Charge|Description|Rev Code|CPT/DRG|Price|Cash Price|BCBS CAP Rate|BCBS CHO Rate|MCR Rate|Tricare Rate|MCD Rate|UHC MCO Rate|Sun MCO Rate|Aetna MCO Rate|IP/OP Rate|IP Century Health Excl Rate|OP Century Health Excl Rate|IP Century Health Non- Excl Rate|OP Century Health Non- Excl Rate|IP/OP Century Health Super Excl Rate|IP/OP Aetna Rate|IP First Health Rate|OP First Health Rate|IP/OP Humana Rate|IP/OP Multiplan Rate|IP Health Partner of KS Rate|OP Health Partner of KS Rate|Min|Max|Median 26000003|HC PICC LINE INSERT COMPLEX <5 YE|0260|36568|1,914.80|1,110.58|||1,406.14|1,406.14|4,039.44|4,120.23|4,120.23|4,201.02|1244.62|1302.06|1397.80|1397.80|1493.54|1148.88|1244.62|1436.10|1627.58|1700.34|1685.02|1436.10|1627.58| 1,148.88 | 4,201.02 | 1,436.10 26000004|HC PICC LINE INSERT UNDER 5 YEARS|0260|36568|1,810.05|1,049.83|||1,406.14|1,406.14|4,039.44|4,120.23|4,120.23|4,201.02|1176.53|1230.83|1321.34|1321.34|1411.84|1086.03|1176.53|1357.54|1538.54|1607.32|1592.84|1357.54|1538.54| 1,086.03 | 4,201.02 | 1,406.14 26000005|HC PICC LINE INSERT COMPLEX OVER|0260|36569|1,899.22|1,101.55|||1,406.14|1,406.14|4,039.44|4,120.23|4,120.23|4,201.02|1234.49|1291.47|1386.43|1386.43|1481.39|1139.53|1234.49|1424.42|1614.34|1686.51|1671.31|1424.42|1614.34| 1,139.53 | 4,201.02 | 1,424.42 26000006|HC PICC LINE INSERT OVER 5 YEARS|0260|36569|1,899.22|1,101.55|||1,406.14|1,406.14|4,039.44|4,120.23|4,120.23|4,201.02|1234.49|1291.47|1386.43|1386.43|1481.39|1139.53|1234.49|1424.42|1614.34|1686.51|1671.31|1424.42|1614.34| 1,139.53 | 4,201.02 | 1,424.42 26000007|HC REPAIR/RESEW CENTRAL LINE|0260|36575|829.95|481.37|1,863.61|1,770.43|541.62|541.62|205.50|209.61|209.61|213.72|539.47|564.37|605.86|605.86|647.36|497.97|539.47|622.46|705.46|737.00|730.36|622.46|705.46| 205.50 | 1,863.61 | 605.86 26000008|HC DECLOT CENTRAL LINE/TPA|0260|36593|806.63|467.85|||310.75|310.75|||||524.31|548.51|588.84|588.84|629.17|483.98|524.31|604.97|685.64|716.29|709.83|604.97|685.64| 310.75 | 716.29 | 588.84 26000009|HC DECLOT CENTRAL LINE/TPA COMPL|0260|36593|329.47|191.09|||310.75|310.75|||||214.16|224.04|240.51|240.51|256.99|197.68|214.16|247.10|280.05|292.57|289.93|247.10|280.05| 197.68 | 310.75 | 247.10 26000010|HC ED-ELECT ANALYSIS W/ REPROG PU|0260|62368|231.18|134.08|||272.47|272.47|||||150.27|157.20|168.76|168.76|180.32|138.71|150.27|173.39|196.50|205.29|203.44|173.39|196.50| 138.71 | 272.47 | 173.39 26000011|HC ANAL SP INF PMP W/REPRG&FILL|0260|62369|740.64|429.57|||272.47|272.47|||||481.42|503.64|540.67|540.67|577.70|444.38|481.42|555.48|629.54|657.69|651.76|555.48|629.54| 272.47 | 657.69 | 540.67 26000012|HC ED-REFILL/MAINT IMPL PUMP/RES|0260|96521|176.38|102.30|278.87|264.93|203.50|203.50|104.93|107.03|107.03|109.12|114.65|119.94|128.76|128.76|137.58|105.83|114.65|132.29|149.92|156.63|155.21|132.29|149.92| 104.93 | 278.87 | 132.29 26000013|HC ED-REFILL/MAINT PORTABLE PUMP|0260|96522|176.38|102.30|||203.50|203.50|104.93|107.03|107.03|109.12|114.65|119.94|128.76|128.76|137.58|105.83|114.65|132.29|149.92|156.63|155.21|132.29|149.92| 104.93 | 203.50 | 128.76 26000014|HC CENTRAL LINE DRESSING & CAP CH|0260|99211|216.88|125.79|49.86|47.37|||||||140.97|147.48|158.32|158.32|169.17|130.13|140.97|162.66|184.35|192.59|190.85|162.66|184.35| 47.37 | 192.59 | 158.32 26000015|HC IV LINE CONSULTATION|0260|99211|171.55|99.50|49.86|47.37|||||||111.51|116.65|125.23|125.23|133.81|102.93|111.51|128.66|145.82|152.34|150.96|128.66|145.82| 47.37 | 152.34 | 125.23 27000441|HC SPRAY ALOE VESTA PROT BARRIER|0270|A4369|59.07|34.26|||||||||38.40|40.17|43.12|43.12|46.07|35.44|38.40|44.30|50.21|52.45|51.98|44.30|50.21| 35.44 | 52.45 | 44.30 27200000|HC MICRO COVERED BILIARY STENT|0272|C2617|9,314.42|5,402.36|||||||||6054.37|6333.81|6799.53|6799.53|7265.25|5588.65|6054.37|6985.82|7917.26|8271.20|8196.69|6985.82|7917.26| 5,588.65 | 8,271.20 | 6,985.82 27200001|HC W/C NON COVERED BILIARY STENT|0272|C2617|6,519.98|3,781.59|||||||||4237.99|4433.59|4759.59|4759.59|5085.58|3911.99|4237.99|4889.99|5541.98|5789.74|5737.58|4889.99|5541.98| 3,911.99 | 5,789.74 | 4,889.99 27400000|HC STOMA DRAINABLE BAG CLAMP|0274|A4363|26.24|15.22|||||||||17.06|17.84|19.16|19.16|20.47|15.74|17.06|19.68|22.30|23.30|23.09|19.68|22.30| 15.74 | 23.30 | 19.68 27400001|HC SKIN BARRIER POWDER|0274|A4371|77.25|44.81|||||||||50.21|52.53|56.39|56.39|60.26|46.35|50.21|57.94|65.66|68.60|67.98|57.94|65.66| 46.35 | 68.60 | 57.94 27400002|HC SEALS COHESIVE EAKIN|0274|A4385|27.38|15.88|||||||||17.80|18.62|19.99|19.99|21.36|16.43|17.80|20.54|23.27|24.31|24.09|20.54|23.27| 16.43 | 24.31 | 20.54 27400003|HC EAKIN COHESIVE SEALS 2 INCH|0274|A4385|24.82|14.40|||||||||16.13|16.88|18.12|18.12|19.36|14.89|16.13|18.62|21.10|22.04|21.84|18.62|21.10| 14.89 | 22.04 | 18.62 27400004|HC ADAPT BARRIER STRIPS|0274|A4385|22.92|13.29|||||||||14.90|15.59|16.73|16.73|17.88|13.75|14.90|17.19|19.48|20.35|20.17|17.19|19.48| 13.75 | 20.35 | 17.19 27400005|HC RING SKIN BARRIER INTEGRITY|0274|A4385|29.25|16.97|||||||||19.01|19.89|21.35|21.35|22.82|17.55|19.01|21.94|24.86|25.97|25.74|21.94|24.86| 17.55 | 25.97 | 21.94 27400006|HC SLEEVE IRRIG. SURFIT 2 3/4F|0274|A4397|53.14|30.82|||||||||34.54|36.14|38.79|38.79|41.45|31.88|34.54|39.86|45.17|47.19|46.76|39.86|45.17| 31.88 | 47.19 | 39.86 27400007|HC STOMA CONE TUBE IRRIGATOR|0274|A4398|296.06|171.71|||||||||192.44|201.32|216.12|216.12|230.93|177.64|192.44|222.05|251.65|262.90|260.53|222.05|251.65| 177.64 | 262.90 | 222.05 27400008|HC STOMAHESIVE PASTE 2 OZ|0274|A4406|106.03|61.50|||||||||68.92|72.10|77.40|77.40|82.70|63.62|68.92|79.52|90.13|94.15|93.31|79.52|90.13| 63.62 | 94.15 | 79.52 27400009|HC WAFER HOLLIS FLEXTEND COVEX2/3|0274|A4407|13.03|7.56|||||||||8.47|8.86|9.51|9.51|10.16|7.82|8.47|9.77|11.08|11.57|11.47|9.77|11.08| 7.82 | 11.57 | 9.77 27400010|HC BARRIER DURAH MOLD CONVEX SK S|0274|A4407|20.77|12.05|||||||||13.50|14.12|15.16|15.16|16.20|12.46|13.50|15.58|17.65|18.44|18.28|15.58|17.65| 12.46 | 18.44 | 15.58 27400011|HC STOMAHESIVE WAFER 2314 FLG2|0274|A4409|47.79|27.72|||||||||31.06|32.50|34.89|34.89|37.28|28.67|31.06|35.84|40.62|42.44|42.06|35.84|40.62| 28.67 | 42.44 | 35.84 27400012|HC WAFER 2-3/4 FLANGE SHAPR TO FI|0274|A4409|8.23|4.77|||||||||5.35|5.60|6.01|6.01|6.42|4.94|5.35|6.17|7.00|7.31|7.24|6.17|7.00| 4.94 | 7.31 | 6.17 27400013|HC STOMA WAF 4 INCH ACCORD FLANGE|0274|A4410|64.11|37.18|||||||||41.67|43.59|46.80|46.80|50.01|38.47|41.67|48.08|54.49|56.93|56.42|48.08|54.49| 38.47 | 56.93 | 48.08 27400014|HC RINGS BARRIER CONVEX MED|0274|A4411|18.01|10.45|||||||||11.71|12.25|13.15|13.15|14.05|10.81|11.71|13.51|15.31|15.99|15.85|13.51|15.31| 10.81 | 15.99 | 13.51 27400015|HC RINGS BARRIER CONVEX SMALL|0274|A4411|19.39|11.25|||||||||12.60|13.19|14.15|14.15|15.12|11.63|12.60|14.54|16.48|17.22|17.06|14.54|16.48| 11.63 | 17.22 | 14.54 27400016|HC POUCHES HIGH OUTPUT DRAINABLE|0274|A4412|53.46|31.01|||||||||34.75|36.35|39.03|39.03|41.70|32.08|34.75|40.10|45.44|47.47|47.04|40.10|45.44| 32.08 | 47.47 | 40.10 27400017|HC POUCH OUTPUT DRAINABLE|0274|A4412|13.41|7.78|||||||||8.72|9.12|9.79|9.79|10.46|8.05|8.72|10.06|11.40|11.91|11.80|10.06|11.40| 8.05 | 11.91 | 10.06 27400018|HC POUCH HIGH OUTPUT 1-3/4 INCH|0274|A4412|12.77|7.41|||||||||8.30|8.68|9.32|9.32|9.96|7.66|8.30|9.58|10.85|11.34|11.24|9.58|10.85| 7.66 | 11.34 | 9.58 27400019|HC POUCH ACTIVE LIFE DRALNABLE|0274|A4424|40.04|23.22|||||||||26.03|27.23|29.23|29.23|31.23|24.02|26.03|30.03|34.03|35.56|35.24|30.03|34.03| 24.02 | 35.56 | 30.03 27400020|HC POUCH,OVL,CUT-FIT SOF FLX DRB|0274|A4424|9.92|5.75|||||||||6.45|6.75|7.24|7.24|7.74|5.95|6.45|7.44|8.43|8.81|8.73|7.44|8.43| 5.95 | 8.81 | 7.44 27400021|HC BAG LOCK N ROLL CLOSURE 2 3/4I|0274|A4425|10.41|6.04|||||||||6.77|7.08|7.60|7.60|8.12|6.25|6.77|7.81|8.85|9.24|9.16|7.81|8.85| 6.25 | 9.24 | 7.81 27400022|HC ES DRBL POUCH W CL&INVIS TAIL|0274|A4425|13.73|7.96|||||||||8.92|9.34|10.02|10.02|10.71|8.24|8.92|10.30|11.67|12.19|12.08|10.30|11.67| 8.24 | 12.19 | 10.30 27400023|HC POUCH W/FILTER RT STOMA SMALL-|0274|A4425|9.33|5.41|||||||||6.06|6.34|6.81|6.81|7.28|5.60|6.06|7.00|7.93|8.29|8.21|7.00|7.93| 5.60 | 8.29 | 7.00 27400024|HC POUCH UROS FLAT BARRIER TRANPA|0274|A4428|19.54|11.33|||||||||12.70|13.29|14.26|14.26|15.24|11.72|12.70|14.66|16.61|17.35|17.20|14.66|16.61| 11.72 | 17.35 | 14.66 27400025|HC POUCHES UROSTOMY W/CONVEX BARR|0274|A4430|47.69|27.66|||||||||31.00|32.43|34.81|34.81|37.20|28.61|31.00|35.77|40.54|42.35|41.97|35.77|40.54| 28.61 | 42.35 | 35.77 27400026|HC POUCH UROSTOMY SURFIT2 3/4F|0274|A4432|39.59|22.96|||||||||25.73|26.92|28.90|28.90|30.88|23.75|25.73|29.69|33.65|35.16|34.84|29.69|33.65| 23.75 | 35.16 | 29.69 27400027|HC CAP STOMA BEIGE (30 PER BX)|0274|A5055|8.88|5.15|||||||||5.77|6.04|6.48|6.48|6.93|5.33|5.77|6.66|7.55|7.89|7.81|6.66|7.55| 5.33 | 7.89 | 6.66 27400028|HC DRAIN/TUBE VERT DEV ATTACHMENT|0274|A5200|25.49|14.78|||||||||16.57|17.33|18.61|18.61|19.88|15.29|16.57|19.12|21.67|22.64|22.43|19.12|21.67| 15.29 | 22.64 | 19.12 27400032|HC CERVICAL COLLAR MED|0274|L0120|113.62|65.90|||||||||73.85|77.26|82.94|82.94|88.62|68.17|73.85|85.22|96.58|100.89|99.99|85.22|96.58| 68.17 | 100.89 | 85.22 27400033|HC CERVICAL COLLAR LG|0274|L0120|113.62|65.90|||||||||73.85|77.26|82.94|82.94|88.62|68.17|73.85|85.22|96.58|100.89|99.99|85.22|96.58| 68.17 | 100.89 | 85.22 27400034|HC CERIVCAL COLLAR MD XLONG|0274|L0120|113.62|65.90|||||||||73.85|77.26|82.94|82.94|88.62|68.17|73.85|85.22|96.58|100.89|99.99|85.22|96.58| 68.17 | 100.89 | 85.22 27400035|HC CERVICAL COLLAR LG XLONG|0274|L0120|113.62|65.90|||||||||73.85|77.26|82.94|82.94|88.62|68.17|73.85|85.22|96.58|100.89|99.99|85.22|96.58| 68.17 | 100.89 | 85.22 27400036|HC PHILADEL COLLAR SM|0274|L0172|427.80|248.12|||||||||278.07|290.90|312.29|312.29|333.68|256.68|278.07|320.85|363.63|379.89|376.46|320.85|363.63| 256.68 | 379.89 | 320.85 27400037|HC PHILADEL COLLAR MD|0274|L0172|427.80|248.12|||||||||278.07|290.90|312.29|312.29|333.68|256.68|278.07|320.85|363.63|379.89|376.46|320.85|363.63| 256.68 | 379.89 | 320.85 27400038|HC PHILADEL COLLAR LG|0274|L0172|427.80|248.12|||||||||278.07|290.90|312.29|312.29|333.68|256.68|278.07|320.85|363.63|379.89|376.46|320.85|363.63| 256.68 | 379.89 | 320.85 27400039|HC LO FLEXIBL L1-BELOW L5 PRE|0274|L0625|117.46|68.13|||||||||76.35|79.87|85.75|85.75|91.62|70.48|76.35|88.10|99.84|104.30|103.36|88.10|99.84| 70.48 | 104.30 | 88.10 27400040|HC PREFAB ELASTIC KO W JNTS|0274|L1810|126.77|73.53|||||||||82.40|86.20|92.54|92.54|98.88|76.06|82.40|95.08|107.75|112.57|111.56|95.08|107.75| 76.06 | 112.57 | 95.08 27400041|HC KO ADJ JNT POS RIGID SUPPORT|0274|L1832|710.80|412.26|||||||||462.02|483.34|518.88|518.88|554.42|426.48|462.02|533.10|604.18|631.19|625.50|533.10|604.18| 426.48 | 631.19 | 533.10 27400042|HC PREFAB MULTILIGAM SUPPORT AFO|0274|L1906|140.04|81.22|||||||||91.03|95.23|102.23|102.23|109.23|84.02|91.03|105.03|119.03|124.36|123.24|105.03|119.03| 84.02 | 124.36 | 105.03 27400043|HC HEEL LIFT TAPR TO METATARS PER|0274|L3300|64.38|37.34|||||||||41.85|43.78|47.00|47.00|50.22|38.63|41.85|48.29|54.72|57.17|56.65|48.29|54.72| 38.63 | 57.17 | 48.29 27400044|HC IMMOBILIZER SHOULDR VEL-MED|0274|L3650|68.29|39.61|||||||||44.39|46.44|49.85|49.85|53.27|40.97|44.39|51.22|58.05|60.64|60.10|51.22|58.05| 40.97 | 60.64 | 51.22 27400045|HC EO W/O JOINTS CF|0274|L3702|616.54|357.59|||||||||400.75|419.25|450.07|450.07|480.90|369.92|400.75|462.41|524.06|547.49|542.56|462.41|524.06| 369.92 | 547.49 | 462.41 27400046|HC WHFO W/JOINT(S) CUSTOM FAB.|0274|L3806|583.37|338.35|||||||||379.19|396.69|425.86|425.86|455.03|350.02|379.19|437.53|495.86|518.03|513.37|437.53|495.86| 350.02 | 518.03 | 437.53 27400047|HC PREFAB WHFO W/O JNTS|0274|L3807|269.83|156.50|||||||||175.39|183.48|196.98|196.98|210.47|161.90|175.39|202.37|229.36|239.61|237.45|202.37|229.36| 161.90 | 239.61 | 202.37 27400048|HC WHFO RIGID W/O JOINTS|0274|L3808|470.54|272.91|||||||||305.85|319.97|343.49|343.49|367.02|282.32|305.85|352.91|399.96|417.84|414.08|352.91|399.96| 282.32 | 417.84 | 352.91 27400049|HC WHO W/O JOINTS CF|0274|L3906|465.23|269.83|||||310.75|316.97|316.97|323.18|302.40|316.36|339.62|339.62|362.88|279.14|302.40|348.92|395.45|413.12|409.40|348.92|395.45| 279.14 | 413.12 | 339.62 27400050|HC WHFO - PREFAB WRIST COCK-UP|0274|L3908|99.56|57.74|||||49.87|50.87|50.87|51.87|64.71|67.70|72.68|72.68|77.66|59.74|64.71|74.67|84.63|88.41|87.61|74.67|84.63| 49.87 | 88.41 | 72.68 27400051|HC HFO W/O JOINTS CF|0274|L3913|522.31|302.94|||||||||339.50|355.17|381.29|381.29|407.40|313.39|339.50|391.73|443.96|463.81|459.63|391.73|443.96| 313.39 | 463.81 | 391.73 27400052|HC HFO W/O JOINTS PF|0274|L3923|127.09|73.71|||||||||82.61|86.42|92.78|92.78|99.13|76.25|82.61|95.32|108.03|112.86|111.84|95.32|108.03| 76.25 | 112.86 | 95.32 27400053|HC FO PIP/DIP W/O JOINT/SPRING|0274|L3927|39.83|23.10|||||||||25.89|27.08|29.08|29.08|31.07|23.90|25.89|29.87|33.86|35.37|35.05|29.87|33.86| 23.90 | 35.37 | 29.87 27400054|HC HFO NONTORSION JOINT PREFAB|0274|L3929|109.86|63.72|||||||||71.41|74.70|80.20|80.20|85.69|65.92|71.41|82.40|93.38|97.56|96.68|82.40|93.38| 65.92 | 97.56 | 82.40 27400055|HC WHFO NONTORSION JOINT PREFAB|0274|L3931|244.34|141.72|||||||||158.82|166.15|178.37|178.37|190.59|146.60|158.82|183.26|207.69|216.97|215.02|183.26|207.69| 146.60 | 216.97 | 183.26 27400056|HC FO W/O JOINTS CF|0274|L3933|463.90|269.06|||||||||301.54|315.45|338.65|338.65|361.84|278.34|301.54|347.93|394.32|411.94|408.23|347.93|394.32| 278.34 | 411.94 | 347.93 27400057|HC SEWHO AIRPLANE DESIGNE|0274|L3960|915.20|530.82|||||||||594.88|622.34|668.10|668.10|713.86|549.12|594.88|686.40|777.92|812.70|805.38|686.40|777.92| 549.12 | 812.70 | 686.40 27400058|HC BOOT AIR EQUALIZER WALKER|0274|L4386|371.53|215.49|||||||||241.49|252.64|271.22|271.22|289.79|222.92|241.49|278.65|315.80|329.92|326.95|278.65|315.80| 222.92 | 329.92 | 278.65 27400059|HC UNLISTED PROC UE ORTHOSIS|0274|L3999|155.73|90.32|||||||||101.22|105.90|113.68|113.68|121.47|93.44|101.22|116.80|132.37|138.29|137.04|116.80|132.37| 93.44 | 138.29 | 116.80 27400060|HC BARRIER SENSURA XPRO WAFERS 3/|0274|A4408|41.25|23.93|||||||||26.81|28.05|30.11|30.11|32.18|24.75|26.81|30.94|35.06|36.63|36.30|30.94|35.06| 24.75 | 36.63 | 30.94 27400061|HC POUCH EAKIN FISTULA & WOUND|0274|A6154|64.28|37.28|||||||||41.78|43.71|46.92|46.92|50.14|38.57|41.78|48.21|54.64|57.08|56.57|48.21|54.64| 38.57 | 57.08 | 48.21 27400062|HC CATHETER, ABLATION OF BONE TUMORS|0274|C1886|14,464.53|8,389.43|||||||||9401.94|9835.88|10559.11|10559.11|11282.33|8678.72|9401.94|10848.40|12294.85|12844.50|12728.79|10848.40|12294.85| 8,678.72 | 12,844.50 | 10,848.40 27500000|HC INSYNC|0275|C2621|29,506.42|17,113.72|||||||||19179.17|20064.37|21539.69|21539.69|23015.01|17703.85|19179.17|22129.82|25080.46|26201.70|25965.65|22129.82|25080.46| 17,703.85 | 26,201.70 | 22,129.82 27500001|HC PACEMAKER-SINGLE RATE RESPONSE|0275|C1786|25,542.66|14,814.74|||||||||16602.73|17369.01|18646.14|18646.14|19923.27|15325.60|16602.73|19157.00|21711.26|22681.88|22477.54|19157.00|21711.26| 15,325.60 | 22,681.88 | 19,157.00 27500002|HC PACEMAKER-DUAL RATE RESPONSE|0275|C1785|21,490.15|12,464.29|||||||||13968.60|14613.30|15687.81|15687.81|16762.32|12894.09|13968.60|16117.61|18266.63|19083.25|18911.33|16117.61|18266.63| 12,894.09 | 19,083.25 | 16,117.61 27500003|HC IMPL SGL CHAMBR RR PACEMAKER-LEADLESS SINGLE|0275|C1786|16,931.25|9,820.13|||||||||11005.31|11513.25|12359.81|12359.81|13206.38|10158.75|11005.31|12698.44|14391.56|15034.95|14899.50|12698.44|14391.56| 10,158.75 | 15,034.95 | 12,698.44 27500004|HC IMPL SGL CHAMBR RR PACEMAKER-LEADLESS DUAL|0275|C1786|20,868.75|12,103.88|||||||||13564.69|14190.75|15234.19|15234.19|16277.63|12521.25|13564.69|15651.56|17738.44|18531.45|18364.50|15651.56|17738.44| 12,521.25 | 18,531.45 | 15,651.56 27600000|HC IOL RESTORE LENS|0276|V2788|1,309.74|759.65|||||||||851.33|890.62|956.11|956.11|1021.60|785.84|851.33|982.31|1113.28|1163.05|1152.57|982.31|1113.28| 785.84 | 1,163.05 | 982.31 27600001|HC IOL NATURAL LENS|0276|C1780|537.80|311.92|||||||||349.57|365.70|392.59|392.59|419.48|322.68|349.57|403.35|457.13|477.57|473.26|403.35|457.13| 322.68 | 477.57 | 403.35 27600002|HC IOL TORIC LENS|0276|V2787|468.56|271.76|||||||||304.56|318.62|342.05|342.05|365.48|281.14|304.56|351.42|398.28|416.08|412.33|351.42|398.28| 281.14 | 416.08 | 351.42 27800000|HC ANCHOR/SCREW IMPLANTABLE|0278|C1713|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800001|HC PERIPHERAL ATHRECTOMY CATHETER|0278|C1714|16,980.63|9,848.77|||||||||11037.41|11546.83|12395.86|12395.86|13244.89|10188.38|11037.41|12735.47|14433.54|15078.80|14942.95|12735.47|14433.54| 10,188.38 | 15,078.80 | 12,735.47 27800002|HC DEFIBRILLATOR-DUAL CHAMBER|0278|C1721|72,046.70|41,787.09|||||||||46830.36|48991.76|52594.09|52594.09|56196.43|43228.02|46830.36|54035.03|61239.70|63977.47|63401.10|54035.03|61239.70| 43,228.02 | 63,977.47 | 54,035.03 27800003|HC DEFRILLATOR-SINGLE CHAMBER|0278|C1722|40,483.65|23,480.52|||||||||26314.37|27528.88|29553.06|29553.06|31577.25|24290.19|26314.37|30362.74|34411.10|35949.48|35625.61|30362.74|34411.10| 24,290.19 | 35,949.48 | 30,362.74 27800004|HC ROTATIONAL ATHERECTOMY CATHETE|0278|C1724|16,980.63|9,848.77|||||||||11037.41|11546.83|12395.86|12395.86|13244.89|10188.38|11037.41|12735.47|14433.54|15078.80|14942.95|12735.47|14433.54| 10,188.38 | 15,078.80 | 12,735.47 27800005|HC CARDIAC BALLOONS|0278|C1725|1,404.86|814.82|||||||||913.16|955.30|1025.55|1025.55|1095.79|842.92|913.16|1053.65|1194.13|1247.52|1236.28|1053.65|1194.13| 842.92 | 1,247.52 | 1,053.65 27800006|HC PERIPHERAL BALLOON|0278|C1725|1,873.13|1,086.42|||||||||1217.53|1273.73|1367.38|1367.38|1461.04|1123.88|1217.53|1404.85|1592.16|1663.34|1648.35|1404.85|1592.16| 1,123.88 | 1,663.34 | 1,404.85 27800007|HC CATH, BAL DIL, NON VASCULAR|0278|C1726|1,809.34|1,049.42|||||||||1176.07|1230.35|1320.82|1320.82|1411.29|1085.60|1176.07|1357.01|1537.94|1606.69|1592.22|1357.01|1537.94| 1,085.60 | 1,606.69 | 1,357.01 27800008|HC DRAINAGE CATHETER|0278|C1729|673.17|390.44|||||||||437.56|457.76|491.41|491.41|525.07|403.90|437.56|504.88|572.19|597.77|592.39|504.88|572.19| 403.90 | 597.77 | 504.88 27800009|HC DRAIN-G/J TUBE|0278|C1729|2,376.27|1,378.24|||||||||1544.58|1615.86|1734.68|1734.68|1853.49|1425.76|1544.58|1782.20|2019.83|2110.13|2091.12|1782.20|2019.83| 1,425.76 | 2,110.13 | 1,782.20 27800010|HC EP CATHETER DIAG-QUAD|0278|C1730|482.59|279.90|||||||||313.68|328.16|352.29|352.29|376.42|289.55|313.68|361.94|410.20|428.54|424.68|361.94|410.20| 289.55 | 428.54 | 361.94 27800011|HC CATH EP 19 OR FEW ELECTRODES-2|0278|C1730|2,144.15|1,243.61|||||||||1393.70|1458.02|1565.23|1565.23|1672.44|1286.49|1393.70|1608.11|1822.53|1904.01|1886.85|1608.11|1822.53| 1,286.49 | 1,904.01 | 1,608.11 27800012|HC CATH EP 19 OR FEW ELECTRODES-3|0278|C1730|4,193.50|2,432.23|||||||||2725.78|2851.58|3061.26|3061.26|3270.93|2516.10|2725.78|3145.13|3564.48|3723.83|3690.28|3145.13|3564.48| 2,516.10 | 3,723.83 | 3,145.13 27800013|HC CATH EP 20 OR MORE ELECTRODES-|0278|C1731|4,375.82|2,537.98|||||||||2844.28|2975.56|3194.35|3194.35|3413.14|2625.49|2844.28|3281.87|3719.45|3885.73|3850.72|3281.87|3719.45| 2,625.49 | 3,885.73 | 3,281.87 27800014|HC CATH EP DIAG/ABL 3D/VECT-1|0278|C1732|4,109.63|2,383.59|||||||||2671.26|2794.55|3000.03|3000.03|3205.51|2465.78|2671.26|3082.22|3493.19|3649.35|3616.47|3082.22|3493.19| 2,465.78 | 3,649.35 | 3,082.22 27800015|HC CATH EP DIAG/ABL 3D/VECT-2|0278|C1732|8,569.32|4,970.21|||||||||5570.06|5827.14|6255.60|6255.60|6684.07|5141.59|5570.06|6426.99|7283.92|7609.56|7541.00|6426.99|7283.92| 5,141.59 | 7,609.56 | 6,426.99 27800016|HC CATH EP DIAG/ABL 3D/VECT-3|0278|C1732|10,363.42|6,010.78|||||||||6736.22|7047.13|7565.30|7565.30|8083.47|6218.05|6736.22|7772.57|8808.91|9202.72|9119.81|7772.57|8808.91| 6,218.05 | 9,202.72 | 7,772.57 27800017|HC CATHETER-ABLATION-SMART TOUCH|0278|C1732|12,507.57|7,254.39|||||||||8129.92|8505.15|9130.53|9130.53|9755.90|7504.54|8129.92|9380.68|10631.43|11106.72|11006.66|9380.68|10631.43| 7,504.54 | 11,106.72 | 9,380.68 27800018|HC ABLATION CATHETER|0278|C1733|2,692.35|1,561.56|||||||||1750.03|1830.80|1965.42|1965.42|2100.03|1615.41|1750.03|2019.26|2288.50|2390.81|2369.27|2019.26|2288.50| 1,615.41 | 2,390.81 | 2,019.26 27800019|HC DIALYSIS CATHETER-TUNNELED|0278|C1750|2,048.63|1,188.21|||||||||1331.61|1393.07|1495.50|1495.50|1597.93|1229.18|1331.61|1536.47|1741.34|1819.18|1802.79|1536.47|1741.34| 1,229.18 | 1,819.18 | 1,536.47 27800020|HC INF CATH-MTI,GRAGG MCNAMARA|0278|C1751|1,170.71|679.01|||||||||760.96|796.08|854.62|854.62|913.15|702.43|760.96|878.03|995.10|1039.59|1030.22|878.03|995.10| 702.43 | 1,039.59 | 878.03 27800021|HC INF CATH-MERCI, RENEGADE|0278|C1751|3,804.80|2,206.78|||||||||2473.12|2587.26|2777.50|2777.50|2967.74|2282.88|2473.12|2853.60|3234.08|3378.66|3348.22|2853.60|3234.08| 2,282.88 | 3,378.66 | 2,853.60 27800022|HC INF CATH-CENTRAL VENOUS LINE|0278|C1751|1,990.21|1,154.32|||||||||1293.64|1353.34|1452.85|1452.85|1552.36|1194.13|1293.64|1492.66|1691.68|1767.31|1751.38|1492.66|1691.68| 1,194.13 | 1,767.31 | 1,492.66 27800023|HC DIALYSIS CATHETER-NON TUNNELED|0278|C1752|1,422.42|825.00|||||||||924.57|967.25|1038.37|1038.37|1109.49|853.45|924.57|1066.82|1209.06|1263.11|1251.73|1066.82|1209.06| 853.45 | 1,263.11 | 1,066.82 27800024|HC IVUS CATHETER-PIONEER|0278|C1753|18,731.32|10,864.17|||||||||12175.36|12737.30|13673.86|13673.86|14610.43|11238.79|12175.36|14048.49|15921.62|16633.41|16483.56|14048.49|15921.62| 11,238.79 | 16,633.41 | 14,048.49 27800025|HC IVUS CATHETER|0278|C1753|3,707.30|2,150.23|||||||||2409.75|2520.96|2706.33|2706.33|2891.69|2224.38|2409.75|2780.48|3151.21|3292.08|3262.42|2780.48|3151.21| 2,224.38 | 3,292.08 | 2,780.48 27800026|HC THROMBECTOMY-MANUAL|0278|C1757|2,487.74|1,442.89|||||||||1617.03|1691.66|1816.05|1816.05|1940.44|1492.64|1617.03|1865.81|2114.58|2209.11|2189.21|1865.81|2114.58| 1,492.64 | 2,209.11 | 1,865.81 27800027|HC THROMBECTOMY-CARDIAC-ANGIOJET|0278|C1757|9,699.74|5,625.85|||||||||6304.83|6595.82|7080.81|7080.81|7565.80|5819.84|6304.83|7274.81|8244.78|8613.37|8535.77|7274.81|8244.78| 5,819.84 | 8,613.37 | 7,274.81 27800028|HC THROMBECTOMY-PERIPH-ANGIOJET|0278|C1757|8,216.83|4,765.76|||||||||5340.94|5587.44|5998.29|5998.29|6409.13|4930.10|5340.94|6162.62|6984.31|7296.55|7230.81|6162.62|6984.31| 4,930.10 | 7,296.55 | 6,162.62 27800029|HC THROMBECTOMY-FOGARTY|0278|C1757|497.54|288.57|||||||||323.40|338.33|363.20|363.20|388.08|298.52|323.40|373.16|422.91|441.82|437.84|373.16|422.91| 298.52 | 441.82 | 373.16 27800030|HC THROMBECTOMY CATH-PERIPH-TRELL|0278|C1757|8,342.29|4,838.53|||||||||5422.49|5672.76|6089.87|6089.87|6506.99|5005.37|5422.49|6256.72|7090.95|7407.95|7341.22|6256.72|7090.95| 5,005.37 | 7,407.95 | 6,256.72 27800031|HC THROMBECTOMY-PERIPHERAL-TREVO|0278|C1757|14,524.35|8,424.12|||||||||9440.83|9876.56|10602.78|10602.78|11328.99|8714.61|9440.83|10893.26|12345.70|12897.62|12781.43|10893.26|12345.70| 8,714.61 | 12,897.62 | 10,893.26 27800032|HC PERIPHERAL-MAX SEPARATORS|0278|C1757|11,448.26|6,639.99|||||||||7441.37|7784.82|8357.23|8357.23|8929.64|6868.96|7441.37|8586.20|9731.02|10166.05|10074.47|8586.20|9731.02| 6,868.96 | 10,166.05 | 8,586.20 27800033|HC CATH INTRA ECHOCARDIOGRAPHY|0278|C1759|10,006.05|5,803.51|||||||||6503.93|6804.11|7304.42|7304.42|7804.72|6003.63|6503.93|7504.54|8505.14|8885.37|8805.32|7504.54|8505.14| 6,003.63 | 8,885.37 | 7,504.54 27800034|HC CONNECT TISSUE HUMAN (INCL FAS|0278|C1762|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800035|HC LOOP RECORDER|0278|C1764|14,221.42|8,248.42|||||||||9243.92|9670.57|10381.64|10381.64|11092.71|8532.85|9243.92|10666.07|12088.21|12628.62|12514.85|10666.07|12088.21| 8,532.85 | 12,628.62 | 10,666.07 27800036|HC EP STEERABLE GUDNG INTRDCR/SHE|0278|C1766|3,825.01|2,218.51|||||||||2486.26|2601.01|2792.26|2792.26|2983.51|2295.01|2486.26|2868.76|3251.26|3396.61|3366.01|2868.76|3251.26| 2,295.01 | 3,396.61 | 2,868.76 27800037|HC GENERATOR,NEUROSTIM (IMPLANTAB|0278|C1767|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800038|HC GRAFT,VASCULAR|0278|C1768|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800039|HC GUIDE WIRE-CORONARY INTERVENTI|0278|C1769|585.35|339.50|||||||||380.48|398.04|427.31|427.31|456.57|351.21|380.48|439.01|497.55|519.79|515.11|439.01|497.55| 351.21 | 519.79 | 439.01 27800040|HC GUIDE WIRE--A|0278|C1769|339.51|196.92|||||||||220.68|230.87|247.84|247.84|264.82|203.71|220.68|254.63|288.58|301.48|298.77|254.63|288.58| 203.71 | 301.48 | 254.63 27800041|HC GUIDE WIRE--B|0278|C1769|643.89|373.46|||||||||418.53|437.85|470.04|470.04|502.23|386.33|418.53|482.92|547.31|571.77|566.62|482.92|547.31| 386.33 | 571.77 | 482.92 27800042|HC ATHERECTOMY/TOTOBLATOR WIRE|0278|C1769|907.29|526.23|||||||||589.74|616.96|662.32|662.32|707.69|544.37|589.74|680.47|771.20|805.67|798.42|680.47|771.20| 544.37 | 805.67 | 680.47 27800043|HC TRANSEND WIRE|0278|C1769|1,258.52|729.94|||||||||818.04|855.79|918.72|918.72|981.65|755.11|818.04|943.89|1069.74|1117.57|1107.50|943.89|1069.74| 755.11 | 1,117.57 | 943.89 27800044|HC RADI|0278|C1769|3,901.78|2,263.03|||||||||2536.16|2653.21|2848.30|2848.30|3043.39|2341.07|2536.16|2926.34|3316.51|3464.78|3433.57|2926.34|3316.51| 2,341.07 | 3,464.78 | 2,926.34 27800045|HC GUIDEWIRE-JAG WIRE STRAIGHT|0278|C1769|1,103.28|639.90|||||||||717.13|750.23|805.39|805.39|860.56|661.97|717.13|827.46|937.79|979.71|970.89|827.46|937.79| 661.97 | 979.71 | 827.46 27800046|HC GUIDEWIRE-JAG WIRE ANGLE|0278|C1769|1,253.14|726.82|||||||||814.54|852.14|914.79|914.79|977.45|751.88|814.54|939.86|1065.17|1112.79|1102.76|939.86|1065.17| 751.88 | 1,112.79 | 939.86 27800047|HC GUIDE WIRE|0278|C1769|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800048|HC REP DEV URIN INCON W/SLING GRA|0278|C1771|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800049|HC INFUSION PUMP, PROGRAMMABLE|0278|C1772|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800050|HC RETRIEVAL DEVICE-MERCI|0278|C1773|18,321.57|10,626.51|||||||||11909.02|12458.67|13374.75|13374.75|14290.82|10992.94|11909.02|13741.18|15573.33|16269.55|16122.98|13741.18|15573.33| 10,992.94 | 16,269.55 | 13,741.18 27800051|HC RETRIEVAL DEVICE-GOOSE NECK SN|0278|C1773|1,843.87|1,069.44|||||||||1198.52|1253.83|1346.03|1346.03|1438.22|1106.32|1198.52|1382.90|1567.29|1637.36|1622.61|1382.90|1567.29| 1,106.32 | 1,637.36 | 1,382.90 27800052|HC RETRIEVAL DEVICE-IVS RECOVERY|0278|C1773|3,345.07|1,940.14|||||||||2174.30|2274.65|2441.90|2441.90|2609.15|2007.04|2174.30|2508.80|2843.31|2970.42|2943.66|2508.80|2843.31| 2,007.04 | 2,970.42 | 2,508.80 27800053|HC JOINT DEVICE (IMPLANTABLE)|0278|C1776|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800054|HC LEAD,NEUROSTIMULATOR(IMPLANTAB|0278|C1778|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800055|HC MESH (IMPLANTABLE)|0278|C1781|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800056|HC PT PROGRAMMER,NEUROSTIMULATOR|0278|C1787|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800057|HC PORT, INDWELLING, IMP|0278|C1788|1,194.61|692.87|||||||||776.50|812.33|872.07|872.07|931.80|716.77|776.50|895.96|1015.42|1060.81|1051.26|895.96|1015.42| 716.77 | 1,060.81 | 895.96 27800058|HC ENLARGE BREAST W IMPLANT|0278|C1789|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800059|HC PFO-SEPTAL DEFECT IMPL SYSTEM|0278|C1817|15,627.94|9,064.21|||||||||10158.16|10627.00|11408.40|11408.40|12189.79|9376.76|10158.16|11720.96|13283.75|13877.61|13752.59|11720.96|13283.75| 9,376.76 | 13,877.61 | 11,720.96 27800060|HC GEN,NEUROSTIM(IMP) W RECHR&CHR|0278|C1820|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800061|HC STENT-CARDIAC-DES|0278|C1874|12,264.46|7,113.39|50,953.75|48,406.06|||||||7971.90|8339.83|8953.06|8953.06|9566.28|7358.68|7971.90|9198.35|10424.79|10890.84|10792.72|9198.35|10424.79| 7,358.68 | 50,953.75 | 9,198.35 27800062|HC COVERED PERIPHERAL STENT|0278|C1874|13,230.00|7,673.40|50,953.75|48,406.06|||||||8599.50|8996.40|9657.90|9657.90|10319.40|7938.00|8599.50|9922.50|11245.50|11748.24|11642.40|9922.50|11245.50| 7,938.00 | 50,953.75 | 9,922.50 27800063|HC COVERED CARDIAC STENT|0278|C1874|14,048.50|8,148.13|50,953.75|48,406.06|||||||9131.53|9552.98|10255.41|10255.41|10957.83|8429.10|9131.53|10536.38|11941.23|12475.07|12362.68|10536.38|11941.23| 8,429.10 | 50,953.75 | 10,536.38 27800064|HC PERIPHERAL DES|0278|C1874|9,079.09|5,265.87|50,953.75|48,406.06|||||||5901.41|6173.78|6627.74|6627.74|7081.69|5447.45|5901.41|6809.32|7717.23|8062.23|7989.60|6809.32|7717.23| 5,447.45 | 50,953.75 | 6,809.32 27800065|HC STENT VASCULAR-CARDIAC-BARE ME|0278|C1876|4,683.35|2,716.34|11,013.51|10,462.83|||||||3044.18|3184.68|3418.85|3418.85|3653.01|2810.01|3044.18|3512.51|3980.85|4158.81|4121.35|3512.51|3980.85| 2,810.01 | 11,013.51 | 3,512.51 27800066|HC STENT VASCUL-PERIPHERAL<100 SH|0278|C1876|7,526.41|4,365.32|11,013.51|10,462.83|||||||4892.17|5117.96|5494.28|5494.28|5870.60|4515.85|4892.17|5644.81|6397.45|6683.45|6623.24|5644.81|6397.45| 4,515.85 | 11,013.51 | 5,644.81 27800067|HC STENT VASCU-PERIPHERAL >100 SH|0278|C1876|12,264.46|7,113.39|11,013.51|10,462.83|||||||7971.90|8339.83|8953.06|8953.06|9566.28|7358.68|7971.90|9198.35|10424.79|10890.84|10792.72|9198.35|10424.79| 7,358.68 | 11,013.51 | 9,198.35 27800068|HC STENT VASCULAR-CAROTID|0278|C1876|14,215.35|8,244.90|11,013.51|10,462.83|||||||9239.98|9666.44|10377.21|10377.21|11087.97|8529.21|9239.98|10661.51|12083.05|12623.23|12509.51|10661.51|12083.05| 8,529.21 | 12,623.23 | 10,661.51 27800069|HC STENT NON-COA/NON-COV W/DEL|0278|C1876|0.00|0.00|11013.51|10462.8345|||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | 11,013.51 | - 27800070|HC MATERIAL VOCAL CORD MED SYN-IM|0278|C1878|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800071|HC IVC FILTER|0278|C1880|3,937.50|2,283.75|||||||||2559.38|2677.50|2874.38|2874.38|3071.25|2362.50|2559.38|2953.13|3346.88|3496.50|3465.00|2953.13|3346.88| 2,362.50 | 3,496.50 | 2,953.13 27800072|HC INSYNC DEFIBRILLATOR|0278|C1882|65,159.65|37,792.60|||||||||42353.77|44308.56|47566.54|47566.54|50824.53|39095.79|42353.77|48869.74|55385.70|57861.77|57340.49|48869.74|55385.70| 39,095.79 | 57,861.77 | 48,869.74 27800073|HC EMBOLIC PROTECTION DEVICE|0278|C1884|8,362.68|4,850.35|||||||||5435.74|5686.62|6104.76|6104.76|6522.89|5017.61|5435.74|6272.01|7108.28|7426.06|7359.16|6272.01|7108.28| 5,017.61 | 7,426.06 | 6,272.01 27800074|HC GUIDE CATH-CORONARY INTERVENTI|0278|C1887|292.68|169.75|||||||||190.24|199.02|213.66|213.66|228.29|175.61|190.24|219.51|248.78|259.90|257.56|219.51|248.78| 175.61 | 259.90 | 219.51 27800075|HC CATHETER/SHEATH--A|0278|C1887|439.02|254.63|||||||||285.36|298.53|320.48|320.48|342.44|263.41|285.36|329.27|373.17|389.85|386.34|329.27|373.17| 263.41 | 389.85 | 329.27 27800076|HC CATHETHER/SHEATH--B|0278|C1887|702.43|407.41|||||||||456.58|477.65|512.77|512.77|547.90|421.46|456.58|526.82|597.07|623.76|618.14|526.82|597.07| 421.46 | 623.76 | 526.82 27800077|HC CATHETER/SHEATH--C|0278|C1887|3,345.07|1,940.14|||||||||2174.30|2274.65|2441.90|2441.90|2609.15|2007.04|2174.30|2508.80|2843.31|2970.42|2943.66|2508.80|2843.31| 2,007.04 | 2,970.42 | 2,508.80 27800078|HC CATHETER-CTO-OUTBACK|0278|C1887|11,316.36|6,563.49|||||||||7355.63|7695.12|8260.94|8260.94|8826.76|6789.82|7355.63|8487.27|9618.91|10048.93|9958.40|8487.27|9618.91| 6,789.82 | 10,048.93 | 8,487.27 27800079|HC CATHETER-CTO-FRONTRUNNER|0278|C1887|5,825.91|3,379.03|||||||||3786.84|3961.62|4252.91|4252.91|4544.21|3495.55|3786.84|4369.43|4952.02|5173.41|5126.80|4369.43|4952.02| 3,495.55 | 5,173.41 | 4,369.43 27800080|HC MICRO-CATH-PROGREAT, MICROGUID|0278|C1887|2,036.20|1,181.00|||||||||1323.53|1384.62|1486.43|1486.43|1588.24|1221.72|1323.53|1527.15|1730.77|1808.15|1791.86|1527.15|1730.77| 1,221.72 | 1,808.15 | 1,527.15 27800081|HC CATHETER--5 MAX ACE|0278|C1887|9,005.68|5,223.29|||||||||5853.69|6123.86|6574.15|6574.15|7024.43|5403.41|5853.69|6754.26|7654.83|7997.04|7925.00|6754.26|7654.83| 5,403.41 | 7,997.04 | 6,754.26 27800082|HC CATHETER GUIDING-1|0278|C1887|727.48|421.94|||||||||472.86|494.69|531.06|531.06|567.43|436.49|472.86|545.61|618.36|646.00|640.18|545.61|618.36| 436.49 | 646.00 | 545.61 27800083|HC SHEATH-PEEL-A-WAY|0278|C1892|216.59|125.62|||||||||140.78|147.28|158.11|158.11|168.94|129.95|140.78|162.44|184.10|192.33|190.60|162.44|184.10| 129.95 | 192.33 | 162.44 27800084|HC EP INTRODUCER-FIXED CURVE|0278|C1893|561.21|325.50|||||||||364.79|381.62|409.68|409.68|437.74|336.73|364.79|420.91|477.03|498.35|493.86|420.91|477.03| 336.73 | 498.35 | 420.91 27800085|HC EP INTRACAR FIXCURVE INTRSHEAT|0278|C1893|3,642.87|2,112.86|||||||||2367.87|2477.15|2659.30|2659.30|2841.44|2185.72|2367.87|2732.15|3096.44|3234.87|3205.73|2732.15|3096.44| 2,185.72 | 3,234.87 | 2,732.15 27800086|HC LDS INTRODUCER|0278|C1894|2,020.59|1,171.94|||||||||1313.38|1374.00|1475.03|1475.03|1576.06|1212.35|1313.38|1515.44|1717.50|1794.28|1778.12|1515.44|1717.50| 1,212.35 | 1,794.28 | 1,515.44 27800087|HC ICD LEAD-VENTRICULAR|0278|C1895|21,514.46|12,478.39|||||||||13984.40|14629.83|15705.56|15705.56|16781.28|12908.68|13984.40|16135.85|18287.29|19104.84|18932.72|16135.85|18287.29| 12,908.68 | 19,104.84 | 16,135.85 27800088|HC PACEMAKER LEAD|0278|C1898|4,634.72|2,688.14|||||||||3012.57|3151.61|3383.35|3383.35|3615.08|2780.83|3012.57|3476.04|3939.51|4115.63|4078.55|3476.04|3939.51| 2,780.83 | 4,115.63 | 3,476.04 27800089|HC LEAD DEFIB LV/CS|0278|C1900|7,774.38|4,509.14|||||||||5053.35|5286.58|5675.30|5675.30|6064.02|4664.63|5053.35|5830.79|6608.22|6903.65|6841.45|5830.79|6608.22| 4,664.63 | 6,903.65 | 5,830.79 27800090|HC WALLSTENT-ESOPHAGEAL 100MM|0278|C2617|16,150.46|9,367.27|||||||||10497.80|10982.31|11789.84|11789.84|12597.36|9690.28|10497.80|12112.85|13727.89|14341.61|14212.40|12112.85|13727.89| 9,690.28 | 14,341.61 | 12,112.85 27800091|HC STENT PANCREATIC|0278|C2617|316.80|183.74|||||||||205.92|215.42|231.26|231.26|247.10|190.08|205.92|237.60|269.28|281.32|278.78|237.60|269.28| 190.08 | 281.32 | 237.60 27800092|HC UROLOGY STENT C2617|0278|C2617|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800093|HC STENT,NON-CO,TEMP,W/O DEL SYS|0278|C2617|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800094|HC PROBE, CRYOABLATION|0278|C2618|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800095|HC STENT NON-VASCULAR-URETERAL|0278|C2625|819.51|475.32|||||||||532.68|557.27|598.24|598.24|639.22|491.71|532.68|614.63|696.58|727.72|721.17|614.63|696.58| 491.71 | 727.72 | 614.63 27800096|HC STENT NON-VASCULAR-BILIARY|0278|C2625|9,480.95|5,498.95|||||||||6162.62|6447.05|6921.09|6921.09|7395.14|5688.57|6162.62|7110.71|8058.81|8419.08|8343.24|7110.71|8058.81| 5,688.57 | 8,419.08 | 7,110.71 27800097|HC SUPRAPUBIC CATHETER|0278|C2627|25.32|14.69|||||||||16.46|17.22|18.48|18.48|19.75|15.19|16.46|18.99|21.52|22.48|22.28|18.99|21.52| 15.19 | 22.48 | 18.99 27800098|HC CATHETER, OCCLUSION|0278|C2628|948.10|549.90|||||||||616.27|644.71|692.11|692.11|739.52|568.86|616.27|711.08|805.89|841.91|834.33|711.08|805.89| 568.86 | 841.91 | 711.08 27800099|HC TAPE-VAGINAL-TENSION-FREE|0278|C2631|5,878.12|3,409.31|||||||||3820.78|3997.12|4291.03|4291.03|4584.93|3526.87|3820.78|4408.59|4996.40|5219.77|5172.75|4408.59|4996.40| 3,526.87 | 5,219.77 | 4,408.59 27800101|HC INJ BULK AG,COL,IMPL,UT,2.5ML|0278|L8603|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800102|HC INJ BULK AG,DESTR/HYAL,IMP,UT|0278|L8604|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800103|HC INJ BULK AG,SYN IMP,UT,1ML SYR|0278|L8606|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800104|HC OSSICULA IMPLANT|0278|L8613|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800105|HC AUD OSSEO DEVICE, ALL COMP|0278|L8690|0.00|0.00|||||3924.96|4003.46|4003.46|4081.96|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | 4,081.96 | - 27800106|HC INJ BULK AG,SYN,IMP,UT,1ML SYR|0278|L8606|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800108|HC DRUG COATED BALLOON|0278|C1725|6,381.42|3,701.22|||||||||4147.92|4339.37|4658.44|4658.44|4977.51|3828.85|4147.92|4786.07|5424.21|5666.70|5615.65|4786.07|5424.21| 3,828.85 | 5,666.70 | 4,786.07 27800109|HC DRAIN-GASTRO OR JEJUNOSTOMY|0278|C1729|995.10|577.16|||||||||646.82|676.67|726.42|726.42|776.18|597.06|646.82|746.33|845.84|883.65|875.69|746.33|845.84| 597.06 | 883.65 | 746.33 27800110|HC CATH EP DIAG/ABL 3D/VECT-0|0278|C1732|6,781.31|3,933.16|||||||||4407.85|4611.29|4950.36|4950.36|5289.42|4068.79|4407.85|5085.98|5764.11|6021.80|5967.55|5085.98|5764.11| 4,068.79 | 6,021.80 | 5,085.98 27800111|HC CATH EP OTHR THAN COOL TIP-1|0278|C1733|4,988.43|2,893.29|||||||||3242.48|3392.13|3641.55|3641.55|3890.98|2993.06|3242.48|3741.32|4240.17|4429.73|4389.82|3741.32|4240.17| 2,993.06 | 4,429.73 | 3,741.32 27800112|HC TRANSL ANGIO LASER CATH|0278|C1885|10,064.40|5,837.35|||||||||6541.86|6843.79|7347.01|7347.01|7850.23|6038.64|6541.86|7548.30|8554.74|8937.19|8856.67|7548.30|8554.74| 6,038.64 | 8,937.19 | 7,548.30 27800113|HC CATHETER-CANTATA, FASTTRACKER|0278|C1887|1,403.91|814.27|||||||||912.54|954.66|1024.85|1024.85|1095.05|842.35|912.54|1052.93|1193.32|1246.67|1235.44|1052.93|1193.32| 842.35 | 1,246.67 | 1,052.93 27800114|HC EP INTRACAR FIXCURVE INTRSHEAT|0278|C1893|957.21|555.18|||||||||622.19|650.90|698.76|698.76|746.62|574.33|622.19|717.91|813.63|850.00|842.34|717.91|813.63| 574.33 | 850.00 | 717.91 27800115|HC CATHETER, SUPRAPUBIC/CYSTOSCOP|0278|C2627|490.04|284.22|||||||||318.53|333.23|357.73|357.73|382.23|294.02|318.53|367.53|416.53|435.16|431.24|367.53|416.53| 294.02 | 435.16 | 367.53 27800116|HC CATH TRANSL ANGIO DRUGCOATED NONLASR|0278|C2623|6,700.49|3,886.28|||||||||4355.32|4556.33|4891.36|4891.36|5226.38|4020.29|4355.32|5025.37|5695.42|5950.04|5896.43|5025.37|5695.42| 4,020.29 | 5,950.04 | 5,025.37 27800117|HC CATHETER GUIDING-0|0278|C1887|1,722.99|999.33|||||||||1119.94|1171.63|1257.78|1257.78|1343.93|1033.79|1119.94|1292.24|1464.54|1530.02|1516.23|1292.24|1464.54| 1,033.79 | 1,530.02 | 1,292.24 27800118|HC BRACHYTX NON-STR YTTRIUM-90|0278|C2616|59,729.97|34,643.38|||17397.64|17397.64|||||38824.48|40616.38|43602.88|43602.88|46589.38|35837.98|38824.48|44797.48|50770.47|53040.21|52562.37|44797.48|50770.47| 17,397.64 | 53,040.21 | 43,602.88 27800119|HC BALLOON-SCORING|0278|C1725|4,403.18|2,553.84|||||||||2862.07|2994.16|3214.32|3214.32|3434.48|2641.91|2862.07|3302.39|3742.70|3910.02|3874.80|3302.39|3742.70| 2,641.91 | 3,910.02 | 3,302.39 27800120|HC BALLOON NON-VASCULAR-VALVULOPLASTY|0278|C1726|3,099.55|1,797.74|||||||||2014.71|2107.69|2262.67|2262.67|2417.65|1859.73|2014.71|2324.66|2634.62|2752.40|2727.60|2324.66|2634.62| 1,859.73 | 2,752.40 | 2,324.66 27800121|HC PALLADIUM NONSTRANDED C2641 SE|0278|C2641|310.73|180.22|||69.5|69.5|||||201.97|211.30|226.83|226.83|242.37|186.44|201.97|233.05|264.12|275.93|273.44|233.05|264.12| 69.50 | 275.93 | 226.83 27800122|HC THROMBECTOMY--3 & 4 MAX ACE|0278|C1757|6,470.75|3,753.04|||||||||4205.99|4400.11|4723.65|4723.65|5047.19|3882.45|4205.99|4853.06|5500.14|5746.03|5694.26|4853.06|5500.14| 3,882.45 | 5,746.03 | 4,853.06 27800123|HC THROMBECTOMY 5 MAX ACE|0278|C1757|9,533.82|5,529.62|||||||||6196.98|6483.00|6959.69|6959.69|7436.38|5720.29|6196.98|7150.37|8103.75|8466.03|8389.76|7150.37|8103.75| 5,720.29 | 8,466.03 | 7,150.37 27800124|HC THROMBECTOMY 3.5 INDIGO CATHETER|0278|C1757|4,939.21|2,864.74|||||||||3210.49|3358.66|3605.62|3605.62|3852.58|2963.53|3210.49|3704.41|4198.33|4386.02|4346.50|3704.41|4198.33| 2,963.53 | 4,386.02 | 3,704.41 27800125|HC THROMBECTOMY 3.5 INDIGO SEPARATOR|0278|C1757|3,043.93|1,765.48|||||||||1978.55|2069.87|2222.07|2222.07|2374.27|1826.36|1978.55|2282.95|2587.34|2703.01|2678.66|2282.95|2587.34| 1,826.36 | 2,703.01 | 2,282.95 27800126|HC EP CATHETER DIAG-DECAPOLAR|0278|C1730|1,471.95|853.73|||||||||956.77|1000.93|1074.52|1074.52|1148.12|883.17|956.77|1103.96|1251.16|1307.09|1295.32|1103.96|1251.16| 883.17 | 1,307.09 | 1,103.96 27800127|HC RETRIEVAL DEVICE|0278|C1773|1,133.69|657.54|||||||||736.90|770.91|827.59|827.59|884.28|680.21|736.90|850.27|963.64|1006.72|997.65|850.27|963.64| 680.21 | 1,006.72 | 850.27 27800128|HC HYBRID NON-VASC BALLOON DILATN CATH--VALVLOPLASTY|0278|C1726|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800129|HC HYBRID CATH HEMODIALYSIS LONG-TERM, TUNNELED|0278|C1750|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800130|HC HYBRID MIDLINE INFUSION CATH|0278|C1751|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800131|HC HYBRID CATH HEMODIALYSIS SHORT-TERM, NON TUNNELED|0278|C1752|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800132|HC HYBRID GRAFT VASCULAR--AAA|0278|C1768|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800133|HC HYBRID PORT INDWELLING IMPL|0278|C1788|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800134|HC HYBRID GUIDE WIRE|0278|C1769|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800135|HC HYBRID TRANSLUM ANGIOPL NON-LASER CATH|0278|C1725|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800136|HC HYBRID CATHETER GUIDING|0278|C1887|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800137|HC HYBRID STENT COATED/COV W/DEL SYS|0278|C1874|0.00|0.00|50953.75|48406.0625|||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | 50,953.75 | - 27800138|HC MICRO COVERED BILIARY STENT|0278|C2617|9,780.09|5,672.45|||||||||6357.06|6650.46|7139.47|7139.47|7628.47|5868.05|6357.06|7335.07|8313.08|8684.72|8606.48|7335.07|8313.08| 5,868.05 | 8,684.72 | 7,335.07 27800139|HC W/C NON COVERED BILIARY STENT|0278|C2617|6,846.03|3,970.70|||||||||4449.92|4655.30|4997.60|4997.60|5339.90|4107.62|4449.92|5134.52|5819.13|6079.27|6024.51|5134.52|5819.13| 4,107.62 | 6,079.27 | 5,134.52 27800140|HC WIRELESS PRESSURE SENSOR|0278|C2624|38,027.99|22,056.23|||||||||24718.19|25859.03|27760.43|27760.43|29661.83|22816.79|24718.19|28520.99|32323.79|33768.86|33464.63|28520.99|32323.79| 22,816.79 | 33,768.86 | 28,520.99 27800141|HC FIDUCIAL MARKERS|0278|A4648|335.48|194.58|||||||||218.06|228.13|244.90|244.90|261.67|201.29|218.06|251.61|285.16|297.91|295.22|251.61|285.16| 201.29 | 297.91 | 251.61 27800142|HC LEAD AICD NON SING/DUAL|0278|C1896|16,409.34|9,517.42|||||||||10666.07|11158.35|11978.82|11978.82|12799.29|9845.60|10666.07|12307.01|13947.94|14571.49|14440.22|12307.01|13947.94| 9,845.60 | 14,571.49 | 12,307.01 27800143|HC INTRO/SHEATH NON-LASER|0278|C1894|340.04|197.22|||||||||221.03|231.23|248.23|248.23|265.23|204.02|221.03|255.03|289.03|301.96|299.24|255.03|289.03| 204.02 | 301.96 | 255.03 27800144|HC EPIFIX|0278|q4131|1,092.97|633.92|||||||||710.43|743.22|797.87|797.87|852.52|655.78|710.43|819.73|929.02|970.56|961.81|819.73|929.02| 655.78 | 970.56 | 819.73 27800145|HC APLIGRAF PER SQ CM|0278|Q4101|190.50|110.49|34.48|32.756|||||||123.83|129.54|139.07|139.07|148.59|114.30|123.83|142.88|161.93|169.16|167.64|142.88|161.93| 32.76 | 169.16 | 139.07 27800146|HC OASIS WOUND MATRIX PER SQ CM|0278|Q4102|42.89|24.88|||||||||27.88|29.17|31.31|31.31|33.45|25.73|27.88|32.17|36.46|38.09|37.74|32.17|36.46| 25.73 | 38.09 | 32.17 27800147|HC DERMAGRAFT PER SQ CM|0278|Q4106|215.08|124.75|||||||||139.80|146.25|157.01|157.01|167.76|129.05|139.80|161.31|182.82|190.99|189.27|161.31|182.82| 129.05 | 190.99 | 161.31 27800148|HC PURAPLY, PURAPLY ANTIMIC, SQ CM|0278|Q4172|729.31|423.00|||||||||474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 437.59 | 647.63 | 546.98 27800149|HC GRAFIX PRIME, SQ CM|0278|Q4133|850.86|493.50|||||||||553.06|578.58|621.13|621.13|663.67|510.52|553.06|638.15|723.23|755.56|748.76|638.15|723.23| 510.52 | 755.56 | 638.15 27800150|HC DRAINAGE CATH PLEURX(PLEURAL/PERITONEAL)|0278|C1729|2,990.15|1,734.29|||||||||1943.60|2033.30|2182.81|2182.81|2332.32|1794.09|1943.60|2242.61|2541.63|2655.25|2631.33|2242.61|2541.63| 1,794.09 | 2,655.25 | 2,242.61 27800151|HC KERECIS, PER SQ CM|0278|Q4158|85.09|49.35|||||||||55.31|57.86|62.12|62.12|66.37|51.05|55.31|63.82|72.33|75.56|74.88|63.82|72.33| 51.05 | 75.56 | 63.82 27800152|HC ASD-SEPTAL DEFECT IMPL SYSTEM|0278|C1817|11,501.12|6,670.65|||||||||7475.73|7820.76|8395.82|8395.82|8970.87|6900.67|7475.73|8625.84|9775.95|10212.99|10120.99|8625.84|9775.95| 6,900.67 | 10,212.99 | 8,625.84 27800153|HC CATHETER GUIDING--BRITE TIP 45CM/55CM|0278|C1887|86.82|50.36|||||||||56.43|59.04|63.38|63.38|67.72|52.09|56.43|65.12|73.80|77.10|76.40|65.12|73.80| 52.09 | 77.10 | 65.12 27800154|HC AFFINITY, PER SQ CM|0278|Q4159|463.05|268.57|||||||||300.98|314.87|338.03|338.03|361.18|277.83|300.98|347.29|393.59|411.19|407.48|347.29|393.59| 277.83 | 411.19 | 347.29 27800155|HC CATHETER, ABLATION OF BONE TUMORS|0278|C1886|14,464.53|8,389.43|||||||||9401.94|9835.88|10559.11|10559.11|11282.33|8678.72|9401.94|10848.40|12294.85|12844.50|12728.79|10848.40|12294.85| 8,678.72 | 12,844.50 | 10,848.40 27800156|HC PROSTH IMPL NOS|0278|L8699|4,079.25|2,365.97|||||||||2651.51|2773.89|2977.85|2977.85|3181.82|2447.55|2651.51|3059.44|3467.36|3622.37|3589.74|3059.44|3467.36| 2,447.55 | 3,622.37 | 3,059.44 27800157|HC PRIMATRIX PER 1 SQ CM|0278|Q4110|385.88|223.81|||||||||250.82|262.40|281.69|281.69|300.99|231.53|250.82|289.41|328.00|342.66|339.57|289.41|328.00| 231.53 | 342.66 | 289.41 27800158|HC INDIGO CATH 6|0278|C1757|7,103.25|4,119.89|||||||||4617.11|4830.21|5185.37|5185.37|5540.54|4261.95|4617.11|5327.44|6037.76|6307.69|6250.86|5327.44|6037.76| 4,261.95 | 6,307.69 | 5,327.44 27800159|HC INDIGO CATH 8 STARIGHT & XTORQ|0278|C1757|10,253.25|5,946.89|||||||||6664.61|6972.21|7484.87|7484.87|7997.54|6151.95|6664.61|7689.94|8715.26|9104.89|9022.86|7689.94|8715.26| 6,151.95 | 9,104.89 | 7,689.94 27800160|HC INDIGO CATH RX|0278|C1757|6,111.00|3,544.38|||||||||3972.15|4155.48|4461.03|4461.03|4766.58|3666.60|3972.15|4583.25|5194.35|5426.57|5377.68|4583.25|5194.35| 3,666.60 | 5,426.57 | 4,583.25 27800161|HC INDIGO SEPARATOR 6|0278|C1757|3,402.00|1,973.16|||||||||2211.30|2313.36|2483.46|2483.46|2653.56|2041.20|2211.30|2551.50|2891.70|3020.98|2993.76|2551.50|2891.70| 2,041.20 | 3,020.98 | 2,551.50 27800162|HC INDIGO SEPARATOR 8|0278|C1757|5,922.00|3,434.76|||||||||3849.30|4026.96|4323.06|4323.06|4619.16|3553.20|3849.30|4441.50|5033.70|5258.74|5211.36|4441.50|5033.70| 3,553.20 | 5,258.74 | 4,441.50 27800163|HC INTRA TUBAL OCCLUSION DEVICE|0278|A4264|553.35|320.94|||||||||359.68|376.28|403.95|403.95|431.61|332.01|359.68|415.01|470.35|491.37|486.95|415.01|470.35| 332.01 | 491.37 | 415.01 27800164|HC NUSHIELD,PER SQ CM|0278|Q4160|892.50|517.65|||||||||580.13|606.90|651.53|651.53|696.15|535.50|580.13|669.38|758.63|792.54|785.40|669.38|758.63| 535.50 | 792.54 | 669.38 27800165|HC INFLATABLE PENILE PROSTHESIS|0278|C1813|44,100.00|25,578.00|||||||||28665.00|29988.00|32193.00|32193.00|34398.00|26460.00|28665.00|33075.00|37485.00|39160.80|38808.00|33075.00|37485.00| 26,460.00 | 39,160.80 | 33,075.00 27800166|HC TISSUE PLACENTAL CRYOPRESERVED|0278|Q4133|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800168|HC FILSHEE CLIP|0278|A4264|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800169|HC NEURAWRAP NERVE PROTECTOR, CM|0278|C9353|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800170|HC DERMACELL, PER SQUARE CENTIMETER|0278|Q4122|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800171|HC INTEGRA BMWD PER 1 SQ CENTIMETER|0278|Q4104|0.00|0.00|||||||||0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00|0.00| - | - | - 27800172|HC EP STEERABLE GUIDING INTRODUCR/SHEATH|0278|C1766|3,115.35|1,806.90|||||||||2024.98|2118.44|2274.21|2274.21|2429.97|1869.21|2024.98|2336.51|2648.05|2766.43|2741.51|2336.51|2648.05| 1,869.21 | 2,766.43 | 2,336.51 27800173|HC HYALOMATRIX, PER SQ CM|0278|Q4117|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 30000000|HC COLLECTION FEE|0300|36415|20.42|11.84|9.48|9.01|||||||13.27|13.89|14.91|14.91|15.93|12.25|13.27|15.32|17.36|18.13|17.97|15.32|17.36| 9.01 | 18.13 | 14.91 30000001|HC BASIC METABOLIC PANEL-POCT|0300|80047|261.48|151.66|15.45|14.68|||||||169.96|177.81|190.88|190.88|203.95|156.89|169.96|196.11|222.26|232.19|230.10|196.11|222.26| 14.68 | 232.19 | 190.88 30000002|HC BASIC METABOLIC PANEL|0300|80048|271.86|157.68|15.45|14.68|||13.74|14.01|14.01|14.29|176.71|184.86|198.46|198.46|212.05|163.12|176.71|203.90|231.08|241.41|239.24|203.90|231.08| 13.74 | 241.41 | 184.86 30000003|HC ELECT-NA-K-CL-C|0300|80051|212.39|123.19|15.45|14.68|||7.85|8.01|8.01|8.16|138.05|144.43|155.04|155.04|165.66|127.43|138.05|159.29|180.53|188.60|186.90|159.29|180.53| 7.85 | 188.60 | 144.43 30000004|HC COMPREHENSIVE METABOLIC PAN|0300|80053|303.77|176.19|17.83|16.94|||16.33|16.65|16.65|16.98|197.45|206.56|221.75|221.75|236.94|182.26|197.45|227.83|258.20|269.75|267.32|227.83|258.20| 16.33 | 269.75 | 206.56 30000005|HC PRENATAL PROF WI HEPATITIS|0300|80055|604.15|350.41|70.28|66.77|||63.36|64.63|64.63|65.90|392.70|410.82|441.03|441.03|471.24|362.49|392.70|453.11|513.53|536.49|531.65|453.11|513.53| 63.36 | 536.49 | 410.82 30000006|HC LIPID PANEL|0300|80061|353.93|205.28|33.95|32.25|||19.78|20.18|20.18|20.57|230.05|240.67|258.37|258.37|276.07|212.36|230.05|265.45|300.84|314.29|311.46|265.45|300.84| 19.78 | 314.29 | 240.67 30000008|HC RENAL FUNCTION PANEL|0300|80069|279.31|162.00|15.98|15.181|||16.33|16.65|16.65|16.98|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 15.18 | 248.03 | 189.93 30000009|HC HEPATITIS PANEL ACUTE|0300|80074|261.64|151.75|108.5|103.075|||40.82|41.64|41.64|42.45|170.07|177.92|191.00|191.00|204.08|156.98|170.07|196.23|222.39|232.34|230.24|196.23|222.39| 40.82 | 232.34 | 177.92 30000010|HC HEPATIC FUNCTION PANEL|0300|80076|253.41|146.98|25.07|23.8165|||14.14|14.43|14.43|14.71|164.72|172.32|184.99|184.99|197.66|152.05|164.72|190.06|215.40|225.03|223.00|190.06|215.40| 14.14 | 225.03 | 172.32 30000011|HC DRUG-SCN-COMA-CHROMATOGRAPH|0300|80100|508.52|294.94|||||22.49|22.94|22.94|23.39|330.54|345.79|371.22|371.22|396.65|305.11|330.54|381.39|432.24|451.57|447.50|381.39|432.24| 22.49 | 451.57 | 371.22 30000012|HC DRUG-SCREEN-SERUM|0300|80100|236.87|137.38|||||22.49|22.94|22.94|23.39|153.97|161.07|172.92|172.92|184.76|142.12|153.97|177.65|201.34|210.34|208.45|177.65|201.34| 22.49 | 210.34 | 172.92 30000013|HC GAMMA HYDROXYBUTYRIC ACID SCR|0300|80100|566.95|328.83|||||22.49|22.94|22.94|23.39|368.52|385.53|413.87|413.87|442.22|340.17|368.52|425.21|481.91|503.45|498.92|425.21|481.91| 22.49 | 503.45 | 413.87 30000014|HC DRUG SCR - MULT CLASS|0300|80101|139.37|80.83|||||19.49|19.88|19.88|20.27|90.59|94.77|101.74|101.74|108.71|83.62|90.59|104.53|118.46|123.76|122.65|104.53|118.46| 19.49 | 123.76 | 101.74 30000015|HC MECONIUM-INITIAL DRUG SCN|0300|80101|124.59|72.26|||||19.49|19.88|19.88|20.27|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 19.49 | 110.64 | 90.95 30000016|HC SALICYLATE-SCREEN-URINE|0300|80101|86.28|50.04|||||19.49|19.88|19.88|20.27|56.08|58.67|62.98|62.98|67.30|51.77|56.08|64.71|73.34|76.62|75.93|64.71|73.34| 19.49 | 76.62 | 62.98 30000017|HC MECONIUM COCAINE CONF|0300|80102|124.59|72.26|||||19.64|20.03|20.03|20.42|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 19.64 | 110.64 | 90.95 30000018|HC MECONIUM PHENCYCLID CONF|0300|80102|124.59|72.26|||||19.64|20.03|20.03|20.42|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 19.64 | 110.64 | 90.95 30000019|HC MECONIUM-AMPHETAMINE CONF|0300|80102|124.59|72.26|||||19.64|20.03|20.03|20.42|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 19.64 | 110.64 | 90.95 30000020|HC MECONIUM-CANNABINOID CONF|0300|80102|124.59|72.26|||||19.64|20.03|20.03|20.42|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 19.64 | 110.64 | 90.95 30000021|HC SINGLE DRUG CONFIRM, GCMS|0300|80102|81.59|47.32|||||19.64|20.03|20.03|20.42|53.03|55.48|59.56|59.56|63.64|48.95|53.03|61.19|69.35|72.45|71.80|61.19|69.35| 19.64 | 72.45 | 59.56 30000022|HC DRUG SCRN MULT-NONCHROMO|0300|80104|112.82|65.44|||||22.49|22.94|22.94|23.39|73.33|76.72|82.36|82.36|88.00|67.69|73.33|84.62|95.90|100.18|99.28|84.62|95.90| 22.49 | 100.18 | 82.36 30000023|HC AMIKACIN TROUGH|0300|80150|432.86|251.06|28.22|26.81|||13.19|13.45|13.45|13.72|281.36|294.34|315.99|315.99|337.63|259.72|281.36|324.65|367.93|384.38|380.92|324.65|367.93| 13.19 | 384.38 | 294.34 30000024|HC AMIKACIN-PEAK|0300|80150|432.86|251.06|28.22|26.81|||13.19|13.45|13.45|13.72|281.36|294.34|315.99|315.99|337.63|259.72|281.36|324.65|367.93|384.38|380.92|324.65|367.93| 13.19 | 384.38 | 294.34 30000026|HC BENZODIAZEPINES QT|0300|80154|394.85|229.01|||||29.83|30.43|30.43|31.02|256.65|268.50|288.24|288.24|307.98|236.91|256.65|296.14|335.62|350.63|347.47|296.14|335.62| 29.83 | 350.63 | 288.24 30000027|HC DS QT - CAFFEINE|0300|80155|66.37|38.49|27.10|25.75|||||||43.14|45.13|48.45|48.45|51.77|39.82|43.14|49.78|56.41|58.94|58.41|49.78|56.41| 25.75 | 58.94 | 48.45 30000028|HC CARBAMAZEPINE-EG-TEGRETOL|0300|80156|203.67|118.13|72.06|68.46|||22.37|22.82|22.82|23.27|132.39|138.50|148.68|148.68|158.86|122.20|132.39|152.75|173.12|180.86|179.23|152.75|173.12| 22.37 | 180.86 | 138.50 30000029|HC CYCLOSPORINE|0300|80158|426.45|247.34|55.96|53.16|||14.50|14.79|14.79|15.08|277.19|289.99|311.31|311.31|332.63|255.87|277.19|319.84|362.48|378.69|375.28|319.84|362.48| 14.50 | 378.69 | 289.99 30000030|HC DS QT - CLOZAPINE|0300|80159|104.66|60.70|34.40|32.68|||||||68.03|71.17|76.40|76.40|81.63|62.80|68.03|78.50|88.96|92.94|92.10|78.50|88.96| 32.68 | 92.94 | 76.40 30000031|HC DIGOXIN-EG-LANOXIN|0300|80162|256.65|148.86|42.76|40.622|||24.01|24.49|24.49|24.97|166.82|174.52|187.35|187.35|200.19|153.99|166.82|192.49|218.15|227.91|225.85|192.49|218.15| 24.01 | 227.91 | 174.52 30000032|HC FREE VALPROIC|0300|80164|368.89|213.96|51.50|48.93|||24.49|24.98|24.98|25.47|239.78|250.85|269.29|269.29|287.73|221.33|239.78|276.67|313.56|327.57|324.62|276.67|313.56| 24.49 | 327.57 | 250.85 30000033|HC VALPROIC ACID; TOTAL|0300|80164|218.60|126.79|51.50|48.93|||24.49|24.98|24.98|25.47|142.09|148.65|159.58|159.58|170.51|131.16|142.09|163.95|185.81|194.12|192.37|163.95|185.81| 24.49 | 194.12 | 148.65 30000034|HC DOXEPIN-SINE-RL|0300|80166|391.56|227.10|||||28.02|28.58|28.58|29.15|254.51|266.26|285.84|285.84|305.42|234.94|254.51|293.67|332.83|347.71|344.57|293.67|332.83| 28.02 | 347.71 | 285.84 30000035|HC ETHOSUXIMIDE-ZARONTIN-QUANT|0300|80168|297.54|172.57|38.99|37.04|||24.33|24.82|24.82|25.31|193.40|202.33|217.20|217.20|232.08|178.52|193.40|223.16|252.91|264.22|261.84|223.16|252.91| 24.33 | 264.22 | 202.33 30000036|HC GENTAMICIN|0300|80170|432.86|251.06|45.14|42.88|||29.65|30.24|30.24|30.83|281.36|294.34|315.99|315.99|337.63|259.72|281.36|324.65|367.93|384.38|380.92|324.65|367.93| 29.65 | 384.38 | 294.34 30000037|HC GENTAMICIN-TROUGH|0300|80170|432.86|251.06|45.14|42.88|||29.65|30.24|30.24|30.83|281.36|294.34|315.99|315.99|337.63|259.72|281.36|324.65|367.93|384.38|380.92|324.65|367.93| 29.65 | 384.38 | 294.34 30000038|HC DS QT - GABAPENTIN|0300|80171|99.56|57.74|24.91|23.66|||||||64.71|67.70|72.68|72.68|77.66|59.74|64.71|74.67|84.63|88.41|87.61|74.67|84.63| 23.66 | 88.41 | 72.68 30000039|HC DS QT - LAMOTRIGINE|0300|80175|204.20|118.44|178.62|169.689|||||||132.73|138.86|149.07|149.07|159.28|122.52|132.73|153.15|173.57|181.33|179.70|153.15|173.57| 122.52 | 181.33 | 153.15 30000040|HC DS QT - LEVETIRACETAM|0300|80177|202.59|117.50|15.65|14.8675|||||||131.68|137.76|147.89|147.89|158.02|121.55|131.68|151.94|172.20|179.90|178.28|151.94|172.20| 14.87 | 179.90 | 147.89 30000041|HC LITHIUM-SERUM|0300|80178|196.01|113.69|20.79|19.75|||10.99|11.21|11.21|11.43|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 10.99 | 174.06 | 133.29 30000042|HC NORTRIPTYLINE (AVENTYL)|0300|80182|174.49|101.20|||||24.49|24.98|24.98|25.47|113.42|118.65|127.38|127.38|136.10|104.69|113.42|130.87|148.32|154.95|153.55|130.87|148.32| 24.49 | 154.95 | 127.38 30000043|HC DS QT - OXCARBAZEPINE|0300|80183|146.78|85.13|||||||||95.41|99.81|107.15|107.15|114.49|88.07|95.41|110.09|124.76|130.34|129.17|110.09|124.76| 88.07 | 130.34 | 110.09 30000044|HC PHENOBARBITAL NEMBUTAL|0300|80184|268.79|155.90|42.45|40.33|||20.61|21.02|21.02|21.43|174.71|182.78|196.22|196.22|209.66|161.27|174.71|201.59|228.47|238.69|236.54|201.59|228.47| 20.61 | 238.69 | 182.78 30000045|HC PHENYTOIN-EG-DILANTIN|0300|80185|307.31|178.24|42.76|40.62|||20.37|20.78|20.78|21.19|199.75|208.97|224.34|224.34|239.70|184.39|199.75|230.48|261.21|272.89|270.43|230.48|261.21| 20.37 | 272.89 | 208.97 30000046|HC DILANTIN-FREE (PHENYTOIN)|0300|80186|177.64|103.03|42.96|40.812|||25.34|25.85|25.85|26.36|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 25.34 | 157.74 | 120.80 30000047|HC PRIMIDONE-MYSOLINE-QUANT|0300|80188|332.75|193.00|42.16|40.05|||29.04|29.63|29.63|30.21|216.29|226.27|242.91|242.91|259.55|199.65|216.29|249.56|282.84|295.48|292.82|249.56|282.84| 29.04 | 295.48 | 226.27 30000048|HC SIROLIMUS|0300|80195|258.27|149.80|14.29|13.58|||13.16|13.42|13.42|13.69|167.88|175.62|188.54|188.54|201.45|154.96|167.88|193.70|219.53|229.34|227.28|193.70|219.53| 13.16 | 229.34 | 175.62 30000049|HC SALICYLATE-LEVEL|0300|80196|196.01|113.69|||||12.82|13.08|13.08|13.33|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 12.82 | 174.06 | 143.09 30000050|HC FK506 (TACROLIMUS)|0300|80197|443.15|257.03|52.95|50.30|||15.70|16.01|16.01|16.33|288.05|301.34|323.50|323.50|345.66|265.89|288.05|332.36|376.68|393.52|389.97|332.36|376.68| 15.70 | 393.52 | 301.34 30000051|HC THEOPHYLLINE-LEVEL-RANDOM|0300|80198|256.65|148.86|47.60|45.22|||25.59|26.10|26.10|26.61|166.82|174.52|187.35|187.35|200.19|153.99|166.82|192.49|218.15|227.91|225.85|192.49|218.15| 25.59 | 227.91 | 174.52 30000052|HC DS QT - TIAGABINE|0300|80199|324.18|188.02|||||||||210.72|220.44|236.65|236.65|252.86|194.51|210.72|243.14|275.55|287.87|285.28|243.14|275.55| 194.51 | 287.87 | 243.14 30000053|HC TOBRAMYCIN|0300|80200|320.42|185.84|27.19|25.83|||29.15|29.73|29.73|30.32|208.27|217.89|233.91|233.91|249.93|192.25|208.27|240.32|272.36|284.53|281.97|240.32|272.36| 25.83 | 284.53 | 217.89 30000054|HC TOBRAMYCIN-TROUGH|0300|80200|315.89|183.22|27.19|25.83|||29.15|29.73|29.73|30.32|205.33|214.81|230.60|230.60|246.39|189.53|205.33|236.92|268.51|280.51|277.98|236.92|268.51| 25.83 | 280.51 | 214.81 30000055|HC TOPIRAMATE|0300|80201|302.34|175.36|52.95|50.3025|||14.01|14.29|14.29|14.57|196.52|205.59|220.71|220.71|235.83|181.40|196.52|226.76|256.99|268.48|266.06|226.76|256.99| 14.01 | 268.48 | 205.59 30000056|HC VANCOMYCIN|0300|80202|367.49|213.14|46.37|44.05|||24.49|24.98|24.98|25.47|238.87|249.89|268.27|268.27|286.64|220.49|238.87|275.62|312.37|326.33|323.39|275.62|312.37| 24.49 | 326.33 | 249.89 30000057|HC VANCOMYCIN TROUGH|0300|80202|388.90|225.56|46.37|44.05|||24.49|24.98|24.98|25.47|252.79|264.45|283.90|283.90|303.34|233.34|252.79|291.68|330.57|345.34|342.23|291.68|330.57| 24.49 | 345.34 | 264.45 30000058|HC DS QT - ZONISAMIDE|0300|80203|223.36|129.55|||||||||145.18|151.88|163.05|163.05|174.22|134.02|145.18|167.52|189.86|198.34|196.56|167.52|189.86| 134.02 | 198.34 | 167.52 30000060|HC ACTH STIMULATION PANEL|0300|80400|370.38|214.82|106.84|101.50|||59.01|60.19|60.19|61.37|240.75|251.86|270.38|270.38|288.90|222.23|240.75|277.79|314.82|328.90|325.93|277.79|314.82| 59.01 | 328.90 | 251.86 30000061|HC AUTO URINE DIP W MICROSCOPIC|0300|81001|131.46|76.25|7.65|7.27|||5.72|5.83|5.83|5.95|85.45|89.39|95.97|95.97|102.54|78.88|85.45|98.60|111.74|116.74|115.68|98.60|111.74| 5.72 | 116.74 | 89.39 30000062|HC ACETONE-URINE|0300|81002|45.69|26.50|8.14|7.73|||3.94|4.02|4.02|4.10|29.70|31.07|33.35|33.35|35.64|27.41|29.70|34.27|38.84|40.57|40.21|34.27|38.84| 3.94 | 40.57 | 31.07 30000063|HC SPECIFIC-GRAVITY-URINE|0300|81002|76.08|44.13|8.14|7.73|||3.94|4.02|4.02|4.10|49.45|51.73|55.54|55.54|59.34|45.65|49.45|57.06|64.67|67.56|66.95|57.06|64.67| 3.94 | 67.56 | 51.73 30000064|HC AUTO URINALYSIS W/O MICROSCOP|0300|81003|95.72|55.52|7.22|6.86|||1.96|2|2|2.04|62.22|65.09|69.88|69.88|74.66|57.43|62.22|71.79|81.36|85.00|84.23|71.79|81.36| 1.96 | 85.00 | 65.09 30000065|HC HCG-URINE QUAL SCR|0300|81025|139.70|81.03|21.35|20.28|||9.72|9.92|9.92|10.11|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 9.72 | 124.05 | 95.00 30000066|HC POCT URINE PREGNANCY-VISUAL|0300|81025|63.82|37.02|21.35|20.28|||9.72|9.92|9.92|10.11|41.48|43.40|46.59|46.59|49.78|38.29|41.48|47.87|54.25|56.67|56.16|47.87|54.25| 9.72 | 56.67 | 43.40 30000067|HC BCR/ABL1 GENE MAJOR BP|0300|81206|1,298.16|752.93|152.46|144.84|||||||843.80|882.75|947.66|947.66|1012.56|778.90|843.80|973.62|1103.44|1152.77|1142.38|973.62|1103.44| 144.84 | 1,152.77 | 947.66 30000068|HC BCR/ABL1 GENE MINOR BP|0300|81207|1,136.19|658.99|135.15|128.39|||||||738.52|772.61|829.42|829.42|886.23|681.71|738.52|852.14|965.76|1008.94|999.85|852.14|965.76| 128.39 | 1,008.94 | 829.42 30000069|HC CYP2C9 GENE COM VARIANTS|0300|81227|1,446.78|839.13|140.59|133.56|||||||940.41|983.81|1056.15|1056.15|1128.49|868.07|940.41|1085.09|1229.76|1284.74|1273.17|1085.09|1229.76| 133.56 | 1,284.74 | 1,056.15 30000070|HC CYTOGEN M ARRAY COPY NO&SNP|0300|81229|5,714.09|3,314.17|1,044.55|992.32|||||||3714.16|3885.58|4171.29|4171.29|4456.99|3428.45|3714.16|4285.57|4856.98|5074.11|5028.40|4285.57|4856.98| 992.32 | 5,074.11 | 4,171.29 30000071|HC EGFR GENE COM VARIANTS|0300|81235|3,533.48|2,049.42|412.29|391.68|||||||2296.76|2402.77|2579.44|2579.44|2756.11|2120.09|2296.76|2650.11|3003.46|3137.73|3109.46|2650.11|3003.46| 391.68 | 3,137.73 | 2,579.44 30000072|HC F2 GENE|0300|81240|471.20|273.30|412.17|391.56|||||||306.28|320.42|343.98|343.98|367.54|282.72|306.28|353.40|400.52|418.43|414.66|353.40|400.52| 282.72 | 418.43 | 353.40 30000073|HC F5 GENE|0300|81241|471.20|273.30|412.17|391.5615|||||||306.28|320.42|343.98|343.98|367.54|282.72|306.28|353.40|400.52|418.43|414.66|353.40|400.52| 282.72 | 418.43 | 353.40 30000074|HC FMR1 GENE DETECTION|0300|81243|865.42|501.94|96.45|91.6275|||||||562.52|588.49|631.76|631.76|675.03|519.25|562.52|649.07|735.61|768.49|761.57|649.07|735.61| 91.63 | 768.49 | 631.76 30000075|HC FMR1 GENE CHARACTERIZATION|0300|81244|1,406.98|816.05|105.43|100.16|||||||914.54|956.75|1027.10|1027.10|1097.44|844.19|914.54|1055.24|1195.93|1249.40|1238.14|1055.24|1195.93| 100.16 | 1,249.40 | 1,027.10 30000076|HC HFE GENE|0300|81256|1,051.25|609.73|||||||||683.31|714.85|767.41|767.41|819.98|630.75|683.31|788.44|893.56|933.51|925.10|788.44|893.56| 630.75 | 933.51 | 788.44 30000077|HC JAK2 GENE|0300|81270|1,360.52|789.10|||||||||884.34|925.15|993.18|993.18|1061.21|816.31|884.34|1020.39|1156.44|1208.14|1197.26|1020.39|1156.44| 816.31 | 1,208.14 | 1,020.39 30000078|HC KRAS GENE|0300|81275|3,223.52|1,869.64|373.29|354.6255|||||||2095.29|2191.99|2353.17|2353.17|2514.35|1934.11|2095.29|2417.64|2739.99|2862.49|2836.70|2417.64|2739.99| 354.63 | 2,862.49 | 2,353.17 30000079|HC MTHFR GENE|0300|81291|723.41|419.58|109.14|103.683|||||||470.22|491.92|528.09|528.09|564.26|434.05|470.22|542.56|614.90|642.39|636.60|542.56|614.90| 103.68 | 642.39 | 528.09 30000080|HC MICROSATELLITE INSTABILITY|0300|81301|1,758.72|1,020.06|151.93|144.33|||||||1143.17|1195.93|1283.87|1283.87|1371.80|1055.23|1143.17|1319.04|1494.91|1561.74|1547.67|1319.04|1494.91| 144.33 | 1,561.74 | 1,283.87 30000081|HC TRB@ GENE REARRANGE AMPLIFY|0300|81340|2,022.90|1,173.28|||||||||1314.89|1375.57|1476.72|1476.72|1577.86|1213.74|1314.89|1517.18|1719.47|1796.34|1780.15|1517.18|1719.47| 1,213.74 | 1,796.34 | 1,517.18 30000082|HC HLA I TYPING 1 AG LR - HLAB27|0300|81374|144.68|83.91|||||||||94.04|98.38|105.62|105.62|112.85|86.81|94.04|108.51|122.98|128.48|127.32|108.51|122.98| 86.81 | 128.48 | 108.51 30000083|HC MO PATH LEVEL I|0300|81400|911.63|528.75|61.02|57.97|||||||592.56|619.91|665.49|665.49|711.07|546.98|592.56|683.72|774.89|809.53|802.23|683.72|774.89| 57.97 | 809.53 | 665.49 30000084|HC MOPATH PROCEDURE LEVEL 4|0300|81403|1,221.58|708.52|||||||||794.03|830.67|891.75|891.75|952.83|732.95|794.03|916.19|1038.34|1084.76|1074.99|916.19|1038.34| 732.95 | 1,084.76 | 916.19 30000085|HC ACETAMINOPHEN-TYLENOL-SERUM|0300|82003|320.42|185.84|||||28.65|29.23|29.23|29.80|208.27|217.89|233.91|233.91|249.93|192.25|208.27|240.32|272.36|284.53|281.97|240.32|272.36| 28.65 | 284.53 | 233.91 30000086|HC ACETONE-SERUM|0300|82009|83.40|48.37|10.16|9.65|||2.07|2.11|2.11|2.15|54.21|56.71|60.88|60.88|65.05|50.04|54.21|62.55|70.89|74.06|73.39|62.55|70.89| 2.07 | 74.06 | 56.71 30000087|HC BETA-HYDROXYBUTYRATE|0300|82010|134.68|78.11|22.85|21.71|||2.07|2.11|2.11|2.15|87.54|91.58|98.32|98.32|105.05|80.81|87.54|101.01|114.48|119.60|118.52|101.01|114.48| 2.07 | 119.60 | 91.58 30000088|HC ACYLCARNITINES; QUANT, EA|0300|82017|569.28|330.18|133.75|127.06|||25.43|25.94|25.94|26.45|370.03|387.11|415.57|415.57|444.04|341.57|370.03|426.96|483.89|505.52|500.97|426.96|483.89| 25.43 | 505.52 | 387.11 30000089|HC ACTH HORMONE|0300|82024|862.44|500.22|93.10|88.45|||34.34|35.03|35.03|35.72|560.59|586.46|629.58|629.58|672.70|517.46|560.59|646.83|733.07|765.85|758.95|646.83|733.07| 34.34 | 765.85 | 586.46 30000090|HC ALBUMIN-SERUM|0300|82040|86.58|50.22|8.35|7.93|||6.87|7.01|7.01|7.14|56.28|58.87|63.20|63.20|67.53|51.95|56.28|64.94|73.59|76.88|76.19|64.94|73.59| 6.87 | 76.88 | 58.87 30000091|HC ALBUMIN, BODY FLUID|0300|82042|86.58|50.22|20.05|19.0475|||6.87|7.01|7.01|7.14|56.28|58.87|63.20|63.20|67.53|51.95|56.28|64.94|73.59|76.88|76.19|64.94|73.59| 6.87 | 76.88 | 58.87 30000092|HC CSF ALBUMIN|0300|82042|106.40|61.71|20.05|19.05|||6.87|7.01|7.01|7.14|69.16|72.35|77.67|77.67|82.99|63.84|69.16|79.80|90.44|94.48|93.63|79.80|90.44| 6.87 | 94.48 | 72.35 30000093|HC URINE MICROALBUMIN; QUANT|0300|82043|107.78|62.51|19.52|18.54|||6.87|7.01|7.01|7.14|70.06|73.29|78.68|78.68|84.07|64.67|70.06|80.84|91.61|95.71|94.85|80.84|91.61| 6.87 | 95.71 | 73.29 30000094|HC ALCOHOL-ETHANOL|0300|82055|268.79|155.90|||||19.49|19.88|19.88|20.27|174.71|182.78|196.22|196.22|209.66|161.27|174.71|201.59|228.47|238.69|236.54|201.59|228.47| 19.49 | 238.69 | 196.22 30000095|HC ALDOLASE-REF|0300|82085|171.74|99.61|25.32|24.05|||14.13|14.41|14.41|14.70|111.63|116.78|125.37|125.37|133.96|103.04|111.63|128.81|145.98|152.51|151.13|128.81|145.98| 14.13 | 152.51 | 116.78 30000096|HC ALDOSTERONE-PLASMA RL|0300|82088|376.46|218.35|96.87|92.03|||40.18|40.98|40.98|41.79|244.70|255.99|274.82|274.82|293.64|225.88|244.70|282.35|319.99|334.30|331.28|282.35|319.99| 40.18 | 334.30 | 255.99 30000097|HC ALPHA-I-ANTITRYPSIN-REF-LAB|0300|82103|142.65|82.74|39.94|37.94|||17.86|18.22|18.22|18.57|92.72|97.00|104.13|104.13|111.27|85.59|92.72|106.99|121.25|126.67|125.53|106.99|121.25| 17.86 | 126.67 | 97.00 30000098|HC ALPHA-I-ANTITRYPSIN PHENTYP|0300|82104|247.57|143.59|64.87|61.63|||17.86|18.22|18.22|18.57|160.92|168.35|180.73|180.73|193.10|148.54|160.92|185.68|210.43|219.84|217.86|185.68|210.43| 17.86 | 219.84 | 168.35 30000099|HC AFP-FOUR MARKER|0300|82105|180.89|104.92|43.75|41.56|||17.86|18.22|18.22|18.57|117.58|123.01|132.05|132.05|141.09|108.53|117.58|135.67|153.76|160.63|159.18|135.67|153.76| 17.86 | 160.63 | 123.01 30000100|HC ALPHA-FETO-PROTEIN-TUMOR-RL|0300|82105|297.54|172.57|43.75|41.56|||17.86|18.22|18.22|18.57|193.40|202.33|217.20|217.20|232.08|178.52|193.40|223.16|252.91|264.22|261.84|223.16|252.91| 17.86 | 264.22 | 202.33 30000101|HC CYSTINE-QUANT-URINE RL|0300|82131|394.85|229.01|224.78|213.54|||25.92|26.44|26.44|26.95|256.65|268.50|288.24|288.24|307.98|236.91|256.65|296.14|335.62|350.63|347.47|296.14|335.62| 25.92 | 350.63 | 268.50 30000102|HC ALA-AMINOLEVULINIC-ACID-RL|0300|82135|519.45|301.28|39.81|37.8195|||21.98|22.42|22.42|22.86|337.64|353.23|379.20|379.20|405.17|311.67|337.64|389.59|441.53|461.27|457.12|389.59|441.53| 21.98 | 461.27 | 353.23 30000103|HC AMINO ACIDS, 6 OR MORE QT, EA|0300|82139|585.35|339.50|417.32|396.45|||23.72|24.19|24.19|24.67|380.48|398.04|427.31|427.31|456.57|351.21|380.48|439.01|497.55|519.79|515.11|439.01|497.55| 23.72 | 519.79 | 417.32 30000104|HC AMMONIA|0300|82140|399.32|231.61|38.83|36.89|||13.74|14.01|14.01|14.29|259.56|271.54|291.50|291.50|311.47|239.59|259.56|299.49|339.42|354.60|351.40|299.49|339.42| 13.74 | 354.60 | 271.54 30000105|HC AMPHETAMINE/METHAMPHET QT|0300|82145|370.34|214.80|||||13.19|13.45|13.45|13.72|240.72|251.83|270.35|270.35|288.87|222.20|240.72|277.76|314.79|328.86|325.90|277.76|314.79| 13.19 | 328.86 | 270.35 30000106|HC AMYLASE BODY FLUID|0300|82150|230.76|133.84|19.69|18.71|||9.62|9.81|9.81|10.00|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 9.62 | 204.91 | 156.92 30000107|HC AMYLASE-SERUM|0300|82150|230.76|133.84|19.69|18.71|||9.62|9.81|9.81|10.00|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 9.62 | 204.91 | 156.92 30000108|HC ANDROSTENEDIONE-REF-LAB|0300|82157|219.52|127.32|93.65|88.9675|||13.19|13.45|13.45|13.72|142.69|149.27|160.25|160.25|171.23|131.71|142.69|164.64|186.59|194.93|193.18|164.64|186.59| 13.19 | 194.93 | 149.27 30000109|HC ACE-ANGIOTENSIN-CONVERTING-|0300|82164|234.03|135.74|38.83|36.89|||21.98|22.42|22.42|22.86|152.12|159.14|170.84|170.84|182.54|140.42|152.12|175.52|198.93|207.82|205.95|175.52|198.93| 21.98 | 207.82 | 159.14 30000110|HC ARSENIC|0300|82175|101.66|58.96|41.19|39.13|||11.68|11.92|11.92|12.15|66.08|69.13|74.21|74.21|79.29|61.00|66.08|76.25|86.41|90.27|89.46|76.25|86.41| 11.68 | 90.27 | 69.13 30000111|HC BARBITURATES NES|0300|82205|268.03|155.46|||||20.61|21.02|21.02|21.43|174.22|182.26|195.66|195.66|209.06|160.82|174.22|201.02|227.83|238.01|235.87|201.02|227.83| 20.61 | 238.01 | 195.66 30000112|HC BETA 2 MICROGLOBULIN|0300|82232|253.41|146.98|33.29|31.63|||29.27|29.85|29.85|30.44|164.72|172.32|184.99|184.99|197.66|152.05|164.72|190.06|215.40|225.03|223.00|190.06|215.40| 29.27 | 225.03 | 172.32 30000113|HC BILE ACIDS, TOTAL|0300|82239|294.67|170.91|85.25|80.99|||31.28|31.91|31.91|32.53|191.54|200.38|215.11|215.11|229.84|176.80|191.54|221.00|250.47|261.67|259.31|221.00|250.47| 31.28 | 261.67 | 200.38 30000114|HC BILIRUBIN-TOTAL|0300|82247|157.73|91.48|16.74|15.90|||7.72|7.87|7.87|8.03|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 7.72 | 140.06 | 107.26 30000115|HC BILIRUBIN-DIRECT|0300|82248|157.73|91.48|15.87|15.08|||4.12|4.20|4.20|4.29|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 4.12 | 140.06 | 107.26 30000116|HC OCCULT-BLOOD-FECES|0300|82270|76.08|44.13|9.76|9.27|||5.00|5.10|5.10|5.20|49.45|51.73|55.54|55.54|59.34|45.65|49.45|57.06|64.67|67.56|66.95|57.06|64.67| 5.00 | 67.56 | 51.73 30000117|HC OCCULT BLOOD OTHER SOURCES|0300|82271|37.01|21.47|6.12|5.81|||5.05|5.15|5.15|5.25|24.06|25.17|27.02|27.02|28.87|22.21|24.06|27.76|31.46|32.86|32.57|27.76|31.46| 5.05 | 32.86 | 25.17 30000119|HC OCC BLD 1 TO 3 DETERMIN.|0300|82272|37.01|21.47|32.38|30.76|||5.05|5.15|5.15|5.25|24.06|25.17|27.02|27.02|28.87|22.21|24.06|27.76|31.46|32.86|32.57|27.76|31.46| 5.05 | 32.86 | 27.02 30000120|HC VIT-D (25-HYDROXY VIT-D3)|0300|82306|245.56|142.42|171.77|163.18|||13.19|13.45|13.45|13.72|159.61|166.98|179.26|179.26|191.54|147.34|159.61|184.17|208.73|218.06|216.09|184.17|208.73| 13.19 | 218.06 | 171.77 30000121|HC CALCITONIN REF-LAB|0300|82308|265.51|154.00|80.42|76.40|||13.19|13.45|13.45|13.72|172.58|180.55|193.82|193.82|207.10|159.31|172.58|199.13|225.68|235.77|233.65|199.13|225.68| 13.19 | 235.77 | 180.55 30000122|HC CALCIUM|0300|82310|139.70|81.03|8.69|8.26|||8.24|8.41|8.41|8.57|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 8.24 | 124.05 | 95.00 30000123|HC IONIZED CALCIUM-BLOOD|0300|82330|127.63|74.03|36.54|34.71|||8.24|8.41|8.41|8.57|82.96|86.79|93.17|93.17|99.55|76.58|82.96|95.72|108.49|113.34|112.31|95.72|108.49| 8.24 | 113.34 | 86.79 30000124|HC CALCIUM-TIMED URINE|0300|82340|145.79|84.56|17.51|16.63|||10.86|11.08|11.08|11.29|94.76|99.14|106.43|106.43|113.72|87.47|94.76|109.34|123.92|129.46|128.30|109.34|123.92| 10.86 | 129.46 | 99.14 30000125|HC STONE ANALYSIS|0300|82360|244.32|141.71|38.64|36.71|||16.48|16.81|16.81|17.14|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 16.48 | 216.96 | 166.14 30000126|HC CO2-CARBON-DIOXIDE|0300|82374|145.79|84.56|8.25|7.84|||8.60|8.77|8.77|8.94|94.76|99.14|106.43|106.43|113.72|87.47|94.76|109.34|123.92|129.46|128.30|109.34|123.92| 7.84 | 129.46 | 99.14 30000127|HC CARBON MONOXIDE-POCT|0300|82375|293.35|170.14|36.06|34.26|||||||190.68|199.48|214.15|214.15|228.81|176.01|190.68|220.01|249.35|260.49|258.15|220.01|249.35| 34.26 | 260.49 | 214.15 30000128|HC CEA-CARCINO-EMBRYONIC-ANTIG|0300|82378|315.89|183.22|55.71|52.92|||34.24|34.92|34.92|35.61|205.33|214.81|230.60|230.60|246.39|189.53|205.33|236.92|268.51|280.51|277.98|236.92|268.51| 34.24 | 280.51 | 214.81 30000129|HC CARNITINE; QUANT, EA|0300|82379|288.67|167.43|152.38|144.76|||25.43|25.94|25.94|26.45|187.64|196.30|210.73|210.73|225.16|173.20|187.64|216.50|245.37|256.34|254.03|216.50|245.37| 25.43 | 256.34 | 196.30 30000130|HC CATECHOLAMINES; FRACTIONATED|0300|82384|301.44|174.84|91.19|86.63|||35.32|36.03|36.03|36.74|195.94|204.98|220.05|220.05|235.12|180.86|195.94|226.08|256.22|267.68|265.27|226.08|256.22| 35.32 | 267.68 | 204.98 30000131|HC CATECHOLAMINES-FRACT-URI RL|0300|82384|315.89|183.22|91.19|86.63|||35.32|36.03|36.03|36.74|205.33|214.81|230.60|230.60|246.39|189.53|205.33|236.92|268.51|280.51|277.98|236.92|268.51| 35.32 | 280.51 | 214.81 30000132|HC CERULOPLASMIN-REF-LAB|0300|82390|171.74|99.61|29.37|27.90|||12.56|12.81|12.81|13.06|111.63|116.78|125.37|125.37|133.96|103.04|111.63|128.81|145.98|152.51|151.13|128.81|145.98| 12.56 | 152.51 | 116.78 30000133|HC CHEMILUMIN ASSAY|0300|82397|264.80|153.58|32.17|30.56|||17.86|18.22|18.22|18.57|172.12|180.06|193.30|193.30|206.54|158.88|172.12|198.60|225.08|235.14|233.02|198.60|225.08| 17.86 | 235.14 | 180.06 30000134|HC CHLORIDE-BLOOD|0300|82435|57.42|33.30|7.76|7.37|||5.49|5.60|5.60|5.71|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 5.49 | 50.99 | 39.05 30000135|HC CHLORIDE URINE RAMDOM|0300|82436|165.29|95.87|16.36|15.542|||5.49|5.60|5.60|5.71|107.44|112.40|120.66|120.66|128.93|99.17|107.44|123.97|140.50|146.78|145.46|123.97|140.50| 5.49 | 146.78 | 112.40 30000136|HC CHLORIDE, OTHER SOURCE|0300|82438|203.95|118.29|7.16|6.80|||5.10|5.20|5.20|5.31|132.57|138.69|148.88|148.88|159.08|122.37|132.57|152.96|173.36|181.11|179.48|152.96|173.36| 5.10 | 181.11 | 138.69 30000137|HC CHOLESTEROL|0300|82465|124.59|72.26|8.54|8.11|||7.86|8.02|8.02|8.18|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 7.86 | 110.64 | 84.72 30000138|HC AMIODAROME RL|0300|82491|256.65|148.86|||||11.45|11.68|11.68|11.91|166.82|174.52|187.35|187.35|200.19|153.99|166.82|192.49|218.15|227.91|225.85|192.49|218.15| 11.45 | 227.91 | 187.35 30000139|HC CITRATE|0300|82507|461.38|267.60|78.56|74.63|||13.19|13.45|13.45|13.72|299.90|313.74|336.81|336.81|359.88|276.83|299.90|346.04|392.17|409.71|406.01|346.04|392.17| 13.19 | 409.71 | 313.74 30000140|HC COPPER-SERUM-REF-LAB|0300|82525|244.32|141.71|21.14|20.08|||20.61|21.02|21.02|21.43|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 20.08 | 216.96 | 166.14 30000141|HC COPPER-URINE-REG-LAB|0300|82525|256.65|148.86|21.14|20.08|||20.61|21.02|21.02|21.43|166.82|174.52|187.35|187.35|200.19|153.99|166.82|192.49|218.15|227.91|225.85|192.49|218.15| 20.08 | 227.91 | 174.52 30000142|HC CORTISOL-URINE|0300|82530|379.84|220.31|52.30|49.69|||19.62|20.02|20.02|20.41|246.90|258.29|277.28|277.28|296.28|227.90|246.90|284.88|322.86|337.30|334.26|284.88|322.86| 19.62 | 337.30 | 258.29 30000143|HC CORTISOL-SERUM|0300|82533|146.34|84.88|47.6|45.22|||29.50|30.09|30.09|30.68|95.12|99.51|106.83|106.83|114.15|87.80|95.12|109.76|124.39|129.95|128.78|109.76|124.39| 29.50 | 129.95 | 99.51 30000144|HC CC/MS, QT|0300|82542|369.52|214.32|248.42|236.00|||11.45|11.68|11.68|11.91|240.19|251.27|269.75|269.75|288.23|221.71|240.19|277.14|314.09|328.13|325.18|277.14|314.09| 11.45 | 328.13 | 251.27 30000145|HC CC/MS, QT|0300|82542|347.70|201.67|248.42|236.00|||11.45|11.68|11.68|11.91|226.01|236.44|253.82|253.82|271.21|208.62|226.01|260.78|295.55|308.76|305.98|260.78|295.55| 11.45 | 308.76 | 248.42 30000149|HC CC/MS - MULTIANALYTES QT|0300|82544|423.23|245.47|||||11.45|11.68|11.68|11.91|275.10|287.80|308.96|308.96|330.12|253.94|275.10|317.42|359.75|375.83|372.44|317.42|359.75| 11.45 | 375.83 | 308.96 30000150|HC CPK-CREATINE-PHOSPHOKINASE|0300|82550|177.64|103.03|18.17|17.26|||11.32|11.54|11.54|11.77|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 11.32 | 157.74 | 120.80 30000151|HC CPK MB-FRACTION ONLY|0300|82553|274.68|159.31|42.47|40.35|||20.03|20.43|20.43|20.83|178.54|186.78|200.52|200.52|214.25|164.81|178.54|206.01|233.48|243.92|241.72|206.01|233.48| 20.03 | 243.92 | 186.78 30000152|HC CREATININE-SERUM|0300|82565|107.78|62.51|8.65|8.22|||9.25|9.43|9.43|9.62|70.06|73.29|78.68|78.68|84.07|64.67|70.06|80.84|91.61|95.71|94.85|80.84|91.61| 8.22 | 95.71 | 73.29 30000153|HC CREATININE-BODY FLUID|0300|82570|113.69|65.94|16.93|16.08|||9.07|9.25|9.25|9.43|73.90|77.31|82.99|82.99|88.68|68.21|73.90|85.27|96.64|100.96|100.05|85.27|96.64| 9.07 | 100.96 | 77.31 30000154|HC CREATININE-CLEARANCE|0300|82575|376.56|218.40|27.60|26.22|||16.48|16.81|16.81|17.14|244.76|256.06|274.89|274.89|293.72|225.94|244.76|282.42|320.08|334.39|331.37|282.42|320.08| 16.48 | 334.39 | 256.06 30000155|HC CRYOGLOBULINS-BLOOD|0300|82595|142.65|82.74|14.72|13.98|||9.62|9.81|9.81|10.00|92.72|97.00|104.13|104.13|111.27|85.59|92.72|106.99|121.25|126.67|125.53|106.99|121.25| 9.62 | 126.67 | 97.00 30000156|HC VITAMIN-B12|0300|82607|168.56|97.76|45.14|42.88|||27.25|27.80|27.80|28.34|109.56|114.62|123.05|123.05|131.48|101.14|109.56|126.42|143.28|149.68|148.33|126.42|143.28| 27.25 | 149.68 | 114.62 30000157|HC B-12 BINDING CAPACITY|0300|82608|112.27|65.12|29.42|27.95|||23.55|24.02|24.02|24.49|72.98|76.34|81.96|81.96|87.57|67.36|72.98|84.20|95.43|99.70|98.80|84.20|95.43| 23.55 | 99.70 | 76.34 30000158|HC DHEA|0300|82626|175.59|101.84|71.95|68.35|||30.22|30.83|30.83|31.43|114.13|119.40|128.18|128.18|136.96|105.35|114.13|131.69|149.25|155.92|154.52|131.69|149.25| 30.22 | 155.92 | 119.40 30000159|HC DHEA-5|0300|82627|379.84|220.31|63.23|60.0685|||30.22|30.83|30.83|31.43|246.90|258.29|277.28|277.28|296.28|227.90|246.90|284.88|322.86|337.30|334.26|284.88|322.86| 30.22 | 337.30 | 258.29 30000161|HC 11-DEOXYCORTICOSTERONE|0300|82633|175.59|101.84|69.97|66.47|||||||114.13|119.40|128.18|128.18|136.96|105.35|114.13|131.69|149.25|155.92|154.52|131.69|149.25| 66.47 | 155.92 | 128.18 30000162|HC DEOXYCORTISOL 11|0300|82634|175.59|101.84|69.97|66.47|||30.22|30.83|30.83|31.43|114.13|119.40|128.18|128.18|136.96|105.35|114.13|131.69|149.25|155.92|154.52|131.69|149.25| 30.22 | 155.92 | 119.40 30000163|HC DIHYDROTESTOSTERONE (DHT)|0300|82651|282.36|163.77|||||40.18|40.98|40.98|41.79|183.53|192.00|206.12|206.12|220.24|169.42|183.53|211.77|240.01|250.74|248.48|211.77|240.01| 40.18 | 250.74 | 206.12 30000164|HC VITAMIN-D-1.25-DIHYDROXY-RL|0300|82652|572.46|332.03|69.56|66.08|||||||372.10|389.27|417.90|417.90|446.52|343.48|372.10|429.35|486.59|508.34|503.76|429.35|486.59| 66.08 | 508.34 | 417.90 30000165|HC PANCREATIC ELASTASE, FECAL|0300|82656|416.20|241.40|17.44|16.57|||17.92|18.28|18.28|18.64|270.53|283.02|303.83|303.83|324.64|249.72|270.53|312.15|353.77|369.59|366.26|312.15|353.77| 16.57 | 369.59 | 283.02 30000166|HC ERYTHROPOIETIN-REF LAB|0300|82668|294.67|170.91|55.81|53.02|||30.22|30.83|30.83|31.43|191.54|200.38|215.11|215.11|229.84|176.80|191.54|221.00|250.47|261.67|259.31|221.00|250.47| 30.22 | 261.67 | 200.38 30000167|HC ESTRADIOL-REF LAB|0300|82670|344.44|199.78|98.44|93.52|||50.53|51.54|51.54|52.55|223.89|234.22|251.44|251.44|268.66|206.66|223.89|258.33|292.77|305.86|303.11|258.33|292.77| 50.53 | 305.86 | 234.22 30000168|HC ESTROGENS TOTAL-SERUM|0300|82672|452.34|262.36|66.45|63.13|||39.21|39.99|39.99|40.78|294.02|307.59|330.21|330.21|352.83|271.40|294.02|339.26|384.49|401.68|398.06|339.26|384.49| 39.21 | 401.68 | 307.59 30000169|HC ESTRIOL-AFP MARKER|0300|82677|215.67|125.09|54.67|51.94|||28.02|28.58|28.58|29.15|140.19|146.66|157.44|157.44|168.22|129.40|140.19|161.75|183.32|191.51|189.79|161.75|183.32| 28.02 | 191.51 | 146.66 30000170|HC ETHYLENE-GLYCOL-RL|0300|82693|250.46|145.27|53.78|51.09|||21.98|22.42|22.42|22.86|162.80|170.31|182.84|182.84|195.36|150.28|162.80|187.85|212.89|222.41|220.40|187.85|212.89| 21.98 | 222.41 | 170.31 30000171|HC FAT-FECES|0300|82705|139.70|81.03|13.93|13.23|||6.87|7.01|7.01|7.14|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 6.87 | 124.05 | 95.00 30000172|HC FAT-FECAL-QUANT-72-HOUR-RL|0300|82710|353.93|205.28|49.81|47.32|||14.71|15.00|15.00|15.29|230.05|240.67|258.37|258.37|276.07|212.36|230.05|265.45|300.84|314.29|311.46|265.45|300.84| 14.71 | 314.29 | 240.67 30000173|HC PEROXISOMAL PANEL|0300|82726|490.23|284.33|145.83|138.54|||12.56|12.81|12.81|13.06|318.65|333.36|357.87|357.87|382.38|294.14|318.65|367.67|416.70|435.32|431.40|367.67|416.70| 12.56 | 435.32 | 333.36 30000174|HC FERRITIN|0300|82728|259.54|150.53|41.86|39.77|||24.64|25.13|25.13|25.62|168.70|176.49|189.46|189.46|202.44|155.72|168.70|194.66|220.61|230.47|228.40|194.66|220.61| 24.64 | 230.47 | 176.49 30000175|HC FETAL FIBRONECTIN|0300|82731|485.90|281.82|108.69|103.26|||98.99|100.97|100.97|102.95|315.84|330.41|354.71|354.71|379.00|291.54|315.84|364.43|413.02|431.48|427.59|364.43|413.02| 98.99 | 431.48 | 330.41 30000176|HC FOLIC ACID-SERUM|0300|82746|168.56|97.76|48.60|46.17|||26.59|27.12|27.12|27.65|109.56|114.62|123.05|123.05|131.48|101.14|109.56|126.42|143.28|149.68|148.33|126.42|143.28| 26.59 | 149.68 | 114.62 30000177|HC FOLIC-ACID-RED-CELL-FOLATE|0300|82747|218.60|126.79|50.02|47.52|||28.46|29.03|29.03|29.59|142.09|148.65|159.58|159.58|170.51|131.16|142.09|163.95|185.81|194.12|192.37|163.95|185.81| 28.46 | 194.12 | 148.65 30000178|HC IGA-IMMUNOGLOBULIN|0300|82784|218.60|126.79|38.71|36.77|||16.81|17.15|17.15|17.48|142.09|148.65|159.58|159.58|170.51|131.16|142.09|163.95|185.81|194.12|192.37|163.95|185.81| 16.81 | 194.12 | 148.65 30000179|HC IGG-IMMUNOGLOBULIN|0300|82784|218.60|126.79|38.71|36.77|||16.81|17.15|17.15|17.48|142.09|148.65|159.58|159.58|170.51|131.16|142.09|163.95|185.81|194.12|192.37|163.95|185.81| 16.81 | 194.12 | 148.65 30000180|HC IGM-IMMUNOGLOBLIN|0300|82784|218.60|126.79|38.71|36.77|||16.81|17.15|17.15|17.48|142.09|148.65|159.58|159.58|170.51|131.16|142.09|163.95|185.81|194.12|192.37|163.95|185.81| 16.81 | 194.12 | 148.65 30000181|HC IMMUNOGLOBULIN; CSF|0300|82784|207.86|120.56|38.71|36.77|||16.81|17.15|17.15|17.48|135.11|141.34|151.74|151.74|162.13|124.72|135.11|155.90|176.68|184.58|182.92|155.90|176.68| 16.81 | 184.58 | 141.34 30000182|HC IGE|0300|82785|309.70|179.63|49.75|47.26|||17.40|17.75|17.75|18.10|201.31|210.60|226.08|226.08|241.57|185.82|201.31|232.28|263.25|275.01|272.54|232.28|263.25| 17.40 | 275.01 | 210.60 30000183|HC IGG SUBCLASS|0300|82787|221.66|128.56|26.53|25.20|||17.79|18.15|18.15|18.50|144.08|150.73|161.81|161.81|172.89|133.00|144.08|166.25|188.41|196.83|195.06|166.25|188.41| 17.79 | 196.83 | 150.73 30000184|HC POCT-GASES|0300|82803|56.09|32.53|53.52|50.84|||27.79|28.34|28.34|28.90|36.46|38.14|40.95|40.95|43.75|33.65|36.46|42.07|47.68|49.81|49.36|42.07|47.68| 27.79 | 53.52 | 40.95 30000185|HC BLOOD GAS-POCT|0300|82803|460.68|267.19|53.52|50.84|||27.79|28.34|28.34|28.90|299.44|313.26|336.30|336.30|359.33|276.41|299.44|345.51|391.58|409.08|405.40|345.51|391.58| 27.79 | 409.08 | 313.26 30000186|HC CAPILLARY GAS-POCT|0300|82803|460.68|267.19|53.52|50.84|||27.79|28.34|28.34|28.90|299.44|313.26|336.30|336.30|359.33|276.41|299.44|345.51|391.58|409.08|405.40|345.51|391.58| 27.79 | 409.08 | 313.26 30000187|HC CORD GAS - ARTERIAL-POCT|0300|82803|460.68|267.19|53.52|50.84|||27.79|28.34|28.34|28.90|299.44|313.26|336.30|336.30|359.33|276.41|299.44|345.51|391.58|409.08|405.40|345.51|391.58| 27.79 | 409.08 | 313.26 30000188|HC CORD GAS - VENOUS-POCT|0300|82803|460.68|267.19|53.52|50.84|||27.79|28.34|28.34|28.90|299.44|313.26|336.30|336.30|359.33|276.41|299.44|345.51|391.58|409.08|405.40|345.51|391.58| 27.79 | 409.08 | 313.26 30000189|HC VENOUS GAS-POCT|0300|82803|460.68|267.19|53.52|50.84|||27.79|28.34|28.34|28.90|299.44|313.26|336.30|336.30|359.33|276.41|299.44|345.51|391.58|409.08|405.40|345.51|391.58| 27.79 | 409.08 | 313.26 30000190|HC GASES, BLOOD, 02 SATURATION-PO|0300|82810|136.56|79.20|38.53|36.60|||11.68|11.92|11.92|12.15|88.76|92.86|99.69|99.69|106.52|81.94|88.76|102.42|116.08|121.27|120.17|102.42|116.08| 11.68 | 121.27 | 92.86 30000191|HC GASTRIN-REF-LAB|0300|82941|344.44|199.78|53.65|50.97|||31.26|31.88|31.88|32.51|223.89|234.22|251.44|251.44|268.66|206.66|223.89|258.33|292.77|305.86|303.11|258.33|292.77| 31.26 | 305.86 | 234.22 30000192|HC GLUCOSE-BODY FLUID|0300|82945|113.69|65.94|11.23|10.67|||6.03|6.15|6.15|6.27|73.90|77.31|82.99|82.99|88.68|68.21|73.90|85.27|96.64|100.96|100.05|85.27|96.64| 6.03 | 100.96 | 77.31 30000193|HC GLUCOSE-SPINAL FLUID|0300|82945|124.59|72.26|11.23|10.67|||6.03|6.15|6.15|6.27|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 6.03 | 110.64 | 84.72 30000194|HC GLUCOSE BLOOD|0300|82947|57.42|33.30|6.79|6.45|||6.03|6.15|6.15|6.27|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 6.03 | 50.99 | 39.05 30000195|HC GESTATIONAL GLUCOSE SCREEN|0300|82950|124.59|72.26|15.78|14.99|||8.60|8.77|8.77|8.94|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 8.60 | 110.64 | 84.72 30000196|HC GLUCOSE-2-HOUR-POST-GLUCOLA|0300|82950|139.70|81.03|15.78|14.99|||8.60|8.77|8.77|8.94|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 8.60 | 124.05 | 95.00 30000197|HC GLUCOSE-TOLERANCE-INITIAL|0300|82951|145.79|84.56|38.32|36.40|||23.29|23.75|23.75|24.22|94.76|99.14|106.43|106.43|113.72|87.47|94.76|109.34|123.92|129.46|128.30|109.34|123.92| 23.29 | 129.46 | 99.14 30000198|HC GLUCOSE-TOLERANCE-ADD-HR|0300|82952|51.58|29.92|11.45|10.88|||6.87|7.01|7.01|7.14|33.53|35.07|37.65|37.65|40.23|30.95|33.53|38.69|43.84|45.80|45.39|38.69|43.84| 6.87 | 45.80 | 35.07 30000199|HC GLUCOSE-6-PHOSPHATE-QUANT-R|0300|82955|320.42|185.84|61.10|58.05|||17.53|17.88|17.88|18.23|208.27|217.89|233.91|233.91|249.93|192.25|208.27|240.32|272.36|284.53|281.97|240.32|272.36| 17.53 | 284.53 | 217.89 30000200|HC BEDSIDE GLUCOSE|0300|82962|165.20|95.82|6.29|5.98|||5.70|5.82|5.82|5.93|107.38|112.34|120.60|120.60|128.86|99.12|107.38|123.90|140.42|146.70|145.38|123.90|140.42| 5.70 | 146.70 | 112.34 30000201|HC GAMMAGLUTAMYL-TRANS FERASE-|0300|82977|157.73|91.48|12.15|11.54|||11.07|11.29|11.29|11.51|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 11.07 | 140.06 | 107.26 30000202|HC FSH-FOLLICLE-STIM-HORM-RL|0300|83001|391.56|227.10|56.05|53.25|||32.97|33.63|33.63|34.29|254.51|266.26|285.84|285.84|305.42|234.94|254.51|293.67|332.83|347.71|344.57|293.67|332.83| 32.97 | 347.71 | 266.26 30000203|HC LH-LEUTEINIZING-HORMONE-REF|0300|83002|227.78|132.11|54.69|51.96|||32.97|33.63|33.63|34.29|148.06|154.89|166.28|166.28|177.67|136.67|148.06|170.84|193.61|202.27|200.45|170.84|193.61| 32.97 | 202.27 | 154.89 30000204|HC GROWTH-HORMONE-REF LAB|0300|83003|338.54|196.35|46.36|44.04|||27.47|28.02|28.02|28.57|220.05|230.21|247.13|247.13|264.06|203.12|220.05|253.91|287.76|300.62|297.92|253.91|287.76| 27.47 | 300.62 | 230.21 30000205|HC HAPTOGLOBIN-REF-LAB|0300|83010|306.81|177.95|40.96|38.91|||20.61|21.02|21.02|21.43|199.43|208.63|223.97|223.97|239.31|184.09|199.43|230.11|260.79|272.45|269.99|230.11|260.79| 20.61 | 272.45 | 208.63 30000206|HC HELICOBACTER PYLORI UREA BREAT|0300|83013|423.23|245.47|216.15|205.34|||68.78|70.15|70.15|71.53|275.10|287.80|308.96|308.96|330.12|253.94|275.10|317.42|359.75|375.83|372.44|317.42|359.75| 68.78 | 375.83 | 287.80 30000207|HC ELECTROPHORESIS-HEMOGLOBIN|0300|83020|376.56|218.40|40.89|38.85|||23.29|23.75|23.75|24.22|244.76|256.06|274.89|274.89|293.72|225.94|244.76|282.42|320.08|334.39|331.37|282.42|320.08| 23.29 | 334.39 | 256.06 30000208|HC HEMOGLOBIN-A1C|0300|83036|189.76|110.06|28.25|26.84|||17.54|17.90|17.90|18.25|123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 17.54 | 168.51 | 129.04 30000209|HC METHEMOGLOBIN|0300|83050|229.72|133.24|14.02|13.32|||7.85|8.01|8.01|8.16|149.32|156.21|167.70|167.70|179.18|137.83|149.32|172.29|195.26|203.99|202.15|172.29|195.26| 7.85 | 203.99 | 156.21 30000210|HC PLASMA-FREE-HEMOGLOBIN|0300|83051|196.01|113.69|16.62|15.79|||1.71|1.75|1.75|1.78|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 1.71 | 174.06 | 133.29 30000211|HC HEMOSIDERIN-URINE|0300|83070|185.54|107.61|7.74|7.35|||2.34|2.39|2.39|2.44|120.60|126.17|135.44|135.44|144.72|111.32|120.60|139.16|157.71|164.76|163.28|139.16|157.71| 2.34 | 164.76 | 126.17 30000212|HC HISTAMINE, PLASMA & URINE|0300|83088|303.77|176.19|78.42|74.50|||32.71|33.36|33.36|34.02|197.45|206.56|221.75|221.75|236.94|182.26|197.45|227.83|258.20|269.75|267.32|227.83|258.20| 32.71 | 269.75 | 206.56 30000213|HC HOMOCYSTEINE, SERUM|0300|83090|373.40|216.57|138.84|131.90|||25.92|26.44|26.44|26.95|242.71|253.91|272.58|272.58|291.25|224.04|242.71|280.05|317.39|331.58|328.59|280.05|317.39| 25.92 | 331.58 | 253.91 30000214|HC HVA,URINE|0300|83150|197.41|114.50|47.57|45.19|||28.17|28.73|28.73|29.29|128.32|134.24|144.11|144.11|153.98|118.45|128.32|148.06|167.80|175.30|173.72|148.06|167.80| 28.17 | 175.30 | 134.24 30000215|HC 5HIAA-URINE-24HR|0300|83497|379.84|220.31|37.85|35.96|||18.45|18.82|18.82|19.19|246.90|258.29|277.28|277.28|296.28|227.90|246.90|284.88|322.86|337.30|334.26|284.88|322.86| 18.45 | 337.30 | 258.29 30000216|HC HYDROXYPROGESTERONE-17-RL|0300|83498|219.52|127.32|68.89|65.45|||36.31|37.03|37.03|37.76|142.69|149.27|160.25|160.25|171.23|131.71|142.69|164.64|186.59|194.93|193.18|164.64|186.59| 36.31 | 194.93 | 149.27 30000217|HC ANTI-MITOCHONORIL-ANTIBY-R|0300|83516|285.51|165.60|239.51|227.53|||13.08|13.34|13.34|13.61|185.58|194.15|208.42|208.42|222.70|171.31|185.58|214.13|242.68|253.53|251.25|214.13|242.68| 13.08 | 253.53 | 208.42 30000218|HC GLIADIN ANTIBODY|0300|83516|170.06|98.63|239.51|227.53|||13.08|13.34|13.34|13.61|110.54|115.64|124.14|124.14|132.65|102.04|110.54|127.55|144.55|151.01|149.65|127.55|144.55| 13.08 | 239.51 | 124.14 30000219|HC SMOOTH-MUSCLE-ANTIBODY-RL|0300|83516|282.36|163.77|239.51|227.53|||13.08|13.34|13.34|13.61|183.53|192.00|206.12|206.12|220.24|169.42|183.53|211.77|240.01|250.74|248.48|211.77|240.01| 13.08 | 250.74 | 206.12 30000220|HC IMMUNOASSAY NON-AB; TTG|0300|83516|303.77|176.19|239.51|227.53|||13.08|13.34|13.34|13.61|197.45|206.56|221.75|221.75|236.94|182.26|197.45|227.83|258.20|269.75|267.32|227.83|258.20| 13.08 | 269.75 | 221.75 30000221|HC TRANGLUTAMINASE|0300|83516|289.30|167.79|239.51|227.53|||13.08|13.34|13.34|13.61|188.05|196.72|211.19|211.19|225.65|173.58|188.05|216.98|245.91|256.90|254.58|216.98|245.91| 13.08 | 256.90 | 211.19 30000222|HC GAD (GLUTAMIC ACID DECARXY) AU|0300|83519|394.85|229.01|28.69|27.26|||15.83|16.15|16.15|16.46|256.65|268.50|288.24|288.24|307.98|236.91|256.65|296.14|335.62|350.63|347.47|296.14|335.62| 15.83 | 350.63 | 268.50 30000223|HC IMMUNOASSAY, QUANT, RIA|0300|83519|473.54|274.65|28.69|27.26|||15.83|16.15|16.15|16.46|307.80|322.01|345.68|345.68|369.36|284.12|307.80|355.16|402.51|420.50|416.72|355.16|402.51| 15.83 | 420.50 | 322.01 30000224|HC RECEPTOR ASSAY - ACR - REF|0300|83519|399.32|231.61|28.69|27.26|||15.83|16.15|16.15|16.46|259.56|271.54|291.50|291.50|311.47|239.59|259.56|299.49|339.42|354.60|351.40|299.49|339.42| 15.83 | 354.60 | 271.54 30000225|HC CENTROMERE ANTIBODY|0300|83520|236.87|137.38|28.69|27.26|||||||153.97|161.07|172.92|172.92|184.76|142.12|153.97|177.65|201.34|210.34|208.45|177.65|201.34| 27.26 | 210.34 | 172.92 30000226|HC GM - 1 ANTIBODY|0300|83520|190.70|110.61|28.69|27.26|||||||123.96|129.68|139.21|139.21|148.75|114.42|123.96|143.03|162.10|169.34|167.82|143.03|162.10| 27.26 | 169.34 | 139.21 30000227|HC IMMUNOASSAY; QUANT, NOT RIA|0300|83520|244.31|141.70|28.69|27.26|||||||158.80|166.13|178.35|178.35|190.56|146.59|158.80|183.23|207.66|216.95|214.99|183.23|207.66| 27.26 | 216.95 | 178.35 30000228|HC INSULIN-LIKE GFB PROTEIN 3|0300|83520|334.15|193.81|28.69|27.26|||||||217.20|227.22|243.93|243.93|260.64|200.49|217.20|250.61|284.03|296.73|294.05|250.61|284.03| 27.26 | 296.73 | 243.93 30000229|HC MYELOPEROXIDASE AB|0300|83520|258.27|149.80|28.69|27.26|||||||167.88|175.62|188.54|188.54|201.45|154.96|167.88|193.70|219.53|229.34|227.28|193.70|219.53| 27.26 | 229.34 | 188.54 30000230|HC THYROTROPIN RECEPTOR AB|0300|83520|244.31|141.70|28.69|27.26|||||||158.80|166.13|178.35|178.35|190.56|146.59|158.80|183.23|207.66|216.95|214.99|183.23|207.66| 27.26 | 216.95 | 178.35 30000231|HC TRYPTASE-REF|0300|83520|247.57|143.59|28.69|27.26|||||||160.92|168.35|180.73|180.73|193.10|148.54|160.92|185.68|210.43|219.84|217.86|185.68|210.43| 27.26 | 219.84 | 180.73 30000232|HC INSULIN-LEVEL|0300|83525|91.16|52.87|39.88|37.89|||15.45|15.76|15.76|16.07|59.25|61.99|66.55|66.55|71.10|54.70|59.25|68.37|77.49|80.95|80.22|68.37|77.49| 15.45 | 80.95 | 61.99 30000233|HC INSULIN-TOTAL|0300|83525|79.64|46.19|39.88|37.89|||15.45|15.76|15.76|16.07|51.77|54.16|58.14|58.14|62.12|47.78|51.77|59.73|67.69|70.72|70.08|59.73|67.69| 15.45 | 70.72 | 54.16 30000234|HC INSULIN, FREE|0300|83527|297.54|172.57|89.03|84.58|||15.45|15.76|15.76|16.07|193.40|202.33|217.20|217.20|232.08|178.52|193.40|223.16|252.91|264.22|261.84|223.16|252.91| 15.45 | 264.22 | 202.33 30000235|HC IRON|0300|83540|110.62|64.16|20.14|19.13|||6.80|6.94|6.94|7.08|71.90|75.22|80.75|80.75|86.28|66.37|71.90|82.97|94.03|98.23|97.35|82.97|94.03| 6.80 | 98.23 | 75.22 30000236|HC IRON BINDING CAP TIBC|0300|83550|145.79|84.56|32.42|30.80|||15.94|16.25|16.25|16.57|94.76|99.14|106.43|106.43|113.72|87.47|94.76|109.34|123.92|129.46|128.30|109.34|123.92| 15.94 | 129.46 | 99.14 30000237|HC LACTIC ACID|0300|83605|201.68|116.97|37.23|35.37|||13.19|13.45|13.45|13.72|131.09|137.14|147.23|147.23|157.31|121.01|131.09|151.26|171.43|179.09|177.48|151.26|171.43| 13.19 | 179.09 | 137.14 30000238|HC LDH-BODY-FLUID|0300|83615|157.73|91.48|17.91|17.0145|||10.31|10.52|10.52|10.72|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 10.31 | 140.06 | 107.26 30000239|HC LDH-LACTIC-DEHYDROGENASE|0300|83615|157.73|91.48|17.91|17.01|||10.31|10.52|10.52|10.72|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 10.31 | 140.06 | 107.26 30000240|HC LDH ISOENZYME ONLY|0300|83625|266.01|154.29|37.00|35.15|||23.09|23.55|23.55|24.02|172.91|180.89|194.19|194.19|207.49|159.61|172.91|199.51|226.11|236.22|234.09|199.51|226.11| 23.09 | 236.22 | 180.89 30000241|HC LACTOFERRIN FECAL QT|0300|83631|132.73|76.98|||||30.50|31.11|31.11|31.72|86.27|90.26|96.89|96.89|103.53|79.64|86.27|99.55|112.82|117.86|116.80|99.55|112.82| 30.50 | 117.86 | 96.89 30000242|HC LEAD - BLOOD|0300|83655|136.79|79.34|19.16|18.20|||15.31|15.61|15.61|15.92|88.91|93.02|99.86|99.86|106.70|82.07|88.91|102.59|116.27|121.47|120.38|102.59|116.27| 15.31 | 121.47 | 93.02 30000243|HC LIPASE-SERUM|0300|83690|196.01|113.69|21.82|20.73|||10.31|10.52|10.52|10.72|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 10.31 | 174.06 | 133.29 30000244|HC LIPOPROTEIN A|0300|83695|142.76|82.80|19.68|18.70|||20.12|20.52|20.52|20.93|92.79|97.08|104.21|104.21|111.35|85.66|92.79|107.07|121.35|126.77|125.63|107.07|121.35| 18.70 | 126.77 | 97.08 30000245|HC HDL-CHOLESTEROL|0300|83718|189.76|110.06|13.82|13.13|||14.72|15.01|15.01|15.31|123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 13.13 | 168.51 | 129.04 30000246|HC DIRECT LDL|0300|83721|177.64|103.03|35.64|33.858|||14.72|15.01|15.01|15.31|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 14.72 | 157.74 | 120.80 30000247|HC MAGNESIUM-SERUM|0300|83735|196.01|113.69|20.32|19.30|||10.99|11.21|11.21|11.43|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 10.99 | 174.06 | 133.29 30000248|HC MAGNESIUM, OTHER SOURCE|0300|83735|196.01|113.69|20.32|19.30|||10.99|11.21|11.21|11.43|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 10.99 | 174.06 | 133.29 30000249|HC MASS SPEC. QUAL|0300|83788|448.67|260.23|||||||||291.64|305.10|327.53|327.53|349.96|269.20|291.64|336.50|381.37|398.42|394.83|336.50|381.37| 269.20 | 398.42 | 336.50 30000250|HC HISTAMINE METABOLITES|0300|83789|381.36|221.19|146.11|138.80|||||||247.88|259.32|278.39|278.39|297.46|228.82|247.88|286.02|324.16|338.65|335.60|286.02|324.16| 138.80 | 338.65 | 278.39 30000251|HC MASS SPECTOMETRY QUAL/QUANT|0300|83789|384.27|222.88|146.11|138.80|||||||249.78|261.30|280.52|280.52|299.73|230.56|249.78|288.20|326.63|341.23|338.16|288.20|326.63| 138.80 | 341.23 | 280.52 30000252|HC TPMT (THIOPURINE METHYTRANSFER|0300|83789|435.63|252.67|146.11|138.80|||||||283.16|296.23|318.01|318.01|339.79|261.38|283.16|326.72|370.29|386.84|383.35|326.72|370.29| 138.80 | 386.84 | 318.01 30000253|HC MERCURY - REF LAB|0300|83825|101.66|58.96|34.00|32.30|||13.19|13.45|13.45|13.72|66.08|69.13|74.21|74.21|79.29|61.00|66.08|76.25|86.41|90.27|89.46|76.25|86.41| 13.19 | 90.27 | 69.13 30000254|HC METANEPHRINES, PLASMA|0300|83835|552.58|320.50|51.72|49.13|||29.76|30.36|30.36|30.95|359.18|375.75|403.38|403.38|431.01|331.55|359.18|414.44|469.69|490.69|486.27|414.44|469.69| 29.76 | 490.69 | 375.75 30000255|HC METANEPHRINES-URINE-REF-LAB|0300|83835|526.31|305.26|51.72|49.13|||29.76|30.36|30.36|30.95|342.10|357.89|384.21|384.21|410.52|315.79|342.10|394.73|447.36|467.36|463.15|394.73|447.36| 29.76 | 467.36 | 357.89 30000257|HC MYELIN-BASIC-PROTEIN-SPINAL|0300|83873|370.38|214.82|35.33|33.56|||31.11|31.73|31.73|32.36|240.75|251.86|270.38|270.38|288.90|222.23|240.75|277.79|314.82|328.90|325.93|277.79|314.82| 31.11 | 328.90 | 251.86 30000258|HC MYOGLOBIN-IMMEDIATE|0300|83874|274.68|159.31|37.48|35.61|||22.41|22.86|22.86|23.31|178.54|186.78|200.52|200.52|214.25|164.81|178.54|206.01|233.48|243.92|241.72|206.01|233.48| 22.41 | 243.92 | 186.78 30000259|HC MYOGLOBIN-URINE|0300|83874|230.76|133.84|37.48|35.61|||22.41|22.86|22.86|23.31|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 22.41 | 204.91 | 156.92 30000260|HC BETA TYPE-NATRIURETIC PEPTIDE|0300|83880|280.18|162.50|57.27|54.41|||30.22|30.83|30.83|31.43|182.12|190.52|204.53|204.53|218.54|168.11|182.12|210.14|238.15|248.80|246.56|210.14|238.15| 30.22 | 248.80 | 190.52 30000261|HC NEPHOLOMETRY, EA ANALYTE|0300|83883|152.96|88.72|39.02|37.07|||||||99.42|104.01|111.66|111.66|119.31|91.78|99.42|114.72|130.02|135.83|134.60|114.72|130.02| 37.07 | 135.83 | 111.66 30000262|HC 5' NUCLEOTIDASE|0300|83915|206.50|119.77|33.82|32.13|||14.91|15.21|15.21|15.51|134.23|140.42|150.75|150.75|161.07|123.90|134.23|154.88|175.53|183.37|181.72|154.88|175.53| 14.91 | 183.37 | 140.42 30000263|HC OLIGOCLONAL-BANDING-IGG-CSF|0300|83916|364.42|211.36|58.93|55.9835|||||||236.87|247.81|266.03|266.03|284.25|218.65|236.87|273.32|309.76|323.60|320.69|273.32|309.76| 55.98 | 323.60 | 266.03 30000264|HC ORGANIC ACIDS-URINE|0300|83919|177.48|102.94|33.79|32.10|||13.19|13.45|13.45|13.72|115.36|120.69|129.56|129.56|138.43|106.49|115.36|133.11|150.86|157.60|156.18|133.11|150.86| 13.19 | 157.60 | 120.69 30000265|HC ORG ACID SINGLE QUANT|0300|83921|346.32|200.87|33.79|32.10|||25.30|25.81|25.81|26.32|225.11|235.50|252.81|252.81|270.13|207.79|225.11|259.74|294.37|307.53|304.76|259.74|294.37| 25.30 | 307.53 | 235.50 30000266|HC OPIATES, CONFIRM|0300|83925|442.01|256.37|||||13.08|13.34|13.34|13.61|287.31|300.57|322.67|322.67|344.77|265.21|287.31|331.51|375.71|392.50|388.97|331.51|375.71| 13.08 | 392.50 | 322.67 30000267|HC OSMOLALITY-SERUM|0300|83930|177.64|103.03|22.57|21.44|||8.45|8.62|8.62|8.79|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 8.45 | 157.74 | 120.80 30000268|HC OSMOLALITY-URINE|0300|83935|177.64|103.03|24.55|23.32|||8.45|8.62|8.62|8.79|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 8.45 | 157.74 | 120.80 30000269|HC OXALATE|0300|83945|244.32|141.71|38.03|36.13|||10.07|10.28|10.28|10.48|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 10.07 | 216.96 | 166.14 30000270|HC PARATHYROID-HORMONE-PTH-REF|0300|83970|607.25|352.21|121.90|115.81|||30.22|30.83|30.83|31.43|394.71|412.93|443.29|443.29|473.66|364.35|394.71|455.44|516.16|539.24|534.38|455.44|516.16| 30.22 | 539.24 | 412.93 30000271|HC PH-BODY-FLUID|0300|83986|76.08|44.13|12.60|11.97|||5.49|5.60|5.60|5.71|49.45|51.73|55.54|55.54|59.34|45.65|49.45|57.06|64.67|67.56|66.95|57.06|64.67| 5.49 | 67.56 | 51.73 30000272|HC PH-FECES|0300|83986|76.08|44.13|12.60|11.97|||5.49|5.60|5.60|5.71|49.45|51.73|55.54|55.54|59.34|45.65|49.45|57.06|64.67|67.56|66.95|57.06|64.67| 5.49 | 67.56 | 51.73 30000273|HC PH-URINE|0300|83986|76.08|44.13|12.60|11.97|||5.49|5.60|5.60|5.71|49.45|51.73|55.54|55.54|59.34|45.65|49.45|57.06|64.67|67.56|66.95|57.06|64.67| 5.49 | 67.56 | 51.73 30000274|HC PHENYALANINE|0300|84030|209.54|121.53|13.34|12.67|||5.49|5.60|5.60|5.71|136.20|142.49|152.96|152.96|163.44|125.72|136.20|157.16|178.11|186.07|184.40|157.16|178.11| 5.49 | 186.07 | 142.49 30000275|HC ALKALINE-PHOSPHATASE|0300|84075|139.70|81.03|8.73|8.29|||9.35|9.54|9.54|9.73|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 8.29 | 124.05 | 95.00 30000276|HC ALKALINE-PHOSPHATASE-ISOENZ|0300|84080|285.51|165.60|43.10|40.95|||26.74|27.28|27.28|27.81|185.58|194.15|208.42|208.42|222.70|171.31|185.58|214.13|242.68|253.53|251.25|214.13|242.68| 26.74 | 253.53 | 194.15 30000277|HC PHOSPHORUS|0300|84100|104.59|60.66|8.02|7.62|||8.24|8.41|8.41|8.57|67.98|71.12|76.35|76.35|81.58|62.75|67.98|78.44|88.90|92.88|92.04|78.44|88.90| 7.62 | 92.88 | 71.12 30000278|HC PHOSPHORUS-URINE|0300|84105|139.70|81.03|13.93|13.23|||8.24|8.41|8.41|8.57|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 8.24 | 124.05 | 95.00 30000279|HC PORPHOBILINOGEN-UR QUANT|0300|84110|101.66|58.96|30.91|29.36|||10.31|10.52|10.52|10.72|66.08|69.13|74.21|74.21|79.29|61.00|66.08|76.25|86.41|90.27|89.46|76.25|86.41| 10.31 | 90.27 | 69.13 30000280|HC PROPHYRIN QUANT-URINE-RF|0300|84120|203.67|118.13|47.61|45.23|||13.74|14.01|14.01|14.29|132.39|138.50|148.68|148.68|158.86|122.20|132.39|152.75|173.12|180.86|179.23|152.75|173.12| 13.74 | 180.86 | 138.50 30000281|HC POCT-POTASSIUM|0300|84132|57.42|33.30|7.76|7.37|||5.49|5.60|5.60|5.71|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 5.49 | 50.99 | 39.05 30000282|HC POTASSIUM URINE RANDOM|0300|84133|165.29|95.87|15.69|14.91|||5.49|5.60|5.60|5.71|107.44|112.40|120.66|120.66|128.93|99.17|107.44|123.97|140.50|146.78|145.46|123.97|140.50| 5.49 | 146.78 | 112.40 30000283|HC PREALBUMIN SERUM|0300|84134|142.65|82.74|38.38|36.46|||6.87|7.01|7.01|7.14|92.72|97.00|104.13|104.13|111.27|85.59|92.72|106.99|121.25|126.67|125.53|106.99|121.25| 6.87 | 126.67 | 97.00 30000284|HC 17-OH PREGNENOLONE|0300|84143|175.59|101.84|70.33|66.81|||34.34|35.03|35.03|35.72|114.13|119.40|128.18|128.18|136.96|105.35|114.13|131.69|149.25|155.92|154.52|131.69|149.25| 34.34 | 155.92 | 119.40 30000285|HC PROGESTERONE-REF-LAB|0300|84144|146.34|84.88|56.39|53.57|||37.72|38.47|38.47|39.23|95.12|99.51|106.83|106.83|114.15|87.80|95.12|109.76|124.39|129.95|128.78|109.76|124.39| 37.72 | 129.95 | 99.51 30000286|HC PROLACTIN-REF-LAB|0300|84146|244.32|141.71|62.44|59.32|||35.02|35.72|35.72|36.42|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 35.02 | 216.96 | 166.14 30000287|HC PROSTATIC SPECIFIC ANTIN|0300|84153|143.20|83.06|53.43|50.76|||28.27|28.84|28.84|29.40|93.08|97.38|104.54|104.54|111.70|85.92|93.08|107.40|121.72|127.16|126.02|107.40|121.72| 28.27 | 127.16 | 97.38 30000288|HC PSA FREE|0300|84154|95.77|55.55|41.60|39.52|||33.26|33.92|33.92|34.59|62.25|65.12|69.91|69.91|74.70|57.46|62.25|71.83|81.40|85.04|84.28|71.83|81.40| 33.26 | 85.04 | 65.12 30000289|HC PROTEIN-TOT-SER,PLAS,OR WB|0300|84155|124.59|72.26|6.79|6.45|||6.61|6.74|6.74|6.87|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 6.45 | 110.64 | 84.72 30000290|HC PROTEIN TOTAL RANDOM URINE|0300|84156|124.59|72.26|14.81|14.07|||6.61|6.74|6.74|6.87|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 6.61 | 110.64 | 84.72 30000291|HC PROTEIN TOTAL-BODY-FLUID|0300|84157|124.59|72.26|14.81|14.07|||6.61|6.74|6.74|6.87|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 6.61 | 110.64 | 84.72 30000292|HC PROTEIN-SPINAL-FLUID|0300|84157|124.59|72.26|14.81|14.07|||6.61|6.74|6.74|6.87|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 6.61 | 110.64 | 84.72 30000293|HC ELECTROPHORESIS-PROTEIN-SER|0300|84165|344.44|199.78|31.67|30.09|||16.48|16.81|16.81|17.14|223.89|234.22|251.44|251.44|268.66|206.66|223.89|258.33|292.77|305.86|303.11|258.33|292.77| 16.48 | 305.86 | 234.22 30000294|HC ELECTROPHORESIS-PROTEIN-SPI|0300|84166|258.27|149.80|125.08|118.83|||27.71|28.26|28.26|28.82|167.88|175.62|188.54|188.54|201.45|154.96|167.88|193.70|219.53|229.34|227.28|193.70|219.53| 27.71 | 229.34 | 175.62 30000295|HC ELECTROPHORESIS-PROTEIN|0300|84166|344.44|199.78|125.08|118.83|||27.71|28.26|28.26|28.82|223.89|234.22|251.44|251.44|268.66|206.66|223.89|258.33|292.77|305.86|303.11|258.33|292.77| 27.71 | 305.86 | 234.22 30000296|HC PROINSULIN - IMM|0300|84206|347.70|201.67|40.14|38.13|||22.24|22.69|22.69|23.13|226.01|236.44|253.82|253.82|271.21|208.62|226.01|260.78|295.55|308.76|305.98|260.78|295.55| 22.24 | 308.76 | 236.44 30000297|HC VITAMIN B-6, PLASMA|0300|84207|394.85|229.01|110.50|104.98|||||||256.65|268.50|288.24|288.24|307.98|236.91|256.65|296.14|335.62|350.63|347.47|296.14|335.62| 104.98 | 350.63 | 288.24 30000298|HC PYRUVIC ACID, BLOOD|0300|84210|145.22|84.23|29.29|27.83|||14.91|15.21|15.21|15.51|94.39|98.75|106.01|106.01|113.27|87.13|94.39|108.92|123.44|128.96|127.79|108.92|123.44| 14.91 | 128.96 | 98.75 30000299|HC PYRUVATE KINASE,ERYTHROCYTES|0300|84220|300.60|174.35|40.10|38.10|||6.67|6.81|6.81|6.94|195.39|204.41|219.44|219.44|234.47|180.36|195.39|225.45|255.51|266.93|264.53|225.45|255.51| 6.67 | 266.93 | 204.41 30000300|HC SOLUBLE TRANSFERIN RECEPTOR|0300|84238|426.45|247.34|373.02|354.37|||66.11|67.43|67.43|68.75|277.19|289.99|311.31|311.31|332.63|255.87|277.19|319.84|362.48|378.69|375.28|319.84|362.48| 66.11 | 378.69 | 311.31 30000301|HC RENIN-ACTIVITY|0300|84244|481.16|279.07|63.20|60.04|||30.22|30.83|30.83|31.43|312.75|327.19|351.25|351.25|375.30|288.70|312.75|360.87|408.99|427.27|423.42|360.87|408.99| 30.22 | 427.27 | 327.19 30000302|HC SELENIUM|0300|84255|315.89|183.22|63.06|59.91|||13.19|13.45|13.45|13.72|205.33|214.81|230.60|230.60|246.39|189.53|205.33|236.92|268.51|280.51|277.98|236.92|268.51| 13.19 | 280.51 | 214.81 30000303|HC SEROTININ-SERUM-REF-LAB|0300|84260|298.47|173.11|97.26|92.40|||30.92|31.53|31.53|32.15|194.01|202.96|217.88|217.88|232.81|179.08|194.01|223.85|253.70|265.04|262.65|223.85|253.70| 30.92 | 265.04 | 202.96 30000304|HC SEX HORMONE BINDING GLOBULIN|0300|84270|379.84|220.31|101.32|96.25|||23.88|24.35|24.35|24.83|246.90|258.29|277.28|277.28|296.28|227.90|246.90|284.88|322.86|337.30|334.26|284.88|322.86| 23.88 | 337.30 | 258.29 30000305|HC SODIUM-BLOOD|0300|84295|57.42|33.30|8.12|7.71|||5.49|5.6|5.6|5.71|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 5.49 | 50.99 | 39.05 30000306|HC SODIUM URINE RANDOM|0300|84300|165.29|95.87|15.36|14.59|||5.49|5.60|5.60|5.71|107.44|112.40|120.66|120.66|128.93|99.17|107.44|123.97|140.50|146.78|145.46|123.97|140.50| 5.49 | 146.78 | 112.40 30000307|HC SOMATOMEDIN-C - REF|0300|84305|405.11|234.96|94.94|90.19|||27.47|28.02|28.02|28.57|263.32|275.47|295.73|295.73|315.99|243.07|263.32|303.83|344.34|359.74|356.50|303.83|344.34| 27.47 | 359.74 | 275.47 30000308|HC SPECTROPHOTOMETRY ANALYTE NES|0300|84311|182.63|105.93|145.86|138.57|||||||118.71|124.19|133.32|133.32|142.45|109.58|118.71|136.97|155.24|162.18|160.71|136.97|155.24| 109.58 | 162.18 | 136.97 30000309|HC SUGARS; SNGL QUAL, EA|0300|84376|116.08|67.33|32.09|30.49|||35.44|36.15|36.15|36.86|75.45|78.93|84.74|84.74|90.54|69.65|75.45|87.06|98.67|103.08|102.15|87.06|98.67| 30.49 | 103.08 | 78.93 30000310|HC SULFATE,QUANT.,24-HR URINE|0300|84392|134.59|78.06|8.07|7.67|||8.60|8.77|8.77|8.94|87.48|91.52|98.25|98.25|104.98|80.75|87.48|100.94|114.40|119.52|118.44|100.94|114.40| 7.67 | 119.52 | 91.52 30000311|HC TESTOSTERONE FREE|0300|84402|206.50|119.77|85.42|81.15|||40.17|40.97|40.97|41.77|134.23|140.42|150.75|150.75|161.07|123.90|134.23|154.88|175.53|183.37|181.72|154.88|175.53| 40.17 | 183.37 | 140.42 30000312|HC TESTOSTERONE|0300|84403|219.52|127.32|82.45|78.33|||40.18|40.98|40.98|41.79|142.69|149.27|160.25|160.25|171.23|131.71|142.69|164.64|186.59|194.93|193.18|164.64|186.59| 40.18 | 194.93 | 149.27 30000313|HC VITAMIN B1 (THIAMINE)|0300|84425|324.99|188.49|57.06|54.21|||38.40|39.17|39.17|39.94|211.24|220.99|237.24|237.24|253.49|194.99|211.24|243.74|276.24|288.59|285.99|243.74|276.24| 38.40 | 288.59 | 220.99 30000314|HC THIOCYANATE-REF LAB|0300|84430|236.87|137.38|47.65|45.27|||13.19|13.45|13.45|13.72|153.97|161.07|172.92|172.92|184.76|142.12|153.97|177.65|201.34|210.34|208.45|177.65|201.34| 13.19 | 210.34 | 161.07 30000315|HC THYROGLOBULIN|0300|84432|106.20|61.60|69.90|66.41|||23.55|24.02|24.02|24.49|69.03|72.22|77.53|77.53|82.84|63.72|69.03|79.65|90.27|94.31|93.46|79.65|90.27| 23.55 | 94.31 | 72.22 30000316|HC FREE-THRYOXINE(FREE-T-4)RL|0300|84439|268.79|155.90|24.18|22.97|||15.18|15.48|15.48|15.78|174.71|182.78|196.22|196.22|209.66|161.27|174.71|201.59|228.47|238.69|236.54|201.59|228.47| 15.18 | 238.69 | 182.78 30000317|HC TSH-THYROID-STIMULATING-HOR|0300|84443|244.32|141.71|34.57|32.84|||20.61|21.02|21.02|21.43|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 20.61 | 216.96 | 166.14 30000318|HC THYROID STIM IMMUGLOB|0300|84445|629.22|364.95|369.46|350.99|||87.59|89.34|89.34|91.10|408.99|427.87|459.33|459.33|490.79|377.53|408.99|471.92|534.84|558.75|553.71|471.92|534.84| 87.59 | 558.75 | 427.87 30000319|HC VITAMIN-E|0300|84446|218.60|126.79|44.19|41.98|||24.96|25.46|25.46|25.96|142.09|148.65|159.58|159.58|170.51|131.16|142.09|163.95|185.81|194.12|192.37|163.95|185.81| 24.96 | 194.12 | 148.65 30000320|HC AST-SGOT|0300|84450|157.73|91.48|8.73|8.29|||9.35|9.54|9.54|9.73|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 8.29 | 140.06 | 107.26 30000321|HC ALT-SGPT|0300|84460|157.73|91.48|8.93|8.48|||9.68|9.88|9.88|10.07|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 8.48 | 140.06 | 107.26 30000322|HC TRANSFERRIN-REF-LAB|0300|84466|209.54|121.53|61.28|58.22|||17.86|18.22|18.22|18.57|136.20|142.49|152.96|152.96|163.44|125.72|136.20|157.16|178.11|186.07|184.40|157.16|178.11| 17.86 | 186.07 | 142.49 30000323|HC TRIGLYCERIDES|0300|84478|196.01|113.69|9.71|9.22|||8.24|8.41|8.41|8.57|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 8.24 | 174.06 | 133.29 30000324|HC T3, TOTAL|0300|84480|350.68|203.39|37.12|35.26|||0.00|0.00|0.00|0.00|227.94|238.46|256.00|256.00|273.53|210.41|227.94|263.01|298.08|311.40|308.60|263.01|298.08| - | 311.40 | 238.46 30000324|HC T3, TOTAL|0300|84480|350.68|203.39|37.12|35.26|||23.55|24.02|24.02|24.49|227.94|238.46|256.00|256.00|273.53|210.41|227.94|263.01|298.08|311.40|308.60|263.01|298.08| 23.55 | 311.40 | 238.46 30000325|HC FREE T3-TRIODOTHYRONINE|0300|84481|569.28|330.18|66.23|62.92|||30.64|31.25|31.25|31.87|370.03|387.11|415.57|415.57|444.04|341.57|370.03|426.96|483.89|505.52|500.97|426.96|483.89| 30.64 | 505.52 | 387.11 30000326|HC REVERSE T3|0300|84482|601.28|348.74|65.20|61.94|||10.34|10.54|10.54|10.75|390.83|408.87|438.93|438.93|469.00|360.77|390.83|450.96|511.09|533.94|529.13|450.96|511.09| 10.34 | 533.94 | 408.87 30000327|HC TROPONIN I, QUANT|0300|84484|271.86|157.68|53.93|51.23|||17.09|17.43|17.43|17.77|176.71|184.86|198.46|198.46|212.05|163.12|176.71|203.90|231.08|241.41|239.24|203.90|231.08| 17.09 | 241.41 | 184.86 30000328|HC TYROSINE|0300|84510|183.62|106.50|43.16|41.00|||9.42|9.61|9.61|9.80|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 9.42 | 163.05 | 124.86 30000329|HC BUN-BLOOD-UREA-NITROGEN|0300|84520|92.58|53.70|6.66|6.33|||7.14|7.29|7.29|7.43|60.18|62.95|67.58|67.58|72.21|55.55|60.18|69.44|78.69|82.21|81.47|69.44|78.69| 6.33 | 82.21 | 62.95 30000330|HC UREA-NITROGEN-URINE|0300|84540|124.59|72.26|14.21|13.50|||8.24|8.41|8.41|8.57|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 8.24 | 110.64 | 84.72 30000331|HC URIC-ACID-SERUM|0300|84550|139.70|81.03|11.57|10.99|||8.18|8.34|8.34|8.5|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 8.18 | 124.05 | 95.00 30000332|HC URIC-ACID-URINE|0300|84560|139.70|81.03|16.03|15.23|||8.24|8.41|8.41|8.57|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 8.24 | 124.05 | 95.00 30000333|HC VMA-(VANILLYLMANDELIC-ACID)|0300|84585|376.56|218.40|47.92|45.52|||26.69|27.22|27.22|27.76|244.76|256.06|274.89|274.89|293.72|225.94|244.76|282.42|320.08|334.39|331.37|282.42|320.08| 26.69 | 334.39 | 256.06 30000334|HC VASOACTIVE-INTESTINAL-PEPTI|0300|84586|387.21|224.58|64.32|61.10|||||||251.69|263.30|282.66|282.66|302.02|232.33|251.69|290.41|329.13|343.84|340.74|290.41|329.13| 61.10 | 343.84 | 282.66 30000335|HC VITAMIN-A-REF-LAB|0300|84590|265.51|154.00|36.88|35.04|||17.82|18.18|18.18|18.53|172.58|180.55|193.82|193.82|207.10|159.31|172.58|199.13|225.68|235.77|233.65|199.13|225.68| 17.82 | 235.77 | 180.55 30000336|HC VOLATILES,METH,ETH,ISOP|0300|84600|206.50|119.77|47.42|45.05|||21.98|22.42|22.42|22.86|134.23|140.42|150.75|150.75|161.07|123.90|134.23|154.88|175.53|183.37|181.72|154.88|175.53| 21.98 | 183.37 | 140.42 30000337|HC ZINC-REF-LAB|0300|84630|183.62|106.50|160.62|152.59|||20.59|21.00|21.00|21.42|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 20.59 | 163.05 | 134.04 30000338|HC C-PEPTIDE REF LAB|0300|84681|244.32|141.71|52.39|49.77|||21.86|22.30|22.30|22.74|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 21.86 | 216.96 | 166.14 30000339|HC BHCG TUMOR MARKER REF|0300|84702|285.51|165.60|47.45|45.08|||11.77|12.01|12.01|12.25|185.58|194.15|208.42|208.42|222.70|171.31|185.58|214.13|242.68|253.53|251.25|214.13|242.68| 11.77 | 253.53 | 194.15 30000340|HC BHCG-SERUM-QUANT|0300|84702|269.81|156.49|47.45|45.08|||11.77|12.01|12.01|12.25|175.38|183.47|196.96|196.96|210.45|161.89|175.38|202.36|229.34|239.59|237.43|202.36|229.34| 11.77 | 239.59 | 183.47 30000341|HC HCG TOTAL-AFP MARKER|0300|84702|256.47|148.75|47.45|45.08|||11.77|12.01|12.01|12.25|166.71|174.40|187.22|187.22|200.05|153.88|166.71|192.35|218.00|227.75|225.69|192.35|218.00| 11.77 | 227.75 | 174.40 30000342|HC BHCG-SERUM-PREGNANCY-TEST-Q|0300|84703|145.79|84.56|26.99|25.64|||11.77|12.01|12.01|12.25|94.76|99.14|106.43|106.43|113.72|87.47|94.76|109.34|123.92|129.46|128.30|109.34|123.92| 11.77 | 129.46 | 99.14 30000343|HC WBC AUTO DIFF|0300|85004|58.75|34.08|10.93|10.38|||11.71|11.94|11.94|12.18|38.19|39.95|42.89|42.89|45.83|35.25|38.19|44.06|49.94|52.17|51.70|44.06|49.94| 10.38 | 52.17 | 39.95 30000344|HC HEMATOCRIT-ONLY|0300|85014|57.42|33.30|7.01|6.66|||1.71|1.75|1.75|1.78|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 1.71 | 50.99 | 39.05 30000345|HC HEMOGLOBIN|0300|85018|57.42|33.30|7.67|7.29|||1.71|1.75|1.75|1.78|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 1.71 | 50.99 | 39.05 30000346|HC CBC-COMPLETE-BLOOD-COUNT|0300|85025|162.45|94.22|10.51|9.98|||6.54|6.67|6.67|6.80|105.59|110.47|118.59|118.59|126.71|97.47|105.59|121.84|138.08|144.26|142.96|121.84|138.08| 6.54 | 144.26 | 110.47 30000347|HC CBC-WITHOUT-DIFF|0300|85027|157.73|91.48|10.93|10.38|||11.71|11.94|11.94|12.18|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 10.38 | 140.06 | 107.26 30000348|HC RETIC CT MANUAL|0300|85044|116.94|67.83|9.64|9.16|||7.56|7.71|7.71|7.86|76.01|79.52|85.37|85.37|91.21|70.16|76.01|87.71|99.40|103.84|102.91|87.71|99.40| 7.56 | 103.84 | 79.52 30000349|HC WBC COUNT ONLY|0300|85048|78.94|45.79|7.55|7.17|||1.71|1.75|1.75|1.78|51.31|53.68|57.63|57.63|61.57|47.36|51.31|59.21|67.10|70.10|69.47|59.21|67.10| 1.71 | 70.10 | 53.68 30000350|HC PLATELET-COUNT|0300|85049|157.73|91.48|11.94|11.34|||11.71|11.94|11.94|12.18|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 11.34 | 140.06 | 107.26 30000351|HC FACTOR V ACTIVITY|0300|85220|501.18|290.68|51.67|49.09|||15.45|15.76|15.76|16.07|325.77|340.80|365.86|365.86|390.92|300.71|325.77|375.89|426.00|445.05|441.04|375.89|426.00| 15.45 | 445.05 | 340.80 30000352|HC FACTOR VII (7) ASSAY|0300|85230|485.90|281.82|51.71|49.12|||15.45|15.76|15.76|16.07|315.84|330.41|354.71|354.71|379.00|291.54|315.84|364.43|413.02|431.48|427.59|364.43|413.02| 15.45 | 431.48 | 330.41 30000353|HC FACTOR VIII; VW PROFILE|0300|85240|397.48|230.54|69.57|66.09|||24.73|25.22|25.22|25.72|258.36|270.29|290.16|290.16|310.03|238.49|258.36|298.11|337.86|352.96|349.78|298.11|337.86| 24.73 | 352.96 | 270.29 30000354|HC FACTOR-VIII-ASSAY|0300|85240|397.48|230.54|69.57|66.09|||24.73|25.22|25.22|25.72|258.36|270.29|290.16|290.16|310.03|238.49|258.36|298.11|337.86|352.96|349.78|298.11|337.86| 24.73 | 352.96 | 270.29 30000355|HC F VIII RISTOCETIN COFACT; VW PROF|0300|85245|322.68|187.15|14.62|13.89|||10.99|11.21|11.21|11.43|209.74|219.42|235.56|235.56|251.69|193.61|209.74|242.01|274.28|286.54|283.96|242.01|274.28| 10.99 | 286.54 | 219.42 30000356|HC VW FACTOR ANTIGEN; VW PROFILE|0300|85246|345.56|200.42|14.62|13.89|||10.99|11.21|11.21|11.43|224.61|234.98|252.26|252.26|269.54|207.34|224.61|259.17|293.73|306.86|304.09|259.17|293.73| 10.99 | 306.86 | 234.98 30000357|HC FACTOR VIII,VW MULTIMETRICANAL|0300|85247|473.54|274.65|14.61|13.88|||10.99|11.21|11.21|11.43|307.80|322.01|345.68|345.68|369.36|284.12|307.80|355.16|402.51|420.50|416.72|355.16|402.51| 10.99 | 420.50 | 322.01 30000358|HC FACTOR-IX-ASSAY|0300|85250|739.27|428.78|54.76|52.02|||15.45|15.76|15.76|16.07|480.53|502.70|539.67|539.67|576.63|443.56|480.53|554.45|628.38|656.47|650.56|554.45|628.38| 15.45 | 656.47 | 502.70 30000359|HC FACTOR XIII (13) ACTIVITY|0300|85290|355.92|206.43|34.93|33.18|||15.45|15.76|15.76|16.07|231.35|242.03|259.82|259.82|277.62|213.55|231.35|266.94|302.53|316.06|313.21|266.94|302.53| 15.45 | 316.06 | 242.03 30000360|HC ANTITHROMBIN III ACTIVITY|0300|85300|294.67|170.91|33.78|32.09|||20.89|21.31|21.31|21.73|191.54|200.38|215.11|215.11|229.84|176.80|191.54|221.00|250.47|261.67|259.31|221.00|250.47| 20.89 | 261.67 | 200.38 30000361|HC PROTEIN-C-ANTIGEN|0300|85302|186.80|108.34|24.08|22.88|||15.45|15.76|15.76|16.07|121.42|127.02|136.36|136.36|145.70|112.08|121.42|140.10|158.78|165.88|164.38|140.10|158.78| 15.45 | 165.88 | 127.02 30000362|HC CLOTTING; PROTEIN C ACTIVITY|0300|85303|268.79|155.90|67.37|64.00|||21.25|21.67|21.67|22.10|174.71|182.78|196.22|196.22|209.66|161.27|174.71|201.59|228.47|238.69|236.54|201.59|228.47| 21.25 | 238.69 | 182.78 30000363|HC PROTEIN-S-ANTIGEN-PLASMA|0300|85305|239.69|139.02|23.80|22.61|||15.70|16.01|16.01|16.33|155.80|162.99|174.97|174.97|186.96|143.81|155.80|179.77|203.74|212.84|210.93|179.77|203.74| 15.70 | 212.84 | 162.99 30000364|HC PROTEIN S, FREE|0300|85306|262.00|151.96|85.12|80.86|||23.55|24.02|24.02|24.49|170.30|178.16|191.26|191.26|204.36|157.20|170.30|196.50|222.70|232.66|230.56|196.50|222.70| 23.55 | 232.66 | 178.16 30000365|HC PROTEIN S,FUNCTIONAL|0300|85306|387.59|224.80|85.12|80.86|||23.55|24.02|24.02|24.49|251.93|263.56|282.94|282.94|302.32|232.55|251.93|290.69|329.45|344.18|341.08|290.69|329.45| 23.55 | 344.18 | 263.56 30000366|HC ACTIVATED PROT C RESIST|0300|85307|607.25|352.21|195.95|186.15|||23.55|24.02|24.02|24.49|394.71|412.93|443.29|443.29|473.66|364.35|394.71|455.44|516.16|539.24|534.38|455.44|516.16| 23.55 | 539.24 | 412.93 30000367|HC FACTOR INHIBITOR|0300|85335|302.20|175.28|49.19|46.73|||14.50|14.79|14.79|15.08|196.43|205.50|220.61|220.61|235.72|181.32|196.43|226.65|256.87|268.35|265.94|226.65|256.87| 14.50 | 268.35 | 205.50 30000368|HC HMT CLOTTING TIME|0300|85347|133.68|77.53|14.67|13.94|||4.12|4.20|4.20|4.29|86.89|90.90|97.59|97.59|104.27|80.21|86.89|100.26|113.63|118.71|117.64|100.26|113.63| 4.12 | 118.71 | 90.90 30000369|HC POCT-ACT|0300|85347|123.53|71.65|14.67|13.94|||4.12|4.2|4.2|4.29|80.29|84.00|90.18|90.18|96.35|74.12|80.29|92.65|105.00|109.69|108.71|92.65|105.00| 4.12 | 109.69 | 84.00 30000370|HC D-DIMER,QUANT|0300|85379|214.14|124.20|57.88|54.99|||13.34|13.61|13.61|13.88|139.19|145.62|156.32|156.32|167.03|128.48|139.19|160.61|182.02|190.16|188.44|160.61|182.02| 13.34 | 190.16 | 145.62 30000371|HC FIBRINOGEN ACTIVITY|0300|85384|230.76|133.84|20.17|19.1615|||13.34|13.61|13.61|13.88|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 13.34 | 204.91 | 156.92 30000372|HC ADMTS|0300|85397|276.58|160.42|13.46|12.79|||||||179.78|188.07|201.90|201.90|215.73|165.95|179.78|207.44|235.09|245.60|243.39|207.44|235.09| 12.79 | 245.60 | 201.90 30000373|HC FETALDEX-FETAL-HGB-STAIN|0300|85460|171.74|99.61|23.93|22.73|||10.99|11.21|11.21|11.43|111.63|116.78|125.37|125.37|133.96|103.04|111.63|128.81|145.98|152.51|151.13|128.81|145.98| 10.99 | 152.51 | 116.78 30000374|HC FETAL-SCREEN-RHOGAM|0300|85461|57.51|33.36|||||10.99|11.21|11.21|11.43|37.38|39.11|41.98|41.98|44.86|34.51|37.38|43.13|48.88|51.07|50.61|43.13|48.88| 10.99 | 51.07 | 41.98 30000375|HC HEPARIN ANTI XA, FAC 10A|0300|85520|382.47|221.83|45.74|43.45|||23.68|24.15|24.15|24.63|248.61|260.08|279.20|279.20|298.33|229.48|248.61|286.85|325.10|339.63|336.57|286.85|325.10| 23.68 | 339.63 | 260.08 30000376|HC LEUKOCYTE ALK PHOS W COUNT|0300|85540|285.51|165.60|32.48|30.86|||12.56|12.81|12.81|13.06|185.58|194.15|208.42|208.42|222.70|171.31|185.58|214.13|242.68|253.53|251.25|214.13|242.68| 12.56 | 253.53 | 194.15 30000377|HC LYSOZYME|0300|85549|189.76|110.06|39.16|37.20|||13.19|13.45|13.45|13.72|123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 13.19 | 168.51 | 129.04 30000379|HC PLT AGGREGATION, EA AGENT|0300|85576|105.08|60.95|43.04|40.89|||11.77|12.01|12.01|12.25|68.30|71.45|76.71|76.71|81.96|63.05|68.30|78.81|89.32|93.31|92.47|78.81|89.32| 11.77 | 93.31 | 71.45 30000384|HC PLATELET FUNCTION TEST, REF|0300|85576|130.06|75.43|43.04|40.89|||11.77|12.01|12.01|12.25|84.54|88.44|94.94|94.94|101.45|78.04|84.54|97.55|110.55|115.49|114.45|97.55|110.55| 11.77 | 115.49 | 88.44 30000385|HC PHOSPHOLIPID HEXAGONAL|0300|85598|147.74|85.69|118.16|112.25|||||||96.03|100.46|107.85|107.85|115.24|88.64|96.03|110.81|125.58|131.19|130.01|110.81|125.58| 88.64 | 131.19 | 110.81 30000386|HC PT-PROTHROMBIN TIME|0300|85610|196.01|113.69|12.64|12.01|||6.87|7.01|7.01|7.14|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 6.87 | 174.06 | 133.29 30000387|HC PT-PROTHROMBIN TIME|0300|85610|196.01|113.69|12.64|12.01|||6.87|7.01|7.01|7.14|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 6.87 | 174.06 | 133.29 30000388|HC RUSSEL-VIPER VENOM DILUTED|0300|85613|244.32|141.71|21.25|20.19|||6.87|7.01|7.01|7.14|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 6.87 | 216.96 | 166.14 30000389|HC ESR-SED-RATE|0300|85651|183.62|106.50|10.41|9.89|||6.42|6.55|6.55|6.68|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 6.42 | 163.05 | 124.86 30000390|HC SICKLE-CELL-TEST|0300|85660|86.79|50.34|11.27|10.71|||6.04|6.17|6.17|6.29|56.41|59.02|63.36|63.36|67.70|52.07|56.41|65.09|73.77|77.07|76.38|65.09|73.77| 6.04 | 77.07 | 59.02 30000391|HC THROMBIN-TIME|0300|85670|116.94|67.83|23.85|22.66|||6.87|7.01|7.01|7.14|76.01|79.52|85.37|85.37|91.21|70.16|76.01|87.71|99.40|103.84|102.91|87.71|99.40| 6.87 | 103.84 | 79.52 30000392|HC PTT|0300|85730|230.76|133.84|17.71|16.82|||6.87|7.01|7.01|7.14|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 6.87 | 204.91 | 156.92 30000393|HC MODIFIED APTT|0300|85732|230.76|133.84|18.17|17.26|||6.87|7.01|7.01|7.14|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 6.87 | 204.91 | 156.92 30000394|HC VISCOSITY|0300|85810|320.42|185.84|29.50|28.03|||15.18|15.48|15.48|15.78|208.27|217.89|233.91|233.91|249.93|192.25|208.27|240.32|272.36|284.53|281.97|240.32|272.36| 15.18 | 284.53 | 217.89 30000395|HC TULAREMIA-FEBRILE-AGGLUTINI|0300|86000|410.93|238.34|25.80|24.51|||6.87|7.01|7.01|7.14|267.10|279.43|299.98|299.98|320.53|246.56|267.10|308.20|349.29|364.91|361.62|308.20|349.29| 6.87 | 364.91 | 279.43 30000396|HC ALLERG SP IGE, QT OR SEMI-QT|0300|86003|100.93|58.54|12.20|11.59|||8.03|8.19|8.19|8.35|65.60|68.63|73.68|73.68|78.73|60.56|65.60|75.70|85.79|89.63|88.82|75.70|85.79| 8.03 | 89.63 | 68.63 30000397|HC IMMUNOCAP IGE ALLERGEN, ADD'L|0300|86003|64.56|37.44|12.20|11.59|||8.03|8.19|8.19|8.35|41.96|43.90|47.13|47.13|50.36|38.74|41.96|48.42|54.88|57.33|56.81|48.42|54.88| 8.03 | 57.33 | 43.90 30000398|HC IMMUNOCAP IGE ALLERGEN, INITIA|0300|86003|64.56|37.44|12.20|11.59|||8.03|8.19|8.19|8.35|41.96|43.90|47.13|47.13|50.36|38.74|41.96|48.42|54.88|57.33|56.81|48.42|54.88| 8.03 | 57.33 | 43.90 30000399|HC RAST SINGLE ALLERGIN, ADD'L|0300|86003|127.86|74.16|12.20|11.59|||8.03|8.19|8.19|8.35|83.11|86.94|93.34|93.34|99.73|76.72|83.11|95.90|108.68|113.54|112.52|95.90|108.68| 8.03 | 113.54 | 86.94 30000400|HC CYTOPLASMIC-NEUT-ANTIBODY|0300|86021|242.90|140.88|21.25|20.19|||9.83|10.02|10.02|10.22|157.89|165.17|177.32|177.32|189.46|145.74|157.89|182.18|206.47|215.70|213.75|182.18|206.47| 9.83 | 215.70 | 165.17 30000401|HC AB ID, PLATELET AB|0300|86022|584.59|339.06|24.88|23.64|||10.99|11.21|11.21|11.43|379.98|397.52|426.75|426.75|455.98|350.75|379.98|438.44|496.90|519.12|514.44|438.44|496.90| 10.99 | 519.12 | 397.52 30000402|HC HEPARIN-INDUCED THROMBOCYTOPEN|0300|86022|584.59|339.06|24.88|23.64|||10.99|11.21|11.21|11.43|379.98|397.52|426.75|426.75|455.98|350.75|379.98|438.44|496.90|519.12|514.44|438.44|496.90| 10.99 | 519.12 | 397.52 30000403|HC CROSSMATCH PLATELETS|0300|86022|668.54|387.75|24.88|23.64|||10.99|11.21|11.21|11.43|434.55|454.61|488.03|488.03|521.46|401.12|434.55|501.41|568.26|593.66|588.32|501.41|568.26| 10.99 | 593.66 | 454.61 30000404|HC ANTINUCLEAR-ANTIBODY-ANA|0300|86038|487.43|282.71|34.84|33.10|||21.85|22.29|22.29|22.72|316.83|331.45|355.82|355.82|380.20|292.46|316.83|365.57|414.32|432.84|428.94|365.57|414.32| 21.85 | 432.84 | 331.45 30000405|HC ANA TITER|0300|86039|246.77|143.13|32.84|31.20|||20.16|20.56|20.56|20.97|160.40|167.80|180.14|180.14|192.48|148.06|160.40|185.08|209.75|219.13|217.16|185.08|209.75| 20.16 | 219.13 | 167.80 30000406|HC ASO-TITER-ANTI-STREPTOLYSIN|0300|86060|183.62|106.50|26.10|24.80|||11.68|11.92|11.92|12.15|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 11.68 | 163.05 | 124.86 30000407|HC STREPTOZYME|0300|86063|151.71|87.99|21.46|20.39|||9.62|9.81|9.81|10.00|98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 9.62 | 134.72 | 103.16 30000408|HC CRP-C-REACTIVE-PROTEIN|0300|86140|124.59|72.26|20.56|19.53|||8.24|8.41|8.41|8.57|80.98|84.72|90.95|90.95|97.18|74.75|80.98|93.44|105.90|110.64|109.64|93.44|105.90| 8.24 | 110.64 | 84.72 30000409|HC CREATIVE PROTEIN-HIGH SENS|0300|86141|182.13|105.64|48.17|45.76|||8.24|8.41|8.41|8.57|118.38|123.85|132.95|132.95|142.06|109.28|118.38|136.60|154.81|161.73|160.27|136.60|154.81| 8.24 | 161.73 | 123.85 30000410|HC BETA 2 GP 1, AB EACH|0300|86146|206.50|119.77|44.65|42.42|||33.57|34.24|34.24|34.91|134.23|140.42|150.75|150.75|161.07|123.90|134.23|154.88|175.53|183.37|181.72|154.88|175.53| 33.57 | 183.37 | 140.42 30000411|HC CARDIOLIPIN-ANTIBODY-SINGLE|0300|86147|206.50|119.77|61.64|58.56|||33.57|34.24|34.24|34.91|134.23|140.42|150.75|150.75|161.07|123.90|134.23|154.88|175.53|183.37|181.72|154.88|175.53| 33.57 | 183.37 | 140.42 30000412|HC ANTIPHOSPATIDYLSERINE,IGG,IGA,|0300|86148|235.54|136.61|38.59|36.66|||22.57|23.02|23.02|23.47|153.10|160.17|171.94|171.94|183.72|141.32|153.10|176.66|200.21|209.16|207.28|176.66|200.21| 22.57 | 209.16 | 160.17 30000413|HC COLD-AGGLUTININS|0300|86156|196.01|113.69|31.44|29.87|||9.81|10.01|10.01|10.20|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 9.81 | 174.06 | 133.29 30000414|HC C1 ESTERASE INHIBITOR|0300|86160|142.65|82.74|43.78|41.59|||17.86|18.22|18.22|18.57|92.72|97.00|104.13|104.13|111.27|85.59|92.72|106.99|121.25|126.67|125.53|106.99|121.25| 17.86 | 126.67 | 97.00 30000415|HC C4-COMPLEMENT-4-REF LAB|0300|86160|247.57|143.59|43.78|41.59|||17.86|18.22|18.22|18.57|160.92|168.35|180.73|180.73|193.10|148.54|160.92|185.68|210.43|219.84|217.86|185.68|210.43| 17.86 | 219.84 | 168.35 30000416|HC COMPLEMENT C2|0300|86160|227.78|132.11|43.78|41.59|||17.86|18.22|18.22|18.57|148.06|154.89|166.28|166.28|177.67|136.67|148.06|170.84|193.61|202.27|200.45|170.84|193.61| 17.86 | 202.27 | 154.89 30000417|HC COMPLEMENT C3|0300|86160|198.21|114.96|43.78|41.59|||17.86|18.22|18.22|18.57|128.84|134.78|144.69|144.69|154.60|118.93|128.84|148.66|168.48|176.01|174.42|148.66|168.48| 17.86 | 176.01 | 134.78 30000418|HC COMPLEMENT CIQ, QUANT|0300|86160|142.65|82.74|43.78|41.59|||17.86|18.22|18.22|18.57|92.72|97.00|104.13|104.13|111.27|85.59|92.72|106.99|121.25|126.67|125.53|106.99|121.25| 17.86 | 126.67 | 97.00 30000419|HC C1 ESTERASE INHIBITOR FUNCT|0300|86161|273.18|158.44|43.71|41.52|||17.86|18.22|18.22|18.57|177.57|185.76|199.42|199.42|213.08|163.91|177.57|204.89|232.20|242.58|240.40|204.89|232.20| 17.86 | 242.58 | 185.76 30000420|HC COMPLEMENT-TOTAL-CH50-REF-L|0300|86162|250.46|145.27|62.43|59.31|||31.40|32.03|32.03|32.66|162.80|170.31|182.84|182.84|195.36|150.28|162.80|187.85|212.89|222.41|220.40|187.85|212.89| 31.40 | 222.41 | 170.31 30000421|HC CYCLIC CITRULLINATED PEPTIDE A|0300|86200|289.37|167.83|253.13|240.47|||20.12|20.52|20.52|20.93|188.09|196.77|211.24|211.24|225.71|173.62|188.09|217.03|245.96|256.96|254.65|217.03|245.96| 20.12 | 256.96 | 211.24 30000422|HC ANTI DNA B|0300|86215|180.89|104.92|49.59|47.11|||11.68|11.92|11.92|12.15|117.58|123.01|132.05|132.05|141.09|108.53|117.58|135.67|153.76|160.63|159.18|135.67|153.76| 11.68 | 160.63 | 123.01 30000423|HC ANTI-DS DNA RL|0300|86225|203.67|118.13|47.77|45.38|||24.84|25.34|25.34|25.84|132.39|138.50|148.68|148.68|158.86|122.20|132.39|152.75|173.12|180.86|179.23|152.75|173.12| 24.84 | 180.86 | 138.50 30000424|HC ENA; ANTI RNP AB|0300|86235|162.84|94.45|41.09|39.04|||32.42|33.07|33.07|33.72|105.85|110.73|118.87|118.87|127.02|97.70|105.85|122.13|138.41|144.60|143.30|122.13|138.41| 32.42 | 144.60 | 110.73 30000425|HC ENA; ANTI SMITH AB|0300|86235|162.84|94.45|41.09|39.04|||32.42|33.07|33.07|33.72|105.85|110.73|118.87|118.87|127.02|97.70|105.85|122.13|138.41|144.60|143.30|122.13|138.41| 32.42 | 144.60 | 110.73 30000426|HC AUTOANTIBODY TO SCLTO ANTIG|0300|86235|312.65|181.34|41.09|39.04|||32.42|33.07|33.07|33.72|203.22|212.60|228.23|228.23|243.87|187.59|203.22|234.49|265.75|277.63|275.13|234.49|265.75| 32.42 | 277.63 | 212.60 30000427|HC EXTRAC NUCLEAR AG-ANTB REF|0300|86235|171.74|99.61|41.09|39.04|||32.42|33.07|33.07|33.72|111.63|116.78|125.37|125.37|133.96|103.04|111.63|128.81|145.98|152.51|151.13|128.81|145.98| 32.42 | 152.51 | 116.78 30000428|HC HISTONE ANTIBODIES|0300|86235|244.32|141.71|41.09|39.04|||32.42|33.07|33.07|33.72|158.81|166.14|178.35|178.35|190.57|146.59|158.81|183.24|207.67|216.96|215.00|183.24|207.67| 32.42 | 216.96 | 166.14 30000429|HC JOI AUTO ANTIBODY|0300|86235|312.65|181.34|41.09|39.04|||32.42|33.07|33.07|33.72|203.22|212.60|228.23|228.23|243.87|187.59|203.22|234.49|265.75|277.63|275.13|234.49|265.75| 32.42 | 277.63 | 212.60 30000430|HC PM-SCL ANTIBODY|0300|86235|253.41|146.98|41.09|39.04|||32.42|33.07|33.07|33.72|164.72|172.32|184.99|184.99|197.66|152.05|164.72|190.06|215.40|225.03|223.00|190.06|215.40| 32.42 | 225.03 | 172.32 30000431|HC SJOGREN'S ANTIBODY REF|0300|86235|142.65|82.74|41.09|39.04|||32.42|33.07|33.07|33.72|92.72|97.00|104.13|104.13|111.27|85.59|92.72|106.99|121.25|126.67|125.53|106.99|121.25| 32.42 | 126.67 | 97.00 30000432|HC FLUO. NON-INFECT. AB|0300|86255|227.78|132.11|39.30|37.34|||20.61|21.02|21.02|21.43|148.06|154.89|166.28|166.28|177.67|136.67|148.06|170.84|193.61|202.27|200.45|170.84|193.61| 20.61 | 202.27 | 154.89 30000433|HC STRAITED MUSCLE ANTIBODY|0300|86255|201.68|116.97|39.30|37.34|||20.61|21.02|21.02|21.43|131.09|137.14|147.23|147.23|157.31|121.01|131.09|151.26|171.43|179.09|177.48|151.26|171.43| 20.61 | 179.09 | 137.14 30000434|HC FLUOR.NON-INFECT. AB TITER|0300|86256|288.67|167.43|44.87|42.63|||20.61|21.02|21.02|21.43|187.64|196.30|210.73|210.73|225.16|173.20|187.64|216.50|245.37|256.34|254.03|216.50|245.37| 20.61 | 256.34 | 196.30 30000435|HC IA QUANT - CA 2729|0300|86300|86.28|50.04|43.13|40.97|||31.99|32.63|32.63|33.27|56.08|58.67|62.98|62.98|67.30|51.77|56.08|64.71|73.34|76.62|75.93|64.71|73.34| 31.99 | 76.62 | 58.67 30000436|HC CARBOHYDRATE ANTIGEN(CA)19-|0300|86301|288.67|167.43|252.51|239.88|||31.99|32.63|32.63|33.27|187.64|196.30|210.73|210.73|225.16|173.20|187.64|216.50|245.37|256.34|254.03|216.50|245.37| 31.99 | 256.34 | 210.73 30000437|HC CANCER ANTIGEN (CA)125|0300|86304|250.46|145.27|43.06|40.91|||31.99|32.63|32.63|33.27|162.80|170.31|182.84|182.84|195.36|150.28|162.80|187.85|212.89|222.41|220.40|187.85|212.89| 31.99 | 222.41 | 170.31 30000438|HC MONONUCLEOSIS-SCREEN|0300|86308|165.29|95.87|15.33|14.56|||9.35|9.54|9.54|9.73|107.44|112.40|120.66|120.66|128.93|99.17|107.44|123.97|140.50|146.78|145.46|123.97|140.50| 9.35 | 146.78 | 112.40 30000439|HC IA; TUMOR AG QUANT EA|0300|86316|221.22|128.31|259.10|246.15|||31.99|32.63|32.63|33.27|143.79|150.43|161.49|161.49|172.55|132.73|143.79|165.92|188.04|196.44|194.67|165.92|188.04| 31.99 | 259.10 | 161.49 30000440|HC IA ANTIBODY QUANT, NOS|0300|86317|153.16|88.83|35.04|33.29|||13.08|13.34|13.34|13.61|99.55|104.15|111.81|111.81|119.46|91.90|99.55|114.87|130.19|136.01|134.78|114.87|130.19| 13.08 | 136.01 | 104.15 30000441|HC PNEUMOCOCCAL ANTIBODY,EACH|0300|86317|106.40|61.71|35.04|33.29|||13.08|13.34|13.34|13.61|69.16|72.35|77.67|77.67|82.99|63.84|69.16|79.80|90.44|94.48|93.63|79.80|90.44| 13.08 | 94.48 | 72.35 30000442|HC STREP PNEUMO AB, EACH|0300|86317|95.77|55.55|35.04|33.29|||13.08|13.34|13.34|13.61|62.25|65.12|69.91|69.91|74.70|57.46|62.25|71.83|81.40|85.04|84.28|71.83|81.40| 13.08 | 85.04 | 65.12 30000443|HC IMMUNOFIXATION-ELEC SERUM|0300|86334|405.11|234.96|76.31|72.49|||||||263.32|275.47|295.73|295.73|315.99|243.07|263.32|303.83|344.34|359.74|356.50|303.83|344.34| 72.49 | 359.74 | 295.73 30000444|HC IMMUNOELECTROPH|0300|86335|305.52|177.20|267.23|253.87|||45.59|46.51|46.51|47.42|198.59|207.75|223.03|223.03|238.31|183.31|198.59|229.14|259.69|271.30|268.86|229.14|259.69| 45.59 | 271.30 | 223.03 30000445|HC INHIBIN A|0300|86336|182.13|105.64|79.01|75.06|||24.2|24.69|24.69|25.17|118.38|123.85|132.95|132.95|142.06|109.28|118.38|136.60|154.81|161.73|160.27|136.60|154.81| 24.20 | 161.73 | 123.85 30000446|HC INSULIN-ANTIBODIES-REF-LAB|0300|86337|250.46|145.27|66.15|62.84|||30.92|31.53|31.53|32.15|162.80|170.31|182.84|182.84|195.36|150.28|162.80|187.85|212.89|222.41|220.40|187.85|212.89| 30.92 | 222.41 | 170.31 30000447|HC INTRINSIC FACTOR BLOCKINGAB|0300|86340|189.76|110.06|41.42|39.35|||23.55|24.02|24.02|24.49|123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 23.55 | 168.51 | 129.04 30000448|HC IA2 AUTOANTIBODIES|0300|86341|392.56|227.68|62.8|59.66|||||||255.16|266.94|286.57|286.57|306.20|235.54|255.16|294.42|333.68|348.59|345.45|294.42|333.68| 59.66 | 348.59 | 286.57 30000449|HC ISLET CELL ANTIBODY|0300|86341|381.36|221.19|62.80|59.66|||||||247.88|259.32|278.39|278.39|297.46|228.82|247.88|286.02|324.16|338.65|335.60|286.02|324.16| 59.66 | 338.65 | 278.39 30000450|HC CU INDEX/FCER|0300|86352|556.10|322.54|95.47|90.70|||108.21|110.38|110.38|112.54|361.47|378.15|405.95|405.95|433.76|333.66|361.47|417.08|472.69|493.82|489.37|417.08|472.69| 90.70 | 493.82 | 378.15 30000451|HC B CELLS, TOTAL CT|0300|86355|173.33|100.53|||||58.61|59.78|59.78|60.96|112.66|117.86|126.53|126.53|135.20|104.00|112.66|130.00|147.33|153.92|152.53|130.00|147.33| 58.61 | 153.92 | 126.53 30000452|HC T-CELLS TOTAL COUNT|0300|86359|334.15|193.81|64.95|61.70|||37.61|38.37|38.37|39.12|217.20|227.22|243.93|243.93|260.64|200.49|217.20|250.61|284.03|296.73|294.05|250.61|284.03| 37.61 | 296.73 | 227.22 30000453|HC CD4-CD8 RATIO|0300|86360|485.90|281.82|107.03|101.68|||37.61|38.37|38.37|39.12|315.84|330.41|354.71|354.71|379.00|291.54|315.84|364.43|413.02|431.48|427.59|364.43|413.02| 37.61 | 431.48 | 330.41 30000454|HC T CELLS, ABSOL CD4 AND CD8|0300|86360|485.90|281.82|107.03|101.68|||37.61|38.37|38.37|39.12|315.84|330.41|354.71|354.71|379.00|291.54|315.84|364.43|413.02|431.48|427.59|364.43|413.02| 37.61 | 431.48 | 330.41 30000455|HC MICROSOMAL ANTIBODY|0300|86376|206.50|119.77|40.08|38.08|||26.17|26.69|26.69|27.21|134.23|140.42|150.75|150.75|161.07|123.90|134.23|154.88|175.53|183.37|181.72|154.88|175.53| 26.17 | 183.37 | 140.42 30000456|HC CRYPTOCCAL ANTIGEN|0300|86403|199.34|115.62|17.20|16.34|||18.42|18.79|18.79|19.16|129.57|135.55|145.52|145.52|155.49|119.60|129.57|149.51|169.44|177.01|175.42|149.51|169.44| 16.34 | 177.01 | 135.55 30000457|HC RHEUMATOID FACTOR QUAL|0300|86430|157.73|91.48|18.33|17.41|||10.11|10.32|10.32|10.52|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 10.11 | 140.06 | 107.26 30000458|HC RHEUMATOID FACTOR QUANT|0300|86431|112.15|65.05|20.25|19.24|||10.11|10.32|10.32|10.52|72.90|76.26|81.87|81.87|87.48|67.29|72.90|84.11|95.33|99.59|98.69|84.11|95.33| 10.11 | 99.59 | 76.26 30000459|HC QUANTIFERON-TB GOLD|0300|86480|322.68|187.15|282.26|268.15|||96.29|98.22|98.22|100.14|209.74|219.42|235.56|235.56|251.69|193.61|209.74|242.01|274.28|286.54|283.96|242.01|274.28| 96.29 | 286.54 | 235.56 30000460|HC VDRL-RPR|0300|86592|107.78|62.51|12.79|12.15|||6.87|7.01|7.01|7.14|70.06|73.29|78.68|78.68|84.07|64.67|70.06|80.84|91.61|95.71|94.85|80.84|91.61| 6.87 | 95.71 | 73.29 30000461|HC VDRL-SPINAL-FLUID|0300|86592|189.76|110.06|12.79|12.15|||6.87|7.01|7.01|7.14|123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 6.87 | 168.51 | 129.04 30000463|HC AB, BACTERIUM, NES|0300|86609|455.49|264.18|26.45|25.13|||9.81|10.01|10.01|10.20|296.07|309.73|332.51|332.51|355.28|273.29|296.07|341.62|387.17|404.48|400.83|341.62|387.17| 9.81 | 404.48 | 309.73 30000464|HC CAT SCRATCH AB-SINGLE|0300|86611|77.51|44.96|15.13|14.37|||12.00|12.24|12.24|12.48|50.38|52.71|56.58|56.58|60.46|46.51|50.38|58.13|65.88|68.83|68.21|58.13|65.88| 12.00 | 68.83 | 52.71 30000465|HC BLASTOMYCES ANTIBODY|0300|86612|206.50|119.77|10.61|10.08|||7.97|8.13|8.13|8.29|134.23|140.42|150.75|150.75|161.07|123.90|134.23|154.88|175.53|183.37|181.72|154.88|175.53| 7.97 | 183.37 | 140.42 30000466|HC B-PERTUSSIS SINGLE AB|0300|86615|111.05|64.41|15.22|14.46|||9.81|10.01|10.01|10.20|72.18|75.51|81.07|81.07|86.62|66.63|72.18|83.29|94.39|98.61|97.72|83.29|94.39| 9.81 | 98.61 | 75.51 30000467|HC COCCIDIODES ANTIBODY|0300|86635|106.50|61.77|40.74|38.70|||7.97|8.13|8.13|8.29|69.23|72.42|77.75|77.75|83.07|63.90|69.23|79.88|90.53|94.57|93.72|79.88|90.53| 7.97 | 94.57 | 72.42 30000468|HC Q-FEVER-ANTIBODIES, EACH|0300|86638|151.71|87.99|7.83|7.44|||7.97|8.13|8.13|8.29|98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 7.44 | 134.72 | 103.16 30000469|HC CMV-IGG|0300|86644|241.57|140.11|56.69|53.86|||9.81|10.01|10.01|10.20|157.02|164.27|176.35|176.35|188.42|144.94|157.02|181.18|205.33|214.51|212.58|181.18|205.33| 9.81 | 214.51 | 164.27 30000470|HC CMV-IGM|0300|86645|241.57|140.11|56.69|53.86|||9.81|10.01|10.01|10.20|157.02|164.27|176.35|176.35|188.42|144.94|157.02|181.18|205.33|214.51|212.58|181.18|205.33| 9.81 | 214.51 | 164.27 30000471|HC COXSACKLE ANTIBODY SINGLE|0300|86658|177.64|103.03|58.55|55.62|||7.97|8.13|8.13|8.29|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 7.97 | 157.74 | 120.80 30000472|HC ECHOVIRUS ANTIBODY SINGLE|0300|86658|177.64|103.03|58.55|55.62|||7.97|8.13|8.13|8.29|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 7.97 | 157.74 | 120.80 30000473|HC POLIOVIRUS ANTIBODY|0300|86658|177.64|103.03|58.55|55.62|||7.97|8.13|8.13|8.29|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 7.97 | 157.74 | 120.80 30000474|HC EPSTEIN-BARR VIRUS IGG-RL-AG|0300|86663|315.89|183.22|47.08|44.73|||9.81|10.01|10.01|10.20|205.33|214.81|230.60|230.60|246.39|189.53|205.33|236.92|268.51|280.51|277.98|236.92|268.51| 9.81 | 280.51 | 214.81 30000475|HC EPSTEIN BARR NUCLEAR ANTIGN|0300|86664|183.62|106.50|49.20|46.74|||9.81|10.01|10.01|10.20|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 9.81 | 163.05 | 124.86 30000476|HC EPSTEIN BARR (VCA) AB|0300|86665|177.47|102.93|51.01|48.46|||9.81|10.01|10.01|10.20|115.36|120.68|129.55|129.55|138.43|106.48|115.36|133.10|150.85|157.59|156.17|133.10|150.85| 9.81 | 157.59 | 120.68 30000477|HC EPSTEIN BARR VIRAL CAPSID|0300|86665|183.62|106.50|51.01|48.46|||9.81|10.01|10.01|10.20|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 9.81 | 163.05 | 124.86 30000478|HC EHRLICHIA ANTIBODY-SINGLE|0300|86666|269.81|156.49|88.16|83.75|||12.00|12.24|12.24|12.48|175.38|183.47|196.96|196.96|210.45|161.89|175.38|202.36|229.34|239.59|237.43|202.36|229.34| 12.00 | 239.59 | 183.47 30000479|HC S CEREVISIAE IGG|0300|86671|219.52|127.32|23.80|22.61|||7.97|8.13|8.13|8.29|142.69|149.27|160.25|160.25|171.23|131.71|142.69|164.64|186.59|194.93|193.18|164.64|186.59| 7.97 | 194.93 | 149.27 30000480|HC S CEREVISIAE IGA|0300|86671|219.52|127.32|23.80|22.61|||7.97|8.13|8.13|8.29|142.69|149.27|160.25|160.25|171.23|131.71|142.69|164.64|186.59|194.93|193.18|164.64|186.59| 7.97 | 194.93 | 149.27 30000481|HC HELICOBACTER PYLORI ANTIBOD|0300|86677|182.13|105.64|31.26|29.70|||9.81|10.01|10.01|10.20|118.38|123.85|132.95|132.95|142.06|109.28|118.38|136.60|154.81|161.73|160.27|136.60|154.81| 9.81 | 161.73 | 123.85 30000482|HC AB, HELMINTH NES|0300|86682|210.59|122.14|26.94|25.59|||9.81|10.01|10.01|10.20|136.88|143.20|153.73|153.73|164.26|126.35|136.88|157.94|179.00|187.00|185.32|157.94|179.00| 9.81 | 187.00 | 143.20 30000483|HC HAEMOPHILUS INFLUENZA B IGG|0300|86684|327.06|189.69|29.01|27.56|||9.81|10.01|10.01|10.20|212.59|222.40|238.75|238.75|255.11|196.24|212.59|245.30|278.00|290.43|287.81|245.30|278.00| 9.81 | 290.43 | 222.40 30000484|HC HERPES SIMPLEX, TYPE I/II|0300|86694|230.76|133.84|60.40|57.38|||9.81|10.01|10.01|10.20|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 9.81 | 204.91 | 156.92 30000485|HC HERPES SIMPLEX, TYPE I|0300|86695|196.01|113.69|49.94|47.44|||9.81|10.01|10.01|10.20|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 9.81 | 174.06 | 133.29 30000486|HC HERPES SIMPLEX, TYPE 2 AB|0300|86696|279.31|162.00|52.73|50.09|||29.75|30.35|30.35|30.94|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 29.75 | 248.03 | 189.93 30000487|HC HISTOPLASMA ANTIBODY|0300|86698|285.51|165.60|46.22|43.91|||9.81|10.01|10.01|10.20|185.58|194.15|208.42|208.42|222.70|171.31|185.58|214.13|242.68|253.53|251.25|214.13|242.68| 9.81 | 253.53 | 194.15 30000488|HC HEPAT-B-COREANTIB(ANTI-HBD)|0300|86704|230.76|133.84|34.79|33.05|||19.10|19.48|19.48|19.87|149.99|156.92|168.45|168.45|179.99|138.46|149.99|173.07|196.15|204.91|203.07|173.07|196.15| 19.10 | 204.91 | 156.92 30000489|HC HEPAT-B-CORE ANTIBODY IGM|0300|86705|218.60|126.79|26.80|25.46|||19.93|20.32|20.32|20.72|142.09|148.65|159.58|159.58|170.51|131.16|142.09|163.95|185.81|194.12|192.37|163.95|185.81| 19.93 | 194.12 | 148.65 30000490|HC HEP-B-SURF-ANITBODY|0300|86706|279.31|162.00|36.46|34.64|||19.42|19.80|19.80|20.19|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 19.42 | 248.03 | 189.93 30000491|HC HEPAT-A-ANTIBODY-IGG&IGM|0300|86708|250.46|145.27|36.12|34.31|||19.93|20.32|20.32|20.72|162.80|170.31|182.84|182.84|195.36|150.28|162.80|187.85|212.89|222.41|220.40|187.85|212.89| 19.93 | 222.41 | 170.31 30000492|HC HEPATITIS A ANTIBODY-IGM|0300|86709|250.46|145.27|39.27|37.31|||19.89|20.28|20.28|20.68|162.80|170.31|182.84|182.84|195.36|150.28|162.80|187.85|212.89|222.41|220.40|187.85|212.89| 19.89 | 222.41 | 170.31 30000493|HC INFLUENZA-A-VIRUS|0300|86710|279.31|162.00|53.37|50.70|||9.81|10.01|10.01|10.20|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 9.81 | 248.03 | 189.93 30000494|HC INFLUENZA-B-VIRUS|0300|86710|279.31|162.00|53.37|50.70|||9.81|10.01|10.01|10.20|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 9.81 | 248.03 | 189.93 30000495|HC LEGIONELLA ANTIBODY, EACH|0300|86713|189.76|110.06|49.05|46.60|||9.81|10.01|10.01|10.20|123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 9.81 | 168.51 | 129.04 30000496|HC LEPTOSPIRA AB|0300|86720|127.54|73.97|27.67|26.29|||9.81|10.01|10.01|10.20|82.90|86.73|93.10|93.10|99.48|76.52|82.90|95.66|108.41|113.26|112.24|95.66|108.41| 9.81 | 113.26 | 86.73 30000497|HC MUMPS-VIRUS-ANTIBODIES|0300|86735|211.16|122.47|51.07|48.52|||9.81|10.01|10.01|10.20|137.25|143.59|154.15|154.15|164.70|126.70|137.25|158.37|179.49|187.51|185.82|158.37|179.49| 9.81 | 187.51 | 143.59 30000498|HC MYCOPLASMA ANTIBODY|0300|86738|139.37|80.83|55.90|53.11|||9.81|10.01|10.01|10.20|90.59|94.77|101.74|101.74|108.71|83.62|90.59|104.53|118.46|123.76|122.65|104.53|118.46| 9.81 | 123.76 | 94.77 30000499|HC PARVO B19 ANTIBODY-SINGLE|0300|86747|88.07|51.08|62.32|59.20|||9.81|10.01|10.01|10.20|57.25|59.89|64.29|64.29|68.69|52.84|57.25|66.05|74.86|78.21|77.50|66.05|74.86| 9.81 | 78.21 | 62.32 30000500|HC PARASITE-SEROLOGY-RL|0300|86753|193.61|112.29|26.45|25.13|||9.81|10.01|10.01|10.20|125.85|131.65|141.34|141.34|151.02|116.17|125.85|145.21|164.57|171.93|170.38|145.21|164.57| 9.81 | 171.93 | 131.65 30000501|HC ROCKY MTN SPOTTED FEVER AB|0300|86757|253.53|147.05|99.50|94.53|||29.75|30.35|30.35|30.94|164.79|172.40|185.08|185.08|197.75|152.12|164.79|190.15|215.50|225.13|223.11|190.15|215.50| 29.75 | 225.13 | 172.40 30000502|HC RUBELLA-SCAN-ANTIBODY-SCRN|0300|86762|139.70|81.03|24.30|23.09|||9.81|10.01|10.01|10.20|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 9.81 | 124.05 | 95.00 30000503|HC RUBELLA AB-MMR IMMUNITY|0300|86762|150.52|87.30|24.30|23.09|||9.81|10.01|10.01|10.20|97.84|102.35|109.88|109.88|117.41|90.31|97.84|112.89|127.94|133.66|132.46|112.89|127.94| 9.81 | 133.66 | 102.35 30000504|HC RUBEOLA-ANTIBODIES|0300|86765|212.39|123.19|53.67|50.99|||9.81|10.01|10.01|10.20|138.05|144.43|155.04|155.04|165.66|127.43|138.05|159.29|180.53|188.60|186.90|159.29|180.53| 9.81 | 188.60 | 144.43 30000505|HC TETANUS ANTITOXOID ANTIBODIES|0300|86774|215.67|125.09|55.85|53.06|||9.81|10.01|10.01|10.20|140.19|146.66|157.44|157.44|168.22|129.40|140.19|161.75|183.32|191.51|189.79|161.75|183.32| 9.81 | 191.51 | 146.66 30000506|HC TOXO-IGG|0300|86777|241.57|140.11|53.32|50.65|||9.81|10.01|10.01|10.20|157.02|164.27|176.35|176.35|188.42|144.94|157.02|181.18|205.33|214.51|212.58|181.18|205.33| 9.81 | 214.51 | 164.27 30000507|HC TOXO-IGM|0300|86778|241.57|140.11|42.68|40.55|||9.81|10.01|10.01|10.2|157.02|164.27|176.35|176.35|188.42|144.94|157.02|181.18|205.33|214.51|212.58|181.18|205.33| 9.81 | 214.51 | 164.27 30000508|HC FLUOR TREP ANTIBODY SERUM|0300|86780|136.73|79.30|41.75|39.66|||21.09|21.51|21.51|21.93|88.87|92.98|99.81|99.81|106.65|82.04|88.87|102.55|116.22|121.42|120.32|102.55|116.22| 21.09 | 121.42 | 92.98 30000509|HC VARICELLA ZOSTER ANTIBODY|0300|86787|227.78|132.11|52.05|49.45|||9.81|10.01|10.01|10.20|148.06|154.89|166.28|166.28|177.67|136.67|148.06|170.84|193.61|202.27|200.45|170.84|193.61| 9.81 | 202.27 | 154.89 30000510|HC WEST NILE VIRUS AB IGM|0300|86788|213.01|123.55|186.34|177.02|||||||138.46|144.85|155.50|155.50|166.15|127.81|138.46|159.76|181.06|189.15|187.45|159.76|181.06| 127.81 | 189.15 | 159.76 30000511|HC WEST NILE VIRUS AB|0300|86789|258.27|149.80|225.92|214.62|||||||167.88|175.62|188.54|188.54|201.45|154.96|167.88|193.70|219.53|229.34|227.28|193.70|219.53| 154.96 | 229.34 | 193.70 30000512|HC THYROGLOBULIN ANTIBODY|0300|86800|86.28|50.04|54.31|51.59|||28.76|29.33|29.33|29.91|56.08|58.67|62.98|62.98|67.30|51.77|56.08|64.71|73.34|76.62|75.93|64.71|73.34| 28.76 | 76.62 | 58.67 30000513|HC HEPATITIS-C-VIRUS-ANTIBODY|0300|86803|279.31|162.00|35.46|33.69|||19.89|20.28|20.28|20.68|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 19.89 | 248.03 | 189.93 30000514|HC ANTIBODY-SCREEN|0300|86850|203.67|118.13|16.84|16.00|49.76|49.76|9.81|10.01|10.01|10.20|132.39|138.50|148.68|148.68|158.86|122.20|132.39|152.75|173.12|180.86|179.23|152.75|173.12| 9.81 | 180.86 | 132.39 30000515|HC ELUATE - RBC|0300|86860|209.54|121.53|15.13|14.37|149.16|149.16|9.81|10.01|10.01|10.20|136.20|142.49|152.96|152.96|163.44|125.72|136.20|157.16|178.11|186.07|184.40|157.16|178.11| 9.81 | 186.07 | 149.16 30000516|HC ANTIBODY-IDENTIFICATION-PAN|0300|86870|373.40|216.57|76.66|72.827|291.26|291.26|9.81|10.01|10.01|10.20|242.71|253.91|272.58|272.58|291.25|224.04|242.71|280.05|317.39|331.58|328.59|280.05|317.39| 9.81 | 331.58 | 272.58 30000517|HC COOMBS-TEST-DIRECT|0300|86880|139.70|81.03|18.27|17.36|55.66|55.66|9.62|9.81|9.81|10.00|90.81|95.00|101.98|101.98|108.97|83.82|90.81|104.78|118.75|124.05|122.94|104.78|118.75| 9.62 | 124.05 | 90.81 30000518|HC AHG EA AB TITER|0300|86886|271.86|157.68|22.95|21.80|149.16|149.16|9.35|9.54|9.54|9.73|176.71|184.86|198.46|198.46|212.05|163.12|176.71|203.90|231.08|241.41|239.24|203.90|231.08| 9.35 | 241.41 | 176.71 30000519|HC CELL SALVAGE PROCESSING|0300|86891|3,385.18|1,963.40|||656.15|656.15|26.82|27.36|27.36|27.89|2200.37|2301.92|2471.18|2471.18|2640.44|2031.11|2200.37|2538.89|2877.40|3006.04|2978.96|2538.89|2877.40| 26.82 | 3,006.04 | 2,301.92 30000520|HC ABO-TYPING|0300|86900|95.77|55.55|13.01|12.36|111.95|111.95|5.39|5.50|5.50|5.61|62.25|65.12|69.91|69.91|74.70|57.46|62.25|71.83|81.40|85.04|84.28|71.83|81.40| 5.39 | 111.95 | 69.91 30000521|HC RH-TYPING|0300|86901|95.77|55.55|12.77|12.13|33.84|33.84|6.87|7.01|7.01|7.14|62.25|65.12|69.91|69.91|74.70|57.46|62.25|71.83|81.40|85.04|84.28|71.83|81.40| 6.87 | 85.04 | 62.25 30000522|HC ANTIGEN TYPE-COMP BLOOD|0300|86902|173.00|100.34|11.71|11.12|291.26|291.26|5.98|6.10|6.10|6.22|112.45|117.64|126.29|126.29|134.94|103.80|112.45|129.75|147.05|153.62|152.24|129.75|147.05| 5.98 | 291.26 | 126.29 30000523|HC DIRECT-RARE-CELL-TYPING|0300|86905|151.71|87.99|33.47|31.80|291.26|291.26|6.21|6.34|6.34|6.46|98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 6.21 | 291.26 | 110.75 30000524|HC CROSSMATCH PK-CELL 1|0300|86920|373.40|216.57|36.41|34.59|149.16|149.16|61.67|62.91|62.91|64.14|242.71|253.91|272.58|272.58|291.25|224.04|242.71|280.05|317.39|331.58|328.59|280.05|317.39| 34.59 | 331.58 | 242.71 30000525|HC COMPATIBILITY TEST - AHG|0300|86922|193.61|112.29|33.05|31.40|149.16|149.16|24.07|24.55|24.55|25.04|125.85|131.65|141.34|141.34|151.02|116.17|125.85|145.21|164.57|171.93|170.38|145.21|164.57| 24.07 | 171.93 | 141.34 30000526|HC ELECTRONIC CROSSMATCH, EA UNIT|0300|86923|96.21|55.80|80.61|76.58|149.16|149.16|14.35|14.64|14.64|14.93|62.54|65.42|70.23|70.23|75.04|57.73|62.54|72.16|81.78|85.43|84.66|72.16|81.78| 14.35 | 149.16 | 72.16 30000527|HC ISO HEMAGGLUTININ TITER|0300|86940|136.73|79.30|24.05|22.85|||14.39|14.68|14.68|14.97|88.87|92.98|99.81|99.81|106.65|82.04|88.87|102.55|116.22|121.42|120.32|102.55|116.22| 14.39 | 121.42 | 92.98 30000528|HC HEMOLYS & AGGLUT, AUTO SCR EA|0300|86940|127.63|74.03|24.05|22.85|||14.39|14.68|14.68|14.97|82.96|86.79|93.17|93.17|99.55|76.58|82.96|95.72|108.49|113.34|112.31|95.72|108.49| 14.39 | 113.34 | 86.79 30000529|HC HEMOLYS & AGGLUT, INCUBATED|0300|86941|172.29|99.93|27.58|26.201|||14.39|14.68|14.68|14.97|111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 14.39 | 152.99 | 117.16 30000530|HC PRETREAT RBC WITH ENZYMES|0300|86971|162.45|94.22|12.32|11.70|291.26|291.26|9.81|10.01|10.01|10.20|105.59|110.47|118.59|118.59|126.71|97.47|105.59|121.84|138.08|144.26|142.96|121.84|138.08| 9.81 | 291.26 | 118.59 30000531|HC AUTO ABSORPTION OF RBC|0300|86978|171.74|99.61|42.67|40.54|33.84|33.84|9.62|9.81|9.81|10.00|111.63|116.78|125.37|125.37|133.96|103.04|111.63|128.81|145.98|152.51|151.13|128.81|145.98| 9.62 | 152.51 | 111.63 30000532|HC SPLITTING OF BLOOD UNIT|0300|86985|127.37|73.87|||149.16|149.16|||||82.79|86.61|92.98|92.98|99.35|76.42|82.79|95.53|108.26|113.10|112.09|95.53|108.26| 76.42 | 149.16 | 95.53 30000533|HC CONCENTRATION FOR INFECT AGNT|0300|87015|127.37|73.87|28.11|26.70|||10.99|11.21|11.21|11.43|82.79|86.61|92.98|92.98|99.35|76.42|82.79|95.53|108.26|113.10|112.09|95.53|108.26| 10.99 | 113.10 | 86.61 30000534|HC CULT-BLOOD|0300|87040|115.48|66.98|30.19|28.68|||12.36|12.61|12.61|12.86|75.06|78.53|84.30|84.30|90.07|69.29|75.06|86.61|98.16|102.55|101.62|86.61|98.16| 12.36 | 102.55 | 78.53 30000535|HC CULT-STOOL|0300|87045|376.56|218.40|23.28|22.12|||14.50|14.79|14.79|15.08|244.76|256.06|274.89|274.89|293.72|225.94|244.76|282.42|320.08|334.39|331.37|282.42|320.08| 14.50 | 334.39 | 256.06 30000536|HC CULT STOOL-ADD EA|0300|87046|65.36|37.91|23.28|22.12|||3.62|3.70|3.70|3.77|42.48|44.44|47.71|47.71|50.98|39.22|42.48|49.02|55.56|58.04|57.52|49.02|55.56| 3.62 | 58.04 | 44.44 30000538|HC CULT-CATH TIP|0300|87070|376.56|218.40|25.07|23.82|||9.62|9.81|9.81|10.00|244.76|256.06|274.89|274.89|293.72|225.94|244.76|282.42|320.08|334.39|331.37|282.42|320.08| 9.62 | 334.39 | 256.06 30000540|HC CULT-AEROBIC|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000541|HC CULTURE-WOUND|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000542|HC CULTURE-BODY FLUID|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000543|HC CULTURE-BRONCH WASH|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000544|HC CULTURE-CSF|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000545|HC CULTURE-GENITAL|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000546|HC CULTURE-JOINT|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000547|HC CULTURE-SPUTUM|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000548|HC BACT CULT; QT AEROBIC|0300|87071|243.89|141.46|24.88|23.64|||7.25|7.39|7.39|7.54|158.53|165.85|178.04|178.04|190.23|146.33|158.53|182.92|207.31|216.57|214.62|182.92|207.31| 7.25 | 216.57 | 165.85 30000549|HC CULT-ANAEROBIC|0300|87075|455.49|264.18|24.54|23.31|||17.11|17.46|17.46|17.80|296.07|309.73|332.51|332.51|355.28|273.29|296.07|341.62|387.17|404.48|400.83|341.62|387.17| 17.11 | 404.48 | 309.73 30000550|HC CULTURE ADD ID,ANAEROBIC|0300|87076|136.73|79.30|24.10|22.90|||17.27|17.62|17.62|17.96|88.87|92.98|99.81|99.81|106.65|82.04|88.87|102.55|116.22|121.42|120.32|102.55|116.22| 17.27 | 121.42 | 92.98 30000551|HC CULTURE-ADDITION ID|0300|87077|54.73|31.74|24.10|22.90|||12.42|12.66|12.66|12.91|35.57|37.22|39.95|39.95|42.69|32.84|35.57|41.05|46.52|48.60|48.16|41.05|46.52| 12.42 | 48.60 | 37.22 30000552|HC CLO TEST|0300|87081|66.61|38.63|18.84|17.90|||9.62|9.81|9.81|10.00|43.30|45.29|48.63|48.63|51.96|39.97|43.30|49.96|56.62|59.15|58.62|49.96|56.62| 9.62 | 59.15 | 45.29 30000553|HC METHICILLIN RES STAPH AURSC|0300|87081|151.71|87.99|18.84|17.90|||9.62|9.81|9.81|10.00|98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 9.62 | 134.72 | 103.16 30000554|HC STREP-SCN-CONFIRMATION|0300|87081|63.92|37.07|18.84|17.90|||9.62|9.81|9.81|10.00|41.55|43.47|46.66|46.66|49.86|38.35|41.55|47.94|54.33|56.76|56.25|47.94|54.33| 9.62 | 56.76 | 43.47 30000555|HC GROUP B STREP SCREEN-GENITA|0300|87081|151.71|87.99|18.84|17.90|||9.62|9.81|9.81|10.00|98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 9.62 | 134.72 | 103.16 30000556|HC GC CULTURE|0300|87081|177.64|103.03|18.84|17.90|||9.62|9.81|9.81|10.00|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 9.62 | 157.74 | 120.80 30000557|HC CULTURE-URINE|0300|87086|291.42|169.02|23.87|22.68|||13.74|14.01|14.01|14.29|189.42|198.17|212.74|212.74|227.31|174.85|189.42|218.57|247.71|258.78|256.45|218.57|247.71| 13.74 | 258.78 | 198.17 30000558|HC URINE CULT; EA ISO|0300|87088|165.29|95.87|20.60|19.57|||13.74|14.01|14.01|14.29|107.44|112.40|120.66|120.66|128.93|99.17|107.44|123.97|140.50|146.78|145.46|123.97|140.50| 13.74 | 146.78 | 112.40 30000559|HC CULT-FUNGUS SKIN,HAIR,NAILS|0300|87101|242.01|140.37|18.98|18.03|||10.99|11.21|11.21|11.43|157.31|164.57|176.67|176.67|188.77|145.21|157.31|181.51|205.71|214.90|212.97|181.51|205.71| 10.99 | 214.90 | 164.57 30000560|HC CULT-FUNGUS OTHER|0300|87102|242.01|140.37|27.99|26.59|||10.99|11.21|11.21|11.43|157.31|164.57|176.67|176.67|188.77|145.21|157.31|181.51|205.71|214.90|212.97|181.51|205.71| 10.99 | 214.90 | 164.57 30000561|HC CULT-FUNGUS-BLOOD|0300|87103|242.01|140.37|28.06|26.66|||10.99|11.21|11.21|11.43|157.31|164.57|176.67|176.67|188.77|145.21|157.31|181.51|205.71|214.90|212.97|181.51|205.71| 10.99 | 214.90 | 164.57 30000562|HC FUNGUS-ID, YEAST ONLY|0300|87106|209.76|121.66|30.30|28.79|||15.87|16.19|16.19|16.50|136.34|142.64|153.12|153.12|163.61|125.86|136.34|157.32|178.30|186.27|184.59|157.32|178.30| 15.87 | 186.27 | 142.64 30000563|HC FUNGUS-ID, MOLD ONLY|0300|87107|209.76|121.66|30.30|28.79|||15.87|16.19|16.19|16.50|136.34|142.64|153.12|153.12|163.61|125.86|136.34|157.32|178.30|186.27|184.59|157.32|178.30| 15.87 | 186.27 | 142.64 30000564|HC CULT-MYCOPLASMA|0300|87109|376.56|218.40|57.44|54.57|||13.74|14.01|14.01|14.29|244.76|256.06|274.89|274.89|293.72|225.94|244.76|282.42|320.08|334.39|331.37|282.42|320.08| 13.74 | 334.39 | 256.06 30000565|HC UREAPLASMA/MYCOPLASMA CULT|0300|87109|285.51|165.60|57.44|54.57|||13.74|14.01|14.01|14.29|185.58|194.15|208.42|208.42|222.70|171.31|185.58|214.13|242.68|253.53|251.25|214.13|242.68| 13.74 | 253.53 | 194.15 30000566|HC CULT-CHLAMYDIA|0300|87110|340.57|197.53|59.79|56.80|||26.17|26.69|26.69|27.21|221.37|231.59|248.62|248.62|265.64|204.34|221.37|255.43|289.48|302.43|299.70|255.43|289.48| 26.17 | 302.43 | 231.59 30000567|HC CULT-AFB/MYCOBACTERIA|0300|87116|338.54|196.35|37.65|35.77|||13.74|14.01|14.01|14.29|220.05|230.21|247.13|247.13|264.06|203.12|220.05|253.91|287.76|300.62|297.92|253.91|287.76| 13.74 | 300.62 | 230.21 30000568|HC CULTURE-AFB BLOOD|0300|87116|338.54|196.35|37.65|35.77|||13.74|14.01|14.01|14.29|220.05|230.21|247.13|247.13|264.06|203.12|220.05|253.91|287.76|300.62|297.92|253.91|287.76| 13.74 | 300.62 | 230.21 30000569|HC CHLAMYDIA TYPING IMMUNO FL|0300|87140|213.01|123.55|20.28|19.27|||10.09|10.29|10.29|10.49|138.46|144.85|155.50|155.50|166.15|127.81|138.46|159.76|181.06|189.15|187.45|159.76|181.06| 10.09 | 189.15 | 144.85 30000570|HC CULTURE,TYPING,AGG,GROUPING|0300|87147|63.92|37.07|14.52|13.79|||9.35|9.54|9.54|9.73|41.55|43.47|46.66|46.66|49.86|38.35|41.55|47.94|54.33|56.76|56.25|47.94|54.33| 9.35 | 56.76 | 43.47 30000571|HC DNA/RNA DIRECT PROBE|0300|87149|286.38|166.10|33.84|32.15|||30.81|31.43|31.43|32.04|186.15|194.74|209.06|209.06|223.38|171.83|186.15|214.79|243.42|254.31|252.01|214.79|243.42| 30.81 | 254.31 | 194.74 30000572|HC CULT TYPE, NA, AMP PROBE, EA O|0300|87150|109.10|63.28|59.23|56.27|||44.82|45.72|45.72|46.62|70.92|74.19|79.64|79.64|85.10|65.46|70.92|81.83|92.74|96.88|96.01|81.83|92.74| 44.82 | 96.88 | 74.19 30000573|HC DNA/RNA SEQUENCING EA ISOLATE|0300|87153|523.28|303.50|339.52|322.54|||||||340.13|355.83|381.99|381.99|408.16|313.97|340.13|392.46|444.79|464.67|460.49|392.46|444.79| 313.97 | 464.67 | 381.99 30000574|HC WORM IDENTIFICATION|0300|87169|142.65|82.74|18.11|17.20|||6.57|6.70|6.70|6.83|92.72|97.00|104.13|104.13|111.27|85.59|92.72|106.99|121.25|126.67|125.53|106.99|121.25| 6.57 | 126.67 | 97.00 30000575|HC TISSUE GRINDING|0300|87176|79.43|46.07|14.65|13.92|||10.64|10.85|10.85|11.06|51.63|54.01|57.98|57.98|61.96|47.66|51.63|59.57|67.52|70.53|69.90|59.57|67.52| 10.64 | 70.53 | 54.01 30000576|HC OVA&PARASITE-(STOOL-EXAM)|0300|87177|367.49|213.14|24.69|23.46|||10.99|11.21|11.21|11.43|238.87|249.89|268.27|268.27|286.64|220.49|238.87|275.62|312.37|326.33|323.39|275.62|312.37| 10.99 | 326.33 | 249.89 30000577|HC SENSITIVITY KIRBY BAUER|0300|87184|288.67|167.43|20.28|19.27|||12.46|12.70|12.70|12.95|187.64|196.30|210.73|210.73|225.16|173.20|187.64|216.50|245.37|256.34|254.03|216.50|245.37| 12.46 | 256.34 | 196.30 30000578|HC BETA LACTAMASE|0300|87185|95.77|55.55|14.58|13.85|||7.30|7.45|7.45|7.59|62.25|65.12|69.91|69.91|74.70|57.46|62.25|71.83|81.40|85.04|84.28|71.83|81.40| 7.30 | 85.04 | 65.12 30000579|HC SENSITIVITY-AEROBIC|0300|87186|70.51|40.90|25.89|24.60|||15.63|15.95|15.95|16.26|45.83|47.95|51.47|51.47|55.00|42.31|45.83|52.88|59.93|62.61|62.05|52.88|59.93| 15.63 | 62.61 | 47.95 30000580|HC SENSITIVITY-ANAEROBIC|0300|87186|481.16|279.07|25.89|24.60|||15.63|15.95|15.95|16.26|312.75|327.19|351.25|351.25|375.30|288.70|312.75|360.87|408.99|427.27|423.42|360.87|408.99| 15.63 | 427.27 | 327.19 30000581|HC EOSINOPHIL-URINE SEDIMENT|0300|87205|101.66|58.96|11.43|10.86|||6.87|7.01|7.01|7.14|66.08|69.13|74.21|74.21|79.29|61.00|66.08|76.25|86.41|90.27|89.46|76.25|86.41| 6.87 | 90.27 | 69.13 30000582|HC GRAM-STAIN|0300|87205|92.58|53.70|11.43|10.86|||6.87|7.01|7.01|7.14|60.18|62.95|67.58|67.58|72.21|55.55|60.18|69.44|78.69|82.21|81.47|69.44|78.69| 6.87 | 82.21 | 62.95 30000583|HC AFB-MYCOB.SMEAR|0300|87206|92.58|53.70|24.14|22.93|||6.87|7.01|7.01|7.14|60.18|62.95|67.58|67.58|72.21|55.55|60.18|69.44|78.69|82.21|81.47|69.44|78.69| 6.87 | 82.21 | 62.95 30000584|HC MALARIA-SMEAR|0300|87207|151.71|87.99|28.48|27.06|||||||98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 27.06 | 134.72 | 110.75 30000585|HC TRICHROME STAIN|0300|87209|89.73|52.04|51.81|49.22|||27.92|28.48|28.48|29.04|58.32|61.02|65.50|65.50|69.99|53.84|58.32|67.30|76.27|79.68|78.96|67.30|76.27| 27.92 | 79.68 | 61.02 30000586|HC TISSUE KOH|0300|87220|130.53|75.71|14.21|13.50|||5.10|5.20|5.20|5.31|84.84|88.76|95.29|95.29|101.81|78.32|84.84|97.90|110.95|115.91|114.87|97.90|110.95| 5.10 | 115.91 | 88.76 30000587|HC VIRAL CULTURE, GENERAL|0300|87252|259.54|150.53|73.14|69.48|||35.23|35.94|35.94|36.64|168.70|176.49|189.46|189.46|202.44|155.72|168.70|194.66|220.61|230.47|228.40|194.66|220.61| 35.23 | 230.47 | 176.49 30000588|HC VIRUS ISO; SHELL VIAL TECH, EA|0300|87254|191.45|111.04|56.98|54.13|||7.52|7.67|7.67|7.82|124.44|130.19|139.76|139.76|149.33|114.87|124.44|143.59|162.73|170.01|168.48|143.59|162.73| 7.52 | 170.01 | 130.19 30000589|HC HSV CULTURE|0300|87255|296.12|171.75|63.33|60.16|||19.62|20.02|20.02|20.41|192.48|201.36|216.17|216.17|230.97|177.67|192.48|222.09|251.70|262.95|260.59|222.09|251.70| 19.62 | 262.95 | 201.36 30000590|HC LEGIONELLA, DFA|0300|87278|209.76|121.66|47.92|45.52|||18.43|18.8|18.8|19.17|136.34|142.64|153.12|153.12|163.61|125.86|136.34|157.32|178.30|186.27|184.59|157.32|178.30| 18.43 | 186.27 | 142.64 30000591|HC CRYPTOSPORIDIUM ANTIGEN, FECES|0300|87328|153.92|89.27|43.13|40.97|||13.08|13.34|13.34|13.61|100.05|104.67|112.36|112.36|120.06|92.35|100.05|115.44|130.83|136.68|135.45|115.44|130.83| 13.08 | 136.68 | 104.67 30000592|HC GIARDIA LAMBLIA ANTIGEN, DIR|0300|87329|174.49|101.20|43.13|40.97|||13.08|13.34|13.34|13.61|113.42|118.65|127.38|127.38|136.10|104.69|113.42|130.87|148.32|154.95|153.55|130.87|148.32| 13.08 | 154.95 | 118.65 30000594|HC HELICOBACTER PYLORI ANT., FECE|0300|87338|273.18|158.44|24.51|23.28|||||||177.57|185.76|199.42|199.42|213.08|163.91|177.57|204.89|232.20|242.58|240.40|204.89|232.20| 23.28 | 242.58 | 199.42 30000595|HC HEPAT-B-SURF-ANTIGEN(HBSAG)|0300|87340|192.71|111.77|19.36|18.39|||15.87|16.19|16.19|16.50|125.26|131.04|140.68|140.68|150.31|115.63|125.26|144.53|163.80|171.13|169.58|144.53|163.80| 15.87 | 171.13 | 131.04 30000596|HC HEPAT-B-(E)ANTIGEN(HBEAG)-R|0300|87350|247.57|143.59|34.11|32.40|||13.08|13.34|13.34|13.61|160.92|168.35|180.73|180.73|193.10|148.54|160.92|185.68|210.43|219.84|217.86|185.68|210.43| 13.08 | 219.84 | 168.35 30000597|HC HISTO PLASMA ANTIGEN|0300|87385|553.58|321.08|43.13|40.97|||13.08|13.34|13.34|13.61|359.83|376.43|404.11|404.11|431.79|332.15|359.83|415.19|470.54|491.58|487.15|415.19|470.54| 13.08 | 491.58 | 376.43 30000598|HC RSV IMMUNOASSAY|0300|87420|405.11|234.96|43.13|40.97|||13.08|13.34|13.34|13.61|263.32|275.47|295.73|295.73|315.99|243.07|263.32|303.83|344.34|359.74|356.50|303.83|344.34| 13.08 | 359.74 | 275.47 30000599|HC ROTAVIRUS IMMUNOASSAY|0300|87425|196.01|113.69|43.13|40.9735|||13.08|13.34|13.34|13.61|127.41|133.29|143.09|143.09|152.89|117.61|127.41|147.01|166.61|174.06|172.49|147.01|166.61| 13.08 | 174.06 | 133.29 30000600|HC INF AG BY EIA-MULT STEP, NOS|0300|87449|272.10|157.82|43.13|40.97|||18.43|18.80|18.80|19.17|176.87|185.03|198.63|198.63|212.24|163.26|176.87|204.08|231.29|241.62|239.45|204.08|231.29| 18.43 | 241.62 | 185.03 30000601|HC LEGIONELLA URINE AG|0300|87449|221.66|128.56|43.13|40.97|||18.43|18.80|18.80|19.17|144.08|150.73|161.81|161.81|172.89|133.00|144.08|166.25|188.41|196.83|195.06|166.25|188.41| 18.43 | 196.83 | 150.73 30000602|HC LYMES, PCR|0300|87476|650.55|377.32|||||13.08|13.34|13.34|13.61|422.86|442.37|474.90|474.90|507.43|390.33|422.86|487.91|552.97|577.69|572.48|487.91|552.97| 13.08 | 577.69 | 474.90 30000603|HC CANDIDA SPECIES DIRECT PROBE|0300|87480|96.41|55.92|45.66|43.38|||13.08|13.34|13.34|13.61|62.67|65.56|70.38|70.38|75.20|57.85|62.67|72.31|81.95|85.61|84.84|72.31|81.95| 13.08 | 85.61 | 65.56 30000605|HC CHLAMYDIA AMPLIFIED PROBE|0300|87491|269.21|156.14|59.23|56.27|||53.93|55.01|55.01|56.09|174.99|183.06|196.52|196.52|209.98|161.53|174.99|201.91|228.83|239.06|236.90|201.91|228.83| 53.93 | 239.06 | 183.06 30000606|HC CLOSTRIDIUM DIFFICILE BY PCR|0300|87493|204.88|118.83|59.23|56.27|||44.82|45.72|45.72|46.62|133.17|139.32|149.56|149.56|159.81|122.93|133.17|153.66|174.15|181.93|180.29|153.66|174.15| 44.82 | 181.93 | 139.32 30000607|HC CMV-DNA/PCR, QUALITATIVE|0300|87496|780.56|452.72|59.23|56.2685|||13.08|13.34|13.34|13.61|507.36|530.78|569.81|569.81|608.84|468.34|507.36|585.42|663.48|693.14|686.89|585.42|663.48| 13.08 | 693.14 | 530.78 30000608|HC CMV DNA BY PCR, QUANT|0300|87497|822.96|477.32|72.27|68.66|||13.08|13.34|13.34|13.61|534.92|559.61|600.76|600.76|641.91|493.78|534.92|617.22|699.52|730.79|724.20|617.22|699.52| 13.08 | 730.79 | 559.61 30000609|HC ENTEROVIRUS RNA, QUAL BY PCR|0300|87498|868.36|503.65|57.90|55.01|||||||564.43|590.48|633.90|633.90|677.32|521.02|564.43|651.27|738.11|771.10|764.16|651.27|738.11| 55.01 | 771.10 | 633.90 30000610|HC IA, DNA AMP PROBE-VANC RESIST|0300|87500|542.42|314.60|||||||||352.57|368.85|395.97|395.97|423.09|325.45|352.57|406.82|461.06|481.67|477.33|406.82|461.06| 325.45 | 481.67 | 406.82 30000611|HC GARDNERELLA VAGINALIS DIREC PR|0300|87510|96.41|55.92|45.66|43.38|||13.08|13.34|13.34|13.61|62.67|65.56|70.38|70.38|75.20|57.85|62.67|72.31|81.95|85.61|84.84|72.31|81.95| 13.08 | 85.61 | 65.56 30000612|HC HBV DNA BY PCR QT|0300|87517|631.70|366.39|157.01|149.16|||13.08|13.34|13.34|13.61|410.61|429.56|461.14|461.14|492.73|379.02|410.61|473.78|536.95|560.95|555.90|473.78|536.95| 13.08 | 560.95 | 429.56 30000613|HC HCF RNA PCR QUAL|0300|87521|680.36|394.61|59.23|56.27|||13.08|13.34|13.34|13.61|442.23|462.64|496.66|496.66|530.68|408.22|442.23|510.27|578.31|604.16|598.72|510.27|578.31| 13.08 | 604.16 | 462.64 30000614|HC HEP C VIRUS RNA PCR QT|0300|87522|789.43|457.87|690.53|656.00|||13.08|13.34|13.34|13.61|513.13|536.81|576.28|576.28|615.76|473.66|513.13|592.07|671.02|701.01|694.70|592.07|671.02| 13.08 | 701.01 | 576.28 30000615|HC HSV BY PCR SINGLE-REF|0300|87529|481.16|279.07|59.23|56.27|||13.08|13.34|13.34|13.61|312.75|327.19|351.25|351.25|375.30|288.70|312.75|360.87|408.99|427.27|423.42|360.87|408.99| 13.08 | 427.27 | 327.19 30000616|HC HIV-1 AMP PROBE W/ REV TRNSCRP|0300|87535|528.75|306.68|59.23|56.27|||13.08|13.34|13.34|13.61|343.69|359.55|385.99|385.99|412.43|317.25|343.69|396.56|449.44|469.53|465.30|396.56|449.44| 13.08 | 469.53 | 359.55 30000617|HC HIV-1 RNA BY PCR QUANT|0300|87536|929.04|538.84|143.57|136.3915|||141.30|144.12|144.12|146.95|603.88|631.75|678.20|678.20|724.65|557.42|603.88|696.78|789.68|824.99|817.56|696.78|789.68| 136.39 | 824.99 | 631.75 30000618|HC M. TUBERCULOSIS DETECTION, PCR|0300|87556|637.69|369.86|51.47|48.8965|||13.08|13.34|13.34|13.61|414.50|433.63|465.51|465.51|497.40|382.61|414.50|478.27|542.04|566.27|561.17|478.27|542.04| 13.08 | 566.27 | 433.63 30000619|HC GC AMPLIFIED PROBE|0300|87591|269.21|156.14|59.23|56.2685|||53.93|55.01|55.01|56.09|174.99|183.06|196.52|196.52|209.98|161.53|174.99|201.91|228.83|239.06|236.90|201.91|228.83| 53.93 | 239.06 | 183.06 30000620|HC HPV-PCR|0300|87621|128.75|74.68|||||54.53|55.62|55.62|56.71|83.69|87.55|93.99|93.99|100.43|77.25|83.69|96.56|109.44|114.33|113.30|96.56|109.44| 54.53 | 114.33 | 93.99 30000621|HC PAPILLOMAVIRUS AMP PROBE|0300|87621|114.87|66.62|||||54.53|55.62|55.62|56.71|74.67|78.11|83.86|83.86|89.60|68.92|74.67|86.15|97.64|102.00|101.09|86.15|97.64| 54.53 | 102.00 | 83.86 30000622|HC RES VIR DNA/RNA 12-25 TARGETS|0300|87633|796.40|461.91|||||||||517.66|541.55|581.37|581.37|621.19|477.84|517.66|597.30|676.94|707.20|700.83|597.30|676.94| 477.84 | 707.20 | 597.30 30000623|HC IA, DNA AMP PROBE-STAPH|0300|87640|319.07|185.06|279.11|265.15|||||||207.40|216.97|232.92|232.92|248.87|191.44|207.40|239.30|271.21|283.33|280.78|239.30|271.21| 191.44 | 283.33 | 239.30 30000624|HC IA, DNA AMP PROBE-MR STAPH|0300|87641|490.10|284.26|428.69|407.26|||||||318.57|333.27|357.77|357.77|382.28|294.06|318.57|367.58|416.59|435.21|431.29|367.58|416.59| 294.06 | 435.21 | 367.58 30000625|HC IA, DNA AMP PROBE-STREP A|0300|87651|223.36|129.55|56.94|54.093|||13.08|13.34|13.34|13.61|145.18|151.88|163.05|163.05|174.22|134.02|145.18|167.52|189.86|198.34|196.56|167.52|189.86| 13.08 | 198.34 | 151.88 30000626|HC IA, DNA AMP PROBE-STREP B|0300|87653|350.98|203.57|40.94|38.89|||||||228.14|238.67|256.22|256.22|273.76|210.59|228.14|263.24|298.33|311.67|308.86|263.24|298.33| 38.89 | 311.67 | 256.22 30000627|HC TRICHOMONAS DIRECT PROBE|0300|87660|89.15|51.71|45.52|43.24|||30.81|31.43|31.43|32.04|57.95|60.62|65.08|65.08|69.54|53.49|57.95|66.86|75.78|79.17|78.45|66.86|75.78| 30.81 | 79.17 | 60.62 30000628|HC TRICHOMONAS VAGINALIS AMPLIF|0300|87661|204.20|118.44|||||||||132.73|138.86|149.07|149.07|159.28|122.52|132.73|153.15|173.57|181.33|179.70|153.15|173.57| 122.52 | 181.33 | 153.15 30000629|HC BORDATELLA PERTUSSIS BY PCR|0300|87798|381.36|221.19|236.03|224.23|||53.94|55.02|55.02|56.10|247.88|259.32|278.39|278.39|297.46|228.82|247.88|286.02|324.16|338.65|335.60|286.02|324.16| 53.94 | 338.65 | 259.32 30000630|HC EBV DNA, PCR|0300|87798|469.19|272.13|236.03|224.23|||53.94|55.02|55.02|56.10|304.97|319.05|342.51|342.51|365.97|281.51|304.97|351.89|398.81|416.64|412.89|351.89|398.81| 53.94 | 416.64 | 319.05 30000631|HC EHRLICHIA PANEL, DNA BY PCR|0300|87798|381.36|221.19|236.03|224.23|||53.94|55.02|55.02|56.10|247.88|259.32|278.39|278.39|297.46|228.82|247.88|286.02|324.16|338.65|335.60|286.02|324.16| 53.94 | 338.65 | 259.32 30000632|HC IA, DNA/RNA AMP PROBE, EA|0300|87798|223.36|129.55|236.03|224.23|||53.94|55.02|55.02|56.10|145.18|151.88|163.05|163.05|174.22|134.02|145.18|167.52|189.86|198.34|196.56|167.52|189.86| 53.94 | 236.03 | 163.05 30000633|HC INF AGENT DET AMP|0300|87798|469.19|272.13|236.03|224.23|||53.94|55.02|55.02|56.10|304.97|319.05|342.51|342.51|365.97|281.51|304.97|351.89|398.81|416.64|412.89|351.89|398.81| 53.94 | 416.64 | 319.05 30000634|HC TRICHOMONAS, PCR|0300|87798|146.34|84.88|236.03|224.23|||53.94|55.02|55.02|56.10|95.12|99.51|106.83|106.83|114.15|87.80|95.12|109.76|124.39|129.95|128.78|109.76|124.39| 53.94 | 236.03 | 106.83 30000635|HC WEST NILLE VIRUS, RNA BY PCR|0300|87798|399.50|231.71|236.03|224.23|||53.94|55.02|55.02|56.10|259.68|271.66|291.64|291.64|311.61|239.70|259.68|299.63|339.58|354.76|351.56|299.63|339.58| 53.94 | 354.76 | 271.66 30000636|HC INF AGENT QT NOS EACH ORG|0300|87799|893.40|518.17|197.82|187.929|||13.08|13.34|13.34|13.61|580.71|607.51|652.18|652.18|696.85|536.04|580.71|670.05|759.39|793.34|786.19|670.05|759.39| 13.08 | 793.34 | 607.51 30000637|HC NOROVIRUS BY PR|0300|87799|538.43|312.29|197.82|187.93|||13.08|13.34|13.34|13.61|349.98|366.13|393.05|393.05|419.98|323.06|349.98|403.82|457.67|478.13|473.82|403.82|457.67| 13.08 | 478.13 | 366.13 30000638|HC STREP GR B OPTICAL OBSERV|0300|87802|173.33|100.53|47.92|45.52|||9.81|10.01|10.01|10.20|112.66|117.86|126.53|126.53|135.20|104.00|112.66|130.00|147.33|153.92|152.53|130.00|147.33| 9.81 | 153.92 | 117.86 30000639|HC INFLUENZA IA W DIR OBS-POCT|0300|87804QW|70.35|40.80|||||||||45.73|47.84|51.36|51.36|54.87|42.21|45.73|52.76|59.80|62.47|61.91|52.76|59.80| 42.21 | 62.47 | 52.76 30000640|HC INFLUENZA IA W DIR OBSV|0300|87804|114.87|66.62|43.13|40.97|||19.48|19.87|19.87|20.26|74.67|78.11|83.86|83.86|89.60|68.92|74.67|86.15|97.64|102.00|101.09|86.15|97.64| 19.48 | 102.00 | 78.11 30000641|HC RSV IA W DIR OBSV|0300|87807|70.35|40.80|61.55|58.47|||18.64|19.02|19.02|19.39|45.73|47.84|51.36|51.36|54.87|42.21|45.73|52.76|59.80|62.47|61.91|52.76|59.80| 18.64 | 62.47 | 51.36 30000642|HC RAPID TRICH TEST|0300|87808|106.03|61.50|||||||||68.92|72.10|77.40|77.40|82.70|63.62|68.92|79.52|90.13|94.15|93.31|79.52|90.13| 63.62 | 94.15 | 79.52 30000643|HC STREP A W/OPTIC - POCT|0300|87880|151.71|87.99|43.13|40.97|||9.81|10.01|10.01|10.2|98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 9.81 | 134.72 | 103.16 30000644|HC STREPTOCOCCUS SCREEN-DIR|0300|87880|151.71|87.99|43.13|40.9735|||9.81|10.01|10.01|10.20|98.61|103.16|110.75|110.75|118.33|91.03|98.61|113.78|128.95|134.72|133.50|113.78|128.95| 9.81 | 134.72 | 103.16 30000645|HC INF AGENT DET CSF UR|0300|87899|202.01|117.17|43.13|40.97|||||||131.31|137.37|147.47|147.47|157.57|121.21|131.31|151.51|171.71|179.38|177.77|151.51|171.71| 40.97 | 179.38 | 147.47 30000646|HC PHENOTYPE PREDICTION|0300|87900|404.02|234.33|328.6|312.17|||||||262.61|274.73|294.93|294.93|315.14|242.41|262.61|303.02|343.42|358.77|355.54|303.02|343.42| 242.41 | 358.77 | 303.02 30000647|HC HIV GENOSURE PLUS|0300|87901|2,231.94|1,294.53|||||372.87|380.33|380.33|387.79|1450.76|1517.72|1629.32|1629.32|1740.91|1339.16|1450.76|1673.96|1897.15|1981.96|1964.11|1673.96|1897.15| 372.87 | 1,981.96 | 1,629.32 30000648|HC HCV GENOTYPE|0300|87902|1,113.24|645.68|973.77|925.08|||||||723.61|757.00|812.67|812.67|868.33|667.94|723.61|834.93|946.25|988.56|979.65|834.93|946.25| 667.94 | 988.56 | 834.93 30000649|HC CYTO EA SEP ADD SAME SITE|0300|88177|55.74|32.33|||||7.47|7.62|7.62|7.77|36.23|37.90|40.69|40.69|43.48|33.44|36.23|41.81|47.38|49.50|49.05|41.81|47.38| 7.47 | 49.50 | 40.69 30000650|HC FLOW CYTOMETRY EA ADDTL MRKR|0300|88185|143.36|83.15|125.40|119.13|||21.27|21.70|21.70|22.12|93.18|97.48|104.65|104.65|111.82|86.02|93.18|107.52|121.86|127.30|126.16|107.52|121.86| 21.27 | 127.30 | 104.65 30000651|HC FLOW CYTOMETRY INTERP 9-15 MAR|0300|88188|197.78|114.71|138.81|131.87|||73.16|74.62|74.62|76.09|128.56|134.49|144.38|144.38|154.27|118.67|128.56|148.34|168.11|175.63|174.05|148.34|168.11| 73.16 | 175.63 | 138.81 30000652|HC TISSUE CULT SOLID TUM|0300|88239|1,091.03|632.80|618.06|587.16|||52.32|53.37|53.37|54.41|709.17|741.90|796.45|796.45|851.00|654.62|709.17|818.27|927.38|968.83|960.11|818.27|927.38| 52.32 | 968.83 | 741.90 30000653|HC CHROM ANAL 5C/1K|0300|88261|1,549.77|898.87|462.85|439.71|||319.56|325.95|325.95|332.34|1007.35|1053.84|1131.33|1131.33|1208.82|929.86|1007.35|1162.33|1317.30|1376.20|1363.80|1162.33|1317.30| 319.56 | 1,376.20 | 1,053.84 30000654|HC CHROM 20-25 CELLS|0300|88264|1,332.20|772.68|550.80|523.26|||225.36|229.87|229.87|234.37|865.93|905.90|972.51|972.51|1039.12|799.32|865.93|999.15|1132.37|1182.99|1172.34|999.15|1132.37| 225.36 | 1,182.99 | 905.90 30000655|HC MOL CYTO 100-300 CELLS|0300|88275|663.61|384.89|116.01|110.2095|||62.39|63.64|63.64|64.89|431.35|451.25|484.44|484.44|517.62|398.17|431.35|497.71|564.07|589.29|583.98|497.71|564.07| 62.39 | 589.29 | 451.25 30000657|HC RECEPTOR ASSAY NON-ENDO|0300|88342|329.41|191.06|226.35|215.0325|149.16|149.16|41.87|42.70|42.70|43.54|214.12|224.00|240.47|240.47|256.94|197.65|214.12|247.06|280.00|292.52|289.88|247.06|280.00| 41.87 | 292.52 | 224.00 30000657|HC RECEPTOR ASSAY NON-ENDO|0300|88342|329.41|191.06|226.35|215.0325|149.16|149.16|13.28|13.55|13.55|13.81|214.12|224.00|240.47|240.47|256.94|197.65|214.12|247.06|280.00|292.52|289.88|247.06|280.00| 13.28 | 292.52 | 224.00 30000658|HC IMMUNOFLOR AB - INDIRECT, EA|0300|88347|414.79|240.58|||||9.62|9.81|9.81|10.00|269.61|282.06|302.80|302.80|323.54|248.87|269.61|311.09|352.57|368.33|365.02|311.09|352.57| 9.62 | 368.33 | 302.80 30000658|HC IMMUNOFLOR AB - INDIRECT, EA|0300|88347|414.79|240.58|||||19.23|19.62|19.62|20.00|269.61|282.06|302.80|302.80|323.54|248.87|269.61|311.09|352.57|368.33|365.02|311.09|352.57| 19.23 | 368.33 | 302.80 30000659|HC TUMOR IHC QT MAGT|0300|88360|397.68|230.65|||149.16|149.16|41.25|42.08|42.08|42.90|258.49|270.42|290.31|290.31|310.19|238.61|258.49|298.26|338.03|353.14|349.96|298.26|338.03| 41.25 | 353.14 | 270.42 30000659|HC TUMOR IHC QT MAGT|0300|88360|397.68|230.65|||149.16|149.16|93.78|95.66|95.66|97.53|258.49|270.42|290.31|290.31|310.19|238.61|258.49|298.26|338.03|353.14|349.96|298.26|338.03| 93.78 | 353.14 | 270.42 30000661|HC MORPHOMETRIC ANALYSIS MANUAL|0300|88368|557.48|323.34|169.87|161.38|291.26|291.26|59.62|60.81|60.81|62.00|362.36|379.09|406.96|406.96|434.83|334.49|362.36|418.11|473.86|495.04|490.58|418.11|473.86| 59.62 | 495.04 | 362.36 30000661|HC MORPHOMETRIC ANALYSIS MANUAL|0300|88368|557.48|323.34|169.87|161.38|291.26|291.26|126.02|128.54|128.54|131.06|362.36|379.09|406.96|406.96|434.83|334.49|362.36|418.11|473.86|495.04|490.58|418.11|473.86| 126.02 | 495.04 | 362.36 30000662|HC CELL-COUNT-BODY-PLEURAL-ETC|0300|89050|104.59|60.66|14.86|14.12|||4.81|4.91|4.91|5.01|67.98|71.12|76.35|76.35|81.58|62.75|67.98|78.44|88.90|92.88|92.04|78.44|88.90| 4.81 | 92.88 | 71.12 30000663|HC CELL-COUNT-SPINAL-FLUID|0300|89050|104.59|60.66|14.86|14.12|||4.81|4.91|4.91|5.01|67.98|71.12|76.35|76.35|81.58|62.75|67.98|78.44|88.90|92.88|92.04|78.44|88.90| 4.81 | 92.88 | 71.12 30000664|HC CELL-COUNT-SYNOVIAL-FLUID|0300|89050|104.59|60.66|14.86|14.12|||4.81|4.91|4.91|5.01|67.98|71.12|76.35|76.35|81.58|62.75|67.98|78.44|88.90|92.88|92.04|78.44|88.90| 4.81 | 92.88 | 71.12 30000665|HC POLYS-STOOL SMEAR|0300|89055|83.40|48.37|11.84|11.25|||6.87|7.01|7.01|7.14|54.21|56.71|60.88|60.88|65.05|50.04|54.21|62.55|70.89|74.06|73.39|62.55|70.89| 6.87 | 74.06 | 56.71 30000666|HC CRYSTAL-EXAM-FLUID-POLARIZD|0300|89060|133.68|77.53|57.76|54.872|||12.91|13.17|13.17|13.43|86.89|90.90|97.59|97.59|104.27|80.21|86.89|100.26|113.63|118.71|117.64|100.26|113.63| 12.91 | 118.71 | 90.90 30000667|HC SEMEN-FERTILITY-ANALYSIS|0300|89320|183.62|106.50|36.66|34.827|||||||119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 34.83 | 163.05 | 134.04 30000668|HC SEMEN-ANALYSIS POST VAS|0300|89321|133.68|77.53|36.35|34.53|||||||86.89|90.90|97.59|97.59|104.27|80.21|86.89|100.26|113.63|118.71|117.64|100.26|113.63| 34.53 | 118.71 | 97.59 30000669|HC PLATELET GEL/PRP INJECTIONS|0300|0232T|689.89|400.14|||270.22|270.22|||||448.43|469.13|503.62|503.62|538.11|413.93|448.43|517.42|586.41|612.62|607.10|517.42|586.41| 270.22 | 612.62 | 503.62 30000670|HC RH IMMUNE GLOBULIN, IV|0636|J2792|388.90|225.56|||29.402|29.402|24.66|25.16|25.16|25.65|252.79|264.45|283.90|283.90|303.34|233.34|252.79|291.68|330.57|345.34|342.23|291.68|330.57| 24.66 | 345.34 | 264.45 30000671|HC LYME CONFIRMATORY WB-REF|0300|86617|113.69|65.94|79.97|75.9715|||9.81|10.01|10.01|10.20|73.90|77.31|82.99|82.99|88.68|68.21|73.90|85.27|96.64|100.96|100.05|85.27|96.64| 9.81 | 100.96 | 79.97 30000672|HC AB, LYME DISEASE|0300|86618|259.54|150.53|60.3|57.285|||9.81|10.01|10.01|10.2|168.70|176.49|189.46|189.46|202.44|155.72|168.70|194.66|220.61|230.47|228.40|194.66|220.61| 9.81 | 230.47 | 176.49 30000673|HC BRUCELLA ANTIBODY-EACH|0300|86622|157.73|91.48|39.71|37.7245|||9.81|10.01|10.01|10.2|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 9.81 | 140.06 | 107.26 30000674|HC DRUG SCR - MULT CLASS|0300|80101|13.41|7.78|||||19.49|19.88|19.88|20.27|8.72|9.12|9.79|9.79|10.46|8.05|8.72|10.06|11.40|11.91|11.80|10.06|11.40| 8.05 | 20.27 | 10.46 30000675|HC VALPROIC ACID; FREE|0300|80165|159.86|92.72|||||||||103.91|108.70|116.70|116.70|124.69|95.92|103.91|119.90|135.88|141.96|140.68|119.90|135.88| 95.92 | 141.96 | 119.90 30000676|HC DRUG SCR-IA OR EA, LIST A|0300|80301|102.10|59.22|||||||||66.37|69.43|74.53|74.53|79.64|61.26|66.37|76.58|86.79|90.66|89.85|76.58|86.79| 61.26 | 90.66 | 76.58 30000677|HC DRUG SCR-PRSMPTV, LIST B|0300|80302|102.10|59.22|||||||||66.37|69.43|74.53|74.53|79.64|61.26|66.37|76.58|86.79|90.66|89.85|76.58|86.79| 61.26 | 90.66 | 76.58 30000678|HC DRUG SCR, PRSMPTV, NOS|0300|80304|319.07|185.06|||||||||207.40|216.97|232.92|232.92|248.87|191.44|207.40|239.30|271.21|283.33|280.78|239.30|271.21| 191.44 | 283.33 | 239.30 30000679|HC ALKALOIDS, NOS|0300|80323|191.45|111.04|28.36|26.94|||||||124.44|130.19|139.76|139.76|149.33|114.87|124.44|143.59|162.73|170.01|168.48|143.59|162.73| 26.94 | 170.01 | 139.76 30000680|HC AMPHETAMINES, 1-2|0300|80324|321.63|186.55|29.20|27.74|||||||209.06|218.71|234.79|234.79|250.87|192.98|209.06|241.22|273.39|285.61|283.03|241.22|273.39| 27.74 | 285.61 | 234.79 30000681|HC ANABOLIC STEROID; 1-2|0300|80327|197.82|114.74|69.97|66.47|||||||128.58|134.52|144.41|144.41|154.30|118.69|128.58|148.37|168.15|175.66|174.08|148.37|168.15| 66.47 | 175.66 | 144.41 30000682|HC ANTIDEPRESSANT TRICYCLIC; 1-2|0300|80335|95.72|55.52|49.12|46.66|||||||62.22|65.09|69.88|69.88|74.66|57.43|62.22|71.79|81.36|85.00|84.23|71.79|81.36| 46.66 | 85.00 | 69.88 30000683|HC TRICY & CYLICALS, 6 OR MORE|0300|80337|319.07|185.06|73.67|69.99|||||||207.40|216.97|232.92|232.92|248.87|191.44|207.40|239.30|271.21|283.33|280.78|239.30|271.21| 69.99 | 283.33 | 232.92 30000684|HC ANTIPSYCHOTICS, NOS 1-3|0300|80342|268.03|155.46|49.27|46.81|||||||174.22|182.26|195.66|195.66|209.06|160.82|174.22|201.02|227.83|238.01|235.87|201.02|227.83| 46.81 | 238.01 | 195.66 30000685|HC BARBITUATES|0300|80345|172.29|99.93|43.57|41.39|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 41.39 | 152.99 | 125.77 30000686|HC BENZODIAZEPINES 1-12|0300|80346|202.93|117.70|43.05|40.90|||||||131.90|137.99|148.14|148.14|158.29|121.76|131.90|152.20|172.49|180.20|178.58|152.20|172.49| 40.90 | 180.20 | 148.14 30000687|HC DEF DRUG; DEXAMETH, GOLD, CLONIDINE|0300|80375|260.46|151.07|44.75|42.51|||||||169.30|177.11|190.14|190.14|203.16|156.28|169.30|195.35|221.39|231.29|229.20|195.35|221.39| 42.51 | 231.29 | 190.14 30000688|HC CYP2C19 GENE COM VARIANTS|0300|81225|1,446.78|839.13|192.22|182.61|||||||940.41|983.81|1056.15|1056.15|1128.49|868.07|940.41|1085.09|1229.76|1284.74|1273.17|1085.09|1229.76| 182.61 | 1,284.74 | 1,056.15 30000689|HC GALACTOSE-1-PHOSPH URIDYLTRANS|0300|82775|224.14|130.00|41.94|39.84|||20.41|20.82|20.82|21.23|145.69|152.42|163.62|163.62|174.83|134.48|145.69|168.11|190.52|199.04|197.24|168.11|190.52| 20.41 | 199.04 | 152.42 30000690|HC ID, GEL QUAL, EA AB/AG|0300|86331|95.72|55.52|70.90|67.36|||17.86|18.22|18.22|18.57|62.22|65.09|69.88|69.88|74.66|57.43|62.22|71.79|81.36|85.00|84.23|71.79|81.36| 17.86 | 85.00 | 69.88 30000691|HC AB, ACTINOMYCES|0300|86602|127.63|74.03|15.59|14.81|||12.00|12.24|12.24|12.48|82.96|86.79|93.17|93.17|99.55|76.58|82.96|95.72|108.49|113.34|112.31|95.72|108.49| 12.00 | 113.34 | 86.79 30000692|HC AB; ASPERGILLUS|0300|86606|223.36|129.55|45.59|43.31|||9.81|10.01|10.01|10.20|145.18|151.88|163.05|163.05|174.22|134.02|145.18|167.52|189.86|198.34|196.56|167.52|189.86| 9.81 | 198.34 | 151.88 30000693|HC AB, FUNGUS NES|0300|86671|215.69|125.10|23.80|22.61|||7.97|8.13|8.13|8.29|140.20|146.67|157.45|157.45|168.24|129.41|140.20|161.77|183.34|191.53|189.81|161.77|183.34| 7.97 | 191.53 | 146.67 30000694|HC CULTURE-BRONCH WASH|0300|87070|314.62|182.48|25.07|23.82|||9.62|9.81|9.81|10.00|204.50|213.94|229.67|229.67|245.40|188.77|204.50|235.97|267.43|279.38|276.87|235.97|267.43| 9.62 | 279.38 | 213.94 30000695|HC SHIGA-LIKE TOXIN AG, EIA|0300|87427|140.40|81.43|43.13|40.97|||18.43|18.8|18.8|19.17|91.26|95.47|102.49|102.49|109.51|84.24|91.26|105.30|119.34|124.68|123.55|105.30|119.34| 18.43 | 124.68 | 95.47 30000697|HC IA-DNA/RNA PROBE 12-25 TARGETS|0300|87507|797.67|462.65|687.63|653.25|||||||518.49|542.42|582.30|582.30|622.18|478.60|518.49|598.25|678.02|708.33|701.95|598.25|678.02| 478.60 | 708.33 | 598.25 30000698|HC MYCOPLASMA PNEUMONIA, PCR|0300|87581|742.18|430.46|56.94|54.09|||13.08|13.34|13.34|13.61|482.42|504.68|541.79|541.79|578.90|445.31|482.42|556.64|630.85|659.06|653.12|556.64|630.85| 13.08 | 659.06 | 504.68 30000699|HC HPV, NA; HIGH RISK TYPES|0300|87624|114.87|66.62|47.92|45.52|||||||74.67|78.11|83.86|83.86|89.60|68.92|74.67|86.15|97.64|102.00|101.09|86.15|97.64| 45.52 | 102.00 | 83.86 30000700|HC HPV, NA; 16, 18|0300|87625|140.40|81.43|47.92|45.52|||||||91.26|95.47|102.49|102.49|109.51|84.24|91.26|105.30|119.34|124.68|123.55|105.30|119.34| 45.52 | 124.68 | 102.49 30000702|HC DS-ALCOHOLS; QT|0300|80320|242.50|140.65|47.67|45.29|||||||157.63|164.90|177.03|177.03|189.15|145.50|157.63|181.88|206.13|215.34|213.40|181.88|206.13| 45.29 | 215.34 | 177.03 30000703|HC ANALGESICS NON-OPIOID 1-2|0300|80329|248.88|144.35|45.50|43.23|||||||161.77|169.24|181.68|181.68|194.13|149.33|161.77|186.66|211.55|221.01|219.01|186.66|211.55| 43.23 | 221.01 | 181.68 30000704|HC ANTIDEPRESSANTS, NOS; 1-2|0300|80338|539.87|313.12|18.78|17.84|||||||350.92|367.11|394.11|394.11|421.10|323.92|350.92|404.90|458.89|479.40|475.09|404.90|458.89| 17.84 | 479.40 | 394.11 30000705|HC ANTIEPILEPTICS, NOS; 1-3|0300|80339|248.88|144.35|46.71|44.37|||||||161.77|169.24|181.68|181.68|194.13|149.33|161.77|186.66|211.55|221.01|219.01|186.66|211.55| 44.37 | 221.01 | 181.68 30000706|HC CANNABINOIDS, NATURAL|0300|80349|172.29|99.93|18.78|17.84|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 17.84 | 152.99 | 125.77 30000707|HC COCAINE|0300|80353|172.29|99.93|27.51|26.13|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 26.13 | 152.99 | 125.77 30000708|HC FENTANYL|0300|80354|172.29|99.93|18.78|17.84|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 17.84 | 152.99 | 125.77 30000709|HC METHADONE|0300|80358|172.29|99.93|44.06|41.86|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 41.86 | 152.99 | 125.77 30000710|HC OPIATES, 1 OR MORE|0300|80361|172.29|99.93|33.56|31.88|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 31.88 | 152.99 | 125.77 30000711|HC OPIOIDS & OPIATE ANALOGS; 1-2|0300|80362|172.29|99.93|43.97|41.77|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 41.77 | 152.99 | 125.77 30000712|HC OXYCODONE|0300|80365|172.29|99.93|18.78|17.84|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 17.84 | 152.99 | 125.77 30000713|HC PROPOXYPHENE|0300|80367|172.29|99.93|18.78|17.84|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 17.84 | 152.99 | 125.77 30000714|HC SKELETAL MUSCLE RELAXANT; 1-2|0300|80369|539.87|313.12|57.00|54.15|||||||350.92|367.11|394.11|394.11|421.10|323.92|350.92|404.90|458.89|479.40|475.09|404.90|458.89| 54.15 | 479.40 | 394.11 30000715|HC TRAMADOL|0300|80373|172.29|99.93|18.78|17.841|||||||111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 17.84 | 152.99 | 125.77 30000716|HC SKELETAL MUSCLE RELAXANT; 1-2|0300|80369|539.87|313.12|57.00|54.15|||||||350.92|367.11|394.11|394.11|421.10|323.92|350.92|404.90|458.89|479.40|475.09|404.90|458.89| 54.15 | 479.40 | 394.11 30000717|HC APOLIPOPROTEIN B|0300|82172|160.80|93.26|26.15|24.84|||||||104.52|109.34|117.38|117.38|125.42|96.48|104.52|120.60|136.68|142.79|141.50|120.60|136.68| 24.84 | 142.79 | 117.38 30000718|HC DS - ROHYPNOL|0300|80301|319.07|185.06|||||||||207.40|216.97|232.92|232.92|248.87|191.44|207.40|239.30|271.21|283.33|280.78|239.30|271.21| 191.44 | 283.33 | 239.30 30000719|HC ALCOHOL BIOMARKERS, 1-2|0300|80321|490.10|284.26|36.48|34.66|||||||318.57|333.27|357.77|357.77|382.28|294.06|318.57|367.58|416.59|435.21|431.29|367.58|416.59| 34.66 | 435.21 | 357.77 30000720|HC AMPHETAMINES 5 OR MORE|0300|80326|344.60|199.87|43.80|41.61|||||||223.99|234.33|251.56|251.56|268.79|206.76|223.99|258.45|292.91|306.00|303.25|258.45|292.91| 41.61 | 306.00 | 251.56 30000721|HC ANTIDEPRESSANTS CLASS 1 OR 2|0300|80332|363.74|210.97|97.26|92.40|||||||236.43|247.34|265.53|265.53|283.72|218.24|236.43|272.81|309.18|323.00|320.09|272.81|309.18| 92.40 | 323.00 | 265.53 30000722|HC BENZODIAZEPINES 13/MORE|0300|80347|191.45|111.04|53.82|51.13|||||||124.44|130.19|139.76|139.76|149.33|114.87|124.44|143.59|162.73|170.01|168.48|143.59|162.73| 51.13 | 170.01 | 139.76 30000723|HC DS BUPRENORPHINE|0300|80348|459.47|266.49|18.78|17.84|||||||298.66|312.44|335.41|335.41|358.39|275.68|298.66|344.60|390.55|408.01|404.33|344.60|390.55| 17.84 | 408.01 | 335.41 30000724|HC OPIOIDS & OP ANALOGS; 5/MORE|0300|80364|409.69|237.62|65.93|62.63|||||||266.30|278.59|299.07|299.07|319.56|245.81|266.30|307.27|348.24|363.80|360.53|307.27|348.24| 62.63 | 363.80 | 299.07 30000725|HC HLA 1 TYPING COMPLETE LOW RES|0300|81372|717.76|416.30|886.77|842.43|||||||466.54|488.08|523.96|523.96|559.85|430.66|466.54|538.32|610.10|637.37|631.63|538.32|610.10| 430.66 | 886.77 | 538.32 30000728|HC PHENCYCLIDINE, QT|0300|83992|172.29|99.93|44.15|41.94|||25.12|25.62|25.62|26.12|111.99|117.16|125.77|125.77|134.39|103.37|111.99|129.22|146.45|152.99|151.62|129.22|146.45| 25.12 | 152.99 | 117.16 30000729|HC MOPATH LEV 6 - ABCD1 GENE|0300|81405|3,190.70|1,850.61|505.75|480.46|||||||2073.96|2169.68|2329.21|2329.21|2488.75|1914.42|2073.96|2393.03|2712.10|2833.34|2807.82|2393.03|2712.10| 480.46 | 2,833.34 | 2,329.21 30000730|HC CREATINE-URINE-REF-LAB|0300|82540|201.25|116.73|21.67|20.59|||8.31|8.47|8.47|8.64|130.81|136.85|146.91|146.91|156.98|120.75|130.81|150.94|171.06|178.71|177.10|150.94|171.06| 8.31 | 178.71 | 136.85 30000731|HC VITAMIN B2, WHOLE BLOOD|0300|84252|278.05|161.27|83.28|79.12|||36.59|37.33|37.33|38.06|180.73|189.07|202.98|202.98|216.88|166.83|180.73|208.54|236.34|246.91|244.68|208.54|236.34| 36.59 | 246.91 | 189.07 30000733|HC UNLISTED MO PATH|0300|81479|957.21|555.18|61.02|57.969|||||||622.19|650.90|698.76|698.76|746.62|574.33|622.19|717.91|813.63|850.00|842.34|717.91|813.63| 57.97 | 850.00 | 698.76 30000734|HC CAPILLARY BLOOD DRAW|0300|36416|13.08|7.59|3.48|3.306|||||||8.50|8.89|9.55|9.55|10.20|7.85|8.50|9.81|11.12|11.62|11.51|9.81|11.12| 3.31 | 11.62 | 9.55 30000735|HC AMNISURE TEST|0300|84112|189.89|110.14|166.11|157.80|||100.79|102.81|102.81|104.82|123.43|129.13|138.62|138.62|148.11|113.93|123.43|142.42|161.41|168.62|167.10|142.42|161.41| 100.79 | 168.62 | 138.62 30000736|HC FLT3 GENE ANALYSIS|0300|81246|765.78|444.15|||||||||497.76|520.73|559.02|559.02|597.31|459.47|497.76|574.34|650.91|680.01|673.89|574.34|650.91| 459.47 | 680.01 | 574.34 30000737|HC NPM1 GENE|0300|81310|957.21|555.18|||||||||622.19|650.90|698.76|698.76|746.62|574.33|622.19|717.91|813.63|850.00|842.34|717.91|813.63| 574.33 | 850.00 | 717.91 30000738|HC COAG TIME; ACTIVATED-POCT|0300|85347|123.53|71.65|14.67|13.94|||4.12|4.2|4.2|4.29|80.29|84.00|90.18|90.18|96.35|74.12|80.29|92.65|105.00|109.69|108.71|92.65|105.00| 4.12 | 109.69 | 84.00 30000739|HC PROTHROMBIN TIME, SUBSTITUTION|0300|85611|184.89|107.24|12.49|11.87|||6.87|7.01|7.01|7.14|120.18|125.73|134.97|134.97|144.21|110.93|120.18|138.67|157.16|164.18|162.70|138.67|157.16| 6.87 | 164.18 | 125.73 30000743|HC MSH2 GENE KNOWN VARIANTS|0300|81296|1,046.55|607.00|||||||||680.26|711.65|763.98|763.98|816.31|627.93|680.26|784.91|889.57|929.34|920.96|784.91|889.57| 627.93 | 929.34 | 784.91 30000744|HC MOPATH LEV 7|0300|81406|4,320.47|2,505.87|132.70|126.07|||||||2808.31|2937.92|3153.94|3153.94|3369.97|2592.28|2808.31|3240.35|3672.40|3836.58|3802.01|3240.35|3672.40| 126.07 | 3,836.58 | 3,153.94 30000745|HC GENERAL HEALTH PANEL|0300|80050|338.22|196.17|57.17|54.31|||||||219.84|229.99|246.90|246.90|263.81|202.93|219.84|253.67|287.49|300.34|297.63|253.67|287.49| 54.31 | 300.34 | 246.90 30000746|HC POCT-GASES|0300|82803|338.22|196.17|53.52|50.84|||27.79|28.34|28.34|28.90|219.84|229.99|246.90|246.90|263.81|202.93|219.84|253.67|287.49|300.34|297.63|253.67|287.49| 27.79 | 300.34 | 229.99 30000747|HC IONIZED CALCIUM-BLOOD|0300|82330|127.63|74.03|36.54|34.71|||8.24|8.41|8.41|8.57|82.96|86.79|93.17|93.17|99.55|76.58|82.96|95.72|108.49|113.34|112.31|95.72|108.49| 8.24 | 113.34 | 86.79 30000748|HC GLUCOSE BLOOD|0300|82947|57.42|33.30|6.79|6.45|||6.03|6.15|6.15|6.27|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 6.03 | 50.99 | 39.05 30000749|HC POCT-POTASSIUM|0300|84132|57.42|33.30|7.76|7.37|||5.49|5.6|5.6|5.71|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 5.49 | 50.99 | 39.05 30000750|HC SODIUM-BLOOD|0300|84295|57.42|33.30|8.12|7.71|||5.49|5.6|5.6|5.71|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 5.49 | 50.99 | 39.05 30000751|HC HEMATOCRIT-ONLY|0300|85014|57.42|33.30|7.01|6.66|||1.71|1.75|1.75|1.78|37.32|39.05|41.92|41.92|44.79|34.45|37.32|43.07|48.81|50.99|50.53|43.07|48.81| 1.71 | 50.99 | 39.05 30000753|HC RAST, MULTIALLERGEN SCREEN|0300|86005|189.76|110.06|39.01|37.06|||||||123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 37.06 | 168.51 | 138.52 30000753|HC RAST, MULTIALLERGEN SCREEN|0300|86005|189.76|110.06|39.01|37.06|||||||123.34|129.04|138.52|138.52|148.01|113.86|123.34|142.32|161.30|168.51|166.99|142.32|161.30| 37.06 | 168.51 | 138.52 30000754|HC HALDOL SERUM|0300|80173|196.42|113.92|57.40|54.53|||22.37|22.82|22.82|23.27|127.67|133.57|143.39|143.39|153.21|117.85|127.67|147.32|166.96|174.42|172.85|147.32|166.96| 22.37 | 174.42 | 133.57 30000755|HC CYSTIC FIBROSIS SCREEN|0300|81220|1,389.15|805.71|1,621.00|1,539.95|||||||902.95|944.62|1014.08|1014.08|1083.54|833.49|902.95|1041.86|1180.78|1233.57|1222.45|1041.86|1180.78| 833.49 | 1,621.00 | 1,041.86 30000759|HC CHROMIUM|0300|82495|191.77|111.23|31.65|30.0675|||10.07|10.28|10.28|10.48|124.65|130.40|139.99|139.99|149.58|115.06|124.65|143.83|163.00|170.29|168.76|143.83|163.00| 10.07 | 170.29 | 130.40 30000765|HC ESTRONE, SERUM|0300|82679|235.00|136.30|48.83|46.39|||27.47|28.02|28.02|28.57|152.75|159.80|171.55|171.55|183.30|141.00|152.75|176.25|199.75|208.68|206.80|176.25|199.75| 27.47 | 208.68 | 159.80 30000767|HC FRUCTOSAMINE|0300|82985|116.85|67.77|32.65|31.02|||18.84|19.22|19.22|19.59|75.95|79.46|85.30|85.30|91.14|70.11|75.95|87.64|99.32|103.76|102.83|87.64|99.32| 18.84 | 103.76 | 79.46 30000773|HC FECAL LACTOFERRIN|0300|83630|109.40|63.45|||||17.92|18.28|18.28|18.64|71.11|74.39|79.86|79.86|85.33|65.64|71.11|82.05|92.99|97.15|96.27|82.05|92.99| 17.92 | 97.15 | 79.86 30000776|HC PROTOPORPHYRIN, WORKPLACE|0300|84202|138.92|80.57|29.17|27.71|||13.74|14.01|14.01|14.29|90.30|94.47|101.41|101.41|108.36|83.35|90.30|104.19|118.08|123.36|122.25|104.19|118.08| 13.74 | 123.36 | 94.47 30000777|HC PROTOPORPHYRIN, ZINC/FREE RBC|0300|84202|115.76|67.14|29.17|27.71|||13.74|14.01|14.01|14.29|75.24|78.72|84.50|84.50|90.29|69.46|75.24|86.82|98.40|102.79|101.87|86.82|98.40| 13.74 | 102.79 | 78.72 30000783|HC ANA BODY FLUID|0300|86038|277.83|161.14|34.84|33.10|||21.85|22.29|22.29|22.72|180.59|188.92|202.82|202.82|216.71|166.70|180.59|208.37|236.16|246.71|244.49|208.37|236.16| 21.85 | 246.71 | 188.92 30000785|HC THYROID PEROXIDASE ANTIBODY|0300|86376|243.11|141.00|40.08|38.08|||26.17|26.69|26.69|27.21|158.02|165.31|177.47|177.47|189.63|145.87|158.02|182.33|206.64|215.88|213.94|182.33|206.64| 26.17 | 215.88 | 165.31 30000786|HC LYME AB; BODY FLUID/CSF|0300|86618|160.39|93.03|60.30|57.29|||9.81|10.01|10.01|10.20|104.25|109.07|117.08|117.08|125.10|96.23|104.25|120.29|136.33|142.43|141.14|120.29|136.33| 9.81 | 142.43 | 109.07 30000802|HC HEMOGLOBIN, UNSTABLE, BLOOD|0300|83068|130.61|75.75|31.56|29.98|||14.91|15.21|15.21|15.51|84.90|88.81|95.35|95.35|101.88|78.37|84.90|97.96|111.02|115.98|114.94|97.96|111.02| 14.91 | 115.98 | 88.81 30000803|HC ELECTROPHORESIS NES|0300|82664|402.48|233.44|61.90|58.81|||||||261.61|273.69|293.81|293.81|313.93|241.49|261.61|301.86|342.11|357.40|354.18|301.86|342.11| 58.81 | 357.40 | 293.81 30000804|HC CPK: ISOENZYMES|0300|82552|256.65|148.86|38.37|36.45|||23.55|24.02|24.02|24.49|166.82|174.52|187.35|187.35|200.19|153.99|166.82|192.49|218.15|227.91|225.85|192.49|218.15| 23.55 | 227.91 | 174.52 30000813|HC ADENOVIRUS ANTIBODIES, QUANT|0300|86603|114.03|66.14|10.61|10.0795|||7.97|8.13|8.13|8.29|74.12|77.54|83.24|83.24|88.94|68.42|74.12|85.52|96.93|101.26|100.35|85.52|96.93| 7.97 | 101.26 | 77.54 30000815|HC HEMOGLOBIN-OXYGEN AFFINITY|0300|82820|303.88|176.25|107.47|102.10|||10.99|11.21|11.21|11.43|197.52|206.64|221.83|221.83|237.03|182.33|197.52|227.91|258.30|269.85|267.41|227.91|258.30| 10.99 | 269.85 | 206.64 30000820|HC IGG SPECIFIC ALLERGEN TESTING|0300|86001|150.06|87.03|10.24|9.728|||8.03|8.19|8.19|8.35|97.54|102.04|109.54|109.54|117.05|90.04|97.54|112.55|127.55|133.25|132.05|112.55|127.55| 8.03 | 133.25 | 102.04 30000821|HC NATURAL KILLER CELLS|0300|86357|353.52|205.04|||||58.61|59.78|59.78|60.96|229.79|240.39|258.07|258.07|275.75|212.11|229.79|265.14|300.49|313.93|311.10|265.14|300.49| 58.61 | 313.93 | 258.07 30000822|HC DRUG TEST; DEFINITIVE, 1-7|0300|G0480|115.48|66.98|57.73|54.84|||||||75.06|78.53|84.30|84.30|90.07|69.29|75.06|86.61|98.16|102.55|101.62|86.61|98.16| 54.84 | 102.55 | 84.30 30000823|HC DRUG TEST, PRESUMPTIVE|0300|G0479|102.10|59.22|||||||||66.37|69.43|74.53|74.53|79.64|61.26|66.37|76.58|86.79|90.66|89.85|76.58|86.79| 61.26 | 90.66 | 76.58 30000827|HC CHLAMYDIA ANTIBODY-IGM|0300|86632|163.56|94.86|50.93|48.3835|||9.81|10.01|10.01|10.2|106.31|111.22|119.40|119.40|127.58|98.14|106.31|122.67|139.03|145.24|143.93|122.67|139.03| 9.81 | 145.24 | 111.22 30000828|HC CHLAMYDIA ANTIBODY|0300|86631|163.56|94.86|53.89|51.20|||9.81|10.01|10.01|10.20|106.31|111.22|119.40|119.40|127.58|98.14|106.31|122.67|139.03|145.24|143.93|122.67|139.03| 9.81 | 145.24 | 111.22 30000829|HC METHYLPHENIDATE|0300|80360|364.65|211.50|18.78|17.84|||||||237.02|247.96|266.19|266.19|284.43|218.79|237.02|273.49|309.95|323.81|320.89|273.49|309.95| 17.84 | 323.81 | 266.19 30000830|HC FLT3 GENE|0300|81245|676.44|392.34|||||||||439.69|459.98|493.80|493.80|527.62|405.86|439.69|507.33|574.97|600.68|595.27|507.33|574.97| 405.86 | 600.68 | 507.33 30000831|HC IA BY NA AMP PROBE; NOS, EA|0300|87798|46.80|27.14|236.03|224.23|||53.94|55.02|55.02|56.10|30.42|31.82|34.16|34.16|36.50|28.08|30.42|35.10|39.78|41.56|41.18|35.10|39.78| 28.08 | 236.03 | 39.78 30000832|HC IA BY NA; STREP B AMP PROBE|0300|86753|46.80|27.14|26.45|25.13|||9.81|10.01|10.01|10.2|30.42|31.82|34.16|34.16|36.50|28.08|30.42|35.10|39.78|41.56|41.18|35.10|39.78| 9.81 | 41.56 | 31.82 30000833|HC BY NA; MULT ORG AMP PROBE|0300|87801|46.80|27.14|118.45|112.53|||53.94|55.02|55.02|56.10|30.42|31.82|34.16|34.16|36.50|28.08|30.42|35.10|39.78|41.56|41.18|35.10|39.78| 28.08 | 118.45 | 39.78 30000834|HC IA BY NA; CYTOMEGALO, AMP PRO|0300|87496|46.80|27.14|59.23|56.27|||13.08|13.34|13.34|13.61|30.42|31.82|34.16|34.16|36.50|28.08|30.42|35.10|39.78|41.56|41.18|35.10|39.78| 13.08 | 59.23 | 34.16 30000835|HC IA BY NA; ENTERO PRO/REV TRNS|0300|87498|46.80|27.14|57.90|55.01|||||||30.42|31.82|34.16|34.16|36.50|28.08|30.42|35.10|39.78|41.56|41.18|35.10|39.78| 28.08 | 57.90 | 35.10 30000836|HC IA BY NA; HERPES AMP PROBE|0300|87529|46.80|27.14|59.23|56.27|||13.08|13.34|13.34|13.61|30.42|31.82|34.16|34.16|36.50|28.08|30.42|35.10|39.78|41.56|41.18|35.10|39.78| 13.08 | 59.23 | 34.16 30000837|HC IA BY NA; HERPES 6 AMP PROBE|0300|87532|46.80|27.14|34.17|32.46|||13.08|13.34|13.34|13.61|30.42|31.82|34.16|34.16|36.50|28.08|30.42|35.10|39.78|41.56|41.18|35.10|39.78| 13.08 | 41.56 | 34.16 30000838|HC BLD COLL FROM VENOUS DEV|0300|36591|131.59|76.32|11.40|10.83|111.95|111.95|||||85.53|89.48|96.06|96.06|102.64|78.95|85.53|98.69|111.85|116.85|115.80|98.69|111.85| 10.83 | 116.85 | 98.69 30000839|HC ETHYLENEDIOXYAMPHETAMINES|0300|80359|115.48|66.98|18.78|17.84|||||||75.06|78.53|84.30|84.30|90.07|69.29|75.06|86.61|98.16|102.55|101.62|86.61|98.16| 17.84 | 102.55 | 84.30 30000840|HC CYP2D6|0300|81226|1,154.74|669.75|676.14|642.33|||||||750.58|785.22|842.96|842.96|900.70|692.84|750.58|866.06|981.53|1025.41|1016.17|866.06|981.53| 642.33 | 1,025.41 | 842.96 30000841|HC IGH VARIABLE REGIONAL MUTATION|0300|81263|1,276.29|740.25|450.8|428.26|||||||829.59|867.88|931.69|931.69|995.51|765.77|829.59|957.22|1084.85|1133.35|1123.14|957.22|1084.85| 428.26 | 1,133.35 | 931.69 30000842|HC TRG GENE REARRANGEMENT ANLYS|0300|81342|1,261.70|731.79|171.22|162.66|||||||820.11|857.96|921.04|921.04|984.13|757.02|820.11|946.28|1072.45|1120.39|1110.30|946.28|1072.45| 162.66 | 1,120.39 | 921.04 30000843|HC HLA II TYPING 1 ALLELE HR, EA|0300|81383|911.63|528.75|188.85|179.41|||||||592.56|619.91|665.49|665.49|711.07|546.98|592.56|683.72|774.89|809.53|802.23|683.72|774.89| 179.41 | 809.53 | 665.49 30000844|HC TARGETED GENOMIC SEQ ANALYSIS|0300|81450|5,088.11|2,951.10|||||||||3307.27|3459.91|3714.32|3714.32|3968.73|3052.87|3307.27|3816.08|4324.89|4518.24|4477.54|3816.08|4324.89| 3,052.87 | 4,518.24 | 3,816.08 30000845|HC CYSTATIN C|0300|82610|127.63|74.03|9.99|9.49|||||||82.96|86.79|93.17|93.17|99.55|76.58|82.96|95.72|108.49|113.34|112.31|95.72|108.49| 9.49 | 113.34 | 93.17 30000846|HC FETAL LUNG MATURITY, QUANT|0300|83661|182.33|105.75|81.59|77.51|||39.75|40.54|40.54|41.34|118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 39.75 | 161.91 | 123.98 30000847|HC LUTEINIZING RELEASING FACTOR|0300|83727|585.88|339.81|52.73|50.0935|||30.88|31.49|31.49|32.11|380.82|398.40|427.69|427.69|456.99|351.53|380.82|439.41|498.00|520.26|515.57|439.41|498.00| 30.88 | 520.26 | 398.40 30000848|HC PHOSPHATIDYLGLYCEROL|0300|84081|181.10|105.04|28.09|26.6855|||10.99|11.21|11.21|11.43|117.72|123.15|132.20|132.20|141.26|108.66|117.72|135.83|153.94|160.82|159.37|135.83|153.94| 10.99 | 160.82 | 123.15 30000849|HC SUGARS; MULTI QUAL, EA SPEC|0300|84377|103.32|59.93|80.24|76.23|||35.44|36.15|36.15|36.86|67.16|70.26|75.42|75.42|80.59|61.99|67.16|77.49|87.82|91.75|90.92|77.49|87.82| 35.44 | 91.75 | 75.42 30000850|HC THYROGLOB, FL; UNLISTED CHEM|0300|84999|279.57|162.15|||||||||181.72|190.11|204.09|204.09|218.06|167.74|181.72|209.68|237.63|248.26|246.02|209.68|237.63| 167.74 | 248.26 | 209.68 30000851|HC TB AG RESPONSE T-CELL SUSP|0300|86481|182.33|105.75|||||97.00|98.94|98.94|100.88|118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 97.00 | 161.91 | 133.10 30000852|HC ENCEPHALITIS AB; ST LOUIS|0300|86653|267.41|155.10|44.80|42.56|||9.81|10.01|10.01|10.20|173.82|181.84|195.21|195.21|208.58|160.45|173.82|200.56|227.30|237.46|235.32|200.56|227.30| 9.81 | 237.46 | 181.84 30000853|HC ENCEPHALITIS AB; WEST EQUINE|0300|86654|267.41|155.10|44.80|42.56|||9.81|10.01|10.01|10.2|173.82|181.84|195.21|195.21|208.58|160.45|173.82|200.56|227.30|237.46|235.32|200.56|227.30| 9.81 | 237.46 | 181.84 30000854|HC LEISHMANIA AB|0300|86717|158.03|91.66|26.41|25.09|||9.81|10.01|10.01|10.2|102.72|107.46|115.36|115.36|123.26|94.82|102.72|118.52|134.33|140.33|139.07|118.52|134.33| 9.81 | 140.33 | 107.46 30000855|HC SENSITIVITY-MYCOBACT, EA AGNT|0300|87190|196.92|114.21|31.53|29.95|||7.85|8.01|8.01|8.16|128.00|133.91|143.75|143.75|153.60|118.15|128.00|147.69|167.38|174.86|173.29|147.69|167.38| 7.85 | 174.86 | 133.91 30000856|HC INFLUENZA AMP MULT 1ST 2 TYPES|0300|87502|546.99|317.25|87.89|83.4955|||||||355.54|371.95|399.30|399.30|426.65|328.19|355.54|410.24|464.94|485.73|481.35|410.24|464.94| 83.50 | 485.73 | 399.30 30000857|HC PHENOTYPE INFECT AGNT DRUG|0300|87900|833.85|483.63|328.60|312.17|||||||542.00|567.02|608.71|608.71|650.40|500.31|542.00|625.39|708.77|740.46|733.79|625.39|708.77| 312.17 | 740.46 | 608.71 30000858|HC HEPATITIS C - DNA OR RNA|0300|87902|1,227.67|712.05|973.77|925.0815|||||||797.99|834.82|896.20|896.20|957.58|736.60|797.99|920.75|1043.52|1090.17|1080.35|920.75|1043.52| 736.60 | 1,090.17 | 920.75 30000859|HC HIV1 PHENOTYPE DNA 1-10 DRUGS|0300|87903|1,762.49|1,022.24|||||||||1145.62|1198.49|1286.62|1286.62|1374.74|1057.49|1145.62|1321.87|1498.12|1565.09|1550.99|1321.87|1498.12| 1,057.49 | 1,565.09 | 1,321.87 30000860|HC PROTEIN WB; IM ID FOR BANDS|0300|84182|350.36|203.21|68.04|64.64|||||||227.73|238.24|255.76|255.76|273.28|210.22|227.73|262.77|297.81|311.12|308.32|262.77|297.81| 64.64 | 311.12 | 255.76 30000861|HC CEBPA GENE FULL SEQUENCE|0300|81218|739.03|428.64|||||||||480.37|502.54|539.49|539.49|576.44|443.42|480.37|554.27|628.18|656.26|650.35|554.27|628.18| 443.42 | 656.26 | 554.27 30000862|HC CALR GENE COMMON VARIANTS|0300|81219|1,203.35|697.94|171.57|162.99|||||||782.18|818.28|878.45|878.45|938.61|722.01|782.18|902.51|1022.85|1068.57|1058.95|902.51|1022.85| 162.99 | 1,068.57 | 878.45 30000863|HC MOPATH LEVEL 2|0300|81401|1,205.78|699.35|194.37|184.65|||||||783.76|819.93|880.22|880.22|940.51|723.47|783.76|904.34|1024.91|1070.73|1061.09|904.34|1024.91| 184.65 | 1,070.73 | 880.22 30000864|HC MOPATH LEVEL 3|0300|81402|1,312.75|761.40|236.04|224.24|||||||853.29|892.67|958.31|958.31|1023.95|787.65|853.29|984.56|1115.84|1165.72|1155.22|984.56|1115.84| 224.24 | 1,165.72 | 958.31 30000865|HC MOPATH LEVEL 5|0300|81404|1,227.67|712.05|442.64|420.51|||||||797.99|834.82|896.20|896.20|957.58|736.60|797.99|920.75|1043.52|1090.17|1080.35|920.75|1043.52| 420.51 | 1,090.17 | 896.20 30000866|HC ENZYME CELL ACTIVITY, EACH|0300|82657|565.20|327.82|41.75|39.66|||38.84|39.62|39.62|40.40|367.38|384.34|412.60|412.60|440.86|339.12|367.38|423.90|480.42|501.90|497.38|423.90|480.42| 38.84 | 501.90 | 384.34 30000867|HC HEAVY METAL; QUANT|0300|83018|221.22|128.31|31.42|29.85|||25.12|25.62|25.62|26.12|143.79|150.43|161.49|161.49|172.55|132.73|143.79|165.92|188.04|196.44|194.67|165.92|188.04| 25.12 | 196.44 | 150.43 30000868|HC RIA NONANTIBODY - MUSK|0300|83519|985.78|571.75|28.69|27.2555|||15.83|16.15|16.15|16.46|640.76|670.33|719.62|719.62|768.91|591.47|640.76|739.34|837.91|875.37|867.49|739.34|837.91| 15.83 | 875.37 | 670.33 30000869|HC T4|0300|84436|200.56|116.32|14.12|13.41|||10.31|10.52|10.52|10.72|130.36|136.38|146.41|146.41|156.44|120.34|130.36|150.42|170.48|178.10|176.49|150.42|170.48| 10.31 | 178.10 | 136.38 30000870|HC HLA CLASS O JOGJ DEF QL|0300|86832|1,081.80|627.44|259.79|246.80|||||||703.17|735.62|789.71|789.71|843.80|649.08|703.17|811.35|919.53|960.64|951.98|811.35|919.53| 246.80 | 960.64 | 789.71 30000871|HC GENOTYPE DNA HIV OTHER REGION|0300|87906|607.75|352.50|||||||||395.04|413.27|443.66|443.66|474.05|364.65|395.04|455.81|516.59|539.68|534.82|455.81|516.59| 364.65 | 539.68 | 455.81 30000872|HC IMMUNOASSAY; QUANT, NONAB-NOS|0300|83520|358.58|207.98|28.69|27.2555|||||||233.08|243.83|261.76|261.76|279.69|215.15|233.08|268.94|304.79|318.42|315.55|268.94|304.79| 27.26 | 318.42 | 261.76 30000873|HC QUANT ASSAY; THER DRUG-INFLIXIMAB|0300|80299|358.58|207.98|51.65|49.0675|||26.17|26.69|26.69|27.21|233.08|243.83|261.76|261.76|279.69|215.15|233.08|268.94|304.79|318.42|315.55|268.94|304.79| 26.17 | 318.42 | 243.83 30000874|HC ANTIDEPRESSANT; 1-2 TRICYCLIC|0300|80335|267.41|155.10|49.12|46.664|||||||173.82|181.84|195.21|195.21|208.58|160.45|173.82|200.56|227.30|237.46|235.32|200.56|227.30| 46.66 | 237.46 | 195.21 30000875|HC GT PANEL, FOR PHEOCHROMOCYTOMA|0300|80424|237.03|137.48|||||||||154.07|161.18|173.03|173.03|184.88|142.22|154.07|177.77|201.48|210.48|208.59|177.77|201.48| 142.22 | 210.48 | 177.77 30000876|HC BRAF GENE|0300|81210|2,060.29|1,194.97|||||||||1339.19|1401.00|1504.01|1504.01|1607.03|1236.17|1339.19|1545.22|1751.25|1829.54|1813.06|1545.22|1751.25| 1,236.17 | 1,829.54 | 1,545.22 30000877|HC IGH GENE REARRANGE; AMP METHOD|0300|81261|1,464.44|849.38|||||||||951.89|995.82|1069.04|1069.04|1142.26|878.66|951.89|1098.33|1244.77|1300.42|1288.71|1098.33|1244.77| 878.66 | 1,300.42 | 1,098.33 30000878|HC IGK REARRANGE-CLONAL POP|0300|81264|1,464.44|849.38|||||||||951.89|995.82|1069.04|1069.04|1142.26|878.66|951.89|1098.33|1244.77|1300.42|1288.71|1098.33|1244.77| 878.66 | 1,300.42 | 1,098.33 30000879|HC MGMT GENE METHLYLATION ANALYS|0300|81287|966.33|560.47|||||||||628.11|657.10|705.42|705.42|753.74|579.80|628.11|724.75|821.38|858.10|850.37|724.75|821.38| 579.80 | 858.10 | 724.75 30000880|HC MLH1 GENE|0300|81288|1,227.67|712.05|||||||||797.99|834.82|896.20|896.20|957.58|736.60|797.99|920.75|1043.52|1090.17|1080.35|920.75|1043.52| 736.60 | 1,090.17 | 920.75 30000881|HC HLA I TYPING 1 LOCUS LOW RES|0300|81373|556.50|322.77|300.91|285.8645|||||||361.73|378.42|406.25|406.25|434.07|333.90|361.73|417.38|473.03|494.17|489.72|417.38|473.03| 285.86 | 494.17 | 406.25 30000882|HC HLA II TYPING 1 LOCUS LOW RES DQB|0300|81376|388.96|225.60|176.40|167.58|||||||252.82|264.49|283.94|283.94|303.39|233.38|252.82|291.72|330.62|345.40|342.28|291.72|330.62| 167.58 | 345.40 | 283.94 30000883|HC HLA I TYPING; 1 ALLELE HIGH RES|0300|81381|814.39|472.35|272.44|258.82|||||||529.35|553.79|594.50|594.50|635.22|488.63|529.35|610.79|692.23|723.18|716.66|610.79|692.23| 258.82 | 723.18 | 594.50 30000884|HC MO PATH LEVEL 8|0300|81407|3,063.08|1,776.59|||||||||1991.00|2082.89|2236.05|2236.05|2389.20|1837.85|1991.00|2297.31|2603.62|2720.02|2695.51|2297.31|2603.62| 1,837.85 | 2,720.02 | 2,297.31 30000885|HC COLLAGEN CROSS LINKS|0300|82523|554.27|321.48|42.62|40.49|||||||360.28|376.90|404.62|404.62|432.33|332.56|360.28|415.70|471.13|492.19|487.76|415.70|471.13| 40.49 | 492.19 | 404.62 30000886|HC COL CHROMOTOG - FATTY ACIDS|0300|82542|291.72|169.20|248.42|236.00|||11.45|11.68|11.68|11.91|189.62|198.37|212.96|212.96|227.54|175.03|189.62|218.79|247.96|259.05|256.71|218.79|247.96| 11.45 | 259.05 | 212.96 30000887|HC COL CHROMOTOG - 6MMP/6TG|0300|82542|480.12|278.47|248.42|236.00|||11.45|11.68|11.68|11.91|312.08|326.48|350.49|350.49|374.49|288.07|312.08|360.09|408.10|426.35|422.51|360.09|408.10| 11.45 | 426.35 | 326.48 30000888|HC LIPOPROTEIN BLD BY NMR|0300|83704|334.27|193.88|27.77|26.38|||41.20|42.02|42.02|42.85|217.28|227.30|244.02|244.02|260.73|200.56|217.28|250.70|284.13|296.83|294.16|250.70|284.13| 26.38 | 296.83 | 227.30 30000889|HC ANTITHROMBIN III AG ASSAY|0300|85301|273.48|158.62|22.20|21.09|||19.56|19.95|19.95|20.34|177.76|185.97|199.64|199.64|213.31|164.09|177.76|205.11|232.46|242.85|240.66|205.11|232.46| 19.56 | 242.85 | 185.97 30000890|HC ANTIBODY; NES (CHIKUNGUNYA)|0300|86790|273.48|158.62|26.45|25.13|||9.81|10.01|10.01|10.20|177.76|185.97|199.64|199.64|213.31|164.09|177.76|205.11|232.46|242.85|240.66|205.11|232.46| 9.81 | 242.85 | 185.97 30000891|HC CYTP, URIN; 3-5 PROBES, MANUAL|0300|88120|1,021.03|592.20|820.33|779.31|149.16|149.16|38.14|38.9|38.9|39.66|663.67|694.30|745.35|745.35|796.40|612.62|663.67|765.77|867.88|906.67|898.51|765.77|867.88| 38.14 | 906.67 | 745.35 30000892|HC CHEMILUMIN - INFLIXIMAB|0300|82397|395.04|229.12|32.17|30.56|||17.86|18.22|18.22|18.57|256.78|268.63|288.38|288.38|308.13|237.02|256.78|296.28|335.78|350.80|347.64|296.28|335.78| 17.86 | 350.80 | 268.63 30000893|HC AB ID; PLATELET IG ASSAY|0300|86023|353.28|204.90|79.52|75.54|||9.83|10.02|10.02|10.22|229.63|240.23|257.89|257.89|275.56|211.97|229.63|264.96|300.29|313.71|310.89|264.96|300.29| 9.83 | 313.71 | 240.23 30000894|HC HIV-1 AG W/ HIV-1 & 2 AB|0300|87389|75.37|43.71|47.20|44.84|||||||48.99|51.25|55.02|55.02|58.79|45.22|48.99|56.53|64.06|66.93|66.33|56.53|64.06| 44.84 | 66.93 | 55.02 30000896|HC AB; HIV-1|0300|86701|198.14|114.92|52.13|49.52|||6.54|6.67|6.67|6.80|128.79|134.74|144.64|144.64|154.55|118.88|128.79|148.61|168.42|175.95|174.36|148.61|168.42| 6.54 | 175.95 | 134.74 30000897|HC AB; HIV-2|0300|86702|218.79|126.90|48.00|45.60|||6.54|6.67|6.67|6.8|142.21|148.78|159.72|159.72|170.66|131.27|142.21|164.09|185.97|194.29|192.54|164.09|185.97| 6.54 | 194.29 | 148.78 30000898|HC CADMIUM|0300|82300|106.96|62.04|50.41|47.89|||10.07|10.28|10.28|10.48|69.52|72.73|78.08|78.08|83.43|64.18|69.52|80.22|90.92|94.98|94.12|80.22|90.92| 10.07 | 94.98 | 72.73 30000899|HC FATTY ACIDS, NONESTERIFIED|0300|82725|88.20|51.16|25.04|23.79|||12.56|12.81|12.81|13.06|57.33|59.98|64.39|64.39|68.80|52.92|57.33|66.15|74.97|78.32|77.62|66.15|74.97| 12.56 | 78.32 | 59.98 30000900|HC OBSTETRIC PANEL W/HIV|0300|80081|860.58|499.14|104.55|99.32|||||||559.38|585.19|628.22|628.22|671.25|516.35|559.38|645.44|731.49|764.20|757.31|645.44|731.49| 99.32 | 764.20 | 628.22 30000901|HC DRUG TEST PRSMV CHEM ANLYZR|0300|80307|133.71|77.55|118.00|112.10|||||||86.91|90.92|97.61|97.61|104.29|80.23|86.91|100.28|113.65|118.73|117.66|100.28|113.65| 80.23 | 118.73 | 100.28 30000902|HC DRUG TEST PRSMV DIR OPT OBS|0300|80305|121.55|70.50|22.12|21.014|||||||79.01|82.65|88.73|88.73|94.81|72.93|79.01|91.16|103.32|107.94|106.96|91.16|103.32| 21.01 | 107.94 | 88.73 30000903|HC CNS DNA AMP PROBE TYPE 12-25|0300|87483|797.67|462.65|687.63|653.25|||||||518.49|542.42|582.30|582.30|622.18|478.60|518.49|598.25|678.02|708.33|701.95|598.25|678.02| 478.60 | 708.33 | 598.25 30000904|HC TESTOSTERONE; BIOAVAILABLE|0300|84410|206.64|119.85|85.42|81.15|||||||134.32|140.52|150.85|150.85|161.18|123.98|134.32|154.98|175.64|183.50|181.84|154.98|175.64| 81.15 | 183.50 | 150.85 30000906|HC HLA II TYPING AG EQUIV LR|0300|81375|881.24|511.12|||||||||572.81|599.24|643.31|643.31|687.37|528.74|572.81|660.93|749.05|782.54|775.49|660.93|749.05| 528.74 | 782.54 | 660.93 30000907|HC VITAMIN, NOS|0300|84591|380.86|220.90|36.88|35.036|||17.82|18.18|18.18|18.53|247.56|258.98|278.03|278.03|297.07|228.52|247.56|285.65|323.73|338.20|335.16|285.65|323.73| 17.82 | 338.20 | 258.98 30000908|HC AB; GIARDIA LAMBLIA|0300|86674|164.09|95.17|29.85|28.36|||9.81|10.01|10.01|10.2|106.66|111.58|119.79|119.79|127.99|98.45|106.66|123.07|139.48|145.71|144.40|123.07|139.48| 9.81 | 145.71 | 111.58 30000909|HC LYMPHOCYTOTOX VC; WO TITRATE|0300|86806|182.33|105.75|94.52|89.79|||86.04|87.76|87.76|89.48|118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 86.04 | 161.91 | 123.98 30000910|HC SERUM PRETX; INHIBIT INCUBATE|0300|86977|182.33|105.75|||149.16|149.16|9.62|9.81|9.81|10|118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 9.62 | 161.91 | 133.10 30000911|HC HEROIN METABOLITE|0300|80356|182.33|105.75|18.78|17.84|||||||118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 17.84 | 161.91 | 133.10 30000912|HC DRUG TEST DEF 1-7 CLASSES|0300|G0480|182.33|105.75|57.73|54.84|||||||118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 54.84 | 161.91 | 133.10 30000913|HC DRUG TEST DEF 8-14CLASSES|0300|G0481|196.92|114.21|88.82|84.38|||||||128.00|133.91|143.75|143.75|153.60|118.15|128.00|147.69|167.38|174.86|173.29|147.69|167.38| 84.38 | 174.86 | 143.75 30000914|HC DRUG TEST DEF 15-21 CLASSES|0300|G0482|249.18|144.52|119.92|113.92|||||||161.97|169.44|181.90|181.90|194.36|149.51|161.97|186.89|211.80|221.27|219.28|186.89|211.80| 113.92 | 221.27 | 181.90 30000915|HC DRUG TEST DEF 22+ CLASSES|0300|G0483|309.96|179.78|155.45|147.68|||||||201.47|210.77|226.27|226.27|241.77|185.98|201.47|232.47|263.47|275.24|272.76|232.47|263.47| 147.68 | 275.24 | 226.27 30000916|HC HLA II TYPE 1 AG LR; CELIAC DIS|0300|81377|297.80|172.72|241.37|229.30|||||||193.57|202.50|217.39|217.39|232.28|178.68|193.57|223.35|253.13|264.45|262.06|223.35|253.13| 178.68 | 264.45 | 223.35 30000917|HC HLA II TYPE 1 AG HR; CELIAC DIS|0300|81383|297.80|172.72|188.85|179.41|||||||193.57|202.50|217.39|217.39|232.28|178.68|193.57|223.35|253.13|264.45|262.06|223.35|253.13| 178.68 | 264.45 | 217.39 30000918|HC HEROIN METABOLITE|0300|80356|182.33|105.75|18.78|17.84|||||||118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 17.84 | 161.91 | 133.10 30000919|HC HGB CHROMATOGRAPHY|0300|83021|158.03|91.66|39.25|37.29|||23.29|23.75|23.75|24.22|102.72|107.46|115.36|115.36|123.26|94.82|102.72|118.52|134.33|140.33|139.07|118.52|134.33| 23.29 | 140.33 | 107.46 30000920|HC PAPPA, SERUM|0300|84163|129.15|74.91|22.75|21.61|||23.39|23.86|23.86|24.33|83.95|87.82|94.28|94.28|100.74|77.49|83.95|96.86|109.78|114.69|113.65|96.86|109.78| 21.61 | 114.69 | 87.82 30000921|HC AB; HEPATITIS D|0300|86692|540.90|313.72|51.51|48.93|||9.81|10.01|10.01|10.20|351.59|367.81|394.86|394.86|421.90|324.54|351.59|405.68|459.77|480.32|475.99|405.68|459.77| 9.81 | 480.32 | 367.81 30000922|HC PML/RARA COM BRKPTS|0300|81315|838.71|486.45|136.47|129.65|||||||545.16|570.32|612.26|612.26|654.19|503.23|545.16|629.03|712.90|744.77|738.06|629.03|712.90| 129.65 | 744.77 | 612.26 30000923|HC LIPOPROTEIN PLA2|0300|83698|425.43|246.75|139.56|132.582|||||||276.53|289.29|310.56|310.56|331.84|255.26|276.53|319.07|361.62|377.78|374.38|319.07|361.62| 132.58 | 377.78 | 310.56 30000924|HC AB; LYMPHOCYTIC CHORIOMENINGITIS|0300|86727|175.04|101.52|66.97|63.6215|||7.97|8.13|8.13|8.29|113.78|119.03|127.78|127.78|136.53|105.02|113.78|131.28|148.78|155.44|154.04|131.28|148.78| 7.97 | 155.44 | 119.03 30000925|HC CHROM ANALY; ADDTL CELL COUNTS|0300|88285|129.36|75.03|21.43|20.3585|||19.62|20.02|20.02|20.41|84.08|87.96|94.43|94.43|100.90|77.62|84.08|97.02|109.96|114.87|113.84|97.02|109.96| 19.62 | 114.87 | 87.96 30000926|HC KIT GENE TARGETED SEQ ANALYSIS|0300|81272|638.14|370.12|||||||||414.79|433.94|465.84|465.84|497.75|382.88|414.79|478.61|542.42|566.67|561.56|478.61|542.42| 382.88 | 566.67 | 478.61 30000927|HC PDGFRA GENE|0300|81314|638.14|370.12|||||||||414.79|433.94|465.84|465.84|497.75|382.88|414.79|478.61|542.42|566.67|561.56|478.61|542.42| 382.88 | 566.67 | 478.61 30000928|HC B CELLS TOTAL CNT|0300|86355|395.04|229.12|||||58.61|59.78|59.78|60.96|256.78|268.63|288.38|288.38|308.13|237.02|256.78|296.28|335.78|350.80|347.64|296.28|335.78| 58.61 | 350.80 | 288.38 30000929|HC MONONUCLEAR CELL AG|0300|86356|303.88|176.25|40.08|38.08|||||||197.52|206.64|221.83|221.83|237.03|182.33|197.52|227.91|258.30|269.85|267.41|227.91|258.30| 38.08 | 269.85 | 221.83 30000930|HC BRCA2 GENE FULL SEQ|0300|81216|6,077.54|3,524.97|||||||||3950.40|4132.73|4436.60|4436.60|4740.48|3646.52|3950.40|4558.16|5165.91|5396.86|5348.24|4558.16|5165.91| 3,646.52 | 5,396.86 | 4,558.16 30000931|HC CORTICOTROPIC RH STIM PANEL|0300|80412|1,002.79|581.62|868.54|825.11|||395.32|403.23|403.23|411.13|651.81|681.90|732.04|732.04|782.18|601.67|651.81|752.09|852.37|890.48|882.46|752.09|852.37| 395.32 | 890.48 | 732.04 30000932|HC H. PYLORI AB; IGM|0300|86677|170.17|98.70|31.26|29.70|||9.81|10.01|10.01|10.2|110.61|115.72|124.22|124.22|132.73|102.10|110.61|127.63|144.64|151.11|149.75|127.63|144.64| 9.81 | 151.11 | 115.72 30000933|HC TOX SELECT DRUG SCREEN|0300|80307|24.31|14.10|118.00|112.10|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 118.00 | 18.23 30000934|HC TOX SELECT AMPHET 1-2|0300|80324|24.31|14.10|29.20|27.74|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 29.20 | 18.23 30000935|HC TOX SELECT CLONAZEPAM|0300|80346|24.31|14.10|43.05|40.90|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 43.05 | 18.23 30000936|HC TOX SELECT BURPRENORPHINE|0300|80348|24.31|14.10|18.78|17.84|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 21.59 | 18.23 30000937|HC TOX SELECT COCAINE|0300|80353|24.31|14.10|27.51|26.13|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 27.51 | 18.23 30000938|HC TOX SELECT FENTANYL|0300|80354|24.31|14.10|18.78|17.84|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 21.59 | 18.23 30000939|HC TOX SELECT METHADONE|0300|80358|24.31|14.10|44.06|41.86|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 44.06 | 18.23 30000940|HC TOX SELECT METHYLENEDIOXYAMPH|0300|80359|24.31|14.10|18.78|17.84|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 21.59 | 18.23 30000941|HC TOX SELECT OPIATES; 1/MORE|0300|80361|24.31|14.10|33.56|31.88|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 33.56 | 18.23 30000942|HC TOX SELECT OXYCODONE|0300|80365|24.31|14.10|18.78|17.84|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 21.59 | 18.23 30000943|HC TOX SELECT TAPENTADOL|0300|80372|24.31|14.10|18.78|17.84|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 21.59 | 18.23 30000944|HC TOX SELECT TRAMADOL|0300|80373|24.31|14.10|18.78|17.84|||||||15.80|16.53|17.75|17.75|18.96|14.59|15.80|18.23|20.66|21.59|21.39|18.23|20.66| 14.59 | 21.59 | 18.23 30000945|HC TOX COMP DRUG SCREEN|0300|80307|12.16|7.05|118.00|112.10|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 118.00 | 9.12 30000946|HC TOX COMP AMPHETA 5/MORE|0300|80326|12.16|7.05|43.80|41.61|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 43.80 | 9.12 30000947|HC TOX COMP ANALGES NON-OP 6/MORE|0300|80331|12.16|7.05|68.24|64.83|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 68.24 | 9.12 30000948|HC TOX COMP ANTIDEPRESS 6/MORE|0300|80334|12.16|7.05|145.86|138.57|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 145.86 | 9.12 30000949|HC TOX COMP TRICY/NON-TRICY 6/MORE|0300|80337|12.16|7.05|73.67|69.99|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 73.67 | 9.12 30000950|HC TOX COMP ANTIDEPRESS, NOS 1-2|0300|80338|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000951|HC TOX COMP ANTIEPILEP, NOS 7/MORE|0300|80341|12.16|7.05|70.07|66.57|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 70.07 | 9.12 30000952|HC TOX COMP ANTIPHSYCOT, NOS 7/MORE|0300|80344|12.16|7.05|73.91|70.21|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 73.91 | 9.12 30000953|HC TOX COMP CLONAZEPAHM|0300|80346|12.16|7.05|43.05|40.90|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 43.05 | 9.12 30000954|HC TOX COMP BUPRENORPHINE|0300|80348|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000955|HC TOX COMP COCAINE|0300|80353|12.16|7.05|27.51|26.13|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 27.51 | 9.12 30000956|HC TOX COMP FENTANYL|0300|80354|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000957|HC TOX COMP GABAPENTIN NON-BLD|0300|80355|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000958|HC TOX COMP KETAMINE, NORKETAMINE|0300|80357|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000959|HC TOX COMP METHADONE|0300|80358|12.16|7.05|44.06|41.86|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 44.06 | 9.12 30000960|HC TOX COMP METHYLENEDIOXYAMPHET|0300|80359|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000961|HC TOX COMP METHYLPHENIDATE|0300|80360|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000962|HC TOX COMP OPIATES; 1/MORE|0300|80361|12.16|7.05|33.56|31.88|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 33.56 | 9.12 30000963|HC TOX COMP OPIOIDS 5/MORE|0300|80364|12.16|7.05|65.93|62.63|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 65.93 | 9.12 30000964|HC TOX COMP OXYCODONE|0300|80365|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000965|HC TOX COMP PREGABALIN|0300|80366|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000966|HC TOX COMP PROPOXYPHENE|0300|80367|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000967|HC TOX COMP SEDATIVE HYPNOTICS|0300|80368|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000968|HC TOX COMP SKEL MUSC RELAX 3/MORE|0300|80370|12.16|7.05|71.26|67.70|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 71.26 | 9.12 30000969|HC TOX COMP STIMULANTS, SYNTHETIC|0300|80371|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000970|HC TOX COMP TAPENTADOL|0300|80372|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000971|HC TOX COMP TRAMADOL|0300|80373|12.16|7.05|18.78|17.84|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 18.78 | 9.12 30000972|HC TOX COMP DRUGS, NOS 7/MORE|0300|80377|12.16|7.05|67.13|63.77|||||||7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 67.13 | 9.12 30000973|HC TOX COMP PCP QUANT|0300|83992|12.16|7.05|44.15|41.94|||25.12|25.62|25.62|26.12|7.90|8.27|8.88|8.88|9.48|7.30|7.90|9.12|10.34|10.80|10.70|9.12|10.34| 7.30 | 44.15 | 10.34 30000974|HC ACETYLCHOLINESTERASE|0300|82013|399.32|231.61|36.69|34.86|||13.19|13.45|13.45|13.72|259.56|271.54|291.50|291.50|311.47|239.59|259.56|299.49|339.42|354.60|351.40|299.49|339.42| 13.19 | 354.60 | 271.54 30000975|HC CHOLINESTERASE, RBC|0300|82482|92.38|53.58|30.35|28.83|||13.08|13.34|13.34|13.61|60.05|62.82|67.44|67.44|72.06|55.43|60.05|69.29|78.52|82.03|81.29|69.29|78.52| 13.08 | 82.03 | 62.82 30000976|HC CAROTENE|0300|82380|177.64|103.03|31.24|29.68|||13.19|13.45|13.45|13.72|115.47|120.80|129.68|129.68|138.56|106.58|115.47|133.23|150.99|157.74|156.32|133.23|150.99| 13.19 | 157.74 | 120.80 30000977|HC RBC CNT-AUTOMATED|0300|85041|54.69|31.72|8.34|7.92|||1.71|1.75|1.75|1.78|35.55|37.19|39.92|39.92|42.66|32.81|35.55|41.02|46.49|48.56|48.13|41.02|46.49| 1.71 | 48.56 | 37.19 30000978|HC FETAL LUNG - LB DENSITY|0300|83664|180.59|104.74|37.39|35.52|||2.00|2.04|2.04|2.08|117.38|122.80|131.83|131.83|140.86|108.35|117.38|135.44|153.50|160.36|158.92|135.44|153.50| 2.00 | 160.36 | 122.80 30000979|HC MEAT FIBERS, FECES|0300|89160|167.22|96.99|51.15|48.59|||6.66|6.79|6.79|6.93|108.69|113.71|122.07|122.07|130.43|100.33|108.69|125.42|142.14|148.49|147.15|125.42|142.14| 6.66 | 148.49 | 113.71 30000980|HC MYCOPHENOLATE DS, QUANT|0300|80180|182.33|105.75|16.23|15.42|||||||118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 15.42 | 161.91 | 133.10 30000981|HC FUNCTIONAL PLASMINOGEN|0300|85420|164.09|95.17|15.81|15.02|||8.63|8.81|8.81|8.98|106.66|111.58|119.79|119.79|127.99|98.45|106.66|123.07|139.48|145.71|144.40|123.07|139.48| 8.63 | 145.71 | 111.58 30000982|HC CELL CNT BF; NOT BLOOD W/ DIFF|0300|89051|182.33|105.75|32.59|30.96|||4.81|4.91|4.91|5.01|118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 4.81 | 161.91 | 123.98 30000983|HC CLOTTING; FACTOR II, PROTHROMBIN SP|0300|85210|121.55|70.50|51.09|48.54|||15.45|15.76|15.76|16.07|79.01|82.65|88.73|88.73|94.81|72.93|79.01|91.16|103.32|107.94|106.96|91.16|103.32| 15.45 | 107.94 | 82.65 30000984|HC CLOTTING; FACTOR XI|0300|85270|254.04|147.34|51.71|49.12|||15.45|15.76|15.76|16.07|165.13|172.75|185.45|185.45|198.15|152.42|165.13|190.53|215.93|225.59|223.56|190.53|215.93| 15.45 | 225.59 | 172.75 30000985|HC CLOTTING; FACTOR XII|0300|85280|279.57|162.15|54.79|52.05|||15.45|15.76|15.76|16.07|181.72|190.11|204.09|204.09|218.06|167.74|181.72|209.68|237.63|248.26|246.02|209.68|237.63| 15.45 | 248.26 | 190.11 30000986|HC SALMONELLA|0300|86768|97.24|56.40|39.50|37.53|||9.81|10.01|10.01|10.20|63.21|66.12|70.99|70.99|75.85|58.34|63.21|72.93|82.65|86.35|85.57|72.93|82.65| 9.81 | 86.35 | 66.12 30000987|HC AB; HBEAB|0300|86707|164.09|95.17|34.11|32.40|||19.93|20.32|20.32|20.72|106.66|111.58|119.79|119.79|127.99|98.45|106.66|123.07|139.48|145.71|144.40|123.07|139.48| 19.93 | 145.71 | 111.58 30000988|HC PREGNENOLONE|0300|84140|374.63|217.29|49.16|46.70|||34.34|35.03|35.03|35.72|243.51|254.75|273.48|273.48|292.21|224.78|243.51|280.97|318.44|332.67|329.67|280.97|318.44| 34.34 | 332.67 | 254.75 30000989|HC VIRAL NEUTRALIZATION|0300|86382|174.49|101.20|46.64|44.31|||30.56|31.17|31.17|31.78|113.42|118.65|127.38|127.38|136.10|104.69|113.42|130.87|148.32|154.95|153.55|130.87|148.32| 30.56 | 154.95 | 118.65 30000990|HC ASCORBIC ACID, BLOOD (VIT C)|0300|82180|140.45|81.46|35.17|33.41|||17.87|18.23|18.23|18.59|91.29|95.51|102.53|102.53|109.55|84.27|91.29|105.34|119.38|124.72|123.60|105.34|119.38| 17.87 | 124.72 | 95.51 30000991|HC VITAMIN K|0300|84597|164.09|95.17|42.71|40.57|||24.79|25.29|25.29|25.78|106.66|111.58|119.79|119.79|127.99|98.45|106.66|123.07|139.48|145.71|144.40|123.07|139.48| 24.79 | 145.71 | 111.58 30000992|HC ALPHA-FETOPROTEIN; AMNIOTIC FL|0300|82106|166.39|96.51|47.78|45.391|||17.86|18.22|18.22|18.57|108.15|113.15|121.46|121.46|129.78|99.83|108.15|124.79|141.43|147.75|146.42|124.79|141.43| 17.86 | 147.75 | 113.15 30000993|HC HBA1/HBA2 GENE|0300|81257|668.54|387.75|253.72|241.03|||||||434.55|454.61|488.03|488.03|521.46|401.12|434.55|501.41|568.26|593.66|588.32|501.41|568.26| 241.03 | 593.66 | 488.03 30000994|HC DS QT; ENVEROLIMUS|0300|80169|182.33|105.75|16.23|15.42|||||||118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 15.42 | 161.91 | 133.10 30000995|HC PLASMA, CRYOPRECIP REDUCE, EA|0300|P9044|273.48|158.62|||65.7|65.7|33.36|34.03|34.03|34.7|177.76|185.97|199.64|199.64|213.31|164.09|177.76|205.11|232.46|242.85|240.66|205.11|232.46| 33.36 | 242.85 | 185.97 30000996|HC LYMPHOCYTE MITOGEN RESP|0300|86353|638.14|370.12|160.73|152.69|||88.64|90.41|90.41|92.18|414.79|433.94|465.84|465.84|497.75|382.88|414.79|478.61|542.42|566.67|561.56|478.61|542.42| 88.64 | 566.67 | 433.94 30000997|HC PATH CONSULT; LIMITED|0300|80500|95.79|55.56|28.11|26.70|49.76|49.76|12.69|12.94|12.94|13.20|62.26|65.14|69.93|69.93|74.72|57.47|62.26|71.84|81.42|85.06|84.30|71.84|81.42| 12.69 | 85.06 | 62.26 30000998|HC PCA3/KLK3 ANTIGEN|0300|81313|650.30|377.17|||||||||422.70|442.20|474.72|474.72|507.23|390.18|422.70|487.73|552.76|577.47|572.26|487.73|552.76| 390.18 | 577.47 | 487.73 30000999|HC ABL 1 GENE|0300|81170|698.92|405.37|310.70|295.17|||||||454.30|475.27|510.21|510.21|545.16|419.35|454.30|524.19|594.08|620.64|615.05|524.19|594.08| 295.17 | 620.64 | 510.21 30001000|HC MUCOPOLYSACCHARIDES|0300|83864|182.33|105.75|46.26|43.95|||13.19|13.45|13.45|13.72|118.51|123.98|133.10|133.10|142.22|109.40|118.51|136.75|154.98|161.91|160.45|136.75|154.98| 13.19 | 161.91 | 123.98 30001001|HC FIBRIN DEGRADATION PRODUCTS|0300|85362|200.56|116.32|33.23|31.57|||12.46|12.70|12.70|12.95|130.36|136.38|146.41|146.41|156.44|120.34|130.36|150.42|170.48|178.10|176.49|150.42|170.48| 12.46 | 178.10 | 136.38 30001002|HC LIDOCAINE|0300|80176|194.48|112.80|50.86|48.32|||25.12|25.62|25.62|26.12|126.41|132.25|141.97|141.97|151.69|116.69|126.41|145.86|165.31|172.70|171.14|145.86|165.31| 25.12 | 172.70 | 132.25 30001003|HC MYCOBACTERIA, CULT, ID EA|0300|87118|109.40|63.45|29.48|28.01|||13.74|14.01|14.01|14.29|71.11|74.39|79.86|79.86|85.33|65.64|71.11|82.05|92.99|97.15|96.27|82.05|92.99| 13.74 | 97.15 | 74.39 30001004|HC POTASSIUM; SERUM, PLASMA, WB|0300|84132|158.03|91.66|7.76|7.37|||5.49|5.60|5.60|5.71|102.72|107.46|115.36|115.36|123.26|94.82|102.72|118.52|134.33|140.33|139.07|118.52|134.33| 5.49 | 140.33 | 107.46 30001005|HC GROWTH HORMONE STIM PANEL|0300|80428|522.93|303.30|192.04|182.44|||24.07|24.55|24.55|25.04|339.90|355.59|381.74|381.74|407.89|313.76|339.90|392.20|444.49|464.36|460.18|392.20|444.49| 24.07 | 464.36 | 355.59 30001006|HC ENCEPHALITIS, EASTERN EQUINE AB|0300|86652|91.16|52.87|44.80|42.56|||9.81|10.01|10.01|10.20|59.25|61.99|66.55|66.55|71.10|54.70|59.25|68.37|77.49|80.95|80.22|68.37|77.49| 9.81 | 80.95 | 61.99 30001007|HC US AB; DENGUE FEVER|0300|86790|156.28|90.64|26.45|25.13|||9.81|10.01|10.01|10.20|101.58|106.27|114.08|114.08|121.90|93.77|101.58|117.21|132.84|138.78|137.53|117.21|132.84| 9.81 | 138.78 | 106.27 30001008|HC HEAT STABLE ALK PHOS|0300|84078|200.56|116.32|24.01|22.81|||10.31|10.52|10.52|10.72|130.36|136.38|146.41|146.41|156.44|120.34|130.36|150.42|170.48|178.10|176.49|150.42|170.48| 10.31 | 178.10 | 136.38 30001009|HC TRICHINELLA AB|0300|86784|115.48|66.98|62.20|59.09|||9.81|10.01|10.01|10.2|75.06|78.53|84.30|84.30|90.07|69.29|75.06|86.61|98.16|102.55|101.62|86.61|98.16| 9.81 | 102.55 | 78.53 30001010|HC CALIFORNIA ENCEPHALITIS AB|0300|86651|115.48|66.98|44.80|42.56|||9.81|10.01|10.01|10.2|75.06|78.53|84.30|84.30|90.07|69.29|75.06|86.61|98.16|102.55|101.62|86.61|98.16| 9.81 | 102.55 | 78.53 30001011|HC FACTOR XIII|0300|85291|170.17|98.70|50.56|48.03|||15.45|15.76|15.76|16.07|110.61|115.72|124.22|124.22|132.73|102.10|110.61|127.63|144.64|151.11|149.75|127.63|144.64| 15.45 | 151.11 | 115.72 30001012|HC UMBILICAL CORD DRUG SCR 5|0300|80307|231.53|134.29|118.00|112.10|||||||150.49|157.44|169.02|169.02|180.59|138.92|150.49|173.65|196.80|205.60|203.75|173.65|196.80| 112.10 | 205.60 | 169.02 30001013|HC UMBILICAL CORD DRUG SCR 7|0300|80307|243.11|141.00|118.00|112.10|||||||158.02|165.31|177.47|177.47|189.63|145.87|158.02|182.33|206.64|215.88|213.94|182.33|206.64| 112.10 | 215.88 | 177.47 30001014|HC UMBILICAL CORD DRUG SCR 9|0300|80307|254.68|147.71|118.00|112.10|||||||165.54|173.18|185.92|185.92|198.65|152.81|165.54|191.01|216.48|226.16|224.12|191.01|216.48| 112.10 | 226.16 | 185.92 30001015|HC UMBILICAL CORD DRUG SCR 12|0300|80307|272.04|157.78|118.00|112.10|||||||176.83|184.99|198.59|198.59|212.19|163.22|176.83|204.03|231.23|241.57|239.40|204.03|231.23| 112.10 | 241.57 | 198.59 30001016|HC UMBILICAL CORD DRUG SCR 13|0300|80307|318.35|184.64|118.00|112.10|||||||206.93|216.48|232.40|232.40|248.31|191.01|206.93|238.76|270.60|282.69|280.15|238.76|270.60| 112.10 | 282.69 | 232.40 30001017|HC MECONIUM DRUG PANEL 5|0300|80307|162.07|94.00|118.00|112.10|||||||105.35|110.21|118.31|118.31|126.41|97.24|105.35|121.55|137.76|143.92|142.62|121.55|137.76| 97.24 | 143.92 | 118.31 30001018|HC MECONIUM DRUG PANEL 7|0300|80307|177.11|102.72|118.00|112.10|||||||115.12|120.43|129.29|129.29|138.15|106.27|115.12|132.83|150.54|157.27|155.86|132.83|150.54| 106.27 | 157.27 | 129.29 30001019|HC MECONIUM DRUG PANEL 9|0300|80307|202.59|117.50|118.00|112.10|||||||131.68|137.76|147.89|147.89|158.02|121.55|131.68|151.94|172.20|179.90|178.28|151.94|172.20| 112.10 | 179.90 | 147.89 30001020|HC MECONIUM DRUG PANEL 12|0300|80307|219.95|127.57|118.00|112.10|||||||142.97|149.57|160.56|160.56|171.56|131.97|142.97|164.96|186.96|195.32|193.56|164.96|186.96| 112.10 | 195.32 | 160.56 30001021|HC MECONIUM DRUG PANEL 13|0300|80307|260.46|151.07|118.00|112.10|||||||169.30|177.11|190.14|190.14|203.16|156.28|169.30|195.35|221.39|231.29|229.20|195.35|221.39| 112.10 | 231.29 | 190.14 30001022|HC VASOPRESSIN|0300|84588|156.28|90.64|101.04|95.99|||30.22|30.83|30.83|31.43|101.58|106.27|114.08|114.08|121.90|93.77|101.58|117.21|132.84|138.78|137.53|117.21|132.84| 30.22 | 138.78 | 106.27 30001024|HC ORG ACID SINGLE QUANT; MMA, UR|0300|83921|341.50|198.07|33.79|32.10|||25.30|25.81|25.81|26.32|221.98|232.22|249.30|249.30|266.37|204.90|221.98|256.13|290.28|303.25|300.52|256.13|290.28| 25.30 | 303.25 | 232.22 30001025|HC HISTAMINE; 24 HR URINE|0300|83088|338.03|196.06|78.42|74.50|||32.71|33.36|33.36|34.02|219.72|229.86|246.76|246.76|263.66|202.82|219.72|253.52|287.33|300.17|297.47|253.52|287.33| 32.71 | 300.17 | 229.86 30001026|HC DEF DRUG; LEFFLUNOMIDE, WARFARIN|0300|80375|156.28|90.64|44.75|42.51|||||||101.58|106.27|114.08|114.08|121.90|93.77|101.58|117.21|132.84|138.78|137.53|117.21|132.84| 42.51 | 138.78 | 114.08 30001027|HC CHROMOTOGRAPHY; 18OH CORTOCOSTERONE|0300|82542|341.50|198.07|248.42|236.00|||11.45|11.68|11.68|11.91|221.98|232.22|249.30|249.30|266.37|204.90|221.98|256.13|290.28|303.25|300.52|256.13|290.28| 11.45 | 303.25 | 248.42 30001028|HC ALUMINUM|0300|82108|126.98|73.65|49.43|46.96|||14.91|15.21|15.21|15.51|82.54|86.35|92.70|92.70|99.04|76.19|82.54|95.24|107.93|112.76|111.74|95.24|107.93| 14.91 | 112.76 | 86.35 30001029|HC ESTRIOL; AFP TETRA|0300|82677|202.59|117.50|54.67|51.94|||28.02|28.58|28.58|29.15|131.68|137.76|147.89|147.89|158.02|121.55|131.68|151.94|172.20|179.90|178.28|151.94|172.20| 28.02 | 179.90 | 137.76 30001030|HC HCG; QUANT; AFP TETRA|0300|84702|243.11|141.00|47.45|45.08|||11.77|12.01|12.01|12.25|158.02|165.31|177.47|177.47|189.63|145.87|158.02|182.33|206.64|215.88|213.94|182.33|206.64| 11.77 | 215.88 | 165.31 30001031|HC AFP TETRA PROFILE|0300|82105|171.33|99.37|43.75|41.56|||17.86|18.22|18.22|18.57|111.36|116.50|125.07|125.07|133.64|102.80|111.36|128.50|145.63|152.14|150.77|128.50|145.63| 17.86 | 152.14 | 116.50 30001032|HC INHIBIN A; AFP TETRA|0300|86336|171.33|99.37|79.01|75.06|||24.20|24.69|24.69|25.17|111.36|116.50|125.07|125.07|133.64|102.80|111.36|128.50|145.63|152.14|150.77|128.50|145.63| 24.20 | 152.14 | 116.50 30001033|HC IMMNOASSAY NONAB; GLIADIN IGG|0300|83516|164.39|95.35|239.51|227.53|||13.08|13.34|13.34|13.61|106.85|111.79|120.00|120.00|128.22|98.63|106.85|123.29|139.73|145.98|144.66|123.29|139.73| 13.08 | 239.51 | 120.00 30001034|HC IMMNOASSAY NONAB; GLIADIN IGM|0300|83516|164.39|95.35|239.51|227.53|||13.08|13.34|13.34|13.61|106.85|111.79|120.00|120.00|128.22|98.63|106.85|123.29|139.73|145.98|144.66|123.29|139.73| 13.08 | 239.51 | 120.00 30001035|HC MANGANESE|0300|83785|183.06|106.17|45.90|43.61|||13.19|13.45|13.45|13.72|118.99|124.48|133.63|133.63|142.79|109.84|118.99|137.30|155.60|162.56|161.09|137.30|155.60| 13.19 | 162.56 | 124.48 30001036|HC OPIOIDS, OPIATE ANALOGS 3-4|0300|80363|173.65|100.72|54.96|52.21|||||||112.87|118.08|126.76|126.76|135.45|104.19|112.87|130.24|147.60|154.20|152.81|130.24|147.60| 52.21 | 154.20 | 126.76 30001037|HC RSV ANTIBODIES|0300|86756|136.86|79.38|50.40|47.88|||9.81|10.01|10.01|10.2|88.96|93.06|99.91|99.91|106.75|82.12|88.96|102.65|116.33|121.53|120.44|102.65|116.33| 9.81 | 121.53 | 93.06 30001038|HC ANTIBODY; FRANCISELLA TULARENSIS|0300|86668|111.29|64.55|19.92|18.92|||9.81|10.01|10.01|10.2|72.34|75.68|81.24|81.24|86.81|66.77|72.34|83.47|94.60|98.83|97.94|83.47|94.60| 9.81 | 98.83 | 75.68 30001039|HC QT DRUG ASSAY; AMIO, FELB, NES|0300|80299|196.80|114.14|51.65|49.07|||26.17|26.69|26.69|27.21|127.92|133.82|143.66|143.66|153.50|118.08|127.92|147.60|167.28|174.76|173.18|147.60|167.28| 26.17 | 174.76 | 133.82 30001040|HC ALCOHOL LEVEL|0300|80307|109.98|63.79|118|112.1|||||||71.49|74.79|80.29|80.29|85.78|65.99|71.49|82.49|93.48|97.66|96.78|82.49|93.48| 65.99 | 118.00 | 82.49 30001041|HC ACETAMINOPHEN LEVEL|0300|80307|109.98|63.79|118|112.1|||||||71.49|74.79|80.29|80.29|85.78|65.99|71.49|82.49|93.48|97.66|96.78|82.49|93.48| 65.99 | 118.00 | 82.49 30001042|HC SALICYLATE LEVEL|0300|80307|127.34|73.86|118.00|112.10|||||||82.77|86.59|92.96|92.96|99.33|76.40|82.77|95.51|108.24|113.08|112.06|95.51|108.24| 76.40 | 118.00 | 95.51 30001043|HC NK CELLS; FLOW/QT LYMPH|0300|86357|92.61|53.71|||||58.61|59.78|59.78|60.96|60.20|62.97|67.61|67.61|72.24|55.57|60.20|69.46|78.72|82.24|81.50|69.46|78.72| 55.57 | 82.24 | 67.61 30001044|HC B CELLS; FLOW/QT LYMPH|0300|86355|92.61|53.71|||||58.61|59.78|59.78|60.96|60.20|62.97|67.61|67.61|72.24|55.57|60.20|69.46|78.72|82.24|81.50|69.46|78.72| 55.57 | 82.24 | 67.61 30001045|HC T CELLS, TOTAL; FLOW/QT LYMPH|0300|86359|92.61|53.71|64.95|61.70|||37.61|38.37|38.37|39.12|60.20|62.97|67.61|67.61|72.24|55.57|60.20|69.46|78.72|82.24|81.50|69.46|78.72| 37.61 | 82.24 | 64.95 30001046|HC T CELLS, ABS CD4/CD8; FLOW LYM|0300|86360|92.61|53.71|107.03|101.6785|||37.61|38.37|38.37|39.12|60.20|62.97|67.61|67.61|72.24|55.57|60.20|69.46|78.72|82.24|81.50|69.46|78.72| 37.61 | 107.03 | 67.61 30001047|HC MAGNESIUM - RBC; REF LAB|0300|83735|202.59|117.50|20.32|19.30|||10.99|11.21|11.21|11.43|131.68|137.76|147.89|147.89|158.02|121.55|131.68|151.94|172.20|179.90|178.28|151.94|172.20| 10.99 | 179.90 | 137.76 30001048|HC DS; ANABOLIC STEROID/MAYO 9 DRUG|0300|80307|231.53|134.29|118.00|112.10|||||||150.49|157.44|169.02|169.02|180.59|138.92|150.49|173.65|196.80|205.60|203.75|173.65|196.80| 112.10 | 205.60 | 169.02 30001049|HC NRAS GENE VARIANTS EXON 2 & 3|0300|81311|614.70|356.53|||||||||399.56|418.00|448.73|448.73|479.47|368.82|399.56|461.03|522.50|545.85|540.94|461.03|522.50| 368.82 | 545.85 | 461.03 30001050|HC FIBRINOGEN; ANTIGEN|0300|85385|144.70|83.93|28.62|27.189|||13.34|13.61|13.61|13.88|94.06|98.40|105.63|105.63|112.87|86.82|94.06|108.53|123.00|128.49|127.34|108.53|123.00| 13.34 | 128.49 | 98.40 30001051|HC OSMOTIC FRAGILITY RBC; INCUBATED|0300|85557|289.41|167.86|24.93|23.68|||11.68|11.92|11.92|12.15|188.12|196.80|211.27|211.27|225.74|173.65|188.12|217.06|246.00|257.00|254.68|217.06|246.00| 11.68 | 257.00 | 196.80 30001052|HC OSTEOCALCIN|0300|83937|277.83|161.14|72.43|68.81|||||||180.59|188.92|202.82|202.82|216.71|166.70|180.59|208.37|236.16|246.71|244.49|208.37|236.16| 68.81 | 246.71 | 202.82 30001053|HC ALLERGEN SPEC IGE RECOMB, EA|0300|86008|100.93|58.54|||||||||65.60|68.63|73.68|73.68|78.73|60.56|65.60|75.70|85.79|89.63|88.82|75.70|85.79| 60.56 | 89.63 | 75.70 30001054|HC DPYD GENE, COMMON VARIANTS|0300|81232|463.05|268.57|190.10|180.60|||||||300.98|314.87|338.03|338.03|361.18|277.83|300.98|347.29|393.59|411.19|407.48|347.29|393.59| 180.60 | 411.19 | 338.03 30001055|HC NICKEL|0300|83885|191.01|110.79|31.39|29.82|||10.07|10.28|10.28|10.48|124.16|129.89|139.44|139.44|148.99|114.61|124.16|143.26|162.36|169.62|168.09|143.26|162.36| 10.07 | 169.62 | 129.89 30001056|HC HEAVY METAL; BERYLLIUM|0300|83018|248.89|144.36|31.42|29.85|||25.12|25.62|25.62|26.12|161.78|169.25|181.69|181.69|194.13|149.33|161.78|186.67|211.56|221.01|219.02|186.67|211.56| 25.12 | 221.01 | 169.25 30001057|HC IA AB; HAEMOPHILUS INFL B|0300|86317|162.07|94.00|35.04|33.288|||13.08|13.34|13.34|13.61|105.35|110.21|118.31|118.31|126.41|97.24|105.35|121.55|137.76|143.92|142.62|121.55|137.76| 13.08 | 143.92 | 110.21 30001058|HC PROSTATIC ACID PHOSPHATASE|0300|84066|87.75|50.90|28.32|26.90|||17.49|17.84|17.84|18.19|57.04|59.67|64.06|64.06|68.45|52.65|57.04|65.81|74.59|77.92|77.22|65.81|74.59| 17.49 | 77.92 | 59.67 30001059|HC CARB DEFICIENT TRANSFERRIN|0300|82373|268.78|155.89|262.97|249.82|||11.07|11.29|11.29|11.51|174.71|182.77|196.21|196.21|209.65|161.27|174.71|201.59|228.46|238.68|236.53|201.59|228.46| 11.07 | 262.97 | 196.21 30001060|HC UNLISTED MICRO PROC - GI PANEL|0300|87999|797.67|462.65|||||2,179.66|2,223.25|2,223.25|2,266.85|518.49|542.42|582.30|582.30|622.18|478.60|518.49|598.25|678.02|708.33|701.95|598.25|678.02| 478.60 | 2,266.85 | 622.18 30001061|HC MICROARRAY HBA1/HBA2|0300|81405|668.54|387.75|505.75|480.46|||||||434.55|454.61|488.03|488.03|521.46|401.12|434.55|501.41|568.26|593.66|588.32|501.41|568.26| 401.12 | 593.66 | 501.41 30001062|HC CYANIDE|0300|82600|212.43|123.21|28.52|27.09|||13.19|13.45|13.45|13.72|138.08|144.45|155.07|155.07|165.70|127.46|138.08|159.32|180.57|188.64|186.94|159.32|180.57| 13.19 | 188.64 | 144.45 30001063|HC ENZYME ACTVITY, NOT RA; TPMT|0300|82657|665.64|386.07|41.75|39.66|||38.84|39.62|39.62|40.40|432.67|452.64|485.92|485.92|519.20|399.38|432.67|499.23|565.79|591.09|585.76|499.23|565.79| 38.84 | 591.09 | 452.64 30001064|HC HLA II TYPING 1 LOC HIGH RES|0300|81382|683.00|396.14|190.57|181.04|||||||443.95|464.44|498.59|498.59|532.74|409.80|443.95|512.25|580.55|606.50|601.04|512.25|580.55| 181.04 | 606.50 | 498.59 30001065|HC CHLAMYDIA PNEU AMP PROBE|0300|87486|318.00|184.44|51.23|48.6685|||13.08|13.34|13.34|13.61|206.70|216.24|232.14|232.14|248.04|190.80|206.70|238.50|270.30|282.38|279.84|238.50|270.30| 13.08 | 282.38 | 216.24 30001066|HC ENZY ACTIV BC, NOT RA; DHR FL PMA|0300|82657|133.41|77.38|41.75|39.66|||38.84|39.62|39.62|40.4|86.72|90.72|97.39|97.39|104.06|80.05|86.72|100.06|113.40|118.47|117.40|100.06|113.40| 38.84 | 118.47 | 90.72 30001067|HC FLOW CYTO; DHR FL PMA|0300|88184|318.35|184.64|184.62|175.389|291.26|291.26|43.19|44.05|44.05|44.92|206.93|216.48|232.40|232.40|248.31|191.01|206.93|238.76|270.60|282.69|280.15|238.76|270.60| 43.19 | 291.26 | 232.40 30001068|HC HBA1/HBA2 GENE DUP/DEL ANALYSIS|0300|81269|1,060.10|614.86|||||||||689.07|720.87|773.87|773.87|826.88|636.06|689.07|795.08|901.09|941.37|932.89|795.08|901.09| 636.06 | 941.37 | 795.08 30001069|HC SERPINA1 GENE|0300|81332|868.80|503.90|110.5|104.975|||||||564.72|590.78|634.22|634.22|677.66|521.28|564.72|651.60|738.48|771.49|764.54|651.60|738.48| 104.98 | 771.49 | 634.22 30001070|HC ALLERG IGE, RECOMB; ALPHA GAL|0300|86008|156.28|90.64|||||||||101.58|106.27|114.08|114.08|121.90|93.77|101.58|117.21|132.84|138.78|137.53|117.21|132.84| 93.77 | 138.78 | 117.21 30001071|HC FETAL CHROMO ANEUPLOIDY|0300|81420|1,840.63|1,067.57|1,572.83|1,494.19|||||||1196.41|1251.63|1343.66|1343.66|1435.69|1104.38|1196.41|1380.47|1564.54|1634.48|1619.75|1380.47|1564.54| 1,104.38 | 1,634.48 | 1,380.47 30001072|HC SNRPN/UBE3A GENE|0300|81331|889.12|515.69|||||||||577.93|604.60|649.06|649.06|693.51|533.47|577.93|666.84|755.75|789.54|782.43|666.84|755.75| 533.47 | 789.54 | 666.84 30001073|HC SODIUM, OTHER SOURCE|0300|84302|115.07|66.74|15.36|14.59|||5.49|5.60|5.60|5.71|74.80|78.25|84.00|84.00|89.75|69.04|74.80|86.30|97.81|102.18|101.26|86.30|97.81| 5.49 | 102.18 | 78.25 30001074|HC GLUCAGON|0300|82943|134.81|78.19|60.62|57.59|||25.84|26.36|26.36|26.87|87.63|91.67|98.41|98.41|105.15|80.89|87.63|101.11|114.59|119.71|118.63|101.11|114.59| 25.84 | 119.71 | 91.67 30001075|HC UNLST CHEM; POTASSIUM, OTHER|0300|84999|104.19|60.43|||||||||67.72|70.85|76.06|76.06|81.27|62.51|67.72|78.14|88.56|92.52|91.69|78.14|88.56| 62.51 | 92.52 | 78.14 30001076|HC CHLORIDE, FECAL ELECTROLYTES|0300|82438|104.19|60.43|7.16|6.80|||5.1|5.2|5.2|5.31|67.72|70.85|76.06|76.06|81.27|62.51|67.72|78.14|88.56|92.52|91.69|78.14|88.56| 5.10 | 92.52 | 70.85 30001077|HC ALBUMIN; OTHER, LYME CNS INDEX|0300|82042|150.50|87.29|20.05|19.05|||6.87|7.01|7.01|7.14|97.83|102.34|109.87|109.87|117.39|90.30|97.83|112.88|127.93|133.64|132.44|112.88|127.93| 6.87 | 133.64 | 102.34 30001078|HC 5-HIAA; PLASMA|0300|83497|248.31|144.02|37.85|35.96|||18.45|18.82|18.82|19.19|161.40|168.85|181.27|181.27|193.68|148.99|161.40|186.23|211.06|220.50|218.51|186.23|211.06| 18.45 | 220.50 | 168.85 30001079|HC DRUG SCREEN; PREGABALIN|0300|80366|138.92|80.57|18.78|17.84|||||||90.30|94.47|101.41|101.41|108.36|83.35|90.30|104.19|118.08|123.36|122.25|104.19|118.08| 17.84 | 123.36 | 101.41 30001080|HC CARBAMAZAPINE, FREE|0300|80157|113.90|66.06|52.71|50.07|||15.28|15.59|15.59|15.89|74.04|77.45|83.15|83.15|88.84|68.34|74.04|85.43|96.82|101.14|100.23|85.43|96.82| 15.28 | 101.14 | 77.45 30001081|HC INF AGENT QT; NOS; EA|0300|87799|469.19|272.13|197.82|187.929|||13.08|13.34|13.34|13.61|304.97|319.05|342.51|342.51|365.97|281.51|304.97|351.89|398.81|416.64|412.89|351.89|398.81| 13.08 | 416.64 | 319.05 30001082|HC BLOOD SMEAR; MANUAL DIFF|0300|85007|30.10|17.46|5.92|5.62|||2.75|2.80|2.80|2.86|19.57|20.47|21.97|21.97|23.48|18.06|19.57|22.58|25.59|26.73|26.49|22.58|25.59| 2.75 | 26.73 | 20.47 30001083|HC ANTIPHSYCHOTICS, ATYPICAL; 1-3|0300|80342|318.35|184.64|49.27|46.81|||||||206.93|216.48|232.40|232.40|248.31|191.01|206.93|238.76|270.60|282.69|280.15|238.76|270.60| 46.81 | 282.69 | 232.40 30001084|HC NEURO CSF PRION PROTEIN QUAL|0300|0035U|1,565.70|908.11|||||||||1017.71|1064.68|1142.96|1142.96|1221.25|939.42|1017.71|1174.28|1330.85|1390.34|1377.82|1174.28|1330.85| 939.42 | 1,390.34 | 1,174.28 30001085|HC OCCULT BLD FHG QUAL 1-3|0300|82274|86.82|50.36|26.83|25.49|||5.00|5.10|5.10|5.20|56.43|59.04|63.38|63.38|67.72|52.09|56.43|65.12|73.80|77.10|76.40|65.12|73.80| 5.00 | 77.10 | 59.04 30001086|HC ANTIBODY, CANDIDA|0300|86628|126.00|73.08|48.43|46.01|||9.81|10.01|10.01|10.20|81.90|85.68|91.98|91.98|98.28|75.60|81.90|94.50|107.10|111.89|110.88|94.50|107.10| 9.81 | 111.89 | 85.68 30001088|HC TARGETED GENOMIC SEQ ANALYSIS 81445|0300|81445|3,031.88|1,758.49|||||||||1970.72|2061.68|2213.27|2213.27|2364.87|1819.13|1970.72|2273.91|2577.10|2692.31|2668.05|2273.91|2577.10| 1,819.13 | 2,692.31 | 2,273.91 30001089|HC FACTOR VIII, VW ACTIVITY|0300|85245|314.21|182.24|14.62|13.89|||10.99|11.21|11.21|11.43|204.24|213.66|229.37|229.37|245.08|188.53|204.24|235.66|267.08|279.02|276.50|235.66|267.08| 10.99 | 279.02 | 213.66 30001090|HC AB; HSV II, REFLEX|0300|86696|165.38|95.92|52.73|50.09|||29.75|30.35|30.35|30.94|107.50|112.46|120.73|120.73|129.00|99.23|107.50|124.04|140.57|146.86|145.53|124.04|140.57| 29.75 | 146.86 | 112.46 30001091|HC IMMUNE COMPLEX ASSAY|0300|86332|281.14|163.06|74.66|70.93|||||||182.74|191.18|205.23|205.23|219.29|168.68|182.74|210.86|238.97|249.65|247.40|210.86|238.97| 70.93 | 249.65 | 205.23 30001092|HC ARSENIC; HEAVY METAL PROFILE|0300|82175|165.38|95.92|41.19|39.13|||11.68|11.92|11.92|12.15|107.50|112.46|120.73|120.73|129.00|99.23|107.50|124.04|140.57|146.86|145.53|124.04|140.57| 11.68 | 146.86 | 112.46 30001093|HC MERCURY; HEAVY METAL PROFILE|0300|83825|154.35|89.52|34.00|32.30|||13.19|13.45|13.45|13.72|100.33|104.96|112.68|112.68|120.39|92.61|100.33|115.76|131.20|137.06|135.83|115.76|131.20| 13.19 | 137.06 | 104.96 30001094|HC LEAD; HEAVY MET PROFILE|0300|83655|137.81|79.93|19.16|18.20|||15.31|15.61|15.61|15.92|89.58|93.71|100.60|100.60|107.49|82.69|89.58|103.36|117.14|122.38|121.27|103.36|117.14| 15.31 | 122.38 | 93.71 30001095|HC CADMIUM; HEAVY METAL PROFILE|0300|82300|137.81|79.93|50.41|47.8895|||10.07|10.28|10.28|10.48|89.58|93.71|100.60|100.60|107.49|82.69|89.58|103.36|117.14|122.38|121.27|103.36|117.14| 10.07 | 122.38 | 93.71 30001096|HC LEAD; OTHER|0300|83655|154.35|89.52|19.16|18.20|||15.31|15.61|15.61|15.92|100.33|104.96|112.68|112.68|120.39|92.61|100.33|115.76|131.20|137.06|135.83|115.76|131.20| 15.31 | 137.06 | 104.96 30001097|HC SENSITIVITY; AGAR DILUTION|0300|87181|308.70|179.05|14.50|13.78|||7.30|7.45|7.45|7.59|200.66|209.92|225.35|225.35|240.79|185.22|200.66|231.53|262.40|274.13|271.66|231.53|262.40| 7.30 | 274.13 | 209.92 30001098|HC FFP, THAWING, EA UNIT|0300|86927|248.06|143.87|||149.16|149.16|26.17|26.69|26.69|27.21|161.24|168.68|181.08|181.08|193.49|148.84|161.24|186.05|210.85|220.28|218.29|186.05|210.85| 26.17 | 220.28 | 168.68 30001099|HC IMMUNOASSAY, NON-AB; PLA2R|0300|83516|248.06|143.87|239.51|227.53|||13.08|13.34|13.34|13.61|161.24|168.68|181.08|181.08|193.49|148.84|161.24|186.05|210.85|220.28|218.29|186.05|210.85| 13.08 | 239.51 | 181.08 30001100|HC MACROSCOPIC EXAM|0300|87168|115.76|67.14|20.13|19.1235|||6.57|6.7|6.7|6.83|75.24|78.72|84.50|84.50|90.29|69.46|75.24|86.82|98.40|102.79|101.87|86.82|98.40| 6.57 | 102.79 | 78.72 30001101|HC LOUSE ID|0300|87172|51.82|30.06|12.87|12.23|||6.57|6.70|6.70|6.83|33.68|35.24|37.83|37.83|40.42|31.09|33.68|38.87|44.05|46.02|45.60|38.87|44.05| 6.57 | 46.02 | 35.24 30001102|HC HEP B GENOTYPE DNA|0300|87912|1,119.04|649.04|484.35|460.1325|||||||727.38|760.95|816.90|816.90|872.85|671.42|727.38|839.28|951.18|993.71|984.76|839.28|951.18| 460.13 | 993.71 | 816.90 30001106|HC DIHYDROTESTOSTERONE|0300|82642|114.66|66.50|||||||||74.53|77.97|83.70|83.70|89.43|68.80|74.53|86.00|97.46|101.82|100.90|86.00|97.46| 68.80 | 101.82 | 86.00 30001107|HC CLOTTING ASSAY, WHOLE BLOOD|0300|85396|347.29|201.43|24.61|23.38|||16.08|16.40|16.40|16.72|225.74|236.16|253.52|253.52|270.89|208.37|225.74|260.47|295.20|308.39|305.62|260.47|295.20| 16.08 | 308.39 | 236.16 30001108|HC FETAL CHROM MICRODELETIONS|0300|81422|1,587.60|920.81|||||||||1031.94|1079.57|1158.95|1158.95|1238.33|952.56|1031.94|1190.70|1349.46|1409.79|1397.09|1190.70|1349.46| 952.56 | 1,409.79 | 1,190.70 30001109|HC IMMUNODIFFUSION, NES|0300|86329|319.73|185.44|25.01|23.76|||17.86|18.22|18.22|18.57|207.82|217.42|233.40|233.40|249.39|191.84|207.82|239.80|271.77|283.92|281.36|239.80|271.77| 17.86 | 283.92 | 217.42 30001110|HC UREA NITROGEN CLEARANCE|0300|84545|192.94|111.91|34.78|33.04|||11.94|12.18|12.18|12.42|125.41|131.20|140.85|140.85|150.49|115.76|125.41|144.71|164.00|171.33|169.79|144.71|164.00| 11.94 | 171.33 | 131.20 30001111|HC INF AGENT DET; GI 3-5 TARGETS|0300|87505|358.31|207.82|211.66|201.08|||||||232.90|243.65|261.57|261.57|279.48|214.99|232.90|268.73|304.56|318.18|315.31|268.73|304.56| 201.08 | 318.18 | 261.57 30001112|HC INF AGENT DET; GI 6-11 TARGETS|0300|87506|573.30|332.51|352.13|334.52|||||||372.65|389.84|418.51|418.51|447.17|343.98|372.65|429.98|487.31|509.09|504.50|429.98|487.31| 334.52 | 509.09 | 418.51 30001113|HC IA INFEC AGNT AB, QT; PNEU|0300|86317|49.61|28.77|35.04|33.288|||13.08|13.34|13.34|13.61|32.25|33.73|36.22|36.22|38.70|29.77|32.25|37.21|42.17|44.05|43.66|37.21|42.17| 13.08 | 44.05 | 35.04 30001114|HC IMMNOASSAY NONAB; GLIADIN IGA|0300|83516|181.91|105.51|239.51|227.53|||13.08|13.34|13.34|13.61|118.24|123.70|132.79|132.79|141.89|109.15|118.24|136.43|154.62|161.54|160.08|136.43|154.62| 13.08 | 239.51 | 132.79 30001115|HC ALLG SPEC IGE; CRUDE, IND|0300|86003|51.82|30.06|12.20|11.59|||8.03|8.19|8.19|8.35|33.68|35.24|37.83|37.83|40.42|31.09|33.68|38.87|44.05|46.02|45.60|38.87|44.05| 8.03 | 46.02 | 35.24 30001116|HC ALLG SPEC IGE; RECOMB, IND|0300|86008|51.82|30.06|||||||||33.68|35.24|37.83|37.83|40.42|31.09|33.68|38.87|44.05|46.02|45.60|38.87|44.05| 31.09 | 46.02 | 38.87 30001117|HC CHLAMYDIA NA, AMP PROBE; OTHER|0300|87491|281.14|163.06|59.23|56.27|||53.93|55.01|55.01|56.09|182.74|191.18|205.23|205.23|219.29|168.68|182.74|210.86|238.97|249.65|247.40|210.86|238.97| 53.93 | 249.65 | 191.18 30001118|HC NEISSERIA NA, AMP PROBE; OTHER|0300|87591|281.14|163.06|59.23|56.27|||53.93|55.01|55.01|56.09|182.74|191.18|205.23|205.23|219.29|168.68|182.74|210.86|238.97|249.65|247.40|210.86|238.97| 53.93 | 249.65 | 191.18 30001119|HC IMMUNOASSAY; QT, NONAB-VEGF|0300|83520|358.31|207.82|28.69|27.26|||||||232.90|243.65|261.57|261.57|279.48|214.99|232.90|268.73|304.56|318.18|315.31|268.73|304.56| 27.26 | 318.18 | 261.57 30001120|HC IMMUNOASSAY; QL/SEMI QT, VGCCA|0300|83516|248.06|143.87|239.51|227.53|||13.08|13.34|13.34|13.61|161.24|168.68|181.08|181.08|193.49|148.84|161.24|186.05|210.85|220.28|218.29|186.05|210.85| 13.08 | 239.51 | 181.08 30001121|HC BULLOUS PEMPHIGOID BP180, BP230|0300|83516|165.38|95.92|239.51|227.53|||13.08|13.34|13.34|13.61|107.50|112.46|120.73|120.73|129.00|99.23|107.50|124.04|140.57|146.86|145.53|124.04|140.57| 13.08 | 239.51 | 120.73 30001122|HC AB; HEPATITIS D (HDV)|0300|86692|165.38|95.92|51.51|48.93|||9.81|10.01|10.01|10.20|107.50|112.46|120.73|120.73|129.00|99.23|107.50|124.04|140.57|146.86|145.53|124.04|140.57| 9.81 | 146.86 | 112.46 30001123|HC PROTOPORPHYRINS FRACTIONATED, WB|0300|82542|242.55|140.68|248.42|236.00|||11.45|11.68|11.68|11.91|157.66|164.93|177.06|177.06|189.19|145.53|157.66|181.91|206.17|215.38|213.44|181.91|206.17| 11.45 | 248.42 | 177.06 30001124|HC CLOTTING; FACTOR X|0300|85260|237.04|137.48|52.04|49.44|||15.45|15.76|15.76|16.07|154.08|161.19|173.04|173.04|184.89|142.22|154.08|177.78|201.48|210.49|208.60|177.78|201.48| 15.45 | 210.49 | 161.19 30001125|HC PLASMINOGEN ACTIVATOR|0300|85415|275.63|159.87|108.07|102.67|||13.34|13.61|13.61|13.88|179.16|187.43|201.21|201.21|214.99|165.38|179.16|206.72|234.29|244.76|242.55|206.72|234.29| 13.34 | 244.76 | 187.43 30001126|HC TROPONIN, POCT|0300|84484|154.35|89.52|53.93|51.2335|||17.09|17.43|17.43|17.77|100.33|104.96|112.68|112.68|120.39|92.61|100.33|115.76|131.20|137.06|135.83|115.76|131.20| 17.09 | 137.06 | 104.96 30001127|HC TRANSCORTIN|0300|84449|143.88|83.45|45.47|43.1965|||23.55|24.02|24.02|24.49|93.52|97.84|105.03|105.03|112.23|86.33|93.52|107.91|122.30|127.77|126.61|107.91|122.30| 23.55 | 127.77 | 97.84 30001128|HC MPN EXTENDED REFLEX PANEL|0300|81479|1,626.19|943.19|61.02|57.97|||||||1057.02|1105.81|1187.12|1187.12|1268.43|975.71|1057.02|1219.64|1382.26|1444.06|1431.05|1219.64|1382.26| 57.97 | 1,444.06 | 1,187.12 30001129|HC HIV-2 QUANT W/ REVERSE TRNSCRP|0300|87539|715.52|415.00|||||13.08|13.34|13.34|13.61|465.09|486.55|522.33|522.33|558.11|429.31|465.09|536.64|608.19|635.38|629.66|536.64|608.19| 13.08 | 635.38 | 522.33 30001130|HC HBB FULL GENE SEQUENCE|0300|81364|1,130.06|655.43|||||||||734.54|768.44|824.94|824.94|881.45|678.04|734.54|847.55|960.55|1003.49|994.45|847.55|960.55| 678.04 | 1,003.49 | 847.55 30001131|HC PROSTAGLANDIN, EACH|0300|84150|186.32|108.07|88.97|84.52|||30.22|30.83|30.83|31.43|121.11|126.70|136.01|136.01|145.33|111.79|121.11|139.74|158.37|165.45|163.96|139.74|158.37| 30.22 | 165.45 | 126.70 30001132|HC BIOFIRE GI PANEL 22 TARGETS|0300|0097U|759.69|440.62|||||||||493.80|516.59|554.57|554.57|592.56|455.81|493.80|569.77|645.74|674.60|668.53|569.77|645.74| 455.81 | 674.60 | 569.77 30001133|HC RESP PTHGN 21 TRGTS; BIOFIRE|0300|0100U|796.40|461.91|||||||||517.66|541.55|581.37|581.37|621.19|477.84|517.66|597.30|676.94|707.20|700.83|597.30|676.94| 477.84 | 707.20 | 597.30 30001134|HC IGG4 PEANUT|0300|86001|90.30|52.37|10.24|9.73|||8.03|8.19|8.19|8.35|58.70|61.40|65.92|65.92|70.43|54.18|58.70|67.73|76.76|80.19|79.46|67.73|76.76| 8.03 | 80.19 | 61.40 30001135|HC TICK-BORN PANEL; LYMES|0300|86618|220.50|127.89|60.30|57.29|||9.81|10.01|10.01|10.20|143.33|149.94|160.97|160.97|171.99|132.30|143.33|165.38|187.43|195.80|194.04|165.38|187.43| 9.81 | 195.80 | 149.94 30001136|HC TICK-BORN PANEL; PROTOZOA, NES|0300|86753|71.93|41.72|26.45|25.1275|||9.81|10.01|10.01|10.2|46.75|48.91|52.51|52.51|56.11|43.16|46.75|53.95|61.14|63.87|63.30|53.95|61.14| 9.81 | 63.87 | 48.91 30001137|HC TICK-BORN PANEL; EHRLICHIA|0300|86666|210.00|121.80|88.16|83.752|||12|12.24|12.24|12.48|136.50|142.80|153.30|153.30|163.80|126.00|136.50|157.50|178.50|186.48|184.80|157.50|178.50| 12.00 | 186.48 | 142.80 30001138|HC 21-HYDROXYLASE AUTOANTIBODY|0300|83519|215.25|124.85|28.69|27.2555|||15.83|16.15|16.15|16.46|139.91|146.37|157.13|157.13|167.90|129.15|139.91|161.44|182.96|191.14|189.42|161.44|182.96| 15.83 | 191.14 | 146.37 30001139|HC ADALIMUMAB|0300|80145|358.58|207.98|||||||||233.08|243.83|261.76|261.76|279.69|215.15|233.08|268.94|304.79|318.42|315.55|268.94|304.79| 215.15 | 318.42 | 268.94 30001140|HC POSACONAZOLE|0300|80187|144.90|84.04|||||||||94.19|98.53|105.78|105.78|113.02|86.94|94.19|108.68|123.17|128.67|127.51|108.68|123.17| 86.94 | 128.67 | 108.68 30001141|HC INFLIXIMAB|0300|80230|309.75|179.66|||||||||201.34|210.63|226.12|226.12|241.61|185.85|201.34|232.31|263.29|275.06|272.58|232.31|263.29| 185.85 | 275.06 | 232.31 30001142|HC LACOSAMIDE|0300|80235|144.90|84.04|||||||||94.19|98.53|105.78|105.78|113.02|86.94|94.19|108.68|123.17|128.67|127.51|108.68|123.17| 86.94 | 128.67 | 108.68 30001143|HC VORICONAZOLE|0300|80285|144.90|84.04|||||||||94.19|98.53|105.78|105.78|113.02|86.94|94.19|108.68|123.17|128.67|127.51|108.68|123.17| 86.94 | 128.67 | 108.68 30001144|HC SULFONYLUREA|0300|80377|183.75|106.58|67.13|63.77|||||||119.44|124.95|134.14|134.14|143.33|110.25|119.44|137.81|156.19|163.17|161.70|137.81|156.19| 63.77 | 163.17 | 134.14 30001145|HC SULFONYLUREA|0300|g0481|183.75|106.58|88.82|84.38|||||||119.44|124.95|134.14|134.14|143.33|110.25|119.44|137.81|156.19|163.17|161.70|137.81|156.19| 84.38 | 163.17 | 134.14 30001148|HC MACROPROLACTIN|0300|84146|194.25|112.67|62.44|59.318|||35.02|35.72|35.72|36.42|126.26|132.09|141.80|141.80|151.52|116.55|126.26|145.69|165.11|172.49|170.94|145.69|165.11| 35.02 | 172.49 | 132.09 30001149|HC THYROGLOBULIN; LYMPH NODE ASP|0300|84432|252.00|146.16|69.9|66.405|||23.55|24.02|24.02|24.49|163.80|171.36|183.96|183.96|196.56|151.20|163.80|189.00|214.20|223.78|221.76|189.00|214.20| 23.55 | 223.78 | 171.36 30001150|HC RETICULOCYTE, AUTOMATED|0300|85045|99.75|57.86|62.41|59.2895|||7.24|7.38|7.38|7.52|64.84|67.83|72.82|72.82|77.81|59.85|64.84|74.81|84.79|88.58|87.78|74.81|84.79| 7.24 | 88.58 | 67.83 30001151|HC MECP2 GENE KNOWN VARIANT|0300|81303|472.50|274.05|||||||||307.13|321.30|344.93|344.93|368.55|283.50|307.13|354.38|401.63|419.58|415.80|354.38|401.63| 283.50 | 419.58 | 354.38 30001152|HC PMP22 GENE DUP/DEL|0300|81324|792.75|459.80|||||||||515.29|539.07|578.71|578.71|618.35|475.65|515.29|594.56|673.84|703.96|697.62|594.56|673.84| 475.65 | 703.96 | 594.56 30001153|HC HLA I TYPING 1 LOCUS, HR|0300|81380|472.50|274.05|||||||||307.13|321.30|344.93|344.93|368.55|283.50|307.13|354.38|401.63|419.58|415.80|354.38|401.63| 283.50 | 419.58 | 354.38 30001154|HC 21 HYDROXYLASE AUTOANTIBODIES|0300|83516|215.25|124.85|239.51|227.5345|||13.08|13.34|13.34|13.61|139.91|146.37|157.13|157.13|167.90|129.15|139.91|161.44|182.96|191.14|189.42|161.44|182.96| 13.08 | 239.51 | 157.13 30001155|HC INF DIS, BACT, FUNG, PRSTS; DNA, PCR|0300|0152U|2,625.00|1,522.50|||||||||1706.25|1785.00|1916.25|1916.25|2047.50|1575.00|1706.25|1968.75|2231.25|2331.00|2310.00|1968.75|2231.25| 1,575.00 | 2,331.00 | 1,968.75 30001156|HC IA; BROADRANGE BACT, PCR|0300|87801|446.25|258.83|118.45|112.53|||53.94|55.02|55.02|56.10|290.06|303.45|325.76|325.76|348.08|267.75|290.06|334.69|379.31|396.27|392.70|334.69|379.31| 53.94 | 396.27 | 303.45 30001157|HC VEDOLIZUMAB|0300|80280|288.75|167.48|||||||||187.69|196.35|210.79|210.79|225.23|173.25|187.69|216.56|245.44|256.41|254.10|216.56|245.44| 173.25 | 256.41 | 216.56 30001158|HC CLOTTING; PREKALLIKREIN|0300|85292|288.75|167.48|38.88|36.94|||15.45|15.76|15.76|16.07|187.69|196.35|210.79|210.79|225.23|173.25|187.69|216.56|245.44|256.41|254.10|216.56|245.44| 15.45 | 256.41 | 196.35 30001159|HC CLOTTING; HMW KININOGEN|0300|85293|197.93|114.80|38.88|36.94|||15.45|15.76|15.76|16.07|128.65|134.59|144.49|144.49|154.39|118.76|128.65|148.45|168.24|175.76|174.18|148.45|168.24| 15.45 | 175.76 | 134.59 30001160|HC GROWTH HORMONE HUMAN AB|0300|86277|57.75|33.50|54.1|51.395|||27.47|28.02|28.02|28.57|37.54|39.27|42.16|42.16|45.05|34.65|37.54|43.31|49.09|51.28|50.82|43.31|49.09| 27.47 | 54.10 | 42.16 30001161|HC BIOTIINIDASE EA SPECIMEN|0300|82261|115.50|66.99|72.43|68.81|||13.74|14.01|14.01|14.29|75.08|78.54|84.32|84.32|90.09|69.30|75.08|86.63|98.18|102.56|101.64|86.63|98.18| 13.74 | 102.56 | 78.54 30001162|HC QUANT ASSAY; THIOPURINE METABOLITES|0300|80299|414.75|240.56|51.65|49.07|||26.17|26.69|26.69|27.21|269.59|282.03|302.77|302.77|323.51|248.85|269.59|311.06|352.54|368.30|364.98|311.06|352.54| 26.17 | 368.30 | 282.03 30001163|HC ALPHA-1-ANTITRYPSIN; FECAL|0300|82103|90.98|52.77|39.94|37.94|||17.86|18.22|18.22|18.57|59.14|61.87|66.42|66.42|70.96|54.59|59.14|68.24|77.33|80.79|80.06|68.24|77.33| 17.86 | 80.79 | 61.87 30011003|HC ESTROGENS, FRACTIONATED|0300|82671|275.63|159.87|93.59|88.91|||48.08|49.04|49.04|50.00|179.16|187.43|201.21|201.21|214.99|165.38|179.16|206.72|234.29|244.76|242.55|206.72|234.29| 48.08 | 244.76 | 187.43 30011004|HC VKORC1 GENE|0300|81355|296.30|171.85|91.35|86.7825|||||||192.60|201.48|216.30|216.30|231.11|177.78|192.60|222.23|251.86|263.11|260.74|222.23|251.86| 86.78 | 263.11 | 216.30 30011005|HC HLA TYPING, COMPLETE|0300|81379|1,157.63|671.43|||||||||752.46|787.19|845.07|845.07|902.95|694.58|752.46|868.22|983.99|1027.98|1018.71|868.22|983.99| 694.58 | 1,027.98 | 868.22 30011006|HC CLOSTRIDIUM DIFF AG, IA|0300|87324|118.44|68.70|43.13|40.97|||13.08|13.34|13.34|13.61|76.99|80.54|86.46|86.46|92.38|71.06|76.99|88.83|100.67|105.17|104.23|88.83|100.67| 13.08 | 105.17 | 80.54 30100000|HC POCT-OCCULT BLOOD TESTING|0301|82272|37.01|21.47|32.38|30.76|||5.05|5.15|5.15|5.25|24.06|25.17|27.02|27.02|28.87|22.21|24.06|27.76|31.46|32.86|32.57|27.76|31.46| 5.05 | 32.86 | 27.02 30100001|HC ESTRADIOL|0301|82670|344.44|199.78|98.44|93.52|||50.53|51.54|51.54|52.55|223.89|234.22|251.44|251.44|268.66|206.66|223.89|258.33|292.77|305.86|303.11|258.33|292.77| 50.53 | 305.86 | 234.22 30200000|HC QUANT OF DRUG, N.E.S.|0302|80299|276.58|160.42|51.65|49.07|||26.17|26.69|26.69|27.21|179.78|188.07|201.90|201.90|215.73|165.95|179.78|207.44|235.09|245.60|243.39|207.44|235.09| 26.17 | 245.60 | 188.07 30200001|HC COCAINE CONF|0302|82520|188.48|109.32|||||12.56|12.81|12.81|13.06|122.51|128.17|137.59|137.59|147.01|113.09|122.51|141.36|160.21|167.37|165.86|141.36|160.21| 12.56 | 167.37 | 137.59 30200002|HC I.A., QUAL/SEMI-QT; MULT STEP|0302|83516|181.91|105.51|239.51|227.53|||13.08|13.34|13.34|13.61|118.24|123.70|132.79|132.79|141.89|109.15|118.24|136.43|154.62|161.54|160.08|136.43|154.62| 13.08 | 239.51 | 132.79 30200003|HC TISSUE TRANSGLUTAMINASE, IGG|0302|83516|272.76|158.20|239.51|227.5345|||13.08|13.34|13.34|13.61|177.29|185.48|199.11|199.11|212.75|163.66|177.29|204.57|231.85|242.21|240.03|204.57|231.85| 13.08 | 242.21 | 199.11 30200004|HC IGFB3, ESOTERIX|0302|83519|450.95|261.55|28.69|27.26|||15.83|16.15|16.15|16.46|293.12|306.65|329.19|329.19|351.74|270.57|293.12|338.21|383.31|400.44|396.84|338.21|383.31| 15.83 | 400.44 | 306.65 30200005|HC PROCALCITONIN|0302|84145|244.38|141.74|213.75|203.06|||30.88|31.49|31.49|32.11|158.85|166.18|178.40|178.40|190.62|146.63|158.85|183.29|207.72|217.01|215.05|183.29|207.72| 30.88 | 217.01 | 178.40 30200006|HC ANTIBODY, HIV-1 AND HIV-2|0302|86703|256.08|148.53|34.65|32.9175|||6.54|6.67|6.67|6.8|166.45|174.13|186.94|186.94|199.74|153.65|166.45|192.06|217.67|227.40|225.35|192.06|217.67| 6.54 | 227.40 | 174.13 30200007|HC HHV-6 ANTIBODY IGG|0302|86790|334.75|194.16|26.45|25.13|||9.81|10.01|10.01|10.2|217.59|227.63|244.37|244.37|261.11|200.85|217.59|251.06|284.54|297.26|294.58|251.06|284.54| 9.81 | 297.26 | 227.63 30200008|HC HHV-6 ANTIBODY, IGM|0302|86790|320.57|185.93|26.45|25.1275|||9.81|10.01|10.01|10.2|208.37|217.99|234.02|234.02|250.04|192.34|208.37|240.43|272.48|284.67|282.10|240.43|272.48| 9.81 | 284.67 | 217.99 30200009|HC ASPERGILLUS ANTIGEN|0302|87305|442.69|256.76|||||||||287.75|301.03|323.16|323.16|345.30|265.61|287.75|332.02|376.29|393.11|389.57|332.02|376.29| 265.61 | 393.11 | 332.02 30200010|HC GALACTOKINASE, BLOOD|0302|82759|348.42|202.08|37.18|35.321|||14.91|15.21|15.21|15.51|226.47|236.93|254.35|254.35|271.77|209.05|226.47|261.32|296.16|309.40|306.61|261.32|296.16| 14.91 | 309.40 | 236.93 30200011|HC VIRUS AB, NES|0302|86790|365.86|212.20|26.45|25.1275|||9.81|10.01|10.01|10.2|237.81|248.78|267.08|267.08|285.37|219.52|237.81|274.40|310.98|324.88|321.96|274.40|310.98| 9.81 | 324.88 | 248.78 30200012|HC CALPROTECTIN, FECAL|0302|83993|453.87|263.24|||||||||295.02|308.63|331.33|331.33|354.02|272.32|295.02|340.40|385.79|403.04|399.41|340.40|385.79| 272.32 | 403.04 | 340.40 30200013|HC MONONUC CELL AG.QT.NOS|0302|86356|348.25|201.99|40.08|38.076|||||||226.36|236.81|254.22|254.22|271.64|208.95|226.36|261.19|296.01|309.25|306.46|261.19|296.01| 38.08 | 309.25 | 254.22 30600002|HC SARS-COV-2 COVID-29 AMP PRB|0306|87635|115.50|66.99|78.06|74.157|||||||75.08|78.54|84.32|84.32|90.09|69.30|75.08|86.63|98.18|102.56|101.64|86.63|98.18| 69.30 | 102.56 | 84.32 30600003|HC SARS-COV-2 COVID-29 AMP PRB U0002|0306|U0002|115.50|66.99|61.32|58.25|||||||75.08|78.54|84.32|84.32|90.09|69.30|75.08|86.63|98.18|102.56|101.64|86.63|98.18| 58.25 | 102.56 | 84.32 30600004|HC IA COVID-19 HIGH THROUGHPUT REF|0306|U0003|115.50|66.99|111.18|105.62|||||||75.08|78.54|84.32|84.32|90.09|69.30|75.08|86.63|98.18|102.56|101.64|86.63|98.18| 69.30 | 111.18 | 86.63 30600005|HC IA COVID-19 HIGH THROUGHPUT SV|0306|U0004|115.50|66.99|111.18|105.62|||||||75.08|78.54|84.32|84.32|90.09|69.30|75.08|86.63|98.18|102.56|101.64|86.63|98.18| 69.30 | 111.18 | 86.63 30600006|HC AB; COVID-19, IGG|0306|86769|90.30|52.37|15.51|14.73|||||||58.70|61.40|65.92|65.92|70.43|54.18|58.70|67.73|76.76|80.19|79.46|67.73|76.76| 14.73 | 80.19 | 65.92 31000001|HC GBONE MARROW ASP ONLY|0310|38220|227.78|132.11|||1,407.00|1,407.00|44.84|45.73|45.73|46.63|148.06|154.89|166.28|166.28|177.67|136.67|148.06|170.84|193.61|202.27|200.45|170.84|193.61| 44.84 | 1,407.00 | 166.28 31000002|HC BONE MARROW ASP & BX|0310|38221|336.49|195.16|||1,407.00|1,407.00|56.98|58.12|58.12|59.26|218.72|228.81|245.64|245.64|262.46|201.89|218.72|252.37|286.02|298.80|296.11|252.37|286.02| 56.98 | 1,407.00 | 245.64 31000003|HC CD4 HELPER T LYMPH|0310|86361|279.31|162.00|40.08|38.08|||37.61|38.37|38.37|39.12|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 37.61 | 248.03 | 189.93 31000004|HC FINE NEEDLE ASP SP ADDQ-SUP|0310|88172|91.06|52.81|68.83|65.39|149.16|149.16|14.86|15.16|15.16|15.46|59.19|61.92|66.47|66.47|71.03|54.64|59.19|68.30|77.40|80.86|80.13|68.30|77.40| 14.86 | 149.16 | 66.47 31000004|HC FINE NEEDLE ASP SP ADDQ-SUP|0310|88172|91.06|52.81|68.83|65.39|149.16|149.16|39.25|40.03|40.03|40.82|59.19|61.92|66.47|66.47|71.03|54.64|59.19|68.30|77.40|80.86|80.13|68.30|77.40| 39.25 | 149.16 | 66.47 31000005|HC FINE NEEDLE ASPIRATION INT & R|0310|88173|83.40|48.37|177.13|168.27|49.76|49.76|17.62|17.98|17.98|18.33|54.21|56.71|60.88|60.88|65.05|50.04|54.21|62.55|70.89|74.06|73.39|62.55|70.89| 17.62 | 177.13 | 60.88 31000005|HC FINE NEEDLE ASPIRATION INT & R|0310|88173|83.40|48.37|177.13|168.27|49.76|49.76|51.01|52.03|52.03|53.05|54.21|56.71|60.88|60.88|65.05|50.04|54.21|62.55|70.89|74.06|73.39|62.55|70.89| 49.76 | 177.13 | 60.88 31000006|HC FLOW CYTOMETRY,INITIAL MARKER|0310|88184|211.06|122.41|184.62|175.39|291.26|291.26|43.19|44.05|44.05|44.92|137.19|143.52|154.07|154.07|164.63|126.64|137.19|158.30|179.40|187.42|185.73|158.30|179.40| 43.19 | 291.26 | 158.30 31000007|HC CHROMOSOME-CULTURE-BLOOD|0310|88230|1,270.84|737.09|462.85|439.71|||34.88|35.58|35.58|36.28|826.05|864.17|927.71|927.71|991.26|762.50|826.05|953.13|1080.21|1128.51|1118.34|953.13|1080.21| 34.88 | 1,128.51 | 864.17 31000008|HC TISSUE CULTURE-SOLID TISSUE|0310|88233|991.85|575.27|320.39|304.37|||52.32|53.37|53.37|54.41|644.70|674.46|724.05|724.05|773.64|595.11|644.70|743.89|843.07|880.76|872.83|743.89|843.07| 52.32 | 880.76 | 674.46 31000009|HC CHROMOSOME-CULTURE-BONE MARROW|0310|88237|1,214.54|704.43|462.85|439.71|||34.88|35.58|35.58|36.28|789.45|825.89|886.61|886.61|947.34|728.72|789.45|910.91|1032.36|1078.51|1068.80|910.91|1032.36| 34.88 | 1,078.51 | 825.89 31000010|HC CHROM 16-20 CELLS 2K W/B|0310|88262|1,729.67|1,003.21|412.46|391.84|||225.36|229.87|229.87|234.37|1124.29|1176.18|1262.66|1262.66|1349.14|1037.80|1124.29|1297.25|1470.22|1535.95|1522.11|1297.25|1470.22| 225.36 | 1,535.95 | 1,176.18 31000011|HC CHROM 16-20 CELLS 2K W/BAND|0310|88262|1,093.20|634.06|412.46|391.84|||225.36|229.87|229.87|234.37|710.58|743.38|798.04|798.04|852.70|655.92|710.58|819.90|929.22|970.76|962.02|819.90|929.22| 225.36 | 970.76 | 743.38 31000012|HC CHROMOSOME-ANAL-BLOOD|0310|88262|1,729.67|1,003.21|412.46|391.84|||225.36|229.87|229.87|234.37|1124.29|1176.18|1262.66|1262.66|1349.14|1037.80|1124.29|1297.25|1470.22|1535.95|1522.11|1297.25|1470.22| 225.36 | 1,535.95 | 1,176.18 31000013|HC MOL. CYTO EA. PROBE (FISH)|0310|88271|157.73|91.48|116.01|110.21|||33.28|33.95|33.95|34.62|102.52|107.26|115.14|115.14|123.03|94.64|102.52|118.30|134.07|140.06|138.80|118.30|134.07| 33.28 | 140.06 | 115.14 31000014|HC MOL CYTO 10-30 CELLS|0310|88273|727.14|421.74|116.01|110.21|||49.93|50.92|50.92|51.92|472.64|494.46|530.81|530.81|567.17|436.28|472.64|545.36|618.07|645.70|639.88|545.36|618.07| 49.93 | 645.70 | 494.46 31000015|HC CHROMOSOME, ADDL KARYOTYPE|0310|88280|473.54|274.65|164.86|156.62|||45.39|46.29|46.29|47.20|307.80|322.01|345.68|345.68|369.36|284.12|307.80|355.16|402.51|420.50|416.72|355.16|402.51| 45.39 | 420.50 | 322.01 31000016|HC CYTOGENETICS|0310|88291|253.41|146.98|86.73|82.39|||32.60|33.26|33.26|33.91|164.72|172.32|184.99|184.99|197.66|152.05|164.72|190.06|215.40|225.03|223.00|190.06|215.40| 32.60 | 225.03 | 172.32 31000017|HC SURG-PATH-GROSS-EXAM|0310|88300|116.94|67.83|25.01|23.76|24.67|24.67|3.85|3.92|3.92|4.00|76.01|79.52|85.37|85.37|91.21|70.16|76.01|87.71|99.40|103.84|102.91|87.71|99.40| 3.85 | 103.84 | 76.01 31000017|HC SURG-PATH-GROSS-EXAM|0310|88300|116.94|67.83|25.01|23.76|24.67|24.67|13.97|14.25|14.25|14.53|76.01|79.52|85.37|85.37|91.21|70.16|76.01|87.71|99.40|103.84|102.91|87.71|99.40| 13.97 | 103.84 | 76.01 31000018|HC SURG PATH LEVEL 2|0310|88302|227.78|132.11|63.35|60.18|24.67|24.67|9.81|10.01|10.01|10.20|148.06|154.89|166.28|166.28|177.67|136.67|148.06|170.84|193.61|202.27|200.45|170.84|193.61| 9.81 | 202.27 | 148.06 31000018|HC SURG PATH LEVEL 2|0310|88302|227.78|132.11|63.35|60.18|24.67|24.67|30.54|31.15|31.15|31.76|148.06|154.89|166.28|166.28|177.67|136.67|148.06|170.84|193.61|202.27|200.45|170.84|193.61| 24.67 | 202.27 | 148.06 31000019|HC SURG PATH LEVEL 3|0310|88304|183.62|106.50|91.43|86.86|49.76|49.76|12.89|13.14|13.14|13.40|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 12.89 | 163.05 | 119.35 31000019|HC SURG PATH LEVEL 3|0310|88304|183.62|106.50|91.43|86.86|49.76|49.76|39.47|40.26|40.26|41.05|119.35|124.86|134.04|134.04|143.22|110.17|119.35|137.72|156.08|163.05|161.59|137.72|156.08| 39.47 | 163.05 | 119.35 31000020|HC CYTOLOGIC-STUDY-BLOCK-CELL-|0310|88305|261.14|151.46|153.81|146.12|49.76|49.76|22.42|22.87|22.87|23.32|169.74|177.58|190.63|190.63|203.69|156.68|169.74|195.86|221.97|231.89|229.80|195.86|221.97| 22.42 | 231.89 | 169.74 31000020|HC CYTOLOGIC-STUDY-BLOCK-CELL-|0310|88305|261.14|151.46|153.81|146.12|49.76|49.76|90.16|91.96|91.96|93.76|169.74|177.58|190.63|190.63|203.69|156.68|169.74|195.86|221.97|231.89|229.80|195.86|221.97| 49.76 | 231.89 | 169.74 31000021|HC SURG PATH LEVEL 4|0310|88305|279.31|162.00|153.81|146.12|49.76|49.76|22.42|22.87|22.87|23.32|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 22.42 | 248.03 | 181.55 31000021|HC SURG PATH LEVEL 4|0310|88305|279.31|162.00|153.81|146.12|49.76|49.76|90.16|91.96|91.96|93.76|181.55|189.93|203.90|203.90|217.86|167.59|181.55|209.48|237.41|248.03|245.79|209.48|237.41| 49.76 | 248.03 | 181.55 31000022|HC SURG PATH LEVEL 5|0310|88307|455.49|264.18|213.73|203.04|291.26|291.26|33.40|34.07|34.07|34.74|296.07|309.73|332.51|332.51|355.28|273.29|296.07|341.62|387.17|404.48|400.83|341.62|387.17| 33.40 | 404.48 | 296.07 31000022|HC SURG PATH LEVEL 5|0310|88307|455.49|264.18|213.73|203.04|291.26|291.26|139.57|142.36|142.36|145.15|296.07|309.73|332.51|332.51|355.28|273.29|296.07|341.62|387.17|404.48|400.83|341.62|387.17| 139.57 | 404.48 | 296.07 31000023|HC SURG PATH LEVEL 6|0310|88309|815.35|472.90|288.45|274.03|656.15|656.15|39.07|39.85|39.85|40.63|529.98|554.44|595.21|595.21|635.97|489.21|529.98|611.51|693.05|724.03|717.51|611.51|693.05| 39.07 | 724.03 | 595.21 31000023|HC SURG PATH LEVEL 6|0310|88309|815.35|472.90|288.45|274.03|656.15|656.15|185.18|188.88|188.88|192.59|529.98|554.44|595.21|595.21|635.97|489.21|529.98|611.51|693.05|724.03|717.51|611.51|693.05| 185.18 | 724.03 | 595.21 31000024|HC SURG-PATH-DECAL-PROC|0310|88311|92.58|53.70|37.93|36.03|||22.45|22.90|22.90|23.35|60.18|62.95|67.58|67.58|72.21|55.55|60.18|69.44|78.69|82.21|81.47|69.44|78.69| 22.45 | 82.21 | 62.95 31000024|HC SURG-PATH-DECAL-PROC|0310|88311|92.58|53.70|37.93|36.03|||3.95|4.03|4.03|4.11|60.18|62.95|67.58|67.58|72.21|55.55|60.18|69.44|78.69|82.21|81.47|69.44|78.69| 3.95 | 82.21 | 62.95 31000025|HC SURG-PATH-SPECIAL-STAIN|0310|88312|171.74|99.61|61.07|58.02|49.76|49.76|12.82|13.08|13.08|13.33|111.63|116.78|125.37|125.37|133.96|103.04|111.63|128.81|145.98|152.51|151.13|128.81|145.98| 12.82 | 152.51 | 111.63 31000025|HC SURG-PATH-SPECIAL-STAIN|0310|88312|171.74|99.61|61.07|58.02|49.76|49.76|25.64|26.16|26.16|26.67|111.63|116.78|125.37|125.37|133.96|103.04|111.63|128.81|145.98|152.51|151.13|128.81|145.98| 25.64 | 152.51 | 111.63 31000026|HC SURG. PATH, SPECIAL STAIN GRII|0310|88313|212.39|123.19|47.41|45.04|33.84|33.84|3.95|4.03|4.03|4.11|138.05|144.43|155.04|155.04|165.66|127.43|138.05|159.29|180.53|188.60|186.90|159.29|180.53| 3.95 | 188.60 | 138.05 31000026|HC SURG. PATH, SPECIAL STAIN GRII|0310|88313|212.39|123.19|47.41|45.04|33.84|33.84|22.83|23.29|23.29|23.74|138.05|144.43|155.04|155.04|165.66|127.43|138.05|159.29|180.53|188.60|186.90|159.29|180.53| 22.83 | 188.60 | 138.05 31000027|HC REF CONSULT W/O SLIDE PREP|0310|88321|382.88|222.07|86.60|82.27|33.84|33.84|53.31|54.38|54.38|55.45|248.87|260.36|279.50|279.50|298.65|229.73|248.87|287.16|325.45|340.00|336.93|287.16|325.45| 33.84 | 340.00 | 248.87 31000028|HC PATHOLOGY CONSULTATION REPORT|0310|88323|119.21|69.14|129.68|123.196|49.76|49.76|14.08|14.36|14.36|14.64|77.49|81.06|87.02|87.02|92.98|71.53|77.49|89.41|101.33|105.86|104.90|89.41|101.33| 14.08 | 129.68 | 87.02 31000028|HC PATHOLOGY CONSULTATION REPORT|0310|88323|119.21|69.14|129.68|123.196|49.76|49.76|76.86|78.40|78.40|79.94|77.49|81.06|87.02|87.02|92.98|71.53|77.49|89.41|101.33|105.86|104.90|89.41|101.33| 49.76 | 129.68 | 87.02 31000029|HC SURG-PATH-FROZEN-SECTION|0310|88331|236.64|137.25|148.21|140.80|149.16|149.16|23.42|23.89|23.89|24.36|153.82|160.92|172.75|172.75|184.58|141.98|153.82|177.48|201.14|210.14|208.24|177.48|201.14| 23.42 | 210.14 | 153.82 31000029|HC SURG-PATH-FROZEN-SECTION|0310|88331|236.64|137.25|148.21|140.80|149.16|149.16|62.80|64.06|64.06|65.31|153.82|160.92|172.75|172.75|184.58|141.98|153.82|177.48|201.14|210.14|208.24|177.48|201.14| 62.80 | 210.14 | 153.82 31000030|HC FROZEN-SECTION ADDL SLIDE|0310|88332|145.79|84.56|101.91|96.8145|||9.51|9.7|9.7|9.89|94.76|99.14|106.43|106.43|113.72|87.47|94.76|109.34|123.92|129.46|128.30|109.34|123.92| 9.51 | 129.46 | 101.91 31000030|HC FROZEN-SECTION ADDL SLIDE|0310|88332|145.79|84.56|101.91|96.81|||25.66|26.17|26.17|26.68|94.76|99.14|106.43|106.43|113.72|87.47|94.76|109.34|123.92|129.46|128.30|109.34|123.92| 25.66 | 129.46 | 101.91 31000031|HC INTRAOP CYTO PATH CONSULT|0310|88333|255.27|148.06|||656.15|656.15|18.15|18.51|18.51|18.87|165.93|173.58|186.35|186.35|199.11|153.16|165.93|191.45|216.98|226.68|224.64|191.45|216.98| 18.15 | 656.15 | 186.35 31000031|HC INTRAOP CYTO PATH CONSULT|0310|88333|255.27|148.06|||656.15|656.15|72.61|74.06|74.06|75.52|165.93|173.58|186.35|186.35|199.11|153.16|165.93|191.45|216.98|226.68|224.64|191.45|216.98| 72.61 | 656.15 | 186.35 31000032|HC IMMUNOHISTO AB, INITIAL AB|0310|88342|288.67|167.43|226.35|215.03|149.16|149.16|41.87|42.70|42.70|43.54|187.64|196.30|210.73|210.73|225.16|173.20|187.64|216.50|245.37|256.34|254.03|216.50|245.37| 41.87 | 256.34 | 210.73 31000032|HC IMMUNOHISTO AB, INITIAL AB|0310|88342|288.67|167.43|226.35|215.03|149.16|149.16|13.28|13.55|13.55|13.81|187.64|196.30|210.73|210.73|225.16|173.20|187.64|216.50|245.37|256.34|254.03|216.50|245.37| 13.28 | 256.34 | 210.73 31000033|HC IMMUNOHISTO AB, EA ADD AB|0310|88343|277.82|161.14|||||||||180.58|188.92|202.81|202.81|216.70|166.69|180.58|208.37|236.15|246.70|244.48|208.37|236.15| 166.69 | 246.70 | 208.37 31000034|HC IMMUNOFLOR AB-DIRECT|0310|88346|519.45|301.28|86.53|82.2035|291.26|291.26|9.81|10.01|10.01|10.20|337.64|353.23|379.20|379.20|405.17|311.67|337.64|389.59|441.53|461.27|457.12|389.59|441.53| 9.81 | 461.27 | 337.64 31000034|HC IMMUNOFLOR AB-DIRECT|0310|88346|519.45|301.28|86.53|82.2035|291.26|291.26|32.54|33.19|33.19|33.84|337.64|353.23|379.20|379.20|405.17|311.67|337.64|389.59|441.53|461.27|457.12|389.59|441.53| 32.54 | 461.27 | 337.64 31000035|HC ELECTRON MICROSCOPY|0310|88348|337.24|195.60|741.97|704.87|656.15|656.15|47.23|48.17|48.17|49.12|219.21|229.32|246.19|246.19|263.05|202.34|219.21|252.93|286.65|299.47|296.77|252.93|286.65| 47.23 | 741.97 | 252.93 31000035|HC ELECTRON MICROSCOPY|0310|88348|337.24|195.60|741.97|704.87|656.15|656.15|159.00|162.18|162.18|165.36|219.21|229.32|246.19|246.19|263.05|202.34|219.21|252.93|286.65|299.47|296.77|252.93|286.65| 159.00 | 741.97 | 252.93 31000036|HC MICRODISSECTION, MANUAL|0310|88381|515.67|299.09|217.69|206.81|||||||335.19|350.66|376.44|376.44|402.22|309.40|335.19|386.75|438.32|457.91|453.79|386.75|438.32| 206.81 | 457.91 | 376.44 31000037|HC MACRO EXAM AND PREP|0310|88387|36.57|21.21|||||5.31|5.42|5.42|5.52|23.77|24.87|26.70|26.70|28.52|21.94|23.77|27.43|31.08|32.47|32.18|27.43|31.08| 5.31 | 32.47 | 26.70 31000037|HC MACRO EXAM AND PREP|0310|88387|36.57|21.21|||||21.01|21.43|21.43|21.85|23.77|24.87|26.70|26.70|28.52|21.94|23.77|27.43|31.08|32.47|32.18|27.43|31.08| 21.01 | 32.47 | 26.70 31000037|HC MACRO EXAM AND PREP|0310|88387|36.57|21.21|||||26.34|26.86|26.86|27.39|23.77|24.87|26.70|26.70|28.52|21.94|23.77|27.43|31.08|32.47|32.18|27.43|31.08| 21.94 | 32.47 | 26.86 31000038|HC CYTO LIQUID BASED NON-GYN|0310|88112|174.16|101.01|64.41|61.19|49.76|49.76|40.28|41.09|41.09|41.89|113.20|118.43|127.14|127.14|135.84|104.50|113.20|130.62|148.04|154.65|153.26|130.62|148.04| 40.28 | 154.65 | 113.20 31000038|HC CYTO LIQUID BASED NON-GYN|0310|88112|174.16|101.01|64.41|61.19|49.76|49.76|90.76|92.57|92.57|94.39|113.20|118.43|127.14|127.14|135.84|104.50|113.20|130.62|148.04|154.65|153.26|130.62|148.04| 49.76 | 154.65 | 113.20 31000039|HC DNA-PLOIDY-SOLID TUMOR|0310|88182|505.65|293.28|153.96|146.26|49.76|49.76|83.04|84.7|84.7|86.36|328.67|343.84|369.12|369.12|394.41|303.39|328.67|379.24|429.80|449.02|444.97|379.24|429.80| 49.76 | 449.02 | 328.67 31000039|HC DNA-PLOIDY-SOLID TUMOR|0310|88182|505.65|293.28|153.96|146.26|49.76|49.76|48.09|49.06|49.06|50.02|328.67|343.84|369.12|369.12|394.41|303.39|328.67|379.24|429.80|449.02|444.97|379.24|429.80| 48.09 | 449.02 | 328.67 31000040|HC IMMUNOHISTO AB; EA ADD SNGL AB|0310|88341|277.82|161.14|226.35|215.03|||||||180.58|188.92|202.81|202.81|216.70|166.69|180.58|208.37|236.15|246.70|244.48|208.37|236.15| 166.69 | 246.70 | 208.37 31000041|HC IMMUNOHISTO AB; EA ADD MULT AB|0310|88344|287.15|166.55|226.35|215.0325|291.26|291.26|||||186.65|195.26|209.62|209.62|223.98|172.29|186.65|215.36|244.08|254.99|252.69|215.36|244.08| 172.29 | 291.26 | 215.36 31000042|HC INSITU HYBRIDIZATION AUTO EA|0310|88367|695.57|403.43|198.02|188.12|291.26|291.26|114.41|116.70|116.70|118.99|452.12|472.99|507.77|507.77|542.54|417.34|452.12|521.68|591.23|617.67|612.10|521.68|591.23| 114.41 | 617.67 | 452.12 31000042|HC INSITU HYBRIDIZATION AUTO EA|0310|88367|695.57|403.43|198.02|188.12|291.26|291.26|175.64|179.15|179.15|182.67|452.12|472.99|507.77|507.77|542.54|417.34|452.12|521.68|591.23|617.67|612.10|521.68|591.23| 175.64 | 617.67 | 452.12 31000043|HC INSITU HYBRIDIZA, EA ADD STAIN|0310|88364|414.79|240.58|262.26|249.15|||||||269.61|282.06|302.80|302.80|323.54|248.87|269.61|311.09|352.57|368.33|365.02|311.09|352.57| 248.87 | 368.33 | 302.80 31000044|HC INSITU HYBRIDIZATION-1ST STAIN|0310|88365|414.79|240.58|262.26|249.15|149.16|149.16|46.77|47.71|47.71|48.64|269.61|282.06|302.80|302.80|323.54|248.87|269.61|311.09|352.57|368.33|365.02|311.09|352.57| 46.77 | 368.33 | 269.61 31000044|HC INSITU HYBRIDIZATION-1ST STAIN|0310|88365|414.79|240.58|262.26|249.15|149.16|149.16|100.73|102.74|102.74|104.76|269.61|282.06|302.80|302.80|323.54|248.87|269.61|311.09|352.57|368.33|365.02|311.09|352.57| 100.73 | 368.33 | 269.61 31000045|HC MORPHOMET ISH, QT/SEMI QT|0310|88377|574.34|333.12|||149.16|149.16|||||373.32|390.55|419.27|419.27|447.99|344.60|373.32|430.76|488.19|510.01|505.42|430.76|488.19| 149.16 | 510.01 | 419.27 31000046|HC CYTOLOGIC-EXAM-CYTOSP-ACCT|0310|88108|127.37|73.87|64.41|61.19|33.84|33.84|10.13|10.33|10.33|10.53|82.79|86.61|92.98|92.98|99.35|76.42|82.79|95.53|108.26|113.10|112.09|95.53|108.26| 10.13 | 113.10 | 82.79 31000046|HC CYTOLOGIC-EXAM-CYTOSP-ACCT|0310|88108|127.37|73.87|64.41|61.19|33.84|33.84|44.63|45.52|45.52|46.41|82.79|86.61|92.98|92.98|99.35|76.42|82.79|95.53|108.26|113.10|112.09|95.53|108.26| 33.84 | 113.10 | 82.79 31000047|HC CYTO NONGYN SMEAR|0310|88160|112.14|65.04|64.61|61.38|24.67|24.67|7.13|7.27|7.27|7.42|72.89|76.26|81.86|81.86|87.47|67.28|72.89|84.11|95.32|99.58|98.68|84.11|95.32| 7.13 | 99.58 | 72.89 31000047|HC CYTO NONGYN SMEAR|0310|88160|112.14|65.04|64.61|61.3795|24.67|24.67|35.08|35.78|35.78|36.48|72.89|76.26|81.86|81.86|87.47|67.28|72.89|84.11|95.32|99.58|98.68|84.11|95.32| 24.67 | 99.58 | 72.89 31000048|HC HISTOCHEM STAIN W FROZEN SECTION|0310|88314|322.98|187.33|143.5|136.325|||6.54|6.67|6.67|6.8|209.94|219.63|235.78|235.78|251.92|193.79|209.94|242.24|274.53|286.81|284.22|242.24|274.53| 6.54 | 286.81 | 219.63 31000048|HC HISTOCHEM STAIN W FROZEN SECTION|0310|88314|322.98|187.33|143.5|136.325|||23.35|23.82|23.82|24.29|209.94|219.63|235.78|235.78|251.92|193.79|209.94|242.24|274.53|286.81|284.22|242.24|274.53| 23.35 | 286.81 | 219.63 31000051|HC FLOW CYTO INTERP 16 OR > MRKRS|0310|88189|243.72|141.36|208.60|198.17|||96.36|98.28|98.28|100.21|158.42|165.73|177.92|177.92|190.10|146.23|158.42|182.79|207.16|216.42|214.47|182.79|207.16| 96.36 | 216.42 | 177.92 31000052|HC MRPHMTRC ALYS ISH, QT/SEMQT EA|0310|88374|850.86|493.50|299.57|284.59|149.16|149.16|||||553.06|578.58|621.13|621.13|663.67|510.52|553.06|638.15|723.23|755.56|748.76|638.15|723.23| 149.16 | 755.56 | 621.13 31000053|HC FLOW CYTOMETRY INTERP 2-8 MKRS|0310|88187|170.17|98.70|109.7|104.215|||58.65|59.83|59.83|61|110.61|115.72|124.22|124.22|132.73|102.10|110.61|127.63|144.64|151.11|149.75|127.63|144.64| 58.65 | 151.11 | 115.72 31000054|HC IMMUNOFL AB STAIN, EA ADD|0310|88350|352.51|204.46|||||||||229.13|239.71|257.33|257.33|274.96|211.51|229.13|264.38|299.63|313.03|310.21|264.38|299.63| 211.51 | 313.03 | 264.38 31000055|HC PROSTATE BX|0310|G0416|1,245.89|722.62|||291.26|291.26|||||809.83|847.21|909.50|909.50|971.79|747.53|809.83|934.42|1059.01|1106.35|1096.38|934.42|1059.01| 291.26 | 1,106.35 | 909.50 31000056|HC KRAS-ADDTL VARIANTS|0310|81276|316.03|183.30|||||||||205.42|214.90|230.70|230.70|246.50|189.62|205.42|237.02|268.63|280.63|278.11|237.02|268.63| 189.62 | 280.63 | 237.02 31000057|HC IHC STAIN, MULTI; COMP ASST|0310|88361|317.25|184.01|173.75|165.0625|291.26|291.26|60.37|61.57|61.57|62.78|206.21|215.73|231.59|231.59|247.46|190.35|206.21|237.94|269.66|281.72|279.18|237.94|269.66| 60.37 | 291.26 | 231.59 31000057|HC IHC STAIN, MULTI; COMP ASST|0310|88361|317.25|184.01|173.75|165.06|291.26|291.26|101.02|103.04|103.04|105.06|206.21|215.73|231.59|231.59|247.46|190.35|206.21|237.94|269.66|281.72|279.18|237.94|269.66| 101.02 | 291.26 | 231.59 31000058|HC INF DIS HCV 6 ASSAYS; FIBROSURE|0310|81596|264.60|153.47|||||||||171.99|179.93|193.16|193.16|206.39|158.76|171.99|198.45|224.91|234.96|232.85|198.45|224.91| 158.76 | 234.96 | 198.45 31000059|HC HTT GENE DET ABNORMAL ALLELES|0310|81271|826.88|479.59|||||||||537.47|562.28|603.62|603.62|644.97|496.13|537.47|620.16|702.85|734.27|727.65|620.16|702.85| 496.13 | 734.27 | 620.16 31000911|HC MCG; IP SITU 25-99 CELLS|0310|88274|911.63|528.75|116.01|110.21|||54.09|55.17|55.17|56.25|592.56|619.91|665.49|665.49|711.07|546.98|592.56|683.72|774.89|809.53|802.23|683.72|774.89| 54.09 | 809.53 | 619.91 31000912|HC IDH 1 COMMON VARIANTS|0310|81120|434.11|251.78|||||||||282.17|295.19|316.90|316.90|338.61|260.47|282.17|325.58|368.99|385.49|382.02|325.58|368.99| 260.47 | 385.49 | 325.58 31000913|HC IDH 2 COMMON VARIANTS|0310|81121|486.20|282.00|||||||||316.03|330.62|354.93|354.93|379.24|291.72|316.03|364.65|413.27|431.75|427.86|364.65|413.27| 291.72 | 431.75 | 364.65 31000914|HC MPN PANEL, FISH|0310|88374|573.30|332.51|299.57|284.59|149.16|149.16|||||372.65|389.84|418.51|418.51|447.17|343.98|372.65|429.98|487.31|509.09|504.50|429.98|487.31| 149.16 | 509.09 | 418.51 31100000|HC GYN CYTOLOGY LIQUID BASED|0311|88142|60.00|34.80|50.92|48.37|||23.35|23.82|23.82|24.29|39.00|40.80|43.80|43.80|46.80|36.00|39.00|45.00|51.00|53.28|52.80|45.00|51.00| 23.35 | 53.28 | 43.80 31100001|HC GYN CYTOLOGY CONVENTIONAL|0311|88164|127.37|73.87|14.67|13.94|||16.24|16.56|16.56|16.89|82.79|86.61|92.98|92.98|99.35|76.42|82.79|95.53|108.26|113.10|112.09|95.53|108.26| 13.94 | 113.10 | 86.61 31100002|HC FISH URINE 3-5 PROBES CMP ASST|0311|88121|1,349.22|782.55|704.19|668.98|291.26|291.26|38.14|38.90|38.90|39.66|876.99|917.47|984.93|984.93|1052.39|809.53|876.99|1011.92|1146.84|1198.11|1187.31|1011.92|1146.84| 38.14 | 1,198.11 | 876.99 31100003|HC CHROM ANLY; ADDTL CELL CT|0311|88285|210.00|121.80|21.43|20.36|||19.62|20.02|20.02|20.41|136.50|142.80|153.30|153.30|163.80|126.00|136.50|157.50|178.50|186.48|184.80|157.50|178.50| 19.62 | 186.48 | 142.80 32000001|HC PERCUTANEOUS PLACE GASTRO TUBE|0320|49440|5,333.64|3,093.51|||1,625.02|1,625.02|||||3466.87|3626.88|3893.56|3893.56|4160.24|3200.18|3466.87|4000.23|4533.59|4736.27|4693.60|4000.23|4533.59| 1,625.02 | 4,736.27 | 3,893.56 32000002|HC MANDIBLE COMPLETE|0320|70110|692.74|401.79|577.09|548.24|108.97|108.97|42.22|43.06|43.06|43.91|450.28|471.06|505.70|505.70|540.34|415.64|450.28|519.56|588.83|615.15|609.61|519.56|588.83| 42.22 | 615.15 | 505.70 32000002|HC MANDIBLE COMPLETE|0320|70110|692.74|401.79|577.09|548.24|108.97|108.97|25.02|25.52|25.52|26.02|450.28|471.06|505.70|505.70|540.34|415.64|450.28|519.56|588.83|615.15|609.61|519.56|588.83| 25.02 | 615.15 | 505.70 32000003|HC FACIAL BONES PARTIAL|0320|70140|522.70|303.17|457.22|434.36|80.90|80.90|25.02|25.52|25.52|26.02|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 25.02 | 464.16 | 381.57 32000003|HC FACIAL BONES PARTIAL|0320|70140|522.70|303.17|457.22|434.36|80.90|80.90|37.92|38.67|38.67|39.43|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 37.92 | 464.16 | 381.57 32000004|HC FACIAL BONES COMPLETE|0320|70150|522.70|303.17|457.22|434.36|108.97|108.97|31.66|32.29|32.29|32.93|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 31.66 | 464.16 | 381.57 32000004|HC FACIAL BONES COMPLETE|0320|70150|522.70|303.17|457.22|434.36|108.97|108.97|49.32|50.31|50.31|51.30|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 49.32 | 464.16 | 381.57 32000005|HC NASAL BONES|0320|70160|427.89|248.18|374.28|355.57|80.90|80.90|21.08|21.50|21.50|21.92|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 21.08 | 379.97 | 312.36 32000005|HC NASAL BONES|0320|70160|427.89|248.18|374.28|355.57|80.90|80.90|32.76|33.42|33.42|34.07|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 32.76 | 379.97 | 312.36 32000006|HC SINUSES PARANASAL PARTIAL|0320|70210|315.92|183.23|126.03|119.7285|80.90|80.90|22.90|23.35|23.35|23.81|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 22.90 | 280.54 | 205.35 32000006|HC SINUSES PARANASAL PARTIAL|0320|70210|315.92|183.23|126.03|119.7285|80.90|80.90|36.63|37.37|37.37|38.10|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 36.63 | 280.54 | 205.35 32000007|HC SKULL LESS THAN 4 VIEWS/TRA|0320|70250|522.70|303.17|457.22|434.359|108.97|108.97|41.71|42.54|42.54|43.38|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 41.71 | 464.16 | 381.57 32000007|HC SKULL LESS THAN 4 VIEWS/TRA|0320|70250|522.70|303.17|457.22|434.359|108.97|108.97|25.02|25.52|25.52|26.02|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 25.02 | 464.16 | 381.57 32000008|HC SKULL COMPLETE|0320|70260|785.02|455.31|653.98|621.28|108.97|108.97|35.99|36.71|36.71|37.43|510.26|533.81|573.06|573.06|612.32|471.01|510.26|588.77|667.27|697.10|690.82|588.77|667.27| 35.99 | 697.10 | 573.06 32000008|HC SKULL COMPLETE|0320|70260|785.02|455.31|653.98|621.28|108.97|108.97|58.65|59.83|59.83|61.00|510.26|533.81|573.06|573.06|612.32|471.01|510.26|588.77|667.27|697.10|690.82|588.77|667.27| 58.65 | 697.10 | 573.06 32000009|HC TEMPOROMANDIBULAR JOINT BIL|0320|70330|522.70|303.17|||80.9|80.9|33.58|34.26|34.26|34.93|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 33.58 | 464.16 | 355.44 32000009|HC TEMPOROMANDIBULAR JOINT BIL|0320|70330|522.70|303.17|||80.9|80.9|50.03|51.03|51.03|52.03|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 50.03 | 464.16 | 355.44 32000010|HC MANDIBLE PARTIAL (PANOREX)|0320|70355|522.70|303.17|||80.9|80.9|23.09|23.55|23.55|24.02|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 23.09 | 464.16 | 355.44 32000010|HC MANDIBLE PARTIAL (PANOREX)|0320|70355|522.70|303.17|||80.9|80.9|36.54|37.27|37.27|38.00|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 36.54 | 464.16 | 355.44 32000011|HC NECK FOR SOFT TISSUE|0320|70360|384.15|222.81|336.02|319.219|80.9|80.9|16.84|17.17|17.17|17.51|249.70|261.22|280.43|280.43|299.64|230.49|249.70|288.11|326.53|341.13|338.05|288.11|326.53| 16.84 | 341.13 | 280.43 32000011|HC NECK FOR SOFT TISSUE|0320|70360|384.15|222.81|336.02|319.219|80.9|80.9|28.34|28.90|28.90|29.47|249.70|261.22|280.43|280.43|299.64|230.49|249.70|288.11|326.53|341.13|338.05|288.11|326.53| 28.34 | 341.13 | 280.43 32000012|HC CHEST SINGLE VIEW|0320|71010|301.83|175.06|||||19.15|19.54|19.54|19.92|196.19|205.24|220.34|220.34|235.43|181.10|196.19|226.37|256.56|268.03|265.61|226.37|256.56| 19.15 | 268.03 | 220.34 32000012|HC CHEST SINGLE VIEW|0320|71010|301.83|175.06|||||31.20|31.83|31.83|32.45|196.19|205.24|220.34|220.34|235.43|181.10|196.19|226.37|256.56|268.03|265.61|226.37|256.56| 31.20 | 268.03 | 220.34 32000013|HC CHEST PA & LAT|0320|71020|408.00|236.64|||||25.02|25.52|25.52|26.02|265.20|277.44|297.84|297.84|318.24|244.80|265.20|306.00|346.80|362.30|359.04|306.00|346.80| 25.02 | 362.30 | 297.84 32000013|HC CHEST PA & LAT|0320|71020|408.00|236.64|||||39.92|40.72|40.72|41.51|265.20|277.44|297.84|297.84|318.24|244.80|265.20|306.00|346.80|362.30|359.04|306.00|346.80| 39.92 | 362.30 | 297.84 32000014|HC APICAL LORDOTIC CHEST|0320|71021|301.83|175.06|||||21.59|22.02|22.02|22.45|196.19|205.24|220.34|220.34|235.43|181.10|196.19|226.37|256.56|268.03|265.61|226.37|256.56| 21.59 | 268.03 | 220.34 32000014|HC APICAL LORDOTIC CHEST|0320|71021|301.83|175.06|||||43.17|44.04|44.04|44.90|196.19|205.24|220.34|220.34|235.43|181.10|196.19|226.37|256.56|268.03|265.61|226.37|256.56| 43.17 | 268.03 | 220.34 32000015|HC CHEST 2 VIEWS W FLUORO|0320|71023|820.53|475.91|||||27.47|28.02|28.02|28.57|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 27.47 | 728.63 | 598.99 32000015|HC CHEST 2 VIEWS W FLUORO|0320|71023|820.53|475.91|||||54.95|56.05|56.05|57.15|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 54.95 | 728.63 | 598.99 32000016|HC CHEST MIN 4 VIEWS|0320|71030|820.53|475.91|||||26.17|26.69|26.69|27.21|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 26.17 | 728.63 | 598.99 32000016|HC CHEST MIN 4 VIEWS|0320|71030|820.53|475.91|||||52.33|53.38|53.38|54.43|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 52.33 | 728.63 | 598.99 32000017|HC CHEST-LAT DECUB/BUCKY|0320|71035|515.66|299.08|||||21.08|21.50|21.50|21.92|335.18|350.65|376.43|376.43|402.21|309.40|335.18|386.75|438.31|457.91|453.78|386.75|438.31| 21.08 | 457.91 | 376.43 32000017|HC CHEST-LAT DECUB/BUCKY|0320|71035|515.66|299.08|||||33.17|33.83|33.83|34.49|335.18|350.65|376.43|376.43|402.21|309.40|335.18|386.75|438.31|457.91|453.78|386.75|438.31| 33.17 | 457.91 | 376.43 32000018|HC RIBS UNI 2 VIEWS|0320|71100|525.74|304.93|459.86|436.87|80.90|80.90|38.37|39.14|39.14|39.91|341.73|357.50|383.79|383.79|410.08|315.44|341.73|394.31|446.88|466.86|462.65|394.31|446.88| 38.37 | 466.86 | 383.79 32000018|HC RIBS UNI 2 VIEWS|0320|71100|525.74|304.93|459.86|436.87|80.90|80.90|23.09|23.55|23.55|24.02|341.73|357.50|383.79|383.79|410.08|315.44|341.73|394.31|446.88|466.86|462.65|394.31|446.88| 23.09 | 466.86 | 383.79 32000019|HC RIBS UNILATERAL W/ PA CHEST|0320|71101|616.25|357.43|539.04|512.09|108.97|108.97|21.59|22.02|22.02|22.45|400.56|419.05|449.86|449.86|480.68|369.75|400.56|462.19|523.81|547.23|542.30|462.19|523.81| 21.59 | 547.23 | 449.86 32000019|HC RIBS UNILATERAL W/ PA CHEST|0320|71101|616.25|357.43|539.04|512.09|108.97|108.97|43.17|44.04|44.04|44.90|400.56|419.05|449.86|449.86|480.68|369.75|400.56|462.19|523.81|547.23|542.30|462.19|523.81| 43.17 | 547.23 | 449.86 32000020|HC RIBS, BILAT 3 VIEWS|0320|71110|646.10|374.74|158.92|150.97|108.97|108.97|31.66|32.29|32.29|32.93|419.97|439.35|471.65|471.65|503.96|387.66|419.97|484.58|549.19|573.74|568.57|484.58|549.19| 31.66 | 573.74 | 419.97 32000020|HC RIBS, BILAT 3 VIEWS|0320|71110|646.10|374.74|158.92|150.97|108.97|108.97|49.96|50.96|50.96|51.96|419.97|439.35|471.65|471.65|503.96|387.66|419.97|484.58|549.19|573.74|568.57|484.58|549.19| 49.96 | 573.74 | 419.97 32000021|HC RIBS BILATERAL W/ PA CHEST|0320|71111|1,000.37|580.21|765.76|727.47|108.97|108.97|35.99|36.71|36.71|37.43|650.24|680.25|730.27|730.27|780.29|600.22|650.24|750.28|850.31|888.33|880.33|750.28|850.31| 35.99 | 888.33 | 727.47 32000021|HC RIBS BILATERAL W/ PA CHEST|0320|71111|1,000.37|580.21|765.76|727.47|108.97|108.97|57.29|58.44|58.44|59.58|650.24|680.25|730.27|730.27|780.29|600.22|650.24|750.28|850.31|888.33|880.33|750.28|850.31| 57.29 | 888.33 | 727.47 32000022|HC STERNUM|0320|71120|427.89|248.18|374.28|355.57|80.90|80.90|26.17|26.69|26.69|27.21|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 26.17 | 379.97 | 312.36 32000022|HC STERNUM|0320|71120|427.89|248.18|374.28|355.57|80.90|80.90|39.66|40.45|40.45|41.24|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 39.66 | 379.97 | 312.36 32000023|HC SPINE ONE VIEW|0320|72020|392.42|227.60|343.25|326.09|80.90|80.90|16.84|17.17|17.17|17.51|255.07|266.85|286.47|286.47|306.09|235.45|255.07|294.32|333.56|348.47|345.33|294.32|333.56| 16.84 | 348.47 | 286.47 32000023|HC SPINE ONE VIEW|0320|72020|392.42|227.60|343.25|326.09|80.90|80.90|26.91|27.45|27.45|27.99|255.07|266.85|286.47|286.47|306.09|235.45|255.07|294.32|333.56|348.47|345.33|294.32|333.56| 26.91 | 348.47 | 286.47 32000024|HC SPINE CERVICAL 2-3 VIEWS|0320|72040|624.79|362.38|546.51|519.1845|80.9|80.9|24.26|24.74|24.74|25.23|406.11|424.86|456.10|456.10|487.34|374.87|406.11|468.59|531.07|554.81|549.82|468.59|531.07| 24.26 | 554.81 | 456.10 32000024|HC SPINE CERVICAL 2-3 VIEWS|0320|72040|624.79|362.38|546.51|519.1845|80.9|80.9|39.04|39.82|39.82|40.60|406.11|424.86|456.10|456.10|487.34|374.87|406.11|468.59|531.07|554.81|549.82|468.59|531.07| 39.04 | 554.81 | 456.10 32000025|HC SPINE CERVICAL 4 VIEWS MIN|0320|72050|722.59|419.10|632.07|600.47|108.97|108.97|35.99|36.71|36.71|37.43|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 35.99 | 641.66 | 527.49 32000025|HC SPINE CERVICAL 4 VIEWS MIN|0320|72050|722.59|419.10|632.07|600.47|108.97|108.97|56.70|57.84|57.84|58.97|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 56.70 | 641.66 | 527.49 32000026|HC SPINE CERVICAL COMPLETE F/E|0320|72052|820.53|475.91|717.73|681.84|108.97|108.97|45.32|46.23|46.23|47.13|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 45.32 | 728.63 | 598.99 32000026|HC SPINE CERVICAL COMPLETE F/E|0320|72052|820.53|475.91|717.73|681.84|108.97|108.97|69.26|70.65|70.65|72.03|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 69.26 | 728.63 | 598.99 32000027|HC SCOLIOSIS THORACOLMBR STAND|0320|72069|566.66|328.66|||||19.91|20.31|20.31|20.71|368.33|385.33|413.66|413.66|441.99|340.00|368.33|425.00|481.66|503.19|498.66|425.00|481.66| 19.91 | 503.19 | 413.66 32000027|HC SCOLIOSIS THORACOLMBR STAND|0320|72069|566.66|328.66|||||33.96|34.64|34.64|35.32|368.33|385.33|413.66|413.66|441.99|340.00|368.33|425.00|481.66|503.19|498.66|425.00|481.66| 33.96 | 503.19 | 413.66 32000028|HC SPINE THORACIC 2 VIEWS|0320|72070|621.94|360.73|544.03|516.83|108.97|108.97|26.17|26.69|26.69|27.21|404.26|422.92|454.02|454.02|485.11|373.16|404.26|466.46|528.65|552.28|547.31|466.46|528.65| 26.17 | 552.28 | 454.02 32000028|HC SPINE THORACIC 2 VIEWS|0320|72070|621.94|360.73|544.03|516.83|108.97|108.97|41.04|41.86|41.86|42.68|404.26|422.92|454.02|454.02|485.11|373.16|404.26|466.46|528.65|552.28|547.31|466.46|528.65| 41.04 | 552.28 | 454.02 32000029|HC SPINE THORACIC 3 VIEW|0320|72072|663.22|384.67|580.14|551.133|108.97|108.97|29.74|30.33|30.33|30.93|431.09|450.99|484.15|484.15|517.31|397.93|431.09|497.42|563.74|588.94|583.63|497.42|563.74| 29.74 | 588.94 | 484.15 32000029|HC SPINE THORACIC 3 VIEW|0320|72072|663.22|384.67|580.14|551.133|108.97|108.97|44.29|45.17|45.17|46.06|431.09|450.99|484.15|484.15|517.31|397.93|431.09|497.42|563.74|588.94|583.63|497.42|563.74| 44.29 | 588.94 | 484.15 32000030|HC SPINE THORACIC-FOUR VIEW|0320|72074|722.59|419.10|632.07|600.47|108.97|108.97|25.72|26.24|26.24|26.75|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 25.72 | 641.66 | 527.49 32000030|HC SPINE THORACIC-FOUR VIEW|0320|72074|722.59|419.10|632.07|600.47|108.97|108.97|51.43|52.46|52.46|53.49|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 51.43 | 641.66 | 527.49 32000031|HC THORACOLUMBAR 2 VIEWS|0320|72080|621.94|360.73|544.03|516.83|80.90|80.90|26.94|27.48|27.48|28.02|404.26|422.92|454.02|454.02|485.11|373.16|404.26|466.46|528.65|552.28|547.31|466.46|528.65| 26.94 | 552.28 | 454.02 32000031|HC THORACOLUMBAR 2 VIEWS|0320|72080|621.94|360.73|544.03|516.83|80.90|80.90|41.87|42.70|42.70|43.54|404.26|422.92|454.02|454.02|485.11|373.16|404.26|466.46|528.65|552.28|547.31|466.46|528.65| 41.87 | 552.28 | 454.02 32000032|HC SCOLIOSIS STRESS COMPLETE|0320|72090|728.41|422.48|||||26.94|27.48|27.48|28.02|473.47|495.32|531.74|531.74|568.16|437.05|473.47|546.31|619.15|646.83|641.00|546.31|619.15| 26.94 | 646.83 | 531.74 32000032|HC SCOLIOSIS STRESS COMPLETE|0320|72090|728.41|422.48|||||45.95|46.87|46.87|47.79|473.47|495.32|531.74|531.74|568.16|437.05|473.47|546.31|619.15|646.83|641.00|546.31|619.15| 45.95 | 646.83 | 531.74 32000033|HC LUMBAR SPINE 2-3 VIEWS|0320|72100|722.59|419.10|632.07|600.47|108.97|108.97|26.94|27.48|27.48|28.02|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 26.94 | 641.66 | 527.49 32000033|HC LUMBAR SPINE 2-3 VIEWS|0320|72100|722.59|419.10|632.07|600.47|108.97|108.97|41.91|42.74|42.74|43.58|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 41.91 | 641.66 | 527.49 32000034|HC LUMBAR SPINE 4 VIEWS|0320|72110|820.53|475.91|717.73|681.84|108.97|108.97|57.63|58.78|58.78|59.94|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 57.63 | 728.63 | 598.99 32000034|HC LUMBAR SPINE 4 VIEWS|0320|72110|820.53|475.91|717.73|681.84|108.97|108.97|36.76|37.50|37.50|38.23|533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 36.76 | 728.63 | 598.99 32000035|HC SPINE LIS COMP INCL BEND VWS|0320|72114|1,073.81|622.81|939.30|892.34|108.97|108.97|47.24|48.19|48.19|49.13|697.98|730.19|783.88|783.88|837.57|644.29|697.98|805.36|912.74|953.54|944.95|805.36|912.74| 47.24 | 953.54 | 783.88 32000035|HC SPINE LIS COMP INCL BEND VWS|0320|72114|1,073.81|622.81|939.30|892.34|108.97|108.97|71.24|72.66|72.66|74.09|697.98|730.19|783.88|783.88|837.57|644.29|697.98|805.36|912.74|953.54|944.95|805.36|912.74| 71.24 | 953.54 | 783.88 32000036|HC PELVIS 1-2 VIEWS|0320|72170|610.05|353.83|343.25|326.09|108.97|108.97|21.08|21.50|21.50|21.92|396.53|414.83|445.34|445.34|475.84|366.03|396.53|457.54|518.54|541.72|536.84|457.54|518.54| 21.08 | 541.72 | 396.53 32000036|HC PELVIS 1-2 VIEWS|0320|72170|610.05|353.83|343.25|326.09|108.97|108.97|32.12|32.76|32.76|33.40|396.53|414.83|445.34|445.34|475.84|366.03|396.53|457.54|518.54|541.72|536.84|457.54|518.54| 32.12 | 541.72 | 396.53 32000037|HC PELVIS COMPLETE|0320|72190|926.10|537.14|322.27|306.16|108.97|108.97|26.94|27.48|27.48|28.02|601.97|629.75|676.05|676.05|722.36|555.66|601.97|694.58|787.19|822.38|814.97|694.58|787.19| 26.94 | 822.38 | 601.97 32000037|HC PELVIS COMPLETE|0320|72190|926.10|537.14|322.27|306.16|108.97|108.97|41.32|42.14|42.14|42.97|601.97|629.75|676.05|676.05|722.36|555.66|601.97|694.58|787.19|822.38|814.97|694.58|787.19| 41.32 | 822.38 | 601.97 32000038|HC SACROILIAC JT 3 OR>VW-72202|0320|72202|586.44|340.14|512.96|487.31|108.97|108.97|25.02|25.52|25.52|26.02|381.19|398.78|428.10|428.10|457.42|351.86|381.19|439.83|498.47|520.76|516.07|439.83|498.47| 25.02 | 520.76 | 428.10 32000038|HC SACROILIAC JT 3 OR>VW-72202|0320|72202|586.44|340.14|512.96|487.31|108.97|108.97|38.12|38.89|38.89|39.65|381.19|398.78|428.10|428.10|457.42|351.86|381.19|439.83|498.47|520.76|516.07|439.83|498.47| 38.12 | 520.76 | 428.10 32000039|HC SACRUM & COCCYX|0320|72220|586.44|340.14|512.96|487.312|80.9|80.9|23.09|23.55|23.55|24.02|381.19|398.78|428.10|428.10|457.42|351.86|381.19|439.83|498.47|520.76|516.07|439.83|498.47| 23.09 | 520.76 | 428.10 32000039|HC SACRUM & COCCYX|0320|72220|586.44|340.14|512.96|487.312|80.90|80.90|34.78|35.47|35.47|36.17|381.19|398.78|428.10|428.10|457.42|351.86|381.19|439.83|498.47|520.76|516.07|439.83|498.47| 34.78 | 520.76 | 428.10 32000040|HC MYELOGRAM LUMBAR|0320|72265|425.05|246.53|3976.55|3777.7225|715.18|715.18|140.64|143.46|143.46|146.27|276.28|289.03|310.29|310.29|331.54|255.03|276.28|318.79|361.29|377.44|374.04|318.79|361.29| 140.64 | 3,976.55 | 318.79 32000040|HC MYELOGRAM LUMBAR|0320|72265|425.05|246.53|3,976.55|3,777.72|715.18|715.18|223.70|228.17|228.17|232.64|276.28|289.03|310.29|310.29|331.54|255.03|276.28|318.79|361.29|377.44|374.04|318.79|361.29| 223.70 | 3,976.55 | 318.79 32000041|HC MYELOGRAM COMPLETE|0320|72270|919.58|533.36|3,976.55|3,777.72|715.18|715.18|183.16|186.83|186.83|190.49|597.73|625.31|671.29|671.29|717.27|551.75|597.73|689.69|781.64|816.59|809.23|689.69|781.64| 183.16 | 3,976.55 | 689.69 32000041|HC MYELOGRAM COMPLETE|0320|72270|919.58|533.36|3,976.55|3,777.72|715.18|715.18|204.10|208.18|208.18|212.26|597.73|625.31|671.29|671.29|717.27|551.75|597.73|689.69|781.64|816.59|809.23|689.69|781.64| 204.10 | 3,976.55 | 689.69 32000042|HC VERTEBROPLASTY FLUOROSCOPY GUI|0320|72291|3,438.67|1,994.43|||||||||2235.14|2338.30|2510.23|2510.23|2682.16|2063.20|2235.14|2579.00|2922.87|3053.54|3026.03|2579.00|2922.87| 2,063.20 | 3,053.54 | 2,579.00 32000043|HC S/I DISCOGRAPHY LUMBAR|0320|72295|2,566.32|1,488.47|||1,754.39|1,754.39|199.92|203.92|203.92|207.92|1668.11|1745.10|1873.41|1873.41|2001.73|1539.79|1668.11|1924.74|2181.37|2278.89|2258.36|1924.74|2181.37| 199.92 | 2,278.89 | 1,754.39 32000043|HC S/I DISCOGRAPHY LUMBAR|0320|72295|2,566.32|1,488.47|||1,754.39|1,754.39|43.83|44.71|44.71|45.58|1668.11|1745.10|1873.41|1873.41|2001.73|1539.79|1668.11|1924.74|2181.37|2278.89|2258.36|1924.74|2181.37| 43.83 | 2,278.89 | 1,754.39 32000044|HC CLAVICLE|0320|73000|275.01|159.51|240.57|228.54|80.90|80.90|21.08|21.50|21.50|21.92|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 21.08 | 244.21 | 200.76 32000044|HC CLAVICLE|0320|73000|275.01|159.51|240.57|228.54|80.90|80.90|31.53|32.16|32.16|32.79|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 31.53 | 244.21 | 200.76 32000045|HC SCAPULA|0320|73010|427.89|248.18|138.09|131.19|108.97|108.97|21.08|21.50|21.50|21.92|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 21.08 | 379.97 | 278.13 32000045|HC SCAPULA|0320|73010|427.89|248.18|138.09|131.19|108.97|108.97|32.56|33.22|33.22|33.87|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 32.56 | 379.97 | 278.13 32000046|HC SHOULDER ONE VIEW|0320|73020|365.38|211.92|319.61|303.63|80.90|80.90|19.15|19.54|19.54|19.92|237.50|248.46|266.73|266.73|285.00|219.23|237.50|274.04|310.57|324.46|321.53|274.04|310.57| 19.15 | 324.46 | 266.73 32000046|HC SHOULDER ONE VIEW|0320|73020|365.38|211.92|319.61|303.63|80.90|80.90|29.01|29.59|29.59|30.17|237.50|248.46|266.73|266.73|285.00|219.23|237.50|274.04|310.57|324.46|321.53|274.04|310.57| 29.01 | 324.46 | 266.73 32000047|HC SHOULDER COMPLETE|0320|73030|400.90|232.52|350.67|333.14|80.90|80.90|23.09|23.55|23.55|24.02|260.59|272.61|292.66|292.66|312.70|240.54|260.59|300.68|340.77|356.00|352.79|300.68|340.77| 23.09 | 356.00 | 292.66 32000047|HC SHOULDER COMPLETE|0320|73030|400.90|232.52|350.67|333.14|80.90|80.90|35.14|35.84|35.84|36.55|260.59|272.61|292.66|292.66|312.70|240.54|260.59|300.68|340.77|356.00|352.79|300.68|340.77| 35.14 | 356.00 | 292.66 32000048|HC ARTHROGRAM SHOULDER|0320|73040|551.12|319.65|482.09|457.99|368.12|368.12|84.01|85.69|85.69|87.37|358.23|374.76|402.32|402.32|429.87|330.67|358.23|413.34|468.45|489.39|484.99|413.34|468.45| 84.01 | 489.39 | 402.32 32000048|HC ARTHROGRAM SHOULDER|0320|73040|551.12|319.65|482.09|457.99|368.12|368.12|90.27|92.08|92.08|93.89|358.23|374.76|402.32|402.32|429.87|330.67|358.23|413.34|468.45|489.39|484.99|413.34|468.45| 90.27 | 489.39 | 402.32 32000049|HC ACROMIO-CLAVICULAR JOINTS|0320|73050|427.89|248.18|173.16|164.50|80.90|80.90|20.19|20.59|20.59|20.99|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 20.19 | 379.97 | 278.13 32000049|HC ACROMIO-CLAVICULAR JOINTS|0320|73050|427.89|248.18|173.16|164.50|80.90|80.90|40.36|41.17|41.17|41.98|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 40.36 | 379.97 | 278.13 32000050|HC HUMERUS|0320|73060|365.38|211.92|319.61|303.63|80.90|80.90|23.09|23.55|23.55|24.02|237.50|248.46|266.73|266.73|285.00|219.23|237.50|274.04|310.57|324.46|321.53|274.04|310.57| 23.09 | 324.46 | 266.73 32000050|HC HUMERUS|0320|73060|365.38|211.92|319.61|303.63|80.90|80.90|34.41|35.10|35.10|35.79|237.50|248.46|266.73|266.73|285.00|219.23|237.50|274.04|310.57|324.46|321.53|274.04|310.57| 34.41 | 324.46 | 266.73 32000051|HC ELBOW 2 VIEWS|0320|73070|315.92|183.23|276.33|262.51|80.90|80.90|21.08|21.50|21.50|21.92|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 21.08 | 280.54 | 230.62 32000051|HC ELBOW 2 VIEWS|0320|73070|315.92|183.23|276.33|262.51|80.90|80.90|31.15|31.77|31.77|32.40|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 31.15 | 280.54 | 230.62 32000052|HC ELBOW COMPLETE|0320|73080|315.92|183.23|276.34|262.52|80.90|80.90|23.09|23.55|23.55|24.02|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 23.09 | 280.54 | 230.62 32000052|HC ELBOW COMPLETE|0320|73080|315.92|183.23|276.34|262.52|80.90|80.90|34.81|35.51|35.51|36.21|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 34.81 | 280.54 | 230.62 32000053|HC FOREARM 2 VIEWS|0320|73090|275.01|159.51|240.57|228.54|80.90|80.90|21.08|21.50|21.50|21.92|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 21.08 | 244.21 | 200.76 32000053|HC FOREARM 2 VIEWS|0320|73090|275.01|159.51|240.57|228.54|80.90|80.90|31.74|32.37|32.37|33.01|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 31.74 | 244.21 | 200.76 32000054|HC UPPER EXTREM, INFANT<12MOS,2VI|0320|73092|275.01|159.51|240.57|228.54|108.97|108.97|13.08|13.34|13.34|13.61|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 13.08 | 244.21 | 200.76 32000054|HC UPPER EXTREM, INFANT<12MOS,2VI|0320|73092|275.01|159.51|240.57|228.54|108.97|108.97|26.17|26.69|26.69|27.21|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 26.17 | 244.21 | 200.76 32000055|HC WRIST 2 VIEWS|0320|73100|275.01|159.51|240.57|228.5415|80.9|80.9|30.27|30.88|30.88|31.49|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 30.27 | 244.21 | 200.76 32000055|HC WRIST 2 VIEWS|0320|73100|275.01|159.51|240.57|228.5415|80.9|80.9|19.91|20.31|20.31|20.71|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 19.91 | 244.21 | 200.76 32000056|HC HAND-COMPLETE 3 VIEWS|0320|73130|275.01|159.51|240.57|228.5415|80.9|80.9|21.46|21.89|21.89|22.31|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 21.46 | 244.21 | 200.76 32000056|HC HAND-COMPLETE 3 VIEWS|0320|73130|275.01|159.51|240.57|228.5415|80.9|80.9|33.48|34.15|34.15|34.82|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 33.48 | 244.21 | 200.76 32000057|HC FINGERS|0320|73140|275.01|159.51|240.57|228.5415|80.9|80.9|16.84|17.17|17.17|17.51|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 16.84 | 244.21 | 200.76 32000057|HC FINGERS|0320|73140|275.01|159.51|240.57|228.5415|80.9|80.9|25.41|25.92|25.92|26.42|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 25.41 | 244.21 | 200.76 32000058|HC HIP PARTIAL|0320|73500|315.92|183.23|||||19.15|19.54|19.54|19.92|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 19.15 | 280.54 | 230.62 32000058|HC HIP PARTIAL|0320|73500|315.92|183.23|||||30.58|31.19|31.19|31.80|205.35|214.83|230.62|230.62|246.42|189.55|205.35|236.94|268.53|280.54|278.01|236.94|268.53| 30.58 | 280.54 | 230.62 32000059|HC HIP COMPLETE|0320|73510|359.98|208.79|||||23.09|23.55|23.55|24.02|233.99|244.79|262.79|262.79|280.78|215.99|233.99|269.99|305.98|319.66|316.78|269.99|305.98| 23.09 | 319.66 | 262.79 32000059|HC HIP COMPLETE|0320|73510|359.98|208.79|||||37.29|38.03|38.03|38.78|233.99|244.79|262.79|262.79|280.78|215.99|233.99|269.99|305.98|319.66|316.78|269.99|305.98| 37.29 | 319.66 | 262.79 32000060|HC HIP BILATERAL|0320|73520|722.59|419.10|||||26.94|27.48|27.48|28.02|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 26.94 | 641.66 | 527.49 32000060|HC HIP BILATERAL|0320|73520|722.59|419.10|||||44.85|45.75|45.75|46.64|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 44.85 | 641.66 | 527.49 32000061|HC HIP OPERATIVE|0320|73530|1,028.63|596.61|||||21.08|21.50|21.50|21.92|668.61|699.47|750.90|750.90|802.33|617.18|668.61|771.47|874.34|913.42|905.19|771.47|874.34| 21.08 | 913.42 | 750.90 32000061|HC HIP OPERATIVE|0320|73530|1,028.63|596.61|||||40.77|41.58|41.58|42.40|668.61|699.47|750.90|750.90|802.33|617.18|668.61|771.47|874.34|913.42|905.19|771.47|874.34| 40.77 | 913.42 | 750.90 32000062|HC PELVIS & HIP (INFANT/CHILD)|0320|73540|427.89|248.18|||||23.09|23.55|23.55|24.02|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 23.09 | 379.97 | 312.36 32000062|HC PELVIS & HIP (INFANT/CHILD)|0320|73540|427.89|248.18|||||36.87|37.61|37.61|38.34|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 36.87 | 379.97 | 312.36 32000063|HC FEMUR 2 VIEWS|0320|73550|427.89|248.18|||||23.09|23.55|23.55|24.02|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 23.09 | 379.97 | 312.36 32000063|HC FEMUR 2 VIEWS|0320|73550|427.89|248.18|||||34.71|35.40|35.40|36.10|278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 34.71 | 379.97 | 312.36 32000064|HC KNEE PARTIAL 1/2 VIEW|0320|73560|469.04|272.04|410.29|389.78|80.90|80.90|21.08|21.50|21.50|21.92|304.88|318.95|342.40|342.40|365.85|281.42|304.88|351.78|398.68|416.51|412.76|351.78|398.68| 21.08 | 416.51 | 342.40 32000064|HC KNEE PARTIAL 1/2 VIEW|0320|73560|469.04|272.04|410.29|389.78|80.90|80.90|31.95|32.59|32.59|33.23|304.88|318.95|342.40|342.40|365.85|281.42|304.88|351.78|398.68|416.51|412.76|351.78|398.68| 31.95 | 416.51 | 342.40 32000065|HC KNEE COMPLETE 3 VIEWS|0320|73562|469.04|272.04|410.29|389.7755|80.90|80.90|23.09|23.55|23.55|24.02|304.88|318.95|342.40|342.40|365.85|281.42|304.88|351.78|398.68|416.51|412.76|351.78|398.68| 23.09 | 416.51 | 342.40 32000065|HC KNEE COMPLETE 3 VIEWS|0320|73562|469.04|272.04|410.29|389.7755|80.90|80.90|35.55|36.26|36.26|36.97|304.88|318.95|342.40|342.40|365.85|281.42|304.88|351.78|398.68|416.51|412.76|351.78|398.68| 35.55 | 416.51 | 342.40 32000066|HC KNEE COMP, 4 OR MORE VIEWS|0320|73564|743.80|431.40|650.62|618.09|108.97|108.97|25.02|25.52|25.52|26.02|483.47|505.78|542.97|542.97|580.16|446.28|483.47|557.85|632.23|660.49|654.54|557.85|632.23| 25.02 | 660.49 | 542.97 32000066|HC KNEE COMP, 4 OR MORE VIEWS|0320|73564|743.80|431.40|650.62|618.09|108.97|108.97|40.27|41.08|41.08|41.88|483.47|505.78|542.97|542.97|580.16|446.28|483.47|557.85|632.23|660.49|654.54|557.85|632.23| 40.27 | 660.49 | 542.97 32000067|HC KNEES STANDING AP|0320|73565|327.23|189.79|286.25|271.94|80.90|80.90|30.07|30.67|30.67|31.27|212.70|222.52|238.88|238.88|255.24|196.34|212.70|245.42|278.15|290.58|287.96|245.42|278.15| 30.07 | 290.58 | 238.88 32000067|HC KNEES STANDING AP|0320|73565|327.23|189.79|286.25|271.94|80.90|80.90|19.91|20.31|20.31|20.71|212.70|222.52|238.88|238.88|255.24|196.34|212.70|245.42|278.15|290.58|287.96|245.42|278.15| 19.91 | 290.58 | 238.88 32000068|HC ARTHROGRAM KNEE|0320|73580|519.74|301.45|||368.12|368.12|105.57|107.68|107.68|109.79|337.83|353.42|379.41|379.41|405.40|311.84|337.83|389.81|441.78|461.53|457.37|389.81|441.78| 105.57 | 461.53 | 368.12 32000068|HC ARTHROGRAM KNEE|0320|73580|519.74|301.45|||368.12|368.12|90.27|92.08|92.08|93.89|337.83|353.42|379.41|379.41|405.40|311.84|337.83|389.81|441.78|461.53|457.37|389.81|441.78| 90.27 | 461.53 | 368.12 32000069|HC TIBIA & FIBULA 2 VIEWS|0320|73590|365.38|211.92|319.61|303.63|80.90|80.90|21.08|21.50|21.50|21.92|237.50|248.46|266.73|266.73|285.00|219.23|237.50|274.04|310.57|324.46|321.53|274.04|310.57| 21.08 | 324.46 | 266.73 32000069|HC TIBIA & FIBULA 2 VIEWS|0320|73590|365.38|211.92|319.61|303.63|80.90|80.90|31.96|32.60|32.60|33.24|237.50|248.46|266.73|266.73|285.00|219.23|237.50|274.04|310.57|324.46|321.53|274.04|310.57| 31.96 | 324.46 | 266.73 32000070|HC LOWER EXTREM,INFANT<12MOS,2 VI|0320|73592|275.01|159.51|240.57|228.54|80.90|80.90|15.14|15.44|15.44|15.74|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 15.14 | 244.21 | 200.76 32000070|HC LOWER EXTREM,INFANT<12MOS,2 VI|0320|73592|275.01|159.51|240.57|228.54|80.90|80.90|30.27|30.88|30.88|31.49|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 30.27 | 244.21 | 200.76 32000071|HC ANKLE 2 VIEWS|0320|73600|275.01|159.51|240.57|228.54|80.90|80.90|19.91|20.31|20.31|20.71|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 19.91 | 244.21 | 200.76 32000071|HC ANKLE 2 VIEWS|0320|73600|275.01|159.51|240.57|228.54|80.90|80.90|30.30|30.91|30.91|31.51|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 30.30 | 244.21 | 200.76 32000072|HC SINUSES PARANASAL COMPL|0320|70220|731.16|424.07|229.06|217.61|80.90|80.90|31.66|32.29|32.29|32.93|475.25|497.19|533.75|533.75|570.30|438.70|475.25|548.37|621.49|649.27|643.42|548.37|621.49| 31.66 | 649.27 | 475.25 32000072|HC SINUSES PARANASAL COMPL|0320|70220|731.16|424.07|229.06|217.61|80.90|80.90|48.62|49.59|49.59|50.56|475.25|497.19|533.75|533.75|570.30|438.70|475.25|548.37|621.49|649.27|643.42|548.37|621.49| 48.62 | 649.27 | 475.25 32000073|HC FOOT COMPLETE|0320|73630|275.01|159.51|240.57|228.5415|80.9|80.9|21.46|21.89|21.89|22.31|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 21.46 | 244.21 | 200.76 32000073|HC FOOT COMPLETE|0320|73630|275.01|159.51|240.57|228.5415|80.9|80.9|33.47|34.14|34.14|34.81|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 33.47 | 244.21 | 200.76 32000074|HC OS CALCIS (HEEL)|0320|73650|275.01|159.51|240.57|228.5415|80.9|80.9|19.15|19.54|19.54|19.92|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 19.15 | 244.21 | 200.76 32000074|HC OS CALCIS (HEEL)|0320|73650|275.01|159.51|240.57|228.5415|80.9|80.9|29.41|30.00|30.00|30.59|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 29.41 | 244.21 | 200.76 32000075|HC TOES|0320|73660|275.01|159.51|240.57|228.54|80.90|80.90|16.84|17.17|17.17|17.51|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 16.84 | 244.21 | 200.76 32000075|HC TOES|0320|73660|275.01|159.51|240.57|228.54|80.90|80.90|25.41|25.92|25.92|26.42|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 25.41 | 244.21 | 200.76 32000076|HC KUB|0320|74000|392.42|227.60|||||22.03|22.47|22.47|22.91|255.07|266.85|286.47|286.47|306.09|235.45|255.07|294.32|333.56|348.47|345.33|294.32|333.56| 22.03 | 348.47 | 286.47 32000076|HC KUB|0320|74000|392.42|227.60|||||33.18|33.84|33.84|34.51|255.07|266.85|286.47|286.47|306.09|235.45|255.07|294.32|333.56|348.47|345.33|294.32|333.56| 33.18 | 348.47 | 286.47 32000077|HC ABD COMP W/DECUBORERECT|0320|74020|563.80|327.00|||||25.02|25.52|25.52|26.02|366.47|383.38|411.57|411.57|439.76|338.28|366.47|422.85|479.23|500.65|496.14|422.85|479.23| 25.02 | 500.65 | 411.57 32000077|HC ABD COMP W/DECUBORERECT|0320|74020|563.80|327.00|||||43.57|44.44|44.44|45.31|366.47|383.38|411.57|411.57|439.76|338.28|366.47|422.85|479.23|500.65|496.14|422.85|479.23| 43.57 | 500.65 | 411.57 32000078|HC ABD OBST/ FREE AIR-CHEST|0320|74022|563.80|327.00|493.15|468.49|108.97|108.97|29.74|30.33|30.33|30.93|366.47|383.38|411.57|411.57|439.76|338.28|366.47|422.85|479.23|500.65|496.14|422.85|479.23| 29.74 | 500.65 | 411.57 32000078|HC ABD OBST/ FREE AIR-CHEST|0320|74022|563.80|327.00|493.15|468.49|108.97|108.97|51.05|52.07|52.07|53.09|366.47|383.38|411.57|411.57|439.76|338.28|366.47|422.85|479.23|500.65|496.14|422.85|479.23| 51.05 | 500.65 | 411.57 32000079|HC PERITONEOGRAM HERNIA EVAL|0320|74190|1,289.11|747.68|||482.89|482.89|51.97|53.01|53.01|54.05|837.92|876.59|941.05|941.05|1005.51|773.47|837.92|966.83|1095.74|1144.73|1134.42|966.83|1095.74| 51.97 | 1,144.73 | 876.59 32000079|HC PERITONEOGRAM HERNIA EVAL|0320|74190|1,289.11|747.68|||482.89|482.89|71.07|72.49|72.49|73.91|837.92|876.59|941.05|941.05|1005.51|773.47|837.92|966.83|1095.74|1144.73|1134.42|966.83|1095.74| 71.07 | 1,144.73 | 876.59 32000080|HC BA SWALLOW ESOPHAGRAM SINGLE CONTRAST|0320|74220|900.90|522.52|632.07|600.4665|178.55|178.55|39.25|40.03|40.03|40.82|585.59|612.61|657.66|657.66|702.70|540.54|585.59|675.68|765.77|800.00|792.79|675.68|765.77| 39.25 | 800.00 | 612.61 32000080|HC BA SWALLOW ESOPHAGRAM SINGLE CONTRAST|0320|74220|900.90|522.52|632.07|600.4665|178.55|178.55|78.50|80.07|80.07|81.64|585.59|612.61|657.66|657.66|702.70|540.54|585.59|675.68|765.77|800.00|792.79|675.68|765.77| 78.50 | 800.00 | 612.61 32000081|HC VIDEO SWALLOW|0320|74230|1,961.12|1,137.45|1715.42|1629.649|178.55|178.55|52.33|53.38|53.38|54.43|1274.73|1333.56|1431.62|1431.62|1529.67|1176.67|1274.73|1470.84|1666.95|1741.47|1725.79|1470.84|1666.95| 52.33 | 1,741.47 | 1,431.62 32000081|HC VIDEO SWALLOW|0320|74230|1,961.12|1,137.45|1715.42|1629.649|178.55|178.55|26.17|26.69|26.69|27.21|1274.73|1333.56|1431.62|1431.62|1529.67|1176.67|1274.73|1470.84|1666.95|1741.47|1725.79|1470.84|1666.95| 26.17 | 1,741.47 | 1,431.62 32000082|HC UGI W/ KUB|0320|74241|1,203.35|697.94|||||59.75|60.95|60.95|62.14|782.18|818.28|878.45|878.45|938.61|722.01|782.18|902.51|1022.85|1068.57|1058.95|902.51|1022.85| 59.75 | 1,068.57 | 878.45 32000082|HC UGI W/ KUB|0320|74241|1,203.35|697.94|||||107.52|109.67|109.67|111.82|782.18|818.28|878.45|878.45|938.61|722.01|782.18|902.51|1022.85|1068.57|1058.95|902.51|1022.85| 107.52 | 1,068.57 | 878.45 32000083|HC UGI W/ SMALL BOWEL|0320|74245|1,705.36|989.11|||||95.74|97.66|97.66|99.57|1108.48|1159.64|1244.91|1244.91|1330.18|1023.22|1108.48|1279.02|1449.56|1514.36|1500.72|1279.02|1449.56| 95.74 | 1,514.36 | 1,244.91 32000083|HC UGI W/ SMALL BOWEL|0320|74245|1,705.36|989.11|||||157.99|161.15|161.15|164.31|1108.48|1159.64|1244.91|1244.91|1330.18|1023.22|1108.48|1279.02|1449.56|1514.36|1500.72|1279.02|1449.56| 157.99 | 1,514.36 | 1,244.91 32000084|HC UGI AIR CONTRAST W/ KUB|0320|74247|1,189.99|690.19|||||115.00|117.30|117.30|119.60|773.49|809.19|868.69|868.69|928.19|713.99|773.49|892.49|1011.49|1056.71|1047.19|892.49|1011.49| 115.00 | 1,056.71 | 868.69 32000084|HC UGI AIR CONTRAST W/ KUB|0320|74247|1,189.99|690.19|||||57.50|58.65|58.65|59.80|773.49|809.19|868.69|868.69|928.19|713.99|773.49|892.49|1011.49|1056.71|1047.19|892.49|1011.49| 57.50 | 1,056.71 | 868.69 32000085|HC BARIUM ENEMA SINGLE CONTRAST|0320|74270|1,839.43|1,066.87|1420.5|1349.475|178.55|178.55|68.41|69.78|69.78|71.15|1195.63|1250.81|1342.78|1342.78|1434.76|1103.66|1195.63|1379.57|1563.52|1633.41|1618.70|1379.57|1563.52| 68.41 | 1,633.41 | 1,342.78 32000085|HC BARIUM ENEMA SINGLE CONTRAST|0320|74270|1,839.43|1,066.87|1420.5|1349.475|178.55|178.55|115.85|118.17|118.17|120.49|1195.63|1250.81|1342.78|1342.78|1434.76|1103.66|1195.63|1379.57|1563.52|1633.41|1618.70|1379.57|1563.52| 115.85 | 1,633.41 | 1,342.78 32000086|HC BARIUM ENEMA DOUBLE CONTRAST|0320|74280|1,759.00|1,020.22|1420.5|1349.475|178.55|178.55|78.64|80.22|80.22|81.79|1143.35|1196.12|1284.07|1284.07|1372.02|1055.40|1143.35|1319.25|1495.15|1561.99|1547.92|1319.25|1495.15| 78.64 | 1,561.99 | 1,284.07 32000086|HC BARIUM ENEMA DOUBLE CONTRAST|0320|74280|1,759.00|1,020.22|1420.5|1349.475|178.55|178.55|157.29|160.43|160.43|163.58|1143.35|1196.12|1284.07|1284.07|1372.02|1055.40|1143.35|1319.25|1495.15|1561.99|1547.92|1319.25|1495.15| 157.29 | 1,561.99 | 1,284.07 32000087|HC BA ENEMA INTUSSUSCEPTION TH|0320|74283|1,147.77|665.71|||178.55|178.55|157.00|160.14|160.14|163.28|746.05|780.48|837.87|837.87|895.26|688.66|746.05|860.83|975.60|1019.22|1010.04|860.83|975.60| 157.00 | 1,019.22 | 780.48 32000087|HC BA ENEMA INTUSSUSCEPTION TH|0320|74283|1,147.77|665.71|||178.55|178.55|78.50|80.07|80.07|81.64|746.05|780.48|837.87|837.87|895.26|688.66|746.05|860.83|975.60|1019.22|1010.04|860.83|975.60| 78.50 | 1,019.22 | 780.48 32000088|HC TUBE CHOLANGIOGRAM|0320|74305|399.55|231.74|||||60.43|61.64|61.64|62.85|259.71|271.69|291.67|291.67|311.65|239.73|259.71|299.66|339.62|354.80|351.60|299.66|339.62| 60.43 | 354.80 | 291.67 32000088|HC TUBE CHOLANGIOGRAM|0320|74305|399.55|231.74|||||31.66|32.29|32.29|32.93|259.71|271.69|291.67|291.67|311.65|239.73|259.71|299.66|339.62|354.80|351.60|299.66|339.62| 31.66 | 354.80 | 291.67 32000089|HC TRANSHEP CHOLEANGIO|0320|74320|680.07|394.44|||||140.64|143.46|143.46|146.27|442.05|462.45|496.45|496.45|530.45|408.04|442.05|510.05|578.06|603.90|598.46|510.05|578.06| 140.64 | 603.90 | 496.45 32000089|HC TRANSHEP CHOLEANGIO|0320|74320|680.07|394.44|||||125.76|128.27|128.27|130.79|442.05|462.45|496.45|496.45|530.45|408.04|442.05|510.05|578.06|603.90|598.46|510.05|578.06| 125.76 | 603.90 | 496.45 32000090|HC ERCP|0320|74330|1,115.85|647.19|||||93.99|95.87|95.87|97.75|725.30|758.78|814.57|814.57|870.36|669.51|725.30|836.89|948.47|990.87|981.95|836.89|948.47| 93.99 | 990.87 | 814.57 32000090|HC ERCP|0320|74330|1,115.85|647.19|||||132.22|134.86|134.86|137.51|725.30|758.78|814.57|814.57|870.36|669.51|725.30|836.89|948.47|990.87|981.95|836.89|948.47| 132.22 | 990.87 | 814.57 32000091|HC INTRO LONG GI TUBE RSI|0320|74340|637.65|369.84|||||27.80|28.36|28.36|28.91|414.47|433.60|465.48|465.48|497.37|382.59|414.47|478.24|542.00|566.23|561.13|478.24|542.00| 27.80 | 566.23 | 465.48 32000091|HC INTRO LONG GI TUBE RSI|0320|74340|637.65|369.84|||||75.29|76.80|76.80|78.31|414.47|433.60|465.48|465.48|497.37|382.59|414.47|478.24|542.00|566.23|561.13|478.24|542.00| 75.29 | 566.23 | 465.48 32000092|HC BILIARY STENT PLACE|0320|74363|2,506.38|1,453.70|||||122.33|124.77|124.77|127.22|1629.15|1704.34|1829.66|1829.66|1954.98|1503.83|1629.15|1879.79|2130.42|2225.67|2205.61|1879.79|2130.42| 122.33 | 2,225.67 | 1,829.66 32000092|HC BILIARY STENT PLACE|0320|74363|2,506.38|1,453.70|||||244.66|249.55|249.55|254.44|1629.15|1704.34|1829.66|1829.66|1954.98|1503.83|1629.15|1879.79|2130.42|2225.67|2205.61|1879.79|2130.42| 244.66 | 2,225.67 | 1,829.66 32000093|HC IVP|0320|74400|1,256.62|728.84|1,099.18|1,044.22|178.55|178.55|67.65|69.01|69.01|70.36|816.80|854.50|917.33|917.33|980.16|753.97|816.80|942.47|1068.13|1115.88|1105.83|942.47|1068.13| 67.65 | 1,115.88 | 917.33 32000093|HC IVP|0320|74400|1,256.62|728.84|1,099.18|1,044.22|178.55|178.55|100.88|102.90|102.90|104.92|816.80|854.50|917.33|917.33|980.16|753.97|816.80|942.47|1068.13|1115.88|1105.83|942.47|1068.13| 100.88 | 1,115.88 | 917.33 32000094|HC IVP COMPLETE W TOMOGRAMS|0320|74415|1,303.33|755.93|||178.55|178.55|59.11|60.29|60.29|61.47|847.16|886.26|951.43|951.43|1016.60|782.00|847.16|977.50|1107.83|1157.36|1146.93|977.50|1107.83| 59.11 | 1,157.36 | 886.26 32000094|HC IVP COMPLETE W TOMOGRAMS|0320|74415|1,303.33|755.93|||178.55|178.55|118.21|120.57|120.57|122.93|847.16|886.26|951.43|951.43|1016.60|782.00|847.16|977.50|1107.83|1157.36|1146.93|977.50|1107.83| 118.21 | 1,157.36 | 886.26 32000095|HC IVP ANTEGRADE|0320|74425|484.71|281.13|||368.12|368.12|40.05|40.85|40.85|41.65|315.06|329.60|353.84|353.84|378.07|290.83|315.06|363.53|412.00|430.42|426.54|363.53|412.00| 40.05 | 430.42 | 353.84 32000095|HC IVP ANTEGRADE|0320|74425|484.71|281.13|||368.12|368.12|51.97|53.01|53.01|54.05|315.06|329.60|353.84|353.84|378.07|290.83|315.06|363.53|412.00|430.42|426.54|363.53|412.00| 51.97 | 430.42 | 353.84 32000096|HC CYSTOGRAM|0320|74430|729.12|422.89|381.13|362.0735|368.12|368.12|42.25|43.09|43.09|43.94|473.93|495.80|532.26|532.26|568.71|437.47|473.93|546.84|619.75|647.46|641.63|546.84|619.75| 42.25 | 647.46 | 473.93 32000096|HC CYSTOGRAM|0320|74430|729.12|422.89|381.13|362.0735|368.12|368.12|41.87|42.70|42.70|43.54|473.93|495.80|532.26|532.26|568.71|437.47|473.93|546.84|619.75|647.46|641.63|546.84|619.75| 41.87 | 647.46 | 473.93 32000097|HC CYSTOGRAM RETROGRADE|0320|74450|484.71|281.13|||230.13|230.13|37.94|38.70|38.70|39.46|315.06|329.60|353.84|353.84|378.07|290.83|315.06|363.53|412.00|430.42|426.54|363.53|412.00| 37.94 | 430.42 | 329.60 32000097|HC CYSTOGRAM RETROGRADE|0320|74450|484.71|281.13|||230.13|230.13|44.48|45.37|45.37|46.26|315.06|329.60|353.84|353.84|378.07|290.83|315.06|363.53|412.00|430.42|426.54|363.53|412.00| 44.48 | 430.42 | 329.60 32000098|HC VOIDING CYSTOGRAM|0320|74455|501.54|290.89|438.72|416.78|230.13|230.13|63.32|64.59|64.59|65.86|326.00|341.05|366.12|366.12|391.20|300.92|326.00|376.16|426.31|445.37|441.36|376.16|426.31| 63.32 | 445.37 | 366.12 32000098|HC VOIDING CYSTOGRAM|0320|74455|501.54|290.89|438.72|416.78|230.13|230.13|58.87|60.05|60.05|61.23|326.00|341.05|366.12|366.12|391.20|300.92|326.00|376.16|426.31|445.37|441.36|376.16|426.31| 58.87 | 445.37 | 366.12 32000099|HC NEPHROSTOMY/1|0320|74475|1,190.08|690.25|||||150.46|153.47|153.47|156.48|773.55|809.25|868.76|868.76|928.26|714.05|773.55|892.56|1011.57|1056.79|1047.27|892.56|1011.57| 150.46 | 1,056.79 | 868.76 32000099|HC NEPHROSTOMY/1|0320|74475|1,190.08|690.25|||||150.46|153.47|153.47|156.48|773.55|809.25|868.76|868.76|928.26|714.05|773.55|892.56|1011.57|1056.79|1047.27|892.56|1011.57| 150.46 | 1,056.79 | 868.76 32000100|HC NEPHRO STENT PLACE|0320|74480|1,360.16|788.89|||||162.90|166.16|166.16|169.41|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 162.90 | 1,207.82 | 992.92 32000100|HC NEPHRO STENT PLACE|0320|74480|1,360.16|788.89|||||183.16|186.83|186.83|190.49|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 183.16 | 1,207.82 | 992.92 32000101|HC HYSTEROSALPINOGRAM|0320|74740|810.34|470.00|708.81|673.3695|230.13|230.13|51.97|53.01|53.01|54.05|526.72|551.03|591.55|591.55|632.07|486.20|526.72|607.76|688.79|719.58|713.10|607.76|688.79| 51.97 | 719.58 | 591.55 32000101|HC HYSTEROSALPINOGRAM|0320|74740|810.34|470.00|708.81|673.3695|230.13|230.13|77.64|79.19|79.19|80.74|526.72|551.03|591.55|591.55|632.07|486.20|526.72|607.76|688.79|719.58|713.10|607.76|688.79| 77.64 | 719.58 | 591.55 32000102|HC THORACIC AORTAGRAM|0320|75605|3,268.49|1,895.72|||4,770.37|4,770.37|195.27|199.17|199.17|203.08|2124.52|2222.57|2386.00|2386.00|2549.42|1961.09|2124.52|2451.37|2778.22|2902.42|2876.27|2451.37|2778.22| 195.27 | 4,770.37 | 2,386.00 32000102|HC THORACIC AORTAGRAM|0320|75605|3,268.49|1,895.72|||4,770.37|4,770.37|314.28|320.57|320.57|326.86|2124.52|2222.57|2386.00|2386.00|2549.42|1961.09|2124.52|2451.37|2778.22|2902.42|2876.27|2451.37|2778.22| 314.28 | 4,770.37 | 2,386.00 32000103|HC ABD AORTOGRAM|0320|75625|3,770.51|2,186.90|2,748.60|2,611.17|2,861.66|2,861.66|179.89|183.49|183.49|187.09|2450.83|2563.95|2752.47|2752.47|2941.00|2262.31|2450.83|2827.88|3204.93|3348.21|3318.05|2827.88|3204.93| 179.89 | 3,348.21 | 2,752.47 32000103|HC ABD AORTOGRAM|0320|75625|3,770.51|2,186.90|2,748.60|2,611.17|2,861.66|2,861.66|603.03|615.09|615.09|627.15|2450.83|2563.95|2752.47|2752.47|2941.00|2262.31|2450.83|2827.88|3204.93|3348.21|3318.05|2827.88|3204.93| 603.03 | 3,348.21 | 2,752.47 32000104|HC ABD AO W/RO|0320|75630|11,898.59|6,901.18|||2,861.66|2,861.66|281.13|286.75|286.75|292.38|7734.08|8091.04|8685.97|8685.97|9280.90|7139.15|7734.08|8923.94|10113.80|10565.95|10470.76|8923.94|10113.80| 281.13 | 10,565.95 | 8,091.04 32000104|HC ABD AO W/RO|0320|75630|11,898.59|6,901.18|||2,861.66|2,861.66|435.02|443.72|443.72|452.42|7734.08|8091.04|8685.97|8685.97|9280.90|7139.15|7734.08|8923.94|10113.80|10565.95|10470.76|8923.94|10113.80| 435.02 | 10,565.95 | 8,091.04 32000105|HC SPINAL ARTERIOGRAM|0320|75705|3,122.64|1,811.13|||4,770.37|4,770.37|347.54|354.49|354.49|361.44|2029.72|2123.40|2279.53|2279.53|2435.66|1873.58|2029.72|2341.98|2654.24|2772.90|2747.92|2341.98|2654.24| 347.54 | 4,770.37 | 2,279.53 32000105|HC SPINAL ARTERIOGRAM|0320|75705|3,122.64|1,811.13|||4,770.37|4,770.37|184.47|188.16|188.16|191.85|2029.72|2123.40|2279.53|2279.53|2435.66|1873.58|2029.72|2341.98|2654.24|2772.90|2747.92|2341.98|2654.24| 184.47 | 4,770.37 | 2,279.53 32000106|HC ARTERIAL EXT UNILATERAL|0320|75710|1,155.95|670.45|7729.4|7342.93|2,861.66|2,861.66|138.68|141.46|141.46|144.23|751.37|786.05|843.84|843.84|901.64|693.57|751.37|866.96|982.56|1026.48|1017.24|866.96|982.56| 138.68 | 7,729.40 | 866.96 32000106|HC ARTERIAL EXT UNILATERAL|0320|75710|1,155.95|670.45|7729.4|7342.93|2,861.66|2,861.66|603.14|615.20|615.20|627.26|751.37|786.05|843.84|843.84|901.64|693.57|751.37|866.96|982.56|1026.48|1017.24|866.96|982.56| 603.14 | 7,729.40 | 866.96 32000107|HC ARTERIAL EXT BILATERAL|0320|75716|6,454.34|3,743.52|5294.36|5029.642|2861.66|2861.66|171.39|174.82|174.82|178.25|4195.32|4388.95|4711.67|4711.67|5034.39|3872.60|4195.32|4840.76|5486.19|5731.45|5679.82|4840.76|5486.19| 171.39 | 5,731.45 | 4,711.67 32000107|HC ARTERIAL EXT BILATERAL|0320|75716|6,454.34|3,743.52|5294.36|5029.642|2861.66|2861.66|613.60|625.87|625.87|638.15|4195.32|4388.95|4711.67|4711.67|5034.39|3872.60|4195.32|4840.76|5486.19|5731.45|5679.82|4840.76|5486.19| 613.60 | 5,731.45 | 4,711.67 32000108|HC VISCERAL|0320|75726|3,586.96|2,080.44|||4770.37|4770.37|327.73|334.29|334.29|340.84|2331.52|2439.13|2618.48|2618.48|2797.83|2152.18|2331.52|2690.22|3048.92|3185.22|3156.52|2690.22|3048.92| 327.73 | 4,770.37 | 2,618.48 32000108|HC VISCERAL|0320|75726|3,586.96|2,080.44|||4,770.37|4,770.37|327.73|334.29|334.29|340.84|2331.52|2439.13|2618.48|2618.48|2797.83|2152.18|2331.52|2690.22|3048.92|3185.22|3156.52|2690.22|3048.92| 327.73 | 4,770.37 | 2,618.48 32000109|HC PELVIC|0320|75736|4,262.76|2,472.40|||4,770.37|4,770.37|314.04|320.32|320.32|326.60|2770.79|2898.68|3111.81|3111.81|3324.95|2557.66|2770.79|3197.07|3623.35|3785.33|3751.23|3197.07|3623.35| 314.04 | 4,770.37 | 3,111.81 32000109|HC PELVIC|0320|75736|4,262.76|2,472.40|||4,770.37|4,770.37|217.84|222.19|222.19|226.55|2770.79|2898.68|3111.81|3111.81|3324.95|2557.66|2770.79|3197.07|3623.35|3785.33|3751.23|3197.07|3623.35| 217.84 | 4,770.37 | 3,111.81 32000110|HC S&I DIALYSIS SHUNT FOR NONDIRE|0320|75791|850.11|493.06|||||55.77|56.89|56.89|58.00|552.57|578.07|620.58|620.58|663.09|510.07|552.57|637.58|722.59|754.90|748.10|637.58|722.59| 55.77 | 754.90 | 620.58 32000110|HC S&I DIALYSIS SHUNT FOR NONDIRE|0320|75791|850.11|493.06|||||204.73|208.82|208.82|212.91|552.57|578.07|620.58|620.58|663.09|510.07|552.57|637.58|722.59|754.90|748.10|637.58|722.59| 204.73 | 754.90 | 620.58 32000110|HC S&I DIALYSIS SHUNT FOR NONDIRE|0320|75791|850.11|493.06|||||148.97|151.94|151.94|154.92|552.57|578.07|620.58|620.58|663.09|510.07|552.57|637.58|722.59|754.90|748.10|637.58|722.59| 148.97 | 754.90 | 620.58 32000111|HC SHUNTOGRAM|0320|75809|583.78|338.59|||108.97|108.97|31.66|32.29|32.29|32.93|379.46|396.97|426.16|426.16|455.35|350.27|379.46|437.84|496.21|518.40|513.73|437.84|496.21| 31.66 | 518.40 | 396.97 32000111|HC SHUNTOGRAM|0320|75809|583.78|338.59|||108.97|108.97|60.12|61.32|61.32|62.52|379.46|396.97|426.16|426.16|455.35|350.27|379.46|437.84|496.21|518.40|513.73|437.84|496.21| 60.12 | 518.40 | 396.97 32000112|HC VENOGRAM EXTREMITY UNI|0320|75820|850.11|493.06|||1,406.14|1,406.14|37.92|38.67|38.67|39.43|552.57|578.07|620.58|620.58|663.09|510.07|552.57|637.58|722.59|754.90|748.10|637.58|722.59| 37.92 | 1,406.14 | 620.58 32000112|HC VENOGRAM EXTREMITY UNI|0320|75820|850.11|493.06|||1,406.14|1,406.14|80.02|81.62|81.62|83.22|552.57|578.07|620.58|620.58|663.09|510.07|552.57|637.58|722.59|754.90|748.10|637.58|722.59| 80.02 | 1,406.14 | 620.58 32000113|HC VENOGRAM EXTREMITY BI|0320|75822|1,360.16|788.89|||1,406.14|1,406.14|59.37|60.56|60.56|61.75|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 59.37 | 1,406.14 | 992.92 32000113|HC VENOGRAM EXTREMITY BI|0320|75822|1,360.16|788.89|||1,406.14|1,406.14|122.34|124.79|124.79|127.23|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 122.34 | 1,406.14 | 992.92 32000114|HC VENOGRAM, IVC W SERIALOGRAPHY|0320|75825|1,696.84|984.17|||2,861.66|2,861.66|135.74|138.45|138.45|141.17|1102.95|1153.85|1238.69|1238.69|1323.54|1018.10|1102.95|1272.63|1442.31|1506.79|1493.22|1272.63|1442.31| 135.74 | 2,861.66 | 1,238.69 32000114|HC VENOGRAM, IVC W SERIALOGRAPHY|0320|75825|1,696.84|984.17|||2,861.66|2,861.66|314.04|320.32|320.32|326.60|1102.95|1153.85|1238.69|1238.69|1323.54|1018.10|1102.95|1272.63|1442.31|1506.79|1493.22|1272.63|1442.31| 314.04 | 2,861.66 | 1,238.69 32000115|HC SVC|0320|75827|1,360.16|788.89|||1406.14|1406.14|135.74|138.45|138.45|141.17|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 135.74 | 1,406.14 | 992.92 32000115|HC SVC|0320|75827|1,360.16|788.89|||1,406.14|1,406.14|314.04|320.32|320.32|326.60|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 314.04 | 1,406.14 | 992.92 32000116|HC RENAL UNILATERAL VENOUS|0320|75831|1,360.16|788.89|||2,861.66|2,861.66|313.98|320.26|320.26|326.54|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 313.98 | 2,861.66 | 992.92 32000116|HC RENAL UNILATERAL VENOUS|0320|75831|1,360.16|788.89|||2861.66|2861.66|244.83|249.72|249.72|254.62|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 244.83 | 2,861.66 | 992.92 32000117|HC RENAL BILATERAL VENOUS|0320|75833|1,436.76|833.32|||2861.66|2861.66|362.4|369.65|369.65|376.9|933.89|977.00|1048.83|1048.83|1120.67|862.06|933.89|1077.57|1221.25|1275.84|1264.35|1077.57|1221.25| 362.40 | 2,861.66 | 1,048.83 32000117|HC RENAL BILATERAL VENOUS|0320|75833|1,436.76|833.32|||2861.66|2861.66|362.40|369.65|369.65|376.90|933.89|977.00|1048.83|1048.83|1120.67|862.06|933.89|1077.57|1221.25|1275.84|1264.35|1077.57|1221.25| 362.40 | 2,861.66 | 1,048.83 32000118|HC EMBOLIZATION|0320|74894|2,943.96|1,707.50|||||||||1913.57|2001.89|2149.09|2149.09|2296.29|1766.38|1913.57|2207.97|2502.37|2614.24|2590.68|2207.97|2502.37| 1,766.38 | 2,614.24 | 2,207.97 32000119|HC ANGIO EXISTING CATHETER|0320|75898|4,445.62|2,578.46|||2861.66|2861.66|42.25|43.09|43.09|43.94|2889.65|3023.02|3245.30|3245.30|3467.58|2667.37|2889.65|3334.22|3778.78|3947.71|3912.15|3334.22|3778.78| 42.25 | 3,947.71 | 3,023.02 32000119|HC ANGIO EXISTING CATHETER|0320|75898|4,445.62|2,578.46|||2861.66|2861.66|156.80|159.94|159.94|163.07|2889.65|3023.02|3245.30|3245.30|3467.58|2667.37|2889.65|3334.22|3778.78|3947.71|3912.15|3334.22|3778.78| 156.80 | 3,947.71 | 3,023.02 32000120|HC S & I MECH REM INTRALUML OBSTR|0320|75902|1,046.23|606.81|||||||||680.05|711.44|763.75|763.75|816.06|627.74|680.05|784.67|889.30|929.05|920.68|784.67|889.30| 627.74 | 929.05 | 784.67 32000121|HC IVUS PERIPHERAL|0320|75945|340.08|197.25|||||||||221.05|231.25|248.26|248.26|265.26|204.05|221.05|255.06|289.07|301.99|299.27|255.06|289.07| 204.05 | 301.99 | 255.06 32000122|HC S/I ENDOGRAFT MODULAR BIFURCAT|0320|75952|1,183.16|686.23|||||118.68|121.05|121.05|123.42|769.05|804.55|863.71|863.71|922.86|709.90|769.05|887.37|1005.69|1050.65|1041.18|887.37|1005.69| 118.68 | 1,050.65 | 863.71 32000122|HC S/I ENDOGRAFT MODULAR BIFURCAT|0320|75952|1,183.16|686.23|||||237.36|242.10|242.10|246.85|769.05|804.55|863.71|863.71|922.86|709.90|769.05|887.37|1005.69|1050.65|1041.18|887.37|1005.69| 237.36 | 1,050.65 | 863.71 32000123|HC S/I ENDOGRAFT INITIAL EXTENSIO|0320|75953|768.26|445.59|||||327.08|333.62|333.62|340.16|499.37|522.42|560.83|560.83|599.24|460.96|499.37|576.20|653.02|682.21|676.07|576.20|653.02| 327.08 | 682.21 | 560.83 32000123|HC S/I ENDOGRAFT INITIAL EXTENSIO|0320|75953|768.26|445.59|||||681.61|695.24|695.24|708.87|499.37|522.42|560.83|560.83|599.24|460.96|499.37|576.20|653.02|682.21|676.07|576.20|653.02| 460.96 | 708.87 | 599.24 32000124|HC PTA PERIPHERAL ARTERY|0320|75962|2,914.79|1,690.58|||||310.73|316.94|316.94|323.16|1894.61|1982.06|2127.80|2127.80|2273.54|1748.87|1894.61|2186.09|2477.57|2588.33|2565.02|2186.09|2477.57| 310.73 | 2,588.33 | 2,127.80 32000124|HC PTA PERIPHERAL ARTERY|0320|75962|2,914.79|1,690.58|||||700.40|714.40|714.40|728.41|1894.61|1982.06|2127.80|2127.80|2273.54|1748.87|1894.61|2186.09|2477.57|2588.33|2565.02|2186.09|2477.57| 700.40 | 2,588.33 | 2,127.80 32000125|HC PTA AO/RENAL/VISCERAL|0320|75966|2,914.79|1,690.58|||||253.00|258.06|258.06|263.12|1894.61|1982.06|2127.80|2127.80|2273.54|1748.87|1894.61|2186.09|2477.57|2588.33|2565.02|2186.09|2477.57| 253.00 | 2,588.33 | 2,127.80 32000125|HC PTA AO/RENAL/VISCERAL|0320|75966|2,914.79|1,690.58|||||253.00|258.06|258.06|263.12|1894.61|1982.06|2127.80|2127.80|2273.54|1748.87|1894.61|2186.09|2477.57|2588.33|2565.02|2186.09|2477.57| 253.00 | 2,588.33 | 2,127.80 32000125|HC PTA AO/RENAL/VISCERAL|0320|75966|2,914.79|1,690.58|||||310.73|316.94|316.94|323.16|1894.61|1982.06|2127.80|2127.80|2273.54|1748.87|1894.61|2186.09|2477.57|2588.33|2565.02|2186.09|2477.57| 310.73 | 2,588.33 | 2,127.80 32000125|HC PTA AO/RENAL/VISCERAL|0320|75966|2,914.79|1,690.58|||||310.73|316.94|316.94|323.16|1894.61|1982.06|2127.80|2127.80|2273.54|1748.87|1894.61|2186.09|2477.57|2588.33|2565.02|2186.09|2477.57| 310.73 | 2,588.33 | 2,127.80 32000126|HC PTA VENOUS/1|0320|75978|6,647.60|3,855.61|||||310.73|316.94|316.94|323.16|4320.94|4520.37|4852.75|4852.75|5185.13|3988.56|4320.94|4985.70|5650.46|5903.07|5849.89|4985.70|5650.46| 310.73 | 5,903.07 | 4,852.75 32000126|HC PTA VENOUS/1|0320|75978|6,647.60|3,855.61|||||707.45|721.60|721.60|735.75|4320.94|4520.37|4852.75|4852.75|5185.13|3988.56|4320.94|4985.70|5650.46|5903.07|5849.89|4985.70|5650.46| 707.45 | 5,903.07 | 4,852.75 32000127|HC BILIARY DRAINAGE|0320|75980|1,187.98|689.03|||||150.46|153.47|153.47|156.48|772.19|807.83|867.23|867.23|926.62|712.79|772.19|890.99|1009.78|1054.93|1045.42|890.99|1009.78| 150.46 | 1,054.93 | 867.23 32000127|HC BILIARY DRAINAGE|0320|75980|1,187.98|689.03|||||150.46|153.47|153.47|156.48|772.19|807.83|867.23|867.23|926.62|712.79|772.19|890.99|1009.78|1054.93|1045.42|890.99|1009.78| 150.46 | 1,054.93 | 867.23 32000128|HC BILIARY DRAIN INT-EXT|0320|75982|1,360.16|788.89|||||183.16|186.83|186.83|190.49|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 183.16 | 1,207.82 | 992.92 32000128|HC BILIARY DRAIN INT-EXT|0320|75982|1,360.16|788.89|||||183.16|186.83|186.83|190.49|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 183.16 | 1,207.82 | 992.92 32000129|HC CHG TUBE/DRAIN CATH|0320|75984|1,953.33|1,132.93|||||45.79|46.71|46.71|47.62|1269.66|1328.26|1425.93|1425.93|1523.60|1172.00|1269.66|1465.00|1660.33|1734.56|1718.93|1465.00|1660.33| 45.79 | 1,734.56 | 1,425.93 32000129|HC CHG TUBE/DRAIN CATH|0320|75984|1,953.33|1,132.93|||||126.96|129.50|129.50|132.04|1269.66|1328.26|1425.93|1425.93|1523.60|1172.00|1269.66|1465.00|1660.33|1734.56|1718.93|1465.00|1660.33| 126.96 | 1,734.56 | 1,425.93 32000130|HC ABCESS DRAINAGE|0320|75989|1,123.13|651.42|||||106.99|109.13|109.13|111.27|730.03|763.73|819.88|819.88|876.04|673.88|730.03|842.35|954.66|997.34|988.35|842.35|954.66| 106.99 | 997.34 | 819.88 32000130|HC ABCESS DRAINAGE|0320|75989|1,123.13|651.42|||||91.58|93.41|93.41|95.25|730.03|763.73|819.88|819.88|876.04|673.88|730.03|842.35|954.66|997.34|988.35|842.35|954.66| 91.58 | 997.34 | 819.88 32000131|HC FLUOROSCOPY GUIDANCE 1 HR|0320|76000|976.19|566.19|853.88|811.186|230.13|230.13|37.22|37.97|37.97|38.71|634.52|663.81|712.62|712.62|761.43|585.71|634.52|732.14|829.76|866.86|859.05|732.14|829.76| 37.22 | 866.86 | 712.62 32000131|HC FLUOROSCOPY GUIDANCE 1 HR|0320|76000|976.19|566.19|853.88|811.186|230.13|230.13|44.18|45.07|45.07|45.95|634.52|663.81|712.62|712.62|761.43|585.71|634.52|732.14|829.76|866.86|859.05|732.14|829.76| 44.18 | 866.86 | 712.62 32000132|HC FLUOROSCOPY EXTENDED > 1 HR|0320|76001|1,360.32|788.99|||||58.02|59.18|59.18|60.34|884.21|925.02|993.03|993.03|1061.05|816.19|884.21|1020.24|1156.27|1207.96|1197.08|1020.24|1156.27| 58.02 | 1,207.96 | 993.03 32000132|HC FLUOROSCOPY EXTENDED > 1 HR|0320|76001|1,360.32|788.99|||||79.66|81.26|81.26|82.85|884.21|925.02|993.03|993.03|1061.05|816.19|884.21|1020.24|1156.27|1207.96|1197.08|1020.24|1156.27| 79.66 | 1,207.96 | 993.03 32000133|HC CHILD 1 VIEW NOSE PELVIS FB|0320|76010|275.01|159.51|240.57|228.54|80.90|80.90|16.59|16.92|16.92|17.25|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 16.59 | 244.21 | 200.76 32000133|HC CHILD 1 VIEW NOSE PELVIS FB|0320|76010|275.01|159.51|240.57|228.54|80.90|80.90|33.17|33.83|33.83|34.49|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 33.17 | 244.21 | 200.76 32000134|HC SINUS TRCT,ABCESS,FISTULA,GI C|0320|76080|502.41|291.40|||482.89|482.89|28.13|28.69|28.69|29.25|326.57|341.64|366.76|366.76|391.88|301.45|326.57|376.81|427.05|446.14|442.12|376.81|427.05| 28.13 | 482.89 | 366.76 32000134|HC SINUS TRCT,ABCESS,FISTULA,GI C|0320|76080|502.41|291.40|||482.89|482.89|40.47|41.28|41.28|42.08|326.57|341.64|366.76|366.76|391.88|301.45|326.57|376.81|427.05|446.14|442.12|376.81|427.05| 40.47 | 482.89 | 366.76 32000135|HC BREAST SURGICAL SPECIMEN|0320|76098|342.94|198.91|||482.89|482.89|27.19|27.73|27.73|28.27|222.91|233.20|250.35|250.35|267.49|205.76|222.91|257.21|291.50|304.53|301.79|257.21|291.50| 27.19 | 482.89 | 250.35 32000135|HC BREAST SURGICAL SPECIMEN|0320|76098|342.94|198.91|||482.89|482.89|16.84|17.17|17.17|17.51|222.91|233.20|250.35|250.35|267.49|205.76|222.91|257.21|291.50|304.53|301.79|257.21|291.50| 16.84 | 482.89 | 250.35 32000136|HC TRANSCRANIAL REALTIME|0320|76506|1,128.52|654.54|678.19|644.28|108.97|108.97|56.68|57.81|57.81|58.94|733.54|767.39|823.82|823.82|880.25|677.11|733.54|846.39|959.24|1002.13|993.10|846.39|959.24| 56.68 | 1,002.13 | 733.54 32000136|HC TRANSCRANIAL REALTIME|0320|76506|1,128.52|654.54|678.19|644.28|108.97|108.97|100.32|102.33|102.33|104.33|733.54|767.39|823.82|823.82|880.25|677.11|733.54|846.39|959.24|1002.13|993.10|846.39|959.24| 100.32 | 1,002.13 | 733.54 32000137|HC THYROID SOF TISSUE NECK|0320|76536|599.37|347.63|678.19|644.28|108.97|108.97|25.90|26.42|26.42|26.94|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 25.90 | 678.19 | 437.54 32000137|HC THYROID SOF TISSUE NECK|0320|76536|599.37|347.63|678.19|644.28|108.97|108.97|51.81|52.85|52.85|53.88|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 51.81 | 678.19 | 437.54 32000138|HC CHEST ECHOGRAPHY|0320|76604|599.37|347.63|156.72|148.88|108.97|108.97|51.97|53.01|53.01|54.05|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 51.97 | 532.24 | 389.59 32000138|HC CHEST ECHOGRAPHY|0320|76604|599.37|347.63|156.72|148.88|108.97|108.97|90.77|92.59|92.59|94.40|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 90.77 | 532.24 | 389.59 32000140|HC ABDOMINAL, COMPLETE PR|0320|76700|1,172.92|680.29|648.56|616.13|108.97|108.97|78.90|80.48|80.48|82.06|762.40|797.59|856.23|856.23|914.88|703.75|762.40|879.69|996.98|1041.55|1032.17|879.69|996.98| 78.90 | 1,041.55 | 762.40 32000140|HC ABDOMINAL, COMPLETE PR|0320|76700|1,172.92|680.29|648.56|616.13|108.97|108.97|134.06|136.74|136.74|139.43|762.40|797.59|856.23|856.23|914.88|703.75|762.40|879.69|996.98|1041.55|1032.17|879.69|996.98| 108.97 | 1,041.55 | 762.40 32000141|HC ABDOMINAL LIMITED|0320|76705|881.16|511.07|487.26|462.90|108.97|108.97|48.81|49.79|49.79|50.77|572.75|599.19|643.25|643.25|687.30|528.70|572.75|660.87|748.99|782.47|775.42|660.87|748.99| 48.81 | 782.47 | 572.75 32000141|HC ABDOMINAL LIMITED|0320|76705|881.16|511.07|487.26|462.90|108.97|108.97|97.61|99.57|99.57|101.52|572.75|599.19|643.25|643.25|687.30|528.70|572.75|660.87|748.99|782.47|775.42|660.87|748.99| 97.61 | 782.47 | 572.75 32000142|HC RETROPERITONEAL COMPLETE|0320|76770|1,041.29|603.95|578.03|549.13|108.97|108.97|78.90|80.48|80.48|82.06|676.84|708.08|760.14|760.14|812.21|624.77|676.84|780.97|885.10|924.67|916.34|780.97|885.10| 78.90 | 924.67 | 676.84 32000142|HC RETROPERITONEAL COMPLETE|0320|76770|1,041.29|603.95|578.03|549.13|108.97|108.97|129.58|132.17|132.17|134.76|676.84|708.08|760.14|760.14|812.21|624.77|676.84|780.97|885.10|924.67|916.34|780.97|885.10| 108.97 | 924.67 | 676.84 32000143|HC RETROPERITONEAL LIMITED|0320|76775|976.85|566.57|539.85|512.86|108.97|108.97|56.68|57.81|57.81|58.94|634.95|664.26|713.10|713.10|761.94|586.11|634.95|732.64|830.32|867.44|859.63|732.64|830.32| 56.68 | 867.44 | 634.95 32000143|HC RETROPERITONEAL LIMITED|0320|76775|976.85|566.57|539.85|512.86|108.97|108.97|97.20|99.14|99.14|101.08|634.95|664.26|713.10|713.10|761.94|586.11|634.95|732.64|830.32|867.44|859.63|732.64|830.32| 97.20 | 867.44 | 634.95 32000144|HC FETAL BIOPHYSICAL PROFILE W/NS|0320|76818|1,184.73|687.14|119.68|113.70|108.97|108.97|49.06|50.04|50.04|51.02|770.07|805.62|864.85|864.85|924.09|710.84|770.07|888.55|1007.02|1052.04|1042.56|888.55|1007.02| 49.06 | 1,052.04 | 770.07 32000144|HC FETAL BIOPHYSICAL PROFILE W/NS|0320|76818|1,184.73|687.14|119.68|113.70|108.97|108.97|98.12|100.09|100.09|102.05|770.07|805.62|864.85|864.85|924.09|710.84|770.07|888.55|1007.02|1052.04|1042.56|888.55|1007.02| 98.12 | 1,052.04 | 770.07 32000145|HC FETAL BIOPHYSICAL PROFILE W/O|0320|76819|641.70|372.19|136.79|129.95|108.97|108.97|49.06|50.04|50.04|51.02|417.11|436.36|468.44|468.44|500.53|385.02|417.11|481.28|545.45|569.83|564.70|481.28|545.45| 49.06 | 569.83 | 417.11 32000145|HC FETAL BIOPHYSICAL PROFILE W/O|0320|76819|641.70|372.19|136.79|129.95|108.97|108.97|98.12|100.09|100.09|102.05|417.11|436.36|468.44|468.44|500.53|385.02|417.11|481.28|545.45|569.83|564.70|481.28|545.45| 98.12 | 569.83 | 417.11 32000146|HC PELVIS|0320|76856|1,585.17|919.40|878.47|834.55|108.97|108.97|64.71|66.00|66.00|67.30|1030.36|1077.92|1157.17|1157.17|1236.43|951.10|1030.36|1188.88|1347.39|1407.63|1394.95|1188.88|1347.39| 64.71 | 1,407.63 | 1,030.36 32000146|HC PELVIS|0320|76856|1,585.17|919.40|878.47|834.55|108.97|108.97|108.98|111.16|111.16|113.34|1030.36|1077.92|1157.17|1157.17|1236.43|951.10|1030.36|1188.88|1347.39|1407.63|1394.95|1188.88|1347.39| 108.97 | 1,407.63 | 1,030.36 32000147|HC PELVIS LIMITED OR FOLLOW UP|0320|76857|1,162.47|674.23|644.99|612.74|108.97|108.97|42.25|43.09|43.09|43.94|755.61|790.48|848.60|848.60|906.73|697.48|755.61|871.85|988.10|1032.27|1022.97|871.85|988.10| 42.25 | 1,032.27 | 755.61 32000147|HC PELVIS LIMITED OR FOLLOW UP|0320|76857|1,162.47|674.23|644.99|612.74|108.97|108.97|67.65|69.01|69.01|70.36|755.61|790.48|848.60|848.60|906.73|697.48|755.61|871.85|988.10|1032.27|1022.97|871.85|988.10| 67.65 | 1,032.27 | 755.61 32000148|HC SONOGRAM-SCROTUM & CONTENTS|0320|76870|514.92|298.65|173.83|165.14|108.97|108.97|92.24|94.08|94.08|95.93|334.70|350.15|375.89|375.89|401.64|308.95|334.70|386.19|437.68|457.25|453.13|386.19|437.68| 92.24 | 457.25 | 334.70 32000148|HC SONOGRAM-SCROTUM & CONTENTS|0320|76870|514.92|298.65|173.83|165.14|108.97|108.97|46.12|47.04|47.04|47.96|334.70|350.15|375.89|375.89|401.64|308.95|334.70|386.19|437.68|457.25|453.13|386.19|437.68| 46.12 | 457.25 | 334.70 32000149|HC TRANSRECTAL|0320|76872|1,074.35|623.12|589.97|560.47|108.97|108.97|61.40|62.63|62.63|63.86|698.33|730.56|784.28|784.28|837.99|644.61|698.33|805.76|913.20|954.02|945.43|805.76|913.20| 61.40 | 954.02 | 698.33 32000149|HC TRANSRECTAL|0320|76872|1,074.35|623.12|589.97|560.47|108.97|108.97|92.24|94.08|94.08|95.93|698.33|730.56|784.28|784.28|837.99|644.61|698.33|805.76|913.20|954.02|945.43|805.76|913.20| 92.24 | 954.02 | 698.33 32000150|HC US SOFT TISSUE/JOINT EXTREMITY NONVASC LIMITED|0320|76882|810.60|470.15|165.28|157.02|108.97|108.97|6.07|6.19|6.19|6.31|526.89|551.21|591.74|591.74|632.27|486.36|526.89|607.95|689.01|719.81|713.33|607.95|689.01| 6.07 | 719.81 | 526.89 32000151|HC ULTRA GUIDE FOR VASCULAR ACCES|0320|76937|1,166.89|676.80|632.29|600.6755|||15.48|15.79|15.79|16.1|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 15.48 | 1,036.20 | 793.49 32000151|HC ULTRA GUIDE FOR VASCULAR ACCES|0320|76937|1,166.89|676.80|632.29|600.6755|||29.33|29.92|29.92|30.51|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 29.33 | 1,036.20 | 793.49 32000152|HC ULTRASOUND GUIDANCE|0320|76942|1,166.89|676.80|169.54|161.06|||39.25|40.03|40.03|40.82|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 39.25 | 1,036.20 | 793.49 32000152|HC ULTRASOUND GUIDANCE|0320|76942|1,166.89|676.80|169.54|161.06|||55.39|56.5|56.5|57.61|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 55.39 | 1,036.20 | 793.49 32000153|HC AMNIOCENTESIS|0320|76946|210.54|122.11|131.08|124.53|||49.91|50.91|50.91|51.91|136.85|143.17|153.69|153.69|164.22|126.32|136.85|157.91|178.96|186.96|185.28|157.91|178.96| 49.91 | 186.96 | 143.17 32000153|HC AMNIOCENTESIS|0320|76946|210.54|122.11|131.08|124.526|||76.59|78.12|78.12|79.65|136.85|143.17|153.69|153.69|164.22|126.32|136.85|157.91|178.96|186.96|185.28|157.91|178.96| 76.59 | 186.96 | 143.17 32000154|HC FLUOR GUIDE FOR CV ACCESS-7599|0320|77001|1,170.19|678.71|||||||||760.62|795.73|854.24|854.24|912.75|702.11|760.62|877.64|994.66|1039.13|1029.77|877.64|994.66| 702.11 | 1,039.13 | 877.64 32000155|HC FLUORO GUIDANCE FOR CV ACCESS|0320|77001|1,125.21|652.62|||||||||731.39|765.14|821.40|821.40|877.66|675.13|731.39|843.91|956.43|999.19|990.18|843.91|956.43| 675.13 | 999.19 | 843.91 32000156|HC FLUORO NEEDLE GUIDE PLCMNT|0320|77002|2,029.90|1,177.34|1798.45|1708.5275|||||||1319.44|1380.33|1481.83|1481.83|1583.32|1217.94|1319.44|1522.43|1725.42|1802.55|1786.31|1522.43|1725.42| 1,217.94 | 1,802.55 | 1,522.43 32000157|HC FLUORO GUIDANCE/DI/THER/INJ|0320|77003|1,569.13|910.10|787.34|747.973|||||||1019.93|1067.01|1145.46|1145.46|1223.92|941.48|1019.93|1176.85|1333.76|1393.39|1380.83|1176.85|1333.76| 747.97 | 1,393.39 | 1,145.46 32000158|HC BONE LENGTH STUDY|0320|77073|416.58|241.62|364.39|346.1705|108.97|108.97|||||270.78|283.27|304.10|304.10|324.93|249.95|270.78|312.44|354.09|369.92|366.59|312.44|354.09| 108.97 | 369.92 | 312.44 32000159|HC BONE SURVEY- LIMITED|0320|77074|940.70|545.61|||108.97|108.97|||||611.46|639.68|686.71|686.71|733.75|564.42|611.46|705.53|799.60|835.34|827.82|705.53|799.60| 108.97 | 835.34 | 686.71 32000160|HC BONE SURVEY-COMPLETE-AXIAL|0320|77075|1,132.88|657.07|990.94|941.39|108.97|108.97|||||736.37|770.36|827.00|827.00|883.65|679.73|736.37|849.66|962.95|1006.00|996.93|849.66|962.95| 108.97 | 1,006.00 | 849.66 32000161|HC OSSEOUS SURVEY-INFANT|0320|77076|1,025.69|594.90|||108.97|108.97|||||666.70|697.47|748.75|748.75|800.04|615.41|666.70|769.27|871.84|910.81|902.61|769.27|871.84| 108.97 | 910.81 | 748.75 32000162|HC JOINT SURVEY SINGLE VW|0320|77077|72.86|42.26|||108.97|108.97|||||47.36|49.54|53.19|53.19|56.83|43.72|47.36|54.65|61.93|64.70|64.12|54.65|61.93| 43.72 | 108.97 | 54.65 32000163|HC MOD SED >5YRS 1ST 30 MIN|0320|99144|271.91|157.71|||||||||176.74|184.90|198.49|198.49|212.09|163.15|176.74|203.93|231.12|241.46|239.28|203.93|231.12| 163.15 | 241.46 | 203.93 32000164|HC TEMPOROMANDIBULAR JNT UNI|0320|70328|522.70|303.17|||80.90|80.90|19.91|20.31|20.31|20.71|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 19.91 | 464.16 | 355.44 32000164|HC TEMPOROMANDIBULAR JNT UNI|0320|70328|522.70|303.17|||80.90|80.90|32.39|33.04|33.04|33.69|339.76|355.44|381.57|381.57|407.71|313.62|339.76|392.03|444.30|464.16|459.98|392.03|444.30| 32.39 | 464.16 | 355.44 32000165|HC WRIST COMPLETE|0320|73110|275.01|159.51|240.57|228.5415|80.90|80.90|21.46|21.89|21.89|22.31|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 21.46 | 244.21 | 200.76 32000165|HC WRIST COMPLETE|0320|73110|275.01|159.51|240.57|228.5415|80.90|80.90|33.47|34.14|34.14|34.81|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 33.47 | 244.21 | 200.76 32000166|HC ARTHROGRAM WRIST|0320|73115|519.74|301.45|||368.12|368.12|63.32|64.59|64.59|65.86|337.83|353.42|379.41|379.41|405.40|311.84|337.83|389.81|441.78|461.53|457.37|389.81|441.78| 63.32 | 461.53 | 368.12 32000166|HC ARTHROGRAM WRIST|0320|73115|519.74|301.45|||368.12|368.12|90.27|92.08|92.08|93.89|337.83|353.42|379.41|379.41|405.40|311.84|337.83|389.81|441.78|461.53|457.37|389.81|441.78| 90.27 | 461.53 | 368.12 32000167|HC HAND PARTIAL 2 VIEWS|0320|73120|286.86|166.38|432.01|410.41|108.97|108.97|14.39|14.68|14.68|14.97|186.46|195.06|209.41|209.41|223.75|172.12|186.46|215.15|243.83|254.73|252.44|215.15|243.83| 14.39 | 432.01 | 209.41 32000167|HC HAND PARTIAL 2 VIEWS|0320|73120|286.86|166.38|432.01|410.41|108.97|108.97|28.78|29.36|29.36|29.93|186.46|195.06|209.41|209.41|223.75|172.12|186.46|215.15|243.83|254.73|252.44|215.15|243.83| 28.78 | 432.01 | 209.41 32000168|HC ARTHROGRAM HIP|0320|73525|555.42|322.14|||368.12|368.12|84.01|85.69|85.69|87.37|361.02|377.69|405.46|405.46|433.23|333.25|361.02|416.57|472.11|493.21|488.77|416.57|472.11| 84.01 | 493.21 | 377.69 32000168|HC ARTHROGRAM HIP|0320|73525|555.42|322.14|||368.12|368.12|90.27|92.08|92.08|93.89|361.02|377.69|405.46|405.46|433.23|333.25|361.02|416.57|472.11|493.21|488.77|416.57|472.11| 90.27 | 493.21 | 377.69 32000169|HC ANKLE COMPLETE *|0320|73610|275.01|159.51|240.57|228.54|80.90|80.90|33.47|34.14|34.14|34.81|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 33.47 | 244.21 | 200.76 32000169|HC ANKLE COMPLETE *|0320|73610|275.01|159.51|240.57|228.54|80.90|80.90|21.46|21.89|21.89|22.31|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 21.46 | 244.21 | 200.76 32000170|HC SMALL BOWEL W/O UGI|0320|74250|1,226.93|711.62|590.75|561.21|178.55|178.55|42.22|43.06|43.06|43.91|797.50|834.31|895.66|895.66|957.01|736.16|797.50|920.20|1042.89|1089.51|1079.70|920.20|1042.89| 42.22 | 1,089.51 | 797.50 32000170|HC SMALL BOWEL W/O UGI|0320|74250|1,226.93|711.62|590.75|561.2125|178.55|178.55|84.44|86.13|86.13|87.82|797.50|834.31|895.66|895.66|957.01|736.16|797.50|920.20|1042.89|1089.51|1079.70|920.20|1042.89| 84.44 | 1,089.51 | 797.50 32000171|HC UROGRAPHY-RETROGRADE W/WO KUB|0320|74420|2,883.18|1,672.24|||368.12|368.12|133.28|135.94|135.94|138.61|1874.07|1960.56|2104.72|2104.72|2248.88|1729.91|1874.07|2162.39|2450.70|2560.26|2537.20|2162.39|2450.70| 133.28 | 2,560.26 | 1,960.56 32000171|HC UROGRAPHY-RETROGRADE W/WO KUB|0320|74420|2,883.18|1,672.24|||368.12|368.12|44.48|45.37|45.37|46.26|1874.07|1960.56|2104.72|2104.72|2248.88|1729.91|1874.07|2162.39|2450.70|2560.26|2537.20|2162.39|2450.70| 44.48 | 2,560.26 | 1,960.56 32000172|HC FOOT 2 VIEWS|0320|73620|275.01|159.51|274.5|260.775|80.9|80.9|19.91|20.31|20.31|20.71|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 19.91 | 274.50 | 200.76 32000172|HC FOOT 2 VIEWS|0320|73620|275.01|159.51|274.50|260.78|80.90|80.90|30.27|30.88|30.88|31.49|178.76|187.01|200.76|200.76|214.51|165.01|178.76|206.26|233.76|244.21|242.01|206.26|233.76| 30.27 | 274.50 | 200.76 32000173|HC BONE AGE STUDY|0320|77072|327.23|189.79|229.10|217.65|108.97|108.97|||||212.70|222.52|238.88|238.88|255.24|196.34|212.70|245.42|278.15|290.58|287.96|245.42|278.15| 108.97 | 290.58 | 238.88 32000175|HC INJECTION ABCESS CATH|0320|76080|623.35|361.54|||482.89|482.89|28.13|28.69|28.69|29.25|405.18|423.88|455.05|455.05|486.21|374.01|405.18|467.51|529.85|553.53|548.55|467.51|529.85| 28.13 | 553.53 | 455.05 32000175|HC INJECTION ABCESS CATH|0320|76080|623.35|361.54|||482.89|482.89|40.47|41.28|41.28|42.08|405.18|423.88|455.05|455.05|486.21|374.01|405.18|467.51|529.85|553.53|548.55|467.51|529.85| 40.47 | 553.53 | 455.05 32000176|HC GUIDE PERC DRAIN W/CATH PLA|0320|75989|1,123.13|651.42|||||106.99|109.13|109.13|111.27|730.03|763.73|819.88|819.88|876.04|673.88|730.03|842.35|954.66|997.34|988.35|842.35|954.66| 106.99 | 997.34 | 819.88 32000176|HC GUIDE PERC DRAIN W/CATH PLA|0320|75989|1,123.13|651.42|||||91.58|93.41|93.41|95.25|730.03|763.73|819.88|819.88|876.04|673.88|730.03|842.35|954.66|997.34|988.35|842.35|954.66| 91.58 | 997.34 | 819.88 32000177|HC MYELOGRAPHY LUMBAR INJ-CERVICAL|0320|62302|3,311.88|1,920.89|4369.78|4151.291|715.18|715.18|||||2152.72|2252.08|2417.67|2417.67|2583.27|1987.13|2152.72|2483.91|2815.10|2940.95|2914.45|2483.91|2815.10| 715.18 | 4,369.78 | 2,483.91 32000178|HC MYELOGRAPHY LUMBAR INJ-THORACIC|0320|62303|3,311.88|1,920.89|4369.78|4151.291|715.18|715.18|||||2152.72|2252.08|2417.67|2417.67|2583.27|1987.13|2152.72|2483.91|2815.10|2940.95|2914.45|2483.91|2815.10| 715.18 | 4,369.78 | 2,483.91 32000179|HC MYELOGRAPHY LUMBAR INJ-LUMBAR|0320|62304|3,311.88|1,920.89|4369.78|4151.291|715.18|715.18|||||2152.72|2252.08|2417.67|2417.67|2583.27|1987.13|2152.72|2483.91|2815.10|2940.95|2914.45|2483.91|2815.10| 715.18 | 4,369.78 | 2,483.91 32000180|HC MYELOGRAPHY LUMBAR INJ 2 OR>RGNS|0320|62305|3,743.26|2,171.09|4369.78|4151.291|715.18|715.18|||||2433.12|2545.42|2732.58|2732.58|2919.74|2245.96|2433.12|2807.45|3181.77|3324.01|3294.07|2807.45|3181.77| 715.18 | 4,369.78 | 2,807.45 32000181|HC ANGIO SELECT ADDT VES|0320|75774|2,720.27|1,577.76|||||327.73|334.29|334.29|340.84|1768.18|1849.78|1985.80|1985.80|2121.81|1632.16|1768.18|2040.20|2312.23|2415.60|2393.84|2040.20|2312.23| 327.73 | 2,415.60 | 1,985.80 32000181|HC ANGIO SELECT ADDT VES|0320|75774|2,720.27|1,577.76|||||503.7|513.78|513.78|523.85|1768.18|1849.78|1985.80|1985.80|2121.81|1632.16|1768.18|2040.20|2312.23|2415.60|2393.84|2040.20|2312.23| 503.70 | 2,415.60 | 1,985.80 32000182|HC PORTAL VENO W/PRESSURE|0320|75885|1,445.21|838.22|||2861.66|2861.66|190.36|194.17|194.17|197.97|939.39|982.74|1055.00|1055.00|1127.26|867.13|939.39|1083.91|1228.43|1283.35|1271.78|1083.91|1228.43| 190.36 | 2,861.66 | 1,055.00 32000182|HC PORTAL VENO W/PRESSURE|0320|75885|1,445.21|838.22|||2861.66|2861.66|323.65|330.13|330.13|336.60|939.39|982.74|1055.00|1055.00|1127.26|867.13|939.39|1083.91|1228.43|1283.35|1271.78|1083.91|1228.43| 323.65 | 2,861.66 | 1,055.00 32000183|HC PORTAL VENO W/O PRESS|0320|75887|1,359.96|788.78|||2861.66|2861.66|190.36|194.17|194.17|197.97|883.97|924.77|992.77|992.77|1060.77|815.98|883.97|1019.97|1155.97|1207.64|1196.76|1019.97|1155.97| 190.36 | 2,861.66 | 992.77 32000183|HC PORTAL VENO W/O PRESS|0320|75887|1,359.96|788.78|||2861.66|2861.66|323.65|330.13|330.13|336.60|883.97|924.77|992.77|992.77|1060.77|815.98|883.97|1019.97|1155.97|1207.64|1196.76|1019.97|1155.97| 323.65 | 2,861.66 | 992.77 32000184|HC S & I STRIP FIBRIN SHEATH|0320|75901|1,196.06|693.71|||||||||777.44|813.32|873.12|873.12|932.93|717.64|777.44|897.05|1016.65|1062.10|1052.53|897.05|1016.65| 717.64 | 1,062.10 | 897.05 32000185|HC IVUS PERIPHERAL ADDT|0320|75946|340.08|197.25|||||||||221.05|231.25|248.26|248.26|265.26|204.05|221.05|255.06|289.07|301.99|299.27|255.06|289.07| 204.05 | 301.99 | 255.06 32000186|HC PTA PERIPHERAL ART ADDT|0320|75964|1,360.16|788.89|||||310.73|316.94|316.94|323.16|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 310.73 | 1,207.82 | 992.92 32000186|HC PTA PERIPHERAL ART ADDT|0320|75964|1,360.16|788.89|||||310.73|316.94|316.94|323.16|884.10|924.91|992.92|992.92|1060.92|816.10|884.10|1020.12|1156.14|1207.82|1196.94|1020.12|1156.14| 310.73 | 1,207.82 | 992.92 32000187|HC PTA VISCERAL ADDT|0320|75968|1,190.08|690.25|||||98.12|100.09|100.09|102.05|773.55|809.25|868.76|868.76|928.26|714.05|773.55|892.56|1011.57|1056.79|1047.27|892.56|1011.57| 98.12 | 1,056.79 | 868.76 32000187|HC PTA VISCERAL ADDT|0320|75968|1,190.08|690.25|||||196.58|200.51|200.51|204.44|773.55|809.25|868.76|868.76|928.26|714.05|773.55|892.56|1011.57|1056.79|1047.27|892.56|1011.57| 196.58 | 1,056.79 | 868.76 32000188|HC ARTHROGRAM ELBOW|0320|73085|519.74|301.45|||368.12|368.12|87.00|88.74|88.74|90.48|337.83|353.42|379.41|379.41|405.40|311.84|337.83|389.81|441.78|461.53|457.37|389.81|441.78| 87.00 | 461.53 | 368.12 32000188|HC ARTHROGRAM ELBOW|0320|73085|519.74|301.45|||368.12|368.12|90.27|92.08|92.08|93.89|337.83|353.42|379.41|379.41|405.40|311.84|337.83|389.81|441.78|461.53|457.37|389.81|441.78| 90.27 | 461.53 | 368.12 32000189|HC CANNULATION THORACIC DUCT|0320|38794|5,148.20|2,985.96|||||||||3346.33|3500.78|3758.19|3758.19|4015.60|3088.92|3346.33|3861.15|4375.97|4571.60|4530.42|3861.15|4375.97| 3,088.92 | 4,571.60 | 3,861.15 32000190|HC HYSTEROSONOGRAPHY|0320|76831|901.34|522.78|678.19|644.28|230.13|230.13|78.5|80.07|80.07|81.64|585.87|612.91|657.98|657.98|703.05|540.80|585.87|676.01|766.14|800.39|793.18|676.01|766.14| 78.50 | 800.39 | 644.28 32000190|HC HYSTEROSONOGRAPHY|0320|76831|901.34|522.78|678.19|644.28|230.13|230.13|157|160.14|160.14|163.28|585.87|612.91|657.98|657.98|703.05|540.80|585.87|676.01|766.14|800.39|793.18|676.01|766.14| 157.00 | 800.39 | 644.28 32000191|HC BILIARY STONE REMOVAL|0320|74327|2,193.12|1,272.01|||||116.2|118.53|118.53|120.85|1425.53|1491.32|1600.98|1600.98|1710.63|1315.87|1425.53|1644.84|1864.15|1947.49|1929.95|1644.84|1864.15| 116.20 | 1,947.49 | 1,600.98 32000191|HC BILIARY STONE REMOVAL|0320|74327|2,193.12|1,272.01|||||164.85|168.15|168.15|171.44|1425.53|1491.32|1600.98|1600.98|1710.63|1315.87|1425.53|1644.84|1864.15|1947.49|1929.95|1644.84|1864.15| 164.85 | 1,947.49 | 1,600.98 32000192|HC NEPHROSTOGRAM/1|0320|74425|1,190.08|690.25|||368.12|368.12|40.05|40.85|40.85|41.65|773.55|809.25|868.76|868.76|928.26|714.05|773.55|892.56|1011.57|1056.79|1047.27|892.56|1011.57| 40.05 | 1,056.79 | 809.25 32000192|HC NEPHROSTOGRAM/1|0320|74425|1,190.08|690.25|||368.12|368.12|51.97|53.01|53.01|54.05|773.55|809.25|868.76|868.76|928.26|714.05|773.55|892.56|1011.57|1056.79|1047.27|892.56|1011.57| 51.97 | 1,056.79 | 809.25 32000193|HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS|0320|47531|1,254.86|727.82|819.25|778.2875|3,183.41|3,183.41|||||815.66|853.30|916.05|916.05|978.79|752.92|815.66|941.15|1066.63|1114.32|1104.28|941.15|1066.63| 752.92 | 3,183.41 | 941.15 32000194|HC INJECTION FOR CHOLANGIOGRAM, INTIAL ACCESS|0320|47532|5,868.88|3,403.95|819.25|778.2875|3,183.41|3,183.41|||||3814.77|3990.84|4284.28|4284.28|4577.73|3521.33|3814.77|4401.66|4988.55|5211.57|5164.61|4401.66|4988.55| 778.29 | 5,211.57 | 4,284.28 32000196|HC PLMT BILIARY DRAINAGE CATH, INTERNAL/EXTERNAL|0320|47534|8,322.38|4,826.98|||3,183.41|3,183.41|||||5409.55|5659.22|6075.34|6075.34|6491.46|4993.43|5409.55|6241.79|7074.02|7390.27|7323.69|6241.79|7074.02| 3,183.41 | 7,390.27 | 6,075.34 32000197|HC CONVERSION EXT BIL DRG CATH|0320|47535|4,788.61|2,777.39|||3,183.41|3,183.41|||||3112.60|3256.25|3495.69|3495.69|3735.12|2873.17|3112.60|3591.46|4070.32|4252.29|4213.98|3591.46|4070.32| 2,873.17 | 4,252.29 | 3,495.69 32000198|HC EXCHANGE BILIARY DRG CATH|0320|47536|7,094.71|4,114.93|||3183.41|3183.41|||||4611.56|4824.40|5179.14|5179.14|5533.87|4256.83|4611.56|5321.03|6030.50|6300.10|6243.34|5321.03|6030.50| 3,183.41 | 6,300.10 | 5,179.14 32000199|HC REMOVAL BILIARY DRG CATH|0320|47537|4,174.78|2,421.37|||809.60|809.60|||||2713.61|2838.85|3047.59|3047.59|3256.33|2504.87|2713.61|3131.09|3548.56|3707.20|3673.81|3131.09|3548.56| 809.60 | 3,707.20 | 3,047.59 32000200|HC PERQ PLMT BILE DUCT STENT, EXISTING ACCESS|0320|47538|10,082.08|5,847.61|||5,060.44|5,060.44|||||6553.35|6855.81|7359.92|7359.92|7864.02|6049.25|6553.35|7561.56|8569.77|8952.89|8872.23|7561.56|8569.77| 5,060.44 | 8,952.89 | 7,359.92 32000201|HC PERQ PLMT BILE DUCT STENT, NEW ACCESS|0320|47539|11,776.18|6,830.18|||5,060.44|5,060.44|||||7654.52|8007.80|8596.61|8596.61|9185.42|7065.71|7654.52|8832.14|10009.75|10457.25|10363.04|8832.14|10009.75| 5,060.44 | 10,457.25 | 8,596.61 32000202|HC PERQ PLMT BILE DUCT STENT, NEW ACCESS W/PL. OF SEP. DRAIN|0320|47540|15,309.95|8,879.77|||5,060.44|5,060.44|||||9951.47|10410.77|11176.26|11176.26|11941.76|9185.97|9951.47|11482.46|13013.46|13595.24|13472.76|11482.46|13013.46| 5,060.44 | 13,595.24 | 11,176.26 32000203|HC PLMT ACCESS BIL TREE SM BWL, NEW ACCESS|0320|47541|5,868.88|3,403.95|||3,183.41|3,183.41|||||3814.77|3990.84|4284.28|4284.28|4577.73|3521.33|3814.77|4401.66|4988.55|5211.57|5164.61|4401.66|4988.55| 3,183.41 | 5,211.57 | 4,284.28 32000204|HC DILATE BILIARY DUCT/AMPULLA, EACH DUCT, ADD ON|0320|47542|5,240.84|3,039.69|||||||||3406.55|3563.77|3825.81|3825.81|4087.86|3144.50|3406.55|3930.63|4454.71|4653.87|4611.94|3930.63|4454.71| 3,144.50 | 4,653.87 | 3,930.63 32000205|HC NJX PX NFROSGRM &/URTRGRM, NEW ACCESS|0320|50430|4,395.86|2,549.60|||574.77|574.77|||||2857.31|2989.18|3208.98|3208.98|3428.77|2637.52|2857.31|3296.90|3736.48|3903.52|3868.36|3296.90|3736.48| 574.77 | 3,903.52 | 3,208.98 32000206|HC NJX PX NFROSGRM &/URTRGRM, EXISTING ACCESS|0320|50431|1,142.73|662.78|||574.77|574.77|||||742.77|777.06|834.19|834.19|891.33|685.64|742.77|857.05|971.32|1014.74|1005.60|857.05|971.32| 574.77 | 1,014.74 | 834.19 32000207|HC PLMT NEPHROSTOMY CATHETER|0320|50432|8,159.46|4,732.49|420.59|399.5605|1792.99|1792.99|||||5303.65|5548.43|5956.41|5956.41|6364.38|4895.68|5303.65|6119.60|6935.54|7245.60|7180.32|6119.60|6935.54| 399.56 | 7,245.60 | 5,956.41 32000208|HC PLMT NEPHROURETERAL CATHETER, NEW ACCESS|0320|50433|13,815.62|8,013.06|420.59|399.5605|3,076.34|3,076.34|||||8980.15|9394.62|10085.40|10085.40|10776.18|8289.37|8980.15|10361.72|11743.28|12268.27|12157.75|10361.72|11743.28| 399.56 | 12,268.27 | 10,085.40 32000209|HC CONVERT NEPHROSTOMY CATHETER|0320|50434|9,105.73|5,281.32|420.59|399.5605|1,792.99|1,792.99|||||5918.72|6191.90|6647.18|6647.18|7102.47|5463.44|5918.72|6829.30|7739.87|8085.89|8013.04|6829.30|7739.87| 399.56 | 8,085.89 | 6,647.18 32000210|HC EXCHANGE NEPHROSTOMY CATH|0320|50435|5,625.57|3,262.83|||1,792.99|1,792.99|||||3656.62|3825.39|4106.67|4106.67|4387.94|3375.34|3656.62|4219.18|4781.73|4995.51|4950.50|4219.18|4781.73| 1,792.99 | 4,995.51 | 4,106.67 32000212|HC PERQ ART M-THROMBECT &/NFS|0320|61645|29,160.51|16,913.10|||||||||18954.33|19829.15|21287.17|21287.17|22745.20|17496.31|18954.33|21870.38|24786.43|25894.53|25661.25|21870.38|24786.43| 17,496.31 | 25,894.53 | 21,870.38 32000213|HC INTRVASC US NONCORONARY 1ST|0320|37252|7,177.94|4,163.21|||||||||4665.66|4881.00|5239.90|5239.90|5598.79|4306.76|4665.66|5383.46|6101.25|6374.01|6316.59|5383.46|6101.25| 4,306.76 | 6,374.01 | 5,383.46 32000214|HC INTRVASC US NONCORONARY ADDL|0320|37253|2,590.68|1,502.59|||||||||1683.94|1761.66|1891.20|1891.20|2020.73|1554.41|1683.94|1943.01|2202.08|2300.52|2279.80|1943.01|2202.08| 1,554.41 | 2,300.52 | 1,943.01 32000215|HC ENTIRE SPINE (SCOLIOSIS) 1 VIEW|0320|72081|566.66|328.66|||80.90|80.90|||||368.33|385.33|413.66|413.66|441.99|340.00|368.33|425.00|481.66|503.19|498.66|425.00|481.66| 80.90 | 503.19 | 413.66 32000216|HC ENTIRE SPINE (SCOLIOSIS) 2 OR 3 VIEWS|0320|72082|728.41|422.48|||108.97|108.97|||||473.47|495.32|531.74|531.74|568.16|437.05|473.47|546.31|619.15|646.83|641.00|546.31|619.15| 108.97 | 646.83 | 531.74 32000217|HC UNILATERAL HIP W/ PELVIS 1 VIEW|0320|73501|454.61|263.67|||80.90|80.90|||||295.50|309.13|331.87|331.87|354.60|272.77|295.50|340.96|386.42|403.69|400.06|340.96|386.42| 80.90 | 403.69 | 331.87 32000218|HC UNILATERAL HIP W/ PELVIS 2-3 VIEWS|0320|73502|669.74|388.45|||80.90|80.90|||||435.33|455.42|488.91|488.91|522.40|401.84|435.33|502.31|569.28|594.73|589.37|502.31|569.28| 80.90 | 594.73 | 488.91 32000219|HC UNILATERAL HIP W/ PELVIS MIN. 4 VIEWS|0320|73503|884.89|513.24|||108.97|108.97|||||575.18|601.73|645.97|645.97|690.21|530.93|575.18|663.67|752.16|785.78|778.70|663.67|752.16| 108.97 | 785.78 | 645.97 32000220|HC BILATERAL HIPS W/PELVIS 2 VIEWS|0320|73521|722.59|419.10|||108.97|108.97|||||469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 108.97 | 641.66 | 527.49 32000221|HC BILATERAL HIPS W/PELVIS 3-4 VIEWS|0320|73522|618.19|358.55|||108.97|108.97|||||401.82|420.37|451.28|451.28|482.19|370.91|401.82|463.64|525.46|548.95|544.01|463.64|525.46| 108.97 | 548.95 | 451.28 32000222|HC BILATERAL HIPS W/PELVIS MIN. 5 VIEWS|0320|73523|1,144.37|663.73|||108.97|108.97|||||743.84|778.17|835.39|835.39|892.61|686.62|743.84|858.28|972.71|1016.20|1007.05|858.28|972.71| 108.97 | 1,016.20 | 835.39 32000223|HC FEMUR 1 VIEW|0320|73551|213.94|124.09|||80.90|80.90|||||139.06|145.48|156.18|156.18|166.87|128.36|139.06|160.46|181.85|189.98|188.27|160.46|181.85| 80.90 | 189.98 | 156.18 32000224|HC FEMUR 2 VIEWS|0320|73552|427.89|248.18|||80.90|80.90|||||278.13|290.97|312.36|312.36|333.75|256.73|278.13|320.92|363.71|379.97|376.54|320.92|363.71| 80.90 | 379.97 | 312.36 32000225|HC L-SPINE BENDING VIEW ONLY, 2-3 VIEWS|0320|72120|722.59|419.10|632.07|600.4665|108.97|108.97|25.25|25.76|25.76|26.26|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 25.25 | 641.66 | 527.49 32000225|HC L-SPINE BENDING VIEW ONLY, 2-3 VIEWS|0320|72120|722.59|419.10|632.07|600.4665|108.97|108.97|50.50|51.51|51.51|52.52|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 50.50 | 641.66 | 527.49 32000226|HC FNA W/IMAGE|0320|10022|1,227.96|712.22|||||107.13|109.27|109.27|111.41|798.17|835.01|896.41|896.41|957.81|736.78|798.17|920.97|1043.77|1090.43|1080.60|920.97|1043.77| 107.13 | 1,090.43 | 896.41 32000227|HC PLMT URETERAL STENT PRQ,PRE EXISTING TRACT|0320|50693|7,972.30|4,623.93|||3,076.34|3,076.34|||||5182.00|5421.16|5819.78|5819.78|6218.39|4783.38|5182.00|5979.23|6776.46|7079.40|7015.62|5979.23|6776.46| 3,076.34 | 7,079.40 | 5,819.78 32000228|HC PLMT URETERAL STENT PRQ, NEW ACESS, W/O CATH|0320|50694|12,682.19|7,355.67|||3,076.34|3,076.34|||||8243.42|8623.89|9258.00|9258.00|9892.11|7609.31|8243.42|9511.64|10779.86|11261.78|11160.33|9511.64|10779.86| 3,076.34 | 11,261.78 | 9,258.00 32000229|HC PLMT URETERAL STENT PRQ, NEW ACESS, W/CATH|0320|50695|19,741.05|11,449.81|||3,076.34|3,076.34|||||12831.68|13423.91|14410.97|14410.97|15398.02|11844.63|12831.68|14805.79|16779.89|17530.05|17372.12|14805.79|16779.89| 3,076.34 | 17,530.05 | 14,410.97 32000230|HC CHOLANGIOGRAM OPERATIVE|0320|74300|662.45|384.22|||||55.60|56.72|56.72|57.83|430.59|450.47|483.59|483.59|516.71|397.47|430.59|496.84|563.08|588.26|582.96|496.84|563.08| 55.60 | 588.26 | 483.59 32000230|HC CHOLANGIOGRAM OPERATIVE|0320|74300|662.45|384.22|||||111.21|113.43|113.43|115.66|430.59|450.47|483.59|483.59|516.71|397.47|430.59|496.84|563.08|588.26|582.96|496.84|563.08| 111.21 | 588.26 | 483.59 32000231|HC SELECTIVE CATH - SEGMENTAL ARTERY|0320|36015|1,917.30|1,112.03|||||523.33|533.79|533.79|544.26|1246.25|1303.76|1399.63|1399.63|1495.49|1150.38|1246.25|1437.98|1629.71|1702.56|1687.22|1437.98|1629.71| 523.33 | 1,702.56 | 1,399.63 32000232|HC PULMONARY UNILATSELECTIVE ANGIO|0320|75741|3,734.03|2,165.74|||2861.66|2861.66|208.68|212.85|212.85|217.02|2427.12|2539.14|2725.84|2725.84|2912.54|2240.42|2427.12|2800.52|3173.93|3315.82|3285.95|2800.52|3173.93| 208.68 | 3,315.82 | 2,725.84 32000232|HC PULMONARY UNILATSELECTIVE ANGIO|0320|75741|3,734.03|2,165.74|||2,861.66|2,861.66|319.58|325.97|325.97|332.37|2427.12|2539.14|2725.84|2725.84|2912.54|2240.42|2427.12|2800.52|3173.93|3315.82|3285.95|2800.52|3173.93| 319.58 | 3,315.82 | 2,725.84 32000233|HC IMAGE CATH FLUID COLXN VISC|0320|49405|4,018.16|2,330.53|||1,407.00|1,407.00|1,040.26|1,061.06|1,061.06|1,081.87|2611.80|2732.35|2933.26|2933.26|3134.16|2410.90|2611.80|3013.62|3415.44|3568.13|3535.98|3013.62|3415.44| 1,040.26 | 3,568.13 | 2,732.35 32000234|HC RETROGRADE BRACHIAL ANGIOGRAM|0320|75658|2,590.25|1,502.35|||||138.68|141.46|141.46|144.23|1683.66|1761.37|1890.88|1890.88|2020.40|1554.15|1683.66|1942.69|2201.71|2300.14|2279.42|1942.69|2201.71| 138.68 | 2,300.14 | 1,890.88 32000234|HC RETROGRADE BRACHIAL ANGIOGRAM|0320|75658|2,590.25|1,502.35|||||138.68|141.46|141.46|144.23|1683.66|1761.37|1890.88|1890.88|2020.40|1554.15|1683.66|1942.69|2201.71|2300.14|2279.42|1942.69|2201.71| 138.68 | 2,300.14 | 1,890.88 32000236|HC ENDOLUMINAL BX BILIARY TREE|0320|47543|4,167.96|2,417.42|||||||||2709.17|2834.21|3042.61|3042.61|3251.01|2500.78|2709.17|3125.97|3542.77|3701.15|3667.80|3125.97|3542.77| 2,500.78 | 3,701.15 | 3,125.97 32000237|HC INJ KNEE ARTHROGRAM|0320|27370|1,007.65|584.44|||||281.62|287.25|287.25|292.88|654.97|685.20|735.58|735.58|785.97|604.59|654.97|755.74|856.50|894.79|886.73|755.74|856.50| 281.62 | 894.79 | 735.58 32000238|HC STERNOCLAVICULAR JOINT MIN 3 VIEWS|0320|71130|418.13|242.52|||80.90|80.90|28.09|28.65|28.65|29.21|271.78|284.33|305.23|305.23|326.14|250.88|271.78|313.60|355.41|371.30|367.95|313.60|355.41| 28.09 | 371.30 | 284.33 32000238|HC STERNOCLAVICULAR JOINT MIN 3 VIEWS|0320|71130|418.13|242.52|||80.9|80.9|42.99|43.85|43.85|44.71|271.78|284.33|305.23|305.23|326.14|250.88|271.78|313.60|355.41|371.30|367.95|313.60|355.41| 42.99 | 371.30 | 284.33 32000239|HC ENDOVASC ILIAC REPR W/GRAFT|0320|34900|14,617.08|8,477.91|||||||||9501.10|9939.61|10670.47|10670.47|11401.32|8770.25|9501.10|10962.81|12424.52|12979.97|12863.03|10962.81|12424.52| 8,770.25 | 12,979.97 | 10,962.81 32000240|HC ILIAC ANEURYSM ENDOVAS RPR|0320|75954|2,162.39|1,254.19|||||||||1405.55|1470.43|1578.54|1578.54|1686.66|1297.43|1405.55|1621.79|1838.03|1920.20|1902.90|1621.79|1838.03| 1,297.43 | 1,920.20 | 1,621.79 32000241|HC NEPHROSTOMY TUBE REMOVAL|0320|50389|3,084.96|1,789.28|||574.77|574.77|509.43|519.62|519.62|529.81|2005.22|2097.77|2252.02|2252.02|2406.27|1850.98|2005.22|2313.72|2622.22|2739.44|2714.76|2313.72|2622.22| 509.43 | 2,739.44 | 2,097.77 32000242|HC ARTHROCENTESIS MAJOR JOINT|0320|20610|1,333.41|773.38|1,616.54|1,535.71|261.17|261.17|294.37|300.26|300.26|306.15|866.72|906.72|973.39|973.39|1040.06|800.05|866.72|1000.06|1133.40|1184.07|1173.40|1000.06|1133.40| 261.17 | 1,616.54 | 973.39 32000243|HC FIX G/COLON TUBE W/DEVICE|0320|49460|1,621.49|940.46|||809.6|809.6|||||1053.97|1102.61|1183.69|1183.69|1264.76|972.89|1053.97|1216.12|1378.27|1439.88|1426.91|1216.12|1378.27| 809.60 | 1,439.88 | 1,183.69 32000244|HC INJECTION URETEROGRAPHY THRU URETEROSTOMY|0320|50684|1,614.20|936.24|437.4|415.53|||56.90|58.04|58.04|59.17|1049.23|1097.66|1178.37|1178.37|1259.08|968.52|1049.23|1210.65|1372.07|1433.41|1420.50|1210.65|1372.07| 56.90 | 1,433.41 | 1,097.66 32000245|HC CYSTOSTOMY TUBE CHNG COMPLICAT|0320|51710|4,367.50|2,533.15|437.4|415.53|574.77|574.77|241.29|246.12|246.12|250.95|2838.88|2969.90|3188.28|3188.28|3406.65|2620.50|2838.88|3275.63|3712.38|3878.34|3843.40|3275.63|3712.38| 241.29 | 3,878.34 | 2,838.88 32000246|HC ESOPHOGRAM|0320|74220|722.59|419.10|632.07|600.4665|178.55|178.55|39.25|40.03|40.03|40.82|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 39.25 | 641.66 | 527.49 32000246|HC ESOPHOGRAM|0320|74220|722.59|419.10|632.07|600.4665|178.55|178.55|78.50|80.07|80.07|81.64|469.68|491.36|527.49|527.49|563.62|433.55|469.68|541.94|614.20|641.66|635.88|541.94|614.20| 78.50 | 641.66 | 527.49 32000247|HC ARTHROCENTESIS SMALL JOINT INJ/ASP|0320|20600|1,333.41|773.38|200.91|190.8645|261.17|261.17|219.80|224.19|224.19|228.59|866.72|906.72|973.39|973.39|1040.06|800.05|866.72|1000.06|1133.40|1184.07|1173.40|1000.06|1133.40| 190.86 | 1,184.07 | 866.72 32000248|HC CHANGE PERCUTANEOUS TUBE (GU OR ABSCESS)|0320|75984|1,953.33|1,132.93|||||45.79|46.71|46.71|47.62|1269.66|1328.26|1425.93|1425.93|1523.60|1172.00|1269.66|1465.00|1660.33|1734.56|1718.93|1465.00|1660.33| 45.79 | 1,734.56 | 1,425.93 32000248|HC CHANGE PERCUTANEOUS TUBE (GU OR ABSCESS)|0320|75984|1,953.33|1,132.93|||||126.96|129.50|129.50|132.04|1269.66|1328.26|1425.93|1425.93|1523.60|1172.00|1269.66|1465.00|1660.33|1734.56|1718.93|1465.00|1660.33| 126.96 | 1,734.56 | 1,425.93 32000249|HC CONVERSION GASTROSTOMY TUBE TO GJ TUBE|0320|49446|6,071.46|3,521.45|||1,625.02|1,625.02|||||3946.45|4128.59|4432.17|4432.17|4735.74|3642.88|3946.45|4553.60|5160.74|5391.46|5342.88|4553.60|5160.74| 1,625.02 | 5,391.46 | 4,432.17 32000250|HC ENTIRE SPINE (SCOLIOSIS) 4-5VIEWS|0320|72083|890.18|516.30|||108.97|108.97|||||578.62|605.32|649.83|649.83|694.34|534.11|578.62|667.64|756.65|790.48|783.36|667.64|756.65| 108.97 | 790.48 | 649.83 32000251|HC RENIN VEIN SAMPLING|0320|75893|4,199.58|2,435.76|||4,770.37|4,770.37|181.2|184.83|184.83|188.45|2729.73|2855.71|3065.69|3065.69|3275.67|2519.75|2729.73|3149.69|3569.64|3729.23|3695.63|3149.69|3569.64| 181.20 | 4,770.37 | 3,065.69 32000251|HC RENIN VEIN SAMPLING|0320|75893|4,199.58|2,435.76|||4,770.37|4,770.37|362.4|369.65|369.65|376.9|2729.73|2855.71|3065.69|3065.69|3275.67|2519.75|2729.73|3149.69|3569.64|3729.23|3695.63|3149.69|3569.64| 362.40 | 4,770.37 | 3,065.69 32000252|HC NONSELECT CATH - TRANSLUMBAR AORTA|0320|36160|1,502.36|871.37|393.23|373.5685|||784.99|800.69|800.69|816.39|976.53|1021.60|1096.72|1096.72|1171.84|901.42|976.53|1126.77|1277.01|1334.10|1322.08|1126.77|1277.01| 373.57 | 1,334.10 | 1,021.60 32000253|HC MANDIBLE PARTIAL LESS THAN 4 VIEWS|0320|70100|472.88|274.27|||80.90|80.90|21.08|21.5|21.5|21.92|307.37|321.56|345.20|345.20|368.85|283.73|307.37|354.66|401.95|419.92|416.13|354.66|401.95| 21.08 | 419.92 | 321.56 32000253|HC MANDIBLE PARTIAL LESS THAN 4 VIEWS|0320|70100|472.88|274.27|||80.90|80.90|33.51|34.18|34.18|34.85|307.37|321.56|345.20|345.20|368.85|283.73|307.37|354.66|401.95|419.92|416.13|354.66|401.95| 33.51 | 419.92 | 321.56 32000254|HC CHEST SINGLE VIEW|0320|71045|301.83|175.06|263.99|250.79|80.90|80.90|||||196.19|205.24|220.34|220.34|235.43|181.10|196.19|226.37|256.56|268.03|265.61|226.37|256.56| 80.90 | 268.03 | 226.37 32000255|HC CHEST 2 VIEWS|0320|71046|408.00|236.64|||80.90|80.90|||||265.20|277.44|297.84|297.84|318.24|244.80|265.20|306.00|346.80|362.30|359.04|306.00|346.80| 80.90 | 362.30 | 297.84 32000256|HC CHEST 3 VIEWS|0320|71047|601.97|349.14|||80.90|80.90|||||391.28|409.34|439.44|439.44|469.54|361.18|391.28|451.48|511.67|534.55|529.73|451.48|511.67| 80.90 | 534.55 | 439.44 32000257|HC CHEST 4 OR MORE VIEWS|0320|71048|820.53|475.91|||108.97|108.97|||||533.34|557.96|598.99|598.99|640.01|492.32|533.34|615.40|697.45|728.63|722.07|615.40|697.45| 108.97 | 728.63 | 598.99 32000258|HC CHEST APICAL LORDOTIC 3VWS|0320|71047|601.97|349.14|||80.9|80.9|||||391.28|409.34|439.44|439.44|469.54|361.18|391.28|451.48|511.67|534.55|529.73|451.48|511.67| 80.90 | 534.55 | 439.44 32000259|HC CHEST LATERAL DECUB|0320|71045|515.66|299.08|263.99|250.7905|80.9|80.9|||||335.18|350.65|376.43|376.43|402.21|309.40|335.18|386.75|438.31|457.91|453.78|386.75|438.31| 80.90 | 457.91 | 376.43 32000260|HC ABDOMEN SINGLE VIEW|0320|74018|392.42|227.60|343.25|326.09|80.9|80.9|||||255.07|266.85|286.47|286.47|306.09|235.45|255.07|294.32|333.56|348.47|345.33|294.32|333.56| 80.90 | 348.47 | 294.32 32000261|HC ABDOMEN 2 VIEWS|0320|74019|563.80|327.00|118.36|112.442|108.97|108.97|||||366.47|383.38|411.57|411.57|439.76|338.28|366.47|422.85|479.23|500.65|496.14|422.85|479.23| 108.97 | 500.65 | 411.57 32000262|HC ABDOMEN 3 OR MORE VIEWS|0320|74021|737.40|427.69|493.15|468.4925|108.97|108.97|||||479.31|501.43|538.30|538.30|575.17|442.44|479.31|553.05|626.79|654.81|648.91|553.05|626.79| 108.97 | 654.81 | 538.30 32000263|HC ABDOMEN COMP W/ DECUB OR ERECT|0320|74019|563.80|327.00|118.36|112.442|108.97|108.97|||||366.47|383.38|411.57|411.57|439.76|338.28|366.47|422.85|479.23|500.65|496.14|422.85|479.23| 108.97 | 500.65 | 411.57 32000264|HC TRANSCATHETER BIOPSY S & I|0320|75970|3,193.89|1,852.46|||||39.25|40.03|40.03|40.82|2076.03|2171.85|2331.54|2331.54|2491.23|1916.33|2076.03|2395.42|2714.81|2836.17|2810.62|2395.42|2714.81| 39.25 | 2,836.17 | 2,331.54 32000264|HC TRANSCATHETER BIOPSY S & I|0320|75970|3,193.89|1,852.46|||||281.46|287.09|287.09|292.72|2076.03|2171.85|2331.54|2331.54|2491.23|1916.33|2076.03|2395.42|2714.81|2836.17|2810.62|2395.42|2714.81| 281.46 | 2,836.17 | 2,331.54 32000265|HC INJECT KNEE ARTHROGRAM/CT/MR|0320|27369|1,007.54|584.37|393.23|373.57|||||||654.90|685.13|735.50|735.50|785.88|604.52|654.90|755.66|856.41|894.70|886.64|755.66|856.41| 373.57 | 894.70 | 735.50 32000266|HC SCLEROTX FLUID COLLECTION|0320|49185|2,864.85|1,661.61|||621.97|621.97|||||1862.15|1948.10|2091.34|2091.34|2234.58|1718.91|1862.15|2148.64|2435.12|2543.99|2521.07|2148.64|2435.12| 621.97 | 2,543.99 | 2,091.34 32000267|HC PULMONARY BILAT SELECTIVE ANGIOGR|0320|75743|5,210.10|3,021.86|||2,861.66|2,861.66|317.11|323.45|323.45|329.80|3386.57|3542.87|3803.37|3803.37|4063.88|3126.06|3386.57|3907.58|4428.59|4626.57|4584.89|3907.58|4428.59| 317.11 | 4,626.57 | 3,542.87 32000267|HC PULMONARY BILAT SELECTIVE ANGIOGR|0320|75743|5,210.10|3,021.86|||2,861.66|2,861.66|330.70|337.32|337.32|343.93|3386.57|3542.87|3803.37|3803.37|4063.88|3126.06|3386.57|3907.58|4428.59|4626.57|4584.89|3907.58|4428.59| 330.70 | 4,626.57 | 3,542.87 32000268|HC SELECTIVE CATH - PULMONARY ARTERY|0320|36014|1,836.45|1,065.14|||||523.33|533.79|533.79|544.26|1193.69|1248.79|1340.61|1340.61|1432.43|1101.87|1193.69|1377.34|1560.98|1630.77|1616.08|1377.34|1560.98| 523.33 | 1,630.77 | 1,340.61 32000269|HC BA SWALLOW ESOPHAGRAM DOUBLE CONTRAST|0320|74221|900.90|522.52|419.77|398.7815|178.55|178.55|||||585.59|612.61|657.66|657.66|702.70|540.54|585.59|675.68|765.77|800.00|792.79|675.68|765.77| 178.55 | 800.00 | 657.66 32000270|HC UGI SINGLE CONTRAST|0320|74240|1,466.85|850.77|503.06|477.91|178.55|178.55|52.33|53.38|53.38|54.43|953.45|997.46|1070.80|1070.80|1144.14|880.11|953.45|1100.14|1246.82|1302.56|1290.83|1100.14|1246.82| 52.33 | 1,302.56 | 953.45 32000270|HC UGI SINGLE CONTRAST|0320|74240|1,466.85|850.77|503.06|477.91|178.55|178.55|104.67|106.76|106.76|108.85|953.45|997.46|1070.80|1070.80|1144.14|880.11|953.45|1100.14|1246.82|1302.56|1290.83|1100.14|1246.82| 104.67 | 1,302.56 | 953.45 32000271|HC UGI DOUBLE CONTRAST|0320|74246|940.80|545.66|419.77|398.78|178.55|178.55|113.65|115.93|115.93|118.20|611.52|639.74|686.78|686.78|733.82|564.48|611.52|705.60|799.68|835.43|827.90|705.60|799.68| 113.65 | 835.43 | 611.52 32000271|HC UGI DOUBLE CONTRAST|0320|74246|940.80|545.66|419.77|398.7815|178.55|178.55|56.83|57.97|57.97|59.11|611.52|639.74|686.78|686.78|733.82|564.48|611.52|705.60|799.68|835.43|827.90|705.60|799.68| 56.83 | 835.43 | 611.52 32000272|HC SMALL BOWEL ADD ON TO UGI|0320|74248|1,226.93|711.62|||||||||797.50|834.31|895.66|895.66|957.01|736.16|797.50|920.20|1042.89|1089.51|1079.70|920.20|1042.89| 736.16 | 1,089.51 | 920.20 32000281|HC XRAY STRESS VIEW|0320|77071|795.38|461.32|||80.9|80.9|||||517.00|540.86|580.63|580.63|620.40|477.23|517.00|596.54|676.07|706.30|699.93|596.54|676.07| 80.90 | 706.30 | 580.63 33100000|HC CHEMO SUBCU/IM INJ|0331|96401|318.62|184.80|49.86|47.37|61.97|61.97|53.88|54.95|54.95|56.03|207.10|216.66|232.59|232.59|248.52|191.17|207.10|238.97|270.83|282.93|280.39|238.97|270.83| 47.37 | 282.93 | 207.10 33100001|HC CC-CHEMO SUBCU/IM HORMONAL|0331|96402|318.62|184.80|49.86|47.367|61.97|61.97|53.88|54.95|54.95|56.03|207.10|216.66|232.59|232.59|248.52|191.17|207.10|238.97|270.83|282.93|280.39|238.97|270.83| 47.37 | 282.93 | 207.10 33100002|HC CHEMO CNS (INTRATHECAL) W LP|0331|96450|1,128.96|654.80|452.73|430.0935|310.75|310.75|98.12|100.09|100.09|102.05|733.82|767.69|824.14|824.14|880.59|677.38|733.82|846.72|959.62|1002.52|993.48|846.72|959.62| 98.12 | 1,002.52 | 733.82 33100003|HC CHEMO INJ VIA SQ RESERVOIR|0331|96542|321.75|186.62|||203.50|203.50|98.12|100.09|100.09|102.05|209.14|218.79|234.88|234.88|250.97|193.05|209.14|241.31|273.49|285.71|283.14|241.31|273.49| 98.12 | 285.71 | 218.79 33300000|HC US GUIDANCE/RADIOELEMENT|0333|76965|1,150.51|667.30|643.06|610.907|||34.02|34.70|34.70|35.38|747.83|782.35|839.87|839.87|897.40|690.31|747.83|862.88|977.93|1021.65|1012.45|862.88|977.93| 34.02 | 1,021.65 | 782.35 33300000|HC US GUIDANCE/RADIOELEMENT|0333|76965|1,150.51|667.30|643.06|610.907|||68.03|69.39|69.39|70.75|747.83|782.35|839.87|839.87|897.40|690.31|747.83|862.88|977.93|1021.65|1012.45|862.88|977.93| 68.03 | 1,021.65 | 782.35 33300001|HC CT CONE BEAM|0333|77014|983.41|570.38|561.23|533.1685|||||||639.22|668.72|717.89|717.89|767.06|590.05|639.22|737.56|835.90|873.27|865.40|737.56|835.90| 533.17 | 873.27 | 717.89 33300002|HC SIMULATION-COMPLEX|0333|77290|962.78|558.41|||338.68|338.68|34.47|35.16|35.16|35.85|625.81|654.69|702.83|702.83|750.97|577.67|625.81|722.09|818.36|854.95|847.25|722.09|818.36| 34.47 | 854.95 | 654.69 33300002|HC SIMULATION-COMPLEX|0333|77290|962.78|558.41|||338.68|338.68|371.43|378.86|378.86|386.29|625.81|654.69|702.83|702.83|750.97|577.67|625.81|722.09|818.36|854.95|847.25|722.09|818.36| 338.68 | 854.95 | 654.69 33300003|HC SIMULATION 3-D|0333|77295|4,430.52|2,569.70|||1,262.18|1,262.18|34.47|35.16|35.16|35.85|2879.84|3012.75|3234.28|3234.28|3455.81|2658.31|2879.84|3322.89|3765.94|3934.30|3898.86|3322.89|3765.94| 34.47 | 3,934.30 | 3,012.75 33300003|HC SIMULATION 3-D|0333|77295|4,430.52|2,569.70|||1,262.18|1,262.18|761.17|776.39|776.39|791.61|2879.84|3012.75|3234.28|3234.28|3455.81|2658.31|2879.84|3322.89|3765.94|3934.30|3898.86|3322.89|3765.94| 761.17 | 3,934.30 | 3,012.75 33300004|HC RADIATION DOSIMETRY-BASIC|0333|77300|1,019.39|591.25|||126.87|126.87|39.25|40.03|40.03|40.82|662.60|693.19|744.15|744.15|795.12|611.63|662.60|764.54|866.48|905.22|897.06|764.54|866.48| 39.25 | 905.22 | 693.19 33300004|HC RADIATION DOSIMETRY-BASIC|0333|77300|1,019.39|591.25|||126.87|126.87|78.50|80.07|80.07|81.64|662.60|693.19|744.15|744.15|795.12|611.63|662.60|764.54|866.48|905.22|897.06|764.54|866.48| 78.50 | 905.22 | 693.19 33300005|HC ISODOSE PLAN COMPLEX|0333|77315|1,131.33|656.17|||||207.08|211.22|211.22|215.36|735.36|769.30|825.87|825.87|882.44|678.80|735.36|848.50|961.63|1004.62|995.57|848.50|961.63| 207.08 | 1,004.62 | 825.87 33300005|HC ISODOSE PLAN COMPLEX|0333|77315|1,131.33|656.17|||||103.54|105.61|105.61|107.68|735.36|769.30|825.87|825.87|882.44|678.80|735.36|848.50|961.63|1004.62|995.57|848.50|961.63| 103.54 | 1,004.62 | 825.87 33300006|HC TELETHERAPY-PORT PLAN|0333|77321|358.53|207.95|||338.68|338.68|120.37|122.77|122.77|125.18|233.04|243.80|261.73|261.73|279.65|215.12|233.04|268.90|304.75|318.37|315.51|268.90|304.75| 120.37 | 338.68 | 261.73 33300006|HC TELETHERAPY-PORT PLAN|0333|77321|358.53|207.95|||338.68|338.68|160.73|163.94|163.94|167.16|233.04|243.80|261.73|261.73|279.65|215.12|233.04|268.90|304.75|318.37|315.51|268.90|304.75| 160.73 | 338.68 | 261.73 33300007|HC SPECIAL DOSIMETRY TLD|0333|77331|1,358.87|788.14|||126.87|126.87|79.66|81.26|81.26|82.85|883.27|924.03|991.98|991.98|1059.92|815.32|883.27|1019.15|1155.04|1206.68|1195.81|1019.15|1155.04| 79.66 | 1,206.68 | 924.03 33300007|HC SPECIAL DOSIMETRY TLD|0333|77331|1,358.87|788.14|||126.87|126.87|5.17|5.27|5.27|5.37|883.27|924.03|991.98|991.98|1059.92|815.32|883.27|1019.15|1155.04|1206.68|1195.81|1019.15|1155.04| 5.17 | 1,206.68 | 924.03 33300008|HC PHYSICS DOSIMETRY TX DEVICE|0333|77331|138.27|80.20|||126.87|126.87|79.66|81.26|81.26|82.85|89.88|94.02|100.94|100.94|107.85|82.96|89.88|103.70|117.53|122.78|121.68|103.70|117.53| 79.66 | 126.87 | 100.94 33300008|HC PHYSICS DOSIMETRY TX DEVICE|0333|77331|138.27|80.20|||126.87|126.87|5.17|5.27|5.27|5.37|89.88|94.02|100.94|100.94|107.85|82.96|89.88|103.70|117.53|122.78|121.68|103.70|117.53| 5.17 | 126.87 | 100.94 33300009|HC TRMT DEVICES-SIMPLE|0333|77332|289.55|167.94|||126.87|126.87|46.89|47.83|47.83|48.77|188.21|196.89|211.37|211.37|225.85|173.73|188.21|217.16|246.12|257.12|254.80|217.16|246.12| 46.89 | 257.12 | 196.89 33300009|HC TRMT DEVICES-SIMPLE|0333|77332|289.55|167.94|||126.87|126.87|18.91|19.28|19.28|19.66|188.21|196.89|211.37|211.37|225.85|173.73|188.21|217.16|246.12|257.12|254.80|217.16|246.12| 18.91 | 257.12 | 196.89 33300010|HC TRMT DEVICES-INTERMEDIATE|0333|77333|733.78|425.59|||126.87|126.87|31.70|32.33|32.33|32.97|476.96|498.97|535.66|535.66|572.35|440.27|476.96|550.34|623.71|651.60|645.73|550.34|623.71| 31.70 | 651.60 | 498.97 33300010|HC TRMT DEVICES-INTERMEDIATE|0333|77333|733.78|425.59|||126.87|126.87|68.70|70.07|70.07|71.45|476.96|498.97|535.66|535.66|572.35|440.27|476.96|550.34|623.71|651.60|645.73|550.34|623.71| 68.70 | 651.60 | 498.97 33300011|HC TRMT DEVICES-COMPLEX|0333|77334|1,057.48|613.34|||338.68|338.68|34.47|35.16|35.16|35.85|687.36|719.09|771.96|771.96|824.83|634.49|687.36|793.11|898.86|939.04|930.58|793.11|898.86| 34.47 | 939.04 | 719.09 33300011|HC TRMT DEVICES-COMPLEX|0333|77334|1,057.48|613.34|||338.68|338.68|110.80|113.02|113.02|115.23|687.36|719.09|771.96|771.96|824.83|634.49|687.36|793.11|898.86|939.04|930.58|793.11|898.86| 110.80 | 939.04 | 719.09 33300012|HC WKLY PHYSICS CHECK|0333|77336|405.23|235.03|||126.87|126.87|85.15|86.85|86.85|88.55|263.40|275.56|295.82|295.82|316.08|243.14|263.40|303.92|344.45|359.84|356.60|303.92|344.45| 85.15 | 359.84 | 275.56 33300013|HC SPEC RADIATION PHYSIC CONSU|0333|77370|457.13|265.14|||126.87|126.87|139.81|142.60|142.60|145.40|297.13|310.85|333.70|333.70|356.56|274.28|297.13|342.85|388.56|405.93|402.27|342.85|388.56| 126.87 | 405.93 | 310.85 33300014|HC 6-10 MEV-COMPLEX|0333|77413|759.21|440.34|||||99.16|101.14|101.14|103.12|493.49|516.26|554.22|554.22|592.18|455.53|493.49|569.41|645.33|674.18|668.10|569.41|645.33| 99.16 | 674.18 | 554.22 33300015|HC THERAPEUTIC RAD PORT FILM|0333|77417|213.94|124.09|||||23.86|24.34|24.34|24.82|139.06|145.48|156.18|156.18|166.87|128.36|139.06|160.46|181.85|189.98|188.27|160.46|181.85| 23.86 | 189.98 | 156.18 33300016|HC RADIATION TX DELIVERY, TX SESS|0333|77418|5,643.10|3,273.00|||||518.16|528.52|528.52|538.89|3668.02|3837.31|4119.46|4119.46|4401.62|3385.86|3668.02|4232.33|4796.64|5011.07|4965.93|4232.33|4796.64| 518.16 | 5,011.07 | 4,119.46 33300017|HC SPECIAL TX PROCEDURE|0333|77470|1,760.25|1,020.95|||542.55|542.55|34.02|34.7|34.7|35.38|1144.16|1196.97|1284.98|1284.98|1373.00|1056.15|1144.16|1320.19|1496.21|1563.10|1549.02|1320.19|1496.21| 34.02 | 1,563.10 | 1,196.97 33300017|HC SPECIAL TX PROCEDURE|0333|77470|1,760.25|1,020.95|||542.55|542.55|312.28|318.53|318.53|324.77|1144.16|1196.97|1284.98|1284.98|1373.00|1056.15|1144.16|1320.19|1496.21|1563.10|1549.02|1320.19|1496.21| 312.28 | 1,563.10 | 1,196.97 33300018|HC INTERSTITIAL APPLI-COMPLEX|0333|77778|980.83|568.88|||708.46|708.46|52.75|53.81|53.81|54.86|637.54|666.96|716.01|716.01|765.05|588.50|637.54|735.62|833.71|870.98|863.13|735.62|833.71| 52.75 | 870.98 | 708.46 33300018|HC INTERSTITIAL APPLI-COMPLEX|0333|77778|980.83|568.88|||708.46|708.46|221.88|226.32|226.32|230.75|637.54|666.96|716.01|716.01|765.05|588.50|637.54|735.62|833.71|870.98|863.13|735.62|833.71| 221.88 | 870.98 | 708.46 33300019|HC RADIOELEMENT-LOADING-HANDLE|0333|77790|732.40|424.79|||||5.17|5.27|5.27|5.37|476.06|498.03|534.65|534.65|571.27|439.44|476.06|549.30|622.54|650.37|644.51|549.30|622.54| 5.17 | 650.37 | 534.65 33300019|HC RADIOELEMENT-LOADING-HANDLE|0333|77790|732.40|424.79|||||33.11|33.78|33.78|34.44|476.06|498.03|534.65|534.65|571.27|439.44|476.06|549.30|622.54|650.37|644.51|549.30|622.54| 33.11 | 650.37 | 534.65 33300020|HC ROBOT LIN-RADSURG FRACTX 2-5-M|0333|G0340|5,167.64|2,997.23|||||||||3358.97|3514.00|3772.38|3772.38|4030.76|3100.58|3358.97|3875.73|4392.49|4588.86|4547.52|3875.73|4392.49| 3,100.58 | 4,588.86 | 3,875.73 33300021|HC INTSTY MODUL RAD TX DLVR SMPL|0333|77385|6,579.24|3,815.96|||542.55|542.55|||||4276.51|4473.88|4802.85|4802.85|5131.81|3947.54|4276.51|4934.43|5592.35|5842.37|5789.73|4934.43|5592.35| 542.55 | 5,842.37 | 4,802.85 33300022|HC INSTY MODUL RAD TX DLVR COMPLEX|0333|77386|6,579.24|3,815.96|||542.55|542.55|||||4276.51|4473.88|4802.85|4802.85|5131.81|3947.54|4276.51|4934.43|5592.35|5842.37|5789.73|4934.43|5592.35| 542.55 | 5,842.37 | 4,802.85 33300023|HC GUIDANCE FOR RADIAJ TX DLVR|0333|77387|394.37|228.73|156.72|148.884|||||||256.34|268.17|287.89|287.89|307.61|236.62|256.34|295.78|335.21|350.20|347.05|295.78|335.21| 148.88 | 350.20 | 287.89 33300024|HC RADIATION TREATMENT DELIVERY|0333|77412|759.21|440.34|||241.68|241.68|99.16|101.14|101.14|103.12|493.49|516.26|554.22|554.22|592.18|455.53|493.49|569.41|645.33|674.18|668.10|569.41|645.33| 99.16 | 674.18 | 516.26 33300025|HC SIMULATION-SIMPLE|0333|77280|703.13|407.82|||126.87|126.87|18.91|19.28|19.28|19.66|457.03|478.13|513.28|513.28|548.44|421.88|457.03|527.35|597.66|624.38|618.75|527.35|597.66| 18.91 | 624.38 | 478.13 33300025|HC SIMULATION-SIMPLE|0333|77280|703.13|407.82|||126.87|126.87|99.09|101.07|101.07|103.06|457.03|478.13|513.28|513.28|548.44|421.88|457.03|527.35|597.66|624.38|618.75|527.35|597.66| 99.09 | 624.38 | 478.13 33300026|HC INTENSITY MOD RAD THER|0333|77301|9,497.97|5,508.82|||1262.18|1262.18|832.81|849.47|849.47|866.12|6173.68|6458.62|6933.52|6933.52|7408.42|5698.78|6173.68|7123.48|8073.27|8434.20|8358.21|7123.48|8073.27| 832.81 | 8,434.20 | 6,458.62 33300026|HC INTENSITY MOD RAD THER|0333|77301|9,497.97|5,508.82|||1262.18|1262.18|1,172.79|1,196.25|1,196.25|1,219.70|6173.68|6458.62|6933.52|6933.52|7408.42|5698.78|6173.68|7123.48|8073.27|8434.20|8358.21|7123.48|8073.27| 1,172.79 | 8,434.20 | 6,458.62 33300027|HC MLC DEVICE PER IMRT PLAN|0333|77338|763.40|442.77|||338.68|338.68|168.76|172.14|172.14|175.51|496.21|519.11|557.28|557.28|595.45|458.04|496.21|572.55|648.89|677.90|671.79|572.55|648.89| 168.76 | 677.90 | 519.11 33300027|HC MLC DEVICE PER IMRT PLAN|0333|77338|763.40|442.77|||338.68|338.68|319.41|325.8|325.8|332.19|496.21|519.11|557.28|557.28|595.45|458.04|496.21|572.55|648.89|677.90|671.79|572.55|648.89| 319.41 | 677.90 | 519.11 33300028|HC 11-19 MEV-COMPLEX|0333|77414|759.21|440.34|||||99.16|101.14|101.14|103.12|493.49|516.26|554.22|554.22|592.18|455.53|493.49|569.41|645.33|674.18|668.10|569.41|645.33| 99.16 | 674.18 | 554.22 33300029|HC STEREOSCOPIC X-RAY GUIDANCE|0333|77421|394.77|228.97|||||145.80|148.72|148.72|151.63|256.60|268.44|288.18|288.18|307.92|236.86|256.60|296.08|335.55|350.56|347.40|296.08|335.55| 145.80 | 350.56 | 288.18 33300029|HC STEREOSCOPIC X-RAY GUIDANCE|0333|77421|394.77|228.97|||||21.35|21.78|21.78|22.21|256.60|268.44|288.18|288.18|307.92|236.86|256.60|296.08|335.55|350.56|347.40|296.08|335.55| 21.35 | 350.56 | 288.18 33300029|HC STEREOSCOPIC X-RAY GUIDANCE|0333|77421|394.77|228.97|||||124.45|126.94|126.94|129.43|256.60|268.44|288.18|288.18|307.92|236.86|256.60|296.08|335.55|350.56|347.40|296.08|335.55| 124.45 | 350.56 | 288.18 33300030|HC TELETHERAPY ISODOSE PLAN, SIMPLE|0333|77307|1,436.56|833.20|||338.68|338.68|||||933.76|976.86|1048.69|1048.69|1120.52|861.94|933.76|1077.42|1221.08|1275.67|1264.17|1077.42|1221.08| 338.68 | 1,275.67 | 1,048.69 33300031|HC BRACHYTHERAPY ISODOSE PLAN SIMPL|0333|77316|1,062.00|615.96|||338.68|338.68|||||690.30|722.16|775.26|775.26|828.36|637.20|690.30|796.50|902.70|943.06|934.56|796.50|902.70| 338.68 | 943.06 | 775.26 33300032|HC RESPIRATOR MOTION MGMT SIMUL|0333|77293|128.04|74.26|||||0.00|0.00|0.00|0.00|83.23|87.07|93.47|93.47|99.87|76.82|83.23|96.03|108.83|113.70|112.68|96.03|108.83| - | 113.70 | 93.47 33300033|HC BRACHTHER-ISODOSE CALC-SIMP|0333|77326|1,062.00|615.96|||||24.37|24.86|24.86|25.35|690.30|722.16|775.26|775.26|828.36|637.20|690.30|796.50|902.70|943.06|934.56|796.50|902.70| 24.37 | 943.06 | 775.26 33300033|HC BRACHTHER-ISODOSE CALC-SIMP|0333|77326|1,062.00|615.96|||||104.67|106.76|106.76|108.85|690.30|722.16|775.26|775.26|828.36|637.20|690.30|796.50|902.70|943.06|934.56|796.50|902.70| 104.67 | 943.06 | 775.26 33300034|HC 20 MEV OR GREATER-COMPLEX|0333|77416|759.21|440.34|||||99.16|101.14|101.14|103.12|493.49|516.26|554.22|554.22|592.18|455.53|493.49|569.41|645.33|674.18|668.10|569.41|645.33| 99.16 | 674.18 | 554.22 33300035|HC STEREOTACTIC BODY-NOT > THAN 5|0333|77373|6,398.06|3,710.87|||1,733.74|1,733.74|||||4158.74|4350.68|4670.58|4670.58|4990.49|3838.84|4158.74|4798.55|5438.35|5681.48|5630.29|4798.55|5438.35| 1,733.74 | 5,681.48 | 4,670.58 33300036|HC SBRT MANAGEMENT 1+ LESIONS =< 5 FRACTIONS|0333|77435|3,441.29|1,995.95|||||||||2236.84|2340.08|2512.14|2512.14|2684.21|2064.77|2236.84|2580.97|2925.10|3055.87|3028.34|2580.97|2925.10| 2,064.77 | 3,055.87 | 2,580.97 33500000|HC CHEMO IV PUSH|0335|96409|847.82|491.74|188.07|178.67|203.50|203.50|53.88|54.95|54.95|56.03|551.08|576.52|618.91|618.91|661.30|508.69|551.08|635.87|720.65|752.86|746.08|635.87|720.65| 53.88 | 752.86 | 551.08 33500001|HC CHEMO IVP EA ADDL DRUG|0335|96411|861.05|499.41|58.03|55.13|61.97|61.97|53.88|54.95|54.95|56.03|559.68|585.51|628.57|628.57|671.62|516.63|559.68|645.79|731.89|764.61|757.72|645.79|731.89| 53.88 | 764.61 | 559.68 33500002|HC CHEMO IV INF INITIAL HR|0335|96413|1,010.99|586.37|276.4|262.58|310.75|310.75|143.12|145.98|145.98|148.84|657.14|687.47|738.02|738.02|788.57|606.59|657.14|758.24|859.34|897.76|889.67|758.24|859.34| 143.12 | 897.76 | 657.14 33500003|HC CHEMO IV INF EA ADDL HR|0335|96415|395.80|229.56|276.4|262.58|61.97|61.97|37.75|38.50|38.50|39.25|257.27|269.14|288.93|288.93|308.72|237.48|257.27|296.85|336.43|351.47|348.30|296.85|336.43| 37.75 | 351.47 | 269.14 33500004|HC CC-CHEMO PROLONG INFUSE W/PUMP|0335|96416|1,188.50|689.33|276.40|262.58|310.75|310.75|143.12|145.98|145.98|148.84|772.53|808.18|867.61|867.61|927.03|713.10|772.53|891.38|1010.23|1055.39|1045.88|891.38|1010.23| 143.12 | 1,055.39 | 772.53 33500005|HC CHEMO ADMIN IV EA SEQ INF 1 HR|0335|96417|588.74|341.47|49.86|47.37|61.97|61.97|81.22|82.84|82.84|84.47|382.68|400.34|429.78|429.78|459.22|353.24|382.68|441.56|500.43|522.80|518.09|441.56|500.43| 47.37 | 522.80 | 382.68 33500006|HC CHEMO INTRATHECAL ADMIN|0335|96450|1,128.96|654.80|452.73|430.09|310.75|310.75|98.12|100.09|100.09|102.05|733.82|767.69|824.14|824.14|880.59|677.38|733.82|846.72|959.62|1002.52|993.48|846.72|959.62| 98.12 | 1,002.52 | 733.82 33500007|HC CC-REFILL/MAINT IMPL PUMP/RES|0335|96521|759.62|440.58|278.87|264.93|203.50|203.50|104.93|107.03|107.03|109.12|493.75|516.54|554.52|554.52|592.50|455.77|493.75|569.72|645.68|674.54|668.47|569.72|645.68| 104.93 | 674.54 | 493.75 34000000|HC LYMPHATICS & LYMPH GLANDS|0340|78195|2,435.87|1,412.80|||489.4|489.4|38.27|39.03|39.03|39.80|1583.32|1656.39|1778.19|1778.19|1899.98|1461.52|1583.32|1826.90|2070.49|2163.05|2143.57|1826.90|2070.49| 38.27 | 2,163.05 | 1,656.39 34000000|HC LYMPHATICS & LYMPH GLANDS|0340|78195|2,435.87|1,412.80|||489.4|489.4|76.54|78.07|78.07|79.60|1583.32|1656.39|1778.19|1778.19|1899.98|1461.52|1583.32|1826.90|2070.49|2163.05|2143.57|1826.90|2070.49| 76.54 | 2,163.05 | 1,656.39 34000001|HC THYROID IMAGING INCL. VASCULAR|0340|78013|1,437.80|833.92|893.41|848.7395|377.12|377.12|127.60|130.15|130.15|132.70|934.57|977.70|1049.59|1049.59|1121.48|862.68|934.57|1078.35|1222.13|1276.77|1265.26|1078.35|1222.13| 127.60 | 1,276.77 | 934.57 34000002|HC THYROID IMAG W SING OR MULT UP|0340|78014|1,513.30|877.71|1314.85|1249.1075|377.12|377.12|198.09|202.05|202.05|206.02|983.65|1029.04|1104.71|1104.71|1180.37|907.98|983.65|1134.98|1286.31|1343.81|1331.70|1134.98|1286.31| 198.09 | 1,343.81 | 1,104.71 34000003|HC THYROID METS-WHOLE BD TL201|0340|78018|2,982.41|1,729.80|2,608.76|2,478.32|489.40|489.40|124.29|126.78|126.78|129.26|1938.57|2028.04|2177.16|2177.16|2326.28|1789.45|1938.57|2236.81|2535.05|2648.38|2624.52|2236.81|2535.05| 124.29 | 2,648.38 | 2,177.16 34000003|HC THYROID METS-WHOLE BD TL201|0340|78018|2,982.41|1,729.80|2,608.76|2,478.32|489.40|489.40|248.58|253.55|253.55|258.52|1938.57|2028.04|2177.16|2177.16|2326.28|1789.45|1938.57|2236.81|2535.05|2648.38|2624.52|2236.81|2535.05| 248.58 | 2,648.38 | 2,177.16 34000004|HC LIVER W/VASC FLOW SPECT|0340|78206|2,494.21|1,446.64|||||181.08|184.71|184.71|188.33|1621.24|1696.06|1820.77|1820.77|1945.48|1496.53|1621.24|1870.66|2120.08|2214.86|2194.90|1870.66|2120.08| 181.08 | 2,214.86 | 1,820.77 34000004|HC LIVER W/VASC FLOW SPECT|0340|78206|2,494.21|1,446.64|||||90.55|92.36|92.36|94.17|1621.24|1696.06|1820.77|1820.77|1945.48|1496.53|1621.24|1870.66|2120.08|2214.86|2194.90|1870.66|2120.08| 90.55 | 2,214.86 | 1,820.77 34000005|HC LIVER/SPLEEN W/FLOW|0340|78216|1,696.38|983.90|||377.12|377.12|98.12|100.09|100.09|102.05|1102.65|1153.54|1238.36|1238.36|1323.18|1017.83|1102.65|1272.29|1441.92|1506.39|1492.81|1272.29|1441.92| 98.12 | 1,506.39 | 1,153.54 34000005|HC LIVER/SPLEEN W/FLOW|0340|78216|1,696.38|983.90|||377.12|377.12|196.25|200.17|200.17|204.10|1102.65|1153.54|1238.36|1238.36|1323.18|1017.83|1102.65|1272.29|1441.92|1506.39|1492.81|1272.29|1441.92| 196.25 | 1,506.39 | 1,153.54 34000006|HC HEPATOBILIARY SYSTEM IMAGING|0340|78226|1,776.62|1,030.44|1,554.04|1,476.34|377.12|377.12|249.47|254.46|254.46|259.45|1154.80|1208.10|1296.93|1296.93|1385.76|1065.97|1154.80|1332.47|1510.13|1577.64|1563.43|1332.47|1510.13| 249.47 | 1,577.64 | 1,296.93 34000006|HC HEPATOBILIARY SYSTEM IMAGING|0340|78226|1,776.62|1,030.44|1,554.04|1,476.34|377.12|377.12|249.47|254.46|254.46|259.45|1154.80|1208.10|1296.93|1296.93|1385.76|1065.97|1154.80|1332.47|1510.13|1577.64|1563.43|1332.47|1510.13| 249.47 | 1,577.64 | 1,296.93 34000007|HC HEPATOBILIARY SYSTEM IMAG W/PH|0340|78227|1,776.62|1,030.44|1554.04|1476.338|489.40|489.40|249.47|254.46|254.46|259.45|1154.80|1208.10|1296.93|1296.93|1385.76|1065.97|1154.80|1332.47|1510.13|1577.64|1563.43|1332.47|1510.13| 249.47 | 1,577.64 | 1,296.93 34000007|HC HEPATOBILIARY SYSTEM IMAG W/PH|0340|78227|1,776.62|1,030.44|1554.04|1476.338|489.40|489.40|249.47|254.46|254.46|259.45|1154.80|1208.10|1296.93|1296.93|1385.76|1065.97|1154.80|1332.47|1510.13|1577.64|1563.43|1332.47|1510.13| 249.47 | 1,577.64 | 1,296.93 34000008|HC GASTROESOPHAGEAL REFLUX STUDY|0340|78262|1,338.91|776.57|||377.12|377.12|43.74|44.61|44.61|45.49|870.29|910.46|977.40|977.40|1044.35|803.35|870.29|1004.18|1138.07|1188.95|1178.24|1004.18|1138.07| 43.74 | 1,188.95 | 910.46 34000008|HC GASTROESOPHAGEAL REFLUX STUDY|0340|78262|1,338.91|776.57|||377.12|377.12|115.77|118.09|118.09|120.40|870.29|910.46|977.40|977.40|1044.35|803.35|870.29|1004.18|1138.07|1188.95|1178.24|1004.18|1138.07| 115.77 | 1,188.95 | 910.46 34000009|HC GASTRIC EMPTYING|0340|78264|2,446.82|1,419.16|1,950.45|1,852.93|377.12|377.12|34.75|35.44|35.44|36.14|1590.43|1663.84|1786.18|1786.18|1908.52|1468.09|1590.43|1835.12|2079.80|2172.78|2153.20|1835.12|2079.80| 34.75 | 2,172.78 | 1,786.18 34000009|HC GASTRIC EMPTYING|0340|78264|2,446.82|1,419.16|1,950.45|1,852.93|377.12|377.12|116.23|118.56|118.56|120.88|1590.43|1663.84|1786.18|1786.18|1908.52|1468.09|1590.43|1835.12|2079.80|2172.78|2153.20|1835.12|2079.80| 116.23 | 2,172.78 | 1,786.18 34000010|HC RBC IMAGING-GI BLOOD LOSS|0340|78278|2,511.24|1,456.52|||377.12|377.12|44.48|45.37|45.37|46.26|1632.31|1707.64|1833.21|1833.21|1958.77|1506.74|1632.31|1883.43|2134.55|2229.98|2209.89|1883.43|2134.55| 44.48 | 2,229.98 | 1,707.64 34000010|HC RBC IMAGING-GI BLOOD LOSS|0340|78278|2,511.24|1,456.52|||377.12|377.12|22.24|22.69|22.69|23.13|1632.31|1707.64|1833.21|1833.21|1958.77|1506.74|1632.31|1883.43|2134.55|2229.98|2209.89|1883.43|2134.55| 22.24 | 2,229.98 | 1,707.64 34000011|HC BONE SCAN LIMITED|0340|78300|1,445.23|838.23|1232.51|1170.8845|377.12|377.12|81.77|83.41|83.41|85.04|939.40|982.76|1055.02|1055.02|1127.28|867.14|939.40|1083.92|1228.45|1283.36|1271.80|1083.92|1228.45| 81.77 | 1,283.36 | 1,055.02 34000011|HC BONE SCAN LIMITED|0340|78300|1,445.23|838.23|1232.51|1170.8845|377.12|377.12|163.54|166.81|166.81|170.08|939.40|982.76|1055.02|1055.02|1127.28|867.14|939.40|1083.92|1228.45|1283.36|1271.80|1083.92|1228.45| 163.54 | 1,283.36 | 1,055.02 34000012|HC BONE SCAN WHOLE BODY 78306|0340|78306|2,291.23|1,328.91|1879.1|1785.145|377.12|377.12|235.50|240.21|240.21|244.92|1489.30|1558.04|1672.60|1672.60|1787.16|1374.74|1489.30|1718.42|1947.55|2034.61|2016.28|1718.42|1947.55| 235.50 | 2,034.61 | 1,672.60 34000012|HC BONE SCAN WHOLE BODY 78306|0340|78306|2,291.23|1,328.91|1879.1|1785.145|377.12|377.12|117.75|120.10|120.10|122.46|1489.30|1558.04|1672.60|1672.60|1787.16|1374.74|1489.30|1718.42|1947.55|2034.61|2016.28|1718.42|1947.55| 117.75 | 2,034.61 | 1,672.60 34000013|HC BONE SCAN 3 PHASE TECH|0340|78315|2,255.98|1,308.47|1,828.19|1,736.78|377.12|377.12|235.50|240.21|240.21|244.92|1466.39|1534.07|1646.87|1646.87|1759.66|1353.59|1466.39|1691.99|1917.58|2003.31|1985.26|1691.99|1917.58| 235.50 | 2,003.31 | 1,646.87 34000013|HC BONE SCAN 3 PHASE TECH|0340|78315|2,255.98|1,308.47|1,828.19|1,736.78|377.12|377.12|117.75|120.10|120.10|122.46|1466.39|1534.07|1646.87|1646.87|1759.66|1353.59|1466.39|1691.99|1917.58|2003.31|1985.26|1691.99|1917.58| 117.75 | 2,003.31 | 1,646.87 34000014|HC BONE SCAN SPECT|0340|78320|2,782.29|1,613.73|||||172.00|175.44|175.44|178.89|1808.49|1891.96|2031.07|2031.07|2170.19|1669.37|1808.49|2086.72|2364.95|2470.67|2448.42|2086.72|2364.95| 172.00 | 2,470.67 | 2,031.07 34000014|HC BONE SCAN SPECT|0340|78320|2,782.29|1,613.73|||||344.01|350.89|350.89|357.77|1808.49|1891.96|2031.07|2031.07|2170.19|1669.37|1808.49|2086.72|2364.95|2470.67|2448.42|2086.72|2364.95| 344.01 | 2,470.67 | 2,031.07 34000015|HC VASCULAR FLOW|0340|78445|759.55|440.54|||377.12|377.12|17.79|18.15|18.15|18.50|493.71|516.49|554.47|554.47|592.45|455.73|493.71|569.66|645.62|674.48|668.40|569.66|645.62| 17.79 | 674.48 | 516.49 34000015|HC VASCULAR FLOW|0340|78445|759.55|440.54|||377.12|377.12|57.07|58.21|58.21|59.35|493.71|516.49|554.47|554.47|592.45|455.73|493.71|569.66|645.62|674.48|668.40|569.66|645.62| 57.07 | 674.48 | 516.49 34000016|HC MYOCARDIAL PERFUSION IMAG- (SP|0340|78451|5,415.08|3,140.75|2,831.90|2,690.31|1,305.94|1,305.94|104.05|106.13|106.13|108.21|3519.80|3682.25|3953.01|3953.01|4223.76|3249.05|3519.80|4061.31|4602.82|4808.59|4765.27|4061.31|4602.82| 104.05 | 4,808.59 | 3,519.80 34000016|HC MYOCARDIAL PERFUSION IMAG- (SP|0340|78451|5,415.08|3,140.75|2,831.90|2,690.31|1,305.94|1,305.94|44.67|45.56|45.56|46.45|3519.80|3682.25|3953.01|3953.01|4223.76|3249.05|3519.80|4061.31|4602.82|4808.59|4765.27|4061.31|4602.82| 44.67 | 4,808.59 | 3,519.80 34000016|HC MYOCARDIAL PERFUSION IMAG- (SP|0340|78451|5,415.08|3,140.75|2,831.90|2,690.31|1,305.94|1,305.94|148.72|151.69|151.69|154.67|3519.80|3682.25|3953.01|3953.01|4223.76|3249.05|3519.80|4061.31|4602.82|4808.59|4765.27|4061.31|4602.82| 148.72 | 4,808.59 | 3,519.80 34000017|HC MYOCARD PERFUS IMAG- (SPECT-MU|0340|78452|5,947.74|3,449.69|2,690.12|2,555.61|1,305.94|1,305.94|201.10|205.12|205.12|209.15|3866.03|4044.46|4341.85|4341.85|4639.24|3568.64|3866.03|4460.81|5055.58|5281.59|5234.01|4460.81|5055.58| 201.10 | 5,281.59 | 3,866.03 34000017|HC MYOCARD PERFUS IMAG- (SPECT-MU|0340|78452|5,947.74|3,449.69|2,690.12|2,555.61|1,305.94|1,305.94|52.87|53.93|53.93|54.98|3866.03|4044.46|4341.85|4341.85|4639.24|3568.64|3866.03|4460.81|5055.58|5281.59|5234.01|4460.81|5055.58| 52.87 | 5,281.59 | 3,866.03 34000017|HC MYOCARD PERFUS IMAG- (SPECT-MU|0340|78452|5,947.74|3,449.69|2690.12|2555.614|1,305.94|1,305.94|253.98|259.06|259.06|264.14|3866.03|4044.46|4341.85|4341.85|4639.24|3568.64|3866.03|4460.81|5055.58|5281.59|5234.01|4460.81|5055.58| 253.98 | 5,281.59 | 3,866.03 34000018|HC MYOCARDIAL PERFUSION, PLANAR,|0340|78454|2,600.40|1,508.23|1189.68|1130.196|1,305.94|1,305.94|81.60|83.23|83.23|84.86|1690.26|1768.27|1898.29|1898.29|2028.31|1560.24|1690.26|1950.30|2210.34|2309.16|2288.35|1950.30|2210.34| 81.60 | 2,309.16 | 1,690.26 34000018|HC MYOCARDIAL PERFUSION, PLANAR,|0340|78454|2,600.40|1,508.23|1189.68|1130.196|1,305.94|1,305.94|42.98|43.84|43.84|44.70|1690.26|1768.27|1898.29|1898.29|2028.31|1560.24|1690.26|1950.30|2210.34|2309.16|2288.35|1950.30|2210.34| 42.98 | 2,309.16 | 1,690.26 34000018|HC MYOCARDIAL PERFUSION, PLANAR,|0340|78454|2,600.40|1,508.23|1189.68|1130.196|1,305.94|1,305.94|124.58|127.07|127.07|129.56|1690.26|1768.27|1898.29|1898.29|2028.31|1560.24|1690.26|1950.30|2210.34|2309.16|2288.35|1950.30|2210.34| 124.58 | 2,309.16 | 1,690.26 34000019|HC HEART BLOOD POOL REST|0340|78472|3,644.71|2,113.93|598.41|568.49|377.12|377.12|225.36|229.87|229.87|234.37|2369.06|2478.40|2660.64|2660.64|2842.87|2186.83|2369.06|2733.53|3098.00|3236.50|3207.34|2733.53|3098.00| 225.36 | 3,236.50 | 2,369.06 34000019|HC HEART BLOOD POOL REST|0340|78472|3,644.71|2,113.93|598.41|568.4895|377.12|377.12|316.51|322.84|322.84|329.17|2369.06|2478.40|2660.64|2660.64|2842.87|2186.83|2369.06|2733.53|3098.00|3236.50|3207.34|2733.53|3098.00| 316.51 | 3,236.50 | 2,369.06 34000020|HC NM PULMONARY VENTILATION IMAGI|0340|78579|2,181.42|1,265.22|||377.12|377.12|264.83|270.13|270.13|275.42|1417.92|1483.37|1592.44|1592.44|1701.51|1308.85|1417.92|1636.07|1854.21|1937.10|1919.65|1636.07|1854.21| 264.83 | 1,937.10 | 1,483.37 34000020|HC NM PULMONARY VENTILATION IMAGI|0340|78579|2,181.42|1,265.22|||377.12|377.12|264.83|270.13|270.13|275.42|1417.92|1483.37|1592.44|1592.44|1701.51|1308.85|1417.92|1636.07|1854.21|1937.10|1919.65|1636.07|1854.21| 264.83 | 1,937.10 | 1,483.37 34000021|HC PULM PERF IMG PARTICULATE|0340|78580|1,354.49|785.60|||377.12|377.12|88.31|90.08|90.08|91.84|880.42|921.05|988.78|988.78|1056.50|812.69|880.42|1015.87|1151.32|1202.79|1191.95|1015.87|1151.32| 88.31 | 1,202.79 | 921.05 34000021|HC PULM PERF IMG PARTICULATE|0340|78580|1,354.49|785.60|||377.12|377.12|176.62|180.16|180.16|183.69|880.42|921.05|988.78|988.78|1056.50|812.69|880.42|1015.87|1151.32|1202.79|1191.95|1015.87|1151.32| 176.62 | 1,202.79 | 921.05 34000022|HC NM PULMONARY VENT & PERF IMAGI|0340|78582|3,381.55|1,961.30|3031.73|2880.1435|489.40|489.40|269.02|274.40|274.40|279.78|2198.01|2299.45|2468.53|2468.53|2637.61|2028.93|2198.01|2536.16|2874.32|3002.82|2975.76|2536.16|2874.32| 269.02 | 3,031.73 | 2,468.53 34000023|HC NM QUANT DIFF PULM PERF & VENT|0340|78598|5,458.85|3,166.13|||489.40|489.40|269.02|274.40|274.40|279.78|3548.25|3712.02|3984.96|3984.96|4257.90|3275.31|3548.25|4094.14|4640.02|4847.46|4803.79|4094.14|4640.02| 269.02 | 4,847.46 | 3,712.02 34000023|HC NM QUANT DIFF PULM PERF & VENT|0340|78598|5,458.85|3,166.13|||489.40|489.40|269.02|274.40|274.40|279.78|3548.25|3712.02|3984.96|3984.96|4257.90|3275.31|3548.25|4094.14|4640.02|4847.46|4803.79|4094.14|4640.02| 269.02 | 4,847.46 | 3,712.02 34000024|HC BRAIN IMAGING,W/VASCULAR FLOW|0340|78601|1,636.28|949.04|||377.12|377.12|||||1063.58|1112.67|1194.48|1194.48|1276.30|981.77|1063.58|1227.21|1390.84|1453.02|1439.93|1227.21|1390.84| 377.12 | 1,453.02 | 1,194.48 34000025|HC BRAIN W CEREBRAL FLOW|0340|78606|1,696.38|983.90|||489.40|489.40|97.20|99.14|99.14|101.08|1102.65|1153.54|1238.36|1238.36|1323.18|1017.83|1102.65|1272.29|1441.92|1506.39|1492.81|1272.29|1441.92| 97.20 | 1,506.39 | 1,153.54 34000025|HC BRAIN W CEREBRAL FLOW|0340|78606|1,696.38|983.90|||489.40|489.40|194.39|198.28|198.28|202.17|1102.65|1153.54|1238.36|1238.36|1323.18|1017.83|1102.65|1272.29|1441.92|1506.39|1492.81|1272.29|1441.92| 194.39 | 1,506.39 | 1,153.54 34000026|HC CISTERNOGRAM,CERE/SPIN FLUI|0340|78630|4,543.57|2,635.27|||489.40|489.40|50.04|51.04|51.04|52.04|2953.32|3089.63|3316.81|3316.81|3543.98|2726.14|2953.32|3407.68|3862.03|4034.69|3998.34|3407.68|3862.03| 50.04 | 4,034.69 | 3,089.63 34000026|HC CISTERNOGRAM,CERE/SPIN FLUI|0340|78630|4,543.57|2,635.27|||489.40|489.40|133.07|135.73|135.73|138.39|2953.32|3089.63|3316.81|3316.81|3543.98|2726.14|2953.32|3407.68|3862.03|4034.69|3998.34|3407.68|3862.03| 133.07 | 4,034.69 | 3,089.63 34000027|HC BRAIN SHUNT EVALUATION|0340|78645|1,699.25|985.57|||489.40|489.40|90.59|92.40|92.40|94.21|1104.51|1155.49|1240.45|1240.45|1325.42|1019.55|1104.51|1274.44|1444.36|1508.93|1495.34|1274.44|1444.36| 90.59 | 1,508.93 | 1,155.49 34000027|HC BRAIN SHUNT EVALUATION|0340|78645|1,699.25|985.57|||489.40|489.40|130.83|133.45|133.45|136.07|1104.51|1155.49|1240.45|1240.45|1325.42|1019.55|1104.51|1274.44|1444.36|1508.93|1495.34|1274.44|1444.36| 130.83 | 1,508.93 | 1,155.49 34000028|HC RENAL SCAN WITH VAS FLO|0340|78707|1,845.21|1,070.22|||489.40|489.40|58.87|60.05|60.05|61.23|1199.39|1254.74|1347.00|1347.00|1439.26|1107.13|1199.39|1383.91|1568.43|1638.55|1623.78|1383.91|1568.43| 58.87 | 1,638.55 | 1,254.74 34000028|HC RENAL SCAN WITH VAS FLO|0340|78707|1,845.21|1,070.22|||489.40|489.40|128.99|131.57|131.57|134.15|1199.39|1254.74|1347.00|1347.00|1439.26|1107.13|1199.39|1383.91|1568.43|1638.55|1623.78|1383.91|1568.43| 128.99 | 1,638.55 | 1,254.74 34000029|HC RENAL - SINGLE W/PHARMA|0340|78708|2,082.89|1,208.08|1821.94|1730.843|489.40|489.40|58.87|60.05|60.05|61.23|1353.88|1416.37|1520.51|1520.51|1624.65|1249.73|1353.88|1562.17|1770.46|1849.61|1832.94|1562.17|1770.46| 58.87 | 1,849.61 | 1,520.51 34000029|HC RENAL - SINGLE W/PHARMA|0340|78708|2,082.89|1,208.08|1821.94|1730.843|489.40|489.40|258.85|264.03|264.03|269.21|1353.88|1416.37|1520.51|1520.51|1624.65|1249.73|1353.88|1562.17|1770.46|1849.61|1832.94|1562.17|1770.46| 258.85 | 1,849.61 | 1,520.51 34000030|HC RENAL - MULTI W/PHARMA|0340|78709|2,720.31|1,577.78|||489.40|489.40|267.73|273.09|273.09|278.44|1768.20|1849.81|1985.83|1985.83|2121.84|1632.19|1768.20|2040.23|2312.26|2415.64|2393.87|2040.23|2312.26| 267.73 | 2,415.64 | 1,849.81 34000030|HC RENAL - MULTI W/PHARMA|0340|78709|2,720.31|1,577.78|||489.40|489.40|58.87|60.05|60.05|61.23|1768.20|1849.81|1985.83|1985.83|2121.84|1632.19|1768.20|2040.23|2312.26|2415.64|2393.87|2040.23|2312.26| 58.87 | 2,415.64 | 1,849.81 34000031|HC NM LOCALIZE TUMOR / INFLAM SINGLE AREA / SINGLE DAY|0340|78800|1,517.32|880.05|||377.12|377.12|67.77|69.13|69.13|70.48|986.26|1031.78|1107.64|1107.64|1183.51|910.39|986.26|1137.99|1289.72|1347.38|1335.24|1137.99|1289.72| 67.77 | 1,347.38 | 1,031.78 34000031|HC NM LOCALIZE TUMOR / INFLAM SINGLE AREA / SINGLE DAY|0340|78800|1,517.32|880.05|||377.12|377.12|151.50|154.53|154.53|157.56|986.26|1031.78|1107.64|1107.64|1183.51|910.39|986.26|1137.99|1289.72|1347.38|1335.24|1137.99|1289.72| 151.50 | 1,347.38 | 1,031.78 34000032|HC NM LOCALIZE TUMOR / INFLAM WHOLE BODY SINGLE DAY|0340|78802|2,862.80|1,660.42|||1305.94|1305.94|49.06|50.04|50.04|51.02|1860.82|1946.70|2089.84|2089.84|2232.98|1717.68|1860.82|2147.10|2433.38|2542.17|2519.26|2147.10|2433.38| 49.06 | 2,542.17 | 1,946.70 34000032|HC NM LOCALIZE TUMOR / INFLAM WHOLE BODY SINGLE DAY|0340|78802|2,862.80|1,660.42|||1305.94|1305.94|149.75|152.75|152.75|155.74|1860.82|1946.70|2089.84|2089.84|2232.98|1717.68|1860.82|2147.10|2433.38|2542.17|2519.26|2147.10|2433.38| 149.75 | 2,542.17 | 1,946.70 34000033|HC NM LOCALIZE TUMOR / INFLAM SPECT SINGLE AREA / SINGLE DAY|0340|78803|4,245.15|2,462.19|||1,305.94|1,305.94|195.37|199.28|199.28|203.19|2759.35|2886.70|3098.96|3098.96|3311.22|2547.09|2759.35|3183.86|3608.38|3769.69|3735.73|3183.86|3608.38| 195.37 | 3,769.69 | 2,886.70 34000033|HC NM LOCALIZE TUMOR / INFLAM SPECT SINGLE AREA / SINGLE DAY|0340|78803|4,245.15|2,462.19|||1,305.94|1,305.94|242.52|247.37|247.37|252.22|2759.35|2886.70|3098.96|3098.96|3311.22|2547.09|2759.35|3183.86|3608.38|3769.69|3735.73|3183.86|3608.38| 242.52 | 3,769.69 | 2,886.70 34000034|HC WDB LOCAL INFLAM LIMITED|0340|78805|3,780.65|2,192.78|||||205.50|209.61|209.61|213.72|2457.42|2570.84|2759.87|2759.87|2948.91|2268.39|2457.42|2835.49|3213.55|3357.22|3326.97|2835.49|3213.55| 205.50 | 3,357.22 | 2,759.87 34000034|HC WDB LOCAL INFLAM LIMITED|0340|78805|3,780.65|2,192.78|||||102.76|104.81|104.81|106.87|2457.42|2570.84|2759.87|2759.87|2948.91|2268.39|2457.42|2835.49|3213.55|3357.22|3326.97|2835.49|3213.55| 102.76 | 3,357.22 | 2,759.87 34000035|HC WBC LOCALIZE-WHOLE BODY|0340|78806|5,345.54|3,100.41|||||49.06|50.04|50.04|51.02|3474.60|3634.97|3902.24|3902.24|4169.52|3207.32|3474.60|4009.16|4543.71|4746.84|4704.08|4009.16|4543.71| 49.06 | 4,746.84 | 3,902.24 34000035|HC WBC LOCALIZE-WHOLE BODY|0340|78806|5,345.54|3,100.41|||||169.38|172.76|172.76|176.15|3474.60|3634.97|3902.24|3902.24|4169.52|3207.32|3474.60|4009.16|4543.71|4746.84|4704.08|4009.16|4543.71| 169.38 | 4,746.84 | 3,902.24 34000036|HC ORAL RADIOPHARM RX|0340|79005|1,019.81|591.49|830.22|788.709|249.62|249.62|88.95|90.73|90.73|92.51|662.88|693.47|744.46|744.46|795.45|611.89|662.88|764.86|866.84|905.59|897.43|764.86|866.84| 88.95 | 905.59 | 744.46 34000036|HC ORAL RADIOPHARM RX|0340|79005|1,019.81|591.49|830.22|788.709|249.62|249.62|168.88|172.26|172.26|175.63|662.88|693.47|744.46|744.46|795.45|611.89|662.88|764.86|866.84|905.59|897.43|764.86|866.84| 168.88 | 905.59 | 744.46 34000037|HC RADIONUCLIDE-NON THY-NON HE|0340|79101|1,431.72|830.40|||249.62|249.62|88.95|90.73|90.73|92.51|930.62|973.57|1045.16|1045.16|1116.74|859.03|930.62|1073.79|1216.96|1271.37|1259.91|1073.79|1216.96| 88.95 | 1,271.37 | 973.57 34000037|HC RADIONUCLIDE-NON THY-NON HE|0340|79101|1,431.72|830.40|||249.62|249.62|176.28|179.81|179.81|183.33|930.62|973.57|1045.16|1045.16|1116.74|859.03|930.62|1073.79|1216.96|1271.37|1259.91|1073.79|1216.96| 176.28 | 1,271.37 | 973.57 34000038|HC RADIOACTIVE TRACER IDENT SENTN|0340|38792|842.07|488.40|2020.34|1919.323|377.12|377.12|196.25|200.17|200.17|204.10|547.35|572.61|614.71|614.71|656.81|505.24|547.35|631.55|715.76|747.76|741.02|631.55|715.76| 196.25 | 2,020.34 | 614.71 34000039|HC THYROID UPTAKE, SINGLE OR MULT|0340|78012|429.23|248.95|260.33|247.3135|377.12|377.12|96.97|98.91|98.91|100.85|279.00|291.88|313.34|313.34|334.80|257.54|279.00|321.92|364.85|381.16|377.72|321.92|364.85| 96.97 | 381.16 | 313.34 34000040|HC LIVER IMAGING-SPECT|0340|78205|2,434.60|1,412.07|||||121.02|123.44|123.44|125.86|1582.49|1655.53|1777.26|1777.26|1898.99|1460.76|1582.49|1825.95|2069.41|2161.92|2142.45|1825.95|2069.41| 121.02 | 2,161.92 | 1,777.26 34000040|HC LIVER IMAGING-SPECT|0340|78205|2,434.60|1,412.07|||||242.04|246.88|246.88|251.72|1582.49|1655.53|1777.26|1777.26|1898.99|1460.76|1582.49|1825.95|2069.41|2161.92|2142.45|1825.95|2069.41| 242.04 | 2,161.92 | 1,777.26 34000041|HC KIDNEY IMAGING, STATIC ONLY|0340|78700|1,636.28|949.04|||377.12|377.12|29.44|30.03|30.03|30.61|1063.58|1112.67|1194.48|1194.48|1276.30|981.77|1063.58|1227.21|1390.84|1453.02|1439.93|1227.21|1390.84| 29.44 | 1,453.02 | 1,112.67 34000041|HC KIDNEY IMAGING, STATIC ONLY|0340|78700|1,636.28|949.04|||377.12|377.12|81.33|82.95|82.95|84.58|1063.58|1112.67|1194.48|1194.48|1276.30|981.77|1063.58|1227.21|1390.84|1453.02|1439.93|1227.21|1390.84| 81.33 | 1,453.02 | 1,112.67 34000042|HC PARATHYROID IMAGING|0340|78070|1,623.92|941.87|||377.12|377.12|66.59|67.93|67.93|69.26|1055.55|1104.27|1185.46|1185.46|1266.66|974.35|1055.55|1217.94|1380.33|1442.04|1429.05|1217.94|1380.33| 66.59 | 1,442.04 | 1,104.27 34000042|HC PARATHYROID IMAGING|0340|78070|1,623.92|941.87|||377.12|377.12|133.19|135.85|135.85|138.51|1055.55|1104.27|1185.46|1185.46|1266.66|974.35|1055.55|1217.94|1380.33|1442.04|1429.05|1217.94|1380.33| 133.19 | 1,442.04 | 1,104.27 34000043|GASTRIC EMPTYING W/SMALL BOWEL TRANSIT|0340|78265|2,553.43|1,480.99|||377.12|377.12|||||1659.73|1736.33|1864.00|1864.00|1991.68|1532.06|1659.73|1915.07|2170.42|2267.45|2247.02|1915.07|2170.42| 377.12 | 2,267.45 | 1,864.00 34000044|HC INTESTINE MECKEL'S DIVERTICULUM|0340|78290|2,146.20|1,244.80|||377.12|377.12|87.64|89.40|89.40|91.15|1395.03|1459.42|1566.73|1566.73|1674.04|1287.72|1395.03|1609.65|1824.27|1905.83|1888.66|1609.65|1824.27| 87.64 | 1,905.83 | 1,459.42 34000044|HC INTESTINE MECKEL'S DIVERTICULUM|0340|78290|2,146.20|1,244.80|||377.12|377.12|175.29|178.79|178.79|182.30|1395.03|1459.42|1566.73|1566.73|1674.04|1287.72|1395.03|1609.65|1824.27|1905.83|1888.66|1609.65|1824.27| 175.29 | 1,905.83 | 1,459.42 34000045|HC NM LOCALIZE TUMOR / INFLAM WHOLE BODY MULTI DAY|0340|78804|3,454.76|2,003.76|||1,305.94|1,305.94|369.13|376.51|376.51|383.89|2245.59|2349.24|2521.97|2521.97|2694.71|2072.86|2245.59|2591.07|2936.55|3067.83|3040.19|2591.07|2936.55| 369.13 | 3,067.83 | 2,349.24 34000045|HC NM LOCALIZE TUMOR / INFLAM WHOLE BODY MULTI DAY|0340|78804|3,454.76|2,003.76|||1,305.94|1,305.94|323.14|329.60|329.60|336.07|2245.59|2349.24|2521.97|2521.97|2694.71|2072.86|2245.59|2591.07|2936.55|3067.83|3040.19|2591.07|2936.55| 323.14 | 3,067.83 | 2,349.24 34000058|HC NM LOCAL TUMOR / INFLAM SPECT W/ CT SINGLE AREA / SINGLE DAY|0340|78830|2,782.29|1,613.73|2,390.27|2,270.76|1,305.94|1,305.94|||||1808.49|1891.96|2031.07|2031.07|2170.19|1669.37|1808.49|2086.72|2364.95|2470.67|2448.42|2086.72|2364.95| 1,305.94 | 2,470.67 | 2,086.72 34000059|HC NM LOCAL TUMOR / INFLAM SPECT W/ CT MULTI AREAS OR DAY|0340|78832|3,616.98|2,097.85|2,390.27|2,270.76|1,480.34|1,480.34|||||2351.04|2459.55|2640.40|2640.40|2821.24|2170.19|2351.04|2712.74|3074.43|3211.88|3182.94|2712.74|3074.43| 1,480.34 | 3,211.88 | 2,640.40 34100000|HC THYROID UPTAKE|0341|78012|297.61|172.61|260.33|247.31|377.12|377.12|96.97|98.91|98.91|100.85|193.45|202.37|217.26|217.26|232.14|178.57|193.45|223.21|252.97|264.28|261.90|223.21|252.97| 96.97 | 377.12 | 223.21 34100001|HC THYROID SCAN|0341|78013|341.72|198.20|893.41|848.74|377.12|377.12|127.60|130.15|130.15|132.70|222.12|232.37|249.46|249.46|266.54|205.03|222.12|256.29|290.46|303.45|300.71|256.29|290.46| 127.60 | 893.41 | 256.29 34100002|HC THYROID SCAN AND UPTAKE|0341|78014|1,481.91|859.51|1,314.85|1,249.11|377.12|377.12|198.09|202.05|202.05|206.02|963.24|1007.70|1081.79|1081.79|1155.89|889.15|963.24|1111.43|1259.62|1315.94|1304.08|1111.43|1259.62| 198.09 | 1,315.94 | 1,081.79 34100003|HC MYOCARDIAL PERFUSION IMAGE, SI|0341|78451|4,999.38|2,899.64|2,831.90|2,690.31|1,305.94|1,305.94|104.05|106.13|106.13|108.21|3249.60|3399.58|3649.55|3649.55|3899.52|2999.63|3249.60|3749.54|4249.47|4439.45|4399.45|3749.54|4249.47| 104.05 | 4,439.45 | 3,249.60 34100003|HC MYOCARDIAL PERFUSION IMAGE, SI|0341|78451|4,999.38|2,899.64|2,831.90|2,690.31|1,305.94|1,305.94|44.67|45.56|45.56|46.45|3249.60|3399.58|3649.55|3649.55|3899.52|2999.63|3249.60|3749.54|4249.47|4439.45|4399.45|3749.54|4249.47| 44.67 | 4,439.45 | 3,249.60 34100003|HC MYOCARDIAL PERFUSION IMAGE, SI|0341|78451|4,999.38|2,899.64|2831.9|2690.305|1305.94|1305.94|148.72|151.69|151.69|154.67|3249.60|3399.58|3649.55|3649.55|3899.52|2999.63|3249.60|3749.54|4249.47|4439.45|4399.45|3749.54|4249.47| 148.72 | 4,439.45 | 3,249.60 34100004|HC MYOCARDIAL PERFUSION IMAGE, MU|0341|78452|5,834.43|3,383.97|2690.12|2555.614|1305.94|1305.94|201.10|205.12|205.12|209.15|3792.38|3967.41|4259.13|4259.13|4550.86|3500.66|3792.38|4375.82|4959.27|5180.97|5134.30|4375.82|4959.27| 201.10 | 5,180.97 | 3,792.38 34100004|HC MYOCARDIAL PERFUSION IMAGE, MU|0341|78452|5,834.43|3,383.97|2690.12|2555.614|1,305.94|1,305.94|52.87|53.93|53.93|54.98|3792.38|3967.41|4259.13|4259.13|4550.86|3500.66|3792.38|4375.82|4959.27|5180.97|5134.30|4375.82|4959.27| 52.87 | 5,180.97 | 3,792.38 34100004|HC MYOCARDIAL PERFUSION IMAGE, MU|0341|78452|5,834.43|3,383.97|2690.12|2555.614|1,305.94|1,305.94|253.98|259.06|259.06|264.14|3792.38|3967.41|4259.13|4259.13|4550.86|3500.66|3792.38|4375.82|4959.27|5180.97|5134.30|4375.82|4959.27| 253.98 | 5,180.97 | 3,792.38 34100005|HC MUGA SCAN|0341|78472|1,864.36|1,081.33|598.41|568.4895|377.12|377.12|225.36|229.87|229.87|234.37|1211.83|1267.76|1360.98|1360.98|1454.20|1118.62|1211.83|1398.27|1584.71|1655.55|1640.64|1398.27|1584.71| 225.36 | 1,655.55 | 1,211.83 34100005|HC MUGA SCAN|0341|78472|1,864.36|1,081.33|598.41|568.49|377.12|377.12|316.51|322.84|322.84|329.17|1211.83|1267.76|1360.98|1360.98|1454.20|1118.62|1211.83|1398.27|1584.71|1655.55|1640.64|1398.27|1584.71| 316.51 | 1,655.55 | 1,211.83 34100006|HC CPET - SIMPLE|0341|94620|275.68|159.89|||||64.68|65.98|65.98|67.27|179.19|187.46|201.25|201.25|215.03|165.41|179.19|206.76|234.33|244.80|242.60|206.76|234.33| 64.68 | 244.80 | 201.25 34100006|HC CPET - SIMPLE|0341|94620|275.68|159.89|||||2.18|2.23|2.23|2.27|179.19|187.46|201.25|201.25|215.03|165.41|179.19|206.76|234.33|244.80|242.60|206.76|234.33| 2.18 | 244.80 | 201.25 34100007|HC CPET - COMPLEX|0341|94621|2,299.05|1,333.45|||264.45|264.45|4.36|4.44|4.44|4.53|1494.38|1563.35|1678.31|1678.31|1793.26|1379.43|1494.38|1724.29|1954.19|2041.56|2023.16|1724.29|1954.19| 4.36 | 2,041.56 | 1,563.35 34100007|HC CPET - COMPLEX|0341|94621|2,299.05|1,333.45|||264.45|264.45|2.18|2.23|2.23|2.27|1494.38|1563.35|1678.31|1678.31|1793.26|1379.43|1494.38|1724.29|1954.19|2041.56|2023.16|1724.29|1954.19| 2.18 | 2,041.56 | 1,563.35 34100008|HC PARATHYROID PLANAR & SPECT/CT|0341|78072|4,717.38|2,736.08|||489.40|489.40|273.87|279.35|279.35|284.83|3066.30|3207.82|3443.69|3443.69|3679.56|2830.43|3066.30|3538.04|4009.77|4189.03|4151.29|3538.04|4009.77| 273.87 | 4,189.03 | 3,207.82 34200000|HC ORAL RADIOPHARM RX|0342|79005|1,019.81|591.49|830.22|788.71|249.62|249.62|88.95|90.73|90.73|92.51|662.88|693.47|744.46|744.46|795.45|611.89|662.88|764.86|866.84|905.59|897.43|764.86|866.84| 88.95 | 905.59 | 744.46 34200000|HC ORAL RADIOPHARM RX|0342|79005|1,019.81|591.49|830.22|788.71|249.62|249.62|168.88|172.26|172.26|175.63|662.88|693.47|744.46|744.46|795.45|611.89|662.88|764.86|866.84|905.59|897.43|764.86|866.84| 168.88 | 905.59 | 744.46 34200001|HC IV RADIOPHARMACEUTICAL|0342|79101|270.04|156.62|||249.62|249.62|88.95|90.73|90.73|92.51|175.53|183.63|197.13|197.13|210.63|162.02|175.53|202.53|229.53|239.80|237.64|202.53|229.53| 88.95 | 249.62 | 197.13 34200001|HC IV RADIOPHARMACEUTICAL|0342|79101|270.04|156.62|||249.62|249.62|176.28|179.81|179.81|183.33|175.53|183.63|197.13|197.13|210.63|162.02|175.53|202.53|229.53|239.80|237.64|202.53|229.53| 162.02 | 249.62 | 197.13 34200002|HC INTRA-ARTERIAL RPHARM RX|0342|79445|1,279.55|742.14|||249.62|249.62|89.59|91.39|91.39|93.18|831.71|870.09|934.07|934.07|998.05|767.73|831.71|959.66|1087.62|1136.24|1126.00|959.66|1087.62| 89.59 | 1,136.24 | 870.09 34200002|HC INTRA-ARTERIAL RPHARM RX|0342|79445|1,279.55|742.14|||249.62|249.62|197.24|201.19|201.19|205.13|831.71|870.09|934.07|934.07|998.05|767.73|831.71|959.66|1087.62|1136.24|1126.00|959.66|1087.62| 197.24 | 1,136.24 | 870.09 34300001|HC Z BRAIN DTPA|0343|A4641|158.81|92.11|303.49|288.32|||||||103.23|107.99|115.93|115.93|123.87|95.29|103.23|119.11|134.99|141.02|139.75|119.11|134.99| 95.29 | 303.49 | 119.11 34300002|HC BREAST SENTINEL NODE ISOTOPE|0343|A9541|295.90|171.62|187.73|178.34|||||||192.34|201.21|216.01|216.01|230.80|177.54|192.34|221.93|251.52|262.76|260.39|221.93|251.52| 177.54 | 262.76 | 216.01 34300003|HC I-131 PER UCI UP TO 100 UCI THYROID UPTAKE|0343|A9531|214.61|124.47|||||||||139.50|145.93|156.67|156.67|167.40|128.77|139.50|160.96|182.42|190.57|188.86|160.96|182.42| 128.77 | 190.57 | 160.96 34300004|HC I-123 MIBG|0343|A4641|5,800.44|3,364.26|303.49|288.32|||||||3770.29|3944.30|4234.32|4234.32|4524.34|3480.26|3770.29|4350.33|4930.37|5150.79|5104.39|4350.33|4930.37| 288.32 | 5,150.79 | 4,234.32 34300005|HC KINEVAC W/ TC 99 A4641|0343|A4641|374.30|217.09|303.49|288.32|||||||243.30|254.52|273.24|273.24|291.95|224.58|243.30|280.73|318.16|332.38|329.38|280.73|318.16| 224.58 | 332.38 | 280.73 34300006|HC TC 99M SESTAMIBI PER DOSE|0343|A9500|638.14|370.12|374.27|355.56|||||||414.79|433.94|465.84|465.84|497.75|382.88|414.79|478.61|542.42|566.67|561.56|478.61|542.42| 355.56 | 566.67 | 465.84 34300007|HC TC 99M MEDRONATE UP TO 30 MCI|0343|A9503|148.63|86.21|303.49|288.32|||||||96.61|101.07|108.50|108.50|115.93|89.18|96.61|111.47|126.34|131.98|130.79|111.47|126.34| 89.18 | 303.49 | 111.47 34300008|HC Z HEART THALLIUM|0343|A9505|1,250.06|725.03|420.51|399.48|||||||812.54|850.04|912.54|912.54|975.05|750.04|812.54|937.55|1062.55|1110.05|1100.05|937.55|1062.55| 399.48 | 1,110.05 | 912.54 34300009|HC THALLOUS CHLORIDE TL201,PER|0343|A9505|253.26|146.89|420.51|399.4845|||||||164.62|172.22|184.88|184.88|197.54|151.96|164.62|189.95|215.27|224.89|222.87|189.95|215.27| 151.96 | 420.51 | 189.95 34300010|HC IN 111 CAPROMAB PENEDETIDE, P|0343|A9507|7,438.10|4,314.10|303.49|288.32|||||||4834.77|5057.91|5429.81|5429.81|5801.72|4462.86|4834.77|5578.58|6322.39|6605.03|6545.53|5578.58|6322.39| 288.32 | 6,605.03 | 5,429.81 34300011|HC I-131 DIAGNOSTIC PER 0.5 MCI|0343|A9508|153.16|88.83|303.49|288.32|||||||99.55|104.15|111.81|111.81|119.46|91.90|99.55|114.87|130.19|136.01|134.78|114.87|130.19| 91.90 | 303.49 | 114.87 34300012|HC Z8 THYROID PERTECHNETATE|0343|A9512|204.20|118.44|72.51|68.88|||||||132.73|138.86|149.07|149.07|159.28|122.52|132.73|153.15|173.57|181.33|179.70|153.15|173.57| 68.88 | 181.33 | 149.07 34300013|HC I-123 SODIUM IODIDE CAP|0343|A9516|214.61|124.47|183.26|174.10|||||||139.50|145.93|156.67|156.67|167.40|128.77|139.50|160.96|182.42|190.57|188.86|160.96|182.42| 128.77 | 190.57 | 160.96 34300014|HC I-131 CAPSULE PER MCI THERAPY|0343|A9517|174.36|101.13|148.68|141.246|20.12|20.12|||||113.33|118.56|127.28|127.28|136.00|104.62|113.33|130.77|148.21|154.83|153.44|130.77|148.21| 20.12 | 154.83 | 130.77 34300015|HC TC99M CERETEC/DOSE UP TO 25 MC|0343|A9521|3,570.33|2,070.79|||||||||2320.71|2427.82|2606.34|2606.34|2784.86|2142.20|2320.71|2677.75|3034.78|3170.45|3141.89|2677.75|3034.78| 2,142.20 | 3,170.45 | 2,677.75 34300016|HC TC 99M MEBROFENIN, UP TO 15MCI|0343|A9537|253.26|146.89|221.54|210.46|||||||164.62|172.22|184.88|184.88|197.54|151.96|164.62|189.95|215.27|224.89|222.87|189.95|215.27| 151.96 | 224.89 | 189.95 34300017|HC TC99M PENETETATE UP TO 25MCI|0343|A9539|148.63|86.21|130.03|123.53|||||||96.61|101.07|108.50|108.50|115.93|89.18|96.61|111.47|126.34|131.98|130.79|111.47|126.34| 89.18 | 131.98 | 111.47 34300018|HC TC 99M ALB AGGREGATED, PE|0343|A9540|148.63|86.21|130.03|123.53|||||||96.61|101.07|108.50|108.50|115.93|89.18|96.61|111.47|126.34|131.98|130.79|111.47|126.34| 89.18 | 131.98 | 111.47 34300019|HC TC 99M SULF COLLOID TO 20MCI|0343|A9541|214.61|124.47|187.73|178.34|||||||139.50|145.93|156.67|156.67|167.40|128.77|139.50|160.96|182.42|190.57|188.86|160.96|182.42| 128.77 | 190.57 | 160.96 34300020|HC IN 111 OXINE, PER 0.5 MCI|0343|A9547|253.26|146.89|||||||||164.62|172.22|184.88|184.88|197.54|151.96|164.62|189.95|215.27|224.89|222.87|189.95|215.27| 151.96 | 224.89 | 189.95 34300021|HC IN 111 DTPA|0343|A9548|2,231.48|1,294.26|||||||||1450.46|1517.41|1628.98|1628.98|1740.55|1338.89|1450.46|1673.61|1896.76|1981.55|1963.70|1673.61|1896.76| 1,338.89 | 1,981.55 | 1,673.61 34300022|HC CC-FDG UP TO 45 MCI|0343|A9552|1,426.81|827.55|1,248.05|1,185.65|||||||927.43|970.23|1041.57|1041.57|1112.91|856.09|927.43|1070.11|1212.79|1267.01|1255.59|1070.11|1212.79| 856.09 | 1,267.01 | 1,070.11 34300023|HC GALLIUM GA 67, PER MCI|0343|A9556|110.21|63.92|303.49|288.3155|||||||71.64|74.94|80.45|80.45|85.96|66.13|71.64|82.66|93.68|97.87|96.98|82.66|93.68| 66.13 | 303.49 | 82.66 34300024|HC XENON XE 133, PER 10 MCI|0343|A9558|223.19|129.45|303.49|288.32|||||||145.07|151.77|162.93|162.93|174.09|133.91|145.07|167.39|189.71|198.19|196.41|167.39|189.71| 133.91 | 303.49 | 167.39 34300025|HC TC99M LABELED RBC UP TO 30MCI|0343|A9560|216.16|125.37|303.49|288.3155|||||||140.50|146.99|157.80|157.80|168.60|129.70|140.50|162.12|183.74|191.95|190.22|162.12|183.74| 129.70 | 303.49 | 162.12 34300026|HC TC99M MERTIATIDE PER STUDY TO|0343|A9562|387.46|224.73|303.49|288.32|||||||251.85|263.47|282.85|282.85|302.22|232.48|251.85|290.60|329.34|344.06|340.96|290.60|329.34| 232.48 | 344.06 | 290.60 34300027|HC IN 111 OCTREOSCAN, PER < 6 MCI|0343|A9572|4,897.91|2,840.79|||||||||3183.64|3330.58|3575.47|3575.47|3820.37|2938.75|3183.64|3673.43|4163.22|4349.34|4310.16|3673.43|4163.22| 2,938.75 | 4,349.34 | 3,673.43 34300049|HC I-131 CAPSULE PER MCI DIAGNOSTIC|0343|A9528|162.89|94.48|93.47|88.80|||||||105.88|110.77|118.91|118.91|127.05|97.73|105.88|122.17|138.46|144.65|143.34|122.17|138.46| 88.80 | 144.65 | 118.91 34300050|HC TC99M PYROPHOSPHATE =< 25MCI|0343|A9538|64.83|37.60|||||||||42.14|44.08|47.33|47.33|50.57|38.90|42.14|48.62|55.11|57.57|57.05|48.62|55.11| 38.90 | 57.57 | 48.62 34300051|HC FLUCICLOVINE F 18 (AXUMIN)|0343|A9588|1,713.29|993.71|506.60|481.27|||||||1113.64|1165.04|1250.70|1250.70|1336.37|1027.97|1113.64|1284.97|1456.30|1521.40|1507.70|1284.97|1456.30| 481.27 | 1,521.40 | 1,250.70 34300064|HC TC99M SUCCIMER DMSA =< 10 MCI|0343|A9551|2,577.75|1,495.10|||||||||1675.54|1752.87|1881.76|1881.76|2010.65|1546.65|1675.54|1933.31|2191.09|2289.04|2268.42|1933.31|2191.09| 1,546.65 | 2,289.04 | 1,933.31 34400000|HC I131 THERAPEUTIC, PER MCI|0344|A9517|134.64|78.09|148.68|141.25|20.12|20.12|||||87.52|91.56|98.29|98.29|105.02|80.78|87.52|100.98|114.44|119.56|118.48|100.98|114.44| 20.12 | 148.68 | 100.98 34400002|HC RADIUM RA223 DICHLORIDE THER|0344|A9606|457.91|265.59|303.49|288.32|143.39|143.39|||||297.64|311.38|334.27|334.27|357.17|274.75|297.64|343.43|389.22|406.62|402.96|343.43|389.22| 143.39 | 406.62 | 334.27 34400003|HC I-131 CAPSULE PER MCI THERAPY|0344|A9517|174.36|101.13|148.68|141.25|20.12|20.12|||||113.33|118.56|127.28|127.28|136.00|104.62|113.33|130.77|148.21|154.83|153.44|130.77|148.21| 20.12 | 154.83 | 130.77 35000000|HC CT ORBITS W/WO CONTRAST|0350|70482|2,544.06|1,475.55|561.23|533.17|178.55|178.55|189.71|193.50|193.50|197.29|1653.64|1729.96|1857.16|1857.16|1984.37|1526.44|1653.64|1908.05|2162.45|2259.13|2238.77|1908.05|2162.45| 178.55 | 2,259.13 | 1,653.64 35000000|HC CT ORBITS W/WO CONTRAST|0350|70482|2,544.06|1,475.55|561.23|533.17|178.55|178.55|379.41|387.00|387.00|394.59|1653.64|1729.96|1857.16|1857.16|1984.37|1526.44|1653.64|1908.05|2162.45|2259.13|2238.77|1908.05|2162.45| 178.55 | 2,259.13 | 1,653.64 35000001|HC CT ANGIO HEAD W/WO C|0350|70496|3,955.27|2,294.06|3,152.48|2,994.86|178.55|178.55|190.49|194.30|194.30|198.11|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,887.35 35000001|HC CT ANGIO HEAD W/WO C|0350|70496|3,955.27|2,294.06|3,152.48|2,994.86|178.55|178.55|387.76|395.52|395.52|403.27|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,887.35 35000002|HC CT ANGIO NECK W/WO C|0350|70498|3,955.27|2,294.06|3135.05|2978.2975|178.55|178.55|190.49|194.30|194.30|198.11|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,887.35 35000002|HC CT ANGIO NECK W/WO C|0350|70498|3,955.27|2,294.06|3135.05|2978.2975|178.55|178.55|387.76|395.52|395.52|403.27|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,887.35 35000003|HC SCREENING CT OF CHEST|0350|71250|2,360.52|1,369.10|561.23|533.1685|108.97|108.97|236.32|241.05|241.05|245.77|1534.34|1605.15|1723.18|1723.18|1841.21|1416.31|1534.34|1770.39|2006.44|2096.14|2077.26|1770.39|2006.44| 108.97 | 2,096.14 | 1,534.34 35000003|HC SCREENING CT OF CHEST|0350|71250|2,360.52|1,369.10|561.23|533.1685|108.97|108.97|314.25|320.53|320.53|326.82|1534.34|1605.15|1723.18|1723.18|1841.21|1416.31|1534.34|1770.39|2006.44|2096.14|2077.26|1770.39|2006.44| 108.97 | 2,096.14 | 1,534.34 35000004|HC CTA CHEST (NON-CORONARY), W/WO|0350|71275|3,955.27|2,294.06|3194.18|3034.471|178.55|178.55|223.00|227.46|227.46|231.92|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,887.35 35000004|HC CTA CHEST (NON-CORONARY), W/WO|0350|71275|3,955.27|2,294.06|3194.18|3034.471|178.55|178.55|445.99|454.91|454.91|463.83|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,887.35 35000005|HC CT ANGIO PELVIS W/WO C|0350|72191|3,955.27|2,294.06|||178.55|178.55|210.29|214.49|214.49|218.70|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,689.58 35000005|HC CT ANGIO PELVIS W/WO C|0350|72191|3,955.27|2,294.06|||178.55|178.55|420.56|428.97|428.97|437.38|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,689.58 35000006|HC CT ANGIO UP EXTREM W/WO C|0350|73206|3,295.24|1,911.24|||178.55|178.55|189.33|193.11|193.11|196.9|2141.91|2240.76|2405.53|2405.53|2570.29|1977.14|2141.91|2471.43|2800.95|2926.17|2899.81|2471.43|2800.95| 178.55 | 2,926.17 | 2,240.76 35000006|HC CT ANGIO UP EXTREM W/WO C|0350|73206|3,295.24|1,911.24|||178.55|178.55|378.64|386.21|386.21|393.79|2141.91|2240.76|2405.53|2405.53|2570.29|1977.14|2141.91|2471.43|2800.95|2926.17|2899.81|2471.43|2800.95| 178.55 | 2,926.17 | 2,240.76 35000007|HC CT ANGIO LOW EXTREM W/WO C|0350|73706|3,295.24|1,911.24|||178.55|178.55|189.33|193.11|193.11|196.90|2141.91|2240.76|2405.53|2405.53|2570.29|1977.14|2141.91|2471.43|2800.95|2926.17|2899.81|2471.43|2800.95| 178.55 | 2,926.17 | 2,240.76 35000007|HC CT ANGIO LOW EXTREM W/WO C|0350|73706|3,295.24|1,911.24|||178.55|178.55|378.64|386.21|386.21|393.79|2141.91|2240.76|2405.53|2405.53|2570.29|1977.14|2141.91|2471.43|2800.95|2926.17|2899.81|2471.43|2800.95| 178.55 | 2,926.17 | 2,240.76 35000008|HC CT ANGIO ABD W/WO C|0350|74175|3,681.76|2,135.42|3155.92|2998.124|178.55|178.55|359.28|366.46|366.46|373.65|2393.14|2503.60|2687.68|2687.68|2871.77|2209.06|2393.14|2761.32|3129.50|3269.40|3239.95|2761.32|3129.50| 178.55 | 3,269.40 | 2,687.68 35000008|HC CT ANGIO ABD W/WO C|0350|74175|3,681.76|2,135.42|3155.92|2998.124|178.55|178.55|444.49|453.38|453.38|462.27|2393.14|2503.60|2687.68|2687.68|2871.77|2209.06|2393.14|2761.32|3129.50|3269.40|3239.95|2761.32|3129.50| 178.55 | 3,269.40 | 2,687.68 35000009|HC CT HRT WO CONT QUANT EVAL COR|0350|75571|484.02|280.73|561.23|533.17|80.90|80.90|||||314.61|329.13|353.33|353.33|377.54|290.41|314.61|363.02|411.42|429.81|425.94|363.02|411.42| 80.90 | 561.23 | 363.02 35000010|HC LV+EF+HEART W/WO GATED W/3D MO|0350|75574|3,172.48|1,840.04|2,792.09|2,652.49|178.55|178.55|||||2062.11|2157.29|2315.91|2315.91|2474.53|1903.49|2062.11|2379.36|2696.61|2817.16|2791.78|2379.36|2696.61| 178.55 | 2,817.16 | 2,379.36 35000011|HC CT ANGIO ABD AORTA & BILAT|0350|75635|3,955.27|2,294.06|2,954.74|2,807.00|178.55|178.55|278.25|283.82|283.82|289.38|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,807.00 35000011|HC CT ANGIO ABD AORTA & BILAT|0350|75635|3,955.27|2,294.06|2954.74|2807.003|178.55|178.55|556.49|567.62|567.62|578.75|2570.93|2689.58|2887.35|2887.35|3085.11|2373.16|2570.93|2966.45|3361.98|3512.28|3480.64|2966.45|3361.98| 178.55 | 3,512.28 | 2,807.00 35000012|HC PERC DRAIN CT CATH PLACE|0350|75989|1,123.13|651.42|||||106.99|109.13|109.13|111.27|730.03|763.73|819.88|819.88|876.04|673.88|730.03|842.35|954.66|997.34|988.35|842.35|954.66| 106.99 | 997.34 | 819.88 35000012|HC PERC DRAIN CT CATH PLACE|0350|75989|1,123.13|651.42|||||91.58|93.41|93.41|95.25|730.03|763.73|819.88|819.88|876.04|673.88|730.03|842.35|954.66|997.34|988.35|842.35|954.66| 91.58 | 997.34 | 819.88 35000013|HC CT LIM/FOLLOWUP.RFA|0350|76380|1,452.53|842.47|561.23|533.17|80.90|80.90|39.25|40.03|40.03|40.82|944.14|987.72|1060.35|1060.35|1132.97|871.52|944.14|1089.40|1234.65|1289.85|1278.23|1089.40|1234.65| 39.25 | 1,289.85 | 944.14 35000013|HC CT LIM/FOLLOWUP.RFA|0350|76380|1,452.53|842.47|561.23|533.17|80.90|80.90|207.97|212.13|212.13|216.29|944.14|987.72|1060.35|1060.35|1132.97|871.52|944.14|1089.40|1234.65|1289.85|1278.23|1089.40|1234.65| 80.90 | 1,289.85 | 944.14 35000014|HC CT GUIDE BIOPSY/LOCAL12|0350|77012|1,813.54|1,051.85|561.23|533.1685|||||||1178.80|1233.21|1323.88|1323.88|1414.56|1088.12|1178.80|1360.16|1541.51|1610.42|1595.92|1360.16|1541.51| 533.17 | 1,610.42 | 1,323.88 35000015|HC CT GUIDE FOR TISSUE ABLATION|0350|77013|2,119.85|1,229.51|||||||||1377.90|1441.50|1547.49|1547.49|1653.48|1271.91|1377.90|1589.89|1801.87|1882.43|1865.47|1589.89|1801.87| 1,271.91 | 1,882.43 | 1,589.89 35000016|HC RAD THERAPY FIELD GUIDANCE|0350|77014|858.15|497.73|561.23|533.17|||||||557.80|583.54|626.45|626.45|669.36|514.89|557.80|643.61|729.43|762.04|755.17|643.61|729.43| 514.89 | 762.04 | 626.45 35000017|HC CT CEREBRAL PERFUSION ANALYSIS|0350|0042T|3,464.20|2,009.24|||||||||2251.73|2355.66|2528.87|2528.87|2702.08|2078.52|2251.73|2598.15|2944.57|3076.21|3048.50|2598.15|2944.57| 2,078.52 | 3,076.21 | 2,598.15 35000018|HC SCREENNG CT CORONARYCALCIUMSCO|0350|75571|105.00|60.90|561.23|533.17|80.9|80.9|||||68.25|71.40|76.65|76.65|81.90|63.00|68.25|78.75|89.25|93.24|92.40|78.75|89.25| 63.00 | 561.23 | 80.90 35000019|HC HEART W/WO GATED W/3D MORPHOL|0350|75572|2,697.21|1,564.38|561.23|533.17|178.55|178.55|||||1753.19|1834.10|1968.96|1968.96|2103.82|1618.33|1753.19|2022.91|2292.63|2395.12|2373.54|2022.91|2292.63| 178.55 | 2,395.12 | 1,968.96 35000020|HC PLACEMENT INTERSTITIAL DEVICE FOR RAD THERAPY|0350|49411|2,042.36|1,184.57|||1262.18|1262.18|||||1327.53|1388.80|1490.92|1490.92|1593.04|1225.42|1327.53|1531.77|1736.01|1813.62|1797.28|1531.77|1736.01| 1,225.42 | 1,813.62 | 1,490.92 35000021|HC FINE NEEDLE ASP BX 1ST LESION INCL CT GUIDANCE|0350|10009|2,119.01|1,229.03|660.00|627.00|621.97|621.97|||||1377.36|1440.93|1546.88|1546.88|1652.83|1271.41|1377.36|1589.26|1801.16|1881.68|1864.73|1589.26|1801.16| 621.97 | 1,881.68 | 1,546.88 35000022|HC FINE NEEDLE ASP BX EA. ADD. LESION INCL CT GUIDANCE|0350|10010|1,059.50|614.51|660.00|627.00|||||||688.68|720.46|773.44|773.44|826.41|635.70|688.68|794.63|900.58|940.84|932.36|794.63|900.58| 627.00 | 940.84 | 773.44 35000035|HC 3D RENDER W/INTRP POSTPROCESS|0350|76376|735.00|426.30|375.92|357.12|||126.40|128.92|128.92|131.45|477.75|499.80|536.55|536.55|573.30|441.00|477.75|551.25|624.75|652.68|646.80|551.25|624.75| 126.40 | 652.68 | 499.80 35000035|HC 3D RENDER W/INTRP POSTPROCESS|0350|76376|735.00|426.30|375.92|357.12|||11.36|11.58|11.58|11.81|477.75|499.80|536.55|536.55|573.30|441.00|477.75|551.25|624.75|652.68|646.80|551.25|624.75| 11.36 | 652.68 | 499.80 35000035|HC 3D RENDER W/INTRP POSTPROCESS|0350|76376|735.00|426.30|375.92|357.12|||137.75|140.51|140.51|143.26|477.75|499.80|536.55|536.55|573.30|441.00|477.75|551.25|624.75|652.68|646.80|551.25|624.75| 137.75 | 652.68 | 499.80 35000036|HC 3D RENDER W/INTRP POSTPROCESS DIFF WK STA|0350|76377|2,138.58|1,240.38|265.24|251.98|||177.88|181.44|181.44|184.99|1390.08|1454.23|1561.16|1561.16|1668.09|1283.15|1390.08|1603.94|1817.79|1899.06|1881.95|1603.94|1817.79| 177.88 | 1,899.06 | 1,454.23 35000036|HC 3D RENDER W/INTRP POSTPROCESS DIFF WK STA|0350|76377|2,138.58|1,240.38|265.24|251.98|||133.21|135.88|135.88|138.54|1390.08|1454.23|1561.16|1561.16|1668.09|1283.15|1390.08|1603.94|1817.79|1899.06|1881.95|1603.94|1817.79| 133.21 | 1,899.06 | 1,454.23 35000036|HC 3D RENDER W/INTRP POSTPROCESS DIFF WK STA|0350|76377|2,138.58|1,240.38|265.24|251.98|||44.67|45.56|45.56|46.45|1390.08|1454.23|1561.16|1561.16|1668.09|1283.15|1390.08|1603.94|1817.79|1899.06|1881.95|1603.94|1817.79| 44.67 | 1,899.06 | 1,454.23 35100000|HC HEAD W/O CONTRAST|0351|70450|1,852.43|1,074.41|561.23|533.17|108.97|108.97|123.10|125.56|125.56|128.02|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100000|HC HEAD W/O CONTRAST|0351|70450|1,852.43|1,074.41|561.23|533.17|108.97|108.97|246.19|251.11|251.11|256.03|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100001|HC HEAD W/ CONTRAST|0351|70460|2,271.78|1,317.63|561.23|533.17|178.55|178.55|151.29|154.32|154.32|157.35|1476.66|1544.81|1658.40|1658.40|1771.99|1363.07|1476.66|1703.84|1931.01|2017.34|1999.17|1703.84|1931.01| 151.29 | 2,017.34 | 1,476.66 35100001|HC HEAD W/ CONTRAST|0351|70460|2,271.78|1,317.63|561.23|533.17|178.55|178.55|302.58|308.63|308.63|314.68|1476.66|1544.81|1658.40|1658.40|1771.99|1363.07|1476.66|1703.84|1931.01|2017.34|1999.17|1703.84|1931.01| 178.55 | 2,017.34 | 1,476.66 35100002|HC HEAD W/W/O CONTRAST|0351|70470|2,775.00|1,609.50|561.23|533.17|178.55|178.55|184.21|187.90|187.90|191.58|1803.75|1887.00|2025.75|2025.75|2164.50|1665.00|1803.75|2081.25|2358.75|2464.20|2442.00|2081.25|2358.75| 178.55 | 2,464.20 | 1,803.75 35100002|HC HEAD W/W/O CONTRAST|0351|70470|2,775.00|1,609.50|561.23|533.17|178.55|178.55|368.42|375.79|375.79|383.16|1803.75|1887.00|2025.75|2025.75|2164.50|1665.00|1803.75|2081.25|2358.75|2464.20|2442.00|2081.25|2358.75| 178.55 | 2,464.20 | 1,803.75 35100003|HC ORBITS/IAC/POST FOSSA W/O|0351|70480|1,852.43|1,074.41|561.23|533.17|108.97|108.97|138.11|140.87|140.87|143.63|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100003|HC ORBITS/IAC/POST FOSSA W/O|0351|70480|1,852.43|1,074.41|561.23|533.17|108.97|108.97|276.20|281.72|281.72|287.25|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100004|HC ORBITS/IAC/POST FOSSA W CON|0351|70481|2,271.78|1,317.63|561.23|533.17|178.55|178.55|160.10|163.30|163.30|166.50|1476.66|1544.81|1658.40|1658.40|1771.99|1363.07|1476.66|1703.84|1931.01|2017.34|1999.17|1703.84|1931.01| 160.10 | 2,017.34 | 1,476.66 35100004|HC ORBITS/IAC/POST FOSSA W CON|0351|70481|2,271.78|1,317.63|561.23|533.17|178.55|178.55|320.19|326.59|326.59|332.99|1476.66|1544.81|1658.40|1658.40|1771.99|1363.07|1476.66|1703.84|1931.01|2017.34|1999.17|1703.84|1931.01| 178.55 | 2,017.34 | 1,476.66 35100005|HC MAXILLOFACIAL W/O CONTRAST|0351|70486|1,852.43|1,074.41|561.23|533.17|108.97|108.97|133.00|135.66|135.66|138.32|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100005|HC MAXILLOFACIAL W/O CONTRAST|0351|70486|1,852.43|1,074.41|561.23|533.17|108.97|108.97|266.01|271.33|271.33|276.65|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100006|HC MAXILLOFACIAL W/ CONTRAST|0351|70487|2,271.78|1,317.63|561.23|533.17|178.55|178.55|157.17|160.31|160.31|163.46|1476.66|1544.81|1658.40|1658.40|1771.99|1363.07|1476.66|1703.84|1931.01|2017.34|1999.17|1703.84|1931.01| 157.17 | 2,017.34 | 1,476.66 35100006|HC MAXILLOFACIAL W/ CONTRAST|0351|70487|2,271.78|1,317.63|561.23|533.17|178.55|178.55|314.32|320.61|320.61|326.90|1476.66|1544.81|1658.40|1658.40|1771.99|1363.07|1476.66|1703.84|1931.01|2017.34|1999.17|1703.84|1931.01| 178.55 | 2,017.34 | 1,476.66 35100007|HC MAXILLOFAC. W/W/O CONTRAST|0351|70488|2,427.76|1,408.10|561.23|533.17|178.55|178.55|183.16|186.83|186.83|190.49|1578.04|1650.88|1772.26|1772.26|1893.65|1456.66|1578.04|1820.82|2063.60|2155.85|2136.43|1820.82|2063.60| 178.55 | 2,155.85 | 1,578.04 35100007|HC MAXILLOFAC. W/W/O CONTRAST|0351|70488|2,427.76|1,408.10|561.23|533.17|178.55|178.55|366.33|373.66|373.66|380.98|1578.04|1650.88|1772.26|1772.26|1893.65|1456.66|1578.04|1820.82|2063.60|2155.85|2136.43|1820.82|2063.60| 178.55 | 2,155.85 | 1,578.04 35100008|HC SOFT NECK W/O CONTRAST|0351|70490|1,852.43|1,074.41|561.23|533.17|108.97|108.97|189.08|192.86|192.86|196.64|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100008|HC SOFT NECK W/O CONTRAST|0351|70490|1,852.43|1,074.41|561.23|533.17|108.97|108.97|278.33|283.90|283.90|289.47|1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 108.97 | 1,644.96 | 1,204.08 35100009|HC SOFT TISSUE NECK W/ CONTRAS|0351|70491|2,071.22|1,201.31|561.23|533.17|178.55|178.55|320.19|326.59|326.59|332.99|1346.29|1408.43|1511.99|1511.99|1615.55|1242.73|1346.29|1553.42|1760.54|1839.24|1822.67|1553.42|1760.54| 178.55 | 1,839.24 | 1,346.29 35100009|HC SOFT TISSUE NECK W/ CONTRAS|0351|70491|2,071.22|1,201.31|561.23|533.17|178.55|178.55|226.60|231.13|231.13|235.67|1346.29|1408.43|1511.99|1511.99|1615.55|1242.73|1346.29|1553.42|1760.54|1839.24|1822.67|1553.42|1760.54| 178.55 | 1,839.24 | 1,346.29 35100010|HC SOFT TISSUE NECK W/WO CONTR|0351|70492|2,821.19|1,636.29|561.23|533.17|178.55|178.55|190.49|194.30|194.30|198.11|1833.77|1918.41|2059.47|2059.47|2200.53|1692.71|1833.77|2115.89|2398.01|2505.22|2482.65|2115.89|2398.01| 178.55 | 2,505.22 | 1,833.77 35100010|HC SOFT TISSUE NECK W/WO CONTR|0351|70492|2,821.19|1,636.29|561.23|533.17|178.55|178.55|387.76|395.52|395.52|403.27|1833.77|1918.41|2059.47|2059.47|2200.53|1692.71|1833.77|2115.89|2398.01|2505.22|2482.65|2115.89|2398.01| 178.55 | 2,505.22 | 1,833.77 35200000|HC THORAX W/O CONTRAST|0352|71250|2,360.52|1,369.10|561.23|533.17|108.97|108.97|236.32|241.05|241.05|245.77|1534.34|1605.15|1723.18|1723.18|1841.21|1416.31|1534.34|1770.39|2006.44|2096.14|2077.26|1770.39|2006.44| 108.97 | 2,096.14 | 1,534.34 35200000|HC THORAX W/O CONTRAST|0352|71250|2,360.52|1,369.10|561.23|533.17|108.97|108.97|314.25|320.53|320.53|326.82|1534.34|1605.15|1723.18|1723.18|1841.21|1416.31|1534.34|1770.39|2006.44|2096.14|2077.26|1770.39|2006.44| 108.97 | 2,096.14 | 1,534.34 35200001|HC THORAX W/ CONTRAST|0352|71260|2,616.98|1,517.85|561.23|533.17|178.55|178.55|299.75|305.74|305.74|311.74|1701.04|1779.55|1910.40|1910.40|2041.24|1570.19|1701.04|1962.74|2224.43|2323.88|2302.94|1962.74|2224.43| 178.55 | 2,323.88 | 1,701.04 35200001|HC THORAX W/ CONTRAST|0352|71260|2,616.98|1,517.85|561.23|533.17|178.55|178.55|375.03|382.53|382.53|390.03|1701.04|1779.55|1910.40|1910.40|2041.24|1570.19|1701.04|1962.74|2224.43|2323.88|2302.94|1962.74|2224.43| 178.55 | 2,323.88 | 1,701.04 35200002|HC THORAX W/WO CONTRAST|0352|71270|2,995.01|1,737.11|561.23|533.17|178.55|178.55|223.00|227.46|227.46|231.92|1946.76|2036.61|2186.36|2186.36|2336.11|1797.01|1946.76|2246.26|2545.76|2659.57|2635.61|2246.26|2545.76| 178.55 | 2,659.57 | 1,946.76 35200002|HC THORAX W/WO CONTRAST|0352|71270|2,995.01|1,737.11|561.23|533.17|178.55|178.55|445.99|454.91|454.91|463.83|1946.76|2036.61|2186.36|2186.36|2336.11|1797.01|1946.76|2246.26|2545.76|2659.57|2635.61|2246.26|2545.76| 178.55 | 2,659.57 | 1,946.76 35200003|HC CERVICAL SP W/O CONTRAST|0352|72125|2,813.90|1,632.06|561.23|533.17|108.97|108.97|157.13|160.27|160.27|163.41|1829.04|1913.45|2054.15|2054.15|2194.84|1688.34|1829.04|2110.43|2391.82|2498.74|2476.23|2110.43|2391.82| 108.97 | 2,498.74 | 1,829.04 35200003|HC CERVICAL SP W/O CONTRAST|0352|72125|2,813.90|1,632.06|561.23|533.17|108.97|108.97|314.25|320.53|320.53|326.82|1829.04|1913.45|2054.15|2054.15|2194.84|1688.34|1829.04|2110.43|2391.82|2498.74|2476.23|2110.43|2391.82| 108.97 | 2,498.74 | 1,829.04 35200004|HC CERVICAL SP WITH CONTRAST|0352|72126|3,340.21|1,937.32|561.23|533.17|368.12|368.12|182.26|185.91|185.91|189.55|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 182.26 | 2,966.11 | 2,171.14 35200004|HC CERVICAL SP WITH CONTRAST|0352|72126|3,340.21|1,937.32|561.23|533.17|368.12|368.12|364.51|371.80|371.80|379.09|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 364.51 | 2,966.11 | 2,171.14 35200005|HC CERVICAL SP W/WO CONTRAST|0352|72127|3,640.44|2,111.46|561.23|533.17|178.55|178.55|212.60|216.85|216.85|221.11|2366.29|2475.50|2657.52|2657.52|2839.54|2184.26|2366.29|2730.33|3094.37|3232.71|3203.59|2730.33|3094.37| 178.55 | 3,232.71 | 2,366.29 35200005|HC CERVICAL SP W/WO CONTRAST|0352|72127|3,640.44|2,111.46|561.23|533.17|178.55|178.55|425.20|433.71|433.71|442.21|2366.29|2475.50|2657.52|2657.52|2839.54|2184.26|2366.29|2730.33|3094.37|3232.71|3203.59|2730.33|3094.37| 178.55 | 3,232.71 | 2,366.29 35200006|HC THORACIC SP W/O CONTRAST|0352|72128|2,813.90|1,632.06|561.23|533.17|108.97|108.97|157.13|160.27|160.27|163.41|1829.04|1913.45|2054.15|2054.15|2194.84|1688.34|1829.04|2110.43|2391.82|2498.74|2476.23|2110.43|2391.82| 108.97 | 2,498.74 | 1,829.04 35200006|HC THORACIC SP W/O CONTRAST|0352|72128|2,813.90|1,632.06|561.23|533.17|108.97|108.97|320.67|327.08|327.08|333.50|1829.04|1913.45|2054.15|2054.15|2194.84|1688.34|1829.04|2110.43|2391.82|2498.74|2476.23|2110.43|2391.82| 108.97 | 2,498.74 | 1,829.04 35200007|HC THORACIC SP W/ CONTRAST|0352|72129|3,340.21|1,937.32|561.23|533.17|178.55|178.55|373.50|380.97|380.97|388.44|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 178.55 | 2,966.11 | 2,171.14 35200007|HC THORACIC SP W/ CONTRAST|0352|72129|3,340.21|1,937.32|561.23|533.17|178.55|178.55|182.26|185.91|185.91|189.55|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 178.55 | 2,966.11 | 2,171.14 35200008|HC THORACIC SP W/WO CONTRAST|0352|72130|3,464.94|2,009.67|561.23|533.17|178.55|178.55|425.20|433.71|433.71|442.21|2252.21|2356.16|2529.41|2529.41|2702.65|2078.96|2252.21|2598.71|2945.20|3076.87|3049.15|2598.71|2945.20| 178.55 | 3,076.87 | 2,252.21 35200008|HC THORACIC SP W/WO CONTRAST|0352|72130|3,464.94|2,009.67|561.23|533.17|178.55|178.55|212.60|216.85|216.85|221.11|2252.21|2356.16|2529.41|2529.41|2702.65|2078.96|2252.21|2598.71|2945.20|3076.87|3049.15|2598.71|2945.20| 178.55 | 3,076.87 | 2,252.21 35200009|HC LUMBAR SP W/O CONTRAST|0352|72131|2,813.90|1,632.06|561.23|533.17|108.97|108.97|157.13|160.27|160.27|163.41|1829.04|1913.45|2054.15|2054.15|2194.84|1688.34|1829.04|2110.43|2391.82|2498.74|2476.23|2110.43|2391.82| 108.97 | 2,498.74 | 1,829.04 35200009|HC LUMBAR SP W/O CONTRAST|0352|72131|2,813.90|1,632.06|561.23|533.17|108.97|108.97|314.25|320.53|320.53|326.82|1829.04|1913.45|2054.15|2054.15|2194.84|1688.34|1829.04|2110.43|2391.82|2498.74|2476.23|2110.43|2391.82| 108.97 | 2,498.74 | 1,829.04 35200010|HC LUMBAR SP W/ CONTRAST|0352|72132|3,340.21|1,937.32|561.23|533.17|368.12|368.12|182.26|185.91|185.91|189.55|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 182.26 | 2,966.11 | 2,171.14 35200010|HC LUMBAR SP W/ CONTRAST|0352|72132|3,340.21|1,937.32|561.23|533.17|368.12|368.12|364.51|371.80|371.80|379.09|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 364.51 | 2,966.11 | 2,171.14 35200011|HC LUMBAR SP W/WO CONTRAST|0352|72133|3,464.94|2,009.67|561.23|533.17|178.55|178.55|212.60|216.85|216.85|221.11|2252.21|2356.16|2529.41|2529.41|2702.65|2078.96|2252.21|2598.71|2945.20|3076.87|3049.15|2598.71|2945.20| 178.55 | 3,076.87 | 2,252.21 35200011|HC LUMBAR SP W/WO CONTRAST|0352|72133|3,464.94|2,009.67|561.23|533.17|178.55|178.55|451.87|460.90|460.90|469.94|2252.21|2356.16|2529.41|2529.41|2702.65|2078.96|2252.21|2598.71|2945.20|3076.87|3049.15|2598.71|2945.20| 178.55 | 3,076.87 | 2,252.21 35200012|HC PELVIS W/O CONTRAST|0352|72192|2,631.57|1,526.31|561.23|533.17|108.97|108.97|154.42|157.51|157.51|160.60|1710.52|1789.47|1921.05|1921.05|2052.62|1578.94|1710.52|1973.68|2236.83|2336.83|2315.78|1973.68|2236.83| 108.97 | 2,336.83 | 1,710.52 35200012|HC PELVIS W/O CONTRAST|0352|72192|2,631.57|1,526.31|561.23|533.17|108.97|108.97|308.83|315.01|315.01|321.18|1710.52|1789.47|1921.05|1921.05|2052.62|1578.94|1710.52|1973.68|2236.83|2336.83|2315.78|1973.68|2236.83| 108.97 | 2,336.83 | 1,710.52 35200013|HC PELVIS W/ CONTRAST|0352|72193|3,008.38|1,744.86|561.23|533.17|178.55|178.55|360.22|367.42|367.42|374.63|1955.45|2045.70|2196.12|2196.12|2346.54|1805.03|1955.45|2256.29|2557.12|2671.44|2647.37|2256.29|2557.12| 178.55 | 2,671.44 | 1,955.45 35200013|HC PELVIS W/ CONTRAST|0352|72193|3,008.38|1,744.86|561.23|533.17|178.55|178.55|289.96|295.76|295.76|301.56|1955.45|2045.70|2196.12|2196.12|2346.54|1805.03|1955.45|2256.29|2557.12|2671.44|2647.37|2256.29|2557.12| 178.55 | 2,671.44 | 1,955.45 35200014|HC PELVIS W/W/O CONTRAST|0352|72194|3,340.21|1,937.32|561.23|533.17|178.55|178.55|210.29|214.49|214.49|218.70|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 178.55 | 2,966.11 | 2,171.14 35200014|HC PELVIS W/W/O CONTRAST|0352|72194|3,340.21|1,937.32|561.23|533.17|178.55|178.55|420.56|428.97|428.97|437.38|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 178.55 | 2,966.11 | 2,171.14 35200015|HC UPPER EXTREMITY W/O CONT|0352|73200|1,751.55|1,015.90|561.23|533.17|108.97|108.97|198.41|202.37|202.37|206.34|1138.51|1191.05|1278.63|1278.63|1366.21|1050.93|1138.51|1313.66|1488.82|1555.38|1541.36|1313.66|1488.82| 108.97 | 1,555.38 | 1,138.51 35200015|HC UPPER EXTREMITY W/O CONT|0352|73200|1,751.55|1,015.90|561.23|533.17|108.97|108.97|271.46|276.89|276.89|282.32|1138.51|1191.05|1278.63|1278.63|1366.21|1050.93|1138.51|1313.66|1488.82|1555.38|1541.36|1313.66|1488.82| 108.97 | 1,555.38 | 1,138.51 35200016|HC UPPER EXTREMITY W/ CONTR|0352|73201|2,157.53|1,251.37|561.23|533.17|368.12|368.12|314.25|320.53|320.53|326.82|1402.39|1467.12|1575.00|1575.00|1682.87|1294.52|1402.39|1618.15|1833.90|1915.89|1898.63|1618.15|1833.90| 314.25 | 1,915.89 | 1,402.39 35200016|HC UPPER EXTREMITY W/ CONTR|0352|73201|2,157.53|1,251.37|561.23|533.17|368.12|368.12|157.13|160.27|160.27|163.41|1402.39|1467.12|1575.00|1575.00|1682.87|1294.52|1402.39|1618.15|1833.90|1915.89|1898.63|1618.15|1833.90| 157.13 | 1,915.89 | 1,402.39 35200017|HC LOW EXTREMITY W/O CONTRAST|0352|73700|1,751.55|1,015.90|561.23|533.17|108.97|108.97|198.41|202.37|202.37|206.34|1138.51|1191.05|1278.63|1278.63|1366.21|1050.93|1138.51|1313.66|1488.82|1555.38|1541.36|1313.66|1488.82| 108.97 | 1,555.38 | 1,138.51 35200017|HC LOW EXTREMITY W/O CONTRAST|0352|73700|1,751.55|1,015.90|561.23|533.17|108.97|108.97|271.46|276.89|276.89|282.32|1138.51|1191.05|1278.63|1278.63|1366.21|1050.93|1138.51|1313.66|1488.82|1555.38|1541.36|1313.66|1488.82| 108.97 | 1,555.38 | 1,138.51 35200018|HC LOW EXTREMITY W/ CONTRAST|0352|73701|2,157.53|1,251.37|561.23|533.17|178.55|178.55|157.13|160.27|160.27|163.41|1402.39|1467.12|1575.00|1575.00|1682.87|1294.52|1402.39|1618.15|1833.90|1915.89|1898.63|1618.15|1833.90| 157.13 | 1,915.89 | 1,402.39 35200018|HC LOW EXTREMITY W/ CONTRAST|0352|73701|2,157.53|1,251.37|561.23|533.17|178.55|178.55|314.25|320.53|320.53|326.82|1402.39|1467.12|1575.00|1575.00|1682.87|1294.52|1402.39|1618.15|1833.90|1915.89|1898.63|1618.15|1833.90| 178.55 | 1,915.89 | 1,402.39 35200019|HC ABDOMEN W/O CONTRAST|0352|74150|2,631.57|1,526.31|561.23|533.17|108.97|108.97|306.54|312.67|312.67|318.80|1710.52|1789.47|1921.05|1921.05|2052.62|1578.94|1710.52|1973.68|2236.83|2336.83|2315.78|1973.68|2236.83| 108.97 | 2,336.83 | 1,710.52 35200019|HC ABDOMEN W/O CONTRAST|0352|74150|2,631.57|1,526.31|561.23|533.17|108.97|108.97|153.27|156.34|156.34|159.40|1710.52|1789.47|1921.05|1921.05|2052.62|1578.94|1710.52|1973.68|2236.83|2336.83|2315.78|1973.68|2236.83| 108.97 | 2,336.83 | 1,710.52 35200020|HC ABDOMEN W/ CONTRAST|0352|74160|3,008.38|1,744.86|561.23|533.17|178.55|178.55|273.36|278.83|278.83|284.29|1955.45|2045.70|2196.12|2196.12|2346.54|1805.03|1955.45|2256.29|2557.12|2671.44|2647.37|2256.29|2557.12| 178.55 | 2,671.44 | 1,955.45 35200020|HC ABDOMEN W/ CONTRAST|0352|74160|3,008.38|1,744.86|561.23|533.17|178.55|178.55|359.16|366.34|366.34|373.53|1955.45|2045.70|2196.12|2196.12|2346.54|1805.03|1955.45|2256.29|2557.12|2671.44|2647.37|2256.29|2557.12| 178.55 | 2,671.44 | 1,955.45 35200021|HC ABDOMEN W/W/O CONTRAST|0352|74170|3,340.21|1,937.32|561.23|533.17|178.55|178.55|359.28|366.46|366.46|373.65|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 178.55 | 2,966.11 | 2,171.14 35200021|HC ABDOMEN W/W/O CONTRAST|0352|74170|3,340.21|1,937.32|561.23|533.17|178.55|178.55|444.49|453.38|453.38|462.27|2171.14|2271.34|2438.35|2438.35|2605.36|2004.13|2171.14|2505.16|2839.18|2966.11|2939.38|2505.16|2839.18| 178.55 | 2,966.11 | 2,171.14 35200022|HC CT ANG ABD & PELV W/WO CONTRAS|0352|74174|3,822.77|2,217.21|3,213.21|3,052.55|368.12|368.12|493.69|503.57|503.57|513.44|2484.80|2599.48|2790.62|2790.62|2981.76|2293.66|2484.80|2867.08|3249.35|3394.62|3364.04|2867.08|3249.35| 368.12 | 3,394.62 | 2,790.62 35200022|HC CT ANG ABD & PELV W/WO CONTRAS|0352|74174|3,822.77|2,217.21|3,213.21|3,052.55|368.12|368.12|493.69|503.57|503.57|513.44|2484.80|2599.48|2790.62|2790.62|2981.76|2293.66|2484.80|2867.08|3249.35|3394.62|3364.04|2867.08|3249.35| 368.12 | 3,394.62 | 2,790.62 35200023|HC CT ABD & PELVIS W/O CONTRAST|0352|74176|4,595.22|2,665.23|1,189.38|1,129.91|230.13|230.13|79.44|81.03|81.03|82.62|2986.89|3124.75|3354.51|3354.51|3584.27|2757.13|2986.89|3446.42|3905.94|4080.56|4043.79|3446.42|3905.94| 79.44 | 4,080.56 | 2,986.89 35200024|HC CT ABD/PELVIS W CONTRAST|0352|74177|5,280.98|3,062.97|1,189.38|1,129.91|368.12|368.12|151.39|154.41|154.41|157.44|3432.64|3591.07|3855.12|3855.12|4119.16|3168.59|3432.64|3960.74|4488.83|4689.51|4647.26|3960.74|4488.83| 151.39 | 4,689.51 | 3,432.64 35200025|HC CT ABD/PELV W & WO CONTRAST|0352|74178|5,626.06|3,263.11|1189.38|1129.911|368.12|368.12|200.25|204.26|204.26|208.26|3656.94|3825.72|4107.02|4107.02|4388.33|3375.64|3656.94|4219.55|4782.15|4995.94|4950.93|4219.55|4782.15| 200.25 | 4,995.94 | 3,656.94 35200026|HC LOW EXTREMITY W/O AND W/ CONTRAST|0352|73702|3,028.84|1,756.73|561.23|533.1685|178.55|178.55|378.64|386.21|386.21|393.79|1968.75|2059.61|2211.05|2211.05|2362.50|1817.30|1968.75|2271.63|2574.51|2689.61|2665.38|2271.63|2574.51| 178.55 | 2,689.61 | 1,968.75 35200026|HC LOW EXTREMITY W/O AND W/ CONTRAST|0352|73702|3,028.84|1,756.73|561.23|533.1685|178.55|178.55|189.33|193.11|193.11|196.9|1968.75|2059.61|2211.05|2211.05|2362.50|1817.30|1968.75|2271.63|2574.51|2689.61|2665.38|2271.63|2574.51| 178.55 | 2,689.61 | 1,968.75 35200027|HC CT GUIDANCE STEREOTACTIC LOCALIZATION|0352|77011|1,852.43|1,074.41|561.23|533.1685|||||||1204.08|1259.65|1352.27|1352.27|1444.90|1111.46|1204.08|1389.32|1574.57|1644.96|1630.14|1389.32|1574.57| 533.17 | 1,644.96 | 1,352.27 35200028|HC CT UPPER EXT W/ & W/O|0352|73202|3,028.84|1,756.73|561.23|533.17|178.55|178.55|378.64|386.21|386.21|393.79|1968.75|2059.61|2211.05|2211.05|2362.50|1817.30|1968.75|2271.63|2574.51|2689.61|2665.38|2271.63|2574.51| 178.55 | 2,689.61 | 1,968.75 35200028|HC CT UPPER EXT W/ & W/O|0352|73202|3,028.84|1,756.73|561.23|533.1685|178.55|178.55|189.33|193.11|193.11|196.9|1968.75|2059.61|2211.05|2211.05|2362.50|1817.30|1968.75|2271.63|2574.51|2689.61|2665.38|2271.63|2574.51| 178.55 | 2,689.61 | 1,968.75 36000130|HC COMPUTER ASSISTED SURGERY|0360|20985|1,070.32|620.79|||||||||695.71|727.82|781.33|781.33|834.85|642.19|695.71|802.74|909.77|950.44|941.88|802.74|909.77| 642.19 | 950.44 | 802.74 36000131|HC INSERT VAD ARTERY ACCESS|0360|33990|47,860.56|27,759.12|||||||||31109.36|32545.18|34938.21|34938.21|37331.24|28716.34|31109.36|35895.42|40681.48|42500.18|42117.29|35895.42|40681.48| 28,716.34 | 42,500.18 | 35,895.42 36000132|HC REMOVE VAD DIFFERENT SESSION|0360|33992|255.27|148.06|||||||||165.93|173.58|186.35|186.35|199.11|153.16|165.93|191.45|216.98|226.68|224.64|191.45|216.98| 153.16 | 226.68 | 191.45 36000133|HC REPOSITION VAD DIFFERENT SESSI|0360|33993|255.27|148.06|||||||||165.93|173.58|186.35|186.35|199.11|153.16|165.93|191.45|216.98|226.68|224.64|191.45|216.98| 153.16 | 226.68 | 191.45 36000134|HC PRENATAL UMBILICAL BLOOD SAMPL|0360|59030|5,922.95|3,435.31|142.48|135.356|281.48|281.48|294.37|300.26|300.26|306.15|3849.92|4027.61|4323.75|4323.75|4619.90|3553.77|3849.92|4442.21|5034.51|5259.58|5212.20|4442.21|5034.51| 135.36 | 5,259.58 | 3,849.92 36000135|HC COMPUTER ASSIST SURGERY W/FLUO|0360|0054T|933.47|541.41|||||||||606.76|634.76|681.43|681.43|728.11|560.08|606.76|700.10|793.45|828.92|821.45|700.10|793.45| 560.08 | 828.92 | 700.10 36000136|HC COMPUTER ASSIST SURGERY CT/MRI|0360|0055T|933.47|541.41|||||||||606.76|634.76|681.43|681.43|728.11|560.08|606.76|700.10|793.45|828.92|821.45|700.10|793.45| 560.08 | 828.92 | 700.10 36000151|HC UNLISTED PACER/DEFIB PROCEDURE|0360|33999|6,720.01|3,897.61|||541.62|541.62|||||4368.01|4569.61|4905.61|4905.61|5241.61|4032.01|4368.01|5040.01|5712.01|5967.37|5913.61|5040.01|5712.01| 541.62 | 5,967.37 | 4,905.61 36000153|HC DLYD PLMT XTN PROSTH 1ST VSL|0360|34710|20,729.59|12,023.16|||||||||13474.23|14096.12|15132.60|15132.60|16169.08|12437.75|13474.23|15547.19|17620.15|18407.88|18242.04|15547.19|17620.15| 12,437.75 | 18,407.88 | 15,547.19 36000154|HC DLYD PLMT XTN PROSTH EA ADDL|0360|34711|16,867.76|9,783.30|||||||||10964.04|11470.08|12313.46|12313.46|13156.85|10120.66|10964.04|12650.82|14337.60|14978.57|14843.63|12650.82|14337.60| 10,120.66 | 14,978.57 | 12,650.82 36000155|HC PERQ ACCESS & CLSR FEM ART-12 FR PLUS|0360|34713|3,413.83|1,980.02|||||||||2218.99|2321.40|2492.10|2492.10|2662.79|2048.30|2218.99|2560.37|2901.76|3031.48|3004.17|2560.37|2901.76| 2,048.30 | 3,031.48 | 2,560.37 36000156|HC FNA BX W/FLUOR GDN EA ADDL|0360|10008|357.95|207.61|660|627|||||||232.67|243.41|261.30|261.30|279.20|214.77|232.67|268.46|304.26|317.86|315.00|268.46|304.26| 214.77 | 660.00 | 268.46 36000157|HC INSJ PICC RS&I <5 YR|0360|36572|3,178.30|1,843.41|||541.62|541.62|||||2065.90|2161.24|2320.16|2320.16|2479.07|1906.98|2065.90|2383.73|2701.56|2822.33|2796.90|2383.73|2701.56| 541.62 | 2,822.33 | 2,320.16 36000158|HC NSJ PICC RS&I 5 YR+|0360|36573|3,555.63|2,062.27|||1406.14|1406.14|||||2311.16|2417.83|2595.61|2595.61|2773.39|2133.38|2311.16|2666.72|3022.29|3157.40|3128.95|2666.72|3022.29| 1,406.14 | 3,157.40 | 2,595.61 36000159|HC LUMBAR PUNCTURE DIAG W/ GUIDANCE|0360|62328|2,110.47|1,224.07|1,398.56|1,328.63|634.59|634.59|||||1371.81|1435.12|1540.64|1540.64|1646.17|1266.28|1371.81|1582.85|1793.90|1874.10|1857.21|1582.85|1793.90| 634.59 | 1,874.10 | 1,540.64 36000160|HC SPINAL PUNCTURE THERAPEUTIC W/ GUIDANCE|0360|62329|2,019.12|1,171.09|1398.56|1328.632|634.59|634.59|||||1312.43|1373.00|1473.96|1473.96|1574.91|1211.47|1312.43|1514.34|1716.25|1792.98|1776.83|1514.34|1716.25| 634.59 | 1,792.98 | 1,473.96 36000161|HC CHEMODENERVATION TRUNK 6+ MUSCLES|0360|64647|1,021.65|592.56|||634.59|634.59|302.21|308.25|308.25|314.30|664.07|694.72|745.80|745.80|796.89|612.99|664.07|766.24|868.40|907.23|899.05|766.24|868.40| 302.21 | 907.23 | 694.72 36000162|HC REMOVE VAD DIFFERENT SESSION/CATHLAB|0360|33992|255.27|148.06|||||||||165.93|173.58|186.35|186.35|199.11|153.16|165.93|191.45|216.98|226.68|224.64|191.45|216.98| 153.16 | 226.68 | 191.45 36100000|HC IMAGE CATH FLUID COLXN VISC PE|0361|49405|3,557.40|2,063.29|||1,407.00|1,407.00|1,040.26|1,061.06|1,061.06|1,081.87|2312.31|2419.03|2596.90|2596.90|2774.77|2134.44|2312.31|2668.05|3023.79|3158.97|3130.51|2668.05|3023.79| 1,040.26 | 3,158.97 | 2,419.03 36100001|HC INJ OF AIR PERITONEAL CAV|0361|49400|2,130.79|1,235.86|437.40|415.53|||266.10|271.42|271.42|276.74|1385.01|1448.94|1555.48|1555.48|1662.02|1278.47|1385.01|1598.09|1811.17|1892.14|1875.10|1598.09|1811.17| 266.10 | 1,892.14 | 1,448.94 36100002|HC US PARACENTESIS W/IMAGING GUID|0361|49083|2,207.21|1,280.18|606.96|576.612|809.60|809.60|327.67|334.22|334.22|340.78|1434.69|1500.90|1611.26|1611.26|1721.62|1324.33|1434.69|1655.41|1876.13|1960.00|1942.34|1655.41|1876.13| 327.67 | 1,960.00 | 1,434.69 36100003|HC INTROL GI TUBE|0361|44500|2,832.18|1,642.66|||809.60|809.60|||||1840.92|1925.88|2067.49|2067.49|2209.10|1699.31|1840.92|2124.14|2407.35|2514.98|2492.32|2124.14|2407.35| 809.60 | 2,514.98 | 2,067.49 36100004|HC FRENOPLASTY|0361|41520|180.68|104.79|||2,736.39|2,736.39|392.50|400.35|400.35|408.20|117.44|122.86|131.90|131.90|140.93|108.41|117.44|135.51|153.58|160.44|159.00|135.51|153.58| 108.41 | 2,736.39 | 153.58 36100005|HC INJ CONTRAST EXISTING CV ACCES|0361|36598|984.01|570.73|||203.50|203.50|186.68|190.42|190.42|194.15|639.61|669.13|718.33|718.33|767.53|590.41|639.61|738.01|836.41|873.80|865.93|738.01|836.41| 186.68 | 873.80 | 669.13 36100009|HC I&D HEMATOMA SEROMA FLUID COLL|0361|10140|940.70|545.61|437.40|415.53|1,407.00|1,407.00|255.12|260.22|260.22|265.33|611.46|639.68|686.71|686.71|733.75|564.42|611.46|705.53|799.60|835.34|827.82|705.53|799.60| 255.12 | 1,407.00 | 686.71 36100011|HC BRONCHOSCOPY|0361|31622|1,824.20|1,058.04|1,141.26|1,084.20|1,496.39|1,496.39|294.37|300.26|300.26|306.15|1185.73|1240.46|1331.67|1331.67|1422.88|1094.52|1185.73|1368.15|1550.57|1619.89|1605.30|1368.15|1550.57| 294.37 | 1,619.89 | 1,331.67 36100013|HC PERC ASPIR INTERVENT DISC|0361|62267|1,902.41|1,103.40|||621.97|621.97|251.26|256.29|256.29|261.31|1236.57|1293.64|1388.76|1388.76|1483.88|1141.45|1236.57|1426.81|1617.05|1689.34|1674.12|1426.81|1617.05| 251.26 | 1,689.34 | 1,293.64 36100015|HC ASPIR CYST BREAST|0361|19000|940.70|545.61|524.33|498.11|621.97|621.97|294.37|300.26|300.26|306.15|611.46|639.68|686.71|686.71|733.75|564.42|611.46|705.53|799.60|835.34|827.82|705.53|799.60| 294.37 | 835.34 | 621.97 36100017|HC BRONCHOSCOPY WITH BRUSHING|0361|31623|1,824.20|1,058.04|1141.26|1084.197|1,496.39|1,496.39|294.37|300.26|300.26|306.15|1185.73|1240.46|1331.67|1331.67|1422.88|1094.52|1185.73|1368.15|1550.57|1619.89|1605.30|1368.15|1550.57| 294.37 | 1,619.89 | 1,331.67 36100018|HC BRONCHOSCOPY W/BRONCH ALVELAR|0361|31624|1,824.20|1,058.04|1,141.26|1,084.20|1,496.39|1,496.39|294.37|300.26|300.26|306.15|1185.73|1240.46|1331.67|1331.67|1422.88|1094.52|1185.73|1368.15|1550.57|1619.89|1605.30|1368.15|1550.57| 294.37 | 1,619.89 | 1,331.67 36100019|HC BRONCHOSCOPY W/BRONCHIAL BIOPS|0361|31625|1,824.20|1,058.04|1,141.26|1,084.20|1,496.39|1,496.39|294.37|300.26|300.26|306.15|1185.73|1240.46|1331.67|1331.67|1422.88|1094.52|1185.73|1368.15|1550.57|1619.89|1605.30|1368.15|1550.57| 294.37 | 1,619.89 | 1,331.67 36100020|HC BRONCHOSCOPY W/TRANSBRONCH BIO|0361|31628|1,824.20|1,058.04|1141.26|1084.197|3098.02|3098.02|294.37|300.26|300.26|306.15|1185.73|1240.46|1331.67|1331.67|1422.88|1094.52|1185.73|1368.15|1550.57|1619.89|1605.30|1368.15|1550.57| 294.37 | 3,098.02 | 1,331.67 36100021|HC BRONCHOSCOPY/NEEDLE BX EACH (REPORT ONCE)|0361|31629|2,094.91|1,215.05|1,141.26|1,084.20|3,098.02|3,098.02|392.50|400.35|400.35|408.20|1361.69|1424.54|1529.28|1529.28|1634.03|1256.95|1361.69|1571.18|1780.67|1860.28|1843.52|1571.18|1780.67| 392.50 | 3,098.02 | 1,529.28 36100022|HC ASPIRATE PLEURA W/IMAGING|0361|32555|2,269.35|1,316.22|1,216.76|1,155.92|541.62|541.62|350.70|357.71|357.71|364.72|1475.08|1543.16|1656.63|1656.63|1770.09|1361.61|1475.08|1702.01|1928.95|2015.18|1997.03|1702.01|1928.95| 350.70 | 2,015.18 | 1,475.08 36100023|HC REMOVE RENAL TUBE W/FLUORO|0361|50389|2,616.17|1,517.38|||574.77|574.77|509.43|519.62|519.62|529.81|1700.51|1779.00|1909.80|1909.80|2040.61|1569.70|1700.51|1962.13|2223.74|2323.16|2302.23|1962.13|2223.74| 509.43 | 2,323.16 | 1,779.00 36100024|HC NEEDLE BX BONE|0361|20220|1,603.67|930.13|636.86|605.02|1407|1407|281.29|286.91|286.91|292.54|1042.39|1090.50|1170.68|1170.68|1250.86|962.20|1042.39|1202.75|1363.12|1424.06|1411.23|1202.75|1363.12| 281.29 | 1,424.06 | 1,170.68 36100025|HC NEEDLE BX ABD OR RETROP MASS|0361|49180|2,207.21|1,280.18|437.40|415.53|1407|1407|457.91|467.07|467.07|476.23|1434.69|1500.90|1611.26|1611.26|1721.62|1324.33|1434.69|1655.41|1876.13|1960.00|1942.34|1655.41|1876.13| 415.53 | 1,960.00 | 1,434.69 36100028|HC EBUS|0361|31620|1,750.41|1,015.24|||||294.37|300.26|300.26|306.15|1137.77|1190.28|1277.80|1277.80|1365.32|1050.25|1137.77|1312.81|1487.85|1554.36|1540.36|1312.81|1487.85| 294.37 | 1,554.36 | 1,277.80 36100031|HC C-NEEDLE BIOPSY-MUSCLE|0361|20206|1,603.67|930.13|636.86|605.02|1407|1407|294.37|300.26|300.26|306.15|1042.39|1090.50|1170.68|1170.68|1250.86|962.20|1042.39|1202.75|1363.12|1424.06|1411.23|1202.75|1363.12| 294.37 | 1,424.06 | 1,170.68 36100036|HC INJ CYSTO/VOIDING|0361|51600|831.45|482.24|437.4|415.53|||196.25|200.17|200.17|204.10|540.44|565.39|606.96|606.96|648.53|498.87|540.44|623.59|706.73|738.33|731.68|623.59|706.73| 196.25 | 738.33 | 565.39 36100037|HC INJ RETRO URETHROGRAM|0361|51610|831.45|482.24|437.40|415.53|||196.25|200.17|200.17|204.10|540.44|565.39|606.96|606.96|648.53|498.87|540.44|623.59|706.73|738.33|731.68|623.59|706.73| 196.25 | 738.33 | 565.39 36100038|HC INJ HYSTEROSALPINGOGRAM|0361|58340|692.74|401.79|95.46|90.69|||190.70|194.51|194.51|198.33|450.28|471.06|505.70|505.70|540.34|415.64|450.28|519.56|588.83|615.15|609.61|519.56|588.83| 90.69 | 615.15 | 471.06 36100039|HC INJ SHOULDER ARTHRO|0361|23350|1,163.23|674.67|437.4|415.53|||261.66|266.9|266.9|272.13|756.10|791.00|849.16|849.16|907.32|697.94|756.10|872.42|988.75|1032.95|1023.64|872.42|988.75| 261.66 | 1,032.95 | 791.00 36100040|HC INJ WRIST ARTHRO|0361|25246|853.29|494.91|444.53|422.3035|||327.08|333.62|333.62|340.16|554.64|580.24|622.90|622.90|665.57|511.97|554.64|639.97|725.30|757.72|750.90|639.97|725.30| 327.08 | 757.72 | 580.24 36100041|HC INJ HIP ARTHRO|0361|27093|2,973.14|1,724.42|437.40|415.53|||105.45|107.56|107.56|109.67|1932.54|2021.74|2170.39|2170.39|2319.05|1783.88|1932.54|2229.86|2527.17|2640.15|2616.36|2229.86|2527.17| 105.45 | 2,640.15 | 2,021.74 36100047|HC NEEDLE BX PANCREAS|0361|48102|1,603.67|930.13|||1407|1407|130.83|133.45|133.45|136.07|1042.39|1090.50|1170.68|1170.68|1250.86|962.20|1042.39|1202.75|1363.12|1424.06|1411.23|1202.75|1363.12| 130.83 | 1,424.06 | 1,170.68 36100049|HC NEEDLE BX DEEP BONE|0361|20225|1,902.41|1,103.40|1,141.26|1,084.20|1,407.00|1,407.00|294.37|300.26|300.26|306.15|1236.57|1293.64|1388.76|1388.76|1483.88|1141.45|1236.57|1426.81|1617.05|1689.34|1674.12|1426.81|1617.05| 294.37 | 1,689.34 | 1,388.76 36100050|HC ASPIR CYST, ABSCESS, HEMO|0361|10160|940.70|545.61|437.40|415.53|345.84|345.84|255.12|260.22|260.22|265.33|611.46|639.68|686.71|686.71|733.75|564.42|611.46|705.53|799.60|835.34|827.82|705.53|799.60| 255.12 | 835.34 | 611.46 36100051|HC CHEST TUBE PLACEMENT|0361|32550|1,857.43|1,077.31|||3,183.41|3,183.41|||||1207.33|1263.05|1355.92|1355.92|1448.80|1114.46|1207.33|1393.07|1578.82|1649.40|1634.54|1393.07|1578.82| 1,114.46 | 3,183.41 | 1,393.07 36100052|HC C-NEEDLE BIOPSY-PLEURA|0361|32400|1,603.67|930.13|||1,407.00|1,407.00|65.42|66.72|66.72|68.03|1042.39|1090.50|1170.68|1170.68|1250.86|962.20|1042.39|1202.75|1363.12|1424.06|1411.23|1202.75|1363.12| 65.42 | 1,424.06 | 1,170.68 36100053|HC NEEDLE BX THYROID|0361|60100|940.70|545.61|394.66|374.93|621.97|621.97|294.37|300.26|300.26|306.15|611.46|639.68|686.71|686.71|733.75|564.42|611.46|705.53|799.60|835.34|827.82|705.53|799.60| 294.37 | 835.34 | 621.97 36100055|HC FNA W/ GUIDANCE|0361|10022|2,196.09|1,273.73|||||107.13|109.27|109.27|111.41|1427.46|1493.34|1603.15|1603.15|1712.95|1317.65|1427.46|1647.07|1866.68|1950.13|1932.56|1647.07|1866.68| 107.13 | 1,950.13 | 1,603.15 36100056|HC THORACENTESIS - ASPIRATION PLEURAL SPACE UNILATERAL|0361|32555|2,269.35|1,316.22|1,216.76|1,155.92|541.62|541.62|350.70|357.71|357.71|364.72|1475.08|1543.16|1656.63|1656.63|1770.09|1361.61|1475.08|1702.01|1928.95|2015.18|1997.03|1702.01|1928.95| 350.70 | 2,015.18 | 1,475.08 36100057|HC THORACENTESIS - BILATERAL ASPIRATION PLEURAL SPACE|0361|32555|2,082.16|1,207.65|1,216.76|1,155.92|541.62|541.62|350.70|357.71|357.71|364.72|1353.40|1415.87|1519.98|1519.98|1624.08|1249.30|1353.40|1561.62|1769.84|1848.96|1832.30|1561.62|1769.84| 350.70 | 1,848.96 | 1,353.40 36100058|HC NASO OR ORO GASTRIC TUBE PLACE|0361|43752|1,788.11|1,037.10|||270.22|270.22|||||1162.27|1215.91|1305.32|1305.32|1394.73|1072.87|1162.27|1341.08|1519.89|1587.84|1573.54|1341.08|1519.89| 270.22 | 1,587.84 | 1,305.32 36100063|HC BIOPSY OF LIVER, PERC, NEEDLE|0361|47000|2,102.64|1,219.53|1,047.21|994.85|1,407.00|1,407.00|281.29|286.91|286.91|292.54|1366.72|1429.80|1534.93|1534.93|1640.06|1261.58|1366.72|1576.98|1787.24|1867.14|1850.32|1576.98|1787.24| 281.29 | 1,867.14 | 1,407.00 36100064|HC US BREAST BIOPSY|0361|19083|4,401.18|2,552.68|2313.83|2198.1385|1,407.00|1,407.00|597.05|608.99|608.99|620.93|2860.77|2992.80|3212.86|3212.86|3432.92|2640.71|2860.77|3300.89|3741.00|3908.25|3873.04|3300.89|3741.00| 597.05 | 3,908.25 | 2,860.77 36100065|HC US BREAST LOCALIZATION|0361|19285|680.45|394.66|562.79|534.6505|621.97|621.97|83.55|85.22|85.22|86.89|442.29|462.71|496.73|496.73|530.75|408.27|442.29|510.34|578.38|604.24|598.80|510.34|578.38| 83.55 | 621.97 | 510.34 36100066|HC DRAIN/INJECT SM JOINT-FINGER/T|0361|20600|519.74|301.45|200.91|190.8645|261.17|261.17|219.8|224.19|224.19|228.59|337.83|353.42|379.41|379.41|405.40|311.84|337.83|389.81|441.78|461.53|457.37|389.81|441.78| 190.86 | 461.53 | 337.83 36100067|HC ASPIRATION DRAIN PELVIS OR HIP|0361|20610|3,216.49|1,865.56|1616.54|1535.713|261.17|261.17|294.37|300.26|300.26|306.15|2090.72|2187.21|2348.04|2348.04|2508.86|1929.89|2090.72|2412.37|2734.02|2856.24|2830.51|2412.37|2734.02| 261.17 | 2,856.24 | 2,090.72 36100068|HC US BIOPSY LUNG-PERCUT|0361|32405|1,454.95|843.87|||||523.33|533.79|533.79|544.26|945.72|989.37|1062.11|1062.11|1134.86|872.97|945.72|1091.21|1236.71|1292.00|1280.36|1091.21|1236.71| 523.33 | 1,292.00 | 1,062.11 36100069|HC INSERT CATH PLEURA W/ IMAGE|0361|32557|3,548.36|2,058.05|1216.76|1155.922|1,406.14|1,406.14|350.7|357.71|357.71|364.72|2306.43|2412.88|2590.30|2590.30|2767.72|2129.02|2306.43|2661.27|3016.11|3150.94|3122.56|2661.27|3016.11| 350.70 | 3,150.94 | 2,306.43 36100070|HC ABLATION, PULM TUMORS, CHEST W|0361|32998|25,676.97|14,892.64|||5,060.44|5,060.44|||||16690.03|17460.34|18744.19|18744.19|20028.04|15406.18|16690.03|19257.73|21825.42|22801.15|22595.73|19257.73|21825.42| 5,060.44 | 22,801.15 | 18,744.19 36100077|HC IMAGE CATH FLUID PERI/RETRO PE|0361|49406|3,387.62|1,964.82|||1,407.00|1,407.00|1,040.26|1,061.06|1,061.06|1,081.87|2201.95|2303.58|2472.96|2472.96|2642.34|2032.57|2201.95|2540.72|2879.48|3008.21|2981.11|2540.72|2879.48| 1,040.26 | 3,008.21 | 2,303.58 36100078|HC RPL GASTRO-CECO TUBE PERC FLUO|0361|49450|1,393.71|808.35|||809.60|809.60|||||905.91|947.72|1017.41|1017.41|1087.09|836.23|905.91|1045.28|1184.65|1237.61|1226.46|1045.28|1184.65| 809.60 | 1,237.61 | 1,017.41 36100079|HC RPL DUODENO-JEJUNOSTOMY TUBE PERC FLU|0361|49451|1,919.93|1,113.56|||809.60|809.60|||||1247.95|1305.55|1401.55|1401.55|1497.55|1151.96|1247.95|1439.95|1631.94|1704.90|1689.54|1439.95|1631.94| 809.60 | 1,704.90 | 1,401.55 36100080|HC REPL GASTRO-JEJUN TUBE PERC FL|0361|49452|1,699.99|985.99|||809.60|809.60|||||1104.99|1155.99|1240.99|1240.99|1325.99|1019.99|1104.99|1274.99|1444.99|1509.59|1495.99|1274.99|1444.99| 809.60 | 1,509.59 | 1,240.99 36100081|HC INJECT GASTRO PERCUT INCL IMAG|0361|49465|1,289.11|747.68|||230.13|230.13|||||837.92|876.59|941.05|941.05|1005.51|773.47|837.92|966.83|1095.74|1144.73|1134.42|966.83|1095.74| 230.13 | 1,144.73 | 941.05 36100082|HC RENAL - BIOPSY|0361|50200|4,525.11|2,624.56|437.4|415.53|1,407.00|1,407.00|281.29|286.91|286.91|292.54|2941.32|3077.07|3303.33|3303.33|3529.59|2715.07|2941.32|3393.83|3846.34|4018.30|3982.10|3393.83|3846.34| 281.29 | 4,018.30 | 2,941.32 36100083|HC CT RENAL ABLATION 1+ RADIOFREQ|0361|50592|23,846.59|13,831.02|||5060.44|5060.44|2071.74|2113.17|2113.17|2154.61|15500.28|16215.68|17408.01|17408.01|18600.34|14307.95|15500.28|17884.94|20269.60|21175.77|20985.00|17884.94|20269.60| 2,071.74 | 21,175.77 | 16,215.68 36100084|HC CIRCUMCISION W CLAMP|0361|54150|463.05|268.57|193.78|184.09|1,792.99|1,792.99|327.08|333.62|333.62|340.16|300.98|314.87|338.03|338.03|361.18|277.83|300.98|347.29|393.59|411.19|407.48|347.29|393.59| 184.09 | 1,792.99 | 338.03 36100085|HC PLACE INTERSTITIAL MARKERS|0361|55876|1,294.74|750.95|||1,262.18|1,262.18|||||841.58|880.42|945.16|945.16|1009.90|776.84|841.58|971.06|1100.53|1149.73|1139.37|971.06|1100.53| 776.84 | 1,262.18 | 971.06 36100086|HC SPINAL PUNCTURE,LUMBAR,DIAG|0361|62270|1,570.80|911.06|611.22|580.66|634.59|634.59|163.54|166.81|166.81|170.08|1021.02|1068.14|1146.68|1146.68|1225.22|942.48|1021.02|1178.10|1335.18|1394.87|1382.30|1178.10|1335.18| 163.54 | 1,394.87 | 1,021.02 36100087|HC INJECTION FOR MYELOGRAM|0361|62284|2,031.77|1,178.43|393.23|373.57|||130.83|133.45|133.45|136.07|1320.65|1381.60|1483.19|1483.19|1584.78|1219.06|1320.65|1523.83|1727.00|1804.21|1787.96|1523.83|1727.00| 130.83 | 1,804.21 | 1,381.60 36100090|HC ASPIR SPINAL CORD|0361|62268|1,603.67|930.13|||822.46|822.46|||||1042.39|1090.50|1170.68|1170.68|1250.86|962.20|1042.39|1202.75|1363.12|1424.06|1411.23|1202.75|1363.12| 822.46 | 1,424.06 | 1,170.68 36100092|HC INJ ABSCESS CATHETER|0361|49424|1,729.67|1,003.21|437.4|415.53|||||||1124.29|1176.18|1262.66|1262.66|1349.14|1037.80|1124.29|1297.25|1470.22|1535.95|1522.11|1297.25|1470.22| 415.53 | 1,535.95 | 1,262.66 36100094|HC NEEDLE BX LYMPH NODE|0361|38505|940.70|545.61|636.86|605.02|1,407.00|1,407.00|294.37|300.26|300.26|306.15|611.46|639.68|686.71|686.71|733.75|564.42|611.46|705.53|799.60|835.34|827.82|705.53|799.60| 294.37 | 1,407.00 | 686.71 36100095|HC U-ASP/INJ SM JOINT/BURSA W/US|0361|20604|1,613.45|935.80|200.91|190.86|261.17|261.17|||||1048.74|1097.15|1177.82|1177.82|1258.49|968.07|1048.74|1210.09|1371.43|1432.74|1419.84|1210.09|1371.43| 190.86 | 1,432.74 | 1,177.82 36100096|HC U-ASP/INJ INTER JOINT/BURSA W/US|0361|20606|1,613.45|935.80|437.4|415.53|634.59|634.59|||||1048.74|1097.15|1177.82|1177.82|1258.49|968.07|1048.74|1210.09|1371.43|1432.74|1419.84|1210.09|1371.43| 415.53 | 1,432.74 | 1,177.82 36100097|HC ASP/DRAIN PELVIS/HIP W/US|0361|20611|3,496.82|2,028.16|1616.54|1535.713|261.17|261.17|||||2272.93|2377.84|2552.68|2552.68|2727.52|2098.09|2272.93|2622.62|2972.30|3105.18|3077.20|2622.62|2972.30| 261.17 | 3,105.18 | 2,552.68 36100099|HC BREAST LIMITED (INCL AXILLA)|0361|76642|491.98|285.35|272.3|258.685|80.9|80.9|||||319.79|334.55|359.15|359.15|383.74|295.19|319.79|368.99|418.18|436.88|432.94|368.99|418.18| 80.90 | 436.88 | 359.15 36100100|HC BRONCHOSCOPY W/ REMOVAL OF VALVE|0361|31648|3,157.90|1,831.58|||3,098.02|3,098.02|||||2052.64|2147.37|2305.27|2305.27|2463.16|1894.74|2052.64|2368.43|2684.22|2804.22|2778.95|2368.43|2684.22| 1,894.74 | 3,098.02 | 2,368.43 36100101|HC SPINAL PUNCTURE, THERAPEUTIC|0361|62272|1,588.65|921.42|611.22|580.659|634.59|634.59|163.54|166.81|166.81|170.08|1032.62|1080.28|1159.71|1159.71|1239.15|953.19|1032.62|1191.49|1350.35|1410.72|1398.01|1191.49|1350.35| 163.54 | 1,410.72 | 1,032.62 36100102|HC INJ ELBOW ARTHRO|0361|24220|1,163.23|674.67|444.53|422.3035|||93.64|95.51|95.51|97.38|756.10|791.00|849.16|849.16|907.32|697.94|756.10|872.42|988.75|1032.95|1023.64|872.42|988.75| 93.64 | 1,032.95 | 791.00 36100103|HC GUIDE CATHET FLUID DRAINAGE SOFT TISSUE|0361|10030|1,941.31|1,125.96|||621.97|621.97|135.78|138.49|138.49|141.21|1261.85|1320.09|1417.16|1417.16|1514.22|1164.79|1261.85|1455.98|1650.11|1723.88|1708.35|1455.98|1650.11| 135.78 | 1,723.88 | 1,320.09 36100104|HC CHOLECYSTOSTOMY, PERCU CATH PL|0361|47490|3,104.09|1,800.37|||3,183.41|3,183.41|392.50|400.35|400.35|408.20|2017.66|2110.78|2265.99|2265.99|2421.19|1862.45|2017.66|2328.07|2638.48|2756.43|2731.60|2328.07|2638.48| 392.50 | 3,183.41 | 2,265.99 36100105|HC BRONCH EBUS IVNTJ PERPH LES|0361|31654|2,485.56|1,441.62|||||||||1615.61|1690.18|1814.46|1814.46|1938.74|1491.34|1615.61|1864.17|2112.73|2207.18|2187.29|1864.17|2112.73| 1,491.34 | 2,207.18 | 1,864.17 36100106|HC BRONCH EBUS SAMPLNG 1/2 NODE|0361|31652|5,193.92|3,012.47|||3,098.02|3,098.02|||||3376.05|3531.87|3791.56|3791.56|4051.26|3116.35|3376.05|3895.44|4414.83|4612.20|4570.65|3895.44|4414.83| 3,098.02 | 4,612.20 | 3,791.56 36100107|HC BRONCH EBUS SAMPLNG 3/> NODE|0361|31653|5,072.21|2,941.88|||3098.02|3098.02|||||3296.94|3449.10|3702.71|3702.71|3956.32|3043.33|3296.94|3804.16|4311.38|4504.12|4463.54|3804.16|4311.38| 3,043.33 | 4,504.12 | 3,702.71 36100108|HC BRONCHOSCOPY/NEEDLE BX ADDL (ADDL LOBE, REPORT ONCE)|0361|31633|1,226.87|711.58|||||294.37|300.26|300.26|306.15|797.47|834.27|895.62|895.62|956.96|736.12|797.47|920.15|1042.84|1089.46|1079.65|920.15|1042.84| 294.37 | 1,089.46 | 895.62 36100126|HC BRONCHOSCOPY W/FB REMOVAL|0361|31635|2,226.81|1,291.55|2291.04|2176.488|1,496.39|1,496.39|327.08|333.62|333.62|340.16|1447.43|1514.23|1625.57|1625.57|1736.91|1336.09|1447.43|1670.11|1892.79|1977.41|1959.59|1670.11|1892.79| 327.08 | 2,291.04 | 1,625.57 36100129|HC AMNIOCENTESIS THERAPEUTIC|0361|59001|308.30|178.81|||281.48|281.48|294.37|300.26|300.26|306.15|200.40|209.64|225.06|225.06|240.47|184.98|200.40|231.23|262.06|273.77|271.30|231.23|262.06| 184.98 | 306.15 | 262.06 36100130|HC PLACEMENT OF LOCALIZATION DEVICE ADD LESION|0361|10036|1,360.91|789.33|||||||||884.59|925.42|993.46|993.46|1061.51|816.55|884.59|1020.68|1156.77|1208.49|1197.60|1020.68|1156.77| 816.55 | 1,208.49 | 1,020.68 36100132|HC BIOPSY, NEEDLE SALIVARY GLAND|0361|42400|1,802.60|1,045.51|||621.97|621.97|65.42|66.72|66.72|68.03|1171.69|1225.77|1315.90|1315.90|1406.03|1081.56|1171.69|1351.95|1532.21|1600.71|1586.29|1351.95|1532.21| 65.42 | 1,600.71 | 1,225.77 36100133|HC BRONCHOSCOPY/LUNG BX ADDL|0361|31632|1,354.43|785.57|||||294.37|300.26|300.26|306.15|880.38|921.01|988.73|988.73|1056.46|812.66|880.38|1015.82|1151.27|1202.73|1191.90|1015.82|1151.27| 294.37 | 1,202.73 | 988.73 36100134|HC BRONCHIAL VALVE REMOV ADDL|0361|31649|5,633.57|3,267.47|||1,496.39|1,496.39|||||3661.82|3830.83|4112.51|4112.51|4394.18|3380.14|3661.82|4225.18|4788.53|5002.61|4957.54|4225.18|4788.53| 1,496.39 | 5,002.61 | 4,112.51 36100135|HC INSERT PLEURAL CATH|0361|32550|5,204.68|3,018.71|||3,183.41|3,183.41|||||3383.04|3539.18|3799.42|3799.42|4059.65|3122.81|3383.04|3903.51|4423.98|4621.76|4580.12|3903.51|4423.98| 3,122.81 | 4,621.76 | 3,799.42 36100136|HC BRONCHIAL VALVE REMOV INT|0361|31648|7,959.83|4,616.70|||3,098.02|3,098.02|||||5173.89|5412.68|5810.68|5810.68|6208.67|4775.90|5173.89|5969.87|6765.86|7068.33|7004.65|5969.87|6765.86| 3,098.02 | 7,068.33 | 5,810.68 36100137|HC BRONCHIAL VALVE ADDL INSERT|0361|31651|5,633.57|3,267.47|||||1337.01|1363.75|1363.75|1390.49|3661.82|3830.83|4112.51|4112.51|4394.18|3380.14|3661.82|4225.18|4788.53|5002.61|4957.54|4225.18|4788.53| 1,337.01 | 5,002.61 | 4,112.51 36100138|HC BRONCHIAL VALVE INITIAL INSERT|0361|31647|20,174.29|11,701.09|||5,822.76|5,822.76|||||13113.29|13718.52|14727.23|14727.23|15735.95|12104.57|13113.29|15130.72|17148.15|17914.77|17753.38|15130.72|17148.15| 5,822.76 | 17,914.77 | 14,727.23 36100139|HC C1-C2 PUNCTURE; WO INJECTION|0361|61050|1,366.00|792.28|||261.17|261.17|392.5|400.35|400.35|408.2|887.90|928.88|997.18|997.18|1065.48|819.60|887.90|1024.50|1161.10|1213.01|1202.08|1024.50|1161.10| 261.17 | 1,213.01 | 928.88 36100195|HC FNA BX W/FLUOR GDN 1ST LES|0361|10007|719.20|417.14|660.00|627.00|621.97|621.97|||||467.48|489.06|525.02|525.02|560.98|431.52|467.48|539.40|611.32|638.65|632.90|539.40|611.32| 431.52 | 660.00 | 560.98 36100196|HC DILAT XST TRC NDURLGC PX|0361|50436|2,159.72|1,252.64|437.40|415.53|3076.34|3076.34|||||1403.82|1468.61|1576.60|1576.60|1684.58|1295.83|1403.82|1619.79|1835.76|1917.83|1900.55|1619.79|1835.76| 415.53 | 3,076.34 | 1,619.79 36100197|HC DILAT XST TRC NEW ACCESS RCS|0361|50437|3,633.40|2,107.37|437.40|415.53|3,076.34|3,076.34|||||2361.71|2470.71|2652.38|2652.38|2834.05|2180.04|2361.71|2725.05|3088.39|3226.46|3197.39|2725.05|3088.39| 415.53 | 3,226.46 | 2,725.05 36100198|HC FNA BX W/FLUOR GDN EA ADDL|0361|10008|357.95|207.61|660|627|||||||232.67|243.41|261.30|261.30|279.20|214.77|232.67|268.46|304.26|317.86|315.00|268.46|304.26| 214.77 | 660.00 | 268.46 36100199|HC INSJ PICC RS&I <5 YR|0361|36572|3,178.30|1,843.41|||541.62|541.62|||||2065.90|2161.24|2320.16|2320.16|2479.07|1906.98|2065.90|2383.73|2701.56|2822.33|2796.90|2383.73|2701.56| 541.62 | 2,822.33 | 2,320.16 36100200|HC NSJ PICC RS&I 5 YR+|0361|36573|3,555.63|2,062.27|||1,406.14|1,406.14|||||2311.16|2417.83|2595.61|2595.61|2773.39|2133.38|2311.16|2666.72|3022.29|3157.40|3128.95|2666.72|3022.29| 1,406.14 | 3,157.40 | 2,595.61 36100201|HC BIOPSY, SOFT TISSUE PELVIS/HIP - SUPERFICIAL|0361|27040|1,791.56|1,039.10|437.4|415.53|1,407.00|1,407.00|327.08|333.62|333.62|340.16|1164.51|1218.26|1307.84|1307.84|1397.42|1074.94|1164.51|1343.67|1522.83|1590.91|1576.57|1343.67|1522.83| 327.08 | 1,590.91 | 1,307.84 36100202|HC US BREAST BIOPSY ADD'L LESION|0361|19084|3,712.12|2,153.03|2313.83|2198.1385|||||||2412.88|2524.24|2709.85|2709.85|2895.45|2227.27|2412.88|2784.09|3155.30|3296.36|3266.67|2784.09|3155.30| 2,198.14 | 3,296.36 | 2,709.85 36100203|HC ENDOVENOUS RF 1ST VEIN|0361|36475|12,847.61|7,451.61|5,140.60|4,883.57|2,861.66|2,861.66|||||8350.95|8736.37|9378.76|9378.76|10021.14|7708.57|8350.95|9635.71|10920.47|11408.68|11305.90|9635.71|10920.47| 2,861.66 | 11,408.68 | 9,378.76 36100204|HC ENDOVENOUS RF VEIN ADD-ON|0361|36476|6,072.15|3,521.85|||||||||3946.90|4129.06|4432.67|4432.67|4736.28|3643.29|3946.90|4554.11|5161.33|5392.07|5343.49|4554.11|5161.33| 3,643.29 | 5,392.07 | 4,554.11 36100205|HC ENDOVEN THER CHEM ADHES 1ST|0361|36482|10,354.05|6,005.35|3,736.70|3,549.87|4,770.37|4,770.37|||||6730.13|7040.75|7558.46|7558.46|8076.16|6212.43|6730.13|7765.54|8800.94|9194.40|9111.56|7765.54|8800.94| 3,549.87 | 9,194.40 | 7,558.46 36100206|HC PHLEB VEINS - <10|0361|37799|3,254.59|1,887.66|||541.62|541.62|||||2115.48|2213.12|2375.85|2375.85|2538.58|1952.75|2115.48|2440.94|2766.40|2890.08|2864.04|2440.94|2766.40| 541.62 | 2,890.08 | 2,375.85 36100207|HC STAB PHLEB VEINS XTR 10-20|0361|37765|5,499.20|3,189.54|||2861.66|2861.66|1337.81|1364.57|1364.57|1391.32|3574.48|3739.46|4014.42|4014.42|4289.38|3299.52|3574.48|4124.40|4674.32|4883.29|4839.30|4124.40|4674.32| 1,337.81 | 4,883.29 | 3,739.46 36100208|HC PHLEB VEINS - EXTREM 20+|0361|37766|6,282.15|3,643.65|||2861.66|2861.66|1337.81|1364.57|1364.57|1391.32|4083.40|4271.86|4585.97|4585.97|4900.08|3769.29|4083.40|4711.61|5339.83|5578.55|5528.29|4711.61|5339.83| 1,337.81 | 5,578.55 | 4,271.86 36100209|HC NJX SCLRSNT 1 INCMPTNT VEIN|0361|36470|850.50|493.29|568.48|540.056|345.84|345.84|||||552.83|578.34|620.87|620.87|663.39|510.30|552.83|637.88|722.93|755.24|748.44|637.88|722.93| 345.84 | 755.24 | 620.87 36100210|HC NJX SCLRSNT MLT INCMPTNT VN|0361|36471|1,266.35|734.48|568.48|540.056|345.84|345.84|||||823.13|861.12|924.44|924.44|987.75|759.81|823.13|949.76|1076.40|1124.52|1114.39|949.76|1076.40| 345.84 | 1,124.52 | 924.44 36100211|HC THER/PROPH/DIAG INJ IA|0361|96373|186.90|108.40|61.27|58.2065|203.5|203.5|30.72|31.33|31.33|31.95|121.49|127.09|136.44|136.44|145.78|112.14|121.49|140.18|158.87|165.97|164.47|140.18|158.87| 30.72 | 203.50 | 136.44 36100212|HC BONE ABLATION RADIOFREQUENCY|0361|20982|9,530.06|5,527.43|||6264.95|6264.95|||||6194.54|6480.44|6956.94|6956.94|7433.45|5718.04|6194.54|7147.55|8100.55|8462.69|8386.45|7147.55|8100.55| 5,718.04 | 8,462.69 | 6,956.94 36100213|HC UNLISTED PROCEDURE ENDOCRINE SYSTEM|0361|60699|9,731.40|5,644.21|||5,060.44|5,060.44|||||6325.41|6617.35|7103.92|7103.92|7590.49|5838.84|6325.41|7298.55|8271.69|8641.48|8563.63|7298.55|8271.69| 5,060.44 | 8,641.48 | 7,103.92 36100214|HC REPLACE CATH ONLY OF VAD|0361|36578|5,727.00|3,321.66|1863.61|1770.4295|2,861.66|2,861.66|205.5|209.61|209.61|213.72|3722.55|3894.36|4180.71|4180.71|4467.06|3436.20|3722.55|4295.25|4867.95|5085.58|5039.76|4295.25|4867.95| 205.50 | 5,085.58 | 3,722.55 37100000|HC MOD SED <5YRS, 1ST 30 MIN|0371|99143|280.07|162.44|||||||||182.05|190.45|204.45|204.45|218.45|168.04|182.05|210.05|238.06|248.70|246.46|210.05|238.06| 168.04 | 248.70 | 210.05 37100001|HC MOD SED >5YRS, 1ST 30 MIN|0371|99144|371.95|215.73|||||||||241.77|252.93|271.52|271.52|290.12|223.17|241.77|278.96|316.16|330.29|327.32|278.96|316.16| 223.17 | 330.29 | 278.96 37100002|HC MOD SED CT EACH ADD 15 MIN|0371|99145|135.94|78.85|||||||||88.36|92.44|99.24|99.24|106.03|81.56|88.36|101.96|115.55|120.71|119.63|101.96|115.55| 81.56 | 120.71 | 101.96 37100003|HC MOD SED SAME PHYS/QHP <5YRS 1ST 15 MIN|0371|99151|280.07|162.44|||||||||182.05|190.45|204.45|204.45|218.45|168.04|182.05|210.05|238.06|248.70|246.46|210.05|238.06| 168.04 | 248.70 | 210.05 37100004|HC MOD SED SAME PHYS/QHP 5/>YRS 1ST 15 MIN|0371|99152|371.95|215.73|||||||||241.77|252.93|271.52|271.52|290.12|223.17|241.77|278.96|316.16|330.29|327.32|278.96|316.16| 223.17 | 330.29 | 278.96 37100005|HC MOD SED SAME PHYS/QHP EA ADD 15 MIN|0371|99153|143.84|83.43|||||||||93.50|97.81|105.00|105.00|112.20|86.30|93.50|107.88|122.26|127.73|126.58|107.88|122.26| 86.30 | 127.73 | 107.88 37100006|HC MOD SED ENDO SERVICE >5YRS|0371|G0500|371.95|215.73|||||||||241.77|252.93|271.52|271.52|290.12|223.17|241.77|278.96|316.16|330.29|327.32|278.96|316.16| 223.17 | 330.29 | 278.96 39000000|HC INFANT PLATELETS|0390|P9011|984.56|571.04|||147.58|147.58|||||639.96|669.50|718.73|718.73|767.96|590.74|639.96|738.42|836.88|874.29|866.41|738.42|836.88| 147.58 | 874.29 | 718.73 39000001|HC NEONATAL FRESH FROZEN PLASM|0390|P9011|134.93|78.26|||147.58|147.58|||||87.70|91.75|98.50|98.50|105.25|80.96|87.70|101.20|114.69|119.82|118.74|101.20|114.69| 80.96 | 147.58 | 101.20 39000002|HC RBC NEONATAL|0390|P9011|537.26|311.61|||147.58|147.58|||||349.22|365.34|392.20|392.20|419.06|322.36|349.22|402.95|456.67|477.09|472.79|402.95|456.67| 147.58 | 477.09 | 392.20 39000003|HC CRYO PRECIPITATE EACH UNIT|0390|P9012|103.32|59.93|||79.85|79.85|22.90|23.35|23.35|23.81|67.16|70.26|75.42|75.42|80.59|61.99|67.16|77.49|87.82|91.75|90.92|77.49|87.82| 22.90 | 91.75 | 75.42 39000004|HC AUTOLOGOUS LR RBCS|0390|P9016|2,445.83|1,418.58|||188.51|188.51|113.82|116.10|116.10|118.38|1589.79|1663.16|1785.46|1785.46|1907.75|1467.50|1589.79|1834.37|2078.96|2171.90|2152.33|1834.37|2078.96| 113.82 | 2,171.90 | 1,663.16 39000005|HC LEUKOCYTE POOR BLOOD UNIT|0390|P9016|393.82|228.42|||188.51|188.51|113.82|116.1|116.1|118.38|255.98|267.80|287.49|287.49|307.18|236.29|255.98|295.37|334.75|349.71|346.56|295.37|334.75| 113.82 | 349.71 | 267.80 39000006|HC ONE DONOR FRESH FROZEN PLAS|0390|P9017|109.40|63.45|||82.66|82.66|30.75|31.36|31.36|31.98|71.11|74.39|79.86|79.86|85.33|65.64|71.11|82.05|92.99|97.15|96.27|82.05|92.99| 30.75 | 97.15 | 79.86 39000007|HC PLATELETS BY PHERESIS|0390|P9035|984.56|571.04|||486.80|486.80|33.36|34.03|34.03|34.70|639.96|669.50|718.73|718.73|767.96|590.74|639.96|738.42|836.88|874.29|866.41|738.42|836.88| 33.36 | 874.29 | 669.50 39000008|HC PLATELET PHERESIS-LR-IRRADI|0390|P9037|1,069.65|620.40|||617.33|617.33|33.36|34.03|34.03|34.7|695.27|727.36|780.84|780.84|834.33|641.79|695.27|802.24|909.20|949.85|941.29|802.24|909.20| 33.36 | 949.85 | 727.36 39000009|HC RED BLOOD CELLS,LR,IRRADIAT|0390|P9040|478.92|277.77|||260.55|260.55|33.36|34.03|34.03|34.70|311.30|325.67|349.61|349.61|373.56|287.35|311.30|359.19|407.08|425.28|421.45|359.19|407.08| 33.36 | 425.28 | 325.67 39000010|HC PLASMA FROZEN WITHIN 24HRS|0390|P9059|109.40|63.45|||71.15|71.15|||||71.11|74.39|79.86|79.86|85.33|65.64|71.11|82.05|92.99|97.15|96.27|82.05|92.99| 65.64 | 97.15 | 79.86 39000013|HC WASHED PACKED CELLS|0390|P9022|1,879.82|1,090.30|||379.86|379.86|113.82|116.10|116.10|118.38|1221.88|1278.28|1372.27|1372.27|1466.26|1127.89|1221.88|1409.87|1597.85|1669.28|1654.24|1409.87|1597.85| 113.82 | 1,669.28 | 1,278.28 39000014|HC IRRADIATION-PROCESS-BLOOD|0390|86945|358.24|207.78|||33.84|33.84|26.17|26.69|26.69|27.21|232.86|243.60|261.52|261.52|279.43|214.94|232.86|268.68|304.50|318.12|315.25|268.68|304.50| 26.17 | 318.12 | 243.60 39000015|HC PLATELETS; HLA-LR, EA UNIT|0390|P9052|3,342.64|1,938.73|||805.18|805.18|66.72|68.06|68.06|69.39|2172.72|2273.00|2440.13|2440.13|2607.26|2005.58|2172.72|2506.98|2841.24|2968.26|2941.52|2506.98|2841.24| 66.72 | 2,968.26 | 2,273.00 39000016|HC BLD PROCESSING AND STORING|0390|86999|729.31|423.00|||24.67|24.67|||||474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 24.67 | 647.63 | 532.40 39000017|HC PLASMA, CRYOPRECIP REDUCE, EA|0390|P9044|273.48|158.62|||65.70|65.70|33.36|34.03|34.03|34.70|177.76|185.97|199.64|199.64|213.31|164.09|177.76|205.11|232.46|242.85|240.66|205.11|232.46| 33.36 | 242.85 | 185.97 39100000|HC BLOOD TRANSFUSION|0391|36430|2,452.82|1,422.64|||397.06|397.06|294.37|300.26|300.26|306.15|1594.33|1667.92|1790.56|1790.56|1913.20|1471.69|1594.33|1839.62|2084.90|2178.10|2158.48|1839.62|2084.90| 294.37 | 2,178.10 | 1,667.92 40100000|HC UNI MAMMO FOR TISSUE MARKER LO|0401|77055|143.60|83.29|||||||||93.34|97.65|104.83|104.83|112.01|86.16|93.34|107.70|122.06|127.52|126.37|107.70|122.06| 86.16 | 127.52 | 107.70 40200000|HC RETROPERITONEAL COMPLETE|0402|76770|1,041.29|603.95|578.03|549.13|108.97|108.97|78.90|80.48|80.48|82.06|676.84|708.08|760.14|760.14|812.21|624.77|676.84|780.97|885.10|924.67|916.34|780.97|885.10| 78.90 | 924.67 | 676.84 40200000|HC RETROPERITONEAL COMPLETE|0402|76770|1,041.29|603.95|578.03|549.13|108.97|108.97|129.58|132.17|132.17|134.76|676.84|708.08|760.14|760.14|812.21|624.77|676.84|780.97|885.10|924.67|916.34|780.97|885.10| 108.97 | 924.67 | 676.84 40200001|HC RETROPERITONEAL LIMITED|0402|76775|527.70|306.07|539.85|512.86|108.97|108.97|56.68|57.81|57.81|58.94|343.01|358.84|385.22|385.22|411.61|316.62|343.01|395.78|448.55|468.60|464.38|395.78|448.55| 56.68 | 539.85 | 385.22 40200001|HC RETROPERITONEAL LIMITED|0402|76775|527.70|306.07|539.85|512.86|108.97|108.97|97.20|99.14|99.14|101.08|343.01|358.84|385.22|385.22|411.61|316.62|343.01|395.78|448.55|468.60|464.38|395.78|448.55| 97.20 | 539.85 | 385.22 40200002|HC ULT SPINAL CANAL & CONTENTS|0402|76800|439.02|254.63|165.28|157.02|108.97|108.97|56.68|57.81|57.81|58.94|285.36|298.53|320.48|320.48|342.44|263.41|285.36|329.27|373.17|389.85|386.34|329.27|373.17| 56.68 | 389.85 | 285.36 40200002|HC ULT SPINAL CANAL & CONTENTS|0402|76800|439.02|254.63|165.28|157.02|108.97|108.97|134.64|137.33|137.33|140.02|285.36|298.53|320.48|320.48|342.44|263.41|285.36|329.27|373.17|389.85|386.34|329.27|373.17| 108.97 | 389.85 | 285.36 40200003|HC OB US < 14 WKS SINGLE FETUS|0402|76801|1,049.37|608.63|579.43|550.46|108.97|108.97|76.00|77.52|77.52|79.04|682.09|713.57|766.04|766.04|818.51|629.62|682.09|787.03|891.96|931.84|923.45|787.03|891.96| 76.00 | 931.84 | 682.09 40200004|HC OB US < 14 WKS ADDL FETUS|0402|76802|473.55|274.66|586.54|557.21|||76.00|77.52|77.52|79.04|307.81|322.01|345.69|345.69|369.37|284.13|307.81|355.16|402.52|420.51|416.72|355.16|402.52| 76.00 | 586.54 | 345.69 40200004|HC OB US < 14 WKS ADDL FETUS|0402|76802|473.55|274.66|586.54|557.21|||38.01|38.77|38.77|39.53|307.81|322.01|345.69|345.69|369.37|284.13|307.81|355.16|402.52|420.51|416.72|355.16|402.52| 38.01 | 586.54 | 345.69 40200005|HC FET & MAT EVAL US OB >14 WKS|0402|76805|1,353.51|785.04|479.25|455.29|108.97|108.97|76.00|77.52|77.52|79.04|879.78|920.39|988.06|988.06|1055.74|812.11|879.78|1015.13|1150.48|1201.92|1191.09|1015.13|1150.48| 76.00 | 1,201.92 | 879.78 40200006|HC OB US >=14 WKS ADDL FETUS|0402|76810|662.45|384.22|104.01|98.81|||120.63|123.04|123.04|125.45|430.59|450.47|483.59|483.59|516.71|397.47|430.59|496.84|563.08|588.26|582.96|496.84|563.08| 98.81 | 588.26 | 450.47 40200006|HC OB US >=14 WKS ADDL FETUS|0402|76810|662.45|384.22|104.01|98.81|||298.49|304.46|304.46|310.43|430.59|450.47|483.59|483.59|516.71|397.47|430.59|496.84|563.08|588.26|582.96|496.84|563.08| 98.81 | 588.26 | 450.47 40200006|HC OB US >=14 WKS ADDL FETUS|0402|76810|662.45|384.22|104.01|98.81|||177.88|181.44|181.44|184.99|430.59|450.47|483.59|483.59|516.71|397.47|430.59|496.84|563.08|588.26|582.96|496.84|563.08| 98.81 | 588.26 | 450.47 40200007|HC US OB AFTER 1ST TRIMESTER (>14|0402|76811|1,049.37|608.63|582.64|553.51|230.13|230.13|76.00|77.52|77.52|79.04|682.09|713.57|766.04|766.04|818.51|629.62|682.09|787.03|891.96|931.84|923.45|787.03|891.96| 76.00 | 931.84 | 682.09 40200007|HC US OB AFTER 1ST TRIMESTER (>14|0402|76811|1,049.37|608.63|582.64|553.51|230.13|230.13|151.99|155.03|155.03|158.07|682.09|713.57|766.04|766.04|818.51|629.62|682.09|787.03|891.96|931.84|923.45|787.03|891.96| 151.99 | 931.84 | 682.09 40200008|HC US OB AFTER 1ST TRI(>14WKS)ADD|0402|76812|1,049.37|608.63|586.54|557.21|||38.01|38.77|38.77|39.53|682.09|713.57|766.04|766.04|818.51|629.62|682.09|787.03|891.96|931.84|923.45|787.03|891.96| 38.01 | 931.84 | 713.57 40200008|HC US OB AFTER 1ST TRI(>14WKS)ADD|0402|76812|1,049.37|608.63|586.54|557.213|||76.00|77.52|77.52|79.04|682.09|713.57|766.04|766.04|818.51|629.62|682.09|787.03|891.96|931.84|923.45|787.03|891.96| 76.00 | 931.84 | 713.57 40200009|HC US OB LMTD, 1 OR MORE FETUS|0402|76815|560.77|325.25|307.84|292.448|108.97|108.97|50.74|51.75|51.75|52.77|364.50|381.32|409.36|409.36|437.40|336.46|364.50|420.58|476.65|497.96|493.48|420.58|476.65| 50.74 | 497.96 | 364.50 40200009|HC US OB LMTD, 1 OR MORE FETUS|0402|76815|560.77|325.25|307.84|292.448|108.97|108.97|45.03|45.93|45.93|46.83|364.50|381.32|409.36|409.36|437.40|336.46|364.50|420.58|476.65|497.96|493.48|420.58|476.65| 45.03 | 497.96 | 364.50 40200009|HC US OB LMTD, 1 OR MORE FETUS|0402|76815|560.77|325.25|307.84|292.448|108.97|108.97|101.46|103.49|103.49|105.52|364.50|381.32|409.36|409.36|437.40|336.46|364.50|420.58|476.65|497.96|493.48|420.58|476.65| 101.46 | 497.96 | 364.50 40200010|HC ULTRASOUND-FOLLOW UP/REPEAT|0402|76816|1,243.20|721.06|292.78|278.14|108.97|108.97|84.14|85.82|85.82|87.50|808.08|845.38|907.54|907.54|969.70|745.92|808.08|932.40|1056.72|1103.96|1094.02|932.40|1056.72| 84.14 | 1,103.96 | 808.08 40200010|HC ULTRASOUND-FOLLOW UP/REPEAT|0402|76816|1,243.20|721.06|292.78|278.14|108.97|108.97|44.55|45.44|45.44|46.33|808.08|845.38|907.54|907.54|969.70|745.92|808.08|932.40|1056.72|1103.96|1094.02|932.40|1056.72| 44.55 | 1,103.96 | 808.08 40200011|HC US OB TRANS-VAG, WITH TRANS AB|0402|76817|742.35|430.56|553.74|526.05|108.97|108.97|108.98|111.16|111.16|113.34|482.53|504.80|541.92|541.92|579.03|445.41|482.53|556.76|631.00|659.21|653.27|556.76|631.00| 108.97 | 659.21 | 526.05 40200011|HC US OB TRANS-VAG, WITH TRANS AB|0402|76817|742.35|430.56|553.74|526.05|108.97|108.97|64.71|66.00|66.00|67.30|482.53|504.80|541.92|541.92|579.03|445.41|482.53|556.76|631.00|659.21|653.27|556.76|631.00| 64.71 | 659.21 | 526.05 40200011|HC US OB TRANS-VAG, WITH TRANS AB|0402|76817|742.35|430.56|553.74|526.05|108.97|108.97|48.22|49.19|49.19|50.15|482.53|504.80|541.92|541.92|579.03|445.41|482.53|556.76|631.00|659.21|653.27|556.76|631.00| 48.22 | 659.21 | 526.05 40200012|HC UMBILICAL ARTERY ECHO|0402|76820|345.68|200.49|||108.97|108.97|55.75|56.86|56.86|57.98|224.69|235.06|252.35|252.35|269.63|207.41|224.69|259.26|293.83|306.96|304.20|259.26|293.83| 55.75 | 306.96 | 235.06 40200012|HC UMBILICAL ARTERY ECHO|0402|76820|345.68|200.49|||108.97|108.97|78.96|80.54|80.54|82.12|224.69|235.06|252.35|252.35|269.63|207.41|224.69|259.26|293.83|306.96|304.20|259.26|293.83| 78.96 | 306.96 | 235.06 40200013|HC FETAL MIDL CEREBRAL ART ECHO|0402|76821|345.68|200.49|||108.97|108.97|55.76|56.88|56.88|57.99|224.69|235.06|252.35|252.35|269.63|207.41|224.69|259.26|293.83|306.96|304.20|259.26|293.83| 55.76 | 306.96 | 235.06 40200013|HC FETAL MIDL CEREBRAL ART ECHO|0402|76821|345.68|200.49|||108.97|108.97|87.98|89.74|89.74|91.5|224.69|235.06|252.35|252.35|269.63|207.41|224.69|259.26|293.83|306.96|304.20|259.26|293.83| 87.98 | 306.96 | 235.06 40200014|HC US TRANSVAGINAL ONLY|0402|76830|1,074.35|623.12|598.31|568.39|108.97|108.97|64.71|66.00|66.00|67.30|698.33|730.56|784.28|784.28|837.99|644.61|698.33|805.76|913.20|954.02|945.43|805.76|913.20| 64.71 | 954.02 | 698.33 40200014|HC US TRANSVAGINAL ONLY|0402|76830|1,074.35|623.12|598.31|568.39|108.97|108.97|108.98|111.16|111.16|113.34|698.33|730.56|784.28|784.28|837.99|644.61|698.33|805.76|913.20|954.02|945.43|805.76|913.20| 108.97 | 954.02 | 698.33 40200015|HC PROSTATE VOL FOR BRACHY SEED I|0402|76873|1,023.19|593.45|578.22|549.31|108.97|108.97|61.4|62.63|62.63|63.86|665.07|695.77|746.93|746.93|798.09|613.91|665.07|767.39|869.71|908.59|900.41|767.39|869.71| 61.40 | 908.59 | 665.07 40200015|HC PROSTATE VOL FOR BRACHY SEED I|0402|76873|1,023.19|593.45|578.22|549.31|108.97|108.97|92.24|94.08|94.08|95.93|665.07|695.77|746.93|746.93|798.09|613.91|665.07|767.39|869.71|908.59|900.41|767.39|869.71| 92.24 | 908.59 | 665.07 40200016|HC ULT INFANT HIPS W PHYS MANIP|0402|76885|439.02|254.63|678.19|644.28|80.90|80.90|49.06|50.04|50.04|51.02|285.36|298.53|320.48|320.48|342.44|263.41|285.36|329.27|373.17|389.85|386.34|329.27|373.17| 49.06 | 678.19 | 320.48 40200016|HC ULT INFANT HIPS W PHYS MANIP|0402|76885|439.02|254.63|678.19|644.28|80.90|80.90|98.12|100.09|100.09|102.05|285.36|298.53|320.48|320.48|342.44|263.41|285.36|329.27|373.17|389.85|386.34|329.27|373.17| 80.90 | 678.19 | 320.48 40200017|HC ULT INFANT HIPS W/O PHYS MANIP|0402|76886|439.02|254.63|128.24|121.83|80.90|80.90|98.12|100.09|100.09|102.05|285.36|298.53|320.48|320.48|342.44|263.41|285.36|329.27|373.17|389.85|386.34|329.27|373.17| 80.90 | 389.85 | 285.36 40200017|HC ULT INFANT HIPS W/O PHYS MANIP|0402|76886|439.02|254.63|128.24|121.83|80.90|80.90|49.06|50.04|50.04|51.02|285.36|298.53|320.48|320.48|342.44|263.41|285.36|329.27|373.17|389.85|386.34|329.27|373.17| 49.06 | 389.85 | 285.36 40200018|HC COMPRESSION REPAIR-PSEUDOAN|0402|76936|1,666.47|966.55|587.01|557.66|264.45|264.45|||||1083.21|1133.20|1216.52|1216.52|1299.85|999.88|1083.21|1249.85|1416.50|1479.83|1466.49|1249.85|1416.50| 264.45 | 1,479.83 | 1,216.52 40200019|HC US GUIDANCE IN INTERSTITIAL BR|0402|76965|1,023.19|593.45|643.06|610.91|||34.02|34.70|34.70|35.38|665.07|695.77|746.93|746.93|798.09|613.91|665.07|767.39|869.71|908.59|900.41|767.39|869.71| 34.02 | 908.59 | 695.77 40200019|HC US GUIDANCE IN INTERSTITIAL BR|0402|76965|1,023.19|593.45|643.06|610.91|||68.03|69.39|69.39|70.75|665.07|695.77|746.93|746.93|798.09|613.91|665.07|767.39|869.71|908.59|900.41|767.39|869.71| 68.03 | 908.59 | 695.77 40200020|HC BREAST LIMITED (INCL AXILLA)|0402|76642|491.98|285.35|272.30|258.69|80.90|80.90|||||319.79|334.55|359.15|359.15|383.74|295.19|319.79|368.99|418.18|436.88|432.94|368.99|418.18| 80.90 | 436.88 | 359.15 40200021|HC BREAST COMPLETE (INCL AXILLA)|0402|76641|737.97|428.02|272.30|258.69|108.97|108.97|||||479.68|501.82|538.72|538.72|575.62|442.78|479.68|553.48|627.27|655.32|649.41|553.48|627.27| 108.97 | 655.32 | 538.72 40200022|HC US EXAM K TRANSP W/DOPPLER|0402|76776|1,417.29|822.03|186.66|177.33|108.97|108.97|||||921.24|963.76|1034.62|1034.62|1105.49|850.37|921.24|1062.97|1204.70|1258.55|1247.22|1062.97|1204.70| 108.97 | 1,258.55 | 1,034.62 40200023|HC FETAL CADIOVASC 2-D U/S|0402|76825|1,031.37|598.19|133.93|127.23|482.89|482.89|78.9|80.48|80.48|82.06|670.39|701.33|752.90|752.90|804.47|618.82|670.39|773.53|876.66|915.86|907.61|773.53|876.66| 78.90 | 915.86 | 670.39 40200023|HC FETAL CADIOVASC 2-D U/S|0402|76825|1,031.37|598.19|133.93|127.23|482.89|482.89|133.92|136.60|136.60|139.28|670.39|701.33|752.90|752.90|804.47|618.82|670.39|773.53|876.66|915.86|907.61|773.53|876.66| 127.23 | 915.86 | 670.39 40200024|HC FETAL CADIOVASC 2-D FOLLOW-UP U/S|0402|76826|672.17|389.86|61.27|58.21|230.13|230.13|28.59|29.16|29.16|29.73|436.91|457.08|490.68|490.68|524.29|403.30|436.91|504.13|571.34|596.89|591.51|504.13|571.34| 28.59 | 596.89 | 436.91 40200024|HC FETAL CADIOVASC 2-D FOLLOW-UP U/S|0402|76826|672.17|389.86|61.27|58.21|230.13|230.13|176.77|180.3|180.3|183.84|436.91|457.08|490.68|490.68|524.29|403.30|436.91|504.13|571.34|596.89|591.51|504.13|571.34| 58.21 | 596.89 | 436.91 40200025|HC COMPLETE FETAL DOPPLER ECHOCARDIOGRAM|0402|76827|625.99|363.07|128.24|121.828|108.97|108.97|66.21|67.54|67.54|68.86|406.89|425.67|456.97|456.97|488.27|375.59|406.89|469.49|532.09|555.88|550.87|469.49|532.09| 66.21 | 555.88 | 406.89 40200025|HC COMPLETE FETAL DOPPLER ECHOCARDIOGRAM|0402|76827|625.99|363.07|128.24|121.83|108.97|108.97|58.47|59.64|59.64|60.81|406.89|425.67|456.97|456.97|488.27|375.59|406.89|469.49|532.09|555.88|550.87|469.49|532.09| 58.47 | 555.88 | 406.89 40200025|HC COMPLETE FETAL DOPPLER ECHOCARDIOGRAM|0402|76827|625.99|363.07|128.24|121.83|108.97|108.97|120.04|122.44|122.44|124.84|406.89|425.67|456.97|456.97|488.27|375.59|406.89|469.49|532.09|555.88|550.87|469.49|532.09| 108.97 | 555.88 | 406.89 40200026|HC LIMITED FETAL DOPPLER ECHOCARDIOGRAM|0402|76828|228.51|132.54|99.72|94.73|108.97|108.97|45.53|46.44|46.44|47.35|148.53|155.39|166.81|166.81|178.24|137.11|148.53|171.38|194.23|202.92|201.09|171.38|194.23| 45.53 | 202.92 | 148.53 40200026|HC LIMITED FETAL DOPPLER ECHOCARDIOGRAM|0402|76828|228.51|132.54|99.72|94.73|108.97|108.97|80.66|82.27|82.27|83.88|148.53|155.39|166.81|166.81|178.24|137.11|148.53|171.38|194.23|202.92|201.09|171.38|194.23| 80.66 | 202.92 | 148.53 40200027|HC ULTRASONIC GUIDANCE, INTRAOP|0402|76998|1,326.12|769.15|235.09|223.34|||||||861.98|901.76|968.07|968.07|1034.37|795.67|861.98|994.59|1127.20|1177.59|1166.99|994.59|1127.20| 223.34 | 1,177.59 | 968.07 40200028|HC FBP WO NON STRESS|0402|76819|641.70|372.19|136.79|129.95|108.97|108.97|49.06|50.04|50.04|51.02|417.11|436.36|468.44|468.44|500.53|385.02|417.11|481.28|545.45|569.83|564.70|481.28|545.45| 49.06 | 569.83 | 417.11 40200028|HC FBP WO NON STRESS|0402|76819|641.70|372.19|136.79|129.9505|108.97|108.97|98.12|100.09|100.09|102.05|417.11|436.36|468.44|468.44|500.53|385.02|417.11|481.28|545.45|569.83|564.70|481.28|545.45| 98.12 | 569.83 | 417.11 40200029|HC US GUIDED CVS|0402|76945|642.98|372.93|135.35|128.5825|||||||417.94|437.23|469.38|469.38|501.52|385.79|417.94|482.24|546.53|570.97|565.82|482.24|546.53| 128.58 | 570.97 | 469.38 40200030|HC OB US NUCHAL MEAS 1 GEST|0402|76813|824.12|477.99|||108.97|108.97|||||535.68|560.40|601.61|601.61|642.81|494.47|535.68|618.09|700.50|731.82|725.23|618.09|700.50| 108.97 | 731.82 | 601.61 40200031|HC US ABDL AORTA SCREEN AAA|0402|76706|1,131.64|656.35|648.56|616.13|108.97|108.97|||||735.57|769.52|826.10|826.10|882.68|678.98|735.57|848.73|961.89|1004.90|995.84|848.73|961.89| 108.97 | 1,004.90 | 826.10 40200033|HC FETAL HEART DOPPLER FOLLOW-UP|0402|76828|211.18|122.48|99.72|94.73|108.97|108.97|45.53|46.44|46.44|47.35|137.27|143.60|154.16|154.16|164.72|126.71|137.27|158.39|179.50|187.53|185.84|158.39|179.50| 45.53 | 187.53 | 137.27 40200033|HC FETAL HEART DOPPLER FOLLOW-UP|0402|76828|211.18|122.48|99.72|94.73|108.97|108.97|80.66|82.27|82.27|83.88|137.27|143.60|154.16|154.16|164.72|126.71|137.27|158.39|179.50|187.53|185.84|158.39|179.50| 80.66 | 187.53 | 137.27 40200034|HC FETAL HEART DOPPLER LIMITED|0402|76815|594.99|345.09|307.84|292.448|108.97|108.97|50.74|51.75|51.75|52.77|386.74|404.59|434.34|434.34|464.09|356.99|386.74|446.24|505.74|528.35|523.59|446.24|505.74| 50.74 | 528.35 | 386.74 40200034|HC FETAL HEART DOPPLER LIMITED|0402|76815|594.99|345.09|307.84|292.448|108.97|108.97|45.03|45.93|45.93|46.83|386.74|404.59|434.34|434.34|464.09|356.99|386.74|446.24|505.74|528.35|523.59|446.24|505.74| 45.03 | 528.35 | 386.74 40200034|HC FETAL HEART DOPPLER LIMITED|0402|76815|594.99|345.09|307.84|292.448|108.97|108.97|101.46|103.49|103.49|105.52|386.74|404.59|434.34|434.34|464.09|356.99|386.74|446.24|505.74|528.35|523.59|446.24|505.74| 101.46 | 528.35 | 386.74 40200035|HC FINE NEEDLE ASP BX 1ST LESION INCL US GUIDANCE|0402|10005|1,926.07|1,117.12|||621.97|621.97|||||1251.95|1309.73|1406.03|1406.03|1502.33|1155.64|1251.95|1444.55|1637.16|1710.35|1694.94|1444.55|1637.16| 621.97 | 1,710.35 | 1,406.03 40200036|HC FINE NEEDLE ASP BX EA. ADD. LESION INCL US GUIDANCE|0402|10006|963.04|558.56|||||||||625.98|654.87|703.02|703.02|751.17|577.82|625.98|722.28|818.58|855.18|847.48|722.28|818.58| 577.82 | 855.18 | 722.28 40200037|HC US SOFT TISSUE/JOINT EXTREMITY COMPLETE|0402|76881|924.00|535.92|165.28|157.016|108.97|108.97|51.93|52.97|52.97|54|600.60|628.32|674.52|674.52|720.72|554.40|600.60|693.00|785.40|820.51|813.12|693.00|785.40| 51.93 | 820.51 | 600.60 40400003|HC CC-PET SKULL BASE TO MIDTHIGH|0404|78815|5,903.71|3,424.15|4024.08|3822.876|1480.34|1480.34|||||3837.41|4014.52|4309.71|4309.71|4604.89|3542.23|3837.41|4427.78|5018.15|5242.49|5195.26|4427.78|5018.15| 1,480.34 | 5,242.49 | 4,309.71 40400006|HC CC-PET SCAN FULL BODY|0404|78816|5,903.71|3,424.15|3745.91|3558.6145|1480.34|1480.34|||||3837.41|4014.52|4309.71|4309.71|4604.89|3542.23|3837.41|4427.78|5018.15|5242.49|5195.26|4427.78|5018.15| 1,480.34 | 5,242.49 | 4,309.71 40400008|HC PET IMAGE W/CT LMTD, BRAIN|0404|78814|6,101.73|3,539.00|1610.62|1530.089|1480.34|1480.34|||||3966.12|4149.18|4454.26|4454.26|4759.35|3661.04|3966.12|4576.30|5186.47|5418.34|5369.52|4576.30|5186.47| 1,480.34 | 5,418.34 | 4,454.26 40900000|HC CDSM APPLIED PATHWAYS|0409|G1000|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900001|HC CDSM EVICORE|0409|G1001|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900002|HC CDSM MEDCURRENT|0409|G1002|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900003|HC CDSM MEDICALIS|0409|G1003|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900004|HC CDSM NDSC|0409|G1004|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900005|HC CDSM NIA|0409|G1005|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900006|HC CDSM TEST APPROP|0409|G1006|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900007|HC CDSM AIM|0409|G1007|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900008|HC CDSM CRANBERRY PK|0409|G1008|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900009|HC CDSM SAGE HEALTH|0409|G1009|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900010|HC CDSM STANSON|0409|G1010|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900011|HC CDSM QUALIFIED NOS|0409|G1011|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900012|HC CDSM AGILEMD|0409|G1012|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900013|HC CDSM EVIDENCECARE|0409|G1013|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900014|HC CDSM INVENIQA|0409|G1014|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900015|HC CDSM RELIANT MEDICAL GROUP|0409|G1015|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900016|HC CDSM SPEED OF CARE|0409|G1016|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900017|HC CDSM HEALTHHELP|0409|G1017|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900018|HC CDSM INFINX|0409|G1018|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 40900019|HC CDSM LOGICNETS AUC|0409|G1019|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 41000000|HC NASAL TRACHEAL SUCTIONING|0410|31720|203.44|118.00|437.40|415.53|187.88|187.88|||||132.24|138.34|148.51|148.51|158.68|122.06|132.24|152.58|172.92|180.65|179.03|152.58|172.92| 122.06 | 437.40 | 158.68 41000001|HC ARTERIAL LINE INSERTION|0410|36620|496.71|288.09|||||294.37|300.26|300.26|306.15|322.86|337.76|362.60|362.60|387.43|298.03|322.86|372.53|422.20|441.08|437.10|372.53|422.20| 294.37 | 441.08 | 362.60 41000002|HC RESPIRATORY RESPONSE TO CODE B|0410|92950|1,274.63|739.29|1119.57|1063.5915|264.45|264.45|131.22|133.85|133.85|136.47|828.51|866.75|930.48|930.48|994.21|764.78|828.51|955.97|1083.44|1131.87|1121.67|955.97|1083.44| 131.22 | 1,131.87 | 930.48 41000003|HC HFOV-INITIAL|0410|94002|3,837.35|2,225.66|||485.26|485.26|||||2494.28|2609.40|2801.27|2801.27|2993.13|2302.41|2494.28|2878.01|3261.75|3407.57|3376.87|2878.01|3261.75| 485.26 | 3,407.57 | 2,801.27 41000004|HC VENTILATOR - INITIAL|0410|94002|3,997.08|2,318.31|||485.26|485.26|||||2598.10|2718.01|2917.87|2917.87|3117.72|2398.25|2598.10|2997.81|3397.52|3549.41|3517.43|2997.81|3397.52| 485.26 | 3,549.41 | 2,917.87 41000005|HC HFOV-SUBSEQUENT|0410|94003|3,444.75|1,997.96|||485.26|485.26|||||2239.09|2342.43|2514.67|2514.67|2686.91|2066.85|2239.09|2583.56|2928.04|3058.94|3031.38|2583.56|2928.04| 485.26 | 3,058.94 | 2,514.67 41000006|HC VENTILATOR - SUBSEQUENT|0410|94003|3,643.33|2,113.13|||485.26|485.26|||||2368.16|2477.46|2659.63|2659.63|2841.80|2186.00|2368.16|2732.50|3096.83|3235.28|3206.13|2732.50|3096.83| 485.26 | 3,235.28 | 2,659.63 41000007|HC BEDSIDE VITAL CAPACITY|0410|94150|166.19|96.39|140.76|133.722|139.55|139.55|6.87|7.01|7.01|7.14|108.02|113.01|121.32|121.32|129.63|99.71|108.02|124.64|141.26|147.58|146.25|124.64|141.26| 6.87 | 147.58 | 124.64 41000008|HC SURFACTANT ADMIN THRU ENDOTRAC|0410|94610|167.79|97.32|||187.88|187.88|||||109.06|114.10|122.49|122.49|130.88|100.67|109.06|125.84|142.62|149.00|147.66|125.84|142.62| 100.67 | 187.88 | 125.84 41000009|HC SIX MINUTE WALK-THORACIC GAS V|0410|94620|349.47|202.69|||||64.68|65.98|65.98|67.27|227.16|237.64|255.11|255.11|272.59|209.68|227.16|262.10|297.05|310.33|307.53|262.10|297.05| 64.68 | 310.33 | 255.11 41000009|HC SIX MINUTE WALK-THORACIC GAS V|0410|94620|349.47|202.69|||||2.18|2.23|2.23|2.27|227.16|237.64|255.11|255.11|272.59|209.68|227.16|262.10|297.05|310.33|307.53|262.10|297.05| 2.18 | 310.33 | 255.11 41000010|HC CONTINUOUS INHALATION TX 1ST H|0410|94644|602.49|349.44|527.02|500.669|111.95|111.95|||||391.62|409.69|439.82|439.82|469.94|361.49|391.62|451.87|512.12|535.01|530.19|451.87|512.12| 111.95 | 535.01 | 451.87 41000011|HC CONTINUOUS INHALATION TX - EA|0410|94645|602.49|349.44|||||||||391.62|409.69|439.82|439.82|469.94|361.49|391.62|451.87|512.12|535.01|530.19|451.87|512.12| 361.49 | 535.01 | 451.87 41000012|HC BUBBLE C-PAP|0410|94660|1,929.49|1,119.10|592.4|562.78|187.88|187.88|||||1254.17|1312.05|1408.53|1408.53|1505.00|1157.69|1254.17|1447.12|1640.07|1713.39|1697.95|1447.12|1640.07| 187.88 | 1,713.39 | 1,408.53 41000013|HC CONTINUOUS POSITIVE AIRWAY - C|0410|94660|677.25|392.81|592.4|562.78|187.88|187.88|||||440.21|460.53|494.39|494.39|528.26|406.35|440.21|507.94|575.66|601.40|595.98|507.94|575.66| 187.88 | 601.40 | 507.94 41000014|HC CONTINUOUS POSITIVE AIRWAY--BI|0410|94660|2,840.99|1,647.77|592.4|562.78|187.88|187.88|||||1846.64|1931.87|2073.92|2073.92|2215.97|1704.59|1846.64|2130.74|2414.84|2522.80|2500.07|2130.74|2414.84| 187.88 | 2,522.80 | 2,073.92 41000015|HC NON INVSIVE POS AIRWY PRESS CP|0410|94660|1,929.49|1,119.10|592.4|562.78|187.88|187.88|||||1254.17|1312.05|1408.53|1408.53|1505.00|1157.69|1254.17|1447.12|1640.07|1713.39|1697.95|1447.12|1640.07| 187.88 | 1,713.39 | 1,408.53 41000016|HC DEMO/EVAL UTILIZATION SVN/MDI|0410|94664|338.38|196.26|295.97|281.1715|187.88|187.88|22.42|22.87|22.87|23.32|219.95|230.10|247.02|247.02|263.94|203.03|219.95|253.79|287.62|300.48|297.77|253.79|287.62| 22.42 | 300.48 | 247.02 41000017|HC END TIDAL CO2 MONITORING|0410|94770|251.50|145.87|||||||||163.48|171.02|183.60|183.60|196.17|150.90|163.48|188.63|213.78|223.33|221.32|188.63|213.78| 150.90 | 223.33 | 188.63 41300000|HC HBO THER PER SESSION - OTHER|0413|99183|3,150.59|1,827.34|||||171.74|175.18|175.18|178.61|2047.88|2142.40|2299.93|2299.93|2457.46|1890.35|2047.88|2362.94|2678.00|2797.72|2772.52|2362.94|2678.00| 171.74 | 2,797.72 | 2,299.93 41300001|HC HBO THER PER 30 MIN - MEDICARE*|0413|G0277|827.03|479.68|||119.28|119.28|||||537.57|562.38|603.73|603.73|645.08|496.22|537.57|620.27|702.98|734.40|727.79|620.27|702.98| 119.28 | 734.40 | 603.73 42000000|HC MOBILITY CURRENT STATUS|0420|G8978|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000001|HC MOBILITY GOAL STATUS|0420|G8979|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000002|HC MOBILITY D/C STATUS|0420|G8980|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000003|HC BODY POS CURRENT STATUS|0420|G8981|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000004|HC BODY POS GOAL STATUS|0420|G8982|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000005|HC BODY POS D/C STATUS|0420|G8983|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000006|HC CARRY CURRENT STATUS|0420|G8984|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000007|HC CARRY GOAL STATUS|0420|G8985|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000008|HC CARRY D/C STATUS|0420|G8986|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000009|HC SELF CARE CURRENT STATUS|0420|G8987|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000010|HC SELF CARE GOAL STATUS|0420|G8988|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000011|HC SELF CARE D/C STATUS|0420|G8989|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000012|HC OTHER PT/OT CURRENT STATUS|0420|G8990|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000013|HC OTHER PT/OT GOAL STATUS|0420|G8991|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000014|HC OTHER PT/OT D/C STATUS|0420|G8992|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000015|HC SUB PT/OT CURRENT STATUS|0420|G8993|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000016|HC SUB PT/OT GOAL STATUS|0420|G8994|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000017|HC SUB PT/OT D/C STATUS|0420|G8995|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000018|HC MOBILITY CURRENT STATUS|0420|G8978|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000019|HC MOBILITY GOAL STATUS|0420|G8979|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000020|HC MOBILITY D/C STATUS|0420|G8980|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000021|HC BODY POS CURRENT STATUS|0420|G8981|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000022|HC BODY POS GOAL STATUS|0420|G8982|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000023|HC BODY POS D/C STATUS|0420|G8983|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000024|HC CARRY CURRENT STATUS|0420|G8984|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000025|HC CARRY GOAL STATUS|0420|G8985|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000026|HC CARRY D/C STATUS|0420|G8986|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000027|HC SELF CARE CURRENT STATUS|0420|G8987|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000028|HC SELF CARE GOAL STATUS|0420|G8988|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000029|HC SELF CARE D/C STATUS|0420|G8989|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000030|HC OTHER PT/OT CURRENT STATUS|0420|G8990|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000031|HC OTHER PT/OT GOAL STATUS|0420|G8991|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000032|HC OTHER PT/OT D/C STATUS|0420|G8992|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000033|HC SUB PT/OT CURRENT STATUS|0420|G8993|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000034|HC SUB PT/OT GOAL STATUS|0420|G8994|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000035|HC SUB PT/OT D/C STATUS|0420|G8995|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000036|HC IP-MOBILITY CURRENT STATUS|0420|G8978|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000037|HC IP-MOBILITY GOAL STATUS|0420|G8979|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000038|HC IP-MOBILITY D/C STATUS|0420|G8980|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000039|HC IP-BODY POS CURRENT STATUS|0420|G8981|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000040|HC IP-BODY POS GOAL STATUS|0420|G8982|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000041|HC IP-BODY POS D/C STATUS|0420|G8983|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000042|HC IP-CARRY CURRENT STATUS|0420|G8984|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000043|HC IP-CARRY GOAL STATUS|0420|G8985|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000044|HC IP-CARRY D/C STATUS|0420|G8986|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000045|HC IP-SELF CARE CURRENT STATUS|0420|G8987|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000046|HC IP-SELF CARE GOAL STATUS|0420|G8988|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000047|HC IP-SELF CARE D/C STATUS|0420|G8989|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000048|HC IP-OTHER PT/OT CURRENT STATUS|0420|G8990|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000049|HC IP-OTHER PT/OT GOAL STATUS|0420|G8991|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000050|HC IP-OTHER PT/OT D/C STATUS|0420|G8992|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000051|HC IP-SUB PT/OT CURRENT STATUS|0420|G8993|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000052|HC IP-SUB PT/OT GOAL STATUS|0420|G8994|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42000053|HC IP-SUB PT/OT D/C STATUS|0420|G8995|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 42100000|HC CANALITH REPOSITIONING PER DAY|0421|95992|184.82|107.20|161.68|153.60|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 42100002|HC IP-CANALITH REPOSITIONING-PER|0421|95992|184.82|107.20|161.68|153.60|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 42100003|HC C-MECHANICAL TRACTION THERAPY|0421|97012|212.36|123.17|51.29|48.73|||16.89|17.23|17.23|17.57|138.03|144.40|155.02|155.02|165.64|127.42|138.03|159.27|180.51|188.58|186.88|159.27|180.51| 16.89 | 188.58 | 144.40 42100004|HC MECHANICAL TRACTION THERAPY|0421|97012|212.36|123.17|51.29|48.73|||16.89|17.23|17.23|17.57|138.03|144.40|155.02|155.02|165.64|127.42|138.03|159.27|180.51|188.58|186.88|159.27|180.51| 16.89 | 188.58 | 144.40 42100005|HC C-ELECTRIC STIMULATION THERAPY-U|0421|97014|115.85|67.19|44.16|41.95|||16.86|17.20|17.20|17.54|75.30|78.78|84.57|84.57|90.36|69.51|75.30|86.89|98.47|102.87|101.95|86.89|98.47| 16.86 | 102.87 | 78.78 42100006|HC ELECTRIC STIMULATION THERAPY-U|0421|97014|115.85|67.19|44.16|41.95|||16.86|17.20|17.20|17.54|75.30|78.78|84.57|84.57|90.36|69.51|75.30|86.89|98.47|102.87|101.95|86.89|98.47| 16.86 | 102.87 | 78.78 42100007|HC IP-ELECTRIC STIMULATION THEP-U|0421|97014|115.85|67.19|44.16|41.95|||16.86|17.20|17.20|17.54|75.30|78.78|84.57|84.57|90.36|69.51|75.30|86.89|98.47|102.87|101.95|86.89|98.47| 16.86 | 102.87 | 78.78 42100008|HC FLUIDOTHERAPY|0421|97022|163.24|94.68|47.02|44.67|||16.48|16.81|16.81|17.14|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 16.48 | 144.96 | 111.00 42100009|HC C-E STIM ATTENDED EA 15 MINS|0421|97032|155.54|90.21|48.44|46.02|||9.81|10.01|10.01|10.20|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 9.81 | 138.12 | 105.77 42100010|HC E STIM ATTENDED EA 15 MINS|0421|97032|155.54|90.21|48.44|46.02|||9.81|10.01|10.01|10.20|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 9.81 | 138.12 | 105.77 42100011|HC IP-ELECTRICAL STIMULATION EA 1|0421|97032|155.54|90.21|48.44|46.02|||9.81|10.01|10.01|10.20|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 9.81 | 138.12 | 105.77 42100012|HC C-IONTOPHORESIS PER 15 MIN|0421|97033|163.24|94.68|54.14|51.43|||9.81|10.01|10.01|10.20|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 9.81 | 144.96 | 111.00 42100013|HC IONTOPHORESIS PER 15 MIN|0421|97033|163.24|94.68|54.14|51.43|||9.81|10.01|10.01|10.20|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 9.81 | 144.96 | 111.00 42100014|HC IP-IONTOPHORESIS PER 15 MIN|0421|97033|163.24|94.68|54.14|51.43|||9.81|10.01|10.01|10.20|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 9.81 | 144.96 | 111.00 42100015|HC IP-ULTRASOUND THERAPY EA 15 MI|0421|97035|155.54|90.21|41.31|39.24|||14.10|14.39|14.39|14.67|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 14.10 | 138.12 | 105.77 42100016|HC C-ULTRASOUND THERAPY EA 15 MINS|0421|97035|155.54|90.21|41.31|39.24|||14.10|14.39|14.39|14.67|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 14.10 | 138.12 | 105.77 42100017|HC ULTRASOUND THERAPY EA 15 MINS|0421|97035|155.54|90.21|41.31|39.24|||14.10|14.39|14.39|14.67|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 14.10 | 138.12 | 105.77 42100018|HC IP-THERAPEUTIC EXERCISES EA 15|0421|97110|184.82|107.20|69.80|66.31|||25.66|26.17|26.17|26.68|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 25.66 | 164.12 | 125.68 42100019|HC C-THERAPEUTIC EXERCISES EA 15 MI|0421|97110|184.82|107.20|69.80|66.31|||25.66|26.17|26.17|26.68|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 25.66 | 164.12 | 125.68 42100020|HC THERAPEUTIC EXERCISES EA 15 MI|0421|97110|184.82|107.20|69.80|66.31|||25.66|26.17|26.17|26.68|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 25.66 | 164.12 | 125.68 42100021|HC IP-NEUROMUSCULAR REEDUCATION E|0421|97112|184.82|107.20|71.23|67.67|||24.87|25.37|25.37|25.87|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 24.87 | 164.12 | 125.68 42100022|HC C-NEUROMUSCULAR REEDUCATION EA 1|0421|97112|184.82|107.20|71.23|67.67|||24.87|25.37|25.37|25.87|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 24.87 | 164.12 | 125.68 42100023|HC NEUROMUSCULAR REEDUCATION EA 1|0421|97112|184.82|107.20|71.23|67.67|||24.87|25.37|25.37|25.87|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 24.87 | 164.12 | 125.68 42100024|HC C-GAIT TRAINING THERAPY EA 15 MI|0421|97116|179.09|103.87|65.54|62.26|||22.18|22.62|22.62|23.06|116.41|121.78|130.74|130.74|139.69|107.45|116.41|134.32|152.23|159.03|157.60|134.32|152.23| 22.18 | 159.03 | 121.78 42100025|HC GAIT TRAINING THERAPY EA 15 MI|0421|97116|179.09|103.87|65.54|62.26|||22.18|22.62|22.62|23.06|116.41|121.78|130.74|130.74|139.69|107.45|116.41|134.32|152.23|159.03|157.60|134.32|152.23| 22.18 | 159.03 | 121.78 42100026|HC IP-GAIT TRAINING THERAPY EA 15|0421|97116|179.09|103.87|65.54|62.26|||22.18|22.62|22.62|23.06|116.41|121.78|130.74|130.74|139.69|107.45|116.41|134.32|152.23|159.03|157.60|134.32|152.23| 22.18 | 159.03 | 121.78 42100027|HC IP-MANUAL THERAPY EA 15 MINS|0421|97124|155.54|90.21|59.84|56.85|||13.04|13.3|13.3|13.57|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 13.04 | 138.12 | 105.77 42100028|HC C-MASSAGE THERAPY EA 15 MINS|0421|97124|155.54|90.21|59.84|56.848|||13.04|13.30|13.30|13.57|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 13.04 | 138.12 | 105.77 42100029|HC MASSAGE THERAPY EA 15 MINS|0421|97124|155.54|90.21|59.84|56.848|||13.04|13.30|13.30|13.57|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 13.04 | 138.12 | 105.77 42100030|HC IP-MANUAL THERAPY EA 15 MINS|0421|97140|184.82|107.20|71.23|67.6685|||20.46|20.87|20.87|21.28|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 20.46 | 164.12 | 125.68 42100031|HC C-MANUAL THERAPY EA 15 MINS|0421|97140|184.82|107.20|71.23|67.6685|||20.46|20.87|20.87|21.28|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 20.46 | 164.12 | 125.68 42100032|HC MANUAL THERAPY EA 15 MINS|0421|97140|184.82|107.20|71.23|67.6685|||20.46|20.87|20.87|21.28|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 20.46 | 164.12 | 125.68 42100033|HC IP-THERAPEUTIC REHAB GROUP|0421|97150|167.67|97.25|31.27|29.7065|||19.95|20.35|20.35|20.75|108.99|114.02|122.40|122.40|130.78|100.60|108.99|125.75|142.52|148.89|147.55|125.75|142.52| 19.95 | 148.89 | 114.02 42100034|HC C-THERAPEUTIC REHAB GROUP|0421|97150|167.67|97.25|31.27|29.71|||19.95|20.35|20.35|20.75|108.99|114.02|122.40|122.40|130.78|100.60|108.99|125.75|142.52|148.89|147.55|125.75|142.52| 19.95 | 148.89 | 114.02 42100035|HC THERAPEUTIC REHAB GROUP|0421|97150|167.67|97.25|31.27|29.71|||19.95|20.35|20.35|20.75|108.99|114.02|122.40|122.40|130.78|100.60|108.99|125.75|142.52|148.89|147.55|125.75|142.52| 19.95 | 148.89 | 114.02 42100036|HC IP-THERAPEUTIC ACTIVITIES EA 1|0421|97530|184.82|107.20|69.80|66.31|||26.01|26.53|26.53|27.05|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 26.01 | 164.12 | 125.68 42100037|HC C-THERAPEUTIC ACTIVITIES EA 15 M|0421|97530|184.82|107.20|69.80|66.31|||26.01|26.53|26.53|27.05|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 26.01 | 164.12 | 125.68 42100038|HC THERAPEUTIC ACTIVITIES EA 15 M|0421|97530|184.82|107.20|69.80|66.31|||26.01|26.53|26.53|27.05|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 26.01 | 164.12 | 125.68 42100039|HC IP-PHYSICAL PERFORM EA 15M|0421|97750|135.70|78.71|75.52|71.74|||20.08|20.48|20.48|20.89|88.21|92.28|99.06|99.06|105.85|81.42|88.21|101.78|115.35|120.50|119.42|101.78|115.35| 20.08 | 120.50 | 92.28 42100040|HC C-PHYSICAL PERFORM EA 15M|0421|97750|135.70|78.71|75.52|71.74|||20.08|20.48|20.48|20.89|88.21|92.28|99.06|99.06|105.85|81.42|88.21|101.78|115.35|120.50|119.42|101.78|115.35| 20.08 | 120.50 | 92.28 42100041|HC PHYSICAL PERFORM EA 15M|0421|97750|135.70|78.71|75.52|71.74|||20.08|20.48|20.48|20.89|88.21|92.28|99.06|99.06|105.85|81.42|88.21|101.78|115.35|120.50|119.42|101.78|115.35| 20.08 | 120.50 | 92.28 42100042|HC IP-ORTHOTIC MGMT AND TRAIN 15|0421|97760|184.82|107.20|159.10|151.15|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 42100043|HC C-ORTHOTIC MGMT AND TRAIN 15 MIN|0421|97760|184.82|107.20|159.10|151.15|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 42100044|HC ORTHOTIC MGMT AND TRAIN 15 MIN|0421|97760|184.82|107.20|159.1|151.145|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 42400000|HC IP-PT EVAL|0424|97001|257.19|149.17|||||68.4|69.77|69.77|71.13|167.17|174.89|187.75|187.75|200.61|154.31|167.17|192.89|218.61|228.38|226.33|192.89|218.61| 68.40 | 228.38 | 187.75 42400001|HC C-PT EVAL|0424|97001|179.09|103.87|||||68.4|69.77|69.77|71.13|116.41|121.78|130.74|130.74|139.69|107.45|116.41|134.32|152.23|159.03|157.60|134.32|152.23| 68.40 | 159.03 | 130.74 42400002|HC PT EVAL|0424|97001|257.19|149.17|||||68.4|69.77|69.77|71.13|167.17|174.89|187.75|187.75|200.61|154.31|167.17|192.89|218.61|228.38|226.33|192.89|218.61| 68.40 | 228.38 | 187.75 42400003|HC IP-PT RE-EVALUATION|0424|97002|194.17|112.62|||||||||126.21|132.04|141.74|141.74|151.45|116.50|126.21|145.63|165.04|172.42|170.87|145.63|165.04| 116.50 | 172.42 | 145.63 42400004|HC C-PT RE-EVALUATION|0424|97002|194.17|112.62|||||||||126.21|132.04|141.74|141.74|151.45|116.50|126.21|145.63|165.04|172.42|170.87|145.63|165.04| 116.50 | 172.42 | 145.63 42400005|HC PT RE-EVALUATION|0424|97002|194.17|112.62|||||||||126.21|132.04|141.74|141.74|151.45|116.50|126.21|145.63|165.04|172.42|170.87|145.63|165.04| 116.50 | 172.42 | 145.63 42400006|HC IP-PT EVAL LOW COMPLEX 20 MIN|0424|97161|314.21|182.24|164.13|155.9235|||||||204.24|213.66|229.37|229.37|245.08|188.53|204.24|235.66|267.08|279.02|276.50|235.66|267.08| 155.92 | 279.02 | 229.37 42400007|HC IP-PT EVAL LOW COMPLEX 20 MIN|0424|97161|314.21|182.24|164.13|155.9235|||||||204.24|213.66|229.37|229.37|245.08|188.53|204.24|235.66|267.08|279.02|276.50|235.66|267.08| 155.92 | 279.02 | 229.37 42400008|HC IP-PT EVAL MOD COMPLEX 30 MIN|0424|97162|344.60|199.87|164.13|155.9235|||||||223.99|234.33|251.56|251.56|268.79|206.76|223.99|258.45|292.91|306.00|303.25|258.45|292.91| 155.92 | 306.00 | 251.56 42400009|HC IP-PT EVAL MOD COMPLEX 30 MIN|0424|97162|344.60|199.87|164.13|155.9235|||||||223.99|234.33|251.56|251.56|268.79|206.76|223.99|258.45|292.91|306.00|303.25|258.45|292.91| 155.92 | 306.00 | 251.56 42400010|HC IP-PT EVAL HIGH COMPLEX 45 MIN|0424|97163|375.00|217.50|164.13|155.9235|||||||243.75|255.00|273.75|273.75|292.50|225.00|243.75|281.25|318.75|333.00|330.00|281.25|318.75| 155.92 | 333.00 | 273.75 42400011|HC IP-PT EVAL HIGH COMPLEX 45 MIN|0424|97163|375.00|217.50|164.13|155.9235|||||||243.75|255.00|273.75|273.75|292.50|225.00|243.75|281.25|318.75|333.00|330.00|281.25|318.75| 155.92 | 333.00 | 273.75 42400012|HC IP-PT RE-EVAL EST PLAN CARE|0424|97164|194.17|112.62|110.7|105.165|||||||126.21|132.04|141.74|141.74|151.45|116.50|126.21|145.63|165.04|172.42|170.87|145.63|165.04| 105.17 | 172.42 | 141.74 42400013|HC IP-PT RE-EVAL EST PLAN CARE|0424|97164|194.17|112.62|110.7|105.165|||||||126.21|132.04|141.74|141.74|151.45|116.50|126.21|145.63|165.04|172.42|170.87|145.63|165.04| 105.17 | 172.42 | 141.74 42400014|HC SELF CARE PATIENT EDUCATION|0424|97535|178.87|103.74|156.44|148.618|||17.81|18.16|18.16|18.52|116.27|121.63|130.58|130.58|139.52|107.32|116.27|134.15|152.04|158.84|157.41|134.15|152.04| 17.81 | 158.84 | 130.58 42400015|HC SELF CARE PATIENT EDUCATION|0424|97535|178.87|103.74|156.44|148.618|||17.81|18.16|18.16|18.52|116.27|121.63|130.58|130.58|139.52|107.32|116.27|134.15|152.04|158.84|157.41|134.15|152.04| 17.81 | 158.84 | 130.58 43000000|HC OT THERAPY-GROUP PHP|0430|G0129|643.47|373.21|||||||||418.26|437.56|469.73|469.73|501.91|386.08|418.26|482.60|546.95|571.40|566.25|482.60|546.95| 386.08 | 571.40 | 482.60 43000001|HC MOBILITY CURRENT STATUS|0430|G8978|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000002|HC MOBILITY GOAL STATUS|0430|G8979|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000003|HC MOBILITY D/C STATUS|0430|G8980|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000004|HC BODY POS CURRENT STATUS|0430|G8981|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000005|HC BODY POS GOAL STATUS|0430|G8982|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000006|HC BODY POS D/C STATUS|0430|G8983|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000007|HC CARRY CURRENT STATUS|0430|G8984|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000008|HC CARRY GOAL STATUS|0430|G8985|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000009|HC CARRY D/C STATUS|0430|G8986|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000010|HC SELF CARE CURRENT STATUS|0430|G8987|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000011|HC SELF CARE GOAL STATUS|0430|G8988|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000012|HC SELF CARE D/C STATUS|0430|G8989|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000013|HC OTHER PT/OT CURRENT STATUS|0430|G8990|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000014|HC OTHER PT/OT GOAL STATUS|0430|G8991|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000015|HC OTHER PT/OT D/C STATUS|0430|G8992|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000016|HC OTHER PT/OT D/C STATUS|0430|G8993|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000017|HC SUB PT/OT GOAL STATUS|0430|G8994|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000018|HC SUB PT/OT D/C STATUS|0430|G8995|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000019|HC IP-MOBILITY CURRENT STATUS|0430|G8978|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000020|HC IP-MOBILITY GOAL STATUS|0430|G8979|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000021|HC IP-MOBILITY D/C STATUS|0430|G8980|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000022|HC IP-BODY POS CURRENT STATUS|0430|G8981|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000023|HC IP-BODY POS GOAL STATUS|0430|G8982|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000024|HC IP-BODY POS D/C STATUS|0430|G8983|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000025|HC IP-CARRY CURRENT STATUS|0430|G8984|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000026|HC IP-CARRY GOAL STATUS|0430|G8985|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000027|HC IP-CARRY D/C STATUS|0430|G8986|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000028|HC IP-SELF CARE CURRENT STATUS|0430|G8987|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000029|HC IP-SELF CARE GOAL STATUS|0430|G8988|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000030|HC IP-SELF CARE D/C STATUS|0430|G8989|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000031|HC IP-OTHER PT/OT CURRENT STATUS|0430|G8990|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000032|HC IP-OTHER PT/OT GOAL STATUS|0430|G8991|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000033|HC IP-OTHER PT/OT D/C STATUS|0430|G8992|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000034|HC IP-SUB PT/OT CURRENT STATUS|0430|G8993|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000035|HC IP-SUB PT/OT GOAL STATUS|0430|G8994|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43000036|HC IP-SUB PT/OT D/C STATUS|0430|G8995|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 43100000|HC ELECTRIC STIMULATION THERAPY-U|0431|97014|115.85|67.19|44.16|41.95|||16.86|17.20|17.20|17.54|75.30|78.78|84.57|84.57|90.36|69.51|75.30|86.89|98.47|102.87|101.95|86.89|98.47| 16.86 | 102.87 | 78.78 43100001|HC IP-ELECTRIC STIMULATION THEP-U|0431|97014|115.85|67.19|44.16|41.95|||16.86|17.20|17.20|17.54|75.30|78.78|84.57|84.57|90.36|69.51|75.30|86.89|98.47|102.87|101.95|86.89|98.47| 16.86 | 102.87 | 78.78 43100002|HC IP-PARAFFIN BATH THERAPY|0431|97018|135.70|78.71|32.77|31.13|||15.96|16.28|16.28|16.60|88.21|92.28|99.06|99.06|105.85|81.42|88.21|101.78|115.35|120.50|119.42|101.78|115.35| 15.96 | 120.50 | 92.28 43100003|HC PARAFFIN BATH THERAPY|0431|97018|135.70|78.71|32.77|31.13|||15.96|16.28|16.28|16.60|88.21|92.28|99.06|99.06|105.85|81.42|88.21|101.78|115.35|120.50|119.42|101.78|115.35| 15.96 | 120.50 | 92.28 43100004|HC IP-WHIRLPOOL/FLUIDOTHERAPY THE|0431|97022|163.24|94.68|47.02|44.67|||16.48|16.81|16.81|17.14|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 16.48 | 144.96 | 111.00 43100005|HC WHIRLPOOL/FLUIDOTHERAPY THERAP|0431|97022|163.24|94.68|47.02|44.67|||16.48|16.81|16.81|17.14|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 16.48 | 144.96 | 111.00 43100006|HC ELECTRICAL STIMULATION EA 15 M|0431|97032|155.54|90.21|48.44|46.02|||9.81|10.01|10.01|10.20|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 9.81 | 138.12 | 105.77 43100007|HC IONTOPHORESIS-15 MIN|0431|97033|163.24|94.68|54.14|51.433|||9.81|10.01|10.01|10.2|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 9.81 | 144.96 | 111.00 43100008|HC IP-IONTOPHORESIS-15 MIN|0431|97033|163.24|94.68|54.14|51.433|||9.81|10.01|10.01|10.2|106.11|111.00|119.17|119.17|127.33|97.94|106.11|122.43|138.75|144.96|143.65|122.43|138.75| 9.81 | 144.96 | 111.00 43100009|HC CONTRAST BATH THERAPY EA 15 MI|0431|97034|200.36|116.21|42.74|40.60|||8.07|8.23|8.23|8.4|130.23|136.24|146.26|146.26|156.28|120.22|130.23|150.27|170.31|177.92|176.32|150.27|170.31| 8.07 | 177.92 | 136.24 43100010|HC IP-ULTRASOUND THERAPY EA 15 MI|0431|97035|155.54|90.21|41.31|39.24|||14.1|14.39|14.39|14.67|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 14.10 | 138.12 | 105.77 43100011|HC ULTRASOUND THERAPY EA 15 MINS|0431|97035|155.54|90.21|41.31|39.24|||14.10|14.39|14.39|14.67|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 14.10 | 138.12 | 105.77 43100012|HC IP-THERAPEUTIC EXERCISES EA 15|0431|97110|184.82|107.20|69.80|66.31|||25.66|26.17|26.17|26.68|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 25.66 | 164.12 | 125.68 43100013|HC THERAPEUTIC EXERCISES EA 15 MI|0431|97110|184.82|107.20|69.8|66.31|||25.66|26.17|26.17|26.68|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 25.66 | 164.12 | 125.68 43100014|HC IP-NEUROMUSCULAR REEDUC EA 15|0431|97112|184.82|107.20|71.23|67.6685|||24.87|25.37|25.37|25.87|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 24.87 | 164.12 | 125.68 43100015|HC NEUROMUSCULAR REEDUCATION EA 1|0431|97112|184.82|107.20|71.23|67.67|||24.87|25.37|25.37|25.87|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 24.87 | 164.12 | 125.68 43100016|HC IP-MASSAGE THERAPY EA 15 MINS|0431|97124|155.54|90.21|59.84|56.85|||13.04|13.30|13.30|13.57|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 13.04 | 138.12 | 105.77 43100017|HC MASSAGE THERAPY EA 15 MINS|0431|97124|155.54|90.21|59.84|56.85|||13.04|13.3|13.3|13.57|101.10|105.77|113.54|113.54|121.32|93.32|101.10|116.66|132.21|138.12|136.88|116.66|132.21| 13.04 | 138.12 | 105.77 43100018|HC IP-MANUAL THERAPY EA 15 MINS|0431|97140|184.82|107.20|71.23|67.67|||20.46|20.87|20.87|21.28|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 20.46 | 164.12 | 125.68 43100019|HC MANUAL THERAPY EA 15 MINS|0431|97140|184.82|107.20|71.23|67.67|||20.46|20.87|20.87|21.28|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 20.46 | 164.12 | 125.68 43100020|HC IP-THERAPEUTIC REHAB GROUP|0431|97150|167.67|97.25|31.27|29.7065|||19.95|20.35|20.35|20.75|108.99|114.02|122.40|122.40|130.78|100.60|108.99|125.75|142.52|148.89|147.55|125.75|142.52| 19.95 | 148.89 | 114.02 43100021|HC THERAPEUTIC REHAB GROUP|0431|97150|167.67|97.25|31.27|29.7065|||19.95|20.35|20.35|20.75|108.99|114.02|122.40|122.40|130.78|100.60|108.99|125.75|142.52|148.89|147.55|125.75|142.52| 19.95 | 148.89 | 114.02 43100022|HC IP-THERAPEUTIC ACTIVITIES EA 1|0431|97530|184.82|107.20|69.8|66.31|||26.01|26.53|26.53|27.05|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 26.01 | 164.12 | 125.68 43100023|HC THERAPEUTIC ACTIVITIES EA 15 M|0431|97530|184.82|107.20|69.8|66.31|||26.01|26.53|26.53|27.05|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 26.01 | 164.12 | 125.68 43100024|HC COGNITIVE SKILLS DEVELOP EA 15|0431|97532|184.82|107.20|||||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 43100025|HC IP-COGNITIVE SKILLS DEVELOP EA|0431|97532|184.82|107.20|||||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 43100026|HC IP-SENSORY INTEGRATION EA 15 M|0431|97533|184.82|107.20|75.52|71.74|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 71.74 | 164.12 | 134.92 43100027|HC SENSORY INTEGRATION EA 15 MIN|0431|97533|184.82|107.20|75.52|71.74|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 71.74 | 164.12 | 134.92 43100028|HC IP-SELF CARE MNGMENT TRAIN EA|0431|97535|178.86|103.74|156.44|148.62|||17.81|18.16|18.16|18.52|116.26|121.62|130.57|130.57|139.51|107.32|116.26|134.15|152.03|158.83|157.40|134.15|152.03| 17.81 | 158.83 | 130.57 43100029|HC SELF CARE MNGMENT TRAIN EA 15|0431|97535|178.86|103.74|156.44|148.62|||17.81|18.16|18.16|18.52|116.26|121.62|130.57|130.57|139.51|107.32|116.26|134.15|152.03|158.83|157.40|134.15|152.03| 17.81 | 158.83 | 130.57 43100030|HC COMMUNITY/WORK REINTEGRAT EA 1|0431|97537|184.82|107.20|||||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 43100031|HC IP-DEBRIDEMENT - NON SELECTIVE|0431|97602|78.67|45.63|||179.55|179.55|261.66|266.9|266.9|272.13|51.14|53.50|57.43|57.43|61.36|47.20|51.14|59.00|66.87|69.86|69.23|59.00|66.87| 47.20 | 272.13 | 66.87 43100032|HC IP-PHYSICAL PERFORM EA 15 MINS|0431|97750|135.70|78.71|75.52|71.74|||20.08|20.48|20.48|20.89|88.21|92.28|99.06|99.06|105.85|81.42|88.21|101.78|115.35|120.50|119.42|101.78|115.35| 20.08 | 120.50 | 92.28 43100033|HC PHYSICAL PERFORM EA 15 MINS|0431|97750|135.70|78.71|75.52|71.74|||20.08|20.48|20.48|20.89|88.21|92.28|99.06|99.06|105.85|81.42|88.21|101.78|115.35|120.50|119.42|101.78|115.35| 20.08 | 120.50 | 92.28 43100034|HC IP-ORTHOTIC MGMT AND TRAIN 15|0431|97760|184.82|107.20|159.10|151.15|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 43100035|HC ORTHOTIC MGMT AND TRAIN 15 MIN|0431|97760|184.82|107.20|159.10|151.15|||||||120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 110.89 | 164.12 | 138.62 43100036|HC PROSTHETIC TRAINING EA 15 MINS|0431|97761|184.82|107.20|71.23|67.6685|||23.08|23.54|23.54|24|120.13|125.68|134.92|134.92|144.16|110.89|120.13|138.62|157.10|164.12|162.64|138.62|157.10| 23.08 | 164.12 | 125.68 43100037|HC COGNITIVE SKILLS DEVELOPMENT|0431|97127|93.77|54.39|||||||||60.95|63.76|68.45|68.45|73.14|56.26|60.95|70.33|79.70|83.27|82.52|70.33|79.70| 56.26 | 83.27 | 70.33 43100038|HC COGNITIVE SKILLS DEVELOPMENT|0431|97127|93.77|54.39|||||||||60.95|63.76|68.45|68.45|73.14|56.26|60.95|70.33|79.70|83.27|82.52|70.33|79.70| 56.26 | 83.27 | 70.33 43400000|HC IP-OT EVAL|0434|97003|257.19|149.17|||||47.64|48.59|48.59|49.54|167.17|174.89|187.75|187.75|200.61|154.31|167.17|192.89|218.61|228.38|226.33|192.89|218.61| 47.64 | 228.38 | 187.75 43400001|HC OT EVALUATION-INITIAL|0434|97003|257.19|149.17|||||47.64|48.59|48.59|49.54|167.17|174.89|187.75|187.75|200.61|154.31|167.17|192.89|218.61|228.38|226.33|192.89|218.61| 47.64 | 228.38 | 187.75 43400002|HC OT RE-EVALUATION|0434|97004|194.17|112.62|||||||||126.21|132.04|141.74|141.74|151.45|116.50|126.21|145.63|165.04|172.42|170.87|145.63|165.04| 116.50 | 172.42 | 145.63 43400003|HC IP-OT RE EVAL|0434|97035|194.17|112.62|41.31|39.2445|||14.1|14.39|14.39|14.67|126.21|132.04|141.74|141.74|151.45|116.50|126.21|145.63|165.04|172.42|170.87|145.63|165.04| 14.10 | 172.42 | 132.04 43400004|HC IP-OT EVAL LOW COMPLEX 30 MIN|0434|97165|344.60|199.87|165.28|157.016|||||||223.99|234.33|251.56|251.56|268.79|206.76|223.99|258.45|292.91|306.00|303.25|258.45|292.91| 157.02 | 306.00 | 251.56 43400005|HC IP-OT EVAL LOW COMPLEX 30 MIN|0434|97165|344.60|199.87|165.28|157.016|||||||223.99|234.33|251.56|251.56|268.79|206.76|223.99|258.45|292.91|306.00|303.25|258.45|292.91| 157.02 | 306.00 | 251.56 43400006|HC IP-OT EVAL MOD COMPLEX 45 MIN|0434|97166|375.00|217.50|165.28|157.016|||||||243.75|255.00|273.75|273.75|292.50|225.00|243.75|281.25|318.75|333.00|330.00|281.25|318.75| 157.02 | 333.00 | 273.75 43400007|HC IP-OT EVAL MOD COMPLEX 45 MIN|0434|97166|375.00|217.50|165.28|157.016|||||||243.75|255.00|273.75|273.75|292.50|225.00|243.75|281.25|318.75|333.00|330.00|281.25|318.75| 157.02 | 333.00 | 273.75 43400008|HC IP-OT EVAL HIGH COMPLEX 60 MIN|0434|97167|405.37|235.11|165.28|157.016|||||||263.49|275.65|295.92|295.92|316.19|243.22|263.49|304.03|344.56|359.97|356.73|304.03|344.56| 157.02 | 359.97 | 295.92 43400009|HC IP-OT EVAL HIGH COMPLEX 60 MIN|0434|97167|405.37|235.11|165.28|157.016|||||||263.49|275.65|295.92|295.92|316.19|243.22|263.49|304.03|344.56|359.97|356.73|304.03|344.56| 157.02 | 359.97 | 295.92 43400010|HC IP-OT RE-EVAL EST PLAN CARE|0434|97168|197.80|114.72|105.36|100.092|||||||128.57|134.50|144.39|144.39|154.28|118.68|128.57|148.35|168.13|175.65|174.06|148.35|168.13| 100.09 | 175.65 | 144.39 43400011|HC IP-OT RE-EVAL EST PLAN CARE|0434|97168|197.80|114.72|105.36|100.092|||||||128.57|134.50|144.39|144.39|154.28|118.68|128.57|148.35|168.13|175.65|174.06|148.35|168.13| 100.09 | 175.65 | 144.39 43400012|HC IP-SELF CARE PATIENT EDUCATION|0434|97535|178.86|103.74|156.44|148.618|||17.81|18.16|18.16|18.52|116.26|121.62|130.57|130.57|139.51|107.32|116.26|134.15|152.03|158.83|157.40|134.15|152.03| 17.81 | 158.83 | 130.57 43400013|HC IP-SELF CARE PATIENT EDUCATION|0434|97535|178.86|103.74|156.44|148.618|||17.81|18.16|18.16|18.52|116.26|121.62|130.57|130.57|139.51|107.32|116.26|134.15|152.03|158.83|157.40|134.15|152.03| 17.81 | 158.83 | 130.57 44000000|HC SWALLOW CURRENT STATUS|0440|G8996|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000001|HC SWALLOW GOAL STATUS|0440|G8997|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000002|HC SWALLOW D/C STATUS|0440|G8998|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000003|HC MOTOR SPEECH CURRENT STATUS|0440|G8999|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000004|HC MOTOR SPEECH D/C STATUS|0440|G9158|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000005|HC LANG COMP CURRENT STATUS|0440|G9159|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000006|HC LANG COMP GOAL STATUS|0440|G9160|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000007|HC LANG COMP D/C STATUS|0440|G9161|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000008|HC LANG EXPRESS CURRENT STATUS|0440|G9162|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000009|HC LANG EXPRESS GOAL STATUS|0440|G9163|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000010|HC LANG EXPRESS D/C STATUS|0440|G9164|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000011|HC ATTEN CURRENT STATUS|0440|G9165|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000012|HC ATTEN GOAL STATUS|0440|G9166|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000013|HC ATTEN D/C STATUS|0440|G9167|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000014|HC MEMORY CURRENT STATUS|0440|G9168|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000015|HC MEMORY GOAL STATUS|0440|G9169|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000016|HC MEMORY D/C STATUS|0440|G9170|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000017|HC VOICE CURRENT STATUS|0440|G9171|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000018|HC VOICE GOAL STATUS|0440|G9172|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000019|HC VOICE D/C STATUS|0440|G9173|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000020|HC SPEECH LANG CURRENT STATUS|0440|G9174|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000021|HC SPEECH LANG GOAL STATUS|0440|G9175|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000022|HC SPEECH LANG D/C STATUS|0440|G9176|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44000023|HC MOTOR SPEECH GOAL STATUS|0440|G9186|0.01|0.01|||||||||0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01|0.01| 0.01 | 0.01 | 0.01 44100000|HC SPEECH/HEARING THERAPY INDIV|0441|92507|385.50|223.59|109.71|104.22|||41.71|42.54|42.54|43.38|250.58|262.14|281.42|281.42|300.69|231.30|250.58|289.13|327.68|342.32|339.24|289.13|327.68| 41.71 | 342.32 | 262.14 44100001|HC TREAT SWALLOWING DYSFUNCTION|0441|92526|385.50|223.59|321.14|305.08|||10.99|11.21|11.21|11.43|250.58|262.14|281.42|281.42|300.69|231.30|250.58|289.13|327.68|342.32|339.24|289.13|327.68| 10.99 | 342.32 | 281.42 44100002|HC EVAL TO USE/FIT VOICE PROSTH|0441|92597|385.50|223.59|||||||||250.58|262.14|281.42|281.42|300.69|231.30|250.58|289.13|327.68|342.32|339.24|289.13|327.68| 231.30 | 342.32 | 289.13 44100003|HC EX SPEECH DEVICE RX EA ADDL 30|0441|92608|187.85|108.95|||||||||122.10|127.74|137.13|137.13|146.52|112.71|122.10|140.89|159.67|166.81|165.31|140.89|159.67| 112.71 | 166.81 | 140.89 44100004|HC EVALUATE SWALLOWING FUNCTION|0441|92610|898.60|521.19|786.03|746.7285|||111.26|113.48|113.48|115.71|584.09|611.05|655.98|655.98|700.91|539.16|584.09|673.95|763.81|797.96|790.77|673.95|763.81| 111.26 | 797.96 | 655.98 44100005|HC MOTION FLUORO SWALLOW FCN|0441|92611|961.56|557.70|841.09|799.0355|||111.26|113.48|113.48|115.71|625.01|653.86|701.94|701.94|750.02|576.94|625.01|721.17|817.33|853.87|846.17|721.17|817.33| 111.26 | 853.87 | 701.94 44100006|HC APHASIA ASSESMENT PER HR|0441|96105|491.90|285.30|||||41.21|42.04|42.04|42.86|319.74|334.49|359.09|359.09|383.68|295.14|319.74|368.93|418.12|436.81|432.87|368.93|418.12| 41.21 | 436.81 | 359.09 44100007|HC COGNITIVE TEST BY HC PRO|0441|96125|740.79|429.66|||||||||481.51|503.74|540.78|540.78|577.82|444.47|481.51|555.59|629.67|657.82|651.90|555.59|629.67| 444.47 | 657.82 | 555.59 44100008|HC COGNITIVE SKILLS DEVELOPMENT|0441|97532|385.50|223.59|||||||||250.58|262.14|281.42|281.42|300.69|231.30|250.58|289.13|327.68|342.32|339.24|289.13|327.68| 231.30 | 342.32 | 289.13 44100009|HC COGNITIVE SKILLS DEVELOPMENT|0441|97127|93.77|54.39|||||||||60.95|63.76|68.45|68.45|73.14|56.26|60.95|70.33|79.70|83.27|82.52|70.33|79.70| 56.26 | 83.27 | 70.33 44400000|HC SPEECH/HEARING EVALUATION|0444|92506|770.42|446.84|||||||||500.77|523.89|562.41|562.41|600.93|462.25|500.77|577.82|654.86|684.13|677.97|577.82|654.86| 462.25 | 684.13 | 577.82 44400001|HC EVALUATION OF SPEECH FLUENCY|0444|92521|740.79|429.66|163.84|155.648|||0.00|0.00|0.00|0.00|481.51|503.74|540.78|540.78|577.82|444.47|481.51|555.59|629.67|657.82|651.90|555.59|629.67| - | 657.82 | 503.74 44400002|HC EVALUATE SPEECH PRODUCTION|0444|92522|740.79|429.66|163.84|155.648|||||||481.51|503.74|540.78|540.78|577.82|444.47|481.51|555.59|629.67|657.82|651.90|555.59|629.67| 155.65 | 657.82 | 540.78 44400003|HC SPEECH SOUND LANG COMPREHEN|0444|92523|740.79|429.66|163.84|155.65|||||||481.51|503.74|540.78|540.78|577.82|444.47|481.51|555.59|629.67|657.82|651.90|555.59|629.67| 155.65 | 657.82 | 540.78 44400004|HC BEHAVRAL QUALIT ANALYS VOICE|0444|92524|740.79|429.66|163.84|155.65|||||||481.51|503.74|540.78|540.78|577.82|444.47|481.51|555.59|629.67|657.82|651.90|555.59|629.67| 155.65 | 657.82 | 540.78 44400005|HC IP-SELF CARE PATIENT EDUCATION|0444|97535|178.86|103.74|156.44|148.62|||17.81|18.16|18.16|18.52|116.26|121.62|130.57|130.57|139.51|107.32|116.26|134.15|152.03|158.83|157.40|134.15|152.03| 17.81 | 158.83 | 130.57 45000000|HC CL TX SHOULDER DISC W/NECK TX|0450|23675|1,068.17|619.54|1,141.26|1,084.20|1,392.35|1,392.35|457.91|467.07|467.07|476.23|694.31|726.36|779.76|779.76|833.17|640.90|694.31|801.13|907.94|948.53|939.99|801.13|907.94| 457.91 | 1,392.35 | 801.13 45000001|HC NASAL ENDO W/BLOOD CONTROL|0450|31238|2,036.92|1,181.41|1,916.32|1,820.50|1,496.39|1,496.39|130.83|133.45|133.45|136.07|1324.00|1385.11|1486.95|1486.95|1588.80|1222.15|1324.00|1527.69|1731.38|1808.78|1792.49|1527.69|1731.38| 130.83 | 1,916.32 | 1,496.39 45000002|HC NASAL TRACHEAL SUCTIONING|0450|31720|203.44|118.00|437.40|415.53|187.88|187.88|||||132.24|138.34|148.51|148.51|158.68|122.06|132.24|152.58|172.92|180.65|179.03|152.58|172.92| 122.06 | 437.40 | 158.68 45000003|HC ASPIRATE PLEURA W/O IMAGING|0450|32554|1,530.32|887.59|1,047.21|994.85|541.62|541.62|350.70|357.71|357.71|364.72|994.71|1040.62|1117.13|1117.13|1193.65|918.19|994.71|1147.74|1300.77|1358.92|1346.68|1147.74|1300.77| 350.70 | 1,358.92 | 1,040.62 45000005|HC REMOVAL FECAL IMPACTION OR FB|0450|45915|2,979.44|1,728.08|||1,036.96|1,036.96|261.66|266.90|266.90|272.13|1936.64|2026.02|2174.99|2174.99|2323.96|1787.66|1936.64|2234.58|2532.52|2645.74|2621.91|2234.58|2532.52| 261.66 | 2,645.74 | 2,026.02 45000006|HC INJ ANESTHETIC AGENT, FACIAL N|0450|64402|430.71|249.81|||||219.80|224.19|224.19|228.59|279.96|292.88|314.42|314.42|335.95|258.43|279.96|323.03|366.10|382.47|379.02|323.03|366.10| 219.80 | 382.47 | 314.42 45000007|HC DRAIN EXTERNAL AUD CANAL ABSCE|0450|69020|583.65|338.52|||621.97|621.97|392.50|400.35|400.35|408.20|379.37|396.88|426.06|426.06|455.25|350.19|379.37|437.74|496.10|518.28|513.61|437.74|496.10| 350.19 | 621.97 | 426.06 45000008|HC EMERGENCY - LEVEL 1|0450|99281|143.35|83.14|||72.60|72.60|17.24|17.59|17.59|17.93|93.18|97.48|104.65|104.65|111.81|86.01|93.18|107.51|121.85|127.29|126.15|107.51|121.85| 17.24 | 127.29 | 97.48 45000009|HC EMERGENCY - LEVEL 2|0450|99282|273.90|158.86|||131.59|131.59|26.76|27.29|27.29|27.83|178.04|186.25|199.95|199.95|213.64|164.34|178.04|205.43|232.82|243.22|241.03|205.43|232.82| 26.76 | 243.22 | 186.25 45000010|HC EMERGENCY - LEVEL 3|0450|99283|442.86|256.86|||231.60|231.60|49.18|50.16|50.16|51.15|287.86|301.14|323.29|323.29|345.43|265.72|287.86|332.15|376.43|393.26|389.72|332.15|376.43| 49.18 | 393.26 | 301.14 45000011|HC EMERGENCY - LEVEL 3 RAPE EXAM|0450|99283|442.86|256.86|||231.60|231.60|49.18|50.16|50.16|51.15|287.86|301.14|323.29|323.29|345.43|265.72|287.86|332.15|376.43|393.26|389.72|332.15|376.43| 49.18 | 393.26 | 301.14 45000012|HC EMERGENCY - LEVEL 4|0450|99284|811.47|470.65|||363.74|363.74|75.28|76.79|76.79|78.29|527.46|551.80|592.37|592.37|632.95|486.88|527.46|608.60|689.75|720.59|714.09|608.60|689.75| 75.28 | 720.59 | 551.80 45000013|HC EMERGENCY - LEVEL 5|0450|99285|1,386.89|804.40|||522.12|522.12|118.55|120.92|120.92|123.29|901.48|943.09|1012.43|1012.43|1081.77|832.13|901.48|1040.17|1178.86|1231.56|1220.46|1040.17|1178.86| 118.55 | 1,231.56 | 943.09 45000014|HC EMERGENCY LEVEL 5 RAPE EXAM|0450|99285|1,386.89|804.40|||522.12|522.12|118.55|120.92|120.92|123.29|901.48|943.09|1012.43|1012.43|1081.77|832.13|901.48|1040.17|1178.86|1231.56|1220.46|1040.17|1178.86| 118.55 | 1,231.56 | 943.09 45000015|HC EMERGENCY - LEVEL CRITICAL|0450|99291|1,743.04|1,010.96|1,372.54|1,303.91|692.68|692.68|153.82|156.90|156.90|159.97|1132.98|1185.27|1272.42|1272.42|1359.57|1045.82|1132.98|1307.28|1481.58|1547.82|1533.88|1307.28|1481.58| 153.82 | 1,547.82 | 1,272.42 45000015|HC EMERGENCY - LEVEL CRITICAL|0450|99291|1,743.04|1,010.96|1,372.54|1,303.91|692.68|692.68|230.97|235.59|235.59|240.21|1132.98|1185.27|1272.42|1272.42|1359.57|1045.82|1132.98|1307.28|1481.58|1547.82|1533.88|1307.28|1481.58| 230.97 | 1,547.82 | 1,272.42 45900006|HC I&D SIMPLE SKIN ABSCESS|0459|10060|583.65|338.52|437.40|415.53|179.55|179.55|254.14|259.22|259.22|264.31|379.37|396.88|426.06|426.06|455.25|350.19|379.37|437.74|496.10|518.28|513.61|437.74|496.10| 179.55 | 518.28 | 415.53 45900007|HC I&D COMPLICATED SKIN ABSCESS|0459|10061|1,225.23|710.63|437.40|415.53|345.84|345.84|254.14|259.22|259.22|264.31|796.40|833.16|894.42|894.42|955.68|735.14|796.40|918.92|1041.45|1088.00|1078.20|918.92|1041.45| 254.14 | 1,088.00 | 796.40 45900008|HC I&D PILONIDAL CYST SIMPLE|0459|10080|616.94|357.83|437.40|415.53|621.97|621.97|255.12|260.22|260.22|265.33|401.01|419.52|450.37|450.37|481.21|370.16|401.01|462.71|524.40|547.84|542.91|462.71|524.40| 255.12 | 621.97 | 450.37 45900009|HC I&D PILONIDAL CYST COMPLICATED|0459|10081|1,075.16|623.59|763.68|725.50|621.97|621.97|327.08|333.62|333.62|340.16|698.85|731.11|784.87|784.87|838.62|645.10|698.85|806.37|913.89|954.74|946.14|806.37|913.89| 327.08 | 954.74 | 731.11 45900010|HC FOREIGN BODY REMOVAL TISSUE SI|0459|10120|593.90|344.46|437.40|415.53|345.84|345.84|255.12|260.22|260.22|265.33|386.04|403.85|433.55|433.55|463.24|356.34|386.04|445.43|504.82|527.38|522.63|445.43|504.82| 255.12 | 527.38 | 415.53 45900011|HC FOREIGN BODY REMOVAL TISSUE CO|0459|10121|7,734.27|4,485.88|437.40|415.53|1,407.00|1,407.00|352.15|359.19|359.19|366.23|5027.28|5259.30|5646.02|5646.02|6032.73|4640.56|5027.28|5800.70|6574.13|6868.03|6806.16|5800.70|6574.13| 352.15 | 6,868.03 | 5,027.28 45900012|HC I&D HEMATOMA SEROMA FLUID COLL|0459|10140|4,436.61|2,573.23|437.40|415.53|1,407.00|1,407.00|255.12|260.22|260.22|265.33|2883.80|3016.89|3238.73|3238.73|3460.56|2661.97|2883.80|3327.46|3771.12|3939.71|3904.22|3327.46|3771.12| 255.12 | 3,939.71 | 2,883.80 45900013|HC I&D PUNCTURE ASPIRATION|0459|10160|624.61|362.27|437.40|415.53|345.84|345.84|255.12|260.22|260.22|265.33|406.00|424.73|455.97|455.97|487.20|374.77|406.00|468.46|530.92|554.65|549.66|468.46|530.92| 255.12 | 554.65 | 424.73 45900014|HC DEBRIDEMENT ECZEMATOUS UP TO 1|0459|11000|438.42|254.28|393.23|373.57|524.17|524.17|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 261.66 | 524.17 | 328.82 45900015|HC DEBRIDEMENT SQ TISSUE|0459|11042|438.42|254.28|393.23|373.57|345.84|345.84|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 261.66 | 393.23 | 328.82 45900016|HC SKIN TAG REMOVAL 1-15|0459|11200|710.21|411.92|437.40|415.53|179.55|179.55|423.90|432.37|432.37|440.85|461.64|482.94|518.45|518.45|553.96|426.13|461.64|532.66|603.68|630.67|624.98|532.66|603.68| 179.55 | 630.67 | 461.64 45900017|HC TRIM NAILS|0459|11719|66.57|38.61|105.42|100.15|55.66|55.66|||||43.27|45.27|48.60|48.60|51.92|39.94|43.27|49.93|56.58|59.11|58.58|49.93|56.58| 39.94 | 105.42 | 51.92 45900018|HC AVULSION OF SINGLE NAIL PLATE|0459|11730|547.98|317.83|105.42|100.15|179.55|179.55|327.08|333.62|333.62|340.16|356.19|372.63|400.03|400.03|427.42|328.79|356.19|410.99|465.78|486.61|482.22|410.99|465.78| 100.15 | 486.61 | 356.19 45900019|HC EVACUATION SUBUNGAL HEMATOMA|0459|11740|547.98|317.83|||111.95|111.95|327.08|333.62|333.62|340.16|356.19|372.63|400.03|400.03|427.42|328.79|356.19|410.99|465.78|486.61|482.22|410.99|465.78| 111.95 | 486.61 | 372.63 45900020|HC REMOVAL NAILBED AND MATRIX|0459|11750|584.09|338.77|524.33|498.11|345.84|345.84|327.08|333.62|333.62|340.16|379.66|397.18|426.39|426.39|455.59|350.45|379.66|438.07|496.48|518.67|514.00|438.07|496.48| 327.08 | 524.33 | 426.39 45900021|HC REPAIR NAILBED|0459|11760|898.51|521.14|524.33|498.11|524.17|524.17|327.08|333.62|333.62|340.16|584.03|610.99|655.91|655.91|700.84|539.11|584.03|673.88|763.73|797.88|790.69|673.88|763.73| 327.08 | 797.88 | 584.03 45900022|HC EXCISION SKIN EDGE TOENAIL|0459|11765|438.42|254.28|524.33|498.11|345.84|345.84|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 261.66 | 524.33 | 328.82 45900023|HC SIMP REP SUPERFICIAL WND=<2.5C|0459|12001|673.22|390.47|437.40|415.53|179.55|179.55|261.01|266.23|266.23|271.45|437.59|457.79|491.45|491.45|525.11|403.93|437.59|504.92|572.24|597.82|592.43|504.92|572.24| 179.55 | 597.82 | 437.59 45900024|HC SIMP REP SUPERFICIAL WND2.6-7.|0459|12002|752.59|436.50|437.40|415.53|179.55|179.55|327.08|333.62|333.62|340.16|489.18|511.76|549.39|549.39|587.02|451.55|489.18|564.44|639.70|668.30|662.28|564.44|639.70| 179.55 | 668.30 | 489.18 45900025|HC SIMP REP SUPERFICIAL WND7.6-12|0459|12004|885.71|513.71|437.40|415.53|179.55|179.55|261.01|266.23|266.23|271.45|575.71|602.28|646.57|646.57|690.85|531.43|575.71|664.28|752.85|786.51|779.42|664.28|752.85| 179.55 | 786.51 | 575.71 45900026|HC SIMP REP SUPERFICIAL WND 12.6-|0459|12005|1,105.82|641.38|1,141.26|1,084.20|345.84|345.84|274.75|280.24|280.24|285.74|718.78|751.96|807.25|807.25|862.54|663.49|718.78|829.37|939.95|981.97|973.12|829.37|939.95| 274.75 | 1,141.26 | 807.25 45900027|HC SIMP REP SUPERFICIAL WND20.1-3|0459|12006|1,405.34|815.10|2,169.94|2,061.44|345.84|345.84|288.48|294.25|294.25|300.02|913.47|955.63|1025.90|1025.90|1096.17|843.20|913.47|1054.01|1194.54|1247.94|1236.70|1054.01|1194.54| 288.48 | 2,169.94 | 1,025.90 45900028|HC SIMP REP SUPERFICIAL WND>30CM|0459|12007|1,615.28|936.86|2,169.94|2,061.44|179.55|179.55|288.48|294.25|294.25|300.02|1049.93|1098.39|1179.15|1179.15|1259.92|969.17|1049.93|1211.46|1372.99|1434.37|1421.45|1211.46|1372.99| 179.55 | 2,169.94 | 1,179.15 45900029|HC SIMPLE REPAIR FACE <2.5CM|0459|12011|696.28|403.84|437.40|415.53|179.55|179.55|78.50|80.07|80.07|81.64|452.58|473.47|508.28|508.28|543.10|417.77|452.58|522.21|591.84|618.30|612.73|522.21|591.84| 78.50 | 618.30 | 452.58 45900030|HC SIMPLE REPAIR FACE 2.6-5CM|0459|12013|796.12|461.75|437.40|415.53|179.55|179.55|423.9|432.37|432.37|440.85|517.48|541.36|581.17|581.17|620.97|477.67|517.48|597.09|676.70|706.95|700.59|597.09|676.70| 179.55 | 706.95 | 517.48 45900031|HC SIMPLE REPAIR FACE 5.1-7.5 CM|0459|12014|959.95|556.77|437.40|415.53|179.55|179.55|423.9|432.37|432.37|440.85|623.97|652.77|700.76|700.76|748.76|575.97|623.97|719.96|815.96|852.44|844.76|719.96|815.96| 179.55 | 852.44 | 623.97 45900032|HC SIMPLE REPAIR FACE 7.6-12.5CM|0459|12015|1,208.25|700.79|1,141.26|1,084.20|179.55|179.55|423.90|432.37|432.37|440.85|785.36|821.61|882.02|882.02|942.44|724.95|785.36|906.19|1027.01|1072.93|1063.26|906.19|1027.01| 179.55 | 1,141.26 | 882.02 45900033|HC SIMPLE REPAIR FACE 12.6-20CM|0459|12016|1,479.60|858.17|1,141.26|1,084.20|345.84|345.84|423.90|432.37|432.37|440.85|961.74|1006.13|1080.11|1080.11|1154.09|887.76|961.74|1109.70|1257.66|1313.88|1302.05|1109.70|1257.66| 345.84 | 1,313.88 | 1,080.11 45900034|HC SIMPLE REPAIR FACE 20.1-30CM|0459|12017|1,786.74|1,036.31|2,169.94|2,061.44|345.84|345.84|457.91|467.07|467.07|476.23|1161.38|1214.98|1304.32|1304.32|1393.66|1072.04|1161.38|1340.06|1518.73|1586.63|1572.33|1340.06|1518.73| 345.84 | 2,169.94 | 1,304.32 45900035|HC SIMPLE REPAIR FACE >30CM|0459|12018|2,142.60|1,242.71|2,169.94|2,061.44|179.55|179.55|||||1392.69|1456.97|1564.10|1564.10|1671.23|1285.56|1392.69|1606.95|1821.21|1902.63|1885.49|1606.95|1821.21| 179.55 | 2,169.94 | 1,606.95 45900036|HC SIMPLE WOUND DEHISCENCE REPAIR|0459|12020|2,663.18|1,544.64|304.90|289.66|524.17|524.17|423.90|432.37|432.37|440.85|1731.07|1810.96|1944.12|1944.12|2077.28|1597.91|1731.07|1997.39|2263.70|2364.90|2343.60|1997.39|2263.70| 289.66 | 2,364.90 | 1,731.07 45900037|HC INT REPAIR SCALP/TRNK/EXT <2.5|0459|12031|1,027.10|595.72|437.40|415.53|345.84|345.84|327.08|333.62|333.62|340.16|667.62|698.43|749.78|749.78|801.14|616.26|667.62|770.33|873.04|912.06|903.85|770.33|873.04| 327.08 | 912.06 | 667.62 45900038|HC INT REPAIR SCALP/TRNK/EXT 2.6-|0459|12032|1,169.84|678.51|437.40|415.53|345.84|345.84|327.08|333.62|333.62|340.16|760.40|795.49|853.98|853.98|912.48|701.90|760.40|877.38|994.36|1038.82|1029.46|877.38|994.36| 327.08 | 1,038.82 | 760.40 45900039|HC INT REPAIR SCALP/TRNK/EXT 7.6-|0459|12034|1,223.61|709.69|1,141.26|1,084.20|345.84|345.84|327.08|333.62|333.62|340.16|795.35|832.05|893.24|893.24|954.42|734.17|795.35|917.71|1040.07|1086.57|1076.78|917.71|1040.07| 327.08 | 1,141.26 | 893.24 45900040|HC INT REPAIR SCALP/TRNK/EXT 12.6|0459|12035|1,746.68|1,013.07|1,141.26|1,084.20|345.84|345.84|327.08|333.62|333.62|340.16|1135.34|1187.74|1275.08|1275.08|1362.41|1048.01|1135.34|1310.01|1484.68|1551.05|1537.08|1310.01|1484.68| 327.08 | 1,551.05 | 1,141.26 45900041|HC INT REPAIR SCALP/TRNK/EXT 20.1|0459|12036|1,812.36|1,051.17|2169.94|2061.443|524.17|524.17|294.37|300.26|300.26|306.15|1178.03|1232.40|1323.02|1323.02|1413.64|1087.42|1178.03|1359.27|1540.51|1609.38|1594.88|1359.27|1540.51| 294.37 | 2,169.94 | 1,323.02 45900042|HC INT REPAIR SCALP/TRNK/EXT >30C|0459|12037|2,104.18|1,220.42|2,169.94|2,061.44|1,715.36|1,715.36|327.08|333.62|333.62|340.16|1367.72|1430.84|1536.05|1536.05|1641.26|1262.51|1367.72|1578.14|1788.55|1868.51|1851.68|1578.14|1788.55| 327.08 | 2,169.94 | 1,578.14 45900043|HC INT REPAIR HAND/FOOT/GEN <2.5C|0459|12041|990.65|574.58|210.86|200.32|345.84|345.84|294.37|300.26|300.26|306.15|643.92|673.64|723.17|723.17|772.71|594.39|643.92|742.99|842.05|879.70|871.77|742.99|842.05| 200.32 | 879.70 | 643.92 45900044|HC INT REPAIR HAND/FOOT/GEN 2.6-7|0459|12042|1,167.30|677.03|437.4|415.53|345.84|345.84|327.08|333.62|333.62|340.16|758.75|793.76|852.13|852.13|910.49|700.38|758.75|875.48|992.21|1036.56|1027.22|875.48|992.21| 327.08 | 1,036.56 | 758.75 45900045|HC INT REPAIR HAND/FOOT/GEN 7.6-1|0459|12044|1,310.64|760.17|1,141.26|1,084.20|524.17|524.17|392.50|400.35|400.35|408.20|851.92|891.24|956.77|956.77|1022.30|786.38|851.92|982.98|1114.04|1163.85|1153.36|982.98|1114.04| 392.50 | 1,163.85 | 956.77 45900046|HC INT REPAIR HAND/FOOT/GEN 12.6-|0459|12045|1,610.11|933.86|1,141.26|1,084.20|524.17|524.17|327.08|333.62|333.62|340.16|1046.57|1094.87|1175.38|1175.38|1255.89|966.07|1046.57|1207.58|1368.59|1429.78|1416.90|1207.58|1368.59| 327.08 | 1,429.78 | 1,094.87 45900047|HC INT REPAIR HAND/FOOT/GEN 20-30|0459|12046|1,904.50|1,104.61|2169.94|2061.443|524.17|524.17|||||1237.93|1295.06|1390.29|1390.29|1485.51|1142.70|1237.93|1428.38|1618.83|1691.20|1675.96|1428.38|1618.83| 524.17 | 2,169.94 | 1,428.38 45900048|HC INT REPAIR HAND/FOOT/GEN >30CM|0459|12047|2,096.49|1,215.96|2,169.94|2,061.44|1,715.36|1,715.36|||||1362.72|1425.61|1530.44|1530.44|1635.26|1257.89|1362.72|1572.37|1782.02|1861.68|1844.91|1572.37|1782.02| 1,257.89 | 2,169.94 | 1,635.26 45900049|HC INTERMEDIATE REPAIR FACE <2.5C|0459|12051|1,090.51|632.50|437.40|415.53|345.84|345.84|392.50|400.35|400.35|408.20|708.83|741.55|796.07|796.07|850.60|654.31|708.83|817.88|926.93|968.37|959.65|817.88|926.93| 345.84 | 968.37 | 708.83 45900050|HC INTERIMEDIATE REPAIR FACE 2.6-|0459|12052|1,203.13|697.82|437.4|415.53|345.84|345.84|392.5|400.35|400.35|408.2|782.03|818.13|878.28|878.28|938.44|721.88|782.03|902.35|1022.66|1068.38|1058.75|902.35|1022.66| 345.84 | 1,068.38 | 782.03 45900051|HC INTERMEDIATE REPAIR FACE 5.1-7|0459|12053|1,292.74|749.79|437.4|415.53|345.84|345.84|392.50|400.35|400.35|408.20|840.28|879.06|943.70|943.70|1008.34|775.64|840.28|969.56|1098.83|1147.95|1137.61|969.56|1098.83| 345.84 | 1,147.95 | 840.28 45900052|HC INTERMEDIATE REPAIR FACE 7.6-1|0459|12054|1,410.48|818.08|1,141.26|1,084.20|345.84|345.84|392.50|400.35|400.35|408.20|916.81|959.13|1029.65|1029.65|1100.17|846.29|916.81|1057.86|1198.91|1252.51|1241.22|1057.86|1198.91| 345.84 | 1,252.51 | 1,029.65 45900053|HC INTERMEDIATE REPAIR FACE 12.6-|0459|12055|1,797.02|1,042.27|1,141.26|1,084.20|345.84|345.84|392.50|400.35|400.35|408.20|1168.06|1221.97|1311.82|1311.82|1401.68|1078.21|1168.06|1347.77|1527.47|1595.75|1581.38|1347.77|1527.47| 345.84 | 1,595.75 | 1,168.06 45900054|HC INTERMEDIATE REPAIR FACE 20.1-|0459|12056|2,234.76|1,296.16|2,169.94|2,061.44|345.84|345.84|||||1452.59|1519.64|1631.37|1631.37|1743.11|1340.86|1452.59|1676.07|1899.55|1984.47|1966.59|1676.07|1899.55| 345.84 | 2,169.94 | 1,676.07 45900055|HC INTERMEDIATE REPAIR FACE >30CM|0459|12057|2,575.22|1,493.63|2,169.94|2,061.44|345.84|345.84|||||1673.89|1751.15|1879.91|1879.91|2008.67|1545.13|1673.89|1931.42|2188.94|2286.80|2266.19|1931.42|2188.94| 345.84 | 2,286.80 | 1,931.42 45900056|HC COMPLEX REPAIR TRUNK 1.1-2.5CM|0459|13100|1,471.92|853.71|437.40|415.53|524.17|524.17|327.08|333.62|333.62|340.16|956.75|1000.91|1074.50|1074.50|1148.10|883.15|956.75|1103.94|1251.13|1307.06|1295.29|1103.94|1251.13| 327.08 | 1,307.06 | 956.75 45900057|HC COMPLEX REPAIR TRUNK 2.6-7.5 C|0459|13101|1,781.64|1,033.35|760.83|722.79|524.17|524.17|392.50|400.35|400.35|408.20|1158.07|1211.52|1300.60|1300.60|1389.68|1068.98|1158.07|1336.23|1514.39|1582.10|1567.84|1336.23|1514.39| 392.50 | 1,582.10 | 1,158.07 45900058|HC COMPLEX REPAIR TRUNK >7.5 EA A|0459|13102|496.63|288.05|||||||||322.81|337.71|362.54|362.54|387.37|297.98|322.81|372.47|422.14|441.01|437.03|372.47|422.14| 297.98 | 441.01 | 372.47 45900059|HC COMP REPAIR SCALP/ARM/LEG 1.1-|0459|13120|1,953.16|1,132.83|437.40|415.53|524.17|524.17|327.08|333.62|333.62|340.16|1269.55|1328.15|1425.81|1425.81|1523.46|1171.90|1269.55|1464.87|1660.19|1734.41|1718.78|1464.87|1660.19| 327.08 | 1,734.41 | 1,269.55 45900060|HC COMP REPAIR SCALP/ARM/LEG 2.6-|0459|13121|1,953.16|1,132.83|760.83|722.79|524.17|524.17|457.91|467.07|467.07|476.23|1269.55|1328.15|1425.81|1425.81|1523.46|1171.90|1269.55|1464.87|1660.19|1734.41|1718.78|1464.87|1660.19| 457.91 | 1,734.41 | 1,269.55 45900061|HC COMP REPAIR SCALP/ARM/LEG >7.5|0459|13122|568.29|329.61|||||||||369.39|386.44|414.85|414.85|443.27|340.97|369.39|426.22|483.05|504.64|500.10|426.22|483.05| 340.97 | 504.64 | 426.22 45900062|HC COMPLEX REPAIR FACE 1.1-2.5 CM|0459|13131|1,740.67|1,009.59|437.40|415.53|345.84|345.84|327.08|333.62|333.62|340.16|1131.44|1183.66|1270.69|1270.69|1357.72|1044.40|1131.44|1305.50|1479.57|1545.71|1531.79|1305.50|1479.57| 327.08 | 1,545.71 | 1,131.44 45900063|HC COMPLEX REPAIR FACE 2.6-7.5CM|0459|13132|2,725.17|1,580.60|760.83|722.79|524.17|524.17|327.08|333.62|333.62|340.16|1771.36|1853.12|1989.37|1989.37|2125.63|1635.10|1771.36|2043.88|2316.39|2419.95|2398.15|2043.88|2316.39| 327.08 | 2,419.95 | 1,771.36 45900064|HC COMPLEX REPAIR FACE >7.5CM EA|0459|13133|1,246.93|723.22|||||||||810.50|847.91|910.26|910.26|972.61|748.16|810.50|935.20|1059.89|1107.27|1097.30|935.20|1059.89| 748.16 | 1,107.27 | 935.20 45900065|HC COMP REPAIR EYELID/NOSE 1.1-2.|0459|13151|2,032.54|1,178.87|437.40|415.53|524.17|524.17|327.08|333.62|333.62|340.16|1321.15|1382.13|1483.75|1483.75|1585.38|1219.52|1321.15|1524.41|1727.66|1804.90|1788.64|1524.41|1727.66| 327.08 | 1,804.90 | 1,321.15 45900066|HC COMP REPAIR EYELID/NOSE 2.6-7.|0459|13152|2,756.95|1,599.03|1141.26|1084.197|524.17|524.17|327.08|333.62|333.62|340.16|1792.02|1874.73|2012.57|2012.57|2150.42|1654.17|1792.02|2067.71|2343.41|2448.17|2426.12|2067.71|2343.41| 327.08 | 2,448.17 | 1,792.02 45900067|HC COMP REPAIR EYELID/NOSE/LIP >7|0459|13153|954.83|553.80|||||||||620.64|649.28|697.03|697.03|744.77|572.90|620.64|716.12|811.61|847.89|840.25|716.12|811.61| 572.90 | 847.89 | 716.12 45900068|HC MINOR LOCAL BURN TX|0459|16000|602.84|349.65|||179.55|179.55|359.79|366.98|366.98|374.18|391.85|409.93|440.07|440.07|470.22|361.70|391.85|452.13|512.41|535.32|530.50|452.13|512.41| 179.55 | 535.32 | 409.93 45900069|HC SMALL BURN TX|0459|16020|854.50|495.61|524.33|498.11|179.55|179.55|217.05|221.39|221.39|225.73|555.43|581.06|623.79|623.79|666.51|512.70|555.43|640.88|726.33|758.80|751.96|640.88|726.33| 179.55 | 758.80 | 555.43 45900070|HC MEDIUM BURN TX|0459|16025|762.83|442.44|524.33|498.11|179.55|179.55|217.05|221.39|221.39|225.73|495.84|518.72|556.87|556.87|595.01|457.70|495.84|572.12|648.41|677.39|671.29|572.12|648.41| 179.55 | 677.39 | 518.72 45900071|HC MAJOR BURN TX|0459|16030|870.33|504.79|524.33|498.11|345.84|345.84|359.79|366.98|366.98|374.18|565.71|591.82|635.34|635.34|678.86|522.20|565.71|652.75|739.78|772.85|765.89|652.75|739.78| 345.84 | 772.85 | 565.71 45900072|HC CHEMICAL CAUTERY, TISSUE|0459|17250|703.21|407.86|437.40|415.53|179.55|179.55|98.12|100.09|100.09|102.05|457.09|478.18|513.34|513.34|548.50|421.93|457.09|527.41|597.73|624.45|618.82|527.41|597.73| 98.12 | 624.45 | 457.09 45900073|HC PUNCTURE ASPIRATION CYST BREAS|0459|19000|493.19|286.05|524.33|498.11|621.97|621.97|294.37|300.26|300.26|306.15|320.57|335.37|360.03|360.03|384.69|295.91|320.57|369.89|419.21|437.95|434.01|369.89|419.21| 294.37 | 621.97 | 369.89 45900074|HC WOUND EXPLORATION NECK|0459|20100|4,044.53|2,345.83|437.4|415.53|452.36|452.36|588.74|600.52|600.52|612.29|2628.94|2750.28|2952.51|2952.51|3154.73|2426.72|2628.94|3033.40|3437.85|3591.54|3559.19|3033.40|3437.85| 415.53 | 3,591.54 | 2,628.94 45900075|HC WOUND EXPLORATION CHEST|0459|20101|1,343.92|779.47|437.40|415.53|1,715.36|1,715.36|588.74|600.52|600.52|612.29|873.55|913.87|981.06|981.06|1048.26|806.35|873.55|1007.94|1142.33|1193.40|1182.65|1007.94|1142.33| 415.53 | 1,715.36 | 981.06 45900076|HC WOUND EXPLORATION TRUNK|0459|20102|1,620.37|939.81|437.40|415.53|1,715.36|1,715.36|588.74|600.52|600.52|612.29|1053.24|1101.85|1182.87|1182.87|1263.89|972.22|1053.24|1215.28|1377.31|1438.89|1425.93|1215.28|1377.31| 415.53 | 1,715.36 | 1,182.87 45900077|HC WOUND EXPLORATION EXTREMITY|0459|20103|2,378.09|1,379.29|437.40|415.53|621.97|621.97|588.74|600.52|600.52|612.29|1545.76|1617.10|1736.01|1736.01|1854.91|1426.85|1545.76|1783.57|2021.38|2111.74|2092.72|1783.57|2021.38| 415.53 | 2,111.74 | 1,545.76 45900078|HC TENDON SHEATH/LIGAMENT INJECTI|0459|20550|368.26|213.59|200.91|190.86|261.17|261.17|219.80|224.19|224.19|228.59|239.37|250.42|268.83|268.83|287.24|220.96|239.37|276.20|313.02|327.01|324.07|276.20|313.02| 190.86 | 327.01 | 261.17 45900079|HC TRIGGER POINT INJ 1-2 MUSCLES|0459|20552|368.26|213.59|200.91|190.86|261.17|261.17|219.80|224.19|224.19|228.59|239.37|250.42|268.83|268.83|287.24|220.96|239.37|276.20|313.02|327.01|324.07|276.20|313.02| 190.86 | 327.01 | 261.17 45900080|HC ARTHROCENTESIS SMALL JOINT|0459|20600|368.26|213.59|200.91|190.86|261.17|261.17|219.80|224.19|224.19|228.59|239.37|250.42|268.83|268.83|287.24|220.96|239.37|276.20|313.02|327.01|324.07|276.20|313.02| 190.86 | 327.01 | 261.17 45900081|HC ARTHROCENTESIS INTERMEDIATE JO|0459|20605|970.28|562.76|437.40|415.53|261.17|261.17|219.80|224.19|224.19|228.59|630.68|659.79|708.30|708.30|756.82|582.17|630.68|727.71|824.74|861.61|853.85|727.71|824.74| 219.80 | 861.61 | 630.68 45900082|HC ARTHROCENTESIS MAJOR JOINT|0459|20610|1,333.41|773.38|1,616.54|1,535.71|261.17|261.17|294.37|300.26|300.26|306.15|866.72|906.72|973.39|973.39|1040.06|800.05|866.72|1000.06|1133.40|1184.07|1173.40|1000.06|1133.40| 261.17 | 1,616.54 | 973.39 45900083|HC JAW REDUCTION|0459|21480|657.59|381.40|||206.19|206.19|392.50|400.35|400.35|408.20|427.43|447.16|480.04|480.04|512.92|394.55|427.43|493.19|558.95|583.94|578.68|493.19|558.95| 206.19 | 583.94 | 447.16 45900084|HC CLOSED TX CLAVICLE W/O MANIP|0459|23500|1,274.79|739.38|1,141.26|1,084.20|206.19|206.19|327.08|333.62|333.62|340.16|828.61|866.86|930.60|930.60|994.34|764.87|828.61|956.09|1083.57|1132.01|1121.82|956.09|1083.57| 206.19 | 1,141.26 | 930.60 45900085|HC CLOSED TX CLAVICLE W/MANIP|0459|23505|2,083.68|1,208.53|1141.26|1084.197|1,392.35|1,392.35|241.29|246.12|246.12|250.95|1354.39|1416.90|1521.09|1521.09|1625.27|1250.21|1354.39|1562.76|1771.13|1850.31|1833.64|1562.76|1771.13| 241.29 | 1,850.31 | 1,392.35 45900086|HC ACROMIOCLAVICULAR DISLOC W/MAN|0459|23545|1,794.44|1,040.78|1,141.26|1,084.20|206.19|206.19|249.68|254.67|254.67|259.67|1166.39|1220.22|1309.94|1309.94|1399.66|1076.66|1166.39|1345.83|1525.27|1593.46|1579.11|1345.83|1525.27| 206.19 | 1,593.46 | 1,166.39 45900087|HC CLOSED TX GREATER HUM TUB W/O|0459|23620|1,505.19|873.01|2,051.68|1,949.10|206.19|206.19|457.91|467.07|467.07|476.23|978.37|1023.53|1098.79|1098.79|1174.05|903.11|978.37|1128.89|1279.41|1336.61|1324.57|1128.89|1279.41| 206.19 | 2,051.68 | 1,098.79 45900088|HC SHOULDER REDUCTION|0459|23650|1,666.47|966.55|1,141.26|1,084.20|206.19|206.19|327.08|333.62|333.62|340.16|1083.21|1133.20|1216.52|1216.52|1299.85|999.88|1083.21|1249.85|1416.50|1479.83|1466.49|1249.85|1416.50| 206.19 | 1,479.83 | 1,133.20 45900089|HC CLOSED SHOULDER REDUCTION W/AN|0459|23655|2,431.85|1,410.47|1,141.26|1,084.20|1,392.35|1,392.35|392.50|400.35|400.35|408.20|1580.70|1653.66|1775.25|1775.25|1896.84|1459.11|1580.70|1823.89|2067.07|2159.48|2140.03|1823.89|2067.07| 392.50 | 2,159.48 | 1,580.70 45900090|HC CLOSED TX GREATER HUM TUB FX W|0459|23665|2,523.99|1,463.91|1,141.26|1,084.20|1,392.35|1,392.35|327.08|333.62|333.62|340.16|1640.59|1716.31|1842.51|1842.51|1968.71|1514.39|1640.59|1892.99|2145.39|2241.30|2221.11|1892.99|2145.39| 327.08 | 2,241.30 | 1,640.59 45900091|HC I&D UPPER ARM OR ELBOW BURSA|0459|23931|1,216.72|705.70|||1,407.00|1,407.00|457.91|467.07|467.07|476.23|790.87|827.37|888.21|888.21|949.04|730.03|790.87|912.54|1034.21|1080.45|1070.71|912.54|1034.21| 457.91 | 1,407.00 | 888.21 45900092|HC CLOSED TX SUPRA/TRANSCONDYLAR|0459|24530|2,010.94|1,166.35|2,051.68|1,949.10|206.19|206.19|392.50|400.35|400.35|408.20|1307.11|1367.44|1467.99|1467.99|1568.53|1206.56|1307.11|1508.21|1709.30|1785.71|1769.63|1508.21|1709.30| 206.19 | 2,051.68 | 1,467.99 45900093|HC POSTERIOR ELBOW REDUCTION|0459|24600|3,647.73|2,115.68|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|2371.02|2480.46|2662.84|2662.84|2845.23|2188.64|2371.02|2735.80|3100.57|3239.18|3210.00|2735.80|3100.57| 206.19 | 3,239.18 | 2,371.02 45900094|HC CLOSED ELBOW REDUCTION W/ANEST|0459|24605|2,840.64|1,647.57|1,575.81|1,497.02|1,392.35|1,392.35|392.50|400.35|400.35|408.20|1846.42|1931.64|2073.67|2073.67|2215.70|1704.38|1846.42|2130.48|2414.54|2522.49|2499.76|2130.48|2414.54| 392.50 | 2,522.49 | 1,846.42 45900095|HC CLOSED TX MONTEGGIA FRACTURE|0459|24620|3,634.95|2,108.27|1,141.26|1,084.20|1,392.35|1,392.35|457.91|467.07|467.07|476.23|2362.72|2471.77|2653.51|2653.51|2835.26|2180.97|2362.72|2726.21|3089.71|3227.84|3198.76|2726.21|3089.71| 457.91 | 3,227.84 | 2,362.72 45900096|HC REDUCTION NURSEMAIDS ELBOW|0459|24640|767.20|444.98|1,141.26|1,084.20|206.19|206.19|457.91|467.07|467.07|476.23|498.68|521.70|560.06|560.06|598.42|460.32|498.68|575.40|652.12|681.27|675.14|575.40|652.12| 206.19 | 1,141.26 | 560.06 45900097|HC CLOSED TX RADIAL SHAFT FX W/ M|0459|25505|2,948.96|1,710.40|2,051.68|1,949.10|1,392.35|1,392.35|392.50|400.35|400.35|408.20|1916.82|2005.29|2152.74|2152.74|2300.19|1769.38|1916.82|2211.72|2506.62|2618.68|2595.08|2211.72|2506.62| 392.50 | 2,618.68 | 2,005.29 45900098|HC CLOSED TX COLLES FX W/ MANIP|0459|25605|3,469.06|2,012.05|2,051.68|1,949.10|1,392.35|1,392.35|392.50|400.35|400.35|408.20|2254.89|2358.96|2532.41|2532.41|2705.87|2081.44|2254.89|2601.80|2948.70|3080.53|3052.77|2601.80|2948.70| 392.50 | 3,080.53 | 2,254.89 45900099|HC WRIST REDUCTION|0459|25660|2,580.31|1,496.58|2,051.68|1,949.10|206.19|206.19|425.20|433.71|433.71|442.21|1677.20|1754.61|1883.63|1883.63|2012.64|1548.19|1677.20|1935.23|2193.26|2291.32|2270.67|1935.23|2193.26| 206.19 | 2,291.32 | 1,883.63 45900100|HC I&D SIMPLE FINGER ABSCESS|0459|26010|854.99|495.89|105.42|100.15|179.55|179.55|255.12|260.22|260.22|265.33|555.74|581.39|624.14|624.14|666.89|512.99|555.74|641.24|726.74|759.23|752.39|641.24|726.74| 100.15 | 759.23 | 555.74 45900101|HC I&D COMPLICATED FINGER ABSCESS|0459|26011|1,397.83|810.74|437.40|415.53|1,407.00|1,407.00|255.12|260.22|260.22|265.33|908.59|950.52|1020.42|1020.42|1090.31|838.70|908.59|1048.37|1188.16|1241.27|1230.09|1048.37|1188.16| 255.12 | 1,407.00 | 1,020.42 45900102|HC OSTEOTOMY CORRCT DFORMTY PHALA|0459|26567|7,900.79|4,582.46|||2,830.40|2,830.40|392.50|400.35|400.35|408.20|5135.51|5372.54|5767.58|5767.58|6162.62|4740.47|5135.51|5925.59|6715.67|7015.90|6952.70|5925.59|6715.67| 392.50 | 7,015.90 | 5,372.54 45900103|HC CLOSED TX METCARP FX W/ MANIP|0459|26605|1,799.57|1,043.75|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|1169.72|1223.71|1313.69|1313.69|1403.66|1079.74|1169.72|1349.68|1529.63|1598.02|1583.62|1349.68|1529.63| 206.19 | 1,598.02 | 1,169.72 45900104|HC THUMB REDUCTION|0459|26641|2,029.95|1,177.37|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|1319.47|1380.37|1481.86|1481.86|1583.36|1217.97|1319.47|1522.46|1725.46|1802.60|1786.36|1522.46|1725.46| 206.19 | 1,802.60 | 1,319.47 45900105|HC HAND REDUCTION|0459|26670|1,812.36|1,051.17|1,141.26|1,084.20|206.19|206.19|237.60|242.36|242.36|247.11|1178.03|1232.40|1323.02|1323.02|1413.64|1087.42|1178.03|1359.27|1540.51|1609.38|1594.88|1359.27|1540.51| 206.19 | 1,609.38 | 1,178.03 45900106|HC FINGER MP REDUCTION|0459|26700|1,786.74|1,036.31|1,141.26|1,084.20|206.19|206.19|39.25|40.03|40.03|40.82|1161.38|1214.98|1304.32|1304.32|1393.66|1072.04|1161.38|1340.06|1518.73|1586.63|1572.33|1340.06|1518.73| 39.25 | 1,586.63 | 1,161.38 45900107|HC CLD TX PRX/MID PH FING/THUMB W|0459|26720|1,039.30|602.79|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|675.55|706.72|758.69|758.69|810.65|623.58|675.55|779.48|883.41|922.90|914.58|779.48|883.41| 206.19 | 1,141.26 | 758.69 45900108|HC CLD TX PR/MID PH FINGER/THUMB|0459|26725|1,894.28|1,098.68|1,588.63|1,509.20|206.19|206.19|392.50|400.35|400.35|408.20|1231.28|1288.11|1382.82|1382.82|1477.54|1136.57|1231.28|1420.71|1610.14|1682.12|1666.97|1420.71|1610.14| 206.19 | 1,682.12 | 1,382.82 45900109|HC CLD TX ARTICULAR FX W/ MANIP|0459|26742|2,124.68|1,232.31|1,141.26|1,084.20|1,392.35|1,392.35|392.50|400.35|400.35|408.20|1381.04|1444.78|1551.02|1551.02|1657.25|1274.81|1381.04|1593.51|1805.98|1886.72|1869.72|1593.51|1805.98| 392.50 | 1,886.72 | 1,392.35 45900110|HC CLD TX DIST PHA FINGER THUMB W|0459|26755|1,681.82|975.46|763.68|725.50|206.19|206.19|392.50|400.35|400.35|408.20|1093.18|1143.64|1227.73|1227.73|1311.82|1009.09|1093.18|1261.37|1429.55|1493.46|1480.00|1261.37|1429.55| 206.19 | 1,493.46 | 1,093.18 45900111|HC REDUCTION FINGER PIP|0459|26770|1,479.60|858.17|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|961.74|1006.13|1080.11|1080.11|1154.09|887.76|961.74|1109.70|1257.66|1313.88|1302.05|1109.70|1257.66| 206.19 | 1,313.88 | 1,080.11 45900112|HC IP JOINT REDUCTION W/ ANESTHES|0459|26775|2,083.68|1,208.53|1,141.26|1,084.20|241.17|241.17|392.50|400.35|400.35|408.20|1354.39|1416.90|1521.09|1521.09|1625.27|1250.21|1354.39|1562.76|1771.13|1850.31|1833.64|1562.76|1771.13| 241.17 | 1,850.31 | 1,354.39 45900113|HC AMPUTATE FING/TH,SGL,W DIR CLO|0459|26951|2,152.46|1,248.43|2,954.97|2,807.22|2,830.40|2,830.40|392.50|400.35|400.35|408.20|1399.10|1463.67|1571.30|1571.30|1678.92|1291.48|1399.10|1614.35|1829.59|1911.38|1894.16|1614.35|1829.59| 392.50 | 2,954.97 | 1,614.35 45900114|HC REDUCTION HIP TRAUMA|0459|27250|3,015.67|1,749.09|763.68|725.50|206.19|206.19|523.33|533.79|533.79|544.26|1960.19|2050.66|2201.44|2201.44|2352.22|1809.40|1960.19|2261.75|2563.32|2677.91|2653.79|2261.75|2563.32| 206.19 | 2,677.91 | 1,960.19 45900115|HC REDUCT HIP (TRAUMA) DISL W/ AN|0459|27252|5,065.92|2,938.23|1,520.24|1,444.23|1,392.35|1,392.35|523.33|533.79|533.79|544.26|3292.85|3444.83|3698.12|3698.12|3951.42|3039.55|3292.85|3799.44|4306.03|4498.54|4458.01|3799.44|4306.03| 523.33 | 4,498.54 | 3,292.85 45900116|HC REDUCTION HIP POST ARTHROPLAST|0459|27265|2,520.97|1,462.16|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|1638.63|1714.26|1840.31|1840.31|1966.36|1512.58|1638.63|1890.73|2142.82|2238.62|2218.45|1890.73|2142.82| 206.19 | 2,238.62 | 1,638.63 45900117|HC REDUC HIP (POST ARTHROPLAS) W/|0459|27266|3,684.20|2,136.84|1,520.24|1,444.23|1,392.35|1,392.35|654.16|667.24|667.24|680.33|2394.73|2505.26|2689.47|2689.47|2873.68|2210.52|2394.73|2763.15|3131.57|3271.57|3242.10|2763.15|3131.57| 654.16 | 3,271.57 | 2,394.73 45900118|HC CLOSED TX FEMORAL SHAFT W/MANI|0459|27502|5,337.27|3,095.62|2,051.68|1,949.10|1,392.35|1,392.35|457.91|467.07|467.07|476.23|3469.23|3629.34|3896.21|3896.21|4163.07|3202.36|3469.23|4002.95|4536.68|4739.50|4696.80|4002.95|4536.68| 457.91 | 4,739.50 | 3,469.23 45900119|HC REDUCTION KNEE|0459|27550|2,931.03|1,700.00|1,141.26|1,084.20|206.19|206.19|457.91|467.07|467.07|476.23|1905.17|1993.10|2139.65|2139.65|2286.20|1758.62|1905.17|2198.27|2491.38|2602.75|2579.31|2198.27|2491.38| 206.19 | 2,602.75 | 1,905.17 45900120|HC REDUCTION KNEE PATELLA|0459|27560|1,925.00|1,116.50|1,141.26|1,084.20|206.19|206.19|457.91|467.07|467.07|476.23|1251.25|1309.00|1405.25|1405.25|1501.50|1155.00|1251.25|1443.75|1636.25|1709.40|1694.00|1443.75|1636.25| 206.19 | 1,709.40 | 1,251.25 45900121|HC REDUCTION PATELLA W/ ANESTHESI|0459|27562|2,941.25|1,705.93|1,520.24|1,444.23|206.19|206.19|457.91|467.07|467.07|476.23|1911.81|2000.05|2147.11|2147.11|2294.18|1764.75|1911.81|2205.94|2500.06|2611.83|2588.30|2205.94|2500.06| 206.19 | 2,611.83 | 1,911.81 45900122|HC CLSD TX TIBIAL SHAFT W/MANIP|0459|27752|3,250.99|1,885.57|2051.68|1949.096|1,392.35|1,392.35|457.91|467.07|467.07|476.23|2113.14|2210.67|2373.22|2373.22|2535.77|1950.59|2113.14|2438.24|2763.34|2886.88|2860.87|2438.24|2763.34| 457.91 | 2,886.88 | 2,113.14 45900123|HC CLSD TX PROX FIB OR SHAFT W/MA|0459|27781|2,500.95|1,450.55|2,051.68|1,949.10|1,392.35|1,392.35|||||1625.62|1700.65|1825.69|1825.69|1950.74|1500.57|1625.62|1875.71|2125.81|2220.84|2200.84|1875.71|2125.81| 1,392.35 | 2,220.84 | 1,875.71 45900124|HC CLOSED TX LAT MALLEOLUS W/MANI|0459|27788|2,513.74|1,457.97|2,051.68|1,949.10|206.19|206.19|392.50|400.35|400.35|408.20|1633.93|1709.34|1835.03|1835.03|1960.72|1508.24|1633.93|1885.31|2136.68|2232.20|2212.09|1885.31|2136.68| 206.19 | 2,232.20 | 1,835.03 45900125|HC CLSD TX BIMALLEOLAR W/MANIP|0459|27810|2,691.14|1,560.86|2,051.68|1,949.10|1,392.35|1,392.35|392.50|400.35|400.35|408.20|1749.24|1829.98|1964.53|1964.53|2099.09|1614.68|1749.24|2018.36|2287.47|2389.73|2368.20|2018.36|2287.47| 392.50 | 2,389.73 | 1,949.10 45900126|HC CLSD TX TRIMALLEOLAR W/ MANIP|0459|27818|2,777.43|1,610.91|2,051.68|1,949.10|1,392.35|1,392.35|392.50|400.35|400.35|408.20|1805.33|1888.65|2027.52|2027.52|2166.40|1666.46|1805.33|2083.07|2360.82|2466.36|2444.14|2083.07|2360.82| 392.50 | 2,466.36 | 1,949.10 45900127|HC REDUCTION ANKLE|0459|27840|2,262.90|1,312.48|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|1470.89|1538.77|1651.92|1651.92|1765.06|1357.74|1470.89|1697.18|1923.47|2009.46|1991.35|1697.18|1923.47| 206.19 | 2,009.46 | 1,470.89 45900128|HC FOREIGN BODY REMOVAL SQ FOOT|0459|28190|1,067.22|618.99|193.78|184.09|621.97|621.97|523.33|533.79|533.79|544.26|693.69|725.71|779.07|779.07|832.43|640.33|693.69|800.42|907.14|947.69|939.15|800.42|907.14| 184.09 | 947.69 | 693.69 45900129|HC FOREIGN BODY REMOVAL FOOT DEEP|0459|28192|2,265.44|1,313.96|437.40|415.53|1,407.00|1,407.00|523.33|533.79|533.79|544.26|1472.54|1540.50|1653.77|1653.77|1767.04|1359.26|1472.54|1699.08|1925.62|2011.71|1993.59|1699.08|1925.62| 415.53 | 2,011.71 | 1,472.54 45900130|HC FOREIGN BODY REMOVAL FOOT COMP|0459|28193|2,657.12|1,541.13|2,169.94|2,061.44|1,407.00|1,407.00|523.33|533.79|533.79|544.26|1727.13|1806.84|1939.70|1939.70|2072.55|1594.27|1727.13|1992.84|2258.55|2359.52|2338.27|1992.84|2258.55| 523.33 | 2,359.52 | 1,939.70 45900131|HC CLSD TX TALUS W/ MANIP|0459|28435|1,940.36|1,125.41|2,281.07|2,167.02|1,392.35|1,392.35|357.37|364.51|364.51|371.66|1261.23|1319.44|1416.46|1416.46|1513.48|1164.22|1261.23|1455.27|1649.31|1723.04|1707.52|1455.27|1649.31| 357.37 | 2,281.07 | 1,416.46 45900132|HC CLSD TX OTHER TOE W/ MANIP|0459|28515|911.30|528.55|609.80|579.31|206.19|206.19|392.50|400.35|400.35|408.20|592.35|619.68|665.25|665.25|710.81|546.78|592.35|683.48|774.61|809.23|801.94|683.48|774.61| 206.19 | 809.23 | 609.80 45900133|HC REDUCTION TOE MP|0459|28630|744.90|432.04|1,141.26|1,084.20|206.19|206.19|130.83|133.45|133.45|136.07|484.19|506.53|543.78|543.78|581.02|446.94|484.19|558.68|633.17|661.47|655.51|558.68|633.17| 130.83 | 1,141.26 | 543.78 45900134|HC REDUCTION TOE IP|0459|28660|657.59|381.40|1141.26|1084.197|206.19|206.19|392.5|400.35|400.35|408.2|427.43|447.16|480.04|480.04|512.92|394.55|427.43|493.19|558.95|583.94|578.68|493.19|558.95| 206.19 | 1,141.26 | 480.04 45900135|HC LONG ARM CAST|0459|29065|450.52|261.30|609.80|579.31|241.17|241.17|261.66|266.90|266.90|272.13|292.84|306.35|328.88|328.88|351.41|270.31|292.84|337.89|382.94|400.06|396.46|337.89|382.94| 241.17 | 609.80 | 328.88 45900136|HC SHORT ARM CAST|0459|29075|438.42|254.28|609.80|579.31|241.17|241.17|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 241.17 | 609.80 | 320.05 45900137|HC LONG ARM SPLINT|0459|29105|438.42|254.28|324.86|308.62|141.18|141.18|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 141.18 | 389.32 | 308.62 45900138|HC SHORT ARM SPLINT|0459|29125|438.42|254.28|324.86|308.62|111.95|111.95|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 111.95 | 389.32 | 308.62 45900139|HC CHEST STRAPPING|0459|29200|263.68|152.93|||141.18|141.18|37.94|38.7|38.7|39.46|171.39|179.30|192.49|192.49|205.67|158.21|171.39|197.76|224.13|234.15|232.04|197.76|224.13| 37.94 | 234.15 | 179.30 45900140|HC SHOULDER VELPEAU STRAPPING|0459|29240|291.80|169.24|391.81|372.2195|111.95|111.95|37.94|38.70|38.70|39.46|189.67|198.42|213.01|213.01|227.60|175.08|189.67|218.85|248.03|259.12|256.78|218.85|248.03| 37.94 | 391.81 | 213.01 45900141|HC ELBOW/WRIST STRAPPING|0459|29260|238.06|138.07|391.81|372.2195|55.66|55.66|28.78|29.36|29.36|29.93|154.74|161.88|173.78|173.78|185.69|142.84|154.74|178.55|202.35|211.40|209.49|178.55|202.35| 28.78 | 391.81 | 173.78 45900142|HC SHORT LEG CAST|0459|29405|438.42|254.28|391.81|372.2195|241.17|241.17|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 241.17 | 391.81 | 320.05 45900143|HC LONG LEG SPLINT|0459|29505|175.04|101.52|324.86|308.617|141.18|141.18|261.66|266.90|266.90|272.13|113.78|119.03|127.78|127.78|136.53|105.02|113.78|131.28|148.78|155.44|154.04|131.28|148.78| 105.02 | 324.86 | 141.18 45900144|HC SHORT LEG SPLINT|0459|29515|438.42|254.28|324.86|308.62|141.18|141.18|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 141.18 | 389.32 | 308.62 45900145|HC HIP STRAPPING|0459|29520|251.08|145.63|391.81|372.22|111.95|111.95|||||163.20|170.73|183.29|183.29|195.84|150.65|163.20|188.31|213.42|222.96|220.95|188.31|213.42| 111.95 | 391.81 | 188.31 45900146|HC KNEE STRAPPING|0459|29530|438.42|254.28|391.81|372.2195|111.95|111.95|261.66|266.9|266.9|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 111.95 | 391.81 | 320.05 45900147|HC UNNA BOOT STRAPPING|0459|29580|248.29|144.01|391.81|372.2195|141.18|141.18|65.42|66.72|66.72|68.03|161.39|168.84|181.25|181.25|193.67|148.97|161.39|186.22|211.05|220.48|218.50|186.22|211.05| 65.42 | 391.81 | 181.25 45900148|HC REMOV/REVI GAUNTLET BOOT/BODY|0459|29700|438.42|254.28|393.23|373.5685|241.17|241.17|261.66|266.9|266.9|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 241.17 | 393.23 | 320.05 45900149|HC REMV/REVI LONG ARM/LEG CAST|0459|29705|438.42|254.28|393.23|373.5685|241.17|241.17|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 241.17 | 393.23 | 320.05 45900150|HC REMV/REVI SHOULDER/HIP SPICA C|0459|29710|570.84|331.09|393.23|373.5685|241.17|241.17|261.66|266.90|266.90|272.13|371.05|388.17|416.71|416.71|445.26|342.50|371.05|428.13|485.21|506.91|502.34|428.13|485.21| 241.17 | 506.91 | 388.17 45900151|HC WEDGE CAST|0459|29740|458.22|265.77|||241.17|241.17|||||297.84|311.59|334.50|334.50|357.41|274.93|297.84|343.67|389.49|406.90|403.23|343.67|389.49| 241.17 | 406.90 | 334.50 45900152|HC FOREIGN BODY REMOVAL NOSE|0459|30300|773.07|448.38|95.46|90.69|111.95|111.95|176.62|180.16|180.16|183.69|502.50|525.69|564.34|564.34|602.99|463.84|502.50|579.80|657.11|686.49|680.30|579.80|657.11| 90.69 | 686.49 | 502.50 45900153|HC ANTERIOR NASAL PACKING SIMPLE|0459|30901|493.19|286.05|210.86|200.32|111.95|111.95|294.37|300.26|300.26|306.15|320.57|335.37|360.03|360.03|384.69|295.91|320.57|369.89|419.21|437.95|434.01|369.89|419.21| 111.95 | 437.95 | 320.57 45900154|HC ANTERIOR NASAL PACKING COMPLEX|0459|30903|657.59|381.40|636.86|605.02|111.95|111.95|392.5|400.35|400.35|408.2|427.43|447.16|480.04|480.04|512.92|394.55|427.43|493.19|558.95|583.94|578.68|493.19|558.95| 111.95 | 636.86 | 480.04 45900155|HC POSTERIOR NASAL PACKING INITIA|0459|30905|724.42|420.16|437.4|415.53|111.95|111.95|359.79|366.98|366.98|374.18|470.87|492.61|528.83|528.83|565.05|434.65|470.87|543.32|615.76|643.28|637.49|543.32|615.76| 111.95 | 643.28 | 470.87 45900156|HC POSTERIOR NASAL PACKING SUBSEQ|0459|30906|952.27|552.32|296.35|281.53|211.60|211.60|||||618.98|647.54|695.16|695.16|742.77|571.36|618.98|714.20|809.43|845.62|838.00|714.20|809.43| 211.60 | 845.62 | 695.16 45900157|HC EMERGENT INTUBATION|0459|31500|987.18|572.56|||211.6|211.6|294.37|300.26|300.26|306.15|641.67|671.28|720.64|720.64|770.00|592.31|641.67|740.39|839.10|876.62|868.72|740.39|839.10| 211.60 | 876.62 | 671.28 45900158|HC TRACHEOTOMY TUBE REPLACE|0459|31502|245.77|142.55|||211.60|211.60|130.83|133.45|133.45|136.07|159.75|167.12|179.41|179.41|191.70|147.46|159.75|184.33|208.90|218.24|216.28|184.33|208.90| 130.83 | 218.24 | 179.41 45900159|HC DIAGNOSTIC LARYNGOSCOPY INDIRE|0459|31505|493.19|286.05|||164.39|164.39|294.37|300.26|300.26|306.15|320.57|335.37|360.03|360.03|384.69|295.91|320.57|369.89|419.21|437.95|434.01|369.89|419.21| 164.39 | 437.95 | 335.37 45900160|HC FORIEGN BODY REMOV LARYNX INDI|0459|31511|831.94|482.53|||164.39|164.39|294.37|300.26|300.26|306.15|540.76|565.72|607.32|607.32|648.91|499.16|540.76|623.96|707.15|738.76|732.11|623.96|707.15| 164.39 | 738.76 | 565.72 45900161|HC LARYNGOSCOPY FLEX; DIAGNOSTIC|0459|31575|519.63|301.39|1,916.32|1,820.50|164.39|164.39|294.37|300.26|300.26|306.15|337.76|353.35|379.33|379.33|405.31|311.78|337.76|389.72|441.69|461.43|457.27|389.72|441.69| 164.39 | 1,916.32 | 379.33 45900162|HC LARYNGOSCOPY FLEX; W/REM FB|0459|31577|1,052.12|610.23|1916.32|1820.504|376.51|376.51|425.20|433.71|433.71|442.21|683.88|715.44|768.05|768.05|820.65|631.27|683.88|789.09|894.30|934.28|925.87|789.09|894.30| 376.51 | 1,916.32 | 768.05 45900163|HC EMERGENCY TRACHEOSTOMY|0459|31603|1,574.32|913.11|||1,352.79|1,352.79|||||1023.31|1070.54|1149.25|1149.25|1227.97|944.59|1023.31|1180.74|1338.17|1398.00|1385.40|1180.74|1338.17| 944.59 | 1,398.00 | 1,180.74 45900164|HC EMERGENT CRICOTHYROTOMY|0459|31605|1,297.83|752.74|||211.60|211.60|488|497.76|497.76|507.52|843.59|882.52|947.42|947.42|1012.31|778.70|843.59|973.37|1103.16|1152.47|1142.09|973.37|1103.16| 211.60 | 1,152.47 | 882.52 45900165|HC TUBE THORACOSTOMY INCL WATER S|0459|32551|1,328.38|770.46|||1,406.14|1,406.14|||||863.45|903.30|969.72|969.72|1036.14|797.03|863.45|996.29|1129.12|1179.60|1168.97|996.29|1129.12| 797.03 | 1,406.14 | 996.29 45900166|HC PERICARDIOCENTESIS INITIAL|0459|33010|5,576.74|3,234.51|||||196.25|200.17|200.17|204.10|3624.88|3792.18|4071.02|4071.02|4349.86|3346.04|3624.88|4182.56|4740.23|4952.15|4907.53|4182.56|4740.23| 196.25 | 4,952.15 | 4,071.02 45900167|HC ER-BLOOD TRANSFUSION|0459|36430|895.41|519.34|||397.06|397.06|294.37|300.26|300.26|306.15|582.02|608.88|653.65|653.65|698.42|537.25|582.02|671.56|761.10|795.12|787.96|671.56|761.10| 294.37 | 795.12 | 608.88 45900168|HC CENTAL LINE INSERTION <5 YRS|0459|36555|1,219.94|707.57|1863.61|1770.4295|2,861.66|2,861.66|480.81|490.42|490.42|500.04|792.96|829.56|890.56|890.56|951.55|731.96|792.96|914.96|1036.95|1083.31|1073.55|914.96|1036.95| 480.81 | 2,861.66 | 914.96 45900169|HC CENTRAL LINE INSERTION >5YRS|0459|36556|4,731.96|2,744.54|1863.61|1770.4295|2,861.66|2,861.66|480.81|490.42|490.42|500.04|3075.77|3217.73|3454.33|3454.33|3690.93|2839.18|3075.77|3548.97|4022.17|4201.98|4164.12|3548.97|4022.17| 480.81 | 4,201.98 | 3,075.77 45900170|HC REMOVE TUNNELED CENT VENOUS CA|0459|36589|2,363.26|1,370.69|930.38|883.86|541.62|541.62|206.28|210.41|210.41|214.53|1536.12|1607.02|1725.18|1725.18|1843.34|1417.96|1536.12|1772.45|2008.77|2098.57|2079.67|1772.45|2008.77| 206.28 | 2,098.57 | 1,536.12 45900171|HC COL BLOOD IMPLANT VENOUS ACC D|0459|36591|131.59|76.32|11.4|10.83|111.95|111.95|||||85.53|89.48|96.06|96.06|102.64|78.95|85.53|98.69|111.85|116.85|115.80|98.69|111.85| 10.83 | 116.85 | 98.69 45900172|HC DECLOT THROMBOLYTIC AGENT IMPL|0459|36593|806.63|467.85|||310.75|310.75|||||524.31|548.51|588.84|588.84|629.17|483.98|524.31|604.97|685.64|716.29|709.83|604.97|685.64| 310.75 | 716.29 | 588.84 45900173|HC ABG DRAW|0459|36600|110.06|63.83|95.46|90.687|111.95|111.95|13.74|14.01|14.01|14.29|71.54|74.84|80.34|80.34|85.85|66.04|71.54|82.55|93.55|97.73|96.85|82.55|93.55| 13.74 | 111.95 | 82.55 45900174|HC ARTERIAL LINE INSERTION PERCUT|0459|36620|496.71|288.09|||||294.37|300.26|300.26|306.15|322.86|337.76|362.60|362.60|387.43|298.03|322.86|372.53|422.20|441.08|437.10|372.53|422.20| 294.37 | 441.08 | 362.60 45900175|HC PLACE INTRAOSSEOUS NEEDLE FOR|0459|36680|450.52|261.30|||270.22|270.22|||||292.84|306.35|328.88|328.88|351.41|270.31|292.84|337.89|382.94|400.06|396.46|337.89|382.94| 270.22 | 400.06 | 328.88 45900176|HC COMPLEX REPAIR LIP VERMILLION|0459|40650|1,876.36|1,088.29|1,632.80|1,551.16|452.36|452.36|294.37|300.26|300.26|306.15|1219.63|1275.92|1369.74|1369.74|1463.56|1125.82|1219.63|1407.27|1594.91|1666.21|1651.20|1407.27|1594.91| 294.37 | 1,666.21 | 1,369.74 45900177|HC COMPLEX REP LIP UP TO 1/2 VERT|0459|40652|2,316.66|1,343.66|1632.8|1551.16|452.36|452.36|327.08|333.62|333.62|340.16|1505.83|1575.33|1691.16|1691.16|1806.99|1390.00|1505.83|1737.50|1969.16|2057.19|2038.66|1737.50|1969.16| 327.08 | 2,057.19 | 1,575.33 45900178|HC REPAIR LIP-OVER 1/2 VERTICAL H|0459|40654|2,333.54|1,353.45|1,632.80|1,551.16|1,352.79|1,352.79|457.91|467.07|467.07|476.23|1516.80|1586.81|1703.48|1703.48|1820.16|1400.12|1516.80|1750.16|1983.51|2072.18|2053.52|1750.16|1983.51| 457.91 | 2,072.18 | 1,586.81 45900179|HC I&D VESTIBULE OF MOUTH SIMPLE|0459|40800|798.66|463.22|||621.97|621.97|253.81|258.89|258.89|263.97|519.13|543.09|583.02|583.02|622.95|479.20|519.13|599.00|678.86|709.21|702.82|599.00|678.86| 253.81 | 709.21 | 583.02 45900180|HC FOREIGN BODY REMOV MOUTH EMB S|0459|40804|819.18|475.12|||809.60|809.60|327.08|333.62|333.62|340.16|532.47|557.04|598.00|598.00|638.96|491.51|532.47|614.39|696.30|727.43|720.88|614.39|696.30| 327.08 | 809.60 | 598.00 45900181|HC I&D SUPRFI SUBLING INTRAORAL A|0459|41005|798.66|463.22|||211.60|211.60|||||519.13|543.09|583.02|583.02|622.95|479.20|519.13|599.00|678.86|709.21|702.82|599.00|678.86| 211.60 | 709.21 | 583.02 45900182|HC CMPLX RP =<2.5 F MOUTH 2/3 A T|0459|41250|867.79|503.32|||270.22|270.22|196.25|200.17|200.17|204.10|564.06|590.10|633.49|633.49|676.88|520.67|564.06|650.84|737.62|770.60|763.66|650.84|737.62| 196.25 | 770.60 | 590.10 45900183|HC COMPLX RE >2.5CM TONGUE / F MO|0459|41252|1,397.64|810.63|||211.60|211.60|392.50|400.35|400.35|408.20|908.47|950.40|1020.28|1020.28|1090.16|838.58|908.47|1048.23|1187.99|1241.10|1229.92|1048.23|1187.99| 211.60 | 1,241.10 | 950.40 45900184|HC I&D DENTAL ABSCESS|0459|41800|721.86|418.68|||111.95|111.95|327.08|333.62|333.62|340.16|469.21|490.86|526.96|526.96|563.05|433.12|469.21|541.40|613.58|641.01|635.24|541.40|613.58| 111.95 | 641.01 | 490.86 45900185|HC REM EMBED FB-DENTOALVEOLAR STR|0459|41805|2,433.34|1,411.34|||1,352.79|1,352.79|392.50|400.35|400.35|408.20|1581.67|1654.67|1776.34|1776.34|1898.01|1460.00|1581.67|1825.01|2068.34|2160.81|2141.34|1825.01|2068.34| 392.50 | 2,160.81 | 1,654.67 45900186|HC I&D PALATE|0459|42000|657.59|381.40|||211.60|211.60|392.50|400.35|400.35|408.20|427.43|447.16|480.04|480.04|512.92|394.55|427.43|493.19|558.95|583.94|578.68|493.19|558.95| 211.60 | 583.94 | 447.16 45900187|HC LACERATION REPR PALATE UP TO 2|0459|42180|1,215.90|705.22|437.40|415.53|452.36|452.36|392.5|400.35|400.35|408.2|790.34|826.81|887.61|887.61|948.40|729.54|790.34|911.93|1033.52|1079.72|1069.99|911.93|1033.52| 392.50 | 1,079.72 | 790.34 45900188|HC DRNG INTRAORAL SUBM OR SUBL AB|0459|42310|819.18|475.12|||452.36|452.36|254.14|259.22|259.22|264.31|532.47|557.04|598.00|598.00|638.96|491.51|532.47|614.39|696.30|727.43|720.88|614.39|696.30| 254.14 | 727.43 | 557.04 45900189|HC I&D TONSIL ABSCESS|0459|42700|878.02|509.25|||211.60|211.60|503.70|513.78|513.78|523.85|570.71|597.05|640.95|640.95|684.86|526.81|570.71|658.52|746.32|779.68|772.66|658.52|746.32| 211.60 | 779.68 | 597.05 45900190|HC FOREIGN BODY REMOVAL PHARYNX|0459|42809|844.75|489.96|||270.22|270.22|302.22|308.27|308.27|314.31|549.09|574.43|616.67|616.67|658.91|506.85|549.09|633.56|718.04|750.14|743.38|633.56|718.04| 270.22 | 750.14 | 574.43 45900191|HC GASTRIC INTUBATION W/ASP OR LA|0459|43753|441.28|255.94|||264.45|264.45|31.26|31.88|31.88|32.51|286.83|300.07|322.13|322.13|344.20|264.77|286.83|330.96|375.09|391.86|388.33|330.96|375.09| 31.26 | 391.86 | 300.07 45900192|HC REPLACE GASTROSTOMY TUBE|0459|43760|547.98|317.83|||||327.08|333.62|333.62|340.16|356.19|372.63|400.03|400.03|427.42|328.79|356.19|410.99|465.78|486.61|482.22|410.99|465.78| 327.08 | 486.61 | 400.03 45900193|HC REPOSITION GASTROSTOMY TUBE|0459|43761|918.92|532.97|437.4|415.53|266.14|266.14|327.08|333.62|333.62|340.16|597.30|624.87|670.81|670.81|716.76|551.35|597.30|689.19|781.08|816.00|808.65|689.19|781.08| 266.14 | 816.00 | 597.30 45900194|HC REDUCTION OF RECTAL PROPLAPSE|0459|45900|1,121.00|650.18|||793.65|793.65|294.37|300.26|300.26|306.15|728.65|762.28|818.33|818.33|874.38|672.60|728.65|840.75|952.85|995.45|986.48|840.75|952.85| 294.37 | 995.45 | 793.65 45900195|HC I&D PERIRECTAL ABSCESS|0459|46040|4,932.87|2,861.06|2422.12|2301.014|1,036.96|1,036.96|425.20|433.71|433.71|442.21|3206.37|3354.35|3601.00|3601.00|3847.64|2959.72|3206.37|3699.65|4192.94|4380.39|4340.93|3699.65|4192.94| 425.20 | 4,380.39 | 3,206.37 45900196|HC I&D PERIANAL ABSCESS|0459|46050|570.84|331.09|437.4|415.53|793.65|793.65|261.66|266.90|266.90|272.13|371.05|388.17|416.71|416.71|445.26|342.50|371.05|428.13|485.21|506.91|502.34|428.13|485.21| 261.66 | 793.65 | 416.71 45900197|HC I&D THROMBOSED HEMORRHOID|0459|46083|639.96|371.18|163.84|155.65|266.14|266.14|254.14|259.22|259.22|264.31|415.97|435.17|467.17|467.17|499.17|383.98|415.97|479.97|543.97|568.28|563.16|479.97|543.97| 155.65 | 568.28 | 415.97 45900198|HC SIMPLE LIGATION HEMORRHOID|0459|46221|1,113.54|645.85|2,087.30|1,982.94|793.65|793.65|288.48|294.25|294.25|300.02|723.80|757.21|812.88|812.88|868.56|668.12|723.80|835.16|946.51|988.82|979.92|835.16|946.51| 288.48 | 2,087.30 | 812.88 45900199|HC EXC EXT THROMBOTIC HEMORRHOID|0459|46320|3,826.31|2,219.26|1,141.26|1,084.20|1,036.96|1,036.96|327.08|333.62|333.62|340.16|2487.10|2601.89|2793.21|2793.21|2984.52|2295.79|2487.10|2869.73|3252.36|3397.76|3367.15|2869.73|3252.36| 327.08 | 3,397.76 | 2,487.10 45900200|HC DIAGNOSTIC ANOSCOPY|0459|46600|230.39|133.63|1,139.82|1,082.83|111.95|111.95|261.66|266.90|266.90|272.13|149.75|156.67|168.18|168.18|179.70|138.23|149.75|172.79|195.83|204.59|202.74|172.79|195.83| 111.95 | 1,139.82 | 179.70 45900201|HC ENDOSCOPIC ANOSCOPY W FB REMOV|0459|46608|552.63|320.53|1,139.82|1,082.83|793.65|793.65|||||359.21|375.79|403.42|403.42|431.05|331.58|359.21|414.47|469.74|490.74|486.31|414.47|469.74| 331.58 | 1,139.82 | 431.05 45900202|HC ABDOMINAL PARACENTESIS W/O IMA|0459|49082|562.92|326.49|437.40|415.53|809.60|809.60|327.67|334.22|334.22|340.78|365.90|382.79|410.93|410.93|439.08|337.75|365.90|422.19|478.48|499.87|495.37|422.19|478.48| 327.67 | 809.60 | 415.53 45900203|HC BLADDER IRRIGATION|0459|51700|328.81|190.71|95.46|90.69|266.14|266.14|196.25|200.17|200.17|204.10|213.73|223.59|240.03|240.03|256.47|197.29|213.73|246.61|279.49|291.98|289.35|246.61|279.49| 90.69 | 291.98 | 240.03 45900204|HC ANCHOR FOLEY CATH SIMPLE|0459|51702|207.36|120.27|95.46|90.687|111.95|111.95|||||134.78|141.00|151.37|151.37|161.74|124.42|134.78|155.52|176.26|184.14|182.48|155.52|176.26| 90.69 | 184.14 | 151.37 45900205|HC ANCHOR FOLEY CATH COMPLICATED|0459|51703|563.16|326.63|95.46|90.687|139.55|139.55|261.66|266.90|266.90|272.13|366.05|382.95|411.11|411.11|439.26|337.90|366.05|422.37|478.69|500.09|495.58|422.37|478.69| 90.69 | 500.09 | 366.05 45900206|HC BLADDER SCAN|0459|51798|216.36|125.49|95.46|90.687|55.66|55.66|196.25|200.17|200.17|204.10|140.63|147.12|157.94|157.94|168.76|129.82|140.63|162.27|183.91|192.13|190.40|162.27|183.91| 55.66 | 204.10 | 162.27 45900207|HC I&D SCROTAL SPACE|0459|54700|1,477.02|856.67|||1,792.99|1,792.99|569.12|580.50|580.50|591.88|960.06|1004.37|1078.22|1078.22|1152.08|886.21|960.06|1107.77|1255.47|1311.59|1299.78|1107.77|1255.47| 569.12 | 1,792.99 | 1,078.22 45900208|HC DRAINAGE SCROTAL WALL ABSCESS|0459|55100|1,093.04|633.96|||1,407.00|1,407.00|254.14|259.22|259.22|264.31|710.48|743.27|797.92|797.92|852.57|655.82|710.48|819.78|929.08|970.62|961.88|819.78|929.08| 254.14 | 1,407.00 | 797.92 45900209|HC FOREIGN BODY REMOVAL SCROTUM|0459|55120|2,380.67|1,380.79|||1,792.99|1,792.99|457.91|467.07|467.07|476.23|1547.44|1618.86|1737.89|1737.89|1856.92|1428.40|1547.44|1785.50|2023.57|2114.03|2094.99|1785.50|2023.57| 457.91 | 2,114.03 | 1,737.89 45900210|HC I&D VULVA/PERINEUM|0459|56405|709.08|411.27|||281.48|281.48|261.66|266.90|266.90|272.13|460.90|482.17|517.63|517.63|553.08|425.45|460.90|531.81|602.72|629.66|623.99|531.81|602.72| 261.66 | 629.66 | 482.17 45900211|HC I&D BARTHOLIN'S GLAND|0459|56420|650.20|377.12|||170.32|170.32|261.66|266.90|266.90|272.13|422.63|442.14|474.65|474.65|507.16|390.12|422.63|487.65|552.67|577.38|572.18|487.65|552.67| 170.32 | 577.38 | 442.14 45900212|HC REMOVAL IUD|0459|58301|493.19|286.05|||281.48|281.48|294.37|300.26|300.26|306.15|320.57|335.37|360.03|360.03|384.69|295.91|320.57|369.89|419.21|437.95|434.01|369.89|419.21| 281.48 | 437.95 | 335.37 45900213|HC VAGINAL DELIVERY ANY METHOD|0459|59409|5,268.01|3,055.45|||2,623.21|2,623.21|588.74|600.52|600.52|612.29|3424.21|3582.25|3845.65|3845.65|4109.05|3160.81|3424.21|3951.01|4477.81|4677.99|4635.85|3951.01|4477.81| 588.74 | 4,677.99 | 3,582.25 45900214|HC LUMBAR PUNCTURE DIAGNOSTIC|0459|62270|1,950.89|1,131.52|611.22|580.659|634.59|634.59|163.54|166.81|166.81|170.08|1268.08|1326.61|1424.15|1424.15|1521.69|1170.53|1268.08|1463.17|1658.26|1732.39|1716.78|1463.17|1658.26| 163.54 | 1,732.39 | 1,268.08 45900215|HC DENTAL BLOCK|0459|64400|414.71|240.53|437.40|415.53|261.17|261.17|||||269.56|282.00|302.74|302.74|323.47|248.83|269.56|311.03|352.50|368.26|364.94|311.03|352.50| 248.83 | 437.40 | 311.03 45900216|HC DIGITAL BLOCK|0459|64450|483.80|280.60|437.40|415.53|634.59|634.59|219.80|224.19|224.19|228.59|314.47|328.98|353.17|353.17|377.36|290.28|314.47|362.85|411.23|429.61|425.74|362.85|411.23| 219.80 | 634.59 | 362.85 45900217|HC REM SUPERVICAIL SUBMUNCT FB|0459|65205|493.19|286.05|437.40|415.53|111.95|111.95|294.37|300.26|300.26|306.15|320.57|335.37|360.03|360.03|384.69|295.91|320.57|369.89|419.21|437.95|434.01|369.89|419.21| 111.95 | 437.95 | 360.03 45900218|HC REM EMBED SUBCONJUCTIVAL FB|0459|65210|876.80|508.54|437.40|415.53|270.22|270.22|523.33|533.79|533.79|544.26|569.92|596.22|640.06|640.06|683.90|526.08|569.92|657.60|745.28|778.60|771.58|657.60|745.28| 270.22 | 778.60 | 569.92 45900219|HC REM CORNEAL FB W/O SLIT LAMP|0459|65220|876.80|508.54|763.68|725.50|270.22|270.22|523.33|533.79|533.79|544.26|569.92|596.22|640.06|640.06|683.90|526.08|569.92|657.60|745.28|778.60|771.58|657.60|745.28| 270.22 | 778.60 | 640.06 45900220|HC REMOVAL CORNEAL FB 2/SLIT LAMP|0459|65222|876.80|508.54|619.78|588.79|111.95|111.95|523.33|533.79|533.79|544.26|569.92|596.22|640.06|640.06|683.90|526.08|569.92|657.60|745.28|778.60|771.58|657.60|745.28| 111.95 | 778.60 | 596.22 45900221|HC I&D EYELID ABSCESS|0459|67700|691.17|400.88|||261.28|261.28|294.37|300.26|300.26|306.15|449.26|470.00|504.55|504.55|539.11|414.70|449.26|518.38|587.49|613.76|608.23|518.38|587.49| 261.28 | 613.76 | 470.00 45900222|HC I&D EAR ABSCESS SIMPLE|0459|69000|750.04|435.02|||621.97|621.97|392.50|400.35|400.35|408.20|487.53|510.03|547.53|547.53|585.03|450.02|487.53|562.53|637.53|666.04|660.04|562.53|637.53| 392.50 | 666.04 | 547.53 45900223|HC I&D EAR ABSCESS COMPLICATED|0459|69005|1,181.47|685.25|||1,407.00|1,407.00|392.50|400.35|400.35|408.20|767.96|803.40|862.47|862.47|921.55|708.88|767.96|886.10|1004.25|1049.15|1039.69|886.10|1004.25| 392.50 | 1,407.00 | 862.47 45900224|HC FB REMOVAL EAR|0459|69200|355.83|206.38|105.42|100.15|111.95|111.95|171.72|175.15|175.15|178.59|231.29|241.96|259.76|259.76|277.55|213.50|231.29|266.87|302.46|315.98|313.13|266.87|302.46| 100.15 | 315.98 | 231.29 45900225|HC CERUMEN REMOVAL - 1 EAR|0459|69210|134.40|77.95|193.78|184.09|55.66|55.66|176.62|180.16|180.16|183.69|87.36|91.39|98.11|98.11|104.83|80.64|87.36|100.80|114.24|119.35|118.27|100.80|114.24| 55.66 | 193.78 | 104.83 45900226|HC CERUMEN REMOVAL - BOTH EARS|0459|69210|591.85|343.27|193.78|184.091|55.66|55.66|176.62|180.16|180.16|183.69|384.70|402.46|432.05|432.05|461.64|355.11|384.70|443.89|503.07|525.56|520.83|443.89|503.07| 55.66 | 525.56 | 384.70 45900227|HC ECHO EXAM OF ABDOMEN|0459|76705|881.16|511.07|487.26|462.897|108.97|108.97|48.81|49.79|49.79|50.77|572.75|599.19|643.25|643.25|687.30|528.70|572.75|660.87|748.99|782.47|775.42|660.87|748.99| 48.81 | 782.47 | 572.75 45900227|HC ECHO EXAM OF ABDOMEN|0459|76705|881.16|511.07|487.26|462.897|108.97|108.97|97.61|99.57|99.57|101.52|572.75|599.19|643.25|643.25|687.30|528.70|572.75|660.87|748.99|782.47|775.42|660.87|748.99| 97.61 | 782.47 | 572.75 45900228|HC CARDIOPULMONARY RESUSCITATION|0459|92950|1,462.26|848.11|1119.57|1063.5915|264.45|264.45|131.22|133.85|133.85|136.47|950.47|994.34|1067.45|1067.45|1140.56|877.36|950.47|1096.70|1242.92|1298.49|1286.79|1096.70|1242.92| 131.22 | 1,298.49 | 1,063.59 45900229|HC TRANSCUTANEOUS PACING|0459|92953|81.93|47.52|||561.91|561.91|||||53.25|55.71|59.81|59.81|63.91|49.16|53.25|61.45|69.64|72.75|72.10|61.45|69.64| 49.16 | 561.91 | 61.45 45900230|HC CARDIOVERSION|0459|92960|1,589.88|922.13|||561.91|561.91|196.25|200.17|200.17|204.1|1033.42|1081.12|1160.61|1160.61|1240.11|953.93|1033.42|1192.41|1351.40|1411.81|1399.09|1192.41|1351.40| 196.25 | 1,411.81 | 1,081.12 45900231|HC RHYTHM ECG - TRACING ONLY|0459|93041|201.22|116.71|176.01|167.2095|55.66|55.66|10.31|10.52|10.52|10.72|130.79|136.83|146.89|146.89|156.95|120.73|130.79|150.92|171.04|178.68|177.07|150.92|171.04| 10.31 | 178.68 | 146.89 45900232|HC ERS-IV HYDRATION INITIAL HR|0459|96360|671.42|389.42|223.01|211.86|203.5|203.5|62.66|63.91|63.91|65.16|436.42|456.57|490.14|490.14|523.71|402.85|436.42|503.57|570.71|596.22|590.85|503.57|570.71| 62.66 | 596.22 | 436.42 45900233|HC ERS-IV HYDRATION EA ADDL HR|0459|96361|250.27|145.16|253.98|241.28|40|40|21.17|21.59|21.59|22.02|162.68|170.18|182.70|182.70|195.21|150.16|162.68|187.70|212.73|222.24|220.24|187.70|212.73| 21.17 | 253.98 | 182.70 45900234|HC ERS-IV INF THERAPY INITIAL HR|0459|96365|671.42|389.42|188.07|178.67|203.50|203.50|109.38|111.56|111.56|113.75|436.42|456.57|490.14|490.14|523.71|402.85|436.42|503.57|570.71|596.22|590.85|503.57|570.71| 109.38 | 596.22 | 436.42 45900235|HC ERS-IV INF THERAPY EA ADDL HR|0459|96366|269.01|156.03|188.07|178.67|40.00|40.00|21.17|21.59|21.59|22.02|174.86|182.93|196.38|196.38|209.83|161.41|174.86|201.76|228.66|238.88|236.73|201.76|228.66| 21.17 | 238.88 | 182.93 45900236|HC ERS-SEQ IV INF THER-NEW DRUG-1|0459|96367|395.80|229.56|188.07|178.67|61.97|61.97|30.72|31.33|31.33|31.95|257.27|269.14|288.93|288.93|308.72|237.48|257.27|296.85|336.43|351.47|348.30|296.85|336.43| 30.72 | 351.47 | 257.27 45900237|HC ERS-CONCURRENT INFUSION|0459|96368|395.80|229.56|1.43|1.3585|||||||257.27|269.14|288.93|288.93|308.72|237.48|257.27|296.85|336.43|351.47|348.30|296.85|336.43| 1.36 | 351.47 | 288.93 45900238|HC ERS-SUBQ/IM THERAPEUTIC INJECT|0459|96372|259.09|150.27|94.17|89.46|61.97|61.97|21.17|21.59|21.59|22.02|168.41|176.18|189.14|189.14|202.09|155.45|168.41|194.32|220.23|230.07|228.00|194.32|220.23| 21.17 | 230.07 | 168.41 45900239|HC ERS-IV PUSH INITIAL THERAPEUTI|0459|96374|285.55|165.62|94.17|89.46|203.50|203.50|30.72|31.33|31.33|31.95|185.61|194.17|208.45|208.45|222.73|171.33|185.61|214.16|242.72|253.57|251.28|214.16|242.72| 30.72 | 253.57 | 203.50 45900240|HC ERS-IV PUSH ADDL NEW DRUG X1|0459|96375|264.60|153.47|94.17|89.46|40.00|40.00|30.72|31.33|31.33|31.95|171.99|179.93|193.16|193.16|206.39|158.76|171.99|198.45|224.91|234.96|232.85|198.45|224.91| 30.72 | 234.96 | 171.99 45900241|HC ERS-IVP SEQ SAME DRUG>30 MIN A|0459|96376|256.88|148.99|94.17|89.4615|||||||166.97|174.68|187.52|187.52|200.37|154.13|166.97|192.66|218.35|228.11|226.05|192.66|218.35| 89.46 | 228.11 | 187.52 45900242|HC MODERATE SEDATION <5YR 1ST 30|0459|99143|280.07|162.44|||||||||182.05|190.45|204.45|204.45|218.45|168.04|182.05|210.05|238.06|248.70|246.46|210.05|238.06| 168.04 | 248.70 | 210.05 45900243|HC MODERATE SEDATION >5YR 1ST 30|0459|99144|371.95|215.73|||||||||241.77|252.93|271.52|271.52|290.12|223.17|241.77|278.96|316.16|330.29|327.32|278.96|316.16| 223.17 | 330.29 | 278.96 45900244|HC MODERATE SEDATION EA ADD 15|0459|99145|135.94|78.85|||||||||88.36|92.44|99.24|99.24|106.03|81.56|88.36|101.96|115.55|120.71|119.63|101.96|115.55| 81.56 | 120.71 | 101.96 45900245|HC MOD SED OTHER THAN ATTEND <5YR|0459|99148|684.61|397.07|||||||||445.00|465.53|499.77|499.77|534.00|410.77|445.00|513.46|581.92|607.93|602.46|513.46|581.92| 410.77 | 607.93 | 513.46 45900246|HC MOD SED OTHER THAN ATTEND >5YR|0459|99149|684.61|397.07|||||||||445.00|465.53|499.77|499.77|534.00|410.77|445.00|513.46|581.92|607.93|602.46|513.46|581.92| 410.77 | 607.93 | 513.46 45900247|HC MOD SED OTHER THAN ATTEND EA A|0459|99150|135.94|78.85|||||||||88.36|92.44|99.24|99.24|106.03|81.56|88.36|101.96|115.55|120.71|119.63|101.96|115.55| 81.56 | 120.71 | 101.96 45900248|HC EMERGENCY - LEVEL 4 RAPE EXAM|0459|99284|811.47|470.65|||363.74|363.74|75.28|76.79|76.79|78.29|527.46|551.80|592.37|592.37|632.95|486.88|527.46|608.60|689.75|720.59|714.09|608.60|689.75| 75.28 | 720.59 | 551.80 45900249|HC CRITICAL CARE EA ADD 30 MIN|0459|99292|604.21|350.44|522.23|496.12|||74.05|75.53|75.53|77.01|392.74|410.86|441.07|441.07|471.28|362.53|392.74|453.16|513.58|536.54|531.70|453.16|513.58| 74.05 | 536.54 | 441.07 45900249|HC CRITICAL CARE EA ADD 30 MIN|0459|99292|604.21|350.44|522.23|496.1185|||74.05|75.53|75.53|77.01|392.74|410.86|441.07|441.07|471.28|362.53|392.74|453.16|513.58|536.54|531.70|453.16|513.58| 74.05 | 536.54 | 441.07 45900250|HC CL TX LUNATE DISLOC W/MANIP|0459|25690|3,882.33|2,251.75|1,141.26|1,084.20|1,392.35|1,392.35|392.50|400.35|400.35|408.20|2523.51|2639.98|2834.10|2834.10|3028.22|2329.40|2523.51|2911.75|3299.98|3447.51|3416.45|2911.75|3299.98| 392.50 | 3,447.51 | 2,523.51 45900251|HC OPEN TX DISTAL PHALANG FRACT E|0459|26765|2,575.53|1,493.81|2,954.97|2,807.22|2,830.40|2,830.40|392.5|400.35|400.35|408.2|1674.09|1751.36|1880.14|1880.14|2008.91|1545.32|1674.09|1931.65|2189.20|2287.07|2266.47|1931.65|2189.20| 392.50 | 2,954.97 | 1,931.65 45900252|HC AMPUTATE FING/TH SGL,WLOCADVFL|0459|26952|4,028.19|2,336.35|2,954.97|2,807.22|2,830.40|2,830.40|523.33|533.79|533.79|544.26|2618.32|2739.17|2940.58|2940.58|3141.99|2416.91|2618.32|3021.14|3423.96|3577.03|3544.81|3021.14|3423.96| 523.33 | 3,577.03 | 2,830.40 45900253|HC INJ CORPORA CAVERNOSA W/PHARM AGENTS|0459|54235|716.00|415.28|||266.14|266.14|196.25|200.17|200.17|204.1|465.40|486.88|522.68|522.68|558.48|429.60|465.40|537.00|608.60|635.81|630.08|537.00|608.60| 196.25 | 635.81 | 486.88 45900254|HC CL TX DSTL RADIOULNAR DISLOC W MANIP|0459|25675|1,372.00|795.76|1141.26|1084.197|206.19|206.19|425.2|433.71|433.71|442.21|891.80|932.96|1001.56|1001.56|1070.16|823.20|891.80|1029.00|1166.20|1218.34|1207.36|1029.00|1166.20| 206.19 | 1,218.34 | 1,001.56 45900255|HC CL TX DSTL FEM EPIPHYS SEP, W/O MANIP|0459|27516|1,132.07|656.60|2051.68|1949.096|206.19|206.19|||||735.85|769.81|826.41|826.41|883.01|679.24|735.85|849.05|962.26|1005.28|996.22|849.05|962.26| 206.19 | 2,051.68 | 849.05 45900256|HC CL TX WB DSTL TIB FX W/MANIP|0459|27825|3,557.01|2,063.07|2051.68|1949.096|1392.35|1392.35|392.5|400.35|400.35|408.2|2312.06|2418.77|2596.62|2596.62|2774.47|2134.21|2312.06|2667.76|3023.46|3158.62|3130.17|2667.76|3023.46| 392.50 | 3,158.62 | 2,312.06 45900257|CL LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS|0459|40830|438.20|254.16|||211.6|211.6|523.33|533.79|533.79|544.26|284.83|297.98|319.89|319.89|341.80|262.92|284.83|328.65|372.47|389.12|385.62|328.65|372.47| 211.60 | 544.26 | 328.65 45900258|HC CL TX ULNAR FRACTURE PROXIMAL END W MNP|0459|24675|720.79|418.06|2051.68|1949.096|1392.35|1392.35|457.91|467.07|467.07|476.23|468.51|490.14|526.18|526.18|562.22|432.47|468.51|540.59|612.67|640.06|634.30|540.59|612.67| 432.47 | 2,051.68 | 540.59 45900259|HC DRAIN/INJ INTER JOINT/BURSA W/US|0459|20606|271.99|157.75|437.40|415.53|634.59|634.59|||||176.79|184.95|198.55|198.55|212.15|163.19|176.79|203.99|231.19|241.53|239.35|203.99|231.19| 163.19 | 634.59 | 212.15 45900260|HC DRAIN CEREBRO SPINAL FLUID|0459|62272|1,490.52|864.50|611.22|580.659|634.59|634.59|163.54|166.81|166.81|170.08|968.84|1013.55|1088.08|1088.08|1162.61|894.31|968.84|1117.89|1266.94|1323.58|1311.66|1117.89|1266.94| 163.54 | 1,323.58 | 968.84 45900261|HC CL TX RADIAL & ULNA FX W MANIP|0459|25565|2,102.84|1,219.65|2,051.68|1,949.10|1,392.35|1,392.35|392.50|400.35|400.35|408.20|1366.85|1429.93|1535.07|1535.07|1640.22|1261.70|1366.85|1577.13|1787.41|1867.32|1850.50|1577.13|1787.41| 392.50 | 2,051.68 | 1,535.07 45900262|HC REPLACE G/C TUBE PERC|0459|49450|2,422.50|1,405.05|||809.60|809.60|||||1574.63|1647.30|1768.43|1768.43|1889.55|1453.50|1574.63|1816.88|2059.13|2151.18|2131.80|1816.88|2059.13| 809.60 | 2,151.18 | 1,768.43 45900263|HC CL TX ART FX MCP/IP JNT; WO MAN|0459|26740|395.04|229.12|1,141.26|1,084.20|206.19|206.19|163.54|166.81|166.81|170.08|256.78|268.63|288.38|288.38|308.13|237.02|256.78|296.28|335.78|350.80|347.64|296.28|335.78| 163.54 | 1,141.26 | 288.38 45900264|HC COLONOSCOPY W/FB REMOVAL|0459|45379|2,003.45|1,162.00|1,863.61|1,770.43|1,036.96|1,036.96|294.37|300.26|300.26|306.15|1302.24|1362.35|1462.52|1462.52|1562.69|1202.07|1302.24|1502.59|1702.93|1779.06|1763.04|1502.59|1702.93| 294.37 | 1,863.61 | 1,462.52 45900265|HC CYSTO W MULTI OBSTR CLOT REM|0459|52001|5,507.65|3,194.44|1,426.20|1,354.89|3,076.34|3,076.34|457.91|467.07|467.07|476.23|3579.97|3745.20|4020.58|4020.58|4295.97|3304.59|3579.97|4130.74|4681.50|4890.79|4846.73|4130.74|4681.50| 457.91 | 4,890.79 | 3,579.97 45900266|HC I & D VAGINAL HEMATOMA|0459|57022|1,719.06|997.05|||2,370.01|2,370.01|294.37|300.26|300.26|306.15|1117.39|1168.96|1254.91|1254.91|1340.87|1031.44|1117.39|1289.30|1461.20|1526.53|1512.77|1289.30|1461.20| 294.37 | 2,370.01 | 1,254.91 45900267|HC EGD REMOVE FOREIGN BODY|0459|43247|2,831.07|1,642.02|1,289.43|1,224.96|809.60|809.60|294.37|300.26|300.26|306.15|1840.20|1925.13|2066.68|2066.68|2208.23|1698.64|1840.20|2123.30|2406.41|2513.99|2491.34|2123.30|2406.41| 294.37 | 2,513.99 | 1,840.20 45900268|HC REMOVE IMPACTED EAR WAX UNI|0459|69209|68.00|39.44|186.33|177.01|55.66|55.66|||||44.20|46.24|49.64|49.64|53.04|40.80|44.20|51.00|57.80|60.38|59.84|51.00|57.80| 40.80 | 186.33 | 53.04 45900269|HC CL TX SC/TX HUMERUS SHFT FX W MANIP|0459|24535|913.46|529.81|2,051.68|1,949.10|1,392.35|1,392.35|457.91|467.07|467.07|476.23|593.75|621.15|666.83|666.83|712.50|548.08|593.75|685.10|776.44|811.15|803.84|685.10|776.44| 457.91 | 2,051.68 | 685.10 45900270|HC MOD SED SAME PHYS/QHP <5YRS 1ST 15 MIN|0459|99151|280.07|162.44|||||||||182.05|190.45|204.45|204.45|218.45|168.04|182.05|210.05|238.06|248.70|246.46|210.05|238.06| 168.04 | 248.70 | 210.05 45900271|HC MOD SED SAME PHYS/QHP 5/>YRS 1ST 15 MIN|0459|99152|371.95|215.73|||||||||241.77|252.93|271.52|271.52|290.12|223.17|241.77|278.96|316.16|330.29|327.32|278.96|316.16| 223.17 | 330.29 | 278.96 45900272|HC MOD SED SAME PHYS/QHP EA ADD 15 MIN|0459|99153|135.94|78.85|||||||||88.36|92.44|99.24|99.24|106.03|81.56|88.36|101.96|115.55|120.71|119.63|101.96|115.55| 81.56 | 120.71 | 101.96 45900273|HC MOD SED OTH PHYS/QHP <5YRS 1ST 15 MIN|0459|99155|684.61|397.07|||||||||445.00|465.53|499.77|499.77|534.00|410.77|445.00|513.46|581.92|607.93|602.46|513.46|581.92| 410.77 | 607.93 | 513.46 45900274|HC MOD SED OTH PHYS/QHP 5/>YRS 1ST 15 MIN|0459|99156|684.61|397.07|||||||||445.00|465.53|499.77|499.77|534.00|410.77|445.00|513.46|581.92|607.93|602.46|513.46|581.92| 410.77 | 607.93 | 513.46 45900275|HC MOD SED OTHER PHYS/QHP EA ADD 15 MIN|0459|99157|135.94|78.85|||||||||88.36|92.44|99.24|99.24|106.03|81.56|88.36|101.96|115.55|120.71|119.63|101.96|115.55| 81.56 | 120.71 | 101.96 45900276|HC CL TX ANKLE DISLOC W ANESTH|0459|27842|1,616.63|937.65|1,520.24|1,444.23|1,392.35|1,392.35|||||1050.81|1099.31|1180.14|1180.14|1260.97|969.98|1050.81|1212.47|1374.14|1435.57|1422.63|1212.47|1374.14| 969.98 | 1,520.24 | 1,260.97 45900277|HC CL LACERATION MOUTH VESTIB; > 2.5 CM|0459|40831|1,453.98|843.31|||452.36|452.36|523.33|533.79|533.79|544.26|945.09|988.71|1061.41|1061.41|1134.10|872.39|945.09|1090.49|1235.88|1291.13|1279.50|1090.49|1235.88| 452.36 | 1,291.13 | 988.71 45900278|HC CL TX ULNAR SHFT FX W MANIP|0459|25535|2,130.19|1,235.51|2,051.68|1,949.10|206.19|206.19|392.50|400.35|400.35|408.20|1384.62|1448.53|1555.04|1555.04|1661.55|1278.11|1384.62|1597.64|1810.66|1891.61|1874.57|1597.64|1810.66| 206.19 | 2,051.68 | 1,555.04 45900279|HC REP ET HAND; WO FG EA TENDON|0459|26410|5,070.30|2,940.77|2,793.99|2,654.29|1,392.35|1,392.35|392.50|400.35|400.35|408.20|3295.70|3447.80|3701.32|3701.32|3954.83|3042.18|3295.70|3802.73|4309.76|4502.43|4461.86|3802.73|4309.76| 392.50 | 4,502.43 | 3,295.70 45900280|HC ASPIRATE PLEURA W/IMAGING|0459|32555|2,269.35|1,316.22|1,216.76|1,155.92|541.62|541.62|350.70|357.71|357.71|364.72|1475.08|1543.16|1656.63|1656.63|1770.09|1361.61|1475.08|1702.01|1928.95|2015.18|1997.03|1702.01|1928.95| 350.70 | 2,015.18 | 1,475.08 45900281|HC ABD PARACENTESIS W/IMAGING|0459|49083|2,207.21|1,280.18|606.96|576.61|809.60|809.60|327.67|334.22|334.22|340.78|1434.69|1500.90|1611.26|1611.26|1721.62|1324.33|1434.69|1655.41|1876.13|1960.00|1942.34|1655.41|1876.13| 327.67 | 1,960.00 | 1,434.69 45900282|HC PERITONEAL LAVAGE|0459|49084|2,310.67|1,340.19|606.96|576.61|809.60|809.60|327.67|334.22|334.22|340.78|1501.94|1571.26|1686.79|1686.79|1802.32|1386.40|1501.94|1733.00|1964.07|2051.87|2033.39|1733.00|1964.07| 327.67 | 2,051.87 | 1,501.94 45900283|HC DX OPHTHAL B-SCAN US|0459|76512|517.09|299.91|678.19|644.28|108.97|108.97|61.40|62.63|62.63|63.86|336.11|351.62|377.48|377.48|403.33|310.25|336.11|387.82|439.53|459.18|455.04|387.82|439.53| 61.40 | 678.19 | 377.48 45900283|HC DX OPHTHAL B-SCAN US|0459|76512|517.09|299.91|678.19|644.28|108.97|108.97|106.82|108.96|108.96|111.10|336.11|351.62|377.48|377.48|403.33|310.25|336.11|387.82|439.53|459.18|455.04|387.82|439.53| 106.82 | 678.19 | 377.48 45900284|HC US TO LOCALIZE FB IN EYE|0459|76529|333.60|193.49|678.19|644.28|80.90|80.90|54.75|55.85|55.85|56.94|216.84|226.85|243.53|243.53|260.21|200.16|216.84|250.20|283.56|296.24|293.57|250.20|283.56| 54.75 | 678.19 | 243.53 45900284|HC US TO LOCALIZE FB IN EYE|0459|76529|333.60|193.49|678.19|644.28|80.90|80.90|94.42|96.31|96.31|98.20|216.84|226.85|243.53|243.53|260.21|200.16|216.84|250.20|283.56|296.24|293.57|250.20|283.56| 80.90 | 678.19 | 243.53 45900285|HC US EXAM OF HEAD AND NECK|0459|76536|599.37|347.63|678.19|644.28|108.97|108.97|25.90|26.42|26.42|26.94|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 25.90 | 678.19 | 437.54 45900285|HC US EXAM OF HEAD AND NECK|0459|76536|599.37|347.63|678.19|644.28|108.97|108.97|51.81|52.85|52.85|53.88|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 51.81 | 678.19 | 437.54 45900286|HC US EXAM CHEST|0459|76604|599.37|347.63|156.72|148.88|108.97|108.97|51.97|53.01|53.01|54.05|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 51.97 | 532.24 | 389.59 45900286|HC US EXAM CHEST|0459|76604|599.37|347.63|156.72|148.88|108.97|108.97|90.77|92.59|92.59|94.40|389.59|407.57|437.54|437.54|467.51|359.62|389.59|449.53|509.46|532.24|527.45|449.53|509.46| 90.77 | 532.24 | 389.59 45900287|HC ULTRASOUND BREAST COMPLETE|0459|76641|737.97|428.02|272.30|258.69|108.97|108.97|||||479.68|501.82|538.72|538.72|575.62|442.78|479.68|553.48|627.27|655.32|649.41|553.48|627.27| 108.97 | 655.32 | 538.72 45900288|HC ULTRASOUND BREAST LIMITED|0459|76642|491.98|285.35|272.30|258.69|80.90|80.90|||||319.79|334.55|359.15|359.15|383.74|295.19|319.79|368.99|418.18|436.88|432.94|368.99|418.18| 80.90 | 436.88 | 359.15 45900289|HC US EXAM ABDOM COMPLETE|0459|76700|1,172.92|680.29|648.56|616.13|108.97|108.97|78.90|80.48|80.48|82.06|762.40|797.59|856.23|856.23|914.88|703.75|762.40|879.69|996.98|1041.55|1032.17|879.69|996.98| 78.90 | 1,041.55 | 762.40 45900289|HC US EXAM ABDOM COMPLETE|0459|76700|1,172.92|680.29|648.56|616.13|108.97|108.97|134.06|136.74|136.74|139.43|762.40|797.59|856.23|856.23|914.88|703.75|762.40|879.69|996.98|1041.55|1032.17|879.69|996.98| 108.97 | 1,041.55 | 762.40 45900290|HC US EXAM ABDO BACK WALL COMP|0459|76770|1,041.29|603.95|578.03|549.13|108.97|108.97|78.90|80.48|80.48|82.06|676.84|708.08|760.14|760.14|812.21|624.77|676.84|780.97|885.10|924.67|916.34|780.97|885.10| 78.90 | 924.67 | 676.84 45900290|HC US EXAM ABDO BACK WALL COMP|0459|76770|1,041.29|603.95|578.03|549.13|108.97|108.97|129.58|132.17|132.17|134.76|676.84|708.08|760.14|760.14|812.21|624.77|676.84|780.97|885.10|924.67|916.34|780.97|885.10| 108.97 | 924.67 | 676.84 45900291|HC US EXAM ABDO BACK WALL LIM|0459|76775|808.31|468.82|539.85|512.86|108.97|108.97|56.68|57.81|57.81|58.94|525.40|549.65|590.07|590.07|630.48|484.99|525.40|606.23|687.06|717.78|711.31|606.23|687.06| 56.68 | 717.78 | 539.85 45900291|HC US EXAM ABDO BACK WALL LIM|0459|76775|808.31|468.82|539.85|512.86|108.97|108.97|97.20|99.14|99.14|101.08|525.40|549.65|590.07|590.07|630.48|484.99|525.40|606.23|687.06|717.78|711.31|606.23|687.06| 97.20 | 717.78 | 539.85 45900292|HC US EXAM K TRANSPL W/DOPPLER|0459|76776|1,341.31|777.96|186.66|177.327|108.97|108.97|||||871.85|912.09|979.16|979.16|1046.22|804.79|871.85|1005.98|1140.11|1191.08|1180.35|1005.98|1140.11| 108.97 | 1,191.08 | 979.16 45900293|HC OB US LIMITED 1+FETUS(S)|0459|76815|560.77|325.25|307.84|292.448|108.97|108.97|50.74|51.75|51.75|52.77|364.50|381.32|409.36|409.36|437.40|336.46|364.50|420.58|476.65|497.96|493.48|420.58|476.65| 50.74 | 497.96 | 364.50 45900293|HC OB US LIMITED 1+FETUS(S)|0459|76815|560.77|325.25|307.84|292.45|108.97|108.97|45.03|45.93|45.93|46.83|364.50|381.32|409.36|409.36|437.40|336.46|364.50|420.58|476.65|497.96|493.48|420.58|476.65| 45.03 | 497.96 | 364.50 45900293|HC OB US LIMITED 1+FETUS(S)|0459|76815|560.77|325.25|307.84|292.45|108.97|108.97|101.46|103.49|103.49|105.52|364.50|381.32|409.36|409.36|437.40|336.46|364.50|420.58|476.65|497.96|493.48|420.58|476.65| 101.46 | 497.96 | 364.50 45900294|HC TRANSVAGINAL OB US|0459|76817|1,003.93|582.28|553.74|526.05|108.97|108.97|108.98|111.16|111.16|113.34|652.55|682.67|732.87|732.87|783.07|602.36|652.55|752.95|853.34|891.49|883.46|752.95|853.34| 108.97 | 891.49 | 652.55 45900294|HC TRANSVAGINAL OB US|0459|76817|1,003.93|582.28|553.74|526.05|108.97|108.97|64.71|66.00|66.00|67.30|652.55|682.67|732.87|732.87|783.07|602.36|652.55|752.95|853.34|891.49|883.46|752.95|853.34| 64.71 | 891.49 | 652.55 45900294|HC TRANSVAGINAL OB US|0459|76817|1,003.93|582.28|553.74|526.05|108.97|108.97|48.22|49.19|49.19|50.15|652.55|682.67|732.87|732.87|783.07|602.36|652.55|752.95|853.34|891.49|883.46|752.95|853.34| 48.22 | 891.49 | 652.55 45900295|HC NON-OB TRANSVAG US|0459|76830|1,074.35|623.12|598.31|568.39|108.97|108.97|64.71|66.00|66.00|67.30|698.33|730.56|784.28|784.28|837.99|644.61|698.33|805.76|913.20|954.02|945.43|805.76|913.20| 64.71 | 954.02 | 698.33 45900295|HC NON-OB TRANSVAG US|0459|76830|1,074.35|623.12|598.31|568.39|108.97|108.97|108.98|111.16|111.16|113.34|698.33|730.56|784.28|784.28|837.99|644.61|698.33|805.76|913.20|954.02|945.43|805.76|913.20| 108.97 | 954.02 | 698.33 45900296|HC SALINE INFUSED SONOHYSTEROGRAM|0459|76831|901.34|522.78|678.19|644.28|230.13|230.13|78.50|80.07|80.07|81.64|585.87|612.91|657.98|657.98|703.05|540.80|585.87|676.01|766.14|800.39|793.18|676.01|766.14| 78.50 | 800.39 | 644.28 45900296|HC SALINE INFUSED SONOHYSTEROGRAM|0459|76831|901.34|522.78|678.19|644.28|230.13|230.13|157|160.14|160.14|163.28|585.87|612.91|657.98|657.98|703.05|540.80|585.87|676.01|766.14|800.39|793.18|676.01|766.14| 157.00 | 800.39 | 644.28 45900297|HC US EXAM PELVIC COMPLETE|0459|76856|1,585.17|919.40|878.47|834.55|108.97|108.97|64.71|66|66|67.3|1030.36|1077.92|1157.17|1157.17|1236.43|951.10|1030.36|1188.88|1347.39|1407.63|1394.95|1188.88|1347.39| 64.71 | 1,407.63 | 1,030.36 45900297|HC US EXAM PELVIC COMPLETE|0459|76856|1,585.17|919.40|878.47|834.55|108.97|108.97|108.98|111.16|111.16|113.34|1030.36|1077.92|1157.17|1157.17|1236.43|951.10|1030.36|1188.88|1347.39|1407.63|1394.95|1188.88|1347.39| 108.97 | 1,407.63 | 1,030.36 45900298|HC US EXAM PELVIC LIMITED|0459|76857|1,162.47|674.23|644.99|612.74|108.97|108.97|42.25|43.09|43.09|43.94|755.61|790.48|848.60|848.60|906.73|697.48|755.61|871.85|988.10|1032.27|1022.97|871.85|988.10| 42.25 | 1,032.27 | 755.61 45900298|HC US EXAM PELVIC LIMITED|0459|76857|1,162.47|674.23|644.99|612.74|108.97|108.97|67.65|69.01|69.01|70.36|755.61|790.48|848.60|848.60|906.73|697.48|755.61|871.85|988.10|1032.27|1022.97|871.85|988.10| 67.65 | 1,032.27 | 755.61 45900299|HC US XTR NON-VASC COMPLETE|0459|76881|712.29|413.13|165.28|157.016|108.97|108.97|51.93|52.97|52.97|54|462.99|484.36|519.97|519.97|555.59|427.37|462.99|534.22|605.45|632.51|626.82|534.22|605.45| 51.93 | 632.51 | 462.99 45900300|HC US XTR NON-VASC LMTD|0402|76882|437.81|253.93|165.28|157.02|108.97|108.97|6.07|6.19|6.19|6.31|284.58|297.71|319.60|319.60|341.49|262.69|284.58|328.36|372.14|388.78|385.27|328.36|372.14| 6.07 | 388.78 | 284.58 45900301|HC US GUIDED PERICARDIOCENTESIS|0459|76930|585.88|339.81|||||98.12|100.09|100.09|102.05|380.82|398.40|427.69|427.69|456.99|351.53|380.82|439.41|498.00|520.26|515.57|439.41|498.00| 98.12 | 520.26 | 427.69 45900301|HC US GUIDED PERICARDIOCENTESIS|0459|76930|585.88|339.81|||||61.40|62.63|62.63|63.86|380.82|398.40|427.69|427.69|456.99|351.53|380.82|439.41|498.00|520.26|515.57|439.41|498.00| 61.40 | 520.26 | 427.69 45900302|HC US GUIDE VASCULAR ACCESS|0459|76937|1,166.89|676.80|632.29|600.68|||15.48|15.79|15.79|16.10|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 15.48 | 1,036.20 | 793.49 45900302|HC US GUIDE VASCULAR ACCESS|0459|76937|1,166.89|676.80|632.29|600.68|||29.33|29.92|29.92|30.51|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 29.33 | 1,036.20 | 793.49 45900303|HC US GUIDED NEEDLE PLACEMENT|0459|76942|1,166.89|676.80|169.54|161.063|||39.25|40.03|40.03|40.82|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 39.25 | 1,036.20 | 793.49 45900303|HC US GUIDED NEEDLE PLACEMENT|0459|76942|1,166.89|676.80|169.54|161.063|||55.39|56.50|56.50|57.61|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 55.39 | 1,036.20 | 793.49 45900304|HC TTE F-UP OR LMTD|0459|93308|899.70|521.83|812.12|771.514|230.13|230.13|78.72|80.30|80.30|81.87|584.81|611.80|656.78|656.78|701.77|539.82|584.81|674.78|764.75|798.93|791.74|674.78|764.75| 78.72 | 812.12 | 656.78 45900304|HC TTE F-UP OR LMTD|0459|93308|899.70|521.83|812.12|771.51|230.13|230.13|206.43|210.56|210.56|214.68|584.81|611.80|656.78|656.78|701.77|539.82|584.81|674.78|764.75|798.93|791.74|674.78|764.75| 206.43 | 812.12 | 656.78 45900305|HC DUPLEX EXT VEINS; UNIL/LIMIT|0459|76536|322.02|186.77|678.19|644.28|108.97|108.97|25.90|26.42|26.42|26.94|209.31|218.97|235.07|235.07|251.18|193.21|209.31|241.52|273.72|285.95|283.38|241.52|273.72| 25.90 | 678.19 | 235.07 45900305|HC DUPLEX EXT VEINS; UNIL/LIMIT|0459|76536|322.02|186.77|678.19|644.28|108.97|108.97|51.81|52.85|52.85|53.88|209.31|218.97|235.07|235.07|251.18|193.21|209.31|241.52|273.72|285.95|283.38|241.52|273.72| 51.81 | 678.19 | 235.07 45900306|HC DRAIN/INJ SMALL JOINT/BURSA W/US|0459|20604|777.86|451.16|200.91|190.8645|261.17|261.17|||||505.61|528.94|567.84|567.84|606.73|466.72|505.61|583.40|661.18|690.74|684.52|583.40|661.18| 190.86 | 690.74 | 567.84 45900307|HC DRAIN/INJ MAJOR JOINT/BURSA W/US|0459|20611|1,152.30|668.33|1616.54|1535.713|261.17|261.17|||||749.00|783.56|841.18|841.18|898.79|691.38|749.00|864.23|979.46|1023.24|1014.02|864.23|979.46| 261.17 | 1,616.54 | 864.23 45900308|HC NONSELECTIVE CATH PLACEMENT IN VEIN|0459|36000|469.70|272.43|95.46|90.69|||294.37|300.26|300.26|306.15|305.31|319.40|342.88|342.88|366.37|281.82|305.31|352.28|399.25|417.09|413.34|352.28|399.25| 90.69 | 417.09 | 319.40 45900309|HC INS TUNNELED CV CATH WO SQ PORT <5YRS|0459|36557|2,882.94|1,672.11|1,863.61|1,770.43|4,770.37|4,770.37|480.81|490.42|490.42|500.04|1873.91|1960.40|2104.55|2104.55|2248.69|1729.76|1873.91|2162.21|2450.50|2560.05|2536.99|2162.21|2450.50| 480.81 | 4,770.37 | 2,104.55 45900310|HC ULTRASOUND BREAST COMPLETE|0459|76641|737.97|428.02|272.30|258.69|108.97|108.97|||||479.68|501.82|538.72|538.72|575.62|442.78|479.68|553.48|627.27|655.32|649.41|553.48|627.27| 108.97 | 655.32 | 538.72 45900311|HC DRAIN BLADDER BY NEEDLE|0459|51100|667.85|387.35|||266.14|266.14|||||434.10|454.14|487.53|487.53|520.92|400.71|434.10|500.89|567.67|593.05|587.71|500.89|567.67| 266.14 | 593.05 | 487.53 45900312|HC INS TUNNELED CV CATH AGE 5/>|0459|36558|3,682.99|2,136.13|1,863.61|1,770.43|2,861.66|2,861.66|480.81|490.42|490.42|500.04|2393.94|2504.43|2688.58|2688.58|2872.73|2209.79|2393.94|2762.24|3130.54|3270.50|3241.03|2762.24|3130.54| 480.81 | 3,270.50 | 2,688.58 45900313|HC US PV RESIDUAL URINE|0459|51798|216.36|125.49|95.46|90.69|55.66|55.66|196.25|200.17|200.17|204.10|140.63|147.12|157.94|157.94|168.76|129.82|140.63|162.27|183.91|192.13|190.40|162.27|183.91| 55.66 | 204.10 | 162.27 45900314|HC US EXAM INFANT HIPS STATIC|0459|76886|2,096.16|1,215.77|128.24|121.828|80.90|80.90|98.12|100.09|100.09|102.05|1362.50|1425.39|1530.20|1530.20|1635.00|1257.70|1362.50|1572.12|1781.74|1861.39|1844.62|1572.12|1781.74| 80.90 | 1,861.39 | 1,362.50 45900314|HC US EXAM INFANT HIPS STATIC|0459|76886|2,096.16|1,215.77|128.24|121.828|80.9|80.9|49.06|50.04|50.04|51.02|1362.50|1425.39|1530.20|1530.20|1635.00|1257.70|1362.50|1572.12|1781.74|1861.39|1844.62|1572.12|1781.74| 49.06 | 1,861.39 | 1,362.50 45900315|HC INSERT CATH PLEURA W/IMAGE|0459|32557|3,280.65|1,902.78|1216.76|1155.922|1,406.14|1,406.14|350.7|357.71|357.71|364.72|2132.42|2230.84|2394.87|2394.87|2558.91|1968.39|2132.42|2460.49|2788.55|2913.22|2886.97|2460.49|2788.55| 350.70 | 2,913.22 | 2,132.42 45900316|HC GUIDE CATHET FLUID DRAINAGE|0459|10030|1,163.23|674.67|||621.97|621.97|135.78|138.49|138.49|141.21|756.10|791.00|849.16|849.16|907.32|697.94|756.10|872.42|988.75|1032.95|1023.64|872.42|988.75| 135.78 | 1,032.95 | 791.00 45900317|HC IMAGE CATH FLUID COLXN VISC|0459|49405|3,335.35|1,934.50|||1,407.00|1,407.00|1,040.26|1,061.06|1,061.06|1,081.87|2167.98|2268.04|2434.81|2434.81|2601.57|2001.21|2167.98|2501.51|2835.05|2961.79|2935.11|2501.51|2835.05| 1,040.26 | 2,961.79 | 2,268.04 45900318|HC IMAGE CATH FLUID PERI/RETRO|0459|49406|4,880.26|2,830.55|||1,407.00|1,407.00|1,040.26|1,061.06|1,061.06|1,081.87|3172.17|3318.58|3562.59|3562.59|3806.60|2928.16|3172.17|3660.20|4148.22|4333.67|4294.63|3660.20|4148.22| 1,040.26 | 4,333.67 | 3,318.58 45900319|HC CLTX MED ANKLE FX W/MNPJ|0459|27762|4,621.96|2,680.74|2051.68|1949.096|1,392.35|1,392.35|392.50|400.35|400.35|408.20|3004.27|3142.93|3374.03|3374.03|3605.13|2773.18|3004.27|3466.47|3928.67|4104.30|4067.32|3466.47|3928.67| 392.50 | 4,104.30 | 3,004.27 45900320|HC BRONCHOSCOPY W/FB REMOVAL|0459|31635|2,226.81|1,291.55|2291.04|2176.488|1,496.39|1,496.39|327.08|333.62|333.62|340.16|1447.43|1514.23|1625.57|1625.57|1736.91|1336.09|1447.43|1670.11|1892.79|1977.41|1959.59|1670.11|1892.79| 327.08 | 2,291.04 | 1,625.57 45900321|HC CL TX TARSAL BONE DISLO; WO ANESTH|0459|28540|784.00|454.72|1141.26|1084.197|206.19|206.19|||||509.60|533.12|572.32|572.32|611.52|470.40|509.60|588.00|666.40|696.19|689.92|588.00|666.40| 206.19 | 1,141.26 | 588.00 45900322|HC DILATE NEPHROSTOMY TRACT PERC|0459|50395|4,679.41|2,714.06|||||392.50|400.35|400.35|408.20|3041.62|3182.00|3415.97|3415.97|3649.94|2807.65|3041.62|3509.56|3977.50|4155.32|4117.88|3509.56|3977.50| 392.50 | 4,155.32 | 3,415.97 45900323|HC INTERROG ONLY PACER (ALL TYPES)|0459|93288|330.36|191.61|||37.15|37.15|19.7|20.1|20.1|20.49|214.73|224.64|241.16|241.16|257.68|198.22|214.73|247.77|280.81|293.36|290.72|247.77|280.81| 19.70 | 293.36 | 224.64 45900324|HC CL TX HUMERUS FX W MANIP|0459|24505|1,599.07|927.46|2051.68|1949.096|1392.35|1392.35|392.5|400.35|400.35|408.2|1039.40|1087.37|1167.32|1167.32|1247.27|959.44|1039.40|1199.30|1359.21|1419.97|1407.18|1199.30|1359.21| 392.50 | 2,051.68 | 1,199.30 45900325|HC CL TX RADIAL HD/NECK FX; WO MANIP|0459|24650|610.19|353.91|1,141.26|1,084.20|206.19|206.19|392.50|400.35|400.35|408.20|396.62|414.93|445.44|445.44|475.95|366.11|396.62|457.64|518.66|541.85|536.97|457.64|518.66| 206.19 | 1,141.26 | 445.44 45900327|HC CL TX TALOTARSAL JOINT DIS; WO ANEST|0459|28570|484.93|281.26|1,141.26|1,084.20|206.19|206.19|||||315.20|329.75|354.00|354.00|378.25|290.96|315.20|363.70|412.19|430.62|426.74|363.70|412.19| 206.19 | 1,141.26 | 363.70 45900328|HC SPL AVULSE NP; EA ADDTL|0459|11732|547.98|317.83|||||24.67|25.17|25.17|25.66|356.19|372.63|400.03|400.03|427.42|328.79|356.19|410.99|465.78|486.61|482.22|410.99|465.78| 24.67 | 486.61 | 400.03 45900329|HC CYSTO W DIL OF URETHRAL STRICTURE|0459|52281|2,337.68|1,355.85|1,584.36|1,505.14|1,792.99|1,792.99|457.91|467.07|467.07|476.23|1519.49|1589.62|1706.51|1706.51|1823.39|1402.61|1519.49|1753.26|1987.03|2075.86|2057.16|1753.26|1987.03| 457.91 | 2,075.86 | 1,706.51 45900330|HC I&D CPLX POSTOP WND INF|0459|10180|4,743.95|2,751.49|437.4|415.53|2,370.01|2,370.01|255.12|260.22|260.22|265.33|3083.57|3225.89|3463.08|3463.08|3700.28|2846.37|3083.57|3557.96|4032.36|4212.63|4174.68|3557.96|4032.36| 255.12 | 4,212.63 | 3,083.57 45900331|HC I&D ABSC/CYS FOM; MASTIC SPACE|0459|41009|3,740.71|2,169.61|||452.36|452.36|||||2431.46|2543.68|2730.72|2730.72|2917.75|2244.43|2431.46|2805.53|3179.60|3321.75|3291.82|2805.53|3179.60| 452.36 | 3,321.75 | 2,730.72 45900332|HC CLTX INTR/PERI/SBTRCHNTC FEM FX W MNP|0459|27240|10,963.87|6,359.04|||1,392.35|1,392.35|523.33|533.79|533.79|544.26|7126.52|7455.43|8003.63|8003.63|8551.82|6578.32|7126.52|8222.90|9319.29|9735.92|9648.21|8222.90|9319.29| 523.33 | 9,735.92 | 7,455.43 45900333|HC REPLACE DUOD/JEJ TUBE PERC|0459|49451|2,332.40|1,352.79|||809.60|809.60|||||1516.06|1586.03|1702.65|1702.65|1819.27|1399.44|1516.06|1749.30|1982.54|2071.17|2052.51|1749.30|1982.54| 809.60 | 2,071.17 | 1,702.65 45900334|HC SKIN FULL GRFT FACE/GENIT/HF = <20 SQ CM|0459|15240|2,511.51|1,456.68|491.53|466.95|1,715.36|1,715.36|327.08|333.62|333.62|340.16|1632.48|1707.83|1833.40|1833.40|1958.98|1506.91|1632.48|1883.63|2134.78|2230.22|2210.13|1883.63|2134.78| 327.08 | 2,230.22 | 1,715.36 45900335|HC CL TX FEMUR FX OR EPIPHYS SEP|0459|27510|3,837.53|2,225.77|2051.68|1949.096|1392.35|1392.35|392.5|400.35|400.35|408.2|2494.39|2609.52|2801.40|2801.40|2993.27|2302.52|2494.39|2878.15|3261.90|3407.73|3377.03|2878.15|3261.90| 392.50 | 3,407.73 | 2,494.39 45900336|HC IRRIGATE CORPORA CAVERNOSA FOR PRIAPISM|0459|54220|430.97|249.96|||266.14|266.14|392.50|400.35|400.35|408.20|280.13|293.06|314.61|314.61|336.16|258.58|280.13|323.23|366.32|382.70|379.25|323.23|366.32| 258.58 | 408.20 | 323.23 45900337|HC INJ EPIDURAL BLOOD OR CLOT PATCH|0459|62273|2,379.22|1,379.95|||634.59|634.59|130.83|133.45|133.45|136.07|1546.49|1617.87|1736.83|1736.83|1855.79|1427.53|1546.49|1784.42|2022.34|2112.75|2093.71|1784.42|2022.34| 130.83 | 2,112.75 | 1,617.87 45900338|HC DR ABSC/HEMATOMA NASAL SEPTUM|0459|30020|897.06|520.29|||452.36|452.36|294.37|300.26|300.26|306.15|583.09|610.00|654.85|654.85|699.71|538.24|583.09|672.80|762.50|796.59|789.41|672.80|762.50| 294.37 | 796.59 | 610.00 45900339|HC FORESKIN MANIPULATION|0459|54450|955.87|554.40|||266.14|266.14|327.08|333.62|333.62|340.16|621.32|649.99|697.79|697.79|745.58|573.52|621.32|716.90|812.49|848.81|841.17|716.90|812.49| 266.14 | 848.81 | 649.99 45900340|HC INS WIRE/PIN W SK TRACT|0459|20650|5,248.78|3,044.29|||2,830.40|2,830.40|327.08|333.62|333.62|340.16|3411.71|3569.17|3831.61|3831.61|4094.05|3149.27|3411.71|3936.59|4461.46|4660.92|4618.93|3936.59|4461.46| 327.08 | 4,660.92 | 3,569.17 45900341|HC RPLC GTUBE NO REVJ TRC|0459|43762|547.98|317.83|437.40|415.53|266.14|266.14|||||356.19|372.63|400.03|400.03|427.42|328.79|356.19|410.99|465.78|486.61|482.22|410.99|465.78| 266.14 | 486.61 | 410.99 45900342|HC BURR HOLE/TREPHINE INFRATENTORIAL|0459|61253|3,413.53|1,979.85|||||||||2218.79|2321.20|2491.88|2491.88|2662.55|2048.12|2218.79|2560.15|2901.50|3031.21|3003.91|2560.15|2901.50| 2,048.12 | 3,031.21 | 2,560.15 45900343|HC REMOVE EMBEDDED FB EYELID|0459|67938|985.97|571.86|488.70|464.27|261.28|261.28|457.91|467.07|467.07|476.23|640.88|670.46|719.76|719.76|769.06|591.58|640.88|739.48|838.07|875.54|867.65|739.48|838.07| 261.28 | 875.54 | 640.88 45900344|HC CHANGE OF CYSTOSTOMY TUBE, SIMPLE|0459|51705|631.77|366.43|95.46|90.687|266.14|266.14|196.25|200.17|200.17|204.10|410.65|429.60|461.19|461.19|492.78|379.06|410.65|473.83|537.00|561.01|555.96|473.83|537.00| 90.69 | 561.01 | 410.65 45900345|HC CYSTO W REM FB/STNT URETH/BLDR; SIMPLE|0459|52310|1,984.50|1,151.01|2793.99|2654.2905|1792.99|1792.99|457.91|467.07|467.07|476.23|1289.93|1349.46|1448.69|1448.69|1547.91|1190.70|1289.93|1488.38|1686.83|1762.24|1746.36|1488.38|1686.83| 457.91 | 2,793.99 | 1,488.38 45900346|HC APPLY LONG LEG CAST|0459|29345|437.69|253.86|391.81|372.22|241.17|241.17|261.66|266.90|266.90|272.13|284.50|297.63|319.51|319.51|341.40|262.61|284.50|328.27|372.04|388.67|385.17|328.27|372.04| 241.17 | 391.81 | 319.51 45900347|HC DR ABSC/HEMATOMA NASAL INT|0459|30000|2,020.92|1,172.13|||211.60|211.60|327.08|333.62|333.62|340.16|1313.60|1374.23|1475.27|1475.27|1576.32|1212.55|1313.60|1515.69|1717.78|1794.58|1778.41|1515.69|1717.78| 211.60 | 1,794.58 | 1,374.23 45900348|HC INSERT CATH PLEURA W/O IMAGE|0459|32556|1,855.51|1,076.20|1,047.21|994.85|1,625.02|1,625.02|350.70|357.71|357.71|364.72|1206.08|1261.75|1354.52|1354.52|1447.30|1113.31|1206.08|1391.63|1577.18|1647.69|1632.85|1391.63|1577.18| 350.70 | 1,647.69 | 1,354.52 45900349|HC TX METATARSAL FX; W MANIP|0459|28475|738.13|428.12|2,281.07|2,167.02|206.19|206.19|457.91|467.07|467.07|476.23|479.78|501.93|538.83|538.83|575.74|442.88|479.78|553.60|627.41|655.46|649.55|553.60|627.41| 206.19 | 2,281.07 | 538.83 45900350|HC INSERT BLADDER CATHETER|0459|51701|206.85|119.97|95.46|90.69|111.95|111.95|||||134.45|140.66|151.00|151.00|161.34|124.11|134.45|155.14|175.82|183.68|182.03|155.14|175.82| 90.69 | 183.68 | 151.00 45900351|HC APPLY FINGER SPLINT, STATIC|0459|29130|347.55|201.58|324.86|308.62|111.95|111.95|17.57|17.92|17.92|18.27|225.91|236.33|253.71|253.71|271.09|208.53|225.91|260.66|295.42|308.62|305.84|260.66|295.42| 17.57 | 324.86 | 253.71 45900352|HC THORCOM CTRL TRAUMTC HEMRRG/RPR LNG TEAR|0459|32110|1,933.40|1,121.37|||||||||1256.71|1314.71|1411.38|1411.38|1508.05|1160.04|1256.71|1450.05|1643.39|1716.86|1701.39|1450.05|1643.39| 1,160.04 | 1,716.86 | 1,450.05 45900353|HC CL TX EC HUMERUS FX W MANIP|0459|24565|3,110.15|1,803.89|2,051.68|1,949.10|1,392.35|1,392.35|523.33|533.79|533.79|544.26|2021.60|2114.90|2270.41|2270.41|2425.92|1866.09|2021.60|2332.61|2643.63|2761.81|2736.93|2332.61|2643.63| 523.33 | 2,761.81 | 2,051.68 45900354|HC OPHTH US B & QUANT A|0459|76510|939.75|545.06|||111.95|111.95|72.52|73.97|73.97|75.42|610.84|639.03|686.02|686.02|733.01|563.85|610.84|704.81|798.79|834.50|826.98|704.81|798.79| 72.52 | 834.50 | 639.03 45900354|HC OPHTH US B & QUANT A|0459|76510|939.75|545.06|||111.95|111.95|145.35|148.26|148.26|151.17|610.84|639.03|686.02|686.02|733.01|563.85|610.84|704.81|798.79|834.50|826.98|704.81|798.79| 111.95 | 834.50 | 639.03 45900355|HC CL TX FX GT PHALANX(S); WO MANIP|0459|28490|440.74|255.63|2,051.68|1,949.10|206.19|206.19|392.50|400.35|400.35|408.20|286.48|299.70|321.74|321.74|343.78|264.44|286.48|330.56|374.63|391.38|387.85|330.56|374.63| 206.19 | 2,051.68 | 343.78 45900356|HC UNLISTED PROCEDURE PHARYNX ADENOIDS|0459|42999|3,667.39|2,127.09|||211.60|211.60|||||2383.80|2493.83|2677.19|2677.19|2860.56|2200.43|2383.80|2750.54|3117.28|3256.64|3227.30|2750.54|3117.28| 211.60 | 3,256.64 | 2,677.19 45900357|HC EGD DIAGNOSTIC BRUSH WASH|0459|43235|2,536.80|1,471.34|1,289.43|1,224.96|809.60|809.60|294.37|300.26|300.26|306.15|1648.92|1725.02|1851.86|1851.86|1978.70|1522.08|1648.92|1902.60|2156.28|2252.68|2232.38|1902.60|2156.28| 294.37 | 2,252.68 | 1,648.92 45900358|HC THROMBOLYSIS CEREBRAL BY IV INFUSION|0459|37195|901.95|523.13|||310.75|310.75|546.21|557.13|557.13|568.06|586.27|613.33|658.42|658.42|703.52|541.17|586.27|676.46|766.66|800.93|793.72|676.46|766.66| 310.75 | 800.93 | 613.33 45900359|HC CLTX DSTL RADIAL FX/EPIPHYSL SEP WO MNP|0459|25600|885.60|513.65|2,051.68|1,949.10|206.19|206.19|392.50|400.35|400.35|408.20|575.64|602.21|646.49|646.49|690.77|531.36|575.64|664.20|752.76|786.41|779.33|664.20|752.76| 206.19 | 2,051.68 | 646.49 45900360|HC ASPIRATE/INJ GANGLION CYST|0459|20612|334.95|194.27|200.91|190.86|261.17|261.17|219.80|224.19|224.19|228.59|217.72|227.77|244.51|244.51|261.26|200.97|217.72|251.21|284.71|297.44|294.76|251.21|284.71| 190.86 | 297.44 | 244.51 45900361|HC OPEN CHEST HEART MASSAGE|0459|32160|3,844.49|2,229.80|||||1,046.66|1,067.59|1,067.59|1,088.52|2498.92|2614.25|2806.48|2806.48|2998.70|2306.69|2498.92|2883.37|3267.82|3413.91|3383.15|2883.37|3267.82| 1,046.66 | 3,413.91 | 2,806.48 45900362|HC REPAIR CARDIAC WOUND; WO CPB|0459|33300|4,727.10|2,741.72|||||||||3072.62|3214.43|3450.78|3450.78|3687.14|2836.26|3072.62|3545.33|4018.04|4197.66|4159.85|3545.33|4018.04| 2,836.26 | 4,197.66 | 3,545.33 45900363|HC TX TARSAL BONE FX; W MANIP|0459|28455|4,308.15|2,498.73|2,281.07|2,167.02|1,392.35|1,392.35|327.08|333.62|333.62|340.16|2800.30|2929.54|3144.95|3144.95|3360.36|2584.89|2800.30|3231.11|3661.93|3825.64|3791.17|3231.11|3661.93| 327.08 | 3,825.64 | 2,800.30 45900364|HC AMPUTATE TOE: IP JOINT|0459|28825|5,654.25|3,279.47|2348.02|2230.619|2,830.40|2,830.40|392.5|400.35|400.35|408.2|3675.26|3844.89|4127.60|4127.60|4410.32|3392.55|3675.26|4240.69|4806.11|5020.97|4975.74|4240.69|4806.11| 392.50 | 5,020.97 | 3,675.26 45900365|HC CL TX OF ACETABULUM FXS); W MANIP|0459|27222|1,501.19|870.69|||206.19|206.19|||||975.77|1020.81|1095.87|1095.87|1170.93|900.71|975.77|1125.89|1276.01|1333.06|1321.05|1125.89|1276.01| 206.19 | 1,333.06 | 1,095.87 45900366|HC REP LACERAT 2.5 CM/<; POST 1/3 TONGUE|0459|41251|967.29|561.03|||211.6|211.6|196.25|200.17|200.17|204.10|628.74|657.76|706.12|706.12|754.49|580.37|628.74|725.47|822.20|858.95|851.22|725.47|822.20| 196.25 | 858.95 | 657.76 45900367|HC REPAIR INTRINSIC MUSCLES OF HAND|0459|26591|7,957.12|4,615.13|||2830.4|2830.4|392.50|400.35|400.35|408.20|5172.13|5410.84|5808.70|5808.70|6206.55|4774.27|5172.13|5967.84|6763.55|7065.92|7002.27|5967.84|6763.55| 392.50 | 7,065.92 | 5,410.84 45900368|HC NON-ROUTINE BL DRAW 3/> YRS|0459|36410|344.97|200.08|391.81|372.22|||17.01|17.35|17.35|17.69|224.23|234.58|251.83|251.83|269.08|206.98|224.23|258.73|293.22|306.33|303.57|258.73|293.22| 17.01 | 391.81 | 251.83 45900369|HC INJECT TRIGGER POINTS 3/>|0459|20553|882.64|511.93|200.91|190.86|261.17|261.17|219.80|224.19|224.19|228.59|573.72|600.20|644.33|644.33|688.46|529.58|573.72|661.98|750.24|783.78|776.72|661.98|750.24| 190.86 | 783.78 | 573.72 45900370|HC CL TX PROX HUMERAL FX; W MANIP|0459|23605|3,183.60|1,846.49|2,051.68|1,949.10|1,392.35|1,392.35|457.91|467.07|467.07|476.23|2069.34|2164.85|2324.03|2324.03|2483.21|1910.16|2069.34|2387.70|2706.06|2827.04|2801.57|2387.70|2706.06| 457.91 | 2,827.04 | 2,069.34 45900371|HC EXTENSOR TENDON REPAIR EACH|0459|26418|5,833.85|3,383.63|2,793.99|2,654.29|1,392.35|1,392.35|392.50|400.35|400.35|408.20|3792.00|3967.02|4258.71|4258.71|4550.40|3500.31|3792.00|4375.39|4958.77|5180.46|5133.79|4375.39|4958.77| 392.50 | 5,180.46 | 3,792.00 45900372|HC CL TX RADIAL HD/NECK FX: W MANIP|0459|24655|1,590.75|922.64|1,575.81|1,497.02|1,392.35|1,392.35|457.91|467.07|467.07|476.23|1033.99|1081.71|1161.25|1161.25|1240.79|954.45|1033.99|1193.06|1352.14|1412.59|1399.86|1193.06|1352.14| 457.91 | 1,575.81 | 1,193.06 45900373|HC CLTX FEMORAL FX PROX HEAD W/MANJ|0459|27268|3,106.45|1,801.74|||2,830.40|2,830.40|||||2019.19|2112.39|2267.71|2267.71|2423.03|1863.87|2019.19|2329.84|2640.48|2758.53|2733.68|2329.84|2640.48| 1,863.87 | 2,830.40 | 2,329.84 45900374|HC DEBRIDEMENT OPEN WOUND 20 SQ CM<|0459|97597|733.95|425.69|||179.55|179.55|261.66|266.9|266.9|272.13|477.07|499.09|535.78|535.78|572.48|440.37|477.07|550.46|623.86|651.75|645.88|550.46|623.86| 179.55 | 651.75 | 499.09 45900375|HC CLTX GRTER HUMERAL TUBEROSITY FX W/MANIP|0459|23625|2,752.05|1,596.19|2051.68|1949.096|1,392.35|1,392.35|||||1788.83|1871.39|2009.00|2009.00|2146.60|1651.23|1788.83|2064.04|2339.24|2443.82|2421.80|2064.04|2339.24| 1,392.35 | 2,443.82 | 2,009.00 45900376|HC CYSTOURETHROSCOPY WITH URETERAL CATH|0459|52005|5,556.60|3,222.83|1590.06|1510.557|1,792.99|1,792.99|457.91|467.07|467.07|476.23|3611.79|3778.49|4056.32|4056.32|4334.15|3333.96|3611.79|4167.45|4723.11|4934.26|4889.81|4167.45|4723.11| 457.91 | 4,934.26 | 3,611.79 45900377|HC CANTHOTOMY|0459|67715|430.00|249.40|||2,002.35|2,002.35|||||279.50|292.40|313.90|313.90|335.40|258.00|279.50|322.50|365.50|381.84|378.40|322.50|365.50| 258.00 | 2,002.35 | 322.50 46000000|HC SPIROMETRY|0460|94010|368.84|213.93|322.63|306.50|139.55|139.55|19.51|19.9|19.9|20.29|239.75|250.81|269.25|269.25|287.70|221.30|239.75|276.63|313.51|327.53|324.58|276.63|313.51| 19.51 | 327.53 | 269.25 46000000|HC SPIROMETRY|0460|94010|368.84|213.93|322.63|306.50|139.55|139.55|39.01|39.79|39.79|40.57|239.75|250.81|269.25|269.25|287.70|221.30|239.75|276.63|313.51|327.53|324.58|276.63|313.51| 39.01 | 327.53 | 269.25 46000001|HC BRONCHOSPASM EVAL W SPIROMT|0460|94060|805.61|467.25|704.67|669.44|264.45|264.45|26.17|26.69|26.69|27.21|523.65|547.81|588.10|588.10|628.38|483.37|523.65|604.21|684.77|715.38|708.94|604.21|684.77| 26.17 | 715.38 | 588.10 46000001|HC BRONCHOSPASM EVAL W SPIROMT|0460|94060|805.61|467.25|704.67|669.44|264.45|264.45|62.80|64.06|64.06|65.31|523.65|547.81|588.10|588.10|628.38|483.37|523.65|604.21|684.77|715.38|708.94|604.21|684.77| 62.80 | 715.38 | 588.10 46000001|HC BRONCHOSPASM EVAL W SPIROMT|0460|94060|805.61|467.25|704.67|669.44|264.45|264.45|31.40|32.03|32.03|32.66|523.65|547.81|588.10|588.10|628.38|483.37|523.65|604.21|684.77|715.38|708.94|604.21|684.77| 31.40 | 715.38 | 588.10 46000002|HC DISABILITY FOLLOW-UP|0460|94060|824.12|477.99|704.67|669.44|264.45|264.45|26.17|26.69|26.69|27.21|535.68|560.40|601.61|601.61|642.81|494.47|535.68|618.09|700.50|731.82|725.23|618.09|700.50| 26.17 | 731.82 | 601.61 46000002|HC DISABILITY FOLLOW-UP|0460|94060|824.12|477.99|704.67|669.44|264.45|264.45|62.80|64.06|64.06|65.31|535.68|560.40|601.61|601.61|642.81|494.47|535.68|618.09|700.50|731.82|725.23|618.09|700.50| 62.80 | 731.82 | 601.61 46000002|HC DISABILITY FOLLOW-UP|0460|94060|824.12|477.99|704.67|669.44|264.45|264.45|31.40|32.03|32.03|32.66|535.68|560.40|601.61|601.61|642.81|494.47|535.68|618.09|700.50|731.82|725.23|618.09|700.50| 31.40 | 731.82 | 601.61 46000003|HC EVALUATION OF WHEEZING|0460|94070|1,480.37|858.61|1,408.48|1,338.06|264.45|264.45|31.40|32.03|32.03|32.66|962.24|1006.65|1080.67|1080.67|1154.69|888.22|962.24|1110.28|1258.31|1314.57|1302.73|1110.28|1258.31| 31.40 | 1,408.48 | 1,080.67 46000003|HC EVALUATION OF WHEEZING|0460|94070|1,480.37|858.61|1,408.48|1,338.06|264.45|264.45|62.80|64.06|64.06|65.31|962.24|1006.65|1080.67|1080.67|1154.69|888.22|962.24|1110.28|1258.31|1314.57|1302.73|1110.28|1258.31| 62.80 | 1,408.48 | 1,080.67 46000003|HC EVALUATION OF WHEEZING|0460|94070|1,480.37|858.61|1,408.48|1,338.06|264.45|264.45|31.40|32.03|32.03|32.66|962.24|1006.65|1080.67|1080.67|1154.69|888.22|962.24|1110.28|1258.31|1314.57|1302.73|1110.28|1258.31| 31.40 | 1,408.48 | 1,080.67 46000004|HC AEROSOL/VAPOR INHAL|0460|94640|172.17|99.86|148.15|140.74|187.88|187.88|12.89|13.14|13.14|13.40|111.91|117.08|125.68|125.68|134.29|103.30|111.91|129.13|146.34|152.89|151.51|129.13|146.34| 12.89 | 187.88 | 129.13 46000005|HC AEROSOL/VAPOR INHAL-SUBSEQU|0460|94640|173.13|100.42|148.15|140.74|187.88|187.88|12.89|13.14|13.14|13.40|112.53|117.73|126.38|126.38|135.04|103.88|112.53|129.85|147.16|153.74|152.35|129.85|147.16| 12.89 | 187.88 | 129.85 46000006|HC SPUTUM INDUCTION-INITIAL|0460|94640|126.36|73.29|148.15|140.74|187.88|187.88|12.89|13.14|13.14|13.40|82.13|85.92|92.24|92.24|98.56|75.82|82.13|94.77|107.41|112.21|111.20|94.77|107.41| 12.89 | 187.88 | 94.77 46000007|HC SPUTUM INDUCTION-SUBSEQUENT|0460|94640|120.02|69.61|148.15|140.74|187.88|187.88|12.89|13.14|13.14|13.40|78.01|81.61|87.61|87.61|93.62|72.01|78.01|90.02|102.02|106.58|105.62|90.02|102.02| 12.89 | 187.88 | 90.02 46000008|HC NEBULIZER WITH PENTAMADINE|0460|94642|847.47|491.53|||187.88|187.88|16.85|17.19|17.19|17.53|550.86|576.28|618.65|618.65|661.03|508.48|550.86|635.60|720.35|752.55|745.77|635.60|720.35| 16.85 | 752.55 | 576.28 46000009|HC EVALUATE PATIENT USE OF INHALE|0460|94664|240.19|139.31|295.97|281.17|187.88|187.88|22.42|22.87|22.87|23.32|156.12|163.33|175.34|175.34|187.35|144.11|156.12|180.14|204.16|213.29|211.37|180.14|204.16| 22.42 | 295.97 | 180.14 46000010|HC CPT THERAPEP ACAPELLA - INITIA|0460|94667|180.08|104.45|||111.95|111.95|||||117.05|122.45|131.46|131.46|140.46|108.05|117.05|135.06|153.07|159.91|158.47|135.06|153.07| 108.05 | 159.91 | 131.46 46000011|HC CPT THERAPEP ACAPELLA-SUBSEQUE|0460|94668|179.87|104.32|||111.95|111.95|||||116.92|122.31|131.31|131.31|140.30|107.92|116.92|134.90|152.89|159.72|158.29|134.90|152.89| 107.92 | 159.72 | 131.31 46000012|HC DIFFUSION STUDY|0460|94729|358.10|207.70|313.24|297.58|||52.97|54.03|54.03|55.09|232.77|243.51|261.41|261.41|279.32|214.86|232.77|268.58|304.39|317.99|315.13|268.58|304.39| 52.97 | 317.99 | 261.41 46000012|HC DIFFUSION STUDY|0460|94729|358.10|207.70|313.24|297.58|||52.97|54.03|54.03|55.09|232.77|243.51|261.41|261.41|279.32|214.86|232.77|268.58|304.39|317.99|315.13|268.58|304.39| 52.97 | 317.99 | 261.41 46000013|HC SPOT CHECK PULSE OXIMETRY|0460|94760|125.94|73.05|32.88|31.24|||11.36|11.58|11.58|11.81|81.86|85.64|91.94|91.94|98.23|75.56|81.86|94.46|107.05|111.83|110.83|94.46|107.05| 11.36 | 111.83 | 85.64 46000014|HC EXERCISE OXIMETRY|0460|94761|584.88|339.23|511.61|486.03|||19.62|20.02|20.02|20.41|380.17|397.72|426.96|426.96|456.21|350.93|380.17|438.66|497.15|519.37|514.69|438.66|497.15| 19.62 | 519.37 | 426.96 46000015|HC NOCTURNAL OXIMETRY|0460|94762|381.68|221.37|333.86|317.17|139.55|139.55|39.25|40.03|40.03|40.82|248.09|259.54|278.63|278.63|297.71|229.01|248.09|286.26|324.43|338.93|335.88|286.26|324.43| 39.25 | 338.93 | 278.63 46000016|HC DISABILITY FT|0460|94010|308.26|178.79|322.63|306.50|139.55|139.55|19.51|19.90|19.90|20.29|200.37|209.62|225.03|225.03|240.44|184.96|200.37|231.20|262.02|273.73|271.27|231.20|262.02| 19.51 | 322.63 | 225.03 46000016|HC DISABILITY FT|0460|94010|308.26|178.79|322.63|306.50|139.55|139.55|39.01|39.79|39.79|40.57|200.37|209.62|225.03|225.03|240.44|184.96|200.37|231.20|262.02|273.73|271.27|231.20|262.02| 39.01 | 322.63 | 225.03 46000017|HC PULMONARY STRESS TEST (6 MINUTE WALK)|0460|94618|280.15|162.49|||111.95|111.95|||||182.10|190.50|204.51|204.51|218.52|168.09|182.10|210.11|238.13|248.77|246.53|210.11|238.13| 111.95 | 248.77 | 204.51 46000018|HC EXERCISE TEST BRONCHOSPASM|0460|94617|280.15|162.49|||111.95|111.95|||||182.10|190.50|204.51|204.51|218.52|168.09|182.10|210.11|238.13|248.77|246.53|210.11|238.13| 111.95 | 248.77 | 204.51 46000019|HC BRONCH CHALLENGE, W HISTAMINE|0460|95070|571.87|331.68|||487.78|487.78|17.01|17.35|17.35|17.69|371.72|388.87|417.47|417.47|446.06|343.12|371.72|428.90|486.09|507.82|503.25|428.90|486.09| 17.01 | 507.82 | 417.47 47000000|HC HEARING SCREEN|0470|92586|466.37|270.49|||||70.65|72.06|72.06|73.48|303.14|317.13|340.45|340.45|363.77|279.82|303.14|349.78|396.41|414.14|410.41|349.78|396.41| 70.65 | 414.14 | 340.45 48000000|HC EECP|0480|G0166|587.18|340.56|303.49|288.32|111.95|111.95|||||381.67|399.28|428.64|428.64|458.00|352.31|381.67|440.39|499.10|521.42|516.72|440.39|499.10| 111.95 | 521.42 | 428.64 48000001|HC CONTRAST-ECHO-COMPLETE-W C&D|0480|C8929|3,142.08|1,822.41|2,161.38|2,053.31|715.18|715.18|||||2042.35|2136.61|2293.72|2293.72|2450.82|1885.25|2042.35|2356.56|2670.77|2790.17|2765.03|2356.56|2670.77| 715.18 | 2,790.17 | 2,293.72 48000002|HC CONTRAST-ECHO-TRANS-LIMITED|0480|C8924|1,112.19|645.07|817.82|776.929|368.12|368.12|||||722.92|756.29|811.90|811.90|867.51|667.31|722.92|834.14|945.36|987.62|978.73|834.14|945.36| 368.12 | 987.62 | 811.90 48000003|HC STRESS ECHO|0480|93350|2,681.42|1,555.22|817.82|776.929|482.89|482.89|64.42|65.71|65.71|67.00|1742.92|1823.37|1957.44|1957.44|2091.51|1608.85|1742.92|2011.07|2279.21|2381.10|2359.65|2011.07|2279.21| 64.42 | 2,381.10 | 1,742.92 48000003|HC STRESS ECHO|0480|93350|2,681.42|1,555.22|817.82|776.929|482.89|482.89|111.55|113.78|113.78|116.01|1742.92|1823.37|1957.44|1957.44|2091.51|1608.85|1742.92|2011.07|2279.21|2381.10|2359.65|2011.07|2279.21| 111.55 | 2,381.10 | 1,742.92 48000003|HC STRESS ECHO|0480|93350|2,681.42|1,555.22|817.82|776.929|482.89|482.89|241.03|245.85|245.85|250.67|1742.92|1823.37|1957.44|1957.44|2091.51|1608.85|1742.92|2011.07|2279.21|2381.10|2359.65|2011.07|2279.21| 241.03 | 2,381.10 | 1,742.92 48000004|HC DOPPLER ECHO-COLOR FLOW|0480|93325|831.41|482.22|678.19|644.2805|||65.1|66.4|66.4|67.71|540.42|565.36|606.93|606.93|648.50|498.85|540.42|623.56|706.70|738.29|731.64|623.56|706.70| 65.10 | 738.29 | 606.93 48000004|HC DOPPLER ECHO-COLOR FLOW|0480|93325|831.41|482.22|678.19|644.2805|||98.12|100.09|100.09|102.05|540.42|565.36|606.93|606.93|648.50|498.85|540.42|623.56|706.70|738.29|731.64|623.56|706.70| 98.12 | 738.29 | 606.93 48000005|HC DOPPLER ECHO LIMITED|0480|93321|729.31|423.00|678.19|644.2805|||45.53|46.44|46.44|47.35|474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 45.53 | 678.19 | 532.40 48000005|HC DOPPLER ECHO LIMITED|0480|93321|729.31|423.00|678.19|644.2805|||62.28|63.52|63.52|64.77|474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 62.28 | 678.19 | 532.40 48000006|HC DOPPLER ECHO-PULSE WAVE|0480|93320|881.24|511.12|678.19|644.2805|||66.02|67.34|67.34|68.66|572.81|599.24|643.31|643.31|687.37|528.74|572.81|660.93|749.05|782.54|775.49|660.93|749.05| 66.02 | 782.54 | 643.31 48000006|HC DOPPLER ECHO-PULSE WAVE|0480|93320|881.24|511.12|678.19|644.2805|||53.90|54.98|54.98|56.06|572.81|599.24|643.31|643.31|687.37|528.74|572.81|660.93|749.05|782.54|775.49|660.93|749.05| 53.90 | 782.54 | 643.31 48000006|HC DOPPLER ECHO-PULSE WAVE|0480|93320|881.24|511.12|678.19|644.2805|||115.25|117.55|117.55|119.86|572.81|599.24|643.31|643.31|687.37|528.74|572.81|660.93|749.05|782.54|775.49|660.93|749.05| 115.25 | 782.54 | 643.31 48000007|HC TEE-OR MONITORING|0480|93318|2,771.97|1,607.74|678.19|644.2805|482.89|482.89|130.83|133.45|133.45|136.07|1801.78|1884.94|2023.54|2023.54|2162.14|1663.18|1801.78|2078.98|2356.17|2461.51|2439.33|2078.98|2356.17| 130.83 | 2,461.51 | 1,801.78 48000007|HC TEE-OR MONITORING|0480|93318|2,771.97|1,607.74|678.19|644.2805|482.89|482.89|261.66|266.90|266.90|272.13|1801.78|1884.94|2023.54|2023.54|2162.14|1663.18|1801.78|2078.98|2356.17|2461.51|2439.33|2078.98|2356.17| 261.66 | 2,461.51 | 1,801.78 48000008|HC ECHO-TEE - I&R ONLY|0480|93314|3,390.04|1,966.22|812.12|771.514|||156.04|159.16|159.16|162.29|2203.53|2305.23|2474.73|2474.73|2644.23|2034.02|2203.53|2542.53|2881.53|3010.36|2983.24|2542.53|2881.53| 156.04 | 3,010.36 | 2,305.23 48000008|HC ECHO-TEE - I&R ONLY|0480|93314|3,390.04|1,966.22|812.12|771.514|||130.83|133.45|133.45|136.07|2203.53|2305.23|2474.73|2474.73|2644.23|2034.02|2203.53|2542.53|2881.53|3010.36|2983.24|2542.53|2881.53| 130.83 | 3,010.36 | 2,305.23 48000009|HC ECHO-TEE|0480|93312|2,759.20|1,600.34|1543.61|1466.4295|482.89|482.89|130.83|133.45|133.45|136.07|1793.48|1876.26|2014.22|2014.22|2152.18|1655.52|1793.48|2069.40|2345.32|2450.17|2428.10|2069.40|2345.32| 130.83 | 2,450.17 | 1,793.48 48000009|HC ECHO-TEE|0480|93312|2,759.20|1,600.34|1543.61|1466.4295|482.89|482.89|261.66|266.90|266.90|272.13|1793.48|1876.26|2014.22|2014.22|2152.18|1655.52|1793.48|2069.40|2345.32|2450.17|2428.10|2069.40|2345.32| 261.66 | 2,450.17 | 1,793.48 48000010|HC ECHO-TRANS-LIMITED|0480|93308|1,098.52|637.14|812.12|771.514|230.13|230.13|78.72|80.3|80.3|81.87|714.04|746.99|801.92|801.92|856.85|659.11|714.04|823.89|933.74|975.49|966.70|823.89|933.74| 78.72 | 975.49 | 771.51 48000010|HC ECHO-TRANS-LIMITED|0480|93308|1,098.52|637.14|812.12|771.514|230.13|230.13|206.43|210.56|210.56|214.68|714.04|746.99|801.92|801.92|856.85|659.11|714.04|823.89|933.74|975.49|966.70|823.89|933.74| 206.43 | 975.49 | 771.51 48000011|HC ECHO-COMPLETE-W C&D|0480|93306|2,823.63|1,637.71|2161.38|2053.311|482.89|482.89|366.84|374.18|374.18|381.51|1835.36|1920.07|2061.25|2061.25|2202.43|1694.18|1835.36|2117.72|2400.09|2507.38|2484.79|2117.72|2400.09| 366.84 | 2,507.38 | 2,053.31 48000012|HC ECHO-TRANS-CONGEN-LIMITED|0480|93304|1,142.46|662.63|817.82|776.929|482.89|482.89|78.72|80.30|80.30|81.87|742.60|776.87|834.00|834.00|891.12|685.48|742.60|856.85|971.09|1014.50|1005.36|856.85|971.09| 78.72 | 1,014.50 | 776.93 48000012|HC ECHO-TRANS-CONGEN-LIMITED|0480|93304|1,142.46|662.63|817.82|776.929|482.89|482.89|206.43|210.56|210.56|214.68|742.60|776.87|834.00|834.00|891.12|685.48|742.60|856.85|971.09|1014.50|1005.36|856.85|971.09| 206.43 | 1,014.50 | 776.93 48000013|HC ECHO-TRANS-CONGEN-COMPLETE|0480|93303|2,375.10|1,377.56|817.82|776.929|482.89|482.89|130.83|133.45|133.45|136.07|1543.82|1615.07|1733.82|1733.82|1852.58|1425.06|1543.82|1781.33|2018.84|2109.09|2090.09|1781.33|2018.84| 130.83 | 2,109.09 | 1,543.82 48000013|HC ECHO-TRANS-CONGEN-COMPLETE|0480|93303|2,375.10|1,377.56|817.82|776.929|482.89|482.89|261.66|266.90|266.90|272.13|1543.82|1615.07|1733.82|1733.82|1852.58|1425.06|1543.82|1781.33|2018.84|2109.09|2090.09|1781.33|2018.84| 261.66 | 2,109.09 | 1,543.82 48000014|HC RENAL 1ST, ACCESS ARTERIES, UN|0480|36251|10,164.07|5,895.16|930.38|883.861|2861.66|2861.66|1,774.49|1,809.98|1,809.98|1,845.47|6606.65|6911.57|7419.77|7419.77|7927.97|6098.44|6606.65|7623.05|8639.46|9025.69|8944.38|7623.05|8639.46| 883.86 | 9,025.69 | 6,606.65 48000015|HC TEE CONGENITAL; GLOBAL|0480|93315|2,456.46|1,424.75|812.12|771.514|482.89|482.89|261.66|266.9|266.9|272.13|1596.70|1670.39|1793.22|1793.22|1916.04|1473.88|1596.70|1842.35|2087.99|2181.34|2161.68|1842.35|2087.99| 261.66 | 2,181.34 | 1,596.70 48000015|HC TEE CONGENITAL; GLOBAL|0480|93315|2,456.46|1,424.75|812.12|771.514|482.89|482.89|130.83|133.45|133.45|136.07|1596.70|1670.39|1793.22|1793.22|1916.04|1473.88|1596.70|1842.35|2087.99|2181.34|2161.68|1842.35|2087.99| 130.83 | 2,181.34 | 1,596.70 48000016|HC TTE W/OR W/O FOL W/CON STRES|0480|C8928|2,681.42|1,555.22|817.82|776.929|715.18|715.18|||||1742.92|1823.37|1957.44|1957.44|2091.51|1608.85|1742.92|2011.07|2279.21|2381.10|2359.65|2011.07|2279.21| 715.18 | 2,381.10 | 1,957.44 48000017|HC TTE W/OR W/O CONTR CONT ECG W/SPRVSN|0480|C8930|2,385.74|1,383.73|2,161.38|2,053.31|715.18|715.18|||||1550.73|1622.30|1741.59|1741.59|1860.88|1431.44|1550.73|1789.31|2027.88|2118.54|2099.45|1789.31|2027.88| 715.18 | 2,161.38 | 1,789.31 48000018|HC STRESS TTE COMPLETE|0480|93351|2,135.64|1,238.67|817.82|776.929|482.89|482.89|366.84|374.18|374.18|381.51|1388.17|1452.24|1559.02|1559.02|1665.80|1281.38|1388.17|1601.73|1815.29|1896.45|1879.36|1601.73|1815.29| 366.84 | 1,896.45 | 1,388.17 48000019|HC TEE GUIDE TRANSCATH INTRACARD STRUCTRAL INTVN|0480|93355|2,822.13|1,636.84|812.12|771.514|||||||1834.38|1919.05|2060.15|2060.15|2201.26|1693.28|1834.38|2116.60|2398.81|2506.05|2483.47|2116.60|2398.81| 771.51 | 2,506.05 | 2,060.15 48000020|HC PAD REHAB PER SESSION|0480|93668|138.27|80.20|||55.66|55.66|||||89.88|94.02|100.94|100.94|107.85|82.96|89.88|103.70|117.53|122.78|121.68|103.70|117.53| 55.66 | 122.78 | 100.94 48000021|HC REPROG (&INTEROG) MULTI DEFIB|0480|93284|701.54|406.89|||37.15|37.15|33.38|34.04|34.04|34.71|456.00|477.05|512.12|512.12|547.20|420.92|456.00|526.16|596.31|622.97|617.36|526.16|596.31| 33.38 | 622.97 | 477.05 48000022|HC CARDIOVERSION/EXTERNAL|0480|92960|1,589.88|922.13|||561.91|561.91|196.25|200.17|200.17|204.10|1033.42|1081.12|1160.61|1160.61|1240.11|953.93|1033.42|1192.41|1351.40|1411.81|1399.09|1192.41|1351.40| 196.25 | 1,411.81 | 1,081.12 48000023|HC INTERROG ONLY PACER (ALL TYPES|0480|93288|330.36|191.61|||37.15|37.15|19.7|20.1|20.1|20.49|214.73|224.64|241.16|241.16|257.68|198.22|214.73|247.77|280.81|293.36|290.72|247.77|280.81| 19.70 | 293.36 | 224.64 48000024|HC PRGRMG DEV EVAL IMPLTBL SYS|0480|93260|334.07|193.76|||37.15|37.15|||||217.15|227.17|243.87|243.87|260.57|200.44|217.15|250.55|283.96|296.65|293.98|250.55|283.96| 37.15 | 296.65 | 243.87 48000025|HC INTERROGATE SUBQ DEFIB|0480|93261|239.63|138.99|||37.15|37.15|||||155.76|162.95|174.93|174.93|186.91|143.78|155.76|179.72|203.69|212.79|210.87|179.72|203.69| 37.15 | 212.79 | 174.93 48000026|HC REPROGRAM & INTEROG SINGLE PAC|0480|93279|223.17|129.44|||37.15|37.15|19.70|20.10|20.10|20.49|145.06|151.76|162.91|162.91|174.07|133.90|145.06|167.38|189.69|198.17|196.39|167.38|189.69| 19.70 | 198.17 | 151.76 48000027|HC REPROGRAM & INTEROG DUAL PACER|0480|93280|223.17|129.44|||37.15|37.15|19.70|20.10|20.10|20.49|145.06|151.76|162.91|162.91|174.07|133.90|145.06|167.38|189.69|198.17|196.39|167.38|189.69| 19.70 | 198.17 | 151.76 48000028|HC REPROGRAM & INTEROG MULTI PACE|0480|93281|223.16|129.43|||37.15|37.15|19.70|20.10|20.10|20.49|145.05|151.75|162.91|162.91|174.06|133.90|145.05|167.37|189.69|198.17|196.38|167.37|189.69| 19.70 | 198.17 | 151.75 48000029|HC REPRGM (&INTEROG) SINGLE DEFIB|0480|93282|334.07|193.76|||37.15|37.15|33.38|34.04|34.04|34.71|217.15|227.17|243.87|243.87|260.57|200.44|217.15|250.55|283.96|296.65|293.98|250.55|283.96| 33.38 | 296.65 | 227.17 48000030|HC REPRGM (&INTEROG) DUAL DEFIB|0480|93283|334.07|193.76|||37.15|37.15|33.38|34.04|34.04|34.71|217.15|227.17|243.87|243.87|260.57|200.44|217.15|250.55|283.96|296.65|293.98|250.55|283.96| 33.38 | 296.65 | 227.17 48000031|HC REPROG (&INTEROG) MULTI DEFIB|0480|93284|334.07|193.76|||37.15|37.15|33.38|34.04|34.04|34.71|217.15|227.17|243.87|243.87|260.57|200.44|217.15|250.55|283.96|296.65|293.98|250.55|283.96| 33.38 | 296.65 | 227.17 48000032|HC LOOP RECORDER INTERROGATION ON|0480|93291|52.47|30.43|||24.67|24.67|19.70|20.10|20.10|20.49|34.11|35.68|38.30|38.30|40.93|31.48|34.11|39.35|44.60|46.59|46.17|39.35|44.60| 19.70 | 46.59 | 35.68 48000033|HC PROG EVAL INPER LEADLS PM INCL INTERROGATION|0480|0389T|468.64|271.81|||||||||304.62|318.68|342.11|342.11|365.54|281.18|304.62|351.48|398.34|416.15|412.40|351.48|398.34| 281.18 | 416.15 | 351.48 48000034|HC LOOP RECORD PROG (INTERROG INC|0480|93285|78.80|45.70|||37.15|37.15|19.70|20.10|20.10|20.49|51.22|53.58|57.52|57.52|61.46|47.28|51.22|59.10|66.98|69.97|69.34|59.10|66.98| 19.70 | 69.97 | 53.58 48000035|HC TCAT RMVL PERM LDLS PM|0480|33275|2,732.65|1,584.94|||2,861.66|2,861.66|||||1776.22|1858.20|1994.83|1994.83|2131.47|1639.59|1776.22|2049.49|2322.75|2426.59|2404.73|2049.49|2322.75| 1,639.59 | 2,861.66 | 2,049.49 48000036|HC PM DEVICE EVAL IN PERSON|0480|93288|157.31|91.24|||37.15|37.15|19.70|20.10|20.10|20.49|102.25|106.97|114.84|114.84|122.70|94.39|102.25|117.98|133.71|139.69|138.43|117.98|133.71| 19.70 | 139.69 | 106.97 48000037|HC INSJ SUBQ CAR RHYTHM MNTR|0480|33285|9,191.44|5,331.04|||8,152.58|8,152.58|||||5974.44|6250.18|6709.75|6709.75|7169.32|5514.86|5974.44|6893.58|7812.72|8162.00|8088.47|6893.58|7812.72| 5,514.86 | 8,162.00 | 6,893.58 48000038|HC RMVL SUBQ CAR RHYTHM MNTR|0480|33286|719.20|417.14|||621.97|621.97|||||467.48|489.06|525.02|525.02|560.98|431.52|467.48|539.40|611.32|638.65|632.90|539.40|611.32| 431.52 | 638.65 | 539.40 48000039|HC MYOCRD STRAIN IMG SPCKL TRCK|0480|93356|78.75|45.68|||||||||51.19|53.55|57.49|57.49|61.43|47.25|51.19|59.06|66.94|69.93|69.30|59.06|66.94| 47.25 | 69.93 | 59.06 48100000|HC VERTEBRO THORACIC (INCL BONE B|0481|22520|10,310.65|5,980.18|||||130.83|133.45|133.45|136.07|6701.92|7011.24|7526.77|7526.77|8042.31|6186.39|6701.92|7732.99|8764.05|9155.86|9073.37|7732.99|8764.05| 130.83 | 9,155.86 | 7,526.77 48100001|HC VERTEBRO LUMBAR (INCL BONE BIO|0481|22521|10,310.65|5,980.18|||||130.83|133.45|133.45|136.07|6701.92|7011.24|7526.77|7526.77|8042.31|6186.39|6701.92|7732.99|8764.05|9155.86|9073.37|7732.99|8764.05| 130.83 | 9,155.86 | 7,526.77 48100002|HC VERTEBRO ADD+ 22522|0481|22522|9,180.60|5,324.75|||||130.83|133.45|133.45|136.07|5967.39|6242.81|6701.84|6701.84|7160.87|5508.36|5967.39|6885.45|7803.51|8152.37|8078.93|6885.45|7803.51| 130.83 | 8,152.37 | 6,701.84 48100003|HC KYPHOPLASTY, THORACIC (22523)|0481|22523|14,234.71|8,256.13|||||1,192.09|1,215.93|1,215.93|1,239.77|9252.56|9679.60|10391.34|10391.34|11103.07|8540.83|9252.56|10676.03|12099.50|12640.42|12526.54|10676.03|12099.50| 1,192.09 | 12,640.42 | 10,391.34 48100004|HC KYPHOPLASTY, LUMBAR (22524)|0481|22524|14,234.71|8,256.13|||||1,192.09|1,215.93|1,215.93|1,239.77|9252.56|9679.60|10391.34|10391.34|11103.07|8540.83|9252.56|10676.03|12099.50|12640.42|12526.54|10676.03|12099.50| 1,192.09 | 12,640.42 | 10,391.34 48100005|HC UNLSTEDPROC PELVIS OR HIP JOIN|0481|27299|8,078.87|4,685.74|||206.19|206.19|||||5251.27|5493.63|5897.58|5897.58|6301.52|4847.32|5251.27|6059.15|6867.04|7174.04|7109.41|6059.15|6867.04| 206.19 | 7,174.04 | 5,897.58 48100006|HC INSERT TUNNEL PLEURAL CATH W/C|0481|32550|6,978.22|4,047.37|||3183.41|3183.41|||||4535.84|4745.19|5094.10|5094.10|5443.01|4186.93|4535.84|5233.67|5931.49|6196.66|6140.83|5233.67|5931.49| 3,183.41 | 6,196.66 | 5,094.10 48100007|HC REMOVE TUNNEL PLEURAL CATH W/C|0481|32552|2,700.86|1,566.50|||541.62|541.62|64.45|65.74|65.74|67.03|1755.56|1836.58|1971.63|1971.63|2106.67|1620.52|1755.56|2025.65|2295.73|2398.36|2376.76|2025.65|2295.73| 64.45 | 2,398.36 | 1,836.58 48100008|HC ASPIRATE PLEURA W/ IMAGING|0481|32555|5,337.29|3,095.63|1216.76|1155.922|541.62|541.62|350.70|357.71|357.71|364.72|3469.24|3629.36|3896.22|3896.22|4163.09|3202.37|3469.24|4002.97|4536.70|4739.51|4696.82|4002.97|4536.70| 350.70 | 4,739.51 | 3,469.24 48100009|HC PERICARDIOCENTESIS; INITIAL|0481|33010|5,576.74|3,234.51|||||196.25|200.17|200.17|204.10|3624.88|3792.18|4071.02|4071.02|4349.86|3346.04|3624.88|4182.56|4740.23|4952.15|4907.53|4182.56|4740.23| 196.25 | 4,952.15 | 4,071.02 48100010|HC PERICARDIOCENTESIS ADDT|0481|33011|1,666.25|966.43|||||122.33|124.77|124.77|127.22|1083.06|1133.05|1216.36|1216.36|1299.68|999.75|1083.06|1249.69|1416.31|1479.63|1466.30|1249.69|1416.31| 122.33 | 1,479.63 | 1,216.36 48100011|HC INSERT/REPL P PACER W/ATRIAL L|0481|33206|14,572.70|8,452.17|25194.3|23934.585|10400.15|10400.15|8,169.61|8,333.00|8,333.00|8,496.39|9472.26|9909.44|10638.07|10638.07|11366.71|8743.62|9472.26|10929.53|12386.80|12940.56|12823.98|10929.53|12386.80| 8,169.61 | 25,194.30 | 10,638.07 48100012|HC INSERT/REPL P-PACER W/VENT LEA|0481|33207|14,777.58|8,571.00|25194.3|23934.585|10400.15|10400.15|8,169.61|8,333.00|8,333.00|8,496.39|9605.43|10048.75|10787.63|10787.63|11526.51|8866.55|9605.43|11083.19|12560.94|13122.49|13004.27|11083.19|12560.94| 8,169.61 | 25,194.30 | 10,787.63 48100013|HC INSERT/REPL P-PACER BOTH LEADS|0481|33208|17,680.76|10,254.84|25,194.30|23,934.59|10400.15|10400.15|10,075.44|10,276.95|10,276.95|10,478.46|11492.49|12022.92|12906.95|12906.95|13790.99|10608.46|11492.49|13260.57|15028.65|15700.51|15559.07|13260.57|15028.65| 10,075.44 | 25,194.30 | 12,906.95 48100014|HC TEMP TRANSVENOUS PACER INSERTION|0481|33210|4,607.99|2,672.63|2,291.04|2,176.49|8152.58|8152.58|||||2995.19|3133.43|3363.83|3363.83|3594.23|2764.79|2995.19|3455.99|3916.79|4091.90|4055.03|3455.99|3916.79| 2,176.49 | 8,152.58 | 3,455.99 48100015|HC UPGRADE PACE/REMOVE OLD|0481|33214|6,677.41|3,872.90|57,382.85|54,513.71|10400.15|10400.15|392.50|400.35|400.35|408.20|4340.32|4540.64|4874.51|4874.51|5208.38|4006.45|4340.32|5008.06|5675.80|5929.54|5876.12|5008.06|5675.80| 392.50 | 57,382.85 | 5,008.06 48100016|HC REPOSITION LEAD|0481|33215|7,056.01|4,092.49|2,291.04|2,176.49|2861.66|2861.66|457.91|467.07|467.07|476.23|4586.41|4798.09|5150.89|5150.89|5503.69|4233.61|4586.41|5292.01|5997.61|6265.74|6209.29|5292.01|5997.61| 457.91 | 6,265.74 | 4,586.41 48100017|HC REPLACE LEAD ONLY-SINGLE CHAMB|0481|33216|6,996.45|4,057.94|2291.04|2176.488|8152.58|8152.58|4,111.09|4,193.32|4,193.32|4,275.54|4547.69|4757.59|5107.41|5107.41|5457.23|4197.87|4547.69|5247.34|5946.98|6212.85|6156.88|5247.34|5946.98| 2,176.49 | 8,152.58 | 5,107.41 48100018|HC REPLACE LEAD ONLY - DUAL CHAM|0481|33217|2,135.64|1,238.67|2,291.04|2,176.49|8152.58|8152.58|4,111.09|4,193.32|4,193.32|4,275.54|1388.17|1452.24|1559.02|1559.02|1665.80|1281.38|1388.17|1601.73|1815.29|1896.45|1879.36|1601.73|1815.29| 1,281.38 | 8,152.58 | 1,815.29 48100019|HC RELOCATION POCKET PACEMAKER|0481|33222|4,362.45|2,530.22|2222.66|2111.527|1715.36|1715.36|392.50|400.35|400.35|408.20|2835.59|2966.47|3184.59|3184.59|3402.71|2617.47|2835.59|3271.84|3708.08|3873.86|3838.96|3271.84|3708.08| 392.50 | 3,873.86 | 2,835.59 48100020|HC RELOCATE POCKET FOR DEFIB|0481|33223|4,938.60|2,864.39|||1715.36|1715.36|457.91|467.07|467.07|476.23|3210.09|3358.25|3605.18|3605.18|3852.11|2963.16|3210.09|3703.95|4197.81|4385.48|4345.97|3703.95|4197.81| 457.91 | 4,385.48 | 3,358.25 48100021|HC LV UPGRADE|0481|33224|13,140.84|7,621.69|25,194.30|23,934.59|10400.15|10400.15|||||8541.55|8935.77|9592.81|9592.81|10249.86|7884.50|8541.55|9855.63|11169.71|11669.07|11563.94|9855.63|11169.71| 7,884.50 | 25,194.30 | 10,249.86 48100022|HC INSERT LV|0481|33225|9,621.95|5,580.73|2,291.04|2,176.49|||631.40|644.02|644.02|656.65|6254.27|6542.93|7024.02|7024.02|7505.12|5773.17|6254.27|7216.46|8178.66|8544.29|8467.32|7216.46|8178.66| 631.40 | 8,544.29 | 6,542.93 48100023|HC REMOVE AND REPLACE SINGLE GEN|0481|33227|6,213.67|3,603.93|25,194.30|23,934.59|8152.58|8152.58|5,609.21|5,721.40|5,721.40|5,833.58|4038.89|4225.30|4535.98|4535.98|4846.66|3728.20|4038.89|4660.25|5281.62|5517.74|5468.03|4660.25|5281.62| 3,728.20 | 25,194.30 | 5,281.62 48100024|HC REMOVE AND REPLACE DUAL GENERA|0481|33228|6,482.29|3,759.73|25,194.30|23,934.59|10400.15|10400.15|6,147.51|6,270.46|6,270.46|6,393.41|4213.49|4407.96|4732.07|4732.07|5056.19|3889.37|4213.49|4861.72|5509.95|5756.27|5704.42|4861.72|5509.95| 3,889.37 | 25,194.30 | 5,509.95 48100025|HC REMOVE AND REPLACE MULTI GEN|0481|33229|6,752.14|3,916.24|25,194.30|23,934.59|18,611.26|18,611.26|6,147.51|6,270.46|6,270.46|6,393.41|4388.89|4591.46|4929.06|4929.06|5266.67|4051.28|4388.89|5064.11|5739.32|5995.90|5941.88|5064.11|5739.32| 4,051.28 | 25,194.30 | 5,739.32 48100026|HC REMOVAL OF PACEMAKER ONLY|0481|33233|3,194.35|1,852.72|2,291.04|2,176.49|8,152.58|8,152.58|457.91|467.07|467.07|476.23|2076.33|2172.16|2331.88|2331.88|2491.59|1916.61|2076.33|2395.76|2715.20|2836.58|2811.03|2395.76|2715.20| 457.91 | 8,152.58 | 2,331.88 48100027|HC REMOVAL LEAD - SINGLE SYSTEM|0481|33234|4,897.27|2,840.42|2,291.04|2,176.49|3,440.37|3,440.37|457.91|467.07|467.07|476.23|3183.23|3330.14|3575.01|3575.01|3819.87|2938.36|3183.23|3672.95|4162.68|4348.78|4309.60|3672.95|4162.68| 457.91 | 4,348.78 | 3,440.37 48100028|HC REMOVAL LEAD - DUAL SYSTEM|0481|33235|5,603.49|3,250.02|2,291.04|2,176.49|3,440.37|3,440.37|457.91|467.07|467.07|476.23|3642.27|3810.37|4090.55|4090.55|4370.72|3362.09|3642.27|4202.62|4762.97|4975.90|4931.07|4202.62|4762.97| 457.91 | 4,975.90 | 3,642.27 48100029|HC REMOVAL DEFIB LEAD/AND GEN|0481|33244|6,359.52|3,688.52|||3,440.37|3,440.37|||||4133.69|4324.47|4642.45|4642.45|4960.43|3815.71|4133.69|4769.64|5405.59|5647.25|5596.38|4769.64|5405.59| 3,440.37 | 5,647.25 | 4,642.45 48100030|HC INSERT/REPOSITION ANY DEFIB SY|0481|33249|8,738.27|5,068.20|57,382.85|54,513.71|32838.89|32838.89|31558.92|32190.09|32190.09|32821.27|5679.88|5942.02|6378.94|6378.94|6815.85|5242.96|5679.88|6553.70|7427.53|7759.58|7689.68|6553.70|7427.53| 5,242.96 | 57,382.85 | 7,427.53 48100031|HC REMOVE/REPLACE SINGLE LEAD DEF|0481|33262|6,636.66|3,849.26|57,382.85|54,513.71|23040.16|23040.16|20,637.98|21,050.74|21,050.74|21,463.50|4313.83|4512.93|4844.76|4844.76|5176.59|3982.00|4313.83|4977.50|5641.16|5893.35|5840.26|4977.50|5641.16| 3,982.00 | 57,382.85 | 5,641.16 48100032|HC REMOVE/REPLACE DUAL LEAD DEFIB|0481|33263|6,917.45|4,012.12|57,382.85|54,513.71|23040.16|23040.16|20,637.98|21,050.74|21,050.74|21,463.50|4496.34|4703.87|5049.74|5049.74|5395.61|4150.47|4496.34|5188.09|5879.83|6142.70|6087.36|5188.09|5879.83| 4,150.47 | 57,382.85 | 5,879.83 48100033|HC REMOVE/REPLACE MULT LEAD DEFIB|0481|33264|6,431.25|3,730.13|57,382.85|54,513.71|32838.89|32838.89|20,637.98|21,050.74|21,050.74|21,463.50|4180.31|4373.25|4694.81|4694.81|5016.38|3858.75|4180.31|4823.44|5466.56|5710.95|5659.50|4823.44|5466.56| 3,858.75 | 57,382.85 | 5,466.56 48100034|HC ILR INSERTION (REVISED DESCRIP|0481|33282|4,002.66|2,321.54|||||457.91|467.07|467.07|476.23|2601.73|2721.81|2921.94|2921.94|3122.07|2401.60|2601.73|3002.00|3402.26|3554.36|3522.34|3002.00|3402.26| 457.91 | 3,554.36 | 2,921.94 48100035|HC ILR REMOVAL|0481|33284|4,002.66|2,321.54|||||331.32|337.95|337.95|344.57|2601.73|2721.81|2921.94|2921.94|3122.07|2401.60|2601.73|3002.00|3402.26|3554.36|3522.34|3002.00|3402.26| 331.32 | 3,554.36 | 2,921.94 48100036|HC IABP INSERTION 33967|0481|33967|3,114.13|1,806.20|||||700.91|714.92|714.92|728.94|2024.18|2117.61|2273.31|2273.31|2429.02|1868.48|2024.18|2335.60|2647.01|2765.35|2740.43|2335.60|2647.01| 700.91 | 2,765.35 | 2,273.31 48100037|HC ENDOGRAFT, MODULAR BIFURCATED|0481|34802|31,870.58|18,484.94|||||1,046.66|1,067.59|1,067.59|1,088.52|20715.88|21671.99|23265.52|23265.52|24859.05|19122.35|20715.88|23902.94|27089.99|28301.08|28046.11|23902.94|27089.99| 1,046.66 | 28,301.08 | 23,265.52 48100038|HC ENDOGRAFT, AORTO-UNIILIAC PROS|0481|34805|33,459.99|19,406.79|||||1,046.66|1,067.59|1,067.59|1,088.52|21748.99|22752.79|24425.79|24425.79|26098.79|20075.99|21748.99|25094.99|28440.99|29712.47|29444.79|25094.99|28440.99| 1,046.66 | 29,712.47 | 24,425.79 48100039|HC ENDOGRAFT EXTENSION, INITIAL|0481|34825|21,891.27|12,696.94|||||1,046.66|1,067.59|1,067.59|1,088.52|14229.33|14886.06|15980.63|15980.63|17075.19|13134.76|14229.33|16418.45|18607.58|19439.45|19264.32|16418.45|18607.58| 1,046.66 | 19,439.45 | 15,980.63 48100040|HC ENDOGRAFT EXTENSION, ADDTL|0481|34826|21,711.38|12,592.60|||||1,046.66|1,067.59|1,067.59|1,088.52|14112.40|14763.74|15849.31|15849.31|16934.88|13026.83|14112.40|16283.54|18454.67|19279.71|19106.01|16283.54|18454.67| 1,046.66 | 19,279.71 | 15,849.31 48100041|HC PTA RENAL 35471|0481|35471|21,813.48|12,651.82|||||1,079.36|1,100.95|1,100.95|1,122.54|14178.76|14833.17|15923.84|15923.84|17014.51|13088.09|14178.76|16360.11|18541.46|19370.37|19195.86|16360.11|18541.46| 1,079.36 | 19,370.37 | 15,923.84 48100042|HC PTA BRACHIOCEPHALIC 35475|0481|35475|16,453.09|9,542.79|||||1,079.36|1,100.95|1,100.95|1,122.54|10694.51|11188.10|12010.76|12010.76|12833.41|9871.85|10694.51|12339.82|13985.13|14610.34|14478.72|12339.82|13985.13| 1,079.36 | 14,610.34 | 12,010.76 48100043|HC PTA VENOUS 35476|0481|35476|16,843.27|9,769.10|||||1,079.36|1,100.95|1,100.95|1,122.54|10948.13|11453.42|12295.59|12295.59|13137.75|10105.96|10948.13|12632.45|14316.78|14956.82|14822.08|12632.45|14316.78| 1,079.36 | 14,956.82 | 12,295.59 48100044|HC VENOUS CATH INJ-36005|0481|36005|1,188.77|689.49|393.23|373.5685|||261.66|266.90|266.90|272.13|772.70|808.36|867.80|867.80|927.24|713.26|772.70|891.58|1010.45|1055.63|1046.12|891.58|1010.45| 261.66 | 1,055.63 | 808.36 48100045|HC SVC/IVC CATH-36010|0481|36010|5,091.75|2,953.22|930.38|883.861|||523.33|533.79|533.79|544.26|3309.64|3462.39|3716.98|3716.98|3971.57|3055.05|3309.64|3818.81|4327.99|4521.47|4480.74|3818.81|4327.99| 523.33 | 4,521.47 | 3,462.39 48100046|HC VENOUS 1ST ORDER-36011|0481|36011|3,184.63|1,847.09|930.38|883.86|||523.33|533.79|533.79|544.26|2070.01|2165.55|2324.78|2324.78|2484.01|1910.78|2070.01|2388.47|2706.94|2827.95|2802.47|2388.47|2706.94| 523.33 | 2,827.95 | 2,165.55 48100047|HC VENOUS 2+ ORDER-36012|0481|36012|2,773.80|1,608.80|930.38|883.86|||523.33|533.79|533.79|544.26|1802.97|1886.18|2024.87|2024.87|2163.56|1664.28|1802.97|2080.35|2357.73|2463.13|2440.94|2080.35|2357.73| 523.33 | 2,463.13 | 1,886.18 48100048|HC RETROBRACHIAL ARTERY-36120|0481|36120|4,853.73|2,815.16|||||784.99|800.69|800.69|816.39|3154.92|3300.54|3543.22|3543.22|3785.91|2912.24|3154.92|3640.30|4125.67|4310.11|4271.28|3640.30|4125.67| 784.99 | 4,310.11 | 3,543.22 48100049|HC EXTREMITY ARTERY CATH-36140|0481|36140|6,408.15|3,716.73|393.23|373.57|||523.33|533.79|533.79|544.26|4165.30|4357.54|4677.95|4677.95|4998.36|3844.89|4165.30|4806.11|5446.93|5690.44|5639.17|4806.11|5446.93| 373.57 | 5,690.44 | 4,357.54 48100050|HC AV DIALYSIS SHUNT ACCESS INITI|0481|36147|6,011.90|3,486.90|||||109.15|111.34|111.34|113.52|3907.74|4088.09|4388.69|4388.69|4689.28|3607.14|3907.74|4508.93|5110.12|5338.57|5290.47|4508.93|5110.12| 109.15 | 5,338.57 | 4,388.69 48100051|HC AV DIALYSIS SHUNT ACCESS-SECON|0481|36148|6,011.90|3,486.90|||||||||3907.74|4088.09|4388.69|4388.69|4689.28|3607.14|3907.74|4508.93|5110.12|5338.57|5290.47|4508.93|5110.12| 3,607.14 | 5,338.57 | 4,508.93 48100052|HC INTRO CATH AORTA-36200|0481|36200|6,837.22|3,965.59|393.23|373.5685|||784.99|800.69|800.69|816.39|4444.19|4649.31|4991.17|4991.17|5333.03|4102.33|4444.19|5127.92|5811.64|6071.45|6016.75|5127.92|5811.64| 373.57 | 6,071.45 | 4,649.31 48100053|HC ART CATH THO/BRACH 1ST-36215|0481|36215|4,133.93|2,397.68|930.38|883.861|||784.99|800.69|800.69|816.39|2687.05|2811.07|3017.77|3017.77|3224.47|2480.36|2687.05|3100.45|3513.84|3670.93|3637.86|3100.45|3513.84| 784.99 | 3,670.93 | 2,811.07 48100054|HC ART CATH THO/BRACH 2ND-36216|0481|36216|4,279.80|2,482.28|930.38|883.861|||784.99|800.69|800.69|816.39|2781.87|2910.26|3124.25|3124.25|3338.24|2567.88|2781.87|3209.85|3637.83|3800.46|3766.22|3209.85|3637.83| 784.99 | 3,800.46 | 2,910.26 48100055|HC ART CATH THO/BRACH 3RD-36217|0481|36217|7,169.06|4,158.05|930.38|883.861|||850.41|867.42|867.42|884.42|4659.89|4874.96|5233.41|5233.41|5591.87|4301.44|4659.89|5376.80|6093.70|6366.13|6308.77|5376.80|6093.70| 850.41 | 6,366.13 | 4,874.96 48100057|HC PLACE CATH CAROTID/INOM ART|0481|36222|13,115.32|7,606.89|930.38|883.861|2,861.66|2,861.66|1887.75|1925.5|1925.5|1963.26|8524.96|8918.42|9574.18|9574.18|10229.95|7869.19|8524.96|9836.49|11148.02|11646.40|11541.48|9836.49|11148.02| 883.86 | 11,646.40 | 8,524.96 48100059|HC CEREBRAL UNILAT INCL ARCH/CARO|0481|36223|16,224.58|9,410.26|930.38|883.861|4,770.37|4,770.37|1,887.75|1,925.50|1,925.50|1,963.26|10545.98|11032.71|11843.94|11843.94|12655.17|9734.75|10545.98|12168.44|13790.89|14407.43|14277.63|12168.44|13790.89| 883.86 | 14,407.43 | 10,545.98 48100060|HC PLACE CATH CAROTD ART|0481|36224|16,410.54|9,518.11|930.38|883.861|4,770.37|4,770.37|3,087.32|3,149.07|3,149.07|3,210.81|10666.85|11159.17|11979.69|11979.69|12800.22|9846.32|10666.85|12307.91|13948.96|14572.56|14441.28|12307.91|13948.96| 883.86 | 14,572.56 | 10,666.85 48100061|HC PLACE CATH SUBCLAVIAN ART|0481|36225|9,694.88|5,623.03|930.38|883.861|2861.66|2861.66|1,887.75|1,925.50|1,925.50|1,963.26|6301.67|6592.52|7077.26|7077.26|7562.01|5816.93|6301.67|7271.16|8240.65|8609.05|8531.49|7271.16|8240.65| 883.86 | 8,609.05 | 6,301.67 48100063|HC PLACE CATH VERTEBRAL ART|0481|36226|13,337.75|7,735.90|930.38|883.861|4770.37|4770.37|3,087.32|3,149.07|3,149.07|3,210.81|8669.54|9069.67|9736.56|9736.56|10403.45|8002.65|8669.54|10003.31|11337.09|11843.92|11737.22|10003.31|11337.09| 883.86 | 11,843.92 | 8,669.54 48100064|HC PLACE CATH INTRACRANIAL ART|0481|36228|6,038.54|3,502.35|930.38|883.861|||||||3925.05|4106.21|4408.13|4408.13|4710.06|3623.12|3925.05|4528.91|5132.76|5362.22|5313.92|4528.91|5132.76| 883.86 | 5,362.22 | 4,408.13 48100065|HC ART CATH ABD/PELVI 1ST-36245|0481|36245|6,103.05|3,539.77|930.38|883.861|||784.99|800.69|800.69|816.39|3966.98|4150.07|4455.23|4455.23|4760.38|3661.83|3966.98|4577.29|5187.59|5419.51|5370.68|4577.29|5187.59| 784.99 | 5,419.51 | 4,150.07 48100066|HC ART CATH ABD PELVI-2ND-36246|0481|36246|10,189.59|5,909.96|930.38|883.861|||784.99|800.69|800.69|816.39|6623.23|6928.92|7438.40|7438.40|7947.88|6113.75|6623.23|7642.19|8661.15|9048.36|8966.84|7642.19|8661.15| 784.99 | 9,048.36 | 6,928.92 48100067|HC ART CATH ABD PELVI-3RD-36247|0481|36247|7,714.82|4,474.60|930.38|883.861|||784.99|800.69|800.69|816.39|5014.63|5246.08|5631.82|5631.82|6017.56|4628.89|5014.63|5786.12|6557.60|6850.76|6789.04|5786.12|6557.60| 784.99 | 6,850.76 | 5,246.08 48100067|HC ART CATH ABD PELVI-3RD-36247|0481|36247|7,714.82|4,474.60|930.38|883.861|||784.99|800.69|800.69|816.39|5014.63|5246.08|5631.82|5631.82|6017.56|4628.89|5014.63|5786.12|6557.60|6850.76|6789.04|5786.12|6557.60| 784.99 | 6,850.76 | 5,246.08 48100068|HC ART CATH ABD PELVI-ADD-36248|0481|36248|3,742.55|2,170.68|||||784.99|800.69|800.69|816.39|2432.66|2544.93|2732.06|2732.06|2919.19|2245.53|2432.66|2806.91|3181.17|3323.38|3293.44|2806.91|3181.17| 784.99 | 3,323.38 | 2,732.06 48100069|HC RENAL 1ST, ACCESS ARTERIES, BI|0481|36252|13,216.19|7,665.39|930.38|883.861|2,861.66|2,861.66|||||8590.52|8987.01|9647.82|9647.82|10308.63|7929.71|8590.52|9912.14|11233.76|11735.98|11630.25|9912.14|11233.76| 883.86 | 11,735.98 | 9,647.82 48100070|HC RENAL 2ND ORDER OR HIGHER UNIL|0481|36253|14,249.38|8,264.64|930.38|883.861|4,770.37|4,770.37|1,774.49|1,809.98|1,809.98|1,845.47|9262.10|9689.58|10402.05|10402.05|11114.52|8549.63|9262.10|10687.04|12111.97|12653.45|12539.45|10687.04|12111.97| 883.86 | 12,653.45 | 9,262.10 48100071|HC RENAL 2ND ORDER OR HIGHER BILA|0481|36254|20,310.70|11,780.21|930.38|883.861|2,861.66|2,861.66|1,774.49|1,809.98|1,809.98|1,845.47|13201.96|13811.28|14826.81|14826.81|15842.35|12186.42|13201.96|15233.03|17264.10|18035.90|17873.42|15233.03|17264.10| 883.86 | 18,035.90 | 13,201.96 48100072|HC CENTRAL LINE INSERTION >5YRS|0481|36556|4,731.96|2,744.54|1863.61|1770.4295|2,861.66|2,861.66|480.81|490.42|490.42|500.04|3075.77|3217.73|3454.33|3454.33|3690.93|2839.18|3075.77|3548.97|4022.17|4201.98|4164.12|3548.97|4022.17| 480.81 | 4,201.98 | 3,075.77 48100073|HC CV ACCESS, TUNNELED, >5YO|0481|36558|9,156.41|5,310.72|1863.61|1770.4295|2,861.66|2,861.66|480.81|490.42|490.42|500.04|5951.67|6226.36|6684.18|6684.18|7142.00|5493.85|5951.67|6867.31|7782.95|8130.89|8057.64|6867.31|7782.95| 480.81 | 8,130.89 | 5,951.67 48100074|HC CV ACCESS, PORT < 5YRS|0481|36560|8,864.69|5,141.52|1863.61|1770.4295|2,861.66|2,861.66|1,189.85|1,213.65|1,213.65|1,237.45|5762.05|6027.99|6471.22|6471.22|6914.46|5318.81|5762.05|6648.52|7534.99|7871.84|7800.93|6648.52|7534.99| 1,189.85 | 7,871.84 | 5,762.05 48100075|HC CV ACCESS, PORT>5YO|0481|36561|8,864.69|5,141.52|1,863.61|1,770.43|2861.66|2861.66|1,189.85|1,213.65|1,213.65|1,237.45|5762.05|6027.99|6471.22|6471.22|6914.46|5318.81|5762.05|6648.52|7534.99|7871.84|7800.93|6648.52|7534.99| 1,189.85 | 7,871.84 | 5,762.05 48100076|HC PICC < 5Y/O|0481|36568|6,810.16|3,949.89|||1,406.14|1,406.14|4,039.44|4,120.23|4,120.23|4,201.02|4426.60|4630.91|4971.42|4971.42|5311.92|4086.10|4426.60|5107.62|5788.64|6047.42|5992.94|5107.62|5788.64| 1,406.14 | 6,047.42 | 4,630.91 48100077|HC PICC W/O PORT >5YO|0481|36569|1,899.22|1,101.55|||1406.14|1406.14|4,039.44|4,120.23|4,120.23|4,201.02|1234.49|1291.47|1386.43|1386.43|1481.39|1139.53|1234.49|1424.42|1614.34|1686.51|1671.31|1424.42|1614.34| 1,139.53 | 4,201.02 | 1,424.42 48100078|HC REPLACE,COMP,NON-TUNNELW/OPORT|0481|36580|6,558.76|3,804.08|||1,406.14|1,406.14|533.15|543.82|543.82|554.48|4263.19|4459.96|4787.89|4787.89|5115.83|3935.26|4263.19|4919.07|5574.95|5824.18|5771.71|4919.07|5574.95| 533.15 | 5,824.18 | 4,459.96 48100079|HC REPLACE,COMP,TUNNEL, W/O PORT|0481|36581|6,246.49|3,622.96|1,863.61|1,770.43|2,861.66|2,861.66|533.15|543.82|543.82|554.48|4060.22|4247.61|4559.94|4559.94|4872.26|3747.89|4060.22|4684.87|5309.52|5546.88|5496.91|4684.87|5309.52| 533.15 | 5,546.88 | 4,060.22 48100080|HC REPLACE,PICC,W/O PORT|0481|36584|7,230.32|4,193.59|1,863.61|1,770.43|1406.14|1406.14|533.15|543.82|543.82|554.48|4699.71|4916.62|5278.13|5278.13|5639.65|4338.19|4699.71|5422.74|6145.77|6420.52|6362.68|5422.74|6145.77| 533.15 | 6,420.52 | 4,699.71 48100081|HC REMOVE TUNNELED W/O PORT-CVOPC|0481|36589|1,967.91|1,141.39|930.38|883.86|541.62|541.62|206.28|210.41|210.41|214.53|1279.14|1338.18|1436.57|1436.57|1534.97|1180.75|1279.14|1475.93|1672.72|1747.50|1731.76|1475.93|1672.72| 206.28 | 1,747.50 | 1,279.14 48100082|HC REMOVE, TUNNELED W/O PORT|0481|36589|1,967.91|1,141.39|930.38|883.86|541.62|541.62|206.28|210.41|210.41|214.53|1279.14|1338.18|1436.57|1436.57|1534.97|1180.75|1279.14|1475.93|1672.72|1747.50|1731.76|1475.93|1672.72| 206.28 | 1,747.50 | 1,279.14 48100083|HC REMOVE, TUNNELED, W/PORT|0481|36590|2,700.86|1,566.50|1,863.61|1,770.43|1,406.14|1,406.14|346.63|353.56|353.56|360.49|1755.56|1836.58|1971.63|1971.63|2106.67|1620.52|1755.56|2025.65|2295.73|2398.36|2376.76|2025.65|2295.73| 346.63 | 2,398.36 | 1,836.58 48100084|HC STRIP FIBRIN SHEATH|0481|36595|5,604.70|3,250.73|||2,861.66|2,861.66|480.81|490.42|490.42|500.04|3643.06|3811.20|4091.43|4091.43|4371.67|3362.82|3643.06|4203.53|4764.00|4976.97|4932.14|4203.53|4764.00| 480.81 | 4,976.97 | 3,811.20 48100085|HC REPOSITION CVP LINE|0481|36597|1,501.84|871.07|||1,406.14|1,406.14|480.81|490.42|490.42|500.04|976.20|1021.25|1096.34|1096.34|1171.44|901.10|976.20|1126.38|1276.56|1333.63|1321.62|1126.38|1276.56| 480.81 | 1,406.14 | 1,096.34 48100086|HC CV CATHETER INJECTION (36598)|0481|36598|623.35|361.54|||203.50|203.50|186.68|190.42|190.42|194.15|405.18|423.88|455.05|455.05|486.21|374.01|405.18|467.51|529.85|553.53|548.55|467.51|529.85| 186.68 | 553.53 | 423.88 48100087|HC DIALYSIS GRAFT DECLOT-36870|0481|36870|11,837.82|6,865.94|||||588.74|600.52|600.52|612.29|7694.58|8049.72|8641.61|8641.61|9233.50|7102.69|7694.58|8878.37|10062.15|10511.98|10417.28|8878.37|10062.15| 588.74 | 10,511.98 | 8,641.61 48100088|HC NEW TIPS-37182|0481|37182|29,873.50|17,326.63|||10,042.94|10,042.94|||||19417.78|20313.98|21807.66|21807.66|23301.33|17924.10|19417.78|22405.13|25392.48|26527.67|26288.68|22405.13|25392.48| 10,042.94 | 26,527.67 | 21,807.66 48100089|HC REVISED TIPS|0481|37183|26,761.22|15,521.51|||4956.84|4956.84|||||17394.79|18197.63|19535.69|19535.69|20873.75|16056.73|17394.79|20070.92|22747.04|23763.96|23549.87|20070.92|22747.04| 4,956.84 | 23,763.96 | 19,535.69 48100090|HC THROMBECTOMY-ARTERIAL, INITIAL|0481|37184|6,998.89|4,059.36|||10042.94|10042.94|1,857.76|1,894.92|1,894.92|1,932.07|4549.28|4759.25|5109.19|5109.19|5459.13|4199.33|4549.28|5249.17|5949.06|6215.01|6159.02|5249.17|5949.06| 1,857.76 | 10,042.94 | 5,109.19 48100090|HC THROMBECTOMY-ARTERIAL, INITIAL|0481|37184|6,998.89|4,059.36|||10,042.94|10,042.94|2,972.42|3,031.87|3,031.87|3,091.32|4549.28|4759.25|5109.19|5109.19|5459.13|4199.33|4549.28|5249.17|5949.06|6215.01|6159.02|5249.17|5949.06| 2,972.42 | 10,042.94 | 5,109.19 48100091|HC THROMBECTOMY-ARTERIAL, ADD|0481|37185|7,276.15|4,220.17|||||606.90|619.04|619.04|631.18|4729.50|4947.78|5311.59|5311.59|5675.40|4365.69|4729.50|5457.11|6184.73|6461.22|6403.01|5457.11|6184.73| 606.90 | 6,461.22 | 5,311.59 48100091|HC THROMBECTOMY-ARTERIAL, ADD|0481|37185|7,276.15|4,220.17|||||971.05|990.47|990.47|1,009.89|4729.50|4947.78|5311.59|5311.59|5675.40|4365.69|4729.50|5457.11|6184.73|6461.22|6403.01|5457.11|6184.73| 971.05 | 6,461.22 | 5,311.59 48100092|HC THROMBECTOMY-ARTERIAL, SECONDA|0481|37186|6,998.89|4,059.36|||||||||4549.28|4759.25|5109.19|5109.19|5459.13|4199.33|4549.28|5249.17|5949.06|6215.01|6159.02|5249.17|5949.06| 4,199.33 | 6,215.01 | 5,249.17 48100093|HC THROMBECTOMY-VENOUS, INITIAL|0481|37187|6,998.89|4,059.36|||10,042.94|10,042.94|1,806.46|1,842.59|1,842.59|1,878.72|4549.28|4759.25|5109.19|5109.19|5459.13|4199.33|4549.28|5249.17|5949.06|6215.01|6159.02|5249.17|5949.06| 1,806.46 | 10,042.94 | 5,109.19 48100093|HC THROMBECTOMY-VENOUS, INITIAL|0481|37187|6,998.89|4,059.36|||10,042.94|10,042.94|2,890.34|2,948.15|2,948.15|3,005.95|4549.28|4759.25|5109.19|5109.19|5459.13|4199.33|4549.28|5249.17|5949.06|6215.01|6159.02|5249.17|5949.06| 2,890.34 | 10,042.94 | 5,109.19 48100094|HC THROMBECTOMY-VENOUS, REPEAT|0481|37188|6,929.60|4,019.17|||2,861.66|2,861.66|1,558.20|1,589.36|1,589.36|1,620.52|4504.24|4712.13|5058.61|5058.61|5405.09|4157.76|4504.24|5197.20|5890.16|6153.48|6098.05|5197.20|5890.16| 1,558.20 | 6,153.48 | 4,712.13 48100094|HC THROMBECTOMY-VENOUS, REPEAT|0481|37188|6,929.60|4,019.17|||2,861.66|2,861.66|2,493.11|2,542.97|2,542.97|2,592.83|4504.24|4712.13|5058.61|5058.61|5405.09|4157.76|4504.24|5197.20|5890.16|6153.48|6098.05|5197.20|5890.16| 2,493.11 | 6,153.48 | 4,712.13 48100095|HC INSERT VENA CAVA FILTER|0481|37191|15,222.90|8,829.28|||4770.37|4770.37|140.24|143.04|143.04|145.85|9894.89|10351.57|11112.72|11112.72|11873.86|9133.74|9894.89|11417.18|12939.47|13517.94|13396.15|11417.18|12939.47| 140.24 | 13,517.94 | 10,351.57 48100096|HC REPOSITION VENA CAVA FILTER|0481|37192|19,608.83|11,373.12|||2,861.66|2,861.66|1,805.82|1,841.94|1,841.94|1,878.05|12745.74|13334.00|14314.45|14314.45|15294.89|11765.30|12745.74|14706.62|16667.51|17412.64|17255.77|14706.62|16667.51| 1,805.82 | 17,412.64 | 13,334.00 48100097|HC RETRIEVE/REMOVE VENA CAVA FILT|0481|37193|18,675.04|10,831.52|||2,861.66|2,861.66|1805.82|1841.94|1841.94|1878.05|12138.78|12699.03|13632.78|13632.78|14566.53|11205.02|12138.78|14006.28|15873.78|16583.44|16434.04|14006.28|15873.78| 1,805.82 | 16,583.44 | 12,699.03 48100098|HC REMOVE INTRVAS FOREIGN BODY|0481|37197|12,169.65|7,058.40|||2,861.66|2,861.66|1,894.71|1,932.60|1,932.60|1,970.50|7910.27|8275.36|8883.84|8883.84|9492.33|7301.79|7910.27|9127.24|10344.20|10806.65|10709.29|9127.24|10344.20| 1,894.71 | 10,806.65 | 8,275.36 48100099|HC THROMBOLYTIC ART THERAPY|0481|37211|7,390.28|4,286.36|||4770.37|4770.37|668.49|681.86|681.86|695.23|4803.68|5025.39|5394.90|5394.90|5764.42|4434.17|4803.68|5542.71|6281.74|6562.57|6503.45|5542.71|6281.74| 668.49 | 6,562.57 | 5,025.39 48100100|HC THROMBOLYTIC VENOUS THERAPY|0481|37212|7,390.28|4,286.36|||2861.66|2861.66|668.49|681.86|681.86|695.23|4803.68|5025.39|5394.90|5394.90|5764.42|4434.17|4803.68|5542.71|6281.74|6562.57|6503.45|5542.71|6281.74| 668.49 | 6,562.57 | 5,025.39 48100101|HC THROMBLYTIC ART/VEN THERAPY|0481|37213|11,065.97|6,418.26|||2861.66|2861.66|1,491.71|1,521.54|1,521.54|1,551.38|7192.88|7524.86|8078.16|8078.16|8631.46|6639.58|7192.88|8299.48|9406.07|9826.58|9738.05|8299.48|9406.07| 1,491.71 | 9,826.58 | 7,524.86 48100102|HC INJECTION FOR CYSTOGRAPHY|0481|51600|1,889.00|1,095.62|437.4|415.53|||196.25|200.17|200.17|204.10|1227.85|1284.52|1378.97|1378.97|1473.42|1133.40|1227.85|1416.75|1605.65|1677.43|1662.32|1416.75|1605.65| 196.25 | 1,677.43 | 1,284.52 48100103|HC CESSJ THERAPY CATH REMOVAL|0481|37214|11,065.97|6,418.26|||2861.66|2861.66|1,491.71|1,521.54|1,521.54|1,551.38|7192.88|7524.86|8078.16|8078.16|8631.46|6639.58|7192.88|8299.48|9406.07|9826.58|9738.05|8299.48|9406.07| 1,491.71 | 9,826.58 | 7,524.86 48100104|HC CAROTID ARTERY STENT W/DIST 37|0481|37215|25,889.07|15,015.66|||||261.66|266.90|266.90|272.13|16827.90|17604.57|18899.02|18899.02|20193.47|15533.44|16827.90|19416.80|22005.71|22989.49|22782.38|19416.80|22005.71| 261.66 | 22,989.49 | 18,899.02 48100105|HC PTA/REVASC ILIAC INITIAL VESSE|0481|37220|24,383.06|14,142.17|7729.4|7342.93|4,956.84|4,956.84|2555.41|2606.52|2606.52|2657.63|15848.99|16580.48|17799.63|17799.63|19018.79|14629.84|15848.99|18287.30|20725.60|21652.16|21457.09|18287.30|20725.60| 2,555.41 | 21,652.16 | 15,848.99 48100106|HC STENT/PTA/REVASC ILIAC INI VES|0481|37221|41,731.98|24,204.55|7,729.40|7,342.93|10,042.94|10,042.94|2,555.41|2,606.52|2,606.52|2,657.63|27125.79|28377.75|30464.35|30464.35|32550.94|25039.19|27125.79|31298.99|35472.18|37058.00|36724.14|31298.99|35472.18| 2,555.41 | 37,058.00 | 27,125.79 48100107|HC PTA/REVASC ILIAC ADDTL VESSEL|0481|37222|17,832.68|10,342.95|7729.4|7342.93|||2,555.41|2,606.52|2,606.52|2,657.63|11591.24|12126.22|13017.86|13017.86|13909.49|10699.61|11591.24|13374.51|15157.78|15835.42|15692.76|13374.51|15157.78| 2,555.41 | 15,835.42 | 12,126.22 48100108|HC STENT/PTA/REVASC ILLIAC ADTL V|0481|37223|25,091.70|14,553.19|7,729.40|7,342.93|||2,555.41|2,606.52|2,606.52|2,657.63|16309.61|17062.36|18316.94|18316.94|19571.53|15055.02|16309.61|18818.78|21327.95|22281.43|22080.70|18818.78|21327.95| 2,555.41 | 22,281.43 | 17,062.36 48100109|HC PTA/REVASC FEM/POP|0481|37224|30,360.92|17,609.33|7,729.40|7,342.93|4,956.84|4,956.84|2,555.41|2,606.52|2,606.52|2,657.63|19734.60|20645.43|22163.47|22163.47|23681.52|18216.55|19734.60|22770.69|25806.78|26960.50|26717.61|22770.69|25806.78| 2,555.41 | 26,960.50 | 19,734.60 48100110|HC ATHERECTOMY/PTA/REVAS FEM/POP|0481|37225|35,130.56|20,375.72|7,729.40|7,342.93|10042.94|10042.94|5425.07|5533.57|5533.57|5642.07|22834.86|23888.78|25645.31|25645.31|27401.84|21078.34|22834.86|26347.92|29860.98|31195.94|30914.89|26347.92|29860.98| 5,425.07 | 31,195.94 | 22,834.86 48100111|HC STENT/PTA/REVASC FEM/POP|0481|37226|53,050.77|30,769.45|7729.4|7342.93|10042.94|10042.94|5,425.07|5,533.57|5,533.57|5,642.07|34483.00|36074.52|38727.06|38727.06|41379.60|31830.46|34483.00|39788.08|45093.15|47109.08|46684.68|39788.08|45093.15| 5,425.07 | 47,109.08 | 34,483.00 48100112|HC STENT/ATHERECTOMY/PTA/REVAS FE|0481|37227|51,367.29|29,793.03|7729.4|7342.93|16,064.00|16,064.00|9,395.53|9,583.44|9,583.44|9,771.35|33388.74|34929.76|37498.12|37498.12|40066.49|30820.37|33388.74|38525.47|43662.20|45614.15|45203.22|38525.47|43662.20| 7,342.93 | 45,614.15 | 33,388.74 48100113|HC PTA/REVAS TIB/PERONEAL INI VES|0481|37228|25,124.52|14,572.22|7729.4|7342.93|10042.94|10042.94|2,555.41|2,606.52|2,606.52|2,657.63|16330.94|17084.67|18340.90|18340.90|19597.13|15074.71|16330.94|18843.39|21355.84|22310.57|22109.58|18843.39|21355.84| 2,555.41 | 22,310.57 | 16,330.94 48100114|HC ATHERECTOMY/PTA/REVAS TIB/PER|0481|37229|25,992.38|15,075.58|7729.4|7342.93|16,064.00|16,064.00|5425.07|5533.57|5533.57|5642.07|16895.05|17674.82|18974.44|18974.44|20274.06|15595.43|16895.05|19494.29|22093.52|23081.23|22873.29|19494.29|22093.52| 5,425.07 | 23,081.23 | 16,895.05 48100115|HC STENT/PTA/REVAS TIB/PERONEAL I|0481|37230|44,597.51|25,866.56|7729.4|7342.93|16,064.00|16,064.00|5425.07|5533.57|5533.57|5642.07|28988.38|30326.31|32556.18|32556.18|34786.06|26758.51|28988.38|33448.13|37907.88|39602.59|39245.81|33448.13|37907.88| 5,425.07 | 39,602.59 | 28,988.38 48100116|HC PTA/REVAS TIB/PERONEAL ADDTL V|0481|37232|23,828.78|13,820.69|7729.4|7342.93|||2555.41|2606.52|2606.52|2657.63|15488.71|16203.57|17395.01|17395.01|18586.45|14297.27|15488.71|17871.59|20254.46|21159.96|20969.33|17871.59|20254.46| 2,555.41 | 21,159.96 | 16,203.57 48100117|HC ATHERECTOMY/PTA/REVAS TIB/PER|0481|37233|25,992.38|15,075.58|7729.4|7342.93|||5425.07|5533.57|5533.57|5642.07|16895.05|17674.82|18974.44|18974.44|20274.06|15595.43|16895.05|19494.29|22093.52|23081.23|22873.29|19494.29|22093.52| 5,425.07 | 23,081.23 | 17,674.82 48100118|HC OPEN/PERQ PLACE STENT 1ST ARTE|0481|37236|42,806.48|24,827.76|||10,042.94|10,042.94|7755.47|7910.58|7910.58|8065.69|27824.21|29108.41|31248.73|31248.73|33389.05|25683.89|27824.21|32104.86|36385.51|38012.15|37669.70|32104.86|36385.51| 7,755.47 | 38,012.15 | 29,108.41 48100119|HC OPEN/PERQ PLACE STENT EA ADD A|0481|37237|22,983.45|13,330.40|||||3,495.53|3,565.44|3,565.44|3,635.35|14939.24|15628.75|16777.92|16777.92|17927.09|13790.07|14939.24|17237.59|19535.93|20409.30|20225.44|17237.59|19535.93| 3,495.53 | 20,409.30 | 16,777.92 48100120|HC OPEN/PERQ PLACE STENT SAME VEI|0481|37238|39,732.47|23,044.83|||10,042.94|10,042.94|7,755.47|7,910.58|7,910.58|8,065.69|25826.11|27018.08|29004.70|29004.70|30991.33|23839.48|25826.11|29799.35|33772.60|35282.43|34964.57|29799.35|33772.60| 7,755.47 | 35,282.43 | 27,018.08 48100121|HC OPEN/PERQ PLACE STENT EA ADD V|0481|37239|23,202.80|13,457.62|||||||||15081.82|15777.90|16938.04|16938.04|18098.18|13921.68|15081.82|17402.10|19722.38|20604.09|20418.46|17402.10|19722.38| 13,921.68 | 20,604.09 | 17,402.10 48100122|HC VASC EMBOLIZE/OCCLUDE VENOUS|0481|37241|27,064.46|15,697.39|||10042.94|10042.94|7,519.87|7,670.27|7,670.27|7,820.66|17591.90|18403.83|19757.06|19757.06|21110.28|16238.68|17591.90|20298.35|23004.79|24033.24|23816.72|20298.35|23004.79| 7,519.87 | 24,033.24 | 18,403.83 48100123|HC VASC EMBOLIZE/OCCLUDE ARTERY|0481|37242|28,417.54|16,482.17|||10042.94|10042.94|7,519.87|7,670.27|7,670.27|7,820.66|18471.40|19323.93|20744.80|20744.80|22165.68|17050.52|18471.40|21313.16|24154.91|25234.78|25007.44|21313.16|24154.91| 7,519.87 | 25,234.78 | 19,323.93 48100124|HC VASC EMBOLIZE/OCCLUDE ORGAN|0481|37243|27,064.46|15,697.39|||10,042.94|10,042.94|7,519.87|7,670.27|7,670.27|7,820.66|17591.90|18403.83|19757.06|19757.06|21110.28|16238.68|17591.90|20298.35|23004.79|24033.24|23816.72|20298.35|23004.79| 7,519.87 | 24,033.24 | 18,403.83 48100125|HC VASC EMBOLIZE/OCCLUDE BLEED|0481|37244|27,064.46|15,697.39|||10,042.94|10,042.94|7,519.87|7,670.27|7,670.27|7,820.66|17591.90|18403.83|19757.06|19757.06|21110.28|16238.68|17591.90|20298.35|23004.79|24033.24|23816.72|20298.35|23004.79| 7,519.87 | 24,033.24 | 18,403.83 48100126|HC IVUS NON-CORONARY-37250|0481|37250|6,854.24|3,975.46|||||||||4455.26|4660.88|5003.60|5003.60|5346.31|4112.54|4455.26|5140.68|5826.10|6086.57|6031.73|5140.68|5826.10| 4,112.54 | 6,086.57 | 5,140.68 48100127|HC BX LYMPH NODE-38505|0481|38505|4,525.11|2,624.56|636.86|605.017|1407|1407|294.37|300.26|300.26|306.15|2941.32|3077.07|3303.33|3303.33|3529.59|2715.07|2941.32|3393.83|3846.34|4018.30|3982.10|3393.83|3846.34| 294.37 | 4,018.30 | 2,941.32 48100128|HC LONG GASTRIC TUBE PLACED,ENTER|0481|44500|643.78|373.39|||809.60|809.60|||||418.46|437.77|469.96|469.96|502.15|386.27|418.46|482.84|547.21|571.68|566.53|482.84|547.21| 386.27 | 809.60 | 482.84 48100129|HC CHOLECYSTOSTOMY-47490|0481|47490|5,591.33|3,242.97|||3,183.41|3,183.41|392.50|400.35|400.35|408.20|3634.36|3802.10|4081.67|4081.67|4361.24|3354.80|3634.36|4193.50|4752.63|4965.10|4920.37|4193.50|4752.63| 392.50 | 4,965.10 | 3,802.10 48100130|HC TRANSHEP CHOLEANGIO-47500|0481|47500|5,220.60|3,027.95|||||65.42|66.72|66.72|68.03|3393.39|3550.01|3811.04|3811.04|4072.07|3132.36|3393.39|3915.45|4437.51|4635.89|4594.13|3915.45|4437.51| 65.42 | 4,635.89 | 3,811.04 48100131|HC TUBE CHOLANGLOGRAM-47505|0481|47505|918.06|532.47|||||65.42|66.72|66.72|68.03|596.74|624.28|670.18|670.18|716.09|550.84|596.74|688.55|780.35|815.24|807.89|688.55|780.35| 65.42 | 815.24 | 670.18 48100132|HC BILIARY DRAINAGE-47510|0481|47510|3,423.01|1,985.35|||||324.29|330.78|330.78|337.27|2224.96|2327.65|2498.80|2498.80|2669.95|2053.81|2224.96|2567.26|2909.56|3039.63|3012.25|2567.26|2909.56| 324.29 | 3,039.63 | 2,498.80 48100133|HC BILIARY DRAIN INT/EXT-47511|0481|47511|5,934.11|3,441.78|||||324.29|330.78|330.78|337.27|3857.17|4035.19|4331.90|4331.90|4628.61|3560.47|3857.17|4450.58|5043.99|5269.49|5222.02|4450.58|5043.99| 324.29 | 5,269.49 | 4,331.90 48100134|HC CHG BILIARY CATH-47525|0481|47525|5,192.64|3,011.73|||||65.42|66.72|66.72|68.03|3375.22|3531.00|3790.63|3790.63|4050.26|3115.58|3375.22|3894.48|4413.74|4611.06|4569.52|3894.48|4413.74| 65.42 | 4,611.06 | 3,790.63 48100135|HC BILIARY DIL W/O STENT-47555|0481|47555|3,151.81|1,828.05|||3,183.41|3,183.41|130.83|133.45|133.45|136.07|2048.68|2143.23|2300.82|2300.82|2458.41|1891.09|2048.68|2363.86|2679.04|2798.81|2773.59|2363.86|2679.04| 130.83 | 3,183.41 | 2,300.82 48100136|HC BILIARY D/L W/STENT-47556|0481|47556|3,819.12|2,215.09|||5,060.44|5,060.44|||||2482.43|2597.00|2787.96|2787.96|2978.91|2291.47|2482.43|2864.34|3246.25|3391.38|3360.83|2864.34|3246.25| 2,291.47 | 5,060.44 | 2,864.34 48100137|HC ABD PARACENTESIS W/IMAGING GUI|0481|49083|5,604.62|3,250.68|606.96|576.61|809.60|809.60|327.67|334.22|334.22|340.78|3643.00|3811.14|4091.37|4091.37|4371.60|3362.77|3643.00|4203.47|4763.93|4976.90|4932.07|4203.47|4763.93| 327.67 | 4,976.90 | 3,643.00 48100138|HC IMAGE CATH FLUID PERI/RETRO|0481|49406|3,387.62|1,964.82|||1407|1407|1,040.26|1,061.06|1,061.06|1,081.87|2201.95|2303.58|2472.96|2472.96|2642.34|2032.57|2201.95|2540.72|2879.48|3008.21|2981.11|2540.72|2879.48| 1,040.26 | 3,008.21 | 2,303.58 48100139|HC INSERT INTRAPERITONEAL CATH-TU|0481|49418|8,373.62|4,856.70|1,141.26|1,084.20|3,183.41|3,183.41|1,443.40|1,472.27|1,472.27|1,501.14|5442.85|5694.06|6112.74|6112.74|6531.42|5024.17|5442.85|6280.22|7117.58|7435.77|7368.79|6280.22|7117.58| 1,084.20 | 7,435.77 | 5,442.85 48100140|HC EXCHG CATH ABSC-49423|0481|49423|2,914.70|1,690.53|437.40|415.53|1625.02|1625.02|196.25|200.17|200.17|204.10|1894.56|1982.00|2127.73|2127.73|2273.47|1748.82|1894.56|2186.03|2477.50|2588.25|2564.94|2186.03|2477.50| 196.25 | 2,588.25 | 1,894.56 48100141|HC INJ ABCS CATH-49424|0481|49424|5,291.10|3,068.84|437.40|415.53|||||||3439.22|3597.95|3862.50|3862.50|4127.06|3174.66|3439.22|3968.33|4497.44|4698.50|4656.17|3968.33|4497.44| 415.53 | 4,698.50 | 3,862.50 48100142|HC INSERT PERITONEAL-VENOUS SHUNT|0481|49425|9,174.78|5,321.37|||||523.33|533.79|533.79|544.26|5963.61|6238.85|6697.59|6697.59|7156.33|5504.87|5963.61|6881.09|7798.56|8147.20|8073.81|6881.09|7798.56| 523.33 | 8,147.20 | 6,697.59 48100143|HC REVISE PERITONEAL-VENOUS SHUNT|0481|49426|4,676.06|2,712.11|||3,183.41|3,183.41|523.33|533.79|533.79|544.26|3039.44|3179.72|3413.52|3413.52|3647.33|2805.64|3039.44|3507.05|3974.65|4152.34|4114.93|3507.05|3974.65| 523.33 | 4,152.34 | 3,183.41 48100144|HC SHUNT EVALUATION-49427|0481|49427|484.71|281.13|||||41.32|42.14|42.14|42.97|315.06|329.60|353.84|353.84|378.07|290.83|315.06|363.53|412.00|430.42|426.54|363.53|412.00| 41.32 | 430.42 | 353.84 48100145|HC REMOVAL PERITONEAL-VENOUS SHUN|0481|49429|3,995.27|2,317.26|||2861.66|2861.66|||||2596.93|2716.78|2916.55|2916.55|3116.31|2397.16|2596.93|2996.45|3395.98|3547.80|3515.84|2996.45|3395.98| 2,397.16 | 3,547.80 | 2,916.55 48100146|HC CONVERT G TUBE TO G/J TUBE|0481|49446|6,071.46|3,521.45|||1625.02|1625.02|||||3946.45|4128.59|4432.17|4432.17|4735.74|3642.88|3946.45|4553.60|5160.74|5391.46|5342.88|4553.60|5160.74| 1,625.02 | 5,391.46 | 4,432.17 48100147|HC CHANGE GASTRO TUBE|0481|49450|1,393.71|808.35|||809.6|809.6|||||905.91|947.72|1017.41|1017.41|1087.09|836.23|905.91|1045.28|1184.65|1237.61|1226.46|1045.28|1184.65| 809.60 | 1,237.61 | 1,017.41 48100148|HC REPLACE J TUBE|0481|49451|5,934.11|3,441.78|||809.60|809.60|||||3857.17|4035.19|4331.90|4331.90|4628.61|3560.47|3857.17|4450.58|5043.99|5269.49|5222.02|4450.58|5043.99| 809.60 | 5,269.49 | 4,331.90 48100149|HC REPLACE G/J TUBE|0481|49452|1,700.50|986.29|||809.60|809.60|||||1105.33|1156.34|1241.37|1241.37|1326.39|1020.30|1105.33|1275.38|1445.43|1510.04|1496.44|1275.38|1445.43| 809.60 | 1,510.04 | 1,241.37 48100150|HC BIOPSY RENAL|0481|50200|4,525.11|2,624.56|437.4|415.53|1,407.00|1,407.00|281.29|286.91|286.91|292.54|2941.32|3077.07|3303.33|3303.33|3529.59|2715.07|2941.32|3393.83|3846.34|4018.30|3982.10|3393.83|3846.34| 281.29 | 4,018.30 | 2,941.32 48100151|HC PERC REMOV/REPLACE URETERAL ST|0481|50382|6,252.50|3,626.45|||1,792.99|1,792.99|1,546.08|1,577.00|1,577.00|1,607.92|4064.13|4251.70|4564.33|4564.33|4876.95|3751.50|4064.13|4689.38|5314.63|5552.22|5502.20|4689.38|5314.63| 1,546.08 | 5,552.22 | 4,251.70 48100152|HC NEPHROSTOMY 50392|0481|50392|7,025.62|4,074.86|||||327.08|333.62|333.62|340.16|4566.65|4777.42|5128.70|5128.70|5479.98|4215.37|4566.65|5269.22|5971.78|6238.75|6182.55|5269.22|5971.78| 327.08 | 6,238.75 | 5,128.70 48100154|HC DRAINAGE/STENT URETER 50393|0481|50393|8,286.11|4,805.94|||||327.08|333.62|333.62|340.16|5385.97|5634.55|6048.86|6048.86|6463.17|4971.67|5385.97|6214.58|7043.19|7358.07|7291.78|6214.58|7043.19| 327.08 | 7,358.07 | 6,048.86 48100155|HC NEPH TUBE CHANGE 50398|0481|50398|4,977.50|2,886.95|||||327.08|333.62|333.62|340.16|3235.38|3384.70|3633.58|3633.58|3882.45|2986.50|3235.38|3733.13|4230.88|4420.02|4380.20|3733.13|4230.88| 327.08 | 4,420.02 | 3,633.58 48100157|HC CHANGE URETEROSTOMY 50688|0481|50688|5,569.45|3,230.28|||1,792.99|1,792.99|65.42|66.72|66.72|68.03|3620.14|3787.23|4065.70|4065.70|4344.17|3341.67|3620.14|4177.09|4734.03|4945.67|4901.12|4177.09|4734.03| 65.42 | 4,945.67 | 3,787.23 48100158|HC CYSTOSTOMY TUBE CHANGE|0481|51705|3,836.56|2,225.20|95.46|90.687|266.14|266.14|196.25|200.17|200.17|204.10|2493.76|2608.86|2800.69|2800.69|2992.52|2301.94|2493.76|2877.42|3261.08|3406.87|3376.17|2877.42|3261.08| 90.69 | 3,406.87 | 2,493.76 48100159|HC CYSTOSTOMY TUBE CHNG-COMPLICAT|0481|51710|4,159.47|2,412.49|437.40|415.53|574.77|574.77|241.29|246.12|246.12|250.95|2703.66|2828.44|3036.41|3036.41|3244.39|2495.68|2703.66|3119.60|3535.55|3693.61|3660.33|3119.60|3535.55| 241.29 | 3,693.61 | 2,703.66 48100160|HC INTRACRANIAL ANGIOPLASTY|0481|61630|6,975.13|4,045.58|||||1,403.17|1,431.24|1,431.24|1,459.30|4533.83|4743.09|5091.84|5091.84|5440.60|4185.08|4533.83|5231.35|5928.86|6193.92|6138.11|5231.35|5928.86| 1,403.17 | 6,193.92 | 5,091.84 48100161|HC DISC ASPIRATION|0481|62267|4,310.19|2,499.91|||621.97|621.97|251.26|256.29|256.29|261.31|2801.62|2930.93|3146.44|3146.44|3361.95|2586.11|2801.62|3232.64|3663.66|3827.45|3792.97|3232.64|3663.66| 251.26 | 3,827.45 | 2,930.93 48100162|HC LUMBAR PUNCTURE|0481|62270|1,951.18|1,131.68|611.22|580.66|634.59|634.59|163.54|166.81|166.81|170.08|1268.27|1326.80|1424.36|1424.36|1521.92|1170.71|1268.27|1463.39|1658.50|1732.65|1717.04|1463.39|1658.50| 163.54 | 1,732.65 | 1,268.27 48100163|HC INJ DISCOGRAPHY LUMBAR EACH LE|0481|62290|2,236.77|1,297.33|||||130.83|133.45|133.45|136.07|1453.90|1521.00|1632.84|1632.84|1744.68|1342.06|1453.90|1677.58|1901.25|1986.25|1968.36|1677.58|1901.25| 130.83 | 1,986.25 | 1,632.84 48100164|HC S/I NASO GASTRIC TUBE|0481|74340|637.65|369.84|||||27.80|28.36|28.36|28.91|414.47|433.60|465.48|465.48|497.37|382.59|414.47|478.24|542.00|566.23|561.13|478.24|542.00| 27.80 | 566.23 | 465.48 48100164|HC S/I NASO GASTRIC TUBE|0481|74340|637.65|369.84|||||75.29|76.80|76.80|78.31|414.47|433.60|465.48|465.48|497.37|382.59|414.47|478.24|542.00|566.23|561.13|478.24|542.00| 75.29 | 566.23 | 465.48 48100165|HC CINERADIOGRAPHY/VIDEORADIOGRAP|0481|76120|1,170.19|678.71|||108.97|108.97|22.24|22.69|22.69|23.13|760.62|795.73|854.24|854.24|912.75|702.11|760.62|877.64|994.66|1039.13|1029.77|877.64|994.66| 22.24 | 1,039.13 | 795.73 48100165|HC CINERADIOGRAPHY/VIDEORADIOGRAP|0481|76120|1,170.19|678.71|||108.97|108.97|44.48|45.37|45.37|46.26|760.62|795.73|854.24|854.24|912.75|702.11|760.62|877.64|994.66|1039.13|1029.77|877.64|994.66| 44.48 | 1,039.13 | 795.73 48100166|HC PERITON-VENOUS SHUNT PATENCY|0481|78291|1,231.77|714.43|||377.12|377.12|16.68|17.01|17.01|17.35|800.65|837.60|899.19|899.19|960.78|739.06|800.65|923.83|1047.00|1093.81|1083.96|923.83|1047.00| 16.68 | 1,093.81 | 837.60 48100166|HC PERITON-VENOUS SHUNT PATENCY|0481|78291|1,231.77|714.43|||377.12|377.12|95.43|97.34|97.34|99.25|800.65|837.60|899.19|899.19|960.78|739.06|800.65|923.83|1047.00|1093.81|1083.96|923.83|1047.00| 95.43 | 1,093.81 | 837.60 48100167|HC PRQ CARDIAC ANGIOPLAST 1 ART|0481|92920|23,655.38|13,720.12|2,954.97|2,807.22|4956.84|4956.84|3,421.23|3,489.66|3,489.66|3,558.08|15376.00|16085.66|17268.43|17268.43|18451.20|14193.23|15376.00|17741.54|20107.07|21005.98|20816.73|17741.54|20107.07| 2,807.22 | 21,005.98 | 15,376.00 48100168|HC PRQ CARDIAC ANGIO ADDL ART|0481|92921|15,154.93|8,789.86|7729.4|7342.93|||3421.23|3489.66|3489.66|3558.08|9850.70|10305.35|11063.10|11063.10|11820.85|9092.96|9850.70|11366.20|12881.69|13457.58|13336.34|11366.20|12881.69| 3,421.23 | 13,457.58 | 10,305.35 48100169|HC PRQ CARD STENT W/ANGIO 1 VSL|0481|92928|39,621.86|22,980.68|11,013.51|10,462.83|10,042.94|10,042.94|5,196.37|5,300.30|5,300.30|5,404.23|25754.21|26942.86|28923.96|28923.96|30905.05|23773.12|25754.21|29716.40|33678.58|35184.21|34867.24|29716.40|33678.58| 5,196.37 | 35,184.21 | 25,754.21 48100170|HC PRQ CARD STENT W/ANGIO ADDL|0481|92929|22,985.22|13,331.43|11,013.51|10,462.83|||5,196.37|5,300.30|5,300.30|5,404.23|14940.39|15629.95|16779.21|16779.21|17928.47|13791.13|14940.39|17238.92|19537.44|20410.88|20226.99|17238.92|19537.44| 5,196.37 | 20,410.88 | 15,629.95 48100171|HC PRQ REVASC BYP GRAFT 1 VSL|0481|92937|60,546.80|35,117.14|11,013.51|10,462.83|10,042.94|10,042.94|5,196.37|5,300.30|5,300.30|5,404.23|39355.42|41171.82|44199.16|44199.16|47226.50|36328.08|39355.42|45410.10|51464.78|53765.56|53281.18|45410.10|51464.78| 5,196.37 | 53,765.56 | 39,355.42 48100172|HC PRQ CARD REVASC MI 1 VSL|0481|92941|51,767.19|30,024.97|28,934.11|27,487.40|||5,196.37|5,300.30|5,300.30|5,404.23|33648.67|35201.69|37790.05|37790.05|40378.41|31060.31|33648.67|38825.39|44002.11|45969.26|45555.13|38825.39|44002.11| 5,196.37 | 45,969.26 | 35,201.69 48100173|HC PRQ CARD REVASC CHRONIC 1VSL|0481|92943|49,300.93|28,594.54|28934.11|27487.4045|10042.94|10042.94|5196.37|5300.3|5300.3|5404.23|32045.60|33524.63|35989.68|35989.68|38454.73|29580.56|32045.60|36975.70|41905.79|43779.23|43384.82|36975.70|41905.79| 5,196.37 | 43,779.23 | 32,045.60 48100174|HC CARDIOVERSION/EXTERNAL|0481|92960|1,589.88|922.13|||561.91|561.91|196.25|200.17|200.17|204.1|1033.42|1081.12|1160.61|1160.61|1240.11|953.93|1033.42|1192.41|1351.40|1411.81|1399.09|1192.41|1351.40| 196.25 | 1,411.81 | 1,081.12 48100175|HC THROMBECT CORONARY|0481|92973|22,841.79|13,248.24|2954.97|2807.2215|||||||14847.16|15532.42|16674.51|16674.51|17816.60|13705.07|14847.16|17131.34|19415.52|20283.51|20100.78|17131.34|19415.52| 2,807.22 | 20,283.51 | 16,674.51 48100176|HC IVUS CORONARY|0481|92978|4,154.61|2,409.67|7749.36|7361.892|||||||2700.50|2825.13|3032.87|3032.87|3240.60|2492.77|2700.50|3115.96|3531.42|3689.29|3656.06|3115.96|3531.42| 2,492.77 | 7,749.36 | 3,115.96 48100177|HC IVUS CORONARY ADDT|0481|92979|1,124.93|652.46|||||||||731.20|764.95|821.20|821.20|877.45|674.96|731.20|843.70|956.19|998.94|989.94|843.70|956.19| 674.96 | 998.94 | 843.70 48100178|HC REPROGRAM & INTEROG SINGLE PAC|0481|93279|468.64|271.81|||37.15|37.15|19.70|20.10|20.10|20.49|304.62|318.68|342.11|342.11|365.54|281.18|304.62|351.48|398.34|416.15|412.40|351.48|398.34| 19.70 | 416.15 | 318.68 48100179|HC REPROGRAM & INTEROG DUAL PACER|0481|93280|468.64|271.81|||37.15|37.15|19.70|20.10|20.10|20.49|304.62|318.68|342.11|342.11|365.54|281.18|304.62|351.48|398.34|416.15|412.40|351.48|398.34| 19.70 | 416.15 | 318.68 48100180|HC REPROGRAM & INTEROG MULTI PACE|0481|93281|468.64|271.81|||37.15|37.15|19.70|20.10|20.10|20.49|304.62|318.68|342.11|342.11|365.54|281.18|304.62|351.48|398.34|416.15|412.40|351.48|398.34| 19.70 | 416.15 | 318.68 48100181|HC REPRGM (&INTEROG) SINGLE DEFIB|0481|93282|701.54|406.89|||37.15|37.15|33.38|34.04|34.04|34.71|456.00|477.05|512.12|512.12|547.20|420.92|456.00|526.16|596.31|622.97|617.36|526.16|596.31| 33.38 | 622.97 | 477.05 48100182|HC REPRGM (&INTEROG) DUAL DEFIB|0481|93283|701.54|406.89|||37.15|37.15|33.38|34.04|34.04|34.71|456.00|477.05|512.12|512.12|547.20|420.92|456.00|526.16|596.31|622.97|617.36|526.16|596.31| 33.38 | 622.97 | 477.05 48100183|HC REPROG (&INTEROG) MULTI DEFIB|0481|93284|701.54|406.89|||37.15|37.15|33.38|34.04|34.04|34.71|456.00|477.05|512.12|512.12|547.20|420.92|456.00|526.16|596.31|622.97|617.36|526.16|596.31| 33.38 | 622.97 | 477.05 48100184|HC LOOP RECORD PROG (INTERROG INC|0481|93285|165.50|95.99|||37.15|37.15|19.70|20.10|20.10|20.49|107.58|112.54|120.82|120.82|129.09|99.30|107.58|124.13|140.68|146.96|145.64|124.13|140.68| 19.70 | 146.96 | 112.54 48100185|HC INTERROG ONLY PACER (ALL TYPES|0481|93288|330.36|191.61|||37.15|37.15|19.7|20.1|20.1|20.49|214.73|224.64|241.16|241.16|257.68|198.22|214.73|247.77|280.81|293.36|290.72|247.77|280.81| 19.70 | 293.36 | 224.64 48100186|HC LOOP RECORDER INTERROGATION ON|0481|93291|110.18|63.90|||24.67|24.67|19.70|20.10|20.10|20.49|71.62|74.92|80.43|80.43|85.94|66.11|71.62|82.64|93.65|97.84|96.96|82.64|93.65| 19.70 | 97.84 | 74.92 48100187|HC RT HEART CATH ONLY|0481|93451|10,653.91|6,179.27|7311.94|6946.343|2899.02|2899.02|1,843.34|1,880.21|1,880.21|1,917.08|6925.04|7244.66|7777.35|7777.35|8310.05|6392.35|6925.04|7990.43|9055.82|9460.67|9375.44|7990.43|9055.82| 1,843.34 | 9,460.67 | 7,244.66 48100188|HC LT HEART CATH ONLY|0481|93452|13,806.94|8,008.03|11021.79|10470.7005|2899.02|2899.02|1,843.34|1,880.21|1,880.21|1,917.08|8974.51|9388.72|10079.07|10079.07|10769.41|8284.16|8974.51|10355.21|11735.90|12260.56|12150.11|10355.21|11735.90| 1,843.34 | 12,260.56 | 10,079.07 48100189|HC LT & RT HEART CATH NO CORS/GRA|0481|93453|24,459.63|14,186.59|11021.79|10470.7005|2899.02|2899.02|1,843.34|1,880.21|1,880.21|1,917.08|15898.76|16632.55|17855.53|17855.53|19078.51|14675.78|15898.76|18344.72|20790.69|21720.15|21524.47|18344.72|20790.69| 1,843.34 | 21,720.15 | 15,898.76 48100190|HC CORONARY CATH ONLY|0481|93454|13,515.22|7,838.83|7311.94|6946.343|2899.02|2899.02|1,843.34|1,880.21|1,880.21|1,917.08|8784.89|9190.35|9866.11|9866.11|10541.87|8109.13|8784.89|10136.42|11487.94|12001.52|11893.39|10136.42|11487.94| 1,843.34 | 12,001.52 | 8,784.89 48100191|HC CORONARY CATH & GRAFTS ONLY|0481|93455|15,652.07|9,078.20|7311.94|6946.343|2899.02|2899.02|1,843.34|1,880.21|1,880.21|1,917.08|10173.85|10643.41|11426.01|11426.01|12208.61|9391.24|10173.85|11739.05|13304.26|13899.04|13773.82|11739.05|13304.26| 1,843.34 | 13,899.04 | 10,173.85 48100192|HC RT HEART CATH & CORS (NO LV)|0481|93456|24,169.13|14,018.10|7311.94|6946.343|2,899.02|2,899.02|1,843.34|1,880.21|1,880.21|1,917.08|15709.93|16435.01|17643.46|17643.46|18851.92|14501.48|15709.93|18126.85|20543.76|21462.19|21268.83|18126.85|20543.76| 1,843.34 | 21,462.19 | 15,709.93 48100193|HC RT HRT CATH & CORS/GRAFTS-NO L|0481|93457|26,306.00|15,257.48|7311.94|6946.343|2,899.02|2,899.02|1,843.34|1,880.21|1,880.21|1,917.08|17098.90|17888.08|19203.38|19203.38|20518.68|15783.60|17098.90|19729.50|22360.10|23359.73|23149.28|19729.50|22360.10| 1,843.34 | 23,359.73 | 17,098.90 48100194|HC LT HEART CATH & CORS|0481|93458|15,207.20|8,820.18|11021.79|10470.7005|2,899.02|2,899.02|1,843.34|1,880.21|1,880.21|1,917.08|9884.68|10340.90|11101.26|11101.26|11861.62|9124.32|9884.68|11405.40|12926.12|13503.99|13382.34|11405.40|12926.12| 1,843.34 | 13,503.99 | 10,470.70 48100195|HC LT HEART CATH & CORS & GRAFTS|0481|93459|17,344.06|10,059.55|11021.79|10470.7005|2,899.02|2,899.02|1,843.34|1,880.21|1,880.21|1,917.08|11273.64|11793.96|12661.16|12661.16|13528.37|10406.44|11273.64|13008.05|14742.45|15401.53|15262.77|13008.05|14742.45| 1,843.34 | 15,401.53 | 11,273.64 48100196|HC COMPLETE CATH & CORS|0481|93460|18,955.82|10,994.38|11021.79|10470.7005|2899.02|2899.02|1,843.34|1,880.21|1,880.21|1,917.08|12321.28|12889.96|13837.75|13837.75|14785.54|11373.49|12321.28|14216.87|16112.45|16832.77|16681.12|14216.87|16112.45| 1,843.34 | 16,832.77 | 12,321.28 48100197|HC COMPLETE CATH & CORS & GRAFTS|0481|93461|22,466.21|13,030.40|11021.79|10470.7005|2899.02|2899.02|1,843.34|1,880.21|1,880.21|1,917.08|14603.04|15277.02|16400.33|16400.33|17523.64|13479.73|14603.04|16849.66|19096.28|19949.99|19770.26|16849.66|19096.28| 1,843.34 | 19,949.99 | 14,603.04 48100198|HC L HRT TRNSPTL PUNCTURE|0481|93462|8,611.86|4,994.88|11021.79|10470.7005|||1,843.34|1,880.21|1,880.21|1,917.08|5597.71|5856.06|6286.66|6286.66|6717.25|5167.12|5597.71|6458.90|7320.08|7647.33|7578.44|6458.90|7320.08| 1,843.34 | 11,021.79 | 6,286.66 48100199|HC MED ADMIN (NITRIC OXIDE ETC)|0481|93463|604.47|350.59|||||||||392.91|411.04|441.26|441.26|471.49|362.68|392.91|453.35|513.80|536.77|531.93|453.35|513.80| 362.68 | 536.77 | 453.35 48100200|HC RHC & RETROGR LHC CONGENITAL|0481|93531|15,400.80|8,932.46|9379.3|8910.335|2899.02|2899.02|245.31|250.22|250.22|255.12|10010.52|10472.54|11242.58|11242.58|12012.62|9240.48|10010.52|11550.60|13090.68|13675.91|13552.70|11550.60|13090.68| 245.31 | 13,675.91 | 10,010.52 48100200|HC RHC & RETROGR LHC CONGENITAL|0481|93531|15,400.80|8,932.46|9379.3|8910.335|2899.02|2899.02|1,079.36|1,100.95|1,100.95|1,122.54|10010.52|10472.54|11242.58|11242.58|12012.62|9240.48|10010.52|11550.60|13090.68|13675.91|13552.70|11550.60|13090.68| 1,079.36 | 13,675.91 | 10,010.52 48100200|HC RHC & RETROGR LHC CONGENITAL|0481|93531|15,400.80|8,932.46|9379.3|8910.335|2899.02|2899.02|245.31|250.22|250.22|255.12|10010.52|10472.54|11242.58|11242.58|12012.62|9240.48|10010.52|11550.60|13090.68|13675.91|13552.70|11550.60|13090.68| 245.31 | 13,675.91 | 10,010.52 48100200|HC RHC & RETROGR LHC CONGENITAL|0481|93531|15,400.80|8,932.46|9379.3|8910.335|2899.02|2899.02|1,079.36|1,100.95|1,100.95|1,122.54|10010.52|10472.54|11242.58|11242.58|12012.62|9240.48|10010.52|11550.60|13090.68|13675.91|13552.70|11550.60|13090.68| 1,079.36 | 13,675.91 | 10,010.52 48100201|HC INJECT CORS CONGENITAL CARD CA|0481|93563|3,415.32|1,980.89|||||||||2219.96|2322.42|2493.18|2493.18|2663.95|2049.19|2219.96|2561.49|2903.02|3032.80|3005.48|2561.49|2903.02| 2,049.19 | 3,032.80 | 2,561.49 48100202|HC INJECT L. VENTR/ATRIAL ANGIO|0481|93565|2,585.75|1,499.74|||||||||1680.74|1758.31|1887.60|1887.60|2016.89|1551.45|1680.74|1939.31|2197.89|2296.15|2275.46|1939.31|2197.89| 1,551.45 | 2,296.15 | 1,939.31 48100203|HC RT VENTRICLE/ATRIAL INJ|0481|93566|5,064.08|2,937.17|||||||||3291.65|3443.57|3696.78|3696.78|3949.98|3038.45|3291.65|3798.06|4304.47|4496.90|4456.39|3798.06|4304.47| 3,038.45 | 4,496.90 | 3,798.06 48100204|HC AORTA (ARCH/DESCENDING THORACI|0481|93567|2,204.64|1,278.69|||||||||1433.02|1499.16|1609.39|1609.39|1719.62|1322.78|1433.02|1653.48|1873.94|1957.72|1940.08|1653.48|1873.94| 1,322.78 | 1,957.72 | 1,653.48 48100205|HC PRES MEASURE/DOPPLER-INITIAL|0481|93571|4,070.72|2,361.02|1932.65|1836.0175|||14.6|14.89|14.89|15.18|2645.97|2768.09|2971.63|2971.63|3175.16|2442.43|2645.97|3053.04|3460.11|3614.80|3582.23|3053.04|3460.11| 14.60 | 3,614.80 | 2,768.09 48100205|HC PRES MEASURE/DOPPLER-INITIAL|0481|93571|4,070.72|2,361.02|1932.65|1836.0175|||14.6|14.89|14.89|15.18|2645.97|2768.09|2971.63|2971.63|3175.16|2442.43|2645.97|3053.04|3460.11|3614.80|3582.23|3053.04|3460.11| 14.60 | 3,614.80 | 2,768.09 48100205|HC PRES MEASURE/DOPPLER-INITIAL|0481|93571|4,070.72|2,361.02|1,932.65|1,836.02|||523.33|533.79|533.79|544.26|2645.97|2768.09|2971.63|2971.63|3175.16|2442.43|2645.97|3053.04|3460.11|3614.80|3582.23|3053.04|3460.11| 523.33 | 3,614.80 | 2,768.09 48100205|HC PRES MEASURE/DOPPLER-INITIAL|0481|93571|4,070.72|2,361.02|1,932.65|1,836.02|||523.33|533.79|533.79|544.26|2645.97|2768.09|2971.63|2971.63|3175.16|2442.43|2645.97|3053.04|3460.11|3614.80|3582.23|3053.04|3460.11| 523.33 | 3,614.80 | 2,768.09 48100206|HC PRES MEASURE/DOPPLER-ADDTL|0481|93572|201.27|116.74|817.82|776.93|||523.33|533.79|533.79|544.26|130.83|136.86|146.93|146.93|156.99|120.76|130.83|150.95|171.08|178.73|177.12|150.95|171.08| 120.76 | 817.82 | 171.08 48100206|HC PRES MEASURE/DOPPLER-ADDTL|0481|93572|201.27|116.74|817.82|776.93|||523.33|533.79|533.79|544.26|130.83|136.86|146.93|146.93|156.99|120.76|130.83|150.95|171.08|178.73|177.12|150.95|171.08| 120.76 | 817.82 | 171.08 48100206|HC PRES MEASURE/DOPPLER-ADDTL|0481|93572|201.27|116.74|817.82|776.93|||14.60|14.89|14.89|15.18|130.83|136.86|146.93|146.93|156.99|120.76|130.83|150.95|171.08|178.73|177.12|150.95|171.08| 14.60 | 817.82 | 146.93 48100206|HC PRES MEASURE/DOPPLER-ADDTL|0481|93572|201.27|116.74|817.82|776.93|||14.60|14.89|14.89|15.18|130.83|136.86|146.93|146.93|156.99|120.76|130.83|150.95|171.08|178.73|177.12|150.95|171.08| 14.60 | 817.82 | 146.93 48100207|HC TRANSCATH CLOSURE OF ASD/PFO|0481|93580|20,099.85|11,657.91|||16,064.00|16,064.00|||||13064.90|13667.90|14672.89|14672.89|15677.88|12059.91|13064.90|15074.89|17084.87|17848.67|17687.87|15074.89|17084.87| 12,059.91 | 17,848.67 | 15,074.89 48100208|HC BUNDLE HIS RECORDING|0481|93600|1,933.52|1,121.44|||6078.48|6078.48|359.79|366.98|366.98|374.18|1256.79|1314.79|1411.47|1411.47|1508.15|1160.11|1256.79|1450.14|1643.49|1716.97|1701.50|1450.14|1643.49| 359.79 | 6,078.48 | 1,411.47 48100209|HC EP-MAPPING TACHYCARDIA|0481|93609|9,242.71|5,360.77|||||137.37|140.12|140.12|142.87|6007.76|6285.04|6747.18|6747.18|7209.31|5545.63|6007.76|6932.03|7856.30|8207.53|8133.58|6932.03|7856.30| 137.37 | 8,207.53 | 6,747.18 48100209|HC EP-MAPPING TACHYCARDIA|0481|93609|9,242.71|5,360.77|||||137.37|140.12|140.12|142.87|6007.76|6285.04|6747.18|6747.18|7209.31|5545.63|6007.76|6932.03|7856.30|8207.53|8133.58|6932.03|7856.30| 137.37 | 8,207.53 | 6,747.18 48100209|HC EP-MAPPING TACHYCARDIA|0481|93609|9,242.71|5,360.77|||||1308.32|1334.49|1334.49|1360.65|6007.76|6285.04|6747.18|6747.18|7209.31|5545.63|6007.76|6932.03|7856.30|8207.53|8133.58|6932.03|7856.30| 1,308.32 | 8,207.53 | 6,747.18 48100209|HC EP-MAPPING TACHYCARDIA|0481|93609|9,242.71|5,360.77|||||1308.32|1334.49|1334.49|1360.65|6007.76|6285.04|6747.18|6747.18|7209.31|5545.63|6007.76|6932.03|7856.30|8207.53|8133.58|6932.03|7856.30| 1,308.32 | 8,207.53 | 6,747.18 48100210|HC ELECTROPHYS MAP 3D ADD-ON|0481|93613|10,364.62|6,011.48|||||1308.32|1334.49|1334.49|1360.65|6737.00|7047.94|7566.17|7566.17|8084.40|6218.77|6737.00|7773.47|8809.93|9203.78|9120.87|7773.47|8809.93| 1,308.32 | 9,203.78 | 7,566.17 48100211|HC EP/COMP W/INDUCTION|0481|93620|13,588.14|7,881.12|||6078.48|6078.48|373.87|381.34|381.34|388.82|8832.29|9239.94|9919.34|9919.34|10598.75|8152.88|8832.29|10191.11|11549.92|12066.27|11957.56|10191.11|11549.92| 373.87 | 12,066.27 | 9,239.94 48100211|HC EP/COMP W/INDUCTION|0481|93620|13,588.14|7,881.12|||6,078.48|6,078.48|373.87|381.34|381.34|388.82|8832.29|9239.94|9919.34|9919.34|10598.75|8152.88|8832.29|10191.11|11549.92|12066.27|11957.56|10191.11|11549.92| 373.87 | 12,066.27 | 9,239.94 48100211|HC EP/COMP W/INDUCTION|0481|93620|13,588.14|7,881.12|||6,078.48|6,078.48|1,415.17|1,443.47|1,443.47|1,471.78|8832.29|9239.94|9919.34|9919.34|10598.75|8152.88|8832.29|10191.11|11549.92|12066.27|11957.56|10191.11|11549.92| 1,415.17 | 12,066.27 | 9,239.94 48100211|HC EP/COMP W/INDUCTION|0481|93620|13,588.14|7,881.12|||6,078.48|6,078.48|1,415.17|1,443.47|1,443.47|1,471.78|8832.29|9239.94|9919.34|9919.34|10598.75|8152.88|8832.29|10191.11|11549.92|12066.27|11957.56|10191.11|11549.92| 1,415.17 | 12,066.27 | 9,239.94 48100212|HC EP-COMP/LT ATRIAL RECORD/PC|0481|93621|14,020.87|8,132.10|||||1648.48|1681.45|1681.45|1714.42|9113.57|9534.19|10235.24|10235.24|10936.28|8412.52|9113.57|10515.65|11917.74|12450.53|12338.37|10515.65|11917.74| 1,648.48 | 12,450.53 | 10,235.24 48100212|HC EP-COMP/LT ATRIAL RECORD/PC|0481|93621|14,020.87|8,132.10|||||1648.48|1681.45|1681.45|1714.42|9113.57|9534.19|10235.24|10235.24|10936.28|8412.52|9113.57|10515.65|11917.74|12450.53|12338.37|10515.65|11917.74| 1,648.48 | 12,450.53 | 10,235.24 48100212|HC EP-COMP/LT ATRIAL RECORD/PC|0481|93621|14,020.87|8,132.10|||||824.24|840.73|840.73|857.21|9113.57|9534.19|10235.24|10235.24|10936.28|8412.52|9113.57|10515.65|11917.74|12450.53|12338.37|10515.65|11917.74| 824.24 | 12,450.53 | 10,235.24 48100212|HC EP-COMP/LT ATRIAL RECORD/PC|0481|93621|14,020.87|8,132.10|||||824.24|840.73|840.73|857.21|9113.57|9534.19|10235.24|10235.24|10936.28|8412.52|9113.57|10515.65|11917.74|12450.53|12338.37|10515.65|11917.74| 824.24 | 12,450.53 | 10,235.24 48100213|HC EP-COMP/LT VENT RECORD/PACE|0481|93622|12,641.27|7,331.94|||||824.24|840.73|840.73|857.21|8216.83|8596.06|9228.13|9228.13|9860.19|7584.76|8216.83|9480.95|10745.08|11225.45|11124.32|9480.95|10745.08| 824.24 | 11,225.45 | 9,228.13 48100213|HC EP-COMP/LT VENT RECORD/PACE|0481|93622|12,641.27|7,331.94|||||1648.48|1681.45|1681.45|1714.42|8216.83|8596.06|9228.13|9228.13|9860.19|7584.76|8216.83|9480.95|10745.08|11225.45|11124.32|9480.95|10745.08| 1,648.48 | 11,225.45 | 9,228.13 48100213|HC EP-COMP/LT VENT RECORD/PACE|0481|93622|12,641.27|7,331.94|||||1648.48|1681.45|1681.45|1714.42|8216.83|8596.06|9228.13|9228.13|9860.19|7584.76|8216.83|9480.95|10745.08|11225.45|11124.32|9480.95|10745.08| 1,648.48 | 11,225.45 | 9,228.13 48100213|HC EP-COMP/LT VENT RECORD/PACE|0481|93622|12,641.27|7,331.94|||||824.24|840.73|840.73|857.21|8216.83|8596.06|9228.13|9228.13|9860.19|7584.76|8216.83|9480.95|10745.08|11225.45|11124.32|9480.95|10745.08| 824.24 | 11,225.45 | 9,228.13 48100214|HC EP/REPEAT AFTER IV DRUGS|0481|93623|4,384.34|2,542.92|||||194.61|198.50|198.50|202.40|2849.82|2981.35|3200.57|3200.57|3419.79|2630.60|2849.82|3288.26|3726.69|3893.29|3858.22|3288.26|3726.69| 194.61 | 3,893.29 | 3,200.57 48100214|HC EP/REPEAT AFTER IV DRUGS|0481|93623|4,384.34|2,542.92|||||194.61|198.50|198.50|202.40|2849.82|2981.35|3200.57|3200.57|3419.79|2630.60|2849.82|3288.26|3726.69|3893.29|3858.22|3288.26|3726.69| 194.61 | 3,893.29 | 3,200.57 48100214|HC EP/REPEAT AFTER IV DRUGS|0481|93623|4,384.34|2,542.92|||||389.23|397.01|397.01|404.79|2849.82|2981.35|3200.57|3200.57|3419.79|2630.60|2849.82|3288.26|3726.69|3893.29|3858.22|3288.26|3726.69| 389.23 | 3,893.29 | 3,200.57 48100214|HC EP/REPEAT AFTER IV DRUGS|0481|93623|4,384.34|2,542.92|||||389.23|397.01|397.01|404.79|2849.82|2981.35|3200.57|3200.57|3419.79|2630.60|2849.82|3288.26|3726.69|3893.29|3858.22|3288.26|3726.69| 389.23 | 3,893.29 | 3,200.57 48100215|HC EP/EVAL DEVICE/LEAD|0481|93641|7,114.36|4,126.33|||||||||4624.33|4837.76|5193.48|5193.48|5549.20|4268.62|4624.33|5335.77|6047.21|6317.55|6260.64|5335.77|6047.21| 4,268.62 | 6,317.55 | 5,335.77 48100216|HC EPS-THRU DEVICE/DEFIB|0481|93642|7,114.36|4,126.33|||1,112.78|1,112.78|||||4624.33|4837.76|5193.48|5193.48|5549.20|4268.62|4624.33|5335.77|6047.21|6317.55|6260.64|5335.77|6047.21| 1,112.78 | 6,317.55 | 5,193.48 48100217|HC EP-ABLATION A-V NODE|0481|93650|10,156.77|5,890.93|2291.04|2176.488|6,078.48|6,078.48|1,046.66|1,067.59|1,067.59|1,088.52|6601.90|6906.60|7414.44|7414.44|7922.28|6094.06|6601.90|7617.58|8633.25|9019.21|8937.96|7617.58|8633.25| 1,046.66 | 9,019.21 | 6,601.90 48100218|HC SVT ABLATION INCL COMP EP STUD|0481|93653|20,749.91|12,034.95|35,595.85|33,816.06|21,464.41|21,464.41|9,478.41|9,667.98|9,667.98|9,857.55|13487.44|14109.94|15147.43|15147.43|16184.93|12449.95|13487.44|15562.43|17637.42|18425.92|18259.92|15562.43|17637.42| 9,478.41 | 35,595.85 | 15,562.43 48100219|HC VT ABLATION INCL COMP EP STUDY|0481|93654|39,762.85|23,062.45|35552.4|33774.78|21464.41|21464.41|9478.41|9667.98|9667.98|9857.55|25845.85|27038.74|29026.88|29026.88|31015.02|23857.71|25845.85|29822.14|33798.42|35309.41|34991.31|29822.14|33798.42| 9,478.41 | 35,552.40 | 29,026.88 48100220|HC ADDTL ABLATION SITE|0481|93655|7,699.02|4,465.43|2291.04|2176.488|||242.63|247.48|247.48|252.33|5004.36|5235.33|5620.28|5620.28|6005.24|4619.41|5004.36|5774.27|6544.17|6836.73|6775.14|5774.27|6544.17| 242.63 | 6,836.73 | 5,235.33 48100221|HC TX ATRIAL FIB PULM VEIN ISOL|0481|93656|46,287.70|26,846.87|57741.44|54854.368|21,464.41|21,464.41|9478.41|9667.98|9667.98|9857.55|30087.01|31475.64|33790.02|33790.02|36104.41|27772.62|30087.01|34715.78|39344.55|41103.48|40733.18|34715.78|39344.55| 9,478.41 | 57,741.44 | 33,790.02 48100222|HC TX L/R ATRIAL FIB ADDL|0481|93657|9,882.08|5,731.61|69614.87|66134.1265|||330.73|337.34|337.34|343.96|6423.35|6719.81|7213.92|7213.92|7708.02|5929.25|6423.35|7411.56|8399.77|8775.29|8696.23|7411.56|8399.77| 330.73 | 69,614.87 | 7,213.92 48100223|HC TILT TABLE TEST|0481|93660|2,020.18|1,171.70|||487.78|487.78|||||1313.12|1373.72|1474.73|1474.73|1575.74|1212.11|1313.12|1515.14|1717.15|1793.92|1777.76|1515.14|1717.15| 487.78 | 1,793.92 | 1,474.73 48100224|HC INTRACARDIAC ECG AT OP|0481|93662|5,766.36|3,344.49|||||||||3748.13|3921.12|4209.44|4209.44|4497.76|3459.82|3748.13|4324.77|4901.41|5120.53|5074.40|4324.77|4901.41| 3,459.82 | 5,120.53 | 4,324.77 48100225|HC PERQ SACRAL AUGMT BILAT INJ(S)|0481|0201T|12,228.00|7,092.24|||6264.95|6264.95|||||7948.20|8315.04|8926.44|8926.44|9537.84|7336.80|7948.20|9171.00|10393.80|10858.46|10760.64|9171.00|10393.80| 6,264.95 | 10,858.46 | 8,926.44 48100226|HC PERC DRUG-EL COR STENT SING|0481|C9600|39,621.86|22,980.68|50,953.75|48,406.06|10,042.94|10,042.94|||||25754.21|26942.86|28923.96|28923.96|30905.05|23773.12|25754.21|29716.40|33678.58|35184.21|34867.24|29716.40|33678.58| 10,042.94 | 50,953.75 | 29,716.40 48100227|HC PERC DRUG-EL COR STENT BRAN|0481|C9601|22,985.22|13,331.43|15,847.78|15,055.39|||||||14940.39|15629.95|16779.21|16779.21|17928.47|13791.13|14940.39|17238.92|19537.44|20410.88|20226.99|17238.92|19537.44| 13,791.13 | 20,410.88 | 16,779.21 48100228|HC PERC D-E COR STENT ATHER S|0481|C9602|64,021.93|37,132.72|15847.78|15055.391|16064|16064|||||41614.25|43534.91|46736.01|46736.01|49937.11|38413.16|41614.25|48016.45|54418.64|56851.47|56339.30|48016.45|54418.64| 15,055.39 | 56,851.47 | 46,736.01 48100229|HC PERC D-E COR REVASC T CABG S|0481|C9604|60,546.80|35,117.14|15847.78|15055.391|10,042.94|10,042.94|||||39355.42|41171.82|44199.16|44199.16|47226.50|36328.08|39355.42|45410.10|51464.78|53765.56|53281.18|45410.10|51464.78| 10,042.94 | 53,765.56 | 44,199.16 48100230|HC PERC D-E COR REVASC W AMI S|0481|C9606|51,767.19|30,024.97|15847.78|15055.391|||||||33648.67|35201.69|37790.05|37790.05|40378.41|31060.31|33648.67|38825.39|44002.11|45969.26|45555.13|38825.39|44002.11| 15,055.39 | 45,969.26 | 37,790.05 48100231|HC NEEDLE ASPIR ABSCESS,CYST,HEMA|0481|10160|3,424.08|1,985.97|437.4|415.53|345.84|345.84|255.12|260.22|260.22|265.33|2225.65|2328.37|2499.58|2499.58|2670.78|2054.45|2225.65|2568.06|2910.47|3040.58|3013.19|2568.06|2910.47| 255.12 | 3,040.58 | 2,225.65 48100232|HC TX S WND DEHISC; SMPL|0481|12020|2,663.18|1,544.64|304.90|289.66|524.17|524.17|423.9|432.37|432.37|440.85|1731.07|1810.96|1944.12|1944.12|2077.28|1597.91|1731.07|1997.39|2263.70|2364.90|2343.60|1997.39|2263.70| 289.66 | 2,364.90 | 1,731.07 48100233|HC BX BONE DEEP|0481|20225|4,311.41|2,500.62|1,141.26|1,084.20|1,407.00|1,407.00|294.37|300.26|300.26|306.15|2802.42|2931.76|3147.33|3147.33|3362.90|2586.85|2802.42|3233.56|3664.70|3828.53|3794.04|3233.56|3664.70| 294.37 | 3,828.53 | 2,802.42 48100234|HC PERQ CERVICOTHORACIC INJECT VERT|0481|22510|13,303.71|7,716.15|||2830.4|2830.4|||||8647.41|9046.52|9711.71|9711.71|10376.89|7982.23|8647.41|9977.78|11308.15|11813.69|11707.26|9977.78|11308.15| 2,830.40 | 11,813.69 | 9,711.71 48100235|HC PERQ LUMBOSACRAL INJECTION VERT|0481|22511|13,303.71|7,716.15|||2830.4|2830.4|||||8647.41|9046.52|9711.71|9711.71|10376.89|7982.23|8647.41|9977.78|11308.15|11813.69|11707.26|9977.78|11308.15| 2,830.40 | 11,813.69 | 9,711.71 48100236|HC VERTEBROPLASTY ADDL INJECT|0481|22512|11,724.78|6,800.37|||||||||7621.11|7972.85|8559.09|8559.09|9145.33|7034.87|7621.11|8793.59|9966.06|10411.60|10317.81|8793.59|9966.06| 7,034.87 | 10,411.60 | 8,793.59 48100237|HC PERQ VERTEBRAL AUGMENTATION THOR|0481|22513|17,718.21|10,276.56|||6264.95|6264.95|||||11516.84|12048.38|12934.29|12934.29|13820.20|10630.93|11516.84|13288.66|15060.48|15733.77|15592.02|13288.66|15060.48| 6,264.95 | 15,733.77 | 12,934.29 48100238|HC PERQ VERTEBRAL AUGMENTATION LUMB|0481|22514|17,718.21|10,276.56|||6264.95|6264.95|||||11516.84|12048.38|12934.29|12934.29|13820.20|10630.93|11516.84|13288.66|15060.48|15733.77|15592.02|13288.66|15060.48| 6,264.95 | 15,733.77 | 12,934.29 48100239|HC PERQ VERTEBRAL AUGMENTATION ADDL|0481|22515|17,718.21|10,276.56|||||||||11516.84|12048.38|12934.29|12934.29|13820.20|10630.93|11516.84|13288.66|15060.48|15733.77|15592.02|13288.66|15060.48| 10,630.93 | 15,733.77 | 13,288.66 48100240|HC INSERT VAD ARTERY ACCESS|0481|33990|3,114.13|1,806.20|||||||||2024.18|2117.61|2273.31|2273.31|2429.02|1868.48|2024.18|2335.60|2647.01|2765.35|2740.43|2335.60|2647.01| 1,868.48 | 2,765.35 | 2,335.60 48100241|HC ENDOGRAFT, UNIBODY BIFURCATED|0481|34804|31,866.92|18,482.81|||||1,046.66|1,067.59|1,067.59|1,088.52|20713.50|21669.51|23262.85|23262.85|24856.20|19120.15|20713.50|23900.19|27086.88|28297.82|28042.89|23900.19|27086.88| 1,046.66 | 28,297.82 | 23,262.85 48100242|HC PTA AORTA 35472|0481|35472|16,642.54|9,652.67|||||1,046.66|1,067.59|1,067.59|1,088.52|10817.65|11316.93|12149.05|12149.05|12981.18|9985.52|10817.65|12481.91|14146.16|14778.58|14645.44|12481.91|14146.16| 1,046.66 | 14,778.58 | 12,149.05 48100243|HC ART CATH THO/BRACH ADD-36218|0481|36218|3,160.32|1,832.99|||||850.41|867.42|867.42|884.42|2054.21|2149.02|2307.03|2307.03|2465.05|1896.19|2054.21|2370.24|2686.27|2806.36|2781.08|2370.24|2686.27| 850.41 | 2,806.36 | 2,307.03 48100244|HC PLACE CATH THORACIC AORTA|0481|36221|9,899.37|5,741.63|930.38|883.86|2,861.66|2,861.66|1,887.75|1,925.50|1,925.50|1,963.26|6434.59|6731.57|7226.54|7226.54|7721.51|5939.62|6434.59|7424.53|8414.46|8790.64|8711.45|7424.53|8414.46| 883.86 | 8,790.64 | 6,434.59 48100245|HC CV ACCESS NON-TUNNELED < 5 YRS|0481|36555|1,377.43|798.91|1863.61|1770.4295|2,861.66|2,861.66|480.81|490.42|490.42|500.04|895.33|936.65|1005.52|1005.52|1074.40|826.46|895.33|1033.07|1170.82|1223.16|1212.14|1033.07|1170.82| 480.81 | 2,861.66 | 1,033.07 48100246|HC CV ACCESS, TUNNELED <5YRS|0481|36557|9,156.41|5,310.72|1,863.61|1,770.43|4,770.37|4,770.37|480.81|490.42|490.42|500.04|5951.67|6226.36|6684.18|6684.18|7142.00|5493.85|5951.67|6867.31|7782.95|8130.89|8057.64|6867.31|7782.95| 480.81 | 8,130.89 | 5,951.67 48100247|HC REPLACE, COMP TUNNEL W/ PORT|0481|36582|7,103.42|4,119.98|1863.61|1770.4295|2,861.66|2,861.66|1,189.85|1,213.65|1,213.65|1,237.45|4617.22|4830.33|5185.50|5185.50|5540.67|4262.05|4617.22|5327.57|6037.91|6307.84|6251.01|5327.57|6037.91| 1,189.85 | 6,307.84 | 4,617.22 48100248|HC TRANSCATHETER BIOPSY|0481|37200|4,894.85|2,839.01|||4,770.37|4,770.37|300.91|306.93|306.93|312.95|3181.65|3328.50|3573.24|3573.24|3817.98|2936.91|3181.65|3671.14|4160.62|4346.63|4307.47|3671.14|4160.62| 300.91 | 4,770.37 | 3,573.24 48100250|HC STENT/ATHERECTOMY/PTA/REVA T-P|0481|37231|45,508.26|26,394.79|7,729.40|7,342.93|16064|16064|9,395.53|9,583.44|9,583.44|9,771.35|29580.37|30945.62|33221.03|33221.03|35496.44|27304.96|29580.37|34131.20|38682.02|40411.33|40047.27|34131.20|38682.02| 7,342.93 | 40,411.33 | 29,580.37 48100251|HC IVUS NON-COR ADDT-37251|0481|37251|2,380.11|1,380.46|||||||||1547.07|1618.47|1737.48|1737.48|1856.49|1428.07|1547.07|1785.08|2023.09|2113.54|2094.50|1785.08|2023.09| 1,428.07 | 2,113.54 | 1,785.08 48100252|HC REV/REINS BILIARY CATH-47530|0481|47530|1,986.38|1,152.10|||||||||1291.15|1350.74|1450.06|1450.06|1549.38|1191.83|1291.15|1489.79|1688.42|1763.91|1748.01|1489.79|1688.42| 1,191.83 | 1,763.91 | 1,489.79 48100253|HC BI CATHETER INJECTION|0481|49465|1,289.65|748.00|||230.13|230.13|||||838.27|876.96|941.44|941.44|1005.93|773.79|838.27|967.24|1096.20|1145.21|1134.89|967.24|1096.20| 230.13 | 1,145.21 | 941.44 48100255|HC PER REMOVAL URETERAL STENT|0481|50384|3,836.56|2,225.20|||1,792.99|1,792.99|1492.06|1521.9|1521.9|1551.74|2493.76|2608.86|2800.69|2800.69|2992.52|2301.94|2493.76|2877.42|3261.08|3406.87|3376.17|2877.42|3261.08| 1,492.06 | 3,406.87 | 2,608.86 48100256|HC PERC REPL EXT/INT URETERAL STE|0481|50387|3,836.56|2,225.20|||1,792.99|1,792.99|746.1|761.02|761.02|775.94|2493.76|2608.86|2800.69|2800.69|2992.52|2301.94|2493.76|2877.42|3261.08|3406.87|3376.17|2877.42|3261.08| 746.10 | 3,406.87 | 2,608.86 48100257|HC PERC REMOVE NEPH TUBE W/FLUORO|0481|50389|3,084.96|1,789.28|||574.77|574.77|509.43|519.62|519.62|529.81|2005.22|2097.77|2252.02|2252.02|2406.27|1850.98|2005.22|2313.72|2622.22|2739.44|2714.76|2313.72|2622.22| 509.43 | 2,739.44 | 2,097.77 48100258|HC NEPHROSTOGRAM 50394|0481|50394|3,425.55|1,986.82|||||392.50|400.35|400.35|408.20|2226.61|2329.37|2500.65|2500.65|2671.93|2055.33|2226.61|2569.16|2911.72|3041.89|3014.48|2569.16|2911.72| 392.50 | 3,041.89 | 2,500.65 48100259|HC PRQ CARD STENT/ATH/ANGIO|0481|92933|64,021.93|37,132.72|11013.51|10462.8345|16,064.00|16,064.00|5196.37|5300.3|5300.3|5404.23|41614.25|43534.91|46736.01|46736.01|49937.11|38413.16|41614.25|48016.45|54418.64|56851.47|56339.30|48016.45|54418.64| 5,196.37 | 56,851.47 | 41,614.25 48100261|HC PRQ CARD REVASC CHRONIC ADDL|0481|92944|31,150.99|18,067.57|28,934.11|27,487.40|||5,196.37|5,300.30|5,300.30|5,404.23|20248.14|21182.67|22740.22|22740.22|24297.77|18690.59|20248.14|23363.24|26478.34|27662.08|27412.87|23363.24|26478.34| 5,196.37 | 28,934.11 | 22,740.22 48100262|HC INTRACARDIAC ECG AT OP (ICE)|0481|93662|4,851.86|2,814.08|||||||||3153.71|3299.26|3541.86|3541.86|3784.45|2911.12|3153.71|3638.90|4124.08|4308.45|4269.64|3638.90|4124.08| 2,911.12 | 4,308.45 | 3,638.90 48100263|HC THRU DEVICE/PACER|0481|93724|6,807.95|3,948.61|||272.47|272.47|10.14|10.34|10.34|10.55|4425.17|4629.41|4969.80|4969.80|5310.20|4084.77|4425.17|5105.96|5786.76|6045.46|5991.00|5105.96|5786.76| 10.14 | 6,045.46 | 4,629.41 48100263|HC THRU DEVICE/PACER|0481|93724|6,807.95|3,948.61|||272.47|272.47|20.28|20.68|20.68|21.09|4425.17|4629.41|4969.80|4969.80|5310.20|4084.77|4425.17|5105.96|5786.76|6045.46|5991.00|5105.96|5786.76| 20.28 | 6,045.46 | 4,629.41 48100265|HC ATHERECTOMY ILIAC|0481|0238T|19,191.36|11,130.99|||16064|16064|||||12474.38|13050.12|14009.69|14009.69|14969.26|11514.82|12474.38|14393.52|16312.66|17041.93|16888.40|14393.52|16312.66| 11,514.82 | 17,041.93 | 14,393.52 48100266|HC PERC D-E COR STENT ATHER BR|0481|C9603|42,434.98|24,612.29|15,847.78|15,055.39|||||||27582.74|28855.79|30977.54|30977.54|33099.28|25460.99|27582.74|31826.24|36069.73|37682.26|37342.78|31826.24|36069.73| 15,055.39 | 37,682.26 | 30,977.54 48100267|HC PERC D-E COR REVASC CHRO SIN|0481|C9607|49,300.93|28,594.54|15,847.78|15,055.39|16,064.00|16,064.00|||||32045.60|33524.63|35989.68|35989.68|38454.73|29580.56|32045.60|36975.70|41905.79|43779.23|43384.82|36975.70|41905.79| 15,055.39 | 43,779.23 | 35,989.68 48100268|HC PERC D-E COR REVASC CHRO ADD|0481|C9608|31,150.99|18,067.57|15,847.78|15,055.39|||||||20248.14|21182.67|22740.22|22740.22|24297.77|18690.59|20248.14|23363.24|26478.34|27662.08|27412.87|23363.24|26478.34| 15,055.39 | 27,662.08 | 22,740.22 48100269|HC ILIAC ANGIOGRAPHY, SAME TIME A|0481|G0278|7,161.77|4,153.83|||||||||4655.15|4870.00|5228.09|5228.09|5586.18|4297.06|4655.15|5371.33|6087.50|6359.65|6302.36|5371.33|6087.50| 4,297.06 | 6,359.65 | 5,371.33 48100270|HC STENT PLACEMT ANTE CAROTID|0481|37218|17,991.93|10,435.32|||||||||11694.75|12234.51|13134.11|13134.11|14033.71|10795.16|11694.75|13493.95|15293.14|15976.83|15832.90|13493.95|15293.14| 10,795.16 | 15,976.83 | 13,493.95 48100271|HC PERQ STENT/CHEST VERT ART|0481|0075T|17,991.93|10,435.32|||||||||11694.75|12234.51|13134.11|13134.11|14033.71|10795.16|11694.75|13493.95|15293.14|15976.83|15832.90|13493.95|15293.14| 10,795.16 | 15,976.83 | 13,493.95 48100272|HC S&I STENT/CHEST VERT ART|0481|0076T|18,891.53|10,957.09|||||||||12279.49|12846.24|13790.82|13790.82|14735.39|11334.92|12279.49|14168.65|16057.80|16775.68|16624.55|14168.65|16057.80| 11,334.92 | 16,775.68 | 14,168.65 48100273|HC PERQ SACRAL AUGMT UNILAT INJ(S)|0481|0200T|12,226.96|7,091.64|||6,264.95|6,264.95|||||7947.52|8314.33|8925.68|8925.68|9537.03|7336.18|7947.52|9170.22|10392.92|10857.54|10759.72|9170.22|10392.92| 6,264.95 | 10,857.54 | 8,925.68 48100274|HC PRQ CARD ANGIO/ATHRECT 1 ART|0481|92924|45,766.25|26,544.43|2954.97|2807.2215|10042.94|10042.94|6523.64|6654.11|6654.11|6784.58|29748.06|31121.05|33409.36|33409.36|35697.68|27459.75|29748.06|34324.69|38901.31|40640.43|40274.30|34324.69|38901.31| 2,807.22 | 40,640.43 | 29,748.06 48100275|HC PRQ CARD ANGIO/ATHRECT ADDL|0481|92925|35,362.50|20,510.25|7729.4|7342.93|||6523.64|6654.11|6654.11|6784.58|22985.63|24046.50|25814.63|25814.63|27582.75|21217.50|22985.63|26521.88|30058.13|31401.90|31119.00|26521.88|30058.13| 6,523.64 | 31,401.90 | 24,046.50 48100276|HC PRQ CARD STENT/ATH/ANGIO|0481|92934|42,434.98|24,612.29|11013.51|10462.8345|||5196.37|5300.3|5300.3|5404.23|27582.74|28855.79|30977.54|30977.54|33099.28|25460.99|27582.74|31826.24|36069.73|37682.26|37342.78|31826.24|36069.73| 5,196.37 | 37,682.26 | 28,855.79 48100277|HC REMOVAL DEFIB ONLY|0481|33241|3,481.21|2,019.10|||3440.37|3440.37|||||2262.79|2367.22|2541.28|2541.28|2715.34|2088.73|2262.79|2610.91|2959.03|3091.31|3063.46|2610.91|2959.03| 2,088.73 | 3,440.37 | 2,610.91 48100278|HC REPAIR LEAD PACE-DEFIB ONE|0481|33218|6,144.02|3,563.53|2,291.04|2,176.49|3440.37|3440.37|4,111.09|4,193.32|4,193.32|4,275.54|3993.61|4177.93|4485.13|4485.13|4792.34|3686.41|3993.61|4608.02|5222.42|5455.89|5406.74|4608.02|5222.42| 2,176.49 | 5,455.89 | 4,193.32 48100279|HC PB VALVULOPLASTY; AORTIC VALVE|0481|92986|11,062.80|6,416.42|||4956.84|4956.84|1,079.36|1,100.95|1,100.95|1,122.54|7190.82|7522.70|8075.84|8075.84|8628.98|6637.68|7190.82|8297.10|9403.38|9823.77|9735.26|8297.10|9403.38| 1,079.36 | 9,823.77 | 7,522.70 48100280|HC I&D HEMATOMA SEROMA FLUID COLL|0481|10140|4,566.54|2,648.59|437.40|415.53|1,407.00|1,407.00|255.12|260.22|260.22|265.33|2968.25|3105.25|3333.57|3333.57|3561.90|2739.92|2968.25|3424.91|3881.56|4055.09|4018.56|3424.91|3881.56| 255.12 | 4,055.09 | 2,968.25 48100281|HC LYMPHANGIOGRAM PELVIC/ABD; BILAT|0481|75807|2,953.60|1,713.09|||2861.66|2861.66|228.96|233.54|233.54|238.11|1919.84|2008.45|2156.13|2156.13|2303.81|1772.16|1919.84|2215.20|2510.56|2622.80|2599.17|2215.20|2510.56| 228.96 | 2,861.66 | 2,156.13 48100281|HC LYMPHANGIOGRAM PELVIC/ABD; BILAT|0481|75807|2,953.60|1,713.09|||2861.66|2861.66|228.96|233.54|233.54|238.11|1919.84|2008.45|2156.13|2156.13|2303.81|1772.16|1919.84|2215.20|2510.56|2622.80|2599.17|2215.20|2510.56| 228.96 | 2,861.66 | 2,156.13 48100282|HC INJECTION FOR LYMPHANGIOGRAPHY|0481|38790|2,909.93|1,687.76|193.78|184.091|||196.25|200.17|200.17|204.1|1891.45|1978.75|2124.25|2124.25|2269.75|1745.96|1891.45|2182.45|2473.44|2584.02|2560.74|2182.45|2473.44| 184.09 | 2,584.02 | 1,978.75 48100283|HC CERVICAL ACCESS W/INJ FOR MYEL|0481|61055|1,737.69|1,007.86|||261.17|261.17|392.5|400.35|400.35|408.2|1129.50|1181.63|1268.51|1268.51|1355.40|1042.61|1129.50|1303.27|1477.04|1543.07|1529.17|1303.27|1477.04| 261.17 | 1,543.07 | 1,181.63 48100284|HC BILIARY STONE REMOVAL-47630|0481|47630|8,333.44|4,833.40|||||261.66|266.9|266.9|272.13|5416.74|5666.74|6083.41|6083.41|6500.08|5000.06|5416.74|6250.08|7083.42|7400.09|7333.43|6250.08|7083.42| 261.66 | 7,400.09 | 6,083.41 48100285|HC PERC D-E COR REVASC T CABG B|0481|C9605|39,512.47|22,917.23|15,847.78|15,055.39|||||||25683.11|26868.48|28844.10|28844.10|30819.73|23707.48|25683.11|29634.35|33585.60|35087.07|34770.97|29634.35|33585.60| 15,055.39 | 35,087.07 | 28,844.10 48100286|HC INTRA-ATRIAL RECORDING|0481|93602|1,933.52|1,121.44|||6078.48|6078.48|||||1256.79|1314.79|1411.47|1411.47|1508.15|1160.11|1256.79|1450.14|1643.49|1716.97|1701.50|1450.14|1643.49| 1,160.11 | 6,078.48 | 1,450.14 48100287|HC INTRA/RIGHT VENT RECORD|0481|93603|1,933.52|1,121.44|||1,112.78|1,112.78|||||1256.79|1314.79|1411.47|1411.47|1508.15|1160.11|1256.79|1450.14|1643.49|1716.97|1701.50|1450.14|1643.49| 1,112.78 | 1,716.97 | 1,411.47 48100288|HC INJECTION PSUEDOANEURYSM-THROM|0481|36002|4,465.90|2,590.22|393.23|373.5685|541.62|541.62|523.33|533.79|533.79|544.26|2902.84|3036.81|3260.11|3260.11|3483.40|2679.54|2902.84|3349.43|3796.02|3965.72|3929.99|3349.43|3796.02| 373.57 | 3,965.72 | 2,902.84 48100289|HC SAME LEAD REPOSITION|0481|33226|6,237.30|3,617.63|25194.3|23934.585|2,861.66|2,861.66|457.91|467.07|467.07|476.23|4054.25|4241.36|4553.23|4553.23|4865.09|3742.38|4054.25|4677.98|5301.71|5538.72|5488.82|4677.98|5301.71| 457.91 | 25,194.30 | 4,553.23 48100290|HC DRAIN BL W/CATH INSERTION|0481|51102|4,361.86|2,529.88|||1,792.99|1,792.99|||||2835.21|2966.06|3184.16|3184.16|3402.25|2617.12|2835.21|3271.40|3707.58|3873.33|3838.44|3271.40|3707.58| 1,792.99 | 3,873.33 | 3,184.16 48100291|HC INSERT GEN ONLY EXIST MULT LEA|0481|33221|5,613.96|3,256.10|25194.3|23934.585|18,611.26|18,611.26|6147.51|6270.46|6270.46|6393.41|3649.07|3817.49|4098.19|4098.19|4378.89|3368.38|3649.07|4210.47|4771.87|4985.20|4940.28|4210.47|4771.87| 3,368.38 | 25,194.30 | 4,771.87 48100292|HC FLOW DIRECT CATHETER PLACEMENT|0481|93503|9,869.15|5,724.11|7311.94|6946.343|1,406.14|1,406.14|1079.36|1100.95|1100.95|1122.54|6414.95|6711.02|7204.48|7204.48|7697.94|5921.49|6414.95|7401.86|8388.78|8763.81|8684.85|7401.86|8388.78| 1,079.36 | 8,763.81 | 6,946.34 48100293|HC REPOSITION VAD DIFF SESSION|0481|33993|1,373.33|796.53|||||||||892.66|933.86|1002.53|1002.53|1071.20|824.00|892.66|1030.00|1167.33|1219.52|1208.53|1030.00|1167.33| 824.00 | 1,219.52 | 1,030.00 48100294|HC INSERT PULSE GEN DUAL LEADS|0481|33213|5,122.09|2,970.81|25194.3|23934.585|10400.15|10400.15|6750.17|6885.18|6885.18|7020.18|3329.36|3483.02|3739.13|3739.13|3995.23|3073.25|3329.36|3841.57|4353.78|4548.42|4507.44|3841.57|4353.78| 3,073.25 | 25,194.30 | 4,353.78 48100295|HC IMPL PRESSURE SENSOR W/ANGIO|0481|C9741|35,645.85|20,674.59|||||||||23169.80|24239.18|26021.47|26021.47|27803.76|21387.51|23169.80|26734.39|30298.97|31653.51|31368.35|26734.39|30298.97| 21,387.51 | 31,653.51 | 26,734.39 48100296|HC ENDOMYOCARDIAL BX|0481|93505|3,669.61|2,128.37|7311.94|6946.343|2861.66|2861.66|201.34|205.36|205.36|209.39|2385.25|2495.33|2678.82|2678.82|2862.30|2201.77|2385.25|2752.21|3119.17|3258.61|3229.26|2752.21|3119.17| 201.34 | 7,311.94 | 2,752.21 48100296|HC ENDOMYOCARDIAL BX|0481|93505|3,669.61|2,128.37|7311.94|6946.343|2,861.66|2,861.66|201.34|205.36|205.36|209.39|2385.25|2495.33|2678.82|2678.82|2862.30|2201.77|2385.25|2752.21|3119.17|3258.61|3229.26|2752.21|3119.17| 201.34 | 7,311.94 | 2,752.21 48100296|HC ENDOMYOCARDIAL BX|0481|93505|3,669.61|2,128.37|7311.94|6946.343|2861.66|2861.66|402.66|410.71|410.71|418.77|2385.25|2495.33|2678.82|2678.82|2862.30|2201.77|2385.25|2752.21|3119.17|3258.61|3229.26|2752.21|3119.17| 402.66 | 7,311.94 | 2,752.21 48100296|HC ENDOMYOCARDIAL BX|0481|93505|3,669.61|2,128.37|7311.94|6946.343|2861.66|2861.66|402.66|410.71|410.71|418.77|2385.25|2495.33|2678.82|2678.82|2862.30|2201.77|2385.25|2752.21|3119.17|3258.61|3229.26|2752.21|3119.17| 402.66 | 7,311.94 | 2,752.21 48100297|HC INS/REP SUBQ DEFIBRILLATOR|0481|33270|8,738.27|5,068.20|||32838.89|32838.89|||||5679.88|5942.02|6378.94|6378.94|6815.85|5242.96|5679.88|6553.70|7427.53|7759.58|7689.68|6553.70|7427.53| 5,242.96 | 32,838.89 | 6,553.70 48100298|HC INSJ SUBQ IMPLTBL DFB ELCTRD|0481|33271|8,930.32|5,179.59|||8152.58|8152.58|||||5804.71|6072.62|6519.13|6519.13|6965.65|5358.19|5804.71|6697.74|7590.77|7930.12|7858.68|6697.74|7590.77| 5,358.19 | 8,152.58 | 6,697.74 48100299|HC RMVL OF SUBQ DEFIBRILLATOR|0481|33272|6,359.52|3,688.52|||3,440.37|3,440.37|||||4133.69|4324.47|4642.45|4642.45|4960.43|3815.71|4133.69|4769.64|5405.59|5647.25|5596.38|4769.64|5405.59| 3,440.37 | 5,647.25 | 4,642.45 48100300|HC REPOS PREV IMPLTBL SUBQ DFB|0481|33273|7,056.01|4,092.49|||3,440.37|3,440.37|||||4586.41|4798.09|5150.89|5150.89|5503.69|4233.61|4586.41|5292.01|5997.61|6265.74|6209.29|5292.01|5997.61| 3,440.37 | 6,265.74 | 5,150.89 48100301|HC ELECTROPHYSIOLOGY EVALUATION|0481|93644|7,114.36|4,126.33|||||||||4624.33|4837.76|5193.48|5193.48|5549.20|4268.62|4624.33|5335.77|6047.21|6317.55|6260.64|5335.77|6047.21| 4,268.62 | 6,317.55 | 5,335.77 48100302|HC INTERROGATE SUBQ DEFIB|0481|93261|503.22|291.87|||37.15|37.15|||||327.09|342.19|367.35|367.35|392.51|301.93|327.09|377.42|427.74|446.86|442.83|377.42|427.74| 37.15 | 446.86 | 367.35 48100303|HC PRGRMG DEV EVAL IMPLTBL SYS|0481|93260|701.54|406.89|||37.15|37.15|||||456.00|477.05|512.12|512.12|547.20|420.92|456.00|526.16|596.31|622.97|617.36|526.16|596.31| 37.15 | 622.97 | 512.12 48100304|HC US GUIDE VASCULAR ACCESS|0481|76937|1,166.89|676.80|632.29|600.6755|||15.48|15.79|15.79|16.1|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 15.48 | 1,036.20 | 793.49 48100304|HC US GUIDE VASCULAR ACCESS|0481|76937|1,166.89|676.80|632.29|600.6755|||29.33|29.92|29.92|30.51|758.48|793.49|851.83|851.83|910.17|700.13|758.48|875.17|991.86|1036.20|1026.86|875.17|991.86| 29.33 | 1,036.20 | 793.49 48100305|HC PERC D-E COR REVASC T CABG B ADDL|0481|92938|39,512.47|22,917.23|11013.51|10462.8345|||5196.37|5300.3|5300.3|5404.23|25683.11|26868.48|28844.10|28844.10|30819.73|23707.48|25683.11|29634.35|33585.60|35087.07|34770.97|29634.35|33585.60| 5,196.37 | 35,087.07 | 26,868.48 48100306|HC REMOVE TUNNELED IP CATH|0481|49422|3,817.91|2,214.39|437.4|415.53|2,861.66|2,861.66|||||2481.64|2596.18|2787.07|2787.07|2977.97|2290.75|2481.64|2863.43|3245.22|3390.30|3359.76|2863.43|3245.22| 415.53 | 3,390.30 | 2,861.66 48100307|HC REMOVAL DUCT GLBLDR CALCULI|0481|47544|3,450.31|2,001.18|||||||||2242.70|2346.21|2518.73|2518.73|2691.24|2070.19|2242.70|2587.73|2932.76|3063.88|3036.27|2587.73|2932.76| 2,070.19 | 3,063.88 | 2,587.73 48100308|HC PLACE CATH XTRNL CAROTID|0481|36227|18,960.27|10,996.96|930.38|883.861|||87.32|89.06|89.06|90.81|12324.18|12892.98|13841.00|13841.00|14789.01|11376.16|12324.18|14220.20|16116.23|16836.72|16685.04|14220.20|16116.23| 87.32 | 16,836.72 | 12,892.98 48100309|HC PERQ CLSR TCAT L ATR APNDGE|0481|33340|30,365.78|17,612.15|||||||||19737.76|20648.73|22167.02|22167.02|23685.31|18219.47|19737.76|22774.34|25810.91|26964.81|26721.89|22774.34|25810.91| 18,219.47 | 26,964.81 | 22,774.34 48100310|HC PTA RENAL, VISERAL, AORTA, OR BRACHIOCEPHALIC INT. ART.|0481|37246|24,728.26|14,342.39|7729.4|7342.93|4,956.84|4,956.84|||||16073.37|16815.22|18051.63|18051.63|19288.04|14836.96|16073.37|18546.20|21019.02|21958.69|21760.87|18546.20|21019.02| 4,956.84 | 21,958.69 | 18,051.63 48100311|HC PTA RENAL, VISERAL, AORTA, OR BRACHIOCEPHALIC ADDT ART.|0481|37247|23,977.09|13,906.71|7729.4|7342.93|||||||15585.11|16304.42|17503.28|17503.28|18702.13|14386.25|15585.11|17982.82|20380.53|21291.66|21099.84|17982.82|20380.53| 7,342.93 | 21,291.66 | 17,503.28 48100312|HC PTA VEIN, INTIAL|0481|37248|23,490.88|13,624.71|7729.4|7342.93|4956.84|4956.84|||||15269.07|15973.80|17148.34|17148.34|18322.89|14094.53|15269.07|17618.16|19967.25|20859.90|20671.97|17618.16|19967.25| 4,956.84 | 20,859.90 | 17,148.34 48100313|HC PTA VEIN, ADDL|0481|37249|22,739.69|13,189.02|7,729.40|7,342.93|||||||14780.80|15462.99|16599.97|16599.97|17736.96|13643.81|14780.80|17054.77|19328.74|20192.84|20010.93|17054.77|19328.74| 7,342.93 | 20,192.84 | 16,599.97 48100314|HC INTRO CATH DIALYSIS CIRCUIT,FLUORO, S&I|0481|36901|6,010.67|3,486.19|||1,406.14|1,406.14|||||3906.94|4087.26|4387.79|4387.79|4688.32|3606.40|3906.94|4508.00|5109.07|5337.47|5289.39|4508.00|5109.07| 1,406.14 | 5,337.47 | 4,387.79 48100315|HC INTRO CATH DIALYSIS CIRCUIT, PTA, FLUORO, S&I|0481|36902|35,512.23|20,597.09|||4,956.84|4,956.84|||||23082.95|24148.32|25923.93|25923.93|27699.54|21307.34|23082.95|26634.17|30185.40|31534.86|31250.76|26634.17|30185.40| 4,956.84 | 31,534.86 | 25,923.93 48100316|HC INTRO CATH DIALYSIS CIRCUIT,PTA, STENT, FLUORO, S&I|0481|36903|51,753.83|30,017.22|||10,042.94|10,042.94|||||33639.99|35192.60|37780.30|37780.30|40367.99|31052.30|33639.99|38815.37|43990.76|45957.40|45543.37|38815.37|43990.76| 10,042.94 | 45,957.40 | 37,780.30 48100317|HC THROMBECTOMY, MECH., DIALYSIS CIRCUIT|0481|36904|23,859.17|13,838.32|||4,956.84|4,956.84|||||15508.46|16224.24|17417.19|17417.19|18610.15|14315.50|15508.46|17894.38|20280.29|21186.94|20996.07|17894.38|20280.29| 4,956.84 | 21,186.94 | 17,417.19 48100318|HC THRMBC/NFS DIALYSIS CIRCUIT WITH PTA PERIPHERAL SEGMENT|0481|36905|47,350.04|27,463.02|||10,042.94|10,042.94|||||30777.53|32198.03|34565.53|34565.53|36933.03|28410.02|30777.53|35512.53|40247.53|42046.84|41668.04|35512.53|40247.53| 10,042.94 | 42,046.84 | 34,565.53 48100319|HC THRMBC/NFS DIALYSIS CIRCUIT WITH PTA AND STENT PERIPHERAL SEGMENT|0481|36906|63,591.63|36,883.15|||16,064.00|16,064.00|||||41334.56|43242.31|46421.89|46421.89|49601.47|38154.98|41334.56|47693.72|54052.89|56469.37|55960.63|47693.72|54052.89| 16,064.00 | 56,469.37 | 46,421.89 48100320|HC BALO ANGIOP CTR DIALYSIS SEG WITH PTA CENTRAL SEGMENT, ADD ON CODE|0481|36907|23,490.88|13,624.71|||||||||15269.07|15973.80|17148.34|17148.34|18322.89|14094.53|15269.07|17618.16|19967.25|20859.90|20671.97|17618.16|19967.25| 14,094.53 | 20,859.90 | 17,618.16 48100321|HC STENT PLMT CTR DIALYSIS SEG W/ PTA & STENT CENTRAL SEGMENT, ADD ON|0481|36908|39,732.47|23,044.83|||||||||25826.11|27018.08|29004.70|29004.70|30991.33|23839.48|25826.11|29799.35|33772.60|35282.43|34964.57|29799.35|33772.60| 23,839.48 | 35,282.43 | 29,799.35 48100322|HC DIALYSIS CIRCUIT EMBOLJ, ADD ON CODE|0481|36909|27,064.46|15,697.39|||||||||17591.90|18403.83|19757.06|19757.06|21110.28|16238.68|17591.90|20298.35|23004.79|24033.24|23816.72|20298.35|23004.79| 16,238.68 | 24,033.24 | 20,298.35 48100323|HC VENOUS SELECTIVE ORGAN BLOOD SAMPLING|0481|36500|2,547.70|1,477.67|||||523.33|533.79|533.79|544.26|1656.01|1732.44|1859.82|1859.82|1987.21|1528.62|1656.01|1910.78|2165.55|2262.36|2241.98|1910.78|2165.55| 523.33 | 2,262.36 | 1,859.82 48100324|HC PERQ DEV SOFT TISS 1ST IMAG|0481|10035|1,360.91|789.33|||621.97|621.97|||||884.59|925.42|993.46|993.46|1061.51|816.55|884.59|1020.68|1156.77|1208.49|1197.60|1020.68|1156.77| 621.97 | 1,208.49 | 993.46 48100325|HC LEADLESS C PM INS/RPL VENTR|0481|0387T|18,329.84|10,631.31|||||||||11914.40|12464.29|13380.78|13380.78|14297.28|10997.90|11914.40|13747.38|15580.36|16276.90|16130.26|13747.38|15580.36| 10,997.90 | 16,276.90 | 13,747.38 48100326|HC LEADLESS C PM REMOVE VENTR|0481|0388T|5,469.78|3,172.47|||||||||3555.36|3719.45|3992.94|3992.94|4266.43|3281.87|3555.36|4102.34|4649.31|4857.16|4813.41|4102.34|4649.31| 3,281.87 | 4,857.16 | 4,102.34 48100327|HC INTERGT EVAL INPER LEADLS PM|0481|0391T|330.36|191.61|||||||||214.73|224.64|241.16|241.16|257.68|198.22|214.73|247.77|280.81|293.36|290.72|247.77|280.81| 198.22 | 293.36 | 247.77 48100328|HC TRANSCATH STENT CCA W/O EPS|0481|37216|23,458.06|13,605.67|||||261.66|266.90|266.90|272.13|15247.74|15951.48|17124.38|17124.38|18297.29|14074.84|15247.74|17593.55|19939.35|20830.76|20643.09|17593.55|19939.35| 261.66 | 20,830.76 | 17,124.38 48100329|HC UNLISTED CARD SERVICE-OVERRIDE DEFIB CARDIOVERSION|0481|93799|279.57|162.15|||139.55|139.55|||||181.72|190.11|204.09|204.09|218.06|167.74|181.72|209.68|237.63|248.26|246.02|209.68|237.63| 139.55 | 248.26 | 204.09 48100330|HC INTRA-ATRIAL PACING|0481|93610|5,330.86|3,091.90|||6,078.48|6,078.48|1,079.36|1,100.95|1,100.95|1,122.54|3465.06|3624.98|3891.53|3891.53|4158.07|3198.52|3465.06|3998.15|4531.23|4733.80|4691.16|3998.15|4531.23| 1,079.36 | 6,078.48 | 3,891.53 48100331|HC INTRAVENTRICULAR PACING|0481|93612|5,330.86|3,091.90|||6,078.48|6,078.48|1,079.36|1,100.95|1,100.95|1,122.54|3465.06|3624.98|3891.53|3891.53|4158.07|3198.52|3465.06|3998.15|4531.23|4733.80|4691.16|3998.15|4531.23| 1,079.36 | 6,078.48 | 3,891.53 48100332|HC PROG EVAL INPER LEADLS PM INCL INTERROGATION|0481|0389T|468.64|271.81|||||||||304.62|318.68|342.11|342.11|365.54|281.18|304.62|351.48|398.34|416.15|412.40|351.48|398.34| 281.18 | 416.15 | 351.48 48100333|HC PERI-PX PACEMAKER DEVICE EVAL|0481|93286|467.68|271.25|||||||||303.99|318.02|341.41|341.41|364.79|280.61|303.99|350.76|397.53|415.30|411.56|350.76|397.53| 280.61 | 415.30 | 350.76 48100334|HC PERI-PX DEVICE EVAL & PRGR- DEFIB|0481|93287|668.13|387.52|||||||||434.28|454.33|487.73|487.73|521.14|400.88|434.28|501.10|567.91|593.30|587.95|501.10|567.91| 400.88 | 593.30 | 501.10 48100335|HC DECLOT VASCULAR DEVICE|0481|36593|1,126.37|653.29|||310.75|310.75|||||732.14|765.93|822.25|822.25|878.57|675.82|732.14|844.78|957.41|1000.22|991.21|844.78|957.41| 310.75 | 1,000.22 | 822.25 48100336|HC UNLISTED PROCEDURE, LUNG AND PLEURA|0481|32999|1,142.58|662.70|||541.62|541.62|||||742.68|776.95|834.08|834.08|891.21|685.55|742.68|856.94|971.19|1014.61|1005.47|856.94|971.19| 541.62 | 1,014.61 | 834.08 48100337|HC TCAT IMPL WRLS P-ART PRS SNR|0481|33289|33,948.43|19,690.09|||28,815.40|28,815.40|||||22066.48|23084.93|24782.35|24782.35|26479.78|20369.06|22066.48|25461.32|28856.17|30146.21|29874.62|25461.32|28856.17| 20,369.06 | 30,146.21 | 25,461.32 48100338|HC TCAT INSJ/RPL PERM LDLS PM|0481|33274|16,928.34|9,818.44|||16,064.00|16,064.00|||||11003.42|11511.27|12357.69|12357.69|13204.11|10157.00|11003.42|12696.26|14389.09|15032.37|14896.94|12696.26|14389.09| 10,157.00 | 16,064.00 | 12,696.26 48100339|HC TCAT RMVL PERM LDLS PM|0481|33275|2,732.65|1,584.94|||2,861.66|2,861.66|||||1776.22|1858.20|1994.83|1994.83|2131.47|1639.59|1776.22|2049.49|2322.75|2426.59|2404.73|2049.49|2322.75| 1,639.59 | 2,861.66 | 2,049.49 48100340|HC INSJ SUBQ CAR RHYTHM MNTR|0481|33285|9,191.44|5,331.04|||8,152.58|8,152.58|||||5974.44|6250.18|6709.75|6709.75|7169.32|5514.86|5974.44|6893.58|7812.72|8162.00|8088.47|6893.58|7812.72| 5,514.86 | 8,162.00 | 6,893.58 48100341|HC RMVL SUBQ CAR RHYTHM MNTR|0481|33286|719.20|417.14|||621.97|621.97|||||467.48|489.06|525.02|525.02|560.98|431.52|467.48|539.40|611.32|638.65|632.90|539.40|611.32| 431.52 | 638.65 | 539.40 48100342|HC PERICARDIOCENTESIS W/IMAGING|0481|33016|1,684.20|976.84|||1,406.14|1,406.14|||||1094.73|1145.26|1229.47|1229.47|1313.68|1010.52|1094.73|1263.15|1431.57|1495.57|1482.10|1263.15|1431.57| 1,010.52 | 1,495.57 | 1,263.15 48100343|HC PRCRD DRG 6YR+ W/O CGEN CAR|0481|33017|1,894.20|1,098.64|||||||||1231.23|1288.06|1382.77|1382.77|1477.48|1136.52|1231.23|1420.65|1610.07|1682.05|1666.90|1420.65|1610.07| 1,136.52 | 1,682.05 | 1,420.65 48200000|HC STRESS TEST, TRACING ONLY|0482|93017|1,651.51|957.88|1,444.61|1,372.38|264.45|264.45|48.08|49.04|49.04|50.00|1073.48|1123.03|1205.60|1205.60|1288.18|990.91|1073.48|1238.63|1403.78|1466.54|1453.33|1238.63|1403.78| 48.08 | 1,466.54 | 1,205.60 61000000|HC MRI BREAST BIOPSY|0610|19085|3,146.13|1,824.76|2,886.60|2,742.27|1,407.00|1,407.00|597.05|608.99|608.99|620.93|2044.98|2139.37|2296.67|2296.67|2453.98|1887.68|2044.98|2359.60|2674.21|2793.76|2768.59|2359.60|2674.21| 597.05 | 2,886.60 | 2,296.67 61000001|HC MRI-ORBITS,FACE/NECK WO CON|0610|70540|2,300.95|1,334.55|645.48|613.21|230.13|230.13|259.57|264.76|264.76|269.95|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000001|HC MRI-ORBITS,FACE/NECK WO CON|0610|70540|2,300.95|1,334.55|645.48|613.21|230.13|230.13|519.14|529.52|529.52|539.91|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000002|HC MRI-ORBITS,FACE/NCK W/WO CON/1|0610|70543|4,295.60|2,491.45|645.48|613.21|368.12|368.12|259.57|264.76|264.76|269.95|2792.14|2921.01|3135.79|3135.79|3350.57|2577.36|2792.14|3221.70|3651.26|3814.49|3780.13|3221.70|3651.26| 259.57 | 3,814.49 | 2,792.14 61000002|HC MRI-ORBITS,FACE/NCK W/WO CON/1|0610|70543|4,295.60|2,491.45|645.48|613.21|368.12|368.12|519.14|529.52|529.52|539.91|2792.14|2921.01|3135.79|3135.79|3350.57|2577.36|2792.14|3221.70|3651.26|3814.49|3780.13|3221.70|3651.26| 368.12 | 3,814.49 | 2,792.14 61000003|HC MRA-HEAD WO CONTRAST|0610|70544|2,300.95|1,334.55|776.81|737.97|230.13|230.13|252.51|257.56|257.56|262.61|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000003|HC MRA-HEAD WO CONTRAST|0610|70544|2,300.95|1,334.55|776.81|737.97|230.13|230.13|519.14|529.52|529.52|539.91|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000004|HC MRA-NECK WO CONTRAST|0610|70547|2,300.95|1,334.55|776.81|737.97|230.13|230.13|252.51|257.56|257.56|262.61|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000004|HC MRA-NECK WO CONTRAST|0610|70547|2,300.95|1,334.55|776.81|737.97|230.13|230.13|519.14|529.52|529.52|539.91|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000005|HC MRI, BRAIN WO CONTRAST|0610|70551|2,300.95|1,334.55|645.48|613.21|230.13|230.13|451.37|460.40|460.40|469.43|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000005|HC MRI, BRAIN WO CONTRAST|0610|70551|2,300.95|1,334.55|645.48|613.21|230.13|230.13|247.18|252.12|252.12|257.07|1495.62|1564.65|1679.69|1679.69|1794.74|1380.57|1495.62|1725.71|1955.81|2043.24|2024.84|1725.71|1955.81| 230.13 | 2,043.24 | 1,495.62 61000006|HC MRI, BRAIN W CONTRAST|0610|70552|2,812.69|1,631.36|645.48|613.21|368.12|368.12|296.60|302.53|302.53|308.46|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 296.60 | 2,497.67 | 1,828.25 61000006|HC MRI, BRAIN W CONTRAST|0610|70552|2,812.69|1,631.36|645.48|613.21|368.12|368.12|542.95|553.81|553.81|564.67|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 368.12 | 2,497.67 | 1,828.25 61000007|HC MRI, BRAIN W/WO CONTRAST|0610|70553|4,475.50|2,595.79|645.48|613.21|368.12|368.12|1,054.61|1,075.70|1,075.70|1,096.80|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000007|HC MRI, BRAIN W/WO CONTRAST|0610|70553|4,475.50|2,595.79|645.48|613.21|368.12|368.12|1,199.05|1,223.03|1,223.03|1,247.01|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000008|HC MRI, CHEST WO CONTRAST|0610|71550|2,148.33|1,246.03|645.48|613.21|230.13|230.13|291.02|296.84|296.84|302.66|1396.41|1460.86|1568.28|1568.28|1675.70|1289.00|1396.41|1611.25|1826.08|1907.72|1890.53|1611.25|1826.08| 230.13 | 1,907.72 | 1,396.41 61000008|HC MRI, CHEST WO CONTRAST|0610|71550|2,148.33|1,246.03|645.48|613.21|230.13|230.13|582.05|593.69|593.69|605.33|1396.41|1460.86|1568.28|1568.28|1675.70|1289.00|1396.41|1611.25|1826.08|1907.72|1890.53|1611.25|1826.08| 230.13 | 1,907.72 | 1,396.41 61000009|HC MRI, CHEST W/WO CONTRAST|0610|71552|3,915.72|2,271.12|645.48|613.21|368.12|368.12|291.02|296.84|296.84|302.66|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 291.02 | 3,477.16 | 2,545.22 61000009|HC MRI, CHEST W/WO CONTRAST|0610|71552|3,915.72|2,271.12|645.48|613.21|368.12|368.12|582.05|593.69|593.69|605.33|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 368.12 | 3,477.16 | 2,545.22 61000010|HC MRI, C SPINE WO CONTRAST|0610|72141|2,455.32|1,424.09|645.48|613.21|230.13|230.13|474.59|484.08|484.08|493.58|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000010|HC MRI, C SPINE WO CONTRAST|0610|72141|2,455.32|1,424.09|645.48|613.21|230.13|230.13|572.43|583.88|583.88|595.33|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000011|HC MRI, C SPINE W CONTRAST|0610|72142|2,461.35|1,427.58|645.48|613.21|368.12|368.12|228.96|233.54|233.54|238.11|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 228.96 | 2,185.68 | 1,599.88 61000011|HC MRI, C SPINE W CONTRAST|0610|72142|2,461.35|1,427.58|645.48|613.21|368.12|368.12|457.91|467.07|467.07|476.23|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 368.12 | 2,185.68 | 1,599.88 61000012|HC MRI, T SPINE WO CONTRAST|0610|72146|2,455.32|1,424.09|645.48|613.21|230.13|230.13|526.97|537.50|537.50|548.04|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000012|HC MRI, T SPINE WO CONTRAST|0610|72146|2,455.32|1,424.09|645.48|613.21|230.13|230.13|624.80|637.30|637.30|649.79|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000013|HC MRI, T SPINE W CONTRAST|0610|72147|2,461.35|1,427.58|645.48|613.21|368.12|368.12|457.91|467.07|467.07|476.23|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 368.12 | 2,185.68 | 1,599.88 61000013|HC MRI, T SPINE W CONTRAST|0610|72147|2,461.35|1,427.58|645.48|613.21|368.12|368.12|228.96|233.54|233.54|238.11|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 228.96 | 2,185.68 | 1,599.88 61000014|HC MRI, L SPINE WO CONTRAST|0610|72148|2,455.32|1,424.09|645.48|613.21|230.13|230.13|526.97|537.50|537.50|548.04|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000014|HC MRI, L SPINE WO CONTRAST|0610|72148|2,455.32|1,424.09|645.48|613.21|230.13|230.13|617.32|629.66|629.66|642.01|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000015|HC MRI, L SPINE W CONTRAST|0610|72149|2,812.69|1,631.36|645.48|613.21|368.12|368.12|228.96|233.54|233.54|238.11|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 228.96 | 2,497.67 | 1,828.25 61000015|HC MRI, L SPINE W CONTRAST|0610|72149|2,812.69|1,631.36|645.48|613.21|368.12|368.12|457.91|467.07|467.07|476.23|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 368.12 | 2,497.67 | 1,828.25 61000016|HC MRI, C SPINE W/WO CONTRAST|0610|72156|4,475.50|2,595.79|645.48|613.21|368.12|368.12|476.27|485.79|485.79|495.32|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000016|HC MRI, C SPINE W/WO CONTRAST|0610|72156|4,475.50|2,595.79|645.48|613.21|368.12|368.12|599.68|611.68|611.68|623.67|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000017|HC MRI, T SPINE W/WO CONTRAST|0610|72157|4,475.50|2,595.79|645.48|613.21|368.12|368.12|475.97|485.49|485.49|495.01|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000017|HC MRI, T SPINE W/WO CONTRAST|0610|72157|4,475.50|2,595.79|645.48|613.21|368.12|368.12|599.39|611.38|611.38|623.37|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000018|HC MRI, L SPINE W/WO CONTRAST|0610|72158|4,475.50|2,595.79|645.48|613.21|368.12|368.12|589.80|601.60|601.60|613.40|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000018|HC MRI, L SPINE W/WO CONTRAST|0610|72158|4,475.50|2,595.79|645.48|613.21|368.12|368.12|476.27|485.79|485.79|495.32|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000019|HC MRI, PELVIS WO CONTRAST|0610|72195|2,455.32|1,424.09|645.48|613.21|230.13|230.13|204.69|208.78|208.78|212.87|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 204.69 | 2,180.32 | 1,595.96 61000019|HC MRI, PELVIS WO CONTRAST|0610|72195|2,455.32|1,424.09|645.48|613.21|230.13|230.13|409.37|417.56|417.56|425.75|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000020|HC MRI, PELVIS W CONTRAST|0610|72196|2,461.35|1,427.58|645.48|613.21|368.12|368.12|204.69|208.78|208.78|212.87|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 204.69 | 2,185.68 | 1,599.88 61000020|HC MRI, PELVIS W CONTRAST|0610|72196|2,461.35|1,427.58|645.48|613.21|368.12|368.12|409.37|417.56|417.56|425.75|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 368.12 | 2,185.68 | 1,599.88 61000021|HC MRI, PELVIS W/WO CONTRAST|0610|72197|4,475.50|2,595.79|645.48|613.21|368.12|368.12|210.29|214.49|214.49|218.7|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 210.29 | 3,974.24 | 2,909.08 61000021|HC MRI, PELVIS W/WO CONTRAST|0610|72197|4,475.50|2,595.79|645.48|613.21|368.12|368.12|420.56|428.97|428.97|437.38|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000022|HC MRI, UPPER EXT-NOT JT WO CON|0610|73218|2,455.32|1,424.09|645.48|613.21|230.13|230.13|259.57|264.76|264.76|269.95|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000022|HC MRI, UPPER EXT-NOT JT WO CON|0610|73218|2,455.32|1,424.09|645.48|613.206|230.13|230.13|519.14|529.52|529.52|539.91|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000023|HC MRI,UPPER EXT-NOT JT W CONTR|0610|73219|2,461.35|1,427.58|645.48|613.21|368.12|368.12|259.57|264.76|264.76|269.95|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 259.57 | 2,185.68 | 1,599.88 61000023|HC MRI,UPPER EXT-NOT JT W CONTR|0610|73219|2,461.35|1,427.58|645.48|613.21|368.12|368.12|519.14|529.52|529.52|539.91|1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 368.12 | 2,185.68 | 1,599.88 61000024|HC MRI,UPPER EXT-NOT JT W/WO CO|0610|73220|4,355.16|2,525.99|645.48|613.21|368.12|368.12|259.57|264.76|264.76|269.95|2830.85|2961.51|3179.27|3179.27|3397.02|2613.10|2830.85|3266.37|3701.89|3867.38|3832.54|3266.37|3701.89| 259.57 | 3,867.38 | 2,830.85 61000024|HC MRI,UPPER EXT-NOT JT W/WO CO|0610|73220|4,355.16|2,525.99|645.48|613.21|368.12|368.12|519.14|529.52|529.52|539.91|2830.85|2961.51|3179.27|3179.27|3397.02|2613.10|2830.85|3266.37|3701.89|3867.38|3832.54|3266.37|3701.89| 368.12 | 3,867.38 | 2,830.85 61000025|HC MRI,UPPER EXT JOINT WO CONTR|0610|73221|2,455.32|1,424.09|645.48|613.21|230.13|230.13|253.62|258.69|258.69|263.76|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000025|HC MRI,UPPER EXT JOINT WO CONTR|0610|73221|2,455.32|1,424.09|645.48|613.21|230.13|230.13|507.24|517.38|517.38|527.53|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000026|HC MRI-UPPER EXT JOINT W CONTRA|0610|73222|2,812.69|1,631.36|645.48|613.21|715.18|715.18|253.62|258.69|258.69|263.76|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 253.62 | 2,497.67 | 1,828.25 61000026|HC MRI-UPPER EXT JOINT W CONTRA|0610|73222|2,812.69|1,631.36|645.48|613.21|715.18|715.18|507.24|517.38|517.38|527.53|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 507.24 | 2,497.67 | 1,828.25 61000027|HC MRI-UPPER EXT JOINT W/WO CON|0610|73223|4,475.50|2,595.79|645.48|613.21|368.12|368.12|507.24|517.38|517.38|527.53|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000027|HC MRI-UPPER EXT JOINT W/WO CON|0610|73223|4,475.50|2,595.79|645.48|613.21|368.12|368.12|253.62|258.69|258.69|263.76|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 253.62 | 3,974.24 | 2,909.08 61000028|HC MRA-UPPER EXT W/WO CONT|0610|73225|2,891.68|1,677.17|776.81|737.97|||259.57|264.76|264.76|269.95|1879.59|1966.34|2110.93|2110.93|2255.51|1735.01|1879.59|2168.76|2457.93|2567.81|2544.68|2168.76|2457.93| 259.57 | 2,567.81 | 1,966.34 61000028|HC MRA-UPPER EXT W/WO CONT|0610|73225|2,891.68|1,677.17|776.81|737.97|||102.44|104.49|104.49|106.54|1879.59|1966.34|2110.93|2110.93|2255.51|1735.01|1879.59|2168.76|2457.93|2567.81|2544.68|2168.76|2457.93| 102.44 | 2,567.81 | 1,966.34 61000028|HC MRA-UPPER EXT W/WO CONT|0610|73225|2,891.68|1,677.17|776.81|737.97|||519.14|529.52|529.52|539.91|1879.59|1966.34|2110.93|2110.93|2255.51|1735.01|1879.59|2168.76|2457.93|2567.81|2544.68|2168.76|2457.93| 519.14 | 2,567.81 | 1,966.34 61000029|HC MRI-LOWER EXT-NOT JT WO CONT|0610|73718|2,455.32|1,424.09|645.48|613.21|230.13|230.13|259.57|264.76|264.76|269.95|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000029|HC MRI-LOWER EXT-NOT JT WO CONT|0610|73718|2,455.32|1,424.09|645.48|613.21|230.13|230.13|519.14|529.52|529.52|539.91|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000030|HC MRI-LOWER EXT-NOT JT W/WO CO|0610|73720|4,475.50|2,595.79|645.48|613.21|368.12|368.12|259.57|264.76|264.76|269.95|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 259.57 | 3,974.24 | 2,909.08 61000030|HC MRI-LOWER EXT-NOT JT W/WO CO|0610|73720|4,475.50|2,595.79|645.48|613.21|368.12|368.12|519.14|529.52|529.52|539.91|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000031|HC MRI-LOWER EXT-JOINT WO CONTR|0610|73721|2,455.32|1,424.09|645.48|613.21|230.13|230.13|556.43|567.56|567.56|578.69|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000031|HC MRI-LOWER EXT-JOINT WO CONTR|0610|73721|2,455.32|1,424.09|645.48|613.21|230.13|230.13|474.59|484.08|484.08|493.58|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000032|HC MRI-LOWER EXT-JOINT CONTRA|0610|73722|3,281.04|1,903.00|645.48|613.21|715.18|715.18|556.43|567.56|567.56|578.69|2132.68|2231.11|2395.16|2395.16|2559.21|1968.62|2132.68|2460.78|2788.88|2913.56|2887.32|2460.78|2788.88| 556.43 | 2,913.56 | 2,132.68 61000032|HC MRI-LOWER EXT-JOINT CONTRA|0610|73722|3,281.04|1,903.00|645.48|613.21|715.18|715.18|474.59|484.08|484.08|493.58|2132.68|2231.11|2395.16|2395.16|2559.21|1968.62|2132.68|2460.78|2788.88|2913.56|2887.32|2460.78|2788.88| 474.59 | 2,913.56 | 2,132.68 61000033|HC MRI-LOWER EXT-JOINT W/WO CON|0610|73723|4,475.50|2,595.79|645.48|613.21|368.12|368.12|474.59|484.08|484.08|493.58|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000033|HC MRI-LOWER EXT-JOINT W/WO CON|0610|73723|4,475.50|2,595.79|645.48|613.21|368.12|368.12|556.43|567.56|567.56|578.69|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000034|HC MRI, ABDOMEN WO CONTRAST|0610|74181|2,455.32|1,424.09|645.48|613.21|230.13|230.13|555.24|566.34|566.34|577.45|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000034|HC MRI, ABDOMEN WO CONTRAST|0610|74181|2,455.32|1,424.09|645.48|613.21|230.13|230.13|277.63|283.18|283.18|288.73|1595.96|1669.62|1792.38|1792.38|1915.15|1473.19|1595.96|1841.49|2087.02|2180.32|2160.68|1841.49|2087.02| 230.13 | 2,180.32 | 1,595.96 61000035|HC MRI, ABDOMEN W/WO CONTRAST|0610|74183|4,475.50|2,595.79|645.48|613.21|368.12|368.12|277.63|283.18|283.18|288.73|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 277.63 | 3,974.24 | 2,909.08 61000035|HC MRI, ABDOMEN W/WO CONTRAST|0610|74183|4,475.50|2,595.79|645.48|613.21|368.12|368.12|555.24|566.34|566.34|577.45|2909.08|3043.34|3267.12|3267.12|3490.89|2685.30|2909.08|3356.63|3804.18|3974.24|3938.44|3356.63|3804.18| 368.12 | 3,974.24 | 2,909.08 61000036|HC CARD MRI-MORPH&FUNC W/O CONTRA|0610|75557|2,461.35|1,427.58|645.48|613.21|230.13|230.13|||||1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 230.13 | 2,185.68 | 1,796.79 61000037|HC CAR MRI-MRPH&FUNC W&WO CNT-FR|0610|75561|2,461.35|1,427.58|645.48|613.21|368.12|368.12|||||1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 368.12 | 2,185.68 | 1,796.79 61000038|HC CAR MRI-MRPH&FUNC W&WO C-FS W|0610|75563|2,461.35|1,427.58|645.48|613.206|715.18|715.18|||||1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 613.21 | 2,185.68 | 1,796.79 61000039|HC MRI BREAST BILAT W CONTR|0610|77059|2,754.34|1,597.52|||||||||1790.32|1872.95|2010.67|2010.67|2148.39|1652.60|1790.32|2065.76|2341.19|2445.85|2423.82|2065.76|2341.19| 1,652.60 | 2,445.85 | 2,065.76 61000040|HC MRA-ABD WO CONTRAST|0610|C8901|2,148.33|1,246.03|776.81|737.9695|230.13|230.13|||||1396.41|1460.86|1568.28|1568.28|1675.70|1289.00|1396.41|1611.25|1826.08|1907.72|1890.53|1611.25|1826.08| 230.13 | 1,907.72 | 1,568.28 61000041|HC MRA-ABD W/WO CONTRAST|0610|C8902|2,891.68|1,677.17|776.81|737.9695|368.12|368.12|||||1879.59|1966.34|2110.93|2110.93|2255.51|1735.01|1879.59|2168.76|2457.93|2567.81|2544.68|2168.76|2457.93| 368.12 | 2,567.81 | 2,110.93 61000042|HC MRI BREAST BILATERAL W/O & W/ NO CAD|0610|C8908|4,790.36|2,778.41|645.48|613.206|368.12|368.12|||||3113.73|3257.44|3496.96|3496.96|3736.48|2874.22|3113.73|3592.77|4071.81|4253.84|4215.52|3592.77|4071.81| 368.12 | 4,253.84 | 3,496.96 61000043|HC MRI BREAST BILAT W/WO CONTR|0610|C8908|2,891.68|1,677.17|645.48|613.21|368.12|368.12|||||1879.59|1966.34|2110.93|2110.93|2255.51|1735.01|1879.59|2168.76|2457.93|2567.81|2544.68|2168.76|2457.93| 368.12 | 2,567.81 | 2,110.93 61000044|HC MRA-CHEST W/CONTRAST|0610|C8909|2,461.35|1,427.58|776.81|737.9695|368.12|368.12|||||1599.88|1673.72|1796.79|1796.79|1919.85|1476.81|1599.88|1846.01|2092.15|2185.68|2165.99|1846.01|2092.15| 368.12 | 2,185.68 | 1,796.79 61000045|HC MRA CHEST WO CONTRAST|0610|C8910|2,147.52|1,245.56|776.81|737.9695|230.13|230.13|||||1395.89|1460.31|1567.69|1567.69|1675.07|1288.51|1395.89|1610.64|1825.39|1907.00|1889.82|1610.64|1825.39| 230.13 | 1,907.00 | 1,567.69 61000046|HC MRA-CHEST W/WO CONTRAST|0610|C8911|2,891.68|1,677.17|776.81|737.9695|368.12|368.12|||||1879.59|1966.34|2110.93|2110.93|2255.51|1735.01|1879.59|2168.76|2457.93|2567.81|2544.68|2168.76|2457.93| 368.12 | 2,567.81 | 2,110.93 61000047|HC MRA-LOWER EXT W/WO CONTRAST|0610|C8914|2,891.68|1,677.17|776.81|737.9695|368.12|368.12|||||1879.59|1966.34|2110.93|2110.93|2255.51|1735.01|1879.59|2168.76|2457.93|2567.81|2544.68|2168.76|2457.93| 368.12 | 2,567.81 | 2,110.93 61000048|HC MRA WO/ FOL W/CONT, PELVIS C89|0610|C8920|2,893.53|1,678.25|776.81|737.9695|368.12|368.12|||||1880.79|1967.60|2112.28|2112.28|2256.95|1736.12|1880.79|2170.15|2459.50|2569.45|2546.31|2170.15|2459.50| 368.12 | 2,569.45 | 2,112.28 61000049|HC MRI-ORBITS,FACE/NCK W/WO CON|0610|70542|3,915.72|2,271.12|645.48|613.206|368.12|368.12|259.57|264.76|264.76|269.95|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 259.57 | 3,477.16 | 2,545.22 61000049|HC MRI-ORBITS,FACE/NCK W/WO CON|0610|70542|3,915.72|2,271.12|645.48|613.206|368.12|368.12|519.14|529.52|529.52|539.91|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 368.12 | 3,477.16 | 2,545.22 61000050|HC MRA WO/CONT, PELVIS C8919|0610|C8919|2,147.52|1,245.56|776.81|737.97|230.13|230.13|||||1395.89|1460.31|1567.69|1567.69|1675.07|1288.51|1395.89|1610.64|1825.39|1907.00|1889.82|1610.64|1825.39| 230.13 | 1,907.00 | 1,567.69 61000051|HC MRA-NECK W/WO CONTRAST|0610|70549|3,915.72|2,271.12|776.81|737.97|368.12|368.12|252.51|257.56|257.56|262.61|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 252.51 | 3,477.16 | 2,545.22 61000051|HC MRA-NECK W/WO CONTRAST|0610|70549|3,915.72|2,271.12|776.81|737.9695|368.12|368.12|519.14|529.52|529.52|539.91|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 368.12 | 3,477.16 | 2,545.22 61000052|HC MRI-TMJ INC ONE OR BOTH JTS|0610|70336|2,148.33|1,246.03|645.48|613.206|230.13|230.13|137.37|140.12|140.12|142.87|1396.41|1460.86|1568.28|1568.28|1675.70|1289.00|1396.41|1611.25|1826.08|1907.72|1890.53|1611.25|1826.08| 137.37 | 1,907.72 | 1,396.41 61000052|HC MRI-TMJ INC ONE OR BOTH JTS|0610|70336|2,148.33|1,246.03|645.48|613.206|230.13|230.13|274.75|280.24|280.24|285.74|1396.41|1460.86|1568.28|1568.28|1675.70|1289.00|1396.41|1611.25|1826.08|1907.72|1890.53|1611.25|1826.08| 230.13 | 1,907.72 | 1,396.41 61000053|HC MRA-HEAD W/WO CONTRAST|0610|70546|3,915.72|2,271.12|776.81|737.9695|368.12|368.12|252.51|257.56|257.56|262.61|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 252.51 | 3,477.16 | 2,545.22 61000053|HC MRA-HEAD W/WO CONTRAST|0610|70546|3,915.72|2,271.12|776.81|737.9695|368.12|368.12|519.14|529.52|529.52|539.91|2545.22|2662.69|2858.48|2858.48|3054.26|2349.43|2545.22|2936.79|3328.36|3477.16|3445.83|2936.79|3328.36| 368.12 | 3,477.16 | 2,545.22 61000054|HC PLACEMENT OF BREAST LOCALIZATION DEVICE|0610|19287|2,860.33|1,658.99|1135.55|1078.7725|621.97|621.97|83.55|85.22|85.22|86.89|1859.21|1945.02|2088.04|2088.04|2231.06|1716.20|1859.21|2145.25|2431.28|2539.97|2517.09|2145.25|2431.28| 83.55 | 2,539.97 | 1,859.21 61000055|HC MRI BREAST VACUUM BIOPSY EACH ADDITIONAL LESION|0610|19086|2,945.29|1,708.27|2886.6|2742.27|||||||1914.44|2002.80|2150.06|2150.06|2297.33|1767.17|1914.44|2208.97|2503.50|2615.42|2591.86|2208.97|2503.50| 1,767.17 | 2,886.60 | 2,208.97 61000056|HC MRI UNLISTED PROCEDURE|0610|76498|4,600.69|2,668.40|645.48|613.21|80.90|80.90|||||2990.45|3128.47|3358.50|3358.50|3588.54|2760.41|2990.45|3450.52|3910.59|4085.41|4048.61|3450.52|3910.59| 80.90 | 4,085.41 | 3,358.50 61000057|HC MRA HEAD W/CONTRAST|0610|70545|2,812.69|1,631.36|776.81|737.97|368.12|368.12|252.51|257.56|257.56|262.61|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 252.51 | 2,497.67 | 1,828.25 61000057|HC MRA HEAD W/CONTRAST|0610|70545|2,812.69|1,631.36|776.81|737.97|368.12|368.12|519.14|529.52|529.52|539.91|1828.25|1912.63|2053.26|2053.26|2193.90|1687.61|1828.25|2109.52|2390.79|2497.67|2475.17|2109.52|2390.79| 368.12 | 2,497.67 | 1,828.25 61000058|HC MRI LOWER EXT NOT JT W/|0610|73719|3,281.04|1,903.00|645.48|613.21|368.12|368.12|259.57|264.76|264.76|269.95|2132.68|2231.11|2395.16|2395.16|2559.21|1968.62|2132.68|2460.78|2788.88|2913.56|2887.32|2460.78|2788.88| 259.57 | 2,913.56 | 2,132.68 61000058|HC MRI LOWER EXT NOT JT W/|0610|73719|3,281.04|1,903.00|645.48|613.206|368.12|368.12|519.14|529.52|529.52|539.91|2132.68|2231.11|2395.16|2395.16|2559.21|1968.62|2132.68|2460.78|2788.88|2913.56|2887.32|2460.78|2788.88| 368.12 | 2,913.56 | 2,132.68 61000059|HC MRI BREAST BILAT W/O CONTRAST, NO CAD|0610|77047|4,178.40|2,423.47|645.48|613.206|230.13|230.13|||||2715.96|2841.31|3050.23|3050.23|3259.15|2507.04|2715.96|3133.80|3551.64|3710.42|3676.99|3133.80|3551.64| 230.13 | 3,710.42 | 3,050.23 61000060|HC MRI BREAST BILAT W/O & W/ CONTRAST, INCL CAD|0610|77049|4,900.61|2,842.35|645.48|613.206|||||||3185.40|3332.41|3577.45|3577.45|3822.48|2940.37|3185.40|3675.46|4165.52|4351.74|4312.54|3675.46|4165.52| 613.21 | 4,351.74 | 3,577.45 61000061|HC MRI BREAST BILATERAL W/ NO CAD|0610|C8906|2,498.27|1,449.00|645.48|613.206|368.12|368.12|||||1623.88|1698.82|1823.74|1823.74|1948.65|1498.96|1623.88|1873.70|2123.53|2218.46|2198.48|1873.70|2123.53| 368.12 | 2,218.46 | 1,823.74 61000062|HC CAD FOR MRI BREAST|0610|C8937|110.25|63.95|656.15|623.3425|||||||71.66|74.97|80.48|80.48|86.00|66.15|71.66|82.69|93.71|97.90|97.02|82.69|93.71| 66.15 | 656.15 | 82.69 62300000|HC POWDER ARGLAES|0623|A6262|69.08|40.07|||||||||44.90|46.97|50.43|50.43|53.88|41.45|44.90|51.81|58.72|61.34|60.79|51.81|58.72| 41.45 | 61.34 | 51.81 62300001|HC WOUND DRAIN COLLECTOR 3 INCH|0623|A6154|118.32|68.63|||||||||76.91|80.46|86.37|86.37|92.29|70.99|76.91|88.74|100.57|105.07|104.12|88.74|100.57| 70.99 | 105.07 | 88.74 62300002|HC DRESSING POLYMEM 8X8|0623|A6211|106.60|61.83|||||||||69.29|72.49|77.82|77.82|83.15|63.96|69.29|79.95|90.61|94.66|93.81|79.95|90.61| 63.96 | 94.66 | 79.95 62300003|HC DRESSING NON-ADHES 4X24 POLYME|0623|A6211|152.37|88.37|||||||||99.04|103.61|111.23|111.23|118.85|91.42|99.04|114.28|129.51|135.30|134.09|114.28|129.51| 91.42 | 135.30 | 114.28 63600001|HC EPIFIX, PER SQ CM|0636|Q4186|1,092.97|633.92|||||||||710.43|743.22|797.87|797.87|852.52|655.78|710.43|819.73|929.02|970.56|961.81|819.73|929.02| 655.78 | 970.56 | 819.73 63600002|HC APLIGRAF PER SQ CM|0636|Q4101|190.50|110.49|34.48|32.756|||||||123.83|129.54|139.07|139.07|148.59|114.30|123.83|142.88|161.93|169.16|167.64|142.88|161.93| 32.76 | 169.16 | 139.07 63600003|HC OASIS WOUND MATRIX PER SQ CM|0636|Q4102|42.89|24.88|||||||||27.88|29.17|31.31|31.31|33.45|25.73|27.88|32.17|36.46|38.09|37.74|32.17|36.46| 25.73 | 38.09 | 32.17 63600004|HC DERMAGRAFT PER SQ CM|0636|Q4106|215.08|124.75|||||||||139.80|146.25|157.01|157.01|167.76|129.05|139.80|161.31|182.82|190.99|189.27|161.31|182.82| 129.05 | 190.99 | 161.31 63600005|HC PURAPLY, PURAPLY ANTIMIC, SQ CM|0636|Q4196|729.31|423.00|||||||||474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 437.59 | 647.63 | 546.98 63600006|HC GRAFIX PRIME, SQ CM|0636|Q4133|850.86|493.50|||||||||553.06|578.58|621.13|621.13|663.67|510.52|553.06|638.15|723.23|755.56|748.76|638.15|723.23| 510.52 | 755.56 | 638.15 63600007|HC KERECIS, PER SQ CM|0636|Q4158|85.09|49.35|||||||||55.31|57.86|62.12|62.12|66.37|51.05|55.31|63.82|72.33|75.56|74.88|63.82|72.33| 51.05 | 75.56 | 63.82 63600008|HC AFFINITY, PER SQ CM|0636|Q4159|463.05|268.57|||||||||300.98|314.87|338.03|338.03|361.18|277.83|300.98|347.29|393.59|411.19|407.48|347.29|393.59| 277.83 | 411.19 | 347.29 63600009|HC PRIMATRIX PER 1 SQ CM|0636|Q4110|385.88|223.81|||||||||250.82|262.40|281.69|281.69|300.99|231.53|250.82|289.41|328.00|342.66|339.57|289.41|328.00| 231.53 | 342.66 | 289.41 68200001|HC CLASS I TRAUMA ACTIVATION|0682|G0390|8,221.69|4,768.58|2,340.90|2,223.86|942.66|942.66|||||5344.10|5590.75|6001.83|6001.83|6412.92|4933.01|5344.10|6166.27|6988.44|7300.86|7235.09|6166.27|6988.44| 942.66 | 7,300.86 | 6,001.83 68200002|HC CLASS II TRAUMA ACTIVATION|0682|G0390|8,221.69|4,768.58|2,340.90|2,223.86|942.66|942.66|||||5344.10|5590.75|6001.83|6001.83|6412.92|4933.01|5344.10|6166.27|6988.44|7300.86|7235.09|6166.27|6988.44| 942.66 | 7,300.86 | 6,001.83 71000006|HC POST RECOVERY - PACU|0710|71000006|82.19|47.67|||||||||53.42|55.89|60.00|60.00|64.11|49.31|53.42|61.64|69.86|72.98|72.33|61.64|69.86| 49.31 | 72.98 | 61.64 71000007|HC POST RECOVERY - PRE-POST|0710|71000007|82.19|47.67|||||||||53.42|55.89|60.00|60.00|64.11|49.31|53.42|61.64|69.86|72.98|72.33|61.64|69.86| 49.31 | 72.98 | 61.64 73000000|HC EKG, TWELVE LEAD, TRACING ONLY|0730|93005|417.77|242.31|||55.66|55.66|19.09|19.47|19.47|19.85|271.55|284.08|304.97|304.97|325.86|250.66|271.55|313.33|355.10|370.98|367.64|313.33|355.10| 19.09 | 370.98 | 284.08 73000001|HC EKG - SIGNAL AVERAGE CC|0730|93278|780.55|452.72|||55.66|55.66|45.39|46.29|46.29|47.20|507.36|530.77|569.80|569.80|608.83|468.33|507.36|585.41|663.47|693.13|686.88|585.41|663.47| 45.39 | 693.13 | 530.77 73000001|HC EKG - SIGNAL AVERAGE CC|0730|93278|780.55|452.72|||55.66|55.66|90.76|92.57|92.57|94.39|507.36|530.77|569.80|569.80|608.83|468.33|507.36|585.41|663.47|693.13|686.88|585.41|663.47| 55.66 | 693.13 | 530.77 74000000|HC EEG-24 HOUR MONITORING|0740|95950|2,654.99|1,539.89|||||137.37|140.12|140.12|142.87|1725.74|1805.39|1938.14|1938.14|2070.89|1592.99|1725.74|1991.24|2256.74|2357.63|2336.39|1991.24|2256.74| 137.37 | 2,357.63 | 1,938.14 74000000|HC EEG-24 HOUR MONITORING|0740|95950|2,654.99|1,539.89|||||274.75|280.24|280.24|285.74|1725.74|1805.39|1938.14|1938.14|2070.89|1592.99|1725.74|1991.24|2256.74|2357.63|2336.39|1991.24|2256.74| 274.75 | 2,357.63 | 1,938.14 74000001|HC EEG-AWAKE AND ASLEEP|0740|95819|795.81|461.57|696.10|661.30|264.45|264.45|58.44|59.61|59.61|60.78|517.28|541.15|580.94|580.94|620.73|477.49|517.28|596.86|676.44|706.68|700.31|596.86|676.44| 58.44 | 706.68 | 580.94 74000001|HC EEG-AWAKE AND ASLEEP|0740|95819|795.81|461.57|696.10|661.30|264.45|264.45|124.94|127.44|127.44|129.94|517.28|541.15|580.94|580.94|620.73|477.49|517.28|596.86|676.44|706.68|700.31|596.86|676.44| 124.94 | 706.68 | 580.94 74000002|HC EEG 41 - 60 MINUTES|0740|95812|409.75|237.66|390.79|371.25|264.45|264.45|19.93|20.32|20.32|20.72|266.34|278.63|299.12|299.12|319.61|245.85|266.34|307.31|348.29|363.86|360.58|307.31|348.29| 19.93 | 390.79 | 299.12 74000002|HC EEG 41 - 60 MINUTES|0740|95812|409.75|237.66|390.79|371.2505|264.45|264.45|9.97|10.17|10.17|10.37|266.34|278.63|299.12|299.12|319.61|245.85|266.34|307.31|348.29|363.86|360.58|307.31|348.29| 9.97 | 390.79 | 299.12 74000003|HC AUDITORY-EV RESP|0740|92585|622.99|361.33|||||70.65|72.06|72.06|73.48|404.94|423.63|454.78|454.78|485.93|373.79|404.94|467.24|529.54|553.22|548.23|467.24|529.54| 70.65 | 553.22 | 454.78 74000003|HC AUDITORY-EV RESP|0740|92585|622.99|361.33|||||141.3|144.12|144.12|146.95|404.94|423.63|454.78|454.78|485.93|373.79|404.94|467.24|529.54|553.22|548.23|467.24|529.54| 141.30 | 553.22 | 454.78 74000004|HC EEG OVER 1 HOUR|0740|95813|589.20|341.74|||264.45|264.45|81.9|83.54|83.54|85.18|382.98|400.66|430.12|430.12|459.58|353.52|382.98|441.90|500.82|523.21|518.50|441.90|500.82| 81.90 | 523.21 | 400.66 74000004|HC EEG OVER 1 HOUR|0740|95813|589.20|341.74|||264.45|264.45|9.97|10.17|10.17|10.37|382.98|400.66|430.12|430.12|459.58|353.52|382.98|441.90|500.82|523.21|518.50|441.90|500.82| 9.97 | 523.21 | 400.66 74000005|HC EEG-COMA OR SLEEP ONLY|0740|95822|777.63|451.03|||264.45|264.45|34.34|35.03|35.03|35.72|505.46|528.79|567.67|567.67|606.55|466.58|505.46|583.22|660.99|690.54|684.31|583.22|660.99| 34.34 | 690.54 | 528.79 74000005|HC EEG-COMA OR SLEEP ONLY|0740|95822|777.63|451.03|||264.45|264.45|76.14|77.67|77.67|79.19|505.46|528.79|567.67|567.67|606.55|466.58|505.46|583.22|660.99|690.54|684.31|583.22|660.99| 76.14 | 690.54 | 528.79 75000000|HC MOTILITY STUDY|0750|91010|3,475.13|2,015.58|3,039.76|2,887.77|487.78|487.78|139.43|142.22|142.22|145|2258.83|2363.09|2536.84|2536.84|2710.60|2085.08|2258.83|2606.35|2953.86|3085.92|3058.11|2606.35|2953.86| 139.43 | 3,085.92 | 2,536.84 75000000|HC MOTILITY STUDY|0750|91010|3,475.13|2,015.58|3039.76|2887.772|487.78|487.78|16.48|16.81|16.81|17.14|2258.83|2363.09|2536.84|2536.84|2710.60|2085.08|2258.83|2606.35|2953.86|3085.92|3058.11|2606.35|2953.86| 16.48 | 3,085.92 | 2,536.84 75000042|HC DISKOGRAPHY S/I LUMBAR|0750|72295|2,453.61|1,423.09|||1,754.39|1,754.39|199.92|203.92|203.92|207.92|1594.85|1668.45|1791.14|1791.14|1913.82|1472.17|1594.85|1840.21|2085.57|2178.81|2159.18|1840.21|2085.57| 199.92 | 2,178.81 | 1,754.39 75000042|HC DISKOGRAPHY S/I LUMBAR|0750|72295|2,453.61|1,423.09|||1754.39|1754.39|43.83|44.71|44.71|45.58|1594.85|1668.45|1791.14|1791.14|1913.82|1472.17|1594.85|1840.21|2085.57|2178.81|2159.18|1840.21|2085.57| 43.83 | 2,178.81 | 1,754.39 75000043|HC DISKOGRAPHY S/I THORACIC/CERVICAL|0750|72285|1,521.27|882.34|||1,754.39|1,754.39|||||988.83|1034.46|1110.53|1110.53|1186.59|912.76|988.83|1140.95|1293.08|1350.89|1338.72|1140.95|1293.08| 912.76 | 1,754.39 | 1,140.95 75000044|HC INJ DISKOGRAPHY LUMBAR EACH LEVEL|0750|62290|2,348.61|1,362.19|||||130.83|133.45|133.45|136.07|1526.60|1597.05|1714.49|1714.49|1831.92|1409.17|1526.60|1761.46|1996.32|2085.57|2066.78|1761.46|1996.32| 130.83 | 2,085.57 | 1,714.49 75000045|HC INJ DISKOGRAPHY THORACIC/CERVICAL|0750|62291|2,348.61|1,362.19|||||130.83|133.45|133.45|136.07|1526.60|1597.05|1714.49|1714.49|1831.92|1409.17|1526.60|1761.46|1996.32|2085.57|2066.78|1761.46|1996.32| 130.83 | 2,085.57 | 1,714.49 75000047|HC EGD LESION ABLATION|0750|43270|3,956.47|2,294.75|1,289.43|1,224.96|1625.02|1625.02|861.5|878.73|878.73|895.96|2571.71|2690.40|2888.22|2888.22|3086.05|2373.88|2571.71|2967.35|3363.00|3513.35|3481.69|2967.35|3363.00| 861.50 | 3,513.35 | 2,571.71 75000048|HC SMALL BOWEL ENDOSCOPY: SEP PROC|0750|44360|1,861.60|1,079.73|1,420.50|1,349.48|1625.02|1625.02|294.37|300.26|300.26|306.15|1210.04|1265.89|1358.97|1358.97|1452.05|1116.96|1210.04|1396.20|1582.36|1653.10|1638.21|1396.20|1582.36| 294.37 | 1,653.10 | 1,358.97 75000049|HC SMALL INTESTINE ENDO W BX: SINGLE/MULTI|0750|44361|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|294.37|300.26|300.26|306.15|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 294.37 | 2,413.01 | 1,766.28 75000050|HC SMALL BOWEL ENDOSCOPY W FB REM|0750|44363|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|327.08|333.62|333.62|340.16|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 327.08 | 2,413.01 | 1,766.28 75000051|HC SM INTESTINE ENDO W REM T/P/L W SNARE|0750|44364|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|||||1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 1,349.48 | 2,413.01 | 1,983.67 75000052|HC SM INT ENDO W REM BY HOT BX/BP CAUTERY|0750|44365|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|294.37|300.26|300.26|306.15|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 294.37 | 2,413.01 | 1,766.28 75000053|HC SI ENDO W BLEED CNTRL|0750|44366|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|294.37|300.26|300.26|306.15|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 294.37 | 2,413.01 | 1,766.28 75000054|HC SM INTESTINE ENDO W ABLATION OF T/P/LES|0750|44369|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|||||1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 1,349.48 | 2,413.01 | 1,983.67 75000055|HC CONVERT PERC GT TO JT|0750|44373|2,717.35|1,576.06|1,420.50|1,349.48|1,625.02|1,625.02|294.37|300.26|300.26|306.15|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 294.37 | 2,413.01 | 1,766.28 75000056|HC SM INT ENDO W ILEUM: DX|0750|44376|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|294.37|300.26|300.26|306.15|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 294.37 | 2,413.01 | 1,766.28 75000057|HC SMALL INT ENDO W ILEUM W BX: SINGLE/MULTI|0750|44377|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|294.37|300.26|300.26|306.15|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 294.37 | 2,413.01 | 1,766.28 75000058|HC SI ENDO TO IL W BLEED CNTRL|0750|44378|2,717.35|1,576.06|1,420.50|1,349.48|1625.02|1625.02|294.37|300.26|300.26|306.15|1766.28|1847.80|1983.67|1983.67|2119.53|1630.41|1766.28|2038.01|2309.75|2413.01|2391.27|2038.01|2309.75| 294.37 | 2,413.01 | 1,766.28 75000059|HC SM INT ENDO W STENT|0750|44379|9,025.13|5,234.58|1,420.50|1,349.48|5028.52|5028.52|294.37|300.26|300.26|306.15|5866.33|6137.09|6588.34|6588.34|7039.60|5415.08|5866.33|6768.85|7671.36|8014.32|7942.11|6768.85|7671.36| 294.37 | 8,014.32 | 5,866.33 75000060|HC G-ESOPH REFLUX W MUCOSAL PH (BRAVO)|0750|91035|1,526.68|885.47|2,303.86|2,188.67|487.78|487.78|81.77|83.41|83.41|85.04|992.34|1038.14|1114.48|1114.48|1190.81|916.01|992.34|1145.01|1297.68|1355.69|1343.48|1145.01|1297.68| 81.77 | 2,303.86 | 1,114.48 75000060|HC G-ESOPH REFLUX W MUCOSAL PH (BRAVO)|0750|91035|1,526.68|885.47|2,303.86|2,188.67|487.78|487.78|163.54|166.81|166.81|170.08|992.34|1038.14|1114.48|1114.48|1190.81|916.01|992.34|1145.01|1297.68|1355.69|1343.48|1145.01|1297.68| 163.54 | 2,303.86 | 1,114.48 75000061|HC G-ESOPH REFLUX W MUCOSAL PH|0750|91035|3,045.00|1,766.10|2,303.86|2,188.67|487.78|487.78|81.77|83.41|83.41|85.04|1979.25|2070.60|2222.85|2222.85|2375.10|1827.00|1979.25|2283.75|2588.25|2703.96|2679.60|2283.75|2588.25| 81.77 | 2,703.96 | 2,188.67 75000061|HC G-ESOPH REFLUX W MUCOSAL PH|0750|91035|3,045.00|1,766.10|2,303.86|2,188.67|487.78|487.78|163.54|166.81|166.81|170.08|1979.25|2070.60|2222.85|2222.85|2375.10|1827.00|1979.25|2283.75|2588.25|2703.96|2679.60|2283.75|2588.25| 163.54 | 2,703.96 | 2,188.67 76100000|HC EPIFIX|0761|Q4131|1,092.97|633.92|||||||||710.43|743.22|797.87|797.87|852.52|655.78|710.43|819.73|929.02|970.56|961.81|819.73|929.02| 655.78 | 970.56 | 819.73 76100001|HC TRAD MED E&M|0761|G0463|447.44|259.52|54.14|51.43|118.74|118.74|||||290.84|304.26|326.63|326.63|349.00|268.46|290.84|335.58|380.32|397.33|393.75|335.58|380.32| 51.43 | 397.33 | 326.63 76100002|HC OP-HEMODIALYSIS MEDICARE ESRD|0761|G0257|2,558.02|1,483.65|||654.34|654.34|||||1662.71|1739.45|1867.35|1867.35|1995.26|1534.81|1662.71|1918.52|2174.32|2271.52|2251.06|1918.52|2174.32| 654.34 | 2,271.52 | 1,867.35 76100003|HC LOPS-FOLLOW-UP VISIT|0761|G0246|347.74|201.69|54.14|51.433|118.74|118.74|||||226.03|236.46|253.85|253.85|271.24|208.64|226.03|260.81|295.58|308.79|306.01|260.81|295.58| 51.43 | 308.79 | 253.85 76100004|HC LOWAPP SKIN SUB FEET >EA 100SQ|0761|C5278|1,262.66|732.34|||||||||820.73|858.61|921.74|921.74|984.87|757.60|820.73|947.00|1073.26|1121.24|1111.14|947.00|1073.26| 757.60 | 1,121.24 | 947.00 76100005|HC LOWAPP SKIN SUB FEET 100 SQ CM|0761|C5277|1,975.10|1,145.56|1141.26|1084.197|524.17|524.17|||||1283.82|1343.07|1441.82|1441.82|1540.58|1185.06|1283.82|1481.33|1678.84|1753.89|1738.09|1481.33|1678.84| 524.17 | 1,753.89 | 1,441.82 76100006|HC LOWAPP SKIN SUB FEET EAADDL25S|0761|C5276|673.46|390.61|||||||||437.75|457.95|491.63|491.63|525.30|404.08|437.75|505.10|572.44|598.03|592.64|505.10|572.44| 404.08 | 598.03 | 505.10 76100007|HC LOWAPP SKIN SUB FEET 25 SQ CM|0761|C5275|1,975.10|1,145.56|524.33|498.1135|524.17|524.17|||||1283.82|1343.07|1441.82|1441.82|1540.58|1185.06|1283.82|1481.33|1678.84|1753.89|1738.09|1481.33|1678.84| 498.11 | 1,753.89 | 1,441.82 76100008|HC LOWAPP SKIN SUB LEGS >100 EASQ|0761|C5274|4,228.82|2,452.72|||||||||2748.73|2875.60|3087.04|3087.04|3298.48|2537.29|2748.73|3171.62|3594.50|3755.19|3721.36|3171.62|3594.50| 2,537.29 | 3,755.19 | 3,171.62 76100009|HC LOWAPP SKIN SUB LEGS 100 SQ CM|0761|C5273|6,614.96|3,836.68|1141.26|1084.197|1715.36|1715.36|||||4299.72|4498.17|4828.92|4828.92|5159.67|3968.98|4299.72|4961.22|5622.72|5874.08|5821.16|4961.22|5622.72| 1,084.20 | 5,874.08 | 4,828.92 76100010|HC LOWAPP SKIN SUB LEGS EAADDL25S|0761|C5272|673.46|390.61|||||||||437.75|457.95|491.63|491.63|525.30|404.08|437.75|505.10|572.44|598.03|592.64|505.10|572.44| 404.08 | 598.03 | 505.10 76100011|HC LOWAPP SKIN SUB LEGS 25 SQ CM|0761|C5271|1,975.10|1,145.56|524.33|498.11|524.17|524.17|||||1283.82|1343.07|1441.82|1441.82|1540.58|1185.06|1283.82|1481.33|1678.84|1753.89|1738.09|1481.33|1678.84| 498.11 | 1,753.89 | 1,441.82 76100012|HC BEHAV CHNG SMOKING > 10 MIN|0761|99407|144.22|83.65|||26.23|26.23|||||93.74|98.07|105.28|105.28|112.49|86.53|93.74|108.17|122.59|128.07|126.91|108.17|122.59| 26.23 | 128.07 | 105.28 76100013|HC BEHAV CHNG SMOKING 3-10 MIN|0761|99406|115.37|66.91|||26.23|26.23|||||74.99|78.45|84.22|84.22|89.99|69.22|74.99|86.53|98.06|102.45|101.53|86.53|98.06| 26.23 | 102.45 | 84.22 76100014|HC E&M EST PT WOUND - LEVEL 5|0761|99215|717.21|415.98|142.48|135.36|||||||466.19|487.70|523.56|523.56|559.42|430.33|466.19|537.91|609.63|636.88|631.14|537.91|609.63| 135.36 | 636.88 | 523.56 76100015|HC E&M EST PT WOUND - LEVEL 4|0761|99214|652.02|378.17|113.99|108.29|||||||423.81|443.37|475.97|475.97|508.58|391.21|423.81|489.02|554.22|578.99|573.78|489.02|554.22| 108.29 | 578.99 | 475.97 76100016|HC E&M EST PT OSTOMY - LEVEL 3|0761|99214|621.13|360.26|113.99|108.29|||||||403.73|422.37|453.42|453.42|484.48|372.68|403.73|465.85|527.96|551.56|546.59|465.85|527.96| 108.29 | 551.56 | 453.42 76100017|HC E&M EST PT WOUND - LEVEL 3|0761|99213|510.74|296.23|95.46|90.69|||||||331.98|347.30|372.84|372.84|398.38|306.44|331.98|383.06|434.13|453.54|449.45|383.06|434.13| 90.69 | 453.54 | 372.84 76100018|HC E&M EST PT OSTOMY - LEVEL 2|0761|99213|486.20|282.00|95.46|90.69|||||||316.03|330.62|354.93|354.93|379.24|291.72|316.03|364.65|413.27|431.75|427.86|364.65|413.27| 90.69 | 431.75 | 354.93 76100019|HC TREATMENT ROOM|0761|99212|366.03|212.30|74.09|70.39|||||||237.92|248.90|267.20|267.20|285.50|219.62|237.92|274.52|311.13|325.03|322.11|274.52|311.13| 70.39 | 325.03 | 267.20 76100021|HC E&M EST PT OSTOMY - LEVEL 1|0761|99212|351.28|203.74|74.09|70.39|||||||228.33|238.87|256.43|256.43|274.00|210.77|228.33|263.46|298.59|311.94|309.13|263.46|298.59| 70.39 | 311.94 | 256.43 76100022|HC E&M EST PT WOUND - LEVEL 2|0761|99212|369.45|214.28|74.09|70.39|||||||240.14|251.23|269.70|269.70|288.17|221.67|240.14|277.09|314.03|328.07|325.12|277.09|314.03| 70.39 | 328.07 | 269.70 76100023|HC PHLEBOTOMY THERAPEUTIC|0761|99195|531.68|308.37|465.08|441.83|111.95|111.95|15.70|16.01|16.01|16.33|345.59|361.54|388.13|388.13|414.71|319.01|345.59|398.76|451.93|472.13|467.88|398.76|451.93| 15.70 | 472.13 | 388.13 76100024|HC BFC FOLLOW-UP VISIT|0761|99212|180.68|104.79|74.09|70.39|||||||117.44|122.86|131.90|131.90|140.93|108.41|117.44|135.51|153.58|160.44|159.00|135.51|153.58| 70.39 | 160.44 | 131.90 76100025|HC IV FLUSH ONLY|0761|99211|180.68|104.79|49.86|47.367|||||||117.44|122.86|131.90|131.90|140.93|108.41|117.44|135.51|153.58|160.44|159.00|135.51|153.58| 47.37 | 160.44 | 131.90 76100026|HC E&M EST PT WOUND - LEVEL 1|0761|99211|312.95|181.51|49.86|47.367|||||||203.42|212.81|228.45|228.45|244.10|187.77|203.42|234.71|266.01|277.90|275.40|234.71|266.01| 47.37 | 277.90 | 228.45 76100027|HC E&M NEW PT WOUND - LEVEL 5|0761|99205|825.86|479.00|237.93|226.03|||||||536.81|561.58|602.88|602.88|644.17|495.52|536.81|619.40|701.98|733.36|726.76|619.40|701.98| 226.03 | 733.36 | 602.88 76100028|HC E&M NEW PT OSTOMY - LEVEL 3|0761|99204|618.69|358.84|142.48|135.36|||||||402.15|420.71|451.64|451.64|482.58|371.21|402.15|464.02|525.89|549.40|544.45|464.02|525.89| 135.36 | 549.40 | 451.64 76100029|HC E&M NEW PT WOUND - LEVEL 4|0761|99204|618.69|358.84|142.48|135.356|||||||402.15|420.71|451.64|451.64|482.58|371.21|402.15|464.02|525.89|549.40|544.45|464.02|525.89| 135.36 | 549.40 | 451.64 76100030|HC E&M NEW PT OSTOMY - LEVEL 2|0761|99203|450.90|261.52|142.48|135.356|||||||293.09|306.61|329.16|329.16|351.70|270.54|293.09|338.18|383.27|400.40|396.79|338.18|383.27| 135.36 | 400.40 | 329.16 76100031|HC E&M NEW PT WOUND - LEVEL 3|0761|99203|557.33|323.25|142.48|135.356|||||||362.26|378.98|406.85|406.85|434.72|334.40|362.26|418.00|473.73|494.91|490.45|418.00|473.73| 135.36 | 494.91 | 406.85 76100032|HC E&M NEW PT OSTOMY - LEVEL 1|0761|99202|350.07|203.04|95.46|90.687|||||||227.55|238.05|255.55|255.55|273.05|210.04|227.55|262.55|297.56|310.86|308.06|262.55|297.56| 90.69 | 310.86 | 255.55 76100033|HC E&M NEW PT WOUND - LEVEL 2|0761|99202|467.65|271.24|95.46|90.69|||||||303.97|318.00|341.38|341.38|364.77|280.59|303.97|350.74|397.50|415.27|411.53|350.74|397.50| 90.69 | 415.27 | 341.38 76100034|HC E&M NEW PT WOUND - LEVEL 1|0761|99201|347.74|201.69|||||||||226.03|236.46|253.85|253.85|271.24|208.64|226.03|260.81|295.58|308.79|306.01|260.81|295.58| 208.64 | 308.79 | 260.81 76100035|HC MOD SED EA ADDTL 15 MIN|0761|99150|135.94|78.85|||||||||88.36|92.44|99.24|99.24|106.03|81.56|88.36|101.96|115.55|120.71|119.63|101.96|115.55| 81.56 | 120.71 | 101.96 76100036|HC MODERATE SEDATION 5 YO OR >|0761|99149|432.72|250.98|||||||||281.27|294.25|315.89|315.89|337.52|259.63|281.27|324.54|367.81|384.26|380.79|324.54|367.81| 259.63 | 384.26 | 324.54 76100037|HC MODERATE SEDATION <5 YO|0761|99148|651.51|377.88|||||||||423.48|443.03|475.60|475.60|508.18|390.91|423.48|488.63|553.78|578.54|573.33|488.63|553.78| 390.91 | 578.54 | 488.63 76100038|HC NEG PRESS WOUND TX > 50 CM|0761|97606|534.10|309.78|||345.84|345.84|57.07|58.21|58.21|59.35|347.17|363.19|389.89|389.89|416.60|320.46|347.17|400.58|453.99|474.28|470.01|400.58|453.99| 57.07 | 474.28 | 363.19 76100039|HC NEG PRESS WOUND TX 50 CM OR <|0761|97605|572.29|331.93|||179.55|179.55|44.08|44.96|44.96|45.84|371.99|389.16|417.77|417.77|446.39|343.37|371.99|429.22|486.45|508.19|503.62|429.22|486.45| 44.08 | 508.19 | 389.16 76100040|HC NSW DEBRIDEM WO A/SESSION|0761|97602|305.52|177.20|||179.55|179.55|261.66|266.90|266.90|272.13|198.59|207.75|223.03|223.03|238.31|183.31|198.59|229.14|259.69|271.30|268.86|229.14|259.69| 179.55 | 272.13 | 229.14 76100041|HC SLCTV WND DEBRIDEM > 20 CM|0761|97598|544.77|315.97|||||261.66|266.9|266.9|272.13|354.10|370.44|397.68|397.68|424.92|326.86|354.10|408.58|463.05|483.76|479.40|408.58|463.05| 261.66 | 483.76 | 397.68 76100042|HC DEB OPEN WOUND 1ST 20 SQ CM OR|0761|97597|302.66|175.54|||179.55|179.55|261.66|266.9|266.9|272.13|196.73|205.81|220.94|220.94|236.07|181.60|196.73|227.00|257.26|268.76|266.34|227.00|257.26| 179.55 | 272.13 | 227.00 76100043|HC IRRIGATE IMPLANT VAD|0761|96523|250.27|145.16|98.78|93.841|55.66|55.66|||||162.68|170.18|182.70|182.70|195.21|150.16|162.68|187.70|212.73|222.24|220.24|187.70|212.73| 55.66 | 222.24 | 182.70 76100044|HC IFC-REFILL/MAINT PORTABLE PUMP|0761|96522|759.62|440.58|||203.5|203.5|104.93|107.03|107.03|109.12|493.75|516.54|554.52|554.52|592.50|455.77|493.75|569.72|645.68|674.54|668.47|569.72|645.68| 104.93 | 674.54 | 516.54 76100045|HC IFC-REFILL/MAINT IMPL PUMP/RES|0761|96521|759.62|440.58|278.87|264.9265|203.50|203.50|104.93|107.03|107.03|109.12|493.75|516.54|554.52|554.52|592.50|455.77|493.75|569.72|645.68|674.54|668.47|569.72|645.68| 104.93 | 674.54 | 493.75 76100046|HC IVP SEQ SAME DRUG>30 MIN APART|0761|96376|256.88|148.99|94.17|89.46|||||||166.97|174.68|187.52|187.52|200.37|154.13|166.97|192.66|218.35|228.11|226.05|192.66|218.35| 89.46 | 228.11 | 187.52 76100047|HC IV PUSH ADDL NEW DRUG X1|0761|96375|264.60|153.47|94.17|89.46|40.00|40.00|30.72|31.33|31.33|31.95|171.99|179.93|193.16|193.16|206.39|158.76|171.99|198.45|224.91|234.96|232.85|198.45|224.91| 30.72 | 234.96 | 171.99 76100048|HC IV PUSH INITIAL THERAPEUTIC|0761|96374|285.55|165.62|94.17|89.46|203.50|203.50|30.72|31.33|31.33|31.95|185.61|194.17|208.45|208.45|222.73|171.33|185.61|214.16|242.72|253.57|251.28|214.16|242.72| 30.72 | 253.57 | 203.50 76100049|HC SUBQ/IM THERAPEUTIC INJECTION|0761|96372|259.09|150.27|94.17|89.46|61.97|61.97|21.17|21.59|21.59|22.02|168.41|176.18|189.14|189.14|202.09|155.45|168.41|194.32|220.23|230.07|228.00|194.32|220.23| 21.17 | 230.07 | 168.41 76100050|HC CONCURRENT INFUSION|0761|96368|395.80|229.56|1.43|1.36|||||||257.27|269.14|288.93|288.93|308.72|237.48|257.27|296.85|336.43|351.47|348.30|296.85|336.43| 1.36 | 351.47 | 288.93 76100051|HC SEQ IV INF THER-NEW DRUG-1|0761|96367|395.80|229.56|188.07|178.67|61.97|61.97|30.72|31.33|31.33|31.95|257.27|269.14|288.93|288.93|308.72|237.48|257.27|296.85|336.43|351.47|348.30|296.85|336.43| 30.72 | 351.47 | 257.27 76100052|HC IV INF THERAPY EA ADDL HR|0761|96366|269.01|156.03|188.07|178.67|40.00|40.00|21.17|21.59|21.59|22.02|174.86|182.93|196.38|196.38|209.83|161.41|174.86|201.76|228.66|238.88|236.73|201.76|228.66| 21.17 | 238.88 | 182.93 76100053|HC IV INF THERAPY INITIAL HR|0761|96365|671.42|389.42|188.07|178.67|203.50|203.50|109.38|111.56|111.56|113.75|436.42|456.57|490.14|490.14|523.71|402.85|436.42|503.57|570.71|596.22|590.85|503.57|570.71| 109.38 | 596.22 | 436.42 76100054|HC IV HYDRATION EA ADDL HR|0761|96361|250.27|145.16|253.98|241.28|40.00|40.00|21.17|21.59|21.59|22.02|162.68|170.18|182.70|182.70|195.21|150.16|162.68|187.70|212.73|222.24|220.24|187.70|212.73| 21.17 | 253.98 | 182.70 76100055|HC IV HYDRATION INITIAL HR|0761|96360|671.42|389.42|223.01|211.86|203.50|203.50|62.66|63.91|63.91|65.16|436.42|456.57|490.14|490.14|523.71|402.85|436.42|503.57|570.71|596.22|590.85|503.57|570.71| 62.66 | 596.22 | 436.42 76100056|HC RAPID DESENSITIZATION PER HOUR|0761|95180|477.51|276.96|||270.22|270.22|55.07|56.17|56.17|57.27|310.38|324.71|348.58|348.58|372.46|286.51|310.38|358.13|405.88|424.03|420.21|358.13|405.88| 55.07 | 424.03 | 324.71 76100057|HC PERC TEST (SCRATCH) W ALLERGE|0761|95004|77.85|45.15|||919.82|919.82|2.84|2.90|2.90|2.95|50.60|52.94|56.83|56.83|60.72|46.71|50.60|58.39|66.17|69.13|68.51|58.39|66.17| 2.84 | 919.82 | 56.83 76100058|HC GE RELUX STUDY-PH STUDY|0761|91034|1,554.72|901.74|1904.92|1809.674|487.78|487.78|81.77|83.41|83.41|85.04|1010.57|1057.21|1134.95|1134.95|1212.68|932.83|1010.57|1166.04|1321.51|1380.59|1368.15|1166.04|1321.51| 81.77 | 1,904.92 | 1,134.95 76100058|HC GE RELUX STUDY-PH STUDY|0761|91034|1,554.72|901.74|1,904.92|1,809.67|487.78|487.78|163.54|166.81|166.81|170.08|1010.57|1057.21|1134.95|1134.95|1212.68|932.83|1010.57|1166.04|1321.51|1380.59|1368.15|1166.04|1321.51| 163.54 | 1,904.92 | 1,134.95 76100059|HC OP - CCPD CYCLER|0761|90945|1,481.71|859.39|||363.74|363.74|102.82|104.88|104.88|106.93|963.11|1007.56|1081.65|1081.65|1155.73|889.03|963.11|1111.28|1259.45|1315.76|1303.90|1111.28|1259.45| 102.82 | 1,315.76 | 1,007.56 76100060|HC OP - HEMODIALYSIS|0761|90935|2,558.02|1,483.65|||654.34|654.34|109.83|112.03|112.03|114.23|1662.71|1739.45|1867.35|1867.35|1995.26|1534.81|1662.71|1918.52|2174.32|2271.52|2251.06|1918.52|2174.32| 109.83 | 2,271.52 | 1,739.45 76100061|HC PED-IMMUN ANY RTE ADDTL VAC/TO|0761|90461|135.67|78.69|||||||||88.19|92.26|99.04|99.04|105.82|81.40|88.19|101.75|115.32|120.47|119.39|101.75|115.32| 81.40 | 120.47 | 101.75 76100062|HC PED-IMMUN ANY RTE 1ST VAC/TO18|0761|90460|135.67|78.69|||||||||88.19|92.26|99.04|99.04|105.82|81.40|88.19|101.75|115.32|120.47|119.39|101.75|115.32| 81.40 | 120.47 | 101.75 76100063|HC REMOVE CERUMEN REQ INSTRM UNLT|0761|69210|675.82|391.98|193.78|184.09|55.66|55.66|176.62|180.16|180.16|183.69|439.28|459.56|493.35|493.35|527.14|405.49|439.28|506.87|574.45|600.13|594.72|506.87|574.45| 55.66 | 600.13 | 439.28 76100064|HC TX RETINAL LESION PRE TERM BIL|0761|67229|2,765.28|1,603.86|||503.86|503.86|||||1797.43|1880.39|2018.65|2018.65|2156.92|1659.17|1797.43|2073.96|2350.49|2455.57|2433.45|2073.96|2350.49| 503.86 | 2,455.57 | 2,018.65 76100065|HC TX RETINAL LESION PRE TERM|0761|67229|4,651.50|2,697.87|||503.86|503.86|||||3023.48|3163.02|3395.60|3395.60|3628.17|2790.90|3023.48|3488.63|3953.78|4130.53|4093.32|3488.63|3953.78| 503.86 | 4,130.53 | 3,395.60 76100067|HC IFC-ELECT ANALYSIS W/REPROG PU|0761|62368|737.70|427.87|||272.47|272.47|||||479.51|501.64|538.52|538.52|575.41|442.62|479.51|553.28|627.05|655.08|649.18|553.28|627.05| 272.47 | 655.08 | 538.52 76100068|HC LUMBAR PUNCTURE DIAGNOSTIC|0761|62270|1,950.89|1,131.52|611.22|580.66|634.59|634.59|163.54|166.81|166.81|170.08|1268.08|1326.61|1424.15|1424.15|1521.69|1170.53|1268.08|1463.17|1658.26|1732.39|1716.78|1463.17|1658.26| 163.54 | 1,732.39 | 1,268.08 76100069|HC BLADDER SCAN|0761|51798|389.46|225.89|95.46|90.69|55.66|55.66|196.25|200.17|200.17|204.10|253.15|264.83|284.31|284.31|303.78|233.68|253.15|292.10|331.04|345.84|342.72|292.10|331.04| 55.66 | 345.84 | 253.15 76100070|HC ANCHOR FOLEY CATH SIMPLE|0761|51702|207.36|120.27|95.46|90.69|111.95|111.95|||||134.78|141.00|151.37|151.37|161.74|124.42|134.78|155.52|176.26|184.14|182.48|155.52|176.26| 90.69 | 184.14 | 151.37 76100071|HC OOU-BLADDER IRRIGATION|0761|51700|328.81|190.71|95.46|90.69|266.14|266.14|196.25|200.17|200.17|204.10|213.73|223.59|240.03|240.03|256.47|197.29|213.73|246.61|279.49|291.98|289.35|246.61|279.49| 90.69 | 291.98 | 240.03 76100072|HC INSERT SMALL BOWEL FEEDING TUB|0761|44500|643.78|373.39|||809.60|809.60|||||418.46|437.77|469.96|469.96|502.15|386.27|418.46|482.84|547.21|571.68|566.53|482.84|547.21| 386.27 | 809.60 | 482.84 76100073|HC CC-CATH DECLOTTING|0761|36593|376.81|218.55|||310.75|310.75|||||244.93|256.23|275.07|275.07|293.91|226.09|244.93|282.61|320.29|334.61|331.59|282.61|320.29| 226.09 | 334.61 | 282.61 76100074|HC PLASMAPHERESIS|0761|36514|4,447.54|2,579.57|||1,363.16|1,363.16|480.81|490.42|490.42|500.04|2890.90|3024.33|3246.70|3246.70|3469.08|2668.52|2890.90|3335.66|3780.41|3949.42|3913.84|3335.66|3780.41| 480.81 | 3,949.42 | 3,024.33 76100075|HC NONSELECTIVE CATH PLACEMENT IN VEIN|0761|36000|469.70|272.43|95.46|90.69|||294.37|300.26|300.26|306.15|305.31|319.40|342.88|342.88|366.37|281.82|305.31|352.28|399.25|417.09|413.34|352.28|399.25| 90.69 | 417.09 | 319.40 76100076|HC EMERGENT INTUBATION|0761|31500|1,025.89|595.02|||211.60|211.60|294.37|300.26|300.26|306.15|666.83|697.61|748.90|748.90|800.19|615.53|666.83|769.42|872.01|910.99|902.78|769.42|872.01| 211.60 | 910.99 | 697.61 76100078|HC APPLY MULTLAY COMPRS LWR LEG|0761|29581|428.83|248.72|391.81|372.22|141.18|141.18|48.02|48.98|48.98|49.94|278.74|291.60|313.05|313.05|334.49|257.30|278.74|321.62|364.51|380.80|377.37|321.62|364.51| 48.02 | 391.81 | 313.05 76100080|HC UNNA BOOT STRAPPING|0761|29580|324.54|188.23|391.81|372.22|141.18|141.18|65.42|66.72|66.72|68.03|210.95|220.69|236.91|236.91|253.14|194.72|210.95|243.41|275.86|288.19|285.60|243.41|275.86| 65.42 | 391.81 | 236.91 76100081|HC KNEE STRAPPING|0761|29530|438.42|254.28|391.81|372.2195|111.95|111.95|261.66|266.9|266.9|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 111.95 | 391.81 | 320.05 76100082|HC APPLY RIGID TOTAL CONTACT LEG|0761|29445|924.50|536.21|51.29|48.7255|241.17|241.17|261.66|266.9|266.9|272.13|600.93|628.66|674.89|674.89|721.11|554.70|600.93|693.38|785.83|820.96|813.56|693.38|785.83| 48.73 | 820.96 | 600.93 76100083|HC SHOULDER VELPEAU STRAPPING|0761|29240|291.80|169.24|391.81|372.22|111.95|111.95|37.94|38.70|38.70|39.46|189.67|198.42|213.01|213.01|227.60|175.08|189.67|218.85|248.03|259.12|256.78|218.85|248.03| 37.94 | 391.81 | 213.01 76100084|HC SHORT ARM SPLINT|0761|29125|438.42|254.28|324.86|308.62|111.95|111.95|261.66|266.90|266.90|272.13|284.97|298.13|320.05|320.05|341.97|263.05|284.97|328.82|372.66|389.32|385.81|328.82|372.66| 111.95 | 389.32 | 308.62 76100085|HC ARTHROCENTESIS MAJOR JOINT|0761|20610|1,333.41|773.38|1,616.54|1,535.71|261.17|261.17|294.37|300.26|300.26|306.15|866.72|906.72|973.39|973.39|1040.06|800.05|866.72|1000.06|1133.40|1184.07|1173.40|1000.06|1133.40| 261.17 | 1,616.54 | 973.39 76100086|HC CHEM CAUT GRANULATION TISS|0761|17250|669.74|388.45|437.40|415.53|179.55|179.55|98.12|100.09|100.09|102.05|435.33|455.42|488.91|488.91|522.40|401.84|435.33|502.31|569.28|594.73|589.37|502.31|569.28| 98.12 | 594.73 | 437.40 76100087|HC DRESSING/DEBRIDE LARGE BURNS|0761|16030|651.93|378.12|524.33|498.11|345.84|345.84|359.79|366.98|366.98|374.18|423.75|443.31|475.91|475.91|508.51|391.16|423.75|488.95|554.14|578.91|573.70|488.95|554.14| 345.84 | 578.91 | 475.91 76100088|HC DRESS/DEBRIDE MEDIUM BURNS|0761|16025|586.73|340.30|524.33|498.11|179.55|179.55|217.05|221.39|221.39|225.73|381.37|398.98|428.31|428.31|457.65|352.04|381.37|440.05|498.72|521.02|516.32|440.05|498.72| 179.55 | 524.33 | 428.31 76100089|HC DRESSING/DEBRIDE PART THICK BU|0761|16020|763.22|442.67|524.33|498.11|179.55|179.55|217.05|221.39|221.39|225.73|496.09|518.99|557.15|557.15|595.31|457.93|496.09|572.42|648.74|677.74|671.63|572.42|648.74| 179.55 | 677.74 | 518.99 76100090|HC FIRST DEGREE BURN INITIAL TX|0761|16000|308.54|178.95|||179.55|179.55|359.79|366.98|366.98|374.18|200.55|209.81|225.23|225.23|240.66|185.12|200.55|231.41|262.26|273.98|271.52|231.41|262.26| 179.55 | 374.18 | 231.41 76100091|HC APP SKIN SUB FEET EA ADDL 25 S|0761|15276|420.87|244.10|||||71.05|72.48|72.48|73.9|273.57|286.19|307.24|307.24|328.28|252.52|273.57|315.65|357.74|373.73|370.37|315.65|357.74| 71.05 | 373.73 | 307.24 76100092|HC APP SKIN SUB FEET 25 SQ CM <|0761|15275|1,156.47|670.75|524.33|498.1135|1715.36|1715.36|193.72|197.6|197.6|201.47|751.71|786.40|844.22|844.22|902.05|693.88|751.71|867.35|983.00|1026.95|1017.69|867.35|983.00| 193.72 | 1,715.36 | 844.22 76100093|HC APP SKIN SUB LEGS EA ADDL 25SQ|0761|15272|987.85|572.95|||||71.05|72.48|72.48|73.90|642.10|671.74|721.13|721.13|770.52|592.71|642.10|740.89|839.67|877.21|869.31|740.89|839.67| 71.05 | 877.21 | 721.13 76100094|HC APP SKIN SUB LEGS 25 SQ CM <|0761|15271|1,127.39|653.89|524.33|498.11|1,715.36|1,715.36|193.72|197.60|197.60|201.47|732.80|766.63|822.99|822.99|879.36|676.43|732.80|845.54|958.28|1001.12|992.10|845.54|958.28| 193.72 | 1,715.36 | 822.99 76100095|HC REMOVAL OF NAIL BED|0761|11750|1,531.54|888.29|524.33|498.11|345.84|345.84|327.08|333.62|333.62|340.16|995.50|1041.45|1118.02|1118.02|1194.60|918.92|995.50|1148.66|1301.81|1360.01|1347.76|1148.66|1301.81| 327.08 | 1,360.01 | 995.50 76100096|HC SPL AVULSE NP, SGL|0761|11730|622.34|360.96|105.42|100.149|179.55|179.55|327.08|333.62|333.62|340.16|404.52|423.19|454.31|454.31|485.43|373.40|404.52|466.76|528.99|552.64|547.66|466.76|528.99| 100.15 | 552.64 | 404.52 76100097|HC DEBRIDE NAIL, 6 OR MORE|0761|11721|491.99|285.35|437.4|415.53|55.66|55.66|||||319.79|334.55|359.15|359.15|383.75|295.19|319.79|368.99|418.19|436.89|432.95|368.99|418.19| 55.66 | 437.40 | 368.99 76100098|HC DEBRIDE NAIL, 1-5|0761|11720|309.51|179.52|105.42|100.149|55.66|55.66|||||201.18|210.47|225.94|225.94|241.42|185.71|201.18|232.13|263.08|274.84|272.37|232.13|263.08| 55.66 | 274.84 | 225.94 76100099|HC TRIM ND NAILS ANY NUMBER|0761|11719|135.12|78.37|105.42|100.149|55.66|55.66|||||87.83|91.88|98.64|98.64|105.39|81.07|87.83|101.34|114.85|119.99|118.91|101.34|114.85| 55.66 | 119.99 | 100.15 76100100|HC BX-SKIN,SQ/MM, SGL|0761|11100|724.86|420.42|||||130.83|133.45|133.45|136.07|471.16|492.90|529.15|529.15|565.39|434.92|471.16|543.65|616.13|643.68|637.88|543.65|616.13| 130.83 | 643.68 | 529.15 76100101|HC TRIM SKIN LESIONS, 2 TO 4|0761|11056|305.54|177.21|188.07|178.6665|179.55|179.55|261.66|266.90|266.90|272.13|198.60|207.77|223.04|223.04|238.32|183.32|198.60|229.16|259.71|271.32|268.88|229.16|259.71| 178.67 | 272.13 | 229.16 76100102|HC PARE BENIGN LES, SGL|0761|11055|305.54|177.21|188.07|178.6665|179.55|179.55|261.66|266.90|266.90|272.13|198.60|207.77|223.04|223.04|238.32|183.32|198.60|229.16|259.71|271.32|268.88|229.16|259.71| 178.67 | 272.13 | 229.16 76100103|HC DEB MUSC/FASCIA EA ADDTL 20 SQ|0761|11046|991.82|575.26|393.23|373.5685|||127.19|129.74|129.74|132.28|644.68|674.44|724.03|724.03|773.62|595.09|644.68|743.87|843.05|880.74|872.80|743.87|843.05| 127.19 | 880.74 | 674.44 76100104|HC DEB SUBQ TISSUE EA ADDTL 20 SQ|0761|11045|991.82|575.26|393.23|373.5685|||127.19|129.74|129.74|132.28|644.68|674.44|724.03|724.03|773.62|595.09|644.68|743.87|843.05|880.74|872.80|743.87|843.05| 127.19 | 880.74 | 674.44 76100105|HC DEBRIDE, SKIN TO BONE 20CM OR|0761|11044|3,302.52|1,915.46|393.23|373.5685|1407|1407|261.66|266.9|266.9|272.13|2146.64|2245.71|2410.84|2410.84|2575.97|1981.51|2146.64|2476.89|2807.14|2932.64|2906.22|2476.89|2807.14| 261.66 | 2,932.64 | 2,146.64 76100106|HC DEBRIDE, SKIN TO MUSCLE 20CM O|0761|11043|1,098.81|637.31|393.23|373.5685|524.17|524.17|261.66|266.9|266.9|272.13|714.23|747.19|802.13|802.13|857.07|659.29|714.23|824.11|933.99|975.74|966.95|824.11|933.99| 261.66 | 975.74 | 714.23 76100107|HC DEBRIDE SKIN-SUBQ 20CM OR<|0761|11042|1,098.81|637.31|393.23|373.5685|345.84|345.84|261.66|266.9|266.9|272.13|714.23|747.19|802.13|802.13|857.07|659.29|714.23|824.11|933.99|975.74|966.95|824.11|933.99| 261.66 | 975.74 | 714.23 76100108|HC PUNCTURE DRAINAGE OF LESION|0761|10160|409.54|237.53|437.4|415.53|345.84|345.84|255.12|260.22|260.22|265.33|266.20|278.49|298.96|298.96|319.44|245.72|266.20|307.16|348.11|363.67|360.40|307.16|348.11| 245.72 | 437.40 | 307.16 76100109|HC I & D PILONIDAL CYST SIMPLE|0761|10080|616.94|357.83|437.4|415.53|621.97|621.97|255.12|260.22|260.22|265.33|401.01|419.52|450.37|450.37|481.21|370.16|401.01|462.71|524.40|547.84|542.91|462.71|524.40| 255.12 | 621.97 | 450.37 76100110|HC I&D ABSC, COMPL OR MULT|0761|10061|833.42|483.38|437.4|415.53|345.84|345.84|254.14|259.22|259.22|264.31|541.72|566.73|608.40|608.40|650.07|500.05|541.72|625.07|708.41|740.08|733.41|625.07|708.41| 254.14 | 740.08 | 541.72 76100111|HC I&D ABSC, SMPL OR SGL|0761|10060|583.65|338.52|437.4|415.53|179.55|179.55|254.14|259.22|259.22|264.31|379.37|396.88|426.06|426.06|455.25|350.19|379.37|437.74|496.10|518.28|513.61|437.74|496.10| 179.55 | 518.28 | 415.53 76100161|HC NPWT <= 50 SQ CM (DISPOSABLE)|0761|97607|694.58|402.86|||345.84|345.84|||||451.48|472.31|507.04|507.04|541.77|416.75|451.48|520.94|590.39|616.79|611.23|520.94|590.39| 345.84 | 616.79 | 507.04 76100162|HC NPWT > 50 SQ CM (DISPOSABLE)|0761|97608|781.69|453.38|||345.84|345.84|||||508.10|531.55|570.63|570.63|609.72|469.01|508.10|586.27|664.44|694.14|687.89|586.27|664.44| 345.84 | 694.14 | 570.63 76100163|HC CV ACCESS, TUNNELED <5YRS|0761|36557|3,314.50|1,922.41|1,863.61|1,770.43|4770.37|4770.37|480.81|490.42|490.42|500.04|2154.43|2253.86|2419.59|2419.59|2585.31|1988.70|2154.43|2485.88|2817.33|2943.28|2916.76|2485.88|2817.33| 480.81 | 4,770.37 | 2,419.59 76100164|HC CV ACCESS, TUNNELED >5YO|0761|36558|3,314.50|1,922.41|1,863.61|1,770.43|2,861.66|2,861.66|480.81|490.42|490.42|500.04|2154.43|2253.86|2419.59|2419.59|2585.31|1988.70|2154.43|2485.88|2817.33|2943.28|2916.76|2485.88|2817.33| 480.81 | 2,943.28 | 2,419.59 76100165|HC SUPERF SFT TISS BX THIGH/KNEE|0761|27323|1,333.72|773.56|437.4|415.53|1407|1407|392.50|400.35|400.35|408.20|866.92|906.93|973.62|973.62|1040.30|800.23|866.92|1000.29|1133.66|1184.34|1173.67|1000.29|1133.66| 392.50 | 1,407.00 | 973.62 76100166|HC TREATMENT ROOM- PULMONARY LAB|0761|99212|366.03|212.30|74.09|70.39|||||||237.92|248.90|267.20|267.20|285.50|219.62|237.92|274.52|311.13|325.03|322.11|274.52|311.13| 70.39 | 325.03 | 267.20 76100167|HC BRONCHIOLITIS OUTPT VISIT-LEVEL 1|0761|99211|180.68|104.79|49.86|47.367|||||||117.44|122.86|131.90|131.90|140.93|108.41|117.44|135.51|153.58|160.44|159.00|135.51|153.58| 47.37 | 160.44 | 131.90 76100168|HC ARTHROCENTESIS INTERMEDIATE JOINT|0761|20605|970.28|562.76|437.4|415.53|261.17|261.17|219.80|224.19|224.19|228.59|630.68|659.79|708.30|708.30|756.82|582.17|630.68|727.71|824.74|861.61|853.85|727.71|824.74| 219.80 | 861.61 | 630.68 76100171|HC SIMPLE REPAIR S/N/A/G/TR/E; 2.5CM/<|0761|12001|579.44|336.08|437.4|415.53|179.55|179.55|261.01|266.23|266.23|271.45|376.64|394.02|422.99|422.99|451.96|347.66|376.64|434.58|492.52|514.54|509.91|434.58|492.52| 179.55 | 514.54 | 415.53 76100172|HC APLIGRAF PER SQ CM|0761|Q4101|190.50|110.49|34.48|32.756|||||||123.83|129.54|139.07|139.07|148.59|114.30|123.83|142.88|161.93|169.16|167.64|142.88|161.93| 32.76 | 169.16 | 139.07 76100173|HC OASIS WOUND MATRIX PER SQ CM|0761|Q4102|42.89|24.88|||||||||27.88|29.17|31.31|31.31|33.45|25.73|27.88|32.17|36.46|38.09|37.74|32.17|36.46| 25.73 | 38.09 | 32.17 76100174|HC DERMAGRAFT PER SQ CM|0761|Q4106|215.08|124.75|||||||||139.80|146.25|157.01|157.01|167.76|129.05|139.80|161.31|182.82|190.99|189.27|161.31|182.82| 129.05 | 190.99 | 161.31 76100176|HC EMERGENT INTUBATION|0761|31500|1,036.54|601.19|||211.6|211.6|294.37|300.26|300.26|306.15|673.75|704.85|756.67|756.67|808.50|621.92|673.75|777.41|881.06|920.45|912.16|777.41|881.06| 211.60 | 920.45 | 704.85 76100177|HC CENTRAL LINE INSERTION >5YRS|0761|36556|2,763.96|1,603.10|1,863.61|1,770.43|2,861.66|2,861.66|480.81|490.42|490.42|500.04|1796.57|1879.49|2017.69|2017.69|2155.89|1658.38|1796.57|2072.97|2349.37|2454.40|2432.28|2072.97|2349.37| 480.81 | 2,861.66 | 2,017.69 76100178|HC CC TREATMENT ROOM|0761|99212|366.03|212.30|74.09|70.39|||||||237.92|248.90|267.20|267.20|285.50|219.62|237.92|274.52|311.13|325.03|322.11|274.52|311.13| 70.39 | 325.03 | 267.20 76100179|HC EPIDRM AUTOGRFT TRNK/ARM/LEG 100 SQ|0761|15110|4,862.03|2,819.98|||1715.36|1715.36|354.12|361.21|361.21|368.29|3160.32|3306.18|3549.28|3549.28|3792.38|2917.22|3160.32|3646.52|4132.73|4317.48|4278.59|3646.52|4132.73| 354.12 | 4,317.48 | 3,306.18 76100180|HC EPIDRM A-GRFT FACE/NCK/HF/G 100 SQ CM|0761|15115|4,862.03|2,819.98|||1,715.36|1,715.36|354.12|361.21|361.21|368.29|3160.32|3306.18|3549.28|3549.28|3792.38|2917.22|3160.32|3646.52|4132.73|4317.48|4278.59|3646.52|4132.73| 354.12 | 4,317.48 | 3,306.18 76100181|HC EPIDRM AUTOGRFT T/A/L ADDL 100 SQ CM|0761|15111|1,823.26|1,057.49|||||354.12|361.21|361.21|368.29|1185.12|1239.82|1330.98|1330.98|1422.14|1093.96|1185.12|1367.45|1549.77|1619.05|1604.47|1367.45|1549.77| 354.12 | 1,619.05 | 1,330.98 76100182|HC EPIDRM A-GRAFT F/N/HF/G ADDL 100 SQ CM|0761|15116|1,823.26|1,057.49|||||354.12|361.21|361.21|368.29|1185.12|1239.82|1330.98|1330.98|1422.14|1093.96|1185.12|1367.45|1549.77|1619.05|1604.47|1367.45|1549.77| 354.12 | 1,619.05 | 1,330.98 76100183|HC REMOVE TUNNELED CENT VENOUS CATH|0761|36589|2,363.26|1,370.69|930.38|883.861|541.62|541.62|206.28|210.41|210.41|214.53|1536.12|1607.02|1725.18|1725.18|1843.34|1417.96|1536.12|1772.45|2008.77|2098.57|2079.67|1772.45|2008.77| 206.28 | 2,098.57 | 1,536.12 76100184|HC BONE MARROW; ASP ONLY|0761|38220|2,370.24|1,374.74|||1,407.00|1,407.00|44.84|45.73|45.73|46.63|1540.66|1611.76|1730.28|1730.28|1848.79|1422.14|1540.66|1777.68|2014.70|2104.77|2085.81|1777.68|2014.70| 44.84 | 2,104.77 | 1,611.76 76100185|HC BONE MARROW; BIOPSY|0761|38221|2,370.24|1,374.74|||1,407.00|1,407.00|56.98|58.12|58.12|59.26|1540.66|1611.76|1730.28|1730.28|1848.79|1422.14|1540.66|1777.68|2014.70|2104.77|2085.81|1777.68|2014.70| 56.98 | 2,104.77 | 1,611.76 76100186|HC PURAPLY, PURAPLY ANTIMIC 2X2|0761|C9349|2,522.17|1,462.86|||||||||1639.41|1715.08|1841.18|1841.18|1967.29|1513.30|1639.41|1891.63|2143.84|2239.69|2219.51|1891.63|2143.84| 1,513.30 | 2,239.69 | 1,891.63 76100187|HC PURAPLY, PURAPLY ANTIMIC 2X4|0761|C9349|3,816.69|2,213.68|||||||||2480.85|2595.35|2786.18|2786.18|2977.02|2290.01|2480.85|2862.52|3244.19|3389.22|3358.69|2862.52|3244.19| 2,290.01 | 3,389.22 | 2,862.52 76100188|HC PURAPLY, PURAPLY ANTIMIC 5X5|0761|C9349|8,508.55|4,934.96|||||||||5530.56|5785.81|6211.24|6211.24|6636.67|5105.13|5530.56|6381.41|7232.27|7555.59|7487.52|6381.41|7232.27| 5,105.13 | 7,555.59 | 6,381.41 76100189|HC PURAPLY, PURAPLY ANTIMIC 6X9|0761|C9349|18,378.45|10,659.50|||||||||11945.99|12497.35|13416.27|13416.27|14335.19|11027.07|11945.99|13783.84|15621.68|16320.06|16173.04|13783.84|15621.68| 11,027.07 | 16,320.06 | 13,783.84 76100190|HC MOD SED OTH PHYS/QHP <5YRS 1ST 15 MIN|0761|99155|684.61|397.07|||||||||445.00|465.53|499.77|499.77|534.00|410.77|445.00|513.46|581.92|607.93|602.46|513.46|581.92| 410.77 | 607.93 | 513.46 76100191|HC MOD SED OTH PHYS/QHP 5/>YRS 1ST 15 MIN|0761|99156|684.61|397.07|||||||||445.00|465.53|499.77|499.77|534.00|410.77|445.00|513.46|581.92|607.93|602.46|513.46|581.92| 410.77 | 607.93 | 513.46 76100192|HC MOD SED OTH PHYS/QHP EA ADD 15 MIN|0761|99157|135.94|78.85|||||||||88.36|92.44|99.24|99.24|106.03|81.56|88.36|101.96|115.55|120.71|119.63|101.96|115.55| 81.56 | 120.71 | 101.96 76100193|HC PURAPLY, PURAPLY ANTIMIC, SQ CM|0761|Q4172|729.31|423.00|||||||||474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 437.59 | 647.63 | 546.98 76100194|HC GRAFIX PRIME, SQ CM|0761|Q4133|850.86|493.50|||||||||553.06|578.58|621.13|621.13|663.67|510.52|553.06|638.15|723.23|755.56|748.76|638.15|723.23| 510.52 | 755.56 | 638.15 76100195|HC DX BONE MARROW BX & ASP|0761|38222|4,746.26|2,752.83|||2,370.01|2,370.01|||||3085.07|3227.46|3464.77|3464.77|3702.08|2847.76|3085.07|3559.70|4034.32|4214.68|4176.71|3559.70|4034.32| 2,370.01 | 4,214.68 | 3,464.77 76100196|HC CHORIONIC VILLUS SAMPLING|0761|59015|810.93|470.34|||633.41|633.41|||||527.10|551.43|591.98|591.98|632.53|486.56|527.10|608.20|689.29|720.11|713.62|608.20|689.29| 486.56 | 720.11 | 608.20 76100197|HC NONSELECTIVE CATH PLACEMENT IN VEIN|0761|36000|469.70|272.43|95.46|90.69|||294.37|300.26|300.26|306.15|305.31|319.40|342.88|342.88|366.37|281.82|305.31|352.28|399.25|417.09|413.34|352.28|399.25| 90.69 | 417.09 | 319.40 76100198|HC APP SKIN SUB LEGS 100 SQ CM <|0761|15273|3,285.45|1,905.56|1141.26|1084.197|3,522.15|3,522.15|295.63|301.54|301.54|307.45|2135.54|2234.11|2398.38|2398.38|2562.65|1971.27|2135.54|2464.09|2792.63|2917.48|2891.20|2464.09|2792.63| 295.63 | 3,522.15 | 2,398.38 76100199|HC APP SKIN SUB LEGS EA ADDL 100 SQ|0761|15274|2,552.29|1,480.33|||||193.72|197.6|197.6|201.47|1658.99|1735.56|1863.17|1863.17|1990.79|1531.37|1658.99|1914.22|2169.45|2266.43|2246.02|1914.22|2169.45| 193.72 | 2,266.43 | 1,863.17 76100200|HC INCISIONAL BIOPSY SKIN SINGLE LESION|0761|11106|3,570.00|2,070.60|437.40|415.53|524.17|524.17|||||2320.50|2427.60|2606.10|2606.10|2784.60|2142.00|2320.50|2677.50|3034.50|3170.16|3141.60|2677.50|3034.50| 415.53 | 3,170.16 | 2,606.10 76100201|HC TANGENTIAL BIOPSY OF SKIN (E.G., SHAVE, SCOOP, SAUCERIZE, CURETTE) SINGLE LESION|0761|11102|262.50|152.25|437.40|415.53|179.55|179.55|||||170.63|178.50|191.63|191.63|204.75|157.50|170.63|196.88|223.13|233.10|231.00|196.88|223.13| 157.50 | 437.40 | 196.88 76200000|HC O/P OBSERVATION|0762|99218|350.07|203.04|||||98.12|100.09|100.09|102.05|227.55|238.05|255.55|255.55|273.05|210.04|227.55|262.55|297.56|310.86|308.06|262.55|297.56| 98.12 | 310.86 | 255.55 76200001|HC DIRECT ADM OBSERVATION|0762|99218|365.18|211.80|||||98.12|100.09|100.09|102.05|237.37|248.32|266.58|266.58|284.84|219.11|237.37|273.89|310.40|324.28|321.36|273.89|310.40| 98.12 | 324.28 | 266.58 76200002|HC OBSERVATION CARVE-OUT - RADIOLOGY|0762|99218|78.46|45.51|||||98.12|100.09|100.09|102.05|51.00|53.35|57.28|57.28|61.20|47.08|51.00|58.85|66.69|69.67|69.04|58.85|66.69| 47.08 | 102.05 | 61.20 76200003|HC OBSERVATION CARVE-OUT - G.I.|0762|99218|78.46|45.51|||||98.12|100.09|100.09|102.05|51.00|53.35|57.28|57.28|61.20|47.08|51.00|58.85|66.69|69.67|69.04|58.85|66.69| 47.08 | 102.05 | 61.20 76200004|HC OBSERVATION CARVE-OUT - CARDIOLOGY|0762|99218|78.46|45.51|||||98.12|100.09|100.09|102.05|51.00|53.35|57.28|57.28|61.20|47.08|51.00|58.85|66.69|69.67|69.04|58.85|66.69| 47.08 | 102.05 | 61.20 76200005|HC OBSERVATION CARVE-OUT - RESPIRATORY|0762|99218|78.46|45.51|||||98.12|100.09|100.09|102.05|51.00|53.35|57.28|57.28|61.20|47.08|51.00|58.85|66.69|69.67|69.04|58.85|66.69| 47.08 | 102.05 | 61.20 76200006|HC DIRECT ADMIT|0762|99218|333.40|193.37|||||98.12|100.09|100.09|102.05|216.71|226.71|243.38|243.38|260.05|200.04|216.71|250.05|283.39|296.06|293.39|250.05|283.39| 98.12 | 296.06 | 243.38 77000000|HC LOW DOSE CT LUNG SCREENING|0770|G0297|200.00|116.00|||||||||130.00|136.00|146.00|146.00|156.00|120.00|130.00|150.00|170.00|177.60|176.00|150.00|170.00| 120.00 | 177.60 | 150.00 77100000|HC IMMUNIZ ADM ONE VACCINE|0771|90471|135.67|78.69|118.67|112.74|61.97|61.97|18.51|18.88|18.88|19.25|88.19|92.26|99.04|99.04|105.82|81.40|88.19|101.75|115.32|120.47|119.39|101.75|115.32| 18.51 | 120.47 | 99.04 77100001|HC IMMUNIZ ADM EA ADDTL VACCI|0771|90472|135.67|78.69|118.67|112.74|||18.51|18.88|18.88|19.25|88.19|92.26|99.04|99.04|105.82|81.40|88.19|101.75|115.32|120.47|119.39|101.75|115.32| 18.51 | 120.47 | 99.04 84000000|HC OP CAPD|0840|90945|1,818.00|1,054.44|||363.74|363.74|102.82|104.88|104.88|106.93|1181.70|1236.24|1327.14|1327.14|1418.04|1090.80|1181.70|1363.50|1545.30|1614.38|1599.84|1363.50|1545.30| 102.82 | 1,614.38 | 1,236.24 85000000|HC OP - CCPD CYCLER|0850|90945|1,481.71|859.39|||363.74|363.74|102.82|104.88|104.88|106.93|963.11|1007.56|1081.65|1081.65|1155.73|889.03|963.11|1111.28|1259.45|1315.76|1303.90|1111.28|1259.45| 102.82 | 1,315.76 | 1,007.56 90000000|HC IOP PSYCH DIAGNOSTIC EVAL|0900|90791|153.31|88.92|||133.63|133.63|||||99.65|104.25|111.92|111.92|119.58|91.99|99.65|114.98|130.31|136.14|134.91|114.98|130.31| 91.99 | 136.14 | 114.98 90000001|HC PHP PSYCH DIAGNOSTIC EVAL|0900|90791|153.31|88.92|||133.63|133.63|||||99.65|104.25|111.92|111.92|119.58|91.99|99.65|114.98|130.31|136.14|134.91|114.98|130.31| 91.99 | 136.14 | 114.98 90000002|HC IOP PSY TX W/PATIENT 45 MIN|0900|90834|268.86|155.94|||133.63|133.63|||||174.76|182.82|196.27|196.27|209.71|161.32|174.76|201.65|228.53|238.75|236.60|201.65|228.53| 133.63 | 238.75 | 196.27 90100000|HC ELECTROCONVULSIVE THERAPY|0901|90870|1,345.17|780.20|||487.78|487.78|392.50|400.35|400.35|408.20|874.36|914.72|981.97|981.97|1049.23|807.10|874.36|1008.88|1143.39|1194.51|1183.75|1008.88|1143.39| 392.50 | 1,194.51 | 914.72 90400000|HC ACTIVITY THERAPY - 45 MIN OR MORE|0904|G0176|643.47|373.21|||||||||418.26|437.56|469.73|469.73|501.91|386.08|418.26|482.60|546.95|571.40|566.25|482.60|546.95| 386.08 | 571.40 | 482.60 90500000|HC IOP SUBSTANCE - DAILY BLUE CROSS|0905|S9480|334.05|193.75|166.75|158.41|||||||217.13|227.15|243.86|243.86|260.56|200.43|217.13|250.54|283.94|296.64|293.96|250.54|283.94| 158.41 | 296.64 | 243.86 91200000|HC PHP - DAILY BLUE CROSS|0912|90899|2,549.38|1,478.64|||26.23|26.23|||||1657.10|1733.58|1861.05|1861.05|1988.52|1529.63|1657.10|1912.04|2166.97|2263.85|2243.45|1912.04|2166.97| 26.23 | 2,263.85 | 1,861.05 91300000|HC PHP DAILY - SELF PAY|0913|90899|962.31|558.14|||26.23|26.23|||||625.50|654.37|702.49|702.49|750.60|577.39|625.50|721.73|817.96|854.53|846.83|721.73|817.96| 26.23 | 854.53 | 702.49 91400000|HC PSY TX PT AND/OR FAM 30 MIN|0914|90832|206.73|119.90|||133.63|133.63|||||134.37|140.58|150.91|150.91|161.25|124.04|134.37|155.05|175.72|183.58|181.92|155.05|175.72| 124.04 | 183.58 | 150.91 91400001|HC PSY TX W/PATIENT 45 MIN|0914|90834|275.66|159.88|||133.63|133.63|||||179.18|187.45|201.23|201.23|215.01|165.40|179.18|206.75|234.31|244.79|242.58|206.75|234.31| 133.63 | 244.79 | 201.23 91500000|HC GROUP PSYCHOTHERAPY PHP|0915|G0410|376.29|218.25|||||||||244.59|255.88|274.69|274.69|293.51|225.77|244.59|282.22|319.85|334.15|331.14|282.22|319.85| 225.77 | 334.15 | 282.22 91500001|HC IOP GROUP PSYCHOTHERAPY|0915|90853|111.34|64.58|97.38|92.51|74.87|74.87|||||72.37|75.71|81.28|81.28|86.85|66.80|72.37|83.51|94.64|98.87|97.98|83.51|94.64| 66.80 | 98.87 | 83.51 91500002|HC IOP FEDERAL(FEP)DAILY BLUE CROSS|0915|90899|334.05|193.75|||26.23|26.23|||||217.13|227.15|243.86|243.86|260.56|200.43|217.13|250.54|283.94|296.64|293.96|250.54|283.94| 26.23 | 296.64 | 243.86 91600000|HC FAMILY PSYCH W/PATIENT 50 MIN|0916|90847|376.29|218.25|33.14|31.48|133.63|133.63|||||244.59|255.88|274.69|274.69|293.51|225.77|244.59|282.22|319.85|334.15|331.14|282.22|319.85| 31.48 | 334.15 | 274.69 92000000|HC CONTRACTION STRESS TEST|0920|59020|482.16|279.65|142.48|135.36|170.32|170.32|39.25|40.03|40.03|40.82|313.40|327.87|351.98|351.98|376.08|289.30|313.40|361.62|409.84|428.16|424.30|361.62|409.84| 39.25 | 428.16 | 313.40 92000000|HC CONTRACTION STRESS TEST|0920|59020|482.16|279.65|142.48|135.36|170.32|170.32|78.50|80.07|80.07|81.64|313.40|327.87|351.98|351.98|376.08|289.30|313.40|361.62|409.84|428.16|424.30|361.62|409.84| 78.50 | 428.16 | 313.40 92000002|HC ACTIGRAPHY|0920|95803|66.37|38.49|||55.66|55.66|||||43.14|45.13|48.45|48.45|51.77|39.82|43.14|49.78|56.41|58.94|58.41|49.78|56.41| 39.82 | 58.94 | 49.78 92000003|HC MULTIPLE SLEEP LATENCY|0920|95805|2,873.46|1,666.61|1,203.88|1,143.69|487.78|487.78|||||1867.75|1953.95|2097.63|2097.63|2241.30|1724.08|1867.75|2155.10|2442.44|2551.63|2528.64|2155.10|2442.44| 487.78 | 2,551.63 | 2,097.63 92000004|HC SLEEP STUDY UNATT&RESP EFFT|0920|95806|663.67|384.93|290.65|276.12|139.55|139.55|||||431.39|451.30|484.48|484.48|517.66|398.20|431.39|497.75|564.12|589.34|584.03|497.75|564.12| 139.55 | 589.34 | 484.48 92000005|HC SLEEP STAGING 4/MORE PARA|0920|95810|5,029.77|2,917.27|1,203.88|1,143.69|919.82|919.82|||||3269.35|3420.24|3671.73|3671.73|3923.22|3017.86|3269.35|3772.33|4275.30|4466.44|4426.20|3772.33|4275.30| 919.82 | 4,466.44 | 3,671.73 92000006|HC SLEEP STAGING W/CPAP|0920|95811|5,748.13|3,333.92|1,203.88|1,143.69|919.82|919.82|||||3736.28|3908.73|4196.13|4196.13|4483.54|3448.88|3736.28|4311.10|4885.91|5104.34|5058.35|4311.10|4885.91| 919.82 | 5,104.34 | 4,196.13 92000007|HC HOME SLEEP TEST/TYPE 3 PORTA|0920|G0399|663.67|384.93|290.65|276.12|139.55|139.55|||||431.39|451.30|484.48|484.48|517.66|398.20|431.39|497.75|564.12|589.34|584.03|497.75|564.12| 139.55 | 589.34 | 484.48 92100000|HC CAPILLARY STICK|0921|36416|25.79|14.96|3.48|3.31|||||||16.76|17.54|18.83|18.83|20.12|15.47|16.76|19.34|21.92|22.90|22.70|19.34|21.92| 3.31 | 22.90 | 18.83 92100001|HC ARTERIAL STICK|0921|36600|60.92|35.33|95.46|90.69|111.95|111.95|13.74|14.01|14.01|14.29|39.60|41.43|44.47|44.47|47.52|36.55|39.60|45.69|51.78|54.10|53.61|45.69|51.78| 13.74 | 111.95 | 45.69 92100002|HC EXTRACRANIAL ARTERIES - BI|0921|93880|771.15|447.27|678.19|644.28|230.13|230.13|203.52|207.59|207.59|211.66|501.25|524.38|562.94|562.94|601.50|462.69|501.25|578.36|655.48|684.78|678.61|578.36|655.48| 203.52 | 684.78 | 562.94 92100002|HC EXTRACRANIAL ARTERIES - BI|0921|93880|771.15|447.27|678.19|644.28|230.13|230.13|162.95|166.21|166.21|169.47|501.25|524.38|562.94|562.94|601.50|462.69|501.25|578.36|655.48|684.78|678.61|578.36|655.48| 162.95 | 684.78 | 562.94 92100003|HC EXTRACRANIAL ARTERIES-UNILI|0921|93882|861.79|499.84|678.19|644.28|108.97|108.97|35.98|36.70|36.70|37.42|560.16|586.02|629.11|629.11|672.20|517.07|560.16|646.34|732.52|765.27|758.38|646.34|732.52| 35.98 | 765.27 | 629.11 92100003|HC EXTRACRANIAL ARTERIES-UNILI|0921|93882|861.79|499.84|678.19|644.28|108.97|108.97|71.96|73.40|73.40|74.84|560.16|586.02|629.11|629.11|672.20|517.07|560.16|646.34|732.52|765.27|758.38|646.34|732.52| 71.96 | 765.27 | 629.11 92100004|HC TRANS/INTRACRANIAL-COMPLETE|0921|93886|899.70|521.83|678.19|644.28|230.13|230.13|49.06|50.04|50.04|51.02|584.81|611.80|656.78|656.78|701.77|539.82|584.81|674.78|764.75|798.93|791.74|674.78|764.75| 49.06 | 798.93 | 644.28 92100004|HC TRANS/INTRACRANIAL-COMPLETE|0921|93886|899.70|521.83|678.19|644.28|230.13|230.13|98.12|100.09|100.09|102.05|584.81|611.80|656.78|656.78|701.77|539.82|584.81|674.78|764.75|798.93|791.74|674.78|764.75| 98.12 | 798.93 | 644.28 92100005|HC ART-ABI-PHYSIO 1-2 LEVELS-BIL|0921|93922|873.96|506.90|678.19|644.28|111.95|111.95|107.28|109.43|109.43|111.57|568.07|594.29|637.99|637.99|681.69|524.38|568.07|655.47|742.87|776.08|769.08|655.47|742.87| 107.28 | 776.08 | 637.99 92100005|HC ART-ABI-PHYSIO 1-2 LEVELS-BIL|0921|93922|873.96|506.90|678.19|644.28|111.95|111.95|53.64|54.71|54.71|55.79|568.07|594.29|637.99|637.99|681.69|524.38|568.07|655.47|742.87|776.08|769.08|655.47|742.87| 53.64 | 776.08 | 637.99 92100006|HC ART-TCPO2-PHYSIO 3+ LEVELS-BIL|0921|93923|1,800.16|1,044.09|678.19|644.28|139.55|139.55|107.28|109.43|109.43|111.57|1170.10|1224.11|1314.12|1314.12|1404.12|1080.10|1170.10|1350.12|1530.14|1598.54|1584.14|1350.12|1530.14| 107.28 | 1,598.54 | 1,170.10 92100006|HC ART-TCPO2-PHYSIO 3+ LEVELS-BIL|0921|93923|1,800.16|1,044.09|678.19|644.28|139.55|139.55|53.64|54.71|54.71|55.79|1170.10|1224.11|1314.12|1314.12|1404.12|1080.10|1170.10|1350.12|1530.14|1598.54|1584.14|1350.12|1530.14| 53.64 | 1,598.54 | 1,170.10 92100007|HC ART-SEG-PRESS-EXERCISE|0921|93924|1,402.70|813.57|678.19|644.28|264.45|264.45|53.64|54.71|54.71|55.79|911.76|953.84|1023.97|1023.97|1094.11|841.62|911.76|1052.03|1192.30|1245.60|1234.38|1052.03|1192.30| 53.64 | 1,245.60 | 911.76 92100007|HC ART-SEG-PRESS-EXERCISE|0921|93924|1,402.70|813.57|678.19|644.28|264.45|264.45|107.28|109.43|109.43|111.57|911.76|953.84|1023.97|1023.97|1094.11|841.62|911.76|1052.03|1192.30|1245.60|1234.38|1052.03|1192.30| 107.28 | 1,245.60 | 911.76 92100008|HC ART-IMAGING-LOWER-BILATERAL|0921|93925|1,449.80|840.88|678.19|644.28|230.13|230.13|53.64|54.71|54.71|55.79|942.37|985.86|1058.35|1058.35|1130.84|869.88|942.37|1087.35|1232.33|1287.42|1275.82|1087.35|1232.33| 53.64 | 1,287.42 | 942.37 92100008|HC ART-IMAGING-LOWER-BILATERAL|0921|93925|1,449.80|840.88|678.19|644.28|230.13|230.13|203.46|207.53|207.53|211.60|942.37|985.86|1058.35|1058.35|1130.84|869.88|942.37|1087.35|1232.33|1287.42|1275.82|1087.35|1232.33| 203.46 | 1,287.42 | 942.37 92100009|HC ART-IMAGING-LOWER-UNI-LIM|0921|93926|824.12|477.99|678.19|644.28|108.97|108.97|40.56|41.37|41.37|42.18|535.68|560.40|601.61|601.61|642.81|494.47|535.68|618.09|700.50|731.82|725.23|618.09|700.50| 40.56 | 731.82 | 601.61 92100009|HC ART-IMAGING-LOWER-UNI-LIM|0921|93926|824.12|477.99|678.19|644.28|108.97|108.97|135.87|138.59|138.59|141.30|535.68|560.40|601.61|601.61|642.81|494.47|535.68|618.09|700.50|731.82|725.23|618.09|700.50| 108.97 | 731.82 | 601.61 92100010|HC ART-IMAGING-UPPER-BILATERAL|0921|93930|1,397.83|810.74|678.19|644.28|230.13|230.13|53.64|54.71|54.71|55.79|908.59|950.52|1020.42|1020.42|1090.31|838.70|908.59|1048.37|1188.16|1241.27|1230.09|1048.37|1188.16| 53.64 | 1,241.27 | 908.59 92100010|HC ART-IMAGING-UPPER-BILATERAL|0921|93930|1,397.83|810.74|678.19|644.28|230.13|230.13|108.64|110.82|110.82|112.99|908.59|950.52|1020.42|1020.42|1090.31|838.70|908.59|1048.37|1188.16|1241.27|1230.09|1048.37|1188.16| 108.64 | 1,241.27 | 908.59 92100011|HC ART-IMAGING-UPPER-UNI-LIM|0921|93931|729.31|423.00|678.19|644.28|108.97|108.97|40.56|41.37|41.37|42.18|474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 40.56 | 678.19 | 532.40 92100011|HC ART-IMAGING-UPPER-UNI-LIM|0921|93931|729.31|423.00|678.19|644.28|108.97|108.97|81.12|82.74|82.74|84.36|474.05|495.93|532.40|532.40|568.86|437.59|474.05|546.98|619.91|647.63|641.79|546.98|619.91| 81.12 | 678.19 | 532.40 92100012|HC VEN-IMAGING-BILATERAL|0921|93970|1,321.26|766.33|678.19|644.28|230.13|230.13|226.34|230.87|230.87|235.39|858.82|898.46|964.52|964.52|1030.58|792.76|858.82|990.95|1123.07|1173.28|1162.71|990.95|1123.07| 226.34 | 1,173.28 | 858.82 92100012|HC VEN-IMAGING-BILATERAL|0921|93970|1,321.26|766.33|678.19|644.28|230.13|230.13|53.64|54.71|54.71|55.79|858.82|898.46|964.52|964.52|1030.58|792.76|858.82|990.95|1123.07|1173.28|1162.71|990.95|1123.07| 53.64 | 1,173.28 | 858.82 92100013|HC VEN-IMAGING-UNI-LIM|0921|93971|934.62|542.08|678.19|644.28|108.97|108.97|120.67|123.08|123.08|125.49|607.50|635.54|682.27|682.27|729.00|560.77|607.50|700.97|794.43|829.94|822.47|700.97|794.43| 108.97 | 829.94 | 644.28 92100013|HC VEN-IMAGING-UNI-LIM|0921|93971|934.62|542.08|678.19|644.28|108.97|108.97|150.14|153.15|153.15|156.15|607.50|635.54|682.27|682.27|729.00|560.77|607.50|700.97|794.43|829.94|822.47|700.97|794.43| 108.97 | 829.94 | 644.28 92100014|HC DOPPLER ABDOMEN OR PELVIS|0921|93975|1,503.46|872.01|678.19|644.28|230.13|230.13|53.64|54.71|54.71|55.79|977.25|1022.35|1097.53|1097.53|1172.70|902.08|977.25|1127.60|1277.94|1335.07|1323.04|1127.60|1277.94| 53.64 | 1,335.07 | 977.25 92100014|HC DOPPLER ABDOMEN OR PELVIS|0921|93975|1,503.46|872.01|678.19|644.28|230.13|230.13|157.13|160.27|160.27|163.41|977.25|1022.35|1097.53|1097.53|1172.70|902.08|977.25|1127.60|1277.94|1335.07|1323.04|1127.60|1277.94| 157.13 | 1,335.07 | 977.25 92100015|HC LIMITED DOPPLER, ABD OR PELVIS|0921|93976|1,042.91|604.89|678.19|644.28|108.97|108.97|40.56|41.37|41.37|42.18|677.89|709.18|761.32|761.32|813.47|625.75|677.89|782.18|886.47|926.10|917.76|782.18|886.47| 40.56 | 926.10 | 678.19 92100015|HC LIMITED DOPPLER, ABD OR PELVIS|0921|93976|1,042.91|604.89|678.19|644.28|108.97|108.97|104.81|106.91|106.91|109.00|677.89|709.18|761.32|761.32|813.47|625.75|677.89|782.18|886.47|926.10|917.76|782.18|886.47| 104.81 | 926.10 | 678.19 92100016|HC DUPLEX AORTO ILIAC|0921|93978|1,320.30|765.77|678.19|644.28|230.13|230.13|53.64|54.71|54.71|55.79|858.20|897.80|963.82|963.82|1029.83|792.18|858.20|990.23|1122.26|1172.43|1161.86|990.23|1122.26| 53.64 | 1,172.43 | 858.20 92100016|HC DUPLEX AORTO ILIAC|0921|93978|1,320.30|765.77|678.19|644.28|230.13|230.13|110.55|112.76|112.76|114.98|858.20|897.80|963.82|963.82|1029.83|792.18|858.20|990.23|1122.26|1172.43|1161.86|990.23|1122.26| 110.55 | 1,172.43 | 858.20 92100017|HC DUPLEX AORTO ILIAC UNI-LIM|0921|93979|638.86|370.54|678.19|644.28|108.97|108.97|81.12|82.74|82.74|84.36|415.26|434.42|466.37|466.37|498.31|383.32|415.26|479.15|543.03|567.31|562.20|479.15|543.03| 81.12 | 678.19 | 466.37 92100017|HC DUPLEX AORTO ILIAC UNI-LIM|0921|93979|638.86|370.54|678.19|644.28|108.97|108.97|40.56|41.37|41.37|42.18|415.26|434.42|466.37|466.37|498.31|383.32|415.26|479.15|543.03|567.31|562.20|479.15|543.03| 40.56 | 678.19 | 466.37 92100018|HC AV IMAGING DIALYSIS ACCESS|0921|93990|630.85|365.89|678.19|644.28|108.97|108.97|53.64|54.71|54.71|55.79|410.05|428.98|460.52|460.52|492.06|378.51|410.05|473.14|536.22|560.19|555.15|473.14|536.22| 53.64 | 678.19 | 460.52 92100018|HC AV IMAGING DIALYSIS ACCESS|0921|93990|630.85|365.89|678.19|644.28|108.97|108.97|107.28|109.43|109.43|111.57|410.05|428.98|460.52|460.52|492.06|378.51|410.05|473.14|536.22|560.19|555.15|473.14|536.22| 107.28 | 678.19 | 460.52 92100019|HC BODY PLETHYSMOGRAPHY|0921|94726|488.13|283.12|426.99|405.64|264.45|264.45|||||317.28|331.93|356.33|356.33|380.74|292.88|317.28|366.10|414.91|433.46|429.55|366.10|414.91| 264.45 | 433.46 | 366.10 92100020|HC INTRACRANIAL ARTERY DOPPLER; LIMITED|0921|93888|725.06|420.53|678.19|644.28|108.97|108.97|35.98|36.70|36.70|37.42|471.29|493.04|529.29|529.29|565.55|435.04|471.29|543.80|616.30|643.85|638.05|543.80|616.30| 35.98 | 678.19 | 529.29 92100020|HC INTRACRANIAL ARTERY DOPPLER; LIMITED|0921|93888|725.06|420.53|678.19|644.28|108.97|108.97|71.96|73.40|73.40|74.84|471.29|493.04|529.29|529.29|565.55|435.04|471.29|543.80|616.30|643.85|638.05|543.80|616.30| 71.96 | 678.19 | 529.29 92100021|HC SCAN HEMO COMPL BI STD|0921|93985|1,647.45|955.52|678.19|644.28|230.13|230.13|||||1070.84|1120.27|1202.64|1202.64|1285.01|988.47|1070.84|1235.59|1400.33|1462.94|1449.76|1235.59|1400.33| 230.13 | 1,462.94 | 1,202.64 92100022|HC DUP-SCAN HEMO COMPL UNI STD|0921|93986|993.30|576.11|678.19|644.28|108.97|108.97|||||645.65|675.44|725.11|725.11|774.77|595.98|645.65|744.98|844.31|882.05|874.10|744.98|844.31| 108.97 | 882.05 | 725.11 92200000|HC EMG ELECTROMYOGRAPHY 5+ MUSCLE|0922|95886|121.55|70.50|413.18|392.52|||71.53|72.96|72.96|74.39|79.01|82.65|88.73|88.73|94.81|72.93|79.01|91.16|103.32|107.94|106.96|91.16|103.32| 71.53 | 413.18 | 88.73 92200000|HC EMG ELECTROMYOGRAPHY 5+ MUSCLE|0922|95886|121.55|70.50|413.18|392.52|||71.53|72.96|72.96|74.39|79.01|82.65|88.73|88.73|94.81|72.93|79.01|91.16|103.32|107.94|106.96|91.16|103.32| 71.53 | 413.18 | 88.73 92200001|HC NVR CNDJ TST 1-2 STUDIES|0922|95907|195.45|113.36|179.53|170.55|139.55|139.55|36.66|37.39|37.39|38.13|127.04|132.91|142.68|142.68|152.45|117.27|127.04|146.59|166.13|173.56|172.00|146.59|166.13| 36.66 | 179.53 | 142.68 92200002|HC NRV CNDJ TST 5-6 STUDIES|0922|95909|288.70|167.45|538.57|511.64|264.45|264.45|36.66|37.39|37.39|38.13|187.66|196.32|210.75|210.75|225.19|173.22|187.66|216.53|245.40|256.37|254.06|216.53|245.40| 36.66 | 538.57 | 216.53 92200003|HC NRV CNDJ TEST 7-8 STUDIES|0922|95910|379.63|220.19|718.08|682.18|264.45|264.45|36.66|37.39|37.39|38.13|246.76|258.15|277.13|277.13|296.11|227.78|246.76|284.72|322.69|337.11|334.07|284.72|322.69| 36.66 | 718.08 | 277.13 92200004|HC NRV CNDJ TEST 9-10 STUDIES|0922|95911|459.93|266.76|897.60|852.72|487.78|487.78|67.89|69.25|69.25|70.60|298.95|312.75|335.75|335.75|358.75|275.96|298.95|344.95|390.94|408.42|404.74|344.95|390.94| 67.89 | 897.60 | 344.95 92200005|HC NRV CNDJ TEST 11-12 STUDIES|0922|95912|539.57|312.95|1,077.13|1,023.27|487.78|487.78|67.89|69.25|69.25|70.60|350.72|366.91|393.89|393.89|420.86|323.74|350.72|404.68|458.63|479.14|474.82|404.68|458.63| 67.89 | 1,077.13 | 404.68 92200006|HC NRV CNDJ TEST 13/> STUDIES|0922|95913|625.83|362.98|1,256.64|1,193.81|487.78|487.78|67.89|69.25|69.25|70.60|406.79|425.56|456.86|456.86|488.15|375.50|406.79|469.37|531.96|555.74|550.73|469.37|531.96| 67.89 | 1,256.64 | 469.37 92200007|HC SOMATOSENSORY COMPLETE MSSP ME|0922|95925|622.99|361.33|||264.45|264.45|11.85|12.09|12.09|12.33|404.94|423.63|454.78|454.78|485.93|373.79|404.94|467.24|529.54|553.22|548.23|467.24|529.54| 11.85 | 553.22 | 423.63 92200007|HC SOMATOSENSORY COMPLETE MSSP ME|0922|95925|622.99|361.33|||264.45|264.45|44.55|45.44|45.44|46.33|404.94|423.63|454.78|454.78|485.93|373.79|404.94|467.24|529.54|553.22|548.23|467.24|529.54| 44.55 | 553.22 | 423.63 92200008|HC VISUAL EVOKED RESPONSE|0922|95930|622.99|361.33|99.72|94.73|264.45|264.45|41.85|42.69|42.69|43.53|404.94|423.63|454.78|454.78|485.93|373.79|404.94|467.24|529.54|553.22|548.23|467.24|529.54| 41.85 | 553.22 | 404.94 92200008|HC VISUAL EVOKED RESPONSE|0922|95930|622.99|361.33|99.72|94.73|264.45|264.45|83.69|85.37|85.37|87.04|404.94|423.63|454.78|454.78|485.93|373.79|404.94|467.24|529.54|553.22|548.23|467.24|529.54| 83.69 | 553.22 | 404.94 92200009|HC ORBIC BL REF|0922|95933|142.16|82.45|98.30|93.39|55.66|55.66|||||92.40|96.67|103.78|103.78|110.88|85.30|92.40|106.62|120.84|126.24|125.10|106.62|120.84| 55.66 | 126.24 | 103.78 92200010|HC NEUROMUSC JUNCTION TEST EA NER|0922|95937|48.78|28.29|131.08|124.53|139.55|139.55|||||31.71|33.17|35.61|35.61|38.05|29.27|31.71|36.59|41.46|43.32|42.93|36.59|41.46| 29.27 | 139.55 | 38.05 92200011|HC SOMATOSENSORY, TIBIAL|0922|95926|1,109.76|643.66|||264.45|264.45|25.07|25.57|25.57|26.07|721.34|754.64|810.12|810.12|865.61|665.86|721.34|832.32|943.30|985.47|976.59|832.32|943.30| 25.07 | 985.47 | 754.64 92200011|HC SOMATOSENSORY, TIBIAL|0922|95926|1,109.76|643.66|||264.45|264.45|47.13|48.07|48.07|49.01|721.34|754.64|810.12|810.12|865.61|665.86|721.34|832.32|943.30|985.47|976.59|832.32|943.30| 47.13 | 985.47 | 754.64 92200012|HC EMG LESS THAN 5 MUSCLES|0922|95885|358.58|207.98|104.01|98.81|||71.53|72.96|72.96|74.39|233.08|243.83|261.76|261.76|279.69|215.15|233.08|268.94|304.79|318.42|315.55|268.94|304.79| 71.53 | 318.42 | 243.83 92200012|HC EMG LESS THAN 5 MUSCLES|0922|95885|358.58|207.98|104.01|98.81|||71.53|72.96|72.96|74.39|233.08|243.83|261.76|261.76|279.69|215.15|233.08|268.94|304.79|318.42|315.55|268.94|304.79| 71.53 | 318.42 | 243.83 92200013|HC EMG NON-EXTREMITY OR FACIAL|0922|95887|252.83|146.64|269.27|255.81|||37.56|38.31|38.31|39.06|164.34|171.92|184.57|184.57|197.21|151.70|164.34|189.62|214.91|224.51|222.49|189.62|214.91| 37.56 | 269.27 | 184.57 92200013|HC EMG NON-EXTREMITY OR FACIAL|0922|95887|252.83|146.64|269.27|255.81|||37.56|38.31|38.31|39.06|164.34|171.92|184.57|184.57|197.21|151.70|164.34|189.62|214.91|224.51|222.49|189.62|214.91| 37.56 | 269.27 | 184.57 92200014|HC NRV COND TEST 3-4 STUDIES|0922|95908|339.13|196.70|359.05|341.10|264.45|264.45|36.66|37.39|37.39|38.13|220.43|230.61|247.56|247.56|264.52|203.48|220.43|254.35|288.26|301.15|298.43|254.35|288.26| 36.66 | 359.05 | 254.35 92200015|HC EMG THORACIC PARASPINAL MUSCLES T3-T11|0922|95869|212.72|123.38|123.96|117.76|139.55|139.55|5.36|5.47|5.47|5.58|138.27|144.65|155.29|155.29|165.92|127.63|138.27|159.54|180.81|188.90|187.19|159.54|180.81| 5.36 | 188.90 | 139.55 92200015|HC EMG THORACIC PARASPINAL MUSCLES T3-T11|0922|95869|212.72|123.38|123.96|117.76|139.55|139.55|19.66|20.06|20.06|20.45|138.27|144.65|155.29|155.29|165.92|127.63|138.27|159.54|180.81|188.90|187.19|159.54|180.81| 19.66 | 188.90 | 139.55 94200000|HC EDUCATION/TRAINING - PER DAY|0942|G0177|643.47|373.21|||||||||418.26|437.56|469.73|469.73|501.91|386.08|418.26|482.60|546.95|571.40|566.25|482.60|546.95| 386.08 | 571.40 | 482.60 94300000|HC CARDIAC REHAB PHASE II UNMONIT|0943|93797|207.44|120.32|181.44|172.37|116.06|116.06|||||134.84|141.06|151.43|151.43|161.80|124.46|134.84|155.58|176.32|184.21|182.55|155.58|176.32| 116.06 | 184.21 | 155.58 94300001|HC CARDIAC REHAB PHASE II MONITOR|0943|93798|207.44|120.32|181.44|172.37|116.06|116.06|27.81|28.37|28.37|28.93|134.84|141.06|151.43|151.43|161.80|124.46|134.84|155.58|176.32|184.21|182.55|155.58|176.32| 27.81 | 184.21 | 151.43 |FINE NEEDLE ASPIRATION BIOPSY, WITHOUT IMAGING GUIDANCE; EACH ADDITIONAL LESION||10004||| 660.00 | 627.00 |||||||||||||||||||| 627.00 | 660.00 | 643.50 |FINE NEEDLE ASPIRATION BIOPSY, INCLUDING MR GUIDANCE; FIRST LESION||10011||| 660.00 | 627.00 | 621.97 | 621.97 |||||||||||||||||| 621.97 | 660.00 | 624.49 |FINE NEEDLE ASPIRATION BIOPSY, INCLUDING MR GUIDANCE; EACH ADDITIONAL LESION (LI||10012||| 660.00 | 627.00 |||||||||||||||||||| 627.00 | 660.00 | 643.50 |DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTUR||11010||| 393.23 | 373.57 | 621.97 | 621.97 |||||||||||||||||| 373.57 | 621.97 | 507.60 |DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTUR||11011||| 393.23 | 373.57 | 621.97 | 621.97 |||||||||||||||||| 373.57 | 621.97 | 507.60 |DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTUR||11012||| 393.23 | 373.57 | 2,370.01 | 2,370.01 |||||||||||||||||| 373.57 | 2,370.01 | 1,381.62 |DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/O||11047||| 393.23 | 373.57 ||| 395.43 | 403.34 | 411.24 ||||||||||||||| 373.57 | 411.24 | 395.43 |PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE THA||11057||| 437.40 | 415.53 | 179.55 | 179.55 | 261.66 | 266.90 | 272.13 ||||||||||||||| 179.55 | 437.40 | 266.90 |TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); EACH SEPARATE/||11103||| 437.40 | 415.53 |||||||||||||||||||| 415.53 | 437.40 | 426.47 |PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION||11104||| 437.40 | 415.53 | 345.84 | 345.84 |||||||||||||||||| 345.84 | 437.40 | 380.69 |PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); EACH SEPARATE/A||11105||| 437.40 | 415.53 |||||||||||||||||||| 415.53 | 437.40 | 426.47 |INCISIONAL BIOPSY OF SKIN (EG, WEDGE) (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED)||11107||| 437.40 | 415.53 |||||||||||||||||||| 415.53 | 437.40 | 426.47 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESIO||11300||| 105.42 | 100.15 | 345.84 | 345.84 | 196.25 | 200.17 | 204.10 ||||||||||||||| 100.15 | 345.84 | 200.17 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESIO||11301||| 105.42 | 100.15 | 179.55 | 179.55 | 196.25 | 200.17 | 204.10 ||||||||||||||| 100.15 | 204.10 | 179.55 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESIO||11302||| 105.42 | 100.15 | 179.55 | 179.55 | 196.25 | 200.17 | 204.10 ||||||||||||||| 100.15 | 204.10 | 179.55 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESIO||11303||| 524.33 | 498.11 | 345.84 | 345.84 | 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 524.33 | 345.84 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,||11305||| 105.42 | 100.15 | 179.55 | 179.55 | 196.25 | 200.17 | 204.10 ||||||||||||||| 100.15 | 204.10 | 179.55 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,||11306||| 105.42 | 100.15 | 179.55 | 179.55 | 196.25 | 200.17 | 204.10 ||||||||||||||| 100.15 | 204.10 | 179.55 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,||11307||| 105.42 | 100.15 | 179.55 | 179.55 | 196.25 | 200.17 | 204.10 ||||||||||||||| 100.15 | 204.10 | 179.55 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET,||11308||| 524.33 | 498.11 | 345.84 | 345.84 | 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 524.33 | 345.84 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE,||11310||| 105.42 | 100.15 | 179.55 | 179.55 | 261.66 | 266.90 | 272.13 ||||||||||||||| 100.15 | 272.13 | 179.55 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE,||11311||| 105.42 | 100.15 | 179.55 | 179.55 | 261.66 | 266.90 | 272.13 ||||||||||||||| 100.15 | 272.13 | 179.55 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE,||11312||| 105.42 | 100.15 | 345.84 | 345.84 | 261.66 | 266.90 | 272.13 ||||||||||||||| 100.15 | 345.84 | 266.90 |SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE,||11313||| 524.33 | 498.11 | 345.84 | 345.84 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 524.33 | 345.84 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11400||| 105.42 | 100.15 | 621.97 | 621.97 | 294.37 | 300.26 | 306.15 ||||||||||||||| 100.15 | 621.97 | 300.26 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11401||| 105.42 | 100.15 | 345.84 | 345.84 | 288.48 | 294.25 | 300.02 ||||||||||||||| 100.15 | 345.84 | 294.25 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11402||| 105.42 | 100.15 | 621.97 | 621.97 | 294.37 | 300.26 | 306.15 ||||||||||||||| 100.15 | 621.97 | 300.26 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11403||| 105.42 | 100.15 | 621.97 | 621.97 | 294.37 | 300.26 | 306.15 ||||||||||||||| 100.15 | 621.97 | 300.26 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11404||| 524.33 | 498.11 | 1,407.00 | 1,407.00 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,407.00 | 498.11 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11406||| 1,275.18 | 1,211.42 | 1,407.00 | 1,407.00 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,407.00 | 1,211.42 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11420||| 105.42 | 100.15 | 1,407.00 | 1,407.00 | 294.37 | 300.26 | 306.15 ||||||||||||||| 100.15 | 1,407.00 | 300.26 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11421||| 105.42 | 100.15 | 621.97 | 621.97 | 294.37 | 300.26 | 306.15 ||||||||||||||| 100.15 | 621.97 | 300.26 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11422||| 105.42 | 100.15 | 1,407.00 | 1,407.00 | 294.37 | 300.26 | 306.15 ||||||||||||||| 100.15 | 1,407.00 | 300.26 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11423||| 105.42 | 100.15 | 1,407.00 | 1,407.00 | 327.08 | 333.62 | 340.16 ||||||||||||||| 100.15 | 1,407.00 | 333.62 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11424||| 524.33 | 498.11 | 1,407.00 | 1,407.00 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,407.00 | 498.11 |EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH||11426||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,370.01 | 1,084.20 |EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED||11440||| 105.42 | 100.15 | 621.97 | 621.97 | 327.08 | 333.62 | 340.16 ||||||||||||||| 100.15 | 621.97 | 333.62 |EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED||11441||| 105.42 | 100.15 | 621.97 | 621.97 | 327.08 | 333.62 | 340.16 ||||||||||||||| 100.15 | 621.97 | 333.62 |EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED||11442||| 105.42 | 100.15 | 621.97 | 621.97 | 294.37 | 300.26 | 306.15 ||||||||||||||| 100.15 | 621.97 | 300.26 |EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED||11443||| 105.42 | 100.15 | 1,407.00 | 1,407.00 | 327.08 | 333.62 | 340.16 ||||||||||||||| 100.15 | 1,407.00 | 333.62 |EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED||11444||| 524.33 | 498.11 | 1,407.00 | 1,407.00 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,407.00 | 498.11 |EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED||11446||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,370.01 | 1,084.20 |EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE||11450||| 105.42 | 100.15 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 2,370.01 | 400.35 |EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH COMPLE||11451||| 524.33 | 498.11 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,370.01 | 498.11 |EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH SIMPLE||11462||| 105.42 | 100.15 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 2,370.01 | 400.35 |EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH COMPLE||11463||| 524.33 | 498.11 | 2,370.01 | 2,370.01 |||||||||||||||||| 498.11 | 2,370.01 | 1,447.17 |EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, O||11470||| 105.42 | 100.15 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 2,370.01 | 400.35 |EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, O||11471||| 524.33 | 498.11 | 2,370.01 | 2,370.01 | 352.15 | 359.19 | 366.23 ||||||||||||||| 352.15 | 2,370.01 | 498.11 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM||11600||| 105.42 | 100.15 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 621.97 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM||11601||| 105.42 | 100.15 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 621.97 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM||11602||| 105.42 | 100.15 | 345.84 | 345.84 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 345.84 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM||11603||| 105.42 | 100.15 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 621.97 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM||11604||| 524.33 | 498.11 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 621.97 | 498.11 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAM||11606||| 1,141.26 | 1,084.20 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 1,084.20 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALI||11620||| 105.42 | 100.15 | 1,407.00 | 1,407.00 |||||||||||||||||| 100.15 | 1,407.00 | 756.21 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALI||11621||| 105.42 | 100.15 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 621.97 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALI||11622||| 105.42 | 100.15 | 621.97 | 621.97 | 425.20 | 433.71 | 442.21 ||||||||||||||| 100.15 | 621.97 | 433.71 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALI||11623||| 105.42 | 100.15 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 1,407.00 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALI||11624||| 524.33 | 498.11 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 498.11 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALI||11626||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,370.01 | 1,084.20 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; E||11640||| 105.42 | 100.15 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 621.97 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; E||11641||| 105.42 | 100.15 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 621.97 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; E||11642||| 105.42 | 100.15 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 621.97 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; E||11643||| 105.42 | 100.15 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 1,407.00 | 400.35 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; E||11644||| 636.86 | 605.02 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 605.02 |EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; E||11646||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,370.01 | 1,084.20 |BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL N||11755||| 524.33 | 498.11 | 621.97 | 621.97 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 621.97 | 498.11 |RECONSTRUCTION OF NAIL BED WITH GRAFT||11762||| 524.33 | 498.11 | 1,715.36 | 1,715.36 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,715.36 | 498.11 |EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE||11770||| 175.25 | 166.49 | 2,370.01 | 2,370.01 | 536.41 | 547.14 | 557.87 ||||||||||||||| 166.49 | 2,370.01 | 547.14 |EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE||11771||| 1,426.20 | 1,354.89 | 2,370.01 | 2,370.01 | 536.41 | 547.14 | 557.87 ||||||||||||||| 536.41 | 2,370.01 | 1,354.89 |EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED||11772||| 1,971.89 | 1,873.30 | 2,370.01 | 2,370.01 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,370.01 | 1,873.30 |REMOVAL OF TISSUE EXPANDER WITHOUT INSERTION OF IMPLANT||11971||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 938.64 | 957.41 | 976.19 ||||||||||||||| 415.53 | 2,370.01 | 957.41 |TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING||12021||| 304.90 | 289.66 | 345.84 | 345.84 | 266.11 | 271.43 | 276.76 ||||||||||||||| 266.11 | 345.84 | 289.66 |SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED||13160||| 524.33 | 498.11 | 1,715.36 | 1,715.36 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 1,715.36 | 498.11 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS||14000||| 524.33 | 498.11 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 498.11 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ C||14001||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,715.36 | 1,084.20 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ||14020||| 524.33 | 498.11 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 498.11 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1||14021||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 1,084.20 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,||14040||| 524.33 | 498.11 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 498.11 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,||14041||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 1,084.20 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFE||14060||| 735.79 | 699.00 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 699.00 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFE||14061||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,715.36 | 1,084.20 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 S||14301||| 2,169.94 | 2,061.44 | 3,522.15 | 3,522.15 | 1,090.48 | 1,112.29 | 1,134.10 ||||||||||||||| 1,090.48 | 3,522.15 | 2,061.44 |ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM,||14302||| 1,085.67 | 1,031.39 ||| 1,090.48 | 1,112.29 | 1,134.10 ||||||||||||||| 1,031.39 | 1,134.10 | 1,090.48 |SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B||15002||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 |||||||||||||||||| 1,084.20 | 1,715.36 | 1,428.31 |SURGICAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF OPEN WOUNDS, B||15004||| 1,141.26 | 1,084.20 | 524.17 | 524.17 |||||||||||||||||| 524.17 | 1,141.26 | 804.18 |PINCH GRAFT, SINGLE OR MULTIPLE, TO COVER SMALL ULCER, TIP OF DIGIT, OR OTHER MI||15050||| 437.40 | 415.53 | 524.17 | 524.17 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 524.17 | 415.53 |SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF||15100||| 3,043.33 | 2,891.16 | 1,715.36 | 1,715.36 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,043.33 | 1,715.36 |SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENI||15120||| 3,043.33 | 2,891.16 | 3,522.15 | 3,522.15 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,522.15 | 2,891.16 |FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS,||15220||| 491.53 | 466.95 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 466.95 |FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS,||15260||| 491.53 | 466.95 | 1,715.36 | 1,715.36 | 438.29 | 447.05 | 455.82 ||||||||||||||| 438.29 | 1,715.36 | 466.95 |APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS,||15277||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 | 295.63 | 301.54 | 307.45 ||||||||||||||| 295.63 | 1,715.36 | 1,084.20 |GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR OR NASAL ALA), INCLUDING PR||15760||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,715.36 | 1,084.20 |GRAFT; DERMA-FAT-FASCIA||15770||| 1,141.26 | 1,084.20 | 3,522.15 | 3,522.15 |||||||||||||||||| 1,084.20 | 3,522.15 | 2,331.71 |BLEPHAROPLASTY, LOWER EYELID;||15820||| 524.33 | 498.11 | 1,715.36 | 1,715.36 |||||||||||||||||| 498.11 | 1,715.36 | 1,119.85 |BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FAT PAD||15821||| 524.33 | 498.11 | 1,715.36 | 1,715.36 |||||||||||||||||| 498.11 | 1,715.36 | 1,119.85 |BLEPHAROPLASTY, UPPER EYELID;||15822||| 524.33 | 498.11 | 1,715.36 | 1,715.36 | 329.70 | 336.29 | 342.88 ||||||||||||||| 329.70 | 1,715.36 | 498.11 |BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID||15823||| 524.33 | 498.11 | 1,715.36 | 1,715.36 | 366.33 | 373.66 | 380.98 ||||||||||||||| 366.33 | 1,715.36 | 498.11 |DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI||17000||| 437.40 | 415.53 | 179.55 | 179.55 | 28.78 | 29.36 | 29.93 ||||||||||||||| 28.78 | 437.40 | 179.55 |DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI||17004||| 1,141.26 | 1,084.20 | 345.84 | 345.84 | 116.44 | 118.77 | 121.10 ||||||||||||||| 116.44 | 1,141.26 | 345.84 |DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); L||17106||| 437.40 | 415.53 | 345.84 | 345.84 | 457.91 | 467.07 | 476.23 ||||||||||||||| 345.84 | 476.23 | 437.40 |DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); 1||17107||| 524.33 | 498.11 | 524.17 | 524.17 | 523.33 | 533.79 | 544.26 ||||||||||||||| 498.11 | 544.26 | 524.17 |DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); O||17108||| 1,141.26 | 1,084.20 | 1,715.36 | 1,715.36 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 1,715.36 | 1,084.20 |DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI||17110||| 524.33 | 498.11 | 179.55 | 179.55 | 217.05 | 221.39 | 225.73 ||||||||||||||| 179.55 | 524.33 | 221.39 |DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGI||17111||| 1,141.26 | 1,084.20 | 179.55 | 179.55 |||||||||||||||||| 179.55 | 1,141.26 | 631.87 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17260||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17261||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17262||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17263||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17264||| 524.33 | 498.11 | 345.84 | 345.84 | 392.50 | 400.35 | 408.20 ||||||||||||||| 345.84 | 524.33 | 400.35 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17266||| 1,141.26 | 1,084.20 | 345.84 | 345.84 | 392.50 | 400.35 | 408.20 ||||||||||||||| 345.84 | 1,141.26 | 400.35 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17270||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17271||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17272||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17273||| 105.42 | 100.15 | 345.84 | 345.84 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 345.84 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17274||| 524.33 | 498.11 | 345.84 | 345.84 | 392.50 | 400.35 | 408.20 ||||||||||||||| 345.84 | 524.33 | 400.35 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17276||| 1,141.26 | 1,084.20 | 345.84 | 345.84 | 392.50 | 400.35 | 408.20 ||||||||||||||| 345.84 | 1,141.26 | 400.35 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17280||| 105.42 | 100.15 | 179.55 | 179.55 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 179.55 |DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, C||17281||| 105.42 | 100.15 | 345.84 | 345.84 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 408.20 | 345.84 |MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP||19020||| 524.33 | 498.11 | 1,407.00 | 1,407.00 | 588.74 | 600.52 | 612.29 ||||||||||||||| 498.11 | 1,407.00 | 600.52 |INJECTION PROCEDURE ONLY FOR MAMMARY DUCTOGRAM OR GALACTOGRAM||19030||| 393.23 | 373.57 |||||||||||||||||||| 373.57 | 393.23 | 383.40 |BIOPSY, BREAST, WITH PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METAL||19081||| 2,144.28 | 2,037.07 | 1,407.00 | 1,407.00 | 597.05 | 608.99 | 620.93 ||||||||||||||| 597.05 | 2,144.28 | 1,407.00 |BIOPSY, BREAST, WITH PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METAL||19082||| 2,144.28 | 2,037.07 |||||||||||||||||||| 2,037.07 | 2,144.28 | 2,090.67 |BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, NOT USING IMAGING GUIDANCE (SEPARAT||19100||| 636.86 | 605.02 | 1,407.00 | 1,407.00 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 1,407.00 | 612.29 |BIOPSY OF BREAST; OPEN, INCISIONAL||19101||| 1,916.32 | 1,820.50 | 3,157.74 | 3,157.74 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,157.74 | 1,820.50 |NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A||19110||| 2,144.28 | 2,037.07 | 3,157.74 | 3,157.74 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,157.74 | 2,037.07 |EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BRE||19120||| 2,144.28 | 2,037.07 | 3,157.74 | 3,157.74 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,157.74 | 2,037.07 |EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL M||19125||| 2,144.28 | 2,037.07 | 3,157.74 | 3,157.74 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,157.74 | 2,037.07 |PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEED||19281||| 393.23 | 373.57 | 621.97 | 621.97 | 83.55 | 85.22 | 86.89 ||||||||||||||| 83.55 | 621.97 | 373.57 |PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEED||19282||| 393.23 | 373.57 |||||||||||||||||||| 373.57 | 393.23 | 383.40 |PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEED||19283||| 393.23 | 373.57 | 621.97 | 621.97 | 83.55 | 85.22 | 86.89 ||||||||||||||| 83.55 | 621.97 | 373.57 |PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEED||19284||| 393.23 | 373.57 |||||||||||||||||||| 373.57 | 393.23 | 383.40 |PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEED||19286||| 562.79 | 534.65 |||||||||||||||||||| 534.65 | 562.79 | 548.72 |PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG CLIP, METALLIC PELLET, WIRE/NEEDL||19288||| 1,135.55 | 1,078.77 |||||||||||||||||||| 1,078.77 | 1,135.55 | 1,107.16 |MASTECTOMY FOR GYNECOMASTIA||19300||| 4,577.81 | 4,348.92 | 3,157.74 | 3,157.74 |||||||||||||||||| 3,157.74 | 4,577.81 | 3,753.33 |MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);||19301||| 4,577.81 | 4,348.92 | 3,157.74 | 3,157.74 |||||||||||||||||| 3,157.74 | 4,577.81 | 3,753.33 |MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);||19302||| 4,577.81 | 4,348.92 | 5,533.94 | 5,533.94 |||||||||||||||||| 4,348.92 | 5,533.94 | 5,055.88 |MASTECTOMY, SIMPLE, COMPLETE||19303||| 4,577.81 | 4,348.92 | 5,533.94 | 5,533.94 |||||||||||||||||| 4,348.92 | 5,533.94 | 5,055.88 |MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY LYMPH NODES||19305||| 4,577.81 | 4,348.92 |||||||||||||||||||| 4,348.92 | 4,577.81 | 4,463.36 |MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY AND INTERNAL MAMMARY L||19306||| 4,577.81 | 4,348.92 |||||||||||||||||||| 4,348.92 | 4,577.81 | 4,463.36 |MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PE||19307||| 4,577.81 | 4,348.92 | 5,533.94 | 5,533.94 | 1,979.53 | 2,019.12 | 2,058.71 ||||||||||||||| 1,979.53 | 5,533.94 | 4,348.92 |BREAST REDUCTION||19318||| 4,577.81 | 4,348.92 | 5,533.94 | 5,533.94 |||||||||||||||||| 4,348.92 | 5,533.94 | 5,055.88 |NIPPLE/AREOLA RECONSTRUCTION||19350||| 4,577.81 | 4,348.92 | 3,157.74 | 3,157.74 | 909.94 | 928.14 | 946.33 ||||||||||||||| 909.94 | 4,577.81 | 3,157.74 |CORRECTION OF INVERTED NIPPLES||19355||| 4,577.81 | 4,348.92 | 3,157.74 | 3,157.74 |||||||||||||||||| 3,157.74 | 4,577.81 | 3,753.33 |TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSI||19357||| 9,174.12 | 8,715.41 | 14,928.70 | 14,928.70 | 2,447.47 | 2,496.42 | 2,545.37 ||||||||||||||| 2,447.47 | 14,928.70 | 8,715.41 |BREAST RECONSTRUCTION; WITH LATISSIMUS DORSI FLAP||19361||| 4,577.81 | 4,348.92 |||||||||||||||||||| 4,348.92 | 4,577.81 | 4,463.36 |BREAST RECONSTRUCTION; WITH FREE FLAP (EG, FTRAM, DIEP, SIEA, GAP FLAP)||19364||| 4,577.81 | 4,348.92 |||||||||||||||||||| 4,348.92 | 4,577.81 | 4,463.36 |BREAST RECONSTRUCTION; WITH SINGLE-PEDICLED TRANSVERSE RECTUS ABDOMINIS MYOCUTAN||19367||| 4,577.81 | 4,348.92 |||||||||||||||||||| 4,348.92 | 4,577.81 | 4,463.36 |BREAST RECONSTRUCTION; WITH SINGLE-PEDICLED TRANSVERSE RECTUS ABDOMINIS MYOCUTAN||19368||| 4,577.81 | 4,348.92 |||||||||||||||||||| 4,348.92 | 4,577.81 | 4,463.36 |BREAST RECONSTRUCTION; WITH BIPEDICLED TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS||19369||| 4,577.81 | 4,348.92 |||||||||||||||||||| 4,348.92 | 4,577.81 | 4,463.36 |REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY,||19370||| 4,577.81 | 4,348.92 | 3,157.74 | 3,157.74 |||||||||||||||||| 3,157.74 | 4,577.81 | 3,753.33 |PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSU||19371||| 4,577.81 | 4,348.92 | 3,157.74 | 3,157.74 |||||||||||||||||| 3,157.74 | 4,577.81 | 3,753.33 |REVISION OF RECONSTRUCTED BREAST (EG, SIGNIFICANT REMOVAL OF TISSUE, RE-ADVANCEM||19380||| 4,577.81 | 4,348.92 | 5,533.94 | 5,533.94 |||||||||||||||||| 4,348.92 | 5,533.94 | 5,055.88 |BIOPSY, MUSCLE; SUPERFICIAL||20200||| 871.96 | 828.36 | 1,407.00 | 1,407.00 | 281.29 | 286.91 | 292.54 ||||||||||||||| 281.29 | 1,407.00 | 828.36 |BIOPSY, MUSCLE; DEEP||20205||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 281.29 | 286.91 | 292.54 ||||||||||||||| 281.29 | 2,370.01 | 1,084.20 |BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLE||20240||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 281.29 | 286.91 | 292.54 ||||||||||||||| 281.29 | 2,370.01 | 1,084.20 |BIOPSY, BONE, OPEN; DEEP (EG, HUMERAL SHAFT, ISCHIUM, FEMORAL SHAFT)||20245||| 1,567.26 | 1,488.90 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,370.01 | 1,488.90 |BIOPSY, VERTEBRAL BODY, OPEN; THORACIC||20250||| 1,567.26 | 1,488.90 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,488.90 |BIOPSY, VERTEBRAL BODY, OPEN; LUMBAR OR CERVICAL||20251||| 1,567.26 | 1,488.90 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,488.90 | 6,264.95 | 3,916.11 |INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE PROCEDURE)||20500||| 393.23 | 373.57 | 1,352.79 | 1,352.79 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 1,352.79 | 373.57 |INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM)||20501||| 393.23 | 373.57 ||| 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 393.23 | 228.59 |REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE||20520||| 105.42 | 100.15 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 100.15 | 1,407.00 | 400.35 |REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED||20525||| 1,567.26 | 1,488.90 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,370.01 | 1,488.90 |INJECTION(S); SINGLE TENDON ORIGIN/INSERTION||20551||| 200.91 | 190.86 | 261.17 | 261.17 | 219.80 | 224.19 | 228.59 ||||||||||||||| 190.86 | 261.17 | 224.19 |ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST||20615||| 200.91 | 190.86 | 621.97 | 621.97 |||||||||||||||||| 190.86 | 621.97 | 411.44 |REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDUR||20670||| 524.33 | 498.11 | 1,407.00 | 1,407.00 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,407.00 | 498.11 |REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR||20680||| 636.86 | 605.02 | 2,370.01 | 2,370.01 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,370.01 | 605.02 |REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM||20694||| 1,127.02 | 1,070.67 | 1,392.35 | 1,392.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,392.35 | 1,070.67 |BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)||20900||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 1,219.53 |BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE||20902||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 1,949.10 |CARTILAGE GRAFT; COSTOCHONDRAL||20910||| 1,916.32 | 1,820.50 | 524.17 | 524.17 |||||||||||||||||| 524.17 | 1,916.32 | 1,172.34 |CARTILAGE GRAFT; NASAL SEPTUM||20912||| 1,916.32 | 1,820.50 | 3,522.15 | 3,522.15 |||||||||||||||||| 1,820.50 | 3,522.15 | 2,719.24 |ALLOGRAFT, INCLUDES TEMPLATING, CUTTING, PLACEMENT AND INTERNAL FIXATION, WHEN P||20932||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |ALLOGRAFT, INCLUDES TEMPLATING, CUTTING, PLACEMENT AND INTERNAL FIXATION, WHEN P||20933||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |ALLOGRAFT, INCLUDES TEMPLATING, CUTTING, PLACEMENT AND INTERNAL FIXATION, WHEN P||20934||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; FIBULA||20955||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 1,219.53 |BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; ILIAC CREST||20956||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 1,219.53 |BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; METATARSAL||20957||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 1,219.53 |BONE GRAFT WITH MICROVASCULAR ANASTOMOSIS; OTHER THAN FIBULA, ILIAC CREST, OR ME||20962||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 1,219.53 |EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM||21011||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 373.77 | 381.25 | 388.72 ||||||||||||||| 373.77 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER||21012||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 373.77 | 381.25 | 388.72 ||||||||||||||| 373.77 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRA||21013||| 1,141.26 | 1,084.20 | 1,407.00 | 1,407.00 | 373.77 | 381.25 | 388.72 ||||||||||||||| 373.77 | 1,407.00 | 1,084.20 |EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRA||21014||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 373.77 | 381.25 | 388.72 ||||||||||||||| 373.77 | 2,370.01 | 1,084.20 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FACE OR SCALP; LESS THA||21015||| 2,169.94 | 2,061.44 | 2,370.01 | 2,370.01 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,370.01 | 2,061.44 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FACE OR SCALP; 2 CM OR||21016||| 2,169.94 | 2,061.44 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 2,061.44 |CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION||21310||| 871.96 | 828.36 | 206.19 | 206.19 | 294.37 | 300.26 | 306.15 ||||||||||||||| 206.19 | 871.96 | 300.26 |CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION||21315||| 871.96 | 828.36 | 1,352.79 | 1,352.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,352.79 | 828.36 |CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION||21320||| 871.96 | 828.36 | 2,736.39 | 2,736.39 | 302.22 | 308.27 | 314.31 ||||||||||||||| 302.22 | 2,736.39 | 828.36 |OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED||21325||| 1,916.32 | 1,820.50 | 2,736.39 | 2,736.39 | 302.22 | 308.27 | 314.31 ||||||||||||||| 302.22 | 2,736.39 | 1,820.50 |OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH INTERNAL AND/OR EXTERNAL SKE||21330||| 1,283.72 | 1,219.53 | 5,086.05 | 5,086.05 | 302.22 | 308.27 | 314.31 ||||||||||||||| 302.22 | 5,086.05 | 1,219.53 |OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION||21336||| 1,916.32 | 1,820.50 | 2,830.40 | 2,830.40 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,830.40 | 1,820.50 |CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION||21337||| 871.96 | 828.36 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 828.36 |BIOPSY, SOFT TISSUE OF NECK OR THORAX||21550||| 871.96 | 828.36 | 1,407.00 | 1,407.00 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,407.00 | 828.36 |EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR G||21552||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMU||21554||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 1,066.23 | 1,087.55 | 1,108.88 ||||||||||||||| 1,066.23 | 2,370.01 | 1,108.88 |EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN||21555||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMU||21556||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,370.01 | 1,084.20 |STERNAL DEBRIDEMENT||21627||| 524.33 | 498.11 | 6,264.95 | 6,264.95 |||||||||||||||||| 498.11 | 6,264.95 | 3,394.64 |OPEN TREATMENT OF STERNUM FRACTURE WITH OR WITHOUT SKELETAL FIXATION||21825||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,011.88 | 6,264.95 | 5,243.99 |BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL||21920||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 266.11 | 271.43 | 276.76 ||||||||||||||| 266.11 | 1,407.00 | 415.53 |BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP||21925||| 1,141.26 | 1,084.20 | 1,407.00 | 1,407.00 | 324.29 | 330.78 | 337.27 ||||||||||||||| 324.29 | 1,407.00 | 1,084.20 |EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM||21930||| 871.96 | 828.36 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 828.36 |EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER||21931||| 871.96 | 828.36 | 1,407.00 | 1,407.00 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 828.36 | 1,407.00 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); L||21932||| 871.96 | 828.36 | 2,370.01 | 2,370.01 | 797.30 | 813.25 | 829.20 ||||||||||||||| 797.30 | 2,370.01 | 829.20 |EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5||21933||| 871.96 | 828.36 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 828.36 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR);||22900||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 3,324.00 | 2,370.01 |EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR);||22901||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 3,324.00 | 2,370.01 |EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM||22902||| 3,324.00 | 3,157.80 | 1,407.00 | 1,407.00 | 797.30 | 813.25 | 829.20 ||||||||||||||| 797.30 | 3,324.00 | 1,407.00 |EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER||22903||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 3,324.00 | 2,370.01 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF ABDOMINAL WALL; LESS TH||22904||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 797.30 | 813.25 | 829.20 ||||||||||||||| 797.30 | 3,324.00 | 2,370.01 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR||22905||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 3,324.00 | 2,370.01 |BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL||23065||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 415.53 |BIOPSY, SOFT TISSUE OF SHOULDER AREA; DEEP||23066||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,370.01 | 1,084.20 |EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER||23071||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 1,407.00 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5||23073||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 1,108.33 |EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM||23075||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); L||23076||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,370.01 | 1,084.20 |ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING BIOPSY||23100||| 1,141.26 | 1,084.20 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,830.40 | 1,084.20 |ARTHROTOMY, ACROMIOCLAVICULAR JOINT OR STERNOCLAVICULAR JOINT, INCLUDING BIOPSY||23101||| 5,022.34 | 4,771.22 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 5,022.34 | 2,830.40 |ARTHROTOMY; GLENOHUMERAL JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY||23105||| 5,022.34 | 4,771.22 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,771.22 | 6,264.95 | 5,643.65 |ARTHROTOMY; STERNOCLAVICULAR JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY||23106||| 5,022.34 | 4,771.22 | 2,830.40 | 2,830.40 | 309.09 | 315.27 | 321.45 ||||||||||||||| 309.09 | 5,022.34 | 2,830.40 |ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL||23107||| 5,022.34 | 4,771.22 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 4,771.22 |CLAVICULECTOMY; PARTIAL||23120||| 5,022.34 | 4,771.22 | 2,830.40 | 2,830.40 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 5,022.34 | 2,830.40 |CLAVICULECTOMY; TOTAL||23125||| 5,022.34 | 4,771.22 | 2,830.40 | 2,830.40 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,022.34 | 2,830.40 |ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT CORACOACROMIAL LIGAMEN||23130||| 1,166.89 | 1,108.55 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,108.55 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA;||23140||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH||23145||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 521.01 | 531.43 | 541.85 ||||||||||||||| 521.01 | 2,830.40 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH||23146||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,219.53 | 6,264.95 | 3,774.34 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS;||23150||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH AUT||23155||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,219.53 | 6,264.95 | 3,774.34 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH ALL||23156||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 1,219.53 |PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTE||23180||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 504.08 | 514.16 | 524.25 ||||||||||||||| 504.08 | 6,264.95 | 1,949.10 |RADICAL RESECTION OF TUMOR, PROXIMAL HUMERUS||23220||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE||23410||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC||23412||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |CORACOACROMIAL LIGAMENT RELEASE, WITH OR WITHOUT ACROMIOPLASTY||23415||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES A||23420||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |TENODESIS OF LONG TENDON OF BICEPS||23430||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 504.08 | 514.16 | 524.25 ||||||||||||||| 504.08 | 6,283.24 | 5,969.08 |CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE OR MAGNUSON TYPE OPERATION||23450||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 6,283.24 | 5,969.08 |CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)||23455||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 672.48 | 685.93 | 699.38 ||||||||||||||| 672.48 | 6,283.24 | 5,969.08 |CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK||23460||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 521.01 | 531.43 | 541.85 ||||||||||||||| 521.01 | 6,283.24 | 5,969.08 |CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER||23462||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |CAPSULORRHAPHY, GLENOHUMERAL JOINT, POSTERIOR, WITH OR WITHOUT BONE BLOCK||23465||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 6,283.24 | 5,969.08 |CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPE MULTIDIRECTIONAL INSTABILITY||23466||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 6,283.24 | 5,969.08 |ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY||23470||| 6,283.24 | 5,969.08 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 5,969.08 |ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL R||23472||| 6,283.24 | 5,969.08 | 12,314.76 | 12,314.76 |||||||||||||||||| 5,969.08 | 12,314.76 | 9,299.00 |REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUM||23473||| 5,022.34 | 4,771.22 | 12,314.76 | 12,314.76 | 8,165.51 | 8,328.82 | 8,492.13 ||||||||||||||| 4,771.22 | 12,314.76 | 8,328.82 |REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUM||23474||| 5,022.34 | 4,771.22 | 12,314.76 | 12,314.76 |||||||||||||||||| 4,771.22 | 12,314.76 | 8,668.55 |OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION;||23480||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 490.62 | 500.43 | 510.24 ||||||||||||||| 490.62 | 6,264.95 | 5,144.79 |OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR NONU||23485||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 569.77 | 581.17 | 592.56 ||||||||||||||| 569.77 | 12,314.76 | 5,144.79 |OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME||23515||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 6,264.95 | 4,011.88 |CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION||23520||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 |||||||||||||||||| 1,084.20 | 1,392.35 | 1,266.81 |CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION||23525||| 1,141.26 | 1,084.20 | 206.19 | 206.19 |||||||||||||||||| 206.19 | 1,141.26 | 645.19 |OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;||23530||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,011.88 | 6,264.95 | 5,243.99 |OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL G||23532||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,011.88 | 6,264.95 | 5,243.99 |CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION||23540||| 1,141.26 | 1,084.20 | 206.19 | 206.19 | 327.08 | 333.62 | 340.16 ||||||||||||||| 206.19 | 1,141.26 | 333.62 |OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;||23550||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 6,264.95 | 4,011.88 |OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL||23552||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 472.83 | 482.28 | 491.74 ||||||||||||||| 472.83 | 6,264.95 | 4,011.88 |CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION||23570||| 1,141.26 | 1,084.20 | 206.19 | 206.19 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 1,141.26 | 206.19 |CLOSED TREATMENT OF SCAPULAR FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELET||23575||| 1,520.24 | 1,444.23 | 1,392.35 | 1,392.35 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 1,520.24 | 1,392.35 |OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) INCLUDES INTERNA||23585||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,011.88 | 6,264.95 | 5,243.99 |CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WIT||23600||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 457.91 | 467.07 | 476.23 ||||||||||||||| 206.19 | 2,051.68 | 467.07 |OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLU||23615||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 12,314.76 | 5,144.79 |OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLU||23616||| 5,415.57 | 5,144.79 | 15,868.13 | 15,868.13 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 15,868.13 | 5,144.79 |OPEN TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE, INCLUDES INTERNAL FIXATIO||23630||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION||23660||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 4,011.88 |OPEN TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROS||23670||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 4,011.88 |OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTUR||23680||| 4,223.03 | 4,011.88 | 12,314.76 | 12,314.76 |||||||||||||||||| 4,011.88 | 12,314.76 | 8,268.90 |MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION||23700||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,392.35 | 1,084.20 |ARTHRODESIS, GLENOHUMERAL JOINT;||23800||| 1,632.80 | 1,551.16 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 1,551.16 |ARTHRODESIS, GLENOHUMERAL JOINT; WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT||23802||| 1,632.80 | 1,551.16 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 1,551.16 |ARTHROTOMY, ELBOW, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY||24000||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,042.09 | 2,830.40 |ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULAR RELEASE (SEPARATE P||24006||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 4,042.09 | 2,830.40 |BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUPERFICIAL||24065||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 415.53 |BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCULA||24066||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 98.12 | 100.09 | 102.05 ||||||||||||||| 98.12 | 2,370.01 | 725.50 |EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR G||24071||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMU||24073||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 725.50 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; LESS THAN||24075||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMU||24076||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,370.01 | 725.50 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF UPPER ARM OR ELBOW AREA||24077||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,324.00 | 2,370.01 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF UPPER ARM OR ELBOW AREA||24079||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 3,324.00 | 2,370.01 |ARTHROTOMY, ELBOW; WITH SYNOVIAL BIOPSY ONLY||24100||| 636.86 | 605.02 | 2,830.40 | 2,830.40 |||||||||||||||||| 605.02 | 2,830.40 | 1,733.63 |ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHO||24101||| 4,127.58 | 3,921.20 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 4,127.58 | 2,830.40 |ARTHROTOMY, ELBOW; WITH SYNOVECTOMY||24102||| 4,127.58 | 3,921.20 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 4,127.58 | 2,830.40 |EXCISION, OLECRANON BURSA||24105||| 2,348.02 | 2,230.62 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 2,230.62 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS;||24110||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 2,830.40 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH AUTOGRAFT (INC||24115||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,219.53 | 6,264.95 | 3,774.34 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH ALLOGRAFT||24116||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 408.55 | 416.72 | 424.89 ||||||||||||||| 408.55 | 6,264.95 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR||24120||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 4,042.09 | 2,830.40 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR||24125||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 4,042.09 | 3,335.19 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR||24126||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 490.62 | 500.43 | 510.24 ||||||||||||||| 490.62 | 6,264.95 | 3,839.99 |RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC BONE, ELBOW, WITH CON||24149||| 5,673.46 | 5,389.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,389.79 |RADICAL RESECTION OF TUMOR, SHAFT OR DISTAL HUMERUS||24150||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |RESECTION OF ELBOW JOINT (ARTHRECTOMY)||24155||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,415.57 | 2,830.40 |REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS||24200||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 523.33 | 533.79 | 544.26 ||||||||||||||| 415.53 | 1,407.00 | 533.79 |REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCU||24201||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,370.01 | 725.50 |MANIPULATION, ELBOW, UNDER ANESTHESIA||24300||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 | 573.70 | 585.17 | 596.65 ||||||||||||||| 573.70 | 1,392.35 | 1,084.20 |REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR||24341||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON||24342||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,283.24 | 5,969.08 |REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE||24343||| 6,283.24 | 5,969.08 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 2,830.40 |RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES H||24344||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,283.24 | 5,969.08 |REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE||24345||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HA||24346||| 6,283.24 | 5,969.08 | 12,314.76 | 12,314.76 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 12,314.76 | 5,969.08 |TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL||24357||| 6,283.24 | 5,969.08 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 6,283.24 | 4,399.74 |TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL||24358||| 6,283.24 | 5,969.08 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 6,283.24 | 4,399.74 |TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S EL||24359||| 6,283.24 | 5,969.08 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 6,283.24 | 4,399.74 |REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQU||24430||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 5,144.79 |REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES||24435||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 12,314.76 | 5,144.79 |CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION||24500||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERC||24515||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 487.83 | 497.59 | 507.35 ||||||||||||||| 487.83 | 12,314.76 | 5,144.79 |TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, W||24516||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 5,144.79 |PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTUR||24538||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 2,807.22 |OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTE||24545||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 5,144.79 |OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTE||24546||| 5,415.57 | 5,144.79 | 15,868.13 | 15,868.13 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 15,868.13 | 5,144.79 |CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MAN||24560||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 523.33 | 533.79 | 544.26 ||||||||||||||| 206.19 | 2,051.68 | 533.79 |PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERA||24566||| 2,954.97 | 2,807.22 | 1,392.35 | 1,392.35 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,954.97 | 1,392.35 |OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTE||24575||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 5,144.79 |CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPU||24576||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 523.33 | 533.79 | 544.26 ||||||||||||||| 206.19 | 2,051.68 | 533.79 |CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULAT||24577||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,051.68 | 1,392.35 |OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNA||24579||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 5,144.79 |PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL,||24582||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 2,807.22 |OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTU||24586||| 2,051.68 | 1,949.10 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 1,949.10 |OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTU||24587||| 2,051.68 | 1,949.10 | 12,314.76 | 12,314.76 |||||||||||||||||| 1,949.10 | 12,314.76 | 7,183.22 |OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION||24615||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 6,264.95 | 1,949.10 |OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROX||24635||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 6,264.95 | 1,949.10 |OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RA||24665||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 1,949.10 |OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RA||24666||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 457.24 | 466.39 | 475.53 ||||||||||||||| 457.24 | 12,314.76 | 5,144.79 |CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROC||24670||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 457.91 | 467.07 | 476.23 ||||||||||||||| 206.19 | 2,051.68 | 467.07 |OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCES||24685||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,144.79 |STUMP ELONGATION, UPPER EXTREMITY||24935||| 5,022.34 | 4,771.22 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,771.22 | 6,264.95 | 5,643.65 |INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DE QUERVAINS DISEASE)||25000||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,051.68 | 1,392.35 |INCISION, FLEXOR TENDON SHEATH, WRIST (EG, FLEXOR CARPI RADIALIS)||25001||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 1,949.10 |DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT;||25020||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,051.68 | 1,392.35 |DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT;||25023||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,949.10 | 2,830.40 | 2,441.04 |DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR COMPARTMENT;||25024||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,949.10 |DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR AND EXTENSOR COMPARTMENT;||25025||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 |||||||||||||||||| 1,392.35 | 2,051.68 | 1,670.72 |INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA||25028||| 524.33 | 498.11 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 498.11 |INCISION AND DRAINAGE, FOREARM AND/OR WRIST; BURSA||25031||| 524.33 | 498.11 | 1,392.35 | 1,392.35 |||||||||||||||||| 498.11 | 1,392.35 | 958.34 |INCISION, DEEP, BONE CORTEX, FOREARM AND/OR WRIST (EG, OSTEOMYELITIS OR BONE ABS||25035||| 524.33 | 498.11 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 498.11 |BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; SUPERFICIAL||25065||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 415.53 |BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; DEEP (SUBFASCIAL OR INTRAMUSCULAR)||25066||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,370.01 | 725.50 |EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; 3 CM OR||25071||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 1,407.00 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRA||25073||| 2,169.94 | 2,061.44 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 2,061.44 |EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS TH||25075||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRA||25076||| 2,169.94 | 2,061.44 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,169.94 | 1,407.00 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOREARM AND/OR WRIST AR||25077||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 |||||||||||||||||| 2,370.01 | 3,324.00 | 2,763.91 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOREARM AND/OR WRIST AR||25078||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 |||||||||||||||||| 2,370.01 | 3,324.00 | 2,763.91 |CAPSULOTOMY, WRIST (EG, CONTRACTURE)||25085||| 5,673.46 | 5,389.79 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 5,673.46 | 4,110.09 |ARTHROTOMY, WRIST JOINT; WITH BIOPSY||25100||| 4,127.58 | 3,921.20 | 2,830.40 | 2,830.40 | 334.72 | 341.42 | 348.11 ||||||||||||||| 334.72 | 4,127.58 | 2,830.40 |ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR||25101||| 4,127.58 | 3,921.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,127.58 | 2,830.40 |ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY||25105||| 4,127.58 | 3,921.20 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 4,127.58 | 2,830.40 |ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR OF TRIANGULAR CARTILAGE, CO||25107||| 4,127.58 | 3,921.20 | 2,830.40 | 2,830.40 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 4,127.58 | 2,830.40 |EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST||25110||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,793.99 | 1,392.35 |EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY||25111||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,793.99 | 1,392.35 |EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT||25112||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,793.99 | 1,392.35 |RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENO||25115||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,051.68 | 1,392.35 |RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENO||25116||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,949.10 |SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;||25118||| 4,042.09 | 3,839.99 | 1,392.35 | 1,392.35 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 4,042.09 | 1,392.35 |SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; WITH RESECTION O||25119||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 383.10 | 390.76 | 398.43 ||||||||||||||| 383.10 | 4,042.09 | 2,830.40 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING||25120||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING||25125||| 1,283.72 | 1,219.53 | 1,392.35 | 1,392.35 | 383.09 | 390.75 | 398.41 ||||||||||||||| 383.09 | 1,392.35 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING||25126||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,219.53 | 2,830.40 | 2,057.06 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES;||25130||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH AUTOGRA||25135||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,219.53 | 6,264.95 | 3,774.34 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH ALLOGRA||25136||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,219.53 | 6,264.95 | 3,774.34 |SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM AND/OR WRIST||25145||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 1,219.53 |PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, F||25150||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,219.53 |PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, F||25151||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,830.40 | 1,219.53 |RADICAL RESECTION OF TUMOR, RADIUS OR ULNA||25170||| 5,673.46 | 5,389.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,389.79 | 6,264.95 | 5,969.21 |EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST||25248||| 763.68 | 725.50 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,392.35 | 725.50 |MANIPULATION, WRIST, UNDER ANESTHESIA||25259||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 |||||||||||||||||| 1,084.20 | 1,392.35 | 1,266.81 |TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TE||25290||| 6,283.24 | 5,969.08 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,283.24 | 2,830.40 |TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON||25295||| 6,283.24 | 5,969.08 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,283.24 | 2,830.40 |CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT REPAIR||25320||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,969.08 | 6,283.24 | 6,264.95 |CENTRALIZATION OF WRIST ON ULNA (EG, RADIAL CLUB HAND)||25335||| 5,673.46 | 5,389.79 | 2,830.40 | 2,830.40 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 5,673.46 | 2,830.40 |OSTEOPLASTY, RADIUS OR ULNA; SHORTENING||25390||| 5,022.34 | 4,771.22 | 6,264.95 | 6,264.95 | 562.58 | 573.83 | 585.08 ||||||||||||||| 562.58 | 6,264.95 | 4,771.22 |OSTEOPLASTY, RADIUS OR ULNA; LENGTHENING WITH AUTOGRAFT||25391||| 5,022.34 | 4,771.22 | 12,314.76 | 12,314.76 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 12,314.76 | 4,771.22 |OSTEOPLASTY, RADIUS AND ULNA; LENGTHENING WITH AUTOGRAFT||25393||| 5,022.34 | 4,771.22 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,771.22 | 6,264.95 | 5,643.65 |REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION T||25400||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,144.79 |REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITH AUTOGRAFT (INCLUDES OBTAINI||25405||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 5,144.79 |REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION||25415||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITH AUTOGRAFT (INCLUDES OBTAIN||25420||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA||25425||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 5,144.79 |REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS AND ULNA||25426||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,415.57 | 2,830.40 |REPAIR OF NONUNION OF CARPAL BONE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)) (INCLU||25431||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |REPAIR OF NONUNION, SCAPHOID CARPAL (NAVICULAR) BONE, WITH OR WITHOUT RADIAL STY||25440||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,144.79 |ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS||25447||| 4,909.79 | 4,664.30 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,909.79 | 2,830.40 |PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT MET||25490||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,219.53 | 6,264.95 | 3,774.34 |PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT MET||25491||| 1,283.72 | 1,219.53 | 12,314.76 | 12,314.76 |||||||||||||||||| 1,219.53 | 12,314.76 | 6,799.24 |PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT MET||25492||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,219.53 | 2,830.40 | 2,057.06 |CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT MANIPULATION||25500||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR||25515||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND CLOSED TREATMENT OF DISLOCATION OF||25520||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,392.35 |OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR||25525||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR||25526||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION||25530||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORM||25545||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION||25560||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN||25574||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN||25575||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATIO||25606||| 2,954.97 | 2,807.22 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,807.22 | 2,954.97 | 2,830.40 |OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO||25607||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO||25608||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATIO||25609||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITHOUT MANIPULATION||25622||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 327.08 | 333.62 | 340.16 ||||||||||||||| 206.19 | 2,051.68 | 333.62 |CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION||25624||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,051.68 | 1,392.35 |OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, INCLUDES INTERNAL FIXATI||25628||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID [NAVICULAR])||25630||| 763.68 | 725.50 | 206.19 | 206.19 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 763.68 | 206.19 |CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID [NAVICULAR])||25635||| 763.68 | 725.50 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,392.35 | 725.50 |OPEN TREATMENT OF CARPAL BONE FRACTURE (OTHER THAN CARPAL SCAPHOID [NAVICULAR]),||25645||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,415.57 | 2,830.40 |CLOSED TREATMENT OF ULNAR STYLOID FRACTURE||25650||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 425.20 | 433.71 | 442.21 ||||||||||||||| 206.19 | 2,051.68 | 433.71 |PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE||25651||| 2,954.97 | 2,807.22 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,954.97 | 2,807.22 |OPEN TREATMENT OF ULNAR STYLOID FRACTURE||25652||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, 1 OR MORE BONES||25670||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 1,949.10 |PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIOULNAR DISLOCATION||25671||| 1,567.26 | 1,488.90 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,830.40 | 1,488.90 |OPEN TREATMENT OF DISTAL RADIOULNAR DISLOCATION, ACUTE OR CHRONIC||25676||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 1,949.10 |CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH MAN||25680||| 1,141.26 | 1,084.20 | 206.19 | 206.19 | 334.72 | 341.42 | 348.11 ||||||||||||||| 206.19 | 1,141.26 | 341.42 |OPEN TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION||25685||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 1,949.10 |OPEN TREATMENT OF LUNATE DISLOCATION||25695||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 1,949.10 |TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)||26055||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,392.35 | 1,084.20 |ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; CAR||26070||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,392.35 |ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; MET||26075||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INT||26080||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,392.35 |ARTHROTOMY WITH BIOPSY; CARPOMETACARPAL JOINT, EACH||26100||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,949.10 | 2,830.40 | 2,441.04 |ARTHROTOMY WITH BIOPSY; METACARPOPHALANGEAL JOINT, EACH||26105||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,949.10 | 2,830.40 | 2,441.04 |ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH||26110||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,051.68 | 1,392.35 |EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTA||26111||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 1,407.00 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFA||26113||| 2,169.94 | 2,061.44 | 1,407.00 | 1,407.00 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,169.94 | 1,407.00 |EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTA||26115||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 457.91 | 467.07 | 476.23 ||||||||||||||| 415.53 | 1,407.00 | 467.07 |EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFA||26116||| 2,169.94 | 2,061.44 | 1,407.00 | 1,407.00 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,169.94 | 1,407.00 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF HAND OR FINGER; LESS TH||26117||| 2,793.99 | 2,654.29 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,793.99 | 2,370.01 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF HAND OR FINGER; 3 CM OR||26118||| 2,793.99 | 2,654.29 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,793.99 | 2,370.01 |FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEME||26121||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 2,654.29 |FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTE||26123||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 2,654.29 |SYNOVECTOMY, CARPOMETACARPAL JOINT||26130||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,654.29 | 2,830.40 | 2,812.20 |SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR||26135||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,830.40 | 2,654.29 |SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION,||26140||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,793.99 | 1,392.35 |SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM AND/O||26145||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,793.99 | 1,392.35 |EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR||26160||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,793.99 | 1,392.35 |EXCISION OF TENDON, PALM, FLEXOR OR EXTENSOR, SINGLE, EACH TENDON||26170||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 |||||||||||||||||| 1,392.35 | 2,793.99 | 2,023.32 |EXCISION OF TENDON, FINGER, FLEXOR OR EXTENSOR, EACH TENDON||26180||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,793.99 | 1,392.35 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL;||26200||| 2,793.99 | 2,654.29 | 1,392.35 | 1,392.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,793.99 | 1,392.35 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL; WITH AUTOGRAFT||26205||| 2,793.99 | 2,654.29 | 6,264.95 | 6,264.95 | 471.00 | 480.42 | 489.84 ||||||||||||||| 471.00 | 6,264.95 | 2,654.29 |REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES O||26412||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 2,654.29 |EXCISION OF EXTENSOR TENDON, WITH IMPLANTATION OF SYNTHETIC ROD FOR DELAYED TEND||26415||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 2,654.29 |REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES||26420||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 150.46 | 153.47 | 156.48 ||||||||||||||| 150.46 | 2,830.40 | 2,654.29 |TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON||26455||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,392.35 |CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL JOINT, EACH JOINT||26520||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,830.40 | 2,654.29 |CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT||26525||| 5,673.46 | 5,389.79 | 1,392.35 | 1,392.35 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 5,673.46 | 1,392.35 |ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOINT||26530||| 2,793.99 | 2,654.29 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 2,654.29 |ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT||26531||| 4,909.79 | 4,664.30 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 4,664.30 |ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT||26535||| 2,793.99 | 2,654.29 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 2,654.29 |ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT||26536||| 4,909.79 | 4,664.30 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 4,664.30 |REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT||26540||| 4,909.79 | 4,664.30 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,909.79 | 2,830.40 |REPAIR NON-UNION, METACARPAL OR PHALANX (INCLUDES OBTAINING BONE GRAFT WITH OR W||26546||| 5,022.34 | 4,771.22 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 4,771.22 |REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT||26548||| 5,022.34 | 4,771.22 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,022.34 | 2,830.40 |CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE||26600||| 609.80 | 579.31 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 609.80 | 400.35 |CLOSED TREATMENT OF METACARPAL FRACTURE, WITH MANIPULATION, WITH EXTERNAL FIXATI||26607||| 3,140.20 | 2,983.19 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,140.20 | 2,830.40 |PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE||26608||| 4,127.58 | 3,921.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,127.58 | 2,830.40 |OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN||26615||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,415.57 | 2,830.40 |CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTUR||26645||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,392.35 | 1,084.20 |PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (B||26650||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 | 228.96 | 233.54 | 238.11 ||||||||||||||| 228.96 | 2,830.40 | 1,509.20 |OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE)||26665||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 1,949.10 |CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPULA||26675||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 |||||||||||||||||| 1,084.20 | 1,392.35 | 1,266.81 |PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB,||26676||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,509.20 |OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; INCLUDES INTERN||26685||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; COMPLEX, MULTIP||26686||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 1,949.10 |CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION;||26705||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 | 359.79 | 366.98 | 374.18 ||||||||||||||| 359.79 | 1,392.35 | 1,084.20 |PERCUTANEOUS SKELETAL FIXATION OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH||26706||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,509.20 | 2,830.40 | 2,209.52 |OPEN TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, INCLUDES INTERNAL FIX||26715||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL O||26727||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,415.57 | 2,830.40 |OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER||26735||| 2,954.97 | 2,807.22 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,954.97 | 2,807.22 |OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHAL||26746||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 5,415.57 | 2,830.40 |CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT MANIPUL||26750||| 609.80 | 579.31 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 609.80 | 400.35 |PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, E||26756||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,509.20 |PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WIT||26776||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,509.20 |OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,||26785||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,415.57 | 2,830.40 |TENOTOMY, ADDUCTOR, SUBCUTANEOUS, OPEN, WITH OBTURATOR NEURECTOMY||27003||| 2,291.04 | 2,176.49 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,176.49 | 6,264.95 | 4,278.00 |CAPSULECTOMY OR CAPSULOTOMY, HIP, WITH OR WITHOUT EXCISION OF HETEROTOPIC BONE,||27036||| 5,673.46 | 5,389.79 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,389.79 |BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR||27041||| 1,141.26 | 1,084.20 | 1,407.00 | 1,407.00 | 352.13 | 359.18 | 366.22 ||||||||||||||| 352.13 | 1,407.00 | 1,084.20 |EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREAT||27043||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCUL||27045||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 1,108.33 |EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; LESS THAN 3 C||27047||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,370.01 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCUL||27048||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,370.01 | 1,084.20 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF PELVIS AND HIP AREA; LE||27049||| 2,169.94 | 2,061.44 | 2,370.01 | 2,370.01 |||||||||||||||||| 2,061.44 | 2,370.01 | 2,269.98 |ARTHROTOMY WITH SYNOVECTOMY, HIP JOINT||27054||| 5,673.46 | 5,389.79 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 5,673.46 | 4,110.09 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF PELVIS AND HIP AREA; 5||27059||| 2,169.94 | 2,061.44 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 2,061.44 |EXCISION OF BONE CYST OR BENIGN TUMOR, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATE||27065||| 609.80 | 579.31 | 6,264.95 | 6,264.95 | 574.88 | 586.37 | 597.87 ||||||||||||||| 574.88 | 6,264.95 | 597.87 |EXCISION OF BONE CYST OR BENIGN TUMOR, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATE||27066||| 1,141.26 | 1,084.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,084.20 |EXCISION OF BONE CYST OR BENIGN TUMOR, WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATE||27067||| 1,632.80 | 1,551.16 | 6,264.95 | 6,264.95 |||||||||||||||||| 1,551.16 | 6,264.95 | 3,948.88 |RADICAL RESECTION OF TUMOR; WING OF ILIUM, 1 PUBIC OR ISCHIAL RAMUS OR SYMPHYSIS||27075||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,839.99 | 6,264.95 | 5,153.52 |RADICAL RESECTION OF TUMOR; ILIUM, INCLUDING ACETABULUM, BOTH PUBIC RAMI, OR ISC||27076||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,839.99 | 6,264.95 | 5,153.52 |REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE||27086||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,370.01 | 415.53 |REMOVAL OF FOREIGN BODY, PELVIS OR HIP; DEEP (SUBFASCIAL OR INTRAMUSCULAR)||27087||| 1,141.26 | 1,084.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,084.20 |INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA||27095||| 437.40 | 415.53 ||| 523.33 | 533.79 | 544.26 ||||||||||||||| 415.53 | 544.26 | 523.33 |INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANC||27096||| 953.17 | 905.51 ||| 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 953.17 | 136.07 |OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE;||27146||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH OPEN REDUCTION OF HIP||27147||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY||27151||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; WITH FEMORAL OSTEOTOMY AND WITH||27156||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |BONE GRAFT, FEMORAL HEAD, NECK, INTERTROCHANTERIC OR SUBTROCHANTERIC AREA (INCLU||27170||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 1,219.53 |OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; SINGLE OR MULTIPLE PINNING OR BONE||27177||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 1,219.53 |OPEN TREATMENT OF ANTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION FOR FRACTURE||27217||| 4,223.03 | 4,011.88 ||| 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,223.03 | 408.20 |OPEN TREATMENT OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION, FOR FRACTUR||27218||| 4,223.03 | 4,011.88 ||| 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,223.03 | 408.20 |OPEN TREATMENT OF POSTERIOR OR ANTERIOR ACETABULAR WALL FRACTURE, WITH INTERNAL||27226||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 4,011.88 |OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVING ANTERIOR AND POSTERIOR (TWO)||27228||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 4,011.88 |OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK, INTERNAL FIXATION OR PRO||27236||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRA||27244||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRA||27245||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF GREATER TROCHANTERIC FRACTURE, INCLUDES INTERNAL FIXATION, WHE||27248||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITHOUT INTERNAL FIXATION||27253||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 5,415.57 | 3,987.60 |OPEN TREATMENT OF HIP DISLOCATION, TRAUMATIC, WITH ACETABULAR WALL AND FEMORAL H||27254||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 5,415.57 | 2,830.40 |OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENIT||27258||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 5,415.57 | 2,830.40 |OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENIT||27259||| 5,415.57 | 5,144.79 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 5,415.57 | 3,987.60 |INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION||27301||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 588.74 | 600.52 | 612.29 ||||||||||||||| 415.53 | 2,370.01 | 600.52 |ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG, IN||27310||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,042.09 | 2,830.40 |BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)||27324||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,370.01 | 725.50 |NEURECTOMY, HAMSTRING MUSCLE||27325||| 1,141.26 | 1,084.20 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,084.20 | 1,754.39 | 1,447.83 |NEURECTOMY, POPLITEAL (GASTROCNEMIUS)||27326||| 1,141.26 | 1,084.20 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,084.20 | 1,754.39 | 1,447.83 |EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM||27327||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 457.91 | 467.07 | 476.23 ||||||||||||||| 415.53 | 1,407.00 | 467.07 |EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULA||27328||| 1,520.24 | 1,444.23 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,370.01 | 1,444.23 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF THIGH OR KNEE AREA; LES||27329||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 |||||||||||||||||| 2,370.01 | 3,324.00 | 2,763.91 |ARTHROTOMY, KNEE; WITH SYNOVIAL BIOPSY ONLY||27330||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,042.09 | 2,830.40 |ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR REMOVAL OF LOOSE OR FO||27331||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,042.09 | 2,830.40 |ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY) KNEE; MEDIAL OR||27332||| 5,328.67 | 5,062.24 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,328.67 | 2,830.40 |ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY) KNEE; MEDIAL AND||27333||| 5,328.67 | 5,062.24 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,328.67 | 2,830.40 |ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR||27334||| 5,328.67 | 5,062.24 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,328.67 | 2,830.40 |ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL A||27335||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 472.83 | 482.28 | 491.74 ||||||||||||||| 472.83 | 6,264.95 | 5,062.24 |EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATE||27337||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULA||27339||| 1,520.24 | 1,444.23 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 1,444.23 |EXCISION, PREPATELLAR BURSA||27340||| 2,348.02 | 2,230.62 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 2,230.62 |EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (EG, BAKER'S CYST)||27345||| 3,324.00 | 3,157.80 | 2,830.40 | 2,830.40 | 281.62 | 287.25 | 292.88 ||||||||||||||| 281.62 | 3,324.00 | 2,830.40 |EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST, GANGLION), KNEE||27347||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 281.62 | 287.25 | 292.88 ||||||||||||||| 281.62 | 4,042.09 | 2,830.40 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR;||27355||| 1,520.24 | 1,444.23 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,830.40 | 1,444.23 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH ALLOGRAFT||27356||| 1,520.24 | 1,444.23 | 12,314.76 | 12,314.76 | 457.23 | 466.38 | 475.52 ||||||||||||||| 457.23 | 12,314.76 | 1,444.23 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH AUTOGRAFT (INC||27357||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 670.34 | 683.75 | 697.16 ||||||||||||||| 670.34 | 6,264.95 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH INTERNAL FIXAT||27358||| 1,520.24 | 1,444.23 |||||||||||||||||||| 1,444.23 | 1,520.24 | 1,482.23 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF THIGH OR KNEE AREA; 5 C||27364||| 3,324.00 | 3,157.80 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 3,324.00 | 2,370.01 |REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA||27372||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 281.62 | 287.25 | 292.88 ||||||||||||||| 281.62 | 2,370.01 | 725.50 |ARTHROTOMY WITH MENISCUS REPAIR, KNEE||27403||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 5,062.24 |REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL||27405||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,062.24 |REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE||27407||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,062.24 |REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL AND CRUCIATE LIG||27409||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,062.24 |ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE)||27418||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,062.24 |RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)||27420||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,062.24 |RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE A||27422||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,062.24 |RECONSTRUCTION OF DISLOCATING PATELLA; WITH PATELLECTOMY||27424||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,062.24 |LATERAL RETINACULAR RELEASE, OPEN||27425||| 5,328.67 | 5,062.24 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,328.67 | 2,830.40 |LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR||27427||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 5,062.24 |LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN)||27428||| 5,328.67 | 5,062.24 | 12,314.76 | 12,314.76 | 457.24 | 466.39 | 475.53 ||||||||||||||| 457.24 | 12,314.76 | 5,062.24 |LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN) AND EXTR||27429||| 5,328.67 | 5,062.24 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 5,062.24 |CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE||27435||| 5,328.67 | 5,062.24 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,328.67 | 2,830.40 |ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS||27437||| 5,328.67 | 5,062.24 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,062.24 |ARTHROPLASTY, PATELLA; WITH PROSTHESIS||27438||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 |||||||||||||||||| 7,467.46 | 12,314.76 | 10,087.62 |ARTHROPLASTY, KNEE, TIBIAL PLATEAU;||27440||| 5,328.67 | 5,062.24 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 5,062.24 |ARTHROPLASTY, KNEE, TIBIAL PLATEAU; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY||27441||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 7,467.46 |ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE;||27442||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 7,467.46 |ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE; WITH DEBRIDEMENT AND||27443||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 7,467.46 |ARTHROPLASTY, KNEE, HINGE PROSTHESIS (EG, WALLDIUS TYPE)||27445||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 12,314.76 | 7,467.46 |ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT||27446||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 650.18 | 663.19 | 676.19 ||||||||||||||| 650.18 | 12,314.76 | 7,467.46 |ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT||27446||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 12,314.76 | 7,467.46 |ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR||27447||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 896.04 | 913.96 | 931.88 ||||||||||||||| 896.04 | 12,314.76 | 7,467.46 |ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR||27447||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 12,314.76 | 7,467.46 |REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITHOUT GRAFT (EG,||27470||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 1,949.10 |REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITH ILIAC OR OTHE||27472||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 2,807.22 |ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR||27475||| 7,729.40 | 7,342.93 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 7,729.40 | 6,264.95 |ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA OR FIBULA (EG, GENU VARUS||27485||| 7,729.40 | 7,342.93 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 7,729.40 | 6,264.95 |REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT||27486||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 |||||||||||||||||| 7,467.46 | 12,314.76 | 10,087.62 |REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTI||27487||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 |||||||||||||||||| 7,467.46 | 12,314.76 | 10,087.62 |REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS, METHYLMETHACRYLATE WITH||27488||| 7,860.48 | 7,467.46 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 7,860.48 | 6,264.95 |CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITH||27503||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,392.35 |OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR WITHOUT EXTERNAL FIXATION, WIT||27506||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 727.43 | 741.97 | 756.52 ||||||||||||||| 727.43 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERC||27507||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WIT||27508||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERA||27509||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,807.22 |OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERC||27511||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITH INTERCOND||27513||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, INCLU||27514||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 1,242.90 | 1,267.76 | 1,292.62 ||||||||||||||| 1,242.90 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITH MANIPULATION, WIT||27517||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,392.35 |OPEN TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION, INCLUDES INTERNAL FIXATI||27519||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION||27520||| 2,051.68 | 1,949.10 | 206.19 | 206.19 |||||||||||||||||| 206.19 | 2,051.68 | 1,077.64 |OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR CO||27524||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION||27530||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 457.91 | 467.07 | 476.23 ||||||||||||||| 206.19 | 2,051.68 | 467.07 |CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT MANIPUL||27532||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,949.10 |OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INT||27535||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WITHO||27536||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF KNEE||27538||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 241.29 | 246.12 | 250.95 ||||||||||||||| 206.19 | 2,051.68 | 246.12 |OPEN TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KN||27540||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA||27552||| 1,520.24 | 1,444.23 | 1,392.35 | 1,392.35 | 249.68 | 254.67 | 259.67 ||||||||||||||| 249.68 | 1,520.24 | 1,392.35 |OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;||27556||| 4,127.58 | 3,921.20 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,921.20 | 6,264.95 | 5,196.27 |OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;||27557||| 4,127.58 | 3,921.20 | 6,264.95 | 6,264.95 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 6,264.95 | 3,921.20 |OPEN TREATMENT OF KNEE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;||27558||| 4,127.58 | 3,921.20 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 3,921.20 |OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL PATELLE||27566||| 4,127.58 | 3,921.20 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 3,921.20 |MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRA||27570||| 1,520.24 | 1,444.23 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,520.24 | 1,392.35 |DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY||27600||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,830.40 | 1,949.10 |DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY||27601||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,949.10 | 2,830.40 | 2,441.04 |DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMEN||27602||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,949.10 | 2,830.40 | 2,441.04 |INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA||27603||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 588.74 | 600.52 | 612.29 ||||||||||||||| 415.53 | 2,370.01 | 600.52 |INCISION AND DRAINAGE, LEG OR ANKLE; INFECTED BURSA||27604||| 437.40 | 415.53 | 2,830.40 | 2,830.40 | 324.63 | 331.13 | 337.62 ||||||||||||||| 324.63 | 2,830.40 | 415.53 |ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH OR WITHOUT ACHILLES TENDON L||27612||| 5,328.67 | 5,062.24 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,328.67 | 2,830.40 |BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; SUPERFICIAL||27613||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 249.68 | 254.67 | 259.67 ||||||||||||||| 249.68 | 1,407.00 | 415.53 |BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)||27614||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,370.01 | 725.50 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF LEG OR ANKLE AREA; LESS||27615||| 1,520.24 | 1,444.23 | 2,370.01 | 2,370.01 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,370.01 | 1,444.23 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF LEG OR ANKLE AREA; 5 CM||27616||| 1,520.24 | 1,444.23 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 1,444.23 |EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; LESS THAN 3 CM||27618||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR||27619||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,370.01 | 725.50 |ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHO||27620||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,042.09 | 2,830.40 |ARTHROTOMY, WITH SYNOVECTOMY, ANKLE;||27625||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 4,042.09 | 2,830.40 |ARTHROTOMY, WITH SYNOVECTOMY, ANKLE; INCLUDING TENOSYNOVECTOMY||27626||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 472.83 | 482.28 | 491.74 ||||||||||||||| 472.83 | 4,042.09 | 2,830.40 |EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/O||27630||| 3,324.00 | 3,157.80 | 2,830.40 | 2,830.40 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,324.00 | 2,830.40 |EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER||27632||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR||27634||| 763.68 | 725.50 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 725.50 | 2,370.01 | 1,087.02 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;||27635||| 1,283.72 | 1,219.53 | 2,830.40 | 2,830.40 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,830.40 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH AUTOGR||27637||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 1,219.53 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH ALLOGR||27638||| 1,283.72 | 1,219.53 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 1,219.53 |INJECTION PROCEDURE FOR ANKLE ARTHROGRAPHY||27648||| 437.40 | 415.53 ||| 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 437.40 | 136.07 |REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;||27650||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INC||27652||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT||27654||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,283.24 | 5,969.08 |REPAIR, FASCIAL DEFECT OF LEG||27656||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,042.09 | 2,830.40 |REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON||27658||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,042.09 | 2,830.40 |REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON||27659||| 4,573.53 | 4,344.85 | 6,264.95 | 6,264.95 |||||||||||||||||| 4,344.85 | 6,264.95 | 5,419.24 |REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON||27664||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,283.24 | 5,969.08 |REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON||27665||| 4,573.53 | 4,344.85 | 6,264.95 | 6,264.95 | 354.12 | 361.21 | 368.29 ||||||||||||||| 354.12 | 6,264.95 | 4,344.85 |REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL||27695||| 5,673.46 | 5,389.79 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,389.79 |REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS||27696||| 5,673.46 | 5,389.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,389.79 | 6,264.95 | 5,969.21 |REPAIR, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCE||27698||| 5,673.46 | 5,389.79 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 5,389.79 |ARTHROPLASTY, ANKLE;||27700||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 3,839.99 |ARTHROPLASTY, ANKLE; WITH IMPLANT (TOTAL ANKLE)||27702||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 |||||||||||||||||| 7,467.46 | 12,314.76 | 10,087.62 |ARTHROPLASTY, ANKLE; REVISION, TOTAL ANKLE||27703||| 7,860.48 | 7,467.46 | 12,314.76 | 12,314.76 |||||||||||||||||| 7,467.46 | 12,314.76 | 10,087.62 |REMOVAL OF ANKLE IMPLANT||27704||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 4,042.09 | 2,830.40 |REPAIR OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT, (EG, COMPRESSION TECHNIQUE||27720||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING GRAFT||27722||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |REPAIR OF NONUNION OR MALUNION, TIBIA; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES O||27724||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |REPAIR OF NONUNION OR MALUNION, TIBIA; BY SYNOSTOSIS, WITH FIBULA, ANY METHOD||27725||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,144.79 | 6,264.95 | 5,840.26 |CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WI||27750||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR||27756||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 2,807.22 |OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE), WITH||27758||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 5,144.79 |TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAME||27759||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 5,144.79 |CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT MANIPULATION||27760||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PE||27766||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION||27780||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION,||27784||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPUL||27786||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL||27792||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI,||27808||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, O||27814||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION||27816||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 241.29 | 246.12 | 250.95 ||||||||||||||| 206.19 | 2,051.68 | 246.12 |OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN||27822||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN||27823||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA||27824||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL||27826||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL||27827||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 5,144.79 |OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL||27828||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 5,144.79 |OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES I||27829||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 5,144.79 |CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; WITHOUT ANESTHESIA||27830||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 2,051.68 | 206.19 |CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; REQUIRING ANESTHESI||27831||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,949.10 | 2,830.40 | 2,441.04 |OPEN TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION, INCLUDES INTERNAL FIX||27832||| 4,127.58 | 3,921.20 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,921.20 | 6,264.95 | 5,196.27 |OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXAT||27846||| 4,127.58 | 3,921.20 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,921.20 | 6,264.95 | 5,196.27 |OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXAT||27848||| 4,127.58 | 3,921.20 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 3,921.20 |MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION||27860||| 1,520.24 | 1,444.23 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,444.23 |DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY, WITH D||27892||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY, WITH DEBRIDEMENT O||27893||| 2,051.68 | 1,949.10 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 1,949.10 |DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMEN||27894||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |INCISION AND DRAINAGE, BURSA, FOOT||28001||| 2,051.68 | 1,949.10 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,407.00 |INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, F||28002||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,051.68 | 1,392.35 |INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, F||28003||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,949.10 | 2,830.40 | 2,441.04 |FASCIOTOMY, FOOT AND/OR TOE||28008||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,830.40 | 1,949.10 |ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY||28020||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY||28022||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY||28024||| 2,051.68 | 1,949.10 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,392.35 |RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)||28035||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 536.41 | 547.14 | 557.87 ||||||||||||||| 536.41 | 2,291.04 | 1,754.39 |EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; 1.5 CM OR GREATER||28039||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 415.53 | 2,370.01 | 1,087.02 |EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5||28041||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 1,108.33 |EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM||28043||| 437.40 | 415.53 | 1,407.00 | 1,407.00 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,407.00 | 415.53 |EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INTRAMUSCULAR); LES||28045||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,370.01 | 1,084.20 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOOT OR TOE; LESS THAN||28046||| 2,051.68 | 1,949.10 | 2,370.01 | 2,370.01 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,370.01 | 1,949.10 |RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOOT OR TOE; 3 CM OR GR||28047||| 2,051.68 | 1,949.10 | 2,370.01 | 2,370.01 | 1,065.71 | 1,087.02 | 1,108.33 ||||||||||||||| 1,065.71 | 2,370.01 | 1,949.10 |NEURECTOMY, INTRINSIC MUSCULATURE OF FOOT||28055||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)||28060||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)||28062||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,830.40 | 1,949.10 |SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL JOINT, EACH||28070||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,891.16 | 6,264.95 | 4,654.14 |SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH||28072||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 4,042.09 | 2,830.40 |EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH||28080||| 1,141.26 | 1,084.20 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,392.35 | 1,084.20 |SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR||28086||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 4,042.09 | 3,335.19 |SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR||28088||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 4,042.09 | 2,830.40 |EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (E||28090||| 4,042.09 | 3,839.99 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,042.09 | 1,392.35 |EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (E||28092||| 4,042.09 | 3,839.99 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,042.09 | 1,392.35 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;||28100||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 4,042.09 | 2,830.40 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ILI||28102||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,839.99 | 6,264.95 | 5,153.52 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ALL||28103||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 3,839.99 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT||28104||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,042.09 | 2,830.40 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT||28106||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 3,839.99 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT||28107||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,839.99 | 6,264.95 | 5,153.52 |EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT||28108||| 4,042.09 | 3,839.99 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,042.09 | 1,392.35 |OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCED||28110||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,043.33 | 2,830.40 |OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD||28111||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,043.33 | 2,830.40 |OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)||28112||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,043.33 | 2,830.40 |OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD||28113||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,043.33 | 2,830.40 |OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITH PARTIAL PROXIMAL PHALAN||28114||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 915.82 | 934.14 | 952.46 ||||||||||||||| 915.82 | 3,043.33 | 2,830.40 |OSTECTOMY, EXCISION OF TARSAL COALITION||28116||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,830.40 | 1,949.10 |OSTECTOMY, CALCANEUS;||28118||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,830.40 | 1,949.10 |OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE||28119||| 2,051.68 | 1,949.10 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,949.10 |PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY||28120||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY||28122||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY||28124||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE||28126||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |RESECTION, CONDYLE(S), DISTAL END OF PHALANX, EACH TOE||28153||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 3,043.33 | 2,860.78 |HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALAN||28160||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 3,043.33 | 2,830.40 |RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY||28238||| 4,247.76 | 4,035.37 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 4,035.37 |CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)||28260||| 5,673.46 | 5,389.79 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,673.46 | 2,830.40 |CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING||28261||| 5,673.46 | 5,389.79 | 1,392.35 | 1,392.35 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 5,673.46 | 1,392.35 |CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND||28262||| 5,673.46 | 5,389.79 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 5,389.79 |CAPSULOTOMY, MIDTARSAL (EG, HEYMAN TYPE PROCEDURE)||28264||| 5,673.46 | 5,389.79 | 1,392.35 | 1,392.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,673.46 | 1,392.35 |CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT||28270||| 5,673.46 | 5,389.79 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,673.46 | 2,830.40 |CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT (SEPARATE PROCEDURE)||28272||| 5,673.46 | 5,389.79 | 1,392.35 | 1,392.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,673.46 | 1,392.35 |CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOM||28285||| 3,398.09 | 3,228.19 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,398.09 | 2,830.40 |CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE (EG, RUIZ-MORA TYPE PRO||28286||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH METATARSA||28288||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF||28289||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 3,043.33 | 2,860.78 |HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF||28291||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,891.16 | 6,264.95 | 4,654.14 |CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; W||28292||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; W||28295||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 3,043.33 | 2,860.78 |CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; W||28296||| 3,398.09 | 3,228.19 | 2,830.40 | 2,830.40 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,398.09 | 2,830.40 |CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; W||28297||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 383.10 | 390.76 | 398.43 ||||||||||||||| 383.10 | 6,264.95 | 2,891.16 |CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; W||28298||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 370.40 | 377.81 | 385.21 ||||||||||||||| 370.40 | 6,264.95 | 2,891.16 |CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; W||28299||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,891.16 | 6,264.95 | 4,654.14 |OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INT||28300||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 2,891.16 |OSTEOTOMY; TALUS||28302||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,891.16 | 6,264.95 | 4,654.14 |OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS;||28304||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 2,891.16 |OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT (INCLUDES||28305||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,891.16 | 6,264.95 | 4,654.14 |OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATA||28306||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,891.16 |OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATA||28307||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 6,264.95 | 2,891.16 |OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATA||28308||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATA||28309||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 2,891.16 |OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST||28310||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,891.16 |OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY TO||28312||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERL||28313||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)||28315||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |REPAIR, NONUNION OR MALUNION; TARSAL BONES||28320||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 |||||||||||||||||| 5,144.79 | 12,314.76 | 8,865.17 |REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES O||28322||| 5,415.57 | 5,144.79 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 5,144.79 |PERCUTANEOUS SKELETAL FIXATION OF CALCANEAL FRACTURE, WITH MANIPULATION||28406||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,807.22 |OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED||28415||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 2,891.16 |OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED||28420||| 5,415.57 | 5,144.79 | 12,314.76 | 12,314.76 | 472.83 | 482.28 | 491.74 ||||||||||||||| 472.83 | 12,314.76 | 5,144.79 |CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION||28430||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |PERCUTANEOUS SKELETAL FIXATION OF TALUS FRACTURE, WITH MANIPULATION||28436||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,807.22 | 6,264.95 | 4,609.96 |OPEN TREATMENT OF TALUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED||28445||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 2,891.16 |TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITHOUT MANIPULA||28450||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 327.08 | 333.62 | 340.16 ||||||||||||||| 206.19 | 2,051.68 | 333.62 |PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANE||28456||| 2,954.97 | 2,807.22 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,807.22 | 6,264.95 | 4,609.96 |OPEN TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), INCLUDES IN||28465||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,891.16 |CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH||28470||| 2,051.68 | 1,949.10 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 2,051.68 | 400.35 |PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH||28476||| 2,954.97 | 2,807.22 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,954.97 | 2,807.22 |OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME||28485||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,891.16 |CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION||28495||| 2,281.07 | 2,167.02 | 206.19 | 206.19 | 85.73 | 87.45 | 89.16 ||||||||||||||| 85.73 | 2,281.07 | 206.19 |PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH||28496||| 2,954.97 | 2,807.22 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,807.22 | 2,954.97 | 2,830.40 |OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL F||28505||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITHOU||28510||| 609.80 | 579.31 | 206.19 | 206.19 | 392.50 | 400.35 | 408.20 ||||||||||||||| 206.19 | 609.80 | 400.35 |OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, INCLUDES||28525||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,043.33 | 2,830.40 |CLOSED TREATMENT OF SESAMOID FRACTURE||28530||| 2,051.68 | 1,949.10 | 206.19 | 206.19 |||||||||||||||||| 206.19 | 2,051.68 | 1,077.64 |OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT INTERNAL FIXATION||28531||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,891.16 |CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; REQUIRING AN||28545||| 1,141.26 | 1,084.20 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,084.20 | 2,830.40 | 1,985.83 |PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL||28546||| 1,588.63 | 1,509.20 | 1,392.35 | 1,392.35 |||||||||||||||||| 1,392.35 | 1,588.63 | 1,450.77 |OPEN TREATMENT OF TARSAL BONE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERF||28555||| 4,084.83 | 3,880.59 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,880.59 | 6,264.95 | 5,174.89 |CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA||28575||| 1,520.24 | 1,444.23 | 2,830.40 | 2,830.40 |||||||||||||||||| 1,444.23 | 2,830.40 | 2,175.32 |PERCUTANEOUS SKELETAL FIXATION OF TALOTARSAL JOINT DISLOCATION, WITH MANIPULATIO||28576||| 1,588.63 | 1,509.20 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 1,509.20 |OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN||28585||| 4,084.83 | 3,880.59 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,880.59 | 6,264.95 | 5,174.89 |CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA||28600||| 1,141.26 | 1,084.20 | 206.19 | 206.19 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 1,141.26 | 206.19 |CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA||28605||| 1,520.24 | 1,444.23 | 206.19 | 206.19 | 266.11 | 271.43 | 276.76 ||||||||||||||| 206.19 | 1,520.24 | 271.43 |PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPU||28606||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 | 334.72 | 341.42 | 348.11 ||||||||||||||| 334.72 | 2,830.40 | 1,509.20 |OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,||28615||| 4,084.83 | 3,880.59 | 6,264.95 | 6,264.95 |||||||||||||||||| 3,880.59 | 6,264.95 | 5,174.89 |CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA||28635||| 1,520.24 | 1,444.23 | 1,392.35 | 1,392.35 |||||||||||||||||| 1,392.35 | 1,520.24 | 1,418.29 |PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MA||28636||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,509.20 |OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXAT||28645||| 4,084.83 | 3,880.59 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 4,084.83 | 3,355.49 |CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA||28665||| 1,520.24 | 1,444.23 | 241.17 | 241.17 | 249.68 | 254.67 | 259.67 ||||||||||||||| 241.17 | 1,520.24 | 254.67 |PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, WITH MANIPU||28666||| 1,588.63 | 1,509.20 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 1,509.20 |OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION,||28675||| 4,084.83 | 3,880.59 | 2,830.40 | 2,830.40 | 131.49 | 134.12 | 136.75 ||||||||||||||| 131.49 | 4,084.83 | 2,830.40 |ARTHRODESIS; PANTALAR||28705||| 4,042.09 | 3,839.99 | 15,868.13 | 15,868.13 | 457.23 | 466.38 | 475.52 ||||||||||||||| 457.23 | 15,868.13 | 3,839.99 |ARTHRODESIS; TRIPLE||28715||| 4,042.09 | 3,839.99 | 12,314.76 | 12,314.76 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 12,314.76 | 3,839.99 |ARTHRODESIS; SUBTALAR||28725||| 4,042.09 | 3,839.99 | 12,314.76 | 12,314.76 | 504.07 | 514.15 | 524.23 ||||||||||||||| 504.07 | 12,314.76 | 3,839.99 |ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;||28730||| 4,042.09 | 3,839.99 | 12,314.76 | 12,314.76 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 12,314.76 | 3,839.99 |ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOM||28735||| 4,042.09 | 3,839.99 | 12,314.76 | 12,314.76 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 12,314.76 | 3,839.99 |ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL NAVICULA||28737||| 4,042.09 | 3,839.99 | 12,314.76 | 12,314.76 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 12,314.76 | 3,839.99 |ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT||28740||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 3,839.99 |ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT||28750||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 3,839.99 |ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT||28755||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 3,839.99 |ARTHRODESIS, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRST METATARSAL NECK, GR||28760||| 4,042.09 | 3,839.99 | 6,264.95 | 6,264.95 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 6,264.95 | 3,839.99 |AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART TYPE PROCEDURE)||28800||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,042.09 | 2,830.40 |AMPUTATION, FOOT; TRANSMETATARSAL||28805||| 4,042.09 | 3,839.99 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,042.09 | 2,830.40 |AMPUTATION, METATARSAL, WITH TOE, SINGLE||28810||| 2,348.02 | 2,230.62 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 2,230.62 |AMPUTATION, TOE; METATARSOPHALANGEAL JOINT||28820||| 2,348.02 | 2,230.62 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,830.40 | 2,230.62 |EXTRACORPOREAL SHOCK WAVE, HIGH ENERGY, PERFORMED BY A PHYSICIAN OR OTHER QUALIF||28890||| 3,108.86 | 2,953.42 | 1,392.35 | 1,392.35 | 222.01 | 226.45 | 230.89 ||||||||||||||| 222.01 | 3,108.86 | 1,392.35 |EXTRACORPOREAL SHOCK WAVE, HIGH ENERGY, PERFORMED BY A PHYSICIAN OR OTHER QUALIF||28890||| 3,108.86 | 2,953.42 | 1,392.35 | 1,392.35 | 355.22 | 362.33 | 369.43 ||||||||||||||| 355.22 | 3,108.86 | 1,392.35 |APPLICATION, CAST; HAND AND LOWER FOREARM (GAUNTLET)||29085||| 609.80 | 579.31 | 141.18 | 141.18 | 261.66 | 266.90 | 272.13 ||||||||||||||| 141.18 | 609.80 | 266.90 |APPLICATION, CAST; FINGER (EG, CONTRACTURE)||29086||| 99.72 | 94.73 | 141.18 | 141.18 | 261.66 | 266.90 | 272.13 ||||||||||||||| 94.73 | 272.13 | 141.18 |APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC||29126||| 324.86 | 308.62 | 111.95 | 111.95 | 261.66 | 266.90 | 272.13 ||||||||||||||| 111.95 | 324.86 | 266.90 |APPLICATION OF FINGER SPLINT; DYNAMIC||29131||| 324.86 | 308.62 | 55.66 | 55.66 | 10.47 | 10.68 | 10.89 ||||||||||||||| 10.47 | 324.86 | 55.66 |STRAPPING; HAND OR FINGER||29280||| 391.81 | 372.22 | 55.66 | 55.66 | 26.13 | 26.65 | 27.17 ||||||||||||||| 26.13 | 391.81 | 55.66 |APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER OR AMBULATORY TYPE||29355||| 391.81 | 372.22 | 241.17 | 241.17 | 261.66 | 266.90 | 272.13 ||||||||||||||| 241.17 | 391.81 | 266.90 |APPLICATION OF LONG LEG CAST BRACE||29358||| 391.81 | 372.22 | 241.17 | 241.17 | 261.66 | 266.90 | 272.13 ||||||||||||||| 241.17 | 391.81 | 266.90 |APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)||29365||| 609.80 | 579.31 | 241.17 | 241.17 |||||||||||||||||| 241.17 | 609.80 | 410.24 |APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); WALKING OR AMBULATORY TYPE||29425||| 391.81 | 372.22 | 241.17 | 241.17 | 261.66 | 266.90 | 272.13 ||||||||||||||| 241.17 | 391.81 | 266.90 |ADDING WALKER TO PREVIOUSLY APPLIED CAST||29440||| 51.29 | 48.73 | 141.18 | 141.18 | 65.42 | 66.72 | 68.03 ||||||||||||||| 48.73 | 141.18 | 66.72 |APPLICATION OF CLUBFOOT CAST WITH MOLDING OR MANIPULATION, LONG OR SHORT LEG||29450||| 391.81 | 372.22 | 141.18 | 141.18 | 261.66 | 266.90 | 272.13 ||||||||||||||| 141.18 | 391.81 | 266.90 |STRAPPING; ANKLE AND/OR FOOT||29540||| 391.81 | 372.22 | 141.18 | 141.18 | 261.66 | 266.90 | 272.13 ||||||||||||||| 141.18 | 391.81 | 266.90 |STRAPPING; TOES||29550||| 391.81 | 372.22 | 55.66 | 55.66 | 65.42 | 66.72 | 68.03 ||||||||||||||| 55.66 | 391.81 | 66.72 |APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; UPPER ARM, FOREARM, HAND, AND FIN||29584||| 391.81 | 372.22 | 141.18 | 141.18 | 67.08 | 68.42 | 69.76 ||||||||||||||| 67.08 | 391.81 | 141.18 |ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPS||29800||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL||29804||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 2,830.40 |ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PRO||29805||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY||29806||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 2,891.16 |ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION||29807||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 2,891.16 |ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY||29819||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL||29820||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 2,891.16 |ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE||29821||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 3,043.33 | 2,830.40 |ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED, 1 OR 2 DISCRETE STRUCTURE||29822||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 3,043.33 | 2,830.40 |ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE, 3 OR MORE DISCRETE STRU||29823||| 3,438.00 | 3,266.10 | 2,830.40 | 2,830.40 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 3,438.00 | 2,830.40 |ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULA||29824||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR||29825||| 4,577.81 | 4,348.92 | 2,830.40 | 2,830.40 | 601.83 | 613.86 | 625.90 ||||||||||||||| 601.83 | 4,577.81 | 2,830.40 |ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL||29826||| 4,577.81 | 4,348.92 ||| 981.24 | 1,000.86 | 1,020.49 ||||||||||||||| 981.24 | 4,577.81 | 1,020.49 |ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR||29827||| 4,577.81 | 4,348.92 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 4,348.92 |ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS||29828||| 6,283.24 | 5,969.08 | 6,264.95 | 6,264.95 |||||||||||||||||| 5,969.08 | 6,283.24 | 6,264.95 |ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCED||29830||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY||29834||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL||29835||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 408.55 | 416.72 | 424.89 ||||||||||||||| 408.55 | 3,043.33 | 2,830.40 |ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE||29836||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 |||||||||||||||||| 2,891.16 | 6,264.95 | 4,654.14 |ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED||29837||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 3,043.33 | 2,860.78 |ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE||29838||| 3,438.00 | 3,266.10 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,438.00 | 2,830.40 |ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCED||29840||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 3,043.33 | 2,830.40 |ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE||29843||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 3,043.33 | 2,860.78 |ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL||29844||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE||29845||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR OF TRIANGULAR FIBROCARTILAG||29846||| 4,223.03 | 4,011.88 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,223.03 | 2,830.40 |ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR FRACTURE OR INSTABILITY||29847||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,264.95 | 4,011.88 |ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT||29848||| 5,336.14 | 5,069.33 | 1,392.35 | 1,392.35 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 5,336.14 | 1,392.35 |ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRA||29850||| 3,043.33 | 2,891.16 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 1,392.35 |ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRA||29851||| 3,043.33 | 2,891.16 | 1,392.35 | 1,392.35 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,043.33 | 1,392.35 |ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICOND||29855||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 6,264.95 | 2,891.16 |ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDY||29856||| 3,043.33 | 2,891.16 | 12,314.76 | 12,314.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 12,314.76 | 2,891.16 |ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE||29860||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 2,891.16 |ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY||29861||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 2,891.16 |ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHO||29862||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 2,891.16 |ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY||29863||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDU||29870||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE||29871||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE||29873||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTE||29874||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION)||29875||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2 OR MORE COMPARTMENTS (EG, MED||29876||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDRO||29877||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE||29879||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING AN||29880||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 392.85 | 400.71 | 408.56 ||||||||||||||| 392.85 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING AN||29880||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY||29881||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)||29882||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)||29883||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT MANIPULATI||29884||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH BONE GR||29885||| 12,163.32 | 11,555.15 | 6,264.95 | 6,264.95 | 408.55 | 416.72 | 424.89 ||||||||||||||| 408.55 | 12,163.32 | 6,264.95 |ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESIO||29886||| 12,163.32 | 11,555.15 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 2,830.40 |ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESIO||29887||| 12,163.32 | 11,555.15 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 6,264.95 |ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONST||29888||| 12,163.32 | 11,555.15 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,163.32 | 6,264.95 |ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONS||29889||| 12,163.32 | 11,555.15 | 12,314.76 | 12,314.76 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 12,314.76 | 11,555.15 |ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR T||29891||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR D||29892||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 2,891.16 |ENDOSCOPIC PLANTAR FASCIOTOMY||29893||| 4,223.03 | 4,011.88 | 2,830.40 | 2,830.40 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,223.03 | 2,830.40 |ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL O||29894||| 4,223.03 | 4,011.88 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,223.03 | 2,830.40 |ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, P||29895||| 4,223.03 | 4,011.88 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,223.03 | 2,830.40 |ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, L||29897||| 4,223.03 | 4,011.88 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,223.03 | 2,830.40 |ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, E||29898||| 4,223.03 | 4,011.88 | 2,830.40 | 2,830.40 | 408.55 | 416.72 | 424.89 ||||||||||||||| 408.55 | 4,223.03 | 2,830.40 |ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH ANKLE ART||29899||| 4,223.03 | 4,011.88 | 6,264.95 | 6,264.95 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 6,264.95 | 4,011.88 |ARTHROSCOPY, METACARPOPHALANGEAL JOINT, DIAGNOSTIC, INCLUDES SYNOVIAL BIOPSY||29900||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 |||||||||||||||||| 2,830.40 | 3,043.33 | 2,860.78 |ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH DEBRIDEMENT||29901||| 3,043.33 | 2,891.16 | 2,830.40 | 2,830.40 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,043.33 | 2,830.40 |ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL; WITH REDUCTION OF DISPLACED UL||29902||| 3,816.96 | 3,626.11 | 1,392.35 | 1,392.35 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,816.96 | 1,392.35 |ARTHROSCOPY, HIP, SURGICAL; WITH FEMOROPLASTY (IE, TREATMENT OF CAM LESION)||29914||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 2,255.50 | 2,300.61 | 2,345.72 ||||||||||||||| 2,255.50 | 6,264.95 | 2,891.16 |ARTHROSCOPY, HIP, SURGICAL; WITH ACETABULOPLASTY (IE, TREATMENT OF PINCER LESION||29915||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 2,255.50 | 2,300.61 | 2,345.72 ||||||||||||||| 2,255.50 | 6,264.95 | 2,891.16 |ARTHROSCOPY, HIP, SURGICAL; WITH LABRAL REPAIR||29916||| 3,043.33 | 2,891.16 | 6,264.95 | 6,264.95 | 2,255.50 | 2,300.61 | 2,345.72 ||||||||||||||| 2,255.50 | 6,264.95 | 2,891.16 |UNLISTED PROCEDURE, ARTHROSCOPY||29999||| 3,043.33 | 2,891.16 | 206.19 | 206.19 |||||||||||||||||| 206.19 | 3,043.33 | 1,548.68 |BIOPSY, INTRANASAL||30100||| 437.40 | 415.53 | 1,352.79 | 1,352.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,352.79 | 415.53 |EXCISION, NASAL POLYP(S), SIMPLE||30110||| 437.40 | 415.53 | 1,352.79 | 1,352.79 | 233.54 | 238.21 | 242.88 ||||||||||||||| 233.54 | 1,352.79 | 415.53 |EXCISION, NASAL POLYP(S), EXTENSIVE||30115||| 1,916.32 | 1,820.50 | 2,736.39 | 2,736.39 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,736.39 | 1,820.50 |EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; INTERNAL APPROACH||30117||| 1,916.32 | 1,820.50 | 2,736.39 | 2,736.39 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,736.39 | 1,820.50 |EXCISION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD||30130||| 1,916.32 | 1,820.50 | 2,736.39 | 2,736.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,736.39 | 1,820.50 |SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD||30140||| 1,863.61 | 1,770.43 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 1,770.43 |INJECTION INTO TURBINATE(S), THERAPEUTIC||30200||| 393.23 | 373.57 | 452.36 | 452.36 |||||||||||||||||| 373.57 | 452.36 | 422.80 |REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA||30310||| 524.33 | 498.11 | 2,736.39 | 2,736.39 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,736.39 | 498.11 |REMOVAL FOREIGN BODY, INTRANASAL; BY LATERAL RHINOTOMY||30320||| 524.33 | 498.11 | 1,352.79 | 1,352.79 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 1,352.79 | 498.11 |RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP||30400||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 2,891.16 |RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL A||30410||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 2,891.16 |RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR||30420||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 2,891.16 |RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OF NASAL TIP WORK)||30430||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 2,891.16 |RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)||30435||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,086.05 | 2,891.16 |RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)||30450||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 2,891.16 |RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE,||30460||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 2,891.16 |RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE,||30462||| 3,043.33 | 2,891.16 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 2,891.16 |SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURIN||30520||| 4,997.07 | 4,747.22 | 2,736.39 | 2,736.39 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 4,997.07 | 2,736.39 |ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHO||30801||| 437.40 | 415.53 | 1,352.79 | 1,352.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,352.79 | 415.53 |ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHO||30802||| 437.40 | 415.53 | 1,352.79 | 1,352.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,352.79 | 415.53 |FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC||30930||| 871.96 | 828.36 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 828.36 |SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL||31020||| 930.38 | 883.86 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 883.86 |SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITHOUT REMOVAL OF ANT||31030||| 930.38 | 883.86 | 5,086.05 | 5,086.05 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,086.05 | 883.86 |SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;||31050||| 636.86 | 605.02 | 5,086.05 | 5,086.05 | 324.29 | 330.78 | 337.27 ||||||||||||||| 324.29 | 5,086.05 | 605.02 |SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; WITH MUCOSAL STRIPPING OR REMOVAL||31051||| 1,320.76 | 1,254.72 | 5,086.05 | 5,086.05 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,086.05 | 1,254.72 |ETHMOIDECTOMY; INTRANASAL, ANTERIOR||31200||| 930.38 | 883.86 | 5,086.05 | 5,086.05 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 5,086.05 | 883.86 |ETHMOIDECTOMY; INTRANASAL, TOTAL||31201||| 3,438.00 | 3,266.10 | 1,352.79 | 1,352.79 | 274.75 | 280.24 | 285.74 ||||||||||||||| 274.75 | 3,438.00 | 1,352.79 |ETHMOIDECTOMY; EXTRANASAL, TOTAL||31205||| 3,043.33 | 2,891.16 | 2,736.39 | 2,736.39 | 555.67 | 566.78 | 577.90 ||||||||||||||| 555.67 | 3,043.33 | 2,736.39 |MAXILLECTOMY; WITHOUT ORBITAL EXENTERATION||31225||| 5,673.46 | 5,389.79 ||| 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,673.46 | 476.23 |MAXILLECTOMY; WITH ORBITAL EXENTERATION (EN BLOC)||31230||| 5,673.46 | 5,389.79 |||||||||||||||||||| 5,389.79 | 5,673.46 | 5,531.62 |NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)||31231||| 1,916.32 | 1,820.50 | 164.39 | 164.39 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 1,916.32 | 164.39 |NASAL/SINUS ENDOSCOPY, DIAGNOSTIC; WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR MEAT||31233||| 1,916.32 | 1,820.50 | 376.51 | 376.51 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,916.32 | 376.51 |NASAL/SINUS ENDOSCOPY, DIAGNOSTIC; WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF SP||31235||| 1,916.32 | 1,820.50 | 1,496.39 | 1,496.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,916.32 | 1,496.39 |NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARA||31237||| 1,916.32 | 1,820.50 | 1,496.39 | 1,496.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,916.32 | 1,496.39 |NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY||31239||| 1,916.32 | 1,820.50 | 3,098.02 | 3,098.02 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 3,098.02 | 1,820.50 |NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION||31240||| 1,916.32 | 1,820.50 | 1,496.39 | 1,496.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,916.32 | 1,496.39 |NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)||31254||| 3,398.09 | 3,228.19 | 5,822.76 | 5,822.76 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,822.76 | 3,228.19 |NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIO||31255||| 8,471.10 | 8,047.55 | 5,822.76 | 5,822.76 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 8,471.10 | 5,822.76 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;||31256||| 2,348.02 | 2,230.62 | 3,098.02 | 3,098.02 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,098.02 | 2,230.62 |NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIO||31257||| 3,267.39 | 3,104.02 | 5,822.76 | 5,822.76 |||||||||||||||||| 3,104.02 | 5,822.76 | 4,545.08 |NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIO||31259||| 3,398.09 | 3,228.19 | 5,822.76 | 5,822.76 |||||||||||||||||| 3,228.19 | 5,822.76 | 4,610.43 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISS||31267||| 2,348.02 | 2,230.62 | 5,822.76 | 5,822.76 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,822.76 | 2,230.62 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOV||31276||| 3,398.09 | 3,228.19 | 5,822.76 | 5,822.76 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 5,822.76 | 3,228.19 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;||31287||| 3,398.09 | 3,228.19 | 5,822.76 | 5,822.76 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,822.76 | 3,228.19 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM||31288||| 3,398.09 | 3,228.19 | 5,822.76 | 5,822.76 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,822.76 | 3,228.19 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; ETHMOI||31290||| 3,398.09 | 3,228.19 |||||||||||||||||||| 3,228.19 | 3,398.09 | 3,313.14 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OF CEREBROSPINAL FLUID LEAK; SPHENO||31291||| 3,398.09 | 3,228.19 |||||||||||||||||||| 3,228.19 | 3,398.09 | 3,313.14 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH ORBITAL DECOMPRESSION; MEDIAL OR INFERIOR||31292||| 3,398.09 | 3,228.19 | 5,822.76 | 5,822.76 |||||||||||||||||| 3,228.19 | 5,822.76 | 4,610.43 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH ORBITAL DECOMPRESSION; MEDIAL AND INFERIOR||31293||| 5,673.46 | 5,389.79 | 5,822.76 | 5,822.76 |||||||||||||||||| 5,389.79 | 5,822.76 | 5,748.11 |NASAL/SINUS ENDOSCOPY, SURGICAL, WITH OPTIC NERVE DECOMPRESSION||31294||| 3,398.09 | 3,228.19 | 5,822.76 | 5,822.76 |||||||||||||||||| 3,228.19 | 5,822.76 | 4,610.43 |LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE), WITH REMOVAL OF TUMOR OR LARYNGOCELE, C||31300||| 3,398.09 | 3,228.19 | 2,736.39 | 2,736.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,398.09 | 2,736.39 |LARYNGOSCOPY, INDIRECT; WITH REMOVAL OF LESION||31512||| 1,916.32 | 1,820.50 | 3,098.02 | 3,098.02 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,098.02 | 1,820.50 |LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION||31515||| 783.62 | 744.44 | 376.51 | 376.51 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 783.62 | 376.51 |LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, NEWBORN||31520||| 783.62 | 744.44 | 376.51 | 376.51 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 783.62 | 376.51 |LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN||31525||| 783.62 | 744.44 | 1,496.39 | 1,496.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,496.39 | 744.44 |LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MI||31526||| 1,141.26 | 1,084.20 | 1,496.39 | 1,496.39 | 359.79 | 366.98 | 374.18 ||||||||||||||| 359.79 | 1,496.39 | 1,084.20 |LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH INSERTION OF OBTURATOR||31527||| 783.62 | 744.44 | 3,098.02 | 3,098.02 |||||||||||||||||| 744.44 | 3,098.02 | 1,940.82 |LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL||31528||| 1,141.26 | 1,084.20 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,098.02 | 1,084.20 |LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, SUBSEQUENT||31529||| 1,141.26 | 1,084.20 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,098.02 | 1,084.20 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL;||31530||| 5,864.38 | 5,571.16 | 1,496.39 | 1,496.39 | 247.27 | 252.22 | 257.16 ||||||||||||||| 247.27 | 5,864.38 | 1,496.39 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; WITH OPERATING MICRO||31531||| 5,864.38 | 5,571.16 | 3,098.02 | 3,098.02 | 247.27 | 252.22 | 257.16 ||||||||||||||| 247.27 | 5,864.38 | 3,098.02 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;||31535||| 5,864.38 | 5,571.16 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,864.38 | 3,098.02 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELES||31536||| 5,864.38 | 5,571.16 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,864.38 | 3,098.02 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCA||31540||| 5,864.38 | 5,571.16 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,864.38 | 3,098.02 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCA||31541||| 5,864.38 | 5,571.16 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,864.38 | 3,098.02 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY;||31560||| 5,864.38 | 5,571.16 | 5,822.76 | 5,822.76 | 538.37 | 549.14 | 559.91 ||||||||||||||| 538.37 | 5,864.38 | 5,571.16 |LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE||31561||| 5,864.38 | 5,571.16 | 5,822.76 | 5,822.76 |||||||||||||||||| 5,571.16 | 5,864.38 | 5,822.76 |LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC;||31570||| 1,916.32 | 1,820.50 | 3,098.02 | 3,098.02 | 209.33 | 213.52 | 217.70 ||||||||||||||| 209.33 | 3,098.02 | 1,820.50 |LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERA||31571||| 1,916.32 | 1,820.50 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,098.02 | 1,820.50 |LARYNGOSCOPY, FLEXIBLE; WITH ABLATION OR DESTRUCTION OF LESION(S) WITH LASER, UN||31572||| 1,916.32 | 1,820.50 | 3,098.02 | 3,098.02 |||||||||||||||||| 1,820.50 | 3,098.02 | 2,507.17 |LARYNGOSCOPY, FLEXIBLE; WITH THERAPEUTIC INJECTION(S) (EG, CHEMODENERVATION AGEN||31573||| 1,916.32 | 1,820.50 | 1,496.39 | 1,496.39 |||||||||||||||||| 1,496.39 | 1,916.32 | 1,658.45 |LARYNGOSCOPY, FLEXIBLE; WITH INJECTION(S) FOR AUGMENTATION (EG, PERCUTANEOUS, TR||31574||| 1,916.32 | 1,820.50 | 1,496.39 | 1,496.39 |||||||||||||||||| 1,496.39 | 1,916.32 | 1,658.45 |LARYNGOSCOPY, FLEXIBLE; WITH BIOPSY(IES)||31576||| 1,916.32 | 1,820.50 | 1,496.39 | 1,496.39 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 1,916.32 | 1,496.39 |LARYNGOSCOPY, FLEXIBLE; WITH REMOVAL OF LESION(S), NON-LASER||31578||| 1,916.32 | 1,820.50 | 3,098.02 | 3,098.02 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 3,098.02 | 1,820.50 |LARYNGOSCOPY, FLEXIBLE OR RIGID TELESCOPIC, WITH STROBOSCOPY||31579||| 1,916.32 | 1,820.50 | 376.51 | 376.51 | 425.20 | 433.71 | 442.21 ||||||||||||||| 376.51 | 1,916.32 | 433.71 |TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMY INCISION||31615||| 1,141.26 | 1,084.20 | 452.36 | 452.36 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,141.26 | 452.36 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31626||| 1,141.26 | 1,084.20 | 5,822.76 | 5,822.76 | 472.55 | 482.00 | 491.45 ||||||||||||||| 472.55 | 5,822.76 | 1,084.20 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31627||| 14.25 | 13.54 |||||||||||||||||||| 13.54 | 14.25 | 13.89 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31630||| 2,291.04 | 2,176.49 | 3,098.02 | 3,098.02 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,098.02 | 2,176.49 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31631||| 2,291.04 | 2,176.49 | 5,822.76 | 5,822.76 | 334.72 | 341.42 | 348.11 ||||||||||||||| 334.72 | 5,822.76 | 2,176.49 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31634||| 2,291.04 | 2,176.49 | 5,822.76 | 5,822.76 | 488.92 | 498.70 | 508.48 ||||||||||||||| 488.92 | 5,822.76 | 2,176.49 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31640||| 2,291.04 | 2,176.49 | 3,098.02 | 3,098.02 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,098.02 | 2,176.49 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31641||| 2,291.04 | 2,176.49 | 3,098.02 | 3,098.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,098.02 | 2,176.49 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31643||| 2,291.04 | 2,176.49 | 1,496.39 | 1,496.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,291.04 | 1,496.39 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31645||| 1,141.26 | 1,084.20 | 1,496.39 | 1,496.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,496.39 | 1,084.20 |BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED||31646||| 1,141.26 | 1,084.20 | 376.51 | 376.51 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,141.26 | 376.51 |CATHETERIZATION WITH BRONCHIAL BRUSH BIOPSY||31717||| 1,141.26 | 1,084.20 | 376.51 | 376.51 |||||||||||||||||| 376.51 | 1,141.26 | 730.35 |THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS, PERICARDIAL SAC, MEDIASTIN||32601||| 2,291.04 | 2,176.49 | 5,060.44 | 5,060.44 |||||||||||||||||| 2,176.49 | 5,060.44 | 3,675.74 |THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); PERICARDIAL SAC, WITH BIOPSY||32604||| 2,291.04 | 2,176.49 | 5,060.44 | 5,060.44 |||||||||||||||||| 2,176.49 | 5,060.44 | 3,675.74 |THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITH BIOPSY||32606||| 2,291.04 | 2,176.49 | 5,060.44 | 5,060.44 |||||||||||||||||| 2,176.49 | 5,060.44 | 3,675.74 |THORACOSCOPY; WITH DIAGNOSTIC BIOPSY(IES) OF LUNG INFILTRATE(S) (EG, WEDGE, INCI||32607||| 2,291.04 | 2,176.49 | 5,060.44 | 5,060.44 | 2,050.97 | 2,091.99 | 2,133.01 ||||||||||||||| 2,050.97 | 5,060.44 | 2,176.49 |THORACOSCOPY; WITH DIAGNOSTIC BIOPSY(IES) OF LUNG NODULE(S) OR MASS(ES) (EG, WED||32608||| 2,291.04 | 2,176.49 | 5,060.44 | 5,060.44 | 2,050.97 | 2,091.99 | 2,133.01 ||||||||||||||| 2,050.97 | 5,060.44 | 2,176.49 |THORACOSCOPY; WITH BIOPSY(IES) OF PLEURA||32609||| 2,291.04 | 2,176.49 | 5,060.44 | 5,060.44 | 2,050.97 | 2,091.99 | 2,133.01 ||||||||||||||| 2,050.97 | 5,060.44 | 2,176.49 |INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STE||33202||| 25,194.30 | 23,934.59 |||||||||||||||||||| 23,934.59 | 25,194.30 | 24,564.44 |INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG, THORACOSCOPY, PER||33203||| 25,194.30 | 23,934.59 |||||||||||||||||||| 23,934.59 | 25,194.30 | 24,564.44 |INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES||33211||| 2,291.04 | 2,176.49 | 8,152.58 | 8,152.58 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 8,152.58 | 2,176.49 |INSERTION OF PACEMAKER PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD||33212||| 25,194.30 | 23,934.59 | 8,152.58 | 8,152.58 | 7,856.33 | 8,013.46 | 8,170.58 ||||||||||||||| 7,856.33 | 25,194.30 | 8,152.58 |REPAIR OF 2 TRANSVENOUS ELECTRODES FOR PERMANENT PACEMAKER OR IMPLANTABLE DEFIBR||33220||| 2,291.04 | 2,176.49 | 3,440.37 | 3,440.37 | 4,111.09 | 4,193.32 | 4,275.54 ||||||||||||||| 2,176.49 | 4,275.54 | 3,440.37 |INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING DUAL||33230||| 57,382.85 | 54,513.71 | 23,040.16 | 23,040.16 | 20,637.98 | 21,050.74 | 21,463.50 ||||||||||||||| 20,637.98 | 57,382.85 | 23,040.16 |INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING MULTI||33231||| 57,382.85 | 54,513.71 | 32,838.89 | 32,838.89 | 20,637.98 | 21,050.74 | 21,463.50 ||||||||||||||| 20,637.98 | 57,382.85 | 32,838.89 |REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; SINGLE||33236||| 2,291.04 | 2,176.49 ||| 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,291.04 | 476.23 |REMOVAL OF PERMANENT EPICARDIAL PACEMAKER AND ELECTRODES BY THORACOTOMY; DUAL LE||33237||| 2,291.04 | 2,176.49 ||| 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,291.04 | 476.23 |REMOVAL OF PERMANENT TRANSVENOUS ELECTRODE(S) BY THORACOTOMY||33238||| 2,291.04 | 2,176.49 ||| 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,291.04 | 476.23 |INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING SINGL||33240||| 57,382.85 | 54,513.71 | 23,040.16 | 23,040.16 | 23,502.28 | 23,972.33 | 24,442.37 ||||||||||||||| 23,040.16 | 57,382.85 | 23,972.33 |CORONARY ENDARTERECTOMY, OPEN, ANY METHOD, OF LEFT ANTERIOR DESCENDING, CIRCUMFL||33572||| 2,954.97 | 2,807.22 |||||||||||||||||||| 2,807.22 | 2,954.97 | 2,881.10 |CLOSURE OF ATRIOVENTRICULAR VALVE (MITRAL OR TRICUSPID) BY SUTURE OR PATCH||33600||| 3,438.00 | 3,266.10 |||||||||||||||||||| 3,266.10 | 3,438.00 | 3,352.05 |CLOSURE OF SEMILUNAR VALVE (AORTIC OR PULMONARY) BY SUTURE OR PATCH||33602||| 3,438.00 | 3,266.10 |||||||||||||||||||| 3,266.10 | 3,438.00 | 3,352.05 |REIMPLANTATION OF AN ANOMALOUS PULMONARY ARTERY||33788||| 3,438.00 | 3,266.10 ||| 1,314.86 | 1,341.16 | 1,367.46 ||||||||||||||| 1,314.86 | 3,438.00 | 1,367.46 |VALVULOPLASTY, FEMORAL VEIN||34501||| 3,438.00 | 3,266.10 | 4,770.37 | 4,770.37 |||||||||||||||||| 3,266.10 | 4,770.37 | 4,104.19 |RECONSTRUCTION OF VENA CAVA, ANY METHOD||34502||| 3,438.00 | 3,266.10 |||||||||||||||||||| 3,266.10 | 3,438.00 | 3,352.05 |REPAIR BLOOD VESSEL, DIRECT; NECK||35201||| 2,169.94 | 2,061.44 | 4,770.37 | 4,770.37 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 4,770.37 | 2,061.44 |REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY||35206||| 2,169.94 | 2,061.44 | 2,861.66 | 2,861.66 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,861.66 | 2,061.44 |REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER||35207||| 2,169.94 | 2,061.44 | 2,861.66 | 2,861.66 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 2,861.66 | 2,061.44 |REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITH BYPASS||35211||| 3,438.00 | 3,266.10 |||||||||||||||||||| 3,266.10 | 3,438.00 | 3,352.05 |REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, WITHOUT BYPASS||35216||| 3,438.00 | 3,266.10 |||||||||||||||||||| 3,266.10 | 3,438.00 | 3,352.05 |REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL||35221||| 2,169.94 | 2,061.44 ||| 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,169.94 | 408.20 |REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY||35226||| 2,169.94 | 2,061.44 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,169.94 | 621.97 |THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; CAROTID, VERTEBRAL,||35301||| 3,043.33 | 2,891.16 ||| 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 3,043.33 | 816.39 |TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO CAROTID ARTERY||35691||| 2,169.94 | 2,061.44 |||||||||||||||||||| 2,061.44 | 2,169.94 | 2,115.69 |TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO SUBCLAVIAN ARTERY||35693||| 2,169.94 | 2,061.44 |||||||||||||||||||| 2,061.44 | 2,169.94 | 2,115.69 |TRANSPOSITION AND/OR REIMPLANTATION; SUBCLAVIAN TO CAROTID ARTERY||35694||| 2,169.94 | 2,061.44 |||||||||||||||||||| 2,061.44 | 2,169.94 | 2,115.69 |TRANSPOSITION AND/OR REIMPLANTATION; CAROTID TO SUBCLAVIAN ARTERY||35695||| 2,169.94 | 2,061.44 |||||||||||||||||||| 2,061.44 | 2,169.94 | 2,115.69 |EXCISION OF INFECTED GRAFT; NECK||35901||| 3,043.33 | 2,891.16 |||||||||||||||||||| 2,891.16 | 3,043.33 | 2,967.25 |INTRODUCTION OF CATHETER, RIGHT HEART OR MAIN PULMONARY ARTERY||36013||| 930.38 | 883.86 ||| 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 930.38 | 544.26 |INTRODUCTION OF NEEDLE OR INTRACATHETER, CAROTID OR VERTEBRAL ARTERY||36100||| 393.23 | 373.57 ||| 784.99 | 800.69 | 816.39 ||||||||||||||| 373.57 | 816.39 | 784.99 |INSERTION OF IMPLANTABLE INTRA-ARTERIAL INFUSION PUMP (EG, FOR CHEMOTHERAPY OF L||36260||| 1,632.80 | 1,551.16 | 4,770.37 | 4,770.37 | 525.94 | 536.46 | 546.98 ||||||||||||||| 525.94 | 4,770.37 | 1,551.16 |REVISION OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP||36261||| 1,632.80 | 1,551.16 | 3,440.37 | 3,440.37 | 525.94 | 536.46 | 546.98 ||||||||||||||| 525.94 | 3,440.37 | 1,551.16 |REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP||36262||| 391.81 | 372.22 | 3,440.37 | 3,440.37 | 525.94 | 536.46 | 546.98 ||||||||||||||| 372.22 | 3,440.37 | 536.46 |INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT WITH ULTRASOUND COMPRESSION MANEUVER||36465||| 413.23 | 392.57 | 1,715.36 | 1,715.36 |||||||||||||||||| 392.57 | 1,715.36 | 1,064.30 |INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT WITH ULTRASOUND COMPRESSION MANEUVER||36466||| 413.23 | 392.57 | 1,715.36 | 1,715.36 |||||||||||||||||| 392.57 | 1,715.36 | 1,064.30 |INJECTION(S) OF SCLEROSANT FOR SPIDER VEINS (TELANGIECTASIA), LIMB OR TRUNK||36468||| 568.48 | 540.06 | 345.84 | 345.84 |||||||||||||||||| 345.84 | 568.48 | 442.95 |ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMA||36473||| 3,736.70 | 3,549.87 | 2,861.66 | 2,861.66 |||||||||||||||||| 2,861.66 | 3,736.70 | 3,205.76 |ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMA||36478||| 5,140.60 | 4,883.57 | 2,861.66 | 2,861.66 |||||||||||||||||| 2,861.66 | 5,140.60 | 3,872.62 |INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE WITH SUBCU||36563||| 1,863.61 | 1,770.43 | 4,770.37 | 4,770.37 | 1,189.85 | 1,213.65 | 1,237.45 ||||||||||||||| 1,189.85 | 4,770.37 | 1,770.43 |INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, REQUIRING||36565||| 1,863.61 | 1,770.43 | 2,861.66 | 2,861.66 | 1,189.85 | 1,213.65 | 1,237.45 ||||||||||||||| 1,189.85 | 2,861.66 | 1,770.43 |INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, REQUIRING||36566||| 1,863.61 | 1,770.43 | 4,770.37 | 4,770.37 | 4,039.44 | 4,120.23 | 4,201.02 ||||||||||||||| 1,770.43 | 4,770.37 | 4,120.23 |INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEO||36570||| 1,863.61 | 1,770.43 | 2,861.66 | 2,861.66 | 4,039.44 | 4,120.23 | 4,201.02 ||||||||||||||| 1,770.43 | 4,201.02 | 2,861.66 |INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEO||36571||| 1,863.61 | 1,770.43 | 2,861.66 | 2,861.66 | 4,039.44 | 4,120.23 | 4,201.02 ||||||||||||||| 1,770.43 | 4,201.02 | 2,861.66 |REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL||36576||| 1,863.61 | 1,770.43 | 1,406.14 | 1,406.14 | 205.50 | 209.61 | 213.72 ||||||||||||||| 205.50 | 1,863.61 | 1,406.14 |REPLACEMENT, COMPLETE, OF A PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,||36585||| 1,863.61 | 1,770.43 | 2,861.66 | 2,861.66 | 533.15 | 543.82 | 554.48 ||||||||||||||| 533.15 | 2,861.66 | 1,770.43 |REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U||37234||| 7,729.40 | 7,342.93 ||| 2,555.41 | 2,606.52 | 2,657.63 ||||||||||||||| 2,555.41 | 7,729.40 | 2,657.63 |REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, U||37235||| 7,729.40 | 7,342.93 ||| 2,555.41 | 2,606.52 | 2,657.63 ||||||||||||||| 2,555.41 | 7,729.40 | 2,657.63 |LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DIST||37700||| 609.80 | 579.31 | 2,861.66 | 2,861.66 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,861.66 | 579.31 |LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN||37718||| 1,141.26 | 1,084.20 | 2,861.66 | 2,861.66 | 404.93 | 413.02 | 421.12 ||||||||||||||| 404.93 | 2,861.66 | 1,084.20 |LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFE||37722||| 1,141.26 | 1,084.20 | 2,861.66 | 2,861.66 | 404.93 | 413.02 | 421.12 ||||||||||||||| 404.93 | 2,861.66 | 1,084.20 |LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS WI||37735||| 1,141.26 | 1,084.20 | 2,861.66 | 2,861.66 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 2,861.66 | 1,084.20 |LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), INCLUDING SKIN||37760||| 1,141.26 | 1,084.20 | 2,861.66 | 2,861.66 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,861.66 | 1,084.20 |LIGATION OF PERFORATOR VEIN(S), SUBFASCIAL, OPEN, INCLUDING ULTRASOUND GUIDANCE,||37761||| 1,141.26 | 1,084.20 | 2,861.66 | 2,861.66 | 1,210.76 | 1,234.97 | 1,259.19 ||||||||||||||| 1,084.20 | 2,861.66 | 1,234.97 |LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION (SEPA||37780||| 1,141.26 | 1,084.20 | 2,861.66 | 2,861.66 | 370.40 | 377.81 | 385.21 ||||||||||||||| 370.40 | 2,861.66 | 1,084.20 |LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), 1 LEG||37785||| 1,141.26 | 1,084.20 | 2,861.66 | 2,861.66 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,861.66 | 1,084.20 |DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE||38300||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 288.48 | 294.25 | 300.02 ||||||||||||||| 288.48 | 2,370.01 | 415.53 |DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; EXTENSIVE||38305||| 1,141.26 | 1,084.20 | 2,370.01 | 2,370.01 | 281.29 | 286.91 | 292.54 ||||||||||||||| 281.29 | 2,370.01 | 1,084.20 |BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL||38500||| 1,141.26 | 1,084.20 | 3,157.74 | 3,157.74 | 281.29 | 286.91 | 292.54 ||||||||||||||| 281.29 | 3,157.74 | 1,084.20 |BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)||38510||| 1,141.26 | 1,084.20 | 3,157.74 | 3,157.74 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,157.74 | 1,084.20 |BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S) WITH EXCISION S||38520||| 1,141.26 | 1,084.20 | 3,157.74 | 3,157.74 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,157.74 | 1,084.20 |BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)||38525||| 1,141.26 | 1,084.20 | 3,157.74 | 3,157.74 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,157.74 | 1,084.20 |BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INTERNAL MAMMARY NODE(S)||38530||| 1,141.26 | 1,084.20 | 3,157.74 | 3,157.74 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,157.74 | 1,084.20 |BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INGUINOFEMORAL NODE(S)||38531||| 1,141.26 | 1,084.20 | 3,157.74 | 3,157.74 |||||||||||||||||| 1,084.20 | 3,157.74 | 2,149.50 |LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE||38570||| 5,415.57 | 5,144.79 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,415.57 | 5,060.44 |LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY||38571||| 5,415.57 | 5,144.79 | 8,907.66 | 8,907.66 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,907.66 | 5,144.79 |LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORT||38572||| 5,415.57 | 5,144.79 | 8,907.66 | 8,907.66 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,907.66 | 5,144.79 |LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORT||38573||| 5,415.57 | 5,144.79 | 8,907.66 | 8,907.66 |||||||||||||||||| 5,144.79 | 8,907.66 | 7,161.62 |UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM||38589||| 5,415.57 | 5,144.79 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 5,415.57 | 5,102.62 |INTRAOPERATIVE IDENTIFICATION (EG, MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES I||38900||| 2,020.34 | 1,919.32 |||||||||||||||||||| 1,919.32 | 2,020.34 | 1,969.83 |MEDIASTINOSCOPY; INCLUDES BIOPSY(IES) OF MEDIASTINAL MASS (EG, LYMPHOMA), WHEN P||39401||| 1,269.97 | 1,206.47 | 5,060.44 | 5,060.44 |||||||||||||||||| 1,206.47 | 5,060.44 | 3,165.21 |MEDIASTINOSCOPY; WITH LYMPH NODE BIOPSY(IES) (EG, LUNG CANCER STAGING)||39402||| 1,269.97 | 1,206.47 | 5,060.44 | 5,060.44 |||||||||||||||||| 1,206.47 | 5,060.44 | 3,165.21 |BIOPSY OF LIP||40490||| 524.33 | 498.11 | 211.60 | 211.60 | 240.40 | 245.21 | 250.02 ||||||||||||||| 211.60 | 524.33 | 245.21 |VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT||40500||| 1,141.26 | 1,084.20 | 2,736.39 | 2,736.39 |||||||||||||||||| 1,084.20 | 2,736.39 | 1,938.83 |EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH PRIMARY CLOSURE||40510||| 1,141.26 | 1,084.20 | 2,736.39 | 2,736.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,736.39 | 1,084.20 |EXCISION OF LIP; V-EXCISION WITH PRIMARY DIRECT LINEAR CLOSURE||40520||| 1,141.26 | 1,084.20 | 2,736.39 | 2,736.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,736.39 | 1,084.20 |EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER O||40525||| 1,141.26 | 1,084.20 | 2,736.39 | 2,736.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,736.39 | 1,084.20 |EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP (ABBE-ESTLAN||40527||| 1,141.26 | 1,084.20 | 5,086.05 | 5,086.05 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,086.05 | 1,084.20 |RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUT RECONSTRUCTION||40530||| 1,141.26 | 1,084.20 | 2,736.39 | 2,736.39 |||||||||||||||||| 1,084.20 | 2,736.39 | 1,938.83 |BIOPSY, VESTIBULE OF MOUTH||40808||| 524.33 | 498.11 | 452.36 | 452.36 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 524.33 | 452.36 |EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITHOUT REPAIR||40810||| 524.33 | 498.11 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 498.11 |EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH SIMPLE REPA||40812||| 524.33 | 498.11 | 1,352.79 | 1,352.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,352.79 | 498.11 |EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH COMPLEX REP||40814||| 1,632.80 | 1,551.16 | 2,736.39 | 2,736.39 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,736.39 | 1,551.16 |EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT||40818||| 537.15 | 510.29 | 452.36 | 452.36 |||||||||||||||||| 452.36 | 537.15 | 481.33 |EXCISION OF LESION OF TONGUE WITHOUT CLOSURE||41110||| 609.80 | 579.31 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 579.31 |EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS||41112||| 783.62 | 744.44 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 744.44 |EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD||41113||| 783.62 | 744.44 | 2,736.39 | 2,736.39 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,736.39 | 744.44 |EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUE FLAP||41114||| 783.62 | 744.44 | 2,736.39 | 2,736.39 | 334.72 | 341.42 | 348.11 ||||||||||||||| 334.72 | 2,736.39 | 744.44 |REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; BONE||41806||| 2,051.68 | 1,949.10 | 1,352.79 | 1,352.79 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,352.79 |GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT||41820||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,736.39 | 1,949.10 |OPERCULECTOMY, EXCISION PERICORONAL TISSUES||41821||| 2,051.68 | 1,949.10 | 1,352.79 | 1,352.79 |||||||||||||||||| 1,352.79 | 2,051.68 | 1,650.94 |EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES||41822||| 2,051.68 | 1,949.10 | 1,352.79 | 1,352.79 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,051.68 | 1,352.79 |EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES||41823||| 2,051.68 | 1,949.10 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 1,949.10 |EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WIT||41825||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,736.39 | 1,949.10 |EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WIT||41826||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 359.79 | 366.98 | 374.18 ||||||||||||||| 359.79 | 2,736.39 | 1,949.10 |EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WIT||41827||| 2,051.68 | 1,949.10 | 5,086.05 | 5,086.05 |||||||||||||||||| 1,949.10 | 5,086.05 | 3,568.87 |EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA, EACH QUADRANT (SPECIFY)||41828||| 2,051.68 | 1,949.10 | 1,352.79 | 1,352.79 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,051.68 | 1,352.79 |ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS OR SEQUESTRECTOMY||41830||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,736.39 | 1,949.10 |DESTRUCTION OF LESION (EXCEPT EXCISION), DENTOALVEOLAR STRUCTURES||41850||| 2,051.68 | 1,949.10 | 1,352.79 | 1,352.79 |||||||||||||||||| 1,352.79 | 2,051.68 | 1,650.94 |PERIODONTAL MUCOSAL GRAFTING||41870||| 2,051.68 | 1,949.10 | 1,352.79 | 1,352.79 |||||||||||||||||| 1,352.79 | 2,051.68 | 1,650.94 |GINGIVOPLASTY, EACH QUADRANT (SPECIFY)||41872||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,736.39 | 1,949.10 |ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)||41874||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,736.39 | 1,949.10 |UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES||41899||| 2,051.68 | 1,949.10 | 211.60 | 211.60 |||||||||||||||||| 211.60 | 2,051.68 | 1,080.35 |BIOPSY OF PALATE, UVULA||42100||| 437.40 | 415.53 | 1,352.79 | 1,352.79 | 212.93 | 217.19 | 221.45 ||||||||||||||| 212.93 | 1,352.79 | 415.53 |UVULECTOMY, EXCISION OF UVULA||42140||| 1,916.32 | 1,820.50 | 2,736.39 | 2,736.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,736.39 | 1,820.50 |PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY)||42145||| 2,954.97 | 2,807.22 | 5,086.05 | 5,086.05 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,086.05 | 2,807.22 |REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX||42182||| 636.86 | 605.02 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,086.05 | 605.02 |EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, EN BLOC REMOVAL WITH SACRIFIC||42425||| 4,909.79 | 4,664.30 | 5,086.05 | 5,086.05 |||||||||||||||||| 4,664.30 | 5,086.05 | 4,997.92 |INJECTION PROCEDURE FOR SIALOGRAPHY||42550||| 437.40 | 415.53 ||| 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 437.40 | 204.10 |TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12||42820||| 2,538.95 | 2,412.00 | 5,086.05 | 5,086.05 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 5,086.05 | 2,412.00 |TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER||42821||| 2,838.16 | 2,696.25 | 2,736.39 | 2,736.39 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 2,838.16 | 2,696.25 |TONSILLECTOMY, PRIMARY OR SECONDARY; YOUNGER THAN AGE 12||42825||| 2,838.16 | 2,696.25 | 5,086.05 | 5,086.05 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 5,086.05 | 2,696.25 |TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER||42826||| 2,538.95 | 2,412.00 | 2,736.39 | 2,736.39 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 2,736.39 | 2,412.00 |ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12||42830||| 2,538.95 | 2,412.00 | 2,736.39 | 2,736.39 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 2,736.39 | 2,412.00 |ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER||42831||| 2,538.95 | 2,412.00 | 2,736.39 | 2,736.39 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 2,736.39 | 2,412.00 |ADENOIDECTOMY, SECONDARY; YOUNGER THAN AGE 12||42835||| 2,538.95 | 2,412.00 | 2,736.39 | 2,736.39 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 2,736.39 | 2,412.00 |ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER||42836||| 2,538.95 | 2,412.00 | 2,736.39 | 2,736.39 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 2,736.39 | 2,412.00 |RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; WITHO||42842||| 2,538.95 | 2,412.00 | 5,086.05 | 5,086.05 | 549.49 | 560.48 | 571.47 ||||||||||||||| 549.49 | 5,086.05 | 2,412.00 |RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; CLOSU||42844||| 2,538.95 | 2,412.00 | 5,086.05 | 5,086.05 | 1,177.49 | 1,201.04 | 1,224.59 ||||||||||||||| 1,177.49 | 5,086.05 | 2,412.00 |RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; CLOSU||42845||| 2,538.95 | 2,412.00 ||| 1,274.07 | 1,299.55 | 1,325.03 ||||||||||||||| 1,274.07 | 2,538.95 | 1,325.03 |RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; CLOSU||42845||| 2,538.95 | 2,412.00 ||| 2,063.12 | 2,104.38 | 2,145.64 ||||||||||||||| 2,063.12 | 2,538.95 | 2,145.64 |EXCISION OF TONSIL TAGS||42860||| 783.62 | 744.44 | 2,736.39 | 2,736.39 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 2,736.39 | 744.44 |EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)||42870||| 2,538.95 | 2,412.00 | 5,086.05 | 5,086.05 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 5,086.05 | 2,412.00 |CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY);||42960||| 437.40 | 415.53 | 452.36 | 452.36 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 452.36 | 415.53 |CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY);||42962||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 2,736.39 | 1,949.10 |CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTADENOIDECTOM||42970||| 437.40 | 415.53 | 211.60 | 211.60 | 654.16 | 667.24 | 680.33 ||||||||||||||| 211.60 | 680.33 | 437.40 |CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTADENOIDECTOM||42972||| 2,051.68 | 1,949.10 | 2,736.39 | 2,736.39 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 2,736.39 | 1,949.10 |ESOPHAGOSCOPY, RIGID, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S)||43191||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 570.18 | 581.58 | 592.99 ||||||||||||||| 570.18 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBS||43192||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 861.50 | 878.73 | 895.96 ||||||||||||||| 861.50 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE||43193||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 861.50 | 878.73 | 895.96 ||||||||||||||| 861.50 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)||43194||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 861.50 | 878.73 | 895.96 ||||||||||||||| 861.50 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER||43195||| 1,289.43 | 1,224.96 | 3,080.79 | 3,080.79 | 861.50 | 878.73 | 895.96 ||||||||||||||| 861.50 | 3,080.79 | 1,224.96 |ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATI||43196||| 1,289.43 | 1,224.96 | 3,080.79 | 3,080.79 | 861.50 | 878.73 | 895.96 ||||||||||||||| 861.50 | 3,080.79 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSNASAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIME||43197||| 1,289.43 | 1,224.96 | 809.60 | 809.60 | 570.18 | 581.58 | 592.99 ||||||||||||||| 570.18 | 1,289.43 | 809.60 |ESOPHAGOSCOPY, FLEXIBLE, TRANSNASAL; WITH BIOPSY, SINGLE OR MULTIPLE||43198||| 1,289.43 | 1,224.96 | 809.60 | 809.60 | 570.18 | 581.58 | 592.99 ||||||||||||||| 570.18 | 1,289.43 | 809.60 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN||43200||| 1,289.43 | 1,224.96 | 809.60 | 809.60 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,289.43 | 809.60 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY S||43201||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE||43202||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH INJECTION SCLEROSIS OF ESOPHAGEAL VARIC||43204||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH BAND LIGATION OF ESOPHAGEAL VARICES||43205||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH OPTICAL ENDOMICROSCOPY||43206||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 788.15 | 803.91 | 819.67 ||||||||||||||| 788.15 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ESOPHAGOGASTRIC FUNDOPLAST||43210||| 1,239.83 | 1,177.84 | 8,907.66 | 8,907.66 |||||||||||||||||| 1,177.84 | 8,907.66 | 5,073.75 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES||43212||| 1,289.43 | 1,224.96 | 5,028.52 | 5,028.52 | 2,016.66 | 2,056.99 | 2,097.32 ||||||||||||||| 1,224.96 | 5,028.52 | 2,056.99 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF ESOPHAGUS, BY BALLOON OR DI||43213||| 871.96 | 828.36 | 1,625.02 | 1,625.02 | 861.50 | 878.73 | 895.96 ||||||||||||||| 828.36 | 1,625.02 | 878.73 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF ESOPHAGUS WITH BALLOON (30||43214||| 871.96 | 828.36 | 1,625.02 | 1,625.02 | 861.50 | 878.73 | 895.96 ||||||||||||||| 828.36 | 1,625.02 | 878.73 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)||43215||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER||43216||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER||43217||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 |||||||||||||||||| 1,224.96 | 1,625.02 | 1,457.23 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION (LESS||43220||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY PAS||43226||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD||43227||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHE||43229||| 1,289.43 | 1,224.96 | 3,080.79 | 3,080.79 | 1,674.24 | 1,707.73 | 1,741.21 ||||||||||||||| 1,224.96 | 3,080.79 | 1,707.73 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC ULTRASOUND EXAMINATION||43231||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRA||43232||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF ESOPHAGUS WITH||43233||| 1,440.45 | 1,368.43 | 1,625.02 | 1,625.02 | 861.50 | 878.73 | 895.96 ||||||||||||||| 861.50 | 1,625.02 | 1,368.43 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECT||43236||| 1,289.43 | 1,224.96 | 809.60 | 809.60 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,289.43 | 809.60 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE||43239||| 1,289.43 | 1,224.96 | 809.60 | 809.60 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,289.43 | 809.60 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSMURAL DRAINAGE OF PSE||43240||| 1,289.43 | 1,224.96 | 3,080.79 | 3,080.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,080.79 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF INTRALUMINAL||43241||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC ULTRASOUND||43242||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INJECTION SCLEROSIS OF ESO||43243||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BAND LIGATION OF ESOPHAGEA||43244||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF GASTRIC/DUODEN||43245||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERC||43246||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FO||43248||| 1,289.43 | 1,224.96 | 809.60 | 809.60 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,289.43 | 809.60 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DI||43249||| 1,440.45 | 1,368.43 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,368.43 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP||43250||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP||43251||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH OPTICAL ENDOMICROSCOPY||43252||| 1,289.43 | 1,224.96 | 3,080.79 | 3,080.79 | 788.15 | 803.91 | 819.67 ||||||||||||||| 788.15 | 3,080.79 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC ULTRASOUND||43253||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 861.50 | 878.73 | 895.96 ||||||||||||||| 861.50 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC MUCOSAL RESECTI||43254||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 570.18 | 581.58 | 592.99 ||||||||||||||| 570.18 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY M||43255||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC ULTRASOUND EXAM||43259||| 1,289.43 | 1,224.96 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,224.96 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, INCLUDING COL||43260||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,080.79 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MU||43261||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,080.79 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPIL||43262||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 3,080.79 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PRESSURE MEASUREMENT||43263||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 |||||||||||||||||| 1,804.26 | 3,080.79 | 2,490.01 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF CALCULI/D||43264||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,080.79 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH DESTRUCTION OF CALCU||43265||| 1,899.22 | 1,804.26 | 5,028.52 | 5,028.52 | 324.29 | 330.78 | 337.27 ||||||||||||||| 324.29 | 5,028.52 | 1,804.26 |ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH PLACEMENT OF ENDOSCOPIC ST||43266||| 1,289.43 | 1,224.96 | 5,028.52 | 5,028.52 | 2,016.66 | 2,056.99 | 2,097.32 ||||||||||||||| 1,224.96 | 5,028.52 | 2,056.99 |ENDOSCOPIC CANNULATION OF PAPILLA WITH DIRECT VISUALIZATION OF PANCREATIC/COMMON||43273||| 1,899.22 | 1,804.26 ||| 1,232.04 | 1,256.69 | 1,281.33 ||||||||||||||| 1,232.04 | 1,899.22 | 1,281.33 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PLACEMENT OF ENDOSCO||43274||| 1,899.22 | 1,804.26 | 5,028.52 | 5,028.52 | 1,644.43 | 1,677.32 | 1,710.20 ||||||||||||||| 1,644.43 | 5,028.52 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF FOREIGN B||43275||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 | 1,644.43 | 1,677.32 | 1,710.20 ||||||||||||||| 1,644.43 | 3,080.79 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL AND EXCHANGE||43276||| 1,899.22 | 1,804.26 | 5,028.52 | 5,028.52 | 1,644.43 | 1,677.32 | 1,710.20 ||||||||||||||| 1,644.43 | 5,028.52 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH TRANS-ENDOSCOPIC BAL||43277||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 | 1,644.43 | 1,677.32 | 1,710.20 ||||||||||||||| 1,644.43 | 3,080.79 | 1,804.26 |ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF TUMOR(S)||43278||| 1,899.22 | 1,804.26 | 3,080.79 | 3,080.79 | 1,644.43 | 1,677.32 | 1,710.20 ||||||||||||||| 1,644.43 | 3,080.79 | 1,804.26 |LAPAROSCOPY, SURGICAL, ESOPHAGOMYOTOMY (HELLER TYPE), WITH FUNDOPLASTY, WHEN PER||43279||| 5,958.42 | 5,660.50 |||||||||||||||||||| 5,660.50 | 5,958.42 | 5,809.46 |LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURE||43280||| 5,958.42 | 5,660.50 | 8,907.66 | 8,907.66 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,907.66 | 5,660.50 |LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WH||43281||| 5,958.42 | 5,660.50 | 8,907.66 | 8,907.66 |||||||||||||||||| 5,660.50 | 8,907.66 | 7,433.04 |LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WH||43282||| 5,958.42 | 5,660.50 | 8,907.66 | 8,907.66 |||||||||||||||||| 5,660.50 | 8,907.66 | 7,433.04 |UNLISTED LAPAROSCOPY PROCEDURE, ESOPHAGUS||43289||| 1,916.32 | 1,820.50 | 5,060.44 | 5,060.44 |||||||||||||||||| 1,820.50 | 5,060.44 | 3,488.38 |ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR COMPLETE; LAPAROTOMY||43327||| 5,958.42 | 5,660.50 |||||||||||||||||||| 5,660.50 | 5,958.42 | 5,809.46 |ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR COMPLETE; THORACOTOMY||43328||| 5,958.42 | 5,660.50 |||||||||||||||||||| 5,660.50 | 5,958.42 | 5,809.46 |REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA LAPAROTOMY,||43332||| 5,958.42 | 5,660.50 |||||||||||||||||||| 5,660.50 | 5,958.42 | 5,809.46 |REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA LAPAROTOMY,||43333||| 5,958.42 | 5,660.50 |||||||||||||||||||| 5,660.50 | 5,958.42 | 5,809.46 |REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA THORACOTOMY||43334||| 5,958.42 | 5,660.50 |||||||||||||||||||| 5,660.50 | 5,958.42 | 5,809.46 |REPAIR, PARAESOPHAGEAL HIATAL HERNIA (INCLUDING FUNDOPLICATION), VIA THORACOTOMY||43335||| 5,958.42 | 5,660.50 |||||||||||||||||||| 5,660.50 | 5,958.42 | 5,809.46 |DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES||43450||| 871.96 | 828.36 | 809.60 | 809.60 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 871.96 | 809.60 |DILATION OF ESOPHAGUS, OVER GUIDE WIRE||43453||| 871.96 | 828.36 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 828.36 |GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; SINGLE SPECIMEN (EG, ACID ANALYSI||43754||| 636.86 | 605.02 | 264.45 | 264.45 |||||||||||||||||| 264.45 | 636.86 | 434.73 |GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; COLLECTION OF MULTIPLE FRACTIONAL||43755||| 636.86 | 605.02 | 139.55 | 139.55 | 44.78 | 45.68 | 46.58 ||||||||||||||| 44.78 | 636.86 | 139.55 |DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; SINGLE||43756||| 636.86 | 605.02 | 809.60 | 809.60 | 56.45 | 57.58 | 58.71 ||||||||||||||| 56.45 | 809.60 | 605.02 |DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; COLLECT||43757||| 636.86 | 605.02 | 809.60 | 809.60 | 56.45 | 57.58 | 58.71 ||||||||||||||| 56.45 | 809.60 | 605.02 |REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED,||43763||| 437.40 | 415.53 | 266.14 | 266.14 |||||||||||||||||| 266.14 | 437.40 | 340.84 |LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; PLACEMENT OF ADJUSTABLE GA||43770||| 17,809.69 | 16,919.21 | 8,907.66 | 8,907.66 |||||||||||||||||| 8,907.66 | 17,809.69 | 12,913.43 |LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REVISION OF ADJUSTABLE GAS||43771||| 17,809.69 | 16,919.21 |||||||||||||||||||| 16,919.21 | 17,809.69 | 17,364.45 |LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GAST||43772||| 17,809.69 | 16,919.21 | 3,080.79 | 3,080.79 |||||||||||||||||| 3,080.79 | 17,809.69 | 10,000.00 |LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL AND REPLACEMENT OF||43773||| 17,809.69 | 16,919.21 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 17,809.69 | 10,989.82 |LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GAST||43774||| 17,809.69 | 16,919.21 | 3,080.79 | 3,080.79 |||||||||||||||||| 3,080.79 | 17,809.69 | 10,000.00 |LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (||43775||| 17,809.69 | 16,919.21 |||||||||||||||||||| 16,919.21 | 17,809.69 | 17,364.45 |GASTRODUODENOSTOMY||43810||| 1,283.72 | 1,219.53 |||||||||||||||||||| 1,219.53 | 1,283.72 | 1,251.63 |GASTROJEJUNOSTOMY; WITHOUT VAGOTOMY||43820||| 1,283.72 | 1,219.53 |||||||||||||||||||| 1,219.53 | 1,283.72 | 1,251.63 |GASTROJEJUNOSTOMY; WITH VAGOTOMY, ANY TYPE||43825||| 1,283.72 | 1,219.53 |||||||||||||||||||| 1,219.53 | 1,283.72 | 1,251.63 |REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION, W||43860||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |REVISION OF GASTROJEJUNAL ANASTOMOSIS (GASTROJEJUNOSTOMY) WITH RECONSTRUCTION, W||43865||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |GASTRIC RESTRICTIVE PROCEDURE, OPEN; REVISION OF SUBCUTANEOUS PORT COMPONENT ONL||43886||| 3,122.04 | 2,965.94 | 3,522.15 | 3,522.15 |||||||||||||||||| 2,965.94 | 3,522.15 | 3,322.10 |GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL OF SUBCUTANEOUS PORT COMPONENT ONLY||43887||| 3,122.04 | 2,965.94 | 1,715.36 | 1,715.36 |||||||||||||||||| 1,715.36 | 3,122.04 | 2,340.65 |GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL AND REPLACEMENT OF SUBCUTANEOUS POR||43888||| 3,122.04 | 2,965.94 | 3,522.15 | 3,522.15 |||||||||||||||||| 2,965.94 | 3,522.15 | 3,322.10 |ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)||44005||| 6,053.86 | 5,751.17 ||| 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 6,053.86 | 680.33 |LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PR||44180||| 6,759.13 | 6,421.17 | 5,060.44 | 5,060.44 | 2,071.74 | 2,113.17 | 2,154.61 ||||||||||||||| 2,071.74 | 6,759.13 | 5,060.44 |LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)||44186||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 | 2,071.74 | 2,113.17 | 2,154.61 ||||||||||||||| 2,071.74 | 6,053.86 | 5,060.44 |LAPAROSCOPY, SURGICAL; ENTERECTOMY, RESECTION OF SMALL INTESTINE, SINGLE RESECTI||44202||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; EACH ADDITIONAL SMALL INTESTINE RESECTION AND ANASTOMOSIS||44203||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS||44204||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH I||44205||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH END COLOSTOMY AND CLOSURE OF DIS||44206||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOM||44207||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOM||44208||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITHOUT PROCTECTOMY, WITH IL||44210||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOA||44211||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |LAPAROSCOPY, SURGICAL; COLECTOMY, TOTAL, ABDOMINAL, WITH PROCTECTOMY, WITH ILEOS||44212||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)||44238||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 6,053.86 | 5,405.80 |SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT I||44370||| 1,420.50 | 1,349.48 | 5,028.52 | 5,028.52 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,028.52 | 1,349.48 |SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT I||44372||| 1,420.50 | 1,349.48 | 1,625.02 | 1,625.02 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,625.02 | 1,349.48 |ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRU||44380||| 1,283.72 | 1,219.53 | 809.60 | 809.60 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,283.72 | 809.60 |ILEOSCOPY, THROUGH STOMA; WITH TRANSENDOSCOPIC BALLOON DILATION||44381||| 1,283.72 | 1,219.53 | 1,625.02 | 1,625.02 |||||||||||||||||| 1,219.53 | 1,625.02 | 1,454.37 |ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE||44382||| 1,283.72 | 1,219.53 | 809.60 | 809.60 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,283.72 | 809.60 |ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR||44385||| 1,420.50 | 1,349.48 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,420.50 | 793.65 |ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR||44386||| 1,420.50 | 1,349.48 | 793.65 | 793.65 |||||||||||||||||| 793.65 | 1,420.50 | 1,071.56 |COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BR||44388||| 1,420.50 | 1,349.48 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,420.50 | 793.65 |COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE||44389||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,420.50 | 1,036.96 |COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF FOREIGN BODY(S)||44390||| 1,420.50 | 1,349.48 | 793.65 | 793.65 |||||||||||||||||| 793.65 | 1,420.50 | 1,071.56 |COLONOSCOPY THROUGH STOMA; WITH CONTROL OF BLEEDING, ANY METHOD||44391||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,420.50 | 1,193.22 |COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S||44392||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,420.50 | 1,036.96 |COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S||44394||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,420.50 | 1,036.96 |COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(||44401||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,420.50 | 1,193.22 |COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDING PRE- AND P||44402||| 1,420.50 | 1,349.48 | 5,028.52 | 5,028.52 |||||||||||||||||| 1,349.48 | 5,028.52 | 3,224.51 |COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC MUCOSAL RESECTION||44403||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,420.50 | 1,193.22 |COLONOSCOPY THROUGH STOMA; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE||44404||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,420.50 | 1,193.22 |COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC BALLOON DILATION||44405||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,420.50 | 1,193.22 |COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC ULTRASOUND EXAMINATION, LIMITED TO TH||44406||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,420.50 | 1,193.22 |COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR||44407||| 1,420.50 | 1,349.48 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,420.50 | 1,193.22 |COLONOSCOPY THROUGH STOMA; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, V||44408||| 1,420.50 | 1,349.48 | 793.65 | 793.65 |||||||||||||||||| 793.65 | 1,420.50 | 1,071.56 |EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OR OMPHALOMESENTERIC DUCT||44800||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |APPENDECTOMY;||44950||| 9,395.85 | 8,926.06 | 3,183.41 | 3,183.41 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 9,395.85 | 3,183.41 |APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (||44955||| 9,395.85 | 8,926.06 ||| 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 9,395.85 | 680.33 |APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS||44960||| 9,395.85 | 8,926.06 ||| 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 9,395.85 | 680.33 |LAPAROSCOPY, SURGICAL, APPENDECTOMY||44970||| 9,395.85 | 8,926.06 | 5,060.44 | 5,060.44 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 9,395.85 | 5,060.44 |UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX||44979||| 9,395.85 | 8,926.06 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 9,395.85 | 6,993.25 |BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)||45100||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 274.75 | 280.24 | 285.74 ||||||||||||||| 274.75 | 2,443.39 | 1,082.83 |PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S||45300||| 1,139.82 | 1,082.83 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 793.65 |PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)||45303||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE||45305||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY||45307||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 |||||||||||||||||| 1,082.83 | 2,443.39 | 1,791.61 |PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION||45308||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,443.39 | 1,082.83 |PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION||45309||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LE||45315||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAU||45317||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,139.82 | 1,059.89 |PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION||45320||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,443.39 | 1,082.83 |PROCTOSIGMOIDOSCOPY, RIGID; WITH DECOMPRESSION OF VOLVULUS||45321||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,443.39 | 1,082.83 |PROCTOSIGMOIDOSCOPY, RIGID; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDI||45327||| 1,139.82 | 1,082.83 | 5,028.52 | 5,028.52 |||||||||||||||||| 1,082.83 | 5,028.52 | 3,084.17 |SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUS||45330||| 1,139.82 | 1,082.83 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 793.65 |SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE||45331||| 1,139.82 | 1,082.83 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 793.65 |SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)||45332||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)||45333||| 1,139.82 | 1,082.83 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 793.65 |SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD||45334||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,139.82 | 1,059.89 |SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE||45335||| 1,139.82 | 1,082.83 | 793.65 | 793.65 |||||||||||||||||| 793.65 | 1,139.82 | 938.24 |SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOL||45337||| 1,139.82 | 1,082.83 | 793.65 | 793.65 |||||||||||||||||| 793.65 | 1,139.82 | 938.24 |SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)||45338||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION||45340||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,139.82 | 1,059.89 |SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION||45341||| 1,139.82 | 1,082.83 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 793.65 |SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TR||45342||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S)||45346||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,139.82 | 1,059.89 |SIGMOIDOSCOPY, FLEXIBLE; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND P||45347||| 1,139.82 | 1,082.83 | 5,028.52 | 5,028.52 |||||||||||||||||| 1,082.83 | 5,028.52 | 3,084.17 |SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION||45349||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 |||||||||||||||||| 1,082.83 | 2,443.39 | 1,791.61 |SIGMOIDOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)||45350||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,139.82 | 1,059.89 |COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHI||45378||| 1,863.61 | 1,770.43 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,863.61 | 793.65 |COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE||45380||| 1,863.61 | 1,770.43 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,863.61 | 1,036.96 |COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE||45381||| 1,863.61 | 1,770.43 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,863.61 | 1,036.96 |COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD||45382||| 1,863.61 | 1,770.43 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,863.61 | 1,036.96 |COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY||45384||| 1,863.61 | 1,770.43 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,863.61 | 1,036.96 |COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY||45385||| 1,863.61 | 1,770.43 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,863.61 | 1,036.96 |COLONOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION||45386||| 2,051.68 | 1,949.10 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,051.68 | 1,036.96 |COLONOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (||45388||| 2,051.68 | 1,949.10 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 2,051.68 | 1,493.03 |COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDES PRE- AND POST-D||45389||| 2,051.68 | 1,949.10 | 5,028.52 | 5,028.52 |||||||||||||||||| 1,949.10 | 5,028.52 | 3,540.10 |COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION||45390||| 1,863.61 | 1,770.43 | 2,443.39 | 2,443.39 |||||||||||||||||| 1,770.43 | 2,443.39 | 2,153.50 |COLONOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVU||45393||| 1,863.61 | 1,770.43 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,863.61 | 1,403.69 |COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)||45398||| 1,863.61 | 1,770.43 | 1,036.96 | 1,036.96 |||||||||||||||||| 1,036.96 | 1,863.61 | 1,403.69 |UNLISTED LAPAROSCOPY PROCEDURE, RECTUM||45499||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 6,053.86 | 5,405.80 |INCISION, ANAL SEPTUM (INFANT)||46070||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 254.14 | 259.22 | 264.31 ||||||||||||||| 254.14 | 2,443.39 | 1,082.83 |SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)||46080||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,443.39 | 1,082.83 |FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED||46200||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 | 288.48 | 294.25 | 300.02 ||||||||||||||| 288.48 | 2,443.39 | 1,982.94 |EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS||46220||| 2,087.30 | 1,982.94 | 1,036.96 | 1,036.96 | 288.48 | 294.25 | 300.02 ||||||||||||||| 288.48 | 2,087.30 | 1,036.96 |EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS||46230||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 | 288.48 | 294.25 | 300.02 ||||||||||||||| 288.48 | 2,443.39 | 1,982.94 |HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS||46250||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,443.39 | 1,982.94 |HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;||46255||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,443.39 | 1,982.94 |HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISSURECTOMY||46257||| 2,332.35 | 2,215.73 | 2,443.39 | 2,443.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,443.39 | 2,215.73 |HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISTULECTOMY,||46258||| 2,332.35 | 2,215.73 | 2,443.39 | 2,443.39 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,443.39 | 2,215.73 |HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;||46260||| 2,332.35 | 2,215.73 | 2,443.39 | 2,443.39 | 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 2,443.39 | 2,215.73 |HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISSUREC||46261||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 | 490.62 | 500.43 | 510.24 ||||||||||||||| 490.62 | 2,443.39 | 1,982.94 |HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISTULEC||46262||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 |||||||||||||||||| 1,982.94 | 2,443.39 | 2,265.35 |SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS||46270||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 287.83 | 293.59 | 299.34 ||||||||||||||| 287.83 | 2,443.39 | 1,082.83 |SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC||46275||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 366.33 | 373.66 | 380.98 ||||||||||||||| 366.33 | 2,443.39 | 1,082.83 |SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC,||46280||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 366.33 | 373.66 | 380.98 ||||||||||||||| 366.33 | 2,443.39 | 1,082.83 |SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE||46285||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 249.68 | 254.67 | 259.67 ||||||||||||||| 249.68 | 2,443.39 | 1,082.83 |ANOSCOPY; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)||46604||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 1,139.82 | 1,036.96 |ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE||46606||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY FOR||46610||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 266.11 | 271.43 | 276.76 ||||||||||||||| 266.11 | 2,443.39 | 1,082.83 |ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE TECHNIQU||46611||| 1,139.82 | 1,082.83 | 793.65 | 793.65 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 793.65 |ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT BIOPS||46612||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 262.92 | 268.18 | 273.44 ||||||||||||||| 262.92 | 2,443.39 | 1,082.83 |ANOSCOPY; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAU||46614||| 1,139.82 | 1,082.83 | 1,036.96 | 1,036.96 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 1,139.82 | 1,036.96 |ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE T||46615||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,443.39 | 1,082.83 |DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM,||46900||| 95.46 | 90.69 | 345.84 | 345.84 | 295.35 | 301.26 | 307.17 ||||||||||||||| 90.69 | 345.84 | 301.26 |DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM,||46910||| 437.40 | 415.53 | 1,715.36 | 1,715.36 | 295.35 | 301.26 | 307.17 ||||||||||||||| 295.35 | 1,715.36 | 415.53 |DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM,||46916||| 437.40 | 415.53 | 179.55 | 179.55 | 295.35 | 301.26 | 307.17 ||||||||||||||| 179.55 | 437.40 | 301.26 |DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM,||46917||| 437.40 | 415.53 | 2,443.39 | 2,443.39 | 295.35 | 301.26 | 307.17 ||||||||||||||| 295.35 | 2,443.39 | 415.53 |DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM,||46922||| 1,139.82 | 1,082.83 | 2,443.39 | 2,443.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,443.39 | 1,082.83 |DESTRUCTION OF INTERNAL HEMORRHOID(S) BY THERMAL ENERGY (EG, INFRARED COAGULATIO||46930||| 2,087.30 | 1,982.94 | 1,036.96 | 1,036.96 | 328.77 | 335.34 | 341.92 ||||||||||||||| 328.77 | 2,087.30 | 1,036.96 |HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOI||46945||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 | 254.14 | 259.22 | 264.31 ||||||||||||||| 254.14 | 2,443.39 | 1,982.94 |HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; 2 OR MORE HEMORR||46946||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,443.39 | 1,982.94 |HEMORRHOIDECTOMY, INTERNAL, BY TRANSANAL HEMORRHOIDAL DEARTERIALIZATION, 2 OR MO||46948||| 2,087.30 | 1,982.94 | 2,443.39 | 2,443.39 |||||||||||||||||| 1,982.94 | 2,443.39 | 2,265.35 |MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER||47300||| 7,311.94 | 6,946.34 |||||||||||||||||||| 6,946.34 | 7,311.94 | 7,129.14 |LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY||47562||| 9,398.32 | 8,928.40 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 9,398.32 | 5,060.44 |LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY||47563||| 9,398.32 | 8,928.40 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 9,398.32 | 5,060.44 |LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT||47564||| 9,398.32 | 8,928.40 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 9,398.32 | 5,060.44 |LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY||47570||| 9,398.32 | 8,928.40 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 9,398.32 | 591.88 |UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT||47579||| 9,398.32 | 8,928.40 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 9,398.32 | 6,994.42 |CHOLECYSTECTOMY;||47600||| 9,398.32 | 8,928.40 ||| 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 9,398.32 | 1,360.65 |CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY||47605||| 9,398.32 | 8,928.40 ||| 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 9,398.32 | 1,360.65 |CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT;||47610||| 9,398.32 | 8,928.40 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 9,398.32 | 591.88 |CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH CHOLEDOCHOENTEROSTOMY||47612||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH TRANSDUODENAL SPHINCTEROTO||47620||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |EXPLORATION FOR CONGENITAL ATRESIA OF BILE DUCTS, WITHOUT REPAIR, WITH OR WITHOU||47700||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |PORTOENTEROSTOMY (EG, KASAI PROCEDURE)||47701||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT; EXTRAH||47711||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |EXCISION OF BILE DUCT TUMOR, WITH OR WITHOUT PRIMARY REPAIR OF BILE DUCT; INTRAH||47712||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |EXCISION OF CHOLEDOCHAL CYST||47715||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |CHOLECYSTOENTEROSTOMY; WITH GASTROENTEROSTOMY||47721||| 9,398.32 | 8,928.40 ||| 625.73 | 638.24 | 650.76 ||||||||||||||| 625.73 | 9,398.32 | 650.76 |CHOLECYSTOENTEROSTOMY; ROUX-EN-Y WITH GASTROENTEROSTOMY||47741||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |DUODENAL EXCLUSION WITH GASTROJEJUNOSTOMY FOR PANCREATIC INJURY||48547||| 9,398.32 | 8,928.40 |||||||||||||||||||| 8,928.40 | 9,398.32 | 9,163.36 |EXCISION OR DESTRUCTION, OPEN, INTRA-ABDOMINAL TUMORS, CYSTS OR ENDOMETRIOMAS, 1||49203||| 3,816.96 | 3,626.11 |||||||||||||||||||| 3,626.11 | 3,816.96 | 3,721.54 |LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLE||49320||| 2,332.35 | 2,215.73 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 2,215.73 |LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)||49321||| 2,332.35 | 2,215.73 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 2,215.73 |LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SIN||49322||| 2,087.30 | 1,982.94 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 1,982.94 |LAPAROSCOPY, SURGICAL; WITH DRAINAGE OF LYMPHOCELE TO PERITONEAL CAVITY||49323||| 2,087.30 | 1,982.94 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 1,982.94 |REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY||49402||| 1,141.26 | 1,084.20 | 3,183.41 | 3,183.41 |||||||||||||||||| 1,084.20 | 3,183.41 | 2,162.34 |INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN||49421||| 1,141.26 | 1,084.20 | 3,183.41 | 3,183.41 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 3,183.41 | 1,084.20 |REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (YOUNGER THAN 37 WEEKS GESTATION||49491||| 8,252.82 | 7,840.18 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 5,060.44 |REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (YOUNGER THAN 37 WEEKS GESTATION||49492||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR, INITIAL INGUINAL HERNIA, FULL TERM INFANT YOUNGER THAN AGE 6 MONTHS, OR||49495||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR, INITIAL INGUINAL HERNIA, FULL TERM INFANT YOUNGER THAN AGE 6 MONTHS, OR||49496||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO YOUNGER THAN 5 YEARS, WITH OR WI||49500||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO YOUNGER THAN 5 YEARS, WITH OR WI||49501||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE||49505||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULAT||49507||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE||49520||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 608.37 | 620.54 | 632.70 ||||||||||||||| 608.37 | 8,252.82 | 3,183.41 |REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED||49521||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 608.37 | 620.54 | 632.70 ||||||||||||||| 608.37 | 8,252.82 | 3,183.41 |REPAIR INGUINAL HERNIA, SLIDING, ANY AGE||49525||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 608.37 | 620.54 | 632.70 ||||||||||||||| 608.37 | 8,252.82 | 3,183.41 |REPAIR LUMBAR HERNIA||49540||| 8,252.82 | 7,840.18 | 5,060.44 | 5,060.44 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 8,252.82 | 5,060.44 |REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE||49550||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED||49553||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR RECURRENT FEMORAL HERNIA; REDUCIBLE||49555||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED||49557||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 |||||||||||||||||| 3,183.41 | 8,252.82 | 5,511.79 |REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE||49560||| 2,954.97 | 2,807.22 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,183.41 | 2,807.22 |REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED||49561||| 2,954.97 | 2,807.22 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,183.41 | 2,807.22 |REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE||49565||| 2,954.97 | 2,807.22 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 2,807.22 |REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED||49566||| 2,954.97 | 2,807.22 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 2,807.22 |IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR OPEN INCISIONAL OR VENTRAL HERNIA R||49568||| 4,713.15 | 4,477.49 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 4,713.15 | 591.88 |REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE)||49570||| 2,954.97 | 2,807.22 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,183.41 | 2,807.22 |REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED||49572||| 2,954.97 | 2,807.22 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,183.41 | 2,807.22 |REPAIR UMBILICAL HERNIA, YOUNGER THAN AGE 5 YEARS; REDUCIBLE||49580||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR UMBILICAL HERNIA, YOUNGER THAN AGE 5 YEARS; INCARCERATED OR STRANGULATED||49582||| 8,252.82 | 7,840.18 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,252.82 | 3,183.41 |REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE||49585||| 3,185.80 | 3,026.51 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,185.80 | 3,026.51 |REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED||49587||| 3,185.80 | 3,026.51 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,185.80 | 3,026.51 |REPAIR SPIGELIAN HERNIA||49590||| 3,185.80 | 3,026.51 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,185.80 | 3,026.51 |REPAIR OF SMALL OMPHALOCELE, WITH PRIMARY CLOSURE||49600||| 2,855.25 | 2,712.49 | 3,183.41 | 3,183.41 |||||||||||||||||| 2,712.49 | 3,183.41 | 3,019.33 |REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH OR WITHOUT PROSTHESIS||49605||| 2,855.25 | 2,712.49 |||||||||||||||||||| 2,712.49 | 2,855.25 | 2,783.87 |REPAIR OF LARGE OMPHALOCELE OR GASTROSCHISIS; WITH REMOVAL OF PROSTHESIS, FINAL||49606||| 2,855.25 | 2,712.49 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 2,855.25 | 591.88 |REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); FIRST STAGE||49610||| 2,855.25 | 2,712.49 |||||||||||||||||||| 2,712.49 | 2,855.25 | 2,783.87 |REPAIR OF OMPHALOCELE (GROSS TYPE OPERATION); SECOND STAGE||49611||| 2,855.25 | 2,712.49 |||||||||||||||||||| 2,712.49 | 2,855.25 | 2,783.87 |LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA||49650||| 3,185.80 | 3,026.51 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 3,026.51 |LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA||49651||| 2,855.25 | 2,712.49 | 5,060.44 | 5,060.44 | 608.37 | 620.54 | 632.70 ||||||||||||||| 608.37 | 5,060.44 | 2,712.49 |LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNI||49652||| 3,185.80 | 3,026.51 | 5,060.44 | 5,060.44 | 2,128.48 | 2,171.05 | 2,213.62 ||||||||||||||| 2,128.48 | 5,060.44 | 3,026.51 |LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNI||49653||| 3,185.80 | 3,026.51 | 5,060.44 | 5,060.44 | 2,128.48 | 2,171.05 | 2,213.62 ||||||||||||||| 2,128.48 | 5,060.44 | 3,026.51 |LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN||49654||| 3,185.80 | 3,026.51 | 8,907.66 | 8,907.66 | 2,128.48 | 2,171.05 | 2,213.62 ||||||||||||||| 2,128.48 | 8,907.66 | 3,026.51 |LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN||49655||| 3,185.80 | 3,026.51 | 8,907.66 | 8,907.66 | 2,128.48 | 2,171.05 | 2,213.62 ||||||||||||||| 2,128.48 | 8,907.66 | 3,026.51 |LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERT||49656||| 2,855.25 | 2,712.49 | 8,907.66 | 8,907.66 | 2,128.48 | 2,171.05 | 2,213.62 ||||||||||||||| 2,128.48 | 8,907.66 | 2,712.49 |LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERT||49657||| 2,855.25 | 2,712.49 | 8,907.66 | 8,907.66 | 2,128.48 | 2,171.05 | 2,213.62 ||||||||||||||| 2,128.48 | 8,907.66 | 2,712.49 |UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY||49659||| 3,185.80 | 3,026.51 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 3,026.51 |PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION,||50080||| 2,793.99 | 2,654.29 | 8,258.13 | 8,258.13 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 8,258.13 | 2,654.29 |PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITH OR WITHOUT DILATION,||50081||| 2,793.99 | 2,654.29 | 8,258.13 | 8,258.13 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 8,258.13 | 2,654.29 |ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS||50390||| 437.40 | 415.53 | 621.97 | 621.97 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 621.97 | 415.53 |RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT I||50561||| 437.40 | 415.53 | 4,413.90 | 4,413.90 | 457.91 | 467.07 | 476.23 ||||||||||||||| 415.53 | 4,413.90 | 467.07 |RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION, INS||50580||| 437.40 | 415.53 | 4,413.90 | 4,413.90 |||||||||||||||||| 415.53 | 4,413.90 | 2,425.65 |LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE||50590||| 14,480.02 | 13,756.02 | 3,076.34 | 3,076.34 | 1,781.54 | 1,817.17 | 1,852.80 ||||||||||||||| 1,781.54 | 14,480.02 | 3,076.34 |URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FOR RETROPERITONEAL FIBROS||50715||| 3,816.96 | 3,626.11 |||||||||||||||||||| 3,626.11 | 3,816.96 | 3,721.54 |URETEROLYSIS FOR OVARIAN VEIN SYNDROME||50722||| 3,816.96 | 3,626.11 |||||||||||||||||||| 3,626.11 | 3,816.96 | 3,721.54 |URETEROLYSIS FOR RETROCAVAL URETER, WITH REANASTOMOSIS OF UPPER URINARY TRACT OR||50725||| 3,816.96 | 3,626.11 |||||||||||||||||||| 3,626.11 | 3,816.96 | 3,721.54 |URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE URETER TO BLADDER||50780||| 2,051.68 | 1,949.10 ||| 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 2,051.68 | 680.33 |URETERONEOCYSTOSTOMY; ANASTOMOSIS OF DUPLICATED URETER TO BLADDER||50782||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |URETERONEOCYSTOSTOMY; WITH EXTENSIVE URETERAL TAILORING||50783||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |URETERONEOCYSTOSTOMY; WITH VESICO-PSOAS HITCH OR BLADDER FLAP||50785||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITH CYSTOSCOPY AND URETERAL STENT P||50947||| 2,087.30 | 1,982.94 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 1,982.94 |LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITHOUT CYSTOSCOPY AND URETERAL STEN||50948||| 2,087.30 | 1,982.94 | 8,907.66 | 8,907.66 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 8,907.66 | 1,982.94 |CYSTECTOMY, PARTIAL, WITH REIMPLANTATION OF URETER(S) INTO BLADDER (URETERONEOCY||51565||| 2,051.68 | 1,949.10 |||||||||||||||||||| 1,949.10 | 2,051.68 | 2,000.39 |INJECTION PROCEDURE AND PLACEMENT OF CHAIN FOR CONTRAST AND/OR CHAIN URETHROCYST||51605||| 437.40 | 415.53 ||| 63.86 | 65.14 | 66.41 ||||||||||||||| 63.86 | 437.40 | 66.41 |ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URET||51715||| 1,139.82 | 1,082.83 | 3,076.34 | 3,076.34 | 531.15 | 541.77 | 552.40 ||||||||||||||| 531.15 | 3,076.34 | 1,082.83 |BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)||51720||| 1,139.82 | 1,082.83 | 266.14 | 266.14 | 327.08 | 333.62 | 340.16 ||||||||||||||| 266.14 | 1,139.82 | 333.62 |CYSTOPLASTY OR CYSTOURETHROPLASTY, PLASTIC OPERATION ON BLADDER AND/OR VESICAL N||51800||| 2,051.68 | 1,949.10 ||| 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 2,051.68 | 442.21 |CYSTOURETHROPLASTY WITH UNILATERAL OR BILATERAL URETERONEOCYSTOSTOMY||51820||| 2,051.68 | 1,949.10 ||| 425.20 | 433.71 | 442.21 ||||||||||||||| 425.20 | 2,051.68 | 442.21 |CLOSURE OF VESICOUTERINE FISTULA; WITH HYSTERECTOMY||51925||| 6,847.48 | 6,505.11 |||||||||||||||||||| 6,505.11 | 6,847.48 | 6,676.29 |CYSTOURETHROSCOPY (SEPARATE PROCEDURE)||52000||| 1,590.06 | 1,510.56 | 574.77 | 574.77 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,590.06 | 574.77 |CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, IN||52007||| 1,426.20 | 1,354.89 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,076.34 | 1,354.89 |CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGA||52010||| 1,426.20 | 1,354.89 | 574.77 | 574.77 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,426.20 | 574.77 |CYSTOURETHROSCOPY, WITH BIOPSY(S)||52204||| 1,426.20 | 1,354.89 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,792.99 | 1,354.89 |CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF||52214||| 4,127.58 | 3,921.20 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,127.58 | 3,076.34 |CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR||52224||| 4,127.58 | 3,921.20 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,127.58 | 3,076.34 |CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND||52234||| 4,127.58 | 3,921.20 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,127.58 | 3,076.34 |CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND||52235||| 4,127.58 | 3,921.20 | 3,076.34 | 3,076.34 | 490.62 | 500.43 | 510.24 ||||||||||||||| 490.62 | 4,127.58 | 3,076.34 |CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND||52240||| 4,127.58 | 3,921.20 | 4,413.90 | 4,413.90 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 4,413.90 | 3,921.20 |CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL O||52260||| 4,127.58 | 3,921.20 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,127.58 | 1,792.99 |CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL ANE||52265||| 4,127.58 | 3,921.20 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,127.58 | 1,792.99 |CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE||52270||| 1,420.50 | 1,349.48 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,792.99 | 1,349.48 |CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE||52275||| 1,420.50 | 1,349.48 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,792.99 | 1,349.48 |CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY||52276||| 4,127.58 | 3,921.20 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,127.58 | 1,792.99 |CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY)||52277||| 1,420.50 | 1,349.48 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,076.34 | 1,349.48 |CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE||52283||| 1,420.50 | 1,349.48 | 1,792.99 | 1,792.99 | 357.37 | 364.51 | 371.66 ||||||||||||||| 357.37 | 1,792.99 | 1,349.48 |CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL||52285||| 1,420.50 | 1,349.48 | 574.77 | 574.77 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,420.50 | 574.77 |CYSTOURETHROSCOPY, WITH INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER||52287||| 1,420.50 | 1,349.48 | 1,792.99 | 1,792.99 | 962.05 | 981.29 | 1,000.53 ||||||||||||||| 962.05 | 1,792.99 | 1,349.48 |CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL||52290||| 1,420.50 | 1,349.48 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,792.99 | 1,349.48 |CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNIL||52301||| 1,420.50 | 1,349.48 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,076.34 | 1,349.48 |CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER DIVERTICULUM||52305||| 2,793.99 | 2,654.29 | 4,413.90 | 4,413.90 |||||||||||||||||| 2,654.29 | 4,413.90 | 3,603.95 |CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FRO||52315||| 1,420.50 | 1,349.48 | 1,792.99 | 1,792.99 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 1,792.99 | 1,349.48 |LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND R||52317||| 1,420.50 | 1,349.48 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,076.34 | 1,349.48 |LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND R||52318||| 1,420.50 | 1,349.48 | 3,076.34 | 3,076.34 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 3,076.34 | 1,349.48 |CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL||52320||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF UR||52325||| 3,839.78 | 3,647.79 | 4,413.90 | 4,413.90 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,413.90 | 3,647.79 |CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC INJECTI||52327||| 3,839.78 | 3,647.79 | 4,413.90 | 4,413.90 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,413.90 | 3,647.79 |CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHO||52330||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR D||52332||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO ESTABL||52334||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, L||52341||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG, BALLO||52342||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG, BALLOON DILATION||52343||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, B||52344||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION ST||52345||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF INTRA-RENAL STRICTURE (EG||52346||| 3,839.78 | 3,647.79 | 4,413.90 | 4,413.90 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 4,413.90 | 3,647.79 |CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC||52351||| 3,839.78 | 3,647.79 | 3,076.34 | 3,076.34 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,839.78 | 3,076.34 |CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULA||52352||| 13,349.24 | 12,681.78 | 3,076.34 | 3,076.34 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 13,349.24 | 3,076.34 |CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETER||52353||| 4,713.15 | 4,477.49 | 4,413.90 | 4,413.90 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 4,713.15 | 4,413.90 |CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGU||52354||| 4,223.03 | 4,011.88 | 4,413.90 | 4,413.90 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 4,413.90 | 4,011.88 |CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH RESECTION OF URETER||52355||| 4,223.03 | 4,011.88 | 4,413.90 | 4,413.90 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 4,413.90 | 4,011.88 |CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY INCLUDI||52356||| 4,713.15 | 4,477.49 | 4,413.90 | 4,413.90 | 2,810.00 | 2,866.20 | 2,922.40 ||||||||||||||| 2,810.00 | 4,713.15 | 4,413.90 |CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERI||52400||| 4,909.79 | 4,664.30 | 3,076.34 | 3,076.34 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,909.79 | 3,076.34 |TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)||52500||| 4,127.58 | 3,921.20 | 3,076.34 | 3,076.34 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 4,127.58 | 3,076.34 |TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INC||52630||| 1,632.80 | 1,551.16 | 4,413.90 | 4,413.90 | 357.37 | 364.51 | 371.66 ||||||||||||||| 357.37 | 4,413.90 | 1,551.16 |TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE||52640||| 1,632.80 | 1,551.16 | 3,076.34 | 3,076.34 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 3,076.34 | 1,551.16 |LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMP||52647||| 1,031.54 | 979.96 | 4,413.90 | 4,413.90 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 4,413.90 | 979.96 |LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COM||52648||| 2,658.64 | 2,525.71 | 4,413.90 | 4,413.90 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 4,413.90 | 2,525.71 |DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; IN||53600||| 2,793.99 | 2,654.29 | 266.14 | 266.14 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 2,793.99 | 266.90 |DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; SU||53601||| 2,793.99 | 2,654.29 | 111.95 | 111.95 | 392.50 | 400.35 | 408.20 ||||||||||||||| 111.95 | 2,793.99 | 400.35 |DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL D||53605||| 2,793.99 | 2,654.29 | 3,076.34 | 3,076.34 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,076.34 | 2,654.29 |DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; INITIA||53620||| 2,793.99 | 2,654.29 | 574.77 | 574.77 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,793.99 | 574.77 |DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; SUBSEQ||53621||| 2,793.99 | 2,654.29 | 266.14 | 266.14 | 392.50 | 400.35 | 408.20 ||||||||||||||| 266.14 | 2,793.99 | 400.35 |DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; INITIAL||53660||| 1,632.80 | 1,551.16 | 139.55 | 139.55 | 261.66 | 266.90 | 272.13 ||||||||||||||| 139.55 | 1,632.80 | 266.90 |DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; SUBSEQUENT||53661||| 1,632.80 | 1,551.16 | 111.95 | 111.95 | 261.66 | 266.90 | 272.13 ||||||||||||||| 111.95 | 1,632.80 | 266.90 |DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA||53665||| 1,632.80 | 1,551.16 | 1,792.99 | 1,792.99 | 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 1,792.99 | 1,551.16 |TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY MICROWAVE THERMOTHERAPY||53850||| 2,768.34 | 2,629.92 | 3,076.34 | 3,076.34 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 3,076.34 | 2,629.92 |TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY||53852||| 1,971.89 | 1,873.30 | 3,076.34 | 3,076.34 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 3,076.34 | 1,873.30 |TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY GENERATED WATER||53854||| 2,768.34 | 2,629.92 | 1,792.99 | 1,792.99 |||||||||||||||||| 1,792.99 | 2,768.34 | 2,211.46 |CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; NEONAT||54160||| 437.40 | 415.53 | 574.77 | 574.77 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 574.77 | 415.53 |CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER||54161||| 1,826.56 | 1,735.23 | 1,792.99 | 1,792.99 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,826.56 | 1,735.23 |REPAIR INCOMPLETE CIRCUMCISION||54163||| 1,632.80 | 1,551.16 | 1,792.99 | 1,792.99 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,792.99 | 1,551.16 |VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE||55250||| 1,139.82 | 1,082.83 | 1,792.99 | 1,792.99 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 1,792.99 | 1,082.83 |EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE)||55500||| 3,695.87 | 3,511.08 | 3,076.34 | 3,076.34 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,695.87 | 3,076.34 |EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE)||55520||| 3,695.87 | 3,511.08 | 3,076.34 | 3,076.34 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,695.87 | 3,076.34 |EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE||55530||| 3,695.87 | 3,511.08 | 3,076.34 | 3,076.34 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,695.87 | 3,076.34 |EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL||55535||| 3,695.87 | 3,511.08 | 3,183.41 | 3,183.41 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 3,695.87 | 3,183.41 |EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH HERNI||55540||| 3,043.33 | 2,891.16 | 3,183.41 | 3,183.41 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,183.41 | 2,891.16 |LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE||55550||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 6,053.86 | 5,060.44 |BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH||55700||| 1,632.80 | 1,551.16 | 1,792.99 | 1,792.99 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 1,792.99 | 1,551.16 |BIOPSY, PROSTATE; INCISIONAL, ANY APPROACH||55705||| 1,632.80 | 1,551.16 | 3,076.34 | 3,076.34 |||||||||||||||||| 1,551.16 | 3,076.34 | 2,354.57 |BIOPSIES, PROSTATE, NEEDLE, TRANSPERINEAL, STEREOTACTIC TEMPLATE GUIDED SATURATI||55706||| 1,632.80 | 1,551.16 | 3,076.34 | 3,076.34 | 648.72 | 661.69 | 674.67 ||||||||||||||| 648.72 | 3,076.34 | 1,551.16 |PROSTATECTOMY, PERINEAL, SUBTOTAL (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING,||55801||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |PROSTATECTOMY, PERINEAL RADICAL;||55810||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |PROSTATECTOMY, PERINEAL RADICAL; WITH LYMPH NODE BIOPSY(S) (LIMITED PELVIC LYMPH||55812||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |PROSTATECTOMY, PERINEAL RADICAL; WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDIN||55815||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY||55821||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING;||55840||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH LYMPH NOD||55842||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH BILATERAL||55845||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE;||55860||| 5,415.57 | 5,144.79 | 4,413.90 | 4,413.90 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,415.57 | 4,413.90 |EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE; WITH||55862||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |EXPOSURE OF PROSTATE, ANY APPROACH, FOR INSERTION OF RADIOACTIVE SUBSTANCE; WITH||55865||| 5,415.57 | 5,144.79 |||||||||||||||||||| 5,144.79 | 5,415.57 | 5,280.18 |LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING||55866||| 5,415.57 | 5,144.79 | 8,907.66 | 8,907.66 |||||||||||||||||| 5,144.79 | 8,907.66 | 7,161.62 |TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL R||55875||| 437.40 | 415.53 | 4,413.90 | 4,413.90 |||||||||||||||||| 415.53 | 4,413.90 | 2,425.65 |HYMENOTOMY, SIMPLE INCISION||56442||| 1,632.80 | 1,551.16 | 2,623.21 | 2,623.21 |||||||||||||||||| 1,551.16 | 2,623.21 | 2,128.01 |PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING||56700||| 1,632.80 | 1,551.16 | 2,623.21 | 2,623.21 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,623.21 | 1,551.16 |DESTRUCTION OF VAGINAL LESION(S); SIMPLE (EG, LASER SURGERY, ELECTROSURGERY, CRY||57061||| 1,632.80 | 1,551.16 | 2,623.21 | 2,623.21 | 244.53 | 249.42 | 254.31 ||||||||||||||| 244.53 | 2,623.21 | 1,551.16 |DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY,||57065||| 3,695.87 | 3,511.08 | 2,623.21 | 2,623.21 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 3,695.87 | 2,623.21 |EXCISION OF VAGINAL SEPTUM||57130||| 3,695.87 | 3,511.08 | 2,623.21 | 2,623.21 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,695.87 | 2,623.21 |EXCISION OF VAGINAL CYST OR TUMOR||57135||| 3,695.87 | 3,511.08 | 2,623.21 | 2,623.21 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,695.87 | 2,623.21 |PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); OPEN AB||57284||| 8,785.17 | 8,345.91 | 4,409.54 | 4,409.54 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 8,785.17 | 4,409.54 |PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, IF PERFORMED); VAGINAL||57285||| 8,785.17 | 8,345.91 | 6,794.31 | 6,794.31 |||||||||||||||||| 6,794.31 | 8,785.17 | 7,570.11 |REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)||57287||| 8,785.17 | 8,345.91 | 2,623.21 | 2,623.21 | 2,244.61 | 2,289.50 | 2,334.39 ||||||||||||||| 2,244.61 | 8,785.17 | 2,623.21 |SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)||57288||| 8,785.17 | 8,345.91 | 4,409.54 | 4,409.54 | 2,896.08 | 2,954.01 | 3,011.93 ||||||||||||||| 2,896.08 | 8,785.17 | 4,409.54 |CONSTRUCTION OF ARTIFICIAL VAGINA; WITH GRAFT||57292||| 5,415.57 | 5,144.79 | 4,409.54 | 4,409.54 |||||||||||||||||| 4,409.54 | 5,415.57 | 4,777.17 |DILATION OF VAGINA UNDER ANESTHESIA (OTHER THAN LOCAL)||57400||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,623.21 | 2,061.44 |PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)||57410||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,623.21 | 2,061.44 |REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (||57415||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,623.21 | 2,061.44 |COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT;||57420||| 2,169.94 | 2,061.44 | 281.48 | 281.48 | 295.35 | 301.26 | 307.17 ||||||||||||||| 281.48 | 2,169.94 | 301.26 |COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT; WITH BIOPSY(S) OF VAGIN||57421||| 2,169.94 | 2,061.44 | 633.41 | 633.41 | 295.35 | 301.26 | 307.17 ||||||||||||||| 295.35 | 2,169.94 | 633.41 |COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;||57452||| 2,169.94 | 2,061.44 | 170.32 | 170.32 | 295.35 | 301.26 | 307.17 ||||||||||||||| 170.32 | 2,169.94 | 301.26 |COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE||57454||| 2,169.94 | 2,061.44 | 281.48 | 281.48 | 295.35 | 301.26 | 307.17 ||||||||||||||| 281.48 | 2,169.94 | 301.26 |COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE||57455||| 2,169.94 | 2,061.44 | 281.48 | 281.48 | 295.35 | 301.26 | 307.17 ||||||||||||||| 281.48 | 2,169.94 | 301.26 |COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURE||57456||| 2,169.94 | 2,061.44 | 281.48 | 281.48 | 295.35 | 301.26 | 307.17 ||||||||||||||| 281.48 | 2,169.94 | 301.26 |COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BI||57460||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 497.16 | 507.10 | 517.05 ||||||||||||||| 497.16 | 2,623.21 | 2,061.44 |COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CO||57461||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 497.16 | 507.10 | 517.05 ||||||||||||||| 497.16 | 2,623.21 | 2,061.44 |BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHO||57500||| 1,632.80 | 1,551.16 | 633.41 | 633.41 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 1,632.80 | 633.41 |CAUTERY OF CERVIX; ELECTRO OR THERMAL||57510||| 5,285.94 | 5,021.64 | 2,623.21 | 2,623.21 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 5,285.94 | 2,623.21 |CAUTERY OF CERVIX; CRYOCAUTERY, INITIAL OR REPEAT||57511||| 5,285.94 | 5,021.64 | 281.48 | 281.48 | 327.08 | 333.62 | 340.16 ||||||||||||||| 281.48 | 5,285.94 | 333.62 |CAUTERY OF CERVIX; LASER ABLATION||57513||| 5,285.94 | 5,021.64 | 2,623.21 | 2,623.21 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 5,285.94 | 2,623.21 |CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND||57520||| 5,285.94 | 5,021.64 | 2,623.21 | 2,623.21 | 493.24 | 503.10 | 512.97 ||||||||||||||| 493.24 | 5,285.94 | 2,623.21 |CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND||57522||| 5,285.94 | 5,021.64 | 2,623.21 | 2,623.21 | 493.24 | 503.10 | 512.97 ||||||||||||||| 493.24 | 5,285.94 | 2,623.21 |RADICAL TRACHELECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PARA-AORT||57531||| 3,816.96 | 3,626.11 |||||||||||||||||||| 3,626.11 | 3,816.96 | 3,721.54 |DILATION AND CURETTAGE OF CERVICAL STUMP||57558||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 |||||||||||||||||| 2,061.44 | 2,623.21 | 2,396.58 |DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATE PROCEDURE)||57800||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,623.21 | 2,061.44 |ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WI||58100||| 2,169.94 | 2,061.44 | 170.32 | 170.32 | 525.94 | 536.46 | 546.98 ||||||||||||||| 170.32 | 2,169.94 | 536.46 |DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)||58120||| 2,423.55 | 2,302.37 | 2,623.21 | 2,623.21 | 525.94 | 536.46 | 546.98 ||||||||||||||| 525.94 | 2,623.21 | 2,302.37 |TOTAL ABDOMINAL HYSTERECTOMY, INCLUDING PARTIAL VAGINECTOMY, WITH PARA-AORTIC AN||58200||| 6,847.48 | 6,505.11 |||||||||||||||||||| 6,505.11 | 6,847.48 | 6,676.29 |RADICAL ABDOMINAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND||58210||| 6,847.48 | 6,505.11 |||||||||||||||||||| 6,505.11 | 6,847.48 | 6,676.29 |VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;||58260||| 6,847.48 | 6,505.11 | 4,409.54 | 4,409.54 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 4,409.54 |VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR||58262||| 6,847.48 | 6,505.11 | 4,409.54 | 4,409.54 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 4,409.54 |VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR||58263||| 6,847.48 | 6,505.11 | 4,409.54 | 4,409.54 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 4,409.54 |VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH COLPO-URETHROCYSTOPEXY (MAR||58267||| 6,847.48 | 6,505.11 |||||||||||||||||||| 6,505.11 | 6,847.48 | 6,676.29 |VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REPAIR OF ENTEROCELE||58270||| 6,847.48 | 6,505.11 | 4,409.54 | 4,409.54 |||||||||||||||||| 4,409.54 | 6,847.48 | 5,457.32 |VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY;||58275||| 6,847.48 | 6,505.11 |||||||||||||||||||| 6,505.11 | 6,847.48 | 6,676.29 |VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL VAGINECTOMY; WITH REPAIR OF ENTEROCE||58280||| 6,847.48 | 6,505.11 ||| 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 1,360.65 |VAGINAL HYSTERECTOMY, RADICAL (SCHAUTA TYPE OPERATION)||58285||| 6,847.48 | 6,505.11 |||||||||||||||||||| 6,505.11 | 6,847.48 | 6,676.29 |VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;||58290||| 6,847.48 | 6,505.11 | 6,794.31 | 6,794.31 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 6,505.11 |VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND||58291||| 6,847.48 | 6,505.11 | 4,409.54 | 4,409.54 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 4,409.54 |VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND||58292||| 6,847.48 | 6,505.11 | 6,794.31 | 6,794.31 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 6,505.11 |VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REPAIR OF ENTEROCELE||58294||| 6,847.48 | 6,505.11 | 4,409.54 | 4,409.54 |||||||||||||||||| 4,409.54 | 6,847.48 | 5,457.32 |TRANSCERVICAL INTRODUCTION OF FALLOPIAN TUBE CATHETER FOR DIAGNOSIS AND/OR RE-ES||58345||| 2,954.97 | 2,807.22 | 2,623.21 | 2,623.21 |||||||||||||||||| 2,623.21 | 2,954.97 | 2,715.22 |ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE||58353||| 2,954.97 | 2,807.22 | 4,409.54 | 4,409.54 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 4,409.54 | 2,807.22 |LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL||58545||| 6,847.48 | 6,505.11 | 5,060.44 | 5,060.44 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 6,847.48 | 5,060.44 |LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR||58546||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 | 719.58 | 733.97 | 748.36 ||||||||||||||| 719.58 | 8,907.66 | 6,505.11 |LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;||58550||| 6,847.48 | 6,505.11 | 5,060.44 | 5,060.44 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 6,847.48 | 5,060.44 |LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH||58552||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 8,907.66 | 6,505.11 |LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;||58553||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 8,907.66 | 6,505.11 |LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;||58554||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 | 1,308.32 | 1,334.49 | 1,360.65 ||||||||||||||| 1,308.32 | 8,907.66 | 6,505.11 |HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)||58555||| 6,623.12 | 6,291.96 | 2,623.21 | 2,623.21 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 6,623.12 | 2,623.21 |HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY||58558||| 6,623.12 | 6,291.96 | 2,623.21 | 2,623.21 | 525.94 | 536.46 | 546.98 ||||||||||||||| 525.94 | 6,623.12 | 2,623.21 |HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)||58559||| 6,623.12 | 6,291.96 | 4,409.54 | 4,409.54 |||||||||||||||||| 4,409.54 | 6,623.12 | 5,350.75 |HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY M||58560||| 2,954.97 | 2,807.22 | 4,409.54 | 4,409.54 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 4,409.54 | 2,807.22 |HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA||58561||| 2,954.97 | 2,807.22 | 4,409.54 | 4,409.54 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 4,409.54 | 2,807.22 |HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY||58562||| 2,954.97 | 2,807.22 | 2,623.21 | 2,623.21 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 2,954.97 | 2,623.21 |HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, EL||58563||| 9,082.95 | 8,628.80 | 4,409.54 | 4,409.54 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 9,082.95 | 4,409.54 |HYSTEROSCOPY, SURGICAL; WITH BILATERAL FALLOPIAN TUBE CANNULATION TO INDUCE OCCL||58565||| 2,954.97 | 2,807.22 | 4,409.54 | 4,409.54 | 2,957.29 | 3,016.43 | 3,075.58 ||||||||||||||| 2,807.22 | 4,409.54 | 3,016.43 |LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;||58570||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 |||||||||||||||||| 6,505.11 | 8,907.66 | 7,877.57 |LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH R||58571||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 |||||||||||||||||| 6,505.11 | 8,907.66 | 7,877.57 |LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;||58572||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 |||||||||||||||||| 6,505.11 | 8,907.66 | 7,877.57 |LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; W||58573||| 6,847.48 | 6,505.11 | 8,907.66 | 8,907.66 |||||||||||||||||| 6,505.11 | 8,907.66 | 7,877.57 |LAPAROSCOPY, SURGICAL, TOTAL HYSTERECTOMY FOR RESECTION OF MALIGNANCY (TUMOR DEB||58575||| 6,847.48 | 6,505.11 |||||||||||||||||||| 6,505.11 | 6,847.48 | 6,676.29 |LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, UNI||58600||| 3,324.00 | 3,157.80 | 2,623.21 | 2,623.21 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,324.00 | 2,623.21 |LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, POS||58605||| 3,324.00 | 3,157.80 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,324.00 | 591.88 |LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) WHEN DONE AT THE TIME OF CESAREAN D||58611||| 3,324.00 | 3,157.80 |||||||||||||||||||| 3,157.80 | 3,324.00 | 3,240.90 |OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND, CLIP, FALOPE RING) VAGINAL O||58615||| 3,324.00 | 3,157.80 | 2,623.21 | 2,623.21 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,324.00 | 2,623.21 |LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEP||58660||| 6,759.13 | 6,421.17 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 6,759.13 | 5,060.44 |LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPH||58661||| 6,759.13 | 6,421.17 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 6,759.13 | 5,060.44 |LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PEL||58662||| 7,858.70 | 7,465.77 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 7,858.70 | 5,060.44 |LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION||58670||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 6,053.86 | 5,060.44 |LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR||58671||| 6,759.13 | 6,421.17 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 6,759.13 | 5,060.44 |LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY||58672||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 6,053.86 | 5,405.80 |LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY (SALPINGONEOSTOMY)||58673||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 6,053.86 | 5,405.80 |UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY||58679||| 6,053.86 | 5,751.17 | 5,060.44 | 5,060.44 |||||||||||||||||| 5,060.44 | 6,053.86 | 5,405.80 |SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)||58700||| 3,816.96 | 3,626.11 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 3,816.96 | 591.88 |FIMBRIOPLASTY||58760||| 6,053.86 | 5,751.17 |||||||||||||||||||| 5,751.17 | 6,053.86 | 5,902.51 |WEDGE RESECTION OR BISECTION OF OVARY, UNILATERAL OR BILATERAL||58920||| 7,860.48 | 7,467.46 | 6,794.31 | 6,794.31 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 7,860.48 | 6,794.31 |OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL||58925||| 7,860.48 | 7,467.46 | 4,409.54 | 4,409.54 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 7,860.48 | 4,409.54 |OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL; FOR OVARIAN, TUBAL OR P||58943||| 7,860.48 | 7,467.46 |||||||||||||||||||| 7,467.46 | 7,860.48 | 7,663.97 |AMNIOCENTESIS; DIAGNOSTIC||59000||| 491.53 | 466.95 | 633.41 | 633.41 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 633.41 | 466.95 |FETAL NON-STRESS TEST||59025||| 260.19 | 247.18 | 170.32 | 170.32 | 20.93 | 21.35 | 21.77 ||||||||||||||| 20.93 | 260.19 | 170.32 |FETAL NON-STRESS TEST||59025||| 260.19 | 247.18 | 170.32 | 170.32 | 41.87 | 42.70 | 43.54 ||||||||||||||| 41.87 | 260.19 | 170.32 |FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICI||59050||| 142.48 | 135.36 |||||||||||||||||||| 135.36 | 142.48 | 138.92 |FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICI||59051||| 142.48 | 135.36 |||||||||||||||||||| 135.36 | 142.48 | 138.92 |SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, REQUIRING SALPINGECTO||59120||| 2,954.97 | 2,807.22 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 2,954.97 | 591.88 |SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN, WITHOUT SALPINGECTOMY||59121||| 2,954.97 | 2,807.22 ||| 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 2,954.97 | 591.88 |SURGICAL TREATMENT OF ECTOPIC PREGNANCY; ABDOMINAL PREGNANCY||59130||| 2,954.97 | 2,807.22 ||| 634.09 | 646.77 | 659.45 ||||||||||||||| 634.09 | 2,954.97 | 659.45 |SURGICAL TREATMENT OF ECTOPIC PREGNANCY; CERVICAL, WITH EVACUATION||59140||| 2,954.97 | 2,807.22 |||||||||||||||||||| 2,807.22 | 2,954.97 | 2,881.10 |LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHOR||59150||| 2,169.94 | 2,061.44 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 2,061.44 |LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECT||59151||| 2,169.94 | 2,061.44 | 5,060.44 | 5,060.44 | 569.12 | 580.50 | 591.88 ||||||||||||||| 569.12 | 5,060.44 | 2,061.44 |CURETTAGE, POSTPARTUM||59160||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,623.21 | 2,061.44 |TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY||59812||| 2,423.55 | 2,302.37 | 2,623.21 | 2,623.21 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,623.21 | 2,302.37 |TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER||59820||| 2,423.55 | 2,302.37 | 2,623.21 | 2,623.21 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,623.21 | 2,302.37 |TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER||59821||| 13,616.59 | 12,935.76 | 2,623.21 | 2,623.21 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 13,616.59 | 2,623.21 |TREATMENT OF SEPTIC ABORTION, COMPLETED SURGICALLY||59830||| 2,169.94 | 2,061.44 ||| 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,169.94 | 544.26 |INDUCED ABORTION, BY DILATION AND CURETTAGE||59840||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,623.21 | 2,061.44 |INDUCED ABORTION, BY DILATION AND EVACUATION||59841||| 2,169.94 | 2,061.44 | 2,623.21 | 2,623.21 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,623.21 | 2,061.44 |INDUCED ABORTION, BY 1 OR MORE INTRA-AMNIOTIC INJECTIONS (AMNIOCENTESIS-INJECTIO||59851||| 2,169.94 | 2,061.44 ||| 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,169.94 | 544.26 |INDUCED ABORTION, BY 1 OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH OR||59856||| 2,169.94 | 2,061.44 ||| 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,169.94 | 544.26 |UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE||59870||| 13,616.59 | 12,935.76 | 2,623.21 | 2,623.21 | 525.94 | 536.46 | 546.98 ||||||||||||||| 525.94 | 13,616.59 | 2,623.21 |INCISION AND DRAINAGE OF THYROGLOSSAL DUCT CYST, INFECTED||60000||| 437.40 | 415.53 | 1,352.79 | 1,352.79 | 248.58 | 253.55 | 258.52 ||||||||||||||| 248.58 | 1,352.79 | 415.53 |EXCISION OF CYST OR ADENOMA OF THYROID, OR TRANSECTION OF ISTHMUS||60200||| 3,561.93 | 3,383.83 | 5,060.44 | 5,060.44 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 5,060.44 | 3,383.83 |PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY||60210||| 3,561.93 | 3,383.83 | 5,060.44 | 5,060.44 | 915.82 | 934.14 | 952.46 ||||||||||||||| 915.82 | 5,060.44 | 3,383.83 |PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, IN||60212||| 3,561.93 | 3,383.83 | 5,060.44 | 5,060.44 | 915.82 | 934.14 | 952.46 ||||||||||||||| 915.82 | 5,060.44 | 3,383.83 |TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY||60220||| 3,561.93 | 3,383.83 | 5,060.44 | 5,060.44 | 915.82 | 934.14 | 952.46 ||||||||||||||| 915.82 | 5,060.44 | 3,383.83 |TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCL||60225||| 3,561.93 | 3,383.83 | 5,060.44 | 5,060.44 | 370.40 | 377.81 | 385.21 ||||||||||||||| 370.40 | 5,060.44 | 3,383.83 |EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;||60280||| 3,561.93 | 3,383.83 | 5,060.44 | 5,060.44 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 5,060.44 | 3,383.83 |EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS; RECURRENT||60281||| 3,561.93 | 3,383.83 | 5,060.44 | 5,060.44 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 5,060.44 | 3,383.83 |ASPIRATION AND/OR INJECTION, THYROID CYST||60300||| 394.66 | 374.93 | 621.97 | 621.97 |||||||||||||||||| 374.93 | 621.97 | 508.32 |INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR CONN||61215||| 1,632.80 | 1,551.16 | 5,700.29 | 5,700.29 | 370.40 | 377.81 | 385.21 ||||||||||||||| 370.40 | 5,700.29 | 1,551.16 |CRANIECTOMY, SUBTEMPORAL, FOR SECTION, COMPRESSION, OR DECOMPRESSION OF SENSORY||61450||| 2,291.04 | 2,176.49 |||||||||||||||||||| 2,176.49 | 2,291.04 | 2,233.76 |CRANIECTOMY, SUBOCCIPITAL; FOR EXPLORATION OR DECOMPRESSION OF CRANIAL NERVES||61458||| 2,291.04 | 2,176.49 |||||||||||||||||||| 2,176.49 | 2,291.04 | 2,233.76 |CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL R||61580||| 2,291.04 | 2,176.49 |||||||||||||||||||| 2,176.49 | 2,291.04 | 2,233.76 |CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; EXTRADURAL, INCLUDING LATERAL R||61581||| 3,043.33 | 2,891.16 |||||||||||||||||||| 2,891.16 | 3,043.33 | 2,967.25 |INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOL||62280||| 393.23 | 373.57 | 822.46 | 822.46 | 130.83 | 133.45 | 136.07 ||||||||||||||| 130.83 | 822.46 | 373.57 |INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOL||62281||| 393.23 | 373.57 | 822.46 | 822.46 | 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 822.46 | 373.57 |INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOL||62282||| 393.23 | 373.57 | 822.46 | 822.46 | 196.25 | 200.17 | 204.10 ||||||||||||||| 196.25 | 822.46 | 373.57 |INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPA||62320||| 830.65 | 789.12 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 830.65 | 711.85 |INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPA||62321||| 2,629.10 | 2,497.65 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 2,629.10 | 1,566.12 |INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPA||62322||| 830.65 | 789.12 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 830.65 | 711.85 |INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPA||62323||| 2,629.10 | 2,497.65 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 2,629.10 | 1,566.12 |INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR IN||62324||| 830.65 | 789.12 | 822.46 | 822.46 |||||||||||||||||| 789.12 | 830.65 | 822.46 |INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR IN||62325||| 2,629.10 | 2,497.65 | 822.46 | 822.46 |||||||||||||||||| 822.46 | 2,629.10 | 1,660.05 |INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR IN||62326||| 830.65 | 789.12 | 822.46 | 822.46 |||||||||||||||||| 789.12 | 830.65 | 822.46 |INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR IN||62327||| 2,629.10 | 2,497.65 | 822.46 | 822.46 |||||||||||||||||| 822.46 | 2,629.10 | 1,660.05 |IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION;||62360||| 1,632.80 | 1,551.16 | 17,031.90 | 17,031.90 |||||||||||||||||| 1,551.16 | 17,031.90 | 9,332.35 |IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION;||62361||| 1,632.80 | 1,551.16 | 17,031.90 | 17,031.90 |||||||||||||||||| 1,551.16 | 17,031.90 | 9,332.35 |IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION;||62362||| 1,632.80 | 1,551.16 | 17,031.90 | 17,031.90 |||||||||||||||||| 1,551.16 | 17,031.90 | 9,332.35 |CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, PERCUTANEOUS, ANY MODA||63600||| 1,141.26 | 1,084.20 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,084.20 | 1,754.39 | 1,447.83 |STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, SEPARATE PROCEDURE NOT FO||63610||| 1,141.26 | 1,084.20 | 1,754.39 | 1,754.39 | 548.34 | 559.31 | 570.28 ||||||||||||||| 548.34 | 1,754.39 | 1,084.20 |PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL||63650||| 1,141.26 | 1,084.20 | 6,160.68 | 6,160.68 |||||||||||||||||| 1,084.20 | 6,160.68 | 3,650.97 |LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDUR||63655||| 3,043.33 | 2,891.16 | 20,479.78 | 20,479.78 |||||||||||||||||| 2,891.16 | 20,479.78 | 11,761.56 |REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLU||63661||| 1,047.21 | 994.85 | 1,754.39 | 1,754.39 |||||||||||||||||| 994.85 | 1,754.39 | 1,400.80 |REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOM||63662||| 1,047.21 | 994.85 | 3,275.30 | 3,275.30 |||||||||||||||||| 994.85 | 3,275.30 | 2,161.26 |REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTR||63663||| 1,047.21 | 994.85 | 6,160.68 | 6,160.68 |||||||||||||||||| 994.85 | 6,160.68 | 3,603.95 |REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTR||63664||| 1,047.21 | 994.85 | 11,236.21 | 11,236.21 |||||||||||||||||| 994.85 | 11,236.21 | 6,141.71 |INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,||63685||| 1,171.17 | 1,112.61 | 29,444.52 | 29,444.52 |||||||||||||||||| 1,112.61 | 29,444.52 | 15,307.85 |REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEI||63688||| 1,141.26 | 1,084.20 | 3,275.30 | 3,275.30 |||||||||||||||||| 1,084.20 | 3,275.30 | 2,208.28 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE||64405||| 437.40 | 415.53 | 261.17 | 261.17 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 437.40 | 261.17 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; VAGUS NERVE||64408||| 437.40 | 415.53 | 261.17 | 261.17 |||||||||||||||||| 261.17 | 437.40 | 338.35 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS||64415||| 437.40 | 415.53 | 822.46 | 822.46 |||||||||||||||||| 415.53 | 822.46 | 629.93 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS, CONTINUOUS IN||64416||| 437.40 | 415.53 | 822.46 | 822.46 |||||||||||||||||| 415.53 | 822.46 | 629.93 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE||64417||| 437.40 | 415.53 | 822.46 | 822.46 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 822.46 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE||64418||| 437.40 | 415.53 | 634.59 | 634.59 | 266.11 | 271.43 | 276.76 ||||||||||||||| 266.11 | 634.59 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, SINGLE LEVE||64420||| 437.40 | 415.53 | 634.59 | 634.59 |||||||||||||||||| 415.53 | 634.59 | 536.00 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, EACH ADDITI||64421||| 437.40 | 415.53 | 822.46 | 822.46 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 822.46 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; ILIOINGUINAL, ILIOHYPOGASTRIC||64425||| 437.40 | 415.53 | 634.59 | 634.59 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 634.59 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PUDENDAL NERVE||64430||| 437.40 | 415.53 | 822.46 | 822.46 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 822.46 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PARACERVICAL (UTERINE) NERVE||64435||| 437.40 | 415.53 | 634.59 | 634.59 |||||||||||||||||| 415.53 | 634.59 | 536.00 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE||64445||| 437.40 | 415.53 | 634.59 | 634.59 | 163.54 | 166.81 | 170.08 ||||||||||||||| 163.54 | 634.59 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, CONTINUOUS INFU||64446||| 437.40 | 415.53 | 822.46 | 822.46 | 163.54 | 166.81 | 170.08 ||||||||||||||| 163.54 | 822.46 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE||64447||| 437.40 | 415.53 | 634.59 | 634.59 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 634.59 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, CONTINUOUS INFU||64448||| 437.40 | 415.53 | 822.46 | 822.46 | 163.54 | 166.81 | 170.08 ||||||||||||||| 163.54 | 822.46 | 415.53 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; NERVES INNERVATING THE SACROIL||64451||| 1,224.74 | 1,163.50 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 1,224.74 | 899.05 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCL||64454||| 1,224.74 | 1,163.50 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 1,224.74 | 899.05 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PLANTAR COMMON DIGITAL NERVE(S||64455||| 437.40 | 415.53 | 261.17 | 261.17 | 139.73 | 142.52 | 145.32 ||||||||||||||| 139.73 | 437.40 | 261.17 |PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (||64461||| 1,303.20 | 1,238.04 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 1,303.20 | 936.32 |PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SECOND AND ANY ADDITION||64462||| 1,303.20 | 1,238.04 |||||||||||||||||||| 1,238.04 | 1,303.20 | 1,270.62 |PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; CONTINUOUS INFUSION BY||64463||| 1,303.20 | 1,238.04 | 634.59 | 634.59 |||||||||||||||||| 634.59 | 1,303.20 | 936.32 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH||64479||| 1,355.34 | 1,287.57 | 822.46 | 822.46 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 1,355.34 | 822.46 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH||64480||| 1,355.34 | 1,287.57 ||| 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 1,355.34 | 272.13 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH||64483||| 1,355.34 | 1,287.57 | 822.46 | 822.46 | 219.80 | 224.19 | 228.59 ||||||||||||||| 219.80 | 1,355.34 | 822.46 |INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH||64484||| 1,355.34 | 1,287.57 ||| 261.66 | 266.90 | 272.13 ||||||||||||||| 261.66 | 1,355.34 | 272.13 |TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BL||64486||| 437.40 | 415.53 |||||||||||||||||||| 415.53 | 437.40 | 426.47 |TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BL||64487||| 437.40 | 415.53 |||||||||||||||||||| 415.53 | 437.40 | 426.47 |TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BL||64488||| 437.40 | 415.53 |||||||||||||||||||| 415.53 | 437.40 | 426.47 |TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BL||64489||| 437.40 | 415.53 |||||||||||||||||||| 415.53 | 437.40 | 426.47 |INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA||64490||| 1,355.34 | 1,287.57 | 822.46 | 822.46 | 328.09 | 334.65 | 341.21 ||||||||||||||| 328.09 | 1,355.34 | 822.46 |INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA||64491||| 1,355.34 | 1,287.57 ||| 116.47 | 118.80 | 121.13 ||||||||||||||| 116.47 | 1,355.34 | 121.13 |INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA||64492||| 1,355.34 | 1,287.57 ||| 116.47 | 118.80 | 121.13 ||||||||||||||| 116.47 | 1,355.34 | 121.13 |INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA||64493||| 1,355.34 | 1,287.57 | 822.46 | 822.46 | 328.09 | 334.65 | 341.21 ||||||||||||||| 328.09 | 1,355.34 | 822.46 |INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA||64494||| 1,355.34 | 1,287.57 ||| 116.47 | 118.80 | 121.13 ||||||||||||||| 116.47 | 1,355.34 | 121.13 |INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEA||64495||| 1,355.34 | 1,287.57 ||| 116.47 | 118.80 | 121.13 ||||||||||||||| 116.47 | 1,355.34 | 121.13 |INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION||64505||| 437.40 | 415.53 | 261.17 | 261.17 | 163.54 | 166.81 | 170.08 ||||||||||||||| 163.54 | 437.40 | 261.17 |INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)||64510||| 437.40 | 415.53 | 822.46 | 822.46 |||||||||||||||||| 415.53 | 822.46 | 629.93 |INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)||64520||| 437.40 | 415.53 | 822.46 | 822.46 | 75.56 | 77.07 | 78.58 ||||||||||||||| 75.56 | 822.46 | 415.53 |INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORIN||64530||| 437.40 | 415.53 | 822.46 | 822.46 | 163.54 | 166.81 | 170.08 ||||||||||||||| 163.54 | 822.46 | 415.53 |PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; CRANIAL NERVE||64553||| 1,141.26 | 1,084.20 | 11,236.21 | 11,236.21 |||||||||||||||||| 1,084.20 | 11,236.21 | 6,188.74 |PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; PERIPHERAL NERVE (||64555||| 1,141.26 | 1,084.20 | 6,160.68 | 6,160.68 |||||||||||||||||| 1,084.20 | 6,160.68 | 3,650.97 |PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRAN||64561||| 1,141.26 | 1,084.20 | 6,160.68 | 6,160.68 |||||||||||||||||| 1,084.20 | 6,160.68 | 3,650.97 |INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRAN||64581||| 3,871.00 | 3,677.45 | 6,160.68 | 6,160.68 |||||||||||||||||| 3,677.45 | 6,160.68 | 5,015.84 |CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVI||64615||| 346.33 | 329.01 | 261.17 | 261.17 | 155.30 | 158.40 | 161.51 ||||||||||||||| 155.30 | 346.33 | 261.17 |NEUROPLASTY; DIGITAL, 1 OR BOTH, SAME DIGIT||64702||| 1,632.80 | 1,551.16 | 1,754.39 | 1,754.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,754.39 | 1,551.16 |NEUROPLASTY; NERVE OF HAND OR FOOT||64704||| 1,632.80 | 1,551.16 | 1,754.39 | 1,754.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 1,754.39 | 1,551.16 |NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED||64708||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 536.41 | 547.14 | 557.87 ||||||||||||||| 536.41 | 2,291.04 | 1,754.39 |NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; SCIATIC NERVE||64712||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 324.29 | 330.78 | 337.27 ||||||||||||||| 324.29 | 2,291.04 | 1,754.39 |NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)||64716||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW||64718||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 536.41 | 547.14 | 557.87 ||||||||||||||| 536.41 | 2,291.04 | 1,754.39 |NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST||64719||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 536.41 | 547.14 | 557.87 ||||||||||||||| 536.41 | 2,291.04 | 1,754.39 |NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL||64721||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 536.41 | 547.14 | 557.87 ||||||||||||||| 536.41 | 2,291.04 | 1,754.39 |DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)||64722||| 1,141.26 | 1,084.20 | 1,754.39 | 1,754.39 | 536.41 | 547.14 | 557.87 ||||||||||||||| 536.41 | 1,754.39 | 1,084.20 |DECOMPRESSION; PLANTAR DIGITAL NERVE||64726||| 1,141.26 | 1,084.20 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,084.20 | 1,754.39 | 1,447.83 |INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN A||64727||| 1,141.26 | 1,084.20 ||| 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 1,141.26 | 680.33 |TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE||64732||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF; INFRAORBITAL NERVE||64734||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF; MENTAL NERVE||64736||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF; INFERIOR ALVEOLAR NERVE BY OSTEOTOMY||64738||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF; LINGUAL NERVE||64740||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE||64742||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,291.04 | 1,754.39 |TRANSECTION OR AVULSION OF; GREATER OCCIPITAL NERVE||64744||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF; PHRENIC NERVE||64746||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF; VAGUS NERVES LIMITED TO PROXIMAL STOMACH (SELECTIVE||64755||| 2,291.04 | 2,176.49 |||||||||||||||||||| 2,176.49 | 2,291.04 | 2,233.76 |TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), ABDOMINAL||64760||| 2,291.04 | 2,176.49 ||| 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,291.04 | 612.29 |TRANSECTION OR AVULSION OF OBTURATOR NERVE, EXTRAPELVIC, WITH OR WITHOUT ADDUCTO||64763||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF OBTURATOR NERVE, INTRAPELVIC, WITH OR WITHOUT ADDUCTO||64766||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL||64771||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,291.04 | 1,754.39 |TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL||64772||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,291.04 | 1,754.39 |EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLY IDENTIFIABLE||64774||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 |||||||||||||||||| 1,754.39 | 2,291.04 | 1,965.44 |EXCISION OF NEUROMA; DIGITAL NERVE, 1 OR BOTH, SAME DIGIT||64776||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,291.04 | 1,754.39 |EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY IN AD||64778||| 2,291.04 | 2,176.49 |||||||||||||||||||| 2,176.49 | 2,291.04 | 2,233.76 |EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE||64782||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,291.04 | 1,754.39 |EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONAL NERVE, EXCEPT SAME DIGIT (LIS||64783||| 2,291.04 | 2,176.49 |||||||||||||||||||| 2,176.49 | 2,291.04 | 2,233.76 |EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC||64784||| 2,291.04 | 2,176.49 | 1,754.39 | 1,754.39 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,291.04 | 1,754.39 |EXCISION OF NEUROMA; SCIATIC NERVE||64786||| 2,291.04 | 2,176.49 | 5,700.29 | 5,700.29 | 1,069.46 | 1,090.85 | 1,112.24 ||||||||||||||| 1,069.46 | 5,700.29 | 2,176.49 |IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NE||64787||| 2,291.04 | 2,176.49 ||| 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 2,291.04 | 408.20 |REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OF EYE OR LENS||65235||| 783.62 | 744.44 | 2,079.16 | 2,079.16 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,079.16 | 744.44 |REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, MAGNETIC EXTRACTIO||65260||| 1,139.82 | 1,082.83 | 2,079.16 | 2,079.16 |||||||||||||||||| 1,082.83 | 2,079.16 | 1,609.49 |REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, NONMAGNETIC EXTRAC||65265||| 783.62 | 744.44 | 2,079.16 | 2,079.16 | 781.07 | 796.69 | 812.31 ||||||||||||||| 744.44 | 2,079.16 | 796.69 |DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AN||66820||| 1,283.72 | 1,219.53 | 2,079.16 | 2,079.16 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 2,079.16 | 1,219.53 |DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AN||66821||| 1,283.72 | 1,219.53 | 503.86 | 503.86 | 588.74 | 600.52 | 612.29 ||||||||||||||| 503.86 | 1,283.72 | 600.52 |REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE PR||66825||| 1,283.72 | 1,219.53 | 2,079.16 | 2,079.16 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 2,079.16 | 1,219.53 |REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/O||66830||| 3,324.00 | 3,157.80 | 2,079.16 | 2,079.16 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,324.00 | 2,079.16 |REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, 1 OR MORE STAGES||66840||| 3,324.00 | 3,157.80 | 2,079.16 | 2,079.16 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,324.00 | 2,079.16 |REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC||66850||| 3,324.00 | 3,157.80 | 2,079.16 | 2,079.16 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,324.00 | 2,079.16 |REMOVAL OF LENS MATERIAL; INTRACAPSULAR||66920||| 3,324.00 | 3,157.80 | 2,079.16 | 2,079.16 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,324.00 | 2,079.16 |REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS||66930||| 3,324.00 | 3,157.80 | 3,917.74 | 3,917.74 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,917.74 | 3,157.80 |REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852)||66940||| 3,324.00 | 3,157.80 | 2,079.16 | 2,079.16 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 3,324.00 | 2,079.16 |EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-||66982||| 3,324.00 | 3,157.80 | 2,079.16 | 2,079.16 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 3,324.00 | 2,079.16 |INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS||66983||| 3,324.00 | 3,157.80 | 2,079.16 | 2,079.16 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 3,324.00 | 2,079.16 |EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1||66984||| 5,023.93 | 4,772.73 | 2,079.16 | 2,079.16 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 5,023.93 | 2,079.16 |INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WIT||66985||| 3,816.96 | 3,626.11 | 2,079.16 | 2,079.16 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 3,816.96 | 2,079.16 |EXCHANGE OF INTRAOCULAR LENS||66986||| 3,816.96 | 3,626.11 | 2,079.16 | 2,079.16 | 850.41 | 867.42 | 884.42 ||||||||||||||| 850.41 | 3,816.96 | 2,079.16 |EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-||66987||| 3,324.00 | 3,157.80 | 3,917.74 | 3,917.74 |||||||||||||||||| 3,157.80 | 3,917.74 | 3,620.87 |EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1||66988||| 3,324.00 | 3,157.80 | 3,917.74 | 3,917.74 |||||||||||||||||| 3,157.80 | 3,917.74 | 3,620.87 |REPAIR OF RETINAL DETACHMENT, INCLUDING DRAINAGE OF SUBRETINAL FLUID WHEN PERFOR||67101||| 3,816.96 | 3,626.11 | 2,079.16 | 2,079.16 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,816.96 | 2,079.16 |REPAIR OF RETINAL DETACHMENT, INCLUDING DRAINAGE OF SUBRETINAL FLUID WHEN PERFOR||67105||| 3,816.96 | 3,626.11 | 503.86 | 503.86 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 3,816.96 | 503.86 |REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL DISSECT||67107||| 3,816.96 | 3,626.11 | 3,917.74 | 3,917.74 | 681.53 | 695.16 | 708.79 ||||||||||||||| 681.53 | 3,917.74 | 3,626.11 |REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY, ANY METHOD, INCLUDING, WHEN PERFO||67108||| 3,816.96 | 3,626.11 | 3,917.74 | 3,917.74 | 956.57 | 975.70 | 994.83 ||||||||||||||| 956.57 | 3,917.74 | 3,626.11 |TREATMENT OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), PH||67228||| 950.33 | 902.81 | 503.86 | 503.86 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 950.33 | 503.86 |ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); FOR EXPLOR||67400||| 1,567.26 | 1,488.90 | 3,305.45 | 3,305.45 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 3,305.45 | 1,488.90 |ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH DRAIN||67405||| 1,567.26 | 1,488.90 | 2,002.35 | 2,002.35 |||||||||||||||||| 1,488.90 | 2,002.35 | 1,784.81 |OPTIC NERVE DECOMPRESSION (EG, INCISION OR FENESTRATION OF OPTIC NERVE SHEATH)||67570||| 2,291.04 | 2,176.49 | 3,305.45 | 3,305.45 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 3,305.45 | 2,176.49 |EXCISION OF CHALAZION; SINGLE||67800||| 1,141.26 | 1,084.20 | 261.28 | 261.28 | 206.06 | 210.18 | 214.30 ||||||||||||||| 206.06 | 1,141.26 | 261.28 |EXCISION OF CHALAZION; MULTIPLE, SAME LID||67801||| 1,141.26 | 1,084.20 | 809.54 | 809.54 | 206.06 | 210.18 | 214.30 ||||||||||||||| 206.06 | 1,141.26 | 809.54 |EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDS||67805||| 1,141.26 | 1,084.20 | 261.28 | 261.28 | 228.96 | 233.54 | 238.11 ||||||||||||||| 228.96 | 1,141.26 | 261.28 |EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING HOSPITALIZATION||67808||| 1,141.26 | 1,084.20 | 2,002.35 | 2,002.35 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 2,002.35 | 1,084.20 |INCISIONAL BIOPSY OF EYELID SKIN INCLUDING LID MARGIN||67810||| 609.80 | 579.31 | 261.28 | 261.28 | 206.06 | 210.18 | 214.30 ||||||||||||||| 206.06 | 609.80 | 261.28 |EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE OR WITH SIMPLE D||67840||| 488.70 | 464.27 | 809.54 | 809.54 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 809.54 | 464.27 |DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM)||67850||| 488.70 | 464.27 | 809.54 | 809.54 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 809.54 | 464.27 |SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL C||67930||| 2,051.68 | 1,949.10 | 2,002.35 | 2,002.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,051.68 | 1,949.10 |SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL C||67935||| 2,051.68 | 1,949.10 | 2,002.35 | 2,002.35 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 2,051.68 | 1,949.10 |SUBCONJUNCTIVAL INJECTION||68200||| 437.40 | 415.53 | 270.22 | 270.22 | 35.93 | 36.64 | 37.36 ||||||||||||||| 35.93 | 437.40 | 270.22 |DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION||68801||| 437.40 | 415.53 | 270.22 | 270.22 | 178.59 | 182.16 | 185.73 ||||||||||||||| 178.59 | 437.40 | 270.22 |PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;||68810||| 437.40 | 415.53 | 261.28 | 261.28 | 178.59 | 182.16 | 185.73 ||||||||||||||| 178.59 | 437.40 | 261.28 |PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; REQUIRING GENERAL ANES||68811||| 924.68 | 878.45 | 2,002.35 | 2,002.35 | 178.59 | 182.16 | 185.73 ||||||||||||||| 178.59 | 2,002.35 | 878.45 |PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE||68815||| 924.68 | 878.45 | 2,002.35 | 2,002.35 | 523.33 | 533.79 | 544.26 ||||||||||||||| 523.33 | 2,002.35 | 878.45 |PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH TRANSLUMINAL BALL||68816||| 924.68 | 878.45 | 2,002.35 | 2,002.35 |||||||||||||||||| 878.45 | 2,002.35 | 1,463.52 |BIOPSY EXTERNAL EAR||69100||| 188.07 | 178.67 | 211.60 | 211.60 | 457.91 | 467.07 | 476.23 ||||||||||||||| 178.67 | 476.23 | 211.60 |BIOPSY EXTERNAL AUDITORY CANAL||69105||| 188.07 | 178.67 | 1,352.79 | 1,352.79 | 171.72 | 175.15 | 178.59 ||||||||||||||| 171.72 | 1,352.79 | 178.67 |EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR||69110||| 437.40 | 415.53 | 2,370.01 | 2,370.01 | 327.08 | 333.62 | 340.16 ||||||||||||||| 327.08 | 2,370.01 | 415.53 |REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA||69205||| 1,141.26 | 1,084.20 | 1,407.00 | 1,407.00 | 171.72 | 175.15 | 178.59 ||||||||||||||| 171.72 | 1,407.00 | 1,084.20 |DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE CLEANING)||69220||| 524.33 | 498.11 | 179.55 | 179.55 |||||||||||||||||| 179.55 | 524.33 | 338.83 |MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION||69420||| 763.68 | 725.50 | 211.60 | 211.60 | 349.32 | 356.31 | 363.29 ||||||||||||||| 211.60 | 763.68 | 356.31 |MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENE||69421||| 1,632.80 | 1,551.16 | 2,736.39 | 2,736.39 | 503.70 | 513.78 | 523.85 ||||||||||||||| 503.70 | 2,736.39 | 1,551.16 |VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA||69424||| 763.68 | 725.50 | 2,736.39 | 2,736.39 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 2,736.39 | 725.50 |TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), LOCAL OR TOPICAL ANESTHE||69433||| 783.62 | 744.44 | 452.36 | 452.36 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 783.62 | 452.36 |TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA||69436||| 1,487.45 | 1,413.08 | 1,352.79 | 1,352.79 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 1,487.45 | 1,352.79 |TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR CL||69610||| 5,285.94 | 5,021.64 | 1,352.79 | 1,352.79 | 294.37 | 300.26 | 306.15 ||||||||||||||| 294.37 | 5,285.94 | 1,352.79 |MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)||69620||| 5,285.94 | 5,021.64 | 2,736.39 | 2,736.39 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 5,285.94 | 2,736.39 |TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MI||69631||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MI||69632||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 457.91 | 467.07 | 476.23 ||||||||||||||| 457.91 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MI||69633||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 573.49 | 584.96 | 596.43 ||||||||||||||| 573.49 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY,||69637||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYM||69641||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYM||69642||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYM||69643||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYM||69644||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYM||69645||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,285.94 | 5,021.64 |TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYM||69646||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,285.94 | 5,021.64 |STAPES MOBILIZATION||69650||| 5,285.94 | 5,021.64 | 2,736.39 | 2,736.39 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 5,285.94 | 2,736.39 |STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH O||69660||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 349.32 | 356.31 | 363.29 ||||||||||||||| 349.32 | 5,285.94 | 5,021.64 |STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH O||69661||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 392.50 | 400.35 | 408.20 ||||||||||||||| 392.50 | 5,285.94 | 5,021.64 |REVISION OF STAPEDECTOMY OR STAPEDOTOMY||69662||| 5,285.94 | 5,021.64 | 5,086.05 | 5,086.05 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 5,285.94 | 5,021.64 |REPAIR OVAL WINDOW FISTULA||69666||| 5,285.94 | 5,021.64 | 2,736.39 | 2,736.39 | 654.16 | 667.24 | 680.33 ||||||||||||||| 654.16 | 5,285.94 | 2,736.39 |REPAIR ROUND WINDOW FISTULA||69667||| 5,285.94 | 5,021.64 | 2,736.39 | 2,736.39 | 472.83 | 482.28 | 491.74 ||||||||||||||| 472.83 | 5,285.94 | 2,736.39 |DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERAL TO GENICULATE GANGLION||69720||| 2,291.04 | 2,176.49 | 5,086.05 | 5,086.05 | 588.74 | 600.52 | 612.29 ||||||||||||||| 588.74 | 5,086.05 | 2,176.49 |DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; INCLUDING MEDIAL TO GENICULATE GANGLI||69725||| 2,291.04 | 2,176.49 | 5,086.05 | 5,086.05 |||||||||||||||||| 2,176.49 | 5,086.05 | 3,688.55 |TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY INCLUDE GRAFT)||69955||| 2,291.04 | 2,176.49 | 5,086.05 | 5,086.05 | 529.87 | 540.47 | 551.06 ||||||||||||||| 529.87 | 5,086.05 | 2,176.49 |DECOMPRESSION INTERNAL AUDITORY CANAL||69960||| 2,291.04 | 2,176.49 | 5,086.05 | 5,086.05 | 784.99 | 800.69 | 816.39 ||||||||||||||| 784.99 | 5,086.05 | 2,176.49 |MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY||69990||| 1,141.26 | 1,084.20 |||||||||||||||||||| 1,084.20 | 1,141.26 | 1,112.73 |Bariatric Surgery Options - Cash Price|||||||||||||||||||||||||||| |Laparoscopic Gastric Sleeve|||| 13,000.00 |||||||||||||||||||||||| |Laparoscopic Roux-en-Y Gastric Bypass|||| 16,000.00 |||||||||||||||||||||||| |Pharmacy Listing (Revenue code 250/no CPT code)|||||||||||||||||||||||||||| |Medication|Charge Quantity|Medication ID|Price||||||||||||||||||||||||| |METOPROLOL TARTRATE 12.5 MG SPLIT TABLET|100 each|1000001| 36.75 |||||||||| 23.89 | 24.99 | 26.83 | 26.83 | 28.67 | 22.05 | 23.89 | 27.56 | 31.24 | 32.63 | 32.34 | 27.56 | 31.24 ||| |MISOPROSTOL 50 MCG PO HALFTAB|1 each|1000002| 12.40 |||||||||| 8.06 | 8.43 | 9.05 | 9.05 | 9.67 | 7.44 | 8.06 | 9.30 | 10.54 | 11.01 | 10.91 | 9.30 | 10.54 ||| |MISOPROSTOL 25 MCG PO SPLIT TABLET|1 each|1000003| 12.40 |||||||||| 8.06 | 8.43 | 9.05 | 9.05 | 9.67 | 7.44 | 8.06 | 9.30 | 10.54 | 11.01 | 10.91 | 9.30 | 10.54 ||| |QUETIAPINE FUMARATE 12.5 MG PO SPLIT TABLET|1 each|1000004| 12.20 |||||||||| 7.93 | 8.30 | 8.91 | 8.91 | 9.52 | 7.32 | 7.93 | 9.15 | 10.37 | 10.83 | 10.74 | 9.15 | 10.37 ||| |SOTALOL HCL 40 MG PO SPLIT TABLET|500 each|1000005| 109.20 |||||||||| 70.98 | 74.26 | 79.72 | 79.72 | 85.18 | 65.52 | 70.98 | 81.90 | 92.82 | 96.97 | 96.10 | 81.90 | 92.82 ||| |TRAZODONE HCL 25 MG PO SPLIT TABLET|500 each|1000006| 55.25 |||||||||| 35.91 | 37.57 | 40.33 | 40.33 | 43.10 | 33.15 | 35.91 | 41.44 | 46.96 | 49.06 | 48.62 | 41.44 | 46.96 ||| |OXYTOCIN 30 UNITS IN LR 500 ML OMNICELL|1000 mL|1000007| 324.00 |||||||||| 210.60 | 220.32 | 236.52 | 236.52 | 252.72 | 194.40 | 210.60 | 243.00 | 275.40 | 287.71 | 285.12 | 243.00 | 275.40 ||| |NOREPINEPHRINE-D5W 32-5 MCG/ML-% INJECTION|250 mL|1000008| 310.00 |||||||||| 201.50 | 210.80 | 226.30 | 226.30 | 241.80 | 186.00 | 201.50 | 232.50 | 263.50 | 275.28 | 272.80 | 232.50 | 263.50 ||| |LIPID SYRINGE FOR NICU|250 mL|1000009| 162.00 |||||||||| 105.30 | 110.16 | 118.26 | 118.26 | 126.36 | 97.20 | 105.30 | 121.50 | 137.70 | 143.86 | 142.56 | 121.50 | 137.70 ||| |CALCIUM GLUCONATE 10% INJ FOR NICU|50 mL|1000012| 54.90 |||||||||| 35.69 | 37.33 | 40.08 | 40.08 | 42.82 | 32.94 | 35.69 | 41.18 | 46.67 | 48.75 | 48.31 | 41.18 | 46.67 ||| |CONIVAPTAN 20MG IV BOLUS|100 mL|1000013| 1,252.80 |||||||||| 814.32 | 851.90 | 914.54 | 914.54 | 977.18 | 751.68 | 814.32 | 939.60 | 1,064.88 | 1,112.49 | 1,102.46 | 939.60 | 1,064.88 ||| |OMEPRAZOLE 2 MG/ML SUSPENSION|50 mL|1000014| 11.95 |||||||||| 7.77 | 8.13 | 8.72 | 8.72 | 9.32 | 7.17 | 7.77 | 8.96 | 10.16 | 10.61 | 10.52 | 8.96 | 10.16 ||| |METOPROLOL 10 MG/ML SUSPENSION|120 mL|1000016| 14.25 |||||||||| 9.26 | 9.69 | 10.40 | 10.40 | 11.12 | 8.55 | 9.26 | 10.69 | 12.11 | 12.65 | 12.54 | 10.69 | 12.11 ||| |LET SOLUTION|2 mL|1000017| 29.50 |||||||||| 19.18 | 20.06 | 21.54 | 21.54 | 23.01 | 17.70 | 19.18 | 22.13 | 25.08 | 26.20 | 25.96 | 22.13 | 25.08 ||| |SUCRALFATE/EUCERIN/40% ZINC OXIDE CREAM|1 oz|1000018| 71.65 |||||||||| 46.57 | 48.72 | 52.30 | 52.30 | 55.89 | 42.99 | 46.57 | 53.74 | 60.90 | 63.63 | 63.05 | 53.74 | 60.90 ||| |MUPIROCIN/NYSTATIN 1:1 TOPICAL OINTMENT|1 oz|1000019| 308.05 |||||||||| 200.23 | 209.47 | 224.88 | 224.88 | 240.28 | 184.83 | 200.23 | 231.04 | 261.84 | 273.55 | 271.08 | 231.04 | 261.84 ||| |TOPIRAMATE 6MG/ML SUSPENSION|100 mL|1000020| 644.80 |||||||||| 419.12 | 438.46 | 470.70 | 470.70 | 502.94 | 386.88 | 419.12 | 483.60 | 548.08 | 572.58 | 567.42 | 483.60 | 548.08 ||| |CAPTOPRIL 1 MG/ML SOLUTION|100 mL|1000024| 24.90 |||||||||| 16.19 | 16.93 | 18.18 | 18.18 | 19.42 | 14.94 | 16.19 | 18.68 | 21.17 | 22.11 | 21.91 | 18.68 | 21.17 ||| |GLYCERIN 50% ENEMAS FOR NICU|3 mL|1000025| 24.50 |||||||||| 15.93 | 16.66 | 17.89 | 17.89 | 19.11 | 14.70 | 15.93 | 18.38 | 20.83 | 21.76 | 21.56 | 18.38 | 20.83 ||| |DR NEWMANS NIPPLE OINTMENT|30 g|1000026| 71.65 |||||||||| 46.57 | 48.72 | 52.30 | 52.30 | 55.89 | 42.99 | 46.57 | 53.74 | 60.90 | 63.63 | 63.05 | 53.74 | 60.90 ||| |MORPHINE 0.4 MG/ML SOLUTION|.5 mL|1000028| 22.05 |||||||||| 14.33 | 14.99 | 16.10 | 16.10 | 17.20 | 13.23 | 14.33 | 16.54 | 18.74 | 19.58 | 19.40 | 16.54 | 18.74 ||| |METRONIDAZOLE 50 MG/ML SUSPENSION|120 mL|1000029| 29.75 |||||||||| 19.34 | 20.23 | 21.72 | 21.72 | 23.21 | 17.85 | 19.34 | 22.31 | 25.29 | 26.42 | 26.18 | 22.31 | 25.29 ||| |AMLODIPINE 1 MG/ML SUSPENSION|60 mL|1000030| 13.40 |||||||||| 8.71 | 9.11 | 9.78 | 9.78 | 10.45 | 8.04 | 8.71 | 10.05 | 11.39 | 11.90 | 11.79 | 10.05 | 11.39 ||| |SPIRONOLACTONE 5 MG/ML SUSPENSION|120 mL|1000032| 22.25 |||||||||| 14.46 | 15.13 | 16.24 | 16.24 | 17.36 | 13.35 | 14.46 | 16.69 | 18.91 | 19.76 | 19.58 | 16.69 | 18.91 ||| |PHYTONADIONE 1 MG/ML SUSPENSION|15 mL|1000033| 355.85 |||||||||| 231.30 | 241.98 | 259.77 | 259.77 | 277.56 | 213.51 | 231.30 | 266.89 | 302.47 | 315.99 | 313.15 | 266.89 | 302.47 ||| |CLONAZEPAM 0.1 MG/ML SUSPENSION|120 mL|1000034| 11.75 |||||||||| 7.64 | 7.99 | 8.58 | 8.58 | 9.17 | 7.05 | 7.64 | 8.81 | 9.99 | 10.43 | 10.34 | 8.81 | 9.99 ||| |VANCOMYCIN 50 MG/ML SOLUTION COMPOUNDED|40 mL|1000035| 88.60 |||||||||| 57.59 | 60.25 | 64.68 | 64.68 | 69.11 | 53.16 | 57.59 | 66.45 | 75.31 | 78.68 | 77.97 | 66.45 | 75.31 ||| |AMIODARONE 5MG/ML SUSPENSION|480 mL|1000036| 355.85 |||||||||| 231.30 | 241.98 | 259.77 | 259.77 | 277.56 | 213.51 | 231.30 | 266.89 | 302.47 | 315.99 | 313.15 | 266.89 | 302.47 ||| |ATENOLOL 2 MG/ML SUSPENSION|100 mL|1000039| 11.85 |||||||||| 7.70 | 8.06 | 8.65 | 8.65 | 9.24 | 7.11 | 7.70 | 8.89 | 10.07 | 10.52 | 10.43 | 8.89 | 10.07 ||| |LANSOPRAZOLE 3MG/ML SUSPENSION|200 mL|1000040| 28.65 |||||||||| 18.62 | 19.48 | 20.91 | 20.91 | 22.35 | 17.19 | 18.62 | 21.49 | 24.35 | 25.44 | 25.21 | 21.49 | 24.35 ||| |OPIUM TINCTURE 0.4MG/ML NICU|1 mL|1000042| 27.40 |||||||||| 17.81 | 18.63 | 20.00 | 20.00 | 21.37 | 16.44 | 17.81 | 20.55 | 23.29 | 24.33 | 24.11 | 20.55 | 23.29 ||| |SODIUM CHLORIDE 0.9 % CHILLED IV SOLN|1000 mL|1000043| 329.00 |||||||||| 213.85 | 223.72 | 240.17 | 240.17 | 256.62 | 197.40 | 213.85 | 246.75 | 279.65 | 292.15 | 289.52 | 246.75 | 279.65 ||| |BACITRACIN 100000 UNITS IN 1000ML NS IRRIGATION|1 each|1000044| 65.10 |||||||||| 42.32 | 44.27 | 47.52 | 47.52 | 50.78 | 39.06 | 42.32 | 48.83 | 55.34 | 57.81 | 57.29 | 48.83 | 55.34 ||| |BACITRACIN 50000 UNITS IN 1000ML NS IRRIGATION|1 each|1000045| 65.10 |||||||||| 42.32 | 44.27 | 47.52 | 47.52 | 50.78 | 39.06 | 42.32 | 48.83 | 55.34 | 57.81 | 57.29 | 48.83 | 55.34 ||| |METRONIDAZOLE IV SYRINGE (NICU)|100 mL|1000046| 138.40 |||||||||| 89.96 | 94.11 | 101.03 | 101.03 | 107.95 | 83.04 | 89.96 | 103.80 | 117.64 | 122.90 | 121.79 | 103.80 | 117.64 ||| |PENTOBARBITAL 50MG/ML ORAL SOLUTION|20 mL|1000049| 2,245.95 |||||||||| 1,459.87 | 1,527.25 | 1,639.54 | 1,639.54 | 1,751.84 | 1,347.57 | 1,459.87 | 1,684.46 | 1,909.06 | 1,994.40 | 1,976.44 | 1,684.46 | 1,909.06 ||| |VECURONIUM IV BOLUS|1 each|1000050| 26.20 |||||||||| 17.03 | 17.82 | 19.13 | 19.13 | 20.44 | 15.72 | 17.03 | 19.65 | 22.27 | 23.27 | 23.06 | 19.65 | 22.27 ||| |ROCURONIUM IV BOLUS|5 mL|1000051| 24.60 |||||||||| 15.99 | 16.73 | 17.96 | 17.96 | 19.19 | 14.76 | 15.99 | 18.45 | 20.91 | 21.84 | 21.65 | 18.45 | 20.91 ||| |SODIUM BICARBONATE INFUSION (STRAIGHT)|50 mL|1000052| 52.30 |||||||||| 34.00 | 35.56 | 38.18 | 38.18 | 40.79 | 31.38 | 34.00 | 39.23 | 44.46 | 46.44 | 46.02 | 39.23 | 44.46 ||| |FUROSEMIDE 10MG/ML CONCENTRATED INFUSION|10 mL|1000053| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |CALCIUM CARBONATE 100MG/ML ELEMENTAL CALCIUM FOR NICU|500 mL|1000054| 35.70 |||||||||| 23.21 | 24.28 | 26.06 | 26.06 | 27.85 | 21.42 | 23.21 | 26.78 | 30.35 | 31.70 | 31.42 | 26.78 | 30.35 ||| |POTASSIUM ACETATE 2MEQ/ML PO FOR NICU|50 mL|1000055| 53.80 |||||||||| 34.97 | 36.58 | 39.27 | 39.27 | 41.96 | 32.28 | 34.97 | 40.35 | 45.73 | 47.77 | 47.34 | 40.35 | 45.73 ||| |SODIUM PHOSPHATE 3MMOLE/ML ORAL FOR NICU|5 mL|1000056| 64.40 |||||||||| 41.86 | 43.79 | 47.01 | 47.01 | 50.23 | 38.64 | 41.86 | 48.30 | 54.74 | 57.19 | 56.67 | 48.30 | 54.74 ||| |POTASSIUM PHOSPHATE 3MMOLE/ML ORAL FOR NICU|5 mL|1000057| 61.90 |||||||||| 40.24 | 42.09 | 45.19 | 45.19 | 48.28 | 37.14 | 40.24 | 46.43 | 52.62 | 54.97 | 54.47 | 46.43 | 52.62 ||| |PENICILLIN GK 2.5 MILLION UNITS IVPB FOR OMNI|50 mL|1000058| 217.70 |||||||||| 141.51 | 148.04 | 158.92 | 158.92 | 169.81 | 130.62 | 141.51 | 163.28 | 185.05 | 193.32 | 191.58 | 163.28 | 185.05 ||| |HEPARIN 1000 UNIT/ML SYRINGE FOR CRRT|20 mL|1000061| 37.80 |||||||||| 24.57 | 25.70 | 27.59 | 27.59 | 29.48 | 22.68 | 24.57 | 28.35 | 32.13 | 33.57 | 33.26 | 28.35 | 32.13 ||| |PENICILLIN GK 5 MILLION UNITS IVPB FOR OMNI|100 mL|1000062| 156.30 |||||||||| 101.60 | 106.28 | 114.10 | 114.10 | 121.91 | 93.78 | 101.60 | 117.23 | 132.86 | 138.79 | 137.54 | 117.23 | 132.86 ||| |SODIUM BICARBONATE FOR NICU|10 mL|1000069| 54.35 |||||||||| 35.33 | 36.96 | 39.68 | 39.68 | 42.39 | 32.61 | 35.33 | 40.76 | 46.20 | 48.26 | 47.83 | 40.76 | 46.20 ||| |NALTREXONE SYRUP 6MG/5ML|5 mL|1000070| 53.15 |||||||||| 34.55 | 36.14 | 38.80 | 38.80 | 41.46 | 31.89 | 34.55 | 39.86 | 45.18 | 47.20 | 46.77 | 39.86 | 45.18 ||| |FENTANYL 50 MCG/ML INFUSION SYRINGE - PEDS 10 ML SYRINGE|10 mL|1000087| 59.30 |||||||||| 38.55 | 40.32 | 43.29 | 43.29 | 46.25 | 35.58 | 38.55 | 44.48 | 50.41 | 52.66 | 52.18 | 44.48 | 50.41 ||| |PRISMASATE BGK 4/2.5 DIALYSIS SOLUTION|5000 mL|1000088| 252.75 |||||||||| 164.29 | 171.87 | 184.51 | 184.51 | 197.15 | 151.65 | 164.29 | 189.56 | 214.84 | 224.44 | 222.42 | 189.56 | 214.84 ||| |ETOPOSIDE 50 MG PO CAPS|100 mg (2 each)|10001| 334.80 |||||||||| 217.62 | 227.66 | 244.40 | 244.40 | 261.14 | 200.88 | 217.62 | 251.10 | 284.58 | 297.30 | 294.62 | 251.10 | 284.58 ||| |ETOPOSIDE 50 MG PO CAPS|50 mg (1 each)|10001| 178.40 |||||||||| 115.96 | 121.31 | 130.23 | 130.23 | 139.15 | 107.04 | 115.96 | 133.80 | 151.64 | 158.42 | 156.99 | 133.80 | 151.64 ||| |LEVOTHYROXINE 25 MCG/ML SUSPENSION|100 mL|1000100| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |SODIUM CHLORIDE 4MEQ/ML ORAL SOLN|30 mL|1000102| 42.50 |||||||||| 27.63 | 28.90 | 31.03 | 31.03 | 33.15 | 25.50 | 27.63 | 31.88 | 36.13 | 37.74 | 37.40 | 31.88 | 36.13 ||| |TOBRAMYCIN 10MG/ML IJ SOLN (NICU)|2 mL|1000104| 139.30 |||||||||| 90.55 | 94.72 | 101.69 | 101.69 | 108.65 | 83.58 | 90.55 | 104.48 | 118.41 | 123.70 | 122.58 | 104.48 | 118.41 ||| |TRAMADOL 5MG/ML SUSPENSION|60 mL|1000106| 395.70 |||||||||| 257.21 | 269.08 | 288.86 | 288.86 | 308.65 | 237.42 | 257.21 | 296.78 | 336.35 | 351.38 | 348.22 | 296.78 | 336.35 ||| |SODIUM CHLORIDE 3 % IV SOLUTION (NICU)|500 mL|1000159| 275.50 |||||||||| 179.08 | 187.34 | 201.12 | 201.12 | 214.89 | 165.30 | 179.08 | 206.63 | 234.18 | 244.64 | 242.44 | 206.63 | 234.18 ||| |CELECOXIB 1MG/ML ORAL SUSPENSION|100 mL|1000166| 644.80 |||||||||| 419.12 | 438.46 | 470.70 | 470.70 | 502.94 | 386.88 | 419.12 | 483.60 | 548.08 | 572.58 | 567.42 | 483.60 | 548.08 ||| |CELECOXIB 10MG/ML ORAL SUSPENSION|100 mL|1000168| 644.80 |||||||||| 419.12 | 438.46 | 470.70 | 470.70 | 502.94 | 386.88 | 419.12 | 483.60 | 548.08 | 572.58 | 567.42 | 483.60 | 548.08 ||| |ZINC OXIDE 20%/NYSTATIN OINTMENT|1 oz|1000196| 90.50 |||||||||| 58.83 | 61.54 | 66.07 | 66.07 | 70.59 | 54.30 | 58.83 | 67.88 | 76.93 | 80.36 | 79.64 | 67.88 | 76.93 ||| |BACITRACIN 100000 UNITS IN 500 ML NS IRRIGATION|1 each|1000204| 65.10 |||||||||| 42.32 | 44.27 | 47.52 | 47.52 | 50.78 | 39.06 | 42.32 | 48.83 | 55.34 | 57.81 | 57.29 | 48.83 | 55.34 ||| |POTASSIUM & SODIUM PHOSPHATES PO PARTIAL PACKET|16 mmol (2 each)|1000206| 16.00 |||||||||| 10.40 | 10.88 | 11.68 | 11.68 | 12.48 | 9.60 | 10.40 | 12.00 | 13.60 | 14.21 | 14.08 | 12.00 | 13.60 ||| |POTASSIUM & SODIUM PHOSPHATES PO PARTIAL PACKET|8 mmol (1 each)|1000206| 15.00 |||||||||| 9.75 | 10.20 | 10.95 | 10.95 | 11.70 | 9.00 | 9.75 | 11.25 | 12.75 | 13.32 | 13.20 | 11.25 | 12.75 ||| |ASPIRIN 1 MG/ML ORAL SOLUTION|81 mL|1000208| 358.35 |||||||||| 232.93 | 243.68 | 261.60 | 261.60 | 279.51 | 215.01 | 232.93 | 268.76 | 304.60 | 318.21 | 315.35 | 268.76 | 304.60 ||| |SIMPLE MAGIC MOUTHWASH|90 mL|1000209| 582.55 |||||||||| 378.66 | 396.13 | 425.26 | 425.26 | 454.39 | 349.53 | 378.66 | 436.91 | 495.17 | 517.30 | 512.64 | 436.91 | 495.17 ||| |PHYTONADIONE 2.5 MG PO SPLIT TABLET|100 each|1000214| 1,766.50 |||||||||| 1,148.23 | 1,201.22 | 1,289.55 | 1,289.55 | 1,377.87 | 1,059.90 | 1,148.23 | 1,324.88 | 1,501.53 | 1,568.65 | 1,554.52 | 1,324.88 | 1,501.53 ||| |INSULIN REGULAR HUMAN (NOVOLIN R) 1 UNITS/ML (TRAIN)|100 mL|1000219| 2,671.00 |||||||||| 1,736.15 | 1,816.28 | 1,949.83 | 1,949.83 | 2,083.38 | 1,602.60 | 1,736.15 | 2,003.25 | 2,270.35 | 2,371.85 | 2,350.48 | 2,003.25 | 2,270.35 ||| |ACETAZOLAMIDE 125 MG PO SPLIT TABLET|100 each|1000220| 229.60 |||||||||| 149.24 | 156.13 | 167.61 | 167.61 | 179.09 | 137.76 | 149.24 | 172.20 | 195.16 | 203.88 | 202.05 | 172.20 | 195.16 ||| |ALLOPURINOL 150 MG PO SPLIT TABLET|100 each|1000221| 174.60 |||||||||| 113.49 | 118.73 | 127.46 | 127.46 | 136.19 | 104.76 | 113.49 | 130.95 | 148.41 | 155.04 | 153.65 | 130.95 | 148.41 ||| |ALPRAZOLAM 0.125 MG PO SPLIT TABLET|100 each|1000222| 23.90 |||||||||| 15.54 | 16.25 | 17.45 | 17.45 | 18.64 | 14.34 | 15.54 | 17.93 | 20.32 | 21.22 | 21.03 | 17.93 | 20.32 ||| |AMIODARONE HCL 100 MG PO SPLIT TABLET|60 each|1000223| 55.65 |||||||||| 36.17 | 37.84 | 40.62 | 40.62 | 43.41 | 33.39 | 36.17 | 41.74 | 47.30 | 49.42 | 48.97 | 41.74 | 47.30 ||| |BORTEZOMIB 3.5 MG INJ SOLR SUBCUT|1 each|1000224| 2,379.20 |||||||||| 1,546.48 | 1,617.86 | 1,736.82 | 1,736.82 | 1,855.78 | 1,427.52 | 1,546.48 | 1,784.40 | 2,022.32 | 2,112.73 | 2,093.70 | 1,784.40 | 2,022.32 ||| |AMITRIPTYLINE HCL 5 MG PO SPLIT TABLET|100 each|1000225| 51.70 |||||||||| 33.61 | 35.16 | 37.74 | 37.74 | 40.33 | 31.02 | 33.61 | 38.78 | 43.95 | 45.91 | 45.50 | 38.78 | 43.95 ||| |AMITRIPTYLINE HCL 12.5 MG PO SPLIT TABLET|100 each|1000226| 81.40 |||||||||| 52.91 | 55.35 | 59.42 | 59.42 | 63.49 | 48.84 | 52.91 | 61.05 | 69.19 | 72.28 | 71.63 | 61.05 | 69.19 ||| |AMLODIPINE BESYLATE 1.25 MG PO SPLIT TABLET|90 each|1000227| 60.35 |||||||||| 39.23 | 41.04 | 44.06 | 44.06 | 47.07 | 36.21 | 39.23 | 45.26 | 51.30 | 53.59 | 53.11 | 45.26 | 51.30 ||| |AMOXICILLIN-POT CLAVULANATE 437.5/62.5 MG PO SPLIT TABLET|20 each|1000228| 92.10 |||||||||| 59.87 | 62.63 | 67.23 | 67.23 | 71.84 | 55.26 | 59.87 | 69.08 | 78.29 | 81.78 | 81.05 | 69.08 | 78.29 ||| |ARIPIPRAZOLE 2.5 MG PO SPLIT TABLET|30 each|1000229| 65.60 |||||||||| 42.64 | 44.61 | 47.89 | 47.89 | 51.17 | 39.36 | 42.64 | 49.20 | 55.76 | 58.25 | 57.73 | 49.20 | 55.76 ||| |ARIPIPRAZOLE 7.5 MG PO SPLIT TABLET|30 each|1000231| 1,873.75 |||||||||| 1,217.94 | 1,274.15 | 1,367.84 | 1,367.84 | 1,461.53 | 1,124.25 | 1,217.94 | 1,405.31 | 1,592.69 | 1,663.89 | 1,648.90 | 1,405.31 | 1,592.69 ||| |VITAMIN C 125 MG PO SPLIT TABLET|100 each|1000232| 14.15 |||||||||| 9.20 | 9.62 | 10.33 | 10.33 | 11.04 | 8.49 | 9.20 | 10.61 | 12.03 | 12.57 | 12.45 | 10.61 | 12.03 ||| |ASPIRIN 20.25 MG PO SPLIT CHEW TABLET|750 each|1000233| 98.30 |||||||||| 63.90 | 66.84 | 71.76 | 71.76 | 76.67 | 58.98 | 63.90 | 73.73 | 83.56 | 87.29 | 86.50 | 73.73 | 83.56 ||| |ASPIRIN 40.5 MG PO CHEW SPLIT TABLET|750 each|1000234| 98.30 |||||||||| 63.90 | 66.84 | 71.76 | 71.76 | 76.67 | 58.98 | 63.90 | 73.73 | 83.56 | 87.29 | 86.50 | 73.73 | 83.56 ||| |ATENOLOL 12.5 MG PO SPLIT TABLET|100 each|1000235| 14.35 |||||||||| 9.33 | 9.76 | 10.48 | 10.48 | 11.19 | 8.61 | 9.33 | 10.76 | 12.20 | 12.74 | 12.63 | 10.76 | 12.20 ||| |ATORVASTATIN CALCIUM 5 MG PO SPLIT TABLET|90 each|1000236| 61.65 |||||||||| 40.07 | 41.92 | 45.00 | 45.00 | 48.09 | 36.99 | 40.07 | 46.24 | 52.40 | 54.75 | 54.25 | 46.24 | 52.40 ||| |BACLOFEN 2.5 MG PO SPLIT TABLET|100 each|1000237| 84.10 |||||||||| 54.67 | 57.19 | 61.39 | 61.39 | 65.60 | 50.46 | 54.67 | 63.08 | 71.49 | 74.68 | 74.01 | 63.08 | 71.49 ||| |BACLOFEN 5 MG SPLIT TABLET|100 each|1000238| 84.10 |||||||||| 54.67 | 57.19 | 61.39 | 61.39 | 65.60 | 50.46 | 54.67 | 63.08 | 71.49 | 74.68 | 74.01 | 63.08 | 71.49 ||| |BENAZEPRIL 5 MG PO SPLIT TABLET|100 each|1000239| 166.10 |||||||||| 107.97 | 112.95 | 121.25 | 121.25 | 129.56 | 99.66 | 107.97 | 124.58 | 141.19 | 147.50 | 146.17 | 124.58 | 141.19 ||| |BETHANECHOL CHLORIDE 12.5 MG PO SPLIT TABLET|100 each|1000240| 76.60 |||||||||| 49.79 | 52.09 | 55.92 | 55.92 | 59.75 | 45.96 | 49.79 | 57.45 | 65.11 | 68.02 | 67.41 | 57.45 | 65.11 ||| |BISOPROLOL FUMARATE 1.25 MG PO SPLIT TABLET|100 each|1000241| 258.70 |||||||||| 168.16 | 175.92 | 188.85 | 188.85 | 201.79 | 155.22 | 168.16 | 194.03 | 219.90 | 229.73 | 227.66 | 194.03 | 219.90 ||| |BISOPROLOL FUMARATE 2.5 MG PO SPLIT TABLET|100 each|1000242| 258.70 |||||||||| 168.16 | 175.92 | 188.85 | 188.85 | 201.79 | 155.22 | 168.16 | 194.03 | 219.90 | 229.73 | 227.66 | 194.03 | 219.90 ||| |BUPROPION HCL 37.5 MG PO SPLIT TABLET|100 each|1000243| 276.95 |||||||||| 180.02 | 188.33 | 202.17 | 202.17 | 216.02 | 166.17 | 180.02 | 207.71 | 235.41 | 245.93 | 243.72 | 207.71 | 235.41 ||| |BUSPIRONE HCL 7.5 MG PO SPLIT TABLET|1 each|1000244| 11.95 |||||||||| 7.77 | 8.13 | 8.72 | 8.72 | 9.32 | 7.17 | 7.77 | 8.96 | 10.16 | 10.61 | 10.52 | 8.96 | 10.16 ||| |OYSTER SHELL 250 MG PO SPLIT TABLET|1000 each|1000245| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |CAPTOPRIL 6.25 MG PO SPLIT TABLET|100 each|1000246| 318.90 |||||||||| 207.29 | 216.85 | 232.80 | 232.80 | 248.74 | 191.34 | 207.29 | 239.18 | 271.07 | 283.18 | 280.63 | 239.18 | 271.07 ||| |CARBIDOPA-LEVODOPA 12.5-50 MG PO SPLIT TABLET|1 split tablet (1 each)|1000248| 11.80 |||||||||| 7.67 | 8.02 | 8.61 | 8.61 | 9.20 | 7.08 | 7.67 | 8.85 | 10.03 | 10.48 | 10.38 | 8.85 | 10.03 ||| |CARBIDOPA-LEVODOPA 12.5-125 MG PO SPLIT TABLET|1 split tablet (1 each)|1000249| 12.05 |||||||||| 7.83 | 8.19 | 8.80 | 8.80 | 9.40 | 7.23 | 7.83 | 9.04 | 10.24 | 10.70 | 10.60 | 9.04 | 10.24 ||| |CARVEDILOL 1.5625 MG PO SPLIT TABLET|100 each|1000250| 45.05 |||||||||| 29.28 | 30.63 | 32.89 | 32.89 | 35.14 | 27.03 | 29.28 | 33.79 | 38.29 | 40.00 | 39.64 | 33.79 | 38.29 ||| |CETIRIZINE HCL 5 MG PO SPLIT TABLET|30 each|1000251| 32.90 |||||||||| 21.39 | 22.37 | 24.02 | 24.02 | 25.66 | 19.74 | 21.39 | 24.68 | 27.97 | 29.22 | 28.95 | 24.68 | 27.97 ||| |METFORMIN 250 MG PO SPLIT TABLET|100 each|1000252| 35.90 |||||||||| 23.34 | 24.41 | 26.21 | 26.21 | 28.00 | 21.54 | 23.34 | 26.93 | 30.52 | 31.88 | 31.59 | 26.93 | 30.52 ||| |METHIMAZOLE 2.5 MG PO SPLIT TABLET|100 each|1000253| 71.85 |||||||||| 46.70 | 48.86 | 52.45 | 52.45 | 56.04 | 43.11 | 46.70 | 53.89 | 61.07 | 63.80 | 63.23 | 53.89 | 61.07 ||| |CARBAMAZEPIME 100 MG PO SPLIT TABLET|100 each|1000254| 208.05 |||||||||| 135.23 | 141.47 | 151.88 | 151.88 | 162.28 | 124.83 | 135.23 | 156.04 | 176.84 | 184.75 | 183.08 | 156.04 | 176.84 ||| |ALLOPURINOL 50 MG PO SPLIT TABLET|100 each|1000255| 87.20 |||||||||| 56.68 | 59.30 | 63.66 | 63.66 | 68.02 | 52.32 | 56.68 | 65.40 | 74.12 | 77.43 | 76.74 | 65.40 | 74.12 ||| |CHLORPHENIRAMINE MALEATE 2 MG PO SPLIT TABLET|100 each|1000256| 12.70 |||||||||| 8.26 | 8.64 | 9.27 | 9.27 | 9.91 | 7.62 | 8.26 | 9.53 | 10.80 | 11.28 | 11.18 | 9.53 | 10.80 ||| |CHLORTHALIDONE 12.5 MG PO SPLIT TABLET|100 each|1000257| 419.15 |||||||||| 272.45 | 285.02 | 305.98 | 305.98 | 326.94 | 251.49 | 272.45 | 314.36 | 356.28 | 372.21 | 368.85 | 314.36 | 356.28 ||| |CITALOPRAM HYDROBROMIDE 5 MG PO SPLIT TABLET|100 each|1000258| 45.05 |||||||||| 29.28 | 30.63 | 32.89 | 32.89 | 35.14 | 27.03 | 29.28 | 33.79 | 38.29 | 40.00 | 39.64 | 33.79 | 38.29 ||| |CLONAZEPAM 0.125 MG PO SPLIT TABLET|100 each|1000259| 37.35 |||||||||| 24.28 | 25.40 | 27.27 | 27.27 | 29.13 | 22.41 | 24.28 | 28.01 | 31.75 | 33.17 | 32.87 | 28.01 | 31.75 ||| |CLONAZEPAM 0.25 MG PO SPLIT TABLET|100 each|1000260| 37.35 |||||||||| 24.28 | 25.40 | 27.27 | 27.27 | 29.13 | 22.41 | 24.28 | 28.01 | 31.75 | 33.17 | 32.87 | 28.01 | 31.75 ||| |CLONIDINE HCL 0.05 MG PO SPLIT TABLET|100 each|1000261| 25.75 |||||||||| 16.74 | 17.51 | 18.80 | 18.80 | 20.09 | 15.45 | 16.74 | 19.31 | 21.89 | 22.87 | 22.66 | 19.31 | 21.89 ||| |CLONIDINE HCL 0.15 MG PO SPLIT TABLET|100 each|1000262| 48.20 |||||||||| 31.33 | 32.78 | 35.19 | 35.19 | 37.60 | 28.92 | 31.33 | 36.15 | 40.97 | 42.80 | 42.42 | 36.15 | 40.97 ||| |CLOPIDOGREL BISULFATE 18.75 MG PO SPLIT TABLET|500 each|1000263| 195.35 |||||||||| 126.98 | 132.84 | 142.61 | 142.61 | 152.37 | 117.21 | 126.98 | 146.51 | 166.05 | 173.47 | 171.91 | 146.51 | 166.05 ||| |VITAMIN B-12 250 MCG PO SPLIT TABLET|130 each|1000264| 15.35 |||||||||| 9.98 | 10.44 | 11.21 | 11.21 | 11.97 | 9.21 | 9.98 | 11.51 | 13.05 | 13.63 | 13.51 | 11.51 | 13.05 ||| |CYANOCOBALAMIN 50 MCG PO SPLIT TABLET|100 each|1000265| 22.65 |||||||||| 14.72 | 15.40 | 16.53 | 16.53 | 17.67 | 13.59 | 14.72 | 16.99 | 19.25 | 20.11 | 19.93 | 16.99 | 19.25 ||| |CYCLOBENZAPRINE HCL 2.5 MG PO SPLIT TABLET|100 each|1000266| 56.30 |||||||||| 36.60 | 38.28 | 41.10 | 41.10 | 43.91 | 33.78 | 36.60 | 42.23 | 47.86 | 49.99 | 49.54 | 42.23 | 47.86 ||| |DIGOXIN 62.5 MCG PO SPLIT TABLET|100 each|1000267| 268.05 |||||||||| 174.23 | 182.27 | 195.68 | 195.68 | 209.08 | 160.83 | 174.23 | 201.04 | 227.84 | 238.03 | 235.88 | 201.04 | 227.84 ||| |CYPROHEPTADINE HCL 2 MG PO SPLIT TABLET|1 each|1000268| 12.40 |||||||||| 8.06 | 8.43 | 9.05 | 9.05 | 9.67 | 7.44 | 8.06 | 9.30 | 10.54 | 11.01 | 10.91 | 9.30 | 10.54 ||| |DESMOPRESSIN ACETATE 0.025 MG PO SPLIT TABLET|30 each|1000269| 140.30 |||||||||| 91.20 | 95.40 | 102.42 | 102.42 | 109.43 | 84.18 | 91.20 | 105.23 | 119.26 | 124.59 | 123.46 | 105.23 | 119.26 ||| |NEFAZODONE HCL 75 MG PO SPLIT TABLET|60 each|1000270| 185.05 |||||||||| 120.28 | 125.83 | 135.09 | 135.09 | 144.34 | 111.03 | 120.28 | 138.79 | 157.29 | 164.32 | 162.84 | 138.79 | 157.29 ||| |ESCITALOPRAM OXALATE 2.5 MG PO SPLIT TABLET|100 each|1000272| 65.00 |||||||||| 42.25 | 44.20 | 47.45 | 47.45 | 50.70 | 39.00 | 42.25 | 48.75 | 55.25 | 57.72 | 57.20 | 48.75 | 55.25 ||| |DOXAZOSIN MESYLATE 1 MG PO SPLIT TABLET|100 each|1000273| 189.75 |||||||||| 123.34 | 129.03 | 138.52 | 138.52 | 148.01 | 113.85 | 123.34 | 142.31 | 161.29 | 168.50 | 166.98 | 142.31 | 161.29 ||| |ESTRADIOL 0.25 MG PO SPLIT TABLET|100 each|1000274| 85.75 |||||||||| 55.74 | 58.31 | 62.60 | 62.60 | 66.89 | 51.45 | 55.74 | 64.31 | 72.89 | 76.15 | 75.46 | 64.31 | 72.89 ||| |ESTRADIOL 0.5 MG PO SPLIT TABLET|100 each|1000275| 85.75 |||||||||| 55.74 | 58.31 | 62.60 | 62.60 | 66.89 | 51.45 | 55.74 | 64.31 | 72.89 | 76.15 | 75.46 | 64.31 | 72.89 ||| |EST ESTROGENS-METHYLTEST 0.312-0.625 MG PO SPLIT TABLET|1 tablet (1 each)|1000276| 22.80 |||||||||| 14.82 | 15.50 | 16.64 | 16.64 | 17.78 | 13.68 | 14.82 | 17.10 | 19.38 | 20.25 | 20.06 | 17.10 | 19.38 ||| |EST ESTROGENS-METHYLTEST 0.312-0.625 MG PO SPLIT TABLET|2 tablet (2 each)|1000276| 28.55 |||||||||| 18.56 | 19.41 | 20.84 | 20.84 | 22.27 | 17.13 | 18.56 | 21.41 | 24.27 | 25.35 | 25.12 | 21.41 | 24.27 ||| |FLECAINIDE ACETATE 25 MG PO SPLIT TABLET|100 each|1000277| 141.20 |||||||||| 91.78 | 96.02 | 103.08 | 103.08 | 110.14 | 84.72 | 91.78 | 105.90 | 120.02 | 125.39 | 124.26 | 105.90 | 120.02 ||| |FLUCONAZOLE 50 MG PO SPLIT TABLET|100 each|1000278| 229.60 |||||||||| 149.24 | 156.13 | 167.61 | 167.61 | 179.09 | 137.76 | 149.24 | 172.20 | 195.16 | 203.88 | 202.05 | 172.20 | 195.16 ||| |DONEPEZIL HCL 2.5 MG PO SPLIT TABLET|90 each|1000279| 50.05 |||||||||| 32.53 | 34.03 | 36.54 | 36.54 | 39.04 | 30.03 | 32.53 | 37.54 | 42.54 | 44.44 | 44.04 | 37.54 | 42.54 ||| |CLORAZEPATE DIPOTASSIUM 3.75 MG PO SPLIT TABLET|100 each|1000280| 311.40 |||||||||| 202.41 | 211.75 | 227.32 | 227.32 | 242.89 | 186.84 | 202.41 | 233.55 | 264.69 | 276.52 | 274.03 | 233.55 | 264.69 ||| |ERYTHROMYCIN STEARATE 125 MG PO SPLIT TABLET|100 each|1000281| 2,292.75 |||||||||| 1,490.29 | 1,559.07 | 1,673.71 | 1,673.71 | 1,788.35 | 1,375.65 | 1,490.29 | 1,719.56 | 1,948.84 | 2,035.96 | 2,017.62 | 1,719.56 | 1,948.84 ||| |MAGNESIUM OXIDE 100 (60.3 MG) MG PO SPLIT TABLET|100 each|1000282| 45.70 |||||||||| 29.71 | 31.08 | 33.36 | 33.36 | 35.65 | 27.42 | 29.71 | 34.28 | 38.85 | 40.58 | 40.22 | 34.28 | 38.85 ||| |MAGNESIUM OXIDE 200 (120.6 MG) MG PO SPLIT TABLET|100 each|1000283| 45.70 |||||||||| 29.71 | 31.08 | 33.36 | 33.36 | 35.65 | 27.42 | 29.71 | 34.28 | 38.85 | 40.58 | 40.22 | 34.28 | 38.85 ||| |MELATONIN 1.5 MG PO SPLIT TABLET|60 each|1000284| 26.35 |||||||||| 17.13 | 17.92 | 19.24 | 19.24 | 20.55 | 15.81 | 17.13 | 19.76 | 22.40 | 23.40 | 23.19 | 19.76 | 22.40 ||| |MELATONIN 0.75 MG PO SPLIT TABLET|60 each|1000285| 26.35 |||||||||| 17.13 | 17.92 | 19.24 | 19.24 | 20.55 | 15.81 | 17.13 | 19.76 | 22.40 | 23.40 | 23.19 | 19.76 | 22.40 ||| |WARFARIN SODIUM 0.25 MG PO SPLIT TABLET|100 each|1000286| 450.10 |||||||||| 292.57 | 306.07 | 328.57 | 328.57 | 351.08 | 270.06 | 292.57 | 337.58 | 382.59 | 399.69 | 396.09 | 337.58 | 382.59 ||| |WARFARIN SODIUM 0.5 MG PO SPLIT TABLET|100 each|1000287| 83.05 |||||||||| 53.98 | 56.47 | 60.63 | 60.63 | 64.78 | 49.83 | 53.98 | 62.29 | 70.59 | 73.75 | 73.08 | 62.29 | 70.59 ||| |WARFARIN SODIUM 1.25 MG PO SPLIT TABLET|100 each|1000288| 482.90 |||||||||| 313.89 | 328.37 | 352.52 | 352.52 | 376.66 | 289.74 | 313.89 | 362.18 | 410.47 | 428.82 | 424.95 | 362.18 | 410.47 ||| |WARFARIN SODIUM 3.75 MG PO SPLIT TABLET|100 each|1000289| 125.80 |||||||||| 81.77 | 85.54 | 91.83 | 91.83 | 98.12 | 75.48 | 81.77 | 94.35 | 106.93 | 111.71 | 110.70 | 94.35 | 106.93 ||| |TORSEMIDE 2.5 MG PO SPLIT TABLET|100 each|1000290| 54.85 |||||||||| 35.65 | 37.30 | 40.04 | 40.04 | 42.78 | 32.91 | 35.65 | 41.14 | 46.62 | 48.71 | 48.27 | 41.14 | 46.62 ||| |TORSEMIDE 5 MG PO SPLIT TABLET|100 each|1000291| 54.85 |||||||||| 35.65 | 37.30 | 40.04 | 40.04 | 42.78 | 32.91 | 35.65 | 41.14 | 46.62 | 48.71 | 48.27 | 41.14 | 46.62 ||| |SPIRONOLACTONE 12.5 MG PO SPLIT TABLET|1000 each|1000292| 231.70 |||||||||| 150.61 | 157.56 | 169.14 | 169.14 | 180.73 | 139.02 | 150.61 | 173.78 | 196.95 | 205.75 | 203.90 | 173.78 | 196.95 ||| |SPIRONOLACTONE 50 MG PO SPLIT TABLET|100 each|1000293| 174.60 |||||||||| 113.49 | 118.73 | 127.46 | 127.46 | 136.19 | 104.76 | 113.49 | 130.95 | 148.41 | 155.04 | 153.65 | 130.95 | 148.41 ||| |SITAGLIPTIN PHOSPHATE 12.5 MG PO SPLIT TABLET|90 each|1000294| 2,970.35 |||||||||| 1,930.73 | 2,019.84 | 2,168.36 | 2,168.36 | 2,316.87 | 1,782.21 | 1,930.73 | 2,227.76 | 2,524.80 | 2,637.67 | 2,613.91 | 2,227.76 | 2,524.80 ||| |SITAGLIPTIN PHOSPHATE 25 MG PO SPLIT TABLET|90 each|1000295| 2,970.35 |||||||||| 1,930.73 | 2,019.84 | 2,168.36 | 2,168.36 | 2,316.87 | 1,782.21 | 1,930.73 | 2,227.76 | 2,524.80 | 2,637.67 | 2,613.91 | 2,227.76 | 2,524.80 ||| |ROPINIROLE HCL 0.0625 MG PO SPLIT TABLET|100 each|1000296| 199.50 |||||||||| 129.68 | 135.66 | 145.64 | 145.64 | 155.61 | 119.70 | 129.68 | 149.63 | 169.58 | 177.16 | 175.56 | 149.63 | 169.58 ||| |ROPINIROLE HCL 0.125 MG PO SPLIT TABLET|100 each|1000297| 199.50 |||||||||| 129.68 | 135.66 | 145.64 | 145.64 | 155.61 | 119.70 | 129.68 | 149.63 | 169.58 | 177.16 | 175.56 | 149.63 | 169.58 ||| |GLIPIZIDE 1.25 MG PO SPLIT TABLET|100 each|1000298| 26.15 |||||||||| 17.00 | 17.78 | 19.09 | 19.09 | 20.40 | 15.69 | 17.00 | 19.61 | 22.23 | 23.22 | 23.01 | 19.61 | 22.23 ||| |GLIPIZIDE 2.5 MG PO SPLIT TABLET|100 each|1000299| 26.15 |||||||||| 17.00 | 17.78 | 19.09 | 19.09 | 20.40 | 15.69 | 17.00 | 19.61 | 22.23 | 23.22 | 23.01 | 19.61 | 22.23 ||| |HYDROCHLOROTHIAZIDE 6.25 MG PO SPLIT TABLET|100 each|1000301| 34.65 |||||||||| 22.52 | 23.56 | 25.29 | 25.29 | 27.03 | 20.79 | 22.52 | 25.99 | 29.45 | 30.77 | 30.49 | 25.99 | 29.45 ||| |HYDROCHLOROTHIAZIDE 12.5 MG PO SPLIT TABLET|100 each|1000302| 34.65 |||||||||| 22.52 | 23.56 | 25.29 | 25.29 | 27.03 | 20.79 | 22.52 | 25.99 | 29.45 | 30.77 | 30.49 | 25.99 | 29.45 ||| |LABETALOL HCL 25 MG PO SPLIT TABLET|100 each|1000303| 116.05 |||||||||| 75.43 | 78.91 | 84.72 | 84.72 | 90.52 | 69.63 | 75.43 | 87.04 | 98.64 | 103.05 | 102.12 | 87.04 | 98.64 ||| |LABETALOL HCL 50 MG PO SPLIT TABLET|100 each|1000304| 116.05 |||||||||| 75.43 | 78.91 | 84.72 | 84.72 | 90.52 | 69.63 | 75.43 | 87.04 | 98.64 | 103.05 | 102.12 | 87.04 | 98.64 ||| |TIAGABINE HCL 2 MG PO SPLIT TABLET|30 each|1000305| 641.70 |||||||||| 417.11 | 436.36 | 468.44 | 468.44 | 500.53 | 385.02 | 417.11 | 481.28 | 545.45 | 569.83 | 564.70 | 481.28 | 545.45 ||| |TOLVAPTAN 7.5 MG PO SPLIT TABLET|10 each|1000306| 10,307.05 |||||||||| 6,699.58 | 7,008.79 | 7,524.15 | 7,524.15 | 8,039.50 | 6,184.23 | 6,699.58 | 7,730.29 | 8,760.99 | 9,152.66 | 9,070.20 | 7,730.29 | 8,760.99 ||| |TRIHEXYPHENIDYL HCL 1 MG PO SPLIT TABLET|100 each|1000307| 53.15 |||||||||| 34.55 | 36.14 | 38.80 | 38.80 | 41.46 | 31.89 | 34.55 | 39.86 | 45.18 | 47.20 | 46.77 | 39.86 | 45.18 ||| |VARENICLINE TARTRATE 0.25 MG PO SPLIT TABLET|56 each|1000308| 940.45 |||||||||| 611.29 | 639.51 | 686.53 | 686.53 | 733.55 | 564.27 | 611.29 | 705.34 | 799.38 | 835.12 | 827.60 | 705.34 | 799.38 ||| |VERAPAMIL HCL 30 MG PO SPLIT TABLET|100 each|1000309| 33.00 |||||||||| 21.45 | 22.44 | 24.09 | 24.09 | 25.74 | 19.80 | 21.45 | 24.75 | 28.05 | 29.30 | 29.04 | 24.75 | 28.05 ||| |VERAPAMIL HCL 60 MG PO SPLIT TABLET|100 each|1000310| 33.00 |||||||||| 21.45 | 22.44 | 24.09 | 24.09 | 25.74 | 19.80 | 21.45 | 24.75 | 28.05 | 29.30 | 29.04 | 24.75 | 28.05 ||| |SIMETHICONE 40 MG CHEW PO SPLIT TABLET|100 each|1000311| 34.25 |||||||||| 22.26 | 23.29 | 25.00 | 25.00 | 26.72 | 20.55 | 22.26 | 25.69 | 29.11 | 30.41 | 30.14 | 25.69 | 29.11 ||| |TOPIRAMATE 12.5 MG PO SPLIT TABLET|60 each|1000312| 25.35 |||||||||| 16.48 | 17.24 | 18.51 | 18.51 | 19.77 | 15.21 | 16.48 | 19.01 | 21.55 | 22.51 | 22.31 | 19.01 | 21.55 ||| |TRAMADOL HCL 25 MG PO SPLIT TABLET|300 each|1000313| 61.25 |||||||||| 39.81 | 41.65 | 44.71 | 44.71 | 47.78 | 36.75 | 39.81 | 45.94 | 52.06 | 54.39 | 53.90 | 45.94 | 52.06 ||| |VENLAFAXINE HCL 12.5 MG PO SPLIT TABLET|100 each|1000314| 88.45 |||||||||| 57.49 | 60.15 | 64.57 | 64.57 | 68.99 | 53.07 | 57.49 | 66.34 | 75.18 | 78.54 | 77.84 | 66.34 | 75.18 ||| |VERAPAMIL HCL ER 120 MG PO SPLIT TABLET|100 each|1000315| 65.40 |||||||||| 42.51 | 44.47 | 47.74 | 47.74 | 51.01 | 39.24 | 42.51 | 49.05 | 55.59 | 58.08 | 57.55 | 49.05 | 55.59 ||| |ZOLPIDEM TARTRATE 2.5 MG PO SPLIT TABLET|100 each|1000316| 57.95 |||||||||| 37.67 | 39.41 | 42.30 | 42.30 | 45.20 | 34.77 | 37.67 | 43.46 | 49.26 | 51.46 | 51.00 | 43.46 | 49.26 ||| |FENOFIBRATE 80 MG PO SPLIT TABLET|90 each|1000317| 145.55 |||||||||| 94.61 | 98.97 | 106.25 | 106.25 | 113.53 | 87.33 | 94.61 | 109.16 | 123.72 | 129.25 | 128.08 | 109.16 | 123.72 ||| |REPAGLINIDE 0.5 MG PO SPLIT TABLET|100 each|1000318| 1,320.75 |||||||||| 858.49 | 898.11 | 964.15 | 964.15 | 1,030.19 | 792.45 | 858.49 | 990.56 | 1,122.64 | 1,172.83 | 1,162.26 | 990.56 | 1,122.64 ||| |ROSUVASTATIN CALCIUM 2.5 MG PO SPLIT TABLET|90 each|1000320| 1,744.30 |||||||||| 1,133.80 | 1,186.12 | 1,273.34 | 1,273.34 | 1,360.55 | 1,046.58 | 1,133.80 | 1,308.23 | 1,482.66 | 1,548.94 | 1,534.98 | 1,308.23 | 1,482.66 ||| |SENNOSIDES 4.3 MG PO SPLIT TABLET|100 each|1000321| 24.30 |||||||||| 15.80 | 16.52 | 17.74 | 17.74 | 18.95 | 14.58 | 15.80 | 18.23 | 20.66 | 21.58 | 21.38 | 18.23 | 20.66 ||| |SERTRALINE HCL 12.5 MG PO SPLIT TABLET|30 each|1000322| 23.00 |||||||||| 14.95 | 15.64 | 16.79 | 16.79 | 17.94 | 13.80 | 14.95 | 17.25 | 19.55 | 20.42 | 20.24 | 17.25 | 19.55 ||| |LEVETIRACETAM 125 MG PO SPLIT TABLET|120 each|1000323| 89.05 |||||||||| 57.88 | 60.55 | 65.01 | 65.01 | 69.46 | 53.43 | 57.88 | 66.79 | 75.69 | 79.08 | 78.36 | 66.79 | 75.69 ||| |PRIMIDONE 12.5 MG PO SPLIT TABLET|100 each|1000324| 99.65 |||||||||| 64.77 | 67.76 | 72.74 | 72.74 | 77.73 | 59.79 | 64.77 | 74.74 | 84.70 | 88.49 | 87.69 | 74.74 | 84.70 ||| |PRIMIDONE 25 MG PO SPLIT TABLET|100 each|1000325| 99.65 |||||||||| 64.77 | 67.76 | 72.74 | 72.74 | 77.73 | 59.79 | 64.77 | 74.74 | 84.70 | 88.49 | 87.69 | 74.74 | 84.70 ||| |PRIMIDONE 125 MG PO SPLIT TABLET|100 each|1000326| 162.55 |||||||||| 105.66 | 110.53 | 118.66 | 118.66 | 126.79 | 97.53 | 105.66 | 121.91 | 138.17 | 144.34 | 143.04 | 121.91 | 138.17 ||| |PROBENECID 250 MG PO SPLIT TABLET|100 each|1000327| 152.80 |||||||||| 99.32 | 103.90 | 111.54 | 111.54 | 119.18 | 91.68 | 99.32 | 114.60 | 129.88 | 135.69 | 134.46 | 114.60 | 129.88 ||| |PROMETHAZINE HCL 6.25 MG PO SPLIT TABLET|100 each|1000328| 44.45 |||||||||| 28.89 | 30.23 | 32.45 | 32.45 | 34.67 | 26.67 | 28.89 | 33.34 | 37.78 | 39.47 | 39.12 | 33.34 | 37.78 ||| |PROPAFENONE HCL 75 MG PO SPLIT TABLET|100 each|1000329| 101.95 |||||||||| 66.27 | 69.33 | 74.42 | 74.42 | 79.52 | 61.17 | 66.27 | 76.46 | 86.66 | 90.53 | 89.72 | 76.46 | 86.66 ||| |PROPRANOLOL HCL 5 MG PO SPLIT TABLET|100 each|1000330| 55.25 |||||||||| 35.91 | 37.57 | 40.33 | 40.33 | 43.10 | 33.15 | 35.91 | 41.44 | 46.96 | 49.06 | 48.62 | 41.44 | 46.96 ||| |LEVOTHYROXINE SODIUM 12.5 MCG PO SPLIT TABLET|1000 each|1000331| 777.70 |||||||||| 505.51 | 528.84 | 567.72 | 567.72 | 606.61 | 466.62 | 505.51 | 583.28 | 661.05 | 690.60 | 684.38 | 583.28 | 661.05 ||| |LEVOTHYROXINE SODIUM 37.5 MCG PO SPLIT TABLET|100 each|1000332| 291.70 |||||||||| 189.61 | 198.36 | 212.94 | 212.94 | 227.53 | 175.02 | 189.61 | 218.78 | 247.95 | 259.03 | 256.70 | 218.78 | 247.95 ||| |LEVOTHYROXINE SODIUM 44 MCG PO SPLIT TABLET|100 each|1000333| 118.55 |||||||||| 77.06 | 80.61 | 86.54 | 86.54 | 92.47 | 71.13 | 77.06 | 88.91 | 100.77 | 105.27 | 104.32 | 88.91 | 100.77 ||| |LEVOTHYROXINE SODIUM 56 MCG PO SPLIT TABLET|100 each|1000334| 147.60 |||||||||| 95.94 | 100.37 | 107.75 | 107.75 | 115.13 | 88.56 | 95.94 | 110.70 | 125.46 | 131.07 | 129.89 | 110.70 | 125.46 ||| |LEVOTHYROXINE SODIUM 62.5 MCG PO SPLIT TABLET|100 each|1000335| 136.00 |||||||||| 88.40 | 92.48 | 99.28 | 99.28 | 106.08 | 81.60 | 88.40 | 102.00 | 115.60 | 120.77 | 119.68 | 102.00 | 115.60 ||| |LEVOTHYROXINE SODIUM 87.5 MCG PO SPLIT TABLET|100 each|1000336| 161.55 |||||||||| 105.01 | 109.85 | 117.93 | 117.93 | 126.01 | 96.93 | 105.01 | 121.16 | 137.32 | 143.46 | 142.16 | 121.16 | 137.32 ||| |MODAFINIL 50 MG PO SPLIT TABLET|100 each|1000337| 3,491.65 |||||||||| 2,269.57 | 2,374.32 | 2,548.90 | 2,548.90 | 2,723.49 | 2,094.99 | 2,269.57 | 2,618.74 | 2,967.90 | 3,100.59 | 3,072.65 | 2,618.74 | 2,967.90 ||| |NABUMETONE 250 MG PO SPLIT TABLET|100 each|1000338| 116.50 |||||||||| 75.73 | 79.22 | 85.05 | 85.05 | 90.87 | 69.90 | 75.73 | 87.38 | 99.03 | 103.45 | 102.52 | 87.38 | 99.03 ||| |NADOLOL 10 MG PO SPLIT TABLET|100 each|1000339| 1,272.20 |||||||||| 826.93 | 865.10 | 928.71 | 928.71 | 992.32 | 763.32 | 826.93 | 954.15 | 1,081.37 | 1,129.71 | 1,119.54 | 954.15 | 1,081.37 ||| |NALTREXONE HCL 25 MG PO SPLIT TABLET|30 each|1000340| 146.60 |||||||||| 95.29 | 99.69 | 107.02 | 107.02 | 114.35 | 87.96 | 95.29 | 109.95 | 124.61 | 130.18 | 129.01 | 109.95 | 124.61 ||| |NATEGLINIDE 60 MG PO SPLIT TABLET|100 each|1000341| 276.95 |||||||||| 180.02 | 188.33 | 202.17 | 202.17 | 216.02 | 166.17 | 180.02 | 207.71 | 235.41 | 245.93 | 243.72 | 207.71 | 235.41 ||| |NEBIVOLOL HCL 1.25 MG PO SPLIT TABLET|100 each|1000342| 842.05 |||||||||| 547.33 | 572.59 | 614.70 | 614.70 | 656.80 | 505.23 | 547.33 | 631.54 | 715.74 | 747.74 | 741.00 | 631.54 | 715.74 ||| |NEBIVOLOL HCL 2.5 MG PO SPLIT TABLET|100 each|1000343| 842.05 |||||||||| 547.33 | 572.59 | 614.70 | 614.70 | 656.80 | 505.23 | 547.33 | 631.54 | 715.74 | 747.74 | 741.00 | 631.54 | 715.74 ||| |CIPROFLOXACIN HCL 125 MG PO SPLIT TABLET|500 each|1000344| 214.05 |||||||||| 139.13 | 145.55 | 156.26 | 156.26 | 166.96 | 128.43 | 139.13 | 160.54 | 181.94 | 190.08 | 188.36 | 160.54 | 181.94 ||| |CLOBAZAM 2.5 MG PO SPLIT TABLET|100 each|1000346| 4,595.25 |||||||||| 2,986.91 | 3,124.77 | 3,354.53 | 3,354.53 | 3,584.30 | 2,757.15 | 2,986.91 | 3,446.44 | 3,905.96 | 4,080.58 | 4,043.82 | 3,446.44 | 3,905.96 ||| |CLOBAZAM 5 MG PO SPLIT TABLET|100 each|1000347| 4,595.25 |||||||||| 2,986.91 | 3,124.77 | 3,354.53 | 3,354.53 | 3,584.30 | 2,757.15 | 2,986.91 | 3,446.44 | 3,905.96 | 4,080.58 | 4,043.82 | 3,446.44 | 3,905.96 ||| |FOLIC ACID 0.5 MG PO SPLIT TABLET|100 each|1000348| 33.00 |||||||||| 21.45 | 22.44 | 24.09 | 24.09 | 25.74 | 19.80 | 21.45 | 24.75 | 28.05 | 29.30 | 29.04 | 24.75 | 28.05 ||| |FUROSEMIDE 5 MG PO SPLIT TABLET|1000 each|1000349| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |FUROSEMIDE 10 MG PO SPLIT TABLET|1000 each|1000350| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |GALANTAMINE HYDROBROMIDE 2 MG PO SPLIT TABLET|60 each|1000351| 338.80 |||||||||| 220.22 | 230.38 | 247.32 | 247.32 | 264.26 | 203.28 | 220.22 | 254.10 | 287.98 | 300.85 | 298.14 | 254.10 | 287.98 ||| |GALANTAMINE HYDROBROMIDE 4 MG PO SPLIT TABLET|60 each|1000352| 338.80 |||||||||| 220.22 | 230.38 | 247.32 | 247.32 | 264.26 | 203.28 | 220.22 | 254.10 | 287.98 | 300.85 | 298.14 | 254.10 | 287.98 ||| |GEMFIBROZIL 300 MG PO SPLIT TABLET|60 each|1000353| 32.95 |||||||||| 21.42 | 22.41 | 24.05 | 24.05 | 25.70 | 19.77 | 21.42 | 24.71 | 28.01 | 29.26 | 29.00 | 24.71 | 28.01 ||| |GLIMEPIRIDE 0.25 MG PO SPLIT TABLET|100 each|1000354| 23.25 |||||||||| 15.11 | 15.81 | 16.97 | 16.97 | 18.14 | 13.95 | 15.11 | 17.44 | 19.76 | 20.65 | 20.46 | 17.44 | 19.76 ||| |GLIMEPIRIDE 0.5 MG PO SPLIT TABLET|100 each|1000355| 23.25 |||||||||| 15.11 | 15.81 | 16.97 | 16.97 | 18.14 | 13.95 | 15.11 | 17.44 | 19.76 | 20.65 | 20.46 | 17.44 | 19.76 ||| |ARMODAFINIL 25 MG PO SPLIT TABLET|30 each|1000356| 1,780.00 |||||||||| 1,157.00 | 1,210.40 | 1,299.40 | 1,299.40 | 1,388.40 | 1,068.00 | 1,157.00 | 1,335.00 | 1,513.00 | 1,580.64 | 1,566.40 | 1,335.00 | 1,513.00 ||| |DEXAMETHASONE 0.25 MG PO SPLIT TABLET|100 each|1000357| 57.75 |||||||||| 37.54 | 39.27 | 42.16 | 42.16 | 45.05 | 34.65 | 37.54 | 43.31 | 49.09 | 51.28 | 50.82 | 43.31 | 49.09 ||| |FEBUXOSTAT 20 MG PO SPLIT TABLET|30 each|1000358| 707.15 |||||||||| 459.65 | 480.86 | 516.22 | 516.22 | 551.58 | 424.29 | 459.65 | 530.36 | 601.08 | 627.95 | 622.29 | 530.36 | 601.08 ||| |FLUPHENAZINE HCL 2.5 MG PO SPLIT TABLET|100 each|1000359| 1,454.45 |||||||||| 945.39 | 989.03 | 1,061.75 | 1,061.75 | 1,134.47 | 872.67 | 945.39 | 1,090.84 | 1,236.28 | 1,291.55 | 1,279.92 | 1,090.84 | 1,236.28 ||| |LORAZEPAM 0.25 MG PO SPLIT TABLET|100 each|1000360| 26.15 |||||||||| 17.00 | 17.78 | 19.09 | 19.09 | 20.40 | 15.69 | 17.00 | 19.61 | 22.23 | 23.22 | 23.01 | 19.61 | 22.23 ||| |METOPROLOL SUCCINATE ER 12.5 MG PO SPLIT TABLET|500 each|1000361| 914.70 |||||||||| 594.56 | 622.00 | 667.73 | 667.73 | 713.47 | 548.82 | 594.56 | 686.03 | 777.50 | 812.25 | 804.94 | 686.03 | 777.50 ||| |MINOXIDIL 2.5 MG PO SPLIT TABLET|100 each|1000363| 117.50 |||||||||| 76.38 | 79.90 | 85.78 | 85.78 | 91.65 | 70.50 | 76.38 | 88.13 | 99.88 | 104.34 | 103.40 | 88.13 | 99.88 ||| |FLUDROCORTISONE ACETATE 0.05 MG PO SPLIT TABLET|100 each|1000364| 136.00 |||||||||| 88.40 | 92.48 | 99.28 | 99.28 | 106.08 | 81.60 | 88.40 | 102.00 | 115.60 | 120.77 | 119.68 | 102.00 | 115.60 ||| |FLUVOXAMINE MALEATE 25 MG PO SPLIT TABLET|100 each|1000365| 126.25 |||||||||| 82.06 | 85.85 | 92.16 | 92.16 | 98.48 | 75.75 | 82.06 | 94.69 | 107.31 | 112.11 | 111.10 | 94.69 | 107.31 ||| |GLYBURIDE MICRONIZED 1.5 MG PO SPLIT TABLET|100 each|1000366| 23.90 |||||||||| 15.54 | 16.25 | 17.45 | 17.45 | 18.64 | 14.34 | 15.54 | 17.93 | 20.32 | 21.22 | 21.03 | 17.93 | 20.32 ||| |HYDRALAZINE HCL 5 MG PO SPLIT TABLET|100 each|1000367| 69.55 |||||||||| 45.21 | 47.29 | 50.77 | 50.77 | 54.25 | 41.73 | 45.21 | 52.16 | 59.12 | 61.76 | 61.20 | 52.16 | 59.12 ||| |HYDROCORTISONE 2.5 MG PO SPLIT TABLET|50 each|1000368| 51.70 |||||||||| 33.61 | 35.16 | 37.74 | 37.74 | 40.33 | 31.02 | 33.61 | 38.78 | 43.95 | 45.91 | 45.50 | 38.78 | 43.95 ||| |HYDROXYCHLOROQUINE SULFATE 100 MG PO SPLIT TABLET|1 each|1000369| 15.05 |||||||||| 9.78 | 10.23 | 10.99 | 10.99 | 11.74 | 9.03 | 9.78 | 11.29 | 12.79 | 13.36 | 13.24 | 11.29 | 12.79 ||| |INDAPAMIDE 1.25 MG PO SPLIT TABLET|100 each|1000370| 88.05 |||||||||| 57.23 | 59.87 | 64.28 | 64.28 | 68.68 | 52.83 | 57.23 | 66.04 | 74.84 | 78.19 | 77.48 | 66.04 | 74.84 ||| |ISOSORBIDE MONONITRATE 5 MG PO SPLIT TABLET|100 each|1000371| 90.55 |||||||||| 58.86 | 61.57 | 66.10 | 66.10 | 70.63 | 54.33 | 58.86 | 67.91 | 76.97 | 80.41 | 79.68 | 67.91 | 76.97 ||| |ISOSORBIDE MONONITRATE ER 15 MG PO SPLIT TABLET|100 each|1000372| 65.00 |||||||||| 42.25 | 44.20 | 47.45 | 47.45 | 50.70 | 39.00 | 42.25 | 48.75 | 55.25 | 57.72 | 57.20 | 48.75 | 55.25 ||| |LACOSAMIDE 25 MG PO SPLIT TABLET|60 each|1000373| 1,204.20 |||||||||| 782.73 | 818.86 | 879.07 | 879.07 | 939.28 | 722.52 | 782.73 | 903.15 | 1,023.57 | 1,069.33 | 1,059.70 | 903.15 | 1,023.57 ||| |LISINOPRIL 1.25 MG PO SPLIT TABLET|100 each|1000374| 13.30 |||||||||| 8.65 | 9.04 | 9.71 | 9.71 | 10.37 | 7.98 | 8.65 | 9.98 | 11.31 | 11.81 | 11.70 | 9.98 | 11.31 ||| |LITHIUM CARBONATE 150 MG PO SPLIT TABLET|100 each|1000375| 57.75 |||||||||| 37.54 | 39.27 | 42.16 | 42.16 | 45.05 | 34.65 | 37.54 | 43.31 | 49.09 | 51.28 | 50.82 | 43.31 | 49.09 ||| |LOSARTAN POTASSIUM 12.5 MG PO SPLIT TABLET|90 each|1000376| 48.20 |||||||||| 31.33 | 32.78 | 35.19 | 35.19 | 37.60 | 28.92 | 31.33 | 36.15 | 40.97 | 42.80 | 42.42 | 36.15 | 40.97 ||| |ISOSORBIDE MONONITRATE 10 MG PO SPLIT TABLET|100 each|1000377| 90.55 |||||||||| 58.86 | 61.57 | 66.10 | 66.10 | 70.63 | 54.33 | 58.86 | 67.91 | 76.97 | 80.41 | 79.68 | 67.91 | 76.97 ||| |IMIPRAMINE HCL 25 MG PO SPLIT TABLET|100 each|1000378| 86.40 |||||||||| 56.16 | 58.75 | 63.07 | 63.07 | 67.39 | 51.84 | 56.16 | 64.80 | 73.44 | 76.72 | 76.03 | 64.80 | 73.44 ||| |GUANFACINE HCL 0.5 MG PO SPLIT TABLET|100 each|1000379| 52.35 |||||||||| 34.03 | 35.60 | 38.22 | 38.22 | 40.83 | 31.41 | 34.03 | 39.26 | 44.50 | 46.49 | 46.07 | 39.26 | 44.50 ||| |METOLAZONE 1.25 MG PO SPLIT TABLET|1 each|1000380| 22.70 |||||||||| 14.76 | 15.44 | 16.57 | 16.57 | 17.71 | 13.62 | 14.76 | 17.03 | 19.30 | 20.16 | 19.98 | 17.03 | 19.30 ||| |LURASIDONE HCL 20 MG PO SPLIT TABLET|1 each|1000381| 110.85 |||||||||| 72.05 | 75.38 | 80.92 | 80.92 | 86.46 | 66.51 | 72.05 | 83.14 | 94.22 | 98.43 | 97.55 | 83.14 | 94.22 ||| |METOPROLOL TARTRATE 6.25 MG PO SPLIT TABLET|100 each|1000382| 34.45 |||||||||| 22.39 | 23.43 | 25.15 | 25.15 | 26.87 | 20.67 | 22.39 | 25.84 | 29.28 | 30.59 | 30.32 | 25.84 | 29.28 ||| |METOCLOPRAMIDE HCL 2.5 MG PO SPLIT TABLET|100 each|1000383| 57.30 |||||||||| 37.25 | 38.96 | 41.83 | 41.83 | 44.69 | 34.38 | 37.25 | 42.98 | 48.71 | 50.88 | 50.42 | 42.98 | 48.71 ||| |PHENAZOPYRIDINE HCL 50 MG PO SPLIT TABLET|100 each|1000384| 28.65 |||||||||| 18.62 | 19.48 | 20.91 | 20.91 | 22.35 | 17.19 | 18.62 | 21.49 | 24.35 | 25.44 | 25.21 | 21.49 | 24.35 ||| |PIOGLITAZONE HCL 7.5 MG PO SPLIT TABLETS|90 each|1000385| 74.55 |||||||||| 48.46 | 50.69 | 54.42 | 54.42 | 58.15 | 44.73 | 48.46 | 55.91 | 63.37 | 66.20 | 65.60 | 55.91 | 63.37 ||| |SOTALOL HCL 20 MG PO SPLIT TABLET|500 each|1000386| 109.20 |||||||||| 70.98 | 74.26 | 79.72 | 79.72 | 85.18 | 65.52 | 70.98 | 81.90 | 92.82 | 96.97 | 96.10 | 81.90 | 92.82 ||| |PYRIDOSTIGMINE BROMIDE 30 MG PO SPLIT TABLET|100 each|1000387| 278.40 |||||||||| 180.96 | 189.31 | 203.23 | 203.23 | 217.15 | 167.04 | 180.96 | 208.80 | 236.64 | 247.22 | 244.99 | 208.80 | 236.64 ||| |NIACIN 250 MG PO SPLIT TABLET|100 each|1000388| 15.60 |||||||||| 10.14 | 10.61 | 11.39 | 11.39 | 12.17 | 9.36 | 10.14 | 11.70 | 13.26 | 13.85 | 13.73 | 11.70 | 13.26 ||| |EZETIMIBE 5 MG PO SPLIT TABLET|100 each|1000389| 2,409.40 |||||||||| 1,566.11 | 1,638.39 | 1,758.86 | 1,758.86 | 1,879.33 | 1,445.64 | 1,566.11 | 1,807.05 | 2,047.99 | 2,139.55 | 2,120.27 | 1,807.05 | 2,047.99 ||| |OXYBUTYNIN CHLORIDE 2.5 MG PO SPLIT TABLET|100 each|1000390| 122.90 |||||||||| 79.89 | 83.57 | 89.72 | 89.72 | 95.86 | 73.74 | 79.89 | 92.18 | 104.47 | 109.14 | 108.15 | 92.18 | 104.47 ||| |TRAZODONE HCL 12.5 MG PO SPLIT TABLET|500 each|1000391| 85.35 |||||||||| 55.48 | 58.04 | 62.31 | 62.31 | 66.57 | 51.21 | 55.48 | 64.01 | 72.55 | 75.79 | 75.11 | 64.01 | 72.55 ||| |PHENOBARBITAL 4.05 MG PO SPLIT TABLET|100 each|1000392| 110.90 |||||||||| 72.09 | 75.41 | 80.96 | 80.96 | 86.50 | 66.54 | 72.09 | 83.18 | 94.27 | 98.48 | 97.59 | 83.18 | 94.27 ||| |PHENOBARBITAL 8.1 MG PO SPLIT TABLET|100 each|1000393| 110.90 |||||||||| 72.09 | 75.41 | 80.96 | 80.96 | 86.50 | 66.54 | 72.09 | 83.18 | 94.27 | 98.48 | 97.59 | 83.18 | 94.27 ||| |OLANZAPINE 1.25 MG PO SPLIT TABLET|30 each|1000394| 29.30 |||||||||| 19.05 | 19.92 | 21.39 | 21.39 | 22.85 | 17.58 | 19.05 | 21.98 | 24.91 | 26.02 | 25.78 | 21.98 | 24.91 ||| |OLMESARTAN MEDOXOMIL 2.5 MG PO SPLIT TABLET|30 each|1000395| 29.55 |||||||||| 19.21 | 20.09 | 21.57 | 21.57 | 23.05 | 17.73 | 19.21 | 22.16 | 25.12 | 26.24 | 26.00 | 22.16 | 25.12 ||| |ESTROGENS CONJUGATED 0.45 MG PO SPLIT TABLET|100 each|1000396| 1,247.70 |||||||||| 811.01 | 848.44 | 910.82 | 910.82 | 973.21 | 748.62 | 811.01 | 935.78 | 1,060.55 | 1,107.96 | 1,097.98 | 935.78 | 1,060.55 ||| |OXCARBAZEPINE 75 MG PO SPLIT TABLET|100 each|1000397| 80.35 |||||||||| 52.23 | 54.64 | 58.66 | 58.66 | 62.67 | 48.21 | 52.23 | 60.26 | 68.30 | 71.35 | 70.71 | 60.26 | 68.30 ||| |SIMVASTATIN 10 MG PO SPLIT TABLET|1000 each|1000398| 192.25 |||||||||| 124.96 | 130.73 | 140.34 | 140.34 | 149.96 | 115.35 | 124.96 | 144.19 | 163.41 | 170.72 | 169.18 | 144.19 | 163.41 ||| |METFORMIN HCL 425 MG PO SPLIT TABLET|100 each|1000399| 34.45 |||||||||| 22.39 | 23.43 | 25.15 | 25.15 | 26.87 | 20.67 | 22.39 | 25.84 | 29.28 | 30.59 | 30.32 | 25.84 | 29.28 ||| |PYRIDOXINE HCL 25 MG PO SPLIT TABLET|100 each|1000400| 31.95 |||||||||| 20.77 | 21.73 | 23.32 | 23.32 | 24.92 | 19.17 | 20.77 | 23.96 | 27.16 | 28.37 | 28.12 | 23.96 | 27.16 ||| |QUINAPRIL HCL 5 MG PO SPLIT TABLET|90 each|1000401| 53.25 |||||||||| 34.61 | 36.21 | 38.87 | 38.87 | 41.54 | 31.95 | 34.61 | 39.94 | 45.26 | 47.29 | 46.86 | 39.94 | 45.26 ||| |PYRIDOSTIGMINE BROMIDE ER 90 MG PO SPLIT TABLET TBCR|30 each|1000403| 1,933.90 |||||||||| 1,257.04 | 1,315.05 | 1,411.75 | 1,411.75 | 1,508.44 | 1,160.34 | 1,257.04 | 1,450.43 | 1,643.82 | 1,717.30 | 1,701.83 | 1,450.43 | 1,643.82 ||| |RALOXIFENE HCL 30 MG PO SPLIT TABLET|30 each|1000404| 433.05 |||||||||| 281.48 | 294.47 | 316.13 | 316.13 | 337.78 | 259.83 | 281.48 | 324.79 | 368.09 | 384.55 | 381.08 | 324.79 | 368.09 ||| |MINOXIDIL 5 MG PO SPLIT TABLET|100 each|1000405| 117.50 |||||||||| 76.38 | 79.90 | 85.78 | 85.78 | 91.65 | 70.50 | 76.38 | 88.13 | 99.88 | 104.34 | 103.40 | 88.13 | 99.88 ||| |MIRTAZAPINE 7.5 MG PO SPLIT TABLET|100 each|1000406| 71.85 |||||||||| 46.70 | 48.86 | 52.45 | 52.45 | 56.04 | 43.11 | 46.70 | 53.89 | 61.07 | 63.80 | 63.23 | 53.89 | 61.07 ||| |PRAVASTATIN SODIUM 5 MG PO SPLIT TABLET|100 each|1000407| 168.20 |||||||||| 109.33 | 114.38 | 122.79 | 122.79 | 131.20 | 100.92 | 109.33 | 126.15 | 142.97 | 149.36 | 148.02 | 126.15 | 142.97 ||| |PRAVASTATIN SODIUM 10 MG PO SPLIT TABLET|90 each|1000408| 113.75 |||||||||| 73.94 | 77.35 | 83.04 | 83.04 | 88.73 | 68.25 | 73.94 | 85.31 | 96.69 | 101.01 | 100.10 | 85.31 | 96.69 ||| |PYRIDOSTIGMINE BROMIDE 15 MG PO SPLIT TABLET|100 each|1000409| 233.80 |||||||||| 151.97 | 158.98 | 170.67 | 170.67 | 182.36 | 140.28 | 151.97 | 175.35 | 198.73 | 207.61 | 205.74 | 175.35 | 198.73 ||| |AZATHIOPRINE 25 MG PO SPLIT TABLET|100 each|1000410| 90.95 |||||||||| 59.12 | 61.85 | 66.39 | 66.39 | 70.94 | 54.57 | 59.12 | 68.21 | 77.31 | 80.76 | 80.04 | 68.21 | 77.31 ||| |MERCAPTOPURINE 25 MG PO SPLIT TABLET|25 each|1000411| 186.55 |||||||||| 121.26 | 126.85 | 136.18 | 136.18 | 145.51 | 111.93 | 121.26 | 139.91 | 158.57 | 165.66 | 164.16 | 139.91 | 158.57 ||| |NADOLOL 20 MG PO SPLIT TABLET|100 each|1000412| 1,272.20 |||||||||| 826.93 | 865.10 | 928.71 | 928.71 | 992.32 | 763.32 | 826.93 | 954.15 | 1,081.37 | 1,129.71 | 1,119.54 | 954.15 | 1,081.37 ||| |VITAMIN D 200 UNITS PO SPLIT TABLET|100 each|1000413| 13.70 |||||||||| 8.91 | 9.32 | 10.00 | 10.00 | 10.69 | 8.22 | 8.91 | 10.28 | 11.65 | 12.17 | 12.06 | 10.28 | 11.65 ||| |ESZOPICLONE 0.5 MG PO SPLIT TABLET|30 each|1000415| 998.60 |||||||||| 649.09 | 679.05 | 728.98 | 728.98 | 778.91 | 599.16 | 649.09 | 748.95 | 848.81 | 886.76 | 878.77 | 748.95 | 848.81 ||| |NYSTATIN 100000 UNIT/ML MT SUSP BULK|473 mL|1000416| 206.65 |||||||||| 134.32 | 140.52 | 150.85 | 150.85 | 161.19 | 123.99 | 134.32 | 154.99 | 175.65 | 183.51 | 181.85 | 154.99 | 175.65 ||| |VITAMIN D 500 UNITS PO SPLIT TABLET|100 each|1000418| 14.35 |||||||||| 9.33 | 9.76 | 10.48 | 10.48 | 11.19 | 8.61 | 9.33 | 10.76 | 12.20 | 12.74 | 12.63 | 10.76 | 12.20 ||| |HYDRALAZINE HCL 12.5 MG PO SPLIT TABLET|100 each|1000419| 71.85 |||||||||| 46.70 | 48.86 | 52.45 | 52.45 | 56.04 | 43.11 | 46.70 | 53.89 | 61.07 | 63.80 | 63.23 | 53.89 | 61.07 ||| |SODIUM GLYCEROPHOSPHATE 1 MMOLE/ML ORAL FOR NICU|20 mL|1000420| 58.50 |||||||||| 38.03 | 39.78 | 42.71 | 42.71 | 45.63 | 35.10 | 38.03 | 43.88 | 49.73 | 51.95 | 51.48 | 43.88 | 49.73 ||| |VITAMIN D 100 UNITS PO SPLIT TABLET|100 each|1000421| 13.70 |||||||||| 8.91 | 9.32 | 10.00 | 10.00 | 10.69 | 8.22 | 8.91 | 10.28 | 11.65 | 12.17 | 12.06 | 10.28 | 11.65 ||| |MILNACIPRAN HCL 25 MG PO SPLIT TABLET|60 each|1000422| 854.60 |||||||||| 555.49 | 581.13 | 623.86 | 623.86 | 666.59 | 512.76 | 555.49 | 640.95 | 726.41 | 758.88 | 752.05 | 640.95 | 726.41 ||| |PAROXETINE HCL 10 MG PO SPLIT TABLET|30 each|1000423| 25.70 |||||||||| 16.71 | 17.48 | 18.76 | 18.76 | 20.05 | 15.42 | 16.71 | 19.28 | 21.85 | 22.82 | 22.62 | 19.28 | 21.85 ||| |HYDRALAZINE HCL 6.25 MG PO SPLIT TABLET|100 each|1000424| 71.85 |||||||||| 46.70 | 48.86 | 52.45 | 52.45 | 56.04 | 43.11 | 46.70 | 53.89 | 61.07 | 63.80 | 63.23 | 53.89 | 61.07 ||| |COLCHICINE 0.3 MG PO SPLIT TABLET|30 each|1000425| 469.90 |||||||||| 305.44 | 319.53 | 343.03 | 343.03 | 366.52 | 281.94 | 305.44 | 352.43 | 399.42 | 417.27 | 413.51 | 352.43 | 399.42 ||| |DILTIAZEM HCL 45 MG PO SPLIT TABLET|100 each|1000426| 88.65 |||||||||| 57.62 | 60.28 | 64.71 | 64.71 | 69.15 | 53.19 | 57.62 | 66.49 | 75.35 | 78.72 | 78.01 | 66.49 | 75.35 ||| |MYCOPHENOLATE MOFETIL 50 MG/ML PO SUSP|30 mL|1000427| 208.85 |||||||||| 135.75 | 142.02 | 152.46 | 152.46 | 162.90 | 125.31 | 135.75 | 156.64 | 177.52 | 185.46 | 183.79 | 156.64 | 177.52 ||| |VERAPAMIL HCL ER 90 MG PO SPLIT TABLET|100 each|1000428| 453.20 |||||||||| 294.58 | 308.18 | 330.84 | 330.84 | 353.50 | 271.92 | 294.58 | 339.90 | 385.22 | 402.44 | 398.82 | 339.90 | 385.22 ||| |THEOPHYLLINE ER 150 MG PO SPLIT TABLET|100 each|1000430| 735.55 |||||||||| 478.11 | 500.17 | 536.95 | 536.95 | 573.73 | 441.33 | 478.11 | 551.66 | 625.22 | 653.17 | 647.28 | 551.66 | 625.22 ||| |ETHAMBUTOL HCL 200 MG PO SPLIT TABLET|100 each|1000431| 342.95 |||||||||| 222.92 | 233.21 | 250.35 | 250.35 | 267.50 | 205.77 | 222.92 | 257.21 | 291.51 | 304.54 | 301.80 | 257.21 | 291.51 ||| |THYROID 15 MG PO SPLIT TABLET|100 each|1000434| 145.35 |||||||||| 94.48 | 98.84 | 106.11 | 106.11 | 113.37 | 87.21 | 94.48 | 109.01 | 123.55 | 129.07 | 127.91 | 109.01 | 123.55 ||| |METHOCARBAMOL 250 MG PO SPLIT TABLET|100 each|1000435| 33.20 |||||||||| 21.58 | 22.58 | 24.24 | 24.24 | 25.90 | 19.92 | 21.58 | 24.90 | 28.22 | 29.48 | 29.22 | 24.90 | 28.22 ||| |NEFAZODONE HCL 50 MG PO SPLIT TABLET|60 each|1000436| 177.35 |||||||||| 115.28 | 120.60 | 129.47 | 129.47 | 138.33 | 106.41 | 115.28 | 133.01 | 150.75 | 157.49 | 156.07 | 133.01 | 150.75 ||| |IBUPROFEN LYSINE IV SYRINGE (NICU)|2 mL|1000437| 1,670.10 |||||||||| 1,085.57 | 1,135.67 | 1,219.17 | 1,219.17 | 1,302.68 | 1,002.06 | 1,085.57 | 1,252.58 | 1,419.59 | 1,483.05 | 1,469.69 | 1,252.58 | 1,419.59 ||| |INDOMETHACIN IV SYRINGE (NICU)|1 each|1000438| 1,029.65 |||||||||| 669.27 | 700.16 | 751.64 | 751.64 | 803.13 | 617.79 | 669.27 | 772.24 | 875.20 | 914.33 | 906.09 | 772.24 | 875.20 ||| |PROMETHAZINE HCL 6.25 MG INJ FOR SDS|.25 mL|1000439| 34.45 |||||||||| 22.39 | 23.43 | 25.15 | 25.15 | 26.87 | 20.67 | 22.39 | 25.84 | 29.28 | 30.59 | 30.32 | 25.84 | 29.28 ||| |SIMVASTATIN 5 MG PO SPLIT TABLET|1000 each|1000440| 192.25 |||||||||| 124.96 | 130.73 | 140.34 | 140.34 | 149.96 | 115.35 | 124.96 | 144.19 | 163.41 | 170.72 | 169.18 | 144.19 | 163.41 ||| |MIDODRINE HCL 2.5 MG PO SPLIT TABLET|100 each|1000442| 797.85 |||||||||| 518.60 | 542.54 | 582.43 | 582.43 | 622.32 | 478.71 | 518.60 | 598.39 | 678.17 | 708.49 | 702.11 | 598.39 | 678.17 ||| |LORATADINE 5 MG PO SPLIT TABLET|90 each|1000444| 26.55 |||||||||| 17.26 | 18.05 | 19.38 | 19.38 | 20.71 | 15.93 | 17.26 | 19.91 | 22.57 | 23.58 | 23.36 | 19.91 | 22.57 ||| |ENALAPRIL MALEATE 1.25 MG PO SPLIT TABLET|100 each|1000445| 99.25 |||||||||| 64.51 | 67.49 | 72.45 | 72.45 | 77.42 | 59.55 | 64.51 | 74.44 | 84.36 | 88.13 | 87.34 | 74.44 | 84.36 ||| |ROFLUMILAST 250 MCG PO SPLIT TABLET|30 each|1000446| 816.85 |||||||||| 530.95 | 555.46 | 596.30 | 596.30 | 637.14 | 490.11 | 530.95 | 612.64 | 694.32 | 725.36 | 718.83 | 612.64 | 694.32 ||| |ATROPINE SULFATE 0.1 MG/ML IV SYRINGE (NICU)|10 mL|1000447| 50.95 |||||||||| 33.12 | 34.65 | 37.19 | 37.19 | 39.74 | 30.57 | 33.12 | 38.21 | 43.31 | 45.24 | 44.84 | 38.21 | 43.31 ||| |SUCCINYLCHOLINE CHLORIDE 20 MG/ML IV SYRINGE (NICU)|10 mL|1000448| 70.15 |||||||||| 45.60 | 47.70 | 51.21 | 51.21 | 54.72 | 42.09 | 45.60 | 52.61 | 59.63 | 62.29 | 61.73 | 52.61 | 59.63 ||| |FOSINOPRIL SODIUM 5 MG PO SPLIT TABLET|90 each|1000449| 64.60 |||||||||| 41.99 | 43.93 | 47.16 | 47.16 | 50.39 | 38.76 | 41.99 | 48.45 | 54.91 | 57.36 | 56.85 | 48.45 | 54.91 ||| |DANTROLENE 5 MG/ML SUSPENSION|100 mL|1000451| 644.80 |||||||||| 419.12 | 438.46 | 470.70 | 470.70 | 502.94 | 386.88 | 419.12 | 483.60 | 548.08 | 572.58 | 567.42 | 483.60 | 548.08 ||| |MIDAZOLAM 0.5MG/ML INFUSION 100ML|100 mL|1000454| 130.15 |||||||||| 84.60 | 88.50 | 95.01 | 95.01 | 101.52 | 78.09 | 84.60 | 97.61 | 110.63 | 115.57 | 114.53 | 97.61 | 110.63 ||| |CLOPIDOGREL BISULFATE 37.5 MG PO SPLIT TABLET|500 each|1000456| 195.35 |||||||||| 126.98 | 132.84 | 142.61 | 142.61 | 152.37 | 117.21 | 126.98 | 146.51 | 166.05 | 173.47 | 171.91 | 146.51 | 166.05 ||| |CHLORPROMAZINE HCL 12.5 MG PO SPLIT TABLET|100 each|1000458| 1,345.25 |||||||||| 874.41 | 914.77 | 982.03 | 982.03 | 1,049.30 | 807.15 | 874.41 | 1,008.94 | 1,143.46 | 1,194.58 | 1,183.82 | 1,008.94 | 1,143.46 ||| |ALBUMIN HUMAN 5 % IV SYRINGE (NICU)|500 mL|1000459| 372.85 |||||||||| 242.35 | 253.54 | 272.18 | 272.18 | 290.82 | 223.71 | 242.35 | 279.64 | 316.92 | 331.09 | 328.11 | 279.64 | 316.92 ||| |CAPTOPRIL 3.125 MG PO SPLIT TABLET|100 each|1000462| 318.90 |||||||||| 207.29 | 216.85 | 232.80 | 232.80 | 248.74 | 191.34 | 207.29 | 239.18 | 271.07 | 283.18 | 280.63 | 239.18 | 271.07 ||| |VALSARTAN 40 MG PO SPLIT TABLET|90 each|1000463| 1,489.45 |||||||||| 968.14 | 1,012.83 | 1,087.30 | 1,087.30 | 1,161.77 | 893.67 | 968.14 | 1,117.09 | 1,266.03 | 1,322.63 | 1,310.72 | 1,117.09 | 1,266.03 ||| |FLECAINIDE ACETATE 12.5 MG PO SPLIT TABLET|100 each|1000464| 141.20 |||||||||| 91.78 | 96.02 | 103.08 | 103.08 | 110.14 | 84.72 | 91.78 | 105.90 | 120.02 | 125.39 | 124.26 | 105.90 | 120.02 ||| |MEDROXYPROGESTERONE ACETATE 1.25 MG PO SPLIT TABLET|100 each|1000465| 51.50 |||||||||| 33.48 | 35.02 | 37.60 | 37.60 | 40.17 | 30.90 | 33.48 | 38.63 | 43.78 | 45.73 | 45.32 | 38.63 | 43.78 ||| |BUSPIRONE HCL 2.5 MG PO SPLIT TABLET|1 each|1000466| 11.25 |||||||||| 7.31 | 7.65 | 8.21 | 8.21 | 8.78 | 6.75 | 7.31 | 8.44 | 9.56 | 9.99 | 9.90 | 8.44 | 9.56 ||| |KETAMINE 10MG/ML ORAL SOLUTION|5 mL|1000467| 53.15 |||||||||| 34.55 | 36.14 | 38.80 | 38.80 | 41.46 | 31.89 | 34.55 | 39.86 | 45.18 | 47.20 | 46.77 | 39.86 | 45.18 ||| |TETRACAINE HCL 2 % SOLUTION|5 mL|1000473| 132.25 |||||||||| 85.96 | 89.93 | 96.54 | 96.54 | 103.16 | 79.35 | 85.96 | 99.19 | 112.41 | 117.44 | 116.38 | 99.19 | 112.41 ||| |PREDNISONE 0.5 MG PO SPLIT TABLET|100 each|1000474| 63.95 |||||||||| 41.57 | 43.49 | 46.68 | 46.68 | 49.88 | 38.37 | 41.57 | 47.96 | 54.36 | 56.79 | 56.28 | 47.96 | 54.36 ||| |HEPARIN SODIUM (PORCINE) 5000 UNIT/ML INJ FOR VASCATH DEACCESS|1 mL|1000475| 41.85 |||||||||| 27.20 | 28.46 | 30.55 | 30.55 | 32.64 | 25.11 | 27.20 | 31.39 | 35.57 | 37.16 | 36.83 | 31.39 | 35.57 ||| |HYDROXYZINE HCL 12.5 MG PO SPLIT TABLET|100 each|1000476| 87.65 |||||||||| 56.97 | 59.60 | 63.98 | 63.98 | 68.37 | 52.59 | 56.97 | 65.74 | 74.50 | 77.83 | 77.13 | 65.74 | 74.50 ||| |DILTIAZEM HCL 15 MG PO SPLIT TABLET|100 each|1000477| 57.50 |||||||||| 37.38 | 39.10 | 41.98 | 41.98 | 44.85 | 34.50 | 37.38 | 43.13 | 48.88 | 51.06 | 50.60 | 43.13 | 48.88 ||| |BENZTROPINE MESYLATE 0.25 MG PO SPLIT TABLET|1 each|1000478| 12.20 |||||||||| 7.93 | 8.30 | 8.91 | 8.91 | 9.52 | 7.32 | 7.93 | 9.15 | 10.37 | 10.83 | 10.74 | 9.15 | 10.37 ||| |AMIODARONE HCL 50 MG PO SPLIT TABLET|100 each|1000479| 98.65 |||||||||| 64.12 | 67.08 | 72.01 | 72.01 | 76.95 | 59.19 | 64.12 | 73.99 | 83.85 | 87.60 | 86.81 | 73.99 | 83.85 ||| |LEVOFLOXACIN IV SYRINGE (PEDS)|100 mL|1000480| 151.10 |||||||||| 98.22 | 102.75 | 110.30 | 110.30 | 117.86 | 90.66 | 98.22 | 113.33 | 128.44 | 134.18 | 132.97 | 113.33 | 128.44 ||| |EPLERENONE 12.5 MG PO SPLIT TABLET|30 each|1000481| 238.20 |||||||||| 154.83 | 161.98 | 173.89 | 173.89 | 185.80 | 142.92 | 154.83 | 178.65 | 202.47 | 211.52 | 209.62 | 178.65 | 202.47 ||| |QUINAPRIL HCL 2.5 MG PO SPLIT TABLET|90 each|1000482| 53.25 |||||||||| 34.61 | 36.21 | 38.87 | 38.87 | 41.54 | 31.95 | 34.61 | 39.94 | 45.26 | 47.29 | 46.86 | 39.94 | 45.26 ||| |LINAGLIPTIN 2.5 PO SPLIT TABLET|30 each|1000484| 981.80 |||||||||| 638.17 | 667.62 | 716.71 | 716.71 | 765.80 | 589.08 | 638.17 | 736.35 | 834.53 | 871.84 | 863.98 | 736.35 | 834.53 ||| |BISOPROLOL-HYDROCHLOROTHIAZIDE 1.25-3.125 MG PO SPLIT TABLET|100 each|1000485| 64.80 |||||||||| 42.12 | 44.06 | 47.30 | 47.30 | 50.54 | 38.88 | 42.12 | 48.60 | 55.08 | 57.54 | 57.02 | 48.60 | 55.08 ||| |ARIPIPRAZOLE 1 MG PO SPLIT TABLET|30 each|1000486| 65.60 |||||||||| 42.64 | 44.61 | 47.89 | 47.89 | 51.17 | 39.36 | 42.64 | 49.20 | 55.76 | 58.25 | 57.73 | 49.20 | 55.76 ||| |DRONEDARONE HCL 200 MG PO SPLIT TABLET|100 each|1000487| 2,300.00 |||||||||| 1,495.00 | 1,564.00 | 1,679.00 | 1,679.00 | 1,794.00 | 1,380.00 | 1,495.00 | 1,725.00 | 1,955.00 | 2,042.40 | 2,024.00 | 1,725.00 | 1,955.00 ||| |CARBIDOPA-LEVODOPA 6.25-25 MG PO SPLIT TABLET|1 split tablet (1 each)|1000488| 11.80 |||||||||| 7.67 | 8.02 | 8.61 | 8.61 | 9.20 | 7.08 | 7.67 | 8.85 | 10.03 | 10.48 | 10.38 | 8.85 | 10.03 ||| |CLOZAPINE 12.5 MG PO SPLIT TABLET|100 each|1000489| 157.60 |||||||||| 102.44 | 107.17 | 115.05 | 115.05 | 122.93 | 94.56 | 102.44 | 118.20 | 133.96 | 139.95 | 138.69 | 118.20 | 133.96 ||| |AMILORIDE HCL 2.5 MG PO SPLIT TABLET|100 each|1000490| 167.35 |||||||||| 108.78 | 113.80 | 122.17 | 122.17 | 130.53 | 100.41 | 108.78 | 125.51 | 142.25 | 148.61 | 147.27 | 125.51 | 142.25 ||| |MELOXICAM 3.75 MG PO SPLIT TABLET|500 each|1000491| 63.55 |||||||||| 41.31 | 43.21 | 46.39 | 46.39 | 49.57 | 38.13 | 41.31 | 47.66 | 54.02 | 56.43 | 55.92 | 47.66 | 54.02 ||| |PINDOLOL 5 MG PO SPLIT TABLET|100 each|1000492| 320.75 |||||||||| 208.49 | 218.11 | 234.15 | 234.15 | 250.19 | 192.45 | 208.49 | 240.56 | 272.64 | 284.83 | 282.26 | 240.56 | 272.64 ||| |PINDOLOL 2.5 MG PO SPLIT TABLET|100 each|1000493| 320.75 |||||||||| 208.49 | 218.11 | 234.15 | 234.15 | 250.19 | 192.45 | 208.49 | 240.56 | 272.64 | 284.83 | 282.26 | 240.56 | 272.64 ||| |LOVASTATIN 10 MG PO SPLIT TABLET|60 each|1000494| 43.70 |||||||||| 28.41 | 29.72 | 31.90 | 31.90 | 34.09 | 26.22 | 28.41 | 32.78 | 37.15 | 38.81 | 38.46 | 32.78 | 37.15 ||| |LOVASTATIN 20 MG PO SPLIT TABLET|60 each|1000495| 43.70 |||||||||| 28.41 | 29.72 | 31.90 | 31.90 | 34.09 | 26.22 | 28.41 | 32.78 | 37.15 | 38.81 | 38.46 | 32.78 | 37.15 ||| |MIRTAZAPINE 3.75 MG PO SPLIT TABLET|100 each|1000496| 71.85 |||||||||| 46.70 | 48.86 | 52.45 | 52.45 | 56.04 | 43.11 | 46.70 | 53.89 | 61.07 | 63.80 | 63.23 | 53.89 | 61.07 ||| |CARBIDOPA-LEVODOPA 5-50 MG PO SPLIT TABLET|1 split tablet (1 each)|1000497| 11.55 |||||||||| 7.51 | 7.85 | 8.43 | 8.43 | 9.01 | 6.93 | 7.51 | 8.66 | 9.82 | 10.26 | 10.16 | 8.66 | 9.82 ||| |ALPRAZOLAM 0.0625 MG PO SPLIT TABLET|100 each|1000498| 23.90 |||||||||| 15.54 | 16.25 | 17.45 | 17.45 | 18.64 | 14.34 | 15.54 | 17.93 | 20.32 | 21.22 | 21.03 | 17.93 | 20.32 ||| |RISPERIDONE 0.125 MG PO SPLIT TABLET|100 each|1000500| 80.35 |||||||||| 52.23 | 54.64 | 58.66 | 58.66 | 62.67 | 48.21 | 52.23 | 60.26 | 68.30 | 71.35 | 70.71 | 60.26 | 68.30 ||| |MELATONIN 0.5 MG PO SPLIT TABLET|180 each|1000502| 24.85 |||||||||| 16.15 | 16.90 | 18.14 | 18.14 | 19.38 | 14.91 | 16.15 | 18.64 | 21.12 | 22.07 | 21.87 | 18.64 | 21.12 ||| |CARISOPRODOL 175 MG PO SPLIT TABLET|100 each|1000503| 37.15 |||||||||| 24.15 | 25.26 | 27.12 | 27.12 | 28.98 | 22.29 | 24.15 | 27.86 | 31.58 | 32.99 | 32.69 | 27.86 | 31.58 ||| |GENTAMICIN SULFATE 10 MG/ML IJ SOLN (PEDS)|2 mL|1000504| 136.95 |||||||||| 89.02 | 93.13 | 99.97 | 99.97 | 106.82 | 82.17 | 89.02 | 102.71 | 116.41 | 121.61 | 120.52 | 102.71 | 116.41 ||| |LIPID SYRINGE (PEDIATRIC)|500 mL|1000505| 162.00 |||||||||| 105.30 | 110.16 | 118.26 | 118.26 | 126.36 | 97.20 | 105.30 | 121.50 | 137.70 | 143.86 | 142.56 | 121.50 | 137.70 ||| |LIPID IVPB (PEDIATRIC)|500 mL|1000506| 162.00 |||||||||| 105.30 | 110.16 | 118.26 | 118.26 | 126.36 | 97.20 | 105.30 | 121.50 | 137.70 | 143.86 | 142.56 | 121.50 | 137.70 ||| |ZONISAMIDE 10 MG/ML ORAL SUSPENSION|100 mL|1000508| 644.80 |||||||||| 419.12 | 438.46 | 470.70 | 470.70 | 502.94 | 386.88 | 419.12 | 483.60 | 548.08 | 572.58 | 567.42 | 483.60 | 548.08 ||| |TRIMETHOPRIM 50 MG PO SPLIT TABLET|100 each|1000509| 86.60 |||||||||| 56.29 | 58.89 | 63.22 | 63.22 | 67.55 | 51.96 | 56.29 | 64.95 | 73.61 | 76.90 | 76.21 | 64.95 | 73.61 ||| |ACETAMINOPHEN 250 MG PO SPLIT TABLET|1000 each|1000510| 35.70 |||||||||| 23.21 | 24.28 | 26.06 | 26.06 | 27.85 | 21.42 | 23.21 | 26.78 | 30.35 | 31.70 | 31.42 | 26.78 | 30.35 ||| |SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG PO SPLIT TABLET|100 each|1000512| 61.45 |||||||||| 39.94 | 41.79 | 44.86 | 44.86 | 47.93 | 36.87 | 39.94 | 46.09 | 52.23 | 54.57 | 54.08 | 46.09 | 52.23 ||| |LIOTHYRONINE SODIUM 12.5 MCG PO SPLIT TABLET|100 each|1000513| 196.60 |||||||||| 127.79 | 133.69 | 143.52 | 143.52 | 153.35 | 117.96 | 127.79 | 147.45 | 167.11 | 174.58 | 173.01 | 147.45 | 167.11 ||| |FINASTERIDE 2.5 MG PO SPLIT TABLET|100 each|1000514| 136.20 |||||||||| 88.53 | 92.62 | 99.43 | 99.43 | 106.24 | 81.72 | 88.53 | 102.15 | 115.77 | 120.95 | 119.86 | 102.15 | 115.77 ||| |LEUCOVORIN CALCIUM 2.5 MG PO SPLIT TABLET|30 each|1000515| 91.60 |||||||||| 59.54 | 62.29 | 66.87 | 66.87 | 71.45 | 54.96 | 59.54 | 68.70 | 77.86 | 81.34 | 80.61 | 68.70 | 77.86 ||| |LITHIUM CARBONATE ER 225 MG PO SPLIT TBCR|100 each|1000517| 111.30 |||||||||| 72.35 | 75.68 | 81.25 | 81.25 | 86.81 | 66.78 | 72.35 | 83.48 | 94.61 | 98.83 | 97.94 | 83.48 | 94.61 ||| |MECLIZINE HCL 6.25 MG PO SPLIT TABLET|100 each|1000522| 75.80 |||||||||| 49.27 | 51.54 | 55.33 | 55.33 | 59.12 | 45.48 | 49.27 | 56.85 | 64.43 | 67.31 | 66.70 | 56.85 | 64.43 ||| |INDOMETHACIN 0.25 MG/ML PO SUSP|10 mL|1000524| 193.75 |||||||||| 125.94 | 131.75 | 141.44 | 141.44 | 151.13 | 116.25 | 125.94 | 145.31 | 164.69 | 172.05 | 170.50 | 145.31 | 164.69 ||| |INDOMETHACIN 2.5 MG/ML PO SUSP|5 mL|1000525| 107.90 |||||||||| 70.14 | 73.37 | 78.77 | 78.77 | 84.16 | 64.74 | 70.14 | 80.93 | 91.72 | 95.82 | 94.95 | 80.93 | 91.72 ||| |TIZANIDINE HCL 1 MG PO SPLIT TABLET|30 each|1000527| 66.60 |||||||||| 43.29 | 45.29 | 48.62 | 48.62 | 51.95 | 39.96 | 43.29 | 49.95 | 56.61 | 59.14 | 58.61 | 49.95 | 56.61 ||| |HYDROXYZINE HCL 5 MG PO SPLIT TABLET|100 each|1000530| 78.10 |||||||||| 50.77 | 53.11 | 57.01 | 57.01 | 60.92 | 46.86 | 50.77 | 58.58 | 66.39 | 69.35 | 68.73 | 58.58 | 66.39 ||| |COLESTIPOL HCL 0.5 G PO SPLIT TABLET|120 each|1000532| 284.10 |||||||||| 184.67 | 193.19 | 207.39 | 207.39 | 221.60 | 170.46 | 184.67 | 213.08 | 241.49 | 252.28 | 250.01 | 213.08 | 241.49 ||| |SODIUM CHLORIDE 0.9 % SOLN FOR PRESSURIZED LINES|500 mL|1000534| 197.00 |||||||||| 128.05 | 133.96 | 143.81 | 143.81 | 153.66 | 118.20 | 128.05 | 147.75 | 167.45 | 174.94 | 173.36 | 147.75 | 167.45 ||| |TADALAFIL 5 MG PO SPLIT TABLET|30 each|1000535| 4,350.50 |||||||||| 2,827.83 | 2,958.34 | 3,175.87 | 3,175.87 | 3,393.39 | 2,610.30 | 2,827.83 | 3,262.88 | 3,697.93 | 3,863.24 | 3,828.44 | 3,262.88 | 3,697.93 ||| |RITONAVIR 50 MG PO SPLIT TABLET|30 each|1000536| 555.90 |||||||||| 361.34 | 378.01 | 405.81 | 405.81 | 433.60 | 333.54 | 361.34 | 416.93 | 472.52 | 493.64 | 489.19 | 416.93 | 472.52 ||| |ENTACAPONE 100 MG PO SPLIT TABLET|100 each|1000538| 678.85 |||||||||| 441.25 | 461.62 | 495.56 | 495.56 | 529.50 | 407.31 | 441.25 | 509.14 | 577.02 | 602.82 | 597.39 | 509.14 | 577.02 ||| |BUMETANIDE 0.5 MG PO SPLIT TABLET|100 each|1000539| 166.95 |||||||||| 108.52 | 113.53 | 121.87 | 121.87 | 130.22 | 100.17 | 108.52 | 125.21 | 141.91 | 148.25 | 146.92 | 125.21 | 141.91 ||| |HALOPERIDOL 0.25 MG PO SPLIT TABLET|1 each|1000543| 11.60 |||||||||| 7.54 | 7.89 | 8.47 | 8.47 | 9.05 | 6.96 | 7.54 | 8.70 | 9.86 | 10.30 | 10.21 | 8.70 | 9.86 ||| |BROMOCRIPTINE MESYLATE 1.25 MG PO SPLIT TABLET|100 each|1000544| 938.15 |||||||||| 609.80 | 637.94 | 684.85 | 684.85 | 731.76 | 562.89 | 609.80 | 703.61 | 797.43 | 833.08 | 825.57 | 703.61 | 797.43 ||| |SOLIFENACIN SUCCINATE 2.5 MG PO SPLIT TABLET|90 each|1000549| 2,422.90 |||||||||| 1,574.89 | 1,647.57 | 1,768.72 | 1,768.72 | 1,889.86 | 1,453.74 | 1,574.89 | 1,817.18 | 2,059.47 | 2,151.54 | 2,132.15 | 1,817.18 | 2,059.47 ||| |TIMOLOL MALEATE 5 MG PO SPLIT TABLET|100 each|1000550| 304.80 |||||||||| 198.12 | 207.26 | 222.50 | 222.50 | 237.74 | 182.88 | 198.12 | 228.60 | 259.08 | 270.66 | 268.22 | 228.60 | 259.08 ||| |SILDENAFIL CITRATE 2.5 MG/ML PO SUSP|300 mL|1000553| 1,890.40 |||||||||| 1,228.76 | 1,285.47 | 1,379.99 | 1,379.99 | 1,474.51 | 1,134.24 | 1,228.76 | 1,417.80 | 1,606.84 | 1,678.68 | 1,663.55 | 1,417.80 | 1,606.84 ||| |LAMOTRIGINE 12.5 MG PO SPLIT TABLET|1 each|1000554| 11.25 |||||||||| 7.31 | 7.65 | 8.21 | 8.21 | 8.78 | 6.75 | 7.31 | 8.44 | 9.56 | 9.99 | 9.90 | 8.44 | 9.56 ||| |GLUTAMINE 500 MG/ML ORAL SUSPENSION|50 mL|1000555| 32.10 |||||||||| 20.87 | 21.83 | 23.43 | 23.43 | 25.04 | 19.26 | 20.87 | 24.08 | 27.29 | 28.50 | 28.25 | 24.08 | 27.29 ||| |PHYTONADIONE 1.25 MG PO SPLIT TABLET|100 each|1000556| 1,766.50 |||||||||| 1,148.23 | 1,201.22 | 1,289.55 | 1,289.55 | 1,377.87 | 1,059.90 | 1,148.23 | 1,324.88 | 1,501.53 | 1,568.65 | 1,554.52 | 1,324.88 | 1,501.53 ||| |BUPROPION HCL 50 MG PO SPLIT TABLET|100 each|1000557| 361.85 |||||||||| 235.20 | 246.06 | 264.15 | 264.15 | 282.24 | 217.11 | 235.20 | 271.39 | 307.57 | 321.32 | 318.43 | 271.39 | 307.57 ||| |ALPHA1-PROTEINASE INHIBITOR 1000 MG IV SOLR (ARALAST)|1000 mg|1000563| 831.20 |||||||||| 540.28 | 565.22 | 606.78 | 606.78 | 648.34 | 498.72 | 540.28 | 623.40 | 706.52 | 738.11 | 731.46 | 623.40 | 706.52 ||| |ANASTROZOLE 0.5 MG PO SPLIT TABLET|30 each|1000567| 60.25 |||||||||| 39.16 | 40.97 | 43.98 | 43.98 | 47.00 | 36.15 | 39.16 | 45.19 | 51.21 | 53.50 | 53.02 | 45.19 | 51.21 ||| |BENAZEPRIL 2.5 MG PO SPLIT TABLET|100 each|1000569| 166.10 |||||||||| 107.97 | 112.95 | 121.25 | 121.25 | 129.56 | 99.66 | 107.97 | 124.58 | 141.19 | 147.50 | 146.17 | 124.58 | 141.19 ||| |METFORMIN HCL 125 MG PO SPLIT TABLET|100 each|1000573| 28.85 |||||||||| 18.75 | 19.62 | 21.06 | 21.06 | 22.50 | 17.31 | 18.75 | 21.64 | 24.52 | 25.62 | 25.39 | 21.64 | 24.52 ||| |FLUCONAZOLE IV CUSTOM DOSE|100 mL|1000574| 162.40 |||||||||| 105.56 | 110.43 | 118.55 | 118.55 | 126.67 | 97.44 | 105.56 | 121.80 | 138.04 | 144.21 | 142.91 | 121.80 | 138.04 ||| |VERAPAMIL HCL ER 60 MG PO SPLIT TABLET|1 each|1000575| 11.45 |||||||||| 7.44 | 7.79 | 8.36 | 8.36 | 8.93 | 6.87 | 7.44 | 8.59 | 9.73 | 10.17 | 10.08 | 8.59 | 9.73 ||| |FAMOTIDINE IV SYRINGE (PEDS)|50 mL|1000576| 138.45 |||||||||| 89.99 | 94.15 | 101.07 | 101.07 | 107.99 | 83.07 | 89.99 | 103.84 | 117.68 | 122.94 | 121.84 | 103.84 | 117.68 ||| |DEXMEDETOMIDINE 4 MCG/ML INFUSION SYRINGE - PEDS 20 ML SYRINGE|20 mL|1000580| 286.80 |||||||||| 186.42 | 195.02 | 209.36 | 209.36 | 223.70 | 172.08 | 186.42 | 215.10 | 243.78 | 254.68 | 252.38 | 215.10 | 243.78 ||| |DEXMEDETOMIDINE 4 MCG/ML INFUSION SYRINGE - PEDS 40 ML SYRINGE|40 mL|1000582| 303.60 |||||||||| 197.34 | 206.45 | 221.63 | 221.63 | 236.81 | 182.16 | 197.34 | 227.70 | 258.06 | 269.60 | 267.17 | 227.70 | 258.06 ||| |MERCAPTOPURINE 12.5 MG PO SPLIT TABLET|25 each|1000583| 186.55 |||||||||| 121.26 | 126.85 | 136.18 | 136.18 | 145.51 | 111.93 | 121.26 | 139.91 | 158.57 | 165.66 | 164.16 | 139.91 | 158.57 ||| |BOTULISM IMMUNE GLOBULIN (HUMAN) 100 MG SOLR|100 mg|1000593| 46,534.45 |||||||||| 30,247.39 | 31,643.43 | 33,970.15 | 33,970.15 | 36,296.87 | 27,920.67 | 30,247.39 | 34,900.84 | 39,554.28 | 41,322.59 | 40,950.32 | 34,900.84 | 39,554.28 ||| |TRIHEXYPHENIDYL HCL 2.5 MG PO SPLIT TABLET|100 each|1000594| 85.15 |||||||||| 55.35 | 57.90 | 62.16 | 62.16 | 66.42 | 51.09 | 55.35 | 63.86 | 72.38 | 75.61 | 74.93 | 63.86 | 72.38 ||| |PRAMIPEXOLE DIHYDROCHLORIDE 0.0625 MG PO SPLIT TABLET|90 each|1000595| 49.50 |||||||||| 32.18 | 33.66 | 36.14 | 36.14 | 38.61 | 29.70 | 32.18 | 37.13 | 42.08 | 43.96 | 43.56 | 37.13 | 42.08 ||| |VANCOMYCIN IN NS 10 MG/ML FOR INTRAOCULAR INJECTION - SDS|1 mL|1000596| 130.15 |||||||||| 84.60 | 88.50 | 95.01 | 95.01 | 101.52 | 78.09 | 84.60 | 97.61 | 110.63 | 115.57 | 114.53 | 97.61 | 110.63 ||| |HALOPERIDOL 0.125 MG PO SPLIT TABLET|1 each|1000597| 11.60 |||||||||| 7.54 | 7.89 | 8.47 | 8.47 | 9.05 | 6.96 | 7.54 | 8.70 | 9.86 | 10.30 | 10.21 | 8.70 | 9.86 ||| |DILTIAZEM 12 MG/ML SUSPENSION|120 mL|1000598| 23.35 |||||||||| 15.18 | 15.88 | 17.05 | 17.05 | 18.21 | 14.01 | 15.18 | 17.51 | 19.85 | 20.73 | 20.55 | 17.51 | 19.85 ||| |SODIUM CHLORIDE 3 % IV BOLUS|500 mL|1000599| 275.50 |||||||||| 179.08 | 187.34 | 201.12 | 201.12 | 214.89 | 165.30 | 179.08 | 206.63 | 234.18 | 244.64 | 242.44 | 206.63 | 234.18 ||| |METHOTREXATE 2 MG/ML ORAL SOLUTION|25 mL|1000600| 155.70 |||||||||| 101.21 | 105.88 | 113.66 | 113.66 | 121.45 | 93.42 | 101.21 | 116.78 | 132.35 | 138.26 | 137.02 | 116.78 | 132.35 ||| |VORICONAZOLE 100 MG PO SPLIT TABLET|30 each|1000602| 1,303.45 |||||||||| 847.24 | 886.35 | 951.52 | 951.52 | 1,016.69 | 782.07 | 847.24 | 977.59 | 1,107.93 | 1,157.46 | 1,147.04 | 977.59 | 1,107.93 ||| |CLORAZEPATE DIPOTASSIUM 1.875 MG PO SPLIT TABLET|100 each|1000603| 311.40 |||||||||| 202.41 | 211.75 | 227.32 | 227.32 | 242.89 | 186.84 | 202.41 | 233.55 | 264.69 | 276.52 | 274.03 | 233.55 | 264.69 ||| |METHENAMINE HIPPURATE 0.5 G PO SPLIT TABLET|100 each|1000605| 383.85 |||||||||| 249.50 | 261.02 | 280.21 | 280.21 | 299.40 | 230.31 | 249.50 | 287.89 | 326.27 | 340.86 | 337.79 | 287.89 | 326.27 ||| |CARBAMAZEPINE 50 MG PO CHEW SPLIT TABLET|100 each|1000606| 128.30 |||||||||| 83.40 | 87.24 | 93.66 | 93.66 | 100.07 | 76.98 | 83.40 | 96.23 | 109.06 | 113.93 | 112.90 | 96.23 | 109.06 ||| |SUCRALFATE 0.5 G PO SPLIT TABLET|100 each|1000607| 73.10 |||||||||| 47.52 | 49.71 | 53.36 | 53.36 | 57.02 | 43.86 | 47.52 | 54.83 | 62.14 | 64.91 | 64.33 | 54.83 | 62.14 ||| |SILDENAFIL CITRATE 10 MG PO SPLIT TABLET|90 each|1000608| 9,370.00 |||||||||| 6,090.50 | 6,371.60 | 6,840.10 | 6,840.10 | 7,308.60 | 5,622.00 | 6,090.50 | 7,027.50 | 7,964.50 | 8,320.56 | 8,245.60 | 7,027.50 | 7,964.50 ||| |SPIRONOLACTONE 6.25 MG PO SPLIT TABLET|500 each|1000609| 188.10 |||||||||| 122.27 | 127.91 | 137.31 | 137.31 | 146.72 | 112.86 | 122.27 | 141.08 | 159.89 | 167.03 | 165.53 | 141.08 | 159.89 ||| |ALLOPURINOL 20 MG/ML SUSPENSION|120 mL|1000610| 17.05 |||||||||| 11.08 | 11.59 | 12.45 | 12.45 | 13.30 | 10.23 | 11.08 | 12.79 | 14.49 | 15.14 | 15.00 | 12.79 | 14.49 ||| |MEMANTINE HCL 2.5 MG PO SPLIT TABLET|100 each|1000611| 1,560.75 |||||||||| 1,014.49 | 1,061.31 | 1,139.35 | 1,139.35 | 1,217.39 | 936.45 | 1,014.49 | 1,170.56 | 1,326.64 | 1,385.95 | 1,373.46 | 1,170.56 | 1,326.64 ||| |VALACYCLOVIR 50 MG/ML SUSPENSION|180 mL|1000612| 1,143.05 |||||||||| 742.98 | 777.27 | 834.43 | 834.43 | 891.58 | 685.83 | 742.98 | 857.29 | 971.59 | 1,015.03 | 1,005.88 | 857.29 | 971.59 ||| |FENTANYL 50 MCG/ML INFUSION SYRINGE - PEDS 20 ML SYRINGE|20 mL|1000616| 68.95 |||||||||| 44.82 | 46.89 | 50.33 | 50.33 | 53.78 | 41.37 | 44.82 | 51.71 | 58.61 | 61.23 | 60.68 | 51.71 | 58.61 ||| |FENTANYL 50 MCG/ML INFUSION SYRINGE - PEDS 40 ML SYRINGE|40 mL|1000618| 91.85 |||||||||| 59.70 | 62.46 | 67.05 | 67.05 | 71.64 | 55.11 | 59.70 | 68.89 | 78.07 | 81.56 | 80.83 | 68.89 | 78.07 ||| |NIFEDIPINE 4 MG/ML SUSPENSION|15 mL|1000633| 23.30 |||||||||| 15.15 | 15.84 | 17.01 | 17.01 | 18.17 | 13.98 | 15.15 | 17.48 | 19.81 | 20.69 | 20.50 | 17.48 | 19.81 ||| |LEVOTHYROXINE SODIUM 31.25 MCG PO SPLIT TABLET|100 each|1000635| 136.00 |||||||||| 88.40 | 92.48 | 99.28 | 99.28 | 106.08 | 81.60 | 88.40 | 102.00 | 115.60 | 120.77 | 119.68 | 102.00 | 115.60 ||| |HYDROCORTISONE 1.25 MG PO SPLIT TABLET|50 each|1000638| 34.90 |||||||||| 22.69 | 23.73 | 25.48 | 25.48 | 27.22 | 20.94 | 22.69 | 26.18 | 29.67 | 30.99 | 30.71 | 26.18 | 29.67 ||| |LINEZOLID IV SYRINGE (NICU)|300 mL|1000640| 204.35 |||||||||| 132.83 | 138.96 | 149.18 | 149.18 | 159.39 | 122.61 | 132.83 | 153.26 | 173.70 | 181.46 | 179.83 | 153.26 | 173.70 ||| |ERYTHROMYCIN ETHYLSUCCINATE 200 MG SPLIT TABLET|100 each|1000647| 2,549.35 |||||||||| 1,657.08 | 1,733.56 | 1,861.03 | 1,861.03 | 1,988.49 | 1,529.61 | 1,657.08 | 1,912.01 | 2,166.95 | 2,263.82 | 2,243.43 | 1,912.01 | 2,166.95 ||| |FLUDROCORTISONE ACETATE 0.025 MG PO SPLIT TABLET|100 each|1000648| 136.00 |||||||||| 88.40 | 92.48 | 99.28 | 99.28 | 106.08 | 81.60 | 88.40 | 102.00 | 115.60 | 120.77 | 119.68 | 102.00 | 115.60 ||| |BUPIVACAINE (PF) 0.25 % INFUSION (ONE-STEP)|30 mL|1000650| 37.15 |||||||||| 24.15 | 25.26 | 27.12 | 27.12 | 28.98 | 22.29 | 24.15 | 27.86 | 31.58 | 32.99 | 32.69 | 27.86 | 31.58 ||| |MILRINONE IV BOLUS|100 mL|1000651| 285.20 |||||||||| 185.38 | 193.94 | 208.20 | 208.20 | 222.46 | 171.12 | 185.38 | 213.90 | 242.42 | 253.26 | 250.98 | 213.90 | 242.42 ||| |LEVOFLOXACIN 0.25 MG/ML PO SOLN (FOR DESENSITIZATION)|10 mL|1000652| 45.20 |||||||||| 29.38 | 30.74 | 33.00 | 33.00 | 35.26 | 27.12 | 29.38 | 33.90 | 38.42 | 40.14 | 39.78 | 33.90 | 38.42 ||| |LEVOFLOXACIN 0.025 MG/ML PO SOLN (FOR DESENSITIZATION)|10 mL|1000653| 45.20 |||||||||| 29.38 | 30.74 | 33.00 | 33.00 | 35.26 | 27.12 | 29.38 | 33.90 | 38.42 | 40.14 | 39.78 | 33.90 | 38.42 ||| |GUAIFENESIN-DM 100-10 MG/5ML PO SYRP BULK|473 mL|1000654| 22.90 |||||||||| 14.89 | 15.57 | 16.72 | 16.72 | 17.86 | 13.74 | 14.89 | 17.18 | 19.47 | 20.34 | 20.15 | 17.18 | 19.47 ||| |APREPITANT 20 MG/ML SUSPENSION|25 mL|1000655| 1,890.70 |||||||||| 1,228.96 | 1,285.68 | 1,380.21 | 1,380.21 | 1,474.75 | 1,134.42 | 1,228.96 | 1,418.03 | 1,607.10 | 1,678.94 | 1,663.82 | 1,418.03 | 1,607.10 ||| |VALACYCLOVIR HCL 250 MG PO SPLIT TABLET|90 each|1000660| 174.10 |||||||||| 113.17 | 118.39 | 127.09 | 127.09 | 135.80 | 104.46 | 113.17 | 130.58 | 147.99 | 154.60 | 153.21 | 130.58 | 147.99 ||| |MIDAZOLAM 0.5 MG/ML INFUSION SYRINGE - PEDS 20 ML SYRINGE|20 mL|1000661| 49.20 |||||||||| 31.98 | 33.46 | 35.92 | 35.92 | 38.38 | 29.52 | 31.98 | 36.90 | 41.82 | 43.69 | 43.30 | 36.90 | 41.82 ||| |MIDAZOLAM 1 MG/ML INFUSION SYRINGE - PEDS 30 ML SYRINGE|30 mL|1000662| 55.60 |||||||||| 36.14 | 37.81 | 40.59 | 40.59 | 43.37 | 33.36 | 36.14 | 41.70 | 47.26 | 49.37 | 48.93 | 41.70 | 47.26 ||| |MIDAZOLAM 1 MG/ML INFUSION SYRINGE - PEDS 40 ML SYRINGE|40 mL|1000663| 58.80 |||||||||| 38.22 | 39.98 | 42.92 | 42.92 | 45.86 | 35.28 | 38.22 | 44.10 | 49.98 | 52.21 | 51.74 | 44.10 | 49.98 ||| |MIDAZOLAM 1 MG/ML INFUSION BAG - PEDS 100 ML BAG|100 mL|1000664| 107.55 |||||||||| 69.91 | 73.13 | 78.51 | 78.51 | 83.89 | 64.53 | 69.91 | 80.66 | 91.42 | 95.50 | 94.64 | 80.66 | 91.42 ||| |MEXILETINE 10 MG/ML SUSPENSION|120 mL|1000669| 25.50 |||||||||| 16.58 | 17.34 | 18.62 | 18.62 | 19.89 | 15.30 | 16.58 | 19.13 | 21.68 | 22.64 | 22.44 | 19.13 | 21.68 ||| |LIDOCAINE 1% IV INFUSION (ONE-STEP)|20 mL|1000670| 39.60 |||||||||| 25.74 | 26.93 | 28.91 | 28.91 | 30.89 | 23.76 | 25.74 | 29.70 | 33.66 | 35.16 | 34.85 | 29.70 | 33.66 ||| |CENTRUM PO SPLIT TABLET|1 halftab (1 each)|1000672| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |PYRIDOXINE HCL 12.5 MG PO SPLIT TABLET|100 each|1000675| 31.95 |||||||||| 20.77 | 21.73 | 23.32 | 23.32 | 24.92 | 19.17 | 20.77 | 23.96 | 27.16 | 28.37 | 28.12 | 23.96 | 27.16 ||| |ISONIAZID 50 MG PO SPLIT TABLET|100 each|1000676| 46.50 |||||||||| 30.23 | 31.62 | 33.95 | 33.95 | 36.27 | 27.90 | 30.23 | 34.88 | 39.53 | 41.29 | 40.92 | 34.88 | 39.53 ||| |GEMFIBROZIL 150 MG PO SPLIT TABLET|60 each|1000677| 32.95 |||||||||| 21.42 | 22.41 | 24.05 | 24.05 | 25.70 | 19.77 | 21.42 | 24.71 | 28.01 | 29.26 | 29.00 | 24.71 | 28.01 ||| |CANAGLIFLOZIN 50 MG PO SPLIT TABLET|90 each|1000679| 3,251.55 |||||||||| 2,113.51 | 2,211.05 | 2,373.63 | 2,373.63 | 2,536.21 | 1,950.93 | 2,113.51 | 2,438.66 | 2,763.82 | 2,887.38 | 2,861.36 | 2,438.66 | 2,763.82 ||| |CILOSTAZOL 25 MG PO SPLIT TABLET|60 each|1000681| 61.65 |||||||||| 40.07 | 41.92 | 45.00 | 45.00 | 48.09 | 36.99 | 40.07 | 46.24 | 52.40 | 54.75 | 54.25 | 46.24 | 52.40 ||| |DESMOPRESSIN ACETATE 0.05 MG PO SPLIT TABLET|30 each|1000682| 140.30 |||||||||| 91.20 | 95.40 | 102.42 | 102.42 | 109.43 | 84.18 | 91.20 | 105.23 | 119.26 | 124.59 | 123.46 | 105.23 | 119.26 ||| |LEVOTHYROXINE SODIUM 18.75 MCG PO SPLIT TABLET|90 each|1000683| 264.75 |||||||||| 172.09 | 180.03 | 193.27 | 193.27 | 206.51 | 158.85 | 172.09 | 198.56 | 225.04 | 235.10 | 232.98 | 198.56 | 225.04 ||| |GLYCOPYRROLATE 0.5 MG PO SPLIT TABLET|100 each|1000686| 112.10 |||||||||| 72.87 | 76.23 | 81.83 | 81.83 | 87.44 | 67.26 | 72.87 | 84.08 | 95.29 | 99.54 | 98.65 | 84.08 | 95.29 ||| |DOCUSATE SODIUM 50 MG/5ML PO LIQD BULK|473 mL|1000697| 51.50 |||||||||| 33.48 | 35.02 | 37.60 | 37.60 | 40.17 | 30.90 | 33.48 | 38.63 | 43.78 | 45.73 | 45.32 | 38.63 | 43.78 ||| |THEOPHYLLINE ER 100 MG PO SPLIT TABLET|1 each|1000700| 11.90 |||||||||| 7.74 | 8.09 | 8.69 | 8.69 | 9.28 | 7.14 | 7.74 | 8.93 | 10.12 | 10.57 | 10.47 | 8.93 | 10.12 ||| |CLONIDINE 20 MCG/ML LIQUID|30 mL|1000701| 14.45 |||||||||| 9.39 | 9.83 | 10.55 | 10.55 | 11.27 | 8.67 | 9.39 | 10.84 | 12.28 | 12.83 | 12.72 | 10.84 | 12.28 ||| |CETIRIZINE 2.5 MG PO SPLIT TABLET|30 each|1000702| 32.90 |||||||||| 21.39 | 22.37 | 24.02 | 24.02 | 25.66 | 19.74 | 21.39 | 24.68 | 27.97 | 29.22 | 28.95 | 24.68 | 27.97 ||| |TELMISARTAN 20 MG PO SPLIT TABLET|1 each|1000703| 25.05 |||||||||| 16.28 | 17.03 | 18.29 | 18.29 | 19.54 | 15.03 | 16.28 | 18.79 | 21.29 | 22.24 | 22.04 | 18.79 | 21.29 ||| |POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN BULK|473 mL|1000704| 405.95 |||||||||| 263.87 | 276.05 | 296.34 | 296.34 | 316.64 | 243.57 | 263.87 | 304.46 | 345.06 | 360.48 | 357.24 | 304.46 | 345.06 ||| |BEVACIZUMAB 100 MG/4ML SOLN (NICU)|4 mL|1000705| 1,654.45 |||||||||| 1,075.39 | 1,125.03 | 1,207.75 | 1,207.75 | 1,290.47 | 992.67 | 1,075.39 | 1,240.84 | 1,406.28 | 1,469.15 | 1,455.92 | 1,240.84 | 1,406.28 ||| |MERCAPTOPURINE 50 MG/ML SUSPENSION|30 mL|1000707| 185.85 |||||||||| 120.80 | 126.38 | 135.67 | 135.67 | 144.96 | 111.51 | 120.80 | 139.39 | 157.97 | 165.03 | 163.55 | 139.39 | 157.97 ||| |ACETAZOLAMIDE 25 MG/ML SUSPENSION|120 mL|1000708| 64.10 |||||||||| 41.67 | 43.59 | 46.79 | 46.79 | 50.00 | 38.46 | 41.67 | 48.08 | 54.49 | 56.92 | 56.41 | 48.08 | 54.49 ||| |DOXYCYCLINE HYCLATE 100 MG IV SOLR (NO RECON)|100 mg (1 each)|1000709| 166.85 |||||||||| 108.45 | 113.46 | 121.80 | 121.80 | 130.14 | 100.11 | 108.45 | 125.14 | 141.82 | 148.16 | 146.83 | 125.14 | 141.82 ||| |DOXYCYCLINE HYCLATE 100 MG IV SOLR (NO RECON)|200 mg (2 each)|1000709| 203.65 |||||||||| 132.37 | 138.48 | 148.66 | 148.66 | 158.85 | 122.19 | 132.37 | 152.74 | 173.10 | 180.84 | 179.21 | 152.74 | 173.10 ||| |ALCOHOL 62 % NA SOLN|12 mL|1000710| 78.95 |||||||||| 51.32 | 53.69 | 57.63 | 57.63 | 61.58 | 47.37 | 51.32 | 59.21 | 67.11 | 70.11 | 69.48 | 59.21 | 67.11 ||| |CARBIDOPA-LEVODOPA ER 12.5-50 MG SPLIT TAB CR|1 each|1000711| 11.65 |||||||||| 7.57 | 7.92 | 8.50 | 8.50 | 9.09 | 6.99 | 7.57 | 8.74 | 9.90 | 10.35 | 10.25 | 8.74 | 9.90 ||| |PROMETHAZINE HCL 6.25 MG INJ FOR SDS - FROM 50 MG/ML|.125 mL|1000712| 34.45 |||||||||| 22.39 | 23.43 | 25.15 | 25.15 | 26.87 | 20.67 | 22.39 | 25.84 | 29.28 | 30.59 | 30.32 | 25.84 | 29.28 ||| |MEGESTROL ACETATE 10 MG PO SPLIT TABLET|1 each|1000713| 11.80 |||||||||| 7.67 | 8.02 | 8.61 | 8.61 | 9.20 | 7.08 | 7.67 | 8.85 | 10.03 | 10.48 | 10.38 | 8.85 | 10.03 ||| |ZIPRASIDONE 2.5 MG/ML ORAL SOLUTION|60 mL|1000715| 395.70 |||||||||| 257.21 | 269.08 | 288.86 | 288.86 | 308.65 | 237.42 | 257.21 | 296.78 | 336.35 | 351.38 | 348.22 | 296.78 | 336.35 ||| |CHEWABLE VITE/IRON CHILDRENS PO SPLIT CHEW|1 split tablet (1 each)|1000720| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |CANAGLIFLOZIN 25 MG PO SPLIT TABLET|90 each|1000721| 3,251.55 |||||||||| 2,113.51 | 2,211.05 | 2,373.63 | 2,373.63 | 2,536.21 | 1,950.93 | 2,113.51 | 2,438.66 | 2,763.82 | 2,887.38 | 2,861.36 | 2,438.66 | 2,763.82 ||| |CABERGOLINE 0.25 MG PO SPLIT TABLET|1 each|1000722| 29.15 |||||||||| 18.95 | 19.82 | 21.28 | 21.28 | 22.74 | 17.49 | 18.95 | 21.86 | 24.78 | 25.89 | 25.65 | 21.86 | 24.78 ||| |LINEZOLID 300 MG PO SPLIT TABLET|30 each|1000727| 406.10 |||||||||| 263.97 | 276.15 | 296.45 | 296.45 | 316.76 | 243.66 | 263.97 | 304.58 | 345.19 | 360.62 | 357.37 | 304.58 | 345.19 ||| |DAPAGLIFLOZIN PROPANEDIOL 5 MG PO SPLIT TABLET|30 each|1000732| 1,096.00 |||||||||| 712.40 | 745.28 | 800.08 | 800.08 | 854.88 | 657.60 | 712.40 | 822.00 | 931.60 | 973.25 | 964.48 | 822.00 | 931.60 ||| |MEGESTROL ACETATE 40 MG/ML PO SUSP 10ML CUP|10 mL|1000735| 24.35 |||||||||| 15.83 | 16.56 | 17.78 | 17.78 | 18.99 | 14.61 | 15.83 | 18.26 | 20.70 | 21.62 | 21.43 | 18.26 | 20.70 ||| |NALOXONE HCL 2 MG/2ML ORAL SOLN|2 mL|1000738| 96.15 |||||||||| 62.50 | 65.38 | 70.19 | 70.19 | 75.00 | 57.69 | 62.50 | 72.11 | 81.73 | 85.38 | 84.61 | 72.11 | 81.73 ||| |ZAFIRLUKAST 10 MG PO SPLIT TABLET|30 each|1000739| 172.25 |||||||||| 111.96 | 117.13 | 125.74 | 125.74 | 134.36 | 103.35 | 111.96 | 129.19 | 146.41 | 152.96 | 151.58 | 129.19 | 146.41 ||| |CANGRELOR 200 MCG/ML BOLUS|1 each|1000740| 1,538.85 |||||||||| 1,000.25 | 1,046.42 | 1,123.36 | 1,123.36 | 1,200.30 | 923.31 | 1,000.25 | 1,154.14 | 1,308.02 | 1,366.50 | 1,354.19 | 1,154.14 | 1,308.02 ||| |ILOPERIDONE 5 MG PO SPLIT TABLET|60 each|1000741| 5,222.40 |||||||||| 3,394.56 | 3,551.23 | 3,812.35 | 3,812.35 | 4,073.47 | 3,133.44 | 3,394.56 | 3,916.80 | 4,439.04 | 4,637.49 | 4,595.71 | 3,916.80 | 4,439.04 ||| |PAROXETINE HCL 5 MG PO SPLIT TABLET|30 each|1000743| 25.70 |||||||||| 16.71 | 17.48 | 18.76 | 18.76 | 20.05 | 15.42 | 16.71 | 19.28 | 21.85 | 22.82 | 22.62 | 19.28 | 21.85 ||| |ALBUMIN HUMAN 25 % IV SYRINGE (NICU)|50 mL|1000748| 203.45 |||||||||| 132.24 | 138.35 | 148.52 | 148.52 | 158.69 | 122.07 | 132.24 | 152.59 | 172.93 | 180.66 | 179.04 | 152.59 | 172.93 ||| |SENNOSIDES 8.8 MG/5 ML PO SYRP|5 mL|1000749| 11.45 |||||||||| 7.44 | 7.79 | 8.36 | 8.36 | 8.93 | 6.87 | 7.44 | 8.59 | 9.73 | 10.17 | 10.08 | 8.59 | 9.73 ||| |THROMBIN 5000 UNITS/50 ML NS SYRINGE FOR CATH LAB/IR|1 each|1000750| 169.10 |||||||||| 109.92 | 114.99 | 123.44 | 123.44 | 131.90 | 101.46 | 109.92 | 126.83 | 143.74 | 150.16 | 148.81 | 126.83 | 143.74 ||| |GLYCOPYRROLATE 0.2 MG/ML IJ SOLN (NICU)|1 mL|1000751| 47.20 |||||||||| 30.68 | 32.10 | 34.46 | 34.46 | 36.82 | 28.32 | 30.68 | 35.40 | 40.12 | 41.91 | 41.54 | 35.40 | 40.12 ||| |NITROPRUSSIDE SODIUM-NACL 50-0.9 MB/100ML-% IV SOLN (NIC)|100 mL|1000752| 325.00 |||||||||| 211.25 | 221.00 | 237.25 | 237.25 | 253.50 | 195.00 | 211.25 | 243.75 | 276.25 | 288.60 | 286.00 | 243.75 | 276.25 ||| |HYDROXYCHLOROQUINE SULFATE 25 MG/ML SUSPENSION|120 mL|1000753| 57.65 |||||||||| 37.47 | 39.20 | 42.08 | 42.08 | 44.97 | 34.59 | 37.47 | 43.24 | 49.00 | 51.19 | 50.73 | 43.24 | 49.00 ||| |OXYTOCIN 30 UNITS IN NS 500 ML OMNICELL|1000 mL|1000759| 1,244.00 |||||||||| 808.60 | 845.92 | 908.12 | 908.12 | 970.32 | 746.40 | 808.60 | 933.00 | 1,057.40 | 1,104.67 | 1,094.72 | 933.00 | 1,057.40 ||| |TEMSIROLIMUS 10 MG/ML CMPD IV SOLN|3 mL|1000760| 2,549.95 |||||||||| 1,657.47 | 1,733.97 | 1,861.46 | 1,861.46 | 1,988.96 | 1,529.97 | 1,657.47 | 1,912.46 | 2,167.46 | 2,264.36 | 2,243.96 | 1,912.46 | 2,167.46 ||| |HYDRALAZINE 4 MG/ML SUSPENSION|100 mL|1000761| 13.30 |||||||||| 8.65 | 9.04 | 9.71 | 9.71 | 10.37 | 7.98 | 8.65 | 9.98 | 11.31 | 11.81 | 11.70 | 9.98 | 11.31 ||| |HYDROCORTISONE 2 MG/ML SUSPENSION|50 mL|1000762| 12.05 |||||||||| 7.83 | 8.19 | 8.80 | 8.80 | 9.40 | 7.23 | 7.83 | 9.04 | 10.24 | 10.70 | 10.60 | 9.04 | 10.24 ||| |LABETALOL 40 MG/ML SUSPENSION|120 mL|1000763| 769.40 |||||||||| 500.11 | 523.19 | 561.66 | 561.66 | 600.13 | 461.64 | 500.11 | 577.05 | 653.99 | 683.23 | 677.07 | 577.05 | 653.99 ||| |RIFAMPIN 25 MG/ML SUSPENSION|120 mL|1000764| 48.20 |||||||||| 31.33 | 32.78 | 35.19 | 35.19 | 37.60 | 28.92 | 31.33 | 36.15 | 40.97 | 42.80 | 42.42 | 36.15 | 40.97 ||| |TACROLIMUS 1 MG/ML SUSPENSION|30 mL|1000765| 176.65 |||||||||| 114.82 | 120.12 | 128.95 | 128.95 | 137.79 | 105.99 | 114.82 | 132.49 | 150.15 | 156.87 | 155.45 | 132.49 | 150.15 ||| |URSODIOL 60 MG/ML SYRUP|60 mL|1000766| 69.30 |||||||||| 45.05 | 47.12 | 50.59 | 50.59 | 54.05 | 41.58 | 45.05 | 51.98 | 58.91 | 61.54 | 60.98 | 51.98 | 58.91 ||| |AZATHIOPRINE 50 MG/ML SUSPENSION|120 mL|1000767| 160.60 |||||||||| 104.39 | 109.21 | 117.24 | 117.24 | 125.27 | 96.36 | 104.39 | 120.45 | 136.51 | 142.61 | 141.33 | 120.45 | 136.51 ||| |IMIPRAMINE HCL 12.5 MG PO SPLIT TABLET|100 each|1000768| 86.40 |||||||||| 56.16 | 58.75 | 63.07 | 63.07 | 67.39 | 51.84 | 56.16 | 64.80 | 73.44 | 76.72 | 76.03 | 64.80 | 73.44 ||| |SACUBITRIL-VALSARTAN 12-13 MG PO SPLIT TAB|60 each|1000769| 1,152.90 |||||||||| 749.39 | 783.97 | 841.62 | 841.62 | 899.26 | 691.74 | 749.39 | 864.68 | 979.97 | 1,023.78 | 1,014.55 | 864.68 | 979.97 ||| |PILOCARPINE HCL 2.5 MG PO SPLIT TABLET|.5 each|1000772| 12.30 |||||||||| 8.00 | 8.36 | 8.98 | 8.98 | 9.59 | 7.38 | 8.00 | 9.23 | 10.46 | 10.92 | 10.82 | 9.23 | 10.46 ||| |PRISMASOL BGK 2/0 32-2 MEQ/L IV SOLN (WHITE SCALE)|5000 mL|1000773| 252.75 |||||||||| 164.29 | 171.87 | 184.51 | 184.51 | 197.15 | 151.65 | 164.29 | 189.56 | 214.84 | 224.44 | 222.42 | 189.56 | 214.84 ||| |BAG BALM SKIN MOISTURIZER EX OINT|113.5 g|1000777| 49.00 |||||||||| 31.85 | 33.32 | 35.77 | 35.77 | 38.22 | 29.40 | 31.85 | 36.75 | 41.65 | 43.51 | 43.12 | 36.75 | 41.65 ||| |HYDROCORTISONE 1 MG/ML ORAL SOLUTION FOR NICU|25 mL|1000779| 12.05 |||||||||| 7.83 | 8.19 | 8.80 | 8.80 | 9.40 | 7.23 | 7.83 | 9.04 | 10.24 | 10.70 | 10.60 | 9.04 | 10.24 ||| |LURASIDONE HCL 10 MG PO SPLIT TABLET|1 each|1000781| 110.85 |||||||||| 72.05 | 75.38 | 80.92 | 80.92 | 86.46 | 66.51 | 72.05 | 83.14 | 94.22 | 98.43 | 97.55 | 83.14 | 94.22 ||| |IMIPRAMINE HCL 5 MG PO SPLIT TABLET|100 each|1000782| 59.40 |||||||||| 38.61 | 40.39 | 43.36 | 43.36 | 46.33 | 35.64 | 38.61 | 44.55 | 50.49 | 52.75 | 52.27 | 44.55 | 50.49 ||| |OXYCODONE 0.01 MG/ML PO SOLN (FOR DESENSITIZATION)|10 mL|1000783| 75.90 |||||||||| 49.34 | 51.61 | 55.41 | 55.41 | 59.20 | 45.54 | 49.34 | 56.93 | 64.52 | 67.40 | 66.79 | 56.93 | 64.52 ||| |CARVEDILOL 1.67 MG/ML SUSPENSION|30 mL|1000785| 14.20 |||||||||| 9.23 | 9.66 | 10.37 | 10.37 | 11.08 | 8.52 | 9.23 | 10.65 | 12.07 | 12.61 | 12.50 | 10.65 | 12.07 ||| |CLOBAZAM 1 MG/ML SUSPENSION|50 mL|1000786| 33.65 |||||||||| 21.87 | 22.88 | 24.56 | 24.56 | 26.25 | 20.19 | 21.87 | 25.24 | 28.60 | 29.88 | 29.61 | 25.24 | 28.60 ||| |TERBINAFINE HCL 125 MG PO SPLIT TABLET|1 each|1000788| 11.65 |||||||||| 7.57 | 7.92 | 8.50 | 8.50 | 9.09 | 6.99 | 7.57 | 8.74 | 9.90 | 10.35 | 10.25 | 8.74 | 9.90 ||| |POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN BOLUS|1000 mL|1000789| 197.00 |||||||||| 128.05 | 133.96 | 143.81 | 143.81 | 153.66 | 118.20 | 128.05 | 147.75 | 167.45 | 174.94 | 173.36 | 147.75 | 167.45 ||| |TRIAMTERENE-HCTZ 18.75-12.5 MG PO SPLIT TABLET|1 split tablet (1 each)|1000790| 11.60 |||||||||| 7.54 | 7.89 | 8.47 | 8.47 | 9.05 | 6.96 | 7.54 | 8.70 | 9.86 | 10.30 | 10.21 | 8.70 | 9.86 ||| |BELLADONNA-MORPHINE 15-7.5 MG RE SUPP|7.5 mg (1 each)|1000791| 67.75 |||||||||| 44.04 | 46.07 | 49.46 | 49.46 | 52.85 | 40.65 | 44.04 | 50.81 | 57.59 | 60.16 | 59.62 | 50.81 | 57.59 ||| |CALCIUM POLYCARBOPHIL 312.5 MG PO SPLIT TABLET|20 each|1000792| 13.95 |||||||||| 9.07 | 9.49 | 10.18 | 10.18 | 10.88 | 8.37 | 9.07 | 10.46 | 11.86 | 12.39 | 12.28 | 10.46 | 11.86 ||| |SUFENTANIL-ROPIVACAINE 0.4MCG/ML-0.1% EPIDURAL IN NS 250ML|250 mL|1000794| 329.70 |||||||||| 214.31 | 224.20 | 240.68 | 240.68 | 257.17 | 197.82 | 214.31 | 247.28 | 280.25 | 292.77 | 290.14 | 247.28 | 280.25 ||| |FENTANYL-ROPIVACAINE 3MCG/ML-0.1% EPIDURAL IN NS 250ML|250 mL|1000795| 266.80 |||||||||| 173.42 | 181.42 | 194.76 | 194.76 | 208.10 | 160.08 | 173.42 | 200.10 | 226.78 | 236.92 | 234.78 | 200.10 | 226.78 ||| |BUPIVACAINE IN DEXTROSE 0.64-8.25 % IT SOLN (ONE-STEP)|2.33 mL|1000797| 44.75 |||||||||| 29.09 | 30.43 | 32.67 | 32.67 | 34.91 | 26.85 | 29.09 | 33.56 | 38.04 | 39.74 | 39.38 | 33.56 | 38.04 ||| |BUSPIRONE HCL 5 MG PO SPLIT TABLET|1 each|1000801| 11.20 |||||||||| 7.28 | 7.62 | 8.18 | 8.18 | 8.74 | 6.72 | 7.28 | 8.40 | 9.52 | 9.95 | 9.86 | 8.40 | 9.52 ||| |RIFABUTIN 20 MG/ML SUSPENSION|60 mL|1000803| 291.60 |||||||||| 189.54 | 198.29 | 212.87 | 212.87 | 227.45 | 174.96 | 189.54 | 218.70 | 247.86 | 258.94 | 256.61 | 218.70 | 247.86 ||| |VITAMIN B-1 25 MG PO SPLIT TABLET|100 each|1000804| 13.95 |||||||||| 9.07 | 9.49 | 10.18 | 10.18 | 10.88 | 8.37 | 9.07 | 10.46 | 11.86 | 12.39 | 12.28 | 10.46 | 11.86 ||| |NORMOSOL-R IV SOLN PREMIX CONTINUOUS|1000 mL|1000805| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |PROPYLTHIOURACIL 25 MG PO SPLIT TABLET|100 each|1000806| 177.70 |||||||||| 115.51 | 120.84 | 129.72 | 129.72 | 138.61 | 106.62 | 115.51 | 133.28 | 151.05 | 157.80 | 156.38 | 133.28 | 151.05 ||| |ASPIRIN 162.5 MG PO SPLIT TABLET|100 each|1000807| 26.80 |||||||||| 17.42 | 18.22 | 19.56 | 19.56 | 20.90 | 16.08 | 17.42 | 20.10 | 22.78 | 23.80 | 23.58 | 20.10 | 22.78 ||| |OXYTOCIN 30 UNITS IN 500 ML (ONE-STEP)|500 mL|1000808| 719.00 |||||||||| 467.35 | 488.92 | 524.87 | 524.87 | 560.82 | 431.40 | 467.35 | 539.25 | 611.15 | 638.47 | 632.72 | 539.25 | 611.15 ||| |GUANFACINE HCL 0.25 MG PO SPLIT TABLET|100 each|1000809| 52.35 |||||||||| 34.03 | 35.60 | 38.22 | 38.22 | 40.83 | 31.41 | 34.03 | 39.26 | 44.50 | 46.49 | 46.07 | 39.26 | 44.50 ||| |FLUPHENAZINE HCL 0.5 MG PO SPLIT TABLET|100 each|1000811| 1,454.45 |||||||||| 945.39 | 989.03 | 1,061.75 | 1,061.75 | 1,134.47 | 872.67 | 945.39 | 1,090.84 | 1,236.28 | 1,291.55 | 1,279.92 | 1,090.84 | 1,236.28 ||| |ALTEPLASE 1 MG/ML IV BOLUS|9 mg (0.09 each)|1000816| 1,627.25 |||||||||| 1,057.71 | 1,106.53 | 1,187.89 | 1,187.89 | 1,269.26 | 976.35 | 1,057.71 | 1,220.44 | 1,383.16 | 1,445.00 | 1,431.98 | 1,220.44 | 1,383.16 ||| |DOXYLAMINE SUCCINATE (SLEEP) 12.5 MG PO SPLIT TABLET|32 each|1000817| 24.85 |||||||||| 16.15 | 16.90 | 18.14 | 18.14 | 19.38 | 14.91 | 16.15 | 18.64 | 21.12 | 22.07 | 21.87 | 18.64 | 21.12 ||| |DEXMEDETOMIDINE 4 MCG/ML INFUSION SYRINGE - NICU 3 ML SYRINGE|3 mL|1000818| 272.55 |||||||||| 177.16 | 185.33 | 198.96 | 198.96 | 212.59 | 163.53 | 177.16 | 204.41 | 231.67 | 242.02 | 239.84 | 204.41 | 231.67 ||| |DEXMEDETOMIDINE 4 MCG/ML INFUSION SYRINGE - NICU 10 ML SYRINGE|10 mL|1000819| 278.40 |||||||||| 180.96 | 189.31 | 203.23 | 203.23 | 217.15 | 167.04 | 180.96 | 208.80 | 236.64 | 247.22 | 244.99 | 208.80 | 236.64 ||| |FLUVOXAMINE MALEATE 12.5 MG PO SPLIT TABLET|100 each|1000824| 126.25 |||||||||| 82.06 | 85.85 | 92.16 | 92.16 | 98.48 | 75.75 | 82.06 | 94.69 | 107.31 | 112.11 | 111.10 | 94.69 | 107.31 ||| |OXYTOCIN-LACTATED RINGERS 30 UNIT/500ML IV INFUSION|500 mL|1000825| 211.50 |||||||||| 137.48 | 143.82 | 154.40 | 154.40 | 164.97 | 126.90 | 137.48 | 158.63 | 179.78 | 187.81 | 186.12 | 158.63 | 179.78 ||| |TRAMADOL HCL 12.5 MG PO SPLIT TABLET|300 each|1000826| 61.25 |||||||||| 39.81 | 41.65 | 44.71 | 44.71 | 47.78 | 36.75 | 39.81 | 45.94 | 52.06 | 54.39 | 53.90 | 45.94 | 52.06 ||| |DOXAZOSIN MESYLATE 0.5 MG PO SPLIT TABLET|100 each|1000827| 189.75 |||||||||| 123.34 | 129.03 | 138.52 | 138.52 | 148.01 | 113.85 | 123.34 | 142.31 | 161.29 | 168.50 | 166.98 | 142.31 | 161.29 ||| |MEROPENEM 10 MG/ML OPHTHALMIC SOLUTION|3 mL|1000828| 63.05 |||||||||| 40.98 | 42.87 | 46.03 | 46.03 | 49.18 | 37.83 | 40.98 | 47.29 | 53.59 | 55.99 | 55.48 | 47.29 | 53.59 ||| |ESTROGENS CONJUGATED 0.15 MG PO SPLIT TABLET|100 each|1000829| 1,247.70 |||||||||| 811.01 | 848.44 | 910.82 | 910.82 | 973.21 | 748.62 | 811.01 | 935.78 | 1,060.55 | 1,107.96 | 1,097.98 | 935.78 | 1,060.55 ||| |ACETAMINOPHEN 40 MG PO SPLIT CHEW TABLET|1 each|1000830| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |CAFFEINE CITRATE 60 MG/3ML IV LOADING DOSE|3 mL|1000831| 71.65 |||||||||| 46.57 | 48.72 | 52.30 | 52.30 | 55.89 | 42.99 | 46.57 | 53.74 | 60.90 | 63.63 | 63.05 | 53.74 | 60.90 ||| |PROPOFOL 100 MG/10ML IV BOLUS|10 mL|1000839| 23.25 |||||||||| 15.11 | 15.81 | 16.97 | 16.97 | 18.14 | 13.95 | 15.11 | 17.44 | 19.76 | 20.65 | 20.46 | 17.44 | 19.76 ||| |PROPOFOL 200 MG/20ML IV BOLUS|20 mL|1000840| 38.55 |||||||||| 25.06 | 26.21 | 28.14 | 28.14 | 30.07 | 23.13 | 25.06 | 28.91 | 32.77 | 34.23 | 33.92 | 28.91 | 32.77 ||| |PROPOFOL 500 MG/50ML IV BOLUS|50 mL|1000841| 140.55 |||||||||| 91.36 | 95.57 | 102.60 | 102.60 | 109.63 | 84.33 | 91.36 | 105.41 | 119.47 | 124.81 | 123.68 | 105.41 | 119.47 ||| |PROPOFOL 1000 MG/100ML IV BOLUS|100 mL|1000842| 56.60 |||||||||| 36.79 | 38.49 | 41.32 | 41.32 | 44.15 | 33.96 | 36.79 | 42.45 | 48.11 | 50.26 | 49.81 | 42.45 | 48.11 ||| |EMPAGLIFLOZIN 12.5 MG PO SPLIT TABLET|90 each|1000845| 3,275.65 |||||||||| 2,129.17 | 2,227.44 | 2,391.22 | 2,391.22 | 2,555.01 | 1,965.39 | 2,129.17 | 2,456.74 | 2,784.30 | 2,908.78 | 2,882.57 | 2,456.74 | 2,784.30 ||| |VENLAFAXINE HCL 18.75 MG PO SPLIT TABLET|100 each|1000846| 90.55 |||||||||| 58.86 | 61.57 | 66.10 | 66.10 | 70.63 | 54.33 | 58.86 | 67.91 | 76.97 | 80.41 | 79.68 | 67.91 | 76.97 ||| |BUSPIRONE HCL 3.75 MG PO SPLIT TABLET |1 each|1000847| 11.95 |||||||||| 7.77 | 8.13 | 8.72 | 8.72 | 9.32 | 7.17 | 7.77 | 8.96 | 10.16 | 10.61 | 10.52 | 8.96 | 10.16 ||| |MIDODRINE HCL 1.25 MG PO SPLIT TABLET|100 each|1000848| 130.20 |||||||||| 84.63 | 88.54 | 95.05 | 95.05 | 101.56 | 78.12 | 84.63 | 97.65 | 110.67 | 115.62 | 114.58 | 97.65 | 110.67 ||| |LIDOCAINE VISCOUS HCL 2 % MT SOLN BULK|100 mL|1000849| 54.75 |||||||||| 35.59 | 37.23 | 39.97 | 39.97 | 42.71 | 32.85 | 35.59 | 41.06 | 46.54 | 48.62 | 48.18 | 41.06 | 46.54 ||| |PROMETHAZINE IVPB FOR OMNI|25 mL|1000851| 34.90 |||||||||| 22.69 | 23.73 | 25.48 | 25.48 | 27.22 | 20.94 | 22.69 | 26.18 | 29.67 | 30.99 | 30.71 | 26.18 | 29.67 ||| |LIOTHYRONINE SODIUM 2.5 MCG PO SPLIT TABLET|90 each|1000854| 149.10 |||||||||| 96.92 | 101.39 | 108.84 | 108.84 | 116.30 | 89.46 | 96.92 | 111.83 | 126.74 | 132.40 | 131.21 | 111.83 | 126.74 ||| |CEPHALEXIN SKIN (FULL STRENGTH) 50 MG/ML TEST|1 mL|1000859| 90.50 |||||||||| 58.83 | 61.54 | 66.07 | 66.07 | 70.59 | 54.30 | 58.83 | 67.88 | 76.93 | 80.36 | 79.64 | 67.88 | 76.93 ||| |CEPHALEXIN SKIN (1:10) 5 MG/ML TEST |1 mL|1000860| 90.50 |||||||||| 58.83 | 61.54 | 66.07 | 66.07 | 70.59 | 54.30 | 58.83 | 67.88 | 76.93 | 80.36 | 79.64 | 67.88 | 76.93 ||| |CEPHALEXIN SKIN (1:100) 0.5 MG/ML TEST|1 mL|1000861| 90.50 |||||||||| 58.83 | 61.54 | 66.07 | 66.07 | 70.59 | 54.30 | 58.83 | 67.88 | 76.93 | 80.36 | 79.64 | 67.88 | 76.93 ||| |SUFENTANIL-ROPIVACAINE 0.4MCG/ML-0.1% EPIDURAL IN NS 100ML|100 mL|1000862| 329.70 |||||||||| 214.31 | 224.20 | 240.68 | 240.68 | 257.17 | 197.82 | 214.31 | 247.28 | 280.25 | 292.77 | 290.14 | 247.28 | 280.25 ||| |LEFLUNOMIDE 5 MG PO SPLIT TABLET|30 each|1000868| 333.40 |||||||||| 216.71 | 226.71 | 243.38 | 243.38 | 260.05 | 200.04 | 216.71 | 250.05 | 283.39 | 296.06 | 293.39 | 250.05 | 283.39 ||| |CABAZITAXEL 10 MG/1 ML CMPD IV SOLN|60 mg|1000870| 11,218.10 |||||||||| 7,291.77 | 7,628.31 | 8,189.21 | 8,189.21 | 8,750.12 | 6,730.86 | 7,291.77 | 8,413.58 | 9,535.39 | 9,961.67 | 9,871.93 | 8,413.58 | 9,535.39 ||| |PERPHENAZINE 1 MG PO SPLIT TABLET|100 each|1000872| 348.35 |||||||||| 226.43 | 236.88 | 254.30 | 254.30 | 271.71 | 209.01 | 226.43 | 261.26 | 296.10 | 309.33 | 306.55 | 261.26 | 296.10 ||| |MILNACIPRAN HCL 12.5 MG PO SPLIT TABLET|60 each|1000873| 854.60 |||||||||| 555.49 | 581.13 | 623.86 | 623.86 | 666.59 | 512.76 | 555.49 | 640.95 | 726.41 | 758.88 | 752.05 | 640.95 | 726.41 ||| |CARBIDOPA-LEVODOPA 2.5-25 MG PO SPLIT TABLET|1 split tablet (1 each)|1000876| 11.55 |||||||||| 7.51 | 7.85 | 8.43 | 8.43 | 9.01 | 6.93 | 7.51 | 8.66 | 9.82 | 10.26 | 10.16 | 8.66 | 9.82 ||| |ACETAMINOPHEN 162.5 MG PO SPLIT TABLET|1000 each|1000878| 33.65 |||||||||| 21.87 | 22.88 | 24.56 | 24.56 | 26.25 | 20.19 | 21.87 | 25.24 | 28.60 | 29.88 | 29.61 | 25.24 | 28.60 ||| |THEOPHYLLINE ER 200 MG PO TB24 SPLIT TABLET|1 each|1000879| 13.55 |||||||||| 8.81 | 9.21 | 9.89 | 9.89 | 10.57 | 8.13 | 8.81 | 10.16 | 11.52 | 12.03 | 11.92 | 10.16 | 11.52 ||| |ATENOLOL 6.25 MG PO SPLIT TABLET|100 each|1000880| 58.15 |||||||||| 37.80 | 39.54 | 42.45 | 42.45 | 45.36 | 34.89 | 37.80 | 43.61 | 49.43 | 51.64 | 51.17 | 43.61 | 49.43 ||| |FAMOTIDINE 40 MG/5ML PO SUSR|2.5 mL|10010| 30.80 |||||||||| 20.02 | 20.94 | 22.48 | 22.48 | 24.02 | 18.48 | 20.02 | 23.10 | 26.18 | 27.35 | 27.10 | 23.10 | 26.18 ||| |FAMOTIDINE 20 MG PO TABS|1000 each|10011| 150.75 |||||||||| 97.99 | 102.51 | 110.05 | 110.05 | 117.59 | 90.45 | 97.99 | 113.06 | 128.14 | 133.87 | 132.66 | 113.06 | 128.14 ||| |OFATUMUMAB 100 MG/5ML IV CONC|5 mL|100265| 1,252.60 |||||||||| 814.19 | 851.77 | 914.40 | 914.40 | 977.03 | 751.56 | 814.19 | 939.45 | 1,064.71 | 1,112.31 | 1,102.29 | 939.45 | 1,064.71 ||| |C1 ESTERASE INHIBITOR (HUMAN) 500 UNITS IV KIT|10 mL|100272| 6,071.05 |||||||||| 3,946.18 | 4,128.31 | 4,431.87 | 4,431.87 | 4,735.42 | 3,642.63 | 3,946.18 | 4,553.29 | 5,160.39 | 5,391.09 | 5,342.52 | 4,553.29 | 5,160.39 ||| |ROMIDEPSIN 10 MG IV SOLR|1 each|100344| 5,259.30 |||||||||| 3,418.55 | 3,576.32 | 3,839.29 | 3,839.29 | 4,102.25 | 3,155.58 | 3,418.55 | 3,944.48 | 4,470.41 | 4,670.26 | 4,628.18 | 3,944.48 | 4,470.41 ||| |SILDENAFIL CITRATE 10 MG/12.5ML IV SOLN|12.5 mL|100417| 447.45 |||||||||| 290.84 | 304.27 | 326.64 | 326.64 | 349.01 | 268.47 | 290.84 | 335.59 | 380.33 | 397.34 | 393.76 | 335.59 | 380.33 ||| |FLECAINIDE ACETATE 50 MG PO TABS|100 each|10043| 141.20 |||||||||| 91.78 | 96.02 | 103.08 | 103.08 | 110.14 | 84.72 | 91.78 | 105.90 | 120.02 | 125.39 | 124.26 | 105.90 | 120.02 ||| |BENDAMUSTINE HCL 25 MG IV SOLR|1 each|100581| 1,102.70 |||||||||| 716.76 | 749.84 | 804.97 | 804.97 | 860.11 | 661.62 | 716.76 | 827.03 | 937.30 | 979.20 | 970.38 | 827.03 | 937.30 ||| |FLUOXETINE HCL 10 MG PO CAPS|100 each|10069| 35.10 |||||||||| 22.82 | 23.87 | 25.62 | 25.62 | 27.38 | 21.06 | 22.82 | 26.33 | 29.84 | 31.17 | 30.89 | 26.33 | 29.84 ||| |ECALLANTIDE 10 MG/ML SC SOLN|1 mL|100698| 9,299.75 |||||||||| 6,044.84 | 6,323.83 | 6,788.82 | 6,788.82 | 7,253.81 | 5,579.85 | 6,044.84 | 6,974.81 | 7,904.79 | 8,258.18 | 8,183.78 | 6,974.81 | 7,904.79 ||| |FLUOXETINE HCL 20 MG PO CAPS|1000 each|10070| 136.20 |||||||||| 88.53 | 92.62 | 99.43 | 99.43 | 106.24 | 81.72 | 88.53 | 102.15 | 115.77 | 120.95 | 119.86 | 102.15 | 115.77 ||| |FLUPHENAZINE HCL 2.5 MG/5ML PO ELIX|60 mL|10072| 71.25 |||||||||| 46.31 | 48.45 | 52.01 | 52.01 | 55.58 | 42.75 | 46.31 | 53.44 | 60.56 | 63.27 | 62.70 | 53.44 | 60.56 ||| |IBUTILIDE FUMARATE 1 MG/10ML IV SOLN|10 mL|100740| 938.95 |||||||||| 610.32 | 638.49 | 685.43 | 685.43 | 732.38 | 563.37 | 610.32 | 704.21 | 798.11 | 833.79 | 826.28 | 704.21 | 798.11 ||| |DALFAMPRIDINE ER 10 MG PO TB12|60 each|100796| 6,113.25 |||||||||| 3,973.61 | 4,157.01 | 4,462.67 | 4,462.67 | 4,768.34 | 3,667.95 | 3,973.61 | 4,584.94 | 5,196.26 | 5,428.57 | 5,379.66 | 4,584.94 | 5,196.26 ||| |RITONAVIR 100 MG PO TABS|30 each|100995| 555.90 |||||||||| 361.34 | 378.01 | 405.81 | 405.81 | 433.60 | 333.54 | 361.34 | 416.93 | 472.52 | 493.64 | 489.19 | 416.93 | 472.52 ||| |MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR|0.5 mL (1 each)|101034| 287.50 |||||||||| 186.88 | 195.50 | 209.88 | 209.88 | 224.25 | 172.50 | 186.88 | 215.63 | 244.38 | 255.30 | 253.00 | 215.63 | 244.38 ||| |GLIPIZIDE 5 MG PO TABS|100 each|10117| 26.15 |||||||||| 17.00 | 17.78 | 19.09 | 19.09 | 20.40 | 15.69 | 17.00 | 19.61 | 22.23 | 23.22 | 23.01 | 19.61 | 22.23 ||| |GLYBURIDE 1.25 MG PO TABS|50 each|10125| 43.20 |||||||||| 28.08 | 29.38 | 31.54 | 31.54 | 33.70 | 25.92 | 28.08 | 32.40 | 36.72 | 38.36 | 38.02 | 32.40 | 36.72 ||| |GLYCOPYRROLATE 1 MG PO TABS|100 each|10130| 112.10 |||||||||| 72.87 | 76.23 | 81.83 | 81.83 | 87.44 | 67.26 | 72.87 | 84.08 | 95.29 | 99.54 | 98.65 | 84.08 | 95.29 ||| |HALOPERIDOL DECANOATE 100 MG/ML IM SOLN|1 mL|10162| 116.85 |||||||||| 75.95 | 79.46 | 85.30 | 85.30 | 91.14 | 70.11 | 75.95 | 87.64 | 99.32 | 103.76 | 102.83 | 87.64 | 99.32 ||| |HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN|1 mL|10177| 48.40 |||||||||| 31.46 | 32.91 | 35.33 | 35.33 | 37.75 | 29.04 | 31.46 | 36.30 | 41.14 | 42.98 | 42.59 | 36.30 | 41.14 ||| |HEPARIN SODIUM (PORCINE) 20000 UNIT/ML IJ SOLN|1 mL|10178| 65.55 |||||||||| 42.61 | 44.57 | 47.85 | 47.85 | 51.13 | 39.33 | 42.61 | 49.16 | 55.72 | 58.21 | 57.68 | 49.16 | 55.72 ||| |HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN|1 mL|10181| 41.85 |||||||||| 27.20 | 28.46 | 30.55 | 30.55 | 32.64 | 25.11 | 27.20 | 31.39 | 35.57 | 37.16 | 36.83 | 31.39 | 35.57 ||| |FLUTICASONE-SALMETEROL 100-50 MCG/DOSE IN AEPB|14 each|102050| 319.65 |||||||||| 207.77 | 217.36 | 233.34 | 233.34 | 249.33 | 191.79 | 207.77 | 239.74 | 271.70 | 283.85 | 281.29 | 239.74 | 271.70 ||| |FLUTICASONE-SALMETEROL 250-50 MCG/DOSE IN AEPB|14 each|102051| 319.65 |||||||||| 207.77 | 217.36 | 233.34 | 233.34 | 249.33 | 191.79 | 207.77 | 239.74 | 271.70 | 283.85 | 281.29 | 239.74 | 271.70 ||| |FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB|14 each|102052| 499.50 |||||||||| 324.68 | 339.66 | 364.64 | 364.64 | 389.61 | 299.70 | 324.68 | 374.63 | 424.58 | 443.56 | 439.56 | 374.63 | 424.58 ||| |HYDROCORTISONE 5 MG PO TABS|50 each|10209| 34.90 |||||||||| 22.69 | 23.73 | 25.48 | 25.48 | 27.22 | 20.94 | 22.69 | 26.18 | 29.67 | 30.99 | 30.71 | 26.18 | 29.67 ||| |LEVOTHYROXINE SODIUM 100 MCG PO CAPS|100 mcg (1 each)|102221| 26.25 |||||||||| 17.06 | 17.85 | 19.16 | 19.16 | 20.48 | 15.75 | 17.06 | 19.69 | 22.31 | 23.31 | 23.10 | 19.69 | 22.31 ||| |HYDROMORPHONE HCL 1 MG/ML PO LIQD|1 mL|10225| 23.55 |||||||||| 15.31 | 16.01 | 17.19 | 17.19 | 18.37 | 14.13 | 15.31 | 17.66 | 20.02 | 20.91 | 20.72 | 17.66 | 20.02 ||| |HYDROMORPHONE HCL 8 MG PO TABS|100 each|10226| 110.95 |||||||||| 72.12 | 75.45 | 80.99 | 80.99 | 86.54 | 66.57 | 72.12 | 83.21 | 94.31 | 98.52 | 97.64 | 83.21 | 94.31 ||| |HYDROMORPHONE HCL 3 MG RE SUPP|3 mg (1 each)|10227| 39.65 |||||||||| 25.77 | 26.96 | 28.94 | 28.94 | 30.93 | 23.79 | 25.77 | 29.74 | 33.70 | 35.21 | 34.89 | 29.74 | 33.70 ||| |LIDOCAINE HCL (PF) 1 % IJ SOLN|2 mL|102449| 38.20 |||||||||| 24.83 | 25.98 | 27.89 | 27.89 | 29.80 | 22.92 | 24.83 | 28.65 | 32.47 | 33.92 | 33.62 | 28.65 | 32.47 ||| |ONABOTULINUMTOXINA 200 UNITS IJ SOLR|200 Units (1 each)|102462| 2,469.55 |||||||||| 1,605.21 | 1,679.29 | 1,802.77 | 1,802.77 | 1,926.25 | 1,481.73 | 1,605.21 | 1,852.16 | 2,099.12 | 2,192.96 | 2,173.20 | 1,852.16 | 2,099.12 ||| |ONABOTULINUMTOXINA 100 UNITS IJ SOLR|100 Units (1 each)|102463| 1,234.80 |||||||||| 802.62 | 839.66 | 901.40 | 901.40 | 963.14 | 740.88 | 802.62 | 926.10 | 1,049.58 | 1,096.50 | 1,086.62 | 926.10 | 1,049.58 ||| |POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN|1000 mL|102464| 197.00 |||||||||| 128.05 | 133.96 | 143.81 | 143.81 | 153.66 | 118.20 | 128.05 | 147.75 | 167.45 | 174.94 | 173.36 | 147.75 | 167.45 ||| |IFOSFAMIDE 1 G IV SOLR|1 each|10248| 52.30 |||||||||| 34.00 | 35.56 | 38.18 | 38.18 | 40.79 | 31.38 | 34.00 | 39.23 | 44.46 | 46.44 | 46.02 | 39.23 | 44.46 ||| |KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN|1000 mL|102493| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |KCL IN DEXTROSE-NACL 20-5-0.225 MEQ/L-%-% IV SOLN|1000 mL|102499| 197.00 |||||||||| 128.05 | 133.96 | 143.81 | 143.81 | 153.66 | 118.20 | 128.05 | 147.75 | 167.45 | 174.94 | 173.36 | 147.75 | 167.45 ||| |CAPSAICIN-CLEANSING GEL 8 % EX KIT|280 cm2 (1 each)|102532| 3,499.35 |||||||||| 2,274.58 | 2,379.56 | 2,554.53 | 2,554.53 | 2,729.49 | 2,099.61 | 2,274.58 | 2,624.51 | 2,974.45 | 3,107.42 | 3,079.43 | 2,624.51 | 2,974.45 ||| |CAPSAICIN-CLEANSING GEL 8 % EX KIT|560 cm2 (2 each)|102532| 6,976.70 |||||||||| 4,534.86 | 4,744.16 | 5,092.99 | 5,092.99 | 5,441.83 | 4,186.02 | 4,534.86 | 5,232.53 | 5,930.20 | 6,195.31 | 6,139.50 | 5,232.53 | 5,930.20 ||| |IMMUNE GLOBULIN (HUMAN) 10 G IV SOLR|1 each|10258| 3,860.85 |||||||||| 2,509.55 | 2,625.38 | 2,818.42 | 2,818.42 | 3,011.46 | 2,316.51 | 2,509.55 | 2,895.64 | 3,281.72 | 3,428.43 | 3,397.55 | 2,895.64 | 3,281.72 ||| |IMMUNE GLOBULIN (HUMAN) 5 G IV SOLR|1 each|10261| 1,930.45 |||||||||| 1,254.79 | 1,312.71 | 1,409.23 | 1,409.23 | 1,505.75 | 1,158.27 | 1,254.79 | 1,447.84 | 1,640.88 | 1,714.24 | 1,698.80 | 1,447.84 | 1,640.88 ||| |PANCRELIPASE (LIP-PROT-AMYL) 10500 UNITS PO CPEP|1 capsule (1 each)|102637| 23.25 |||||||||| 15.11 | 15.81 | 16.97 | 16.97 | 18.14 | 13.95 | 15.11 | 17.44 | 19.76 | 20.65 | 20.46 | 17.44 | 19.76 ||| |PANCRELIPASE (LIP-PROT-AMYL) 10500 UNITS PO CPEP|2 capsule (2 each)|102637| 29.50 |||||||||| 19.18 | 20.06 | 21.54 | 21.54 | 23.01 | 17.70 | 19.18 | 22.13 | 25.08 | 26.20 | 25.96 | 22.13 | 25.08 ||| |PANCRELIPASE (LIP-PROT-AMYL) 10500 UNITS PO CPEP|3 capsule (3 each)|102637| 35.75 |||||||||| 23.24 | 24.31 | 26.10 | 26.10 | 27.89 | 21.45 | 23.24 | 26.81 | 30.39 | 31.75 | 31.46 | 26.81 | 30.39 ||| |INDOCYANINE GREEN 25 MG IV SOLR|7.5 mg (0.3 each)|10266| 88.70 |||||||||| 57.66 | 60.32 | 64.75 | 64.75 | 69.19 | 53.22 | 57.66 | 66.53 | 75.40 | 78.77 | 78.06 | 66.53 | 75.40 ||| |INDOMETHACIN SODIUM 1 MG IV SOLR|1 each|10267| 1,029.65 |||||||||| 669.27 | 700.16 | 751.64 | 751.64 | 803.13 | 617.79 | 669.27 | 772.24 | 875.20 | 914.33 | 906.09 | 772.24 | 875.20 ||| |SIROLIMUS 0.5 MG PO TABS|100 each|102698| 1,438.70 |||||||||| 935.16 | 978.32 | 1,050.25 | 1,050.25 | 1,122.19 | 863.22 | 935.16 | 1,079.03 | 1,222.90 | 1,277.57 | 1,266.06 | 1,079.03 | 1,222.90 ||| |SIPULEUCEL-T IV SUSP|250 mL|102786| 92,914.65 |||||||||| 60,394.52 | 63,181.96 | 67,827.69 | 67,827.69 | 72,473.43 | 55,748.79 | 60,394.52 | 69,685.99 | 78,977.45 | 82,508.21 | 81,764.89 | 69,685.99 | 78,977.45 ||| |INSULIN NPH (HUMAN) (ISOPHANE) 100 UNIT/ML SC SUSP|10 mL|10284| 293.20 |||||||||| 190.58 | 199.38 | 214.04 | 214.04 | 228.70 | 175.92 | 190.58 | 219.90 | 249.22 | 260.36 | 258.02 | 219.90 | 249.22 ||| |MINERAL OIL LIGHT 100 % EX OIL|25 mL|102926| 25.85 |||||||||| 16.80 | 17.58 | 18.87 | 18.87 | 20.16 | 15.51 | 16.80 | 19.39 | 21.97 | 22.95 | 22.75 | 19.39 | 21.97 ||| |HEPARIN LOCK FLUSH 1 UNIT/ML IV SOLN|2 mL|102975| 40.15 |||||||||| 26.10 | 27.30 | 29.31 | 29.31 | 31.32 | 24.09 | 26.10 | 30.11 | 34.13 | 35.65 | 35.33 | 30.11 | 34.13 ||| |INTERFERON ALFA-2B 10000000 UNITS IJ SOLR|1 each|10299| 638.00 |||||||||| 414.70 | 433.84 | 465.74 | 465.74 | 497.64 | 382.80 | 414.70 | 478.50 | 542.30 | 566.54 | 561.44 | 478.50 | 542.30 ||| |INTERFERON ALFA-2B 50000000 UNITS IJ SOLR|1 each|10304| 1,781.25 |||||||||| 1,157.81 | 1,211.25 | 1,300.31 | 1,300.31 | 1,389.38 | 1,068.75 | 1,157.81 | 1,335.94 | 1,514.06 | 1,581.75 | 1,567.50 | 1,335.94 | 1,514.06 ||| |BETAMETHASONE VALERATE 0.1 % EX CREA|15 g|1031| 76.15 |||||||||| 49.50 | 51.78 | 55.59 | 55.59 | 59.40 | 45.69 | 49.50 | 57.11 | 64.73 | 67.62 | 67.01 | 57.11 | 64.73 ||| |AMPICILLIN-SULBACTAM SODIUM 15 (10-5) G IV SOLR|1 each|103154| 182.05 |||||||||| 118.33 | 123.79 | 132.90 | 132.90 | 142.00 | 109.23 | 118.33 | 136.54 | 154.74 | 161.66 | 160.20 | 136.54 | 154.74 ||| |BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN|30 mL|103171| 49.85 |||||||||| 32.40 | 33.90 | 36.39 | 36.39 | 38.88 | 29.91 | 32.40 | 37.39 | 42.37 | 44.27 | 43.87 | 37.39 | 42.37 ||| |MEPIVACAINE HCL (PF) 1 % IJ SOLN|30 mL|103175| 44.10 |||||||||| 28.67 | 29.99 | 32.19 | 32.19 | 34.40 | 26.46 | 28.67 | 33.08 | 37.49 | 39.16 | 38.81 | 33.08 | 37.49 ||| |BUPIVACAINE HCL (PF) 0.25 % IJ SOLN|30 mL|103177| 46.35 |||||||||| 30.13 | 31.52 | 33.84 | 33.84 | 36.15 | 27.81 | 30.13 | 34.76 | 39.40 | 41.16 | 40.79 | 34.76 | 39.40 ||| |BUPIVACAINE HCL (PF) 0.5 % IJ SOLN|30 mL|103178| 37.45 |||||||||| 24.34 | 25.47 | 27.34 | 27.34 | 29.21 | 22.47 | 24.34 | 28.09 | 31.83 | 33.26 | 32.96 | 28.09 | 31.83 ||| |CABAZITAXEL 60 MG/1.5ML IV SOLN|1.5 mL|103182| 17,129.95 |||||||||| 11,134.47 | 11,648.37 | 12,504.86 | 12,504.86 | 13,361.36 | 10,277.97 | 11,134.47 | 12,847.46 | 14,560.46 | 15,211.40 | 15,074.36 | 12,847.46 | 14,560.46 ||| |BETAMETHASONE VALERATE 0.1 % EX OINT|15 g|1033| 64.65 |||||||||| 42.02 | 43.96 | 47.19 | 47.19 | 50.43 | 38.79 | 42.02 | 48.49 | 54.95 | 57.41 | 56.89 | 48.49 | 54.95 ||| |IOTHALAMATE MEGLUMINE 17.2 % UR SOLN|250 mL|10330| 23.00 |||||||||| 14.95 | 15.64 | 16.79 | 16.79 | 17.94 | 13.80 | 14.95 | 17.25 | 19.55 | 20.42 | 20.24 | 17.25 | 19.55 ||| |IOTHALAMATE MEGLUMINE 43 % IV SOLN|50 mL|10332| 11.00 |||||||||| 7.15 | 7.48 | 8.03 | 8.03 | 8.58 | 6.60 | 7.15 | 8.25 | 9.35 | 9.77 | 9.68 | 8.25 | 9.35 ||| |GAMMAGARD 1 GM/10ML IJ SOLN|10 mL|103362| 293.35 |||||||||| 190.68 | 199.48 | 214.15 | 214.15 | 228.81 | 176.01 | 190.68 | 220.01 | 249.35 | 260.49 | 258.15 | 220.01 | 249.35 ||| |ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN|.3 mL|103438| 45.25 |||||||||| 29.41 | 30.77 | 33.03 | 33.03 | 35.30 | 27.15 | 29.41 | 33.94 | 38.46 | 40.18 | 39.82 | 33.94 | 38.46 ||| |ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN|.6 mL|103440| 56.50 |||||||||| 36.73 | 38.42 | 41.25 | 41.25 | 44.07 | 33.90 | 36.73 | 42.38 | 48.03 | 50.17 | 49.72 | 42.38 | 48.03 ||| |ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN|.8 mL|103441| 63.95 |||||||||| 41.57 | 43.49 | 46.68 | 46.68 | 49.88 | 38.37 | 41.57 | 47.96 | 54.36 | 56.79 | 56.28 | 47.96 | 54.36 ||| |ENOXAPARIN SODIUM 100 MG/ML SC SOLN|1 mL|103442| 62.25 |||||||||| 40.46 | 42.33 | 45.44 | 45.44 | 48.56 | 37.35 | 40.46 | 46.69 | 52.91 | 55.28 | 54.78 | 46.69 | 52.91 ||| |DONEPEZIL HCL 23 MG PO TABS|23 mg (1 each)|103445| 15.85 |||||||||| 10.30 | 10.78 | 11.57 | 11.57 | 12.36 | 9.51 | 10.30 | 11.89 | 13.47 | 14.07 | 13.95 | 11.89 | 13.47 ||| |ENOXAPARIN SODIUM 300 MG/3ML IJ SOLN|3 mL|103479| 94.25 |||||||||| 61.26 | 64.09 | 68.80 | 68.80 | 73.52 | 56.55 | 61.26 | 70.69 | 80.11 | 83.69 | 82.94 | 70.69 | 80.11 ||| |FLORANEX PO PACK|1 packet (1 each)|103481| 14.40 |||||||||| 9.36 | 9.79 | 10.51 | 10.51 | 11.23 | 8.64 | 9.36 | 10.80 | 12.24 | 12.79 | 12.67 | 10.80 | 12.24 ||| |ISOSORBIDE MONONITRATE 20 MG PO TABS|100 each|10357| 90.55 |||||||||| 58.86 | 61.57 | 66.10 | 66.10 | 70.63 | 54.33 | 58.86 | 67.91 | 76.97 | 80.41 | 79.68 | 67.91 | 76.97 ||| |NA SULFATE-K SULFATE-MG SULF 17.5-3.13-1.6 GM/177ML PO SOLN|177 mL|103599| 127.85 |||||||||| 83.10 | 86.94 | 93.33 | 93.33 | 99.72 | 76.71 | 83.10 | 95.89 | 108.67 | 113.53 | 112.51 | 95.89 | 108.67 ||| |ISRADIPINE 2.5 MG PO CAPS|10 mg (4 each)|10362| 25.05 |||||||||| 16.28 | 17.03 | 18.29 | 18.29 | 19.54 | 15.03 | 16.28 | 18.79 | 21.29 | 22.24 | 22.04 | 18.79 | 21.29 ||| |ISRADIPINE 2.5 MG PO CAPS|2.5 mg (1 each)|10362| 13.05 |||||||||| 8.48 | 8.87 | 9.53 | 9.53 | 10.18 | 7.83 | 8.48 | 9.79 | 11.09 | 11.59 | 11.48 | 9.79 | 11.09 ||| |ISRADIPINE 2.5 MG PO CAPS|5 mg (2 each)|10362| 15.05 |||||||||| 9.78 | 10.23 | 10.99 | 10.99 | 11.74 | 9.03 | 9.78 | 11.29 | 12.79 | 13.36 | 13.24 | 11.29 | 12.79 ||| |K PHOS MONO-SOD PHOS DI & MONO 155-852-130 MG PO TABS|250 mg (1 each)|10365| 12.45 |||||||||| 8.09 | 8.47 | 9.09 | 9.09 | 9.71 | 7.47 | 8.09 | 9.34 | 10.58 | 11.06 | 10.96 | 9.34 | 10.58 ||| |K PHOS MONO-SOD PHOS DI & MONO 155-852-130 MG PO TABS|500 mg (2 each)|10365| 13.85 |||||||||| 9.00 | 9.42 | 10.11 | 10.11 | 10.80 | 8.31 | 9.00 | 10.39 | 11.77 | 12.30 | 12.19 | 10.39 | 11.77 ||| |FINGOLIMOD HCL 0.5 MG PO CAPS|0.5 mg (1 each)|103853| 526.05 |||||||||| 341.93 | 357.71 | 384.02 | 384.02 | 410.32 | 315.63 | 341.93 | 394.54 | 447.14 | 467.13 | 462.92 | 394.54 | 447.14 ||| |LIDOCAINE HCL (PF) 0.5 % IJ SOLN|50 mL|103899| 25.00 |||||||||| 16.25 | 17.00 | 18.25 | 18.25 | 19.50 | 15.00 | 16.25 | 18.75 | 21.25 | 22.20 | 22.00 | 18.75 | 21.25 ||| |LEUPROLIDE ACETATE 15 MG IM KIT|1 each|10391| 4,986.20 |||||||||| 3,241.03 | 3,390.62 | 3,639.93 | 3,639.93 | 3,889.24 | 2,991.72 | 3,241.03 | 3,739.65 | 4,238.27 | 4,427.75 | 4,387.86 | 3,739.65 | 4,238.27 ||| |LEUPROLIDE ACETATE 7.5 MG IM KIT|1 each|10392| 2,470.15 |||||||||| 1,605.60 | 1,679.70 | 1,803.21 | 1,803.21 | 1,926.72 | 1,482.09 | 1,605.60 | 1,852.61 | 2,099.63 | 2,193.49 | 2,173.73 | 1,852.61 | 2,099.63 ||| |LEVOBUNOLOL HCL 0.5 % OP SOLN|10 mL|10394| 52.75 |||||||||| 34.29 | 35.87 | 38.51 | 38.51 | 41.15 | 31.65 | 34.29 | 39.56 | 44.84 | 46.84 | 46.42 | 39.56 | 44.84 ||| |ACETAMINOPHEN 325 MG RE SUPP|50 each|104| 76.40 |||||||||| 49.66 | 51.95 | 55.77 | 55.77 | 59.59 | 45.84 | 49.66 | 57.30 | 64.94 | 67.84 | 67.23 | 57.30 | 64.94 ||| |LEVOTHYROXINE SODIUM 112 MCG PO TABS|90 each|10404| 264.75 |||||||||| 172.09 | 180.03 | 193.27 | 193.27 | 206.51 | 158.85 | 172.09 | 198.56 | 225.04 | 235.10 | 232.98 | 198.56 | 225.04 ||| |LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN|50 mL|10426| 45.50 |||||||||| 29.58 | 30.94 | 33.22 | 33.22 | 35.49 | 27.30 | 29.58 | 34.13 | 38.68 | 40.40 | 40.04 | 34.13 | 38.68 ||| |LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN|20 mL|10427| 41.10 |||||||||| 26.72 | 27.95 | 30.00 | 30.00 | 32.06 | 24.66 | 26.72 | 30.83 | 34.94 | 36.50 | 36.17 | 30.83 | 34.94 ||| |LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN|10 mL|10428| 47.90 |||||||||| 31.14 | 32.57 | 34.97 | 34.97 | 37.36 | 28.74 | 31.14 | 35.93 | 40.72 | 42.54 | 42.15 | 35.93 | 40.72 ||| |BETHANECHOL CHLORIDE 10 MG PO TABS|100 each|1043| 112.95 |||||||||| 73.42 | 76.81 | 82.45 | 82.45 | 88.10 | 67.77 | 73.42 | 84.71 | 96.01 | 100.30 | 99.40 | 84.71 | 96.01 ||| |BETHANECHOL CHLORIDE 25 MG PO TABS|100 each|1044| 127.30 |||||||||| 82.75 | 86.56 | 92.93 | 92.93 | 99.29 | 76.38 | 82.75 | 95.48 | 108.21 | 113.04 | 112.02 | 95.48 | 108.21 ||| |LIOTHYRONINE SODIUM 5 MCG PO TABS|90 each|10443| 149.10 |||||||||| 96.92 | 101.39 | 108.84 | 108.84 | 116.30 | 89.46 | 96.92 | 111.83 | 126.74 | 132.40 | 131.21 | 111.83 | 126.74 ||| |BETHANECHOL CHLORIDE 5 MG PO TABS|100 each|1045| 82.25 |||||||||| 53.46 | 55.93 | 60.04 | 60.04 | 64.16 | 49.35 | 53.46 | 61.69 | 69.91 | 73.04 | 72.38 | 61.69 | 69.91 ||| |LITHIUM CARBONATE ER 450 MG PO TBCR|100 each|10455| 111.30 |||||||||| 72.35 | 75.68 | 81.25 | 81.25 | 86.81 | 66.78 | 72.35 | 83.48 | 94.61 | 98.83 | 97.94 | 83.48 | 94.61 ||| |LORATADINE 10 MG PO TABS|300 each|10466| 46.95 |||||||||| 30.52 | 31.93 | 34.27 | 34.27 | 36.62 | 28.17 | 30.52 | 35.21 | 39.91 | 41.69 | 41.32 | 35.21 | 39.91 ||| |LOVASTATIN 40 MG PO TABS|100 each|10471| 58.15 |||||||||| 37.80 | 39.54 | 42.45 | 42.45 | 45.36 | 34.89 | 37.80 | 43.61 | 49.43 | 51.64 | 51.17 | 43.61 | 49.43 ||| |LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ|5 mL|10475| 4,481.40 |||||||||| 2,912.91 | 3,047.35 | 3,271.42 | 3,271.42 | 3,495.49 | 2,688.84 | 2,912.91 | 3,361.05 | 3,809.19 | 3,979.48 | 3,943.63 | 3,361.05 | 3,809.19 ||| |ACETAMINOPHEN 650 MG RE SUPP|12 each|105| 25.85 |||||||||| 16.80 | 17.58 | 18.87 | 18.87 | 20.16 | 15.51 | 16.80 | 19.39 | 21.97 | 22.95 | 22.75 | 19.39 | 21.97 ||| |MECHLORETHAMINE HCL 10 MG IJ SOLR|1 each|10515| 643.00 |||||||||| 417.95 | 437.24 | 469.39 | 469.39 | 501.54 | 385.80 | 417.95 | 482.25 | 546.55 | 570.98 | 565.84 | 482.25 | 546.55 ||| |MEGESTROL ACETATE 40 MG/ML PO SUSP|10 mL|10521| 24.35 |||||||||| 15.83 | 16.56 | 17.78 | 17.78 | 18.99 | 14.61 | 15.83 | 18.26 | 20.70 | 21.62 | 21.43 | 18.26 | 20.70 ||| |MELPHALAN HCL 50 MG IV SOLR|1 each|10522| 742.10 |||||||||| 482.37 | 504.63 | 541.73 | 541.73 | 578.84 | 445.26 | 482.37 | 556.58 | 630.79 | 658.98 | 653.05 | 556.58 | 630.79 ||| |MELPHALAN 2 MG PO TABS|2 mg (1 each)|10523| 45.55 |||||||||| 29.61 | 30.97 | 33.25 | 33.25 | 35.53 | 27.33 | 29.61 | 34.16 | 38.72 | 40.45 | 40.08 | 34.16 | 38.72 ||| |MELPHALAN 2 MG PO TABS|6 mg (3 each)|10523| 92.55 |||||||||| 60.16 | 62.93 | 67.56 | 67.56 | 72.19 | 55.53 | 60.16 | 69.41 | 78.67 | 82.18 | 81.44 | 69.41 | 78.67 ||| |MERCAPTOPURINE 50 MG PO TABS|25 each|10531| 186.55 |||||||||| 121.26 | 126.85 | 136.18 | 136.18 | 145.51 | 111.93 | 121.26 | 139.91 | 158.57 | 165.66 | 164.16 | 139.91 | 158.57 ||| |LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN|100 mL|105328| 162.10 |||||||||| 105.37 | 110.23 | 118.33 | 118.33 | 126.44 | 97.26 | 105.37 | 121.58 | 137.79 | 143.94 | 142.65 | 121.58 | 137.79 ||| |LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN|100 mL|105329| 184.45 |||||||||| 119.89 | 125.43 | 134.65 | 134.65 | 143.87 | 110.67 | 119.89 | 138.34 | 156.78 | 163.79 | 162.32 | 138.34 | 156.78 ||| |MESALAMINE ER 250 MG PO CPCR|1,000 mg (4 each)|10533| 47.25 |||||||||| 30.71 | 32.13 | 34.49 | 34.49 | 36.86 | 28.35 | 30.71 | 35.44 | 40.16 | 41.96 | 41.58 | 35.44 | 40.16 ||| |MESALAMINE ER 250 MG PO CPCR|250 mg (1 each)|10533| 23.35 |||||||||| 15.18 | 15.88 | 17.05 | 17.05 | 18.21 | 14.01 | 15.18 | 17.51 | 19.85 | 20.73 | 20.55 | 17.51 | 19.85 ||| |MESALAMINE ER 250 MG PO CPCR|500 mg (2 each)|10533| 29.65 |||||||||| 19.27 | 20.16 | 21.64 | 21.64 | 23.13 | 17.79 | 19.27 | 22.24 | 25.20 | 26.33 | 26.09 | 22.24 | 25.20 ||| |LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN|100 mL|105330| 199.55 |||||||||| 129.71 | 135.69 | 145.67 | 145.67 | 155.65 | 119.73 | 129.71 | 149.66 | 169.62 | 177.20 | 175.60 | 149.66 | 169.62 ||| |MONSELS FERRIC SUBSULFATE EX SOLN|8 mL|105335| 52.30 |||||||||| 34.00 | 35.56 | 38.18 | 38.18 | 40.79 | 31.38 | 34.00 | 39.23 | 44.46 | 46.44 | 46.02 | 39.23 | 44.46 ||| |MESNA 100 MG/ML IV SOLN|10 mL|10537| 41.55 |||||||||| 27.01 | 28.25 | 30.33 | 30.33 | 32.41 | 24.93 | 27.01 | 31.16 | 35.32 | 36.90 | 36.56 | 31.16 | 35.32 ||| |METHADONE HCL 10 MG/ML IJ SOLN|20 mL|10546| 753.10 |||||||||| 489.52 | 512.11 | 549.76 | 549.76 | 587.42 | 451.86 | 489.52 | 564.83 | 640.14 | 668.75 | 662.73 | 564.83 | 640.14 ||| |METHIMAZOLE 5 MG PO TABS|100 each|10553| 71.85 |||||||||| 46.70 | 48.86 | 52.45 | 52.45 | 56.04 | 43.11 | 46.70 | 53.89 | 61.07 | 63.80 | 63.23 | 53.89 | 61.07 ||| |METHYLPREDNISOLONE 2 MG PO TABS|1 split tablet|10573| 13.40 |||||||||| 8.71 | 9.11 | 9.78 | 9.78 | 10.45 | 8.04 | 8.71 | 10.05 | 11.39 | 11.90 | 11.79 | 10.05 | 11.39 ||| |DORZOLAMIDE HCL-TIMOLOL MAL PF 22.3-6.8 MG/ML OP SOLN|1 drop (0.25 each)|105751| 12.20 |||||||||| 7.93 | 8.30 | 8.91 | 8.91 | 9.52 | 7.32 | 7.93 | 9.15 | 10.37 | 10.83 | 10.74 | 9.15 | 10.37 ||| |MEXILETINE HCL 150 MG PO CAPS|100 each|10595| 290.45 |||||||||| 188.79 | 197.51 | 212.03 | 212.03 | 226.55 | 174.27 | 188.79 | 217.84 | 246.88 | 257.92 | 255.60 | 217.84 | 246.88 ||| |MEXILETINE HCL 200 MG PO CAPS|100 each|10596| 348.60 |||||||||| 226.59 | 237.05 | 254.48 | 254.48 | 271.91 | 209.16 | 226.59 | 261.45 | 296.31 | 309.56 | 306.77 | 261.45 | 296.31 ||| |MICONAZOLE NITRATE 2 % EX POWD|43 g|10599| 40.40 |||||||||| 26.26 | 27.47 | 29.49 | 29.49 | 31.51 | 24.24 | 26.26 | 30.30 | 34.34 | 35.88 | 35.55 | 30.30 | 34.34 ||| |MICONAZOLE NITRATE 200 MG VA SUPP|3 each|10604| 112.95 |||||||||| 73.42 | 76.81 | 82.45 | 82.45 | 88.10 | 67.77 | 73.42 | 84.71 | 96.01 | 100.30 | 99.40 | 84.71 | 96.01 ||| |MIDODRINE HCL 5 MG PO TABS|100 each|10610| 177.70 |||||||||| 115.51 | 120.84 | 129.72 | 129.72 | 138.61 | 106.62 | 115.51 | 133.28 | 151.05 | 157.80 | 156.38 | 133.28 | 151.05 ||| |MINOCYCLINE HCL 100 MG IV SOLR|100 mg (1 each)|10612| 469.30 |||||||||| 305.05 | 319.12 | 342.59 | 342.59 | 366.05 | 281.58 | 305.05 | 351.98 | 398.91 | 416.74 | 412.98 | 351.98 | 398.91 ||| |MINOCYCLINE HCL 100 MG IV SOLR|200 mg (2 each)|10612| 808.55 |||||||||| 525.56 | 549.81 | 590.24 | 590.24 | 630.67 | 485.13 | 525.56 | 606.41 | 687.27 | 717.99 | 711.52 | 606.41 | 687.27 ||| |MISOPROSTOL 100 MCG PO TABS|100 each|10628| 450.95 |||||||||| 293.12 | 306.65 | 329.19 | 329.19 | 351.74 | 270.57 | 293.12 | 338.21 | 383.31 | 400.44 | 396.84 | 338.21 | 383.31 ||| |MISOPROSTOL 200 MCG PO TABS|1 each|10629| 15.75 |||||||||| 10.24 | 10.71 | 11.50 | 11.50 | 12.29 | 9.45 | 10.24 | 11.81 | 13.39 | 13.99 | 13.86 | 11.81 | 13.39 ||| |VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML SC INJ|0.5 mL (1 each)|106316| 289.50 |||||||||| 188.18 | 196.86 | 211.34 | 211.34 | 225.81 | 173.70 | 188.18 | 217.13 | 246.08 | 257.08 | 254.76 | 217.13 | 246.08 ||| |MITOMYCIN 5 MG IV SOLR|10 mg (2 each)|10632| 1,010.10 |||||||||| 656.57 | 686.87 | 737.37 | 737.37 | 787.88 | 606.06 | 656.57 | 757.58 | 858.59 | 896.97 | 888.89 | 757.58 | 858.59 ||| |DIAZEPAM 5 MG/5ML PO SOLN|5 mL|106375| 25.00 |||||||||| 16.25 | 17.00 | 18.25 | 18.25 | 19.50 | 15.00 | 16.25 | 18.75 | 21.25 | 22.20 | 22.00 | 18.75 | 21.25 ||| |NATAMYCIN 5 % OP SUSP|15 mL|10692| 653.65 |||||||||| 424.87 | 444.48 | 477.16 | 477.16 | 509.85 | 392.19 | 424.87 | 490.24 | 555.60 | 580.44 | 575.21 | 490.24 | 555.60 ||| |AKWA TEARS 2-15-83 % OP OINT|3.5 g|107023| 45.90 |||||||||| 29.84 | 31.21 | 33.51 | 33.51 | 35.80 | 27.54 | 29.84 | 34.43 | 39.02 | 40.76 | 40.39 | 34.43 | 39.02 ||| |NICARDIPINE HCL 20 MG PO CAPS|90 each|10712| 355.15 |||||||||| 230.85 | 241.50 | 259.26 | 259.26 | 277.02 | 213.09 | 230.85 | 266.36 | 301.88 | 315.37 | 312.53 | 266.36 | 301.88 ||| |FLORANEX PO TABS|1 tablet (1 each)|107130| 11.70 |||||||||| 7.61 | 7.96 | 8.54 | 8.54 | 9.13 | 7.02 | 7.61 | 8.78 | 9.95 | 10.39 | 10.30 | 8.78 | 9.95 ||| |FLORANEX PO TABS|4 tablet (4 each)|107130| 13.70 |||||||||| 8.91 | 9.32 | 10.00 | 10.00 | 10.69 | 8.22 | 8.91 | 10.28 | 11.65 | 12.17 | 12.06 | 10.28 | 11.65 ||| |NIFEDIPINE ER 60 MG PO TB24|100 each|10720| 124.80 |||||||||| 81.12 | 84.86 | 91.10 | 91.10 | 97.34 | 74.88 | 81.12 | 93.60 | 106.08 | 110.82 | 109.82 | 93.60 | 106.08 ||| |NITROFURANTOIN 25 MG/5ML PO SUSP|230 mL|10723| 1,285.90 |||||||||| 835.84 | 874.41 | 938.71 | 938.71 | 1,003.00 | 771.54 | 835.84 | 964.43 | 1,093.02 | 1,141.88 | 1,131.59 | 964.43 | 1,093.02 ||| |NORTRIPTYLINE HCL 10 MG/5ML PO SOLN|473 mL|10757| 380.45 |||||||||| 247.29 | 258.71 | 277.73 | 277.73 | 296.75 | 228.27 | 247.29 | 285.34 | 323.38 | 337.84 | 334.80 | 285.34 | 323.38 ||| |IODINE TINCTURE EX TINC|473 mL|107682| 87.45 |||||||||| 56.84 | 59.47 | 63.84 | 63.84 | 68.21 | 52.47 | 56.84 | 65.59 | 74.33 | 77.66 | 76.96 | 65.59 | 74.33 ||| |OLSALAZINE SODIUM 250 MG PO CAPS|250 mg (1 each)|10773| 50.15 |||||||||| 32.60 | 34.10 | 36.61 | 36.61 | 39.12 | 30.09 | 32.60 | 37.61 | 42.63 | 44.53 | 44.13 | 37.61 | 42.63 ||| |OLSALAZINE SODIUM 250 MG PO CAPS|500 mg (2 each)|10773| 78.30 |||||||||| 50.90 | 53.24 | 57.16 | 57.16 | 61.07 | 46.98 | 50.90 | 58.73 | 66.56 | 69.53 | 68.90 | 58.73 | 66.56 ||| |BISACODYL 5 MG PO TBEC|10 mg (2 each)|1079| 11.15 |||||||||| 7.25 | 7.58 | 8.14 | 8.14 | 8.70 | 6.69 | 7.25 | 8.36 | 9.48 | 9.90 | 9.81 | 8.36 | 9.48 ||| |BISACODYL 5 MG PO TBEC|5 mg (1 each)|1079| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |OXANDROLONE 2.5 MG PO TABS|100 each|10803| 598.55 |||||||||| 389.06 | 407.01 | 436.94 | 436.94 | 466.87 | 359.13 | 389.06 | 448.91 | 508.77 | 531.51 | 526.72 | 448.91 | 508.77 ||| |OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP|473 mL|10810| 63.25 |||||||||| 41.11 | 43.01 | 46.17 | 46.17 | 49.34 | 37.95 | 41.11 | 47.44 | 53.76 | 56.17 | 55.66 | 47.44 | 53.76 ||| |OXYCODONE HCL 100 MG/5ML PO CONC|1 mL|10812| 32.50 |||||||||| 21.13 | 22.10 | 23.73 | 23.73 | 25.35 | 19.50 | 21.13 | 24.38 | 27.63 | 28.86 | 28.60 | 24.38 | 27.63 ||| |PERTUZUMAB 420 MG/14ML IV SOLN|14 mL|108302| 7,854.45 |||||||||| 5,105.39 | 5,341.03 | 5,733.75 | 5,733.75 | 6,126.47 | 4,712.67 | 5,105.39 | 5,890.84 | 6,676.28 | 6,974.75 | 6,911.92 | 5,890.84 | 6,676.28 ||| |PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR|4000 mL|10839| 64.15 |||||||||| 41.70 | 43.62 | 46.83 | 46.83 | 50.04 | 38.49 | 41.70 | 48.11 | 54.53 | 56.97 | 56.45 | 48.11 | 54.53 ||| |IPRATROPIUM-ALBUTEROL 20-100 MCG/ACT IN AERS|4 g|108408| 836.75 |||||||||| 543.89 | 568.99 | 610.83 | 610.83 | 652.67 | 502.05 | 543.89 | 627.56 | 711.24 | 743.03 | 736.34 | 627.56 | 711.24 ||| |PAMIDRONATE DISODIUM 30 MG IV SOLR|1 each|10845| 128.15 |||||||||| 83.30 | 87.14 | 93.55 | 93.55 | 99.96 | 76.89 | 83.30 | 96.11 | 108.93 | 113.80 | 112.77 | 96.11 | 108.93 ||| |CULTURELLE PO CAPS|1 capsule (1 each)|108467| 12.05 |||||||||| 7.83 | 8.19 | 8.80 | 8.80 | 9.40 | 7.23 | 7.83 | 9.04 | 10.24 | 10.70 | 10.60 | 9.04 | 10.24 ||| |CULTURELLE PO CAPS|2 capsule (2 each)|108467| 13.10 |||||||||| 8.52 | 8.91 | 9.56 | 9.56 | 10.22 | 7.86 | 8.52 | 9.83 | 11.14 | 11.63 | 11.53 | 9.83 | 11.14 ||| |PAROXETINE HCL 20 MG PO TABS|90 each|10855| 47.80 |||||||||| 31.07 | 32.50 | 34.89 | 34.89 | 37.28 | 28.68 | 31.07 | 35.85 | 40.63 | 42.45 | 42.06 | 35.85 | 40.63 ||| |ROTIGOTINE 1 MG/24HR TD PT24|1 patch (1 each)|108702| 70.85 |||||||||| 46.05 | 48.18 | 51.72 | 51.72 | 55.26 | 42.51 | 46.05 | 53.14 | 60.22 | 62.91 | 62.35 | 53.14 | 60.22 ||| |METHOTREXATE SODIUM (PF) 250 MG/10ML IJ SOLN|10 mL|108885| 18.75 |||||||||| 12.19 | 12.75 | 13.69 | 13.69 | 14.63 | 11.25 | 12.19 | 14.06 | 15.94 | 16.65 | 16.50 | 14.06 | 15.94 ||| |CARFILZOMIB 60 MG IV SOLR|1 each|108899| 3,614.70 |||||||||| 2,349.56 | 2,458.00 | 2,638.73 | 2,638.73 | 2,819.47 | 2,168.82 | 2,349.56 | 2,711.03 | 3,072.50 | 3,209.85 | 3,180.94 | 2,711.03 | 3,072.50 ||| |PENICILLAMINE 250 MG PO CAPS|100 each|10894| 54,389.55 |||||||||| 35,353.21 | 36,984.89 | 39,704.37 | 39,704.37 | 42,423.85 | 32,633.73 | 35,353.21 | 40,792.16 | 46,231.12 | 48,297.92 | 47,862.80 | 40,792.16 | 46,231.12 ||| |BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP|236 mL|1090| 22.40 |||||||||| 14.56 | 15.23 | 16.35 | 16.35 | 17.47 | 13.44 | 14.56 | 16.80 | 19.04 | 19.89 | 19.71 | 16.80 | 19.04 ||| |VANCOMYCIN 31 MG/ML OPHTHALMIC SOLUTION|15 mL|109064| 222.25 |||||||||| 144.46 | 151.13 | 162.24 | 162.24 | 173.36 | 133.35 | 144.46 | 166.69 | 188.91 | 197.36 | 195.58 | 166.69 | 188.91 ||| |MIRABEGRON ER 25 MG PO TB24|90 each|109087| 2,544.55 |||||||||| 1,653.96 | 1,730.29 | 1,857.52 | 1,857.52 | 1,984.75 | 1,526.73 | 1,653.96 | 1,908.41 | 2,162.87 | 2,259.56 | 2,239.20 | 1,908.41 | 2,162.87 ||| |PENTOSTATIN 10 MG IV SOLR|1 each|10910| 3,274.65 |||||||||| 2,128.52 | 2,226.76 | 2,390.49 | 2,390.49 | 2,554.23 | 1,964.79 | 2,128.52 | 2,455.99 | 2,783.45 | 2,907.89 | 2,881.69 | 2,455.99 | 2,783.45 ||| |PERMETHRIN 5 % EX CREA|60 g|10917| 220.35 |||||||||| 143.23 | 149.84 | 160.86 | 160.86 | 171.87 | 132.21 | 143.23 | 165.26 | 187.30 | 195.67 | 193.91 | 165.26 | 187.30 ||| |PERMETHRIN 1 % EX LIQD|59 mL|10918| 46.55 |||||||||| 30.26 | 31.65 | 33.98 | 33.98 | 36.31 | 27.93 | 30.26 | 34.91 | 39.57 | 41.34 | 40.96 | 34.91 | 39.57 ||| |ZIV-AFLIBERCEPT 100 MG/4ML IV SOLN|4 mL|109181| 2,374.75 |||||||||| 1,543.59 | 1,614.83 | 1,733.57 | 1,733.57 | 1,852.31 | 1,424.85 | 1,543.59 | 1,781.06 | 2,018.54 | 2,108.78 | 2,089.78 | 1,781.06 | 2,018.54 ||| |ZIV-AFLIBERCEPT 200 MG/8ML IV SOLN|8 mL|109182| 4,749.45 |||||||||| 3,087.14 | 3,229.63 | 3,467.10 | 3,467.10 | 3,704.57 | 2,849.67 | 3,087.14 | 3,562.09 | 4,037.03 | 4,217.51 | 4,179.52 | 3,562.09 | 4,037.03 ||| |MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN|1 mL|109306| 22.65 |||||||||| 14.72 | 15.40 | 16.53 | 16.53 | 17.67 | 13.59 | 14.72 | 16.99 | 19.25 | 20.11 | 19.93 | 16.99 | 19.25 ||| |PHENELZINE SULFATE 15 MG PO TABS|15 mg (1 each)|10933| 12.40 |||||||||| 8.06 | 8.43 | 9.05 | 9.05 | 9.67 | 7.44 | 8.06 | 9.30 | 10.54 | 11.01 | 10.91 | 9.30 | 10.54 ||| |PHENELZINE SULFATE 15 MG PO TABS|30 mg (2 each)|10933| 13.75 |||||||||| 8.94 | 9.35 | 10.04 | 10.04 | 10.73 | 8.25 | 8.94 | 10.31 | 11.69 | 12.21 | 12.10 | 10.31 | 11.69 ||| |OFATUMUMAB 1000 MG/50ML IV CONC|50 mL|109527| 8,955.25 |||||||||| 5,820.91 | 6,089.57 | 6,537.33 | 6,537.33 | 6,985.10 | 5,373.15 | 5,820.91 | 6,716.44 | 7,611.96 | 7,952.26 | 7,880.62 | 6,716.44 | 7,611.96 ||| |HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN|1 mL|109539| 50.40 |||||||||| 32.76 | 34.27 | 36.79 | 36.79 | 39.31 | 30.24 | 32.76 | 37.80 | 42.84 | 44.76 | 44.35 | 37.80 | 42.84 ||| |MORPHINE SULFATE (PF) 4 MG/ML IV SOLN|1 mL|109607| 50.15 |||||||||| 32.60 | 34.10 | 36.61 | 36.61 | 39.12 | 30.09 | 32.60 | 37.61 | 42.63 | 44.53 | 44.13 | 37.61 | 42.63 ||| |PHENYLEPHRINE IN HARD FAT 0.25 % RE SUPP|1 suppository (1 each)|10964| 11.40 |||||||||| 7.41 | 7.75 | 8.32 | 8.32 | 8.89 | 6.84 | 7.41 | 8.55 | 9.69 | 10.12 | 10.03 | 8.55 | 9.69 ||| |LINACLOTIDE 145 MCG PO CAPS|30 each|110042| 945.90 |||||||||| 614.84 | 643.21 | 690.51 | 690.51 | 737.80 | 567.54 | 614.84 | 709.43 | 804.02 | 839.96 | 832.39 | 709.43 | 804.02 ||| |PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS|100 each|11019| 265.55 |||||||||| 172.61 | 180.57 | 193.85 | 193.85 | 207.13 | 159.33 | 172.61 | 199.16 | 225.72 | 235.81 | 233.68 | 199.16 | 225.72 ||| |PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ|.5 mL|11037| 232.00 |||||||||| 150.80 | 157.76 | 169.36 | 169.36 | 180.96 | 139.20 | 150.80 | 174.00 | 197.20 | 206.02 | 204.16 | 174.00 | 197.20 ||| |CALCIUM POLYCARBOPHIL 625 MG PO TABS|60 each|11046| 25.75 |||||||||| 16.74 | 17.51 | 18.80 | 18.80 | 20.09 | 15.45 | 16.74 | 19.31 | 21.89 | 22.87 | 22.66 | 19.31 | 21.89 ||| |POLYSACCHARIDE IRON COMPLEX 150 MG PO CAPS|1 capsule (1 each)|11050| 11.25 |||||||||| 7.31 | 7.65 | 8.21 | 8.21 | 8.78 | 6.75 | 7.31 | 8.44 | 9.56 | 9.99 | 9.90 | 8.44 | 9.56 ||| |HISTAMINE PHOSPHATE 2.75 MG/ML IJ SOLN|5 mL|110509| 497.20 |||||||||| 323.18 | 338.10 | 362.96 | 362.96 | 387.82 | 298.32 | 323.18 | 372.90 | 422.62 | 441.51 | 437.54 | 372.90 | 422.62 ||| |DARUNAVIR ETHANOLATE 800 MG PO TABS|30 each|110611| 3,687.70 |||||||||| 2,397.01 | 2,507.64 | 2,692.02 | 2,692.02 | 2,876.41 | 2,212.62 | 2,397.01 | 2,765.78 | 3,134.55 | 3,274.68 | 3,245.18 | 2,765.78 | 3,134.55 ||| |POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN|100 mL|11074| 140.00 |||||||||| 91.00 | 95.20 | 102.20 | 102.20 | 109.20 | 84.00 | 91.00 | 105.00 | 119.00 | 124.32 | 123.20 | 105.00 | 119.00 ||| |POTASSIUM CHLORIDE 10 MEQ/50ML IV SOLN|50 mL|11075| 40.05 |||||||||| 26.03 | 27.23 | 29.24 | 29.24 | 31.24 | 24.03 | 26.03 | 30.04 | 34.04 | 35.56 | 35.24 | 30.04 | 34.04 ||| |PRAMOXINE-HC 1-1 % EX FOAM|10 g|11105| 186.30 |||||||||| 121.10 | 126.68 | 136.00 | 136.00 | 145.31 | 111.78 | 121.10 | 139.73 | 158.36 | 165.43 | 163.94 | 139.73 | 158.36 ||| |INFUVITE ADULT IV INJ|10 mL|111207| 53.05 |||||||||| 34.48 | 36.07 | 38.73 | 38.73 | 41.38 | 31.83 | 34.48 | 39.79 | 45.09 | 47.11 | 46.68 | 39.79 | 45.09 ||| |BIVIGAM 10 GM/100ML IV SOLN|100 mL|111209| 2,733.55 |||||||||| 1,776.81 | 1,858.81 | 1,995.49 | 1,995.49 | 2,132.17 | 1,640.13 | 1,776.81 | 2,050.16 | 2,323.52 | 2,427.39 | 2,405.52 | 2,050.16 | 2,323.52 ||| |BIVIGAM 5 GM/50ML IV SOLN|50 mL|111210| 1,366.25 |||||||||| 888.06 | 929.05 | 997.36 | 997.36 | 1,065.68 | 819.75 | 888.06 | 1,024.69 | 1,161.31 | 1,213.23 | 1,202.30 | 1,024.69 | 1,161.31 ||| |APIXABAN 2.5 MG PO TABS|100 each|111333| 1,651.25 |||||||||| 1,073.31 | 1,122.85 | 1,205.41 | 1,205.41 | 1,287.98 | 990.75 | 1,073.31 | 1,238.44 | 1,403.56 | 1,466.31 | 1,453.10 | 1,238.44 | 1,403.56 ||| |PROCARBAZINE HCL 50 MG PO CAPS|100 mg (2 each)|11136| 428.60 |||||||||| 278.59 | 291.45 | 312.88 | 312.88 | 334.31 | 257.16 | 278.59 | 321.45 | 364.31 | 380.60 | 377.17 | 321.45 | 364.31 ||| |PROCARBAZINE HCL 50 MG PO CAPS|50 mg (1 each)|11136| 225.30 |||||||||| 146.45 | 153.20 | 164.47 | 164.47 | 175.73 | 135.18 | 146.45 | 168.98 | 191.51 | 200.07 | 198.26 | 168.98 | 191.51 ||| |APIXABAN 5 MG PO TABS|100 each|111366| 1,651.25 |||||||||| 1,073.31 | 1,122.85 | 1,205.41 | 1,205.41 | 1,287.98 | 990.75 | 1,073.31 | 1,238.44 | 1,403.56 | 1,466.31 | 1,453.10 | 1,238.44 | 1,403.56 ||| |PROCHLORPERAZINE 25 MG RE SUPP|12 each|11138| 239.10 |||||||||| 155.42 | 162.59 | 174.54 | 174.54 | 186.50 | 143.46 | 155.42 | 179.33 | 203.24 | 212.32 | 210.41 | 179.33 | 203.24 ||| |PROMETHAZINE HCL 12.5 MG RE SUPP|1 each|11143| 37.25 |||||||||| 24.21 | 25.33 | 27.19 | 27.19 | 29.06 | 22.35 | 24.21 | 27.94 | 31.66 | 33.08 | 32.78 | 27.94 | 31.66 ||| |PROMETHAZINE HCL 25 MG RE SUPP|1 each|11144| 37.25 |||||||||| 24.21 | 25.33 | 27.19 | 27.19 | 29.06 | 22.35 | 24.21 | 27.94 | 31.66 | 33.08 | 32.78 | 27.94 | 31.66 ||| |METANX 3-90.314-2-35 MG PO CAPS|1 capsule (1 each)|111866| 14.60 |||||||||| 9.49 | 9.93 | 10.66 | 10.66 | 11.39 | 8.76 | 9.49 | 10.95 | 12.41 | 12.96 | 12.85 | 10.95 | 12.41 ||| |PSEUDOEPHEDRINE-CODEINE-GG 30-10-100 MG/5ML PO SOLN|118 mL|11196| 229.00 |||||||||| 148.85 | 155.72 | 167.17 | 167.17 | 178.62 | 137.40 | 148.85 | 171.75 | 194.65 | 203.35 | 201.52 | 171.75 | 194.65 ||| |ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR|1 each|111970| 4,681.90 |||||||||| 3,043.24 | 3,183.69 | 3,417.79 | 3,417.79 | 3,651.88 | 2,809.14 | 3,043.24 | 3,511.43 | 3,979.62 | 4,157.53 | 4,120.07 | 3,511.43 | 3,979.62 ||| |ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR|1 each|111971| 7,491.05 |||||||||| 4,869.18 | 5,093.91 | 5,468.47 | 5,468.47 | 5,843.02 | 4,494.63 | 4,869.18 | 5,618.29 | 6,367.39 | 6,652.05 | 6,592.12 | 5,618.29 | 6,367.39 ||| |MORPHINE SULFATE ER 30 MG PO TBCR|100 each|112112| 250.85 |||||||||| 163.05 | 170.58 | 183.12 | 183.12 | 195.66 | 150.51 | 163.05 | 188.14 | 213.22 | 222.75 | 220.75 | 188.14 | 213.22 ||| |GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN|2 mL|112123| 60.40 |||||||||| 39.26 | 41.07 | 44.09 | 44.09 | 47.11 | 36.24 | 39.26 | 45.30 | 51.34 | 53.64 | 53.15 | 45.30 | 51.34 ||| |ATRACURIUM BESYLATE 50 MG/5ML IV SOLN|5 mL|112124| 47.60 |||||||||| 30.94 | 32.37 | 34.75 | 34.75 | 37.13 | 28.56 | 30.94 | 35.70 | 40.46 | 42.27 | 41.89 | 35.70 | 40.46 ||| |ATRACURIUM BESYLATE 100 MG/10ML IV SOLN|10 mL|112125| 64.15 |||||||||| 41.70 | 43.62 | 46.83 | 46.83 | 50.04 | 38.49 | 41.70 | 48.11 | 54.53 | 56.97 | 56.45 | 48.11 | 54.53 ||| |CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN|5 mL|112127| 56.60 |||||||||| 36.79 | 38.49 | 41.32 | 41.32 | 44.15 | 33.96 | 36.79 | 42.45 | 48.11 | 50.26 | 49.81 | 42.45 | 48.11 ||| |CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN|10 mL|112128| 73.55 |||||||||| 47.81 | 50.01 | 53.69 | 53.69 | 57.37 | 44.13 | 47.81 | 55.16 | 62.52 | 65.31 | 64.72 | 55.16 | 62.52 ||| |MORPHINE SULFATE ER 15 MG PO TBCR|100 each|112134| 142.35 |||||||||| 92.53 | 96.80 | 103.92 | 103.92 | 111.03 | 85.41 | 92.53 | 106.76 | 121.00 | 126.41 | 125.27 | 106.76 | 121.00 ||| |MORPHINE SULFATE ER 100 MG PO TBCR|100 each|112136| 614.05 |||||||||| 399.13 | 417.55 | 448.26 | 448.26 | 478.96 | 368.43 | 399.13 | 460.54 | 521.94 | 545.28 | 540.36 | 460.54 | 521.94 ||| |DRY MOUTH MOUTHWASH MT LIQD|473 mL|112247| 42.95 |||||||||| 27.92 | 29.21 | 31.35 | 31.35 | 33.50 | 25.77 | 27.92 | 32.21 | 36.51 | 38.14 | 37.80 | 32.21 | 36.51 ||| |QUINAPRIL HCL 20 MG PO TABS|90 each|11252| 53.25 |||||||||| 34.61 | 36.21 | 38.87 | 38.87 | 41.54 | 31.95 | 34.61 | 39.94 | 45.26 | 47.29 | 46.86 | 39.94 | 45.26 ||| |MEMANTINE HCL ER 7 MG PO CP24|30 each|112607| 986.85 |||||||||| 641.45 | 671.06 | 720.40 | 720.40 | 769.74 | 592.11 | 641.45 | 740.14 | 838.82 | 876.32 | 868.43 | 740.14 | 838.82 ||| |MEMANTINE HCL ER 14 MG PO CP24|30 each|112608| 986.85 |||||||||| 641.45 | 671.06 | 720.40 | 720.40 | 769.74 | 592.11 | 641.45 | 740.14 | 838.82 | 876.32 | 868.43 | 740.14 | 838.82 ||| |MEMANTINE HCL ER 21 MG PO CP24|30 each|112609| 986.85 |||||||||| 641.45 | 671.06 | 720.40 | 720.40 | 769.74 | 592.11 | 641.45 | 740.14 | 838.82 | 876.32 | 868.43 | 740.14 | 838.82 ||| |MEMANTINE HCL ER 28 MG PO CP24|30 each|112610| 986.85 |||||||||| 641.45 | 671.06 | 720.40 | 720.40 | 769.74 | 592.11 | 641.45 | 740.14 | 838.82 | 876.32 | 868.43 | 740.14 | 838.82 ||| |DOXYLAMINE-PYRIDOXINE 10-10 MG PO TBEC|1 tablet (1 each)|112616| 28.30 |||||||||| 18.40 | 19.24 | 20.66 | 20.66 | 22.07 | 16.98 | 18.40 | 21.23 | 24.06 | 25.13 | 24.90 | 21.23 | 24.06 ||| |DOXYLAMINE-PYRIDOXINE 10-10 MG PO TBEC|2 tablet (2 each)|112616| 44.60 |||||||||| 28.99 | 30.33 | 32.56 | 32.56 | 34.79 | 26.76 | 28.99 | 33.45 | 37.91 | 39.60 | 39.25 | 33.45 | 37.91 ||| |CANAGLIFLOZIN 100 MG PO TABS|90 each|112635| 3,251.55 |||||||||| 2,113.51 | 2,211.05 | 2,373.63 | 2,373.63 | 2,536.21 | 1,950.93 | 2,113.51 | 2,438.66 | 2,763.82 | 2,887.38 | 2,861.36 | 2,438.66 | 2,763.82 ||| |CANAGLIFLOZIN 300 MG PO TABS|30 each|112636| 1,098.45 |||||||||| 713.99 | 746.95 | 801.87 | 801.87 | 856.79 | 659.07 | 713.99 | 823.84 | 933.68 | 975.42 | 966.64 | 823.84 | 933.68 ||| |DEXMEDETOMIDINE HCL IN NACL 200 MCG/50ML IV SOLN|50 mL|112756| 316.20 |||||||||| 205.53 | 215.02 | 230.83 | 230.83 | 246.64 | 189.72 | 205.53 | 237.15 | 268.77 | 280.79 | 278.26 | 237.15 | 268.77 ||| |DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN|100 mL|112757| 350.00 |||||||||| 227.50 | 238.00 | 255.50 | 255.50 | 273.00 | 210.00 | 227.50 | 262.50 | 297.50 | 310.80 | 308.00 | 262.50 | 297.50 ||| |RIBAVIRIN 200 MG PO TABS|168 each|11287| 235.80 |||||||||| 153.27 | 160.34 | 172.13 | 172.13 | 183.92 | 141.48 | 153.27 | 176.85 | 200.43 | 209.39 | 207.50 | 176.85 | 200.43 ||| |RIFABUTIN 150 MG PO CAPS|150 mg (1 each)|11290| 61.80 |||||||||| 40.17 | 42.02 | 45.11 | 45.11 | 48.20 | 37.08 | 40.17 | 46.35 | 52.53 | 54.88 | 54.38 | 46.35 | 52.53 ||| |RIFABUTIN 150 MG PO CAPS|300 mg (2 each)|11290| 101.60 |||||||||| 66.04 | 69.09 | 74.17 | 74.17 | 79.25 | 60.96 | 66.04 | 76.20 | 86.36 | 90.22 | 89.41 | 76.20 | 86.36 ||| |RIFAMPIN 150 MG PO CAPS|30 each|11292| 223.95 |||||||||| 145.57 | 152.29 | 163.48 | 163.48 | 174.68 | 134.37 | 145.57 | 167.96 | 190.36 | 198.87 | 197.08 | 167.96 | 190.36 ||| |ARTIFICIAL TEARS 83-15 % OP OINT|3.5 g|113325| 41.80 |||||||||| 27.17 | 28.42 | 30.51 | 30.51 | 32.60 | 25.08 | 27.17 | 31.35 | 35.53 | 37.12 | 36.78 | 31.35 | 35.53 ||| |PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT|500 Units|113343| 2,568.15 |||||||||| 1,669.30 | 1,746.34 | 1,874.75 | 1,874.75 | 2,003.16 | 1,540.89 | 1,669.30 | 1,926.11 | 2,182.93 | 2,280.52 | 2,259.97 | 1,926.11 | 2,182.93 ||| |SODIUM GLYCEROPHOSPHATE 1 MMOLE/ML IV SOLN|20 mL|113347| 58.50 |||||||||| 38.03 | 39.78 | 42.71 | 42.71 | 45.63 | 35.10 | 38.03 | 43.88 | 49.73 | 51.95 | 51.48 | 43.88 | 49.73 ||| |IMMUNE GLOBULIN (HUMAN) 40 GM/400ML IV SOLN|400 mL|113370| 11,916.10 |||||||||| 7,745.47 | 8,102.95 | 8,698.75 | 8,698.75 | 9,294.56 | 7,149.66 | 7,745.47 | 8,937.08 | 10,128.69 | 10,581.50 | 10,486.17 | 8,937.08 | 10,128.69 ||| |SELEGILINE HCL 5 MG PO TABS|10 mg (2 each)|11340| 23.15 |||||||||| 15.05 | 15.74 | 16.90 | 16.90 | 18.06 | 13.89 | 15.05 | 17.36 | 19.68 | 20.56 | 20.37 | 17.36 | 19.68 ||| |SELEGILINE HCL 5 MG PO TABS|5 mg (1 each)|11340| 14.10 |||||||||| 9.17 | 9.59 | 10.29 | 10.29 | 11.00 | 8.46 | 9.17 | 10.58 | 11.99 | 12.52 | 12.41 | 10.58 | 11.99 ||| |SILVER NITRATE-POT NITRATE 75-25 % EX MISC|1 each|11359| 35.15 |||||||||| 22.85 | 23.90 | 25.66 | 25.66 | 27.42 | 21.09 | 22.85 | 26.36 | 29.88 | 31.21 | 30.93 | 26.36 | 29.88 ||| |INFLUENZA VIRUS VAC LIVE QUAD NA SUSP|1 each|113634| 78.65 |||||||||| 51.12 | 53.48 | 57.41 | 57.41 | 61.35 | 47.19 | 51.12 | 58.99 | 66.85 | 69.84 | 69.21 | 58.99 | 66.85 ||| |SINCALIDE 5 MCG IJ SOLR|1 each|11368| 224.45 |||||||||| 145.89 | 152.63 | 163.85 | 163.85 | 175.07 | 134.67 | 145.89 | 168.34 | 190.78 | 199.31 | 197.52 | 168.34 | 190.78 ||| |NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN|10 mL|113684| 68.60 |||||||||| 44.59 | 46.65 | 50.08 | 50.08 | 53.51 | 41.16 | 44.59 | 51.45 | 58.31 | 60.92 | 60.37 | 51.45 | 58.31 ||| |FLUTICASONE FUROATE-VILANTEROL 100-25 MCG/INH IN AEPB|28 each|113860| 296.40 |||||||||| 192.66 | 201.55 | 216.37 | 216.37 | 231.19 | 177.84 | 192.66 | 222.30 | 251.94 | 263.20 | 260.83 | 222.30 | 251.94 ||| |NIMODIPINE 60 MG/20ML PO SOLN|20 mL|113861| 191.70 |||||||||| 124.61 | 130.36 | 139.94 | 139.94 | 149.53 | 115.02 | 124.61 | 143.78 | 162.95 | 170.23 | 168.70 | 143.78 | 162.95 ||| |FENOFIBRIC ACID 135 MG PO CPDR|90 each|114007| 852.70 |||||||||| 554.26 | 579.84 | 622.47 | 622.47 | 665.11 | 511.62 | 554.26 | 639.53 | 724.80 | 757.20 | 750.38 | 639.53 | 724.80 ||| |SODIUM CHLORIDE 0.9 % IR SOLN|500 mL|11403| 199.50 |||||||||| 129.68 | 135.66 | 145.64 | 145.64 | 155.61 | 119.70 | 129.68 | 149.63 | 169.58 | 177.16 | 175.56 | 149.63 | 169.58 ||| |SODIUM SACCHARIN POWD|1000 g|11409| 4,252.90 |||||||||| 2,764.39 | 2,891.97 | 3,104.62 | 3,104.62 | 3,317.26 | 2,551.74 | 2,764.39 | 3,189.68 | 3,614.97 | 3,776.58 | 3,742.55 | 3,189.68 | 3,614.97 ||| |GOLIMUMAB 50 MG/4ML IV SOLN|4 mL|114101| 3,919.25 |||||||||| 2,547.51 | 2,665.09 | 2,861.05 | 2,861.05 | 3,057.02 | 2,351.55 | 2,547.51 | 2,939.44 | 3,331.36 | 3,480.29 | 3,448.94 | 2,939.44 | 3,331.36 ||| |FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN|15 mL|114123| 2,388.00 |||||||||| 1,552.20 | 1,623.84 | 1,743.24 | 1,743.24 | 1,862.64 | 1,432.80 | 1,552.20 | 1,791.00 | 2,029.80 | 2,120.54 | 2,101.44 | 1,791.00 | 2,029.80 ||| |VINCRISTINE SULFATE LIPOSOME 5 MG/31ML IV SUSP|1 each|114323| 23,246.10 |||||||||| 15,109.97 | 15,807.35 | 16,969.65 | 16,969.65 | 18,131.96 | 13,947.66 | 15,109.97 | 17,434.58 | 19,759.19 | 20,642.54 | 20,456.57 | 17,434.58 | 19,759.19 ||| |STREPTOZOCIN 1 G IV SOLR|1 each|11436| 725.05 |||||||||| 471.28 | 493.03 | 529.29 | 529.29 | 565.54 | 435.03 | 471.28 | 543.79 | 616.29 | 643.84 | 638.04 | 543.79 | 616.29 ||| |CLOBAZAM 2.5 MG/ML PO SUSP|120 mL|114364| 188.20 |||||||||| 122.33 | 127.98 | 137.39 | 137.39 | 146.80 | 112.92 | 122.33 | 141.15 | 159.97 | 167.12 | 165.62 | 141.15 | 159.97 ||| |DOLUTEGRAVIR SODIUM 50 MG PO TABS|50 mg (1 each)|114457| 148.40 |||||||||| 96.46 | 100.91 | 108.33 | 108.33 | 115.75 | 89.04 | 96.46 | 111.30 | 126.14 | 131.78 | 130.59 | 111.30 | 126.14 ||| |SULFACETAMIDE-PREDNISOLONE 10-0.2 % OP SUSP|5 mL|11452| 321.55 |||||||||| 209.01 | 218.65 | 234.73 | 234.73 | 250.81 | 192.93 | 209.01 | 241.16 | 273.32 | 285.54 | 282.96 | 241.16 | 273.32 ||| |DEXAMETHASONE SODIUM PHOSPHATE 100 MG/10ML IJ SOLN|10 mL|114723| 41.55 |||||||||| 27.01 | 28.25 | 30.33 | 30.33 | 32.41 | 24.93 | 27.01 | 31.16 | 35.32 | 36.90 | 36.56 | 31.16 | 35.32 ||| |HYLAN 16 MG/2ML IX SOSY|2 mL|114737| 893.35 |||||||||| 580.68 | 607.48 | 652.15 | 652.15 | 696.81 | 536.01 | 580.68 | 670.01 | 759.35 | 793.29 | 786.15 | 670.01 | 759.35 ||| |ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN|2 mL|114740| 193.15 |||||||||| 125.55 | 131.34 | 141.00 | 141.00 | 150.66 | 115.89 | 125.55 | 144.86 | 164.18 | 171.52 | 169.97 | 144.86 | 164.18 ||| |MILRINONE LACTATE 10 MG/10ML IV SOLN|10 mL|114746| 200.15 |||||||||| 130.10 | 136.10 | 146.11 | 146.11 | 156.12 | 120.09 | 130.10 | 150.11 | 170.13 | 177.73 | 176.13 | 150.11 | 170.13 ||| |MILRINONE LACTATE 20 MG/20ML IV SOLN|20 mL|114747| 268.55 |||||||||| 174.56 | 182.61 | 196.04 | 196.04 | 209.47 | 161.13 | 174.56 | 201.41 | 228.27 | 238.47 | 236.32 | 201.41 | 228.27 ||| |ETOPOSIDE 500 MG/25ML IV SOLN|25 mL|114750| 56.40 |||||||||| 36.66 | 38.35 | 41.17 | 41.17 | 43.99 | 33.84 | 36.66 | 42.30 | 47.94 | 50.08 | 49.63 | 42.30 | 47.94 ||| |OXYCODONE HCL ER 15 MG PO T12A|20 each|114760| 251.30 |||||||||| 163.35 | 170.88 | 183.45 | 183.45 | 196.01 | 150.78 | 163.35 | 188.48 | 213.61 | 223.15 | 221.14 | 188.48 | 213.61 ||| |DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN|2 mL|114942| 142.65 |||||||||| 92.72 | 97.00 | 104.13 | 104.13 | 111.27 | 85.59 | 92.72 | 106.99 | 121.25 | 126.67 | 125.53 | 106.99 | 121.25 ||| |BORTEZOMIB 3.5 MG IJ SOLR|1 each|114963| 2,379.20 |||||||||| 1,546.48 | 1,617.86 | 1,736.82 | 1,736.82 | 1,855.78 | 1,427.52 | 1,546.48 | 1,784.40 | 2,022.32 | 2,112.73 | 2,093.70 | 1,784.40 | 2,022.32 ||| |TEMAZEPAM 7.5 MG PO CAPS|30 each|11500| 359.10 |||||||||| 233.42 | 244.19 | 262.14 | 262.14 | 280.10 | 215.46 | 233.42 | 269.33 | 305.24 | 318.88 | 316.01 | 269.33 | 305.24 ||| |TENIPOSIDE 10 MG/ML IV SOLN|5 mL|11501| 5,181.60 |||||||||| 3,368.04 | 3,523.49 | 3,782.57 | 3,782.57 | 4,041.65 | 3,108.96 | 3,368.04 | 3,886.20 | 4,404.36 | 4,601.26 | 4,559.81 | 3,886.20 | 4,404.36 ||| |VORTIOXETINE HBR 5 MG PO TABS|30 each|115156| 858.30 |||||||||| 557.90 | 583.64 | 626.56 | 626.56 | 669.47 | 514.98 | 557.90 | 643.73 | 729.56 | 762.17 | 755.30 | 643.73 | 729.56 ||| |VORTIOXETINE HBR 10 MG PO TABS|30 each|115157| 858.30 |||||||||| 557.90 | 583.64 | 626.56 | 626.56 | 669.47 | 514.98 | 557.90 | 643.73 | 729.56 | 762.17 | 755.30 | 643.73 | 729.56 ||| |TETRACAINE HCL 1 % IJ SOLN|2 mL|11517| 176.95 |||||||||| 115.02 | 120.33 | 129.17 | 129.17 | 138.02 | 106.17 | 115.02 | 132.71 | 150.41 | 157.13 | 155.72 | 132.71 | 150.41 ||| |MULTIVITAMINS PO CHEW|1 tablet (1 each)|115218| 11.20 |||||||||| 7.28 | 7.62 | 8.18 | 8.18 | 8.74 | 6.72 | 7.28 | 8.40 | 9.52 | 9.95 | 9.86 | 8.40 | 9.52 ||| |TOCILIZUMAB 162 MG/0.9ML SC SOSY|.9 mL|115294| 2,146.35 |||||||||| 1,395.13 | 1,459.52 | 1,566.84 | 1,566.84 | 1,674.15 | 1,287.81 | 1,395.13 | 1,609.76 | 1,824.40 | 1,905.96 | 1,888.79 | 1,609.76 | 1,824.40 ||| |SUCCINYLCHOLINE CHLORIDE 20 MG/ML PREFILLED SYRINGE|10 mL|115333| 70.15 |||||||||| 45.60 | 47.70 | 51.21 | 51.21 | 54.72 | 42.09 | 45.60 | 52.61 | 59.63 | 62.29 | 61.73 | 52.61 | 59.63 ||| |PHENYLEPHRINE-MINERAL OIL-PET 0.25-14-74.9 % RE OINT|57 g|115338| 41.00 |||||||||| 26.65 | 27.88 | 29.93 | 29.93 | 31.98 | 24.60 | 26.65 | 30.75 | 34.85 | 36.41 | 36.08 | 30.75 | 34.85 ||| |DOCETAXEL 20 MG/ML IV CONC|1 mL|115394| 111.35 |||||||||| 72.38 | 75.72 | 81.29 | 81.29 | 86.85 | 66.81 | 72.38 | 83.51 | 94.65 | 98.88 | 97.99 | 83.51 | 94.65 ||| |THROMBIN 5000 UNITS EX SOLR|1 each|11548| 169.10 |||||||||| 109.92 | 114.99 | 123.44 | 123.44 | 131.90 | 101.46 | 109.92 | 126.83 | 143.74 | 150.16 | 148.81 | 126.83 | 143.74 ||| |GEMCITABINE HCL 2 G IV SOLR|1 each|115606| 191.05 |||||||||| 124.18 | 129.91 | 139.47 | 139.47 | 149.02 | 114.63 | 124.18 | 143.29 | 162.39 | 169.65 | 168.12 | 143.29 | 162.39 ||| |ULIPRISTAL ACETATE 30 MG PO TABS|1 each|115609| 96.25 |||||||||| 62.56 | 65.45 | 70.26 | 70.26 | 75.08 | 57.75 | 62.56 | 72.19 | 81.81 | 85.47 | 84.70 | 72.19 | 81.81 ||| |TIMOLOL MALEATE 0.25 % OP SOLN|5 mL|11561| 43.75 |||||||||| 28.44 | 29.75 | 31.94 | 31.94 | 34.13 | 26.25 | 28.44 | 32.81 | 37.19 | 38.85 | 38.50 | 32.81 | 37.19 ||| |TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT|3.5 g|11566| 463.60 |||||||||| 301.34 | 315.25 | 338.43 | 338.43 | 361.61 | 278.16 | 301.34 | 347.70 | 394.06 | 411.68 | 407.97 | 347.70 | 394.06 ||| |ERIBULIN MESYLATE 1 MG/2ML IV SOLN|2 mL|115833| 1,751.40 |||||||||| 1,138.41 | 1,190.95 | 1,278.52 | 1,278.52 | 1,366.09 | 1,050.84 | 1,138.41 | 1,313.55 | 1,488.69 | 1,555.24 | 1,541.23 | 1,313.55 | 1,488.69 ||| |TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP|5 mL|11584| 56.80 |||||||||| 36.92 | 38.62 | 41.46 | 41.46 | 44.30 | 34.08 | 36.92 | 42.60 | 48.28 | 50.44 | 49.98 | 42.60 | 48.28 ||| |FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR|1 each|115843| 658.05 |||||||||| 427.73 | 447.47 | 480.38 | 480.38 | 513.28 | 394.83 | 427.73 | 493.54 | 559.34 | 584.35 | 579.08 | 493.54 | 559.34 ||| |DENOSUMAB 120 MG/1.7ML SC SOLN|1.7 mL|115864| 3,491.25 |||||||||| 2,269.31 | 2,374.05 | 2,548.61 | 2,548.61 | 2,723.18 | 2,094.75 | 2,269.31 | 2,618.44 | 2,967.56 | 3,100.23 | 3,072.30 | 2,618.44 | 2,967.56 ||| |TRIFLURIDINE 1 % OP SOLN|7.5 mL|11595| 369.75 |||||||||| 240.34 | 251.43 | 269.92 | 269.92 | 288.41 | 221.85 | 240.34 | 277.31 | 314.29 | 328.34 | 325.38 | 277.31 | 314.29 ||| |FENTANYL-BUPIVACAINE 3-0.0625 MCG/ML-% IN NACL IJ SOLN|250 mL|116074| 266.80 |||||||||| 173.42 | 181.42 | 194.76 | 194.76 | 208.10 | 160.08 | 173.42 | 200.10 | 226.78 | 236.92 | 234.78 | 200.10 | 226.78 ||| |ACETAMINOPHEN 10 MG/ML IV SOLN|100 mL|116082| 123.25 |||||||||| 80.11 | 83.81 | 89.97 | 89.97 | 96.14 | 73.95 | 80.11 | 92.44 | 104.76 | 109.45 | 108.46 | 92.44 | 104.76 ||| |BUPRENORPHINE 10 MCG/HR TD PTWK|1 patch (1 each)|116091| 189.20 |||||||||| 122.98 | 128.66 | 138.12 | 138.12 | 147.58 | 113.52 | 122.98 | 141.90 | 160.82 | 168.01 | 166.50 | 141.90 | 160.82 ||| |CLONIDINE HCL ER 0.1 MG PO TB12|60 each|116096| 437.20 |||||||||| 284.18 | 297.30 | 319.16 | 319.16 | 341.02 | 262.32 | 284.18 | 327.90 | 371.62 | 388.23 | 384.74 | 327.90 | 371.62 ||| |LURASIDONE HCL 40 MG PO TABS|1 each|116099| 110.85 |||||||||| 72.05 | 75.38 | 80.92 | 80.92 | 86.46 | 66.51 | 72.05 | 83.14 | 94.22 | 98.43 | 97.55 | 83.14 | 94.22 ||| |LURASIDONE HCL 80 MG PO TABS|30 each|116100| 2,686.35 |||||||||| 1,746.13 | 1,826.72 | 1,961.04 | 1,961.04 | 2,095.35 | 1,611.81 | 1,746.13 | 2,014.76 | 2,283.40 | 2,385.48 | 2,363.99 | 2,014.76 | 2,283.40 ||| |CEFTAROLINE FOSAMIL 400 MG IV SOLR|1 each|116101| 483.70 |||||||||| 314.41 | 328.92 | 353.10 | 353.10 | 377.29 | 290.22 | 314.41 | 362.78 | 411.15 | 429.53 | 425.66 | 362.78 | 411.15 ||| |CEFTAROLINE FOSAMIL 600 MG IV SOLR|1 each|116102| 430.10 |||||||||| 279.57 | 292.47 | 313.97 | 313.97 | 335.48 | 258.06 | 279.57 | 322.58 | 365.59 | 381.93 | 378.49 | 322.58 | 365.59 ||| |DEXTROMETHORPHAN-QUINIDINE 20-10 MG PO CAPS|1 capsule (1 each)|116103| 65.30 |||||||||| 42.45 | 44.40 | 47.67 | 47.67 | 50.93 | 39.18 | 42.45 | 48.98 | 55.51 | 57.99 | 57.46 | 48.98 | 55.51 ||| |IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IJ SOLN|100 mL|116184| 2,956.25 |||||||||| 1,921.56 | 2,010.25 | 2,158.06 | 2,158.06 | 2,305.88 | 1,773.75 | 1,921.56 | 2,217.19 | 2,512.81 | 2,625.15 | 2,601.50 | 2,217.19 | 2,512.81 ||| |GAMUNEX-C 20 GM/200ML IJ SOLN|200 mL|116210| 4,898.35 |||||||||| 3,183.93 | 3,330.88 | 3,575.80 | 3,575.80 | 3,820.71 | 2,939.01 | 3,183.93 | 3,673.76 | 4,163.60 | 4,349.73 | 4,310.55 | 3,673.76 | 4,163.60 ||| |GAMUNEX-C 10 GM/100ML IJ SOLN|100 mL|116211| 2,449.20 |||||||||| 1,591.98 | 1,665.46 | 1,787.92 | 1,787.92 | 1,910.38 | 1,469.52 | 1,591.98 | 1,836.90 | 2,081.82 | 2,174.89 | 2,155.30 | 1,836.90 | 2,081.82 ||| |GLYCOPYRROLATE 1 MG/5ML PO SOLN|473 mL|116262| 1,058.95 |||||||||| 688.32 | 720.09 | 773.03 | 773.03 | 825.98 | 635.37 | 688.32 | 794.21 | 900.11 | 940.35 | 931.88 | 794.21 | 900.11 ||| |HEMORRHOIDAL HYGIENE 50 % EX PADS|100 each|116273| 40.40 |||||||||| 26.26 | 27.47 | 29.49 | 29.49 | 31.51 | 24.24 | 26.26 | 30.30 | 34.34 | 35.88 | 35.55 | 30.30 | 34.34 ||| |VANCOMYCIN HCL 125 MG PO CAPS|20 each|11628| 1,226.10 |||||||||| 796.97 | 833.75 | 895.05 | 895.05 | 956.36 | 735.66 | 796.97 | 919.58 | 1,042.19 | 1,088.78 | 1,078.97 | 919.58 | 1,042.19 ||| |VANCOMYCIN HCL 50 MG/ML PO SOLR|300 mL|11630| 405.95 |||||||||| 263.87 | 276.05 | 296.34 | 296.34 | 316.64 | 243.57 | 263.87 | 304.46 | 345.06 | 360.48 | 357.24 | 304.46 | 345.06 ||| |WARFARIN SODIUM 1 MG PO TABS|1 each|11664| 11.80 |||||||||| 7.67 | 8.02 | 8.61 | 8.61 | 9.20 | 7.08 | 7.67 | 8.85 | 10.03 | 10.48 | 10.38 | 8.85 | 10.03 ||| |PURALUBE 85-15 % OP OINT|1 g|116688| 23.20 |||||||||| 15.08 | 15.78 | 16.94 | 16.94 | 18.10 | 13.92 | 15.08 | 17.40 | 19.72 | 20.60 | 20.42 | 17.40 | 19.72 ||| |ZIDOVUDINE 100 MG PO CAPS|100 mg (1 each)|11692| 14.15 |||||||||| 9.20 | 9.62 | 10.33 | 10.33 | 11.04 | 8.49 | 9.20 | 10.61 | 12.03 | 12.57 | 12.45 | 10.61 | 12.03 ||| |ZIDOVUDINE 100 MG PO CAPS|200 mg (2 each)|11692| 23.30 |||||||||| 15.15 | 15.84 | 17.01 | 17.01 | 18.17 | 13.98 | 15.15 | 17.48 | 19.81 | 20.69 | 20.50 | 17.48 | 19.81 ||| |ZIDOVUDINE 100 MG PO CAPS|300 mg (3 each)|11692| 26.45 |||||||||| 17.19 | 17.99 | 19.31 | 19.31 | 20.63 | 15.87 | 17.19 | 19.84 | 22.48 | 23.49 | 23.28 | 19.84 | 22.48 ||| |FENTANYL PCA 50 MCG/ML PREMIX|50 mL|117131| 223.00 |||||||||| 144.95 | 151.64 | 162.79 | 162.79 | 173.94 | 133.80 | 144.95 | 167.25 | 189.55 | 198.02 | 196.24 | 167.25 | 189.55 ||| |FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN|.4 mL|117212| 227.70 |||||||||| 148.01 | 154.84 | 166.22 | 166.22 | 177.61 | 136.62 | 148.01 | 170.78 | 193.55 | 202.20 | 200.38 | 170.78 | 193.55 ||| |FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN|.6 mL|117213| 144.15 |||||||||| 93.70 | 98.02 | 105.23 | 105.23 | 112.44 | 86.49 | 93.70 | 108.11 | 122.53 | 128.01 | 126.85 | 108.11 | 122.53 ||| |FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN|.8 mL|117214| 280.35 |||||||||| 182.23 | 190.64 | 204.66 | 204.66 | 218.67 | 168.21 | 182.23 | 210.26 | 238.30 | 248.95 | 246.71 | 210.26 | 238.30 ||| |PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSP|2 mL|117232| 358.10 |||||||||| 232.77 | 243.51 | 261.41 | 261.41 | 279.32 | 214.86 | 232.77 | 268.58 | 304.39 | 317.99 | 315.13 | 268.58 | 304.39 ||| |PENICILLIN G BENZATHINE 2400000 UNIT/4ML IM SUSP|4 mL|117233| 698.05 |||||||||| 453.73 | 474.67 | 509.58 | 509.58 | 544.48 | 418.83 | 453.73 | 523.54 | 593.34 | 619.87 | 614.28 | 523.54 | 593.34 ||| |PENICILLIN G BENZATHINE & PROC 1200000 UNIT/2ML IM SUSP|2 mL|117234| 292.35 |||||||||| 190.03 | 198.80 | 213.42 | 213.42 | 228.03 | 175.41 | 190.03 | 219.26 | 248.50 | 259.61 | 257.27 | 219.26 | 248.50 ||| |PANITUMUMAB 100 MG/5ML IV SOLN|5 mL|117238| 2,663.50 |||||||||| 1,731.28 | 1,811.18 | 1,944.36 | 1,944.36 | 2,077.53 | 1,598.10 | 1,731.28 | 1,997.63 | 2,263.98 | 2,365.19 | 2,343.88 | 1,997.63 | 2,263.98 ||| |PANITUMUMAB 400 MG/20ML IV SOLN|20 mL|117240| 10,653.95 |||||||||| 6,925.07 | 7,244.69 | 7,777.38 | 7,777.38 | 8,310.08 | 6,392.37 | 6,925.07 | 7,990.46 | 9,055.86 | 9,460.71 | 9,375.48 | 7,990.46 | 9,055.86 ||| |ERTAPENEM SODIUM 1 G IV SOLR|1 each|117242| 332.60 |||||||||| 216.19 | 226.17 | 242.80 | 242.80 | 259.43 | 199.56 | 216.19 | 249.45 | 282.71 | 295.35 | 292.69 | 249.45 | 282.71 ||| |PALIVIZUMAB 50 MG/0.5ML IM SOLN|.5 mL|117243| 3,232.20 |||||||||| 2,100.93 | 2,197.90 | 2,359.51 | 2,359.51 | 2,521.12 | 1,939.32 | 2,100.93 | 2,424.15 | 2,747.37 | 2,870.19 | 2,844.34 | 2,424.15 | 2,747.37 ||| |TOCILIZUMAB 80 MG/4ML IV SOLN|4 mL|117244| 957.40 |||||||||| 622.31 | 651.03 | 698.90 | 698.90 | 746.77 | 574.44 | 622.31 | 718.05 | 813.79 | 850.17 | 842.51 | 718.05 | 813.79 ||| |TOCILIZUMAB 200 MG/10ML IV SOLN|10 mL|117245| 2,393.45 |||||||||| 1,555.74 | 1,627.55 | 1,747.22 | 1,747.22 | 1,866.89 | 1,436.07 | 1,555.74 | 1,795.09 | 2,034.43 | 2,125.38 | 2,106.24 | 1,795.09 | 2,034.43 ||| |TOCILIZUMAB 400 MG/20ML IV SOLN|20 mL|117246| 4,786.85 |||||||||| 3,111.45 | 3,255.06 | 3,494.40 | 3,494.40 | 3,733.74 | 2,872.11 | 3,111.45 | 3,590.14 | 4,068.82 | 4,250.72 | 4,212.43 | 3,590.14 | 4,068.82 ||| |BEVACIZUMAB 100 MG/4ML IV SOLN|4 mL|117248| 1,654.45 |||||||||| 1,075.39 | 1,125.03 | 1,207.75 | 1,207.75 | 1,290.47 | 992.67 | 1,075.39 | 1,240.84 | 1,406.28 | 1,469.15 | 1,455.92 | 1,240.84 | 1,406.28 ||| |BEVACIZUMAB 400 MG/16ML IV SOLN|16 mL|117249| 4,731.30 |||||||||| 3,075.35 | 3,217.28 | 3,453.85 | 3,453.85 | 3,690.41 | 2,838.78 | 3,075.35 | 3,548.48 | 4,021.61 | 4,201.39 | 4,163.54 | 3,548.48 | 4,021.61 ||| |PRALATREXATE 40 MG/2ML IV SOLN|2 mL|117256| 24,415.95 |||||||||| 15,870.37 | 16,602.85 | 17,823.64 | 17,823.64 | 19,044.44 | 14,649.57 | 15,870.37 | 18,311.96 | 20,753.56 | 21,681.36 | 21,486.04 | 18,311.96 | 20,753.56 ||| |IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IV SOLN|50 mL|117270| 1,489.55 |||||||||| 968.21 | 1,012.89 | 1,087.37 | 1,087.37 | 1,161.85 | 893.73 | 968.21 | 1,117.16 | 1,266.12 | 1,322.72 | 1,310.80 | 1,117.16 | 1,266.12 ||| |IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IV SOLN|100 mL|117271| 2,979.05 |||||||||| 1,936.38 | 2,025.75 | 2,174.71 | 2,174.71 | 2,323.66 | 1,787.43 | 1,936.38 | 2,234.29 | 2,532.19 | 2,645.40 | 2,621.56 | 2,234.29 | 2,532.19 ||| |IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IV SOLN|200 mL|117272| 5,958.05 |||||||||| 3,872.73 | 4,051.47 | 4,349.38 | 4,349.38 | 4,647.28 | 3,574.83 | 3,872.73 | 4,468.54 | 5,064.34 | 5,290.75 | 5,243.08 | 4,468.54 | 5,064.34 ||| |FULVESTRANT 250 MG/5ML IM SOLN|5 mL|117279| 1,811.50 |||||||||| 1,177.48 | 1,231.82 | 1,322.40 | 1,322.40 | 1,412.97 | 1,086.90 | 1,177.48 | 1,358.63 | 1,539.78 | 1,608.61 | 1,594.12 | 1,358.63 | 1,539.78 ||| |HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP|.5 mL|117296| 79.10 |||||||||| 51.42 | 53.79 | 57.74 | 57.74 | 61.70 | 47.46 | 51.42 | 59.33 | 67.24 | 70.24 | 69.61 | 59.33 | 67.24 ||| |LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN|50 mL|117301| 143.80 |||||||||| 93.47 | 97.78 | 104.97 | 104.97 | 112.16 | 86.28 | 93.47 | 107.85 | 122.23 | 127.69 | 126.54 | 107.85 | 122.23 ||| |PIPERACILLIN-TAZOBACTAM IN DEX 4-0.5 GM/100ML IV SOLN|100 mL|117304| 171.60 |||||||||| 111.54 | 116.69 | 125.27 | 125.27 | 133.85 | 102.96 | 111.54 | 128.70 | 145.86 | 152.38 | 151.01 | 128.70 | 145.86 ||| |DOCETAXEL 80 MG/4ML IV CONC|4 mL|117305| 176.50 |||||||||| 114.73 | 120.02 | 128.85 | 128.85 | 137.67 | 105.90 | 114.73 | 132.38 | 150.03 | 156.73 | 155.32 | 132.38 | 150.03 ||| |POLIOVIRUS VACCINE INACTIVATED IJ INJ|5 mL|117310| 695.95 |||||||||| 452.37 | 473.25 | 508.04 | 508.04 | 542.84 | 417.57 | 452.37 | 521.96 | 591.56 | 618.00 | 612.44 | 521.96 | 591.56 ||| |CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN|100 mL|117311| 138.10 |||||||||| 89.77 | 93.91 | 100.81 | 100.81 | 107.72 | 82.86 | 89.77 | 103.58 | 117.39 | 122.63 | 121.53 | 103.58 | 117.39 ||| |AMIKACIN SULFATE 500 MG/2ML IJ SOLN|2 mL|117312| 57.10 |||||||||| 37.12 | 38.83 | 41.68 | 41.68 | 44.54 | 34.26 | 37.12 | 42.83 | 48.54 | 50.70 | 50.25 | 42.83 | 48.54 ||| |CARBONYL IRON 45 MG PO TABS|45 mg (1 each)|117322| 11.35 |||||||||| 7.38 | 7.72 | 8.29 | 8.29 | 8.85 | 6.81 | 7.38 | 8.51 | 9.65 | 10.08 | 9.99 | 8.51 | 9.65 ||| |BACLOFEN 10 MG/20ML IT SOLN|20 mL|117331| 478.80 |||||||||| 311.22 | 325.58 | 349.52 | 349.52 | 373.46 | 287.28 | 311.22 | 359.10 | 406.98 | 425.17 | 421.34 | 359.10 | 406.98 ||| |BACLOFEN 40 MG/20ML IT SOLN|20 mL|117333| 1,813.05 |||||||||| 1,178.48 | 1,232.87 | 1,323.53 | 1,323.53 | 1,414.18 | 1,087.83 | 1,178.48 | 1,359.79 | 1,541.09 | 1,609.99 | 1,595.48 | 1,359.79 | 1,541.09 ||| |BELIMUMAB 120 MG IV SOLR|1 each|117532| 1,113.30 |||||||||| 723.65 | 757.04 | 812.71 | 812.71 | 868.37 | 667.98 | 723.65 | 834.98 | 946.31 | 988.61 | 979.70 | 834.98 | 946.31 ||| |BELIMUMAB 400 MG IV SOLR|1 each|117533| 3,710.90 |||||||||| 2,412.09 | 2,523.41 | 2,708.96 | 2,708.96 | 2,894.50 | 2,226.54 | 2,412.09 | 2,783.18 | 3,154.27 | 3,295.28 | 3,265.59 | 2,783.18 | 3,154.27 ||| |DOCETAXEL 80 MG/8ML IV SOLN|8 mL|117597| 994.00 |||||||||| 646.10 | 675.92 | 725.62 | 725.62 | 775.32 | 596.40 | 646.10 | 745.50 | 844.90 | 882.67 | 874.72 | 745.50 | 844.90 ||| |DOCETAXEL 160 MG/16ML IV SOLN|16 mL|117598| 1,421.30 |||||||||| 923.85 | 966.48 | 1,037.55 | 1,037.55 | 1,108.61 | 852.78 | 923.85 | 1,065.98 | 1,208.11 | 1,262.11 | 1,250.74 | 1,065.98 | 1,208.11 ||| |DOCETAXEL 20 MG/2ML IV SOLN|2 mL|117600| 102.05 |||||||||| 66.33 | 69.39 | 74.50 | 74.50 | 79.60 | 61.23 | 66.33 | 76.54 | 86.74 | 90.62 | 89.80 | 76.54 | 86.74 ||| |IPILIMUMAB 50 MG/10ML IV SOLN|10 mL|117645| 11,133.60 |||||||||| 7,236.84 | 7,570.85 | 8,127.53 | 8,127.53 | 8,684.21 | 6,680.16 | 7,236.84 | 8,350.20 | 9,463.56 | 9,886.64 | 9,797.57 | 8,350.20 | 9,463.56 ||| |IPILIMUMAB 200 MG/40ML IV SOLN|40 mL|117646| 44,534.30 |||||||||| 28,947.30 | 30,283.32 | 32,510.04 | 32,510.04 | 34,736.75 | 26,720.58 | 28,947.30 | 33,400.73 | 37,854.16 | 39,546.46 | 39,190.18 | 33,400.73 | 37,854.16 ||| |FLEBOGAMMA DIF 5 GM/100ML IV SOLN|100 mL|117661| 967.90 |||||||||| 629.14 | 658.17 | 706.57 | 706.57 | 754.96 | 580.74 | 629.14 | 725.93 | 822.72 | 859.50 | 851.75 | 725.93 | 822.72 ||| |FLEBOGAMMA DIF 10 GM/200ML IV SOLN|200 mL|117663| 1,935.75 |||||||||| 1,258.24 | 1,316.31 | 1,413.10 | 1,413.10 | 1,509.89 | 1,161.45 | 1,258.24 | 1,451.81 | 1,645.39 | 1,718.95 | 1,703.46 | 1,451.81 | 1,645.39 ||| |FLEBOGAMMA DIF 10 GM/100ML IV SOLN|100 mL|117704| 1,936.00 |||||||||| 1,258.40 | 1,316.48 | 1,413.28 | 1,413.28 | 1,510.08 | 1,161.60 | 1,258.40 | 1,452.00 | 1,645.60 | 1,719.17 | 1,703.68 | 1,452.00 | 1,645.60 ||| |FLEBOGAMMA DIF 5 GM/50ML IV SOLN|50 mL|117705| 967.90 |||||||||| 629.14 | 658.17 | 706.57 | 706.57 | 754.96 | 580.74 | 629.14 | 725.93 | 822.72 | 859.50 | 851.75 | 725.93 | 822.72 ||| |FLEBOGAMMA DIF 20 GM/200ML IV SOLN|200 mL|117706| 3,871.50 |||||||||| 2,516.48 | 2,632.62 | 2,826.20 | 2,826.20 | 3,019.77 | 2,322.90 | 2,516.48 | 2,903.63 | 3,290.78 | 3,437.89 | 3,406.92 | 2,903.63 | 3,290.78 ||| |INSULIN ASPART 100 UNIT/ML SC SOPN|3 mL|117920| 244.40 |||||||||| 158.86 | 166.19 | 178.41 | 178.41 | 190.63 | 146.64 | 158.86 | 183.30 | 207.74 | 217.03 | 215.07 | 183.30 | 207.74 ||| |INSULIN GLARGINE 100 UNIT/ML SC SOPN|3 mL|117923| 194.15 |||||||||| 126.20 | 132.02 | 141.73 | 141.73 | 151.44 | 116.49 | 126.20 | 145.61 | 165.03 | 172.41 | 170.85 | 145.61 | 165.03 ||| |INSULIN ASPART 100 UNIT/ML SC SOCT|3 mL|117930| 236.35 |||||||||| 153.63 | 160.72 | 172.54 | 172.54 | 184.35 | 141.81 | 153.63 | 177.26 | 200.90 | 209.88 | 207.99 | 177.26 | 200.90 ||| |INSULIN DETEMIR 100 UNIT/ML SC SOPN|3 mL|117932| 208.05 |||||||||| 135.23 | 141.47 | 151.88 | 151.88 | 162.28 | 124.83 | 135.23 | 156.04 | 176.84 | 184.75 | 183.08 | 156.04 | 176.84 ||| |INSULIN NPH (HUMAN) (ISOPHANE) 100 UNIT/ML SC SUPN|3 mL|117933| 211.45 |||||||||| 137.44 | 143.79 | 154.36 | 154.36 | 164.93 | 126.87 | 137.44 | 158.59 | 179.73 | 187.77 | 186.08 | 158.59 | 179.73 ||| |INTERFERON BETA-1B 0.3 MG SC KIT|250 mcg (1 each)|117940| 912.60 |||||||||| 593.19 | 620.57 | 666.20 | 666.20 | 711.83 | 547.56 | 593.19 | 684.45 | 775.71 | 810.39 | 803.09 | 684.45 | 775.71 ||| |INTERFERON BETA-1B 0.3 MG SC KIT|62.5 mcg (0.25 each)|117940| 228.15 |||||||||| 148.30 | 155.14 | 166.55 | 166.55 | 177.96 | 136.89 | 148.30 | 171.11 | 193.93 | 202.60 | 200.77 | 171.11 | 193.93 ||| |2-OCTYL CYANOACRYLATE 0.5 ML TOP APPL|1 each|117954| 46.95 |||||||||| 30.52 | 31.93 | 34.27 | 34.27 | 36.62 | 28.17 | 30.52 | 35.21 | 39.91 | 41.69 | 41.32 | 35.21 | 39.91 ||| |LEVOMILNACIPRAN HCL ER 20 MG PO CP24|30 each|117955| 878.25 |||||||||| 570.86 | 597.21 | 641.12 | 641.12 | 685.04 | 526.95 | 570.86 | 658.69 | 746.51 | 779.89 | 772.86 | 658.69 | 746.51 ||| |LEVOMILNACIPRAN HCL ER 40 MG PO CP24|30 each|117956| 878.25 |||||||||| 570.86 | 597.21 | 641.12 | 641.12 | 685.04 | 526.95 | 570.86 | 658.69 | 746.51 | 779.89 | 772.86 | 658.69 | 746.51 ||| |OBINUTUZUMAB 1000 MG/40ML IV SOLN|40 mL|117962| 9,868.90 |||||||||| 6,414.79 | 6,710.85 | 7,204.30 | 7,204.30 | 7,697.74 | 5,921.34 | 6,414.79 | 7,401.68 | 8,388.57 | 8,763.58 | 8,684.63 | 7,401.68 | 8,388.57 ||| |NEVIRAPINE ER 400 MG PO TB24|400 mg (1 each)|118020| 80.20 |||||||||| 52.13 | 54.54 | 58.55 | 58.55 | 62.56 | 48.12 | 52.13 | 60.15 | 68.17 | 71.22 | 70.58 | 60.15 | 68.17 ||| |HYDROGEL GEL|100 g|118239| 132.70 |||||||||| 86.26 | 90.24 | 96.87 | 96.87 | 103.51 | 79.62 | 86.26 | 99.53 | 112.80 | 117.84 | 116.78 | 99.53 | 112.80 ||| |ROFLUMILAST 500 MCG PO TABS|30 each|118408| 816.85 |||||||||| 530.95 | 555.46 | 596.30 | 596.30 | 637.14 | 490.11 | 530.95 | 612.64 | 694.32 | 725.36 | 718.83 | 612.64 | 694.32 ||| |VILAZODONE HCL 10 MG PO TABS|30 each|118409| 615.45 |||||||||| 400.04 | 418.51 | 449.28 | 449.28 | 480.05 | 369.27 | 400.04 | 461.59 | 523.13 | 546.52 | 541.60 | 461.59 | 523.13 ||| |VILAZODONE HCL 40 MG PO TABS|30 each|118411| 615.45 |||||||||| 400.04 | 418.51 | 449.28 | 449.28 | 480.05 | 369.27 | 400.04 | 461.59 | 523.13 | 546.52 | 541.60 | 461.59 | 523.13 ||| |LINAGLIPTIN 5 MG PO TABS|30 each|118518| 981.80 |||||||||| 638.17 | 667.62 | 716.71 | 716.71 | 765.80 | 589.08 | 638.17 | 736.35 | 834.53 | 871.84 | 863.98 | 736.35 | 834.53 ||| |AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN|100 mL|118865| 304.70 |||||||||| 198.06 | 207.20 | 222.43 | 222.43 | 237.67 | 182.82 | 198.06 | 228.53 | 259.00 | 270.57 | 268.14 | 228.53 | 259.00 ||| |AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN|200 mL|118866| 316.20 |||||||||| 205.53 | 215.02 | 230.83 | 230.83 | 246.64 | 189.72 | 205.53 | 237.15 | 268.77 | 280.79 | 278.26 | 237.15 | 268.77 ||| |FIDAXOMICIN 200 MG PO TABS|200 mg (1 each)|118954| 443.35 |||||||||| 288.18 | 301.48 | 323.65 | 323.65 | 345.81 | 266.01 | 288.18 | 332.51 | 376.85 | 393.69 | 390.15 | 332.51 | 376.85 ||| |BELATACEPT 250 MG IV SOLR|1 each|119238| 1,944.05 |||||||||| 1,263.63 | 1,321.95 | 1,419.16 | 1,419.16 | 1,516.36 | 1,166.43 | 1,263.63 | 1,458.04 | 1,652.44 | 1,726.32 | 1,710.76 | 1,458.04 | 1,652.44 ||| |GADODIAMIDE 287 MG/ML IV SOLN|10 mL|11929| 56.90 |||||||||| 36.99 | 38.69 | 41.54 | 41.54 | 44.38 | 34.14 | 36.99 | 42.68 | 48.37 | 50.53 | 50.07 | 42.68 | 48.37 ||| |LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT|45 mg (1 each)|119309| 14,820.85 |||||||||| 9,633.55 | 10,078.18 | 10,819.22 | 10,819.22 | 11,560.26 | 8,892.51 | 9,633.55 | 11,115.64 | 12,597.72 | 13,160.91 | 13,042.35 | 11,115.64 | 12,597.72 ||| |RIVAROXABAN 10 MG PO TABS|30 each|119697| 997.65 |||||||||| 648.47 | 678.40 | 728.28 | 728.28 | 778.17 | 598.59 | 648.47 | 748.24 | 848.00 | 885.91 | 877.93 | 748.24 | 848.00 ||| |ZINC OXIDE 40 % EX PSTE|57 g|120015| 40.25 |||||||||| 26.16 | 27.37 | 29.38 | 29.38 | 31.40 | 24.15 | 26.16 | 30.19 | 34.21 | 35.74 | 35.42 | 30.19 | 34.21 ||| |MECLIZINE HCL 25 MG PO TABS|100 each|12025| 88.45 |||||||||| 57.49 | 60.15 | 64.57 | 64.57 | 68.99 | 53.07 | 57.49 | 66.34 | 75.18 | 78.54 | 77.84 | 66.34 | 75.18 ||| |EMTRICITAB-RILPIVIR-TENOFOV DF 200-25-300 MG PO TABS|1 tablet (1 each)|120364| 225.95 |||||||||| 146.87 | 153.65 | 164.94 | 164.94 | 176.24 | 135.57 | 146.87 | 169.46 | 192.06 | 200.64 | 198.84 | 169.46 | 192.06 ||| |ABATACEPT 125 MG/ML SC SOSY|1 mL|120380| 2,384.10 |||||||||| 1,549.67 | 1,621.19 | 1,740.39 | 1,740.39 | 1,859.60 | 1,430.46 | 1,549.67 | 1,788.08 | 2,026.49 | 2,117.08 | 2,098.01 | 1,788.08 | 2,026.49 ||| |GAMMAKED 1 GM/10ML IJ SOLN|10 mL|120403| 295.65 |||||||||| 192.17 | 201.04 | 215.82 | 215.82 | 230.61 | 177.39 | 192.17 | 221.74 | 251.30 | 262.54 | 260.17 | 221.74 | 251.30 ||| |GAMMAKED 5 GM/50ML IJ SOLN|50 mL|120405| 1,478.15 |||||||||| 960.80 | 1,005.14 | 1,079.05 | 1,079.05 | 1,152.96 | 886.89 | 960.80 | 1,108.61 | 1,256.43 | 1,312.60 | 1,300.77 | 1,108.61 | 1,256.43 ||| |GAMMAKED 10 GM/100ML IJ SOLN|100 mL|120406| 2,956.25 |||||||||| 1,921.56 | 2,010.25 | 2,158.06 | 2,158.06 | 2,305.88 | 1,773.75 | 1,921.56 | 2,217.19 | 2,512.81 | 2,625.15 | 2,601.50 | 2,217.19 | 2,512.81 ||| |GAMMAKED 20 GM/200ML IJ SOLN|200 mL|120407| 5,912.45 |||||||||| 3,843.09 | 4,020.47 | 4,316.09 | 4,316.09 | 4,611.71 | 3,547.47 | 3,843.09 | 4,434.34 | 5,025.58 | 5,250.26 | 5,202.96 | 4,434.34 | 5,025.58 ||| |BRENTUXIMAB VEDOTIN 50 MG IV SOLR|1 each|120434| 12,752.25 |||||||||| 8,288.96 | 8,671.53 | 9,309.14 | 9,309.14 | 9,946.76 | 7,651.35 | 8,288.96 | 9,564.19 | 10,839.41 | 11,324.00 | 11,221.98 | 9,564.19 | 10,839.41 ||| |IBANDRONATE SODIUM 3 MG/3ML IV SOLN|3 mL|120641| 504.60 |||||||||| 327.99 | 343.13 | 368.36 | 368.36 | 393.59 | 302.76 | 327.99 | 378.45 | 428.91 | 448.08 | 444.05 | 378.45 | 428.91 ||| |HYDROXOCOBALAMIN 5 G IV SOLR|5,000 mg (1 each)|120681| 2,068.10 |||||||||| 1,344.27 | 1,406.31 | 1,509.71 | 1,509.71 | 1,613.12 | 1,240.86 | 1,344.27 | 1,551.08 | 1,757.89 | 1,836.47 | 1,819.93 | 1,551.08 | 1,757.89 ||| |ARGATROBAN 50 MG/50ML IV SOLN|50 mL|120721| 452.00 |||||||||| 293.80 | 307.36 | 329.96 | 329.96 | 352.56 | 271.20 | 293.80 | 339.00 | 384.20 | 401.38 | 397.76 | 339.00 | 384.20 ||| |THEOPHYLLINE ER 300 MG PO TB12|100 each|12098| 735.55 |||||||||| 478.11 | 500.17 | 536.95 | 536.95 | 573.73 | 441.33 | 478.11 | 551.66 | 625.22 | 653.17 | 647.28 | 551.66 | 625.22 ||| |BLISTEX MEDICATED EX OINT|10 g|121093| 37.05 |||||||||| 24.08 | 25.19 | 27.05 | 27.05 | 28.90 | 22.23 | 24.08 | 27.79 | 31.49 | 32.90 | 32.60 | 27.79 | 31.49 ||| |NUTRISOURCE FIBER PO PACK|1 packet (1 each)|121164| 11.85 |||||||||| 7.70 | 8.06 | 8.65 | 8.65 | 9.24 | 7.11 | 7.70 | 8.89 | 10.07 | 10.52 | 10.43 | 8.89 | 10.07 ||| |CLOBAZAM 10 MG PO TABS|30 each|121374| 157.00 |||||||||| 102.05 | 106.76 | 114.61 | 114.61 | 122.46 | 94.20 | 102.05 | 117.75 | 133.45 | 139.42 | 138.16 | 117.75 | 133.45 ||| |CLOBAZAM 20 MG PO TABS|20 mg (1 each)|121375| 14.05 |||||||||| 9.13 | 9.55 | 10.26 | 10.26 | 10.96 | 8.43 | 9.13 | 10.54 | 11.94 | 12.48 | 12.36 | 10.54 | 11.94 ||| |BUPIVACAINE LIPOSOME 1.3 % IJ SUSP|10 mL|121416| 373.50 |||||||||| 242.78 | 253.98 | 272.66 | 272.66 | 291.33 | 224.10 | 242.78 | 280.13 | 317.48 | 331.67 | 328.68 | 280.13 | 317.48 ||| |GEMCITABINE HCL 200 MG/5.26ML IV SOLN|5.26 mL|121421| 18.55 |||||||||| 12.06 | 12.61 | 13.54 | 13.54 | 14.47 | 11.13 | 12.06 | 13.91 | 15.77 | 16.47 | 16.32 | 13.91 | 15.77 ||| |GEMCITABINE HCL 1 GM/26.3ML IV SOLN|26.3 mL|121422| 66.25 |||||||||| 43.06 | 45.05 | 48.36 | 48.36 | 51.68 | 39.75 | 43.06 | 49.69 | 56.31 | 58.83 | 58.30 | 49.69 | 56.31 ||| |GEMCITABINE HCL 2 GM/52.6ML IV SOLN|52.6 mL|121423| 132.50 |||||||||| 86.13 | 90.10 | 96.73 | 96.73 | 103.35 | 79.50 | 86.13 | 99.38 | 112.63 | 117.66 | 116.60 | 99.38 | 112.63 ||| |TESTOSTERONE 2 MG/24HR TD PT24|1 patch (1 each)|121442| 40.45 |||||||||| 26.29 | 27.51 | 29.53 | 29.53 | 31.55 | 24.27 | 26.29 | 30.34 | 34.38 | 35.92 | 35.60 | 30.34 | 34.38 ||| |RIVAROXABAN 15 MG PO TABS|30 each|121469| 997.65 |||||||||| 648.47 | 678.40 | 728.28 | 728.28 | 778.17 | 598.59 | 648.47 | 748.24 | 848.00 | 885.91 | 877.93 | 748.24 | 848.00 ||| |RIVAROXABAN 20 MG PO TABS|30 each|121470| 997.65 |||||||||| 648.47 | 678.40 | 728.28 | 728.28 | 778.17 | 598.59 | 648.47 | 748.24 | 848.00 | 885.91 | 877.93 | 748.24 | 848.00 ||| |LEVOTHYROXINE SODIUM 100 MCG IV SOLR|1 each|121628| 232.75 |||||||||| 151.29 | 158.27 | 169.91 | 169.91 | 181.55 | 139.65 | 151.29 | 174.56 | 197.84 | 206.68 | 204.82 | 174.56 | 197.84 ||| |QUINIDINE GLUCONATE ER 324 MG PO TBCR|324 mg (1 each)|12197| 32.10 |||||||||| 20.87 | 21.83 | 23.43 | 23.43 | 25.04 | 19.26 | 20.87 | 24.08 | 27.29 | 28.50 | 28.25 | 24.08 | 27.29 ||| |QUINIDINE GLUCONATE ER 324 MG PO TBCR|648 mg (2 each)|12197| 52.15 |||||||||| 33.90 | 35.46 | 38.07 | 38.07 | 40.68 | 31.29 | 33.90 | 39.11 | 44.33 | 46.31 | 45.89 | 39.11 | 44.33 ||| |QUINIDINE GLUCONATE ER 324 MG PO TBCR|972 mg (3 each)|12197| 67.20 |||||||||| 43.68 | 45.70 | 49.06 | 49.06 | 52.42 | 40.32 | 43.68 | 50.40 | 57.12 | 59.67 | 59.14 | 50.40 | 57.12 ||| |ACETYLCYSTEINE 10 % IN SOLN|10 mL|122| 56.90 |||||||||| 36.99 | 38.69 | 41.54 | 41.54 | 44.38 | 34.14 | 36.99 | 42.68 | 48.37 | 50.53 | 50.07 | 42.68 | 48.37 ||| |FIRST-OMEPRAZOLE 2 MG/ML PO SUSP|90 mL|122026| 89.95 |||||||||| 58.47 | 61.17 | 65.66 | 65.66 | 70.16 | 53.97 | 58.47 | 67.46 | 76.46 | 79.88 | 79.16 | 67.46 | 76.46 ||| |DORNASE ALFA 1 MG/ML IN SOLN|2.5 mL|12211| 260.60 |||||||||| 169.39 | 177.21 | 190.24 | 190.24 | 203.27 | 156.36 | 169.39 | 195.45 | 221.51 | 231.41 | 229.33 | 195.45 | 221.51 ||| |POSACONAZOLE 100 MG PO TBEC|300 mg (3 each)|122271| 363.45 |||||||||| 236.24 | 247.15 | 265.32 | 265.32 | 283.49 | 218.07 | 236.24 | 272.59 | 308.93 | 322.74 | 319.84 | 272.59 | 308.93 ||| |INSULIN GLULISINE 100 UNIT/ML SC SOPN|3 mL|122369| 240.50 |||||||||| 156.33 | 163.54 | 175.57 | 175.57 | 187.59 | 144.30 | 156.33 | 180.38 | 204.43 | 213.56 | 211.64 | 180.38 | 204.43 ||| |GADOTERATE MEGLUMINE 5 MMOL/10ML IV SOLN|10 mL|122446| 50.30 |||||||||| 32.70 | 34.20 | 36.72 | 36.72 | 39.23 | 30.18 | 32.70 | 37.73 | 42.76 | 44.67 | 44.26 | 37.73 | 42.76 ||| |GADOTERATE MEGLUMINE 7.5 MMOL/15ML IV SOLN|15 mL|122448| 75.45 |||||||||| 49.04 | 51.31 | 55.08 | 55.08 | 58.85 | 45.27 | 49.04 | 56.59 | 64.13 | 67.00 | 66.40 | 56.59 | 64.13 ||| |GADOTERATE MEGLUMINE 10 MMOL/20ML IV SOLN|20 mL|122449| 100.60 |||||||||| 65.39 | 68.41 | 73.44 | 73.44 | 78.47 | 60.36 | 65.39 | 75.45 | 85.51 | 89.33 | 88.53 | 75.45 | 85.51 ||| |DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS|30 each|122561| 1,096.00 |||||||||| 712.40 | 745.28 | 800.08 | 800.08 | 854.88 | 657.60 | 712.40 | 822.00 | 931.60 | 973.25 | 964.48 | 822.00 | 931.60 ||| |GLATIRAMER ACETATE 40 MG/ML SC SOSY|1 mL|122628| 333.90 |||||||||| 217.04 | 227.05 | 243.75 | 243.75 | 260.44 | 200.34 | 217.04 | 250.43 | 283.82 | 296.50 | 293.83 | 250.43 | 283.82 ||| |INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC SUPN|3 mL|122785| 244.40 |||||||||| 158.86 | 166.19 | 178.41 | 178.41 | 190.63 | 146.64 | 158.86 | 183.30 | 207.74 | 217.03 | 215.07 | 183.30 | 207.74 ||| |PRAMLINTIDE ACETATE 1500 MCG/1.5ML SC SOPN|1.5 mL|122791| 926.25 |||||||||| 602.06 | 629.85 | 676.16 | 676.16 | 722.48 | 555.75 | 602.06 | 694.69 | 787.31 | 822.51 | 815.10 | 694.69 | 787.31 ||| |HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR|100 mg (1 each)|122794| 61.70 |||||||||| 40.11 | 41.96 | 45.04 | 45.04 | 48.13 | 37.02 | 40.11 | 46.28 | 52.45 | 54.79 | 54.30 | 46.28 | 52.45 ||| |HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR|50 mg (0.5 each)|122794| 47.85 |||||||||| 31.10 | 32.54 | 34.93 | 34.93 | 37.32 | 28.71 | 31.10 | 35.89 | 40.67 | 42.49 | 42.11 | 35.89 | 40.67 ||| |HYDROCORTISONE NA SUCCINATE PF 250 MG IJ SOLR|125 mg (0.5 each)|122795| 59.60 |||||||||| 38.74 | 40.53 | 43.51 | 43.51 | 46.49 | 35.76 | 38.74 | 44.70 | 50.66 | 52.92 | 52.45 | 44.70 | 50.66 ||| |HYDROCORTISONE NA SUCCINATE PF 250 MG IJ SOLR|250 mg (1 each)|122795| 85.15 |||||||||| 55.35 | 57.90 | 62.16 | 62.16 | 66.42 | 51.09 | 55.35 | 63.86 | 72.38 | 75.61 | 74.93 | 63.86 | 72.38 ||| |ESLICARBAZEPINE ACETATE 400 MG PO TABS|30 each|122814| 2,130.20 |||||||||| 1,384.63 | 1,448.54 | 1,555.05 | 1,555.05 | 1,661.56 | 1,278.12 | 1,384.63 | 1,597.65 | 1,810.67 | 1,891.62 | 1,874.58 | 1,597.65 | 1,810.67 ||| |UMECLIDINIUM-VILANTEROL 62.5-25 MCG/INH IN AEPB|14 each|122818| 224.90 |||||||||| 146.19 | 152.93 | 164.18 | 164.18 | 175.42 | 134.94 | 146.19 | 168.68 | 191.17 | 199.71 | 197.91 | 168.68 | 191.17 ||| |ACETYLCYSTEINE 20 % IN SOLN|10 mL|123| 56.90 |||||||||| 36.99 | 38.69 | 41.54 | 41.54 | 44.38 | 34.14 | 36.99 | 42.68 | 48.37 | 50.53 | 50.07 | 42.68 | 48.37 ||| |EXENATIDE 5 MCG/0.02ML SC SOPN|1.2 mL|123091| 1,448.60 |||||||||| 941.59 | 985.05 | 1,057.48 | 1,057.48 | 1,129.91 | 869.16 | 941.59 | 1,086.45 | 1,231.31 | 1,286.36 | 1,274.77 | 1,086.45 | 1,231.31 ||| |EXENATIDE 10 MCG/0.04ML SC SOPN|2.4 mL|123093| 1,448.60 |||||||||| 941.59 | 985.05 | 1,057.48 | 1,057.48 | 1,129.91 | 869.16 | 941.59 | 1,086.45 | 1,231.31 | 1,286.36 | 1,274.77 | 1,086.45 | 1,231.31 ||| |LIRAGLUTIDE 18 MG/3ML SC SOPN|3 mL|123095| 641.30 |||||||||| 416.85 | 436.08 | 468.15 | 468.15 | 500.21 | 384.78 | 416.85 | 480.98 | 545.11 | 569.47 | 564.34 | 480.98 | 545.11 ||| |FAMOTIDINE 200 MG/20ML IV SOLN|20 mL|123102| 49.10 |||||||||| 31.92 | 33.39 | 35.84 | 35.84 | 38.30 | 29.46 | 31.92 | 36.83 | 41.74 | 43.60 | 43.21 | 36.83 | 41.74 ||| |EPINEPHRINE 0.15 MG/0.15ML IJ SOAJ|2 each|123108| 598.70 |||||||||| 389.16 | 407.12 | 437.05 | 437.05 | 466.99 | 359.22 | 389.16 | 449.03 | 508.90 | 531.65 | 526.86 | 449.03 | 508.90 ||| |PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT|1000 Units|123260| 5,136.25 |||||||||| 3,338.56 | 3,492.65 | 3,749.46 | 3,749.46 | 4,006.28 | 3,081.75 | 3,338.56 | 3,852.19 | 4,365.81 | 4,560.99 | 4,519.90 | 3,852.19 | 4,365.81 ||| |TOBRAMYCIN 0.3 % OP OINT|3.5 g|123330| 437.50 |||||||||| 284.38 | 297.50 | 319.38 | 319.38 | 341.25 | 262.50 | 284.38 | 328.13 | 371.88 | 388.50 | 385.00 | 328.13 | 371.88 ||| |PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML IV SUSP|2 mL|123334| 545.75 |||||||||| 354.74 | 371.11 | 398.40 | 398.40 | 425.69 | 327.45 | 354.74 | 409.31 | 463.89 | 484.63 | 480.26 | 409.31 | 463.89 ||| |APREMILAST 30 MG PO TABS|60 each|123338| 7,478.45 |||||||||| 4,860.99 | 5,085.35 | 5,459.27 | 5,459.27 | 5,833.19 | 4,487.07 | 4,860.99 | 5,608.84 | 6,356.68 | 6,640.86 | 6,581.04 | 5,608.84 | 6,356.68 ||| |EPINEPHRINE 30 MG/30ML IJ SOLN|30 mL|123600| 457.55 |||||||||| 297.41 | 311.13 | 334.01 | 334.01 | 356.89 | 274.53 | 297.41 | 343.16 | 388.92 | 406.30 | 402.64 | 343.16 | 388.92 ||| |RAMUCIRUMAB 100 MG/10ML IV SOLN|10 mL|123682| 1,792.20 |||||||||| 1,164.93 | 1,218.70 | 1,308.31 | 1,308.31 | 1,397.92 | 1,075.32 | 1,164.93 | 1,344.15 | 1,523.37 | 1,591.47 | 1,577.14 | 1,344.15 | 1,523.37 ||| |RAMUCIRUMAB 500 MG/50ML IV SOLN|50 mL|123683| 8,960.90 |||||||||| 5,824.59 | 6,093.41 | 6,541.46 | 6,541.46 | 6,989.50 | 5,376.54 | 5,824.59 | 6,720.68 | 7,616.77 | 7,957.28 | 7,885.59 | 6,720.68 | 7,616.77 ||| |ESTROPIPATE 0.75 MG PO TABS|100 each|12400| 131.00 |||||||||| 85.15 | 89.08 | 95.63 | 95.63 | 102.18 | 78.60 | 85.15 | 98.25 | 111.35 | 116.33 | 115.28 | 98.25 | 111.35 ||| |VEDOLIZUMAB 300 MG IV SOLR|300 mg (1 each)|124095| 13,966.65 |||||||||| 9,078.32 | 9,497.32 | 10,195.65 | 10,195.65 | 10,893.99 | 8,379.99 | 9,078.32 | 10,474.99 | 11,871.65 | 12,402.39 | 12,290.65 | 10,474.99 | 11,871.65 ||| |DALBAVANCIN HCL 500 MG IV SOLR|1 each|124206| 2,901.40 |||||||||| 1,885.91 | 1,972.95 | 2,118.02 | 2,118.02 | 2,263.09 | 1,740.84 | 1,885.91 | 2,176.05 | 2,466.19 | 2,576.44 | 2,553.23 | 2,176.05 | 2,466.19 ||| |CYCLOPHOSPHAMIDE 25 MG PO CAPS|100 each|124326| 1,576.75 |||||||||| 1,024.89 | 1,072.19 | 1,151.03 | 1,151.03 | 1,229.87 | 946.05 | 1,024.89 | 1,182.56 | 1,340.24 | 1,400.15 | 1,387.54 | 1,182.56 | 1,340.24 ||| |CETIRIZINE HCL 1 MG/ML PO SOLN|480 mL|124336| 46.95 |||||||||| 30.52 | 31.93 | 34.27 | 34.27 | 36.62 | 28.17 | 30.52 | 35.21 | 39.91 | 41.69 | 41.32 | 35.21 | 39.91 ||| |ANTIHEM FACT (BDD-RFVIIIFC) 500 UNITS IV SOLR|500 Units|124448| 2,290.80 |||||||||| 1,489.02 | 1,557.74 | 1,672.28 | 1,672.28 | 1,786.82 | 1,374.48 | 1,489.02 | 1,718.10 | 1,947.18 | 2,034.23 | 2,015.90 | 1,718.10 | 1,947.18 ||| |ANTIHEM FACT (BDD-RFVIIIFC) 750 UNITS IV SOLR|750 Units|124449| 3,436.20 |||||||||| 2,233.53 | 2,336.62 | 2,508.43 | 2,508.43 | 2,680.24 | 2,061.72 | 2,233.53 | 2,577.15 | 2,920.77 | 3,051.35 | 3,023.86 | 2,577.15 | 2,920.77 ||| |ANTIHEM FACT (BDD-RFVIIIFC) 1000 UNITS IV SOLR|1000 Units|124450| 4,651.50 |||||||||| 3,023.48 | 3,163.02 | 3,395.60 | 3,395.60 | 3,628.17 | 2,790.90 | 3,023.48 | 3,488.63 | 3,953.78 | 4,130.53 | 4,093.32 | 3,488.63 | 3,953.78 ||| |CULTURELLE DIGESTIVE HEALTH PO CHEW|1 tablet (1 each)|124707| 12.35 |||||||||| 8.03 | 8.40 | 9.02 | 9.02 | 9.63 | 7.41 | 8.03 | 9.26 | 10.50 | 10.97 | 10.87 | 9.26 | 10.50 ||| |EMPAGLIFLOZIN 25 MG PO TABS|90 each|124718| 3,275.65 |||||||||| 2,129.17 | 2,227.44 | 2,391.22 | 2,391.22 | 2,555.01 | 1,965.39 | 2,129.17 | 2,456.74 | 2,784.30 | 2,908.78 | 2,882.57 | 2,456.74 | 2,784.30 ||| |ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS|1 tablet (1 each)|124825| 240.80 |||||||||| 156.52 | 163.74 | 175.78 | 175.78 | 187.82 | 144.48 | 156.52 | 180.60 | 204.68 | 213.83 | 211.90 | 180.60 | 204.68 ||| |USTEKINUMAB 45 MG/0.5ML SC SOSY|.5 mL|124947| 23,711.85 |||||||||| 15,412.70 | 16,124.06 | 17,309.65 | 17,309.65 | 18,495.24 | 14,227.11 | 15,412.70 | 17,783.89 | 20,155.07 | 21,056.12 | 20,866.43 | 17,783.89 | 20,155.07 ||| |USTEKINUMAB 90 MG/ML SC SOSY|1 mL|124948| 47,423.70 |||||||||| 30,825.41 | 32,248.12 | 34,619.30 | 34,619.30 | 36,990.49 | 28,454.22 | 30,825.41 | 35,567.78 | 40,310.15 | 42,112.25 | 41,732.86 | 35,567.78 | 40,310.15 ||| |HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP|.5 mL|124952| 83.40 |||||||||| 54.21 | 56.71 | 60.88 | 60.88 | 65.05 | 50.04 | 54.21 | 62.55 | 70.89 | 74.06 | 73.39 | 62.55 | 70.89 ||| |PB-HYOSCY-ATROPINE-SCOPOLAMINE 16.2 MG/5ML PO ELIX|120 mL|124953| 469.95 |||||||||| 305.47 | 319.57 | 343.06 | 343.06 | 366.56 | 281.97 | 305.47 | 352.46 | 399.46 | 417.32 | 413.56 | 352.46 | 399.46 ||| |PB-HYOSCY-ATROPINE-SCOPOLAMINE 16.2 MG PO TABS|1 tablet (1 each)|124955| 35.00 |||||||||| 22.75 | 23.80 | 25.55 | 25.55 | 27.30 | 21.00 | 22.75 | 26.25 | 29.75 | 31.08 | 30.80 | 26.25 | 29.75 ||| |LITHIUM 8 MEQ/5ML PO SOLN|5 mL|124956| 13.50 |||||||||| 8.78 | 9.18 | 9.86 | 9.86 | 10.53 | 8.10 | 8.78 | 10.13 | 11.48 | 11.99 | 11.88 | 10.13 | 11.48 ||| |GOLIMUMAB 100 MG/ML SC SOSY|1 mL|124962| 11,339.10 |||||||||| 7,370.42 | 7,710.59 | 8,277.54 | 8,277.54 | 8,844.50 | 6,803.46 | 7,370.42 | 8,504.33 | 9,638.24 | 10,069.12 | 9,978.41 | 8,504.33 | 9,638.24 ||| |SODIUM HYALURONATE 20 MG/2ML IX SOSY|2 mL|124965| 416.45 |||||||||| 270.69 | 283.19 | 304.01 | 304.01 | 324.83 | 249.87 | 270.69 | 312.34 | 353.98 | 369.81 | 366.48 | 312.34 | 353.98 ||| |ANTIHEMOPHILIC FACTOR-VWF 2000 UNITS IV SOLR|2000 Units|125112| 5,218.45 |||||||||| 3,391.99 | 3,548.55 | 3,809.47 | 3,809.47 | 4,070.39 | 3,131.07 | 3,391.99 | 3,913.84 | 4,435.68 | 4,633.98 | 4,592.24 | 3,913.84 | 4,435.68 ||| |OCTAGAM 5 GM/50ML IV SOLN|50 mL|125139| 1,774.10 |||||||||| 1,153.17 | 1,206.39 | 1,295.09 | 1,295.09 | 1,383.80 | 1,064.46 | 1,153.17 | 1,330.58 | 1,507.99 | 1,575.40 | 1,561.21 | 1,330.58 | 1,507.99 ||| |OCTAGAM 10 GM/100ML IV SOLN|100 mL|125140| 3,548.15 |||||||||| 2,306.30 | 2,412.74 | 2,590.15 | 2,590.15 | 2,767.56 | 2,128.89 | 2,306.30 | 2,661.11 | 3,015.93 | 3,150.76 | 3,122.37 | 2,661.11 | 3,015.93 ||| |OCTAGAM 20 GM/200ML IV SOLN|200 mL|125141| 7,096.25 |||||||||| 4,612.56 | 4,825.45 | 5,180.26 | 5,180.26 | 5,535.08 | 4,257.75 | 4,612.56 | 5,322.19 | 6,031.81 | 6,301.47 | 6,244.70 | 5,322.19 | 6,031.81 ||| |MENTHOL-ZINC OXIDE 0.44-20.6 % EX OINT|113 g|125541| 42.10 |||||||||| 27.37 | 28.63 | 30.73 | 30.73 | 32.84 | 25.26 | 27.37 | 31.58 | 35.79 | 37.38 | 37.05 | 31.58 | 35.79 ||| |DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD|118 mL|12556| 14.95 |||||||||| 9.72 | 10.17 | 10.91 | 10.91 | 11.66 | 8.97 | 9.72 | 11.21 | 12.71 | 13.28 | 13.16 | 11.21 | 12.71 ||| |VASOPRESSIN 20 UNIT/ML IV SOLN|1 mL|125829| 405.90 |||||||||| 263.84 | 276.01 | 296.31 | 296.31 | 316.60 | 243.54 | 263.84 | 304.43 | 345.02 | 360.44 | 357.19 | 304.43 | 345.02 ||| |ALEMTUZUMAB 12 MG/1.2ML IV SOLN|1.2 mL|125839| 36,562.60 |||||||||| 23,765.69 | 24,862.57 | 26,690.70 | 26,690.70 | 28,518.83 | 21,937.56 | 23,765.69 | 27,421.95 | 31,078.21 | 32,467.59 | 32,175.09 | 27,421.95 | 31,078.21 ||| |UMECLIDINIUM BROMIDE 62.5 MCG/INH IN AEPB|7 each|125935| 171.20 |||||||||| 111.28 | 116.42 | 124.98 | 124.98 | 133.54 | 102.72 | 111.28 | 128.40 | 145.52 | 152.03 | 150.66 | 128.40 | 145.52 ||| |FLUTICASONE FUROATE 100 MCG/ACT IN AEPB|14 each|125946| 191.05 |||||||||| 124.18 | 129.91 | 139.47 | 139.47 | 149.02 | 114.63 | 124.18 | 143.29 | 162.39 | 169.65 | 168.12 | 143.29 | 162.39 ||| |FLUTICASONE FUROATE 200 MCG/ACT IN AEPB|14 each|125947| 244.25 |||||||||| 158.76 | 166.09 | 178.30 | 178.30 | 190.52 | 146.55 | 158.76 | 183.19 | 207.61 | 216.89 | 214.94 | 183.19 | 207.61 ||| |HYDROCODONE BITARTRATE ER 30 MG PO T24A|60 each|125952| 1,582.25 |||||||||| 1,028.46 | 1,075.93 | 1,155.04 | 1,155.04 | 1,234.16 | 949.35 | 1,028.46 | 1,186.69 | 1,344.91 | 1,405.04 | 1,392.38 | 1,186.69 | 1,344.91 ||| |HPV 9-VALENT RECOMB VACCINE IM SUSP|.5 mL|126023| 463.05 |||||||||| 300.98 | 314.87 | 338.03 | 338.03 | 361.18 | 277.83 | 300.98 | 347.29 | 393.59 | 411.19 | 407.48 | 347.29 | 393.59 ||| |BLINATUMOMAB 35 MCG IV SOLR|1 each|126024| 5,945.35 |||||||||| 3,864.48 | 4,042.84 | 4,340.11 | 4,340.11 | 4,637.37 | 3,567.21 | 3,864.48 | 4,459.01 | 5,053.55 | 5,279.47 | 5,231.91 | 4,459.01 | 5,053.55 ||| |CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR|1.5 g (1 each)|126077| 349.55 |||||||||| 227.21 | 237.69 | 255.17 | 255.17 | 272.65 | 209.73 | 227.21 | 262.16 | 297.12 | 310.40 | 307.60 | 262.16 | 297.12 ||| |NIVOLUMAB 40 MG/4ML IV SOLN|4 mL|126079| 1,627.80 |||||||||| 1,058.07 | 1,106.90 | 1,188.29 | 1,188.29 | 1,269.68 | 976.68 | 1,058.07 | 1,220.85 | 1,383.63 | 1,445.49 | 1,432.46 | 1,220.85 | 1,383.63 ||| |NIVOLUMAB 100 MG/10ML IV SOLN|10 mL|126080| 4,069.50 |||||||||| 2,645.18 | 2,767.26 | 2,970.74 | 2,970.74 | 3,174.21 | 2,441.70 | 2,645.18 | 3,052.13 | 3,459.08 | 3,613.72 | 3,581.16 | 3,052.13 | 3,459.08 ||| |CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN|2 mL|1262| 73.60 |||||||||| 47.84 | 50.05 | 53.73 | 53.73 | 57.41 | 44.16 | 47.84 | 55.20 | 62.56 | 65.36 | 64.77 | 55.20 | 62.56 ||| |MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY|.5 mL|126222| 371.45 |||||||||| 241.44 | 252.59 | 271.16 | 271.16 | 289.73 | 222.87 | 241.44 | 278.59 | 315.73 | 329.85 | 326.88 | 278.59 | 315.73 ||| |PEMBROLIZUMAB 100 MG/4ML IV SOLN|4 mL|126325| 7,216.25 |||||||||| 4,690.56 | 4,907.05 | 5,267.86 | 5,267.86 | 5,628.68 | 4,329.75 | 4,690.56 | 5,412.19 | 6,133.81 | 6,408.03 | 6,350.30 | 5,412.19 | 6,133.81 ||| |NALOXEGOL OXALATE 12.5 MG PO TABS|30 each|126455| 759.80 |||||||||| 493.87 | 516.66 | 554.65 | 554.65 | 592.64 | 455.88 | 493.87 | 569.85 | 645.83 | 674.70 | 668.62 | 569.85 | 645.83 ||| |NALOXEGOL OXALATE 25 MG PO TABS|30 each|126456| 759.80 |||||||||| 493.87 | 516.66 | 554.65 | 554.65 | 592.64 | 455.88 | 493.87 | 569.85 | 645.83 | 674.70 | 668.62 | 569.85 | 645.83 ||| |DEXMEDETOMIDINE HCL IN NACL 80 MCG/20ML IV SOLN|20 mL|126460| 296.00 |||||||||| 192.40 | 201.28 | 216.08 | 216.08 | 230.88 | 177.60 | 192.40 | 222.00 | 251.60 | 262.85 | 260.48 | 222.00 | 251.60 ||| |SECUKINUMAB 150 MG/ML SC SOAJ|1 mL|126465| 11,384.90 |||||||||| 7,400.19 | 7,741.73 | 8,310.98 | 8,310.98 | 8,880.22 | 6,830.94 | 7,400.19 | 8,538.68 | 9,677.17 | 10,109.79 | 10,018.71 | 8,538.68 | 9,677.17 ||| |GLATIRAMER ACETATE 20 MG/ML SC SOSY|1 mL|126749| 102.75 |||||||||| 66.79 | 69.87 | 75.01 | 75.01 | 80.15 | 61.65 | 66.79 | 77.06 | 87.34 | 91.24 | 90.42 | 77.06 | 87.34 ||| |POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN|5 mL|126751| 61.90 |||||||||| 40.24 | 42.09 | 45.19 | 45.19 | 48.28 | 37.14 | 40.24 | 46.43 | 52.62 | 54.97 | 54.47 | 46.43 | 52.62 ||| |POTASSIUM PHOSPHATES 45 MMOLE/15ML IV SOLN|15 mL|126752| 61.45 |||||||||| 39.94 | 41.79 | 44.86 | 44.86 | 47.93 | 36.87 | 39.94 | 46.09 | 52.23 | 54.57 | 54.08 | 46.09 | 52.23 ||| |POTASSIUM PHOSPHATES 150 MMOLE/50ML IV SOLN|50 mL|126753| 160.60 |||||||||| 104.39 | 109.21 | 117.24 | 117.24 | 125.27 | 96.36 | 104.39 | 120.45 | 136.51 | 142.61 | 141.33 | 120.45 | 136.51 ||| |PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN|2 mL|126756| 91.85 |||||||||| 59.70 | 62.46 | 67.05 | 67.05 | 71.64 | 55.11 | 59.70 | 68.89 | 78.07 | 81.56 | 80.83 | 68.89 | 78.07 ||| |RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY|300 mcg (1 each)|126761| 242.45 |||||||||| 157.59 | 164.87 | 176.99 | 176.99 | 189.11 | 145.47 | 157.59 | 181.84 | 206.08 | 215.30 | 213.36 | 181.84 | 206.08 ||| |INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY|.5 mL|126767| 126.75 |||||||||| 82.39 | 86.19 | 92.53 | 92.53 | 98.87 | 76.05 | 82.39 | 95.06 | 107.74 | 112.55 | 111.54 | 95.06 | 107.74 ||| |INFLUENZA VAC SPLIT QUAD 0.5 ML IM SUSY|.5 mL|126769| 66.60 |||||||||| 43.29 | 45.29 | 48.62 | 48.62 | 51.95 | 39.96 | 43.29 | 49.95 | 56.61 | 59.14 | 58.61 | 49.95 | 56.61 ||| |MEMANTINE HCL-DONEPEZIL HCL 14-10 MG PO CP24|1 each|126781| 55.65 |||||||||| 36.17 | 37.84 | 40.62 | 40.62 | 43.41 | 33.39 | 36.17 | 41.74 | 47.30 | 49.42 | 48.97 | 41.74 | 47.30 ||| |MEMANTINE HCL-DONEPEZIL HCL 28-10 MG PO CP24|1 capsule (1 each)|126782| 55.65 |||||||||| 36.17 | 37.84 | 40.62 | 40.62 | 43.41 | 33.39 | 36.17 | 41.74 | 47.30 | 49.42 | 48.97 | 41.74 | 47.30 ||| |CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR|2.5 g (1 each)|126797| 759.10 |||||||||| 493.42 | 516.19 | 554.14 | 554.14 | 592.10 | 455.46 | 493.42 | 569.33 | 645.24 | 674.08 | 668.01 | 569.33 | 645.24 ||| |ISAVUCONAZONIUM SULFATE 372 MG IV SOLR|372 mg (1 each)|126844| 627.70 |||||||||| 408.01 | 426.84 | 458.22 | 458.22 | 489.61 | 376.62 | 408.01 | 470.78 | 533.55 | 557.40 | 552.38 | 470.78 | 533.55 ||| |FAMOTIDINE IN NACL 20-0.9 MG/50ML-% IV SOLN|50 mL|12735| 142.05 |||||||||| 92.33 | 96.59 | 103.70 | 103.70 | 110.80 | 85.23 | 92.33 | 106.54 | 120.74 | 126.14 | 125.00 | 106.54 | 120.74 ||| |ASENAPINE MALEATE 2.5 MG SL SUBL|60 each|127567| 2,514.95 |||||||||| 1,634.72 | 1,710.17 | 1,835.91 | 1,835.91 | 1,961.66 | 1,508.97 | 1,634.72 | 1,886.21 | 2,137.71 | 2,233.28 | 2,213.16 | 1,886.21 | 2,137.71 ||| |METHYLPHENIDATE HCL ER (XR) 15 MG PO CP24|90 each|127613| 1,369.75 |||||||||| 890.34 | 931.43 | 999.92 | 999.92 | 1,068.41 | 821.85 | 890.34 | 1,027.31 | 1,164.29 | 1,216.34 | 1,205.38 | 1,027.31 | 1,164.29 ||| |METHYLPHENIDATE HCL ER (XR) 10 MG PO CP24|10 mg (1 each)|127614| 37.00 |||||||||| 24.05 | 25.16 | 27.01 | 27.01 | 28.86 | 22.20 | 24.05 | 27.75 | 31.45 | 32.86 | 32.56 | 27.75 | 31.45 ||| |METHYLPHENIDATE HCL ER (XR) 10 MG PO CP24|20 mg (2 each)|127614| 51.95 |||||||||| 33.77 | 35.33 | 37.92 | 37.92 | 40.52 | 31.17 | 33.77 | 38.96 | 44.16 | 46.13 | 45.72 | 38.96 | 44.16 ||| |METHYLPHENIDATE HCL ER (XR) 10 MG PO CP24|30 mg (3 each)|127614| 66.95 |||||||||| 43.52 | 45.53 | 48.87 | 48.87 | 52.22 | 40.17 | 43.52 | 50.21 | 56.91 | 59.45 | 58.92 | 50.21 | 56.91 ||| |METHYLPHENIDATE HCL ER (XR) 10 MG PO CP24|40 mg (4 each)|127614| 81.90 |||||||||| 53.24 | 55.69 | 59.79 | 59.79 | 63.88 | 49.14 | 53.24 | 61.43 | 69.62 | 72.73 | 72.07 | 61.43 | 69.62 ||| |METHYLPHENIDATE HCL ER (XR) 10 MG PO CP24|50 mg (5 each)|127614| 96.90 |||||||||| 62.99 | 65.89 | 70.74 | 70.74 | 75.58 | 58.14 | 62.99 | 72.68 | 82.37 | 86.05 | 85.27 | 72.68 | 82.37 ||| |METHYLPHENIDATE HCL ER (XR) 10 MG PO CP24|60 mg (6 each)|127614| 111.85 |||||||||| 72.70 | 76.06 | 81.65 | 81.65 | 87.24 | 67.11 | 72.70 | 83.89 | 95.07 | 99.32 | 98.43 | 83.89 | 95.07 ||| |GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR|1 each|127705| 354.95 |||||||||| 230.72 | 241.37 | 259.11 | 259.11 | 276.86 | 212.97 | 230.72 | 266.21 | 301.71 | 315.20 | 312.36 | 266.21 | 301.71 ||| |FLUTICASONE FUROATE-VILANTEROL 200-25 MCG/INH IN AEPB|28 each|127924| 296.40 |||||||||| 192.66 | 201.55 | 216.37 | 216.37 | 231.19 | 177.84 | 192.66 | 222.30 | 251.94 | 263.20 | 260.83 | 222.30 | 251.94 ||| |VARICELLA-ZOSTER IMMUNE GLOB 125 UNIT/1.2ML IM SOLN|1.2 mL|127930| 2,580.70 |||||||||| 1,677.46 | 1,754.88 | 1,883.91 | 1,883.91 | 2,012.95 | 1,548.42 | 1,677.46 | 1,935.53 | 2,193.60 | 2,291.66 | 2,271.02 | 1,935.53 | 2,193.60 ||| |CANGRELOR TETRASODIUM 50 MG IV SOLR|1 each|128168| 1,538.85 |||||||||| 1,000.25 | 1,046.42 | 1,123.36 | 1,123.36 | 1,200.30 | 923.31 | 1,000.25 | 1,154.14 | 1,308.02 | 1,366.50 | 1,354.19 | 1,154.14 | 1,308.02 ||| |SACUBITRIL-VALSARTAN 24-26 MG PO TABS|1 tablet (1 each)|128219| 35.85 |||||||||| 23.30 | 24.38 | 26.17 | 26.17 | 27.96 | 21.51 | 23.30 | 26.89 | 30.47 | 31.83 | 31.55 | 26.89 | 30.47 ||| |SACUBITRIL-VALSARTAN 49-51 MG PO TABS|1 tablet (1 each)|128220| 35.85 |||||||||| 23.30 | 24.38 | 26.17 | 26.17 | 27.96 | 21.51 | 23.30 | 26.89 | 30.47 | 31.83 | 31.55 | 26.89 | 30.47 ||| |SACUBITRIL-VALSARTAN 97-103 MG PO TABS|1 tablet (1 each)|128221| 35.85 |||||||||| 23.30 | 24.38 | 26.17 | 26.17 | 27.96 | 21.51 | 23.30 | 26.89 | 30.47 | 31.83 | 31.55 | 26.89 | 30.47 ||| |BREXPIPRAZOLE 0.25 MG PO TABS|30 each|128253| 2,440.35 |||||||||| 1,586.23 | 1,659.44 | 1,781.46 | 1,781.46 | 1,903.47 | 1,464.21 | 1,586.23 | 1,830.26 | 2,074.30 | 2,167.03 | 2,147.51 | 1,830.26 | 2,074.30 ||| |BREXPIPRAZOLE 0.5 MG PO TABS|30 each|128254| 2,440.35 |||||||||| 1,586.23 | 1,659.44 | 1,781.46 | 1,781.46 | 1,903.47 | 1,464.21 | 1,586.23 | 1,830.26 | 2,074.30 | 2,167.03 | 2,147.51 | 1,830.26 | 2,074.30 ||| |BREXPIPRAZOLE 1 MG PO TABS|30 each|128255| 2,440.35 |||||||||| 1,586.23 | 1,659.44 | 1,781.46 | 1,781.46 | 1,903.47 | 1,464.21 | 1,586.23 | 1,830.26 | 2,074.30 | 2,167.03 | 2,147.51 | 1,830.26 | 2,074.30 ||| |BREXPIPRAZOLE 2 MG PO TABS|30 each|128256| 2,440.35 |||||||||| 1,586.23 | 1,659.44 | 1,781.46 | 1,781.46 | 1,903.47 | 1,464.21 | 1,586.23 | 1,830.26 | 2,074.30 | 2,167.03 | 2,147.51 | 1,830.26 | 2,074.30 ||| |BREXPIPRAZOLE 4 MG PO TABS|30 each|128258| 2,440.35 |||||||||| 1,586.23 | 1,659.44 | 1,781.46 | 1,781.46 | 1,903.47 | 1,464.21 | 1,586.23 | 1,830.26 | 2,074.30 | 2,167.03 | 2,147.51 | 1,830.26 | 2,074.30 ||| |LACTOSE MONOHYDRATE POWD|1000 g|12837| 764.35 |||||||||| 496.83 | 519.76 | 557.98 | 557.98 | 596.19 | 458.61 | 496.83 | 573.26 | 649.70 | 678.74 | 672.63 | 573.26 | 649.70 ||| |ASPARAGINASE ERWINIA CHRYSANTH 10000 UNITS IJ SOLR|1 each|128684| 5,982.60 |||||||||| 3,888.69 | 4,068.17 | 4,367.30 | 4,367.30 | 4,666.43 | 3,589.56 | 3,888.69 | 4,486.95 | 5,085.21 | 5,312.55 | 5,264.69 | 4,486.95 | 5,085.21 ||| |FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY|.5 mL|128687| 563.70 |||||||||| 366.41 | 383.32 | 411.50 | 411.50 | 439.69 | 338.22 | 366.41 | 422.78 | 479.15 | 500.57 | 496.06 | 422.78 | 479.15 ||| |FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY|.8 mL|128688| 901.90 |||||||||| 586.24 | 613.29 | 658.39 | 658.39 | 703.48 | 541.14 | 586.24 | 676.43 | 766.62 | 800.89 | 793.67 | 676.43 | 766.62 ||| |RITUXIMAB 100 MG/10ML IV SOLN|10 mL|128689| 1,950.45 |||||||||| 1,267.79 | 1,326.31 | 1,423.83 | 1,423.83 | 1,521.35 | 1,170.27 | 1,267.79 | 1,462.84 | 1,657.88 | 1,732.00 | 1,716.40 | 1,462.84 | 1,657.88 ||| |RITUXIMAB 500 MG/50ML IV SOLN|50 mL|128690| 9,752.25 |||||||||| 6,338.96 | 6,631.53 | 7,119.14 | 7,119.14 | 7,606.76 | 5,851.35 | 6,338.96 | 7,314.19 | 8,289.41 | 8,660.00 | 8,581.98 | 7,314.19 | 8,289.41 ||| |MAGNESIUM SULFATE 2 GM/50ML IV SOLN|50 mL|128692| 159.55 |||||||||| 103.71 | 108.49 | 116.47 | 116.47 | 124.45 | 95.73 | 103.71 | 119.66 | 135.62 | 141.68 | 140.40 | 119.66 | 135.62 ||| |MAGNESIUM SULFATE 4 GM/100ML IV SOLN|100 mL|128693| 145.55 |||||||||| 94.61 | 98.97 | 106.25 | 106.25 | 113.53 | 87.33 | 94.61 | 109.16 | 123.72 | 129.25 | 128.08 | 109.16 | 123.72 ||| |MAGNESIUM SULFATE 20 GM/500ML IV SOLN|500 mL|128694| 143.05 |||||||||| 92.98 | 97.27 | 104.43 | 104.43 | 111.58 | 85.83 | 92.98 | 107.29 | 121.59 | 127.03 | 125.88 | 107.29 | 121.59 ||| |MAGNESIUM SULFATE 40 GM/1000ML IV SOLN|1000 mL|128695| 148.20 |||||||||| 96.33 | 100.78 | 108.19 | 108.19 | 115.60 | 88.92 | 96.33 | 111.15 | 125.97 | 131.60 | 130.42 | 111.15 | 125.97 ||| |PEGFILGRASTIM 6 MG/0.6ML SC SOSY|.6 mL|128697| 12,801.75 |||||||||| 8,321.14 | 8,705.19 | 9,345.28 | 9,345.28 | 9,985.37 | 7,681.05 | 8,321.14 | 9,601.31 | 10,881.49 | 11,367.95 | 11,265.54 | 9,601.31 | 10,881.49 ||| |PEGFILGRASTIM 6 MG/0.6ML SC PSKT|.6 mL|128698| 12,801.75 |||||||||| 8,321.14 | 8,705.19 | 9,345.28 | 9,345.28 | 9,985.37 | 7,681.05 | 8,321.14 | 9,601.31 | 10,881.49 | 11,367.95 | 11,265.54 | 9,601.31 | 10,881.49 ||| |INTERFERON BETA-1A 30 MCG/0.5ML IM PSKT|1 each|128700| 14,665.45 |||||||||| 9,532.54 | 9,972.51 | 10,705.78 | 10,705.78 | 11,439.05 | 8,799.27 | 9,532.54 | 10,999.09 | 12,465.63 | 13,022.92 | 12,905.60 | 10,999.09 | 12,465.63 ||| |INTERFERON BETA-1A 22 MCG/0.5ML SC SOAJ|.5 mL|128706| 2,896.55 |||||||||| 1,882.76 | 1,969.65 | 2,114.48 | 2,114.48 | 2,259.31 | 1,737.93 | 1,882.76 | 2,172.41 | 2,462.07 | 2,572.14 | 2,548.96 | 2,172.41 | 2,462.07 ||| |CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN|2 mL|128708| 96.35 |||||||||| 62.63 | 65.52 | 70.34 | 70.34 | 75.15 | 57.81 | 62.63 | 72.26 | 81.90 | 85.56 | 84.79 | 72.26 | 81.90 ||| |DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY|.42 mL|128721| 397.55 |||||||||| 258.41 | 270.33 | 290.21 | 290.21 | 310.09 | 238.53 | 258.41 | 298.16 | 337.92 | 353.02 | 349.84 | 298.16 | 337.92 ||| |DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY|.4 mL|128723| 636.10 |||||||||| 413.47 | 432.55 | 464.35 | 464.35 | 496.16 | 381.66 | 413.47 | 477.08 | 540.69 | 564.86 | 559.77 | 477.08 | 540.69 ||| |DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY|.3 mL|128725| 954.15 |||||||||| 620.20 | 648.82 | 696.53 | 696.53 | 744.24 | 572.49 | 620.20 | 715.61 | 811.03 | 847.29 | 839.65 | 715.61 | 811.03 ||| |DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY|.5 mL|128728| 1,590.20 |||||||||| 1,033.63 | 1,081.34 | 1,160.85 | 1,160.85 | 1,240.36 | 954.12 | 1,033.63 | 1,192.65 | 1,351.67 | 1,412.10 | 1,399.38 | 1,192.65 | 1,351.67 ||| |DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY|.3 mL|128731| 2,385.30 |||||||||| 1,550.45 | 1,622.00 | 1,741.27 | 1,741.27 | 1,860.53 | 1,431.18 | 1,550.45 | 1,788.98 | 2,027.51 | 2,118.15 | 2,099.06 | 1,788.98 | 2,027.51 ||| |DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY|.4 mL|128732| 3,180.40 |||||||||| 2,067.26 | 2,162.67 | 2,321.69 | 2,321.69 | 2,480.71 | 1,908.24 | 2,067.26 | 2,385.30 | 2,703.34 | 2,824.20 | 2,798.75 | 2,385.30 | 2,703.34 ||| |DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY|.6 mL|128733| 4,770.55 |||||||||| 3,100.86 | 3,243.97 | 3,482.50 | 3,482.50 | 3,721.03 | 2,862.33 | 3,100.86 | 3,577.91 | 4,054.97 | 4,236.25 | 4,198.08 | 3,577.91 | 4,054.97 ||| |DARBEPOETIN ALFA 500 MCG/ML IJ SOSY|1 mL|128734| 7,950.95 |||||||||| 5,168.12 | 5,406.65 | 5,804.19 | 5,804.19 | 6,201.74 | 4,770.57 | 5,168.12 | 5,963.21 | 6,758.31 | 7,060.44 | 6,996.84 | 5,963.21 | 6,758.31 ||| |MORPHINE SULFATE-NACL 50-0.9 MG/50ML-% IV SOSY|50 mL|128835| 182.40 |||||||||| 118.56 | 124.03 | 133.15 | 133.15 | 142.27 | 109.44 | 118.56 | 136.80 | 155.04 | 161.97 | 160.51 | 136.80 | 155.04 ||| |HYDROMORPHONE PCA STANDARD 0.2 MG/ML PREMIX|50 mL|128836| 185.75 |||||||||| 120.74 | 126.31 | 135.60 | 135.60 | 144.89 | 111.45 | 120.74 | 139.31 | 157.89 | 164.95 | 163.46 | 139.31 | 157.89 ||| |CLARITHROMYCIN 250 MG/5ML PO SUSR|50 mL|12886| 199.95 |||||||||| 129.97 | 135.97 | 145.96 | 145.96 | 155.96 | 119.97 | 129.97 | 149.96 | 169.96 | 177.56 | 175.96 | 149.96 | 169.96 ||| |PENTOSAN POLYSULFATE SODIUM 100 MG PO CAPS|100 mg (1 each)|12912| 36.55 |||||||||| 23.76 | 24.85 | 26.68 | 26.68 | 28.51 | 21.93 | 23.76 | 27.41 | 31.07 | 32.46 | 32.16 | 27.41 | 31.07 ||| |TRABECTEDIN 1 MG IV SOLR|1 each|129134| 6,303.90 |||||||||| 4,097.54 | 4,286.65 | 4,601.85 | 4,601.85 | 4,917.04 | 3,782.34 | 4,097.54 | 4,727.93 | 5,358.32 | 5,597.86 | 5,547.43 | 4,727.93 | 5,358.32 ||| |OXYTOCIN-LACTATED RINGERS 30 UNIT/500ML IV BOLUS|500 mL|129138| 211.50 |||||||||| 137.48 | 143.82 | 154.40 | 154.40 | 164.97 | 126.90 | 137.48 | 158.63 | 179.78 | 187.81 | 186.12 | 158.63 | 179.78 ||| |INSULIN DEGLUDEC 200 UNIT/ML SC SOPN|3 mL|129140| 444.20 |||||||||| 288.73 | 302.06 | 324.27 | 324.27 | 346.48 | 266.52 | 288.73 | 333.15 | 377.57 | 394.45 | 390.90 | 333.15 | 377.57 ||| |IDARUCIZUMAB 2.5 GM/50ML IV SOLN|50 mL|129226| 4,116.00 |||||||||| 2,675.40 | 2,798.88 | 3,004.68 | 3,004.68 | 3,210.48 | 2,469.60 | 2,675.40 | 3,087.00 | 3,498.60 | 3,655.01 | 3,622.08 | 3,087.00 | 3,498.60 ||| |CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS|1,334 mg (2 each)|129239| 12.05 |||||||||| 7.83 | 8.19 | 8.80 | 8.80 | 9.40 | 7.23 | 7.83 | 9.04 | 10.24 | 10.70 | 10.60 | 9.04 | 10.24 ||| |CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS|2,001 mg (3 each)|129239| 12.60 |||||||||| 8.19 | 8.57 | 9.20 | 9.20 | 9.83 | 7.56 | 8.19 | 9.45 | 10.71 | 11.19 | 11.09 | 9.45 | 10.71 ||| |CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS|667 mg (1 each)|129239| 11.55 |||||||||| 7.51 | 7.85 | 8.43 | 8.43 | 9.01 | 6.93 | 7.51 | 8.66 | 9.82 | 10.26 | 10.16 | 8.66 | 9.82 ||| |IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ|10 mL|129244| 2,643.40 |||||||||| 1,718.21 | 1,797.51 | 1,929.68 | 1,929.68 | 2,061.85 | 1,586.04 | 1,718.21 | 1,982.55 | 2,246.89 | 2,347.34 | 2,326.19 | 1,982.55 | 2,246.89 ||| |TACROLIMUS 5 MG/ML IV SOLN|1 mL|12935| 427.15 |||||||||| 277.65 | 290.46 | 311.82 | 311.82 | 333.18 | 256.29 | 277.65 | 320.36 | 363.08 | 379.31 | 375.89 | 320.36 | 363.08 ||| |TALIMOGENE LAHERPAREPVEC 1000000 UNIT/ML INTRA-LESION SUSP|1 mL|129362| 76.90 |||||||||| 49.99 | 52.29 | 56.14 | 56.14 | 59.98 | 46.14 | 49.99 | 57.68 | 65.37 | 68.29 | 67.67 | 57.68 | 65.37 ||| |TALIMOGENE LAHERPAREPVEC 100000000 UNIT/ML INTRA-LESION SUSP|1 mL|129363| 7,687.85 |||||||||| 4,997.10 | 5,227.74 | 5,612.13 | 5,612.13 | 5,996.52 | 4,612.71 | 4,997.10 | 5,765.89 | 6,534.67 | 6,826.81 | 6,765.31 | 5,765.89 | 6,534.67 ||| |MEPOLIZUMAB 100 MG SC SOLR|100 mg (1 each)|129398| 6,315.70 |||||||||| 4,105.21 | 4,294.68 | 4,610.46 | 4,610.46 | 4,926.25 | 3,789.42 | 4,105.21 | 4,736.78 | 5,368.35 | 5,608.34 | 5,557.82 | 4,736.78 | 5,368.35 ||| |DARATUMUMAB 100 MG/5ML IV SOLN|5 mL|129452| 824.75 |||||||||| 536.09 | 560.83 | 602.07 | 602.07 | 643.31 | 494.85 | 536.09 | 618.56 | 701.04 | 732.38 | 725.78 | 618.56 | 701.04 ||| |DARATUMUMAB 400 MG/20ML IV SOLN|20 mL|129453| 3,299.00 |||||||||| 2,144.35 | 2,243.32 | 2,408.27 | 2,408.27 | 2,573.22 | 1,979.40 | 2,144.35 | 2,474.25 | 2,804.15 | 2,929.51 | 2,903.12 | 2,474.25 | 2,804.15 ||| |PATIROMER SORBITEX CALCIUM 8.4 G PO PACK|8.4 g (1 each)|129652| 84.15 |||||||||| 54.70 | 57.22 | 61.43 | 61.43 | 65.64 | 50.49 | 54.70 | 63.11 | 71.53 | 74.73 | 74.05 | 63.11 | 71.53 ||| |NECITUMUMAB 800 MG/50ML IV SOLN|50 mL|129681| 6,426.25 |||||||||| 4,177.06 | 4,369.85 | 4,691.16 | 4,691.16 | 5,012.48 | 3,855.75 | 4,177.06 | 4,819.69 | 5,462.31 | 5,706.51 | 5,655.10 | 4,819.69 | 5,462.31 ||| |ELOTUZUMAB 300 MG IV SOLR|1 each|129715| 4,031.55 |||||||||| 2,620.51 | 2,741.45 | 2,943.03 | 2,943.03 | 3,144.61 | 2,418.93 | 2,620.51 | 3,023.66 | 3,426.82 | 3,580.02 | 3,547.76 | 3,023.66 | 3,426.82 ||| |ELOTUZUMAB 400 MG IV SOLR|1 each|129716| 3,843.00 |||||||||| 2,497.95 | 2,613.24 | 2,805.39 | 2,805.39 | 2,997.54 | 2,305.80 | 2,497.95 | 2,882.25 | 3,266.55 | 3,412.58 | 3,381.84 | 2,882.25 | 3,266.55 ||| |BENDAMUSTINE HCL 100 MG/4ML IV SOLN|4 mL|129777| 3,671.65 |||||||||| 2,386.57 | 2,496.72 | 2,680.30 | 2,680.30 | 2,863.89 | 2,202.99 | 2,386.57 | 2,753.74 | 3,120.90 | 3,260.43 | 3,231.05 | 2,753.74 | 3,120.90 ||| |SUGAMMADEX SODIUM 200 MG/2ML IV SOLN|2 mL|130026| 231.15 |||||||||| 150.25 | 157.18 | 168.74 | 168.74 | 180.30 | 138.69 | 150.25 | 173.36 | 196.48 | 205.26 | 203.41 | 173.36 | 196.48 ||| |CARIPRAZINE HCL 1.5 MG PO CAPS|30 each|130299| 2,564.80 |||||||||| 1,667.12 | 1,744.06 | 1,872.30 | 1,872.30 | 2,000.54 | 1,538.88 | 1,667.12 | 1,923.60 | 2,180.08 | 2,277.54 | 2,257.02 | 1,923.60 | 2,180.08 ||| |CARIPRAZINE HCL 3 MG PO CAPS|1 each|130300| 106.80 |||||||||| 69.42 | 72.62 | 77.96 | 77.96 | 83.30 | 64.08 | 69.42 | 80.10 | 90.78 | 94.84 | 93.98 | 80.10 | 90.78 ||| |CIPROFLOXACIN 6 % TP SUSP|1 mL|130307| 567.10 |||||||||| 368.62 | 385.63 | 413.98 | 413.98 | 442.34 | 340.26 | 368.62 | 425.33 | 482.04 | 503.58 | 499.05 | 425.33 | 482.04 ||| |BUDESONIDE 3 MG PO CPEP|3 mg (1 each)|130524| 59.90 |||||||||| 38.94 | 40.73 | 43.73 | 43.73 | 46.72 | 35.94 | 38.94 | 44.93 | 50.92 | 53.19 | 52.71 | 44.93 | 50.92 ||| |BUDESONIDE 3 MG PO CPEP|6 mg (2 each)|130524| 97.75 |||||||||| 63.54 | 66.47 | 71.36 | 71.36 | 76.25 | 58.65 | 63.54 | 73.31 | 83.09 | 86.80 | 86.02 | 73.31 | 83.09 ||| |BUDESONIDE 3 MG PO CPEP|9 mg (3 each)|130524| 135.65 |||||||||| 88.17 | 92.24 | 99.02 | 99.02 | 105.81 | 81.39 | 88.17 | 101.74 | 115.30 | 120.46 | 119.37 | 101.74 | 115.30 ||| |CLADRIBINE 10 MG/10ML IV SOLN|10 mL|130528| 726.60 |||||||||| 472.29 | 494.09 | 530.42 | 530.42 | 566.75 | 435.96 | 472.29 | 544.95 | 617.61 | 645.22 | 639.41 | 544.95 | 617.61 ||| |CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN|20 mL|130530| 548.35 |||||||||| 356.43 | 372.88 | 400.30 | 400.30 | 427.71 | 329.01 | 356.43 | 411.26 | 466.10 | 486.93 | 482.55 | 411.26 | 466.10 ||| |HYDROCOD POLST-CPM POLST ER 10-8 MG/5ML PO SUER|5 mL|130536| 16.05 |||||||||| 10.43 | 10.91 | 11.72 | 11.72 | 12.52 | 9.63 | 10.43 | 12.04 | 13.64 | 14.25 | 14.12 | 12.04 | 13.64 ||| |PROPOFOL 100 MG/10ML IV INFUSION|10 mL|130554| 23.25 |||||||||| 15.11 | 15.81 | 16.97 | 16.97 | 18.14 | 13.95 | 15.11 | 17.44 | 19.76 | 20.65 | 20.46 | 17.44 | 19.76 ||| |PROPOFOL 200 MG/20ML IV INFUSION|20 mL|130555| 38.55 |||||||||| 25.06 | 26.21 | 28.14 | 28.14 | 30.07 | 23.13 | 25.06 | 28.91 | 32.77 | 34.23 | 33.92 | 28.91 | 32.77 ||| |FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN|2 mL|130559| 48.30 |||||||||| 31.40 | 32.84 | 35.26 | 35.26 | 37.67 | 28.98 | 31.40 | 36.23 | 41.06 | 42.89 | 42.50 | 36.23 | 41.06 ||| |FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN|5 mL|130560| 51.50 |||||||||| 33.48 | 35.02 | 37.60 | 37.60 | 40.17 | 30.90 | 33.48 | 38.63 | 43.78 | 45.73 | 45.32 | 38.63 | 43.78 ||| |FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN|20 mL|130561| 66.00 |||||||||| 42.90 | 44.88 | 48.18 | 48.18 | 51.48 | 39.60 | 42.90 | 49.50 | 56.10 | 58.61 | 58.08 | 49.50 | 56.10 ||| |FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN|50 mL|130562| 91.45 |||||||||| 59.44 | 62.19 | 66.76 | 66.76 | 71.33 | 54.87 | 59.44 | 68.59 | 77.73 | 81.21 | 80.48 | 68.59 | 77.73 ||| |DIVALPROEX SODIUM 125 MG PO CSDR|125 mg (1 each)|130563| 12.75 |||||||||| 8.29 | 8.67 | 9.31 | 9.31 | 9.95 | 7.65 | 8.29 | 9.56 | 10.84 | 11.32 | 11.22 | 9.56 | 10.84 ||| |DIVALPROEX SODIUM 125 MG PO CSDR|250 mg (2 each)|130563| 14.50 |||||||||| 9.43 | 9.86 | 10.59 | 10.59 | 11.31 | 8.70 | 9.43 | 10.88 | 12.33 | 12.88 | 12.76 | 10.88 | 12.33 ||| |EPTIFIBATIDE 20 MG/10ML IV SOLN|10 mL|130564| 205.45 |||||||||| 133.54 | 139.71 | 149.98 | 149.98 | 160.25 | 123.27 | 133.54 | 154.09 | 174.63 | 182.44 | 180.80 | 154.09 | 174.63 ||| |FENTANYL CITRATE (PF) 500 MCG/10ML IJ SOLN|10 mL|130596| 51.60 |||||||||| 33.54 | 35.09 | 37.67 | 37.67 | 40.25 | 30.96 | 33.54 | 38.70 | 43.86 | 45.82 | 45.41 | 38.70 | 43.86 ||| |ACETYLCHOLINE CHLORIDE 20 MG IO SOLR|1 each|130942| 229.50 |||||||||| 149.18 | 156.06 | 167.54 | 167.54 | 179.01 | 137.70 | 149.18 | 172.13 | 195.08 | 203.80 | 201.96 | 172.13 | 195.08 ||| |INSULIN REGULAR HUMAN (CONC) 500 UNIT/ML SC SOPN|3 mL|131104| 574.45 |||||||||| 373.39 | 390.63 | 419.35 | 419.35 | 448.07 | 344.67 | 373.39 | 430.84 | 488.28 | 510.11 | 505.52 | 430.84 | 488.28 ||| |RESLIZUMAB 100 MG/10ML IV SOLN|10 mL|131110| 1,914.80 |||||||||| 1,244.62 | 1,302.06 | 1,397.80 | 1,397.80 | 1,493.54 | 1,148.88 | 1,244.62 | 1,436.10 | 1,627.58 | 1,700.34 | 1,685.02 | 1,436.10 | 1,627.58 ||| |MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN|100 mL|131118| 102.00 |||||||||| 66.30 | 69.36 | 74.46 | 74.46 | 79.56 | 61.20 | 66.30 | 76.50 | 86.70 | 90.58 | 89.76 | 76.50 | 86.70 ||| |SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY|10 mL|131121| 147.30 |||||||||| 95.75 | 100.16 | 107.53 | 107.53 | 114.89 | 88.38 | 95.75 | 110.48 | 125.21 | 130.80 | 129.62 | 110.48 | 125.21 ||| |EPHEDRINE SULFATE-NACL 25-0.9 MG/5ML-% IV SOSY|5 mL|131125| 95.95 |||||||||| 62.37 | 65.25 | 70.04 | 70.04 | 74.84 | 57.57 | 62.37 | 71.96 | 81.56 | 85.20 | 84.44 | 71.96 | 81.56 ||| |VANCOMYCIN HCL IN NACL 1-0.9 GM/200ML-% IV SOLN|200 mL|131254| 169.85 |||||||||| 110.40 | 115.50 | 123.99 | 123.99 | 132.48 | 101.91 | 110.40 | 127.39 | 144.37 | 150.83 | 149.47 | 127.39 | 144.37 ||| |BRIVARACETAM 50 MG PO TABS|100 each|131375| 4,102.60 |||||||||| 2,666.69 | 2,789.77 | 2,994.90 | 2,994.90 | 3,200.03 | 2,461.56 | 2,666.69 | 3,076.95 | 3,487.21 | 3,643.11 | 3,610.29 | 3,076.95 | 3,487.21 ||| |BRIVARACETAM 100 MG PO TABS|60 each|131377| 2,470.40 |||||||||| 1,605.76 | 1,679.87 | 1,803.39 | 1,803.39 | 1,926.91 | 1,482.24 | 1,605.76 | 1,852.80 | 2,099.84 | 2,193.72 | 2,173.95 | 1,852.80 | 2,099.84 ||| |BRIVARACETAM 10 MG/ML PO SOLN|300 mL|131378| 2,470.25 |||||||||| 1,605.66 | 1,679.77 | 1,803.28 | 1,803.28 | 1,926.80 | 1,482.15 | 1,605.66 | 1,852.69 | 2,099.71 | 2,193.58 | 2,173.82 | 1,852.69 | 2,099.71 ||| |BRIVARACETAM 50 MG/5ML IV SOLN|5 mL|131379| 218.65 |||||||||| 142.12 | 148.68 | 159.61 | 159.61 | 170.55 | 131.19 | 142.12 | 163.99 | 185.85 | 194.16 | 192.41 | 163.99 | 185.85 ||| |POTASSIUM GLUCONATE 550 (90 K) MG PO TABS|100 each|131382| 22.85 |||||||||| 14.85 | 15.54 | 16.68 | 16.68 | 17.82 | 13.71 | 14.85 | 17.14 | 19.42 | 20.29 | 20.11 | 17.14 | 19.42 ||| |ATEZOLIZUMAB 1200 MG/20ML IV SOLN|20 mL|131478| 13,645.80 |||||||||| 8,869.77 | 9,279.14 | 9,961.43 | 9,961.43 | 10,643.72 | 8,187.48 | 8,869.77 | 10,234.35 | 11,598.93 | 12,117.47 | 12,008.30 | 10,234.35 | 11,598.93 ||| |VERAPAMIL HCL ER 120 MG PO TBCR|100 each|13184| 147.00 |||||||||| 95.55 | 99.96 | 107.31 | 107.31 | 114.66 | 88.20 | 95.55 | 110.25 | 124.95 | 130.54 | 129.36 | 110.25 | 124.95 ||| |INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY|.5 mL|132008| 132.55 |||||||||| 86.16 | 90.13 | 96.76 | 96.76 | 103.39 | 79.53 | 86.16 | 99.41 | 112.67 | 117.70 | 116.64 | 99.41 | 112.67 ||| |METHYLENE BLUE 50 MG/10ML IV SOLN|10 mL|132427| 481.95 |||||||||| 313.27 | 327.73 | 351.82 | 351.82 | 375.92 | 289.17 | 313.27 | 361.46 | 409.66 | 427.97 | 424.12 | 361.46 | 409.66 ||| |FENTANYL CITRATE-NACL 1-0.9 MG/100ML-% IV SOLN|100 mL|132430| 351.85 |||||||||| 228.70 | 239.26 | 256.85 | 256.85 | 274.44 | 211.11 | 228.70 | 263.89 | 299.07 | 312.44 | 309.63 | 263.89 | 299.07 ||| |HYDROMORPHONE PCA STANDARD 0.2 MG/ML PREMIX|50 mL|132433| 223.00 |||||||||| 144.95 | 151.64 | 162.79 | 162.79 | 173.94 | 133.80 | 144.95 | 167.25 | 189.55 | 198.02 | 196.24 | 167.25 | 189.55 ||| |MORPHINE PCA STANDARD 1 MG/ML PREMIX|50 mL|132434| 223.00 |||||||||| 144.95 | 151.64 | 162.79 | 162.79 | 173.94 | 133.80 | 144.95 | 167.25 | 189.55 | 198.02 | 196.24 | 167.25 | 189.55 ||| |LIDOCAINE-SODIUM BICARBONATE 1-8.4 % IJ SOSY|10 mL|132535| 49.65 |||||||||| 32.27 | 33.76 | 36.24 | 36.24 | 38.73 | 29.79 | 32.27 | 37.24 | 42.20 | 44.09 | 43.69 | 37.24 | 42.20 ||| |VANCOMYCIN HCL IN NACL 1.5-0.9 GM/500ML-% IV SOLN|500 mL|132584| 182.00 |||||||||| 118.30 | 123.76 | 132.86 | 132.86 | 141.96 | 109.20 | 118.30 | 136.50 | 154.70 | 161.62 | 160.16 | 136.50 | 154.70 ||| |INFLIXIMAB-DYYB 100 MG IV SOLR|1 each|132846| 1,944.15 |||||||||| 1,263.70 | 1,322.02 | 1,419.23 | 1,419.23 | 1,516.44 | 1,166.49 | 1,263.70 | 1,458.11 | 1,652.53 | 1,726.41 | 1,710.85 | 1,458.11 | 1,652.53 ||| |CHLOROPROCAINE HCL (PF) 2 % IJ SOLN|20 mL|132849| 74.15 |||||||||| 48.20 | 50.42 | 54.13 | 54.13 | 57.84 | 44.49 | 48.20 | 55.61 | 63.03 | 65.85 | 65.25 | 55.61 | 63.03 ||| |NALOXONE HCL 4 MG/10ML IJ SOLN|10 mL|132856| 209.10 |||||||||| 135.92 | 142.19 | 152.64 | 152.64 | 163.10 | 125.46 | 135.92 | 156.83 | 177.74 | 185.68 | 184.01 | 156.83 | 177.74 ||| |NALOXONE HCL 2 MG/2ML IJ SOSY|2 mL|132857| 96.15 |||||||||| 62.50 | 65.38 | 70.19 | 70.19 | 75.00 | 57.69 | 62.50 | 72.11 | 81.73 | 85.38 | 84.61 | 72.11 | 81.73 ||| |COAGULATION FACTOR IX (RECOMB) 250 UNITS IV KIT|250 Units|132858| 703.70 |||||||||| 457.41 | 478.52 | 513.70 | 513.70 | 548.89 | 422.22 | 457.41 | 527.78 | 598.15 | 624.89 | 619.26 | 527.78 | 598.15 ||| |COAGULATION FACTOR IX (RECOMB) 500 UNITS IV KIT|500 Units|132859| 1,407.35 |||||||||| 914.78 | 957.00 | 1,027.37 | 1,027.37 | 1,097.73 | 844.41 | 914.78 | 1,055.51 | 1,196.25 | 1,249.73 | 1,238.47 | 1,055.51 | 1,196.25 ||| |COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV KIT|2000 Units|132861| 5,793.70 |||||||||| 3,765.91 | 3,939.72 | 4,229.40 | 4,229.40 | 4,519.09 | 3,476.22 | 3,765.91 | 4,345.28 | 4,924.65 | 5,144.81 | 5,098.46 | 4,345.28 | 4,924.65 ||| |VANCOMYCIN HCL IN NACL 1.25-0.9 GM/250ML-% IV SOLN|250 mL|132980| 174.15 |||||||||| 113.20 | 118.42 | 127.13 | 127.13 | 135.84 | 104.49 | 113.20 | 130.61 | 148.03 | 154.65 | 153.25 | 130.61 | 148.03 ||| |DEXMEDETOMIDINE HCL 400 MCG/4ML IV SOLN|4 mL|133145| 268.45 |||||||||| 174.49 | 182.55 | 195.97 | 195.97 | 209.39 | 161.07 | 174.49 | 201.34 | 228.18 | 238.38 | 236.24 | 201.34 | 228.18 ||| |M.V.I. PEDIATRIC IV SOLR|5 mL (1 each)|133174| 57.75 |||||||||| 37.54 | 39.27 | 42.16 | 42.16 | 45.05 | 34.65 | 37.54 | 43.31 | 49.09 | 51.28 | 50.82 | 43.31 | 49.09 ||| |INFUVITE PEDIATRIC IV SOLN|5 mL|133181| 63.80 |||||||||| 41.47 | 43.38 | 46.57 | 46.57 | 49.76 | 38.28 | 41.47 | 47.85 | 54.23 | 56.65 | 56.14 | 47.85 | 54.23 ||| |USTEKINUMAB 130 MG/26ML IV SOLN|26 mL|133198| 3,448.30 |||||||||| 2,241.40 | 2,344.84 | 2,517.26 | 2,517.26 | 2,689.67 | 2,068.98 | 2,241.40 | 2,586.23 | 2,931.06 | 3,062.09 | 3,034.50 | 2,586.23 | 2,931.06 ||| |OLARATUMAB 500 MG/50ML IV SOLN|50 mL|133384| 3,645.20 |||||||||| 2,369.38 | 2,478.74 | 2,661.00 | 2,661.00 | 2,843.26 | 2,187.12 | 2,369.38 | 2,733.90 | 3,098.42 | 3,236.94 | 3,207.78 | 2,733.90 | 3,098.42 ||| |FAMCICLOVIR 500 MG PO TABS|30 each|13358| 331.95 |||||||||| 215.77 | 225.73 | 242.32 | 242.32 | 258.92 | 199.17 | 215.77 | 248.96 | 282.16 | 294.77 | 292.12 | 248.96 | 282.16 ||| |TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS|25 mg (1 each)|133890| 103.15 |||||||||| 67.05 | 70.14 | 75.30 | 75.30 | 80.46 | 61.89 | 67.05 | 77.36 | 87.68 | 91.60 | 90.77 | 77.36 | 87.68 ||| |POTASSIUM GLUCONATE 595 (99 K) MG PO TABS|100 each|13413| 24.50 |||||||||| 15.93 | 16.66 | 17.89 | 17.89 | 19.11 | 14.70 | 15.93 | 18.38 | 20.83 | 21.76 | 21.56 | 18.38 | 20.83 ||| |CEFAZOLIN SODIUM-DEXTROSE 2-5 GM/50ML-% IV SOLN|50 mL|134340| 149.65 |||||||||| 97.27 | 101.76 | 109.24 | 109.24 | 116.73 | 89.79 | 97.27 | 112.24 | 127.20 | 132.89 | 131.69 | 112.24 | 127.20 ||| |NEFAZODONE HCL 100 MG PO TABS|60 each|13444| 177.35 |||||||||| 115.28 | 120.60 | 129.47 | 129.47 | 138.33 | 106.41 | 115.28 | 133.01 | 150.75 | 157.49 | 156.07 | 133.01 | 150.75 ||| |NEFAZODONE HCL 150 MG PO TABS|60 each|13445| 185.05 |||||||||| 120.28 | 125.83 | 135.09 | 135.09 | 144.34 | 111.03 | 120.28 | 138.79 | 157.29 | 164.32 | 162.84 | 138.79 | 157.29 ||| |CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/100ML-% IV SOLN|100 mL|134621| 163.75 |||||||||| 106.44 | 111.35 | 119.54 | 119.54 | 127.73 | 98.25 | 106.44 | 122.81 | 139.19 | 145.41 | 144.10 | 122.81 | 139.19 ||| |LINACLOTIDE 72 MCG PO CAPS|30 each|134718| 945.90 |||||||||| 614.84 | 643.21 | 690.51 | 690.51 | 737.80 | 567.54 | 614.84 | 709.43 | 804.02 | 839.96 | 832.39 | 709.43 | 804.02 ||| |OLARATUMAB 190 MG/19ML IV SOLN|19 mL|134842| 1,385.20 |||||||||| 900.38 | 941.94 | 1,011.20 | 1,011.20 | 1,080.46 | 831.12 | 900.38 | 1,038.90 | 1,177.42 | 1,230.06 | 1,218.98 | 1,038.90 | 1,177.42 ||| |CAPSAICIN 0.025 % EX CREA|60 g|1350| 47.15 |||||||||| 30.65 | 32.06 | 34.42 | 34.42 | 36.78 | 28.29 | 30.65 | 35.36 | 40.08 | 41.87 | 41.49 | 35.36 | 40.08 ||| |POLYETHYL GLYC-PROPYL GLYC PF 0.4-0.3 % OP SOLN|1 drop (0.003333333333333333333 each)|135007| 34.05 |||||||||| 22.13 | 23.15 | 24.86 | 24.86 | 26.56 | 20.43 | 22.13 | 25.54 | 28.94 | 30.24 | 29.96 | 25.54 | 28.94 ||| |POLYETHYL GLYC-PROPYL GLYC PF 0.4-0.3 % OP SOLN|2 drop (0.006666666666666666667 each)|135007| 34.05 |||||||||| 22.13 | 23.15 | 24.86 | 24.86 | 26.56 | 20.43 | 22.13 | 25.54 | 28.94 | 30.24 | 29.96 | 25.54 | 28.94 ||| |DESMOPRESSIN ACETATE 1.5 MG/ML NA SOLN|2.5 mL|13506| 1,411.85 |||||||||| 917.70 | 960.06 | 1,030.65 | 1,030.65 | 1,101.24 | 847.11 | 917.70 | 1,058.89 | 1,200.07 | 1,253.72 | 1,242.43 | 1,058.89 | 1,200.07 ||| |SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN|5 mL|135061| 64.40 |||||||||| 41.86 | 43.79 | 47.01 | 47.01 | 50.23 | 38.64 | 41.86 | 48.30 | 54.74 | 57.19 | 56.67 | 48.30 | 54.74 ||| |SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN|15 mL|135062| 61.45 |||||||||| 39.94 | 41.79 | 44.86 | 44.86 | 47.93 | 36.87 | 39.94 | 46.09 | 52.23 | 54.57 | 54.08 | 46.09 | 52.23 ||| |PORACTANT ALFA 120 MG/1.5ML INTRATRACHEA SUSP|1.5 mL|135071| 939.55 |||||||||| 610.71 | 638.89 | 685.87 | 685.87 | 732.85 | 563.73 | 610.71 | 704.66 | 798.62 | 834.32 | 826.80 | 704.66 | 798.62 ||| |PORACTANT ALFA 240 MG/3ML INTRATRACHEA SUSP|3 mL|135072| 1,852.65 |||||||||| 1,204.22 | 1,259.80 | 1,352.43 | 1,352.43 | 1,445.07 | 1,111.59 | 1,204.22 | 1,389.49 | 1,574.75 | 1,645.15 | 1,630.33 | 1,389.49 | 1,574.75 ||| |ATROPINE SULFATE 0.5 MG/5ML IJ SOSY|5 mL|135077| 51.10 |||||||||| 33.22 | 34.75 | 37.30 | 37.30 | 39.86 | 30.66 | 33.22 | 38.33 | 43.44 | 45.38 | 44.97 | 38.33 | 43.44 ||| |ATROPINE SULFATE 1 MG/10ML IJ SOSY|10 mL|135078| 50.95 |||||||||| 33.12 | 34.65 | 37.19 | 37.19 | 39.74 | 30.57 | 33.12 | 38.21 | 43.31 | 45.24 | 44.84 | 38.21 | 43.31 ||| |ATROPINE SULFATE 8 MG/20ML IJ SOLN|20 mL|135087| 165.80 |||||||||| 107.77 | 112.74 | 121.03 | 121.03 | 129.32 | 99.48 | 107.77 | 124.35 | 140.93 | 147.23 | 145.90 | 124.35 | 140.93 ||| |CEFAZOLIN SODIUM 2 GM/20ML IV SOSY|20 mL|135101| 38.20 |||||||||| 24.83 | 25.98 | 27.89 | 27.89 | 29.80 | 22.92 | 24.83 | 28.65 | 32.47 | 33.92 | 33.62 | 28.65 | 32.47 ||| |NAPROXEN 500 MG PO TBEC|100 each|13523| 204.90 |||||||||| 133.19 | 139.33 | 149.58 | 149.58 | 159.82 | 122.94 | 133.19 | 153.68 | 174.17 | 181.95 | 180.31 | 153.68 | 174.17 ||| |NITROPRUSSIDE SODIUM-NACL 50-0.9 MG/100ML-% IV SOLN|100 mL|135237| 325.00 |||||||||| 211.25 | 221.00 | 237.25 | 237.25 | 253.50 | 195.00 | 211.25 | 243.75 | 276.25 | 288.60 | 286.00 | 243.75 | 276.25 ||| |AVELUMAB 200 MG/10ML IV SOLN|10 mL|135304| 2,440.85 |||||||||| 1,586.55 | 1,659.78 | 1,781.82 | 1,781.82 | 1,903.86 | 1,464.51 | 1,586.55 | 1,830.64 | 2,074.72 | 2,167.47 | 2,147.95 | 1,830.64 | 2,074.72 ||| |OCRELIZUMAB 300 MG/10ML IV SOLN|10 mL|135403| 33,385.65 |||||||||| 21,700.67 | 22,702.24 | 24,371.52 | 24,371.52 | 26,040.81 | 20,031.39 | 21,700.67 | 25,039.24 | 28,377.80 | 29,646.46 | 29,379.37 | 25,039.24 | 28,377.80 ||| |CARBAMIDE PEROXIDE 10 % MT SOLN|60 mL|1358| 48.50 |||||||||| 31.53 | 32.98 | 35.41 | 35.41 | 37.83 | 29.10 | 31.53 | 36.38 | 41.23 | 43.07 | 42.68 | 36.38 | 41.23 ||| |TETRACAINE HCL POWD|25 g|13583| 533.80 |||||||||| 346.97 | 362.98 | 389.67 | 389.67 | 416.36 | 320.28 | 346.97 | 400.35 | 453.73 | 474.01 | 469.74 | 400.35 | 453.73 ||| |TRASTUZUMAB 150 MG IV SOLR|1 each|136031| 2,313.05 |||||||||| 1,503.48 | 1,572.87 | 1,688.53 | 1,688.53 | 1,804.18 | 1,387.83 | 1,503.48 | 1,734.79 | 1,966.09 | 2,053.99 | 2,035.48 | 1,734.79 | 1,966.09 ||| |MIDOSTAURIN 25 MG PO CAPS|56 each|136090| 18,640.40 |||||||||| 12,116.26 | 12,675.47 | 13,607.49 | 13,607.49 | 14,539.51 | 11,184.24 | 12,116.26 | 13,980.30 | 15,844.34 | 16,552.68 | 16,403.55 | 13,980.30 | 15,844.34 ||| |DURVALUMAB 120 MG/2.4ML IV SOLN|2.4 mL|136096| 1,325.10 |||||||||| 861.32 | 901.07 | 967.32 | 967.32 | 1,033.58 | 795.06 | 861.32 | 993.83 | 1,126.34 | 1,176.69 | 1,166.09 | 993.83 | 1,126.34 ||| |DURVALUMAB 500 MG/10ML IV SOLN|10 mL|136097| 5,521.20 |||||||||| 3,588.78 | 3,754.42 | 4,030.48 | 4,030.48 | 4,306.54 | 3,312.72 | 3,588.78 | 4,140.90 | 4,693.02 | 4,902.83 | 4,858.66 | 4,140.90 | 4,693.02 ||| |EDARAVONE 30 MG/100ML IV SOLN|100 mL|136142| 1,160.60 |||||||||| 754.39 | 789.21 | 847.24 | 847.24 | 905.27 | 696.36 | 754.39 | 870.45 | 986.51 | 1,030.61 | 1,021.33 | 870.45 | 986.51 ||| |PRENATAL ADULT GUMMY/DHA/FA 0.4-25 MG PO CHEW|1 tablet (1 each)|136439| 11.30 |||||||||| 7.35 | 7.68 | 8.25 | 8.25 | 8.81 | 6.78 | 7.35 | 8.48 | 9.61 | 10.03 | 9.94 | 8.48 | 9.61 ||| |MICONAZOLE NITRATE 2 % EX OINT|57 g|13651| 46.25 |||||||||| 30.06 | 31.45 | 33.76 | 33.76 | 36.08 | 27.75 | 30.06 | 34.69 | 39.31 | 41.07 | 40.70 | 34.69 | 39.31 ||| |ASPIRIN EC 325 MG PO TBEC|100 each|13654| 14.15 |||||||||| 9.20 | 9.62 | 10.33 | 10.33 | 11.04 | 8.49 | 9.20 | 10.61 | 12.03 | 12.57 | 12.45 | 10.61 | 12.03 ||| |HEMIN 350 MG IV SOLR|1 each|136551| 14,908.20 |||||||||| 9,690.33 | 10,137.58 | 10,882.99 | 10,882.99 | 11,628.40 | 8,944.92 | 9,690.33 | 11,181.15 | 12,671.97 | 13,238.48 | 13,119.22 | 11,181.15 | 12,671.97 ||| |HYDROMORPHONE HCL-NACL 20-0.9 MG/100ML-% IV SOLN|100 mL|136698| 91.45 |||||||||| 59.44 | 62.19 | 66.76 | 66.76 | 71.33 | 54.87 | 59.44 | 68.59 | 77.73 | 81.21 | 80.48 | 68.59 | 77.73 ||| |INFLIXIMAB-ABDA 100 MG IV SOLR|1 each|136713| 1,547.85 |||||||||| 1,006.10 | 1,052.54 | 1,129.93 | 1,129.93 | 1,207.32 | 928.71 | 1,006.10 | 1,160.89 | 1,315.67 | 1,374.49 | 1,362.11 | 1,160.89 | 1,315.67 ||| |INFLUENZA VAC RECOM HA QUAD PF 0.5 ML IM SOSY|.5 mL|136714| 134.95 |||||||||| 87.72 | 91.77 | 98.51 | 98.51 | 105.26 | 80.97 | 87.72 | 101.21 | 114.71 | 119.84 | 118.76 | 101.21 | 114.71 ||| |AFLIBERCEPT 2 MG/0.05ML IZ SOLN|.05 mL|136829| 3,516.30 |||||||||| 2,285.60 | 2,391.08 | 2,566.90 | 2,566.90 | 2,742.71 | 2,109.78 | 2,285.60 | 2,637.23 | 2,988.86 | 3,122.47 | 3,094.34 | 2,637.23 | 2,988.86 ||| |LEUPROLIDE ACETATE 3.75 MG IM KIT|1 each|13691| 2,072.85 |||||||||| 1,347.35 | 1,409.54 | 1,513.18 | 1,513.18 | 1,616.82 | 1,243.71 | 1,347.35 | 1,554.64 | 1,761.92 | 1,840.69 | 1,824.11 | 1,554.64 | 1,761.92 ||| |METHYLPHENIDATE 8.6 MG PO TBED|30 each|136939| 776.45 |||||||||| 504.69 | 527.99 | 566.81 | 566.81 | 605.63 | 465.87 | 504.69 | 582.34 | 659.98 | 689.49 | 683.28 | 582.34 | 659.98 ||| |METHYLPHENIDATE 17.3 MG PO TBED|30 each|136940| 776.45 |||||||||| 504.69 | 527.99 | 566.81 | 566.81 | 605.63 | 465.87 | 504.69 | 582.34 | 659.98 | 689.49 | 683.28 | 582.34 | 659.98 ||| |METHYLPHENIDATE 25.9 MG PO TBED|30 each|136941| 776.45 |||||||||| 504.69 | 527.99 | 566.81 | 566.81 | 605.63 | 465.87 | 504.69 | 582.34 | 659.98 | 689.49 | 683.28 | 582.34 | 659.98 ||| |INOTUZUMAB OZOGAMICIN 0.9 MG IV SOLR|1 each|137068| 40,758.90 |||||||||| 26,493.29 | 27,716.05 | 29,754.00 | 29,754.00 | 31,791.94 | 24,455.34 | 26,493.29 | 30,569.18 | 34,645.07 | 36,193.90 | 35,867.83 | 30,569.18 | 34,645.07 ||| |CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP|500 mL|137241| 35.70 |||||||||| 23.21 | 24.28 | 26.06 | 26.06 | 27.85 | 21.42 | 23.21 | 26.78 | 30.35 | 31.70 | 31.42 | 26.78 | 30.35 ||| |CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL|1 drop (0.125 each)|137245| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL|2 drop (0.25 each)|137245| 11.20 |||||||||| 7.28 | 7.62 | 8.18 | 8.18 | 8.74 | 6.72 | 7.28 | 8.40 | 9.52 | 9.95 | 9.86 | 8.40 | 9.52 ||| |EPINEPHRINE PF 1 MG/ML IJ SOLN|1 mL|137255| 66.95 |||||||||| 43.52 | 45.53 | 48.87 | 48.87 | 52.22 | 40.17 | 43.52 | 50.21 | 56.91 | 59.45 | 58.92 | 50.21 | 56.91 ||| |GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR|1 each|137286| 17,872.90 |||||||||| 11,617.39 | 12,153.57 | 13,047.22 | 13,047.22 | 13,940.86 | 10,723.74 | 11,617.39 | 13,404.68 | 15,191.97 | 15,871.14 | 15,728.15 | 13,404.68 | 15,191.97 ||| |L-GLUTAMINE POWD|25 g|13733| 1,195.50 |||||||||| 777.08 | 812.94 | 872.72 | 872.72 | 932.49 | 717.30 | 777.08 | 896.63 | 1,016.18 | 1,061.60 | 1,052.04 | 896.63 | 1,016.18 ||| |LIDOCAINE IN DEXTROSE 5-7.5 % INTRASPINAL SOLN|2 mL|137381| 51.20 |||||||||| 33.28 | 34.82 | 37.38 | 37.38 | 39.94 | 30.72 | 33.28 | 38.40 | 43.52 | 45.47 | 45.06 | 38.40 | 43.52 ||| |SPIRONOLACTONE 25 MG/5ML PO SUSP|118 mL|137608| 593.80 |||||||||| 385.97 | 403.78 | 433.47 | 433.47 | 463.16 | 356.28 | 385.97 | 445.35 | 504.73 | 527.29 | 522.54 | 445.35 | 504.73 ||| |FLUTICASONE-UMECLIDIN-VILANT 100-62.5-25 MCG/INH IN AEPB|28 each|137614| 536.80 |||||||||| 348.92 | 365.02 | 391.86 | 391.86 | 418.70 | 322.08 | 348.92 | 402.60 | 456.28 | 476.68 | 472.38 | 402.60 | 456.28 ||| |BENRALIZUMAB 30 MG/ML SC SOSY|1 mL|137865| 10,362.35 |||||||||| 6,735.53 | 7,046.40 | 7,564.52 | 7,564.52 | 8,082.63 | 6,217.41 | 6,735.53 | 7,771.76 | 8,808.00 | 9,201.77 | 9,118.87 | 7,771.76 | 8,808.00 ||| |ARSENIC TRIOXIDE 12 MG/6ML IV SOLN|6 mL|138095| 1,322.45 |||||||||| 859.59 | 899.27 | 965.39 | 965.39 | 1,031.51 | 793.47 | 859.59 | 991.84 | 1,124.08 | 1,174.34 | 1,163.76 | 991.84 | 1,124.08 ||| |BACITRACIN ZINC 500 UNIT/GM EX OINT|28.35 g|13818| 42.35 |||||||||| 27.53 | 28.80 | 30.92 | 30.92 | 33.03 | 25.41 | 27.53 | 31.76 | 36.00 | 37.61 | 37.27 | 31.76 | 36.00 ||| |ANGIOTENSIN II ACETATE 2.5 MG/ML IV SOLN|1 mL|138280| 2,857.45 |||||||||| 1,857.34 | 1,943.07 | 2,085.94 | 2,085.94 | 2,228.81 | 1,714.47 | 1,857.34 | 2,143.09 | 2,428.83 | 2,537.42 | 2,514.56 | 2,143.09 | 2,428.83 ||| |NIVOLUMAB 240 MG/24ML IV SOLN|24 mL|138298| 9,766.70 |||||||||| 6,348.36 | 6,641.36 | 7,129.69 | 7,129.69 | 7,618.03 | 5,860.02 | 6,348.36 | 7,325.03 | 8,301.70 | 8,672.83 | 8,594.70 | 7,325.03 | 8,301.70 ||| |ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN|1000 mg|138303| 756.95 |||||||||| 492.02 | 514.73 | 552.57 | 552.57 | 590.42 | 454.17 | 492.02 | 567.71 | 643.41 | 672.17 | 666.12 | 567.71 | 643.41 ||| |LIDO-EPINEPHRINE-TETRACAINE 4-0.05-0.5 % EX SOLN|3 mL|138591| 47.80 |||||||||| 31.07 | 32.50 | 34.89 | 34.89 | 37.28 | 28.68 | 31.07 | 35.85 | 40.63 | 42.45 | 42.06 | 35.85 | 40.63 ||| |COLESTIPOL HCL 1 G PO TABS|120 each|13884| 284.10 |||||||||| 184.67 | 193.19 | 207.39 | 207.39 | 221.60 | 170.46 | 184.67 | 213.08 | 241.49 | 252.28 | 250.01 | 213.08 | 241.49 ||| |TALC 4 G PL POWD|1 each|139003| 331.35 |||||||||| 215.38 | 225.32 | 241.89 | 241.89 | 258.45 | 198.81 | 215.38 | 248.51 | 281.65 | 294.24 | 291.59 | 248.51 | 281.65 ||| |MAGNESIUM CHLORIDE 64 MG PO TBEC|128 mg (2 each)|139041| 11.35 |||||||||| 7.38 | 7.72 | 8.29 | 8.29 | 8.85 | 6.81 | 7.38 | 8.51 | 9.65 | 10.08 | 9.99 | 8.51 | 9.65 ||| |MAGNESIUM CHLORIDE 64 MG PO TBEC|64 mg (1 each)|139041| 11.20 |||||||||| 7.28 | 7.62 | 8.18 | 8.18 | 8.74 | 6.72 | 7.28 | 8.40 | 9.52 | 9.95 | 9.86 | 8.40 | 9.52 ||| |BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR|1 each|139053| 1,130.00 |||||||||| 734.50 | 768.40 | 824.90 | 824.90 | 881.40 | 678.00 | 734.50 | 847.50 | 960.50 | 1,003.44 | 994.40 | 847.50 | 960.50 ||| |COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR|50 mg (0.3333333333333333333 each)|139060| 51.60 |||||||||| 33.54 | 35.09 | 37.67 | 37.67 | 40.25 | 30.96 | 33.54 | 38.70 | 43.86 | 45.82 | 45.41 | 38.70 | 43.86 ||| |RABIES IMMUNE GLOBULIN 300 UNIT/ML IJ SOLN|1 mL|139308| 1,377.45 |||||||||| 895.34 | 936.67 | 1,005.54 | 1,005.54 | 1,074.41 | 826.47 | 895.34 | 1,033.09 | 1,170.83 | 1,223.18 | 1,212.16 | 1,033.09 | 1,170.83 ||| |ASCORBIC ACID 25000 MG/50ML IV SOLN|50 mL|139766| 466.95 |||||||||| 303.52 | 317.53 | 340.87 | 340.87 | 364.22 | 280.17 | 303.52 | 350.21 | 396.91 | 414.65 | 410.92 | 350.21 | 396.91 ||| |DEXAMETHASONE 9 % IO SUSP|.005 mL|139768| 1,154.00 |||||||||| 750.10 | 784.72 | 842.42 | 842.42 | 900.12 | 692.40 | 750.10 | 865.50 | 980.90 | 1,024.75 | 1,015.52 | 865.50 | 980.90 ||| |COCAINE HCL 40 MG/ML NA SOLN|4 mL|139775| 462.10 |||||||||| 300.37 | 314.23 | 337.33 | 337.33 | 360.44 | 277.26 | 300.37 | 346.58 | 392.79 | 410.34 | 406.65 | 346.58 | 392.79 ||| |ACITRETIN 25 MG PO CAPS|30 each|13979| 1,938.20 |||||||||| 1,259.83 | 1,317.98 | 1,414.89 | 1,414.89 | 1,511.80 | 1,162.92 | 1,259.83 | 1,453.65 | 1,647.47 | 1,721.12 | 1,705.62 | 1,453.65 | 1,647.47 ||| |LAMOTRIGINE 25 MG PO TABS|1 each|13981| 11.40 |||||||||| 7.41 | 7.75 | 8.32 | 8.32 | 8.89 | 6.84 | 7.41 | 8.55 | 9.69 | 10.12 | 10.03 | 8.55 | 9.69 ||| |EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN|1 mL|139882| 226.65 |||||||||| 147.32 | 154.12 | 165.45 | 165.45 | 176.79 | 135.99 | 147.32 | 169.99 | 192.65 | 201.27 | 199.45 | 169.99 | 192.65 ||| |EPOETIN ALFA-EPBX 40000 UNIT/ML IJ SOLN|1 mL|139883| 906.45 |||||||||| 589.19 | 616.39 | 661.71 | 661.71 | 707.03 | 543.87 | 589.19 | 679.84 | 770.48 | 804.93 | 797.68 | 679.84 | 770.48 ||| |DAUNORUBICIN HCL 20 MG/4ML IV SOLN|4 mL|139916| 278.50 |||||||||| 181.03 | 189.38 | 203.31 | 203.31 | 217.23 | 167.10 | 181.03 | 208.88 | 236.73 | 247.31 | 245.08 | 208.88 | 236.73 ||| |DAPTOMYCIN 350 MG IV SOLR|1 each|140134| 615.65 |||||||||| 400.17 | 418.64 | 449.42 | 449.42 | 480.21 | 369.39 | 400.17 | 461.74 | 523.30 | 546.70 | 541.77 | 461.74 | 523.30 ||| |HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN|500 mL|140231| 48.15 |||||||||| 31.30 | 32.74 | 35.15 | 35.15 | 37.56 | 28.89 | 31.30 | 36.11 | 40.93 | 42.76 | 42.37 | 36.11 | 40.93 ||| |ARIPIPRAZOLE LAUROXIL ER 675 MG/2.4ML IM PRSY|2.4 mL|140419| 3,988.05 |||||||||| 2,592.23 | 2,711.87 | 2,911.28 | 2,911.28 | 3,110.68 | 2,392.83 | 2,592.23 | 2,991.04 | 3,389.84 | 3,541.39 | 3,509.48 | 2,991.04 | 3,389.84 ||| |FENTANYL CITRATE-NACL 10-0.9 MCG/ML-% IV SOSY|1 mL|140470| 59.10 |||||||||| 38.42 | 40.19 | 43.14 | 43.14 | 46.10 | 35.46 | 38.42 | 44.33 | 50.24 | 52.48 | 52.01 | 44.33 | 50.24 ||| |CARFILZOMIB 10 MG IV SOLR|1 each|140623| 602.45 |||||||||| 391.59 | 409.67 | 439.79 | 439.79 | 469.91 | 361.47 | 391.59 | 451.84 | 512.08 | 534.98 | 530.16 | 451.84 | 512.08 ||| |EPINEPHRINE 1 MG/10ML IJ SOSY|10 mL|140625| 43.40 |||||||||| 28.21 | 29.51 | 31.68 | 31.68 | 33.85 | 26.04 | 28.21 | 32.55 | 36.89 | 38.54 | 38.19 | 32.55 | 36.89 ||| |EPHEDRINE SULFATE 25 MG/5ML IV SOSY|5 mL|140639| 79.95 |||||||||| 51.97 | 54.37 | 58.36 | 58.36 | 62.36 | 47.97 | 51.97 | 59.96 | 67.96 | 71.00 | 70.36 | 59.96 | 67.96 ||| |PHENYLEPHRINE HCL 1 MG/10ML IV SOSY|10 mL|140701| 62.25 |||||||||| 40.46 | 42.33 | 45.44 | 45.44 | 48.56 | 37.35 | 40.46 | 46.69 | 52.91 | 55.28 | 54.78 | 46.69 | 52.91 ||| |MOGAMULIZUMAB-KPKC 20 MG/5ML IV SOLN|5 mL|140746| 8,021.90 |||||||||| 5,214.24 | 5,454.89 | 5,855.99 | 5,855.99 | 6,257.08 | 4,813.14 | 5,214.24 | 6,016.43 | 6,818.62 | 7,123.45 | 7,059.27 | 6,016.43 | 6,818.62 ||| |EUCERIN EX CREA|57 g|14090| 40.70 |||||||||| 26.46 | 27.68 | 29.71 | 29.71 | 31.75 | 24.42 | 26.46 | 30.53 | 34.60 | 36.14 | 35.82 | 30.53 | 34.60 ||| |DILTIAZEM HCL ER 90 MG PO CP12|100 each|14101| 830.40 |||||||||| 539.76 | 564.67 | 606.19 | 606.19 | 647.71 | 498.24 | 539.76 | 622.80 | 705.84 | 737.40 | 730.75 | 622.80 | 705.84 ||| |HYDROXOCOBALAMIN ACETATE 1000 MCG/ML IM SOLN|30 mL|141017| 81.05 |||||||||| 52.68 | 55.11 | 59.17 | 59.17 | 63.22 | 48.63 | 52.68 | 60.79 | 68.89 | 71.97 | 71.32 | 60.79 | 68.89 ||| |CLONIDINE 0.1 MG/24HR TD PTWK|1 patch (1 each)|141020| 49.55 |||||||||| 32.21 | 33.69 | 36.17 | 36.17 | 38.65 | 29.73 | 32.21 | 37.16 | 42.12 | 44.00 | 43.60 | 37.16 | 42.12 ||| |CEFEPIME-DEXTROSE 1-5 GM-%(50ML) IV SOLR|1 each|141134| 159.95 |||||||||| 103.97 | 108.77 | 116.76 | 116.76 | 124.76 | 95.97 | 103.97 | 119.96 | 135.96 | 142.04 | 140.76 | 119.96 | 135.96 ||| |CEFTRIAXONE SODIUM-DEXTROSE 1-3.74 GM-%(50ML) IV SOLR|1 each|141136| 159.95 |||||||||| 103.97 | 108.77 | 116.76 | 116.76 | 124.76 | 95.97 | 103.97 | 119.96 | 135.96 | 142.04 | 140.76 | 119.96 | 135.96 ||| |CEFOXITIN SODIUM-DEXTROSE 1-4 GM-%(50ML) IV SOLR|1 each|141137| 158.90 |||||||||| 103.29 | 108.05 | 116.00 | 116.00 | 123.94 | 95.34 | 103.29 | 119.18 | 135.07 | 141.10 | 139.83 | 119.18 | 135.07 ||| |CEFAZOLIN SODIUM-DEXTROSE 1-4 GM-%(50ML) IV SOLR|1 each|141138| 151.65 |||||||||| 98.57 | 103.12 | 110.70 | 110.70 | 118.29 | 90.99 | 98.57 | 113.74 | 128.90 | 134.67 | 133.45 | 113.74 | 128.90 ||| |CEFEPIME-DEXTROSE 2-5 GM-%(50ML) IV SOLR|1 each|141140| 170.55 |||||||||| 110.86 | 115.97 | 124.50 | 124.50 | 133.03 | 102.33 | 110.86 | 127.91 | 144.97 | 151.45 | 150.08 | 127.91 | 144.97 ||| |CEFOXITIN SODIUM-DEXTROSE 2-2.2 GM-%(50ML) IV SOLR|1 each|141142| 177.75 |||||||||| 115.54 | 120.87 | 129.76 | 129.76 | 138.65 | 106.65 | 115.54 | 133.31 | 151.09 | 157.84 | 156.42 | 133.31 | 151.09 ||| |CEFTRIAXONE SODIUM-DEXTROSE 2-2.22 GM-%(50ML) IV SOLR|1 each|141143| 170.65 |||||||||| 110.92 | 116.04 | 124.57 | 124.57 | 133.11 | 102.39 | 110.92 | 127.99 | 145.05 | 151.54 | 150.17 | 127.99 | 145.05 ||| |CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR|1 each|141144| 153.70 |||||||||| 99.91 | 104.52 | 112.20 | 112.20 | 119.89 | 92.22 | 99.91 | 115.28 | 130.65 | 136.49 | 135.26 | 115.28 | 130.65 ||| |PAMIDRONATE DISODIUM 90 MG IV SOLR|30 mg (0.3333333333333333333 each)|14122| 128.75 |||||||||| 83.69 | 87.55 | 93.99 | 93.99 | 100.43 | 77.25 | 83.69 | 96.56 | 109.44 | 114.33 | 113.30 | 96.56 | 109.44 ||| |PAMIDRONATE DISODIUM 90 MG IV SOLR|60 mg (0.6666666666666666667 each)|14122| 223.50 |||||||||| 145.28 | 151.98 | 163.16 | 163.16 | 174.33 | 134.10 | 145.28 | 167.63 | 189.98 | 198.47 | 196.68 | 167.63 | 189.98 ||| |PAMIDRONATE DISODIUM 90 MG IV SOLR|90 mg (1 each)|14122| 318.25 |||||||||| 206.86 | 216.41 | 232.32 | 232.32 | 248.24 | 190.95 | 206.86 | 238.69 | 270.51 | 282.61 | 280.06 | 238.69 | 270.51 ||| |RIVAROXABAN 2.5 MG PO TABS|100 each|141266| 1,647.95 |||||||||| 1,071.17 | 1,120.61 | 1,203.00 | 1,203.00 | 1,285.40 | 988.77 | 1,071.17 | 1,235.96 | 1,400.76 | 1,463.38 | 1,450.20 | 1,235.96 | 1,400.76 ||| |FENTANYL PCA 50 MCG/ML PREMIX 55 ML|55 mL|141312| 189.70 |||||||||| 123.31 | 129.00 | 138.48 | 138.48 | 147.97 | 113.82 | 123.31 | 142.28 | 161.25 | 168.45 | 166.94 | 142.28 | 161.25 ||| |KETOCONAZOLE 2 % EX SHAM|120 mL|14132| 75.60 |||||||||| 49.14 | 51.41 | 55.19 | 55.19 | 58.97 | 45.36 | 49.14 | 56.70 | 64.26 | 67.13 | 66.53 | 56.70 | 64.26 ||| |CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN|7 mL|141323| 13,506.25 |||||||||| 8,779.06 | 9,184.25 | 9,859.56 | 9,859.56 | 10,534.88 | 8,103.75 | 8,779.06 | 10,129.69 | 11,480.31 | 11,993.55 | 11,885.50 | 10,129.69 | 11,480.31 ||| |OMALIZUMAB 150 MG/ML SC SOSY|1 mL|141653| 2,318.50 |||||||||| 1,507.03 | 1,576.58 | 1,692.51 | 1,692.51 | 1,808.43 | 1,391.10 | 1,507.03 | 1,738.88 | 1,970.73 | 2,058.83 | 2,040.28 | 1,738.88 | 1,970.73 ||| |OMALIZUMAB 75 MG/0.5ML SC SOSY|.5 mL|141654| 1,159.25 |||||||||| 753.51 | 788.29 | 846.25 | 846.25 | 904.22 | 695.55 | 753.51 | 869.44 | 985.36 | 1,029.41 | 1,020.14 | 869.44 | 985.36 ||| |MORPHINE PCA 1 MG/ML PREMIX 55 ML|55 mL|141715| 182.60 |||||||||| 118.69 | 124.17 | 133.30 | 133.30 | 142.43 | 109.56 | 118.69 | 136.95 | 155.21 | 162.15 | 160.69 | 136.95 | 155.21 ||| |DEXMEDETOMIDINE HCL-DEXTROSE 200MCG/50ML -5% IV SOLN|50 mL|141734| 306.05 |||||||||| 198.93 | 208.11 | 223.42 | 223.42 | 238.72 | 183.63 | 198.93 | 229.54 | 260.14 | 271.77 | 269.32 | 229.54 | 260.14 ||| |REVEFENACIN 175 MCG/3ML IN SOLN|3 mL|141804| 98.40 |||||||||| 63.96 | 66.91 | 71.83 | 71.83 | 76.75 | 59.04 | 63.96 | 73.80 | 83.64 | 87.38 | 86.59 | 73.80 | 83.64 ||| |PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOSY|.6 mL|141943| 8,577.55 |||||||||| 5,575.41 | 5,832.73 | 6,261.61 | 6,261.61 | 6,690.49 | 5,146.53 | 5,575.41 | 6,433.16 | 7,290.92 | 7,616.86 | 7,548.24 | 6,433.16 | 7,290.92 ||| |VITAMIN A & D EX OINT|113 g|142029| 39.15 |||||||||| 25.45 | 26.62 | 28.58 | 28.58 | 30.54 | 23.49 | 25.45 | 29.36 | 33.28 | 34.77 | 34.45 | 29.36 | 33.28 ||| |COAG FACT XA INACTIVATED-ZHZO 200 MG IV SOLR|1 each|142239| 11,299.75 |||||||||| 7,344.84 | 7,683.83 | 8,248.82 | 8,248.82 | 8,813.81 | 6,779.85 | 7,344.84 | 8,474.81 | 9,604.79 | 10,034.18 | 9,943.78 | 8,474.81 | 9,604.79 ||| |FLUCONAZOLE 10 MG/ML PO SUSR|35 mL|14232| 55.65 |||||||||| 36.17 | 37.84 | 40.62 | 40.62 | 43.41 | 33.39 | 36.17 | 41.74 | 47.30 | 49.42 | 48.97 | 41.74 | 47.30 ||| |FLUCONAZOLE 40 MG/ML PO SUSR|35 mL|14233| 144.15 |||||||||| 93.70 | 98.02 | 105.23 | 105.23 | 112.44 | 86.49 | 93.70 | 108.11 | 122.53 | 128.01 | 126.85 | 108.11 | 122.53 ||| |GADOTERATE MEGLUMINE 2.5 MMOL/5ML IV SOLN|5 mL|142336| 30.00 |||||||||| 19.50 | 20.40 | 21.90 | 21.90 | 23.40 | 18.00 | 19.50 | 22.50 | 25.50 | 26.64 | 26.40 | 22.50 | 25.50 ||| |PRUCALOPRIDE SUCCINATE 2 MG PO TABS|30 each|142437| 928.45 |||||||||| 603.49 | 631.35 | 677.77 | 677.77 | 724.19 | 557.07 | 603.49 | 696.34 | 789.18 | 824.46 | 817.04 | 696.34 | 789.18 ||| |WIXELA INHUB 250-50 MCG/DOSE IN AEPB|60 each|142557| 253.25 |||||||||| 164.61 | 172.21 | 184.87 | 184.87 | 197.54 | 151.95 | 164.61 | 189.94 | 215.26 | 224.89 | 222.86 | 189.94 | 215.26 ||| |KETAMINE HCL 50 MG/ML IJ SOSY|1 mL|142590| 47.10 |||||||||| 30.62 | 32.03 | 34.38 | 34.38 | 36.74 | 28.26 | 30.62 | 35.33 | 40.04 | 41.82 | 41.45 | 35.33 | 40.04 ||| |PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN|10 mg (2 mL)|142831| 68.85 |||||||||| 44.75 | 46.82 | 50.26 | 50.26 | 53.70 | 41.31 | 44.75 | 51.64 | 58.52 | 61.14 | 60.59 | 51.64 | 58.52 ||| |PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN|5 mg (1 mL)|142831| 51.45 |||||||||| 33.44 | 34.99 | 37.56 | 37.56 | 40.13 | 30.87 | 33.44 | 38.59 | 43.73 | 45.69 | 45.28 | 38.59 | 43.73 ||| |DEXRAZOXANE HCL 250 MG IV SOLR|1 each|142838| 476.15 |||||||||| 309.50 | 323.78 | 347.59 | 347.59 | 371.40 | 285.69 | 309.50 | 357.11 | 404.73 | 422.82 | 419.01 | 357.11 | 404.73 ||| |DEXRAZOXANE HCL 500 MG IV SOLR|1 each|142839| 785.05 |||||||||| 510.28 | 533.83 | 573.09 | 573.09 | 612.34 | 471.03 | 510.28 | 588.79 | 667.29 | 697.12 | 690.84 | 588.79 | 667.29 ||| |PALIPERIDONE PALMITATE ER 117 MG/0.75ML IM SUSY|.75 mL|142842| 2,674.25 |||||||||| 1,738.26 | 1,818.49 | 1,952.20 | 1,952.20 | 2,085.92 | 1,604.55 | 1,738.26 | 2,005.69 | 2,273.11 | 2,374.73 | 2,353.34 | 2,005.69 | 2,273.11 ||| |PALIPERIDONE PALMITATE ER 156 MG/ML IM SUSY|1 mL|142843| 3,554.45 |||||||||| 2,310.39 | 2,417.03 | 2,594.75 | 2,594.75 | 2,772.47 | 2,132.67 | 2,310.39 | 2,665.84 | 3,021.28 | 3,156.35 | 3,127.92 | 2,665.84 | 3,021.28 ||| |PALIPERIDONE PALMITATE ER 234 MG/1.5ML IM SUSY|1.5 mL|142844| 5,314.55 |||||||||| 3,454.46 | 3,613.89 | 3,879.62 | 3,879.62 | 4,145.35 | 3,188.73 | 3,454.46 | 3,985.91 | 4,517.37 | 4,719.32 | 4,676.80 | 3,985.91 | 4,517.37 ||| |LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY|5 mL|142858| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY|5 mL|142859| 40.10 |||||||||| 26.07 | 27.27 | 29.27 | 29.27 | 31.28 | 24.06 | 26.07 | 30.08 | 34.09 | 35.61 | 35.29 | 30.08 | 34.09 ||| |HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY|1 mL|142861| 239.45 |||||||||| 155.64 | 162.83 | 174.80 | 174.80 | 186.77 | 143.67 | 155.64 | 179.59 | 203.53 | 212.63 | 210.72 | 179.59 | 203.53 ||| |DENOSUMAB 60 MG/ML SC SOSY|1 mL|142862| 2,654.80 |||||||||| 1,725.62 | 1,805.26 | 1,938.00 | 1,938.00 | 2,070.74 | 1,592.88 | 1,725.62 | 1,991.10 | 2,256.58 | 2,357.46 | 2,336.22 | 1,991.10 | 2,256.58 ||| |DEXAMETHASONE 0.4 MG OP INST|1 each|142865| 1,140.65 |||||||||| 741.42 | 775.64 | 832.67 | 832.67 | 889.71 | 684.39 | 741.42 | 855.49 | 969.55 | 1,012.90 | 1,003.77 | 855.49 | 969.55 ||| |ANTIINHIBITOR COAGULANT CMPLX 500 UNITS IV SOLR|500 Units|142866| 2,311.35 |||||||||| 1,502.38 | 1,571.72 | 1,687.29 | 1,687.29 | 1,802.85 | 1,386.81 | 1,502.38 | 1,733.51 | 1,964.65 | 2,052.48 | 2,033.99 | 1,733.51 | 1,964.65 ||| |ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR|2500 Units|142868| 11,916.10 |||||||||| 7,745.47 | 8,102.95 | 8,698.75 | 8,698.75 | 9,294.56 | 7,149.66 | 7,745.47 | 8,937.08 | 10,128.69 | 10,581.50 | 10,486.17 | 8,937.08 | 10,128.69 ||| |HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN|500 mL|142872| 41.55 |||||||||| 27.01 | 28.25 | 30.33 | 30.33 | 32.41 | 24.93 | 27.01 | 31.16 | 35.32 | 36.90 | 36.56 | 31.16 | 35.32 ||| |HEPARIN (PORCINE) IN NACL 12500-0.45 UT/250ML-% IV SOLN|250 mL|142874| 49.55 |||||||||| 32.21 | 33.69 | 36.17 | 36.17 | 38.65 | 29.73 | 32.21 | 37.16 | 42.12 | 44.00 | 43.60 | 37.16 | 42.12 ||| |ATEZOLIZUMAB 840 MG/14ML IV SOLN|14 mL|142925| 9,552.05 |||||||||| 6,208.83 | 6,495.39 | 6,973.00 | 6,973.00 | 7,450.60 | 5,731.23 | 6,208.83 | 7,164.04 | 8,119.24 | 8,482.22 | 8,405.80 | 7,164.04 | 8,119.24 ||| |FIRST-BACLOFEN 5 MG/ML PO SUSP|120 mL|142962| 176.65 |||||||||| 114.82 | 120.12 | 128.95 | 128.95 | 137.79 | 105.99 | 114.82 | 132.49 | 150.15 | 156.87 | 155.45 | 132.49 | 150.15 ||| |LIDO-EPINEPHRINE-TETRACAINE 4-0.05-0.5 % EX GEL|3 mL|142990| 53.55 |||||||||| 34.81 | 36.41 | 39.09 | 39.09 | 41.77 | 32.13 | 34.81 | 40.16 | 45.52 | 47.55 | 47.12 | 40.16 | 45.52 ||| |MORPHINE SULF MICROINFUSION PF 200 MG/20ML (10 MG/ML) IJ SOLN|20 mL|143013| 424.15 |||||||||| 275.70 | 288.42 | 309.63 | 309.63 | 330.84 | 254.49 | 275.70 | 318.11 | 360.53 | 376.65 | 373.25 | 318.11 | 360.53 ||| |FAT EMULSION PLANT BASED 20 % IV EMUL|500 mL|143017| 162.00 |||||||||| 105.30 | 110.16 | 118.26 | 118.26 | 126.36 | 97.20 | 105.30 | 121.50 | 137.70 | 143.86 | 142.56 | 121.50 | 137.70 ||| |AMPHOTERICIN B 50 MG IV SOLR|1 each|143020| 196.65 |||||||||| 127.82 | 133.72 | 143.55 | 143.55 | 153.39 | 117.99 | 127.82 | 147.49 | 167.15 | 174.63 | 173.05 | 147.49 | 167.15 ||| |PROMETHAZINE-DM 6.25-15 MG/5ML PO SOLN|473 mL|143316| 30.75 |||||||||| 19.99 | 20.91 | 22.45 | 22.45 | 23.99 | 18.45 | 19.99 | 23.06 | 26.14 | 27.31 | 27.06 | 23.06 | 26.14 ||| |ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY|1.17 mL|143330| 1,874.75 |||||||||| 1,218.59 | 1,274.83 | 1,368.57 | 1,368.57 | 1,462.31 | 1,124.85 | 1,218.59 | 1,406.06 | 1,593.54 | 1,664.78 | 1,649.78 | 1,406.06 | 1,593.54 ||| |LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN|5 mL|143525| 242.70 |||||||||| 157.76 | 165.04 | 177.17 | 177.17 | 189.31 | 145.62 | 157.76 | 182.03 | 206.30 | 215.52 | 213.58 | 182.03 | 206.30 ||| |BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN|4 mL|144155| 1,005.40 |||||||||| 653.51 | 683.67 | 733.94 | 733.94 | 784.21 | 603.24 | 653.51 | 754.05 | 854.59 | 892.80 | 884.75 | 754.05 | 854.59 ||| |BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN|16 mL|144156| 4,021.60 |||||||||| 2,614.04 | 2,734.69 | 2,935.77 | 2,935.77 | 3,136.85 | 2,412.96 | 2,614.04 | 3,016.20 | 3,418.36 | 3,571.18 | 3,539.01 | 3,016.20 | 3,418.36 ||| |AMLODIPINE BENZOATE 1 MG/ML PO SUSP|150 mL|144229| 912.00 |||||||||| 592.80 | 620.16 | 665.76 | 665.76 | 711.36 | 547.20 | 592.80 | 684.00 | 775.20 | 809.86 | 802.56 | 684.00 | 775.20 ||| |TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN|100 mL|144584| 165.75 |||||||||| 107.74 | 112.71 | 121.00 | 121.00 | 129.29 | 99.45 | 107.74 | 124.31 | 140.89 | 147.19 | 145.86 | 124.31 | 140.89 ||| |SALINE 0.65 % NA SOLN|44 mL|14469| 35.50 |||||||||| 23.08 | 24.14 | 25.92 | 25.92 | 27.69 | 21.30 | 23.08 | 26.63 | 30.18 | 31.52 | 31.24 | 26.63 | 30.18 ||| |DORZOLAMIDE HCL 2 % OP SOLN|10 mL|14471| 98.00 |||||||||| 63.70 | 66.64 | 71.54 | 71.54 | 76.44 | 58.80 | 63.70 | 73.50 | 83.30 | 87.02 | 86.24 | 73.50 | 83.30 ||| |MIDAZOLAM HCL (PF) 10 MG/2ML IJ SOLN|2 mL|144736| 48.05 |||||||||| 31.23 | 32.67 | 35.08 | 35.08 | 37.48 | 28.83 | 31.23 | 36.04 | 40.84 | 42.67 | 42.28 | 36.04 | 40.84 ||| |MIDAZOLAM HCL (PF) 5 MG/ML IJ SOLN|1 mL|144737| 47.90 |||||||||| 31.14 | 32.57 | 34.97 | 34.97 | 37.36 | 28.74 | 31.14 | 35.93 | 40.72 | 42.54 | 42.15 | 35.93 | 40.72 ||| |MIDAZOLAM HCL (PF) 2 MG/2ML IJ SOLN|2 mL|144738| 47.70 |||||||||| 31.01 | 32.44 | 34.82 | 34.82 | 37.21 | 28.62 | 31.01 | 35.78 | 40.55 | 42.36 | 41.98 | 35.78 | 40.55 ||| |MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN|5 mL|144739| 47.80 |||||||||| 31.07 | 32.50 | 34.89 | 34.89 | 37.28 | 28.68 | 31.07 | 35.85 | 40.63 | 42.45 | 42.06 | 35.85 | 40.63 ||| |RISPERIDONE MICROSPHERES ER 12.5 MG IM SRER|1 each|144741| 512.65 |||||||||| 333.22 | 348.60 | 374.23 | 374.23 | 399.87 | 307.59 | 333.22 | 384.49 | 435.75 | 455.23 | 451.13 | 384.49 | 435.75 ||| |RISPERIDONE MICROSPHERES ER 25 MG IM SRER|1 each|144742| 991.15 |||||||||| 644.25 | 673.98 | 723.54 | 723.54 | 773.10 | 594.69 | 644.25 | 743.36 | 842.48 | 880.14 | 872.21 | 743.36 | 842.48 ||| |RISPERIDONE MICROSPHERES ER 37.5 MG IM SRER|1 each|144743| 1,469.80 |||||||||| 955.37 | 999.46 | 1,072.95 | 1,072.95 | 1,146.44 | 881.88 | 955.37 | 1,102.35 | 1,249.33 | 1,305.18 | 1,293.42 | 1,102.35 | 1,249.33 ||| |RISPERIDONE MICROSPHERES ER 50 MG IM SRER|1 each|144744| 1,948.45 |||||||||| 1,266.49 | 1,324.95 | 1,422.37 | 1,422.37 | 1,519.79 | 1,169.07 | 1,266.49 | 1,461.34 | 1,656.18 | 1,730.22 | 1,714.64 | 1,461.34 | 1,656.18 ||| |LANSOPRAZOLE 15 MG PO TBDD|100 each|144745| 2,894.60 |||||||||| 1,881.49 | 1,968.33 | 2,113.06 | 2,113.06 | 2,257.79 | 1,736.76 | 1,881.49 | 2,170.95 | 2,460.41 | 2,570.40 | 2,547.25 | 2,170.95 | 2,460.41 ||| |INSULIN LISPRO (1 UNIT DIAL) 100 UNIT/ML SC SOPN|3 mL|144748| 233.70 |||||||||| 151.91 | 158.92 | 170.60 | 170.60 | 182.29 | 140.22 | 151.91 | 175.28 | 198.65 | 207.53 | 205.66 | 175.28 | 198.65 ||| |LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY|10 mL|144950| 46.10 |||||||||| 29.97 | 31.35 | 33.65 | 33.65 | 35.96 | 27.66 | 29.97 | 34.58 | 39.19 | 40.94 | 40.57 | 34.58 | 39.19 ||| |DAKINS (FULL STRENGTH) 0.5 % EX SOLN|473 mL|145408| 55.40 |||||||||| 36.01 | 37.67 | 40.44 | 40.44 | 43.21 | 33.24 | 36.01 | 41.55 | 47.09 | 49.20 | 48.75 | 41.55 | 47.09 ||| |RITUXIMAB-ABBS 100 MG/10ML IV SOLN|10 mL|145548| 1,737.20 |||||||||| 1,129.18 | 1,181.30 | 1,268.16 | 1,268.16 | 1,355.02 | 1,042.32 | 1,129.18 | 1,302.90 | 1,476.62 | 1,542.63 | 1,528.74 | 1,302.90 | 1,476.62 ||| |RITUXIMAB-ABBS 500 MG/50ML IV SOLN|50 mL|145549| 8,685.95 |||||||||| 5,645.87 | 5,906.45 | 6,340.74 | 6,340.74 | 6,775.04 | 5,211.57 | 5,645.87 | 6,514.46 | 7,383.06 | 7,713.12 | 7,643.64 | 6,514.46 | 7,383.06 ||| |LUSPATERCEPT-AAMT 75 MG SC SOLR|1 each|145587| 21,209.70 |||||||||| 13,786.31 | 14,422.60 | 15,483.08 | 15,483.08 | 16,543.57 | 12,725.82 | 13,786.31 | 15,907.28 | 18,028.25 | 18,834.21 | 18,664.54 | 15,907.28 | 18,028.25 ||| |ALBUTEROL SULFATE 2.5 MG/0.5ML IN NEBU|1 each|145807| 11.80 |||||||||| 7.67 | 8.02 | 8.61 | 8.61 | 9.20 | 7.08 | 7.67 | 8.85 | 10.03 | 10.48 | 10.38 | 8.85 | 10.03 ||| |TEPROTUMUMAB-TRBW 500 MG IV SOLR|1 each|146136| 30,612.05 |||||||||| 19,897.83 | 20,816.19 | 22,346.80 | 22,346.80 | 23,877.40 | 18,367.23 | 19,897.83 | 22,959.04 | 26,020.24 | 27,183.50 | 26,938.60 | 22,959.04 | 26,020.24 ||| |CEFUROXIME SODIUM 750 MG IJ SOLR|750 mg (1 each)|1465| 135.40 |||||||||| 88.01 | 92.07 | 98.84 | 98.84 | 105.61 | 81.24 | 88.01 | 101.55 | 115.09 | 120.24 | 119.15 | 101.55 | 115.09 ||| |DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR|1 each|146731| 1,565.75 |||||||||| 1,017.74 | 1,064.71 | 1,143.00 | 1,143.00 | 1,221.29 | 939.45 | 1,017.74 | 1,174.31 | 1,330.89 | 1,390.39 | 1,377.86 | 1,174.31 | 1,330.89 ||| |TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOLN|.5 mL|14678| 232.35 |||||||||| 151.03 | 158.00 | 169.62 | 169.62 | 181.23 | 139.41 | 151.03 | 174.26 | 197.50 | 206.33 | 204.47 | 174.26 | 197.50 ||| |ISATUXIMAB-IRFC 100 MG/5ML IV SOLN|5 mL|146782| 1,335.45 |||||||||| 868.04 | 908.11 | 974.88 | 974.88 | 1,041.65 | 801.27 | 868.04 | 1,001.59 | 1,135.13 | 1,185.88 | 1,175.20 | 1,001.59 | 1,135.13 ||| |ISATUXIMAB-IRFC 500 MG/25ML IV SOLN|25 mL|146783| 6,677.15 |||||||||| 4,340.15 | 4,540.46 | 4,874.32 | 4,874.32 | 5,208.18 | 4,006.29 | 4,340.15 | 5,007.86 | 5,675.58 | 5,929.31 | 5,875.89 | 5,007.86 | 5,675.58 ||| |INFLUENZA VAC A&B SA ADJ QUAD 0.5 ML IM PRSY|.5 mL|146876| 135.00 |||||||||| 87.75 | 91.80 | 98.55 | 98.55 | 105.30 | 81.00 | 87.75 | 101.25 | 114.75 | 119.88 | 118.80 | 101.25 | 114.75 ||| |HYDROCORTISONE ACE-PRAMOXINE 1-1 % EX CREA|30 g|146956| 262.40 |||||||||| 170.56 | 178.43 | 191.55 | 191.55 | 204.67 | 157.44 | 170.56 | 196.80 | 223.04 | 233.01 | 230.91 | 196.80 | 223.04 ||| |HYDROCORT-PRAMOXINE (PERIANAL) 1-1 % EX FOAM|10 g|146974| 315.60 |||||||||| 205.14 | 214.61 | 230.39 | 230.39 | 246.17 | 189.36 | 205.14 | 236.70 | 268.26 | 280.25 | 277.73 | 236.70 | 268.26 ||| |REMDESIVIR 100 MG IV SOLR|1 each|147232| 1,012.80 |||||||||| 658.32 | 688.70 | 739.34 | 739.34 | 789.98 | 607.68 | 658.32 | 759.60 | 860.88 | 899.37 | 891.26 | 759.60 | 860.88 ||| |MULTIVITAMIN/ZINC STRESS PO TABS|1 tablet (1 each)|147247| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN|200 mL|147259| 473.40 |||||||||| 307.71 | 321.91 | 345.58 | 345.58 | 369.25 | 284.04 | 307.71 | 355.05 | 402.39 | 420.38 | 416.59 | 355.05 | 402.39 ||| |SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR|1 each|147337| 4,134.70 |||||||||| 2,687.56 | 2,811.60 | 3,018.33 | 3,018.33 | 3,225.07 | 2,480.82 | 2,687.56 | 3,101.03 | 3,514.50 | 3,671.61 | 3,638.54 | 3,101.03 | 3,514.50 ||| |POLYETHYLENE GLYCOL 400 1 % OP SOLN|15 mL|147454| 43.15 |||||||||| 28.05 | 29.34 | 31.50 | 31.50 | 33.66 | 25.89 | 28.05 | 32.36 | 36.68 | 38.32 | 37.97 | 32.36 | 36.68 ||| |GLYBURIDE MICRONIZED 3 MG PO TABS|100 each|14778| 62.50 |||||||||| 40.63 | 42.50 | 45.63 | 45.63 | 48.75 | 37.50 | 40.63 | 46.88 | 53.13 | 55.50 | 55.00 | 46.88 | 53.13 ||| |POLY-VI-SOL/IRON 11 MG/ML PO SOLN|.5 mL|148179| 11.15 |||||||||| 7.25 | 7.58 | 8.14 | 8.14 | 8.70 | 6.69 | 7.25 | 8.36 | 9.48 | 9.90 | 9.81 | 8.36 | 9.48 ||| |CENTRUM PO TABS|1 tablet (1 each)|1482| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |TACROLIMUS ER 1 MG PO CP24|30 each|148218| 315.35 |||||||||| 204.98 | 214.44 | 230.21 | 230.21 | 245.97 | 189.21 | 204.98 | 236.51 | 268.05 | 280.03 | 277.51 | 236.51 | 268.05 ||| |LOSARTAN POTASSIUM 25 MG PO TABS|100 each|14823| 128.75 |||||||||| 83.69 | 87.55 | 93.99 | 93.99 | 100.43 | 77.25 | 83.69 | 96.56 | 109.44 | 114.33 | 113.30 | 96.56 | 109.44 ||| |FOSFOMYCIN TROMETHAMINE 3 G PO PACK|3 g (1 each)|14825| 211.50 |||||||||| 137.48 | 143.82 | 154.40 | 154.40 | 164.97 | 126.90 | 137.48 | 158.63 | 179.78 | 187.81 | 186.12 | 158.63 | 179.78 ||| |DOPAMINE IN D5W 0.8-5 MG/ML-% IV SOLN|500 mL|14844| 285.50 |||||||||| 185.58 | 194.14 | 208.42 | 208.42 | 222.69 | 171.30 | 185.58 | 214.13 | 242.68 | 253.52 | 251.24 | 214.13 | 242.68 ||| |DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN|250 mL|14845| 282.25 |||||||||| 183.46 | 191.93 | 206.04 | 206.04 | 220.16 | 169.35 | 183.46 | 211.69 | 239.91 | 250.64 | 248.38 | 211.69 | 239.91 ||| |DOXYLAMINE SUCCINATE (SLEEP) 25 MG PO TABS|32 each|14847| 24.85 |||||||||| 16.15 | 16.90 | 18.14 | 18.14 | 19.38 | 14.91 | 16.15 | 18.64 | 21.12 | 22.07 | 21.87 | 18.64 | 21.12 ||| |NITROGLYCERIN IN D5W 400-5 MCG/ML-% IV SOLN|250 mL|14895| 291.00 |||||||||| 189.15 | 197.88 | 212.43 | 212.43 | 226.98 | 174.60 | 189.15 | 218.25 | 247.35 | 258.41 | 256.08 | 218.25 | 247.35 ||| |BACTERIOSTATIC WATER(BENZ ALC) IJ SOLN|30 mL|14979| 36.45 |||||||||| 23.69 | 24.79 | 26.61 | 26.61 | 28.43 | 21.87 | 23.69 | 27.34 | 30.98 | 32.37 | 32.08 | 27.34 | 30.98 ||| |MOEXIPRIL HCL 7.5 MG PO TABS|100 each|15025| 209.50 |||||||||| 136.18 | 142.46 | 152.94 | 152.94 | 163.41 | 125.70 | 136.18 | 157.13 | 178.08 | 186.04 | 184.36 | 157.13 | 178.08 ||| |FAMOTIDINE 10 MG PO TABS|60 each|15065| 26.25 |||||||||| 17.06 | 17.85 | 19.16 | 19.16 | 20.48 | 15.75 | 17.06 | 19.69 | 22.31 | 23.31 | 23.10 | 19.69 | 22.31 ||| |CASTOR OIL OIL|473 mL|15209| 69.15 |||||||||| 44.95 | 47.02 | 50.48 | 50.48 | 53.94 | 41.49 | 44.95 | 51.86 | 58.78 | 61.41 | 60.85 | 51.86 | 58.78 ||| |ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN|20 mL|15330| 197.10 |||||||||| 128.12 | 134.03 | 143.88 | 143.88 | 153.74 | 118.26 | 128.12 | 147.83 | 167.54 | 175.02 | 173.45 | 147.83 | 167.54 ||| |DICLOFENAC SODIUM 25 MG PO TBEC|100 each|15339| 242.90 |||||||||| 157.89 | 165.17 | 177.32 | 177.32 | 189.46 | 145.74 | 157.89 | 182.18 | 206.47 | 215.70 | 213.75 | 182.18 | 206.47 ||| |DICLOFENAC SODIUM 50 MG PO TBEC|100 each|15340| 72.90 |||||||||| 47.39 | 49.57 | 53.22 | 53.22 | 56.86 | 43.74 | 47.39 | 54.68 | 61.97 | 64.74 | 64.15 | 54.68 | 61.97 ||| |DICLOFENAC SODIUM 75 MG PO TBEC|100 each|15341| 103.00 |||||||||| 66.95 | 70.04 | 75.19 | 75.19 | 80.34 | 61.80 | 66.95 | 77.25 | 87.55 | 91.46 | 90.64 | 77.25 | 87.55 ||| |AYR SALINE NASAL NA GEL|14.1 g|15372| 38.85 |||||||||| 25.25 | 26.42 | 28.36 | 28.36 | 30.30 | 23.31 | 25.25 | 29.14 | 33.02 | 34.50 | 34.19 | 29.14 | 33.02 ||| |IBUPROFEN 40 MG/ML PO SUSP|15 mL|15419| 24.60 |||||||||| 15.99 | 16.73 | 17.96 | 17.96 | 19.19 | 14.76 | 15.99 | 18.45 | 20.91 | 21.84 | 21.65 | 18.45 | 20.91 ||| |PROVISC 10 MG/ML IO SOLN|.85 mL|15422| 396.05 |||||||||| 257.43 | 269.31 | 289.12 | 289.12 | 308.92 | 237.63 | 257.43 | 297.04 | 336.64 | 351.69 | 348.52 | 297.04 | 336.64 ||| |LEUCOVORIN CALCIUM 200 MG IJ SOLR|1 each|15426| 83.05 |||||||||| 53.98 | 56.47 | 60.63 | 60.63 | 64.78 | 49.83 | 53.98 | 62.29 | 70.59 | 73.75 | 73.08 | 62.29 | 70.59 ||| |RIMANTADINE HCL 100 MG PO TABS|100 mg (1 each)|15440| 15.75 |||||||||| 10.24 | 10.71 | 11.50 | 11.50 | 12.29 | 9.45 | 10.24 | 11.81 | 13.39 | 13.99 | 13.86 | 11.81 | 13.39 ||| |CHERRY PO SYRP|473 mL|1562| 50.50 |||||||||| 32.83 | 34.34 | 36.87 | 36.87 | 39.39 | 30.30 | 32.83 | 37.88 | 42.93 | 44.84 | 44.44 | 37.88 | 42.93 ||| |BICALUTAMIDE 50 MG PO TABS|30 each|15746| 34.95 |||||||||| 22.72 | 23.77 | 25.51 | 25.51 | 27.26 | 20.97 | 22.72 | 26.21 | 29.71 | 31.04 | 30.76 | 26.21 | 29.71 ||| |CARVEDILOL 6.25 MG PO TABS|500 each|15747| 72.90 |||||||||| 47.39 | 49.57 | 53.22 | 53.22 | 56.86 | 43.74 | 47.39 | 54.68 | 61.97 | 64.74 | 64.15 | 54.68 | 61.97 ||| |CARVEDILOL 25 MG PO TABS|500 each|15748| 72.90 |||||||||| 47.39 | 49.57 | 53.22 | 53.22 | 56.86 | 43.74 | 47.39 | 54.68 | 61.97 | 64.74 | 64.15 | 54.68 | 61.97 ||| |CARVEDILOL 12.5 MG PO TABS|100 each|15749| 34.25 |||||||||| 22.26 | 23.29 | 25.00 | 25.00 | 26.72 | 20.55 | 22.26 | 25.69 | 29.11 | 30.41 | 30.14 | 25.69 | 29.11 ||| |AZITHROMYCIN 200 MG/5ML PO SUSR|30 mL|15797| 76.35 |||||||||| 49.63 | 51.92 | 55.74 | 55.74 | 59.55 | 45.81 | 49.63 | 57.26 | 64.90 | 67.80 | 67.19 | 57.26 | 64.90 ||| |GUAIFENESIN-DM 100-10 MG/5ML PO SYRP|473 mL|15816| 22.90 |||||||||| 14.89 | 15.57 | 16.72 | 16.72 | 17.86 | 13.74 | 14.89 | 17.18 | 19.47 | 20.34 | 20.15 | 17.18 | 19.47 ||| |NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN|250 mL|15859| 289.25 |||||||||| 188.01 | 196.69 | 211.15 | 211.15 | 225.62 | 173.55 | 188.01 | 216.94 | 245.86 | 256.85 | 254.54 | 216.94 | 245.86 ||| |DEXTROSE-NACL 5-0.45 % IV SOLN|1000 mL|15861| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |LAMIVUDINE 10 MG/ML PO SOLN|240 mL|15881| 252.20 |||||||||| 163.93 | 171.50 | 184.11 | 184.11 | 196.72 | 151.32 | 163.93 | 189.15 | 214.37 | 223.95 | 221.94 | 189.15 | 214.37 ||| |DEXTROSE-NACL 5-0.9 % IV SOLN|1000 mL|15882| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |GENTAMICIN IN SALINE 2-0.9 MG/ML-% IV SOLN|50 mL|15912| 140.20 |||||||||| 91.13 | 95.34 | 102.35 | 102.35 | 109.36 | 84.12 | 91.13 | 105.15 | 119.17 | 124.50 | 123.38 | 105.15 | 119.17 ||| |DAKINS (1/2 STRENGTH) 0.25 % EX SOLN|473 mL|15950| 55.40 |||||||||| 36.01 | 37.67 | 40.44 | 40.44 | 43.21 | 33.24 | 36.01 | 41.55 | 47.09 | 49.20 | 48.75 | 41.55 | 47.09 ||| |DOBUTAMINE IN D5W 4-5 MG/ML-% IV SOLN|250 mL|15982| 286.50 |||||||||| 186.23 | 194.82 | 209.15 | 209.15 | 223.47 | 171.90 | 186.23 | 214.88 | 243.53 | 254.41 | 252.12 | 214.88 | 243.53 ||| |METHADONE HCL 10 MG/ML PO CONC|1 mL|15996| 26.00 |||||||||| 16.90 | 17.68 | 18.98 | 18.98 | 20.28 | 15.60 | 16.90 | 19.50 | 22.10 | 23.09 | 22.88 | 19.50 | 22.10 ||| |TRETINOIN 10 MG PO CAPS|10 mg (1 each)|16005| 77.85 |||||||||| 50.60 | 52.94 | 56.83 | 56.83 | 60.72 | 46.71 | 50.60 | 58.39 | 66.17 | 69.13 | 68.51 | 58.39 | 66.17 ||| |SAQUINAVIR MESYLATE 200 MG PO CAPS|1,000 mg (5 each)|16006| 67.25 |||||||||| 43.71 | 45.73 | 49.09 | 49.09 | 52.46 | 40.35 | 43.71 | 50.44 | 57.16 | 59.72 | 59.18 | 50.44 | 57.16 ||| |GLUCOSE 4 G PO CHEW|10 each|16050| 14.85 |||||||||| 9.65 | 10.10 | 10.84 | 10.84 | 11.58 | 8.91 | 9.65 | 11.14 | 12.62 | 13.19 | 13.07 | 11.14 | 12.62 ||| |DESMOPRESSIN ACETATE 0.1 MG PO TABS|30 each|16052| 140.30 |||||||||| 91.20 | 95.40 | 102.42 | 102.42 | 109.43 | 84.18 | 91.20 | 105.23 | 119.26 | 124.59 | 123.46 | 105.23 | 119.26 ||| |DESMOPRESSIN ACETATE 0.2 MG PO TABS|100 each|16053| 266.60 |||||||||| 173.29 | 181.29 | 194.62 | 194.62 | 207.95 | 159.96 | 173.29 | 199.95 | 226.61 | 236.74 | 234.61 | 199.95 | 226.61 ||| |IPRATROPIUM BROMIDE 0.03 % NA SOLN|30 mL|16070| 102.75 |||||||||| 66.79 | 69.87 | 75.01 | 75.01 | 80.15 | 61.65 | 66.79 | 77.06 | 87.34 | 91.24 | 90.42 | 77.06 | 87.34 ||| |FAMCICLOVIR 125 MG PO TABS|30 each|16082| 114.15 |||||||||| 74.20 | 77.62 | 83.33 | 83.33 | 89.04 | 68.49 | 74.20 | 85.61 | 97.03 | 101.37 | 100.45 | 85.61 | 97.03 ||| |ANASTROZOLE 1 MG PO TABS|30 each|16205| 78.45 |||||||||| 50.99 | 53.35 | 57.27 | 57.27 | 61.19 | 47.07 | 50.99 | 58.84 | 66.68 | 69.66 | 69.04 | 58.84 | 66.68 ||| |CALCITRIOL 1 MCG/ML PO SOLN|15 mL|16218| 319.30 |||||||||| 207.55 | 217.12 | 233.09 | 233.09 | 249.05 | 191.58 | 207.55 | 239.48 | 271.41 | 283.54 | 280.98 | 239.48 | 271.41 ||| |GOSERELIN ACETATE 10.8 MG SC IMPL|1 each|16254| 2,828.55 |||||||||| 1,838.56 | 1,923.41 | 2,064.84 | 2,064.84 | 2,206.27 | 1,697.13 | 1,838.56 | 2,121.41 | 2,404.27 | 2,511.75 | 2,489.12 | 2,121.41 | 2,404.27 ||| |DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA|28 g|16299| 37.35 |||||||||| 24.28 | 25.40 | 27.27 | 27.27 | 29.13 | 22.41 | 24.28 | 28.01 | 31.75 | 33.17 | 32.87 | 28.01 | 31.75 ||| |GLIMEPIRIDE 1 MG PO TABS|100 each|16355| 45.50 |||||||||| 29.58 | 30.94 | 33.22 | 33.22 | 35.49 | 27.30 | 29.58 | 34.13 | 38.68 | 40.40 | 40.04 | 34.13 | 38.68 ||| |GLIMEPIRIDE 2 MG PO TABS|1 each|16356| 12.15 |||||||||| 7.90 | 8.26 | 8.87 | 8.87 | 9.48 | 7.29 | 7.90 | 9.11 | 10.33 | 10.79 | 10.69 | 9.11 | 10.33 ||| |GLIMEPIRIDE 4 MG PO TABS|100 each|16357| 180.85 |||||||||| 117.55 | 122.98 | 132.02 | 132.02 | 141.06 | 108.51 | 117.55 | 135.64 | 153.72 | 160.59 | 159.15 | 135.64 | 153.72 ||| |CEFEPIME HCL 1 G IJ SOLR|1 g (1 each)|16369| 142.50 |||||||||| 92.63 | 96.90 | 104.03 | 104.03 | 111.15 | 85.50 | 92.63 | 106.88 | 121.13 | 126.54 | 125.40 | 106.88 | 121.13 ||| |CEFEPIME HCL 2 G IJ SOLR|2 g (1 each)|16371| 145.80 |||||||||| 94.77 | 99.14 | 106.43 | 106.43 | 113.72 | 87.48 | 94.77 | 109.35 | 123.93 | 129.47 | 128.30 | 109.35 | 123.93 ||| |CHLOROTHIAZIDE 250 MG PO TABS|100 each|1639| 137.05 |||||||||| 89.08 | 93.19 | 100.05 | 100.05 | 106.90 | 82.23 | 89.08 | 102.79 | 116.49 | 121.70 | 120.60 | 102.79 | 116.49 ||| |CHLORPHENIRAMINE MALEATE 4 MG PO TABS|100 each|1645| 12.70 |||||||||| 8.26 | 8.64 | 9.27 | 9.27 | 9.91 | 7.62 | 8.26 | 9.53 | 10.80 | 11.28 | 11.18 | 9.53 | 10.80 ||| |CHLORPROMAZINE HCL 25 MG/ML IJ SOLN|1 mL|1649| 88.40 |||||||||| 57.46 | 60.11 | 64.53 | 64.53 | 68.95 | 53.04 | 57.46 | 66.30 | 75.14 | 78.50 | 77.79 | 66.30 | 75.14 ||| |ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN|1000 mL|16825| 278.00 |||||||||| 180.70 | 189.04 | 202.94 | 202.94 | 216.84 | 166.80 | 180.70 | 208.50 | 236.30 | 246.86 | 244.64 | 208.50 | 236.30 ||| |MELATONIN 3 MG PO TABS|60 each|16830| 26.35 |||||||||| 17.13 | 17.92 | 19.24 | 19.24 | 20.55 | 15.81 | 17.13 | 19.76 | 22.40 | 23.40 | 23.19 | 19.76 | 22.40 ||| |LISTERINE ANTISEPTIC MT LIQD|250 mL|16844| 38.75 |||||||||| 25.19 | 26.35 | 28.29 | 28.29 | 30.23 | 23.25 | 25.19 | 29.06 | 32.94 | 34.41 | 34.10 | 29.06 | 32.94 ||| |MUPIROCIN CALCIUM 2 % NA OINT|1 g|16958| 66.15 |||||||||| 43.00 | 44.98 | 48.29 | 48.29 | 51.60 | 39.69 | 43.00 | 49.61 | 56.23 | 58.74 | 58.21 | 49.61 | 56.23 ||| |HYOSCYAMINE SULFATE ER 0.375 MG PO TB12|375 mcg (1 each)|17010| 13.70 |||||||||| 8.91 | 9.32 | 10.00 | 10.00 | 10.69 | 8.22 | 8.91 | 10.28 | 11.65 | 12.17 | 12.06 | 10.28 | 11.65 ||| |HYOSCYAMINE SULFATE ER 0.375 MG PO TB12|750 mcg (2 each)|17010| 22.35 |||||||||| 14.53 | 15.20 | 16.32 | 16.32 | 17.43 | 13.41 | 14.53 | 16.76 | 19.00 | 19.85 | 19.67 | 16.76 | 19.00 ||| |BLEOMYCIN SULFATE 30 UNITS IJ SOLR|2 Units (0.06666666666666666667 each)|17012| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |HYOSCYAMINE SULFATE 0.125 MG SL SUBL|125 mcg (1 each)|17023| 11.50 |||||||||| 7.48 | 7.82 | 8.40 | 8.40 | 8.97 | 6.90 | 7.48 | 8.63 | 9.78 | 10.21 | 10.12 | 8.63 | 9.78 ||| |HYOSCYAMINE SULFATE 0.125 MG SL SUBL|250 mcg (2 each)|17023| 12.00 |||||||||| 7.80 | 8.16 | 8.76 | 8.76 | 9.36 | 7.20 | 7.80 | 9.00 | 10.20 | 10.66 | 10.56 | 9.00 | 10.20 ||| |HYOSCYAMINE SULFATE 0.125 MG SL SUBL|375 mcg (3 each)|17023| 12.45 |||||||||| 8.09 | 8.47 | 9.09 | 9.09 | 9.71 | 7.47 | 8.09 | 9.34 | 10.58 | 11.06 | 10.96 | 9.34 | 10.58 ||| |CLONIDINE HCL POWD|1 g|17085| 557.65 |||||||||| 362.47 | 379.20 | 407.08 | 407.08 | 434.97 | 334.59 | 362.47 | 418.24 | 474.00 | 495.19 | 490.73 | 418.24 | 474.00 ||| |GEMCITABINE HCL 200 MG IV SOLR|1 each|17121| 25.05 |||||||||| 16.28 | 17.03 | 18.29 | 18.29 | 19.54 | 15.03 | 16.28 | 18.79 | 21.29 | 22.24 | 22.04 | 18.79 | 21.29 ||| |GEMCITABINE HCL 1 G IV SOLR|1 each|17122| 68.20 |||||||||| 44.33 | 46.38 | 49.79 | 49.79 | 53.20 | 40.92 | 44.33 | 51.15 | 57.97 | 60.56 | 60.02 | 51.15 | 57.97 ||| |INTERFERON BETA-1A 30 MCG IM KIT|1 each|17213| 3,594.50 |||||||||| 2,336.43 | 2,444.26 | 2,623.99 | 2,623.99 | 2,803.71 | 2,156.70 | 2,336.43 | 2,695.88 | 3,055.33 | 3,191.92 | 3,163.16 | 2,695.88 | 3,055.33 ||| |CIDOFOVIR 75 MG/ML IV SOLN|5 mL|17378| 2,031.35 |||||||||| 1,320.38 | 1,381.32 | 1,482.89 | 1,482.89 | 1,584.45 | 1,218.81 | 1,320.38 | 1,523.51 | 1,726.65 | 1,803.84 | 1,787.59 | 1,523.51 | 1,726.65 ||| |CHLORDIAZEPOXIDE-CLIDINIUM 5-2.5 MG PO CAPS|1 capsule (1 each)|1738| 12.70 |||||||||| 8.26 | 8.64 | 9.27 | 9.27 | 9.91 | 7.62 | 8.26 | 9.53 | 10.80 | 11.28 | 11.18 | 9.53 | 10.80 ||| |CHLORDIAZEPOXIDE-CLIDINIUM 5-2.5 MG PO CAPS|2 capsule (2 each)|1738| 14.35 |||||||||| 9.33 | 9.76 | 10.48 | 10.48 | 11.19 | 8.61 | 9.33 | 10.76 | 12.20 | 12.74 | 12.63 | 10.76 | 12.20 ||| |INSULIN LISPRO 100 UNIT/ML SC SOLN|10 mL|17405| 551.10 |||||||||| 358.22 | 374.75 | 402.30 | 402.30 | 429.86 | 330.66 | 358.22 | 413.33 | 468.44 | 489.38 | 484.97 | 413.33 | 468.44 ||| |MELATONIN 5 MG PO TABS|120 each|17427| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |BUSPIRONE HCL 15 MG PO TABS|100 each|17464| 35.30 |||||||||| 22.95 | 24.00 | 25.77 | 25.77 | 27.53 | 21.18 | 22.95 | 26.48 | 30.01 | 31.35 | 31.06 | 26.48 | 30.01 ||| |CANDIDA ALBICANS SKN TST ANTGN ID SOLN|1 mL|17524| 457.55 |||||||||| 297.41 | 311.13 | 334.01 | 334.01 | 356.89 | 274.53 | 297.41 | 343.16 | 388.92 | 406.30 | 402.64 | 343.16 | 388.92 ||| |CLONIDINE HCL 0.1 MG PO TABS|500 each|1755| 65.60 |||||||||| 42.64 | 44.61 | 47.89 | 47.89 | 51.17 | 39.36 | 42.64 | 49.20 | 55.76 | 58.25 | 57.73 | 49.20 | 55.76 ||| |IODIXANOL 320 MG/ML IV SOLN|100 mL|17595| 111.30 |||||||||| 72.35 | 75.68 | 81.25 | 81.25 | 86.81 | 66.78 | 72.35 | 83.48 | 94.61 | 98.83 | 97.94 | 83.48 | 94.61 ||| |CETAPHIL MOISTURIZING EX LOTN|473 mL|17624| 34.70 |||||||||| 22.56 | 23.60 | 25.33 | 25.33 | 27.07 | 20.82 | 22.56 | 26.03 | 29.50 | 30.81 | 30.54 | 26.03 | 29.50 ||| |CLOTRIMAZOLE 1 % EX SOLN|30 mL|1768| 146.55 |||||||||| 95.26 | 99.65 | 106.98 | 106.98 | 114.31 | 87.93 | 95.26 | 109.91 | 124.57 | 130.14 | 128.96 | 109.91 | 124.57 ||| |CLOTRIMAZOLE 1 % VA CREA|45 g|1769| 41.65 |||||||||| 27.07 | 28.32 | 30.40 | 30.40 | 32.49 | 24.99 | 27.07 | 31.24 | 35.40 | 36.99 | 36.65 | 31.24 | 35.40 ||| |ACETIC ACID 2 % OT SOLN|15 mL|17801| 86.75 |||||||||| 56.39 | 58.99 | 63.33 | 63.33 | 67.67 | 52.05 | 56.39 | 65.06 | 73.74 | 77.03 | 76.34 | 65.06 | 73.74 ||| |ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS|6.7 g|17837| 101.75 |||||||||| 66.14 | 69.19 | 74.28 | 74.28 | 79.37 | 61.05 | 66.14 | 76.31 | 86.49 | 90.35 | 89.54 | 76.31 | 86.49 ||| |DEXTROSE-NACL 5-0.225 % IV SOLN|1000 mL|17858| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |DEXAMETHASONE 1 MG/ML PO CONC|30 mL|17946| 71.55 |||||||||| 46.51 | 48.65 | 52.23 | 52.23 | 55.81 | 42.93 | 46.51 | 53.66 | 60.82 | 63.54 | 62.96 | 53.66 | 60.82 ||| |ZAFIRLUKAST 20 MG PO TABS|1 each|17960| 16.05 |||||||||| 10.43 | 10.91 | 11.72 | 11.72 | 12.52 | 9.63 | 10.43 | 12.04 | 13.64 | 14.25 | 14.12 | 12.04 | 13.64 ||| |AMMONIUM LACTATE 12 % EX CREA|140 g|17997| 46.15 |||||||||| 30.00 | 31.38 | 33.69 | 33.69 | 36.00 | 27.69 | 30.00 | 34.61 | 39.23 | 40.98 | 40.61 | 34.61 | 39.23 ||| |TRACE MINERALS CR-CU-MN-SE-ZN 10-1000-500-60 MCG/ML IV SOLN|10 mL|18259| 68.20 |||||||||| 44.33 | 46.38 | 49.79 | 49.79 | 53.20 | 40.92 | 44.33 | 51.15 | 57.97 | 60.56 | 60.02 | 51.15 | 57.97 ||| |TRACE MINERALS CR-CU-MN-SE-ZN 4-400-100-20 MCG/ML IV SOLN|10 mL|18260| 59.00 |||||||||| 38.35 | 40.12 | 43.07 | 43.07 | 46.02 | 35.40 | 38.35 | 44.25 | 50.15 | 52.39 | 51.92 | 44.25 | 50.15 ||| |TRACE MINERALS CR-CU-MN-ZN 0.01-1-0.5-5 MG/ML IV SOLN|1 mL|18262| 57.10 |||||||||| 37.12 | 38.83 | 41.68 | 41.68 | 44.54 | 34.26 | 37.12 | 42.83 | 48.54 | 50.70 | 50.25 | 42.83 | 48.54 ||| |TRACE MINERALS CR-CU-MN-ZN 100-25-1500 MCG/ML IV SOLN|2 mL|18267| 53.30 |||||||||| 34.65 | 36.24 | 38.91 | 38.91 | 41.57 | 31.98 | 34.65 | 39.98 | 45.31 | 47.33 | 46.90 | 39.98 | 45.31 ||| |BISOPROLOL FUMARATE 5 MG PO TABS|1 each|18288| 13.40 |||||||||| 8.71 | 9.11 | 9.78 | 9.78 | 10.45 | 8.04 | 8.71 | 10.05 | 11.39 | 11.90 | 11.79 | 10.05 | 11.39 ||| |BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MG PO TABS|1 tablet (1 each)|18289| 12.15 |||||||||| 7.90 | 8.26 | 8.87 | 8.87 | 9.48 | 7.29 | 7.90 | 9.11 | 10.33 | 10.79 | 10.69 | 9.11 | 10.33 ||| |BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MG PO TABS|1 tablet (1 each)|18290| 12.15 |||||||||| 7.90 | 8.26 | 8.87 | 8.87 | 9.48 | 7.29 | 7.90 | 9.11 | 10.33 | 10.79 | 10.69 | 9.11 | 10.33 ||| |BISOPROLOL-HYDROCHLOROTHIAZIDE 2.5-6.25 MG PO TABS|100 each|18291| 132.25 |||||||||| 85.96 | 89.93 | 96.54 | 96.54 | 103.16 | 79.35 | 85.96 | 99.19 | 112.41 | 117.44 | 116.38 | 99.19 | 112.41 ||| |GABAPENTIN 400 MG PO CAPS|100 each|18307| 33.20 |||||||||| 21.58 | 22.58 | 24.24 | 24.24 | 25.90 | 19.92 | 21.58 | 24.90 | 28.22 | 29.48 | 29.22 | 24.90 | 28.22 ||| |GABAPENTIN 300 MG PO CAPS|100 each|18308| 35.30 |||||||||| 22.95 | 24.00 | 25.77 | 25.77 | 27.53 | 21.18 | 22.95 | 26.48 | 30.01 | 31.35 | 31.06 | 26.48 | 30.01 ||| |GABAPENTIN 100 MG PO CAPS|500 each|18309| 84.30 |||||||||| 54.80 | 57.32 | 61.54 | 61.54 | 65.75 | 50.58 | 54.80 | 63.23 | 71.66 | 74.86 | 74.18 | 63.23 | 71.66 ||| |RISPERIDONE 3 MG PO TABS|60 each|18312| 42.95 |||||||||| 27.92 | 29.21 | 31.35 | 31.35 | 33.50 | 25.77 | 27.92 | 32.21 | 36.51 | 38.14 | 37.80 | 32.21 | 36.51 ||| |DOBUTAMINE IN D5W 2 MG/ML IV SOLN|250 mL|18315| 282.50 |||||||||| 183.63 | 192.10 | 206.23 | 206.23 | 220.35 | 169.50 | 183.63 | 211.88 | 240.13 | 250.86 | 248.60 | 211.88 | 240.13 ||| |COLLODION FLEXIBLE EX LIQD|100 mL|1838| 252.95 |||||||||| 164.42 | 172.01 | 184.65 | 184.65 | 197.30 | 151.77 | 164.42 | 189.71 | 215.01 | 224.62 | 222.60 | 189.71 | 215.01 ||| |BUPROPION HCL ER (SR) 100 MG PO TB12|60 each|18385| 106.25 |||||||||| 69.06 | 72.25 | 77.56 | 77.56 | 82.88 | 63.75 | 69.06 | 79.69 | 90.31 | 94.35 | 93.50 | 79.69 | 90.31 ||| |BUPROPION HCL ER (SR) 150 MG PO TB12|100 each|18386| 73.90 |||||||||| 48.04 | 50.25 | 53.95 | 53.95 | 57.64 | 44.34 | 48.04 | 55.43 | 62.82 | 65.62 | 65.03 | 55.43 | 62.82 ||| |CARVEDILOL 3.125 MG PO TABS|100 each|18551| 27.40 |||||||||| 17.81 | 18.63 | 20.00 | 20.00 | 21.37 | 16.44 | 17.81 | 20.55 | 23.29 | 24.33 | 24.11 | 20.55 | 23.29 ||| |DONEPEZIL HCL 5 MG PO TABS|90 each|18786| 28.05 |||||||||| 18.23 | 19.07 | 20.48 | 20.48 | 21.88 | 16.83 | 18.23 | 21.04 | 23.84 | 24.91 | 24.68 | 21.04 | 23.84 ||| |DONEPEZIL HCL 10 MG PO TABS|90 each|18787| 28.60 |||||||||| 18.59 | 19.45 | 20.88 | 20.88 | 22.31 | 17.16 | 18.59 | 21.45 | 24.31 | 25.40 | 25.17 | 21.45 | 24.31 ||| |ONDANSETRON HCL 4 MG/5ML PO SOLN|50 mL|18877| 57.40 |||||||||| 37.31 | 39.03 | 41.90 | 41.90 | 44.77 | 34.44 | 37.31 | 43.05 | 48.79 | 50.97 | 50.51 | 43.05 | 48.79 ||| |LEVOFLOXACIN 250 MG PO TABS|50 each|18918| 61.45 |||||||||| 39.94 | 41.79 | 44.86 | 44.86 | 47.93 | 36.87 | 39.94 | 46.09 | 52.23 | 54.57 | 54.08 | 46.09 | 52.23 ||| |LEVOFLOXACIN 500 MG PO TABS|50 each|18919| 67.70 |||||||||| 44.01 | 46.04 | 49.42 | 49.42 | 52.81 | 40.62 | 44.01 | 50.78 | 57.55 | 60.12 | 59.58 | 50.78 | 57.55 ||| |TOPIRAMATE 25 MG PO TABS|1000 each|18920| 161.10 |||||||||| 104.72 | 109.55 | 117.60 | 117.60 | 125.66 | 96.66 | 104.72 | 120.83 | 136.94 | 143.06 | 141.77 | 120.83 | 136.94 ||| |TOPIRAMATE 200 MG PO TABS|30 each|18921| 84.05 |||||||||| 54.63 | 57.15 | 61.36 | 61.36 | 65.56 | 50.43 | 54.63 | 63.04 | 71.44 | 74.64 | 73.96 | 63.04 | 71.44 ||| |COPPER SULFATE 0.4 MG/ML IV SOLN|10 mL|1901| 40.60 |||||||||| 26.39 | 27.61 | 29.64 | 29.64 | 31.67 | 24.36 | 26.39 | 30.45 | 34.51 | 36.05 | 35.73 | 30.45 | 34.51 ||| |HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS|12.5 mg (1 each)|19146| 11.35 |||||||||| 7.38 | 7.72 | 8.29 | 8.29 | 8.85 | 6.81 | 7.38 | 8.51 | 9.65 | 10.08 | 9.99 | 8.51 | 9.65 ||| |HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS|25 mg (2 each)|19146| 11.70 |||||||||| 7.61 | 7.96 | 8.54 | 8.54 | 9.13 | 7.02 | 7.61 | 8.78 | 9.95 | 10.39 | 10.30 | 8.78 | 9.95 ||| |ATORVASTATIN CALCIUM 10 MG PO TABS|100 each|19176| 98.85 |||||||||| 64.25 | 67.22 | 72.16 | 72.16 | 77.10 | 59.31 | 64.25 | 74.14 | 84.02 | 87.78 | 86.99 | 74.14 | 84.02 ||| |ATORVASTATIN CALCIUM 40 MG PO TABS|90 each|19177| 78.25 |||||||||| 50.86 | 53.21 | 57.12 | 57.12 | 61.04 | 46.95 | 50.86 | 58.69 | 66.51 | 69.49 | 68.86 | 58.69 | 66.51 ||| |ATORVASTATIN CALCIUM 20 MG PO TABS|1000 each|19178| 646.90 |||||||||| 420.49 | 439.89 | 472.24 | 472.24 | 504.58 | 388.14 | 420.49 | 485.18 | 549.87 | 574.45 | 569.27 | 485.18 | 549.87 ||| |CABERGOLINE 0.5 MG PO TABS|8 each|19226| 119.15 |||||||||| 77.45 | 81.02 | 86.98 | 86.98 | 92.94 | 71.49 | 77.45 | 89.36 | 101.28 | 105.81 | 104.85 | 89.36 | 101.28 ||| |CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN|10 mL|19333| 113.10 |||||||||| 73.52 | 76.91 | 82.56 | 82.56 | 88.22 | 67.86 | 73.52 | 84.83 | 96.14 | 100.43 | 99.53 | 84.83 | 96.14 ||| |DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP|.5 mL|19451| 81.80 |||||||||| 53.17 | 55.62 | 59.71 | 59.71 | 63.80 | 49.08 | 53.17 | 61.35 | 69.53 | 72.64 | 71.98 | 61.35 | 69.53 ||| |ZINC ACETATE 25 MG PO CAPS|250 each|19456| 921.95 |||||||||| 599.27 | 626.93 | 673.02 | 673.02 | 719.12 | 553.17 | 599.27 | 691.46 | 783.66 | 818.69 | 811.32 | 691.46 | 783.66 ||| |BACITRACIN-POLYMYXIN B OP OINT|3.5 g|19584| 77.15 |||||||||| 50.15 | 52.46 | 56.32 | 56.32 | 60.18 | 46.29 | 50.15 | 57.86 | 65.58 | 68.51 | 67.89 | 57.86 | 65.58 ||| |DEXAMETHASONE 0.1 % OP SUSP|5 mL|19596| 175.95 |||||||||| 114.37 | 119.65 | 128.44 | 128.44 | 137.24 | 105.57 | 114.37 | 131.96 | 149.56 | 156.24 | 154.84 | 131.96 | 149.56 ||| |EPINEPHRINE HCL (NASAL) 0.1 % NA SOLN|30 mL|19604| 505.65 |||||||||| 328.67 | 343.84 | 369.12 | 369.12 | 394.41 | 303.39 | 328.67 | 379.24 | 429.80 | 449.02 | 444.97 | 379.24 | 429.80 ||| |PHENYLEPHRINE HCL 10 % OP SOLN|5 mL|19636| 109.30 |||||||||| 71.05 | 74.32 | 79.79 | 79.79 | 85.25 | 65.58 | 71.05 | 81.98 | 92.91 | 97.06 | 96.18 | 81.98 | 92.91 ||| |BENZOCAINE 20 % MT GEL|30 g|19691| 47.65 |||||||||| 30.97 | 32.40 | 34.78 | 34.78 | 37.17 | 28.59 | 30.97 | 35.74 | 40.50 | 42.31 | 41.93 | 35.74 | 40.50 ||| |BENZOCAINE 20 % MT SOLN|25 each|19696| 532.40 |||||||||| 346.06 | 362.03 | 388.65 | 388.65 | 415.27 | 319.44 | 346.06 | 399.30 | 452.54 | 472.77 | 468.51 | 399.30 | 452.54 ||| |BETAXOLOL HCL 0.25 % OP SUSP|10 mL|19703| 618.55 |||||||||| 402.06 | 420.61 | 451.54 | 451.54 | 482.47 | 371.13 | 402.06 | 463.91 | 525.77 | 549.27 | 544.32 | 463.91 | 525.77 ||| |CARBACHOL 0.01 % IO SOLN|1.5 mL|19704| 102.60 |||||||||| 66.69 | 69.77 | 74.90 | 74.90 | 80.03 | 61.56 | 66.69 | 76.95 | 87.21 | 91.11 | 90.29 | 76.95 | 87.21 ||| |DIAZOXIDE 50 MG/ML PO SUSP|30 mL|19713| 737.00 |||||||||| 479.05 | 501.16 | 538.01 | 538.01 | 574.86 | 442.20 | 479.05 | 552.75 | 626.45 | 654.46 | 648.56 | 552.75 | 626.45 ||| |KETOROLAC TROMETHAMINE 0.5 % OP SOLN|5 mL|19733| 94.30 |||||||||| 61.30 | 64.12 | 68.84 | 68.84 | 73.55 | 56.58 | 61.30 | 70.73 | 80.16 | 83.74 | 82.98 | 70.73 | 80.16 ||| |UREA 10 % EX CREA|71 g|19775| 47.50 |||||||||| 30.88 | 32.30 | 34.68 | 34.68 | 37.05 | 28.50 | 30.88 | 35.63 | 40.38 | 42.18 | 41.80 | 35.63 | 40.38 ||| |POVIDONE-IODINE 5 % OP SOLN|30 mL|19791| 60.25 |||||||||| 39.16 | 40.97 | 43.98 | 43.98 | 47.00 | 36.15 | 39.16 | 45.19 | 51.21 | 53.50 | 53.02 | 45.19 | 51.21 ||| |BENZOCAINE 20 % MT CREA|7 g|19800| 37.80 |||||||||| 24.57 | 25.70 | 27.59 | 27.59 | 29.48 | 22.68 | 24.57 | 28.35 | 32.13 | 33.57 | 33.26 | 28.35 | 32.13 ||| |INTERFERON ALFA-2B 10000000 UNIT/ML IJ SOLN|3.2 mL|19898| 2,053.20 |||||||||| 1,334.58 | 1,396.18 | 1,498.84 | 1,498.84 | 1,601.50 | 1,231.92 | 1,334.58 | 1,539.90 | 1,745.22 | 1,823.24 | 1,806.82 | 1,539.90 | 1,745.22 ||| |ITRACONAZOLE 10 MG/ML PO SOLN|150 mL|19928| 632.05 |||||||||| 410.83 | 429.79 | 461.40 | 461.40 | 493.00 | 379.23 | 410.83 | 474.04 | 537.24 | 561.26 | 556.20 | 474.04 | 537.24 ||| |MAGIC MOUTHWASH|90 mL|200009| 582.55 |||||||||| 378.66 | 396.13 | 425.26 | 425.26 | 454.39 | 349.53 | 378.66 | 436.91 | 495.17 | 517.30 | 512.64 | 436.91 | 495.17 ||| |AZITHROMYCIN IV SYRINGE (PEDS)|250 mL|2000271| 147.30 |||||||||| 95.75 | 100.16 | 107.53 | 107.53 | 114.89 | 88.38 | 95.75 | 110.48 | 125.21 | 130.80 | 129.62 | 110.48 | 125.21 ||| |MANNITOL 20% IV SOLN FOR ONC|250 mL|2000418| 214.75 |||||||||| 139.59 | 146.03 | 156.77 | 156.77 | 167.51 | 128.85 | 139.59 | 161.06 | 182.54 | 190.70 | 188.98 | 161.06 | 182.54 ||| |ESMOLOL 10 MG/ML INFUSION (STRAIGHT)|10 mL|2000438| 61.10 |||||||||| 39.72 | 41.55 | 44.60 | 44.60 | 47.66 | 36.66 | 39.72 | 45.83 | 51.94 | 54.26 | 53.77 | 45.83 | 51.94 ||| |MAGNESIUM SULFATE 40MG/ML BOLUS|100 mL|2000449| 145.55 |||||||||| 94.61 | 98.97 | 106.25 | 106.25 | 113.53 | 87.33 | 94.61 | 109.16 | 123.72 | 129.25 | 128.08 | 109.16 | 123.72 ||| |PHENYLEPHRINE HCL 0.06% CUSTOM MIX NA SOLN|15 mL|2000530| 40.05 |||||||||| 26.03 | 27.23 | 29.24 | 29.24 | 31.24 | 24.03 | 26.03 | 30.04 | 34.04 | 35.56 | 35.24 | 30.04 | 34.04 ||| |PHENYLEPHRINE 10 MG/100 ML INFUSION (ONE-STEP)|100 mL|2000586| 217.70 |||||||||| 141.51 | 148.04 | 158.92 | 158.92 | 169.81 | 130.62 | 141.51 | 163.28 | 185.05 | 193.32 | 191.58 | 163.28 | 185.05 ||| |PHENYLEPHRINE 10 MG/500 ML INFUSION (ONE-STEP)|500 mL|2000592| 217.70 |||||||||| 141.51 | 148.04 | 158.92 | 158.92 | 169.81 | 130.62 | 141.51 | 163.28 | 185.05 | 193.32 | 191.58 | 163.28 | 185.05 ||| |ESTROGENS CONJUGATED 0.3125 PO SPLIT TABLET|100 each|2000697| 1,247.70 |||||||||| 811.01 | 848.44 | 910.82 | 910.82 | 973.21 | 748.62 | 811.01 | 935.78 | 1,060.55 | 1,107.96 | 1,097.98 | 935.78 | 1,060.55 ||| |FENTANYL PCA 50 MCG/ML COMPOUNDED|50 mL|2000753| 198.00 |||||||||| 128.70 | 134.64 | 144.54 | 144.54 | 154.44 | 118.80 | 128.70 | 148.50 | 168.30 | 175.82 | 174.24 | 148.50 | 168.30 ||| |CYANOCOBALAMIN 100 MCG PO TABS|100 each|2008| 22.65 |||||||||| 14.72 | 15.40 | 16.53 | 16.53 | 17.67 | 13.59 | 14.72 | 16.99 | 19.25 | 20.11 | 19.93 | 16.99 | 19.25 ||| |CYTARABINE (PF) 100 MG/ML IJ SOLN|20 mL|20156| 38.20 |||||||||| 24.83 | 25.98 | 27.89 | 27.89 | 29.80 | 22.92 | 24.83 | 28.65 | 32.47 | 33.92 | 33.62 | 28.65 | 32.47 ||| |ETOMIDATE 2 MG/ML IV SOLN|20 mL|20472| 46.05 |||||||||| 29.93 | 31.31 | 33.62 | 33.62 | 35.92 | 27.63 | 29.93 | 34.54 | 39.14 | 40.89 | 40.52 | 34.54 | 39.14 ||| |MELOXICAM 7.5 MG PO TABS|500 each|20566| 63.55 |||||||||| 41.31 | 43.21 | 46.39 | 46.39 | 49.57 | 38.13 | 41.31 | 47.66 | 54.02 | 56.43 | 55.92 | 47.66 | 54.02 ||| |ACTIDOSE WITH SORBITOL 25 GM/120ML PO LIQD|120 mL|20585| 49.70 |||||||||| 32.31 | 33.80 | 36.28 | 36.28 | 38.77 | 29.82 | 32.31 | 37.28 | 42.25 | 44.13 | 43.74 | 37.28 | 42.25 ||| |DACARBAZINE 200 MG IV SOLR|1 each|2091| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |AZITHROMYCIN 250 MG PO TABS|30 each|20943| 153.35 |||||||||| 99.68 | 104.28 | 111.95 | 111.95 | 119.61 | 92.01 | 99.68 | 115.01 | 130.35 | 136.17 | 134.95 | 115.01 | 130.35 ||| |LEVOCARNITINE 200 MG/ML IV SOLN|5 mL|20954| 96.35 |||||||||| 62.63 | 65.52 | 70.34 | 70.34 | 75.15 | 57.81 | 62.63 | 72.26 | 81.90 | 85.56 | 84.79 | 72.26 | 81.90 ||| |LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT|1 each|21045| 7,410.30 |||||||||| 4,816.70 | 5,039.00 | 5,409.52 | 5,409.52 | 5,780.03 | 4,446.18 | 4,816.70 | 5,557.73 | 6,298.76 | 6,580.35 | 6,521.06 | 5,557.73 | 6,298.76 ||| |CITALOPRAM HYDROBROMIDE 20 MG PO TABS|500 each|21062| 135.15 |||||||||| 87.85 | 91.90 | 98.66 | 98.66 | 105.42 | 81.09 | 87.85 | 101.36 | 114.88 | 120.01 | 118.93 | 101.36 | 114.88 ||| |AZITHROMYCIN 500 MG IV SOLR|500 mg (1 each)|21063| 135.30 |||||||||| 87.95 | 92.00 | 98.77 | 98.77 | 105.53 | 81.18 | 87.95 | 101.48 | 115.01 | 120.15 | 119.06 | 101.48 | 115.01 ||| |LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT|1 each|21108| 9,880.45 |||||||||| 6,422.29 | 6,718.71 | 7,212.73 | 7,212.73 | 7,706.75 | 5,928.27 | 6,422.29 | 7,410.34 | 8,398.38 | 8,773.84 | 8,694.80 | 7,410.34 | 8,398.38 ||| |DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN|5 mL|21135| 404.85 |||||||||| 263.15 | 275.30 | 295.54 | 295.54 | 315.78 | 242.91 | 263.15 | 303.64 | 344.12 | 359.51 | 356.27 | 303.64 | 344.12 ||| |AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS|100 each|21284| 229.50 |||||||||| 149.18 | 156.06 | 167.54 | 167.54 | 179.01 | 137.70 | 149.18 | 172.13 | 195.08 | 203.80 | 201.96 | 172.13 | 195.08 ||| |PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS|90 each|21287| 49.50 |||||||||| 32.18 | 33.66 | 36.14 | 36.14 | 38.61 | 29.70 | 32.18 | 37.13 | 42.08 | 43.96 | 43.56 | 37.13 | 42.08 ||| |PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS|90 each|21288| 49.50 |||||||||| 32.18 | 33.66 | 36.14 | 36.14 | 38.61 | 29.70 | 32.18 | 37.13 | 42.08 | 43.96 | 43.56 | 37.13 | 42.08 ||| |MYCOPHENOLATE MOFETIL 500 MG PO TABS|1,000 mg (2 each)|21374| 23.60 |||||||||| 15.34 | 16.05 | 17.23 | 17.23 | 18.41 | 14.16 | 15.34 | 17.70 | 20.06 | 20.96 | 20.77 | 17.70 | 20.06 ||| |MYCOPHENOLATE MOFETIL 500 MG PO TABS|250 mg (0.5 each)|21374| 12.65 |||||||||| 8.22 | 8.60 | 9.23 | 9.23 | 9.87 | 7.59 | 8.22 | 9.49 | 10.75 | 11.23 | 11.13 | 9.49 | 10.75 ||| |MYCOPHENOLATE MOFETIL 500 MG PO TABS|500 mg (1 each)|21374| 14.30 |||||||||| 9.30 | 9.72 | 10.44 | 10.44 | 11.15 | 8.58 | 9.30 | 10.73 | 12.16 | 12.70 | 12.58 | 10.73 | 12.16 ||| |LETROZOLE 2.5 MG PO TABS|2.5 mg (1 each)|21509| 12.05 |||||||||| 7.83 | 8.19 | 8.80 | 8.80 | 9.40 | 7.23 | 7.83 | 9.04 | 10.24 | 10.70 | 10.60 | 9.04 | 10.24 ||| |BCG LIVE 50 MG IS SUSR|50 mg|21570| 16,135.05 |||||||||| 10,487.78 | 10,971.83 | 11,778.59 | 11,778.59 | 12,585.34 | 9,681.03 | 10,487.78 | 12,101.29 | 13,714.79 | 14,327.92 | 14,198.84 | 12,101.29 | 13,714.79 ||| |CARMUSTINE IN POLIFEPROSAN 7.7 MG IL WAFR|8 each|21672| 66,493.45 |||||||||| 43,220.74 | 45,215.55 | 48,540.22 | 48,540.22 | 51,864.89 | 39,896.07 | 43,220.74 | 49,870.09 | 56,519.43 | 59,046.18 | 58,514.24 | 49,870.09 | 56,519.43 ||| |LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS|1 tablet (1 each)|21810| 15.35 |||||||||| 9.98 | 10.44 | 11.21 | 11.21 | 11.97 | 9.21 | 9.98 | 11.51 | 13.05 | 13.63 | 13.51 | 11.51 | 13.05 ||| |TIAGABINE HCL 4 MG PO TABS|30 each|21827| 641.70 |||||||||| 417.11 | 436.36 | 468.44 | 468.44 | 500.53 | 385.02 | 417.11 | 481.28 | 545.45 | 569.83 | 564.70 | 481.28 | 545.45 ||| |BACLOFEN 0.05 MG/ML IT SOLN|1 mL|21880| 96.10 |||||||||| 62.47 | 65.35 | 70.15 | 70.15 | 74.96 | 57.66 | 62.47 | 72.08 | 81.69 | 85.34 | 84.57 | 72.08 | 81.69 ||| |AMPHOTERICIN B LIPOSOME 50 MG IV SUSR|1 each|21900| 533.15 |||||||||| 346.55 | 362.54 | 389.20 | 389.20 | 415.86 | 319.89 | 346.55 | 399.86 | 453.18 | 473.44 | 469.17 | 399.86 | 453.18 ||| |CLOPIDOGREL BISULFATE 75 MG PO TABS|500 each|22142| 195.35 |||||||||| 126.98 | 132.84 | 142.61 | 142.61 | 152.37 | 117.21 | 126.98 | 146.51 | 166.05 | 173.47 | 171.91 | 146.51 | 166.05 ||| |ACARBOSE 25 MG PO TABS|100 each|22148| 101.75 |||||||||| 66.14 | 69.19 | 74.28 | 74.28 | 79.37 | 61.05 | 66.14 | 76.31 | 86.49 | 90.35 | 89.54 | 76.31 | 86.49 ||| |DILTIAZEM HCL 100 MG IV SOLR|1 each|22156| 460.00 |||||||||| 299.00 | 312.80 | 335.80 | 335.80 | 358.80 | 276.00 | 299.00 | 345.00 | 391.00 | 408.48 | 404.80 | 345.00 | 391.00 ||| |FOMEPIZOLE 1 GM/ML IV SOLN|1.5 mL|22185| 2,857.45 |||||||||| 1,857.34 | 1,943.07 | 2,085.94 | 2,085.94 | 2,228.81 | 1,714.47 | 1,857.34 | 2,143.09 | 2,428.83 | 2,537.42 | 2,514.56 | 2,143.09 | 2,428.83 ||| |CEFDINIR 300 MG PO CAPS|60 each|22289| 172.60 |||||||||| 112.19 | 117.37 | 126.00 | 126.00 | 134.63 | 103.56 | 112.19 | 129.45 | 146.71 | 153.27 | 151.89 | 129.45 | 146.71 ||| |CEFDINIR 125 MG/5ML PO SUSR|60 mL|22290| 73.60 |||||||||| 47.84 | 50.05 | 53.73 | 53.73 | 57.41 | 44.16 | 47.84 | 55.20 | 62.56 | 65.36 | 64.77 | 55.20 | 62.56 ||| |BUTALBITAL-ASA-CAFFEINE 50-325-40 MG PO CAPS|1 capsule (1 each)|22294| 13.30 |||||||||| 8.65 | 9.04 | 9.71 | 9.71 | 10.37 | 7.98 | 8.65 | 9.98 | 11.31 | 11.81 | 11.70 | 9.98 | 11.31 ||| |BUTALBITAL-ASA-CAFFEINE 50-325-40 MG PO CAPS|2 capsule (2 each)|22294| 15.55 |||||||||| 10.11 | 10.57 | 11.35 | 11.35 | 12.13 | 9.33 | 10.11 | 11.66 | 13.22 | 13.81 | 13.68 | 11.66 | 13.22 ||| |LACTASE 3000 UNITS PO TABS|3,000 Units (1 each)|22469| 11.15 |||||||||| 7.25 | 7.58 | 8.14 | 8.14 | 8.70 | 6.69 | 7.25 | 8.36 | 9.48 | 9.90 | 9.81 | 8.36 | 9.48 ||| |LACTASE 3000 UNITS PO TABS|6,000 Units (2 each)|22469| 11.30 |||||||||| 7.35 | 7.68 | 8.25 | 8.25 | 8.81 | 6.78 | 7.35 | 8.48 | 9.61 | 10.03 | 9.94 | 8.48 | 9.61 ||| |LACTASE 3000 UNITS PO TABS|9,000 Units (3 each)|22469| 11.45 |||||||||| 7.44 | 7.79 | 8.36 | 8.36 | 8.93 | 6.87 | 7.44 | 8.59 | 9.73 | 10.17 | 10.08 | 8.59 | 9.73 ||| |KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN|1 mL|22472| 41.10 |||||||||| 26.72 | 27.95 | 30.00 | 30.00 | 32.06 | 24.66 | 26.72 | 30.83 | 34.94 | 36.50 | 36.17 | 30.83 | 34.94 ||| |KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN|1 mL|22473| 43.45 |||||||||| 28.24 | 29.55 | 31.72 | 31.72 | 33.89 | 26.07 | 28.24 | 32.59 | 36.93 | 38.58 | 38.24 | 32.59 | 36.93 ||| |MONTELUKAST SODIUM 5 MG PO CHEW|5 mg (1 each)|22510| 12.80 |||||||||| 8.32 | 8.70 | 9.34 | 9.34 | 9.98 | 7.68 | 8.32 | 9.60 | 10.88 | 11.37 | 11.26 | 9.60 | 10.88 ||| |DESIPRAMINE HCL 25 MG PO TABS|100 each|2286| 241.65 |||||||||| 157.07 | 164.32 | 176.40 | 176.40 | 188.49 | 144.99 | 157.07 | 181.24 | 205.40 | 214.59 | 212.65 | 181.24 | 205.40 ||| |BRINZOLAMIDE 1 % OP SUSP|10 mL|22953| 646.40 |||||||||| 420.16 | 439.55 | 471.87 | 471.87 | 504.19 | 387.84 | 420.16 | 484.80 | 549.44 | 574.00 | 568.83 | 484.80 | 549.44 ||| |AMPHOTERICIN B LIPID 5 MG/ML IV SUSP|20 mL|22981| 205.45 |||||||||| 133.54 | 139.71 | 149.98 | 149.98 | 160.25 | 123.27 | 133.54 | 154.09 | 174.63 | 182.44 | 180.80 | 154.09 | 174.63 ||| |DORZOLAMIDE HCL-TIMOLOL MAL 22.3-6.8 MG/ML OP SOLN|10 mL|22982| 128.10 |||||||||| 83.27 | 87.11 | 93.51 | 93.51 | 99.92 | 76.86 | 83.27 | 96.08 | 108.89 | 113.75 | 112.73 | 96.08 | 108.89 ||| |CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN|222 mL|23063| 41.15 |||||||||| 26.75 | 27.98 | 30.04 | 30.04 | 32.10 | 24.69 | 26.75 | 30.86 | 34.98 | 36.54 | 36.21 | 30.86 | 34.98 ||| |BASILIXIMAB 20 MG IV SOLR|1 each|23082| 8,164.40 |||||||||| 5,306.86 | 5,551.79 | 5,960.01 | 5,960.01 | 6,368.23 | 4,898.64 | 5,306.86 | 6,123.30 | 6,939.74 | 7,249.99 | 7,184.67 | 6,123.30 | 6,939.74 ||| |KETAMINE HCL POWD|5 g|23101| 328.65 |||||||||| 213.62 | 223.48 | 239.91 | 239.91 | 256.35 | 197.19 | 213.62 | 246.49 | 279.35 | 291.84 | 289.21 | 246.49 | 279.35 ||| |EPTIFIBATIDE 75 MG/100ML IV SOLN|100 mL|23123| 616.35 |||||||||| 400.63 | 419.12 | 449.94 | 449.94 | 480.75 | 369.81 | 400.63 | 462.26 | 523.90 | 547.32 | 542.39 | 462.26 | 523.90 ||| |ACYCLOVIR SODIUM 50 MG/ML IV SOLN|10 mL|23128| 69.40 |||||||||| 45.11 | 47.19 | 50.66 | 50.66 | 54.13 | 41.64 | 45.11 | 52.05 | 58.99 | 61.63 | 61.07 | 52.05 | 58.99 ||| |VERAPAMIL HCL ER 180 MG PO CP24|100 each|23150| 338.20 |||||||||| 219.83 | 229.98 | 246.89 | 246.89 | 263.80 | 202.92 | 219.83 | 253.65 | 287.47 | 300.32 | 297.62 | 253.65 | 287.47 ||| |VERAPAMIL HCL ER 240 MG PO CP24|100 each|23151| 378.90 |||||||||| 246.29 | 257.65 | 276.60 | 276.60 | 295.54 | 227.34 | 246.29 | 284.18 | 322.07 | 336.46 | 333.43 | 284.18 | 322.07 ||| |CLINIMIX E/DEXTROSE (4.25/5) 4.25 % IV SOLN|2000 mL|23162| 356.00 |||||||||| 231.40 | 242.08 | 259.88 | 259.88 | 277.68 | 213.60 | 231.40 | 267.00 | 302.60 | 316.13 | 313.28 | 267.00 | 302.60 ||| |DEXAMETHASONE 0.5 MG/5ML PO SOLN|500 mL|2320| 55.25 |||||||||| 35.91 | 37.57 | 40.33 | 40.33 | 43.10 | 33.15 | 35.91 | 41.44 | 46.96 | 49.06 | 48.62 | 41.44 | 46.96 ||| |DEXAMETHASONE 0.5 MG PO TABS|100 each|2322| 57.75 |||||||||| 37.54 | 39.27 | 42.16 | 42.16 | 45.05 | 34.65 | 37.54 | 43.31 | 49.09 | 51.28 | 50.82 | 43.31 | 49.09 ||| |DEXAMETHASONE 2 MG PO TABS|100 each|2326| 150.30 |||||||||| 97.70 | 102.20 | 109.72 | 109.72 | 117.23 | 90.18 | 97.70 | 112.73 | 127.76 | 133.47 | 132.26 | 112.73 | 127.76 ||| |DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN|1 mL|2331| 36.45 |||||||||| 23.69 | 24.79 | 26.61 | 26.61 | 28.43 | 21.87 | 23.69 | 27.34 | 30.98 | 32.37 | 32.08 | 27.34 | 30.98 ||| |DEXTROSE 20 % IV SOLN|500 mL|2359| 205.50 |||||||||| 133.58 | 139.74 | 150.02 | 150.02 | 160.29 | 123.30 | 133.58 | 154.13 | 174.68 | 182.48 | 180.84 | 154.13 | 174.68 ||| |DEXTROSE 25 % IV SOLN|10 mL|2360| 51.25 |||||||||| 33.31 | 34.85 | 37.41 | 37.41 | 39.98 | 30.75 | 33.31 | 38.44 | 43.56 | 45.51 | 45.10 | 38.44 | 43.56 ||| |LEUCOVORIN CALCIUM 500 MG IJ SOLR|1 each|23617| 116.85 |||||||||| 75.95 | 79.46 | 85.30 | 85.30 | 91.14 | 70.11 | 75.95 | 87.64 | 99.32 | 103.76 | 102.83 | 87.64 | 99.32 ||| |INFLIXIMAB 100 MG IV SOLR|1 each|23796| 2,399.30 |||||||||| 1,559.55 | 1,631.52 | 1,751.49 | 1,751.49 | 1,871.45 | 1,439.58 | 1,559.55 | 1,799.48 | 2,039.41 | 2,130.58 | 2,111.38 | 1,799.48 | 2,039.41 ||| |LEFLUNOMIDE 10 MG PO TABS|30 each|23872| 333.40 |||||||||| 216.71 | 226.71 | 243.38 | 243.38 | 260.05 | 200.04 | 216.71 | 250.05 | 283.39 | 296.06 | 293.39 | 250.05 | 283.39 ||| |DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN|500 mL|23876| 221.50 |||||||||| 143.98 | 150.62 | 161.70 | 161.70 | 172.77 | 132.90 | 143.98 | 166.13 | 188.28 | 196.69 | 194.92 | 166.13 | 188.28 ||| |OXALIPLATIN 100 MG IV SOLR|1 each|23929| 519.50 |||||||||| 337.68 | 353.26 | 379.24 | 379.24 | 405.21 | 311.70 | 337.68 | 389.63 | 441.58 | 461.32 | 457.16 | 389.63 | 441.58 ||| |MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR|1.5 g (3 each)|23968| 697.95 |||||||||| 453.67 | 474.61 | 509.50 | 509.50 | 544.40 | 418.77 | 453.67 | 523.46 | 593.26 | 619.78 | 614.20 | 523.46 | 593.26 ||| |MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR|1 g (2 each)|23968| 508.65 |||||||||| 330.62 | 345.88 | 371.31 | 371.31 | 396.75 | 305.19 | 330.62 | 381.49 | 432.35 | 451.68 | 447.61 | 381.49 | 432.35 ||| |DIAZEPAM 5 MG/ML IJ SOLN|2 mL|2401| 95.75 |||||||||| 62.24 | 65.11 | 69.90 | 69.90 | 74.69 | 57.45 | 62.24 | 71.81 | 81.39 | 85.03 | 84.26 | 71.81 | 81.39 ||| |DIAZEPAM 2 MG PO TABS|100 each|2404| 33.50 |||||||||| 21.78 | 22.78 | 24.46 | 24.46 | 26.13 | 20.10 | 21.78 | 25.13 | 28.48 | 29.75 | 29.48 | 25.13 | 28.48 ||| |NEVIRAPINE 50 MG/5ML PO SUSP|240 mL|24119| 429.60 |||||||||| 279.24 | 292.13 | 313.61 | 313.61 | 335.09 | 257.76 | 279.24 | 322.20 | 365.16 | 381.48 | 378.05 | 322.20 | 365.16 ||| |DICLOXACILLIN SODIUM 250 MG PO CAPS|100 each|2414| 152.00 |||||||||| 98.80 | 103.36 | 110.96 | 110.96 | 118.56 | 91.20 | 98.80 | 114.00 | 129.20 | 134.98 | 133.76 | 114.00 | 129.20 ||| |MIDAZOLAM HCL 2 MG/ML PO SYRP|4 mL|24176| 26.00 |||||||||| 16.90 | 17.68 | 18.98 | 18.98 | 20.28 | 15.60 | 16.90 | 19.50 | 22.10 | 23.09 | 22.88 | 19.50 | 22.10 ||| |ISOSORBIDE MONONITRATE ER 60 MG PO TB24|500 each|24268| 241.05 |||||||||| 156.68 | 163.91 | 175.97 | 175.97 | 188.02 | 144.63 | 156.68 | 180.79 | 204.89 | 214.05 | 212.12 | 180.79 | 204.89 ||| |ALUM HYDROXIDE-MAG CARBONATE 95-358 MG/15ML PO SUSP|355 mL|24314| 23.65 |||||||||| 15.37 | 16.08 | 17.26 | 17.26 | 18.45 | 14.19 | 15.37 | 17.74 | 20.10 | 21.00 | 20.81 | 17.74 | 20.10 ||| |LAMIVUDINE 100 MG PO TABS|60 each|24419| 1,481.50 |||||||||| 962.98 | 1,007.42 | 1,081.50 | 1,081.50 | 1,155.57 | 888.90 | 962.98 | 1,111.13 | 1,259.28 | 1,315.57 | 1,303.72 | 1,111.13 | 1,259.28 ||| |OCTREOTIDE ACETATE 10 MG IM KIT|1 each|24434| 6,161.10 |||||||||| 4,004.72 | 4,189.55 | 4,497.60 | 4,497.60 | 4,805.66 | 3,696.66 | 4,004.72 | 4,620.83 | 5,236.94 | 5,471.06 | 5,421.77 | 4,620.83 | 5,236.94 ||| |OCTREOTIDE ACETATE 20 MG IM KIT|1 each|24435| 8,761.95 |||||||||| 5,695.27 | 5,958.13 | 6,396.22 | 6,396.22 | 6,834.32 | 5,257.17 | 5,695.27 | 6,571.46 | 7,447.66 | 7,780.61 | 7,710.52 | 6,571.46 | 7,447.66 ||| |OCTREOTIDE ACETATE 30 MG IM KIT|1 each|24436| 13,120.35 |||||||||| 8,528.23 | 8,921.84 | 9,577.86 | 9,577.86 | 10,233.87 | 7,872.21 | 8,528.23 | 9,840.26 | 11,152.30 | 11,650.87 | 11,545.91 | 9,840.26 | 11,152.30 ||| |CILOSTAZOL 50 MG PO TABS|60 each|24473| 61.65 |||||||||| 40.07 | 41.92 | 45.00 | 45.00 | 48.09 | 36.99 | 40.07 | 46.24 | 52.40 | 54.75 | 54.25 | 46.24 | 52.40 ||| |CILOSTAZOL 100 MG PO TABS|60 each|24474| 67.50 |||||||||| 43.88 | 45.90 | 49.28 | 49.28 | 52.65 | 40.50 | 43.88 | 50.63 | 57.38 | 59.94 | 59.40 | 50.63 | 57.38 ||| |CELECOXIB 100 MG PO CAPS|100 each|24500| 84.30 |||||||||| 54.80 | 57.32 | 61.54 | 61.54 | 65.75 | 50.58 | 54.80 | 63.23 | 71.66 | 74.86 | 74.18 | 63.23 | 71.66 ||| |CELECOXIB 200 MG PO CAPS|100 each|24501| 442.20 |||||||||| 287.43 | 300.70 | 322.81 | 322.81 | 344.92 | 265.32 | 287.43 | 331.65 | 375.87 | 392.67 | 389.14 | 331.65 | 375.87 ||| |ISOSORBIDE MONONITRATE ER 30 MG PO TB24|500 each|24521| 229.60 |||||||||| 149.24 | 156.13 | 167.61 | 167.61 | 179.09 | 137.76 | 149.24 | 172.20 | 195.16 | 203.88 | 202.05 | 172.20 | 195.16 ||| |TIMOLOL MALEATE 0.25 % OP SOLG|5 mL|24575| 332.55 |||||||||| 216.16 | 226.13 | 242.76 | 242.76 | 259.39 | 199.53 | 216.16 | 249.41 | 282.67 | 295.30 | 292.64 | 249.41 | 282.67 ||| |TIMOLOL MALEATE 0.5 % OP SOLG|5 mL|24576| 361.20 |||||||||| 234.78 | 245.62 | 263.68 | 263.68 | 281.74 | 216.72 | 234.78 | 270.90 | 307.02 | 320.75 | 317.86 | 270.90 | 307.02 ||| |ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR|1 each|24585| 1,797.90 |||||||||| 1,168.64 | 1,222.57 | 1,312.47 | 1,312.47 | 1,402.36 | 1,078.74 | 1,168.64 | 1,348.43 | 1,528.22 | 1,596.54 | 1,582.15 | 1,348.43 | 1,528.22 ||| |LACTULOSE 20 G PO PACK|15 g (0.75 each)|24586| 29.50 |||||||||| 19.18 | 20.06 | 21.54 | 21.54 | 23.01 | 17.70 | 19.18 | 22.13 | 25.08 | 26.20 | 25.96 | 22.13 | 25.08 ||| |LACTULOSE 20 G PO PACK|20 g (1 each)|24586| 33.70 |||||||||| 21.91 | 22.92 | 24.60 | 24.60 | 26.29 | 20.22 | 21.91 | 25.28 | 28.65 | 29.93 | 29.66 | 25.28 | 28.65 ||| |LACTULOSE 20 G PO PACK|30 g (1.5 each)|24586| 47.00 |||||||||| 30.55 | 31.96 | 34.31 | 34.31 | 36.66 | 28.20 | 30.55 | 35.25 | 39.95 | 41.74 | 41.36 | 35.25 | 39.95 ||| |LACTULOSE 20 G PO PACK|40 g (2 each)|24586| 55.35 |||||||||| 35.98 | 37.64 | 40.41 | 40.41 | 43.17 | 33.21 | 35.98 | 41.51 | 47.05 | 49.15 | 48.71 | 41.51 | 47.05 ||| |MODAFINIL 100 MG PO TABS|90 each|24702| 271.10 |||||||||| 176.22 | 184.35 | 197.90 | 197.90 | 211.46 | 162.66 | 176.22 | 203.33 | 230.44 | 240.74 | 238.57 | 203.33 | 230.44 ||| |DILTIAZEM HCL 30 MG PO TABS|100 each|2475| 52.75 |||||||||| 34.29 | 35.87 | 38.51 | 38.51 | 41.15 | 31.65 | 34.29 | 39.56 | 44.84 | 46.84 | 46.42 | 39.56 | 44.84 ||| |LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU|3 mL|24915| 27.55 |||||||||| 17.91 | 18.73 | 20.11 | 20.11 | 21.49 | 16.53 | 17.91 | 20.66 | 23.42 | 24.46 | 24.24 | 20.66 | 23.42 ||| |ANTIHEMOPHILIC FACTOR (RECOMB) 220-400 UNITS IV SOLR|325 Units|24924| 1,128.45 |||||||||| 733.49 | 767.35 | 823.77 | 823.77 | 880.19 | 677.07 | 733.49 | 846.34 | 959.18 | 1,002.06 | 993.04 | 846.34 | 959.18 ||| |ANTIHEMOPHILIC FACTOR (RECOMB) 401-800 UNITS IV SOLR|600 Units|24925| 2,083.30 |||||||||| 1,354.15 | 1,416.64 | 1,520.81 | 1,520.81 | 1,624.97 | 1,249.98 | 1,354.15 | 1,562.48 | 1,770.81 | 1,849.97 | 1,833.30 | 1,562.48 | 1,770.81 ||| |ANTIHEMOPHILIC FACTOR (RECOMB) 801-1240 UNITS IV SOLR|1000 Units|24926| 3,472.15 |||||||||| 2,256.90 | 2,361.06 | 2,534.67 | 2,534.67 | 2,708.28 | 2,083.29 | 2,256.90 | 2,604.11 | 2,951.33 | 3,083.27 | 3,055.49 | 2,604.11 | 2,951.33 ||| |DIPHENHYDRAMINE HCL 25 MG PO CAPS|100 each|2509| 24.10 |||||||||| 15.67 | 16.39 | 17.59 | 17.59 | 18.80 | 14.46 | 15.67 | 18.08 | 20.49 | 21.40 | 21.21 | 18.08 | 20.49 ||| |ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU|20 mL|251| 122.30 |||||||||| 79.50 | 83.16 | 89.28 | 89.28 | 95.39 | 73.38 | 79.50 | 91.73 | 103.96 | 108.60 | 107.62 | 91.73 | 103.96 ||| |CIPROFLOXACIN HCL 250 MG PO TABS|100 each|25118| 68.75 |||||||||| 44.69 | 46.75 | 50.19 | 50.19 | 53.63 | 41.25 | 44.69 | 51.56 | 58.44 | 61.05 | 60.50 | 51.56 | 58.44 ||| |CIPROFLOXACIN HCL 500 MG PO TABS|100 each|25119| 200.55 |||||||||| 130.36 | 136.37 | 146.40 | 146.40 | 156.43 | 120.33 | 130.36 | 150.41 | 170.47 | 178.09 | 176.48 | 150.41 | 170.47 ||| |DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD|60 mL|2515| 167.40 |||||||||| 108.81 | 113.83 | 122.20 | 122.20 | 130.57 | 100.44 | 108.81 | 125.55 | 142.29 | 148.65 | 147.31 | 125.55 | 142.29 ||| |AMOXICILLIN 400 MG/5ML PO SUSR|100 mL|25246| 30.30 |||||||||| 19.70 | 20.60 | 22.12 | 22.12 | 23.63 | 18.18 | 19.70 | 22.73 | 25.76 | 26.91 | 26.66 | 22.73 | 25.76 ||| |RISPERIDONE 0.25 MG PO TABS|100 each|25519| 80.35 |||||||||| 52.23 | 54.64 | 58.66 | 58.66 | 62.67 | 48.21 | 52.23 | 60.26 | 68.30 | 71.35 | 70.71 | 60.26 | 68.30 ||| |DIVALPROEX SODIUM 500 MG PO TBEC|90 each|2553| 88.55 |||||||||| 57.56 | 60.21 | 64.64 | 64.64 | 69.07 | 53.13 | 57.56 | 66.41 | 75.27 | 78.63 | 77.92 | 66.41 | 75.27 ||| |DOCUSATE CALCIUM 240 MG PO CAPS|240 mg (1 each)|2565| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |DOCUSATE SODIUM 100 MG PO CAPS|750 each|2566| 68.75 |||||||||| 44.69 | 46.75 | 50.19 | 50.19 | 53.63 | 41.25 | 44.69 | 51.56 | 58.44 | 61.05 | 60.50 | 51.56 | 58.44 ||| |IVERMECTIN 3 MG PO TABS|20 each|25820| 193.95 |||||||||| 126.07 | 131.89 | 141.58 | 141.58 | 151.28 | 116.37 | 126.07 | 145.46 | 164.86 | 172.23 | 170.68 | 145.46 | 164.86 ||| |DOPAMINE HCL 40 MG/ML IV SOLN|10 mL|2595| 133.65 |||||||||| 86.87 | 90.88 | 97.56 | 97.56 | 104.25 | 80.19 | 86.87 | 100.24 | 113.60 | 118.68 | 117.61 | 100.24 | 113.60 ||| |DOXAPRAM HCL 20 MG/ML IV SOLN|20 mL|2607| 214.90 |||||||||| 139.69 | 146.13 | 156.88 | 156.88 | 167.62 | 128.94 | 139.69 | 161.18 | 182.67 | 190.83 | 189.11 | 161.18 | 182.67 ||| |DOXEPIN HCL 10 MG PO CAPS|100 each|2608| 132.70 |||||||||| 86.26 | 90.24 | 96.87 | 96.87 | 103.51 | 79.62 | 86.26 | 99.53 | 112.80 | 117.84 | 116.78 | 99.53 | 112.80 ||| |DOXEPIN HCL 10 MG/ML PO CONC|120 mL|2614| 47.20 |||||||||| 30.68 | 32.10 | 34.46 | 34.46 | 36.82 | 28.32 | 30.68 | 35.40 | 40.12 | 41.91 | 41.54 | 35.40 | 40.12 ||| |DOXORUBICIN HCL 50 MG IV SOLR|1 each|2619| 390.40 |||||||||| 253.76 | 265.47 | 284.99 | 284.99 | 304.51 | 234.24 | 253.76 | 292.80 | 331.84 | 346.68 | 343.55 | 292.80 | 331.84 ||| |MUSCLE RUB 10-15 % EX CREA|85 g|26210| 39.45 |||||||||| 25.64 | 26.83 | 28.80 | 28.80 | 30.77 | 23.67 | 25.64 | 29.59 | 33.53 | 35.03 | 34.72 | 29.59 | 33.53 ||| |PANTOPRAZOLE SODIUM 20 MG PO TBEC|100 each|26224| 73.30 |||||||||| 47.65 | 49.84 | 53.51 | 53.51 | 57.17 | 43.98 | 47.65 | 54.98 | 62.31 | 65.09 | 64.50 | 54.98 | 62.31 ||| |DOXYCYCLINE HYCLATE 50 MG PO CAPS|50 each|2624| 146.60 |||||||||| 95.29 | 99.69 | 107.02 | 107.02 | 114.35 | 87.96 | 95.29 | 109.95 | 124.61 | 130.18 | 129.01 | 109.95 | 124.61 ||| |QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR|1 each|26335| 908.15 |||||||||| 590.30 | 617.54 | 662.95 | 662.95 | 708.36 | 544.89 | 590.30 | 681.11 | 771.93 | 806.44 | 799.17 | 681.11 | 771.93 ||| |SIROLIMUS 1 MG/ML PO SOLN|60 mL|26336| 3,176.30 |||||||||| 2,064.60 | 2,159.88 | 2,318.70 | 2,318.70 | 2,477.51 | 1,905.78 | 2,064.60 | 2,382.23 | 2,699.86 | 2,820.55 | 2,795.14 | 2,382.23 | 2,699.86 ||| |CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR|1 tablet (1 each)|26371| 12.50 |||||||||| 8.13 | 8.50 | 9.13 | 9.13 | 9.75 | 7.50 | 8.13 | 9.38 | 10.63 | 11.10 | 11.00 | 9.38 | 10.63 ||| |CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR|2 tablet (2 each)|26371| 13.95 |||||||||| 9.07 | 9.49 | 10.18 | 10.18 | 10.88 | 8.37 | 9.07 | 10.46 | 11.86 | 12.39 | 12.28 | 10.46 | 11.86 ||| |DROPERIDOL 2.5 MG/ML IJ SOLN|2 mL|2654| 48.10 |||||||||| 31.27 | 32.71 | 35.11 | 35.11 | 37.52 | 28.86 | 31.27 | 36.08 | 40.89 | 42.71 | 42.33 | 36.08 | 40.89 ||| |ENTACAPONE 200 MG PO TABS|100 each|26547| 678.05 |||||||||| 440.73 | 461.07 | 494.98 | 494.98 | 528.88 | 406.83 | 440.73 | 508.54 | 576.34 | 602.11 | 596.68 | 508.54 | 576.34 ||| |LEVETIRACETAM 250 MG PO TABS|120 each|26816| 89.05 |||||||||| 57.88 | 60.55 | 65.01 | 65.01 | 69.46 | 53.43 | 57.88 | 66.79 | 75.69 | 79.08 | 78.36 | 66.79 | 75.69 ||| |LEVETIRACETAM 500 MG PO TABS|500 each|26817| 362.50 |||||||||| 235.63 | 246.50 | 264.63 | 264.63 | 282.75 | 217.50 | 235.63 | 271.88 | 308.13 | 321.90 | 319.00 | 271.88 | 308.13 ||| |DOFETILIDE 125 MCG PO CAPS|60 each|26965| 411.25 |||||||||| 267.31 | 279.65 | 300.21 | 300.21 | 320.78 | 246.75 | 267.31 | 308.44 | 349.56 | 365.19 | 361.90 | 308.44 | 349.56 ||| |OXCARBAZEPINE 150 MG PO TABS|100 each|27049| 133.90 |||||||||| 87.04 | 91.05 | 97.75 | 97.75 | 104.44 | 80.34 | 87.04 | 100.43 | 113.82 | 118.90 | 117.83 | 100.43 | 113.82 ||| |CHARCOAL ACTIVATED PO LIQD|120 mL|27099| 49.70 |||||||||| 32.31 | 33.80 | 36.28 | 36.28 | 38.77 | 29.82 | 32.31 | 37.28 | 42.25 | 44.13 | 43.74 | 37.28 | 42.25 ||| |CLONIDINE HCL (ANALGESIA) 500 MCG/ML EP SOLN|10 mL|27113| 385.30 |||||||||| 250.45 | 262.00 | 281.27 | 281.27 | 300.53 | 231.18 | 250.45 | 288.98 | 327.51 | 342.15 | 339.06 | 288.98 | 327.51 ||| |NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR|90 each|27183| 236.90 |||||||||| 153.99 | 161.09 | 172.94 | 172.94 | 184.78 | 142.14 | 153.99 | 177.68 | 201.37 | 210.37 | 208.47 | 177.68 | 201.37 ||| |MONTELUKAST SODIUM 4 MG PO CHEW|4 mg (1 each)|27234| 12.80 |||||||||| 8.32 | 8.70 | 9.34 | 9.34 | 9.98 | 7.68 | 8.32 | 9.60 | 10.88 | 11.37 | 11.26 | 9.60 | 10.88 ||| |AMPICILLIN SODIUM 1 G IV SOLR|1,000 mg (1 each)|27280| 153.00 |||||||||| 99.45 | 104.04 | 111.69 | 111.69 | 119.34 | 91.80 | 99.45 | 114.75 | 130.05 | 135.86 | 134.64 | 114.75 | 130.05 ||| |AMPICILLIN SODIUM 2 G IV SOLR|2,000 mg (1 each)|27281| 178.75 |||||||||| 116.19 | 121.55 | 130.49 | 130.49 | 139.43 | 107.25 | 116.19 | 134.06 | 151.94 | 158.73 | 157.30 | 134.06 | 151.94 ||| |AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IV SOLR|1.5 g (1 each)|27282| 142.80 |||||||||| 92.82 | 97.10 | 104.24 | 104.24 | 111.38 | 85.68 | 92.82 | 107.10 | 121.38 | 126.81 | 125.66 | 107.10 | 121.38 ||| |AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IV SOLR|3,000 mg (1 each)|27283| 148.35 |||||||||| 96.43 | 100.88 | 108.30 | 108.30 | 115.71 | 89.01 | 96.43 | 111.26 | 126.10 | 131.73 | 130.55 | 111.26 | 126.10 ||| |CEFAZOLIN SODIUM 1 G IV SOLR|1 g (1 each)|27297| 22.60 |||||||||| 14.69 | 15.37 | 16.50 | 16.50 | 17.63 | 13.56 | 14.69 | 16.95 | 19.21 | 20.07 | 19.89 | 16.95 | 19.21 ||| |CEFAZOLIN SODIUM 1 G IV SOLR|250 mg (0.25 each)|27297| 12.40 |||||||||| 8.06 | 8.43 | 9.05 | 9.05 | 9.67 | 7.44 | 8.06 | 9.30 | 10.54 | 11.01 | 10.91 | 9.30 | 10.54 ||| |CEFAZOLIN SODIUM 1 G IV SOLR|500 mg (0.5 each)|27297| 13.80 |||||||||| 8.97 | 9.38 | 10.07 | 10.07 | 10.76 | 8.28 | 8.97 | 10.35 | 11.73 | 12.25 | 12.14 | 10.35 | 11.73 ||| |CEFUROXIME SODIUM 1.5 G IV SOLR|1.5 g (1 each)|27299| 141.60 |||||||||| 92.04 | 96.29 | 103.37 | 103.37 | 110.45 | 84.96 | 92.04 | 106.20 | 120.36 | 125.74 | 124.61 | 106.20 | 120.36 ||| |CEFTRIAXONE SODIUM 1 G IV SOLR|1 each|27308| 141.25 |||||||||| 91.81 | 96.05 | 103.11 | 103.11 | 110.18 | 84.75 | 91.81 | 105.94 | 120.06 | 125.43 | 124.30 | 105.94 | 120.06 ||| |CEFTRIAXONE SODIUM 2 G IV SOLR|1 each|27309| 146.50 |||||||||| 95.23 | 99.62 | 106.95 | 106.95 | 114.27 | 87.90 | 95.23 | 109.88 | 124.53 | 130.09 | 128.92 | 109.88 | 124.53 ||| |CEFEPIME HCL 1 G IV SOLR|1 each|27310| 140.20 |||||||||| 91.13 | 95.34 | 102.35 | 102.35 | 109.36 | 84.12 | 91.13 | 105.15 | 119.17 | 124.50 | 123.38 | 105.15 | 119.17 ||| |CEFEPIME HCL 2 G IV SOLR|1 each|27311| 147.20 |||||||||| 95.68 | 100.10 | 107.46 | 107.46 | 114.82 | 88.32 | 95.68 | 110.40 | 125.12 | 130.71 | 129.54 | 110.40 | 125.12 ||| |SOMATROPIN 5 MG SC SOLR|1 each|27314| 595.85 |||||||||| 387.30 | 405.18 | 434.97 | 434.97 | 464.76 | 357.51 | 387.30 | 446.89 | 506.47 | 529.11 | 524.35 | 446.89 | 506.47 ||| |SODIUM CHLORIDE 0.9 % IN AERS|1 oz|27318| 636.80 |||||||||| 413.92 | 433.02 | 464.86 | 464.86 | 496.70 | 382.08 | 413.92 | 477.60 | 541.28 | 565.48 | 560.38 | 477.60 | 541.28 ||| |MAGNESIUM SULFATE (LAXATIVE) PO GRAN|454 g|27322| 36.60 |||||||||| 23.79 | 24.89 | 26.72 | 26.72 | 28.55 | 21.96 | 23.79 | 27.45 | 31.11 | 32.50 | 32.21 | 27.45 | 31.11 ||| |HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP|1 mL|27326| 150.45 |||||||||| 97.79 | 102.31 | 109.83 | 109.83 | 117.35 | 90.27 | 97.79 | 112.84 | 127.88 | 133.60 | 132.40 | 112.84 | 127.88 ||| |MINERAL OIL LIGHT OIL|10 mL|27386| 50.90 |||||||||| 33.09 | 34.61 | 37.16 | 37.16 | 39.70 | 30.54 | 33.09 | 38.18 | 43.27 | 45.20 | 44.79 | 38.18 | 43.27 ||| |THEOPHYLLINE ER 200 MG PO CP24|100 each|27419| 766.70 |||||||||| 498.36 | 521.36 | 559.69 | 559.69 | 598.03 | 460.02 | 498.36 | 575.03 | 651.70 | 680.83 | 674.70 | 575.03 | 651.70 ||| |PENTAMIDINE ISETHIONATE 300 MG IJ SOLR|1 each|27430| 342.90 |||||||||| 222.89 | 233.17 | 250.32 | 250.32 | 267.46 | 205.74 | 222.89 | 257.18 | 291.47 | 304.50 | 301.75 | 257.18 | 291.47 ||| |DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ|25 mL|27431| 3,559.60 |||||||||| 2,313.74 | 2,420.53 | 2,598.51 | 2,598.51 | 2,776.49 | 2,135.76 | 2,313.74 | 2,669.70 | 3,025.66 | 3,160.92 | 3,132.45 | 2,669.70 | 3,025.66 ||| |TESTOSTERONE 4 MG/24HR TD PT24|1 patch (1 each)|27453| 58.90 |||||||||| 38.29 | 40.05 | 43.00 | 43.00 | 45.94 | 35.34 | 38.29 | 44.18 | 50.07 | 52.30 | 51.83 | 44.18 | 50.07 ||| |ESTRADIOL 0.05 MG/24HR TD PTTW|1 patch (1 each)|27459| 51.35 |||||||||| 33.38 | 34.92 | 37.49 | 37.49 | 40.05 | 30.81 | 33.38 | 38.51 | 43.65 | 45.60 | 45.19 | 38.51 | 43.65 ||| |ESTRADIOL 0.1 MG/24HR TD PTTW|1 patch (1 each)|27461| 35.90 |||||||||| 23.34 | 24.41 | 26.21 | 26.21 | 28.00 | 21.54 | 23.34 | 26.93 | 30.52 | 31.88 | 31.59 | 26.93 | 30.52 ||| |DINOPROSTONE 10 MG VA INST|10 mg (1 each)|27467| 925.55 |||||||||| 601.61 | 629.37 | 675.65 | 675.65 | 721.93 | 555.33 | 601.61 | 694.16 | 786.72 | 821.89 | 814.48 | 694.16 | 786.72 ||| |FELODIPINE ER 2.5 MG PO TB24|100 each|27489| 100.90 |||||||||| 65.59 | 68.61 | 73.66 | 73.66 | 78.70 | 60.54 | 65.59 | 75.68 | 85.77 | 89.60 | 88.79 | 75.68 | 85.77 ||| |LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12|1 tablet (1 each)|27520| 12.95 |||||||||| 8.42 | 8.81 | 9.45 | 9.45 | 10.10 | 7.77 | 8.42 | 9.71 | 11.01 | 11.50 | 11.40 | 9.71 | 11.01 ||| |DM-GUAIFENESIN ER 30-600 MG PO TB12|1 tablet (1 each)|27543| 12.10 |||||||||| 7.87 | 8.23 | 8.83 | 8.83 | 9.44 | 7.26 | 7.87 | 9.08 | 10.29 | 10.74 | 10.65 | 9.08 | 10.29 ||| |DM-GUAIFENESIN ER 30-600 MG PO TB12|2 tablet (2 each)|27543| 13.20 |||||||||| 8.58 | 8.98 | 9.64 | 9.64 | 10.30 | 7.92 | 8.58 | 9.90 | 11.22 | 11.72 | 11.62 | 9.90 | 11.22 ||| |CARBAMAZEPINE ER 100 MG PO TB12|100 each|27634| 212.20 |||||||||| 137.93 | 144.30 | 154.91 | 154.91 | 165.52 | 127.32 | 137.93 | 159.15 | 180.37 | 188.43 | 186.74 | 159.15 | 180.37 ||| |CARBAMAZEPINE ER 200 MG PO TB12|100 each|27635| 367.25 |||||||||| 238.71 | 249.73 | 268.09 | 268.09 | 286.46 | 220.35 | 238.71 | 275.44 | 312.16 | 326.12 | 323.18 | 275.44 | 312.16 ||| |ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12|1 capsule (1 each)|27644| 36.55 |||||||||| 23.76 | 24.85 | 26.68 | 26.68 | 28.51 | 21.93 | 23.76 | 27.41 | 31.07 | 32.46 | 32.16 | 27.41 | 31.07 ||| |FLUORESCEIN SODIUM 1 MG OP STRP|1 strip (0.01 each)|27663| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |COAL TAR EXTRACT 0.5 % EX SHAM|251 mL|27670| 38.30 |||||||||| 24.90 | 26.04 | 27.96 | 27.96 | 29.87 | 22.98 | 24.90 | 28.73 | 32.56 | 34.01 | 33.70 | 28.73 | 32.56 ||| |WHITE PETROLATUM GEL|16.8 g|27849| 35.15 |||||||||| 22.85 | 23.90 | 25.66 | 25.66 | 27.42 | 21.09 | 22.85 | 26.36 | 29.88 | 31.21 | 30.93 | 26.36 | 29.88 ||| |VENLAFAXINE HCL ER 150 MG PO CP24|1 each|27859| 12.30 |||||||||| 8.00 | 8.36 | 8.98 | 8.98 | 9.59 | 7.38 | 8.00 | 9.23 | 10.46 | 10.92 | 10.82 | 9.23 | 10.46 ||| |FENTANYL 25 MCG/HR TD PT72|1 patch (1 each)|27905| 31.85 |||||||||| 20.70 | 21.66 | 23.25 | 23.25 | 24.84 | 19.11 | 20.70 | 23.89 | 27.07 | 28.28 | 28.03 | 23.89 | 27.07 ||| |FENTANYL 50 MCG/HR TD PT72|1 patch (1 each)|27906| 48.30 |||||||||| 31.40 | 32.84 | 35.26 | 35.26 | 37.67 | 28.98 | 31.40 | 36.23 | 41.06 | 42.89 | 42.50 | 36.23 | 41.06 ||| |FENTANYL 75 MCG/HR TD PT72|1 patch (1 each)|27907| 47.70 |||||||||| 31.01 | 32.44 | 34.82 | 34.82 | 37.21 | 28.62 | 31.01 | 35.78 | 40.55 | 42.36 | 41.98 | 35.78 | 40.55 ||| |FENTANYL 100 MCG/HR TD PT72|1 patch (1 each)|27908| 79.25 |||||||||| 51.51 | 53.89 | 57.85 | 57.85 | 61.82 | 47.55 | 51.51 | 59.44 | 67.36 | 70.37 | 69.74 | 59.44 | 67.36 ||| |FENTANYL 100 MCG/HR TD PT72|2 patch (2 each)|27908| 136.45 |||||||||| 88.69 | 92.79 | 99.61 | 99.61 | 106.43 | 81.87 | 88.69 | 102.34 | 115.98 | 121.17 | 120.08 | 102.34 | 115.98 ||| |FENTANYL 100 MCG/HR TD PT72|3 patch (3 each)|27908| 193.65 |||||||||| 125.87 | 131.68 | 141.36 | 141.36 | 151.05 | 116.19 | 125.87 | 145.24 | 164.60 | 171.96 | 170.41 | 145.24 | 164.60 ||| |CALCIUM CARBONATE-VITAMIN D 250-125 MG-UNIT PO TABS|1 tablet (1 each)|27983| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |CALCIUM CARBONATE-VITAMIN D 250-125 MG-UNIT PO TABS|2 tablet (2 each)|27983| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |CALCIUM CARBONATE-VITAMIN D 500-200 MG-UNIT PO TABS|1 tablet (1 each)|27985| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |CALCIUM CARBONATE-VITAMIN D 500-200 MG-UNIT PO TABS|2 tablet (2 each)|27985| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OP SOLN|15 mL|27991| 48.90 |||||||||| 31.79 | 33.25 | 35.70 | 35.70 | 38.14 | 29.34 | 31.79 | 36.68 | 41.57 | 43.42 | 43.03 | 36.68 | 41.57 ||| |SILVER NITRATE 0.5 % EX SOLN|960 mL|28001| 147.85 |||||||||| 96.10 | 100.54 | 107.93 | 107.93 | 115.32 | 88.71 | 96.10 | 110.89 | 125.67 | 131.29 | 130.11 | 110.89 | 125.67 ||| |GELATIN ABSORBABLE OP FILM|6 each|28028| 2,561.35 |||||||||| 1,664.88 | 1,741.72 | 1,869.79 | 1,869.79 | 1,997.85 | 1,536.81 | 1,664.88 | 1,921.01 | 2,177.15 | 2,274.48 | 2,253.99 | 1,921.01 | 2,177.15 ||| |BENZOCAINE-MENTHOL 20-0.5 % EX AERO|78 g|28048| 27.05 |||||||||| 17.58 | 18.39 | 19.75 | 19.75 | 21.10 | 16.23 | 17.58 | 20.29 | 22.99 | 24.02 | 23.80 | 20.29 | 22.99 ||| |ENEMA 7-19 GM/118ML RE ENEM|133 mL|2805| 12.70 |||||||||| 8.26 | 8.64 | 9.27 | 9.27 | 9.91 | 7.62 | 8.26 | 9.53 | 10.80 | 11.28 | 11.18 | 9.53 | 10.80 ||| |ASPIRIN BUF(CACARB-MGCARB-MGO) 325 MG PO TABS|1 tablet (1 each)|28122| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |OLANZAPINE 5 MG PO TBDP|30 each|28159| 75.35 |||||||||| 48.98 | 51.24 | 55.01 | 55.01 | 58.77 | 45.21 | 48.98 | 56.51 | 64.05 | 66.91 | 66.31 | 56.51 | 64.05 ||| |CITALOPRAM HYDROBROMIDE 10 MG/5ML PO SOLN|240 mL|28228| 323.45 |||||||||| 210.24 | 219.95 | 236.12 | 236.12 | 252.29 | 194.07 | 210.24 | 242.59 | 274.93 | 287.22 | 284.64 | 242.59 | 274.93 ||| |PENTAMIDINE ISETHIONATE 300 MG IN SOLR|300 mg (1 each)|28235| 342.90 |||||||||| 222.89 | 233.17 | 250.32 | 250.32 | 267.46 | 205.74 | 222.89 | 257.18 | 291.47 | 304.50 | 301.75 | 257.18 | 291.47 ||| |FENOFIBRATE 160 MG PO TABS|90 each|28252| 145.55 |||||||||| 94.61 | 98.97 | 106.25 | 106.25 | 113.53 | 87.33 | 94.61 | 109.16 | 123.72 | 129.25 | 128.08 | 109.16 | 123.72 ||| |CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR|100 each|28264| 184.80 |||||||||| 120.12 | 125.66 | 134.90 | 134.90 | 144.14 | 110.88 | 120.12 | 138.60 | 157.08 | 164.10 | 162.62 | 138.60 | 157.08 ||| |RIVASTIGMINE TARTRATE 1.5 MG PO CAPS|60 each|28278| 94.65 |||||||||| 61.52 | 64.36 | 69.09 | 69.09 | 73.83 | 56.79 | 61.52 | 70.99 | 80.45 | 84.05 | 83.29 | 70.99 | 80.45 ||| |INSULIN GLARGINE 100 UNIT/ML SC SOLN|10 mL|28282| 567.75 |||||||||| 369.04 | 386.07 | 414.46 | 414.46 | 442.85 | 340.65 | 369.04 | 425.81 | 482.59 | 504.16 | 499.62 | 425.81 | 482.59 ||| |EPHEDRINE SULFATE 50 MG/ML IJ SOLN|1 mL|2833| 116.80 |||||||||| 75.92 | 79.42 | 85.26 | 85.26 | 91.10 | 70.08 | 75.92 | 87.60 | 99.28 | 103.72 | 102.78 | 87.60 | 99.28 ||| |FERRIC SUBSULFATE 259 MG/GM EX SOLN|8 g|28357| 35.90 |||||||||| 23.34 | 24.41 | 26.21 | 26.21 | 28.00 | 21.54 | 23.34 | 26.93 | 30.52 | 31.88 | 31.59 | 26.93 | 30.52 ||| |COLESEVELAM HCL 625 MG PO TABS|1,250 mg (2 each)|28372| 30.15 |||||||||| 19.60 | 20.50 | 22.01 | 22.01 | 23.52 | 18.09 | 19.60 | 22.61 | 25.63 | 26.77 | 26.53 | 22.61 | 25.63 ||| |COLESEVELAM HCL 625 MG PO TABS|1,875 mg (3 each)|28372| 36.75 |||||||||| 23.89 | 24.99 | 26.83 | 26.83 | 28.67 | 22.05 | 23.89 | 27.56 | 31.24 | 32.63 | 32.34 | 27.56 | 31.24 ||| |COLESEVELAM HCL 625 MG PO TABS|625 mg (1 each)|28372| 23.60 |||||||||| 15.34 | 16.05 | 17.23 | 17.23 | 18.41 | 14.16 | 15.34 | 17.70 | 20.06 | 20.96 | 20.77 | 17.70 | 20.06 ||| |HEPARIN LOCK FLUSH 100 UNIT/ML IV SOLN|5 mL|28393| 35.30 |||||||||| 22.95 | 24.00 | 25.77 | 25.77 | 27.53 | 21.18 | 22.95 | 26.48 | 30.01 | 31.35 | 31.06 | 26.48 | 30.01 ||| |ESTRADIOL 0.1 MG/24HR TD PTWK|1 patch (1 each)|28409| 60.55 |||||||||| 39.36 | 41.17 | 44.20 | 44.20 | 47.23 | 36.33 | 39.36 | 45.41 | 51.47 | 53.77 | 53.28 | 45.41 | 51.47 ||| |PETROLEUM JELLY GEL|369 g|28508| 36.10 |||||||||| 23.47 | 24.55 | 26.35 | 26.35 | 28.16 | 21.66 | 23.47 | 27.08 | 30.69 | 32.06 | 31.77 | 27.08 | 30.69 ||| |INSULIN ASPART 100 UNIT/ML SC SOLN|10 mL|28534| 578.70 |||||||||| 376.16 | 393.52 | 422.45 | 422.45 | 451.39 | 347.22 | 376.16 | 434.03 | 491.90 | 513.89 | 509.26 | 434.03 | 491.90 ||| |NEW SKIN EX AERO|28.5 mL|28612| 40.75 |||||||||| 26.49 | 27.71 | 29.75 | 29.75 | 31.79 | 24.45 | 26.49 | 30.56 | 34.64 | 36.19 | 35.86 | 30.56 | 34.64 ||| |BUDESONIDE 0.25 MG/2ML IN SUSP|2 mL|28774| 32.65 |||||||||| 21.22 | 22.20 | 23.83 | 23.83 | 25.47 | 19.59 | 21.22 | 24.49 | 27.75 | 28.99 | 28.73 | 24.49 | 27.75 ||| |BUDESONIDE 0.5 MG/2ML IN SUSP|2 mL|28775| 36.35 |||||||||| 23.63 | 24.72 | 26.54 | 26.54 | 28.35 | 21.81 | 23.63 | 27.26 | 30.90 | 32.28 | 31.99 | 27.26 | 30.90 ||| |GLYCERIN LIQD|473 mL|28815| 73.20 |||||||||| 47.58 | 49.78 | 53.44 | 53.44 | 57.10 | 43.92 | 47.58 | 54.90 | 62.22 | 65.00 | 64.42 | 54.90 | 62.22 ||| |METHYL SALICYLATE EX LIQD|60 mL|28829| 47.90 |||||||||| 31.14 | 32.57 | 34.97 | 34.97 | 37.36 | 28.74 | 31.14 | 35.93 | 40.72 | 42.54 | 42.15 | 35.93 | 40.72 ||| |CYCLOSPORINE MODIFIED 25 MG PO CAPS|30 each|28842| 90.55 |||||||||| 58.86 | 61.57 | 66.10 | 66.10 | 70.63 | 54.33 | 58.86 | 67.91 | 76.97 | 80.41 | 79.68 | 67.91 | 76.97 ||| |CYCLOSPORINE MODIFIED 100 MG PO CAPS|30 each|28843| 295.85 |||||||||| 192.30 | 201.18 | 215.97 | 215.97 | 230.76 | 177.51 | 192.30 | 221.89 | 251.47 | 262.71 | 260.35 | 221.89 | 251.47 ||| |LEVOFLOXACIN 0.5 % OP SOLN|5 mL|28872| 154.00 |||||||||| 100.10 | 104.72 | 112.42 | 112.42 | 120.12 | 92.40 | 100.10 | 115.50 | 130.90 | 136.75 | 135.52 | 115.50 | 130.90 ||| |ERYTHROMYCIN BASE 250 MG PO TBEC|100 each|2891| 1,549.55 |||||||||| 1,007.21 | 1,053.69 | 1,131.17 | 1,131.17 | 1,208.65 | 929.73 | 1,007.21 | 1,162.16 | 1,317.12 | 1,376.00 | 1,363.60 | 1,162.16 | 1,317.12 ||| |CARMUSTINE 100 MG IV SOLR|1 each|28911| 5,475.25 |||||||||| 3,558.91 | 3,723.17 | 3,996.93 | 3,996.93 | 4,270.70 | 3,285.15 | 3,558.91 | 4,106.44 | 4,653.96 | 4,862.02 | 4,818.22 | 4,106.44 | 4,653.96 ||| |SODIUM HYALURONATE 10 MG/ML IO SOLN|.85 mL|28913| 294.90 |||||||||| 191.69 | 200.53 | 215.28 | 215.28 | 230.02 | 176.94 | 191.69 | 221.18 | 250.67 | 261.87 | 259.51 | 221.18 | 250.67 ||| |NA HYALUR & NA CHOND-NA HYALUR 0.55-0.5 ML IO KIT|1.05 mL|28917| 440.70 |||||||||| 286.46 | 299.68 | 321.71 | 321.71 | 343.75 | 264.42 | 286.46 | 330.53 | 374.60 | 391.34 | 387.82 | 330.53 | 374.60 ||| |NA CHONDROIT SULF-NA HYALURON 40-30 MG/ML IO SOLN|.75 mL|28923| 418.45 |||||||||| 271.99 | 284.55 | 305.47 | 305.47 | 326.39 | 251.07 | 271.99 | 313.84 | 355.68 | 371.58 | 368.24 | 313.84 | 355.68 ||| |SODIUM HYALURONATE 12 MG/ML IO SOLN|.8 mL|28924| 271.20 |||||||||| 176.28 | 184.42 | 197.98 | 197.98 | 211.54 | 162.72 | 176.28 | 203.40 | 230.52 | 240.83 | 238.66 | 203.40 | 230.52 ||| |SODIUM HYALURONATE 16 MG/ML IO SOLN|.8 mL|28925| 320.15 |||||||||| 208.10 | 217.70 | 233.71 | 233.71 | 249.72 | 192.09 | 208.10 | 240.11 | 272.13 | 284.29 | 281.73 | 240.11 | 272.13 ||| |ARGATROBAN 250 MG/2.5ML IV SOLN|2.5 mL|28947| 1,027.25 |||||||||| 667.71 | 698.53 | 749.89 | 749.89 | 801.26 | 616.35 | 667.71 | 770.44 | 873.16 | 912.20 | 903.98 | 770.44 | 873.16 ||| |SIROLIMUS 1 MG PO TABS|30 each|28958| 886.60 |||||||||| 576.29 | 602.89 | 647.22 | 647.22 | 691.55 | 531.96 | 576.29 | 664.95 | 753.61 | 787.30 | 780.21 | 664.95 | 753.61 ||| |LEVOFLOXACIN 750 MG PO TABS|20 each|28964| 55.25 |||||||||| 35.91 | 37.57 | 40.33 | 40.33 | 43.10 | 33.15 | 35.91 | 41.44 | 46.96 | 49.06 | 48.62 | 41.44 | 46.96 ||| |METFORMIN HCL ER 500 MG PO TB24|100 each|28995| 35.10 |||||||||| 22.82 | 23.87 | 25.62 | 25.62 | 27.38 | 21.06 | 22.82 | 26.33 | 29.84 | 31.17 | 30.89 | 26.33 | 29.84 ||| |ERYTHROMYCIN ETHYLSUCCINATE 400 MG PO TABS|100 each|2901| 2,549.35 |||||||||| 1,657.08 | 1,733.56 | 1,861.03 | 1,861.03 | 1,988.49 | 1,529.61 | 1,657.08 | 1,912.01 | 2,166.95 | 2,263.82 | 2,243.43 | 1,912.01 | 2,166.95 ||| |ERYTHROMYCIN STEARATE 250 MG PO TABS|30 each|2904| 703.25 |||||||||| 457.11 | 478.21 | 513.37 | 513.37 | 548.54 | 421.95 | 457.11 | 527.44 | 597.76 | 624.49 | 618.86 | 527.44 | 597.76 ||| |ARSENIC TRIOXIDE 10 MG/10ML IV SOLN|10 mL|29071| 834.50 |||||||||| 542.43 | 567.46 | 609.19 | 609.19 | 650.91 | 500.70 | 542.43 | 625.88 | 709.33 | 741.04 | 734.36 | 625.88 | 709.33 ||| |SOMATROPIN 5 MG/1.5ML SC SOLN|1.5 mL|29073| 1,406.10 |||||||||| 913.97 | 956.15 | 1,026.45 | 1,026.45 | 1,096.76 | 843.66 | 913.97 | 1,054.58 | 1,195.19 | 1,248.62 | 1,237.37 | 1,054.58 | 1,195.19 ||| |FLUVASTATIN SODIUM ER 80 MG PO TB24|80 mg (1 each)|29172| 31.60 |||||||||| 20.54 | 21.49 | 23.07 | 23.07 | 24.65 | 18.96 | 20.54 | 23.70 | 26.86 | 28.06 | 27.81 | 23.70 | 26.86 ||| |DILTIAZEM HCL ER BEADS 120 MG PO CP24|90 each|29269| 138.25 |||||||||| 89.86 | 94.01 | 100.92 | 100.92 | 107.84 | 82.95 | 89.86 | 103.69 | 117.51 | 122.77 | 121.66 | 103.69 | 117.51 ||| |DILTIAZEM HCL ER BEADS 180 MG PO CP24|90 each|29271| 162.35 |||||||||| 105.53 | 110.40 | 118.52 | 118.52 | 126.63 | 97.41 | 105.53 | 121.76 | 138.00 | 144.17 | 142.87 | 121.76 | 138.00 ||| |DILTIAZEM HCL ER BEADS 240 MG PO CP24|90 each|29273| 258.00 |||||||||| 167.70 | 175.44 | 188.34 | 188.34 | 201.24 | 154.80 | 167.70 | 193.50 | 219.30 | 229.10 | 227.04 | 193.50 | 219.30 ||| |DILTIAZEM HCL ER BEADS 300 MG PO CP24|90 each|29275| 279.85 |||||||||| 181.90 | 190.30 | 204.29 | 204.29 | 218.28 | 167.91 | 181.90 | 209.89 | 237.87 | 248.51 | 246.27 | 209.89 | 237.87 ||| |DILTIAZEM HCL ER BEADS 360 MG PO CP24|90 each|29277| 333.50 |||||||||| 216.78 | 226.78 | 243.46 | 243.46 | 260.13 | 200.10 | 216.78 | 250.13 | 283.48 | 296.15 | 293.48 | 250.13 | 283.48 ||| |DOCOSANOL 10 % EX CREA|2 g|29287| 63.15 |||||||||| 41.05 | 42.94 | 46.10 | 46.10 | 49.26 | 37.89 | 41.05 | 47.36 | 53.68 | 56.08 | 55.57 | 47.36 | 53.68 ||| |BALSALAZIDE DISODIUM 750 MG PO CAPS|2,250 mg (3 each)|29299| 15.70 |||||||||| 10.21 | 10.68 | 11.46 | 11.46 | 12.25 | 9.42 | 10.21 | 11.78 | 13.35 | 13.94 | 13.82 | 11.78 | 13.35 ||| |PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN|5 mL|29302| 12.75 |||||||||| 8.29 | 8.67 | 9.31 | 9.31 | 9.95 | 7.65 | 8.29 | 9.56 | 10.84 | 11.32 | 11.22 | 9.56 | 10.84 ||| |CROTALIDAE POLYVAL IMMUNE FAB IV SOLR|1 each|29313| 6,570.30 |||||||||| 4,270.70 | 4,467.80 | 4,796.32 | 4,796.32 | 5,124.83 | 3,942.18 | 4,270.70 | 4,927.73 | 5,584.76 | 5,834.43 | 5,781.86 | 4,927.73 | 5,584.76 ||| |ESTROGENS CONJUGATED 1.25 MG PO TABS|100 each|2938| 1,247.70 |||||||||| 811.01 | 848.44 | 910.82 | 910.82 | 973.21 | 748.62 | 811.01 | 935.78 | 1,060.55 | 1,107.96 | 1,097.98 | 935.78 | 1,060.55 ||| |NATEGLINIDE 120 MG PO TABS|100 each|29438| 276.95 |||||||||| 180.02 | 188.33 | 202.17 | 202.17 | 216.02 | 166.17 | 180.02 | 207.71 | 235.41 | 245.93 | 243.72 | 207.71 | 235.41 ||| |TACROLIMUS 0.1 % EX OINT|60 g|29443| 818.40 |||||||||| 531.96 | 556.51 | 597.43 | 597.43 | 638.35 | 491.04 | 531.96 | 613.80 | 695.64 | 726.74 | 720.19 | 613.80 | 695.64 ||| |MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN|10 mL|29464| 58.20 |||||||||| 37.83 | 39.58 | 42.49 | 42.49 | 45.40 | 34.92 | 37.83 | 43.65 | 49.47 | 51.68 | 51.22 | 43.65 | 49.47 ||| |ETHYL CHLORIDE EX AERO|103.5 mL|2951| 97.55 |||||||||| 63.41 | 66.33 | 71.21 | 71.21 | 76.09 | 58.53 | 63.41 | 73.16 | 82.92 | 86.62 | 85.84 | 73.16 | 82.92 ||| |ESOMEPRAZOLE MAGNESIUM 20 MG PO CPDR|30 each|29745| 75.10 |||||||||| 48.82 | 51.07 | 54.82 | 54.82 | 58.58 | 45.06 | 48.82 | 56.33 | 63.84 | 66.69 | 66.09 | 56.33 | 63.84 ||| |ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR|30 each|29746| 340.50 |||||||||| 221.33 | 231.54 | 248.57 | 248.57 | 265.59 | 204.30 | 221.33 | 255.38 | 289.43 | 302.36 | 299.64 | 255.38 | 289.43 ||| |ZIPRASIDONE HCL 40 MG PO CAPS|40 each|29779| 422.70 |||||||||| 274.76 | 287.44 | 308.57 | 308.57 | 329.71 | 253.62 | 274.76 | 317.03 | 359.30 | 375.36 | 371.98 | 317.03 | 359.30 ||| |ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN|250 mL|29805| 737.75 |||||||||| 479.54 | 501.67 | 538.56 | 538.56 | 575.45 | 442.65 | 479.54 | 553.31 | 627.09 | 655.12 | 649.22 | 553.31 | 627.09 ||| |GALANTAMINE HYDROBROMIDE 8 MG PO TABS|60 each|29807| 338.80 |||||||||| 220.22 | 230.38 | 247.32 | 247.32 | 264.26 | 203.28 | 220.22 | 254.10 | 287.98 | 300.85 | 298.14 | 254.10 | 287.98 ||| |EYE STREAM OP SOLN|30 mL|2999| 69.50 |||||||||| 45.18 | 47.26 | 50.74 | 50.74 | 54.21 | 41.70 | 45.18 | 52.13 | 59.08 | 61.72 | 61.16 | 52.13 | 59.08 ||| |EYE WASH OP SOLN|118 mL|3000| 39.35 |||||||||| 25.58 | 26.76 | 28.73 | 28.73 | 30.69 | 23.61 | 25.58 | 29.51 | 33.45 | 34.94 | 34.63 | 29.51 | 33.45 ||| |METOPROLOL SUCCINATE ER 50 MG PO TB24|500 each|30070| 761.10 |||||||||| 494.72 | 517.55 | 555.60 | 555.60 | 593.66 | 456.66 | 494.72 | 570.83 | 646.94 | 675.86 | 669.77 | 570.83 | 646.94 ||| |VALGANCICLOVIR HCL 450 MG PO TABS|60 each|30148| 2,939.95 |||||||||| 1,910.97 | 1,999.17 | 2,146.16 | 2,146.16 | 2,293.16 | 1,763.97 | 1,910.97 | 2,204.96 | 2,498.96 | 2,610.68 | 2,587.16 | 2,204.96 | 2,498.96 ||| |CITALOPRAM HYDROBROMIDE 10 MG PO TABS|100 each|30264| 45.05 |||||||||| 29.28 | 30.63 | 32.89 | 32.89 | 35.14 | 27.03 | 29.28 | 33.79 | 38.29 | 40.00 | 39.64 | 33.79 | 38.29 ||| |PLEGISOL PF SOLN|1000 mL|30272| 245.00 |||||||||| 159.25 | 166.60 | 178.85 | 178.85 | 191.10 | 147.00 | 159.25 | 183.75 | 208.25 | 217.56 | 215.60 | 183.75 | 208.25 ||| |METHYLCELLULOSE 2 % GEL|1000 mL|30371| 92.60 |||||||||| 60.19 | 62.97 | 67.60 | 67.60 | 72.23 | 55.56 | 60.19 | 69.45 | 78.71 | 82.23 | 81.49 | 69.45 | 78.71 ||| |FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX|473 mL|3069| 31.75 |||||||||| 20.64 | 21.59 | 23.18 | 23.18 | 24.77 | 19.05 | 20.64 | 23.81 | 26.99 | 28.19 | 27.94 | 23.81 | 26.99 ||| |FERROUS SULFATE 300 (60 FE) MG/5ML PO SYRP|5 mL|3071| 24.05 |||||||||| 15.63 | 16.35 | 17.56 | 17.56 | 18.76 | 14.43 | 15.63 | 18.04 | 20.44 | 21.36 | 21.16 | 18.04 | 20.44 ||| |FERROUS SULFATE 325 (65 FE) MG PO TABS|1000 each|3074| 31.55 |||||||||| 20.51 | 21.45 | 23.03 | 23.03 | 24.61 | 18.93 | 20.51 | 23.66 | 26.82 | 28.02 | 27.76 | 23.66 | 26.82 ||| |FISH OIL 1000 MG PO CAPS|145 each|3113| 36.90 |||||||||| 23.99 | 25.09 | 26.94 | 26.94 | 28.78 | 22.14 | 23.99 | 27.68 | 31.37 | 32.77 | 32.47 | 27.68 | 31.37 ||| |BRIMONIDINE TARTRATE 0.15 % OP SOLN|5 mL|31158| 371.10 |||||||||| 241.22 | 252.35 | 270.90 | 270.90 | 289.46 | 222.66 | 241.22 | 278.33 | 315.44 | 329.54 | 326.57 | 278.33 | 315.44 ||| |AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR|125 mL|31177| 99.85 |||||||||| 64.90 | 67.90 | 72.89 | 72.89 | 77.88 | 59.91 | 64.90 | 74.89 | 84.87 | 88.67 | 87.87 | 74.89 | 84.87 ||| |FLEET PEDIATRIC 3.5-9.5 GM/59ML RE ENEM|66 mL|3128| 13.65 |||||||||| 8.87 | 9.28 | 9.96 | 9.96 | 10.65 | 8.19 | 8.87 | 10.24 | 11.60 | 12.12 | 12.01 | 10.24 | 11.60 ||| |ALTEPLASE 2 MG IJ SOLR|2 mg (1 each)|31310| 322.15 |||||||||| 209.40 | 219.06 | 235.17 | 235.17 | 251.28 | 193.29 | 209.40 | 241.61 | 273.83 | 286.07 | 283.49 | 241.61 | 273.83 ||| |DIGOXIN IMMUNE FAB 40 MG IV SOLR|1 each|31432| 7,850.25 |||||||||| 5,102.66 | 5,338.17 | 5,730.68 | 5,730.68 | 6,123.20 | 4,710.15 | 5,102.66 | 5,887.69 | 6,672.71 | 6,971.02 | 6,908.22 | 5,887.69 | 6,672.71 ||| |ALBUTEROL SULFATE 0.63 MG/3ML IN NEBU|3 mL|31577| 13.80 |||||||||| 8.97 | 9.38 | 10.07 | 10.07 | 10.76 | 8.28 | 8.97 | 10.35 | 11.73 | 12.25 | 12.14 | 10.35 | 11.73 ||| |ALBUTEROL SULFATE 1.25 MG/3ML IN NEBU|3 mL|31578| 13.80 |||||||||| 8.97 | 9.38 | 10.07 | 10.07 | 10.76 | 8.28 | 8.97 | 10.35 | 11.73 | 12.25 | 12.14 | 10.35 | 11.73 ||| |AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24|100 each|31587| 837.85 |||||||||| 544.60 | 569.74 | 611.63 | 611.63 | 653.52 | 502.71 | 544.60 | 628.39 | 712.17 | 744.01 | 737.31 | 628.39 | 712.17 ||| |DEXMETHYLPHENIDATE HCL 10 MG PO TABS|100 each|31847| 223.20 |||||||||| 145.08 | 151.78 | 162.94 | 162.94 | 174.10 | 133.92 | 145.08 | 167.40 | 189.72 | 198.20 | 196.42 | 167.40 | 189.72 ||| |FLUOCINONIDE 0.05 % EX CREA|15 g|3187| 102.60 |||||||||| 66.69 | 69.77 | 74.90 | 74.90 | 80.03 | 61.56 | 66.69 | 76.95 | 87.21 | 91.11 | 90.29 | 76.95 | 87.21 ||| |FROVATRIPTAN SUCCINATE 2.5 MG PO TABS|9 each|31882| 1,023.45 |||||||||| 665.24 | 695.95 | 747.12 | 747.12 | 798.29 | 614.07 | 665.24 | 767.59 | 869.93 | 908.82 | 900.64 | 767.59 | 869.93 ||| |FLUOCINONIDE 0.05 % EX OINT|30 g|3189| 247.10 |||||||||| 160.62 | 168.03 | 180.38 | 180.38 | 192.74 | 148.26 | 160.62 | 185.33 | 210.04 | 219.42 | 217.45 | 185.33 | 210.04 ||| |FLUOCINONIDE 0.05 % EX SOLN|20 mL|3190| 120.70 |||||||||| 78.46 | 82.08 | 88.11 | 88.11 | 94.15 | 72.42 | 78.46 | 90.53 | 102.60 | 107.18 | 106.22 | 90.53 | 102.60 ||| |MOXIFLOXACIN HCL IN NACL 400 MG/250ML IV SOLN|250 mL|31906| 199.40 |||||||||| 129.61 | 135.59 | 145.56 | 145.56 | 155.53 | 119.64 | 129.61 | 149.55 | 169.49 | 177.07 | 175.47 | 149.55 | 169.49 ||| |ENOXAPARIN SODIUM 150 MG/ML SC SOLN|1 mL|31921| 90.15 |||||||||| 58.60 | 61.30 | 65.81 | 65.81 | 70.32 | 54.09 | 58.60 | 67.61 | 76.63 | 80.05 | 79.33 | 67.61 | 76.63 ||| |ERTAPENEM SODIUM 1 G IJ SOLR|1 g (1 each)|31922| 306.25 |||||||||| 199.06 | 208.25 | 223.56 | 223.56 | 238.88 | 183.75 | 199.06 | 229.69 | 260.31 | 271.95 | 269.50 | 229.69 | 260.31 ||| |FLUOROMETHOLONE 0.1 % OP SUSP|10 mL|3208| 301.45 |||||||||| 195.94 | 204.99 | 220.06 | 220.06 | 235.13 | 180.87 | 195.94 | 226.09 | 256.23 | 267.69 | 265.28 | 226.09 | 256.23 ||| |FOLIC ACID 5 MG/ML IJ SOLN|10 mL|3232| 118.95 |||||||||| 77.32 | 80.89 | 86.83 | 86.83 | 92.78 | 71.37 | 77.32 | 89.21 | 101.11 | 105.63 | 104.68 | 89.21 | 101.11 ||| |BLISTEX LIP BALM 2-2.5-6.6 % EX STCK|4.25 g|32324| 35.55 |||||||||| 23.11 | 24.17 | 25.95 | 25.95 | 27.73 | 21.33 | 23.11 | 26.66 | 30.22 | 31.57 | 31.28 | 26.66 | 30.22 ||| |LEVALBUTEROL HCL 0.31 MG/3ML IN NEBU|3 mL|32329| 22.80 |||||||||| 14.82 | 15.50 | 16.64 | 16.64 | 17.78 | 13.68 | 14.82 | 17.10 | 19.38 | 20.25 | 20.06 | 17.10 | 19.38 ||| |TALC 4 G PL AERP|30 g|32569| 258.90 |||||||||| 168.29 | 176.05 | 189.00 | 189.00 | 201.94 | 155.34 | 168.29 | 194.18 | 220.07 | 229.90 | 227.83 | 194.18 | 220.07 ||| |PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN|10 mL|32855| 96.45 |||||||||| 62.69 | 65.59 | 70.41 | 70.41 | 75.23 | 57.87 | 62.69 | 72.34 | 81.98 | 85.65 | 84.88 | 72.34 | 81.98 ||| |LEUPROLIDE ACETATE 7.5 MG SC KIT|1 each|32893| 670.40 |||||||||| 435.76 | 455.87 | 489.39 | 489.39 | 522.91 | 402.24 | 435.76 | 502.80 | 569.84 | 595.32 | 589.95 | 502.80 | 569.84 ||| |IMATINIB MESYLATE 100 MG PO TABS|90 each|32979| 729.75 |||||||||| 474.34 | 496.23 | 532.72 | 532.72 | 569.21 | 437.85 | 474.34 | 547.31 | 620.29 | 648.02 | 642.18 | 547.31 | 620.29 ||| |AMPHETAMINE-DEXTROAMPHET ER 5 MG PO CP24|100 each|33005| 271.70 |||||||||| 176.61 | 184.76 | 198.34 | 198.34 | 211.93 | 163.02 | 176.61 | 203.78 | 230.95 | 241.27 | 239.10 | 203.78 | 230.95 ||| |MIDODRINE HCL 10 MG PO TABS|100 each|33083| 797.85 |||||||||| 518.60 | 542.54 | 582.43 | 582.43 | 622.32 | 478.71 | 518.60 | 598.39 | 678.17 | 708.49 | 702.11 | 598.39 | 678.17 ||| |URELLE 81 MG PO TABS|81 mg (1 each)|33126| 32.80 |||||||||| 21.32 | 22.30 | 23.94 | 23.94 | 25.58 | 19.68 | 21.32 | 24.60 | 27.88 | 29.13 | 28.86 | 24.60 | 27.88 ||| |METHYLPHENIDATE HCL ER (LA) 30 MG PO CP24|100 each|33199| 856.00 |||||||||| 556.40 | 582.08 | 624.88 | 624.88 | 667.68 | 513.60 | 556.40 | 642.00 | 727.60 | 760.13 | 753.28 | 642.00 | 727.60 ||| |AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS|1 tablet (1 each)|33228| 14.40 |||||||||| 9.36 | 9.79 | 10.51 | 10.51 | 11.23 | 8.64 | 9.36 | 10.80 | 12.24 | 12.79 | 12.67 | 10.80 | 12.24 ||| |AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR|50 mL|33230| 44.45 |||||||||| 28.89 | 30.23 | 32.45 | 32.45 | 34.67 | 26.67 | 28.89 | 33.34 | 37.78 | 39.47 | 39.12 | 33.34 | 37.78 ||| |DIALYVITE PO TABS|1 tablet (1 each)|33458| 11.30 |||||||||| 7.35 | 7.68 | 8.25 | 8.25 | 8.81 | 6.78 | 7.35 | 8.48 | 9.61 | 10.03 | 9.94 | 8.48 | 9.61 ||| |ESCITALOPRAM OXALATE 10 MG PO TABS|500 each|33512| 188.10 |||||||||| 122.27 | 127.91 | 137.31 | 137.31 | 146.72 | 112.86 | 122.27 | 141.08 | 159.89 | 167.03 | 165.53 | 141.08 | 159.89 ||| |ESCITALOPRAM OXALATE 20 MG PO TABS|100 each|33513| 57.30 |||||||||| 37.25 | 38.96 | 41.83 | 41.83 | 44.69 | 34.38 | 37.25 | 42.98 | 48.71 | 50.88 | 50.42 | 42.98 | 48.71 ||| |RASBURICASE 1.5 MG IV SOLR|1 each|33591| 1,353.40 |||||||||| 879.71 | 920.31 | 987.98 | 987.98 | 1,055.65 | 812.04 | 879.71 | 1,015.05 | 1,150.39 | 1,201.82 | 1,190.99 | 1,015.05 | 1,150.39 ||| |LEUPROLIDE ACETATE (3 MONTH) 22.5 MG SC KIT|22.5 mg (1 each)|33669| 2,011.20 |||||||||| 1,307.28 | 1,367.62 | 1,468.18 | 1,468.18 | 1,568.74 | 1,206.72 | 1,307.28 | 1,508.40 | 1,709.52 | 1,785.95 | 1,769.86 | 1,508.40 | 1,709.52 ||| |HEMATOGEN PO CAPS|1 capsule (1 each)|33690| 11.65 |||||||||| 7.57 | 7.92 | 8.50 | 8.50 | 9.09 | 6.99 | 7.57 | 8.74 | 9.90 | 10.35 | 10.25 | 8.74 | 9.90 ||| |EZETIMIBE 10 MG PO TABS|90 each|34153| 412.90 |||||||||| 268.39 | 280.77 | 301.42 | 301.42 | 322.06 | 247.74 | 268.39 | 309.68 | 350.97 | 366.66 | 363.35 | 309.68 | 350.97 ||| |GENTAMICIN SULFATE 0.1 % EX CREA|15 g|3423| 108.35 |||||||||| 70.43 | 73.68 | 79.10 | 79.10 | 84.51 | 65.01 | 70.43 | 81.26 | 92.10 | 96.21 | 95.35 | 81.26 | 92.10 ||| |GENTAMICIN SULFATE 0.1 % EX OINT|15 g|3424| 108.35 |||||||||| 70.43 | 73.68 | 79.10 | 79.10 | 84.51 | 65.01 | 70.43 | 81.26 | 92.10 | 96.21 | 95.35 | 81.26 | 92.10 ||| |GENTAMICIN SULFATE 10 MG/ML IJ SOLN|2 mL|3425| 136.95 |||||||||| 89.02 | 93.13 | 99.97 | 99.97 | 106.82 | 82.17 | 89.02 | 102.71 | 116.41 | 121.61 | 120.52 | 102.71 | 116.41 ||| |GENTAMICIN SULFATE 40 MG/ML IJ SOLN|20 mL|3426| 170.75 |||||||||| 110.99 | 116.11 | 124.65 | 124.65 | 133.19 | 102.45 | 110.99 | 128.06 | 145.14 | 151.63 | 150.26 | 128.06 | 145.14 ||| |GENTAMICIN SULFATE 0.3 % OP OINT|3.5 g|3427| 87.40 |||||||||| 56.81 | 59.43 | 63.80 | 63.80 | 68.17 | 52.44 | 56.81 | 65.55 | 74.29 | 77.61 | 76.91 | 65.55 | 74.29 ||| |GENTAMICIN SULFATE 0.3 % OP SOLN|5 mL|3428| 101.25 |||||||||| 65.81 | 68.85 | 73.91 | 73.91 | 78.98 | 60.75 | 65.81 | 75.94 | 86.06 | 89.91 | 89.10 | 75.94 | 86.06 ||| |GENTIAN VIOLET 1 % EX SOLN|59 mL|3430| 31.25 |||||||||| 20.31 | 21.25 | 22.81 | 22.81 | 24.38 | 18.75 | 20.31 | 23.44 | 26.56 | 27.75 | 27.50 | 23.44 | 26.56 ||| |ARIPIPRAZOLE 10 MG PO TABS|30 each|34369| 65.60 |||||||||| 42.64 | 44.61 | 47.89 | 47.89 | 51.17 | 39.36 | 42.64 | 49.20 | 55.76 | 58.25 | 57.73 | 49.20 | 55.76 ||| |ARIPIPRAZOLE 15 MG PO TABS|30 each|34370| 32.10 |||||||||| 20.87 | 21.83 | 23.43 | 23.43 | 25.04 | 19.26 | 20.87 | 24.08 | 27.29 | 28.50 | 28.25 | 24.08 | 27.29 ||| |DIVALPROEX SODIUM ER 250 MG PO TB24|1 each|34418| 14.10 |||||||||| 9.17 | 9.59 | 10.29 | 10.29 | 11.00 | 8.46 | 9.17 | 10.58 | 11.99 | 12.52 | 12.41 | 10.58 | 11.99 ||| |GERITOL TONIC PO LIQD|354 mL|3444| 28.80 |||||||||| 18.72 | 19.58 | 21.02 | 21.02 | 22.46 | 17.28 | 18.72 | 21.60 | 24.48 | 25.57 | 25.34 | 21.60 | 24.48 ||| |ATOMOXETINE HCL 10 MG PO CAPS|30 each|34444| 247.30 |||||||||| 160.75 | 168.16 | 180.53 | 180.53 | 192.89 | 148.38 | 160.75 | 185.48 | 210.21 | 219.60 | 217.62 | 185.48 | 210.21 ||| |ATOMOXETINE HCL 18 MG PO CAPS|30 each|34445| 842.90 |||||||||| 547.89 | 573.17 | 615.32 | 615.32 | 657.46 | 505.74 | 547.89 | 632.18 | 716.47 | 748.50 | 741.75 | 632.18 | 716.47 ||| |HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS|1-2 tablet (1-2 each)|34505| 23.00 |||||||||| 14.95 | 15.64 | 16.79 | 16.79 | 17.94 | 13.80 | 14.95 | 17.25 | 19.55 | 20.42 | 20.24 | 17.25 | 19.55 ||| |HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS|1 tablet (1 each)|34505| 23.00 |||||||||| 14.95 | 15.64 | 16.79 | 16.79 | 17.94 | 13.80 | 14.95 | 17.25 | 19.55 | 20.42 | 20.24 | 17.25 | 19.55 ||| |HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS|2 tablet (2 each)|34505| 23.95 |||||||||| 15.57 | 16.29 | 17.48 | 17.48 | 18.68 | 14.37 | 15.57 | 17.96 | 20.36 | 21.27 | 21.08 | 17.96 | 20.36 ||| |PIPERACILLIN-TAZOBACTAM IN DEX 2-0.25 GM/50ML IV SOLN|50 mL|34523| 156.95 |||||||||| 102.02 | 106.73 | 114.57 | 114.57 | 122.42 | 94.17 | 102.02 | 117.71 | 133.41 | 139.37 | 138.12 | 117.71 | 133.41 ||| |PIPERACILLIN-TAZOBACTAM IN DEX 3-0.375 GM/50ML IV SOLN|50 mL|34524| 164.30 |||||||||| 106.80 | 111.72 | 119.94 | 119.94 | 128.15 | 98.58 | 106.80 | 123.23 | 139.66 | 145.90 | 144.58 | 123.23 | 139.66 ||| |HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS|1-2 tablet (1-2 each)|34544| 23.00 |||||||||| 14.95 | 15.64 | 16.79 | 16.79 | 17.94 | 13.80 | 14.95 | 17.25 | 19.55 | 20.42 | 20.24 | 17.25 | 19.55 ||| |HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS|1 tablet (1 each)|34544| 23.00 |||||||||| 14.95 | 15.64 | 16.79 | 16.79 | 17.94 | 13.80 | 14.95 | 17.25 | 19.55 | 20.42 | 20.24 | 17.25 | 19.55 ||| |HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS|2 tablet (2 each)|34544| 23.95 |||||||||| 15.57 | 16.29 | 17.48 | 17.48 | 18.68 | 14.37 | 15.57 | 17.96 | 20.36 | 21.27 | 21.08 | 17.96 | 20.36 ||| |DTAP-HEPATITIS B RECOMB-IPV IM SUSP|.5 mL|34550| 190.10 |||||||||| 123.57 | 129.27 | 138.77 | 138.77 | 148.28 | 114.06 | 123.57 | 142.58 | 161.59 | 168.81 | 167.29 | 142.58 | 161.59 ||| |ELETRIPTAN HYDROBROMIDE 40 MG PO TABS|6 each|34684| 835.80 |||||||||| 543.27 | 568.34 | 610.13 | 610.13 | 651.92 | 501.48 | 543.27 | 626.85 | 710.43 | 742.19 | 735.50 | 626.85 | 710.43 ||| |BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL|1 tablet (1 each)|34713| 14.85 |||||||||| 9.65 | 10.10 | 10.84 | 10.84 | 11.58 | 8.91 | 9.65 | 11.14 | 12.62 | 13.19 | 13.07 | 11.14 | 12.62 ||| |NICOTINE POLACRILEX 2 MG MT LOZG|81 each|34769| 97.55 |||||||||| 63.41 | 66.33 | 71.21 | 71.21 | 76.09 | 58.53 | 63.41 | 73.16 | 82.92 | 86.62 | 85.84 | 73.16 | 82.92 ||| |ESCITALOPRAM OXALATE 5 MG/5ML PO SOLN|240 mL|34897| 303.30 |||||||||| 197.15 | 206.24 | 221.41 | 221.41 | 236.57 | 181.98 | 197.15 | 227.48 | 257.81 | 269.33 | 266.90 | 227.48 | 257.81 ||| |GLYCOPYRROLATE 0.2 MG/ML IJ SOLN|1 mL|3497| 47.20 |||||||||| 30.68 | 32.10 | 34.46 | 34.46 | 36.82 | 28.32 | 30.68 | 35.40 | 40.12 | 41.91 | 41.54 | 35.40 | 40.12 ||| |NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OP SUSP|7.5 mL|35126| 290.40 |||||||||| 188.76 | 197.47 | 211.99 | 211.99 | 226.51 | 174.24 | 188.76 | 217.80 | 246.84 | 257.88 | 255.55 | 217.80 | 246.84 ||| |FISH OIL 500 MG PO CAPS|130 each|35150| 24.85 |||||||||| 16.15 | 16.90 | 18.14 | 18.14 | 19.38 | 14.91 | 16.15 | 18.64 | 21.12 | 22.07 | 21.87 | 18.64 | 21.12 ||| |CYCLOBENZAPRINE HCL 5 MG PO TABS|100 each|35184| 56.30 |||||||||| 36.60 | 38.28 | 41.10 | 41.10 | 43.91 | 33.78 | 36.60 | 42.23 | 47.86 | 49.99 | 49.54 | 42.23 | 47.86 ||| |CYCLOSPORINE 0.05 % OP EMUL|1 drop (1 each)|35209| 37.30 |||||||||| 24.25 | 25.36 | 27.23 | 27.23 | 29.09 | 22.38 | 24.25 | 27.98 | 31.71 | 33.12 | 32.82 | 27.98 | 31.71 ||| |LEUPROLIDE ACETATE (4 MONTH) 30 MG SC KIT|1 each|35236| 2,681.60 |||||||||| 1,743.04 | 1,823.49 | 1,957.57 | 1,957.57 | 2,091.65 | 1,608.96 | 1,743.04 | 2,011.20 | 2,279.36 | 2,381.26 | 2,359.81 | 2,011.20 | 2,279.36 ||| |ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP|473 mL|353| 27.85 |||||||||| 18.10 | 18.94 | 20.33 | 20.33 | 21.72 | 16.71 | 18.10 | 20.89 | 23.67 | 24.73 | 24.51 | 20.89 | 23.67 ||| |GUAIFENESIN 100 MG/5ML PO SYRP|473 mL|3542| 24.90 |||||||||| 16.19 | 16.93 | 18.18 | 18.18 | 19.42 | 14.94 | 16.19 | 18.68 | 21.17 | 22.11 | 21.91 | 18.68 | 21.17 ||| |APREPITANT 80 MG PO CAPS|6 each|35488| 2,747.00 |||||||||| 1,785.55 | 1,867.96 | 2,005.31 | 2,005.31 | 2,142.66 | 1,648.20 | 1,785.55 | 2,060.25 | 2,334.95 | 2,439.34 | 2,417.36 | 2,060.25 | 2,334.95 ||| |APREPITANT 125 MG PO CAPS|6 each|35489| 4,279.85 |||||||||| 2,781.90 | 2,910.30 | 3,124.29 | 3,124.29 | 3,338.28 | 2,567.91 | 2,781.90 | 3,209.89 | 3,637.87 | 3,800.51 | 3,766.27 | 3,209.89 | 3,637.87 ||| |HYDROCODONE-IBUPROFEN 7.5-200 MG PO TABS|1-2 tablet (1-2 each)|35613| 23.55 |||||||||| 15.31 | 16.01 | 17.19 | 17.19 | 18.37 | 14.13 | 15.31 | 17.66 | 20.02 | 20.91 | 20.72 | 17.66 | 20.02 ||| |HYDROCODONE-IBUPROFEN 7.5-200 MG PO TABS|1 tablet (1 each)|35613| 23.55 |||||||||| 15.31 | 16.01 | 17.19 | 17.19 | 18.37 | 14.13 | 15.31 | 17.66 | 20.02 | 20.91 | 20.72 | 17.66 | 20.02 ||| |HYDROCODONE-IBUPROFEN 7.5-200 MG PO TABS|2 tablet (2 each)|35613| 25.10 |||||||||| 16.32 | 17.07 | 18.32 | 18.32 | 19.58 | 15.06 | 16.32 | 18.83 | 21.34 | 22.29 | 22.09 | 18.83 | 21.34 ||| |CLONAZEPAM 1 MG PO TBDP|60 each|35628| 153.30 |||||||||| 99.65 | 104.24 | 111.91 | 111.91 | 119.57 | 91.98 | 99.65 | 114.98 | 130.31 | 136.13 | 134.90 | 114.98 | 130.31 ||| |HALOPERIDOL 10 MG PO TABS|100 each|3580| 187.90 |||||||||| 122.14 | 127.77 | 137.17 | 137.17 | 146.56 | 112.74 | 122.14 | 140.93 | 159.72 | 166.86 | 165.35 | 140.93 | 159.72 ||| |POLYETHYL GLYCOL-PROPYL GLYCOL 0.4-0.3 % OP SOLN|15 mL|35891| 54.25 |||||||||| 35.26 | 36.89 | 39.60 | 39.60 | 42.32 | 32.55 | 35.26 | 40.69 | 46.11 | 48.17 | 47.74 | 40.69 | 46.11 ||| |MONTELUKAST SODIUM 4 MG PO PACK|4 mg (1 each)|36023| 23.35 |||||||||| 15.18 | 15.88 | 17.05 | 17.05 | 18.21 | 14.01 | 15.18 | 17.51 | 19.85 | 20.73 | 20.55 | 17.51 | 19.85 ||| |POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN|1000 mL|36046| 197.00 |||||||||| 128.05 | 133.96 | 143.81 | 143.81 | 153.66 | 118.20 | 128.05 | 147.75 | 167.45 | 174.94 | 173.36 | 147.75 | 167.45 ||| |IMATINIB MESYLATE 400 MG PO TABS|30 each|36092| 649.80 |||||||||| 422.37 | 441.86 | 474.35 | 474.35 | 506.84 | 389.88 | 422.37 | 487.35 | 552.33 | 577.02 | 571.82 | 487.35 | 552.33 ||| |CARBIDOPA-LEVODOPA-ENTACAPONE 37.5-150-200 MG PO TABS|1 tablet (1 each)|36137| 23.25 |||||||||| 15.11 | 15.81 | 16.97 | 16.97 | 18.14 | 13.95 | 15.11 | 17.44 | 19.76 | 20.65 | 20.46 | 17.44 | 19.76 ||| |ATAZANAVIR SULFATE 150 MG PO CAPS|60 each|36149| 2,646.65 |||||||||| 1,720.32 | 1,799.72 | 1,932.05 | 1,932.05 | 2,064.39 | 1,587.99 | 1,720.32 | 1,984.99 | 2,249.65 | 2,350.23 | 2,329.05 | 1,984.99 | 2,249.65 ||| |OMALIZUMAB 150 MG SC SOLR|150 mg (1 each)|36151| 2,318.50 |||||||||| 1,507.03 | 1,576.58 | 1,692.51 | 1,692.51 | 1,808.43 | 1,391.10 | 1,507.03 | 1,738.88 | 1,970.73 | 2,058.83 | 2,040.28 | 1,738.88 | 1,970.73 ||| |OMALIZUMAB 150 MG SC SOLR|225 mg (1.5 each)|36151| 3,477.70 |||||||||| 2,260.51 | 2,364.84 | 2,538.72 | 2,538.72 | 2,712.61 | 2,086.62 | 2,260.51 | 2,608.28 | 2,956.05 | 3,088.20 | 3,060.38 | 2,608.28 | 2,956.05 ||| |OMALIZUMAB 150 MG SC SOLR|300 mg (2 each)|36151| 4,636.95 |||||||||| 3,014.02 | 3,153.13 | 3,384.97 | 3,384.97 | 3,616.82 | 2,782.17 | 3,014.02 | 3,477.71 | 3,941.41 | 4,117.61 | 4,080.52 | 3,477.71 | 3,941.41 ||| |OMALIZUMAB 150 MG SC SOLR|375 mg (2.5 each)|36151| 5,796.20 |||||||||| 3,767.53 | 3,941.42 | 4,231.23 | 4,231.23 | 4,521.04 | 3,477.72 | 3,767.53 | 4,347.15 | 4,926.77 | 5,147.03 | 5,100.66 | 4,347.15 | 4,926.77 ||| |METHYLPHENIDATE HCL ER (CD) 30 MG PO CPCR|100 each|36349| 532.50 |||||||||| 346.13 | 362.10 | 388.73 | 388.73 | 415.35 | 319.50 | 346.13 | 399.38 | 452.63 | 472.86 | 468.60 | 399.38 | 452.63 ||| |ARIPIPRAZOLE 5 MG PO TABS|30 each|36438| 65.60 |||||||||| 42.64 | 44.61 | 47.89 | 47.89 | 51.17 | 39.36 | 42.64 | 49.20 | 55.76 | 58.25 | 57.73 | 49.20 | 55.76 ||| |METHYLPHENIDATE HCL ER (CD) 10 MG PO CPCR|30 each|36495| 271.70 |||||||||| 176.61 | 184.76 | 198.34 | 198.34 | 211.93 | 163.02 | 176.61 | 203.78 | 230.95 | 241.27 | 239.10 | 203.78 | 230.95 ||| |CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP|7.5 mL|36576| 502.90 |||||||||| 326.89 | 341.97 | 367.12 | 367.12 | 392.26 | 301.74 | 326.89 | 377.18 | 427.47 | 446.58 | 442.55 | 377.18 | 427.47 ||| |BUPROPION HCL ER (XL) 150 MG PO TB24|30 each|36775| 64.40 |||||||||| 41.86 | 43.79 | 47.01 | 47.01 | 50.23 | 38.64 | 41.86 | 48.30 | 54.74 | 57.19 | 56.67 | 48.30 | 54.74 ||| |BUPROPION HCL ER (XL) 300 MG PO TB24|90 each|36776| 64.60 |||||||||| 41.99 | 43.93 | 47.16 | 47.16 | 50.39 | 38.76 | 41.99 | 48.45 | 54.91 | 57.36 | 56.85 | 48.45 | 54.91 ||| |PHENYLEPHRINE HCL 0.125 % NA SOLN|15 mL|36952| 40.05 |||||||||| 26.03 | 27.23 | 29.24 | 29.24 | 31.24 | 24.03 | 26.03 | 30.04 | 34.04 | 35.56 | 35.24 | 30.04 | 34.04 ||| |DOCUSATE SODIUM 50 MG/5ML PO LIQD|10 mL|36962| 12.15 |||||||||| 7.90 | 8.26 | 8.87 | 8.87 | 9.48 | 7.29 | 7.90 | 9.11 | 10.33 | 10.79 | 10.69 | 9.11 | 10.33 ||| |THEOPHYLLINE ER 400 MG PO TB24|100 each|36973| 275.70 |||||||||| 179.21 | 187.48 | 201.26 | 201.26 | 215.05 | 165.42 | 179.21 | 206.78 | 234.35 | 244.82 | 242.62 | 206.78 | 234.35 ||| |ALFUZOSIN HCL ER 10 MG PO TB24|10 mg (1 each)|36982| 11.85 |||||||||| 7.70 | 8.06 | 8.65 | 8.65 | 9.24 | 7.11 | 7.70 | 8.89 | 10.07 | 10.52 | 10.43 | 8.89 | 10.07 ||| |DAPTOMYCIN 500 MG IV SOLR|1 each|36989| 911.05 |||||||||| 592.18 | 619.51 | 665.07 | 665.07 | 710.62 | 546.63 | 592.18 | 683.29 | 774.39 | 809.01 | 801.72 | 683.29 | 774.39 ||| |HYDROCHLOROTHIAZIDE 50 MG PO TABS|100 each|3721| 34.05 |||||||||| 22.13 | 23.15 | 24.86 | 24.86 | 26.56 | 20.43 | 22.13 | 25.54 | 28.94 | 30.24 | 29.96 | 25.54 | 28.94 ||| |HYDROCORTISONE 0.5 % EX CREA|28.35 g|3725| 39.10 |||||||||| 25.42 | 26.59 | 28.54 | 28.54 | 30.50 | 23.46 | 25.42 | 29.33 | 33.24 | 34.72 | 34.41 | 29.33 | 33.24 ||| |HYDROCORTISONE 1 % EX CREA|14.2 g|3726| 39.10 |||||||||| 25.42 | 26.59 | 28.54 | 28.54 | 30.50 | 23.46 | 25.42 | 29.33 | 33.24 | 34.72 | 34.41 | 29.33 | 33.24 ||| |HYDROCORTISONE 2.5 % EX CREA|28 g|3727| 41.20 |||||||||| 26.78 | 28.02 | 30.08 | 30.08 | 32.14 | 24.72 | 26.78 | 30.90 | 35.02 | 36.59 | 36.26 | 30.90 | 35.02 ||| |HYDROCORTISONE 2.5 % EX LOTN|59 mL|3729| 89.55 |||||||||| 58.21 | 60.89 | 65.37 | 65.37 | 69.85 | 53.73 | 58.21 | 67.16 | 76.12 | 79.52 | 78.80 | 67.16 | 76.12 ||| |HYDROCORTISONE 1 % EX OINT|28 g|3731| 38.00 |||||||||| 24.70 | 25.84 | 27.74 | 27.74 | 29.64 | 22.80 | 24.70 | 28.50 | 32.30 | 33.74 | 33.44 | 28.50 | 32.30 ||| |TADALAFIL 10 MG PO TABS|30 each|37401| 4,350.50 |||||||||| 2,827.83 | 2,958.34 | 3,175.87 | 3,175.87 | 3,393.39 | 2,610.30 | 2,827.83 | 3,262.88 | 3,697.93 | 3,863.24 | 3,828.44 | 3,262.88 | 3,697.93 ||| |CHOLESTYRAMINE LIGHT 4 G PO PACK|4 g (1 each)|37482| 15.30 |||||||||| 9.95 | 10.40 | 11.17 | 11.17 | 11.93 | 9.18 | 9.95 | 11.48 | 13.01 | 13.59 | 13.46 | 11.48 | 13.01 ||| |HYDROGEN PEROXIDE 3 % EX SOLN|237 mL|3752| 34.90 |||||||||| 22.69 | 23.73 | 25.48 | 25.48 | 27.22 | 20.94 | 22.69 | 26.18 | 29.67 | 30.99 | 30.71 | 26.18 | 29.67 ||| |BSS IO SOLN|500 mL|37579| 155.45 |||||||||| 101.04 | 105.71 | 113.48 | 113.48 | 121.25 | 93.27 | 101.04 | 116.59 | 132.13 | 138.04 | 136.80 | 116.59 | 132.13 ||| |HYDROMORPHONE HCL POWD|1 g|3762| 286.00 |||||||||| 185.90 | 194.48 | 208.78 | 208.78 | 223.08 | 171.60 | 185.90 | 214.50 | 243.10 | 253.97 | 251.68 | 214.50 | 243.10 ||| |SELENIUM SULFIDE 2.5 % EX LOTN|120 mL|37630| 52.75 |||||||||| 34.29 | 35.87 | 38.51 | 38.51 | 41.15 | 31.65 | 34.29 | 39.56 | 44.84 | 46.84 | 46.42 | 39.56 | 44.84 ||| |ESCITALOPRAM OXALATE 5 MG PO TABS|100 each|37635| 65.00 |||||||||| 42.25 | 44.20 | 47.45 | 47.45 | 50.70 | 39.00 | 42.25 | 48.75 | 55.25 | 57.72 | 57.20 | 48.75 | 55.25 ||| |METOPROLOL TARTRATE 25 MG PO TABS|500 each|37637| 69.75 |||||||||| 45.34 | 47.43 | 50.92 | 50.92 | 54.41 | 41.85 | 45.34 | 52.31 | 59.29 | 61.94 | 61.38 | 52.31 | 59.29 ||| |CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR|100 mL|37642| 125.00 |||||||||| 81.25 | 85.00 | 91.25 | 91.25 | 97.50 | 75.00 | 81.25 | 93.75 | 106.25 | 111.00 | 110.00 | 93.75 | 106.25 ||| |GUAIFENESIN ER 600 MG PO TB12|1,200 mg (2 each)|37651| 12.50 |||||||||| 8.13 | 8.50 | 9.13 | 9.13 | 9.75 | 7.50 | 8.13 | 9.38 | 10.63 | 11.10 | 11.00 | 9.38 | 10.63 ||| |GUAIFENESIN ER 600 MG PO TB12|600 mg (1 each)|37651| 11.75 |||||||||| 7.64 | 7.99 | 8.58 | 8.58 | 9.17 | 7.05 | 7.64 | 8.81 | 9.99 | 10.43 | 10.34 | 8.81 | 9.99 ||| |HYDROXYZINE HCL 25 MG/ML IM SOLN|1 mL|3769| 70.45 |||||||||| 45.79 | 47.91 | 51.43 | 51.43 | 54.95 | 42.27 | 45.79 | 52.84 | 59.88 | 62.56 | 62.00 | 52.84 | 59.88 ||| |HYDROXYZINE HCL 50 MG/ML IM SOLN|1 mL|3770| 74.25 |||||||||| 48.26 | 50.49 | 54.20 | 54.20 | 57.92 | 44.55 | 48.26 | 55.69 | 63.11 | 65.93 | 65.34 | 55.69 | 63.11 ||| |HYDROXYZINE HCL 10 MG PO TABS|100 each|3772| 78.10 |||||||||| 50.77 | 53.11 | 57.01 | 57.01 | 60.92 | 46.86 | 50.77 | 58.58 | 66.39 | 69.35 | 68.73 | 58.58 | 66.39 ||| |HYDROXYZINE PAMOATE 25 MG PO CAPS|500 each|3777| 98.85 |||||||||| 64.25 | 67.22 | 72.16 | 72.16 | 77.10 | 59.31 | 64.25 | 74.14 | 84.02 | 87.78 | 86.99 | 74.14 | 84.02 ||| |TALC 5 G PL SUSR|1 each|37812| 224.45 |||||||||| 145.89 | 152.63 | 163.85 | 163.85 | 175.07 | 134.67 | 145.89 | 168.34 | 190.78 | 199.31 | 197.52 | 168.34 | 190.78 ||| |HYOSCYAMINE SULFATE 0.125 MG/ML PO SOLN|15 mL|3782| 62.50 |||||||||| 40.63 | 42.50 | 45.63 | 45.63 | 48.75 | 37.50 | 40.63 | 46.88 | 53.13 | 55.50 | 55.00 | 46.88 | 53.13 ||| |HYOSCYAMINE SULFATE 0.125 MG PO TABS|125 mcg (1 each)|3783| 12.40 |||||||||| 8.06 | 8.43 | 9.05 | 9.05 | 9.67 | 7.44 | 8.06 | 9.30 | 10.54 | 11.01 | 10.91 | 9.30 | 10.54 ||| |HYOSCYAMINE SULFATE 0.125 MG PO TABS|250 mcg (2 each)|3783| 13.80 |||||||||| 8.97 | 9.38 | 10.07 | 10.07 | 10.76 | 8.28 | 8.97 | 10.35 | 11.73 | 12.25 | 12.14 | 10.35 | 11.73 ||| |HYOSCYAMINE SULFATE 0.125 MG PO TABS|375 mcg (3 each)|3783| 15.20 |||||||||| 9.88 | 10.34 | 11.10 | 11.10 | 11.86 | 9.12 | 9.88 | 11.40 | 12.92 | 13.50 | 13.38 | 11.40 | 12.92 ||| |HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN|5 mL|37848| 35.20 |||||||||| 22.88 | 23.94 | 25.70 | 25.70 | 27.46 | 21.12 | 22.88 | 26.40 | 29.92 | 31.26 | 30.98 | 26.40 | 29.92 ||| |PEMETREXED DISODIUM 500 MG IV SOLR|1 each|37894| 5,489.85 |||||||||| 3,568.40 | 3,733.10 | 4,007.59 | 4,007.59 | 4,282.08 | 3,293.91 | 3,568.40 | 4,117.39 | 4,666.37 | 4,874.99 | 4,831.07 | 4,117.39 | 4,666.37 ||| |CETUXIMAB 100 MG/50ML IV SOLN|50 mL|37989| 1,383.70 |||||||||| 899.41 | 940.92 | 1,010.10 | 1,010.10 | 1,079.29 | 830.22 | 899.41 | 1,037.78 | 1,176.15 | 1,228.73 | 1,217.66 | 1,037.78 | 1,176.15 ||| |HEPARIN LOCK FLUSH 10 UNIT/ML IV SOLN|5 mL|37994| 34.85 |||||||||| 22.65 | 23.70 | 25.44 | 25.44 | 27.18 | 20.91 | 22.65 | 26.14 | 29.62 | 30.95 | 30.67 | 26.14 | 29.62 ||| |FOLBEE PLUS PO TABS|1 tablet (1 each)|37998| 11.90 |||||||||| 7.74 | 8.09 | 8.69 | 8.69 | 9.28 | 7.14 | 7.74 | 8.93 | 10.12 | 10.57 | 10.47 | 8.93 | 10.12 ||| |MYCOPHENOLATE SODIUM 180 MG PO TBEC|120 each|38062| 1,444.25 |||||||||| 938.76 | 982.09 | 1,054.30 | 1,054.30 | 1,126.52 | 866.55 | 938.76 | 1,083.19 | 1,227.61 | 1,282.49 | 1,270.94 | 1,083.19 | 1,227.61 ||| |CINACALCET HCL 30 MG PO TABS|30 each|38100| 374.95 |||||||||| 243.72 | 254.97 | 273.71 | 273.71 | 292.46 | 224.97 | 243.72 | 281.21 | 318.71 | 332.96 | 329.96 | 281.21 | 318.71 ||| |LACTULOSE 10 GM/15ML PO SOLN|946 mL|38245| 51.50 |||||||||| 33.48 | 35.02 | 37.60 | 37.60 | 40.17 | 30.90 | 33.48 | 38.63 | 43.78 | 45.73 | 45.32 | 38.63 | 43.78 ||| |CYCLOPHOSPHAMIDE 1 G IJ SOLR|1 each|38270| 1,087.20 |||||||||| 706.68 | 739.30 | 793.66 | 793.66 | 848.02 | 652.32 | 706.68 | 815.40 | 924.12 | 965.43 | 956.74 | 815.40 | 924.12 ||| |CYCLOPHOSPHAMIDE 500 MG IJ SOLR|1 each|38271| 543.60 |||||||||| 353.34 | 369.65 | 396.83 | 396.83 | 424.01 | 326.16 | 353.34 | 407.70 | 462.06 | 482.72 | 478.37 | 407.70 | 462.06 ||| |CYCLOPHOSPHAMIDE 2 G IJ SOLR|1 each|38280| 2,174.40 |||||||||| 1,413.36 | 1,478.59 | 1,587.31 | 1,587.31 | 1,696.03 | 1,304.64 | 1,413.36 | 1,630.80 | 1,848.24 | 1,930.87 | 1,913.47 | 1,630.80 | 1,848.24 ||| |ACETYLCYSTEINE 200 MG/ML IV SOLN|30 mL|38303| 387.90 |||||||||| 252.14 | 263.77 | 283.17 | 283.17 | 302.56 | 232.74 | 252.14 | 290.93 | 329.72 | 344.46 | 341.35 | 290.93 | 329.72 ||| |TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS|5 each|38315| 209.20 |||||||||| 135.98 | 142.26 | 152.72 | 152.72 | 163.18 | 125.52 | 135.98 | 156.90 | 177.82 | 185.77 | 184.10 | 156.90 | 177.82 ||| |NELFINAVIR MESYLATE 625 MG PO TABS|120 each|38318| 2,542.35 |||||||||| 1,652.53 | 1,728.80 | 1,855.92 | 1,855.92 | 1,983.03 | 1,525.41 | 1,652.53 | 1,906.76 | 2,161.00 | 2,257.61 | 2,237.27 | 1,906.76 | 2,161.00 ||| |METHYLPHENIDATE HCL ER (LA) 10 MG PO CP24|100 each|38387| 1,728.10 |||||||||| 1,123.27 | 1,175.11 | 1,261.51 | 1,261.51 | 1,347.92 | 1,036.86 | 1,123.27 | 1,296.08 | 1,468.89 | 1,534.55 | 1,520.73 | 1,296.08 | 1,468.89 ||| |IBUPROFEN 800 MG PO TABS|500 each|3845| 189.15 |||||||||| 122.95 | 128.62 | 138.08 | 138.08 | 147.54 | 113.49 | 122.95 | 141.86 | 160.78 | 167.97 | 166.45 | 141.86 | 160.78 ||| |FLUOXETINE HCL 20 MG/5ML PO SOLN|120 mL|38488| 160.80 |||||||||| 104.52 | 109.34 | 117.38 | 117.38 | 125.42 | 96.48 | 104.52 | 120.60 | 136.68 | 142.79 | 141.50 | 120.60 | 136.68 ||| |ETHOSUXIMIDE 250 MG/5ML PO SOLN|473 mL|38489| 353.35 |||||||||| 229.68 | 240.28 | 257.95 | 257.95 | 275.61 | 212.01 | 229.68 | 265.01 | 300.35 | 313.77 | 310.95 | 265.01 | 300.35 ||| |OCTAGAM 5 GM/100ML IV SOLN|100 mL|38634| 1,774.10 |||||||||| 1,153.17 | 1,206.39 | 1,295.09 | 1,295.09 | 1,383.80 | 1,064.46 | 1,153.17 | 1,330.58 | 1,507.99 | 1,575.40 | 1,561.21 | 1,330.58 | 1,507.99 ||| |OCTAGAM 10 GM/200ML IV SOLN|200 mL|38635| 3,548.15 |||||||||| 2,306.30 | 2,412.74 | 2,590.15 | 2,590.15 | 2,767.56 | 2,128.89 | 2,306.30 | 2,661.11 | 3,015.93 | 3,150.76 | 3,122.37 | 2,661.11 | 3,015.93 ||| |ADENOSINE 6 MG/2ML IV SOLN|2 mL|38703| 54.65 |||||||||| 35.52 | 37.16 | 39.89 | 39.89 | 42.63 | 32.79 | 35.52 | 40.99 | 46.45 | 48.53 | 48.09 | 40.99 | 46.45 ||| |INDOMETHACIN 50 MG PO CAPS|100 each|3898| 76.60 |||||||||| 49.79 | 52.09 | 55.92 | 55.92 | 59.75 | 45.96 | 49.79 | 57.45 | 65.11 | 68.02 | 67.41 | 57.45 | 65.11 ||| |RIFAXIMIN 200 MG PO TABS|30 each|39063| 1,413.65 |||||||||| 918.87 | 961.28 | 1,031.96 | 1,031.96 | 1,102.65 | 848.19 | 918.87 | 1,060.24 | 1,201.60 | 1,255.32 | 1,244.01 | 1,060.24 | 1,201.60 ||| |AMILORIDE HCL 5 MG PO TABS|100 each|391| 68.30 |||||||||| 44.40 | 46.44 | 49.86 | 49.86 | 53.27 | 40.98 | 44.40 | 51.23 | 58.06 | 60.65 | 60.10 | 51.23 | 58.06 ||| |NITAZOXANIDE 500 MG PO TABS|30 each|39254| 8,406.95 |||||||||| 5,464.52 | 5,716.73 | 6,137.07 | 6,137.07 | 6,557.42 | 5,044.17 | 5,464.52 | 6,305.21 | 7,145.91 | 7,465.37 | 7,398.12 | 6,305.21 | 7,145.91 ||| |EMTRICITABINE-TENOFOVIR DF 200-300 MG PO TABS|1 tablet (1 each)|39255| 149.50 |||||||||| 97.18 | 101.66 | 109.14 | 109.14 | 116.61 | 89.70 | 97.18 | 112.13 | 127.08 | 132.76 | 131.56 | 112.13 | 127.08 ||| |PHENOL 89 % EX SWAB|30 each|39587| 290.85 |||||||||| 189.05 | 197.78 | 212.32 | 212.32 | 226.86 | 174.51 | 189.05 | 218.14 | 247.22 | 258.27 | 255.95 | 218.14 | 247.22 ||| |IODINE STRONG 5 % PO SOLN|473 mL|3961| 163.10 |||||||||| 106.02 | 110.91 | 119.06 | 119.06 | 127.22 | 97.86 | 106.02 | 122.33 | 138.64 | 144.83 | 143.53 | 122.33 | 138.64 ||| |ACAMPROSATE CALCIUM 333 MG PO TBEC|333 mg (1 each)|39720| 13.30 |||||||||| 8.65 | 9.04 | 9.71 | 9.71 | 10.37 | 7.98 | 8.65 | 9.98 | 11.31 | 11.81 | 11.70 | 9.98 | 11.31 ||| |ACAMPROSATE CALCIUM 333 MG PO TBEC|666 mg (2 each)|39720| 15.60 |||||||||| 10.14 | 10.61 | 11.39 | 11.39 | 12.17 | 9.36 | 10.14 | 11.70 | 13.26 | 13.85 | 13.73 | 11.70 | 13.26 ||| |FLUMAZENIL 1 MG/10ML IV SOLN|10 mL|39745| 151.50 |||||||||| 98.48 | 103.02 | 110.60 | 110.60 | 118.17 | 90.90 | 98.48 | 113.63 | 128.78 | 134.53 | 133.32 | 113.63 | 128.78 ||| |IRON DEXTRAN 50 MG/ML IJ SOLN|2 mL|3990| 89.00 |||||||||| 57.85 | 60.52 | 64.97 | 64.97 | 69.42 | 53.40 | 57.85 | 66.75 | 75.65 | 79.03 | 78.32 | 66.75 | 75.65 ||| |LEVOFLOXACIN 25 MG/ML PO SOLN|100 mL|39970| 253.90 |||||||||| 165.04 | 172.65 | 185.35 | 185.35 | 198.04 | 152.34 | 165.04 | 190.43 | 215.82 | 225.46 | 223.43 | 190.43 | 215.82 ||| |FIRST-MOUTHWASH BLM MT SUSP|237 mL|39986| 89.85 |||||||||| 58.40 | 61.10 | 65.59 | 65.59 | 70.08 | 53.91 | 58.40 | 67.39 | 76.37 | 79.79 | 79.07 | 67.39 | 76.37 ||| |SODIUM CHLORIDE 0.45 % IV BOLUS|1000 mL|400292| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |DEXTROSE 5 % IV BOLUS|1000 mL|400293| 198.00 |||||||||| 128.70 | 134.64 | 144.54 | 144.54 | 154.44 | 118.80 | 128.70 | 148.50 | 168.30 | 175.82 | 174.24 | 148.50 | 168.30 ||| |DEXTROSE 5 % AND 0.9 % NACL IV BOLUS|1000 mL|400294| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |DEXTROSE 5 % AND 0.45 % NACL IV BOLUS|1000 mL|400295| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |LACTATED RINGERS IV BOLUS|1000 mL|400296| 198.00 |||||||||| 128.70 | 134.64 | 144.54 | 144.54 | 154.44 | 118.80 | 128.70 | 148.50 | 168.30 | 175.82 | 174.24 | 148.50 | 168.30 ||| |DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS|1000 mL|400297| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |DEXTROSE 10 % IV BOLUS|250 mL|400302| 199.25 |||||||||| 129.51 | 135.49 | 145.45 | 145.45 | 155.42 | 119.55 | 129.51 | 149.44 | 169.36 | 176.93 | 175.34 | 149.44 | 169.36 ||| |NATALIZUMAB 300 MG/15ML IV CONC|15 mL|40120| 14,722.35 |||||||||| 9,569.53 | 10,011.20 | 10,747.32 | 10,747.32 | 11,483.43 | 8,833.41 | 9,569.53 | 11,041.76 | 12,514.00 | 13,073.45 | 12,955.67 | 11,041.76 | 12,514.00 ||| |ISONIAZID 100 MG PO TABS|100 each|4026| 46.50 |||||||||| 30.23 | 31.62 | 33.95 | 33.95 | 36.27 | 27.90 | 30.23 | 34.88 | 39.53 | 41.29 | 40.92 | 34.88 | 39.53 ||| |ESZOPICLONE 1 MG PO TABS|100 each|40320| 125.80 |||||||||| 81.77 | 85.54 | 91.83 | 91.83 | 98.12 | 75.48 | 81.77 | 94.35 | 106.93 | 111.71 | 110.70 | 94.35 | 106.93 ||| |SOLIFENACIN SUCCINATE 5 MG PO TABS|90 each|40392| 2,422.90 |||||||||| 1,574.89 | 1,647.57 | 1,768.72 | 1,768.72 | 1,889.86 | 1,453.74 | 1,574.89 | 1,817.18 | 2,059.47 | 2,151.54 | 2,132.15 | 1,817.18 | 2,059.47 ||| |CLOFARABINE 1 MG/ML IV SOLN|20 mL|40404| 6,421.60 |||||||||| 4,174.04 | 4,366.69 | 4,687.77 | 4,687.77 | 5,008.85 | 3,852.96 | 4,174.04 | 4,816.20 | 5,458.36 | 5,702.38 | 5,651.01 | 4,816.20 | 5,458.36 ||| |ARIPIPRAZOLE 1 MG/ML PO SOLN|150 mL|40446| 655.10 |||||||||| 425.82 | 445.47 | 478.22 | 478.22 | 510.98 | 393.06 | 425.82 | 491.33 | 556.84 | 581.73 | 576.49 | 491.33 | 556.84 ||| |HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN|1.2 mL|40449| 228.65 |||||||||| 148.62 | 155.48 | 166.91 | 166.91 | 178.35 | 137.19 | 148.62 | 171.49 | 194.35 | 203.04 | 201.21 | 171.49 | 194.35 ||| |SENNA 176 MG/5ML PO SYRP|237 mL|40470| 46.65 |||||||||| 30.32 | 31.72 | 34.05 | 34.05 | 36.39 | 27.99 | 30.32 | 34.99 | 39.65 | 41.43 | 41.05 | 34.99 | 39.65 ||| |PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR|1 each|40475| 2,147.55 |||||||||| 1,395.91 | 1,460.33 | 1,567.71 | 1,567.71 | 1,675.09 | 1,288.53 | 1,395.91 | 1,610.66 | 1,825.42 | 1,907.02 | 1,889.84 | 1,610.66 | 1,825.42 ||| |PEGAPTANIB SODIUM 0.3 MG IO SOLN|.09 mL|40575| 1,522.50 |||||||||| 989.63 | 1,035.30 | 1,111.43 | 1,111.43 | 1,187.55 | 913.50 | 989.63 | 1,141.88 | 1,294.13 | 1,351.98 | 1,339.80 | 1,141.88 | 1,294.13 ||| |ALEMTUZUMAB 30 MG/ML IV SOLN|1 mL|40661| 2,619.65 |||||||||| 1,702.77 | 1,781.36 | 1,912.34 | 1,912.34 | 2,043.33 | 1,571.79 | 1,702.77 | 1,964.74 | 2,226.70 | 2,326.25 | 2,305.29 | 1,964.74 | 2,226.70 ||| |FLUTICASONE PROPIONATE HFA 44 MCG/ACT IN AERO|10.6 g|40697| 396.95 |||||||||| 258.02 | 269.93 | 289.77 | 289.77 | 309.62 | 238.17 | 258.02 | 297.71 | 337.41 | 352.49 | 349.32 | 297.71 | 337.41 ||| |FLUTICASONE PROPIONATE HFA 110 MCG/ACT IN AERO|12 g|40698| 519.85 |||||||||| 337.90 | 353.50 | 379.49 | 379.49 | 405.48 | 311.91 | 337.90 | 389.89 | 441.87 | 461.63 | 457.47 | 389.89 | 441.87 ||| |FLUTICASONE PROPIONATE HFA 220 MCG/ACT IN AERO|12 g|40699| 788.65 |||||||||| 512.62 | 536.28 | 575.71 | 575.71 | 615.15 | 473.19 | 512.62 | 591.49 | 670.35 | 700.32 | 694.01 | 591.49 | 670.35 ||| |LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT|1 each|40801| 5,626.25 |||||||||| 3,657.06 | 3,825.85 | 4,107.16 | 4,107.16 | 4,388.48 | 3,375.75 | 3,657.06 | 4,219.69 | 4,782.31 | 4,996.11 | 4,951.10 | 4,219.69 | 4,782.31 ||| |FLUCONAZOLE IV SYRINGE (NICU)|100 mL|40840032| 143.80 |||||||||| 93.47 | 97.78 | 104.97 | 104.97 | 112.16 | 86.28 | 93.47 | 107.85 | 122.23 | 127.69 | 126.54 | 107.85 | 122.23 ||| |METRONIDAZOLE IV SYRINGE (PEDS)|100 mL|40840043| 138.40 |||||||||| 89.96 | 94.11 | 101.03 | 101.03 | 107.95 | 83.04 | 89.96 | 103.80 | 117.64 | 122.90 | 121.79 | 103.80 | 117.64 ||| |PRISMASATE BGK 2/0 DIALYSIS SOLUTION|5000 mL|40840046| 252.75 |||||||||| 164.29 | 171.87 | 184.51 | 184.51 | 197.15 | 151.65 | 164.29 | 189.56 | 214.84 | 224.44 | 222.42 | 189.56 | 214.84 ||| |MIDAZOLAM HCL 2 MG/2ML IJ SOLN|2 mL|40872| 47.60 |||||||||| 30.94 | 32.37 | 34.75 | 34.75 | 37.13 | 28.56 | 30.94 | 35.70 | 40.46 | 42.27 | 41.89 | 35.70 | 40.46 ||| |GLYCERIN (LAXATIVE) 2 G RE SUPP|2 suppository (2 each)|41003| 13.70 |||||||||| 8.91 | 9.32 | 10.00 | 10.00 | 10.69 | 8.22 | 8.91 | 10.28 | 11.65 | 12.17 | 12.06 | 10.28 | 11.65 ||| |GLYCERIN (LAXATIVE) 2 G RE SUPP|1 suppository (1 each)|41003| 12.35 |||||||||| 8.03 | 8.40 | 9.02 | 9.02 | 9.63 | 7.41 | 8.03 | 9.26 | 10.50 | 10.97 | 10.87 | 9.26 | 10.50 ||| |IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS|12.9 g|41142| 808.40 |||||||||| 525.46 | 549.71 | 590.13 | 590.13 | 630.55 | 485.04 | 525.46 | 606.30 | 687.14 | 717.86 | 711.39 | 606.30 | 687.14 ||| |MICAFUNGIN SODIUM 50 MG IV SOLR|100 mg (2 each)|41144| 457.85 |||||||||| 297.60 | 311.34 | 334.23 | 334.23 | 357.12 | 274.71 | 297.60 | 343.39 | 389.17 | 406.57 | 402.91 | 343.39 | 389.17 ||| |MICAFUNGIN SODIUM 50 MG IV SOLR|50 mg (1 each)|41144| 293.95 |||||||||| 191.07 | 199.89 | 214.58 | 214.58 | 229.28 | 176.37 | 191.07 | 220.46 | 249.86 | 261.03 | 258.68 | 220.46 | 249.86 ||| |ENTECAVIR 0.5 MG PO TABS|30 each|41147| 2,164.15 |||||||||| 1,406.70 | 1,471.62 | 1,579.83 | 1,579.83 | 1,688.04 | 1,298.49 | 1,406.70 | 1,623.11 | 1,839.53 | 1,921.77 | 1,904.45 | 1,623.11 | 1,839.53 ||| |ESOMEPRAZOLE SODIUM 40 MG IV SOLR|20 mg (0.5 each)|41174| 160.60 |||||||||| 104.39 | 109.21 | 117.24 | 117.24 | 125.27 | 96.36 | 104.39 | 120.45 | 136.51 | 142.61 | 141.33 | 120.45 | 136.51 ||| |ESOMEPRAZOLE SODIUM 40 MG IV SOLR|40 mg (1 each)|41174| 191.20 |||||||||| 124.28 | 130.02 | 139.58 | 139.58 | 149.14 | 114.72 | 124.28 | 143.40 | 162.52 | 169.79 | 168.26 | 143.40 | 162.52 ||| |ORA-BLEND PO SUSP|473 mL|41227| 45.65 |||||||||| 29.67 | 31.04 | 33.32 | 33.32 | 35.61 | 27.39 | 29.67 | 34.24 | 38.80 | 40.54 | 40.17 | 34.24 | 38.80 ||| |GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % OP SOLN|15 mL|41412| 36.65 |||||||||| 23.82 | 24.92 | 26.75 | 26.75 | 28.59 | 21.99 | 23.82 | 27.49 | 31.15 | 32.55 | 32.25 | 27.49 | 31.15 ||| |LEVOCARNITINE 1 GM/10ML PO SOLN|118 mL|41623| 98.95 |||||||||| 64.32 | 67.29 | 72.23 | 72.23 | 77.18 | 59.37 | 64.32 | 74.21 | 84.11 | 87.87 | 87.08 | 74.21 | 84.11 ||| |VINORELBINE TARTRATE 50 MG/5ML IV SOLN|5 mL|41673| 65.10 |||||||||| 42.32 | 44.27 | 47.52 | 47.52 | 50.78 | 39.06 | 42.32 | 48.83 | 55.34 | 57.81 | 57.29 | 48.83 | 55.34 ||| |PALIVIZUMAB 100 MG/ML IM SOLN|1 mL|41675| 6,103.30 |||||||||| 3,967.15 | 4,150.24 | 4,455.41 | 4,455.41 | 4,760.57 | 3,661.98 | 3,967.15 | 4,577.48 | 5,187.81 | 5,419.73 | 5,370.90 | 4,577.48 | 5,187.81 ||| |GAMMAGARD 5 GM/50ML IJ SOLN|50 mL|41778| 1,466.75 |||||||||| 953.39 | 997.39 | 1,070.73 | 1,070.73 | 1,144.07 | 880.05 | 953.39 | 1,100.06 | 1,246.74 | 1,302.47 | 1,290.74 | 1,100.06 | 1,246.74 ||| |GAMMAGARD 10 GM/100ML IJ SOLN|100 mL|41779| 2,933.45 |||||||||| 1,906.74 | 1,994.75 | 2,141.42 | 2,141.42 | 2,288.09 | 1,760.07 | 1,906.74 | 2,200.09 | 2,493.43 | 2,604.90 | 2,581.44 | 2,200.09 | 2,493.43 ||| |GAMMAGARD 20 GM/200ML IJ SOLN|200 mL|41780| 5,866.85 |||||||||| 3,813.45 | 3,989.46 | 4,282.80 | 4,282.80 | 4,576.14 | 3,520.11 | 3,813.45 | 4,400.14 | 4,986.82 | 5,209.76 | 5,162.83 | 4,400.14 | 4,986.82 ||| |SODIUM TETRADECYL SULFATE 3 % IV SOLN|2 mL|41793| 181.10 |||||||||| 117.72 | 123.15 | 132.20 | 132.20 | 141.26 | 108.66 | 117.72 | 135.83 | 153.94 | 160.82 | 159.37 | 135.83 | 153.94 ||| |AMINOSYN II 10 % IV SOLN|2000 mL|418| 318.00 |||||||||| 206.70 | 216.24 | 232.14 | 232.14 | 248.04 | 190.80 | 206.70 | 238.50 | 270.30 | 282.38 | 279.84 | 238.50 | 270.30 ||| |AMINOSYN II 15 % IV SOLN|2000 mL|419| 328.00 |||||||||| 213.20 | 223.04 | 239.44 | 239.44 | 255.84 | 196.80 | 213.20 | 246.00 | 278.80 | 291.26 | 288.64 | 246.00 | 278.80 ||| |RAMELTEON 8 MG PO TABS|8 mg (1 each)|42064| 48.95 |||||||||| 31.82 | 33.29 | 35.73 | 35.73 | 38.18 | 29.37 | 31.82 | 36.71 | 41.61 | 43.47 | 43.08 | 36.71 | 41.61 ||| |AMINOSYN II 8.5 % IV SOLN|500 mL|421| 298.50 |||||||||| 194.03 | 202.98 | 217.91 | 217.91 | 232.83 | 179.10 | 194.03 | 223.88 | 253.73 | 265.07 | 262.68 | 223.88 | 253.73 ||| |DICYCLOMINE HCL 10 MG/5ML PO SOLN|473 mL|42119| 257.70 |||||||||| 167.51 | 175.24 | 188.12 | 188.12 | 201.01 | 154.62 | 167.51 | 193.28 | 219.05 | 228.84 | 226.78 | 193.28 | 219.05 ||| |KETAMINE HCL 10 MG/ML IJ SOLN|20 mL|4236| 70.35 |||||||||| 45.73 | 47.84 | 51.36 | 51.36 | 54.87 | 42.21 | 45.73 | 52.76 | 59.80 | 62.47 | 61.91 | 52.76 | 59.80 ||| |KETAMINE HCL 100 MG/ML IJ SOLN|5 mL|4237| 49.45 |||||||||| 32.14 | 33.63 | 36.10 | 36.10 | 38.57 | 29.67 | 32.14 | 37.09 | 42.03 | 43.91 | 43.52 | 37.09 | 42.03 ||| |LANOLIN EX OINT|9 g|4346| 38.00 |||||||||| 24.70 | 25.84 | 27.74 | 27.74 | 29.64 | 22.80 | 24.70 | 28.50 | 32.30 | 33.74 | 33.44 | 28.50 | 32.30 ||| |LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO|15 g|43472| 162.45 |||||||||| 105.59 | 110.47 | 118.59 | 118.59 | 126.71 | 97.47 | 105.59 | 121.84 | 138.08 | 144.26 | 142.96 | 121.84 | 138.08 ||| |AMITRIPTYLINE HCL 25 MG PO TABS|1 each|435| 11.90 |||||||||| 7.74 | 8.09 | 8.69 | 8.69 | 9.28 | 7.14 | 7.74 | 8.93 | 10.12 | 10.57 | 10.47 | 8.93 | 10.12 ||| |DIGOXIN 0.05 MG/ML PO SOLN|60 mL|43556| 312.60 |||||||||| 203.19 | 212.57 | 228.20 | 228.20 | 243.83 | 187.56 | 203.19 | 234.45 | 265.71 | 277.59 | 275.09 | 234.45 | 265.71 ||| |AMMONIA AROMATIC IN INHA|1 each|439| 34.85 |||||||||| 22.65 | 23.70 | 25.44 | 25.44 | 27.18 | 20.91 | 22.65 | 26.14 | 29.62 | 30.95 | 30.67 | 26.14 | 29.62 ||| |LEUCOVORIN CALCIUM 25 MG PO TABS|25 each|4397| 486.05 |||||||||| 315.93 | 330.51 | 354.82 | 354.82 | 379.12 | 291.63 | 315.93 | 364.54 | 413.14 | 431.61 | 427.72 | 364.54 | 413.14 ||| |LEUCOVORIN CALCIUM 5 MG PO TABS|30 each|4398| 91.60 |||||||||| 59.54 | 62.29 | 66.87 | 66.87 | 71.45 | 54.96 | 59.54 | 68.70 | 77.86 | 81.34 | 80.61 | 68.70 | 77.86 ||| |LEVOTHYROXINE SODIUM 100 MCG PO TABS|1 each|4423| 12.20 |||||||||| 7.93 | 8.30 | 8.91 | 8.91 | 9.52 | 7.32 | 7.93 | 9.15 | 10.37 | 10.83 | 10.74 | 9.15 | 10.37 ||| |LEVOTHYROXINE SODIUM 150 MCG PO TABS|90 each|4425| 264.75 |||||||||| 172.09 | 180.03 | 193.27 | 193.27 | 206.51 | 158.85 | 172.09 | 198.56 | 225.04 | 235.10 | 232.98 | 198.56 | 225.04 ||| |LEVOTHYROXINE SODIUM 200 MCG PO TABS|100 each|4426| 161.75 |||||||||| 105.14 | 109.99 | 118.08 | 118.08 | 126.17 | 97.05 | 105.14 | 121.31 | 137.49 | 143.63 | 142.34 | 121.31 | 137.49 ||| |LIDOCAINE HCL 4 % EX SOLN|50 mL|4450| 109.30 |||||||||| 71.05 | 74.32 | 79.79 | 79.79 | 85.25 | 65.58 | 71.05 | 81.98 | 92.91 | 97.06 | 96.18 | 81.98 | 92.91 ||| |LIDOCAINE HCL 0.5 % IJ SOLN|50 mL|4451| 41.85 |||||||||| 27.20 | 28.46 | 30.55 | 30.55 | 32.64 | 25.11 | 27.20 | 31.39 | 35.57 | 37.16 | 36.83 | 31.39 | 35.57 ||| |AMOXICILLIN 250 MG PO CAPS|100 each|450| 46.75 |||||||||| 30.39 | 31.79 | 34.13 | 34.13 | 36.47 | 28.05 | 30.39 | 35.06 | 39.74 | 41.51 | 41.14 | 35.06 | 39.74 ||| |LITHIUM CARBONATE 300 MG PO CAPS|100 each|4529| 56.90 |||||||||| 36.99 | 38.69 | 41.54 | 41.54 | 44.38 | 34.14 | 36.99 | 42.68 | 48.37 | 50.53 | 50.07 | 42.68 | 48.37 ||| |LOPERAMIDE HCL 1 MG/5ML PO LIQD|118 mL|4561| 15.70 |||||||||| 10.21 | 10.68 | 11.46 | 11.46 | 12.25 | 9.42 | 10.21 | 11.78 | 13.35 | 13.94 | 13.82 | 11.78 | 13.35 ||| |MAGNESIUM CHLORIDE 200 MG/ML IJ SOLN|50 mL|4709| 62.80 |||||||||| 40.82 | 42.70 | 45.84 | 45.84 | 48.98 | 37.68 | 40.82 | 47.10 | 53.38 | 55.77 | 55.26 | 47.10 | 53.38 ||| |MANNITOL 20 % IV SOLN|250 mL|4749| 237.75 |||||||||| 154.54 | 161.67 | 173.56 | 173.56 | 185.45 | 142.65 | 154.54 | 178.31 | 202.09 | 211.12 | 209.22 | 178.31 | 202.09 ||| |MEDROXYPROGESTERONE ACETATE 10 MG PO TABS|100 each|4854| 77.05 |||||||||| 50.08 | 52.39 | 56.25 | 56.25 | 60.10 | 46.23 | 50.08 | 57.79 | 65.49 | 68.42 | 67.80 | 57.79 | 65.49 ||| |MEGESTROL ACETATE 20 MG PO TABS|100 each|4870| 100.10 |||||||||| 65.07 | 68.07 | 73.07 | 73.07 | 78.08 | 60.06 | 65.07 | 75.08 | 85.09 | 88.89 | 88.09 | 75.08 | 85.09 ||| |METHADONE HCL 5 MG/5ML PO SOLN|5 mL|4952| 22.60 |||||||||| 14.69 | 15.37 | 16.50 | 16.50 | 17.63 | 13.56 | 14.69 | 16.95 | 19.21 | 20.07 | 19.89 | 16.95 | 19.21 ||| |METHAZOLAMIDE 25 MG PO TABS|100 each|4961| 658.30 |||||||||| 427.90 | 447.64 | 480.56 | 480.56 | 513.47 | 394.98 | 427.90 | 493.73 | 559.56 | 584.57 | 579.30 | 493.73 | 559.56 ||| |METHOCARBAMOL 500 MG PO TABS|100 each|4971| 33.20 |||||||||| 21.58 | 22.58 | 24.24 | 24.24 | 25.90 | 19.92 | 21.58 | 24.90 | 28.22 | 29.48 | 29.22 | 24.90 | 28.22 ||| |METHOTREXATE 2.5 MG PO TABS|100 each|4973| 654.60 |||||||||| 425.49 | 445.13 | 477.86 | 477.86 | 510.59 | 392.76 | 425.49 | 490.95 | 556.41 | 581.28 | 576.05 | 490.95 | 556.41 ||| |METHOTREXATE SODIUM 1 G IJ SOLR|1 each|4975| 94.40 |||||||||| 61.36 | 64.19 | 68.91 | 68.91 | 73.63 | 56.64 | 61.36 | 70.80 | 80.24 | 83.83 | 83.07 | 70.80 | 80.24 ||| |METHYCLOTHIAZIDE 5 MG PO TABS|10 mg (2 each)|4978| 23.15 |||||||||| 15.05 | 15.74 | 16.90 | 16.90 | 18.06 | 13.89 | 15.05 | 17.36 | 19.68 | 20.56 | 20.37 | 17.36 | 19.68 ||| |METHYCLOTHIAZIDE 5 MG PO TABS|2.5 mg (0.5 each)|4978| 12.55 |||||||||| 8.16 | 8.53 | 9.16 | 9.16 | 9.79 | 7.53 | 8.16 | 9.41 | 10.67 | 11.14 | 11.04 | 9.41 | 10.67 ||| |METHYCLOTHIAZIDE 5 MG PO TABS|5 mg (1 each)|4978| 14.10 |||||||||| 9.17 | 9.59 | 10.29 | 10.29 | 11.00 | 8.46 | 9.17 | 10.58 | 11.99 | 12.52 | 12.41 | 10.58 | 11.99 ||| |METHYLDOPA 250 MG PO TABS|100 each|4982| 59.40 |||||||||| 38.61 | 40.39 | 43.36 | 43.36 | 46.33 | 35.64 | 38.61 | 44.55 | 50.49 | 52.75 | 52.27 | 44.55 | 50.49 ||| |METHYLDOPA 500 MG PO TABS|100 each|4983| 84.10 |||||||||| 54.67 | 57.19 | 61.39 | 61.39 | 65.60 | 50.46 | 54.67 | 63.08 | 71.49 | 74.68 | 74.01 | 63.08 | 71.49 ||| |METHYLENE BLUE 1 % IJ SOLN|10 mL|4985| 370.90 |||||||||| 241.09 | 252.21 | 270.76 | 270.76 | 289.30 | 222.54 | 241.09 | 278.18 | 315.27 | 329.36 | 326.39 | 278.18 | 315.27 ||| |METHYLPREDNISOLONE 4 MG PO TABS|100 each|4993| 107.55 |||||||||| 69.91 | 73.13 | 78.51 | 78.51 | 83.89 | 64.53 | 69.91 | 80.66 | 91.42 | 95.50 | 94.64 | 80.66 | 91.42 ||| |METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP|1 mL|4995| 53.90 |||||||||| 35.04 | 36.65 | 39.35 | 39.35 | 42.04 | 32.34 | 35.04 | 40.43 | 45.82 | 47.86 | 47.43 | 40.43 | 45.82 ||| |METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP|1 mL|4996| 68.55 |||||||||| 44.56 | 46.61 | 50.04 | 50.04 | 53.47 | 41.13 | 44.56 | 51.41 | 58.27 | 60.87 | 60.32 | 51.41 | 58.27 ||| |METOCLOPRAMIDE HCL 10 MG PO TABS|100 each|5005| 32.20 |||||||||| 20.93 | 21.90 | 23.51 | 23.51 | 25.12 | 19.32 | 20.93 | 24.15 | 27.37 | 28.59 | 28.34 | 24.15 | 27.37 ||| |MICONAZOLE NITRATE 2 % EX CREA|42.5 g|5039| 40.50 |||||||||| 26.33 | 27.54 | 29.57 | 29.57 | 31.59 | 24.30 | 26.33 | 30.38 | 34.43 | 35.96 | 35.64 | 30.38 | 34.43 ||| |MINERAL OIL PO OIL|473 mL|5086| 23.90 |||||||||| 15.54 | 16.25 | 17.45 | 17.45 | 18.64 | 14.34 | 15.54 | 17.93 | 20.32 | 21.22 | 21.03 | 17.93 | 20.32 ||| |MINERAL OIL RE ENEM|133 mL|5087| 14.60 |||||||||| 9.49 | 9.93 | 10.66 | 10.66 | 11.39 | 8.76 | 9.49 | 10.95 | 12.41 | 12.96 | 12.85 | 10.95 | 12.41 ||| |MINOXIDIL 10 MG PO TABS|100 each|5114| 117.50 |||||||||| 76.38 | 79.90 | 85.78 | 85.78 | 91.65 | 70.50 | 76.38 | 88.13 | 99.88 | 104.34 | 103.40 | 88.13 | 99.88 ||| |MINOXIDIL 2.5 MG PO TABS|100 each|5115| 65.60 |||||||||| 42.64 | 44.61 | 47.89 | 47.89 | 51.17 | 39.36 | 42.64 | 49.20 | 55.76 | 58.25 | 57.73 | 49.20 | 55.76 ||| |MORPHINE SULFATE 10 MG/ML IJ SOLN|1 mL|5168| 50.80 |||||||||| 33.02 | 34.54 | 37.08 | 37.08 | 39.62 | 30.48 | 33.02 | 38.10 | 43.18 | 45.11 | 44.70 | 38.10 | 43.18 ||| |MORPHINE SULFATE 15 MG/ML IJ SOLN|1 mL|5169| 47.90 |||||||||| 31.14 | 32.57 | 34.97 | 34.97 | 37.36 | 28.74 | 31.14 | 35.93 | 40.72 | 42.54 | 42.15 | 35.93 | 40.72 ||| |MORPHINE SULFATE 10 MG/5ML PO SOLN|5 mL|5176| 22.85 |||||||||| 14.85 | 15.54 | 16.68 | 16.68 | 17.82 | 13.71 | 14.85 | 17.14 | 19.42 | 20.29 | 20.11 | 17.14 | 19.42 ||| |MORPHINE SULFATE 30 MG PO TABS|100 each|5179| 154.05 |||||||||| 100.13 | 104.75 | 112.46 | 112.46 | 120.16 | 92.43 | 100.13 | 115.54 | 130.94 | 136.80 | 135.56 | 115.54 | 130.94 ||| |MORPHINE SULFATE POWD|5 g|5184| 95.20 |||||||||| 61.88 | 64.74 | 69.50 | 69.50 | 74.26 | 57.12 | 61.88 | 71.40 | 80.92 | 84.54 | 83.78 | 71.40 | 80.92 ||| |NALBUPHINE HCL 10 MG/ML IJ SOLN|10 mL|5339| 100.15 |||||||||| 65.10 | 68.10 | 73.11 | 73.11 | 78.12 | 60.09 | 65.10 | 75.11 | 85.13 | 88.93 | 88.13 | 75.11 | 85.13 ||| |NALBUPHINE HCL 20 MG/ML IJ SOLN|10 mL|5340| 132.25 |||||||||| 85.96 | 89.93 | 96.54 | 96.54 | 103.16 | 79.35 | 85.96 | 99.19 | 112.41 | 117.44 | 116.38 | 99.19 | 112.41 ||| |NAPROXEN 375 MG PO TABS|100 each|5392| 43.40 |||||||||| 28.21 | 29.51 | 31.68 | 31.68 | 33.85 | 26.04 | 28.21 | 32.55 | 36.89 | 38.54 | 38.19 | 32.55 | 36.89 ||| |NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN|10 mL|5474| 130.10 |||||||||| 84.57 | 88.47 | 94.97 | 94.97 | 101.48 | 78.06 | 84.57 | 97.58 | 110.59 | 115.53 | 114.49 | 97.58 | 110.59 ||| |NEOSTIGMINE METHYLSULFATE 0.5 MG/ML IJ SOLN|10 mL|5489| 59.30 |||||||||| 38.55 | 40.32 | 43.29 | 43.29 | 46.25 | 35.58 | 38.55 | 44.48 | 50.41 | 52.66 | 52.18 | 44.48 | 50.41 ||| |NEOSTIGMINE METHYLSULFATE 1 MG/ML IJ SOLN|10 mL|5490| 60.75 |||||||||| 39.49 | 41.31 | 44.35 | 44.35 | 47.39 | 36.45 | 39.49 | 45.56 | 51.64 | 53.95 | 53.46 | 45.56 | 51.64 ||| |NEW SKIN EX LIQD|30 mL|5534| 40.70 |||||||||| 26.46 | 27.68 | 29.71 | 29.71 | 31.75 | 24.42 | 26.46 | 30.53 | 34.60 | 36.14 | 35.82 | 30.53 | 34.60 ||| |NIACIN 500 MG PO TABS|100 each|5542| 15.60 |||||||||| 10.14 | 10.61 | 11.39 | 11.39 | 12.17 | 9.36 | 10.14 | 11.70 | 13.26 | 13.85 | 13.73 | 11.70 | 13.26 ||| |NITROGLYCERIN 5 MG/ML IV SOLN|10 mL|5599| 155.05 |||||||||| 100.78 | 105.43 | 113.19 | 113.19 | 120.94 | 93.03 | 100.78 | 116.29 | 131.79 | 137.68 | 136.44 | 116.29 | 131.79 ||| |NITROGLYCERIN ER 2.5 MG PO CPCR|100 each|5600| 83.70 |||||||||| 54.41 | 56.92 | 61.10 | 61.10 | 65.29 | 50.22 | 54.41 | 62.78 | 71.15 | 74.33 | 73.66 | 62.78 | 71.15 ||| |NITROGLYCERIN ER 9 MG PO CPCR|60 each|5602| 81.80 |||||||||| 53.17 | 55.62 | 59.71 | 59.71 | 63.80 | 49.08 | 53.17 | 61.35 | 69.53 | 72.64 | 71.98 | 61.35 | 69.53 ||| |NITROGLYCERIN 2 % TD OINT|1 g|5606| 38.15 |||||||||| 24.80 | 25.94 | 27.85 | 27.85 | 29.76 | 22.89 | 24.80 | 28.61 | 32.43 | 33.88 | 33.57 | 28.61 | 32.43 ||| |NORMOSOL-R IV SOLN|1000 mL|5660| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |NYSTATIN 500000 UNITS PO TABS|1,000,000 Units (2 each)|5752| 15.40 |||||||||| 10.01 | 10.47 | 11.24 | 11.24 | 12.01 | 9.24 | 10.01 | 11.55 | 13.09 | 13.68 | 13.55 | 11.55 | 13.09 ||| |NYSTATIN 500000 UNITS PO TABS|500,000 Units (1 each)|5752| 13.20 |||||||||| 8.58 | 8.98 | 9.64 | 9.64 | 10.30 | 7.92 | 8.58 | 9.90 | 11.22 | 11.72 | 11.62 | 9.90 | 11.22 ||| |ORA-PLUS PO LIQD|473 mL|5851| 58.35 |||||||||| 37.93 | 39.68 | 42.60 | 42.60 | 45.51 | 35.01 | 37.93 | 43.76 | 49.60 | 51.81 | 51.35 | 43.76 | 49.60 ||| |ORA-SWEET SF PO SYRP|473 mL|5853| 45.65 |||||||||| 29.67 | 31.04 | 33.32 | 33.32 | 35.61 | 27.39 | 29.67 | 34.24 | 38.80 | 40.54 | 40.17 | 34.24 | 38.80 ||| |OXAZEPAM 10 MG PO CAPS|100 each|5930| 221.30 |||||||||| 143.85 | 150.48 | 161.55 | 161.55 | 172.61 | 132.78 | 143.85 | 165.98 | 188.11 | 196.51 | 194.74 | 165.98 | 188.11 ||| |OYSTER SHELL 500 MG PO TABS|1000 each|5953| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |PAPAVERINE HCL 30 MG/ML IJ SOLN|2 mL|6030| 111.95 |||||||||| 72.77 | 76.13 | 81.72 | 81.72 | 87.32 | 67.17 | 72.77 | 83.96 | 95.16 | 99.41 | 98.52 | 83.96 | 95.16 ||| |PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR|5 Million Units (1 each)|6086| 48.30 |||||||||| 31.40 | 32.84 | 35.26 | 35.26 | 37.67 | 28.98 | 31.40 | 36.23 | 41.06 | 42.89 | 42.50 | 36.23 | 41.06 ||| |PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR|200 mL|6091| 46.50 |||||||||| 30.23 | 31.62 | 33.95 | 33.95 | 36.27 | 27.90 | 30.23 | 34.88 | 39.53 | 41.29 | 40.92 | 34.88 | 39.53 ||| |AQUAPHOR EX OINT|50 g|612| 40.60 |||||||||| 26.39 | 27.61 | 29.64 | 29.64 | 31.67 | 24.36 | 26.39 | 30.45 | 34.51 | 36.05 | 35.73 | 30.45 | 34.51 ||| |PHENOBARBITAL 20 MG/5ML PO ELIX|473 mL|6212| 170.30 |||||||||| 110.70 | 115.80 | 124.32 | 124.32 | 132.83 | 102.18 | 110.70 | 127.73 | 144.76 | 151.23 | 149.86 | 127.73 | 144.76 ||| |PHENOBARBITAL 16.2 MG PO TABS|100 each|6215| 110.90 |||||||||| 72.09 | 75.41 | 80.96 | 80.96 | 86.50 | 66.54 | 72.09 | 83.18 | 94.27 | 98.48 | 97.59 | 83.18 | 94.27 ||| |PHENOBARBITAL 30 MG PO TABS|100 mg (3.333333333333333333 each)|6216| 13.45 |||||||||| 8.74 | 9.15 | 9.82 | 9.82 | 10.49 | 8.07 | 8.74 | 10.09 | 11.43 | 11.94 | 11.84 | 10.09 | 11.43 ||| |PHENOBARBITAL 30 MG PO TABS|15 mg (0.5 each)|6216| 11.40 |||||||||| 7.41 | 7.75 | 8.32 | 8.32 | 8.89 | 6.84 | 7.41 | 8.55 | 9.69 | 10.12 | 10.03 | 8.55 | 9.69 ||| |PHENOBARBITAL 30 MG PO TABS|30 mg (1 each)|6216| 11.75 |||||||||| 7.64 | 7.99 | 8.58 | 8.58 | 9.17 | 7.05 | 7.64 | 8.81 | 9.99 | 10.43 | 10.34 | 8.81 | 9.99 ||| |PHENOBARBITAL 30 MG PO TABS|60 mg (2 each)|6216| 12.50 |||||||||| 8.13 | 8.50 | 9.13 | 9.13 | 9.75 | 7.50 | 8.13 | 9.38 | 10.63 | 11.10 | 11.00 | 9.38 | 10.63 ||| |PHENOBARBITAL 60 MG PO TABS|100 mg (1.666666666666666667 each)|6218| 12.55 |||||||||| 8.16 | 8.53 | 9.16 | 9.16 | 9.79 | 7.53 | 8.16 | 9.41 | 10.67 | 11.14 | 11.04 | 9.41 | 10.67 ||| |PHENOBARBITAL 60 MG PO TABS|15 mg (0.25 each)|6218| 11.25 |||||||||| 7.31 | 7.65 | 8.21 | 8.21 | 8.78 | 6.75 | 7.31 | 8.44 | 9.56 | 9.99 | 9.90 | 8.44 | 9.56 ||| |PHENOBARBITAL 60 MG PO TABS|30 mg (0.5 each)|6218| 11.50 |||||||||| 7.48 | 7.82 | 8.40 | 8.40 | 8.97 | 6.90 | 7.48 | 8.63 | 9.78 | 10.21 | 10.12 | 8.63 | 9.78 ||| |PHENOBARBITAL 60 MG PO TABS|60 mg (1 each)|6218| 11.95 |||||||||| 7.77 | 8.13 | 8.72 | 8.72 | 9.32 | 7.17 | 7.77 | 8.96 | 10.16 | 10.61 | 10.52 | 8.96 | 10.16 ||| |PHENYLEPHRINE HCL 0.25 % NA SOLN|15 mL|6243| 41.15 |||||||||| 26.75 | 27.98 | 30.04 | 30.04 | 32.10 | 24.69 | 26.75 | 30.86 | 34.98 | 36.54 | 36.21 | 30.86 | 34.98 ||| |PHENYLEPHRINE HCL 1 % NA SOLN|30 mL|6245| 37.65 |||||||||| 24.47 | 25.60 | 27.48 | 27.48 | 29.37 | 22.59 | 24.47 | 28.24 | 32.00 | 33.43 | 33.13 | 28.24 | 32.00 ||| |PHENYLEPHRINE HCL 2.5 % OP SOLN|2 mL|6246| 95.20 |||||||||| 61.88 | 64.74 | 69.50 | 69.50 | 74.26 | 57.12 | 61.88 | 71.40 | 80.92 | 84.54 | 83.78 | 71.40 | 80.92 ||| |PHENYTOIN SODIUM 50 MG/ML IJ SOLN|2 mL|6256| 36.40 |||||||||| 23.66 | 24.75 | 26.57 | 26.57 | 28.39 | 21.84 | 23.66 | 27.30 | 30.94 | 32.32 | 32.03 | 27.30 | 30.94 ||| |PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS|1 each|6257| 12.15 |||||||||| 7.90 | 8.26 | 8.87 | 8.87 | 9.48 | 7.29 | 7.90 | 9.11 | 10.33 | 10.79 | 10.69 | 9.11 | 10.33 ||| |PHYSOSTIGMINE SALICYLATE 1 MG/ML IJ SOLN|2 mL|6270| 181.40 |||||||||| 117.91 | 123.35 | 132.42 | 132.42 | 141.49 | 108.84 | 117.91 | 136.05 | 154.19 | 161.08 | 159.63 | 136.05 | 154.19 ||| |PILOCARPINE HCL 2 % OP SOLN|15 mL|6280| 185.85 |||||||||| 120.80 | 126.38 | 135.67 | 135.67 | 144.96 | 111.51 | 120.80 | 139.39 | 157.97 | 165.03 | 163.55 | 139.39 | 157.97 ||| |PILOCARPINE HCL 4 % OP SOLN|15 mL|6282| 193.20 |||||||||| 125.58 | 131.38 | 141.04 | 141.04 | 150.70 | 115.92 | 125.58 | 144.90 | 164.22 | 171.56 | 170.02 | 144.90 | 164.22 ||| |PODOPHYLLUM RESIN 25 % EX SOLN|15 mL|6356| 218.50 |||||||||| 142.03 | 148.58 | 159.51 | 159.51 | 170.43 | 131.10 | 142.03 | 163.88 | 185.73 | 194.03 | 192.28 | 163.88 | 185.73 ||| |POTASSIUM BICARBONATE 25 MEQ PO TBEF|30 each|6423| 37.25 |||||||||| 24.21 | 25.33 | 27.19 | 27.19 | 29.06 | 22.35 | 24.21 | 27.94 | 31.66 | 33.08 | 32.78 | 27.94 | 31.66 ||| |POTASSIUM GLUCONATE 2.5 MEQ PO TABS|2.5 mEq (1 each)|6443| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |POVIDONE-IODINE 10 % EX OINT|28.35 g|6455| 36.85 |||||||||| 23.95 | 25.06 | 26.90 | 26.90 | 28.74 | 22.11 | 23.95 | 27.64 | 31.32 | 32.72 | 32.43 | 27.64 | 31.32 ||| |POVIDONE-IODINE 10 % EX SOLN|118 mL|6458| 36.90 |||||||||| 23.99 | 25.09 | 26.94 | 26.94 | 28.78 | 22.14 | 23.99 | 27.68 | 31.37 | 32.77 | 32.47 | 27.68 | 31.37 ||| |POVIDONE-IODINE 7.5 % EX SOLN|118 mL|6460| 49.80 |||||||||| 32.37 | 33.86 | 36.35 | 36.35 | 38.84 | 29.88 | 32.37 | 37.35 | 42.33 | 44.22 | 43.82 | 37.35 | 42.33 ||| |PRALIDOXIME CHLORIDE 1 G IV SOLR|1 each|6462| 197.20 |||||||||| 128.18 | 134.10 | 143.96 | 143.96 | 153.82 | 118.32 | 128.18 | 147.90 | 167.62 | 175.11 | 173.54 | 147.90 | 167.62 ||| |PREDNISOLONE 5 MG PO TABS|50 each|6483| 1,481.05 |||||||||| 962.68 | 1,007.11 | 1,081.17 | 1,081.17 | 1,155.22 | 888.63 | 962.68 | 1,110.79 | 1,258.89 | 1,315.17 | 1,303.32 | 1,110.79 | 1,258.89 ||| |ASCORBIC ACID 500 MG/ML IJ SOLN|50 mL|654| 204.35 |||||||||| 132.83 | 138.96 | 149.18 | 149.18 | 159.39 | 122.61 | 132.83 | 153.26 | 173.70 | 181.46 | 179.83 | 153.26 | 173.70 ||| |PRIMAQUINE PHOSPHATE 26.3 MG PO TABS|26.3 mg (1 each)|6541| 14.70 |||||||||| 9.56 | 10.00 | 10.73 | 10.73 | 11.47 | 8.82 | 9.56 | 11.03 | 12.50 | 13.05 | 12.94 | 11.03 | 12.50 ||| |PROMETHAZINE HCL 50 MG/ML IJ SOLN|1 mL|6619| 37.50 |||||||||| 24.38 | 25.50 | 27.38 | 27.38 | 29.25 | 22.50 | 24.38 | 28.13 | 31.88 | 33.30 | 33.00 | 28.13 | 31.88 ||| |PROPRANOLOL HCL 20 MG/5ML PO SOLN|500 mL|6654| 122.70 |||||||||| 79.76 | 83.44 | 89.57 | 89.57 | 95.71 | 73.62 | 79.76 | 92.03 | 104.30 | 108.96 | 107.98 | 92.03 | 104.30 ||| |PROPYLTHIOURACIL 50 MG PO TABS|30 each|6662| 196.40 |||||||||| 127.66 | 133.55 | 143.37 | 143.37 | 153.19 | 117.84 | 127.66 | 147.30 | 166.94 | 174.40 | 172.83 | 147.30 | 166.94 ||| |PSEUDOEPHEDRINE HCL 30 MG/5ML PO SYRP|120 mL|6713| 14.25 |||||||||| 9.26 | 9.69 | 10.40 | 10.40 | 11.12 | 8.55 | 9.26 | 10.69 | 12.11 | 12.65 | 12.54 | 10.69 | 12.11 ||| |PYRIDOXINE HCL 100 MG/ML IJ SOLN|1 mL|6744| 62.65 |||||||||| 40.72 | 42.60 | 45.73 | 45.73 | 48.87 | 37.59 | 40.72 | 46.99 | 53.25 | 55.63 | 55.13 | 46.99 | 53.25 ||| |QUINIDINE SULFATE 200 MG PO TABS|100 each|6777| 73.30 |||||||||| 47.65 | 49.84 | 53.51 | 53.51 | 57.17 | 43.98 | 47.65 | 54.98 | 62.31 | 65.09 | 64.50 | 54.98 | 62.31 ||| |QUINIDINE SULFATE 300 MG PO TABS|100 each|6778| 116.90 |||||||||| 75.99 | 79.49 | 85.34 | 85.34 | 91.18 | 70.14 | 75.99 | 87.68 | 99.37 | 103.81 | 102.87 | 87.68 | 99.37 ||| |ASPIRIN 81 MG PO CHEW|500 each|680| 73.90 |||||||||| 48.04 | 50.25 | 53.95 | 53.95 | 57.64 | 44.34 | 48.04 | 55.43 | 62.82 | 65.62 | 65.03 | 55.43 | 62.82 ||| |ASPIRIN 325 MG PO TABS|500 each|681| 70.80 |||||||||| 46.02 | 48.14 | 51.68 | 51.68 | 55.22 | 42.48 | 46.02 | 53.10 | 60.18 | 62.87 | 62.30 | 53.10 | 60.18 ||| |ASPIRIN 81 MG PO TBEC|750 each|688| 98.30 |||||||||| 63.90 | 66.84 | 71.76 | 71.76 | 76.67 | 58.98 | 63.90 | 73.73 | 83.56 | 87.29 | 86.50 | 73.73 | 83.56 ||| |INSULIN DETEMIR 100 UNIT/ML SC SOLN|10 mL|70261| 614.05 |||||||||| 399.13 | 417.55 | 448.26 | 448.26 | 478.96 | 368.43 | 399.13 | 460.54 | 521.94 | 545.28 | 540.36 | 460.54 | 521.94 ||| |BRIMONIDINE TARTRATE 0.1 % OP SOLN|5 mL|70262| 350.20 |||||||||| 227.63 | 238.14 | 255.65 | 255.65 | 273.16 | 210.12 | 227.63 | 262.65 | 297.67 | 310.98 | 308.18 | 262.65 | 297.67 ||| |ABATACEPT 250 MG IV SOLR|1,000 mg (4 each)|70287| 9,660.85 |||||||||| 6,279.55 | 6,569.38 | 7,052.42 | 7,052.42 | 7,535.46 | 5,796.51 | 6,279.55 | 7,245.64 | 8,211.72 | 8,578.83 | 8,501.55 | 7,245.64 | 8,211.72 ||| |ABATACEPT 250 MG IV SOLR|500 mg (2 each)|70287| 4,830.45 |||||||||| 3,139.79 | 3,284.71 | 3,526.23 | 3,526.23 | 3,767.75 | 2,898.27 | 3,139.79 | 3,622.84 | 4,105.88 | 4,289.44 | 4,250.80 | 3,622.84 | 4,105.88 ||| |ABATACEPT 250 MG IV SOLR|750 mg (3 each)|70287| 7,245.65 |||||||||| 4,709.67 | 4,927.04 | 5,289.32 | 5,289.32 | 5,651.61 | 4,347.39 | 4,709.67 | 5,434.24 | 6,158.80 | 6,434.14 | 6,376.17 | 5,434.24 | 6,158.80 ||| |ARIPIPRAZOLE 2 MG PO TABS|30 each|70306| 65.60 |||||||||| 42.64 | 44.61 | 47.89 | 47.89 | 51.17 | 39.36 | 42.64 | 49.20 | 55.76 | 58.25 | 57.73 | 49.20 | 55.76 ||| |ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR|500 Units|70405| 1,386.80 |||||||||| 901.42 | 943.02 | 1,012.36 | 1,012.36 | 1,081.70 | 832.08 | 901.42 | 1,040.10 | 1,178.78 | 1,231.48 | 1,220.38 | 1,040.10 | 1,178.78 ||| |ANTIHEMOPHILIC FACTOR-VWF 1000-2400 UNITS IV SOLR|1000 Units|70406| 2,773.60 |||||||||| 1,802.84 | 1,886.05 | 2,024.73 | 2,024.73 | 2,163.41 | 1,664.16 | 1,802.84 | 2,080.20 | 2,357.56 | 2,462.96 | 2,440.77 | 2,080.20 | 2,357.56 ||| |LUBIPROSTONE 24 MCG PO CAPS|60 each|70472| 792.45 |||||||||| 515.09 | 538.87 | 578.49 | 578.49 | 618.11 | 475.47 | 515.09 | 594.34 | 673.58 | 703.70 | 697.36 | 594.34 | 673.58 ||| |FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP|16 g|70536| 67.90 |||||||||| 44.14 | 46.17 | 49.57 | 49.57 | 52.96 | 40.74 | 44.14 | 50.93 | 57.72 | 60.30 | 59.75 | 50.93 | 57.72 ||| |METHOHEXITAL SODIUM 0.5 G IJ SOLR|1 each|70545| 180.70 |||||||||| 117.46 | 122.88 | 131.91 | 131.91 | 140.95 | 108.42 | 117.46 | 135.53 | 153.60 | 160.46 | 159.02 | 135.53 | 153.60 ||| |RHO D IMMUNE GLOBULIN 2500 UNIT/2.2ML IJ SOLN|2.2 mL|70573| 1,773.10 |||||||||| 1,152.52 | 1,205.71 | 1,294.36 | 1,294.36 | 1,383.02 | 1,063.86 | 1,152.52 | 1,329.83 | 1,507.14 | 1,574.51 | 1,560.33 | 1,329.83 | 1,507.14 ||| |RHO D IMMUNE GLOBULIN 5000 UNIT/4.4ML IJ SOLN|4.4 mL|70574| 3,546.20 |||||||||| 2,305.03 | 2,411.42 | 2,588.73 | 2,588.73 | 2,766.04 | 2,127.72 | 2,305.03 | 2,659.65 | 3,014.27 | 3,149.03 | 3,120.66 | 2,659.65 | 3,014.27 ||| |RHO D IMMUNE GLOBULIN 1500 UNIT/1.3ML IJ SOLN|1.3 mL|70575| 1,057.30 |||||||||| 687.25 | 718.96 | 771.83 | 771.83 | 824.69 | 634.38 | 687.25 | 792.98 | 898.71 | 938.88 | 930.42 | 792.98 | 898.71 ||| |NEOMYCIN-POLYMYXIN B GU 40-200000 IR SOLN|1 mL|70678| 149.20 |||||||||| 96.98 | 101.46 | 108.92 | 108.92 | 116.38 | 89.52 | 96.98 | 111.90 | 126.82 | 132.49 | 131.30 | 111.90 | 126.82 ||| |SIMETHICONE 40 MG/0.6ML PO SUSP|30 mL|7228| 15.70 |||||||||| 10.21 | 10.68 | 11.46 | 11.46 | 12.25 | 9.42 | 10.21 | 11.78 | 13.35 | 13.94 | 13.82 | 11.78 | 13.35 ||| |SIMPLE SYRUP PO SYRP|3800 mL|7242| 198.55 |||||||||| 129.06 | 135.01 | 144.94 | 144.94 | 154.87 | 119.13 | 129.06 | 148.91 | 168.77 | 176.31 | 174.72 | 148.91 | 168.77 ||| |SODIUM BENZOATE POWD|500 g|7305| 61.45 |||||||||| 39.94 | 41.79 | 44.86 | 44.86 | 47.93 | 36.87 | 39.94 | 46.09 | 52.23 | 54.57 | 54.08 | 46.09 | 52.23 ||| |ATROPINE SULFATE 0.4 MG/ML IJ SOLN|1 mL|731| 48.50 |||||||||| 31.53 | 32.98 | 35.41 | 35.41 | 37.83 | 29.10 | 31.53 | 36.38 | 41.23 | 43.07 | 42.68 | 36.38 | 41.23 ||| |SODIUM BICARBONATE 325 MG PO TABS|1000 each|7311| 53.15 |||||||||| 34.55 | 36.14 | 38.80 | 38.80 | 41.46 | 31.89 | 34.55 | 39.86 | 45.18 | 47.20 | 46.77 | 39.86 | 45.18 ||| |SODIUM CHLORIDE 0.45 % IV SOLN|1000 mL|7318| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |SODIUM CHLORIDE 4 MEQ/ML IV SOLN|30 mL|7322| 42.50 |||||||||| 27.63 | 28.90 | 31.03 | 31.03 | 33.15 | 25.50 | 27.63 | 31.88 | 36.13 | 37.74 | 37.40 | 31.88 | 36.13 ||| |SODIUM CHLORIDE 0.9 % IN NEBU|3 mL|7325| 11.25 |||||||||| 7.31 | 7.65 | 8.21 | 8.21 | 8.78 | 6.75 | 7.31 | 8.44 | 9.56 | 9.99 | 9.90 | 8.44 | 9.56 ||| |SODIUM CHLORIDE 3 % IN NEBU|15 mL|7327| 12.60 |||||||||| 8.19 | 8.57 | 9.20 | 9.20 | 9.83 | 7.56 | 8.19 | 9.45 | 10.71 | 11.19 | 11.09 | 9.45 | 10.71 ||| |SODIUM CHLORIDE 1 G PO TABS|1 g (1 each)|7328| 11.20 |||||||||| 7.28 | 7.62 | 8.18 | 8.18 | 8.74 | 6.72 | 7.28 | 8.40 | 9.52 | 9.95 | 9.86 | 8.40 | 9.52 ||| |SODIUM CHLORIDE 1 G PO TABS|2 g (2 each)|7328| 11.35 |||||||||| 7.38 | 7.72 | 8.29 | 8.29 | 8.85 | 6.81 | 7.38 | 8.51 | 9.65 | 10.08 | 9.99 | 8.51 | 9.65 ||| |ATROPINE SULFATE 1 MG/ML IJ SOLN|1 mL|734| 47.10 |||||||||| 30.62 | 32.03 | 34.38 | 34.38 | 36.74 | 28.26 | 30.62 | 35.33 | 40.04 | 41.82 | 41.45 | 35.33 | 40.04 ||| |SODIUM LACTATE 5 MEQ/ML IV SOLN|10 mL|7346| 38.80 |||||||||| 25.22 | 26.38 | 28.32 | 28.32 | 30.26 | 23.28 | 25.22 | 29.10 | 32.98 | 34.45 | 34.14 | 29.10 | 32.98 ||| |SODIUM THIOSULFATE 25 % IV SOLN|50 mL|7364| 235.45 |||||||||| 153.04 | 160.11 | 171.88 | 171.88 | 183.65 | 141.27 | 153.04 | 176.59 | 200.13 | 209.08 | 207.20 | 176.59 | 200.13 ||| |STERILE WATER FOR IRRIGATION IR SOLN|1000 mL|7485| 43.45 |||||||||| 28.24 | 29.55 | 31.72 | 31.72 | 33.89 | 26.07 | 28.24 | 32.59 | 36.93 | 38.58 | 38.24 | 32.59 | 36.93 ||| |STRESS FORMULA PO TABS|1 tablet (1 each)|7518| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |HYALURONIDASE HUMAN 150 UNIT/ML IJ SOLN|1 mL|76338| 139.05 |||||||||| 90.38 | 94.55 | 101.51 | 101.51 | 108.46 | 83.43 | 90.38 | 104.29 | 118.19 | 123.48 | 122.36 | 104.29 | 118.19 ||| |DECITABINE 50 MG IV SOLR|1 each|76364| 1,410.00 |||||||||| 916.50 | 958.80 | 1,029.30 | 1,029.30 | 1,099.80 | 846.00 | 916.50 | 1,057.50 | 1,198.50 | 1,252.08 | 1,240.80 | 1,057.50 | 1,198.50 ||| |METHYLPHENIDATE 10 MG/9HR TD PTCH|1 patch (1 each)|76393| 45.75 |||||||||| 29.74 | 31.11 | 33.40 | 33.40 | 35.69 | 27.45 | 29.74 | 34.31 | 38.89 | 40.63 | 40.26 | 34.31 | 38.89 ||| |METHYLPHENIDATE 15 MG/9HR TD PTCH|1 patch (1 each)|76394| 45.75 |||||||||| 29.74 | 31.11 | 33.40 | 33.40 | 35.69 | 27.45 | 29.74 | 34.31 | 38.89 | 40.63 | 40.26 | 34.31 | 38.89 ||| |SURGILUBE EX GEL|3 g|7640| 34.20 |||||||||| 22.23 | 23.26 | 24.97 | 24.97 | 26.68 | 20.52 | 22.23 | 25.65 | 29.07 | 30.37 | 30.10 | 25.65 | 29.07 ||| |VARENICLINE TARTRATE 0.5 MG PO TABS|56 each|76444| 940.45 |||||||||| 611.29 | 639.51 | 686.53 | 686.53 | 733.55 | 564.27 | 611.29 | 705.34 | 799.38 | 835.12 | 827.60 | 705.34 | 799.38 ||| |RASAGILINE MESYLATE 1 MG PO TABS|30 each|76481| 878.30 |||||||||| 570.90 | 597.24 | 641.16 | 641.16 | 685.07 | 526.98 | 570.90 | 658.73 | 746.56 | 779.93 | 772.90 | 658.73 | 746.56 ||| |NALTREXONE 380 MG IM SUSR|1 each|76527| 2,645.80 |||||||||| 1,719.77 | 1,799.14 | 1,931.43 | 1,931.43 | 2,063.72 | 1,587.48 | 1,719.77 | 1,984.35 | 2,248.93 | 2,349.47 | 2,328.30 | 1,984.35 | 2,248.93 ||| |DASATINIB 50 MG PO TABS|60 each|76718| 33,443.85 |||||||||| 21,738.50 | 22,741.82 | 24,414.01 | 24,414.01 | 26,086.20 | 20,066.31 | 21,738.50 | 25,082.89 | 28,427.27 | 29,698.14 | 29,430.59 | 25,082.89 | 28,427.27 ||| |IBUPROFEN LYSINE 10 MG/ML IV SOLN|2 mL|76780| 937.35 |||||||||| 609.28 | 637.40 | 684.27 | 684.27 | 731.13 | 562.41 | 609.28 | 703.01 | 796.75 | 832.37 | 824.87 | 703.01 | 796.75 ||| |LENALIDOMIDE 25 MG PO CAPS|25 mg (1 each)|76784| 1,606.05 |||||||||| 1,043.93 | 1,092.11 | 1,172.42 | 1,172.42 | 1,252.72 | 963.63 | 1,043.93 | 1,204.54 | 1,365.14 | 1,426.17 | 1,413.32 | 1,204.54 | 1,365.14 ||| |ARIPIPRAZOLE 10 MG PO TBDP|30 each|76822| 1,929.95 |||||||||| 1,254.47 | 1,312.37 | 1,408.86 | 1,408.86 | 1,505.36 | 1,157.97 | 1,254.47 | 1,447.46 | 1,640.46 | 1,713.80 | 1,698.36 | 1,447.46 | 1,640.46 ||| |GUAIFENESIN 100 MG/5ML PO SOLN|5 mL|76829| 12.10 |||||||||| 7.87 | 8.23 | 8.83 | 8.83 | 9.44 | 7.26 | 7.87 | 9.08 | 10.29 | 10.74 | 10.65 | 9.08 | 10.29 ||| |APREPITANT 40 MG PO CAPS|1 each|76843| 204.60 |||||||||| 132.99 | 139.13 | 149.36 | 149.36 | 159.59 | 122.76 | 132.99 | 153.45 | 173.91 | 181.68 | 180.05 | 153.45 | 173.91 ||| |RASBURICASE 7.5 MG IV SOLR|1 each|76868| 6,767.00 |||||||||| 4,398.55 | 4,601.56 | 4,939.91 | 4,939.91 | 5,278.26 | 4,060.20 | 4,398.55 | 5,075.25 | 5,751.95 | 6,009.10 | 5,954.96 | 5,075.25 | 5,751.95 ||| |IDURSULFASE 6 MG/3ML IV SOLN|3 mL|76878| 6,510.00 |||||||||| 4,231.50 | 4,426.80 | 4,752.30 | 4,752.30 | 5,077.80 | 3,906.00 | 4,231.50 | 4,882.50 | 5,533.50 | 5,780.88 | 5,728.80 | 4,882.50 | 5,533.50 ||| |GLYCERIN (LAXATIVE) 1.2 G RE SUPP|0.5 suppository (0.5 each)|76974| 11.40 |||||||||| 7.41 | 7.75 | 8.32 | 8.32 | 8.89 | 6.84 | 7.41 | 8.55 | 9.69 | 10.12 | 10.03 | 8.55 | 9.69 ||| |GLYCERIN (LAXATIVE) 1.2 G RE SUPP|1 suppository (1 each)|76974| 11.80 |||||||||| 7.67 | 8.02 | 8.61 | 8.61 | 9.20 | 7.08 | 7.67 | 8.85 | 10.03 | 10.48 | 10.38 | 8.85 | 10.03 ||| |MORPHINE SULFATE 1 MG/ML IV SOLN|30 mL|77005| 60.55 |||||||||| 39.36 | 41.17 | 44.20 | 44.20 | 47.23 | 36.33 | 39.36 | 45.41 | 51.47 | 53.77 | 53.28 | 45.41 | 51.47 ||| |TAMOXIFEN CITRATE 10 MG PO TABS|100 each|7711| 121.25 |||||||||| 78.81 | 82.45 | 88.51 | 88.51 | 94.58 | 72.75 | 78.81 | 90.94 | 103.06 | 107.67 | 106.70 | 90.94 | 103.06 ||| |HYPROMELLOSE 2.5 % OP SOLN|15 mL|77164| 46.25 |||||||||| 30.06 | 31.45 | 33.76 | 33.76 | 36.08 | 27.75 | 30.06 | 34.69 | 39.31 | 41.07 | 40.70 | 34.69 | 39.31 ||| |FLUTICASONE-SALMETEROL 45-21 MCG/ACT IN AERO|8 g|77173| 433.95 |||||||||| 282.07 | 295.09 | 316.78 | 316.78 | 338.48 | 260.37 | 282.07 | 325.46 | 368.86 | 385.35 | 381.88 | 325.46 | 368.86 ||| |FLUTICASONE-SALMETEROL 115-21 MCG/ACT IN AERO|8 g|77174| 433.95 |||||||||| 282.07 | 295.09 | 316.78 | 316.78 | 338.48 | 260.37 | 282.07 | 325.46 | 368.86 | 385.35 | 381.88 | 325.46 | 368.86 ||| |FLUTICASONE-SALMETEROL 230-21 MCG/ACT IN AERO|8 g|77175| 627.15 |||||||||| 407.65 | 426.46 | 457.82 | 457.82 | 489.18 | 376.29 | 407.65 | 470.36 | 533.08 | 556.91 | 551.89 | 470.36 | 533.08 ||| |LEVETIRACETAM 500 MG/5ML IV SOLN|5 mL|77195| 53.80 |||||||||| 34.97 | 36.58 | 39.27 | 39.27 | 41.96 | 32.28 | 34.97 | 40.35 | 45.73 | 47.77 | 47.34 | 40.35 | 45.73 ||| |CIPROFLOXACIN 200 MG/20ML IV SOLN|20 mL|77256| 15.70 |||||||||| 10.21 | 10.68 | 11.46 | 11.46 | 12.25 | 9.42 | 10.21 | 11.78 | 13.35 | 13.94 | 13.82 | 11.78 | 13.35 ||| |SELENIUM 40 MCG/ML IV SOLN|10 mL|77308| 67.40 |||||||||| 43.81 | 45.83 | 49.20 | 49.20 | 52.57 | 40.44 | 43.81 | 50.55 | 57.29 | 59.85 | 59.31 | 50.55 | 57.29 ||| |CAFFEINE CITRATE 20 MG/ML PO SOLN|3 mL|77411| 71.85 |||||||||| 46.70 | 48.86 | 52.45 | 52.45 | 56.04 | 43.11 | 46.70 | 53.89 | 61.07 | 63.80 | 63.23 | 53.89 | 61.07 ||| |CAFFEINE CITRATE 60 MG/3ML IV SOLN|3 mL|77412| 71.65 |||||||||| 46.57 | 48.72 | 52.30 | 52.30 | 55.89 | 42.99 | 46.57 | 53.74 | 60.90 | 63.63 | 63.05 | 53.74 | 60.90 ||| |ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU|2 mL|77581| 59.15 |||||||||| 38.45 | 40.22 | 43.18 | 43.18 | 46.14 | 35.49 | 38.45 | 44.36 | 50.28 | 52.53 | 52.05 | 44.36 | 50.28 ||| |SITAGLIPTIN PHOSPHATE 50 MG PO TABS|90 each|77616| 2,970.35 |||||||||| 1,930.73 | 2,019.84 | 2,168.36 | 2,168.36 | 2,316.87 | 1,782.21 | 1,930.73 | 2,227.76 | 2,524.80 | 2,637.67 | 2,613.91 | 2,227.76 | 2,524.80 ||| |VICKS VAPORUB 4.73-1.2-2.6 % EX OINT|50 g|77636| 41.20 |||||||||| 26.78 | 28.02 | 30.08 | 30.08 | 32.14 | 24.72 | 26.78 | 30.90 | 35.02 | 36.59 | 36.26 | 30.90 | 35.02 ||| |ATAZANAVIR SULFATE 300 MG PO CAPS|30 each|77648| 3,031.00 |||||||||| 1,970.15 | 2,061.08 | 2,212.63 | 2,212.63 | 2,364.18 | 1,818.60 | 1,970.15 | 2,273.25 | 2,576.35 | 2,691.53 | 2,667.28 | 2,273.25 | 2,576.35 ||| |CARVEDILOL PHOSPHATE ER 10 MG PO CP24|30 each|77664| 593.50 |||||||||| 385.78 | 403.58 | 433.26 | 433.26 | 462.93 | 356.10 | 385.78 | 445.13 | 504.48 | 527.03 | 522.28 | 445.13 | 504.48 ||| |CARVEDILOL PHOSPHATE ER 40 MG PO CP24|30 each|77666| 536.35 |||||||||| 348.63 | 364.72 | 391.54 | 391.54 | 418.35 | 321.81 | 348.63 | 402.26 | 455.90 | 476.28 | 471.99 | 402.26 | 455.90 ||| |MICAFUNGIN SODIUM 100 MG IV SOLR|50 mg (0.5 each)|77685| 293.95 |||||||||| 191.07 | 199.89 | 214.58 | 214.58 | 229.28 | 176.37 | 191.07 | 220.46 | 249.86 | 261.03 | 258.68 | 220.46 | 249.86 ||| |METOCLOPRAMIDE HCL 5 MG/5ML PO SOLN|473 mL|77725| 82.90 |||||||||| 53.89 | 56.37 | 60.52 | 60.52 | 64.66 | 49.74 | 53.89 | 62.18 | 70.47 | 73.62 | 72.95 | 62.18 | 70.47 ||| |TETANUS IMMUNE GLOBULIN 250 UNIT/ML IM INJ|250 Units (1 each)|7789| 1,081.35 |||||||||| 702.88 | 735.32 | 789.39 | 789.39 | 843.45 | 648.81 | 702.88 | 811.01 | 919.15 | 960.24 | 951.59 | 811.01 | 919.15 ||| |TETRACAINE HCL 0.5 % OP SOLN|4 mL|7795| 53.95 |||||||||| 35.07 | 36.69 | 39.38 | 39.38 | 42.08 | 32.37 | 35.07 | 40.46 | 45.86 | 47.91 | 47.48 | 40.46 | 45.86 ||| |GUAIFENESIN-CODEINE 100-10 MG/5ML PO SYRP|473 mL|78003| 85.75 |||||||||| 55.74 | 58.31 | 62.60 | 62.60 | 66.89 | 51.45 | 55.74 | 64.31 | 72.89 | 76.15 | 75.46 | 64.31 | 72.89 ||| |AQUADEKS PO LIQD|.5 mL|78030| 11.40 |||||||||| 7.41 | 7.75 | 8.32 | 8.32 | 8.89 | 6.84 | 7.41 | 8.55 | 9.69 | 10.12 | 10.03 | 8.55 | 9.69 ||| |THEOPHYLLINE 80 MG/15ML PO ELIX|473 mL|7820| 677.00 |||||||||| 440.05 | 460.36 | 494.21 | 494.21 | 528.06 | 406.20 | 440.05 | 507.75 | 575.45 | 601.18 | 595.76 | 507.75 | 575.45 ||| |THERA PO TABS|1 tablet (1 each)|7825| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |MESALAMINE 1.2 G PO TBEC|1.2 g (1 each)|78310| 36.45 |||||||||| 23.69 | 24.79 | 26.61 | 26.61 | 28.43 | 21.87 | 23.69 | 27.34 | 30.98 | 32.37 | 32.08 | 27.34 | 30.98 ||| |MESALAMINE 1.2 G PO TBEC|2.4 g (2 each)|78310| 60.90 |||||||||| 39.59 | 41.41 | 44.46 | 44.46 | 47.50 | 36.54 | 39.59 | 45.68 | 51.77 | 54.08 | 53.59 | 45.68 | 51.77 ||| |MESALAMINE 1.2 G PO TBEC|4.8 g (4 each)|78310| 99.75 |||||||||| 64.84 | 67.83 | 72.82 | 72.82 | 77.81 | 59.85 | 64.84 | 74.81 | 84.79 | 88.58 | 87.78 | 74.81 | 84.79 ||| |AZACITIDINE 100 MG IJ SUSR|1 each|78420| 462.05 |||||||||| 300.33 | 314.19 | 337.30 | 337.30 | 360.40 | 277.23 | 300.33 | 346.54 | 392.74 | 410.30 | 406.60 | 346.54 | 392.74 ||| |ALISKIREN FUMARATE 150 MG PO TABS|30 each|78653| 409.85 |||||||||| 266.40 | 278.70 | 299.19 | 299.19 | 319.68 | 245.91 | 266.40 | 307.39 | 348.37 | 363.95 | 360.67 | 307.39 | 348.37 ||| |THIORIDAZINE HCL 10 MG PO TABS|100 each|7894| 120.85 |||||||||| 78.55 | 82.18 | 88.22 | 88.22 | 94.26 | 72.51 | 78.55 | 90.64 | 102.72 | 107.31 | 106.35 | 90.64 | 102.72 ||| |THIOTEPA 15 MG IJ SOLR|1 each|7901| 1,557.00 |||||||||| 1,012.05 | 1,058.76 | 1,136.61 | 1,136.61 | 1,214.46 | 934.20 | 1,012.05 | 1,167.75 | 1,323.45 | 1,382.62 | 1,370.16 | 1,167.75 | 1,323.45 ||| |THYROID 60 MG PO TABS|100 each|7947| 204.70 |||||||||| 133.06 | 139.20 | 149.43 | 149.43 | 159.67 | 122.82 | 133.06 | 153.53 | 174.00 | 181.77 | 180.14 | 153.53 | 174.00 ||| |TIMOLOL MALEATE 10 MG PO TABS|100 each|7967| 304.80 |||||||||| 198.12 | 207.26 | 222.50 | 222.50 | 237.74 | 182.88 | 198.12 | 228.60 | 259.08 | 270.66 | 268.22 | 228.60 | 259.08 ||| |TOBRAMYCIN SULFATE 10 MG/ML IJ SOLN|2 mL|7993| 139.30 |||||||||| 90.55 | 94.72 | 101.69 | 101.69 | 108.65 | 83.58 | 90.55 | 104.48 | 118.41 | 123.70 | 122.58 | 104.48 | 118.41 ||| |TRAZODONE HCL 100 MG PO TABS|1000 each|8083| 250.40 |||||||||| 162.76 | 170.27 | 182.79 | 182.79 | 195.31 | 150.24 | 162.76 | 187.80 | 212.84 | 222.36 | 220.35 | 187.80 | 212.84 ||| |TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE|5 g|8121| 155.40 |||||||||| 101.01 | 105.67 | 113.44 | 113.44 | 121.21 | 93.24 | 101.01 | 116.55 | 132.09 | 138.00 | 136.75 | 116.55 | 132.09 ||| |DIVALPROEX SODIUM ER 500 MG PO TB24|100 each|81426| 203.25 |||||||||| 132.11 | 138.21 | 148.37 | 148.37 | 158.54 | 121.95 | 132.11 | 152.44 | 172.76 | 180.49 | 178.86 | 152.44 | 172.76 ||| |BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO|6.9 g|81453| 439.15 |||||||||| 285.45 | 298.62 | 320.58 | 320.58 | 342.54 | 263.49 | 285.45 | 329.36 | 373.28 | 389.97 | 386.45 | 329.36 | 373.28 ||| |BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO|6 g|81454| 500.10 |||||||||| 325.07 | 340.07 | 365.07 | 365.07 | 390.08 | 300.06 | 325.07 | 375.08 | 425.09 | 444.09 | 440.09 | 375.08 | 425.09 ||| |LISDEXAMFETAMINE DIMESYLATE 30 MG PO CAPS|100 each|81474| 1,932.10 |||||||||| 1,255.87 | 1,313.83 | 1,410.43 | 1,410.43 | 1,507.04 | 1,159.26 | 1,255.87 | 1,449.08 | 1,642.29 | 1,715.70 | 1,700.25 | 1,449.08 | 1,642.29 ||| |LISDEXAMFETAMINE DIMESYLATE 50 MG PO CAPS|100 each|81475| 1,932.10 |||||||||| 1,255.87 | 1,313.83 | 1,410.43 | 1,410.43 | 1,507.04 | 1,159.26 | 1,255.87 | 1,449.08 | 1,642.29 | 1,715.70 | 1,700.25 | 1,449.08 | 1,642.29 ||| |LISDEXAMFETAMINE DIMESYLATE 70 MG PO CAPS|100 each|81476| 1,932.10 |||||||||| 1,255.87 | 1,313.83 | 1,410.43 | 1,410.43 | 1,507.04 | 1,159.26 | 1,255.87 | 1,449.08 | 1,642.29 | 1,715.70 | 1,700.25 | 1,449.08 | 1,642.29 ||| |TRIHEXYPHENIDYL HCL 2 MG PO TABS|100 each|8166| 53.15 |||||||||| 34.55 | 36.14 | 38.80 | 38.80 | 41.46 | 31.89 | 34.55 | 39.86 | 45.18 | 47.20 | 46.77 | 39.86 | 45.18 ||| |TRIHEXYPHENIDYL HCL 5 MG PO TABS|100 each|8167| 85.15 |||||||||| 55.35 | 57.90 | 62.16 | 62.16 | 66.42 | 51.09 | 55.35 | 63.86 | 72.38 | 75.61 | 74.93 | 63.86 | 72.38 ||| |ECULIZUMAB 300 MG/30ML IV SOLN|30 mL|81696| 13,401.50 |||||||||| 8,710.98 | 9,113.02 | 9,783.10 | 9,783.10 | 10,453.17 | 8,040.90 | 8,710.98 | 10,051.13 | 11,391.28 | 11,900.53 | 11,793.32 | 10,051.13 | 11,391.28 ||| |TRIMETHOBENZAMIDE HCL 100 MG/ML IM SOLN|2 mL|8178| 113.75 |||||||||| 73.94 | 77.35 | 83.04 | 83.04 | 88.73 | 68.25 | 73.94 | 85.31 | 96.69 | 101.01 | 100.10 | 85.31 | 96.69 ||| |GLUCOSE 40 % PO GEL|15 g|81823| 36.40 |||||||||| 23.66 | 24.75 | 26.57 | 26.57 | 28.39 | 21.84 | 23.66 | 27.30 | 30.94 | 32.32 | 32.03 | 27.30 | 30.94 ||| |AZITHROMYCIN 1 % OP SOLN|2.5 mL|81880| 422.15 |||||||||| 274.40 | 287.06 | 308.17 | 308.17 | 329.28 | 253.29 | 274.40 | 316.61 | 358.83 | 374.87 | 371.49 | 316.61 | 358.83 ||| |TRIPROLIDINE-PSE 2.5-60 MG PO TABS|1 tablet (1 each)|8213| 11.15 |||||||||| 7.25 | 7.58 | 8.14 | 8.14 | 8.70 | 6.69 | 7.25 | 8.36 | 9.48 | 9.90 | 9.81 | 8.36 | 9.48 ||| |PERFLUTREN PROTEIN A MICROSPH IV SUSP|3 mL|82177| 288.50 |||||||||| 187.53 | 196.18 | 210.61 | 210.61 | 225.03 | 173.10 | 187.53 | 216.38 | 245.23 | 256.19 | 253.88 | 216.38 | 245.23 ||| |FLUOROURACIL 2.5 GM/50ML IV SOLN|50 mL|82180| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |METHOTREXATE SODIUM 250 MG/10ML IJ SOLN|10 mL|82181| 69.75 |||||||||| 45.34 | 47.43 | 50.92 | 50.92 | 54.41 | 41.85 | 45.34 | 52.31 | 59.29 | 61.94 | 61.38 | 52.31 | 59.29 ||| |FLUOROURACIL 500 MG/10ML IV SOLN|10 mL|82200| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |FLUOROURACIL 1 GM/20ML IV SOLN|20 mL|82204| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |TEMSIROLIMUS 25 MG/ML IV SOLN|1 mL|82228| 3,673.70 |||||||||| 2,387.91 | 2,498.12 | 2,681.80 | 2,681.80 | 2,865.49 | 2,204.22 | 2,387.91 | 2,755.28 | 3,122.65 | 3,262.25 | 3,232.86 | 2,755.28 | 3,122.65 ||| |CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN|4 mL|82301| 135.20 |||||||||| 87.88 | 91.94 | 98.70 | 98.70 | 105.46 | 81.12 | 87.88 | 101.40 | 114.92 | 120.06 | 118.98 | 101.40 | 114.92 ||| |CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN|6 mL|82302| 137.40 |||||||||| 89.31 | 93.43 | 100.30 | 100.30 | 107.17 | 82.44 | 89.31 | 103.05 | 116.79 | 122.01 | 120.91 | 103.05 | 116.79 ||| |MELATONIN 1 MG PO TABS|180 each|82464| 24.85 |||||||||| 16.15 | 16.90 | 18.14 | 18.14 | 19.38 | 14.91 | 16.15 | 18.64 | 21.12 | 22.07 | 21.87 | 18.64 | 21.12 ||| |METHYLCELLULOSE 1 % GEL|500 mL|82599| 136.20 |||||||||| 88.53 | 92.62 | 99.43 | 99.43 | 106.24 | 81.72 | 88.53 | 102.15 | 115.77 | 120.95 | 119.86 | 102.15 | 115.77 ||| |BACITRACIN 500 UNIT/GM OP OINT|3.5 g|852| 219.80 |||||||||| 142.87 | 149.46 | 160.45 | 160.45 | 171.44 | 131.88 | 142.87 | 164.85 | 186.83 | 195.18 | 193.42 | 164.85 | 186.83 ||| |VERAPAMIL HCL 40 MG PO TABS|100 each|8529| 54.20 |||||||||| 35.23 | 36.86 | 39.57 | 39.57 | 42.28 | 32.52 | 35.23 | 40.65 | 46.07 | 48.13 | 47.70 | 40.65 | 46.07 ||| |VERAPAMIL HCL 80 MG PO TABS|100 each|8530| 27.80 |||||||||| 18.07 | 18.90 | 20.29 | 20.29 | 21.68 | 16.68 | 18.07 | 20.85 | 23.63 | 24.69 | 24.46 | 20.85 | 23.63 ||| |BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM EX OINT|14.2 g|855| 41.45 |||||||||| 26.94 | 28.19 | 30.26 | 30.26 | 32.33 | 24.87 | 26.94 | 31.09 | 35.23 | 36.81 | 36.48 | 31.09 | 35.23 ||| |VINBLASTINE SULFATE 1 MG/ML IV SOLN|10 mL|8594| 89.45 |||||||||| 58.14 | 60.83 | 65.30 | 65.30 | 69.77 | 53.67 | 58.14 | 67.09 | 76.03 | 79.43 | 78.72 | 67.09 | 76.03 ||| |VINCRISTINE SULFATE 1 MG/ML IV SOLN|1 mL|8597| 11.95 |||||||||| 7.77 | 8.13 | 8.72 | 8.72 | 9.32 | 7.17 | 7.77 | 8.96 | 10.16 | 10.61 | 10.52 | 8.96 | 10.16 ||| |VITAMIN B-12 500 MCG PO TABS|130 each|8657| 15.60 |||||||||| 10.14 | 10.61 | 11.39 | 11.39 | 12.17 | 9.36 | 10.14 | 11.70 | 13.26 | 13.85 | 13.73 | 11.70 | 13.26 ||| |VITAMIN B-6 50 MG PO TABS|100 each|8667| 14.55 |||||||||| 9.46 | 9.89 | 10.62 | 10.62 | 11.35 | 8.73 | 9.46 | 10.91 | 12.37 | 12.92 | 12.80 | 10.91 | 12.37 ||| |VITAMIN C 500 MG PO TABS|300 each|8680| 28.85 |||||||||| 18.75 | 19.62 | 21.06 | 21.06 | 22.50 | 17.31 | 18.75 | 21.64 | 24.52 | 25.62 | 25.39 | 21.64 | 24.52 ||| |VITAMIN E 100 UNITS PO CAPS|100 each|8698| 14.55 |||||||||| 9.46 | 9.89 | 10.62 | 10.62 | 11.35 | 8.73 | 9.46 | 10.91 | 12.37 | 12.92 | 12.80 | 10.91 | 12.37 ||| |VITAMIN E 1000 UNITS PO CAPS|30 each|8699| 24.05 |||||||||| 15.63 | 16.35 | 17.56 | 17.56 | 18.76 | 14.43 | 15.63 | 18.04 | 20.44 | 21.36 | 21.16 | 18.04 | 20.44 ||| |WARFARIN SODIUM 10 MG PO TABS|100 each|8748| 147.85 |||||||||| 96.10 | 100.54 | 107.93 | 107.93 | 115.32 | 88.71 | 96.10 | 110.89 | 125.67 | 131.29 | 130.11 | 110.89 | 125.67 ||| |THROMBIN 5000 UNITS EX KIT|1 each|87798| 178.70 |||||||||| 116.16 | 121.52 | 130.45 | 130.45 | 139.39 | 107.22 | 116.16 | 134.03 | 151.90 | 158.69 | 157.26 | 134.03 | 151.90 ||| |WHITE PETROLATUM EX OINT|28.4 g|8780| 35.45 |||||||||| 23.04 | 24.11 | 25.88 | 25.88 | 27.65 | 21.27 | 23.04 | 26.59 | 30.13 | 31.48 | 31.20 | 26.59 | 30.13 ||| |MORPHINE SULFATE ER 10 MG PO CP24|100 each|87824| 702.05 |||||||||| 456.33 | 477.39 | 512.50 | 512.50 | 547.60 | 421.23 | 456.33 | 526.54 | 596.74 | 623.42 | 617.80 | 526.54 | 596.74 ||| |TRIPLE DYE EX SWAB|1 applicator (1 each)|87825| 42.80 |||||||||| 27.82 | 29.10 | 31.24 | 31.24 | 33.38 | 25.68 | 27.82 | 32.10 | 36.38 | 38.01 | 37.66 | 32.10 | 36.38 ||| |BRIMONIDINE TARTRATE-TIMOLOL 0.2-0.5 % OP SOLN|5 mL|87834| 382.55 |||||||||| 248.66 | 260.13 | 279.26 | 279.26 | 298.39 | 229.53 | 248.66 | 286.91 | 325.17 | 339.70 | 336.64 | 286.91 | 325.17 ||| |LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN|.5 mL|87861| 12,995.70 |||||||||| 8,447.21 | 8,837.08 | 9,486.86 | 9,486.86 | 10,136.65 | 7,797.42 | 8,447.21 | 9,746.78 | 11,046.35 | 11,540.18 | 11,436.22 | 9,746.78 | 11,046.35 ||| |DIAZEPAM 10 MG RE GEL|1 each|87867| 566.95 |||||||||| 368.52 | 385.53 | 413.87 | 413.87 | 442.22 | 340.17 | 368.52 | 425.21 | 481.91 | 503.45 | 498.92 | 425.21 | 481.91 ||| |INSULIN GLULISINE 100 UNIT/ML IJ SOLN|10 mL|87889| 568.50 |||||||||| 369.53 | 386.58 | 415.01 | 415.01 | 443.43 | 341.10 | 369.53 | 426.38 | 483.23 | 504.83 | 500.28 | 426.38 | 483.23 ||| |IFOSFAMIDE 1 GM/20ML IV SOLN|20 mL|87925| 98.30 |||||||||| 63.90 | 66.84 | 71.76 | 71.76 | 76.67 | 58.98 | 63.90 | 73.73 | 83.56 | 87.29 | 86.50 | 73.73 | 83.56 ||| |EPIRUBICIN HCL 50 MG/25ML IV SOLN|25 mL|88008| 124.60 |||||||||| 80.99 | 84.73 | 90.96 | 90.96 | 97.19 | 74.76 | 80.99 | 93.45 | 105.91 | 110.64 | 109.65 | 93.45 | 105.91 ||| |POLIGRIP SUPER STRONG CREA|40 g|88015| 39.60 |||||||||| 25.74 | 26.93 | 28.91 | 28.91 | 30.89 | 23.76 | 25.74 | 29.70 | 33.66 | 35.16 | 34.85 | 29.70 | 33.66 ||| |FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU|2 mL|88225| 58.75 |||||||||| 38.19 | 39.95 | 42.89 | 42.89 | 45.83 | 35.25 | 38.19 | 44.06 | 49.94 | 52.17 | 51.70 | 44.06 | 49.94 ||| |IDARUBICIN HCL 10 MG/10ML IV SOLN|10 mL|88242| 277.95 |||||||||| 180.67 | 189.01 | 202.90 | 202.90 | 216.80 | 166.77 | 180.67 | 208.46 | 236.26 | 246.82 | 244.60 | 208.46 | 236.26 ||| |IDARUBICIN HCL 20 MG/20ML IV SOLN|20 mL|88243| 423.30 |||||||||| 275.15 | 287.84 | 309.01 | 309.01 | 330.17 | 253.98 | 275.15 | 317.48 | 359.81 | 375.89 | 372.50 | 317.48 | 359.81 ||| |TRYPAN BLUE 0.06 % OP SOLN|.5 mL|88317| 191.70 |||||||||| 124.61 | 130.36 | 139.94 | 139.94 | 149.53 | 115.02 | 124.61 | 143.78 | 162.95 | 170.23 | 168.70 | 143.78 | 162.95 ||| |ANTIHEMOPHILIC FACTOR-VWF 1500 UNITS IV SOLR|1500 Units|88338| 3,913.85 |||||||||| 2,544.00 | 2,661.42 | 2,857.11 | 2,857.11 | 3,052.80 | 2,348.31 | 2,544.00 | 2,935.39 | 3,326.77 | 3,475.50 | 3,444.19 | 2,935.39 | 3,326.77 ||| |CISPLATIN 50 MG/50ML IV SOLN|50 mL|88376| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |CISPLATIN 100 MG/100ML IV SOLN|100 mL|88377| 859.65 |||||||||| 558.77 | 584.56 | 627.54 | 627.54 | 670.53 | 515.79 | 558.77 | 644.74 | 730.70 | 763.37 | 756.49 | 644.74 | 730.70 ||| |NASOGEL NA GEL|28.4 g|88380| 42.70 |||||||||| 27.76 | 29.04 | 31.17 | 31.17 | 33.31 | 25.62 | 27.76 | 32.03 | 36.30 | 37.92 | 37.58 | 32.03 | 36.30 ||| |CARISOPRODOL 250 MG PO TABS|100 each|88406| 571.15 |||||||||| 371.25 | 388.38 | 416.94 | 416.94 | 445.50 | 342.69 | 371.25 | 428.36 | 485.48 | 507.18 | 502.61 | 428.36 | 485.48 ||| |RALTEGRAVIR POTASSIUM 400 MG PO TABS|400 mg (1 each)|88608| 79.20 |||||||||| 51.48 | 53.86 | 57.82 | 57.82 | 61.78 | 47.52 | 51.48 | 59.40 | 67.32 | 70.33 | 69.70 | 59.40 | 67.32 ||| |IXABEPILONE 15 MG IV SOLR|1 each|88652| 2,199.60 |||||||||| 1,429.74 | 1,495.73 | 1,605.71 | 1,605.71 | 1,715.69 | 1,319.76 | 1,429.74 | 1,649.70 | 1,869.66 | 1,953.24 | 1,935.65 | 1,649.70 | 1,869.66 ||| |IXABEPILONE 45 MG IV SOLR|1 each|88653| 6,598.80 |||||||||| 4,289.22 | 4,487.18 | 4,817.12 | 4,817.12 | 5,147.06 | 3,959.28 | 4,289.22 | 4,949.10 | 5,608.98 | 5,859.73 | 5,806.94 | 4,949.10 | 5,608.98 ||| |HEPATITIS B IMMUNE GLOBULIN IJ SOLN|1 mL|88654| 398.90 |||||||||| 259.29 | 271.25 | 291.20 | 291.20 | 311.14 | 239.34 | 259.29 | 299.18 | 339.07 | 354.22 | 351.03 | 299.18 | 339.07 ||| |OSELTAMIVIR PHOSPHATE 30 MG PO CAPS|10 each|88704| 216.30 |||||||||| 140.60 | 147.08 | 157.90 | 157.90 | 168.71 | 129.78 | 140.60 | 162.23 | 183.86 | 192.07 | 190.34 | 162.23 | 183.86 ||| |OSELTAMIVIR PHOSPHATE 45 MG PO CAPS|10 each|88705| 311.30 |||||||||| 202.35 | 211.68 | 227.25 | 227.25 | 242.81 | 186.78 | 202.35 | 233.48 | 264.61 | 276.43 | 273.94 | 233.48 | 264.61 ||| |ZINC GLUCONATE 50 MG PO TABS|100 mg (2 each)|8872| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |ZINC GLUCONATE 50 MG PO TABS|200 mg (4 each)|8872| 11.15 |||||||||| 7.25 | 7.58 | 8.14 | 8.14 | 8.70 | 6.69 | 7.25 | 8.36 | 9.48 | 9.90 | 9.81 | 8.36 | 9.48 ||| |ZINC GLUCONATE 50 MG PO TABS|50 mg (1 each)|8872| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |ZINC OXIDE 20 % EX OINT|56.7 g|8874| 41.50 |||||||||| 26.98 | 28.22 | 30.30 | 30.30 | 32.37 | 24.90 | 26.98 | 31.13 | 35.28 | 36.85 | 36.52 | 31.13 | 35.28 ||| |NEBIVOLOL HCL 5 MG PO TABS|30 each|89284| 334.25 |||||||||| 217.26 | 227.29 | 244.00 | 244.00 | 260.72 | 200.55 | 217.26 | 250.69 | 284.11 | 296.81 | 294.14 | 250.69 | 284.11 ||| |CLOPIDOGREL BISULFATE 300 MG PO TABS|300 mg (1 each)|89346| 65.15 |||||||||| 42.35 | 44.30 | 47.56 | 47.56 | 50.82 | 39.09 | 42.35 | 48.86 | 55.38 | 57.85 | 57.33 | 48.86 | 55.38 ||| |PEMETREXED DISODIUM 100 MG IV SOLR|1 each|89350| 1,098.00 |||||||||| 713.70 | 746.64 | 801.54 | 801.54 | 856.44 | 658.80 | 713.70 | 823.50 | 933.30 | 975.02 | 966.24 | 823.50 | 933.30 ||| |ACEBUTOLOL HCL 200 MG PO CAPS|50 each|8939| 175.75 |||||||||| 114.24 | 119.51 | 128.30 | 128.30 | 137.09 | 105.45 | 114.24 | 131.81 | 149.39 | 156.07 | 154.66 | 131.81 | 149.39 ||| |ZINC OXIDE 11.3 % EX CREA|56 g|89412| 38.25 |||||||||| 24.86 | 26.01 | 27.92 | 27.92 | 29.84 | 22.95 | 24.86 | 28.69 | 32.51 | 33.97 | 33.66 | 28.69 | 32.51 ||| |ACETAMINOPHEN 160 MG/5ML PO SUSP|118 mL|8943| 15.90 |||||||||| 10.34 | 10.81 | 11.61 | 11.61 | 12.40 | 9.54 | 10.34 | 11.93 | 13.52 | 14.12 | 13.99 | 11.93 | 13.52 ||| |THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR|1 each|89570| 195.90 |||||||||| 127.34 | 133.21 | 143.01 | 143.01 | 152.80 | 117.54 | 127.34 | 146.93 | 166.52 | 173.96 | 172.39 | 146.93 | 166.52 ||| |BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS|1 tablet (1 each)|8958| 12.40 |||||||||| 8.06 | 8.43 | 9.05 | 9.05 | 9.67 | 7.44 | 8.06 | 9.30 | 10.54 | 11.01 | 10.91 | 9.30 | 10.54 ||| |BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS|2 tablet (2 each)|8958| 13.80 |||||||||| 8.97 | 9.38 | 10.07 | 10.07 | 10.76 | 8.28 | 8.97 | 10.35 | 11.73 | 12.25 | 12.14 | 10.35 | 11.73 ||| |ACETAZOLAMIDE ER 500 MG PO CP12|1,000 mg (2 each)|8962| 33.30 |||||||||| 21.65 | 22.64 | 24.31 | 24.31 | 25.97 | 19.98 | 21.65 | 24.98 | 28.31 | 29.57 | 29.30 | 24.98 | 28.31 ||| |ACETAZOLAMIDE ER 500 MG PO CP12|500 mg (1 each)|8962| 25.15 |||||||||| 16.35 | 17.10 | 18.36 | 18.36 | 19.62 | 15.09 | 16.35 | 18.86 | 21.38 | 22.33 | 22.13 | 18.86 | 21.38 ||| |ACYCLOVIR 5 % EX OINT|5 g|8968| 254.20 |||||||||| 165.23 | 172.86 | 185.57 | 185.57 | 198.28 | 152.52 | 165.23 | 190.65 | 216.07 | 225.73 | 223.70 | 190.65 | 216.07 ||| |ACYCLOVIR 200 MG PO CAPS|100 each|8969| 92.80 |||||||||| 60.32 | 63.10 | 67.74 | 67.74 | 72.38 | 55.68 | 60.32 | 69.60 | 78.88 | 82.41 | 81.66 | 69.60 | 78.88 ||| |ACYCLOVIR 200 MG/5ML PO SUSP|473 mL|8970| 761.45 |||||||||| 494.94 | 517.79 | 555.86 | 555.86 | 593.93 | 456.87 | 494.94 | 571.09 | 647.23 | 676.17 | 670.08 | 571.09 | 647.23 ||| |MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS|120 each|89740| 47.45 |||||||||| 30.84 | 32.27 | 34.64 | 34.64 | 37.01 | 28.47 | 30.84 | 35.59 | 40.33 | 42.14 | 41.76 | 35.59 | 40.33 ||| |LISDEXAMFETAMINE DIMESYLATE 20 MG PO CAPS|100 each|89783| 1,932.10 |||||||||| 1,255.87 | 1,313.83 | 1,410.43 | 1,410.43 | 1,507.04 | 1,159.26 | 1,255.87 | 1,449.08 | 1,642.29 | 1,715.70 | 1,700.25 | 1,449.08 | 1,642.29 ||| |ALBUMIN HUMAN 25 % IV SOLN|50 mL|8981| 203.45 |||||||||| 132.24 | 138.35 | 148.52 | 148.52 | 158.69 | 122.07 | 132.24 | 152.59 | 172.93 | 180.66 | 179.04 | 152.59 | 172.93 ||| |ALBUMIN HUMAN 5 % IV SOLN|500 mL|8982| 372.85 |||||||||| 242.35 | 253.54 | 272.18 | 272.18 | 290.82 | 223.71 | 242.35 | 279.64 | 316.92 | 331.09 | 328.11 | 279.64 | 316.92 ||| |ALPROSTADIL 500 MCG/ML IJ SOLN|1 mL|9001| 237.95 |||||||||| 154.67 | 161.81 | 173.70 | 173.70 | 185.60 | 142.77 | 154.67 | 178.46 | 202.26 | 211.30 | 209.40 | 178.46 | 202.26 ||| |ALTEPLASE 100 MG IV SOLR|81 mg (0.81 each)|9002| 14,645.10 |||||||||| 9,519.32 | 9,958.67 | 10,690.92 | 10,690.92 | 11,423.18 | 8,787.06 | 9,519.32 | 10,983.83 | 12,448.34 | 13,004.85 | 12,887.69 | 10,983.83 | 12,448.34 ||| |ALUM & MAG HYDROXIDE-SIMETH 200-200-25 MG PO CHEW|1 tablet (1 each)|9007| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |ALUM & MAG HYDROXIDE-SIMETH 200-200-25 MG PO CHEW|2 tablet (2 each)|9007| 11.15 |||||||||| 7.25 | 7.58 | 8.14 | 8.14 | 8.70 | 6.69 | 7.25 | 8.36 | 9.48 | 9.90 | 9.81 | 8.36 | 9.48 ||| |ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP|30 mL|9009| 23.55 |||||||||| 15.31 | 16.01 | 17.19 | 17.19 | 18.37 | 14.13 | 15.31 | 17.66 | 20.02 | 20.91 | 20.72 | 17.66 | 20.02 ||| |ALUM & MAG HYDROXIDE-SIMETH 400-400-40 MG/5ML PO SUSP|355 mL|9014| 16.20 |||||||||| 10.53 | 11.02 | 11.83 | 11.83 | 12.64 | 9.72 | 10.53 | 12.15 | 13.77 | 14.39 | 14.26 | 12.15 | 13.77 ||| |ALUMINUM CHLORIDE 20 % EX SOLN|37.5 mL|9028| 46.30 |||||||||| 30.10 | 31.48 | 33.80 | 33.80 | 36.11 | 27.78 | 30.10 | 34.73 | 39.36 | 41.11 | 40.74 | 34.73 | 39.36 ||| |AMINOCAPROIC ACID 500 MG PO TABS|1 g (2 each)|9063| 111.20 |||||||||| 72.28 | 75.62 | 81.18 | 81.18 | 86.74 | 66.72 | 72.28 | 83.40 | 94.52 | 98.75 | 97.86 | 83.40 | 94.52 ||| |AMINOCAPROIC ACID 500 MG PO TABS|2 g (4 each)|9063| 200.40 |||||||||| 130.26 | 136.27 | 146.29 | 146.29 | 156.31 | 120.24 | 130.26 | 150.30 | 170.34 | 177.96 | 176.35 | 150.30 | 170.34 ||| |AMINOCAPROIC ACID 500 MG PO TABS|3 g (6 each)|9063| 289.60 |||||||||| 188.24 | 196.93 | 211.41 | 211.41 | 225.89 | 173.76 | 188.24 | 217.20 | 246.16 | 257.16 | 254.85 | 217.20 | 246.16 ||| |AMINOCAPROIC ACID 500 MG PO TABS|5 g (10 each)|9063| 467.95 |||||||||| 304.17 | 318.21 | 341.60 | 341.60 | 365.00 | 280.77 | 304.17 | 350.96 | 397.76 | 415.54 | 411.80 | 350.96 | 397.76 ||| |AMIODARONE HCL 200 MG PO TABS|500 each|9066| 297.10 |||||||||| 193.12 | 202.03 | 216.88 | 216.88 | 231.74 | 178.26 | 193.12 | 222.83 | 252.54 | 263.82 | 261.45 | 222.83 | 252.54 ||| |AMLODIPINE BESYLATE 10 MG PO TABS|1 each|9069| 11.25 |||||||||| 7.31 | 7.65 | 8.21 | 8.21 | 8.78 | 6.75 | 7.31 | 8.44 | 9.56 | 9.99 | 9.90 | 8.44 | 9.56 ||| |AMLODIPINE BESYLATE 2.5 MG PO TABS|90 each|9070| 33.30 |||||||||| 21.65 | 22.64 | 24.31 | 24.31 | 25.97 | 19.98 | 21.65 | 24.98 | 28.31 | 29.57 | 29.30 | 24.98 | 28.31 ||| |AMLODIPINE BESYLATE 5 MG PO TABS|50 each|9071| 27.10 |||||||||| 17.62 | 18.43 | 19.78 | 19.78 | 21.14 | 16.26 | 17.62 | 20.33 | 23.04 | 24.06 | 23.85 | 20.33 | 23.04 ||| |AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS|100 each|9081| 177.60 |||||||||| 115.44 | 120.77 | 129.65 | 129.65 | 138.53 | 106.56 | 115.44 | 133.20 | 150.96 | 157.71 | 156.29 | 133.20 | 150.96 ||| |AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR|1.5 g (1 each)|9083| 140.75 |||||||||| 91.49 | 95.71 | 102.75 | 102.75 | 109.79 | 84.45 | 91.49 | 105.56 | 119.64 | 124.99 | 123.86 | 105.56 | 119.64 ||| |AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR|3 g (1 each)|9084| 158.00 |||||||||| 102.70 | 107.44 | 115.34 | 115.34 | 123.24 | 94.80 | 102.70 | 118.50 | 134.30 | 140.30 | 139.04 | 118.50 | 134.30 ||| |AMIFOSTINE 500 MG IV SOLR|500 mg (1 each)|91000| 2,201.25 |||||||||| 1,430.81 | 1,496.85 | 1,606.91 | 1,606.91 | 1,716.98 | 1,320.75 | 1,430.81 | 1,650.94 | 1,871.06 | 1,954.71 | 1,937.10 | 1,650.94 | 1,871.06 ||| |HYPROMELLOSE 0.3 % OP GEL|10 g|91018| 48.70 |||||||||| 31.66 | 33.12 | 35.55 | 35.55 | 37.99 | 29.22 | 31.66 | 36.53 | 41.40 | 43.25 | 42.86 | 36.53 | 41.40 ||| |ESOMEPRAZOLE MAGNESIUM 10 MG PO PACK|10 mg (1 each)|91031| 36.90 |||||||||| 23.99 | 25.09 | 26.94 | 26.94 | 28.78 | 22.14 | 23.99 | 27.68 | 31.37 | 32.77 | 32.47 | 27.68 | 31.37 ||| |IRINOTECAN HCL 40 MG/2ML IV SOLN|2 mL|91055| 30.20 |||||||||| 19.63 | 20.54 | 22.05 | 22.05 | 23.56 | 18.12 | 19.63 | 22.65 | 25.67 | 26.82 | 26.58 | 22.65 | 25.67 ||| |DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24|90 each|91073| 220.45 |||||||||| 143.29 | 149.91 | 160.93 | 160.93 | 171.95 | 132.27 | 143.29 | 165.34 | 187.38 | 195.76 | 194.00 | 165.34 | 187.38 ||| |DESVENLAFAXINE SUCCINATE ER 100 MG PO TB24|90 each|91074| 2,592.95 |||||||||| 1,685.42 | 1,763.21 | 1,892.85 | 1,892.85 | 2,022.50 | 1,555.77 | 1,685.42 | 1,944.71 | 2,204.01 | 2,302.54 | 2,281.80 | 1,944.71 | 2,204.01 ||| |ANTITHROMBIN III (HUMAN) 500 UNITS IV SOLR|500 Units|9116| 3,985.75 |||||||||| 2,590.74 | 2,710.31 | 2,909.60 | 2,909.60 | 3,108.89 | 2,391.45 | 2,590.74 | 2,989.31 | 3,387.89 | 3,539.35 | 3,507.46 | 2,989.31 | 3,387.89 ||| |OXYMORPHONE HCL ER 30 MG PO TB12|100 each|91180| 1,298.75 |||||||||| 844.19 | 883.15 | 948.09 | 948.09 | 1,013.03 | 779.25 | 844.19 | 974.06 | 1,103.94 | 1,153.29 | 1,142.90 | 974.06 | 1,103.94 ||| |SECRETIN ACETATE (HUMAN) 16 MCG IV SOLR|1 each|91185| 1,022.25 |||||||||| 664.46 | 695.13 | 746.24 | 746.24 | 797.36 | 613.35 | 664.46 | 766.69 | 868.91 | 907.76 | 899.58 | 766.69 | 868.91 ||| |APRACLONIDINE HCL 1 % OP SOLN|1 drop (0.5 each)|9120| 86.20 |||||||||| 56.03 | 58.62 | 62.93 | 62.93 | 67.24 | 51.72 | 56.03 | 64.65 | 73.27 | 76.55 | 75.86 | 64.65 | 73.27 ||| |APRACLONIDINE HCL 1 % OP SOLN|2 drop (1 each)|9120| 86.20 |||||||||| 56.03 | 58.62 | 62.93 | 62.93 | 67.24 | 51.72 | 56.03 | 64.65 | 73.27 | 76.55 | 75.86 | 64.65 | 73.27 ||| |ARGININE HCL (DIAGNOSTIC) 10 % IV SOLN|300 mL|9123| 324.40 |||||||||| 210.86 | 220.59 | 236.81 | 236.81 | 253.03 | 194.64 | 210.86 | 243.30 | 275.74 | 288.07 | 285.47 | 243.30 | 275.74 ||| |CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN|200 mL|91238| 138.85 |||||||||| 90.25 | 94.42 | 101.36 | 101.36 | 108.30 | 83.31 | 90.25 | 104.14 | 118.02 | 123.30 | 122.19 | 104.14 | 118.02 ||| |OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN|1 mL|91279| 52.75 |||||||||| 34.29 | 35.87 | 38.51 | 38.51 | 41.15 | 31.65 | 34.29 | 39.56 | 44.84 | 46.84 | 46.42 | 39.56 | 44.84 ||| |BENDAMUSTINE HCL 100 MG IV SOLR|1 each|91300| 4,410.75 |||||||||| 2,866.99 | 2,999.31 | 3,219.85 | 3,219.85 | 3,440.39 | 2,646.45 | 2,866.99 | 3,308.06 | 3,749.14 | 3,916.75 | 3,881.46 | 3,308.06 | 3,749.14 ||| |REGADENOSON 0.4 MG/5ML IV SOLN|5 mL|91408| 499.20 |||||||||| 324.48 | 339.46 | 364.42 | 364.42 | 389.38 | 299.52 | 324.48 | 374.40 | 424.32 | 443.29 | 439.30 | 374.40 | 424.32 ||| |CERTOLIZUMAB PEGOL 2 X 200 MG SC KIT|200 mg (1 each)|91495| 9,513.10 |||||||||| 6,183.52 | 6,468.91 | 6,944.56 | 6,944.56 | 7,420.22 | 5,707.86 | 6,183.52 | 7,134.83 | 8,086.14 | 8,447.63 | 8,371.53 | 7,134.83 | 8,086.14 ||| |CERTOLIZUMAB PEGOL 2 X 200 MG SC KIT|400 mg (2 each)|91495| 19,026.15 |||||||||| 12,367.00 | 12,937.78 | 13,889.09 | 13,889.09 | 14,840.40 | 11,415.69 | 12,367.00 | 14,269.61 | 16,172.23 | 16,895.22 | 16,743.01 | 14,269.61 | 16,172.23 ||| |LUBIPROSTONE 8 MCG PO CAPS|60 each|91534| 792.45 |||||||||| 515.09 | 538.87 | 578.49 | 578.49 | 618.11 | 475.47 | 515.09 | 594.34 | 673.58 | 703.70 | 697.36 | 594.34 | 673.58 ||| |ASPIRIN-ACETAMINOPHEN-CAFFEINE 250-250-65 MG PO TABS|1 tablet (1 each)|9158| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |ASPIRIN-ACETAMINOPHEN-CAFFEINE 250-250-65 MG PO TABS|2 tablet (2 each)|9158| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN|.6 mL|91651| 268.70 |||||||||| 174.66 | 182.72 | 196.15 | 196.15 | 209.59 | 161.22 | 174.66 | 201.53 | 228.40 | 238.61 | 236.46 | 201.53 | 228.40 ||| |AZATHIOPRINE 50 MG PO TABS|100 each|9183| 162.35 |||||||||| 105.53 | 110.40 | 118.52 | 118.52 | 126.63 | 97.41 | 105.53 | 121.76 | 138.00 | 144.17 | 142.87 | 121.76 | 138.00 ||| |AZTREONAM 1 G IJ SOLR|1 g (1 each)|9185| 187.80 |||||||||| 122.07 | 127.70 | 137.09 | 137.09 | 146.48 | 112.68 | 122.07 | 140.85 | 159.63 | 166.77 | 165.26 | 140.85 | 159.63 ||| |AZTREONAM 1 G IJ SOLR|500 mg (0.5 each)|9185| 158.90 |||||||||| 103.29 | 108.05 | 116.00 | 116.00 | 123.94 | 95.34 | 103.29 | 119.18 | 135.07 | 141.10 | 139.83 | 119.18 | 135.07 ||| |AZTREONAM 2 G IJ SOLR|1 g (0.5 each)|9186| 188.70 |||||||||| 122.66 | 128.32 | 137.75 | 137.75 | 147.19 | 113.22 | 122.66 | 141.53 | 160.40 | 167.57 | 166.06 | 141.53 | 160.40 ||| |AZTREONAM 2 G IJ SOLR|2 g (1 each)|9186| 247.40 |||||||||| 160.81 | 168.23 | 180.60 | 180.60 | 192.97 | 148.44 | 160.81 | 185.55 | 210.29 | 219.69 | 217.71 | 185.55 | 210.29 ||| |AZTREONAM 2 G IJ SOLR|500 mg (0.25 each)|9186| 159.35 |||||||||| 103.58 | 108.36 | 116.33 | 116.33 | 124.29 | 95.61 | 103.58 | 119.51 | 135.45 | 141.50 | 140.23 | 119.51 | 135.45 ||| |AZTREONAM IN DEXTROSE 2 GM/50ML IV SOLN|50 mL|9189| 160.40 |||||||||| 104.26 | 109.07 | 117.09 | 117.09 | 125.11 | 96.24 | 104.26 | 120.30 | 136.34 | 142.44 | 141.15 | 120.30 | 136.34 ||| |THROMBIN (RECOMBINANT) 20000 UNITS EX SOLR|1 each|91965| 681.55 |||||||||| 443.01 | 463.45 | 497.53 | 497.53 | 531.61 | 408.93 | 443.01 | 511.16 | 579.32 | 605.22 | 599.76 | 511.16 | 579.32 ||| |ROPINIROLE HCL ER 2 MG PO TB24|30 each|92015| 156.25 |||||||||| 101.56 | 106.25 | 114.06 | 114.06 | 121.88 | 93.75 | 101.56 | 117.19 | 132.81 | 138.75 | 137.50 | 117.19 | 132.81 ||| |BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG RE SUPP|15 mg (0.5 each)|9219| 44.90 |||||||||| 29.19 | 30.53 | 32.78 | 32.78 | 35.02 | 26.94 | 29.19 | 33.68 | 38.17 | 39.87 | 39.51 | 33.68 | 38.17 ||| |BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG RE SUPP|30 mg (1 each)|9219| 67.75 |||||||||| 44.04 | 46.07 | 49.46 | 49.46 | 52.85 | 40.65 | 44.04 | 50.81 | 57.59 | 60.16 | 59.62 | 50.81 | 57.59 ||| |BENAZEPRIL HCL 10 MG PO TABS|100 each|9220| 166.10 |||||||||| 107.97 | 112.95 | 121.25 | 121.25 | 129.56 | 99.66 | 107.97 | 124.58 | 141.19 | 147.50 | 146.17 | 124.58 | 141.19 ||| |BENZOIN EX LIQD|118 mL|9243| 47.15 |||||||||| 30.65 | 32.06 | 34.42 | 34.42 | 36.78 | 28.29 | 30.65 | 35.36 | 40.08 | 41.87 | 41.49 | 35.36 | 40.08 ||| |BENZTROPINE MESYLATE 1 MG/ML IJ SOLN|2 mL|9259| 137.55 |||||||||| 89.41 | 93.53 | 100.41 | 100.41 | 107.29 | 82.53 | 89.41 | 103.16 | 116.92 | 122.14 | 121.04 | 103.16 | 116.92 ||| |BENZYLPENICILLOYL POLYLYSINE 0.25 ML ID SOLN|.25 mL|9260| 308.50 |||||||||| 200.53 | 209.78 | 225.21 | 225.21 | 240.63 | 185.10 | 200.53 | 231.38 | 262.23 | 273.95 | 271.48 | 231.38 | 262.23 ||| |BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP|5 mL|9266| 104.40 |||||||||| 67.86 | 70.99 | 76.21 | 76.21 | 81.43 | 62.64 | 67.86 | 78.30 | 88.74 | 92.71 | 91.87 | 78.30 | 88.74 ||| |BETAXOLOL HCL 0.5 % OP SOLN|5 mL|9268| 130.00 |||||||||| 84.50 | 88.40 | 94.90 | 94.90 | 101.40 | 78.00 | 84.50 | 97.50 | 110.50 | 115.44 | 114.40 | 97.50 | 110.50 ||| |DTAP-IPV VACCINE IM SUSP|.5 mL|92788| 134.95 |||||||||| 87.72 | 91.77 | 98.51 | 98.51 | 105.26 | 80.97 | 87.72 | 101.21 | 114.71 | 119.84 | 118.76 | 101.21 | 114.71 ||| |DARUNAVIR ETHANOLATE 600 MG PO TABS|60 each|92851| 3,687.70 |||||||||| 2,397.01 | 2,507.64 | 2,692.02 | 2,692.02 | 2,876.41 | 2,212.62 | 2,397.01 | 2,765.78 | 3,134.55 | 3,274.68 | 3,245.18 | 2,765.78 | 3,134.55 ||| |COAGULATION FACTOR VIIA RECOMB 1 MG IV SOLR|1000 mcg|92853| 4,787.00 |||||||||| 3,111.55 | 3,255.16 | 3,494.51 | 3,494.51 | 3,733.86 | 2,872.20 | 3,111.55 | 3,590.25 | 4,068.95 | 4,250.86 | 4,212.56 | 3,590.25 | 4,068.95 ||| |COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR|2000 mcg|92854| 8,546.75 |||||||||| 5,555.39 | 5,811.79 | 6,239.13 | 6,239.13 | 6,666.47 | 5,128.05 | 5,555.39 | 6,410.06 | 7,264.74 | 7,589.51 | 7,521.14 | 6,410.06 | 7,264.74 ||| |BLEOMYCIN SULFATE 15 UNITS IJ SOLR|2 Units (0.1333333333333333333 each)|9289| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |VANCOMYCIN HCL IN DEXTROSE 1-5 GM/200ML-% IV SOLN|200 mL|92895| 174.50 |||||||||| 113.43 | 118.66 | 127.39 | 127.39 | 136.11 | 104.70 | 113.43 | 130.88 | 148.33 | 154.96 | 153.56 | 130.88 | 148.33 ||| |BROMOCRIPTINE MESYLATE 2.5 MG PO TABS|100 each|9297| 938.15 |||||||||| 609.80 | 637.94 | 684.85 | 684.85 | 731.76 | 562.89 | 609.80 | 703.61 | 797.43 | 833.08 | 825.57 | 703.61 | 797.43 ||| |BUMETANIDE 0.25 MG/ML IJ SOLN|10 mL|9308| 38.65 |||||||||| 25.12 | 26.28 | 28.21 | 28.21 | 30.15 | 23.19 | 25.12 | 28.99 | 32.85 | 34.32 | 34.01 | 28.99 | 32.85 ||| |AMIODARONE HCL 150 MG/3ML IV SOLN|3 mL|93084| 40.60 |||||||||| 26.39 | 27.61 | 29.64 | 29.64 | 31.67 | 24.36 | 26.39 | 30.45 | 34.51 | 36.05 | 35.73 | 30.45 | 34.51 ||| |BUMETANIDE 1 MG PO TABS|100 each|9310| 166.95 |||||||||| 108.52 | 113.53 | 121.87 | 121.87 | 130.22 | 100.17 | 108.52 | 125.21 | 141.91 | 148.25 | 146.92 | 125.21 | 141.91 ||| |BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN|2 mL|9316| 43.25 |||||||||| 28.11 | 29.41 | 31.57 | 31.57 | 33.74 | 25.95 | 28.11 | 32.44 | 36.76 | 38.41 | 38.06 | 32.44 | 36.76 ||| |BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN|50 mL|9317| 44.10 |||||||||| 28.67 | 29.99 | 32.19 | 32.19 | 34.40 | 26.46 | 28.67 | 33.08 | 37.49 | 39.16 | 38.81 | 33.08 | 37.49 ||| |BUPIVACAINE-EPINEPHRINE 0.5% -1:200000 IJ SOLN|50 mL|9318| 61.15 |||||||||| 39.75 | 41.58 | 44.64 | 44.64 | 47.70 | 36.69 | 39.75 | 45.86 | 51.98 | 54.30 | 53.81 | 45.86 | 51.98 ||| |BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN|1 mL|9320| 62.60 |||||||||| 40.69 | 42.57 | 45.70 | 45.70 | 48.83 | 37.56 | 40.69 | 46.95 | 53.21 | 55.59 | 55.09 | 46.95 | 53.21 ||| |BUPROPION HCL 100 MG PO TABS|100 each|9321| 160.50 |||||||||| 104.33 | 109.14 | 117.17 | 117.17 | 125.19 | 96.30 | 104.33 | 120.38 | 136.43 | 142.52 | 141.24 | 120.38 | 136.43 ||| |BUPROPION HCL 75 MG PO TABS|100 each|9322| 249.95 |||||||||| 162.47 | 169.97 | 182.46 | 182.46 | 194.96 | 149.97 | 162.47 | 187.46 | 212.46 | 221.96 | 219.96 | 187.46 | 212.46 ||| |BUSPIRONE HCL 10 MG PO TABS|100 each|9323| 32.60 |||||||||| 21.19 | 22.17 | 23.80 | 23.80 | 25.43 | 19.56 | 21.19 | 24.45 | 27.71 | 28.95 | 28.69 | 24.45 | 27.71 ||| |BUSPIRONE HCL 5 MG PO TABS|1 each|9324| 11.25 |||||||||| 7.31 | 7.65 | 8.21 | 8.21 | 8.78 | 6.75 | 7.31 | 8.44 | 9.56 | 9.99 | 9.90 | 8.44 | 9.56 ||| |BUTAMBEN-TETRACAINE-BENZOCAINE 2-2-14 % EX AERO|20 g|9328| 122.50 |||||||||| 79.63 | 83.30 | 89.43 | 89.43 | 95.55 | 73.50 | 79.63 | 91.88 | 104.13 | 108.78 | 107.80 | 91.88 | 104.13 ||| |BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN|1 mL|9333| 42.25 |||||||||| 27.46 | 28.73 | 30.84 | 30.84 | 32.96 | 25.35 | 27.46 | 31.69 | 35.91 | 37.52 | 37.18 | 31.69 | 35.91 ||| |BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN|1 mL|9334| 57.25 |||||||||| 37.21 | 38.93 | 41.79 | 41.79 | 44.66 | 34.35 | 37.21 | 42.94 | 48.66 | 50.84 | 50.38 | 42.94 | 48.66 ||| |CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN|2 mL|9347| 4,332.25 |||||||||| 2,815.96 | 2,945.93 | 3,162.54 | 3,162.54 | 3,379.16 | 2,599.35 | 2,815.96 | 3,249.19 | 3,682.41 | 3,847.04 | 3,812.38 | 3,249.19 | 3,682.41 ||| |CALCITRIOL 0.25 MCG PO CAPS|1 each|9350| 12.35 |||||||||| 8.03 | 8.40 | 9.02 | 9.02 | 9.63 | 7.41 | 8.03 | 9.26 | 10.50 | 10.97 | 10.87 | 9.26 | 10.50 ||| |CALCITRIOL 0.5 MCG PO CAPS|100 each|9351| 110.05 |||||||||| 71.53 | 74.83 | 80.34 | 80.34 | 85.84 | 66.03 | 71.53 | 82.54 | 93.54 | 97.72 | 96.84 | 82.54 | 93.54 ||| |MIDAZOLAM HCL 50 MG/10ML IJ SOLN|10 mL|93523| 51.50 |||||||||| 33.48 | 35.02 | 37.60 | 37.60 | 40.17 | 30.90 | 33.48 | 38.63 | 43.78 | 45.73 | 45.32 | 38.63 | 43.78 ||| |ROMIPLOSTIM 250 MCG SC SOLR|1 each|93566| 4,005.60 |||||||||| 2,603.64 | 2,723.81 | 2,924.09 | 2,924.09 | 3,124.37 | 2,403.36 | 2,603.64 | 3,004.20 | 3,404.76 | 3,556.97 | 3,524.93 | 3,004.20 | 3,404.76 ||| |ROMIPLOSTIM 500 MCG SC SOLR|1 each|93567| 8,011.15 |||||||||| 5,207.25 | 5,447.58 | 5,848.14 | 5,848.14 | 6,248.70 | 4,806.69 | 5,207.25 | 6,008.36 | 6,809.48 | 7,113.90 | 7,049.81 | 6,008.36 | 6,809.48 ||| |GADOXETATE DISODIUM 0.25 MOL/L IV SOLN|10 mL|93574| 142.00 |||||||||| 92.30 | 96.56 | 103.66 | 103.66 | 110.76 | 85.20 | 92.30 | 106.50 | 120.70 | 126.10 | 124.96 | 106.50 | 120.70 ||| |MITOXANTRONE HCL 25 MG/12.5ML IV CONC|12.5 mL|93747| 561.75 |||||||||| 365.14 | 381.99 | 410.08 | 410.08 | 438.17 | 337.05 | 365.14 | 421.31 | 477.49 | 498.83 | 494.34 | 421.31 | 477.49 ||| |CALCIUM CARBONATE ANTACID 500 MG PO CHEW|1,000 mg (2 each)|9385| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |CALCIUM CARBONATE ANTACID 500 MG PO CHEW|500 mg (1 each)|9385| 11.05 |||||||||| 7.18 | 7.51 | 8.07 | 8.07 | 8.62 | 6.63 | 7.18 | 8.29 | 9.39 | 9.81 | 9.72 | 8.29 | 9.39 ||| |SORBITOL 70 % SOLN|473 mL|93927| 31.75 |||||||||| 20.64 | 21.59 | 23.18 | 23.18 | 24.77 | 19.05 | 20.64 | 23.81 | 26.99 | 28.19 | 27.94 | 23.81 | 26.99 ||| |CAPTOPRIL 12.5 MG PO TABS|30 each|9401| 110.15 |||||||||| 71.60 | 74.90 | 80.41 | 80.41 | 85.92 | 66.09 | 71.60 | 82.61 | 93.63 | 97.81 | 96.93 | 82.61 | 93.63 ||| |CAPTOPRIL 25 MG PO TABS|100 each|9402| 344.45 |||||||||| 223.89 | 234.23 | 251.45 | 251.45 | 268.67 | 206.67 | 223.89 | 258.34 | 292.78 | 305.87 | 303.12 | 258.34 | 292.78 ||| |CARBIDOPA-LEVODOPA 10-100 MG PO TABS|0.5 tablet (0.5 each)|9406| 11.30 |||||||||| 7.35 | 7.68 | 8.25 | 8.25 | 8.81 | 6.78 | 7.35 | 8.48 | 9.61 | 10.03 | 9.94 | 8.48 | 9.61 ||| |CARBIDOPA-LEVODOPA 10-100 MG PO TABS|1 tablet (1 each)|9406| 11.55 |||||||||| 7.51 | 7.85 | 8.43 | 8.43 | 9.01 | 6.93 | 7.51 | 8.66 | 9.82 | 10.26 | 10.16 | 8.66 | 9.82 ||| |CARBIDOPA-LEVODOPA 10-100 MG PO TABS|2 tablet (2 each)|9406| 12.10 |||||||||| 7.87 | 8.23 | 8.83 | 8.83 | 9.44 | 7.26 | 7.87 | 9.08 | 10.29 | 10.74 | 10.65 | 9.08 | 10.29 ||| |CARBIDOPA-LEVODOPA 25-100 MG PO TABS|0.5 tablet (0.5 each)|9407| 11.40 |||||||||| 7.41 | 7.75 | 8.32 | 8.32 | 8.89 | 6.84 | 7.41 | 8.55 | 9.69 | 10.12 | 10.03 | 8.55 | 9.69 ||| |CARBIDOPA-LEVODOPA 25-100 MG PO TABS|1 tablet (1 each)|9407| 11.80 |||||||||| 7.67 | 8.02 | 8.61 | 8.61 | 9.20 | 7.08 | 7.67 | 8.85 | 10.03 | 10.48 | 10.38 | 8.85 | 10.03 ||| |CARBIDOPA-LEVODOPA 25-100 MG PO TABS|2 tablet (2 each)|9407| 12.55 |||||||||| 8.16 | 8.53 | 9.16 | 9.16 | 9.79 | 7.53 | 8.16 | 9.41 | 10.67 | 11.14 | 11.04 | 9.41 | 10.67 ||| |CARBIDOPA-LEVODOPA 25-250 MG PO TABS|1 tablet (1 each)|9408| 12.05 |||||||||| 7.83 | 8.19 | 8.80 | 8.80 | 9.40 | 7.23 | 7.83 | 9.04 | 10.24 | 10.70 | 10.60 | 9.04 | 10.24 ||| |CARBIDOPA-LEVODOPA 25-250 MG PO TABS|2 tablet (2 each)|9408| 13.10 |||||||||| 8.52 | 8.91 | 9.56 | 9.56 | 10.22 | 7.86 | 8.52 | 9.83 | 11.14 | 11.63 | 11.53 | 9.83 | 11.14 ||| |CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN|1 mL|9413| 634.45 |||||||||| 412.39 | 431.43 | 463.15 | 463.15 | 494.87 | 380.67 | 412.39 | 475.84 | 539.28 | 563.39 | 558.32 | 475.84 | 539.28 ||| |CHEWABLE VITE/IRON CHILDRENS 15 MG PO CHEW|100 each|94479| 24.30 |||||||||| 15.80 | 16.52 | 17.74 | 17.74 | 18.95 | 14.58 | 15.80 | 18.23 | 20.66 | 21.58 | 21.38 | 18.23 | 20.66 ||| |CEFOTAXIME SODIUM 1 G IJ SOLR|1 g (1 each)|9452| 133.90 |||||||||| 87.04 | 91.05 | 97.75 | 97.75 | 104.44 | 80.34 | 87.04 | 100.43 | 113.82 | 118.90 | 117.83 | 100.43 | 113.82 ||| |CEFOTAXIME SODIUM 1 G IJ SOLR|2 g (2 each)|9452| 137.75 |||||||||| 89.54 | 93.67 | 100.56 | 100.56 | 107.45 | 82.65 | 89.54 | 103.31 | 117.09 | 122.32 | 121.22 | 103.31 | 117.09 ||| |CEFOTAXIME SODIUM 500 MG IJ SOLR|250 mg (0.5 each)|9455| 131.35 |||||||||| 85.38 | 89.32 | 95.89 | 95.89 | 102.45 | 78.81 | 85.38 | 98.51 | 111.65 | 116.64 | 115.59 | 98.51 | 111.65 ||| |CEFOTAXIME SODIUM 500 MG IJ SOLR|500 mg (1 each)|9455| 132.65 |||||||||| 86.22 | 90.20 | 96.83 | 96.83 | 103.47 | 79.59 | 86.22 | 99.49 | 112.75 | 117.79 | 116.73 | 99.49 | 112.75 ||| |CEFOXITIN SODIUM 2 G IV SOLR|2 g (1 each)|9463| 57.55 |||||||||| 37.41 | 39.13 | 42.01 | 42.01 | 44.89 | 34.53 | 37.41 | 43.16 | 48.92 | 51.10 | 50.64 | 43.16 | 48.92 ||| |CEFTAZIDIME 1 G IJ SOLR|1 g (1 each)|9474| 139.15 |||||||||| 90.45 | 94.62 | 101.58 | 101.58 | 108.54 | 83.49 | 90.45 | 104.36 | 118.28 | 123.57 | 122.45 | 104.36 | 118.28 ||| |CEFTAZIDIME 1 G IJ SOLR|2 g (2 each)|9474| 148.25 |||||||||| 96.36 | 100.81 | 108.22 | 108.22 | 115.64 | 88.95 | 96.36 | 111.19 | 126.01 | 131.65 | 130.46 | 111.19 | 126.01 ||| |CEFTAZIDIME 2 G IJ SOLR|1 g (0.5 each)|9476| 139.65 |||||||||| 90.77 | 94.96 | 101.94 | 101.94 | 108.93 | 83.79 | 90.77 | 104.74 | 118.70 | 124.01 | 122.89 | 104.74 | 118.70 ||| |CEFTAZIDIME 2 G IJ SOLR|2 g (1 each)|9476| 149.30 |||||||||| 97.05 | 101.52 | 108.99 | 108.99 | 116.45 | 89.58 | 97.05 | 111.98 | 126.91 | 132.58 | 131.38 | 111.98 | 126.91 ||| |CEFTRIAXONE SODIUM 1 G IJ SOLR|1,000 mg (1 each)|9487| 138.20 |||||||||| 89.83 | 93.98 | 100.89 | 100.89 | 107.80 | 82.92 | 89.83 | 103.65 | 117.47 | 122.72 | 121.62 | 103.65 | 117.47 ||| |CEFTRIAXONE SODIUM 1 G IJ SOLR|2,000 mg (2 each)|9487| 146.40 |||||||||| 95.16 | 99.55 | 106.87 | 106.87 | 114.19 | 87.84 | 95.16 | 109.80 | 124.44 | 130.00 | 128.83 | 109.80 | 124.44 ||| |CEFTRIAXONE SODIUM 1 G IJ SOLR|500 mg (0.5 each)|9487| 134.10 |||||||||| 87.17 | 91.19 | 97.89 | 97.89 | 104.60 | 80.46 | 87.17 | 100.58 | 113.99 | 119.08 | 118.01 | 100.58 | 113.99 ||| |CEFTRIAXONE SODIUM 250 MG IJ SOLR|250 mg (1 each)|9489| 131.35 |||||||||| 85.38 | 89.32 | 95.89 | 95.89 | 102.45 | 78.81 | 85.38 | 98.51 | 111.65 | 116.64 | 115.59 | 98.51 | 111.65 ||| |CEFTRIAXONE SODIUM 250 MG IJ SOLR|500 mg (2 each)|9489| 132.65 |||||||||| 86.22 | 90.20 | 96.83 | 96.83 | 103.47 | 79.59 | 86.22 | 99.49 | 112.75 | 117.79 | 116.73 | 99.49 | 112.75 ||| |CEFTRIAXONE SODIUM 500 MG IJ SOLR|500 mg (1 each)|9490| 131.70 |||||||||| 85.61 | 89.56 | 96.14 | 96.14 | 102.73 | 79.02 | 85.61 | 98.78 | 111.95 | 116.95 | 115.90 | 98.78 | 111.95 ||| |CEFTRIAXONE SODIUM 10 G IV SOLR|0.5 g (0.05 each)|9491| 131.50 |||||||||| 85.48 | 89.42 | 96.00 | 96.00 | 102.57 | 78.90 | 85.48 | 98.63 | 111.78 | 116.77 | 115.72 | 98.63 | 111.78 ||| |CEFTRIAXONE SODIUM 10 G IV SOLR|1 g (0.1 each)|9491| 133.00 |||||||||| 86.45 | 90.44 | 97.09 | 97.09 | 103.74 | 79.80 | 86.45 | 99.75 | 113.05 | 118.10 | 117.04 | 99.75 | 113.05 ||| |CEFTRIAXONE SODIUM 10 G IV SOLR|2 g (0.2 each)|9491| 136.00 |||||||||| 88.40 | 92.48 | 99.28 | 99.28 | 106.08 | 81.60 | 88.40 | 102.00 | 115.60 | 120.77 | 119.68 | 102.00 | 115.60 ||| |CEFUROXIME AXETIL 250 MG PO TABS|20 each|9495| 34.65 |||||||||| 22.52 | 23.56 | 25.29 | 25.29 | 27.03 | 20.79 | 22.52 | 25.99 | 29.45 | 30.77 | 30.49 | 25.99 | 29.45 ||| |CEPHALEXIN 250 MG PO CAPS|100 each|9499| 44.85 |||||||||| 29.15 | 30.50 | 32.74 | 32.74 | 34.98 | 26.91 | 29.15 | 33.64 | 38.12 | 39.83 | 39.47 | 33.64 | 38.12 ||| |CEPHALEXIN 500 MG PO CAPS|500 each|9500| 320.95 |||||||||| 208.62 | 218.25 | 234.29 | 234.29 | 250.34 | 192.57 | 208.62 | 240.71 | 272.81 | 285.00 | 282.44 | 240.71 | 272.81 ||| |CEPHALEXIN 125 MG/5ML PO SUSR|100 mL|9501| 61.45 |||||||||| 39.94 | 41.79 | 44.86 | 44.86 | 47.93 | 36.87 | 39.94 | 46.09 | 52.23 | 54.57 | 54.08 | 46.09 | 52.23 ||| |CEPHALEXIN 250 MG/5ML PO SUSR|100 mL|9502| 69.75 |||||||||| 45.34 | 47.43 | 50.92 | 50.92 | 54.41 | 41.85 | 45.34 | 52.31 | 59.29 | 61.94 | 61.38 | 52.31 | 59.29 ||| |CETIRIZINE HCL 10 MG PO TABS|300 each|9506| 126.05 |||||||||| 81.93 | 85.71 | 92.02 | 92.02 | 98.32 | 75.63 | 81.93 | 94.54 | 107.14 | 111.93 | 110.92 | 94.54 | 107.14 ||| |CHLORAMBUCIL 2 MG PO TABS|50 each|9513| 2,126.35 |||||||||| 1,382.13 | 1,445.92 | 1,552.24 | 1,552.24 | 1,658.55 | 1,275.81 | 1,382.13 | 1,594.76 | 1,807.40 | 1,888.20 | 1,871.19 | 1,594.76 | 1,807.40 ||| |CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN|15 mL|9516| 34.35 |||||||||| 22.33 | 23.36 | 25.08 | 25.08 | 26.79 | 20.61 | 22.33 | 25.76 | 29.20 | 30.50 | 30.23 | 25.76 | 29.20 ||| |CHLOROTHIAZIDE 250 MG/5ML PO SUSP|237 mL|9525| 165.20 |||||||||| 107.38 | 112.34 | 120.60 | 120.60 | 128.86 | 99.12 | 107.38 | 123.90 | 140.42 | 146.70 | 145.38 | 123.90 | 140.42 ||| |CHLOROTHIAZIDE SODIUM 500 MG IV SOLR|1,000 mg (2 each)|9526| 409.75 |||||||||| 266.34 | 278.63 | 299.12 | 299.12 | 319.61 | 245.85 | 266.34 | 307.31 | 348.29 | 363.86 | 360.58 | 307.31 | 348.29 ||| |CHLOROTHIAZIDE SODIUM 500 MG IV SOLR|500 mg (1 each)|9526| 221.90 |||||||||| 144.24 | 150.89 | 161.99 | 161.99 | 173.08 | 133.14 | 144.24 | 166.43 | 188.62 | 197.05 | 195.27 | 166.43 | 188.62 ||| |MESALAMINE ER 0.375 G PO CP24|1.5 g (4 each)|95687| 57.35 |||||||||| 37.28 | 39.00 | 41.87 | 41.87 | 44.73 | 34.41 | 37.28 | 43.01 | 48.75 | 50.93 | 50.47 | 43.01 | 48.75 ||| |RUFINAMIDE 200 MG PO TABS|120 each|95691| 3,177.65 |||||||||| 2,065.47 | 2,160.80 | 2,319.68 | 2,319.68 | 2,478.57 | 1,906.59 | 2,065.47 | 2,383.24 | 2,701.00 | 2,821.75 | 2,796.33 | 2,383.24 | 2,701.00 ||| |FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN|.5 mL|95693| 11.10 |||||||||| 7.22 | 7.55 | 8.10 | 8.10 | 8.66 | 6.66 | 7.22 | 8.33 | 9.44 | 9.86 | 9.77 | 8.33 | 9.44 ||| |CHOLINE FENOFIBRATE 135 MG PO CPDR|90 each|95840| 269.95 |||||||||| 175.47 | 183.57 | 197.06 | 197.06 | 210.56 | 161.97 | 175.47 | 202.46 | 229.46 | 239.72 | 237.56 | 202.46 | 229.46 ||| |CHOLESTYRAMINE 4 G PO PACK|4 g (1 each)|9588| 15.30 |||||||||| 9.95 | 10.40 | 11.17 | 11.17 | 11.93 | 9.18 | 9.95 | 11.48 | 13.01 | 13.59 | 13.46 | 11.48 | 13.01 ||| |CHOLESTYRAMINE 4 G PO PACK|8 g (2 each)|9588| 25.55 |||||||||| 16.61 | 17.37 | 18.65 | 18.65 | 19.93 | 15.33 | 16.61 | 19.16 | 21.72 | 22.69 | 22.48 | 19.16 | 21.72 ||| |IMIPENEM-CILASTATIN 500 MG IV SOLR|1,000 mg (2 each)|9603| 217.70 |||||||||| 141.51 | 148.04 | 158.92 | 158.92 | 169.81 | 130.62 | 141.51 | 163.28 | 185.05 | 193.32 | 191.58 | 163.28 | 185.05 ||| |IMIPENEM-CILASTATIN 500 MG IV SOLR|250 mg (0.5 each)|9603| 151.95 |||||||||| 98.77 | 103.33 | 110.92 | 110.92 | 118.52 | 91.17 | 98.77 | 113.96 | 129.16 | 134.93 | 133.72 | 113.96 | 129.16 ||| |IMIPENEM-CILASTATIN 500 MG IV SOLR|500 mg (1 each)|9603| 173.85 |||||||||| 113.00 | 118.22 | 126.91 | 126.91 | 135.60 | 104.31 | 113.00 | 130.39 | 147.77 | 154.38 | 152.99 | 130.39 | 147.77 ||| |IMIPENEM-CILASTATIN 500 MG IV SOLR|750 mg (1.5 each)|9603| 195.75 |||||||||| 127.24 | 133.11 | 142.90 | 142.90 | 152.69 | 117.45 | 127.24 | 146.81 | 166.39 | 173.83 | 172.26 | 146.81 | 166.39 ||| |CIPROFLOXACIN HCL 0.3 % OP SOLN|5 mL|9610| 81.50 |||||||||| 52.98 | 55.42 | 59.50 | 59.50 | 63.57 | 48.90 | 52.98 | 61.13 | 69.28 | 72.37 | 71.72 | 61.13 | 69.28 ||| |CLARITHROMYCIN 250 MG PO TABS|60 each|9616| 143.70 |||||||||| 93.41 | 97.72 | 104.90 | 104.90 | 112.09 | 86.22 | 93.41 | 107.78 | 122.15 | 127.61 | 126.46 | 107.78 | 122.15 ||| |CLARITHROMYCIN 500 MG PO TABS|60 each|9617| 143.70 |||||||||| 93.41 | 97.72 | 104.90 | 104.90 | 112.09 | 86.22 | 93.41 | 107.78 | 122.15 | 127.61 | 126.46 | 107.78 | 122.15 ||| |CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN|50 mL|9626| 152.35 |||||||||| 99.03 | 103.60 | 111.22 | 111.22 | 118.83 | 91.41 | 99.03 | 114.26 | 129.50 | 135.29 | 134.07 | 114.26 | 129.50 ||| |CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN|50 mL|9627| 156.25 |||||||||| 101.56 | 106.25 | 114.06 | 114.06 | 121.88 | 93.75 | 101.56 | 117.19 | 132.81 | 138.75 | 137.50 | 117.19 | 132.81 ||| |CLOBETASOL PROPIONATE 0.05 % EX CREA|15 g|9630| 52.85 |||||||||| 34.35 | 35.94 | 38.58 | 38.58 | 41.22 | 31.71 | 34.35 | 39.64 | 44.92 | 46.93 | 46.51 | 39.64 | 44.92 ||| |CLOBETASOL PROPIONATE 0.05 % EX OINT|15 g|9631| 106.80 |||||||||| 69.42 | 72.62 | 77.96 | 77.96 | 83.30 | 64.08 | 69.42 | 80.10 | 90.78 | 94.84 | 93.98 | 80.10 | 90.78 ||| |CLOMIPRAMINE HCL 25 MG PO CAPS|30 each|9635| 442.10 |||||||||| 287.37 | 300.63 | 322.73 | 322.73 | 344.84 | 265.26 | 287.37 | 331.58 | 375.79 | 392.58 | 389.05 | 331.58 | 375.79 ||| |CLONAZEPAM 0.5 MG PO TABS|100 each|9637| 23.25 |||||||||| 15.11 | 15.81 | 16.97 | 16.97 | 18.14 | 13.95 | 15.11 | 17.44 | 19.76 | 20.65 | 20.46 | 17.44 | 19.76 ||| |CLONAZEPAM 1 MG PO TABS|100 each|9638| 25.95 |||||||||| 16.87 | 17.65 | 18.94 | 18.94 | 20.24 | 15.57 | 16.87 | 19.46 | 22.06 | 23.04 | 22.84 | 19.46 | 22.06 ||| |CLONAZEPAM 2 MG PO TABS|100 each|9639| 29.90 |||||||||| 19.44 | 20.33 | 21.83 | 21.83 | 23.32 | 17.94 | 19.44 | 22.43 | 25.42 | 26.55 | 26.31 | 22.43 | 25.42 ||| |CLOTRIMAZOLE 10 MG MT TROC|10 mg (1 each)|9644| 13.40 |||||||||| 8.71 | 9.11 | 9.78 | 9.78 | 10.45 | 8.04 | 8.71 | 10.05 | 11.39 | 11.90 | 11.79 | 10.05 | 11.39 ||| |CLOZAPINE 100 MG PO TABS|100 each|9647| 368.70 |||||||||| 239.66 | 250.72 | 269.15 | 269.15 | 287.59 | 221.22 | 239.66 | 276.53 | 313.40 | 327.41 | 324.46 | 276.53 | 313.40 ||| |CLOZAPINE 25 MG PO TABS|100 each|9648| 158.00 |||||||||| 102.70 | 107.44 | 115.34 | 115.34 | 123.24 | 94.80 | 102.70 | 118.50 | 134.30 | 140.30 | 139.04 | 118.50 | 134.30 ||| |COLLAGENASE 250 UNIT/GM EX OINT|30 g|9682| 502.30 |||||||||| 326.50 | 341.56 | 366.68 | 366.68 | 391.79 | 301.38 | 326.50 | 376.73 | 426.96 | 446.04 | 442.02 | 376.73 | 426.96 ||| |COSYNTROPIN 0.25 MG IJ SOLR|0.25 mg (1 each)|9686| 200.00 |||||||||| 130.00 | 136.00 | 146.00 | 146.00 | 156.00 | 120.00 | 130.00 | 150.00 | 170.00 | 177.60 | 176.00 | 150.00 | 170.00 ||| |COSYNTROPIN 0.25 MG IJ SOLR|0.5 mg (2 each)|9686| 365.95 |||||||||| 237.87 | 248.85 | 267.14 | 267.14 | 285.44 | 219.57 | 237.87 | 274.46 | 311.06 | 324.96 | 322.04 | 274.46 | 311.06 ||| |COSYNTROPIN 0.25 MG IJ SOLR|0.75 mg (3 each)|9686| 531.90 |||||||||| 345.74 | 361.69 | 388.29 | 388.29 | 414.88 | 319.14 | 345.74 | 398.93 | 452.12 | 472.33 | 468.07 | 398.93 | 452.12 ||| |CHOLECALCIFEROL 400 UNIT/ML PO LIQD|1 mL|96930| 11.30 |||||||||| 7.35 | 7.68 | 8.25 | 8.25 | 8.81 | 6.78 | 7.35 | 8.48 | 9.61 | 10.03 | 9.94 | 8.48 | 9.61 ||| |ARMODAFINIL 50 MG PO TABS|30 each|96965| 606.20 |||||||||| 394.03 | 412.22 | 442.53 | 442.53 | 472.84 | 363.72 | 394.03 | 454.65 | 515.27 | 538.31 | 533.46 | 454.65 | 515.27 ||| |LACOSAMIDE 200 MG/20ML IV SOLN|20 mL|96972| 180.65 |||||||||| 117.42 | 122.84 | 131.87 | 131.87 | 140.91 | 108.39 | 117.42 | 135.49 | 153.55 | 160.42 | 158.97 | 135.49 | 153.55 ||| |CYTARABINE (PF) 20 MG/ML IJ SOLN|5 mL|96982| 27.00 |||||||||| 17.55 | 18.36 | 19.71 | 19.71 | 21.06 | 16.20 | 17.55 | 20.25 | 22.95 | 23.98 | 23.76 | 20.25 | 22.95 ||| |DEGARELIX ACETATE 80 MG SC SOLR|1 each|96986| 1,003.55 |||||||||| 652.31 | 682.41 | 732.59 | 732.59 | 782.77 | 602.13 | 652.31 | 752.66 | 853.02 | 891.15 | 883.12 | 752.66 | 853.02 ||| |CONIVAPTAN HCL IN DEXTROSE 20-5 MG/100ML-% IV SOLN|100 mL|96988| 1,252.80 |||||||||| 814.32 | 851.90 | 914.54 | 914.54 | 977.18 | 751.68 | 814.32 | 939.60 | 1,064.88 | 1,112.49 | 1,102.46 | 939.60 | 1,064.88 ||| |CYCLOPENTOLATE HCL 2 % OP SOLN|2 mL|9700| 101.90 |||||||||| 66.24 | 69.29 | 74.39 | 74.39 | 79.48 | 61.14 | 66.24 | 76.43 | 86.62 | 90.49 | 89.67 | 76.43 | 86.62 ||| |CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN|2 mL|9701| 88.25 |||||||||| 57.36 | 60.01 | 64.42 | 64.42 | 68.84 | 52.95 | 57.36 | 66.19 | 75.01 | 78.37 | 77.66 | 66.19 | 75.01 ||| |CYCLOSPORINE 50 MG/ML IV SOLN|5 mL|9705| 198.60 |||||||||| 129.09 | 135.05 | 144.98 | 144.98 | 154.91 | 119.16 | 129.09 | 148.95 | 168.81 | 176.36 | 174.77 | 148.95 | 168.81 ||| |CYCLOSPORINE 25 MG PO CAPS|1 each|9707| 25.10 |||||||||| 16.32 | 17.07 | 18.32 | 18.32 | 19.58 | 15.06 | 16.32 | 18.83 | 21.34 | 22.29 | 22.09 | 18.83 | 21.34 ||| |MILNACIPRAN HCL 50 MG PO TABS|60 each|97089| 854.60 |||||||||| 555.49 | 581.13 | 623.86 | 623.86 | 666.59 | 512.76 | 555.49 | 640.95 | 726.41 | 758.88 | 752.05 | 640.95 | 726.41 ||| |CYTARABINE 20 MG/ML IJ SOLN|25 mL|9709| 53.90 |||||||||| 35.04 | 36.65 | 39.35 | 39.35 | 42.04 | 32.34 | 35.04 | 40.43 | 45.82 | 47.86 | 47.43 | 40.43 | 45.82 ||| |FEBUXOSTAT 40 MG PO TABS|30 each|97133| 613.30 |||||||||| 398.65 | 417.04 | 447.71 | 447.71 | 478.37 | 367.98 | 398.65 | 459.98 | 521.31 | 544.61 | 539.70 | 459.98 | 521.31 ||| |DANTROLENE SODIUM 20 MG IV SOLR|1 each|9716| 186.50 |||||||||| 121.23 | 126.82 | 136.15 | 136.15 | 145.47 | 111.90 | 121.23 | 139.88 | 158.53 | 165.61 | 164.12 | 139.88 | 158.53 ||| |DANTROLENE SODIUM 25 MG PO CAPS|30 each|9718| 123.40 |||||||||| 80.21 | 83.91 | 90.08 | 90.08 | 96.25 | 74.04 | 80.21 | 92.55 | 104.89 | 109.58 | 108.59 | 92.55 | 104.89 ||| |DEFEROXAMINE MESYLATE 2 G IJ SOLR|1 each|9722| 107.55 |||||||||| 69.91 | 73.13 | 78.51 | 78.51 | 83.89 | 64.53 | 69.91 | 80.66 | 91.42 | 95.50 | 94.64 | 80.66 | 91.42 ||| |DEFEROXAMINE MESYLATE 500 MG IJ SOLR|1,000 mg (2 each)|9723| 175.45 |||||||||| 114.04 | 119.31 | 128.08 | 128.08 | 136.85 | 105.27 | 114.04 | 131.59 | 149.13 | 155.80 | 154.40 | 131.59 | 149.13 ||| |DEFEROXAMINE MESYLATE 500 MG IJ SOLR|500 mg (1 each)|9723| 152.75 |||||||||| 99.29 | 103.87 | 111.51 | 111.51 | 119.15 | 91.65 | 99.29 | 114.56 | 129.84 | 135.64 | 134.42 | 114.56 | 129.84 ||| |DILTIAZEM HCL 125 MG/25ML IV SOLN|25 mL|97253| 149.20 |||||||||| 96.98 | 101.46 | 108.92 | 108.92 | 116.38 | 89.52 | 96.98 | 111.90 | 126.82 | 132.49 | 131.30 | 111.90 | 126.82 ||| |DILTIAZEM HCL 50 MG/10ML IV SOLN|10 mL|97254| 44.70 |||||||||| 29.06 | 30.40 | 32.63 | 32.63 | 34.87 | 26.82 | 29.06 | 33.53 | 38.00 | 39.69 | 39.34 | 33.53 | 38.00 ||| |DEMECLOCYCLINE HCL 150 MG PO TABS|100 each|9726| 1,336.55 |||||||||| 868.76 | 908.85 | 975.68 | 975.68 | 1,042.51 | 801.93 | 868.76 | 1,002.41 | 1,136.07 | 1,186.86 | 1,176.16 | 1,002.41 | 1,136.07 ||| |TEMOZOLOMIDE 100 MG IV SOLR|1 each|97260| 1,488.85 |||||||||| 967.75 | 1,012.42 | 1,086.86 | 1,086.86 | 1,161.30 | 893.31 | 967.75 | 1,116.64 | 1,265.52 | 1,322.10 | 1,310.19 | 1,116.64 | 1,265.52 ||| |DESFLURANE IN SOLN|240 mL|9747| 335.80 |||||||||| 218.27 | 228.34 | 245.13 | 245.13 | 261.92 | 201.48 | 218.27 | 251.85 | 285.43 | 298.19 | 295.50 | 251.85 | 285.43 ||| |DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN|1 mL|9748| 146.05 |||||||||| 94.93 | 99.31 | 106.62 | 106.62 | 113.92 | 87.63 | 94.93 | 109.54 | 124.14 | 129.69 | 128.52 | 109.54 | 124.14 ||| |DEXTRAN 40 IN D5W 10 % IV SOLN|500 mL|9759| 220.50 |||||||||| 143.33 | 149.94 | 160.97 | 160.97 | 171.99 | 132.30 | 143.33 | 165.38 | 187.43 | 195.80 | 194.04 | 165.38 | 187.43 ||| |AMIODARONE HCL 450 MG/9ML IV SOLN|9 mL|97692| 47.30 |||||||||| 30.75 | 32.16 | 34.53 | 34.53 | 36.89 | 28.38 | 30.75 | 35.48 | 40.21 | 42.00 | 41.62 | 35.48 | 40.21 ||| |AMIODARONE HCL 900 MG/18ML IV SOLN|18 mL|97694| 59.65 |||||||||| 38.77 | 40.56 | 43.54 | 43.54 | 46.53 | 35.79 | 38.77 | 44.74 | 50.70 | 52.97 | 52.49 | 44.74 | 50.70 ||| |TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN|30 mL|97790| 168.60 |||||||||| 109.59 | 114.65 | 123.08 | 123.08 | 131.51 | 101.16 | 109.59 | 126.45 | 143.31 | 149.72 | 148.37 | 126.45 | 143.31 ||| |DEXTROSE IN LACTATED RINGERS 5 % IV SOLN|1000 mL|9788| 199.00 |||||||||| 129.35 | 135.32 | 145.27 | 145.27 | 155.22 | 119.40 | 129.35 | 149.25 | 169.15 | 176.71 | 175.12 | 149.25 | 169.15 ||| |TOLVAPTAN 15 MG PO TABS|10 each|97893| 10,307.05 |||||||||| 6,699.58 | 7,008.79 | 7,524.15 | 7,524.15 | 8,039.50 | 6,184.23 | 6,699.58 | 7,730.29 | 8,760.99 | 9,152.66 | 9,070.20 | 7,730.29 | 8,760.99 ||| |LAMOTRIGINE ER 200 MG PO TB24|30 each|97967| 150.50 |||||||||| 97.83 | 102.34 | 109.87 | 109.87 | 117.39 | 90.30 | 97.83 | 112.88 | 127.93 | 133.64 | 132.44 | 112.88 | 127.93 ||| |FLUOROURACIL 5 GM/100ML IV SOLN|100 mL|98249| 136.15 |||||||||| 88.50 | 92.58 | 99.39 | 99.39 | 106.20 | 81.69 | 88.50 | 102.11 | 115.73 | 120.90 | 119.81 | 102.11 | 115.73 ||| |DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN|120 mL|9828| 166.75 |||||||||| 108.39 | 113.39 | 121.73 | 121.73 | 130.07 | 100.05 | 108.39 | 125.06 | 141.74 | 148.07 | 146.74 | 125.06 | 141.74 ||| |SUFENTANIL CITRATE 100 MCG/2ML IV SOLN|2 mL|98287| 59.80 |||||||||| 38.87 | 40.66 | 43.65 | 43.65 | 46.64 | 35.88 | 38.87 | 44.85 | 50.83 | 53.10 | 52.62 | 44.85 | 50.83 ||| |FERUMOXYTOL 510 MG/17ML IV SOLN|17 mL|98312| 2,008.45 |||||||||| 1,305.49 | 1,365.75 | 1,466.17 | 1,466.17 | 1,566.59 | 1,205.07 | 1,305.49 | 1,506.34 | 1,707.18 | 1,783.50 | 1,767.44 | 1,506.34 | 1,707.18 ||| |DRONEDARONE HCL 400 MG PO TABS|60 each|98329| 1,388.95 |||||||||| 902.82 | 944.49 | 1,013.93 | 1,013.93 | 1,083.38 | 833.37 | 902.82 | 1,041.71 | 1,180.61 | 1,233.39 | 1,222.28 | 1,041.71 | 1,180.61 ||| |PRASUGREL HCL 5 MG PO TABS|1 each|98372| 53.80 |||||||||| 34.97 | 36.58 | 39.27 | 39.27 | 41.96 | 32.28 | 34.97 | 40.35 | 45.73 | 47.77 | 47.34 | 40.35 | 45.73 ||| |DIGOXIN 0.1 MG/ML IJ SOLN|1 mL|9853| 240.15 |||||||||| 156.10 | 163.30 | 175.31 | 175.31 | 187.32 | 144.09 | 156.10 | 180.11 | 204.13 | 213.25 | 211.33 | 180.11 | 204.13 ||| |DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN|1 mL|9859| 281.25 |||||||||| 182.81 | 191.25 | 205.31 | 205.31 | 219.38 | 168.75 | 182.81 | 210.94 | 239.06 | 249.75 | 247.50 | 210.94 | 239.06 ||| |DOXAZOSIN MESYLATE 2 MG PO TABS|100 each|9895| 189.75 |||||||||| 123.34 | 129.03 | 138.52 | 138.52 | 148.01 | 113.85 | 123.34 | 142.31 | 161.29 | 168.50 | 166.98 | 142.31 | 161.29 ||| |ACETAMINOPHEN 80 MG PO CHEW|30 each|99| 13.35 |||||||||| 8.68 | 9.08 | 9.75 | 9.75 | 10.41 | 8.01 | 8.68 | 10.01 | 11.35 | 11.85 | 11.75 | 10.01 | 11.35 ||| |DOXYCYCLINE MONOHYDRATE 25 MG/5ML PO SUSR|60 mL|9902| 59.90 |||||||||| 38.94 | 40.73 | 43.73 | 43.73 | 46.72 | 35.94 | 38.94 | 44.93 | 50.92 | 53.19 | 52.71 | 44.93 | 50.92 ||| |DRONABINOL 2.5 MG PO CAPS|60 each|9904| 203.95 |||||||||| 132.57 | 138.69 | 148.88 | 148.88 | 159.08 | 122.37 | 132.57 | 152.96 | 173.36 | 181.11 | 179.48 | 152.96 | 173.36 ||| |OPIUM 10 MG/ML (1%) PO TINC|.05 mL|99405| 22.50 |||||||||| 14.63 | 15.30 | 16.43 | 16.43 | 17.55 | 13.50 | 14.63 | 16.88 | 19.13 | 19.98 | 19.80 | 16.88 | 19.13 ||| |VALGANCICLOVIR HCL 50 MG/ML PO SOLR|88 mL|99443| 1,683.40 |||||||||| 1,094.21 | 1,144.71 | 1,228.88 | 1,228.88 | 1,313.05 | 1,010.04 | 1,094.21 | 1,262.55 | 1,430.89 | 1,494.86 | 1,481.39 | 1,262.55 | 1,430.89 ||| |LEVONORGESTREL 1.5 MG PO TABS|1 each|99445| 97.90 |||||||||| 63.64 | 66.57 | 71.47 | 71.47 | 76.36 | 58.74 | 63.64 | 73.43 | 83.22 | 86.94 | 86.15 | 73.43 | 83.22 ||| |ILOPERIDONE 1 MG PO TABS|60 each|99453| 2,661.20 |||||||||| 1,729.78 | 1,809.62 | 1,942.68 | 1,942.68 | 2,075.74 | 1,596.72 | 1,729.78 | 1,995.90 | 2,262.02 | 2,363.15 | 2,341.86 | 1,995.90 | 2,262.02 ||| |ILOPERIDONE 6 MG PO TABS|60 each|99456| 3,269.30 |||||||||| 2,125.05 | 2,223.12 | 2,386.59 | 2,386.59 | 2,550.05 | 1,961.58 | 2,125.05 | 2,451.98 | 2,778.91 | 2,903.14 | 2,876.98 | 2,451.98 | 2,778.91 ||| |ILOPERIDONE 8 MG PO TABS|60 each|99457| 3,269.30 |||||||||| 2,125.05 | 2,223.12 | 2,386.59 | 2,386.59 | 2,550.05 | 1,961.58 | 2,125.05 | 2,451.98 | 2,778.91 | 2,903.14 | 2,876.98 | 2,451.98 | 2,778.91 ||| |ILOPERIDONE 10 MG PO TABS|60 each|99458| 5,222.40 |||||||||| 3,394.56 | 3,551.23 | 3,812.35 | 3,812.35 | 4,073.47 | 3,133.44 | 3,394.56 | 3,916.80 | 4,439.04 | 4,637.49 | 4,595.71 | 3,916.80 | 4,439.04 ||| |SAXAGLIPTIN HCL 2.5 MG PO TABS|30 each|99496| 939.15 |||||||||| 610.45 | 638.62 | 685.58 | 685.58 | 732.54 | 563.49 | 610.45 | 704.36 | 798.28 | 833.97 | 826.45 | 704.36 | 798.28 ||| |SAXAGLIPTIN HCL 5 MG PO TABS|30 each|99497| 939.15 |||||||||| 610.45 | 638.62 | 685.58 | 685.58 | 732.54 | 563.49 | 610.45 | 704.36 | 798.28 | 833.97 | 826.45 | 704.36 | 798.28 ||| |ERGOTAMINE-CAFFEINE 2-100 MG RE SUPP|1 suppository (1 each)|9950| 167.80 |||||||||| 109.07 | 114.10 | 122.49 | 122.49 | 130.88 | 100.68 | 109.07 | 125.85 | 142.63 | 149.01 | 147.66 | 125.85 | 142.63 ||| |OXALIPLATIN 50 MG/10ML IV SOLN|10 mL|99610| 90.15 |||||||||| 58.60 | 61.30 | 65.81 | 65.81 | 70.32 | 54.09 | 58.60 | 67.61 | 76.63 | 80.05 | 79.33 | 67.61 | 76.63 ||| |SEVELAMER CARBONATE 2.4 G PO PACK|1 each|99695| 59.10 |||||||||| 38.42 | 40.19 | 43.14 | 43.14 | 46.10 | 35.46 | 38.42 | 44.33 | 50.24 | 52.48 | 52.01 | 44.33 | 50.24 ||| |ESTROGENS CONJUGATED 25 MG IJ SOLR|1 each|9972| 620.60 |||||||||| 403.39 | 422.01 | 453.04 | 453.04 | 484.07 | 372.36 | 403.39 | 465.45 | 527.51 | 551.09 | 546.13 | 465.45 | 527.51 ||| |ESTROGENS CONJUGATED 0.3 MG PO TABS|100 each|9973| 1,247.70 |||||||||| 811.01 | 848.44 | 910.82 | 910.82 | 973.21 | 748.62 | 811.01 | 935.78 | 1,060.55 | 1,107.96 | 1,097.98 | 935.78 | 1,060.55 ||| |ESTROGENS CONJUGATED 0.625 MG PO TABS|100 each|9974| 1,247.70 |||||||||| 811.01 | 848.44 | 910.82 | 910.82 | 973.21 | 748.62 | 811.01 | 935.78 | 1,060.55 | 1,107.96 | 1,097.98 | 935.78 | 1,060.55 ||| |ESTROGENS CONJUGATED 0.9 MG PO TABS|100 each|9975| 1,247.70 |||||||||| 811.01 | 848.44 | 910.82 | 910.82 | 973.21 | 748.62 | 811.01 | 935.78 | 1,060.55 | 1,107.96 | 1,097.98 | 935.78 | 1,060.55 ||| |HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR|0.5 mL (1 each)|99752| 55.00 |||||||||| 35.75 | 37.40 | 40.15 | 40.15 | 42.90 | 33.00 | 35.75 | 41.25 | 46.75 | 48.84 | 48.40 | 41.25 | 46.75 ||| |ASENAPINE MALEATE 5 MG SL SUBL|1 each|99754| 63.55 |||||||||| 41.31 | 43.21 | 46.39 | 46.39 | 49.57 | 38.13 | 41.31 | 47.66 | 54.02 | 56.43 | 55.92 | 47.66 | 54.02 ||| |ASENAPINE MALEATE 10 MG SL SUBL|60 each|99755| 2,514.95 |||||||||| 1,634.72 | 1,710.17 | 1,835.91 | 1,835.91 | 1,961.66 | 1,508.97 | 1,634.72 | 1,886.21 | 2,137.71 | 2,233.28 | 2,213.16 | 1,886.21 | 2,137.71 ||| |ESTROGENS, CONJUGATED 0.625 MG/GM VA CREA|30 g|9977| 772.35 |||||||||| 502.03 | 525.20 | 563.82 | 563.82 | 602.43 | 463.41 | 502.03 | 579.26 | 656.50 | 685.85 | 679.67 | 579.26 | 656.50 ||| |ETHANOLAMINE OLEATE 5 % IV SOLN|2 mL|9984| 838.75 |||||||||| 545.19 | 570.35 | 612.29 | 612.29 | 654.23 | 503.25 | 545.19 | 629.06 | 712.94 | 744.81 | 738.10 | 629.06 | 712.94 ||| |PRALATREXATE 20 MG/ML IV SOLN|1 mL|99982| 8,727.90 |||||||||| 5,673.14 | 5,934.97 | 6,371.37 | 6,371.37 | 6,807.76 | 5,236.74 | 5,673.14 | 6,545.93 | 7,418.72 | 7,750.38 | 7,680.55 | 6,545.93 | 7,418.72 ||| |PSYCHOSES||885|||2,382.24|2,263.13|7,888.54|5,108.30|3,127.52|3,190.07|3,190.07|3,252.62||||||||||||||2,263.13|7,888.54|3,190.07 |SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC||871|||33,892.94|32,198.29|11,649.28|10,884.64|11,367.73|11,595.08|11,595.08|11,822.44||||||||||||||10,884.64|33,892.94|11,649.28 |NORMAL NEWBORN||795|||1,437.92|1,366.02|1,651.86|852.73|928.16|946.72|946.72|965.29||||||||||||||852.73|1,651.86|965.29 |MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC||470|||39,357.12|37,389.26|11,838.17|12,564.48|9,318.89|9,505.27|9,505.27|9,691.65||||||||||||||9,318.89|39,357.12|11,838.17 |VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC||807|||8,141.28|7,734.22|4,336.98|2,879.07|3,184.23|3,247.91|3,247.91|3,311.60||||||||||||||2,879.07|8,141.28|3,311.60 |PULMONARY EDEMA AND RESPIRATORY FAILURE||189|||23,189.60|22,030.12|7,815.26|7,147.45|6,516.51|6,646.84|6,646.84|6,777.17||||||||||||||6,516.51|23,189.60|7,147.45 |SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC||872|||19,714.50|18,728.78|6,604.40|5,648.25|5,083.71|5,185.38|5,185.38|5,287.06||||||||||||||5,083.71|19,714.50|5,648.25 |HEART FAILURE AND SHOCK WITH MCC||291|||27,999.59|26,599.61|8,507.09|8,137.69|8,357.66|8,524.81|8,524.81|8,691.97||||||||||||||8,137.69|27,999.59|8,524.81 |NEONATE WITH OTHER SIGNIFICANT PROBLEMS||794|||2,283.78|2,169.59|8,902.16|31,355.60|1,854.50|1,891.59|1,891.59|1,928.68||||||||||||||1,854.50|31,355.60|2,169.59 |INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC||853|||97,057.95|92,205.05|29,981.53|33,127.80|33,869.72|34,547.11|34,547.11|35,224.51||||||||||||||29,981.53|97,057.95|34,547.11 |CESAREAN SECTION WITHOUT STERILIZATION WITH CC||787|||10,510.88|9,985.34|6,849.31|5,258.63|5,245.80|5,350.72|5,350.72|5,455.63||||||||||||||5,245.80|10,510.88|5,455.63 |SIMPLE PNEUMONIA AND PLEURISY WITH MCC||193|||26,963.49|25,615.32|8,327.14|7,311.25|5,954.20|6,073.28|6,073.28|6,192.37||||||||||||||5,954.20|26,963.49|7,311.25 |ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC||280|||32,087.30|30,482.94|10,207.19|11,898.48|10,404.49|10,612.58|10,612.58|10,820.67||||||||||||||10,207.19|32,087.30|10,820.67 |DIABETES WITH CC||638|||16,001.12|15,201.06|5,757.01|4,370.84|4,854.17|4,951.25|4,951.25|5,048.34||||||||||||||4,370.84|16,001.12|5,048.34 |VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC||806|||8,141.28|7,734.22|4,889.98|3,261.28|3,724.75|3,799.25|3,799.25|3,873.74||||||||||||||3,261.28|8,141.28|3,873.74 |DEPRESSIVE NEUROSES||881|||2,382.24|2,263.13|5,292.20|2,929.62|2,357.07|2,404.21|2,404.21|2,451.35||||||||||||||2,263.13|5,292.20|2,404.21 |RENAL FAILURE WITH CC||683|||17,784.06|16,894.86|5,749.26|4,974.16|5,192.84|5,296.70|5,296.70|5,400.55||||||||||||||4,974.16|17,784.06|5,400.55 |ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC||392|||13,991.29|13,291.73|5,071.73|4,647.90|3,750.39|3,825.40|3,825.40|3,900.41||||||||||||||3,750.39|13,991.29|4,647.90 |PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC||247|||40,285.46|38,271.19|12,364.34|16,492.45|10,222.34|10,426.79|10,426.79|10,631.23||||||||||||||10,222.34|40,285.46|12,364.34 |GASTROINTESTINAL HEMORRHAGE WITH CC||378|||18,810.73|17,870.19|6,435.15|6,190.90|5,431.83|5,540.47|5,540.47|5,649.10||||||||||||||5,431.83|18,810.73|6,190.90 |INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS||65|||20,028.36|19,026.94|6,584.11|7,672.57|9,078.22|9,259.78|9,259.78|9,441.35||||||||||||||6,584.11|20,028.36|9,259.78 |MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC||641|||13,652.83|12,970.19|5,003.80|4,564.98|4,411.25|4,499.48|4,499.48|4,587.70||||||||||||||4,411.25|13,652.83|4,587.70 |POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC||917|||26,592.90|25,263.26|9,321.09|8,098.60|7,515.05|7,665.35|7,665.35|7,815.65||||||||||||||7,515.05|26,592.90|8,098.60 |CELLULITIS WITHOUT MCC||603|||15,936.83|15,139.99|5,550.82|4,006.16|4,000.24|4,080.24|4,080.24|4,160.25||||||||||||||4,000.24|15,936.83|4,160.25 |RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC||177|||35,985.98|34,186.68|11,512.81|9,392.86|10,346.67|10,553.60|10,553.60|10,760.54||||||||||||||9,392.86|35,985.98|10,760.54 |MEDICAL BACK PROBLEMS WITHOUT MCC||552|||16,350.91|15,533.36|6,130.05|5,413.67|4,694.82|4,788.72|4,788.72|4,882.61||||||||||||||4,694.82|16,350.91|5,413.67 |KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC||690|||14,800.52|14,060.49|5,237.40|4,013.57|3,981.57|4,061.20|4,061.20|4,140.83||||||||||||||3,981.57|14,800.52|4,140.83 |MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES||483|||45,617.28|43,336.42|14,736.62|15,702.40|10,475.43|10,684.94|10,684.94|10,894.45||||||||||||||10,475.43|45,617.28|14,736.62 |HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC||481|||37,417.23|35,546.37|13,003.75|16,498.51|11,941.95|12,180.79|12,180.79|12,419.63||||||||||||||11,941.95|37,417.23|13,003.75 |ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC||281|||19,345.79|18,378.50|6,071.05|7039.589896|5,588.77|5,700.55|5,700.55|5,812.32||||||||||||||5,588.77|19,345.79|6,071.05 |FULL TERM NEONATE WITH MAJOR PROBLEMS||793|||3,798.86|3,608.92|24,207.85|29,747.88|6,950.79|7,089.81|7,089.81|7,228.82||||||||||||||3,608.92|29,747.88|7,089.81 |INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC||854|||45,006.57|42,756.24|12,997.19|11,953.75|10,867.77|11,085.13|11,085.13|11,302.48||||||||||||||10,867.77|45,006.57|11,953.75 |RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS||208|||43,590.42|41,410.90|15,666.23|15,555.45|15,041.36|15,342.19|15,342.19|15,643.01||||||||||||||15,041.36|43,590.42|15,643.01 |INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC||64|||32,758.52|31,120.59|11,916.23|14,797.77|19,906.86|20,305.00|20,305.00|20,703.13||||||||||||||11,916.23|32,758.52|20,305.00 |POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC||918|||12,968.41|12,319.99|5,230.82|3,532.94|3,070.28|3,131.69|3,131.69|3,193.09||||||||||||||3,070.28|12,968.41|3,532.94 |SIMPLE PNEUMONIA AND PLEURISY WITH CC||194|||18,330.49|17,413.97|5,659.29|5,261.32|5,670.67|5,784.08|5,784.08|5,897.50||||||||||||||5,261.32|18,330.49|5,784.08 |RENAL FAILURE WITH MCC||682|||28,521.44|27,095.37|9,277.59|9,081.43|7,823.99|7,980.47|7,980.47|8,136.95||||||||||||||7,823.99|28,521.44|9,081.43 |ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC||897|||2,382.24|2,263.13|5,435.81||4,576.20|4,667.72|4,667.72|4,759.25||||||||||||||2,263.13|5,435.81|4,621.96 |CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC||287|||21,860.44|20,767.42|7,369.51|8,821.23|6,834.03|6,970.71|6,970.71|7,107.39||||||||||||||6,834.03|21,860.44|7,369.51 |MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC||640|||21,399.11|20,329.15|7,833.13|8,179.49|6,906.67|7,044.80|7,044.80|7,182.94||||||||||||||6,906.67|21,399.11|7,833.13 |MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC||330|||48,234.02|45,822.32|15,646.56|16,844.32|12,655.75|12,908.87|12,908.87|13,161.98||||||||||||||12,655.75|48,234.02|15,646.56 |PREMATURITY WITHOUT MAJOR PROBLEMS||792|||2,928.13|2,781.72|14,432.71|1,398.08||||||||||||||||||1,398.08|14,432.71|2,854.93 |CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC||309|||14,844.00|14,101.80|4,982.34|4,023.01|5,688.06|5801.8212|5,801.82|5,915.58||||||||||||||4,023.01|14,844.00|5,801.82 |SEIZURES WITHOUT MCC||101|||15,016.08|14,265.28|5,802.30|5,059.09|3,767.26|3842.6052|3,842.61|3,917.95||||||||||||||3,767.26|15,016.08|5,059.09 |PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS||246|||61,436.88|58,365.04|19,142.70|22,239.12|17,655.21|18008.3142|18,008.31|18,361.42||||||||||||||17,655.21|61,436.88|19,142.70 |KIDNEY AND URINARY TRACT INFECTIONS WITH MCC||689|||20,459.42|19,436.45|7,138.90|7,001.17|7,181.60|7325.232|7,325.23|7,468.86||||||||||||||7,001.17|20,459.42|7,325.23 |HEART FAILURE AND SHOCK WITH CC||292|||18,353.18|17,435.52|5,850.56|4,896.64|5,644.27|5757.1554|5,757.16|5,870.04||||||||||||||4,896.64|18,353.18|5,850.56 |HYPERTENSION WITHOUT MCC||305|||12,527.88|11,901.49|4917.397443|4,669.47|3825.57|3902.0814|3,902.08|3,978.59||||||||||||||3,825.57|12,527.88|4,669.47 |SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS||870|||111,139.98|105,582.98|38,802.01|45,421.97|43,523.43|44393.8986|44,393.90|45,264.37||||||||||||||38,802.01|111,139.98|45,264.37 |CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC||788|||10,510.88|9,985.34|5,802.89|5,820.15|4,552.34|4643.3868|4,643.39|4,734.43||||||||||||||4,552.34|10,510.88|5,802.89 |DIABETES WITH MCC||637|||26,135.34|24,828.57|8708.50961|8,453.17|8511.81|8682.0462|8,682.05|8,852.28||||||||||||||8,453.17|26,135.34|8,708.51 |LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC||493|||38,867.43|36,924.06|14,372.52|17,277.77|10,094.29|10296.1758|10,296.18|10,498.06||||||||||||||10,094.29|38,867.43|14,372.52 |GASTROINTESTINAL HEMORRHAGE WITH MCC||377|||33,104.53|31,449.30|11236.30523|10,533.43|12148.61|12391.5822|12,391.58|12,634.55||||||||||||||10,533.43|33,104.53|12,391.58 |OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC||698|||29,351.45|27,883.88|10,090.98|8,330.48|10,870.03|11087.4306|11,087.43|11,304.83||||||||||||||8,330.48|29,351.45|11,087.43 |PREMATURITY WITH MAJOR PROBLEMS||791|||3,390.86|3,221.32|23,580.36|1,986.56||0|0.00|0.00||||||||||||||1,986.56|23,580.36|3,306.09 |CESAREAN SECTION WITH STERILIZATION WITH CC||784|||10,510.88|9,985.34|7,041.18|6,211.13|5,808.57|5924.7414|5,924.74|6,040.91||||||||||||||5,808.57|10,510.88|6,211.13 |PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE||175|||28,056.31|26,653.49|9,718.55|10,519.28|8,625.09|8797.5918|8,797.59|8,970.09||||||||||||||8,625.09|28,056.31|9,718.55 |DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC||439|||16,681.76|15,847.67|5,548.45|5,402.21|4,483.45|4573.119|4,573.12|4,662.79||||||||||||||4,483.45|16,681.76|5,402.21 |CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC||190|||21,890.69|20,796.16|7,213.98|6,311.57|6,983.43|7123.0986|7,123.10|7,262.77||||||||||||||6,311.57|21,890.69|7,213.98 |EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE||790|||4,206.83|3,996.49|34,286.90|5,417.04||0|0.00|0.00||||||||||||||3,996.49|34,286.90|4,811.93 |NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY||789|||9,412.53|8,941.90|10,757.21|17,280.46|1,346.99|1373.9298|1,373.93|1,400.87||||||||||||||1,346.99|17,280.46|8,941.90 |CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC||286|||41,170.32|39,111.80|13,710.48|16,906.34|13,209.76|13473.9552|13,473.96|13,738.15||||||||||||||13,209.76|41,170.32|13,738.15 |CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC||191|||17,623.33|16,742.16|5,779.07|4,718.00|5,632.57|5745.2214|5,745.22|5,857.87||||||||||||||4,718.00|17,623.33|5,779.07 |PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC||274|||45,749.61|43,462.13|20,094.35|23,591.36|11,110.68|11332.8936|11,332.89|11,555.11||||||||||||||11,110.68|45,749.61|20,094.35 |GASTROINTESTINAL OBSTRUCTION WITH CC||389|||16,462.44|15,639.32|5,413.78|5,012.58|4,158.88|4242.0576|4,242.06|4,325.24||||||||||||||4,158.88|16,462.44|5,012.58 |TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC||86|||21,542.82|20,465.68|8,101.86|8,231.39|6,517.05|6647.391|6,647.39|6,777.73||||||||||||||6,517.05|21,542.82|8,101.86 |SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC||460|||75,093.51|71,338.83|23,951.61|24,566.77|13,838.73|14115.5046|14,115.50|14,392.28||||||||||||||13,838.73|75,093.51|23,951.61 |OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC||832|||12,805.62|12,165.34|5,163.49|3,054.33|3,195.81|3259.7262|3,259.73|3,323.64||||||||||||||3,054.33|12,805.62|3,323.64 |PULMONARY EMBOLISM WITHOUT MCC||176|||17,725.45|16,839.18|5,800.51|5,396.14|4,136.01|4218.7302|4,218.73|4,301.45||||||||||||||4,136.01|17,725.45|5,396.14 |OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC||394|||17,965.56|17,067.28|6,109.79|5,817.45|5,218.62|5322.9924|5,322.99|5,427.36||||||||||||||5,218.62|17,965.56|5,817.45 |CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC||308|||22,972.19|21,823.58|7,663.29|7,742.00|9,103.11|9285.1722|9,285.17|9,467.23||||||||||||||7,663.29|22,972.19|9,285.17 |OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC||516|||39,081.06|37,127.01|12,202.86|18,034.10|10,208.27|10412.4354|10,412.44|10,616.60||||||||||||||10,208.27|39,081.06|12,202.86 |MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC||329|||95,876.25|91,082.44|29,419.58|29,181.64|34,835.61|35532.3222|35,532.32|36,229.03||||||||||||||29,181.64|95,876.25|35,532.32 |ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC||267|||123,983.63|117,784.45|33,892.40|2,767.17|30,908.44|31526.6088|31,526.61|32,144.78||||||||||||||2,767.17|123,983.63|32,144.78 |CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC||25|||81,234.56|77,172.83|27,282.70|30,040.44|25,510.24|26020.4448|26,020.44|26,530.65||||||||||||||25,510.24|81,234.56|27,282.70 |BRONCHITIS AND ASTHMA WITH CC/MCC||202|||16,978.62|16,129.69|6,270.68|5,727.12|4,547.21|4638.1542|4,638.15|4,729.10||||||||||||||4,547.21|16,978.62|5,727.12 |SEIZURES WITH MCC||100|||29,568.89|28,090.45|11,681.44|11,983.41|8,260.73|8425.9446|8,425.94|8,591.16||||||||||||||8,260.73|29,568.89|11,681.44 |SYNCOPE AND COLLAPSE||312|||14,426.16|13,704.85|5,505.55|5,168.97|3,619.52|3691.9104|3,691.91|3,764.30||||||||||||||3,619.52|14,426.16|5,168.97 |ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC||391|||22,546.76|21,419.42|7,932.03|7,294.40|7,883.68|8041.3536|8,041.35|8,199.03||||||||||||||7,294.40|22,546.76|8,041.35 |ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC||896|||2,382.24|2,263.13|11,105.81|9,349.72|8,006.69|8166.8238|8,166.82|8,326.96||||||||||||||2,263.13|11,105.81|8,166.82 |HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC||480|||56,702.54|53,867.41|18,539.65|23,199.71|13,040.31|13301.1162|13,301.12|13,561.92||||||||||||||13,040.31|56,702.54|18,539.65 |DIABETES WITHOUT CC/MCC||639|||11,357.52|10,789.64|4,147.49|3,218.14|3,426.40|3494.928|3,494.93|3,563.46||||||||||||||3,218.14|11,357.52|3,563.46 |VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC||805|||8,141.28|7,734.22|6,635.37|3,972.45|4,585.78|4677.4956|4,677.50|4,769.21||||||||||||||3,972.45|8,141.28|4,769.21 |BRONCHITIS AND ASTHMA WITHOUT CC/MCC||203|||12,662.13|12,029.02|4,720.75|3,466.88|3,095.93|3157.8486|3,157.85|3,219.77||||||||||||||3,095.93|12,662.13|3,466.88 |LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC||418|||31,355.61|29,787.83|10,576.05|11,024.85|6,691.56|6825.3912|6,825.39|6,959.22||||||||||||||6,691.56|31,355.61|10,576.05 |FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC||563|||14,879.93|14,135.93|5,705.76|4,780.69|3,204.43|3268.5186|3,268.52|3,332.61||||||||||||||3,204.43|14,879.93|4,780.69 |ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC||282|||14,288.14|13,573.73|4,839.91|6,828.60|4,422.84|4511.2968|4,511.30|4,599.75||||||||||||||4,422.84|14,288.14|4,839.91 |CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC||310|||10,603.12|10,072.96|3,844.18|3,373.18|3,467.32|3536.6664|3,536.67|3,606.01||||||||||||||3,373.18|10,603.12|3,606.01 |COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC||454|||152,576.89|144,948.05|36,855.22|38,505.74|22,451.30|22900.326|22,900.33|23,349.35||||||||||||||22,451.30|152,576.89|36,855.22 |CESAREAN SECTION WITHOUT STERILIZATION WITH MCC||786|||10,510.88|9,985.34|9,998.03||7,889.07|8046.8514|8,046.85|8,204.63||||||||||||||7,889.07|10,510.88|9,094.98 |PERIPHERAL VASCULAR DISORDERS WITH CC||300|||18,895.81|17,951.02|6,727.14|6,110.68|6,053.78|6174.8556|6,174.86|6,295.93||||||||||||||6,053.78|18,895.81|6,295.93 |CHEST PAIN||313|||12,518.43|11,892.51|4,811.91|4,389.04|4,023.14|4103.6028|4,103.60|4,184.07||||||||||||||4,023.14|12,518.43|4,389.04 |MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT||469|||62,321.74|59,205.65|18,896.61|16,974.42|11,639.10|11871.882|11,871.88|12,104.66||||||||||||||11,639.10|62,321.74|16,974.42 |KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC||660|||35,980.29|34,181.28|9,117.88|9,504.76|5,483.58|5593.2516|5,593.25|5,702.92||||||||||||||5,483.58|35,980.29|9,117.88 |INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC||66|||14,320.27|13,604.26|4,752.92|6,217.87|6,125.11|6247.6122|6,247.61|6,370.11||||||||||||||4,752.92|14,320.27|6,247.61 |PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC||243|||49,998.08|47,498.18|15,608.43|20,191.21|13,657.03|13930.1706|13,930.17|14,203.31||||||||||||||13,657.03|49,998.08|15,608.43 |MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC||331|||31,179.78|29,620.79|10,707.15|13,646.41|8,109.41|8271.5982|8,271.60|8,433.79||||||||||||||8,109.41|31,179.78|10,707.15 |OTITIS MEDIA AND URI WITHOUT MCC||153|||13,314.42|12,648.70|4,751.13|3,248.47|2,846.16|2903.0832|2,903.08|2,960.01||||||||||||||2,846.16|13,314.42|3,248.47 |OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC||580|||30,544.49|29,017.27|10,052.86|12,786.94|6,169.99|6293.3898|6,293.39|6,416.79||||||||||||||6,169.99|30,544.49|10,052.86 |TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC||605|||15,161.65|14,403.57|5,934.58|5,376.59|3,962.56|4041.8112|4,041.81|4,121.06||||||||||||||3,962.56|15,161.65|5,376.59 |DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC||57|||20,260.90|19,247.86|8,050.04|10,883.96|11,848.53|12085.5006|12,085.50|12,322.47||||||||||||||8,050.04|20,260.90|12,085.50 |REVISION OF HIP OR KNEE REPLACEMENT WITH CC||467|||64,995.21|61,745.45|21,827.23|23,314.98|17,079.41|17420.9982|17,421.00|17,762.59||||||||||||||17,079.41|64,995.21|21,827.23 |OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC||699|||19,372.28|18,403.67|6,625.83|6,680.30|6,666.88|6800.2176|6,800.22|6,933.56||||||||||||||6,625.83|19,372.28|6,800.22 |EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC||981|||91,760.17|87,172.16|26,737.42|33,611.80|28,348.75|28915.725|28,915.73|29,482.70||||||||||||||26,737.42|91,760.17|29,482.70 |OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC||393|||30,884.84|29,340.60|10,370.46|8,207.13|8,022.75|8183.205|8,183.21|8,343.66||||||||||||||8,022.75|30,884.84|8,343.66 |AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC||617|||37,935.30|36,038.54|12,637.85|10,308.96|9,935.63|10134.3426|10,134.34|10,333.06||||||||||||||9,935.63|37,935.30|10,333.06 |VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C||768|||8,141.28|7,734.22|7,493.47|3,781.01|4,342.70|4429.554|4,429.55|4,516.41||||||||||||||3,781.01|8,141.28|4,516.41 |OTHER DISORDERS OF NERVOUS SYSTEM WITH CC||92|||17,158.25|16,300.34|6,392.83|7,019.37|7,640.63|7793.4426|7,793.44|7,946.26||||||||||||||6,392.83|17,158.25|7,793.44 |LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC||494|||29,865.74|28,372.45|11,552.13|12,499.10|5,799.51|5915.5002|5,915.50|6,031.49||||||||||||||5,799.51|29,865.74|11,552.13 |O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC||621|||29,275.82|27,812.03|10,029.61|11,946.34|5,869.31|5986.6962|5,986.70|6,104.08||||||||||||||5,869.31|29,275.82|10,029.61 |OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC||833|||8,556.68|8,128.85|3,710.69|2,288.56|2,690.71|2744.5242|2,744.52|2,798.34||||||||||||||2,288.56|8,556.68|2,798.34 |TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC||87|||14,970.67|14,222.14|5,656.91|5,482.43|2,744.06|2798.9412|2,798.94|2,853.82||||||||||||||2,744.06|14,970.67|5,482.43 |MAJOR CHEST TRAUMA WITH CC||184|||19,143.48|18,186.31|6,710.45|6,067.54|5,777.25|5892.795|5,892.80|6,008.34||||||||||||||5,777.25|19,143.48|6,067.54 |PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC||242|||71,537.08|67,960.23|22,699.03|28,727.97|19,384.91|19772.6082|19,772.61|20,160.31||||||||||||||19,384.91|71,537.08|22,699.03 |OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC||271|||59,417.59|56,446.71|21,758.11|3,207.35|20,839.65|21256.443|21,256.44|21,673.24||||||||||||||3,207.35|59,417.59|21,673.24 |LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC||419|||23,709.55|22,524.07|8,353.95|9,379.38|5,047.15|5148.093|5,148.09|5,249.04||||||||||||||5,047.15|23,709.55|8,353.95 |CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC||433|||17,326.51|16,460.18|6,645.49|6,196.97|5,191.19|5295.0138|5,295.01|5,398.84||||||||||||||5,191.19|17,326.51|6,196.97 |CERVICAL SPINAL FUSION WITH CC||472|||54,927.15|52,180.79|18,710.68|18,939.42|11,586.67|11818.4034|11,818.40|12,050.14||||||||||||||11,586.67|54,927.15|18,710.68 |ENDOCRINE DISORDERS WITH CC||644|||19,139.71|18,182.72|6,584.72|5,034.15|5,208.84|5313.0168|5,313.02|5,417.19||||||||||||||5,034.15|19,139.71|5,417.19 |CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC||785|||10,510.88|9,985.34|5,970.95|5,100.89|4,627.35|4719.897|4,719.90|4,812.44||||||||||||||4,627.35|10,510.88|5,100.89 |CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC||236|||71,871.74|68,278.15|24,834.15|35,303.78|27,169.94|27713.3388|27,713.34|28,256.74||||||||||||||24,834.15|71,871.74|28,256.74 |OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC||314|||36,555.07|34,727.32|12,931.65|13,891.11|11,618.53|11850.9006|11,850.90|12,083.27||||||||||||||11,618.53|36,555.07|12,931.65 |HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC||482|||30,682.52|29,148.39|10,329.93|11,927.46|6,868.13|7005.4926|7,005.49|7,142.86||||||||||||||6,868.13|30,682.52|10,329.93 |ATHEROSCLEROSIS WITHOUT MCC||303|||12,151.63|11,544.05|4,547.34|4,502.96|4,123.52|4205.9904|4,205.99|4,288.46||||||||||||||4,123.52|12,151.63|4,502.96 |CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC||432|||31,323.46|29,757.29|11,732.09|12,777.50|10,644.21|10857.0942|10,857.09|11,069.98||||||||||||||10,644.21|31,323.46|11,732.09 |ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION||880|||2,382.24|2,263.13|5,662.86|4,651.94|2,798.00|2853.96|2,853.96|2,909.92||||||||||||||2,263.13|5,662.86|2,853.96 |BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC||462|||60,777.02|57,738.17|19,252.96|18,723.70|13,556.40|13827.528|13,827.53|14,098.66||||||||||||||13,556.40|60,777.02|18,723.70 |CELLULITIS WITH MCC||602|||27,171.48|25,812.91|9,077.36|8,614.95|6,830.33|6966.9366|6,966.94|7,103.54||||||||||||||6,830.33|27,171.48|8,614.95 |RED BLOOD CELL DISORDERS WITHOUT MCC||812|||16,207.21|15,396.85|5,758.80|4,891.92|4,161.65|4244.883|4,244.88|4,328.12||||||||||||||4,161.65|16,207.21|4,891.92 |COMPLICATIONS OF TREATMENT WITH MCC||919|||33,297.36|31,632.49|11,447.86|10,019.10|8,253.84|8418.9168|8,418.92|8,583.99||||||||||||||8,253.84|33,297.36|10,019.10 |BONE DISEASES AND ARTHROPATHIES WITHOUT MCC||554|||13,872.18|13,178.57|5,226.67|4,384.32|5,422.69|5531.1438|5,531.14|5,639.60||||||||||||||4,384.32|13,872.18|5,531.14 |MAJOR CHEST PROCEDURES WITH CC||164|||48,822.04|46,380.94|16,223.40|18,396.77|17,116.49|17458.8198|17,458.82|17,801.15||||||||||||||16,223.40|48,822.04|17,801.15 |SOFT TISSUE PROCEDURES WITH CC||501|||30,372.44|28,853.82|10,915.11|11,402.34|8,727.47|8902.0194|8,902.02|9,076.57||||||||||||||8,727.47|30,372.44|10,915.11 |POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC||862|||35,072.75|33,319.11|11,712.43|9,212.20|9,341.53|9528.3606|9,528.36|9,715.19||||||||||||||9,212.20|35,072.75|9,715.19 |RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC||178|||25,666.46|24,383.14|7,702.63|7,728.52|9,853.97|10051.0494|10,051.05|10,248.13||||||||||||||7,702.63|25,666.46|10,051.05 |AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC||269|||73,815.41|70,124.64|26,227.36|2,885.13|22,468.27|22917.6354|22,917.64|23,367.00||||||||||||||2,885.13|73,815.41|23,367.00 |LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC||417|||46,764.93|44,426.68|14,958.30|14,611.04|8,161.92|8325.1584|8,325.16|8,488.40||||||||||||||8,161.92|46,764.93|14,611.04 |DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC||438|||31,408.55|29,838.12|10,029.02|10,536.80|8,831.86|9008.4972|9,008.50|9,185.13||||||||||||||8,831.86|31,408.55|10,029.02 |PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC||543|||21,121.17|20,065.11|6,733.70|6,004.85|7,157.76|7300.9152|7,300.92|7,444.07||||||||||||||6,004.85|21,121.17|7,300.92 |ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY||884|||2,382.24|2,263.13|9,120.27|12,716.83|3,603.04|3675.1008|3,675.10|3,747.16||||||||||||||2,263.13|12,716.83|3,675.10 |OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC||957|||123,849.36|117,656.89|44,737.18|51,339.19|49,412.37|50400.6174|50,400.62|51,388.86||||||||||||||44,737.18|123,849.36|51,339.19 |NERVOUS SYSTEM NEOPLASMS WITH MCC||54|||25,657.01|24,374.16|8,655.47|7,866.71|8,705.20|8879.304|8,879.30|9,053.41||||||||||||||7,866.71|25,657.01|8,879.30 |ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC||62|||35,768.55|33,980.12|12,358.39|13,376.10|12,633.69|12886.3638|12,886.36|13,139.04||||||||||||||12,358.39|35,768.55|13,139.04 |RESPIRATORY NEOPLASMS WITH MCC||180|||31,701.61|30,116.53|10,872.21|11,353.13|10,299.08|10505.0616|10,505.06|10,711.04||||||||||||||10,299.08|31,701.61|10,872.21 |PNEUMOTHORAX WITH CC||200|||19,744.72|18,757.48|6,922.59|5,663.08|5,975.12|6094.6224|6,094.62|6,214.12||||||||||||||5,663.08|19,744.72|6,214.12 |POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES||776|||12,792.59|12,152.96|5,097.95|2,742.90|3,233.25|3297.915|3,297.92|3,362.58||||||||||||||2,742.90|12,792.59|3,362.58 |EXTRACRANIAL PROCEDURES WITHOUT CC/MCC||39|||20,058.59|19,055.66|7,303.96|12,133.74|4,212.95|4297.209|4,297.21|4,381.47||||||||||||||4,212.95|20,058.59|7,303.96 |CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC||74|||17,135.53|16,278.75|6,585.31|7,098.91|7,108.10|7250.262|7,250.26|7,392.42||||||||||||||6,585.31|17,135.53|7,250.26 |HEADACHES WITHOUT MCC||103|||13,611.26|12,930.70|5,451.91|5,531.64|3,554.29|3625.3758|3,625.38|3,696.46||||||||||||||3,554.29|13,611.26|5,451.91 |MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC||372|||20,968.04|19,919.64|6,640.14|5,626.01|5,020.66|5121.0732|5,121.07|5,221.49||||||||||||||5,020.66|20,968.04|5,626.01 |SIGNS AND SYMPTOMS WITHOUT MCC||948|||13,908.07|13,212.67|5,198.05|4,366.80|6,542.63|6673.4826|6,673.48|6,804.34||||||||||||||4,366.80|13,908.07|6,673.48 |OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC||270|||89,523.45|85,047.28|31,393.81|1,872.64|35,442.08|36150.9216|36,150.92|36,859.76||||||||||||||1,872.64|89,523.45|36,150.92 |HYPERTENSION WITH MCC||304|||19,113.24|18,157.58|7,045.34|6,486.83|7,285.03|7430.7306|7,430.73|7,576.43||||||||||||||6,486.83|19,113.24|7,430.73 |DISORDERS OF THE BILIARY TRACT WITH CC||445|||19,952.71|18,955.07|6,933.33|6,315.61|5,926.80|6045.336|6,045.34|6,163.87||||||||||||||5,926.80|19,952.71|6,315.61 |PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC||273|||67,118.48|63,762.56|23,382.51|29,888.77|15,489.47|15799.2594|15,799.26|16,109.05||||||||||||||15,489.47|67,118.48|23,382.51 |MEDICAL BACK PROBLEMS WITH MCC||551|||29,444.11|27,971.90|10,188.71|9,594.42|11,135.58|11358.2916|11,358.29|11,581.00||||||||||||||9,594.42|29,444.11|11,358.29 |COAGULATION DISORDERS||813|||32,803.90|31,163.71|9,721.52|8,079.05|3,280.71|3346.3242|3,346.32|3,411.94||||||||||||||3,280.71|32,803.90|8,079.05 |OTHER O.R. PROCEDURES FOR INJURIES WITH CC||908|||37,632.79|35,751.15|12,675.40|11,882.30|11,716.99|11951.3298|11,951.33|12,185.67||||||||||||||11,716.99|37,632.79|12,185.67 |PERIPHERAL VASCULAR DISORDERS WITH MCC||299|||26,878.39|25,534.47|9,642.28|8,860.32|6,356.47|6483.5994|6,483.60|6,610.73||||||||||||||6,356.47|26,878.39|8,860.32 |STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC||328|||28,651.89|27,219.30|10,441.37|13,206.90|5,877.05|5994.591|5,994.59|6,112.13||||||||||||||5,877.05|28,651.89|10,441.37 |ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA||894|||2,382.24|2,263.13|3,779.23|2,990.29|3,081.60|3143.232|3,143.23|3,204.86||||||||||||||2,263.13|3,779.23|3,081.60 |COMPLICATIONS OF TREATMENT WITH CC||920|||18,890.13|17,945.62|6,638.35|6,164.61|4,746.60|4841.532|4,841.53|4,936.46||||||||||||||4,746.60|18,890.13|6,164.61 |OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC||91|||30,024.55|28,523.32|10,342.46|11,194.72|11,512.19|11742.4338|11,742.43|11,972.68||||||||||||||10,342.46|30,024.55|11,742.43 |CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC||219|||142,919.14|135,773.18|48,516.97|50,649.59|37,208.32|37952.4864|37,952.49|38,696.65||||||||||||||37,208.32|142,919.14|48,516.97 |OTHER VASCULAR PROCEDURES WITH CC||253|||49,211.53|46,750.95|16,330.05|20,458.83|14,634.38|14927.0676|14,927.07|15,219.76||||||||||||||14,634.38|49,211.53|16,330.05 |HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC||354|||31,461.48|29,888.41|11,141.57|11,857.36|8,891.42|9069.2484|9,069.25|9,247.08||||||||||||||8,891.42|31,461.48|11,141.57 |GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC||390|||11,470.97|10,897.42|3,988.38|3,344.87|3,163.27|3226.5354|3,226.54|3,289.80||||||||||||||3,163.27|11,470.97|3,344.87 |REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC||468|||52,019.24|49,418.28|17,225.70|18,484.40|11,083.86|11305.5372|11,305.54|11,527.21||||||||||||||11,083.86|52,019.24|17,225.70 |BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC||519|||31,773.45|30,184.78|12,182.60|14,458.02|8,440.74|8609.5548|8,609.55|8,778.37||||||||||||||8,440.74|31,773.45|12,182.60 |TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC||69|||13,664.21|12,981.00|5,201.03|5,374.57|3,347.65|3414.603|3,414.60|3,481.56||||||||||||||3,347.65|13,664.21|5,201.03 |CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC||220|||96,566.37|91,738.05|32,694.65|37,212.15|33,796.39|34472.3178|34,472.32|35,148.25||||||||||||||32,694.65|96,566.37|35,148.25 |STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC||326|||102,953.20|97,805.54|32,562.36|32,136.20|29,017.24|29597.5848|29,597.58|30,177.93||||||||||||||29,017.24|102,953.20|32,136.20 |LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC||840|||59,461.10|56,488.05|19,679.02|26,766.35|17,599.67|17951.6634|17,951.66|18,303.66||||||||||||||17,599.67|59,461.10|19,679.02 |LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA||956|||70,175.78|66,666.99|23,451.64|49,038.50|25,627.74|26140.2948|26,140.29|26,652.85||||||||||||||23,451.64|70,175.78|26,652.85 |EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC||982|||51,835.82|49,244.03|14,746.83|19,562.95|10,511.15|10721.373|10,721.37|10,931.60||||||||||||||10,511.15|51,835.82|14,746.83 |CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC||233|||139,120.67|132,164.64|46,953.33|53,279.91|41,549.54|42380.5308|42,380.53|43,211.52||||||||||||||41,549.54|139,120.67|46,953.33 |OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC||315|||18,381.54|17,462.46|6,327.88|6,527.95|5,457.64|5566.7928|5,566.79|5,675.95||||||||||||||5,457.64|18,381.54|6,327.88 |OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC||831|||18,315.91|17,400.11|7,197.29|4,546.11|5,318.53|5424.9006|5,424.90|5,531.27||||||||||||||4,546.11|18,315.91|5,531.27 |NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC||987|||60,735.44|57,698.67|18,930.78|30,248.73|17,930.40|18289.008|18,289.01|18,647.62||||||||||||||17,930.40|60,735.44|18,930.78 |CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR||23|||101,126.75|96,070.41|34,258.29|40,275.92|28,756.12|29331.2424|29,331.24|29,906.36||||||||||||||28,756.12|101,126.75|34,258.29 |CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC||26|||56,642.02|53,809.92|18,739.27|19,966.06|16,167.53|16490.8806|16,490.88|16,814.23||||||||||||||16,167.53|56,642.02|18,739.27 |EXTRACRANIAL PROCEDURES WITH CC||38|||29,419.52|27,948.54|10,392.53|17,049.92|8,416.64|8584.9728|8,584.97|8,753.31||||||||||||||8,416.64|29,419.52|10,392.53 |RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS||207|||101,149.46|96,091.99|34,640.26|44,071.76|35,603.50|36315.57|36,315.57|37,027.64||||||||||||||34,640.26|101,149.46|37,027.64 |CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC||234|||92,788.72|88,149.28|32,203.04|39,262.08|32,326.61|32973.1422|32,973.14|33,619.67||||||||||||||32,203.04|92,788.72|33,619.67 |ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC||283|||31,410.45|29,839.93|11,627.82|23,921.66|11,367.10|11594.442|11,594.44|11,821.78||||||||||||||11,367.10|31,410.45|11,821.78 |GASTROINTESTINAL OBSTRUCTION WITH MCC||388|||29,897.88|28,402.99|9,525.48|8,903.47|7,627.36|7779.9072|7,779.91|7,932.45||||||||||||||7,627.36|29,897.88|8,903.47 |DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC||440|||12,040.06|11,438.06|4,127.23|3,975.82|3,360.51|3427.7202|3,427.72|3,494.93||||||||||||||3,360.51|12,040.06|3,975.82 |PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC||542|||36,112.65|34,307.02|11,274.45|11,410.43|12,385.60|12633.312|12,633.31|12,881.02||||||||||||||11,274.45|36,112.65|12,633.31 |TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC||558|||15,989.77|15,190.28|5,631.28|3,377.90|5,422.74|5531.1948|5,531.19|5,639.65||||||||||||||3,377.90|15,989.77|5,631.28 |POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC||863|||19,075.42|18,121.65|6,341.00|4,834.62|5,573.15|5684.613|5,684.61|5,796.08||||||||||||||4,834.62|19,075.42|5,796.08 |ALLERGIC REACTIONS WITHOUT MCC||916|||10,553.96|10,026.26|4,433.53|3,421.71|2,957.51|3016.6602|3,016.66|3,075.81||||||||||||||2,957.51|10,553.96|3,421.71 |OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC||963|||49,716.34|47,230.52|16,750.17|19,438.25|13,998.55|14278.521|14,278.52|14,558.49||||||||||||||13,998.55|49,716.34|16,750.17 |ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES||3|||333,841.61|317,149.53|113,685.16|165,422.61|109,674.10|111867.582|111,867.58|114,061.06||||||||||||||109,674.10|333,841.61|114,061.06 |DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC||56|||35,002.81|33,252.67|13,550.77|20,293.00|18,432.94|18801.5988|18,801.60|19,170.26||||||||||||||13,550.77|35,002.81|19,170.26 |TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC||83|||24,590.64|23,361.11|8,511.85|7,884.23|8,529.90|8700.498|8,700.50|8,871.10||||||||||||||7,884.23|24,590.64|8,700.50 |MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC||435|||33,042.13|31,390.02|10,961.59|12,601.56|9,647.57|9840.5214|9,840.52|10,033.47||||||||||||||9,647.57|33,042.13|10,961.59 |DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC||442|||17,717.89|16,832.00|6,068.08|6,153.83|5,157.90|5261.058|5,261.06|5,364.22||||||||||||||5,157.90|17,717.89|6,068.08 |O.R. PROCEDURES FOR OBESITY WITH CC||620|||34,802.39|33,062.27|11,011.06|12,426.30|7,275.50|7421.01|7,421.01|7,566.52||||||||||||||7,275.50|34,802.39|11,011.06 |OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC||673|||63,450.50|60,277.98|21,153.27|18,460.13|19,094.42|19476.3084|19,476.31|19,858.20||||||||||||||18,460.13|63,450.50|19,858.20 |VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC||798|||8,141.28|7,734.22|5,446.54||4,830.81|4927.4262|4,927.43|5,024.04||||||||||||||4,830.81|8,141.28|5,235.29 |NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC||988|||33,149.90|31,492.41|9,755.46|12,716.16|8,874.26|9051.7452|9,051.75|9,229.23||||||||||||||8,874.26|33,149.90|9,755.46 |TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC||85|||38,489.29|36,564.83|14,260.49|10,355.47|14,663.01|14956.2702|14,956.27|15,249.53||||||||||||||10,355.47|38,489.29|14,956.27 |OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC||166|||69,570.74|66,092.20|23,099.47|30,851.38|24,609.74|25101.9348|25,101.93|25,594.13||||||||||||||23,099.47|69,570.74|25,594.13 |INFLAMMATORY BOWEL DISEASE WITH CC||386|||18,899.59|17,954.61|6,436.93|6,633.11|4,865.80|4963.116|4,963.12|5,060.43||||||||||||||4,865.80|18,899.59|6,436.93 |LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC||492|||59,718.22|56,732.31|21,183.66|25,213.23|14,953.35|15252.417|15,252.42|15,551.48||||||||||||||14,953.35|59,718.22|21,183.66 |UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC||742|||29,468.68|27,995.25|10,748.26|11,507.50|6,562.35|6693.597|6,693.60|6,824.84||||||||||||||6,562.35|29,468.68|10,748.26 |PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR||41|||40,374.32|38,355.60|14,525.07|16,893.53|11,938.59|12177.3618|12,177.36|12,416.13||||||||||||||11,938.59|40,374.32|14,525.07 |PNEUMOTHORAX WITH MCC||199|||33,093.18|31,438.52|11,168.96|7,297.77|9,935.93|10134.6486|10,134.65|10,333.37||||||||||||||7,297.77|33,093.18|10,333.37 |CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC||235|||109,856.19|104,363.38|36,450.61|40,095.26|31,402.25|32030.295|32,030.30|32,658.34||||||||||||||31,402.25|109,856.19|36,450.61 |STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC||327|||49,913.00|47,417.35|16,067.26|18,133.20|9,273.20|9458.664|9,458.66|9,644.13||||||||||||||9,273.20|49,913.00|16,067.26 |OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC||395|||12,773.66|12,134.98|4,388.22|4,600.03|3,459.61|3528.8022|3,528.80|3,597.99||||||||||||||3,459.61|12,773.66|4,388.22 |COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC||455|||117,099.53|111,244.55|29,066.21|29,184.33|16,876.85|17214.387|17,214.39|17,551.92||||||||||||||16,876.85|117,099.53|29,066.21 |OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC||515|||60,241.96|57,229.86|19,210.04|23,042.64|13,525.36|13795.8672|13,795.87|14,066.37||||||||||||||13,525.36|60,241.96|19,210.04 |OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC||517|||33,495.91|31,821.11|8,839.60|12,174.86|8,543.03|8713.8906|8,713.89|8,884.75||||||||||||||8,543.03|33,495.91|8,884.75 |ENDOCRINE DISORDERS WITH MCC||643|||30,722.22|29,186.11|10,428.27|9,393.53|9,533.33|9723.9966|9,724.00|9,914.66||||||||||||||9,393.53|30,722.22|9,914.66 |RED BLOOD CELL DISORDERS WITH MCC||811|||24,564.17|23,335.96|8,725.78|8,391.15|6,818.44|6954.8088|6,954.81|7,091.18||||||||||||||6,818.44|24,564.17|8,391.15 |CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC||847|||22,467.37|21,344.00|8,473.13|8,627.76|6,768.20|6903.564|6,903.56|7,038.93||||||||||||||6,768.20|22,467.37|8,473.13 |POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC||856|||88,048.70|83,646.27|27,604.48|21,703.21|29,826.93|30423.4686|30,423.47|31,020.01||||||||||||||21,703.21|88,048.70|30,423.47 |OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC||964|||26,857.62|25,514.74|9,386.04|9,272.20|7,648.28|7801.2456|7,801.25|7,954.21||||||||||||||7,648.28|26,857.62|9,272.20 |NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC||71|||19,056.50|18,103.68|6,540.03|7,548.53|8,677.28|8850.8256|8,850.83|9,024.37||||||||||||||6,540.03|19,056.50|8,850.83 |TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC||82|||38,135.71|36,228.92|13,972.69|13,885.04|14,355.94|14643.0588|14,643.06|14,930.18||||||||||||||13,885.04|38,135.71|14,643.06 |OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC||206|||15,435.79|14,664.00|5,785.62|4,865.63|2,976.84|3036.3768|3,036.38|3,095.91||||||||||||||2,976.84|15,435.79|4,865.63 |ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC||266|||162,574.99|154,446.24|42,808.86|32,322.25|46,349.59|47276.5818|47,276.58|48,203.57||||||||||||||32,322.25|162,574.99|47,276.58 |ANGINA PECTORIS||311|||11,516.33|10,940.51|4,670.09|3,558.56|4,249.10|4334.082|4,334.08|4,419.06||||||||||||||3,558.56|11,516.33|4,419.06 |DIGESTIVE MALIGNANCY WITH MCC||374|||38,466.59|36,543.26|12,839.28|12,981.75|11,011.44|11231.6688|11,231.67|11,451.90||||||||||||||11,011.44|38,466.59|12,839.28 |MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC||436|||22,094.89|20,990.15|7,191.94|6,995.77|6,165.68|6288.9936|6,288.99|6,412.31||||||||||||||6,165.68|22,094.89|6,995.77 |DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC||441|||35,483.04|33,708.89|11,741.63|11,392.91|10,861.45|11078.679|11,078.68|11,295.91||||||||||||||10,861.45|35,483.04|11,392.91 |WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC||464|||58,493.03|55,568.38|18,241.70|20,669.15|12,824.73|13081.2246|13,081.22|13,337.72||||||||||||||12,824.73|58,493.03|18,241.70 |FRACTURES OF HIP AND PELVIS WITHOUT MCC||536|||13,690.66|13,006.13|5,114.64|5,610.51|5,293.71|5399.5842|5,399.58|5,505.46||||||||||||||5,114.64|13,690.66|5,505.46 |SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC||623|||35,210.79|33,450.25|11,677.27|9,917.31|10,486.57|10696.3014|10,696.30|10,906.03||||||||||||||9,917.31|35,210.79|10,906.03 |SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS||29|||57,757.56|54,869.68|20,151.55|20,198.63|16,486.67|16816.4034|16,816.40|17,146.14||||||||||||||16,486.67|57,757.56|20,151.55 |MAJOR CHEST PROCEDURES WITH MCC||163|||94,565.99|89,837.69|30,070.90|28,803.47|33,025.82|33686.3364|33,686.34|34,346.85||||||||||||||28,803.47|94,565.99|33,686.34 |OTHER VASCULAR PROCEDURES WITH MCC||252|||62,151.57|59,043.99|20,304.70|22,456.18|16,168.06|16491.4212|16,491.42|16,814.78||||||||||||||16,168.06|62,151.57|20,304.70 |GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC||379|||12,690.49|12,055.97|4,313.14|4128.841148|3,392.52|3460.3704|3,460.37|3,528.22||||||||||||||3,392.52|12,690.49|4,128.84 |TRANSURETHRAL PROCEDURES WITH CC||669|||24,789.16|23,549.70|9,645.25|9,884.95|5,308.07|5414.2314|5,414.23|5,520.39||||||||||||||5,308.07|24,789.16|9,645.25 |CESAREAN SECTION WITH STERILIZATION WITH MCC||783|||10,510.88|9,985.34|11,676.09|8,598.78|7,502.50|7652.55|7,652.55|7,802.60||||||||||||||7,502.50|11,676.09|8,598.78 |PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC||40|||71,930.36|68,333.84|24,101.18|29,911.68|20,099.78|20501.7756|20,501.78|20,903.77||||||||||||||20,099.78|71,930.36|24,101.18 |DYSEQUILIBRIUM||149|||12,681.03|12,046.98|4,899.51|5,326.04|2,638.81|2691.5862|2,691.59|2,744.36||||||||||||||2,638.81|12,681.03|4,899.51 |OTHER HEART ASSIST SYSTEM IMPLANT||215|||300,128.28|285,121.87|67,006.53|66,044.61|34,222.68|34907.1336|34,907.13|35,591.59||||||||||||||34,222.68|300,128.28|66,044.61 |PERITONEAL ADHESIOLYSIS WITH CC||336|||44,129.29|41,922.83|14,120.46|12,004.98|12,318.18|12564.5436|12,564.54|12,810.91||||||||||||||12,004.98|44,129.29|12,810.91 |RENAL FAILURE WITHOUT CC/MCC||684|||11,858.56|11,265.63|4,136.76|3,358.35|3,472.98|3542.4396|3,542.44|3,611.90||||||||||||||3,358.35|11,858.56|3,611.90 |MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC||809|||23,132.90|21,976.26|7,796.77|7,686.05|5,156.39|5259.5178|5,259.52|5,362.65||||||||||||||5,156.39|23,132.90|7,686.05 |POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC||857|||38,789.91|36,850.41|12,641.44|12,350.80|13,350.83|13617.8466|13,617.85|13,884.86||||||||||||||12,350.80|38,789.91|13,617.85 |VIRAL ILLNESS WITHOUT MCC||866|||14,632.23|13,900.62|5,505.55|4,244.79|2,935.82|2994.5364|2,994.54|3,053.25||||||||||||||2,935.82|14,632.23|4,244.79 |OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC||922|||29,935.68|28,438.90|9,977.17|12,894.12|7,143.37|7286.2374|7,286.24|7,429.10||||||||||||||7,143.37|29,935.68|9,977.17 |SIGNS AND SYMPTOMS WITH MCC||947|||21,408.55|20,338.12|7,608.47|10,690.50|8,318.71|8485.0842|8,485.08|8,651.46||||||||||||||7,608.47|21,408.55|8,651.46 |OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC||958|||72,915.42|69,269.65|25,576.62|31,027.99|28,002.21|28562.2542|28,562.25|29,122.30||||||||||||||25,576.62|72,915.42|29,122.30 |MAJOR CHEST TRAUMA WITH MCC||183|||27,837.00|26,445.15|9,786.48|13,080.17|8,646.42|8819.3484|8,819.35|8,992.28||||||||||||||8,646.42|27,837.00|9,786.48 |OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC||205|||27,373.76|26,005.07|10,541.50|8,527.99|9,350.65|9537.663|9,537.66|9,724.68||||||||||||||8,527.99|27,373.76|9,724.68 |CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC||226|||131,852.77|125,260.13|39,916.36|47,859.50|26,771.18|27306.6036|27,306.60|27,842.03||||||||||||||26,771.18|131,852.77|39,916.36 |WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC||463|||96,479.39|91,655.42|32,489.07|37,489.88|23,133.24|23595.9048|23,595.90|24,058.57||||||||||||||23,133.24|96,479.39|32,489.07 |CERVICAL SPINAL FUSION WITH MCC||471|||92,707.42|88,072.05|30,411.75|28,156.34|21,630.23|22062.8346|22,062.83|22,495.44||||||||||||||21,630.23|92,707.42|28,156.34 |CERVICAL SPINAL FUSION WITHOUT CC/MCC||473|||42,824.69|40,683.46|15,653.70|16,087.99|8,349.05|8516.031|8,516.03|8,683.01||||||||||||||8,349.05|42,824.69|15,653.70 |KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC||486|||39,118.88|37,162.94|13,318.96|16,594.91|9,262.95|9448.209|9,448.21|9,633.47||||||||||||||9,262.95|39,118.88|13,318.96 |OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC||579|||50,761.90|48,223.81|17,963.41|19,686.31|11,570.93|11802.3486|11,802.35|12,033.77||||||||||||||11,570.93|50,761.90|17,963.41 |OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC||581|||22,374.73|21,255.99|7,977.93|10,745.77|5,262.03|5367.2706|5,367.27|5,472.51||||||||||||||5,262.03|22,374.73|7,977.93 |URINARY STONES WITHOUT MCC||694|||13,790.88|13,101.34|4,862.55|3,443.28|4,224.57|4309.0614|4,309.06|4,393.55||||||||||||||3,443.28|13,790.88|4,393.55 |UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC||743|||19,077.32|18,123.45|7,264.05|8,639.90|5,057.28|5158.4256|5,158.43|5,259.57||||||||||||||5,057.28|19,077.32|7,264.05 |RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC||815|||18,534.67|17,607.94|6,430.96|5,291.66|4,307.93|4394.0886|4,394.09|4,480.25||||||||||||||4,307.93|18,534.67|5,291.66 |LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC||841|||30,474.54|28,950.81|10,175.01|16,565.25|8,870.71|9048.1242|9,048.12|9,225.54||||||||||||||8,870.71|30,474.54|10,175.01 |OTHER O.R. PROCEDURES FOR INJURIES WITH MCC||907|||71,985.17|68,385.91|24,097.02|23,200.38|22,723.63|23178.1026|23,178.10|23,632.58||||||||||||||22,723.63|71,985.17|23,632.58 |TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES||4|||206,953.85|196,606.16|71,202.28|91,690.61|62,899.47|64157.4594|64,157.46|65,415.45||||||||||||||62,899.47|206,953.85|71,202.28 |TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC||84|||16,012.45|15,211.83|5,904.79|5,944.86|5,748.48|5863.4496|5,863.45|5,978.42||||||||||||||5,748.48|16,012.45|5,944.86 |OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC||167|||36,617.47|34,786.60|11,606.36|13,938.97|12,085.05|12326.751|12,326.75|12,568.45||||||||||||||11,606.36|36,617.47|12,568.45 |RESPIRATORY NEOPLASMS WITH CC||181|||22,263.16|21,150.00|7,196.10|7,245.19|6,230.24|6354.8448|6,354.84|6,479.45||||||||||||||6,230.24|22,263.16|7,196.10 |PLEURAL EFFUSION WITH MCC||186|||29,748.50|28,261.08|9,712.59|10,271.21|8,577.49|8749.0398|8,749.04|8,920.59||||||||||||||8,577.49|29,748.50|9,712.59 |HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC||355|||23,380.58|22,211.55|8,616.13|9,419.82|6,234.27|6358.9554|6,358.96|6,483.64||||||||||||||6,234.27|23,380.58|8,616.13 |MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC||371|||33,756.82|32,068.98|10,815.59|9,305.23|9,203.09|9387.1518|9,387.15|9,571.21||||||||||||||9,203.09|33,756.82|9,571.21 |DIGESTIVE MALIGNANCY WITH CC||375|||23,259.57|22,096.59|7,696.67|8,069.61|6,416.02|6544.3404|6,544.34|6,672.66||||||||||||||6,416.02|23,259.57|7,696.67 |DISORDERS OF THE BILIARY TRACT WITH MCC||444|||30,052.91|28,550.26|10,461.04|9,364.55|9,185.22|9368.9244|9,368.92|9,552.63||||||||||||||9,185.22|30,052.91|9,552.63 |SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC||511|||32,176.17|30,567.36|12,246.94|18,520.80|9,911.25|10109.475|10,109.48|10,307.70||||||||||||||9,911.25|32,176.17|12,246.94 |CONNECTIVE TISSUE DISORDERS WITH CC||546|||22,017.37|20,916.50|7,706.79|9,647.67|8,278.11|8443.6722|8,443.67|8,609.23||||||||||||||7,706.79|22,017.37|8,609.23 |OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC||565|||18,147.08|17,239.73|6,513.21|7,805.36|5,624.23|5736.7146|5,736.71|5,849.20||||||||||||||5,624.23|18,147.08|6,513.21 |KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC||659|||65,887.63|62,593.25|16,396.19|17,072.17|13,316.63|13582.9626|13,582.96|13,849.30||||||||||||||13,316.63|65,887.63|16,396.19 |TRAUMATIC INJURY WITHOUT MCC||914|||13,834.36|13,142.64|5,811.84|4,690.36|3,400.02|3468.0204|3,468.02|3,536.02||||||||||||||3,400.02|13,834.36|4,690.36 |ALLERGIC REACTIONS WITH MCC||915|||30,327.06|28,810.71|10,632.66|10,166.05|7,638.31|7791.0762|7,791.08|7,943.84||||||||||||||7,638.31|30,327.06|10,166.05 |MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC||59|||19,160.50|18,202.48|7,229.48|11,378.08|7,161.76|7304.9952|7,305.00|7,448.23||||||||||||||7,161.76|19,160.50|7,448.23 |NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC||70|||30,786.51|29,247.18|10,506.34|15,744.87|10,657.77|10870.9254|10,870.93|11,084.08||||||||||||||10,506.34|30,786.51|11,084.08 |PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC||244|||40,449.96|38,427.46|12,826.16|14,638.01|10,757.13|10972.2726|10,972.27|11,187.42||||||||||||||10,757.13|40,449.96|12,826.16 |OTHER CIRCULATORY SYSTEM O.R. PROCEDURES||264|||53,091.27|50,436.71|19,870.29|19,323.65|16,912.91|17251.1682|17,251.17|17,589.43||||||||||||||16,912.91|53,091.27|19,323.65 |AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC||268|||118,750.13|112,812.62|41,959.10|15,182.00|36,216.06|36940.3812|36,940.38|37,664.70||||||||||||||15,182.00|118,750.13|37,664.70 |APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC||343|||19,094.33|18,139.61|7,127.58|7,459.55|3,748.00|3822.96|3,822.96|3,897.92||||||||||||||3,748.00|19,094.33|7,127.58 |FOOT PROCEDURES WITH CC||504|||30,139.88|28,632.89|11,087.34|16,121.69|8,677.56|8851.1112|8,851.11|9,024.66||||||||||||||8,677.56|30,139.88|11,087.34 |TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC||604|||25,575.69|24,296.91|9,403.32|8,002.87|7,090.40|7232.208|7,232.21|7,374.02||||||||||||||7,090.40|25,575.69|8,002.87 |KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC||661|||26,434.08|25,112.38|6,859.41|8,294.08|5,112.98|5215.2396|5,215.24|5,317.50||||||||||||||5,112.98|26,434.08|6,859.41 |INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC||728|||14,819.44|14,078.47|5,304.73|3,396.10|4,128.86|4211.4372|4,211.44|4,294.01||||||||||||||3,396.10|14,819.44|4,294.01 |VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC||797|||8,141.28|7,734.22|5,998.34|6883.199505|5,072.35|5173.797|5,173.80|5,275.24||||||||||||||5,072.35|8,141.28|5,998.34 |CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA||955|||107,341.55|101,974.47|37,986.84|50,419.72|41,869.47|42706.8594|42,706.86|43,544.25||||||||||||||37,986.84|107,341.55|43,544.25 |OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC||155|||16,511.61|15,686.03|5,920.30|4,785.41|3,731.28|3805.9056|3,805.91|3,880.53||||||||||||||3,731.28|16,511.61|4,785.41 |SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC||195|||13,444.87|12,772.63|4,479.39|3,640.80|5,400.64|5508.6528|5,508.65|5,616.67||||||||||||||3,640.80|13,444.87|5,508.65 |CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC||224|||143,959.01|136,761.06|44,387.99|53,733.58|31,912.33|32550.5766|32,550.58|33,188.82||||||||||||||31,912.33|143,959.01|44,387.99 |OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC||229|||86,195.79|81,886.00|24,281.14|31,099.44|20,767.50|21182.85|21,182.85|21,598.20||||||||||||||20,767.50|86,195.79|24,281.14 |PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC||250|||51,002.04|48,451.94|15,550.03|18,828.86|13,137.47|13400.2194|13,400.22|13,662.97||||||||||||||13,137.47|51,002.04|15,550.03 |PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC||337|||29,636.95|28,155.10|10,245.33|9,906.52|8,809.26|8985.4452|8,985.45|9,161.63||||||||||||||8,809.26|29,636.95|9,906.52 |INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC||351|||26,677.98|25,344.08|9,397.95|13,310.04|8,041.97|8202.8094|8,202.81|8,363.65||||||||||||||8,041.97|26,677.98|9,397.95 |MAJOR ESOPHAGEAL DISORDERS WITH CC||369|||20,098.29|19,093.38|6,933.33|6,878.48|6,084.34|6206.0268|6,206.03|6,327.71||||||||||||||6,084.34|20,098.29|6,878.48 |COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC||453|||216,116.24|205,310.43|55,301.28|61,427.04|39,638.74|40431.5148|40,431.51|41,224.29||||||||||||||39,638.74|216,116.24|55,301.28 |SPINAL FUSION EXCEPT CERVICAL WITH MCC||459|||123,756.73|117,568.89|40,631.44|42,226.08|29,024.55|29605.041|29,605.04|30,185.53||||||||||||||29,024.55|123,756.73|40,631.44 |SKIN DEBRIDEMENT WITH CC||571|||27,545.82|26,168.53|10,246.52|8,248.24|6,452.97|6582.0294|6,582.03|6,711.09||||||||||||||6,452.97|27,545.82|8,248.24 |MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC||808|||42,249.91|40,137.41|13,494.76|13,401.71|9,453.13|9642.1926|9,642.19|9,831.26||||||||||||||9,453.13|42,249.91|13,401.71 |SPINAL PROCEDURES WITH MCC||28|||101,521.92|96,445.82|35,198.02|28,607.98|29,557.01|30148.1502|30,148.15|30,739.29||||||||||||||28,607.98|101,521.92|30,739.29 |OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC||93|||13,199.08|12,539.13|5,172.42|5,321.32|4,505.96|4596.0792|4,596.08|4,686.20||||||||||||||4,505.96|13,199.08|5,172.42 |PLEURAL EFFUSION WITH CC||187|||20,485.89|19,461.60|6,667.54|6,546.83|5,737.23|5851.9746|5,851.97|5,966.72||||||||||||||5,737.23|20,485.89|6,546.83 |CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC||192|||13,826.81|13,135.47|4,657.57|3,997.39|3,862.43|3939.6786|3,939.68|4,016.93||||||||||||||3,862.43|13,826.81|4,016.93 |RESPIRATORY SIGNS AND SYMPTOMS||204|||13,785.20|13,095.94|5,239.18|4,630.37|3,648.63|3721.6026|3,721.60|3,794.58||||||||||||||3,648.63|13,785.20|4,630.37 |CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC||261|||35,241.04|33,478.99|12,382.82|11,934.20|10,369.69|10577.0838|10,577.08|10,784.48||||||||||||||10,369.69|35,241.04|11,934.20 |HEART FAILURE AND SHOCK WITHOUT CC/MCC||293|||12,737.75|12,100.86|4,405.51|3,471.60|4,284.66|4370.3532|4,370.35|4,456.05||||||||||||||3,471.60|12,737.75|4,405.51 |PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC||301|||13,278.49|12,614.57|4,941.24|4,054.69|5,765.50|5880.81|5,880.81|5,996.12||||||||||||||4,054.69|13,278.49|5,880.81 |APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC||339|||33,452.41|31,779.79|10,617.16|10,546.24|6,616.41|6748.7382|6,748.74|6,881.07||||||||||||||6,616.41|33,452.41|10,546.24 |OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC||356|||71,068.19|67,514.78|26,089.09|27,195.75|23,155.73|23618.8446|23,618.84|24,081.96||||||||||||||23,155.73|71,068.19|26,089.09 |OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC||357|||39,328.76|37,362.32|13,946.47|13,572.93|10,290.91|10496.7282|10,496.73|10,702.55||||||||||||||10,290.91|39,328.76|13,572.93 |COMPLICATED PEPTIC ULCER WITH CC||381|||20,211.74|19,201.15|6,831.43|6,178.77|5,642.84|5755.6968|5,755.70|5,868.55||||||||||||||5,642.84|20,211.74|6,178.77 |INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC||387|||13,951.58|13,254.00|4,768.42|4,515.10|4,634.09|4726.7718|4,726.77|4,819.45||||||||||||||4,515.10|13,951.58|4,768.42 |BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC||478|||41,580.60|39,501.57|14,561.43|13,159.71|10,161.91|10365.1482|10,365.15|10,568.39||||||||||||||10,161.91|41,580.60|13,159.71 |KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC||488|||33,259.55|31,596.57|12,283.31|15,610.05|8,513.60|8683.872|8,683.87|8,854.14||||||||||||||8,513.60|33,259.55|12,283.31 |BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC||520|||22,333.13|21,216.47|8,962.96|11,685.46|6,111.20|6233.424|6,233.42|6,355.65||||||||||||||6,111.20|22,333.13|8,962.96 |FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC||562|||25,830.93|24,539.38|8,906.94|10,714.09|9,659.85|9853.047|9,853.05|10,046.24||||||||||||||8,906.94|25,830.93|10,046.24 |OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC||564|||28,786.13|27,346.82|9,537.40|5,822.17|5,905.45|6023.559|6,023.56|6,141.67||||||||||||||5,822.17|28,786.13|6,141.67 |OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC||629|||41,504.97|39,429.72|14,501.24|15,552.75|9,939.70|10138.494|10,138.49|10,337.29||||||||||||||9,939.70|41,504.97|14,501.24 |ENDOCRINE DISORDERS WITHOUT CC/MCC||645|||13,717.14|13,031.28|5,092.00|3,590.91|4,400.70|4488.714|4,488.71|4,576.73||||||||||||||3,590.91|13,717.14|4,576.73 |CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC||846|||46,545.62|44,218.34|16,426.59|14087.94305|14,612.48|14904.7296|14,904.73|15,196.98||||||||||||||14,087.94|46,545.62|15,196.98 |INTERSTITIAL LUNG DISEASE WITH MCC||196|||30,847.02|29,304.67|10,862.08|10,821.95|9,649.68|9842.6736|9,842.67|10,035.67||||||||||||||9,649.68|30,847.02|10,821.95 |UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC||256|||30,707.10|29,171.75|10,307.89|6,505.71|8,556.44|8727.5688|8,727.57|8,898.70||||||||||||||6,505.71|30,707.10|8,898.70 |CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC||260|||70,521.76|66,995.67|21,874.90|26,818.93|18,664.71|19038.0042|19,038.00|19,411.30||||||||||||||18,664.71|70,521.76|21,874.90 |OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC||272|||42,556.21|40,428.40|16,539.22||14,001.92|14281.9584|14,281.96|14,562.00||||||||||||||14,001.92|42,556.21|15,550.61 |CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC||307|||15,208.91|14,448.46|5,691.47|7,713.01|5,294.00|5399.88|5,399.88|5,505.76||||||||||||||5,294.00|15,208.91|5,691.47 |PERITONEAL ADHESIOLYSIS WITH MCC||335|||78,012.77|74,112.13|23,699.55|22,051.05|20,992.00|21411.84|21,411.84|21,831.68||||||||||||||20,992.00|78,012.77|22,051.05 |APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC||340|||22,259.38|21,146.41|7,836.70|8,021.07|6,293.65|6419.523|6,419.52|6,545.40||||||||||||||6,293.65|22,259.38|7,836.70 |APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC||342|||25,099.23|23,844.27|9,056.51|9,846.53|6,833.92|6970.5984|6,970.60|7,107.28||||||||||||||6,833.92|25,099.23|9,056.51 |MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC||373|||14,779.70|14,040.72|4,947.19|3,886.17|3,472.49|3541.9398|3,541.94|3,611.39||||||||||||||3,472.49|14,779.70|3,886.17 |AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC||474|||68,557.31|65,129.44|24,786.46|32,197.55|17,560.12|17911.3224|17,911.32|18,262.52||||||||||||||17,560.12|68,557.31|24,786.46 |SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC||512|||25,583.27|24,304.11|9,790.07|11,568.17|6,709.65|6843.843|6,843.84|6,978.04||||||||||||||6,709.65|25,583.27|9,790.07 |CONNECTIVE TISSUE DISORDERS WITH MCC||545|||46,150.45|43,842.93|15,411.17|20,244.47|17,148.29|17491.2558|17,491.26|17,834.22||||||||||||||15,411.17|46,150.45|17,834.22 |AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC||560|||20,446.20|19,423.89|6,930.92|11,039.68|11,686.97|11920.7094|11,920.71|12,154.45||||||||||||||6,930.92|20,446.20|11,920.71 |MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC||760|||16,116.45|15,310.63|6,014.44|3,509.35|3,554.54|3625.6308|3,625.63|3,696.72||||||||||||||3,509.35|16,116.45|3,696.72 |OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC||909|||24,564.17|23,335.96|8,709.69|8,566.42|7,895.36|8053.2672|8,053.27|8,211.17||||||||||||||7,895.36|24,564.17|8,566.42 |VENTRICULAR SHUNT PROCEDURES WITH MCC||31|||71,533.30|67,956.64|26,534.24|28,668.65|10,867.68|11085.0336|11,085.03|11,302.39||||||||||||||10,867.68|71,533.30|26,534.24 |NERVOUS SYSTEM NEOPLASMS WITHOUT MCC||55|||19,665.33|18,682.06|6,734.29|7,006.56|6,633.45|6766.119|6,766.12|6,898.79||||||||||||||6,633.45|19,665.33|6,898.79 |ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC||61|||50,752.46|48,214.84|17,727.44|20,550.51|18,361.82|18729.0564|18,729.06|19,096.29||||||||||||||17,727.44|50,752.46|19,096.29 |CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC||73|||25,258.06|23,995.16|9,153.64|10,896.77|9,214.61|9398.9022|9,398.90|9,583.19||||||||||||||9,153.64|25,258.06|9,583.19 |DENTAL AND ORAL DISEASES WITH CC||158|||16,226.11|15,414.80|5,814.81|4,677.56|4,220.17|4304.5734|4,304.57|4,388.98||||||||||||||4,220.17|16,226.11|4,677.56 |CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC||216|||178,941.01|169,993.96|62,669.58|70,964.16|62,932.09|64190.7318|64,190.73|65,449.37||||||||||||||62,669.58|178,941.01|65,449.37 |PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC||251|||31,883.13|30,288.97|10,407.42|13,010.74|7,850.92|8007.9384|8,007.94|8,164.96||||||||||||||7,850.92|31,883.13|10,407.42 |MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC||345|||30,758.14|29,220.23|9,918.17|9,529.70|8,513.03|8683.2906|8,683.29|8,853.55||||||||||||||8,513.03|30,758.14|9,529.70 |INFLAMMATORY BOWEL DISEASE WITH MCC||385|||32,510.84|30,885.30|10,164.87|8,713.37|5,109.09|5211.2718|5,211.27|5,313.45||||||||||||||5,109.09|32,510.84|8,713.37 |REVISION OF HIP OR KNEE REPLACEMENT WITH MCC||466|||95,280.68|90,516.65|32,367.51|33,425.75|23,045.28|23506.1856|23,506.19|23,967.09||||||||||||||23,045.28|95,280.68|32,367.51 |KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC||485|||60,752.43|57,714.81|20,822.54|25,497.03|14,692.07|14985.9114|14,985.91|15,279.75||||||||||||||14,692.07|60,752.43|20,822.54 |KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC||489|||24,562.28|23,334.17|8,252.63|10,824.64|5,597.27|5709.2154|5,709.22|5,821.16||||||||||||||5,597.27|24,562.28|8,252.63 |FOOT PROCEDURES WITHOUT CC/MCC||505|||23,804.10|22,613.90|11,087.34|12,002.29|8,264.34|8429.6268|8,429.63|8,594.91||||||||||||||8,264.34|23,804.10|11,087.34 |OSTEOMYELITIS WITH CC||540|||24,261.65|23,048.57|8,235.36|6,719.39|8,886.65|9064.383|9,064.38|9,242.12||||||||||||||6,719.39|24,261.65|9,064.38 |KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC||656|||65,450.86|62,178.32|20,072.30|22,289.68|16,399.42|16727.4084|16,727.41|17,055.40||||||||||||||16,399.42|65,450.86|20,072.30 |KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC||657|||37,986.35|36,087.03|12,041.96|14,516.67|9,665.15|9858.453|9,858.45|10,051.76||||||||||||||9,665.15|37,986.35|12,041.96 |TRANSURETHRAL PROCEDURES WITH MCC||668|||46,362.21|44,044.10|16,934.31|20,615.22|13,767.88|14043.2376|14,043.24|14,318.60||||||||||||||13,767.88|46,362.21|16,934.31 |OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC||674|||43,766.26|41,577.95|14,701.47|15,553.43|10,959.13|11178.3126|11,178.31|11,397.50||||||||||||||10,959.13|43,766.26|14,701.47 |FEVER AND INFLAMMATORY CONDITIONS||864|||16,035.15|15,233.39|5,730.80|4,833.27|2,469.18|2518.5636|2,518.56|2,567.95||||||||||||||2,469.18|16,035.15|4,833.27 |WOUND DEBRIDEMENTS FOR INJURIES WITH CC||902|||34,533.89|32,807.20|12,210.60|14,773.50|11,269.07|11494.4514|11,494.45|11,719.83||||||||||||||11,269.07|34,533.89|12,210.60 |NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC||72|||13,857.05|13,164.20|5,112.25|5,773.64|4,902.93|5000.9886|5,000.99|5,099.05||||||||||||||4,902.93|13,857.05|5,112.25 |UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC||255|||49,540.50|47,063.48|15,670.40|19,027.72|13,242.66|13507.5132|13,507.51|13,772.37||||||||||||||13,242.66|49,540.50|15,670.40 |CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC||306|||26,524.86|25,198.62|9,477.22|11,251.34|9,166.96|9350.2992|9,350.30|9,533.64||||||||||||||9,166.96|26,524.86|9,533.64 |COMPLICATED PEPTIC ULCER WITH MCC||380|||36,961.58|35,113.50|11,738.06|10,981.71|6,179.43|6303.0186|6,303.02|6,426.61||||||||||||||6,179.43|36,961.58|10,981.71 |UNCOMPLICATED PEPTIC ULCER WITHOUT MCC||384|||16,035.15|15,233.39|5,834.48|7,210.81|4,526.95|4617.489|4,617.49|4,708.03||||||||||||||4,526.95|16,035.15|5,834.48 |SOFT TISSUE PROCEDURES WITH MCC||500|||60,548.25|57,520.84|19,310.75|19,746.98|13,598.22|13870.1844|13,870.18|14,142.15||||||||||||||13,598.22|60,548.25|19,310.75 |SOFT TISSUE PROCEDURES WITHOUT CC/MCC||502|||22,219.68|21,108.70|8,446.91|10,114.82|5,737.82|5852.5764|5,852.58|5,967.33||||||||||||||5,737.82|22,219.68|8,446.91 |HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC||514|||17,120.42|16,264.40|6,441.10|6,704.56|4,286.55|4372.281|4,372.28|4,458.01||||||||||||||4,286.55|17,120.42|6,441.10 |BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR||518|||55,301.52|52,536.44|21,875.51|20,625.33|15,453.92|15762.9984|15,763.00|16,072.08||||||||||||||15,453.92|55,301.52|20,625.33 |FRACTURES OF HIP AND PELVIS WITH MCC||535|||23,132.90|21,976.26|7,868.88|9,231.75|8,464.72|8634.0144|8,634.01|8,803.31||||||||||||||7,868.88|23,132.90|8,803.31 |SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC||556|||14,066.92|13,363.57|5,321.42|4,817.09|4,451.59|4540.6218|4,540.62|4,629.65||||||||||||||4,451.59|14,066.92|4,817.09 |TENDONITIS, MYOSITIS AND BURSITIS WITH MCC||557|||27,027.77|25,676.38|8,822.92|7,988.72|9,563.11|9754.3722|9,754.37|9,945.63||||||||||||||7,988.72|27,027.77|9,754.37 |MINOR SKIN DISORDERS WITHOUT MCC||607|||13,722.80|13,036.66|5,436.42|2,959.28|4,976.93|5076.4686|5,076.47|5,176.01||||||||||||||2,959.28|13,722.80|5,176.01 |ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC||614|||45,218.35|42,957.43|14,739.60|20,649.60|10,109.12|10311.3024|10,311.30|10,513.48||||||||||||||10,109.12|45,218.35|14,739.60 |AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC||616|||75,730.70|71,944.17|24,285.91|29,846.30|16,894.27|17232.1554|17,232.16|17,570.04||||||||||||||16,894.27|75,730.70|24,285.91 |OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC||628|||65,065.17|61,811.91|22,553.62|35,356.36|15,663.04|15976.3008|15,976.30|16,289.56||||||||||||||15,663.04|65,065.17|22,553.62 |INBORN AND OTHER DISORDERS OF METABOLISM||642|||23,153.70|21,996.02|8,188.88|11,219.66|7,379.40|7526.988|7,526.99|7,674.58||||||||||||||7,379.40|23,153.70|8,188.88 |KIDNEY AND URINARY TRACT NEOPLASMS WITH CC||687|||19,211.55|18,250.97|6,760.51|6,755.80|6,069.53|6190.9206|6,190.92|6,312.31||||||||||||||6,069.53|19,211.55|6,755.80 |POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES||769|||41,098.46|39,043.54|10,172.63|8,764.60|5,649.71|5762.7042|5,762.70|5,875.70||||||||||||||5,649.71|41,098.46|8,764.60 |ABORTION WITHOUT D&C||779|||12,951.41|12,303.84|6,716.42|2,778.63|5,108.33|5210.4966|5,210.50|5,312.66||||||||||||||2,778.63|12,951.41|5,312.66 |LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC||823|||84,204.87|79,994.63|27,314.86|34,330.39|23,015.29|23475.5958|23,475.60|23,935.90||||||||||||||23,015.29|84,204.87|27,314.86 |COMPLICATIONS OF TREATMENT WITHOUT CC/MCC||921|||13,159.38|12,501.41|4,636.72|3,938.07|3,110.94|3173.1588|3,173.16|3,235.38||||||||||||||3,110.94|13,159.38|3,938.07 |OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC||923|||15,346.93|14,579.58|6,060.93|3,416.32|4,186.31|4270.0362|4,270.04|4,353.76||||||||||||||3,416.32|15,346.93|4,353.76 |O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC||940|||36,125.89|34,319.60|13,731.34|15,802.84|11,349.25|11576.235|11,576.24|11,803.22||||||||||||||11,349.25|36,125.89|13,731.34 |EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC||983|||33,304.95|31,639.70|9,603.21|11,986.78|9,095.75|9277.665|9,277.67|9,459.58||||||||||||||9,095.75|33,304.95|9,603.21 |CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC||27|||43,174.48|41,015.76|15,484.47|18,623.94|11,982.40|12222.048|12,222.05|12,461.70||||||||||||||11,982.40|43,174.48|15,484.47 |VENTRICULAR SHUNT PROCEDURES WITH CC||32|||38,479.83|36,555.84|13,699.15|12,712.79|10,350.17|10557.1734|10,557.17|10,764.18||||||||||||||10,350.17|38,479.83|12,712.79 |HYPERTENSIVE ENCEPHALOPATHY WITH CC||78|||18,294.55|17,379.82|6,171.76|8,323.74|6,033.30|6153.966|6,153.97|6,274.63||||||||||||||6,033.30|18,294.55|6,274.63 |BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC||95|||44,019.63|41,818.65|15,461.84|24,148.83|15,944.69|16263.5838|16,263.58|16,582.48||||||||||||||15,461.84|44,019.63|16,582.48 |NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC||99|||23,766.30|22,577.99|8,843.17|8,027.82|8,883.38|9061.0476|9,061.05|9,238.72||||||||||||||8,027.82|23,766.30|9,061.05 |NEUROLOGICAL EYE DISORDERS||123|||13,558.31|12,880.39|5,077.10|5,347.61|3,177.81|3241.3662|3,241.37|3,304.92||||||||||||||3,177.81|13,558.31|5,077.10 |OTHER DISORDERS OF THE EYE WITH MCC||124|||22,996.76|21,846.92|8,852.11|10,466.70|5,808.33|5924.4966|5,924.50|6,040.66||||||||||||||5,808.33|22,996.76|8,852.11 |EPISTAXIS WITHOUT MCC||151|||13,297.40|12,632.53|4,908.46|2,694.36|3,032.59|3093.2418|3,093.24|3,153.89||||||||||||||2,694.36|13,297.40|3,153.89 |DENTAL AND ORAL DISEASES WITHOUT CC/MCC||159|||11,677.04|11,093.19|4,424.59|5,760.15|2,698.47|2752.4394|2,752.44|2,806.41||||||||||||||2,698.47|11,677.04|4,424.59 |RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC||179|||18,262.42|17,349.30|5,707.55|4,356.01|9,384.74|9572.4348|9,572.43|9,760.13||||||||||||||4,356.01|18,262.42|9,572.43 |OTHER CARDIOTHORACIC PROCEDURES WITH MCC||228|||131,427.34|124,855.97|37,553.62|50,646.22|32,366.15|33013.473|33,013.47|33,660.80||||||||||||||32,366.15|131,427.34|37,553.62 |AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC||239|||91,472.78|86,899.14|29,171.68|38,448.44|25,041.29|25542.1158|25,542.12|26,042.94||||||||||||||25,041.29|91,472.78|29,171.68 |AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC||240|||50,737.33|48,200.46|17,142.28|21,424.14|14,528.92|14819.4984|14,819.50|15,110.08||||||||||||||14,528.92|50,737.33|17,142.28 |OTHER VASCULAR PROCEDURES WITHOUT CC/MCC||254|||32,580.79|30,951.75|11,299.48|14,951.46|9,069.93|9251.3286|9,251.33|9,432.73||||||||||||||9,069.93|32,580.79|11,299.48 |CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC||262|||28,597.07|27,167.22|10,695.23|9,771.70|8,894.93|9072.8286|9,072.83|9,250.73||||||||||||||8,894.93|28,597.07|9,771.70 |OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC||316|||12,285.88|11,671.59|4,982.94|4,065.48|4,569.15|4660.533|4,660.53|4,751.92||||||||||||||4,065.48|12,285.88|4,751.92 |HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC||353|||55,099.21|52,344.25|18,443.12|17,562.91|16,232.32|16556.9664|16,556.97|16,881.61||||||||||||||16,232.32|55,099.21|17,562.91 |OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC||358|||25,553.01|24,275.36|8,495.76|8,801.00|7,225.04|7369.5408|7,369.54|7,514.04||||||||||||||7,225.04|25,553.01|8,495.76 |DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC||446|||14,431.82|13,710.23|5,380.40|4,825.86|4,492.44|4582.2888|4,582.29|4,672.14||||||||||||||4,492.44|14,431.82|4,825.86 |SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC||457|||133,751.06|127,063.51|39,262.06|41,862.74|30,116.50|30718.83|30,718.83|31,321.16||||||||||||||30,116.50|133,751.06|39,262.06 |LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC||496|||32,994.86|31,345.12|12,348.84|12,687.84|8,561.03|8732.2506|8,732.25|8,903.47||||||||||||||8,561.03|32,994.86|12,348.84 |AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC||559|||36,305.51|34,490.23|11,647.48|9,704.29|12,271.32|12516.7464|12,516.75|12,762.17||||||||||||||9,704.29|36,305.51|12,516.75 |SKIN ULCERS WITH MCC||592|||26,952.14|25,604.53|10,567.71|12,620.43|8,019.43|8179.8186|8,179.82|8,340.21||||||||||||||8,019.43|26,952.14|10,567.71 |KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC||696|||13,110.20|12,454.69|4,626.59|3,431.83|3,995.19|4075.0938|4,075.09|4,155.00||||||||||||||3,431.83|13,110.20|4,155.00 |TRANSURETHRAL PROSTATECTOMY WITH CC/MCC||713|||28,506.30|27,080.99|9,405.11|8,594.06|4,694.30|4788.186|4,788.19|4,882.07||||||||||||||4,694.30|28,506.30|8,594.06 |RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC||814|||31,427.47|29,856.10|11,783.94|16,986.56|8,206.98|8371.1196|8,371.12|8,535.26||||||||||||||8,206.98|31,427.47|11,783.94 |RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC||816|||13,163.15|12,504.99|4,454.97|3,758.09|2,868.62|2925.9924|2,925.99|2,983.36||||||||||||||2,868.62|13,163.15|3,758.09 |MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC||829|||62,849.24|59,706.78|19,619.42|21,666.81|16,406.15|16734.273|16,734.27|17,062.40||||||||||||||16,406.15|62,849.24|19,619.42 |ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC||834|||105,861.11|100,568.05|36,569.19|63,414.96|43,706.74|44580.8748|44,580.87|45,455.01||||||||||||||36,569.19|105,861.11|45,455.01 |ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC||835|||43,531.82|41,355.23|13,112.19|28,743.48|11,568.37|11799.7374|11,799.74|12,031.10||||||||||||||11,568.37|43,531.82|13,112.19 |CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC||837|||115,991.57|110,191.99|34,478.19|27,715.48|17,789.11|18144.8922|18,144.89|18,500.67||||||||||||||17,789.11|115,991.57|27,715.48 |CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC||839|||24,938.54|23,691.61|9,373.53|6,521.88|16,135.25|16457.955|16,457.96|16,780.66||||||||||||||6,521.88|24,938.54|16,457.96 |OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC||868|||19,459.25|18,486.29|6,823.67|7,065.88|6,259.63|6384.8226|6,384.82|6,510.02||||||||||||||6,259.63|19,459.25|6,823.67 |OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC||965|||17,426.72|16,555.38|5,956.62|4,014.24|4,691.02|4784.8404|4,784.84|4,878.66||||||||||||||4,014.24|17,426.72|4,878.66 |CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC||24|||71,801.78|68,211.69|23,950.42|26,970.60|19,971.29|20370.7158|20,370.72|20,770.14||||||||||||||19,971.29|71,801.78|23,950.42 |PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC||42|||36,381.13|34,562.07|11,748.79|9,878.21|9,572.51|9763.9602|9,763.96|9,955.41||||||||||||||9,572.51|36,381.13|9,955.41 |NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC||67|||27,109.09|25,753.64|9,005.85|10,659.49|9,056.94|9238.0788|9,238.08|9,419.22||||||||||||||9,005.85|27,109.09|9,419.22 |NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC||68|||16,507.83|15,682.44|5,811.84|7,067.90|5,649.30|5762.286|5,762.29|5,875.27||||||||||||||5,649.30|16,507.83|5,875.27 |VIRAL MENINGITIS WITHOUT CC/MCC||76|||15,696.71|14,911.87|6,361.85|3,786.40|6,236.10|6360.822|6,360.82|6,485.54||||||||||||||3,786.40|15,696.71|6,361.85 |CONCUSSION WITHOUT CC/MCC||90|||13,979.95|13,280.95|5,610.42|9,084.12|5,434.42|5543.1084|5,543.11|5,651.80||||||||||||||5,434.42|13,979.95|5,651.80 |NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC||97|||59,030.00|56,078.50|22,878.40|18,174.32|23,857.27|24334.4154|24,334.42|24,811.56||||||||||||||18,174.32|59,030.00|24,334.42 |NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC||98|||34,808.06|33,067.66|13,095.52|16,468.18|13,420.11|13688.5122|13,688.51|13,956.91||||||||||||||13,095.52|34,808.06|13,956.91 |OTHER DISORDERS OF THE EYE WITHOUT MCC||125|||13,719.03|13,033.08|5,494.82|4,216.47|3,468.89|3538.2678|3,538.27|3,607.65||||||||||||||3,468.89|13,719.03|4,216.47 |PNEUMOTHORAX WITHOUT CC/MCC||201|||13,904.30|13,209.09|4,744.58|3,224.88|3,943.58|4022.4516|4,022.45|4,101.32||||||||||||||3,224.88|13,904.30|4,101.32 |PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC||249|||36,188.29|34,378.88|11,715.41|17,124.07|11,686.89|11920.6278|11,920.63|12,154.37||||||||||||||11,686.89|36,188.29|12,154.37 |ATHEROSCLEROSIS WITH MCC||302|||20,022.68|19,021.55|7,032.84|10,057.52|6,666.27|6799.5954|6,799.60|6,932.92||||||||||||||6,666.27|20,022.68|7,032.84 |MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC||344|||58,667.00|55,733.65|17,207.22|14,987.19|15,113.22|15415.4844|15,415.48|15,717.75||||||||||||||14,987.19|58,667.00|15,717.75 |AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC||475|||39,706.91|37,721.56|13,588.32|16,056.98|10,831.01|11047.6302|11,047.63|11,264.25||||||||||||||10,831.01|39,706.91|13,588.32 |BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC||477|||59,011.10|56,060.55|20,520.42|29,651.48|14,473.47|14762.9394|14,762.94|15,052.41||||||||||||||14,473.47|59,011.10|20,520.42 |SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC||510|||46,171.24|43,862.68|16,788.91|20,432.54|11,773.57|12009.0414|12,009.04|12,244.51||||||||||||||11,773.57|46,171.24|16,788.91 |BONE DISEASES AND ARTHROPATHIES WITH MCC||553|||23,231.21|22,069.65|8,074.46|34,486.78|8,701.41|8875.4382|8,875.44|9,049.47||||||||||||||8,074.46|34,486.78|9,049.47 |OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC||566|||13,535.63|12,858.85|4,994.86|4,785.41|5,356.41|5463.5382|5,463.54|5,570.67||||||||||||||4,785.41|13,535.63|5,463.54 |SKIN DEBRIDEMENT WITHOUT CC/MCC||572|||19,646.42|18,664.10|7,087.06|10,068.31|4,357.57|4444.7214|4,444.72|4,531.87||||||||||||||4,357.57|19,646.42|7,087.06 |BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC||584|||31,752.67|30,165.04|11,387.67|20,834.98|7,209.80|7353.996|7,354.00|7,498.19||||||||||||||7,209.80|31,752.67|11,387.67 |SKIN ULCERS WITH CC||593|||19,281.51|18,317.43|7,290.86|4,356.01|5,404.93|5513.0286|5,513.03|5,621.13||||||||||||||4,356.01|19,281.51|5,621.13 |SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC||622|||66,626.89|63,295.55|22,045.34|27,032.62|15,301.75|15607.785|15,607.79|15,913.82||||||||||||||15,301.75|66,626.89|22,045.34 |KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC||686|||31,518.21|29,942.30|11,679.06|11,561.43|10,850.78|11067.7956|11,067.80|11,284.81||||||||||||||10,850.78|31,518.21|11,561.43 |OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC||700|||13543.19|12866.0305|4954.927745|5,990.70|4314.36|4400.6472|4,400.65|4,486.93||||||||||||||4,314.36|13,543.19|4,954.93 |BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC||726|||14,002.65|13,302.52|4,946.00|4,653.29|3,819.52|3895.9104|3,895.91|3,972.30||||||||||||||3,819.52|14,002.65|4,653.29 |INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC||758|||19,077.32|18,123.45|6,279.03|4,941.80|3,509.68|3579.8736|3,579.87|3,650.07||||||||||||||3,509.68|19,077.32|4,941.80 |VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC||796|||8,141.28|7,734.22|6,880.28|7,990.74|5,325.97|5432.4894|5,432.49|5,539.01||||||||||||||5,325.97|8,141.28|6,880.28 |MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC||810|||16,343.33|15,526.16|6,241.47|11,788.60|4,169.90|4253.298|4,253.30|4,336.70||||||||||||||4,169.90|16,343.33|6,241.47 |OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC||817|||45,102.97|42,847.82|14,233.08|12,189.01|6,344.20|6471.084|6,471.08|6,597.97||||||||||||||6,344.20|45,102.97|12,189.01 |LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC||824|||44,369.40|42,150.93|14,596.00|17,593.24|12,091.84|12333.6768|12,333.68|12,575.51||||||||||||||12,091.84|44,369.40|14,596.00 |NEUROSES EXCEPT DEPRESSIVE||882|||2,382.24|2,263.13|5,420.92|9,512.85|2,133.70|2176.374|2,176.37|2,219.05||||||||||||||2,133.70|9,512.85|2,263.13 |WOUND DEBRIDEMENTS FOR INJURIES WITH MCC||901|||74,437.43|70,715.56|25,915.11|31,891.51|24,475.67|24965.1834|24,965.18|25,454.70||||||||||||||24,475.67|74,437.43|25,915.11 |HAND PROCEDURES FOR INJURIES||906|||29,627.50|28,146.13|11,205.91|11,505.48|10,300.89|10506.9078|10,506.91|10,712.93||||||||||||||10,300.89|29,627.50|11,205.91 |TRAUMATIC INJURY WITH MCC||913|||25,640.00|24,358.00|10,267.98|12,244.29|3,570.02|3641.4204|3,641.42|3,712.82||||||||||||||3,570.02|25,640.00|10,267.98 |HIV WITH MAJOR RELATED CONDITION WITH MCC||974|||50,162.55|47,654.42|16,520.73|20,350.97|16,292.73|16618.5846|16,618.58|16,944.44||||||||||||||16,292.73|50,162.55|16,944.44 |HIV WITH MAJOR RELATED CONDITION WITH CC||975|||25,692.92|24,408.27|8,138.82|9,920.00|7,759.63|7914.8226|7,914.82|8,070.02||||||||||||||7,759.63|25,692.92|8,138.82 |EXTRACRANIAL PROCEDURES WITH MCC||37|||58,400.40|55,480.38|20,030.59|39,115.12|16,630.64|16963.2528|16,963.25|17,295.87||||||||||||||16,630.64|58,400.40|20,030.59 |SPINAL DISORDERS AND INJURIES WITH CC/MCC||52|||28,200.01|26,790.01|11,511.61|13,041.75|11,730.28|11964.8856|11,964.89|12,199.49||||||||||||||11,511.61|28,200.01|12,199.49 |SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC||53|||16,307.41|15,492.04|7,286.70|8,781.46|7,222.79|7367.2458|7,367.25|7,511.70||||||||||||||7,222.79|16,307.41|7,511.70 |VIRAL MENINGITIS WITH CC/MCC||75|||31,985.22|30,385.96|10,206.00|5,672.52|10,337.35|10544.097|10,544.10|10,750.84||||||||||||||5,672.52|31,985.22|10,544.10 |EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC||147|||23,480.79|22,306.75|8,269.94|9,735.30|5,353.74|5460.8148|5,460.81|5,567.89||||||||||||||5,353.74|23,480.79|8,269.94 |EPISTAXIS WITH MCC||150|||23,747.37|22,560.00|8,410.54|9,911.92|5,450.84|5559.8568|5,559.86|5,668.87||||||||||||||5,450.84|23,747.37|8,410.54 |OTITIS MEDIA AND URI WITH MCC||152|||20,064.26|19,061.05|6,933.90|5,805.32|4,431.20|4519.824|4,519.82|4,608.45||||||||||||||4,431.20|20,064.26|5,805.32 |OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC||168|||24,484.77|23,260.53|8,676.92|10,655.44|8,892.68|9070.5336|9,070.53|9,248.39||||||||||||||8,676.92|24,484.77|9,248.39 |APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC||341|||40,693.86|38,659.17|14,318.89|11,879.60|12,497.86|12747.8172|12,747.82|12,997.77||||||||||||||11,879.60|40,693.86|12,997.77 |INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC||352|||18,460.95|17,537.90|7,089.44|8,011.64|5,951.62|6070.6524|6,070.65|6,189.68||||||||||||||5,951.62|18,460.95|7,089.44 |DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC||443|||12,374.73|11,755.99|4,466.29|4,972.81|3,648.11|3721.0722|3,721.07|3,794.03||||||||||||||3,648.11|12,374.73|4,466.29 |SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC||456|||177,842.52|168,950.39|51,752.71|58,623.48|32,089.88|32731.6776|32,731.68|33,373.48||||||||||||||32,089.88|177,842.52|51,752.71 |FOOT PROCEDURES WITH MCC||503|||42,879.51|40,735.53|16,181.07|21,283.25|9,111.44|9293.6688|9,293.67|9,475.90||||||||||||||9,111.44|42,879.51|16,181.07 |HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC||513|||28,407.98|26,987.58|9,806.74|9,417.13|6,721.72|6856.1544|6,856.15|6,990.59||||||||||||||6,721.72|28,407.98|9,417.13 |OSTEOMYELITIS WITH MCC||539|||34,722.98|32,986.83|12,084.26|9,795.97|13,317.97|13584.3294|13,584.33|13,850.69||||||||||||||9,795.97|34,722.98|13,584.33 |AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC||561|||12,936.27|12,289.46|5,230.82|6,364.15|11,130.45|11353.059|11,353.06|11,575.67||||||||||||||5,230.82|12,936.27|11,353.06 |SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC||577|||42,690.44|40,555.92|15,734.74|11,894.43|10,092.84|10294.6968|10,294.70|10,496.55||||||||||||||10,092.84|42,690.44|11,894.43 |BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC||585|||28,708.61|27,273.18|10,865.06|18,950.88|6,863.20|7000.464|7,000.46|7,137.73||||||||||||||6,863.20|28,708.61|10,865.06 |MAJOR SKIN DISORDERS WITHOUT MCC||596|||17,725.45|16,839.18|6,411.31|3,459.46|4,703.16|4797.2232|4,797.22|4,891.29||||||||||||||3,459.46|17,725.45|4,891.29 |TRANSURETHRAL PROCEDURES WITHOUT CC/MCC||670|||17,407.81|16,537.42|6,335.62|7,324.06|4,879.80|4977.396|4,977.40|5,074.99||||||||||||||4,879.80|17,407.81|6,335.62 |VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC||746|||27,657.37|26,274.50|10,107.07|7,415.06|6,468.88|6598.2576|6,598.26|6,727.64||||||||||||||6,468.88|27,657.37|7,415.06 |MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC||754|||36,309.27|34,493.81|11,368.00|6,659.40|7,015.83|7156.1466|7,156.15|7,296.46||||||||||||||6,659.40|36,309.27|7,296.46 |ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY||770|||15,639.98|14,857.98|5,808.85|5,855.20|2,808.73|2864.9046|2,864.90|2,921.08||||||||||||||2,808.73|15,639.98|5,808.85 |OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC||803|||35,392.28|33,622.67|11,748.18|14,718.90|9,646.04|9838.9608|9,838.96|10,031.88||||||||||||||9,646.04|35,392.28|11,748.18 |OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC||818|||24,202.08|22,991.98|8,361.69|7,503.37|6,042.09|6162.9318|6,162.93|6,283.77||||||||||||||6,042.09|24,202.08|7,503.37 |ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC||836|||21,518.22|20,442.31|7,486.31|18,461.48|6,401.27|6529.2954|6,529.30|6,657.32||||||||||||||6,401.27|21,518.22|7,486.31 |OTHER MENTAL DISORDER DIAGNOSES||887|||2,382.24|2,263.13|6,944.63|8,068.26|2,691.92|2745.7584|2,745.76|2,799.60||||||||||||||2,263.13|8,068.26|2,745.76 |OTHER FACTORS INFLUENCING HEALTH STATUS||951|||18,689.71|17,755.22|3,842.98|2,921.53|3,828.36|3904.9272|3,904.93|3,981.49||||||||||||||2,921.53|18,689.71|3,904.93 |SPINAL PROCEDURES WITHOUT CC/MCC||30|||33,998.84|32,298.90|14,562.62|14,077.16|11,970.59|12210.0018|12,210.00|12,449.41||||||||||||||11,970.59|33,998.84|14,077.16 |VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC||33|||29,748.50|28,261.08|10,770.30|14,378.48|9,857.31|10054.4562|10,054.46|10,251.60||||||||||||||9,857.31|29,748.50|10,770.30 |ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC||63|||28,810.72|27,370.18|10,705.96|12,397.31|10,870.74|11088.1548|11,088.15|11,305.57||||||||||||||10,705.96|28,810.72|11,305.57 |NONTRAUMATIC STUPOR AND COMA WITH MCC||80|||22,989.20|21,839.74|12,982.89|15,653.20|13,299.96|13565.9592|13,565.96|13,831.96||||||||||||||12,982.89|22,989.20|13,831.96 |NONTRAUMATIC STUPOR AND COMA WITHOUT MCC||81|||14,465.85|13,742.56|5,117.01|6,477.39|4,908.01|5006.1702|5,006.17|5,104.33||||||||||||||4,908.01|14,465.85|5,117.01 |CONCUSSION WITH MCC||88|||25,813.93|24,523.23|9,212.64|10,919.02|9,277.55|9463.101|9,463.10|9,648.65||||||||||||||9,212.64|25,813.93|9,648.65 |HEADACHES WITH MCC||102|||20,202.29|19,192.18|7,379.65|7,259.35|7,321.97|7468.4094|7,468.41|7,614.85||||||||||||||7,259.35|20,202.29|7,468.41 |EXTRAOCULAR PROCEDURES EXCEPT ORBIT||115|||24,864.79|23,621.55|9,176.87|10,874.52|7,437.71|7586.4642|7,586.46|7,735.22||||||||||||||7,437.71|24,864.79|9,176.87 |MAJOR HEAD AND NECK PROCEDURES WITH CC||141|||37,393.52|35,523.84|13,671.16|2,982.20|9,192.45|9376.299|9,376.30|9,560.15||||||||||||||2,982.20|37,393.52|9,560.15 |OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC||154|||26,640.17|25,308.16|9,708.43|16,718.27|6,347.04|6473.9808|6,473.98|6,600.92||||||||||||||6,347.04|26,640.17|9,708.43 |MAJOR CHEST PROCEDURES WITHOUT CC/MCC||165|||34,312.69|32,597.06|11,890.01|14,150.63|10,928.72|11147.2944|11,147.29|11,365.87||||||||||||||10,928.72|34,312.69|11,890.01 |MAJOR CHEST TRAUMA WITHOUT CC/MCC||185|||13,579.13|12,900.17|5,126.55|4,461.17|4,299.86|4385.8572|4,385.86|4,471.85||||||||||||||4,299.86|13,579.13|4,471.85 |CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC||217|||118,313.36|112,397.69|39,207.24|44,383.19|33,811.23|34487.4546|34,487.45|35,163.68||||||||||||||33,811.23|118,313.36|39,207.24 |CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC||221|||85,849.80|81,557.31|27,643.81|32,798.17|23,706.09|24180.2118|24,180.21|24,654.33||||||||||||||23,706.09|85,849.80|27,643.81 |CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC||225|||110,722.14|105,186.03|34,046.74|40,548.93|29,301.54|29887.5708|29,887.57|30,473.60||||||||||||||29,301.54|110,722.14|34,046.74 |CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC||259|||36,785.75|34,946.46|13,150.94|15,864.19|11,040.93|11261.7486|11,261.75|11,482.57||||||||||||||11,040.93|36,785.75|13,150.94 |MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC||346|||22,958.95|21,811.00|8,114.40|7,979.28|6,879.70|7017.294|7,017.29|7,154.89||||||||||||||6,879.70|22,958.95|7,979.28 |DIGESTIVE MALIGNANCY WITHOUT CC/MCC||376|||17,192.28|16,332.67|5,851.17|4,185.47|4,766.88|4862.2176|4,862.22|4,957.56||||||||||||||4,185.47|17,192.28|4,957.56 |PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC||405|||105,668.27|100,384.86|34,664.69|34,525.88|21,365.34|21792.6468|21,792.65|22,219.95||||||||||||||21,365.34|105,668.27|34,525.88 |CHOLECYSTECTOMY WITH C.D.E. WITH MCC||411|||67,653.56|64,270.88|22,877.21|28,077.47|13,990.28|14270.0856|14,270.09|14,549.89||||||||||||||13,990.28|67,653.56|22,877.21 |CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC||414|||66,710.09|63,374.59|22,121.00|18,929.98|13,517.15|13787.493|13,787.49|14,057.84||||||||||||||13,517.15|66,710.09|18,929.98 |CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC||415|||37,948.53|36,051.10|12,624.76|12,829.40|7,575.64|7727.1528|7,727.15|7,878.67||||||||||||||7,575.64|37,948.53|12,624.76 |OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC||423|||80,638.99|76,607.04|25,419.31|25,890.70|15,580.80|15892.416|15,892.42|16,204.03||||||||||||||15,580.80|80,638.99|25,419.31 |LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC||498|||42,525.95|40,399.65|15,916.51|10,176.16|11,142.36|11365.2072|11,365.21|11,588.05||||||||||||||10,176.16|42,525.95|11,588.05 |MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC||507|||35,352.57|33,584.94|12,567.54|15,132.12|8,719.26|8893.6452|8,893.65|9,068.03||||||||||||||8,719.26|35,352.57|12,567.54 |FRACTURES OF FEMUR WITHOUT MCC||534|||13,902.43|13,207.31|5,215.94|3,998.07|5,410.34|5518.5468|5,518.55|5,626.75||||||||||||||3,998.07|13,902.43|5,518.55 |SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC||538|||11,877.46|11,283.59|4,815.50|5,398.16|4,949.30|5048.286|5,048.29|5,147.27||||||||||||||4,815.50|11,877.46|5,147.27 |PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC||544|||14,757.02|14,019.17|5,142.05|4,120.08|5,325.27|5431.7754|5,431.78|5,538.28||||||||||||||4,120.08|14,757.02|5,431.78 |SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC||555|||23,928.89|22,732.45|8,637.58|9,752.15|9,349.75|9536.745|9,536.75|9,723.74||||||||||||||8,637.58|23,928.89|9,723.74 |MASTECTOMY FOR MALIGNANCY WITH CC/MCC||582|||25,278.86|24,014.92|10,264.40|29,745.18|6,464.83|6594.1266|6,594.13|6,723.42||||||||||||||6,464.83|29,745.18|10,264.40 |MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC||583|||22,416.31|21,295.49|9,681.00|18,980.54|6,077.92|6199.4784|6,199.48|6,321.04||||||||||||||6,077.92|22,416.31|9,681.00 |THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC||627|||17,220.63|16,359.60|7,559.03|8,821.23|5,005.43|5105.5386|5,105.54|5,205.65||||||||||||||5,005.43|17,220.63|7,559.03 |MAJOR BLADDER PROCEDURES WITH CC||654|||57,226.26|54,364.95|17,798.94|20,211.44|14,492.98|14782.8396|14,782.84|15,072.70||||||||||||||14,492.98|57,226.26|17,798.94 |KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC||658|||28,997.90|27,548.01|9,926.52|14,894.16|7,891.13|8048.9526|8,048.95|8,206.78||||||||||||||7,891.13|28,997.90|9,926.52 |MAJOR MALE PELVIC PROCEDURES WITH CC/MCC||707|||33,565.86|31,887.57|11,961.51|19,018.96|6,044.43|6165.3186|6,165.32|6,286.21||||||||||||||6,044.43|33,565.86|11,961.51 |TESTES PROCEDURES WITH CC/MCC||711|||37,736.77|35,849.93|13,211.11|15,939.69|6,704.39|6838.4778|6,838.48|6,972.57||||||||||||||6,704.39|37,736.77|13,211.11 |OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC||717|||33,361.65|31,693.57|11,233.92|15,905.98|5,660.16|5773.3632|5,773.36|5,886.57||||||||||||||5,660.16|33,361.65|11,233.92 |MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC||722|||32,841.71|31,199.62|10,700.60|12,787.61|8,781.85|8957.487|8,957.49|9,133.12||||||||||||||8,781.85|32,841.71|10,700.60 |OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC||729|||21,117.39|20,061.52|6,504.27|7,518.20|5,163.26|5266.5252|5,266.53|5,369.79||||||||||||||5,163.26|21,117.39|6,504.27 |D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC||744|||31,860.43|30,267.41|11,207.11|8,484.85|7,210.86|7355.0772|7,355.08|7,499.29||||||||||||||7,210.86|31,860.43|8,484.85 |MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC||755|||6,140.36|5,833.34|7,236.04|5,075.27|4,344.35|4431.237|4,431.24|4,518.12||||||||||||||4,344.35|7,236.04|5,075.27 |INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC||759|||14,359.98|13,641.98|4,587.86|3,643.49|2,875.09|2932.5918|2,932.59|2,990.09||||||||||||||2,875.09|14,359.98|3,643.49 |SPLENECTOMY WITH MCC||799|||89939.4|85442.43|31169.14643|25,451.19|26325.48|26851.9896|26,851.99|27,378.50||||||||||||||25,451.19|89,939.40|27,378.50 |LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC||820|||111,841.44|106,249.37|34,407.27|40,672.96|29,106.50|29688.63|29,688.63|30,270.76||||||||||||||29,106.50|111,841.44|34,407.27 |LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC||821|||43,700.10|41,515.10|13,358.91|14,847.65|11,029.38|11249.9676|11,249.97|11,470.56||||||||||||||11,029.38|43,700.10|13,358.91 |OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC||844|||21,238.41|20,176.49|7,551.26|8,833.36|6,460.93|6590.1486|6,590.15|6,719.37||||||||||||||6,460.93|21,238.41|7,551.26 |VIRAL ILLNESS WITH MCC||865|||28,876.89|27,433.05|9,329.43|7,603.13|8,746.57|8921.5014|8,921.50|9,096.43||||||||||||||7,603.13|28,876.89|9,096.43 |SKIN GRAFTS FOR INJURIES WITH CC/MCC||904|||60,767.57|57,729.19|22,692.47|33,900.31|21,370.13|21797.5326|21,797.53|22,224.94||||||||||||||21,370.13|60,767.57|22,692.47 |AFTERCARE WITH CC/MCC||949|||21,170.33|20,111.81|7,113.88|19,166.59|12,938.03|13196.7906|13,196.79|13,455.55||||||||||||||7,113.88|21,170.33|13,455.55 |OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC||959|||41,037.96|38,986.06|16,809.75|22,437.98|18,206.03|18570.1506|18,570.15|18,934.27||||||||||||||16,809.75|41,037.96|18,934.27 |HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC||976|||17,154.45|16,296.73|6,172.34|7,101.61|5,757.69|5872.8438|5,872.84|5,988.00||||||||||||||5,757.69|17,154.45|6,172.34 |HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC||1|||496,248.30|471,435.89|173,120.15|220,117.45|144,490.34|147380.1468|147,380.15|150,269.95||||||||||||||144,490.34|496,248.30|173,120.15 |TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC||11|||89,810.85|85,320.31|30,409.36|34,787.42|27,628.54|28181.1108|28,181.11|28,733.68||||||||||||||27,628.54|89,810.85|30,409.36 |TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC||12|||64,373.17|61,154.51|23,350.94|25,207.84|21,104.74|21526.8348|21,526.83|21,948.93||||||||||||||21,104.74|64,373.17|23,350.94 |CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC||36|||32,482.47|30,858.35|11,547.96|14,059.63|9,401.36|9589.3872|9,589.39|9,777.41||||||||||||||9,401.36|32,482.47|11,547.96 |MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC||58|||32,516.51|30,890.68|10,865.66|12,068.35|11,041.12|11261.9424|11,261.94|11,482.76||||||||||||||10,865.66|32,516.51|11,482.76 |MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC||60|||15,371.51|14,602.93|5,972.73|7,177.11|4,612.89|4705.1478|4,705.15|4,797.41||||||||||||||4,612.89|15,371.51|5,972.73 |HYPERTENSIVE ENCEPHALOPATHY WITH MCC||77|||29,207.76|27,747.37|9,645.25|11,462.34|9,739.10|9933.882|9,933.88|10,128.66||||||||||||||9,645.25|29,207.76|10,128.66 |CONCUSSION WITH CC||89|||18,451.48|17,528.91|6,840.36|8,331.16|6,746.61|6881.5422|6,881.54|7,016.47||||||||||||||6,746.61|18,451.48|7,016.47 |BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC||94|||65,095.41|61,840.64|22,166.30|20,558.60|23,097.55|23559.501|23,559.50|24,021.45||||||||||||||20,558.60|65,095.41|23,559.50 |BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC||96|||41,321.57|39,255.49|14,410.06|13,800.10|14,822.58|15119.0316|15,119.03|15,415.48||||||||||||||13,800.10|41,321.57|15,119.03 |INTRAOCULAR PROCEDURES WITH CC/MCC||116|||28,389.09|26,969.64|11,702.89|28,820.32|9,607.15|9799.293|9,799.29|9,991.44||||||||||||||9,607.15|28,820.32|11,702.89 |ACUTE MAJOR EYE INFECTIONS WITH CC/MCC||121|||18,782.36|17,843.24|7,600.12|4,221.87|4,935.92|5034.6384|5,034.64|5,133.36||||||||||||||4,221.87|18,782.36|5,133.36 |SINUS AND MASTOID PROCEDURES WITH CC/MCC||135|||36,112.65|34,307.02|13,272.49|16,017.21|6,938.69|7077.4638|7,077.46|7,216.24||||||||||||||6,938.69|36,112.65|13,272.49 |MOUTH PROCEDURES WITH CC/MCC||137|||26,963.49|25,615.32|9,268.05|7,987.37|4,760.42|4855.6284|4,855.63|4,950.84||||||||||||||4,760.42|26,963.49|7,987.37 |MAJOR HEAD AND NECK PROCEDURES WITH MCC||140|||67,428.91|64,057.46|24,237.04|3,596.98|9,652.08|9845.1216|9,845.12|10,038.16||||||||||||||3,596.98|67,428.91|10,038.16 |OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC||145|||20,107.74|19,102.35|7,747.92|3,362.39|3,392.28|3460.1256|3,460.13|3,527.97||||||||||||||3,362.39|20,107.74|3,527.97 |EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC||146|||35,432.01|33,660.41|12,631.90|15,212.34|8,365.75|8533.065|8,533.07|8,700.38||||||||||||||8,365.75|35,432.01|12,631.90 |RESPIRATORY NEOPLASMS WITHOUT CC/MCC||182|||16,171.29|15,362.73|5,209.39|5,892.28|4,377.12|4464.6624|4,464.66|4,552.20||||||||||||||4,377.12|16,171.29|5,209.39 |INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC||198|||14,700.31|13,965.29|4,940.03|5,469.62|4,125.89|4208.4078|4,208.41|4,290.93||||||||||||||4,125.89|14,700.31|4,940.03 |CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC||222|||161,066.21|153,012.90|50,697.97|50,168.96|43,852.85|44729.907|44,729.91|45,606.96||||||||||||||43,852.85|161,066.21|50,168.96 |CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITHOUT MCC||223|||121,054.90|115,002.16|37,534.55|46,481.65|32,349.49|32996.4798|32,996.48|33,643.47||||||||||||||32,349.49|121,054.90|37,534.55 |CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC||227|||103,641.40|98,459.33|31,812.73|31,652.20|19,315.97|19702.2894|19,702.29|20,088.61||||||||||||||19,315.97|103,641.40|31,652.20 |AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC||241|||27,369.98|26,001.48|9,999.81|11,907.91|8,287.21|8452.9542|8,452.95|8,618.70||||||||||||||8,287.21|27,369.98|9,999.81 |AICD GENERATOR PROCEDURES||245|||88,606.45|84,176.13|32,778.65|40,509.83|28,193.39|28757.2578|28,757.26|29,321.13||||||||||||||28,193.39|88,606.45|32,778.65 |PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS||248|||58,037.37|55,135.50|19,429.92|22,666.50|14,731.94|15026.5788|15,026.58|15,321.22||||||||||||||14,731.94|58,037.37|19,429.92 |CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC||258|||54,055.54|51,352.76|19,593.20|23,953.35|16,670.76|17004.1752|17,004.18|17,337.59||||||||||||||16,670.76|54,055.54|19,593.20 |OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC||319|||71,683.15|68,098.99|26,234.50|32,292.59|22,474.51|22924.0002|22,924.00|23,373.49||||||||||||||22,474.51|71,683.15|26,234.50 |OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC||320|||41,039.47|38,987.50|15,078.68|18,284.87|12,725.56|12980.0712|12,980.07|13,234.58||||||||||||||12,725.56|41,039.47|15,078.68 |ANAL AND STOMAL PROCEDURES WITH MCC||347|||46,241.21|43,929.15|15,185.33|18,419.01|13,282.41|13548.0582|13,548.06|13,813.71||||||||||||||13,282.41|46,241.21|15,185.33 |ANAL AND STOMAL PROCEDURES WITH CC||348|||27,388.88|26,019.44|8,516.02|9,153.56|7,243.38|7388.2476|7,388.25|7,533.12||||||||||||||7,243.38|27,388.88|8,516.02 |ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC||349|||17,517.49|16,641.62|6,352.31|6,702.54|5,284.15|5389.833|5,389.83|5,495.52||||||||||||||5,284.15|17,517.49|6,352.31 |INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC||350|||47,233.83|44,872.14|15,130.51|18,350.26|13,232.77|13497.4254|13,497.43|13,762.08||||||||||||||13,232.77|47,233.83|15,130.51 |MAJOR ESOPHAGEAL DISORDERS WITH MCC||368|||33,745.48|32,058.21|12,090.82|12,417.53|10,342.63|10549.4826|10,549.48|10,756.34||||||||||||||10,342.63|33,745.48|12,090.82 |MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC||370|||13,906.21|13,210.90|4,971.61|3,237.01|3,980.92|4060.5384|4,060.54|4,140.16||||||||||||||3,237.01|13,906.21|4,140.16 |UNCOMPLICATED PEPTIC ULCER WITH MCC||383|||25,609.72|24,329.23|8,328.32|9,808.78|6,980.46|7120.0692|7,120.07|7,259.68||||||||||||||6,980.46|25,609.72|8,328.32 |BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC||409|||46,602.34|44,272.22|13,115.77|18,145.33|7,882.86|8040.5172|8,040.52|8,198.17||||||||||||||7,882.86|46,602.34|13,115.77 |CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC||413|||34,025.30|32,324.04|10,834.07|12,955.46|6,455.27|6584.3754|6,584.38|6,713.48||||||||||||||6,455.27|34,025.30|10,834.07 |HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC||420|||69,217.17|65,756.31|21,457.18|45,793.40|13,101.81|13363.8462|13,363.85|13,625.88||||||||||||||13,101.81|69,217.17|21,457.18 |WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC||465|||36,583.43|34,754.26|11,502.67|11,073.38|7,948.79|8107.7658|8,107.77|8,266.74||||||||||||||7,948.79|36,583.43|11,073.38 |AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC||476|||21,605.19|20,524.93|7,427.91|7,714.36|6,361.15|6488.373|6,488.37|6,615.60||||||||||||||6,361.15|21,605.19|7,427.91 |KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC||487|||29,275.82|27,812.03|10,291.21|8,279.93|7,072.25|7213.695|7,213.70|7,355.14||||||||||||||7,072.25|29,275.82|8,279.93 |MAJOR THUMB OR JOINT PROCEDURES||506|||25,505.74|24,230.45|9,310.37|10,068.98|6,362.57|6489.8214|6,489.82|6,617.07||||||||||||||6,362.57|25,505.74|9,310.37 |SEPTIC ARTHRITIS WITH MCC||548|||35,418.74|33,647.80|12,611.05|15,186.72|13,924.45|14202.939|14,202.94|14,481.43||||||||||||||12,611.05|35,418.74|14,481.43 |SEPTIC ARTHRITIS WITH CC||549|||22,355.81|21,238.02|7,946.96|6,533.34|8,554.59|8725.6818|8,725.68|8,896.77||||||||||||||6,533.34|22,355.81|8,725.68 |SEPTIC ARTHRITIS WITHOUT CC/MCC||550|||15,369.61|14,601.13|5,776.68|5,409.62|6,055.93|6177.0486|6,177.05|6,298.17||||||||||||||5,409.62|15,369.61|6,177.05 |SKIN DEBRIDEMENT WITH MCC||570|||46,330.06|44,013.56|17,418.16|21,222.58|11,209.31|11433.4962|11,433.50|11,657.68||||||||||||||11,209.31|46,330.06|17,418.16 |SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC||573|||73,983.67|70,284.49|33,513.41|41,432.67|21,883.90|22321.578|22,321.58|22,759.26||||||||||||||21,883.90|73,983.67|33,513.41 |SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC||574|||53,753.02|51,065.37|19,873.27|24,291.74|12,837.57|13094.3214|13,094.32|13,351.07||||||||||||||12,837.57|53,753.02|19,873.27 |SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC||575|||30,518.04|28,992.14|11,013.45|13,180.61|6,961.60|7100.832|7,100.83|7,240.06||||||||||||||6,961.60|30,518.04|11,013.45 |SKIN ULCERS WITHOUT CC/MCC||594|||13,327.65|12,661.27|5,395.30|6,126.19|3,892.52|3970.3704|3,970.37|4,048.22||||||||||||||3,892.52|13,327.65|5,395.30 |MAJOR SKIN DISORDERS WITH MCC||595|||34,940.41|33,193.39|12,506.76|15,055.27|9,566.55|9757.881|9,757.88|9,949.21||||||||||||||9,566.55|34,940.41|12,506.76 |NON-MALIGNANT BREAST DISORDERS WITH CC/MCC||600|||18,610.32|17,679.80|6,450.04|4,980.90|4,734.07|4828.7514|4,828.75|4,923.43||||||||||||||4,734.07|18,610.32|4,980.90 |MINOR SKIN DISORDERS WITH MCC||606|||25,917.91|24,622.01|9,520.71|8,449.13|7,184.07|7327.7514|7,327.75|7,471.43||||||||||||||7,184.07|25,917.91|8,449.13 |ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC||615|||26,950.24|25,602.73|9,896.72|14,237.59|6,666.99|6800.3298|6,800.33|6,933.67||||||||||||||6,666.99|26,950.24|9,896.72 |THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC||626|||26,349.02|25,031.57|10,362.72|14,710.81|6,998.20|7138.164|7,138.16|7,278.13||||||||||||||6,998.20|26,349.02|10,362.72 |MINOR BLADDER PROCEDURES WITH MCC||662|||54,635.97|51,904.17|17,975.34|21,922.29|14,640.90|14933.718|14,933.72|15,226.54||||||||||||||14,640.90|54,635.97|17,975.34 |PROSTATECTOMY WITH CC||666|||33,802.19|32,112.08|10,851.36|12,977.03|8,666.70|8840.034|8,840.03|9,013.37||||||||||||||8,666.70|33,802.19|10,851.36 |KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC||688|||12,491.94|11,867.34|4,600.37|5,127.85|3,969.70|4049.094|4,049.09|4,128.49||||||||||||||3,969.70|12,491.94|4,600.37 |MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC||708|||24,855.33|23,612.56|9,403.90|14,385.22|4,693.67|4787.5434|4,787.54|4,881.42||||||||||||||4,693.67|24,855.33|9,403.90 |TESTES PROCEDURES WITHOUT CC/MCC||712|||17,914.52|17,018.79|6,818.31|7,912.54|3,328.12|3394.6824|3,394.68|3,461.24||||||||||||||3,328.12|17,914.52|6,818.31 |TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC||714|||15,261.85|14,498.76|6,049.60|6,947.24|2,922.13|2980.5726|2,980.57|3,039.02||||||||||||||2,922.13|15,261.85|6,049.60 |OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC||718|||17,146.87|16,289.53|7,883.18|7,512.81|3,890.52|3968.3304|3,968.33|4,046.14||||||||||||||3,890.52|17,146.87|7,512.81 |BENIGN PROSTATIC HYPERTROPHY WITH MCC||725|||24,953.64|23,705.96|8,155.50|9,591.72|6,587.16|6718.9032|6,718.90|6,850.65||||||||||||||6,587.16|24,953.64|8,155.50 |INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC||727|||27,341.64|25,974.56|8,967.12|10,610.95|7,287.04|7432.7808|7,432.78|7,578.52||||||||||||||7,287.04|27,341.64|8,967.12 |OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC||730|||11412.36|10841.742|3887.686894|4,232.65|2906.9|2965.038|2,965.04|3,023.18||||||||||||||2,906.90|11,412.36|3,887.69 |D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC||745|||18,375.86|17,457.07|7,491.67|8,628.44|4,704.75|4798.845|4,798.85|4,892.94||||||||||||||4,704.75|18,375.86|7,491.67 |OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC||749|||50,013.18|47,512.52|16,650.05|17,251.48|10,882.21|11099.8542|11,099.85|11,317.50||||||||||||||10,882.21|50,013.18|16,650.05 |INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC||757|||25,934.94|24,638.19|9,586.86|4,575.77|5,864.25|5981.535|5,981.54|6,098.82||||||||||||||4,575.77|25,934.94|6,098.82 |SPLENECTOMY WITH CC||800|||51,737.52|49,150.64|18,104.05|22,084.08|15,104.69|15406.7838|15,406.78|15,708.88||||||||||||||15,104.69|51,737.52|18,104.05 |OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC||802|||64,057.40|60,854.53|22,616.79|27,750.53|18,980.41|19360.0182|19,360.02|19,739.63||||||||||||||18,980.41|64,057.40|22,616.79 |OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC||804|||22,149.74|21,042.25|8,645.94|8,991.77|6,981.71|7121.3442|7,121.34|7,260.98||||||||||||||6,981.71|22,149.74|8,645.94 |OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC||819|||14,947.04|14,199.69|6,463.16|5,594.33|5,754.37|5869.4574|5,869.46|5,984.54||||||||||||||5,594.33|14,947.04|5,984.54 |MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC||826|||97,965.49|93,067.22|30,530.93|61,694.66|25,777.37|26292.9174|26,292.92|26,808.46||||||||||||||25,777.37|97,965.49|30,530.93 |MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC||827|||43,753.03|41,565.38|15,399.86|18,982.56|12,782.23|13037.8746|13,037.87|13,293.52||||||||||||||12,782.23|43,753.03|15,399.86 |CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT||838|||52,386.04|49,766.74|13,976.85|16,005.07|16,942.01|17280.8502|17,280.85|17,619.69||||||||||||||13,976.85|52,386.04|17,280.85 |OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC||845|||15,619.21|14,838.25|5,566.32|6,340.55|4,637.86|4730.6172|4,730.62|4,823.37||||||||||||||4,637.86|15,619.21|5,566.32 |CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC||848|||17,681.96|16,797.86|6,648.47|5,556.58|5,631.76|5744.3952|5,744.40|5,857.03||||||||||||||5,556.58|17,681.96|5,857.03 |INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC||855|||28,595.17|27,165.41|9,425.36|7,146.77|9,809.55|10005.741|10,005.74|10,201.93||||||||||||||7,146.77|28,595.17|10,005.74 |POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC||858|||25,146.49|23,889.17|8,551.77|8,904.81|8,847.62|9024.5724|9,024.57|9,201.52||||||||||||||8,551.77|25,146.49|9,024.57 |OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC||867|||49,287.14|46,822.78|13,802.24|14,206.58|13,185.80|13449.516|13,449.52|13,713.23||||||||||||||13,185.80|49,287.14|13,802.24 |DISORDERS OF PERSONALITY AND IMPULSE CONTROL||883|||2,382.24|2,263.13|9,921.76|7,408.32|3,011.70|3071.934|3,071.93|3,132.17||||||||||||||2,263.13|9,921.76|3,071.93 |BEHAVIORAL AND DEVELOPMENTAL DISORDERS||886|||2,382.24|2,263.13|7,795.59|5,940.14|1,765.02|1800.3204|1,800.32|1,835.62||||||||||||||1,765.02|7,795.59|2,263.13 |WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC||903|||22,164.84|21,056.60|7,276.55|8,644.61|6,514.29|6644.5758|6,644.58|6,774.86||||||||||||||6,514.29|22,164.84|7,276.55 |FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC||928|||108,525.14|103,098.88|39,363.96|20,927.33|33,363.49|34030.7598|34,030.76|34,698.03||||||||||||||20,927.33|108,525.14|34,698.03 |EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT||933|||54,235.14|51,523.38|13,969.69|16,892.18|11,600.89|11832.9078|11,832.91|12,064.93||||||||||||||11,600.89|54,235.14|13,969.69 |NON-EXTENSIVE BURNS||935|||28,627.33|27,195.96|12,037.21|7,752.78|9,934.44|10133.1288|10,133.13|10,331.82||||||||||||||7,752.78|28,627.33|10,331.82 |O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC||939|||56,468.09|53,644.69|20,695.02|25,337.27|17,329.92|17676.5184|17,676.52|18,023.12||||||||||||||17,329.92|56,468.09|20,695.02 |O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC||941|||25,692.92|24,408.27|11,985.95|16,764.11|9,850.24|10047.2448|10,047.24|10,244.25||||||||||||||9,850.24|25,692.92|11,985.95 |AFTERCARE WITHOUT CC/MCC||950|||10,962.37|10,414.25|4,919.78|9,889.67|5,067.67|5169.0234|5,169.02|5,270.38||||||||||||||4,919.78|10,962.37|5,270.38 |HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC||969|||95,085.93|90,331.63|35,003.76|43,303.96|29,618.79|30211.1658|30,211.17|30,803.54||||||||||||||29,618.79|95,085.93|35,003.76 |NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC||989|||19,710.71|18,725.17|6,479.12|6,959.37|6,133.64|6256.3128|6,256.31|6,378.99||||||||||||||6,133.64|19,710.71|6,479.12 |HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC||2|||276,891.37|263,046.80|95,449.42|119,203.18|87,742.26|89497.1052|89,497.11|91,251.95||||||||||||||87,742.26|276,891.37|95,449.42 |LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT||5|||202,803.73|192,663.54|61,437.27|91,631.29|56,306.29|57432.4158|57,432.42|58,558.54||||||||||||||56,306.29|202,803.73|61,437.27 |LIVER TRANSPLANT WITHOUT MCC||6|||91,378.26|86,809.35|28,474.48|35,710.94|25,840.21|26357.0142|26,357.01|26,873.82||||||||||||||25,840.21|91,378.26|28,474.48 |LUNG TRANSPLANT||7|||183,412.55|174,241.92|69,487.87|86,604.55|63,747.11|65022.0522|65,022.05|66,296.99||||||||||||||63,747.11|183,412.55|69,487.87 |SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT||8|||102,737.67|97,600.79|32,854.95|40,605.55|29,888.88|30486.6576|30,486.66|31,084.44||||||||||||||29,888.88|102,737.67|32,854.95 |PANCREAS TRANSPLANT||10|||81,374.48|77,305.76|22,074.52|27,069.02|19,925.00|20323.5|20,323.50|20,722.00||||||||||||||19,925.00|81,374.48|22,074.52 |TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC||13|||41,418.00|39,347.10|16,728.12|20,356.37|14,983.54|15283.2108|15,283.21|15,582.88||||||||||||||14,983.54|41,418.00|16,728.12 |ALLOGENEIC BONE MARROW TRANSPLANT||14|||219,186.78|208,227.44|76,665.47|105,551.38|62,914.46|64172.7492|64,172.75|65,431.04||||||||||||||62,914.46|219,186.78|76,665.47 |AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC||16|||116,744.07|110,906.87|40,598.07|46,389.97|33,115.41|33777.7182|33,777.72|34,440.03||||||||||||||33,115.41|116,744.07|40,598.07 |AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC||17|||82,663.93|78,530.73|29,299.81|36,141.68|23,780.75|24256.365|24,256.37|24,731.98||||||||||||||23,780.75|82,663.93|29,299.81 |CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY||18|||632,943.16|601,296.00|222,960.01|159,828.28|183,783.61|187459.2822|187,459.28|191,134.95||||||||||||||159,828.28|632,943.16|191,134.95 |SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS||19|||121,868.95|115,775.50|40,214.90|49,847.41|36,691.37|37425.1974|37,425.20|38,159.02||||||||||||||36,691.37|121,868.95|40,214.90 |INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC||20|||184,478.93|175,254.98|62,014.09|84,365.88|52,410.87|53459.0874|53,459.09|54,507.30||||||||||||||52,410.87|184,478.93|62,014.09 |INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC||21|||135,278.74|128,514.80|45,397.43|53,724.82|38,249.41|39014.3982|39,014.40|39,779.39||||||||||||||38,249.41|135,278.74|45,397.43 |INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC||22|||94,492.25|89,767.64|29,475.01|37,557.29|24,679.59|25173.1818|25,173.18|25,666.77||||||||||||||24,679.59|94,492.25|29,475.01 |CAROTID ARTERY STENT PROCEDURES WITH MCC||34|||69,674.72|66,190.98|24,201.29|29,739.79|20,185.10|20588.802|20,588.80|20,992.50||||||||||||||20,185.10|69,674.72|24,201.29 |CAROTID ARTERY STENT PROCEDURES WITH CC||35|||43,577.18|41,398.32|14,443.43|17,487.41|11,869.02|12106.4004|12,106.40|12,343.78||||||||||||||11,869.02|43,577.18|14,443.43 |HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC||79|||12,974.08|12,325.38|4,847.66|5,437.94|4,620.65|4713.063|4,713.06|4,805.48||||||||||||||4,620.65|12,974.08|4,847.66 |ORBITAL PROCEDURES WITH CC/MCC||113|||38,037.40|36,135.53|13,577.58|16,400.09|11,217.21|11441.5542|11,441.55|11,665.90||||||||||||||11,217.21|38,037.40|13,577.58 |ORBITAL PROCEDURES WITHOUT CC/MCC||114|||22,866.31|21,722.99|9,130.39|10,815.88|7,397.79|7545.7458|7,545.75|7,693.70||||||||||||||7,397.79|22,866.31|9,130.39 |INTRAOCULAR PROCEDURES WITHOUT CC/MCC||117|||15,768.55|14,980.12|6,707.48|7,773.68|5,316.89|5423.2278|5,423.23|5,529.57||||||||||||||5,316.89|15,768.55|6,707.48 |ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC||122|||11,060.68|10,507.65|4,353.07|2,283.84|2,673.30|2726.766|2,726.77|2,780.23||||||||||||||2,283.84|11,060.68|2,780.23 |SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC||136|||22,508.96|21,383.51|7,998.18|9,394.21|4,069.66|4151.0532|4,151.05|4,232.45||||||||||||||4,069.66|22,508.96|7,998.18 |MOUTH PROCEDURES WITHOUT CC/MCC||138|||15,639.98|14,857.98|5,540.69|5,961.71|2,640.25|2693.055|2,693.06|2,745.86||||||||||||||2,640.25|15,639.98|5,540.69 |SALIVARY GLAND PROCEDURES||139|||18,581.94|17,652.84|7,827.17|7,901.09|3,976.63|4056.1626|4,056.16|4,135.70||||||||||||||3,976.63|18,581.94|7,827.17 |MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC||142|||27,558.80|26,180.86|10,103.50|6,199.67|8,754.72|8929.8144|8,929.81|9,104.91||||||||||||||6,199.67|27,558.80|9,104.91 |OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC||143|||48,478.08|46,054.18|18,177.94|12,722.90|9,607.07|9799.2114|9,799.21|9,991.35||||||||||||||9,607.07|48,478.08|12,722.90 |OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC||144|||28,632.45|27,200.83|10,947.89|4,435.56|6,124.91|6247.4082|6,247.41|6,369.91||||||||||||||4,435.56|28,632.45|6,369.91 |EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC||148|||15,303.44|14,538.27|5,202.23|5,883.51|3,235.45|3300.159|3,300.16|3,364.87||||||||||||||3,235.45|15,303.44|5,202.23 |OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC||156|||12,595.94|11,966.14|4,435.30|4,010.87|2,705.88|2759.9976|2,760.00|2,814.12||||||||||||||2,705.88|12,595.94|4,010.87 |DENTAL AND ORAL DISEASES WITH MCC||157|||28,264.29|26,851.08|9,886.60|8,582.60|6,470.07|6599.4714|6,599.47|6,728.87||||||||||||||6,470.07|28,264.29|8,582.60 |PLEURAL EFFUSION WITHOUT CC/MCC||188|||14,861.02|14,117.97|4,855.42|4,736.20|4,046.96|4127.8992|4,127.90|4,208.84||||||||||||||4,046.96|14,861.02|4,736.20 |INTERSTITIAL LUNG DISEASE WITH CC||197|||19,674.79|18,691.05|6,509.03|6,515.14|5,589.38|5701.1676|5,701.17|5,812.96||||||||||||||5,589.38|19,674.79|6,509.03 |CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC||218|||103,639.53|98,457.55|31,164.97|38,484.17|26,783.20|27318.864|27,318.86|27,854.53||||||||||||||26,783.20|103,639.53|31,164.97 |CORONARY BYPASS WITH PTCA WITH MCC||231|||147,581.63|140,202.55|51,109.74|70,187.60|44,212.69|45096.9438|45,096.94|45,981.20||||||||||||||44,212.69|147,581.63|51,109.74 |CORONARY BYPASS WITH PTCA WITHOUT MCC||232|||109,243.62|103,781.44|35,664.60|44,133.77|30,715.38|31329.6876|31,329.69|31,944.00||||||||||||||30,715.38|109,243.62|35,664.60 |UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC||257|||20,502.90|19,477.76|7,435.07|8,687.08|6,045.90|6166.818|6,166.82|6,287.74||||||||||||||6,045.90|20,502.90|7,435.07 |VEIN LIGATION AND STRIPPING||263|||39,428.95|37,457.50|14,253.94|17,249.46|12,004.84|12244.9368|12,244.94|12,485.03||||||||||||||12,004.84|39,428.95|14,253.94 |AICD LEAD PROCEDURES||265|||56,118.31|53,312.39|20,554.99|25,161.33|17,511.25|17861.475|17,861.48|18,211.70||||||||||||||17,511.25|56,118.31|20,554.99 |ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC||284|||14,798.63|14,058.70|4,891.77|5,493.89|4,475.88|4565.3976|4,565.40|4,654.92||||||||||||||4,475.88|14,798.63|4,891.77 |ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC||285|||10,347.88|9,830.49|3,474.72|3,714.27|3,026.19|3086.7138|3,086.71|3,147.24||||||||||||||3,026.19|10,347.88|3,474.72 |ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC||288|||52,813.33|50,172.66|16,492.74|23,090.50|16,344.09|16670.9718|16,670.97|16,997.85||||||||||||||16,344.09|52,813.33|16,997.85 |ACUTE AND SUBACUTE ENDOCARDITIS WITH CC||289|||32,083.54|30,479.36|10,304.92|13,446.88|10,013.73|10214.0046|10,214.00|10,414.28||||||||||||||10,013.73|32,083.54|10,414.28 |ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC||290|||19,939.47|18,942.50|6,616.31|7,659.08|6,240.14|6364.9428|6,364.94|6,489.75||||||||||||||6,240.14|19,939.47|6,616.31 |DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC||294|||18,578.15|17,649.24|8,156.69|9,593.07|7,816.02|7972.3404|7,972.34|8,128.66||||||||||||||7,816.02|18,578.15|8,156.69 |DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC||295|||14,042.34|13,340.22|6,364.22|7,342.26|5,982.27|6101.9154|6,101.92|6,221.56||||||||||||||5,982.27|14,042.34|6,364.22 |CARDIAC ARREST, UNEXPLAINED WITH MCC||296|||24,322.15|23,106.04|10,020.08|9,231.08|9,722.33|9916.7766|9,916.78|10,111.22||||||||||||||9,231.08|24,322.15|10,020.08 |CARDIAC ARREST, UNEXPLAINED WITH CC||297|||12,266.96|11,653.61|4,715.38|5,272.11|4,295.43|4381.3386|4,381.34|4,467.25||||||||||||||4,295.43|12,266.96|4,715.38 |CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC||298|||8,464.72|8,041.48|3,425.86|3,652.93|2,976.20|3035.724|3,035.72|3,095.25||||||||||||||2,976.20|8,464.72|3,425.86 |RECTAL RESECTION WITH MCC||332|||86,159.88|81,851.89|25,304.30|31,125.06|22,445.10|22894.002|22,894.00|23,342.90||||||||||||||22,445.10|86,159.88|25,304.30 |RECTAL RESECTION WITH CC||333|||45,857.38|43,564.51|13,274.89|13,000.63|11,552.51|11783.5602|11,783.56|12,014.61||||||||||||||11,552.51|45,857.38|13,000.63 |RECTAL RESECTION WITHOUT CC/MCC||334|||31,158.98|29,601.03|10,105.88|14,563.18|8,682.99|8856.6498|8,856.65|9,030.31||||||||||||||8,682.99|31,158.98|10,105.88 |APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC||338|||56,190.15|53,380.64|17,194.71|13,736.74|15,101.89|15403.9278|15,403.93|15,705.97||||||||||||||13,736.74|56,190.15|15,705.97 |COMPLICATED PEPTIC ULCER WITHOUT CC/MCC||382|||15,575.71|14,796.92|5,094.98|5,119.76|4,091.15|4172.973|4,172.97|4,254.80||||||||||||||4,091.15|15,575.71|5,094.98 |PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC||406|||53,081.82|50,427.73|17,660.70|21,716.69|11,106.67|11328.8034|11,328.80|11,550.94||||||||||||||11,106.67|53,081.82|17,660.70 |PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC||407|||37,863.45|35,970.28|13,125.91|16,558.51|6,767.74|6903.0948|6,903.09|7,038.45||||||||||||||6,767.74|37,863.45|13,125.91 |BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC||408|||68,965.71|65,517.42|22,859.93|24,444.76|13,979.47|14259.0594|14,259.06|14,538.65||||||||||||||13,979.47|68,965.71|22,859.93 |BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC||410|||29,449.76|27,977.27|9,846.67|13,780.56|5,837.49|5954.2398|5,954.24|6,070.99||||||||||||||5,837.49|29,449.76|9,846.67 |CHOLECYSTECTOMY WITH C.D.E. WITH CC||412|||47,231.94|44,870.34|14,077.55|17,027.68|8,484.62|8654.3124|8,654.31|8,824.00||||||||||||||8,484.62|47,231.94|14,077.55 |CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC||416|||25,225.93|23,964.63|8,991.56|11,629.51|5,302.47|5408.5194|5,408.52|5,514.57||||||||||||||5,302.47|25,225.93|8,991.56 |HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC||421|||32,994.86|31,345.12|11,891.81|11,256.74|7,117.06|7259.4012|7,259.40|7,401.74||||||||||||||7,117.06|32,994.86|11,256.74 |HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC||422|||24,467.75|23,244.36|9,165.56|10,860.37|5,411.33|5519.5566|5,519.56|5,627.78||||||||||||||5,411.33|24,467.75|9,165.56 |OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC||424|||43,579.08|41,400.13|14,112.72|13,190.05|8,506.61|8676.7422|8,676.74|8,846.87||||||||||||||8,506.61|43,579.08|13,190.05 |OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC||425|||30,251.43|28,738.86|9,713.19|11,547.95|5,753.97|5869.0494|5,869.05|5,984.13||||||||||||||5,753.97|30,251.43|9,713.19 |CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC||434|||11,788.60|11,199.17|4,208.87|3,593.61|2,179.65|2223.243|2,223.24|2,266.84||||||||||||||2,179.65|11,788.60|3,593.61 |MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC||437|||17,112.86|16,257.22|5,846.99|7,447.42|4,923.41|5021.8782|5,021.88|5,120.35||||||||||||||4,923.41|17,112.86|5,846.99 |SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC||458|||100,181.39|95,172.32|30,415.33|34,118.05|20,549.63|20960.6226|20,960.62|21,371.62||||||||||||||20,549.63|100,181.39|30,415.33 |BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC||461|||96,382.96|91,563.81|36,724.70|45,465.11|26,197.89|26721.8478|26,721.85|27,245.81||||||||||||||26,197.89|96,382.96|36,724.70 |BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC||479|||32,440.88|30,818.84|11,298.27|9,462.29|7,800.90|7956.918|7,956.92|8,112.94||||||||||||||7,800.90|32,440.88|9,462.29 |LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC||495|||57006.93|54156.5835|22172.84779|17,941.75|15669.07|15982.4514|15,982.45|16,295.83||||||||||||||15,669.07|57,006.93|17,941.75 |LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC||497|||23,512.93|22,337.28|9,209.05|8,653.38|6,289.27|6415.0554|6,415.06|6,540.84||||||||||||||6,289.27|23,512.93|8,653.38 |LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC||499|||19,875.19|18,881.43|7,659.72|12,062.96|5,168.27|5271.6354|5,271.64|5,375.00||||||||||||||5,168.27|19,875.19|7,659.72 |MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC||508|||30504.79|28979.5505|8,942.68|10,579.94|6,096.54|6218.4708|6,218.47|6,340.40||||||||||||||6,096.54|30,504.79|8,942.68 |ARTHROSCOPY||509|||31314.03|29748.3285|10,490.84|12,524.04|7,216.69|7361.0238|7,361.02|7,505.36||||||||||||||7,216.69|31,314.03|10,490.84 |HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC||521|||60,803.36|57,763.19|18,771.45|22,921.98|13,284.12|13549.8024|13,549.80|13,815.48||||||||||||||13,284.12|60,803.36|18,771.45 |HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC||522|||43,449.97|41,277.47|13,561.51|16,156.75|12,651.55|12904.581|12,904.58|13,157.61||||||||||||||12,651.55|43,449.97|13,561.51 |FRACTURES OF FEMUR WITH MCC||533|||27,283.01|25,918.86|8,934.34|10,569.83|9,691.41|9885.2382|9,885.24|10,079.07||||||||||||||8,934.34|27,283.01|10,079.07 |SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC||537|||17,103.41|16,248.24|6,077.61|6,982.97|6,402.40|6530.448|6,530.45|6,658.50||||||||||||||6,077.61|17,103.41|6,658.50 |OSTEOMYELITIS WITHOUT CC/MCC||541|||17201.73|16341.6435|5525.800486|5,937.44|5767.1|5882.442|5,882.44|5,997.78||||||||||||||5,525.80|17,201.73|5,937.44 |CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC||547|||14,902.61|14,157.48|5,480.51|6,693.78|5,714.95|5829.249|5,829.25|5,943.55||||||||||||||5,480.51|14,902.61|5,943.55 |SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC||576|||101,140.00|96,083.00|30,614.96|37,861.98|19,961.60|20360.832|20,360.83|20,760.06||||||||||||||19,961.60|101,140.00|30,614.96 |SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC||578|||26,114.55|24,808.82|10,233.99|14,482.29|6,444.67|6573.5634|6,573.56|6,702.46||||||||||||||6,444.67|26,114.55|10,233.99 |MALIGNANT BREAST DISORDERS WITH MCC||597|||32,892.78|31,248.14|10,269.76|14,069.74|5,045.00|5145.9|5,145.90|5,246.80||||||||||||||5,045.00|32,892.78|10,269.76 |MALIGNANT BREAST DISORDERS WITH CC||598|||20,073.72|19,070.03|7,138.31|4,610.15|4,804.76|4900.8552|4,900.86|4,996.95||||||||||||||4,610.15|20,073.72|4,996.95 |MALIGNANT BREAST DISORDERS WITHOUT CC/MCC||599|||13,633.94|12,952.24|4,516.35|5,022.02|4,575.96|4667.4792|4,667.48|4,759.00||||||||||||||4,516.35|13,633.94|4,759.00 |NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC||601|||12,854.96|12,212.21|4,614.06|3,137.92|3,269.20|3334.584|3,334.58|3,399.97||||||||||||||3,137.92|12,854.96|3,399.97 |AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC||618|||22,317.99|21,202.09|8,281.23|9,749.46|5,518.76|5629.1352|5,629.14|5,739.51||||||||||||||5,518.76|22,317.99|8,281.23 |O.R. PROCEDURES FOR OBESITY WITH MCC||619|||55,621.04|52,839.99|18,757.74|22,212.15|12,965.07|13224.3714|13,224.37|13,483.67||||||||||||||12,965.07|55,621.04|18,757.74 |SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC||624|||21,349.96|20,282.46|7,037.59|8,188.25|4,634.83|4727.5266|4,727.53|4,820.22||||||||||||||4,634.83|21,349.96|7,037.59 |THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC||625|||49,410.03|46,939.53|17,447.36|21,258.98|12,033.70|12274.374|12,274.37|12,515.05||||||||||||||12,033.70|49,410.03|17,447.36 |OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC||630|||25,715.61|24,429.83|8,900.39|11,469.75|5,958.82|6077.9964|6,078.00|6,197.17||||||||||||||5,958.82|25,715.61|8,900.39 |KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC||650|||82,560.05|78,432.05|27,410.20|18,336.10|22,553.02|23004.0804|23,004.08|23,455.14||||||||||||||18,336.10|82,560.05|23,455.14 |KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC||651|||67,574.07|64,195.37|22,526.82|93,807.94|18,457.79|18826.9458|18,826.95|19,196.10||||||||||||||18,457.79|93,807.94|22,526.82 |KIDNEY TRANSPLANT||652|||59,633.13|56,651.47|19,477.60|24,420.49|15,900.70|16218.714|16,218.71|16,536.73||||||||||||||15,900.70|59,633.13|19,477.60 |MAJOR BLADDER PROCEDURES WITH MCC||653|||114,305.04|108,589.79|32,988.41|45,905.97|27,230.93|27775.5486|27,775.55|28,320.17||||||||||||||27,230.93|114,305.04|32,988.41 |MAJOR BLADDER PROCEDURES WITHOUT CC/MCC||655|||43,100.72|40,945.68|12,911.98|13,771.12|10,394.75|10602.645|10,602.65|10,810.54||||||||||||||10,394.75|43,100.72|12,911.98 |MINOR BLADDER PROCEDURES WITH CC||663|||31,484.17|29,909.96|10,020.66|11,933.53|7,970.09|8129.4918|8,129.49|8,288.89||||||||||||||7,970.09|31,484.17|10,020.66 |MINOR BLADDER PROCEDURES WITHOUT CC/MCC||664|||24,554.71|23,326.97|7,573.31|12,327.20|5,917.73|6036.0846|6,036.08|6,154.44||||||||||||||5,917.73|24,554.71|7,573.31 |PROSTATECTOMY WITH MCC||665|||58,861.72|55,918.63|18,612.35|22,721.77|15,175.10|15478.602|15,478.60|15,782.10||||||||||||||15,175.10|58,861.72|18,612.35 |PROSTATECTOMY WITHOUT CC/MCC||667|||18,839.08|17,897.13|6,445.28|7,444.05|4,971.75|5071.185|5,071.19|5,170.62||||||||||||||4,971.75|18,839.08|6,445.28 |URETHRAL PROCEDURES WITH CC/MCC||671|||29,693.67|28,208.99|11,104.02|13,293.86|8,878.59|9056.1618|9,056.16|9,233.73||||||||||||||8,878.59|29,693.67|11,104.02 |URETHRAL PROCEDURES WITHOUT CC/MCC||672|||16,528.63|15,702.20|7,374.89|8,611.58|5,751.32|5866.3464|5,866.35|5,981.37||||||||||||||5,751.32|16,528.63|7,374.89 |OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC||675|||29,485.70|28,011.42|10,956.83|13,827.74|8,755.15|8930.253|8,930.25|9,105.36||||||||||||||8,755.15|29,485.70|10,956.83 |URINARY STONES WITH MCC||693|||25,189.99|23,930.49|8,077.44|9,493.98|7,349.70|7496.694|7,496.69|7,643.69||||||||||||||7,349.70|25,189.99|8,077.44 |KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC||695|||23,622.59|22,441.46|7,287.88|8,502.38|6,582.18|6713.8236|6,713.82|6,845.47||||||||||||||6,582.18|23,622.59|7,287.88 |URETHRAL STRICTURE||697|||17,804.87|16,914.63|6,457.79|7,460.23|5,775.26|5890.7652|5,890.77|6,006.27||||||||||||||5,775.26|17,804.87|6,457.79 |PENIS PROCEDURES WITH CC/MCC||709|||37286.79|35422.4505|14293.26119|17298.66474|7275.91|7421.4282|7,421.43|7,566.95||||||||||||||7,275.91|37,286.79|14,293.26 |PENIS PROCEDURES WITHOUT CC/MCC||710|||26791.42|25451.849|10050.46317|8228.02205|5035.14|5135.8428|5,135.84|5,236.55||||||||||||||5,035.14|26,791.42|8,228.02 |OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC||715|||35,532.18|33,755.57|12,547.30|15,106.50|6,353.79|6480.8658|6,480.87|6,607.94||||||||||||||6,353.79|35,532.18|12,547.30 |OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC||716|||21,758.35|20,670.43|8,123.33|9,551.27|4,017.35|4097.697|4,097.70|4,178.04||||||||||||||4,017.35|21,758.35|8,123.33 |MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC||723|||20,758.14|19,720.23|7,006.62|8,149.15|5,596.44|5708.3688|5,708.37|5,820.30||||||||||||||5,596.44|20,758.14|7,006.62 |MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC||724|||12,374.73|11,755.99|4,386.44|4,858.89|3,337.00|3403.74|3,403.74|3,470.48||||||||||||||3,337.00|12,374.73|4,386.44 |PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC||734|||47,750.00|45,362.50|13,762.33|13,076.12|8,934.40|9113.088|9,113.09|9,291.78||||||||||||||8,934.40|47,750.00|13,076.12 |PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC||735|||23079.96|21925.962|8939.71172|11,353.13|5681.47|5795.0994|5,795.10|5,908.73||||||||||||||5,681.47|23,079.96|8,939.71 |UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC||736|||81841.48|77749.406|25891.26382|47,186.76|5975.86|6095.3772|6,095.38|6,214.89||||||||||||||5,975.86|81,841.48|25,891.26 |UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC||737|||37,884.25|35,990.04|12,781.47|14,000.31|5,691.30|5805.126|5,805.13|5,918.95||||||||||||||5,691.30|37,884.25|12,781.47 |UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC||738|||25,520.88|24,244.84|9,315.73|9,537.12|5,420.28|5528.6856|5,528.69|5,637.09||||||||||||||5,420.28|25,520.88|9,315.73 |UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC||739|||64,439.33|61,217.36|23,290.17|28,595.85|15,361.07|15668.2914|15,668.29|15,975.51||||||||||||||15,361.07|64,439.33|23,290.17 |UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC||740|||31,990.88|30,391.34|11,242.86|15,114.59|7,234.98|7379.6796|7,379.68|7,524.38||||||||||||||7,234.98|31,990.88|11,242.86 |UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC||741|||22,637.54|21,505.66|8,141.21|10,820.60|5,142.86|5245.7172|5,245.72|5,348.57||||||||||||||5,142.86|22,637.54|8,141.21 |VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC||747|||17,203.62|16,343.44|6,106.21|7,785.81|3,770.23|3845.6346|3,845.63|3,921.04||||||||||||||3,770.23|17,203.62|6,106.21 |FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES||748|||21,253.52|20,190.84|8,551.18|9,942.25|5,419.40|5527.788|5,527.79|5,636.18||||||||||||||5,419.40|21,253.52|8,551.18 |OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC||750|||25,233.47|23,971.80|9,251.96|9,204.79|5,892.09|6009.9318|6,009.93|6,127.77||||||||||||||5,892.09|25,233.47|9,204.79 |MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC||756|||11170.33|10611.8135|5975.707552|6854.887451|3529.49|3600.0798|3,600.08|3,670.67||||||||||||||3,529.49|11,170.33|5,975.71 |MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC||761|||10124.78|9618.541|4032.473482|2349.900448|2273.11|2318.5722|2,318.57|2,364.03||||||||||||||2,273.11|10,124.78|2,364.03 |SPLENECTOMY WITHOUT CC/MCC||801|||33,008.09|31,357.69|10,548.64|9,778.44|8,615.83|8788.1466|8,788.15|8,960.46||||||||||||||8,615.83|33,008.09|9,778.44 |LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC||822|||24,297.56|23,082.68|7,974.95|7,923.33|6,405.45|6533.559|6,533.56|6,661.67||||||||||||||6,405.45|24,297.56|7,923.33 |LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC||825|||26407.61|25087.2295|8863.439173|10,794.31|7168.51|7311.8802|7,311.88|7,455.25||||||||||||||7,168.51|26,407.61|8,863.44 |MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC||828|||28,623.53|27,192.35|10,514.07|13,305.32|8,586.14|8757.8628|8,757.86|8,929.59||||||||||||||8,586.14|28,623.53|10,514.07 |MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC||830|||25,846.07|24,553.77|9,315.12|13,332.95|7,556.44|7707.5688|7,707.57|7,858.70||||||||||||||7,556.44|25,846.07|9,315.12 |LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC||842|||21,113.61|20,057.93|7,043.55|6,557.61|5,994.62|6114.5124|6,114.51|6,234.40||||||||||||||5,994.62|21,113.61|6,557.61 |OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC||843|||34,910.16|33,164.65|11,856.04|13,671.35|10,414.66|10622.9532|10,622.95|10,831.25||||||||||||||10,414.66|34,910.16|11,856.04 |RADIOTHERAPY||849|||31,660.03|30,077.03|15,339.67|18,612.48|13,614.20|13886.484|13,886.48|14,158.77||||||||||||||13,614.20|31,660.03|15,339.67 |OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC||869|||13,407.06|12,736.71|4,842.89|2,875.02|4,293.74|4379.6148|4,379.61|4,465.49||||||||||||||2,875.02|13,407.06|4,465.49 |O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS||876|||58,311.54|55,395.96|19,950.74|26,305.27|16,690.70|17024.514|17,024.51|17,358.33||||||||||||||16,690.70|58,311.54|19,950.74 |ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY||895|||2,382.24|2,263.13|10,003.40|10,939.91|8,300.57|8466.5814|8,466.58|8,632.59||||||||||||||2,263.13|10,939.91|8,466.58 |SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC||905|||26,910.55|25,565.02|10,300.74|15,004.71|9,428.60|9617.172|9,617.17|9,805.74||||||||||||||9,428.60|26,910.55|10,300.74 |EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT||927|||301,894.21|286,799.50|125,839.70|157,363.11|107,632.07|109784.7114|109,784.71|111,937.35||||||||||||||107,632.07|301,894.21|125,839.70 |FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC||929|||46,626.92|44,295.57|18,446.69|9,449.48|15,398.97|15706.9494|15,706.95|16,014.93||||||||||||||9,449.48|46,626.92|16,014.93 |FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY||934|||31,605.17|30,024.91|12,061.03|3,861.90|9,954.99|10154.0898|10,154.09|10,353.19||||||||||||||3,861.90|31,605.17|10,353.19 |REHABILITATION WITH CC/MCC||945|||24,165.23|22,956.97|9,364.00|11,109.11|8,828.14|9004.7028|9,004.70|9,181.27||||||||||||||8,828.14|24,165.23|9,364.00 |REHABILITATION WITHOUT CC/MCC||946|||19,192.65|18,233.02|7,233.65|8,434.30|6,475.92|6605.4384|6,605.44|6,734.96||||||||||||||6,475.92|19,192.65|7,233.65 |HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC||970|||52,696.12|50,061.31|18,066.51|22,036.89|15,072.45|15373.899|15,373.90|15,675.35||||||||||||||15,072.45|52,696.12|18,066.51 |HIV WITH OR WITHOUT OTHER RELATED CONDITION||977|||21,888.81|20,794.37|8,387.31|9,882.93|8,012.60|8172.852|8,172.85|8,333.10||||||||||||||8,012.60|21,888.81|8,387.31