Charge Code Description,"Rev
Code","Proc
Code","Rate
Exception",,,,,,,,,
3020001,SEMI PRIVATE,NSG,A,120,,,,,,"1,003.00",N,N
3020007,SEMI PRIVATE W/TELEMENTAR,NSG,A,120,,,,,,"1,379.50",N,N
3029980,CONVERSION DEFAULT,NSG,A,999,,,,,,0.00,N,N
3080001,OB ROOM,DNU,A,130,,,,,,944.00,N,N
3090001,NURSERY,DNU,A,170,,,,,,540.00,N,N
3120001,SPECIAL CARE,SCA,A,200,,,,,,"1,543.00",N,N
3150001,SWING BED (SNF),SWB,A,120,,,,,,359.50,N,N
3150007,NON REIMBURSED SKILLED 2,SWB,A,120,,,,,,255.00,N,N
3160001,ACUTE HOSPICE SKILL RESPI,HSP,A,125,,,,,,291.00,N,N
3160002,HOSPICE/SKILLED/RESPITE,HSP,A,125,,,,,,160.00,N,N
3210001,OR ROOM,OR,A,360,,,,,,715.00,N,Y
3210004,CLINIC/CONSULT NEW,OR,A,510,99212,,,,,52.00,N,Y
3210008,ER MINOR SURG,OR,A,360,99999,,,,,510.00,N,Y
3210011,ENT EXCISION,OR,A,360,99999,,,,,180.00,N,Y
,,OR,A,360,99998,,,,,180.00,N,Y
,,OR,A,360,99997,,,,,180.00,N,Y
3210012,PODIATRY SURGERY 1,OR,A,360,99997,,,,,601.00,N,Y
,,OR,A,360,99998,,,,,601.00,N,Y
,,OR,A,360,99999,,,,,601.00,N,Y
3210013,AMPUTATION OF DIGIT,OR,A,360,99999,,,,,"1,300.00",N,Y
,,OR,A,360,99998,,,,,"1,300.00",N,Y
,,OR,A,360,99997,,,,,"1,300.00",N,Y
3210014,ENDOSCOPY,OR,A,360,99997,,,,,"2,222.00",N,Y
,,OR,A,360,99998,,,,,"2,222.00",N,Y
,,OR,A,360,99999,,,,,"2,222.00",N,Y
3210018,MAJOR SURGERY,OR,A,360,99999,,,,,"1,455.00",N,Y
,,OR,A,360,99998,,,,,"1,455.00",N,Y
,,OR,A,360,99997,,,,,"1,455.00",N,Y
3210019,MINOR SURGERY,OR,A,360,99999,,,,,728.00,N,Y
3210021,HIP PROSTHESIS,OR,A,360,99999,,,,,"2,279.00",N,Y
,,OR,A,360,99998,,,,,"2,279.00",N,Y
,,OR,A,360,99997,,,,,"2,279.00",N,Y
3210022,HIP PINNING,OR,A,360,99997,,,,,"2,402.00",N,Y
,,OR,A,360,99998,,,,,"2,402.00",N,Y
,,OR,A,360,99999,,,,,"2,402.00",N,Y
3210024,LAP CHOLE,OR,A,360,99999,,,,,"3,377.00",N,Y
,,OR,A,360,99998,,,,,"3,377.00",N,Y
,,OR,A,360,99997,,,,,"3,377.00",N,Y
3210026,LAPROSCOPY,OR,A,360,99999,,,,,843.00,N,Y
3210027,BMTT / EAR TUBES,OR,A,360,99998,,,,,"2,701.00",N,Y
,,OR,A,360,99997,,,,,"2,701.00",N,Y
,,OR,A,360,69436,,,,,"2,701.00",N,Y
3210028,TONSILECTOMY & ADNOIDECTO,OR,A,360,99997,,,,,"2,837.00",N,Y
,,OR,A,360,99998,,,,,"2,837.00",N,Y
,,OR,A,360,99999,,,,,"2,837.00",N,Y
3210029,HYSTEROSCOPY,OR,A,360,99999,,,,,197.00,N,Y
,,OR,A,360,99998,,,,,197.00,N,Y
,,OR,A,360,99997,,,,,197.00,N,Y
3210031,ENDOMETRIAL BIOPSY,OR,A,360,99997,,,,,197.00,N,Y
,,OR,A,360,99998,,,,,197.00,N,Y
,,OR,A,360,99999,,,,,197.00,N,Y
3210032,VAGINAL WALL BIOPSY,OR,A,360,99999,,,,,197.00,N,Y
,,OR,A,360,99998,,,,,197.00,N,Y
,,OR,A,360,99997,,,,,197.00,N,Y
3210033,COLPOSCOPY BIOPSY,OR,A,360,99997,,,,,261.00,N,Y
,,OR,A,360,99998,,,,,261.00,N,Y
,,OR,A,360,99999,,,,,261.00,N,Y
3210034,COLONOSCOPY,OR,A,360,99999,,,,,"2,338.00",N,Y
3210035,HERNIA OPEN,OR,A,360,99999,,,,,"4,567.00",N,Y
,,OR,A,360,99998,,,,,"4,567.00",N,Y
,,OR,A,360,99997,,,,,"4,567.00",N,Y
3210036,CARP TUNNEL OR TRIG RELEA,OR,A,360,99997,,,,,"1,965.00",N,Y
,,OR,A,360,99998,,,,,"1,965.00",N,Y
,,OR,A,360,99999,,,,,"1,965.00",N,Y
3210037,COLON RESECTION,OR,A,360,99999,,,,,"5,310.00",N,Y
,,OR,A,360,99998,,,,,"5,310.00",N,Y
,,OR,A,360,99997,,,,,"5,310.00",N,Y
3210038,EPIDURAL PROCEDURE,OR,A,360,99997,,,,,510.00,N,Y
,,OR,A,360,99998,,,,,510.00,N,Y
,,OR,A,360,99999,,,,,510.00,N,Y
3210039,LUMPECTOMY,OR,A,360,19160,,,,,"3,491.00",N,Y
3210040,LYMPH NODE BIOPSY,OR,A,360,38500,,,,,"1,310.00",N,Y
3210041,APPENDECTOMY,OR,A,360,44950,,,,,"2,691.00",N,Y
3210042,LAPROSCOPIC APPENDECTOMY,OR,A,360,44970,,,,,"5,455.00",N,Y
3210043,FRENULOTOMY,OR,A,360,41010,,,,,910.00,N,Y
3210044,LAPROSCOPIC TUBAL LIGATIO,OR,A,360,99999,,,,,"2,182.00",N,Y
,,OR,A,360,99998,,,,,"2,182.00",N,Y
,,OR,A,360,99997,,,,,"2,182.00",N,Y
3210045,VASECTOMY,OR,A,360,99997,,,,,897.00,N,Y
,,OR,A,360,99998,,,,,897.00,N,Y
,,OR,A,360,99999,,,,,897.00,N,Y
3210046,HEMORRHOIDECTOMY,OR,A,360,99999,,,,,"1,907.00",N,Y
,,OR,A,360,99998,,,,,"1,907.00",N,Y
,,OR,A,360,99997,,,,,"1,907.00",N,Y
3210047,HYSTERECOMY,OR,A,360,99997,,,,,"2,573.00",N,Y
,,OR,A,360,99998,,,,,"2,573.00",N,Y
,,OR,A,360,99999,,,,,"2,573.00",N,Y
3210048,PARACENTESIS,OR,A,360,49080,,,,,467.00,N,Y
3210050,DIAGNOSTIC LAPROSCOPY,OR,A,360,99999,,,,,843.00,N,Y
3210051,EXCISION OF LIPOMA,OR,A,360,99999,,,,,"1,310.00",N,Y
,,OR,A,360,99998,,,,,"1,310.00",N,Y
,,OR,A,360,99997,,,,,"1,310.00",N,Y
3210052,EXCISION OF NODULE,OR,A,360,99997,,,,,"1,055.00",N,Y
,,OR,A,360,99998,,,,,"1,055.00",N,Y
,,OR,A,360,99999,,,,,"1,055.00",N,Y
3210053,NASAL CAUTERIZATION,OR,A,360,99999,,,,,765.00,N,Y
,,OR,A,360,99998,,,,,765.00,N,Y
,,OR,A,360,99997,,,,,765.00,N,Y
3210054,EXTERNAL HEMORRHOIDECTOMY,OR,A,360,99997,,,,,"1,201.00",N,Y
,,OR,A,360,99998,,,,,"1,201.00",N,Y
,,OR,A,360,99999,,,,,"1,201.00",N,Y
3210055,GANGLION CYST,OR,A,360,99999,,,,,874.00,N,Y
,,OR,A,360,99998,,,,,874.00,N,Y
,,OR,A,360,99997,,,,,874.00,N,Y
3210056,GANGLION CYST W/O ANETHES,OR,A,360,99997,,,,,510.00,N,Y
,,OR,A,360,99998,,,,,510.00,N,Y
,,OR,A,360,99999,,,,,510.00,N,Y
3210057,INFUSE A PORT,OR,A,360,99999,,,,,874.00,N,Y
,,OR,A,360,99998,,,,,874.00,N,Y
,,OR,A,360,99997,,,,,874.00,N,Y
3210058,HIDRADPENITIS(EXSKIN/SUBA,OR,A,360,11450,,,,,"1,310.00",N,Y
3210059,TEAR DUCT OPEN,OR,A,360,99997,,,,,147.00,N,Y
,,OR,A,360,99998,,,,,147.00,N,Y
,,OR,A,360,99999,,,,,147.00,N,Y
3210060,I & D OF WOUND,OR,A,360,99999,,,,,728.00,N,Y
,,OR,A,360,99998,,,,,728.00,N,Y
,,OR,A,360,99997,,,,,728.00,N,Y
3210061,BONE BIOPSY,OR,A,360,99997,,,,,"1,455.00",N,Y
,,OR,A,360,99998,,,,,"1,455.00",N,Y
,,OR,A,360,99999,,,,,"1,455.00",N,Y
3210062,RECTAL POLYP REMOVAL,OR,A,360,99999,,,,,874.00,N,Y
,,OR,A,360,99998,,,,,874.00,N,Y
,,OR,A,360,99997,,,,,874.00,N,Y
3210063,MASECTOMY (BILATERAL),OR,A,360,99997,,,,,"3,637.00",N,Y
,,OR,A,360,99998,,,,,"3,637.00",N,Y
,,OR,A,360,99999,,,,,"3,637.00",N,Y
3210064,PERI ANAL ABCESS,OR,A,360,99999,,,,,728.00,N,Y
,,OR,A,360,99998,,,,,728.00,N,Y
,,OR,A,360,99997,,,,,728.00,N,Y
3210065,CLOSED REDUCTION OF ELBOW,OR,A,360,99997,,,,,656.00,N,Y
,,OR,A,360,99998,,,,,656.00,N,Y
,,OR,A,360,99999,,,,,656.00,N,Y
3210066,DIS DECUBITUS ULCER COCCY,OR,A,360,99999,,,,,947.00,N,Y
,,OR,A,360,99998,,,,,947.00,N,Y
,,OR,A,360,99997,,,,,947.00,N,Y
3210067,LAP OOPHERECTOMY,OR,A,360,99997,,,,,"4,364.00",N,Y
,,OR,A,360,99998,,,,,"4,364.00",N,Y
,,OR,A,360,99999,,,,,"4,364.00",N,Y
3210068,FLEXIBLE SIGMOIDOSCOPY,OR,A,360,99999,,,,,582.00,N,Y
,,OR,A,360,99998,,,,,582.00,N,Y
,,OR,A,360,99997,,,,,582.00,N,Y
3210069,G TUBE REPLACEMENT,OR,A,360,99997,,,,,656.00,N,Y
,,OR,A,360,99998,,,,,656.00,N,Y
,,OR,A,360,99999,,,,,656.00,N,Y
3210070,CLOSURE OF LOOP LEOSTOMY,OR,A,360,99999,,,,,"1,455.00",N,Y
,,OR,A,360,99998,,,,,"1,455.00",N,Y
,,OR,A,360,99997,,,,,"1,455.00",N,Y
3210071,WOUND DEBRIDEMENT,OR,A,360,99997,,,,,947.00,N,Y
,,OR,A,360,99998,,,,,947.00,N,Y
,,OR,A,360,99999,,,,,947.00,N,Y
3210072,TEMPORAL ARTERY BIOPSY,OR,A,360,99999,,,,,910.00,N,Y
,,OR,A,360,99998,,,,,910.00,N,Y
,,OR,A,360,99997,,,,,910.00,N,Y
3210073,RECTAL EXAM WITH BIOPSY,OR,A,360,99997,,,,,369.00,N,Y
,,OR,A,360,99998,,,,,369.00,N,Y
,,OR,A,360,99999,,,,,369.00,N,Y
3210074,RECTAL EXAM,OR,A,370,99999,,,,,306.00,N,Y
,,OR,A,370,99998,,,,,306.00,N,Y
,,OR,A,370,99997,,,,,306.00,N,Y
3210075,EXCISION OF BREAST MASS,OR,A,360,99997,,,,,"1,310.00",N,Y
,,OR,A,360,99998,,,,,"1,310.00",N,Y
,,OR,A,360,99999,,,,,"1,310.00",N,Y
3210076,OP CLINIC SURGERY,OR,A,360,99999,,,,,261.00,N,Y
,,OR,A,360,99999,,,,,261.00,N,Y
,,OR,A,360,99997,,,,,261.00,N,Y
3210077,MASTECTOMY (UNILATERAL),OR,A,360,99997,,,,,"1,819.00",N,Y
,,OR,A,360,99999,,,,,"1,819.00",N,Y
,,OR,A,360,99998,,,,,"1,819.00",N,Y
3210078,BILATERAL KNEE ARTHROSCOP,OR,A,360,99998,,,,,"3,247.00",N,Y
,,OR,A,360,99999,,,,,"3,247.00",N,Y
,,OR,A,360,99997,,,,,"3,247.00",N,Y
3210079,FEEDING TUBE INSERTION,OR,A,360,99997,,,,,715.00,N,Y
,,OR,A,360,99999,,,,,715.00,N,Y
,,OR,A,360,99998,,,,,715.00,N,Y
3210080,OPEN ROTATOR CUFF REPAIR,OR,A,360,99998,,,,,"3,117.00",N,Y
,,OR,A,360,99999,,,,,"3,117.00",N,Y
,,OR,A,360,99997,,,,,"3,117.00",N,Y
3210081,ELBOW ARTHROSCOPY,OR,A,360,99997,,,,,"2,083.00",N,Y
,,OR,A,360,99999,,,,,"2,083.00",N,Y
,,OR,A,360,99998,,,,,"2,083.00",N,Y
3210082,PORT REMOVAL,OR,A,360,99998,,,,,659.00,N,Y
,,OR,A,360,99999,,,,,659.00,N,Y
,,OR,A,360,99997,,,,,659.00,N,Y
3210083,CYST EXCISION,OR,A,360,99997,,,,,"1,844.00",N,Y
,,OR,A,360,99999,,,,,"1,844.00",N,Y
,,OR,A,360,99998,,,,,"1,844.00",N,Y
3210084,LAPROSCOPIC HERNIA,OR,A,360,99998,,,,,"3,525.00",N,Y
,,OR,A,360,99999,,,,,"3,525.00",N,Y
,,OR,A,360,99997,,,,,"3,525.00",N,Y
3210085,TOOTH EXTRACTION,OR,A,360,99997,,,,,926.00,N,Y
,,OR,A,360,99999,,,,,926.00,N,Y
,,OR,A,360,99998,,,,,926.00,N,Y
3210086,LAPARSCOPIC HEMICOLECTOMY,OR,A,360,99998,,,,,"5,966.00",N,Y
,,OR,A,360,99999,,,,,"5,966.00",N,Y
,,OR,A,360,99997,,,,,"5,966.00",N,Y
3210087,TRIGGER INJECTION,OR,A,360,99997,,,,,93.00,N,Y
,,OR,A,360,99999,,,,,93.00,N,Y
,,OR,A,360,99998,,,,,93.00,N,Y
3210088,SIGMOIDOSCOPY,OR,A,360,99998,,,,,694.00,N,Y
,,OR,A,360,99999,,,,,694.00,N,Y
,,OR,A,360,99997,,,,,694.00,N,Y
3210089,PUNC ASPIRA CYST OF BREAS,OR,A,360,19000,,,,,232.00,N,Y
3210090,PLACEMENT OF POWER PORT,OR,A,360,99997,,,,,723.00,N,Y
,,OR,A,360,99999,,,,,723.00,N,Y
,,OR,A,360,99998,,,,,723.00,N,Y
3210091,BMT/EAR TUBES/ADNOIDECTOM,OR,A,360,99998,,,,,"2,188.00",N,Y
,,OR,A,360,99999,,,,,"2,188.00",N,Y
,,OR,A,360,99997,,,,,"2,188.00",N,Y
3210092,PARTIAL BOWEL RESECTION,OR,A,360,99997,,,,,"2,468.00",N,Y
,,OR,A,360,99999,,,,,"2,468.00",N,Y
,,OR,A,360,99998,,,,,"2,468.00",N,Y
3210093,TVT w/ ABBREVO,OR,A,360,99998,,,,,673.00,N,Y
,,OR,A,360,99999,,,,,673.00,N,Y
,,OR,A,360,99997,,,,,673.00,N,Y
3210094,C-SECTION,OR,A,360,99997,,,,,"1,459.00",N,Y
,,OR,A,360,99999,,,,,"1,459.00",N,Y
,,OR,A,360,99998,,,,,"1,459.00",N,Y
3210095,UPPERGIENDOSCOPY ESOPHAGU,OR,A,360,43248,,,,,449.00,N,Y
3210096,LAPROSCOPIC HYSTERECTOMY,OR,A,360,99998,,,,,"1,964.00",N,Y
,,OR,A,360,99999,,,,,"1,964.00",N,Y
,,OR,A,360,99997,,,,,"1,964.00",N,Y
3210097,OPEN LAPORATOMY,OR,A,360,99997,,,,,"1,515.00",N,Y
,,OR,A,360,99999,,,,,"1,515.00",N,Y
,,OR,A,360,99998,,,,,"1,515.00",N,Y
3210098,NAIL REMOVAL,OR,A,360,99998,,,,,129.00,N,Y
,,OR,A,360,99999,,,,,129.00,N,Y
,,OR,A,360,99997,,,,,129.00,N,Y
3210099,EXCISION BONE CYST,OR,A,360,99997,,,,,696.00,N,Y
,,OR,A,360,99999,,,,,696.00,N,Y
,,OR,A,360,99998,,,,,696.00,N,Y
3210100,PARTIAL EXCISION BONE,OR,A,360,99998,,,,,802.00,N,Y
,,OR,A,360,99999,,,,,802.00,N,Y
,,OR,A,360,99997,,,,,802.00,N,Y
3210101,EXCISION LES OVARY/PELVIC,OR,A,360,99997,,,,,"1,320.00",N,Y
,,OR,A,360,99999,,,,,"1,320.00",N,Y
,,OR,A,360,99998,,,,,"1,320.00",N,Y
3210102,LAYER SKIN CLOSE 2.6-7.5,OR,A,360,99997,,,,,471.00,N,N
,,OR,A,360,99998,,,,,471.00,N,N
,,OR,A,360,99999,,,,,471.00,N,N
3210103,IMAGE GUIDED INJECTION,OR,A,360,99997,,,,,385.00,N,N
,,OR,A,360,99998,,,,,385.00,N,N
,,OR,A,360,99999,,,,,385.00,N,N
3210104,"ENTERECTOMY, RESEC SM INT",OR,A,360,99999,,,,,"2,420.00",N,N
,,OR,A,360,99998,,,,,"2,420.00",N,N
,,OR,A,360,99997,,,,,"2,420.00",N,N
3210105,ENTEROLYSIS,OR,A,360,99997,,,,,"2,200.00",N,N
,,OR,A,360,99998,,,,,"2,200.00",N,N
,,OR,A,360,99999,,,,,"2,200.00",N,N
3210106,DETERMINATION VENOUS PRES,OR,A,360,99999,,,,,28.00,N,N
,,OR,A,360,99998,,,,,28.00,N,N
,,OR,A,360,99997,,,,,28.00,N,N
3210107,OPEN CHOLE,OR,A,360,99999,,,,,"3,465.00",N,N
,,OR,A,360,99997,,,,,"3,465.00",N,N
,,OR,A,360,99998,,,,,"3,465.00",N,N
3210108,EXCISION BENIGN LESION- 3.1-4CM,OR,A,360,11404,,,,,330.00,N,N
3210109,EXCISION BENIGN LESION,OR,A,360,11403,,,,,303.00,N,N
3210110,EXCISION BENIGN LESION- 1.1-2CM,OR,A,360,11402,,,,,248.00,N,N
3210111,BIOPSY SKIN,OR,A,360,11100,,,,,110.00,N,N
3210112,EXCISION BENIGN LESION INCLUDING MARGINS,OR,A,360,11422,,,,,366.00,N,N
3210113,AMPUTATION METATORSAL WITH TOE SINGLE,OR,A,360,28810,,,,,"1,100.00",N,N
3210114,EXCISION MALIGNANT LESION,OR,A,360,11622,,,,,457.00,N,N
3210115,"REPAIR, INTERMED WDS OF NECK HAND ETC",OR,A,360,12042,,,,,539.00,N,N
3210116,EXCISION OF LESION,OR,A,360,99999,,,,,688.00,N,N
3210117,LAPARASCOPY SURG ABDOMEN PERII OMENT DG,OR,A,360,49320,,,,,792.00,N,N
3210118,MASTECTOMY MOD RAD,OR,A,360,19307,,,,,"3,080.00",N,N
3210119,EXPLORATOMY LAPAROTOMY,OR,A,360,49000,,,,,"2,008.00",N,N
3210120,INTRANASAL EXCISION BIOPSY,OR,A,360,30100,,,,,193.00,N,N
3210121,SPHINCTERTOMY ANAL,OR,A,360,46080,,,,,347.00,N,N
3210122,REPAIR INT WOUND EXT < 2.5CM,OR,A,360,12031,,,,,358.00,N,N
3210123,IMPLANT MESH HERNIA RPR,OR,A,360,49568,,,,,633.00,N,N
3210124,LAP W/ ASPIRATION OF CYST,OR,A,360,49322,,,,,897.00,N,N
3210125,SI INJECTION WITH IMAGING,OR,A,360,27096,,,,,993.00,N,N
3210126,PILONIDAL CYST REMOVAL,OR,A,360,11770,,,,,660.00,N,N
3210127,"COLECTOMY, PARTIAL; W/ ANASTOMASIS",OR,A,360,44140,,,,,"3,300.00",N,N
3210128,REP INIT INSC OR VENTRAL HERNIA;REDUCIBL,OR,A,360,49560,,,,,"1,807.00",N,N
3210129,MICROSCOPE,ORS,A,360,69990,,,,,245.00,N,N
3210130,LARG JOINT /BURSA/SHD/KN - SINGLE OR BIL,OR,A,360,20610,,,,,133.00,N,N
3210131,"EXC OF HYDROCELE OF SPERM CORD, UNILATER",OR,A,360,55500,,,,,"1,069.00",N,N
3210132,REMOVAL FECAL IMPACT; UNDER ANESTH,OR,A,360,45915,,,,,605.00,N,N
3210133,"EXC PILONIDAL CYST OR SINUS, EXTENSIVE",OR,A,360,11771,,,,,"1,430.00",N,N
3210134,"LAPAROSCOPY, ENTEROLYSIS",OR,A,360,44180,,,,,"2,310.00",N,N
3210135,SUTURE OF SMALL INT,OR,A,360,44603,,,,,"4,125.00",N,N
3210136,EX SKIN LESION-MA 4.0 +CM,OR,A,360,11606,,,,,880.00,N,N
3210137,INCISION&REM OF FOREIGN BODY SIMPLE,OR,A,360,10120,,,,,263.00,N,N
3210138,"EXCIS, B9 LES MARG, S/N/H/F/G; > 4.0 CM",OR,A,360,11426,,,,,935.00,N,N
3210139,"RPR INIT ING HERNIA > 5 YRS, REDUCIBLE",OR,A,360,49505,,,,,"1,650.00",N,N
3210140,"EPIDURAL, BLOOD OR CLOT PATCH",OR,A,360,62273,,,,,550.00,N,N
3210141,"BIOPSY, SOFT TIS, BACK/FLANK SUPERFICIAL",OR,A,360,21920,,,,,715.00,N,N
3210142,EXC BARTHOLINS GLAND OR CYST,OR,A,360,56740,,,,,750.00,N,N
3210143,LAPAR; CHOLECYSTECT W/ CHOLANGIOGRAPHY,OR,A,360,47563,,,,,"3,500.00",N,N
3210144,"CORRECTION, HAMMERTOE",OR,A,360,28285,,,,,"1,400.00",N,N
3210200,SKIN CANCER REMOVAL,OR,A,360,99998,,,,,"1,592.00",N,Y
,,OR,A,360,99999,,,,,"1,592.00",N,Y
,,OR,A,360,99997,,,,,"1,592.00",N,Y
3210201,EYELID ENTROPION REPAIR,OR,A,360,99997,,,,,"1,708.00",N,Y
,,OR,A,360,99999,,,,,"1,708.00",N,Y
,,OR,A,360,99998,,,,,"1,708.00",N,Y
3210202,EXCISION MULT LES 2.1-3cm,OR,A,360,99998,,,,,224.00,N,Y
,,OR,A,360,99999,,,,,224.00,N,Y
,,OR,A,360,99997,,,,,224.00,N,Y
3210203,BILATERAL BLEPHAROPLASTY,OR,A,360,99997,,,,,"1,683.00",N,Y
,,OR,A,360,99999,,,,,"1,683.00",N,Y
,,OR,A,360,99998,,,,,"1,683.00",N,Y
3210204,LOWER LID LESION REMOVAL,OR,A,360,99998,,,,,"1,087.00",N,Y
,,OR,A,360,99999,,,,,"1,087.00",N,Y
,,OR,A,360,99997,,,,,"1,087.00",N,Y
3210205,MINOR SKIN CANCER REMOVAL,OR,A,360,99997,,,,,196.00,N,Y
,,OR,A,360,99999,,,,,196.00,N,Y
,,OR,A,360,99998,,,,,196.00,N,Y
3210206,REPAIR WOUNDS 7.6-12.5C,OR,A,360,12034,,,,,589.00,N,Y
3210207,EXC MALIG LESION FACE ETC,OR,A,360,11646,,,,,831.00,N,Y
3210208,REP INTERM WOUND FACE<2.5,OR,A,360,12051,,,,,393.00,N,Y
3210209,LAYER SKIN CLOS 2.6-7.5,OR,A,360,12032,,,,,471.00,N,Y
3210210,RP INTERM WOUNDFACE>2.5,OR,A,360,12052,,,,,471.00,N,Y
3210211,FASCIOCUTRANEOUS FLAP,OR,A,360,15738,,,,,"2,581.00",N,Y
3210212,EXCISION FOR LIP,OR,A,360,99998,,,,,533.00,N,Y
,,OR,A,360,99999,,,,,533.00,N,Y
,,OR,A,360,99997,,,,,533.00,N,Y
3210213,LAYERED SUTURE TRUNK,OR,A,360,99997,,,,,393.00,N,Y
,,OR,A,360,99999,,,,,393.00,N,Y
,,OR,A,360,99998,,,,,393.00,N,Y
3210214,LAYERED SUTURE FACE >2.5,OR,A,360,12051,,,,,365.00,N,Y
3210215,LAY CLOSURE 12.6-20CM,OR,A,360,12035,,,,,584.00,N,Y
3210216,OUT PAT SURGERY UNDER LOC,OR,A,360,99998,,,,,261.00,N,Y
,,OR,A,360,99999,,,,,261.00,N,Y
,,OR,A,360,99997,,,,,261.00,N,Y
3210217,COMPLEX RPR- 2.6 TO 7.5CM,OR,A,360,13132,,,,,"1,010.00",N,Y
3210218,SPLIT GRAFT-TRK 100 SQ CM,OR,A,360,99997,,,,,"1,543.00",N,Y
,,OR,A,360,99999,,,,,"1,543.00",N,Y
,,OR,A,360,99998,,,,,"1,543.00",N,Y
3210219,WOUND RPR TRK/ARM 100 SQ,OR,A,360,99998,,,,,533.00,N,Y
,,OR,A,360,99999,,,,,533.00,N,Y
,,OR,A,360,99997,,,,,533.00,N,Y
3210220,EXC MULT LESIONS >4.CM,OR,A,360,99997,,,,,354.00,N,Y
,,OR,A,360,99999,,,,,354.00,N,Y
,,OR,A,360,99998,,,,,354.00,N,Y
3210221,"REPAIR COMP, FACE 1.1-2.5",OR,A,360,99999,,,,,688.00,N,N
,,OR,A,360,99998,,,,,688.00,N,N
,,OR,A,360,99997,,,,,688.00,N,N
3210222,FULL THICKNESS GRAFT,OR,A,360,99997,,,,,"1,760.00",N,N
,,OR,A,360,99998,,,,,"1,760.00",N,N
,,OR,A,360,99999,,,,,"1,760.00",N,N
3210223,FULL THICKNESS GRAFT FREE,OR,A,360,15260,,,,,"1,705.00",N,N
3210224,LAC REPIMED WFACE EARSETC 7.6-12.5CM,OR,A,360,12054,,,,,550.00,N,N
3210225,LACEREPINTERMNECHANDSETC,OR,A,360,12044,,,,,385.00,N,N
3210226,EXCISION EXTERNAL EAR,OR,A,360,99997,,,,,715.00,N,Y
,,OR,A,360,99998,,,,,715.00,N,Y
,,OR,A,360,99999,,,,,715.00,N,Y
3210227,MYOCUTANEOUS FLAP,OR,A,360,15732,,,,,"2,640.00",N,N
3210228,REP INTER WOUDSCALP AXILLAE TRNK 7.6-12.,OR,A,360,12034,,,,,385.00,N,N
3210229,BIOPSY SKIN/SUB MUCOUS MEMBR/LESION,OR,A,360,11100,,,,,110.00,N,N
3210230,BIOP SKIN/SUBC MUCOUS MEMBR/LESION EA AD,OR,A,360,11101,,,,,50.00,N,N
3210231,REPAIR COMPLES 1.1-2.5CM,OR,A,360,13131,,,,,468.00,N,N
3210232,EXCISION MALIGNANT LESION.SKIN 1.1 -2.5C,OR,A,360,11602,,,,,473.00,N,N
3210233,EXCISION OFB9 LESION MARGIN 1.1-2CM,OR,A,360,11442,,,,,275.00,N,N
3210234,REMOVAL OF SKIN TAGES,OR,A,360,11200,,,,,158.00,N,N
3210235,INCISION AND DRAINAGE SIMPLE OR SINGLE,OR,A,360,10060,,,,,209.00,N,N
3210236,EXCISION BENIGN LESION 3.1-4CM,OR,A,360,99999,,,,,578.00,N,N
3210237,DELAY OF FLAP OR SECTIONING OF FLAPEYELI,OR,A,360,15630,,,,,880.00,N,N
3210238,"EXCISION, MALIGNANT LESION INCLUDMARGINS",OR,A,360,11626,,,,,"2,000.00",N,N
3210239,"EXCISION, BENIGN LESION-DIAM>4CM",OR,A,360,11406,,,,,523.00,N,N
3210240,EXCISION BENIGN LESION EXCPT SKINTAG SCA,OR,A,360,11420,,,,,176.00,N,N
3210241,EXC BEG EXSKINTAG,OR,A,360,11423,,,,,385.00,N,N
3210242,Ex malign lesion 0.6to 1.0 cm,OR,A,360,11641,,,,,385.00,N,N
3210243,"RPR, COMP, EYELID,NOSE,EAR,LIP 2.6-7.5CM",OR,A,360,13152,,,,,880.00,N,N
3210244,"EXC, MALIG, LESIONS, TRUNK,ARM,LEG 3.1-4",OR,A,360,11604,,,,,523.00,N,N
3210245,"EXC, MALIG, FACE, EAR,NOSE,LIP, LESIONS",OR,A,360,11643,,,,,578.00,N,N
3210246,"EXCISION, BENIGN, TRUNK, ARMS, LEGS",OR,A,360,11403,,,,,413.00,N,N
3210247,PARTIAL COLECTOMY,OR,A,360,,,,,,"2,613.00",N,N
3210248,REPAIR INCOMPLETE CIRCUMCISION,OR,A,360,,,,,,440.00,N,N
3210249,"EXCISION, OPEN, INTRA-ABDOMINAL TUMORS",OR,A,360,49203,,,,,"2,503.00",N,N
3210250,"OOPHORECTOMY, PARTIAL OR TOTAL",OR,A,360,58940,,,,,990.00,N,N
3210251,STEROID INJECTION,OR,A,360,27096,,,,,993.00,N,N
3210300,YAG LASER BILATERAL,OR,A,360,99998,,,,,"3,815.00",N,Y
,,OR,A,360,99999,,,,,"3,815.00",N,Y
,,OR,A,360,99997,,,,,"3,815.00",N,Y
3210301,CATARACT,OR,A,360,99997,,,,,"4,712.00",N,Y
,,OR,A,360,99999,,,,,"4,712.00",N,Y
,,OR,A,360,99998,,,,,"4,712.00",N,Y
3210302,YAG LASER SINGLE,OR,A,360,99998,,,,,"1,907.00",N,Y
,,OR,A,360,99999,,,,,"1,907.00",N,Y
,,OR,A,360,99997,,,,,"1,907.00",N,Y
3210303,CATARACT COMPLEX,OR,A,360,99997,,,,,"4,937.00",N,Y
,,OR,A,360,99999,,,,,"4,937.00",N,Y
,,OR,A,360,99998,,,,,"4,937.00",N,Y
3210304,BILATERAL BLEPHAROPLASTY,OR,A,360,99998,,,,,"1,683.00",N,Y
,,OR,A,360,99999,,,,,"1,683.00",N,Y
,,OR,A,360,99997,,,,,"1,683.00",N,Y
3210400,CARP TUNNEL OR TRIGRELEAS,OR,A,360,99997,,,,,"1,965.00",N,Y
,,OR,A,360,99999,,,,,"1,965.00",N,Y
,,OR,A,360,99998,,,,,"1,965.00",N,Y
3210401,HIP PINNING- PLATES & SCR,OR,A,360,99998,,,,,"3,568.00",N,Y
,,OR,A,360,99999,,,,,"3,568.00",N,Y
,,OR,A,360,99997,,,,,"3,568.00",N,Y
3210402,GANGLION CYST/MASS REMOVA,OR,A,360,99997,,,,,874.00,N,Y
,,OR,A,360,99999,,,,,874.00,N,Y
,,OR,A,360,99998,,,,,874.00,N,Y
3210403,KNEE ARTHROSCOPIC,OR,A,360,99998,,,,,"1,795.00",N,Y
,,OR,A,360,99999,,,,,"1,795.00",N,Y
,,OR,A,360,99997,,,,,"1,795.00",N,Y
3210404,HIP PINNING- ROD AND NAIL,OR,A,360,99997,,,,,"2,300.00",N,Y
,,OR,A,360,99999,,,,,"2,300.00",N,Y
,,OR,A,360,99998,,,,,"2,300.00",N,Y
3210405,ACHILLES TENDON REPAIR,OR,A,360,99998,,,,,"1,459.00",N,Y
,,OR,A,360,99999,,,,,"1,459.00",N,Y
,,OR,A,360,99997,,,,,"1,459.00",N,Y
3210406,TIBIA FRACTURE NAILING,OR,A,360,99997,,,,,"1,571.00",N,Y
,,OR,A,360,99999,,,,,"1,571.00",N,Y
,,OR,A,360,99998,,,,,"1,571.00",N,Y
3210407,CHONDROPLASY,OR,A,360,99998,,,,,"1,234.00",N,Y
,,OR,A,360,99999,,,,,"1,234.00",N,Y
,,OR,A,360,99997,,,,,"1,234.00",N,Y
3210408,TRIGGER INJECTION- JOINT,OR,A,360,99997,,,,,118.00,N,Y
,,OR,A,360,99999,,,,,118.00,N,Y
,,OR,A,360,99998,,,,,118.00,N,Y
3210409,REMOVAL OF HARDWARE,OR,A,360,99998,,,,,"1,346.00",N,Y
,,OR,A,360,99999,,,,,"1,346.00",N,Y
,,OR,A,360,99997,,,,,"1,346.00",N,Y
3210410,EXCISION PREPATELLA BURSA,OR,A,360,99997,,,,,"1,234.00",N,Y
,,OR,A,360,99999,,,,,"1,234.00",N,Y
,,OR,A,360,99998,,,,,"1,234.00",N,Y
3210411,ARTHROPLASTY REPLACE HIP,OR,A,360,99998,,,,,"6,600.00",N,Y
,,OR,A,360,99999,,,,,"6,600.00",N,Y
,,OR,A,360,99997,,,,,"6,600.00",N,Y
3210412,ARTHROPLASTY KNEE REPL TO,OR,A,360,99997,,,,,"7,150.00",N,Y
,,OR,A,360,99999,,,,,"7,150.00",N,Y
,,OR,A,360,99998,,,,,"7,150.00",N,Y
3210413,OPEN SHOULDER RPR,OR,A,360,99998,,,,,"2,244.00",N,Y
,,OR,A,360,99999,,,,,"2,244.00",N,Y
,,OR,A,360,99997,,,,,"2,244.00",N,Y
3210414,ARTHOPLASTY OF THUMB CMC,OR,A,360,99997,,,,,"1,346.00",N,Y
,,OR,A,360,99999,,,,,"1,346.00",N,Y
,,OR,A,360,99998,,,,,"1,346.00",N,Y
3210415,TENDON GRAFT,OR,A,360,99998,,,,,"1,346.00",N,Y
,,OR,A,360,99999,,,,,"1,346.00",N,Y
,,OR,A,360,99997,,,,,"1,346.00",N,Y
3210416,ARTHROSCOPIC ACL REPAIR,OR,A,360,99997,,,,,"2,020.00",N,Y
,,OR,A,360,99999,,,,,"2,020.00",N,Y
,,OR,A,360,99998,,,,,"2,020.00",N,Y
3210417,KNEE MENISCAL REPAIR,OR,A,360,99998,,,,,"1,122.00",N,Y
,,OR,A,360,99999,,,,,"1,122.00",N,Y
,,OR,A,360,99997,,,,,"1,122.00",N,Y
3210418,GANG CYST/OTHER W/O ANES,OR,A,360,99997,,,,,510.00,N,Y
,,OR,A,360,99999,,,,,510.00,N,Y
,,OR,A,360,99998,,,,,510.00,N,Y
3210419,SINGLE TENDON TENOTOMY,OR,A,360,99998,,,,,842.00,N,Y
,,OR,A,360,99999,,,,,842.00,N,Y
,,OR,A,360,99997,,,,,842.00,N,Y
3210420,MANIPULATION W/ ANESTHESI,OR,A,360,99997,,,,,453.00,N,Y
,,OR,A,360,99999,,,,,453.00,N,Y
,,OR,A,360,99998,,,,,453.00,N,Y
3210421,OSTEOCHONDRAL AUTOGRAPH,OR,A,360,99998,,,,,"2,020.00",N,Y
,,OR,A,360,99999,,,,,"2,020.00",N,Y
,,OR,A,360,99997,,,,,"2,020.00",N,Y
3210422,ARTHO SHOULD ROTATOR CUFF,OR,A,360,99997,,,,,"2,132.00",N,Y
,,OR,A,360,99999,,,,,"2,132.00",N,Y
,,OR,A,360,99998,,,,,"2,132.00",N,Y
3210423,ANKLE OPEN RED INTERN FIX,OR,A,360,99998,,,,,"1,346.00",N,Y
,,OR,A,360,99999,,,,,"1,346.00",N,Y
,,OR,A,360,99997,,,,,"1,346.00",N,Y
3210424,REPAIR QUAD TENDON,OR,A,360,99997,,,,,"1,010.00",N,Y
,,OR,A,360,99999,,,,,"1,010.00",N,Y
,,OR,A,360,99998,,,,,"1,010.00",N,Y
3210425,ELBOW FRACTURE CLOSED RED,OR,A,360,99998,,,,,729.00,N,Y
,,OR,A,360,99999,,,,,729.00,N,Y
,,OR,A,360,99997,,,,,729.00,N,Y
3210426,OPEN RED FIXATION FOREARM,OR,A,360,99997,,,,,"1,234.00",N,Y
,,OR,A,360,99999,,,,,"1,234.00",N,Y
,,OR,A,360,99998,,,,,"1,234.00",N,Y
3210427,KNEE ANTH REMOV FOR BODY,OR,A,360,99998,,,,,196.00,N,Y
,,OR,A,360,99999,,,,,196.00,N,Y
,,OR,A,360,99997,,,,,196.00,N,Y
3210428,HEMIARTHROPLASY,OR,A,360,99997,,,,,"1,795.00",N,Y
,,OR,A,360,99999,,,,,"1,795.00",N,Y
,,OR,A,360,99998,,,,,"1,795.00",N,Y
3210429,ID OF WOUND,OR,A,360,99998,,,,,617.00,N,Y
,,OR,A,360,99999,,,,,617.00,N,Y
,,OR,A,360,99997,,,,,617.00,N,Y
3210430,AMPUTATION OF METACARPAL,OR,A,360,99997,,,,,898.00,N,Y
,,OR,A,360,99999,,,,,898.00,N,Y
,,OR,A,360,99998,,,,,898.00,N,Y
3210431,HEMI-ARTHROPLASTY HIP REP,OR,A,360,99998,,,,,"2,356.00",N,Y
,,OR,A,360,99999,,,,,"2,356.00",N,Y
,,OR,A,360,99997,,,,,"2,356.00",N,Y
3210432,ULNAR NERVE TRANSPOSITION,OR,A,360,99997,,,,,"1,010.00",N,Y
,,OR,A,360,99999,,,,,"1,010.00",N,Y
,,OR,A,360,99998,,,,,"1,010.00",N,Y
3210433,BICEP TENDON RPR,OR,A,360,99998,,,,,"1,346.00",N,Y
,,OR,A,360,99999,,,,,"1,346.00",N,Y
,,OR,A,360,99997,,,,,"1,346.00",N,Y
3210434,OP RED INT FIX WRIST,OR,A,360,99997,,,,,"1,234.00",N,Y
,,OR,A,360,99999,,,,,"1,234.00",N,Y
,,OR,A,360,99998,,,,,"1,234.00",N,Y
3210435,OP RED INT FIX CLAVICLE,OR,A,360,99998,,,,,"1,459.00",N,Y
,,OR,A,360,99999,,,,,"1,459.00",N,Y
,,OR,A,360,99997,,,,,"1,459.00",N,Y
3210436,OP RED INT FIX FINGER,OR,A,360,99997,,,,,"1,066.00",N,Y
,,OR,A,360,99999,,,,,"1,066.00",N,Y
,,OR,A,360,99998,,,,,"1,066.00",N,Y
3210437,SHOULDER DECOMPRESSION,OR,A,360,99998,,,,,785.00,N,Y
,,OR,A,360,99999,,,,,785.00,N,Y
,,OR,A,360,99997,,,,,785.00,N,Y
3210438,ASPIRATION OF MAJOR JOINT,OR,A,360,99997,,,,,103.00,N,Y
,,OR,A,360,99999,,,,,103.00,N,Y
,,OR,A,360,99998,,,,,103.00,N,Y
3210439,ARTHROSCOPY SHOULDER,OR,A,360,99998,,,,,"1,234.00",N,Y
,,OR,A,360,99999,,,,,"1,234.00",N,Y
,,OR,A,360,99997,,,,,"1,234.00",N,Y
3210440,INJ PLATELET RICH PLASMA,OR,A,360,99997,,,,,34.00,N,Y
,,OR,A,360,99999,,,,,34.00,N,Y
,,OR,A,360,99998,,,,,34.00,N,Y
3210441,PART LAT/MEDIAL MENISCECTOMY,OR,A,360,99998,,,,,"1,346.00",N,Y
,,OR,A,360,99999,,,,,"1,346.00",N,Y
,,OR,A,360,99997,,,,,"1,346.00",N,Y
3210442,ARTHRO SHOULD LABRAL RPR,OR,A,360,99997,,,,,"2,244.00",N,Y
,,OR,A,360,99999,,,,,"2,244.00",N,Y
,,OR,A,360,99998,,,,,"2,244.00",N,Y
3210443,I & D OF DEEP ABCESS,OR,A,360,99998,,,,,"1,010.00",N,Y
,,OR,A,360,99999,,,,,"1,010.00",N,Y
,,OR,A,360,99997,,,,,"1,010.00",N,Y
3210444,REVISION OF KNEE ARTHRO,OR,A,360,99997,,,,,"2,020.00",N,Y
,,OR,A,360,99999,,,,,"2,020.00",N,Y
,,OR,A,360,99998,,,,,"2,020.00",N,Y
3210445,TIBIAL PLATEAU FRACTURE,OR,A,360,99998,,,,,"1,739.00",N,Y
,,OR,A,360,99999,,,,,"1,739.00",N,Y
,,OR,A,360,99997,,,,,"1,739.00",N,Y
3210446,REVISION HIP ARTHOPLASTY,OR,A,360,99999,,,,,"3,080.00",N,N
,,OR,A,360,99998,,,,,"3,080.00",N,N
,,OR,A,360,99997,,,,,"3,080.00",N,N
3210447,OPEN SURGICAL REDUCTION,OR,A,360,99997,,,,,"1,760.00",N,N
,,OR,A,360,99998,,,,,"1,760.00",N,N
,,OR,A,360,99999,,,,,"1,760.00",N,N
3210448,RPR FRACTURE W/ BONE GRAF,OR,A,360,99999,,,,,"1,210.00",N,N
,,OR,A,360,99998,,,,,"1,210.00",N,N
,,OR,A,360,99997,,,,,"1,210.00",N,N
3210449,DEBRIDEMENT OF BONE,OR,A,360,99997,,,,,440.00,N,N
,,OR,A,360,99998,,,,,440.00,N,N
,,OR,A,360,99999,,,,,440.00,N,N
3210450,DEBRIDEMENT SOFT TISSUE,OR,A,360,11043,,,,,303.00,N,N
3210451,WRIST FRACTURE CLOSE REDU,OR,A,360,99999,,,,,880.00,N,N
,,OR,A,360,99998,,,,,880.00,N,N
,,OR,A,360,99997,,,,,880.00,N,N
3210452,OUTPATIENT CLINIC SURGERY,OR,A,360,99999,,,,,261.00,N,N
,,OR,A,360,99998,,,,,261.00,N,N
,,OR,A,360,99997,,,,,261.00,N,N
3210453,"EXCISION, ELBOW BURSA",OR,A,360,24105,,,,,677.00,N,N
3210454,OPEN TX FEMORAL SUPR,OR,A,360,27511,,,,,"1,980.00",N,N
3210455,APPLICATION OF UNI EXT FIXATION SYS,OR,A,360,99999,,,,,"1,155.00",N,N
,,OR,A,360,99998,,,,,"1,155.00",N,N
3210456,CLD TRMT TIBIAL FRACTURE,OR,A,360,99998,,,,,"1,210.00",N,N
,,OR,A,360,99999,,,,,"1,210.00",N,N
3210457,ARTHROSCOPY SHOULDER SURG DEBRID LIMITED,OR,A,360,29822,,,,,"1,544.00",N,N
3210459,"CLD TRMT PHALANGEAL FRACTURE, W/MANIP",OR,A,360,,,,,,617.00,N,N
3210460,PERCUTANEOUS SKELETAL FIX,OR,A,360,26727,,,,,"1,012.00",N,N
3210461,TENODESIS OF LONG TENDON OF BICEPS,OR,A,360,23430,,,,,"1,595.00",N,N
3210462,ARTHOSC SHOULD DIAG W/WO SYNOVIAL BIOPSY,OR,A,360,29805,,,,,"1,232.00",N,N
3210463,CLOSED RED ANKLE,OR,A,360,27810,,,,,963.00,N,N
3210464,"ARTHROTOMY, KNEE REMOVAL FOR BODY",OR,A,360,27310,,,,,"1,320.00",N,N
3210465,ORTF PROXIMAL HUMERUS FX REPAIR WH PLATE,OR,A,360,23615,,,,,"2,310.00",N,N
3210466,ARTHROSCOPY BICEPS TENODESIS,OR,A,360,29828,,,,,"2,420.00",N,N
3210467,ARTHOSCOPY KNEE SURG INF LAVAGE & DRAIN,OR,A,360,29871,,,,,"1,342.00",N,N
3210468,CLD RED PERCUT PINNING SM FINGER,OR,A,360,26608,,,,,"1,018.00",N,N
3210469,"DEBRIDEMENT, SUB TISSUE, FIRST 20 SQ",OR,A,360,11042,,,,,275.00,N,N
3210470,CLSD TRMT OF FEM FRAC DISTAL,OR,A,360,,,,,,"1,320.00",N,N
3210471,"KNEE ARTHRO SURG, LIM SYNOV",OR,A,360,,,,,,963.00,N,N
3210472,"TENOTOMY, ABDUCT/EXTEN HIP, OPEN",OR,A,360,27006,,,,,"1,705.00",N,N
3210473,EXCIS SOFT TUMOR KNEE/THIGH,OR,A,360,,,,,,"1,128.00",N,N
3210474,OPEN REDUCTION FIXATION OF HIP,OR,A,360,,,,,,"2,420.00",N,N
3210475,OPEN ROTATOR CUFF,OR,A,360,,,,,,"1,617.00",N,N
3210476,"TENOTOMY, SHOULDER AREA",OR,A,360,23405,,,,,"1,265.00",N,N
3210477,SHOULDER ARTHRO DECOMPRESSION,OR,A,360,29826,,,,,358.00,N,N
3210478,OPEN RED FIXATION ELBOW,OR,A,360,24685,,,,,"1,293.00",N,N
3210479,"FOOT, REMOVAL OF FOR BODY",OR,A,360,,,,,,385.00,N,N
3210480,OPEN RPR EXT TENDON,OR,A,360,99999,,,,,908.00,N,N
3210481,REVISION OF TOTAL KNEE ARTHRO,OR,A,360,27486,,,,,"2,750.00",N,N
3210482,"REMOVAL OF IMPLANT, DEEP",OR,A,360,20680,,,,,"1,210.00",N,N
3210483,OPEN RED INT FIX DISTAL RADIUS,OR,A,360,25607,,,,,"1,650.00",N,N
3210484,PERCUTANEOUS PINNING DISTAL ULNA,OR,A,360,25651,,,,,"1,100.00",N,N
3210485,OPEN RED INT FIX PROX HUMERUS,OR,A,360,23615,,,,,"1,980.00",N,N
3210486,"DEBRIDE, SUB TISSUE; EA ADD",OR,A,360,11045,,,,,94.00,N,N
3210487,OPEN TX PATELLAR FRACTURE,OR,A,360,27524,,,,,"1,843.00",N,N
3210488,OPEN TRMT FEMORAL FRACTURE,OR,A,360,27236,,,,,"2,750.00",N,N
3210489,ARTHROPLASTY; RADIAL HEAD,OR,A,360,24365,,,,,"1,562.00",N,N
3210490,"ARTH, KNEE, FOR REMOVAL FB OR LOOSE BODY",OR,A,360,29874,,,,,"1,320.00",N,N
3210491,ARTHRO MAJOR JOINT W/O ULTRASOUND GUID,OR,A,360,20610,,,,,127.00,N,Y
3210492,"OPEN TX TIBIAL FRAC, PROXIMAL; UNICONDYL",OR,A,360,27535,,,,,"1,815.00",N,N
3210493,LACE REP <2.5CM EXGT&OE,OR,A,360,12001,,,,,216.00,N,N
3210494,EXCISION BENIGN LESION INCLUDING MARGINS,OR,A,360,11422,,,,,366.00,N,N
3210495,OPEN TREAT FEM SHAFT FX W/ PLATE/SCREWS,OR,A,360,27507,,,,,"2,420.00",N,N
3210496,RECONSTRUCT COMPLETE SHOULD CUFF AVUL,OR,A,360,23420,,,,,"2,393.00",N,N
3210497,DEBRID INC REM OF FB AT SITE OF OPEN FX,OR,A,360,11010,,,,,"1,174.00",N,N
3210498,"REPAIR PRIMARY LIGAMENT, ANKLE, COLLATER",OR,A,360,27695,,,,,"1,174.00",N,N
3210499,INCISION; EXTENSOR TEND SHEATH WRIST,OR,A,360,25000,,,,,820.00,N,N
3210500,"OPEN TX METATARSAL FX, INCLUDES INT FIX",OR,A,360,28485,,,,,"1,320.00",N,N
3210501,REM OF PROSTH; INC TOTAL KNEE PROSTH,OR,A,360,27488,,,,,"2,970.00",N,N
3210502,REPAIR EXTENSOR TEND LEG PRIMARY,OR,A,360,27664,,,,,880.00,N,N
3210503,"CLSD TR METACARP FRAC, SINGLE, W/ MANIP",OR,A,360,26605,,,,,792.00,N,N
3210504,"ARTHRO; INTRPOSITION, INTERCARP OR CARPO",OR,A,360,25447,,,,,"2,200.00",N,N
3210505,"TRANSPL OF TENDON, CMC OR DORS EACH TEN",OR,A,360,26483,,,,,"2,310.00",N,N
3210506,RECONST DISLOCAT PATELLA W/ REALIGN,OR,A,360,27422,,,,,"2,035.00",N,N
3210507,"DEB OPEN WND, PER SESS FIRST 20SQCM OR <",OR,A,360,97597,,,,,110.00,N,N
3210508,"NEG PRESS WOUND THER, < OR = 50 SQ CENT",OR,A,360,97605,,,,,83.00,N,N
3210509,"RPR, TEND-MUSC UPP ARM OR ELBOW; EACH",OR,A,360,24341,,,,,"2,090.00",N,N
3210510,"ARTHROTOMY, ELBOW, W/SYNOVECTOMY",OR,A,360,24102,,,,,"1,530.00",N,N
3210511,"TENOTOMY, ELBOW, LAT/MED DEBRIDEMT OPEN",OR,A,360,24358,,,,,"1,300.00",N,N
3210512,"REPAIR, PRIM, TORN LIG, KNEE, COLLATERAL",OR,A,360,27405,,,,,"2,000.00",N,N
3210600,APPLICATION OF APLIGRAF,OR,A,360,99997,,,,,505.00,N,Y
,,OR,A,360,99999,,,,,505.00,N,Y
,,OR,A,360,99998,,,,,505.00,N,Y
3210601,DEBRIDEMENT WATERJET,OR,A,360,97597,,,,,56.00,N,Y
3210602,LIGATION & DIV VEINS,OR,A,360,99998,,,,,673.00,N,Y
,,OR,A,360,99999,,,,,673.00,N,Y
,,OR,A,360,99997,,,,,673.00,N,Y
3210603,VARICOSE VEINS > 20 INCIS,OR,A,360,99997,,,,,"1,302.00",N,Y
,,OR,A,360,99999,,,,,"1,302.00",N,Y
,,OR,A,360,99998,,,,,"1,302.00",N,Y
3210604,DEBRIDEMENT MUS/FASCIA 20,OR,A,360,11043,,,,,309.00,N,Y
3210605,DEBRIDEMENT EACH ADD,OR,A,360,,,,,,101.00,N,Y
3220004,FLOOR RECOVERY,FLR,A,710,,,,,,281.50,N,Y
3230001,ER TYPE 2,ER,A,450,99282,,,,,248.00,N,Y
3230021,ER NURSING ASSESSMENT,ER,A,450,99201,,,,,60.00,N,Y
3230022,ER TYPE 1,ER,A,450,99281,,,,,193.00,N,Y
3230024,AMBULANCE,ER,A,540,,,,,,0.00,N,Y
3230025,ER XIX TRIAGE,ER,A,450,99211,,,,,31.00,N,Y
3230026,ER XIX TYPE 2,ER,A,450,99282,,,,,217.00,N,Y
3230027,ER XIX TYPE 1,ER,A,450,99281,,,,,162.00,N,Y
3230030,ER TYPE 3,ER,A,450,99283,,,,,303.00,N,Y
3230031,ER TYPE 4,ER,A,450,99284,,,,,413.00,N,Y
3230032,ER TYPE 5,ER,A,450,99285,,,,,556.00,N,Y
3230033,ER TYPE 6,ER,A,450,99291,,,,,593.00,N,Y
3230034,ER XIX TYPE 3,ER,A,450,99283,,,,,272.00,N,Y
3230035,ER XIX TYPE 4,ER,A,450,99284,,,,,382.00,N,Y
3230036,ER XIX TYPE 5,ER,A,450,99285,,,,,556.00,N,Y
3230037,ER XIX TYPE 6,ER,A,450,99291,,,,,566.00,N,Y
3230038,OTHER ER,ER,A,459,,,,,,575.00,N,Y
3230042,ER CRITICALCARE ADD1/2 HR,ER,A,450,99292,,,,,237.00,N,Y
3230050,ER NO CHARGE,ER,A,450,99201,,,,,0.00,N,Y
3239409,VAGINAL DELIVERY W/O EPIS,ER,A,450,59409,,,,,"1,320.00",N,N
3240001,OBSERVATION INITIAL DAY,OBS,A,762,99219,,,,,467.50,N,N
3240010,OBSERVATION EA ADDTL DAY PER HOUR,OBS,A,762,G0378,,,,,38.00,N,N
3250021,COLOSTOMY BAGS 10 PER PKG,CS,A,271,,,,,,12.50,N,Y
3250055,NASAL PACK POPE POST,CS,A,272,,,,,,24.00,N,Y
3250077,TELFA 2X3,CS,A,272,,,,,,3.00,N,Y
3250092,ZIMMER KNEE IMMOBLIZER,CS,A,271,,,,,,65.00,N,Y
3250122,PACING PROBE (CCU),CS,A,272,,,,,,129.00,N,Y
3250133,CATH 6 FR STRAIGHT,CS,A,272,,,,,,30.00,N,Y
3250174,CROUPETTE DISP. TENT,CS,A,271,,,,,,95.00,N,Y
3250292,BLOOD TUBING SET,CS,A,272,,,,,,22.54,N,Y
3250306,PCA TUBING,CS,A,272,,,,,,70.00,N,Y
3250323,BLOOD FILTERS(BL BANK),CS,A,272,,,,,,57.50,N,Y
3250361,THORACENTESIS TRAY W/CATH,CS,A,272,,,,,,84.50,N,Y
3250377,FAST PATCH DISPOSABLE,CS,A,271,,,,,,70.50,N,Y
3250387,HUBER NEEDLE,CS,A,272,,,,,,15.54,N,Y
3250399,KNEE NEOPR SM,CS,A,271,,,,,,41.00,N,Y
3250400,KNEE HINGED NEOP XLG,CS,A,271,,,,,,137.00,N,Y
3250403,TENNIS ELBOW,CS,A,271,,,,,,24.00,N,Y
3250404,TENNIS ELBOW 2001 MED,CS,A,271,,,,,,40.50,N,Y
3250428,AMBU INFANT,CS,A,271,,,,,,0.00,N,Y
3250445,EXPLORA CURRETTE #120,CS,A,272,,,,,,19.00,N,Y
3250462,RESTORE DRESSING 4X4,CS,A,272,,,,,,19.00,N,Y
3250470,"KNEE IMMOB 22"" UNIV",CS,A,270,,,,,,74.50,N,Y
3250479,QUIK PACE PATCH EACH,CS,A,271,,,,,,126.50,N,Y
3250487,CATH IV 18GX1.16,CS,A,272,,,,,,7.50,N,Y
3250488,CATH IV 20GX1.16,CS,A,272,,,,,,7.50,N,Y
3250489,CATH IV 22GX1,CS,A,272,,,,,,7.50,N,Y
3250515,CATH IV 14GX1.75,CS,A,272,,,,,,7.50,N,Y
3250516,CATH IV #16-50,CS,A,272,,,,,,6.50,N,Y
3250518,CATH IV 24GX.75,CS,A,272,,,,,,7.50,N,Y
3250519,LUMBER PUNCTURE TRAY,CS,A,272,,,,,,54.50,N,Y
3250521,DEFIB PADS,CS,A,272,,,,,,15.00,N,Y
3250526,CONTINU-FLO SOLN SET,CS,A,272,,,,,,10.68,N,Y
3250527,SECONDARY MED SET,CS,A,272,,,,,,5.50,N,Y
3250530,NITRO SET,CS,A,272,,,,,,23.00,N,Y
3250531,BURETROL SOL SET,CS,A,272,,,,,,15.50,N,Y
3250553,CATH EXT SET,CS,A,272,,,,,,6.53,N,Y
3250568,LENS MORGAN MEDI-FLOW,CS,A,272,,,,,,86.50,N,Y
3250575,METER PEAK FLOW,CS,A,271,,,,,,37.50,N,Y
3250582,PRIMCAST 4X30,CS,A,270,,,,,,36.00,N,Y
3250589,SPLINT TIB/FIB YOUTH HIP,CS,A,271,,,,,,153.50,N,Y
3250591,"TAPE CASTING 4""",CS,A,271,,,,,,15.50,N,Y
3250593,"TAPE DELTA-LITE 3""",CS,A,271,,,,,,56.50,N,Y
3250594,CATH 16FR FOLEY COUDE,CS,A,272,,,,,,38.00,N,Y
3250595,CATH 14FR FOLEY,CS,A,272,,,,,,15.00,N,Y
3250596,CATH 16FR FOLEY COUDE,CS,A,272,,,,,,60.00,N,Y
3250597,CATH 18FR STRAIGHT COUDE,CS,A,272,,,,,,18.50,N,Y
3250598,CATH 18FR FOLEY COUDE,CS,A,272,,,,,,57.50,N,Y
3250599,CATH 20FR FOLEY COUDE,CS,A,272,,,,,,55.50,N,Y
3250600,CATH 22FR FOLEY COUDE,CS,A,272,,,,,,54.00,N,Y
3250601,CATH 10FR FOLEY PED,CS,A,272,,,,,,28.50,N,Y
3250605,CATH 16FR FOLEY,CS,A,272,,,,,,45.00,N,Y
3250607,CATH 20FR FOLEY,CS,A,272,,,,,,16.50,N,Y
3250608,CATH 22FR FOLEY,CS,A,272,,,,,,16.50,N,Y
3250609,CATH 24FR FOLEY,CS,A,272,,,,,,15.50,N,Y
3250610,CATH 8FR STRAIGHT LATEX,CS,A,272,,,,,,16.00,N,Y
3250611,CATH 10FR STRAIGHT,CS,A,272,,,,,,16.00,N,Y
3250612,CATH 12FR FOLEY,CS,A,272,,,,,,16.00,N,Y
3250613,CATH 14FR STRAIGHT LATEX,CS,A,272,,,,,,16.00,N,Y
3250614,CATH 16FR STRAIGHT,CS,A,272,,,,,,16.00,N,Y
3250615,CATH 18FR STRAIGHT LATEX,CS,A,272,,,,,,5.50,N,Y
3250616,CATH 24FR RECTAL,CS,A,272,,,,,,9.50,N,Y
3250621,"TAPE MEGAZINC 1""",CS,A,271,,,,,,12.00,N,Y
3250622,"CASTING TAPE 2"" BLUE",CS,A,271,,,,,,10.00,N,Y
3250623,"CASTING TAPE 2"" PINK",CS,A,271,,,,,,10.00,N,Y
3250627,ELECTRODE PEDI-PADZ,CS,A,272,,,,,,146.00,N,Y
3250628,ELECTRODE STAT-PADZ,CS,A,272,,,,,,115.50,N,Y
3250632,VAPORIZER COOL MIST,CS,A,990,,,,,,39.50,N,Y
3250633,METER PEAK FLOW - CHILD,CS,A,271,,,,,,78.50,N,Y
3250634,"SCOTCHCAST 2""-SHORT ARM",CS,A,271,,,,,,13.50,N,Y
3250638,"SCOTCHCAST 3""-SHORT ARM",CS,A,271,,,,,,17.00,N,Y
3250639,"SCOTCHCAST 3""-LONG ARM",CS,A,271,,,,,,67.50,N,Y
3250642,"TAPE CASTING 5""",CS,A,271,,,,,,17.50,N,Y
3250643,CATH 18FR FOLEY L/F,CS,A,272,,,,,,15.00,N,Y
3250644,COLLAR PHILLY EXTRIC LOW,CS,A,271,,,,,,42.00,N,Y
3250645,CATHETER EPISTAXIS,CS,A,272,,,,,,103.50,N,Y
3250647,DRESSING EPISTAXIS,CS,A,272,,,,,,23.50,N,Y
3250648,DETECTOR CO2 EASY CAP II,CS,A,272,,,,,,33.30,N,Y
3250649,DETECTOR PEDOATRIC CO2,CS,A,272,,,,,,0.00,N,Y
3250653,RIB BELT MENS LARGE,CS,A,271,,,,,,26.00,N,Y
3250658,RIB BELT FE LRG,CS,A,271,,,,,,25.50,N,Y
3250668,COLLAR FOAM CERVICAL UNIV,CS,A,271,,,,,,14.50,N,Y
3250671,TRAY ADD-A-FOLEY,CS,A,271,,,,,,6.50,N,Y
3250673,KNEE NEOPR XXLG,CS,A,271,,,,,,41.00,N,Y
3250674,KNEE HINGED NEOP LG,CS,A,271,,,,,,137.00,N,Y
3250675,KNEE HINGED NEOP SM,CS,A,271,,,,,,137.00,N,Y
3250676,TULI HEEL CP LG,CS,A,271,,,,,,22.50,N,Y
3250677,HEEL CUP PLAST JR,CS,A,271,,,,,,6.50,N,Y
3250678,TENNIS ELBOW 2001 XL,CS,A,271,,,,,,40.50,N,Y
3250681,STOCKING ANTI KNEE SM REG,CS,A,271,,,,,,14.00,N,Y
3250682,STOCKING ANTI EMB MED XL,CS,A,271,,,,,,16.00,N,Y
3250683,STOCKING ANTI TH,CS,A,271,,,,,,28.50,N,Y
3250684,STOCKING ANTI-EMB,CS,A,271,,,,,,28.50,N,Y
3250685,STOCKING ANTI-EMB LRG SH,CS,A,271,,,,,,27.50,N,Y
3250686,STOCKING ANTI-TH SM SHT,CS,A,271,,,,,,28.50,N,Y
3250692,COLLAR PHILLY EXTRIC SHT,CS,A,271,,,,,,42.00,N,Y
3250693,COLLAR PHILLY EXTRIC REG,CS,A,271,,,,,,42.00,N,Y
3250694,COLLAR PHILLY EXTRIC TALL,CS,A,271,,,,,,42.00,N,Y
3250695,STOCKING ANTI-EMB LRG REG,CS,A,271,,,,,,16.00,N,Y
3250696,PROBE INTRA VAGINAL,CS,A,272,,,,,,95.50,N,Y
3250697,SET WARMING BLOOD/FLUID,CS,A,272,,,,,,36.50,N,Y
3250698,SLEEVE SCD SM,CS,A,271,,,,,,158.00,N,Y
3250699,SLEEVE SCD MED,CS,A,271,,,,,,139.00,N,Y
3250700,SLEEVE SCD LRG,CS,A,271,,,,,,166.00,N,Y
3250701,SLEEVE SCD KNEE REG,CS,A,271,,,,,,118.00,N,Y
3250702,SLEEVE SCD KNEE LRG,CS,A,271,,,,,,151.00,N,Y
3250709,SET KANGAROO FEEDING,CS,A,271,,,,,,9.00,N,Y
3250711,COMBITUBE 41FR,CS,A,272,,,,,,92.00,N,Y
3250712,EXT NEOP TENNIS ELBOW LG,CS,A,271,,,,,,36.50,N,Y
3250717,KIT IV SECUREMENT,CS,A,272,,,,,,7.00,N,Y
3250724,"TAPE CASTING 3""",CS,A,271,,,,,,12.53,N,Y
3250728,"BOOT UNNA'S 3""X10YD",CS,A,272,,,,,,36.50,N,Y
3250729,ELETRODE QUIK PACE,CS,A,272,,,,,,101.00,N,Y
3250730,DUODERM 6X6,CS,A,272,,,,,,42.00,N,Y
3250739,PRIMACAST 3X12,CS,A,271,,,,,,11.00,N,Y
3250750,SENSOR OXYGEN INFANT,CS,A,272,,,,,,58.50,N,Y
3250752,CONTINU FLO SET 2 SITE,CS,A,272,,,,,,11.00,N,Y
3250753,SENSOR OXIMAX INFANT 02,CS,A,272,,,,,,39.19,N,Y
3250754,VALVE PEEP 30 MM,CS,A,271,,,,,,17.86,N,Y
3250755,TRAY LACERATION W/O TEETH,CS,A,272,,,,,,28.50,N,Y
3250756,SYRINGE NACL 3ML PREFILLE,CS,A,258,,,,,,5.50,N,Y
3250757,SYRINGE NACL 5ML PREFILLE,CS,A,258,,,,,,5.50,N,Y
3250758,SODIUM CHLORIDE 0.9% 10 M,CS,A,258,A4216,,,,,5.50,N,Y
3250759,SPONGE HEMOSTATIC,CS,A,272,,,,,,28.50,N,Y
3250760,TUM-E-VAC,CS,A,272,,,,,,68.04,N,Y
3250768,CATHETER KIT FEMALE,CS,A,272,,,,,,6.50,N,Y
3250769,DRESSING SORBSAN 4X4,CS,A,272,,,,,,14.50,N,Y
3250771,CONTACT REMOVER HARD LENS,CS,A,272,,,,,,9.00,N,Y
3250772,CONTACT REMOVER SOFT LENS,CS,A,272,,,,,,21.50,N,Y
3250773,"SPLINT PRIMACAST 2""",CS,A,271,,,,,,7.50,N,Y
3250774,AIRWAY NASOPHARYNGEAL 28F,CS,A,271,,,,,,36.50,N,Y
3250775,AIRWAY NASOPHARYNGEAL 30F,CS,A,271,,,,,,36.50,N,Y
3250776,AIRWAY NASOPHARYNGEAL 32F,CS,A,271,,,,,,36.50,N,Y
3250777,DUODERM THIN 6X6,CS,A,272,,,,,,28.00,N,Y
3250778,DERMABOND DHV12,CS,A,272,,,,,,87.50,N,Y
3250779,CAUTERY DISPOSABLE,CS,A,272,,,,,,44.50,N,Y
3250780,KNEE SLEEVE XXL,CS,A,271,,,,,,48.50,N,Y
3250781,FORCEP WOUND CLOSURE,CS,A,272,,,,,,11.50,N,Y
3250784,DRESSING KALTOSTAT ROPE,CS,A,272,,,,,,17.00,N,Y
3250786,"TAPE CASTING 2""",CS,A,271,,,,,,8.50,N,Y
3250788,"SPLINT SCOTCHCAST 2""",CS,A,271,,,,,,119.00,N,Y
3250790,SPLINT PRIMACAST 4 X 15,CS,A,272,,,,,,18.50,N,Y
3250791,"BRACE, ANKLE LACE UP",CS,A,271,,,,,,64.00,N,Y
3250794,CATH 14FR FOLEY COUDE,CS,A,272,,,,,,81.50,N,Y
3250795,CATH 12FR STRAIGHT,CS,A,272,,,,,,14.50,N,Y
3250796,CANISTER VAC W/GEL,CS,A,271,,,,,,123.50,N,Y
3250797,DRESSING GRANULATED L,CS,A,272,,,,,,143.74,N,Y
3250801,SPLINT CONFORMABLE 2 INCH,CS,A,271,,,,,,9.50,N,Y
3250802,SPLINT WRIST RL WS-22,CS,A,271,,,,,,24.15,N,Y
3250803,SPLINT CONFORMABLE 4X15,CS,A,272,,,,,,20.90,N,Y
3250804,SUPPORTER ATHLETC MED,CS,A,271,,,,,,28.67,N,Y
3250805,FORCEP WOUND CLOSURE GR,CS,A,272,,,,,,10.46,N,Y
3250806,FORCEP WOUND CLOSURE PURP,CS,A,272,,,,,,10.15,N,Y
3250807,MANOMETER PRESSURE DISPOS,CS,A,272,,,,,,0.00,N,Y
3250808,RESUSCITATOR PED. MANUAL,CS,A,272,,,,,,0.00,N,Y
3250809,RESUSCITATOR INFANT MAN.,CS,A,272,,,,,,0.00,N,Y
3250810,EDEMA WEAR MED,CS,A,271,,,,,,44.13,N,N
3250813,CATH 10FR FOLEY,CS,A,272,,,,,,19.60,N,Y
3250814,GEL WOUND SOLOSITE,CS,A,271,,,,,,46.06,N,Y
3250815,DRESSING GRANULATED M,CS,A,272,,,,,,142.98,N,Y
3250816,RESUSCITATOR ADULT,CS,A,272,,,,,,44.20,N,Y
3250818,SET YELLOW STRIP GEMSTAR,CS,A,272,,,,,,33.95,N,Y
3250819,CATHETER TROCAR 16FR PVC,CS,A,272,,,,,,36.92,N,Y
3250820,CATHETER TROCAR 20FR PVC,CS,A,272,,,,,,36.83,N,Y
3250821,CATHETER TROCAR 24FR PVC,CS,A,272,,,,,,36.85,N,Y
3250822,CATHETER TROCAR 28FR PVC,CS,A,272,,,,,,36.82,N,Y
3250823,CIRCUIT DISP PATIENT,CS,A,272,,,,,,21.88,N,Y
3250824,SET NITRO,CS,A,272,,,,,,69.00,N,Y
3250825,AIRWAY NASOPHARYNGEAL 30F,CS,A,272,,,,,,7.17,N,Y
3250826,AIRWAY NASOPHARYNGEAL 32F,CS,A,272,,,,,,7.17,N,Y
3250827,RESUSCITATOR ADULT,CS,A,272,,,,,,42.30,N,Y
3250828,"BOOT UNNA 4""X10 BANDAGE",CS,A,272,,,,,,43.09,N,Y
3250829,DRESSING XEROFORM 1X8,CS,A,272,,,,,,0.00,N,Y
3250830,DRESSING XEROFORM 4X4,CS,A,272,,,,,,0.00,N,Y
3250831,DRESSING DUODERM 4X4,CS,A,272,,,,,,10.29,N,Y
3250832,DRESSING AQUACELL 6X6,CS,A,272,,,,,,32.41,N,Y
3250833,DRESSING AMD FOAM 4X8,CS,A,272,,,,,,39.20,N,Y
3250834,SET EXT 1.2 MICRON FILTER,CS,A,272,,,,,,8.83,N,Y
3250835,"TAPE CASTING 2"" BLACK",CS,A,271,,,,,,10.40,N,Y
3250836,"TAPE CASTING 3"" BLACK",CS,A,271,,,,,,12.64,N,Y
3250837,"TAPE CASTING 4"" BLACK",CS,A,271,,,,,,16.56,N,Y
3250838,"TAPE CASTING 3"" BLUE",CS,A,271,,,,,,12.64,N,Y
3250839,"TAPE CASTING 4"" BLUE",CS,A,271,,,,,,16.56,N,Y
3250840,"TAPE CASTING 2"" RED",CS,A,271,,,,,,10.40,N,Y
3250841,"TAPE CASTING 3"" RED",CS,A,271,,,,,,12.64,N,Y
3250842,"TAPE CASTING 4"" RED",CS,A,271,,,,,,16.56,N,Y
3250843,"TAPE CASTING 3"" PINK",CS,A,271,,,,,,12.64,N,Y
3250844,"TAPE CASTING 4"" PINK",CS,A,271,,,,,,16.56,N,Y
3250845,"TAPE CASTING 2"" YELLOW",CS,A,271,,,,,,10.40,N,Y
3250846,"TAPE CASTING 3"" YELLOW",CS,A,271,,,,,,12.64,N,Y
3250847,DRESSING AMD 4X4,ORS,A,272,,,,,,21.41,N,Y
3250848,DRESSING AMD 4X4 W/SHT,CS,A,272,,,,,,24.98,N,Y
3250849,CATH 12FR COUDE,CS,A,272,,,,,,47.63,N,Y
3250850,DRESSING ADAPTIC 3X3,CS,A,272,,,,,,2.58,N,Y
3250851,KIT CHEST TUBE INSERTION,CS,A,272,,,,,,10.03,N,Y
3250852,"BANDAGE SURE PRESS 4""",CS,A,271,,,,,,38.78,N,Y
3250853,GEL DUODERM HYDROACTIVE,CS,A,272,,,,,,12.76,N,Y
3250854,CANISTER INFOVAC 500ML GE,CS,A,272,,,,,,157.10,N,Y
3250855,DRESSING SIMPLACE MED,CS,A,272,,,,,,136.04,N,Y
3250976,DRESSING MEPILEX AG 4X4,CS,A,272,,,,,,21.28,N,Y
3250977,OXISENSOR II NEO/ADULT,CS,A,272,,,,,,54.60,N,Y
3250978,OXISENSOR II PED,CS,A,272,,,,,,42.00,N,Y
3250979,OXISENSOR II ADULT,CS,A,272,,,,,,46.20,N,Y
3250980,DRAINAGE CHEST,CS,A,272,,,,,,77.65,N,Y
3250981,POUCH DRAINABLE,CS,A,272,,,,,,25.89,N,Y
3250984,STABILIZER ANKLE REG 10.5,CS,A,271,,,,,,63.05,N,Y
3250985,CATH 14FR FOLEY DOVER,CS,A,272,,,,,,62.70,N,Y
3250986,CATH 16FR FOLEY COUDE,CS,A,272,,,,,,62.70,N,Y
3250988,INTRODUCER ET COUDE,CS,A,272,,,,,,29.63,N,Y
3250989,INTRODUCER ET STRAIGHT,CS,A,272,,,,,,29.63,N,Y
3250990,INTRODUCER ET PED,CS,A,272,,,,,,29.63,N,Y
3250991,GUAZE XEROFORM 5X9,CS,A,272,,,,,,2.66,N,Y
3250996,LOOP MICROBORE I.V. CONN,CS,A,272,,,,,,8.56,N,Y
3250997,CATH 18FR FOLEY COUDE,CS,A,272,,,,,,62.70,N,Y
3250998,CATHETER TROCAR 10FR PVC,CS,A,272,,,,,,36.30,N,Y
3250999,AIRWAY NASAL 14F,CS,A,272,,,,,,7.50,N,Y
3251000,AIRWAY NASAL 18F,CS,A,272,,,,,,7.50,N,Y
3251001,AIRWAY NASAL 20F,CS,A,272,,,,,,7.50,N,Y
3251002,AIRWAY NASAL 24F,CS,A,272,,,,,,7.50,N,Y
3251003,AIRWAY NASOPHARYNGEAL 26F,CS,A,272,,,,,,7.18,N,Y
3251004,AIRWAY NASOPHARYNGEAL 28F,CS,A,272,,,,,,7.50,N,Y
3251005,"CATH TROCAR 32FR 16""L",CS,A,272,,,,,,40.77,N,Y
3251006,RESUSCITATOR ADULT,CS,A,272,,,,,,40.68,N,Y
3251007,INFU-SURG BAG 500ML PRESS,CS,A,272,,,,,,26.22,N,Y
3251008,METER PEAK FLOW UNIVERSAL,CS,A,272,,,,,,18.39,N,Y
3251009,UNFU-SURG BAG 1000ML PRES,CS,A,272,,,,,,26.22,N,Y
3251010,DRESSING MEPILEX AGBORDER,CS,A,272,,,,,,24.61,N,Y
3251011,DRESSING 6X6 AQUACEL AG,CS,A,272,,,,,,53.59,N,Y
3251012,DRESSING DUODERM 4X4,CS,A,272,,,,,,9.44,N,Y
3251013,DRESSING VERSIVA 4X4,CS,A,272,,,,,,11.23,N,Y
3251014,DRESSING DUODERM 4.5X7.5,CS,A,272,,,,,,11.85,N,Y
3251015,DRESSING AG HYDRO,CS,A,272,,,,,,28.18,N,Y
3251016,"TAPE CASTING 3"" PURPLE",CS,A,271,,,,,,12.64,N,Y
3251017,RHINO ROCKET MED,CS,A,272,,,,,,52.20,N,Y
3251018,RHINO ROCKET LRG.,CS,A,272,,,,,,59.38,N,Y
3251019,"TAPE CASTING 2"" PURPLE",CS,A,271,,,,,,10.40,N,Y
3251020,RHINO RAPID SZ 7.5,CS,A,272,,,,,,0.00,N,Y
3251021,RHINO RAPID SZ 12,CS,A,272,,,,,,0.00,N,Y
3251022,DERMABOND SKIN ADHESIVE,CS,A,272,,,,,,129.51,N,Y
3251023,ELECTRODE PEDI-PADZ II,CS,A,272,,,,,,173.37,N,Y
3251024,ELECTRODE CPR-D PADZ,CS,A,272,,,,,,246.74,N,Y
3251025,SET SOLUTION DUO-VENT,CS,A,272,,,,,,9.14,N,Y
3251026,DRESSING EXTRA AQUACELL,CS,A,272,,,,,,17.62,N,Y
3251027,"STRIP PACKING 1/4""X1YD",CS,A,272,,,,,,3.03,N,Y
3251028,TRAY FOLEY 14FR,CS,A,272,,,,,,51.66,N,Y
3251029,TRAY COUDE 16FR,CS,A,272,,,,,,59.60,N,Y
3251030,KIT CATH INFANT 5FR,CS,A,272,,,,,,6.27,N,Y
3251031,KIT CATH PED 8FR,CS,A,272,,,,,,6.27,N,Y
3251032,EXTRACTOR KATZ,CS,A,272,,,,,,128.77,N,Y
3251033,DRESSING MEPILEX 4X12,CS,A,272,,,,,,23.00,N,Y
3251034,SENSOR OXIMAX NEONATAL 02,CS,A,272,,,,,,61.50,N,Y
3251035,SENSOR OXIMAX PEDIATRIC,CS,A,272,,,,,,34.62,N,Y
3251036,EPISTAXIS RAPID RHINO 5.5,CS,A,272,,,,,,101.70,N,N
3251037,SET BLOOD/FLUID WARMER,CS,A,272,,,,,,38.85,N,N
3251038,SET SOLUTION NON-DEHP,CS,A,272,,,,,,11.88,N,N
3251039,CLEARLINK VALVE,CS,A,272,,,,,,3.87,N,N
3251040,CONNECTOR Y INFOVAC,CS,A,272,,,,,,6.82,N,N
3251041,NASAL DEVICE MAD LMA,CS,A,272,,,,,,13.14,N,N
3251042,HYDROFERA BLUE 4X4,CS,A,272,,,,,,22.28,N,N
3251043,DRESSING MEPILEX BORDER,CS,A,272,,,,,,89.95,N,N
3251044,SET 25MM NEEDLE EZIO,CS,A,272,,,,,,218.00,N,N
3251045,SET 15MM NEEDLE EZIO,CS,A,272,,,,,,230.00,N,N
3251046,STABILIZER EZ,CS,A,272,,,,,,35.00,N,N
3251047,SET 45MM NEEDLE EZIO,CS,A,272,,,,,,230.00,N,N
3251048,SYSTEM CPAP O2 RESQ MED,CS,A,272,,,,,,140.01,N,N
3251049,SYSTEM CPAP O2 RESQ LRG,CS,A,272,,,,,,140.01,N,N
3251050,DRESSING DRAWTEX,CS,A,272,,,,,,29.40,N,N
3251051,"BOOT UNNA 4""X10"" BANDAGE",CS,A,272,,,,,,15.73,N,N
3251052,SLEEVE VASCO PRESS CALF M,CS,A,272,,,,,,40.54,N,N
3251053,SLEEVE VASCO PRESS CALF L,CS,A,272,,,,,,53.87,N,N
3251054,KIT MINI TRACH II,CS,A,272,,,,,,55.30,N,Y
3251055,NEEDLE HUBER SAFETY 20GX3/4,CS,A,272,,,,,,11.13,N,N
3251056,KIT IV STANDARD,CS,A,272,,,,,,5.19,N,N
3251057,EASYTUBE 41FR,ER,A,272,,,,,,109.00,N,N
3251058,EASYTUBE 28FR,CS,A,272,,,,,,99.12,N,N
3251059,DRESSING MEPILEX BORDER SACRUM,CS,A,272,,,,,,36.65,N,N
3251060,CATHETER 10FR FOLEY,CS,A,272,,,,,,12.81,N,N
3251061,CATHETER 14FR FOLEY COUDE,CS,A,272,,,,,,118.71,N,N
3251062,CATHETER 6FR PED,CS,A,272,,,,,,81.03,N,N
3251063,CATHETER 18FR FOLEY COUDE,CS,A,272,,,,,,118.71,N,N
3251064,CATHETER 14FR FOLEY,CS,A,272,,,,,,12.81,N,N
3251065,CATHETER 16FR FOLEY,CS,A,272,,,,,,12.81,N,N
3251066,TRAY CATHETER FOLEY,CS,A,272,,,,,,5.71,N,N
3251067,CATHETER 16FR FOLEY COUDE,CS,A,272,,,,,,118.71,N,N
3251068,BOOT UNNA 4X10 CALAMINE,CS,A,272,,,,,,15.73,N,N
3251069,POUCH DRAINABLE ONE PIECE,ORS,A,272,,,,,,7.45,N,N
3251070,CATHERTER 18FR FOLEY,CS,A,272,,,,,,12.81,N,N
3251071,SYSTEM PREVALON TURN & POSITION,CS,A,270,,,,,,217.04,N,N
3251072,FORCEP REPLACEMENT,CS,A,271,,,,,,22.71,N,N
3251073,SENSOR ADHESIVE LNOP ADULT,CS,A,271,,,,,,51.87,N,N
3251074,SENSOR ADHESIVE LNOP PED,CS,A,271,,,,,,58.52,N,N
3251075,SENSOR ADHESIVE LNOP INFANT,CS,A,271,,,,,,66.50,N,N
3251076,BLADE BIOPSY BIOPBLADE,CS,A,272,,,,,,3.26,N,N
3251078,TRAY LACERATION,CS,A,272,,,,,,15.65,N,N
3251079,CATHETER TROCAR 12FR PVC,CS,A,272,,,,,,36.83,N,N
3251080,RESUSCITATOR INFANT,CS,A,272,,,,,,45.88,N,N
3251081,RESUSCITATOR PEDIATRIC,CS,A,272,,,,,,36.05,N,N
3251082,CATH TOUCHLESS 14FR,CS,A,272,,,,,,8.54,N,N
3251083,CATH TOUCHLESS 14FR COUDE,CS,A,272,,,,,,17.64,N,N
3251084,CATH 24FR FOLEY 3-WAY 30CC,CS,A,272,,,,,,33.92,N,N
3251085,RESUSCITATOR ADULT,CS,A,270,,,,,,24.40,N,N
3251086,"TAPE CASTING 3"" RED",CS,A,271,,,,,,7.89,N,N
3251087,"TAPE CASTING 3"" PINK",CS,A,271,,,,,,12.89,N,N
3251088,"TAPE CASTING 3"" PURPLE",CS,A,271,,,,,,12.89,N,N
3251089,ATTACHMENT TUBE HORIZONTAL,CS,A,272,,,,,,17.57,N,N
3251090,"TAPE CASTING 2"" PINK",CS,A,271,,,,,,6.86,N,N
3251091,STOPCOCK 3-WAY,CS,A,272,,,,,,6.69,N,N
3251092,TUBE ENDOTRACHEAL CUFFED 3.5,CS,A,272,,,,,,5.24,N,N
3251093,TUBE ENDOTRACHEAL HVT 7.5,CS,A,272,,,,,,4.91,N,N
3251094,TUBE ENDOTRACHEAL UNCUFFED 2.5,CS,A,272,,,,,,7.81,N,N
3251095,SYSTEM WOUND MGMT FISTULA,CS,A,272,,,,,,136.81,N,N
3251096,RESUSCITATOR PED,CS,A,272,,,,,,29.30,N,N
3251097,"TAPE CASTING 3"" YELLOW",CS,A,271,,,,,,7.89,N,N
3251098,"TAPE CASTING 2"" YELLOW",CS,A,271,,,,,,6.87,N,N
3251099,TUBE ENDOTRACHEAL HVT 7.0,CS,A,272,,,,,,9.91,N,N
3251100,TRAY LUMBAR PUNCTURE ADULT,CS,A,271,,,,,,25.52,N,N
3251101,"TAPE CASTING 2"" BLUE",CS,A,271,,,,,,6.87,N,N
3251102,"TAPE CASTING 3"" BLUE",CS,A,271,,,,,,7.89,N,N
3251103,"TAPE CASTING 2"" PURPLE",CS,A,271,,,,,,6.87,N,N
3251104,SET FEEDING W/FLUSH 1000ML,CS,A,271,,,,,,14.67,N,N
3251105,BAG FEEDING KANGAROO GRAVITY,CS,A,270,,,,,,5.28,N,N
3251106,NEEDLE GRIPPER PLUS LUER 20 X 3/4,CS,A,272,,,,,,16.06,N,N
3251107,SET SOLUTION W/ 3 CLEARLINK SITES 60DMP,CS,A,272,,,,,,8.11,N,N
3251108,KIT STATLOCK PICC/CVC DRESSING,CS,A,272,,,,,,43.75,N,N
3251109,SET POWERLOC MAX INFUSION 20X1,CS,A,272,,,,,,80.97,N,N
3251110,TUBE FEEDING 8FR 7G WT W/STYLET,CS,A,272,,,,,,75.85,N,N
3251111,TUBE FEEDING 10FR PILL 3G WT W/STYLET,CS,A,272,,,,,,75.85,N,N
3251112,MEPILEX 6X6,CS,A,272,,,,,,25.33,N,N
3251113,INTRASITE GEL 15GM,CS,A,272,,,,,,10.35,N,N
3251114,ALLEVYN GENTLE 6X6,CS,A,272,,,,,,26.25,N,N
3251115,POLYMEM 3X3,CS,A,272,,,,,,13.62,N,N
3251116,ALLEVYN GENTLE BORDER SACRUM,CS,A,272,,,,,,23.79,N,N
3251117,NEEDLE GRIPPER PLUS LUER 20 X 1,CS,A,272,,,,,,11.48,N,Y
3251118,ANASEPT 8 OZ PUMP,CS,A,270,,,,,,38.88,N,N
3251119,ALLEVYN NON-ADHESIVE HEEL,CS,A,272,,,,,,26.16,N,N
3251120,ALLEVYN 6X6 NON-ADHESIVE,CS,A,272,,,,,,24.95,N,N
3251121,"TAPE CASTING 3"" BLACK",CS,A,272,,,,,,5.64,N,N
3251122,INTRASITE GEL 25GR,CS,A,272,,,,,,14.67,N,N
3251123,ALLEVYN GENTLE BORDER 4X4,CS,A,272,,,,,,8.52,N,N
3251124,"TAPE CASTING 2"" BLACK",CS,A,272,,,,,,6.87,N,N
3251125,TUBE MEDIHONEY1.5 OZ W/APPLICATOR,CS,A,272,,,,,,50.42,N,N
3251126,ALLEVYN GENTLE BORDER 7X7,CS,A,272,,,,,,22.03,N,N
3251127,TRAY SUTURE REMOVAL,CS,A,272,,,,,,1.57,N,N
3251128,SHEET ADHESIVE NON MEDIHONY HSC 4X4,CS,A,272,,,,,,31.77,N,N
3251129,GEL SILVASORB WOUND 1.5OZ,CS,A,272,,,,,,50.40,N,N
3251130,CATH 8FR,CS,A,272,,,,,,1.19,N,N
3251131,"TAPE CASTING 2"" RED",CS,A,272,,,,,,6.87,N,N
3251132,DRESSING AQUACELL AG EXTRA,CS,A,272,,,,,,17.10,N,N
3251133,DRESSING AQUACEL AG 8X10,CS,A,272,,,,,,88.60,N,N
3251134,ELECTRODE ONESTEP DEFIB ADULT,CS,A,272,,,,,,172.13,N,N
3251135,ELECTRODE ONESTEP DEFIB PED,CS,A,272,,,,,,177.20,N,N
3251136,CURETTE DERMAL 4MM DISP,CS,A,272,,,,,,4.93,N,N
3251137,COMPRESSION LIGHT COFLEX,CS,A,271,,,,,,28.32,N,N
3251138,"DRESSING PROMOGRAN PRISMA 4 3/4""",CS,A,272,,,,,,31.59,N,N
3251139,PASTE DUODERM,CS,A,270,,,,,,28.49,N,N
3251140,ANASEPT 4OZ FLIP TOP,CS,A,270,,,,,,43.01,N,N
3251141,EDEMA WEAR CLOSED TOE MED,CS,A,271,,,,,,80.29,N,N
3251142,EDEMA WEAR LRG,CS,A,271,,,,,,77.43,N,N
3251143,"DRAPE V.A.C. 12""X10""",CS,A,270,,,,,,22.01,N,N
3251144,CANISTER FREEDOM 300ML W/GEL,CS,A,270,,,,,,100.00,N,N
3251145,SENSOR INFANT DISP,CS,A,270,,,,,,54.60,N,N
3251146,SENSOR PED DISP,CS,A,270,,,,,,61.60,N,N
3251147,DRESSING AQUACEL FOAM 4X4 ADHESIVE,CS,A,272,,,,,,7.23,N,N
3251148,DRESSING AQUACEL FOAM 6X6,CS,A,272,,,,,,14.43,N,N
3251149,KIT CRICOTHYROIDOTOMY,CS,A,272,,,,,,272.28,N,N
3251150,DRESSING AQUACELL FOAM 7X7 ADHESIVE,CS,A,272,,,,,,15.04,N,N
3251151,SYSTEM CPAP 02-MAX MED,CS,A,271,,,,,,129.00,N,N
3251152,SYSTEM CPAP 02-MAX LRG,CS,A,271,,,,,,132.81,N,N
3251153,DRESSING FOAMLITE 4X4 ADH,CS,A,270,,,,,,6.51,N,N
3251154,DRESSING FOAMLITE 6X6 ADH,CS,A,270,,,,,,9.44,N,N
3251155,TUBE LARYNGEAL KING LTS-D SZ 1,CS,A,272,,,,,,85.93,N,N
3251156,TUBE LARYNGEAL KING LTS-D SZ 2,CS,A,272,,,,,,85.93,N,N
3251157,TUBE LARYNGEAL KING LTS-D SZ 2.5,CS,A,272,,,,,,85.93,N,N
3251158,TUBE LARYNGEAL KING LTS-D SZ 3,CS,A,272,,,,,,78.39,N,N
3251159,TUBE LARYNGEAL KING LTS-D SZ 4,CS,A,272,,,,,,78.39,N,N
3251160,TUBE LARYNGEAL KING LTS-D SZ 5,CS,A,272,,,,,,78.39,N,N
3251161,DRESSING THIN FOAM,CS,A,272,,,,,,139.02,N,N
3251162,MEPITEL 4X7.2 CONTACT LAYER,CS,A,272,,,,,,31.42,N,N
3251163,GEL WOUND DUODERM HYDROCATIVE 30G,CS,A,272,,,,,,6.48,N,N
3257775,OTHER SUPPLY/DEVICES,CS,A,279,,,,,,0.00,N,Y
3257777,SPECIAL ORDER NON-COVERED,CS,A,273,,,,,,0.00,N,Y
3258888,SPECIAL ORDER,CS,A,272,,,,,,0.00,N,Y
3258889,SPECIAL ORDER N/S,CS,A,271,,,,,,0.00,N,Y
3259999,CONVERSION CODE,CS,A,270,,,,,,0.00,N,Y
3260003,PENROSE DRAIN,ORS,A,272,,,,,,5.95,N,Y
3260007,SUPPORT ATHLETIC L,ORS,A,271,,,,,,28.66,N,Y
3260117,SUT 3-0 SURGI SG636,ORS,A,272,,,,,,7.50,N,Y
3260119,SUT 2-0 CHROM 811H,ORS,A,272,,,,,,8.00,N,Y
3260168,SUT 0 ETHIBOND X412H,ORS,A,272,,,,,,9.00,N,Y
3260343,SUT 0 VICRYL ENDOLOOP,ORS,A,272,,,,,,57.50,N,Y
3260360,DISPOSABLE SKIN STAPLE EA,ORS,A,272,,,,,,13.85,N,Y
3260387,TRU CUT BIOPSY NEEDLE,ORS,A,272,,,,,,46.46,N,N
3260398,XEROFORM DRESSING 2X2,ORS,A,272,,,,,,5.50,N,Y
3260412,LDS 15W,ORS,A,272,,,,,,311.00,N,Y
3260414,ENDOCLOSE,ORS,A,272,,,,,,155.45,N,Y
3260431,PAPARELLA TYPE 1,ORS,A,272,,,,,,39.42,N,Y
3260442,ENDO CLIP,ORS,A,272,,,,,,262.50,N,Y
3260468,MESH PREFIX SM,ORS,A,272,,,,,,440.25,N,Y
3260475,SUT2-0 SURGI VP833,ORS,A,270,,,,,,8.00,N,Y
3260478,SUT 2-0 VICRYL J269H,ORS,A,270,,,,,,25.00,N,Y
3260575,ENDOCATCH,ORS,A,272,,,,,,181.00,N,Y
3260584,SUT 0 POLY CL260,ORS,A,272,,,,,,10.00,N,Y
3260593,REUT-BOB VENT TUBE,ORS,A,272,,,,,,48.50,N,Y
3260602,SUT5-0 PRO 8618G,ORS,A,272,,,,,,34.00,N,Y
3260607,SUT 1-0 CHROM CC01G,ORS,A,272,,,,,,11.00,N,Y
3260613,SUT 3-0 VICRYL J316H,ORS,A,272,,,,,,8.00,N,Y
3260614,SUT 5-0 CHROMIC 687G,ORS,A,272,,,,,,17.50,N,Y
3260615,SUT 4-0 NYLON 1670H,ORS,A,272,,,,,,7.00,N,Y
3260617,SUT 5-0 ETHILON G695G,ORS,A,272,,,,,,14.50,N,Y
3260632,STAPLE REMOVER,ORS,A,272,,,,,,8.50,N,Y
3260635,INDERMIL,ORS,A,272,G0168,,,,,84.00,N,Y
3260648,SUTURE 4-0 SURGI XP-8619,ORS,A,272,,,,,,37.50,N,Y
3260653,PLUG PERFIX MESH-MED,ORS,A,272,,,,,,344.00,N,Y
3260658,PARACENTESIS KIT,ORS,A,272,,,,,,136.00,N,Y
3260662,SURGINEEDLE 120 MM,ORS,A,272,,,,,,121.87,N,Y
3260664,BLADE CAUTERY ELECTR 5 MM,ORS,A,272,,,,,,5.00,N,Y
3260665,BLADE CAUTERY ELECT 16.51,ORS,A,272,,,,,,13.00,N,Y
3260667,CATH 3 WAY 22 FR 30 CC,ORS,A,272,,,,,,29.00,N,Y
3260669,RELOAD STAPLER 60-3.8,ORS,A,272,,,,,,484.59,N,Y
3260672,BLANKET UPPER BODY,ORS,A,272,,,,,,34.00,N,Y
3260673,TROCAR BLADELESS 12MM,ORS,A,272,,,,,,137.01,N,Y
3260674,TROCAR BLADELESS 11MM,ORS,A,272,,,,,,132.96,N,Y
3260675,CATH 24FR FOLEY 3-WAY,ORS,A,272,,,,,,26.77,N,Y
3260676,SUTURE 0 ETHIBOND,ORS,A,272,,,,,,58.50,N,Y
3260677,PORT MRI IMPLANTED,ORS,A,272,,,,,,326.94,N,Y
3260681,LMA UNIQUE SIZE 4,ORS,A,272,,,,,,59.50,N,Y
3260683,SUT 4-0 CHROMIC GUT,ORS,A,272,,,,,,31.50,N,Y
3260688,SUT 4-0 MONO Y835G,ORS,A,272,,,,,,21.00,N,Y
3260689,SUT 4-0 CHROMIC G121H,ORS,A,272,,,,,,9.00,N,Y
3260690,SUT 4-0 SILK 1677G,ORS,A,272,,,,,,15.00,N,Y
3260691,SUT 4-0 ETHILON 1667H,ORS,A,272,,,,,,15.00,N,Y
3260692,SUT 4-0 PROLENE 8619G,ORS,A,272,,,,,,20.50,N,Y
3260693,SUT 5-0 ETHILON 1666G,ORS,A,272,,,,,,15.00,N,Y
3260695,SUT 0 VICRYL J207G,ORS,A,272,,,,,,8.50,N,Y
3260696,SUT 0 PDS II Z991G,ORS,A,272,,,,,,25.00,N,Y
3260697,SUT 0 VICRYL VCP740D,ORS,A,272,,,,,,51.00,N,Y
3260698,SUT 0 VICRYL VCP329H,ORS,A,272,,,,,,8.00,N,Y
3260699,SUT 2-0 SILK 685G,ORS,A,272,,,,,,6.50,N,Y
3260700,SUT 2-0 PROLENE 8623H,ORS,A,272,,,,,,8.50,N,Y
3260701,SUT 2-0 VICRYL VCP328H,ORS,A,272,,,,,,8.00,N,Y
3260702,SUT 2-0 VICRYL VCP351H,ORS,A,272,,,,,,8.00,N,Y
3260703,SUT 3-0 VICRYL J205G,ORS,A,272,,,,,,8.50,N,Y
3260704,SUT 3-0 SILK C053D,ORS,A,272,,,,,,38.50,N,Y
3260705,SUT 3-0 VICRYL VCP316H,ORS,A,272,,,,,,8.00,N,Y
3260706,SUT 3-0 ETHILON 1671H,ORS,A,272,,,,,,6.50,N,Y
3260707,SUT 3-0 PDS II Z416H,ORS,A,272,,,,,,10.00,N,Y
3260708,SUT 3-0 PDS II Z258H,ORS,A,272,,,,,,10.00,N,Y
3260709,SUT 3-0 CHROMIC GUT G122H,ORS,A,272,,,,,,8.00,N,Y
3260710,SUT 0 VICRYL VCP260H,ORS,A,272,,,,,,10.50,N,Y
3260711,SUT 3-0 VICRYL VCPB944H,ORS,A,272,,,,,,8.50,N,Y
3260712,SUT 4-0 GUT CHROMIC 1654G,ORS,A,272,,,,,,15.50,N,Y
3260713,SUT 4-0 ETHILON 1629H,ORS,A,272,,,,,,7.00,N,Y
3260714,SUT 6-0 ETHILON 667G,ORS,A,272,,,,,,7.00,N,Y
3260717,SUT 0 DEXON VCP207G,ORS,A,272,,,,,,9.00,N,Y
3260718,SUT 4-0 VICRYL VCP422H,ORS,A,272,,,,,,10.50,N,Y
3260719,SUT 3-0 SILK BLACK C003D,ORS,A,272,,,,,,35.00,N,Y
3260722,ENDOPOUCH,ORS,A,272,,,,,,97.52,N,Y
3260723,SET TUBE IRRIGATION,ORS,A,272,,,,,,57.00,N,Y
3260724,SUT 3-0 VICRYL,ORS,A,272,,,,,,8.50,N,Y
3260725,SUT VICRYL PLUS 0,ORS,A,272,,,,,,8.00,N,Y
3260726,SUT 3-0 ETHILON,ORS,A,272,,,,,,14.50,N,N
3260728,SUT 4-0 PROLENE 8831H,ORS,A,272,,,,,,9.00,N,Y
3260732,SUT 3-0 VICRYL VCP265H,ORS,A,272,,,,,,8.50,N,Y
3260733,SUT 0 VICRYL VCP267H,ORS,A,272,,,,,,8.00,N,Y
3260734,SUT 1 ETHIBOND X425H,ORS,A,272,,,,,,7.50,N,Y
3260735,SUT 5-0 MAXON Z421H,ORS,A,272,,,,,,12.50,N,Y
3260736,"NEEDLE 1/2"" CUTTING",ORS,A,272,,,,,,19.00,N,Y
3260737,TUBE FEEDING 24 FR BOLUS,ORS,A,272,,,,,,57.00,N,Y
3260738,SUT MERSILENE 5MM,ORS,A,272,,,,,,117.00,N,Y
3260740,SUT 2-0 ENDO ETHIBOND,ORS,A,272,,,,,,91.00,N,Y
3260741,STAPLER SKIN PROXIMATE,ORS,A,272,,,,,,24.50,N,Y
3260742,SUT ETHILON 3-0,ORS,A,272,,,,,,14.50,N,Y
3260743,SUT VICRYL 5-0,ORS,A,272,,,,,,15.50,N,Y
3260744,GRASPER DUCKBILL DISP,ORS,A,272,,,,,,220.50,N,Y
3260745,CARTRIDGE CURVTEK 12MM,ORS,A,272,,,,,,803.00,N,Y
3260746,SUT 4-0 SILK 7734G,ORS,A,272,,,,,,14.50,N,Y
3260747,SEPRAFILM 5X6,ORS,A,272,,,,,,390.00,N,Y
3260748,SUT 3-0 SILK 1679H,ORS,A,272,,,,,,13.34,N,Y
3260749,SUT 6-0 ETHILON 697G,ORS,A,272,,,,,,13.09,N,Y
3260750,LMA UNIQUE SZ 5,ORS,A,272,,,,,,84.00,N,Y
3260752,IMPACT LIGASURE,ORS,A,272,,,,,,"1,027.50",N,Y
3260753,SUT 4-0 PROLENE 8634G,ORS,A,272,,,,,,20.20,N,Y
3260754,SUT 3-0 ETHILON 1691H,ORS,A,272,,,,,,12.78,N,Y
3260755,SUT 4-0 MONOCRYL MCP426H,ORS,A,272,,,,,,17.57,N,Y
3260756,SUT 3-0 VICRYL J327H,ORS,A,272,,,,,,0.00,N,Y
3260757,SUT 4-0 MONOCRYL MCP494G,ORS,A,272,,,,,,0.00,N,Y
3260759,SUT 2-0 VICRYL ETVCP328H,ORS,A,272,,,,,,0.00,N,Y
3260760,ATLAS HANDSWITCHING 10MM,ORS,A,272,,,,,,637.50,N,Y
3260761,SEALER DIVIDER 5MM,ORS,A,272,,,,,,703.11,N,Y
3260762,PATCH HERNIA KUGEL ROUND,ORS,A,272,,,,,,305.25,N,Y
3260763,MESH COMPOSIX L/P 4X5,ORS,A,278,,,,,,840.75,N,Y
3260764,MESH COMPOSIX L/P 4X6,ORS,A,278,,,,,,771.00,N,Y
3260765,MESH COMPOSIX L/P 6X8,ORS,A,278,,,,,,"1,023.75",N,Y
3260766,MESH COMPOSIX L/P 7X9,ORS,A,278,,,,,,"1,356.25",N,Y
3260767,MESH COMPOSIX L/P 8X10,ORS,A,278,,,,,,"1,858.50",N,Y
3260768,PATCH HERNIA VENTRALEX SM,ORS,A,278,,,,,,590.85,N,Y
3260769,PATCH HERNIA VENTRALEX M,ORS,A,272,,,,,,626.25,N,Y
3260770,PATCH KUGEL MOD OVAL SM,ORS,A,272,,,,,,296.87,N,Y
3260771,PATCH KUGEL MOD OVAL M,ORS,A,278,,,,,,486.00,N,Y
3260772,PERMASORB LAP 12-SHOT,ORS,A,272,,,,,,422.50,N,Y
3260773,PATCH COMP KUGEL OVAL SM,ORS,A,272,,,,,,706.25,N,Y
3260774,PATCH HERNIA VENTRALEX L,ORS,A,278,,,,,,870.00,N,Y
3260775,PATCH COMP KUGEL OVAL XL,ORS,A,272,,,,,,"1,790.00",N,Y
3260776,IMPLANT COLLAMEND 8X10,ORS,A,272,,,,,,"5,196.50",N,Y
3260777,ROTH NET RETRIEVER,ORS,A,272,,,,,,195.00,N,Y
3260778,TIP ENDOPATH DILATING 5MM,ORS,A,272,,,,,,109.05,N,Y
3260779,SUT 0 VICRYL VCP603H,ORS,A,272,,,,,,8.44,N,Y
3260780,SUT 0 VICRYL VCP418H,ORS,A,272,,,,,,8.00,N,Y
3260781,SUT 0 ETHIBOND CX27D,ORS,A,272,,,,,,29.60,N,Y
3260782,SUT 2-0 VICRYL VCP317H,ORS,A,272,,,,,,8.00,N,Y
3260783,SUT 4-0 MONOCRYL MCP496G,ORS,A,272,,,,,,15.81,N,Y
3260784,SUT 3-0 VICRYL VCP338H,ORS,A,272,,,,,,8.00,N,Y
3260785,SUT 0 VIRCYL D9681,ORS,A,272,,,,,,66.00,N,Y
3260786,SUT 0 VICRYL VCP340H,ORS,A,272,,,,,,8.00,N,Y
3260787,MESH PERFIX PLUG XL,ORS,A,272,,,,,,382.00,N,Y
3260788,SPATULA CURVED,ORS,A,272,,,,,,118.44,N,Y
3260789,NEEDLE PNEUMOPERITONEUM,ORS,A,272,,,,,,127.85,N,Y
3260790,CATHETER CHOLANGIOGRAPHY,ORS,A,272,,,,,,96.00,N,Y
3260792,STAPLER W/STAPLES 55-4.8,ORS,A,272,,,,,,833.73,N,Y
3260793,STAPLER GIA UNIVERSIAL,ORS,A,272,,,,,,519.60,N,Y
3260794,RELOAD STAPLER 30 - 3.5,ORS,A,272,,,,,,442.74,N,Y
3260795,MESH 3D MAX L-M,ORS,A,272,,,,,,320.00,N,Y
3260796,MESH 3D MAX R-M,ORS,A,272,,,,,,320.00,N,Y
3260797,DISSECTOR BALLOON,ORS,A,272,,,,,,760.77,N,Y
3260798,TROCAR 5MM SHORT,ORS,A,272,,,,,,241.32,N,Y
3260799,PROTACK 5MM SINGLE USE,ORS,A,272,,,,,,697.67,N,Y
3260800,KIT BLAKE DRAIN,ORS,A,272,,,,,,157.63,N,Y
3260801,TROCAR DILATING 5MM SHORT,ORS,A,272,,,,,,132.70,N,Y
3260802,TROCAR DILATING 5MM,ORS,A,272,,,,,,132.70,N,Y
3260803,TROCAR BLADELESS 5MM,ORS,A,272,,,,,,246.50,N,Y
3260804,TROCAR BLUNT 12MM,ORS,A,272,,,,,,147.00,N,Y
3260805,ENDOCLIP APPLIER 5MM,ORS,A,272,,,,,,231.75,N,Y
3260806,NEEDLE INJECTION LOWER,ORS,A,272,,,,,,92.07,N,Y
3260807,ABSORBATACK 5MM,ORS,A,272,,,,,,943.43,N,Y
3260808,PARIETEX LEFT,ORS,A,272,,,,,,310.00,N,Y
3260809,PARIETEX RIGHT,ORS,A,272,,,,,,310.00,N,Y
3260810,TRAY PICC 4FR GROSHONG,ORS,A,272,,,,,,220.02,N,Y
3260811,SPONGE ULTRAFOAM,ORS,A,272,,,,,,30.76,N,Y
3260813,STRYKFLOW SUCTION/IRR,ORS,A,272,,,,,,208.14,N,Y
3260814,PADDLE RETRACT ENDO 12MM,ORS,A,272,,,,,,591.22,N,Y
3260815,CUTTER LINEAR FLEX 45MM,ORS,A,272,,,,,,276.21,N,Y
3260816,SCISSORS ENDOPATH 5MM,ORS,A,272,,,,,,189.00,N,Y
3260817,SUT 3-0 SILK K832H,ORS,A,272,,,,,,7.79,N,Y
3260818,SUT 2-0 PROLENE 8833H,ORS,A,272,,,,,,8.53,N,Y
3260819,SUT 4-0 VICRYL ETVCP496G,ORS,A,272,,,,,,16.25,N,Y
3260820,SUT 3-0 PROLENE 8684G,ORS,A,272,,,,,,9.03,N,Y
3260821,ENDOPATH PROBE PLUS,ORS,A,272,,,,,,101.10,N,Y
3260822,ENDOPATH PROBE HANDLE,ORS,A,272,,,,,,161.12,N,Y
3260823,SUT VICRYL 7-0 J488G,ORS,A,272,,,,,,10.13,N,Y
3260824,SUT VICRYL 6-0 J489G,ORS,A,272,,,,,,9.95,N,Y
3260825,SUT ETHILON 70- 1647G,ORS,A,272,,,,,,9.70,N,Y
3260826,SUT ETHILON 6-0 G696G,ORS,A,272,,,,,,9.56,N,Y
3260827,SUT 5-0 SURGIPRO SP5698G,ORS,A,272,,,,,,27.05,N,Y
3260828,SUT 2-0 VICRYL ETVCP286G,ORS,A,272,,,,,,8.22,N,Y
3260829,SUT 3-0 ETHILON 1669H,ORS,A,272,,,,,,7.50,N,Y
3260830,LIGACLIP 10MM,ORS,A,272,,,,,,200.86,N,Y
3260831,NEEDLE PNEUMOPERITONEUM,ORS,A,272,,,,,,58.48,N,Y
3260832,SURGICEL 2X3 ABS HEMOSTAT,ORS,A,272,,,,,,137.88,N,Y
3260833,DISSECTOR KITTNER BLUNT,ORS,A,272,,,,,,34.82,N,Y
3260834,SUT 0 SILK,ORS,A,272,,,,,,47.09,N,Y
3260835,SUT 3-0 PROLENE 8632G,ORS,A,272,,,,,,17.64,N,Y
3260836,LIGASURE ADVANCE 5MM,ORS,A,272,,,,,,"1,419.07",N,Y
3260837,CUTTER LINEAR 45-2.5,ORS,A,272,,,,,,313.49,N,Y
3260838,CUTTER & RELOAD 30-3.5,ORS,A,272,,,,,,434.83,N,Y
3260839,STAPLER PROX ACCESS 55MM,ORS,A,272,,,,,,319.84,N,Y
3260840,RELOAD PROX CUTTER,ORS,A,272,,,,,,142.92,N,Y
3260841,CUTTER LINEAR PROX 55MM,ORS,A,272,,,,,,222.22,N,Y
3260842,GELPORT SYSTEM,ORS,A,272,,,,,,"1,695.00",N,Y
3260843,RELOAD BLUE ETS35,ORS,A,272,,,,,,217.06,N,Y
3260844,TIP ENDOCUT SCISSORS,ORS,A,272,,,,,,125.55,N,Y
3260845,TRAY CHOLECYSTECTOMY,ORS,A,272,,,,,,388.53,N,Y
3260846,SUT 3-0 PDS II Z497G,ORS,A,272,,,,,,17.32,N,Y
3260847,SUT 4-0 ETHILON 699H,ORS,A,272,,,,,,15.14,N,Y
3260848,SUT 5-0 PROLENE 8605G,ORS,A,272,,,,,,17.11,N,Y
3260849,SUT 6-0 PROLENE 8697G,ORS,A,272,,,,,,17.22,N,Y
3260850,SUT 5-0 ETHILON 698H,ORS,A,272,,,,,,14.84,N,Y
3260851,SUT 6-0 ETHILON 689G,ORS,A,272,,,,,,16.41,N,Y
3260852,PROTECTOR CORNEAL MED,ORS,A,272,,,,,,70.00,N,Y
3260853,PROTECTOR CORNEAL LRG,ORS,A,272,,,,,,70.00,N,Y
3260854,ELECTRODE NEEDLE COATED,ORS,A,272,,,,,,31.81,N,Y
3260855,TROCAR DEXIDE 2PK,ORS,A,272,,,,,,175.82,N,Y
3260857,TROCAR 5MM BLADELESS VERS,ORS,A,272,,,,,,205.42,N,Y
3260858,CATH CENTRAL VENOUS 7FR,ORS,A,272,,,,,,234.00,N,Y
3260859,POWERPORT MRI,ORS,A,278,,,,,,765.00,N,Y
3260860,ENDOCLIP 10MM,ORS,A,272,,,,,,485.31,N,Y
3260861,MESH PERMACOL 10X15CM,ORS,A,272,,,,,,"4,725.00",N,Y
3260862,NEEDLE INSUFFLATION 14G,ORS,A,272,,,,,,122.10,N,Y
3260863,SUT 0 PROLENE C821G,ORS,A,272,,,,,,33.47,N,Y
3260864,SUT 0 PROLENE 8424H,ORS,A,272,,,,,,9.00,N,Y
3260865,RELOAD STAPLER 30-2.5MM,ORS,A,272,,,,,,538.35,N,Y
3260866,RELOAD STAPLER 45-3.5MM,ORS,A,272,,,,,,613.30,N,Y
3260867,NEEDLE REGIONAL BLOCK INS,ORS,A,272,,,,,,32.20,N,Y
3260868,SUT 3-0 VICRYL J497G,ORS,A,272,,,,,,17.01,N,Y
3260869,SUT 2-0 VICRYL J266H,ORS,A,272,,,,,,8.12,N,Y
3260870,SUT 0 VICRYL J334H,ORS,A,272,,,,,,7.67,N,Y
3260871,KIT APC 20,ORS,A,272,,,,,,487.50,N,Y
3260872,KIT APC 60,ORS,A,272,,,,,,825.00,N,Y
3260873,APPLICATOR HARVEST,ORS,A,272,,,,,,220.00,N,Y
3260874,RETRIEVER SUTURE HEWSON,ORS,A,272,,,,,,329.00,N,Y
3260875,SUT 5-0 PROLENE 8698G,ORS,A,272,,,,,,17.30,N,Y
3260876,SUT 6-0 CHROMIC 1635G,ORS,A,272,,,,,,25.00,N,Y
3260877,SCREW BONE CORTICAL,ORS,A,272,,,,,,99.00,N,Y
3260879,WIRE GUIDE 3.2X400MM,ORS,A,272,,,,,,360.00,N,Y
3260880,BIT DRILL 3-FLUTED 4.2MM,ORS,A,272,,,,,,651.00,N,Y
3260881,BIT DRILL 3-FLUTED 4.2MM,ORS,A,272,,,,,,610.50,N,Y
3260882,ROD REAMING BALL TIP 2.5,ORS,A,272,,,,,,345.00,N,Y
3260883,NAIL TIBIAL 10X345MM,ORS,A,278,,,,,,"2,346.00",N,Y
3260884,END CAP TIBIAL NAIL 0MM,ORS,A,272,,,,,,321.00,N,Y
3260885,SCREW LOCKING 5MM,ORS,A,272,,,,,,364.50,N,Y
3260886,SCREW LOCKING 5X32MM,ORS,A,278,,,,,,499.50,N,N
3260887,SCREW LOCKING 5X42MM,ORS,A,278,,,,,,499.50,N,N
3260888,SUT VICRYL 0 J267H,ORS,A,272,,,,,,25.00,N,Y
3260889,SUT 4-0 VIRCYL J496G,ORS,A,272,,,,,,49.88,N,Y
3260890,SCREW 3.5MM CORTEX SLFTAP,ORS,A,278,,,,,,126.00,N,Y
3260891,SCREW 3.5 CORTEX 12 MM,ORS,A,278,,,,,,101.25,N,Y
3260892,SCREW 3.5 CORTEX 14 MM,ORS,A,278,,,,,,117.00,N,Y
3260893,SCREW 3.5 CORTEX 16 MM,ORS,A,278,,,,,,108.75,N,Y
3260894,SCREW 3.5 CORTEX 18 MM,ORS,A,278,,,,,,108.75,N,Y
3260895,SCREW CORTEX 20 MM,ORS,A,278,,,,,,126.00,N,Y
3260907,SCREW 4.0MM CANCELLOUS FT,ORS,A,278,,,,,,98.25,N,Y
3260914,SCREW 4.0MM CANCELLOUS PT,ORS,A,278,,,,,,61.25,N,Y
3260926,SCREW 4.0MM CANNUL SHRT T,ORS,A,278,,,,,,528.00,N,Y
3260948,BLADE 3.5MM AGGRESSIVE PL,ORS,A,272,,,,,,219.72,N,Y
3260949,BLADE 4.0MM AGGRESSIVE PL,ORS,A,272,,,,,,219.72,N,Y
3260950,WASHER 7.0MM,ORS,A,272,,,,,,105.00,N,Y
3260951,PLATE LCP 3.5MM 5 HOLE 72,ORS,A,272,,,,,,486.00,N,Y
3260952,PLATE LCP 3.5MM 6 HOLE 85,ORS,A,272,,,,,,624.00,N,Y
3260953,PLATE LCP 3.5MM 8 HL 111,ORS,A,272,,,,,,682.50,N,Y
3260954,PLATE LCP 3.5MM 9 HL 124,ORS,A,272,,,,,,589.50,N,Y
3260955,PLATE LCP 3.5MM 10 HL 137,ORS,A,272,,,,,,606.00,N,Y
3260956,PLATE LCP 3.5MM 12HL 163,ORS,A,272,,,,,,670.50,N,Y
3260957,PLATE LCP 3.5MM 14 HL 189,ORS,A,272,,,,,,"1,003.50",N,Y
3260958,PLATE T LCP 3.5MM OBRT 52,ORS,A,272,,,,,,586.50,N,Y
3260959,PLATE T LCP 3.5MM OBRT 63,ORS,A,272,,,,,,615.00,N,Y
3260960,PLATE T LCP 3.5MM OBRT 74,ORS,A,272,,,,,,640.50,N,Y
3260961,PLATE T LCP 3.5MM OBRT 96,ORS,A,272,,,,,,696.00,N,Y
3260962,PLATE T LCP 3.5MM RTAN 50,ORS,A,272,,,,,,516.00,N,Y
3260963,PLATE T LCP 3.5MM RTAN 56,ORS,A,272,,,,,,537.00,N,Y
3260964,PLATE T LCP 3.5MM RTAN 67,ORS,A,272,,,,,,589.50,N,Y
3260965,PLATE T LCP 3.5MM RTAN 78,ORS,A,272,,,,,,688.50,N,Y
3260966,PLATE T LCP 3.5MM RTAN 87,ORS,A,272,,,,,,862.50,N,Y
3260967,PLATE LCP 1/3 TUB 5 HL 57,ORS,A,272,,,,,,348.00,N,Y
3260968,PLATE LCP 1/3 TUB 6 HL 69,ORS,A,272,,,,,,348.00,N,Y
3260969,PLATE LCP 1/3 TUB 7 HL 81,ORS,A,278,,,,,,400.50,N,Y
3260970,PLATE LCP 1/3 TUB 8 HL 93,ORS,A,278,,,,,,430.50,N,Y
3260971,PLATE LCP 1/3TUB 10HL 117,ORS,A,272,,,,,,463.50,N,Y
3260972,PLATE LCP 1/3TUB 12HL 141,ORS,A,272,,,,,,310.50,N,Y
3260973,PLATE LCP PROXHUM 3.5 90,ORS,A,272,,,,,,"3,361.50",N,Y
3260974,PLATE LCP PROXHUM 3.5 114,ORS,A,272,,,,,,"2,545.50",N,Y
3260975,PLATE T LCP 3.5MM OBLT 52,ORS,A,272,,,,,,586.50,N,Y
3260976,PLATE T LCP 3.5MM OBLT 63,ORS,A,272,,,,,,615.00,N,Y
3260977,PLATE T LCP 3.5MM OBLT 74,ORS,A,272,,,,,,640.50,N,Y
3260978,PLATE T LCP 3.5MM OBLT 96,ORS,A,272,,,,,,696.00,N,Y
3260979,PLATE RECON 3.5 5 HL 70,ORS,A,272,,,,,,715.50,N,Y
3260980,PLATE RECON 3.5 6 HL 84,ORS,A,272,,,,,,828.00,N,Y
3260981,PLATE RECON 3.5 7 HL 98,ORS,A,272,,,,,,870.00,N,Y
3260982,PLATE RECON 3.5 8 HL 112,ORS,A,272,,,,,,907.50,N,Y
3260983,PLATE RECON 3.5 10 HL 140,ORS,A,272,,,,,,937.50,N,Y
3260984,PLATE RECON 3.5 12 HL 168,ORS,A,272,,,,,,"1,018.50",N,Y
3260985,WIRE KIRSCHNER 1.25 150MM,ORS,A,272,,,,,,54.25,N,Y
3260986,WIRE KIRSCHNER 2.0 150MM,ORS,A,272,,,,,,54.25,N,Y
3260987,WIRE KIRSCHNER 1.6 150MM,ORS,A,272,,,,,,80.15,N,Y
3260988,WIRE GUIDE 1.25 THRD 150,ORS,A,272,,,,,,144.75,N,Y
3260989,SCREW 2.7MM CORTEX SLFTAP,ORS,A,278,,,,,,175.00,N,Y
3260995,SCREW 2.7 CORTEX 22 MM,ORS,A,272,,,,,,140.25,N,Y
3261025,SCREW 3.5MM LOCK SLFTAP,ORS,A,278,,,,,,321.00,N,Y
3261063,"WIRE GUIDE 3.2MMX38""",ORS,A,272,,,,,,318.00,N,Y
3261064,NAIL TROCHANTERIC LONG LT,ORS,A,278,,,,,,"3,148.50",N,Y
3261065,SCREW LAG 105MMX10.5MM,ORS,A,272,,,,,,811.50,N,Y
3261066,WIRE GUIDE BALL NOSE 3MM,ORS,A,272,,,,,,358.00,N,Y
3261067,SCREW ANTI-ROTATION 95X5,ORS,A,272,,,,,,397.50,N,Y
3261068,PIN GUIDE 3.2MM,ORS,A,272,,,,,,318.00,N,Y
3261069,PIN GUIDE 2.5MM,ORS,A,272,,,,,,318.00,N,Y
3261070,SUT 2 ORTHOCORD,ORS,A,272,,,,,,79.31,N,Y
3261071,ANCHOR GII QA+,ORS,A,278,,,,,,700.50,N,Y
3261072,ELECTRODE PREMIERE90 VAPR,ORS,A,272,,,,,,412.50,N,Y
3261073,ELECTRODE PREMIERE50 VAPR,ORS,A,272,,,,,,429.00,N,Y
3261074,NEEDLE SUT PASSER EXPRESS,ORS,A,272,,,,,,177.15,N,Y
3261075,STEM CORAIL STD,ORS,A,278,,,,,,"4,050.00",N,Y
3261076,SECTOR PINNACLE,ORS,A,278,,,,,,"2,025.00",N,Y
3261077,LINER ALTRX PINNACLE 54,ORS,A,272,,,,,,"2,980.50",N,Y
3261078,HEAD FEMORAL ARTICULEZE,ORS,A,278,,,,,,750.00,N,Y
3261079,SCREW 6.5MM CANCELLOUS,ORS,A,278,,,,,,150.00,N,Y
3261080,BLADE SAW STABLECUT 21MM,ORS,A,272,,,,,,394.00,N,Y
3261081,BLADE SAW STABLECUT 13MM,ORS,A,272,,,,,,307.50,N,Y
3261082,BIT DRILL 2.0MM FAST,ORS,A,272,,,,,,252.00,N,Y
3261083,NAIL FIXATION 11X360MM,ORS,A,278,,,,,,"2,860.50",N,Y
3261084,BLADE HELICAL 11X95MM,ORS,A,272,,,,,,"1,231.50",N,Y
3261085,WIRE GUIDE 3.2X400MM,ORS,A,272,,,,,,202.00,N,Y
3261086,SUT 1 ETHIBOND X538H,ORS,A,272,,,,,,9.00,N,Y
3261087,CEMENT BONE 40G,ORS,A,272,,,,,,304.00,N,Y
3261088,BOWL SMART MIX,ORS,A,272,,,,,,240.00,N,Y
3261089,TRAY MBT TIBIAL SZ 2,ORS,A,278,,,,,,"5,165.60",N,Y
3261090,FEMUR C/R POROCOAT SZ 2,ORS,A,278,,,,,,"7,241.30",N,Y
3261091,INSERT CVD RP 2X12.5,ORS,A,278,,,,,,"3,127.50",N,Y
3261092,SECTOR PINNACLE 50 MM,ORS,A,278,,,,,,"1,725.00",N,Y
3261094,HEAD FEMORAL ARTICULEZ 32,ORS,A,278,,,,,,750.00,N,N
3261095,STEM CORAIL STD SZ 11,ORS,A,278,,,,,,"3,750.00",N,Y
3261096,QUICK CLIP 2,ORS,A,272,,,,,,195.00,N,Y
3261097,CANNULA 8.5X75 THREADED,ORS,A,272,,,,,,83.40,N,Y
3261098,SHUTTLE SUTURE 45 RT,ORS,A,272,,,,,,420.00,N,Y
3261099,ANCHOR LUPINE BR W/ORTHOC,ORS,A,278,,,,,,651.00,N,Y
3261100,PERCPASSER CHIA,ORS,A,272,,,,,,334.00,N,Y
3261101,GRASPER SUTURE 60,ORS,A,272,,,,,,367.50,N,Y
3261102,SHEAR HS FOCUS 17CM,ORS,A,272,,,,,,870.00,N,Y
3261103,SEALER 6.0 BIPOLAR AQUAM,ORS,A,272,,,,,,817.50,N,Y
3261104,FEMUR PS CEMENTED SZ 5 RT,ORS,A,278,,,,,,"5,644.10",N,Y
3261105,TRAY MBT TIBIAL SZ 4,ORS,A,278,,,,,,"5,165.60",N,Y
3261106,INSERT TIBIAL SZ 5,ORS,A,278,,,,,,"3,885.00",N,Y
3261107,PATELLA OVAL DOME 35MM,ORS,A,278,,,,,,544.50,N,Y
3261108,BLADE PATELLA PLANAR,ORS,A,272,,,,,,245.26,N,Y
3261110,SHELL ACETABULAR SZ 54,ORS,A,278,,,,,,"3,916.00",N,Y
3261111,LINER ALTRX PINNACLE 54,ORS,A,278,,,,,,"1,050.00",N,Y
3261112,HEAD ARTICULEZE CERAM 36,ORS,A,278,,,,,,"1,312.50",N,Y
3261113,STAPLER GIA100 3.8,ORS,A,272,,,,,,954.84,N,Y
3261114,RELOAD STAPLER GIA 60 3.8,ORS,A,272,,,,,,343.92,N,Y
3261115,RELOAD STAPLER GIA100 3.8,ORS,A,272,,,,,,485.59,N,Y
3261116,KIT ACL,ORS,A,272,,,,,,859.50,N,Y
3261117,OMNISPAN 0 DEGREE,ORS,A,272,,,,,,448.50,N,Y
3261118,OMNISPAN 12 DEGREE,ORS,A,278,,,,,,601.50,N,Y
3261119,KIT RIGIDFIX BR CROSS PIN,ORS,A,272,,,,,,615.00,N,Y
3261120,GUN MENISCAL DEPLOYMENT,ORS,A,272,,,,,,430.50,N,Y
3261121,SHEATH BIOINTRAFIX SM,ORS,A,272,,,,,,516.00,N,Y
3261122,SCREW BIOINTRAFIX 6-8X30,ORS,A,272,,,,,,486.00,N,Y
3261123,PROBE SUCTION 3.5MM,ORS,A,272,,,,,,329.62,N,Y
3261124,PROBE HOOK 3.5MM,ORS,A,272,,,,,,314.46,N,Y
3261125,RESECTOR 5.5,ORS,A,272,,,,,,219.72,N,Y
3261126,PATELLA OVAL 32MM,ORS,A,278,,,,,,544.50,N,Y
3261127,FEMORAL COMP LT SZ 4,ORS,A,278,,,,,,"8,478.80",N,Y
3261128,INSERT CVD RP 10MM SZ 4,ORS,A,278,,,,,,"3,696.00",N,Y
3261130,SUT 2 ORTHOCORD,ORS,A,272,,,,,,97.25,N,Y
3261131,SUT 2 ORTHOCORD,ORS,A,272,,,,,,87.00,N,Y
3261132,ANCHOR VERSALOK PEEK,ORS,A,272,,,,,,595.50,N,Y
3261133,ANCHOR VERSALOK,ORS,A,278,,,,,,693.00,N,Y
3261134,CANNULA THREADED CLEAR,ORS,A,272,,,,,,123.00,N,Y
3261135,TRAY MBT TIBIAL SZ 3,ORS,A,278,,,,,,"2,025.00",N,Y
3261136,INSERT CVD RP SZ 3,ORS,A,278,,,,,,"3,315.15",N,Y
3261137,FEMUR C/R POROCOAT SZ 3,ORS,A,278,,,,,,"8,478.80",N,Y
3261138,PATELLA OVAL 38MM,ORS,A,278,,,,,,544.50,N,Y
3261139,ANCHOR HEALIX BR W/ORTHOC,ORS,A,278,,,,,,609.00,N,Y
3261140,KIT COR DISPOSABLE 6MM,ORS,A,278,,,,,,"1,279.50",N,Y
3261141,KIT COR DISPOSABLE 8MM,ORS,A,278,,,,,,"1,464.00",N,Y
3261142,KIT COR DISPOSABLE 10MM,ORS,A,278,,,,,,"1,279.50",N,Y
3261143,ANCHOR HEALIX TI W/ORTHOC,ORS,A,272,,,,,,517.50,N,Y
3261144,BLADE PATELLA PLANER,ORS,A,272,,,,,,245.26,N,Y
3261145,INSERT CVD RP 5X12.5MM,ORS,A,278,,,,,,"3,696.00",N,Y
3261146,TRAY MBT TIBIAL SZ 5,ORS,A,278,,,,,,"2,025.00",N,Y
3261147,FEMUR C/R POROCOAT SZ 5,ORS,A,278,,,,,,"8,478.80",N,Y
3261148,BIT DRILL 2.7MM CANNULATE,ORS,A,278,,,,,,"1,156.50",N,Y
3261149,DRESSING 6X6 AQUA HYDRO,ORS,A,272,,,,,,26.52,N,Y
3261150,SET CONVERSION PICC SELD,ORS,A,272,,,,,,97.02,N,Y
3261151,SCREW 6.5MM CANNUL 32MM T,ORS,A,278,,,,,,468.00,N,Y
3261152,SCREW 7.3MM CANNUL 32MM T,ORS,A,272,,,,,,468.00,N,Y
3261153,WIRE GUIDE 2.8MM TROCAR P,ORS,A,272,,,,,,200.00,N,Y
3261154,WASHER 13.0MM,ORS,A,272,,,,,,144.00,N,Y
3261155,ANCHOR HEALIX TI W/ORTHOC,ORS,A,272,,,,,,517.50,N,Y
3261156,SCREW 6.5MM CANNUL 16MM T,ORS,A,278,,,,,,559.50,N,Y
3261157,SCREW 6.5MM CANNUL 16MM THRD 105MM,ORS,A,278,,,,,,559.50,N,N
3261158,SPONGE GELFOAM,ORS,A,272,,,,,,40.25,N,Y
3261159,SUT 3-0 PLAIN N862H,ORS,A,272,,,,,,9.98,N,Y
3261160,BLADE PATELLA PLANER,ORS,A,272,,,,,,362.00,N,Y
3261161,TRAY MBT TIBIAL SZ 2.5,ORS,A,278,,,,,,"5,424.10",N,Y
3261162,FEMUR C/R POROCOAT 2.5,ORS,A,278,,,,,,"8,478.80",N,Y
3261163,INSERT CVD RP 2.5,ORS,A,278,,,,,,"3,696.00",N,Y
3261164,BIT DRILL 2.5MM QC GOLD,ORS,A,278,,,,,,252.00,N,Y
3261165,FEMUR C/R POROCOAT 4,ORS,A,278,,,,,,"3,300.00",N,Y
3261166,BIT DRILL 2.5MM QC GOLD,ORS,A,272,,,,,,248.00,N,Y
3261167,BIT DRILL 3.5MM QC,ORS,A,272,,,,,,246.25,N,Y
3261168,BLADE 7MM X 20MM X .38MM,ORS,A,272,,,,,,147.40,N,Y
3261169,PLATE 3 HOLE 135 DEGREE,ORS,A,278,,,,,,858.00,N,Y
3261170,SCREW BONE CORTICAL 38MM,ORS,A,272,,,,,,139.92,N,Y
3261171,SCREW BONE CORTICAL 40MM,ORS,A,272,,,,,,139.92,N,Y
3261172,SCREW LAG KEYLESS 95MM,ORS,A,272,,,,,,523.11,N,Y
3261173,"DRILL 7"" SOLID TWIST 3.8",ORS,A,272,,,,,,238.00,N,Y
3261174,ASSEMBLY BUTTON SPRING,ORS,A,272,,,,,,288.00,N,Y
3261175,"PIN GUIDE 9"" THREAD 3.2MM",ORS,A,272,,,,,,108.00,N,Y
3261176,SCREW COMPRESSION SHORT,ORS,A,278,,,,,,150.00,N,Y
3261177,NEEDLE SUT EXPRESSEW III,ORS,A,272,,,,,,366.00,N,Y
3261179,STEM CEMENTED FEMORAL SZ3,ORS,A,278,,,,,,"1,200.00",N,Y
3261180,HEAD BIPOLAR SZ 46,ORS,A,278,,,,,,525.00,N,Y
3261181,HEAD FEMORAL ARTICULEZ 28,ORS,A,278,,,,,,637.50,N,Y
3261182,CENTRALIZER STEM 10MM,ORS,A,278,,,,,,150.00,N,Y
3261183,KIT PREP W/RESTRICTORS,ORS,A,272,,,,,,408.45,N,Y
3261184,REAMER INSET PATELLA 28MM,ORS,A,272,,,,,,320.00,N,Y
3261185,FEMUR PS CEMENTED SZ 3 RT,ORS,A,278,,,,,,"5,644.10",N,Y
3261186,INSERT TIBIAL SZ 3,ORS,A,278,,,,,,"1,500.00",N,Y
3261187,PATELLA INSET 28MM,ORS,A,278,,,,,,"1,669.50",N,Y
3261188,PLATE 3 HOLE 130 DEGREE,ORS,A,272,,,,,,858.00,N,Y
3261189,SCREW BONE CORTICAL 42MM,ORS,A,278,,,,,,147.00,N,Y
3261190,SCREW BONE CORTICAL 48MM,ORS,A,272,,,,,,139.92,N,Y
3261191,SCREW LAG KEYLESS 105MM,ORS,A,272,,,,,,520.11,N,Y
3261192,FEMUR C/R POROCOAT SZ4,ORS,A,278,,,,,,"8,478.80",N,Y
3261193,LOOP VESSEL MAXI WHITE,ORS,A,272,,,,,,11.31,N,Y
3261194,ABSORBATACK,ORS,A,272,,,,,,925.46,N,Y
3261196,SUT 4-0 MONO Y496G,ORS,A,272,,,,,,20.09,N,Y
3261197,FEMUR C/R POROCOAT SZ 3 L,ORS,A,278,,,,,,"3,300.00",N,Y
3261198,STEM CEMENTED FEMORAL SZ6,ORS,A,278,,,,,,"1,200.00",N,Y
3261199,HEAD BIPOLAR SZ 54,ORS,A,278,,,,,,525.00,N,Y
3261200,CENTRALIZER STEM 13MM,ORS,A,278,,,,,,120.00,N,Y
3261201,STAPLER EEA 31MM 4.8MM,ORS,A,272,,,,,,"1,354.19",N,Y
3261202,STAPLER EEA 28MM 3.5MM,ORS,A,272,,,,,,"1,443.53",N,Y
3261203,STAPLER EEA 25MM 3.5MM,ORS,A,272,,,,,,"1,443.53",N,Y
3261204,STAPLER TA60 3.5MM,ORS,A,272,,,,,,438.03,N,Y
3261205,RELOAD TA60 3.5MM,ORS,A,272,,,,,,286.58,N,Y
3261206,STAPLER GIA80 3.8MM,ORS,A,272,,,,,,716.84,N,Y
3261207,RELOAD GIA80 3.8MM,ORS,A,272,,,,,,372.08,N,Y
3261208,SUT 3-0 SILK C013D,ORS,A,272,,,,,,27.85,N,Y
3261209,SUT 2-0 PROLENE 8623H,ORS,A,272,,,,,,9.34,N,Y
3261210,STEM CEMENTED FEMORAL SZ4,ORS,A,278,,,,,,"1,200.00",N,Y
3261211,CENTRALIZER STEM 9.25MM,ORS,A,278,,,,,,150.00,N,Y
3261212,HEAD BIPOLAR SZ 48,ORS,A,278,,,,,,525.00,N,Y
3261213,GRAFT PATELLA BONE TENDON,ORS,A,278,,,,,,"3,960.00",N,Y
3261214,BURR 4MM ROUND,ORS,A,272,,,,,,138.60,N,Y
3261215,KIT PIN BTB CROSS,ORS,A,272,,,,,,577.50,N,Y
3261216,SCREW MILAGRO 8X23MM,ORS,A,272,,,,,,562.50,N,Y
3261217,HEAD BIPOLAR SZ 43,ORS,A,278,,,,,,"1,896.96",N,Y
3261218,HEAD FEMORAL ARTICULEZ 28,ORS,A,278,,,,,,637.50,N,Y
3261219,FEMUR C/R POROCOAT 4,ORS,A,278,,,,,,"3,300.00",N,Y
3261220,APLIGRAF,ORS,A,278,,,,,,"2,271.00",N,Y
3261221,BLADE SAGITTAL DUAL CUT,ORS,A,272,,,,,,206.80,N,Y
3261222,DRILL BIT THREEFLUTED 4MM,ORS,A,272,,,,,,334.50,N,Y
3261223,SCREW LOCKING 5 MM TI,ORS,A,272,,,,,,387.00,N,Y
3261224,BLADE HELICAL 11X100MM,ORS,A,278,,,,,,"1,231.50",N,Y
3261225,NAIL FIXATION 11X360MM,ORS,A,278,,,,,,"3,058.50",N,Y
3261226,LIGASURE 5MM LAPROSCOPIC,ORS,A,272,,,,,,810.00,N,Y
3261227,PATELLA 41 OVAL,ORS,A,278,,,,,,"1,836.00",N,Y
3261228,PLATFORM INSERT ROT 510MM,ORS,A,278,,,,,,"3,696.00",N,Y
3261229,PLATE CLAVICLE LT 7 HOLE,ORS,A,278,,,,,,"1,614.00",N,Y
3261230,PLATE LEFT RADIUS,ORS,A,278,,,,,,"1,416.69",N,Y
3261231,PEG FL THREAD 2.5 X 24 MM,ORS,A,272,,,,,,203.52,N,Y
3261232,PEG THREAD 2.5 X 24 MM,ORS,A,272,,,,,,203.52,N,Y
3261233,PEG THREAD 2.5 X 22 MM,ORS,A,272,,,,,,203.52,N,Y
3261234,SCREW CORICAL 3.5 X 14 MM,ORS,A,272,,,,,,203.52,N,Y
3261235,SCREW CORICAL 3.5 X 13 MM,ORS,A,272,,,,,,203.52,N,Y
3261236,WIRE .062 K,ORS,A,272,,,,,,81.62,N,Y
3261237,TIPS 2.0 DRIVER,ORS,A,272,,,,,,136.74,N,Y
3261238,BIT DRILL 2.5 MM,ORS,A,272,,,,,,224.72,N,Y
3261239,BIT DRILL 2.0 MM QCK CPL,ORS,A,272,,,,,,284.00,N,Y
3261240,BIT DRILL 2.7 MM QC,ORS,A,278,,,,,,376.00,N,Y
3261241,"SUT 0 PDS II 36"" Z359T",ORS,A,272,,,,,,10.53,N,Y
3261242,PLATE CLAVICLE LF 7 HOLE,ORS,A,278,,,,,,"1,573.50",N,Y
3261243,SCREW LOCKING 10 MM,ORS,A,272,,,,,,272.00,N,Y
3261244,SCREW LOCKING 12 MM,ORS,A,272,,,,,,272.00,N,Y
3261245,SCREW LOCKING 14 MM,ORS,A,272,,,,,,272.00,N,Y
3261246,SCREW LOCKING 16 MM,ORS,A,272,,,,,,272.00,N,Y
3261247,SCREW CORTEX SELFTAP 12MM,ORS,A,278,,,,,,124.50,N,Y
3261248,BIT DRILL QK CPL 1.5 MM,ORS,A,272,,,,,,216.25,N,Y
3261249,BIT DRILL QC 2.0 MM,ORS,A,272,,,,,,270.00,N,Y
3261250,"NEEDLE RETROBULBAR 1 1/2""",ORS,A,272,,,,,,8.40,N,Y
3261251,VAPR COOL PULSE 90 W/HAND,ORS,A,272,,,,,,564.00,N,Y
3261252,CANNULA THREADED CLR 5.5,ORS,A,272,,,,,,123.00,N,Y
3261253,SUT 3-0 VICRYL J344H,ORS,A,272,,,,,,7.35,N,Y
3261254,SUT 2-0 VICRYL J345H,ORS,A,272,,,,,,7.25,N,Y
3261255,SUT 0 VICRYL J346H,ORS,A,272,,,,,,7.25,N,Y
3261256,SUT 2-0 CHROMIC 923H,ORS,A,272,,,,,,10.75,N,Y
3261257,STEM UNIV FLUTED 75X16 MM,ORS,A,278,,,,,,"3,840.00",N,Y
3261258,BOLT FEMORAL ADAPTER,ORS,A,272,,,,,,750.00,N,Y
3261259,ADAPTER FEMORAL,ORS,A,278,,,,,,"3,922.60",N,Y
3261260,TIBIAL TRAY ROTATING CEM,ORS,A,278,,,,,,"7,506.58",N,Y
3261261,FEMUR PS CEMENTED SZ 2.5,ORS,A,278,,,,,,"5,364.77",N,Y
3261262,SLEEVE UNIV FEMORAL FULL,ORS,A,278,,,,,,"4,733.34",N,Y
3261263,INSERT TIBIAL ROTATING,ORS,A,278,,,,,,"3,658.59",N,Y
3261264,CEMENT BONE GENTAMICIN40G,ORS,A,272,,,,,,334.20,N,Y
3261265,MESH ABBREVO,ORS,A,272,,,,,,"2,169.75",N,Y
3261266,SCREW 6.5 X 20 MM,ORS,A,272,,,,,,354.78,N,Y
3261267,ALTRXLINER 32 X 50 MM,ORS,A,278,,,,,,"3,490.05",N,Y
3261268,HEAD CERAMIC 32 MM,ORS,A,278,,,,,,"4,318.44",N,Y
3261269,PIN GUIDE THREADED 3.2MM,ORS,A,272,,,,,,358.00,N,Y
3261270,NAIL HIP FRACTURE 11X360,ORS,A,278,,,,,,"4,374.00",N,Y
3261271,SCREW LAG HIP 10.5X95MM,ORS,A,278,,,,,,"1,215.00",N,Y
3261272,BIT DRILL 4.3MM,ORS,A,272,,,,,,400.00,N,Y
3261273,SCREW CORTICAL 5.0X38MM,ORS,A,278,,,,,,348.00,N,Y
3261274,KIT RIGIDFIX ST FEMORAL,ORS,A,278,,,,,,729.00,N,Y
3261275,SHEATH TIB BIOINTRAFIX LG,ORS,A,278,,,,,,516.00,N,Y
3261276,SCREW TAPERED 8-10X30MM,ORS,A,278,,,,,,415.50,N,Y
3261277,FEMUR PS CEMENTED SZ 5 LT,ORS,A,278,,,,,,"5,644.10",N,Y
3261278,SCREW LAG KEYLESS 80MM,ORS,A,278,,,,,,555.00,N,Y
3261279,SCREW BONE CORTICAL 36MM,ORS,A,278,,,,,,147.00,N,Y
3261280,SUT 2-0 PROLENE 8685H,ORS,A,272,,,,,,5.58,N,Y
3261281,SUT 3-0 PROLENE 8422H,ORS,A,272,,,,,,6.88,N,Y
3261282,TRUMATCH RESECTION GUIDE,ORS,A,272,,,,,,"2,400.00",N,Y
3261283,INTERCEED GYNECARE,ORS,A,272,,,,,,417.93,N,Y
3261284,SUPRALOOP BRUCKER/MESSROG,ORS,A,272,,,,,,331.24,N,Y
3261285,CABLE CAUTERY MONO DISP,ORS,A,272,,,,,,78.68,N,Y
3261286,CANNULA THREAD CL 5.5X90,ORS,A,272,,,,,,87.00,N,Y
3261287,SUT SHUTTLE IDEAL 45 LEFT,ORS,A,272,,,,,,301.50,N,Y
3261288,STEM CORAIL STD SZ 14,ORS,A,278,,,,,,"4,050.00",N,N
3261289,HANDPIECE MORCELLEX,ORS,A,272,,,,,,"1,093.50",N,Y
3261290,FEMUR POROCOAT SZ 5 L,ORS,A,278,,,,,,"3,300.00",N,Y
3261291,FEMUR C/R CEMENTED SZ 2.5,ORS,A,278,,,,,,"5,243.70",N,Y
3261292,TIP CONTROL FENESTRATED,ORS,A,272,,,,,,151.13,N,Y
3261293,DRAIN JP FLAT 10MM 100CC,ORS,A,272,,,,,,31.64,N,Y
3261294,DRAIN JP ROUND 7FR 400ML,ORS,A,272,,,,,,29.26,N,Y
3261295,DRAIN JP ROUND 7FR,ORS,A,272,,,,,,15.50,N,Y
3261296,DERMACARRIER II 3:1,ORS,A,272,,,,,,79.65,N,Y
3261297,BLADE DERMATOME,ORS,A,272,,,,,,115.50,N,Y
3261298,DERMACARRIER II 1.5:1,ORS,A,272,,,,,,79.65,N,Y
3261299,INSERT CVD RP AOX SZ 6,ORS,A,278,,,,,,"3,850.00",N,Y
3261300,FEMUR C/R POROCOAT SZ 6,ORS,A,278,,,,,,"8,075.10",N,Y
3261301,TRAY MBT TIBIAL SZ 6,ORS,A,278,,,,,,"5,165.60",N,Y
3261302,INSERT CVD RP AOX SZ 3,ORS,A,278,,,,,,"2,100.00",N,Y
3261303,ANCHOR HEALIX KNOTLESS BR,ORS,A,272,,,,,,735.00,N,Y
3261304,GRAFT SEMITENDINOSUS,ORS,A,278,,,,,,"3,300.00",N,Y
3261305,FORCEP BIOPSY ENDOJAW HOT,ORS,A,272,,,,,,44.88,N,Y
3261306,SPOT ENDOSCOPIC MARKER,ORS,A,272,,,,,,88.50,N,Y
3261307,HEAD FEMORAL MSPEC METAL,ORS,A,278,,,,,,637.50,N,Y
3261308,SCREW 6.5MM CANCELLOUS 35,ORS,A,278,,,,,,150.00,N,Y
3261309,STEM CORAIL STD SZ 13,ORS,A,278,,,,,,"3,750.00",N,Y
3261310,INSERT CVD RP AOX SZ 3,ORS,A,278,,,,,,"2,100.00",N,Y
3261312,STAT GVL PED SZ 0,ORS,A,272,,,,,,66.50,N,Y
3261313,STAT GVL PED SZ 1,ORS,A,272,,,,,,66.50,N,Y
3261314,STAT GVL PED SZ 2,ORS,A,272,,,,,,66.50,N,Y
3261315,STAT GVL PED SZ 2.5,ORS,A,272,,,,,,66.50,N,Y
3261316,STAT GVL ADULT SZ 3,ORS,A,272,,,,,,50.01,N,Y
3261317,STAT GVL ADULT SZ 4,ORS,A,272,,,,,,50.01,N,Y
3261318,STEM CEMENTED FEMORAL SZ3,ORS,A,278,,,,,,"5,706.80",N,Y
3261319,HEAD BIPOLAR SZ 50,ORS,A,278,,,,,,450.00,N,Y
3261320,STRIPPER VEIN DISP,ORS,A,272,,,,,,85.74,N,Y
3261321,"KIT SUCTION WOUND 1/8"" DR",ORS,A,272,,,,,,24.59,N,Y
3261322,"KIT SUCTION WOUND 3/16""",ORS,A,272,,,,,,24.59,N,Y
3261323,INSERT CVD RP AOX SZ 3,ORS,A,278,,,,,,"4,042.50",N,Y
3261324,PLATE LCP 3.5MM 6 HL 102,ORS,A,278,,,,,,"2,602.50",N,Y
3261325,SCREW 3.5MM LOCK SLFTP 65,ORS,A,278,,,,,,300.00,N,Y
3261326,SCREW 3.5MM CONICAL 65,ORS,A,278,,,,,,328.00,N,Y
3261327,GRANULES CHRONOS LRG,ORS,A,278,,,,,,"1,323.00",N,Y
3261328,BIT DRILL 2.8MM PERCUTAN,ORS,A,272,,,,,,451.50,N,Y
3261329,FORCEP CAESAR GRASPING,ORS,A,272,,,,,,310.00,N,Y
3261330,DEVICE TALON GRASPING,ORS,A,272,,,,,,272.00,N,Y
3261331,TRAP POLYP ETRAP,ORS,A,272,,,,,,18.02,N,Y
3261332,VALVE BIOPSY BIOSHIELD,ORS,A,272,,,,,,14.00,N,Y
3261333,SCREW BONE CORTICAL 26MM,ORS,A,278,,,,,,147.00,N,Y
3261334,SCREW BONE CORTICAL 30MM,ORS,A,278,,,,,,147.00,N,Y
3261335,"SURGICLIP M-11.5""",ORS,A,272,,,,,,377.66,N,Y
3261336,NAIL FIXATION 12X400MM,ORS,A,278,,,,,,"3,220.50",N,Y
3261337,BIT DRILL QC 6MM/10MM,ORS,A,272,,,,,,"1,014.00",N,Y
3261338,INSERT CVD RP AOX SZ 4,ORS,A,278,,,,,,"2,100.00",N,Y
3261339,INSERT CVD RP AOX SZ 5,ORS,A,278,,,,,,"2,100.00",N,Y
3261340,PLATE LCP 3.5MM 8HL 115,ORS,A,278,,,,,,"1,806.00",N,Y
3261341,SCREW CORTEX SELFTAP 14MM,ORS,A,278,,,,,,124.50,N,Y
3261342,BIT DRILL 2.8MM QC 165MM,ORS,A,278,,,,,,274.00,N,Y
3261343,PLUG PERFIX LIGHT MED,ORS,A,272,,,,,,331.50,N,Y
3261344,PLUG PERFIX LIGHT LRG,ORS,A,272,,,,,,344.00,N,Y
3261345,PLUG PERFIX LIGHT XL,ORS,A,272,,,,,,301.50,N,Y
3261346,ATHLETIC SUPPORTER XL,ORS,A,271,,,,,,47.60,N,Y
3261347,STRUT CORTICAL 22X80MM,ORS,A,278,,,,,,"1,200.00",N,N
3261348,STRUT CORTICAL 20X80MM,ORS,A,278,,,,,,"1,200.00",N,N
3261349,CERCLAGE CABLE 1.5MM,ORS,A,278,,,,,,619.50,N,N
3261350,RECLAIM PROX BODY 24X75,ORS,A,278,,,,,,"7,381.00",N,N
3261351,RECLAIM DIST STEM 18X190,ORS,A,278,,,,,,"6,171.00",N,N
3261352,FEMUR C/R CEMENTED SZ 3,ORS,A,278,,,,,,"2,400.00",N,N
3261353,INSERT CVD RP AOX SZ 4,ORS,A,278,,,,,,"4,042.50",N,N
3261354,HEAD BIPOLAR 28MM,ORS,A,278,,,,,,450.00,N,N
3261355,HEAD FEMORAL 28MM,ORS,A,278,,,,,,637.50,N,N
3261356,FILLER BONE VOID 20CC,ORS,A,278,,,,,,"4,500.00",N,N
3261357,ANCHOR HEALIX BR W/ORTHOC,ORS,A,278,,,,,,627.00,N,N
3261358,CATH CHOLANGIOGRAPHY 17GA,ORS,A,272,,,,,,0.00,N,N
3261359,STEM CORAIL OFFSET,ORS,A,278,,,,,,"8,891.30",N,N
3261360,CARTRIDGE PRISM II MIXING,ORS,A,272,,,,,,294.00,N,N
3261361,"WIRE GUIDE 1.6MM X 9.25""",ORS,A,272,,,,,,63.00,N,N
3261362,SCREW 55MM X 5.5,ORS,A,278,,,,,,804.00,N,N
3261363,BIT ACUTRAK 2 5.5,ORS,A,272,,,,,,567.00,N,N
3261364,SCREW CANNUL 6.5MM X 75,ORS,A,278,,,,,,489.00,N,N
3261365,SCREW CANNUL 6.5MM X 80,ORS,A,278,,,,,,489.00,N,N
3261366,CHIPS CANCELLOUS 1-4MM,ORS,A,278,,,,,,637.50,N,N
3261367,PUTTY H-GENIN 1CC SYRINGE,ORS,A,278,,,,,,412.50,N,N
3261368,TUBING PUMP DUO PT SET,ORS,A,272,,,,,,135.30,N,N
3261369,TUBING PUMP ONE DAY SET,ORS,A,272,,,,,,136.77,N,N
3261370,NAIL FIXATION 11X360MM,ORS,A,278,,,,,,"3,438.00",N,N
3261371,BLADE HELICAL 11X90MM,ORS,A,278,,,,,,"1,293.00",N,N
3261372,SCREW LOCKING 5X44MM,ORS,A,278,,,,,,346.50,N,N
3261373,BIT DRILL QC 4X195MM,ORS,A,272,,,,,,366.00,N,N
3261374,LINER ATRX 36X56,ORS,A,278,,,,,,"3,410.00",N,N
3261375,STEM CORAIL STD SZ 10,ORS,A,278,,,,,,"4,050.00",N,N
3261376,SHELL GRIPTION 56MM,ORS,A,278,,,,,,"1,725.00",N,N
3261377,HEAD BIOLOX CERAMIC,ORS,A,278,,,,,,"3,613.50",N,N
3261378,MESH COMPOSIX L/P 6X10,ORS,A,278,,,,,,"1,431.75",N,N
3261379,ROD REAMING STR BALL 3MM,ORS,A,272,,,,,,331.50,N,N
3261380,SCREW 6.5MM CANNUL 16X90,ORS,A,278,,,,,,811.50,N,N
3261381,SCREW 6.5MM CANNUL 16X95,ORS,A,278,,,,,,523.50,N,N
3261382,SLEEVE METAPHYSEAL 29MM,ORS,A,278,,,,,,"4,778.40",N,N
3261383,INSERT CVD RS AOX SZ 2.5,ORS,A,278,,,,,,"4,042.50",N,N
3261384,STEM UNIV FLUTED 75X10,ORS,A,278,,,,,,"3,727.50",N,N
3261385,INSERT CVD RP AOX SZ 5,ORS,A,278,,,,,,"4,042.50",N,N
3261386,SORBAFIX,ORS,A,272,,,,,,975.00,N,N
3261387,FEMUR C/R CEMENTED SZ 3,ORS,A,278,,,,,,"5,401.00",N,N
3261388,SCREW 6.5MM CANNUL 16MM T,ORS,A,278,,,,,,738.00,N,N
3261389,BIT DRILL 5.0MM CANNUL QC,ORS,A,272,,,,,,847.50,N,N
3261390,LINER ALTRX NEUTRAL 32X50,ORS,A,278,,,,,,"3,417.00",N,N
3261391,SCREW 6.5MM CANCELLOUS 15,ORS,A,278,,,,,,379.50,N,N
3261392,SECTOR GRIPTION 58MM,ORS,A,278,,,,,,"4,849.90",N,N
3261393,LINER ALTRX 58MM,ORS,A,278,,,,,,"3,410.00",N,N
3261394,STEM CEMENTED FEMORAL SZ2,ORS,A,278,,,,,,"5,878.40",N,N
3261395,CENTRALIZER STEM 8.5MM,ORS,A,278,,,,,,374.00,N,N
3261396,SCREW CANNUL 6.5MM X 70,ORS,A,278,,,,,,523.50,N,N
3261397,INSERT CVD RP AOX SZ 4,ORS,A,278,,,,,,"7,012.50",N,N
3261398,CUTTER PROXIMATE LINEAR 75MM,ORS,A,272,,,,,,265.31,N,N
3261399,RELOAD GIA 80MM,ORS,A,272,,,,,,176.85,N,N
3261400,RELOAD LINEAR CUTTER,ORS,A,272,,,,,,241.92,N,N
3261401,PLATE 2.4MM VA-LCP VLR,ORS,A,272,,,,,,"1,852.50",N,Y
3261402,SCREW 2.7MM CORTEX ST 14,ORS,A,278,,,,,,144.00,N,Y
3261403,SCREW 2.7MM CORTEX ST 16,ORS,A,278,,,,,,144.00,N,Y
3261404,SCREW 2.4 VA LOCKING 12,ORS,A,272,,,,,,338.00,N,Y
3261405,SCREW 2.4MM VA LOCKING 18,ORS,A,272,,,,,,338.00,N,Y
3261406,SCREW 2.4MM VA LOCKING 20,ORS,A,272,,,,,,338.00,N,Y
3261407,SCREW 2.4MM VA LOCKING 22,ORS,A,272,,,,,,338.00,N,Y
3261408,BIT DRILL 1.8MM QC 110,ORS,A,272,,,,,,388.50,N,Y
3261409,SCREW 6.5MM CANCELLOUS 25,ORS,A,278,,,,,,150.00,N,N
3261410,HEAD BIPOLAR SZ 45,ORS,A,278,,,,,,525.00,N,N
3261411,NAIL FIXATION 12X360MM,ORS,A,278,,,,,,"3,438.00",N,N
3261412,BLADE HELICAL 11X85MM,ORS,A,278,,,,,,"1,245.00",N,N
3261413,PLATE 2.4MM VA-LCP VLR,ORS,A,278,,,,,,"2,410.50",N,N
3261414,SCREW 2.7MM CORTEX ST 10,ORS,A,278,,,,,,144.00,N,N
3261415,SCREW 2.7MM CORTEX ST 12,ORS,A,278,,,,,,144.00,N,N
3261416,PIN 1.8MM VA LOCKING 14,ORS,A,278,,,,,,338.00,N,N
3261417,PIN 1.8MM VA LOCKING 16,ORS,A,278,,,,,,324.00,N,N
3261418,PIN 1.8MM VA LOCKING 18,ORS,A,278,,,,,,324.00,N,N
3261419,TROCAR 5MM VERSASTEP SHORT,ORS,A,272,,,,,,232.38,N,N
3261420,TROCAR 12MM VERSASTEP PLUS SHORT,ORS,A,272,,,,,,277.78,N,N
3261421,NEEDLE INSUFFLATION 14G SHORT,ORS,A,272,,,,,,78.85,N,N
3261422,TROCAR 12MM VERSASTEP,ORS,A,272,,,,,,167.90,N,N
3261423,STYLET INTUBATING 14FR,ORS,A,272,,,,,,7.11,N,N
3261424,STYLET INTUBATING 10FR,ORS,A,272,,,,,,7.11,N,N
3261425,STYLET INTUBATING 6FR,ORS,A,272,,,,,,7.11,N,N
3261426,STEM CEMENTED FEMORAL SZ 5,ORS,A,278,,,,,,"5,878.40",N,N
3261427,CENTRALIZER STEM 12MM,ORS,A,278,,,,,,374.00,N,N
3261428,BLADE EXTENDED COATED ELECTRODE,ORS,A,272,,,,,,20.48,N,N
3261429,BLADE EDGE INSULATED COATED ELECTRODE,ORS,A,272,,,,,,19.01,N,N
3261430,INSERT CVD RP AOX SZ 4,ORS,A,278,,,,,,"4,042.50",N,N
3261431,WIRE GUIDE 1.25MM,ORS,A,272,,,,,,107.25,N,N
3261432,TUBE ENDOTRACHEAL HVT 8.0,ORS,A,272,,,,,,4.91,N,N
3261433,SUT 3-0 SILK A304H,ORS,A,272,,,,,,8.16,N,N
3261434,SUT 4-0 SILK A303H,ORS,A,272,,,,,,8.16,N,N
3261435,SUT 2-0 SILK A305H,ORS,A,272,,,,,,7.88,N,N
3261436,SUT 2-0 PROLENE 8689H,ORS,A,272,,,,,,5.48,N,N
3261437,HEAD FEMORAL 36,ORS,A,278,,,,,,750.00,N,N
3261438,LINER ATRX PINNACLE 56,ORS,A,278,,,,,,"1,275.00",N,N
3261439,SNARE ROTATABLE MED,ORS,A,272,,,,,,79.80,N,N
3261440,SUCTION FRAZIER 12FR,ORS,A,272,,,,,,6.78,N,N
3261441,DRAIN BLAKE FLAT 10MM,ORS,A,272,,,,,,125.65,N,N
3261442,RESERVOIR J VAC 100CC,ORS,A,272,,,,,,86.02,N,N
3261443,NET NYLON,ORS,A,270,,,,,,41.75,N,N
3261444,SUT 2-0 SILK K833H,ORS,A,272,,,,,,4.06,N,N
3261445,SPONGE K DISSECTOR STERILE,ORS,A,272,,,,,,10.08,N,N
3261446,STAPLER PROXIMATE RL LINEAR,ORS,A,272,,,,,,210.90,N,N
3261447,RELOAD PROXIMATE LINEAR,ORS,A,272,,,,,,126.54,N,N
3261448,PUTTY DBX 1CC,ORS,A,278,,,,,,370.50,N,N
3261449,PUTTY DBX 2.5CC,ORS,A,278,,,,,,825.00,N,N
3261450,PUTTY DBX 5CC,ORS,A,278,,,,,,"1,522.50",N,N
3261451,MIX DBX 2.5CC,ORS,A,278,,,,,,"1,020.00",N,N
3261452,MIX DBX 5CC,ORS,A,278,,,,,,"1,845.00",N,N
3261453,PLATE LCP 3.5MM CLAVICLE 7H,ORS,A,278,,,,,,"1,914.00",N,N
3261454,HEAD BIOLOX CERAMIC,ORS,A,278,,,,,,"1,350.00",N,N
3261455,FEMUR C/R CEMENTED SZ 5,ORS,A,278,,,,,,"5,401.00",N,N
3261456,KNEEALIGN 2,ORS,A,272,,,,,,"1,200.00",N,N
3261457,TROCAR BLADELESS 5MM SHORT,ORS,A,272,,,,,,103.53,N,N
3261458,TROCAR BLADELESS 12MM SHORT,ORS,A,272,,,,,,137.01,N,N
3261459,TUBE ENDOTRAC HVT 6.0,ORS,A,272,,,,,,4.90,N,N
3261460,DECANTER BAG,CS,A,272,,,,,,3.85,N,N
3261461,INTERPULSE HANDPIECE,ORS,A,272,,,,,,133.89,N,N
3261462,POWERPORT MRI IMPLANTABLE 8FR,ORS,A,278,,,,,,522.00,N,N
3261463,SHELL GRIPTION 52MM,ORS,A,278,,,,,,"2,025.00",N,N
3261464,LINER ALTRX 36 X 52MM,ORS,A,278,,,,,,"1,050.00",N,N
3261465,STEM CORAIL SZ 9,ORS,A,278,,,,,,"9,246.60",N,N
3261466,SCREW SZ 55,ORS,A,278,,,,,,379.50,N,N
3261467,LINER ALTRX 32 X 48MM,ORS,A,278,,,,,,"3,417.00",N,N
3261468,SECTOR GRIPTION 48MM,ORS,A,278,,,,,,"4,849.90",N,N
3261469,STEM CEMENTED SZ 5,ORS,A,278,,,,,,"1,200.00",N,N
3261470,CENTRALIZER STEM SZ 5,ORS,A,278,,,,,,120.00,N,N
3261471,HEAD BIPOLAR SZ 28,ORS,A,278,,,,,,"2,031.00",N,N
3261472,TIP FEMORAL CANAL COAXIAL,ORS,A,272,,,,,,32.08,N,N
3261473,PLATE LCP 3.5MM 8HL 130MM,ORS,A,278,,,,,,"1,690.50",N,N
3261474,SCREW 2.7MM LOCKING SFTP,ORS,A,278,,,,,,304.00,N,N
3261475,SCREW 2.7MM LOCKING SFTP,ORS,A,278,,,,,,304.00,N,N
3261476,BIT DRILL 1.8MM QC 100MM,ORS,A,272,,,,,,330.00,N,N
3261477,BIT DRILL 2.0MM QC 140MM,ORS,A,272,,,,,,388.50,N,N
3261478,SUT 5-0 POLY SL1689G,ORS,A,272,,,,,,26.82,N,N
3261479,TRAY SPINAL,ORS,A,272,,,,,,31.84,N,N
3261480,TRAY EPIDURAL,ORS,A,272,,,,,,64.09,N,N
3261481,RELOAD ECHELON 45 BLUE,ORS,A,272,,,,,,241.90,N,N
3261482,STAPLER ECHELON 45 FLEX,ORS,A,272,,,,,,416.71,N,N
3261483,RELOAD ECHELON 45 WHITE,ORS,A,272,,,,,,241.90,N,N
3261484,BLANKET LOWER BODY,ORS,A,272,,,,,,27.82,N,N
3261485,ADAPER FEMORAL 5 DEGREE,ORS,A,278,,,,,,"3,884.10",N,N
3261486,TC3 FEMORAL CEMENTED SZ 5 RT,ORS,A,278,,,,,,"10,397.20",N,N
3261487,STEM UNIV FLUTED 75X18,ORS,A,278,,,,,,"3,840.00",N,N
3261488,TC3 INSERT SZ 5,ORS,A,278,,,,,,"4,667.30",N,N
3261489,TRAY TIBIAL ROTATING SZ 4,ORS,A,278,,,,,,"8,693.30",N,N
3261490,BLADE SAW,ORS,A,272,,,,,,370.00,N,N
3261491,LINER ALTRX 36X52,ORS,A,278,,,,,,"1,050.00",N,N
3261492,BALL PIN X-SERIES 6MM,ORS,A,271,,,,,,19.25,N,N
3261493,DRAPE INSTRUMENT MAGNETIC 10X16,ORS,A,272,,,,,,14.55,N,N
3261494,INSERT CVD RP AOX SZ 3,ORS,A,278,,,,,,"4,042.50",N,N
3261495,INSERT CVD RP SZ 3,ORS,A,278,,,,,,"3,696.00",N,N
3261496,GRAFT SEMI-T GRACILIS COMBO,ORS,A,278,,,,,,"4,500.00",N,N
3261497,NAIL TIBIAL 11X390MM,ORS,A,278,,,,,,"2,812.50",N,N
3261498,SCREW LOCKING 5X36MM,ORS,A,278,,,,,,429.00,N,N
3261499,HOOK EXTRACTION,ORS,A,278,,,,,,643.50,N,N
3261500,ECND CAP TIBIAL NAIL 15MM,ORS,A,278,,,,,,496.50,N,N
3261501,SCREW LOCKING 5X40MM,ORS,A,278,,,,,,429.00,N,N
3261502,SCREW LOCKING 5X48MM,ORS,A,278,,,,,,616.50,N,N
3261503,SCREW LOCKING 5X38MM,ORS,A,278,,,,,,429.00,N,N
3261504,TUBING FLOSTEADY PUMP,ORS,A,272,,,,,,136.50,N,N
3261505,FORCEP BIOPSY DISP 160,ORS,A,272,,,,,,43.75,N,N
3261506,FORCEP BIOPSY DISP 230,ORS,A,272,,,,,,33.25,N,N
3261507,SNARE MEDIUM,ORS,A,272,,,,,,60.37,N,N
3261508,PACK KNEE ARTHROSCOPY,ORS,A,272,,,,,,214.15,N,N
3261509,PACK LAPAROSCOPY,ORS,A,272,,,,,,147.81,N,N
3261510,PACK ORTHO MAJOR,ORS,A,272,,,,,,312.78,N,N
3261511,STAPLER ENDO ILS 29MM CURVED,ORS,A,272,,,,,,440.55,N,N
3261512,PLATE 4.5MM VA-LCP 8 HL 195MM,ORS,A,278,,,,,,"3,271.50",N,N
3261513,SCREW 5.0MM SFT VARIABLE 70MM,ORS,A,278,,,,,,340.50,N,N
3261514,SCREW 5.0MM SFT VARIABLE 80MM,ORS,A,278,,,,,,340.50,N,N
3261515,SCREW 4.5MM CORTEX SFT 34MM,ORS,A,278,,,,,,92.25,N,N
3261516,SCREW 4.5MM CORTEX SFT 38MM,ORS,A,278,,,,,,92.25,N,N
3261517,CABLE 1.7MM CRIMP 750MM,ORS,A,278,,,,,,918.00,N,N
3261518,BIT DRILL 3.2MM QC,ORS,A,272,,,,,,228.75,N,N
3261519,BIT DRILL 4.3MM QC,ORS,A,272,,,,,,316.00,N,N
3261520,WIRE GUIDE DRILL TIP 2.5MM,ORS,A,272,,,,,,221.25,N,N
3261521,SCREW 4.5MM CORTEX SFT 38MM,ORS,A,278,,,,,,92.25,N,N
3261522,BIT DRILL CANNULATED COUNTER SINK,ORS,A,272,,,,,,669.00,N,N
3261523,PLATE DVR ANATOMIC EXT,ORS,A,278,,,,,,"2,260.50",N,N
3261524,KWIRE 1.6MM SS,ORS,A,272,,,,,,81.00,N,N
3261525,BIT DRILL 2.5MM,ORS,A,272,,,,,,252.00,N,N
3261526,SCREW CORTICAL 3.5X12MM,ORS,A,278,,,,,,228.00,N,N
3261527,SCREW CORTICAL 3.5X14MM,ORS,A,278,,,,,,228.00,N,N
3261528,PEG PARTIAL THREAD 2.5X16MM,ORS,A,278,,,,,,228.00,N,N
3261529,PEG PARTIAL THREAD 2.5X18MM,ORS,A,278,,,,,,228.00,N,N
3261530,PEG PARTIAL THREAD 2.5X20MM,ORS,A,278,,,,,,228.00,N,N
3261531,NAIL FIXATION 11X400MM,ORS,A,278,,,,,,"3,438.00",N,N
3261532,BIT DRILL 2.7MM QC,ORS,A,272,,,,,,232.50,N,N
3261533,SCREW 2.7MM CORTEX ST 14,ORS,A,278,,,,,,162.50,N,N
3261534,PEELAWAY FLYTE TOGA L,ORS,A,272,,,,,,208.32,N,N
3261535,PEELAWAY FLYTE TOGA 2X,ORS,A,272,,,,,,208.32,N,N
3261536,TOWEL DISP OR BLUE,ORS,A,272,,,,,,11.27,N,N
3261537,TOWEL DISP OR GREEN,ORS,A,272,,,,,,12.50,N,N
3261538,SPONGE LAP,ORS,A,272,,,,,,7.94,N,N
3261539,COVER XL MAYO TRAY,ORS,A,272,,,,,,5.21,N,N
3261540,ANCHOR HEALIX BR W/ORTHOC,ORS,A,278,,,,,,745.50,N,N
3261541,FEMORAL TC3 CEMENTED SZ 5,ORS,A,278,,,,,,"10,397.20",N,N
3261542,STEM UNIVERSAL FLUTED,ORS,A,278,,,,,,"3,727.50",N,N
3261543,INSERT TIBIAL TC3 SZ 5,ORS,A,278,,,,,,"6,364.50",N,N
3261544,STEM UNIV FLUTED 75X12,ORS,A,278,,,,,,"3,727.50",N,N
3261545,TRAY REVISION SZ 3,ORS,A,278,,,,,,"4,149.07",N,N
3261546,PACK EXTREMITY,ORS,A,272,,,,,,233.14,N,N
3261547,TUBE T MODIFIED,ORS,A,272,,,,,,69.89,N,N
3261548,INSERT TIBIAL 3X15,ORS,A,278,,,,,,"3,696.00",N,N
3261549,NAIL FIXATION 11X130,ORS,A,278,,,,,,"3,438.00",N,N
3261550,PLATE TIBIA 3.5MM 6H 117MM,ORS,A,278,,,,,,"3,099.00",N,N
3261551,SCREW 3.5MM LOCKING SLFTP 65MM,ORS,A,278,,,,,,334.50,N,N
3261552,SCREW 3.5MM LOCKING SLFTP 75MM,ORS,A,278,,,,,,334.50,N,N
3261553,SCREW 3.5MM LOCKING SLFTP 80MM,ORS,A,278,,,,,,334.50,N,N
3261554,SCREW 3.5MM CORTEX SLFTP 85MM,ORS,A,278,,,,,,98.25,N,N
3261555,LIGASURE IMPACT OPEN,ORS,A,272,,,,,,"1,205.29",N,N
3261556,BALLS PIN W-SERIES .7MM,ORS,A,271,,,,,,19.25,N,N
3261557,BALLS PIN W-SERIES .9MM,ORS,A,271,,,,,,19.25,N,N
3261558,BALLS PIN W-SERIES 1.1MM,ORS,A,271,,,,,,20.40,N,N
3261559,BALLS PIN W-SERIES 1.6MM,ORS,A,271,,,,,,19.25,N,N
3261560,BALLS PIN W-SERIES 2MM,ORS,A,271,,,,,,19.25,N,N
3261561,BALLS PIN W-SERIES 2.5MM,ORS,A,271,,,,,,19.25,N,N
3261562,ANCHOR HEALIX ADVANCE KNOTLESS,ORS,A,278,,,,,,870.00,N,N
3261563,NAIL FIXATION 11MM,ORS,A,278,,,,,,"3,559.50",N,N
3261564,TUBING INTERMEDIARY,ORS,A,272,,,,,,82.54,N,N
3261565,CLAMP LRG MULTI-PIN 6 POSITION,ORS,A,272,,,,,,"1,917.00",N,N
3261566,ATTACHMENT ROD,ORS,A,272,,,,,,"1,074.00",N,N
3261567,CLAMP LRG COMBINATION,ORS,A,272,,,,,,"1,566.00",N,N
3261568,ROD CARBON FIBER 11X300,ORS,A,272,,,,,,522.00,N,N
3261569,ROD CARBON FIBER 11X350,ORS,A,272,,,,,,577.50,N,N
3261570,BIT DRILL 3.5MM 195MM QC,ORS,A,272,,,,,,216.00,N,N
3261571,SCREW 5.0MM SCHANZ,ORS,A,278,,,,,,420.00,N,N
3261572,SCREW HYDROXYAPATITE SCHANZ,ORS,A,278,,,,,,459.00,N,N
3261573,FORCEP BIOPSY W/NEEDLE LRG CAP,ORS,A,272,,,,,,43.75,N,N
3261574,HEAD BIPOLAR SZ 44,ORS,A,278,,,,,,"2,031.00",N,N
3261575,STRYKEPROBE DISP L-TIP,ORS,A,272,,,,,,30.47,N,N
3261576,MESH COMPOSIX L/P 6.2X10.2,ORS,A,278,,,,,,"1,431.00",N,N
3261577,NAIL FIXATION 12 X 400MM,ORS,A,278,,,,,,"3,559.50",N,N
3261578,SLEEVE TIBIAL 45MM,ORS,A,272,,,,,,"5,017.10",N,N
3261579,FEMUR TC3 4 LEFT,ORS,A,278,,,,,,"10,605.10",N,N
3261580,SLEEVE FEMORAL 40MM,ORS,A,272,,,,,,"5,755.20",N,N
3261581,INSERT TC3 4X17.5 RP,ORS,A,272,,,,,,"4,667.30",N,N
3261582,SUT 0 PROLENE 8690H,ORS,A,272,,,,,,12.80,N,N
3261583,CANNULA SONOPLEX STIM 22G,ORS,A,272,,,,,,48.37,N,N
3261584,LIGASURE SEALER/DIVIDER BLUNT TIP,ORS,A,272,,,,,,651.20,N,N
3261585,LIGACLIP CLIP APPLIER,ORS,A,272,,,,,,144.82,N,N
3261586,FEMUR CR CEMENTED 3 LT,ORS,A,278,,,,,,"5,401.00",N,N
3261587,PIN THREADED HEADLESS 65MM,ORS,A,270,,,,,,237.50,N,N
3261588,PIN THREADED HEADED 46MM,ORS,A,270,,,,,,237.50,N,N
3261589,INSERT TIBIAL SZ 6,ORS,A,278,,,,,,"3,850.00",N,N
3261590,CRUCIATE FEMORAL SZ 6,ORS,A,278,,,,,,"2,775.00",N,N
3261591,PLATFORM TIBIAL BASE SZ 6,ORS,A,278,,,,,,"2,025.00",N,N
3261592,DOME PATELLA MEDIALIZED,ORS,A,278,,,,,,"2,250.00",N,N
3261593,INSERT CVD RP AOX SZ 4,ORS,A,278,,,,,,"4,042.50",N,N
3261594,SPONGE LAP 5PK,ORS,A,272,,,,,,4.54,N,N
3261595,PLATFORM TIBIAL BASE SZ 3,ORS,A,278,,,,,,"4,895.00",N,N
3261596,CRUCIATE FEMORAL SZ 3,ORS,A,278,,,,,,"7,480.00",N,N
3261597,DOME PATELLA MEDIALIZED 29MM,ORS,A,278,,,,,,"2,250.00",N,N
3261598,INSERT TIBIAL SZ 3,ORS,A,278,,,,,,"3,850.00",N,N
3261599,PLATE 2.4MM VA-LCP 6H,ORS,A,278,,,,,,"2,359.50",N,N
3261600,SCREW 2.4MM VA 14MM,ORS,A,278,,,,,,374.00,N,N
3261601,SCREW 2.4MM VA 18MM,ORS,A,278,,,,,,346.50,N,N
3261602,SCREW 2.4MM VA 20MM,ORS,A,278,,,,,,346.50,N,N
3261603,SCREW 2.4MM VA 22MM,ORS,A,278,,,,,,362.00,N,N
3261604,SCREW 2.4MM VA 24MM,ORS,A,278,,,,,,324.00,N,N
3261605,SCREW 2.7MM CORTEX 14MM,ORS,A,278,,,,,,152.50,N,N
3261606,SCREW 2.7MM CORTEX 20MM,ORS,A,278,,,,,,127.50,N,N
3261607,INSERT CVD RP AOX SZ 4,ORS,A,278,,,,,,"2,100.00",N,N
3261608,LINER ALTRX PINNACLE 32X50,ORS,A,278,,,,,,"1,275.00",N,N
3261609,SCREW CANCELLOUS 6.5MMX30,ORS,A,278,,,,,,150.00,N,N
3261610,STEM COCAIL KS 15,ORS,A,278,,,,,,"4,050.00",N,N
3261611,CUP SECTOR GRIPTON 62MM,ORS,A,278,,,,,,"4,849.90",N,N
3261612,LINER ALTEX 36X62 10 DEGREE,ORS,A,278,,,,,,"3,410.00",N,N
3261613,TOWEL OR STERILE 16'X26' BLUE,OR,A,272,,,,,,17.00,N,N
3261614,HEAD FEMORAL,ORS,A,278,,,,,,750.00,N,N
3261615,NAIL FIXATION 12X400,ORS,A,278,,,,,,"3,667.50",N,N
3261616,SCREW 5.0MM LOCK 54,ORS,A,278,,,,,,360.00,N,N
3261617,SCREW 5.0MM LOCK 56,ORS,A,278,,,,,,360.00,N,N
3261618,PEELAWAY FLYTE TOGA XL,ORS,A,272,,,,,,208.32,N,N
3261619,SUT VICRYL 0 ENDOLOOP EJ10G,ORS,A,272,,,,,,117.58,N,N
3261620,FEMORAL C/R POROCOAT SZ 2.5,ORS,A,278,,,,,,"8,478.80",N,N
3261621,INSERT CVD RP AOX SZ 2.5,ORS,A,278,,,,,,"4,042.50",N,N
3261622,TRAY TIBIAL MBT SZ 2,ORS,A,278,,,,,,"5,424.10",N,N
3261623,INSERT TIBIAL TC3 SZ 4,ORS,A,278,,,,,,"4,994.00",N,N
3261624,AUGMENT DISTAL SZ 4,ORS,A,278,,,,,,"2,455.50",N,N
3261625,BLADE FLEX CHISEL 10MM,ORS,A,278,,,,,,312.00,N,N
3261626,CRUCIATE FEMORAL SZ 5,ORS,A,278,,,,,,"2,775.00",N,N
3261627,PLATFORM TIBIAL BASE SZ 5,ORS,A,278,,,,,,"1,950.00",N,N
3261628,INSERT TIBIAL SZ 5,ORS,A,278,,,,,,"3,850.00",N,N
3261629,DOME PATELLA MEDIALIZED 35MM,ORS,A,278,,,,,,600.00,N,N
3261630,INSERT TIBIAL SZ 4,ORS,A,278,,,,,,"1,650.00",N,N
3261631,PLATFORM TIBIAL BASE SZ 4,ORS,A,278,,,,,,"1,950.00",N,N
3261632,CRUCIATE FEMORAL SZ 4,ORS,A,278,,,,,,"3,300.00",N,N
3261633,FILLER BONE VOID 10CC,ORS,A,278,,,,,,"2,250.00",N,N
3261634,INSERT TIBIAL SZ 5,ORS,A,278,,,,,,"3,850.00",N,N
3261635,PLATE AUTOCAPTURE EXPRESSEW III,ORS,A,272,,,,,,132.50,N,N
3261636,CRUCIATE FEMORAL SZ 5 LEFT,ORS,A,278,,,,,,"2,775.00",N,N
3261637,INSERT TIBIAL SZ 5/ 6MM,ORS,A,278,,,,,,"1,650.00",N,N
3261638,NAIL FIXATION 12X380,ORS,A,278,,,,,,"3,667.50",N,N
3261639,NAIL FIXATION 12X420,ORS,A,278,,,,,,"3,667.50",N,N
3261640,FEMUR TC3 CEMENTED SZ 4,ORS,A,278,,,,,,"3,639.02",N,N
3261641,ANCHOR HEALIX ADVANCED W/ O/C,ORS,A,278,,,,,,745.50,N,N
3261642,ASPIRATOR MIDDLE EAR JUHN TYM-TAP,ORS,A,272,,,,,,61.25,N,N
3261643,SCREW MILAGRO BR 7X15MM,ORS,A,278,,,,,,664.50,N,N
3261644,KIT THOR/PARA,ORS,A,272,,,,,,84.95,N,N
3261645,SYSTEM IMPLANT HEALIX TRANSTEND,ORS,A,278,,,,,,"1,620.00",N,N
3261646,GUIDEWIRE TROCAR TIP,ORS,A,272,,,,,,204.00,N,N
3261647,HEAD BI-POLAR SZ 47,ORS,A,278,,,,,,525.00,N,N
3261648,STEM CORAIL OFFSET SZ 13,ORS,A,278,,,,,,"9,246.60",N,N
3261649,SCREW 6.5MM CANNUL,ORS,A,278,,,,,,170.00,N,N
3261650,SCREW 7.0MM CANNUL 90,ORS,A,278,,,,,,570.00,N,N
3261651,SCREW 7.0MM CANNUL 95,ORS,A,278,,,,,,570.00,N,N
3261652,SUT 3-0 VICRYL J944H,ORS,A,272,,,,,,5.16,N,N
3261653,SUT 2-0 VICRYL J945H,ORS,A,272,,,,,,5.17,N,N
3261654,SUT 3-0 VICRYL J232H,ORS,A,272,,,,,,5.00,N,N
3261655,SUT 2-0 VICRYL J417H,ORS,A,272,,,,,,4.82,N,N
3261656,TIP MARYLAND DISSECTOR SINGLE USE,ORS,A,272,,,,,,152.95,N,N
3261657,CRUCIATE FEMORAL SZ 6,ORS,A,278,,,,,,"2,962.50",N,N
3261658,INSERT TIBIAL SZ 6,ORS,A,278,,,,,,"2,100.00",N,N
3261659,INSERT TIBIAL SZ 6,ORS,A,278,,,,,,"3,850.00",N,N
3261660,INSERT TIBIAL SZ 8,ORS,A,278,,,,,,"2,100.00",N,N
3261661,DOME PATELLA MEDIALIZED 38MM,ORS,A,278,,,,,,750.00,N,N
3261662,CRUCIATE FEMORAL SZ 8 RIGHT,ORS,A,278,,,,,,"2,775.00",N,N
3261663,PLATFORM TIBIAL BASE SZ 8,ORS,A,278,,,,,,"1,950.00",N,N
3261664,INSERT TIBIAL SZ 6,ORS,A,278,,,,,,"3,850.00",N,N
3261665,SCREW 2.4MM VA 16MM,ORS,A,278,,,,,,374.00,N,N
3261666,SCREW 2.7MM CORTEX 16MM,ORS,A,278,,,,,,162.50,N,N
3261667,INSERT TIBIAL SZ 6,ORS,A,278,,,,,,"1,650.00",N,N
3261668,BIT DRILL 5.0MM CANN QC 300MM,ORS,A,270,,,,,,"1,141.50",N,N
3261669,CENTRALIZER STEM 10.5MM,ORS,A,278,,,,,,374.00,N,N
3261670,CRUCIATE FEMORAL SZ 5N LEFT,ORS,A,278,,,,,,"2,962.50",N,N
3261671,FEMUR TC3 3 RIGHT,ORS,A,278,,,,,,"3,639.02",N,N
3261672,TRAY TIBIAL ROTATING SZ 2.5,ORS,A,278,,,,,,"4,149.08",N,N
3261673,ROD REAMING 3.0MM X 950MM,ORS,A,272,,,,,,357.00,N,N
3261674,NAIL FIXATION 12MM/130 DEG 420MM,ORS,A,278,,,,,,"3,667.50",N,N
3261675,SCREW SET 130 DEG,ORS,A,278,,,,,,342.00,N,N
3261676,BLADE HELICAL 11MM X 105,ORS,A,278,,,,,,"1,332.00",N,N
3261677,SCREW 5.0MM X 52,ORS,A,278,,,,,,372.00,N,N
3261678,HEAD FEMORAL CERAMIC,ORS,A,278,,,,,,"1,312.50",N,N
3261679,PLASMA PEAK PLATELET RICH,ORS,A,272,,,,,,525.00,N,N
3261680,STEM CEMENTED FEMORAL SZ 4,ORS,A,278,,,,,,"5,878.40",N,N
3261681,INSERT TIBIAL SZ 5,ORS,A,278,,,,,,"2,100.00",N,N
3261682,DOME PATELLA MEDIALIZED 32MM,ORS,A,278,,,,,,600.00,N,N
3261683,BLADE OMNICUT,ORS,A,272,,,,,,162.50,N,N
3261684,BURR BARRELL 5.0MM,ORS,A,272,,,,,,162.50,N,N
3261685,BLADE SHAVER AGGRESSIVE +,ORS,A,272,,,,,,150.00,N,N
3261686,SUT 0 VICRYL JJ41G,ORS,A,272,,,,,,33.71,N,N
3261687,SUT 3-0 VICRYL PLUS VCPB944H,ORS,A,272,,,,,,7.46,N,N
3261688,SUT 3-0 VICRYL J416H,ORS,A,272,,,,,,4.83,N,N
3261689,SUT 3-0 VICRYL J285G,ORS,A,272,,,,,,5.68,N,N
3261690,SUT 2-0 ETHILON 585H,ORS,A,272,,,,,,11.30,N,N
3261691,NEEDLE MAYO 1/2 TAPER 2PK,ORS,A,272,,,,,,10.24,N,N
3261692,CRUCIATE FEMORAL SZ 6N RIGHT,ORS,A,278,,,,,,"3,300.00",N,N
3261693,INSERT TIBIAL AOX SZ 6,ORS,A,278,,,,,,"2,100.00",N,N
3261694,LARYNGOSCOPE BRITEPRO SOLO MAC 2,ORS,A,272,,,,,,51.31,N,N
3261695,LARYNGOSCOPE BRITEPRO SOLO MILLER 2,ORS,A,272,,,,,,51.31,N,N
3261696,PADDLE ENDO RETRACT 12MM,ORS,A,272,,,,,,676.89,N,N
3261697,SCREW 2.4MM VA 28MM,ORS,A,278,,,,,,324.00,N,N
3261698,PEAK 30ML DISP,ORS,A,272,,,,,,552.00,N,N
3261699,INSERT TIBIAL TC3 SZ 3,ORS,A,278,,,,,,"2,481.00",N,N
3261700,FEMUR TC3 LEFT SIZE 3,ORS,A,278,,,,,,"3,639.02",N,N
3261701,LINER ALTRX 36X54,ORS,A,278,,,,,,"1,050.00",N,N
3261702,ANCHOR HEALIX ADV 5.5,ORS,A,278,,,,,,834.00,N,N
3261703,HEAD FEMORAL CERAMIC 32MM,ORS,A,278,,,,,,"1,350.00",N,N
3261704,SYSTEM S-ROM TOTAL HIP,ORS,A,278,,,,,,"4,050.00",N,N
3261705,SYSTEM S-ROM MODULAR HIP,ORS,A,278,,,,,,750.00,N,N
3261706,LINER PINNACLE ALTRX 32MM,ORS,A,278,,,,,,"1,050.00",N,N
3261707,BIT DRILL 35MM,ORS,A,272,,,,,,570.37,N,N
3261708,LINER ALTRX 36X56MM,ORS,A,278,,,,,,"1,050.00",N,N
3261709,PLATE 2.7/3.5MM OLECRANON,ORS,A,278,,,,,,"2,139.00",N,N
3261710,SCREW 2.7MM METAPHYSEAL ST 38MM,ORS,A,278,,,,,,157.50,N,N
3261711,SCREW 2.7MM METAPHYSEAL ST 60MM,ORS,A,278,,,,,,157.50,N,N
3261712,SCREW 2.7MM VA LOCK ST 14MM,ORS,A,278,,,,,,361.50,N,N
3261713,SCREW 2.7MM VA LOCK ST 16MM,ORS,A,278,,,,,,361.50,N,N
3261714,SCREW 2.7MM VA LOCK ST 26MM,ORS,A,278,,,,,,392.00,N,N
3261715,SCREW 2.7MM VA LOCK ST 28MM,ORS,A,278,,,,,,392.00,N,N
3261716,SCREW 2.7MM VA LOCK ST 38MM,ORS,A,278,,,,,,361.50,N,N
3261717,WIRE COMPRESSION 1.6MM,ORS,A,272,,,,,,157.50,N,N
3261718,SCREW 3.5MM CORTEX LOW PRO ST 20MM,ORS,A,278,,,,,,148.50,N,N
3261719,SCREW 3.5MM CORTEX LOW PRO ST 22MM,ORS,A,278,,,,,,49.50,N,N
3261720,CRUCIATE FEMORAL SZ 8 PS,ORS,A,278,,,,,,"3,300.00",N,N
3261721,INSERT TIBIAL SZ 8 AOX,ORS,A,278,,,,,,"2,100.00",N,N
3261722,SCREW CORTEX 2.4MM ST 20MM,ORS,A,278,,,,,,193.75,N,N
3261723,INSERT TIBIAL SZ 8 AOX,ORS,A,278,,,,,,"1,650.00",N,N
3261724,CRUCIATE FEMORAL SZ 8 LEFT,ORS,A,278,,,,,,"2,775.00",N,N
3261725,INSERT TIBIAL SZ 8 10MM,ORS,A,278,,,,,,"2,100.00",N,N
3261726,STEM CORAIL STD SZ 16,ORS,A,278,,,,,,"5,170.00",N,N
3261727,GELFOAM SZ 4 6X2,ORS,A,272,,,,,,75.81,N,N
3261728,LINER ALTRX PINNALE 32X50,ORS,A,278,,,,,,"1,275.00",N,N
3261729,SCREW 3.5MM CORTEX LOW PRO ST 14MM,ORS,A,278,,,,,,146.25,N,N
3261730,SCREW 3.5MM CORTEX LOW PRO ST 16MM,ORS,A,278,,,,,,146.25,N,N
3261731,GELFOAM SZ 100,ORS,A,272,,,,,,160.12,N,N
3261732,SCREW BIOINTRAFIX 7-9X30,ORS,A,278,,,,,,486.00,N,N
3261733,INSERT TIBIAL SZ 5 AOX,ORS,A,278,,,,,,"1,650.00",N,N
3261734,CRUCIATE FEMORAL SZ 7 LEFT,ORS,A,278,,,,,,"2,962.50",N,N
3261735,INSERT TIBIAL SZ 7 AOX,ORS,A,278,,,,,,"2,100.00",N,N
3261736,TUBE EAR PAPARELLA II,ORS,A,272,,,,,,87.50,N,N
3261737,ELECTRODE TRIPOLAR 90,ORS,A,272,,,,,,622.50,N,N
3261738,SCREW BONE CANCELLOUS 6.5MM X 40MM,ORS,A,278,,,,,,150.00,N,N
3261739,FEMUR CEMENTED PS SZ 3,ORS,A,278,,,,,,"2,400.00",N,N
3261740,IRRISEPT,ORS,A,272,,,,,,156.53,N,N
3261741,CRUCIATE FEMORAL SZ 6N LEFT,ORS,A,278,,,,,,"2,962.50",N,N
3261742,PLATFORM TIBIAL BASE SZ 7,ORS,A,278,,,,,,"2,025.00",N,N
3261743,SUT 4-0 ETHILON 1667G,ORS,A,272,,,,,,10.30,N,N
3261754,SCREW 6.5MM CANNUL 16MM TH,ORS,A,278,,,,,,690.00,N,N
3261791,SUT 4-0 SILK 736G,ORS,A,272,,,,,,6.20,N,N
3261792,SUT 4-0 SILK 683G,ORS,A,272,,,,,,5.32,N,N
3261793,INSERT TIBIAL SZ 4,ORS,A,278,,,,,,"2,100.00",N,N
3261794,CRUCIATE FEMUR SZ 4,ORS,A,278,,,,,,"2,775.00",N,N
3261795,PLATE 2.4MM TI VA-LCP 2 CLMN,ORS,A,278,,,,,,"2,205.00",N,N
3261796,SCREW 2.7MM CORTEX TI ST 16MM,ORS,A,278,,,,,,141.25,N,N
3261797,SCREW 2.7MM CORTEX TI ST 18MM,ORS,A,278,,,,,,141.25,N,N
3261798,SCREW 2.4MM TI VA LOCK 24MM,ORS,A,278,,,,,,301.50,N,N
3261799,SCREW 2.4MM CORTEX TI ST 24MM,ORS,A,278,,,,,,206.25,N,N
3261800,PIN 1.8MM BUTTRESS TI VA LOCK 20MM,ORS,A,278,,,,,,301.50,N,N
3261801,PIN 1.8MM BUTTRESS TI VA LOCK 22MM,ORS,A,278,,,,,,301.50,N,N
3261802,INSERT TIBIAL ROTATING SZ 3,ORS,A,278,,,,,,"1,500.00",N,N
3261803,INSERT TIBIAL ROTATING SZ 2.5,ORS,A,278,,,,,,"1,500.00",N,N
3261804,BLADE FLEX CHISEL 10MM,ORS,A,278,,,,,,270.40,N,N
3261805,INSERT TIBIAL SZ 8,ORS,A,278,,,,,,"2,100.00",N,N
3261807,TFNA 12MM/125 DEG TI CANN 380MM,ORS,A,278,,,,,,"4,210.80",N,N
3261808,CABLE 1.7MM COCR TI CRIMP 750MM,ORS,A,278,,,,,,"1,266.00",N,N
3261809,SCREW 5.0MM TI LOCKING 52MM,ORS,A,278,,,,,,576.00,N,N
3261810,BLADE TFNA HELICAL 95MM,ORS,A,272,,,,,,"1,800.00",N,N
3261811,ANCHOR HEALIX ADVANCED 4.5MM,ORS,A,278,,,,,,783.00,N,N
3261812,INSERT TIBIAL SZ 4,ORS,A,278,,,,,,"2,100.00",N,N
3261813,INSERT TIBIAL SZ 7,ORS,A,278,,,,,,"2,100.00",N,N
3261814,CRUCIATE FEMORAL SZ 7,ORS,A,278,,,,,,"2,775.00",N,N
3261815,PATELLA 38MM,ORS,A,278,,,,,,600.00,N,N
3261816,SECTOR GRIPTION 58MM,ORS,A,278,,,,,,"2,025.00",N,N
3261817,LINER ALTRX 58MM,ORS,A,278,,,,,,"1,050.00",N,N
3261818,HEAD FEMORAL METAL,ORS,A,278,,,,,,750.00,N,N
3261819,PIN 1.8MM VA LOCK BUTTRESS 22MM,ORS,A,278,,,,,,301.50,N,N
3261820,WIRE COMPRESSION 2.6,ORS,A,272,,,,,,108.75,N,N
3261821,PIN 1.8MM BUTTRESS VA LOCK W/T8 20MM,ORS,A,278,,,,,,324.00,N,N
3261822,BLADE HELICAL TFNA 80MM,ORS,A,278,,,,,,"1,692.00",N,N
3261823,NAIL 11MM/125 TFN 360MM,ORS,A,278,,,,,,"3,677.30",N,N
3261824,GRYPHON BR W/ PROKNOT TECH,ORS,A,278,,,,,,814.50,N,N
3261825,SHUTTLE IDEAL STRAIGHT CRESCENT,ORS,A,278,,,,,,370.50,N,N
3261826,SHUTTLE IDEAL 25 RIGHT,ORS,A,278,,,,,,370.50,N,N
3261827,SUT 7 MONO STEEL,ORS,A,272,,,,,,45.01,N,N
3261828,CRUCIATE FEMORAL SZ 5N RIGHT,ORS,A,278,,,,,,"2,775.00",N,N
3261829,SCREW 2.4MM CORTEX ST 18MM,ORS,A,278,,,,,,249.00,N,N
3261830,STAPLER CURVED ILS 25MM,ORS,A,272,,,,,,373.58,N,N
3261831,INSERT TIBIAL SZ 4,ORS,A,278,,,,,,"2,100.00",N,N
3261832,STAPLER CONTOUR CURVED 40MM,ORS,A,272,,,,,,630.63,N,N
3261833,RELOAD CONTOUR 40MM,ORS,A,272,,,,,,354.82,N,N
3261834,FORCEP BIOPSY HOT RADIAL JAW 4,ORS,A,272,,,,,,106.80,N,N
3261835,STAPLER ENDO ILS 33MM CVD,ORS,A,272,,,,,,440.55,N,N
3261836,SCISSORS INSERT CVD METZ,ORS,A,272,,,,,,141.78,N,N
3261837,CHIPS CANCELLOUS 4-10MM 15CC,ORS,A,278,,,,,,637.50,N,N
3261838,NAIL TIBIAL 10MM TI CANN 315MM,ORS,A,278,,,,,,"3,210.00",N,N
3261839,SCREW 5.0MM TI LOCK 46MM,ORS,A,278,,,,,,499.50,N,N
3261840,ROD CARBON FIBER 11X400,ORS,A,278,,,,,,633.00,N,N
3261841,SCREW 5.0MM SCHANZ 60MM THRD 175,ORS,A,278,,,,,,420.00,N,N
3261842,AUGMENT POST SZ 4 - 4MM,ORS,A,278,,,,,,851.02,N,N
3261843,INSERT TIBIAL RP TC3 SZ 4,ORS,A,278,,,,,,"2,481.00",N,N
3261844,PLATE 3.5MM TIBIA VA-LCP 4H 87MM LT,ORS,A,278,,,,,,"3,379.50",N,N
3261845,SCREW 3.5MM CORTEX ST 80MM,ORS,A,278,,,,,,108.75,N,N
3261846,SCREW 3.5MM LOCK ST 85MM,ORS,A,278,,,,,,334.50,N,N
3261847,INSERT TIBIAL SZ 4,ORS,A,278,,,,,,"2,100.00",N,N
3261848,CUTTER LINEAR PROX 100MM,ORS,A,272,,,,,,303.92,N,N
3261849,RELOAD CUTTER LINEAR PROX 100MM,ORS,A,272,,,,,,213.23,N,N
3261850,PUTTY G-GENIN 2.5CC SYRINGE,ORS,A,278,,,,,,412.50,N,N
3261851,HEAD RADIAL 26MM,ORS,A,278,,,,,,"3,982.50",N,N
3261852,STEM RADIAL 10MM,ORS,A,278,,,,,,"3,982.50",N,N
3261853,TRAP POLY QUICKCATCH,ORS,A,272,,,,,,9.59,N,N
3261854,PLATE 3.5MM LCP TIBIA MEDIAL PROX 4H,ORS,A,278,,,,,,"3,124.50",N,N
3261855,SCREW 3.5MM CONICAL ST FT 85MM,ORS,A,278,,,,,,304.50,N,N
3261856,SCREW 3.5MM LOCK ST STAR RECESS 70MM,ORS,A,278,,,,,,372.00,N,N
3261857,INJECT NORIAN DRILLABLE 5CC,ORS,A,278,,,,,,"3,058.50",N,N
3261858,NEEDLE DELIVERY 10GAX10CM,ORS,A,278,,,,,,210.00,N,N
3261859,NAIL TFNA 12MM/125 DEG TI CANN,ORS,A,278,,,,,,"3,935.80",N,N
3261860,BLADE TFNA HELICAL 105MM,ORS,A,278,,,,,,"1,701.00",N,N
3261861,SCREW 5.0MM TI LOCK 72MM,ORS,A,278,,,,,,499.50,N,N
3261862,TRAY SKIN PREP,ORS,A,272,,,,,,9.20,N,N
3261863,NAIL 8.2MM TI ADOL LAT ENTRFEMORAL,ORS,A,278,,,,,,"3,394.50",N,N
3261864,SCREW 5.0MM TI RECON 65MM,ORS,A,278,,,,,,501.00,N,N
3261865,SCREW 5.0MM TI RECON 75MM,ORS,A,278,,,,,,501.00,N,N
3261866,SCREW 4.0MM TI LOCK 40MM,ORS,A,278,,,,,,499.50,N,N
3261867,WIRE GUIDE 3.2MM X 400MM,ORS,A,272,,,,,,314.00,N,N
3261868,BIT DRILL 5.0MM ROCON LRG QC,ORS,A,272,,,,,,"1,002.00",N,N
3261869,BIT DRILL 3.2MM 3-FLUTED QC,ORS,A,272,,,,,,496.50,N,N
3261870,ROD REAMING 2.5MM BALL TIP 950MM,ORS,A,272,,,,,,374.00,N,N
3261871,BIT DRILL 13.0MM CANNUL 300MM,ORS,A,272,,,,,,"1,302.00",N,N
3261872,TFNA TI CANN 12MM/130 DEG,ORS,A,278,,,,,,"4,114.50",N,N
3261873,GRAFT ADMATRIX 4X6,ORS,A,278,,,,,,"1,200.00",N,N
3261874,TRAY EPIDURAL CONTINUOUS,ORS,A,272,,,,,,65.10,N,N
3261875,SCREW 2.7MM CORTEX ST 18MM,ORS,A,278,,,,,,152.50,N,N
3261876,TRAY SPINAL,ORS,A,272,,,,,,41.50,N,N
3261877,CANNULA THREAD CL 8.5X90,ORS,A,272,,,,,,111.00,N,N
3261878,PIN 1.8MM VA LOCK 24MM,ORS,A,278,,,,,,324.00,N,N
3261879,PIN 1.8MM VA LOCK 28MM,ORS,A,278,,,,,,324.00,N,N
3261880,PLATE 2.4MM VA-LCP 2 CLMN 7H/4H,ORS,A,278,,,,,,"2,448.00",N,N
3261881,SCREW 2.4MM VA LOCK 26MM,ORS,A,278,,,,,,324.00,N,N
3261882,TFNA 12MM/125 DEG TI CANN 360MM,ORS,A,278,,,,,,"3,935.80",N,N
3261883,PIN 6.0MM TRANSFIXATION 225MM,ORS,A,272,,,,,,342.00,N,N
3261884,SCREW 5.0MM SD SCHANZ 200MM,ORS,A,272,,,,,,450.00,N,N
3261885,BIT DRILL 3.5 QC,ORS,A,272,,,,,,266.00,N,N
3261886,ROD 11.0 CARBON FIBER 300MM,ORS,A,272,,,,,,618.00,N,N
3261887,ROD 11.0 CARBON FIBER 350MM,ORS,A,272,,,,,,618.00,N,N
3261888,CLAMP LRG OPEN ADJ,ORS,A,272,,,,,,"1,389.00",N,N
3261889,CENTERALIZER STEM 8.5MM,ORS,A,278,,,,,,150.00,N,N
3261890,INSERT TIBIAL SZ 7X6 AOX RP,ORS,A,278,,,,,,"2,100.00",N,N
3261891,ELECTRODE VAPR P50 W/HAND,ORS,A,272,,,,,,580.50,N,N
3261892,CRUCIATE FEMORAL SZ 6N RIGHT,ORS,A,278,,,,,,"2,962.50",N,N
3261893,SCREW 6.5MM CANCELLOUS 45,ORS,A,278,,,,,,150.00,N,N
3261894,STEM FEMORAL CEMENTED SZ 7,ORS,A,278,,,,,,"1,200.00",N,N
3261895,HEAD SELF CENTERING 56X28,ORS,A,278,,,,,,525.00,N,N
3261896,TFNA 12MM/125 DEG TI CANN 400MM,ORS,A,278,,,,,,"3,935.80",N,N
3261897,LINER ALTRX NEUTRAL 36X58,ORS,A,278,,,,,,"1,050.00",N,N
3261898,HEAD FEMORAL CERAMIC 36,ORS,A,278,,,,,,"1,350.00",N,N
3261899,BLADE HELICAL TFNA 90MM,ORS,A,278,,,,,,"1,701.00",N,N
3261900,SCREW 5.0MM TI LOCK 50MM,ORS,A,278,,,,,,537.00,N,N
3261901,TFNA 11MM/125 DEG TI CANN 380MM,ORS,A,278,,,,,,"3,935.80",N,N
3261902,TFNA 12MM/125 DEG TI CANN 400MM,ORS,A,278,,,,,,"4,210.80",N,N
3261903,TFNA 11MM/125 DEG TI CANN 360MM LT,ORS,A,278,,,,,,"3,935.80",N,N
3261904,SCREW 5.0MM TI LOCK T25 56MM,ORS,A,278,,,,,,537.00,N,N
3261905,REPAIR MENISCAL SYSTEM TRUESPAN,ORS,A,278,,,,,,909.00,N,N
3261906,REPAIR MENISCAL SYSTEM TRUESPAN 12,ORS,A,278,,,,,,909.00,N,N
3261907,FEMUR COLUMBUS RT F5,ORS,A,278,,,,,,"2,700.00",N,N
3261908,PLATE TIBIAL COLUMBUS RT F5,ORS,A,278,,,,,,"1,800.00",N,N
3261909,OBTURATOR TIBIAL COLUMBUS 14MM,ORS,A,278,,,,,,375.00,N,N
3261910,SURFACE GLIDING COLUMBUS T4,ORS,A,278,,,,,,600.00,N,N
3261911,PATELLA 3-PEGS P3 COLUMBUS,ORS,A,278,,,,,,525.00,N,N
3261912,REVISION CORAIL STD SZ 14,ORS,A,278,,,,,,"5,170.00",N,N
3261913,LINER ALTRX PINNALE 36X50,ORS,A,278,,,,,,"1,050.00",N,N
3261914,SECTOR GRIPTON 60MM,ORS,A,278,,,,,,"1,725.00",N,N
3261915,PLATFORM TIBIAL BASE SZ 9,ORS,A,278,,,,,,"2,025.00",N,N
3261916,INSERT TIBIAL SZ 8,ORS,A,278,,,,,,"1,650.00",N,N
3261917,CORAIL OFFSET SZ 12,ORS,A,278,,,,,,"4,050.00",N,N
3261918,KIT RIGIDLOOP,ORS,A,278,,,,,,973.50,N,N
3261919,PREPARATION GRAFT SPEEDTRAP 20MM WH,ORS,A,272,,,,,,210.00,N,N
3261920,SUT PERMATAPE,ORS,A,272,,,,,,237.50,N,N
3261921,PREPARATION GRAFT SPEEDTRAP 20MM GR/WH,ORS,A,272,,,,,,210.00,N,N
3261922,RIGIDLOOP ADJ,ORS,A,278,,,,,,804.00,N,N
3261923,SHEATH INTRAFIX,ORS,A,278,,,,,,562.50,N,N
3261924,SCREW INTRAFIX 8X30MM,ORS,A,278,,,,,,540.00,N,N
3261925,INTRAFIX ADVANTAGE BR 7X30,ORS,A,278,,,,,,"1,275.00",N,N
3261926,RIGIDLOOP ADJUSTABLE,ORS,A,278,,,,,,853.50,N,N
3261927,SPEEDTRAP 30MM GR/WHT,ORS,A,272,,,,,,210.00,N,N
3261928,SPEEDTRAP 30MM WHT,ORS,A,272,,,,,,210.00,N,N
3261929,NAIL TFNA 11MM/125 TI CANN RT,ORS,A,278,,,,,,"4,210.80",N,N
3261930,BLADE HELICAL TFNA 110MM,ORS,A,278,,,,,,"1,800.00",N,N
3261931,PLATE 2.7MM/3.5MM VA LCP PROX 2H LT,ORS,A,278,,,,,,"2,017.40",N,N
3261932,SCREW 2.7MM VA LOCK ST 12MM,ORS,A,278,,,,,,361.50,N,N
3261933,SCREW 2.7MM VA LOCK ST 30MM,ORS,A,278,,,,,,361.50,N,N
3261934,WIRE 1.6MM COMPRESSION 15MM/150MM,ORS,A,278,,,,,,200.00,N,N
3261935,SHUTTLE IDEAL 25 LEFT,ORS,A,278,,,,,,420.00,N,N
3261936,CRUCIATE RETAINING FEMORAL SZ 10 RIGHT,ORS,A,278,,,,,,"2,962.50",N,N
3261937,PLATFORM ROTATING TIBIAL BASE SZ 10,ORS,A,278,,,,,,"2,750.00",N,N
3261938,INSERT TIBIAL SZ 10,ORS,A,278,,,,,,"2,100.00",N,N
3261939,DOME PATELLA MEDIALIZED 41MM,ORS,A,278,,,,,,600.00,N,N
3261940,PLATE 2.0MM VAL 12HL,ORS,A,278,,,,,,"1,345.50",N,N
3261941,SCREW 2.0MM CORTEX SLFTP 10MM,ORS,A,278,,,,,,200.00,N,N
3261942,SCREW 2.0MM CORTEX SLFTP 12MM,ORS,A,278,,,,,,200.00,N,N
3261943,SCREW 2.0MM CORTEX SLFTP 8MM,ORS,A,278,,,,,,200.00,N,N
3261944,BIT DRILL 1.5MM J-LATCH 57MM,ORS,A,278,,,,,,292.00,N,N
3261945,SCREW 2.0MM VA-LOCK SLFTP 9MM,ORS,A,278,,,,,,312.00,N,N
3261946,LIGACLIP LRG,ORS,A,272,,,,,,220.67,N,N
3261947,TFNA 10MM/125 DEG TI CANN 400MM LT,ORS,A,278,,,,,,"4,210.80",N,N
3261948,SCREW 5.0MM TI LOCK 54MM,ORS,A,278,,,,,,576.00,N,N
3261949,REVISION CORAIL STD SZ 12,ORS,A,278,,,,,,"5,170.00",N,N
3261950,TFNA 12MM/125 DEG TI ANN 380MM RT,ORS,A,278,,,,,,"4,210.80",N,N
3261951,SCREW 5.0MM TI LOCK 64MM,ORS,A,278,,,,,,576.00,N,N
3261952,PLATE 3.5MM LCP PROX HUM 2H RT,ORS,A,278,,,,,,"3,384.70",N,N
3261953,WIRE 2.8MM COMPRESSION 20MM,ORS,A,278,,,,,,202.00,N,N
3261954,PLATE 3.5MM CLAVICLE 6H LFT 85MM,ORS,A,278,,,,,,"2,586.00",N,N
3261955,SCREW 3.5MM CORTEX LOW PRO SLFT 18MM,ORS,A,278,,,,,,150.00,N,N
3261956,SCREW 3.5MM CORTEX LOW PRO SLFT 20MM,ORS,A,278,,,,,,150.00,N,N
3261957,HEAD FEMORAL CERAMIC 32MM,ORS,A,278,,,,,,"1,312.50",N,N
3261958,CABLE COCR 1.7MMX750MM,ORS,A,278,,,,,,"1,266.00",N,N
3261959,TFNA FENESTRATED HELICAL BLADE 90MM,ORS,A,278,,,,,,"1,926.00",N,N
3261960,SCREW 5.0MM TI LOCK 66MM,ORS,A,278,,,,,,576.00,N,N
3261961,REVISION CORAIL STD SZ 13,ORS,A,278,,,,,,"5,170.00",N,N
3261962,LARYNGOSCOPE BRITEPRO SOLO MILLER 3,ORS,A,272,,,,,,43.18,N,N
3261963,HEAD BIPOLAR SZ 28,ORS,A,278,,,,,,450.00,N,N
3261964,MASK AURA LARYNGEAL SZ 4,ORS,A,272,,,,,,23.70,N,N
3261965,LINER ALTRX 36X60,ORS,A,278,,,,,,"1,275.00",N,N
3261966,IRRIGATION PULSAVAC,ORS,A,272,,,,,,90.00,N,N
3261967,GRYPHON-T BR DS,ORS,A,278,,,,,,684.00,N,N
3261968,EXPRESSEW III AUTOCAPTURE,ORS,A,278,,,,,,132.50,N,N
3261969,PICO 4X12,ORS,A,272,,,,,,330.00,N,N
3261970,PICO 6X12,ORS,A,272,,,,,,330.00,N,N
3261971,MICRODEBRIDER TOPAZ EZ,ORS,A,272,,,,,,822.00,N,N
3261972,BASE TIBIAL CEMENTED SZ 7,ORS,A,278,,,,,,"1,950.00",N,N
3261973,BASE TIBIAL CEMENTED SZ 5,ORS,A,278,,,,,,"1,950.00",N,N
3261974,BLADE 7MM PRECISION THIN,ORS,A,272,,,,,,95.13,N,N
3261975,BASE TIBIAL CEMENTED SZ 8,ORS,A,278,,,,,,"1,950.00",N,N
3261976,ELECTRODE L-HOOK WIRE LAPAROSCOPIC,ORS,A,272,,,,,,107.52,N,N
3261977,BASE TIBIAL CEMENTED SZ 4,ORS,A,278,,,,,,"1,950.00",N,N
3261978,BASE TIBIAL CEMENTED SZ 6,ORS,A,278,,,,,,"1,950.00",N,N
3261979,ANCHOR HEALIX ADVANCE 4.5,ORS,A,278,,,,,,945.00,N,N
3261980,KIT ACL TWISTR,ORS,A,272,,,,,,577.50,N,N
3261981,REAMER TWISTR,ORS,A,272,,,,,,795.00,N,N
3261982,INTRAFIX ADVANCE,ORS,A,278,,,,,,"1,351.50",N,N
3261983,NAIL TFNA 11X340MM LT,ORS,A,278,,,,,,"4,505.60",N,N
3261984,ANCHOR HEALIX ADV KNOTLESS 4.75,ORS,A,278,,,,,,901.50,N,N
3261985,PATCH HERNIA VENTRALEX MED,ORS,A,278,,,,,,705.75,N,N
3261986,SUT 5-0 VICRYL J503G,ORS,A,272,,,,,,14.41,N,N
3261987,SUT NUROLON 0 C521D,ORS,A,272,,,,,,30.03,N,N
3261988,EXOFIN 1ML SKIN ADHESIVE,ORS,A,272,,,,,,50.15,N,N
3268888,SPECIAL ORDER,ORS,A,272,,,,,,0.00,N,Y
3269998,ENCHANCED BILLING,ORS,A,999,,,,,,0.00,N,N
3270003,OCC THERAPY EVALUATION,OT,A,430,97003,GO,,,,144.00,N,Y
3270005,PARAFFIN BATH,OT,A,431,97018,GO,59,,,54.00,N,Y
3270006,ULTRASOUND (PER 15 MIN),OT,A,430,97035,GO,59,,,59.00,N,Y
3270007,IONTOPHORESIS (PER 15MIN),OT,A,430,97033,GO,59,,,75.00,N,Y
3270008,ELECT STIMULATION UNATTED,OT,A,430,G0283,59,,,,61.50,N,Y
3270010,WHIRLPOOL,OT,A,431,97022,GO,59,,,71.00,N,Y
3270013,OT RE-EVAL,OT,A,434,97004,GO,,,,48.00,N,Y
3270015,CONTRAST BATH (PER 15MIN),OT,A,430,97034,GO,59,,,79.00,N,Y
3270016,THER EX/PROCEDURE PER 15 MIN,OT,A,430,97110,GO,59,,,77.00,N,Y
3270017,NEUROMUSCULAR RE-ED 15MIN,OT,A,430,97112,GO,,,,77.00,N,Y
3270018,AQUATIC THERAPY W/EX 15MI,OT,A,430,97113,GO,,,,56.50,N,Y
3270019,ORTHOTIC FIT/TRAIN 15MIN,OT,A,430,97760,GO,,,,62.00,N,Y
3270020,THERAPEUTIC ACTIVITY 15MN,OT,A,430,97530,GO,,,,54.00,N,Y
3270021,COGNITIVE SKILLS/COMP TRA,OT,A,430,97532,GO,,,,65.00,N,Y
3270022,SENSORY INTEGRATION 15MIN,OT,A,430,97533,GO,,,,54.50,N,Y
3270023,SELFCARE/HOME MANAGE 15MN,OT,A,430,97535,GO,,,,54.00,N,Y
3270024,COMMUNITY/WORK REINT 15MN,OT,A,430,97537,GO,,,,54.50,N,Y
3270025,W/C MANAGEMENT TRAIN 15MN,OT,A,430,97542,GO,,,,46.50,N,Y
3270026,MANUAL THERAPY/TRACT 15 MIN,OT,A,430,97140,GO,,,,63.00,N,N
3270027,ORTHOTIC/ PROSTHETIC CHECK,OT,A,431,97762,GO,,,,58.00,N,N
3270442,MOBILITY CURRENT STATUS-CH,OT,A,431,G8978,GO,CH,,,0.01,N,N
3270443,MOBILITY CURRENT STATUS,OT,A,431,G8978,GO,CI,,,0.01,N,N
3270444,MOBILITY CURRENT STATUS,OT,A,431,G8978,GO,CJ,,,0.01,N,N
3270445,MOBILITY CURRENT STATUS,OT,A,431,G8978,GO,CK,,,0.01,N,N
3270446,MOBILITY CURRENT STATUS,OT,A,431,G8978,GO,CL,,,0.01,N,N
3270447,MOBILITY CURRENT STATUS,OT,A,431,G8978,GO,CM,,,0.01,N,N
3270448,MOBILITY CURRENT STATUS,OT,A,431,G8978,GO,CN,,,0.01,N,N
3270449,MOBILITY GOAL STATUS,OT,A,431,G8979,GO,CH,,,0.01,N,N
3270450,MOBILITY GOAL STATUS,OT,A,431,G8979,GO,CI,,,0.01,N,N
3270451,MOBILITY GOAL STATUS,OT,A,431,G8979,GO,CK,,,0.01,N,N
3270452,MOBOLITY GOAL STATUS,OT,A,431,G8979,GO,CL,,,0.01,N,N
3270453,MOBILITY GOAL STATUS,OT,A,431,G8979,GO,CM,,,0.01,N,N
3270454,MOBILITY GOAL STATUS,OT,A,431,G8979,GO,CN,,,0.01,N,N
3270455,MOBILITY GOAL STATUS,OT,A,431,G8979,GO,CJ,,,0.01,N,N
3270456,MOBILITY DC STATUS,OT,A,431,G8980,GO,CH,,,0.01,N,N
3270457,MOBILITY DC STATUS,OT,A,431,G8980,GO,CI,,,0.01,N,N
3270458,MOBILITY DC STATUS,OT,A,431,G8980,GO,CJ,,,0.01,N,N
3270459,MOBILITY DC STATUS,OT,A,431,G8980,GO,CK,,,0.01,N,N
3270460,MOBILITY DC STATUS,OT,A,431,G8980,GO,CL,,,0.01,N,N
3270461,MOBILITY DC STATUS,OT,A,431,G8980,GO,CM,,,0.01,N,N
3270462,MOBILITY DC STATUS,OT,A,431,G8980,GO,CN,,,0.01,N,N
3270463,BODY POS CURRENT STATUS,OT,A,431,G8981,GO,CH,,,0.01,N,N
3270464,BODY POS CURRENT STATUS,OT,A,431,G8981,GO,CI,,,0.01,N,N
3270465,BODY POS CURRENT STATUS,OT,A,431,G8981,GO,CJ,,,0.01,N,N
3270466,BODY POS CURRENT STATUS,OT,A,431,G8981,GO,CK,,,0.01,N,N
3270467,BODY OS CURRENT STATUS,OT,A,431,G8981,GO,CL,,,0.01,N,N
3270468,BODY POS CURRENT STATUS,OT,A,431,G8981,GO,CM,,,0.01,N,N
3270469,BODY POS CURRENT STATUS,OT,A,431,G8981,GO,CN,,,0.01,N,N
3270470,BODY GOAL STATUS,OT,A,431,G8982,GO,CH,,,0.01,N,N
3270471,BODY POS GOAL STATUS,OT,A,431,G8982,GO,CI,,,0.01,N,N
3270472,BODY POS GOAL STATUS,OT,A,431,G8982,GO,CJ,,,0.01,N,N
3270473,BODY POS GOAL STATUS,OT,A,431,G8982,GO,CK,,,0.01,N,N
3270474,BODY POS GOAL STATUS,OT,A,431,G8982,GO,CL,,,0.01,N,N
3270475,BODY POS GOAL STATUS,OT,A,431,G8982,GO,CM,,,0.01,N,N
3270476,BODY POS GOAL STATUS,OT,A,431,G8982,GO,CN,,,0.01,N,N
3270477,BODY POS DC STATUS,OT,A,431,G8983,GO,CH,,,0.01,N,N
3270478,BODY POS DC STATUS,OT,A,431,G8983,GO,CI,,,0.01,N,N
3270479,BODY POS DC STATUS,OT,A,431,G8983,GO,CJ,,,0.01,N,N
3270480,BODY POS DC STATUS,OT,A,431,G8983,GO,CK,,,0.01,N,N
3270481,BODY POS DC STATUS,OT,A,431,G8983,GO,CL,,,0.01,N,N
3270482,BODY POS DC STATUS,OT,A,431,G8983,GO,CM,,,0.01,N,N
3270483,BODY DC STATUS,OT,A,431,G8983,GO,CN,,,0.01,N,N
3270484,CARRY CURRENT STATUS,OT,A,431,G8984,GO,CH,,,0.01,N,N
3270485,CARRY CURRENT STATUS,OT,A,431,G8984,GO,CI,,,0.01,N,N
3270486,CARRY CURRENT STATUS,OT,A,431,G8984,GO,CJ,,,0.01,N,N
3270487,CARRY CURRENT STATUS,OT,A,431,G8984,GO,CK,,,0.01,N,N
3270488,CARRY CURRENT STATUS,OT,A,431,G8984,GO,CL,,,0.01,N,N
3270489,CARRY CURRENT STATUS,OT,A,431,G8984,GO,CM,,,0.01,N,N
3270490,CARRY CURRENT STATUS,OT,A,431,G8984,GO,CN,,,0.01,N,N
3270491,CARRY GOAL STATUS,OT,A,431,G8985,GO,CH,,,0.01,N,N
3270492,CARRY GOAL STATUS,OT,A,431,G8985,GO,CI,,,0.01,N,N
3270493,CARRY GOAL STATUS,OT,A,431,G8985,GO,CJ,,,0.01,N,N
3270494,CARRY GOAL STATUS,OT,A,431,G8985,GO,CK,,,0.01,N,N
3270495,CARRY GOAL STATUS,OT,A,431,G8985,GO,CL,,,0.01,N,N
3270496,CARRY GOAL STATUS,OT,A,431,G8985,GO,CM,,,0.01,N,N
3270497,CARRY GOAL STATUS,OT,A,431,G8985,GO,CN,,,0.01,N,N
3270498,CARRY DC STATUS,OT,A,431,G8986,GO,CH,,,0.01,N,N
3270499,CARRY DC STATUS,OT,A,431,G8986,GO,CI,,,0.01,N,N
3270500,CARRY DC STATUS,OT,A,431,G8986,GO,CJ,,,0.01,N,N
3270501,CARRY DC STATUS,OT,A,431,G8986,GO,CK,,,0.01,N,N
3270502,CARRY DC STATUS,OT,A,431,G8986,GO,CL,,,0.01,N,N
3270503,CARRY DC STATUS,OT,A,431,G8986,GO,CM,,,0.01,N,N
3270504,CARRY DC STATUS,OT,A,431,G8986,GO,CN,,,0.01,N,N
3270505,SELF CARE CURRENT STATUS,OT,A,431,G8987,GO,CH,,,0.01,N,N
3270506,SELF CARE CURRENT STATUS,OT,A,431,G8987,GO,CI,,,0.01,N,N
3270507,SELF CARE CURRENT STATUS,OT,A,431,G8987,GO,CJ,,,0.01,N,N
3270508,SELF CARE CURRENT STATUS,OT,A,431,G8987,GO,CK,,,0.01,N,N
3270509,SELF CARE CURRENT STATUS,OT,A,431,G8987,GO,CL,,,0.01,N,N
3270510,SELF CARE CURRENT STATUS,OT,A,431,G8987,GO,CM,,,0.01,N,N
3270511,SELF CARE CURRENT STATUS,OT,A,431,G8987,GO,CN,,,0.01,N,N
3270512,SELF CARE GOAL STATUS,OT,A,431,G8988,GO,CH,,,0.01,N,N
3270513,SELF CARE GOAL STATUS,OT,A,431,G8988,GO,CI,,,0.01,N,N
3270514,SELF CARE GOAL STATUS,OT,A,431,G8988,GO,CJ,,,0.01,N,N
3270515,SELF CARE GOAL STATUS,OT,A,431,G8988,GO,CK,,,0.01,N,N
3270516,SELF CARE GOAL STATUS,OT,A,431,G8988,GO,CL,,,0.01,N,N
3270517,SELF CARE GOAL STATUS,OT,A,431,G8988,GO,CM,,,0.01,N,N
3270518,SELF CARE GOAL STATUS,OT,A,431,G8988,GO,CN,,,0.01,N,N
3270519,SELF CARE DC STATUS,OT,A,431,G8989,GO,CH,,,0.01,N,N
3270520,SELF CARE DC STATUS,OT,A,431,G8989,GO,CI,,,0.01,N,N
3270521,SELF CARE DC STATUS,OT,A,431,G8989,GO,CJ,,,0.01,N,N
3270522,SELF CARE DC STATUS,OT,A,431,G8989,GO,CK,,,0.01,N,N
3270523,SELF CARE DC STATUS,OT,A,431,G8989,GO,CL,,,0.01,N,N
3270524,SELF CARE DC STATUS,OT,A,431,G8989,GO,CM,,,0.01,N,N
3270525,SELF CARE DC STATUS,OT,A,431,G8989,GO,CN,,,0.01,N,N
3270526,OTHER PT OT CURRENT STATUS,OT,A,431,G8990,GO,CH,,,0.01,N,N
3270527,OTHER PT OT CURRENT STATUS,OT,A,431,G8990,GO,CI,,,0.01,N,N
3270528,OTHER PT OT CURRENT STATUS,OT,A,431,G8990,GO,CJ,,,0.01,N,N
3270529,OTHER PT OT CURRENT STATUS,OT,A,431,G8990,GO,CK,,,0.01,N,N
3270530,OTHER PT OT CURRENT STATUS,OT,A,431,G8990,GO,CL,,,0.01,N,N
3270531,OTHER PT OT CURRENT STATUS,OT,A,431,G8990,GO,CM,,,0.01,N,N
3270532,OTHER PT OT CURRENT STATUS,OT,A,431,G8990,GO,CN,,,0.01,N,N
3270533,OTHER PT OT GOAL STATUS,OT,A,431,G8991,GO,CH,,,0.01,N,N
3270534,OTHER PT OT GOAL STATUS,OT,A,431,G8991,GO,CI,,,0.01,N,N
3270535,OTHER PT OT GOAL STATUS,OT,A,431,G8991,GO,CJ,,,0.01,N,N
3270536,OTHER PT OT GOAL STATUS,OT,A,431,G8991,GO,CK,,,0.01,N,N
3270537,OTHER PT OT GOAL STATUS,OT,A,431,G8991,GO,CL,,,0.01,N,N
3270538,OTHER PT OT GOAL STATUS,OT,A,431,G8991,GO,CM,,,0.01,N,N
3270539,OTHER PT OT GOAL STATUS,OT,A,431,G8991,GO,CN,,,0.01,N,N
3270540,OTHER PT OT DC STATUS,OT,A,431,G8992,GO,CH,,,0.01,N,N
3270541,OTHER PT OT DC STATUS,OT,A,431,G8992,GO,CI,,,0.01,N,N
32705417,SUB PT OT CURRENT STATUS,OT,A,431,G8993,GO,CH,,,0.01,N,N
3270542,OTHER PT OT DC STATUS,OT,A,431,G8992,GO,CJ,,,0.01,N,N
3270543,OTHER PT OT DC STATUS,OT,A,431,G8992,GO,CK,,,0.01,N,N
3270544,OTHER PT OT DC STATUS,OT,A,431,G8992,GO,CL,,,0.01,N,N
3270545,OTHER PT OT DC STATUS,OT,A,431,G8992,GO,CM,,,0.01,N,N
3270546,OTHER PT OT DC STATUS,OT,A,431,G8992,GO,CN,,,0.01,N,N
3270548,SUB PT OT CURRENT STATUS,OT,A,431,G8993,GO,CI,,,0.01,N,N
3270549,SUB PT OT CURRENT STATUS,OT,A,431,G8993,GO,CJ,,,0.01,N,N
3270550,SUB PT OT CURRENT STATUS,OT,A,431,G8993,GO,CK,,,0.01,N,N
3270551,SUB PT OT CURRENT STATUS,OT,A,431,G8993,GO,CL,,,0.01,N,N
3270552,SUB PT OT CURRENT STATUS,OT,A,431,G8993,GO,CM,,,0.01,N,N
3270553,SUB PT OT CURRENT STATUS,OT,A,431,G8993,GO,CN,,,0.01,N,N
3270554,SUB PT OT GOAL STATUS,OT,A,431,G8994,GO,CH,,,0.01,N,N
3270555,SUB PT OT GOAL STATUS,OT,A,431,G8994,GO,CI,,,0.01,N,N
3270556,SUB PT OT GOAL STATUS,OT,A,431,G8994,GO,CJ,,,0.01,N,N
3270557,SUB PT OT GOAL STATUS,OT,A,431,G8994,GO,CK,,,0.01,N,N
3270558,SUB PT OT GOAL STATUS,OT,A,431,G8994,GO,CL,,,0.01,N,N
3270559,SUB PT OT GOAL STATUS,OT,A,431,G8994,GO,CM,,,0.01,N,N
3270560,SUB PT OT GOAL STATUS,OT,A,431,G8994,GO,CN,,,0.01,N,N
3270561,SUB PT OT DC STATUS,OT,A,431,G8995,GO,CH,,,0.01,N,N
3270562,SUB PT OT DC STATUS,OT,A,431,G8995,GO,CI,,,0.01,N,N
3270563,SUB PT OT DC STATUS,OT,A,431,G8995,GO,CJ,,,0.01,N,N
3270564,SUB PT OT DC STATUS,OT,A,431,G8995,GO,CK,,,0.01,N,N
3270565,SUB PT OT DC STATUS,OT,A,431,G8995,GO,CL,,,0.01,N,N
3270566,SUB PT OT DC STATUS,OT,A,431,G8995,GO,CM,,,0.01,N,N
3270567,SUB PT OT DC STATUS,OT,A,431,G8995,GO,CN,,,0.01,N,N
3270568,HAND FINGER STRAPPING,OT,A,430,29280,GO,,,,21.00,N,N
3270569,ELBOW WRIST STRAPPING,OT,A,430,29260,GO,,,,26.50,N,N
3270570,ORTHOTIC PROSETHETIC RECHECK,OT,A,430,97762,GO,,,,58.00,N,N
3270571,THERAPEUTIC PROCEDURE GROUP,OT,A,430,97150,GO,,,,44.00,N,N
3270572,EVAL LOW 30,OT,A,430,97165,GO,59,,,113.50,N,N
3270573,EVAL MOD 45,OT,A,430,97166,GO,59,,,113.50,N,N
3270574,EVAL HIGH 60,OT,A,430,97167,GO,59,,,113.50,N,N
3270575,RE EVAL,OT,A,430,97168,GO,59,,,59.00,N,N
3280003,OR RECOVERY,REC,A,710,,,,,,281.50,N,Y
3300001,ORTHO IP PROB FOCUSED,ORP,A,960,99231,,,,,48.00,N,Y
3300002,ORTHO IP EXPANDED,ORP,A,960,99232,,,,,87.00,N,Y
3300003,ORTHO INPATIENT DETAILED,ORP,A,960,99233,,,,,137.00,N,Y
3300004,ORTHO INPATIENT LEVEL 4,ORP,A,960,99234,,,,,215.00,N,Y
3300005,ORTHO ADMIT IP PROB FOCUS,ORP,A,960,99221,,,,,165.00,N,Y
3300006,ORTHO IP ADMIT EXPANDED,ORP,A,960,99222,,,,,220.00,N,Y
3300007,ORTHO IP ADMIT DETAILED,ORP,A,960,99223,,,,,303.00,N,Y
3300008,ORTHO DISCHARGEDAY<30MIN,ORP,A,960,99238,,,,,132.00,N,Y
3300009,ORTHO DISCHARDAY>30MIN,ORP,A,960,99239,,,,,165.00,N,Y
3300010,ORTHO SNF PROBLEM FOCUSED,ORP,A,960,99307,,,,,86.00,N,Y
3300011,ORTHO SNF PROBLEM EXPANDE,ORP,A,960,99308,,,,,132.00,N,Y
3300012,OTHO SNF DETAILED,ORP,A,960,99309,,,,,172.00,N,Y
3300013,ORTHO SNF COMPREHENSIVE,ORP,A,960,99310,,,,,252.00,N,Y
3300014,ORTHO SNF DISCHARGE<30MIN,ORP,A,960,99315,,,,,116.00,N,Y
3300015,ORTHO SNF DISCHARGE>30MIN,ORP,A,960,99316,,,,,153.00,N,Y
3300016,HIP PINNING PRO FEES,ORP,A,960,,,,,,"2,420.00",N,Y
3300017,GANGLION CYST/MASS REMOVAL PRO FEES,ORP,A,960,,,,,,550.00,N,Y
3300018,CARPAL TUN/TRIG REL PROFE,ORP,A,960,,,,,,946.00,N,Y
3300019,ORTHO KNEE ARTHROSCOPIC,ORP,A,960,,,,,,"1,320.00",N,Y
3300020,TIBIA FRACTURE PRO FEES,ORP,A,960,,,,,,"1,980.00",N,Y
3300021,ACHILLES TENDON REPAIR,ORP,A,960,,,,,,"1,320.00",N,Y
3300022,TRIGGER INJECTION-PRO FEE,ORP,A,960,,,,,,127.00,N,Y
3300023,REMOVAL OF HARDWARE- PRO,ORP,A,960,,,,,,"1,430.00",N,Y
3300024,EXCISION PREPATELLA BURSA,ORP,A,960,,,,,,825.00,N,Y
3300025,ARTHOPLASTY REPLACE HIP-,ORP,A,960,,,,,,"3,410.00",N,Y
3300026,PRO FEES TOTAL KNEE REPLA,ORP,A,960,,,,,,"2,860.00",N,Y
3300027,OPEN SHOULDER RPR PRO,ORP,A,960,,,,,,"2,200.00",N,Y
3300028,ARTHROPLASTY THUMB PRO FE,ORP,A,960,,,,,,"1,320.00",N,Y
3300029,TENDON GRAFT PRO FEES,ORP,A,960,,,,,,"1,320.00",N,Y
3300030,ARTHROSCOPIC ACL RPR-PRO,ORP,A,960,,,,,,"1,980.00",N,Y
3300031,KNEE MENISCAL RPR- PRO FE,ORP,A,960,,,,,,"1,100.00",N,Y
3300032,SINGLE TEND TENOTOMY-PRO,ORP,A,960,,,,,,825.00,N,Y
3300033,MANIPULATION W/ ANES- PRO,ORP,A,960,,,,,,446.00,N,Y
3300034,OSTEOCHONDRAL AUTO- PROF,ORP,A,960,,,,,,"1,980.00",N,Y
3300035,ARTH SHOULD ROT CUFF PRO,ORP,A,960,,,,,,"2,090.00",N,Y
3300036,ANKLE OPEN RED INT FIX PR,ORP,A,960,,,,,,"1,320.00",N,Y
3300037,REPAIR QUAD TENDON- PRO,ORP,A,960,,,,,,"1,045.00",N,Y
3300038,ELBOW FRAC CLOSED RED PRO,ORP,A,960,,,,,,"1,320.00",N,Y
3300039,OPEN RED FOREARM PRO FEES,ORP,A,960,,,,,,"1,375.00",N,Y
3300040,KNEE ANTHRO REM FOR BODY-,ORP,A,960,,,,,,193.00,N,Y
3300041,HEMIARTHROPLASTY- PRO FEE,ORP,A,960,,,,,,"1,760.00",N,Y
3300042,ID OF WOUND- PRO FEE,ORP,A,960,,,,,,605.00,N,Y
3300043,AMPUTATION METACARP-PRO F,ORP,A,960,,,,,,880.00,N,Y
3300044,IP CONSULT,ORP,A,960,99221,,,,,77.00,N,Y
3300045,OP CONSULT,ORP,A,960,99211,,,,,55.00,N,Y
3300046,HEMI-ARTH HIP REPLAC PRO,ORP,A,960,,,,,,"2,310.00",N,Y
3300047,ULNAR NERVE TRANS- PRO,ORP,A,960,,,,,,"1,100.00",N,Y
3300048,BICEP TENDON RPR- PRO,ORP,A,960,,,,,,"1,320.00",N,Y
3300049,OP RED INT FIX WRIST-PRO,ORP,A,960,,,,,,"1,210.00",N,Y
3300050,OP RED INT FIX CLAV- PROF,ORP,A,960,,,,,,"1,430.00",N,Y
3300051,OP RED INT FIX FINGER-PRO,ORP,A,960,,,,,,"1,045.00",N,Y
3300052,SHOULD DECOMPRESS-PRO,ORP,A,960,,,,,,770.00,N,Y
3300053,ARTHROSCOPY SHOULDER,ORP,A,960,,,,,,"1,210.00",N,Y
3300054,PART LAT/MEDIAL MENISCECTOMY-PRO,ORP,A,960,,,,,,"1,320.00",N,Y
3300055,ARTHRO SHOULDER-PRO FEES,ORP,A,960,,,,,,"2,200.00",N,Y
3300056,I&D OF DEEP ABCESS-PRO FE,ORP,A,960,,,,,,"1,320.00",N,Y
3300057,REVISION OF KNEE ARTH-PRO,ORP,A,960,,,,,,"2,750.00",N,Y
3300058,TIBIAL PLATEAU FRX-PRO,ORP,A,960,,,,,,"1,815.00",N,Y
3300059,ASPIRAAND/OR INJEC GANGCY,ORP,A,960,,,,,,88.00,N,Y
3300060,LAY CLOSURE - PRO FEES,ORP,A,960,,,,,,770.00,N,Y
3300061,REVISION HIP ARTHRO- PRO,ORP,A,960,,,,,,"3,080.00",N,N
3300062,OPEN SURGICAL RED- PRO FE,ORP,A,960,,,,,,"1,760.00",N,N
3300063,RPR FRAC W BONE GRA-PRO,ORP,A,960,,,,,,"1,430.00",N,N
3300064,DEBRIDEMENT OF BONE-PROF,ORP,A,960,,,,,,550.00,N,N
3300065,DEBRIDEMENT SOFT TISS-PRO,ORP,A,960,11043,,,,,468.00,N,N
3300066,WRIST FRACTURE CL RED-PRO,ORP,A,960,,,,,,880.00,N,N
3300067,"EXCISION, ELBOW BURSA PRO",ORP,A,960,,,,,,677.00,N,N
3300068,PRO FEES- OPEN TX FEMORAL SUPR,ORP,A,960,27511,,,,,"1,980.00",N,N
3300069,APPLICATION UNI EXT FIXATION SYS,ORP,A,960,99999,,,,,"1,155.00",N,N
,,ORP,A,960,99998,,,,,"1,155.00",N,N
3300070,CLD TRMT TIBIAL FRACTURE,ORP,A,960,99998,,,,,"1,210.00",N,N
,,ORP,A,960,99999,,,,,"1,210.00",N,N
3300071,"PRO FEES- CLD TRMT PHAL FRAC, W/MANIP",ORP,A,960,,,,,,617.00,N,N
3300072,PERCUT SKELETAL FIX UNSTABLE PHALANG,ORP,A,960,26727,,,,,495.00,N,Y
3300073,CLOSED RED ANKLE-PRO,ORP,A,960,27810,,,,,963.00,N,N
3300074,ARTHROTOMY KNEE REMOVAL--PRO FEES,ORP,A,960,27310,,,,,"1,320.00",N,N
3300075,ORIT PROIXMAL HUMERUS RX,ORP,A,960,23615,,,,,"2,310.00",N,N
3300076,ARTHROSCOPY BICEPS TENODESIS,ORP,A,960,29828,,,,,"2,420.00",N,N
3300077,ARTHROSCOPYKNEE SURG INFEC LAVAGE &DRAIN,ORP,A,960,29871,,,,,"1,342.00",N,N
3300078,CLD RED PERCUT PINNING SM FINGER- PRO FE,ORP,A,960,26608,,,,,"1,018.00",N,Y
3300079,"DEBRIDEMENT, SUB TISSUE 20 SQ-PRO",ORP,A,960,,,,,,275.00,N,N
3300080,CLSD TRMT OF FEM FRAC DISTAL- PRO FEE,ORP,A,960,,,,,,"1,320.00",N,Y
3300081,"KNEE ARTHO SURG, LIM SYNO- PRO FEE",ORP,A,960,,,,,,963.00,N,Y
3300082,"TENOTOMY, ABD/EXTEN HIP OPEN-PRO FEE",ORP,A,960,27006,,,,,"1,705.00",N,Y
3300083,EXCIS SOFT TUMOR KNEE/THIGH- PRO FEE,ORP,A,960,,,,,,"1,128.00",N,Y
3300084,OPEN RED FIXATION HIP- PRO,ORP,A,960,,,,,,"2,420.00",N,Y
3300085,OPEN ROTATOR CUFF- PRO FEE,ORP,A,960,,,,,,"1,617.00",N,Y
3300086,"TENOTOMY, SHOULDER- PRO FEE",ORP,A,960,23405,,,,,"1,265.00",N,Y
3300087,SHOULDER ARTHRO DECOMPRESS-PRO,ORP,A,960,29826,,,,,358.00,N,Y
3300088,OPEN RED FIXATION ELBOW-PRO FEE,ORP,A,960,24685,,,,,"1,293.00",N,Y
3300089,"FOOT, REMOVAL OF FOR BODY, PRO FEE",ORP,A,960,,,,,,715.00,N,N
3300090,OPEN RPR EXT TENDON-PRO,ORP,A,960,99999,,,,,908.00,N,N
3300091,REV TOTAL KNEE ARTHRO-PRO,ORP,A,960,27486,,,,,"2,750.00",N,N
3300092,"REMOVAL OF IMPLANT, DEEP, PRO FEE",ORP,A,960,20680,,,,,825.00,N,N
3300093,OPEN RED INT FIX DISTAL RADIUS,ORP,A,960,25607,,,,,"1,650.00",N,N
3300094,PERCUTANEOUS PINNING DISTAL ULNA,ORP,A,960,25651,,,,,"1,100.00",N,N
3300095,OPEN RED INT FIX PROX HUMERUS,ORP,A,960,23615,,,,,"1,980.00",N,Y
3300096,"DEBRIDE, SUB TISSUE, EA ADD- PRO FEE",ORP,A,960,11045,,,,,94.00,N,N
3300097,OPEN TX PATELLAR FRACTURE PRO FEE,ORP,A,960,27524,,,,,"1,843.00",N,Y
3300098,EXC BENIGN LESION 3.1-4.0- PRO FEES,ORP,A,960,11424,,,,,578.00,N,N
3300099,OPEN TRMT OF FEMORAL FRACTURE,ORP,A,960,27236,,,,,"2,750.00",N,N
3300100,ARTHROPLASTY; RADIAL HEAD PRO,ORP,A,960,24365,,,,,"1,287.00",N,Y
3300101,"ARTH, KNEE, FOR REMOVAL FB OR LOOSE BODY",ORP,A,960,29874,,,,,"1,320.00",N,Y
3300102,ARTHOR MAJOR JOINT W/O ULTRASOUND GUID,ORP,A,960,20610,,,,,127.00,N,Y
3300103,"OPEN TX TIBIAL FRAC, PROXIMAL; UNICONDYL",ORP,A,960,27535,,,,,"1,815.00",N,Y
3300104,LACE REP <2.5CM EXGT&OE,OR,A,960,12001,,,,,216.00,N,Y
3300105,EXCISION BENIGN LESION INCLUDING MARGINS,ORP,A,960,11422,,,,,366.00,N,Y
3300106,OPEN TREAT FEM SHAFT FX W/ PLATE/SCREWS,ORP,A,960,27507,,,,,"2,420.00",N,Y
3300107,RECONSTRUCT COMPLETE SHOULD CUFF AVUL,ORP,A,960,23420,,,,,"2,393.00",N,Y
3300108,DEBRID INC REM OF FB AT SITE OF OPEN FX,ORP,A,960,11010,,,,,688.00,N,Y
3300109,"REPAIR PRIMARY LIGAMENT, ANKLE, COLLATER",ORP,A,960,27695,,,,,"1,174.00",N,Y
3300110,ARTHROSCOPY SHOULDER SURG DEBRID LIMITED,ORP,A,960,29822,,,,,"1,544.00",N,Y
3300111,INCISION; EXTENSOR TEND SHEATH WRIST,ORP,A,960,25000,,,,,820.00,N,Y
3300112,"OPEN TX METATARSAL FX, INCLUDES INT FIX",ORP,A,960,28485,,,,,"1,320.00",N,Y
3300113,REM OF PROSTH; INC TOTAL KNEE PROSTH,ORP,A,960,27488,,,,,"2,970.00",N,Y
3300114,REPAIR EXTENSOR TEND LEG PRIMARY,ORP,A,960,27664,,,,,880.00,N,Y
3300115,"CLSD TR METACARP FRAC, SINGLE, W/ MANIP",ORP,A,960,26605,,,,,792.00,N,Y
3300116,"ARTHRO; INTRPOSITION, INTERCARP OR CARPO",ORP,A,960,25447,,,,,"2,200.00",N,Y
3300117,"TRANSPL OF TENDON, CMC OR DORS EACH TEN",ORP,A,960,26483,,,,,"2,310.00",N,Y
3300118,RECONST DISLOCAT PATELLA W/ REALIGN,ORP,A,960,27422,,,,,"2,035.00",N,Y
3300119,"DEBRIDEMENT, SUB TISSUE, FIRST 20 SQ",ORP,A,960,11042,,,,,275.00,N,Y
3300120,"DEB OPEN WND, PER SESS FIRST 20SQCM OR <",ORP,A,960,97597,,,,,110.00,N,Y
3300121,"NEG PRESS WOUND THER, < OR = 50 SQ CENT",ORP,A,960,97605,,,,,83.00,N,Y
3300122,"RPR, TEND-MUSC UPP ARM OR ELBOW; EACH",ORP,A,960,,,,,,"2,090.00",N,Y
3300123,"ARTHROTOMY, ELBOW, W/SYNOVECTOMY",ORP,A,960,24102,,,,,"1,530.00",N,Y
3300124,"TENOTOMY, ELBOW, LAT/MED DEBRIDEMT OPEN",ORP,A,960,24358,,,,,"1,300.00",N,Y
3300125,INCISION&REM OF FOREIGN BODY SIMPLE,ORP,A,960,10120,,,,,263.00,N,Y
3300126,COLONOSCOPY - PROF,ORP,A,960,,,,,,"1,200.00",N,Y
3300127,LAP CHOLE - PROF,ORP,A,960,47562,,,,,"1,650.00",N,Y
3300128,EGD - PROF,ORP,A,960,43235,,,,,650.00,N,Y
3300129,EXC MAL LES INCL MARG OVER 4 CM - PROF,ORP,A,960,11626,,,,,"1,000.00",N,Y
3300130,"EXC PILONIDAL CYST OR SINUS, PROF",ORP,A,960,11771,,,,,"1,430.00",N,Y
3300131,INC AND DRAINAGE HEMATOMA,ORP,A,960,10140,,,,,425.00,N,Y
3300132,"REPAIR, PRIM, TORN LIG, KNEE, COLL, PROF",ORP,A,960,27405,,,,,"1,700.00",N,Y
3309805,SHOULDER ARTHOROSCOPY DIAG,ORP,A,960,29805,,,,,"1,018.00",N,N
3310001,ORTHO LEVEL 1 NEW,ORT,A,983,99201,,,,,98.00,N,Y
3310002,ORTHO LEVEL 2 NEW,ORT,A,983,99202,,,,,135.00,N,Y
3310003,ORTHO LEVEL 3 NEW,ORT,A,983,99203,,,,,177.00,N,Y
3310004,ORTHO LEVEL 4 NEW,ORT,A,983,99204,,,,,265.00,N,Y
3310005,ORTHO LEVEL 5 NEW,ORT,A,960,99205,,,,,328.00,N,Y
3310006,ORTHO LEVEL 1 EST,ORT,A,960,99211,,,,,70.00,N,Y
3310007,ORTHO LEVEL 2 EST,ORT,A,983,99212,,,,,98.00,N,Y
3310008,ORTHO LEVEL 3 EST,ORT,A,983,99213,,,,,135.00,N,Y
3310009,ORTHO LEVEL 4 EST,ORT,A,983,99214,,,,,185.00,N,Y
3310010,ORTHO LEVEL 5 EST,ORT,A,983,99215,,,,,250.00,N,Y
3310011,ARTHRO MAJOR JOINT,ORT,A,990,20610,,,,,121.00,N,Y
3310012,DEPO MEDROL INJ 40MG,ORT,A,990,J1030,,,,,13.00,N,Y
3310013,ARTHRO SMALL JOINT,ORT,A,983,20600,,,,,100.00,N,Y
3310014,APPLIC FINGER SPLINT,ORT,A,990,29130,,,,,58.00,N,Y
3310015,ORTHO F-UP VIST NO CHARGE,ORT,A,960,99024,,,,,0.00,N,Y
3310016,ANTHRO INTERMED JOINT,ORT,A,960,20605,,,,,101.00,N,Y
3310017,APPLICATION LONG ARM CAST,ORT,A,960,29065,,,,,199.00,N,Y
3310018,DEXAMETHASONE P 1MG INJ,ORT,A,990,J1100,,,,,2.00,N,Y
3310019,SYNVISC-ONE PER 1MG,ORT,A,960,J7325,,,,,35.50,N,Y
3310020,ORTHOVISC INJ PER 30 MG,ORT,A,636,J7324,,,,,720.00,N,Y
3310021,APPL OF SHORT ARM CAST,ORT,A,960,29075,,,,,139.00,N,Y
3310022,APP SHORT ARM SPLINT,ORT,A,960,29125,,,,,98.00,N,Y
3310023,INJ TEND LIGAMENT OR TRIG,ORT,A,960,20550,,,,,109.00,N,Y
3310024,APPLICATION SHORT LEG CAS,ORT,A,960,29405,,,,,189.00,N,Y
3310025,AVULSION OF NAIL,ORT,A,960,11730,,,,,120.00,N,Y
3310026,ASPIR AND/OR INJEC GANGCY,ORT,A,960,20612,,,,,126.00,N,Y
3310027,INJ THEXAPEUTIC CARPALTUN,ORT,A,510,20526,,,,,142.00,N,Y
3310028,APPL LONG ARM SPLINT,ORT,A,960,29105,,,,,120.00,N,Y
3310029,TR CLOSED MEACARPAL FX,ORT,A,960,26600,,,,,420.00,N,Y
3310030,CL TR DISTAL RADIAL FX,ORT,A,960,25600,,,,,525.00,N,Y
3310031,CL TR CARPAL SCAPH FX WO,ORT,A,960,25622,,,,,551.50,N,Y
3310032,KETOROLAC 15 MG,ORT,A,990,J1885,,,,,16.00,N,Y
3310033,IMTHERPEUTIC INJECTION,ORT,A,960,96372,,,,,52.00,N,Y
3310034,FRACTURE CARE FOOT/ANKLE,ORT,A,960,,,,,,321.50,N,Y
3310035,FX CARE/ELBOW,ORT,A,960,24620,,,,,525.00,N,Y
3310036,FX CARE PHALANGES,ORT,A,960,26720,,,,,350.00,N,Y
3310037,CLTREAT BIMALLEOLAR FX,ORT,A,960,27808,,,,,550.00,N,Y
3310038,FX CARE TIBIA W/ FIBULA,ORT,A,960,27750,,,,,350.00,N,Y
3310039,FX CARE FIBULA SHAFT,ORT,A,960,27780,,,,,550.00,N,N
3310040,FX CARE PROX TIBIA,ORT,A,960,27530,,,,,550.00,N,N
3310041,SYNVISC INJECTION,ORT,A,960,J3490,,,,,"1,442.00",N,N
3310042,FX CARE LAT MALLEOLUS,ORT,A,960,27786,,,,,500.00,N,Y
3310043,FX CARE MED CONDYLE HUMERUS,ORT,A,960,24576,,,,,755.00,N,N
3310044,TRIGGER PT INJ 1/2 MUSC,ORT,A,960,20552,,,,,115.00,N,N
3310045,FX CARE DISTAL RADIUS W/ ULNA,ORT,A,960,25560,,,,,300.00,N,N
3310046,FX CARE SUPRACONDYLAR HUMERUS,ORT,A,960,24530,,,,,650.00,N,N
3310047,FX CARE HUMERUS; GREAT TUBEROSITY,ORT,A,960,23620,,,,,600.00,N,N
3310048,FRACTURE CARE CLAVICLE,ORT,A,960,23500,,,,,445.00,N,N
3310049,FRACTURE CARE MEDIAL MALLEOLUS,ORT,A,960,27760,,,,,615.00,N,N
3310050,FX CARE HEAD OF RADIUS,ORT,A,960,24650,,,,,565.00,N,N
3310051,FX CARE TRIMALLEOLAR ANKLE,ORT,A,960,27816,,,,,675.00,N,N
3310052,FRACTURE CARE METATARSAL BONE,ORT,A,960,28470,,,,,488.00,N,N
3310053,MONOVISC 88 MG,ORT,A,960,J7327,,,,,"1,950.00",N,Y
3310054,FRACTURE CARE OLECRANON PROCESS;ULNA,ORT,A,960,24670,,,,,310.00,N,Y
3310055,APPLICATION SHORT LEG CAST,ORT,A,990,29425,,,,,182.00,N,Y
3310056,APPLICATION LONG LEG CAST,ORT,A,990,29345,,,,,180.00,N,N
3310201,MEDICARE OV NP LEVEL 1,ORT,A,510,99201,,,,,29.40,N,N
3310202,MEDICARE OV NP LEVEL 1,ORT,A,510,99202,,,,,40.50,N,N
3310203,MEDICARE OV NP LEVEL 3,ORT,A,510,99203,,,,,53.10,N,N
3310204,MEDICARE OV NP LEVEL 4,ORT,A,510,99204,,,,,79.50,N,N
3310205,MEDICARE OV NP LEVEL 5,ORT,A,510,99205,,,,,98.40,N,N
3310206,MEDICARE OV EP LEVEL 1,ORT,A,510,99211,,,,,21.00,N,N
3310207,MEDICARE OV EP LEVEL 2,ORT,A,510,99212,,,,,29.40,N,N
3310208,MEDICARE OV EP LEVEL 3,ORT,A,510,99213,,,,,40.50,N,N
3310209,MEDICARE OV EP LEVEL 4,ORT,A,510,99214,,,,,55.50,N,N
3310210,MEDICARE OV EP LEVEL 5,ORT,A,510,99215,,,,,75.00,N,N
3319217,OBSERVATION DISCHARGE,ORP,A,990,99217,,,,,112.00,N,Y
3319218,OBSERVATION LEVEL 1,ORP,A,990,99218,,,,,107.00,N,Y
3319441,E/M TELEPHONE SERV 5-10 MIN,ORT,A,990,99441,,,,,20.00,N,N
3319442,E/M TELEPHONE SERV 11-20 MIN,ORT,A,990,99442,,,,,40.00,N,N
3319443,E/M TELEPHONE SERV 21-30 MIN,ORT,A,990,99443,,,,,60.00,N,N
3319515,APPLICATION SHORT LEG SPL,ORT,A,990,29515,,,,,92.00,N,N
3319924,SUBSEQUENT OBS CARE 1,ORP,A,990,99224,,,,,55.00,N,Y
3320201,NEW PT LEVEL 1,ORC,A,983,99201,,,,,86.00,N,Y
3320202,NEW PT LEVEL 2,ORC,A,983,99202,,,,,132.00,N,Y
3320203,NEW PT LEVEL 3,ORC,A,983,99203,,,,,149.00,N,Y
3320204,NEW PT LEVEL 4,ORC,A,983,99204,,,,,292.00,N,Y
3320205,NEW PT LEVEL 5,ORC,A,983,99205,,,,,315.00,N,Y
3320211,EST PT LEVEL 1,ORC,A,983,99211,,,,,52.00,N,Y
3320212,EST PT LEVEL 2,ORC,A,983,99212,,,,,75.00,N,Y
3320213,EST PT LEVEL 3,ORC,A,983,99213,,,,,120.00,N,Y
3320214,EST PT LEVEL 4,ORC,A,983,99214,,,,,177.00,N,Y
3320215,EST PT LEVEL 5,ORC,A,983,99215,,,,,223.00,N,Y
3322201,NEW PT MED LEVEL 1,ORC,A,510,99201,,,,,25.80,N,N
3322202,NEW PT MED LEVEL 2,ORC,A,510,99202,,,,,39.60,N,N
3322203,NEW PT MED LEVEL 3,ORC,A,510,99203,,,,,44.70,N,N
3322204,NEW PT MED LEVEL 4,ORC,A,510,99204,,,,,87.60,N,N
3322205,NEW PT MED LEVEL 5,ORC,A,510,99205,,,,,94.50,N,N
3322211,EST PT MED LEVEL 1,ORC,A,510,99211,,,,,15.60,N,N
3322212,EST PT MED LEVEL 2,ORC,A,510,99212,,,,,22.50,N,N
3322213,EST PT MED LEVEL 3,ORC,A,510,99213,,,,,36.00,N,N
3322214,EST PT MED LEVEL 4,ORC,A,510,99214,,,,,53.10,N,N
3322215,EST PT MED LEVEL 5,ORC,A,510,99215,,,,,66.90,N,N
3323301,KENALOG PER 10 MG,ORC,A,636,J3301,,,,,5.00,N,Y
3326372,"THERA, PROPHY, DIAINJ, SUBCU",ORC,A,960,96372,,,,,52.00,N,Y
3329024,GLOBAL/POST OP VISIT,ORC,A,983,99024,,,,,0.00,N,N
3330021,FINE NEEDLE ASPIRATION W/O IMAGING,ERP,A,981,10021,,,,,300.00,N,Y
3330060,DRAINAGE OF SKIN ABCESS,ERP,A,981,10060,,,,,240.00,N,Y
3330061,SIMP INCIS DR MULT LESION,ERP,A,981,10061,,,,,337.00,N,Y
3330080,INCISI DRAIN PILONID CYST,ERP,A,981,10080,,,,,213.00,N,Y
3330103,EXP PENETR WOUND EXT,ERP,A,981,20103,,,,,848.00,N,Y
3330120,INCISION&REM OF FOREI SIM,ERP,A,981,10120,,,,,263.00,N,Y
3330121,COMP INCIS REMOVAL FB,ERP,A,981,10121,,,,,421.00,N,Y
3330140,INCISION & DRAINAGE,ERP,A,981,10140,,,,,306.00,N,Y
3330160,PUNCT ASPIR ABCESS HEMATO,ERP,A,981,10160,,,,,208.00,N,Y
3330168,WOUND CLOSURE BY ADHESIVE,ERP,A,981,G0168,,,,,204.00,N,Y
3330252,LACERATION TONGUE REPAIR >2.5CM,ERP,A,981,41252,,,,,561.00,N,N
3330281,ER PROFESSIONAL LEVEL 1,ERP,A,981,99281,,,,,42.00,N,Y
3330282,ER PROFESSIONAL LEVEL 2,ERP,A,981,99282,,,,,66.00,N,Y
3330283,ER PROFESSIONAL LEVEL 3,ERP,A,981,99283,,,,,130.00,N,Y
3330284,ER PROFESSIONAL LEVEL 4,ERP,A,981,99284,,,,,196.00,N,Y
3330285,ER PROFESSIONAL LEVEL 5,ERP,A,981,99285,,,,,298.00,N,Y
3330291,CRITICAL CARE 1ST HR,ERP,A,981,99291,,,,,524.00,N,Y
3330292,CRITICAL CARE ADD'L 1/2HR,ERP,A,981,99292,,,,,237.00,N,Y
3330300,REMOV FORN BODY INTRANASA,ERP,A,981,30300,,,,,252.00,N,Y
3330309,"CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMP",ERP,A,981,30901,,,,,138.00,N,Y
3330550,INJ SINGLE TENDON SHEATHOR LIGAMENT APON,ER,A,981,20550,,,,,88.00,N,N
3330605,INJECTION INTO MED JOINT,ERP,A,981,20605,,,,,136.00,N,Y
3330610,ASPIRATION OF MAJOR JOINT,ERP,A,981,20610,,,,,170.00,N,Y
3330702,CATH INSERTION,ERP,A,981,51702,,,,,83.00,N,N
3330799,CASTING STRAPPING SPLINT,ERP,A,981,29799,,,,,56.00,N,Y
3330800,I&D ABSCESS MOUTH,ERP,A,981,40800,,,,,275.00,N,Y
3330901,CAUTER ANTERIOR NASAL SIM,ERP,A,981,30901,,,,,168.00,N,Y
3331042,DEBRID FIRST 20 SQ CM,ERP,A,981,11042,,,,,157.00,N,Y
3331044,"DEBRIDEMENT, SUB TISSUE",ERP,A,981,11044,,,,,578.00,N,N
3331100,BIOPSY-SKIN,ERP,A,981,11100,,,,,170.00,N,Y
3331101,BIOPSY-EACH ADDITIONAL,ERP,A,981,11101,,,,,84.00,N,Y
3331202,CLOSURE OF SPLIT WOUND,ERP,A,981,12020,,,,,440.00,N,Y
3331400,EX SKIN LESION-BN <.5CM,ERP,A,981,11400,,,,,241.00,N,Y
3331401,EX SKIN LESION-BN 0.6-1.0,ERP,A,981,11401,,,,,273.00,N,Y
3331402,EX SKIN LESION-BN 1.1-2.0,ERP,A,981,11402,,,,,301.00,N,Y
3331403,EX SKIN LESION-BN 2.1-3.0,ERP,A,981,11403,,,,,344.00,N,Y
3331404,EX SKIN LESION-BN 3.1-4.0,ERP,A,981,11404,,,,,375.00,N,Y
3331406,EX SKIN LESION-BN 4.0 +CM,ERP,A,981,11406,,,,,440.00,N,Y
3331420,EX SKIN LESION-BN <.5 CM,ERP,A,981,11420,,,,,227.00,N,Y
3331421,EX SKIN LESION-BN 0.6-1.0,ERP,A,981,11421,,,,,284.00,N,Y
3331422,EX SKIN LESION-BN 1.1-2.0,ERP,A,981,11422,,,,,314.00,N,Y
3331423,EX SKIN LESION-BN 2.1-3.0,ERP,A,981,11423,,,,,374.00,N,Y
3331424,EX SKIN LESION-BN 3.1-4.0,ERP,A,981,11424,,,,,421.00,N,Y
3331426,EX SKIN LESION-BN 4.0 +CM,ERP,A,981,11426,,,,,558.00,N,Y
3331440,EX SKIN LESION-BN < .5CM,ERP,A,981,11440,,,,,272.00,N,Y
3331441,EX SKIN LESION-BN 0.6-1.0,ERP,A,981,11441,,,,,315.00,N,Y
3331442,EX SKIN LESION-BN 1.1-2.0,ERP,A,981,11442,,,,,342.00,N,Y
3331443,EX SKIN LESION-BN 2.1-3.0,ERP,A,981,11443,,,,,427.00,N,Y
3331444,EX SKIN LESION-BN 3.1-4.0,ERP,A,981,11444,,,,,527.00,N,Y
3331446,EX SKIN LESION-BN 4.0 +CM,ERP,A,981,11446,,,,,640.00,N,Y
3331480,UNCOMPLICAT TRT TEMPOROMANDIBULAR DISLOC,ERP,A,981,21480,,,,,83.00,N,N
3331500,INTUBATION ENDOTRACHEAL,ERP,A,981,31500,,,,,252.00,N,Y
3331600,EX SKIN LESION-MA < .5CM,ERP,A,981,11600,,,,,291.00,N,Y
3331601,EX SKIN LESION-MA 0.6-1.0,ERP,A,981,11601,,,,,335.00,N,Y
3331602,EX SKIN LESION-MA 1.1-2.0,ERP,A,981,11602,,,,,351.00,N,Y
3331603,EX SKIN LESION-MA 2.1-3.0,ERP,A,981,11603,,,,,384.00,N,Y
3331604,EX SKIN LESION-MA 3.1-4.0,ERP,A,981,11604,,,,,415.00,N,Y
3331606,EX SKIN LESION-MA 4.0 +CM,ERP,A,981,11606,,,,,521.00,N,Y
3331620,EX SKIN LESION-MA < .5CM,ERP,A,981,11620,,,,,281.00,N,Y
3331621,EX SKIN LESION-MA 0.6-1.0,ERP,A,981,11621,,,,,340.00,N,Y
3331622,EX SKIN LESION-MA 1.1-2.0,ERP,A,981,11622,,,,,381.00,N,Y
3331623,EX SKIN LESION-MA 2.1-3.0,ERP,A,981,11623,,,,,424.00,N,Y
3331624,EX SKIN LESION-MA 3.1-4.0,ERP,A,981,11624,,,,,488.00,N,Y
3331626,EX SKIN LESION-MA 4.0 +CM,ERP,A,981,11626,,,,,629.00,N,Y
3331640,EX SKIN LESION-MA < .5CM,ERP,A,981,11640,,,,,303.00,N,Y
3331641,EX SKIN LESION-MA 0.6-1.0,ERP,A,981,11641,,,,,398.00,N,Y
3331643,EX SKIN LESION-MA 2.1-3.0,ERP,A,981,11643,,,,,499.00,N,Y
3331644,EX SKIN LESION-MA 3.1-4.0,ERP,A,981,11644,,,,,625.00,N,Y
3331646,EX SKIN LESION-MA 4.0 +CM,ERP,A,981,11646,,,,,823.00,N,Y
3331730,AVULSION OF NAIL SIMP;SIN,ERP,A,981,11730,,,,,129.00,N,Y
3331740,EVACUATION OF SUBUNGUAL HEMATOMA,ERP,A,981,11740,,,,,83.00,N,N
3331765,"EXCIXION O F TOE, NAIL",ERP,A,981,11765,,,,,256.00,N,Y
3332000,INCISION DRAIN OF ABSCESS HAND,ERP,A,981,20005,,,,,611.00,N,N
3332001,LACERATION REPAIR <2.5CM,ERP,A,981,12001,,,,,295.00,N,Y
3332002,LACERATION REPAIR 2.6-7.5,ERP,A,981,12002,,,,,315.00,N,Y
3332004,LACERATION REPA 7.6-12.5,ERP,A,981,12004,,,,,356.00,N,Y
3332005,LACERATION REPAIR 12.6-20,ERP,A,981,12005,,,,,438.00,N,Y
3332006,LACERTION REPAIR 21-25 CM,ERP,A,981,12006,,,,,520.00,N,Y
3332007,REPAIR OF SUPERFICIAL WOUNDS >30 CM,ERP,A,960,12007,,,,,495.00,N,N
3332011,LACERATION FACE <2.5 CM,ERP,A,981,12011,,,,,305.00,N,Y
3332013,LACERATION FACE 2.6-7.5,ERP,A,981,12013,,,,,333.00,N,Y
3332014,LACERATION FACE 7.6-12.5,ERP,A,981,12014,,,,,392.00,N,Y
3332015,LACERATION FACE 12.6-20,ERP,A,981,12015,,,,,479.00,N,Y
3332016,LAC FAEELNL 12.6 20CM,ERP,A,981,12016,,,,,449.00,N,Y
3332020,CHEST TUBE THORACOSTOMY,ERP,A,981,32551,,,,,542.00,N,Y
3332031,REP INTERM LAC EXT2.5CM<,ERP,A,981,12031,,,,,309.00,N,Y
3332032,LYR CLOS LAC REP 2.6-7.5C,ERP,A,981,12032,,,,,370.00,N,Y
3332034,"REPAIR OTHER EXT SCALP,ET",ERP,A,981,12034,,,,,337.00,N,Y
3332035,REP INTMED WD EX 12.6CM >,ERP,A,960,12035,,,,,393.00,N,Y
3332041,INTERMED WOUND REP2.5<,ERP,A,981,12041,,,,,337.00,N,Y
3332042,LYR CLOS LAC REP 2.6-7.5C,ERP,A,981,12042,,,,,527.00,N,Y
3332044,LACERATION HAND 7.6-12.5,ERP,A,981,12044,,,,,392.00,N,Y
3332051,WOUND FACE LAY CLOSU2.5<,ERP,A,981,12051,,,,,305.00,N,Y
3332054,LAYERED CLOSE 7.6-12.5,ERP,A,981,12054,,,,,405.00,N,Y
3332464,CL TR RADIAL HEAD SUBLUX,ERP,A,981,24640,,,,,252.00,N,Y
3333,test2,ANS,A,322,,,,,,1.00,N,N
3333010,EKG INTERPRETATION,ERP,A,981,93010,,,,,26.00,N,Y
3333121,REP COMPX SC AR LG2.6 7.5,ERP,A,981,13121,,,,,697.00,N,Y
3333122,REP CONPX SC AR ADDITION,ERP,A,981,13122,,,,,204.00,N,Y
3333650,CL REDUCTION OF SHOULDER,ERP,A,981,23650,,,,,898.00,N,Y
3333655,DISLOC MANIPULA W ANEST,ERP,A,981,23655,,,,,876.00,N,Y
3334600,TREAT CLOSED ELBOW DISL WITHOUT ANESTHES,ERP,A,981,24600,,,,,633.00,N,Y
3334605,TR CL ELBOW DISL REQ ANES,ERP,A,981,24605,,,,,909.00,N,Y
3334640,INHALATION TREATMENT,ERP,A,981,94640,,,,,50.00,N,Y
3334760,PULSE OXIMETRY,ERP,A,981,94760,,,,,25.00,N,Y
3335005,I&D OF SUBMUSCOSAL ABCESS,ERP,A,981,45005,,,,,491.00,N,Y
3335205,FOREIGN BODY REMOVAL EYE,ERP,A,981,65205,,,,,412.00,N,Y
3335220,REMOVAL FOR BODY EXT EYE,ERP,A,981,65220,,,,,116.00,N,Y
3335222,REMOVAL FOREIGN BODY EXT EYE CORNEAL W S,ERP,A,981,65222,,,,,110.00,N,N
3335505,CL TREAT RAD SHAFTFX WMAN,ERP,A,981,25505,,,,,920.00,N,Y
3335565,"CLSD RED, ULNAR & RADIUS FRACTURE",ERP,A,981,25565,,,,,"1,210.00",N,N
3335605,CL TREAT DISTAL RADIAL FX,ERP,A,960,25605,,,,,"1,234.00",N,Y
3336000,BURN CARE - INITIAL,ERP,A,981,16000,,,,,139.00,N,Y
3336010,DRAIN FINGER ABCESS SIMPL,ERP,A,981,26010,,,,,281.00,N,Y
3336020,BURN-DEBR/DRESSING SMALL,ERP,A,981,16020,,,,,140.00,N,Y
3336025,BURN-DEBR/DRESSING MEDIUM,ERP,A,981,16025,,,,,268.00,N,Y
3336083,I&D,ERP,A,981,46083,,,,,234.00,N,Y
3336320,EX THROMBOSED HEMORR EXT,ERP,A,981,46320,,,,,252.00,N,Y
3336405,INCISION & DRAIN OF VULVA/PERINEAL ABCES,ERP,A,981,56405,,,,,237.00,N,N
3336569,PICC WO SUB PORT,ERP,A,981,36569,,,,,523.00,N,N
3336705,CL TR METACARPOPHANGEAL DISLOC SG,ERP,A,981,26705,,,,,979.00,N,N
3336725,CL TR PHALANGEAL SHAFT FX,ERP,A,981,26725,,,,,617.00,N,Y
3336765,OPEN TREAT DIS PHALANGAL,ERP,A,981,26765,,,,,926.00,N,Y
3336770,CLD TR INTER JOINT DISLOC,ERP,A,981,26770,,,,,505.00,N,Y
3336775,CLOSED TRMT INTERPHAL JT DISLOCATION,ERP,A,981,26775,,,,,770.00,N,N
3336910,DESTRUCTION LESIONS,ERP,A,981,46910,,,,,303.00,N,N
3336952,AMPUTATION FING OT THUMB PRIMARY OR SEC,ERP,A,981,26952,,,,,"1,375.00",N,N
3336989,PROC HANDS FINGERS UNLIST,ERP,A,981,26989,,,,,220.00,N,N
3337250,CHEM CAUTER OF GRAN TISSU,ERP,A,981,17250,,,,,112.00,N,Y
3337560,CL TRMT PATE DISLOC W/OAN,ERP,A,981,27560,,,,,533.00,N,Y
3337562,CLOSED REDUCTION OF PATELLAR DISLOCATION,ERP,A,981,27562,,,,,"1,084.00",N,N
3337597,DEBRIDEMENT OPEN WOUND,ERP,A,981,97597,,,,,138.00,N,Y
3337602,REMOV DEVITALIZEDTISS WOU,ERP,A,981,97602,,,,,62.00,N,Y
3337788,CLOSED TR DISTAL FIBULAR RX WITH MANIPUL,ER,A,981,27788,,,,,715.00,N,N
3337810,CL TREAT BIMALLEOLAR FX,ERP,A,981,27810,,,,,842.00,N,Y
3337818,TRIMALLEDAR ANKLE FX W MANIPULATION,ERP,A,981,27818,,,,,935.00,N,N
3337825,CL TREAT DIST TIBIA/REQUIRING MANIP,ERP,A,981,27825,,,,,"1,217.00",N,Y
3337840,CLOSED TREATMENT ANKLE DISLOC WO ANESTHE,ERP,A,981,27840,,,,,798.00,N,N
3338435,CLSD TR TALUS FRAC W/ MANIPULATION,ERP,A,981,28435,,,,,880.00,N,Y
3338515,FRAC TREAT PLANANGE WITH MANIPULATION,ERP,A,981,28515,,,,,350.00,N,Y
3338660,"CL TRMT INT PHALANG JT, W/O ANESTH",ERP,A,981,28660,,,,,300.00,N,Y
3338823,PERCUTANEOUS ABSCESSDRAIN,ERP,A,981,58823,,,,,561.00,N,Y
3339065,APPLICATION LONG ARM CAST,ERP,A,981,29065,,,,,204.00,N,Y
3339075,APPLICATION SHORT ARM CAS,ERP,A,981,29075,,,,,190.00,N,Y
3339085,APPLY HAND/WRIST CAST,ERP,A,981,29085,,,,,162.00,N,Y
3339105,APPLY LONG ARM SPLINT,ERP,A,981,29105,,,,,162.00,N,Y
3339125,APPLY FOREARM SPLINT,ERP,A,981,29125,,,,,128.00,N,Y
3339130,APPLY FINGER SPLINT,ERP,A,981,29130,,,,,105.00,N,Y
3339200,FOREGN BODY REMVL EXT,ERP,A,981,69200,,,,,309.00,N,Y
3339209,REMOVE IMPACTED EAR WAX,ERP,A,981,69209,,,,,33.00,N,Y
3339210,EAR LAVAGE,ERP,A,981,69210,,,,,138.00,N,Y
3339240,SHOULDER STRAPPING,ERP,A,981,29240,,,,,90.00,N,Y
3339260,STRAPPING ELBOW OR WRIST,OR,A,360,29260,,,,,83.00,N,N
3339345,APPLICATION LONG LEG CAST,ERP,A,981,29345,,,,,291.00,N,Y
3339405,APPLICATION SHORT LEG CAS,ERP,A,981,29405,,,,,194.00,N,Y
3339505,APPLY LONG LEG SPLINT,ERP,A,981,29505,,,,,168.00,N,Y
3339515,APPLY SHORT LEG SPLINT,ERP,A,981,29515,,,,,140.00,N,Y
3339516,I&D SIMPLE,ERP,A,981,10060,,,,,281.00,N,Y
3340201,ONCOLOGY NP LEVEL 1,ONC,A,983,99201,,,,,94.00,N,Y
3340202,ONCOLOGY NP LEVEL 2,ONC,A,983,99202,,,,,130.00,N,Y
3340203,ONCOLOGY NP LEVEL 3,ONC,A,983,99203,,,,,170.00,N,Y
3340204,ONCOLOGY NP LEVEL 4,ONC,A,983,99204,,,,,255.00,N,Y
3340205,ONCOLOGY NP LEVEL 5,ONC,A,960,99205,,,,,315.00,N,Y
3342201,MEDICARE ONC NP LEVEL 1,ONC,A,510,99201,,,,,28.20,N,N
3342202,MEDICARE ONC NP LEVEL 2,ONC,A,510,99202,,,,,39.00,N,N
3342203,MEDICARE ONC NP LEVEL 3,ONC,A,510,99203,,,,,51.00,N,N
3342204,MEDICARE ONC NP LEVEL 4,ONC,A,510,99204,,,,,76.50,N,N
3342205,MEDICARE ONC NP LEVEL 5,ONC,A,510,99205,,,,,94.50,N,N
3342211,MEDICARE ONC EST PT LEVEL 1,ONC,A,510,99211,,,,,20.10,N,N
3342212,MEDICARE ONC EST PT LEVEL 2,ONC,A,510,99212,,,,,28.20,N,N
3342213,MEDICARE ONC EST PT LEVEL 3,ONC,A,510,99213,,,,,39.00,N,N
3342214,MEDICARE ONC EST PT LEVEL 4,ONC,A,510,99214,,,,,53.40,N,N
3342215,MEDICARE ONC EST PT LEVEL 5,ONC,A,510,99215,,,,,72.00,N,N
3349211,ONCOLOGY EST PT LEVEL 1,ONC,A,983,99211,,,,,67.00,N,Y
3349212,ONCOLOGY EST PT LEVEL 2,ONC,A,983,99212,,,,,94.00,N,Y
3349213,ONCOLOGY EST PT LEVEL 3,ONC,A,983,99213,,,,,130.00,N,Y
3349214,ONCOLOGY EST PT LEVEL 4,ONC,A,983,99214,,,,,178.00,N,Y
3349215,ONCOLOGY EST PT LEVEL 5,ONC,A,983,99215,,,,,240.00,N,Y
3350001,SPENOPALATINE GANGLION-SINGLE OR BILATER,PMC,A,360,64505,,,,,855.00,N,N
3350002,LESSER OCCIPITAL N,PMC,A,360,64450,,,,,544.00,N,N
3350003,GREAT OCCIPITAL N-SINGLE OR BILATERAL,PMC,A,360,64405,,,,,380.00,N,N
3350004,INTERCOSTAL (SINGLE),PMC,A,360,64420,,,,,680.00,N,N
3350005,INTERCOSTAL (MULTIPLE),PMC,A,360,64421,,,,,728.00,N,N
3350006,LLIO/HYPOGASTRIC N,PMC,A,360,64425,,,,,765.00,N,N
3350007,SCIATIC N BLOCK,PMC,A,360,64445,,,,,363.00,N,N
3350008,FEMORAL N BLOCK,PMC,A,360,64447,,,,,934.00,N,N
3350009,PERIPHERAL N BLOCK,PMC,A,360,64450,,,,,544.00,N,N
3350010,STELLATE GANGLION,PMC,A,360,64510,,,,,830.00,N,N
3350011,LUMBAR SMPATHETIC,PMC,A,360,64520,,,,,"1,561.00",N,N
3350012,CERVICAL/THORACIC,PMC,A,360,64490,,,,,"1,463.00",N,N
3350013,CERVICAL/THORACIC LEVEL 2,PMC,A,360,64491,,,,,567.00,N,N
3350014,CERVICAL/THORACIC 3 & ADDL LEVELS,PMC,A,360,64492,,,,,747.00,N,N
3350016,CERIVAL THORACIC RF,PMC,A,360,64633,,,,,"1,649.00",N,N
3350017,CERVICAL THORACIC RF ADDITIONAL,PMC,A,360,64634,,,,,825.00,N,N
3350018,LUMBAR SINGLE,PMC,A,360,64493,,,,,"2,860.00",N,N
3350019,LUMBAR SECOND LEVEL,PMC,A,360,64494,,,,,"1,466.00",N,N
3350020,LUMBAR THIRD LEVEL,PMC,A,360,64495,,,,,"1,400.00",N,N
3350021,L/S RF ABLATION,PMC,A,360,64635,,,,,"3,443.00",N,N
3350022,L/S RF ADDITIONAL LEVEL,PMC,A,360,64636,,,,,"1,613.00",N,N
3350023,CERVICAL/THORACIC,PMC,A,360,62321,,,,,"1,668.00",N,N
3350024,LUMBAR/SACRAL,PMC,A,360,62323,,,,,"1,600.00",N,N
3350025,LUMBAR/SACRAL TRANS,PMC,A,360,64483,,,,,"1,996.00",N,N
3350026,ADDITIONAL LEVEL,PMC,A,360,64484,,,,,"1,537.00",N,N
3350027,SI JOINT-INCL IMAGING,PMC,A,360,27096,,,,,903.00,N,N
3350028,TRIGGER INJECTION PRO FEE,PMC,A,360,,,,,,120.00,N,Y
3350029,MARCAINE 0.25% PER 30ML,PMC,A,990,S0020,,,,,5.00,N,Y
3350030,SI JOINT R ABLATION,PMC,A,360,64999,,,,,500.00,N,N
3350031,LARG JOINT /BURSA/SHD/KN - SINGLE OR BIL,PMC,A,360,20610,,,,,550.00,N,N
3350040,NEURLOYTIC DESTRUCTION OTHER NERVE,PMC,A,360,64640,,,,,"1,970.00",N,N
3350070,LUMBAR PUNCTURE,PMC,A,360,62270,,,,,"1,035.00",N,N
3350073,BLOOD PATCH,PMC,A,360,62273,,,,,500.00,N,N
3350074,TRP INJ ONE -TWO MUCLES,PMC,A,360,20552,,,,,524.00,N,N
3350201,NP LEVEL 1,PMC,A,983,99201,,,,,78.00,N,Y
3350202,NP LEVEL 2,PMC,A,983,99202,,,,,120.00,N,Y
3350203,NP LEVEL 3,PMC,A,983,99203,,,,,109.00,N,Y
3350204,NP LEVEL 4,PMC,A,983,99204,,,,,265.00,N,Y
3350205,NP LEVEL 5,PMC,A,960,99205,,,,,286.00,N,Y
3350211,ES PT LEVEL 1,PMC,A,983,99211,,,,,47.00,N,Y
3350212,ES PT LEVEL 2,PMC,A,983,99212,,,,,68.00,N,Y
3350213,ES PT LEVEL 3,PMC,A,983,99213,,,,,109.00,N,Y
3350214,ES PT LEVEL 4,PMC,A,983,99214,,,,,161.00,N,Y
3350215,ES PT LEVEL 5,PMC,A,983,99215,,,,,203.00,N,Y
3350526,INJ CARPAL TUNNEL SINGLE OR BILATERAL,PMC,A,960,20526,,,,,142.00,N,Y
3350550,INJ LIGAMENT TENDON SINGEL BILATERAL,PMC,A,960,20550,,,,,109.00,N,Y
3350552,TRP INJ ONE -TWO MUCLES,PMC,A,960,20552,,,,,115.00,N,Y
3350553,TRP INJ 3 OR MORE MUSCLES,PMC,A,960,20553,,,,,134.00,N,Y
3350600,FINGER TOE INJ,PMC,A,960,20600,,,,,100.00,N,Y
3350605,INTERMEDIATE JT BURS SINGLE OR BILATERAL,PMC,A,960,20605,,,,,105.00,N,Y
3350610,LARG JOINT /BURSA/SHD/KN - SINGLE OR BIL,PMC,A,510,20610,,,,,126.00,N,Y
3351030,DEPO MEDROL 40MG,PMC,A,990,J1030,,,,,13.00,N,Y
3351040,DEPO MEDROL 80 MG,PMC,A,990,J1040,,,,,12.00,N,N
3351100,DEXAMETHASONE PER 1 MG INJ,PMC,A,990,J1100,,,,,2.00,N,Y
3351900,SCAR INJECTION,PMC,A,960,11900,,,,,105.00,N,Y
3352201,MED NP LEVEL 1,PMC,A,510,99201,,,,,23.40,N,Y
3352202,MED NP LEVEL 2,PMC,A,510,99202,,,,,36.00,N,Y
3352203,MED NP LEVEL 3,PMC,A,510,99203,,,,,46.80,N,Y
3352204,MED NP LEVLE 4,PMC,A,510,99204,,,,,79.50,N,Y
3352205,MED NP LEVEL 5,PMC,A,510,99205,,,,,85.80,N,Y
3352211,ES PT MED LEVEL 1,PMC,A,510,99211,,,,,14.10,N,Y
3352212,ES PT MED LEVEL 2,PMC,A,510,99212,,,,,20.40,N,Y
3352213,ES PT MED LEVEL 3,PMC,A,510,99213,,,,,32.70,N,Y
3352214,ES PT MED LEVEL 4,PMC,A,510,99214,,,,,48.30,N,Y
3352215,ES PT MED LEVEL 5,PMC,A,510,99215,,,,,60.90,N,Y
3352270,LUMBAR PUUNCTURE,PMC,A,960,62270,,,,,290.00,N,Y
3352273,BLOOD PATCH,PMC,A,960,62273,,,,,315.00,N,Y
3352310,CERVICAL/THORACIC EPIDURAL INJ/CATH,PMC,A,960,62321,,,,,450.00,N,Y
3352311,LUMBAR/SACRAL EPIDURAL INJ/CATH,PMC,A,960,62323,,,,,376.00,N,Y
3353301,KENALOG PER 10 MG,PMC,A,636,J3301,,,,,20.00,N,Y
3354405,GREAT OCCIPITAL N SINGLE OR BILATERAL,PMC,A,960,64405,,,,,185.00,N,Y
3354420,INTERCOSTAL SINGLE,PMC,A,960,64420,,,,,205.00,N,Y
3354421,INTERCOSTAL MULTIPLE,PMC,A,960,64421,,,,,280.00,N,Y
3354425,LLIO HYPOGASTRIC N,PMC,A,960,64425,,,,,245.00,N,Y
3354445,SCIATIC N BLOCK,PMC,A,960,64445,,,,,245.00,N,Y
3354447,FEMORAL N BLOCK,PMC,A,960,64447,,,,,215.00,N,Y
3354450,LESSER OCCIPITAL N,PMC,A,960,64450,,,,,145.00,N,Y
3354451,PERIPHERAL N BLOCK,PMC,A,960,,,,,,145.00,N,Y
3354483,LUMBAR/SACRAL TRANS EPIDURAL INJ/CATH,PMC,A,960,64483,,,,,411.00,N,Y
3354484,ADDITIONAL LEVEL,PMC,A,960,64484,,,,,160.00,N,Y
3354490,CERVICAL/ THORACIC,PMC,A,960,64490,,,,,360.00,N,Y
3354491,CERVICAL /THORACIC 2ND LEVEL,PMC,A,960,64491,,,,,170.00,N,Y
3354492,CERVICAL/THORACIC 3RD LEVEL,PMC,A,960,64492,,,,,170.00,N,Y
3354493,LUMBAR SINGLE,PMC,A,960,64493,,,,,325.00,N,Y
3354494,LUMBAR SINGLE 2ND LEVEL,PMC,A,960,64494,,,,,160.00,N,Y
3354495,LUMBAR SINGLE 3RD LEVEL,PMC,A,960,64495,,,,,160.00,N,Y
3354505,SPENOPALATINE GANGLION SINGLE OR BILATER,PMC,A,960,64505,,,,,185.00,N,Y
3354510,STELLATE GANGLION,PMC,A,960,64510,,,,,235.00,N,Y
3354520,LUMBAR SMPATHETIC,PMC,A,960,64520,,,,,345.00,N,Y
3354633,CERVICAL/THORACIC RF,PMC,A,960,64633,,,,,735.00,N,Y
3354634,CERVICAL/THORACIC RF X,PMC,A,960,64634,,,,,330.00,N,Y
3354635,L/S RF ABLATION,PMC,A,960,64635,,,,,725.00,N,Y
3354636,L/S RF X,PMC,A,960,64636,,,,,300.00,N,Y
3354640,NEURLOYTIC DESTRUCTION OTHER NERVE,PMC,A,960,64640,,,,,245.00,N,Y
3354999,SI JOINT R ABLATION,PMC,A,960,64999,,,,,250.00,N,Y
3357096,SI JOINT- INCLUDES IMAGING - SNGL OR BIL,PMC,A,960,27096,,,,,350.00,N,Y
3500000,WEIGHT CHECK NO CHARGE,PED,A,990,99999,,,,,0.00,N,N
3500001,DIAPER RASH OINTMENT,PED,A,990,,,,,,6.50,N,Y
3500002,DIAPHENHYDRAMINE12.5MG/5M,PED,A,990,,,,,,0.58,N,Y
3500003,ELECTROLYLTE ORALSOL (PED,PED,A,990,,,,,,5.96,N,Y
3500004,LAT GEL,PED,A,990,,,,,,25.00,N,Y
3500005,SOD PHOSPATE PED ENEMIA,PED,A,990,,,,,,2.52,N,Y
3500006,ACETAMINOPHEN 120MGCOD LI,PED,A,990,J0131,,,,,1.00,N,Y
3500007,AZITHROMYCIN 250MGTAB,PED,A,990,,,,,,2.34,N,Y
3500008,DEXTROSE 25% 10ML SYRINGE,PED,A,990,,,,,,9.26,N,Y
3500011,DRUG SCR COLLECT & KIT,PED,A,990,80100,,,,,69.00,N,Y
3500017,SED RATE,PED,A,990,85651,,,,,33.00,N,N
3500024,OCCULT BLOOD SCREENING,PED,A,990,82270,,,,,49.00,N,N
3500025,REM SKIN TAGS EA ADD'L 10,PED,A,990,11201,,,,,37.00,N,Y
3500048,BASIC METABOLIC PANEL,PED,A,990,80048,,,,,54.00,N,N
3500051,ELECTROLYTES,PED,A,990,80051,,,,,54.00,N,N
3500053,COMPREHENSIVE METABOLIC PANEL,PED,A,990,80053,,,,,97.00,N,N
3500060,DRAIN SKIN ABCESS SIMPLE,PED,A,990,10060,,,,,244.00,N,N
3500069,RENAL PROFILE,PED,A,990,80069,,,,,65.00,N,N
3500096,PTT,PED,A,300,85730,,,,,49.00,N,N
3500100,DEXAMETHASONE 1 MG,PED,A,990,J1100,,,,,8.00,N,Y
3500104,DEPO MEDROL 80 MG,PED,A,990,J1040,,,,,12.00,N,N
3500115,ALLERGY 1 W/O EXTRACT,PED,A,990,95115,,,,,18.00,N,Y
3500117,ALLERGY 2+ W/OEXTRACT,PED,A,990,95117,,,,,22.00,N,Y
3500162,ZOFRAN 4MG TABLET,PED,A,990,Q0162,,,,,3.00,N,N
3500164,VALPROIC ACID,PED,A,990,80164,,,,,100.00,N,N
3500171,EPI PEN,PED,A,990,J0171,,,,,155.00,N,Y
3500178,LITHIUM,PED,A,990,80178,,,,,50.00,N,N
3500201,NEW OP LEVEL 1,PED,A,990,99201,,,,,98.00,N,Y
3500202,NEW OP LEVEL 2,PED,A,990,99202,,,,,135.00,N,Y
3500203,NEW OP LEVEL 3,PED,A,990,99203,,,,,177.00,N,Y
3500204,NEW OP LEVEL 4,PED,A,990,99204,,,,,265.00,N,Y
3500205,NEW OP LEVEL 5,PED,A,990,99205,,,,,328.00,N,Y
3500211,OFFICE VISIT LEVEL 1,PED,A,990,99211,,,,,70.00,N,Y
3500212,OFFICE VISIT LEVEL 2,PED,A,990,99212,,,,,98.00,N,Y
3500213,OFFICE VISIT LEVEL 3,PED,A,990,99213,,,,,135.00,N,Y
3500214,OFFICE VISIT LEVEL 4,PED,A,990,99214,,,,,185.00,N,Y
3500215,OFFICE VISIT LEVEL 5,PED,A,990,99215,,,,,250.00,N,Y
3500300,REMOV FOREIGN BODY INTRANAS,PED,A,981,30300,,,,,229.50,N,N
3500416,FINGER/HEEL STICK,PED,A,990,36416,,,,,5.00,N,N
3500432,HIV 1 & 2 AB,PED,A,990,G0432,,,,,65.50,N,N
3500434,DRUG SCREEN,PED,A,990,G0477,,,,,43.00,N,N
3500443,MICROALBUMIN URINE,PED,A,990,82043,,,,,38.00,N,N
3500447,BEHAVORIAL COUNSEL FOR OBESITY 15M,PED,A,990,G0447,,,,,36.00,N,N
3500449,INFLUENZE A & B,PED,A,990,87804,,,,,51.00,N,Y
3500465,IMMUNIZATION <18 W/COUNSE,PED,A,990,,,,,,16.50,N,Y
3500466,EA ADD IMMUNIZ <18 W/COUN,PED,A,990,,,,,,16.50,N,Y
3500471,IMMUNIZATION 1,PED,A,990,90471,,,,,63.00,N,Y
3500472,EA ADD IMMUNIZATION,PED,A,990,90472,,,,,26.00,N,Y
3500473,INTRANASAL ADMIN STATE,PED,A,990,90473,,,,,19.68,N,N
3500529,HERPES SIMPLEX VIRUS PCR,PED,A,990,87529,,,,,97.00,N,N
3500560,BICILLIN LA600000 UNITS,PED,A,990,J0560,,,,,56.60,N,Y
3500561,"BICILLIN LA PER 100,000 UNITS",PED,A,990,J0561,,,,,16.00,N,N
3500580,BICILLIN LA 1.2 MILL UNIT,PED,A,990,J0580,,,,,98.02,N,Y
3500633,VAQTA HEP A PED,PED,A,990,90633,,,,,60.00,N,Y
3500649,GARDASIL (HPV),PED,A,990,90649,,,,,245.00,N,Y
3500650,UA DRUG SCREEN COLLECT,PED,A,990,,,,,,17.00,N,Y
3500651,GARDASIL 9,PED,A,990,90651,,,,,375.00,N,N
3500655,LEAD TESTING,PED,A,990,83655,,,,,43.00,N,N
3500657,INFLUENZA QUAD VACCINE 0.25ML,PED,A,990,90657,,,,,50.00,N,Y
3500658,INFLUENZA >3YRS,PED,A,990,90658,,,,,50.00,N,Y
3500660,INFLUENZA VAC INTRANASAL,PED,A,960,90660,,,,,55.00,N,N
3500669,PREVNAR (PNEUMOCOCCAL),PED,A,990,90669,,,,,146.00,N,Y
3500670,PNEUMOCOCCAL VAC PREVNAR 13,PED,A,990,90670,,,,,340.00,N,N
3500680,ROTATEQ (ROTOVIRUS),PED,A,990,90680,,,,,144.00,N,Y
3500685,FLU VACC <3 YRS QUAD SPLIT VIRUS .25 ML,PED,A,990,90685,,,,,50.00,N,N
3500686,"FLUARIX, QUADRIVALENT SPLIT VIRUS 0.5 ML",PED,A,990,90686,,,,,50.00,N,N
3500696,ROCEPHIN PER 250MG,PED,A,990,J0696,,,,,19.00,N,Y
3500697,ROCEPHIN PER 500 MG,PED,A,990,J0696,,,,,38.00,N,N
3500698,ROCEPHIN 1 GRAM,PED,A,990,J0696,,,,,76.00,N,N
3500700,DTAP < 7 yrs,PED,A,990,90700,,,,,44.00,N,Y
3500707,MMR,PED,A,990,90707,,,,,128.00,N,Y
3500710,PROQUAD (MMR/VAR),PED,A,990,90710,,,,,254.00,N,Y
3500713,IPV,PED,A,990,90713,,,,,58.00,N,Y
3500714,DECACAC-TD-ADULT >7YRS,PED,A,990,90714,,,,,54.00,N,Y
3500715,TDAP-Adacel,PED,A,990,90715,,,,,67.00,N,Y
3500716,VARICELLA,PED,A,990,90716,,,,,230.00,N,Y
3500723,PEDIARIX (DTAP-HEP-B-IPV),PED,A,990,90723,,,,,140.00,N,Y
3500732,PNEUMONIA >2 YRS,PED,A,990,90732,,,,,174.00,N,Y
3500734,MENACTRA 4MCG 0.5ML/SDV,PED,A,990,90734,,,,,212.00,N,Y
3500736,ZOSTAVAX (ZOSTER/SHINGLES,PED,A,990,90736,,,,,320.00,N,Y
3500737,HIB,PED,A,990,90648,,,,,55.00,N,Y
3500744,HEP B 0-19YRS (ENGERIX-B),PED,A,990,90744,,,,,32.00,N,Y
3500772,"THERA, PROPHY, DIAINJ, SUBCU",PED,A,990,96372,,,,,52.00,N,Y
3500801,LIPID PANEL,PED,A,990,80061,,,,,81.00,N,N
3500807,RSV TEST,PED,A,990,87807,,,,,41.00,N,N
3500808,TRICHOMONAS,PED,A,990,87808,,,,,29.00,N,N
3500870,BILIRUBIN TRANSCUTANEOUS,PED,A,990,88720,,,,,11.00,N,N
3500904,CHLAMYDIA URINE,PED,A,990,87491,,,,,65.00,N,N
3500905,BV,PED,A,990,87905,,,,,29.00,N,N
3500920,GONORRHOEAE URINE,PED,A,990,87591,,,,,55.00,N,N
3501002,UA DIP W/O MICRO,PED,A,990,81002,,,,,9.00,N,N
3501003,UA AUTOMATED W/O MICRO,PED,A,990,81003,,,,,29.00,N,Y
3501025,PREG URINE,PED,A,990,81025,,,,,22.00,N,Y
3501030,DEPO MEDROL 40 MG,PED,A,990,J1030,,,,,13.00,N,Y
3501050,DEPO PROV 1 MG,PED,A,960,J1050,,,,,150.00,N,Y
3501055,DEPO-PROY 150MG,PED,A,990,J1055,,,,,116.40,N,Y
3501100,BIOPSY SKIN,PED,A,990,11100,,,,,114.00,N,Y
3501101,BIOPSY EA ADD'L,PED,A,990,11101,,,,,52.00,N,Y
3501102,DEBRIDEMENT OF SKIN,PED,A,990,11000,,,,,70.00,N,N
3501200,REMOVAL OF SKIN TAGS 1-15,PED,A,990,11200,,,,,166.00,N,Y
3501201,DIPHENHYDRAMINE 50MG/ML,PED,A,990,J1200,,,,,3.50,N,Y
3501301,SHAVE SINGLE LESION0.6TO1.0CM ARMS LEGS,PED,A,960,11301,,,,,100.00,N,N
3501473,"INTRANASAL/ORAL IMMUNIZ, 1 VACCINE",PED,A,990,90473,,,,,63.00,N,N
3501730,AVULSION OF NAIL,PED,A,990,11730,,,,,116.50,N,N
3501855,KETOTOLAC 15 MG,PED,A,990,J1885,,,,,16.00,N,Y
3501885,KETOROLAC PER 15 MG,PED,A,990,J1885,,,,,16.00,N,N
3502001,LAC REP <2.5CM EXGTANDOE,PED,A,960,12001,,,,,196.00,N,N
3502002,LAC REP 2.6-7.5 EGT OE,PED,A,990,12002,,,,,219.00,N,Y
3502011,LACER REPAIR FACE <2.5,PED,A,960,12011,,,,,214.50,N,N
3502013,LACER REP FACE<2.5 REENLM,PED,A,960,12013,,,,,227.50,N,N
3502038,INFLUENZA QUAD VACCINE 0.5ML,PED,A,636,Q2038,,,,,50.00,N,N
3502250,MIDAZOLAM 10MG/5MG SYRUP,PED,A,990,J2250,,,,,7.00,N,Y
3502301,NUBAIN PER 10MG,PED,A,990,J2300,,,,,4.50,N,Y
3502306,VIT D AS HYDROX,PED,A,990,82306,,,,,218.00,N,N
3502390,CERULOPLASMIN,PED,A,300,82390,,,,,80.00,N,N
3502550,PROMETHAZINE UP TO 50MG,PED,A,990,J2550,,,,,4.00,N,Y
3502567,TYMPANOMETRY,PED,A,990,92567,,,,,38.00,N,Y
3502607,B 12,PED,A,990,82607,,,,,81.00,N,N
3502728,"FERRITIN, RIA",PED,A,990,82728,,,,,76.00,N,N
3502784,IMMUNOGLOB. IgA,PED,A,990,82784,,,,,70.00,N,N
3502785,ALLERGY PROFILE CHILDHOOD,PED,A,990,82785,,,,,81.00,N,N
,,PED,A,990,86003,91,,,,81.00,N,N
3502920,SOLU MEDROL UP TO 40 MG,PED,A,990,J2920,,,,,10.00,N,N
3502930,SOLU MEDROL UP TO 125MG,PED,A,990,J2930,,,,,6.00,N,N
3502947,GLUCOSE,PED,A,990,82948,,,,,36.00,N,Y
3503030,SUMATRIPTAN 6MG,PED,A,990,J3030,,,,,32.00,N,N
3503036,HEMOGLOBIN A1C,PED,A,990,83036,,,,,73.00,N,N
3503301,KENALOG PER 10MG,PED,A,990,J3301,,,,,20.00,N,Y
3503360,DIAZEPAM2.5MG UP 5MG,PED,A,990,J3360,,,,,223.94,N,Y
3503362,DIAZEPAM10MG RECTAL JELX2,PED,A,990,J3360,,,,,263.54,N,Y
3503410,HYDRDOZYZINE UP TO 25MG,PED,A,990,J3410,,,,,2.50,N,Y
3503420,VIT B-12 UP TO 1000MG,PED,A,990,J3420,,,,,20.00,N,Y
3503516,TISSUE TRANSGLUTAMINASE,PED,A,990,83516,,,,,81.00,N,N
3503540,IRON,PED,A,990,83540,,,,,38.00,N,N
3503550,IRON BINDING,PED,A,990,83550,,,,,42.00,N,N
3503655,LEAD,PED,A,990,83655,,,,,43.00,N,N
3503930,SERUM OSMOLALITY,PED,A,990,83930,,,,,50.00,N,N
3503935,URINE OSMOLALITY,PED,A,990,83935,,,,,40.00,N,N
3503970,PARATHYROID HORMONE,PED,A,300,83970,,,,,139.00,N,N
3504100,PHOSPHORUS,PED,A,300,84100,,,,,35.00,N,N
3504132,POTASSIUM K+K,PED,A,990,84132,,,,,37.00,N,N
3504439,FREE T4,PED,A,990,84439,,,,,72.00,N,N
3504443,TSH,PED,A,990,84443,,,,,92.00,N,N
3504640,BREATHING TREATMENT,PED,A,990,94640,,,,,42.00,N,Y
3504703,HCG,PED,A,990,84703,,,,,25.00,N,N
3504780,"Carseat challenge, first 60 minutes",PED,A,990,94780,,,,,50.00,N,N
3504781,"Carseat challenge, each add'l 30 minutes",PED,A,990,94781,,,,,18.00,N,N
3505000,NOCALL/NO SHOW,PED,A,990,,,,,,20.00,N,N
3505018,HEMOGLOBIN,PED,A,990,85018,,,,,22.00,N,N
3505025,CBC W/DIFF,PED,A,990,85025,,,,,71.00,N,N
3505027,CBC HEMOGRAM,PED,A,300,85027,,,,,71.00,N,N
3505045,RETICULOCYTES (RETIO CT),PED,A,990,85045,,,,,33.00,N,N
3505049,PLATELETS PLT,PED,A,990,85049,,,,,33.00,N,N
3505205,FOREIGN BODY REMOVAL EYE,PED,A,990,65205,,,,,114.00,N,Y
3505610,INR,PED,A,990,85610,,,,,22.00,N,Y
3506039,ANTINUCLEAR ANTIBODY,PED,A,990,86039,,,,,84.00,N,N
3506110,DEVELOPMENT TEST W/SNORING AND DOCUMENT,PED,A,990,96110,,,,,22.00,N,N
3506127,BRIEF EMOTIONAL/BEH ASSESS,PED,A,990,96127,,,,,16.00,N,N
3506140,C REACTIVE PROTEIN,PED,A,990,86140,,,,,33.00,N,N
3506209,EAR LAVAGE 1 OR BOTH EARS,PED,A,510,69209,,,,,31.00,N,N
3506211,SPORTS PHYSICAL,PED,A,990,,,,,,10.00,N,Y
3506235,ENDOMYSIAL ANTIBODY,PED,A,990,86235,,,,,99.00,N,N
3506255,ENDOMYSIAL AB,PED,A,990,86255,,,,,140.00,N,N
3506308,MONO SCREEN,PED,A,990,86308,,,,,40.00,N,N
3506415,DRAW FEE,PED,A,990,36415,,,,,18.00,N,Y
3506416,FINGER OR HEEL STICK,PED,A,990,36416,,,,,5.00,N,N
3506430,RHEUMATOID FACTOR,PED,A,990,86430,,,,,45.00,N,N
3506580,TB TEST,PED,A,990,86580,,,,,16.00,N,Y
3506588,RAPID STREP,PED,A,990,87880,,,,,27.00,N,Y
3506663,EPSTEIN BARR VIRUS TITER,PED,A,960,86663,,,,,98.00,N,N
3506664,EPSTEIN BARR VIRUS NUCLEAR ANTIGEN,PED,A,990,86664,,,,,68.00,N,N
3506665,EPSTEIN-BARR VIR ANTIPROOF,PED,A,990,86665,,,,,86.00,N,N
3506677,H. PYLORI,PED,A,990,86677,,,,,107.00,N,N
3506812,HLA B 27,PED,A,990,86812,,,,,175.50,N,N
3507000,DESTRU BENIGN LESION CRYO,PED,A,990,17000,,,,,120.00,N,Y
3507003,DESTRUC BENIGN LES EA2-14,PED,A,990,17003,,,,,16.00,N,Y
3507070,CULTURE (OTHER SOURCE),PED,A,990,87070,,,,,65.00,N,N
3507077,ID CULTURE,PED,A,990,87077,,,,,55.00,N,N
3507081,THROAT CULTURE,PED,A,990,87081,,,,,65.00,N,N
3507086,URINE CULTURE,PED,A,990,87086,,,,,67.00,N,N
3507088,ID URINE BACTERIA,PED,A,990,87088,,,,,55.00,N,N
3507102,FUNGUS CULTURE,PED,A,990,87102,,,,,38.00,N,N
3507110,REMOVAL OF WARTS UP TO 14,PED,A,990,17110,,,,,146.00,N,Y
3507186,SENSITIVITY CULTURE,PED,A,990,87186,,,,,83.00,N,N
3507205,GRAM STAIN,PED,A,990,87205,,,,,33.00,N,N
3507365,"FOOT OS CALCIS,MIN 2 VIEW",PED,A,990,73650,,,,,127.00,N,N
3507486,"CHYLMD PNEUM, DNA, AMP PROBE",PED,A,990,87486,,,,,152.00,N,N
3507490,CHLAMYDIA PROBE,PED,A,990,87490,,,,,147.00,N,N
3507500,CHEST (1 VIEW) FRONTAL,PED,A,990,71045,,,,,137.00,N,N
3507501,CHEST (2 VIEW) FRONT&LATER,PED,A,990,71046,,,,,159.00,N,N
3507502,"SHOULDER, COMPL, MIN 2 VIEW",PED,A,990,73030,,,,,143.00,N,N
3507503,"HUMERUS, MIN 2 VIEW",PED,A,990,73060,,,,,142.00,N,N
3507504,ELBOW ANTERO/POSTERIOR VIEW,PED,A,990,73070,,,,,127.00,N,N
3507505,"UPPER EXTREM, INFANT MIN 2V",PED,A,990,73092,,,,,124.00,N,N
3507506,"FOREARM, 2 VIEW",PED,A,990,73090,,,,,130.00,N,N
3507507,WRIST 2 VIEW,PED,A,990,73100,,,,,122.00,N,N
3507508,"WRIST, MIN 3 VIEW",PED,A,990,73110,,,,,135.00,N,N
3507509,"HAND, MIN 3 VIEW",PED,A,990,73130,,,,,134.00,N,N
3507510,FINGER(S) MIN 2 VIEW,PED,A,990,73140,,,,,108.00,N,N
3507511,"FEMUR, 2 VIEW",PED,A,990,73552,,,,,135.00,N,N
3507512,TIBIA & FIBULA LEG 2 VIEW,PED,A,990,73590,,,,,125.00,N,N
3507513,KNEE <=2 VIEWS,PED,A,990,73560,,,,,137.00,N,N
3507515,"LWR EXTREM INFANT, MIN 2VW",PED,A,990,73592,,,,,122.00,N,N
3507516,ANKLE 2 VIEWS,PED,A,990,73600,,,,,124.00,N,N
3507517,ANKLE MIN 3 VIEWS,PED,A,990,73610,,,,,140.00,N,N
3507518,FOOT 2 VIEWS,PED,A,990,73620,,,,,124.00,N,N
3507519,"FOOT, MIN 3 VIEW",PED,A,990,73630,,,,,137.00,N,N
3507520,TOE(S) MIN 2 VIEWS,PED,A,990,73660,,,,,108.00,N,N
3507521,KNEE 3 VIEW,PED,A,990,73562,,,,,147.00,N,N
3507522,SHOULDER 1 VIEW,PED,A,990,73020,,,,,118.00,N,N
3507526,TIBIA 3 VIEW,PED,A,990,73590,,,,,70.00,N,N
3507527,HAND 2 VIEW,PED,A,990,73120,,,,,124.00,N,N
3507528,HAND 2 VIEWS,PED,A,990,73130,,,,,134.00,N,N
3507529,"KNEES, COMPLETE 4 OR >",PED,A,990,73564,,,,,157.00,N,N
3507530,"KNEES, AP BI-LAT STND",PED,A,990,73565,,,,,131.00,N,N
3507531,BONE AGE,PED,A,990,77072,,,,,140.00,N,N
3507581,"M. PNEUMON, DNA, AMP PROBE",PED,A,990,87581,,,,,152.00,N,N
3507590,GC PROBE,PED,A,990,87590,,,,,183.00,N,N
3507613,ALBUTEROL 0.63MG/3ML,PED,A,990,J7613,,,,,2.26,N,Y
3507614,ALBUTEROL 1.25MG/3ML,PED,A,990,J7613,,,,,4.52,N,Y
3507633,RESPITORY VIRUS PANEL,PED,A,990,87633,,,,,281.00,N,N
3507798,"DETECT AGENT, NOS, DNA, AMP",PED,A,990,87798,,,,,65.00,N,N
3507800,"EXCISION CHALAZION, SINGLE",PED,A,990,67800,,,,,260.00,N,N
3507802,"MNT, 15 MIN, INITIAL INDIV",PED,A,990,97802,,,,,22.00,N,N
3508005,"HEALTH PANEL-COMP MET, CBC, TSH",PED,A,300,80050,,,,,260.00,N,N
3508030,DRUG SCREEN,PED,A,990,80305,,,,,43.00,N,N
3508213,COLLEGE/CAMP/PRESCHOOL PH,PED,A,990,99213,,,,,17.50,N,Y
3508561,PT PRO TIME,PED,A,300,85610,,,,,22.00,N,N
3508720,BILIRUBIN TRANSCUTANEOUS,PED,A,960,88720,,,,,11.00,N,Y
3508750,FILM ARRAY INFECTIOUS DIARRHEA PANEL,PED,A,990,87507,,,,,648.00,N,N
3509024,GLOBAL/POST OP VISIT,PED,A,990,99024,,,,,0.00,N,N
3509047,EACH ADD'L IMMUNE(STATE),PED,A,990,90472,,,,,6.00,N,N
3509200,"FOREIGN BODY REMOV, EAR",PED,A,990,69200,,,,,150.00,N,N
3509210,CERUMEN REMOVAL 1 OR BOTH EARS,PED,A,990,69210,,,,,78.00,N,Y
3509211,COLLEGE CAMP PRESCHOOL PH,PED,A,990,,,,,,20.00,N,N
3509217,OBSERVATION DISCHARGE,PED,A,990,99217,,,,,102.00,N,N
3509219,OBSERVATION INITIAL LEVEL 2,PED,A,990,99219,,,,,158.50,N,N
3509381,NEW PATIENT <1,PED,A,990,99381,,,,,161.00,N,Y
3509382,NEW PATIENT 1-4 YR,PED,A,990,99382,,,,,166.00,N,Y
3509383,NEW PATIENT 5-11 YR,PED,A,990,99383,,,,,176.00,N,Y
3509384,NEW PATIENT 12-17 YR,PED,A,990,99384,,,,,198.00,N,Y
3509385,NEW PATIENT 18-39 YR,PED,A,990,99385,,,,,187.00,N,Y
3509391,ESTAB PATIENT <1,PED,A,990,99391,,,,,146.00,N,Y
3509392,ESTAB PATIENT 1-4 YR,PED,A,990,99392,,,,,155.00,N,Y
3509393,ESTAB PATIENT 5-11 YR,PED,A,990,99393,,,,,155.00,N,Y
3509394,ESTAB PATIENT 12-17 YR,PED,A,990,99394,,,,,166.00,N,Y
3509395,ESTAB PATIENT 18-39,PED,A,990,99395,,,,,171.00,N,Y
3509471,IMMUNIZATION (STATE),PED,A,990,90471,,,,,19.68,N,Y
3509580,UNNA BOOT APPLICATION,PED,A,990,29580,,,,,75.00,N,N
4000001,DEXTROSE 5% 100 ML,IV,A,258,,,,,,31.65,N,Y
4000004,LACTATED RINGER'S 1000 ML,IV,A,258,J3490,,,,,53.10,N,Y
4000006,DEXTROSE 5% / RINGER'S 50,IV,A,258,,,,,,51.40,N,Y
4000008,SODIUM CHLORIDE 0.45% 100,IV,A,258,,,,,,53.65,N,Y
4000009,NACL .9% 1000ML INJ,IV,A,258,J7030,,,,,52.60,N,Y
4000010,SODIUM CHLORIDE 0.9% 500,IV,A,258,,,,,,31.60,N,Y
4000011,SODIUM CHLORIDE 0.2% / DE,IV,A,258,,,,,,50.25,N,Y
4000012,DEXTROSE 5% 500 ML,IV,A,258,,,,,,52.20,N,Y
4000014,SODIUM CHLORIDE 0.9% / DE,IV,A,258,,,,,,53.05,N,Y
4000015,DEXTROSE 2.5% / SODIUM CH,IV,A,258,,,,,,51.10,N,Y
4000016,.9% NACL IR 1000ML 2B7124,IV,A,258,,,,,,40.50,N,Y
4000018,LACTATED RINGER'S / DEXTR,IV,A,258,,,,,,50.15,N,Y
4000019,DEXTROSE 5% 250 ML,IV,A,258,,,,,,52.30,N,Y
4000020,SODIUM CHLORIDE 0.9% 100,IV,A,258,,,,,,51.65,N,Y
4000021,SODIUM CHLORIDE 0.9% 250,IV,A,258,,,,,,51.20,N,Y
4000023,SODIUM CHLORIDE 0.45% / D,IV,A,258,J7042,,,,,53.80,N,Y
4000024,H2O ir 1000 2B7114,IV,A,258,,,,,,40.50,N,Y
4000030,.9% NACL IRR 2F7123,IV,A,258,J7120,,,,,53.05,N,Y
4000031,5% DEX INJ 500ML GLASS,IV,A,258,,,,,,40.00,N,Y
4000032,.9% NACL 3000 ML,IV,A,272,,,,,,77.25,N,Y
4000033,DEX 5% NACL 45% 500ML,IV,A,258,,,,,,19.15,N,Y
4000034,DEX 10% 1000ML,IV,A,258,,,,,,52.50,N,Y
4000036,5% DEX 500ML,IV,A,258,,,,,,10.78,N,Y
4000037,WATER 1000ML IRR,IV,A,258,,,,,,53.55,N,Y
4010001,GLUCOSE /FBS,LAB,A,300,82947,,,,,36.00,N,Y
4010002,"UA,DIP W/MICRO AUTOMATED",LAB,A,300,81001,,,,,49.00,N,N
4010003,SODIUM/NA,LAB,A,300,84295,,,,,37.00,N,Y
4010004,POTASSIUM K+ K,LAB,A,300,84132,,,,,37.00,N,Y
4010005,CHLORIDE CHL CL,LAB,A,300,82435,,,,,35.00,N,Y
4010006,CO 2,LAB,A,300,82374,,,,,37.00,N,Y
4010007,URIC ACID,LAB,A,300,84550,,,,,81.00,N,Y
4010008,CBC AND DIFF,LAB,A,300,85025,,,,,71.00,N,Y
4010009,PLATELETS PLT,LAB,A,300,85049,,,,,33.00,N,Y
4010010,SERUM ACETONE,LAB,A,300,82009,,,,,35.00,N,Y
4010011,DIGOXIN/DGN /LANOXIN,LAB,A,300,80162,,,,,99.00,N,Y
4010012,THEOPHYLLIN (AMINOPHYLLIN,LAB,A,300,80198,,,,,106.00,N,Y
4010015,PT PRO TIME,LAB,A,300,85610,,,,,22.00,N,Y
4010016,T 3,LAB,A,300,84480,,,,,95.00,N,Y
4010017,SED RATE SR,LAB,A,300,85651,,,,,33.00,N,Y
4010018,HGB HEMOGLOBIN,LAB,A,300,85018,,,,,65.00,N,Y
4010019,HCT,LAB,A,300,85014,,,,,35.00,N,Y
4010020,WBC,LAB,A,300,85048,,,,,23.00,N,Y
4010021,BUN/UREA NITROGEN,LAB,A,300,84520,,,,,35.00,N,Y
4010022,"CREATININE, BLOOD",LAB,A,300,82565,,,,,40.00,N,Y
4010023,FREE T4,LAB,A,300,84439,,,,,72.00,N,Y
4010024,"ELECTROPHORESIS,PROT.SERU",LAB,A,300,84165,,,,,80.00,N,Y
4010025,ELECTROPHRESIS URINE,LAB,A,300,84166,,,,,80.00,N,Y
4010026,URINE CULTURE,LAB,A,300,87086,,,,,67.00,N,Y
4010027,ID,LAB,A,300,87077,,,,,55.00,N,Y
4010028,"SENSITIVITY, ANTIBIOTIC",LAB,A,300,87186,,,,,83.00,N,Y
4010032,DRAW FEE,LAB,A,300,36415,,,,,18.00,N,Y
4010034,TRAVEL ALLOWANCE,LAB,A,300,P9604,,,,,13.00,N,Y
4010035,CEA,LAB,A,300,82378,,,,,140.00,N,Y
4010036,HEPATIC FUNCTION PANEL,LAB,A,300,80076,,,,,79.00,N,Y
4010037,ALCOHOL (BLOOD OR CHEM.),LAB,A,300,80320,,,,,76.00,N,Y
4010038,LITHIUM,LAB,A,300,80178,,,,,50.00,N,Y
4010039,CHOLESTEROL,LAB,A,300,82465,,,,,46.00,N,Y
4010040,TRIGLYCERIDES,LAB,A,300,84478,,,,,92.00,N,Y
4010041,AMYLASE,LAB,A,300,82150,,,,,48.00,N,Y
4010043,ALT,LAB,A,300,84460,,,,,70.00,N,Y
4010048,THROAT CULTURE,LAB,A,300,87070,,,,,65.00,N,Y
4010049,ACID PHOSPHATASE,LAB,A,300,84060,,,,,55.00,N,Y
4010050,GRAM STAIN,LAB,A,300,87205,,,,,33.00,N,Y
4010052,CATECHOLAMINE URINE,LAB,A,300,82382,,,,,109.00,N,Y
4010053,VMA,LAB,A,300,84585,,,,,76.00,N,Y
4010054,DIRECT COOMBES,LAB,A,300,86880,,,,,42.00,N,Y
4010055,INDIRECT COOMBES/ANTIBODY,LAB,A,300,86885,,,,,45.00,N,Y
4010057,RH,LAB,A,300,86901,,,,,73.00,N,Y
4010058,CROSSMATCH ANTIGLOBULIN,LAB,A,300,86922,,,,,65.00,N,Y
4010059,BLOOD MORPHOLOGY,LAB,A,300,85060,,,,,78.00,N,Y
4010061,TOTAL BILIRUBIN,LAB,A,300,82247,,,,,37.00,N,Y
4010062,AST,LAB,A,300,84450,,,,,81.00,N,Y
4010063,DILANTIN OR PTN,LAB,A,300,80185,,,,,99.00,N,Y
4010064,T4,LAB,A,300,84436,,,,,52.00,N,Y
4010065,CKMB,LAB,A,300,82553,,,,,110.00,N,Y
4010066,CPK ISOENZYME,LAB,A,300,82552,,,,,99.00,N,Y
4010067,B 12,LAB,A,300,82607,,,,,81.00,N,Y
4010068,CK,LAB,A,300,82550,,,,,64.00,N,Y
4010069,LDH,LAB,A,300,83615,,,,,46.00,N,Y
4010070,BLEEDING TIME,LAB,A,300,85002,,,,,35.00,N,Y
4010072,VALPROIC ACID (DEPAKINE),LAB,A,300,80164,,,,,100.00,N,Y
4010073,SPUTUM CULTURE,LAB,A,300,87070,,,,,65.00,N,Y
4010074,T.B. CULTURE (ACID FAST),LAB,A,300,87116,,,,,90.00,N,Y
4010075,CULTURE OF ABSCESS,LAB,A,300,87070,,,,,65.00,N,Y
4010077,ALK PHOSPHATASE,LAB,A,300,84075,,,,,39.00,N,Y
4010078,FOLATE (FOLIC ACID),LAB,A,300,82746,,,,,81.00,N,Y
4010079,IRON (SERUM),LAB,A,300,83540,,,,,38.00,N,Y
4010080,IRON BINDING,LAB,A,300,83550,,,,,42.00,N,Y
4010081,SEROLOGY VDRL,LAB,A,300,86592,,,,,33.00,N,Y
4010082,GC CULTURE TRANSGROW,LAB,A,300,87081,,,,,45.00,N,Y
4010084,OCCULT BLOOD EMESIS,LAB,A,300,82271,,,,,49.00,N,Y
4010085,"COLD AGG., TITER",LAB,A,300,86157,,,,,62.00,N,Y
4010086,CBC (HEMOGRAM),LAB,A,300,85027,,,,,71.00,N,Y
4010087,CALCIUM,LAB,A,300,82310,,,,,54.00,N,Y
4010088,BLD CULTURE,LAB,A,300,87040,,,,,78.00,N,Y
4010089,QUINIDINE,LAB,A,300,80194,,,,,95.00,N,Y
4010090,CULTURE OF EYE,LAB,A,300,87070,,,,,65.00,N,Y
4010091,STOOL CULTURE,LAB,A,300,87045,,,,,71.00,N,Y
4010092,MONO SCREEN,LAB,A,300,86308,,,,,40.00,N,Y
4010093,GLUCOSE TOLERANCE,LAB,A,300,82950,,,,,76.00,N,Y
4010094,GLUCOSE TOLERANCE ADD.,LAB,A,300,82952,,,,,32.00,N,Y
4010095,PHENOBARB,LAB,A,300,80184,,,,,87.00,N,Y
4010096,PTT,LAB,A,300,85730,,,,,49.00,N,Y
4010098,"ANA, TITER",LAB,A,300,86039,,,,,84.00,N,Y
4010099,TSH,LAB,A,300,84443,,,,,92.00,N,Y
4010100,HUMAN GROWTH HORMONE,LAB,A,300,83003,,,,,125.00,N,Y
4010101,MAGNES. SERUM,LAB,A,300,83735,,,,,50.00,N,Y
4010102,MAGNES URINE,LAB,A,300,83735,,,,,50.00,N,Y
4010103,GLYCOHGB,LAB,A,300,83036,,,,,73.00,N,Y
4010104,FUNGUS CULTURE,LAB,A,300,87102,,,,,38.00,N,Y
4010105,"ACETONE SERUM,QUANTITATIV",LAB,A,300,82010,,,,,62.00,N,Y
4010106,ASO/ADB,LAB,A,300,86060,,,,,55.00,N,Y
4010107,C REACTIVE PROTEIN,LAB,A,300,86140,,,,,33.00,N,Y
4010108,IMMOUNOELECT SERUM,LAB,A,300,86320,,,,,164.00,N,Y
4010111,"LDH, ISOENZYMES",LAB,A,300,83625,,,,,95.00,N,Y
4010112,CARBOXYHEMOGLOBIN,LAB,A,300,82375,,,,,97.00,N,Y
4010113,TEGRETOL,LAB,A,300,80156,,,,,107.00,N,Y
4010116,RBC,LAB,A,300,85041,,,,,25.00,N,Y
4010118,PH BODY FLUID,LAB,A,300,83986,,,,,26.00,N,Y
4010119,NOSE CULTURE,LAB,A,300,87070,,,,,65.00,N,Y
4010120,RA OR RHEUMATON,LAB,A,300,86430,,,,,45.00,N,Y
4010124,VITAMIN C ABSORBIC ACID.,LAB,A,300,82180,,,,,90.00,N,Y
4010125,GENITAL CULTURE,LAB,A,300,87070,,,,,65.00,N,Y
4010127,ERA,LAB,A,300,84233,,,,,472.00,N,Y
4010128,LIPID PANEL,LAB,A,300,80061,,,,,81.00,N,Y
4010130,HDL,LAB,A,300,83718,,,,,62.00,N,Y
4010133,RETICULOCYTES (RETIO CT),LAB,A,300,85045,,,,,33.00,N,Y
4010135,EOSINOPHIL (NASAL SCREEN),LAB,A,300,89190,,,,,27.00,N,Y
4010137,UA W/O MICRO AUTOMATED,LAB,A,300,81003,,,,,59.00,N,Y
4010141,OCCULT BLOOD FECES,LAB,A,300,82272,,,,,49.00,N,Y
4010142,OCCULT BLOOD OTHER,LAB,A,300,82271,,,,,33.00,N,Y
4010143,ALBUMIN,LAB,A,300,82040,,,,,37.00,N,Y
4010145,GGT,LAB,A,300,82977,,,,,55.00,N,Y
4010146,PHOSPHORUS,LAB,A,300,84100,,,,,35.00,N,Y
4010147,HAPTOGLOBIN QUANTITATIVE,LAB,A,300,83010,,,,,125.00,N,Y
4010148,T PROTEIN,LAB,A,300,84155,,,,,28.00,N,Y
4010151,BETA HCG SCREEN SERUM,LAB,A,300,84703,,,,,56.00,N,Y
4010152,BHCG QUANTITATIVE,LAB,A,300,84702,,,,,111.00,N,Y
4010153,CHLORIDE SPINAL FL.,LAB,A,300,82438,,,,,37.00,N,Y
4010155,CELL COUNT BODY FLUID,LAB,A,300,89050,,,,,35.00,N,Y
4010156,CELL CT.WITH DIFF.BODY FL,LAB,A,300,89051,,,,,42.00,N,Y
4010158,ABO,LAB,A,300,86900,,,,,145.00,N,Y
4010159,ANTIBODY ID,LAB,A,300,86870,,,,,123.00,N,Y
4010160,ANTIBODY TITER,LAB,A,300,86886,,,,,43.00,N,Y
4010161,"CORTISOL, TOTAL",LAB,A,300,82533,,,,,119.00,N,Y
4010163,STONE ANALYSIS,LAB,A,300,82365,,,,,55.00,N,Y
4010164,ACETAMINOPHEN TYLENOL,LAB,A,300,80329,,,,,150.00,N,Y
4010165,LIPASE,LAB,A,300,83690,,,,,55.00,N,Y
4010166,OVA &PARA,LAB,A,300,87177,,,,,68.00,N,Y
4010167,"PSA, TOTAL",LAB,A,300,84153,,,,,70.00,N,Y
4010168,SALICYLATES,LAB,A,300,80329,,,,,55.00,N,Y
4010170,CULTURE (OTHER SOURCE),LAB,A,300,87070,,,,,65.00,N,Y
4010171,NEO NATAL SCREEN,LAB,A,300,84437,,,,,153.00,N,Y
,,LAB,A,300,84030,,,,,153.00,N,Y
,,LAB,A,300,83789,,,,,153.00,N,Y
,,LAB,A,300,83020,,,,,153.00,N,Y
,,LAB,A,300,83498,,,,,153.00,N,Y
,,LAB,A,300,82776,,,,,153.00,N,Y
,,LAB,A,300,82261,,,,,153.00,N,Y
4010173,"FERRITIN, RIA",LAB,A,300,82728,,,,,76.00,N,Y
4010174,PAP SMEAR,LAB,A,310,88150,,,,,33.00,N,Y
4010176,ANAEROBE CULTURE,LAB,A,300,87075,,,,,43.00,N,Y
4010178,HETREROPHILE ANTIBODY TIT,LAB,A,300,86309,,,,,61.00,N,Y
4010179,RUBELLA ANTIBODY,LAB,A,300,86762,,,,,107.00,N,Y
4010180,PROSTATIC ACID PHOS P.A.P,LAB,A,300,84066,,,,,87.00,N,Y
4010181,LYME DISEASE,LAB,A,300,86618,,,,,126.00,N,Y
4010182,URINE CALCIUM,LAB,A,300,82340,,,,,46.00,N,Y
4010183,URINE OXALATE,LAB,A,300,83945,,,,,32.00,N,Y
4010184,URINE PHOSPHORUS,LAB,A,300,84105,,,,,39.00,N,Y
4010185,URINE URIC ACID,LAB,A,300,84560,,,,,36.00,N,Y
4010186,URINE CITRATE,LAB,A,300,82507,,,,,59.00,N,Y
4010187,MALARIA SMEARS-,LAB,A,300,87207,,,,,52.00,N,Y
4010188,HEP B SURFACE AG,LAB,A,300,87340,,,,,71.00,N,Y
4010189,HIV 1 & 2 AB,LAB,A,300,G0432,,,,,71.00,N,Y
4010190,AMMONIA LEVEL,LAB,A,300,82140,,,,,138.00,N,Y
4010191,PROCAINMIDE,LAB,A,300,80190,,,,,125.00,N,Y
4010192,CLOSTRIDIUM DIFFICILE TOX,LAB,A,300,87493,,,,,145.00,N,Y
4010193,VANCOMYCIN,LAB,A,300,80202,,,,,103.00,N,Y
4010194,RPR SEROLOGY,LAB,A,300,86592,,,,,33.00,N,Y
4010195,PROLACTIN,LAB,A,300,84146,,,,,143.00,N,Y
4010198,HEAVY METAL SCREEN UA,LAB,A,300,83015,,,,,245.00,N,Y
4010199,AMTRIPTYLINE (ELAVI),LAB,A,300,80152,,,,,141.00,N,Y
4010201,LIDICAINE LEVEL,LAB,A,300,80176,,,,,110.00,N,Y
4010202,PSEUDOCHOLINESTERASE,LAB,A,300,82480,,,,,74.00,N,Y
4010203,ZINC,LAB,A,300,84630,,,,,87.00,N,Y
4010204,5' NUCLEOTIDASE,LAB,A,300,83915,,,,,84.00,N,Y
4010205,ROTAVIRUS AG,LAB,A,300,87425,,,,,89.00,N,Y
4010206,DRUG SCREN/PANEL 112,LAB,A,300,80307,,,,,107.00,N,Y
4010207,BLOOD GASES,LAB,A,300,82803,,,,,116.00,N,Y
4010208,MELLARIL (THIORDAZINE),LAB,A,300,84022,,,,,130.00,N,Y
4010209,CA 125,LAB,A,300,86304,,,,,153.00,N,Y
4010210,MICROSOMAL ANTIBODY,LAB,A,300,86376,,,,,113.00,N,Y
4010214,DRUG SCREEN (BLOOD),LAB,A,300,80100,,,,,103.00,N,Y
4010216,LAB SCREENING,LAB,A,300,84999,,,,,9.00,N,Y
4010217,CREAT. CLEAR.24HR URINE,LAB,A,300,82575,,,,,71.00,N,Y
4010219,URINE CREAT,LAB,A,300,82570,,,,,39.00,N,Y
4010220,METAEPHRINES,LAB,A,300,83835,,,,,141.00,N,Y
4010221,PROGESTERONE,LAB,A,300,84144,,,,,153.00,N,Y
4010223,KOH PREP,LAB,A,300,87220,,,,,42.00,N,Y
4010225,URINE IMMUNO ELECTROPHORE,LAB,A,300,86325,,,,,164.00,N,Y
4010226,RSV ANTIGEN,LAB,A,300,87420,,,,,89.00,N,Y
4010228,MYCOPLASMA ANTIBODY,LAB,A,300,86738,,,,,99.00,N,Y
4010229,LH LAB,LAB,A,300,83002,,,,,145.00,N,Y
4010230,ANGIOTENSIN I (RENIN),LAB,A,300,84244,,,,,163.00,N,Y
4010231,COMP TOTAL SERUM,LAB,A,300,86162,,,,,150.00,N,Y
4010232,NORPACE LEVEL,LAB,A,300,80299,,,,,117.00,N,Y
4010233,CELLBOUND ANTI PLA,LAB,A,300,86023,,,,,234.00,N,Y
4010236,DRUG/URINE COLLECT SCREEN,LAB,A,300,,,,,,28.00,N,Y
4010239,SEROTONIN (5-HIAA),LAB,A,300,84260,,,,,112.00,N,Y
4010240,GENTAMYCIN (SINGLE),LAB,A,300,80170,,,,,122.00,N,Y
4010241,MYCOPLASMA TITER(IgG IgM),LAB,A,300,86738,,,,,99.00,N,Y
4010242,CHLAMYDIA PROBE,LAB,A,300,87490,,,,,147.00,N,Y
4010243,IMIPRAMINE,LAB,A,300,80335,,,,,147.00,N,Y
4010244,GIARDIA SPECIFIC ANTIGEN,LAB,A,300,87329,,,,,97.00,N,Y
4010245,ADH VASOPRESSIN,LAB,A,300,84588,,,,,249.00,N,Y
4010246,HALDOL,LAB,A,300,80173,,,,,156.00,N,Y
4010248,HEP B CORE AB,LAB,A,300,86704,,,,,90.00,N,Y
4010249,HEPATITS A AB,LAB,A,300,86708,,,,,93.00,N,Y
4010250,HEPATITS C AB,LAB,A,300,86803,,,,,106.00,N,Y
4010251,BICARBONATE,LAB,A,300,82374,,,,,37.00,N,Y
4010252,IONIZED CALCIUM,LAB,A,300,82330,,,,,100.00,N,Y
4010254,TRANSFERRIN,LAB,A,300,84466,,,,,95.00,N,Y
4010255,FECAL LEUKOCYTES,LAB,A,300,89055,,,,,33.00,N,Y
4010256,CHOLINESTERASE RBC ONLY,LAB,A,300,82482,,,,,66.00,N,Y
4010257,URINE AMYLASE 12 OR 24HR,LAB,A,300,82150,,,,,48.00,N,Y
4010258,HLA B 27,LAB,A,300,86812,,,,,190.00,N,Y
4010259,RHEUM SCREEN II,LAB,A,300,86256,,,,,60.00,N,N
4010260,BETA 2 MICROGLOBULIN,LAB,A,300,82232,,,,,122.00,N,Y
4010262,ANTI-MITOCHONDRIAL ANTIBO,LAB,A,300,86255,,,,,90.00,N,Y
4010263,JOINT FLUID CRYSTALS,LAB,A,300,89060,,,,,55.00,N,Y
4010264,MUCIN TEST,LAB,A,300,83872,,,,,45.00,N,Y
4010266,ALPHA FETO PROTEIN,LAB,A,300,82105,,,,,125.00,N,Y
4010269,RUBEOLA ANTIBODY,LAB,A,300,86765,,,,,103.00,N,Y
4010270,TOBRAMYCIN (NEBCIN),LAB,A,300,80200,,,,,119.00,N,Y
4010271,EPSTEIN BARR VIRUS TITER,LAB,A,300,86663,,,,,98.00,N,Y
4010272,ANTITHROMBIN III ANTIGEN,LAB,A,300,85301,,,,,81.00,N,Y
4010273,ANTITHROMBIN III ACTIVITY,LAB,A,300,85300,,,,,209.00,N,Y
4010274,PROTEIN C,LAB,A,300,85302,,,,,81.00,N,Y
4010275,PROTEIN S,LAB,A,300,85305,,,,,81.00,N,Y
4010276,FSH,LAB,A,300,83001,,,,,138.00,N,Y
4010277,HEP B SUR AB,LAB,A,300,86706,,,,,80.00,N,Y
4010278,ENA,LAB,A,300,86235,,,,,150.00,N,Y
4010279,ANTI CENTROMERE,LAB,A,300,86255,,,,,90.00,N,Y
4010280,CMV TITER IGM,LAB,A,300,86645,,,,,125.00,N,Y
4010281,ACID FAST CULTURE,LAB,A,300,87116,,,,,87.00,N,Y
4010282,PROLIXIN,LAB,A,300,80299,,,,,100.00,N,Y
4010285,HEPATITIS BE AG,LAB,A,300,87350,,,,,87.00,N,Y
4010286,HEPATITIS BE AB,LAB,A,300,86707,,,,,87.00,N,Y
4010287,PRA PANEL,LAB,A,300,84234,,,,,474.00,N,Y
4010288,NAPA,LAB,A,300,80192,,,,,125.00,N,Y
4010289,24 HR URINE COLLECTION,LAB,A,300,81050,,,,,23.00,N,Y
4010290,URINE MYOGLOBIN,LAB,A,300,83874,,,,,97.00,N,Y
4010291,LEUKOCYTE ALK PHOSPHATASE,LAB,A,300,85540,,,,,91.00,N,Y
4010292,LEAD,LAB,A,300,83655,,,,,90.00,N,Y
4010293,CLONAZEPAM (CLONOPIN),LAB,A,300,80346,,,,,138.00,N,Y
4010294,VITAMIN A,LAB,A,300,84590,,,,,44.00,N,Y
4010297,NAVANE(THIOTHIXENE),LAB,A,300,80299,,,,,100.00,N,Y
4010298,Quantitative assay drug,LAB,A,300,80299,,,,,147.00,N,Y
4010299,PROLIXIN,LAB,A,300,80299,,,,,100.00,N,Y
4010301,THIOTHIXENE,LAB,A,300,80299,,,,,100.00,N,Y
4010302,SERUM OSMOLALITY,LAB,A,300,83930,,,,,50.00,N,Y
4010303,CHLAMYDIA BYDNA PROPE,LAB,A,300,87490,,,,,147.00,N,Y
4010304,EPSTEIN BAR VIRUS IgG IgM,LAB,A,300,86665,,,,,82.00,N,N
4010306,LOXITANE (LOXAPINE),LAB,A,300,80299,,,,,110.00,N,Y
4010307,QUALITATIVE FECAL FAT,LAB,A,300,82705,,,,,39.00,N,Y
4010310,MYSOLINE,LAB,A,300,80188,,,,,122.00,N,Y
4010311,SERUM METHAPHETAMINE LEVE,LAB,A,300,82145,,,,,255.00,N,Y
4010312,MUMPS IQG,LAB,A,300,86735,,,,,104.00,N,Y
4010313,72HR FECAL FAT QUANT.,LAB,A,300,82710,,,,,153.00,N,Y
4010315,AMIODARONE,LAB,A,300,80345,,,,,133.00,N,Y
4010316,MTN. SPOTTED FEVER AB,LAB,A,300,86000,,,,,122.00,N,Y
4010320,RSV ANTIBODY,LAB,A,300,86756,,,,,109.00,N,Y
4010321,PROZAC LEVEL,LAB,A,300,80299,,,,,117.00,N,Y
4010322,PROTEIN C FUNCTIONAL,LAB,A,300,85303,,,,,220.00,N,Y
4010323,PROTEIN S FUNCTIONAL,LAB,A,300,85306,,,,,249.00,N,Y
4010324,ESTRADIOL,LAB,A,300,82670,,,,,207.00,N,Y
4010325,"C3 , COMPLEMENT",LAB,A,300,86160,,,,,89.00,N,Y
4010326,ANTI DS DNA,LAB,A,300,86225,,,,,30.00,N,Y
4010327,ANTI SM RNP,LAB,A,300,86235,,,,,106.00,N,Y
4010328,ANTI SSA,LAB,A,300,86235,,,,,106.00,N,Y
4010329,ANTI SSB,LAB,A,300,86235,,,,,106.00,N,Y
4010330,ANTI PLATELET ANTIBODY,LAB,A,300,86022,,,,,247.00,N,Y
4010331,TRAZODONE LEVEL,LAB,A,300,80299,,,,,100.00,N,Y
4010332,IMMUNOGLOB.IgA,LAB,A,300,82784,,,,,70.00,N,Y
4010333,IMMUNOGLOB.IgG,LAB,A,300,82784,,,,,70.00,N,Y
4010334,IMMUNOGLOB.IgM,LAB,A,300,82784,,,,,70.00,N,Y
4010338,ELECTROLYTES,LAB,A,300,80051,,,,,54.00,N,Y
4010341,ZOLOFF,LAB,A,300,80299,,,,,100.00,N,Y
4010342,NORTRIPTYLINE SERUM,LAB,A,300,80335,,,,,100.00,N,Y
4010343,MERCURY,LAB,A,300,83825,,,,,139.00,N,Y
4010344,PARATHYROID HORMONE,LAB,A,300,83970,,,,,139.00,N,Y
4010345,URINE 24HR LEAD,LAB,A,300,83655,,,,,95.00,N,Y
4010346,24HR URINE MERCURY,LAB,A,300,83825,,,,,139.00,N,Y
4010347,ERYTHROPOIETIN,LAB,A,300,82668,,,,,153.00,N,Y
4010348,POST-VAS SEMEN COUNT,LAB,A,300,89321,,,,,46.00,N,Y
4010349,FTA,LAB,A,300,86780,,,,,99.00,N,Y
4010350,H. PYLORIC ANTIBODY,LAB,A,300,86677,,,,,107.00,N,Y
4010352,CAROTENE (SERUM),LAB,A,300,82380,,,,,70.00,N,Y
4010353,FRUCTOSAMINE,LAB,A,300,82985,,,,,111.00,N,Y
4010354,PREALBUMIN,LAB,A,300,84134,,,,,107.00,N,Y
4010355,DHEA-S,LAB,A,300,82627,,,,,164.00,N,Y
4010356,17-OH PROGESTERONE,LAB,A,300,83498,,,,,86.00,N,Y
4010361,WELLNESS HEMOCCULT BLOOD,LAB,A,300,82270,,,,,5.00,N,Y
4010363,ALCOHOL SALIVA (QED),LAB,A,300,80323,,,,,80.00,N,Y
4010364,ORGAMOPHOSPHATE,LAB,A,300,82441,,,,,151.00,N,Y
4010365,CHOLINESTERASE,LAB,A,300,82480,,,,,89.00,N,Y
4010367,ANTI-NATIVE DNA,LAB,A,300,86225,,,,,100.00,N,Y
4010368,PSA FREE,LAB,A,300,84154,,,,,180.00,N,Y
4010369,TESTOSTERONE FREE,LAB,A,300,84402,,,,,188.00,N,Y
4010370,TESTOSTERONE TOTAL,LAB,A,300,84403,,,,,190.00,N,Y
4010371,ENDOMYSIAL ANTIBODY,LAB,A,300,86255,,,,,99.00,N,Y
4010374,TROPONIN I QUENT,LAB,A,300,84484,,,,,97.00,N,Y
4010375,MYOGLOBIN,LAB,A,300,83874,,,,,124.00,N,Y
4010379,FREE T3,LAB,A,300,84481,,,,,126.00,N,Y
4010380,PAXEL,LAB,A,300,80299,,,,,209.00,N,Y
4010382,FUNGUS HISTOPLASMA,LAB,A,300,86698,,,,,93.00,N,Y
4010383,GLUCOMETER,LAB,A,300,82948,,,,,25.00,N,Y
4010385,"SODIUM, URINE",LAB,A,300,84300,,,,,32.00,N,Y
4010386,VIRAL CULTURE,LAB,A,300,87252,,,,,192.00,N,Y
4010388,RISPERIDONE,LAB,A,300,82542,,,,,133.00,N,Y
4010389,CHLAMYDIA IGG,LAB,A,300,86631,,,,,89.00,N,Y
4010390,MEPARIDINE,LAB,A,300,80299,,,,,100.00,N,Y
4010391,IMMUNOASSAY OF ANALYTE NOT OTHERISE SPEC,LAB,A,300,83520,,,,,110.00,N,Y
4010393,COXSACKIE VIRUS B,LAB,A,300,86658,,,,,118.00,N,Y
4010394,FLOW CELL CYTOMETRY,LAB,A,310,88182,,,,,521.00,N,Y
4010395,POOLING OF PLATELETS,LAB,A,300,86965,,,,,17.00,N,Y
4010397,MYOCARDIAC ANTIBODIES,LAB,A,300,86255,,,,,90.00,N,Y
4010398,ACTH,LAB,A,300,82024,,,,,282.00,N,Y
4010399,HEPATITIS A AB IG TOTAL,LAB,A,300,86708,,,,,84.00,N,Y
4010400,HEPATITIS B COR AB IGM,LAB,A,300,86705,,,,,55.00,N,Y
4010401,PARVOVIRUS,LAB,A,300,86747,,,,,111.00,N,Y
4010402,BASIC METABOLIC PANEL,LAB,A,300,80048,,,,,54.00,N,Y
4010403,COMP METABOLIC PANEL,LAB,A,300,80053,,,,,97.00,N,Y
4010404,CERULOPLASMIN,LAB,A,300,82390,,,,,80.00,N,Y
4010405,ETHOSUXIMIDE (ZARONTIN),LAB,A,300,80168,,,,,119.00,N,Y
4010407,FACTOR 11 LEVEL,LAB,A,300,85210,,,,,236.00,N,Y
4010408,ANTI CARDIO LIPID PROTEIN,LAB,A,300,86147,,,,,188.00,N,Y
4010409,CROSSMATCH IMMEDIATE SPIN,LAB,A,300,86921,,,,,59.00,N,Y
4010410,CROSSMATCH ANTIGLOBULIN,LAB,A,300,86922,,,,,76.00,N,Y
4010411,MANUALLY DIFFERENTIAL,LAB,A,300,85007,,,,,31.00,N,Y
4010412,FUNGUS COCCIDIOIDES,LAB,A,300,86635,,,,,87.00,N,Y
4010413,FUNGUS ASPERGILLUS,LAB,A,300,86606,,,,,111.00,N,Y
4010414,FUNGUS BLASTOMYCES,LAB,A,300,86612,,,,,97.00,N,Y
4010415,GC PROBE,LAB,A,300,87590,,,,,183.00,N,Y
4010416,"VARICELLA-ZOSTER,ANTI AB",LAB,A,300,86787,,,,,97.00,N,Y
4010417,VITAMIN E,LAB,A,300,84446,,,,,106.00,N,Y
4010418,TOXOPLASMA,LAB,A,300,86777,,,,,107.00,N,Y
4010419,HISTOPLASMA,LAB,A,300,86698,,,,,93.00,N,Y
4010420,ASPERGILLUS,LAB,A,300,86606,,,,,111.00,N,Y
4010421,PNEUMOCOCCAL AB,LAB,A,300,86609,,,,,156.00,N,Y
4010422,LEUCINE AMINOPAP,LAB,A,300,83670,,,,,66.00,N,Y
4010423,HGB ELECTROPHORESIS,LAB,A,300,83020,,,,,56.00,N,Y
4010424,VARICELLA-ZOST AB TITER,LAB,A,300,86787,,,,,97.00,N,Y
4010425,HEMOQUANT,LAB,A,300,82274,,,,,59.00,N,Y
4010426,THERAPUTIC PHLEBOTOMY,LAB,A,940,99195,,,,,189.00,N,Y
4010427,"D-DIMER, QUANTITATIVE",LAB,A,300,85379,,,,,54.00,N,Y
4010428,EPSTEINBARR VIRUS CAPSIDA,LAB,A,300,86665,,,,,135.00,N,Y
4010429,METHEMOGLOBIN,LAB,A,300,83050,,,,,95.00,N,Y
4010430,GIARDIA ANTIBODY,LAB,A,300,86674,,,,,218.00,N,Y
4010431,HEP C AB BY RIBA,LAB,A,300,86804,,,,,161.00,N,Y
4010432,URINE PROTEIN,LAB,A,300,84156,,,,,40.00,N,Y
4010439,DISUEFIRAM,LAB,A,300,80299,,,,,129.00,N,Y
4010440,LACTIC ACID,LAB,A,300,83605,,,,,80.00,N,Y
4010441,IGE,LAB,A,300,82785,,,,,122.00,N,Y
4010442,HEPATITIS PROFILE,LAB,A,300,80074,,,,,232.00,N,Y
4010443,MICRO ALBUMN OF URINE,LAB,A,300,82043,,,,,38.00,N,Y
4010445,RUBELLA IGG,LAB,A,300,86762,,,,,107.00,N,Y
4010446,RUBELLA IGM,LAB,A,300,86762,,,,,107.00,N,Y
4010447,FECAL PH & REDUCE SUB,LAB,A,300,83986,,,,,39.00,N,Y
4010448,"FECAL FAT, QUAL",LAB,A,300,89125,,,,,70.00,N,Y
4010449,ALPHA 1 ANTITRYPSIN,LAB,A,300,82103,,,,,99.00,N,Y
4010450,RBC FOLATE,LAB,A,300,82747,,,,,127.00,N,Y
4010451,WET MOUNT,LAB,A,300,87210,,,,,33.00,N,Y
4010452,NEUTROPHIL CYTOPLASMIC AB,LAB,A,300,86255,,,,,90.00,N,Y
4010454,MERCURY/HAIR,LAB,A,300,83825,,,,,170.00,N,Y
4010455,INFLUENZA TYPE A VIRUS AN,LAB,A,300,87400,,,,,62.00,N,Y
4010456,CYCLOSPORINE,LAB,A,300,80158,,,,,151.00,N,Y
4010457,ALDOLASE,LAB,A,300,82085,,,,,74.00,N,Y
4010458,URINE OSMOLALITY,LAB,A,300,83935,,,,,40.00,N,Y
4010459,ANTI CENTROMERE,LAB,A,300,83520,,,,,97.00,N,Y
4010460,COMPLEMENT TOTAL,LAB,A,300,86162,,,,,150.00,N,Y
4010461,CLYOGLOBULIN,LAB,A,300,82595,,,,,48.00,N,Y
4010462,IGG SUB CLASSES,LAB,A,300,82787,,,,,37.00,N,Y
4010463,FIBRINOGEN,LAB,A,300,85384,,,,,107.00,N,Y
4010464,OSTEOCALCIM,LAB,A,300,83937,,,,,135.00,N,Y
4010466,PSA SCREENING,LAB,A,300,G0103,,,,,92.00,N,Y
4010467,HYPERSENSITIVITY PNEUMO 1,LAB,A,300,86329,,,,,103.00,N,Y
4010468,HYPERSENSITIVITY PNEUM0 2,LAB,A,300,86606,,,,,111.00,N,Y
4010469,HYPERSENSITIVITY PNEUMO 3,LAB,A,300,86609,,,,,97.00,N,Y
4010470,URINE POTASSIUM,LAB,A,300,84133,,,,,38.00,N,Y
4010471,IMMUNOGLOOBULINS QUANT,LAB,A,300,82784,,,,,79.00,N,Y
4010472,C4 COMPLEMENT,LAB,A,300,86160,,,,,89.00,N,Y
4010473,VIT B (THIAMINE),LAB,A,300,84425,,,,,156.00,N,Y
4010474,VIT B6 (PYROXIDAL PH),LAB,A,300,84207,,,,,207.00,N,Y
4010475,"HEAVY METALS, SERUM",LAB,A,300,83015,,,,,139.00,N,Y
4010476,GABAPENTIN (NEURONTIN),LAB,A,300,80171,,,,,155.00,N,Y
4010477,HOMOCYSTEINE,LAB,A,300,83090,,,,,108.00,N,Y
4010478,T+B CELL MARKER 1,LAB,A,300,86359,,,,,135.00,N,Y
4010479,T+B CELL MARKERS 2,LAB,A,300,86360,,,,,135.00,N,Y
4010480,T+B CELL MARKERS 3,LAB,A,300,88360,,,,,64.00,N,Y
4010481,LUPUS ANTICOAGULANT,LAB,A,300,85705,,,,,38.00,N,Y
4010482,LUPUS ANTICOAGULANT,LAB,A,300,85705,,,,,119.00,N,Y
4010483,ANGIOTENSION COVERT ENZYM,LAB,A,300,82164,,,,,110.00,N,Y
4010484,Quantitative drug assay,LAB,A,300,80299,,,,,151.00,N,Y
4010485,RAST allergen,LAB,A,300,86003,,,,,33.00,N,Y
4010486,C2 COMPLEMENT,LAB,A,300,86160,,,,,89.00,N,Y
4010487,"C, ESTERASE INHIBITOR",LAB,A,300,83883,,,,,100.00,N,Y
4010488,LEGIONEELE URINARY ANTIGE,LAB,A,300,86713,,,,,234.00,N,Y
4010489,ANCA- ANTINUCLEAR,LAB,A,300,86255,,,,,140.00,N,Y
4010490,CRYPTO COCCUS,LAB,A,300,86641,,,,,107.00,N,Y
4010491,GASTRIN,LAB,A,300,82941,,,,,130.00,N,Y
4010492,VITAMIN D 1.25 DIHYDROXY,LAB,A,300,82652,,,,,200.00,N,Y
4010493,C-PEPTIDE,LAB,A,300,84681,,,,,153.00,N,Y
4010499,CHLORDIAZEPOXIDE (LIBRIUM,LAB,A,300,80154,,,,,100.00,N,Y
4010500,GLOMERULAR BASEMENT MEMBR,LAB,A,300,83520,,,,,205.00,N,Y
4010501,"PORPHOBILINOGEN,QUANTITIV",LAB,A,300,84110,,,,,71.00,N,Y
4010502,RAPID STREP SCREEN,LAB,A,300,87430,,,,,89.00,N,Y
4010503,THYROGLOBULIN ANTIBODY,LAB,A,300,86800,,,,,125.00,N,Y
4010504,FIBRIN SPLIT PRODUCT,LAB,A,300,85362,,,,,98.00,N,Y
4010505,GAD ANTIBODY,LAB,A,300,83519,,,,,171.00,N,Y
4010506,ISLET CELL ANTIBODY,LAB,A,300,86341,,,,,176.00,N,Y
4010507,C REATIVE PROTEIN HS,LAB,A,300,86141,,,,,72.00,N,Y
4010508,BODY FLUID CRYSTALS,LAB,A,300,89060,,,,,55.00,N,Y
4010509,URINE EOSINOPHILS,LAB,A,300,89050,,,,,43.00,N,Y
4010510,SERUM COPPER,LAB,A,300,82525,,,,,93.00,N,Y
4010511,HEPATITIS A AB IGM,LAB,A,300,86709,,,,,93.00,N,Y
4010512,"CH50, COMPLEMENT",LAB,A,300,86162,,,,,150.00,N,Y
4010519,FACTOR V LEIDEN,LAB,A,300,81241,,,,,108.00,N,Y
4010520,REPTILASE THROMBIN TIME,LAB,A,300,85635,,,,,74.00,N,Y
4010521,THROMBIN TIME,LAB,A,300,85670,,,,,64.00,N,Y
4010522,FACTOR V,LAB,A,300,85220,,,,,100.00,N,Y
4010523,ALK PHOS ISO ENZYMES,LAB,A,300,84080,,,,,74.00,N,Y
4010524,URINE HISTOPLASMA ANTIGEN,LAB,A,300,87385,,,,,211.00,N,Y
4010525,CLONIDINE,LAB,A,300,80299,,,,,276.00,N,Y
4010526,COPPER URINE 24 HR,LAB,A,300,82525,,,,,93.00,N,Y
4010527,"CHLAMYDIA ANTIGEN, SERUM",LAB,A,300,87270,,,,,188.00,N,Y
4010528,CMV IGG IGM,LAB,A,300,86644,,,,,107.00,N,Y
4010529,CLOZAPINE,LAB,A,300,80159,,,,,84.00,N,Y
4010530,"URINE, EOSINOPHILS",LAB,A,300,89050,,,,,45.00,N,Y
4010531,RENAL PROFILE,LAB,A,300,80069,,,,,65.00,N,Y
4010533,UA MICROSCOPIC ONLY,LAB,A,300,81015,,,,,23.00,N,Y
4010534,DRUG SCREEN CONFIRMATION,LAB,A,300,80307,,,,,38.00,N,Y
4010535,BLOOD CULTURE FUNGAL,LAB,A,300,87103,,,,,68.00,N,Y
4010536,GLIADIN AB IG IGA,LAB,A,300,83516,,,,,111.00,N,Y
4010537,METHYLMALONIC ACID,LAB,A,300,82542,,,,,179.00,N,Y
4010538,FECAL FAT QUANT,LAB,A,300,82710,,,,,100.00,N,Y
4010539,ARSENIC HAIR,LAB,A,300,82175,,,,,140.00,N,Y
4010540,5HIAA,LAB,A,300,83497,,,,,79.00,N,Y
4010541,"AMYLASE, BODY FLUID",LAB,A,300,82150,,,,,50.00,N,Y
4010542,ANTI-SMOOTH MUSCLE AB,LAB,A,300,86255,,,,,90.00,N,Y
4010543,URINE UREA NITROGEN,LAB,A,300,84540,,,,,46.00,N,Y
4010544,ENDOMYSIAL AB,LAB,A,300,86255,,,,,90.00,N,Y
4010545,RETICULUM AB,LAB,A,300,86255,,,,,116.00,N,Y
4010546,CUTANEOUS IMMUNOFLUORESCE,LAB,A,300,88347,,,,,237.00,N,Y
4010547,"RENIN, PLASMA",LAB,A,300,84244,,,,,163.00,N,Y
4010548,"SODIUM, FECES",LAB,A,300,84302,,,,,89.00,N,Y
4010549,"POTASIUM, FECES",LAB,A,300,84999,,,,,91.00,N,Y
4010551,"PORPHYRINS, PLASMA",LAB,A,300,84311,,,,,298.00,N,Y
4010552,HERPES VIRUS ANTIBODY,LAB,A,300,86695,,,,,99.00,N,Y
4010553,FREE CORTISOL 24 HR URINE,LAB,A,300,82530,,,,,125.00,N,Y
4010554,D-XYLOSE,LAB,A,300,84620,,,,,111.00,N,Y
4010555,CORTISOL STIMULATION,LAB,A,300,80400,,,,,240.00,N,Y
4010556,RIA NON ANTIBODY,LAB,A,300,83519,,,,,107.00,N,Y
4010557,"VITAMIN D, AS HYDROXY",LAB,A,300,82306,,,,,218.00,N,Y
4010558,ACETYLCHOLINE BINDING AB,LAB,A,300,84238,,,,,123.00,N,Y
4010559,"FACTOR II LEVEL, QUANT",LAB,A,300,85210,,,,,43.00,N,Y
4010560,NURSING HOME DRAW FEE,LAB,A,300,36415,,,,,18.00,N,Y
4010561,ALDOSTERONE,LAB,A,300,82088,,,,,299.00,N,Y
4010562,ANTI DRASE B,LAB,A,300,86215,,,,,95.00,N,Y
4010563,S HYDROXYINDOLEACETIC ACI,LAB,A,300,83497,,,,,79.00,N,Y
4010565,DILUTE RUSSELL VIPER,LAB,A,300,85613,,,,,99.00,N,Y
4010566,COLUMN CHROMATOGRAPHY QUANT,LAB,A,300,82542,,,,,147.00,N,Y
4010568,EHRICHIA AB,LAB,A,300,86666,,,,,85.00,N,Y
4010569,ROCKY MOUTAIN SPOTTED FEV,LAB,A,300,86757,,,,,87.00,N,Y
4010571,ALPHA FETO PROTEIN MATERN,LAB,A,300,82105,,,,,200.00,N,Y
4010572,DECT OF AGENT BY DNA AMP,LAB,A,300,87798,,,,,152.00,N,Y
4010573,RIA NON ANTIBODY,LAB,A,300,83519,,,,,104.00,N,N
4010574,ESTROGEN FRACTIONATION,LAB,A,300,82671,,,,,237.00,N,Y
4010575,HUMAN PAPILLOMA VIRUS,LAB,A,300,87624,,,,,163.00,N,Y
4010576,DIRECT BILIRUBIN,LAB,A,300,82248,,,,,37.00,N,Y
4010577,C9-COMPLEMENT 9,LAB,A,300,86161,,,,,231.00,N,Y
4010578,SCREENING FECAL OCC.BLD.,LAB,A,300,G0107,,,,,33.00,N,Y
4010579,HEPATITIS C RNA BY PCR QU,LAB,A,300,87522,,,,,313.00,N,Y
4010580,FACTOR VIII,LAB,A,300,85240,,,,,46.00,N,Y
4010581,RISTOCETIN CO-FACTOR,LAB,A,300,85245,,,,,140.00,N,Y
4010582,"INSULIN, TOTAL",LAB,A,300,83525,,,,,52.00,N,Y
4010583,VON WILLEBRAND FACTOR,LAB,A,300,85247,,,,,168.00,N,Y
4010584,ACETYLCHOLENE BLOCK AB,LAB,A,300,84238,,,,,123.00,N,Y
4010585,TOPIRAMATE,LAB,A,300,80201,,,,,116.00,N,Y
4010586,HEPATITIS C GENOTYPE,LAB,A,300,87902,,,,,906.00,N,Y
4010587,BARTONELLA HENSELAE AB,LAB,A,300,86611,,,,,80.00,N,Y
4010588,RH COMPLETE PHENOTYPE,LAB,A,300,86906,,,,,65.00,N,Y
4010589,ESTRONE,LAB,A,300,82679,,,,,183.00,N,Y
4010590,"ALK.PHOS, FRACTION",LAB,A,300,84075,,,,,62.00,N,Y
4010591,ALPHA 1 ANTITRYPSIN PHENO,LAB,A,300,82104,,,,,151.00,N,Y
4010592,BNP (NATRIURETIC PEPTIDE),LAB,A,300,83880,,,,,209.00,N,Y
4010593,DIRECT LDL,LAB,A,300,83721,,,,,56.00,N,Y
4010594,"SPECIFIC GRAVITY, URINE",LAB,A,300,81003,,,,,25.00,N,Y
4010595,FUNGAL COMPLEMENT FIXATIO,LAB,A,300,86171,,,,,43.00,N,Y
4010597,OXCARBAZEPINE/TRILEPTAL,LAB,A,300,80183,,,,,100.00,N,Y
4010598,"AMPHETAMINE, QUANTITATIVE",LAB,A,300,82492,,,,,195.00,N,Y
4010599,"ALCOHOL, URINE",LAB,A,300,80301,,,,,103.00,N,Y
4010600,FINGER STICK,LAB,A,300,36416,,,,,14.00,N,Y
4010602,II-DEOXYCORTISOL (METYRAP,LAB,A,300,82634,,,,,176.00,N,Y
4010603,INSULIN ANTIBODIES,LAB,A,300,86337,,,,,157.00,N,Y
4010605,TETANUS ANTIBODY IgG,LAB,A,300,86317,,,,,111.00,N,Y
4010606,PROTHROMBIN G20210A MUTATION,LAB,A,300,83891,,,,,92.00,N,Y
,,LAB,A,300,81240,,,,,92.00,N,Y
4010607,PROTHROMBIN MUTATION 2,LAB,A,300,83896,,,,,32.00,N,Y
4010608,PROTHROMBIN MUTATION 3,LAB,A,300,83892,,,,,125.00,N,Y
,,LAB,A,300,83898,,,,,125.00,N,Y
4010609,PROTHROMBIN MUTATION 4,LAB,A,300,83912,,,,,32.00,N,Y
4010610,WHIPPLE'S DISEASE,LAB,A,300,87798,,,,,600.00,N,Y
4010611,TOXIC SHOCK SCREEN,LAB,A,300,86403,,,,,180.00,N,Y
4010612,LIPOPROTIEN (A),LAB,A,300,82172,,,,,118.00,N,Y
4010613,SEX HORMONE BINDING GLOBI,LAB,A,300,84270,,,,,164.00,N,Y
4010618,ANDROSTENEDIONE,LAB,A,300,82157,,,,,76.00,N,Y
4010619,ZONISAMIDE LEVEL,LAB,A,300,80203,,,,,180.00,N,Y
4010620,IGF-1 (INSULIN-GROWTH FAC,LAB,A,300,84305,,,,,68.00,N,Y
4010621,Drug level,LAB,A,300,80299,,,,,100.00,N,Y
4010622,THYROGLOBULIN,LAB,A,300,86800,,,,,114.00,N,Y
4010623,CARDIOLIPIN AB 1G6 & 1GM,LAB,A,300,86147,,,,,183.00,N,Y
4010624,"PERTUSSIS, PCR",LAB,A,300,87798,,,,,120.00,N,Y
4010625,TISSUE TRANSGULTAMINASE,LAB,A,300,83516,,,,,81.00,N,Y
4010626,SERUM VISCOSITY,LAB,A,300,85810,,,,,50.00,N,Y
4010627,GLUTEN/COELIAC PANEL PRT1,LAB,A,300,83516,,,,,83.00,N,Y
4010628,GLUTEN/COELIAC PANEL PRT2,LAB,A,300,86255,,,,,88.00,N,Y
4010629,GLUTEN/COELIAC PANEL PRT3,LAB,A,300,86256,,,,,88.00,N,Y
4010630,LAMOTRIGINE,LAB,A,300,80175,,,,,99.00,N,Y
4010631,CORTISOL 24HR URINE,LAB,A,300,82530,,,,,61.00,N,Y
4010632,"OSMALILITY, STOOL",LAB,A,300,83935,,,,,49.00,N,Y
4010633,REVERSE T3,LAB,A,300,84482,,,,,106.00,N,Y
4010634,EGFR EST GLOM FILT RATE,LAB,A,300,82565,,,,,38.00,N,Y
4010635,SSA/RO SSB/LA,LAB,A,300,86235,,,,,79.00,N,Y
4010636,"CRYPTOSPORIDIUM AG, ST001",LAB,A,300,87328,,,,,56.00,N,Y
4010637,WELLNESS PSA SCREENING,LAB,A,300,,,,,,37.00,N,Y
4010640,CYSTINE URINE QUANTITATIV,LAB,A,300,82136,,,,,24.00,N,Y
4010641,WELLNESS THYROID,LAB,A,300,,,,,,21.00,N,Y
4010642,WELLNESS TOTAL BLOOD ANAL,LAB,A,300,,,,,,54.00,N,Y
4010643,H PYLORI AG - STOOL,LAB,A,300,87338,,,,,117.00,N,Y
4010644,FARMERS LUNG BATTERY,LAB,A,300,86331,,,,,43.00,N,Y
4010645,CANCER ANTIGEN 19-9,LAB,A,300,86301,,,,,60.00,N,Y
4010646,VASO INTEST PEPTIDE,LAB,A,300,84586,,,,,83.00,N,Y
4010647,MISC TEST,LAB,A,300,84999,,,,,144.00,N,Y
4010648,SCLERODERMA ANTIBODIES IG,LAB,A,300,86235,,,,,66.00,N,Y
4010649,AMIMOLEVULINIC ACID-URINE,LAB,A,300,82135,,,,,89.00,N,Y
4010650,HIV-WESTERN BLOT,LAB,A,300,86689,,,,,103.00,N,Y
4010651,BENCE JONES PROTEIN #1,LAB,A,300,84156,,,,,13.00,N,Y
4010652,BENCE JONES PROTEIN #2,LAB,A,300,83883,,,,,30.00,N,Y
4010653,BENCE JONES PROTEIN #3,LAB,A,300,83883,,,,,47.00,N,Y
4010656,OLIGOCLONAL BANDING,LAB,A,300,83916,,,,,70.00,N,Y
4010657,OLIGOCLONAL BANDING,LAB,A,300,83916,,,,,33.00,N,Y
4010658,C-IQ LEVEL,LAB,A,300,86332,,,,,61.00,N,Y
4010659,INFLUENZA A,LAB,A,300,87400,,,,,51.00,N,Y
4010660,INFLUENZA B,LAB,A,300,87400,,,,,51.00,N,Y
4010661,HIV-PCR,LAB,A,300,87536,,,,,172.00,N,Y
4010662,BCR/ABL FISH 1,LAB,A,300,88271,,,,,87.00,N,Y
4010663,BCR/ABL FISH 2,LAB,A,300,88271,,,,,87.00,N,Y
4010664,BCR/ABL FISH 3,LAB,A,300,88275,,,,,87.00,N,Y
4010665,BCR/ABL FISH 4,LAB,A,300,88275,,,,,87.00,N,Y
4010666,BCR/ABL FISH 5,LAB,A,300,88291,,,,,87.00,N,Y
4010667,"METANEPHRINE, PLASMA",LAB,A,300,83835,,,,,108.00,N,Y
4010668,TRICHROME STAIN,LAB,A,300,87209,,,,,23.00,N,Y
4010669,SERUM CATECHOLAMINES,LAB,A,300,82384,,,,,83.00,N,Y
4010671,REDUCING SUBSTANCE STOOL,LAB,A,300,84376,,,,,39.00,N,Y
4010672,CIRCUL ANTI COAG SCREEN 1,LAB,A,300,85610,,,,,36.00,N,Y
4010673,CIRCUL ANTICOAG SCREEN 2,LAB,A,300,85730,,,,,40.00,N,Y
4010674,CIRCUL ANTI COAG SCREEN 3,LAB,A,300,85732,,,,,74.00,N,Y
4010675,CIRCUL ANTI COAG SCREEN 4,LAB,A,300,85611,,,,,64.00,N,Y
4010676,FACTOR X ACTIVITY,LAB,A,300,85260,,,,,78.00,N,Y
4010677,C-1 ESTERASE INHIBITOR ANITGEN,LAB,A,300,86160,,,,,53.00,N,Y
4010678,IMMUNO FREE LIGHT CHAINS1,LAB,A,300,83883,,,,,236.00,N,Y
4010679,IMMUNO FREE LIGHT CHAINS2,LAB,A,300,83883,,,,,236.00,N,Y
4010680,N-TELEPEPTIDE (URINE NTX),LAB,A,300,82523,,,,,78.00,N,Y
4010681,KEPPRA LEVEL,LAB,A,300,80177,,,,,81.00,N,Y
4010682,CANCER ANTIGEN MARKER,LAB,A,300,86300,,,,,65.00,N,Y
4010683,D-DIMER,LAB,A,300,85378,,,,,82.00,N,Y
4010684,RABIES VIRUS ANTIBODY,LAB,A,300,86317,,,,,114.00,N,Y
4010685,"CATECHOLAMINES, PLASMA",LAB,A,300,82384,,,,,75.00,N,Y
4010686,MICOPHENOLIC ACID (MMF),LAB,A,300,80299,,,,,94.00,N,Y
4010687,HEMOCHROM MUTATION DET#1,LAB,A,300,83890,,,,,83.00,N,Y
4010688,HEMOCHROM MUTATION DET#2,LAB,A,300,83900,,,,,83.00,N,Y
4010689,HEMOCHROM MUTATION DET#3,LAB,A,300,83896,,,,,83.00,N,Y
4010690,HEMOCHROM MUTATION DET#4,LAB,A,300,83896,,,,,83.00,N,Y
4010691,HEMOCHROM MUTATION DET#5,LAB,A,300,83896,,,,,83.00,N,Y
4010692,HEMOCHROM MUTATION DET#6,LAB,A,300,83896,,,,,83.00,N,Y
4010693,HEMOCHROM MUTATION DET#7,LAB,A,300,83912,,,,,83.00,N,Y
4010694,ANTIDIURETIC HORMONE,LAB,A,300,84588,,,,,63.00,N,Y
4010695,SIROLIMUS,LAB,A,300,80195,,,,,85.00,N,Y
4010696,TACROLIMUS,LAB,A,300,80197,,,,,99.00,N,Y
4010697,THYROID PEROXIDASE AB,LAB,A,300,86376,,,,,55.00,N,Y
4010698,FUNGAL SMEAR,LAB,A,300,87206,,,,,38.00,N,Y
4010699,C/Q BINDING ASSAY,LAB,A,300,86332,,,,,52.00,N,Y
4010700,PTH-C-TERMINAL,LAB,A,300,83970,,,,,116.00,N,Y
4010701,PTH-N-TERMINAL,LAB,A,300,83970,,,,,116.00,N,Y
4010702,ANTI RNP,LAB,A,300,86235,,,,,59.00,N,N
4010703,CALCITONIN,LAB,A,300,82308,,,,,174.00,N,Y
4010704,"HISTAMINE, URINE",LAB,A,300,83088,,,,,109.00,N,Y
4010705,PROSTAGLANDIN,LAB,A,300,84150,,,,,161.00,N,Y
4010706,TRYPTASE,LAB,A,300,83520,,,,,86.00,N,Y
4010707,NIMETHYLHISTAMINE,LAB,A,300,83789,,,,,84.00,N,Y
4010708,IGG INDEX CSF #1,LAB,A,300,82040,,,,,24.00,N,Y
4010709,IGG INDEX CSF #2,LAB,A,300,82042,,,,,35.00,N,Y
4010710,IGG INDEX CSF #3,LAB,A,300,82784,,,,,61.00,N,Y
4010711,IGG INDEX CSF #4,LAB,A,300,82784,,,,,61.00,N,Y
4010712,PRO BNP,LAB,A,300,83880,,,,,167.00,N,Y
4010713,"CARNITINE, FREE/TOTAL",LAB,A,300,82379,,,,,61.00,N,Y
4010714,PERTUSSIS AB,LAB,A,300,86615,,,,,87.00,N,Y
4010715,GLUCOSE 6 PHOS DEHYDROG,LAB,A,300,82955,,,,,53.00,N,Y
4010716,IMMUNOFIXATION SERUM,LAB,A,300,86334,,,,,145.00,N,Y
4010717,Q FEVER ANTIBODIES,LAB,A,300,86638,,,,,79.00,N,Y
4010718,TRICHOMONAS CULTURE,LAB,A,300,87070,,,,,55.00,N,Y
4010719,CMZ PCR,LAB,A,300,87497,,,,,158.00,N,Y
4010720,FACTOR IX,LAB,A,300,85250,,,,,46.00,N,Y
4010721,BETA -2 GLYCOPROTEIN G,LAB,A,300,86146,,,,,80.00,N,Y
4010722,BETA - 2 GLYCOPROTEIN M,LAB,A,300,86146,,,,,80.00,N,Y
4010723,PYRUVIC ACID,LAB,A,300,84210,,,,,57.00,N,Y
4010724,ANTI MUSK,LAB,A,300,83519,,,,,744.00,N,Y
4010725,ACETYLCHOLENE MODULATING,LAB,A,300,84238,,,,,123.00,N,Y
4010726,FLUNITRAZEPAM (ROHYPNOL),LAB,A,300,80101,,,,,103.00,N,Y
4010727,GHB,LAB,A,300,80100,,,,,107.00,N,Y
4010728,KETAMINE (URINE),LAB,A,300,80101,,,,,103.00,N,Y
4010729,MRSA CULTURE NARE,LAB,A,300,87081,,,,,35.00,N,Y
4010730,HFE1(HEMOCHROMATOSIS HFE),LAB,A,300,83890,,,,,165.00,N,Y
4010731,HFE2 (GENE ANALYSIS),LAB,A,300,83898,,,,,165.00,N,Y
4010732,HFE 3,LAB,A,300,83912,,,,,165.00,N,Y
4010733,JAK - 2 MUTATION 1,LAB,A,300,81270,,,,,173.00,N,Y
4010734,JAK - MUTATION 2,LAB,A,300,83900,,,,,112.00,N,Y
4010735,JAK MUTATION 3,LAB,A,300,83914,,,,,94.00,N,Y
4010736,JAK MUTATION 4,LAB,A,300,83894,,,,,94.00,N,Y
4010737,JAK - MUTATION 5,LAB,A,300,83912,,,,,94.00,N,Y
4010738,FETAL BLEED SCREEN,LAB,A,300,85461,,,,,42.00,N,Y
4010739,"HEPC RNA, PCR, QUALITATIV",LAB,A,300,87521,,,,,210.00,N,Y
4010740,BK VIRUS QUANTITATIVEPCR,LAB,A,300,87799,,,,,432.00,N,Y
4010741,SELENIUM,LAB,A,300,84255,,,,,46.00,N,Y
4010742,COPPER (SERUM),LAB,A,300,82525,,,,,44.00,N,Y
4010743,VITAMIN K,LAB,A,300,84597,,,,,109.00,N,Y
4010744,HEP C RNA PCR QUANT,LAB,A,300,87522,,,,,210.00,N,Y
4010745,INTRINSIC BLOCKING AB,LAB,A,300,86340,,,,,49.00,N,Y
4010746,IMMUNOFIXATION URINE,LAB,A,300,86335,,,,,80.00,N,Y
4010747,MUMPS VIRUS AB 1 GM,LAB,A,300,86735,,,,,41.00,N,Y
4010748,ALDOSTERONE 24 HR URINE,LAB,A,300,82088,,,,,131.00,N,Y
4010749,SHIGA TOXIN,LAB,A,300,87427,,,,,59.00,N,Y
4010750,HISTOPLASMA AG (ANTIGEN),LAB,A,300,87385,,,,,184.00,N,Y
4010751,"HOMOVANILLIC ACID, URINE",LAB,A,300,83150,,,,,57.00,N,Y
4010752,SERUM LIGHT CHAIN QUANT,LAB,A,300,83883,,,,,87.00,N,Y
4010753,ARIPIPRAZOLE (ABILIFY),LAB,A,300,82542,,,,,218.00,N,Y
4010754,HISTONE AB IGG,LAB,A,300,83516,,,,,46.00,N,Y
4010755,BENZODIAZIPINE (BLOOD),LAB,A,300,80154,,,,,92.00,N,Y
4010756,WEST NILE AB IYG,LAB,A,300,86788,,,,,92.00,N,Y
4010757,WEST NILE AB IGM,LAB,A,300,86789,,,,,43.00,N,Y
4010758,LACTOSE TOLERACE TEST,LAB,A,300,82951,,,,,51.00,N,Y
4010760,HISTPOLASMA AG URINE,LAB,A,300,87385,,,,,187.00,N,Y
4010761,BRUCELLA ANTIBODY,LAB,A,300,86622,,,,,35.00,N,Y
4010762,ANABOLIC STEROIDS,LAB,A,300,80100,,,,,151.00,N,Y
4010763,"TOXOPLASMA, IGM",LAB,A,300,86778,,,,,43.00,N,Y
4010764,ARTERIAL BLOOD COLLECTION,LAB,A,300,36600,,,,,81.00,N,Y
4010765,CD4 ABSOLUTE COUNT,LAB,A,300,86361,,,,,218.00,N,Y
4010766,HIV VIRAL LOAD,LAB,A,300,87536,,,,,246.00,N,Y
4010767,IGE RECEPTOR AB,LAB,A,300,88184,,,,,208.00,N,Y
4010768,SJOGRENS TITER,LAB,A,300,86235,,,,,106.00,N,Y
4010769,"KETONE, SERUM",LAB,A,300,82009,,,,,55.00,N,Y
4010770,IMMUNOGLOBULIN D,LAB,A,300,82784,,,,,45.00,N,Y
4010771,IMMUNGLOBULIN E,LAB,A,300,82785,,,,,54.00,N,Y
4010772,P+C ANCA,LAB,A,300,86255,,,,,90.00,N,Y
4010773,CA19-9,LAB,A,300,86301,,,,,76.00,N,Y
4010774,DIPTHERIA,LAB,A,300,86648,,,,,78.00,N,Y
4010775,TETANUS AB,LAB,A,300,86774,,,,,76.00,N,Y
4010776,WELLNESS HEMAGRAM,LAB,A,300,85027,,,,,20.00,N,Y
4010777,WELLNESS COMP PANEL,LAB,A,300,80053,,,,,35.00,N,Y
4010778,WELLNESS BASIC PANEL,LAB,A,300,80048,,,,,25.00,N,Y
4010779,WELLNESS LIPID PANEL,LAB,A,300,80061,,,,,20.00,N,Y
4010780,WELLNESS ALT,LAB,A,300,84460,,,,,10.00,N,Y
4010781,WELLNESS GLUCOSE,LAB,A,300,82947,,,,,10.00,N,Y
4010782,WELLNESS A1C,LAB,A,300,,,,,,20.00,N,Y
4010783,WELLNESS TSH,LAB,A,300,84443,,,,,30.00,N,Y
4010784,WELLNESS FT4,LAB,A,300,84439,,,,,20.00,N,Y
4010785,WELLNESS PSA,LAB,A,300,G0103,,,,,30.00,N,Y
4010787,FELBAMATE,LAB,A,250,80299,,,,,56.00,N,Y
4010788,WELLNESS HCG,LAB,A,300,,,,,,25.00,N,Y
4010790,ZAP 70 #1,LAB,A,300,88184,,,,,135.00,N,Y
4010791,ZAP 70#2,LAB,A,300,88185,,,,,81.00,N,Y
4010792,ZAP 70 #3,LAB,A,300,88185,,,,,81.00,N,Y
4010793,ZAP 70 #4,LAB,A,300,88187,,,,,130.00,N,Y
4010794,ANTI DNA B TITER #1,LAB,A,300,86060,,,,,37.00,N,Y
4010795,ANTI DNA B TITER #2,LAB,A,300,86215,,,,,62.00,N,Y
4010796,ANTI MYELIN AB,LAB,A,300,86255,,,,,118.00,N,Y
4010797,ANTI NEURONAL AB,LAB,A,300,86255,,,,,90.00,N,Y
4010798,RISPERIDONE,LAB,A,300,82542,,,,,105.00,N,Y
4010799,HERPES SIMPLEX TYPE 1 & 2,LAB,A,300,86694,,,,,43.00,N,Y
4010800,OXYCODONE,LAB,A,300,80301,,,,,103.00,N,Y
4010801,PH STOOL,LAB,A,300,83986,,,,,28.00,N,Y
4010802,CYSTIC FIBROS70GENO R CAR,LAB,A,300,83900,,,,,302.00,N,Y
4010803,"TISSUE TRANSGLUTABIG,IGA",LAB,A,300,83516,,,,,81.00,N,Y
4010804,THYROID ANTIBODY PANEL,LAB,A,300,86376,,,,,76.00,N,Y
4010805,KARYOTYPE BLOOD #1,LAB,A,300,88262,,,,,827.00,N,Y
4010806,KARYOTYPE BLOOD #2,LAB,A,300,88237,,,,,827.00,N,Y
4010807,CYP206 #1,LAB,A,300,83892,,,,,108.00,N,Y
4010808,CYP206 #2,LAB,A,300,83900,,,,,216.00,N,Y
4010809,PLATELET FUNCT ASSAY(PFA),LAB,A,300,85576,,,,,119.00,N,Y
4010810,LKM AB,LAB,A,300,86376,,,,,79.00,N,Y
4010811,CSF GLUCOSE,LAB,A,300,82945,,,,,29.00,N,Y
4010812,CSF PROTEIN,LAB,A,300,84157,,,,,31.00,N,Y
4010813,ANTI-THROMBIN III ACTIVIT,LAB,A,300,85300,,,,,38.00,N,Y
4010814,BETA HCG SCREEN URINE,LAB,A,300,84703,,,,,65.00,N,Y
4010815,CHROMOGRANIN A,LAB,A,300,86316,,,,,77.00,N,Y
4010816,HANDLING FEE,LAB,A,300,36415,,,,,22.00,N,Y
4010817,IMMUNFIX E-PHORSIS/URINE/CSF,LAB,A,300,86335,,,,,140.00,N,Y
4010818,CHLORIDE UA RANDOM,LAB,A,300,82436,,,,,45.00,N,Y
4010819,CELL ABSORPTION,PHA,A,300,86978,,,,,126.00,N,Y
4010820,EPSTEIN-BARR VIR ANTIPROF,LAB,A,300,86665,,,,,86.00,N,Y
4010821,CYTOMEGALOIRUS(CMV)PCR QU,LAB,A,300,87496,,,,,116.00,N,Y
4010822,MYCOPHENOLIC ACID,LAB,A,300,80180,,,,,110.00,N,Y
4010823,"AMYLASE, ISOENZYMES",LAB,A,300,82150,,,,,45.00,N,Y
4010824,ALPHA 1 ANTIRYPSIN FECAL,LAB,A,300,82103,,,,,140.00,N,Y
4010825,SICKLE CELL SCREEN,LAB,A,300,85660,,,,,46.00,N,Y
4010826,HGB ELECRO SICKLE CELL,LAB,A,300,85660,,,,,44.00,N,Y
4010827,PANCREASTATIN,LAB,A,300,83519,,,,,253.00,N,Y
4010828,HISTONE ANTIBODIES,LAB,A,300,83516,,,,,43.00,N,Y
4010829,ANTI-SSA (ANTI-RO),LAB,A,300,86235,,,,,43.00,N,Y
4010830,ANTI-SSB(ANTI-LA),LAB,A,300,86235,,,,,43.00,N,Y
4010831,ANTI-RNP,LAB,A,300,86235,,,,,106.00,N,Y
4010832,CYTOPATH FLUID WASHING,LAB,A,300,88104,,,,,355.00,N,Y
4010833,FLOWCYTOMETRY MARKER,LAB,A,300,88184,,,,,355.00,N,Y
4010834,FLOWCYTOMETRY MARKER- ADD,LAB,A,300,88185,,,,,124.00,N,Y
4010835,"NICOTINE, URINE",LAB,A,300,80323,,,,,42.00,N,Y
4010836,CYCLIC C PEPTIDE AB,LAB,A,300,86200,,,,,57.00,N,Y
4010837,HUMAN HERPESVIRUS 6 HHV6,LAB,A,300,86790,,,,,48.00,N,Y
4010838,STREP PNEUMONIA ANTIGEN;,LAB,A,300,87449,,,,,108.00,N,Y
4010839,VON WILLEBRAND FACT ANTIG,LAB,A,300,85246,,,,,69.00,N,Y
4010840,SOLUBLE TRANSFERRIN RECEP,LAB,A,300,84238,,,,,75.00,N,Y
4010841,CHROMIUM,LAB,A,300,82495,,,,,49.00,N,Y
4010842,COBALT,LAB,A,300,83789,,,,,100.00,N,Y
4010843,BETA-HYDROXYBUTYRATE,LAB,A,300,82010,,,,,46.00,N,Y
4010844,VARICELLA-ZOSTER VIRUSTGB,LAB,A,300,86787,,,,,96.00,N,Y
4010845,STREP PNEUMONIA Ig623X23,LAB,A,300,86317,,,,,70.00,N,Y
4010846,WESTNILES AB IGG IGM,LAB,A,300,86788,,,,,92.00,N,Y
4010847,ANTI-SMITH ANTIBODIES,LAB,A,300,86235,,,,,43.00,N,Y
4010848,PYRIDOZAL 5 PHOSPHATE PLA,LAB,A,300,84207,,,,,81.00,N,Y
4010849,HERPES SIMPLEX VIRUS PCR,LAB,A,300,87529,,,,,97.00,N,Y
4010850,PLASMA PORPHYRIN,LAB,A,300,82492,,,,,110.00,N,Y
4010851,ANTIGEN SCREENING,LAB,A,300,86904,,,,,27.00,N,Y
4010852,ID FOR URINE BACTERIN,LAB,A,300,87088,,,,,55.00,N,Y
4010853,IMMUNGLOBULIN G SUBCLASS,LAB,A,300,82787,,,,,38.00,N,Y
4010854,TOXOCARA ANTIBODY IG6,LAB,A,300,86682,,,,,69.00,N,Y
4010855,COCCIDIOIDES AB,LAB,A,300,86635,,,,,36.00,N,Y
4010856,TRICHINELLA AB,LAB,A,300,86784,,,,,43.00,N,Y
4010857,STRONGLYLOIDES AB,LAB,A,300,86682,,,,,69.00,N,Y
4010858,WHEAT ALLERGEN IgE,LAB,A,300,,,,,,34.00,N,Y
4010859,AMINO ACIDS,LAB,A,300,,,,,,34.00,N,Y
4010860,"SULFATE, URINE",LAB,A,300,84392,,,,,16.00,N,Y
4010861,MTHRM1,LAB,A,300,81291,,,,,22.00,N,Y
4010862,MTHRM2,LAB,A,300,83900,,,,,92.00,N,Y
4010863,MTHRM3,LAB,A,300,83896,,,,,22.00,N,Y
4010864,MTHRM4,LAB,A,300,83912,,,,,81.00,N,Y
4010865,ANTI CARDIOLIPIN IGA,LAB,A,300,86147,,,,,97.00,N,Y
4010866,SEROTONIN SERUM,LAB,A,300,84260,,,,,106.00,N,Y
4010867,SURGICAL PATH EXAM ONLY,LAB,A,300,88300,,,,,55.00,N,Y
4010869,SURGICAL PATHOLOGY EXAM I,LAB,A,300,88302,,,,,103.00,N,Y
4010870,SURG PAT DIAGEXAM SM,LAB,A,300,88304,,,,,106.00,N,Y
4010871,SURG PATH DIAG EXAM LG,LAB,A,300,88305,,,,,140.00,N,Y
4010872,SURG PATH COMPLEX DIAG,LAB,A,300,88307,,,,,300.00,N,Y
4010873,SURG PATH COMPREHENSIVE D,LAB,A,300,88309,,,,,414.00,N,Y
4010874,SURPATH DEALCIFICATION PR,LAB,A,300,88311,,,,,25.00,N,Y
4010875,SPECIAL STAINSGROUP 1,LAB,A,300,88312,,,,,137.00,N,Y
4010876,SPECIAL STAINS GROUP 2,LAB,A,300,,,,,,112.00,N,Y
4010877,CNSULT DUR SURG FR SECTIO,LAB,A,300,88331,,,,,73.00,N,Y
4010878,CNSULT DUR SUR EA ADD FRS,LAB,A,300,88332,,,,,32.00,N,Y
4010879,IMMUNOCYTOCHEMISTRY,LAB,A,300,88342,,,,,132.00,N,Y
4010880,IMMUNOFLUORESCENT STUDY,LAB,A,300,88346,,,,,127.00,N,Y
4010881,TUMOR IMMUNIHISTOCHEM,LAB,A,300,88360,,,,,140.00,N,Y
4010882,TISSUE HYBRIDIZATION,LAB,A,300,88365,,,,,215.00,N,Y
4010883,CLO TEST,LAB,A,300,83009,,,,,113.00,N,Y
4010884,COTININE,LAB,A,300,80302,,,,,89.00,N,Y
4010885,THYROGLOBULIN TUMOR MARKE,LAB,A,300,84432,,,,,52.00,N,Y
4010886,SURGICAL PATH LEVEL 1,LAB,A,300,88300,,,,,50.00,N,Y
4010887,SURGICAL PATH LEVEL 2,LAB,A,300,88302,,,,,97.00,N,Y
4010888,SURGICAL PATH LEVEL 3,LAB,A,300,88304,,,,,100.00,N,Y
4010889,SURGICAL PATH LEVEL 4,LAB,A,300,88305,,,,,135.00,N,Y
4010890,SURGICAL PATH LEVEL 5,LAB,A,300,88307,,,,,225.00,N,Y
4010891,SURGICAL PATH LEVEL 6,LAB,A,300,88309,,,,,319.00,N,Y
4010892,SURG PATH DECALCIFICATION,LAB,A,300,88311,,,,,19.00,N,Y
4010893,SURG PATH SPECIAL STAIN,LAB,A,300,88312,,,,,131.00,N,Y
4010894,SURG PATH GROUP 2 STAIN,LAB,A,300,,,,,,107.00,N,Y
4010895,SURG PATH TISSUE BLOCK,LAB,A,300,88331,,,,,68.00,N,Y
4010896,SURG PATH ADD TISSUE BLOC,LAB,A,300,88332,,,,,27.00,N,Y
4010897,SURG PATH IMMUNOHISTCHEMI,LAB,A,319,88342,,,,,126.00,N,Y
4010898,SURG PATH IMMUNOFLORECEN,LAB,A,300,88346,,,,,122.00,N,Y
4010899,SURG PATH MORPHO ANALYSIS,LAB,A,300,88360,,,,,135.00,N,Y
4010900,SURG PATH INSITZ HYDRIDIZ,LAB,A,300,88365,,,,,210.00,N,Y
4010901,CYTOLOGY FLUID TC,LAB,A,300,88104,,,,,77.00,N,Y
4010902,CYTOLOGY NON-GYN TC,LAB,A,300,88112,,,,,79.00,N,Y
4010903,FINE NEEDLE ASPIRATE TC,LAB,A,300,88173,,,,,120.00,N,Y
4010904,CHLAMYDIA TRACH URINEPCR,LAB,A,300,87491,,,,,65.00,N,Y
4010906,MYSATHENIA GRAVIS EVAL 1,LAB,A,300,83519,,,,,54.00,N,N
4010907,MYASTHENIA GRAVIS EVAL 2,LAB,A,300,83520,,,,,54.00,N,N
4010908,PROTHROMBIN MUTATION 5,LAB,A,300,83908,,,,,49.00,N,N
4010909,PROTHROMBIN MUTATION 6,LAB,A,300,83903,,,,,49.00,N,N
4010910,HEPATITIS B DNA QUANT,LAB,A,300,87517,,,,,166.00,N,N
4010911,"NOROVIRUS, STOOL",LAB,A,300,87798,,,,,70.00,N,N
4010912,FOOD ALLERGY PROFILE,LAB,A,300,86003,,,,,22.00,N,N
4010913,RESPIRATORY ALLERGY PROFI,LAB,A,300,86003,,,,,22.00,N,N
4010914,GAD 65,LAB,A,300,86341,,,,,95.00,N,N
4010915,WELLNESS CHOLESTEROL,LAB,A,300,82465,,,,,10.00,N,N
4010916,VONWILLEBRAND FACTOR ACTI,LAB,A,300,,,,,,95.00,N,N
4010917,PERTUSSIS BY PCR,LAB,A,300,87798,,,,,158.00,N,N
4010918,PLASMA HEMOGLOBIN,LAB,A,300,83051,,,,,27.00,N,N
4010919,THELPER/SUPPRESSOR PANEL,LAB,A,300,86360,,,,,151.00,N,N
4010920,GCBYDNAPROBE URINE,LAB,A,300,87591,,,,,59.00,N,Y
4010921,DEXAMETH SUPP POST CORTIS,LAB,A,300,82533,,,,,54.00,N,Y
4010922,BETA-HUMAN CHORIONIC,LAB,A,300,84702,,,,,38.00,N,Y
4010923,SURGICAL PATH DECALCIFICATION GROUP 2,LAB,A,300,88313,,,,,107.00,N,N
4010942,RESPIRATORY VIRUS PANEL,LAB,A,306,87633,,,,,281.00,N,Y
4010943,CONNECTIVE TISSUE DISEASE CASCADE,LAB,A,300,,,,,,94.00,N,N
4010944,PROCALCITONIN,LAB,A,300,84145,,,,,281.00,N,N
4010945,FT4 DIALYSIS,LAB,A,300,84439,,,,,113.00,N,N
4010946,"C1Q COMPLEMENT, FUNCTIONAL",LAB,A,300,86161,,,,,68.00,N,N
4010947,GROUP B STREP,LAB,A,300,87081,,,,,32.00,N,N
4010948,FLECAINIDE,LAB,A,300,80299,,,,,55.00,N,N
4010949,CYCLOSPORA,LAB,A,300,87206,,,,,46.00,N,N
4010950,BORREILA BURGDONFER 1GAND1GM WESTERN BLO,LAB,A,300,86617,,,,,81.00,N,N
4010951,ENTEROVIRUS PCR,LAB,A,300,87498,,,,,81.00,N,N
4010952,ADENOVIRUS ANTIBODY,LAB,A,300,86603,,,,,81.00,N,N
4010953,VARICELLA ZOSTER BY PCR,LAB,A,300,87798,,,,,90.00,N,N
4010954,URINE LIGHT CHAINS,LAB,A,300,83883,,,,,49.00,N,N
4010955,C-1 ESTERASE INHIBITOR,LAB,A,300,86161,,,,,165.00,N,N
4010956,UGT1A1,LAB,A,300,81350,,,,,971.00,N,N
4010957,FECAL CALPROTECTIN,LAB,A,300,83993,,,,,200.00,N,N
4010958,BULLOUS PEMPHIGOLD ANTIBODIES,LAB,A,300,83516,,,,,100.00,N,N
4010959,ECHO VIRUS,LAB,A,300,86658,,,,,62.00,N,N
4010960,"ALLERGY PROFILE, CHILDHOOD",LAB,A,300,82785,,,,,81.00,N,N
,,LAB,A,300,86003,91,,,,81.00,N,N
4010961,VORICONAZOLE,LAB,A,300,80299,,,,,54.00,N,N
4010962,THROMBOPILIA PROFILE,LAB,A,300,81241,,,,,834.00,N,N
,,LAB,A,300,81240,,,,,834.00,N,N
,,LAB,A,300,85732,,,,,834.00,N,N
,,LAB,A,300,85730,,,,,834.00,N,N
,,LAB,A,300,85611,,,,,834.00,N,N
,,LAB,A,300,85597,,,,,834.00,N,N
,,LAB,A,300,85598,,,,,834.00,N,N
,,LAB,A,300,85610,,,,,834.00,N,N
,,LAB,A,300,85390,,,,,834.00,N,N
,,LAB,A,300,85420,,,,,834.00,N,N
,,LAB,A,300,85384,,,,,834.00,N,N
,,LAB,A,300,85670,,,,,834.00,N,N
,,LAB,A,300,85635,,,,,834.00,N,N
,,LAB,A,300,85613,,,,,834.00,N,N
,,LAB,A,300,85613,,,,,834.00,N,N
,,LAB,A,300,85613,91,,,,834.00,N,N
,,LAB,A,300,85230,,,,,834.00,N,N
,,LAB,A,300,85240,,,,,834.00,N,N
,,LAB,A,300,85220,,,,,834.00,N,N
,,LAB,A,300,85210,,,,,834.00,N,N
,,LAB,A,300,85260,,,,,834.00,N,N
,,LAB,A,300,85250,,,,,834.00,N,N
,,LAB,A,300,85270,,,,,834.00,N,N
,,LAB,A,300,85280,,,,,834.00,N,N
,,LAB,A,300,85300,,,,,834.00,N,N
,,LAB,A,300,85301,,,,,834.00,N,N
,,LAB,A,300,85302,,,,,834.00,N,N
,,LAB,A,300,85305,,,,,834.00,N,N
,,LAB,A,300,85303,,,,,834.00,N,N
,,LAB,A,300,85379,,,,,834.00,N,N
,,LAB,A,300,85366,,,,,834.00,N,N
,,LAB,A,300,85307,,,,,834.00,N,N
,,LAB,A,300,85335,,,,,834.00,N,N
,,LAB,A,300,85306,,,,,834.00,N,N
4010963,LDL PARTICAL CONCENTRATION,LAB,A,300,83704,,,,,80.00,N,N
4010964,HANTAVIRUS IgG IgM,LAB,A,300,86790,,,,,135.00,N,N
,,LAB,A,300,86790,91,,,,135.00,N,N
4010965,QUETIAPINE,LAB,A,300,80342,,,,,120.00,N,N
4010966,GABITRIL,LAB,A,300,80199,,,,,95.00,N,N
4010967,DETEC OF AGENT BY DNA AMP,LAB,A,300,87798,,,,,110.00,N,N
4010968,SURGICAL PATH IMMUNOHISTO CHEMISTY2,LAB,A,319,GO462,,,,,121.00,N,N
4010969,COLD ABSORTION,LAB,A,300,86978,,,,,207.00,N,N
4010970,PANCREATIC ELASTASEL,LAB,A,300,82656,,,,,102.00,N,N
4010971,LYMPHOEYTE TRANSFORMATION TEST,LAB,A,300,86353,,,,,999.00,N,N
4010972,LACOSAMIDE,LAB,A,300,80299,,,,,119.00,N,N
4010973,PHENOTYPE ANTIGEN TEST,LAB,A,300,86905,,,,,58.00,N,N
4010974,ETHYL GLUCVRONIDE SCREEN URINE,LAB,A,300,80101,,,,,85.00,N,N
,,LAB,A,300,82542,,,,,85.00,N,N
4010975,STAT FEE,LAB,A,300,S3600,,,,,162.00,N,N
4010976,ALLERGEN MILK,LAB,A,300,86003,,,,,32.00,N,N
4010977,ALLERGEN EGG YOLK,LAB,A,300,86003,,,,,32.00,N,N
4010978,ALLERGEN EGG WHITE,LAB,A,300,86003,,,,,32.00,N,N
4010980,GLUCOGON,LAB,A,300,82943,,,,,86.00,N,N
4010981,PAP SMEAR,LAB,A,300,88175,,,,,95.00,N,N
4010983,SUPERSATURATION PROFILE UNNO,LAB,A,300,83735,,,,,313.00,N,N
,,LAB,A,300,82340,,,,,313.00,N,N
,,LAB,A,300,82507,,,,,313.00,N,N
,,LAB,A,300,82436,,,,,313.00,N,N
,,LAB,A,300,82570,,,,,313.00,N,N
,,LAB,A,300,84392,,,,,313.00,N,N
,,LAB,A,300,84300,,,,,313.00,N,N
,,LAB,A,300,83945,,,,,313.00,N,N
,,LAB,A,300,83935,,,,,313.00,N,N
,,LAB,A,300,83986,,,,,313.00,N,N
,,LAB,A,300,84105,,,,,313.00,N,N
,,LAB,A,300,84133,,,,,313.00,N,N
,,LAB,A,300,84560,,,,,313.00,N,N
4010986,CROSSMATCH IMM SPIN UNIT 2,LAB,A,300,86920,,,,,59.00,N,N
4010987,CROSSMATCH AHG UNIT 2,LAB,A,300,86921,,,,,76.00,N,N
4010990,CROSSMATCH IMM SPIN UNIT 3,LAB,A,300,86920,,,,,59.00,N,N
4010991,CROSSMATCH AHG UNIT 3,LAB,A,300,86921,,,,,76.00,N,N
4010993,CROSSMATCH IMM SPIN UNIT 4,LAB,A,300,86920,,,,,59.00,N,N
4010995,CROSSMATCH AHG UNIT 4,LAB,A,300,86921,,,,,76.00,N,N
4010997,GLUCOSE TOLERANCE 1 HOUR,LAB,A,300,82951,,,,,76.00,N,N
4011001,PKU,LAB,A,300,84030,,,,,27.00,N,N
4011002,GALACTOSE 1 PHOSPHATE URIDYL TRANS SCR,LAB,A,300,82776,,,,,27.00,N,N
4011003,MASS SPECTROMETRY NOS,LAB,A,300,83789,,,,,84.00,N,N
4011004,BIOTINIDASE,LAB,A,300,82261,,,,,53.00,N,N
4011017,INFECTIOUS AGENT BY PCR,LAB,A,300,87798,,,,,70.00,N,N
4011020,CONCENTRATION OF INFECTIOUS AGENT,LAB,A,300,87015,,,,,29.00,N,N
4011030,STTOL CULTURE ADDT'L PATHOGENS,LAB,A,300,87046,,,,,42.00,N,Y
4011039,EPSTEIN BARR VIRUS NUCLEAR ANTIGEN,LAB,A,300,86664,,,,,68.00,N,N
4011050,THYROID STIMULATING IMMUNOGLBIN,LAB,A,300,84445,,,,,119.00,N,N
4011051,TSH RECEPTOR ANTIBODY,LAB,A,300,83519,,,,,81.00,N,N
4011053,CADMIUM,LAB,A,300,82300,,,,,100.00,N,N
4011055,HERPES SIMPLEX TYPE 2,LAB,A,300,86696,,,,,30.00,N,N
4011061,ANTIOBODY ELUTION,LAB,A,300,86860,,,,,130.00,N,N
4011075,CHLAMYDIA PNEUMONIA BY PCR,LAB,A,300,87486,,,,,152.00,N,N
4011076,MYCOPLASMA PNEUMONIA BY PCR,LAB,A,300,87581,,,,,152.00,N,N
4011088,TRICHOMONAS VAGINALIS,LAB,A,300,87808,,,,,53.00,N,N
4011089,ID FOR URINE BACTERIA #2,LAB,A,300,87088,,,,,55.00,N,N
4011090,ID #2,LAB,A,300,87077,,,,,55.00,N,N
4011091,SENSITIVITY ANTIBIOTIC #2,LAB,A,300,87186,,,,,83.00,N,N
4011094,RAPID BLOOD CULTRUE PATHOGEN ID,LAB,A,300,87150,,,,,14.00,N,N
4011096,HEMOCHROMATOSIS HFE GENE ANALYSIS,LAB,A,300,81256,,,,,513.00,N,N
4011097,EACH ADD SINGLE ANTIBODY STAIN,LAB,A,300,88341,,,,,143.00,N,N
4011102,SULFONYLUREA,LAB,A,300,80377,,,,,189.00,N,N
4011103,ANTIXA,LAB,A,300,85520,,,,,58.00,N,N
4011104,FILM ARRAY INFECTIOUS DIARRHEA PANEL,LAB,A,300,87507,,,,,648.00,N,N
4011111,HYPOGLYCEMIC SULONYLUREA PANEL,LAB,A,300,80304,,,,,81.00,N,N
4011123,HLA CLASS I HIGH DEFIN QUAL,LAB,A,300,86832,,,,,503.00,N,N
4011124,HLA CLAS II HIGH DEFINE QUAL,LAB,A,300,86833,,,,,458.00,N,N
4011126,HEMAGLOBIN CHROMATOGRAPHY,LAB,A,300,83021,,,,,81.00,N,N
4011127,ELECTROPHORETIC TEST,LAB,A,300,82664,,,,,152.00,N,N
4011133,ETHYL GLUCURONIDE,LAB,A,300,80321,,,,,151.00,N,N
4011134,"EPSTEIN BARR, MOLECULAR DETECT PCR QUAL",LAB,A,300,87798,,,,,177.00,N,N
4011135,EVEROLIMUS,LAB,A,300,80169,,,,,81.00,N,N
4011140,CHEMILUMINESENT ASSAY,LAB,A,300,82397,,,,,65.00,N,N
4011142,quantiFERON TB IN TUBE,LAB,A,300,86480,,,,,273.00,N,N
4011145,HEPATITIS C AB FOR MEDICARE PATIENTS,LAB,A,300,G0472,,,,,106.00,N,N
4011146,MANGANESE,LAB,A,300,83785,,,,,110.00,N,N
4011148,TESTOSTERONE BIOAVAILABLE,LAB,A,300,84410,,,,,158.00,N,N
4011150,FISH ANALYSIS,LAB,A,300,88374,,,,,379.00,N,N
4011153,BCR ABL1 GENE MAJOR BP,LAB,A,300,81206,,,,,275.00,N,N
4011154,BCR ABL1 GENE MINOR BP,LAB,A,300,81207,,,,,247.00,N,N
4011155,BCR ABL1 GENE OTHER BP,LAB,A,300,81208,,,,,271.00,N,N
4011156,CANDIDA ANTIBODY,LAB,A,300,86628,,,,,55.00,N,N
4011158,PROTOZOA ANTIBODY NOS,LAB,A,300,86753,,,,,55.00,N,N
4011160,PREGNENOLONES,LAB,A,300,84140,,,,,94.00,N,N
4011161,ANA by IMUNODIFFUSION,LAB,A,300,86038,,,,,45.00,N,N
4011164,ALUMINUM SERUM,LAB,A,300,82108,,,,,96.00,N,N
4011166,GROUP B STREP by PCR,LAB,A,300,87653,,,,,129.00,N,N
4020001,WHOLE BLOOD,BLB,A,390,P9010,,,,,311.50,N,Y
4020002,BLOOD UNIT,BLB,A,390,P9021,,,,,281.50,N,Y
4020003,FRESH FROZEN PLASMA(SINGL,BLB,A,390,P9017,,,,,79.00,N,Y
4020004,"PLATELETS, PHERESIS",BLB,A,390,P9034,,,,,643.00,N,Y
4020005,CRYOPRECIPITATE,BLB,A,390,P9012,,,,,79.00,N,Y
4020008,LEUKO REDUCED RED BLOOD C,BLB,A,390,P9016,,,,,225.50,N,Y
4020009,RHOGRAM,BLB,A,390,90384,,,,,135.00,N,Y
4030001,HOLTER MONITOR RECORDER,EKG,A,731,93225,,,,,154.50,N,Y
4030002,EKG INTERP REPORT,EKG,A,990,93010,,,,,24.00,N,Y
4030008,HM DR REVIEW AND INTERP,EKG,A,960,93227,,,,,57.50,N,Y
4030013,EKG TRACING ONLY,EKG,A,730,93005,,,,,40.00,N,Y
4030014,EKG TRACING INTREP & RPT,EKG,A,730,93000,,,,,65.00,N,Y
4030015,EVENT MONITOR SETUP(EM),EKG,A,730,93270,,,,,116.00,N,Y
4030016,EVENT MONIT INER RPT(EM),EKG,A,730,93272,,,,,56.50,N,Y
4030367,ECG-TRACING ONLY,EKG,A,990,G0404,,,,,40.00,N,Y
4030368,ECG INTERP & REPORT ONLY,EKG,A,990,G0405,,,,,25.00,N,Y
4033000,"EKG TRACING, INTERP RPT",EKG,A,730,93000,,,,,65.00,N,Y
4033005,EKG TRACING ONLY,EKG,A,730,93005,,,,,40.00,N,Y
4033010,EKG INTERPR & RPT,EKG,A,730,93010,,,,,25.00,N,Y
4040001,"TEMPORAMANDIBULAR,BILATER",RAD,A,320,70330,,,,,186.00,N,Y
4040002,SOFT TISSUE NECK,RAD,A,320,70360,,,,,119.00,N,Y
4040003,"MANDIBLE, MIN 4 VIEW",RAD,A,320,70110,,,,,175.00,N,Y
4040004,"MASTOID, MIN 3 VIEW PER S",RAD,A,320,70130,,,,,195.00,N,Y
4040005,"FACIAL BONES, MIN 3 VIEW",RAD,A,320,70150,,,,,194.00,N,Y
4040006,"NASAL BONES, MIN 3 VIEW",RAD,A,320,70160,,,,,143.00,N,Y
4040007,"SINUS SERIES, MIN 3 VIEW",RAD,A,320,70220,,,,,175.00,N,Y
4040008,"SKULL,MIN 4 VIEWS,W/WO ST",RAD,A,320,70260,,,,,184.00,N,Y
4040009,CHEST 4 VIEWS,RAD,A,320,71048,,,,,184.00,N,Y
4040010,CHEST (1 VIEW) FRONTAL,RAD,A,320,71045,,,,,137.00,N,Y
4040011,CHEST (2 VIEW)FRONT&LATER,RAD,A,320,71046,,,,,159.00,N,Y
4040012,"CHEST,AP & LATERAL W/FLUR",RAD,A,320,71023,,,,,158.00,N,Y
4040013,"RIBS UNILAT,MIN 3VW W/PA",RAD,A,320,71101,,,,,184.00,N,Y
4040014,RIBS BILAT W/CHST MIN 4VW,RAD,A,320,71111,,,,,232.00,N,Y
4040015,"STERNUM, MIN 2 VIEW",RAD,A,320,71120,,,,,143.00,N,Y
4040017,"STERNOCLAV.JT(S),MIN 3 VW",RAD,A,320,71130,,,,,167.00,N,Y
4040018,SPINE CERVICAL AP & L,RAD,A,320,72040,,,,,160.00,N,Y
4040019,"C SPINE, MIN 4 VIEWS",RAD,A,320,72050,,,,,212.00,N,Y
4040021,"SPINE THORACIC, 3 VIEW",RAD,A,320,72072,,,,,157.00,N,Y
4040022,SPINE LUMBAR 2 OR 3 VIEW,RAD,A,320,72100,,,,,167.00,N,Y
4040024,"L SPINE, MIN 4 VIEWS",RAD,A,320,72110,,,,,218.00,N,Y
4040025,"SACRUM COCCYX, MIN 2 VIEW",RAD,A,320,72220,,,,,142.00,N,Y
4040026,PELVIS SACRO JT 3 OR MORE,RAD,A,320,72202,,,,,143.00,N,Y
4040027,PELVIS 1VIEW,RAD,A,320,72170,,,,,130.00,N,Y
4040028,"CLAVICLE, COMPLETE",RAD,A,320,73000,,,,,119.00,N,Y
4040029,"SCAPULA, COMPLETE",RAD,A,320,73010,,,,,137.00,N,Y
4040030,"SHOULDER,COMPL,MIN 2 VIEW",RAD,A,320,73030,,,,,143.00,N,Y
4040031,"HUMERUS, MIN 2 VIEW",RAD,A,320,73060,,,,,142.00,N,Y
4040032,ELBOW ANTEROPOSTERIOR VIE,RAD,A,320,73070,,,,,127.00,N,Y
4040033,"UPPER EXTREM,INFANT,MIN2V",RAD,A,320,73092,,,,,124.00,N,Y
4040034,"FOREARM, 2 VIEW",RAD,A,320,73090,,,,,130.00,N,Y
4040035,WRIST 2 VIEW,RAD,A,320,73100,,,,,122.00,N,Y
4040036,"WRIST, MIN 3 VIEW",RAD,A,320,73110,,,,,135.00,N,Y
4040037,"HAND, MIN 3 VIEW",RAD,A,320,73130,,,,,134.00,N,Y
4040038,FINGER(S) MIN 2 VIEW,RAD,A,320,73140,,,,,108.00,N,Y
4040039,ACROMIOCLAVICULAR JTS/BIL,RAD,A,320,73050,,,,,143.00,N,Y
4040040,"2 VIEW HIP, WITH/WITHOUT PELVIS",RAD,A,320,73502,,,,,157.00,N,Y
4040043,"FEMUR, 2 VIEW MINIMUM",RAD,A,320,73552,,,,,135.00,N,Y
4040044,TIBIA & FIBULA LEG 2 VIEW,RAD,A,320,73590,,,,,125.00,N,Y
4040045,KNEE <=2 VIEWS,RAD,A,320,73560,,,,,137.00,N,Y
4040046,KNEE 3 VIEWS,RAD,A,320,73562,,,,,147.00,N,Y
4040047,"LWR EXTREM INFANT,MIN 2VW",RAD,A,320,73592,,,,,122.00,N,Y
4040048,ANKLE 2VIEWS,RAD,A,320,73600,,,,,124.00,N,Y
4040049,ANKLE MIN 3 VIEWS,RAD,A,320,73610,,,,,140.00,N,Y
4040050,FOOT 2 VIEWS,RAD,A,320,73620,,,,,124.00,N,Y
4040051,"FOOT, MIN 3 VIEW",RAD,A,320,73630,,,,,137.00,N,Y
4040052,"FOOT OS CALCIS,MIN 2 VIEW",RAD,A,320,73650,,,,,127.00,N,Y
4040053,TOE(S) MIN 2 VIEWS,RAD,A,320,73660,,,,,108.00,N,Y
4040054,ABDOMEN KUB,RAD,A,320,74018,,,,,137.00,N,Y
4040055,ABDOMEN UPRIGHT,RAD,A,320,74019,,,,,175.00,N,Y
4040056,ESOPHAGUS,RAD,A,320,74220,,,,,327.00,N,Y
4040057,MOD. BA SWALLOW VCR,RAD,A,320,74230,,,,,306.00,N,Y
4040059,UGI SM BOWEL,RAD,A,320,74249,,,,,512.00,N,Y
4040060,UGI DOUBLE CONTR W/O KUB,RAD,A,320,74246,,,,,422.00,N,Y
4040061,"COLON, BARIUM W OR WO KUB",RAD,A,320,74270,,,,,342.00,N,Y
4040062,COLON AIR CONTRAST W/BAR,RAD,A,320,74280,,,,,443.00,N,Y
4040065,CHOLANGIO POST OP,RAD,A,320,74305,,,,,260.00,N,Y
4040066,CHOLANGIO OR,RAD,A,320,74300,,,,,266.00,N,Y
4040068,IVP W/NEPHR TOMO,RAD,A,320,74415,,,,,423.00,N,Y
4040069,IVP DRIP/BOLUS TECH,RAD,A,320,74410,,,,,388.00,N,Y
4040072,"CYSTOGRAPHY, MIN 3 VIEW",RAD,A,320,74430,,,,,370.00,N,Y
4040073,URO - CYSTO RETROGRADE,RAD,A,320,74450,,,,,510.00,N,Y
4040074,URETHROCYSTOGRAPHY VOIDIN,RAD,A,320,74455,,,,,603.00,N,Y
4040081,BONE AGE,RAD,A,320,77072,,,,,140.00,N,Y
4040083,"BONE SURVEY, COMPLETE",RAD,A,320,77075,,,,,289.00,N,Y
4040084,"FISTULA,ABSCESS,SINUS TRA",RAD,A,320,76080,,,,,255.00,N,Y
4040088,"TOMOS, SNGL PLANE, NO URO",RAD,A,320,76100,,,,,249.00,N,Y
4040089,ELBOW 3 VIEW,RAD,A,320,73080,,,,,142.00,N,Y
4040092,"BIL HIPS 3-4 VIEWS, WITH/WITHOUT PELVIS",RAD,A,320,73522,,,,,179.00,N,Y
4040093,SHOULDER 1 VIEW,RAD,A,320,73020,,,,,118.00,N,Y
4040094,"1 VIEW HIP, WITH/ WITHOUT PELVIS",RAD,A,320,73501,,,,,127.00,N,Y
4040096,EYE FOR F.B.,RAD,A,320,70030,,,,,117.00,N,Y
4040099,HAND 2 VIEW,RAD,A,320,73120,,,,,124.00,N,Y
4040100,"ABDO SERIES,INCL PA CHEST",RAD,A,320,74022,,,,,206.00,N,Y
4040103,"KNEES, COMPLETE 4 OR >",RAD,A,320,73564,,,,,157.00,N,Y
4040104,"KNEES, AP BI-LAT STND.",RAD,A,320,73565,,,,,131.00,N,Y
4040105,S.I. JOINTS 2 VIEWS,RAD,A,320,72200,,,,,133.00,N,Y
4040106,SCOLIOSIS 4 OR 5 VIEWS,RAD,A,320,72083,,,,,200.00,N,Y
4040107,SKULL <=3VIEWS,RAD,A,320,70250,,,,,186.00,N,Y
4040108,SPINE 1 VIEW,RAD,A,320,72020,,,,,140.00,N,Y
4040112,SMALL BOWEL,RAD,A,320,74250,,,,,422.00,N,Y
4040113,"RIBS UNILAT W/O CHST,2VW",RAD,A,320,71100,,,,,135.00,N,Y
4040114,LOW OSMOLAR CONTRAST 300 100 ML,RAD,A,636,Q9967,,,,,105.00,N,Y
4040115,LOW ASMOLAR CONTRAST 300 50 ML,RAD,A,636,Q9967,,,,,66.00,N,Y
4040116,CYSTOGRAPHIN 300 ML,RAD,A,636,Q9958,,,,,98.00,N,Y
4040117,"ORBIT XRAY, MIN 4 VIEW",RAD,A,320,70200,,,,,194.00,N,Y
4040118,FLUOROSCOPY < 1HR,RAD,A,320,76000,,,,,176.00,N,Y
4040120,PELVIS 3 OR MORE VIEWS,RAD,A,320,72190,,,,,383.00,N,Y
4040121,MANDIBLE < 3 VIEWS,RAD,A,320,70100,,,,,154.00,N,Y
4040123,UGI DOUBLE CONTR. W/KUB,RAD,A,320,74247,,,,,458.00,N,Y
4040124,"SPINE THORACIC, 2 VIEW",RAD,A,320,72070,,,,,132.00,N,Y
4040125,UGI SINGLE CONTRAST,RAD,A,320,74240,,,,,367.00,N,Y
4040126,L-SPINE 4VIEWS + BENDING,RAD,A,320,72114,,,,,262.00,N,Y
4040127,NOSE TO RECTUM - CHILD FB,RAD,A,320,76010,,,,,137.00,N,Y
4040128,RIBS BILATERAL WO CHEST,RAD,A,320,71110,,,,,91.00,N,Y
4040129,LOW OSMOLAR 180 10ML,RAD,A,636,Q9965,,,,,22.00,N,Y
4040130,CR EPIDURAL INJ W FLUORO,RAD,A,320,77003,,,,,72.00,N,Y
4040131,ISOVUE- M 300 15ML,RAD,A,636,Q9967,,,,,81.00,N,Y
4040132,"BIL HIPS 2 VIEWS, WITH/WITHOUT PELVIS",RAD,A,320,73521,,,,,116.00,N,Y
4040133,SCOLIOSIS 1 VIEW,RAD,A,320,72081,,,,,113.00,N,N
4040134,SCOLIOSIS 2 OR 3 VIEWS,RAD,A,320,72082,,,,,184.00,N,N
4040135,SCOLIOSIS MIN 6 VIEWS,RAD,A,320,72084,,,,,238.00,N,N
4041115,LUMBAR SPINE BENDING ONLY,RAD,A,320,72120,,,,,86.00,N,Y
4041116,FLUORO GUIDE NEEDLE PLACEMENT,RAD,A,320,77002,,,,,178.00,N,N
4050001,C.T.HEAD WO CONTRAST,CT,A,351,70450,,,,,"1,204.00",N,Y
4050002,CT HEAD/BRAIN W/CONTRAST,CT,A,351,70460,,,,,"1,220.00",N,Y
4050003,CT HEAD/BRAIN W/WO CONTRA,CT,A,351,70470,,,,,"1,487.00",N,Y
4050004,CT CHEST W/O CONTRAST,CT,A,352,71250,,,,,"1,267.00",N,Y
4050005,CT CHEST WITH CONTRAST,CT,A,352,71260,,,,,"1,480.00",N,Y
4050006,CT CHEST W/WO CONTRAST,CT,A,352,71270,,,,,"1,805.00",N,Y
4050007,CT C-SPINE W/O CONTRAST,CT,A,352,72125,,,,,"1,267.00",N,Y
4050008,CT C-SPINE WITH CONTRAST,CT,A,352,72126,,,,,"1,473.00",N,Y
4050009,CT THORACIC W/O CONTRAST,CT,A,352,72128,,,,,"1,267.00",N,Y
4050010,CT THORACIC W/ CONTRAST,CT,A,352,72129,,,,,"1,473.00",N,Y
4050011,CT L-SPINE W/O CONTRAST,CT,A,352,72131,,,,,"1,267.00",N,Y
4050012,CT L-SPINE WITH CONTRAST,CT,A,352,72132,,,,,"1,473.00",N,Y
4050013,CT PELVIS W/O CONTRAST,CT,A,352,72192,,,,,"1,353.00",N,Y
4050014,CT PELVIS WITH CONTRAST,CT,A,352,72193,,,,,"1,770.00",N,Y
4050015,CT PELVIS W/WO CONTRAST,CT,A,352,72194,,,,,"1,813.00",N,Y
4050016,CT ABDOMEN W/O CONTRAST,CT,A,352,74150,,,,,"1,232.00",N,Y
4050017,CT ABDOMEN WITH CONTRAST,CT,A,352,74160,,,,,"1,653.00",N,Y
4050018,"CT ORBIT,SELLA,EAR W/O CO",CT,A,351,70480,,,,,"1,103.00",N,Y
4050019,"CT ORBIT,SELLA,EAR W/CONT",CT,A,351,70481,,,,,"1,281.00",N,Y
4050020,"CT ORBIT,SELLA,EAR W/WO C",CT,A,351,70482,,,,,"1,532.00",N,Y
4050021,CT LOWER EXT.WO CONTRAST,CT,A,352,73700,,,,,"1,092.00",N,Y
4050022,CT LOWER EXT. W CONTRAST,CT,A,352,73701,,,,,"1,267.00",N,Y
4050023,CT LOWER EXT. W/WO CONTR.,CT,A,352,73702,,,,,"1,532.00",N,Y
4050024,CT NECK TISSUE WITH CONTR,CT,A,351,70491,,,,,"1,281.00",N,Y
4050025,CT MAXILLOFACIAL W/O CONT,CT,A,351,70486,,,,,"1,068.00",N,Y
4050027,MAXILLOFACIAL LTD > 10,CT,A,351,76380,,,,,892.00,N,Y
4050028,CT MAXILLOFACIAL AREA W/C,CT,A,351,70487,,,,,"1,261.00",N,Y
4050029,CT MAXILLOFACIAL W/WO CON,CT,A,351,70488,,,,,"1,526.00",N,Y
4050030,CT SOFT TISSUE NECK WO CO,CT,A,351,70490,,,,,"1,103.00",N,Y
4050031,CT SOFT TISSUE NECK W/WO,CT,A,351,70492,,,,,"1,532.00",N,Y
4050032,CT CERVICAL SPINE W/WO CO,CT,A,351,72127,,,,,"1,779.00",N,Y
4050033,CT THORACIC SPINE W/WO CO,CT,A,351,72130,,,,,"1,779.00",N,Y
4050034,CT LUMBAR SPINE W/WO CONT,CT,A,351,72133,,,,,"1,779.00",N,Y
4050035,CT UPPER EXTREMITY W/O CO,CT,A,352,73200,,,,,"1,092.00",N,Y
4050036,CT UPPER EXTREMITY W CONT,CT,A,352,73201,,,,,"1,267.00",N,Y
4050037,"CT UPPER EXTREMITY W, W/O",CT,A,352,73202,,,,,"1,532.00",N,Y
4050038,"CT ABDOMEN W, W/O",CT,A,352,74170,,,,,"1,752.00",N,Y
4050040,CT DRAIN PERITONEAL ABSCE,CT,A,490,49021,,,,,664.00,N,Y
4050041,CT GUIDED ASPIRATION,CT,A,351,75989,,,,,626.00,N,Y
4050043,MAXILLOFACIAL LTD = < 10,CT,A,351,76380,,,,,312.00,N,Y
4050044,CTA CHEST,CT,A,352,71275,,,,,"1,480.00",N,Y
4050045,CTA NECK WITH CONTRAST,CT,A,351,70498,,,,,"1,291.00",N,Y
4050046,CT ANGIO PELVIS,CT,A,351,72191,,,,,909.00,N,Y
4050047,CT ANGIO ABDOMEN,CT,A,351,74175,,,,,964.00,N,Y
4050048,CTA ABD PELVIS WO/W CONTRAST,CT,A,351,74174,,,,,"1,377.00",N,N
4050049,CT RECONSTRUCTION,CT,A,351,76376,,,,,81.00,N,N
4050139,LOW OSMOLAR CONTRAST 300 100 ML,CT,A,636,Q9967,,,,,103.00,N,Y
4050140,LOW OSMOLAR CONTRAST 300 50ML,CT,A,636,Q9967,,,,,64.00,N,Y
4050200,"DXA, AXIAL SITE",CT,A,320,77080,,,,,334.00,N,Y
4050201,"DXA, APPENDICULAR SITE",CT,A,320,77081,,,,,167.00,N,Y
4050202,VERTEBRAL FX ASSESSMENT,CT,A,320,77086,,,,,178.00,N,Y
4050203,CT ABD/PELVIS WO,CT,A,350,74176,,,,,"1,188.00",N,Y
4050204,CT ABD/PELVIS WITH,CT,A,350,74177,,,,,"1,404.00",N,Y
4050205,CT ABD/PELVIS WO/WITH,CT,A,350,74178,,,,,"1,728.00",N,Y
4050206,CT LUNG SCREENING,CT,A,350,G0297,,,,,486.00,N,N
4060001,US ABDOMEN COMPLETE,US,A,402,76700,,,,,507.00,N,Y
4060003,US OB COMPLETE,US,A,402,76805,,,,,476.00,N,Y
4060004,US FOLLOW UP OB,US,A,402,76816,,,,,381.00,N,Y
4060005,US ABDOMINAL LIMITED,US,A,402,76705,,,,,367.00,N,Y
4060006,"US RENAL, LIMITED",US,A,402,76775,,,,,491.00,N,Y
4060007,"US RENAL, COMPLETE",US,A,402,76770,,,,,491.00,N,Y
4060008,"US PELVIS,NON OB, COMPLET",US,A,402,76856,,,,,507.00,N,Y
4060009,U S TESTICLE,US,A,402,76870,,,,,396.00,N,Y
4060012,ULTRA SOUND AORTA,US,A,402,76775,,,,,367.00,N,Y
4060013,THYROID ULTRA,US,A,402,76536,,,,,361.00,N,Y
4060014,SOFT TISSUE NECK U. S.,US,A,402,76536,,,,,286.00,N,Y
4060016,OB LIMITED - 1ST TRIMESTE,US,A,402,76801,,,,,381.00,N,Y
4060017,TRANS. VAGINAL US,US,A,402,76830,,,,,507.00,N,Y
4060018,OB US LTD,US,A,402,76815,,,,,381.00,N,Y
4060019,DUPLEX SCAN UNI EXT VENOU,US,A,921,93971,,,,,559.00,N,Y
4060020,DOPPLER SPECTRAL COMPLETE,US,A,480,93320,,,,,413.00,N,Y
4060021,DOPPLER COL. FLOW VEL.MAP,US,A,480,93325,,,,,413.00,N,Y
4060022,DUP SCAN EXT VEIN BILAT,US,A,921,93970,,,,,825.00,N,Y
4060023,REAL-TIME 2D W/WO MMODE C,US,A,480,93306,,,,,949.00,N,Y
4060024,DUPLEX EXTRACRANIAL ARTER,US,A,921,93880,,,,,976.00,N,Y
4060025,US EXTREMITY NON-VASCULAR,US,A,402,76881,,,,,286.00,N,Y
4060027,VAS EXTREMITY ARTERIAL,US,A,921,93923,,,,,414.00,N,Y
4060028,BIOPHYS PROFILE-W/NO STRE,US,A,402,76818,,,,,381.00,N,Y
4060029,LTD RETROP/BLADDER,US,A,402,76775,,,,,313.00,N,Y
4060030,ULTRASOUND GUID FOR INCIS,US,A,402,76942,,,,,307.00,N,Y
4060031,PERITONEOCENTESIS SURGERY,US,A,490,49083,,,,,675.00,N,Y
4060032,DUPLEX SCAN LE ART:COMPLE,US,A,921,93925,,,,,513.00,N,Y
4060033,BIO PROFILE W/O NON-STRES,US,A,402,76819,,,,,381.00,N,Y
4060034,VAS ANKLE/ABI LTD,US,A,921,93922,,,,,334.00,N,Y
4060035,ECHO STRESS,US,A,480,93350,,,,,413.00,N,Y
4060036,OB - TRANSVAGINAL US,US,A,402,76817,,,,,381.00,N,Y
4060037,VASDUPLEX SCAN LOW ARTERI,US,A,402,93926,,,,,333.00,N,Y
4060038,ECHO DOPPLER LIMITED,US,A,402,93307,,,,,413.00,N,Y
4060039,US CHEST,US,A,402,76604,,,,,313.00,N,Y
4060040,AAA SCREEN ULTRASOUND EXA,US,A,402,76706,,,,,367.00,N,Y
4060041,VAS DUP EXT ARTERY LTD,US,A,402,93931,,,,,333.00,N,Y
4060043,DUPLEX ABD/PELVIS COMPLET,US,A,402,93975,,,,,606.00,N,Y
4060044,PELVIS LIMITED,US,A,402,76857,,,,,182.00,N,Y
4060045,US AORTA DUPLEX,US,A,402,93978,,,,,424.00,N,Y
4060046,BIOP OF BREAST AUTO VAC,US,A,402,19083,,,,,"1,512.00",N,Y
4060047,VAS DUPLEX OF AORTA,US,A,402,93978,,,,,419.00,N,Y
4060048,US BREAST UNILATERAL COMPLETE,US,A,402,76641,,,,,175.00,N,N
4060049,US BREAST UNILATERAL LIMITED,US,A,402,76642,,,,,372.00,N,N
4060050,REAL TIME FOLLOWUP 2D W/WO MMODE C,US,A,480,93308,,,,,257.00,N,N
4060117,US DUP ABD/ PELVIS LTD,US,A,402,93976,,,,,313.00,N,N
4060118,US ART LLP EXT COMP,US,A,402,93930,,,,,449.00,N,N
4070001,ACHROMYCIN & V 100 MG,PHA,A,250,,,,,,0.95,N,Y
4070002,ACHROMYCIN & V 250MG,PHA,A,250,,,,,,1.14,N,Y
4070003,ACHROMYCIN & V 100MG/IM,PHA,A,250,,,,,,8.54,N,Y
4070004,ACHROMYCIN & V 250 MG IM,PHA,A,250,,,,,,12.34,N,Y
4070005,ACHROMYCIN 500 MG,PHA,A,250,,,,,,0.95,N,Y
4070006,ACHROMYCIN 500 MG IM,PHA,A,250,,,,,,22.14,N,Y
4070007,ACHROMYCIN SYRUP 125/5ML,PHA,A,250,,,,,,6.65,N,Y
4070008,ATCH 40U 5ML IM,PHA,A,250,,,,,,10.44,N,Y
4070009,ATCH 80 U IM,PHA,A,250,,,,,,20.87,N,Y
4070010,ACTIFED,PHA,A,250,,,,,,1.37,N,Y
4070011,ADAPIN 50 MG,PHA,A,250,,,,,,0.95,N,Y
4070012,ADREN. CHLOR SOL/1000 1C,PHA,A,250,,,,,,14.92,N,Y
4070013,ADREN. OIL 1/500 1CC,PHA,A,250,,,,,,12.37,N,Y
4070014,ALUPENT MDI 14GM,PHA,A,250,,,,,,59.94,N,Y
4070015,ADVAIR DISKUS 250/50 #14,PHA,A,250,,,,,,274.75,N,Y
4070016,ALBAMYCIN 250 MG,PHA,A,250,,,,,,2.53,N,Y
4070017,ALLBEE T,PHA,A,250,,,,,,0.95,N,Y
4070018,ALBUMIN HUMAN 50M IM,PHA,A,250,,,,,,111.53,N,Y
4070019,ALDOCHLOR 250 MG,PHA,A,250,,,,,,1.08,N,Y
4070020,METHYLDOPA 500 MG PO,PHA,A,250,,,,,,1.41,N,Y
4070021,METHYLDOPA 250 MG TAB,PHA,A,250,,,,,,2.75,N,Y
4070022,ALDACTAZIDE,PHA,A,250,,,,,,1.29,N,Y
4070023,ALDACTOME,PHA,A,250,,,,,,1.21,N,Y
4070024,ALDORIL 25,PHA,A,250,,,,,,1.33,N,Y
4070025,ALLOPURINOL 100 MG TAB,PHA,A,250,,,,,,3.00,N,Y
4070026,ALKERAN 2 MG TAB,PHA,A,250,,,,,,24.25,N,Y
4070027,ALOPHEN,PHA,A,250,,,,,,0.95,N,Y
4070028,ALUDROX TAB,PHA,A,250,,,,,,0.95,N,Y
4070029,ALUDROX TSP.,PHA,A,250,,,,,,0.95,N,Y
4070030,ALUPENT 20 MG INHALER,PHA,A,250,,,,,,18.34,N,Y
4070031,METAPROTERENOL 2.5ML NEB,PHA,A,250,,,,,,7.59,N,Y
4070032,AMBENYL EXP OZ.,PHA,A,250,,,,,,3.41,N,Y
4070033,AMESEC,PHA,A,250,,,,,,0.95,N,Y
4070034,AMINOPH CONSTANT 300 MG,PHA,A,250,,,,,,0.95,N,Y
4070035,AMINOPHYLLIN 100 MG,PHA,A,250,,,,,,1.27,N,Y
4070036,AMINOPHYLLINE 200MG TAB,PHA,A,250,,,,,,2.07,N,Y
4070037,AMINOPHYLLIN 250 MG IM,PHA,A,250,,,,,,18.64,N,Y
4070038,AMINOPHYLLINE 25 MG/ML 20,PHA,A,250,,,,,,32.68,N,Y
4070039,AMINOPHYLLIN SUPP 250 MG,PHA,A,250,,,,,,2.53,N,Y
4070040,AMONOPHYLLIN SUPP 500 MI,PHA,A,250,,,,,,3.80,N,Y
4070041,AMITRIPTYLINE 10 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4070042,AMMONIUM CHL. 15,PHA,A,250,,,,,,1.27,N,Y
4070043,AMMONIUM CHLORIDE 7.5GM,PHA,A,250,,,,,,0.95,N,Y
4070044,AMOPHGEL BOTTLE 12OZ.,PHA,A,250,,,,,,6.96,N,Y
4070045,AMOPHJEL LIQUID HPO,PHA,A,250,,,,,,1.42,N,Y
4070046,AMPHOJEL TABS EACH,PHA,A,250,,,,,,0.95,N,Y
4070047,AMPICILLIN 500 MG CAP,PHA,A,250,,,,,,1.39,N,Y
4070048,AMPICILLIN 250 MG CAP,PHA,A,250,,,,,,1.29,N,Y
4070049,AMPICILLIN 1 GM VIAL,PHA,A,250,,,,,,59.50,N,Y
4070050,AMPICILLIN IM 500 MG,PHA,A,250,,,,,,25.87,N,Y
4070051,AMOXICILLIN 250 MG / 5 ML,PHA,A,250,,,,,,12.95,N,Y
4070052,AMOXICILLIN 125 MG / 5 ML,PHA,A,250,,,,,,11.10,N,Y
4070053,AMYL NITRITE INHALANT,PHA,A,250,,,,,,12.55,N,Y
4070054,AMITRIPTYLINE 100MG TAB,PHA,A,250,,,,,,2.07,N,Y
4070055,AMITRIPTYLINE 25 MG TAB,PHA,A,250,,,,,,2.80,N,Y
4070056,AMOXICILLIN 250 MG CAP,PHA,A,250,,,,,,2.15,N,Y
4070057,AMOXICILLIN 250 MG CHEW T,PHA,A,250,,,,,,2.27,N,Y
4070058,ACHEPHEN SUPP 650 MG,PHA,A,250,,,,,,4.19,N,Y
4070059,ANCEF PREFILLED IM,PHA,A,250,,,,,,18.98,N,Y
4070060,CEFAZOLIN 1 GM / 50 ML,PHA,A,250,,,,,,131.00,N,Y
4070061,CEFAZOLIN 500 MG VIAL,PHA,A,636,J0690,,,,,33.80,N,Y
4070062,CEFAZOLIN 1 GM VIAL,PHA,A,250,,,,,,33.45,N,Y
4070063,ANECTINE IM,PHA,A,250,,,,,,10.12,N,Y
4070064,CEPHRADRINE 500MG PO,PHA,A,250,,,,,,1.68,N,Y
4070065,ANTEPAR 500 MG,PHA,A,250,,,,,,0.95,N,Y
4070066,ANTEPAR SYRUP TSP,PHA,A,250,,,,,,0.95,N,Y
4070067,MECLIZINE 12.5 MG TAB,PHA,A,250,,,,,,0.10,N,Y
4070068,MECLIZINE 25MG TAB,PHA,A,250,,,,,,3.00,N,Y
4070069,ANUCORT-HC 25 MG SUPP,PHA,A,250,,,,,,53.60,N,Y
4070070,A.P.C.,PHA,A,250,,,,,,0.95,N,Y
4070071,APRESOLINE,PHA,A,250,,,,,,0.95,N,Y
4070072,HYDRALIZINE INJ 1CC,PHA,A,250,,,,,,16.73,N,Y
4070073,AQUAMEPHYTON BABY 1MG,PHA,A,250,,,,,,15.70,N,Y
4070074,VITAMIN K 10 MG/ML 1 ML A,PHA,A,250,,,,,,200.30,N,Y
4070075,APLISOL TEST,PHA,A,250,,,,,,14.83,N,Y
4070076,AQUASOL A.,PHA,A,250,,,,,,1.27,N,Y
4070077,ARALEN 500 MG,PHA,A,250,,,,,,6.33,N,Y
4070078,ARAMINE 10MG/ML 10ML MDV,PHA,A,250,,,,,,40.15,N,Y
4070079,ARISTOCORT 4 MG,PHA,A,250,,,,,,2.53,N,Y
4070080,ARLIDIN TAB,PHA,A,250,,,,,,0.95,N,Y
4070081,TRIHEXYPHENIDYL 2MG TAB,PHA,A,250,,,,,,2.25,N,Y
4070082,ASBRON 1 OZ.,PHA,A,250,,,,,,2.53,N,Y
4070083,A.S.A. SUPP,PHA,A,250,,,,,,2.53,N,Y
4070084,ASPIRIN 325 MG TAB,PHA,A,250,,,,,,0.10,N,Y
4070085,ASPIRIN WITH CODINE,PHA,A,250,,,,,,1.27,N,Y
4070086,ASCORBIC ACID 100 MG TAB,PHA,A,250,,,,,,1.28,N,Y
4070087,ASCORBIC ACID 2CC,PHA,A,250,,,,,,13.40,N,Y
4070088,ASCRIPTIN,PHA,A,250,,,,,,1.35,N,Y
4070089,AMOXAPINE 25 MG TAB,PHA,A,250,,,,,,2.78,N,Y
4070090,ASPIRIN,PHA,A,250,,,,,,0.95,N,Y
4070091,HYDROXYZINE HCL 10 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4070092,HYDROXYZINE PAMOATE 25MG,PHA,A,250,,,,,,2.12,N,Y
4070093,ATENOLOL 25 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4070094,LORAZEPAM 0.5 MG TAB,PHA,A,250,,,,,,3.20,N,Y
4070095,LORAZEPAM 2 MG/ML 1 ML VI,PHA,A,250,,,,,,33.60,N,Y
4070096,ATROMID S TAB,PHA,A,250,,,,,,1.99,N,Y
4070097,ATROPINE 0.4 MG/ML 1 ML S,PHA,A,250,,,,,,47.95,N,Y
4070098,ATROPINE SULF. 0.4 MG TAB,PHA,A,250,,,,,,1.27,N,Y
4070099,ATROPINE 0.4 MG/ML 20 ML,PHA,A,250,,,,,,174.30,N,Y
4070100,NORTRIPTYLINE 25 MG CAP,PHA,A,250,,,,,,2.45,N,Y
4070101,AZOGANTANOL,PHA,A,250,,,,,,1.27,N,Y
4070102,SULFASALAZINE 500 MG TAB,PHA,A,250,,,,,,3.30,N,Y
4070103,ASPIRIN 81 MG CHEW TAB,PHA,A,250,,,,,,0.10,N,Y
4070104,SULFATRIM DS PO,PHA,A,250,,,,,,1.41,N,Y
4070105,SULFATRIM SS PO,PHA,A,250,,,,,,1.39,N,Y
4070106,SULFAMETHOXAZOLE 80 MG/ML,PHA,A,250,,,,,,66.95,N,Y
4070107,SULFAMETH 200 MG / TMP 40,PHA,A,250,,,,,,24.05,N,Y
4070108,BANTHINE 50 MG,PHA,A,250,,,,,,0.95,N,Y
4070109,BECOTIN WITH VIT. C,PHA,A,250,,,,,,0.95,N,Y
4070110,DONNATAL ELIXIR 120 ML,PHA,A,250,,,,,,149.75,N,Y
4070111,BELLERGAL,PHA,A,250,,,,,,2.14,N,Y
4070112,ANSPOR 250 MG PO,PHA,A,250,,,,,,2.22,N,Y
4070113,DIPHENHYDRAMINE 12.5 MG /,PHA,A,250,,,,,,2.80,N,Y
4070114,OP DIPHENHYDRAMINE 12.5 M,PHA,A,253,,,,,,7.50,N,N
4070115,DIPHENHYDRAMINE 50 MG/ML,PHA,A,250,,,,,,32.85,N,Y
4070116,BELLEDONNA OPIUM B&O SUPP,PHA,A,250,,,,,,3.16,N,Y
4070117,DIPHENHYDRAMINE 25 MG CAP,PHA,A,250,,,,,,0.15,N,Y
4070118,DIPHENHYDRAMINE 50 MG PO,PHA,A,250,,,,,,1.53,N,Y
4070119,BENEMID,PHA,A,250,,,,,,0.95,N,Y
4070120,DICYCLOMINE 20MG TAB,PHA,A,250,,,,,,2.43,N,Y
4070121,BENTYL 10MG/ML 2ML AMP,PHA,A,250,,,,,,34.44,N,Y
4070122,BENYLIN EPECT. TSP.,PHA,A,250,,,,,,2.48,N,Y
4070123,BENZOCAINE LOZENGES,PHA,A,250,,,,,,0.95,N,Y
4070124,BENZOIN COMPOUND TINCTURE,PHA,A,250,,,,,,20.00,N,Y
4070125,BETALIN COMP,PHA,A,250,,,,,,0.95,N,Y
4070126,BENTALIN S 100MG PO,PHA,A,250,,,,,,1.08,N,Y
4070127,BENTALIN S 100 MG IM,PHA,A,250,,,,,,8.22,N,Y
4070128,BETALIN S 50 MG,PHA,A,250,,,,,,0.95,N,Y
4070129,BETALIN 12 AMP/100MCGM,PHA,A,250,,,,,,12.02,N,Y
4070130,BETALIN 12 1000MG IM,PHA,A,250,,,,,,12.34,N,Y
4070131,BETALIN COMPLEX OZ.,PHA,A,250,,,,,,1.59,N,Y
4070132,"BICILLIN LA 600,000 UNITS",PHA,A,250,,,,,,171.50,N,Y
4070133,BICILLIN LA 1.2 MILLION U,PHA,A,250,,,,,,275.05,N,Y
4070134,BISACODYL 10 MG SUPP,PHA,A,250,,,,,,0.30,N,Y
4070135,BLENOXANE 15 UNITS,PHA,A,250,,,,,,164.45,N,Y
4070136,BONINE,PHA,A,250,,,,,,0.95,N,Y
4070137,BRETYLOL AMP 2 ML,PHA,A,250,,,,,,8.22,N,Y
4070138,BRICORYL 2.5 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070139,BRICORYL 2.5 MG IM,PHA,A,250,,,,,,8.22,N,Y
4070140,BRETHINE 2.5 MG TAB,PHA,A,250,,,,,,2.80,N,Y
4070141,BRONKO TABS,PHA,A,250,,,,,,1.27,N,Y
4070142,BRONKEPHRINE 2MG/CC,PHA,A,250,,,,,,8.22,N,Y
4070143,BRONDECON ELXIR OZ,PHA,A,250,,,,,,2.53,N,Y
4070144,BRONDECON TAB,PHA,A,250,,,,,,0.95,N,Y
4070145,BUMETANIDE 1 MG TAB,PHA,A,250,,,,,,6.15,N,Y
4070146,ASPIRIN 325 MG BUFFERED T,PHA,A,250,,,,,,0.15,N,Y
4070147,BUSPIRONE 5 MG TAB,PHA,A,250,,,,,,2.35,N,Y
4070148,BUTAZOLIDIN ALKA,PHA,A,250,,,,,,0.95,N,Y
4070149,BUTAZOLIDIN,PHA,A,250,,,,,,0.95,N,Y
4070150,CAFERGOT 1 GM PO,PHA,A,250,,,,,,1.28,N,Y
4070151,VERAPAMIL 180 MG SR CAP,PHA,A,250,,,,,,9.60,N,Y
4070152,CALCIDRINE SYRUP OZ,PHA,A,250,,,,,,2.53,N,Y
4070153,CALCIUM GLUCONATE 10% 10,PHA,A,636,J0610,,,,,69.05,N,Y
4070154,CALCIUM CHLORIDE 10% 100,PHA,A,250,,,,,,70.55,N,Y
4070155,CACL 10% 1GMIM PREFIL SYR,PHA,A,250,,,,,,10.41,N,Y
4070156,CALCIUM CARBONATE 1250 MG,PHA,A,250,,,,,,1.80,N,Y
4070157,CA GLUCONATE 10% 5OML SDV,PHA,A,250,,,,,,19.00,N,Y
4070158,CALCIUM LACTATE 5 GR,PHA,A,250,,,,,,1.29,N,Y
4070159,CAMALOX 12 OZ BOTTLE,PHA,A,250,,,,,,9.49,N,Y
4070160,CAMALOX 1OZ.,PHA,A,250,,,,,,0.95,N,Y
4070161,CAMALOX TABS,PHA,A,250,,,,,,0.95,N,Y
4070162,CANTIL,PHA,A,250,,,,,,1.14,N,Y
4070163,CANTIL PHENOBARBITAL,PHA,A,250,,,,,,1.14,N,Y
4070164,SUCRALFATE 1GM TAB,PHA,A,250,,,,,,3.50,N,Y
4070165,CAPTOPRIL 25 MG TAB,PHA,A,250,,,,,,2.27,N,Y
4070166,DILTIAZEM 30 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4070167,TIAZAC 300MG CAP,PHA,A,250,,,,,,7.50,N,Y
4070168,CASCARA C.P.C. OZ,PHA,A,250,,,,,,0.95,N,Y
4070169,CASTOR OIL 1 OZ,PHA,A,250,,,,,,1.27,N,Y
4070170,CASTOR OIL 2 OZ,PHA,A,250,,,,,,1.90,N,Y
4070171,CLONIDINE 0.1 MG / DAY PA,PHA,A,250,,,,,,83.10,N,Y
4070172,CLONIDINE 0.2 MG / DAY PA,PHA,A,250,,,,,,148.55,N,Y
4070173,CEDILANDID D 4 MG 2 CC IM,PHA,A,250,,,,,,11.39,N,Y
4070174,"CALCIPARINE 0.8 20,000",PHA,A,250,,,,,,11.39,N,Y
4070175,CEFOBID 1GM IM,PHA,A,250,,,,,,19.61,N,Y
4070176,CEFOBID 2MG IM,PHA,A,250,,,,,,51.02,N,Y
4070177,CEFOL VITAMIN,PHA,A,250,,,,,,0.95,N,Y
4070178,CEFACLOR 250 MG / 5 ML SU,PHA,A,250,,,,,,37.91,N,Y
4070179,CEFACLOR SUSP 250MG 1 TSP,PHA,A,250,,,,,,5.67,N,Y
4070180,CEFACLOR SUSP 125MG 1 TSP,PHA,A,250,,,,,,4.13,N,Y
4070181,CEFACLOR CAP 250MG,PHA,A,250,,,,,,4.31,N,Y
4070182,CELESTONE 6MG/ML MDV,PHA,A,250,,,,,,61.42,N,Y
4070183,CENTRUM CHEW TAB,PHA,A,250,,,,,,0.45,N,Y
4070184,CEVALIN 500 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070185,CEVALIN 500 MG IM,PHA,A,250,,,,,,8.22,N,Y
4070186,CE VI SOL 50 CC BTL,PHA,A,250,,,,,,8.86,N,Y
4070187,ACTIVATED CHARCOAL 50 GM,PHA,A,250,,,,,,93.65,N,Y
4070188,CHERACOL COUGH SYRUP OZ,PHA,A,250,,,,,,2.53,N,Y
4070189,CHLORAL HYDRATE TAB/SYRUP,PHA,A,250,,,,,,0.95,N,Y
4070190,CHLOROMYCETIN PALM OZ,PHA,A,250,,,,,,6.96,N,Y
4070191,CHOLEDYL 200 MG,PHA,A,250,,,,,,3.01,N,Y
4070192,CHLOROTHIAZIDE 500 MG,PHA,A,250,,,,,,1.27,N,Y
4070193,CHOROMYCETIN 250 MG,PHA,A,250,,,,,,1.59,N,Y
4070194,LACTULOSE 10 GM / 15 ML S,PHA,A,250,,,,,,4.10,N,Y
4070195,CHYMORAL,PHA,A,250,,,,,,2.85,N,Y
4070196,CHLOR TRIMETON 8MG PO,PHA,A,250,,,,,,0.95,N,Y
4070197,CHLOR TRIMETON 12MG,PHA,A,250,,,,,,1.29,N,Y
4070198,IVPB CLINDAMYCIN 900 MG,PHA,A,250,,,,,,112.05,N,Y
4070199,CLINDAMYCIN 150 MG CAP,PHA,A,250,,,,,,3.15,N,Y
4070200,CLINDAMYCIN 300 MG / 2 ML,PHA,A,250,,,,,,59.30,N,Y
4070201,CLINDAMYCIN 150 MG/ML 2 M,PHA,A,250,,,,,,38.05,N,Y
4070202,CLONIDINE 0.1 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4070203,CLONIDINE 0.3 MG / DAY PA,PHA,A,250,,,,,,147.25,N,Y
4070204,SULINDAC 200 MG TAB,PHA,A,250,,,,,,2.75,N,Y
4070205,CLOXACILLIN 500 MG PO,PHA,A,250,,,,,,1.52,N,Y
4070206,CODEINE PHOSPHATE AMP,PHA,A,250,,,,,,8.22,N,Y
4070207,CODEINE PHOSPHATE 1,PHA,A,250,,,,,,2.53,N,Y
4070208,CODEINE SULPHATE 1 GR,PHA,A,250,,,,,,2.53,N,Y
4070209,BENZTROPINE 1 MG TAB,PHA,A,250,,,,,,2.70,N,Y
4070210,COGENTIN IM,PHA,A,250,,,,,,18.10,N,Y
4070211,DOCUSATE SODIUM 60 MG / 1,PHA,A,250,,,,,,2.40,N,Y
4070212,COLACE CAPS 100 MG,PHA,A,250,,,,,,3.16,N,Y
4070213,PROBENECID W. COLCHICINE,PHA,A,250,,,,,,4.65,N,Y
4070214,COLCRYS 0.6 MG TAB,PHA,A,250,,,,,,33.25,N,Y
4070215,COLY MYCIN M 150 MG IM,PHA,A,250,,,,,,22.77,N,Y
4070216,COMBID SPANS,PHA,A,250,,,,,,1.27,N,Y
4070217,PROCHLORPERAZINE 5 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4070218,COMPAZINE 10 MG,PHA,A,250,,,,,,4.31,N,Y
4070219,PROCHLORPERAZINE 5 MG/ML,PHA,A,250,,,,,,38.85,N,Y
4070220,COMPAZINE SPANSULE 10 MG,PHA,A,250,,,,,,3.89,N,Y
4070221,COMPAZINE SUPP 5 MG,PHA,A,250,,,,,,3.16,N,Y
4070222,PROCHLORPERAZINE 25 MG SU,PHA,A,250,,,,,,16.45,N,Y
4070223,CONSTANT T 300 MG,PHA,A,250,,,,,,0.95,N,Y
4070224,COPYRONIL,PHA,A,250,,,,,,0.95,N,Y
4070225,NADOLOL 40 MG TAB,PHA,A,250,,,,,,9.35,N,Y
4070226,CORICIDIN,PHA,A,250,,,,,,1.45,N,Y
4070227,CORAMINE OZ,PHA,A,250,,,,,,8.22,N,Y
4070228,CORRECTOL,PHA,A,250,,,,,,1.39,N,Y
4070229,HYDROCORTISONE 100 MG ENE,PHA,A,250,,,,,,24.40,N,Y
4070230,CORTISONE 25 MG 1CC IM,PHA,A,250,,,,,,8.22,N,Y
4070231,CORTISONE 25MG PO,PHA,A,250,,,,,,0.95,N,Y
4070232,CORTONE ACETATE 1 CC IM,PHA,A,250,,,,,,8.22,N,Y
4070233,CORTONE SUSP. OZ,PHA,A,250,,,,,,1.59,N,Y
4070234,WARFARIN 2 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4070235,WARARIN 1 MG TAB,PHA,A,250,,,,,,2.15,N,Y
4070236,COUMADIN 50 MG IM,PHA,A,250,,,,,,13.28,N,Y
4070237,CRYSTODIGIN .15 .1 .2,PHA,A,250,,,,,,0.95,N,Y
4070238,CRYSTODIGIN IM,PHA,A,250,,,,,,8.22,N,Y
4070239,TUBOCURARINE 15MG 5ML,PHA,A,250,,,,,,14.35,N,Y
4070240,CYCLOSPASMAL PO,PHA,A,250,,,,,,1.27,N,Y
4070241,CITOMEL 25 MCGM PO,PHA,A,250,,,,,,1.27,N,Y
4070242,CYTOXAN 500 MG IM,PHA,A,250,,,,,,32.89,N,Y
4070243,CYTOXAN 200 MG/AMP IM,PHA,A,250,,,,,,20.24,N,Y
4070244,CYTOZAN 25 MG,PHA,A,250,,,,,,2.22,N,Y
4070245,FLURAZEPAM 30MG PO,PHA,A,250,,,,,,1.37,N,Y
4070246,FLURAZEPAM 15MG PO,PHA,A,250,,,,,,1.35,N,Y
4070247,DAPSONE 100 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070248,DARVOCET N 50 MG PO,PHA,A,250,,,,,,1.77,N,Y
4070249,PROPOXYPHENE 100 MG / ACE,PHA,A,250,,,,,,3.30,N,Y
4070250,CANTRIUM 50 MG,PHA,A,250,,,,,,1.27,N,Y
4070251,PROPOXYPHENE 65MG CAP,PHA,A,250,,,,,,3.49,N,Y
4070252,DATRIL PO,PHA,A,250,,,,,,0.95,N,Y
4070253,D.B.I.,PHA,A,250,,,,,,0.95,N,Y
4070254,DEAPRIL ST,PHA,A,250,,,,,,1.27,N,Y
4070255,DEBRISAN 25 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070256,dexamethasone PF 10 mg/ml 1 ml SDV,PHA,A,250,,,,,,37.95,N,Y
4070257,DEXAMETHASONE 4 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4070258,DECADRON 25 MG,PHA,A,250,,,,,,0.95,N,Y
4070259,DEXAMETHASONE 4 MG/ML 1 M,PHA,A,250,,,,,,33.15,N,Y
4070260,DECLOMYCIN 300 MG,PHA,A,250,,,,,,6.94,N,Y
4070261,DEMECLOCYCLINE 150 MG TAB,PHA,A,250,,,,,,36.55,N,Y
4070262,DELADUMONE INJ 2 CC,PHA,A,250,,,,,,39.22,N,Y
4070263,DELESTROGEN 20 MG/1MG(5ML,PHA,A,250,,,,,,33.40,N,Y
4070264,TESTOSTERONE ENANTHATE 20,PHA,A,636,J3130,,,,,13.40,N,Y
4070265,PREDNISONE 1 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4070266,MEPERIDINE 50MG TAB,PHA,A,250,,,,,,4.05,N,Y
4070267,DEMEROL 100 MG/ML 1 ML SY,PHA,A,250,,,,,,38.40,N,Y
4070268,DEPO-MEDROL 40MG/ML 10ML,PHA,A,250,,,,,,96.86,N,Y
4070269,MEDROXYPROGESTERONE ACETA,PHA,A,250,,,,,,269.30,N,Y
4070270,DEPROL PO,PHA,A,250,,,,,,2.53,N,Y
4070271,DERMOPLAST 2.75 OZ CAN,PHA,A,250,,,,,,6.33,N,Y
4070272,TRAZODONE 50 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4070273,DEXEDRINE 50 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070274,DEXTROSE 50% 25 GM / 50 M,PHA,A,250,,,,,,48.20,N,Y
4070275,DIABETA 2.5 MG,PHA,A,250,,,,,,0.95,N,Y
4070276,GLYBURIDE 5 MG TAB,PHA,A,250,,,,,,2.75,N,Y
4070277,CHLORPROPAMIDE 100MG TAB,PHA,A,250,,,,,,2.53,N,Y
4070278,DIABINESE 250 MG PE,PHA,A,250,,,,,,1.35,N,Y
4070279,DIALOSE TAB,PHA,A,250,,,,,,0.95,N,Y
4070280,DICACLCIUM PHOSPHATE PO,PHA,A,250,,,,,,0.95,N,Y
4070281,DICLOXACILLIN 250MG PO,PHA,A,250,,,,,,1.59,N,Y
4070282,"DICUMAROL 25, 50 PO",PHA,A,250,,,,,,1.33,N,Y
4070283,(DES) DIETHYLSTILBESTROL,PHA,A,250,,,,,,1.32,N,Y
4070284,DI GEL 1 OZ & TAB,PHA,A,250,,,,,,0.95,N,Y
4070285,DIGITALIS PO,PHA,A,250,,,,,,0.95,N,Y
4070286,DIGOXIN 0.125 MG TAB,PHA,A,250,,,,,,4.70,N,Y
4070287,LANOXIN .5MG/2ML INJ,PHA,A,250,,,,,,15.26,N,Y
4070288,DIGITOXIN .2 AMP,PHA,A,250,,,,,,3.80,N,Y
4070289,DIHYDROERGOTAMINE 1 MG/ML,PHA,A,250,,,,,,565.55,N,Y
4070290,PHENYTOIN 100 MG ER CAP,PHA,A,250,,,,,,2.65,N,Y
4070291,DILANTIN 250 MG IM,PHA,A,250,,,,,,26.55,N,Y
4070292,DILANTIN 100 MG IM,PHA,A,250,,,,,,26.15,N,Y
4070293,DILANTIN SUSP 1 TSP,PHA,A,250,,,,,,1.85,N,Y
4070294,DILAUDID SUPP 3 MG,PHA,A,250,,,,,,3.16,N,Y
4070295,DILAUDID CADD CASSETTE,PHA,A,250,,,,,,55.20,N,Y
4070296,ACETAZOLAMIDE 500 MG VIAL,PHA,A,250,,,,,,91.16,N,Y
4070297,DIMETANE (ELIXIR) OZ,PHA,A,250,,,,,,1.59,N,Y
4070298,TENIVAC 0.5 ML SYRINGE,PHA,A,250,,,,,,153.85,N,Y
4070299,DIPH TET ADULT 1CC,PHA,A,250,,,,,,17.10,N,Y
4070300,DIPYRIDAMOLE 25MG TAB,PHA,A,250,,,,,,3.00,N,Y
4070301,DIPYRIDAMOLE 50MG PO,PHA,A,250,,,,,,1.41,N,Y
4070302,SALSALATE 750MG TAB,PHA,A,250,,,,,,6.05,N,Y
4070303,DIUPRES 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070304,CHLOROTHIAZIDE 250MG PO,PHA,A,250,,,,,,1.37,N,Y
4070305,CHLOROTHIAZIDE 500 MG TAB,PHA,A,250,,,,,,2.68,N,Y
4070306,DOCUSATE SODIUM 100 MG CA,PHA,A,250,,,,,,0.15,N,Y
4070307,DIFLUNISAL 500 MG TAB,PHA,A,250,,,,,,5.95,N,Y
4070308,DOLOPHINE IM,PHA,A,250,,,,,,8.22,N,Y
4070309,DOLOBID 500 MG PO,PHA,A,250,,,,,,1.84,N,Y
4070310,GI COCKTAIL,PHA,A,250,,,,,,10.00,N,Y
4070311,DONNAZYME PO,PHA,A,250,,,,,,0.95,N,Y
4070312,DORBANTYL FORTE,PHA,A,250,,,,,,0.95,N,Y
4070313,DOPAMINE 1600 MCG/ML / D5,PHA,A,250,,,,,,108.20,N,Y
4070314,DOPAMINE 40MG/ML 5ML SDV,PHA,A,250,,,,,,0.76,N,Y
4070315,DORIDEN 0.5MG PO,PHA,A,250,,,,,,1.59,N,Y
4070316,DOXEPIN 50 MG PO,PHA,A,250,,,,,,1.45,N,Y
4070317,DOXIDAN,PHA,A,250,,,,,,0.95,N,Y
4070318,DRAMAMINE 50 MG PO,PHA,A,250,,,,,,1.40,N,Y
4070319,DRAMAMINE 50 MG 1CC IM,PHA,A,250,,,,,,8.22,N,Y
4070320,DRIXORAL PO,PHA,A,250,,,,,,2.01,N,Y
4070321,BISACODYL 5 MG TAB,PHA,A,250,,,,,,0.10,N,Y
4070322,DULCOLAX SUPP,PHA,A,250,,,,,,1.93,N,Y
4070323,DUOTRATE PO,PHA,A,250,,,,,,0.95,N,Y
4070324,DURACILLIN AS IM,PHA,A,250,,,,,,8.22,N,Y
4070325,TRIAMTERENE 37.5 MG / HYD,PHA,A,250,,,,,,3.25,N,Y
4070326,DYRENIUM 50MG PO,PHA,A,250,,,,,,1.21,N,Y
4070327,DYMELOR 500 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070328,DYMELOR 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070329,EASPIRIN PO,PHA,A,250,,,,,,0.95,N,Y
4070330,ASPIRIN EC 325 MG TAB,PHA,A,250,,,,,,0.05,N,Y
4070331,EDECRIN 50MG TAB,PHA,A,250,,,,,,3.00,N,Y
4070332,EDECRIN SODIUM 1 ML IM,PHA,A,250,,,,,,43.10,N,Y
4070333,ELAVIL 10 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070334,ELAVIL 25MG PO,PHA,A,250,,,,,,1.27,N,Y
4070335,ELDEC PO.,PHA,A,250,,,,,,0.95,N,Y
4070336,ELIXICON PER OZ.,PHA,A,250,,,,,,3.48,N,Y
4070337,EMETE CON 50 MG IM,PHA,A,250,,,,,,7.91,N,Y
4070338,EMPIRIN PO,PHA,A,250,,,,,,0.95,N,Y
4070339,EMPIRIN #3 CODEINE PO,PHA,A,250,,,,,,1.27,N,Y
4070340,ERYPED 200 MG / 5 ML SUSP,PHA,A,250,,,,,,184.20,N,Y
4070341,ERYTHROMYCIN DR 250MG CAP,PHA,A,250,,,,,,3.00,N,Y
4070342,METHYCLOTHIAZIDE 5MG PO,PHA,A,250,,,,,,1.30,N,Y
4070343,ENOVID 5MG & 10 MG PO,PHA,A,250,,,,,,2.22,N,Y
4070344,ENTOZYME PO,PHA,A,250,,,,,,0.95,N,Y
4070345,EPHEDRINE 50 MG/ML 1 ML A,PHA,A,250,,,,,,130.55,N,Y
4070346,EPHEDRINE PO,PHA,A,250,,,,,,0.95,N,Y
4070347,EPHEDRINE SULPHATE 3/8 GR,PHA,A,250,,,,,,0.95,N,Y
4070348,EPI 1MG/ML 30ML MDV,PHA,A,250,,,,,,20.38,N,Y
4070349,EPINEPHRINE 1 MG/ML 1 ML,PHA,A,250,,,,,,77.40,N,Y
4070350,EQUAGESIC PO,PHA,A,250,,,,,,0.95,N,Y
4070351,EQUANIL PO,PHA,A,250,,,,,,0.95,N,Y
4070352,ERYPED 400 MG / 5 ML SUSP,PHA,A,250,,,,,,64.90,N,Y
4070353,ERGOTRATE AMPS IM,PHA,A,250,,,,,,8.86,N,Y
4070354,ERY-TAB 500 MG TAB,PHA,A,250,,,,,,2.67,N,Y
4070355,ERYTHROCIN STEARATE 250MG,PHA,A,250,,,,,,0.95,N,Y
4070356,ERTHROMYCIN (EES)200&400,PHA,A,250,,,,,,1.31,N,Y
4070357,EES 200 MG / SULFISOXAZOL,PHA,A,250,,,,,,63.25,N,Y
4070358,EES/SULFISOX SUSP 200ML,PHA,A,250,,,,,,21.51,N,Y
4070359,ERTHROCIN 500MG ADV,PHA,A,250,,,,,,20.92,N,Y
4070360,ESTRADIOL 1 MG TAB,PHA,A,250,,,,,,2.80,N,Y
4070361,ESTRONE 5MG/ML IM,PHA,A,250,,,,,,23.75,N,Y
4070362,ETRAFON 2 25 PO,PHA,A,250,,,,,,1.94,N,Y
4070363,EUTRON PO,PHA,A,250,,,,,,0.95,N,Y
4070364,ETHAQUIN 100 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070365,HYDROCHLOROTHIAZIDE 25 MG,PHA,A,250,,,,,,3.15,N,Y
4070366,EX LAX PO,PHA,A,250,,,,,,1.57,N,Y
4070367,BUTALBITAL 50 MG / ASPIRI,PHA,A,250,,,,,,4.35,N,Y
4070368,FILIBON O T TAB,PHA,A,250,,,,,,0.95,N,Y
4070369,INFLUENZA VACCINE 0.25 ML,PHA,A,636,,,,,,113.20,N,Y
4070370,FERROUS SULFATE 300 MG /,PHA,A,250,,,,,,1.20,N,Y
4070371,FERROUS SULFATE 325 MG TA,PHA,A,250,,,,,,0.40,N,Y
4070372,FERGON PO,PHA,A,250,,,,,,1.37,N,Y
4070373,FER IN SOL 50 CC BOTTLE,PHA,A,250,,,,,,16.36,N,Y
4070374,FERRO SEQUELS PO,PHA,A,250,,,,,,1.37,N,Y
4070375,FERRIC SUBSULFATE SOLUTIO,PHA,A,250,,,,,,0.00,N,Y
4070376,METRONIDAZOLE 250 MG TAB,PHA,A,250,,,,,,3.40,N,Y
4070377,MERTONIDAZOLE 500MG IV,PHA,A,250,,,,,,43.38,N,Y
4070378,FLUDROCORTISONE 0.1 MG TA,PHA,A,250,,,,,,4.25,N,Y
4070379,FLEET SALINE ENEMA 4.5 OZ,PHA,A,250,,,,,,3.60,N,Y
4070380,FLEET PHOSPHO-SODA 90 ML,PHA,A,250,,,,,,7.15,N,Y
4070381,GLYCERIN ADULT SUPP,PHA,A,250,,,,,,0.45,N,Y
4070382,CYCLOBENZAPRINE 10 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4070383,FLUOROURACIL 1 GM IM,PHA,A,250,,,,,,32.36,N,Y
4070384,ADRUCIL 50MG/ML 10ML VIAL,PHA,A,636,J9190,,,,,47.71,N,Y
4070385,FULVICIN 250 MG PO,PHA,A,250,,,,,,1.01,N,Y
4070386,FUMASORB PO,PHA,A,250,,,,,,0.95,N,Y
4070387,FUNGIZONE 50MG VIAL,PHA,A,250,,,,,,3.96,N,Y
4070388,NITROFURANTOIN 100MG CAP,PHA,A,250,,,,,,3.96,N,Y
4070389,NITROFURANTOIN 50MG PO,PHA,A,250,,,,,,2.07,N,Y
4070390,FURACIN SOL. EA.APPLIC.,PHA,A,250,,,,,,1.59,N,Y
4070391,FUROSEMIDE 20 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4070392,FUROSEMIDE 10 MG PO(LASIX,PHA,A,250,,,,,,1.33,N,Y
4070393,GANTANOL 0.5 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070394,GANTANOL SUSP OZ,PHA,A,250,,,,,,4.75,N,Y
4070395,SULFISOXAZOLE 500MG PO,PHA,A,250,,,,,,1.41,N,Y
4070396,GANTRISIN SUSP 1 TSP,PHA,A,250,,,,,,1.79,N,Y
4070397,GENTAMICIN 40 MG/ML 2 ML,PHA,A,250,,,,,,51.10,N,Y
4070398,GENTAMYCIN 60 MG IM/IV,PHA,A,250,,,,,,41.36,N,Y
4070399,GENTAMYCIN 10 MG IM/IV,PHA,A,250,,,,,,25.07,N,Y
4070400,GENTAMICIN 80MG ADV,PHA,A,636,J1580,,,,,19.83,N,Y
4070401,GARAMYCIN 60 MG IM,PHA,A,250,,,,,,8.86,N,Y
4070402,GARAMYCIN 80 MG IM,PHA,A,250,,,,,,10.12,N,Y
4070403,GARAMYCIN 40 MG PER CC IM,PHA,A,250,,,,,,8.22,N,Y
4070404,GAVISON LIQUID 1 OZ,PHA,A,250,,,,,,1.48,N,Y
4070405,GAVISON TABLET,PHA,A,250,,,,,,1.44,N,Y
4070406,GELUSIL OZ.,PHA,A,250,,,,,,0.95,N,Y
4070407,GELUSIL BOTTLE 12 OZ,PHA,A,250,,,,,,6.33,N,Y
4070408,GELUSIL TAB,PHA,A,250,,,,,,1.35,N,Y
4070409,GEOCILLIN,PHA,A,250,,,,,,4.23,N,Y
4070410,GEOPEN 1 GM IM,PHA,A,250,,,,,,8.86,N,Y
4070411,GEOPEN 2GM IM,PHA,A,250,,,,,,11.39,N,Y
4070412,GERIPLEX PO,PHA,A,250,,,,,,0.95,N,Y
4070413,GERIX ELIXIR PO,PHA,A,250,,,,,,0.95,N,Y
4070414,GAMMAR PER INJ.,PHA,A,250,,,,,,12.75,N,Y
4070415,GAMMAGARD SD 10GM VIAL,PHA,A,250,,,,,,975.00,N,Y
4070416,GLUCAGON 1 MG EMERGENCY K,PHA,A,250,,,,,,451.20,N,Y
4070417,GLUCOTROL XL 10MG TAB,PHA,A,250,,,,,,3.43,N,Y
4070418,GOLYTELY 4000 ML,PHA,A,250,,,,,,64.15,N,Y
4070419,GAVISON TABS,PHA,A,250,,,,,,0.95,N,Y
4070420,GUANIDINE PO,PHA,A,250,,,,,,0.95,N,Y
4070421,GLIPIZIDE ER 2.5 MG TAB,PHA,A,250,,,,,,3.00,N,Y
4070422,HEPARIN LOCK FLUSH 100 UN,PHA,A,250,,,,,,31.80,N,Y
4070423,TRIAZOLAM 0.25 MG TAB,PHA,A,250,,,,,,3.60,N,Y
4070424,HALOPERIDOL 5MG TAB,PHA,A,250,,,,,,3.50,N,Y
4070425,HALOPERIDOL LACTATE 5 MG/,PHA,A,250,,,,,,33.25,N,Y
4070426,HEPARIN PF 1000 UNITS/ML,PHA,A,250,,,,,,4.50,N,Y
4070427,HEPARIN 5000 UNITS/ML 1 M,PHA,A,250,,,,,,33.35,N,Y
4070428,HERPER C BITABS,PHA,A,250,,,,,,1.27,N,Y
4070429,HISTAMINE PHOSPHATE 1 CC,PHA,A,250,,,,,,7.91,N,Y
4070430,HISTOPLASMIN TINE TEST,PHA,A,250,,,,,,14.87,N,Y
4070431,HOMICEBRIN OZ,PHA,A,250,,,,,,1.27,N,Y
4070432,HUMATIN 250 MG PO,PHA,A,250,,,,,,2.97,N,Y
4070433,HYCODAN OZ,PHA,A,250,,,,,,3.16,N,Y
4070434,HYCODAN TAB,PHA,A,250,,,,,,1.72,N,Y
4070435,hydroxyurea 500 mg cap,PHA,A,250,,,,,,3.65,N,Y
4070436,HYDROCODONE 2.5 MG / APAP,PHA,A,250,,,,,,12.05,N,Y
4070437,HYDERGINE TAB,PHA,A,250,,,,,,1.80,N,Y
4070438,HYDRIODIC ACID,PHA,A,250,,,,,,1.08,N,Y
4070439,HYDRO CORTISONE EMENA,PHA,A,250,,,,,,6.88,N,Y
4070440,HYDROCORTISONE 2.5% 30GM,PHA,A,250,,,,,,15.21,N,Y
4070441,HCTZ 50MG TAB,PHA,A,250,,,,,,2.06,N,Y
4070442,HYDRO DIURILL 25 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070443,HYDRO DIURILL 50 MG PO,PHA,A,250,,,,,,1.08,N,Y
4070444,HYDROMAX OZ,PHA,A,250,,,,,,0.95,N,Y
4070445,HYDROGEN PEROXIDE 3% 480,PHA,A,250,,,,,,0.85,N,Y
4070446,CHLORTHALIDONE 25 MG TAB,PHA,A,250,,,,,,6.05,N,Y
4070447,CHLORTHALIDONE 50MG TAB,PHA,A,250,,,,,,2.14,N,Y
4070448,CHLORTHALIDONE 100MG PO,PHA,A,250,,,,,,1.77,N,Y
4070449,HYPERSTAT 15MG/ML 20ML,PHA,A,250,,,,,,234.26,N,Y
4070450,HYPERTET 250 UNITS IM,PHA,A,250,,,,,,66.35,N,Y
4070451,HYDROPRES 25 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070452,HYDROPRES 50 MG PO,PHA,A,250,,,,,,1.08,N,Y
4070453,HYDRALAZINE 10 MG TAB,PHA,A,250,,,,,,2.15,N,Y
4070454,HYDRALAZINE 20 MG/ML 1 ML,PHA,A,250,,,,,,40.90,N,Y
4070455,IBERET 500 MG PO,PHA,A,250,,,,,,1.73,N,Y
4070456,IBERET SOL OZ,PHA,A,250,,,,,,2.53,N,Y
4070457,IBUPROFEN 200 MG TAB,PHA,A,250,,,,,,0.15,N,Y
4070458,IBUPROFEN 200 MG TAB #250,PHA,A,250,,,,,,25.25,N,Y
4070459,ILOPAN 2CC IM,PHA,A,250,,,,,,10.75,N,Y
4070461,ILOPAN CHOLINE TAB,PHA,A,250,,,,,,1.90,N,Y
4070462,ILOSONE 125 MG 1.5 ML IM,PHA,A,250,,,,,,12.02,N,Y
4070463,ILOSONE SUSP 100 BTL 250M,PHA,A,250,,,,,,20.24,N,Y
4070464,IPECAC SYRUP 1 OZ,PHA,A,250,,,,,,10.65,N,Y
4070465,ILOSONE 125 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070466,ILOSONE 250 MG PO,PHA,A,250,,,,,,1.14,N,Y
4070467,ILOSONE 500 MG PO,PHA,A,250,,,,,,1.90,N,Y
4070468,ILOSONE OZ,PHA,A,250,,,,,,4.12,N,Y
4070469,ILOTYCIN 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070470,IMIPRAMINE 25 MG PO,PHA,A,250,,,,,,1.28,N,Y
4070471,LOPERAMIDE 2 MG CAP,PHA,A,250,,,,,,0.50,N,Y
4070472,PROPRANOLOL 20MG TAB,PHA,A,250,,,,,,2.10,N,Y
4070473,PROPRANOLOL 40MG TAB,PHA,A,250,,,,,,2.08,N,Y
4070474,PROPRANOLOL 10 MG TAB,PHA,A,250,,,,,,3.30,N,Y
4070475,PROPRANOLOL 1 MG/ML 1 ML,PHA,A,250,,,,,,44.60,N,Y
4070476,INFLUENZA VACCINE 0.5 ML,PHA,A,636,Q2038,,,,,113.20,N,Y
4070477,IMFERON 2CC IM,PHA,A,250,,,,,,13.28,N,Y
4070478,INDOMETHACIN 25 MG CAP,PHA,A,250,,,,,,3.00,N,Y
4070479,HUMULIN 70/30 100 UNITS/M,PHA,A,250,,,,,,293.75,N,Y
4070480,IRCON PO,PHA,A,250,,,,,,0.95,N,Y
4070481,ISMELIN 25MG PO,PHA,A,250,,,,,,0.95,N,Y
4070482,ISONIAZID 100 MG PO,PHA,A,250,,,,,,1.28,N,Y
4070483,ISODIAZID 100 MG IM,PHA,A,250,,,,,,7.91,N,Y
4070484,INTROPIN (DOPAMIN) 40MGIM,PHA,A,250,,,,,,8.54,N,Y
4070485,ISOSORBIDE DINITRATE 10MG,PHA,A,250,,,,,,1.31,N,Y
4070486,ISOSORBIDE DN 20MG TAB,PHA,A,250,,,,,,2.10,N,Y
4070487,ISUPREL 0.2MG/ML 1ML AMP,PHA,A,250,,,,,,25.97,N,Y
4070488,VERAPAMIL 2.5 MG/ML 2 ML,PHA,A,250,,,,,,36.65,N,Y
4070489,VERAPAMIL 80 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4070490,ISOSORBIDE 10 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070491,POTASSIUM GLUCONATE 550 M,PHA,A,250,,,,,,0.15,N,Y
4070492,KANTREX 0.5GM TABS,PHA,A,250,,,,,,3.48,N,Y
4070493,KANTREX 0.5 GM 2CC IM,PHA,A,250,,,,,,17.08,N,Y
4070494,ATTAPULGITE SUSP 8OZ,PHA,A,250,,,,,,17.65,N,Y
4070495,CEPHALEXIN 500 MG CAP,PHA,A,250,,,,,,3.60,N,Y
4070496,CEPHALEXIN 250 MG CAP,PHA,A,250,,,,,,2.40,N,Y
4070497,CEPHALEXIN 250 MG / 5 ML,PHA,A,250,,,,,,76.85,N,Y
4070498,CEPHALEXIN SUSP250MG 1TSP,PHA,A,250,,,,,,2.41,N,Y
4070499,CEPHALEXIN 125 MG / 5 ML,PHA,A,250,,,,,,58.30,N,Y
4070500,CEPHALEXIN SUSP125MG 1TSP,PHA,A,250,,,,,,1.68,N,Y
4070501,KENALOG-40 40 MG/ML 1 ML,PHA,A,250,,,,,,72.95,N,Y
4070502,K LYTE TAB OR PKET.,PHA,A,250,,,,,,2.87,N,Y
4070503,KEFLIN 1GM IM,PHA,A,250,,,,,,8.86,N,Y
4070504,KEFZOL 1 GM ADD-VAN,PHA,A,250,,,,,,40.42,N,Y
4070505,KEFZOL 1/2 GM IM,PHA,A,250,,,,,,10.12,N,Y
4070506,K LOR PO,PHA,A,250,,,,,,2.97,N,Y
4070507,LIDOCAINE 2% JELLY 30 ML,PHA,A,250,,,,,,36.35,N,Y
4070508,LIDOCAINE 1% 50ML MDV,PHA,A,250,,,,,,16.63,N,Y
4070509,LIDOCAINE 4% TOPICAL SOLN,PHA,A,250,,,,,,38.30,N,Y
4070510,LIDOCAINE 2% 20ML MDV,PHA,A,250,,,,,,15.69,N,Y
4070511,LIDOCAINE 2% 5ML SYR,PHA,A,250,,,,,,18.21,N,Y
4070512,DIGOXIN 0.25 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4070513,LANOXIN 2CC AMP IM,PHA,A,250,,,,,,7.91,N,Y
4070514,LAROBEC PO,PHA,A,250,,,,,,0.95,N,Y
4070515,LARGON IM,PHA,A,250,,,,,,7.91,N,Y
4070516,LEDERCILLIN VK 125 MG/5ML,PHA,A,250,,,,,,3.80,N,Y
4070517,LEDERCILLIN VK 250 MGTAB,PHA,A,250,,,,,,0.95,N,Y
4070518,LEDERCILLIN VK 250 MG ML,PHA,A,250,,,,,,5.06,N,Y
4070519,LIDOCAINE 0.4% / D5W 500,PHA,A,250,,,,,,91.30,N,Y
4070520,FUROSEMIDE 10MG/ML 10 ML,PHA,A,250,,,,,,15.89,N,Y
4070521,FUROSEMIDE 40 MG TAB,PHA,A,250,,,,,,2.15,N,Y
4070522,LEVOPHED AMP IM,PHA,A,250,,,,,,71.70,N,Y
4070523,LIBRITABS 10 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070524,CHLORDIAZEPOXIDE 5 MG / C,PHA,A,250,,,,,,2.44,N,Y
4070525,CHLORDIAZEPOXIDE 10 MG CA,PHA,A,250,,,,,,3.13,N,Y
4070526,CHLORDIAZEPOXIDE 10MG CAP,PHA,A,250,,,,,,3.14,N,Y
4070527,LIMBITROL PO,PHA,A,250,,,,,,1.80,N,Y
4070528,LINOCIN 500 MG CAPS PO,PHA,A,250,,,,,,1.52,N,Y
4070529,LINCOCIN 300MG/ML 2ML,PHA,A,250,,,,,,32.64,N,Y
4070530,LIPO FLAVONOID TAB PO,PHA,A,250,,,,,,1.43,N,Y
4070531,LIVER INJ. IM,PHA,A,250,,,,,,8.22,N,Y
4070532,LITHIUM CARBONATE 300 MG,PHA,A,250,,,,,,2.10,N,Y
4070533,GEMFIBROZIL 600 MG TAB,PHA,A,250,,,,,,2.40,N,Y
4070534,LOZENGES PO,PHA,A,250,,,,,,1.43,N,Y
4070535,METOPROLOL 50MG TAB,PHA,A,250,,,,,,3.00,N,Y
4070536,LOXITANE 10 MG PO,PHA,A,250,,,,,,1.71,N,Y
4070537,DIPHENOXYLATE 2.5 MG / AT,PHA,A,250,,,,,,4.40,N,Y
4070538,LORELCO 250 MG PO,PHA,A,250,,,,,,3.23,N,Y
4070539,MAPROTILINE 25MG PO,PHA,A,250,,,,,,1.40,N,Y
4070540,LUMINAL 60 MG/ML 1 ML SYR,PHA,A,250,,,,,,44.80,N,Y
4070541,LEUKERAN 2MG TAB,PHA,A,250,,,,,,7.50,N,Y
4070542,MAALOX 12 OZ BOTTLE,PHA,A,250,,,,,,9.49,N,Y
4070543,OP MAALOX SUSPENSION 150,PHA,A,253,,,,,,9.70,N,N
4070544,TUBERCULIN SKIN TEST 5 UN,PHA,A,250,,,,,,65.60,N,Y
4070545,MACRODANTIN 100 MG PO,PHA,A,250,,,,,,1.59,N,Y
4070546,MACRODANTIN 50 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070547,MAGNESIUM 250 MG TAB,PHA,A,250,,,,,,0.10,N,Y
4070548,MAGNESIUM SULFATE 50% 0.5,PHA,A,250,,,,,,36.50,N,Y
4070549,MANDELAMINE SUSP. OZ,PHA,A,250,,,,,,2.53,N,Y
4070550,MANDOL 1GM IM,PHA,A,250,,,,,,13.92,N,Y
4070551,MANDOL 2GM IM,PHA,A,250,,,,,,24.04,N,Y
4070552,MARAX PO,PHA,A,250,,,,,,1.62,N,Y
4070553,MAREZINE 50 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070554,MARPLAN PO,PHA,A,250,,,,,,0.95,N,Y
4070555,MAXIDEX PO,PHA,A,250,,,,,,0.95,N,Y
4070556,MEBARAL 50 MG PO,PHA,A,250,,,,,,1.59,N,Y
4070557,MECLOFENAMATE 50MG PO,PHA,A,250,,,,,,1.37,N,Y
4070558,MECLIZINE 25 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070559,DEXAMETHASONE 2MG,PHA,A,250,,,,,,1.89,N,Y
4070560,MEDROL 4GM PO,PHA,A,250,,,,,,1.08,N,Y
4070561,DEXAMETHASONE 6MG PO,PHA,A,250,,,,,,1.90,N,Y
4070562,MEGESTROL 20MG,PHA,A,250,,,,,,1.95,N,Y
4070563,THIORIDAZINE 10MG TAB,PHA,A,250,,,,,,2.20,N,Y
4070564,MEPHYTON 5 MG TAB,PHA,A,250,,,,,,280.90,N,Y
4070565,AQUA MEPHYTON 1 MG IM,PHA,A,250,,,,,,7.91,N,Y
4070566,AQUA MEPHYTON 10 MG 1CC,PHA,A,250,,,,,,8.54,N,Y
4070567,MEPROBAMATE 400 MG PO,PHA,A,250,,,,,,1.29,N,Y
4070568,METAHYDRIN 2MG PO,PHA,A,250,,,,,,0.95,N,Y
4070569,METAHYDRIN 2MG PO,PHA,A,250,,,,,,1.62,N,Y
4070570,METAMUCIL 0.52 GM CAP,PHA,A,250,,,,,,0.15,N,Y
4070571,METAMUCIL PACKET,PHA,A,250,,,,,,0.10,N,Y
4070572,METAPREL 15CC INHALER,PHA,A,250,,,,,,13.28,N,Y
4070573,METAPREL LIQUID PER OZ,PHA,A,250,,,,,,1.38,N,Y
4070574,METHERGINE 0.2MG PO,PHA,A,250,,,,,,3.55,N,Y
4070575,METHERGINE IM,PHA,A,250,,,,,,16.40,N,Y
4070576,METHISCOL PO,PHA,A,250,,,,,,0.95,N,Y
4070577,METICORTEN 1MG PO,PHA,A,250,,,,,,0.95,N,Y
4070578,METICORTEN 5 MG PO,PHA,A,250,,,,,,1.01,N,Y
4070579,MICEBRIN T PO,PHA,A,250,,,,,,0.95,N,Y
4070580,GLUCOTROL XL 5 MG TAB,PHA,A,250,,,,,,3.85,N,Y
4070581,MICRO K PO,PHA,A,250,,,,,,1.55,N,Y
4070582,MILK OF MAGNESIA CONCENTR,PHA,A,250,,,,,,2.90,N,Y
4070583,MILTOWN PO,PHA,A,250,,,,,,0.95,N,Y
4070584,MILTRATE PO,PHA,A,250,,,,,,1.27,N,Y
4070585,MINOCYCLINE 100 MG CAP,PHA,A,250,,,,,,5.20,N,Y
4070586,MINOXIDE 100 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070587,MINERAL OIL [473 ML],PHA,A,250,,,,,,21.10,N,Y
4070588,PRAZOSIN 1 MG CAP,PHA,A,250,,,,,,3.90,N,Y
4070589,MILPATH 400 PO,PHA,A,250,,,,,,1.27,N,Y
4070590,"MITHYRACIN 2,000 MEG IV",PHA,A,636,J9270,,,,,95.77,N,Y
4070591,MOMENTUM PO,PHA,A,250,,,,,,1.28,N,Y
4070592,MODANE PO,PHA,A,250,,,,,,0.95,N,Y
4070593,MODURETIC 50 MG PO,PHA,A,250,,,,,,2.11,N,Y
4070594,MONOCID 500MGM IM,PHA,A,250,,,,,,13.92,N,Y
4070595,MONOCID 1GM IM,PHA,A,250,,,,,,27.83,N,Y
4070596,MORPHINE 15 MG ER TAB,PHA,A,250,,,,,,5.30,N,Y
4070597,MORPHINE 10 MG/ML 1 ML SY,PHA,A,250,,,,,,39.25,N,Y
4070598,MOTRIN 600 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070599,MOTRIN 400 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070600,ACETYLCYSTEINE 20% 30 ML,PHA,A,250,,,,,,56.20,N,Y
4070601,MULTICERBIN PO,PHA,A,250,,,,,,0.95,N,Y
4070602,THERAPEUTIC-M PLUS TAB,PHA,A,250,,,,,,0.20,N,Y
4070603,MYCIFRADIN SULPHATE PO,PHA,A,250,,,,,,1.27,N,Y
4070604,MYCIFRADIN SULPHATE IM,PHA,A,250,,,,,,12.65,N,Y
4070605,MYCOSTATIN VAG SUPP,PHA,A,250,,,,,,2.85,N,Y
4070606,NYSTATIN OINT 30GM,PHA,A,250,,,,,,13.02,N,Y
4070607,MYCOSTATIN TAB,PHA,A,250,,,,,,1.27,N,Y
4070608,"NYSTATIN 500,000 U TABS",PHA,A,250,,,,,,1.45,N,Y
4070609,NYSTATIN SUSP 1 TSP,PHA,A,250,,,,,,1.71,N,Y
4070610,MYADEC PO,PHA,A,250,,,,,,0.95,N,Y
4070611,MYSTECLIN F 250 MG CAPS,PHA,A,250,,,,,,1.59,N,Y
4070612,MYLANTA 12 OZ BOTTLE,PHA,A,250,,,,,,29.77,N,Y
4070613,SIMETHICONE 80 MG CHEW TA,PHA,A,250,,,,,,0.20,N,Y
4070614,PRIMIDONE 50 MG TAB,PHA,A,250,,,,,,2.45,N,Y
4070615,MITOMYCIN 20 MG,PHA,A,636,J9290,,,,,919.98,N,Y
4070616,FENOPROFEN 600MG TAB,PHA,A,250,,,,,,2.32,N,Y
4070617,NARCAN 1MG/ML 2ML AMP,PHA,A,250,,,,,,23.63,N,Y
4070618,NAQUA PO,PHA,A,250,,,,,,0.95,N,Y
4070619,NAPROXEN 250 MG TAB,PHA,A,250,,,,,,2.35,N,Y
4070620,NATABEC PO,PHA,A,250,,,,,,0.95,N,Y
4070621,NATALIN PO,PHA,A,250,,,,,,1.43,N,Y
4070622,TOBRAMYCIN 60MG IV/IM,PHA,A,250,,,,,,29.25,N,Y
4070623,TOBRAMYCIN 40 MG/ML 2 ML,PHA,A,250,,,,,,50.00,N,Y
4070624,NATURACIL PO,PHA,A,250,,,,,,0.95,N,Y
4070625,NATURETIN WITH K PO,PHA,A,250,,,,,,0.95,N,Y
4070626,thiothixene 5 mg cap,PHA,A,250,,,,,,7.05,N,Y
4070627,NEG GRAM 500 MG PO,PHA,A,250,,,,,,2.22,N,Y
4070628,NEMBUTAL PO,PHA,A,250,,,,,,0.95,N,Y
4070629,NEMBUTAL IM,PHA,A,250,,,,,,8.22,N,Y
4070630,NEMBUTAL ELIXER OZ,PHA,A,250,,,,,,2.22,N,Y
4070631,NEMBUTAL SUPP.,PHA,A,250,,,,,,2.85,N,Y
4070632,NEOCYCLATE PO,PHA,A,250,,,,,,0.95,N,Y
4070633,NEOLOID OZ,PHA,A,250,,,,,,1.27,N,Y
4070634,NEOMYCIN 500 MG TAB,PHA,A,250,,,,,,5.85,N,Y
4070635,NEO SYNEPHRINE BTL 15 ML,PHA,A,250,,,,,,43.23,N,Y
4070636,NEPTAZANE PO,PHA,A,250,,,,,,1.28,N,Y
4070637,NIACACINAMIDE PO,PHA,A,250,,,,,,0.95,N,Y
4070638,NIFEDEPHINE 20 MG PO,PHA,A,250,,,,,,1.31,N,Y
4070639,NIACIN 250 MG SR CAP,PHA,A,250,,,,,,0.15,N,Y
4070640,NICODERM CQ 14MG 14 PATCH,PHA,A,250,,,,,,96.84,N,Y
4070641,NICOTINIC ACID PO,PHA,A,250,,,,,,0.95,N,Y
4070642,NITROPRESS 25 MG/ML 2 ML,PHA,A,250,,,,,,134.30,N,Y
4070643,NITROGLYCERIN 0.4 MG/HR P,PHA,A,250,,,,,,7.25,N,Y
4070644,NITROGLYCERIN 2.5 MG ER C,PHA,A,250,,,,,,2.75,N,Y
4070645,NITRO-BID 2% OINT PACKET,PHA,A,250,,,,,,6.70,N,Y
4070647,NITRO-BID 2% OINT 30 GM,PHA,A,250,,,,,,149.00,N,Y
4070648,NITROGLYCERIN 0.4 MG SL T,PHA,A,250,,,,,,7.85,N,Y
4070649,NOCTEC PO,PHA,A,250,,,,,,0.95,N,Y
4070650,NOLUDAR CAP 50 MG. PO,PHA,A,250,,,,,,0.95,N,Y
4070651,NOLUDAR CAP 200 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070652,NORGESIC PO,PHA,A,250,,,,,,1.20,N,Y
4070653,DISOPYRAMIDE 100 MG CAP,PHA,A,250,,,,,,8.35,N,Y
4070654,TAMOXIFEN 10MG TAB,PHA,A,250,,,,,,5.80,N,Y
4070655,NORLESTRIN PO,PHA,A,250,,,,,,1.39,N,Y
4070656,NORLUTIN 5MG PO,PHA,A,250,,,,,,0.95,N,Y
4070657,LABETALOL 100 MG TAB,PHA,A,250,,,,,,3.60,N,Y
4070658,NOROXIN 400MG TAB,PHA,A,250,,,,,,11.00,N,Y
4070659,DESIPRAMINE 25MG PO,PHA,A,250,,,,,,1.20,N,Y
4070660,NOVAHISTINE ELIX 0Z,PHA,A,250,,,,,,2.15,N,Y
4070661,NOVAHISTINE LP,PHA,A,250,,,,,,1.27,N,Y
4070662,NYDRAZID 1ML IM,PHA,A,250,,,,,,8.86,N,Y
4070663,NYDRAZID PO,PHA,A,250,,,,,,0.95,N,Y
4070664,NYSTATIN SUSP 5 ML CUP,PHA,A,250,,,,,,6.05,N,Y
4070665,NYSTATIN TAB,PHA,A,250,,,,,,0.95,N,Y
4070666,OMNIPEN N 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070667,OMNIPEN 500 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070668,ONCOLOGY SWISH 240 ML,PHA,A,250,,,,,,96.55,N,Y
4070669,OPTILETS PO,PHA,A,250,,,,,,0.95,N,Y
4070670,ORENZYME PO,PHA,A,250,,,,,,1.90,N,Y
4070671,ORNADE CAP,PHA,A,250,,,,,,1.33,N,Y
4070672,ORGANIDIN TAB,PHA,A,250,,,,,,1.15,N,Y
4070673,ORGANIDIN LIQ 1 TSP,PHA,A,250,,,,,,4.31,N,Y
4070674,TOLBUTAMIDE PO,PHA,A,250,,,,,,1.37,N,Y
4070675,CALCIUM CARBONATE 500 MG,PHA,A,250,,,,,,0.15,N,Y
4070676,OXBILE OP,PHA,A,250,,,,,,0.95,N,Y
4070677,OMINIPEN SUS. 150 ML,PHA,A,250,,,,,,5.06,N,Y
4070678,OMNIPEN SUSP. 250 MG,PHA,A,250,,,,,,7.28,N,Y
4070679,OMINPEN 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070680,OMNIPEN 500 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070681,OMNIPEN IM,PHA,A,250,,,,,,8.22,N,Y
4070682,OMINPEN 2 GM IM,PHA,A,250,,,,,,13.92,N,Y
4070683,OGEN 1.25 MG PO,PHA,A,250,,,,,,1.15,N,Y
4070684,OPIUM 22 GTTS.,PHA,A,250,,,,,,2.85,N,Y
4070685,OXACILLIN CAPS 500 MG PO,PHA,A,250,,,,,,1.52,N,Y
4070686,OXACILLIN 500MG ADD-VAN,PHA,A,250,,,,,,17.91,N,Y
4070689,PAGITANE 125 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070690,PAMINE TAB PO,PHA,A,250,,,,,,0.95,N,Y
4070691,PANTOPON GR 1/3 IM,PHA,A,250,,,,,,7.91,N,Y
4070692,PARADIONE 300 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070693,PAREGORIC LIQ 1 TSP,PHA,A,250,,,,,,1.35,N,Y
4070694,PAREPECTOLIN 1 OZ,PHA,A,250,,,,,,1.59,N,Y
4070695,PARAFON FORTE PO,PHA,A,250,,,,,,2.11,N,Y
4070696,PATHIBAMATE 200 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070697,PATHIBAMATE 400 MG PO,PHA,A,250,,,,,,1.59,N,Y
4070698,PARLODEL 2.5 MG. PO,PHA,A,250,,,,,,2.65,N,Y
4070699,PAVABID PO,PHA,A,250,,,,,,0.95,N,Y
4070700,PAPAVERINE 150MG PO,PHA,A,250,,,,,,1.30,N,Y
4070701,PENICILLIN 1 CC PROCAINE,PHA,A,250,,,,,,25.06,N,Y
4070702,PENICILLIN 2CC IM,PHA,A,250,,,,,,8.54,N,Y
4070703,PENICILLIN 3CC IM,PHA,A,250,,,,,,10.12,N,Y
4070704,PENICILLIN 4CC IM,PHA,A,250,,,,,,11.39,N,Y
4070705,PENICILLN VK 250 MG TAB,PHA,A,250,,,,,,2.40,N,Y
4070706,PENTOBARBITAL 100 MG CAPS,PHA,A,250,,,,,,0.95,N,Y
4070707,OXYCODONE 5 MG / ACETAMIN,PHA,A,250,,,,,,3.75,N,Y
4070708,PERCORTEN PIVALATE PER CC,PHA,A,250,,,,,,8.22,N,Y
4070709,CYPROHEPTADINE 4MG PO,PHA,A,250,,,,,,1.30,N,Y
4070710,DOCUSATE NA/CASANTHRANOL,PHA,A,250,,,,,,1.53,N,Y
4070711,DOCUSATE/CASAN SYR 120ML,PHA,A,250,,,,,,6.07,N,Y
4070712,PERITRATE 10 MG,PHA,A,250,,,,,,0.95,N,Y
4070713,PERITRATE SA 80 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070714,FLUPHENAZINE 10 MG TAB,PHA,A,250,,,,,,38.70,N,Y
4070715,PERSANTINE 25 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070716,PERSANTINE 50 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070717,DIPYRIDAMOLE 75MG PO,PHA,A,250,,,,,,1.34,N,Y
4070718,PERTOFRANE 25 MG TAB,PHA,A,250,,,,,,1.21,N,Y
4070719,PERTOFRANE 50 MG PO,PHA,A,250,,,,,,1.71,N,Y
4070720,PETROGALAR 1 PT,PHA,A,250,,,,,,5.38,N,Y
4070721,PETROGALAR 1 OZ,PHA,A,250,,,,,,0.95,N,Y
4070722,PROMETHAZINE 50MG PO,PHA,A,250,,,,,,1.35,N,Y
4070723,PROMETHAZINE 25 MG SUPP,PHA,A,250,,,,,,38.50,N,Y
4070724,PROMETHAZINE / CODEINE SY,PHA,A,250,,,,,,5.45,N,Y
4070725,PROMETHAZINE 12.5 MG SUPP,PHA,A,250,,,,,,38.50,N,Y
4070726,PROMETHAZINE 50 MG/ML 1 M,PHA,A,250,,,,,,34.70,N,Y
4070727,PROMETHAZINE 25 MG/ML 1 M,PHA,A,250,,,,,,34.25,N,Y
4070728,PHENERGAN WITH COD. 1 OZ.,PHA,A,250,,,,,,2.85,N,Y
4070729,PROMETHAZINE SYRUP 60ML,PHA,A,250,,,,,,5.61,N,Y
4070730,PHENOBARB WI BELLADONNA,PHA,A,250,,,,,,0.95,N,Y
4070731,PHENOBARBITAL 20 MG / 5 M,PHA,A,250,,,,,,4.55,N,Y
4070732,PHENOBARBITAL 30 MG TAB,PHA,A,250,,,,,,4.25,N,Y
4070733,PHENOBARBITRAL 1 1/2,PHA,A,250,,,,,,1.27,N,Y
4070734,OXYTOCIN 10 UNITS/ML 1 ML,PHA,A,250,,,,,,51.90,N,Y
4070735,PITOCIN 5 UNITS 1 AMP,PHA,A,250,,,,,,12.71,N,Y
4070736,PHOSPHOLINE .06% 5CC BTL,PHA,A,250,,,,,,31.76,N,Y
4070737,PIPERCILLIN 2GM IV,PHA,A,250,,,,,,33.95,N,Y
4070738,PIPERCILLIN 3GM IV,PHA,A,250,,,,,,38.67,N,Y
4070739,PIPERCILLIN 4GM IV,PHA,A,250,,,,,,43.40,N,Y
4070740,PITRESSIN TANNATE 1 CC,PHA,A,250,,,,,,18.71,N,Y
4070741,PITUITRIN 1CC,PHA,A,250,,,,,,8.54,N,Y
4070742,PLACEBO,PHA,A,250,,,,,,1.50,N,Y
4070743,PLACIDYL 500 MG PO,PHA,A,250,,,,,,1.92,N,Y
4070744,POLY VI SOL 50 CC BTL.,PHA,A,250,,,,,,14.13,N,Y
4070745,POYLCILLIN 250 MG CAPS,PHA,A,250,,,,,,0.95,N,Y
4070746,POLYCILLIN 500 MG CAPS,PHA,A,250,,,,,,1.08,N,Y
4070747,POLYMAGNA TAB,PHA,A,250,,,,,,0.95,N,Y
4070748,PONSTEL 250 MG PO,PHA,A,250,,,,,,2.09,N,Y
4070749,PONTOCAINE 2% SOLN 30ML,PHA,A,250,,,,,,31.64,N,Y
4070750,POTASSIUM CHLORIDE 40 MEQ,PHA,A,250,,,,,,7.00,N,Y
4070751,POTASSIUM ACETATE 2 MEQ/M,PHA,A,250,,,,,,31.29,N,Y
4070752,POTASSIUM CHLORIDE 2 MEQ/,PHA,A,250,,,,,,70.05,N,Y
4070753,POTASSIUM CHLORIDE 2 MEQ/,PHA,A,250,,,,,,83.00,N,Y
4070754,POTASSIUM CHLORIDE 8 MEQ,PHA,A,250,,,,,,2.13,N,Y
4070755,POTASSIUM CHLORIDE 10 MEQ,PHA,A,250,,,,,,5.85,N,Y
4070756,PROVIDINE IODINE 1 OZ,PHA,A,250,,,,,,2.47,N,Y
4070757,PREDINSONE 10 MG PO,PHA,A,250,,,,,,1.35,N,Y
4070758,PREDNISONE 5 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4070759,PREDNISONE 20 MG TAB,PHA,A,250,,,,,,2.75,N,Y
4070760,PREMARIN 0.3 MG TAB,PHA,A,250,,,,,,24.55,N,Y
4070761,PREMARIN 25MG VIAL,PHA,A,250,,,,,,86.33,N,Y
4070762,PRISCOLINE 100MG INJ,PHA,A,250,,,,,,22.37,N,Y
4070763,PROBENECID 500 MG TAB,PHA,A,250,,,,,,4.35,N,Y
4070764,PROPANTHELINE 15MG PO,PHA,A,250,,,,,,1.30,N,Y
4070765,PROCAINAMIDE 250 MG PO,PHA,A,250,,,,,,2.22,N,Y
4070766,PROCAINAMIDE 750MG ER TAB,PHA,A,250,,,,,,3.00,N,Y
4070767,PROGESTERONE OIL 50 MG IM,PHA,A,250,,,,,,22.48,N,Y
4070768,PROGESTERONE OIL 25 MG IM,PHA,A,250,,,,,,32.46,N,Y
4070769,PROLOID 1 1/2 GR. PO,PHA,A,250,,,,,,0.95,N,Y
4070770,PROLOID 3GR PO,PHA,A,250,,,,,,0.95,N,Y
4070771,PROLUTIN 250 MG PER 1CC,PHA,A,250,,,,,,0.95,N,Y
4070772,NIFEDIPINE 10MG CAP,PHA,A,250,,,,,,2.18,N,Y
4070773,PROCAINAMIDE 375MG CAP,PHA,A,250,,,,,,2.31,N,Y
4070774,PROCAINAMIDE 100 MG/ML 10,PHA,A,250,,,,,,79.40,N,Y
4070775,PRONESTYL 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070776,PROPYLTHIOURACIL 50 MG TA,PHA,A,250,,,,,,8.25,N,Y
4070777,PROPANTHELINE 15 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070778,PROSTIGMIN 1.1000 IM,PHA,A,250,,,,,,13.46,N,Y
4070779,PROSTAPHLIN 250 MG PO,PHA,A,250,,,,,,1.59,N,Y
4070780,PROSTAPHLIN 500 MG PO,PHA,A,250,,,,,,2.53,N,Y
4070781,PROSTAPHLIN GM IM,PHA,A,250,,,,,,20.24,N,Y
4070782,PROAIR HFA MDI 8.5 GM,PHA,A,250,,,,,,108.22,N,Y
4070783,MEDROXYPROGESTERONE 2.5 M,PHA,A,250,,,,,,2.45,N,Y
4070784,PURODIGIN 0.2 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070785,PHENAZOPYRIDINE 100 MG TA,PHA,A,250,,,,,,4.70,N,Y
4070786,PHENAZOPYRIDINE 200MG PO,PHA,A,250,,,,,,1.33,N,Y
4070787,PROPINE 0.1% 10CC BTL.,PHA,A,250,,,,,,65.56,N,Y
4070788,QUININE PO ALL DOSES,PHA,A,250,,,,,,1.65,N,Y
4070789,QUIBRON TAB,PHA,A,250,,,,,,0.95,N,Y
4070790,QUIBRON OZ.,PHA,A,250,,,,,,1.90,N,Y
4070791,QUELIDRINE SYRUP OZ,PHA,A,250,,,,,,1.90,N,Y
4070792,QUINIDEX EXTENTABS PO,PHA,A,250,,,,,,1.93,N,Y
4070793,QUINIDINE SULFATE 200 MG,PHA,A,250,,,,,,2.40,N,Y
4070794,CHOLESTYRAMINE POWDER FOR,PHA,A,250,,,,,,10.05,N,Y
4070795,QUESTRAN 4 GM POWDER,PHA,A,250,,,,,,4.54,N,Y
4070796,QUINIDINE GLUCONATE 324 M,PHA,A,250,,,,,,4.05,N,Y
4070797,IMOGAM 150 UNITS/ML 2 ML,PHA,A,250,,,,,,"1,027.70",N,Y
4070798,RAUTRAX PO,PHA,A,250,,,,,,0.95,N,Y
4070799,RAUDIXIN 50 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070800,RAUDIXIN 100 MG PO,PHA,A,250,,,,,,1.08,N,Y
4070801,RAUOLFIA PO,PHA,A,250,,,,,,2.25,N,Y
4070802,PHENTOLAMINE 5 MG VIAL,PHA,A,250,,,,,,"1,860.10",N,Y
4070803,METOCLOPRAMIDE 10MG TAB,PHA,A,250,,,,,,2.07,N,Y
4070804,METOCLOPRAMIDE 5 MG/ML 2,PHA,A,636,,,,,,40.90,N,Y
4070805,REGROTON PO,PHA,A,250,,,,,,1.27,N,Y
4070806,NABUMETONE 750MG TAB,PHA,A,250,,,,,,3.71,N,Y
4070807,RENESE 2MG PO,PHA,A,250,,,,,,1.70,N,Y
4070808,RESERPINE 0.25 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070809,TEMAZEPAM 15 MG CAP,PHA,A,250,,,,,,3.40,N,Y
4070810,TEMAZEPAM 30MG CAP,PHA,A,250,,,,,,3.15,N,Y
4070811,RHO GAM 300MCG SYRINGE,PHA,A,250,,,,,,239.00,N,Y
4070812,RIOPAN SUSP 12 OZ,PHA,A,250,,,,,,7.78,N,Y
4070813,RIOPAN SUSP 1 OZ,PHA,A,250,,,,,,1.57,N,Y
4070814,METHYLPHENIDATE 10MG PO,PHA,A,250,,,,,,2.11,N,Y
4070815,MERHYLPHENIDATE 20MG PO,PHA,A,250,,,,,,1.82,N,Y
4070816,GLYCOPYRROLATE 0.2 MG/ML,PHA,A,250,,,,,,59.20,N,Y
4070817,METHOCARBAMOL 500 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4070818,GUAIFENESIN-DM SUGAR FREE,PHA,A,250,,,,,,9.60,N,Y
4070819,RONDOMYCIN 150 MG PO,PHA,A,250,,,,,,1.90,N,Y
4070820,RONDOMYCIN 300 MG,PHA,A,250,,,,,,3.16,N,Y
4070821,RUBRAMIN 100 MGM VITB12IM,PHA,A,250,,,,,,8.91,N,Y
4070822,"RUBRAMIN 1,000 MGMCC IM",PHA,A,250,,,,,,8.54,N,Y
4070823,RUTIN WITH C PO,PHA,A,250,,,,,,0.95,N,Y
4070824,RU VERT PO,PHA,A,250,,,,,,0.95,N,Y
4070825,RUFEN 400 MG (MOTRIN),PHA,A,250,,,,,,0.95,N,Y
4070826,RUFEN 600 MG (MOTRIN) PO,PHA,A,250,,,,,,1.08,N,Y
4070827,RYNA CX 1 OZ,PHA,A,250,,,,,,3.16,N,Y
4070828,SANDRIL 2.5 MG 0.25 TAB,PHA,A,250,,,,,,0.95,N,Y
4070829,SANSERT 2MG PO,PHA,A,250,,,,,,1.27,N,Y
4070830,SALUTENSIN TABS,PHA,A,250,,,,,,1.01,N,Y
4070831,SCOPOLAMINE 0.4MG IM,PHA,A,250,,,,,,12.96,N,Y
4070832,SECONAL 50 MG & 100MG PO,PHA,A,250,,,,,,0.95,N,Y
4070833,SECONAL 50 MG & 100MG IM,PHA,A,250,,,,,,7.91,N,Y
4070834,SEPTRA DOUBLE STRENGTH OZ,PHA,A,250,,,,,,1.27,N,Y
4070835,SERPASIL 2CC,PHA,A,250,,,,,,3.16,N,Y
4070836,SERPASIL 0.25 MG,PHA,A,250,,,,,,0.95,N,Y
4070837,OXAZEPAM 15 MG CAP,PHA,A,250,,,,,,4.45,N,Y
4070838,SERPASIL WIH APRESOLINE,PHA,A,250,,,,,,0.95,N,Y
4070839,SERUTAN DOSE,PHA,A,250,,,,,,0.95,N,Y
4070840,SILAIN TAB,PHA,A,250,,,,,,0.95,N,Y
4070841,SIGTABS PO,PHA,A,250,,,,,,0.95,N,Y
4070842,CARBIDOPA 25 MG / LEVODOP,PHA,A,250,,,,,,2.80,N,Y
4070843,CARBIDOPA 50 MG / LEVODOP,PHA,A,250,,,,,,6.59,N,Y
4070844,DOXEPIN 10 MG CAP,PHA,A,250,,,,,,3.75,N,Y
4070845,DOXEPIN 25 MG CAP,PHA,A,250,,,,,,4.30,N,Y
4070846,DOXEPIN 100MG PO,PHA,A,250,,,,,,1.44,N,Y
4070847,SODA MINTS PO,PHA,A,250,,,,,,0.95,N,Y
4070848,SORBITRATE 5MG PO,PHA,A,250,,,,,,0.95,N,Y
4070849,SLOBID 200 MG PO,PHA,A,250,,,,,,1.56,N,Y
4070850,SLOW K TAB 600 MG PO,PHA,A,250,,,,,,1.53,N,Y
4070851,SLO FE PO,PHA,A,250,,,,,,1.41,N,Y
4070852,SODIUM CHLORIDE 1 GM TAB,PHA,A,250,,,,,,0.30,N,Y
4070853,SLO PHYLLIN LIQ 1 TSP,PHA,A,250,,,,,,2.03,N,Y
4070854,SODIUM CHLORIDE BACTERIOS,PHA,A,250,,,,,,0.00,N,Y
4070855,SODIUM BICARBONATE 7.5% 5,PHA,A,250,,,,,,20.34,N,Y
4070856,SODIUM EDECRIN 50 MG 50ML,PHA,A,250,,,,,,27.80,N,Y
4070857,SODIUM SALILCYLATE PO,PHA,A,250,,,,,,0.95,N,Y
4070858,SOLU-CORTEF 250MG VIAL,PHA,A,250,,,,,,18.10,N,Y
4070859,SOLU-CORTEF 100MG VIAL,PHA,A,250,,,,,,17.42,N,Y
4070860,SOLU-CORTEF PF 100MG VIAL,PHA,A,250,,,,,,3.62,N,Y
4070861,SOLU-MEDROL 125 MG VIAL,PHA,A,250,,,,,,66.75,N,Y
4070862,SOLU-MEDROL 40 MG VIAL,PHA,A,250,,,,,,51.35,N,Y
4070863,SOLU MEDROL 500 MG VIAL,PHA,A,250,,,,,,50.70,N,Y
4070864,CARISOPRODOL 350 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4070865,SPARINE 25 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070866,SPARINE 25 MG CC IM,PHA,A,250,,,,,,7.91,N,Y
4070867,OXTRIPHYLLINE 200 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070868,PABALATE PO,PHA,A,250,,,,,,0.95,N,Y
4070869,SPARINE 50 MG IM,PHA,A,250,,,,,,8.54,N,Y
4070870,STAPHACILLIN 1GM IM,PHA,A,250,,,,,,10.75,N,Y
4070871,SPIRONOLACTONE 25 MG TAB,PHA,A,250,,,,,,2.45,N,Y
4070872,TRIFLUOPERAZINE PO ALL DO,PHA,A,250,,,,,,1.83,N,Y
4070873,STILBESTEROL 5 & 25 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070874,STILBESTEROL SUPP VAG 0.1,PHA,A,250,,,,,,3.48,N,Y
4070875,STILPHOSTROL 50 MG TAB,PHA,A,250,,,,,,2.22,N,Y
4070876,STILPHOSTROL 1CC AMP IM,PHA,A,250,,,,,,8.54,N,Y
4070877,STREPTOMYCIN 1 GM 2CC,PHA,A,250,,,,,,8.54,N,Y
4070878,STRESS TABS 600 ZINC PO,PHA,A,250,,,,,,1.44,N,Y
4070879,SUCARYL PO,PHA,A,250,,,,,,0.95,N,Y
4070880,PSEUDOEPHEDRINE 30 MG TAB,PHA,A,250,,,,,,3.20,N,Y
4070881,PSEUDOEPHEDRINE 60MG PO,PHA,A,250,,,,,,1.30,N,Y
4070882,SURBEX WITH C PO,PHA,A,250,,,,,,0.95,N,Y
4070883,SURBEX T PO,PHA,A,250,,,,,,0.95,N,Y
4070884,SUSPHRINE (1.2000) 1CC,PHA,A,250,,,,,,21.04,N,Y
4070885,SWEETA 2 OZ,PHA,A,250,,,,,,6.01,N,Y
4070886,SWEETA 4 0Z,PHA,A,250,,,,,,9.81,N,Y
4070887,FLUOCINOLONE SOL.60CC BTL,PHA,A,250,,,,,,32.81,N,Y
4070888,SYNLAGOS DC PO,PHA,A,250,,,,,,0.95,N,Y
4070889,SYNKAYVITE 5MG IM,PHA,A,250,,,,,,8.54,N,Y
4070890,FENTANYL 50 MCG/ML 2 ML V,PHA,A,250,,,,,,38.30,N,Y
4070891,SUBLIMAZE 5ML,PHA,A,250,,,,,,16.89,N,Y
4070892,SUBLIMAZE 10ML,PHA,A,250,,,,,,30.08,N,Y
4070893,SUBLIMAZE 20ML,PHA,A,250,,,,,,30.06,N,Y
4070894,SYNTAYVITE 1CC IM,PHA,A,250,,,,,,8.86,N,Y
4070895,LEVOTHYROXINE 112 MCG TAB,PHA,A,250,,,,,,4.75,N,Y
4070896,LEVOTHYROXINE 200 MCG VIA,PHA,A,250,,,,,,447.10,N,Y
4070897,LEVOTHYROXINE 88 MCG TAB,PHA,A,250,,,,,,3.75,N,Y
4070898,SUMYCIN PO 250 MG,PHA,A,250,,,,,,0.95,N,Y
4070899,SUMMETREL 100 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070900,SURFAK 240 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070901,SPEROMALACTON 25 MG PO,PHA,A,250,,,,,,1.21,N,Y
4070902,TABRON PO,PHA,A,250,,,,,,0.95,N,Y
4070903,TACE PO,PHA,A,250,,,,,,1.59,N,Y
4070904,CIMETIDINE LIQUID 1 TSP,PHA,A,250,,,,,,1.97,N,Y
4070905,TABAMET LIQ. 1 OZ 30CC,PHA,A,250,,,,,,3.61,N,Y
4070906,TAGAMET 300MG ADD-VAN,PHA,A,250,,,,,,43.52,N,Y
4070907,CIMETIDINE 400 MG TAB,PHA,A,250,,,,,,2.27,N,Y
4070908,CIMETIDINE 300 MG TAB,PHA,A,250,,,,,,2.27,N,Y
4070909,TALWIN 60 MG PO,PHA,A,250,,,,,,3.73,N,Y
4070910,TALWIN 60 MG IM,PHA,A,250,,,,,,38.00,N,Y
4070911,TANDERAIL PO,PHA,A,250,,,,,,0.95,N,Y
4070912,TAO 250 MG PO,PHA,A,250,,,,,,1.14,N,Y
4070913,METHIMAZOLE 5 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4070914,CLEMASTINE PO ALL DOSES,PHA,A,250,,,,,,1.80,N,Y
4070915,TEDRAL PO,PHA,A,250,,,,,,0.95,N,Y
4070916,TEDRAL SUSP OZ3,PHA,A,250,,,,,,1.90,N,Y
4070917,TEGRETOL 200 MG PO,PHA,A,250,,,,,,1.91,N,Y
4070918,CARBAMAZEPINE 200 MG TAB,PHA,A,250,,,,,,5.20,N,Y
4070919,TEMARIL 5 MG PO,PHA,A,250,,,,,,1.27,N,Y
4070920,TELDRIN TAB,PHA,A,250,,,,,,0.95,N,Y
4070921,TENORMIN 50 MG PO,PHA,A,250,,,,,,2.30,N,Y
4070922,ENLON 10 MG/ML 15 ML MDV,PHA,A,250,,,,,,48.52,N,Y
4070923,TERFONYL PO,PHA,A,250,,,,,,0.95,N,Y
4070924,TERPPIN HYDRATE ELIX OZ,PHA,A,250,,,,,,0.95,N,Y
4070925,TERRAMYCIN 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070926,TERRAMYCIN AMPS 250MG/2CC,PHA,A,250,,,,,,7.91,N,Y
4070927,BAYTET 250 UNITS/ML SYR,PHA,A,250,,,,,,261.48,N,Y
4070928,HYPERTET HUMAN ANTI TOX,PHA,A,250,,,,,,66.35,N,Y
4070929,TETANUS TOXOID IM,PHA,A,250,,,,,,19.38,N,Y
4070930,TETRACYCLINE 100 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070931,TETRACYCLINE 100 MG IM,PHA,A,250,,,,,,7.91,N,Y
4070932,TETRACYCLINE 250 MG CAP,PHA,A,250,,,,,,2.15,N,Y
4070933,TETRACYCLINE 250 MG IM,PHA,A,250,,,,,,11.71,N,Y
4070934,TETRACYCLINE 500 MG PO,PHA,A,250,,,,,,1.35,N,Y
4070935,TETRACYCLINE 500 MG IM,PHA,A,250,,,,,,20.24,N,Y
4070936,THEELIN 1CC 2MG IM,PHA,A,250,,,,,,7.91,N,Y
4070937,THEELIN 1CC 5MG IM,PHA,A,250,,,,,,8.54,N,Y
4070938,THEOPHYLLINE 300 MG ER TA,PHA,A,250,,,,,,2.95,N,Y
4070939,THERAGAN MULTIPLE VIT.,PHA,A,250,,,,,,1.35,N,Y
4070940,THEOPHYILLIN 250 MG TAB,PHA,A,250,,,,,,0.95,N,Y
4070941,THEOPHYILLIN 250 MG IV,PHA,A,250,,,,,,9.81,N,Y
4070942,THERMOTABLS PO,PHA,A,250,,,,,,1.45,N,Y
4070943,THIAMINE CHLORIDE 50MG,PHA,A,250,,,,,,0.95,N,Y
4070944,THIAMINE 100 MG TAB,PHA,A,250,,,,,,0.05,N,Y
4070945,THIAMINE 100 MG/ML 2 ML S,PHA,A,250,,,,,,56.60,N,Y
4070946,CHLORPROMAZINE 50MG TAB,PHA,A,250,,,,,,2.43,N,Y
4070947,CHLORPROMAZINE 25 MG/ML 2,PHA,A,250,,,,,,61.95,N,Y
4070948,THORAZINE SPANSULE PO,PHA,A,250,,,,,,1.59,N,Y
4070949,THORAZINE SUPP 100 MG SUP,PHA,A,250,,,,,,3.16,N,Y
4070950,THIOSULFIL PO,PHA,A,250,,,,,,0.95,N,Y
4070951,THROAT DISCS PO,PHA,A,250,,,,,,1.45,N,Y
4070952,THYROID 60MG TAB,PHA,A,250,,,,,,2.04,N,Y
4070953,THYROLAR 2GR TABS,PHA,A,250,,,,,,1.71,N,Y
4070954,OP TRIMETHOBENZAMIDE 100,PHA,A,250,,,,,,7.70,N,Y
4070955,TIMENTIN 3.1 GM IV,PHA,A,250,,,,,,35.42,N,Y
4070956,TITRALAC TAB,PHA,A,250,,,,,,1.35,N,Y
4070957,IMIPRAMINE 50MG TAB,PHA,A,250,,,,,,3.50,N,Y
4070958,IMIPRAMINE 10 MG,PHA,A,250,,,,,,1.28,N,Y
4070959,IMIPRAMINE 25 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4070960,TOFRANIL PM 100 MG,PHA,A,250,,,,,,1.59,N,Y
4070961,TOLINASE 100 MG PO,PHA,A,250,,,,,,0.95,N,Y
4070962,TOLINASE 250 MG PO,PHA,A,250,,,,,,1.14,N,Y
4070963,TOLECTIN PO,PHA,A,250,,,,,,1.21,N,Y
4070964,TONOCARD 400 MG PO,PHA,A,250,,,,,,1.92,N,Y
4070965,TORECAN 10MG TAB,PHA,A,250,,,,,,3.39,N,Y
4070966,TRANSDERN 5 MG PO,PHA,A,250,,,,,,1.90,N,Y
4070967,TRANSDERM SCOP 1.5 MG (1,PHA,A,250,,,,,,97.30,N,Y
4070968,CLORAZEPATE 3.75 MG TAB,PHA,A,250,,,,,,3.20,N,Y
4070969,ATRACURIUM 50MG/5ML SDV,PHA,A,250,,,,,,28.56,N,Y
4070970,PENTOXIFYLLINE 400 MG ER,PHA,A,250,,,,,,2.65,N,Y
4070971,TRIAVIL 2-10 2/25,PHA,A,250,,,,,,1.65,N,Y
4070972,TRIAVIL 4-10,PHA,A,250,,,,,,1.08,N,Y
4070973,PERPHENAZINE PO,PHA,A,250,,,,,,1.35,N,Y
4070974,TRIMETHOPRIM 100 MG TAB,PHA,A,250,,,,,,2.85,N,Y
4070975,TRINALIN PO,PHA,A,250,,,,,,2.08,N,Y
4070976,TRINSICON CAP,PHA,A,250,,,,,,3.31,N,Y
4070977,TRIPLE SULFA OZ,PHA,A,250,,,,,,0.95,N,Y
4070978,TRI VI SOL 30 M1,PHA,A,250,,,,,,9.38,N,Y
4070979,TROPH IRON OZ,PHA,A,250,,,,,,3.16,N,Y
4070980,TROPHITE OZ,PHA,A,250,,,,,,3.16,N,Y
4070981,TUBERCULIN TEST TINE,PHA,A,250,,,,,,14.06,N,Y
4070982,TUBOCURARINE PER ML,PHA,A,250,,,,,,21.10,N,Y
4070983,TUINAL 1 1/2 & 3 GR,PHA,A,250,,,,,,0.95,N,Y
4070984,APAP 325MG 2 TABS,PHA,A,250,,,,,,0.00,N,Y
4070985,ACETAMINOPHEN 650 MG SUPP,PHA,A,250,,,,,,0.85,N,Y
4070986,TYLOSTERONE PO,PHA,A,250,,,,,,0.95,N,Y
4070987,TYZINE 15 CC,PHA,A,250,,,,,,6.01,N,Y
4070988,TINACTIN BOTTLE SOL 10ML,PHA,A,250,,,,,,5.38,N,Y
4070989,TALWIN NX TAB,PHA,A,250,,,,,,6.50,N,Y
4070990,TALWIN IM,PHA,A,250,,,,,,7.91,N,Y
4070991,TWIN K 30 CC OZ,PHA,A,250,,,,,,2.67,N,Y
4070992,TRANSDERM NITRO 5,PHA,A,250,,,,,,2.22,N,Y
4070993,AMP/SULB 1.5GM IVP,PHA,A,250,,,,,,31.00,N,Y
4070994,NAFCILLIN 1GM ADD-VAN,PHA,A,250,,,,,,26.73,N,Y
4070995,NAFCILLIN 2 GM VIAL,PHA,A,250,,,,,,83.15,N,Y
4070996,UROBIOTIC 250 MG PO,PHA,A,250,,,,,,2.40,N,Y
4070997,BETHANECHOL 5MG IM,PHA,A,250,,,,,,16.76,N,Y
4070998,BETHANECHOL 5MG PO,PHA,A,250,,,,,,1.40,N,Y
4070999,BETHANECHOL 10 MG TAB,PHA,A,250,,,,,,3.55,N,Y
4071000,URECHOLINE 25MG TAB,PHA,A,250,,,,,,5.25,N,Y
4071001,BETHANECHOL 50 MG PO,PHA,A,250,,,,,,1.40,N,Y
4071002,URISED PO,PHA,A,250,,,,,,2.15,N,Y
4071003,ENALAPRIL 5 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4071004,VALMID 500 MG,PHA,A,250,,,,,,0.95,N,Y
4071005,DIAZEPAM 2MG TAB,PHA,A,250,,,,,,3.07,N,Y
4071006,VALIUM 10 MG PO,PHA,A,250,,,,,,1.79,N,Y
4071007,DIAZEPAM 5 MG/ML 2 ML SYR,PHA,A,250,,,,,,134.25,N,Y
4071008,DIAZEPAM 10MG TUBEX,PHA,A,250,,,,,,14.57,N,Y
4071009,VANCENASE INHALER,PHA,A,250,,,,,,44.54,N,Y
4071010,VERAPAMIL 5LMG.2ML IM,PHA,A,250,,,,,,25.93,N,Y
4071011,VERAPAMIL (ISOPTIN) 80 MG,PHA,A,250,,,,,,0.95,N,Y
4071012,VENTOLIN 0.5CC MG,PHA,A,250,,,,,,1.90,N,Y
4071013,VENTOLIN HFA MDI 8 GM,PHA,A,250,,,,,,48.60,N,Y
4071014,CEPHRADRINE 500MG PO,PHA,A,250,,,,,,1.68,N,Y
4071015,CEPHRADRINE 250MG PO,PHA,A,250,,,,,,1.75,N,Y
4071017,VELOSEF 250 MG /5M1 100ML,PHA,A,250,,,,,,21.51,N,Y
4071018,PENICILLIN ALL DOSES PO,PHA,A,250,,,,,,1.30,N,Y
4071019,V CILLIN 125 MG PO,PHA,A,250,,,,,,0.95,N,Y
4071020,V CILLIN 250 MG PO,PHA,A,250,,,,,,1.08,N,Y
4071021,DOXYCYCLINE 50MG PO,PHA,A,250,,,,,,1.30,N,Y
4071022,DOXYCYCLINE 100 MG TAB,PHA,A,250,,,,,,3.90,N,Y
4071023,VIBRAMYCIN SUSP OZ,PHA,A,250,,,,,,4.12,N,Y
4071024,VERAPAMIL 5 MG 2ML IV,PHA,A,250,,,,,,25.30,N,Y
4071025,VERAPAMIL 80 MG.,PHA,A,250,,,,,,0.95,N,Y
4071026,midazolam 25 mg / 5 ml MDV,PHA,A,250,,,,,,38.60,N,Y
4071027,HYDROCODONE 10 MG / ACETA,PHA,A,250,,,,,,4.10,N,Y
4071028,PINDOLOL PO ALL DOSES,PHA,A,250,,,,,,1.50,N,Y
4071029,VIVACTIL 5MG,PHA,A,250,,,,,,0.95,N,Y
4071030,VIVACTIL 10MG TAB,PHA,A,250,,,,,,4.70,N,Y
4071031,VIGRAN,PHA,A,250,,,,,,0.95,N,Y
4071032,VIDAYLIN 10 CC PO,PHA,A,250,,,,,,1.60,N,Y
4071033,VIDAYLIN 50 ML/50CC BTL,PHA,A,250,,,,,,14.98,N,Y
4071034,HYDROXYZINE 50MG PO,PHA,A,250,,,,,,1.41,N,Y
4071035,HYDROXYZINE HCL 25 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4071036,HYDROXYZINE 25MG IM,PHA,A,250,,,,,,13.46,N,Y
4071037,HYDROXYZINE 100MG IM,PHA,A,250,,,,,,13.16,N,Y
4071038,HYDROXYZINE 50 MG/ML 1 ML,PHA,A,250,,,,,,43.55,N,Y
4071039,VITAMIN K 1 MG / 0.5 ML S,PHA,A,250,,,,,,47.05,N,Y
4071040,VITAMIN E 400 UNITS CAP,PHA,A,250,,,,,,0.20,N,Y
4071041,VITAMIN C 500 MG TAB,PHA,A,250,,,,,,0.15,N,Y
4071042,DICLOFENAC SODIUM 75 MG D,PHA,A,250,,,,,,2.10,N,Y
4071043,WYAMINE ELIXER OZ,PHA,A,250,,,,,,1.90,N,Y
4071044,WYAMINE SULPHATE 15 MG IV,PHA,A,250,,,,,,11.95,N,Y
4071045,WYAMINE 2CC AMP IM,PHA,A,250,,,,,,7.91,N,Y
4071046,AMPHADASE 150 UNITS/ML 1,PHA,A,250,,,,,,130.40,N,Y
4071047,"WYCILLIN 600,000",PHA,A,250,,,,,,4.12,N,Y
4071048,"WYCILLIN 1,200, 000 IM",PHA,A,250,,,,,,6.01,N,Y
4071049,GUANABENZ 4MG PO,PHA,A,250,,,,,,1.60,N,Y
4071050,ALPRAZOLAM 0.25 MG TAB,PHA,A,250,,,,,,3.15,N,Y
4071051,LIDOCAINE PF 2% / EPINEPH,PHA,A,250,,,,,,7.95,N,Y
4071052,XYLOCAINE 50CC 2%BTL/IV,PHA,A,250,,,,,,30.07,N,Y
4071053,LIDOCAINE 1% 10 MG/ML 5 M,PHA,A,250,,,,,,63.20,N,Y
4071054,LIDOCAINE PF 4% 5 ML AMP,PHA,A,250,,,,,,8.10,N,Y
4071055,ZANTAC 300 MG,PHA,A,250,,,,,,6.85,N,Y
4071056,CALCIUM CARBONATE LIQUID,PHA,A,250,,,,,,46.36,N,Y
4071057,RANITIDINE 150 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4071058,ZEBEC PO,PHA,A,250,,,,,,1.37,N,Y
4071059,PRINIVIL 5MG TAB,PHA,A,250,,,,,,3.33,N,Y
4071060,ZORPRIN PO,PHA,A,250,,,,,,0.95,N,Y
4071061,ZYLOPRIM 100 MG PO,PHA,A,250,,,,,,0.95,N,Y
4071062,ZAROXOLYN 5MG TAB,PHA,A,250,,,,,,3.72,N,Y
4071063,Z BEC PO,PHA,A,250,,,,,,0.95,N,Y
4071064,ZENTINIC CAP,PHA,A,250,,,,,,0.95,N,Y
4071065,ZINC SULFATE 220 MG CAP,PHA,A,250,,,,,,0.10,N,Y
4071066,ACYCLOVIR 200 MG CAP,PHA,A,250,,,,,,2.27,N,Y
4071067,ACYCLOVIR 500 MG VIAL,PHA,A,250,,,,,,60.35,N,Y
4071068,COLYTE 1 GALLON,PHA,A,250,,,,,,16.45,N,Y
4071069,PENICILLIN SUSP 125MG BTL,PHA,A,250,,,,,,12.90,N,Y
4071070,PENICILLIN SUSP 125MG BTL,PHA,A,250,,,,,,13.50,N,Y
4071071,PENICILLIN SUSP 125MG 200,PHA,A,250,,,,,,13.87,N,Y
4071072,PENICILLIN VK 250 MG / 5,PHA,A,250,,,,,,35.50,N,Y
4071073,PENICILLIN SUSP 250MG 150,PHA,A,250,,,,,,13.75,N,Y
4071074,PENICILLIN SUSP 250MG 200,PHA,A,250,,,,,,14.19,N,Y
4071075,KEFLEX 125MG 100BTL,PHA,A,250,,,,,,11.39,N,Y
4071076,SLOPHYLLIN 80 4OZBTL,PHA,A,250,,,,,,5.71,N,Y
4071077,CEFACLOR 125 MG / 5 ML SU,PHA,A,250,,,,,,20.67,N,Y
4071078,OINTMENT PER APPLICATION,PHA,A,250,,,,,,1.75,N,Y
4071079,VITAMIN A&D OINT 4OZ,PHA,A,250,,,,,,5.75,N,Y
4071080,AFRIN NOSE DROPS 20 ML,PHA,A,250,,,,,,10.02,N,Y
4071081,ARISTOCORT 0.1% 15GM.,PHA,A,250,,,,,,11.07,N,Y
4071082,ACHROMYCIN 3%OINT.1OZ TUB,PHA,A,250,,,,,,15.45,N,Y
4071083,AVC DIENESTROL 4 OZ,PHA,A,250,,,,,,20.24,N,Y
4071084,AVC CREAM 40 OZ,PHA,A,250,,,,,,17.71,N,Y
4071085,AURALGAN EARDROPS 10ML,PHA,A,250,,,,,,22.68,N,Y
4071086,AUROMYCIN 1/2 OZ.TUBE,PHA,A,250,,,,,,5.38,N,Y
4071088,AUROMYCIN 1 OZ TUBE,PHA,A,250,,,,,,9.81,N,Y
4071089,BACITRACIN / POLYMYXIN B,PHA,A,250,,,,,,18.75,N,Y
4071090,BACITRACIN 500 UNITS/GM O,PHA,A,250,,,,,,6.15,N,Y
4071091,BACITRACIN 500 UNITS/GRAM,PHA,A,250,,,,,,7.85,N,Y
4071092,BACITRACIN OINT 4OZ 120GM,PHA,A,250,,,,,,23.94,N,Y
4071093,BENGAY ULTRA OINT 4OZ,PHA,A,250,,,,,,29.25,N,Y
4071094,BETADINE OINT. 1 OZ TUBE,PHA,A,250,,,,,,6.65,N,Y
4071095,BACIGUENT 1 /2 OZ TUBE,PHA,A,250,,,,,,3.16,N,Y
4071096,BORIC ACID 250 GM,PHA,A,250,,,,,,3.16,N,Y
4071097,BIOZYME 1/2 OZ TUBE,PHA,A,250,,,,,,3.48,N,Y
4071098,BOROFAX 1 3/4 OZ TUBE,PHA,A,250,,,,,,4.43,N,Y
4071099,CALAMINE LOTION 120 ML,PHA,A,250,,,,,,3.70,N,Y
4071100,CORDRAN O.5% 15GM TUBE,PHA,A,250,,,,,,10.75,N,Y
4071101,CORTATRIGEN 10 CC BOTTLE,PHA,A,250,,,,,,13.28,N,Y
4071102,NEOMYCIN / POLY B / HC OT,PHA,A,250,,,,,,285.00,N,Y
4071103,CHLOROMYCETIN CREAM 1 OZ,PHA,A,250,,,,,,10.44,N,Y
4071104,CHLOROMYCETIN OPH. 3.5GM,PHA,A,250,,,,,,7.91,N,Y
4071105,CARBAMIDE PEROXIDE 6.5% O,PHA,A,250,,,,,,6.05,N,Y
4071106,DEBROX EAR DROPS 0.1% 1OZ,PHA,A,250,,,,,,21.12,N,Y
4071107,DECADRON SPRAY TOPICAL,PHA,A,250,,,,,,20.24,N,Y
4071108,DECA SPRAY CAN 25 GM,PHA,A,250,,,,,,11.39,N,Y
4071109,DAPSON TUBE,PHA,A,250,,,,,,6.65,N,Y
4071110,DECADRON CR. 30GM TUBE,PHA,A,250,,,,,,12.65,N,Y
4071111,DECARON CR TOPICAL 15GM T,PHA,A,250,,,,,,10.12,N,Y
4071112,DEXAMETHASONE 0.1% OPHTH,PHA,A,250,,,,,,32.88,N,Y
4071113,DERMOPLAST 6 OZ TUBE,PHA,A,250,,,,,,7.91,N,Y
4071114,DESENEX OINT.90 OZ TUBE,PHA,A,250,,,,,,5.69,N,Y
4071115,DESENEX POWDER 1.5 OZ,PHA,A,250,,,,,,5.06,N,Y
4071116,DIAPER RASH OINTMENT 113,PHA,A,250,,,,,,6.45,N,Y
4071117,DIPROSONE 0.5% 15 GM TUBE,PHA,A,250,,,,,,15.18,N,Y
4071118,ELASE EACH APPLICATION,PHA,A,250,,,,,,3.24,N,Y
4071119,ELASE OINT 30GM,PHA,A,250,,,,,,43.21,N,Y
4071120,EYE WASH SOLUTION 120 ML,PHA,A,250,,,,,,14.30,N,Y
4071121,EFUDEX CR. 5%TUBE 25GM,PHA,A,250,,,,,,25.30,N,Y
4071122,FLUOCINONIDE CR 30GM,PHA,A,250,,,,,,17.78,N,Y
4071123,FLUOROPLEX LOTION 30ML,PHA,A,250,,,,,,39.86,N,Y
4071124,EUCERIN CREAM 113 GM,PHA,A,250,,,,,,13.35,N,Y
4071125,FURACIN CR 30GM,PHA,A,250,,,,,,25.28,N,Y
4071126,GANTRISIN OPHTH. OINT.TUB,PHA,A,250,,,,,,5.38,N,Y
4071127,GRANULEX 2oz CAN,PHA,A,250,,,,,,35.00,N,Y
4071128,GRANULEX SPRAY 4 OZ,PHA,A,250,,,,,,63.15,N,Y
4071129,HALOG CR PER APPL.,PHA,A,250,,,,,,2.66,N,Y
4071130,HALOG CR 60GM,PHA,A,250,,,,,,54.39,N,Y
4071131,NEOMYCIN / POLY B / DEX O,PHA,A,250,,,,,,14.55,N,Y
4071132,GARAMYCIN CR 15GM,PHA,A,250,,,,,,27.21,N,Y
4071133,GENTAMICIN 0.3% OPHTH OIN,PHA,A,250,,,,,,27.20,N,Y
4071134,GENTIAN VIOLET PER APP,PHA,A,250,,,,,,1.85,N,Y
4071135,HALOG CR. 0.025% 15 GM TU,PHA,A,250,,,,,,10.44,N,Y
4071136,HYDROCORTISONE 1% CREAM 3,PHA,A,250,,,,,,5.45,N,Y
4071137,ISOPTOCARPINE 1/2% 15ML,PHA,A,250,,,,,,22.25,N,Y
4071138,ERYTHROMYCIN 0.5% OPHTH O,PHA,A,250,,,,,,22.15,N,Y
4071139,KY JELLY 5 OZ TUBE,PHA,A,250,,,,,,9.52,N,Y
4071140,TRIAMCINOLONE ACETONIDE 0,PHA,A,250,,,,,,22.05,N,Y
4071141,TRIAMCINOLONE ACETONIDE 0,PHA,A,250,,,,,,17.10,N,Y
4071142,LINDANE LOTION 2 OZ,PHA,A,250,,,,,,14.58,N,Y
4071143,LIDEX CR. 0.05% 30 GM TUB,PHA,A,250,,,,,,26.57,N,Y
4071144,FLUOCINONIDE 0.05% GEL 60,PHA,A,250,,,,,,618.45,N,Y
4071145,CLOTRIMAZOLE / BETAMETHAS,PHA,A,250,,,,,,39.40,N,Y
4071146,MASSE CREAM 60GM,PHA,A,250,,,,,,11.38,N,Y
4071147,MENTHOL BTL.1/2 OX,PHA,A,250,,,,,,6.01,N,Y
4071148,MEDROL .25%7.5GM TUBE,PHA,A,250,,,,,,5.38,N,Y
4071149,NEO MEDROL 1% 7.5GM TUBE,PHA,A,250,,,,,,8.54,N,Y
4071150,MYCOLOG CR 15GM,PHA,A,250,,,,,,12.99,N,Y
4071151,MYCOLOG CR 30GM,PHA,A,250,,,,,,13.95,N,Y
4071152,MYCOLOG CR 60GM,PHA,A,250,,,,,,14.99,N,Y
4071153,MONISTAT 7 VAG CR 45GM,PHA,A,250,,,,,,22.07,N,Y
4071154,MYCOSTATIN CR 15 GM TUBE,PHA,A,250,,,,,,10.44,N,Y
4071155,MYCOSTATIN CR 30 GM TUBE,PHA,A,250,,,,,,17.08,N,Y
4071156,MYCOSTATIN OINT. 15 GM TU,PHA,A,250,,,,,,10.75,N,Y
4071157,NEO DECABRON TROPICAL 30G,PHA,A,250,,,,,,12.65,N,Y
4071158,NEODECARON TOPICAL 15GM T,PHA,A,250,,,,,,9.18,N,Y
4071159,TENSILON 1CC IM,PHA,A,250,,,,,,15.40,N,Y
4071160,NEOMEDROL CR. 0.25%7.5GRT,PHA,A,250,,,,,,5.38,N,Y
4071161,NEOMEDROL CR. 1% 7.5GR TU,PHA,A,250,,,,,,8.54,N,Y
4071162,TRIPLE ABX OINT 15 GM,PHA,A,250,,,,,,3.10,N,Y
4071163,NEOSPORIN OPTH. OINT,PHA,A,250,,,,,,22.78,N,Y
4071164,NEOSPORIN OPTH SUSP 5CC,PHA,A,250,,,,,,28.94,N,Y
4071165,NIVEA OIL PINT BTL,PHA,A,250,,,,,,12.12,N,Y
4071166,NIVEA LOTION 8 OZ,PHA,A,250,,,,,,18.85,N,Y
4071167,DIBUCAINE 1% OINT 1 OZ,PHA,A,250,,,,,,16.80,N,Y
4071168,NITROBID OINT 2%20GM TUBE,PHA,A,250,,,,,,6.65,N,Y
4071169,POLYSPORIN CR 15GM,PHA,A,250,,,,,,12.88,N,Y
4071170,DOUBLE ABX OINT 30GM,PHA,A,250,,,,,,16.22,N,Y
4071171,PREMARIN VAGINAL CREAM 42,PHA,A,250,,,,,,"1,475.70",N,Y
4071172,SILVER SULFADIAZINE 1% CR,PHA,A,250,,,,,,32.40,N,Y
4071173,SYNALAR LOT.20 ML BTL,PHA,A,250,,,,,,13.28,N,Y
4071174,FLUOCINONIDE 0.05% CREAM,PHA,A,250,,,,,,72.65,N,Y
4071175,SULFAMYLON CR 14.5 CAN,PHA,A,250,,,,,,117.65,N,Y
4071176,SULFAMYLON CR 4 OZ,PHA,A,250,,,,,,41.75,N,Y
4071177,SULFAMYLON CR 2 OZ,PHA,A,250,,,,,,26.57,N,Y
4071178,SALICYLIC ACID 4 OZ,PHA,A,250,,,,,,5.38,N,Y
4071179,SCARLET RED OINT.1 OZ TUB,PHA,A,250,,,,,,6.65,N,Y
4071180,SPECTROCIN OINT. 1/2 OZ,PHA,A,250,,,,,,4.75,N,Y
4071181,TERRA CORTRIL OPT.5ML,PHA,A,250,,,,,,13.92,N,Y
4071182,TERRAMYCIN 5MG/1/2 OZTUBE,PHA,A,250,,,,,,7.28,N,Y
4071183,TERRAMYCIN 1/8OZ OPT.TUBE,PHA,A,250,,,,,,7.28,N,Y
4071184,TINACTIN 15GM TUBE,PHA,A,250,,,,,,11.40,N,Y
4071185,timolol 0.25% ophth soln,PHA,A,250,,,,,,14.90,N,Y
4071186,TIMOLOL MALEATE 0.5% OPHT,PHA,A,250,,,,,,16.60,N,Y
4071187,TOPICORT 60 GM TUBE,PHA,A,250,,,,,,25.30,N,Y
4071188,TOPICORT CR 15GM TUBE,PHA,A,250,,,,,,12.02,N,Y
4071189,TRONOTHANE 1% 1 OZ TUBE,PHA,A,250,,,,,,5.38,N,Y
4071191,EYESTREAM 2OZ BOTTLE,PHA,A,250,,,,,,5.38,N,Y
4071192,VISINE 0.05% OPHTH SOLN 1,PHA,A,250,,,,,,15.75,N,Y
4071193,VIOFORM TUBE 1 OZ.,PHA,A,250,,,,,,6.33,N,Y
4071194,ZINC OXIDE OINT 60GM,PHA,A,250,,,,,,4.15,N,Y
4071195,BETAMETHASONE 0.05% CREAM,PHA,A,250,,,,,,13.22,N,Y
4071196,SILVADENE OINT. 20 GM TUB,PHA,A,250,,,,,,6.01,N,Y
4071197,SILVER SULFADIAZINE 1% CR,PHA,A,250,,,,,,87.65,N,Y
4071198,SILVER SULFADIAZINE 1% CR,PHA,A,250,,,,,,160.70,N,Y
4071199,CLOTRIMAZOLE 1% CREAM 15,PHA,A,250,,,,,,7.10,N,Y
4071200,CLOTRIMAZOLE CR 15GM,PHA,A,250,,,,,,9.95,N,Y
4071201,LOTRIMIN SOL 10ML,PHA,A,250,,,,,,10.60,N,Y
4071202,FLUOROPEX LOTION 30 CC BT,PHA,A,250,,,,,,16.77,N,Y
4071203,WITCH HAZEL 16 OZ BTL,PHA,A,250,,,,,,8.28,N,Y
4071204,TEARISOL EYE DROPS 15ML,PHA,A,250,,,,,,21.00,N,Y
4071205,CEPACOL LOZENGE,PHA,A,250,,,,,,0.50,N,Y
4071206,CLINITEST EACH,PHA,A,250,,,,,,2.85,N,Y
4071207,GLUCOSE 4 GM CHEW TAB,PHA,A,250,,,,,,2.50,N,Y
4071208,PENTOTHAL 500 MG 20 ML SY,PHA,A,250,,,,,,45.53,N,Y
4071209,FORANE ANESTHESIA GAS,PHA,A,250,,,,,,25.00,N,Y
4071210,TRACRIUM IV,PHA,A,250,,,,,,29.10,N,Y
4071211,FENTANYL 50 MCG/ML 2 ML A,PHA,A,250,,,,,,32.50,N,Y
4071212,DROPERIDOL 2.5 MG/ML 2 ML,PHA,A,250,,,,,,45.25,N,Y
4071213,INAPSINE 2ML IV,PHA,A,250,,,,,,19.08,N,Y
4071214,INAPSINE 3ML IV,PHA,A,250,,,,,,22.62,N,Y
4071215,INAPSINE MULTIDOSE 10MLIV,PHA,A,250,,,,,,42.54,N,Y
4071216,SUCCINYLCHOLINE 20 MG/ML,PHA,A,250,,,,,,103.50,N,Y
4071217,NARCAN IV,PHA,A,250,,,,,,11.39,N,Y
4071218,PROSTIGMIN IV,PHA,A,250,,,,,,14.42,N,Y
4071219,TRACRIUM IV,PHA,A,250,,,,,,29.10,N,Y
4071220,FLECAINIDE 50 MG TAB,PHA,A,250,,,,,,2.75,N,Y
4071221,ADM FEE PER PO,PHA,A,250,,,,,,0.95,N,Y
4071222,ADM FEE PER IM,PHA,A,250,,,,,,4.00,N,Y
4071224,AUGMENTIN 250MG TAB,PHA,A,250,,,,,,10.00,N,Y
4071225,LIDOCAINE 1%/EPI 50ML MDV,PHA,A,250,,,,,,19.02,N,Y
4071226,VASOXYL 20MG IM,PHA,A,250,,,,,,31.40,N,Y
4071227,KETO DIASTIX BTL 100STRIP,PHA,A,250,,,,,,20.60,N,Y
4071228,CIPRO 500 MG TAB,PHA,A,250,,,,,,11.35,N,Y
4071229,MORPHINE 2 MG/ML 1 ML SYR,PHA,A,250,,,,,,39.25,N,Y
4071230,LIDEX CR 15 GM TUBE,PHA,A,250,,,,,,18.34,N,Y
4071231,SALINE NASAL MIST 50CC,PHA,A,250,,,,,,7.95,N,Y
4071232,DILAUDID 2 MG TAB,PHA,A,250,,,,,,3.70,N,Y
4071233,AMINOPHYLLINE 25 MG/ML 10,PHA,A,250,,,,,,48.60,N,Y
4071234,DICLOFENAC SODIUM 50 MG D,PHA,A,250,,,,,,3.25,N,Y
4071235,PILOPINE HS OPHTH GEL,PHA,A,250,,,,,,30.50,N,Y
4071236,CEFUROXIME 250 MG TAB,PHA,A,250,,,,,,6.25,N,Y
4071237,NUBAIN 10MG/ML 1ML AMP,PHA,A,250,,,,,,15.93,N,Y
4071238,BETOPTIC-S 0.25% OPH 5ML,PHA,A,250,,,,,,110.55,N,Y
4071239,THYROXIN 0.2 MG PO,PHA,A,250,,,,,,1.27,N,Y
4071240,ORPHENADRINE 100 MG ER TA,PHA,A,250,,,,,,4.25,N,Y
4071241,PILOCARPINE 2% OPHTH SOLN,PHA,A,250,,,,,,154.45,N,Y
4071242,PRED FORTE 1% OPHTH SOLN,PHA,A,250,,,,,,79.25,N,Y
4071243,EVAC-Q-KWIK,PHA,A,250,,,,,,18.00,N,Y
4071244,CALCIUM CARBONATE 500 MG,PHA,A,250,,,,,,0.05,N,Y
4071245,OP NYSTATIN SUSP 60 ML,PHA,A,253,,,,,,68.45,N,N
4071246,AZACTAM 1GM IVPB,PHA,A,250,,,,,,18.98,N,Y
4071247,AZTREONAM 1 GM VIAL,PHA,A,250,,,,,,158.20,N,Y
4071248,KETOCONAZOLE 2% CRM 15GM,PHA,A,250,,,,,,35.97,N,Y
4071249,BACLOFEN 10 MG TAB,PHA,A,250,,,,,,2.80,N,Y
4071250,PROVENTIL REPETABS 4MG,PHA,A,250,,,,,,4.05,N,Y
4071251,MYLANTA SUSPENSION 150 ML,PHA,A,250,,,,,,12.85,N,Y
4071252,TOAZAMIDE 250MG PO,PHA,A,250,,,,,,1.34,N,Y
4071253,NICARDIPINE 30 MG.PO,PHA,A,250,,,,,,0.95,N,Y
4071254,TRIAMCIN 0.05%/VANICREAM,PHA,A,250,,,,,,45.00,N,Y
4071255,ENALAPRIL 2.5 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4071256,QUININE SULFATE 260 MG TA,PHA,A,250,,,,,,3.75,N,Y
4071257,PROZAC 20MG CAP,PHA,A,250,,,,,,8.21,N,Y
4071258,AXID 150 MG CAP,PHA,A,250,,,,,,6.03,N,Y
4071259,TRIDIL 10CC INJ,PHA,A,250,,,,,,39.10,N,Y
4071260,NON IONIC CONTRAST MEDIA,PHA,A,636,A4646,,,,,118.00,N,Y
4071261,OXYBUTYNIN 5 MG ER TAB,PHA,A,250,,,,,,8.70,N,Y
4071262,MEVACOR 40MG TAB,PHA,A,250,,,,,,10.92,N,Y
4071263,POTASSIUM CHLORIDE 20 MEQ,PHA,A,250,,,,,,4.55,N,Y
4071264,MIDAZOLAM 1 MG/ML 2 ML SD,PHA,A,250,,,,,,33.20,N,Y
4071265,MIDAZOLAM 1 MG/ML INJ [PE,PHA,A,250,,,,,,1.60,N,Y
,,PHA,A,250,,,,,,1.00,N,Y
4071266,LITHIUM CARBONATE 300 MG,PHA,A,250,,,,,,2.75,N,Y
4071267,CEFTRIAXONE 1 GM / 50 ML,PHA,A,250,J0696,,,,,131.00,N,Y
4071268,ZANTAC 50MG IV PREMIX,PHA,A,250,,,,,,23.74,N,Y
4071269,DILANTIN IVPB 100MG,PHA,A,250,,,,,,8.22,N,Y
4071270,FLAVOXATE 100 MG TAB,PHA,A,250,,,,,,5.65,N,Y
4071271,ALBUTEROL 4MG TAB,PHA,A,250,,,,,,2.11,N,Y
4071272,VANCOMYCIN 500 MG VIAL,PHA,A,250,,,,,,53.90,N,Y
4071273,GENTAMICIN 40MG/ML 2ML,PHA,A,250,,,,,,1.14,N,Y
4071274,VANCERIL MDI 17GM,PHA,A,250,,,,,,93.54,N,Y
4071275,ATROVENT HFA MDI 12.9 GM,PHA,A,250,,,,,,265.05,N,Y
4071276,AMIODARONE 200 MG TAB,PHA,A,250,,,,,,11.80,N,Y
4071277,AMPICILLIN / SULBACTAM 1.,PHA,A,250,,,,,,37.30,N,Y
4071278,COCAINE 4% TOP SOLN 4ML,PHA,A,250,,,,,,34.06,N,Y
4071279,PIROXICAM 20MG CAP,PHA,A,250,,,,,,2.30,N,Y
4071280,LOPROX 1% CR 15GM,PHA,A,250,,,,,,46.81,N,Y
4071281,hydrocodone / acetaminophen oral soln 5,PHA,A,250,,,,,,3.80,N,Y
4071282,ACTIVASE 100 MG VIAL,PHA,A,250,,,,,,"9,493.30",N,Y
4071283,NYSTATIN OINT 15 GM,PHA,A,250,,,,,,49.55,N,Y
4071284,VITAMIN E PO,PHA,A,250,,,,,,2.21,N,Y
4071285,HEPARIN 50 UNITS/ML / 0.4,PHA,A,250,,,,,,109.40,N,Y
4071286,FLUTICASONE NASAL SPRAY 1,PHA,A,250,,,,,,24.60,N,Y
4071287,DEXTROSTIX EACH,PHA,A,250,,,,,,2.78,N,Y
4071288,MUPIROCIN 2% OINT 22 GM,PHA,A,250,,,,,,33.40,N,Y
4071289,PEPCID 40MG PO,PHA,A,250,,,,,,4.05,N,Y
4071290,LOPROX 15 GM TUBE 1%,PHA,A,250,,,,,,11.39,N,Y
4071291,INDOMETHACIN 50MG CAP,PHA,A,250,,,,,,2.12,N,Y
4071292,KETO-DIASTIX,PHA,A,250,,,,,,0.95,N,Y
4071293,DRISTAN SPRAY BOTTLE,PHA,A,250,,,,,,5.06,N,Y
4071294,PHENOL 1.4% THROAT SPRAY,PHA,A,250,,,,,,7.15,N,Y
4071295,FE-TINIC 150MG FORTE CAP,PHA,A,250,,,,,,2.31,N,Y
4071296,LIDOCAINE 2% VISCOUS 100,PHA,A,250,,,,,,50.60,N,Y
4071297,NASACORT AQ NASAL SPRAY 1,PHA,A,250,,,,,,491.30,N,Y
4071298,TEROZOL VAGINAL SUPP EA,PHA,A,250,,,,,,9.86,N,Y
4071299,DARBID 5MG,PHA,A,250,,,,,,0.95,N,Y
4071300,SOLU-MEDROL IVPB,PHA,A,636,J2930,,,,,17.00,N,Y
4071301,ALBUTEROL 0.083% 2.5 MG /,PHA,A,250,,,,,,10.80,N,Y
4071302,AMBESOL GEL TUBE,PHA,A,250,,,,,,9.50,N,Y
4071303,FIBERCON PO,PHA,A,250,,,,,,1.37,N,Y
4071304,"DEHYDROCOLIC ACID,PO 250",PHA,A,250,,,,,,1.59,N,Y
4071305,ORPHENADRINE 30 MG/ML 2 M,PHA,A,250,,,,,,45.90,N,Y
4071306,ERYTHROMYCIN 500 MG IVPB,PHA,A,250,,,,,,11.39,N,Y
4071307,BETADINE 5% OPHTH SOLN 30,PHA,A,250,,,,,,22.10,N,Y
4071308,HYDROCORTISONE 20 MG TAB,PHA,A,250,,,,,,2.45,N,Y
4071309,EULEXIN 125MG PO,PHA,A,250,,,,,,2.60,N,Y
4071310,ZOLADEX 3.6MG SUB Q,PHA,A,250,,,,,,395.09,N,Y
4071311,FLECAINIDE 100 MG TAB,PHA,A,250,,,,,,3.45,N,Y
4071312,CALCIUM CITRATE 950 MG TA,PHA,A,250,,,,,,0.15,N,Y
4071313,PHAZYME 95 PO,PHA,A,250,,,,,,1.53,N,Y
4071314,MEXILETINE 200MG PO,PHA,A,250,,,,,,1.85,N,Y
4071315,BACITRACIN / POLYMYXIN B,PHA,A,250,,,,,,49.20,N,Y
4071316,ORUDIS 75 MG PO,PHA,A,250,,,,,,2.13,N,Y
4071317,FLURBIPROFEN 0.03% OPHTH,PHA,A,250,,,,,,23.12,N,Y
4071318,PILOCARPINE 4% OPHTH SOLN,PHA,A,250,,,,,,161.40,N,Y
4071319,FML EYE DROPS 5ML,PHA,A,250,,,,,,20.98,N,Y
4071320,AYR NASAL MIST BOTTLE,PHA,A,250,,,,,,6.33,N,Y
4071321,KETOROLAC 30 MG/ML 1 ML S,PHA,A,250,,,,,,33.50,N,Y
4071322,KETOROLAC 30 MG/ML 2 ML S,PHA,A,250,,,,,,37.35,N,Y
4071323,TRIAMTERENE 75 MG / HYDRO,PHA,A,250,,,,,,2.15,N,Y
4071324,EMINASE VIAL,PHA,A,250,,,,,,"2,333.00",N,Y
4071325,SILDEC DM PED DROPS 30 ML,PHA,A,250,,,,,,46.50,N,Y
4071326,DURICEF 100 CC BOTTLE,PHA,A,250,,,,,,24.04,N,Y
4071327,ARTIFICIAL TEARS OPHTH OI,PHA,A,250,,,,,,8.50,N,Y
4071328,AMINOPHYLLIN IVPB 750MG,PHA,A,250,,,,,,10.75,N,Y
4071329,AMPICILLIN 500 IVPB,PHA,A,250,,,,,,3.80,N,Y
4071330,ISORBIDE 40 MG PO,PHA,A,250,,,,,,2.53,N,Y
4071331,CEPHALEXIN 250MG5C(KEFLEX,PHA,A,250,,,,,,12.65,N,Y
4071332,CEPHALEXIN250MG5C(KEFLEX),PHA,A,250,,,,,,9.49,N,Y
4071333,PROVENTYL INHALER REFILL,PHA,A,250,,,,,,25.30,N,Y
4071334,GENTRASUL GENT. SULF. 5ML,PHA,A,250,,,,,,10.12,N,Y
4071335,TOBREX SUSP 5ML,PHA,A,250,,,,,,54.70,N,Y
4071336,ZOVIRAX 5% CREAM 2 GM,PHA,A,250,,,,,,391.95,N,Y
4071337,GENTAMYCIN OPT SOL,PHA,A,250,,,,,,15.18,N,Y
4071338,PROCTOSOL-HC 2.5% RECTAL,PHA,A,250,,,,,,64.60,N,Y
4071339,CYTOTEC 200MCG TAB,PHA,A,250,,,,,,4.72,N,Y
4071340,PROPOFOL 10 MG/ML 20 ML S,PHA,A,250,,,,,,40.90,N,Y
4071341,TORADOL 60MG,PHA,A,250,,,,,,12.65,N,Y
4071342,DEPAKOTE 500MG TAB,PHA,A,250,,,,,,5.43,N,Y
4071343,ACIDOPHILUS 6 MG CAP,PHA,A,250,,,,,,0.10,N,Y
4071344,NIFEDIPINE 30 MG ER TAB,PHA,A,250,,,,,,3.30,N,Y
4071345,NIFEDICAL XL 60MG TAB,PHA,A,250,,,,,,6.93,N,Y
4071346,FAMOTIDINE 20 MG TAB,PHA,A,250,,,,,,0.35,N,Y
4071347,FORTAZ 2 GM VIAL,PHA,A,250,,,,,,61.79,N,Y
4071348,NIZORAL PO,PHA,A,250,,,,,,3.60,N,Y
4071349,HALOTHANE ANESTHESIA GAS,PHA,A,636,,,,,,25.00,N,Y
4071350,NORTRIPTYLINE 10 MG CAP,PHA,A,250,,,,,,2.35,N,Y
4071351,DOXAZOSIN 2MG TAB,PHA,A,250,,,,,,3.00,N,Y
4071352,OTO CORT SUSPENSION,PHA,A,250,,,,,,8.86,N,Y
4071353,CALCITRIOL 0.25 MCG CAP,PHA,A,250,,,,,,3.95,N,Y
4071354,PEDIAZOLE 250 MG/5CC PO,PHA,A,250,,,,,,1.73,N,Y
4071355,CAPOZIDE PO,PHA,A,250,,,,,,2.26,N,Y
4071356,VIOKASE PO,PHA,A,250,,,,,,1.46,N,Y
4071357,SUPRAX 400MG TAB PO,PHA,A,250,,,,,,6.30,N,Y
4071358,MEVACOR 20MG PO,PHA,A,250,,,,,,3.04,N,Y
4071359,CECLOR PO 1 Tsp.250MG,PHA,A,250,,,,,,2.53,N,Y
4071360,LODINE 300 MG P.O.,PHA,A,250,,,,,,2.27,N,Y
4071361,TRIMETHOBENZAMIDE 100 MG,PHA,A,250,,,,,,10.95,N,Y
4071362,HYTRIN 2MG CAP,PHA,A,250,,,,,,6.00,N,Y
4071363,FLEXALL 454 4OZ,PHA,A,250,,,,,,11.05,N,Y
4071364,SERENTIL 25MG TAB,PHA,A,250,,,,,,4.06,N,Y
4071365,CIPROFLOXACIN 250 MG TAB,PHA,A,250,,,,,,2.45,N,Y
4071366,MAGNEVIST 20 ML,PHA,A,255,,,,,,267.50,N,Y
4071367,AMOXICILLIN / CLAVULANATE,PHA,A,250,,,,,,263.90,N,Y
4071368,DOBUTAMINE 12.5 MG/ML 20,PHA,A,250,,,,,,60.05,N,Y
4071369,SELDANE 60MG PO,PHA,A,250,,,,,,2.07,N,Y
4071370,FELODIPINE 5 MG ER TAB,PHA,A,250,,,,,,4.65,N,Y
4071371,MINITRAN PATCH 5MG,PHA,A,250,,,,,,1.50,N,Y
4071372,METHOTREXATE 25 MG/ML 2 M,PHA,A,636,J9250,,,,,101.50,N,Y
4071373,ELDEPRYL 5MG PO,PHA,A,250,,,,,,3.15,N,Y
4071374,CHOLONE MAG TRI (CHOLE),PHA,A,250,,,,,,0.95,N,Y
4071375,MIVACRON 2 MG/ML 5 ML SDV,PHA,A,250,,,,,,75.75,N,Y
4071376,MIACALCIN 200 UNITS/ML 2,PHA,A,250,,,,,,173.54,N,Y
4071377,LORAZEPAM INTENSOL 2 MG/M,PHA,A,250,,,,,,46.15,N,Y
4071378,CARDENE 20MG PO,PHA,A,250,,,,,,1.97,N,Y
4071379,CLOTRIMAZOLE 1% VAGINAL C,PHA,A,250,,,,,,13.55,N,Y
4071380,AMANTADINE 100 MG CAP,PHA,A,250,,,,,,62.00,N,Y
4071381,HEMORRHOID PADS #100,PHA,A,250,,,,,,10.70,N,Y
4071382,MIDRIN PO,PHA,A,250,,,,,,1.57,N,Y
4071383,AZITHROMYCIN 250 MG TAB,PHA,A,250,,,,,,3.45,N,Y
4071384,KWELCOF 2 TSP,PHA,A,250,,,,,,2.56,N,Y
4071385,AUGMENTIN 250 MG PO,PHA,A,250,,,,,,2.00,N,Y
4071386,CEFADROXIL 500MG CAP,PHA,A,250,,,,,,7.32,N,Y
4071387,HUMULIN U 10ML VIAL,PHA,A,250,,,,,,55.80,N,Y
4071388,OXYBUTYNIN 5 MG TAB,PHA,A,250,,,,,,3.40,N,Y
4071389,PRAZOSIN 2MG PO,PHA,A,250,,,,,,1.39,N,Y
4071390,OMEPRAZOLE 20 MG CAP,PHA,A,250,,,,,,2.75,N,Y
4071391,ADRENALIN TOPICAL SOLN 30,PHA,A,250,,,,,,55.75,N,Y
4071392,TERBUTALINE 1 MG/ML 1 ML,PHA,A,250,,,,,,35.95,N,Y
4071393,FLOXIN 400 MG PO,PHA,A,250,,,,,,7.89,N,Y
4071394,FLUMAZENIL 0.1 MG/ML PER,PHA,A,250,,,,,,62.50,N,Y
4071395,PAMELOR 50 MG,PHA,A,250,,,,,,1.30,N,Y
4071396,PROPAFENONE 150 MG TAB,PHA,A,250,,,,,,2.75,N,Y
4071397,PRINIVIL 10MG TAB,PHA,A,250,,,,,,3.37,N,Y
4071398,ESMOLOL 10 MG/ML 10 ML SD,PHA,A,250,,,,,,56.90,N,Y
4071399,MONISTAT SUPP BOX,PHA,A,250,,,,,,28.00,N,Y
4071400,MEPERIDINE (DEMORAL)PRE F,PHA,A,250,,,,,,20.00,N,Y
4071401,MORPHINE 30MG/PREFIL PCA,PHA,A,250,,,,,,63.50,N,Y
4071402,FERROUS GLUCONATE 324 MG,PHA,A,250,,,,,,0.40,N,Y
4071403,HEMATINIC PO,PHA,A,250,,,,,,1.48,N,Y
4071404,FOSINOPRIL 10 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4071405,SALBUTEROL SYRUP PER OZ,PHA,A,250,,,,,,2.41,N,Y
4071406,SULFA (DOUBLE STRENGTH)PO,PHA,A,250,,,,,,0.95,N,Y
4071407,Estradiol 0.075 mg/day patch,PHA,A,250,,,,,,1.00,N,Y
4071408,HABITROL 21MG PATCH,PHA,A,250,,,,,,5.73,N,Y
4071409,ACETAMINOPHEN 80 MG CHEWA,PHA,A,250,,,,,,11.70,N,Y
4071410,OXACILLIN 2 GM VIAL,PHA,A,250,,,,,,111.00,N,Y
4071411,PEDIAPREL SYRUP 1OZ=3TSP,PHA,A,250,,,,,,1.75,N,Y
4071412,DILTIAZEM 240 MG ER CAP,PHA,A,250,,,,,,3.80,N,Y
4071413,CIPRO 200MG IVPB,PHA,A,250,,,,,,63.50,N,Y
4071414,AZATHIOPRINE 50 MG TAB,PHA,A,250,,,,,,4.00,N,Y
4071415,FLUCONAZOLE 100 MG TAB,PHA,A,250,,,,,,4.10,N,Y
4071416,GLYBURIDE 2.5 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4071417,HYDROXYCHLOROQUINE 200 MG,PHA,A,250,,,,,,8.55,N,Y
4071418,ATROPINE 0.1 MG/ML 5 ML S,PHA,A,250,,,,,,67.55,N,Y
4071419,PROCTOFOAM 10GM,PHA,A,250,,,,,,31.05,N,Y
4071420,DOXYCYCLINE 100 MG PO,PHA,A,250,,,,,,1.47,N,Y
4071421,BETAMETHASONE 6 MG/ML PER,PHA,A,250,,,,,,195.95,N,Y
4071422,BENZONATATE 100 MG CAP,PHA,A,250,,,,,,2.85,N,Y
4071423,NABUMETONE 500 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4071424,IBU 100MG/5ML SUSP 4OZ,PHA,A,250,,,,,,9.10,N,Y
4071425,VASERETIC 10/25 PO,PHA,A,250,,,,,,3.03,N,Y
4071426,ZOLOFT 100 MG PO,PHA,A,250,,,,,,4.69,N,Y
4071427,MANOPLAX 50 MG,PHA,A,250,,,,,,0.95,N,Y
4071428,HYOSCYAMINE 0.125 MG TAB,PHA,A,250,,,,,,2.50,N,Y
4071429,MG SULFATE 40MG/ML 1L IV,PHA,A,250,,,,,,31.00,N,Y
4071430,ACETAMINOPHEN 160 MG / 5,PHA,A,250,,,,,,4.50,N,Y
4071431,QUINAPRIL 10 MG TAB,PHA,A,250,,,,,,2.35,N,Y
4071432,SUPRAX SUSP 50ML BTL,PHA,A,250,,,,,,36.77,N,Y
4071433,AMLODIPINE 5 MG TAB,PHA,A,250,,,,,,2.40,N,Y
4071434,TICLOPIDINE 250MG TAB,PHA,A,250,,,,,,3.34,N,Y
4071435,ERYPED/400MG/60CCBOTTLE,PHA,A,250,,,,,,9.90,N,Y
4071436,ENTEX LA PO,PHA,A,250,,,,,,1.25,N,Y
4071437,CLARITHROMYCIN 250 MG TAB,PHA,A,250,,,,,,17.75,N,Y
4071438,CEFZIL 250MG TAB,PHA,A,250,,,,,,9.75,N,Y
4071439,CORDARONE 200MG PO,PHA,A,250,,,,,,2.75,N,Y
4071440,PROHANCE 10ML(MRI CONTRAS,PHA,A,255,,,,,,72.00,N,Y
4071441,ACETAMINOPHEN 80 MG / 0.8,PHA,A,250,,,,,,14.50,N,Y
4071442,IMITREX 5MG NASAL SPRAY,PHA,A,250,,,,,,49.77,N,Y
4071443,SUMATRIPTAN 6 MG 0.5 ML V,PHA,A,250,,,,,,64.15,N,Y
4071444,MORPHINE PF 1 MG/ML 10 ML,PHA,A,250,,,,,,65.55,N,Y
4071445,SALSALATE 500 MG TAB,PHA,A,250,,,,,,5.15,N,Y
4071446,TESSELON 100 MG,PHA,A,250,,,,,,0.95,N,Y
4071447,GERITOL COMPLETE P.O.,PHA,A,250,,,,,,1.32,N,Y
4071448,DYNAPEN 250 MG PO,PHA,A,250,,,,,,0.95,N,Y
4071449,PRIMAXIN 500 MG VIAL,PHA,A,250,,,,,,95.70,N,Y
4071450,LAMISIL CREAM 15 GM,PHA,A,250,,,,,,32.90,N,Y
4071451,ACETIC ACID 0.25% IRRIGAT,PHA,A,250,,,,,,22.75,N,Y
4071452,CORDARONE 200 MG PO,PHA,A,250,,,,,,3.25,N,Y
4071453,PEDIAZOLE 100 ML BOTTLE,PHA,A,250,,,,,,50.31,N,Y
4071454,PROPULSID 10MG PO,PHA,A,250,,,,,,2.35,N,Y
4071455,SENNA 8.6 MG TAB,PHA,A,250,,,,,,0.15,N,Y
4071456,CITRUCEL SUGAR-FREE 16.9,PHA,A,250,,,,,,59.00,N,Y
4071457,ISOSORBIDE MONONITRATE 20,PHA,A,250,,,,,,2.35,N,Y
4071458,ONDANSETRON 2 MG/ML PER 1,PHA,A,636,J2405,,,,,0.50,N,Y
4071459,FLUDARABINE 50 MG VIAL [P,PHA,A,636,J9185,,,,,410.40,N,Y
4071460,AZMACORT MDI 20 GM,PHA,A,250,,,,,,263.65,N,Y
4071461,LOXAPINE 5 MG CAP,PHA,A,250,,,,,,3.40,N,Y
4071462,BUPROPION SR 150 MG TAB,PHA,A,250,,,,,,3.10,N,Y
4071463,LUPRON 7.5MG,PHA,A,636,J9217,,,,,"1,362.50",N,Y
4071464,CREON 6000 UNITS CAP,PHA,A,250,,,,,,8.50,N,Y
4071465,ACEBUTOLOL 200 MG CAP,PHA,A,250,,,,,,2.85,N,Y
4071466,K-PHOS 500 MG TAB,PHA,A,250,,,,,,2.90,N,Y
4071467,PEDIAPRED SOLN 120ML,PHA,A,250,,,,,,41.02,N,Y
4071468,DIDRONEL 200 MG PO,PHA,A,250,,,,,,2.76,N,Y
4071469,LOTENSIN 5MG TAB,PHA,A,250,,,,,,3.74,N,Y
4071470,TORADOL PO 10MG,PHA,A,250,,,,,,2.40,N,Y
4071471,TORADOL PO 20MG,PHA,A,250,,,,,,4.50,N,Y
4071472,BRETYLIUM 50MG/ML 10ML SY,PHA,A,250,,,,,,30.89,N,Y
4071473,OCEAN MIST NASAL SPRAY,PHA,A,250,,,,,,9.20,N,Y
4071474,BIAXIN 250MG PO,PHA,A,250,,,,,,3.50,N,Y
4071475,TESTOSTERONE CYPIO 200 MG,PHA,A,636,J1070,,,,,19.25,N,Y
4071476,ZOSYN 2.25GM IVPB,PHA,A,250,,,,,,37.69,N,Y
4071477,colestipol micronized 1 gm tab,PHA,A,250,,,,,,5.90,N,Y
4071478,ADENOCARD 3 MG/ML 2 ML SY,PHA,A,250,,,,,,134.37,N,Y
4071479,BIAXIN SUSP 250/50ML,PHA,A,250,,,,,,68.15,N,Y
4071480,NICOTINE 21 MG PATCH,PHA,A,250,,,,,,6.05,N,Y
4071481,CYCLOPENTOLATE 1% OPHTH S,PHA,A,250,,,,,,13.40,N,Y
4071482,PHENYLEPHRINE 2.5% OPHTH,PHA,A,250,,,,,,12.60,N,Y
4071483,TOBREX OINT 3.5GM,PHA,A,250,,,,,,80.61,N,Y
4071484,LEVOBUNOLOL 0.5% OPHTH SO,PHA,A,250,,,,,,16.80,N,Y
4071485,OPTHAINE SOL 5% 1 DOSE,PHA,A,250,,,,,,7.76,N,Y
4071486,BUPIVACAINE PF 0.25% 10 M,PHA,A,250,,,,,,11.35,N,Y
4071487,CLONAZEPAM 0.5 MG TAB,PHA,A,250,,,,,,3.20,N,Y
4071488,MAXITROL OINTMENT EYE,PHA,A,250,,,,,,52.00,N,Y
4071489,TIMOLOL 0.5% GFS OPHT 5ML,PHA,A,250,,,,,,58.07,N,Y
4071490,PREDNISOLONE ACETATE 1% O,PHA,A,250,,,,,,73.60,N,Y
4071491,ALCAINE 0.5% OPHTH 15ML,PHA,A,250,,,,,,48.66,N,Y
4071492,CIPROFLOXACIN 0.3% OPHTH,PHA,A,250,,,,,,16.15,N,Y
4071493,TROPICAMIDE 1% OPHTH SOLN,PHA,A,250,,,,,,16.85,N,Y
4071494,FLUORESCEIN 0.25% / BENOX,PHA,A,250,,,,,,18.25,N,Y
4071495,PAXIL 20MG TAB,PHA,A,250,,,,,,7.50,N,Y
4071496,ELECTROLYTE ORAL SOLUTION,PHA,A,250,,,,,,10.35,N,Y
4071497,NEUPOGEN 300 MCG VIAL,PHA,A,636,J1440,,,,,975.85,N,Y
,,PHA,A,636,J1440,,,,,975.85,N,Y
4071498,FENTANYL 25 MCG/HR PATCH,PHA,A,250,,,,,,14.10,N,Y
4071499,PCE 500MG PO,PHA,A,250,,,,,,2.53,N,Y
4071500,NORVASC 5 MG,PHA,A,250,,,,,,1.50,N,Y
4071501,FINASTERIDE 5 MG TAB,PHA,A,250,,,,,,4.75,N,Y
4071502,LACTAID PO,PHA,A,250,,,,,,1.34,N,Y
4071503,ISOSORBIDE MONONITRATE 60,PHA,A,250,,,,,,3.25,N,Y
4071504,ADENOCARD 6 MG,PHA,A,250,,,,,,32.00,N,Y
4071505,INFED VIAL,PHA,A,250,,,,,,47.00,N,Y
4071506,OP IBUPROFEN 100 MG / 5 M,PHA,A,253,,,,,,16.70,N,N
4071507,SEREVENT 50 MCG DISKUS #2,PHA,A,250,,,,,,277.80,N,Y
4071508,AEROBID INHALER,PHA,A,250,,,,,,54.83,N,Y
4071509,CYCLANDELATE PO 200 MG,PHA,A,250,,,,,,1.32,N,Y
4071510,VEPESID(ETOPOSIDE) 100MG,PHA,A,636,J9182,,,,,186.29,N,Y
4071511,PRESERVISION TAB,PHA,A,250,,,,,,0.30,N,Y
4071512,STREPTOKINASE VIAL,PHA,A,250,,,,,,"1,037.50",N,Y
4071513,STADOL 2MG IM,PHA,A,250,,,,,,31.10,N,Y
4071514,GLUCEMA PER CAN,PHA,A,250,,,,,,23.50,N,Y
4071515,ENOXAPARIN 30 MG / 0.3 ML,PHA,A,250,,,,,,40.70,N,Y
4071516,GUANFACINE 1 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4071517,OP METHYLPREDNISOLONE 4 M,PHA,A,253,,,,,,65.40,N,N
4071518,THEOPHYLLINE 200 MG ER TA,PHA,A,250,,,,,,2.65,N,Y
4071519,RESCAPS PO,PHA,A,250,,,,,,1.57,N,Y
4071520,RHINOCORT INHALER,PHA,A,250,,,,,,71.00,N,Y
4071521,EMETROL BOTTLE,PHA,A,250,,,,,,10.71,N,Y
4071522,ALPRAZOLAM 0.25 mg PO,PHA,A,250,,,,,,1.35,N,Y
4071523,HYOSCYAMINE ER 0.375 MG T,PHA,A,250,,,,,,2.30,N,Y
4071524,UNIPHYL 400MG PO,PHA,A,250,,,,,,1.84,N,Y
4071525,EFFEXOR XR 75MG CAP,PHA,A,250,,,,,,7.16,N,Y
4071526,RECOMBIVAX HB PED/ADOL 5,PHA,A,250,,,,,,93.65,N,Y
4071527,PINDOLOL 10MG PO,PHA,A,250,,,,,,2.63,N,Y
4071528,RISPERIDONE 0.25 MG TAB,PHA,A,250,,,,,,2.90,N,Y
4071529,PREDNISOLONE 5 MG / 5 ML,PHA,A,250,,,,,,5.30,N,Y
4071530,COGNEX 10 MG PO,PHA,A,250,,,,,,2.34,N,Y
4071531,INTERFERON 3CC VIAL,PHA,A,250,,,,,,189.12,N,Y
4071532,CECLOR SUSP 250MG BOTTLE,PHA,A,250,,,,,,65.75,N,Y
4071533,THEOLAIR SK 200,PHA,A,250,,,,,,0.95,N,Y
4071534,PHOSLO 667 MG TAB,PHA,A,250,,,,,,5.05,N,Y
4071535,ISOVUE 300 50 ML,PHA,A,636,A4646,,,,,111.50,N,Y
4071536,METFORMIN 500 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4071537,ZOVIRAX 800MG PO,PHA,A,250,,,,,,4.75,N,Y
4071538,TOPROL XL 50MG TAB,PHA,A,250,,,,,,4.00,N,Y
4071539,CATAFLAM 50MG PO,PHA,A,250,,,,,,2.48,N,Y
4071540,PROMEHAZINE WITH COD,PHA,A,250,,,,,,6.90,N,Y
4071541,FAMVIR 500 MG PO,PHA,A,250,,,,,,7.00,N,Y
4071542,BREVITAL 500MG 50ML,PHA,A,250,,,,,,17.10,N,Y
4071543,MORPHINE 10 MG / 0.5 ML O,PHA,A,250,,,,,,11.25,N,Y
4071544,MORPHINE 1OMG TAB,PHA,A,250,,,,,,3.54,N,Y
4071545,SOTALOL 80 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4071546,FENTANYL 75 MCG/HR PATCH,PHA,A,250,,,,,,109.35,N,Y
4071547,CYSTOGRAFIN INJ,PHA,A,250,,,,,,50.70,N,Y
4071548,PEPTO BISMOL 8OZ,PHA,A,250,,,,,,13.05,N,Y
4071549,MYLICON 40 MG / 0.6 ML PE,PHA,A,250,,,,,,46.65,N,Y
4071550,VITAMIN B-12 1000 MCG/ML,PHA,A,250,,,,,,38.05,N,Y
4071551,VIT K IM,PHA,A,250,,,,,,8.88,N,Y
4071552,SODIUM BICARBONATE 650 MG,PHA,A,250,,,,,,0.05,N,Y
4071553,ISOTOPE,PHA,A,250,,,,,,152.14,N,Y
4071554,SEVOFLURANE ANESTHESIA GA,PHA,A,250,,,,,,25.00,N,Y
4071555,MUTAMYCIN PER 5MG,PHA,A,636,J9280,,,,,66.71,N,Y
4071556,SIMVASTATIN 10 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4071557,NAFCILLIN 2 GM / 100 ML,PHA,A,250,,,,,,144.70,N,Y
4071558,OCUFEN,PHA,A,250,,,,,,43.54,N,Y
4071560,BUPIVACAINE 0.5% / EPINEP,PHA,A,250,,,,,,8.65,N,Y
4071561,LUVOX 50 MG PO,PHA,A,250,,,,,,2.90,N,Y
4071562,TOBRAMYCIN OPHTH SOLN,PHA,A,250,,,,,,12.71,N,Y
4071563,SPORANOX 200MG PO,PHA,A,250,,,,,,11.62,N,Y
4071564,AMBIEN 10MG TAB,PHA,A,250,,,,,,7.52,N,Y
4071565,LEUCOVORIN PER 50MG,PHA,A,636,J0640,,,,,18.02,N,Y
4071566,VOLMAX 4MG TAB,PHA,A,250,,,,,,4.10,N,Y
4071567,KINEVAC INJ,PHA,A,250,,,,,,58.25,N,Y
4071568,BREVITAL 500 MG VIAL,PHA,A,250,,,,,,221.05,N,Y
4071569,ROWASA 500MG SUPP,PHA,A,250,,,,,,5.15,N,Y
4071570,MERCAPTOPURINE 50 MG TAB,PHA,A,250,,,,,,7.00,N,Y
4071571,OCTREOTIDE 1000 MCG/ML 5,PHA,A,250,,,,,,"1,112.05",N,Y
4071572,MAG-OXIDE 400 MG TAB,PHA,A,250,,,,,,0.35,N,Y
4071573,PREVACID 30 MG CAP,PHA,A,250,,,,,,13.55,N,Y
4071574,TUSSIN DM SUGAR-FREE / AL,PHA,A,250,,,,,,9.60,N,Y
4071575,FOLIC ACID 1 MG TAB,PHA,A,250,,,,,,0.25,N,Y
4071576,VITAMIN B-6 100 MG TAB,PHA,A,250,,,,,,0.10,N,Y
4071577,ERY-TAB 333 MG TAB,PHA,A,250,,,,,,7.40,N,Y
4071578,LOTREL PO,PHA,A,250,,,,,,3.47,N,Y
4071579,NEO POLY BAC OPTH OINT,PHA,A,250,,,,,,21.50,N,Y
4071580,DOXYCYCLINE 100 MG VIAL,PHA,A,250,,,,,,69.65,N,Y
4071581,METOLAZONE 2.5 MG TAB,PHA,A,250,,,,,,8.95,N,Y
4071582,PREDNISOLONE 15 MG / 5 ML,PHA,A,250,,,,,,17.90,N,Y
4071583,LIDOCAINE(VISC)15CC SUSP,PHA,A,250,,,,,,2.51,N,Y
4071584,VANTIN 200MG,PHA,A,250,,,,,,3.84,N,Y
4071585,HYZAAR 50/12.5,PHA,A,250,,,,,,2.15,N,Y
4071586,MAGNESIUM CITRATE SOLUTIO,PHA,A,250,,,,,,3.35,N,Y
4071587,CEFZIL 250MG 100CC BOTTLE,PHA,A,250,,,,,,69.56,N,Y
4071588,HIBICLENSE 30CC,PHA,A,250,,,,,,1.60,N,Y
4071589,TRANSDERM NITRO O.4MG.PAT,PHA,A,250,,,,,,2.11,N,Y
4071590,TOBRADEX OPHTH OINT 3.5 G,PHA,A,250,,,,,,379.95,N,Y
4071591,ALBUTEROL 2MG/5ML 120ML,PHA,A,250,,,,,,6.89,N,Y
4071592,CIPRO 200MG 20ML SDV,PHA,A,250,,,,,,44.58,N,Y
4071593,MORPHINE 1 MG/ML 30 ML PC,PHA,A,250,,,,,,109.35,N,Y
4071594,MEPERIDINE 10 MG/ML 30 ML,PHA,A,250,,,,,,111.10,N,Y
4071595,IMITREX 50MG TAB,PHA,A,250,,,,,,46.00,N,Y
4071596,ASACOL 400 MG TAB,PHA,A,250,,,,,,14.80,N,Y
4071597,PRAVASTATIN 20 MG TAB,PHA,A,250,,,,,,4.10,N,Y
4071598,TOBRADEX,PHA,A,250,,,,,,41.50,N,Y
4071599,LOTREL 5/20 CAP,PHA,A,250,,,,,,5.74,N,Y
4071600,ATORVASTATIN 10 MG TAB,PHA,A,250,,,,,,11.90,N,Y
4071601,STADOL NASAL SPRAY,PHA,A,250,,,,,,64.27,N,Y
4071602,CLAFORAN 2GM ADV,PHA,A,250,,,,,,56.88,N,Y
4071603,CEREBYX PER 50MG,PHA,A,250,,,,,,11.28,N,Y
4071604,FOSPHENYTOIN 50 MG PE/ML,PHA,A,250,,,,,,117.80,N,Y
4071605,LOSARTAN 25 MG TAB,PHA,A,250,,,,,,2.15,N,Y
4071606,HYDROCODONE 7.5 MG / ACET,PHA,A,250,,,,,,3.25,N,Y
4071607,TIAZAC 240MG CAP,PHA,A,250,,,,,,4.24,N,Y
4071608,CLAFORAN 1GM ADV,PHA,A,250,,,,,,52.95,N,Y
4071609,INFUVITE ADULT 10 ML SDV,PHA,A,250,,,,,,92.95,N,Y
4071610,GABAPENTIN 100 MG CAP,PHA,A,250,,,,,,2.70,N,Y
4071611,AMINOSYN 7% 500 ML,PHA,A,250,,,,,,68.11,N,Y
4071612,AMINOSYN/MULTIVIT BAG,PHA,A,250,,,,,,102.50,N,Y
4071613,MAG CITRATE 10OZ,PHA,A,250,,,,,,7.33,N,Y
4071614,DOUBLE ANTIBIOTIC OINTMEN,PHA,A,250,,,,,,11.35,N,Y
4071615,TRUSOPT 10ML BOTTLE,PHA,A,250,,,,,,86.56,N,Y
4071616,SERZONE 100MG TAB,PHA,A,250,,,,,,4.54,N,Y
4071617,EPOGEN 10000 UNITS,PHA,A,635,Q0136,,,,,269.52,N,Y
4071618,DURACEF SUSP 250MG/50ML,PHA,A,250,,,,,,46.25,N,Y
4071619,DURACEF SUSP 500MG/50ML,PHA,A,250,,,,,,27.94,N,Y
4071620,BIAXIN 250MG/5ML SUS 50ML,PHA,A,250,,,,,,75.01,N,Y
4071621,EPOGEN 15000 UNITS,PHA,A,635,Q0136,,,,,404.28,N,Y
4071622,DONNATAL ELIXIR 120ML,PHA,A,250,,,,,,21.06,N,Y
4071623,CETACAINE SPRAY,PHA,A,250,,,,,,50.00,N,Y
4071624,GUAIFENEX PSE PO(ZEPHREX),PHA,A,250,,,,,,1.43,N,Y
4071625,LESCOL 20MG,PHA,A,250,,,,,,3.33,N,Y
4071626,TYLENOL EXTRA-STRENGTH 50,PHA,A,250,,,,,,0.10,N,Y
4071627,DURACT 25MG PO,PHA,A,250,,,,,,2.93,N,Y
4071628,TARKA 4/240 MG,PHA,A,250,,,,,,3.49,N,Y
4071629,HALFPRIN P.O.,PHA,A,250,,,,,,1.35,N,Y
4071630,ULTRAM 50MG TAB,PHA,A,250,,,,,,3.75,N,Y
4071631,BICITRA 15CC (1/2 OZ) PO,PHA,A,250,,,,,,1.65,N,Y
4071632,BICITRA 30CC (1 OZ) PO,PHA,A,250,,,,,,2.89,N,Y
4071633,SODIUM CITRATE AND CITRIC,PHA,A,250,,,,,,29.65,N,Y
4071634,VI-Q-TUSS 5ML,PHA,A,250,,,,,,6.15,N,Y
4071635,METOPROLOL 1 MG/ML 5 ML S,PHA,A,250,,,,,,32.25,N,Y
4071636,DIGOXIN 250 MCG/ML 2 ML A,PHA,A,250,,,,,,53.05,N,Y
4071637,PENICILLIN G POTASSIUM 5,PHA,A,250,,,,,,72.95,N,Y
4071638,DOSTINEX 0.5MG PO,PHA,A,250,,,,,,53.49,N,Y
4071639,BENADRYL CREAM 1 OZ,PHA,A,250,,,,,,14.00,N,Y
4071640,ULTRAVATE .05% CREAM,PHA,A,250,,,,,,87.58,N,Y
4071641,DOPAMINE 200MG,PHA,A,250,,,,,,31.81,N,Y
4071642,VALTREX 500MG PO,PHA,A,250,,,,,,6.29,N,Y
4071643,AMARYL 2 MG TAB,PHA,A,250,,,,,,4.50,N,Y
4071644,REZALIN 400MG PO,PHA,A,250,,,,,,10.73,N,Y
4071645,NORPLANT KIT,PHA,A,250,,,,,,400.00,N,Y
4071646,DEPO-MEDROL 40MG/ML 5ML,PHA,A,250,,,,,,59.93,N,Y
4071647,COGENTIN 2MG,PHA,A,250,,,,,,1.31,N,Y
4071648,DIDRONEL 200MG,PHA,A,250,,,,,,4.59,N,Y
4071649,VALTREX 1 GM TAB,PHA,A,250,,,,,,4.45,N,Y
4071650,LUPRON DEPOT PER 3.75 MG,PHA,A,636,J1950,,,,,"1,710.40",N,Y
4071651,CEFPROZIL 250 MG / 5 ML S,PHA,A,250,,,,,,63.55,N,Y
4071652,CEFZIL 500MG TAB,PHA,A,250,,,,,,16.49,N,Y
4071653,ARICEPT 10MG TAB,PHA,A,250,,,,,,10.31,N,Y
4071654,BISOPROLOL 2.5 MG / HCTZ,PHA,A,250,,,,,,2.25,N,Y
4071655,PREDNISONE TAPER PACK,PHA,A,250,,,,,,18.35,N,Y
4071656,CEDAX 400 MG,PHA,A,250,,,,,,11.81,N,Y
4071657,PRECOSE 50 MG,PHA,A,250,,,,,,1.65,N,Y
4071658,PRECOSE 100MG,PHA,A,250,,,,,,2.27,N,Y
4071659,SULAR 8.5 MG ER TAB,PHA,A,250,,,,,,13.75,N,Y
4071660,ALPRAZOLAM .25MG TAB,PHA,A,250,,,,,,3.10,N,Y
4071661,DIOVAN 80 MG TAB,PHA,A,250,,,,,,3.00,N,Y
4071662,INDERAL LA 120MG,PHA,A,250,,,,,,1.95,N,Y
4071663,PRELONE SYRUP 25CC,PHA,A,250,,,,,,6.62,N,Y
4071664,"EPOGEN 20,000 UNITS",PHA,A,635,Q0136,,,,,539.04,N,Y
4071665,PRANDIN 1 MG TAB,PHA,A,250,,,,,,7.45,N,Y
4071666,CARDIZEM 5MG/ML 25MG SYR,PHA,A,250,,,,,,54.77,N,Y
4071667,DEMADEX 20MG PO,PHA,A,250,,,,,,2.31,N,Y
4071668,LATANOPROST 0.005% OPHTH,PHA,A,250,,,,,,21.55,N,Y
4071669,TOTAL PARENTERAL NUTRITIO,PHA,A,250,,,,,,"1,725.00",N,Y
4071670,MOEXIPRIL 7.5 MG TAB,PHA,A,250,,,,,,3.45,N,Y
4071671,EMADINE OPTH SOL,PHA,A,250,,,,,,63.42,N,Y
4071672,RIFAMPIN 600MG P.O.,PHA,A,250,,,,,,6.36,N,Y
4071673,RIFAMPIN INJ,PHA,A,250,,,,,,134.12,N,Y
4071674,AVAPRO 150 MG TAB,PHA,A,250,,,,,,3.65,N,Y
4071675,OP GUAIFENESIN 100 MG / D,PHA,A,253,,,,,,9.60,N,Y
4071676,DERMABOND 1 TUBE,PHA,A,250,,,,,,62.50,N,Y
4071677,CIPROFLOXACIN 400 MG / D5,PHA,A,250,,,,,,82.05,N,Y
4071678,NEOSTIGMINE,PHA,A,250,,,,,,18.94,N,Y
4071679,LIDOCAINE 5% / DEXTROSE 7,PHA,A,250,,,,,,51.85,N,Y
4071680,CITALOPRAM 20 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4071681,CHROMAGEN PO,PHA,A,250,,,,,,1.83,N,Y
4071682,DEFEROXAMINE 500 MG VIAL,PHA,A,250,,,,,,63.55,N,Y
4071683,CEFTRIAXONE 1 GM VIAL,PHA,A,250,,,,,,35.95,N,Y
4071684,RIMSO-50 50ML IRRIGATION,PHA,A,250,,,,,,100.58,N,Y
4071685,SOLU-MEDROL 1GM VIAL,PHA,A,250,,,,,,36.67,N,Y
4071686,PLAVIX 75 MG TAB,PHA,A,250,,,,,,2.85,N,Y
4071687,MAVIK 2MG TAB,PHA,A,250,,,,,,3.40,N,Y
4071688,EPOGEN 5000 UNITS,PHA,A,634,Q0136,,,,,134.76,N,Y
4071689,MAVICK 2 MG PO,PHA,A,250,,,,,,2.24,N,Y
4071690,BUPRENORPHINE 0.3 MG/ML 1,PHA,A,250,,,,,,28.34,N,Y
4071691,NITROGLYCERIN 100 MCG/ML,PHA,A,250,,,,,,110.15,N,Y
4071692,OLANZAPINE 2.5 MG TAB,PHA,A,250,,,,,,2.35,N,Y
4071693,BECONASE AQ NASAL SPRAY 2,PHA,A,250,,,,,,327.83,N,Y
4071694,OXYMETAZOLINE 0.05% NASAL,PHA,A,250,,,,,,4.65,N,Y
4071695,HEALON 10 MG/ML 0.85 ML S,PHA,A,250,,,,,,164.10,N,Y
4071696,MIOCHOL-E OPHTH SYSTEM PA,PHA,A,250,,,,,,98.36,N,Y
4071697,PILOCARPINE 1% OPHTH SOLN,PHA,A,250,,,,,,136.85,N,Y
4071698,LEVOFLOXACIN 250 MG / D5W,PHA,A,250,,,,,,83.30,N,Y
4071699,PRANDIN 2MG TAB,PHA,A,250,,,,,,3.70,N,Y
4071700,IPRATROPIUM 0.5 MG 2.5 ML,PHA,A,250,,,,,,10.80,N,Y
4071701,ALBUTEROL 2.5 MG / IPRATR,PHA,A,250,,,,,,11.40,N,Y
4071702,ATROPINE 1% OPHTH SOLN 5,PHA,A,250,,,,,,61.55,N,Y
4071703,KETAMINE 50 MG/ML 10 ML V,PHA,A,250,,,,,,42.35,N,Y
4071704,POLOCAINE 2%,PHA,A,250,,,,,,24.76,N,Y
4071705,POLOCAINE MPF 2% 20 ML SD,PHA,A,250,,,,,,34.75,N,Y
4071706,BUPIVACAINE 0.25% 50 ML M,PHA,A,250,,,,,,9.75,N,Y
4071707,LIDOCAINE PF 0.5% 50 ML S,PHA,A,250,,,,,,6.80,N,Y
4071708,LIDOCAINE PF 2% 5 ML SDV,PHA,A,250,,,,,,6.25,N,Y
4071709,NEOSTIGMINE 1:1000 1 MG/M,PHA,A,250,,,,,,153.25,N,Y
4071710,CEDAX 90MG,PHA,A,250,,,,,,41.47,N,Y
4071711,FLOVENT HFA 220 MCG MDI 1,PHA,A,250,,,,,,605.35,N,Y
4071712,TILADE INHALER,PHA,A,250,,,,,,48.90,N,Y
4071713,CELEBREX 100 MG CAP,PHA,A,250,,,,,,3.90,N,Y
4071714,DETROL 2 MG TAB,PHA,A,250,,,,,,10.65,N,Y
4071715,REMERON 15MG TAB,PHA,A,250,,,,,,7.58,N,Y
4071716,SINGULAIR 10 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4071717,CLARITIN 10MG TAB,PHA,A,250,,,,,,6.38,N,Y
4071718,TENORETIC,PHA,A,250,,,,,,1.25,N,Y
4071719,OFLOXACIN 0.3% OTIC SOLN,PHA,A,250,,,,,,84.40,N,Y
4071720,HYDROCODONE SYRUP TSP,PHA,A,250,,,,,,83.25,N,Y
4071721,SKELAXIN 400 MG TAB,PHA,A,250,,,,,,6.85,N,Y
4071722,AUGMENTIN 125 MG / 5 ML S,PHA,A,250,,,,,,165.95,N,Y
4071723,AMOXICILLIN / K CLAVULANA,PHA,A,250,,,,,,8.10,N,Y
4071724,BISACODYL 5MG PO,PHA,A,250,,,,,,3.63,N,Y
4071725,DILTIAZEM 120 MG ER CAP,PHA,A,250,,,,,,3.35,N,Y
4071726,CIPRO 750MG PO,PHA,A,250,,,,,,6.24,N,Y
4071727,ENOXAPARIN 40 MG / 0.4 ML,PHA,A,250,J1650,,,,,61.65,N,Y
4071728,ENOXAPARIN 60 MG / 0.6 ML,PHA,A,250,,,,,,52.45,N,Y
4071729,ENOXAPARIN 80 MG / 0.8 ML,PHA,A,250,,,,,,58.65,N,Y
4071730,TRICOR 145 MG TAB,PHA,A,250,,,,,,28.10,N,Y
4071731,DILTIAZEM 180 MG ER CAP,PHA,A,250,,,,,,3.55,N,Y
4071732,OXYCONTIN 10 MG TAB,PHA,A,250,,,,,,13.45,N,Y
4071733,GUAIFENESIN 200MG TAB,PHA,A,250,,,,,,0.08,N,Y
4071734,OP PROMETHAZINE / CODEINE,PHA,A,253,,,,,,22.60,N,Y
4071735,CRANBERRY 520 MG CAP,PHA,A,250,,,,,,0.95,N,Y
4071736,PREMPRO 5/.625 MG PO,PHA,A,250,,,,,,1.67,N,Y
4071737,TERAZOSIN 1 MG CAP,PHA,A,250,,,,,,2.55,N,Y
4071738,ACCOLATE 20MG TAB,PHA,A,250,,,,,,4.02,N,Y
4071739,OXAPROZIN 600 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4071740,BIAXIN 500MG TAB,PHA,A,250,,,,,,10.23,N,Y
4071741,ZOLADEX PER 3.6MG,PHA,A,636,J9202,,,,,824.81,N,Y
4071742,ACETAMINOPHEN 300 MG / CO,PHA,A,250,,,,,,3.75,N,Y
4071743,CORTROSYN 0.25 MG VIAL,PHA,A,250,,,,,,124.50,N,Y
4071744,PYRIDOSTIGMINE 60 MG TAB,PHA,A,250,,,,,,3.40,N,Y
4071745,FAMOTIDINE 20 MG / NS 50,PHA,A,250,,,,,,89.40,N,Y
4071746,CARVEDILOL 12.5 MG TAB,PHA,A,250,,,,,,2.50,N,Y
4071747,DYNACIRC 5MG CAP,PHA,A,250,,,,,,4.35,N,Y
4071748,PNEUMOVAX 0.5 ML SDV,PHA,A,250,,,,,,464.65,N,Y
4071749,IBUPROFEN 100 MG / 5 ML S,PHA,A,250,,,,,,2.70,N,Y
4071750,NEPHRO CAP,PHA,A,250,,,,,,2.50,N,Y
4071751,TRANYLCYPROMINE 10 MG TAB,PHA,A,300,,,,,,15.50,N,Y
4071752,XOPENEX 0.63 MG 3 ML NEB,PHA,A,250,,,,,,35.35,N,Y
4071753,PROMOTE WITH FIBER 1000CC,PHA,A,250,,,,,,14.95,N,Y
4071754,VIROPTIC EYE DROPS,PHA,A,250,,,,,,121.20,N,Y
4071755,LEVADOPA 25/100,PHA,A,250,,,,,,1.67,N,Y
4071756,VIOXX 25MG TAB,PHA,A,250,,,,,,7.50,N,Y
4071757,TUNOPTIC .05 DROPS,PHA,A,250,,,,,,11.65,N,Y
4071758,METRONIDAZOLE 500 MG / 0.,PHA,A,250,,,,,,86.05,N,Y
4071759,FLAGYL 250MG,PHA,A,250,,,,,,1.35,N,Y
4071760,AZITHROMYCIN 500 MG VIAL,PHA,A,250,,,,,,56.50,N,Y
4071761,S-2 2.25% 0.5 ML NEB,PHA,A,250,,,,,,19.25,N,Y
4071859,SOLU-CORTEF 100 MG VIAL,PHA,A,250,,,,,,74.45,N,Y
4071860,albuterol 100 mcg / ipratropium 20 mcg p,PHA,A,250,,,,,,525.35,N,Y
4071861,EFFEEROX 225 MG,PHA,A,250,,,,,,5.50,N,Y
4071862,CHOLINE MG TRI 1000MG TAB,PHA,A,250,,,,,,2.32,N,Y
4071863,ISOSORBIDE DINITRATE 10 M,PHA,A,250,,,,,,4.55,N,Y
4071864,SULAR 20 MG TAB,PHA,A,250,,,,,,7.78,N,Y
4071865,SULAR 40 MG,PHA,A,250,,,,,,2.88,N,Y
4071866,EFFEXOR XR 150MG CAP,PHA,A,250,,,,,,6.99,N,Y
4071867,HYALGAN 10MG/ML 2ML SYR,PHA,A,250,,,,,,244.39,N,Y
4071869,LEVAQUIN 500 MG TAB,PHA,A,250,,,,,,2.70,N,Y
4071870,ALLEGRA 60 MG,PHA,A,250,,,,,,2.00,N,Y
4071871,ATACAND 16MG TAB,PHA,A,250,,,,,,4.65,N,Y
4071872,TAMSULOSIN 0.4 MG CAP,PHA,A,250,,,,,,3.55,N,Y
4071873,FLEETS PREPKIT #1,PHA,A,250,,,,,,7.88,N,Y
4071874,OPTI-GEN TAB,PHA,A,250,,,,,,0.23,N,Y
4071875,AVANDIA 4MG TAB,PHA,A,250,,,,,,10.00,N,Y
4071876,TORSEMIDE 20 MG TAB,PHA,A,250,,,,,,5.75,N,Y
4071877,LOTREL 5/20,PHA,A,250,,,,,,4.13,N,Y
4071878,BRIMONIDINE 0.15% OPHTH S,PHA,A,250,,,,,,207.90,N,Y
4071879,SEPTR 100CC,PHA,A,250,,,,,,5.35,N,Y
4071880,ESTRATEST TAB,PHA,A,250,,,,,,4.12,N,Y
4071881,RAMIPRIL 2.5 MG CAP,PHA,A,250,,,,,,2.20,N,Y
4071882,LORABID SUSPENSION 200 MG,PHA,A,250,,,,,,55.00,N,Y
4071883,MG OXIDE,PHA,A,250,,,,,,1.50,N,Y
4071884,LIQUID MOTRIN 100MG,PHA,A,250,,,,,,1.85,N,Y
4071885,PREPARATION H,PHA,A,250,,,,,,11.20,N,Y
4071886,OP PREDNISOLONE 5 MG / 5,PHA,A,253,,,,,,145.70,N,Y
4071887,ACETAMINOPHEN / CODEINE O,PHA,A,250,,,,,,5.35,N,Y
4071888,TOBRAMYCIN 0.3% / DEXAMET,PHA,A,250,,,,,,83.05,N,Y
4071889,SULFAMETHOXAZOLE 800 MG /,PHA,A,250,,,,,,2.60,N,Y
4071890,LEVOFLOXACIN 250 MG TAB,PHA,A,250,,,,,,2.85,N,Y
4071891,CYTOXAN 25MG TAB,PHA,A,636,J8530,,,,,5.16,N,Y
4071892,SOLU MEDROL 60MG IVPB,PHA,A,250,,,,,,17.69,N,Y
4071893,ZOLOFT 50MG TAB,PHA,A,250,,,,,,6.48,N,Y
4071894,IPOL 10 DOSE / 5 ML MDV,PHA,A,250,,,,,,0.00,N,Y
4071895,CEREBYX 350MG,PHA,A,250,,,,,,75.39,N,Y
4071896,TAMOXIFEN 10 MG TAB,PHA,A,250,,,,,,3.25,N,Y
4071897,NEOMYCIN POLY OTIC DROPS,PHA,A,250,,,,,,29.87,N,Y
4071898,PRAZOSIN 5 MG CAP,PHA,A,250,,,,,,3.65,N,Y
4071899,PYRIDIUM PLUS TAB,PHA,A,250,,,,,,6.38,N,Y
4071900,ACTONEL 5MG TAB,PHA,A,250,,,,,,5.75,N,Y
4071901,HYPERRAB 150 UNITS/ML 10,PHA,A,250,90375,,,,,"4,746.45",N,Y
4071902,IMOVAX 1 ML SDV,PHA,A,250,,,,,,"1,118.30",N,Y
4071903,ACETAMINOPHEN 650 MG ER T,PHA,A,250,,,,,,0.25,N,Y
4071904,AMINOSYN 8.5% 500ML,PHA,A,250,,,,,,53.83,N,Y
4071905,MYI-12,PHA,A,250,,,,,,9.98,N,Y
4071906,POTASSIUM CHLORIDE 30 MEQ,PHA,A,250,,,,,,87.40,N,Y
4071907,INTRALIPID 20% 250 ML,PHA,A,250,,,,,,98.10,N,Y
4071908,POTASSIUM CHLORIDE 40 MEQ,PHA,A,250,,,,,,83.20,N,Y
4071909,ANINOSYN 1500 ML 8.5%,PHA,A,250,,,,,,76.48,N,Y
4071910,ASPIRIN EC 81 MG TAB,PHA,A,250,,,,,,0.15,N,Y
4071911,AMOXICILLIN / CLAVULANATE,PHA,A,250,,,,,,32.55,N,Y
4071912,DOXAZOSIN 1 MG TAB,PHA,A,250,,,,,,3.15,N,Y
4071913,CARDURA 8MG TAB,PHA,A,250,,,,,,4.23,N,Y
4071914,ACTIVATED CHARCOAL 50 GM,PHA,A,250,,,,,,154.50,N,Y
4071915,DIVALPROEX 125 MG SPRINKL,PHA,A,250,,,,,,4.55,N,Y
4071916,DIVALPROEX DR 250 MG TAB,PHA,A,250,,,,,,2.40,N,Y
4071917,WARFARIN 2.5 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4071918,WARFARIN 5 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4071919,CYCLOGYL 1% OPHTH 15ML,PHA,A,250,,,,,,19.48,N,Y
4071921,DEMEROL 50 MG/ML 1 ML SYR,PHA,A,250,,,,,,37.70,N,Y
4071922,DEMEROL 25MG 1ML SYR,PHA,A,250,,,,,,16.79,N,Y
4071923,DIAZEPAM 5 MG TAB,PHA,A,250,,,,,,3.20,N,Y
4071924,FENTANYL 50 MCG/HR PATCH,PHA,A,250,,,,,,20.40,N,Y
4071925,EPINEPHRINE 0.1 MG/ML 10,PHA,A,250,,,,,,59.90,N,Y
4071926,ERYTHROCIN 1GM ADV,PHA,A,250,,,,,,25.85,N,Y
4071927,FLEET MINERAL OIL ENEMA 4,PHA,A,250,,,,,,5.65,N,Y
4071928,METFORMIN 850 MG TAB,PHA,A,250,,,,,,2.15,N,Y
4071929,HALOPERIDOL 1 MG TAB,PHA,A,250,,,,,,2.35,N,Y
4071930,TERAZOSIN 5 MG CAP,PHA,A,250,,,,,,2.35,N,Y
4071931,IBUPROFEN 400 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4071932,IBUPROFEN 600 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4071933,HUMULIN R 100 UNITS/ML [1,PHA,A,250,,,,,,243.75,N,Y
4071934,LEVOFLOXACIN 500 MG / D5W,PHA,A,250,,,,,,83.30,N,Y
4071935,LIPITOR 40MG TAB,PHA,A,250,,,,,,9.18,N,Y
4071936,BENAZEPRIL 10 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4071937,LOTENSIN 40MG TAB,PHA,A,250,,,,,,3.74,N,Y
4071938,LOTENSIN HCT 20/12.5 TAB,PHA,A,250,,,,,,3.74,N,Y
4071939,LOTENSIN HCT 20/25 TAB,PHA,A,250,,,,,,3.74,N,Y
4071940,"EPOGEN 25,000 UNITS",PHA,A,635,Q0136,,,,,673.80,N,Y
4071941,"EPOGEN 30,000 UNITS",PHA,A,635,Q0136,,,,,808.56,N,Y
4071942,"EPOGEN 35,000 UNITS",PHA,A,635,Q0136,,,,,943.32,N,Y
4071943,"EPOGEN 40,000 UNITS",PHA,A,635,Q0136,,,,,"1,078.08",N,Y
4071944,"EPOGEN 45,000 UNITS",PHA,A,635,Q0136,,,,,"1,212.84",N,Y
4071945,"EPOGEN 50,000 UNITS",PHA,A,635,Q0136,,,,,"1,347.60",N,Y
4071946,"EPOGEN 55,000 UNITS",PHA,A,635,Q0136,,,,,"1,482.36",N,Y
4071947,"EPOGEN 60,000 UNITS",PHA,A,635,Q0136,,,,,"1,617.12",N,Y
4071948,BUPIVACAINE PF 0.5% 10 ML,PHA,A,250,,,,,,7.20,N,Y
4071949,SODIUM POLYSTYRENE SULFON,PHA,A,250,,,,,,31.85,N,Y
4071950,POTASSIUM CHLORIDE 40 MEQ,PHA,A,250,,,,,,85.90,N,Y
4071951,EPOGEN 8000 UNITS,PHA,A,636,,,,,,215.62,N,Y
4071952,EPOGEN 7000 UNITS,PHA,A,636,,,,,,188.66,N,Y
4071953,IV ADMIXTURE,PHA,A,250,,,,,,60.00,N,Y
4071954,AMOXICILLIN / K CLAVULANA,PHA,A,250,,,,,,5.20,N,Y
4071955,MI-ACID 4FL.OZ.,PHA,A,250,,,,,,2.35,N,Y
4071956,DOUBLE ANTIBIOTIC OINT PA,PHA,A,250,,,,,,0.85,N,Y
4071957,HUMULIN N 100 UNITS/ML [1,PHA,A,250,,,,,,243.75,N,Y
4071958,COMPAZINE 5MG/ML 2ML VIAL,PHA,A,250,,,,,,31.69,N,Y
4071959,LEVOTHYROXINE 75 MCG TAB,PHA,A,250,,,,,,2.70,N,Y
4071960,LEVOTHYROXINE 100 MCG TAB,PHA,A,250,,,,,,2.75,N,Y
4071961,ACETYLCYSTEINE 10% 30ML,PHA,A,250,,,,,,28.32,N,Y
4071962,APAP 80MG CHEW TAB,PHA,A,250,,,,,,0.00,N,Y
4071963,DEMEROL 75 MG/ML 1 ML SYR,PHA,A,250,,,,,,38.40,N,Y
4071964,NAPROXEN EC 500 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4071965,NARCAN 0.02MG/ML 2ML AMP,PHA,A,250,,,,,,18.85,N,Y
4071966,NARCAN 1MG/ML 10ML MDV,PHA,A,250,,,,,,29.81,N,Y
4071967,NALOXONE 0.4 MG/ML 1 ML S,PHA,A,250,,,,,,79.80,N,Y
4071968,gabapentin 100 mg cap,PHA,A,250,,,,,,2.35,N,Y
4071969,NICOTINE 14 MG PATCH,PHA,A,250,,,,,,6.35,N,Y
4071970,NICOTINE 7 MG PATCH,PHA,A,250,,,,,,6.35,N,Y
4071971,GENTAMICIN OPHTH 15ML,PHA,A,250,,,,,,13.17,N,Y
4071972,CALAN SR 240MG TAB,PHA,A,250,,,,,,5.75,N,Y
4071973,LEVOTHYROXINE 50 MCG TAB,PHA,A,250,,,,,,2.65,N,Y
4071974,DILTIAZEM 5 MG/ML 5 ML SD,PHA,A,250,,,,,,36.65,N,Y
4071975,HYDROCODONE 5 MG / ACETAM,PHA,A,250,,,,,,3.25,N,Y
4071976,ZOCOR 40MG TAB,PHA,A,250,,,,,,9.45,N,Y
4071977,MUCINEX 600 MG TAB,PHA,A,250,,,,,,1.60,N,Y
4071978,TRIAM 75MG/HCTZ 50MG,PHA,A,250,,,,,,2.11,N,Y
4071980,SODIUM CHLORIDE 0.9% NEB,PHA,A,250,,,,,,10.45,N,Y
4071981,GENTAMICIN 0.3% OPHTH SOL,PHA,A,250,,,,,,38.35,N,Y
4071982,MIRALAX POWDER FOR ORAL S,PHA,A,250,,,,,,23.75,N,Y
4071983,NITROGLYCERIN 0.2 MG/HR P,PHA,A,250,,,,,,6.95,N,Y
4071984,FLUOXETINE 10 MG CAP,PHA,A,250,,,,,,2.25,N,Y
4071985,REMERON 30MG TAB,PHA,A,250,,,,,,7.06,N,Y
4071986,RISPERIDONE 1 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4071987,CEFTRIAXONE 500 MG VIAL,PHA,A,250,,,,,,34.20,N,Y
4071988,ATACAND 4 MG TAB,PHA,A,250,,,,,,12.90,N,Y
4071989,FUROSEMIDE 10 MG/ML 4 ML,PHA,A,250,,,,,,36.80,N,Y
4071990,TRIAMTERENE 50 MG / HYDRO,PHA,A,250,,,,,,9.00,N,Y
4071991,PN ADMIXTURE,PHA,A,250,,,,,,40.00,N,Y
4071992,GUAIFENESIN 100 MG / 5 ML,PHA,A,250,,,,,,4.40,N,Y
4071993,PREMARIN 0.625 MG TAB,PHA,A,250,,,,,,24.55,N,Y
4071994,PREMARIN 0.9MG TAB,PHA,A,250,,,,,,3.53,N,Y
4071995,PROMETHAZINE 50 MG SUPP,PHA,A,250,,,,,,37.00,N,Y
4071996,SYNTHROID 0.125MG TAB,PHA,A,250,,,,,,2.85,N,Y
4071997,THIORIDAZINE 25 MG TAB,PHA,A,250,,,,,,3.05,N,Y
4071998,THIORIDAZINE 50MG TAB,PHA,A,250,,,,,,2.30,N,Y
4071999,TUMS EX TAB,PHA,A,250,,,,,,0.18,N,Y
4072000,SIMVASTATIN 20 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4072001,FOSAMAX 10MG TAB,PHA,A,250,,,,,,9.00,N,Y
4072002,NITRO-DUR 0.3MG/HR PATCH,PHA,A,250,,,,,,7.08,N,Y
4072003,VISCOAT 0.5 MG OPHTH SYRI,PHA,A,250,,,,,,219.67,N,Y
4072004,VERAPAMIL 120 MG ER TAB,PHA,A,250,,,,,,4.35,N,Y
4072005,AGGRENOX 200 MG / 25 MG C,PHA,A,250,,,,,,42.45,N,Y
4072006,CLOTRIMAZOLE 10 MG TROCHE,PHA,A,250,,,,,,3.30,N,Y
4072007,ZYPREXA 5MG TAB,PHA,A,250,,,,,,13.35,N,Y
4072008,HYDRALAZINE 25 MG TAB,PHA,A,250,,,,,,2.50,N,Y
4072009,isosorbide DN 40 mg ER tab,PHA,A,250,,,,,,11.05,N,Y
4072010,AMANTADINE 50 MG / 5 ML S,PHA,A,250,,,,,,8.77,N,Y
4072011,SALINE 0.65% NASAL SPRAY,PHA,A,250,,,,,,4.55,N,Y
4072012,CORTISPORIN OPHTH 7.5ML,PHA,A,250,,,,,,63.58,N,Y
4072013,sotalol 120 mg tab,PHA,A,250,,,,,,2.40,N,Y
4072014,THERMOTAB,PHA,A,250,,,,,,0.20,N,Y
4072015,DESITIN OINTMENT 56 GM,PHA,A,250,,,,,,13.70,N,Y
4072016,PROPARACAINE 0.5% OPHTH S,PHA,A,250,,,,,,68.55,N,Y
4072017,POTASSIUM CHLORIDE 20 MEQ,PHA,A,250,,,,,,83.95,N,Y
4072018,TAMIFLU 75 MG CAP,PHA,A,250,,,,,,45.85,N,Y
4072019,CELEBREX 200MG CAP,PHA,A,250,,,,,,6.87,N,Y
4072020,NITROFURANTOIN MACROCRYST,PHA,A,250,,,,,,4.90,N,Y
4072021,DANTRIUM 20 MG VIAL,PHA,A,250,,,,,,370.00,N,Y
4072022,LIDOCAINE 2% JELLY 5ML,PHA,A,250,,,,,,9.78,N,Y
4072023,DIOVAN HCT 160MG/12.5MG,PHA,A,250,,,,,,4.84,N,Y
4072024,ISOSORBIDE MONONITRATE 30,PHA,A,250,,,,,,3.55,N,Y
4072025,BAYCOL 0.4MG TAB,PHA,A,250,,,,,,5.02,N,Y
4072026,ARTIFICIAL TEARS OPHTH SO,PHA,A,250,,,,,,7.10,N,Y
4072027,FLUORESCEIN OPHTHALMIC ST,PHA,A,250,,,,,,10.15,N,Y
4072028,NEOMYCIN / POLY B / BAC /,PHA,A,250,,,,,,41.65,N,Y
4072029,OXYCODONE 4.88 MG / ASPIR,PHA,A,250,,,,,,6.70,N,Y
4072030,NALBUPHINE 10 MG/ML 1 ML,PHA,A,250,,,,,,47.15,N,Y
4072031,LAT topical gel 3 ml,PHA,A,250,,,,,,20.30,N,Y
4072032,ACETAMINOPHEN 120 MG PEDI,PHA,A,250,,,,,,0.70,N,Y
4072033,ERYTHRO/SULFISOX 100ML,PHA,A,250,,,,,,13.88,N,Y
4072034,GLIPIZIDE 5 MG TAB,PHA,A,250,,,,,,2.10,N,Y
4072035,SILDEC DM 30ML,PHA,A,250,,,,,,14.00,N,Y
4072036,ARTIFICIAL TEARS 15ML,PHA,A,250,,,,,,5.65,N,Y
4072037,FUROSEMIDE 10MG/ML 2ML,PHA,A,250,,,,,,15.59,N,Y
4072038,INDAPAMIDE 2.5 MG TAB,PHA,A,250,,,,,,3.20,N,Y
4072039,ZYRTEC 10MG TAB,PHA,A,250,,,,,,5.78,N,Y
4072040,DEXAMETHASONE 4 MG/ML 30,PHA,A,250,,,,,,63.95,N,Y
4072041,ISOPROPYL ALCOHOL 70% 480,PHA,A,250,,,,,,10.20,N,Y
4072042,FIBERCON 625 MG TAB,PHA,A,250,,,,,,0.20,N,Y
4072043,CALCITONIN NASAL SPRAY 3.,PHA,A,250,,,,,,73.75,N,Y
4072044,HALOPERIDOL LACTATE 5 MG/,PHA,A,250,,,,,,87.80,N,Y
4072045,DIFLUCAN 200MG/D5W 100ML,PHA,A,250,,,,,,102.05,N,Y
4072046,NITROFURANTOIN MONOHYDRAT,PHA,A,250,,,,,,7.20,N,Y
4072047,IV INFUSION,PHA,A,510,90784,,,,,15.00,N,Y
4072048,INJECTION,PHA,A,510,90782,,,,,15.00,N,Y
4072049,BUMINATE 25% 50ML VIAL,PHA,A,250,,,,,,250.20,N,Y
4072050,NALBUPHINE 20MG/ML AMP,PHA,A,250,,,,,,17.74,N,Y
4072051,METHOCARB 400MG/ASA 325MG,PHA,A,250,,,,,,3.11,N,Y
4072052,PAMIDRONATE 30 MG VIAL [P,PHA,A,636,J2430,,,,,70.85,N,Y
4072053,HYPERTET 250 UNITS/ML 1 M,PHA,A,250,,,,,,338.20,N,Y
4072054,MEGESTROL 40 MG/ML SUSPEN,PHA,A,250,,,,,,79.40,N,Y
4072055,ACTIVASE CATHFLO 2 MG VIA,PHA,A,250,,,,,,755.65,N,Y
4072056,ACTOS 45MG TAB,PHA,A,250,,,,,,12.35,N,Y
4072057,VICKS VAPORUB,PHA,A,250,,,,,,12.90,N,Y
4072058,MIDAZOLAM 2 MG/ML SYRUP 5,PHA,A,250,,,,,,28.00,N,Y
4072059,CANTHARIDIN PLUS,PHA,A,250,,,,,,10.00,N,Y
4072060,ALUMINUM CHLORIDE 20% TOP,PHA,A,250,,,,,,43.60,N,Y
4072061,PROPARACAINE DERM APP,PHA,A,250,,,,,,1.00,N,Y
4072062,KENALOG-10 DERM INJ,PHA,A,250,,,,,,2.85,N,Y
4072063,lidocaine BUFFERED 0.9% 10 ml syringe,PHA,A,250,,,,,,9.10,N,Y
4072064,CEFPROZIL 125 MG / 5 ML S,PHA,A,250,,,,,,84.00,N,Y
4072065,AMOXIL 875MG TAB,PHA,A,250,,,,,,4.02,N,Y
4072066,VENLAFAXINE ER 37.5 MG CA,PHA,A,250,,,,,,3.55,N,Y
4072067,LIDOCAINE 1% 10 ML MDV,PHA,A,250,,,,,,5.85,N,Y
4072068,LIDOCAINE PF 2% 5 ML SDV,PHA,A,250,,,,,,6.25,N,Y
4072069,LIDOCAINE 1% / EPINEPHRIN,PHA,A,250,,,,,,6.05,N,Y
4072070,LIDOCAINE 2.5% / PRILOCAI,PHA,A,250,,,,,,30.55,N,Y
4072071,FLONASE NASAL SPRAY 16GM,PHA,A,250,,,,,,112.42,N,Y
4072072,FLOVENT HFA 110 MCG MDI 1,PHA,A,250,,,,,,448.35,N,Y
4072073,TROLAMINE SALICYLATE 10%,PHA,A,250,,,,,,9.95,N,Y
4072074,BSS OPHTH SOLN 30 ML,PHA,A,250,,,,,,18.00,N,Y
4072075,EPINEPHRINE SULFITE FREE,PHA,A,250,,,,,,43.85,N,Y
4072076,MARCAINE / EPI / LIDOCAIN,PHA,A,250,,,,,,35.01,N,Y
4072077,DILTIAZEM 5 MG/ML 25 ML S,PHA,A,250,,,,,,39.24,N,Y
4072078,FLUCONAZOLE 150 MG TAB,PHA,A,250,,,,,,3.40,N,Y
4072079,KERI LOTION 6.5OZ.,PHA,A,250,,,,,,16.75,N,Y
4072080,PROPRANOLOL 40MG TAB,PHA,A,250,,,,,,2.08,N,Y
4072081,TNKASE 50 MG VIAL,PHA,A,250,,,,,,"8,504.20",N,Y
4072082,FLEET PEDIATRIC ENEMA 2.2,PHA,A,250,,,,,,5.95,N,Y
4072083,SEROQUEL 25 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4072084,GLYBURIDE MICRONIZED 3 MG,PHA,A,250,,,,,,2.15,N,Y
4072085,PHENOBARBITAL 97.2MG TAB,PHA,A,250,,,,,,3.08,N,Y
4072086,FERRLECIT 62.5MG 5ML AMP,PHA,A,250,,,,,,66.00,N,Y
4072087,ANUCORT-HC 25MG SUPP,PHA,A,250,,,,,,5.26,N,Y
4072088,SILVER NITRATE APPLICATOR,PHA,A,250,,,,,,25.00,N,Y
4072089,REFRESH TEARS OPHTH 30ML,PHA,A,250,,,,,,44.50,N,Y
4072090,PREVACID 15MG CAP,PHA,A,250,,,,,,10.35,N,Y
4072091,ALENDRONATE 70 MG TAB,PHA,A,250,,,,,,4.35,N,Y
4072092,PHOS-NA K POWDER PACKET,PHA,A,250,,,,,,3.10,N,Y
4072093,RISPERDAL 0.5MG TAB,PHA,A,250,,,,,,8.00,N,Y
4072094,"EPOGEN 14,000 UNITS",PHA,A,635,Q0136,,,,,377.33,N,Y
4072095,BISOPROLOL 5 MG TAB,PHA,A,250,,,,,,3.10,N,Y
4072099,labetalol 20 mg / 4 ml syringe,PHA,A,250,,,,,,60.05,N,Y
4072100,VANCOMYCIN 1 GM VIAL,PHA,A,250,,,,,,60.90,N,Y
4072101,CARAFATE 1GM/10ML 200ML,PHA,A,250,,,,,,20.99,N,Y
4072102,KENALOG-40 40 MG/ML 5 ML,PHA,A,250,,,,,,7.40,N,Y
4072103,LABETALOL 5MG/ML 20ML MDV,PHA,A,250,,,,,,12.10,N,Y
4072104,PIPERACILLIN / TAZOBACTAM,PHA,A,250,,,,,,70.75,N,Y
4072105,BISMUTH SUBSALICYLATE TAB,PHA,A,250,,,,,,0.00,N,Y
4072106,ANTIPYRINE 5.4% / BENZOCA,PHA,A,250,,,,,,34.85,N,Y
4072107,AZITHROMYCIN 100 MG / 5 M,PHA,A,250,,,,,,63.15,N,Y
4072108,AZITHROMYCIN 200 MG / 5 M,PHA,A,250,,,,,,44.00,N,Y
4072109,VAQTA 50 UNITS/ML 1ML SYR,PHA,A,250,,,,,,114.94,N,Y
4072110,CEFOXITIN 1 GM VIAL,PHA,A,250,,,,,,43.15,N,Y
4072111,DICYCLOMINE 10 MG CAP,PHA,A,250,,,,,,2.20,N,Y
4072112,DEPO-MEDROL PF 80 MG/ML 1,PHA,A,250,,,,,,89.00,N,Y
4072113,DEPO-MEDROL PF 40 MG/ML 1,PHA,A,250,,,,,,63.15,N,Y
4072114,SODIUM CHLORIDE 0.9% 10 M,PHA,A,250,,,,,,0.00,N,Y
4072115,BUPIVACAINE PF 0.25% 30 M,PHA,A,250,,,,,,6.15,N,Y
4072116,ARTHROTEC 50 MG TAB,PHA,A,250,,,,,,15.50,N,Y
4072119,famotidine 10 mg/ml 2 ml SDV,PHA,A,250,,,,,,33.30,N,Y
4072120,POTASSIUM CHLORIDE 20 MEQ,PHA,A,250,,,,,,82.90,N,Y
4072121,SUPARTZ 10 MG/ML 2.5 ML S,PHA,A,636,,,,,,159.40,N,Y
4072122,NA THIOSULFATE 25% 50ML,PHA,A,250,,,,,,35.95,N,Y
4072124,ETHYL CHLORIDE SPRAY 3.5,PHA,A,250,,,,,,150.55,N,Y
4072125,AMPICILLIN / SULBACTAM 3,PHA,A,250,,,,,,43.55,N,Y
4072126,TYLENOL 325 MG TAB,PHA,A,250,,,,,,0.00,N,Y
4072127,TOPIRAMATE 25 MG TAB,PHA,A,250,,,,,,2.45,N,Y
4072128,EPINEPHRINE 0.3 MG SYRING,PHA,A,250,,,,,,705.60,N,Y
4072129,DEPO-ESTRADIOL 5MG/ML 5ML,PHA,A,250,,,,,,67.00,N,Y
4072130,MANNITOL 25% 50 ML SDV,PHA,A,250,,,,,,22.44,N,Y
4072131,PROTAMINE 10 MG/ML 25 ML,PHA,A,250,,,,,,145.55,N,Y
4072132,SODIUM CHLORIDE 0.9% 100,PHA,A,250,,,,,,38.95,N,Y
4072133,NEUT 4% 5 ML SDV,PHA,A,250,,,,,,29.41,N,Y
4072134,SENSORCAINE 0.5%/EPI 50ML,PHA,A,250,,,,,,25.01,N,Y
4072135,BUPIVACAINE 0.5% 50 ML MD,PHA,A,250,,,,,,7.00,N,Y
4072136,STERILE WATER FOR INJECTI,PHA,A,250,,,,,,0.00,N,Y
4072137,STERILE WATER FOR INJECTI,PHA,A,250,,,,,,0.00,N,Y
4072138,BACTERIOSTATIC STERILE WA,PHA,A,250,,,,,,0.00,N,Y
4072139,TRIPEDIA 0.5 ML SDV,PHA,A,250,,,,,,148.40,N,Y
4072140,ACTHIB 0.5 ML VIAL,PHA,A,250,,,,,,79.55,N,Y
4072141,M-M-R II 0.5 ML SDV,PHA,A,250,,,,,,350.80,N,Y
4072142,PREVNAR 0.5 ML SYRINGE,PHA,A,250,,,,,,449.40,N,Y
4072143,MUMPSVAX VIAL,PHA,A,250,,,,,,0.00,N,Y
4072144,TETANUS/DIPHTH PED DOSE,PHA,A,250,,,,,,0.00,N,Y
4072145,POTASSIUM CHLORIDE 20 MEQ,PHA,A,250,,,,,,83.95,N,Y
4072146,SODIUM CHLORIDE 3% 500 ML,PHA,A,250,,,,,,84.00,N,Y
4072147,PLAN B ONE-STEP 1.5 MG TA,PHA,A,250,,,,,,75.70,N,Y
4072148,AEROZOIN SPRAY 3.5OZ,PHA,A,250,,,,,,0.00,N,Y
4072149,GLYCERIN PED SUPP,PHA,A,250,,,,,,2.75,N,Y
4072150,METHYLENE BLUE 1% 10 ML S,PHA,A,250,,,,,,72.10,N,Y
4072151,PROTOPAM 1 GM VIAL,PHA,A,250,,,,,,511.65,N,Y
4072152,LUGOL'S SOLUTION 15 ML,PHA,A,250,,,,,,68.50,N,Y
4072153,ACETIC ACID 3% SOLUTION,PHA,A,250,,,,,,0.00,N,Y
4072154,LANTUS 100 UNITS/ML [10 M,PHA,A,250,,,,,,666.25,N,Y
4072155,CARBIDOPA 25 MG / LEVODOP,PHA,A,250,,,,,,2.70,N,Y
4072156,CERUMENEX 10% OTIC SOLN 6,PHA,A,250,,,,,,70.91,N,Y
4072157,PRIMIDONE 250 MG TAB,PHA,A,250,,,,,,4.15,N,Y
4072158,PLETAL 100MG TAB,PHA,A,250,,,,,,5.45,N,Y
4072159,DILTIAZEM 60 MG ER CAP,PHA,A,250,,,,,,2.75,N,Y
4072160,FEROCON CAP,PHA,A,250,,,,,,2.70,N,Y
4072161,THEO-24 400MG CAP,PHA,A,250,,,,,,3.79,N,Y
4072162,HUMULIN L 100 UNITS/ML [1,PHA,A,250,,,,,,78.05,N,Y
4072163,HUMALOG 100 UNITS/ML [10,PHA,A,250,,,,,,475.95,N,Y
4072164,LISINOPRIL 2.5 MG TAB,PHA,A,250,,,,,,2.05,N,Y
4072165,DEXAMETHASONE 1 MG TAB,PHA,A,250,,,,,,3.20,N,Y
4072166,CETAPHIL CLEANSER 8OZ,PHA,A,250,,,,,,23.90,N,Y
4072167,DIPROLENE 0.05% LOTION,PHA,A,250,,,,,,92.37,N,Y
4072168,NIZORAL 2% SHAMPOO 4OZ,PHA,A,250,,,,,,61.17,N,Y
4072169,BUPROPION SR 100 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4072170,iron sucrose 20 mg/ml 5 ml SDV,PHA,A,250,,,,,,192.10,N,Y
4072171,ONDANSETRON 2 MG/ML 2 ML,PHA,A,250,,,,,,33.20,N,Y
4072172,PSEUDOEPHEDRINE 7.5 MG /,PHA,A,250,,,,,,8.60,N,Y
4072173,GLY-OXIDE ORAL TOPICAL SO,PHA,A,250,,,,,,42.70,N,Y
4072174,TRAMADOL 50 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4072175,CEFTRIAXONE 2 GM VIAL,PHA,A,250,,,,,,56.86,N,Y
4072176,CARVEDILOL 6.25 MG TAB,PHA,A,250,,,,,,2.23,N,Y
4072177,FLEET PREP KIT #3,PHA,A,250,,,,,,8.58,N,Y
4072178,ACETAZOLAMIDE 250 MG TAB,PHA,A,250,,,,,,8.20,N,Y
4072179,DYNACIRC 2.5 MG CAP,PHA,A,250,,,,,,5.33,N,Y
4072180,TRILEPTAL 300MG TAB,PHA,A,250,,,,,,5.79,N,Y
4072181,AMOX 500MG CAP,PHA,A,250,,,,,,3.00,N,Y
4072182,OXCARBAZEPINE 150 MG TAB,PHA,A,250,,,,,,2.85,N,Y
4072183,TRILEPTAL 300MG TAB,PHA,A,250,,,,,,5.79,N,Y
4072184,BETOPTIC-S 0.25% OPH 15ML,PHA,A,250,,,,,,204.59,N,Y
4072185,ALBUTEROL 4 MG ER TAB,PHA,A,250,,,,,,4.44,N,Y
4072186,GAVISCON SUSP 12 OZ,PHA,A,250,,,,,,27.65,N,Y
4072187,ADVAIR DISKUS 100/50 #14,PHA,A,250,,,,,,235.15,N,Y
4072188,PROVIGIL 200 MG TAB,PHA,A,250,,,,,,54.90,N,Y
4072189,SERZONE 50MG TAB,PHA,A,250,,,,,,6.00,N,Y
4072190,DONEPEZIL 5 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4072191,ZETIA 10 MG TAB,PHA,A,250,,,,,,47.15,N,Y
4072192,MYCOPHENOLATE 500 MG TAB,PHA,A,250,,,,,,4.10,N,Y
4072193,PERMAX 0.25MG TAB,PHA,A,250,,,,,,7.00,N,Y
4072194,NEORAL 25MG CAP,PHA,A,250,,,,,,6.00,N,Y
4072195,NEORAL 100MG CAP,PHA,A,250,,,,,,14.54,N,Y
4072196,NORTRIPTYLINE 10 MG / 5 M,PHA,A,250,,,,,,38.95,N,Y
4072197,CARBATROL 300MG ER CAP,PHA,A,250,,,,,,3.82,N,Y
4072198,CAPSAICIN 0.025% CREAM 6,PHA,A,250,,,,,,13.35,N,Y
4072199,METHIMAZOLE 10MG TAB,PHA,A,250,,,,,,2.91,N,Y
4072200,CARAFATE 1GM/10ML 120ML,PHA,A,250,,,,,,31.00,N,Y
4072201,FRAGMIN 5000 IU / 0.2 ML,PHA,A,250,,,,,,71.60,N,Y
4072202,TESTOSTERONE ENANTHATE 20,PHA,A,636,J3130,,,,,26.80,N,Y
4072203,AMILORIDE 5 MG TAB,PHA,A,250,,,,,,17.15,N,Y
4072204,FLURBIPROFEN 100MG TAB,PHA,A,250,,,,,,2.64,N,Y
4072205,ARICEPT 5MG TAB,PHA,A,250,,,,,,11.33,N,Y
4072206,XOPENEX 1.25 MG 0.5 ML NE,PHA,A,250,,,,,,23.30,N,Y
4072207,HIPREX 1 GM TAB,PHA,A,250,,,,,,8.30,N,Y
4072208,METHYLPHENIDATE 5 MG TAB,PHA,A,250,,,,,,4.85,N,Y
4072209,METOCLOPRAMIDE 5 MG TAB,PHA,A,250,,,,,,4.85,N,Y
4072210,DAPSONE 25 MG TAB,PHA,A,250,,,,,,6.60,N,Y
4072211,CARBATROL 200MG ER CAP,PHA,A,250,,,,,,3.34,N,Y
4072212,MIRTAZAPINE 15 MG TAB,PHA,A,250,,,,,,2.70,N,Y
4072213,LISINOPRIL 10 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4072214,ALBUTEROL 2 MG / 5 ML SYR,PHA,A,250,,,,,,7.55,N,Y
4072215,ZOLPIDEM 5 MG TAB,PHA,A,250,,,,,,3.45,N,Y
4072216,PROCANBID 500 MG TAB,PHA,A,250,,,,,,4.78,N,Y
4072217,COMVAX 0.5 ML SDV,PHA,A,250,,,,,,53.50,N,Y
4072218,CYANIDE ANTIDOTE KIT,PHA,A,250,,,,,,820.00,N,Y
4072219,AMIODARONE 50 MG/ML 3 ML,PHA,A,250,,,,,,35.20,N,Y
4072220,FORTAZ 1 GM VIAL,PHA,A,250,,,,,,48.15,N,Y
4072221,ACTOS 15 MG TAB,PHA,A,250,,,,,,2.35,N,Y
4072222,LIDOCAINE 2% / EPINEPHRIN,PHA,A,250,,,,,,8.05,N,Y
4072223,D5W 100ML,PHA,A,250,,,,,,0.00,N,Y
4072224,TRICHLORACETIC ACID 85% 3,PHA,A,250,,,,,,0.00,N,Y
4072225,VARIVAX 0.5 ML SDV,PHA,A,250,,,,,,609.80,N,Y
4072226,VASOPRESSIN 20 UNITS/ML 1,PHA,A,250,,,,,,469.30,N,Y
4072227,DOCUSATE SODIUM 50 MG / S,PHA,A,250,,,,,,0.10,N,Y
4072228,ROCURONIUM 10 MG/ML 5 ML,PHA,A,250,,,,,,41.25,N,Y
4072229,ACTONEL 35 MG TAB,PHA,A,250,,,,,,94.85,N,Y
4072230,MIDODRINE 5 MG TAB,PHA,A,250,,,,,,9.30,N,Y
4072231,NICOTINE 4MG LOZENGE,PHA,A,250,,,,,,3.00,N,Y
4072232,SULINDAC 150 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4072233,HYDROCHLOROTHIAZIDE 12.5,PHA,A,250,,,,,,2.40,N,Y
4072234,XOPENEX 0.63MG NEB #12 OP,PHA,A,250,,,,,,66.16,N,Y
4072235,ZOVIRAX 5% OINT 30 GM,PHA,A,250,,,,,,618.87,N,Y
4072236,INTAL MDI 8.1 GM,PHA,A,250,,,,,,193.22,N,Y
4072237,ALBUTEROL 2 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4072238,PROTONIX 40 MG VIAL,PHA,A,250,,,,,,45.65,N,Y
4072239,ACTOS 15MG TAB,PHA,A,250,,,,,,8.69,N,Y
4072240,MAXALT-MLT 5 MG TAB,PHA,A,250,,,,,,6.25,N,Y
4072241,NITROGLYCERIN 0.1 MG/HR P,PHA,A,250,,,,,,7.45,N,Y
4072242,FABRAZYME 70MG,PHA,A,636,J3490,,,,,"9,756.50",N,Y
4072243,PROPRANOLOL ER 60 MG CAP,PHA,A,250,,,,,,6.10,N,Y
4072244,MYCOPHENOLATE 250 MG CAP,PHA,A,250,,,,,,3.80,N,Y
4072245,NARDIL 15 MG TAB,PHA,A,250,,,,,,3.93,N,Y
4072246,DILANTIN 50 MG CHEW TAB,PHA,A,250,,,,,,3.55,N,Y
4072247,CHLORPHENIRAMINE 4 MG TAB,PHA,A,250,,,,,,0.15,N,Y
4072248,ADVAIR DISKUS 500/50 #14,PHA,A,250,,,,,,441.50,N,Y
4072249,NITROGLYCERIN 9 MG ER CAP,PHA,A,250,,,,,,2.40,N,Y
4072250,BAL IN OIL 100 MG/ML 3 ML,PHA,A,250,,,,,,454.60,N,Y
4072251,CIPRO HC OTIC SUSP 10 ML,PHA,A,250,,,,,,420.99,N,Y
4072252,DORZOLAMIDE 2% OPHTH SOLN,PHA,A,250,,,,,,25.75,N,Y
4072253,"NYSTOP 100,000 UNITS/GM T",PHA,A,250,,,,,,43.30,N,Y
4072254,INFLAMASE FORTE 1% 5ML,PHA,A,250,,,,,,46.26,N,Y
4072255,OP ACETAMINOPHEN / CODEIN,PHA,A,253,,,,,,17.40,N,Y
4072256,OP AMANTADINE 100 MG CAPS,PHA,A,250,,,,,,10.71,N,Y
4072257,METOPROLOL SUCCINATE 25 M,PHA,A,250,,,,,,4.80,N,Y
4072258,SERTRALINE 25 MG TAB,PHA,A,250,,,,,,2.70,N,Y
4072259,ETODOLAC 500MG ER TAB,PHA,A,250,,,,,,5.00,N,Y
4072260,THYROID 30 MG TAB,PHA,A,250,,,,,,4.80,N,Y
4072261,LEXAPRO 10 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4072262,DORZOLAMIDE 2.23% / TIMOL,PHA,A,250,,,,,,29.70,N,Y
4072263,FERREX 150 FORTE CAP,PHA,A,250,,,,,,2.45,N,Y
4072264,NYSTATIN CREAM 15 GM,PHA,A,250,,,,,,29.25,N,Y
4072265,VECURONIUM 10 MG VIAL,PHA,A,250,,,,,,46.05,N,Y
4072266,CARBATROL CAP 100 MG,PHA,A,250,,,,,,5.60,N,Y
4072267,DANTRIUM 25 MG CAP,PHA,A,250,,,,,,5.12,N,Y
4072268,VITAMIN A & D OINT 60 GM,PHA,A,250,,,,,,4.35,N,Y
4072269,RISPERDAL CONSTA 25MG SYR,PHA,A,636,J3490,,,,,569.00,N,Y
4072270,LORATADINE 10 MG TAB,PHA,A,250,,,,,,0.80,N,Y
4072271,HYDROMORPHONE 2 MG/ML 1 M,PHA,A,250,,,,,,35.70,N,Y
4072272,VANCOCIN 250MG CAP,PHA,A,250,,,,,,32.00,N,Y
4072273,ZOFRAN 4 MG TAB,PHA,A,250,,,,,,108.75,N,Y
4072274,OXYCONTIN 20 MG TAB,PHA,A,250,,,,,,23.00,N,Y
4072275,FENOFIBRATE MICRONIZED 20,PHA,A,250,,,,,,11.90,N,Y
4072276,SINGULAIR 4 MG CHEWABLE T,PHA,A,250,,,,,,3.00,N,Y
4072277,FENTANYL 100 MCG/HR PATCH,PHA,A,250,,,,,,55.35,N,Y
4072278,CHLORHEXIDINE GLUCONATE 0,PHA,A,250,,,,,,16.95,N,Y
4072279,CARBIDOPA 10 MG / LEVODOP,PHA,A,250,,,,,,2.85,N,Y
4072280,TRANDOLAPRIL 1 MG TAB,PHA,A,250,,,,,,3.45,N,Y
4072281,PAXIL CR 12.5 MG TAB,PHA,A,250,,,,,,9.88,N,Y
4072282,ZONISAMIDE 100 MG CAP,PHA,A,250,,,,,,2.55,N,Y
4072283,MICARDIS 20 MG TAB,PHA,A,250,,,,,,3.75,N,Y
4072284,PROTONIX 40 MG TAB,PHA,A,250,,,,,,19.90,N,Y
4072285,TIMOLOL MALEATE 0.5% GEL,PHA,A,250,,,,,,166.90,N,Y
4072286,THEO-24 100 MG CAP,PHA,A,250,,,,,,4.25,N,Y
4072287,ATRACURIUM 10 MG/ML 10 ML,PHA,A,250,,,,,,40.06,N,Y
4072288,MORPHINE 15 MG/ML 20 ML M,PHA,A,250,,,,,,68.85,N,Y
4072289,CHLORDIAZEPOXIDE 25 MG CA,PHA,A,250,,,,,,5.65,N,Y
4072290,AVANDIA 2 MG TAB,PHA,A,250,,,,,,14.80,N,Y
4072291,AVINZA 30 MG CAP,PHA,A,250,,,,,,14.35,N,Y
4072292,BUDESONIDE 0.5 MG / 2 ML,PHA,A,250,,,,,,41.45,N,Y
4072293,CILOSTAZOL 50 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4072294,BETOPTIC-S 0.25% OPHTH SU,PHA,A,250,,,,,,525.05,N,Y
4072295,BEXTRA 10MG TAB,PHA,A,250,,,,,,11.00,N,Y
4072296,AMOXICILLIN / CLAVULANATE,PHA,A,250,,,,,,32.45,N,Y
4072297,LEVAQUIN 750 MG / D5W 150,PHA,A,250,,,,,,90.25,N,Y
4072298,EPSOM SALT 4LB,PHA,A,250,,,,,,11.70,N,Y
4072299,AZOPT 1% OPHTH SUSP 10 ML,PHA,A,250,,,,,,482.25,N,Y
4072300,SPIRIVA HANDIHALER #5,PHA,A,250,,,,,,85.90,N,Y
4072301,GAMMAGARD 10% PER 500 MG,PHA,A,636,J1569,,,,,55.45,N,Y
4072302,NIASPAN 500 MG TAB,PHA,A,250,,,,,,4.70,N,Y
4072303,ACIPHEX 20MG TAB,PHA,A,250,,,,,,8.81,N,Y
4072304,NAROPIN 2 MG/ML 10 ML AMP,PHA,A,250,,,,,,5.45,N,Y
4072305,OXYCODONE 10 MG / ACETAMI,PHA,A,250,,,,,,4.70,N,Y
4072306,SODIUM BICARBONATE 8.4% 5,PHA,A,250,,,,,,68.55,N,Y
4072307,MANNITOL 20% 500 ML,PHA,A,250,,,,,,169.25,N,Y
4072308,PHENYLEPHRINE 1% 10 MG/ML,PHA,A,250,,,,,,45.20,N,Y
4072309,BETIMOL 0.5% OPHTH SOLN 5,PHA,A,250,,,,,,100.25,N,Y
4072310,SUCRALFATE 1 GM / 10 ML S,PHA,A,250,,,,,,36.20,N,Y
4072311,"VITAMIN D 50,000 UNITS CA",PHA,A,250,,,,,,2.90,N,Y
4072312,PEDIARIX 0.5 ML SYRINGE,PHA,A,250,,,,,,374.85,N,Y
4072313,DICLOFENAC SODIUM 0.1% OP,PHA,A,250,,,,,,25.75,N,Y
4072314,OXYCODONE 5 MG IMMEDIATE,PHA,A,250,,,,,,3.80,N,Y
4072315,PULMICORT MDI,PHA,A,250,,,,,,329.93,N,Y
4072316,METHADONE 5 MG TAB,PHA,A,250,,,,,,3.75,N,Y
4072317,METHADONE 10MG TAB,PHA,A,250,,,,,,4.00,N,Y
4072318,influenza high dose 0.5 ml,PHA,A,250,,,,,,436.10,N,Y
4072319,OP CELEBREX 100 MG CAPS #,PHA,A,253,,,,,,5.65,N,Y
4072320,PAROXETINE 10 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4072321,CHLORPROMAZINE 25 MG TAB,PHA,A,250,,,,,,18.50,N,Y
4072322,METOPROLOL TARTRATE 25 MG,PHA,A,250,,,,,,2.25,N,Y
4072323,ZELNORM 6 MG TAB,PHA,A,250,,,,,,14.05,N,Y
4072324,ADENOCARD 3 MG/ML 4 ML SY,PHA,A,250,,,,,,236.95,N,Y
4072325,EXCEDRIN TAB #24,PHA,A,250,,,,,,13.65,N,Y
4072326,VIGAMOX 0.5% OPHTH SOLN 3,PHA,A,250,,,,,,20.00,N,Y
4072327,PIPERACILLIN / TAZOBACTAM,PHA,A,250,,,,,,63.85,N,Y
4072328,VIAL - STERILE EMPTY 30 M,PHA,A,250,,,,,,0.00,N,Y
4072329,MICONAZOLE 2% POWDER 3 OZ,PHA,A,250,,,,,,27.25,N,Y
4072330,PSEUDOEPHEDRINE ER (12 HO,PHA,A,250,,,,,,4.50,N,Y
4072331,SUDAFED 240 MG 24 HOUR TA,PHA,A,250,,,,,,6.80,N,Y
4072332,TRAVATAN Z 0.004% OPHTH S,PHA,A,250,,,,,,331.30,N,Y
4072333,WOUND CARE,PHA,A,250,,,,,,0.00,N,Y
4072334,BLOOD GLUCOSE - FINGERSTI,PHA,A,250,,,,,,0.00,N,Y
4072335,RIFAMPIN 300 MG CAP,PHA,A,250,,,,,,7.95,N,Y
4072336,RIVASTIGMINE 1.5 MG CAP,PHA,A,250,,,,,,312.00,N,Y
4072337,ELIDEL 1% CREAM 30 GM,PHA,A,250,,,,,,251.95,N,Y
4072338,TB TEST - READ,PHA,A,250,,,,,,0.00,N,Y
4072339,PATCH - REMOVE,PHA,A,250,,,,,,0.00,N,Y
4072340,NAMENDA 5 MG TAB,PHA,A,250,,,,,,3.40,N,Y
4072341,MORPHINE 30 MG ER TAB,PHA,A,250,,,,,,6.55,N,Y
4072342,BSS OPHTH SOLN 500 ML,PHA,A,250,,,,,,27.10,N,Y
4072343,VALPROATE 100 MG/ML 5 ML,PHA,A,250,,,,,,47.81,N,Y
4072344,TUBE FEEDING,PHA,A,250,,,,,,0.00,N,Y
4072345,CYMBALTA 20 MG CAP,PHA,A,250,,,,,,3.45,N,Y
4072346,AQUAPHOR OINT 1.75 OZ,PHA,A,250,,,,,,20.95,N,Y
4072347,PULSE OX,PHA,A,250,,,,,,0.00,N,Y
4072348,LIDODERM 5% PATCH,PHA,A,250,,,,,,24.55,N,Y
4072349,GABITRIL 2 MG TAB,PHA,A,250,,,,,,27.40,N,Y
4072350,CAPTOPRIL 12.5 MG TAB,PHA,A,250,,,,,,2.05,N,Y
4072351,MELOXICAM 7.5 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4072352,ABILIFY 5 MG TAB,PHA,A,250,,,,,,9.25,N,Y
4072353,TORSEMIDE 10 MG TAB,PHA,A,250,,,,,,2.35,N,Y
4072354,CHLORPHENIRAMINE 12 MG TR,PHA,A,250,,,,,,0.20,N,Y
4072355,MENACTRA 4 MCG / 0.5 ML S,PHA,A,250,90734,,,,,550.45,N,Y
4072356,LEVETIRACETAM 250 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4072357,DIVALPROEX ER 250 MG TAB,PHA,A,250,,,,,,2.60,N,Y
4072358,NEBUPENT 300 MG VIAL ***F,PHA,A,250,,,,,,128.72,N,Y
4072359,FARESTON 60 MG TAB,PHA,A,250,,,,,,19.80,N,Y
4072360,LEVOTHYROXINE 25 MCG TAB,PHA,A,250,,,,,,2.55,N,Y
4072361,LUNESTA 1 MG TAB,PHA,A,250,,,,,,18.20,N,Y
4072362,CARNITOR 330 MG TAB,PHA,A,250,,,,,,6.15,N,Y
4072363,LUMIGAN 0.03% OPHTH SOLN,PHA,A,250,,,,,,178.30,N,Y
4072364,EPIPEN JR 0.15 MG SYRINGE,PHA,A,250,,,,,,171.36,N,Y
4072365,RID SHAMPOO 120 ML,PHA,A,250,,,,,,43.20,N,Y
4072366,VESICARE 5 MG TAB,PHA,A,250,,,,,,47.70,N,Y
4072367,METAXALONE 800 MG TAB,PHA,A,250,,,,,,20.00,N,Y
4072368,BOOSTRIX 0.5 ML SYRINGE,PHA,A,250,,,,,,214.40,N,Y
4072369,HUMALOG MIX 75/25 100 UNI,PHA,A,250,,,,,,269.15,N,Y
4072370,ROPINIROLE 0.25 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4072371,BUMETANIDE 0.25 MG/ML 4 M,PHA,A,250,,,,,,38.70,N,Y
4072372,TEVETEN HCT 600 MG / 12.5,PHA,A,250,,,,,,10.60,N,Y
4072373,LAMOTRIGINE 25 MG TAB,PHA,A,250,,,,,,2.40,N,Y
4072375,OXACILLIN 1 GM VIAL,PHA,A,250,,,,,,79.00,N,Y
4072376,ZOMETA 4 MG 5 ML SDV [PER,PHA,A,636,J3487,,,,,244.45,N,Y
4072377,OP DICYCLOMINE 10 MG CAPS,PHA,A,253,,,,,,35.40,N,Y
4072378,DETROL LA 4 MG CAP,PHA,A,250,,,,,,16.25,N,Y
4072379,CARBOFED DM PED DROPS 30,PHA,A,250,,,,,,14.50,N,Y
4072380,UROXATRAL 10 MG TAB,PHA,A,250,,,,,,3.75,N,Y
4072381,ENABLEX 7.5 MG TAB,PHA,A,250,,,,,,35.30,N,Y
4072382,NITRO 0.4MG SL TAB #25,PHA,A,250,,,,,,9.20,N,Y
4072383,METFORMIN 500 MG ER TAB,PHA,A,250,,,,,,2.65,N,Y
4072384,PROPRANOLOL ER 80 MG CAP,PHA,A,250,,,,,,4.60,N,Y
4072385,CUBICIN 500 MG VIAL,PHA,A,636,J0878,,,,,0.93,N,Y
4072387,TAMIFLU 6 MG/ML SUSP 60 M,PHA,A,250,,,,,,457.20,N,Y
4072388,LOVASTATIN 10 MG TAB,PHA,A,250,,,,,,2.20,N,Y
4072389,CEFEPIME 1 GM VIAL,PHA,A,250,,,,,,57.05,N,Y
4072390,FOMEPIZOLE 1 GM/ML 1.5 ML,PHA,A,250,,,,,,"3,143.65",N,Y
4072391,SODIUM THIOSULFATE 25% 25,PHA,A,250,,,,,,106.20,N,Y
4072392,ADACEL 0.5 ML SYRINGE,PHA,A,250,,,,,,193.90,N,Y
4072393,HEPARIN LOCK FLUSH 100 UN,PHA,A,250,,,,,,32.00,N,Y
4072394,MEDROXYPROGESTERONE 10 MG,PHA,A,250,,,,,,2.55,N,Y
4072395,bicalutamide 50 mg tab,PHA,A,250,,,,,,3.30,N,Y
4072396,TIZANIDINE 4 MG TAB,PHA,A,250,,,,,,2.95,N,Y
4072397,DETROL LA 2 MG CAP,PHA,A,250,,,,,,19.30,N,Y
4072398,DAKIN'S 0.125% TOPICAL SO,PHA,A,250,,,,,,42.50,N,Y
4072399,ATRAC-TAIN 10% CREAM 5 OZ,PHA,A,250,,,,,,25.05,N,Y
4072402,SUFENTANIL 50 MCG/ML 1 ML,PHA,A,250,,,,,,56.80,N,Y
4072403,GLIMEPIRIDE 1 MG TAB,PHA,A,250,,,,,,2.10,N,Y
4072404,SALIVA SUBSTITUTE 120 ML,PHA,A,250,,,,,,24.50,N,Y
4072405,EVISTA 60 MG TAB,PHA,A,250,,,,,,21.75,N,Y
4072406,ZOSTAVAX VIAL,PHA,A,250,90736,,,,,994.90,N,Y
4072407,GARDASIL 0.5 ML SDV,PHA,A,250,,,,,,671.50,N,Y
4072408,MESALAMINE 4 GM ENEMA 60,PHA,A,250,,,,,,58.95,N,Y
4072409,LYRICA 50 MG CAP,PHA,A,250,,,,,,10.45,N,Y
4072410,LYRICA 25 MG CAP,PHA,A,250,,,,,,37.25,N,Y
4072411,ACETAMINOPHEN 160 MG / 5,PHA,A,250,,,,,,4.10,N,Y
4072412,MIRALAX POWDER FOR ORAL S,PHA,A,250,,,,,,4.40,N,Y
4072413,FLEET PHOSPHO-SODA 45 ML,PHA,A,250,,,,,,16.40,N,Y
4072414,AVODART 0.5 MG CAP,PHA,A,250,,,,,,3.20,N,Y
4072415,SODIUM BICARBONATE 4.2% 1,PHA,A,250,,,,,,71.70,N,Y
4072416,PROQUAD VIAL,PHA,A,250,,,,,,606.60,N,Y
4072417,PRAMIPEXOLE 0.25 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4072418,VITAMIN B-12 1000 MCG TAB,PHA,A,250,,,,,,0.10,N,Y
4072419,BACITRACIN 500 UNITS/GM O,PHA,A,250,,,,,,190.88,N,Y
4072420,RENAGEL 800 MG TAB,PHA,A,250,,,,,,8.95,N,Y
4072421,ACETAMINOPHEN 300 MG / CO,PHA,A,250,,,,,,4.08,N,Y
4072422,ROTATEQ ORAL SUSP 2 ML,PHA,A,250,,,,,,363.85,N,Y
4072423,MUPIROCIN 2% OINT PACKET,PHA,A,250,,,,,,28.50,N,Y
4072424,GUAIFENESIN 100 MG / DM 1,PHA,A,250,,,,,,1.85,N,Y
4072425,GUAIFENESIN 100 MG / 5 ML,PHA,A,250,,,,,,2.05,N,Y
4072426,ALUMINUM & MAGNESIUM HYDR,PHA,A,250,,,,,,3.35,N,Y
4072427,METHOCARBAMOL 750 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4072428,MORPHINE 5 MG / 0.25 ML O,PHA,A,250,,,,,,18.00,N,Y
4072429,ZELNORM 2 MG TAB,PHA,A,250,,,,,,17.25,N,Y
4072430,FLUCONAZOLE 50 MG TAB,PHA,A,250,,,,,,6.10,N,Y
4072431,LISINOPRIL 20 MG / HYDROC,PHA,A,250,,,,,,2.15,N,Y
4072432,STARLIX 120 MG TAB,PHA,A,250,,,,,,8.50,N,Y
4072433,STARLIX 60 MG TAB,PHA,A,250,,,,,,9.25,N,Y
4072434,CARBIDOPA 25 MG / LEVODOP,PHA,A,250,,,,,,3.15,N,Y
4072435,VITAMIN B-12 250 MCG TAB,PHA,A,250,,,,,,0.05,N,Y
4072436,VAQTA PEDIATRIC / ADOLESC,PHA,A,250,,,,,,191.85,N,Y
4072437,LEVOBUNOLOL 0.25% OPHTH S,PHA,A,250,,,,,,18.20,N,Y
4072438,INFANRIX 0.5 ML SYRINGE,PHA,A,250,,,,,,138.80,N,Y
4072439,SODIUM CHLORIDE 0.9% 25 M,PHA,A,250,,,,,,31.80,N,Y
4072440,MINOXIDIL 2.5 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4072441,BUPIVACAINE 0.75% / DEXTR,PHA,A,250,,,,,,36.10,N,Y
4072442,CHANTIX 0.5 MG TAB,PHA,A,250,,,,,,28.70,N,Y
4072443,CRESTOR 5 MG TAB,PHA,A,250,,,,,,2.95,N,Y
4072444,SANCTURA 20 MG TAB,PHA,A,250,,,,,,12.90,N,Y
4072445,PHENELZINE 15 MG TAB,PHA,A,250,,,,,,4.40,N,Y
4072447,GALANTAMINE ER 8 MG CAP,PHA,A,250,,,,,,7.70,N,Y
4072448,POLY B / TRIMETHOPRIM OPH,PHA,A,250,,,,,,18.05,N,Y
4072449,FORADIL 12 MCG AEROLIZER,PHA,A,250,,,,,,90.90,N,Y
4072450,CYMBALTA 30 MG CAP,PHA,A,250,,,,,,3.80,N,Y
4072451,QVAR 80 MCG MDI 8.7 GM,PHA,A,250,,,,,,424.49,N,Y
4072452,BUPROPION XL (24 HOUR) 15,PHA,A,250,,,,,,3.75,N,Y
4072453,MORPHINE 20 MG / 1 ML ORA,PHA,A,250,,,,,,18.00,N,Y
4072454,OP C-PHEN DM PED DROPS 30,PHA,A,253,,,,,,40.65,N,Y
4072455,NORPACE CR (12 HOUR) 150,PHA,A,250,,,,,,3.35,N,Y
4072456,TRIAMCINOLONE ACETONIDE 0,PHA,A,250,,,,,,17.75,N,Y
4072457,ONDANSETRON 4 MG ORALLY D,PHA,A,250,,,,,,6.20,N,Y
4072458,XOPENEX HFA METERED DOSE,PHA,A,250,,,,,,104.45,N,Y
4072459,ADVAIR HFA 115/21 MDI 12,PHA,A,250,,,,,,399.35,N,Y
4072460,VITAMIN D-3 1000 UNITS TA,PHA,A,250,,,,,,0.10,N,Y
4072461,SODIUM CHLORIDE 5% OPHTH,PHA,A,250,,,,,,18.15,N,Y
4072462,MUCINEX DM 600 MG / 30 MG,PHA,A,250,,,,,,1.85,N,Y
4072464,ZYFLO 600 MG TAB,PHA,A,250,,,,,,12.45,N,Y
4072465,TRIAMCINOLONE 0.1% IN ORA,PHA,A,250,,,,,,59.85,N,Y
4072466,OMEPRAZOLE 2 MG/ML SOLUTI,PHA,A,250,,,,,,53.80,N,Y
4072467,ADVAIR HFA 230/21 MDI 12,PHA,A,250,,,,,,430.05,N,Y
4072468,VITAMIN C 500 MG / 5 ML S,PHA,A,250,,,,,,20.65,N,Y
4072469,ferrous sulfate 220 mg / 5 ml elixir 5 m,PHA,A,250,,,,,,2.40,N,Y
4072470,RECLAST 5 MG / 100 ML [PE,PHA,A,636,J3489,,,,,297.05,N,Y
4072471,DILANTIN 30 MG CAP,PHA,A,250,,,,,,4.05,N,Y
4072472,PALGIC 4 MG TAB,PHA,A,250,,,,,,4.24,N,Y
4072473,ETOMIDATE 2 MG/ML 20 ML V,PHA,A,250,,,,,,87.50,N,Y
4072474,VALPROIC ACID 250 MG CAP,PHA,A,250,,,,,,2.85,N,Y
4072475,PROVOCHOLINE 100 MG VIAL,PHA,A,250,,,,,,0.00,N,Y
4072476,CEFTRIAXONE 2 GM / 50 ML,PHA,A,250,J0696,,,,,158.90,N,Y
4072477,METHENAMINE MANDELATE 1 G,PHA,A,250,,,,,,3.10,N,Y
4072478,ARTHROTEC 75 MG TAB,PHA,A,250,,,,,,17.25,N,Y
4072479,JANUVIA 50 MG TAB,PHA,A,250,,,,,,69.90,N,Y
4072480,FENTANYL 12 MCG/HR PATCH,PHA,A,250,,,,,,34.30,N,Y
4072481,ZYPREXA ZYDIS 5 MG TAB,PHA,A,250,,,,,,7.40,N,Y
4072482,EXELON 4.6 MG / 24 HOURS,PHA,A,250,,,,,,48.75,N,Y
4072483,BENICAR 20 MG TAB,PHA,A,250,,,,,,29.60,N,Y
4072484,ABILIFY 7.5 MG/ML SDV,PHA,A,250,,,,,,107.10,N,Y
4072485,DAKIN'S 0.25% TOPICAL SOL,PHA,A,250,,,,,,42.50,N,Y
4072486,SOLOSITE WOUND GEL 3 OZ,PHA,A,250,,,,,,81.40,N,Y
4072487,ACCUZYME OINT 30 GM,PHA,A,250,,,,,,208.90,N,Y
4072488,LEVEMIR 100 UNITS/ML [10,PHA,A,250,,,,,,660.70,N,Y
4072489,RELENZA DISKHALER,PHA,A,250,,,,,,124.95,N,Y
4072490,LIDOCAINE 2% VISCOUS 15 M,PHA,A,250,,,,,,5.60,N,Y
4072491,VITAMIN D-3 400 UNITS TAB,PHA,A,250,,,,,,0.05,N,Y
4072492,COUGH LOZENGE,PHA,A,250,,,,,,3.60,N,Y
4072493,HYDROMORPHONE 10 MG/ML 50,PHA,A,250,,,,,,782.80,N,Y
4072494,VANCOCIN 125 MG CAP,PHA,A,250,,,,,,23.75,N,Y
4072495,HYDROMORPHONE 10 MG/ML 5,PHA,A,250,,,,,,91.35,N,Y
4072496,CHANTIX STARTING MONTH PA,PHA,A,250,,,,,,544.70,N,Y
4072497,CLOZAPINE 100 MG TAB,PHA,A,250,,,,,,5.70,N,Y
4072499,MORPHINE 4 MG/ML 1 ML SYR,PHA,A,250,,,,,,39.25,N,Y
4072500,DONNATAL ELIXIR 10 ML,PHA,A,250,,,,,,75.30,N,Y
4072501,INDIGO CARMINE 0.8% 5 ML,PHA,A,250,,,,,,66.00,N,Y
4072502,DESMOPRESSIN 0.2 MG TAB,PHA,A,250,,,,,,6.18,N,Y
4072503,BUFFERED SALT TAB,PHA,A,250,,,,,,2.20,N,Y
4072504,ZYVOX 600 MG TAB,PHA,A,250,,,,,,442.90,N,Y
4072505,INVANZ 1 GM VIAL,PHA,A,250,,,,,,507.25,N,Y
4072506,HYDROCODONE 7.5 MG / APAP,PHA,A,250,,,,,,12.70,N,Y
4072507,tacrolimus 0.5 mg cap,PHA,A,250,,,,,,4.20,N,Y
4072508,ACETYLCYSTEINE 10% 4 ML S,PHA,A,250,,,,,,34.60,N,Y
4072509,MAGIC MOUTH SWISH 240 ML,PHA,A,250,,,,,,59.10,N,Y
4072510,AMPICILLIN 2 GM VIAL,PHA,A,250,,,,,,42.80,N,Y
4072511,DOCUSATE SODIUM 100 MG /,PHA,A,250,,,,,,1.65,N,Y
4072512,METOCLOPRAMIDE 10 MG / 10,PHA,A,250,,,,,,3.80,N,Y
4072513,SENNA 8.8 MG / 5 ML SYRUP,PHA,A,250,,,,,,36.70,N,Y
4072514,DIGOXIN 0.125 MG / 2.5 ML,PHA,A,250,,,,,,5.19,N,Y
4072515,ASTELIN NASAL SPRAY 30 ML,PHA,A,250,,,,,,251.06,N,Y
4072516,RISPERIDONE 3 MG TAB,PHA,A,250,,,,,,4.80,N,Y
4072517,ANASTROZOLE 1 MG TAB,PHA,A,250,,,,,,8.50,N,Y
4072518,STALEVO 50 TAB,PHA,A,250,,,,,,10.02,N,Y
4072519,GLYCERIN 480 ML,PHA,A,250,,,,,,40.35,N,Y
4072520,FELODIPINE 2.5 MG ER TAB,PHA,A,250,,,,,,4.55,N,Y
4072521,DETROL 1 MG TAB,PHA,A,250,,,,,,8.90,N,Y
4072522,MIDODRINE 2.5 MG TAB,PHA,A,250,,,,,,4.05,N,Y
4072523,HAVRIX ADULT 1440 EL UNIT,PHA,A,250,,,,,,317.50,N,Y
,,PHA,A,250,,,,,,317.50,N,Y
4072524,ADENOSINE 3 MG/ML 2 ML SD,PHA,A,250,,,,,,41.60,N,Y
4072525,DEXAMETHASONE 0.5 MG / 5,PHA,A,250,,,,,,14.15,N,Y
4072526,HAVRIX PED/ADOL 720 EL UN,PHA,A,250,,,,,,30.10,N,Y
4072527,INTEGRILIN 2 MG/ML 10 ML,PHA,A,250,,,,,,538.45,N,Y
4072528,INTEGRILIN 0.75 MG/ML 100,PHA,A,250,,,,,,"1,778.25",N,Y
4072529,CEFEPIME 2 GM VIAL,PHA,A,250,,,,,,66.72,N,Y
4072530,CITRACAL 200 MG / VITAMIN,PHA,A,250,,,,,,0.15,N,Y
4072531,BETADINE SUGAR PASTE,PHA,A,250,,,,,,35.00,N,Y
4072532,STALEVO 100 TAB,PHA,A,250,,,,,,10.02,N,Y
4072533,MORPHINE 20 MG/ML ORAL SO,PHA,A,250,,,,,,65.95,N,Y
4072534,NICOTROL INHALER #168,PHA,A,250,,,,,,303.85,N,Y
4072535,LEFLUNOMIDE 20 MG TAB,PHA,A,250,,,,,,3.70,N,Y
4072536,EXELON 9.5 MG / 24 HOURS,PHA,A,250,,,,,,42.95,N,Y
4072538,CARBAMAZEPINE 100 MG / 5,PHA,A,250,,,,,,43.75,N,Y
4072539,NASAL CEASE,PHA,A,250,,,,,,7.60,N,Y
4072540,INVANZ PER 500 MG,PHA,A,636,J1335,,,,,144.15,N,Y
4072541,LACTINEX 1 GM PACKET,PHA,A,250,,,,,,4.40,N,Y
4072542,ROZEREM 8 MG TAB,PHA,A,250,,,,,,27.90,N,Y
4072543,OPCON-A OPHTH SOLN 15 ML,PHA,A,250,,,,,,24.00,N,Y
4072544,CENTRUM LIQUID 236 ML,PHA,A,250,,,,,,34.40,N,Y
4072545,ACETASOL HC OTIC SOLN 10,PHA,A,250,,,,,,49.57,N,Y
4072546,SODIUM CHLORIDE 5% OPHTH,PHA,A,250,,,,,,31.20,N,Y
4072547,DELSYM 30 MG / 5 ML SUSPE,PHA,A,250,,,,,,34.85,N,Y
4072548,NAPROXEN SODIUM 220 MG TA,PHA,A,250,,,,,,0.20,N,Y
4072549,NOVOLOG MIX 70/30 100 UNI,PHA,A,250,,,,,,303.25,N,Y
4072550,ANACIN 400 MG / 32 MG TAB,PHA,A,250,,,,,,0.55,N,Y
4072551,AQUAPHILIC OINT 454 GM,PHA,A,250,,,,,,33.20,N,Y
4072552,KETOTIFEN 0.025% OPHTH SO,PHA,A,250,,,,,,27.45,N,Y
4072553,BONIVA 150 MG TAB,PHA,A,250,,,,,,451.30,N,Y
4072554,LETROZOLE 2.5 MG TAB,PHA,A,250,,,,,,2.55,N,Y
4072555,NOVOLOG 100 UNITS/ML [10,PHA,A,250,,,,,,301.00,N,Y
4072556,DILTIAZEM 90 MG ER (12 HO,PHA,A,250,,,,,,5.65,N,Y
4072557,RIMANTADINE 100 MG TAB,PHA,A,250,,,,,,8.15,N,Y
4072558,FENOFIBRATE 160 MG TAB,PHA,A,250,,,,,,4.85,N,Y
4072559,CLIMARA 0.1 MG / DAY PATC,PHA,A,250,,,,,,69.60,N,Y
4072560,PATANOL 0.1% OPHTH SOLN 5,PHA,A,250,,,,,,170.05,N,Y
4072561,CALMOSEPTINE OINTMENT 113,PHA,A,250,,,,,,20.15,N,Y
4072562,POVIDONE - IODINE 10% OIN,PHA,A,250,,,,,,11.85,N,Y
4072563,ALOE VESTA LOTION 8 OZ,PHA,A,250,,,,,,6.50,N,Y
4072564,BROVANA 15 MCG / 2 ML NEB,PHA,A,250,,,,,,30.60,N,Y
4072565,BOTOX 100 UNITS VIAL,PHA,A,250,,,,,,"1,803.23",N,Y
4072566,PIPERACILLIN / TAZOBACTAM,PHA,A,250,,,,,,80.75,N,Y
4072567,TERCONAZOLE 0.8% VAGINAL,PHA,A,250,,,,,,50.55,N,Y
4072568,CYCLESSA TAB #28,PHA,A,250,,,,,,226.70,N,Y
4072569,MORPHINE PF 0.1 MG/ML EPI,PHA,A,250,,,,,,70.35,N,Y
4072570,CIPRO 10% 500 MG / 5 ML S,PHA,A,250,,,,,,542.85,N,Y
4072571,COENZYME Q10 60 MG CAP,PHA,A,250,,,,,,1.60,N,Y
4072572,POTASSIUM CHLORIDE 40 MEQ,PHA,A,250,,,,,,85.70,N,Y
4072573,TOPIRAMATE 100 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4072574,BUDESONIDE 0.25 MG / 2 ML,PHA,A,250,,,,,,37.05,N,Y
4072575,LOVAZA 1 GM CAP,PHA,A,250,,,,,,5.90,N,Y
4072576,GALANTAMINE 4 MG TAB,PHA,A,250,,,,,,3.85,N,Y
4072577,RISPERDAL CONSTA 12.5 MG,PHA,A,250,,,,,,474.00,N,Y
4072578,SIMVASTATIN 5 MG TAB,PHA,A,250,,,,,,2.15,N,Y
4072579,URSODIOL 300 MG CAP,PHA,A,250,,,,,,3.55,N,Y
4072580,POTASSIUM CHLORIDE 20 MEQ,PHA,A,250,,,,,,19.80,N,Y
4072581,CREON 10 CAP,PHA,A,250,,,,,,7.85,N,Y
4072582,BYSTOLIC 5 MG TAB,PHA,A,250,,,,,,19.10,N,Y
4072583,DAKIN'S 0.0625% TOPICAL S,PHA,A,250,,,,,,96.85,N,Y
4072584,AMBIEN CR 12.5 MG TAB,PHA,A,250,,,,,,24.45,N,Y
4072585,BYETTA 10 MCG/DOSE #60,PHA,A,250,,,,,,"1,307.85",N,Y
4072586,ARIXTRA 2.5 MG / 0.5 ML S,PHA,A,250,,,,,,77.50,N,Y
4072587,ACULAR LS 0.4% OPHTH SOLN,PHA,A,250,,,,,,190.30,N,Y
4072588,PAULSON'S ENT SWISH 240 M,PHA,A,250,,,,,,61.80,N,Y
4072589,SODIUM NITRITE 30 MG/ML 1,PHA,A,250,,,,,,305.00,N,Y
4072590,LODOSYN 25 MG TAB,PHA,A,250,,,,,,4.24,N,Y
4072591,AZILECT 1 MG TAB,PHA,A,250,,,,,,59.40,N,Y
4072592,TEKTURNA 150 MG TAB,PHA,A,250,,,,,,15.05,N,Y
4072593,BRIMONIDINE 0.2% OPHTH SO,PHA,A,250,,,,,,15.05,N,Y
4072594,VISION BLUE 0.06% 0.5 ML,PHA,A,250,,,,,,111.50,N,Y
4072595,KETOROLAC 0.5% OPHTH SOLN,PHA,A,250,,,,,,16.65,N,Y
4072596,TETRACAINE 0.5% OPHTH SOL,PHA,A,250,,,,,,16.75,N,Y
4072597,ZYMAR 0.3% OPHTH SOLN 5 M,PHA,A,250,,,,,,152.80,N,Y
4072598,BUPIVACAINE PF 0.75% 10 M,PHA,A,250,,,,,,6.45,N,Y
4072599,LIDOCAINE PF 1% 5 ML SDV,PHA,A,250,,,,,,6.50,N,Y
4072600,ROPINIROLE 5 MG TAB,PHA,A,250,,,,,,4.05,N,Y
4072601,POTASSIUM CHLORIDE 40 MEQ,PHA,A,250,,,,,,83.15,N,Y
4072602,POTASSIUM CHLORIDE 10 MEQ,PHA,A,250,,,,,,95.00,N,Y
4072603,RIFAMPIN 150 MG CAP,PHA,A,250,,,,,,5.10,N,Y
4072604,TAMIFLU 15 MG/ML SUSP 60,PHA,A,250,,,,,,519.50,N,Y
4072605,EPINEPHRINE 1 MG/ML SULFI,PHA,A,250,,,,,,43.05,N,Y
4072606,BSS PLUS OPHTH SOLN 500 M,PHA,A,250,,,,,,113.25,N,Y
4072607,METHOTREXATE 2.5 MG TAB,PHA,A,250,,,,,,12.05,N,Y
4072608,ISTALOL 0.5% OPHTH SOLN 2,PHA,A,250,,,,,,150.00,N,Y
4072609,OP OXYCODONE 5 MG IMMEDIA,PHA,A,253,,,,,,18.00,N,Y
4072610,PULMOZYME 1 MG/ML 2.5 ML,PHA,A,250,,,,,,293.85,N,Y
4072611,OASIS MOISTURIZING MOUTH,PHA,A,250,,,,,,22.35,N,Y
4072612,IODOSORB GEL 40 GM,PHA,A,250,,,,,,339.90,N,Y
4072613,DEXTROSE 5% 250 ML NON-PV,PHA,A,250,,,,,,2.70,N,Y
4072614,ABILIFY 2 MG TAB,PHA,A,250,,,,,,22.30,N,Y
4072615,PACLITAXEL 6 MG/ML [PER 3,PHA,A,250,,,,,,195.00,N,Y
4072616,SANTYL 250 UNITS/GM OINT,PHA,A,250,,,,,,394.95,N,Y
4072617,CEFEPIME PER 500 MG,PHA,A,636,J0692,,,,,81.35,N,Y
,,PHA,A,636,J0692,,,,,16.30,N,Y
4072618,SANCTURA XR 60 MG CAP,PHA,A,250,,,,,,17.70,N,Y
4072619,HUMULIN R 100 UNITS/ML [3,PHA,A,250,,,,,,38.65,N,Y
4072620,SARNA LOTION 7.5 OZ,PHA,A,250,,,,,,33.50,N,Y
4072621,PREVNAR 13 0.5 ML SYRINGE,PHA,A,250,90670,,,,,883.60,N,Y
4072622,HUMALOG 100 UNITS/ML [3 M,PHA,A,250,,,,,,103.10,N,Y
4072623,HYDROCODONE 5 MG / ACETAM,PHA,A,250,,,,,,4.05,N,Y
4072624,HYDROCODONE 7.5 MG / ACET,PHA,A,250,,,,,,4.20,N,Y
4072625,HYDROCODONE 10 MG / ACETA,PHA,A,250,,,,,,4.45,N,Y
4072626,CHLORDIAZEPOXIDE 5 MG CAP,PHA,A,250,,,,,,3.35,N,Y
4072627,ENTOCORT EC 3 MG CAP,PHA,A,250,,,,,,52.10,N,Y
4072628,GLUCOSAMINE SULFATE 500 M,PHA,A,250,,,,,,0.40,N,Y
4072629,PHENYTOIN 125 MG / 5 ML S,PHA,A,250,,,,,,118.95,N,Y
4072630,ALPHAGAN P 0.1% OPHTH SOL,PHA,A,250,,,,,,286.90,N,Y
4072631,FOLIC ACID 400 MCG TAB,PHA,A,250,,,,,,0.05,N,Y
4072632,MAGINEX DS 1230 MG PACKET,PHA,A,250,,,,,,3.75,N,Y
4072633,CITALOPRAM 10 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4072634,COMBIGAN OPHTH SOLN 5 ML,PHA,A,250,,,,,,315.25,N,Y
4072635,NAPROXEN EC 375 MG TAB,PHA,A,250,,,,,,2.80,N,Y
4072636,VENLAFAXINE 37.5 MG IMMED,PHA,A,250,,,,,,3.50,N,Y
4072637,DEXTROSE 25% 2.5 GM / 10,PHA,A,250,,,,,,62.90,N,Y
4072639,NAFCILLIN 12 GRAMS IN NOR,PHA,A,250,,,,,,402.57,N,Y
4072640,ROPINIROLE 1 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4072641,BENZOIN COMPOUND TINCTURE,PHA,A,250,,,,,,4.45,N,Y
4072642,NAROPIN 5 MG/ML 30 ML SDV,PHA,A,250,,,,,,18.05,N,Y
4072643,PENICILLIN G POTASSIUM 12,PHA,A,250,,,,,,72.26,N,Y
4072644,XENADERM OINT 30 GM,PHA,A,250,,,,,,208.15,N,Y
4072645,HERCEPTIN 22 MG/ML 20 ML,PHA,A,636,J9355,,,,,100.80,N,Y
4072646,NAFCILLIN 12 GRAMS IN DEX,PHA,A,250,,,,,,314.37,N,Y
4072647,COMTAN 200 MG TAB,PHA,A,250,,,,,,12.50,N,Y
4072648,VFEND 200 MG TAB,PHA,A,250,,,,,,125.30,N,Y
4072649,BUPIVACAINE 0.25% / EPINE,PHA,A,250,,,,,,7.30,N,Y
4072650,PHENOL LIQUIFIED 30 ML,PHA,A,250,,,,,,61.20,N,Y
4072651,CEFTAZIDIME 2 GM / 50 ML,PHA,A,250,,,,,,146.25,N,Y
4072652,CALCIUM CHLORIDE 10% 100,PHA,A,250,,,,,,36.90,N,Y
4072653,THROMBIN 5000 UNITS VIAL,PHA,A,250,,,,,,319.45,N,Y
4072654,CLINDAMYCIN 900 MG / 6 ML,PHA,A,636,J3490,,,,,65.10,N,Y
4072655,SODIUM CHLORIDE 0.9% 100,PHA,A,258,,,,,,30.30,N,Y
4072656,HYPERRAB 150 UNITS/ML 2 M,PHA,A,636,90375,,,,,724.90,N,Y
4072657,RABAVERT 1 ML SDV,PHA,A,636,90675,,,,,"1,219.44",N,Y
4072658,ENGERIX-B ADULT 20 MCG/ML,PHA,A,250,,,,,,251.65,N,Y
4072659,FENTAN20 MCG/1MG30MLPCA,PHA,A,250,,,,,,54.48,N,Y
4072660,FENTANYL 20 MCG/ML 30 ML,PHA,A,250,,,,,,81.00,N,Y
4072661,GUAIFENESIN 100 MG / CODE,PHA,A,250,,,,,,11.65,N,Y
4072662,GEODON 40 MG CAP,PHA,A,250,,,,,,34.70,N,Y
4072663,PHENOBARBITAL 65 MG/ML 1,PHA,A,250,,,,,,97.05,N,Y
4072664,HUMULIN N 100 UNITS/ML [3,PHA,A,250,,,,,,38.65,N,Y
4072665,MAGNESIUM SULFATE 50% 0.5,PHA,A,636,J3475,,,,,0.40,N,Y
4072666,CISPLATIN 1 MG/ML PER 50,PHA,A,636,J9062,,,,,81.79,N,Y
4072667,POVIDONE - IODINE 10% SWA,PHA,A,250,,,,,,0.95,N,Y
4072668,CLOZAPINE 25 MG TAB,PHA,A,250,,,,,,3.35,N,Y
4072669,VALPROIC ACID 250 MG / 5,PHA,A,250,,,,,,4.25,N,Y
4072670,LIALDA 1.2 GM DR TAB,PHA,A,250,,,,,,37.50,N,Y
4072671,STALEVO 125 TAB,PHA,A,250,,,,,,17.55,N,Y
4072672,PRAMIPEXOLE 1 MG TAB,PHA,A,250,,,,,,2.25,N,Y
4072673,PENTASA 250 MG CR CAP,PHA,A,250,,,,,,14.00,N,Y
4072674,RAMIPRIL 1.25 MG CAP,PHA,A,250,,,,,,2.20,N,Y
4072675,VITAMIN D 8000 UNITS/ML O,PHA,A,250,,,,,,337.75,N,Y
4072676,CLINIMIX 4.25/20 1000 ML,PHA,A,250,,,,,,212.25,N,Y
4072677,CLINDAMYCIN 600 MG / 4 ML,PHA,A,250,,,,,,65.10,N,Y
4072678,SODIUM PHOSPHATE 3 MMOL/M,PHA,A,250,,,,,,47.95,N,Y
4072679,FENOFIBRATE MICRONIZED 13,PHA,A,250,,,,,,8.35,N,Y
4072680,ZOSYN 2.25 GM / 50 ML,PHA,A,250,,,,,,128.35,N,Y
4072681,CLINIMIX 5/15 1000 ML,PHA,A,250,,,,,,214.85,N,Y
4072682,RISPERDAL CONSTA 25 MG /,PHA,A,250,,,,,,"1,693.50",N,Y
4072683,QUINAPRIL 5 MG TAB,PHA,A,250,,,,,,2.65,N,Y
4072684,ZYMAXID 0.5% OPHTH SOLN 2,PHA,A,250,,,,,,172.80,N,Y
4072685,NUCYNTA 50 MG TAB,PHA,A,250,,,,,,13.20,N,Y
4072686,NUCYNTA 75 MG TAB,PHA,A,250,,,,,,14.10,N,Y
4072687,AMERICAINE 20% RECTAL OIN,PHA,A,250,,,,,,17.55,N,Y
4072688,FISH OIL 1200 MG CAP,PHA,A,250,,,,,,0.35,N,Y
4072689,BENEFIBER 6 GM PACKET,PHA,A,250,,,,,,1.70,N,Y
4072690,ARIDOL TEST KIT,PHA,A,250,,,,,,0.00,N,Y
4072691,HUMULIN 70/30 100 UNITS/M,PHA,A,250,,,,,,38.65,N,Y
4072693,FENOFIBRATE 54 MG TAB,PHA,A,250,,,,,,3.15,N,Y
4072694,CAPSAICIN 0.075% CREAM 60,PHA,A,250,,,,,,19.45,N,Y
4072695,CUBICIN 500 MG VIAL,PHA,A,250,,,,,,"1,395.60",N,Y
4072696,PRAMOSONE CREAM 30 GM,PHA,A,250,,,,,,304.80,N,Y
4072697,EDECRIN 25 MG TAB,PHA,A,250,,,,,,17.00,N,Y
4072698,CLINIMIX 4.25/10 1000 ML,PHA,A,250,,,,,,216.00,N,Y
4072699,HALFLYTELY 2000 ML,PHA,A,250,,,,,,241.50,N,Y
4072700,NEXTERONE 150 MG / 100 ML,PHA,A,250,,,,,,233.25,N,Y
4072701,NEXTERONE 360 MG / 200 ML,PHA,A,250,,,,,,285.50,N,Y
4072702,PRADAXA 75 MG CAP,PHA,A,250,,,,,,30.50,N,Y
4072703,RANEXA 500 MG TAB,PHA,A,250,,,,,,28.40,N,Y
4072704,CARVEDILOL 3.125 MG TAB,PHA,A,250,,,,,,2.30,N,Y
4072705,PRIMAXIN 250 MG VIAL,PHA,A,250,,,,,,73.15,N,Y
4072706,XARELTO 10 MG TAB,PHA,A,250,,,,,,51.65,N,Y
4072707,LIDOCAINE 0.5% / EPINEPHR,PHA,A,250,,,,,,7.00,N,Y
4072708,SYNERCID 500 MG VIAL,PHA,A,250,,,,,,890.15,N,Y
4072709,MICONAZOLE 2% CREAM 142 G,PHA,A,250,,,,,,50.60,N,Y
4072710,ENTEREG 12 MG CAP,PHA,A,250,,,,,,788.85,N,Y
4072711,CULTURELLE 10 BILLION CEL,PHA,A,250,,,,,,3.95,N,Y
4072712,OP ACETAMINOPHEN 160 MG /,PHA,A,253,,,,,,5.00,N,Y
4072713,OP AMOXICILLIN 125 MG / 5,PHA,A,253,,,,,,10.80,N,Y
4072714,OP AMOXICILLIN 250 MG / 5,PHA,A,253,,,,,,12.35,N,Y
4072715,OP AMOXICILLIN / K CLAV 2,PHA,A,253,,,,,,263.90,N,N
4072716,OP AMOXICILLIN / K CLAV 4,PHA,A,253,,,,,,48.45,N,Y
4072717,OP AMOXICILLIN / K CLAV 6,PHA,A,253,,,,,,32.55,N,Y
4072718,OP AUGMENTIN 125 MG / 5 M,PHA,A,253,,,,,,165.95,N,Y
4072719,OP AZITHROMYCIN 100 MG /,PHA,A,253,,,,,,63.25,N,Y
4072720,OP AZITHROMYCIN 200 MG /,PHA,A,250,,,,,,57.85,N,Y
4072721,OP CEPHALEXIN 125 MG / 5,PHA,A,253,,,,,,58.30,N,Y
4072722,OP CEPHALEXIN 250 MG / 5,PHA,A,253,,,,,,63.70,N,Y
4072723,OP PENICILLN VK 250 MG /,PHA,A,253,,,,,,23.05,N,Y
4072724,OP SULFA 200 MG / TMP 40,PHA,A,253,,,,,,43.65,N,Y
4072725,OP CEFPROZIL 125 MG / 5 M,PHA,A,253,,,,,,84.00,N,Y
4072726,OP TAMIFLU 6 MG/ML SUSP 6,PHA,A,253,,,,,,686.45,N,Y
4072727,OP ELECTROLYTE ORAL SOLUT,PHA,A,253,,,,,,10.35,N,Y
4072728,OP NEOMYCIN/POLY B/BACITR,PHA,A,253,,,,,,59.05,N,Y
4072729,OP GENTAMICIN 0.3% OPHTH,PHA,A,253,,,,,,25.60,N,Y
4072730,OP GENTAMICIN 0.3% OPHTH,PHA,A,253,,,,,,80.15,N,Y
4072731,OP TOBRA/DEX OPHTH SUSP 2,PHA,A,253,,,,,,177.10,N,Y
4072732,OP POLY B / TRIMETH OPHTH,PHA,A,253,,,,,,30.00,N,Y
4072733,OP ANTIPYRINE / BENZOCAIN,PHA,A,253,,,,,,34.85,N,Y
4072734,OP NEOMYCIN / POLY B / HC,PHA,A,253,,,,,,218.20,N,Y
4072735,OP OFLOXACIN 0.3% OTIC SO,PHA,A,253,,,,,,84.60,N,Y
4072736,OP VENTOLIN HFA MDI 8 GM,PHA,A,253,,,,,,104.00,N,Y
4072737,OP DOUBLE ANTIBIOTIC OINT,PHA,A,253,,,,,,11.35,N,Y
4072738,OP NYSTATIN OINT 15 GM,PHA,A,253,,,,,,38.60,N,Y
4072739,OP SILVER SULFADIAZINE 1%,PHA,A,253,,,,,,33.75,N,Y
4072740,OP SILVER SULFADIAZINE 1%,PHA,A,253,,,,,,92.50,N,Y
4072741,OP TRIAMCINOLONE ACETONID,PHA,A,253,,,,,,22.10,N,Y
4072742,AMITIZA 24 MCG CAP,PHA,A,250,,,,,,20.55,N,Y
4072743,METHYLPREDNISOLONE 4 MG D,PHA,A,250,,,,,,37.50,N,Y
4072744,OP TAKE HOME MEDICATION,PHA,A,253,,,,,,1.00,N,Y
4072745,ALBUTEROL 0.042% 1.25 MG/,PHA,A,250,,,,,,13.30,N,Y
4072746,PERFOROMIST 20 MCG / 2 ML,PHA,A,250,,,,,,31.25,N,Y
4072747,PROMETHAZINE 12.5 MG TAB,PHA,A,250,,,,,,2.45,N,Y
4072748,SODIUM CHLORIDE 0.9% 50 M,PHA,A,250,,,,,,32.15,N,Y
4072749,KETOROLAC 15 MG/ML 1 ML S,PHA,A,250,,,,,,33.50,N,Y
4072750,ABREVA 10% CREAM 2 GM,PHA,A,250,,,,,,71.60,N,Y
4072751,CEFEPIME 2 GM / 50 ML,PHA,A,250,,,,,,156.10,N,Y
4072752,CEFAZOLIN 2 GM / 50 ML,PHA,A,250,J0690,,,,,110.50,N,Y
4072753,OFIRMEV 1000 MG / 100 ML,PHA,A,250,,,,,,263.45,N,Y
4072754,TRANEXAMIC ACID 100 MG/ML,PHA,A,250,,,,,,57.95,N,Y
4072755,PROBENECID 500 MG / COLCH,PHA,A,250,,,,,,5.10,N,Y
4072756,EXPAREL 1.3% 13.3 MG/ML 2,PHA,A,250,,,,,,"1,241.50",N,Y
4072757,CREON 3000 UNITS CAP,PHA,A,250,,,,,,7.25,N,Y
4072758,ACETAMINOPHEN / CODEINE O,PHA,A,250,,,,,,28.75,N,Y
4072759,BUPROPION 75 MG TAB,PHA,A,250,,,,,,2.85,N,Y
4072760,OP CLOTRIMAZOLE / BETAMET,PHA,A,253,,,,,,80.65,N,Y
4072761,DIAZEPAM 2.5 MG RECTAL GE,PHA,A,250,,,,,,476.10,N,Y
4072762,DIAZEPAM 10 MG RECTAL GEL,PHA,A,250,,,,,,509.35,N,Y
4072763,MOM CONCENTRATE 400 ML,PHA,A,250,,,,,,36.00,N,Y
4072764,ALBUTEROL 0.021% 0.63 MG,PHA,A,250,,,,,,14.90,N,Y
4072765,SODIUM CHLORIDE 0.9% 500,PHA,A,250,,,,,,30.55,N,Y
4072766,ATROPINE 0.1 MG/ML 10 ML,PHA,A,250,,,,,,66.50,N,Y
4072767,LIDOCAINE 2% 20 MG/ML 5 M,PHA,A,250,,,,,,55.70,N,Y
4072768,ROPINIROLE ER 4 MG TAB,PHA,A,250,,,,,,22.30,N,Y
4072769,sodium chloride 4 mEq/ml 30 ml SDV,PHA,A,250,,,,,,58.35,N,N
4072770,Estradiol 0.075 mg/day patch,PHA,A,250,,,,,,55.35,N,Y
4072771,LUMIGAN 0.01%OPHTH 2.5ML,PHA,A,250,,,,,,314.80,N,N
4072772,DR FILLMANS MMV WITH DOXY,PHA,A,250,,,,,,55.35,N,N
4072773,BUPROPIOM 100 MG TAB,PHA,A,250,,,,,,3.30,N,Y
4072774,rifaximin 550 mg tab,PHA,A,250,,,,,,147.00,N,N
4072775,TPN amino acids 4.25% / dextrose 10% 2 L,PHA,A,250,,,,,,145.65,N,N
4072776,cefdinir 125 mg / 5 ml susp 60 ml,PHA,A,250,,,,,,50.20,N,N
4072777,levetiracetam 100 mg/ml 5 ml SDV,PHA,A,250,,,,,,48.60,N,N
4072778,wheat dextrin powder 144 gm,PHA,A,250,,,,,,34.60,N,N
4072779,TPN amino acids 5% / dextrose 20% 2000 m,PHA,A,250,,,,,,338.50,N,N
4072780,Hyophen tab,PHA,A,250,,,,,,2.15,N,N
4072781,potassium phosphate 3 mM P/ml 15 ml SDV,PHA,A,250,,,,,,132.80,N,N
4072782,cyclophosphamide 50 mg tab,PHA,A,250,,,,,,46.35,N,N
4072783,lactobacillus GG 15 billion cells cap,PHA,A,250,,,,,,2.10,N,N
4072784,TPN amino acids 5% / dextrose 20% 1000 m,PHA,A,250,,,,,,212.00,N,N
4072785,ertapenem 1 gm ADV,PHA,A,250,,,,,,423.20,N,N
4072786,rOPINIRole 2 mg ER tab,PHA,A,250,,,,,,5.40,N,N
4072787,rivaroxaban 15 mg tab,PHA,A,250,,,,,,44.65,N,N
4072788,sildenafil 20 mg tab,PHA,A,250,,,,,,7.10,N,N
4072789,mometasone 220 mcg per inhalation DPI #,PHA,A,250,,,,,,150.20,N,N
4072790,venlafaxine 25 mg immediate release tab,PHA,A,250,,,,,,2.45,N,N
4072791,tobramycin 1.2 gm vial,PHA,A,250,,,,,,332.25,N,N
4072792,valganciclovir 450 mg tab,PHA,A,250,,,,,,314.00,N,N
4072793,tacrolimus 5 mg cap,PHA,A,250,,,,,,47.10,N,N
4072794,prasugrel 10 mg tab,PHA,A,250,,,,,,73.10,N,N
4072795,apixaban 2.5 mg tab,PHA,A,250,,,,,,23.35,N,N
4072796,mirabegron 25 mg ER tab,PHA,A,250,,,,,,48.95,N,N
4072797,saxagliptin 25 mg tab,PHA,A,250,,,,,,56.80,N,N
4072798,roflumilast 500 mcg tab,PHA,A,250,,,,,,39.35,N,N
4072799,ziprasidone 20 mg cap,PHA,A,250,,,,,,4.65,N,N
4072800,bifantis 4 mg cap,PHA,A,250,,,,,,3.30,N,N
4072801,memantine 28 mg ER cap,PHA,A,250,,,,,,49.50,N,N
4072802,COMPOUND Dr.Fillman's Magic MW w/ Doxy,PHA,A,250,,,,,,152.70,N,N
4072803,aminocaproic acid 500 mg tab,PHA,A,250,,,,,,28.35,N,N
4072804,sirolimus 0.5 mg tab,PHA,A,250,,,,,,33.00,N,N
4072805,mesalamine HD 800 mg tab,PHA,A,250,,,,,,35.45,N,N
4072806,nafcillin 2 gm ADV,PHA,A,250,,,,,,150.60,N,N
4072807,naltrexone 50 mg tab,PHA,A,250,,,,,,5.10,N,N
4072808,morphine 50 mg/ml 20 ml SDV,PHA,A,250,,,,,,94.90,N,N
4072809,aliskiren 300 mg tab,PHA,A,250,,,,,,31.70,N,N
4072810,op Ventolin HFA 18 gm,PHA,A,253,,,,,,105.20,N,N
4072811,albuterol 90 mcg/inhalation MDI 18 gm,PHA,A,250,,,,,,48.60,N,N
4072812,budesonide 160 mcg / formoterol 4.5 mcg,PHA,A,250,,,,,,299.65,N,N
4072813,vancomycin 750 mg vial,PHA,A,250,,,,,,90.95,N,N
4072814,budesonide 80 mcg / formoterol 4.5 mcg,PHA,A,250,,,,,,299.65,N,N
4072815,ticagrelor 90 mg tab,PHA,A,250,,,,,,29.75,N,N
4072816,ofloxacin 0.3% ophth soln 5 ml,PHA,A,250,,,,,,40.70,N,N
4072817,insulin aspart 100 units/ml [3 ml pen],PHA,A,250,,,,,,127.25,N,N
4072818,insulin detemir 100 units/ml [3 ml pen],PHA,A,250,,,,,,213.90,N,N
4072819,insulin glargine 100 units/ml [3 ml pen],PHA,A,250,,,,,,147.40,N,N
4072820,IVPB linezolid 600 mg / 300 ml,PHA,A,250,,,,,,210.90,N,N
4072821,benztropine 0.5 mg tab,PHA,A,250,,,,,,2.40,N,N
4072822,tizanidine 2 mg tab,PHA,A,250,,,,,,5.10,N,N
4072823,oseltamivir 30 mg cap,PHA,A,250,,,,,,42.10,N,N
4072824,triamcinolone 0.1% cream 454 gm,PHA,A,250,,,,,,79.20,N,N
4072825,Eucerin cream 454 gm,PHA,A,250,,,,,,48.15,N,N
4072826,op ciprofloxacin 0.3% ophth soln 2.5 ml,PHA,A,253,,,,,,20.70,N,N
4072827,olodaterol 2.5 mcg/actuation MDI 4 gm,PHA,A,250,,,,,,268.30,N,N
4072828,lubiprostone 8 mcg cap,PHA,A,250,,,,,,29.45,N,N
4072829,vitamin B complex cap,PHA,A,250,,,,,,0.15,N,N
4072830,caspofungin 50 mg vial,PHA,A,250,,,,,,390.45,N,N
4072831,olanzapine 10 mg vial,PHA,A,250,,,,,,136.65,N,N
4072832,canagliflozin 100 mg tab,PHA,A,250,,,,,,70.40,N,N
4072833,fluphenazine 1 mg tab,PHA,A,250,,,,,,2.50,N,N
4072834,nicotine polacrilex 2 mg gum,PHA,A,250,,,,,,0.05,N,N
4072835,brinzolamide/brimonidine ophth susp 8 ml,PHA,A,250,,,,,,294.35,N,N
4072836,lurasidone 80 mg tab,PHA,A,250,,,,,,189.55,N,N
4072837,rotigotine 1 mg / 24 hours transdermal p,PHA,A,250,,,,,,107.20,N,N
4072838,cefdinir 300 mg cap,PHA,A,250,,,,,,7.40,N,N
4072839,IVPB magnesium 2 gm / 50 ml premix,PHA,A,250,,,,,,120.25,N,N
4072840,cyclosporine 0.05% ophth emulsion 0.4 ml,PHA,A,250,,,,,,26.15,N,N
4072841,nadolol 80 mg tab,PHA,A,250,,,,,,14.85,N,N
4072842,vitamin D 5000 units tab,PHA,A,250,,,,,,0.10,N,N
4072843,flumazenil 0.1 mg/ml 10 ml vial,PHA,A,250,,,,,,75.15,N,N
4072844,fluconazole 200 mg tab,PHA,A,250,,,,,,6.30,N,N
4072845,insulin glargine 100 units/ml [3 ml],PHA,A,250,,,,,,253.20,N,N
4072846,nadolol 20 mg tab,PHA,A,250,,,,,,16.25,N,N
4072856,hepatitis B ped/adol 10 mcg / 0.5 ml,PHA,A,250,,,,,,1.00,N,N
4073000,LEUCOVORIN CALCIUM PER 50,PHA,A,636,J0640,,,,,45.45,N,Y
,,PHA,A,636,J0640,,,,,7.10,N,Y
4073001,FLUOROURACIL 50 MG/ML [PE,PHA,A,636,J9190,,,,,108.85,N,Y
4073002,"EPOGEN 5,000 UNITS",PHA,A,636,Q0136,,,,,153.50,N,Y
4073003,SOLU-MEDROL 1 GM VIAL,PHA,A,250,,,,,,162.90,N,Y
4073004,ROFERON-A PER 3MIU,PHA,A,636,J9213,,,,,70.77,N,Y
4073005,"EPOGEN 7,000 UNITS",PHA,A,636,Q0136,,,,,214.50,N,Y
4073006,"EPOGEN 8,000 UNITS",PHA,A,636,Q0136,,,,,245.00,N,Y
4073007,"EPOGEN 10,000 UNITS",PHA,A,634,Q0136,,,,,306.00,N,Y
4073008,"EPOGEN 14,000 UNITS",PHA,A,636,Q0136,,,,,428.50,N,Y
4073009,"EPOGEN 15,000 UNITS",PHA,A,636,Q0136,,,,,458.50,N,Y
4073010,"EPOGEN 20,000 UNITS",PHA,A,636,Q0136,,,,,611.50,N,Y
4073011,"EPOGEN 25,000 UNITS",PHA,A,635,Q0136,,,,,764.50,N,Y
4073012,"EPOGEN 30,000 UNITS",PHA,A,635,Q0136,,,,,917.00,N,Y
4073013,"EPOGEN 35,000 UNITS",PHA,A,635,Q0136,,,,,"1,070.00",N,Y
4073014,"EPOGEN 40,000 UNITS",PHA,A,636,Q0136,,,,,"1,222.50",N,Y
4073015,"EPOGEN 45,000 UNITS",PHA,A,635,Q0136,,,,,"1,375.50",N,Y
4073016,"EPOGEN 50,000 UNITS",PHA,A,635,Q0136,,,,,"1,528.00",N,Y
4073017,"EPOGEN 55,000 UNITS",PHA,A,635,Q0136,,,,,"1,681.00",N,Y
4073018,"EPOGEN 60,000 UNITS",PHA,A,635,Q0136,,,,,"1,833.50",N,Y
4073019,ANZEMET PER 10MG,PHA,A,636,J1260,,,,,15.78,N,Y
4073020,CAMPTOSAR PER 20MG,PHA,A,636,J9206,,,,,289.15,N,Y
4073021,iron sucrose 20 mg/ml 5 ml SDV per 1 mg,PHA,A,636,J1756,,,,,1.20,N,Y
4073022,VANCOMYCIN PER 500 MG,PHA,A,636,J3370,,,,,9.10,N,Y
4073023,NEUPOGEN 480 MCG VIAL,PHA,A,636,J1441,,,,,"1,263.20",N,Y
,,PHA,A,636,J1441,,,,,"1,598.80",N,Y
4073024,CEFTRIAXONE 250 MG VIAL,PHA,A,636,J0696,,,,,33.30,N,Y
4073025,ARANESP PER 1 MCG (NON-ES,PHA,A,636,J0881,EC,,,,13.15,N,Y
4073026,GEMCITABINE PER 200 MG,PHA,A,636,J9201,,,,,646.65,N,Y
4073027,VELCADE PER 0.1 MG,PHA,A,636,J9041,,,,,69.15,N,Y
4073028,REMICADE 100 MG / 20 ML V,PHA,A,636,J1745,,,,,166.05,N,Y
4073029,ETOPOSIDE 100 MG / 5 ML M,PHA,A,636,J9181,,,,,102.55,N,Y
4073031,CEFTRIAXONE PER 250 MG IV,PHA,A,636,J0696,,,,,11.00,N,N
4073032,CEFAZOLIN per 500 mg,PHA,A,636,J0690,,,,,7.40,N,N
4073033,ganciclovir IV per 500 mg,PHA,A,636,,,,,,449.10,N,N
4073034,ferumoxytol per 1 mg,PHA,A,636,Q0138,,,,,3.55,N,N
4073035,febuxostat 40 mg tab,PHA,A,250,,,,,,46.65,N,N
4073036,BELATACEPT [per 1 mg],PHA,A,636,J0485,,,,,8.00,N,N
4073079,PEAK FLOW METER,PHA,A,250,,,,,,52.38,N,Y
4073080,filgrastim per 1 mcg,PHA,A,636,J1442,,,,,3.60,N,N
4073081,mitomycin 40 mg vial,PHA,A,636,J7315,,,,,"1,333.10",N,N
4073082,nafcillin 10 gm vial,PHA,A,250,,,,,,602.50,N,N
4073083,denosumab [per 1 mg],PHA,A,636,,,,,,26.75,N,N
4073084,atorvastatin 20 mg tab,PHA,A,250,,,,,,3.25,N,N
4073085,Carimune per 500 mg,PHA,A,636,,,,,,51.45,N,N
4073086,daptomycin [per 1 mg],PHA,A,636,J0878,,,,,2.40,N,N
4073087,natalizumab 20 mg/ml 15 ml [per 1 mg],PHA,A,636,J2323,,,,,30.00,N,N
4073088,edaravone IV per 1 mg,PHA,A,636,C9493,,,,,27.15,N,N
4073089,paliperidone IM [per 1 mg],PHA,A,636,,,,,,14.25,N,N
4073090,omalizumab per 5 mg,PHA,A,636,,,,,,53.20,N,N
4073091,ferric carboxymaltose IV per 1 mg,PHA,A,636,,,,,,4.20,N,N
4073092,aripiprazole IM injection [per 1 mg],PHA,A,636,,,,,,7.10,N,N
4073093,amoxicillin 875 mg tab,PHA,A,250,,,,,,3.15,N,N
4073094,epoetin alfa 2000 units/ml 1 ml SDV,PHA,A,636,,,,,,124.84,N,N
4073095,epoetin alfa 4000 units/ml 1 ml SDV,PHA,A,636,,,,,,249.68,N,N
4073096,certolizumab pegol 200 mg vial,PHA,A,636,,,,,,"2,063.75",N,N
4073097,rabies immune globulin 300 units/ml 1 ml,PHA,A,636,90375,,,,,984.54,N,N
4073500,OP AZITHROMYCIN 250 MG TA,PHA,A,250,,,,,,23.00,N,Y
4073501,HYDROCO 5/APAP 500 #15 OP,PHA,A,250,,,,,,9.64,N,Y
4073502,OP NITROFURANTOIN MACROCR,PHA,A,253,,,,,,51.20,N,Y
4073503,VIOXX 25MG TAB #6 OP,PHA,A,250,,,,,,39.50,N,Y
4073504,OP CEPHALEXIN 250 MG CAPS,PHA,A,253,,,,,,10.40,N,Y
4073505,OP AMOXICILLIN 250 MG CAP,PHA,A,253,,,,,,6.35,N,Y
4073506,OP AMOXICILLIN 250 MG CHE,PHA,A,253,,,,,,7.44,N,Y
4073507,OP LEVOFLOXACIN 250 MG TA,PHA,A,253,,,,,,7.55,N,Y
4073508,OP AMOXICILLIN / K CLAVUL,PHA,A,253,,,,,,31.10,N,Y
4073509,OP SULFA 800 MG / TMP 160,PHA,A,253,,,,,,9.20,N,Y
4073510,OP CLARITHROMYCIN 250 MG,PHA,A,250,,,,,,5.10,N,Y
4073511,PROPOX-N/APAP TAB #18 OP,PHA,A,250,,,,,,12.24,N,Y
4073512,OP TETRACYCLINE 250 MG CA,PHA,A,253,,,,,,7.85,N,Y
4073513,OP CYCLOBENZAPRINE 10 MG,PHA,A,250,,,,,,6.80,N,Y
4073514,MECLIZINE 25MG TAB #12 OP,PHA,A,250,,,,,,8.00,N,Y
4073515,OP PROMETHAZINE 25 MG SUP,PHA,A,253,,,,,,100.70,N,Y
4073516,OP PYRIDIUM PLUS TABS #6,PHA,A,250,,,,,,31.31,N,Y
4073517,OP DIPHENHYDRAMINE 25 MG,PHA,A,253,,,,,,5.00,N,Y
4073518,OP LEVAQUIN 500 MG TABS #,PHA,A,253,,,,,,8.30,N,Y
4073519,OP PENICILLIN VK 250 MG T,PHA,A,253,,,,,,11.75,N,Y
4073520,OP ERY-TAB 333 MG TABS #9,PHA,A,253,,,,,,5.15,N,Y
4073521,OP CEPHALEXIN 500 MG CAPS,PHA,A,253,,,,,,11.00,N,Y
4073522,OP CEFUROXIME 250 MG TABS,PHA,A,253,,,,,,30.80,N,Y
4073523,OP AMOXICILLIN / K CLAVUL,PHA,A,253,,,,,,42.80,N,Y
4073524,AUGMENTIN 250MG TAB #9 OP,PHA,A,250,,,,,,68.00,N,Y
4073525,OP TRAMADOL 50 MG TABS #1,PHA,A,253,,,,,,10.40,N,Y
4073526,OP IBUPROFEN 400 MG TABS,PHA,A,253,,,,,,9.50,N,Y
4073527,OP IBUPROFEN 600 MG TABS,PHA,A,253,,,,,,7.70,N,Y
4073528,OP ACETAMINOPHEN 120 MG P,PHA,A,253,,,,,,5.00,N,Y
4073529,APAP/CODEINE TAB #15 OP,PHA,A,250,,,,,,11.95,N,Y
4073530,OP PROCHLORPERAZINE 25 MG,PHA,A,253,,,,,,16.40,N,Y
4073531,OP PROMETHAZINE 12.5 MG S,PHA,A,253,,,,,,100.25,N,Y
4073532,OP PROMETHAZINE 50 MG SUP,PHA,A,253,,,,,,6.65,N,Y
4073533,OP LORATADINE 10 MG TABS,PHA,A,253,,,,,,5.00,N,Y
4073534,OP HYDROXYZINE HCL 25 MG,PHA,A,253,,,,,,8.60,N,Y
4073535,OP MUCINEX 600 MG TABS #6,PHA,A,253,,,,,,9.60,N,Y
4073536,OP VALACYCLOVIR 1 GM TABS,PHA,A,253,,,,,,14.80,N,Y
4073537,OP ALPRAZOLAM 0.25 MG TAB,PHA,A,253,,,,,,7.35,N,Y
4073538,OP DIAZEPAM 5 MG TABS #6,PHA,A,250,,,,,,7.20,N,Y
4073539,OP PREDNISONE 5 MG TABS #,PHA,A,253,,,,,,12.20,N,Y
4073540,OP PSEUDOEPHEDRINE 30 MG,PHA,A,250,,,,,,8.40,N,Y
4073541,OP FAMOTIDINE 20 MG TABS,PHA,A,253,,,,,,5.00,N,Y
4073542,OP LOPERAMIDE 2 MG CAPS #,PHA,A,253,,,,,,5.00,N,N
4073543,METOCLOPR 10MG TAB #12 OP,PHA,A,253,,,,,,5.80,N,Y
4073544,PRILOSEC 20MG CAP #3 OP,PHA,A,253,,,,,,29.57,N,Y
4073545,OP ALBUTEROL 0.083% 2.5 M,PHA,A,253,,,,,,13.75,N,Y
4073546,OP ALBUTEROL / IPRATROPIU,PHA,A,253,,,,,,16.50,N,Y
4073547,OP FUROSEMIDE 40 MG TABS,PHA,A,253,,,,,,5.45,N,Y
4073548,PREVACID 30MG CAP #3 OP,PHA,A,253,,,,,,5.59,N,Y
4073549,OP APAP 300 MG / CODEINE,PHA,A,253,,,,,,13.00,N,Y
4073550,OP HYDROCODONE 5 MG / APA,PHA,A,253,,,,,,9.00,N,Y
4073551,OP PROPOXYPHENE 100 MG /,PHA,A,253,,,,,,9.00,N,Y
4073552,OP METOCLOPRAMIDE 5 MG TA,PHA,A,253,,,,,,39.20,N,Y
4073553,OP DOXYCYCLINE 100 MG TAB,PHA,A,253,,,,,,24.80,N,Y
4073554,PREVACID 15MG CAP #6 OP,PHA,A,253,,,,,,8.55,N,Y
4073555,OP SINGULAIR 10 MG TABS #,PHA,A,253,,,,,,10.75,N,Y
4073556,OP SINGULAIR 4 MG CHEW TA,PHA,A,253,,,,,,17.85,N,Y
4073557,OP PROTONIX 40 MG TABS #3,PHA,A,253,,,,,,6.35,N,Y
4073558,OP ORPHENADRINE 100 MG ER,PHA,A,253,,,,,,5.15,N,Y
4073559,OP HYDROCODONE 5 MG / APA,PHA,A,253,,,,,,32.50,N,Y
4073560,MAXIPIME 2GM VIAL,PHA,A,250,,,,,,100.75,N,Y
4073561,EPOGEN PER 1000 UNITS [NO,PHA,A,636,J0885,EC,,,,46.05,N,Y
4073562,CAFFEINE / SODIUM BENZOAT,PHA,A,250,,,,,,41.86,N,Y
4073563,INFLUENZA VACCINE OP,PHA,A,250,90658,,,,,118.00,N,Y
4073564,RECOMBIVAX HB ADULT 10 MC,PHA,A,250,90746,,,,,225.25,N,Y
4073565,PODOCON-25 TOPICAL SOLN 1,PHA,A,250,,,,,,172.04,N,Y
4073566,NEULASTA 6 MG SYRINGE,PHA,A,250,,,,,,"7,482.21",N,Y
4073567,OP MECLIZINE 12.5 MG TABS,PHA,A,253,,,,,,5.00,N,Y
4073568,NEULASTA 6 MG SYRINGE,PHA,A,636,J2505,,,,,"6,195.50",N,Y
4073569,OP CLINDAMYCIN 150 MG CAP,PHA,A,250,,,,,,31.40,N,Y
4073570,OP TAMIFLU 75 MG CAPS #6,PHA,A,253,,,,,,255.20,N,Y
4073571,EPOGEN PER 1000 UNITS [ES,PHA,A,636,J0886,,,,,46.05,N,Y
4073572,ARANESP PER 1 MCG (ESRD),PHA,A,636,J0882,,,,,13.20,N,Y
4073573,RITUXAN PER 100 MG,PHA,A,636,J9310,,,,,"1,382.75",N,Y
4073574,CAMPATH PER 10 MG,PHA,A,636,J9010,,,,,"1,515.69",N,Y
4073575,DEXAMETHASONE 4 MG/ML PER,PHA,A,636,J1100,,,,,5.30,N,Y
,,PHA,A,636,J1100,,,,,0.60,N,Y
4073576,OP PROCHLORPERAZINE 5 MG,PHA,A,253,,,,,,5.40,N,Y
4073577,OP COLCHICINE 0.6 MG TABS,PHA,A,250,,,,,,7.50,N,Y
4073578,ENOXAPARIN PER 10 MG,PHA,A,636,J1650,,,,,5.75,N,Y
4073579,OP PHENAZOPYRIDINE 100 MG,PHA,A,253,,,,,,47.00,N,Y
4073580,OP NITROGLYCERIN 0.4 MG S,PHA,A,253,,,,,,95.90,N,Y
4073581,OP ONDANSETRON 4 MG ORALL,PHA,A,253,,,,,,17.60,N,Y
4073582,BONIVA SYRINGE PER 1 MG,PHA,A,636,J1740,,,,,600.20,N,Y
,,PHA,A,636,J1740,,,,,600.20,N,Y
4073584,OP BUDESONIDE 0.5 MG 2 ML,PHA,A,253,,,,,,272.00,N,Y
4073585,OP OMEPRAZOLE 20 MG CAP #,PHA,A,253,,,,,,7.25,N,Y
4073586,OP NABUMETONE 500 MG TABS,PHA,A,253,,,,,,8.30,N,Y
4073587,OP BUTALBITAL / ASPIRIN /,PHA,A,253,,,,,,30.30,N,Y
4073588,OP CIPROFLOXACIN 250 MG T,PHA,A,253,,,,,,7.40,N,Y
4073589,GAMUNEX 10% PER 500 MG,PHA,A,636,,,,,,61.30,N,Y
4073590,DILTIAZEM 100 MG ADV,PHA,A,250,,,,,,97.00,N,Y
4073591,HYDROCODONE / ACETAMINOPH,PHA,A,250,,,,,,115.20,N,Y
4073592,OP PREDNISONE 20 MG TABS,PHA,A,253,,,,,,11.30,N,Y
4073593,BENLYSTA PER 10 MG,PHA,A,636,J0490,,,,,55.35,N,Y
4073594,OP METRONIDAZOLE 250 MG T,PHA,A,253,,,,,,38.60,N,Y
4073595,OP NAPROXEN 250 MG TABS #,PHA,A,253,,,,,,7.25,N,Y
4073596,vinorelbine 10 mg/ml 5 ml SDV per 10 mg,PHA,A,250,,,,,,107.70,N,N
4073597,op cefdinir 125 mg / 5 ml susp 60 ml,PHA,A,253,,,,,,48.85,N,N
4073598,op sucralfate 1 gm / 10 ml susp cups #4,PHA,A,253,,,,,,130.20,N,N
4073599,op albuterol 0.021% 0.63 mg / 3 ml #5,PHA,A,253,,,,,,24.00,N,N
4073600,darboepoetin [per 1 mcg] (500 mcg syr),PHA,A,636,,,,,,10.00,N,N
4073601,C1 esterase inhibitor,PHA,A,636,,,,,,0.00,N,N
4073602,op amoxicillin 875 mg tabs #6,PHA,A,253,,,,,,11.90,N,N
4076000,DRUGS MED NON COV PO,PHA,A,253,,,,,,0.00,N,Y
4077000,PRE OP MEDICATION VISIT,PHA,A,990,,,,,,0.00,N,N
4080017,ANESTHESIA,ANS,A,370,99999,,,,,54.00,N,Y
4080018,ANESTHESIST FEE PER UNIT,ANS,A,370,99999,,,,,93.00,N,Y
4080019,ANESTHESIA FEE PER MINUTE,ANS,A,370,99999,,,,,6.50,N,Y
4080020,EPIDURAL,ANS,A,370,99999,,,,,651.50,N,Y
4080021,TRIGGER POINT INJECTION,ANS,A,370,99999,,,,,439.50,N,Y
4080022,ANESTHESIA PER UNIT,ANS,A,370,99999,,,,,93.00,N,Y
4080023,PIC LINE/ MED LINE INSERTION,ANS,A,370,36556,,,,,475.00,N,N
4080024,INSERT AIRWAY,ANS,A,370,,,,,,240.00,N,Y
4080025,"INJECTION, BRACHIAL PLEXUS",ANS,A,370,64415,,,,,275.00,N,Y
4080026,STEROID INJECTION,ANS,A,370,27096,,,,,285.00,N,N
4080027,SI INJECTION WITH IMAGING,ANS,A,370,27096,,,,,350.00,N,N
4080028,LARG JOINT /BURSA/SHD/KN - SINGLE OR BIL,ANS,A,370,20610,,,,,121.00,N,N
4080029,PICC WO SUB PORT AGE 5 TO OLDER,ANS,A,370,36569,,,,,475.00,N,N
4080030,"EPIDURAL, BLOOD OR CLOT PATCH",ANS,A,370,62273,,,,,315.00,N,Y
4080452,CK LANG COMP GOAL STATUS,ST,A,440,,,,,,,N,N
4090001,SPEECH TREATMENT,ST,A,440,92507,GN,,,,144.00,N,Y
4090003,EVAL SWALLOWING FUNCTION,ST,A,440,92610,GN,,,,215.00,N,Y
4090004,SWALLOW TREATMENT,ST,A,440,92526,GN,,,,129.50,N,Y
4090006,MODIFIED BARIUM SWALLOW,ST,A,440,92611,GN,,,,216.00,N,Y
4090007,EVAL OF APHASIA,ST,A,440,96105,GN,,,,136.50,N,Y
4090008,EVAL OF COGNTION,ST,A,440,96125,GN,,,,180.00,N,Y
4090009,DEVELOPMENT TEST EXTENDED,ST,A,440,96110,GN,,,,254.00,N,Y
4090010,THER EX/PROCEDURE PER 15 MIN,ST,A,440,97110,GN,59,,,77.00,N,Y
4090011,NEUROMUSCULAR REEDUCATION,ST,A,440,97112,GN,,,,77.00,N,Y
4090013,SELF CARE HOME MANG PER 1,ST,A,440,97535,GN,,,,54.00,N,Y
4090014,THER ACTIVITIES 15 MIN,ST,A,440,97530,GN,,,,54.00,N,Y
4090015,SPEECH GRP TX (PROC),ST,A,440,92508,GN,,,,79.00,N,Y
4090016,THERAPEUTIC PROCEDURE GROUP,ST,A,440,97150,GN,,,,44.00,N,Y
4090017,SENSORY INTETRATION (P15M,ST,A,440,97533,GN,,,,61.50,N,Y
4090018,COMM WK INTEGR ( PER15MN),ST,A,440,97537,GN,,,,61.50,N,Y
4090019,EVAL SPEECH DEVICE,ST,A,440,,,,,,238.00,N,Y
4090020,TX SPEECH DEVICE,ST,A,440,,,,,,154.00,N,Y
4090021,RE-VAL SPEECH DEVICE (PRO,ST,A,440,,,,,,203.50,N,Y
4090022,EVAL VOICE PROSTHETIC PRO,ST,A,440,,,,,,238.00,N,Y
4090023,VOICE PROSTH TRAIN/MOD PR,ST,A,440,,,,,,152.00,N,Y
4090024,SPEECH EVAL OF SPEECH FLUENCY,ST,A,440,92521,GN,,,,154.00,N,N
4090025,EVAL SPEECH SOUND PRODUCTION,ST,A,440,92522,GN,,,,125.00,N,N
4090026,EVAL SPEECH SD PROD WITH EVAL LANGCOMP E,ST,A,440,92523,GN,,,,260.00,N,N
4090027,BEHAVORIAL QUALANALYSIS VOICE RESONA,ST,A,440,92524,GN,,,,160.00,N,N
4090028,AAC EVAL NON-SPEECH-GEN DEVICE 1 HR,ST,A,440,92605,,,,,160.00,N,N
4090029,AAC EVAL NON-SPEECH GEN DEVICE ADD 30 MI,ST,A,440,92618,,,,,45.00,N,N
4090030,TX SERVICES FOR USE OF NON-SPEECH GEN,ST,A,440,92606,,,,,120.00,N,N
4090031,AAC EVAL SPEECH-GEN DEVICE 1 HR,ST,A,440,92607,,,,,210.00,N,N
4090032,AAC EVAL SPEECH-GEN DEVICE ADD 30 MINS,ST,A,440,92608,,,,,85.00,N,N
4090033,TX SERVICES FOR USE OF SPEECH GEN DEVICE,ST,A,440,92609,,,,,175.00,N,N
4090034,TEAM CONFERENCE W/ PT OR FAMILY 30 MIN,ST,A,440,,,,,,55.00,N,N
4090035,TEAM CONFERENCE W/O PT OR FAMILY 30 MIN,ST,A,440,99368,,,,,50.00,N,N
4090400,CH SWALLOW CURR STATUS,ST,A,440,G8996,GN,CI,,,0.01,N,N
4090401,CI SWALLOW CURR STATUS,ST,A,440,G8996,GN,CI,,,0.01,N,N
4090402,CJ SWALLOW CURR STATUS,ST,A,440,G8996,GN,CJ,,,0.01,N,N
4090403,CK SWALLOW CURR STATUS,ST,A,440,G8996,GN,CK,,,0.01,N,N
4090404,CL SWALLOW CURR STATUS,ST,A,440,G8996,GN,CL,,,0.01,N,N
4090405,CM SWALLOW CURR STATUS,ST,A,440,G8996,GN,CM,,,0.01,N,N
4090406,CN SWALLOW CURR STATUS,ST,A,440,G8996,GN,CN,,,0.01,N,N
4090407,CH SWALLOW GOAL STATUS,ST,A,440,G8997,GN,CH,,,0.01,N,N
4090408,CI SWALLOW GOAL STATUS,ST,A,440,G8997,GN,CI,,,0.01,N,N
4090409,CJ SWALLOW GOAL STATUS,ST,A,440,G8997,GN,CJ,,,0.01,N,N
4090410,CK SWALLOW GOAL STATUS,ST,A,440,G8997,GN,CK,,,0.01,N,N
4090411,CL SWALLOW GOAL STATUS,ST,A,440,G8997,GN,CL,,,0.01,N,N
4090412,CM SWALLOW GOAL STATUS,ST,A,440,G8997,GN,CM,,,0.01,N,N
4090413,CN SWALLOW GOAL STATUS,ST,A,440,G8997,GN,CN,,,0.01,N,N
4090414,CH SWALLOW DC STATUS,ST,A,440,G8998,GN,CH,,,0.01,N,N
4090415,CI SWALLOW DC STATUS,ST,A,440,G8998,GN,CI,,,0.01,N,N
4090416,CJ SWALLOW DC STATUS,ST,A,440,G8998,GN,CJ,,,0.01,N,N
4090417,CK SWALLOW DC STATUS,ST,A,440,G8998,GN,CK,,,0.01,N,N
4090418,CL SWALLOW DC STATUS,ST,A,440,G8998,GN,CL,,,0.01,N,N
4090419,CM SWALLOW DC STATUS,ST,A,440,G8998,GN,CM,,,0.01,N,N
4090420,CN SWALLOW DC STATUS,ST,A,440,G8998,GN,CN,,,0.01,N,N
4090421,CH MOTOR SP CURR STATUS,ST,A,440,G8999,GN,CH,,,0.01,N,N
4090422,CI MOTOR SP CURR STATUS,ST,A,440,G8999,GN,CI,,,0.01,N,N
4090423,CJ MOTOR SP CURR STATUS,ST,A,440,G8999,GN,CJ,,,0.01,N,N
4090424,CK MOTOR SP CURR STATUS,ST,A,440,G8999,GN,CK,,,0.01,N,N
4090425,CL MOTOR SP CURR STATUS,ST,A,440,G8999,GN,CL,,,0.01,N,N
4090426,CM MOTOR SP CURR STATUS,ST,A,440,G8999,GN,CM,,,0.01,N,N
4090427,CN MOTOR SP CURR STATUS,ST,A,440,G8999,GN,CN,,,0.01,N,N
4090428,CH MOTOR SP GOAL STATUS,ST,A,440,G9186,GN,CH,,,0.01,N,N
4090429,CI MOTOR SP GOAL STATUS,ST,A,440,G9186,GN,CI,,,0.01,N,N
4090430,CJ MOTOR SP GOAL STATUS,ST,A,440,G9186,GN,CJ,,,0.01,N,N
4090431,CK MOTOR SP GOAL STATUS,ST,A,440,G9186,GN,CK,,,0.01,N,N
4090432,CL MOTOR SP GOAL STATUS,ST,A,440,G9186,GN,CL,,,0.01,N,N
4090433,CM MOTOR SP GOAL STATUS,ST,A,440,G9186,GN,CM,,,0.01,N,N
4090434,CN MOTOR SP GOAL STATUS,ST,A,440,G9186,GN,CN,,,0.01,N,N
4090435,CH MOTOR SPEECH DC STATUS,ST,A,440,G9158,GN,CH,,,0.01,N,N
4090436,CI MOTOR SPEECH DC STATUS,ST,A,440,G9158,GN,CI,,,0.01,N,N
4090437,CJ MOTOR SPEECH DC STATUS,ST,A,440,G9158,GN,CJ,,,0.01,N,N
4090438,CK MOTOR SPEECH DC STATUS,ST,A,440,G9158,GN,CK,,,0.01,N,N
4090439,CL MOTOR SPEECH DC STATUS,ST,A,440,G9158,GN,CL,,,0.01,N,N
4090440,CM MOTOR SPEECH DC STATUS,ST,A,440,G9158,GN,CM,,,0.01,N,N
4090441,CN MOTOR SPEECH DC STATUS,ST,A,440,G9158,GN,CN,,,0.01,N,N
4090442,CH LANG COMP CURR STATUS,ST,A,440,G9159,GN,CH,,,0.01,N,N
4090443,CI LANG COMP CURR STATUS,ST,A,440,G9159,GN,CI,,,0.01,N,N
4090444,CJ LANG COMP CURR STATUS,ST,A,440,G9159,GN,CJ,,,0.01,N,N
4090445,CK LANG COMP CURR STATUS,ST,A,440,G9159,GN,CK,,,0.01,N,N
4090446,CL LANG COMP CURR STATUS,ST,A,440,G9159,GN,CL,,,0.01,N,N
4090447,CM LANG COMP CURR STATUS,ST,A,440,G9159,GN,CM,,,0.01,N,N
4090448,CN LANG COMP CURR STATUS,ST,A,440,G9159,GN,CN,,,0.01,N,N
4090449,CH LANG COMP GOAL STATUS,ST,A,440,G9160,GN,CH,,,0.01,N,N
4090450,CI LANG COMP GOAL STATUS,ST,A,440,G9160,GN,CI,,,0.01,N,N
4090451,CJ LANG COMP GOAL STATUS,ST,A,440,G9160,GN,CJ,,,0.01,N,N
4090452,CK LANG COMP GOAL STATUS,ST,A,440,G9160,GN,CK,,,0.01,N,N
4090453,CL LANG COMP GOAL STATUS,ST,A,440,G9160,GN,CL,,,0.01,N,N
4090454,CM LANG COMP GOAL STATUS,ST,A,440,G9160,GN,CM,,,0.01,N,N
4090455,CN LANG COMP GOAL STATUS,ST,A,440,G9160,GN,CN,,,0.01,N,N
4090456,CH LANG COMP DC STATUS,ST,A,440,G9161,GN,CH,,,0.01,N,N
4090457,CI LANG COMP DC STATUS,ST,A,440,G9161,GN,CI,,,0.01,N,N
4090458,CJ LANG COMP DC STATUS,ST,A,440,G9161,GN,CJ,,,0.01,N,N
4090459,CK LANG COMP DC STATUS,ST,A,440,G9161,GN,CK,,,0.01,N,N
4090460,CL LANG COMP DC STATUS,ST,A,440,G9161,GN,CL,,,0.01,N,N
4090461,CM LANG COMP DC STATUS,ST,A,440,G9161,GN,CM,,,0.01,N,N
4090462,CN LANG COMP DC STATUS,ST,A,440,G9161,GN,CN,,,0.01,N,N
4090463,CH LANG EXPRESS CURR STAT,ST,A,440,G9162,GN,CH,,,0.01,N,N
4090464,CI LANG EXPRESS CURR STAT,ST,A,440,G9162,GN,CI,,,0.01,N,N
4090465,CJ LANG EXPRESS CURR STAT,ST,A,440,G9162,GN,CJ,,,0.01,N,N
4090466,CK LANG EXPRESS CORR STAT,ST,A,440,G9162,GN,CK,,,0.01,N,N
4090467,CL LANG EXPRESS CURR STAT,ST,A,440,G9162,GN,CL,,,0.01,N,N
4090468,CM LANG EXPRESS CURR STAT,ST,A,440,G9162,GN,CM,,,0.01,N,N
4090469,CN LANG EXPRESS CURR STAT,ST,A,440,G9162,GN,CN,,,0.01,N,N
4090470,CH LANG EXPRESS GOAL STAT,ST,A,440,G9163,GN,CH,,,0.01,N,N
4090471,CI LANG EXPRESS GOAL STAT,ST,A,440,G9163,GN,CI,,,0.01,N,N
4090472,CJ LANG EXPRESS GOAL STAT,ST,A,440,G9163,GN,CJ,,,0.01,N,N
4090473,CK LANG EXPRESS GOAL STAT,ST,A,440,G9163,GN,CK,,,0.01,N,N
4090474,CL LANG EXPRESS GOAL STAT,ST,A,440,G9163,GN,CL,,,0.01,N,N
4090475,CM LANG EXPRESS GOAL STAT,ST,A,440,G9163,GN,CM,,,0.01,N,N
4090476,CN LANG EXPRESS GOAL STAT,ST,A,440,G9163,GN,CN,,,0.01,N,N
4090477,CH LANG EXPRESS DC STATUS,ST,A,440,G9164,GN,CH,,,0.01,N,N
4090478,CI LANG EXPRESS DC STATUS,ST,A,440,G9164,GN,CI,,,0.01,N,N
4090479,CJ LANG EXPRESS DC STATUS,ST,A,440,G9164,GN,CJ,,,0.01,N,N
4090480,CK LANG EXPRESS DC STATUS,ST,A,440,G9164,GN,CK,,,0.01,N,N
4090481,CL LANG EXPRESS DC STATUS,ST,A,440,G9164,GN,CL,,,0.01,N,N
4090482,CM LANG EXPRESS DC STATUS,ST,A,440,G9164,GN,CM,,,0.01,N,N
4090483,CN LANG EXPRESS DC STATUS,ST,A,440,G9164,GN,CN,,,0.01,N,N
4090484,CH ATTEN CURR STATUS,ST,A,440,G9165,GN,CH,,,0.01,N,N
4090485,CI ATTEN CURR STATUS,ST,A,440,G9165,GN,CI,,,0.01,N,N
4090486,CJ ATTEN CURR STATUS,ST,A,440,G9165,GN,CJ,,,0.01,N,N
4090487,CK ATTEN CURR STATUS,ST,A,440,G9165,GN,CK,,,0.01,N,N
4090488,CL ATTEN CURR STATUS,ST,A,440,G9165,GN,CL,,,0.01,N,N
4090489,CM ATTEN CURR STATUS,ST,A,440,G9165,GN,CM,,,0.01,N,N
4090490,CN ATTEN CURR STATUS,ST,A,440,G9165,GN,CN,,,0.01,N,N
4090491,CH ATTEN GOAL STATUS,ST,A,440,G9166,GN,CH,,,0.01,N,N
4090492,CI ATTEN GOAL STATUS,ST,A,440,G9166,GN,CI,,,0.01,N,N
4090493,CJ ATTEN GOAL STATUS,ST,A,440,G9166,GN,CJ,,,0.01,N,N
4090494,CK ATTEN GOAL STATUS,ST,A,440,G9166,GN,CK,,,0.01,N,N
4090495,CL ATTEN GOAL STATUS,ST,A,440,G9166,GN,CL,,,0.01,N,N
4090496,CM ATTEN GOAL STATUS,ST,A,440,G9166,GN,CM,,,0.01,N,N
4090497,CN ATTEN GOAL STATUS,ST,A,440,G9166,GN,CN,,,0.01,N,N
4090498,CH ATTEN DC STATUS,ST,A,440,G9167,GN,CH,,,0.01,N,N
4090499,CI ATTEN DC STATUS,ST,A,440,G9167,GN,CI,,,0.01,N,N
4090500,CJ ATTEN DC STATUS,ST,A,440,G9167,GN,CJ,,,0.01,N,N
4090501,CK ATTEN DC STATUS,ST,A,440,G9167,GN,CK,,,0.01,N,N
4090502,CL ATTEN DC STATUS,ST,A,440,G9167,GN,CL,,,0.01,N,N
4090503,CM ATTEN DC STATUS,ST,A,440,G9167,GN,CM,,,0.01,N,N
4090504,CN ATTEN DC STATUS,ST,A,440,G9167,GN,CN,,,0.01,N,N
4090505,CH MEMORY CURR STATUS,ST,A,440,G9168,GN,CH,,,0.01,N,N
4090506,CI MEMORY CURR STATUS,ST,A,440,G9168,GN,CI,,,0.01,N,N
4090507,CJ MEMORY CURR STATUS,ST,A,440,G9168,GN,CJ,,,0.01,N,N
4090508,CK MEMORY CURR STATUS,ST,A,440,G9168,GN,CK,,,0.01,N,N
4090509,CL MEMORY CURR STATUS,ST,A,440,G9168,GN,CK,,,0.01,N,N
4090510,CM MEMORY CURR STATUS,ST,A,440,G9168,GN,CM,,,0.01,N,N
4090511,CN MEMORY CURR STATUS,ST,A,440,G9168,GN,CN,,,0.01,N,N
4090512,CH MEMORY GOAL STATUS,ST,A,440,G9169,GN,CH,,,0.01,N,N
4090513,CI MEMORY GOAL STATUS,ST,A,440,G9169,GN,CI,,,0.01,N,N
4090514,CJ MEMORY GOAL STATUS,ST,A,440,G9169,GN,CJ,,,0.01,N,N
4090515,CK MEMORY GOAL STATUS,ST,A,440,G9169,GN,CK,,,0.01,N,N
4090516,CL MEMORY GOAL STATUS,ST,A,440,G9169,GN,CL,,,0.01,N,N
4090517,CM MEMORY GOAL STATUS,ST,A,440,G9169,GN,CM,,,0.01,N,N
4090518,CN MEMORY GOAL STATUS,ST,A,440,G9169,GN,CN,,,0.01,N,N
4090519,CH MEMORY DC STATUS,ST,A,440,G9170,GN,CH,,,0.01,N,N
4090520,CI MEMORY DC STATUS,ST,A,440,G9170,GN,CI,,,0.01,N,N
4090521,CJ MEMORY DC STATUS,ST,A,440,G9170,GN,CJ,,,0.01,N,N
4090522,CK MEMORY DC STATUS,ST,A,440,G9170,GN,CK,,,0.01,N,N
4090523,CL MEMORY DC STATUS,ST,A,440,G9170,GN,CL,,,0.01,N,N
4090524,CM MEMORY DC STATUS,ST,A,440,G9170,GN,CM,,,0.01,N,N
4090525,CN MEMORY DC STATUS,ST,A,440,G9170,GN,CN,,,0.01,N,N
4090526,CH VOICE CURR STATUS,ST,A,440,G9171,GN,CH,,,0.01,N,N
4090527,CI VOICE CURR STATUS,ST,A,440,G9171,GN,CI,,,0.01,N,N
4090528,CJ VOICE CURR STATUS,ST,A,440,G9171,GN,CJ,,,0.01,N,N
4090529,CK VOICE CURR STATUS,ST,A,440,G9171,GN,CK,,,0.01,N,N
4090530,CL VOICE CURR STATUS,ST,A,440,G9171,GN,CL,,,0.01,N,N
4090531,CM VOICE CURR STATUS,ST,A,440,G9171,GN,CM,,,0.01,N,N
4090532,CN VOICE CURR STATUS,ST,A,440,G9171,GN,CN,,,0.01,N,N
4090533,CH VOICE GOAL STATUS,ST,A,440,G9172,GN,CH,,,0.01,N,N
4090534,CI VOICE GOAL STATUS,ST,A,440,G9172,GN,CI,,,0.01,N,N
4090535,CJ VOICE GOAL STATUS,ST,A,440,G9172,GN,CJ,,,0.01,N,N
4090536,CK VOICE GOAL STATUS,ST,A,440,G9172,GN,CK,,,0.01,N,N
4090537,CL VOICE GOAL STATUS,ST,A,440,G9172,GN,CL,,,0.01,N,N
4090538,CM VOICE GOAL STATUS,ST,A,440,G9172,GN,CM,,,0.01,N,N
4090539,CN VOICE GOAL STATUS,ST,A,440,G9172,GN,CN,,,0.01,N,N
4090540,CH VOICE DC STATUS,ST,A,440,G9173,GN,CH,,,0.01,N,N
4090541,CI VOICE DC STATUS,ST,A,440,G9173,GN,CI,,,0.01,N,N
4090542,CJ VOICE DC STATUS,ST,A,440,G9173,GN,CJ,,,0.01,N,N
4090543,CK VOICE DC STATUS,ST,A,440,G9173,GN,CK,,,0.01,N,N
,,ST,A,440,G9173,GN,CK,,,0.01,N,N
4090544,CL VOICE DC STATUS,ST,A,440,G9173,GN,CL,,,0.01,N,N
,,ST,A,440,G9173,GN,CL,,,0.01,N,N
4090545,CM VOICE DC STATUS,ST,A,440,G9173,GN,CM,,,0.01,N,N
,,ST,A,440,G9173,GN,CM,,,0.01,N,N
4090546,CN VOICE DC STATUS,ST,A,440,G9173,GN,CN,,,0.01,N,N
,,ST,A,440,G9173,GN,CN,,,0.01,N,N
4090547,CH SPEECH LANG CURR STAT,ST,A,440,G9174,GN,CH,,,0.01,N,N
,,ST,A,440,G9174,GN,CH,,,0.01,N,N
4090548,CI SPEECH LANG CURR STAT,ST,A,440,G9174,GN,CI,,,0.01,N,N
,,ST,A,440,G9174,GN,CI,,,0.01,N,N
4090549,CJ SPEECH LANG CURR STAT,ST,A,440,G9174,GN,CJ,,,0.01,N,N
,,ST,A,440,G9174,GN,CJ,,,0.01,N,N
4090550,CK SPEECH LANG CURR STAT,ST,A,440,G9174,GN,CK,,,0.01,N,N
4090551,CL SPEECH LANG CURR STAT,ST,A,440,G9174,GN,CL,,,0.01,N,N
4090552,CM SPEECH LANG CURR STAT,ST,A,440,G9174,GN,CM,,,0.01,N,N
4090553,CN SPEECH LANG CURR STAT,ST,A,440,G9174,GN,CN,,,0.01,N,N
4090554,CH SPEECH LANG GOAL STAT,ST,A,440,G9175,GN,CH,,,0.01,N,N
4090555,CI SPEECH LANG GOAL STAT,ST,A,440,G9175,GN,CI,,,0.01,N,N
4090556,CJ SPEECH LANG GOAL STAT,ST,A,440,G9175,GN,CJ,,,0.01,N,N
4090557,CK SPEECH LANG GOAL STAT,ST,A,440,G9175,GN,CK,,,0.01,N,N
,,ST,A,440,G9175,GN,CK,,,0.01,N,N
4090558,CL SPEECH LANG GOAL STAT,ST,A,440,G9175,GN,CL,,,0.01,N,N
4090559,CM SPEECH LANG GOAL STAT,ST,A,440,G9175,GN,CM,,,0.01,N,N
4090560,CN SPEECH LANG GOAL STAT,ST,A,440,G9175,GN,CN,,,0.01,N,N
4090561,CH SPEECH LANG DC STATUS,ST,A,440,G9176,GN,CH,,,0.01,N,N
4090562,CI SPEECH LANG DC STATUS,ST,A,440,G9176,GN,CI,,,0.01,N,N
4090563,CJ SPEECH LANG DC STATUS,ST,A,440,G9176,GN,CJ,,,0.01,N,N
4090564,CK SPEECH LANG DC STATUS,ST,A,440,G9176,GN,CK,,,0.01,N,N
4090565,CL SPEECH LANG DC STATUS,ST,A,440,G9176,GN,CL,,,0.01,N,N
4090566,CM SPEECH LANG DC STATUS,ST,A,440,G9176,GN,CM,,,0.01,N,N
4090567,CN SPEECH LANG DC STATUS,ST,A,440,G9176,GN,CN,,,0.01,N,N
4090568,DEV OF COG SKILLS/MEDICARE (PER 15 MIN),ST,A,440,G0515,GN,,,,74.00,N,N
4090569,DEV OF COG SKILLS/INS (PROC),ST,A,440,97127,GN,,,,135.00,N,N
4100005,RADIOLOGICAL EX SURG SPEC,MAM,A,320,76098,,,,,102.00,N,Y
4100006,CAD SCREENING MAMMOGRAPHY,MAM,A,403,77052,,,,,53.00,N,Y
4100007,CAD DIAGNOSTIC MAMMOGRAPH,MAM,A,401,77051,,,,,53.00,N,Y
4100008,SCREENING MAMMOGRAM DIGIT,MAM,A,403,77067,,,,,450.00,N,Y
4100009,DIAGNOSTIC MAMMOGRAM DIGI,MAM,A,401,77066,,,,,485.00,N,Y
4100011,UNILATERAL MAMMOGRAM DIGI,MAM,A,401,77065,,,,,392.00,N,Y
4100012,DIGITAL SCREEN MAMMO UNI,MAM,A,403,77067,,,,,450.00,N,Y
4100013,MG SCREENING TOMO BREAST,MAM,A,403,77063,,,,,43.00,N,N
4100014,MG DIAGNOSTIC TOMO BREAST,MAM,A,401,G0279,,,,,43.00,N,N
4100015,"MAMMOGRAM DIAGNOSTIC, UNILATERAL",MAM,A,401,77065,,,,,444.00,N,N
4100016,MAMMOGRAM DIAGNOSTIC BILATERAL,MAM,A,401,77066,,,,,621.00,N,N
4100017,MAMMOGRAM SCREENING,MAM,A,403,77067,,,,,502.00,N,N
4100018,MAMMOGRAM SCREENING UNILATERAL,MAM,A,403,77067,,,,,449.00,N,N
4100019,TOMO UNILATERAL,MAM,A,401,G0279,,,,,43.00,N,N
4110039,HALF DAY OXYGEN,INH,A,270,,,,,,123.50,N,Y
4110040,WHOLE DAY OXYGEN,INH,A,270,,,,,,245.00,N,Y
4130001,INIT/DISCH EVAL,PT,A,420,97001,GP,,,,167.50,N,Y
4130002,RE-EVAL.SHORT EVAL.,PT,A,424,97002,GP,,,,56.50,N,Y
4130015,BIO FEEDBACK,PT,A,420,90901,GP,,,,89.00,N,Y
4130016,BIO FEEDBACK ANORECTAL,PT,A,420,90911,GP,,,,133.00,N,Y
4130017,MECHANICAL TRACT PER PROC,PT,A,420,97012,GP,,,,49.50,N,Y
4130018,ELECT STIMULATIONS UNATTED,PT,A,420,G0283,GP,59,,,61.50,N,Y
4130019,VASOPNEUMATIC PER PROC,PT,A,420,97016,GP,59,,,46.00,N,Y
4130020,PARAFFIN BATH PER PROC,PT,A,420,97018,GP,59,,,54.00,N,Y
4130021,WHIRLPOOL,PT,A,420,97022,GP,59,,,71.00,N,Y
4130030,THER.EX/PROCEDURE PER15 MIN,PT,A,420,97110,GP,59,,,77.00,N,Y
4130034,THERAPEUTIC ACTDIVITY 15MIN,PT,A,420,97530,GP,,,,54.00,N,Y
4130036,GAIT TR/15 MIN,PT,A,420,97116,GP,,,,77.00,N,Y
4130038,MANUAL ELEC STIM 15 MIN,PT,A,420,97032,GP,59,,,65.50,N,Y
4130040,MANUAL THERAPY/TRACT 15MIN,PT,A,420,97140,GP,,,,63.00,N,Y
4130041,MASSAGE 15 MIN,PT,A,420,97124,GP,,,,54.00,N,Y
4130042,CONTRAST BATH 15 MIN,PT,A,420,97034,GP,59,,,79.00,N,Y
4130043,ULTRASOUND 15 MIN,PT,A,420,97035,GP,59,,,59.00,N,Y
4130046,SELF CARE/HOME MNGMNT 15M,PT,A,420,97535,GP,,,,54.00,N,Y
4130049,TENS APPLICATION,PT,A,420,64550,GP,,,,54.00,N,Y
4130051,ORTHOTIC TR/15 MIN,PT,A,420,97760,GP,,,,62.00,N,Y
4130053,PROSTHETIC TR/15MIN,PT,A,420,97761,GP,,,,61.50,N,Y
4130090,IONTOPHORESIS 15 MIN,PT,A,420,97033,GP,59,,,75.00,N,Y
4130105,WOUND MGMT FIRST 20SQ CM,PT,A,420,97597,GP,,,,35.00,N,Y
4130106,WOUND MGMT EA ADD 20SQ CM,PT,A,420,97598,GP,,,,20.00,N,Y
4130107,WOUND MGMT W/O WHIRLPOOL,PT,A,420,97602,GP,,,,72.00,N,Y
4130165,CI SELF CARE CURR STATUS,PT,A,420,,,,,,,N,N
4130171,AQUATIC THERAPY W/EX 15MN,PT,A,420,97113,GP,,,,65.50,N,Y
4130172,NEUROMUSCULAR RE-ED 15MIN,PT,A,420,97112,GP,59,,,77.00,N,Y
4130173,THERAPEUTIC PROCEDURE GROUP,PT,A,420,97150,GP,,,,44.00,N,Y
4130175,BURN RX SMALL,PT,A,420,16020,GP,,,,115.50,N,Y
4130176,BURN RX MEDIUM,PT,A,420,16025,GP,,,,233.50,N,Y
4130177,BURN RX LARGE,PT,A,420,16030,GP,,,,267.00,N,Y
4130178,STRAPPING SHOULDER,PT,A,420,29240,,,,,31.50,N,Y
4130179,STRAPPING ELBOW OR WRIST,PT,A,420,29260,,,,,26.50,N,Y
4130180,STRAPPING HAND OR FINGER,PT,A,420,29280,,,,,21.00,N,Y
4130181,STRAPPING HIP/TRUNK,PT,A,420,29520,,,,,31.50,N,Y
4130182,STRAPPING KNEE,PT,A,420,29530,,,,,31.50,N,Y
4130183,STRAPPING ANKLE OR FOOT,PT,A,420,29540,,,,,26.50,N,Y
4130184,POST OFFER SCREENS,PT,A,424,97161,,,,,100.00,N,N
4130185,ORTHOTIC/ PROSTHETIC CHECK,PT,A,420,97763,,,,,58.00,N,N
4130301,CANALITH REPOSITIONING/DAY,PT,A,420,95992,GP,,,,70.00,N,N
4130400,CH MOBILITY CURR STATUS,PT,A,420,G8978,GP,CH,,,0.01,N,N
4130401,CI MOBILITY CURR STATUS,PT,A,420,G8978,GP,CI,,,0.01,N,N
4130402,CJ MOBILITY CURR STATUS,PT,A,420,G8978,GP,CJ,,,0.01,N,N
4130403,CK MOBILITY CURR STATUS,PT,A,420,G8978,GP,CK,,,0.01,N,N
4130404,CL MOBILITY CURR STATUS,PT,A,420,G8978,GP,CL,,,0.01,N,N
4130405,CM MOBILITY CURR STATUS,PT,A,420,G8978,GP,CM,,,0.01,N,N
4130406,CN MOBILITY CURR STATUS,PT,A,420,G8978,GP,CN,,,0.01,N,N
4130408,CH MOBILITY GOAL STATUS,PT,A,420,G8979,GP,CH,,,0.01,N,N
4130409,CI MOBILITY GOAL STATUS,PT,A,420,G8979,GP,CI,,,0.01,N,N
4130410,CJ MOBILITY GOAL STATUS,PT,A,420,G8979,GP,CJ,,,0.01,N,N
4130411,CK MOBILITY GOAL STATUS,PT,A,420,G8979,GP,CK,,,0.01,N,N
4130412,CL MOBILITY GOAL STATUS,PT,A,420,G8979,GP,CL,,,0.01,N,N
4130413,CM MOBILITY GOAL STATUS,PT,A,420,G8979,GP,CM,,,0.01,N,N
4130414,CN MOBILITY GOAL STATUS,PT,A,420,G8979,GP,CN,,,0.01,N,N
4130415,CH MOBILITY DC STATUS,PT,A,420,G8980,GP,CH,,,0.01,N,N
4130416,CI MOBILITY DC STATUS,PT,A,420,G8980,GP,CI,,,0.01,N,N
4130417,CJ MOBILITY DC STATUS,PT,A,420,G8980,GP,CJ,,,0.01,N,N
4130418,CK MOBILITY DC STATUS,PT,A,420,G8980,GP,CK,,,0.01,N,N
4130419,CL MOBILITY DC STATUS,PT,A,420,G8980,GP,CL,,,0.01,N,N
4130420,CM MOBILITY DC STATUS,PT,A,420,G8980,GP,CM,,,0.01,N,N
4130421,CN MOBILITY DC STATUS,PT,A,420,G8980,GP,CN,,,0.01,N,N
4130422,CH BODY POS CURR STATUS,PT,A,420,G8981,GP,CH,,,0.01,N,N
4130423,CI BODY POS CURR STATUS,PT,A,420,G8981,GP,CI,,,0.01,N,N
4130424,CJ BODY POS CURR STATUS,PT,A,420,G8981,GP,CJ,,,0.01,N,N
4130425,CK BODY POS CURR STATUS,PT,A,420,G8981,GP,CK,,,0.01,N,N
4130426,CL BODY POS CURR STATUS,PT,A,420,G8981,GP,CL,,,0.01,N,N
4130427,CM BODY POS CURR STATUS,PT,A,420,G8981,GP,CM,,,0.01,N,N
4130428,CN BODY POS CURR STATUS,PT,A,420,G8981,GP,CN,,,0.01,N,N
4130429,CH BODY POS GOAL STATUS,PT,A,420,G8982,GP,CH,,,0.01,N,N
4130430,CI BODY POS GOAL STATUS,PT,A,420,G8982,GP,CI,,,0.01,N,N
4130431,CJ BODY POS GOAL STATUS,PT,A,420,G8982,GP,CJ,,,0.01,N,N
4130432,CK BODY POS GOAL STATUS,PT,A,420,G8982,GP,CK,,,0.01,N,N
4130433,CL BODY POS GOAL STATUS,PT,A,420,G8982,GP,CL,,,0.01,N,N
4130434,CM BODY POS GOAL STATUS,PT,A,420,G8982,GP,CM,,,0.01,N,N
4130435,CN BODY POS GOAL STATUS,PT,A,420,G8982,GP,CN,,,0.01,N,N
4130436,CH BODY POS DC STATUS,PT,A,420,G8983,GP,CH,,,0.01,N,N
4130437,CI BODY POS DC STATUS,PT,A,420,G8983,GP,CI,,,0.01,N,N
4130438,CJ BODY POS DC STATUS,PT,A,420,G8983,GP,CJ,,,0.01,N,N
4130439,CK BODY POS DC STATUS,PT,A,420,G8983,GP,CK,,,0.01,N,N
4130440,CL BODY POS DC STATUS,PT,A,420,G8983,GP,CL,,,0.01,N,N
4130441,CM BODY POS DC STATUS,PT,A,420,G8983,GP,CM,,,0.01,N,N
4130442,CN BODY POS DC STATUS,PT,A,420,G8983,GP,CN,,,0.01,N,N
4130443,CH CARRY CURR STATUS,PT,A,420,G8984,GP,CH,,,0.01,N,N
4130444,CI CARRY CURR STATUS,PT,A,420,G8984,GP,CI,,,0.01,N,N
4130445,CJ CARRY CURR STATUS,PT,A,420,G8984,GP,CJ,,,0.01,N,N
4130446,CK CARRY CURR STATUS,PT,A,420,G8984,GP,CK,,,0.01,N,N
4130447,CL CARRY CURR STATUS,PT,A,420,G8984,GP,CL,,,0.01,N,N
4130448,CM CARRY CURR STATUS,PT,A,420,G8984,GP,CM,,,0.01,N,N
4130449,CN CARRY CURR STATUS,PT,A,420,G8984,GP,CN,,,0.01,N,N
4130450,CH CARRY GOAL STATUS,PT,A,420,G8985,GP,CH,,,0.01,N,N
4130451,CI CARRY GOAL STATUS,PT,A,420,G8985,GP,CI,,,0.01,N,N
4130452,CJ CARRY GOAL STATUS,PT,A,420,G8985,GP,CJ,,,0.01,N,N
4130453,CK CARRY GOAL STATUS,PT,A,420,G8985,GP,CK,,,0.01,N,N
4130454,CL CARRY GOAL STATUS,PT,A,420,G8985,GP,CL,,,0.01,N,N
4130455,CM CARRY GOAL STATUS,PT,A,420,G8985,GP,CM,,,0.01,N,N
4130456,CN CARRY GOAL STATUS,PT,A,420,G8985,GP,CN,,,0.01,N,N
4130457,CH CARRY DC STATUS,PT,A,420,G8986,GP,CH,,,0.01,N,N
4130458,CI CARRY DC STATUS,PT,A,420,G8986,GP,CI,,,0.01,N,N
4130459,CJ CARRY DC STATUS,PT,A,420,G8986,GP,CJ,,,0.01,N,N
4130460,CK CARRY DC STATUS,PT,A,420,G8986,GP,CK,,,0.01,N,N
4130461,CL CARRY DC STATUS,PT,A,420,G8986,GP,CL,,,0.01,N,N
4130462,CM CARRY DC STATUS,PT,A,420,G8986,GP,CM,,,0.01,N,N
4130463,CN CARRY DC STATUS,PT,A,420,G8986,GP,CN,,,0.01,N,N
4130464,CH SELF CARE CURR STATUS,PT,A,420,G8987,GP,CH,,,0.01,N,N
4130465,CI SELF CARE CURR STATUS,PT,A,420,G8987,GP,CI,,,0.01,N,N
4130466,CJ SELF CARE CURR STATUS,PT,A,420,G8987,GP,CJ,,,0.01,N,N
4130467,CK SLEF CARE CURR STATUS,PT,A,420,G8987,GP,CK,,,0.01,N,N
4130468,CL SELF CARE CURR STATUS,PT,A,420,G8987,GP,CL,,,0.01,N,N
4130469,CM SELF CARE CURR STATUS,PT,A,420,G8987,GP,CM,,,0.01,N,N
4130470,CN SELF CARE CURR STATUS,PT,A,420,G8987,GP,CN,,,0.01,N,N
4130471,CH SELF CARE GOAL STATUS,PT,A,420,G8988,GP,CH,,,0.01,N,N
4130472,CI SELF CARE GOAL STATUS,PT,A,420,G8988,GP,CI,,,0.01,N,N
4130473,CJ SELF CARE GOAL STATUS,PT,A,420,G8988,GP,CJ,,,0.01,N,N
4130474,CK SELF CARE GOAL STATUS,PT,A,420,G8988,GP,CK,,,0.01,N,N
4130475,CL SELF CARE GOAL STATUS,PT,A,420,G8988,GP,CL,,,0.01,N,N
4130476,CM SELF CARE GOAL STATUS,PT,A,420,G8988,GP,CM,,,0.01,N,N
4130477,CN SELF CARE GOAL STATUS,PT,A,420,G8988,GP,CN,,,0.01,N,N
4130478,CH SELF CARE DC STATUS,PT,A,420,G8989,GP,CH,,,0.01,N,N
4130479,CI SELF CARE DC STATUS,PT,A,420,G8989,GP,CI,,,0.01,N,N
4130480,CJ SELF CARE DC STATUS,PT,A,420,G8989,GP,CJ,,,0.01,N,N
4130481,CK SELF CARE DC STATUS,PT,A,420,G8989,GP,CK,,,0.01,N,N
4130482,CL SELF CARE DC STATUS,PT,A,420,G8989,GP,CL,,,0.01,N,N
4130483,CM SELF CARE DC STATUS,PT,A,420,G8989,GP,CM,,,0.01,N,N
4130484,CN SELF CARE DC STATUS,PT,A,420,G8989,GP,CN,,,0.01,N,N
4130485,CH OTHER PT CURR STATUS,PT,A,420,G8990,GP,CH,,,0.01,N,N
4130486,CI OTHER PT CURR STATUS,PT,A,420,G8990,GP,CI,,,0.01,N,N
4130487,CJ OTHER PT CURR STATUS,PT,A,420,G8990,GP,CJ,,,0.01,N,N
4130488,CK OTHER PT CURR STATUS,PT,A,420,G8990,GP,CK,,,0.01,N,N
4130489,CL OTHER PT CURR STATUS,PT,A,420,G8990,GP,CL,,,0.01,N,N
4130490,CM OTHER PT CURR STATUS,PT,A,420,G8990,GP,CM,,,0.01,N,N
4130491,CN OTHER PT CURR STATUS,PT,A,420,G8990,GP,CN,,,0.01,N,N
4130492,CH OTHER PT GOAL STATUS,PT,A,420,G8991,GP,CH,,,0.01,N,N
4130493,CI OTHER PT GOAL STATUS,PT,A,420,G8991,GP,CI,,,0.01,N,N
4130494,CJ OTHER PT GOAL STATUS,PT,A,420,G8991,GP,CJ,,,0.01,N,N
4130495,CK OTHERPT GOAL STATUS,PT,A,420,G8991,GP,CK,,,0.01,N,N
4130496,CL OTHER PT GOAL STATUS,PT,A,420,G8991,GP,CL,,,0.01,N,N
4130497,CM OTHER PT GOAL STATUS,PT,A,420,G8991,GP,CM,,,0.01,N,N
4130498,CN OTHER PT GOAL STATUS,PT,A,420,G8991,GP,CN,,,0.01,N,N
4130499,CH OTHER PT DC STATUS,PT,A,420,G8992,GP,CH,,,0.01,N,N
4130500,CI OTHER PT DC STATUS,PT,A,420,G8992,GP,CI,,,0.01,N,N
4130501,CJ OTHER PT DC STATUS,PT,A,420,G8992,GP,CJ,,,0.01,N,N
4130502,CK OTHER PT DC STATUS,PT,A,420,G8992,GP,CK,,,0.01,N,N
4130503,CL OTHER PT DC STATUS,PT,A,420,G8992,GP,CL,,,0.01,N,N
4130504,CM OTHER PT DC STATUS,PT,A,420,G8992,GP,CM,,,0.01,N,N
4130505,CN OTHER PT DC STATUS,PT,A,420,G8992,GP,CN,,,0.01,N,N
4130506,CH SUB PT CURR STATUS,PT,A,420,G8993,GP,CH,,,0.01,N,N
4130507,CI SUB PT CURR STATUS,PT,A,420,G8993,GP,CI,,,0.01,N,N
4130508,CJ SUB PT CURR STATUS,PT,A,420,G8993,GP,CJ,,,0.01,N,N
4130509,CK SUB PT CURR STATUS,PT,A,420,G8993,GP,CK,,,0.01,N,N
4130510,CL SUB PT CURR STATUS,PT,A,420,G8993,GP,CL,,,0.01,N,N
4130511,CM SUB PT CURR STATUS,PT,A,420,G8993,GP,CM,,,0.01,N,N
4130512,CN SUB PT CURR STATUS,PT,A,420,G8993,GP,CN,,,0.01,N,N
4130513,CH SUB PT GOAL STATUS,PT,A,420,G8994,GP,CH,,,0.01,N,N
4130514,CI SUB PT GOAL STATUS,PT,A,420,G8994,GP,CI,,,0.01,N,N
4130515,CJ SUB PT GOAL STATUS,PT,A,420,G8994,GP,CJ,,,0.01,N,N
4130516,CK SUB PT GOAL STATUS,PT,A,420,G8994,GP,CK,,,0.01,N,N
4130517,CL SUB PT GOAL STATUS,PT,A,420,G8994,GP,CL,,,0.01,N,N
4130518,CM SUB PT GOAL STATUS,PT,A,420,G8994,GP,CM,,,0.01,N,N
4130519,CN SUB PT GOAL STATUS,PT,A,420,G8994,GP,CN,,,0.01,N,N
4130520,CH SUB PT DC STATUS,PT,A,420,G8995,GP,CH,,,0.01,N,N
4130521,CI SUB PT DC STATUS,PT,A,420,G8995,GP,CI,,,0.01,N,N
4130522,CJ SUB PT DC STATUS,PT,A,420,G8995,GP,CJ,,,0.01,N,N
4130523,CK SUB PT DC STATUS,PT,A,420,G8995,GP,CK,,,0.01,N,N
4130524,CL SUB PT DC STATUS,PT,A,420,G8995,GP,CL,,,0.01,N,N
4130525,CM SUB PT DC STATUS,PT,A,420,G8995,GP,CM,,,0.01,N,N
4130526,CN SUB PT DC STATUS,PT,A,420,G8995,GP,CN,,,0.01,N,N
4132302,EVAL LOW 20,PT,A,420,97161,GP,59,,,167.50,N,N
4132303,EVAL MOD 30,PT,A,420,97162,GP,59,,,167.50,N,N
4132304,EVAL HIGH 40,PT,A,420,97163,GP,59,,,167.50,N,N
4132305,RE EVAL,PT,A,420,97164,GP,59,,,62.00,N,N
4150001,BONE LIMTD NUC MED/JOINT,NUC,A,341,78300,,,,,575.00,N,Y
4150002,BONE NUCLEAR MED WHOLE B,NUC,A,341,78306,,,,,872.00,N,Y
4150003,BONE-REGIONAL NUCLEAR MED,NUC,A,341,78305,,,,,771.00,N,Y
4150004,"LIVER/SPLEEN NUC MED,STAT",NUC,A,341,78215,,,,,620.00,N,Y
4150005,"THYROID NUC MED, SINGLE",NUC,A,341,78014,,,,,"1,485.00",N,Y
4150006,LUNG PERFUSION NUCLEAR ME,NUC,A,341,78582,,,,,729.00,N,Y
4150007,H.B.T.I. NUCLEAR MED,NUC,A,341,78227,,,,,"2,668.00",N,Y
4150008,CARDIAC P.Y.P. NUCLEAR ME,NUC,A,341,78466,,,,,617.00,N,Y
4150009,THYROID-TC99M NUCLEAR MED,NUC,A,341,78018,,,,,"1,094.00",N,Y
4150010,"LUNG INHAL NUC MED,MULTIP",NUC,A,341,78587,,,,,143.00,N,Y
4150011,"R.A.I.U. NUC MED ONLY,SIN",NUC,A,341,78012,,,,,254.00,N,Y
4150012,RENAL NUC MED W/VAS FLOW,NUC,A,341,78701,,,,,826.00,N,Y
4150014,G.I.BLEEDING NUCLEAR MED,NUC,A,341,78278,,,,,"1,168.00",N,Y
4150015,MECKELS NUCLEAR MED,NUC,A,341,78261,,,,,881.00,N,Y
4150017,BILAT.VENOGRAM NUCLEAR ME,NUC,A,341,78458,,,,,744.00,N,Y
4150018,"THYROID 1-123 NUC MD,MULT",NUC,A,341,78014,,,,,"1,485.00",N,Y
4150019,SALIVARY GLND NUC MED W/S,NUC,A,341,78231,,,,,523.00,N,Y
4150020,TESTICULAR NUCLEAR MED,NUC,A,341,78761,,,,,716.00,N,Y
4150026,3-PHASE BONE SCAN,NUC,A,341,78315,,,,,"1,102.00",N,Y
4150028,"TECHNESIUM THYROID,IMAGE",NUC,A,341,78013,,,,,539.00,N,Y
4150029,"MUGA SCAN, SINGLE STUDY",NUC,A,341,78472,,,,,"1,003.00",N,Y
4150030,LUNG PERF/MAA VENT/DTPA,NUC,A,341,78598,,,,,756.00,N,Y
4150031,ISOTOPE (THYR UPTAKE SIN),NUC,A,636,A9512,,,,,278.00,N,Y
,,NUC,A,636,A9531,,,,,278.00,N,Y
4150032,KINEVAC,NUC,A,636,J2805,,,,,107.00,N,Y
4150033,ISOTOPE(THYROID UPTAKE),NUC,A,636,A9516,,,,,465.00,N,Y
4150034,ISOTOPE(THYROID SCAN ONLY,NUC,A,255,A9531,,,,,167.00,N,Y
,,NUC,A,255,A9512,,,,,167.00,N,Y
4150035,ISOTOPE(HEPATOB SCAN),NUC,A,636,A9537,,,,,207.00,N,Y
4150036,ISOTOPE(3 PHASE BONE SCAN,NUC,A,636,A4641,,,,,181.00,N,Y
4150037,ISO 3PBONESCAN TC99 MEDR,NUC,A,636,A9503,,,,,130.00,N,Y
4150038,ISOTOPE HDP WHOLE BODY SC,NUC,A,636,A9503,,,,,181.00,N,Y
4150040,ISOTOPE (LIMITEDBONESCAN),NUC,A,636,A4641,,,,,181.00,N,Y
4150041,ISO TC99MMEDR LIMITED BON,NUC,A,636,A9503,,,,,130.00,N,Y
4150042,ISOTOPE (REST MUGA BLOOD,NUC,A,636,A4641,,,,,252.00,N,Y
4150043,ISO LUNG SCAN VENT&PERFUS,NUC,A,636,A9567,,,,,544.00,N,Y
4150044,ISO LUNG SCANVENTPER(AERO,NUC,A,636,A9567,,,,,258.00,N,Y
4150045,ISO LUNGSCAN VENT ONLY,NUC,A,636,A9540,,,,,324.00,N,Y
,,NUC,A,636,A4641,,,,,324.00,N,Y
4150046,ISO LUNGSCAN PERFUSION,NUC,A,636,A4641,,,,,220.00,N,Y
,,NUC,A,636,A9540,,,,,220.00,N,Y
4150047,"RENAL SCAN, SINGLE W/PHAR",NUC,A,341,78708,,,,,"1,133.00",N,Y
4150049,GASTRIC EMPTYING STUDY,NUC,A,341,78264,,,,,621.00,N,Y
4150050,ISOTOPE GASTRIC EMPTYING,NUC,A,636,A9541,,,,,562.00,N,Y
,,NUC,A,636,A4641,,,,,562.00,N,Y
4150051,RENAL LASIX MAG 3,NUC,A,341,78709,,,,,"1,135.00",N,Y
4150052,TECNNESCAN MAG 3,NUC,A,636,A9562,,,,,648.00,N,Y
4150053,MYOCARDIAL PERF STRESS,NUC,A,341,78452,,,,,999.00,N,Y
4150054,ISOTOPE TC99 SESTMIBI,NUC,A,636,A9500,,,,,555.00,N,Y
4150055,CARDIAC BLOOD POOL IMAGIN,NUC,A,341,78481,,,,,568.00,N,Y
4150056,T99 - MVGA,NUC,A,636,A9560,,,,,252.00,N,Y
4150057,HIDA SCAN WO KINEVAC,NUC,A,341,78226,,,,,529.00,N,Y
4150058,NM LOCALIZING INFLAMMATORY PROCESS WB,NUC,A,341,78806,,,,,594.00,N,N
4150059,TC 99M AUTO WBC,NUC,A,636,A9569,,,,,"4,958.00",N,N
4150132,BONE SPECT,NUC,A,340,78320,,,,,518.00,N,N
4150133,NM PARATHYROID SCAN,NUC,A,340,78071,,,,,810.00,N,N
4200001,"FACE,NECK AN ORBT MRI W/O",MRI,A,611,70540,,,,,"2,064.00",N,Y
4200003,BRAIN MRI W/WO CONTRAST,MRI,A,611,70553,,,,,"5,011.00",N,Y
4200005,BRAIN(CONTRAST)MRI,MRI,A,611,70552,,,,,"2,496.00",N,Y
4200006,"BRAIN(PITUITARY,SELLA,IAC",MRI,A,611,70551,,,,,"2,086.00",N,Y
4200007,CHEST MRI W/O CONTRAST,MRI,A,610,71550,,,,,"2,073.00",N,Y
4200008,CERVICAL SPINE MRI WO CON,MRI,A,612,72141,,,,,"2,087.00",N,Y
4200009,THORACIC SPINE MRI WITH C,MRI,A,612,72147,,,,,"2,496.00",N,Y
4200010,THORACIC SPINE W/O,MRI,A,612,72146,,,,,"2,318.00",N,Y
4200011,LUMBAR SPINE MRI W/O,MRI,A,612,72148,,,,,"2,507.00",N,Y
4200012,LUMBAR (CONTRAST) MRI,MRI,A,612,72149,,,,,"2,496.00",N,Y
4200013,MRI PELVIS W/CONTRAST,MRI,A,612,72196,,,,,"2,481.00",N,Y
4200014,MRI UP EXTRM LNG BNE W/WO,MRI,A,610,73220,,,,,"4,582.00",N,Y
4200015,MRI UP JOINT W/O CONTRAST,MRI,A,610,73221,,,,,"2,064.00",N,Y
4200016,"MRI,LWR EXTR LNG BNE W/WO",MRI,A,610,73720,,,,,"4,582.00",N,Y
4200017,"MRI,LWR EXTREM, JOINT W/O",MRI,A,610,73721,,,,,"2,236.00",N,Y
4200019,ABDOMEN MRI W/O CONTRAST,MRI,A,610,74181,,,,,"2,073.00",N,Y
4200020,HEART MRI W/O CONTRAST,MRI,A,610,,,,,,"2,086.00",N,Y
4200021,C-SPINE W/WO CONTRAST,MRI,A,610,72156,,,,,"4,632.00",N,Y
4200022,MRI CERVICAL SPINE W,MRI,A,610,72142,,,,,"2,498.00",N,Y
4200023,MRI THOTACIC SPINE W/WO,MRI,A,610,72157,,,,,"4,632.00",N,Y
4200024,MRI LUMBAR SPINE W/WO,MRI,A,610,72158,,,,,"4,631.00",N,Y
4200025,MRA HEAD WITH CONTRAST,MRI,A,611,70545,,,,,"2,086.00",N,Y
4200026,OMNISCAN,MRI,A,636,A9579,,,,,230.00,N,Y
4200028,MRI ABDOMEN WO/WITH CONTR,MRI,A,610,74183,,,,,"4,587.00",N,Y
4200029,MRI TMJ(S),MRI,A,610,70336,,,,,"2,086.00",N,Y
4200030,MRA ABDOMEN,MRI,A,610,74185,,,,,"2,086.00",N,Y
4200031,MRI PELVIS W/WO CONTRAST,MRI,A,610,72197,,,,,"2,098.00",N,Y
4200032,MRI ORBIT/FACE/NECK W/WO,MRI,A,610,70543,,,,,"4,582.00",N,Y
4200033,MRI UP EXTR.LNG BONE W/O,MRI,A,610,73218,,,,,"2,564.00",N,Y
4200034,MRI LWR EXT. LNG BONE W/O,MRI,A,610,73718,,,,,"2,564.00",N,Y
4200035,MRI PELVIS W/O CONTRAST,MRI,A,610,72195,,,,,"1,396.00",N,Y
4200036,CHEST W/WO CONTRAST,MRI,A,610,71552,,,,,"4,564.00",N,Y
4200037,MRI UPPER EXT JOINT WO/W,MRI,A,610,73223,,,,,"4,721.00",N,Y
4200038,MRI LOW EXTREM JOINT W/WO,MRI,A,610,73723,,,,,"4,721.00",N,Y
4200039,MRA NECK W &WO CONTRAST,MRI,A,610,70549,,,,,"2,348.00",N,Y
4200040,MRA OF HEAD W/D,MRI,A,610,70544,,,,,"2,086.00",N,Y
4200041,MRA OF UPPER EXTREMITY,MRI,A,611,73225,,,,,"2,086.00",N,Y
4200042,MULTIHANCE,MRI,A,636,A9577,,,,,197.00,N,Y
4200043,MRI UP EXT L BONE W/CONTR,MRI,A,610,73219,,,,,"1,113.00",N,Y
4200044,MRA LOWER EXTREM W/WO CON,MRI,A,611,73725,,,,,"1,675.00",N,Y
4200045,MRI LOW EXT NON JT W/CON,MRI,A,610,73719,,,,,"1,075.00",N,N
4200046,MRA NECK,MRI,A,610,70547,,,,,929.00,N,N
4200047,MRI UPPER JOINE WITH CONTRAST,RAD,A,610,73222,,,,,"1,026.00",N,N
4200048,MRA NECK WITH CONTRAST,MRI,A,610,70548,,,,,"1,099.00",N,N
4210001,MH CLINIC,BEH,A,510,99201,,,,,21.00,N,N
4210048,BASIC METABOLIC PANEL,BEH,A,990,80048,,,,,54.00,N,N
4210053,COMPREHENSIVE METABOLIC PANEL,BEH,A,990,80053,,,,,97.00,N,N
4210074,HEPATITIS PROFILE,BEH,A,990,80074,,,,,232.00,N,N
4210178,LITHIUM,BEH,A,990,80178,,,,,50.00,N,N
4210306,VIT D AS HYDROXY,BEH,A,990,82306,,,,,218.00,N,N
4210471,INJECTION IMMUNIZATION 1,BEH,A,990,90471,,,,,63.00,N,N
4210477,DRUG SCREENING MEDICARE/XIX CLINIC,BEH,A,990,G0477,,,,,40.00,N,N
4210658,INFLUENZA VACCINE 3YR.&UP,BEH,A,990,90658,,,,,50.00,N,N
4210785,INTERACTIVE COMPLEXITY,BEH,A,990,90785,,,,,22.00,N,N
4210791,PSYCHIATRIC DIAG EVALUATION,BEH,A,990,90791,,,,,203.00,N,N
4210792,PSYCHIATRIC DIAG EVAL W/ MED SERVICE,BEH,A,990,90792,,,,,226.00,N,N
4210832,PSYCHOTHERAPY 30 MINUTES W/ PATIENT,BEH,A,990,90832,,,,,102.00,N,N
4210833,PSYCHOTHERAPY 30 MINUTES INCLUDES E/M,BEH,A,990,90833,,,,,104.00,N,N
4210834,PSYCHOTHERAPY 45 MINUTES W/ PATIENT,BEH,A,990,90834,,,,,130.00,N,N
4210836,"PSYCHOTHERAPY, 45 MINUTES INCLUDES E/M",BEH,A,990,90836,,,,,131.00,N,N
4210837,PSYCHOTHERAPY 60 MINUTES W/ PATIENT,BEH,A,990,90837,,,,,203.00,N,N
4210838,PSYCHOTHERAPY 60 MINUTES INCLUDES E/M,BEH,A,990,90838,,,,,175.00,N,N
4210839,PSYCHOTHERAPY FOR CRISIS; FIRST 60 MIN,BEH,A,990,90839,,,,,208.00,N,N
4210840,PSYCHOTHERAPY FOR CRISIS; EACH ADD 30 MI,BEH,A,990,90840,,,,,100.00,N,N
4210846,FAM PSYCHOTHER W/O PT PRESENT 50 MIN,BEH,A,990,90846,,,,,163.00,N,N
4210847,FAM PSYCHOTHERAP W/ PT PRESENT MINS,BEH,A,990,90847,,,,,168.00,N,N
4210853,GROUP PSYCHOTHERAPY,BEH,A,990,90853,,,,,57.00,N,N
4212038,INFLUENZA QUAD VACCINE 0.5ML,BEH,A,990,Q2038,,,,,50.00,N,N
4216127,BRIEF EMOTIONAL/BEH ASSESS,BEH,A,990,96127,,,,,16.00,N,N
4216415,DRAW FEE,BEH,A,990,36415,,,,,18.00,N,N
4218005,"HEALTH PANEL-COMP MET, CBC, TSH",BEH,A,990,80050,,,,,260.00,N,N
4219212,EST VISIT LEVEL 2,BEH,A,990,99212,,,,,98.00,N,N
4219213,EST VISIT LEVEL 3,BEH,A,990,99213,,,,,135.00,N,N
4219214,EST VISIT LEVEL 4,BEH,A,990,99214,,,,,185.00,N,N
4219215,EST VISIT LEVEL 5,BEH,A,990,99215,,,,,250.00,N,N
4219231,SUBS INPATIENT LEVEL 1,BEH,A,990,99231,,,,,59.00,N,N
4219232,SUBS INPATIENT LEVEL 2,BEH,A,990,99232,,,,,96.00,N,N
4219233,SUBS INPATIENT LEVEL 3,BEH,A,990,,,,,,152.00,N,N
4219406,SMOKING CESS. COUNS. 3-10 MIN,BEH,A,990,99406,,,,,21.00,N,N
4219407,SMOKING CESS. COUNS. > 10 MIN,BEH,A,990,99407,,,,,47.00,N,N
4220005,"CARD PHASE II,MONITOR",CRH,A,943,93798,,,,,261.00,N,Y
4240013,WELLNESS HRA HEALTH RISKA,WEL,A,509,,,,,,46.50,N,Y
4240014,WELLNESS BODY COMP ANALY,WEL,A,509,,,,,,26.50,N,Y
4240015,WELLNESS DIET ANALY,WEL,A,509,,,,,,26.50,N,Y
4240016,WELLNESS CPR,WEL,A,509,,,,,,14.00,N,Y
4240017,WELLNESS FIRST AID,WEL,A,509,,,,,,14.00,N,Y
4330001,COMPLETE SPIROMETRY,RT,A,460,94060,,,,,264.00,N,Y
4330002,SIMPLE SPIROMETRY,RT,A,460,94010,,,,,142.00,N,Y
4330005,PULSE OX SINGLE CHECK,RT,A,460,94760,,,,,45.50,N,Y
4330006,MULTIPLE PULSE OX W/EXCER,RT,A,460,94761,,,,,131.50,N,Y
4330008,PULSE OX OVERNITE WI PO,RT,A,460,94762,,,,,218.50,N,Y
4330009,NEBULIZER TREATMENT,RT,A,410,94640,,,,,78.00,N,Y
4330010,AEROSOL TREAT SUBSEQUENT,RT,A,410,94665,,,,,50.50,N,Y
4330011,CPT INITIAL (IN EXPLANA),RT,A,410,94667,,,,,111.00,N,Y
4330012,CPT SUBSEQUENT,RT,A,410,94668,,,,,62.50,N,Y
4330013,FLUTTER VALVE INIT,RT,A,410,94667,,,,,114.00,N,Y
4330015,FLUTTER VALVE SUBSEQUENT,RT,A,410,94668,,,,,48.50,N,Y
4330017,MDI/INITIAL,RT,A,410,94664,,,,,34.00,N,Y
4330031,DEMO FOR AEROSOL TREAT&EV,RT,A,410,G0238,59,,,,75.00,N,Y
4330033,BREATH EXER & ANXIETY RED,RT,A,410,G0237,59,,,,125.00,N,Y
4330035,METHACHOLINE CHALLENGE,RT,A,460,94070,,,,,428.50,N,Y
4330038,PULMONARY STRESS TEST SIM,RT,A,460,94618,,,,,391.50,N,Y
4330039,NIF,RT,A,460,94799,,,,,68.50,N,Y
4330040,SELF CARE MGMT TRAINING,RT,A,410,G0238,59,,,,75.00,N,Y
4330041,CONSUL/ASSESSMENT,RT,A,510,99211,,,,,50.50,N,Y
4330043,POLYSOMNOGRAPHY SLEEP STA,RT,A,740,95810,,,,,"2,843.50",N,Y
4330044,POLYSOMNOGRAPHY W/CPAP,RT,A,740,95811,,,,,"2,843.50",N,Y
4330045,POLYSOMNO SLEEP STAGE MED,RT,A,740,95810,,,,,"2,843.50",N,Y
4330046,POLYSOMNOGRAPH W/CPAP MED,RT,A,740,95811,,,,,"2,843.50",N,Y
4330048,PENTAMIDINE,RT,A,410,94642,,,,,235.00,N,Y
4330049,WELLNESS PULM FCTN TEST,RT,A,410,,,,,,41.50,N,Y
4330050,MDI/SUBSEQUENT,RT,A,410,94640,,,,,29.50,N,Y
4330051,AEROSOL TENT INITIAL,RT,A,410,94664,,,,,89.50,N,Y
4330052,AEROSOL TENT SUBSEQUENT,RT,A,410,94640,,,,,29.50,N,Y
4330053,IS INITIAL,RT,A,460,94667,,,,,67.00,N,Y
4330054,IS SUBSEQUENT,RT,A,460,94668,,,,,54.50,N,Y
4330055,RESP FLOW VOLUME LOOP,RT,A,460,94375,,,,,94.00,N,Y
4330056,MVV (MAX VOLUNTARY VENT),RT,A,460,94200,,,,,67.00,N,Y
4330057,LUNG VOLUMES(HELIUM/NITR),RT,A,460,94727,,,,,94.50,N,Y
4330058,DIFFUSING CAPACITY(DLCO),RT,A,460,94729,,,,,120.00,N,Y
4330059,PFT INTERPRETATION,RT,A,990,94016,,,,,42.50,N,Y
4330060,CONTINUOUS AEROSOL INITIA,RT,A,410,94664,,,,,60.00,N,Y
4330061,CONTINOUS AEROSOL SUBSEQU,RT,A,410,94640,,,,,30.50,N,Y
4330062,SMOKING CESSATION INTERMA,RT,A,942,99406,,,,,17.00,N,Y
4330063,SMOKING CESSATION INTENSI,RT,A,942,G0437,,,,,45.00,N,Y
4330064,ASTHMA EDUCATION SINGLE,RT,A,942,98960,,,,,45.00,N,Y
4330065,ASTHMA EDUCATION 2-4 PAT,RT,A,942,98961,,,,,23.50,N,Y
4330066,ASTHMA EDUCATION 5-8 PAT,RT,A,942,98962,,,,,17.00,N,Y
4330067,SPUTUM INDUCTION,RT,A,410,89220,,,,,36.50,N,Y
4330068,EXPIRED GAS COLL (BREATHC,RT,A,410,94250,,,,,58.50,N,Y
4330069,PULMONARY REHAB SESSION,RT,A,460,G0424,,,,,158.00,N,Y
4330070,CRADIOPULMONARY RES(CPR),RT,A,410,92950,,,,,410.50,N,Y
4330071,STRESS TEST TRACING ONLY,RT,A,482,93017,,,,,265.50,N,Y
4330072,ST DR SUPERVISION ONLY,RT,A,960,93016,,,,,56.50,N,Y
4330073,DRREVIEW INTER RPT ONLY,RT,A,960,93018,,,,,37.00,N,Y
4330074,STRESS TEST DR SUPERV INT,RT,A,482,93015,,,,,280.50,N,Y
4330075,MSLT (DAY SLEEP TE NARCOL,RT,A,740,95805,,,,,"1,326.00",N,Y
4330076,CPAP INITIATION MANAGEMEN,RT,A,410,94660,,,,,135.00,N,N
4330077,HOME SLEEP STUDY - MEDICARE PATIENT,RT,A,740,G0399,,,,,291.00,N,N
4330078,HOME SLEEP STUDY,RT,A,740,95800,,,,,291.00,N,N
4340048,TELEHEALTH ORIGSITE FACFE,SPC,A,510,Q3014,,,,,30.00,N,Y
4346000,PATIENT TYPE 39,SPC,A,990,,,,,,0.00,N,N
4350001,"DIAB. ED, INDIV 30 MIN",DIA,A,942,G0108,,,,,136.00,N,Y
4350002,DIAB. ED GROUP 30 MIN,DIA,A,942,G0109,,,,,83.00,N,Y
4350003,"MNT, 15 MIN,INITIAL INDIV",DIA,A,942,97802,,,,,24.00,N,Y
4350004,"MNT,15 MIN,REASSESS INDIV",DIA,A,942,97803,,,,,24.00,N,Y
4350005,"MNT, 30 MIN, GROUP",DIA,A,942,97804,,,,,17.00,N,Y
4350016,MED NUT THER AFTER 2ND REFERRAL 15 min,DIA,A,942,G0270,,,,,50.00,N,N
4350017,MED NUT THER AFTER 2ND REF ADDTL 2HR,DIA,A,942,G0271,,,,,33.00,N,N
4360101,BLOOD ADMIN EA HR,BLA,A,391,36430,,,,,98.00,N,Y
4360102,BLOOD ADMIN 2 HOURS,BLA,A,391,36430,,,,,195.50,N,Y
4360103,BLOOD ADMIN 3 HOURS,BLA,A,391,36430,,,,,293.00,N,Y
4360104,BLOOD ADMIN 4 HOURS,BLA,A,391,36430,,,,,389.50,N,Y
4360105,BLOOD ADMIN 5 HOURS,BLA,A,391,36430,,,,,487.00,N,Y
4360106,BLOOD ADMIN 6 HOURS,BLA,A,391,36430,,,,,588.50,N,Y
4360107,BLOOD ADMIN 7 HOURS,BLA,A,391,36430,,,,,681.00,N,Y
4360108,BLOOD ADMIN 8 HOURS,BLA,A,391,36430,,,,,778.50,N,Y
4360109,BLOOD ADMIN 9 HOURS,BLA,A,391,36430,,,,,875.50,N,Y
4360110,BLOOD ADMIN 10 HOURS,BLA,A,391,36430,,,,,944.00,N,Y
4360111,BLOOD ADMIN 11 HOURS,BLA,A,391,36430,,,,,944.00,N,Y
4360112,BLOOD ADMIN 12 HOURS,BLA,A,391,36430,,,,,944.00,N,Y
4370001,CHEMO THERAPY 1 HOUR,CHE,A,335,96413,,,,,270.00,N,Y
,,CHE,A,335,96413,,,,,270.00,N,Y
4370002,CHEMO THERAPY EA ADD HR,CHE,A,335,96415,,,,,55.00,N,Y
4370025,CHEMO THERAPY SUBQ,CHE,A,331,,,,,,100.00,N,Y
4370026,CHEMO THERAPY IVP,CHE,A,335,96409,,,,,198.00,N,Y
4370027,BLADDER INSTILL ANIT-CARCINOGENIC,CHE,A,335,51720,,,,,165.00,N,N
4380001,IV THERAPY 1 HOUR,MSO,A,761,96365,,,,,140.00,N,Y
4380002,IV THERAPY EA ADD HR,MSO,A,761,96366,,,,,56.00,N,N
4380013,"INJECTION,SQ/IM (THERAPEU",MSO,A,510,96372,,,,,45.00,N,Y
4380014,"THERAPEUTIC INJ, ARTERIAL",MSO,A,761,,,,,,56.00,N,N
4380015,IV PUSH INITIAL,MSO,A,761,96523,,,,,56.00,N,Y
4380016,"ANTIBIOTIC INJECTION, IM",MSO,A,761,96372,,,,,45.00,N,N
4380017,OUTPATIENT VISIT,MSO,A,761,99211,,,,,48.00,N,Y
4380018,VACCINE INJECTION,MSO,A,771,90471,,,,,35.00,N,N
4380020,CARDIO VERSION PER VISIT,MSO,A,761,92960,,,,,681.00,N,N
4380022,WELLNESS CHILDBIRTH CLASS,MSO,A,510,,,,,,35.00,N,Y
4380023,WOUND CARE <20SQ CM,MSO,A,510,97597,,,,,125.50,N,Y
4380024,WOUND CARE >20SQ CM,MSO,A,510,97598,,,,,191.00,N,Y
4380025,NEG PRESS WOUND TH THAN,MSO,A,510,97606,,,,,191.00,N,Y
4380027,EXPANDED OUTPATIENT VISIT,MSO,A,510,99213,,,,,113.50,N,Y
4380028,WOUREM DEVITALIZE TISSUES,MSO,A,510,97602,,,,,55.00,N,Y
4380029,ELEC STIM UNATTEND PRESS,MSO,A,510,,,,,,22.00,N,Y
4380030,ELECTROMAGNTIC TX ULCERS,MSO,A,510,G0329,,,,,20.00,N,Y
4380031,UNNA BOOT STRAPPING,MSO,A,510,29580,,,,,75.00,N,Y
4380032,WOUND CARE ESTAB PATIENT,MSO,A,761,99211,,,,,48.00,N,Y
4380033,WOUND CARE NEW PATIENT,MSO,A,510,99201,,,,,53.00,N,Y
4380034,APY MULTLAY COMPRS LOWLEG,MSO,A,510,29581,,,,,65.00,N,Y
4380035,DOPPLEXII NON INVAS STUDY,MSO,A,920,93922,,,,,125.00,N,Y
4380036,WOUND CARE FOLLOW UP,MSO,A,960,99024,,,,,0.00,N,Y
4380556,PIC LINE/ MID LINE INSERTION,MSO,A,761,36569,,,,,250.00,N,N
4385000,CMG,MSO,A,510,,,,,,300.00,N,Y
4385001,URETHRAL PRESSURE PROFILE,MSO,A,510,51797,TC,,,,125.00,N,Y
4385002,EMG,MSO,A,510,51784,TC,,,,200.00,N,Y
4385003,UROFLOW,MSO,A,510,51741,TC,,,,25.00,N,Y
4387602,NON SELECTIVE DEBRIEMENT,MSO,A,420,97602,,,,,65.00,N,Y
4390001,MED INFLU SPLIT VIR AFLUR,DIA,A,636,Q2035,,,,,0.00,N,Y
4390002,MED INFLU SPL VIR FLULAVA,DIA,A,636,Q2036,,,,,0.00,N,Y
4390003,MED INFL SPL VIR FLUVIRIN,DIA,A,636,Q2037,,,,,0.00,N,Y
4390004,MED INFLU SPLIT VIR FLUZO,DIA,A,636,Q2038,,,,,0.00,N,Y
4390005,MED INFLU SPLIT VIR NOS,DIA,A,636,Q2039,,,,,0.00,N,Y
4390006,NEW DIABETES CLINIC LEV.1,DIA,A,990,99201,,,,,70.00,N,Y
4390007,NEW DIABETES CLINIC LEV.2,DIA,A,990,99202,,,,,125.00,N,Y
4390008,NEW DIABETES CLINIC LEV.3,DIA,A,990,99203,,,,,184.00,N,Y
4390009,NEW DIABETES CLINIC LEV.4,DIA,A,990,99204,,,,,266.00,N,Y
4390010,NEW DIABETES CLINIC LEV.5,DIA,A,990,99205,,,,,339.00,N,Y
4390011,EST.DIABETES CLINIC LEV.1,DIA,A,990,99211,,,,,42.00,N,Y
4390012,EST.DIABETES CLINIC LEV.2,DIA,A,990,99212,,,,,76.00,N,Y
4390013,EST.DIABETES CLINIC LEV.3,DIA,A,990,99213,,,,,104.00,N,Y
4390014,EST.DIABETES CLINIC LEV.4,DIA,A,990,99214,,,,,162.00,N,Y
4390015,EST.DIABETES CLINIC LEV.5,DIA,A,990,99215,,,,,235.00,N,Y
4390201,NEW DIABETES CLINIC LEV.1,DIA,A,510,99201,,,,,69.00,N,Y
4390202,NEW DIABETES CLINIC LEV.2,DIA,A,510,99202,,,,,123.00,N,Y
4390203,NEW DIABETES CLINIC LEV.2,DIA,A,510,99203,,,,,180.00,N,Y
4390204,NEW DIABETES CLINIC LEV.4,DIA,A,510,99204,,,,,260.00,N,Y
4390205,NEW DIABETES CLINIC LEV.5,DIA,A,510,99205,,,,,332.00,N,Y
4390211,EST.DIABETES CLINIC LEV.1,DIA,A,510,99211,,,,,41.00,N,Y
4390212,EST.DIABETES CLINIC LEV.2,DIA,A,510,99212,,,,,74.00,N,Y
4390213,EST.DIABETES CLINIC LEV.3,DIA,A,510,99213,,,,,102.00,N,Y
4390214,EST.DIABETES CLINIC LEV.4,DIA,A,510,99214,,,,,158.00,N,Y
4390215,EST.DIABEATES CLINIC LEV.,DIA,A,510,99215,,,,,230.00,N,Y
4400001,OUTPATIENT VISIT INR MNGM,DNU,A,761,99211,,,,,33.00,N,N
4400002,FINGER/HEEL STICK,DNU,A,300,36416,,,,,7.00,N,Y
4400003,INR,DNU,A,300,85610,,,,,13.50,N,Y
4410001,MED MANAGE LEVEL 1,MMG,A,510,99201,,,,,37.00,N,Y
4410002,MED MAN LEVEL 2 NEW PATIE,MMG,A,510,99202,,,,,52.00,N,Y
4410003,MED MANAGE LEVEL 3 NEW,MMG,A,510,99203,,,,,65.00,N,Y
4410004,MED MANAG LEVEL 4 NEW PAT,MMG,A,510,99204,,,,,95.00,N,Y
4410005,MED MANAGE LEVEL 5 NEW PA,MMG,A,510,99205,,,,,125.00,N,Y
4410006,MED MANAGE LEVEL 1 ESTAB,MMG,A,510,99211,,,,,35.00,N,Y
4410007,MED MANAGE LEVEL 2 ESTAB,MMG,A,510,99212,,,,,50.00,N,Y
4410008,MED MANAGE LEVEL 3 ESTAB,MMG,A,510,99213,,,,,60.00,N,Y
4410009,MED MANGE LEVEL 4 ESTAB,MMG,A,510,99214,,,,,90.00,N,Y
4410010,MED MANAGE LEVEL 5 ESTAB,MMG,A,510,99215,,,,,120.00,N,Y
4420001,NEW HEALTHY SENIOR LEVEL1,DNU,A,990,99201,,,,,62.50,N,Y
4420002,NEW HEALTHY SENIOR LEVEL2,DNU,A,990,99202,,,,,111.50,N,Y
4420003,NEW HEALTHY SENIOR LEVEL3,DNU,A,990,99203,,,,,164.00,N,Y
4420004,NEW HEALTHY SENIOR LEVEL4,DNU,A,990,99204,,,,,236.50,N,Y
4420005,NEW HEALTHY SENIOR LEVEL5,DNU,A,990,99205,,,,,301.50,N,Y
4420011,EST.HEALTHY SENIOR LEVEL1,DNU,A,990,99211,,,,,37.50,N,Y
4420012,EST.HEALTHY SENIOR LEVEL2,DNU,A,990,99212,,,,,67.50,N,Y
4420013,EST.HEALTHY SENIOR LEVEL3,DNU,A,990,99213,,,,,92.50,N,Y
4420014,EST.HEALTHY SENIOR LEVEL4,DNU,A,990,99214,,,,,144.00,N,Y
4420015,EST.HEALTHY SENIOR LEVEL5,DNU,A,990,99215,,,,,209.00,N,Y
4420201,NEW HEALTHY SENIOR LEVEL1,DNU,A,510,99201,,,,,62.50,N,Y
4420202,NEW HEALTHY SENIOR LEVEL2,DNU,A,510,99202,,,,,111.50,N,Y
4420203,NEW HEALTHY SENIOR LEVEL3,DNU,A,510,99203,,,,,164.00,N,Y
4420204,NEW HEALTHY SENIOR LEVEL4,DNU,A,510,99204,,,,,236.50,N,Y
4420205,NEW HEALTHY SENIOR LEVEL5,DNU,A,510,99205,,,,,301.50,N,Y
4420211,EST.HEALTHY SENIOR LEVEL1,DNU,A,510,99211,,,,,37.50,N,Y
4420212,EST.HEALTHY SENIOR LEVEL2,DNU,A,510,99212,,,,,67.50,N,Y
4420213,EST.HEALTHY SENIOR LEVEL3,DNU,A,510,99213,,,,,92.50,N,Y
4420214,EST.HEALTHY SENIOR LEVEL4,DNU,A,510,99214,,,,,144.00,N,Y
4420215,EST.HEALTHY SENIOR LEVEL5,DNU,A,510,99215,,,,,209.00,N,Y
4439213,NEURO OFC VISIT 15 MIN,DNU,A,990,99213,,,,,123.00,N,Y
4439214,NEURO OFC VISIT 25 MIN,DNU,A,990,99214,,,,,143.00,N,Y
4439215,NEURO OFC VISIT 40 MIN,DNU,A,990,99215,,,,,190.50,N,Y
4439216,NUEROLOGY NO CHARGE,DNU,A,990,,,,,,0.00,N,Y
4439241,OFFICE CONSULT 15MIN NEUR,DNU,A,990,99241,,,,,123.00,N,Y
4439242,OFFICE CONSULT 30MIN NEUR,DNU,A,990,99242,,,,,143.00,N,Y
4439243,OFFICE CONSULT 40MIN NEUR,DNU,A,990,99243,,,,,190.50,N,Y
4439244,OFFICE CONSULT 60MIN NEUR,DNU,A,990,99244,,,,,268.00,N,Y
4439245,OFFICE CONSULT 80MIN NEUR,DNU,A,990,99245,,,,,348.00,N,Y
4449497,ADV CARE PLANNING - 1ST 30 MIN FTF,SS,A,983,99497,,,,,99.00,N,N
4449498,ADV CARE PLANNING - EACH ADD'L 30 MIN,SS,A,983,99498,,,,,90.00,N,N
4450001,CD/ IM NEW L1 10 MIN,INT,A,983,99201,,,,,98.00,N,Y
4450002,CD / IM NEW L2 20 MIN,INT,A,983,99202,,,,,135.00,N,Y
4450003,CD / IM NEW L3 30MIN,INT,A,983,99203,,,,,177.00,N,Y
4450004,CD / IM NEW L4 45MIN,INT,A,983,99204,,,,,265.00,N,Y
4450005,CD / IM NEW L5 60 MIN,INT,A,960,99205,,,,,328.00,N,Y
4450006,CD / IM EST L1 5 MIN,INT,A,960,99211,,,,,70.00,N,Y
4450007,CD / IM EST L2 10 MIN,INT,A,983,99212,,,,,98.00,N,Y
4450008,CD / IM EST L3 15 MIN,INT,A,983,99213,,,,,135.00,N,Y
4450009,CD / IM EST L4 25 MIN,INT,A,983,99214,,,,,185.00,N,Y
4450010,CD / IM EST L5 40MIN,INT,A,983,99215,,,,,250.00,N,Y
4450011,EMPLOYEE PHYSICAL,INT,A,960,99213,,,,,0.00,N,Y
4450012,KENALOG PER 10 MG,INT,A,636,J3301,,,,,20.00,N,Y
4450013,"THERA,PROPHY,DIAINJ",INT,A,960,96372,,,,,52.00,N,Y
4450014,ZOSTAVAX VACCINE,INT,A,960,90736,,,,,320.00,N,Y
4450015,PHYSICAL EST 40-64 YRS,INT,A,960,99396,,,,,175.00,N,Y
4450016,IMMUNIZATION ADMIN,INT,A,960,90471,,,,,63.00,N,Y
4450017,TB INJECTION,INT,A,960,86580,,,,,16.00,N,Y
4450018,WOUNDCARE DEBRIDEMENT,INT,A,960,97597,,,,,125.50,N,N
4450019,WOUND CARE NEG PRESSURE,INT,A,960,97605,,,,,191.00,N,N
4450020,DOT PHYSICAL,INT,A,960,99499,,,,,123.00,N,N
4450021,MEDICARE INITIAL EXAM,INT,A,960,G0402,,,,,182.00,N,Y
4450022,CAMP PHYSICAL,INT,A,983,99211,,,,,20.00,N,Y
4450023,HEP B ADULT,INT,A,960,90746,,,,,100.00,N,N
4450024,IMMUNIZATION STATE,INT,A,960,90471,,,,,19.68,N,N
4450025,ALLERGY MULTIPLE,INT,A,990,95117,,,,,22.00,N,N
4450026,VITAMIN B-12 1000 MCG,INT,A,990,J3420,,,,,20.00,N,Y
4450027,RABAVERT 1 ML,INT,A,960,90675,,,,,550.00,N,N
4450028,HYPERRAB 150 UNITS/ML 2 M,INT,A,960,90375,,,,,966.00,N,N
4450029,RAPID STREP,INT,A,990,87880,,,,,27.00,N,N
4450030,CONTRACT PHYSICAL,INT,A,990,,,,,,50.00,N,N
4450031,ROCEPHIN 1 GRAM,INT,A,990,J0696,,,,,76.00,N,Y
4450032,MMR,INT,A,990,90707,,,,,128.00,N,N
4450060,DRAIN SKIN ABSESS SIMPLE,INT,A,960,10060,,,,,235.00,N,Y
4450201,MEDICARE OV NP LEVEL 1,INT,A,510,99201,,,,,29.40,N,N
4450202,MEDICARE OV NP LEVEL 2,INT,A,510,99202,,,,,40.50,N,N
4450203,MEDICARE OV NP LEVEL 3,INT,A,510,99203,,,,,53.10,N,N
4450204,MEDICARE OV NP LEVEL 4,INT,A,510,99204,,,,,79.50,N,N
4450205,MEDICARE OV NP LEVEL 5,INT,A,510,99205,,,,,98.40,N,N
4450206,MEDICARE OV EP LEVEL 1,INT,A,510,99211,,,,,21.00,N,N
4450207,MEDICARE OV EP LEVEL 2,INT,A,510,99212,,,,,29.40,N,N
4450208,MEDICARE OV EP LEVEL 3,INT,A,510,99213,,,,,40.50,N,N
4450209,MEDICARE OV EP LEVEL 4,INT,A,510,99214,,,,,55.50,N,N
4450210,MEDICARE OV EP LEVEL 5,INT,A,510,99215,,,,,75.00,N,N
4450221,INPATIENT INITIAL LEVEL 1,INT,A,990,99221,,,,,143.00,N,N
4450222,INPATIENT INITIAL LEVEL 2,INT,A,990,99222,,,,,194.00,N,N
4450223,INPATIENT INITIAL LEVEL 3,INT,A,990,99223,,,,,286.00,N,N
4450231,INPATIENT SUBS LEVEL 1,INT,A,990,99231,,,,,56.50,N,N
4450232,INPATIENT SUBS LEVEL 2,INT,A,990,99232,,,,,92.00,N,N
4450233,INPATIENT SUBS LEVEL 3,INT,A,990,99233,,,,,146.00,N,N
4450238,HOSPITAL DISCHARGE,INT,A,990,99238,,,,,101.00,N,N
4450239,HOSPITAL DISCHARGE,INT,A,990,99239,,,,,148.00,N,N
4450304,SKILLED CARE ADMIT 1,INT,A,990,99304,,,,,156.00,N,N
4450305,SKILLED CARE ADMIT 2,INT,A,990,99305,,,,,218.00,N,N
4450306,SKILLED CARE ADMIT 3,INT,A,990,99306,,,,,281.00,N,N
4450315,SKILLED DISCHARGE,INT,A,990,99315,,,,,92.00,N,N
4450316,SKILLED DISCHARGE,INT,A,990,99316,,,,,117.50,N,N
4450439,ANN WELL VIS SUBSEQUENT,INT,A,960,G0439,,,,,198.00,N,Y
4450444,ANNUAL DEPRESSION SCREENING 15 MINUTES,INT,A,983,G0444,,,,,22.00,N,Y
4450472,EACH ADD'L IMMUNIZATION,INT,A,990,90472,,,,,26.00,N,N
4450658,INFLUENZA >3 YRS,INT,A,990,90658,,,,,50.00,N,N
4450662,FLUZONE HD,INT,A,990,90662,,,,,70.00,N,N
4450670,PNEUMO VAC PREVNAR 13,INT,A,990,90670,,,,,340.00,N,Y
4450686,"FLUARIX, QUADRIVALENT SPLIT VIRUS 0.5 ML",INT,A,990,90686,,,,,50.00,N,N
4450714,TENIVAC,INT,A,990,90714,,,,,54.00,N,N
4450715,TDAP - ADACEL,INT,A,990,90715,,,,,67.00,N,N
4450732,PNEUMONIA ADULT,INT,A,960,90732,,,,,174.00,N,N
4450750,SHINGRIX ZOSTER VACCINE,INT,A,990,90750,,,,,260.00,N,Y
4451001,"CARD REHAB PHASE II, MONITOR",INT,A,990,93798,,,,,237.50,N,N
4451002,"DIAB ED, INDIV., 30 MINUTES",INT,A,990,G0108,,,,,124.00,N,N
4451003,"DIAB. ED., GROUP, 30 MINUTES",INT,A,990,G0109,,,,,75.00,N,N
4451004,"MNT 15 MIN, INITIAL, INDIV.",INT,A,942,97802,,,,,22.00,N,Y
4451005,"MNT, 15 MIN, REASSESS INDIV",INT,A,990,97803,,,,,22.00,N,N
4451006,"MNT, 30 MINUTES GROUP",INT,A,990,97804,,,,,22.00,N,N
4451885,KETOROLAC PER 15MG,INT,A,960,J1885,,,,,16.00,N,Y
4452038,INFLUENZA QUAD VACCINE 0.5ML,INT,A,636,Q2038,,,,,50.00,N,Y
4452039,FLUARIX MEDICARE QUAD SPLIT VIRUS 0.5 ML,INT,A,990,Q2039,,,,,50.00,N,N
4455610,INR,INT,A,990,85610,,,,,22.00,N,Y
4456372,"THERA,PROPHY,DIANIJ,SUBCU",INT,A,960,96372,,,,,52.00,N,Y
4459009,ADM PNEUMOCOCCAL VAC,INT,A,990,G0009,,,,,63.00,N,Y
4459024,GLOBAL/POST OP/NC VISIT,INT,A,990,99024,,,,,0.00,N,N
4459211,SPORTS PHYSICAL,INT,A,960,99211,,,,,5.00,N,Y
4459217,OBSERVATION DISCHARGE,INT,A,990,99217,,,,,102.00,N,Y
4459218,OBSERVATION INITIAL LEVEL 1,INT,A,990,99218,,,,,97.00,N,Y
4459219,OBSERVATION INITIAL LEVEL 2,INT,A,990,99219,,,,,158.50,N,Y
4459220,OBSERVATION INITIAL LEVEL 3,INT,A,990,99220,,,,,219.50,N,Y
4459224,OBSERVATION SUBS LEVEL 1,INT,A,990,99224,,,,,50.00,N,Y
4459225,OBSERVATION SUBS LEVEL 2,INT,A,990,99225,,,,,80.00,N,Y
4459235,LEVEL2 OBSERSV/IP,INT,A,990,99235,,,,,275.00,N,Y
4459301,NURS HOME INITIAL/ADMIT LEVEL 1,INT,A,994,99304,,,,,156.00,N,N
4459305,"NURSING HOME, INITIAL VISIT",INT,A,994,99305,,,,,218.00,N,N
4459310,NURSING HOME COMPREHENSIV,INT,A,994,99310,,,,,229.00,N,Y
4459311,NH/SNF PROBLEM FOCUS,INT,A,994,99307,,,,,78.00,N,Y
4459312,NH/SNF EXPANDED,INT,A,994,99308,,,,,120.00,N,Y
4459313,NURSING HOME DETAILED,INT,A,994,99309,,,,,156.00,N,Y
4459325,NEW PT ASSIST LIVING,INT,A,994,99325,,,,,135.00,N,N
4459386,PHYSICAL NEW 40-64 YRS,INT,A,990,99386,,,,,210.00,N,N
4459395,PHYSICAL ESTA. 18-39 YRS,INT,A,990,99395,,,,,165.00,N,N
4459397,PHYSICAL ESTB 65 & OLDER,INT,A,960,99397,,,,,190.00,N,Y
4459495,TCM - FTF WITHIN 14 DAYS,INT,A,990,99495,,,,,208.00,N,Y
4459497,ADVANCED CARE PLANNING,INT,A,983,99497,,,,,99.00,N,Y
4460001,OFFICE VISIT LEVEL 1 NEW,SLP,A,990,99201,,,,,40.00,N,Y
4460002,OFFICE VISIT LEVEL 2 NEW,SLP,A,990,99202,,,,,65.00,N,Y
4460003,OFFICE VISIT LEVEL 3 NEW,SLP,A,990,99203,,,,,95.00,N,Y
4460004,OFFICE VISIT LEVEL 4 NEW,SLP,A,990,99204,,,,,155.00,N,Y
4460005,OFFICE VISIT LEVEL 5 NEW,SLP,A,990,99205,,,,,195.00,N,Y
4460006,OFFICE VISIT LEVEL 1 ESTABLISHED,SLP,A,990,99211,,,,,20.00,N,Y
4460007,OFFICE VISIT LEVEL 2 ESTABILSHED,SLP,A,990,99212,,,,,40.00,N,Y
4460008,OFFICE VISIT LEVEL 3 ESTABLISHED,SLP,A,990,99213,,,,,70.00,N,Y
4460009,OFFICE VISIT LEVEL 4 ESTABLISHED,SLP,A,990,99214,,,,,95.00,N,Y
4460010,OFFICE VISIT LEVEL 5 ESTABLISHED,SLP,A,990,99215,,,,,135.00,N,Y
4950202,NP LEVEL 2,GCP,A,990,99203,,,,,130.00,N,Y
4950203,NP LEVEL 3,GCP,A,990,99203,,,,,170.00,N,Y
4950211,EST PT LEVEL 1,GCP,A,990,99211,,,,,45.00,N,Y
4950212,EST PT LEVEL 2,GCP,A,990,99212,,,,,65.00,N,Y
4950213,EST PT LEVEL 3,GCP,A,990,99213,,,,,105.00,N,Y
4950214,EST PT LEVEL 4,GCP,A,983,99214,,,,,155.00,N,Y
4950215,EST PT LEVEL 5,GCP,A,990,99215,,,,,195.00,N,Y
4950221,INPATIENT INITIAL LEVEL 1,GCP,A,990,99221,,,,,143.00,N,N
4950222,INPATIENT INITIAL LEVEL 2,GCP,A,990,99222,,,,,194.00,N,N
4950223,INPATIENT INITIAL LEVEL 3,GCP,A,990,99223,,,,,286.00,N,N
4950231,INPATIENT SUBS LEVEL 1,GCP,A,990,99231,,,,,56.50,N,N
4950232,INPATIENT SUBS LEVEL 2,GCP,A,990,99232,,,,,92.00,N,N
4950233,INPATIENT SUBS LEVEL 3,GCP,A,990,99233,,,,,146.00,N,N
4950238,HOSPITAL DISCHARGE,GCP,A,990,99238,,,,,101.00,N,N
4950239,HOSPITAL DISCHARGE,GCP,A,990,99239,,,,,148.00,N,N
4950304,NHOME/SKILLED CARE ADMIT 1,GCP,A,990,99304,,,,,156.00,N,N
4950305,NHOME/SKILLED CARE ADMIT 2,GCP,A,990,99305,,,,,218.00,N,N
4950306,NHOME/SKILLED CARE ADMIT 3,GCP,A,990,99306,,,,,281.00,N,N
4950311,NHOME/SKILLED CARE LEVEL 1,GCP,A,990,99307,,,,,78.00,N,N
4950312,NHOME/SKILLED CARE LEVEL 2,GCP,A,990,99308,,,,,120.00,N,N
4950313,NHOME/SKILLED CARE LEVEL 3,GCP,A,990,99309,,,,,156.00,N,N
4950315,SKILLED DISCHARGE,GCP,A,990,99315,,,,,92.00,N,N
4950316,SKILLED DISCHARGE,GCP,A,990,99316,,,,,117.50,N,N
4950772,"THERA,PROPHY,DIAINJ,SUBCU",GCP,A,990,96372,,,,,52.00,N,Y
4951696,ROCEPHIN 1 GRAM,GCP,A,990,J0696,,,,,76.00,N,Y
4952202,WOUND CLINIC MED NP LEVEL 2,GCP,A,510,99202,,,,,39.00,N,N
4952203,WOUND CLINIC MED NP LEVEL 3,GCP,A,510,99203,,,,,51.00,N,N
4952211,WOUND CLINIC MED EST LEVEL 1,GCP,A,510,99211,,,,,13.50,N,N
4952212,WOUND CLINIC MED EST LEVEL 2,GCP,A,510,99212,,,,,19.50,N,N
4952213,WOUND CLINIC MED EST LEVEL 3,GCP,A,510,99213,,,,,31.50,N,N
4952214,WOUND CLINIC MED EST LEVEL 4,GCP,A,510,99214,,,,,46.50,N,N
4952215,WOUND CLINIC EST MED LEVEL 5,GCP,A,510,99215,,,,,58.50,N,N
4959217,OBSERVATION DISCHARGE,GCP,A,990,99217,,,,,102.00,N,Y
4959218,OBSERVATION LEVEL 1,GCP,A,990,99218,,,,,97.00,N,Y
4959219,OBSERVATION LEVEL 2,GCP,A,990,99219,,,,,158.50,N,Y
4959220,OBSERVATION LEVEL 3,GCP,A,990,99220,,,,,219.50,N,Y
4959234,LEVEL 1 OBSERV IP SAME DAY,GCP,A,990,99234,,,,,235.00,N,Y
4959235,LEVEL 2 OBSERV IP SAME DAY,GCP,A,990,99235,,,,,275.00,N,Y
4959236,LEVEL 3 OBSERV IP SAME DAY,GCP,A,990,99236,,,,,350.00,N,Y
4959924,SUBSEQUENT OBS LEVEL 1,GCP,A,990,99224,,,,,50.00,N,Y
4959925,SUBSEQUENT OBS LEVEL 2,GCP,A,990,99225,,,,,80.00,N,Y
4960000,WEIGHT CHECK NO CHARGE,STC,A,990,,,,,,0.00,N,N
4960002,DEBRIDMENT WOUND UPTO 10%,STC,A,990,11000,,,,,31.50,N,Y
4960003,DEBRID WOUND EA ADD 10%,STC,A,990,11001,,,,,22.50,N,Y
4960010,SCRN PELVIC/BREAST EXAM,STC,A,990,G0101,,,,,57.00,N,Y
4960011,DRUG SCR COLLECTION & KIT,STC,A,990,80100,,,,,69.00,N,Y
4960024,OCCULT BLOOD SCREENING,STC,A,990,82270,,,,,49.00,N,N
4960025,REMOVAL SKIN TAGS (EA 10),STC,A,990,11201,,,,,36.00,N,Y
4960030,SUPARTZ PER INJECTION,STC,A,990,J7321,,,,,124.50,N,Y
4960031,MARCAINE 0.25% PER 30ML,STC,A,990,S0020,,,,,7.00,N,Y
4960032,CONTRACT PHYSICAL,STC,A,990,,,,,,50.00,N,Y
4960033,COMMUNITY HEALTH SCREENIN,STC,A,990,99213,,,,,18.50,N,Y
4960048,BASIC METABOLIC PANEL,STC,A,990,80048,,,,,54.00,N,N
4960050,INCIS POSTOP WOUND INFECT,STC,A,990,10180,,,,,199.00,N,Y
4960051,ELECTROLYTES,PED,A,990,80051,,,,,54.00,N,N
4960053,COMPREHENSIVE METABOLIC PANEL,STC,A,990,80053,,,,,97.00,N,N
4960055,PARING/CUTTING BENIGN LES,STC,A,990,11055,,,,,54.00,N,Y
4960060,DRAIN SKIN ABCESS SIMPLE,STC,A,990,10060,,,,,244.00,N,Y
4960061,DRAIN SKIN ABCESS COMPLIC,STC,A,990,10061,,,,,432.00,N,Y
4960069,RENAL PROFILE,STC,A,990,80069,,,,,65.00,N,N
4960070,EAR CULTURE,STC,A,990,87070,,,,,65.00,N,N
4960074,HEPATITIS PROFILE,STC,A,300,80074,,,,,232.00,N,N
4960076,HEPATIC FUNCTION PANEL,STC,A,990,80076,,,,,79.00,N,N
4960080,SPECIAL FORMS,STC,A,990,99080,,,,,22.50,N,Y
4960085,CASTING FOREARM/HAND,STC,A,990,29085,,,,,115.00,N,Y
4960091,PAP COLLECTION,STC,A,990,Q0091,,,,,68.00,N,Y
4960096,PTT,STC,A,990,85730,,,,,49.00,N,N
4960100,DEXAMETHASONE PER 1MG,STC,A,990,J1100,,,,,8.00,N,Y
4960101,UA DRUG SCREEN,STC,A,990,80101,,,,,41.00,N,N
4960102,"PROSTATE SCREEN, DIG RECTAL EXAM",STC,A,990,G0102,,,,,26.00,N,N
4960103,PSA SCREEN,STC,A,990,G0103,,,,,85.00,N,N
4960104,DEPO MEDROL 80 MG,STC,A,990,J1040,,,,,14.25,N,N
4960113,SHAV EPIDERM/DERMAL LES,STC,A,990,11302,,,,,115.00,N,N
4960115,ALLERGY SINGLE,STC,A,990,95115,,,,,18.00,N,Y
4960117,ALLERGY MULTIPLE,STC,A,990,95117,,,,,22.00,N,Y
4960120,FB REMOVAL & INCISION,STC,A,990,10120,,,,,218.00,N,Y
4960132,POTASSIUM K+ K,STC,A,990,84132,,,,,37.00,N,N
4960150,ADENOCARD PER 6MG,STC,A,990,J0150,,,,,80.00,N,Y
4960156,PROTEIN/CREAT RATIO URINE,STC,A,990,84156,,,,,40.00,N,N
4960160,COMPLEMENT 4,STC,A,990,86160,,,,,89.00,N,N
4960162,ZOFRAN 4MG TABLET,STC,A,990,Q0162,,,,,3.00,N,N
4960164,VALPROIC ACID,STC,A,990,80164,,,,,100.00,N,N
4960165,PROTEIN ELECTROPHORSES SERUM,STC,A,990,84165,,,,,80.00,N,N
4960170,EPI PEN,STC,A,990,J0171,,,,,155.00,N,Y
4960177,KEPPRA LEVEL,STC,A,990,80177,,,,,81.00,N,N
4960178,LITHIUM,STC,A,990,80178,,,,,50.00,N,N
4960179,PHY RECERT FOR HOME HEALT,STC,A,994,G0179,,,,,79.50,N,Y
4960180,PHY CERT FOR HOME HEALTH,STC,A,994,G0180,,,,,103.00,N,Y
4960197,TACROLIMUS,STC,A,990,80197,,,,,99.00,N,N
4960198,THEOPHYLLINE,STC,A,990,80198,,,,,106.00,N,N
4960201,NEW OUTPATIENT LEVEL 1,STC,A,990,99201,,,,,78.00,N,Y
4960202,NEW OUTPATIENT LEVEL 2,STC,A,990,99202,,,,,125.00,N,Y
4960203,NEW OUTPATIENT LEVEL 3,STC,A,990,99203,,,,,182.00,N,Y
4960204,NEW OUTPATIENT LEVEL 4,STC,A,990,99204,,,,,277.00,N,Y
4960205,NEW OUTPATIENT LEVEL 5,STC,A,990,99205,,,,,338.00,N,Y
4960210,WET MOUNTCULTURE TRICHOMONAS,STC,A,990,87210,,,,,33.00,N,N
4960211,OFFICE VISIT LEVEL 1,STC,A,990,99211,,,,,47.00,N,Y
4960212,OFFICE VISIT LEVEL 2,STC,A,990,99212,,,,,73.00,N,Y
4960213,OFFICE VISIT LEVEL 3,STC,A,990,99213,,,,,120.00,N,Y
4960214,OFFICE VISIT LEVEL 4,STC,A,990,99214,,,,,172.00,N,Y
4960215,OFFICE VISIT LEVEL 5,STC,A,990,99215,,,,,229.00,N,Y
4960221,INPATIENT INITIAL LEVEL 1,STC,A,990,99221,,,,,143.00,N,Y
4960222,INPATIENT INITIAL LEVEL 2,STC,A,990,99222,,,,,194.00,N,Y
4960223,INPATIENT INITIAL LEVEL 3,STC,A,990,99223,,,,,286.00,N,Y
4960231,INPATIENT LEVEL 1,STC,A,990,99231,,,,,56.50,N,Y
4960232,INPATIENT LEVEL 2,STC,A,990,99232,,,,,92.00,N,Y
4960233,INPATIENT LEVEL 3,STC,A,990,99233,,,,,146.00,N,Y
4960238,HOSPITAL DISCHARGE,STC,A,990,99238,,,,,101.00,N,Y
4960239,HOSPITAL DISCHARGE,STC,A,990,99239,,,,,148.00,N,Y
4960270,MORPHINE UP TO 10MG,STC,A,990,J2270,,,,,3.50,N,Y
4960283,EMERGENCY LEVEL 3,STC,A,990,,,,,,87.50,N,Y
4960291,CRITICAL CARE 1ST HOUR,STC,A,990,99291,,,,,308.00,N,Y
4960292,CRITICAL CARE ADD'1 1/2HR,STC,A,990,99292,,,,,145.50,N,Y
4960299,QUANTATIVE ASSAY DRUG,STC,A,990,80299,,,,,67.00,N,N
4960300,REMOV FORN BODY INTRANAS,STC,A,990,30300,,,,,229.50,N,N
4960301,SKILLED CARE ADMIT 1,STC,A,990,99304,,,,,156.00,N,Y
4960302,SKILLED CARE ADMIT 2,STC,A,990,99305,,,,,218.00,N,Y
4960303,SKILLED CARE ADMIT 3,STC,A,990,99306,,,,,281.00,N,Y
4960306,VIT D AS HYDROXY,STC,A,990,82306,,,,,218.00,N,N
4960311,SKILLED CARE LEVEL 1,STC,A,990,99307,,,,,78.00,N,Y
4960312,SKILLED CARE LEVEL 2,STC,A,990,99308,,,,,120.00,N,Y
4960313,SKILLED CARE LEVEL 3,STC,A,990,99309,,,,,156.00,N,Y
4960315,SKILLED DISCHARGE,STC,A,990,99315,,,,,92.00,N,Y
4960316,SKILLED DISCHARGE,STC,A,990,99316,,,,,117.50,N,Y
4960317,TELEHEALTH ORIG SITE,STC,A,990,Q3014,,,,,30.00,N,Y
4960318,TELEHEALTH PROF FEE,STC,A,990,99212,,,,,23.50,N,Y
4960320,ALCOHOL (BLOOD OR CHEM),STC,A,990,80320,,,,,76.00,N,N
4960344,MEDICARE INITIAL PREV. EX,STC,A,770,G0402,,,,,182.00,N,Y
4960366,MED.INIT.ECG-W/INTER&REPO,STC,A,990,G0366,,,,,40.50,N,Y
4960375,RABIES IMMUNE GLOBLIN PER,STC,A,990,90375,,,,,"1,802.00",N,Y
4960378,SYNAGIS (PHARMACY),STC,A,990,90378,,,,,"1,484.50",N,Y
4960400,EXCI BENIGN LES <.05CM,STC,A,990,11400,,,,,120.00,N,N
4960403,TESTOSTERONE TOTAL,STC,A,990,84403,,,,,190.00,N,N
4960416,FINGER/HEELSTICK,STC,A,990,36416,,,,,5.00,N,Y
4960420,I&D BARTHOLINS GLAND,STC,A,990,56420,,,,,112.50,N,Y
4960425,ANETPARTUM CARE ONLY 4-6V,STC,A,990,59425,,,,,356.50,N,Y
4960426,ANETPARTUM 7 OR MORE V,STC,A,990,59426,,,,,624.00,N,Y
4960430,POSTPARTUM CARE ONLY,STC,A,990,59430,,,,,194.00,N,Y
4960432,HIV 1 & 2 AB,STC,A,990,G0432,,,,,65.50,N,N
4960434,DRUG SCREENING MEDICARE/XIX CLINIC,STC,A,990,G0477,,,,,43.00,N,N
4960436,T4,STC,A,990,84436,,,,,52.00,N,N
4960438,ANN WELLNESS FIRST VISIT,STC,A,990,G0438,,,,,270.00,N,Y
4960439,ANN WELL VIS SUBSEQUENT,STC,A,990,G0439,,,,,198.00,N,Y
4960441,FILGRASTIM (NEUPO) 480MCG,STC,A,990,J1441,,,,,685.00,N,Y
4960442,NEUPOGEN 300 MCG VIAL,STC,A,990,J1440,,,,,438.50,N,Y
4960443,MICROALBUMIN URINE,STC,A,990,82043,,,,,38.00,N,N
4960444,ANNUAL DEPRESSION SCREENING 15 MINUTES,STC,A,990,G0444,,,,,22.00,N,N
4960447,BEHAVORIAL COUNSELING OBESITY 15M,STC,A,990,G0447,,,,,36.00,N,N
4960449,INFLUENZE A&B RAPID FLU,STC,A,990,87804,,,,,51.00,N,N
4960460,ATROPINE UP TO 0.3MG,STC,A,990,J0460,,,,,5.00,N,Y
4960465,IMMUNIZ<18YRS W/COUNSEL 1,STC,A,990,,,,,,16.50,N,Y
4960466,INNUNIZ<18YRS W/COUNSEL2+,STC,A,990,,,,,,16.50,N,Y
4960471,INJECTION IMMUNIZATION 1,STC,A,990,90471,,,,,63.00,N,Y
4960472,INJECTION IMMUNIZATION 2+,STC,A,990,90472,,,,,26.00,N,Y
4960473,INTRANASAL ADMIN STATE,STC,A,990,90473,,,,,19.68,N,N
4960490,CHLAMYDIA PROBE,STC,A,990,87490,,,,,147.00,N,N
4960520,BUN/UREA NITROGEN,STC,A,990,84520,,,,,35.00,N,N
4960522,HEP C RNA PCR QUANT,STC,A,990,87522,,,,,210.00,N,N
4960529,HERPES SIMPLEX VIRUS PCR,STC,A,990,87529,,,,,97.00,N,N
4960552,TRIGGER PT INJ TO 1/2MUSC,STC,A,990,20552,,,,,115.00,N,Y
4960553,TRIGGERPOINT 3+ MUSCLES,STC,A,990,20553,,,,,134.00,N,Y
4960561,"BICILLIN LA PER 100,000 UNITS",STC,A,990,J0561,,,,,16.00,N,N
4960570,"CREATININE, RANDOM URINE",STC,A,990,82570,,,,,39.00,N,N
4960590,GC PROBE,STC,A,990,87590,,,,,183.00,N,N
4960600,ARTHO SM JNT,STC,A,990,20600,,,,,100.00,N,Y
4960605,ARTHRO INTERMED JNT,STC,A,990,20605,,,,,105.00,N,Y
4960610,ARTHRO MAJOR JNT,STC,A,990,20610,,,,,126.00,N,Y
4960612,ASPIR AND/OR INJEC GANG CY,STC,A,990,20612,,,,,126.00,N,N
4960620,FXCARE/ELBOW,STC,A,990,24620,,,,,510.00,N,Y
4960632,HEPATITIS A ADULT (VAQTA),STC,A,990,90632,,,,,125.00,N,Y
4960633,VAQTA PEDIATRIC,STC,A,990,90633,,,,,60.00,N,Y
4960642,EX SKIN LESION-MA 1.1-2.0,STC,A,990,11642,,,,,317.00,N,Y
4960643,H PYLORI AG-STOOL,STC,A,990,87338,,,,,117.00,N,N
4960649,GARDASIL VACCINE,STC,A,990,90649,,,,,245.00,N,Y
4960650,DRUG SCREEN COLLECTION,STC,A,990,,,,,,20.00,N,Y
4960651,GARDASIL 9,STC,A,990,90651,,,,,375.00,N,N
4960652,VIT D 1.25 DIHYDROXY,STC,A,990,82652,,,,,200.00,N,N
4960657,INFLUENZA QUAD VACCINE 0.25ML,STC,A,990,90657,,,,,50.00,N,Y
4960658,INFLUENZA VACCINE 3YR.&UP,STC,A,990,90658,,,,,50.00,N,Y
4960660,INFLUENZA VAC INTRANASAL,STC,A,990,90660,,,,,55.00,N,Y
4960662,FLUZONE HD,STC,A,990,90662,,,,,70.00,N,N
4960669,PNEUMO PED (PREVNAR),STC,A,990,90669,,,,,146.00,N,Y
4960670,PNEUMOCOCAL VAC. PREVNAR 13,STC,A,990,90670,,,,,340.00,N,N
4960675,IMOVAX 1ML VIAL,STC,A,990,90675,,,,,355.50,N,Y
4960678,SYNAGIS (PHARMACY),STC,A,990,90378,,,,,"1,484.50",N,Y
4960680,ROTATEQ VACCINE (ROTAVIRU,STC,A,990,90680,,,,,144.00,N,Y
4960685,FLU VACC <3 YRS QUAD SPLIT VIRUS .25 ML,STC,A,990,90685,,,,,50.00,N,N
4960686,"FLUARIX, QUADRIVALENT SPLIT VIRUS 0.5 ML",STC,A,990,90686,,,,,50.00,N,N
4960690,CEFAZOLIN PER 500MG,STC,A,990,J0690,,,,,3.50,N,Y
4960696,ROCEPHIN PER 250MG,STC,A,990,J0696,,,,,19.00,N,Y
4960697,ROCEPHIN 500MG,STC,A,990,J0696,,,,,38.00,N,Y
4960698,ROCEPHIN 1 GRAM,STC,A,990,J0696,,,,,76.00,N,Y
4960700,DTAP < 7 yrs,STC,A,990,90700,,,,,44.00,N,Y
4960707,MMR,STC,A,990,90707,,,,,128.00,N,Y
4960708,HEP A AB,STC,A,990,86708,,,,,93.00,N,N
4960710,PROQUAD VACCINE,STC,A,990,90710,,,,,254.00,N,Y
4960713,POLIO (IPOL),STC,A,990,90713,,,,,58.00,N,Y
4960714,DECAVAC-TD-ADULT,STC,A,990,90714,,,,,54.00,N,Y
4960715,TDAP- Adacel,STC,A,636,90715,,,,,67.00,N,Y
4960716,CHICKEN POX (VARIVAX),STC,A,990,90716,,,,,230.00,N,Y
4960719,TRIMMING NAILS (ANY #),STC,A,990,11719,,,,,20.00,N,Y
4960723,PEDIARIX (DTAP-HEPB-IPV),STC,A,990,90723,,,,,140.00,N,Y
4960730,AVULSION OF TOE NAIL PARTIAL OR COMPLETE,STC,A,990,11730,,,,,96.00,N,N
4960732,PNEUMONIA ADULT (PNEUMOVA,STC,A,990,90732,,,,,174.00,N,Y
4960734,MENACTRA 4MCG 0.5ML SDV,STC,A,990,90734,,,,,212.00,N,Y
4960736,ZOSTAVAX VACCINE,STC,A,990,90736,,,,,320.00,N,Y
4960737,HIB VACCINE (ACTHIB),STC,A,990,90648,,,,,55.00,N,Y
4960740,BK VIRUS QUANTITATIVEPCR,STC,A,990,87799,,,,,432.00,N,N
4960744,HEP B PED/ADOL (ENGERIX-B),STC,A,990,90744,,,,,32.00,N,Y
4960746,HEP B ADULT (ENGERIX-B),STC,A,990,90746,,,,,100.00,N,Y
4960748,COMVAX 0.5ML,STC,A,990,90748,,,,,55.50,N,Y
4960750,SHINGRIX ZOSTER VACCINE,STC,A,990,90750,,,,,260.00,N,N
4960770,BLEPJARP DRAIN ABS EYELID,STC,A,990,67700,,,,,245.00,N,Y
4960772,"THERA,PROPHY,DIAINJ,SUBCU",STC,A,990,96372,,,,,52.00,N,Y
4960801,LIPID PANEL,STC,A,990,80061,,,,,81.00,N,N
4960802,HEMOGLOBIN A1C,STC,A,990,83036,,,,,73.00,N,N
4960803,ALTI,STC,A,990,84460,,,,,70.00,N,N
4960804,CLOSTRIDIUM DIFFICILE,STC,A,990,87324,,,,,145.00,N,N
4960805,CK,STC,A,990,82550,,,,,64.00,N,N
4960806,GLUCOSE,STC,A,990,82947,,,,,36.00,N,N
4960807,RSV TEST,STC,A,990,87807,,,,,41.00,N,N
4960808,TRICHOMONAS,STC,A,990,87808,,,,,29.00,N,N
4960827,FETAL DOPPLER,STC,A,990,76827,,,,,136.00,N,Y
4960860,COMPLEMENT 3,STC,A,990,86160,,,,,89.00,N,N
4960870,GENITAL CULTURE,STC,A,990,87070,,,,,65.00,N,N
4960880,ARANSEP PER 5MCG,STC,A,990,J0880,,,,,29.00,N,Y
4960885,EPOGEN PER 1000 UNITES,STC,A,990,J0885,,,,,44.50,N,Y
4960897,PROLIA(DENOSUMAD)PER 1MG,STC,A,990,J0897,,,,,"1,710.00",N,Y
4960901,CAURTERIZATION OF NOSE,STC,A,990,30901,,,,,87.00,N,Y
4960904,CHLAMYDIA URINE,STC,A,300,87491,,,,,65.00,N,N
4960905,BV,STC,A,990,87905,,,,,29.00,N,N
4960920,GONORRHOEAE URINE,STC,A,300,87591,,,,,59.00,N,N
4960970,PARATHYROID HORMONE,STC,A,990,83970,,,,,139.00,N,N
4960992,SCHOOL/OTHER STAFF PHYSICALS,STC,A,990,99211,,,,,50.00,N,N
4961000,UA DIP W/MICRO,STC,A,990,81000,,,,,11.00,N,Y
4961001,DEPO-ESTRADIOL UP TO 5MG,STC,A,990,J1000,,,,,13.00,N,Y
4961002,UA DIP W/O MICRO,STC,A,990,81002,,,,,9.00,N,Y
4961003,UA AUTO W/O MICRO,STC,A,990,81003,,,,,29.00,N,Y
4961025,PREG URINE,STC,A,990,81025,,,,,22.00,N,Y
4961030,DEPO MEDROL 40MG,STC,A,990,J1030,,,,,13.00,N,Y
4961040,"DEBRIDEMENT, SKIN LESION",STC,A,990,11040,,,,,55.50,N,Y
4961050,DEPO PROV 1 MG,STC,A,990,J1050,,,,,150.00,N,Y
4961055,DEPO-PRVERA 150MG,STC,A,990,J1055,,,,,116.40,N,Y
4961056,CORN REMOVAL,STC,A,990,11055,,,,,65.50,N,Y
4961071,DEPO TEST PER 1 MG,STC,A,636,J1071,,,,,60.00,N,N
4961080,TESTOSTERONE CYP 200 MG,STC,A,636,J1080,,,,,21.00,N,Y
4961100,BIOPSY-SKIN,STC,A,990,11100,,,,,114.00,N,Y
4961101,BIOPSY-EACH ADD'L,STC,A,990,11101,,,,,52.00,N,Y
4961102,DEBRIDEMENT OF SKIN,STC,A,990,11000,,,,,70.00,N,N
4961111,CARE COORDINATOR VISIT,STC,A,990,,,,,,0.00,N,N
4961174,EVACUATION OF SUBUNGUAL H,STC,A,990,11740,,,,,52.00,N,Y
4961200,REMOVAL SKIN TAGS,STC,A,990,11200,,,,,166.00,N,Y
4961201,DIPHENHYDRAMINE 50MG/ML 1,STC,A,990,J1200,,,,,3.50,N,Y
4961241,FACTOR V LEIDEN,STC,A,990,81241,,,,,108.00,N,N
4961291,MTHFR,STC,A,990,81291,,,,,81.00,N,N
4961300,SHAVE OF EPID/DERM LE .5<,STC,A,990,11300,,,,,81.00,N,Y
4961301,SHAVING SINGLE LESION0.6 TO1.0CM ARMLEG,STC,A,990,11301,,,,,100.00,N,N
4961302,COTININE,STC,A,990,80302,,,,,89.00,N,N
4961305,"SHAVE EPID DERMLE,5SNHFG",STC,A,990,11305,,,,,79.50,N,Y
4961310,SHAVE BIO N F E EL L ME,STC,A,990,11310,,,,,98.00,N,Y
4961400,EX SKIN LESION-BN <.5CM,STC,A,990,11400,,,,,150.00,N,Y
4961401,EX SKIN LESION-BN 0.6-1.0,STC,A,990,11401,,,,,174.00,N,Y
4961402,EX SKIN LESION-BN 1.1-2.0,STC,A,990,11402,,,,,205.50,N,Y
4961403,EX SKIN LESION-BN 2.1-3.0,STC,A,990,11403,,,,,223.00,N,Y
4961404,EX SKIN LESION-BN 3.1-4.0,STC,A,990,11404,,,,,254.00,N,Y
4961406,EX SKIN LESION-BN 4.0 +CM,STC,A,990,11406,,,,,344.00,N,Y
4961420,EX SKIN LESION-BN <.5 CM,STC,A,990,11420,,,,,147.50,N,Y
4961421,EX SKIN LESION-BN 0.6-1.0,STC,A,990,11421,,,,,185.50,N,Y
4961422,EX SKIN LESION-BN 1.1-2.0,STC,A,990,11422,,,,,214.50,N,Y
4961423,EX SKIN LESION-BN 2.1-3.0,STC,A,990,11423,,,,,245.00,N,Y
4961424,EX SKIN LESION-BN 3.1-4.0,STC,A,990,11424,,,,,281.50,N,Y
4961426,EX SKIN LESION-BN 4.0 +CM,STC,A,990,11426,,,,,391.00,N,Y
4961436,SMOKING CESS 3-10 MIN MEDICARE/MEDICAID,STC,A,990,G0436,,,,,21.00,N,N
4961437,SMOKING CESS > 10 MIN MEDICARE/MEDICAID,STC,A,990,G0437,,,,,47.00,N,N
4961440,EX SKIN LESION-BN < .5CM,STC,A,990,11440,,,,,178.00,N,Y
4961441,EX SKIN LESION-BN 0.6-1.0,STC,A,990,11441,,,,,205.50,N,Y
4961442,EX SKIN LESION-BN 1.1-2.0,STC,A,990,11442,,,,,227.50,N,Y
4961443,EX SKIN LESION-BN 2.1-3.0,STC,A,990,11443,,,,,278.00,N,Y
4961444,EX SKIN LESION-BN 3.1-4.0,STC,A,990,11444,,,,,352.00,N,Y
4961446,EX SKIN LESION-BN 4.0 +CM,STC,A,990,11446,,,,,453.00,N,Y
4961472,HEPATITIS C AB FOR MEDICARE PATIENTS,STC,A,990,G0472,,,,,98.00,N,N
4961473,"INTRANASAL/ORAL IMMUNIZATION, 1 VACCINE",STC,A,990,90473,,,,,63.00,N,N
4961600,EX SKIN LESION-MA < .5CM,STC,A,990,11600,,,,,207.00,N,Y
4961601,EX SKIN LESION-MA 0.6-1.0,STC,A,990,11601,,,,,237.00,N,Y
4961602,EX SKIN LESION-MA 1.1-2.0,STC,A,990,11602,,,,,254.00,N,Y
4961603,EX SKIN LESION-MA 2.1-3.0,STC,A,990,11603,,,,,278.00,N,Y
4961604,EX SKIN LESION-MA 3.1-4.0,STC,A,990,11604,,,,,306.00,N,Y
4961606,EX SKIN LESION-MA 4.0 +CM,STC,A,990,11606,,,,,399.50,N,Y
4961610,GLUCAGON PER 1MG,STC,A,990,J1610,,,,,325.30,N,Y
4961620,EX SKIN LESION-MA < .5CM,STC,A,990,11620,,,,,200.50,N,Y
4961621,EX SKIN LESION-MA 0.6-1.0,STC,A,990,11621,,,,,237.00,N,Y
4961622,EX SKIN LESION-MA 1.1-2.0,STC,A,990,11622,,,,,267.50,N,Y
4961623,EX SKIN LESION-MA 2.1-3.0,STC,A,990,11623,,,,,316.00,N,Y
4961624,EX SKIN LESION-MA 3.1-4.0,STC,A,990,11624,,,,,361.50,N,Y
4961626,EX SKIN LESION-MA 4.0 +CM,STC,A,990,11626,,,,,477.00,N,Y
4961640,EX SKIN LESION-MA < .5CM,STC,A,990,11640,,,,,213.00,N,Y
4961641,EX SKIN LESION-MA 0.6-1.0,STC,A,990,11641,,,,,274.50,N,Y
4961643,EX SKIN LESION-MA 2.1-3.0,STC,A,990,11643,,,,,366.00,N,Y
4961644,EX SKIN LESION-MA 3.1-4.0,STC,A,990,11644,,,,,464.00,N,Y
4961646,EX SKIN LESION-MA 4.0 +CM,STC,A,990,11646,,,,,622.50,N,Y
4961650,LOVENOX PER 10MG,STC,A,990,J1650,,,,,11.50,N,Y
4961730,AVULSION OF NAIL,STC,A,990,11730,,,,,116.50,N,Y
4961732,AVULSION OF NAIL; EACH ADD'L,STC,A,990,11732,,,,,65.00,N,N
4961750,EXCIS OF NAIL & NAIM MATR,STC,A,990,11750,,,,,289.50,N,Y
4961820,HUMULIN R UP TP 100 UNITS,STC,A,990,J1820,,,,,7.30,N,Y
4961885,KETOROLAC PER 15MG,STC,A,990,J1885,,,,,16.00,N,Y
4961900,LESION INJECTION UP TO 7,STC,A,990,11900,,,,,54.00,N,Y
4961940,FUROSEMIDE UP TO 20MG,STC,A,990,J1940,,,,,3.00,N,Y
4961950,LUPRON PER 3.75MG,STC,A,990,J1950,,,,,667.00,N,Y
4961981,INSER NONBIODEG DRUG DELI,STC,A,990,11981,,,,,260.00,N,N
4961982,REMOV NONBIODEG DRUG DEL,STC,A,990,11982,,,,,290.00,N,N
4961983,REM REINSERT NONBIODEG IM,STC,A,990,11983,,,,,405.00,N,N
4962001,LACERATION REPAIR <2.5CM,STC,A,990,12001,,,,,196.00,N,Y
4962002,LACERATION REPAIR 2.6-7.5,STC,A,990,12002,,,,,219.00,N,Y
4962004,LACERATION REPAI 7.6-12.5,STC,A,990,12004,,,,,245.00,N,Y
4962005,LACERATION REPAIR 12.6-20,STC,A,990,12005,,,,,303.00,N,Y
4962011,LACERATION REP FACE <2.5,STC,A,990,12011,,,,,214.50,N,Y
4962013,LACERAT REP FACE 2.6-7.5,STC,A,990,12013,,,,,227.50,N,Y
4962014,LACERAT RE FACE 7.6-12.5,STC,A,990,12014,,,,,267.50,N,Y
4962015,LACERAT RE FACE 12.6-20,STC,A,990,12015,,,,,339.00,N,Y
4962024,ACTH,STC,A,300,82024,,,,,282.00,N,N
4962035,MED INFLU SPLIT VIR AFLUR,STC,A,636,Q2035,,,,,0.00,N,Y
4962036,MED INFLU SPLIT V FLUAVA,STC,A,636,Q2036,,,,,0.00,N,Y
4962037,MED INFLU SPLIT FLUVIRIN,STC,A,636,Q2037,,,,,0.00,N,Y
4962038,INFLUENZA QUAD VACCINE 0.5ML,STC,A,636,90688,,,,,50.00,N,Y
4962039,FLUARIX MEDICARE QUAD SPLIT VIRUS 0.5 ML,STC,A,636,90686,,,,,50.00,N,Y
4962060,INJECTION INTO MED JOINT,STC,A,990,20605,,,,,101.00,N,Y
4962103,FERRITIN IRA,STC,A,990,82103,,,,,99.00,N,N
4962150,AMYLASE,STC,A,990,82150,,,,,48.00,N,N
4962175,DEMEROL PER 100MG,STC,A,990,J2175,,,,,3.50,N,Y
4962200,I&D SOFT TISSUE ABSCESS,STC,A,990,20005,,,,,134.00,N,Y
4962248,DIRECT BILIRUBIN,STC,A,990,82248,,,,,37.00,N,N
4962261,BIOTINIDASE,STC,A,990,82261,,,,,53.00,N,N
4962270,OCCULT BLOOD SCREENING,STC,A,990,82270,,,,,49.00,N,Y
4962272,OCC BL SC DIGITAL RECTAL,STC,A,990,82272,,,,,9.00,N,Y
4962274,HEMOQUANT,STC,A,990,82274,,,,,59.00,N,N
4962301,NUBAIN PER 10MG,STC,A,990,J2300,,,,,4.50,N,Y
4962310,CALCIUM,STC,A,990,82310,,,,,54.00,N,N
4962330,IONIZED CALCIUM,STC,A,990,82330,,,,,100.00,N,N
4962340,URINE CALCIUM,STC,A,990,82340,,,,,46.00,N,N
4962343,VALPROATE 100MG/ML 5ML SD,STC,A,990,J3490,,,,,53.00,N,Y
4962360,NORFLEX UP TO 60MG,STC,A,990,J2360,,,,,15.00,N,Y
4962365,STONE ANALYSIS,STC,A,960,82365,,,,,55.00,N,N
4962378,CEA,STC,A,990,82378,,,,,140.00,N,N
4962380,CAROTENE (SERUM),STC,A,990,82380,,,,,70.00,N,N
4962390,CERULOPLASMIN,STC,A,300,82390,,,,,80.00,N,N
4962397,CHEMILUMINESENT ASSAY,STC,A,990,82397,,,,,65.00,N,N
4962405,ONDANSETRON(ZOFRAN)PER1MG INJ,STC,A,990,J2405,,,,,2.30,N,Y
4962436,CHLORIDE UA RANDOM,STC,A,990,82436,,,,,45.00,N,N
4962465,CHOLESTEROL,STC,A,990,82465,,,,,46.00,N,N
4962505,NEULASTA 6MG,STC,A,990,J2505,,,,,"5,381.50",N,Y
4962507,URINE CITRATE,STC,A,990,82507,,,,,59.00,N,N
4962530,CORTISOL 24 HR URINE,STC,A,990,82530,,,,,61.00,N,N
4962533,"CORTISOL, TOTAL",STC,A,990,82533,,,,,119.00,N,N
4962542,METHYLMALONIC ACID,STC,A,990,82542,,,,,179.00,N,N
4962550,PROMETHAZINE UP TO 50MG,STC,A,990,J2550,,,,,4.00,N,Y
4962553,CKMB,STC,A,990,82553,,,,,110.00,N,N
4962565,CREATININE,STC,A,990,82565,,,,,40.00,N,N
4962567,TYMPANOMETRY,STC,A,990,92567,,,,,38.00,N,Y
4962607,B 12,STC,A,990,82607,,,,,81.00,N,N
4962660,CLSD TR METACARPAL FX W/O,STC,A,990,26600,,,,,408.00,N,Y
4962670,ESTRADIOL,STC,A,990,82670,,,,,207.00,N,N
4962671,ESTROGEN FRACTIONATION,STC,A,990,82671,,,,,237.00,N,N
4962679,ESTRONE,STC,A,990,82679,,,,,183.00,N,N
4962728,"FERRITIN, RIA",STC,A,990,82728,,,,,76.00,N,N
4962746,FOLATE (FOLIC ACID),STC,A,990,82746,,,,,81.00,N,N
4962765,METOCLOPRAMIDE 10 MG,STC,A,636,J2765,,,,,4.00,N,N
4962776,GALACTOSE 1 PHOSPHATE URIDYL TRANS SCR,STC,A,990,82776,,,,,27.00,N,N
4962784,IMMUNOGLOBULIN A,STC,A,990,82784,,,,,70.00,N,N
4962785,ALLERGY PROFILE CHILDHOOD,STC,A,990,86003,91,,,,81.00,N,N
,,STC,A,990,82785,,,,,81.00,N,N
4962790,RHO GAM,STC,A,990,J2790,,,,,371.00,N,Y
4962920,SOLU-MEDROL UP TO 40MG,STC,A,990,J2920,,,,,10.00,N,Y
4962930,SOLU MEDROL UP TO 125MG,STC,A,990,J2930,,,,,7.10,N,N
4962947,GLUCOSE,STC,A,990,82948,,,,,36.00,N,Y
4962977,GGT,STC,A,990,82977,,,,,55.00,N,N
4963001,FSH,STC,A,990,83001,,,,,138.00,N,N
4963002,LH,STC,A,990,83002,,,,,145.00,N,N
4963020,HGB ELECTROPHORESIS,STC,A,990,83020,,,,,56.00,N,N
4963030,SUMATRIPTAN 6MG,STC,A,990,J3030,,,,,32.00,N,Y
4963090,HOMOCYSTEINE,STC,A,990,83090,,,,,108.00,N,N
4963152,LAC REP C2.6CM/7.5CMFCM,STC,A,990,13152,,,,,566.00,N,Y
4963225,HOLTER MONITOR,STC,A,990,93225,,,,,32.00,N,Y
4963270,EVENT MONITOR,STC,A,990,93270,,,,,27.00,N,Y
4963301,KENALOG PER 10MG,STC,A,636,J3301,,,,,20.00,N,Y
4963410,HYDROXYZINE UP TO 25MG,STC,A,990,J3410,,,,,2.50,N,Y
4963420,VITAMIN B-12 1000MCG,STC,A,990,J3420,,,,,20.00,N,Y
4963498,17-OH PROGESTERONE,STC,A,990,83498,,,,,86.00,N,N
4963516,TISSUE TRANSGLUTAMINASE,STC,A,990,83516,,,,,81.00,N,N
4963519,GAD ANTIBODY,STC,A,990,83519,,,,,171.00,N,N
4963520,IMMUNOASSAY OF ANALYTE NOT OTHERISE SPEC,STC,A,990,83520,,,,,110.00,N,N
4963525,"INSULIN, TOTAL",STC,A,300,83525,,,,,52.00,N,N
4963540,IRON,STC,A,990,83540,,,,,38.00,N,N
4963550,IRON BINDING,STC,A,990,83550,,,,,42.00,N,N
4963605,LACTIC ACID,STC,A,990,83605,,,,,80.00,N,N
4963615,LDH,STC,A,990,83615,,,,,46.00,N,N
4963650,"FOOT OS CALCIS,MIN 2 VIEW",STC,A,990,73650,,,,,127.00,N,N
4963690,LIPASE,STC,A,990,83690,,,,,55.00,N,N
4963718,HDL,STC,A,990,83718,,,,,62.00,N,N
4963735,MAGNESIUM SERUM,STC,A,300,83735,,,,,50.00,N,N
4963789,MASS SPECTROMETRY NOS,STC,A,990,83789,,,,,84.00,N,N
4963835,METAEPHRINES,STC,A,990,83835,,,,,141.00,N,N
4963880,BNP,STC,A,990,83880,,,,,209.00,N,N
4963898,FACTOR V LEIDEN,STC,A,990,83898,,,,,108.00,N,N
4963930,I&D HEMATOMA/ELBOW,STC,A,990,23930,,,,,204.00,N,Y
4963935,URINE OSMOLALITY,STC,A,990,83935,,,,,40.00,N,N
4963970,PARATHYROID HORMONE,STC,A,300,83970,,,,,139.00,N,N
4963993,FECAL CALPROTECTIN,STC,A,990,83993,,,,,200.00,N,N
4964010,SPIROMETRY,STC,A,990,94010,,,,,64.50,N,Y
4964016,PULMONARY FUNCTION INTERP,STC,A,990,94016,,,,,38.50,N,Y
4964030,NEO NATAL SCREEN,STC,A,990,84030,,,,,153.00,N,N
4964056,DEST OFLESION(CRYO) PENIS,STC,A,990,54056,,,,,112.50,N,Y
4964100,PHOSPHORUS,STC,A,300,84100,,,,,35.00,N,N
4964133,URINE POTASSIUM,STC,A,990,84133,,,,,38.00,N,N
4964146,PROLACTIN,STC,A,990,84146,,,,,143.00,N,N
4964153,PSA,STC,A,990,84153,,,,,70.00,N,N
4964155,TOTAL PROTEIN,STC,A,990,84155,,,,,28.00,N,N
4964270,SEX HORMONE BINDING GLOBI,STC,A,990,84270,,,,,164.00,N,N
4964295,SODIUM/NA,STC,A,990,84295,,,,,37.00,N,N
4964300,"SODIUM, URINE",STC,A,990,84300,,,,,32.00,N,N
4964402,TESTOSTERONE; FREE,STC,A,990,84402,,,,,188.00,N,N
4964425,VIT B (THIAMINE),STC,A,300,84425,,,,,156.00,N,N
4964439,FREE T4,STC,A,990,84439,,,,,72.00,N,N
4964443,TSH,STC,A,990,84443,,,,,92.00,N,N
4964450,AST,STC,A,990,84450,,,,,81.00,N,N
4964466,TRANSFERRIN,STC,A,300,84466,,,,,95.00,N,N
4964478,TRIGLYCERIDES,STC,A,990,84478,,,,,92.00,N,N
4964479,THYROID HORMONE UPTAKE,STC,A,990,84479,,,,,12.00,N,N
4964480,T3,STC,A,990,84480,,,,,95.00,N,N
4964481,FREE T3,STC,A,990,84481,,,,,126.00,N,N
4964484,TROPONIN,STC,A,990,84484,,,,,97.00,N,N
4964550,URIC ACID,STC,A,990,84550,,,,,81.00,N,N
4964640,INHALATION TREATMENT,STC,A,410,94640,,,,,42.00,N,Y
4964681,C-PEPTIDE,STC,A,300,84681,,,,,153.00,N,N
4964702,HCG QUANTITATIVE,STC,A,300,84702,,,,,111.00,N,N
4964703,BETA HCG SCREEN SERUM,STC,A,990,84703,,,,,25.00,N,Y
4964900,SYNVISC 1,STC,A,990,J3490,,,,,"1,442.00",N,Y
4965000,NOCALL/NOSHOW,STC,A,990,,,,,,20.50,N,Y
4965014,HEMATOCRIT,STC,A,990,85014,,,,,35.00,N,N
4965018,HEMOGLOBIN,STC,A,990,85018,,,,,22.00,N,Y
4965025,CBC W/DIFF,STC,A,990,85025,,,,,71.00,N,N
4965027,CBC HEMOGRAM,STC,A,300,85027,,,,,71.00,N,N
4965045,RETICULOCYTES (RETIO CT),STC,A,990,85045,,,,,33.00,N,N
4965046,"BC, RETICULOCYTES, AUTO, 1 OR MORE",STC,A,990,85046,,,,,11.00,N,N
4965048,WBC,STC,A,990,85048,,,,,23.00,N,N
4965049,PLATELETS PLT,STC,A,990,85049,,,,,33.00,N,N
4965060,BLOOD MORPHOLOGY,STC,A,990,85060,,,,,78.00,N,N
4965205,FOREIGN BODY REMOVAL EYE,STC,A,990,65205,,,,,114.00,N,Y
4965378,D-DIMER,STC,A,990,85378,,,,,82.00,N,N
4965610,INR,STC,A,990,85610,,,,,22.00,N,Y
4965651,SED RATE,STC,A,990,85651,,,,,33.00,N,N
4965660,SICKLE CELL SCREEN,STC,A,990,85660,,,,,46.00,N,N
4965705,LUPUS ANTICOAGULANT,STC,A,990,85705,,,,,119.00,N,N
4966000,BURN CARE INITIAL,STC,A,990,16000,,,,,94.00,N,Y
4966003,RAST ALLERGEN,STC,A,990,86003,,,,,33.00,N,N
4966010,DRAINED ABSCESS,STC,A,990,26010,,,,,153.00,N,Y
4966020,BURN DEBR/DRSG SM,STC,A,990,16020,,,,,112.00,N,Y
4966025,BURN DEBR/DRESG MED,STC,A,990,16025,,,,,196.00,N,Y
4966039,ANTINUCLEAR ANTIBODY,STC,A,990,86039,,,,,84.00,N,N
4966083,EVAC. OF THROMBOSED HEMOR,STC,A,990,46083,,,,,369.00,N,Y
4966127,BRIEF EMOTIONAL/BEH ASSESS,STC,A,990,96127,,,,,16.00,N,N
4966140,C REACTIVE PROTEIN,STC,A,990,86140,,,,,33.00,N,N
4966147,ANTI CARDIOLIPIN IGA,STC,A,990,86147,,,,,97.00,N,N
4966200,CYCLIC C PEPTIDE AB,STC,A,990,86200,,,,,57.00,N,N
4966211,SPORTS PHYSICAL,STC,A,990,,,,,,10.00,N,Y
4966235,ENDOMYSIAL ANTIBODY,STC,A,990,86235,,,,,99.00,N,N
4966255,ANCA-ANTINUCLEAR,STC,A,990,86255,,,,,140.00,N,N
4966308,INFECTIOUS MONONUCLEOSIS,STC,A,990,86308,,,,,40.00,N,N
4966337,INSULIN ANTIBODIES,STC,A,990,86337,,,,,157.00,N,N
4966341,ISLET CELL ANTIBODY,STC,A,990,86341,,,,,176.00,N,N
4966345,APP OF LONG LEG CAST,STC,A,990,29345,,,,,180.00,N,Y
4966376,THYROID ANTIBODY PANEL,STC,A,990,86376,,,,,76.00,N,N
4966401,CHEMO ADM,STC,A,990,96401,,,,,163.50,N,Y
4966415,VENIPUNTURE,STC,A,990,36415,,,,,18.00,N,Y
4966430,RHEUMATOID FACTOR,STC,A,990,86430,,,,,45.00,N,N
4966468,"INF MULT TELANG, LEG",STC,A,990,36468,,,,,214.50,N,Y
4966469,"INJ MULT TELANF, FACE",STC,A,990,36469,,,,,214.50,N,Y
4966470,INJ SINGLE VARICOSE VEIN,STC,A,990,36470,,,,,86.00,N,Y
4966471,INJ MULT VARIC CEINS SLEG,STC,A,990,36471,,,,,191.50,N,Y
4966580,TUBERCULIN INTRADERMAL,STC,A,990,86580,,,,,16.00,N,Y
4966588,RAPID STREP,STC,A,990,87880,,,,,27.00,N,Y
4966592,RPR SEROLOGY,STC,A,990,86592,,,,,33.00,N,N
4966600,ANOSCOPY,STC,A,990,46600,,,,,109.00,N,Y
4966605,BIOPSY ONE VULVAR LESION,STC,A,990,56605,,,,,119.50,N,Y
4966615,PERTUSSIS AB87.00,STC,A,990,86615,,,,,87.00,N,N
4966618,LYME DISEASE,STC,A,990,86618,,,,,126.00,N,N
4966635,FUNGUS COCCIDIOIDES,STC,A,990,86635,,,,,87.00,N,N
4966644,CMV IGG IGM,STC,A,300,86644,,,,,107.00,N,N
4966645,CMV TITER IGM,STC,A,990,86645,,,,,125.00,N,N
4966663,EPSTEIN BARR VIRUS TITER,STC,A,960,86663,,,,,98.00,N,N
4966664,EPSTEIN BARR VIRUS NUCLEAR ANTIGEN,STC,A,990,86664,,,,,68.00,N,N
4966665,EPSTEIN BARR VIR ANTIPROF,STC,A,300,86665,,,,,86.00,N,N
4966677,H. PYLORI,STC,A,990,86677,,,,,107.00,N,N
4966695,HERPES VIRUS ANTIBODY,STC,A,990,86695,,,,,99.00,N,N
4966696,HERPES SIMPLEX TYPE 2,STC,A,990,86696,,,,,30.00,N,N
4966703,"HIV ANTI, 1 AND 2, SINGLE RESULT",STC,A,990,86703,,,,,16.00,N,N
4966704,HEP B CORE AB,STC,A,990,86704,,,,,90.00,N,N
4966705,HEP B COR AB 1 GM,STC,A,990,86705,,,,,55.00,N,N
4966706,HEP B SUR ANTIBODY,STC,A,300,86706,,,,,80.00,N,N
4966708,HEP A AB IG TOTAL,STC,A,990,86708,,,,,93.00,N,N
4966735,MUMPS VIRUS AB 1 GM,STC,A,990,86735,,,,,104.00,N,N
4966742,CLSD TRMT ARTICULAR FRACTURE,STC,A,990,26742,,,,,800.00,N,N
4966747,PARVOVIRUS,STC,A,990,86747,,,,,111.00,N,N
4966757,ROCKY MOUTAIN SPOTTED FEV,STC,A,990,86757,,,,,87.00,N,N
4966762,RUBELLA ANTIBODY,STC,A,990,86762,,,,,107.00,N,N
4966765,RUBEOLA ANTIBODY,STC,A,300,86765,,,,,103.00,N,N
4966787,VARICELLA ZOSTER ANTIBODY,STC,A,300,86787,,,,,97.00,N,N
4966800,THYROGLOBIN,STC,A,990,86800,,,,,114.00,N,N
4966803,HEP C AB,STC,A,990,86803,,,,,106.00,N,N
4966885,INDIRECT COOMBES/ANTIBODY,STC,A,990,86885,,,,,45.00,N,N
4966900,ABO,STC,A,990,86900,,,,,145.00,N,N
4966901,RH,STC,A,990,86901,,,,,73.00,N,N
4966920,CROSSMATCH IMM SPIN UNIT 3,STC,A,990,86920,,,,,59.00,N,N
4966921,CROSSMATCH AHG UNIT 2,STC,A,990,86921,,,,,76.00,N,N
4966922,CROSSMATCH ANTIGLOBULIN,STC,A,990,86922,,,,,76.00,N,N
4967000,"DESTRUCT.,BENIGN LESION 1",STC,A,990,17000,,,,,120.00,N,Y
4967003,DESTRUBENIGN LESION A2-14,STC,A,990,17003,,,,,16.00,N,Y
4967045,STOOL CULTURE,STC,A,990,87045,,,,,71.00,N,N
4967046,STOOL CULTURE ADD'L PATHOGENS,STC,A,990,87046,,,,,42.00,N,N
4967070,WOUND CULTURE,STC,A,990,87070,,,,,65.00,N,N
4967077,ID CULTURE,STC,A,990,87077,,,,,55.00,N,N
4967081,THROAT CULTURE,STC,A,990,87081,,,,,65.00,N,N
4967086,URINE CULTURE,STC,A,990,87086,,,,,67.00,N,N
4967088,ID URINE BACTERIA,STC,A,990,87088,,,,,55.00,N,N
4967102,FUNGUS CULTURE,STC,A,990,87102,,,,,38.00,N,N
4967110,REMOVAL OF WARTS,STC,A,990,17110,,,,,146.00,N,Y
4967170,DIAPHRAGM/CERV CAP FITTIN,STC,A,990,57170,,,,,118.00,N,Y
4967177,OVA & PARA,STC,A,990,87177,,,,,68.00,N,N
4967186,SENSITIVITY CULTURE,STC,A,990,87186,,,,,83.00,N,N
4967205,GRAM STAIN,STC,A,990,87205,,,,,33.00,N,N
4967206,FUNGAL SMEAR,STC,A,990,87206,,,,,38.00,N,N
4967209,TRICHROME STAIN,STC,A,990,87209,,,,,23.00,N,N
4967210,WET MOUNT,STC,A,990,87210,,,,,33.00,N,N
4967220,WET MOUNT (KOH),STC,A,990,87220,,,,,12.00,N,N
4967230,CLOSTRIDIUM DIFFICULE TOX,STC,A,990,87230,,,,,145.00,N,N
4967300,PARAGARD,STC,A,990,J7300,,,,,658.00,N,N
4967301,SKYLA,STC,A,990,J7301,,,,,600.00,N,N
4967302,MIRENA,STC,A,990,J7298,,,,,800.00,N,N
4967307,IMPLANON/NEXPLANON,STC,A,990,J7307,,,,,"1,100.00",N,N
4967320,SYNVISC PER 16MG,STC,A,990,J7320,,,,,412.00,N,Y
4967325,SYNVISC ONE PER 1MG,STC,A,990,J7325,,,,,34.50,N,Y
4967329,GIARDIA SPECIFIC ANTIGEN,STC,A,990,87329,,,,,97.00,N,N
4967340,HEP B SURFACE AG,STC,A,990,87340,,,,,71.00,N,N
4967365,"FOOT OS CALCIS,MIN 2 VIEW",STC,A,990,73650,,,,,127.00,N,N
4967427,SHIGA TOXIN,STC,A,990,87427,,,,,59.00,N,N
4967452,COLPOSCOPY,STC,A,990,57452,,,,,156.50,N,Y
4967454,COLPOSCOPY W/BIOPSY,STC,A,990,57454,,,,,237.50,N,Y
4967486,"CHYLMD PNEUM, DNA, AMP PROBE",STC,A,990,87486,,,,,152.00,N,N
4967493,CLOSTRIDIUM DIFFICILE TOX,STC,A,990,87493,,,,,145.00,N,N
4967500,CHEST (1VIEW) FRONTAL,STC,A,990,71045,,,,,137.00,N,N
4967501,CHEST (2vIEW)FRONT&lATERAL,STC,A,990,71046,,,,,159.00,N,N
4967502,SHOULDER COMPL MIN 2 VIEW,STC,A,990,73030,,,,,143.00,N,N
4967503,HUMERUS MIN 2 VIEW,STC,A,990,73060,,,,,142.00,N,N
4967504,ELBOW ANTEROPOSTERIOR VIEW,STC,A,990,73070,,,,,127.00,N,N
4967505,UPPER EXTREM INFANTMIN 2V,STC,A,990,73092,,,,,124.00,N,N
4967506,FOREARM 2 VIEW,STC,A,990,73090,,,,,130.00,N,N
4967507,WRIST 2 VIEW,STC,A,990,73100,,,,,122.00,N,N
4967508,WRIST MIN 3 VIEW,STC,A,990,73110,,,,,135.00,N,N
4967509,HAND MIN 3 VIEW,STC,A,990,73130,,,,,134.00,N,N
4967510,FINGER(S) MIN 2 VIEW,STC,A,990,73140,,,,,108.00,N,N
4967511,FEMUR 2 VIEW,STC,A,990,73552,,,,,135.00,N,N
4967512,TIBIA & FIBULA LEG 2 VIEW,STC,A,990,73590,,,,,125.00,N,N
4967513,KNEE <=2 VIEWS,STC,A,990,73560,TC,,,,137.00,N,N
4967515,"LWR EXTREM INFANT, MIN 2VW",STC,A,990,73592,,,,,122.00,N,N
4967516,ANKLE 2 VIEWS,STC,A,990,73600,,,,,124.00,N,N
4967517,ANKLE MIN 3 VIEWS,STC,A,990,73610,,,,,140.00,N,N
4967518,FOOT 2 VIEWS,STC,A,990,73620,,,,,124.00,N,N
4967519,"FOOT, MIN 3 VIEW",STC,A,990,73630,,,,,137.00,N,N
4967520,TOE(S) MIN 2 VIEWS,STC,A,990,73660,,,,,108.00,N,N
4967521,KNEE 3 VIEW,STC,A,990,73562,TC,,,,147.00,N,N
4967522,SHOULDER 1 VIEW,STC,A,990,73020,,,,,118.00,N,N
4967526,TIBIA 3 VIEW,STC,A,990,73590,,,,,70.00,N,N
4967527,HAND 2 VIEW,STC,A,990,73120,,,,,124.00,N,N
4967528,HAND 2 VIEWS,STC,A,990,73130,,,,,134.00,N,N
4967529,"KNEES, COMPLETE 4 OR >",STC,A,990,73564,TC,,,,157.00,N,N
4967530,"KNEES, AP BI-LAT STND",STC,A,990,73565,TC,,,,131.00,N,N
4967531,BONE AGE,STC,A,990,77072,,,,,140.00,N,N
4967581,"M. PNEUMON, DNA, AMP PROBE",STC,A,990,87581,,,,,152.00,N,N
4967590,GC PROBE,STC,A,990,87590,,,,,183.00,N,N
4967624,HUMAN PAPILLOMA VIRUS,STC,A,990,87624,,,,,163.00,N,N
4967633,RESPITORY VIRUS PANEL,STC,A,990,87633,,,,,281.00,N,N
4967798,"DETECT AGENT, NOS, DNA, AMP",STC,A,990,87798,,,,,65.00,N,N
4967800,"EXCISION CHALAZION, SINGLE",STC,A,990,67800,,,,,260.00,N,N
4967802,"MNT, 15 MIN, INITIAL INDIV",STC,A,990,97802,,,,,22.00,N,Y
4968005,"HEALTH PANEL-COMP MET, CBC, TSH",STC,A,300,80050,,,,,260.00,N,N
4968016,DIGOXIN/DGN /LANOXIN,STC,A,990,80162,,,,,99.00,N,N
4968030,DRUG SCREEN,STC,A,990,80305,,,,,43.00,N,N
4968100,ENDOMETRIAL BIOPSY,STC,A,990,58100,,,,,158.00,N,Y
4968101,"UA, DIP W/ MICRO AUTOMATED",STC,A,990,81001,,,,,49.00,N,N
4968164,PAP,STC,A,990,88164,,,,,25.00,N,N
4968175,PAP SMEAR,STC,A,990,88175,,,,,95.00,N,N
4968190,FOREIGN BODY REMOVAL FOOT,STC,A,990,28190,,,,,166.00,N,Y
4968213,GCH EMPLOYEE PHYSICAL,STC,A,990,99213,,,,,0.00,N,Y
4968233,TISSUE CULTURE SKIN/BIOPS,STC,A,990,88233,,,,,379.00,N,Y
4968300,INSERTION INTRAUTERDEVICE,STC,A,990,58300,,,,,135.00,N,N
4968301,REM INTRAUTERINE DEVICE,STC,A,990,58301,,,,,177.00,N,N
4968305,PATH LEVEL 4,STC,A,990,88305,,,,,135.00,N,N
4968310,HAPTOGLOBIN QUANTITATIVE,STC,A,990,83010,,,,,125.00,N,N
4968346,IMMUNOFLUORESCENT STUDY,STC,A,990,88346,,,,,127.00,N,N
4968350,CORTROSYN PER 0.25 MG,STC,A,990,J0835,,,,,137.00,N,Y
4968393,SERUM OSMOLALITY,STC,A,300,83930,,,,,50.00,N,N
4968403,PKU,STC,A,990,84030,,,,,27.00,N,N
4968470,FRACTURE CARE-FOOT/ANKLE,STC,A,990,28470,,,,,312.50,N,Y
4968561,PT PRO TIME,STC,A,990,85610,,,,,22.00,N,N
4968708,MRSA CULTURE NARE,STC,A,990,87081,,,,,35.00,N,N
4968716,FITTING INSERTION PESSARY,STC,A,990,57160,,,,,107.50,N,Y
4968720,BILIRUBIN TRANSCUTANEOUS,STC,A,960,88720,,,,,11.00,N,N
4968750,FILM ARRAY INFECTIOUS DIARRHEA PANEL,STC,A,990,87507,,,,,648.00,N,N
4968925,OMT 1-2,STC,A,990,98925,,,,,46.00,N,Y
4968926,OMT 3-4,STC,A,990,98926,,,,,61.50,N,Y
4968927,OMT 5-6,STC,A,990,98927,,,,,76.50,N,Y
4969000,DRAIN ER ABCESS/HEMATOMA,STC,A,990,69000,,,,,143.00,N,Y
4969008,ADM FLU VACCINE,STC,A,990,G0008,,,,,22.00,N,Y
4969009,ADM PNEUMOCOCCAL VACCINE,STC,A,990,G0009,,,,,63.00,N,Y
4969010,ADM HEPATITIS B VACCINE,STC,A,990,G0010,,,,,9.00,N,Y
4969024,GLOBAL/POST OP VISIT,STC,A,990,99024,,,,,0.00,N,N
4969046,SMOKING CESS. COUNS. 3-10 MIN,STC,A,990,99406,,,,,21.00,N,N
4969047,EACH ADD'L IMMUNE(STATE),STC,A,990,90472,,,,,6.00,N,N
4969055,FECAL LEUKOCYTES,STC,A,990,89055,,,,,33.00,N,N
4969069,KINRIX (DTAP-IVP),STC,A,990,,,,,,0.00,N,Y
4969080,PARACENTESIS,STC,A,990,49080,,,,,92.00,N,Y
4969105,APPLICATION LONG ARM SPLI,STC,A,990,29105,,,,,120.00,N,Y
4969125,APPLICATION SHORT ARM SPL,STC,A,990,29125,,,,,98.00,N,Y
4969130,APPLICATION FINGER SPLINT,STC,A,990,29130,,,,,58.00,N,Y
4969200,"FOREIGN BODY REMOV, EAR",STC,A,990,69200,,,,,150.00,N,N
4969209,EAR LAVAGE 1 OR BOTH EARS,STC,A,990,69209,,,,,31.00,N,N
4969210,CERUMEN REMOVAL 1 OR BOTH EARS,STC,A,990,69210,,,,,78.00,N,Y
4969211,PRESCHOOL/CAMP PHYSICAL,STC,A,990,,,,,,20.00,N,Y
4969213,DOT PHYSICAL,STC,A,990,99499,,,,,123.00,N,Y
4969214,UA DRUG SCREEN,STC,A,990,80100,,,,,30.00,N,N
4969217,OBSERVATION DISCHARGE,STC,A,990,99217,,,,,102.00,N,Y
4969218,OBSERVATION LEVEL 1,STC,A,990,99218,,,,,97.00,N,Y
4969219,OBSERVATION LEVEL 2,STC,A,990,99219,,,,,158.50,N,Y
4969220,OBSERVATION LEVEL 3,STC,A,990,99220,,,,,219.50,N,Y
4969241,OFFICE CONSULT LEVEL 1,STC,A,990,99241,,,,,75.00,N,N
4969243,OFFICE CONSULT LEVEL 3,STC,A,990,99243,,,,,185.00,N,N
4969301,NURSING HOME ADMIT LEVEL1,STC,A,994,99304,,,,,156.00,N,Y
4969302,NURSING HOME ADMIT LEVEL2,STC,A,994,99305,,,,,218.00,N,Y
4969303,NURSING HOME ADMIT LEVEL3,STC,A,994,99306,,,,,281.00,N,Y
4969310,COMPREHENSIVE,STC,A,990,99310,,,,,229.00,N,Y
4969311,NURSING HOME LEVEL 1,STC,A,994,99307,,,,,78.00,N,Y
4969312,NURSING HOME LEVEL 2,STC,A,994,99308,,,,,120.00,N,Y
4969313,NURSING HOME LEV3 DETAIL,STC,A,994,99309,,,,,156.00,N,Y
4969324,NEWPT ASISITED LIVING V,STC,A,990,99324,,,,,94.00,N,Y
4969325,NEWPT ASSISTED LIVING V,STC,A,990,99325,,,,,135.00,N,Y
4969326,NEWPT ASSISTED LIVING V,STC,A,990,99326,,,,,234.00,N,Y
4969327,NEWPT ASSISTED LIVING VIS,STC,A,990,99327,,,,,312.00,N,Y
4969328,NEWPT ASSISTED LIVING VIS,STC,A,990,99328,,,,,364.00,N,Y
4969334,ESTABPT ASSISTED LIVING V,STC,A,990,99334,,,,,101.00,N,Y
4969335,ESTABPT ASSISTED LIVING V,STC,A,990,99335,,,,,161.00,N,Y
4969336,ESTABPT ASSISTED LIVING A,STC,A,990,99336,,,,,229.00,N,Y
4969337,ESTABPT ASSISTED LIVING V,STC,A,990,99337,,,,,328.00,N,Y
4969347,HOME VISIT ESTA. LEVEL 2,STC,A,994,99347,,,,,94.00,N,Y
4969348,HOME VISIT ESTA. LEVEL 3,STC,A,994,99348,,,,,146.00,N,N
4969381,PHYSICAL NEW 0-1 YR,STC,A,990,99381,,,,,161.00,N,N
4969382,PHYSICAL NEW 1-4 YRS,STC,A,990,99382,,,,,166.00,N,Y
4969383,PHYSICAL NEW 5-11 YRS,STC,A,990,99383,,,,,176.00,N,Y
4969384,PHYSICAL NEW 12-17 YRS,STC,A,990,99384,,,,,198.00,N,Y
4969385,PHYSICAL NEW 18-39 YRS,STC,A,990,99385,,,,,187.00,N,Y
4969386,PHYSICAL NEW 40-64 YRS,STC,A,990,99386,,,,,218.00,N,Y
4969387,PHYSICAL NEW 65 & OLDER,STC,A,990,99387,,,,,239.00,N,N
4969391,PHYSICAL ESTA. 0-1 YRS,STC,A,990,99391,,,,,146.00,N,N
4969392,PHYSICAL ESTA. 1-4 YRS,STC,A,990,99392,,,,,155.00,N,Y
4969393,PHYSICAL ESTA. 5-11 YRS,STC,A,990,99393,,,,,155.00,N,N
4969394,PHYSICAL ESTA. 12-17 YRS,STC,A,990,99394,,,,,166.00,N,N
4969395,PHYSICAL ESTA. 18-39 YRS,STC,A,990,99395,,,,,171.00,N,Y
4969396,PHYSICAL ESTA. 40-64 YRS,STC,A,990,99396,,,,,182.00,N,Y
4969397,PHYSICAL ESTA. 65 & OLDER,STC,A,990,99397,,,,,198.00,N,Y
4969401,PM/RISK COUNSELING - 15 MIN,STC,A,990,99401,,,,,57.00,N,N
4969402,PM/RISK COUNSELING - 30 MIN,STC,A,990,99402,,,,,99.00,N,N
4969403,PM/RISK COUNSELING - 45 MIN,STC,A,990,99403,,,,,137.00,N,N
4969404,PM/RISK COUNSELING - 60 MIN,STC,A,990,99404,,,,,177.00,N,N
4969407,SMOKING CESS. COUNS. >10 MIN,STC,A,990,99407,,,,,47.00,N,N
4969471,IMMUNIZATION (STATE),STC,A,990,90471,,,,,19.68,N,Y
4969495,TCM - FTF WITHIN 14 DAYS,STC,A,990,99495,,,,,208.00,N,N
4969496,TCM - FTF WITHIN 7 DAYS,STC,A,990,99496,,,,,286.00,N,N
4969497,ADVANCED CARE PLANNING,STC,A,983,99497,,,,,99.00,N,N
4969515,APPLICATION SHORT LEG SPL,STC,A,990,29515,,,,,92.00,N,N
4969580,UNNA BOOT APPLICATION,STC,A,990,29580,,,,,75.00,N,N
4969900,PAP COLLECTION,STC,A,990,99000,,,,,56.00,N,Y
4969901,ST GREGORY H&P,STC,A,990,99204,,,,,190.50,N,Y
4969921,WOUND CARE,STC,A,990,99211,,,,,53.00,N,N
4969924,SUBSEQUENT CARE 1,STC,A,990,,,,,,50.00,N,N
4969925,SUBSEQUENT CARE 2,STC,A,990,,,,,,80.00,N,N
4969926,SUBSEQUENT CARE 3,STC,A,990,,,,,,110.00,N,N
4970002,DEBRID WOUND UP TO 10%,ADC,A,990,,,,,,31.50,N,Y
4970003,DEBRID WOUND EA ADD 10%,ADC,A,990,11001,,,,,22.50,N,Y
4970010,SCRN PELVIC/BREAST EXAM,ADC,A,990,G0101,,,,,57.00,N,Y
4970011,DRUG SCR COLLECTION & KIT,ADC,A,990,80100,,,,,69.00,N,Y
4970024,OCCULT BLOOD SCREENING,ADC,A,990,82270,,,,,49.00,N,Y
4970025,REMOV SKIN TAG (EA AD 10),ADC,A,990,11201,,,,,36.00,N,Y
4970030,SUPARTZ PER INJECTIONS,ADC,A,990,J7321,,,,,124.50,N,Y
4970031,MARCAINE 0.25% PER 30ML,ADC,A,990,S0020,,,,,5.00,N,Y
4970032,CONTRACT PHYSICAL,ADC,A,990,,,,,,50.00,N,Y
4970033,COMMUNITY HEALTH SCREENIN,ADC,A,990,99213,,,,,18.50,N,Y
4970040,REMOVAL OF INCLUSION CYST,ADC,A,990,10040,,,,,116.50,N,Y
4970050,INCIS POSTOP WOUND INFECT,ADC,A,990,10180,,,,,199.00,N,Y
4970055,PARING/CUTTING BENIGN LES,ADC,A,990,11055,,,,,54.00,N,Y
4970060,DRAIN SKIN ABCESS SIMPLE,ADC,A,983,10060,,,,,244.00,N,Y
4970061,DRAIN SKIN ABCESS COMPLIC,ADC,A,990,10061,,,,,432.00,N,Y
4970080,SPECIAL FORMS,ADC,A,990,99080,,,,,22.50,N,Y
4970085,CASTING FOREARM/HAND,ADC,A,990,29085,,,,,115.00,N,Y
4970091,PAP COLLECTION,ADC,A,990,Q0091,,,,,68.00,N,Y
4970100,DEXAMETHASONE PER 1MG,ADC,A,990,J1100,,,,,8.00,N,Y
4970101,UA DRUG SCREEN,ADC,A,990,80101,,,,,41.00,N,N
4970102,"PROSTATE SCREEN, DIG RECTAL EXAM",ADC,A,990,G0102,,,,,26.00,N,N
4970104,DEPO MEDROL 80 MG,ADC,A,990,J1040,,,,,14.25,N,N
4970113,SHAV EPIDERM/DERMAL LES,ADC,A,990,11302,,,,,115.00,N,N
4970115,ALLERGY SINGLE,ADC,A,990,95115,,,,,18.00,N,Y
4970117,ALLERGY MULTIPLE,ADC,A,990,95117,,,,,22.00,N,Y
4970120,FB REMOVAL & INC SIMPLE,ADC,A,990,10120,,,,,218.00,N,Y
4970150,ADENOCARD PER 6MG,ADC,A,990,J0150,,,,,80.00,N,Y
4970162,ZOFRAN 4MG TABLET,ADC,A,990,Q0162,,,,,3.00,N,N
4970170,EPI PEN,ADC,A,990,J0171,,,,,155.00,N,Y
4970179,PHY RECERT FOR HOME HEALT,ADC,A,960,G0179,,,,,79.50,N,Y
4970180,PHY CERT FOR HOME HEALTH,ADC,A,994,G0180,,,,,103.00,N,Y
4970201,NEW OUTPATIENT LEVEL 1,ADC,A,990,99201,,,,,78.00,N,Y
4970202,NEW OUTPATIENT LEVEL 2,ADC,A,990,99202,,,,,125.00,N,Y
4970203,NEW OUTPATIENT LEVEL 3,ADC,A,990,99203,,,,,182.00,N,Y
4970204,NEW OUTPATIENT LEVEL 4,ADC,A,990,99204,,,,,277.00,N,Y
4970205,NEW OUTPATIENT LEVEL 5,ADC,A,990,99205,,,,,338.00,N,Y
4970211,OFFICE VISIT LEVEL 1,ADC,A,990,99211,,,,,47.00,N,Y
4970212,OFFICE VISIT LEVEL 2,ADC,A,990,99212,,,,,73.00,N,Y
4970213,OFFICE VISIT LEVEL 3,ADC,A,990,99213,,,,,120.00,N,Y
4970214,OFFICE VISIT LEVEL 4,ADC,A,983,99214,,,,,172.00,N,Y
4970215,OFFICE VISIT LVEL 5,ADC,A,990,99215,,,,,229.00,N,Y
4970238,HOSPITAL DISCHARGE,ADC,A,990,99238,,,,,101.00,N,Y
4970239,HOSPITAL DISCHARGE,ADC,A,990,99239,,,,,148.00,N,Y
4970270,MORPHINE UP TO 10MG,ADC,A,990,J2270,,,,,2.50,N,Y
4970300,REMOV FORN BODY INTRANAS,ADC,A,990,30300,,,,,229.50,N,N
4970312,SKILLED CARE LEVEL 2,ADC,A,990,99308,,,,,120.00,N,Y
4970317,TELEHEALTH ORIG SITE,ADC,A,990,Q3014,,,,,30.00,N,Y
4970318,TELEHEALTH PROF FEE,ADC,A,990,99212,,,,,23.50,N,Y
4970344,MEDICARE INITIAL PREV.EXA,ADC,A,770,G0402,,,,,182.00,N,Y
4970366,MED.INIT.ECG-W/INTER&REPO,ADC,A,990,G0366,,,,,40.50,N,Y
4970375,RABIES IMMUNE GLOBLIN PER,ADC,A,990,90375,,,,,"1,802.00",N,Y
4970378,SYNAGIS (PHARMACY),ADC,A,990,90378,,,,,"1,484.50",N,Y
4970400,EXC BENIGNLESION <.05CM,ADC,A,990,11400,,,,,120.00,N,N
4970416,FINGER / HEEL STICK,ADC,A,300,36416,,,,,5.00,N,Y
4970420,I & D BARTHOLIN'S GLAND,ADC,A,990,56420,,,,,112.50,N,Y
4970425,ANTEPARTUM CARE ONLY 4-6V,ADC,A,990,59425,,,,,356.50,N,Y
4970426,ANTEPARTUM 7 OR MORE V,ADC,A,990,59430,,,,,624.00,N,Y
4970430,POSTPARTUM CARE ONLY,ADC,A,990,59430,,,,,194.00,N,Y
4970434,DRUG SCREEN MEDICARE/XIX CLINIC,ADC,A,990,G0477,,,,,43.00,N,N
4970438,ANN WELLNESS FIRST VISIT,ADC,A,983,G0438,,,,,270.00,N,Y
4970439,ANN WELL VISSUBSEQUENT VI,ADC,A,983,G0439,,,,,198.00,N,Y
4970441,FILGRASTIM (NEUPO) 480MCG,ADC,A,990,J1441,,,,,685.00,N,Y
4970442,NEUPOGEN 300 MCG VIAL,ADC,A,990,J1440,,,,,328.50,N,Y
4970443,MICROALBUMIN URINE,ADC,A,990,82043,,,,,38.00,N,Y
4970444,ANNUAL DEPRESSION SCREENING 15 MINUTES,ADC,A,983,G0444,,,,,22.00,N,Y
4970447,BEHAVIORAL COUNSELING OBESITY 15M,ADC,A,510,G0447,,,,,36.00,N,Y
4970449,INFLUENZE A&B RAPID FLU,ADC,A,990,87804,,,,,51.00,N,Y
4970460,ATROPINE UP TO 0.3MG,ADC,A,990,J0460,,,,,5.00,N,Y
4970465,IMMUNIZ<18YRS W/COUNSEL 1,ADC,A,990,,,,,,16.50,N,Y
4970466,IMMUNIZ<18YRS W/COUNSEL2+,ADC,A,990,,,,,,16.50,N,Y
4970471,INJECTION IMMUNIZATION 1,ADC,A,990,90471,,,,,63.00,N,Y
4970472,INJECTION IMMUNIZATION 2+,ADC,A,990,90472,,,,,26.00,N,Y
4970473,INTRANSAL ADMIN STATE,ADC,A,990,90473,,,,,19.68,N,N
4970552,TRIGGER PT INJ TO 1/2MUSC,ADC,A,990,20552,,,,,115.00,N,Y
4970553,TRIGGERPOINT 3+MUSCLES,ADC,A,990,20553,,,,,134.00,N,Y
4970561,"BICILLIN LA PER 100,000 UNITS",ADC,A,990,J0561,,,,,16.00,N,N
4970600,ARTHRO SMALL JOINT,ADC,A,990,20600,,,,,100.00,N,Y
4970605,ARTHRO INTERMED JOINT,ADC,A,990,20605,,,,,105.00,N,Y
4970610,ARTRHO MAJOR JOINT,ADC,A,510,20610,,,,,126.00,N,Y
4970612,ASPIR AND/OR INJEC GANG CY,ADC,A,990,20612,,,,,126.00,N,Y
4970620,FX CARE/ELBOW,ADC,A,990,24620,,,,,510.00,N,Y
4970632,"HEP A , ADULT DOSAGE",ADC,A,990,90632,,,,,125.00,N,Y
4970633,VAQTA PEDIATRIC,ADC,A,990,90633,,,,,60.00,N,Y
4970642,EX SKIN LESMA1.1-2.0FEENL,ADC,A,990,11642,,,,,317.00,N,Y
4970649,GARDASIL VACCINE,ADC,A,990,90649,,,,,245.00,N,Y
4970650,DRUG SCREEN COLLECTION,ADC,A,990,,,,,,20.00,N,Y
4970651,GARDASIL 9,ADC,A,990,90651,,,,,375.00,N,N
4970655,LEAD TESTING,ADC,A,990,83655,,,,,43.00,N,N
4970657,INFLUENZA QUAD VACCINE 0.25ML,ADC,A,990,90657,,,,,50.00,N,Y
4970658,INFLUENZA VACCINE 3YR&UP,ADC,A,990,90658,,,,,50.00,N,Y
4970660,INFLUENZA VAC INTRANASAL,ADC,A,990,90660,,,,,55.00,N,Y
4970662,FLUZONE HD,ADC,A,990,90662,,,,,70.00,N,Y
4970669,PREVNAR 0.5 ML VIAL <5YRS,ADC,A,990,90669,,,,,146.00,N,Y
4970670,PNEUMOCOCCAL VAC PREVNAR 13,ADC,A,990,90670,,,,,340.00,N,Y
4970675,RABIES VACCINE PER DOSE,ADC,A,990,90675,,,,,355.50,N,Y
4970680,ROTATEQ VACCINE(ROTAVIRUS,ADC,A,990,90680,,,,,144.00,N,Y
4970682,"INFLUENZA VAC QUAD, PRSRV/ANTI FREE",ADC,A,990,90682,,,,,70.00,N,Y
4970685,FLU VACC <3 YRS QUAD SPLIT VIRUS .25 ML,ADC,A,990,90685,,,,,50.00,N,N
4970686,"FLUARIX, QUADRIVALENT SPLIT VIRUS 0.5 ML",ADC,A,990,90686,,,,,50.00,N,N
4970690,CEFAZOLIN PER 500 MG,ADC,A,990,J0690,,,,,3.50,N,Y
4970696,ROCEPHIN PER 250 MG,ADC,A,990,J0696,,,,,19.00,N,Y
4970697,ROCEPHIN 500MG,ADC,A,990,J0696,,,,,38.00,N,N
4970698,ROCEPHIN 1 GRAM,ADC,A,990,J0696,,,,,76.00,N,Y
4970700,Dtap < 7 yrs,ADC,A,990,90700,,,,,44.00,N,Y
4970707,MMR,ADC,A,990,90707,,,,,128.00,N,Y
4970710,PROQUAD VACCINE,ADC,A,990,90710,,,,,254.00,N,Y
4970713,POLIO IM,ADC,A,990,90713,,,,,58.00,N,Y
4970714,TENIVAC,ADC,A,990,90714,,,,,54.00,N,Y
4970715,TDAP-Adacel,ADC,A,636,90715,,,,,67.00,N,Y
4970716,CHICKEN POX VARIVAX,ADC,A,990,90716,,,,,230.00,N,Y
4970719,TRIMMING NAILS (ANY #),ADC,A,990,11719,,,,,20.00,N,Y
4970723,PEDIARIX (DTAP-HEPB-IPV),ADC,A,990,90723,,,,,140.00,N,Y
4970732,PNEUMONIA AD (PNEMOVA 2Y>,ADC,A,636,90732,,,,,174.00,N,Y
4970734,MENACTRA 4MCG 0.5ML SDV,ADC,A,990,90734,,,,,212.00,N,Y
4970736,ZOSTAVAX VACCINE,ADC,A,990,90736,,,,,320.00,N,Y
4970737,HIB VACCINE (ACTHIB),ADC,A,990,90648,,,,,55.00,N,Y
4970744,HEP B PED/ADOL (ENGERIX-B),ADC,A,990,90744,,,,,32.00,N,Y
4970746,HEP B ADULT (ENGERIX-B),ADC,A,990,90746,,,,,100.00,N,Y
4970748,COMVAX 0.5ML,ADC,A,990,90748,,,,,55.50,N,Y
4970750,SHINGRIX ZOSTER VACCINE,ADC,A,990,90750,,,,,260.00,N,Y
4970770,BLEPHAR DRAIN ABS EYELID,ADC,A,990,67700,,,,,245.00,N,Y
4970772,THERA.PROPH DIAGINJ SUCUT,ADC,A,990,96372,,,,,52.00,N,Y
4970802,HEMOGLOBIN A1C,ADC,A,300,83036,,,,,73.00,N,Y
4970807,RSV TEST,ADC,A,990,87807,,,,,41.00,N,N
4970808,TRICHOMONAS,ADC,A,990,87808,,,,,29.00,N,Y
4970880,ARANESP PER 1MCG,ADC,A,990,,,,,,6.00,N,Y
4970885,EPOGEN PER 1000 UNITS,ADC,A,990,J0885,,,,,44.50,N,Y
4970897,PROLIA(DENOSUMAD)PER 1MG,ADC,A,990,J0897,,,,,"1,710.00",N,Y
4970901,CAURTERIZATION OF NOSE,ADC,A,990,30901,,,,,138.50,N,Y
4970905,BV,ADC,A,990,87905,,,,,29.00,N,Y
4970992,SCHOOL/OTHER STAFF PHYSICALS,ADC,A,990,99211,,,,,50.00,N,N
4971000,UA DIP W/MICRO,ADC,A,990,81000,,,,,11.00,N,Y
4971001,DEPO-ESPRADIOL UP TO 5MG,ADC,A,636,J1000,,,,,13.00,N,Y
4971002,UA DIP W/O MICRO,ADC,A,990,81002,,,,,9.00,N,Y
4971003,UA AUTO W/O MICRO,ADC,A,300,81003,,,,,29.00,N,Y
4971025,PREG URINE,ADC,A,990,81025,,,,,22.00,N,Y
4971030,DEPO MEDROL 40MG,ADC,A,990,J1030,,,,,13.00,N,Y
4971040,"DEBRIDEMENT, SKIN LESION",ADC,A,990,11042,,,,,55.50,N,Y
4971050,DEPO PROV 1 MG,ADC,A,990,J1050,,,,,150.00,N,Y
4971055,DEPO PROVERA 150MG,ADC,A,990,J1055,,,,,116.40,N,Y
4971056,CORN REMOVAL,ADC,A,990,11056,,,,,65.50,N,Y
4971071,DEPO TEST PER 1 MG,ADC,A,636,J1071,,,,,60.00,N,N
4971080,TESTOSTERONE CYP 200MG,ADC,A,990,J1080,,,,,17.80,N,Y
4971100,BIOPSY-SKIN,ADC,A,990,11100,,,,,114.00,N,Y
4971101,BIOPSY-EACH ADD'L,ADC,A,990,11101,,,,,52.00,N,Y
4971102,DEBRIDEMENT OF SKIN,ADC,A,990,11000,,,,,70.00,N,N
4971111,CARE COORDINATOR VISIT,ADC,A,990,,,,,,0.00,N,N
4971174,EVACUATION OF SUBUNGUAL H,ADC,A,990,11740,,,,,52.00,N,Y
4971200,REMOVAL SKIN TAGS,ADC,A,990,11200,,,,,166.00,N,Y
4971201,DIPHENHYDRAMINE 50MG/ML 1,ADC,A,990,J1200,,,,,3.50,N,Y
4971300,SHAVE OF EPID/DERM LE .5<,ADC,A,990,11300,,,,,81.00,N,Y
4971301,SHAV SINGLE LESION0.6 TO1.0CM ARMS LEGS,ADC,A,990,11301,,,,,100.00,N,N
4971305,SHAVE OF EPID/DERM 0.5CM<,ADC,A,990,11305,,,,,79.50,N,Y
4971310,"SHAV BIOP F,E,EY,NO,LI,ME",ADC,A,990,11310,,,,,98.00,N,Y
4971400,EX SKIN LES <.5 TAL,ADC,A,990,11400,,,,,150.00,N,Y
4971401,EX SKIN LES BNO.6-1.0 TAL,ADC,A,990,11401,,,,,174.00,N,Y
4971402,EX SKIN LES 1.1-2.0 TAL,ADC,A,990,11402,,,,,205.50,N,Y
4971403,EX SKIN LES 2.L-3.0 TAL,ADC,A,990,11403,,,,,223.00,N,Y
4971404,EX SKIN LES 3.1-4.0 TAL,ADC,A,990,11404,,,,,254.00,N,Y
4971406,"EX SKIN LES4,0-+CM TAL",ADC,A,990,11406,,,,,344.00,N,Y
4971420,EX SKIN LES <0.5CM SNNFG,ADC,A,990,11420,,,,,147.50,N,Y
4971421,EX SKIN LES0.6-1.0 SNFG,ADC,A,990,11421,,,,,185.50,N,Y
4971422,EX SKIN LES-BN1.1SNHFG,ADC,A,990,11422,,,,,214.50,N,Y
4971423,EX SKIN LES 2.1-3.0SNHFG,ADC,A,990,11423,,,,,245.00,N,Y
4971424,EX SKIN LES 3.1-4.0SNHFG,ADC,A,990,11424,,,,,281.50,N,Y
4971426,EX SKIN LES 4.0+CMSNHFG,ADC,A,990,11426,,,,,391.00,N,Y
4971436,SMOKING CESS 3-10 MIN MEDICARE/MEDICAID,ADC,A,942,G0436,,,,,21.00,N,N
4971437,SMOKING CESS > 10 MIN MEDICARE/MEDICAID,ADC,A,983,G0437,,,,,47.00,N,N
4971440,EX SKIN LES <.5CM FEENLM,ADC,A,990,11440,,,,,178.00,N,Y
4971441,EX SKIN LES 0.6-1.0 FEENL,ADC,A,990,11441,,,,,205.50,N,Y
4971442,EX SKIN LESION-BN 1.1-2.0,ADC,A,990,11442,,,,,227.50,N,Y
4971443,EX SKIN LES2.1-3.0FEENLM,ADC,A,990,11443,,,,,278.00,N,Y
4971444,EX SKIN LES 3.1-4.0FEENLM,ADC,A,990,11444,,,,,352.00,N,Y
4971446,EX SKIN LESION-BN 4.0 +CM,ADC,A,990,11446,,,,,453.00,N,Y
4971473,"INTRANASAL/ORAL IMMUNIZ, 1 VACCINE",ADC,A,990,90473,,,,,63.00,N,N
4971600,EX SKIN LESMA<.5CM TAL,ADC,A,990,11600,,,,,207.00,N,Y
4971601,EX SKIN LESma0.6-1.0TAL,ADC,A,990,11601,,,,,237.00,N,Y
4971602,EX SKIN LESMA1.1-2.0TAL,ADC,A,990,11602,,,,,254.00,N,Y
4971603,EX SKIN LESMA2.1-3.0TAL,ADC,A,990,11603,,,,,278.00,N,Y
4971604,EX SKIN LESMA3.1-4.0TAL,ADC,A,990,11604,,,,,306.00,N,Y
4971606,EX SKIN LESMA4.0+CM TAL,ADC,A,990,11606,,,,,399.50,N,Y
4971610,GLUCAGON PER 1MG,ADC,A,990,J1610,,,,,325.30,N,Y
4971620,EX SKIN LESMA<.5CM SNHFG,ADC,A,990,11620,,,,,200.50,N,Y
4971621,EX SKIN LESMA0.6-1.0SNHFG,ADC,A,990,11621,,,,,237.00,N,Y
4971622,EX SKIN LESMA 1.1-2.0SNHF,ADC,A,990,11622,,,,,267.50,N,Y
4971623,EX SKIN LESMA2.1-3.0 SNHF,ADC,A,990,11623,,,,,316.00,N,Y
4971624,EX SKIN LESMA3.1-4.0SCHFG,ADC,A,990,11624,,,,,361.50,N,Y
4971626,EX SKIN LESMA 4.0+CM SCHF,ADC,A,990,11626,,,,,477.00,N,Y
4971640,EX SKIN LESMA<.5CM FEENL,ADC,A,990,11640,,,,,213.00,N,Y
4971641,EX SKIN LESMA0.6-1.0FEENL,ADC,A,990,11641,,,,,274.50,N,Y
4971643,EX SKIN LESMA2.1-3.0FEENL,ADC,A,990,11643,,,,,366.00,N,Y
4971644,EX SKIN LESMA3.1-4.0FEENL,ADC,A,990,11644,,,,,464.00,N,Y
4971646,EX SKIN LESMA4.0+CMFEENL,ADC,A,990,11646,,,,,622.50,N,Y
4971650,LOVENOX PER 10MG,ADC,A,990,J1650,,,,,11.50,N,Y
4971730,AVULSION OF NAIL,ADC,A,990,11730,,,,,116.50,N,Y
4971732,AVULSION OF NAIL; EACH ADD'L,ADC,A,990,11732,,,,,65.00,N,Y
4971750,EXCIS OF NAIL & NAIL MATR,ADC,A,990,11750,,,,,289.50,N,Y
4971820,HUMULIN R PER 5 UNITS,ADC,A,990,J1815,,,,,7.30,N,Y
4971885,KETOROLAC PER 15MG,ADC,A,990,J1885,,,,,16.00,N,Y
4971900,LESION INJECTION UP TO 7,ADC,A,990,11900,,,,,54.00,N,Y
4971940,FUROSEMIDE UP TO 20MG,ADC,A,990,J1940,,,,,3.00,N,Y
4971950,LUPRON PER 3.75MG,ADC,A,990,J1950,,,,,500.00,N,Y
4971981,INSER NONBIODEG DRUG DELI,ADC,A,990,11981,,,,,260.00,N,N
4971982,REMOV NONBIODEG DRUG DEL,ADC,A,990,11982,,,,,290.00,N,N
4971983,REM REINSERT NONBIODEG IM,ADC,A,990,11983,,,,,405.00,N,N
4972001,LACE REP <2.5CM EXGT&OE,ADC,A,990,12001,,,,,196.00,N,Y
4972002,LACE REP 2.6-7.5 EGT& OE,ADC,A,990,12002,,,,,219.00,N,Y
4972004,LAC REP 7.6-12.5 SNA,ADC,A,990,12004,,,,,245.00,N,Y
4972005,LACER REP 2.6-7.5 SNAEGTR,ADC,A,990,12005,,,,,303.00,N,Y
4972011,LAC FAC/EAR7.6-12.5REENLM,ADC,A,990,12011,,,,,214.50,N,Y
4972013,LACER REP FACE<2.5 REENLM,ADC,A,990,12013,,,,,227.50,N,Y
4972014,LACE EYEL/NOS5.1-7.5REENL,ADC,A,990,12014,,,,,267.50,N,Y
4972015,LAC FAC/EA 7.6-12/5REENLM,ADC,A,990,12015,,,,,339.00,N,Y
4972035,MED INFLU SPLIT VIR AFLUR,ADC,A,636,Q2035,,,,,0.00,N,Y
4972036,MED INFLU SPLIT VIR FLULA,ADC,A,636,Q2036,,,,,0.00,N,Y
4972038,INFLUENZA QUAD VACCINE 0.5ML,ADC,A,636,Q2038,,,,,50.00,N,Y
4972039,FLUARIX MEDICARE QUAD SPLIT VIRUS 0.5 ML,ADC,A,636,Q2039,,,,,50.00,N,Y
4972060,INJECTION INTO MED JOINT,ADC,A,990,20605,,,,,101.00,N,Y
4972175,DEMEROL PER 100 MG,ADC,A,990,J2175,,,,,3.50,N,Y
4972200,I & D SOFT TISSUE ABSCESS,ADC,A,990,20005,,,,,134.00,N,Y
4972201,MEDICARE OV NP LEVEL 1,ADC,A,510,99201,,,,,23.40,N,N
4972202,MEDICARE OV NP LEVEL 2,ADC,A,510,99202,,,,,37.50,N,N
4972203,MEDICARE OV NP LEVEL 3,ADC,A,510,99203,,,,,54.60,N,N
4972204,MEDICARE OV NP LEVEL 4,ADC,A,510,99204,,,,,83.10,N,N
4972205,MEDICARE OV NP LEVEL 5,ADC,A,510,99205,,,,,101.40,N,N
4972211,MEDICARE OV EP LEVEL 1,ADC,A,510,99211,,,,,14.10,N,Y
4972212,MEDICARE OV EP LEVEL 2,ADC,A,510,99212,,,,,21.90,N,N
4972213,MEDICARE OV EP LEVEL 3,ADC,A,510,99213,,,,,36.00,N,N
4972214,MEDICARE OV EP LEVEL 4,ADC,A,510,99214,,,,,51.60,N,N
4972215,MEDICARE OV EP LEVEL 5,ADC,A,510,99215,,,,,68.70,N,N
4972270,OCCULT BLOOD SCREEN CARDS,ADC,A,990,G0328,,,,,9.00,N,Y
4972272,OCC BL SCREEN DIG RECTAL,ADC,A,990,82272,,,,,9.00,N,Y
4972301,NUBAIN PER 10MG,ADC,A,990,J2300,,,,,4.50,N,Y
4972343,VALPROATE 100MG/ML 5ML SD,ADC,A,250,,,,,,53.00,N,Y
4972360,NORFLEX UP TO 60MG,ADC,A,990,J2360,,,,,15.00,N,Y
4972405,ONDANSETRON(ZOFRAN)PER1MG INJ,ADC,A,990,J2405,,,,,2.30,N,Y
4972505,NEULASTA 6MG,ADC,A,990,J2505,,,,,"5,381.50",N,Y
4972550,PROMETHAZINE UP TO 50MG,ADC,A,990,J2550,,,,,4.00,N,Y
4972567,TYMPANOMETRY,ADC,A,990,92567,,,,,38.00,N,Y
4972660,CLSD TR METACARPAL FX W/O,ADC,A,990,26600,,,,,408.00,N,Y
4972765,METOCLOPRAMIDE 10 MG,ADC,A,636,J2765,,,,,4.00,N,N
4972790,RHO GAM,ADC,A,990,J2790,,,,,371.00,N,Y
4972920,SOLU MEDROL UP TO 40 MG,ADC,A,990,J2920,,,,,10.00,N,Y
4972930,SOLU MEDROL UP TO 125MG,ADC,A,990,J2930,,,,,7.10,N,N
4972947,GLUCOSE,ADC,A,990,82948,,,,,36.00,N,Y
4973030,SUMATRIPTAN 6MG,ADC,A,990,J3030,,,,,32.00,N,Y
4973152,LAC REP COM2.6CM/7.5CMFCM,ADC,A,990,13152,,,,,566.00,N,Y
4973225,HOLTER MONITOR,ADC,A,990,93225,,,,,32.00,N,Y
4973270,EVENT MONITOR,ADC,A,990,93270,,,,,27.00,N,Y
4973301,KENALOG PER 10MG,ADC,A,636,J3301,,,,,20.00,N,Y
4973410,HYDROXYZINE UP TO 25MG,ADC,A,990,J3410,,,,,2.50,N,Y
4973420,VIT B-12 1000MCG,ADC,A,636,J3420,,,,,20.00,N,Y
4973930,I&D HEMATOMA/ELBOW,ADC,A,990,23930,,,,,204.00,N,Y
4974010,SPIROMETRY,ADC,A,990,94010,,,,,64.50,N,Y
4974016,PULMONARY FUNCTION INTERP,ADC,A,990,94016,,,,,38.50,N,Y
4974056,DEST.OF LESION(CRYO)PENIS,ADC,A,990,54056,,,,,112.50,N,Y
4974640,INHALATION TREATMENT,ADC,A,410,94640,,,,,42.00,N,Y
4974703,HCG,ADC,A,990,84703,,,,,25.00,N,Y
4974760,PULSE OXIMETRY,ADC,A,990,94760,,,,,4.50,N,Y
4974900,SYNVISC 1,ADC,A,990,J3490,,,,,"1,442.00",N,Y
4975000,NOCALL/NOSHOW,ADC,A,990,,,,,,20.50,N,Y
4975018,HEMOGLOBIN,ADC,A,990,85018,,,,,22.00,N,Y
4975025,CBC W/DIFF,ADC,A,300,85025,,,,,71.00,N,Y
4975205,FOREI BODY REM EYESUPERFI,ADC,A,990,65205,,,,,114.00,N,Y
4975610,INR,ADC,A,990,85610,,,,,22.00,N,Y
4976000,BURN CARE INITIAL,ADC,A,990,16000,,,,,94.00,N,Y
4976010,DRAINED ABSCESS FINGER,ADC,A,990,26010,,,,,153.00,N,Y
4976020,BURN DEBR/DRSG < THAN 5%,ADC,A,990,16020,,,,,112.00,N,Y
4976025,BURN DEBR/DRSG MED 5%-10%,ADC,A,990,16025,,,,,196.00,N,Y
4976083,EVAC. OF THROMBOSED HEMOR,ADC,A,990,46083,,,,,369.00,N,Y
4976211,SPORTS PHYSICAL,ADC,A,990,,,,,,10.00,N,Y
4976345,APP LONG LEG CAST,ADC,A,990,29345,,,,,180.00,N,Y
4976400,"CHEMOTHERAPY, IM",ADC,A,990,96400,,,,,44.50,N,Y
4976415,DRAW FEE,ADC,A,990,36415,,,,,18.00,N,Y
4976468,"INJ MULT TELANG.,LEG",ADC,A,990,36468,,,,,214.50,N,Y
4976469,"INJ MULT TELANG, FACE",ADC,A,990,36469,,,,,214.50,N,Y
4976470,INJ SINGLE VARICOSE VEIN,ADC,A,990,36470,,,,,86.00,N,Y
4976471,INJ MULT VARIC VEINS SLEG,ADC,A,990,36471,,,,,191.50,N,Y
4976501,"DESTRUCTION LESION, VULVA, SIMPLE",ADC,A,990,56501,,,,,236.00,N,N
4976580,TUBERCULIN INTRADERMAL,ADC,A,990,86580,,,,,16.00,N,Y
4976588,RAPID STREP,ADC,A,990,87880,,,,,27.00,N,Y
4976605,BIOPSY ONE VULVAR LESION,ADC,A,990,56605,,,,,119.50,N,Y
4977000,"DESTRUCT.,BENIGN LESION 1",ADC,A,990,17000,,,,,120.00,N,Y
4977003,DESTRUCT BEN LES ADD2-14,ADC,A,990,17003,,,,,16.00,N,Y
4977110,REMOVAL OF WARTS 1-14,ADC,A,990,17110,,,,,146.00,N,Y
4977160,FITTING INSERTION PESSARY,ADC,A,990,57160,,,,,107.50,N,Y
4977170,DIAPHRAGM/CERV CAP FITTIN,ADC,A,990,57170,,,,,118.00,N,Y
4977210,WET MOUNT,ADC,A,990,87210,,,,,33.00,N,N
4977220,WET MOUNT (KOH),ADC,A,990,87220,,,,,12.00,N,Y
4977300,PARAGARD,ADC,A,990,J7300,,,,,658.00,N,N
4977301,SKYLA,ADC,A,990,J7301,,,,,600.00,N,N
4977302,MIRENA,ADC,A,990,J7298,,,,,800.00,N,Y
4977307,IMPLANON/NEXPLANON,ADC,A,990,J7307,,,,,"1,100.00",N,N
4977320,SYNVISC PER INJECTION,ADC,A,990,,,,,,412.00,N,Y
4977325,SYNVISC-ONE PER 1 MG,ADC,A,990,J7325,,,,,34.50,N,Y
4977452,COLPOSCOPY,ADC,A,990,57452,,,,,156.50,N,Y
4977454,COLPOSCOPY W/BIOPSY,ADC,A,990,57454,,,,,237.50,N,Y
4977625,ALBUTEROL NGB PER 0.5MG,ADC,A,990,J7619,,,,,1.00,N,Y
4977800,"EXCISION CHALAZION, SINGLE",ADC,A,990,67800,,,,,260.00,N,N
4977802,"MNT, 15 MN, INITIAL INDIV",ADC,A,990,97802,,,,,22.00,N,N
4977803,"MNT, 15 MIN, REASSESS INDIV",ADC,A,990,97803,,,,,22.00,N,Y
4978030,DRUG SCREEN,ADC,A,990,80305,,,,,43.00,N,Y
4978100,ENDOMETRIAL BIOPSY,ADC,A,990,58100,,,,,158.00,N,Y
4978164,PAP,ADC,A,990,88164,,,,,25.00,N,N
4978190,FOREIGN BODY REMOVALFOOT,ADC,A,990,28190,,,,,166.00,N,Y
4978213,GCH EMPLOYEE PHYSICAL,ADC,A,990,99213,,,,,0.00,N,Y
4978233,TISSUE CULTURE SKIN/BIOPS,ADC,A,990,88233,,,,,379.00,N,Y
4978300,INSERTION INTRAUTERDEVICE,ADC,A,990,58300,,,,,135.00,N,Y
4978301,REM INTRAUTERINE DEVICE,ADC,A,990,58301,,,,,177.00,N,N
4978350,CORTROSYN PER 0.25 MG,ADC,A,990,J0835,,,,,103.00,N,Y
4978470,FRACTURE CARE/METATORSAL,ADC,A,990,28470,,,,,312.50,N,Y
4978720,BILIRUBIN TRANSCUTANEOUS,ADC,A,990,88720,,,,,11.00,N,N
4978925,OMT 1-2,ADC,A,990,98925,,,,,46.00,N,Y
4978926,OMT 3-4,ADC,A,990,98926,,,,,61.50,N,Y
4978927,OMT 5-6,ADC,A,990,98927,,,,,76.50,N,Y
4979000,DRAIN EAR ABCESS/HEMATOMA,ADC,A,990,69000,,,,,143.00,N,Y
4979008,ADM FLU VACCINE,ADC,A,990,G0008,,,,,22.00,N,Y
4979009,ADM PNEUMOCOCCAL VACCINE,ADC,A,990,G0009,,,,,63.00,N,Y
4979010,ADM HEPATITIS B VACCINE,ADC,A,990,G0010,,,,,9.00,N,Y
4979024,GLOBAL/POST OP VISIT,ADC,A,990,99024,,,,,0.00,N,N
4979047,EACH ADD'L IMMUNE(STATE),ADC,A,990,90472,,,,,6.00,N,N
4979069,KINRIX (DTAP-IPV),ADC,A,990,,,,,,0.00,N,Y
4979105,APPLICATION LONG ARM SPLI,ADC,A,990,29105,,,,,120.00,N,Y
4979125,APPLICATION SHORT ARM SPL,ADC,A,990,29125,,,,,98.00,N,Y
4979130,APPLICATION FINGER SPLINT,ADC,A,990,29130,,,,,58.00,N,Y
4979200,"FOREIGN BODY REMOV, EAR",ADC,A,990,69200,,,,,150.00,N,N
4979209,EAR LAVAGE 1 OR BOTH EARS,ADC,A,510,69209,,,,,31.00,N,Y
4979210,CERUMEN REMOVAL 1 OR BOTH EARS,ADC,A,990,69210,,,,,78.00,N,Y
4979211,PRESCHOOL/CAMP PHYSICAL,ADC,A,990,,,,,,20.00,N,Y
4979213,DOT PHYSICAL,ADC,A,990,99499,,,,,123.00,N,Y
4979217,OBSERVATION DISCHARGE,ADC,A,990,99217,,,,,102.00,N,Y
4979218,OBSERVATION LEVEL 1,ADC,A,990,99218,,,,,97.00,N,Y
4979219,OBSERVATION LEVEL 2,ADC,A,990,99219,,,,,158.50,N,Y
4979220,OBSERVATION LEVEL 3,ADC,A,990,99220,,,,,219.50,N,Y
4979241,OFFICE CONSULT LEVEL 1,ADC,A,990,99241,,,,,75.00,N,Y
4979242,OFFICE CONSULT LEVEL 2,ADC,A,990,99242,,,,,135.00,N,Y
4979243,OFFICE CONSULT LEVEL 3,ADC,A,990,99243,,,,,185.00,N,Y
4979301,NURSING HOME ADMIT LEVEL1,ADC,A,994,99304,,,,,156.00,N,Y
4979302,NURSING HOME ADMIT LEVEL2,ADC,A,990,99305,,,,,218.00,N,Y
4979303,NURSING HOME ADMIT LEVEL3,ADC,A,994,99306,,,,,281.00,N,Y
4979310,COMPREHENSIVE,ADC,A,994,99310,,,,,229.00,N,Y
4979311,NURSING HOME LEVEL 1,ADC,A,994,99307,,,,,78.00,N,Y
4979312,NURSING HOME LEVEL 2,ADC,A,994,99308,,,,,120.00,N,N
4979313,NURSING HOME LEV 3 DETAIL,ADC,A,994,99309,,,,,156.00,N,Y
4979324,NEWPT ASSISTED LIVING V,ADC,A,990,99324,,,,,94.00,N,Y
4979325,NEWPT ASSISTED LIVING V,ADC,A,990,99325,,,,,135.00,N,Y
4979326,NEWPT ASSISTED LIVING V,ADC,A,990,99326,,,,,234.00,N,Y
4979327,NEWPT ASSISTED LIVING VIS,ADC,A,990,99327,,,,,312.00,N,Y
4979328,NEWPT ASSISTED LIVING VIS,ADC,A,990,99.32,,,,,306.00,N,Y
4979334,ESTABPT ASSISTED LIVING V,ADC,A,990,99334,,,,,101.00,N,Y
4979335,ESTB PT ASSISTED LIVING V,ADC,A,990,99335,,,,,161.00,N,Y
4979336,ESTABPT ASSISTED LIVING V,ADC,A,990,99336,,,,,229.00,N,Y
4979337,ESTABPT ASSISTED LIVING V,ADC,A,990,99337,,,,,328.00,N,Y
4979341,HOME VISIT NEW LEVEL 1,ADC,A,969,99341,,,,,94.00,N,Y
4979342,HOME VISIT NEW LEVEL 2,ADC,A,969,99342,,,,,138.00,N,Y
4979343,HOME VISIT NEW LEVEL 3,ADC,A,969,99343,,,,,210.00,N,Y
4979344,HOME VISIT NEW LEVEL 4,ADC,A,969,99344,,,,,294.00,N,Y
4979345,HOME VISIT NEW LEVEL 5,ADC,A,969,99345,,,,,350.00,N,Y
4979347,HOME VISIT ESTA. LEVEL 2,ADC,A,969,99347,,,,,94.00,N,Y
4979348,HOME VISIT ESTA. LEVEL 3,ADC,A,969,99348,,,,,146.00,N,Y
4979349,HOME VISIT ESTA. LEVEL 4,ADC,A,969,99349,,,,,214.00,N,Y
4979350,HOME VISIT ESTA. LEVEL 5,ADC,A,969,99350,,,,,302.00,N,Y
4979381,PHYSICAL NEW 0-1 YR,ADC,A,990,99381,,,,,161.00,N,Y
4979382,PHYSICAL NEW 1-4 YRS,ADC,A,990,99382,,,,,166.00,N,Y
4979383,PHYSICAL NEW 5-11 YRS,ADC,A,990,99383,,,,,176.00,N,Y
4979384,PHYSICAL NEW 12-17 YRS,ADC,A,990,99384,,,,,198.00,N,Y
4979385,PHYSICAL NEW 18-39 YRS,ADC,A,990,99385,,,,,187.00,N,Y
4979386,PHYSICAL NEW 40-64 YRS,ADC,A,990,99386,,,,,218.00,N,Y
4979387,PHYSICAL NEW 65 & OLDER,ADC,A,990,99387,,,,,239.00,N,Y
4979391,PHYSICAL ESTA. 0-1 YRS,ADC,A,990,99391,,,,,146.00,N,Y
4979392,PHYSICAL ESTA. 1-4 YRS,ADC,A,990,99392,,,,,155.00,N,Y
4979393,PHYSICAL ESTA. 5-11 YRS,ADC,A,990,99393,,,,,155.00,N,Y
4979394,PHYSICAL ESTA. 12-17 YRS,ADC,A,990,99394,,,,,166.00,N,Y
4979395,PHYSICAL ESTA. 18-39 YRS,ADC,A,990,99395,,,,,171.00,N,Y
4979396,PHYSICAL ESTA. 40-64 YRS,ADC,A,990,99396,,,,,182.00,N,Y
4979397,PHYSICAL ESTA. 65 & OLDER,ADC,A,983,99397,,,,,198.00,N,Y
4979406,SMOKING CESS. COUNS. 3-10 MIN,ADC,A,990,99406,,,,,21.00,N,Y
4979407,SMOKING CESS. COUNS. > 10 MIN,ADC,A,990,99407,,,,,47.00,N,Y
4979471,IMMUNIZATION (STATE),ADC,A,990,90471,,,,,19.68,N,Y
4979495,TCM - FTF WITHIN 14 DAYS,ADC,A,990,99495,,,,,208.00,N,Y
4979496,TCM - FTF WITHIN 7 DAYS,ADC,A,983,99496,,,,,286.00,N,Y
4979497,ADVANCED CARE PLANNING,ADC,A,983,99497,,,,,99.00,N,Y
4979505,APPLICATION LONG LEG SPLI,ADC,A,990,29505,,,,,98.00,N,Y
4979515,APPLICATION SHORT LEG SPL,ADC,A,990,29515,,,,,92.00,N,Y
4979580,UNNA BOOT APPLICATION,ADC,A,990,29580,,,,,75.00,N,Y
4979901,ST GREGORY H&P,ADC,A,990,99204,,,,,190.50,N,Y
4979921,WOUND CARE,ADC,A,990,99211,,,,,53.00,N,Y
4979924,SUBSEQUENT OBS CARE 1,ADC,A,990,,,,,,50.00,N,N
4979925,SUBSEQUENT CARE 2,ADC,A,990,,,,,,80.00,N,N
4979926,SUBSEQUENT CARE 3,ADC,A,990,,,,,,110.00,N,N
4980000,WEIGHT CHECK NO CHARGE,PNC,A,990,99999,,,,,0.00,N,N
4980002,DEBRIDMENT WOUND UPTO 10%,PNC,A,990,11000,,,,,31.50,N,Y
4980003,DEBRID WOUND EA ADD 10%,PNC,A,990,11001,,,,,22.50,N,Y
4980010,SCRN PELVIC/BREAST EXAM,PNC,A,990,G0101,,,,,57.00,N,Y
4980011,DRUG SCR COLLECTION & KIT,PNC,A,990,80100,,,,,69.00,N,Y
4980024,OCCULT BLOOD SCREENING,PNC,A,990,82270,,,,,49.00,N,Y
4980025,REMOVAL SKIN TAGS (EAAD10,PNC,A,990,11201,,,,,36.00,N,Y
4980030,SUPARTZ PER INJCECTION,PNC,A,990,J7321,,,,,124.50,N,Y
4980031,MARCAINE 0.25% PER 30ML,PNC,A,990,S0020,,,,,7.00,N,Y
4980032,CONTRACT PHYSICAL,PNC,A,990,,,,,,50.00,N,Y
4980033,COMMUNITY HEALTH SCREENIN,PNC,A,990,99213,,,,,18.50,N,Y
4980040,REMOVAL OF INCLUSION CYST,PNC,A,990,10040,,,,,116.50,N,Y
4980050,INCIS POSTOP WOUND INFECT,PNC,A,990,10180,,,,,199.00,N,Y
4980055,PARING/CUTTING BENIGN LES,PNC,A,990,11055,,,,,54.00,N,Y
4980060,DRAIN SKIN ABCESS SIMPLE,PNC,A,983,10060,,,,,244.00,N,Y
4980061,DRAIN SKIN ABCESS COMPLIC,PNC,A,990,10061,,,,,432.00,N,Y
4980080,SPECIAL FORMS,PNC,A,990,99080,,,,,22.50,N,Y
4980085,CASTING FOREARM/HAND,PNC,A,990,29085,,,,,115.00,N,Y
4980091,PAP COLLECTION,PNC,A,990,Q0091,,,,,68.00,N,Y
4980100,DEXAMETHASONE PER 1MG,PNC,A,990,J1100,,,,,8.00,N,Y
4980101,UA DRUG SCREEN,PNC,A,990,80101,,,,,41.00,N,N
4980102,"PROSTATE SCREEN, DIG RECTAL EXAM",PNC,A,990,G0102,,,,,26.00,N,N
4980104,DEPO MEDROL 80 MG,PNC,A,990,J1040,,,,,14.25,N,N
4980113,SHAV EPIDERM/DERMAL LES,PNC,A,990,11302,,,,,115.00,N,N
4980115,ALLERGY SINGLE,PNC,A,990,95115,,,,,18.00,N,Y
4980117,ALLERGY MULTIPLE,PNC,A,990,95117,,,,,22.00,N,Y
4980120,FB REMOVAL & INCISION,PNC,A,990,10120,,,,,218.00,N,Y
4980150,ADENOCARD PER 6MG,PNC,A,990,J0150,,,,,80.00,N,Y
4980160,PUNCT ASPIR ABCESS HEMATO CYST,PNC,A,990,10160,,,,,189.00,N,Y
4980162,ZOFRAN 4MG TABLET,PNC,A,990,Q0162,,,,,3.00,N,N
4980170,EPI PEN,PNC,A,990,J0171,,,,,155.00,N,Y
4980179,PHY RECERT FOR HOME HEALT,PNC,A,994,G0179,,,,,79.50,N,Y
4980180,PHY CERT FOR HOME HEALTH,PNC,A,994,G0180,,,,,103.00,N,Y
4980201,NEW OUTPATIENT LEVEL 1,PNC,A,990,99201,,,,,78.00,N,Y
4980202,NEW OUTPATIENT LEVEL 2,PNC,A,990,99202,,,,,125.00,N,Y
4980203,NEW OUTPATIENT LEVEL 3,PNC,A,990,99203,,,,,182.00,N,Y
4980204,NEW OUTPATIENT LEVEL 4,PNC,A,990,99204,,,,,277.00,N,Y
4980205,NEW OUTPATIENT LEVEL 5,PNC,A,990,99205,,,,,338.00,N,Y
4980211,OFFICE VISIT LEVEL 1,PNC,A,990,99211,,,,,47.00,N,Y
4980212,OFFICE VISIT LEVEL 2,PNC,A,990,99212,,,,,73.00,N,Y
4980213,OFFICE VISIT LEVEL 3,PNC,A,983,99213,,,,,120.00,N,Y
4980214,OFFICE VISIT LEVEL 4,PNC,A,983,99214,,,,,172.00,N,Y
4980215,OFFICE VISIT LEVEL 5,PNC,A,990,99215,,,,,229.00,N,Y
4980221,INPATIENT INITIAL LEVEL 1,PNC,A,990,99221,,,,,143.00,N,Y
4980222,INPATIENT INITIAL LEVEL 2,PNC,A,990,99222,,,,,194.00,N,Y
4980223,INPATIENT INITIAL LEVEL 3,PNC,A,990,99223,,,,,286.00,N,Y
4980231,INPATIENT LEVEL 1,PNC,A,990,99231,,,,,56.50,N,Y
4980232,INPATIENT LEVEL 2,PNC,A,990,99232,,,,,92.00,N,Y
4980233,INPATIENT LEVEL 3,PNC,A,990,99233,,,,,146.00,N,Y
4980238,HOSPITAL DISCHARGE,PNC,A,990,99238,,,,,101.00,N,Y
4980239,HOSPITAL DISCHARGE,PNC,A,990,99239,,,,,148.00,N,Y
4980270,MORPHINE UP TO 10MG,PNC,A,990,J2270,,,,,3.50,N,Y
4980283,EMERGENCY LEVEL 3,PNC,A,990,99283,,,,,87.50,N,Y
4980291,CRITICAL CARE 1ST HOUR,PNC,A,990,99291,,,,,308.00,N,Y
4980292,CRITICAL CARE ADD'l 1/2HR,PNC,A,990,99292,,,,,145.50,N,Y
4980300,REMOV FORN BODY INTANAS,PNC,A,990,30300,,,,,229.50,N,N
4980301,SKILLED CARE ADMIT 1,PNC,A,990,99304,,,,,156.00,N,Y
4980302,SKILLED CARE ADMIT 2,PNC,A,990,99305,,,,,218.00,N,Y
4980303,SKILLED CARE ADMIT 3,PNC,A,990,99306,,,,,281.00,N,Y
4980311,SKILLED CARE LEVEL 1,PNC,A,990,99307,,,,,78.00,N,Y
4980312,SKILLED CARE LEVEL 2,PNC,A,990,99308,,,,,120.00,N,Y
4980313,SKILLED CARE LEVEL 3,PNC,A,990,99309,,,,,156.00,N,Y
4980315,SKILLED DISCHARGE,PNC,A,990,99315,,,,,92.00,N,Y
4980316,SKILLED DISCHARGE,PNC,A,990,99316,,,,,117.50,N,Y
4980317,TELEHEALTH ORIG SITE,PNC,A,990,Q3014,,,,,30.00,N,Y
4980318,TELEHEALTH PROF FEE,PNC,A,990,99212,,,,,23.50,N,Y
4980344,MEDICARE INITIAL PREV.EXA,PNC,A,770,G0402,,,,,182.00,N,Y
4980366,MED.INIT.ECG-W/INTER&REPO,PNC,A,990,G0366,,,,,40.50,N,Y
4980375,RABIES IMMUNE GLOBLIN PER,PNC,A,990,90375,,,,,"1,802.00",N,Y
4980378,SYNAGIS (PHARMACY),PNC,A,990,90378,,,,,"1,484.50",N,Y
4980400,EXCI BENIGN LES <.05CM,PNC,A,990,11400,,,,,120.00,N,N
4980416,FINGER / HEEL STICK,PNC,A,300,36416,,,,,5.00,N,Y
4980420,I & D BARTHOLIN'S GLAND,PNC,A,990,56420,,,,,112.50,N,Y
4980425,ANETPARTUM CARE ONLY 4-6V,PNC,A,990,59425,,,,,356.50,N,Y
4980426,ANETPARTUM 7 OR MORE V,PNC,A,990,59426,,,,,624.00,N,Y
4980430,POSTPARTUM CARE ONLY,PNC,A,990,59430,,,,,194.00,N,Y
4980434,DRUG SCREEN MEDICARE/XIX CLINIC,PNC,A,990,G0477,,,,,43.00,N,N
4980438,ANN WELLNESS FIRST VISIT,PNC,A,983,G0438,,,,,270.00,N,Y
4980439,ANN WELL VIS SUBSEQUEN,PNC,A,983,G0439,,,,,198.00,N,Y
4980441,FILGRASTIM (NEUPO) 480MCG,PNC,A,990,J1441,,,,,685.00,N,Y
4980442,NEUPOGEN 300 MCG VIAL,PNC,A,990,J1440,,,,,438.50,N,Y
4980443,MICROALBUMIN URINE,PNC,A,990,82043,,,,,38.00,N,Y
4980444,ANNUAL DEPRESSION SCREENING 15 MINUTES,PNC,A,983,G0444,,,,,22.00,N,Y
4980447,BEHAVORIAL COUNSELING OBESITY 15M,PNC,A,510,G0447,,,,,36.00,N,Y
4980449,INFLUENZE A&B RAPID FLU,PNC,A,990,87804,,,,,51.00,N,Y
4980460,ATROPINE UP TO 0.3MG,PNC,A,990,J0460,,,,,5.00,N,Y
4980465,IMMUNIZ<18YRS W/COUNSEL 1,PNC,A,990,,,,,,16.50,N,Y
4980466,IMMUNIZ<18YRS W/COUNSEL2+,PNC,A,990,,,,,,16.50,N,Y
4980471,INJECTION IMMUNIZATION 1,PNC,A,990,90471,,,,,63.00,N,Y
4980472,INJECTION IMMUNIZATION 2+,PNC,A,990,90472,,,,,26.00,N,Y
4980473,INTRANASAL ADMIN STATE,PNC,A,990,90473,,,,,19.68,N,N
4980552,TRIGGER PT INJ TO 1/2MUSC,PNC,A,990,20552,,,,,115.00,N,Y
4980553,TRIGGERPOINT 3+ MUSCLES,PNC,A,990,20553,,,,,134.00,N,Y
4980561,"BICILLIN LA PER 100,000 UNITS",PNC,A,990,J0561,,,,,16.00,N,N
4980600,ARTHRO SMALL JOINT,PNC,A,990,20600,,,,,100.00,N,Y
4980605,ARTHRO INTERMED JOINT,PNC,A,990,20605,,,,,105.00,N,Y
4980610,ARTHRO MAJOR JOINT,PNC,A,510,20610,,,,,126.00,N,Y
4980612,ASPIR AND/OR INJEC GANG CY,PNC,A,990,20612,,,,,126.00,N,Y
4980620,FX CARE/ELBOW,PNC,A,990,24620,,,,,510.00,N,Y
4980632,HEPATITIS A ADULT (VAQTA),PNC,A,990,90632,,,,,125.00,N,Y
4980633,VAQTA PEDIATRIC,PNC,A,990,90633,,,,,60.00,N,Y
4980642,EX SKIN LESMA1.1-2.0FEENL,PNC,A,990,11642,,,,,317.00,N,Y
4980649,GARDASIL VACCINE,PNC,A,990,90649,,,,,245.00,N,Y
4980650,DRUG SCREEN COLLECTION,PNC,A,990,,,,,,20.00,N,Y
4980651,GARDASIL 9,PNC,A,990,90651,,,,,375.00,N,N
4980657,INFLUENZA QUAD VACCINE 0.25ML,PNC,A,990,90657,,,,,50.00,N,Y
4980658,INFLUENZA VACCINE 3YR.&UP,PNC,A,990,90658,,,,,50.00,N,Y
4980660,INFLUENZA VAC INTRANASAL,PNC,A,990,90660,,,,,55.00,N,Y
4980662,FLUZONE HD,PNC,A,990,90662,,,,,70.00,N,Y
4980669,PNEUMO PED (PREVNAR) <5yr,PNC,A,990,90669,,,,,146.00,N,Y
4980670,PNEUMOCOCCAL VAC PREVNAR 13,PNC,A,250,90670,,,,,340.00,N,Y
4980675,RABIES VACCINE PER DOSE,PNC,A,990,90675,,,,,355.50,N,Y
4980680,ROTATEQ VACCINE(ROTAVIRUS,PNC,A,990,90680,,,,,144.00,N,Y
4980685,FLU VACC <3 YRS QUAD SPLIT VIRUS .25 ML,PNC,A,990,90685,,,,,50.00,N,N
4980686,"FLUARIX, QUADRIVALENT SPLIT VIRUS 0.5 ML",PNC,A,990,90686,,,,,50.00,N,N
4980690,CEFAZOLIN PER 500MG,PNC,A,990,J0690,,,,,3.50,N,Y
4980696,ROCEPHIN PER 250MG,PNC,A,990,J0696,,,,,19.00,N,Y
4980697,ROCEPHIN 500MG,PNC,A,990,J0696,,,,,38.00,N,Y
4980698,ROCEPHIN 1 GRAM,PNC,A,990,J0696,,,,,76.00,N,Y
4980700,DTAP < 7 yrs,PNC,A,990,90700,,,,,44.00,N,Y
4980707,MMR,PNC,A,990,90707,,,,,128.00,N,Y
4980710,PROQUAD VACCINE,PNC,A,990,90710,,,,,254.00,N,Y
4980713,POLIO (IPOL),PNC,A,990,90713,,,,,58.00,N,Y
4980714,DECAVAC-TD-ADULT,PNC,A,990,90714,,,,,54.00,N,Y
4980715,TDAP-Adacel,PNC,A,636,90715,,,,,67.00,N,Y
4980716,CHICKEN POX (VARIVAX),PNC,A,990,90716,,,,,230.00,N,Y
4980719,TRIMMING NAILS (ANY #),PNC,A,990,11719,,,,,20.00,N,Y
4980723,PEDIARIX (DTAP-HEPB-IPV),PNC,A,990,90723,,,,,140.00,N,Y
4980732,PNEUM ADULT(PNEUMOVA 2YR>,PNC,A,636,90732,,,,,174.00,N,Y
4980734,MENACTRA 4MCG 0.5ML SDV,PNC,A,990,90734,,,,,212.00,N,Y
4980736,ZOSTAVAX VACCINE,PNC,A,990,90736,,,,,320.00,N,Y
4980737,HIB VACCINE (ACTHIB),PNC,A,990,90648,,,,,55.00,N,Y
4980744,HEP B PED/ADOL (ENGERIX-B),PNC,A,990,90744,,,,,32.00,N,Y
4980746,HEP B ADULT (ENGERIX-B),PNC,A,990,90746,,,,,100.00,N,Y
4980748,COMVAX 0.5ML,PNC,A,990,90748,,,,,55.50,N,Y
4980750,SHINGRIX ZOSTER VACCINE,PNC,A,990,90750,,,,,260.00,N,Y
4980770,BLEPHARO DRAIN ABS EYELID,PNC,A,990,67700,,,,,245.00,N,Y
4980772,"THERA,PROPHY,DIAINJ,SUBCU",PNC,A,990,96372,,,,,52.00,N,Y
4980802,HEMOGLOBIN A1C,PNC,A,300,83036,,,,,73.00,N,Y
4980807,RSV TEST,PNC,A,990,87807,,,,,41.00,N,N
4980808,TRICHOMONAS,PNC,A,990,87808,,,,,29.00,N,Y
4980827,FETAL DOPPLER,PNC,A,990,76827,,,,,136.00,N,Y
4980880,ARANESP PER 5MCG,PNC,A,990,J0880,,,,,29.00,N,Y
4980885,EPOGEN 1000 UNITS,PNC,A,990,J0885,,,,,44.50,N,Y
4980897,PROLIA(DENOSUMAD)PER 1MG,PNC,A,990,J0897,,,,,"1,710.00",N,Y
4980901,CAURTERIZATION OF NOSE,PNC,A,990,30901,,,,,87.00,N,Y
4980905,BV,PNC,A,990,87905,,,,,29.00,N,Y
4980925,OMT (1-2 REGIONS),PNC,A,990,98925,,,,,40.00,N,N
4980992,SCHOOL/OTHER STAFF PHYSICALS,PNC,A,990,99211,,,,,50.00,N,N
4981000,UA DIP W/MICRO,PNC,A,990,81000,,,,,11.00,N,Y
4981001,DEPO-ESTRADIOL UP TO 5MG,PNC,A,990,J1000,,,,,13.00,N,Y
4981002,UA DIP W/O MICRO,PNC,A,990,81002,,,,,9.00,N,Y
4981003,UA AUTO W/O MICRO,PNC,A,300,81003,,,,,29.00,N,Y
4981025,PREG URINE,PNC,A,990,81025,,,,,22.00,N,Y
4981030,DEPO MEDROL 40MG,PNC,A,990,J1030,,,,,13.00,N,Y
4981040,"DEBRIDEMENT, SKIN LESION",PNC,A,990,11042,,,,,55.50,N,Y
4981050,DEPO PROV 1MG,PNC,A,990,J1050,,,,,150.00,N,Y
4981055,DEPO-PROVERA 150MG,PNC,A,990,J1055,,,,,111.00,N,Y
4981056,CORN REMOVAL,PNC,A,990,11055,,,,,65.50,N,Y
4981070,DEPO-TESTOST PER 100MG,PNC,A,636,J1070,,,,,11.50,N,Y
4981071,DEPO TEST PER 1 MG,PNC,A,636,J1071,,,,,60.00,N,Y
4981080,TESTOSTERONE CYP 200 MG,PNC,A,636,J1080,,,,,17.80,N,Y
4981100,BIOPSY-SKIN,PNC,A,990,11100,,,,,114.00,N,Y
4981101,BIOPSY-EACH ADD'L,PNC,A,990,11101,,,,,52.00,N,Y
4981102,DEBRIDEMENT OF SKIN,PNC,A,990,11000,,,,,70.00,N,N
4981111,CARE COORDINATOR VISIT,PNC,A,990,,,,,,0.00,N,N
4981174,EVACUATION OF SUBUNGUAL H,PNC,A,990,11740,,,,,52.00,N,Y
4981200,REMOVAL SKIN TAGS,PNC,A,990,11200,,,,,166.00,N,Y
4981201,DIPHENHYDRAMINE 50MG/ML 1,PNC,A,990,J1200,,,,,3.50,N,Y
4981300,"SHAVE OF EPID/DERM ,5>TAL",PNC,A,990,11300,,,,,81.00,N,Y
4981301,SHAV SINGLE LESION0.6 TO1.0CM ARMS LEGS,PNC,A,990,11301,,,,,100.00,N,Y
4981305,SHAVE EPID DERMLE.5SNHFG,PNC,A,990,11305,,,,,79.50,N,Y
4981310,SHAVE BIO N F E EL LI ME,PNC,A,990,11310,,,,,98.00,N,Y
4981400,EX SKIN LES <.5CM TAL,PNC,A,990,11400,,,,,150.00,N,Y
4981401,EX SKIN LES BN0.6-1.0 TAL,PNC,A,990,11401,,,,,174.00,N,Y
4981402,EX SKIN LES 1.1-2.0 TAL,PNC,A,990,11402,,,,,205.50,N,Y
4981403,EX SKIN LES 2.1-3.0 TAL,PNC,A,990,11403,,,,,223.00,N,Y
4981404,EX SKIN LES 3/1-4.0 TAL,PNC,A,990,11404,,,,,254.00,N,Y
4981406,EX SKIN LES4.0-+CM TAL,PNC,A,990,11406,,,,,344.00,N,Y
4981420,EX SKIN LES <0.5CM SNNFG,PNC,A,990,11420,,,,,147.50,N,Y
4981421,EX SKIN LES0.6-1.0 SNHFG,PNC,A,990,11421,,,,,185.50,N,Y
4981422,EX SKIN LES-BN1.1-2SNHFG,PNC,A,990,11422,,,,,214.50,N,Y
4981423,EX SKIN LES 2.1-3.0SNHFG,PNC,A,990,11423,,,,,245.00,N,Y
4981424,EX SKIN LES 3.1-4.0SNHFG,PNC,A,990,11424,,,,,281.50,N,Y
4981426,EX SKIN LES 4.0+CMSNHFG,PNC,A,990,11426,,,,,391.00,N,Y
4981436,SMOKING CESS 3-10 MIN MEDICARE/MEDICAID,PNC,A,942,G0436,,,,,21.00,N,Y
4981437,SMOKING CESS > 10 MIN MEDICARE/MEDICAID,PNC,A,983,G0437,,,,,47.00,N,Y
4981440,EX SKIN LES <.5CM FEENLM,PNC,A,990,11440,,,,,178.00,N,Y
4981441,EX SKIN LES 0.6-1.O FEENL,PNC,A,990,11441,,,,,205.50,N,Y
4981442,EX SKIN LESION-BN 1.1-2.0,PNC,A,990,11442,,,,,227.50,N,Y
4981443,EX SKIN LES2.1-3.0FEENLM,PNC,A,990,11443,,,,,278.00,N,Y
4981444,EX SKIN LES 3.1-4.0FEENLM,PNC,A,990,11444,,,,,352.00,N,Y
4981446,EX SKIN LESION-BN 4.0 +CM,PNC,A,990,11446,,,,,453.00,N,Y
4981473,"INTRANASAL/ORAL IMMUN, 1 VACCINE",PNC,A,990,90473,,,,,63.00,N,N
4981600,EX SKIN LESMA<.5CM TAL,PNC,A,990,11600,,,,,207.00,N,Y
4981601,EX SKIN LESMA0.6-1.0 TAL,PNC,A,990,11601,,,,,237.00,N,Y
4981602,EX SKIN LESMA1.1-2.0TAL,PNC,A,990,11602,,,,,254.00,N,Y
4981603,EX SKIN LESMA2.1-3.0TAL,PNC,A,990,11603,,,,,278.00,N,Y
4981604,EX SKIN LESMA3.1-4.0TAL,PNC,A,990,11604,,,,,306.00,N,Y
4981606,EX SKIN LESMA4.0+CM TAL,PNC,A,990,11606,,,,,399.50,N,Y
4981610,GLUCAGON PER 1MG,PNC,A,990,J1610,,,,,325.30,N,Y
4981620,EX SKIN LESMA<.5CM SNHFG,PNC,A,990,11620,,,,,200.50,N,Y
4981621,EX SKIN LESMA0.6-1.0SNHFG,PNC,A,990,11621,,,,,237.00,N,Y
4981622,EX SKIN LESMA 1.1-2.0SNHF,PNC,A,990,11622,,,,,267.50,N,Y
4981623,EX SKIN LESMA2.1-3.0 SNHF,PNC,A,990,11623,,,,,316.00,N,Y
4981624,EX SKIN LESMA3.1-4.0SCHFG,PNC,A,990,11624,,,,,361.50,N,Y
4981626,EX SKIN LESMA 4.0+CM SCHF,PNC,A,990,11626,,,,,477.00,N,Y
4981640,EX SKIN LESMA<.5CM FEENL,PNC,A,990,11640,,,,,213.00,N,Y
4981641,EX SKIN LESMA0.6-1.0FEENL,PNC,A,990,11641,,,,,274.50,N,Y
4981643,EX SKIN LESMA2.1-3.0FEENL,PNC,A,990,11643,,,,,366.00,N,Y
4981644,EX SKIN LESMA3.1-4.0FEENL,PNC,A,990,11644,,,,,464.00,N,Y
4981646,EX SKIN LESMA4.0+CMFEENL,PNC,A,990,11646,,,,,622.50,N,Y
4981650,LOVENOX PER 10MG,PNC,A,990,J1650,,,,,11.50,N,Y
4981730,AVULSION OF NAIL,PNC,A,990,11730,,,,,116.50,N,Y
4981732,AVULSION OF NAIL; EACH ADD'L,PNC,A,990,11732,,,,,65.00,N,Y
4981750,EXCIS OF NAIL & NAIL MATR,PNC,A,990,11750,,,,,289.50,N,Y
4981820,HUMULIN R PER 5 UNITS,PNC,A,990,J1815,,,,,7.30,N,Y
4981885,KETOROLAC PER 15MG,PNC,A,990,J1885,,,,,16.00,N,Y
4981900,LESION INJECTION UP TO 7,PNC,A,990,11900,,,,,54.00,N,Y
4981940,FUROSEMIDE UP TO 20MG,PNC,A,990,J1940,,,,,3.00,N,Y
4981950,LUPRON PER 3.75MG,PNC,A,990,J1950,,,,,667.00,N,Y
4981981,INSER NONBIODEG DRUG DELI,PNC,A,990,11981,,,,,260.00,N,N
4981982,REMOV NONBIODEG DRUG DEL,PNC,A,990,11982,,,,,290.00,N,N
4981983,REM REINSERT NONBIODEG IM,PNC,A,990,11983,,,,,405.00,N,N
4982001,LACE REP <2.5CM EXGT&OE,PNC,A,990,12001,,,,,196.00,N,Y
4982002,LACE REP 2.6-7.5 EGT& OE,PNC,A,990,12002,,,,,219.00,N,Y
4982004,LAC REP 7.6-12.5 SNA,PNC,A,990,12004,,,,,245.00,N,Y
4982005,LACER REP 12.6-20.0 SNAEGTR,PNC,A,990,12005,,,,,303.00,N,Y
4982011,LAC FAC/EAR7.6-12.5REENLM,PNC,A,990,12011,,,,,214.50,N,Y
4982013,LACER REP FACE<2.5 REENLM,PNC,A,990,12013,,,,,227.50,N,Y
4982014,LACE EYEL/NOS5.1-7.5REENL,PNC,A,990,12014,,,,,267.50,N,Y
4982015,LAC FAC/EA 7.6-12.5REENLM,PNC,A,990,12015,,,,,339.00,N,Y
4982035,MED INFLU SPLIT VIR AFLUR,PNC,A,636,Q2035,,,,,0.00,N,Y
4982036,MED INFLU SPLIT V FLULAVA,PNC,A,636,Q2036,,,,,0.00,N,Y
4982037,MED INFLU SPLIT FLUVIRIN,PNC,A,636,Q2037,,,,,0.00,N,Y
4982038,INFLUENZA QUAD VACCINE 0.5ML,PNC,A,636,Q2038,,,,,50.00,N,Y
4982039,FLUARIX MEDICARE QUAD SPLIT VIRUS 0.5 ML,PNC,A,636,Q2039,,,,,50.00,N,Y
4982060,INJECTION INTO MED JOINT,PNC,A,990,20605,,,,,101.00,N,Y
4982175,DEMEROL PER 100MG,PNC,A,990,J2175,,,,,3.50,N,Y
4982200,I & D SOFT TISSUE ABSCES,PNC,A,990,20005,,,,,134.00,N,Y
4982201,MEDICARE OV NP LEVEL 1,PNC,A,510,99201,,,,,23.40,N,N
4982202,MEDICARE OV NP LEVEL 2,PNC,A,510,99202,,,,,37.50,N,N
4982203,MEDICARE OV NP LEVEL 3,PNC,A,510,99203,,,,,54.60,N,N
4982204,MEDICARE OV NP LEVEL 4,PNC,A,510,99204,,,,,83.10,N,N
4982205,MEDICARE OV NP LEVEL 5,PNC,A,510,99205,,,,,101.40,N,N
4982211,MEDICARE OV EP LEVEL 1,PNC,A,510,99211,,,,,14.10,N,Y
4982212,MEDICARE OV EP LEVEL 2,PNC,A,510,99212,,,,,21.90,N,N
4982213,MEDICARE OV EP LEVEL 3,PNC,A,510,99213,,,,,36.00,N,N
4982214,MEDICARE OV EP LEVEL 4,PNC,A,510,99214,,,,,51.60,N,N
4982215,MEDICARE OV EP LEVEL 5,PNC,A,510,99215,,,,,68.70,N,N
4982270,OCCULT BLOOD SCREEN CARDS,PNC,A,990,G0328,,,,,9.00,N,Y
4982272,OCC BL SC DIGITAL RECTAL,PNC,A,990,82272,,,,,9.00,N,Y
4982301,NUBAIN PER 10MG,PNC,A,990,J2300,,,,,4.50,N,Y
4982343,VALPROATE 100MG/ML 5ML SD,PNC,A,990,J3490,,,,,53.00,N,Y
4982360,NORFLEX UP TO 60MG,PNC,A,990,J2360,,,,,15.00,N,Y
4982405,ONDANSETRON(ZOFRAN)PER1MG INJ,PNC,A,990,J2405,,,,,2.30,N,Y
4982505,NEULASTA 6MG,PNC,A,990,J2505,,,,,"5,381.50",N,Y
4982550,PROMETHAZINE UP TO 50MG,PNC,A,990,J2550,,,,,4.00,N,Y
4982567,TYMPANOMETRY,PNC,A,990,92567,,,,,38.00,N,Y
4982660,CLSD TR METACARPAL FX W/O,PNC,A,990,26600,,,,,408.00,N,Y
4982790,RHO GAM,PNC,A,990,J2790,,,,,371.00,N,Y
4982920,SOLU-MEDROL UP TO 40MG,PNC,A,990,J2920,,,,,10.00,N,Y
4982930,SOLU MEDROL UP TO 125MG,PNC,A,990,J2930,,,,,7.10,N,N
4982947,GLUCOSE,PNC,A,990,82948,,,,,36.00,N,Y
4983030,SUMATRIPTAN 6MG,PNC,A,990,J3030,,,,,32.00,N,Y
4983152,LAC REP C2.6CM/7.5CMFCM,PNC,A,990,13152,,,,,566.00,N,Y
4983225,HOLTER MONITOR,PNC,A,990,93225,,,,,32.00,N,Y
4983270,EVENT MONITOR,PNC,A,990,93270,,,,,27.00,N,Y
4983301,KENALOG PER 10MG,PNC,A,636,J3301,,,,,20.00,N,Y
4983410,HYDROXYZINE UP TO 25MG,PNC,A,990,J3410,,,,,2.50,N,Y
4983420,VITAMIN B-12 1000MCG,PNC,A,990,J3420,,,,,20.00,N,Y
4983930,I&D HEMATOMA/ELBOW,PNC,A,990,23930,,,,,204.00,N,Y
4984010,SPIROMETRY,PNC,A,990,94010,,,,,64.50,N,Y
4984016,PULMONARY FUNCTION INTERP,PNC,A,990,94016,,,,,38.50,N,Y
4984056,DEST.OF LESION(CRYO)PENIS,PNC,A,990,54056,,,,,112.50,N,Y
4984640,INHALATION TREATMENT,PNC,A,410,94640,,,,,42.00,N,Y
4984703,HCG,PNC,A,990,84703,,,,,25.00,N,Y
4984900,SYNVISC 1,PNC,A,990,J3490,,,,,"1,442.00",N,Y
4985000,NOCALL/NOSHOW,PNC,A,990,,,,,,20.50,N,Y
4985018,HEMOGLOBIN,PNC,A,990,85018,,,,,22.00,N,Y
4985025,CBC W/DIFF,PNC,A,990,85025,,,,,71.00,N,Y
4985027,CBC HEMOGRAM,PNC,A,300,85027,,,,,71.00,N,N
4985205,FORGN BODY REMOV EYE SUPE,PNC,A,990,65205,,,,,114.00,N,Y
4985250,VASECTOMY,PNC,A,990,55250,,,,,725.00,N,N
4985610,INR,PNC,A,300,85610,,,,,22.00,N,Y
4986000,BURN CARE INITIAL,PNC,A,990,16000,,,,,94.00,N,Y
4986010,DRAINED ABSCESS FINGER,PNC,A,990,26010,,,,,153.00,N,Y
4986020,BURN DEBR/DRSG SM < 5%,PNC,A,990,16020,,,,,112.00,N,Y
4986025,BURN DEBR/DRESG MED 5%-10,PNC,A,990,16025,,,,,196.00,N,Y
4986083,INCISION THROMBOSED HEMOR,PNC,A,990,46083,,,,,369.00,N,Y
4986211,SPORTS PHYSICAL,PNC,A,990,,,,,,10.00,N,Y
4986345,APP OF LONG LEG CAST,PNC,A,990,29345,,,,,180.00,N,Y
4986415,DRAW FEE,PNC,A,990,36415,,,,,18.00,N,Y
4986468,"INJ MULT TELANG,,LEG",PNC,A,990,36468,,,,,214.50,N,Y
4986469,"INJ MULT TELANG, FACE",PNC,A,990,36469,,,,,214.50,N,Y
4986470,INJ SINGLE VARICOSE VEIN,PNC,A,990,36470,,,,,86.00,N,Y
4986471,INJ MULT VARIC VEINS SLEG,PNC,A,990,36471,,,,,191.50,N,Y
4986569,PICC WO SUB PORT,PNC,A,990,36569,,,,,475.00,N,N
4986580,TUBERCULIN INTRADERMAL,PNC,A,990,86580,,,,,16.00,N,Y
4986588,RAPID STREP,PNC,A,990,87880,,,,,27.00,N,Y
4986600,ANOSCOPY,PNC,A,990,46600,,,,,109.00,N,Y
4986605,BIOPSY ONE VULVAR LESION,PNC,A,990,56605,,,,,119.50,N,Y
4987000,"DESTRUCT.,BENIGN LESION 1",PNC,A,990,17000,,,,,120.00,N,Y
4987003,DESTRUBENIGN LESION A2-14,PNC,A,990,17003,,,,,16.00,N,Y
4987110,REMOVAL OF WARTS,PNC,A,990,17110,,,,,146.00,N,Y
4987160,FITTING INSERTION PESSARY,PNC,A,990,57160,,,,,107.50,N,Y
4987170,DIAPHRAGM/CERV CAP FITTIN,PNC,A,990,57170,,,,,118.00,N,Y
4987210,WET MOUNT,PNC,A,990,87210,,,,,33.00,N,N
4987220,WET MOUNT (KOH),PNC,A,990,87220,,,,,12.00,N,N
4987300,PARAGARD,PNC,A,990,J7300,,,,,658.00,N,N
4987301,SKYLA,PNC,A,990,J7301,,,,,600.00,N,N
4987302,MIRENA,PNC,A,990,J7298,,,,,800.00,N,N
4987307,IMPLANON/NEXPLANON,PNC,A,990,J7307,,,,,"1,100.00",N,N
4987320,SYNVISC PER INJECTION,PNC,A,990,,,,,,412.00,N,Y
4987325,SYNVISC-ONE PER 1MG,PNC,A,990,J7325,,,,,34.50,N,Y
4987365,"FOOT OS CALCIS,MIN 2 VIEW",PNC,A,990,73650,,,,,127.00,N,Y
4987454,COLPOSCOPY W/BIOPSY,PNC,A,990,57454,,,,,237.50,N,Y
4987500,CHEST (1 VIEW) FRONTAL,PNC,A,990,71045,,,,,137.00,N,Y
4987501,CHEST (2 VIEW)FRONT & LATERAL,PNC,A,320,71046,,,,,159.00,N,Y
4987502,SHOULDER COMPL MIN 2 VIEW,PNC,A,990,73030,,,,,143.00,N,Y
4987503,HUMERUS MIN 2 VIEW,PNC,A,990,73060,,,,,142.00,N,Y
4987504,ELBOW ANTEROSPOSTERIOR VIEW,PNC,A,990,73070,,,,,127.00,N,Y
4987505,UPPER EXTREMINFANT MIN2V,PNC,A,990,73092,,,,,124.00,N,Y
4987506,FOREARM 2 VIEW,PNC,A,990,73090,,,,,130.00,N,Y
4987507,WRIST 2 VIEW,PNC,A,990,73100,TC,,,,122.00,N,Y
4987508,WRIST MIN 3 VIEW,PNC,A,990,73110,,,,,135.00,N,Y
4987509,HAND MIN 3 VIEW,PNC,A,990,73130,,,,,134.00,N,Y
4987510,FINGER(S) MIN 2 VIEW,PNC,A,990,73140,,,,,108.00,N,Y
4987511,FEMUR 2 VIEW,PNC,A,990,73552,,,,,135.00,N,Y
4987512,TIBIA & FIBULA LEG 2 VIEW,PNC,A,990,73590,,,,,125.00,N,Y
4987513,KNEE<=2 VIEWS,PNC,A,320,73560,,,,,137.00,N,Y
4987515,"LWR EXTREM INFANT, MIN 2 VW",PNC,A,990,73592,,,,,122.00,N,Y
4987516,ANKLE 2 VIEWS,PNC,A,990,73600,,,,,124.00,N,Y
4987517,ANKLE MIN 3 VIEWS,PNC,A,990,73610,,,,,140.00,N,Y
4987518,FOOT 2 VIEWS,PNC,A,990,73620,,,,,124.00,N,Y
4987519,"FOOT, MIN 3 VIEW",PNC,A,990,73630,,,,,137.00,N,Y
4987520,TOE(S) MIN 2 VIEWS,PNC,A,990,73660,,,,,108.00,N,Y
4987521,KNEE 3 VIEW,PNC,A,990,73562,,,,,147.00,N,Y
4987522,SHOULDER 1 VIEW,PNC,A,990,73020,,,,,118.00,N,Y
4987526,TIBIA 3 VIEW,PNC,A,990,73590,,,,,70.00,N,Y
4987527,HAND 2 VIEW,PNC,A,990,73120,,,,,124.00,N,Y
4987528,HAND 2 VIEWS,PNC,A,990,73130,,,,,134.00,N,Y
4987529,"KNEES, COMPLETE 4 OR >",PNC,A,990,73564,,,,,157.00,N,Y
4987530,"KNEES, AP BI-LAT STND",PNC,A,990,73565,,,,,131.00,N,Y
4987531,BONE AGE,PNC,A,990,77072,,,,,140.00,N,N
4987800,"EXCISION CHALAZION, SINGLE",PNC,A,990,67800,,,,,260.00,N,Y
4988030,DRUG SCREEN,PNC,A,990,80305,,,,,43.00,N,N
4988100,ENDOMETRIAL BIOPSY,PNC,A,990,58100,,,,,158.00,N,Y
4988164,PAP,PNC,A,990,88164,,,,,25.00,N,N
4988190,FOREIGN BODY REMOVAL FOOT,PNC,A,990,28190,,,,,166.00,N,Y
4988213,GCH EMPLOYEE PHYSICAL,PNC,A,990,99213,,,,,0.00,N,Y
4988233,TISSUE CULTURE SKIN/BIOSP,PNC,A,990,88233,,,,,379.00,N,Y
4988300,INSERTION INTRAUTERDEVICE,PNC,A,990,58300,,,,,135.00,N,N
4988301,REM INTRAUTERINE DEVICE,PNC,A,990,58301,,,,,177.00,N,N
4988350,CORTROSYN PER 0.25 MG,PNC,A,990,J0835,,,,,137.00,N,Y
4988470,FRACTURE CARE/METATARSAL,PNC,A,990,28470,,,,,312.50,N,Y
4988925,OMT 1-2,PNC,A,990,98925,,,,,46.00,N,Y
4988926,OMT 3-4,PNC,A,990,98926,,,,,61.50,N,Y
4988927,OMT 5-6,PNC,A,990,98927,,,,,76.50,N,Y
4989000,DRAIN EAR ABCESS/HEMATOMA,PNC,A,990,69000,,,,,143.00,N,Y
4989008,ADM FLU VACCINE,PNC,A,990,G0008,,,,,22.00,N,Y
4989009,ADM PNEUMOCOCCAL VACCINE,PNC,A,990,G0009,,,,,63.00,N,Y
4989010,ADM HEPATITIS B VACCINE,PNC,A,990,G0010,,,,,9.00,N,Y
4989024,GLOBAL/POST OP VISIT,PNC,A,990,99024,,,,,0.00,N,N
4989047,EACH ADD'L IMMUNE(STATE),PNC,A,990,90472,,,,,6.00,N,N
4989062,BEXSERO 0.5ml,PNC,A,990,90620,,,,,250.00,N,N
4989069,KINRIX(DTAP-IVP),PNC,A,990,,,,,,0.00,N,Y
4989080,PARACENTESIS,PNC,A,990,49080,,,,,92.00,N,Y
4989105,APPLICATION LONG ARM SPLI,PNC,A,990,29105,,,,,120.00,N,Y
4989125,APPLICATION SHORT ARM SPL,PNC,A,990,29125,,,,,98.00,N,Y
4989130,APPLICATION FINGER SPLINT,PNC,A,990,29130,,,,,58.00,N,Y
4989200,"FOREIGN BODY REMOV, EAR",PNC,A,990,69200,,,,,150.00,N,N
4989209,EAR LAVAGE 1 OR BOTH EARS,PNC,A,510,69209,,,,,31.00,N,Y
4989210,CERUMEN REMOVAL 1 OR BOTH EARS,PNC,A,990,69210,,,,,78.00,N,Y
4989211,PRESCHOOL/CAMP PHYSICAL,PNC,A,990,,,,,,20.00,N,Y
4989213,DOT PHYSICAL,PNC,A,990,99499,,,,,123.00,N,Y
4989217,OBSERVATION DISCHARGE,PNC,A,990,99217,,,,,102.00,N,Y
4989218,OBSERVATION LEVEL 1,PNC,A,990,99218,,,,,97.00,N,Y
4989219,OBSERVATION LEVEL 2,PNC,A,990,99219,,,,,158.50,N,Y
4989220,OBSERVATION LEVEL 3,PNC,A,990,99220,,,,,219.50,N,Y
4989234,OBERV IP SAME DAY,PNC,A,990,99234,,,,,235.00,N,Y
4989235,LEVEL2 OBSERSV/IP,PNC,A,990,99235,,,,,275.00,N,Y
4989236,LEVEL3 OBSERV/IP SAME DAY,PNC,A,990,99236,,,,,350.00,N,N
4989241,OFFICE CONSULT LEVEL 1,PNC,A,990,99241,,,,,75.00,N,Y
4989242,OFFICE CONSULT LEVEL 2,PNC,A,990,99242,,,,,135.00,N,Y
4989243,OFFICE CONSULT LEVEL 3,PNC,A,990,99243,,,,,185.00,N,Y
4989301,NURSING HOME ADMIT LEVEL1,PNC,A,994,99304,,,,,156.00,N,Y
4989302,NURSING HOME ADMIT LEVEL2,PNC,A,994,99305,,,,,218.00,N,Y
4989303,NURSING HOME ADMIT LEVEL3,PNC,A,994,99306,,,,,281.00,N,Y
4989310,COMPREHENSIVE,PNC,A,994,99310,,,,,229.00,N,Y
4989311,NURSING HOME LEVEL 1,PNC,A,994,99307,,,,,78.00,N,Y
4989312,NURSING HOME LEVEL 2,PNC,A,994,99308,,,,,120.00,N,Y
4989313,NURSING HOME LEV3 DETAIL,PNC,A,994,99309,,,,,156.00,N,Y
4989324,NEWPT ASISTED LIVING V,PNC,A,990,99324,,,,,94.00,N,Y
4989325,NEWPT ASSISTED LIVING V,PNC,A,990,99325,,,,,135.00,N,Y
4989326,NEWPT ASSISTED LIVING V,PNC,A,990,99326,,,,,234.00,N,Y
4989327,NEWPT ASSISTED LIVING VIS,PNC,A,990,99327,,,,,312.00,N,Y
4989328,NEWPT ASSISTED LIVING VIS,PNC,A,990,99328,,,,,364.00,N,Y
4989334,ESTABPT ASSISTED LIVING V,PNC,A,990,99334,,,,,101.00,N,Y
4989335,ESTABPT ASSISTED LIVING V,PNC,A,990,99335,,,,,161.00,N,Y
4989336,ESTABPT ASSISTED LIVING V,PNC,A,990,99336,,,,,229.00,N,Y
4989337,ESTABPT ASSISTED LIVING V,ADC,A,990,99337,,,,,328.00,N,Y
4989341,HOME VISIT NEW LEVEL 1,PNC,A,994,99341,,,,,94.00,N,Y
4989342,HOME VISIT NEW LEVEL 2,PNC,A,994,99342,,,,,138.00,N,Y
4989343,HOME VISIT NEW LEVEL 3,PNC,A,994,99343,,,,,210.00,N,Y
4989344,HOME VISIT NEW LEVEL 4,PNC,A,994,99344,,,,,294.00,N,Y
4989345,HOME VISIT NEW LEVEL 5,PNC,A,994,99345,,,,,350.00,N,Y
4989347,HOME VISIT ESTA. LEVEL 2,PNC,A,994,99347,,,,,94.00,N,Y
4989348,HOME VISIT ESTA. LEVEL 3,PNC,A,994,99348,,,,,146.00,N,Y
4989349,HOME VISIT ESTA. LEVEL 4,PNC,A,994,99349,,,,,214.00,N,Y
4989350,HOME VISIT ESTA. LEVEL 5,PNC,A,994,99350,,,,,302.00,N,Y
4989381,PHYSICAL NEW 0-1 YR,PNC,A,990,99381,,,,,161.00,N,Y
4989382,PHYSICAL NEW 1-4 YRS,PNC,A,990,99382,,,,,166.00,N,Y
4989383,PHYSICAL NEW 5-11 YRS,PNC,A,990,99383,,,,,176.00,N,Y
4989384,PHYSICAL NEW 12-17 YRS,PNC,A,990,99384,,,,,198.00,N,Y
4989385,PHYSICAL NEW 18-39 YRS,PNC,A,990,99385,,,,,187.00,N,Y
4989386,PHYSICAL NEW 40-64 YRS,PNC,A,990,99386,,,,,218.00,N,Y
4989387,PHYSICAL NEW 65 & OLDER,PNC,A,990,99387,,,,,239.00,N,Y
4989391,PHYSICAL ESTA. 0-1 YRS,PNC,A,990,99391,,,,,146.00,N,Y
4989392,PHYSICAL ESTA. 1-4 YRS,PNC,A,990,99392,,,,,155.00,N,Y
4989393,PHYSICAL ESTA. 5-11 YRS,PNC,A,990,99393,,,,,155.00,N,Y
4989394,PHYSICAL ESTA. 12-17 YRS,PNC,A,990,99394,,,,,166.00,N,Y
4989395,PHYSICAL ESTA. 18-39 YRS,PNC,A,990,99395,,,,,171.00,N,Y
4989396,PHYSICAL ESTA. 40-64 YRS,PNC,A,990,99396,,,,,182.00,N,Y
4989397,PHYSICAL ESTA. 65 & OLDER,PNC,A,983,99397,,,,,198.00,N,Y
4989406,SMOKING CESS. COUNS. 3-10 MIN,PNC,A,990,99406,,,,,21.00,N,Y
4989407,SMOKING CESS. COUNS. > 10 MIN,PNC,A,990,99407,,,,,47.00,N,Y
4989471,IMMUNIZATION (STATE),PNC,A,990,90471,,,,,19.68,N,Y
4989495,TCM - FTF WITHIN 14 DAYS,PNC,A,990,99495,,,,,208.00,N,Y
4989496,TCM - FTF WITHIN 7 DAYS,PNC,A,983,99496,,,,,286.00,N,Y
4989497,ADVANCED CARE PLANNING,PNC,A,983,99497,,,,,99.00,N,Y
4989505,APPLICATION LONG LEG SPLI,PNC,A,990,29505,,,,,98.00,N,Y
4989515,APPLICATION SHORT LEG SPL,PNC,A,990,29515,,,,,92.00,N,Y
4989580,UNNA BOOT APLICATION,PNC,A,990,29580,,,,,75.00,N,Y
4989900,PAP COLLECTION,PNC,A,990,99000,,,,,56.00,N,Y
4989901,ST GREGORY H&P,PNC,A,990,99204,,,,,190.50,N,Y
4989921,WOUND CARE,PNC,A,990,99211,,,,,53.00,N,Y
4989924,SUBSEQUENT OBS CARE 1,PNC,A,990,99224,,,,,50.00,N,Y
4989925,SUBSEQUENT CARE 2,PNC,A,990,99225,,,,,80.00,N,N
4989926,SUBSEQUENT CARE 3,PNC,A,990,,,,,,110.00,N,N
4990002,DEBRIDMENT OF WOUND <10%,DNU,A,990,11000,,,,,30.50,N,Y
4990003,DEBR WOUND EA ADD 10%,DNU,A,990,11001,,,,,22.00,N,Y
4990010,SCRN PELVIC/BREAST EXAM,DNU,A,990,G0101,,,,,43.50,N,Y
4990011,DRUG SCR COLLECTION & KIT,DNU,A,990,80100,,,,,62.50,N,Y
4990024,OCCULT BLOOD SCREENING,DNU,A,990,82270,,,,,10.00,N,Y
4990025,REMOVAL SKIN TAGS (EAAD10,DNU,A,990,11201,,,,,21.00,N,Y
4990030,SUPARTZ PER INJECTION,DNU,A,990,J7319,,,,,121.50,N,Y
4990031,MARCAINE 0.25% PER 30ML,DNU,A,990,S0020,,,,,6.50,N,Y
4990032,PANORA & BAYARD NURSING,DNU,A,990,99213,,,,,45.00,N,Y
4990033,COMMUNITY HEALTH SCREENIN,DNU,A,990,99213,,,,,18.00,N,Y
4990040,REMOVAL OF INCLUSION CYST,DNU,A,990,10040,,,,,114.00,N,Y
4990055,PARING/CUTTING BENIGN LES,DNU,A,990,11055,,,,,52.50,N,Y
4990060,DRAIN SKIN ABCESS SIMPLE,DNU,A,990,10060,,,,,124.50,N,Y
4990061,DRAIN SKIN ABCESS,DNU,A,990,10061,,,,,227.00,N,Y
4990080,SPECIAL FORMS,DNU,A,990,99080,,,,,22.00,N,Y
4990085,CASTING FOREARM/HAND,DNU,A,990,29085,,,,,112.50,N,Y
4990091,PAP COLLECTION,DNU,A,990,Q0091,,,,,54.50,N,Y
4990100,DEXAMETHASONE PER 1MG INJ,DNU,A,990,J1100,,,,,1.50,N,Y
4990115,ALLERGY SINGLE,DNU,A,990,95115,,,,,16.00,N,Y
4990117,ALLERGY MULTIPLE,DNU,A,990,95117,,,,,20.00,N,Y
4990120,FB REMOVAL & INCISION,DNU,A,990,10120,,,,,151.50,N,Y
4990150,ADENOCARD PER 6MG,DNU,A,990,J0150,,,,,78.00,N,Y
4990170,EPINEPHRINE 1MG/ML AMP1ML,DNU,A,990,J0170,,,,,3.50,N,Y
4990179,PHY RECERT FOR HOME HEALT,DNU,A,990,G0179,,,,,77.50,N,Y
4990180,PHY CERT FOR HOME HEALTH,DNU,A,990,G0180,,,,,100.50,N,Y
4990201,NEW OUTPATIENT LEVEL 1,DNU,A,990,99201,,,,,43.00,N,Y
4990202,NEW OUTPATIENT LEVEL 2,DNU,A,990,99202,,,,,77.50,N,Y
4990203,NEW OUTPATIENT LEVEL 3,DNU,A,990,99203,,,,,114.00,N,Y
4990204,NEW OUTPATIENT LEVEL 4,DNU,A,990,99204,,,,,162.00,N,Y
4990205,NEW OUTPATIENT LEVEL 5,DNU,A,990,99205,,,,,204.00,N,Y
4990211,OFFICE VISIT LEVEL 1,DNU,A,990,99211,,,,,25.00,N,Y
4990212,OFFICE VISIT LEVEL 2,DNU,A,990,99212,,,,,45.00,N,Y
4990213,OFFICE VISIT LEVEL 3,DNU,A,990,99213,,,,,61.50,N,Y
4990214,OFFICE VISIT LEVEL 4,DNU,A,990,99214,,,,,96.00,N,Y
4990215,OFFICE VISIT LEVEL 5,DNU,A,990,99215,,,,,141.50,N,Y
4990221,INPATIENT INITIAL LEVEL 1,DNU,A,990,99221,,,,,85.50,N,Y
4990222,INPATIENT INITIAL LEVEL 2,DNU,A,990,99222,,,,,141.75,N,Y
4990223,INPATIENT INITIAL LEVEL 3,DNU,A,990,99223,,,,,254.00,N,Y
4990231,INPATIENT LEVEL 1,DNU,A,990,99231,,,,,44.00,N,Y
4990232,INPATIENT LEVEL 2,DNU,A,990,99232,,,,,78.75,N,Y
4990233,INPATIENT LEVEL 3,DNU,A,990,99233,,,,,124.15,N,Y
4990238,HOSPITAL DISCHARGE,DNU,A,990,99238,,,,,89.75,N,Y
4990239,HOSPITAL DISCHARGE,DNU,A,990,99239,,,,,127.00,N,Y
4990270,MORPHINE UP TO 10MG,DNU,A,990,J2270,,,,,3.00,N,Y
4990291,CRITICAL CARE 1ST HOUR,DNU,A,990,99291,,,,,301.50,N,Y
4990292,CRITICAL CARE ADD'L 1/2HR,DNU,A,990,99292,,,,,142.25,N,Y
4990301,SKILLED CARE ADMIT 1,DNU,A,990,99304,,,,,79.50,N,Y
4990302,SKILLED CARE ADMIT 2,DNU,A,990,99302,,,,,108.00,N,Y
4990303,SKILLED NURSING,DNU,A,990,99303,,,,,138.00,N,Y
4990311,SKILLED CARE LEVEL 1,DNU,A,990,99307,,,,,46.00,N,Y
4990312,SKILLED CARE LEVEL 2,DNU,A,990,99308,,,,,70.50,N,Y
4990313,SKILLED CARE LEVEL 3,DNU,A,990,99313,,,,,96.00,N,Y
4990315,SKILLED DISCHARGE,DNU,A,990,99315,,,,,79.00,N,Y
4990316,SKILLED DISCHARGE,DNU,A,990,99316,,,,,97.50,N,Y
4990344,MEDICARE INITIAL PREV.EXA,DNU,A,990,G0344,,,,,96.00,N,Y
4990366,MED.INIT.ECG-W/INTER&REPO,DNU,A,990,G0366,,,,,39.50,N,Y
4990367,MED.INIT.ECG-TRACING ONLY,DNU,A,990,G0367,,,,,26.50,N,Y
4990368,MED.INIT.ECG-INTER&REP ON,DNU,A,990,G0368,,,,,13.50,N,Y
4990375,RABIES IMMUNE GLOBLIN PER,DNU,A,990,90375,,,,,"1,766.50",N,Y
4990378,SYNAGIS (PHARMACY),DNU,A,990,90378,,,,,"1,454.90",N,Y
4990416,FINGER / HEEL STICK,DNU,A,990,36416,,,,,4.00,N,Y
4990420,I & D BARTHOLIN'S GLAND,DNU,A,990,56420,,,,,110.00,N,Y
4990425,ANETPARTUM CARE ONLY4-6V,DNU,A,990,59425,,,,,349.50,N,Y
4990426,ANETPARTUM CARE 7 OR MORE,DNU,A,990,59426,,,,,611.50,N,Y
4990430,POSTPARTUM CARE ONLY,DNU,A,990,59430,,,,,190.00,N,Y
4990441,FILGRASTIM (NEUPO) 480MCG,DNU,A,990,J1441,,,,,671.50,N,Y
4990442,NEUOPGEN 300 MCG VIAL,DNU,A,990,,,,,,429.50,N,Y
4990449,INFLUENZE A&B RAPID FLU,DNU,A,990,87804,,,,,35.00,N,Y
4990460,ATROPINE UP TO 0.3MG,DNU,A,990,J0460,,,,,4.50,N,Y
4990465,IMMUNIZ<8YRS W/COUNSEL 1,DNU,A,990,90465,,,,,16.00,N,Y
4990466,IMMUNIZ<8YRS W/COUNSEL 2+,DNU,A,990,90466,,,,,16.00,N,Y
4990471,INJECTION IMMUNIZATION 1,DNU,A,990,90471,,,,,21.50,N,Y
4990472,INJECTION IMMUNIZATION 2+,DNU,A,990,90472,,,,,13.00,N,Y
4990552,TRIGGER PT INJTO 1/2 MUSC,DNU,A,990,20552,,,,,42.00,N,Y
4990553,TRIGGERPOINT 3+ MUSCLES,DNU,A,990,20553,,,,,100.00,N,Y
4990600,ARTHRO SMALL JOINT,DNU,A,990,20600,,,,,70.50,N,Y
4990605,ARTHRO INTERMED JOINT,DNU,A,990,20605,,,,,77.50,N,Y
4990610,ARTHRO MAJOR JOINT,DNU,A,990,20610,,,,,92.00,N,Y
4990620,FX CARE/ELBOW,DNU,A,990,24620,,,,,500.00,N,Y
4990632,HEPATITIS A ADULT (VAQTA),DNU,A,990,90632,,,,,125.00,N,Y
4990633,VAQTA PEDIATRIC,DNU,A,990,90633,,,,,45.50,N,Y
4990642,EX SKIN LESMA1.1-2.0FEENL,DNU,A,990,11642,,,,,310.50,N,Y
4990649,GARDASIL VACCINE,DNU,A,990,90649,,,,,239.50,N,Y
4990650,DRUG SCREEN COLLECTION,DNU,A,990,,,,,,16.50,N,Y
4990657,INFLUENZA VACCINE 6-35 MO,DNU,A,990,90657,,,,,9.00,N,Y
4990658,INFLUENZA VACCINE 3YR.&UP,DNU,A,990,90658,,,,,25.00,N,Y
4990669,PNEUMO PED (PREVNAR) <5YR,DNU,A,990,90669,,,,,142.50,N,Y
4990675,RABIES VACCINE PER DOSE,DNU,A,990,90375,,,,,301.22,N,Y
4990680,ROTATEQ VICCINE(ROTAVIRUS,DNU,A,990,90680,,,,,138.14,N,Y
4990690,CEFAZOLIN PER 500MG,DNU,A,990,J0690,,,,,3.00,N,Y
4990696,ROCEPHIN PER 250MG,DNU,A,990,J0696,,,,,18.00,N,Y
4990700,DTAP,DNU,A,990,90700,,,,,35.50,N,Y
4990707,MMR,DNU,A,990,90707,,,,,96.00,N,Y
4990710,PRQUAD VACCINE,DNU,A,990,90710,,,,,248.36,N,Y
4990713,POLIO (IPOL),DNU,A,990,90713,,,,,53.00,N,Y
4990716,CHICKEN POX (VARIVAX),DNU,A,990,90716,,,,,166.00,N,Y
4990718,DT ADULT,DNU,A,990,90718,,,,,30.50,N,Y
4990719,TRIMMING NAILS (ANY #),DNU,A,990,11719,,,,,19.50,N,Y
4990723,PEDIARIX (DTAP-HEPB-IVP),DNU,A,990,90723,,,,,79.50,N,Y
4990732,PNEU ADLUT (PNEUM2YRS>,DNU,A,990,90732,,,,,22.50,N,Y
4990734,MENACTRA 4 MCG 0.5ML SDV,DNU,A,990,90734,,,,,139.50,N,Y
4990736,ZOSTAVAX VACCINE,DNU,A,990,,,,,,290.70,N,Y
4990737,HIB VACCINE (ACTHIB),DNU,A,990,90648,,,,,53.00,N,Y
4990744,HEP B PED/ADOLESCENT (REC,DNU,A,990,90744,,,,,21.50,N,Y
4990746,HEP B ADULT (RECOMBIVAX),DNU,A,990,90746,,,,,58.50,N,Y
4990748,COMVAX 0.5ML,DNU,A,990,90748,,,,,54.00,N,Y
4990772,"THERA,PROPH,DIAGINJ SUBCU",DNU,A,990,90772,,,,,25.00,N,Y
4990788,INJECTION ANTIBIOTIC,DNU,A,990,90788,,,,,10.50,N,Y
4990880,ARANESP PER 1MCG,DNU,A,990,J0881,,,,,28.00,N,Y
4990901,CAURTERIZATION OF NOSE,DNU,A,990,30901,,,,,85.00,N,Y
4991000,UA DIP W/MICRO,DNU,A,990,81000,,,,,10.00,N,Y
4991001,DEPO-ESTRADIOL UP TO 5MG,DNU,A,250,J1000,,,,,12.50,N,Y
4991002,UA DIP W/O MICRO,DNU,A,990,81002,,,,,7.50,N,Y
4991025,PREG URINE,DNU,A,990,81025,,,,,19.50,N,Y
4991040,"DEBRIDEMENT, SKIN LESION",DNU,A,990,11040,,,,,54.00,N,Y
4991055,DEPO-PROVERA 150MG,DNU,A,990,J1055,,,,,108.50,N,Y
4991056,CORN REMOVAL,DNU,A,990,11055,,,,,64.00,N,Y
4991070,DEPO-TESTOST PER 100MG,DNU,A,990,J1070,,,,,11.00,N,Y
4991100,BIOPSY-SKIN,DNU,A,990,11100,,,,,92.00,N,Y
4991101,BIOPSY-EACH ADD'L,DNU,A,990,11101,,,,,34.50,N,Y
4991174,EVACUATION OF SUBUNGUAL H,DNU,A,990,11740,,,,,50.50,N,Y
4991200,REMOVAL SKIN TAGS,DNU,A,990,11200,,,,,109.00,N,Y
4991201,DIPHENHYDRAMINE 50MG/ML 1,DNU,A,990,J1200,,,,,3.00,N,Y
4991300,SHAVE OF EPID/DERM LE .5<,DNU,A,990,11300,,,,,79.00,N,Y
4991305,SHAVE OF EPID/DERM 0.5CM<,DNU,A,990,11305,,,,,77.50,N,Y
4991310,SHAVE BIOPSY NOSE 0.3CM,DNU,A,990,11310,,,,,96.00,N,Y
4991400,EX SKIN LES <.5CM TAL,DNU,A,990,11400,,,,,147.00,N,Y
4991401,EX SKIN LES BNO.6-1.0 TAL,DNU,A,990,11401,,,,,170.50,N,Y
4991402,EX SKIN LES 1.1-2.0 TAL,DNU,A,990,11402,,,,,201.00,N,Y
4991403,"EX SKIN LES 2,1-3.0 TAL",DNU,A,990,11403,,,,,218.50,N,Y
4991404,EX SKIN LES 3.1-4.0 TAL,DNU,A,990,11404,,,,,249.00,N,Y
4991406,EX SKIN LES4.0-+CM TAL,DNU,A,990,11406,,,,,336.60,N,Y
4991420,EX SKIN LES <0.5CM SNNFG,DNU,A,990,11420,,,,,144.50,N,Y
4991421,EX SKIN LES0.6-1.0 SNHFG,DNU,A,990,11421,,,,,181.50,N,Y
4991422,EX SKIN LES-BN1.12SNHFG,DNU,A,990,11422,,,,,210.00,N,Y
4991423,EX SKIN LES 2.1-3.0SNHFG,DNU,A,990,11423,,,,,240.00,N,Y
4991424,EX SKIN LES 3.1-4.0OSNHFG,DNU,A,990,11424,,,,,275.50,N,Y
4991426,EX SKIN LES 4.0+CMSNHFG,DNU,A,990,11426,,,,,383.00,N,Y
4991440,EX SKIN LES <.5CM FEENLM,DNU,A,990,11440,,,,,174.50,N,Y
4991441,EX SKIN LES 0.6-1.0 FEENL,DNU,A,990,11441,,,,,201.00,N,Y
4991442,EX SKIN LESION-BN 1.1-2.0,DNU,A,990,11442,,,,,223.00,N,Y
4991443,EX SKIN LES2.1-3.0FEENLM,DNU,A,990,11443,,,,,272.50,N,Y
4991444,EX SKIN LES 3.1-4.0FEENLM,DNU,A,990,11444,,,,,345.00,N,Y
4991446,EX SKIN LESION-BN 4.0 +CM,DNU,A,990,11446,,,,,444.00,N,Y
4991600,EX SKIN LESMA<.5CM TAL,DNU,A,990,11600,,,,,202.50,N,Y
4991601,EX SKIN LESMA0.6-1.0TAL,DNU,A,990,11601,,,,,232.00,N,Y
4991602,EX SKIN LESMA1.1-2.0TAL,DNU,A,990,11602,,,,,249.00,N,Y
4991603,EX SKIN LESMA2.1-3.0TAL,DNU,A,990,11603,,,,,272.50,N,Y
4991604,EX SKIN LESMA3.1-4.0TAL,DNU,A,990,11604,,,,,300.00,N,Y
4991606,EX SKIN LESMA4.0+CMTAL,DNU,A,990,11606,,,,,391.50,N,Y
4991610,GLUCAGON PER 1MG,DNU,A,990,J1610,,,,,156.50,N,Y
4991620,EX SKIN LESMA<.5CM SNHFG,DNU,A,990,11620,,,,,196.50,N,Y
4991621,EX SKIN LESMA0.6-1.0SNHFG,DNU,A,990,11621,,,,,232.00,N,Y
4991622,EX SKIN LESMA 1.1-2.0SNHF,DNU,A,990,11622,,,,,262.00,N,Y
4991623,EX SKIN LESMA2.1-3.0 SNHF,DNU,A,990,11623,,,,,309.50,N,Y
4991624,EX SKIN LESMA3.1-4.0SCHFG,DNU,A,990,11624,,,,,354.00,N,Y
4991626,EX SKIN LESMA 4.+CM SCHF,DNU,A,990,11626,,,,,467.50,N,Y
4991640,EX SKIN LESMA<.5CM FEENL,DNU,A,990,11640,,,,,208.50,N,Y
4991641,EX SKIN LESMA0.6-1.0FEENL,DNU,A,990,11641,,,,,269.00,N,Y
4991643,EX SKIN LESMA2.1-3.0FEENL,DNU,A,990,11643,,,,,358.50,N,Y
4991644,EX SKIN LESMA3.1-4.0FEENL,DNU,A,990,11644,,,,,454.50,N,Y
4991646,EX SKIN LESMA4.0+CMFEENL,DNU,A,990,11646,,,,,610.00,N,Y
4991650,LOVENOX PER 10MG,DNU,A,990,J1650,,,,,11.00,N,Y
4991730,AVULSION OF NAIL,DNU,A,990,11730,,,,,114.00,N,Y
4991750,EXCIS OF NAIL & NAIL MATR,DNU,A,990,11750,,,,,283.50,N,Y
4991820,HUMULIN R PER 5 UNITS,DNU,A,990,J1815,,,,,0.31,N,Y
4991885,KETOROLAC PER 15MG,DNU,A,990,J1885,,,,,7.50,N,Y
4991900,LESION INJECTION UP TO 7,DNU,A,990,11900,,,,,52.50,N,Y
4991940,FUROSEMIDE UP TO 20MG,DNU,A,990,J1940,,,,,2.50,N,Y
4991950,LUPRON PER 3.75MG,DNU,A,990,J1950,,,,,653.50,N,Y
4992001,LACE REP < 2.5CM EXGT&OE,DNU,A,990,12001,,,,,192.00,N,Y
4992002,LACE REP 2.6-7.5 EGT& OE,DNU,A,990,12002,,,,,214.50,N,Y
4992004,LACE REP 7.6-12.5 SNA,DNU,A,990,12004,,,,,240.00,N,Y
4992005,LACER REP 2.6-7.5 SNAEGTR,DNU,A,990,12005,,,,,297.00,N,Y
4992011,LAC FAC/EAR7.6-12.5REENLM,DNU,A,990,12011,,,,,210.00,N,Y
4992013,LACER REP FACE<2.5 REENLM,DNU,A,990,12013,,,,,223.00,N,Y
4992014,LACE EYEL/NOS5.1-7.5REENL,DNU,A,990,12014,,,,,262.00,N,Y
4992015,LAC FAC/EA 7.6-12/5REENLM,DNU,A,990,12015,,,,,332.00,N,Y
4992060,INJECTION INTO MED JOINT,DNU,A,990,20605,,,,,77.50,N,Y
4992175,DEMEROL PER 100MG,DNU,A,990,J2175,,,,,3.00,N,Y
4992270,OCCULT BLOOD SCREEN CARDS,DNU,A,990,G0328,,,,,7.50,N,Y
4992272,OCC BL SC DIGITAL RECTAL,DNU,A,990,G0328,,,,,7.50,N,Y
4992301,NALBUPHINE PER 10MG,DNU,A,990,J2300,,,,,4.00,N,Y
4992360,NORFLEX UP TO 60MG,DNU,A,990,J2360,,,,,43.50,N,Y
4992550,PROMETHAZINE UP TO 50MG,DNU,A,990,J2550,,,,,4.00,N,Y
4992567,TYMPANOMETRY,DNU,A,990,92567,,,,,36.00,N,Y
4992790,RHO GAM,DNU,A,990,J2790,,,,,363.50,N,Y
4992947,GLUCOSE,DNU,A,990,82948,,,,,6.50,N,Y
4993000,EKG,DNU,A,990,93000,,,,,44.00,N,Y
4993005,EKG TRACING ONLY,DNU,A,990,93005,,,,,30.50,N,Y
4993010,EKG INTERPR & REPORT ONLY,DNU,A,990,93010,,,,,18.00,N,Y
4993030,IMITREX 6MG,DNU,A,990,J3030,,,,,105.50,N,Y
4993036,GLYCATED HEMOGLOBIN,DNU,A,990,83036,,,,,28.00,N,Y
4993152,LAC REP C2.6CM/7.5CMFCM,DNU,A,990,13152,,,,,554.50,N,Y
4993225,HOLTER MONITOR,DNU,A,990,93225,,,,,31.00,N,Y
4993270,EVENT MONITOR,DNU,A,990,93270,,,,,26.00,N,Y
4993301,KENALOG PER 10MG,DNU,A,990,J3301,,,,,4.00,N,Y
4993410,HYDROXYZINE UP TO 25MG,DNU,A,990,J3410,,,,,2.00,N,Y
4993420,VITAMIN B-12 1000MCG,DNU,A,990,J3420,,,,,2.50,N,Y
4993930,I&D HEMATOMA/ELBOW,DNU,A,990,23930,,,,,200.00,N,Y
4994010,SPIROMETRY,DNU,A,990,94010,,,,,63.00,N,Y
4994016,PULMONARY FUNCTION INTERP,DNU,A,990,94016,,,,,37.50,N,Y
4994056,DEST.OF LESION(CRYO)PENIS,DNU,A,990,54056,,,,,110.00,N,Y
4994640,INHALATION TREATMENT,DNU,A,990,94640,,,,,18.00,N,Y
4994703,HCG,DNU,A,990,84703,,,,,22.50,N,Y
4995018,HEMOGLOBIN,DNU,A,990,85018,,,,,7.50,N,Y
4995205,FOREIGN BODY REMOVAL EYE,DNU,A,990,65205,,,,,68.50,N,Y
4995610,INR,DNU,A,990,85610,,,,,11.00,N,Y
4996000,BURN CARE INITIAL,DNU,A,990,16000,,,,,92.00,N,Y
4996010,DRAINED ABSCESS FINGER,DNU,A,990,26010,,,,,150.00,N,Y
4996020,BURN DEBR/DRSG