 MG	54359252	$411
COCAINE HCL NASAL PER 1MG	54359294	$518
COCAINE HCL NASAL PER 1MG	54359302	$458
COCAINE HCL NASAL PER 1MG	54359310	$186
MENB-FHBP VACC 2/3 DOSE IM	54359351	$492
EPO ALFA EPBX PER 1000U	54359484	$94
EPO ALFA EPBX PER 100U ESRD	54359492	$94
EPO ALFA EPBX PER 1000U	54359500	$130
EPO ALFA EPBX PER 100U ESRD	54359518	$130
TREPROSTINIL PER 1MG	54359609	$40,095
BCG LIVE INTRAVESICAL PER 1MG	54359815	$2,424
BCG LIVE INTRAVESICAL PER 1MG	54359823	$542
TOCILIZUMAB PER 1MG	54360094	$2,794
ERAVACYCLINE PER 1MG	54360128	$202
EPINEPHRINE PER 0.1MG	54360235	$54
RITUXIMAB-ABBS PER 10MG	54361118	$1,453
RITUXIMAB-ABBS PER 10MG	54361126	$4,582
CAPLACIZUMAB PER 1MG INJ	54361928	$18,189
REMDESIVIR PER 1MG	54363288	$1,354
HEP B VAC 20MCG/0.5ML 1ML	54363460	$316
MENINGOC/DIPH OLIGO 0.5ML VL	54364468	$435
VISAPAQUE 320 PER 1ML	54365671	$349
FIBRINOGEN PER 1MG	54365770	$5
ISOVUE 250 100ML PER 1ML	54366232	$4
ERAVACYCLINE PER 1MG	54366992	$309
PEGFILGRASTIM PER 0.5MG	54367008	$28,498
CEFIDEROCOL PER 10MG	54367156	$583
PNEUMO 20 VALENT VACC 0.5ML	54369269	$653
BORTEZOMIB NOS PER 0.1MG	54370903	$10,428
ERTAPENEM/SWFI 0.5 GM/5 ML	54371042	$62
FLUARIX QUAD 0.5ML SYR	54371729	$68
TENECTEPLASE PER 1MG	54372057	$16,015
CHLOROPROCAINE PER 1MG	54372065	$72
CHLOROPROCAINE PER 1MG	54372073	$355
CHLOROPROCAINE PER 1MG	54372081	$328
CHLOROPROCAINE PER 1MG	54372099	$352
CEFEPIME HCL PER 500MG	54372271	$465
VANCOMYCIN PER 500MG	54372503	$580
CALCIUM GLUC INJ PER 10MG	54373014	$26
CEFEPIME PER 500MG	54373378	$708
SOD FER GLUC COMP PER 12.5MG	54373592	$51
MEROPENEM PER 100MG	54373683	$153
ISOVUE M 200 PER 1ML	54373717	$357
ISOVUE M 200 PER 1ML	54373725	$389
ISOVUE 200 PER 1ML	54373733	$403
ISOVUE 200 200ML PER 1ML	54373741	$2
ISOVUE 250 PER 1ML	54373758	$403
ISOVUE 250 150ML PER 1ML	54373766	$3
ISOVUE 250 200ML PER 1ML	54373774	$2
VISIPAQUE 270 PER 1ML	54373782	$403
VISIPAQUE 270 100ML PER 1ML	54373790	$4
VISIPAQUE 270 150ML PER 1ML	54373808	$3
VISIPAQUE 270 200ML PER 1ML	54373816	$2
IODIXANOL 270 F-K PER 1ML	54373832	$410
IODIXANOL 270 150ML FK PER 1ML	54373840	$3
ISOVUE M 300 PER 1ML	54373857	$98
ISOVUE 300 PER 1ML	54373865	$195
ISOVUE 300 PER 1ML	54373873	$349
ISOVUE 300 PER 1ML	54373881	$460
ISOVUE 300 100ML PER 1ML	54373899	$4
ISOVUE 300 150ML PER 1ML	54373907	$3
ISOVUE 300 200ML PER 1ML	54373915	$2
ISOVUE 370 PER 1ML	54373923	$349
ISOVUE 370 75ML PER 1ML	54373931	$6
ISOVUE 370 100ML PER 1ML	54373949	$4
ISOVUE 370 125ML PER 1ML	54373956	$3
ISOVUE 370 150ML PER 1ML	54373964	$3
ISOVUE 370 200ML PER 1ML	54373972	$2
ISOVUE 370 500ML PER 1ML	54373980	$1
VISIPAQUE 320 PER 1ML	54374004	$406
VISIPAQUE 320 150ML PER 1ML	54374012	$3
VISIPAQUE 320 200ML PER 1ML	54374020	$2
VISIPAQUE 320 500ML PER 1ML	54374038	$1
IODIXANOL 320 F-K PER 1ML	54374046	$349
IODIXANOL 320 F-K PER 1ML	54374053	$406
IODIXANOL320 150ML FK PER 1ML	54374061	$3
IODIXANOL320 200ML FK PER 1ML	54374079	$2
GADIVIST PER 0.1ML	54374095	$147
GADIVIST PER 0.1ML	54374103	$207
GADIVIST PER 0.1ML	54374111	$311
EOVIST PER 1ML	54374129	$310
LUMASON PER 1ML	54374145	$40
CYSTOGRAFIN PER 1ML	54374186	$182
GASTROGRAFIN PER 1ML	54374194	$23
GASTROGRAFIN PER 1ML	54374202	$93
CYSTOGRAFIN PER 1ML	54374517	$182
ALLOPURINOL SODIUM 1MG	54374624	$4,151
ALFENTANIL HYDROCHLORID 500MCG	54374632	$546
ALFENTANIL HYDROCHLORID 500MCG	54374640	$691
AZTREONAM PER 100MG	54374657	$16
AZTREONAM PER 100MG	54374665	$456
AZTREONAM PER 100MG	54374673	$562
AZTREONAM PER 100MG	54374681	$171
AZTREONAM PER 100MG	54374699	$143
AZTREONAM PER 100MG	54374707	$1,083
AZTREONAM PER 100MG	54374715	$782
AZTREONAM PER 100MG	54374731	$430
AZTREONAM PER 100MG	54374749	$300
BUPIVICAINE PER 0.5MG	54374764	$52
BUPIVICAINE PER 0.5MG	54374772	$157
BUPIVICAINE PER 0.5MG	54374806	$157
BUPIVICAINE PER 0.5MG	54374814	$157
BUPIVICAINE PER 0.5MG	54374822	$14
BUPIVICAINE PER 0.5MG	54374830	$21
BUPIVICAINE PER 0.5MG	54374848	$172
BUPIVICAINE PER 0.5MG	54374855	$9
BUPIVICAINE PER 0.5MG	54374889	$34
BUPIVICAINE PER 0.5MG	54374897	$2
BUPIVICAINE PER 0.5MG	54374905	$118
BUPIVICAINE PER 0.5MG	54374913	$128
BUPIVICAINE PER 0.5MG	54374939	$35
BUPIVICAINE PER 0.5MG	54374947	$282
BUPIVICAINE PER 0.5MG	54374954	$228
BUPIVICAINE PER 0.5MG	54374962	$233
BUPIVICAINE PER 0.5MG	54374970	$134
BUPIVICAINE PER 0.5MG	54374988	$136
BUPIVICAINE PER 0.5MG	54374996	$340
BUPIVICAINE PER 0.5MG	54375001	$332
BUPIVICAINE PER 0.5MG	54375019	$239
BUPIVICAINE PER 0.5MG	54375043	$63
BUPIVICAINE PER 0.5MG	54375050	$73
BUPIVICAINE PER 0.5MG	54375068	$340
BUPIVICAINE PER 0.5MG	54375076	$186
BUPIVICAINE PER 0.5MG	54375084	$134
BUPIVICAINE PER 0.5MG	54375118	$488
BUPIVICAINE PER 0.5MG	54375126	$528
BUPIVICAINE PER 0.5MG	54375167	$1,458
BUPIVICAINE PER 0.5MG	54375175	$480
BUPIVICAINE PER 0.5MG	54375191	$858
BUPIVICAINE PER 0.5MG	54375209	$757
METRONIDAZOLE PER 10MG	54375225	$684
METRONIDAZOLE PER 10MG	54375233	$1
METRONIDAZOLE PER 10MG	54375241	$1
METRONIDAZOLE PER 10MG	54375266	$152
METRONIDAZOLE PER 10MG	54375274	$23
METRONIDAZOLE PER 10MG	54375282	$168
NITROGLYCERIN PER 5MG	54375308	$401
NITROGLYCERIN PER 5MG	54375316	$369
NITROGLYCERIN PER 5MG	54375324	$473
NITROGLYCERIN PER 5MG	54375332	$1,452
NITROGLYCERIN PER 5MG	54375357	$98
NITROGLYCERIN PER 5MG	54375399	$507
CLINDAMYCIN PHOSPHATE 300MG	54375415	$110
CLINDAMYCIN PHOSPHATE 300MG	54375431	$66
CLINDAMYCIN PHOSPHATE 300MG	54375456	$172
CLINDAMYCIN PHOSPHATE 300MG	54375464	$177
CLINDAMYCIN PHOSPHATE 300MG	54375472	$101
CLINDAMYCIN PHOSPHATE 300MG	54375480	$95
CLINDAMYCIN PHOSPHATE 300MG	54375514	$916
CLINDAMYCIN PHOSPHATE 300MG	54375522	$199
CLINDAMYCIN PHOSPHATE 300MG	54375548	$150
CLINDAMYCIN PHOSPHATE 300MG	54375589	$277
VASOPRESSIN PER 1 UNIT	54375597	$16
VASOPRESSIN PER 1 UNIT	54375621	$112
VASOPRESSIN PER 1 UNIT	54375639	$709
VASOPRESSIN PER 1 UNIT	54375647	$652
VASOPRESSIN PER 1 UNIT	54375662	$1,178
VASOPRESSIN PER 1 UNIT	54375670	$686
VASOPRESSIN PER 1 UNIT	54375746	$193
VASOPRESSIN PER 1 UNIT	54375753	$2,188
ESMOLOL HYDROCHLORIDE PER 10MG	54375795	$59
ESMOLOL HYDROCHLORIDE PER 10MG	54375829	$206
ESMOLOL HYDROCHLORIDE PER 10MG	54375837	$2,086
ESMOLOL HYDROCHLORIDE PER 10MG	54375845	$1,171
LABETALOL HYDROCHLORIDE 5MG	54375860	$14
LABETALOL HYDROCHLORIDE 5MG	54375878	$24
LABETALOL HYDROCHLORIDE 5MG	54375894	$145
LABETALOL HYDROCHLORIDE 5MG	54375910	$938
LABETALOL HYDROCHLORIDE 5MG	54375936	$484
PHENYLEPHRINE HYDROCHLOR 20MCG	54375944	$16
PHENYLEPHRINE HYDROCHLOR 20MCG	54376009	$71
PHENYLEPHRINE HYDROCHLOR 20MCG	54376017	$15
PHENYLEPHRINE HYDROCHLOR 20MCG	54376058	$105
PHENYLEPHRINE HYDROCHLOR 20MCG	54376074	$146
PHENYLEPHRINE HYDROCHLOR 20MCG	54376090	$70
PHENYLEPHRINE HYDROCHLOR 20MCG	54376124	$58
PHENYLEPHRINE HYDROCHLOR 20MCG	54376140	$101
PHENYLEPHRINE HYDROCHLOR 20MCG	54376157	$173
PHENYLEPHRINE HYDROCHLOR 20MCG	54376199	$52
ISOVUE 300 500ML PER 1ML	54376967	$1
OLANZAPINE INJ PER 0.5MG	54377056	$453
MYCOPHENOLATE MOF PER 10MG	54377072	$282
GLYCOPYROLATE INJ PER 0.1MG	54377569	$110
GLYCOPYROLATE INJ PER 0.1MG	54377577	$31
GLYCOPYROLATE INJ PER 0.1MG	54377601	$62
GLYCOPYROLATE INJ PER 0.1MG	54377619	$79
BUMETAMIDE PER 0.5MG	54377635	$262
BUMETAMIDE PER 0.5MG	54377643	$38
BUMETAMIDE PER 0.5MG	54377650	$91
NICARDIPIN INJ PER 0.1MG	54377692	$815
NICARDIPIN INJ PER 0.1MG	54377718	$143
NICARDIPIN INJ PER 0.1MG	54377742	$182
NICARDIPIN INJ PER 0.1MG	54377767	$1,681
NICARDIPIN INJ PER 0.1MG	54377783	$576
NICARDIPIN INJ PER 0.1MG	54377791	$30
NICARDIPIN INJ PER 0.1MG	54377809	$2,761
FLUPHENAZINE HCL PER 1.25MG	54377825	$208
FLUPHENAZINE HCL PER 1.25MG	54377833	$46
NICARDIPIN INJ PER 0.1MG	54377932	$1,068
GADOBUTROL CONTRAST PER 0.1ML	54378252	$39
GADOBUTROL CONTRAST PER 0.1ML	54378260	$147
GADOBUTROL CONTRAST PER 0.1ML	54378278	$196
GADOBUTROL CONTRAST PER 0.1ML	54378294	$20
GADOBUTROL CONTRAST PER 0.1ML	54378302	$20
GADOBUTROL CONTRAST PER 0.1ML	54378310	$20
GADOBUTROL CONTRAST PER 0.1ML	54378328	$20
BALFAXAR PER IU 20ML	54378435	$4
BALFAXAR PER IU 40ML	54378443	$4
METHYLPREDNISOLONE ACETATE 1MG	54378633	$213
METHYLPREDNISOLONE ACETATE 1MG	54378641	$140
METHYLPREDNISOLONE ACETATE 1MG	54378658	$83
METHYLPREDNISOLONE ACETATE 1MG	54378666	$147
METHPRED SOD SUCCINATE 5MG	54378682	$13
METHPRED SOD SUCCINATE 5MG	54378690	$89
METHPRED SOD SUCCINATE 5MG	54378708	$56
METHPRED SOD SUCCINATE 5MG	54378716	$36
METHPRED SOD SUCCINATE 5MG	54378724	$271
METHPRED SOD SUCCINATE 5MG	54378732	$140
METHPRED SOD SUCCINATE 5MG	54378740	$631
METHPRED SOD SUCCINATE 5MG	54378757	$101
METHPRED SOD SUCCINATE 5MG	54378773	$753
METHPRED SOD SUCCINATE 5MG	54378781	$1,558
HYDROXOCOBALAMIN PER 25MG	54378799	$1,799
CYCLOPHOSPHAMIDE PER 5MG	54378807	$856
CYCLOPHOSPHAMIDE PER 5MG	54378815	$304
CYCLOPHOSPHAMIDE PER 5MG	54378831	$384
METHOTREXATE SOD PER 50MG	54378849	$310
METHOTREXATE SOD PER 50MG	54378856	$760
METHOTREXATE SOD PER 50MG	54378872	$388
METHOTREXATE SOD PER 50MG	54378880	$36
METHOTREXATE SOD PER 50MG	54378898	$701
LEVOTHYROXINE PER 10MCG	54378906	$1,369
LEVOTHYROXINE PER 10MCG	54378914	$538
LEVOTHYROXINE PER 10MCG	54378930	$28
LEVOTHYROXINE PER 10MCG	54378948	$1,261
CEFTRIAXONE PER 250MG	54379151	$5
PANTOPRAZOLE SOD PER 40MG	54379375	$579
PANTOPRAZOLE SOD PER 40MG	54379383	$424
PANTOPRAZOLE SOD PER 40MG	54379391	$444
PANTOPRAZOLE SOD PER 40MG	54379425	$324
PANTOPRAZOLE SOD PER 40MG	54379441	$91
POTASSIUM CHLORIDE PER 2MEQ	54380142	$262
POTASSIUM CHLORIDE PER 2MEQ	54380159	$440
POTASSIUM CHLORIDE PER 2MEQ	54380175	$626
POTASSIUM CHLORIDE PER 2MEQ	54380183	$426
POTASSIUM CHLORIDE PER 2MEQ	54380191	$426
POTASSIUM CHLORIDE PER 2MEQ	54380209	$436
POTASSIUM CHLORIDE PER 2MEQ	54380217	$98
POTASSIUM CHLORIDE PER 2MEQ	54380233	$436
POTASSIUM CHLORIDE PER 2MEQ	54380241	$437
INFLUENZA VAC FLUARIX 0.5ML	54380266	$53
CAPECITABINE ORAL PER 50MG	54380753	$136
LIDOCAINE/EPI PER 1MG	54380761	$182
LIDOCAINE/EPI PER 1MG	54380779	$274
LIDOCAINE/EPI PER 1MG	54380803	$81
LIDOCAINE/EPI PER 1MG	54380829	$28
LIDOCAINE/EPI PER 1MG	54380852	$73
LIDOCAINE/EPI PER 1MG	54380860	$134
LIDOCAINE/EPI PER 1MG	54380878	$176
LIDOCAINE/EPI PER 1MG	54380894	$230
LIDOCAINE/EPI PER 1MG	54380902	$304
LIDOCAINE/EPI PER 1MG	54380910	$28
LIDOCAINE D5W PER 1MG	54380928	$390
LIDOCAINE D5W PER 1MG	54380936	$97
LIDOCAINE D5W PER 1MG	54380944	$189
LIDOCAINE HCL PER 1MG	54380969	$16
LIDOCAINE HCL PER 1MG	54380985	$28
LIDOCAINE HCL PER 1MG	54380993	$16
LIDOCAINE HCL PER 1MG	54381017	$38
LIDOCAINE HCL PER 1MG	54381025	$14
LIDOCAINE HCL PER 1MG	54381041	$8
LIDOCAINE HCL PER 1MG	54381058	$208
LIDOCAINE HCL PER 1MG	54381066	$52
LIDOCAINE HCL PER 1MG	54381074	$27
LIDOCAINE HCL PER 1MG	54381082	$71
LIDOCAINE HCL PER 1MG	54381090	$144
LIDOCAINE HCL PER 1MG	54381116	$236
LIDOCAINE HCL PER 1MG	54381124	$8
LIDOCAINE HCL PER 1MG	54381132	$23
LIDOCAINE HCL PER 1MG	54381140	$116
LIDOCAINE HCL PER 1MG	54381181	$12
LIDOCAINE HCL PER 1MG	54381199	$60
LIDOCAINE HCL PER 1MG	54381207	$69
LIDOCAINE HCL PER 1MG	54381215	$37
LIDOCAINE HCL PER 1MG	54381223	$150
LIDOCAINE HCL PER 1MG	54381264	$184
LIDOCAINE HCL PER 1MG	54381272	$116
LIDOCAINE HCL PER 1MG	54381280	$185
LIDOCAINE HCL PER 1MG	54381298	$255
LIDOCAINE HCL PER 1MG	54381306	$38
LIDOCAINE HCL PER 1MG	54381314	$72
LIDOCAINE HCL PER 1MG	54381322	$78
LIDOCAINE HCL PER 1MG	54381330	$327
HYDROMORPHONE PER 0.1MG	54381355	$7
HYDROMORPHONE PER 0.1MG	54381363	$19
HYDROMORPHONE PER 0.1MG	54381371	$27
HYDROMORPHONE PER 0.1MG	54381389	$28
HYDROMORPHONE PER 0.1MG	54381397	$92
HYDROMORPHONE PER 0.1MG	54381405	$78
HYDROMORPHONE PER 0.1MG	54381413	$184
HYDROMORPHONE PER 0.1MG	54381421	$71
HYDROMORPHONE PER 0.1MG	54381439	$198
HYDROMORPHONE PER 0.1MG	54381447	$160
HYDROMORPHONE PER 0.1MG	54381454	$496
HYDROMORPHONE PER 0.1MG	54381462	$86
HYDROMORPHONE PER 0.1MG	54381470	$91
HYDROMORPHONE PER 0.1MG	54381488	$63
HYDROMORPHONE PER 0.1MG	54381496	$116
HYDROMORPHONE PER 0.1MG	54381504	$71
HYDROMORPHONE PER 0.1MG	54381553	$27
HYDROMORPHONE PER 0.1MG	54381561	$160
HYDROMORPHONE PER 0.1MG	54381579	$62
HYDROMORPHONE PER 0.1MG	54381587	$124
HYDROMORPHONE PER 0.1MG	54381595	$38
HYDROMORPHONE PER 0.1MG	54381603	$105
HYDROMORPHONE PER 0.1MG	54381611	$490
HYDROMORPHONE PER 0.1MG	54381629	$120
HYDROMORPHONE PER 0.1MG	54381652	$285
MRI ORBIT/FACE/NCK W/CON	54600101	$4,976
MRI ORBIT/FACE/NCK W/O CON	54600200	$4,307
MRI ORBIT/FACE/NCK WO/W CON	54600309	$4,162
MRI BRAIN W/O CON	54600507	$4,585
MRI BRAIN W/CON	54600606	$5,510
MRI BRAIN WO/W CON	54600705	$5,786
MRI CHEST W/CON	54600804	$5,212
MRI CHEST W/O CON	54600903	$5,412
MRI CHEST W/WO CON	54601000	$7,207
MRA CHEST W/CON	54601109	$5,101
MRI C-SPINE W/O CON	54601208	$4,770
MRI C-SPINE W/CON	54601307	$6,201
MRI T-SPINE W/O CON	54601406	$3,728
MRI T-SPINE W/CON	54601505	$6,201
MRI L-SPINE W/O CON	54601604	$4,770
MRI L-SPINE W/CON	54601703	$6,201
MRI C-SPINE WO/W CON	54601802	$6,828
MRI T-SPINE WO/W CON	54601901	$6,828
MRI L-SPINE WO/W CON	54602008	$6,828
MRA SPINAL CONTENTS	54602107	$5,407
MRI PELVIS W/CON	54602206	$5,473
MRI PELVIS W/O CON	54602305	$4,770
MRI PELVIS WO/W CON	54602404	$5,743
MRI ABD W/CON	54602602	$4,270
MRI ABD W/O CON	54602701	$4,144
MRI ABD W0/W CON	54602800	$4,528
MRA ABD W/CON	54602909	$5,809
MRI BREAST W/CON BIL	54603501	$2,720
MRI SPECTROSCOPY	54603709	$6,155
MRI BONE MARROW	54603808	$2,681
MRI ORBIT/FACE/NCK W/CON LTD	54603907	$2,681
MRI ORBIT/FACE/NCK W/O CON LTD	54604004	$3,218
MRI ORBIT/FACE/NCK WO/W LTD	54604103	$2,681
MRI BRAIN W/O CON LTD	54604301	$3,268
MRI BRAIN W/CON LTD	54604400	$2,590
MRI BRAIN WO/W CON LTD	54604509	$4,078
MRI CHEST W/O CON LTD	54604707	$2,874
MRI C-SPINE W/O CON LTD	54605001	$3,132
MRI C-SPINE W/CONTRAST LTD	54605100	$2,438
MRI T-SPINE W/O CON LTD	54605209	$2,681
MRI T-SPINE W/CON LTD	54605308	$4,002
MRI L-SPINE W/O CON LTD	54605407	$3,077
MRI L-SPINE W/CON LTD	54605506	$3,696
MRI T-SPINE WO/W CON LTD	54605704	$4,180
MRI L-SPINE WO/W CON LTD	54605803	$4,430
MRI PELVIS WO/W CON LTD	54606009	$2,681
MRI PELVIS W/O CON LTD	54606108	$2,534
MRI PELVIS W/CON LTD	54606207	$2,606
MRI ABD W/CON LTD	54606405	$2,681
MRI ABD W/O CON LTD	54606504	$3,010
MRI ABD W0/W CON LTD	54606603	$2,681
MRI SPECTROSCOPY LTD	54607502	$4,308
MRI TMJ W/O CON LT	54607809	$3,920
MRI TMJ W/WO CON LT	54607908	$3,920
MRI TMJ W/O CONT RT	54608104	$3,920
MRI TMJ W/WO CON RT	54608203	$3,920
MRI EXT UP W/CON LT	54608302	$4,998
MRI EXT UP W/O CON LT	54608401	$5,502
MRI EXT UP WO/W CON LT	54608500	$6,005
MRI EXT UP W/CON RT	54608609	$4,726
MRI EXT UP W/O CON RT	54608708	$5,502
MRI EXT UP WO/W CON RT	54608807	$6,034
MRI EXT UP JOINT W/O CON LT	54608906	$4,828
MRI EXT UP JOINT W/O CON RT	54609003	$4,828
MRI EXT LOW W/CON LT	54609300	$5,998
MRI EXT LOW WO/W CON LT	54609409	$4,585
MRI EXT LOW W/O CON LT	54609508	$5,502
MRI EXT LOW W/CON RT	54609607	$5,998
MRI EXT LOW WO/W CON RT	54609706	$4,585
MRI EXT LOW W/O CON RT	54609805	$5,502
MRI EXT LOW JOINT W/O CON LT	54609904	$5,115
MRI EXT LOW JOINT W/O CON RT	54610001	$5,115
MRI EXT UP WO/W CON BIL	54610506	$12,003
MRI EXT UP JOINT W/O CON BIL	54610605	$9,175
MRI EXT LOW WO/W CON BIL	54610803	$9,175
MRI EXT LOW JOINT W/O CON BIL	54610902	$9,175
MRA HEAD W/O CON	54611108	$3,268
MRA HEAD W/O CON LTD	54611207	$840
MRA HEAD W/CON	54611306	$3,917
MRA HEAD W/WO CON	54611504	$5,312
MRA NECK W/O CON	54611702	$3,163
MRA NECK W/O CON LTD	54611801	$1,470
MRA NECK W/CON	54611900	$3,696
MRA NECK W/CON LTD	54612007	$1,400
MRA NECK WO/W CON	54612106	$4,863
MRI EXT UP W/O CON BIL	54612304	$10,410
MRI EXT UP W/CON BIL	54612403	$9,457
MRI EXT UP JOINT W/ CON BIL	54612502	$9,457
MRI EXT UP JOINT W/ CON LT	54612601	$4,726
MRI EXT UP JOINT W/ CON RT	54612809	$4,998
MRI EXT UP JOINT WO/W CON BIL	54613005	$10,402
MRI EXT UP JOINT WO/W CON LT	54613104	$5,833
MRI EXT UP JNT WO/W CON LT LTD	54613203	$2,731
MRI EXT UP JOINT WO/W CON RT	54613302	$5,833
MRI EXT LOW W/O CON BIL	54613500	$10,410
MRI EXT LOW W/CON BIL	54613609	$9,457
MRI EXT LOW JOINT W/CON BIL	54613708	$9,457
MRI EXT LOW JOINT W/CON LT	54613807	$4,998
MRI EXT LOW JOINT W/CON RT	54614003	$5,198
MRI EXT LOW JOINT WO/W BIL	54614201	$11,672
MRI EXT LOW JOINT WO/W LT	54614300	$5,832
MRI EXT LOW JOINT WO/W RT	54614508	$5,832
MRI GUIDE FOR NDL PLACE S/I	54614706	$2,100
MRI EXT UP JNT W/O CON LT LTD	54671201	$3,049
MRI EXT UP JNT W/O CON RT LTD	54671300	$3,049
MRI EXT LOW W/O CON LT LTD	54671805	$2,534
MRI EXT LOW W/O CON RT LTD	54672100	$2,534
MRI EXT LOW JNT W/O CON LT LTD	54672209	$2,681
MRI EXT LOW JNT W/O CON RT LTD	54672308	$2,634
MRA ABD W/O CON	54672712	$4,973
MRA ABD WO/W CON	54672720	$1,830
MRA CHEST W/O CON	54672753	$4,510
MRA CHEST WO/W CON	54672761	$5,678
MRA EXT LOW W/CON RT	54672860	$5,862
MRA EXT LOW W/CON LT	54672878	$5,862
MRI BREAST W/O CON RT	54672902	$1,087
MRA EXT LOW W/O CON RT	54673041	$5,862
MRA EXT LOW W/O CON LT	54673058	$5,862
MRA PELVIS W/CON LTD	54673165	$5,862
MRA PELVIS W/O CON	54673173	$6,214
GADOTERIDOL PER 1ML	54673314	$303
GADOTERIDOL PER 1ML	54673322	$312
GADOTERIDOL PER 1ML	54673355	$246
GADOTERIDOL PER 1ML	54673363	$260
GADOLINIUM CONT PER 1ML	54673462	$246
GADOLINIUM CONT PER 1ML	54673470	$299
GADOLINIUM CONT PER 1ML	54673488	$303
GADOLINIUM CONT PER 1ML	54673496	$312
GADOLINIUM CONT PER 1ML	54673504	$368
GADOLINIUM CONT PER 1ML	54673512	$330
GADOTERIDOL PER 1ML	54673561	$243
MULTIHANCE CONTRAST PER 1ML	54673827	$398
MULTIHANCE CONTRAST PER 1ML	54673835	$491
MRV HEAD W/CON	54673900	$4,692
MRV HEAD W/O CON	54673918	$3,268
MRCP W/O CON	54673942	$4,144
MRA EXT UP W/WO CON LT	54674007	$4,726
MULTIHANCE CONTRAST PER 1ML	54674098	$283
MULTIHANCE CONTRAST PER 1ML	54674239	$44
MRI IAC W/W/O CONTRAST	54674445	$5,786
MRI IAC W/O CONTRAST	54674452	$4,585
SPIROMETRY W/GRAPHC RECRD	55000095	$539
SPIROMETRY W&WO BRONCH	55000111	$1,364
VITAL CAPACITY TEST	55000137	$286
RESPIRATORY FLOW VOLUME LOOP	55000210	$606
INHAL TX EACH INITIAL	55000269	$302
AEROSOL INHALE PENTAMIDINE	55000277	$1,424
VENTILATOR MGMT INITIAL DAY	55000319	$3,183
VENTILATOR MGMT SUB DAY	55000327	$2,864
CPAP/BIPAP	55000335	$2,839
DEMO EVAL INH TX	55000350	$319
CHEST WALL MANIP INITIAL	55000376	$234
CHEST WALL MANIP SUBSQ	55000384	$210
PULSE OXIMETRY SINGLE	55000459	$392
PULSE OXIMETRY OVERNIGHT	55000475	$387
NASO-TRACH SUCTION	55000509	$294
ARTERIAL BLOOD PUNCTURE	55000517	$159
CARBON MONO QUANT	55000525	$137
BLOOD GAS PH ONLY 300	55000533	$592
BLOOD GASES 300	55000541	$627
BLOOD GASES W/O2 SAT 300	55000558	$942
BLOOD GASES O2 SAT ONLY 300	55000566	$628
GLUCOSE QUANT BY BLOOD DRAW	55000574	$194
ACT CLOT TIME 300	55000590	$374
CPR	55000608	$1,930
CARDIOVERSION EXTERNAL	55000616	$3,434
EKG TRACING	55000624	$638
HFOV VENT FIRST DAY	55000830	$3,183
HFOV VENT SUBSEQUENT	55000848	$3,024
INTUBATION E-TUBE EMERGENCY	55000863	$1,131
EXTREM STDY TCPO2 BIL COMPLETE	55000871	$440
NEWBORN RESUSCITATION 480	55000889	$978
CREATININE 300	55000897	$185
SODIUM 300	55000905	$198
POTASSIUM 300	55000913	$175
IONIZED CALCIUM 300	55000939	$202
BLOOD COUNT HEMATOCRIT	55000954	$141
HEMOGLOBIN 300	55000970	$146
BRONCH DIAGNOSTIC	55000988	$2,035
TRACHEOTOMY TUBE CHANGE	55001267	$484
ART CATH/MNTRG OR TRANS PERC	55001283	$396
NITRIC OXIDE THERAPY INITL DAY	55001556	$3,183
NITRIC OXIDE TX ADDL DAYS	55001564	$19,104
POC BLD GASES W/CALC O2 301	55001614	$645
MDI TREATMENT INITIAL	55001648	$302
SMOKE BEHAVE CHG SYMP 3-10MIN	55001804	$106
SMOKE BEHAVE CHG SYMP >10MIN	55001812	$95
ASSIST AT DELIVERY	55001820	$697
CAPILLARY BLOOD GASES	55001838	$627
SURFACTANT ADMIN ET TUBE	55001861	$113
INHALE TX AEROSOL FIRST HR	55001879	$733
INHALE TX AEROSOL EA ADDL HR	55001887	$692
POC SPUTUM COLLECT	55002018	$192
POC URINE PREG TEST	55002042	$121
SMOKE BEHAVE CHG ASYMP 3-10MIN	55002109	$86
SMOKE BEHAVE CHG ASYMP >10MIN	55002117	$86
POC LACTATE	55002125	$314
6 MINUTE WALK PERFRM TEST	55002133	$201
CHEST TREATMNT W/FLUTTER DEV	55002141	$319
POC PLAVIX (P2Y12) ASSAY TRAP	55002166	$170
PLETHYS LUNG VOL AIRWAY RESIST	55002208	$774
PFT BY GAS	55002216	$788
AIRWY RESIST IMPLS OSCILLOMTRY	55002224	$223
CO MEMBRANE DIFUSE CAPACITY	55002232	$788
MECHANIC CHEST WALL OSCIL/SESS	55002398	$294
HBO TREATMENT PER 30 MIN	55506208	$1,061
HOT/COLD PACK	56000052	$76
PT RE-EVALUATION	56003551	$200
PT WHIRLPOOL 420	56003858	$180
PT ELEC STIM/15MIN ATTEND 420	56004153	$136
PT IONTOPHORESIS 15MIN 420	56004203	$180
PT ULTRASOUND 15MIN 420	56004302	$144
PT THERAPEUTIC EXER 15MIN 420	56004559	$165
PT NEUROMUS RE-ED 15MIN 420	56004609	$153
PT GAIT TRAINING 15MIN 420	56004708	$144
PT MASSAGE THERAPY 15MIN 420	56004757	$140
PT TILT TABLE 15MIN 420	56004807	$58
PT MANUAL THERAPY 15MIN 420	56004906	$209
PT GROUP THERAPEUTIC 420	56004955	$140
PT ORTHROT MGT/TRAIN 15MIN	56005002	$244
PT THERAPEUTIC ACT 15MIN 420	56005101	$171
PT W/C TRAINING 15MIN 420	56005259	$136
PT CHECK ORTHO/PROS 15MIN	56005408	$167
PT N/SELCTV DEBRIDEMENT 420	56005853	$406
PT SENS INTEG TECH 15MIN 420	56005861	$131
TRACTION MECHANICAL APPLICATN	56005903	$299
SPLINT/CRUTCH FITTING 15MIN	56006000	$192
HOME/FAMILY INSTRUCT 15MIN	56006034	$194
DEBRIDE SELECT <=20CM SESSN GP	56006984	$645
NEG PRESS WOUND TX </=50CM GP	56007016	$435
NEG PRESS WOUND TX >50CM	56007024	$675
DEBRIDE SELECT EA ADD 20CM	56007289	$581
CANALITH REPOSITION PER DAY	56007297	$70
MIST THERAPY WOUND US-PER DAY	56007313	$392
NEG PRES WND NO DME </=50CM PT	56008899	$511
NEG PRES WND NO DME >50CM PT	56008907	$574
PT EVAL LOW COMPLEXITY	56008931	$332
PT EVAL MODERATE COMPLEXITY	56008949	$399
PT EVAL HIGH COMPLEXITY	56008956	$599
PT COGNITIVE SKILLS ADDL 15MIN	56009087	$164
ELEC STIM ATTENDED 15M CQ	56009871	$136
IONTOPHORESIS 15MIN CQ	56009889	$180
ULTRASOUND 15MIN CQ	56009897	$144
EXERCISE THERAPEUTIC 15MIN CQ	56009905	$165
NEUROMUSC RE-ED 15MIN CQ	56009913	$153
GAIT TRAINING 15MIN CQ	56009939	$144
MASSAGE THERAPY 15MIN CQ	56009947	$168
TILT TABLE 15MIN CQ	56009954	$58
MANUAL THERAPY TECH 15MIN CQ	56009970	$209
ACTIVITY THERAPEUTIC 15MIN CQ	56010002	$171
PT COGNITIVE SKILLS ADD 15M CQ	56010028	$164
SENSORY INTEGRAT TECHNQ 15M CQ	56010036	$131
HOME/FAMILY INSTRUCT 15MIN CQ	56010051	$194
WHEELCHAIR TRAIN 15MIN CQ	56010077	$136
ORTHOTIC MGT/TRAIN 15MIN CQ	56010093	$244
CHECK ORTHO/PROSTH 15MIN CQ	56010127	$139
DEBRIDE SELECT FIRST 20CM CQ	56010168	$645
DEBRIDE SELECT EA ADD 20CM CQ	56010176	$581
HOT/COLD PACK CQ	56010424	$76
TRACTION MECHANICAL APPLY CQ	56010432	$282
WHIRLPOOL CQ	56010465	$180
GROUP THERAPEUTIC REHAB CQ	56010507	$140
NONSELECTIVE DEBRIDEMENT CQ	56010531	$406
NEG PRESS WOUND TX </=50CM CQ	56010549	$435
NEG PRESS WOUND TX >50CM CQ	56010556	$675
MIST THERAPY WOUND US /DAY CQ	56010572	$392
NEG PRES WND NO DME </=50CM CQ	56010606	$511
NEG PRES WND NO DME >50CM CQ	56010614	$453
AU HEAR TEST PUR TON AIR ON471	57000655	$183
AU TYMPAN IMPED TEST 471	57001307	$118
ST SPEECH/HEAR TX IND 440	57002651	$320
ST SPEECH/HEARING TX GROUP 440	57002909	$152
ST TRMT FOR FEED 440	57003303	$320
ST ASSES APHASIA PER HR 440	57003659	$950
ST SELF CARE MGT TRAIN 15M 440	57003857	$158
ST PHYS PERFORM TEST 15 MIN440	57003956	$208
ST TX COGNI-LINGUISTIC 15M 440	57004004	$173
ST THERAP ACTIVITIES-15M 440	57004053	$171
ST THERAP EXERCISE-15M 440	57004103	$165
EVAL SPEECH DEVC 1TO1 1HR	57004236	$1,079
EVAL SPEECH DEVC 1TO1 ADD30MIN	57004244	$410
PROG/MOD SPCHGEN DEVICE 440	57004251	$304
EVAL ORAL SWALL FUNCTION 440	57004269	$847
MOTION FLUORO EVAL VID/CINE440	57004277	$935
FIBEROPT SWAL EVAL CINE/VID440	57004285	$210
FBROPT EVAL SWAL&LRYN SENS 440	57004327	$427
EVAL USE/FIT VOICE PROSTH	57004582	$206
EVAL SPEECH FLUENCY	57006603	$906
EVAL SOUND PRODUCTION	57006611	$958
EVAL SOUND SPEECH COMPREH	57006629	$958
BEHAVIORAL QUALIT ANALY VOICE	57006637	$906
ST HOME/FAMILY INSTRCT 15MIN	57006652	$194
ST DEVELOPMENTAL TEST 1HR	57006710	$906
ST DEVELOPMT TEST ADD 30MIN	57006728	$453
ST COGNITIVE SKILLS ADDL 15MIN	57006777	$136
OT RE-EVALUATION	57102303	$244
OT PARAFFIN BATH 430	57102550	$78
OT ELEC STIM ATTEND/15 MIN 430	57102956	$144
OT ULTRASOUND 15MIN 430	57103103	$136
OT THERAPEUTIC EXER 15MIN 430	57103350	$165
OT NEUROMUS RE-ED 15MIN 430	57103400	$153
OT GAIT TRAINING 15MIN 430	57103509	$136
OT MASSAGE THERAPY 15MIN 430	57103558	$148
OT MANUAL THERAPY 15MIN 430	57103707	$209
OT GROUP THERAPEUTIC 430	57103756	$136
OT ORTHROT FIT/TRAIN 15MIN	57103806	$207
OT THERAPEUTIC ACT 15MIN 430	57103905	$171
OT SELF CARE MGT TRAIN 15M 430	57103954	$194
OT COM/WORK REINTEGRAT 15M 430	57104002	$139
OT W/C TRAINING 15MIN 430	57104051	$97
OT CHECK ORTHO/PROS 15MIN	57104200	$147
OT COGNITIVE SKILLS 15MIN 430	57104309	$141
OT SENSORY INTEGRATION 430	57104556	$131
OT SPLINT SHORT ARM STATIC 430	57104705	$276
OT NON-SELECV DEBRIDEMENT 430	57104929	$406
OT HOME/FAMLY INSTRCT 15MIN430	57104960	$194
OT EVAL LOW COMPLEXITY	57107096	$302
OT EVAL MODERATE COMPLEXITY	57107104	$410
OT EVAL HIGH COMPLEXITY	57107112	$545
OT MANUAL LYMPHATIC DRAINAGE	57107203	$136
OT COGNITIVE SKILLS ADDL 15MIN	57107328	$141
OT PARAFFIN BATH CO	57108052	$78
OT GROUP THERAPEUTIC CO	57108086	$136
OT NON-SELECV DEBRIDEMENT CO	57108128	$406
OT SPLINT SHORT ARM STATIC CO	57108185	$276
OT MANUAL LYMPHATIC DRAIN CO	57108243	$136
OT THERAPEUTIC ACT 15MIN CO	57108383	$171
OT THERAPEUTIC EXER 15MIN CO	57108391	$165
OT MANUAL THERAPY 15MIN CO	57108409	$136
OT SELF CARE MGT TRAIN 15M CO	57108417	$194
OT HOME/FAMLY INSTRCT 15M CO	57108425	$194
OT ORTHROT FIT/TRAIN 15MIN CO	57108433	$195
OT MASSAGE THERAPY 15MIN CO	57108441	$140
OT ULTRASOUND 15MIN CO	57108458	$136
OT NEUROMUS RE-ED 15MIN CO	57108466	$153
OT ELEC STIM ATTEND/15 MIN CO	57108474	$136
OT COGNITIVE SKILLS 15MIN CO	57108482	$141
OT COGNITIVE SKILLS ADD 15M CO	57108490	$141
OT CHECK ORTHO/PROS 15MIN CO	57108516	$139
OT GAIT TRAINING 15MIN CO	57108557	$136
OT W/C TRAINING 15MIN CO	57108573	$136
OT COM/WORK REINTEGRAT 15M CO	57108581	$139
OT SENSORY INTEGRATION CO	57108599	$158
ST SPEECH/HEAR TX IND 440	57906604	$320
ST SPEECH/HEARING TX GROUP 440	57906901	$152
ST TRMT FOR FEED 440	57907701	$303
ASSESSMT APHASIA PER HR ST	57908808	$950
PT RE-EVALUATION	57909558	$184
OT RE-EVALUATION	57909657	$140
HOT/COLD PACK	57909707	$100
PARAFFIN BATH OT	57910051	$78
ELEC STIM/15MIN ATTEND OT	57910853	$144
ELEC STIM/15MIN ATTEND PT	57910903	$144
ULTRASOUND 15MIN OT	57911158	$136
ULTRASOUND 15MIN PT	57911208	$144
THERAPEUTIC EXER 15MIN OT	57911653	$166
THERAPEUTIC EXER 15MIN PT	57911703	$188
NEUROMUS RE-ED 15MIN OT	57911752	$153
NEUROMUS RE-ED 15MIN PT	57911802	$153
GAIT TRAINING 15MIN PT	57912008	$144
MASSAGE THERAPY 15MIN OT	57912057	$140
MASSAGE THERAPY 15MIN PT	57912107	$148
TILT TABLE 15MIN PT	57912255	$58
MANUAL THERAPY 15MIN OT	57912354	$144
MANUAL THERAPY 15MIN PT	57912404	$174
GROUP THERAPEUTIC OT	57912453	$136
GROUP THERAPEUTIC PT	57912503	$140
ORTHROT MGT/TRAIN 15MIN OT	57912552	$207
ORTHROT MGT/TRAIN 15MIN PT	57912602	$203
THERAPEUTIC ACTIVITY 15MIN OT	57912750	$166
THERAPEUTIC ACTIVITY 15MIN PT	57912800	$171
SELF CARE MGT TRAIN 15MIN OT	57912909	$166
COM/WORK REINTEGRAT 15MIN OT	57913055	$139
W/C TRAINING 15MIN OT	57913154	$100
W/C TRAINING 15MIN PT	57913204	$136
CHECK ORTHO/PROS 15MIN OT	57913451	$147
COGNITIVE SKILLS 15MIN ST	57913709	$144
COGNITIVE SKILLS 15MIN OT	57913758	$149
SPLINT SHORT ARM STATIC OT	57914228	$276
DEBRIDE NON SELECT W/O ANES PT	57914251	$406
SENSORY INTEG TECH 15MIN OT	57914269	$131
EVAL ORAL SWALL FUNCTION 440	57914301	$847
MOTION FLUORO EVAL VID/CINE440	57914350	$935
DEBRIDE SELECT <=20CM SESSION	57914384	$398
NEG PRESS WOUND TX </=50CM	57914400	$291
NEG PRESS WOUND TX >50CM	57914418	$342
THERAPEUTIC EXER 15MIN SP	57914715	$156
DEBRIDE SELECT EA ADD 20CM	57914723	$434
EVAL SPEECH FLUENCY ST	57914731	$906
EVAL SOUND PRODUCTION ST	57914749	$958
EVAL SOUND SPEECH COMPREH ST	57914756	$958
BEHAVIORAL QUALIT ANALY VOICE	57914764	$906
HOT/COLD PACK PT	57914772	$100
HOME/FAMILY INSTRUCT 15MIN PT	57914798	$166
HOME/FAMILY INSTRUCT 15MIN OT	57914822	$144
OT EVAL LOW COMPLEXITY	57914848	$272
OT EVAL MODERATE COMPLEXITY	57914855	$410
OT EVAL HIGH COMPLEXITY	57914863	$545
PT EVAL LOW COMPLEXITY	57914871	$266
PT EVAL MODERATE COMPLEXITY	57914889	$399
PT EVAL HIGH COMPLEXITY	57914897	$599
THERAPEUTIC ACT 15MIN ST	57914913	$172
SP FIBEROPT SWAL EVAL CINE/VID	57919128	$175
ST COGNITIVE SKILLS ADDL 15MIN	57919177	$136
OT COGNITIVE SKILLS ADDL 15MIN	57919185	$141
DEVICE EXCHANGE TRAPPER 97CM X 10MM X 10MM X 0.014IN	59400	$4,864
IMPLANT BREAST SMOOTHSILK ROUND MINI 310CC	59510	$7,425
Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)	70336	$3,920
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s)	70540	$4,307
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s)	70542	$4,976
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and furthe	70543	$4,162
Magnetic resonance angiography, head; without contrast material(s)	70544	$3,268
Magnetic resonance angiography, head; with contrast material(s) Non-Facility Critical Care Intensivists	70545	$3,917
Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences	70546	$5,312
Magnetic resonance angiography, neck; without contrast material(s)	70547	$3,163
Magnetic resonance angiography, neck; with contrast material(s)	70548	$3,696
Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences	70549	$4,863
MRI IAC W/O CONTRAST	70551	$922
MRI IAC W/O CONTRAST	70551	$4,585
Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)	70552	$5,510
Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and furth	70553	$5,786
Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)	71550	$5,412
Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s) Non	71551	$5,212
Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s),	71552	$7,207
Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material	72141	$4,770
Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)	72142	$6,201
Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material	72146	$3,728
Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) Facility Trauma Critical Care	72147	$6,201
Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material	72148	$4,770
Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) Facility Wound Care	72149	$6,201
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further	72156	$6,828
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further	72157	$6,828
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further	72158	$6,828
Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)	72159	$5,407
Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) Facility Cardiovascular Thoracic Surgery	72195	$4,770
Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) Facility Critical Care Intensivists	72196	$5,473
Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences Non-F	72197	$5,743
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)	73218	$5,502
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility	73219	$4,998
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) a	73220	$6,005
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) Non-facility All Other Specialists	73221	$4,828
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility Specialists	73222	$9,457
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and fu	73223	$10,402
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)	73718	$5,502
HC MRI LOWER EXT W CONTRAST	73719	$5,998
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) an	73720	$4,585
MRI EXT LOW JNT W/O CON RT LTD	73721	$768
MRI EXT LOW JNT W/O CON RT LTD	73721	$5,115
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) Facility Neurology	73722	$9,457
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and fu	73723	$11,672
CT ABD PELVIS W/CON	74177	$870
Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) Facility Critical Care Intensivists	74181	$4,144
Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)	74182	$4,270
Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences	74183	$4,528
Magnetic resonance spectroscopy Facility Neurosurgery	76390	$6,155
Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device)	77021	$2,100
Magnetic resonance imaging, breast, without contrast material; unilateral Non-Facility All Other Specialists	77046	$1,087
Magnetic resonance (eg, proton) imaging, bone marrow blood supply Non-Facility ICC	77084	$2,681
PR URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	81025	$121
Calcium; ionized	82330	$202
Carboxyhemoglobin; quantitative	82375	$137
ASSAY OF CREATININE	82565	$185
BLOOD PH	82800	$592
BLOOD GASES ANY COMBINATION	82803	$627
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, e	82805	$942
Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry	82810	$628
Glucose; quantitative, blood (except reagent strip) Facility Mid Levels	82947	$194
Lactate (lactic acid)	83605	$314
ASSAY OF SERUM POTASSIUM	84132	$175
Sodium; serum, plasma or whole blood	84295	$198
HC HEMATOCRIT	85014	$141
Blood count; hemoglobin (Hgb) Non-facility All Other Specialists	85018	$146
Coagulation time; activated Non-Facility MD DO	85347	$374
Platelet, aggregation (in vitro), each agent	85576	$170
Sputum, obtaining specimen, aerosol induced technique (separate procedure) Facility	89220	$192
Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use Non-Facility Neurology	90375	$10,893
MENB-FHBP VACC 2/3 DOSE IM	90621	$492
Hepatitis A vaccine (HepA), adult dosage, for intramuscular use Facility Critical Care Intensivists	90632	$360
Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use Non-Facility Critical Care	90649	$504
2VHPV VACCINE 3 DOSE IM	90650	$492
Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use	90656	$53
Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use Non-Facility	90677	$653
RV1 VACC 2 DOSE LIVE ORAL	90681	$392
HC IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE 49281-0422-50	90686	$116
DTAP-IPV VACCINE 4-6 YRS IM	90696	$218
Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use	90715	$268
MENACWYD/MENACWYCRM VACC IM	90734	$435
Hepatitis B vaccine (HepB), CpG-adjuvanted, adult dosage, 2 dose or 4 dose schedule, for intramuscular use Non-Facility Critical Care Inten	90739	$316
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual Non-Facility Trauma Critical Care	92507	$320
Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals	92508	$152
EVALUATION OF SPEECH FLUENCY	92521	$906
Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); Facility PCP and Mid-Levels	92522	$958
Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehensi	92523	$958
Behavioral and qualitative analysis of voice and resonance Facility Neurosurgery E&M	92524	$906
HC SWALLOWING TREATMENT GN	92526	$320
Screening test, pure tone, air only	92551	$183
Tympanometry (impedance testing)	92567	$118
Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech Facility Critical Care Intensivists	92597	$206
EX FOR SPEECH DEVICE RX 1HR	92607	$1,079
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each add	92608	$410
Therapeutic services for the use of speech-generating device, including programming and modification Non-Facility Cardiovascular Thoracic S	92609	$304
EVALUATE SWALLOWING FUNCTION	92610	$847
Motion fluoroscopic evaluation of swallowing function by cine or video recording	92611	$935
ENDOSCOPY SWALLOW (FEES) VID	92612	$210
FEES W/LARYNGEAL SENSE TEST	92616	$427
Cardiopulmonary resuscitation (eg, in cardiac arrest)	92950	$1,930
Cardioversion, elective, electrical conversion of arrhythmia; external	92960	$3,434
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report Facility MD DO	93005	$638
TTE W/DOPPLER COMPLETE	93306	$614
Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/br	93923	$440
Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpati	94002	$3,183
Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpati	94003	$2,864
Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary	94010	$539
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration Non-Facility General Surgery	94060	$1,364
Vital capacity, total (separate procedure) Non-Facility Hospitalists - Internal Medicine Critical Care Neurosurgery	94150	$286
Respiratory flow volume loop Non-Facility ICC	94375	$606
Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube	94610	$113
Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed Non-	94618	$201
Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such	94640	$302
AEROSOL INHALATION TREATMENT	94642	$1,424
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour Facility General Surgery	94644	$733
CBT EACH ADDL HOUR	94645	$692
Continuous positive airway pressure ventilation (CPAP), initiation and management Non-Facility Specialists	94660	$2,839
HC EVALUATE PT USE OF INHALER	94664	$319
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation Fa	94667	$234
CHEST WALL MANIPULATION	94668	$210
Mechanical chest wall oscillation to facilitate lung function, per session Non-Facility Mid Levels	94669	$294
Plethysmography for determination of lung volumes and, when performed, airway resistance	94726	$774
Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes Facility All	94727	$788
Airway resistance by oscillometry Non-Facility Specialists	94728	$223
Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure) Facility Trauma Critical Car	94729	$788
HC PULSE OXIMETRY SINGLE	94760	$392
Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)	94762	$387
CANALITH REPOSITIONING PROC	95992	$70
Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech producti	96105	$950
Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executi	96112	$906
DEVEL TST PHYS/QHP EA ADDL	96113	$453
HC HOT/COLD PACKS THERAPY 1+ AREA	97010	$76
Application of a modality to 1 or more areas; traction, mechanical	97012	$299
Application of a modality to 1 or more areas; paraffin bath Facility MD DO	97018	$78
Application of a modality to 1 or more areas; whirlpool Facility Neurology	97022	$180
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes	97032	$136
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Non-Facility Critical Care Intensivists	97033	$180
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Facility MD DO	97035	$144
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexib	97110	$165
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, po	97112	$153
Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) Facility Hospitalists - Internal Medicine	97116	$144
HC MASSAGE 15 MIN	97124	$140
Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pr	97129	$173
Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pr	97130	$164
Unlisted therapeutic procedure (specify) Non-Facility Trauma Critical Care	97139	$58
HC MANUAL THER TECH, 1+ REGIONS, 15 MIN EACH	97140	$209
Therapeutic procedure(s), group (2 or more individuals) Facility Wound Care	97150	$140
HC PT EVAL LOW COMPLEX 20MIN	97161	$332
Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or	97162	$399
Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/o	97163	$599
Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use	97164	$200
HC OT EVAL LOW COMPLEXITY 30MIN	97165	$302
HC OT EVAL MOD COMPLEXITY 45MIN	97166	$410
HC OT EVAL HIGH COMPLEXITY 60MIN	97167	$545
Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional o	97168	$244
Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes	97530	$171
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) pa	97533	$131
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and	97535	$194
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modifi	97537	$139
Wheelchair management (eg, assessment, fitting, training), each 15 minutes Non-Facility Trauma Critical Care	97542	$136
HC DEBRIDE WOUND <=20 SQ CM	97597	$645
Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (	97598	$581
Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion,	97602	$406
Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical appl	97605	$435
Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical appl	97606	$675
HC NEG PRESS WOUND TX </=50SQCM W/O DME	97607	$511
Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including pr	97608	$574
LOW FREQUENCY NON-THERMAL US	97610	$392
Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes Facility Internal	97750	$208
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ie	97760	$244
Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prost	97763	$167
BEHAV CHNG SMOKING 3-10 MIN	99406	$106
Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes	99407	$95
Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of	99464	$697
HC DELIVERY/BIRTHING ROOM RESUSCITATION	99465	$978
GADOTERIDOL PER 1ML	A9576	$303
MULTIHANCE CONTRAST PER 1ML	A9577	$398
GADOLINIUM CONT PER 1ML	A9579	$246
EOVIST PER 1ML	A9581	$310
GADOBUTROL CONTRAST PER 0.1ML	A9585	$147
MRA ABD W/CON	C8900	$5,809
MRA ABD W/O CON	C8901	$4,973
MRA ABD WO/W CON	C8902	$1,830
MRI BREAST W/CON BIL	C8906	$2,720
MRA CHEST W/CON	C8909	$5,101
MRA CHEST W/O CON	C8910	$4,510
HC MRA CHEST WWO CONTRAST	C8911	$5,678
MRA EXT LOW W/CON LT	C8912	$5,862
MRA EXT LOW W/O CON LT	C8913	$5,862
MRA PELVIS W/CON LTD	C8918	$5,862
MRA PELVIS W/O CON	C8919	$6,214
MRA EXT UP W/WO CON LT	C8936	$4,726
COCAINE HCL NASAL PER 1MG	C9046	$518
CAPLACIZUMAB PER 1MG INJ	C9047	$18,189
LIDOCAINE/TETRA 70-70MG PATCH	C9285	$101
CANGRELOR PER 1MG	C9460	$3,206
CONIVAPTAN PER 1MG	C9488	$504
HBO TREATMENT PER 30 MIN	G0277	$1,061
ERAVACYCLINE PER 1MG	J0122	$202
ACETAMINOPHEN INJ PER 10MG	J0131	$83
ACYCLOVIR PER 5MG	J0133	$66
ADENOSINE PER 1MG INJ	J0153	$546
ADRENAL EPINEPH INJ PER 0.1MG	J0171	$613
ALEMTUZUMAB PER 1MG	J0202	$7,960
ALLOPURINOL SODIUM 1MG	J0206	$4,151
ALFENTANIL HYDROCHLORID 500MCG	J0216	$546
REMDESIVIR PER 1MG	J0248	$1,354
AMIKACIN SULF PER 100MG	J0278	$146
AMIODARONE HCL PER 30MG	J0282	$198
AMPICILLIN/NS 500MG/50ML IVPB	J0290	$34
AMP SOD/SULBACT PER 1.5GM	J0295	$116
SUCCINYLCHOLIN CHL UP TO 20MG	J0330	$95
AZITHROMYCN/D5W 500MG/250ML GN	J0456	$81
AZTREONAM PER 100MG	J0457	$16
DIMERCAPROL PER 100MG	J0470	$456
BELATACEPT PER 1MG	J0485	$2,358
BENZTROPINE MESYL PER 1MG	J0515	$702
PEN G BENZ/PROC PER 100000	J0558	$269
PEN G BENZ INJ PER 100000U	J0561	$208
BIVALIRUDIN PER 1MG	J0583	$3,262
BUPRENORPHINE PER 0.1MG	J0592	$23
C1 ESTERASE BERINERT PER 10U	J0597	$7,158
CALCIUM GLUC INJ PER 10MG	J0612	$26
CASPOFUNGIN ACET PER 5MG	J0637	$2,472
LEVOTHYROXINE PER 10MCG	J0650	$1,369
BUPIVICAINE PER 0.5MG	J0665	$52
BUPIVACAINE LIPOSOME PER 1MG	J0666	$1,468
CEFAZOLIN PER 500MG	J0690	$16
CEFEPIME PER 500MG	J0692	$37
CEFOXITIN/NS 1GM/100ML	J0694	$34
CEFTOLOZANE/TAZOBACTAM 50/25MG	J0695	$530
CEFTRIAXONE PER 250MG	J0696	$16
CEFUROXIME SOD PER 750MG	J0697	$16
CEFOTAXIME PER 1G 636	J0698	$247
CEFIDEROCOL PER 10MG	J0699	$583
CEFTAROLINE FOSAMIL PER 10MG	J0712	$262
CEFTAZIDIME PER 500MG	J0713	$32
ANASCORP UP TO 120MG	J0716	$13,946
CLONIDINE 1MG/10ML VIAL	J0735	$265
CLINDAMYCIN PHOSPHATE 300MG	J0736	$110
IMIPENEM/CILAS PER 250MG	J0743	$146
CIPROFLAXACIN PER 200MG	J0744	$358
CROTALIDAE IMMUNE FAB TO 1MG	J0840	$13,166
CYTOMEGALOVIRUS PER VIAL	J0850	$4,829
DALBAVANCIN PER 5MG	J0875	$3,616
DAPTOMYCIN PER 1MG	J0878	$251
ARGATROBAN PER 1MG NONESRD	J0883	$13,008
ARGATROBAN PER 1MG ESRD	J0884	$11,825
EPOETIN ALFA PER 1000U NONESRD	J0885	$1,060
DENOSUMAB PER 1MG	J0897	$3,172
METHYLPREDNISOLONE ACETATE 1MG	J1010	$213
TESTOSTERON CYP PER 1MG INJ	J1071	$398
DEXAMETHASONE 0.5MG/5ML	J1100	$16
PHENYTOIN PER 50MG	J1165	$30
HYDROMORPHONE PER 0.1MG	J1171	$7
DIMENHYDRINATE 50MG/1ML VIAL	J1240	$28
DOBUTAMINE PER 250MG INJ	J1250	$2,052
DOPAMINE HCL PER 40MG	J1265	$781
DORIPENEM PER 10MG	J1267	$106
ECALLANTIDE PER 1MG	J1290	$32,087
EPOPROSTENOL 0.5MG VIAL	J1325	$213
ERTAPENEM SOD PER 500MG	J1335	$90
ESTADIOL VALERATE PER 10MG	J1380	$1,167
INJ FILGRASTIM G-CSF PER 1MCG	J1442	$3,222
TBO-FILGRASTIM PER 1MCG	J1447	$1,839
FLUCONAZOLE PER 200MG	J1450	$3,558
FOSAPREPITANT PER 1MG	J1453	$984
IMMUNE GLOB/HIZENTRA PER 100MG	J1559	$2,091
IVIG NONLYOPHILIZED PER 500MG	J1568	$464
IVIG NONLYOPHILIZED PER 500MG	J1572	$3,098
GENTAMICIN SULF UP TO 80MG	J1580	$15
GLYCOPYROLATE INJ PER 0.1MG	J1596	$110
HEMIN PER 1MG	J1640	$21,461
HEPARIN LOC PER 10 UNITS	J1642	$95
HEPARIN/NS 1000U/500ML PF	J1644	$275
HYDROCORTISONE UP TO 100MG	J1720	$24
IBUPROFEN INJ PER 100MG	J1741	$42
IBUTILIDE FUM PER 1MG	J1742	$686
ICATIBANT INJ PER 1MG	J1744	$9,782
IRON SUCROSE CPLX PER 1MG	J1756	$422
IMIGLUCERASE PER 10 UNITS	J1786	$6,094
ESMOLOL HYDROCHLORIDE PER 10MG	J1805	$59
INSULIN PER 5 UNITS	J1815	$30
ISAVUCONAZONIUM PER 1MG	J1833	$1,224
METRONIDAZOLE PER 10MG	J1836	$684
LABETALOL HYDROCHLORIDE 5MG	J1920	$14
LARONIDASE PER 0.1MG	J1931	$3,731
BUMETAMIDE PER 0.5MG	J1939	$262
LEVETIRACETAM PER 10MG	J1953	$688
LEVOFLOXACIN PER 250MG	J1956	$236
LIDOCAINE D5W PER 1MG	J2002	$390
LIDOCAINE HCL PER 1MG	J2003	$16
LIDOCAINE/EPI PER 1MG	J2004	$182
LINEZOLID PER 200MG	J2020	$1,622
LORAZEPAM PER 2MG	J2060	$39
MEPERIDINE HCL PER 100MG	J2175	$352
MEROPENEM PER 100MG	J2185	$118
MEROPENEM/VABOR PER 10MG/10MG	J2186	$644
METHYLNAL TREXONE PER 0.1 MG	J2212	$472
MICAFUNGIN SOD PER 1MG	J2248	$458
MIDAZOLAM PER 1MG	J2250	$14
MILRINONE LACT PER 5MG	J2260	$1,351
MINOCYCLINE PER 1MG	J2265	$560
MORPHINE SULF PER 10MG INJ	J2270	$15
MORPHINE SULF PF PER 10MG	J2274	$63
MOXIFLOXACIN PER 100MG	J2280	$562
NITROGLYCERIN PER 5MG	J2305	$401
OCTREOTIDE ACET PER 25 MCG	J2354	$29
OLANZAPINE INJ PER 0.5MG	J2359	$453
PHENYLEPHRINE HYDROCHLOR 20MCG	J2371	$16
CHLOROPROCAINE PER 1MG	J2401	$72
NICARDIPIN INJ PER 0.1MG	J2404	$815
ONDANSETRON PER 1MG	J2405	$206
ORITAVANCIN PER 10MG	J2407	$8,289
OXYMORPHONE 1MG/1ML AMP	J2410	$15
PAMIDRONATE DISOD PER 30MG GN	J2430	$122
PANTOPRAZOLE SOD PER 40MG	J2470	$579
PEGFILGRASTIM PER 0.5MG	J2506	$28,498
PEN G POT UP TO 600MU	J2540	$23
PIPER/TAZO PER 1.125GM	J2543	$265
PERAMIVIR PER 1MG	J2547	$1,157
PROMETHAZINE/NS 25MG/50ML	J2550	$14
PLERIXAFOR INJ PER 1MG	J2562	$25,219
OXYTOCIN UP TO 10 UNITS	J2590	$136
VASOPRESSIN PER 1 UNIT	J2598	$16
FLUPHENAZINE HCL PER 1.25MG	J2679	$208
OXACILLIN SODIUM UP TO 250MG	J2700	$53
PROPOFOL INJ PER 10MG	J2704	$357
NEOSTIGMINE METHY UP TO 0.5MG	J2710	$61
METOCLOPRAMIDE 10MG/NS 50ML PB	J2765	$58
RASBURICASE PER 0.5MG	J2783	$11,088
RHO(D) IMM GLOB 50MCG MINI SYR	J2788	$164
RHO(D) IMMUNE GLOB 300MCG SYR	J2790	$1,790
ROPIVACAINE PER 1MG	J2795	$306
SOD FER GLUC COMP PER 12.5MG	J2916	$14
METHPRED SOD SUCCINATE 5MG	J2919	$13
RETEPLASE PER 18.1MG	J2993	$16,690
FENTANYL CITRATE PER 0.1MG	J3010	$23
SUMATRIPTAN 6MG/0.5ML INJ	J3030	$1,294
TENECTEPLASE PER 1MG	J3101	$16,015
TESTOSTERONE ENANTH PER 1MG	J3121	$1,151
TIGECYCLINE PER 1MG	J3243	$751
TIROFIBAN HCL INJ PER 0.25MG	J3246	$2,232
TOCILIZUMAB PER 1MG	J3262	$5,587
TREPROSTINIL PER 1MG	J3285	$40,095
TRIAMCINOLONE ACET PER 1MG	J3300	$516
VANCOMYCIN PER 500MG	J3370	$95
HYDROXOCOBALAMIN PER 25MG	J3424	$1,799
VORICONAZOLE PER 10MG	J3465	$368
MAG SULFATE PER 500MG	J3475	$80
POTASSIUM CHL PER 2MEQ	J3480	$18
ZOLEDRONC ACID/RECLAST PER 1MG	J3489	$5,952
HC NITRIC OXIDE PER HOUR	J3490	$430
SODIUM CHL 0.9% 1000ML BAG	J7030	$318
SODIUM CHL 0.9% 500ML BAG	J7040	$319
D5NS 500ML BAG	J7042	$291
SOD CHL 0.9% ADD-VANT 250ML	J7050	$220
DEXTROSE 5%-WATER 500ML BAG	J7060	$250
D5W 1000ML BAG	J7070	$270
DEXTRAN/NS 10% 500ML	J7100	$2,423
RINGERS LACTATED 250ML BAG	J7120	$304
BALFAXAR PER IU 40ML	J7165	$4
PROTHROMBIN CMPLEX PER IU	J7168	$10
FIBRINOGEN PER 1MG	J7178	$5
FACTOR VIII(WILATE1000)PERUNIT	J7183	$6
VWF PER UNIT (HUMATE-P)>600 VL	J7187	$8
FACTOR VIIA PER 1MCG	J7189	$12
FACTOR IX(PROFILNINE)PER UNIT	J7194	$4
FACTOR IX(BENEFIX)PER UNIT	J7195	$2
ANTITHROMBIN RECOM PER 50IU	J7196	$15,578
ANTITHROMBIN III PER IU	J7197	$22
CYCLOSPORINE ORAL PER 100MG	J7502	$17
PREDNISONE IR ORAL 1MG	J7512	$1
DACLIZUMAB PER 25MG	J7513	$2,267
MYCOPHENOLATE MOF PER 10MG	J7519	$282
SIROLIMUS ORAL PER 1 MG	J7520	$49
EVEROLIMUS PER 0.25 MG	J7527	$933
CAPECITABINE ORAL PER 50MG	J8522	$136
CYCLOPHOSPHAMIDE ORAL PER 25MG	J8530	$23
MELPHALAN 2MG TAB	J8600	$28
ARSENIC TRIOXIDE PER 1MG	J9017	$944
CLOFARABINE PER 1MG	J9027	$8,810
BCG LIVE INTRAVESICAL PER 1MG	J9030	$2,424
BORTEZOMIB NOS PER 0.1MG	J9041	$10,428
BRENTUXIMAB VEDOTIN PER 1MG	J9042	$15,720
CYCLOPHOSPHAMIDE PER 5MG	J9075	$856
DOCETAXEL PER 1MG	J9171	$5,972
FLUOROURACIL INJ PER 500MG	J9190	$35
GEMCITABINE 200MG/5.26ML VIAL	J9201	$2,062
IRINOTECAN PER 20MG	J9206	$141
INTERFERON A2B PER 1 MILL UNIT	J9214	$594
METHOTREXATE SOD PER 50MG	J9260	$310
PACLITAXEL PER 1MG INJ	J9267	$3,838
RITUXIMAB PER 10 MG	J9312	$28,318
TOPOTECAN PER 0.1MG	J9351	$7,526
TRASTUZUMAB PER 10MG	J9355	$574
GLIADEL WAFER 7.7-192.3	J9999	$14,824
ALBUMIN HUMAN 5% PER 50ML	P9041	$120
PLASMA PROT (HUMAN) 5% 250ML	P9048	$185
FERUMOXYTOL PER 1MG NONESRD	Q0138	$1,811
FOSPHENYTOIN PER 50MG	Q2009	$84
INJ BETA INTERFERON PER 1MCG	Q3027	$2,736
EPOETIN ALFA PER 100UNITS ESRD	Q4081	$1,060
FILGRASTIM G-CSF BIO PER 1MCG	Q5101	$876
EPO ALFA EPBX PER 100U ESRD	Q5105	$384
EPO ALFA EPBX PER 1000U	Q5106	$384
RITUXIMAB-ABBS PER 10MG	Q5115	$1,453
LUMASON PER 1ML	Q9950	$40
DEFINITY RT PER 1ML	Q9957	$816
CYSTOGRAFIN PER 1ML	Q9958	$182
GASTROGRAFIN PER 1ML	Q9963	$23
IODIXANOL 270 150ML FK PER 1ML	Q9966	$4
ISOVUE 300 500ML PER 1ML	Q9967	$349
METHYLENE BLUE PER 1MG	Q9968	$834