Description CPT/HCPCS Code Professional Charge Technical Charge

INSULIN SYRINGE ICC EACH

A4206

($

2.00)

AIRWAY BER 90 MED ADULT


($

2.00)

STERI STRIP 1/4 X 4


($

2.00)

ENSURE CAN STRAWBERRY

B4150

($

2.00)

PROMOTE W/FIBER

B4150

($

2.00)

PROMOTE W/FIBER

B4150

($

2.00)

SUPLENA 4/UNITS PER CAN/24/CS

B4152

($

3.00)

SUTURE VICRYL J340H

A4649

($

3.00)

ELASTIC BANDAGE 2

A6448

($

3.00)

METRONCLOTH ELECTRODES 2X2 80/PK

A4556

($

3.00)

O2 TUBINGT 7 FT


($

3.00)

BANDAGE SPOT


($

3.00)

GLUCERNA STRAW

B4150

($

3.00)

GLUCERNA CHOC

B4150

($

3.00)

GLUCERNA VANILLA

B4150

($

3.00)

PROCHLORPERAZINE (COMPAZINE) TAB 5 MG

Q0164

($

4.00)

HUMULIN R VIAL

J1815

($

4.00)

HUMULIN N VIAL

J1815

($

4.00)

HUMALOG (LISPRO) VIAL

J1815

($

4.00)

LEVEMIR INSULIN

J1815

($

4.00)

NOVOLOG INSULIN INJ

J1815

($

4.00)

HUMULIN 70/30 VIAL

J1815

($

4.00)

LANTUS INSULIN

J1815

($

4.00)

PETAMEN 1.5 100CALORIE/86.4 UNIT/CS

B4153

($

4.00)

ENSURE CAN CHOC

B4150

($

4.00)

WATER STERILE 1000ML

J7030

($

4.00)

TAPE MEDIPORE 4 INCH DO NOT USE

A4452

($

4.00)

CATHETER URETH 8FR

A4344

($

4.00)

CATHETER URETH 12FR UTILITY

A4344

($

4.00)

SUCTION TUBING 6 FOOT


($

4.00)

SUCTION CATHETER 8FR


($

4.00)

CATHETER 16 FR SELF CATH


($

4.00)

CATHETER URETH 14FR UTILITY RED


($

4.00)

CATHETER URETH 10FR UTILITY RED


($

4.00)

CATHETER URETH 18FR UTILITY RED


($

4.00)

PEROXIDE 4 OZ BOTTLE


($

4.00)

DRESSING XEROFORM 4X4


($

4.00)

AMMONIA INHALANTS


($

4.00)

COLOSTOMY CLAMP


($

4.00)

FLEETS (PHOS SOD) ENEMA

A9150

($

4.00)

O2 CANNULA


($

4.00)

PLASTER PARIS 3 INCH


($

4.00)

PLASTER PARIS 4 INCH


($

4.00)

PLASTER SPLINTS 5 X 30


($

4.00)

PLASTER SPLINTS 4 X 15


($

4.00)

STOCKINET 2


($

4.00)

STOCKINET 6


($

4.00)

HAIRBRUSH


($

4.00)

CARAFE GRAY


($

4.00)

DUMMY 1 TAB

J8499

($

4.00)

NICORETTE GUM

S4995

($

4.00)

MISOPROSTOL (CYTOTEC) TAB 200MCG

S0191

($

4.00)

HYDROXYUREA CAP 500MG

S0176

($

4.00)

FINASTERIDE (PROSCAR) TAB 5MG

S0138

($

4.00)

ONDANSETRON (ZOFRAN) TAB 8MG

S0119

($

4.00)

HYDROXYZINE PAM CAP 25MG

Q0177

($

4.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

HYDROXYZINE CAP 25MG

Q0177

($

4.00)

PROMETHAZINE(PHENERGAN)LIQ 6.25 MG/5ML

Q0169

($

4.00)

PROMETHAZINE/CODEINE LIQ 6.25/10MG 5ML

Q0169

($

4.00)

ONDANSETRON (ZOFRAN) TAB 4MG

Q0162

($

4.00)

ONDANSETRON ODT (ZOFRAN) TAB 4MG

Q0162

($

4.00)

AZITHROMYCIN TAB 250MG

Q0144

($

4.00)

DEXAMETHASONE SOL 1MG/1ML

J8540

($

4.00)

VALPROIC ACID SYRUP 250MG/5 ML 480 ML

J8499

($

4.00)

ZIDOVUDINE(RETROVIR) TAB 300MG

J8499

($

4.00)

ESTRADIOL TAB 0.5MG

J8499

($

4.00)

FLECAINIDE ACETATE TAB 50MG

J8499

($

4.00)

MEGESTROL TAB 20MG

J8499

($

4.00)

ROPINIROLE TAB 0.25MG

J8499

($

4.00)

DILTIAZEM CD (CARDIZEM) CAP 180MG

J8499

($

4.00)

LEVOTHYROXINE (SYTHROID) TAB 88 MCG

J8499

($

4.00)

ALENDRONATE SOD (FOSAMAX) TAB 35MG

J8499

($

4.00)

AMOXICILLIN (TRIMOX) CAP 250MG

J8499

($

4.00)

CLONAZEPAM (KLONOPIN) TAB 1MG

J8499

($

4.00)

CLONIDINE HCL (CATAPRES) TAB 0.2MG

J8499

($

4.00)

DOXYCYCLINE (VIBRAMYCIN) TAB 100MG

J8499

($

4.00)

ALBUTEROL LIQ-SYRUP 2MG/5 ML 16 OZ

J8499

($

4.00)

LEVOTHYROXINE (SYNTHROID) TAB 25 MCG

J8499

($

4.00)

CODEINE SULFATE TAB 30MG

J8499

($

4.00)

SIMVASTATIN (ZOCOR) TAB 20MG

J8499

($

4.00)

DILTIAZEM (CARDIZEM) HCL TAB 30MG

J8499

($

4.00)

DEXAMETHASONE (DECADRON) TAB 4MG

J8499

($

4.00)

CIPROFLOXACIN (CIPRO) TAB 250MG

J8499

($

4.00)

WARFARIN(COUMADIN)TAB 2MG

J8499

($

4.00)

PHENOBARBITAL ELIXIR 20MG/5ML 100CC

J8499

($

4.00)

LEVOTHYROXINE SOD(SYNTHROID) TAB 125MCG

J8499

($

4.00)

PHENYTOIN SOD EXT(DILANTIN) CAP 100 MG

J8499

($

4.00)

AMOXICILLIN/CLAV(AUGMENTIN)TAB 875/125MG

J8499

($

4.00)

LEVOTHYROXINE SOD (SYNTHROID) TAB 50 MCG

J8499

($

4.00)

PHENYTOIN LIQ 125MG/5ML

J8499

($

4.00)

ACYCLOVIR (ZOVIRAX) TAB 200MG

J8499

($

4.00)

HYDROMORPHONE (DILAUDID) TAB:2MG

J8499

($

4.00)

FOLIC ACID (FOLVITE) TAB 1MG

J8499

($

4.00)

LEVOTHYROXINE SOD(SYNTHROID) TAB 100MCG

J8499

($

4.00)

ISOSORBIDE DINITRATE (ISORDIL) TAB 20MG

J8499

($

4.00)

HALOPERIDOL (HALDOL) TAB 0.5 MG

J8499

($

4.00)

INDOMETHACIN (INDOCIN) CAP 25MG

J8499

($

4.00)

CARBIDOPA/LEVO (SINEMET) TAB 25/250 MG

J8499

($

4.00)

CARVEDILOL(COREG) TAB 3.125MG

J8499

($

4.00)

DULOXETINE(CYMBALTA) CAP 20MG

J8499

($

4.00)

LORAZEPAM (ATIVAN) TAB 1MG

J8499

($

4.00)

CHLORDIAZEPOXIDE HCL CAPS 10MG

J8499

($

4.00)

CHLORDIAZEPOXIDE (LIBRIUM) CAP 25MG

J8499

($

4.00)

DIPHENOXYLATE HCL/ATROPINE SUL TAB

J8499

($

4.00)

THIORIDAZINE HCL (MELLARIL) TAB 10MG

J8499

($

4.00)

LEVOTHYROXINE (SYNTHROID) TAB 75 MCG

J8499

($

4.00)

OXYBUTYNIN (DITROPAN) TAB 5MG

J8499

($

4.00)

DIVALPROEX SOD (DEPAKOTE) SPK CAP 125MG

J8499

($

4.00)

DICYCLOMINE HCL (BENTYL) CAP 10MG

J8499

($

4.00)

NITROSTAT SUBLINGUAL TAB 0.4MG

J8499

($

4.00)

CAPTOPRIL(CAPOTEN)TAB 12.5MG

J8499

($

4.00)

QUETIAPINE FUMARATE(SEROQUIL)TAB 300MG

J8499

($

4.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

PROPYLTHIOURACIL TAB 50 MG

J8499

($

4.00)

FLUOXETINE HCL (PROZAC) CAP 20MG

J8499

($

4.00)

ALPRAZOLAM (XANAX) TAB 0.25MG

J8499

($

4.00)

PREDNISONE TAB 20MG

J8499

($

4.00)

PRAMIPEXOLE DI-HCL(MIRAPEX) TAB 0.125 MG

J8499

($

4.00)

PROPRANOLOL (INDERAL) TAB 10 MG

J8499

($

4.00)

MEMANTINE TAB 10MG

J8499

($

4.00)

QUINIDINE SULFATE TAB 200MG

J8499

($

4.00)

DOXAZOSIN (CARDURA) TAB 8 MG

J8499

($

4.00)

SYNTHROID (LEVOTHYROXINE) TAB 0.1MG

J8499

($

4.00)

THEOPHYLLINE ER (THEO-DUR) TAB 200MG

J8499

($

4.00)

IMIPRAMINE HCL(TOFRANIL) TAB 25MG

J8499

($

4.00)

ACETAMINOPHEN/CODEINE 300MG/30MG TAB

J8499

($

4.00)

AMPICILLIN CAP 500MG

J8499

($

4.00)

DIAZEPAM (VALIUM) TAB 5MG

J8499

($

4.00)

ACYCLOVIR (ZOVIRAX) TAB 800MG

J8499

($

4.00)

ENALAPRIL MALEATE(VASOTEC) TAB 5MG

J8499

($

4.00)

METOPROLOL TART (LOPRESSOR) TAB 50MG

J8499

($

4.00)

ESCITALOPRAM(LEXAPRO)TAB 5MG

J8499

($

4.00)

METHIMAZOLE (TAPAZOLE) TAB 5MG

J8499

($

4.00)

LITHIUM CARBONATE TAB 300 MG

J8499

($

4.00)

FEXOFENADINE HCL(ALLEGRA)TAB 180MG

J8499

($

4.00)

CYCLOBENZAPRINE (FLEXERIL) TAB 10 MG

J8499

($

4.00)

VITAMIN D2 (ERGOCALCIFEROL) CAP 50,000 U

J8499

($

4.00)

ATORVASTATIN (LIPITOR) TAB 40MG

J8499

($

4.00)

FLORASTOR CAP 250MG

J8499

($

4.00)

TRIAMTERENE/HCTZ 37.5-25MG

J8499

($

4.00)

METFORMIN ER (GLUCOPHAGE) TAB 500 MG

J8499

($

4.00)

QUETIAPINE FUMARATE(SEROQUEL) TAB 50 MG

J8499

($

4.00)

LAMOTRIGINE(LAMICTAL) TAB 5MG

J8499

($

4.00)

METRONIDAZOLE (FLAGYL) TAB 500MG

J8499

($

4.00)

AMOXICILLIN/CLAV (AUGMENTIN) TAB 500/125

J8499

($

4.00)

PROMETHAZINE (PHENERGAN) TAB 25MG

J8499

($

4.00)

PRAVASTATIN (PRAVACHOL)TAB 10MG

J8499

($

4.00)

ATENOLOL (TENORMIN) TAB 100MG

J8499

($

4.00)

CARBIDOPA/LEV (SINEMET) TAB 25/100MG

J8499

($

4.00)

PENTOXIFYLLINE ER (TRENTAL)TAB 400MG

J8499

($

4.00)

LISINOPRIL (PRINIVIL) TAB 10MG

J8499

($

4.00)

WARFARIN(COUMADIN) TAB 1MG

J8499

($

4.00)

DEXAMETHASONE (DECADRON) TAB 0.5MG

J8499

($

4.00)

DICLOXACILLIN SOD (DYNAPEN) CAP 250MG

J8499

($

4.00)

ISOSORBIDE DINITRATE (ISORDIL) TAB 10MG

J8499

($

4.00)

SILDENAFIL CITRATE 20 MG

J8499

($

4.00)

VENLAFAXINE ER (EFFEXOR) TAB 75MG

J8499

($

4.00)

VALIUM (DIAZEPAM) TAB 2MG

J8499

($

4.00)

ENALAPRIL MALEATE(VASOTEC) TAB 10MG

J8499

($

4.00)

VERAPAMIL (CALAN) TAB 80MG

J8499

($

4.00)

LACTULOSE SOLUTION 10GM/15 ML

J8499

($

4.00)

PREDNISONE SOL 5 MG/5ML

J8499

($

4.00)

OMEPRAZOLE (PRILOSEC) CAP 20MG

J8499

($

4.00)

DICLOFENAC SODIUM DR (VOLTARAN) TAB 50MG

J8499

($

4.00)

SUCRALFATE (CARAFATE) TAB 1 GM

J8499

($

4.00)

DIVALPROEX DR (DEPAKOTE) TAB 250MG

J8499

($

4.00)

DILTIAZEM CD (CARDIZEM CD) CAP 240MG

J8499

($

4.00)

LOVASTATIN (MEVCOR)TAB 20MG

J8499

($

4.00)

SULFASALAZINE (AZULFIDINE)TAB: 500MG

J8499

($

4.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

ALLOPURINOL (ZYLOPRIM) TAB 100MG

J8499

($

4.00)

AMITRIPTYLINE HCL (ELAVIL) TAB 10MG

J8499

($

4.00)

AMITRIPTYLINE HCL (ELAVIL) TAB 25MG

J8499

($

4.00)

PRAZOSIN (MINIPRESS) CAP 2MG

J8499

($

4.00)

PEN V POTASSIUM TAB 500MG

J8499

($

4.00)

PRIMIDONE (MYSOLINE) TAB 250 MG

J8499

($

4.00)

MELOXICAM (MOBIC) TAB 7.5MG

J8499

($

4.00)

BUMETANIDE (BUMEX) TAB 2MG

J8499

($

4.00)

INDOMETHACIN (INDOCIN) CAP 50MG

J8499

($

4.00)

PROPRANOLOL HCL(INDERAL)TAB:80MG

J8499

($

4.00)

BENZTROPINE (COGENTIN) TAB 0.5MG

J8499

($

4.00)

MECLIZINE (ANTIVERT) TAB 12.5MG

J8499

($

4.00)

FLUCONAZOLE(DIFLUCAN) TAB 100MG

J8499

($

4.00)

DILTIAZEM CD (CARDIZEM) CAP 120MG

J8499

($

4.00)

ACETAMINOPHEN/CODEINE LIQ 120/12MG 5/ML

J8499

($

4.00)

FUROSEMIDE (LASIX) TAB 40MG

J8499

($

4.00)

SULFAMETHOXAZOLE/TMP(SEPTRA)TAB 400/80MG

J8499

($

4.00)

SULFAMETHOXAZOLE 800/TMP 160 TABLET

J8499

($

4.00)

METRONIDAZOLE (FLAGYL) TAB 250MG

J8499

($

4.00)

METOCLOPRAMIDE HCL (REGLAN) TAB 10 MG

J8499

($

4.00)

THIORIDAZINE HCL TAB: 25MG

J8499

($

4.00)

POTASSIUM CHL TAB 20 MEQ

J8499

($

4.00)

POTASSIUM CHL ER TAB 10 MEQ+

J8499

($

4.00)

RANITIDINE (ZANTAC) TAB 150MG

J8499

($

4.00)

FLUPHENAZINE HCL (PROLIXIN)TAB 2.5MG

J8499

($

4.00)

HALOPERIDOL (HALDOL) TAB 1MG

J8499

($

4.00)

KETOLORAC(TORADOL) TAB 10MG

J8499

($

4.00)

FEXOFENADINE HCL(ALLEGRA) TAB 60MG

J8499

($

4.00)

CITALOPRAM (CELEXA) TAB 20MG

J8499

($

4.00)

LOVASTATIN (MEVCOR)TAB 40MG

J8499

($

4.00)

NIFEDIPINE(PROCARDIA) CAP 10MG

J8499

($

4.00)

ACYCLOVIR (ZOVIRAX) TAB 400MG

J8499

($

4.00)

LEVOFLOXACIN(LEVAQUIN) TAB 250MG

J8499

($

4.00)

ESOMEPRAZOLE MAG(NEXIUM) CAP 20MG

J8499

($

4.00)

FLUCONAZOLE (DIFLUCAN) TAB 150MG

J8499

($

4.00)

ESCITALOPRAM(LEXAPRO)TAB 10MG

J8499

($

4.00)

HYDROCODONE ACETAMINOPHEN TAB 5/325MG

J8499

($

4.00)

NIACIN ER TAB 250MG

J8499

($

4.00)

LEVETIRACETAM ER (KEPPRA) TAB 500MG

J8499

($

4.00)

CEPHALEXIN (KEFLEX) CAP 500MG

J8499

($

4.00)

METFORMIN (GLUCOPHAGE) TAB 500MG

J8499

($

4.00)

GLYBURIDE (DIABETA)(MICRONASE) TAB 5MG

J8499

($

4.00)

PHENYTOIN CHEW TAB 50MG

J8499

($

4.00)

OXYCODONE/APAP (PERCOCET) TAB 5/325MG

J8499

($

4.00)

RELAFEN (NABUMETONE) TAB: 500MG

J8499

($

4.00)

SODIUM BICARBONATE 650MG TAB

J8499

($

4.00)

PROPRANOLOL HCL (INDERAL) TAB 20MG

J8499

($

4.00)

CARBAMAZEPINE(TEGRETOL)CHEW TAB 100MG

J8499

($

4.00)

PRAVACHOL (PRAVASTATIN) TAB 20MG

J8499

($

4.00)

WARFARIN (COUMADIN) TAB 5MG

J8499

($

4.00)

MECLIZINE (ANTIVERT) TAB 25MG

J8499

($

4.00)

BENZONATATE (TESSALON) CAP 100MG

J8499

($

4.00)

AMLODIPINE (NORVASC) TAB 5MG

J8499

($

4.00)

PEN VK (PENICILLIN V POTASSIUM)TAB 250MG

J8499

($

4.00)

LISINOPRIL (PRINIVIL) TAB 40MG

J8499

($

4.00)

BUSPIRONE HCL (BUSPAR) TAB 10MG

J8499

($

4.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

METOPROLOL SUC ER (TOPROL XL) TAB 50MG

J8499

($

4.00)

NIFEDIPINE XL (PROCARDIA) TAB 30MG

J8499

($

4.00)

SODIUM BICARB/SOD. CIT. GRANULES 500GM

J8499

($

4.00)

OXYCODONE HCL TAB 10 MG

J8499

($

4.00)

SERTRALINE (ZOLOFT) TAB 50MG

J8499

($

4.00)

AMIODARONE HCL (PACERONE) TAB 200MG

J8499

($

4.00)

TRAMADOL (ULTRAM) TAB 50MG

J8499

($

4.00)

ALLOPURINOL (ZYLOPRIM) TAB 300MG

J8499

($

4.00)

IBUPROFEN (MOTRIN) TAB 800MG

J8499

($

4.00)

VERAPAMIL ER (CALAN) TAB 240MG

J8499

($

4.00)

CLONIDINE HCL (CATAPRES) TAB 0.1MG

J8499

($

4.00)

HYDROXYZINE HCL (VISTARIL) TAB 10MG

J8499

($

4.00)

GUIATUSS AC GUAIFEN/COD SYRUP

J8499

($

4.00)

CLOPIDOGREL BISULFATE(PLAVIX) TAB 75MG

J8499

($

4.00)

CARVEDILOL (COREG) TAB 12.5 MG

J8499

($

4.00)

GLIMEPIRIDE (AMARYL) TAB 2MG

J8499

($

4.00)

LEVETIRACETAM (KEPPRA) TAB 500MG

J8499

($

4.00)

SERTRALINE (ZOLOFT) TAB 25MG

J8499

($

4.00)

PRAMIPEXOLE DI-HCL(MIRAPEX) TAB 0.5 MG

J8499

($

4.00)

MONTELUKAST SOD(SINGULAIR MON) TAB 10MG

J8499

($

4.00)

ISOSORBIDE MONON ER (IMDUR) TAB 30MG

J8499

($

4.00)

QUETIAPINE FUMARATE TAB 25 MG UD

J8499

($

4.00)

MEPROBAMATE TAB 400MG

J8499

($

4.00)

AMPICILLIN CAP 250MG

J8499

($

4.00)

PANTOPRAZOLE (PROTONIX) TAB 40MG

J8499

($

4.00)

PANTOPRAZOLE (PROTONIX) TAB 20MG

J8499

($

4.00)

METOPROLOL TART (LOPRESSOR) TAB 25MG

J8499

($

4.00)

RIFAMPIN CAPS 300MG

J8499

($

4.00)

THYROID (ARMOUR THYROID) 120MG TAB

J8499

($

4.00)

FUROSEMIDE (LASIX) TAB 20MG

J8499

($

4.00)

PAROXETINE (PAXIL) TAB 10MG

J8499

($

4.00)

QUINAPRIL (ACCUPRIL) TAB 20 MG

J8499

($

4.00)

CILOSTAZOL(PLETAL) TAB 100 MG

J8499

($

4.00)

CEFUROXIME (CEFTIN)(AXETIL) TAB 500MG

J8499

($

4.00)

VENLAFAXINE (EFFEXOR) TAB 37.5 MG

J8499

($

4.00)

CLOTRIMAZOLE TROCHE (LOZENGE) 10MG

J8499

($

4.00)

DOXAZOSIN MESYLATE (CARDURA) TAB 1MG

J8499

($

4.00)

BACLOFEN (LIORESAL) TAB 10MG

J8499

($

4.00)

METHOCARBAMOL (ROBAXIN) TAB 500MG

J8499

($

4.00)

OXYCODONE HCL TAB 5MG

J8499

($

4.00)

LOSARTAN/HCTZ(HYZAAR)TAB 50/12.5MG

J8499

($

4.00)

ISOSORBIDE MON ER (IMDUR) TAB 60MG

J8499

($

4.00)

LISINOPRIL (PRINIVIL) TAB 5MG

J8499

($

4.00)

MIDODRINE HCL 5MG

J8499

($

4.00)

BUPROPION (WELLBUTRIN) TAB 75MG

J8499

($

4.00)

DULOXETINE HCL DR(CYMBALTA) CAP 60MG

J8499

($

4.00)

GLIPIZIDE (GLUCOTROL) TAB 5MG

J8499

($

4.00)

TERAZOSIN (HYTRIN) CAP 1MG

J8499

($

4.00)

MIRTAZEPINE (REMERON) TAB 15MG

J8499

($

4.00)

TEMAZEPAM CAP: 15MG

J8499

($

4.00)

BUPROPION ER(WELLBUTRIN) TAB 150MG

J8499

($

4.00)

LEVOFLOXACIN(LEVAQUIN) TAB 500MG

J8499

($

4.00)

LABETALOL HCL (TRANDATE)TAB 100MG

J8499

($

4.00)

GABAPENTIN (NEURONTIN) CAP 300MG

J8499

($

4.00)

TOPIRAMATE TAB 100MG

J8499

($

4.00)

SULFA/TRIMETH (SEPTRA) SUSP 200/40 5ml

J8499

($

4.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

TAMSULOSIN (FLOMAX) CAP 0.4MG

J8499

($

4.00)

RISPERIDONE (RISPERDAL) TAB 0.5 MG

J8499

($

4.00)

LOSARTAN POTASSIUM (COZAAR) TAB 50MG

J8499

($

4.00)

METOPROLOL (TOPROL XL) TAB 25MG

J8499

($

4.00)

TRAZODONE HCL TAB 100MG

J8499

($

4.00)

CETIRIZINE (ZYRTEC) TAB 10 MG

J8499

($

4.00)

ATENOLOL TAB 25MG

J8499

($

4.00)

BUPROPION (WELLBUTRIN) XL TAB 300MG

J8499

($

4.00)

CIPROFLOXACIN (CIPRO) TAB 500MG

J8499

($

4.00)

HYDRALAZINE HCL (APRESOLINE)TAB 100MG

J8499

($

4.00)

ATORVASTATIN (LIPITOR) TAB 10MG

J8499

($

4.00)

GABAPENTIN (NEURONTIN) CAP 100MG

J8499

($

4.00)

HYDRALAZINE HCL (APRESOLINE)TAB 10MG

J8499

($

4.00)

LISINOPRIL (PRINIVIL) TAB 20MG

J8499

($

4.00)

RISPERIDONE (RISPERDAL) TAB 1 MG

J8499

($

4.00)

SPIRONOLACTONE (ALDACTONE) TAB 25 MG

J8499

($

4.00)

LEVETIRACETAM (KEPPRA) SOL 100MG/ML

J8499

($

4.00)

IMIPRAMINE TAB 25MG

J8499

($

4.00)

GEMFIBROZIL (LOPID) TAB 600MG

J8499

($

4.00)

DONEPEZIL HCL(ARICEPT)TAB 5MG

J8499

($

4.00)

AMOXICILLIN (TRIMOX) CAP 500MG

J8499

($

4.00)

CEPHALEXIN (KEFLEX) CAP 250MG

J8499

($

4.00)

LOSARTAN POTASSIUM (COZAAR) TAB 25MG

J8499

($

4.00)

HYDROCHLOROTHIAZIDE (HCTZ) TAB 25MG

J8499

($

4.00)

DONEPEZIL HCL(ARICEPT) TAB 10MG

J8499

($

4.00)

TRAZODONE HCL TAB 50MG

J8499

($

4.00)

SIMVASTATIN (ZOCOR) TAB 10MG

J8499

($

4.00)

PREDNISONE TAB 10MG

J8499

($

4.00)

ZOLPIDEM (AMBIEN) TAB 5MG

J8499

($

4.00)

FLUOXETINE HCL(PROZAC) CAP 10MG

J8499

($

4.00)

OLANZAPINE (ZYPREXA) TAB 5MG

J8499

($

4.00)

PREDNISOLONE ORAL SOLUTION 15MG/5ML

J8499

($

4.00)

IPRATROPIUM (ATROVENT) 0.02% NEB

J7644

($

4.00)

DUONEB 3ML

J7644

($

4.00)

VENTOLIN (ALBUTEROL) NEB 2.5MG/3ML

J7613

($

4.00)

ACETYLCYSTEINE (MUCOMYST) 20% NEBULIZER

J7608

($

4.00)

FLUOR-I-STRIP FLUORESCEIN SODIUM

J3490

($

4.00)

PROPARACAINE HCL 0.5% OPTH DROP

J3490

($

4.00)

PREDNISONE TAB 5MG

J3490

($

4.00)

CYCLOPENTOLATE OPTH (CYCLOGYL) 2%

J3490

($

4.00)

FERRIC SUBSULFATE AQUEOUS

J3490

($

4.00)

BETADINE OINT 1/32 OZ

J3490

($

4.00)

SODIUM CHLOR 3 ML NEB 0.9%

J3490

($

4.00)

ACIDOPHILUS

J3490

($

4.00)

SILVER NITRATE STICKS BTL

J3490

($

4.00)

NITROGLYCERIN PATCH 0.4 MG/HR

J3490

($

4.00)

NITROGLYCERIN PATCH 0.2 MG/HR

J3490

($

4.00)

CLINDAMYCIN HCL (CLEOCIN) CAP 150MG

J3490

($

4.00)

SIMETHICONE CHEW TAB 80 MG

J3490

($

4.00)

FERROUS SULFATE SYRUP BTL 220MG/5ML

J3490

($

4.00)

LIDOCAINE (XYLOCAINE) VISCOUS 2%

J3490

($

4.00)

PREDNISONE TAB 1MG

J3490

($

4.00)

HYDROCORTISONE ACETATE (ANUSOL)SUPP:25MG

J3490

($

4.00)

CIMETIDINE (TAGAMET) TAB 200MG

A9270

($

4.00)

ZZZCALCARB (CALCIUM CARBONATE)TAB 1250MG

A9270

($

4.00)

BAKING SODA TSP.

A9270

($

4.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

VITAMIN PRENATAL

A9153

($

4.00)

MULTI VITAMIN LIQUID

A9153

($

4.00)

VITAMIN THERAPY M

A9153

($

4.00)

MULTIVITAMIN CHEWABLE TAB

A9153

($

4.00)

MULTIVITAMIN TAB

A9153

($

4.00)

MULTIVITAMIN/MINERAL (THERA-M) TAB

A9153

($

4.00)

MULTIVITAMIN W/IRON TAB

A9153

($

4.00)

VITAMIN B-12 TAB 1000 MCG

A9152

($

4.00)

VITAMIN D-3 TAB 1000 IU

A9152

($

4.00)

VIT B-6 (PYRIDOXINE HCL) TAB:100MG

A9152

($

4.00)

VITAMIN D TAB 400 IU

A9152

($

4.00)

VITAMIN A CAP 10,000 IU

A9152

($

4.00)

VITAMIN K TAB 100MCG

A9152

($

4.00)

VITAMIN D3 TAB 2000 IU

A9152

($

4.00)

VITAMIN B-1 (THIAMINE HCL) TAB 100MG

A9152

($

4.00)

VITAMIN D LIQUID 1000 IU

A9152

($

4.00)

VITAMIN B 6 (PYRIDOXINE) TAB 100MG

A9152

($

4.00)

VIT C ASCORBIC ACID CAPS:500MG

A9152

($

4.00)

VITAMIN E CAP 400 IU

A9152

($

4.00)

VITAMIN D-3 TAB 5000 IU

A9152

($

4.00)

VITAMIN C (ASCORBIC ACID) TAB 500MG

A9150

($

4.00)

DIPHENHYDRAMINE (BENADRYL) CAP 25MG

A9150

($

4.00)

BISACODYL SUPPOSITORY 10MG

A9150

($

4.00)

ASPIRIN TAB (WHITE) 325 MG

A9150

($

4.00)

SENNA LAX TAB 8.6 MG

A9150

($

4.00)

ACETAMINOPHEN (TYLENOL) SUPP 325MG

A9150

($

4.00)

DOCUSATE SODIUM (COLACE) CAP 100MG

A9150

($

4.00)

ACETAMINOPHEN (TYLENOL) SUPP 650MG

A9150

($

4.00)

ACETAMINOPHEN (TYLENOL) SUPP 120MG

A9150

($

4.00)

GLYCERIN PED (SANI)SUPP

A9150

($

4.00)

GLYCERIN (SANI-SUPP) ADULT SUPPOSITORY

A9150

($

4.00)

FAMOTIDINE (PEPCID) TAB 20MG

A9150

($

4.00)

METAMUCIL POWDER (PSYLLIUM POWDER)

A9150

($

4.00)

MIRALAX POWDER

A9150

($

4.00)

ALMACONE 200-200-20

A9150

($

4.00)

SENNOSIDES/DOCUSOD TAB

A9150

($

4.00)

ROBITUSSIN/AC (GUIATUSS)100-10MG/5ML dos

A9150

($

4.00)

PREPARATION H WIPES

A9150

($

4.00)

ACETAMINOPHEN LIQUID 500MG/15ML

A9150

($

4.00)

MILK OF MAG *CONCENTRATE* 400ML

A9150

($

4.00)

MILK OF MAGNESIUM CONC 100ML

A9150

($

4.00)

TUMS (CALCIUM CARBONATE) TAB 1000MG

A9150

($

4.00)

FIBER-LAX (FIBERCON) TABLET

A9150

($

4.00)

DOCUSATE SOD(DIALOSE)SOLN 60MG15ML

A9150

($

4.00)

LOPERAMIDE HCL(IMODIUM)TAB 2MG

A9150

($

4.00)

NAPROXEN (ALEVE) TAB 500 MG

A9150

($

4.00)

PEPTO-BISMOL LIQUID

A9150

($

4.00)

TUMS (CALCIUM CARBONATE) TAB 500MG

A9150

($

4.00)

MILK OF MAGNESIA 30ML

A9150

($

4.00)

IBUPROFEN (MOTRIN) TAB 600MG

A9150

($

4.00)

ASPIRIN TAB CHEWABLE 81MG

A9150

($

4.00)

DOCUSATE CALCIUM CAP 240MG

A9150

($

4.00)

ASPIRIN EC TAB 81MG

A9150

($

4.00)

RASPBERRY SYRUP

A9150

($

4.00)

PSEUDOEPHEDRINE HCL (SUDAFED) TAB 30 MG

A9150

($

4.00)

CEPASTAT LOZENGE

A9150

($

4.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

OXYMETAZOLINE (AFRIN) NASAL SPRAY

A9150


($

4.00)

FISH OIL CAP 1000 MG

A9150


($

4.00)

ASPIRIN EC TAB 325MG

A9150


($

4.00)

FERROUS SULFATE TAB 325MG

A9150


($

4.00)

ACETAMINOPHEN (TYLENOL) TAB 325MG

A9150


($

4.00)

ACETAMINOPHEN (TYLENOL) CHEW TAB 80MG

A9150


($

4.00)

ACETAMINOPHEN ES (TYLENOL GELCAP) 500MG

A9150


($

4.00)

ACETAMINOPHEN ES 500MG

A9150


($

4.00)

GUAIFENESIN LIQ 100MG/5ML

A9150


($

4.00)

IBUPROFEN CHILD SUSP 100MG/5ML

A9150


($

4.00)

TUMS (CALCIUM CARBONATE) TAB 750MG

A9150


($

4.00)

MAGNESIUM OXIDE TAB 400 MG

A9150


($

4.00)

SIMETHICONE LIQ 40 MG/0.6ML

A9150


($

4.00)

CALCIUM 600MG WITH VIT D 400 TABLET

A9150


($

4.00)

NAPROXEN SODIUM (ALEVE) GELCAP 220 MG

A9150


($

4.00)

DIPHENHYDRAMINE(BENADRYL) LIQ 12.5MG/5ML

A9150


($

4.00)

DOCUSATE SOD (DIOCTO) SOL 50MG/5ML

A9150


($

4.00)

ZINC SULFATE TAB 220MG

A9150


($

4.00)

ACETAMINOPHEN TR 650 MG TAB

A9150


($

4.00)

MELATONIN 3MG

A9150


($

4.00)

MELATONIN 5MG

A9150


($

4.00)

FERROUS GLUCONATE TAB 324MG

A9150


($

4.00)

ACETAMINOPHEN SUSP 160MG/5ML

A9150


($

4.00)

IBUPROFEN (MOTRIN) TAB 200MG

A9150


($

4.00)

BISACODYL (DULCOLAX) TAB 5MG

A9150


($

4.00)

COUGH DROPS

A9150


($

4.00)

SENNA PLUS (WITH DOCUSATE) TAB 8.6/50MG

A9150


($

4.00)

TYLENOL ES TAB 500MG

A9150


($

4.00)

OS-CAL 500 CALCIUM CARBONATE TAB 500MG

A9150


($

4.00)

GLUCOSAMINE/CHONDROITIN CAP 500/400 MG

A9150


($

4.00)

LORATADINE (CLARITIN) TAB 10MG

A9150


($

4.00)

CALCIUM SUPPLEMENT(CARBONATE)TAB 600MG

A9150


($

4.00)

MILK OF MAGNESIA 400MG/5ML

A9150


($

4.00)

MELATONIN TABLET, DISINTEGRATING 3MG

A9150


($

4.00)

BACITRACIN OINT 500U/GM 1/32 OZ

A6250


($

4.00)

NEOSPORIN 1/32 OZ PK TOPICAL

A6250


($

4.00)

ROSUVASTATIN CALCIUM(CRESTOR) TAB 20MG



($

4.00)

OCUSOFT LID SCRUB EYELID CLEANSER PAD



($

4.00)

NP THYROID ORAL TABLET 90MG



($

4.00)

THERMOTABS ORAL TABLET 287MG-180MG-15MG



($

4.00)

FLUDROCORTISONE ACETATE AVPAK TAB 0.1MG



($

4.00)

CARBIDOPA AND LEVODOPA TAB ER 50MG-200MG



($

4.00)

AZO CRANBERRY ORAL GEL CAP 250MG-60MG



($

4.00)

HYDRALAZINE HCL TABLET 25MG



($

4.00)

GLUCERNA 100ML :1UNIT

B4150


($

4.00)

BOOST PUDDING CHOC 150ML

B4150


($

4.00)

BOOST PUDDING VANILLA 150ML

B4150


($

4.00)

AMANTADINE HCL TAB 100MG

J8499


($

4.33)

LANOXIN TAB 0.125MG

J8499


($

4.67)

HALOPERIDOL (HALDOL) TAB 5MG

J8499


($

4.67)

CLARITHROMYCIN (BIAXIN) TAB 250MG

J8499


($

4.67)

LANSOPRAZOLE (PREVACID) CAP 30MG

J8499


($

4.67)

DEXTROMETHORPHAN/GUAIFENSIN SYRUP

A9150


($

4.75)

MOLECULE NUCLEIC AMPLI 2 SEQ


83900

($

5.00)

VASELINE GAUZE PACKING STRIP

A6266


($

5.00)

DRESSING KERLIX 6

A6206


($

5.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

ARM BOARD CHIEF

A4649

($

5.00)

VENI-GUARD DRESSING

A4649

($

5.00)

NEEDLE LOCK DEVICE

A4649

($

5.00)

EXTENSION TUBE

A4222

($

5.00)

NEEDLE SPINAL 20X6 DO NOT USE

A4215

($

5.00)

TUBE GAUZE 5/8 1FT SIZE 1


($

5.00)

TUBE GAUZE 1/2 1FT


($

5.00)

TUBE GAUZE 7.8


($

5.00)

CATHETER PLUG


($

5.00)

TUBE GAUZE 1 1/2 1 FT SIZE 34


($

5.00)

COLD PACK PERI-K


($

5.00)

DRESSINET 6 1FT

A6208

($

5.00)

ELECTRODE MONITOR ADULT


($

5.00)

VASELINE LIP THERAPY


($

5.00)

CAST PADDING 2


($

5.00)

PILL MEDTIME PLANNER


($

5.00)

ZIDOVUDINE(RETROVIR) TAB 100MG

S0104

($

5.00)

PREMARIN CONJUGATED ESTROGEN TAB: 0.3MG

J8499

($

5.00)

SELEGILINE HCL (ELDEPRYL) TAB 5MG

J8499

($

5.00)

GALANTAMINE (RAZADYNE) TAB 4MG

J8499

($

5.00)

VALACYCLOVIR HCL (30) TAB 500MG

J8499

($

5.00)

NITROFURANTOIN (MACRODANTIN) CAPS 50 MG

J8499

($

5.00)

CROMOLYN SOD(INTAL)AMP 10 MG/ML UD 2ML

J7631

($

5.00)

RACEPINEPHRINE INH 2.25% AMP INH SOL

J3535

($

5.00)

NITROGLYCERIN OINT (NITRO-BID) 2%

J3490

($

5.00)

NICOTINE PATCH 21MG/24HR

J3490

($

5.00)

DRY EYES(TETRAHYDROZOLINE HCL) OPTH

J3490

($

5.00)

AURODEX OTIC 5.4-1.4 15ML

A9150

($

5.00)

MASSENGILL DOUCHE

A9150

($

5.00)

MAGNESIUM CITRATE SOLUTION BOTTLE

A9150

($

5.00)

ASPIRIN SUPP 300MG

A9150

($

5.00)

HYDROCORTISONE CREAM 1% 1OZ

A6250

($

5.00)

TRIAMCINOLONE CREAM 1% 80 GM

A6250

($

5.00)

MEDROXYPROGESTERONE ACETATE 10MG


($

5.00)

BOOST VHC 237ML

B4150

($

5.00)

MEGESTROL ACET SUSP 400MG/10ML

S0179

($

5.33)

CEFUROXIME (CEFTIN) TAB 250MG

J8499

($

5.33)

PHENAZOPYRIDINE (PYRIDIUM) TAB 100MG

J8499

($

5.33)

OCEAN NASAL DROPS SOD CHL SPRAY 0.65%

A9150

($

5.50)

TRIAMCINOLONE CREAM 0.1% 15 GM

A6250

($

5.67)

NEPRO CAN VANILLA

B4150

($

6.00)

ENSURE CAN VANILLA

B4150

($

6.00)

OPTISOURCE CARMEL

B4150

($

6.00)

OPTISOURCE STRAWBERRY

B4150

($

6.00)

PARAFFIN WAX

A4265

($

6.00)

DRESSING KERLIX SPECIALTY

A6251

($

6.00)

SUTURE 4-0 FS-2 ANTIBACTERIAL

A4649

($

6.00)

QUICK CATH 20 G

A4222

($

6.00)

NEBULIZER MEDICATION DELIVERY DISPOSABLE

A7004

($

6.00)

EYE SHIELD ALUM

A6412

($

6.00)

CAST PADDING 3


($

6.00)

STOCKINET 3


($

6.00)

O2 MASK NON-REBREATHING


($

6.00)

MASK NEBULIZER INFANT TURTLE


($

6.00)

CHLORTHALIDONE TAB 25MG

J8499

($

6.00)

SUMATRIPTAN (IMITREX) TAB 50 MG

J8499

($

6.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

TERBUTALINE (BRETHINE) SULF TAB 5MG

J8499


($

6.00)

PREGABALIN (LYRICA) CAP 25MG

J8499


($

6.00)

PIROXICAM CAP 20MG

J8499


($

6.00)

PREMARIN CONJUGATED ESTROGEN TAB:0.625MG

J8499


($

6.00)

ACETAZOLAMIDE TAB 250MG

J8499


($

6.00)

NADOLOL(CORGARD) TAB 20MG

J8499


($

6.00)

LEVALBUTEROL 1.25MG/3ML NEB

J7644


($

6.00)

BRIMONIDINE(ALPHAGAN OPTH DROPS .2%:5ML

J3490


($

6.00)

NICOTINE PATCH 7MG/24HR

A9150


($

6.00)

FLEETS ENEMA PED.

A9150


($

6.00)

TEARISOL (TEARS NATURAL)OPTH DROPS 15CC

A9150


($

6.00)

EAR WAX DROPS 6.5%

A9150


($

6.00)

PEDIALYTE (ELECTROLYTE) POWDER

A9150


($

6.00)

PAD SCRIPT



($

6.00)

VALSARTAN(DIOVAN)TAB 40MG

J8499


($

6.67)

NEOSPORIN(TRIPLE ANTIBIOTIC)OINT 15GM

A6250


($

6.75)

*MUTATION ID BY ENZYMATIC LIGATION SING


83914

($

7.00)

INTERPRETATION AND REPORT


83912

($

7.00)

*SEPARATION IDENTIFICATION BY HI RESOL


83909

($

7.00)

*MUTATION IDENTIFICATION BY SEQ SINGLE


83904

($

7.00)

^^AMPLIFICATION TARGET EA NUCLEIC ACID


83898

($

7.00)

*NUCLEIC ACID PROBE EA


83896

($

7.00)

ISOLATION OR EXTR OF HI PURIFIED NEUC AC


83891

($

7.00)

KANGAROO FEEDING BAG PUMP SET

B4035


($

7.00)

TOUCH CONTROL SOLUTION

A4256


($

7.00)

TAPE TRAINERS 1 IN



($

7.00)

SPLINT FINGER ALUM STRIP SM

L3999


($

7.00)

CATHETER EXTERNAL MED

A4349


($

7.00)

CATHETER COUDE 18FR

A4340


($

7.00)

CATHETER EXTERNAL



($

7.00)

VACURETTE 9 MM



($

7.00)

VELCRO LOOP 1 FT

A9900


($

7.00)

FLEET ENEMA (MINERAL OIL)

A9150


($

7.00)

ELASTIC BANDAGE 3

A6449


($

7.00)

COLD PACK



($

7.00)

NEBULIZER SET W/T



($

7.00)

DRESSINET SIZE 11 TUBE GAUZE 1YARD



($

7.00)

MASK N95



($

7.00)

STOCKINET 4



($

7.00)

PILL SPLITTER



($

7.00)

SCALPEL SAFETY #11



($

7.00)

OXYCONTIN (OXYCODONE CR) TAB 10 MG

J8499


($

7.00)

PACERONE(AMIODARONE)TAB: 100MG

J8499


($

7.00)

METOLAZONE TAB 5MG

J8499


($

7.00)

NITROFURANTOIN MONOH ER(2XDay) CAP100 MG

J8499


($

7.00)

LAMIVUDINE (EPIVIR) TAB 150MG

J8499


($

7.00)

MEPERIDINE HCL (DEMEROL) TAB 50MG

J8499


($

7.00)

HYDROCORTISONE (ANUSOL HC) SUPP 25MG

A9150


($

7.00)

EPSON SALT

A9150


($

7.00)

ZINC OXIDE OINTMENT TOPICAL 40%

A6250


($

7.00)

RALOXIFENE(EVISTA) TAB 60 MG

J8499


($

7.33)

THERABAND LEVEL 2 /ORANGE

A9300


($

7.50)

NICOTINE PATCH 14MG/24HR

J3490


($

7.67)

MINERAL OIL BOTTLE 16OZ

A9150


($

7.75)

MOLECULE NECLEIC TRANSFER


83897

($

8.00)

SPLINT FINGER FROG LG

L3933


($

8.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

SPLINT FINGER FROG MED

A4570

($

8.00)

HUMIDIFIER CONCENTRATOR

E0555

($

8.00)

ENDOTRACHEAL TUBE 3.0

E0485

($

8.00)

ENDOTRACHEAL TUBE 2.0

E0485

($

8.00)

COBAN 3IN

A6454

($

8.00)

SUTURE VICRYL 5-0 C-3 J385H

A4649

($

8.00)

TIP BLUNT HYFRECATOR

A4649

($

8.00)

SALEM SUMP TUBE 10FR


($

8.00)

SALEM SUMP TUBE 18FR


($

8.00)

FEEDING TUBE 5FR INFANT


($

8.00)

TUBE GAUZE 1 1FT


($

8.00)

SALEM SUMP TUBE 14FR W/VALVE


($

8.00)

NACL IRRIGATION 1000ML


($

8.00)

BARRIER WITH FLANGE


($

8.00)

THERABAND ALL LEVELS PER YARD

A9300

($

8.00)

THERABAND LEVEL 1 /PEACH

A9300

($

8.00)

O2 TUBING 30 FT

A4616

($

8.00)

ICE PACKS


($

8.00)

TEMPERATURE SENSOR


($

8.00)

DATASCOPE BANDAGE N


($

8.00)

CAST PADDING 4


($

8.00)

DENTEMP ORAL HYGIENE ACCESSORY


($

8.00)

PENICILLIN V POT SOL 125MG/5ML 100ML

J8499

($

8.00)

AMOXICILLIN SUSP 250MG/5 ML 150ML BTL

J8499

($

8.00)

LIDOCAINE JELLY 2 % PER TUBE

J3490

($

8.00)

HYDROCORTISONE 2.5% CR (HYTONE)

A6250

($

8.00)

MEMANTINE TAB 5MG

J8499

($

8.67)

CELEBREX (CELECOXIB) CAP 100MG

J8499

($

8.67)

MUCUS SPEC TRAP 40 CC

S8210

($

9.00)

ENDOTRACHEAL TUBE UNCUFF 3.0

E0485

($

9.00)

DRESSING TEGADERM 4 X 10

A6252

($

9.00)

PENROSE DRAIN 1/2 STERILE

A4649

($

9.00)

STOMAHESIVE WAFER 1 1/2 INCH

A4373

($

9.00)

IV PUMP SECONDARY BLOOD SET DON'T USE

A4305

($

9.00)

NEEDLE SPINAL 22GX31/2 DO NOT USE

A4215

($

9.00)

DRAPE STERILE SMALL


($

9.00)

V L NEEDLE ELECTRODE


($

9.00)

DRESSING XEROFROM 2X2


($

9.00)

THERABAND LEVEL 3 /GREEN

A9300

($

9.00)

ARM BOARD (WHITE)

A4649

($

9.00)

SUCTION CANISTER SMALL


($

9.00)

O2 TUBING 25 FT


($

9.00)

PLASTER PARIS 2 INCH


($

9.00)

AMOXICILLIN SUSP 125MG/5ML 150MLPER BTL

J8499

($

9.00)

KAYEXALATE(SOD POLYSTYRENE SULF)

J8499

($

9.00)

AMOX/CLAV (AUGMENTIN) TAB 250/125MG

J8499

($

9.00)

CARBAMAZEPINE ER(TEGRETOL) TAB 200MG

J8499

($

9.00)

ASPERCREME 10% 1.25OZ

J3490

($

9.00)

FENTANYL TRANSDERM PATCH 50MCG

J3490

($

9.00)

A&D OINTMENT 113 GM

A6250

($

9.00)

TRIAMCINOLONE ACETONIDE OINT. 0.1% 15 GM

A6250

($

9.00)

TRIAMCINOLONE 0.25 OINT 15 GM

A6250

($

9.00)

BOX BIO-HAZARD


($

9.00)

PENICILLIN V POT SOL 250MG/5ML

J8499

($

9.33)

SIGNANEL GEL

A4558

($

10.00)

M6 TANK REFILL


($

10.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

COBAN 4IN

A6454

($

10.00)

COFLEX 3IN CAMO

A6454

($

10.00)

COFLEX 1IN ASST

A6454

($

10.00)

COFLEX 3IN RAINBOW

A6454

($

10.00)

COFLEX 3IN ASST

A6454

($

10.00)

AIRSTRIP DRESSING 1848.25CM

A6258

($

10.00)

DRESSING SIMPURITY ALGINATE 2 X2

A6196

($

10.00)

MISC STERILE ITEMS

A4649

($

10.00)

INTRACATH

A4649

($

10.00)

SYRINGE EAR 1 OZ

A4320

($

10.00)

WATER IRRG 1000

A4217

($

10.00)

WATER IRRG 1500

A4217

($

10.00)

AMNIHOOK OB


($

10.00)

TOWEL STERILE DISPOSABLE


($

10.00)

HUMIDIFIER CONCENTRATOR BOTTLE


($

10.00)

UNDERPADS 10PK LG

T4541

($

10.00)

ELASTIC BANDAGE 6

A6450

($

10.00)

BILI LIGHT EYE PAD

A6411

($

10.00)

FINGER PROTECTOR MED

A4570

($

10.00)

DIAPERS NURSERY


($

10.00)

PACIFIER


($

10.00)

NEOSHADES


($

10.00)

AIRWAY BER 80 SM ADULT


($

10.00)

BETADINE SOLUTION 4 OZ


($

10.00)

PREGABALIN (LYRICA) CAP 50MG

J8499

($

10.00)

NADOLOL TAB 40MG

J8499

($

10.00)

CANDESARTAN (ATACAND)TAB 16MG

J8499

($

10.00)

DUTASTERIDE (AVODART) 0.5MG TAB

J8499

($

10.00)

CLOTRIMAZOLE CRM 1% 15GM

J3490

($

10.00)

LANOLIN (LANOLIN HYDROUS) TOP 1OZ TUBE

A6250

($

10.00)

MICONAZOLE CREAM 2% 30 GM

A6250

($

10.00)

SIGNANEL GEL

A4558

($

11.00)

SPLINT FINGER TIP STAX

L3999

($

11.00)

SPLINT FINGER ALUM STRIP MED

L3999

($

11.00)

TRACH MIST UNIT

S8189

($

11.00)

ENDOTRACHEAL TUBE 4.0

E0485

($

11.00)

ENDOTRACHEAL TUBE 4.5

E0485

($

11.00)

ENDOTRACHEAL TUBE 6.0

E0485

($

11.00)

ENDOTRACHEAL TUBE 7.0

E0485

($

11.00)

ENDOTRACHEAL TUBE 7.5

E0485

($

11.00)

ENDOTRACHEAL TUBE 8.0

E0485

($

11.00)

ENDOTRACHEAL TUBE 2.5

E0485

($

11.00)

ENDOTRACHEAL TUBE 3.5

E0485

($

11.00)

LAPAROTOMY SPONGE

A4649

($

11.00)

SUTURE SILK K832H SH

A4649

($

11.00)

HANDPIECE HYFRECATOR

A4649

($

11.00)

MICRO DRIP

A4649

($

11.00)

TRACH CARE KIT

A4625

($

11.00)

COLOSTOMY DRAINABLE POUCHES

A4377

($

11.00)

SYRINGE EAR 3 OZ

A4320

($

11.00)

INSYTE-N W24GA

A4222

($

11.00)

QUIK CATH 18G

A4222

($

11.00)

ENDOTRACHEAL TUBE 5.5


($

11.00)

ANESTHESIA MASK SM ADULT


($

11.00)

ENDOTRACHEAL TUBE 6.5


($

11.00)

ANESTHESIA FILTERS


($

11.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

EZ PREP 220


($

11.00)

ADSON TISSUE FORCEPS WITH TEETH


($

11.00)

ENDOTRACHEAL TUBE 8.5

E0485

($

11.00)

SAFETY SCREW SPIKE SET KANGAROO

B4035

($

11.00)

SUCTION BRUSH

A9900

($

11.00)

PUTTY EXCERISE TAN

A9300

($

11.00)

PUTTY EXCERISE YELLOW

A9300

($

11.00)

PUTTY EXCERISE RED

A9300

($

11.00)

PUTTY EXCERISE GREEN

A9300

($

11.00)

PUTTY EXCERISE BLUE

A9300

($

11.00)

THERABAND LEVEL 4 /BLUE

A9300

($

11.00)

ELASTOPLAST 1 IN

A6208

($

11.00)

DATASCOPE BANDAGE P


($

11.00)

DATASCOPE BANDAGE LA


($

11.00)

DATASCOPE BANDAGE A


($

11.00)

CAST COVER PLAIN


($

11.00)

SCALPEL SAFETY #15


($

11.00)

OXYCONTIN (OXYCODONE CR) TAB 20 MG

J8499

($

11.00)

LIDOCAINE/PRILOCAINE TUBE 2.5%/2.5%

J3490

($

11.00)

PROCTOZONE(HYDROCORT) SUPP : 25MG

J3490

($

11.00)

PEDIALYTE(ELECTROLYTE) LIQ 960ML

A9150

($

11.00)

ZZZ

A9150

($

11.00)

NAPHAZOLINE/PHENIR MAL OPTH 0.025-0.3%

A9150

($

11.00)

ADENOSINE (ADENOCARD) SDV 6MG/2ML

J0153

($

12.00)

AUDIOLOGY GROUP 100 OR MORE


($

12.00)

TANK REFILL SMALL 15-22 CU FT MU

E0443

($

12.00)

SPLINT FINGER ALUM STRIP LG

L3999

($

12.00)

ENDOTRACHEAL TUBE 5.0

E0485

($

12.00)

COFLEX 4IN CAMO

A6454

($

12.00)

NUGAUZE PLAIN 1/4

A6407

($

12.00)

AIRSTRIP DRESSING 26 X 8.25 CM

A6259

($

12.00)

NUGAUZE PLAIN 1/2

A6228

($

12.00)

DRAPE SMALL DO NOT USE-DUPLICATE

A4649

($

12.00)

SUTURE ETHILON 2-0 FS C-15

A4649

($

12.00)

SUTURE VICRYL 2-0 CT-1 NEEDLE

A4649

($

12.00)

SUTURE ETHILON 2-0 STRAIGHT NEEDLE

A4649

($

12.00)

SUTURE ETHIBOND X412H 0 W/CT-2 NEEDLE

A4649

($

12.00)

SUTURE VICRYL J351H

A4649

($

12.00)

SUTURE VICRYL 5-0 P-3

A4649

($

12.00)

STAPLE REMOVER

A4649

($

12.00)

INSYTE 20 GA

A4649

($

12.00)

CATHETER 30FR 30CC

A4338

($

12.00)

CATHETER FEMALE KIT

A4327

($

12.00)

INSYTE 22W GA

A4222

($

12.00)

INSYTE 14GA

A4222

($

12.00)

INJECTION SITE

A4222

($

12.00)

EXT/SET SMARTSITE

A4222

($

12.00)

INJECTION VALVE ULTRASITE ASPIRATION

A4222

($

12.00)

BREATHING BAG NON LATEX ADULT


($

12.00)

ANESTHESIA MASK INFANT


($

12.00)

ANESTHESIA MASK CHILD


($

12.00)

ANESTHESIA MASK ADULT LG


($

12.00)

ANESTHESIA MASK ADULT M


($

12.00)

PREP BASIN SMALL


($

12.00)

LR IRRIGATING SOLUTION


($

12.00)

ELASTIC BANDAGE 4

A6446

($

12.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

SCALPEL SAFETY #10



($

12.00)

LESCOL XL (FLUVASTATIN SODIUM) TAB 80MG

J8499


($

12.00)

DRONABINOL (MARINOL) CAP 2.5MG

J8499


($

12.00)

DIPHENHYDRAMINE CREAM 1%

A9150


($

12.00)

GLUTOSE DEXTROSE 15GM ORAL

A9150


($

12.00)

ZINC OXIDE OINT : 120GM

A6250


($

12.00)

LANTISEPTIC OINT 4.5OZ

A6250


($

12.00)

ZOSTRIX CREAM 0.025% 2OZ

A6250


($

12.00)

CALMOSEPTINE OINT 2.5 OZ

A6250


($

12.00)

IODOFORM 1/4 INCH

A6222


($

13.00)

MASTISOL LIQUID ADHESIVE

A4649


($

13.00)

INSYTE 16W GA

A4649


($

13.00)

IV MED 2 SET

A4305


($

13.00)

EXT/SET 60 LOW VOL 1.3ML 3WAY STOPCOCK

A4222


($

13.00)

NASOPHARYNGEAL AIRWAY 22FR



($

13.00)

WOUND IRRIGATOR



($

13.00)

RECTAL TUBE

E0352


($

13.00)

THERABAND LEVEL 5/PLUM

A9300


($

13.00)

THERMOMETER DISPOSABLE DIGITAL



($

13.00)

PLASTER PARIS 6 INCH



($

13.00)

LAUNDRI BACSTAT LIQ SOFT5GL



($

13.00)

SCALPEL SAFETY #12



($

13.00)

COLCHICINE(COLRYS) TAB 0.6 MG

J8499


($

13.00)

XXXRABEPRAZOLE SOD(ACIPHEX) TAB: 20MG

J8499


($

13.00)

SKELAXIN (METAXALONE) TAB: 800MG

J8499


($

13.00)

TEMAZEPAM CAP 7.5 MG

J8499


($

13.00)

POTASSIUM CHLORIDE SOLN 10% 20MEQ PO

J8499


($

13.00)

PROMETHAZINE(PHENADOZ)SUPP 12.5 MG

J8498


($

13.00)

GENTAMICIN OPTH SOLUTION 5 ML 0.3%

J3490


($

13.00)

MUPIROCIN(BACTROBAN)OINT 2% 22GM TUBE

J3490


($

13.00)

NUPERCAINAL (DIBUCAINE) TOPICAL

A9150


($

13.00)

BENGAY 2OZ

A6250


($

13.00)

ESOMEPRAZOLE MAG(NEXIUM) CAP 40MG

J8499


($

13.33)

SPLINT FINGER 1/2 IN

L3999


($

14.00)

VAG PACKING

A6407


($

14.00)

SUTURE SILK 683H

A4649


($

14.00)

SUTURE VICRYL 3-0 V393-A

A4649


($

14.00)

SUTURE ETHIBOND CX21T

A4649


($

14.00)

SUTURE PROLENE 8670H DC'D BY MANUFACTOR

A4649


($

14.00)

SUTURE ETHIBOND CX12T

A4649


($

14.00)

CATHETER COUDE 14FR SELF CATH

A4340


($

14.00)

CATHETER TRAY URETH

A4310


($

14.00)

TRACH TUBE CHANGE



($

14.00)

NASOGASTRIC SUMP TUBE 16FR



($

14.00)

ARM SLING TRIANGLE LG

A4565


($

14.00)

EAR IRRIGATION-EA



($

14.00)

COMFORT BATH



($

14.00)

THERMOMETER HYPOTHERMIA RECTAL/ESOPHAGEA



($

14.00)

*CHARGE ABG KIT



($

14.00)

LAMP 3.5 V HALOGEN



($

14.00)

NYSTATIN (NYSTOP) PWD 100,000U/GM

J8499


($

14.00)

LINDANE (PERMETHRIN)60ML LOTION

J3490


($

14.00)

LIDOCAINE (LIDODERM) PATCH 5%

J3490


($

14.33)

COBAN 6IN

A6455


($

14.75)

AUDIOLOGY SET UP FEE EA DAY



($

15.00)

GLUCOSE FINGER STICK


82948

($

15.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

SPLINT FINGER TIP SUPPT

L3999

($

15.00)

IODOFORM 1/2 INCH

A6266

($

15.00)

SUTURE VICRYL J219H 3-0 SH-1 CV-25

A4649

($

15.00)

SUTURE PROLENE 4-0 BB TAPER

A4649

($

15.00)

IV TUBING PRIMARY SET

A4222

($

15.00)

NEEDLE PORT-A-CATH 3/4 (GRIPPER MICRO)

A4222

($

15.00)

NEEDLE SPINAL 22X2 1/2 DO NOT USE

A4215

($

15.00)

ET TUBE HOLDER


($

15.00)

ESOPHAGEAL STETHOSCOPE 12FR DO NOT USE


($

15.00)

ESOPHAGEAL STETHOSCOPE 18FR DO NOT USE


($

15.00)

PREP BASIN LARGE


($

15.00)

SUTURE REMOVAL TRAY


($

15.00)

TRACHEOSTOMY MASK

A7525

($

15.00)

INSPIROMETER

A4649

($

15.00)

FEEDING TUBE 5FR


($

15.00)

OXYGEN PER HOUR


($

15.00)

INDINAVIR (CRIXIVAN) CAP 400MG

J8499

($

15.00)

FENTANYL TRANSDERM PATCH 75MCG

J3490

($

15.00)

DEBROX CARBAMIDE PERO OTIC 0.065 15ML

J3490

($

15.00)

FENTANYL TRANSDERM PATCH 100MCG

J3490

($

15.00)

CHLORASEPTIC SPRAY BTL PHENOL

A9150

($

15.00)

THERA-GESIC

A6250

($

15.00)

ACCU-CHEK INFORM II CONTROL H/L

A4256

($

15.25)

VARENICLINE(CHANTIX)TAB 0.5 MG

J8499

($

15.33)

FENTANYL TRANSDERM PATCH 25MCG

J3490

($

15.33)

CLOTRI BETAMETH DIP(LOTRISONE) CR 15GM

A6250

($

15.33)

CLINDAMYCIN (CLEOCIN) VIAL IM 600MG

J3490

($

16.00)

CEFUROXIME INJ 750MG SDV FOR IM

J0697

($

16.00)

SPLINT BASEBALL MED

L3999

($

16.00)

SPLINT BASEBALL LG

L3999

($

16.00)

DRESSING ALLEVYN 3X3

A6210

($

16.00)

DRESSING SIMPURITY SILVER ALGINATE2 X2

A6196

($

16.00)

SUTURE VICRYL J635H

A4649

($

16.00)

CATHETER URETH 14 FR WHISTLE TIP

A4344

($

16.00)

SUCTION CONNECTION TUBE 10 FT


($

16.00)

NACL IRRIGATION 500ML


($

16.00)

SUCTION CATHETER 5/6FR


($

16.00)

BLOOD PRESSURE CUFF CHILD

A4663

($

16.00)

BLOOD PRESSURE CUFF SM ADULT

A4663

($

16.00)

BLOOD PRESSURE CUFF ADULT

A4663

($

16.00)

BLOOD PRESSURE CUFF INFANT

A4663

($

16.00)

BLOOD PRESSURE CUFF SM INFANT

A4663

($

16.00)

PERI PADS 12/PK - PACK

A4649

($

16.00)

FINGER PROTECTOR METAL

A4570

($

16.00)

ARM SLING SM

A4565

($

16.00)

ARM SLING XSM

A4565

($

16.00)

ONE TOUCH GLUCOSE SOLUTION

A4256

($

16.00)

ONE TOUCH GLUCOSE SOLUTION

A4256

($

16.00)

BREAST SHIELD


($

16.00)

DOUCHE VAG


($

16.00)

FOLIC ACID FOR IV 50MG/10ML VIAL

J3490

($

16.00)

DILTIAZEM IV BOLUS 25MG/5ML

J3490

($

16.00)

PROPOFOL DRIP/PREMXI 10MG/ML(500MG/50ML)

J3490

($

16.00)

MAGNESIUM SULFATE IM VIAL : 1GM / 2ML

J3475

($

16.00)

OXYTOCIN (PITOCIN) INJ 10U/ML SDV FOR IM

J2590

($

16.00)

ZZZCEFTRIAXONE (ROCEPHIN) IV 1GM DELETED

J0696

($

16.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

RALTEGRAVIR(ISENTRESS) TAB 100MG

J8499

($

16.00)

NITROFURANTOIN (MACRODANTIN) CAP 25 MG

J8499

($

16.00)

PROPAFENONE SR(RYTHMOL) CAP 225 MG

J8499

($

16.00)

APIXABAN (ELIQUIS) 5MG TAB

J8499

($

16.00)

TRIAMCINOLONE ACETONIDE CRM 0.1% 30GM

A6250

($

16.00)

KETOCONAZOLE CREAM 30 GM: 2% TOP

A6250

($

16.00)

BUDESONIDE(PULMICORT) NEB 0.5MG/2ML

J7626

($

16.33)

ADULT EXTRA LG DIAPER/BRIEF 12

A4335

($

17.00)

SUTURE PROLENE 8832H SH V-20

A4649

($

17.00)

MONTGOMERY STRAPS DRESSING

A4461

($

17.00)

NEEDLE SPINAL 18GX3.5 DO NOT USE

A4215

($

17.00)

TUBE CHECK ESOPHAGEL INTUBATION


($

17.00)

SUCTION BRUSH DENTURE

A9900

($

17.00)

ELASTOPLAST 2 IN

A6208

($

17.00)

BLOOD PRESSURE CUFF SM CHILD

A4663

($

17.00)

ARM SLING MED

A4565

($

17.00)

ARM SLING LG

A4565

($

17.00)

ARM SLING X-LG

A4565

($

17.00)

TAPE SURGICAL FOAM

A4452

($

17.00)

COLOSTOMY PASTE 2OZ

A4405

($

17.00)

PRE-TENS SKIN PREP


($

17.00)

O2 MASK ELIMINATION


($

17.00)

COMFORT HAIR CARE


($

17.00)

AMBU BAG


($

17.00)

GLOVES MEDICAL VINAL LG


($

17.00)

MASK EARLOOP


($

17.00)

OLANZAPINE (ZYPREXA) TAB 10MG

J8499

($

17.00)

URSODIOL (ACTIGALL) CAP 300MG

J8499

($

17.00)

MUPIROCIN(BACTROBAN) OINT 2% TUBE 15GM

J3490

($

17.00)

AMBESOL 20% LIQUID

A9150

($

17.00)

ORAJEL(BENZOCAINE) LIQUID 20%

A9150

($

17.00)

SULFADIAZINE (THERMAZENE) CR 1% 25GM

A6250

($

17.00)

EZETIMIBE TAB 10MG

J8499

($

17.33)

VANCOCIN (VANCOMYCIN) CAP 125MG

J8499

($

17.33)

INDIVIDUAL OBSERVATION/HOUR


($

18.00)

PANTOPRAZOLE(PROTONIX)IV 40MG/VIAL

S0164

($

18.00)

FAMOTIDINE (PEPCID) INJ 20MG

S0028

($

18.00)

MARCAINE/EPI (BUPIVACAINE)INJ 0.25% 10ML

S0020

($

18.00)

METHOTREXATE SODIUM INJ:50MG

J9260

($

18.00)

FLUOROURACIL (ADRUCIL) 50MG/1ML10MLVIAL

J9190

($

18.00)

FLUOROURACIL (ADRUCIL) 50MG/1ML100MLVIAL

J9190

($

18.00)

DACARBAZINE 200MG VIAL

J9130

($

18.00)

AMINOCAPROIC ACID 1GM/4ML UP TO 5GM

J3490

($

18.00)

VECURONIUM: 10MG VIAL

J3490

($

18.00)

ETOMIDATE INJ 2 MG/ML

J3490

($

18.00)

CALCIUM CHLORIDE 10% SYRINGE 100 MG/1ML

J3490

($

18.00)

CLINDAMYCIN (CLEOCIN) VIAL FOR IV 600MG

J3490

($

18.00)

DILTIAZEM (CARDIZEM) HCL INJ 5MG/ML

J3490

($

18.00)

SODIUM CHLORIDE VIAL 30ML

J3490

($

18.00)

BACITRACIN INJ 50MU

J3490

($

18.00)

FOLIC ACID INJ 10ML VIAL 5MG/ML

J3490

($

18.00)

METOPROLOL TART 5MG/5ML VIAL

J3490

($

18.00)

MARCAIN/EPI INJ 0.5% 10ML 5MG/ML

J3490

($

18.00)

METRONIDAZOLE (FLAGYL) IV 500MG/100ML

J3490

($

18.00)

FLUMAZENIL(ROMAZICON) INJ 0.1MG/ML

J3490

($

18.00)

SODIUM CHLORIDE PF VIAL 10ML

J3490

($

18.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

WATER STERILE PF INJ 10ML

J3490

($

18.00)

VALPROATE SOD INJ 500 MG VIAL

J3490

($

18.00)

LABETALOL INJECTION 100MG VIAL

J3490

($

18.00)

LIDOCAINE 2% 5ML SYRINGE

J3490

($

18.00)

WATER STERILE BACT INJ 30ML

J3490

($

18.00)

TUBOCURARINE MDV 3MG 10ML

J3490

($

18.00)

SELENIUM INJ 40MCG/ML 10ML

J3490

($

18.00)

ZINC SULFATE INJ 25MG/5ML

J3490

($

18.00)

SODIUM BICARB/NEUT 4% SDV

J3490

($

18.00)

BUPIVACAINE-MFP .25% 10ML VIAL

J3490

($

18.00)

SODIUM BICARB (NEUT) 4% 5ML

J3490

($

18.00)

ROCURONIUM(ZEMURON) MDV 50MG VIAL

J3490

($

18.00)

PROPOFOL (DIPRIVAN) IVP 200MG/20ML VIAL

J3490

($

18.00)

ESMOLOL HCL(BREVIBLOC)INJ 100MG/10ML

J3490

($

18.00)

POTASSIUM CHLORIDE INJ PER 20MEQ

J3480

($

18.00)

POTASSIUM CHLORIDE INJ PER 10MEQ

J3480

($

18.00)

MAGNESIUM SO4 INJ 4GM/100ML PREMIX

J3475

($

18.00)

MAGNESIUM SO4 INJ 1GM/100ML PREMIX

J3475

($

18.00)

MAGNESIUM SULFATE IV VIAL 1GM/2ML

J3475

($

18.00)

MAGNESIUM SULF VIAL 1GM / 2ML PER 500MG

J3475

($

18.00)

PHYTONADIONE (VITAMIN K) 1MG/0.5ML INJ

J3430

($

18.00)

CYANOCOBALAMIN 1000 MCG/ML INJ

J3420

($

18.00)

VANCOMYCIN HCL VIAL 1000MG

J3370

($

18.00)

TRIMCINALONE ACETONI (5ML VIAL) 40MG/ML

J3301

($

18.00)

TERBUTALINE(BRETHINE)INJ 1 MG/ML

J3105

($

18.00)

FENTANYL CIT(SUBLIMAZE) 250MCG/5ML

J3010

($

18.00)

FENTANYL CIT(SUBLIMAZE) 100MCG/2ML

J3010

($

18.00)

METHYLPREDNISOLONE INJ 500MG

J2930

($

18.00)

METHYLPREDNISOLONE(SOLU-MEDROL) 40MG

J2920

($

18.00)

METOCLOPRAMIDE (REGLAN) INJ 5MG

J2765

($

18.00)

PROCAINAMIDE INJ 500 MG/ML 1MG

J2690

($

18.00)

PROMETHAZINE (PHENERGAN) 25MG INJ

J2550

($

18.00)

PIPERACILLIN/TAZOBACTAM(ZOSYN) 4.5 GM

J2543

($

18.00)

PENICILLIN G POTASSIUM INJ 5MU VIAL

J2540

($

18.00)

ONDANSETRON (ZOFRAN) VIAL 4MG/2ML

J2405

($

18.00)

PHENYLEPHRINE(NEO SYNEPHRINE)INJ 10MG/ML

J2370

($

18.00)

MORPHINE SULFATE 10MG/ML INJ

J2270

($

18.00)

MORPHINE SULFATE 2MG/ML INJ

J2270

($

18.00)

MORPHINE SULFATE PCA 1MG/ML(30ML)

J2270

($

18.00)

MIDAZOLAM (VERSED) HCL INJ 5MG/1ML

J2250

($

18.00)

MEPERIDINE (DEMEROL) 25MG/ML

J2175

($

18.00)

MEPERIDINE (DEMEROL) 50MG/ML

J2175

($

18.00)

MEPERIDINE(DEMEROL) 75MG/ML

J2175

($

18.00)

LORAZEPAM(ATIVAN) VIAL 2MG/ML

J2060

($

18.00)

LORAZEPAM(ATIVAN) 2MG/ML SYRINGE

J2060

($

18.00)

LIDOCAINE SYRINGE 2% 10MG

J2001

($

18.00)

XYLOCAINE (LIDOCAINE) AMP 1% 10ML

J2001

($

18.00)

LIDOCAINE HCL 1% 10ML UP TO 10MG

J2001

($

18.00)

LEVOFLOXACIN (LEVAQUIN) IV 500MG PREMIX

J1956

($

18.00)

LEVOFLOXACIN (LEVAQUIN) IV 250MG PREMIX1

J1956

($

18.00)

LEVETIRACETAM(KEPPRA)500MG/5ML VIAL

J1953

($

18.00)

FUROSEMIDE (LASIX) INJ 20MG/2ML

J1940

($

18.00)

FUROSEMIDE (LASIX) INJ 40MG/4ML VIAL

J1940

($

18.00)

FUROSEMIDE (LASIX) 100MG INJ

J1940

($

18.00)

KETOROLAC (TORADOL) VIAL 30MG/ML

J1885

($

18.00)

KETOROLAC (TORADOL) IM 60MG VIAL

J1885

($

18.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

PROPRANOLOL(INDERAL) INJ 1MG/ML

J1800


($

18.00)

HYDROCORTISONE (SOLU-CORTEF) INJ 100MG

J1720


($

18.00)

ENOXAPARIN(LOVENOX) SYRINGE 30MG

J1650


($

18.00)

ENOXAPARIN(LOVENOX) SYRINGE 40MG

J1650


($

18.00)

HEPARIN SODIUM VIAL 10,000 UNITS/ML

J1644


($

18.00)

HEPARIN FLUSH SYRINGE100U/ML 5ML

J1642


($

18.00)

HEPARIN FLUSH SYRINGE 10U/ML 5ML

J1642


($

18.00)

HALDOL (HALOPERIDOL) DECANOATE IM 50MG

J1631


($

18.00)

HALOPERIDOL (HALDOL) INJ 5MG/ML

J1630


($

18.00)

GENTAMICIN IV 100MG/50ML PREMIX

J1580


($

18.00)

GENTAMICIN SULFATE IV 40MG/ML 2ML VIAL

J1580


($

18.00)

DOPAMINE (INTROPIN) VIAL 200MG/5ML VIAL

J1265


($

18.00)

DOPAMINE (INTROPIN) VIAL 400MG/5ML VIAL

J1265


($

18.00)

DOBUTREX (DOBUTAMINE) VIAL 12.5MG/ML

J1250


($

18.00)

DIPHENHYDRAMINE (BENADRYL) INJ 50MG/ML

J1200


($

18.00)

HYDROMORPHONE (DILAUDID) HCL 1MG/ML

J1170


($

18.00)

HYDROMORPHONE (DILAUDID) AMP 2MG/ML

J1170


($

18.00)

HYDROMORPHONE (DILAUDID) INJ 10MG/ML

J1170


($

18.00)

LANOXIN AMP 0.5MG/2ML

J1160


($

18.00)

DEXAMETHASONE INJ 10 MG/MLPER 1MG

J1100


($

18.00)

METHYLPREDNISOLONE ACETATE INJ 40MG

J1030


($

18.00)

CEFTAZIDIME(TAZICEF} VIAL 1GM

J0713


($

18.00)

CEFUROXIME INJ 750MG SDV

J0697


($

18.00)

CEFTRIAXONE (ROCEPHIN) INJ 1GM

J0696


($

18.00)

CEFOXITIN (MEFOXIN) IV VIAL : 1GM

J0694


($

18.00)

CEFEPIME INJ 1GM

J0692


($

18.00)

CEFAZOLIN (ANCEF) VIAL 1GM

J0690


($

18.00)

CALCIUM GLUCONATE 10% VIAL 10ML

J0610


($

18.00)

BUTORPHANOL TARTRATE(STADOL) 2 MG/ML SDV

J0595


($

18.00)

ATROPINE SYR 1MG/10ML INJ

J0461


($

18.00)

AZITHROMYCIN (ZITHROMAX) VIAL 500MG

J0456


($

18.00)

HYDRALAZINE HCL (APRESOLINE)VIAL 20MG/ML

J0360


($

18.00)

AMPICILLIN/SULBACTAM (UNASYN) 3GM VIAL

J0295


($

18.00)

AMPICILLIN/SULBACTAM (UNASYN) 1.5GM

J0295


($

18.00)

AMPICILLIN SODIUM IV VIAL 1GM PER 500MG

J0290


($

18.00)

AMPICILLIN SODIUM IV 2GM VIAL PER 500MG

J0290


($

18.00)

AMIODARONE HCL (CORDARONE) VIAL 150MG

J0282


($

18.00)

ACYCLOVIR (ZOVIRAX) IV VIAL 500MG/10ML

J0133


($

18.00)

WATER VIAL 10ML

A9150


($

18.00)

0.45% NS 1L WITH NA BICARB AND 40MEQKCL



($

18.00)

TB SKIN TEST MDV (TUBERSOL) 5 TU/0.1ML


86580

($

18.00)

PPD(TUBERCULIN PURIF)INJ 5U/0.1 ML


86580

($

18.00)

XYLOCAINE EPI 1% 30ML

J3490


($

18.00)

LIDOCAINE HCL 1% : 20ML

J3490


($

18.00)

MARCAIN(BUPIVACAINE)INJ 0.5% 10ML 5MG/ML

J3490


($

18.00)

LIDOCAINE HCL 1% : 10ML

J2001


($

18.00)

XYLOCAINE EPI 1% 20ML

J2001


($

18.00)

LIDOCAINE/ EPI 2% 20ML

J2001


($

18.00)

LIDOCAINE/ EPI 2% 10ML

J2001


($

18.00)

LIDOCAINE (XYLOCAINE) 2% 10ML

J2001


($

18.00)

PICC LINE CAP

A4649


($

18.00)

SUBCLAVIAN

A4649


($

18.00)

BREATHING CIRCUIT



($

18.00)

HUMIDVENT



($

18.00)

BREATHING CIRCUIT-PEDIATRIC



($

18.00)

WATER STERILE PF INJ 50ML



($

18.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

MEDI-BOTTLE



($

18.00)

LUMBAR TRACTION PER SHIFT

E0890


($

18.00)

PENCIL HANDSWITCH BLADE

A4649


($

18.00)

TENS LEAD WIRE REPLACEMENT

A4595


($

18.00)

TAPE UMBILICAL

A4452


($

18.00)

PEAK FLOW METER/USE



($

18.00)

WALKER HEEL (CHILDS) SMALL



($

18.00)

GLOVE COMPRESSION EDEMA



($

18.00)

J-SPLINT 2



($

18.00)

0.45% NS 1000ML WITH SODIUM BICARB



($

18.00)

NITROLINGUAL SPRAY 0.4MG PER DOSE

J8499


($

18.00)

CETACAINE BENZOCAINE/TETRACAINE SPRAY

J8499


($

18.00)

CARVEDILOL(COREG) CR CAP 40 MG

J8499


($

18.00)

ONGLYZA (SAXAGLIPTIN) TAB 5MG

J8499


($

18.00)

SOLIFENACIN(VESICARE) TAB 5MG

J8499


($

18.00)

NS FLUSH (SOD CHL 0.9%) INJ

J3490


($

18.00)

LIDOCAINE HYDROCHLORIDE INJ 1% 50ML

J3490


($

18.00)

TINACTIN CREAM (TOLNAFTATE) 1% 15GM

A6250


($

18.00)

4 WAY NASAL SPRAY

A9150


($

18.25)

CIRCUMCISION NEWBORN PER MIN SURGICAL


54160

($

18.33)

INJECTION MAJOR JOINT PER MIN



($

18.33)

MARCAINE(BUPIVACAINE)INJ 0.25% 50ML

J3490


($

18.33)

PROCHLORPERAZINE MALEATE SUPP:25MG

J3490


($

18.33)

THIAMINE HCL INJ 200MG VIAL

J3411


($

18.67)

BETAMETHASONE (5 ML VIAL) INJ 6MG/ML

J0702


($

18.67)

I & D PER MIN



($

19.00)

REMOVE FOREIGN BODY THIGH DEEP PER MIN



($

19.00)

BUPIVACAINE)0.5% 30ML 5MG/ML

J3490


($

19.00)

MVI ADULT 100ML MDV

J3490


($

19.00)

FLUCONAZOLE IV 200MG/100ML PREMIX

J1450


($

19.00)

CALICIUM FO(LEUCOVORIN) 100MG VIAL

J0640


($

19.00)

THERMACARE XLG BACK



($

19.00)

THERMACARE NECK AND ARM



($

19.00)

REECOVER ICE MED WRAP 33'



($

19.00)

REECOVER ICE MED WRAP 66'



($

19.00)

ENDOTRACHEAL TUBE RAE 5.0 DO NOT USE

E0485


($

19.00)

ENDOTRACHEAL TUBE RAE 6.0

E0485


($

19.00)

DRESSING DUODERM .4X4 INCH

A6243


($

19.00)

DRESSING INTERDRY 10 X12'

A6210


($

19.00)

SUTURE ETHILON 626H

A4649


($

19.00)

SUTURE ETHILON 660H

A4649


($

19.00)

SUTURE PLAIN GUT S164H

A4649


($

19.00)

SUTURE SILK M195T

A4649


($

19.00)

SUTURE SILK SA66G

A4649


($

19.00)

SUTURE ETHILON 642H

A4649


($

19.00)

SUTURE VICRYL J303H

A4649


($

19.00)

SUTURE VICRYL J466H

A4649


($

19.00)

SUTURE VICRYL J465H

A4649


($

19.00)

SUTURE VICRYL J315H

A4649


($

19.00)

SUTURE VICRYL J433H

A4649


($

19.00)

SUTURE VICRYL 4-0 FS-2 J392H

A4649


($

19.00)

SUTURE VICRYL J302H

A4649


($

19.00)

SUTURE ETHIBOND X833H

A4649


($

19.00)

BITE BLOCK

A4649


($

19.00)

URINE DRAIN BAG

A4357


($

19.00)

CATHETER 18FR 5CC

A4338


($

19.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

ESOPHAGEAL INTUBATION DETECTOR



($

19.00)

WOUND PREP



($

19.00)

SPLINT TAILOR

Q4050


($

19.00)

AQUAPLAST PRODRAPE 3/32

A9999


($

19.00)

DUMBELL 1#

A9300


($

19.00)

NITRATEST ROLL DIAGNOSTIC AIDS

A9270


($

19.00)

ANTI EMBOLISM SOX KNEE MED

A6531


($

19.00)

ANTI EMBOLISM SOX KNEE XL LONG

A6531


($

19.00)

ANTI EMBOLISM SOX KNEE MED LONG

A6531


($

19.00)

SHUR CLEANS 6OZ BTL

A4649


($

19.00)

DRESSING SPONGE EAR-WICK



($

19.00)

TUB BATH UNASSISTED



($

19.00)

ELECTRODE REM



($

19.00)

ANTI EMBOLISM SOX KNEE SM



($

19.00)

ANTI EMBOLISM SOX KNEE L



($

19.00)

SCOTCHCAST TAPE 2 INCH



($

19.00)

MOLESKIN 1FT



($

19.00)

NYLATEX WRAP



($

19.00)

SPLINT SAM SHET



($

19.00)

ARTIFICIAL TEARS(NATURALE II)OPTH DROPS

A9150


($

19.00)

NUPERCAINAL (DIBUCAINE) TOPICAL 1% OINT

A6250


($

19.00)

CETAPHIL CREAM

A6250


($

19.25)

ESOMEPRAZOLE(NEXIUM) IV VIAL 40MG

J3490


($

20.00)

METHYLPREDNISOLONE(SOLU-MEDROL)125MG

J2930


($

20.00)

OCTREOTIDE INJ 1MG/5ML VIAL

J2353


($

20.00)

TRAVEL ALLOWANCE

P9604


($

20.00)

POSTURE PILLOW

E0190


($

20.00)

WHEELCHAIR LEG RESTS

E0990


($

20.00)

VIGILON DRESSING

A6258


($

20.00)

SPLINT FINGER FROG SM

L3999


($

20.00)

CERVICAL COLLAR SOFT SM

L0172


($

20.00)

SUTURE STEEL 540G

A4649


($

20.00)

T-CON EXTENSION SET

A4222


($

20.00)

SMARTSITE EXT 2Y

A4222


($

20.00)

FILTER GAS SAMPLING



($

20.00)

COLOSTOMY POUCH



($

20.00)

BLOOD PRESSURE CUFF ADULT LG DISPOSABLE

A4663


($

20.00)

O2 CANNULA PED



($

20.00)

OLMESARTAN(BENICAR) TAB 40MG

J8499


($

20.00)

SUCRALFATE (CARAFATE) SUSP 1GM/10ML

J8499


($

20.00)

ERYTHROMYCIN DR (ERY-TAB DR) TAB 333MG

J8499


($

20.00)

RID SHAMPOO (PIPERONYL BUT/PYRETHRINS)

J3490


($

20.00)

GOLYTELY

E0352


($

20.00)

GOLYTELY

E0352


($

20.00)

EUCERIN CR 113GM

A6250


($

20.00)

TERBINAFINE(LAMASIL)HCL CREAM1%

A6250


($

20.25)

NYSTATIN SUSP 100,000U/ML

J8499


($

20.67)

DEXTROSE 50% SYR 25GM

J7060


($

21.00)

SODIUM BICARB 8.4% 50ML 50MEQ

J3490


($

21.00)

TRACE METALS (MULTITRACE-5) 1ML SDV

B4193


($

21.00)

OXIMETER SINGLE USE


94760

($

21.00)

LEG REST ELEVATING

E0990


($

21.00)

SUTURE ETHILON 697G

A4649


($

21.00)

LAPAROTOMY PACK

A4649


($

21.00)

SUTURE ETHILON 3-0 663G FS-1

A4649


($

21.00)

ANTI REFLUX VALVE SALEM SUMP



($

21.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

OSTOMY POUCH/FACEPLATE



($

21.00)

TAPE UMBILICAL

A4452


($

21.00)

METER ADAPTER



($

21.00)

DRESSINET SIZE 10 TUBE GAUZE 1YARD



($

21.00)

BASIC ASSIST DEVICE



($

21.00)

CERVICAL COLLAR EXTENSION



($

21.00)

TOLTERODINE TARTRAT (DETROL LA) CAP 4MG

J8499


($

21.00)

CEFDINIR ORAL PWD FOR SUSP 250MG/5ML

J8499


($

21.00)

SILODOSIN 8MG CAP



($

21.00)

NUTREN RPT 100ML :1UNIT

B4150


($

21.00)

RANITIDINE(ZANTAC) 25MG/ML (150MG VIAL)

J2780


($

21.33)

GLYCOPYRROLATE(ROBINUL) 0.2MG/ML

J7643


($

21.67)

DARIFENACIN(ENABLEX ER)TAB 15MG

J8499


($

21.67)

ENOXAPARIN(LOVENOX) SYRINGE 60MG

J1650


($

22.00)

PULMOAID/NEBULIZER MACHINE

E0570


($

22.00)

FLUTICASONE PROPIONATE(FLONASE)

J3535


($

22.00)

TOLTERODINE TARTRATE(DETROL LA) CAP 2MG

J8499


($

22.33)

ADULT DAY CARE PER HR



($

23.00)

VINCRISTINE SULF SDV 1MG

J9370


($

23.00)

VINCRISTINE SULFATE INJ 2MG/2ML VIAL

J9370


($

23.00)

TAPE LEUKO



($

23.00)

NACL 0.9% 250ML GLASS BOTTLE

J7050


($

23.00)

ANESTHESIA MASK TODDLER



($

23.00)

SPOON SOUP

A9999


($

23.00)

DRESSINET 5

A6208


($

23.00)

ARM SLING CHILD

A4565


($

23.00)

CATH HOLDER SECURE STATLOCK

A4334


($

23.00)

ORTHO GLASS 3 PER FT.



($

23.00)

J-SPLINT 3



($

23.00)

RIB BELT UNIVERSAL MALE



($

23.00)

INHALER SPACER/CHAMER



($

23.00)

CASTILE SOAP TOWELETTE



($

23.00)

GENTAMICIN OPTH OINT 3.5GM

J3490


($

23.00)

LUBRIDERM SKIN REPAIR

A6250


($

23.00)

MVI ADULT (VIAL 1 AND VIAL 2) WHITE/BLUE

J3490


($

23.33)

OXYTOCIN (PITOCIN) INJ 10U/ML MDV

J2590


($

23.33)

METHYLENE BLUE1% 10MG/ML

Q9968


($

24.00)

KETAMINE INJ 100MG/ML

J3490


($

24.00)

MAGNESIUM CHLORIDE 200MG/ML(50ML VIAL)

J3490


($

24.00)

MORPHINE SULFATE PCA 5MG/ML(30ML)

J2270


($

24.00)

ACYCLOVIR (ZOVIRAX) IV VIAL 1000MG

J0133


($

24.00)

CAPILLARY COLLECTION FEE


36416

($

24.00)

TANK REFILL MEDIUM ME

E0443


($

24.00)

SUTURE SILK 5-0 P-3 640G 12CT

A4649


($

24.00)

SUTURE VICRYL J507G

A4649


($

24.00)

SUTURE VICRYL J489G

A4649


($

24.00)

CATHETER 14FR 5CC

A4346


($

24.00)

CATHETER 20FR 30CC

A4340


($

24.00)

CATHETER 12FR SILICONE

A4338


($

24.00)

CATHETER 22FR 5CC

A4338


($

24.00)

FLEX CONNECTOR



($

24.00)

HEAT MOSTURE EXCHANGER DO NOT USE



($

24.00)

GAS SAMPLING LINE 10 FT



($

24.00)

TRACH FLEX TUBE



($

24.00)

LARGE BASIN



($

24.00)

ASPIRATOR MECONIUM



($

24.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

CATHETER 18FR 30CC SILICONE



($

24.00)

SHOE POST-OP M-M

L3260


($

24.00)

FLUSH BAG DOUBLE SPIKE SET KANGAROO

B4035


($

24.00)

CATH HOLDER LEG STRAP

A4334


($

24.00)

UPPER GI POWDER SCOOP



($

24.00)

EYE IRRIGATION



($

24.00)

ANTI EMBOLISM SOX KNEE XL



($

24.00)

WALKER HEEL MEDIUM



($

24.00)

J-SPLINT 4



($

24.00)

SHOE POST-OP W-M



($

24.00)

SHOE POST-OP W-L



($

24.00)

SHOE POST-OP M-L



($

24.00)

SHOE POST-OP M-XL



($

24.00)

SHOE POST-OP W-S



($

24.00)

GLOVES MEDICAL VINAL MED



($

24.00)

KETAMINE HCL INJ SOLUTION 50MG/1ML

J3490


($

24.00)

SODIUM BICARB (INFANT)4.2% SYRINGE

J3490


($

24.67)

INJECTION FEE INFLUENZA

G0008


($

25.00)

NAFCILLIN SODIUM IV VIAL 2GM

S0032


($

25.00)

MORPHINE SULFATE PCA 5MG/ML(150MG/30ML)

J2270


($

25.00)

EPINEPHRINE INJ 1MG/ML 1:1000

J0171


($

25.00)

COCAINE and Metabolites BLOOD GC MS


80353

($

25.00)

*BENZODIAZEPINES


80346

($

25.00)

TRICYCLIC ANTIDEPRESSANT PANEL


80336

($

25.00)

*PCP


80102

($

25.00)

TIPOLISHER DO NOT USE

E0485


($

25.00)

ENDOTRACHEAL TUBE RAE 4.0

E0485


($

25.00)

ENDOTRACHEAL TUBE RAE 4.5 DO NOT USE

E0485


($

25.00)

SUTURE ETHILON 2-0 PSLX

A4649


($

25.00)

SUTURE M-136

A4649


($

25.00)

SUTURE VICRYL 513G

A4649


($

25.00)

SUTURE ETHILON 6-0 P-1

A4649


($

25.00)

CATHETER FOLEY10FR 3CC

A4344


($

25.00)

CATHETER HOLDER

A4334


($

25.00)

O2 TUBING 35 FT



($

25.00)

O2 TUBING 50 FT



($

25.00)

SCOTCHCAST TAPE 3 INCH



($

25.00)

FAMVIR (FAMCICLOVIR) TAB:500MG

J8499


($

25.00)

PROMETHAZINE(PHENERGAN) SUPP 25MG

J8498


($

25.00)

HOLDER 2 SLOT CUP/MUG

E0705


($

25.00)

PIPERACILLIN/TAZOBACTAM(ZOSYN) 3.375GM

J2543


($

25.33)

ASCORBIC ACID 500MG/ML

J3490


($

26.00)

GENTAMICIN SULFATE IV 800MG/20ML VIAL

J1580


($

26.00)

PISTACHIO IgE


86003

($

26.00)

PEANUT IgE


86003

($

26.00)

SCALLOP IgE


86003

($

26.00)

HAZELNUT IgE


86003

($

26.00)

PECAN NUT IgE


86003

($

26.00)

OYSTER IgE


86003

($

26.00)

WALNUT IgE


86003

($

26.00)

*ALLERGEN SPEC IGE QUANTITATIVE


86003

($

26.00)

ALMOND IgE


86003

($

26.00)

CASHEW NUT IgE


86003

($

26.00)

*ALLERGEN TUNA IgE


86003

($

26.00)

*ALLERGEN SALMON IgE


86003

($

26.00)

*NORMETANEPHRINE


83835

($

26.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

SKIN STAPLER

A4649


($

26.00)

SUTURE SILK 684G

A4649


($

26.00)

SUTURE ETHILON 698G 5-0 P-3

A4649


($

26.00)

INTUBATION STYLET 2.5-4.5MM



($

26.00)

INTUBATION STYLET 7.5-10.0MM



($

26.00)

ELASTOPLAST 3 IN

A6208


($

26.00)

ARMBOARD FOR ABG BLUE

A4649


($

26.00)

GLOVES EXAM VINYL LG



($

26.00)

GLOVES EXAM VINYL MED



($

26.00)

ELECTRODE FETAL MON



($

26.00)

CAST REMOVAL PLASTER



($

26.00)

LACRI-LUBE OPTH 7 GM LUBRICANT

A9150


($

26.00)

SPECTAZOLE (ECONAZOLE)CR 30GM TOP 0.01

A6250


($

26.00)

NYSTATIN(MYCOLOG, MYCOSTATIN) PWDR 15GM

A6250


($

26.00)

IMIPENEM/CILASTATIN (PRIMAXIN)INJ 500MG

J0743


($

26.33)

RIVAROXABAN 15MG

J3490


($

26.33)

RIVAROXABAN 10MG

J3490


($

26.33)

ENOXAPARIN(LOVENOX) SYRINGE 100MG

J1650


($

26.67)

NYSTATIN CREAM 15GM

A6250


($

26.67)

SHORT STAY TREATMENT RM/ADDL HR

G0378


($

27.00)

ADENOSINE (ADENOCARD) SYR 6MG/2ML

J0153


($

27.00)

PUMP SUPPLY KIT

B4036


($

27.00)

DRESSING ALLEVYN AG 3X3

A6210


($

27.00)

SUTURE SILK 0 KS NEEDLE

A4649


($

27.00)

SUTURE PROLENE 8697G

A4649


($

27.00)

SUTURE VICRYL 2-0 CT-1 J339H

A4649


($

27.00)

CATHETER FOLEY DOVER 14FR 30CC

A4340


($

27.00)

LTA KIT



($

27.00)

NASOPHARYNGEAL AIRWAY 30FR



($

27.00)

NASOPHARYNGEAL AIRWAY 32FR



($

27.00)

NASOPHARYNGEAL AIRWAY 34FR



($

27.00)

BALL EXCERCISE 2 55CM ORANGE

A9300


($

27.00)

ADMISSION KIT DO NOT USE



($

27.00)

O2 MASK REBREATHING



($

27.00)

CARDIAC MONITOR SET-UP DO NOT USE



($

27.00)

REVIA (NALTREXONE HCL) TAB: 50MG

J8499


($

27.00)

ACETYLCYSTEINE (MUCOMYST) 20% PER BTL

J7608


($

27.33)

TOBRAMYCIN 80MG VIAL

J3260


($

28.00)

DOBUTREX (DOBUTAMINE) PREMIX 500MG

J1250


($

28.00)

SUTURE PROLENE 8663G

A4649


($

28.00)

SUTURE PROLENE 8603G

A4649


($

28.00)

CATHETER FOLEY SILICONE 14FR 5CC

A4344


($

28.00)

CATHETER 22FR 10CC SILICONE

A4338


($

28.00)

BIFURCATED EXT SET MLL W/SMARTSITE VALVE

A4222


($

28.00)

EAR TUBE SHEENY EACH



($

28.00)

GRANULUX SPRAY



($

28.00)

CAST PADDING 6



($

28.00)

SYSTANE EYE DROPS

J3490


($

28.00)

DRESSING MEPILEX BORDER 10X10CM / 4X4

A6196


($

28.25)

SULFAMETHOXAZOLE(SEPTRA) IV 10ML

J3490


($

28.67)

NITROGLYCERIN 25MG/250ML GLASS BOTTLE

J3490


($

29.00)

INSULIN FOR INSULIN PUMP PER 50 UNITS

J1817


($

29.00)

*BLOOD COUNT HEMATOCRIT


85014

($

29.00)

*ASSAY OF SERUM ALBUMIN


82040

($

29.00)

DRESSING XTRSASORB

A6209


($

29.00)

CATHETER STRAIGHT THORACIC 28FR SILICONE

A4649


($

29.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

SUTURE SILK 2-0 FS BLACK BRAIDED

A4649


($

29.00)

SUTURE SILK 3-0 FS-1 684G

A4649


($

29.00)

SUTURE PROLENE 8663G 3-0 PS-1

A4649


($

29.00)

PICC+CRESENT

A4222


($

29.00)

MORTUARY PACK XL



($

29.00)

J-SPLINT 6 PER FT



($

29.00)

MODAFINIL TAB 100MG

J8499


($

29.00)

ROBITUSSIN/AC BTL (GUIATUSS)100-10MG/5ML

A9150


($

29.00)

REFRESH PM OPHT 3.5 GM

A9150


($

29.00)

SUMATRIPTAN (IMITREX) SUBQ 6MG/0.5 ML

J3030


($

29.33)

MESNA 100MG/ML PER 200MG

J9209


($

30.00)

PROPOFOL (DIPRIVAN) IVP 500MG/50ML VIAL

J2704


($

30.00)

FLU VACCINE QUADRIVALENT 5ML MDV


90756

($

30.00)

FLU QUADRIVALENT VACCINE


90658

($

30.00)

FLU VACCINE (FLUZONE) INJECTION 0.5ML


90658

($

30.00)

H/H/AIDE VISIT



($

30.00)

URINE DIP W/O FURTHER TESTING


81002

($

30.00)

*BLOOD COUNT RED BLOOD CELL


85041

($

30.00)

*BLOOD COUNT HEMOGLOBIN


85018

($

30.00)

Casein IgG F78


86001

($

30.00)

EGG WHITE F1 IgG


86001

($

30.00)

MAIZE/CORN (F8) IgG


86001

($

30.00)

SOYBEAN (F14) IgG


86001

($

30.00)

WHEAT F4 IgG


86001

($

30.00)

BEEF (F27) IgG


86001

($

30.00)

ORANGE IgG


86001

($

30.00)

PEANUT (F13) IgG


86001

($

30.00)

PORK (F26) IgG


86001

($

30.00)

CODFISH IgG


86001

($

30.00)

CACAO (Chocolate) F93 IgG


86001

($

30.00)

COFFEE IgG


86001

($

30.00)

TOMATO (F25) IgG


86001

($

30.00)

YEAST Bakers Brewers F45 IgG


86001

($

30.00)

*HEMOGLOBIN FRACTION CHROMATOGRAPHY


83021

($

30.00)

GLUCOSE FASTING BIOMETRIC SCREEN


82947

($

30.00)

HF GLUCOSE (SPECIAL) FASTING


82947

($

30.00)

MRO FEE


80500

($

30.00)

LIPID PANEL BIOMETRIC SCREEN


80061

($

30.00)

SUTURE VICRYL CTX J365H

A4649


($

30.00)

DURAPREP

A4649


($

30.00)

TAPE MEDIPORE 4IN

A4649


($

30.00)

SUTURE REMOVAL



($

30.00)

EMERGENCY DEL PACK



($

30.00)

BLOOD FLIUD WARMING SYSTEM



($

30.00)

DRESSINET SIZE 9 TUBE GAUZE 1YARD



($

30.00)

J-SPLINT 5



($

30.00)

KWELL (LINDANE) SHAMPOO 1% :

J3490


($

30.00)

PROCHLORPERAZINE(COMPAZINE) INJ 10MG

J0780


($

30.33)

SITAGLIPTIN TAB 50MG

J8499


($

30.33)

DRESSING MEDIHONEY CALCIUM ALG 2x2

A6196


($

30.50)

CIPROFLOXACIN (CIPRO) PREMIX 400MG

J0744


($

30.67)

*REVERSE TRANSCRIPTION


83902

($

31.00)

KINESIOTAPE 2X16 6 PK BEIGE



($

31.00)

KINESIOTAPE 2X16 6PK BLACK



($

31.00)

ENDOTRACHEAL TUBE UNCUFF 5.0

E0485


($

31.00)

BARD ADD A FOLEY TRAY

A4310


($

31.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

WALKER TIPS

A4637


($

31.00)

BASIC CAST



($

31.00)

ANUCORT-HC 2.5% CREAM :28.35GM

A6250


($

31.00)

PACLITAXEL (TAXOL) INJ : 6MG/ML 5ML VIAL

J9267


($

32.00)

MANNITOL IV 20% 500ML PREMIX

J2150


($

32.00)

ESTRADIOL CYPIONATE INJ(5ML MDV) 5MG/ML

J1000


($

32.00)

*ADD-ON DRUG CONFIRMATION


80307

($

32.00)

CANE QUAD

E0105


($

32.00)

DRESSING DUODERM5.CGF 6X7

A6243


($

32.00)

KALTOSTAT DRESSING ALGINATE BANDAGE 2X2

A6196


($

32.00)

SUTURE ETHILON 4-0 662G FS-2

A4649


($

32.00)

DRESSING KIT PICC LINE

A4649


($

32.00)

NEEDLE PORT-A-CATH 1 IN (GRIPPER PLUS)

A4222


($

32.00)

ORTHO GLASS 4 PER FT.



($

32.00)

SCOTCHCAST TAPE 4 INCH



($

32.00)

RIB BELT MED



($

32.00)

RIB BELT LG



($

32.00)

HYDROCORTISONE 250MG VIAL INJ

J1720


($

32.33)

ERYTHROMYCIN OPTH OINT 0.5%

J3490


($

32.67)

FENTANYL TRANSDERM PATCH 12MCG

J3490


($

32.67)

PEN G IV (PFIZERPEN) 600,000 UN

J2540


($

33.00)

PLATELET COUNT


85049

($

33.00)

RBC COUNT


85041

($

33.00)

*MOLECULAR DIAGNOSTICS


83896

($

33.00)

ADAPTIC 3 X 3

A6455


($

33.00)

ANTI EMBOLISM SOX KNEE LG LONG

A6532


($

33.00)

TENS SILVER



($

33.00)

OXYHOOD



($

33.00)

PT HANDLING/ORDERING ORTHOTIC PROSTH


99002

($

34.00)

URIC ACID SYNOVIAL FLUID


84560

($

34.00)

CANE SM

E0100


($

34.00)

LIGACLIP LARGE TITANIUM

A4649


($

34.00)

SUTURE VICRYL J532H

A4649


($

34.00)

CATHETER FOLEY 16FR 5CC SILICONE

A4344


($

34.00)

INTUBATION STYLET 5-7MM



($

34.00)

CATHETER THORASIC 20FR



($

34.00)

ANTI EMBOLISM SOX KNEE LG SHORT



($

34.00)

AQUAPHOR OINT 14OZ

A6250


($

34.25)

IODINE STRONG SOLUTION

J3490


($

34.67)

KYTRIL SDV (GRANISETRON HCL) INJ 100MCG

J1626


($

35.00)

CANE QUAD

E0105


($

35.00)

TAPE COVERALL STRETCH



($

35.00)

ENDOTRACHEAL TUBE RAE 5.5 DO NOT USE

E0485


($

35.00)

SUMP DRAIN

A4649


($

35.00)

VALLEY LAB EXTENDED ELECTRODE

A4649


($

35.00)

CATHETER 16FR 30CC SILICONE

A4344


($

35.00)

BUTTON ZIPPER AID

A9281


($

35.00)

ANTI EMBOLISM SOX KNEE SMALL SHORT



($

35.00)

ATHLETIC SUPPORTER



($

35.00)

ANTI EMBOLISM SOX KNEE MED SHORT



($

35.00)

ORTHO GLASS 5 PER FT.



($

35.00)

FLUOROMETHLONE OPTH SUSP:0.1%

J3490


($

35.00)

NEO/POLY/DEX(MAXITROL) OPTH 5 CC BTL

J3490


($

35.33)

CISPLATIN (PLATINOL) 50MG

J9060


($

36.00)

DOPAMINE (INTROPIN) PREMIX 800MG/500D5W

J1265


($

36.00)

RUBEOLA IgM Antibody MEASLES


86765

($

36.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

WALKER BASKET/ATTACHMENT FOR WALKER

A9999

($

36.00)

SUTURE SOFSILK 2-0 GS833 V-20 NEEDLE

A4649

($

36.00)

CATHETER COUDE 20FR 30CC

A4340

($

36.00)

IV PUMP SET HOSPIRA

A4305

($

36.00)

REACHER


($

36.00)

BAIRHUGGER BLANKET


($

36.00)

OXYGEN MINIMUM


($

36.00)

MASSAGE CREAM


($

36.00)

SULFADIAZINE (THERMAZENE) CR 1% 50GM

A6250

($

36.00)

OSELTAMIVIR PHOS(TAMIFLU) CAP: 75MG

G9019

($

36.67)

MORPHINE SULFATE ORAL SOLUTION 20MG/1ML


($

36.67)

TOBRAMYCIN 1200MG/30ML VIAL

J3260

($

37.00)

MORGUE FEE ADDITIONAL DAY


($

37.00)

OXYGEN ROLLING STAND E TANK

E1355

($

37.00)

DRESSING SORBAVIEW

A6254

($

37.00)

DRESSING MEDIHONEY CALCIUM ALG GEL

A6196

($

37.00)

SUTURE VICRYL 3-0 J644H UNDYED TIES

A4649

($

37.00)

SUTURE PROLENE 8941H/use 8661g/3007235

A4649

($

37.00)

ADMINISTRATION SET CONTINUE FLO

A4222

($

37.00)

BREATHING BAG NON LATEX PED


($

37.00)

PROTECTIVE OINTMENT

A4335

($

37.00)

GAIT BELT


($

37.00)

TRIAMCINOLONE (NASACORT)INHAL 55 MCG

J7683

($

37.00)

NEO/POLY DEXA(MAXITROL)OPTH OINT 3.5GM

J3490

($

37.67)

PILLOW POSTURE NECK

E0190

($

38.00)

DRESSING SILFLEX SILICONE 3X4

A6239

($

38.00)

SUTURE PROLENE 4-0 V-4 8925H

A4649

($

38.00)

MINI TRAY

A4649

($

38.00)

EVACUATED CONT. 500 ML

A4649

($

38.00)

CATHETER FOLEY 16FR 30CC

A4344

($

38.00)

WEIGHTS CUFF 2#

A9300

($

38.00)

IV ARMBOARD CHILD

A4649

($

38.00)

COLOSTOMY BELT

A4367

($

38.00)

CAVILON SPRAY


($

38.00)

TUB BATH ASSISTED


($

38.00)

CAST REMOVAL HEXCELITE


($

38.00)

SCOTCHCAST TAPE 5 INCH


($

38.00)

RENOGRAFIN (X-RAY)


($

38.00)

ATROPINE SULFATE OPTH SOLUTION 1%

J3490

($

38.00)

SPECIAL DUTY RN - BY HOUR


($

38.00)

AZITHROMYCIN(ZITHROMAX) SUSP 200MG/5ML

Q0144

($

38.67)

CARBOPLATIN 150MG/15ML VIAL

J9045

($

39.00)

PHYTONADIONE(VIT K) 10MG/ML AMP

J3430

($

39.00)

DRESSING ALLEVYN 5. IN X5. INCH SILVER

A6210

($

39.00)

TRANSFUSION FILTER

A4649

($

39.00)

PAD DIGNITY XL

T4535

($

39.00)

ACID MANTLE 1OZ CR

A6250

($

39.00)

BOUDREAUXS BUTT PASTE

A6250

($

39.75)

DRESSING ALLEVYN SILVER 3X3

A6210

($

40.00)

WINGS/15PK XL

T4524

($

40.00)

ATTENDS BOOSTER PAD 24/PK

T4522

($

40.00)

WEIGHTS ANKLE 1 LB

A9300

($

40.00)

CRUTCH ACCESORY KIT

A4637

($

40.00)

PLASTER PARIS 2 INCH XTRA FAST


($

40.00)

CAST SHOE CANVAS S


($

40.00)

CARDIAC MONITOR - SHIFT DO NOT USE


($

40.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

SCOPOLAMINE PATCH (TRANSDERM SCOP) 1.5MG

J3490


($

40.00)

*CHARGE DRUG CONF BUP GC/MS


80348

($

41.00)

*CHARGE DRUG CONF TCA GC/MS


80332

($

41.00)

*CHARGE DRUG CONF AMP / METH GC/MS


80324

($

41.00)

ELECTRODE TENS PER PAIR

A4595


($

41.00)

ENDOMETRIAL CURETTE

A4550


($

41.00)

CATHETER 28FR 30CC

A4338


($

41.00)

AIRWAY LMA SIZE 5



($

41.00)

AIRWAY LMA SIZE 4



($

41.00)

AIRWAY LMA SIZE 2



($

41.00)

AIRWAY LMA SIZE 3



($

41.00)

PULLEY SHOULDER

A9300


($

41.00)

IV ARMBOARD PED/INF

A4649


($

41.00)

GLOVES EXAM BOX SMALL NITRILE



($

41.00)

BILI LIGHT - DAY



($

41.00)

TENS CLEAN-COTE



($

41.00)

GLOVES EXAM BOX XLARGE NITRILE



($

41.00)

GLOVES EXAM BOX MED NITRILE



($

41.00)

GLOVES EXAM BOX XSMALL



($

41.00)

ACETAZOLAMIDE 500MG VIAL

J1120


($

41.00)

NEOMYCIN/BACIT/POL(TRIPLE)OPTH OINT 3.5G

A6250


($

41.00)

INTUBATION TRACHEAL TUBE INTRODUCER 15FR


170

($

42.00)

HEMOGLOBIN


85018

($

42.00)

HEMATOCRIT


85014

($

42.00)

SPUN HEMATOCRIT


85014

($

42.00)

SULFATE 24HOUR URINE


84392

($

42.00)

PHOSPHORUS INORGANIC URINE withCREAT


84105

($

42.00)

OXALATE RANDOM URINE in ADULTS


83945

($

42.00)

DRAW FEE BLOOD


36415

($

42.00)

SYRINGE 3/10 CC INSULIN 100/BX

S8490


($

42.00)

INTRACATH 16 GA WIRE STYLET

A4222


($

42.00)

DRESSING BIOPATCH



($

42.00)

SURECARE PULLUPS LARGE

T4527


($

42.00)

SURECARE BRIEF MED PULLUPS

T4526


($

42.00)

SURECARE PULLUPS XLG

T4526


($

42.00)

WINGS MEDIUM/12PK

T4523


($

42.00)

WINGS LARGE/18PK

T4523


($

42.00)

SENSOR OXIMAX ADULT DATASCOPE

E0445


($

42.00)

GLOVES EXAM BOX LARGE NITRILE



($

42.00)

DOXY-100 (DOXYCYCLINE ) IV 100MG

J3490


($

42.33)

CEPHALEXIN (KEFLEX) SUSP 250 MG/5ML

J8499


($

42.67)

ACTIVATED CHARCOAL/SORBITOL 25GM

J8499


($

43.00)

*CHARGE MANUAL DIFF


85007

($

44.00)

CREATININE PERITONEAL FLUID


82570

($

44.00)

URINE QUANTITATIVE TIMED SPEC


82340

($

44.00)

WALKER SEAT

E0156


($

44.00)

CLAVICLE SPLINT MEEK X-LG

L3650


($

44.00)

UNNA FLEXI-WRAP

A6456


($

44.00)

SUTURE PROLENE 5/0 FS-3 8661G

A4649


($

44.00)

HOT/COLD PACK DRESSING



($

44.00)

SUCTION CANISTER LARGE



($

44.00)

CEPHALEXIN (KEFLEX) SUSP 125 MG/5ML

J8499


($

44.00)

ZZZPFIZERPEN 20 MMU INJ

J2540


($

45.00)

BILIRUBIN FRACTIONATED


82248

($

45.00)

HEATED H2O ATTACHMENT CPAP

E0562


($

45.00)

CATHETER COUDE 16FR 15CC SILICONE

A4340


($

45.00)

Description CPT/HCPCS Code Professional Charge Technical Charge

CATHETER 22FR 30CC

A4338


($

45.00)

CATHETER 24FR 30CC

A4338


($

45.00)

BRIEF DIGNITY XL

T4524


($

45.00)

SHOE HORN

A9900


($

45.00)

BALL EXCERCISE 1 45CM YELLOW

A9300


($

45.00)

BANANA BAG (D5LR FOLIC THIAMINE MVI)



($

45.00)

REMICADE IVPB IN NS 250ML



($

45.00)

AZITHROMYCIN IV 500MG/250ML NS



($

45.00)

D5 0.9% NACL 1000ML WITH KCL 20MEQ



($

45.00)

NACL 0.9% 250ML WITH KCL 20MEQ RIDER



($

45.00)

VANCOMYCIN IV 1000MG / 250ML NS



($

45.00)

VANCOMYCIN IV 1250MG / 250ML NS



($

45.00)

VANCOMYCIN IV 750MG / 250ML NS



($

45.00)

MAGNESIUM SULFATE 1GM / D5W 50ML



($

45.00)

MAGNESIUM SULFATE 2GM/D5W 50ML OB**



($

45.00)

ACYCLOVIR IV 1000MG / NS 250ML



($

45.00)

VANCOMYCIN IV 1500MG / 250ML NS



($

45.00)

RANITIDINE IV 150MG/250ML NS CONTINUOUS



($

45.00)

FAMOTIDINE IV 40MG / 250ML NS



($

45.00)

NACL 0.9% 250ML WITH KCL 40MEQ RIDER