Effective: September 1, 2020 DESCRIPTION NUMBER Price CPT … · 2020. 11. 7. · coaptite...

Effective: September 1, 2020

DESCRIPTION NUMBER Price CPT

Supplies

SUTURE SOFSILK CS-423 1162025 15.50

KUGEL MESH 10 X 13 1600001 4,413.60

KUGEL MESH 5 X 7 1600002 4,401.20

PROTAK 5 MM 1600003 1,125.80

VASCULAR BOOT 1600004 386.30

PUTTY 1648276 12.80

KUGEL MESH 8 X 10 1650000 3,532.90 C1781

MICROLINE CLIP CARTRIDGE 1650001 177.20

5.0 SUTURE ANCHOR 1650002 687.10 C1781

3.5M SUTURE ANCHOR 1650003 687.10

DYONICS TUBING 7205699 1650005 204.00

BIO FASTAK TAP 1650006 1,217.50

CONTIGEN COLLAGEN SKIN TEST 1650007 189.60

BIO FASTAK 3.0 SUTURE ANCHOR 1650008 867.30

TWIST IN CANNULA 1650010 150.40

ACCESS TUBING 15 7205931 1650011 309.00

COMPRESSION STOCKINGS 1650012 69.00 A6530

KNEE ORTHOSIS 1650013 121.00 L1820

CANNULA 8 X 76 014718 1650014 189.60

ORTHOTICS FOOT CUSTOM MOLDED 1650015 344.80 L3030

FAST FIX CURVED NEEDLE 7207877 1650017 989.90

VULCAN 60 DEGREE SUCTION 1650019 677.80

CYSTOSCOPY IRRIGATION SET 1650021 20.60

MERSILENE TAPE RS21 1650022 314.20

ENDOBUTTON CL 7207323 1650023 797.30

QUICKANCHOR SUTURE 212034 1650024 853.90

CONTIGEN COLLAGEN IMPLANT 2.5C 1650028 143.20 L8603

GRAFT HARVESTING KIT 1650035 558.30

ACCESS 15 TUBING 7205931 1650037 293.00

ACROMIOBLASTER 1650039 333.80

EXTREMITY SHEET 29415 1650041 55.70

DRESSING MAXORB II 2X2 1650042 6.20

DRESSING MAXORB II 4X4 1650043 10.30

DISTAL CENTRALIZER 30.01.12 1650051 502.70

SELF CATHETER STERILE 1650066 8.30

SODIUM CHLORIDE IRR 0.9% 250M 1650067 14.50

SODIUM CHL IRRI 0.9% 500M 1650068 28.90 A4217

STERILE WATER FOR IRRI 250ML 1650069 26.80

SODIUM CHL IRR 100ML 1650071 53.60 A4217

FREE NEEDLE AR 7150 1650072 93.80

SODIUM CHLORIDE IRRIG 3000ML 1650074 105.10

STERILE WATER INJECTION 1000ML 1650076 10.30 A4217

GLYCINE IRRI 3000ML 1650077 55.70

SPINAL TRAY 1650080 160.70



T U R Y SET 1650081 36.10

CATHETER SHEATH SWANZ GANZ 1650086 323.50

TRANSFIX INPLANT AR 1351 1650087 619.10

CATHETER TROCAR 16 FR 1650088 66.00

CATHETER 12 FRENCH 1650089 8.30

CATHETER 24 FRENCH 1650090 20.60

ISOSOURCE 1650092 8.30

BASIC BIOPSY TRAY 1650095 247.20

CATHETER PLUG 1650096 5.20

KIT SHOULDER STABLIZATION 1650101 171.00

FIBER WIRE AR 7200 1650105 91.70

TISSUE BUTTON 10MM AR 2240B 1650108 377.00

SUTURE RETRIEVER PASSER 1650109 333.80

WASHERS CANNULATED 6.5MM 1650111 94.80

CYSTO DRAIN BAG 1650116 24.80

JOINT TOE 1650118 1,977.60

LAPROSCOPIC PROCEDURE 1650119 2,334.00

ENDODISSECT CAUTERY 1650121 704.60

SURGIPAD 7 1/2 X 8 1650125 5.20 A6253

SURGIPAD 8 X 10 1650126 5.20 A6253

HERNIA STERILE BALLOON 1650127 599.50

STRUCTURAL BALLOON-HERNIA 10MM 1650128 370.80

RAPE/MALICIOUS ASSULT CRIME KIT 1650130 72.10

HEEL BOOT 1650131 44.30

STOMA IRRIGATION DRAIN 2 1650132 133.90

STOMA BAG 2 3/4 1650133 117.50

STOMA BAG 2 1650134 117.50

STOMA BAG 1 1/2 1650135 117.50

STOMA BAG 1 1650136 117.50

SKIN GEL 1650137 14.50

STAPLER SKIN SINGLE USE 1650141 19.60

HOLLIHESIVE PASTE 1650142 39.20

HOLLIHESIVE 4X4 1650143 11.40

HOLLIHESIVE 8 X 8 1650144 41.20

DRAINAGE POUCH CLAMP 1650145 8.30

UROSTOMY POUCH 1 1/4 1650146 150.40

COMBINATION CONE TUBE IRRI KIT 1650147 98.90

AMNIHOOK 1650148 4.20

ANDERSON TUBE 1650149 56.70

ATHLETIC SUPPORTER SMALL 1650151 30.90

ATHLETIC SUPPORTER MEDIUM 1650152 32.00

ATHLETIC SUPPORTER LARGE 1650153 32.00

URETERAL STENT POLARIS 1650154 418.20

LACTATED RINGER 3000ML 1650155 20.60

COUDE CATHETER STERILE 1650170 11.40



EVACUATED CONTAINER 1000 ML 1650175 36.10

KERLIX 4X4 STERILE 10S 1650178 5.20

TRACH CARE TRAY 1650179 8.30

MANIPULTION INJECTOR 1650182 74.20

FILSHIR CLIPS 1650183 173.10

SKIN STITCH 0.2ML 1650186 61.80

ACE WRAP 6X10 1650187 54.60

ACE WRAP 6" 1650188 14.50 A6450

ACE WRAP 4" 1650189 12.40 A6449

ACE WRAP 3" 1650190 11.40 A6448

ACE WRAP 2" 1650191 10.30 A6448

HERNIA PATCH 1650192 978.50

PORT CATH HUBER PLUS 01-1901 1650193 39.20 A6266

PORT 8MM 1650197 160.70

PORT 12MM 1650199 185.40

ADAPTIC 3 X 3 1650200 3.10

ADAPTIC 3 X 8 1650201 8.30

ADAPTIC 3 X 16 1650202 8.30

SLING SYSTEM SPARC 1650203 1,854.00

TELFA 3 X 4 1650204 2.10

JEJUNOSTOMY KIT 1650209 337.90

BANANNA SUTURE LASSO 1650210 467.70

SORBITOL 3% 1650213 39.20

IN BED AFO BOOT MEDIUM 1650214 152.50

COAPTITE INJECTION 1650216 927.00

VASELINE GAUZE 1/2 X 72 1650225 2.10

VASELINE GAUZE 3 X 18 1650226 2.10


COMPRESSION BOOT 1650229 216.30


WRIST SPLINT LEFT 1650231 72.10 A4570

WRIST SPLINT RIGHT 1650232 72.10 A4570

AIRWAY SIZE 0 1650233 5.20

AIRWAY SIZE 1 1650234 5.20

AIRWAY SIZE 2-80MM 1650235 5.20

AIRWAY SIZE 4-100MM 1650236 5.20

AIRWAY SIZE 3-90MM 1650237 5.20

CATHETER TEXAS SMALL MEDIUM 1650248 5.20

CATHETER TEXAS MEDIUM LARGE 1650249 5.20

ABDOMINAL BINDER UNIVERSAL 1650250 69.10 A4463

ANESTHESIA BREATHING CIRCUIT 1650251 80.40

ARM SLING CHILD 1650253 26.80

ARM SLING SMALL 1650254 26.80

ARM SLING MEDIUM 1650255 26.80 A4565

ARM SLING LARGE 1650256 26.80 A4565



BETADINE GAUZE PAD 3 X 9 1650257 5.20

BLADDER CARE TRAY WO CATHETER 1650258 56.70

CATHETER CARE TRAY 1650261 12.40

COLOPLAST SIZE 1 1650265 32.00

COLOPLAST SIZE 3 1650267 39.20

CATHETER 8FR 3CC 2 WAY 1650268 56.70

CATHETER 10 FRENCH 3CC 2 WAY 1650269 56.70











CATHETER 6 FRENCH SUCTION 1650290 4.20

ANES PEDS BREATHING CIRCUIT 1650293 10.30

CATHETER 8 FRENCH URETHRAL 1650296 5.20




MICROFOAM TAPE 1650302 48.50

EPIDURAL TRAY 1650304 203.00

DRAINBAG W TUBING 1650306 35.10

DISPOZ A BAG DRAINBAG 1650307 12.40

PLATE 3.5MM LC DCP 2 HOLE 1650308 300.80

SLEEVES LARYN 1650309 2.10

ARTHRO FLO TUBING 1650312 193.70

URIMETER 1650313 69.10

TELFA 8 X 6 STERILE 1650315 4.20

THORA DRAIN 3 1650317 269.90

STOMACH TUBE 5 FRENCH 1650322 4.20

STOMACH TUBE 18FR 1650335 4.20

PACKING STRIP IODOFORM 2 X 5 1650344 29.90

PACKING STRIP IDOFORM 1 X 5 1650345 20.60 A6266

PACKING STRIP IODOFORM 1/2 X 5 1650346 18.60 A6266

PACKING STRIP IODOFORM 1/4 X 5 1650347 17.60 A6266

PACKING STRIP 1 X 5 PLAIN 1650349 18.60

COMPRIFOAM BANDAGE 1650350 14.50

DRESSING MEPILEX 1650351 28.90

POLYMEM DRESSING 5X5 1650352 25.80

POLYMEM SACRAL 4.5X4.7 1650353 30.90

THUMBSPICA RT SM/MED 1650354 129.80



THUMBSPICA RT MED/LG 1650355 129.80

THUMBSPICA LT SM/MED 1650356 129.80

THUMBSPICA LT MED/LG 1650357 125.70

SITZ BATH KIT 1650361 16.50

STERI STRIP 1/8 X 3 1650365 4.20

SUTURE STRIP 1 4 X 3 1650366 8.30

I V ARM BOARD 1650371 5.20

SHOULDER IMMOBILIZER UNIVERSAL 1650373 84.50

GROUND IT PAD ADULT 1650374 16.50

GAYMAR PAD SMALL 1650376 45.40

GAYMAR PAD LARGE 1650377 44.30

HEEL AND ELBOW PROTECTOR 1650379 42.30

IRRIGATION TRAY 1650384 25.80

BIOPSY NEEDLE 1650387 86.60

NOZ STOP 1650389 53.60

EGG CRATE MATTRESS 1650392 76.30

LIMB HOLDER 1650395 26.80

KIDNEY STONE FILTER 1650400 5.20

HEMORRHOID SPONGE 1650403 101.00

SPONGE 2X2 1650417 5.20

CATHETER TROCAR 28FR 1650419 66.00

CATHETER EXTERNAL MALE 1650421 28.90

RESOURCE HN 1650423 5.20

STOMA BAG 3 1650432 117.50

ARTERIOGRAM TRAY 1650440 30.90

KNEE IMMOBILIZER 24 1650441 233.00

SULTZER HIP PROSTHESIS 1650442 7,358.40

SMALL GLENOID DWB001 1650449 3,363.00

WOUND DRAIN 7MM X 20 CM PERFOR 1650454 68.00

WOUND DRAIN 7MM X 20CM 3/4 PER 1650455 68.00

CHYSTROGRAM TRAY 1650460 30.90

ATHLETIC SUPPORTER XL 1650461 35.10


COLLAR CUFF SET SM MED 1650467 44.30

TEGADERM 2 3/8 X 2 3/4 1650468 10.30

FOOT ELEVATORS 1650473 75.20 E0191

FEEDING BAG 1650475 45.40

TEGADERM 4 X 10 DRESSING 1650478 14.50

TEGADERM 4 X 4 3/4 1650479 10.30

CONFORM 1 1650481 6.20 A6445

PER Q CATH TRAY 1650489 226.60

LAP CHOLE KIT 1650496 2,807.80

VAC THERAPY 50CM WOUND 1650536 210.20 97605

MEDELA DRESSING LARGE 1650537 173.10 97606

SOUNDS TRAY 1650560 44.30



TRACHEOTOMY TRAY 1650610 121.60

EXCHANGE TUBE 1650651 364.70

COBAN STERILE 1650682 20.60

STOP COCK 1 WAY 1650684 10.30

PATELLAR SUPPORT BRACE 1650685 97.90 99070

90 DEGREE SUTURE LASSO 1650687 566.50

INSTRUMENT CANNULA AR 6550 1650688 150.40

PATELLAR SUPPORTS 1650691 43.30 99070

BACK SUPPORTS 1650692 106.10 99070

DELUX TENNIS ELBOW 1650693 48.50 99070

ANKLE STABILIZERS 1650694 75.20 99070

CHO PAT KNEE STRAP 1650695 84.50 99070

HEEL CUPS 1650696 70.10 E0370

NEOPRENE TENNIS ELBOW STRAP 1650697 44.30 99070

ELASTIC WRIST SUPPORT W TENS 1650698 78.30 99070

ORANGE CANNULA 5.5 7204895 1650740 86.60

HYSTEROSALPINGOGRAM TRAY 1650830 30.90

LAP PACK 1651001 116.40

CUSTOM PACK 1651004 44.30

PERI GYN PACK 1651005 72.10

CYSTO PACK 1651006 61.80

ENDOBUTTON CL 15MM 7209353 1651008 1,048.60

DOUBLE ARM SUTURE 1651009 240.00

MAYO STAND COVER 1651011 36.10

CONFORM 4 1651052 6.20 A6446

CONFORM 6 1651053 7.30 A6447

MULTIPLE CLIP APPLIER 20/20 1651055 406.90

ENDOCLIP II ML 1651056 976.50

STAPLER 35W 1651058 175.10

STAPLER SKIN PREMIUM 12W 1651059 144.20

LINEAR CUTTER 1651061 487.20

STAPLER EEA 31 SURGICAL 1651062 982.70



STAPLER SURGICAL 1651065 982.70

FLUID BLOOD WARMER SET 1651070 85.50

CONFORM 2 1651074 5.20 A6445

PRESSURE TRANSDUCER 1651087 180.30

MCNEALY GLASSMAN VISCERA RETAI 1651090 38.20

CATHETER TRIPLE LUMEN 1651091 487.20

ENDOBUTTON FIXATION 013186 1651099 514.00

IOBAN DRESSING 1651101 5.20

FRAZIER SUCTION INSTRUMENT 1651102 12.40

YANKAUER SUCTION INSTRUMENT 1651103 7.30

CATHETER URETHRAL 6FR SPIRAL 1651129 29.90



CATHETER URETHRAL 14 FR CONE T 1651132 35.10

LEG HOLDER PADS 3757 1651149 121.60

CHOLANGIOGRAPHIC KIT 1651152 146.30

POUCH DRAIN OSTOMY 4 1/3 IN 1651155 28.20

CATH URETERAL WHISTLE TIP 4 FR 1651157 26.80

NEEDLE INTRAOSSEOUS 1651159 48.50

PREMIUM WALKER SMALL 1651201 156.60 L4360

PREMIUM WALKER MED 1651202 156.60 L4360

SYRINGE MANIFIER 1651203 16.50

SUPRAPUBIC URETHRAL SUPPORT SY 1651205 1,761.30

SHEATH INTRODUCER 8 1651237 82.40

EFFUSION BAG 1651239 5.20

MICRO EXTENSION SET 1651281 10.30

LMA LARENGEAL MASK AIRWAY 1651282 28.90

PRISMA MATRIX ULCER DRESSING 1651286 27.30

STERILIZED ELASTIC BANDAGE 2 1651417 11.40



STERLIZED ELASTIC BANDAGE 6 1651420 23.70

STERILIZED COTTON BALLS 1651421 4.20

STERLIZED RUBBER SHODS 1651422 4.20

STERILIZED LEAD SHOTS 1651423 4.20

STERILIZED WIDE TAPE 1651424 4.20

STERILIZED Y CONNECTOR 1651425 4.20

STERILIZED 4 CAST PADDING 1651426 12.40

STERILIZED 6 CAST PADDING 1651427 16.50

STERILIZED 3 SOFT ROLL PADDIN 1651428 12.40

STERILIZED 6 SOFT ROLL PADDIN 1651429 25.80

STERILIZED PENROSE TUBING 1X36 1651430 2.10

MESH PERFIX PLUG MED 1651432 506.80

MESH PLUG LARGE PERFIX BARD 1651433 206.00 C1781

CATHETER STAMELY CYSTO ETER 1651434 105.10

MESH MONOFILAMENT 10X14 1651435 852.90 C1781

CATHETER URETER 3 FR 1651436 29.90

MESH PROCEED 15CM 15CM 1651437 1,174.20 C1781

DILATION CATHETER 1651450 1,426.60

INFLATION DEVICE 1651451 353.30

CALIBRATION CATHETER 1651452 164.80

PERITONEAL DIALYSIS TRAY 1651557 327.60

GASTROSTOMY TUBE 26 FR 1651561 26.80


NASAL TUBE LIGHTED STYLE 1651563 137.00

GALVESTON BRACE SMALL 1651567 228.70

GALVESTON BRACE MEDIUM 1651568 228.70

GALVESTON BRACE LARGE 1651569 227.70



STERILE WATER 500ML 1651584 5.20 A4218

SODIUM CHL IRRI 1000 ML 1651585 53.60 A4217

SODCHL 1500ML 1651586 80.40

DRESSING SURESITE 2.75X2 7/8 1651683 2.40

POUCH DRAIN OSTOMY 4IN 12IN 1651800 4.80

BLOOD SET 1652000 61.80

SUCTION CATH 5FR 1652001 7.30

CATHETER SUCTION 14FR 1652002 7.30

EASY CAP II END TIDAL CO2 DECT 1652003 84.30

CONNECT TUBE 6 1652004 7.30

UNICATH KIT 1652005 14.50

HOT COLD PACK 1652006 10.30

LUMBAR PUNCTURE TRAY ADULT 1652008 56.70

LUMBAR PUNCTURE TRAY PED 1652009 61.80

MASK TRACH 1652010 35.10

NEBULIZER KIT 1652011 20.60

NITRO TUBING 1652012 129.80

PACING PAD QUIKPACE 1652013 236.90

SALEM SUMP 10FR 1652014 11.40

SALEM SUMP 16FR 1652015 11.40

SALEM SUMP 18FR 1652016 11.40

SOD CHL IRR 1000ML BOTTLE 1652017 7.30

SOD CHL IRR 1500ML 1652019 7.30

SPINAL NEEDLE 18G 1.5 1652021 7.30

SPINAL NEEDLE 20G 3.5 1652022 7.30

SPINAL NEEDLE 22G 6 1652023 35.10

SUTURE REMOVAL TRAY 1652024 20.60

THORACENTESIS TRAY 1652025 113.30

URETHERAL CATH TRAY 1652026 19.60

WOUND CLOSURE KIT 1652027 97.90

CRASH CART KIT 1652028 147.30

HUMID KIT 1652029 8.30

IV KIT 1652030 151.50

O2 SENSOR PED 1652031 25.80

MASK ACCUCON 1652032 10.30

MASK AEROSOL ADULT 1652033 4.20

MASK AEROSOL PEDS 1652034 5.20

MASK NON REBREATH 1652035 10.30

MASK NON REBREATH PED 1652036 8.30

MASK O2 PED 1652038 6.20

O2 SENSOR NEO NATAL 1652039 25.80

SURGICEL STERILE DRESS 2X14IN 1652402 385.10

HAND CAST PLASTER 1653000 13.40

FIBERGLASS LONG ARM CAST 1653001 638.60

FIBERGLASS SHORT ARM CAST 1653002 320.40



SHORT ARM CAST PLASTER 1653003 68.00

LONG ARM CAST PLASTER 1653004 79.40

FIBERGLASS LONG LEG CAST 1653005 638.60

FIBERGLASS SHORT LEG CAST 1653006 320.40

LONG LEG CAST PLASTER 1653007 103.00

ORTHOPEDIC FELT 1653008 14.50

FINGER SP 5" 1653009 8.30 Q4049

FINGERCOT SPLINT 1653010 16.50

SHORT LEG CAST PLASTER 1653011 72.10

ALUMINUM SHORT LEG SPLINT MED. 1653012 161.80

CRISS CROSS BACK SUPPORT LARGE 1653013 104.10

CLAVICLE STRAP ADULT 1653014 43.30

LEG SPLINT S SHORT LEG 1653015 167.90

SLING AND SWATHE UNIVERSAL 1653029 53.60

E Z WALK CAST BOOT MEDIUM 1653030 48.50

LEG SPLINT M SHORT LEG 1653031 167.90

UNIVERSAL PELVIC BELT 1653034 164.80

FINGER SPLINT ZIMFOAM 1/2 X 9 1653035 10.30

FINGER SPLINT ZIMFOAM 3/4 X 18 1653036 11.40

FINGER SPLINT ZIMFOAM 1 X 8 1653037 12.40

CUTAWAY ARM ELEVATOR SLING 1653038 76.30

KNEE DRESSING 12 1653039 78.30

SPIDER PLATE 16MM 1653040 245.20

HICKMAN CATHETER 1653041 587.10

SERPENTINE FOAM COLLAR LARGE 1653042 72.10 L0120

SERPENTINE FOAM COLLAR MEDIUM 1653043 72.10 L0120

SERPENTINE FOAM COLLAR SMALL 1653044 72.10 L0120

SHOULDER IOMMOB MALE FEMALE S 1653045 84.50

SHOULDER IMMOB MALE FEMALE ME 1653046 84.50

SHOULDER IMMOB MALE FEMALE LG 1653047 84.50

SHOULDER IMMOB MALE XLG 1653048 82.40

NIGHT SPLINT PLANTER MED 1653049 192.70 L4396

SHOULDER IMMOBILIZER, XLG 1653054 84.50

KNEE IMMOBILIZER EXOFORM 1653055 226.60

KNEE IMMOBILIZER 28 1653057 226.60

KARAYA POWDER 1653058 25.80

PHILADELPHIA COLLAR SMALL 1653063 178.20 L0120

PHILADELPHIA COLLAR MED 1653064 178.20 L0120

PHILADELPHIA COLLAR ADULT 1653065 178.20 L0120

TUNA KIT 1653066 2,781.00

TIBIA FIBULA SPLINT 1653067 178.20

TIBIA FIBULA SPLINT SM CHD 1653068 178.20

CUSHION CAST BOOT XL 1653070 66.00

CUSHION CAST BOOT X SMALL 1653071 66.00

POST OP SHOE LADIES SMALL 1653072 66.00



POST OP SHOE LADIES MEDIUM 1653073 66.00

POST OP SHOE MEN S LARGE 1653074 66.00

FINGER SP 3.5" 1653082 13.40 A4570

FINGER SP 3" 1653083 13.40 Q4049

FOREARM SPLINT CHILD 1653093 43.30

FOREARM SPLINT RIGHT SM GEL 1653094 43.30 A4570

FOREARM SPLINT YOUTH 1653095 43.30

FOREARM SPLINT LEFT LG GEL 1653096 48.50 A4570

FOREARM SPLINT ADULT 1653097 48.50

FOREARM SPLINT RIGHT 1653102 30.90

FOREARM SPLINT LEFT 1653103 30.90

FIBERGLASS HAND CAST 1653105 90.70

FOREARM SPLINT CHILD 1653106 39.20

SHORT LEG SPLINT SMALL 1653109 165.90

LEG SPLINT M FULL LEG 1653110 165.90

SHORT LEG SPLINT LARGE 1653111 165.90

SHORT LEG PLASTER CAST 1653116 119.50

ALUMINUM SHORTLEG SPLINT SMALL 1653123 167.90

TEGADERM 3 7/8 X 5 1/2 1653127 10.30

FECAL BAG STERILE 1653133 20.60

PARIETEX 6 INCH 1653142 648.90

ADAPTOR PLUG 1653150 4.20

ARTERIAL CATH 18G/4 1/4 1653153 48.50

FULL LEG ABDUCTION WEDGE 1653191 153.50

UTENSIL HOLDER 1653192 17.60

LEG SPACER 1653193 91.70

RAISED TOILET SEAT 1653194 85.50

ABDUCTION PILLOW 1653195 228.70

ACL BRACE 1653196 762.20

LONG ARM CAST SPECIAL 1653200 185.40

OSTOMY SYS W FLATING 2 PIECG F 1653205 42.30

OSTOMY SYS W FLANGE 2 PIEC 1653206 18.60

IN TIDAL CO2 1653207 62.90

SIMPLE STRAP HEADGEAR 1653300 124.70

CONVERTIBLE HEADGEAR 1653301 143.20

INFLATION DEVICE 1654023 328.60

LENS HOOD 1654026 75.20

DUO DERM DRESSING 4X4 1654027 14.50

DUO DERM DRESSING 8X8 1654028 78.30

STABILITY THREAD 1654030 26.80

SURGICAL TROCAR 5MM 1654031 366.70

REDUCER CAP 5MM/3MM 1654032 18.60

ENDOPATH TROCAR 10/11MM 1654033 420.30

ENDOLOOP PDS II 1654034 84.50

ENDOSCOPIC CLIP APPLIER 1654035 760.20



SURGICAL SCISSOR 1654037 413.10

SURGICAL TROCAR 5MM 1654038 413.10

HOOK SCISSOR 1654039 413.10

PORT A CATH 1654042 13.40

STAX FINGER SPLINT 1654044 17.60

ASP IRRATOR 1654046 118.50

URETERAL STENT 1654048 517.10

ALLEVYN 3X3 ADHESIVE 1654049 59.80

SUTURE LASSO 90 DEGREES 1654050 566.50

CHOLE LAP PACK 1654054 261.70

L HOOK 1654056 180.30

J HOOK 1654057 180.30

ENDOCLIP L 1654058 976.50

ENDO DISSECT AUTO SUTURE 1654059 420.30

STATAKS SUTURE 2D 1654060 453.20

ENDO SHEARS CAUTERY 1654061 667.50

PRESSPATCH 1654063 16.50

EASY PROBE 1654064 28.90

PICC LINE 1654065 190.60

SUCTION COAGULATOR 1654071 180.30

SUCTION L HOOK 1654072 180.30

FORCEP BIOPSY UROLOGY 1654073 432.60

FORCEPS BIOPSY HOT 1654074 401.70

SNARES POLYPECTOMY HOT 1654075 148.40

VERSAPORT LONG 5-10MM 1654076 640.70

STABILIZING THREAD 10MM 1654077 26.80

STABILIZING THREAD 5MM 1654078 26.80

XEROFORM GAUZE 4X4 1654079 5.20

SURGIPORT 5MM 1654080 980.60

CONVERTER ALL SIZES 1654081 20.60

MINI STATAR SUTURE O 1654082 542.90

FORCEP BIOPSY COLD 1654085 279.20

G TUBE PEG KIT 1654089 925.00

INSUFILTER 1654092 75.20

VERSAPORT 5-10MM 1654094 640.70

VERSAPORT 5-11MM 1654095 636.60

REDUCER SLEEVE 1654096 36.10

TA 30 STAPLER 1654097 845.70

CATHETER OPT BALLOON DILATION 1654105 1,836.50

DRESSING HEEL ELBOW STERILE 1654110 24.80

MITAK QUICK ANCHOR 1654111 853.90

SKIN SLEEVE ADULT 1654112 46.40

SURGIPORT 10.5 PREMIUM 1654115 438.80

SURGIPATCH 10.5 PREMIUM 1654116 38.20

ENDOCATCH GOLD 1654117 663.40



BENZOIN TINCTURE 1654119 5.20

PROTEKT GLOVE 1654121 113.30

NASAL PACKING 1654122 55.70

DOUBLE J URETERAL STENT 1654138 611.90

ENDO CLIP 5MM CLIP APPLIER 1654140 693.20

VERSAPORT 5-12MM 1654141 632.50

FORCEP GRASPING URETEROSCOPIC 1654142 488.30

STONE EXTRACTOR HELICAL 1654143 412.00

DOUBLE TROCAR 292.56-292.58 1654152 43.30

PREMIUM PASTE 1654153 30.90

OSTOMY BARRIER WITH FLANGE 1654154 91.70

STOMA POUCH 18133 1654155 25.80

SKIN CLEANSER 1654156 16.50

SKIN GEL WIPES 1654157 28.90

SKIN CONDITIONING CREME 1654158 14.50

SAGGITAL SAW BLADE 7205807 1654159 91.70

THREADED WASHER 1654162 570.70

RIB BELT MALE 6 1654165 29.90 L0220

HOSE KNEE SMALL 1654166 26.80

HOSE THIGH SMALL 1654167 50.50

ABDOMINAL BINDER 46-62 M/F 1654170 67.00 A4463

GROUNDIT PAD INFANT 1654175 11.40

ELASTOPLAST 3 1654176 23.70

GAUZE SPONGE 4X4 STERILE 2 S 1654177 5.20

STERILE WATER 100ML 1654178 4.20 A4216

SODIUM CHLORIDE FOR IRR 110ML 1654179 8.30

LOOP OSTOMY POUCH PK/10 1654182 148.40

LOOP OSTOMY GASKET 1654183 36.10

LOOP OSTOMY STARTER KIT 4 1654184 130.90

MICRO SHIELD 1654185 18.60

OSTOMY BELT 1654186 26.80

AERO CHAMBER 1654187 56.70

AIR WALKER 1654188 302.90

AIR SPLINT 1654190 66.00

ANGIOCATH 10G X 3 1654191 85.50

BONANNO CATHETER 1654193 235.90

AIR MATTRESS/PUMP 1654194 138.10 E0181

ICE BAG THROAT 1654195 5.20

ANKLE BRACE AIRCAST 1654196 123.60

TOAD SPLINT SMALL 1654198 16.50 A4570

TOAD SPLINT MEDIUM 1654199 16.50 A4570

TOAD SPLINT LARGE BASEBALL 1654203 20.60 A4570

DISPOSABLE EMERGENCY TRACH TRA 1654215 222.50

BAIR HUGGER BLANKET 1654217 24.80

HEMOVAC 100ML MINI KIT 1654221 130.90



KERLIX ROLL 4 X 5YDS 1654222 10.30

POCKET PK FLOWMETER 1654224 57.70

OSTOMY POUCH 4614 1654227 122.60

REPLICARE WOUND DRESSING 1654228 39.20

CRYOTHERAPY UNIT SHOULDER 1654229 502.70

CRYOTHERAPY UNIT 2750HD 1654230 502.70

KNEE BRACE LONG 137005Y 1654231 579.90

KNEE BRACE LONG 137005Y 1654232 579.90

STERI CATH 1654233 72.10

MESH MALL GORTEX DUAL 1654234 388.40

MESH MEDIUM GORTEX DUAL 1654235 1,963.20 C1781

LARGE GORTEX DUAL MESH 1654236 852.90

SHOULDER IMMOBILIZER SMALL 1654238 205.00

SURGIWAND II W CAUTERY 1654241 562.40

VERES NEEDLE 120MM 1654242 181.30

LIGAMENT STAPLE AR 1011 1654246 476.90

IMPERVIOUS STOCKINETTE 1654247 10.30

PEDI ENDO TUBE HOLDER 1654259 23.70

PHILADELPHIA COLLAR PEDIATRIC 1654260 93.80 L0120

CYCLONE BUR 1654261 254.50

DIA B WOUND GEL 1654262 113.30

FLANGE 2 3/4 14804 1654264 24.80

PESSARY KIT 3 1654265 167.90

SHOULDER IMMOBILIZER MEDIUM 1654268 205.00

SHOULDER IMMOBILIZER LARGE 1654269 205.00

VAR A PULSE WOUND DEBRIDEMENT 1654273 339.90

FLAOPION RING 1654274 224.60

EXTERNAL WRITST FIXATION SYSTE 1654276 2,350.50

MULTI TRAUMA DRESSING 1654278 14.50

LENS FOG REDUCTION 1654279 36.10

A LINE ARM BOARD PEDIACTRIC 1654281 53.60

IRRIGATER 1654282 234.90

INFUSION DRAIN 1654283 566.50

RAE NASAL TUBE 1654284 24.80

AUTO TRANSFUSION DRAIN 1654286 451.20

DISPOSABLE LO PRO WAND 1654306 484.10

STAR SLEEVE 1654308 233.90

DERMA BOND 1654309 136.00

LANCET WITH DEVICE 1654312 29.90

ABSORBABLE HEMOSTAT 1654316 197.80

STYLET LIGHTED 1654317 18.60

ARTHROCARE SYSTEM 1654318 568.60

DISPOSABLE BIOPSY PUNCH 1654320 10.30

PLUG PATCH MESH MEDIUM 1654326 685.00

INJECTION THERAPY NEEDLE 1654337 218.40



MARLEX MESH 10X14 1654338 612.90

OSTOMY SYSTEM 3903 PER BOX 1654344 161.80

OSTOMY SYSTEM W FLANGE 3703 1654345 36.10

COVERSITE DRESSING 1654349 10.30

SACRAL DRESSING 1654350 50.50

ENDO GIA CARTRIDGE SUTURE 1654351 586.10

ENDO BABCOCK 1654352 527.40

ENDO PEANUT 5MM 1654353 98.90

CHRONIC SURGITIE 1654354 147.30

VERSATAK INSTRUMENT 1654355 1,125.80

VERSATAK RELOAD 1654356 252.40

ADAPT PORT 5/10MM 1654357 488.30

EXPANSION CUP INSERT 1654359 1,615.10

EXPANSION CUP 1654360 4,092.20

DRESSING OPSITE 11X17 3/4 1654361 26.80

COVERSITE 6X6 1654362 7.30

OPSITE PLUS 4X4 6X6 1654363 10.30

BLOCK 1654364 987.80

SURGICAL CABLE 03-18 GA 1654365 512.00

SURGICAL CABLE 01-18 GA 1654366 751.90

SOLOSITE GEL 1654368 53.60

SOLOSITE 2X2 4X4 1654369 17.60

MULTIFIRE ENDO GIA 30-2.0 1654370 2,773.80

GORTEX VASCULAR GRAFT 7MMX70CM 1654371 2,840.80

INTRODUCER SINGLE PRESSURE 1654377 93.80

SINGLE FIBRE OPTIC SENSOR 1654379 1,032.10

DUAL FIBRE OPTIC SENSOR 1654380 2,455.60

GORE TEX VASCULAR GRAFT 7MMX50 1654384 2,238.20

DAKINS 0.25% TOPICAL SOLUTION 1654386 10.30

VESSEL LOOPS 1654388 42.30

DRAINAGE KIT PLEURX 1654390 230.80

DRAINAGE COLLECTOR J P DRAIN 1654391 73.20

SKIN BARRIER 14203 1654392 10.30

XLG LEFT GEL WRIST 1654394 119.50 A4570

XSM LT GEL WRIST SP 1654395 119.50

IMPLANTED PORT MRI BARD PORT 1654399 2,539.00

ACE WRAP 4 STERILE 1654400 12.40

ACTICOAT 4 X 4 1654401 56.70

ACTICOAT 7 4 X 5 1654402 135.00

PRIMAPORE 2 X 3 1654412 10.30

POLYMEM 1X3 1654415 6.20

TWO PIECE OSTOMY SYSTEM 1655245 140.10

DISPOSABLE CAITUY CORD 1655246 24.80

DISPOSABLE CLIPPER BLADE 1655247 12.40

CABLE & CRIMP STAINLESS STEEL 1655413 350.20



HERNIA PATCH SM OVAL 8CM 12CM 1655416 1,536.80

PICC SO LO 4FR 1655417 504.70

PICC SO LO 5FR 1655418 505.80

MICROINTRODUCER MICROEZ 4.5FR 1655419 146.30

MICROINTRODUCER MICROEZ 1655420 146.30

PICC DRESSING TRAY 1655421 41.20

POWER MIDLINE 4F SL 1655422 489.30

EXUDERM DRESSING 4X4 1655444 4.22

SMALL FOAM KIT 1656225 66.00

MEDIUM FOAM KIT 1656226 72.10

ADULT/CHILD DEFIBRILLATION ELECTRODES 1656600 60.00

DECUBITUS BED CARE DAILY 1658888 197.80

CRICOTHYROTOMY CATH TRAY 1659094 375.00

CSR MISC 1659999 0.00

ST WTR 1000ML BT 1660000 10.30

IN BED AFO THERABOOT LG 1660001 152.50

WRIST FOREARM SPLINT RT CHILD 1660009 72.10

WRIST FOREARM SPLINT RT LG 1660010 72.10

WRIST FOREARM SPLINT RT MED 1660011 72.10

WRIST FOREARM SPLINT RT SM 1660012 72.10

WRIST FOREARM SPLINT RT YOUTH 1660013 72.10

CATHETER COUDE 8FR 1660014 56.70












SUTURE STRIP 1/2 1660026 8.30

CATHETER TROCAR 24FR 1660027 66.00





COLLAR CUFF SET MD LG 1660032 44.30

OPSITE 11X11 1660033 14.50

V.A.C. DRESSING MEDIUM 1660034 173.10 97606

BASIC PACK DEROYAL 1660035 44.30

PREMIUM WALKER XSM 1660036 156.60 L4360

PREMIUM WALKER LARGE 1660037 156.60 L4360



PREMIUM WALKER XLG 1660038 156.60 L4360

MESH PLUG X LARGE 1660039 206.00 C1781

GASTROSTOMY TUBE 22 FR 1660040 26.80

GASTROSTOMY TUBE 24FR 1660041 26.80

ENTERAL FEEDING TUBE 1660042 62.90

SUCTION CATH 12 FR 1660043 7.30

SUCTION CATH 8 FR 1660044 7.30

PEDICAPS END TIDAL CO2 DETECT 1660045 84.50

SALEM SUMP 12 FR 1660046 11.40

SALEM SUMP 14FR 1660047 11.40

O2 SENSOR ADULT 1660048 20.60

CLAVICLE STRAP ADULT XL 1660049 43.30

CLAVICLE STRAP CHILD 1660050 43.30

CLAVICLE STRAP MED LG 1660051 43.30

KNEE DRESSING 16 DEROYAL 1660052 226.60

DARCO SHOE CHILD 1660053 66.00

POST OP SHOE MEN S SMALL 1660054 66.00

POST OP SHOE MEN S MEDIUM 1660055 66.00

POST OP SHOE LADIES LARGE 1660056 66.00

POST OP SHOE MEN S XLG 1660057 66.00

MED LEFT GEL WRIST 1660058 43.30 A4570

FOREARM SPLINT LEFT SM GEL 1660059 43.30 A4570

MED RT GEL WRIST 1660060 43.30 A4570

FOREARM SPLINT RIGHT LG GEL 1660061 48.50 A4570

FULL LEG SPLINT SMALL 1660062 165.90

FULL LEG SPLINT LARGE 1660063 165.90

ALLEVYN 5X5 1660064 59.80

XEROFORM 5 X 9 1660065 5.20

SKIN SLEEVE ADULT SMALL 1660066 46.40

ENDO CLINCH 5MM 1660067 693.20

OSTOMY POUCH 1.5 3847 H 1660068 66.00

RIB BELT FEMALE 6 1660069 29.90 L0220

HOSE KNEE LARGE 1660070 26.80

HOSE KNEE MEDIUM 1660071 26.80

HOSE KNEE X LARGE 1660072 26.80

HOSE KNEE XXL 1660073 26.80

HOSE KNEE XXXL 1660074 26.80

HOSE THIGH LARGE 1660075 50.50

HOSE THIGH MEDIUM 1660076 50.50

HOSE THIGH X LARGE 1660077 50.50

HOSE THIGH XXL 1660078 50.50

OSTOMY POUCH 4 3806 1660080 122.60

OSTOMY POUCH 8632 1660081 122.60

PHILADELPHIA COLLAR INFANT 1660082 93.80 L0120

FLANGE 1.5 3727 H 1660083 24.80



PESSARY KIT 1 1660084 167.90

PESSARY KIT 4 1660086 167.90

PESSARY KIT 5 1660087 167.90

PESSARY KIT 6 1660088 167.90

PESSARY KIT 7 1660089 167.90

A LINE ARM BOARD 1660090 53.60

STYLET ENDOTRACH FLEX SLIP 12FR 1660091 18.60

FLANGE BARRIER 3738 1660092 36.10

SKIN BARRIER 7800 1660093 10.30

FOREARM SPLINT RIGHT XLARGE GE 1660094 119.50 A4570

W F SPLINT ADULT RIGHT NO FOAM 1660095 72.10

W F SPLINT ADULT LEFT NO FOAM 1660096 72.10

WRIST FOREARM SPLINT LT SMALL 1660097 72.10

WRIST FOREARM SPLINT LT MED 1660098 72.10

WRIST FOREARM SPLINT LT LG 1660099 72.10

WRIST FOREARM SPLINT LT CHILD 1660100 72.10

WRIST FOREARM SPLINT LT YOUTH 1660101 72.10

D5W 250ML 1660102 23.00

LACTATED RINGERS IRR 3000ML 1660103 23.70

D5W 500ML 1660104 23.00

D5W 100ML 1660105 23.70

D5 LACTATED RINGERS 500ML BRAU 1660106 23.70

NORMAL SALINE 50ML 1660107 10.30




CATHETER URETHERAL 12 FR 1660113 1.20

NS 1000ML 1660114 23.70


PACKING STRIP PLAIN 2 X 5 1660116 12.40

PACKING STRIP PLAIN 1 2 X 5 1660117 8.30

BIOPSY NEEDLE 1660118 46.90

D5 1/4 NS 1000ML BRAUN 1660119 23.70

D5 1/2 NS 1000ML 1660120 10.30

D5 NS 1000ML 1660121 23.70

D5 LR 1000ML 1660122 23.70

LACTATED RINGERS 1000ML 1660123 10.30

FEED BAG KANGAROO 1660124 23.70

LUMBOSACRAL SUPPORT LG 1660125 60.00

LUMBOSACRAL 48 1660126 60.00

RIB BELT FEMALE LARGE 1660127 28.90 L0220

RIB BELT MALE LARGE 1660128 20.60 L0220

MASK O2 ADULT 1660129 1.60

1/2 NS 1000ML 1660130 23.70

FRAZIER SUCTION INST. 3312 1660131 30.90



SUTURE PROLENE CT 1 8424H 1660132 17.60

ETHICON SUTURE 3 0 FS2 1660133 20.10

ETHICON SUTURE 0 PROLENE FSLX 1660134 23.20

ETHICON G122H 1660135 23.20

ETHICON G123H 1660136 23.20

ETHICON G121H 1660137 26.80

ETHICON J204G 1660138 14.10

ETHICON J207G 1660139 14.10

ETHICON J315H 1660140 12.10

ETHICON J316H 1660141 11.60

ETHICON J327H 1660142 13.20

ETHICON J338H 1660143 11.70

ETHICON J345H 1660144 12.40

ETHICON J346H 1660145 12.40

ETHICON J341H 1660146 12.10

ETHICON J329H 1660147 12.10

ETHICON J328H 1660148 12.20

ETHICON 663H 1660149 14.50

ETHICON 662H 1660150 12.50

SUTURE PROLENE 3 0 8675H 1660151 18.60

ETHICON R499T 1660152 14.50

SUTURE PROLENE 0 CT 28412 1660153 18.60

ETHICON A185H 1660154 11.40

ETHICON A184H 1660155 11.90

ETHICON A183H 1660156 14.00

ETHICON W31G 1660157 39.20

ETHICON SUTURE OS 4 X519H 1660158 18.30

SUTURE 0 SILK C027D 1660159 62.90

SUTURE 3 0 SILK POPOFF 1660160 62.90

ETHICON C026D 1660161 62.90

ETHICON J416H 1660162 11.40

SUTURE CX21D 1660163 79.40

SUTURE S185 1660164 9.30

SUTURE CS423 1660166 8.30

SUTURE CX41D 1660167 92.70

ARTHRO DRAPE KNEE W POUCH 1660168 0.00

SPOT ENDOSCOPY MARKER 1660169 0.00

SCRUB TRAY 1660170 9.30

IRRIGATION TUBING PK 1660171 20.60

CLEANING BRUSHES 1660172 0.00

INTRODUCER WIRE GUIDE 1660173 0.00

GROSHONG 8FR CATHETHER 1660174 164.80

VIAL O JET 1660175 0.00

CHLORAPREP 1660176 0.00

Y TYPE LARGE BORE IRRIGATION Hospira 1660177 0.00



SONY PRINT UPC 55 1660178 0.00

SKIN SCRIBE 1660179 0.00

LITE GLOVE COVER 1660180 0.00

GOWN SLEEVE 1660181 0.00

ELECTRO SURG TIP CLEANER 2X2 1660182 0.00

OFP FILTER 1660183 0.00

GOWN LARGE STERILE 1660184 0.00

SPORVIEW INDICATORS 1660185 0.00

LENS FOG REDUCTION DEVICE 1660186 0.00

INSUFFLATION TUBING SET 1660187 46.40

GOWN PACK X LARGE 1660188 0.00

MACOSAL ATOMIZATION DEVICE 1660189 0.00

LAPAROTOMY SHEET 1660190 0.00

HALF SHEET 1660191 0.00

THYROID SHEET 1660192 0.00

VENODYNE LEGGING 12 1660193 51.50

LITHOTOMY PACK 1660194 154.50

QUICK COMBO PADS LIFEPAK 12 1660195 77.30

QUIK PACE ELECTRODE 1660196 77.30

BIOPSY PUNCH 5MM 1660197 4.80

BURRETTE SET BRAUN 1660198 10.30

UNNAPAK 4 1660199 14.80

UNNAPAK 3 1660200 14.80

TRACHEOSTOMY TUBE 7 1660201 41.20





STYLET CHILD 1660206 8.00

STYLET PEDIATRIC 1660207 8.00

LARYNGEAL MASK SZ 1.5 1660208 28.90

LARYNGEAL MASK SZ. 2 1660209 28.90

LARYNGEAL MASK SZ 3 1660210 28.90


MASK TRACH AEROSOL 1660212 3.00

D5W 1000ML 1660213 23.70

D5 1/3 NS 1000ML 1660214 23.70

MICROLINE SCISSOR TIP 1660215 94.80

HYDROSURGE 26880 1660216 77.30

BOVIE CORD 1660217 18.60

ALGINATE DRESSING 4" 1660218 18.60


ALLEVYN 7X7 NONADHESIVE 1660238 20.60

SKIN BARRIER 4 IN 1661460 15.40

FLANGE 4" 3706 1662019 9.30



KNEE 14" IMMOBILIZER 1662020 86.60

ADAPT PORT TAUT 5MM UNIVERSAL 1662021 0.00

OXYMIZER O-224 1662022 77.30 A4615

XSM RT GEL WRIST SP 1662023 119.50 A4570

MESH PERITEX TET1515 1662024 525.30

LUMBO SACRAL XXL 1662027 64.90

CATH TEXAS PED 1662028 3.70

DRESSING SLIT 3" 1662029 10.30

PROTACK 5MM SINGLE USE INSTRUMENT 1662030 0.00

SUTURE Z341H 1662031 55.20

SUTURE Z346H 1662032 58.20

SUTURE Z346H 1662033 54.10

V.A.C. DRSG SMALL 1662034 154.50 97606

ADAPT PORT TAUT 5MM LONG 1662035 102.50

ALLEVYN 8X8 NONADHESIVE 1662036 46.40

DRESSING MEDIHONEY 1662037 13.40

Surgery

OPERATING ROOM PER MIN 20000001 28.70

RECOVERY ROOM 1/2 HOUR 2112000 265.40

RECOVERY ROOM FEE FIRST 30 MIN 2112001 187.20

MAJOR REC RM FEE FIRST 30 MIN 2112002 298.50

RECOVERY RM FEE ADD 15 MIN EAC 2112006 87.70

MAJOR REC RM FEE ADD 15 MINUTE 2112007 99.50

RECOVERY ROOM 1 HOUR 2112010 458.50

RECOVERY ROOM 1 1/2 HOURS 2112020 574.50

RECOVERY ROOM 2 HOURS 2112030 688.20

RECOVERY ROOM 2 1/2 HOURS 2112040 803.10

RECOVERY ROOM 3 HOURS 2112050 919.20

RECOVERY ROOM 3 1/2 HOURS 2112070 1,032.90

RECOVERY ROOM 4 HOURS 2112080 1,147.80

RECOVERY ROOM 5 HOURS 2112085 1,376.40

RECOVERY ROOM 0-4 HOURS 2112999 364.90

ANESTHESIA FIRST 1/2 HOUR 2244000 350.10

ANESTHESIA 15 MIN 2244005 210.10

ANESTHESIA 45 MINUTES 2244008 434.00

ANESTHESIA 1 HOUR 2244010 517.80

ANESTHESIA 15MIN EA 2244015 42.50

ANESTHESIA 1 1/2 HOURS 2244020 870.00

ANESTHESIA 2 HOURS 2244030 560.20









ANESTHESIA 5 1/2 HOURS 2244100 1,050.30

ANESTHESIA 6 HOURS 2244110 1,120.40






CO2 MONITOR 2244201 0.00 94681

PRO FEE CRNA 2244205 0.00

INHALE ETH FOR 2244230 35.10

HELIUM 2244240 6.40

PERI NERV STIM 2244245 3.20

P S C 3 OR OVER 2244250 49.90

NITROSE OXIDE 2244260 6.40

INTUBATION 2244270 27.60

Nursing

ADMINISTRATION FLU 2500008 23.70 G0008

ADMINISTRATION PNEUMO 2500009 23.70 G0009

ANES NONINVASIVE IMAGING OR RADIATION TH 2501922 68.20 1922

INJ ANES AGENT OTH PERIPHERA 2501991 93.60 1991

FINE NEEDLE ASPIRATION WO GUIDANCE 2510021 213.30 10021

DRAIN ABSCESS CYST HEMA SIMP 2510060 469.10 10060

I&D ABSCESS COMPLIC MX 2510061 572.20 10061

I&D PILONIDAL CYST SIMPLE 2510080 441.90 10080

REMOVAL FOREIGN BODY SIMPLE 2510120 340.00 10120

INCISION & DRAINAGE OF HEMATOMA 2510140 568.60 10140

DEBRID SUBCUT TISSUE 2511042 163.50 11042

DEBRID MUS FASCIA 20SQ CM 2511043 414.60 11043

SHAV EPIDERMAL OR DERMAL LESION 2.0CM > 2511303 223.00 11303

EXCISION BENIGN 2511400 241.90 11400

DEBRIDEMENT OF NAILS ANY METHOD 2511720 238.10 11720

REMOVAL NAIL FIRST 2511730 437.10 11730

AVULSION OF NAIL EACH ADDITIONAL 2511732 118.50 11732

EVACUATION OF SUBUNGUAL HEMATOMA 2511740 185.40 11740

PART COMP PERM NAIL REMOVAL 2511750 402.80 11750

INSERTION NON BIODERADABLE DRUG IMPLANT 2511981 437.80 11981

REMOVAL NON BIODERADABLE DRUG IMPLANT 2511982 267.80 11982

REPAIR WOUND SIMPLE 2.5CM LESS 2512001 281.90 12001

REPAIR SIMPLE 2.6CM-7.5CM 2512002 469.10 12002

REPAIR LACERATION 7.6-12.5 CM 2512004 514.10 12004

SIMPLE REPAIR SUPERFICIAL WOUN 2512011 425.20 12011

SIMPLE REPAIR WOUND FACE 2.6/5 2512013 342.40 12013

REPAIR WOUND NK HAND FEET GEN 2512014 533.10 12014

REPAIR SIMPLE 7.6CM TO 12.5CM 2512015 428.80 12015

TREAT SUPERFICIAL WOUND SIMPLE CLOSURE 2512020 412.00 12020



TREAT SUPERFICIAL WOUND SIMPLE PACKING 2512021 355.40 12021

REPAIR INTERMEDIATE 2.6-7.5 2512032 666.90 12032

REPAIR INT WND 7.6cm to 12.5cm 2512034 630.10 12034

LAYR CL NECK FT GENIT 2.5 LESS 2512041 486.90 12041

REP INT NECK HAND FT 2.6 7.5 2512042 355.40 12042

SUTURES FACE COMPL 12.6-20.0CM 2512055 770.00 12055

REP COMPLXSCLP EXTREM 1.1-2.5 2513120 787.70 13120

REPAIR COMPLEX 2.6-7.5CM 2513121 947.60 13121

REP COMPLXSCLP EXTR EA AD 5CM 2513122 277.20 13122

RPR COMPLX FORHD AX FT 1.1-2.5 2513131 912.10 13131

REP COMPLX FORHD AX FT 2.6-7.5 2513132 1,613.30 13132

REP COMPLX FORHD AX FT EA ADD 2513133 470.30 13133

REP COMPLX LIP EXTREM 1.1-2.5 2513151 414.60 13151

INT TRT FIRST DEGREE BURN 2516000 242.90 16000

DEBRIDEMENT WO ANESTH 2516020 222.70 16020

DRESSING DEBRIDEMENT PARTIAL THICKNESS 2516025 319.90 16025

CAST ROOM 2516050 137.50

HOSPITAL ER CRITICAL CARE 1 HR 2516080 933.40 99291

ER CRITICAL CARE ADD 1/2 HOUR 2516085 268.90 99292

I&D SUBACEOUS CYST ABCESS HEMATOMA 2516086 328.20 10160

REM FOREIGN BODY SIMPLE 2516090 340.00 10120

REMOVAL OF FOREIGN COMPLEX 2516091 903.80 10121

SIMPLE CLOSURE SCALP TRUNK EXT 2516092 281.90 12001

REPAIR INT WND 2.5CM OR < 2516093 359.00 12031

SUTURES SCALP TRUNK EXT S 2516094 469.10 12002

SUTURES SCALP TRUNK EXT COMP 2516095 666.90 12032


SUTURES SCALP TRUNK EXT COM 2516097 630.10 12034

SIMP REPR SCALP TRNK 12.6-20 2516098 656.30 12005

SUTURES SCALP TRUNK EXT C 2516099 492.80 12035


SUTURES SCALP TRUNK EXT C 2516101 1,202.30 12037

SUTURES FACE UP TO 2.5CM 2516102 425.20 12011

INTERMEDIATE CLOSURE FACE UP TO 2.5 2516103 340.00 12051

SUTURES FACE SIMPLE 2.6-5.0 CM 2516104 342.40 12013

SUTURES FACE COMPLEX 2.6-5.0CM 2516105 370.80 12052



SUTURES FACE SIMPLE 7.6 TO 12. 2516108 428.80 12015

SUTURES FACE COM 7.6-12.5 CM 2516109 499.90 12054

DISLOCATION REDUCTION OF SHOUL 2516110 589.90 23650

DISLOCATION REDUCTION OF FINGE 2516111 800.80 26770

DISLOCATION REDUCTION OF HIP 2516112 1,588.50 27250

DISLOCATION REDUCTION OF TOE 2516113 483.30 28660

CAST ELBOW TO FINGER SHORT ARM 2516114 231.00 29075



CAST APPLICATION LONG ARM 2516115 273.70 29065

SPLINT LONG ARM 2516116 232.20 29105

SPLINT SHORT ARM 2516117 169.40 29125

SPLINT FINGER 2516118 169.40 29130

CAST APPLICATION LEG WALKING 2516119 368.40 29355

CAST APPLICATION SHORT LEG 2516120 229.80 29405

NASAL PACKING ANTERIOR 2516121 279.60 30901

NASAL PACKING POSTERIOR INTIA 2516123 582.80 30905

ENDOTRACHEAL TUBE INSERTION 2516124 345.90 31500

CENTRAL VEIN CANNULATION 2516126 141.00 36620

BLOOD TRANSFUSION 2516127 458.40 36430

SPLINT LONG LEG THIGH ANKLE TO 2516128 200.20 29505

SPLINT SHORT LEG CALF FOOT 2516130 178.90 29515

BLADDER CATH SIMPLE 2516134 354.20 51702

BLADDER CATH COMPLEX 2516135 348.30 51703

I&D PERINEAL ABSCESS 2516136 382.60 56405

LUMBAR PUNCTURE 2516137 351.80 62270

REMOVAL FOREIGN BODY EAR 2516138 207.30 69200

REMOVAL FOREIGN BODY EYE 2516139 144.60 65205

REMOVAL IMPACTED CERUMEN EAR 2516140 128.00 69210

DIGITAL BLOCK 2516141 216.80 64400

INFUSION THERAPY BY MD 2516143 96.00 90780

REMOVAL FECAL IMPACTION 2516144 478.60 45915

BLADDER SCAN 2516145 92.70 51798

CPR 2516148 816.20 92950

CONVERSION MAJOR ARRHYTHMIA EL 2516149 625.50 92960


APPLIC SHOULDER TO HAND 2516153 273.70 29065

I&D HEMATOMA SEROMA FLUID COLL 2516155 568.60 10140


OUTPATIENT CLINIC 2516200 69.00 99212

OP IV THERAPY CLINIC 2516210 414.60 99215


SUTURES FACE COMPLEX 2518105 370.80 12052

LUMBAR PUNCTURE 2518137 351.80 62270

INCISION OF SOFT TISSUE ABSCES 2520000 296.20

EXPLORATION OF PENETRATE WOUND EXTREMI 2520103 829.20 20103

REMOVE FB MUSCL TEND SIMPLE 2520520 435.90 20520

INJ TNDN SHTH LIG TRIG PT 2520550 202.60 20550

INJECT TENDON SHEATH SINGLE 2520551 199.00 20551

INJ SING MULTI TRIG MUSCLE 1-2 2520552 205.00 20552

ARTHROCENTS ASPIR INJ INTRM JT 2520605 191.90 20605

ARTHROCENTESIS MAJ JOINT BURSA 2520610 228.70 20610

TEMPOROMANDIBULAR DISLOCATE CLOSED TREAT 2521480 236.90 21480

CLAVICULAR FX CLOSED TREATMENT 2523500 296.20 23500



REDUCTION SHOULDER NO ANESTH 2523650 589.90 23650

CLOSED SHOULDER DISLOC ANETH 2523655 387.90 23655

REMOVAL FOREIGN BODY ARM 2524200 339.90 24200

CLO TRT HUMERAL SHFT FX WO MA 2524500 995.00 24500

CLO TRT HUMER CONDYL FX WO MA 2524576 945.30 24576

CLSD TREAT ELBOW DISL WO ANES 2524600 947.60 24600

CLSD TREAT ELBOW DISL W ANES 2524605 1,273.50 24605

CLSD TRT RADIAL HD W MAN CHILD 2524640 206.20 24640

CLO TRT RAD HEAD NECK FX WO MA 2524650 651.50 24650

FX TREAT RADIAL HEAD W MANIP 2524655 781.80 24655

CLO TRT RAD SHAFT FX WO MANI 2525500 616.00 25500

CLO TRT RADIAL SHAFT FX W MANI 2525505 1,293.50 25505

CLSD TX RADIAL ULNAR FX W MAN 2525565 722.60 25565

CLO TRT DIST RAD FX WO MANIP 2525600 1,984.10 25600

CLOSED TREATMENT DISTAL RAD FX W MANIPUL 2525605 1,044.80 25605

CLSD TRT DIS RADULNA DISL W MA 2525675 777.10 25675

DRAINAGE OF FINGER ABSCESS SIM 2526010 651.50 26010

REMOVAL FOREIGN BODY HAND 2526070 790.10 26070

ARTHROTOMY LOOSE FB METACARP 2526075 639.70 26075

REPAIR TENDON FINGER EACH TENDON 2526418 1,079.50 26418

FX TREATMENT REDUC METACARP 2526605 696.50 26605

CLSD TRTMT PHAL FX W MANIPULA 2526725 593.50 26725

DISLOCATION TR IP JT REDUCTION 2526770 800.80 26770

CLSD TRTMNT KNEE WO ANEST 2527550 1,545.00 27550

CLSD TRTMNT PET DISL WO ANEST 2527560 608.90 27560

I&D LEG OR ANKLE DEEP ABSCESSS 2527603 1,007.10 27603

CLO TRT ANKLE FRACT WO MA 2527760 1,076.80 27760

CLO TRT ANKLE FRACT W MA 2527762 1,665.50 27762

CLSD TRMT PROX FIB SHFT FX W M 2527781 819.70 27781

CLO TRT DISTAL FIB FX WO MANIP 2527786 741.50 27786

CLO TRT DISTAL FIB FX W MANIP 2527788 1,111.10 27788

CLOSE TRMT ANKLE FX W MANIP 2527810 1,176.30 27810

CLOSE TREAT ANKLE FX W/MANIPULATION 2527818 648.90 27818

CLOSED TREAT OF ANKLE DISLOCATION W/O AN 2527840 432.60 27840

ANKLE MANIPULATION WITH ANESTHESIA 2527860 489.30 27860

REMOVAL FOREIGN BODY SUBCUT 2528190 445.00 28190

REMOVED FB FOOT DEEP 2528192 905.00 28192

TRT METATARSAL FX WO MANIP EA 2528470 665.70 28470

CLO TRT METATARSAL FX W MANIP 2528475 893.20 28475

CLO TRT FX PHALANX 2528515 177.70 28515

CLOSED TREAT OF METATARSOPHALANGEAL JOIN 2528630 266.60 28630

CAST LONG ARM 2529065 273.70 29065

CAST SHORT ARM 2529075 231.00 29075

APPL CAST HAND LOWER FOREARM 2529085 273.70 29085

CAST APP SHOULDER HAND 2529105 232.20 29105



APPLICATION SHORT ARM SPLINT 2529125 169.40 29125

APPLICATION OF FINGER SPLINT 2529130 169.40 29130

STRAPPING RIBS 2529200 150.50 29200

STRAPPING SHOULDER 2529240 169.40 29240

STRAPPING ELBOW WRIST 2529260 130.30 29260

STRAPPING HAND FINGER 2529280 112.60 29280

CAST BOOT 2529355 368.40 29355

APPLICATION SHORT LEG CAST 2529405 229.80 29405

APPL CAST WALKING AMBULATORY 2529425 159.90 29425

CAST APP ANKLE TOES 2529505 200.20 29505

SPLINT APP SHORT LEG FOOT 2529515 178.90 29515

STRAPPING KNEE 2529530 183.60 29530

STRAPPING ANKLE FOOT ANY AGE 2529540 118.50 29540

STRAPPING TOES 2529550 85.30 29550

STRAPPING UNNA BOOT 2529580 112.20 29580

DENIS BROWNE SPLINT STRAPPING 2529590 92.40 29590

CASTING STRAPPING UNLISTED PRO 2529799 109.00 29799

REMOVAL FB INTRANASAL 2530300 309.20 30300

CAUTERY NASAL HEMORRHAGE SIMPL 2530901 279.60 30901

CONTRL NASAL HEMORR ANT COMPLX 2530903 304.50 30903

CNTRL NASAL HEMMORHAGE POSTE 2530905 582.80 30905

CONTRL NASAL HEMORR POST SUBSQ 2530906 535.40 30906

INTUBATION ENDOTRACHEAL EMER 2531500 345.90 31500

LARYNGOSCOPY INDIRECT SEP PRO 2531505 268.90 31505

LARYNGOSCOPY FIBEROPT DX 2531526 613.60 31526

THORACENTESIS ASPIRATION OF PLEURAL SPAC 2532554 947.60 32554

PLEURAL DRAINAGE CHEST TUBE 2532556 947.60 32556

REPAIR BLOOD VESSEL HAND FINGER 2535207 927.00 35207

INTRO NEEDLE INTRACATH VEIN 2536000 98.40 36000

INJECTION OF SCLEROSING SINGLE VEIN 2536470 207.30 36470

INSRT NON TUNLED CATH 5YRS < 2536555 361.30 36555

INSERTION CENTRAL VENOUS CATHE 2536556 414.60 36556

INST TUNLED CENT CATH WO SUB 2536558 805.50 36558

CENTRAL VENOUS CATH INSERT 5YR OR OLDER 2536569 1,266.90 36569

IV PORT FLUSH DECLOTTING 2536593 519.00 36593

PLACEMENT OF NEEDLE INTRAOSSEOUS INFUSIO 2536680 160.00 36680

REPR LIP FULL THICK VERMILION 2540650 781.80 40650

REP LAC 2.5CM> ANT 2/3 TONGUE 2541250 539.00 41250

DRAIN ABSCESS HEMATOMA DENTOALVEOLAR 2541800 349.50 41800

CTRL NASOPHARYN HEM SIMPLE 2542970 1,054.30 42970

NASO GASTRIC TUBE PLACEMENT 2543752 110.10 43752

CHANGE OF G TUBE 2543760 290.30 43762

UNLISTED PROCEDURE RECTUM 2545999 592.30 45999

INCISION OF THROMBOSED HEMORRHOID EXT 2546083 236.90 46083

EXCISION OF EXT HEMORRHOID TAG 2546230 687.10 46230



INSERT BLADDER CATHETER 2551701 157.60 51701

CATH URETHRA SIMPLE 2551702 354.20 51702


BLADDER SCAN 2551798 92.70 51798

VAG DELIVERY ONLY 2559409 1,681.10 59409

SPINAL PUNCTURE THERAPEUTIC BY NEEDLE 2562272 467.90 62272

INJ ANES PERIPHERAL NERV BRANC 2564450 264.90 64450

REMOVAL FOREIGN BODY 2565205 144.60 65205

REMOVAL FOREIGN BODY CORNEAL W/O SLIT LA 2565220 148.10 65220

DRAINAGE EXTERNAL EAR ABCESS SIMPLE 2569000 325.80 69000

DRAIN EXT AUDIT CANAL ABSCESS 2569020 266.60 69020

REMOVAL FB EAR 2569200 207.30 69200

EAR IRRIGATION 2569210 128.00 69210

IMMUNIZATION ADMINISTRATION 2590471 53.40 90471

ADMIN IMMUNIZATION EACH ADDITIONAL 2590472 33.20 90472

INJECTION RABIES VACCINE 2590675 41.50 90675

TD 7YRS OR OLDER 2590718 77.70 90714

INTRAVENOUS TRANS HYDRA 1 HR 2590760 157.60 96360

INTERVENOUS INFUSION ADD 1 HR 2590761 51.00 96361

THERA OR DIAG INJECT SUB INTRA 2590772 28.50 96372

INTRAVENOUS PUSH SINGLE INITAL 2590774 142.20 96374

INJ EACH ADD PUSH NEW SUBSTANC 2590775 71.10 96375

DIAGNOSTIC INJECTION 2590782 14.30 G0351

INJECTION OF ANTIBIOTIC 2590788 14.30 90772

CPR HEART LUNG RESUSCITATION 2592950 816.20 92950

INTRAVENOUS INFUSION 2592977 154.50 92977

NEBULIZER TREATMENT 2594640 77.00 94640

ALLERGY INJECTION SINGLE 2595115 20.40 95115

ALLERGY INJECTION MULTIPLE 2595117 26.10 95117

IV INFUSION HYDR 31MIN TO 1HR 2596360 157.60 96360

IV INFUSION HYDRATION ADD HR 2596361 51.00 96361

IV INFUSION THERAPY UP TO 1HR 2596365 142.20 96365

IV INFUSION THERAPY ADD 1HR 2596366 47.40 96366

ADD SEQ INFUSION UP TO 1 HR 2596367 83.00 96367

CONCURRENT INFUSION 2596368 55.80 96368

IM SUBCUTANEOUS INJECTION 2596372 28.50 96372

IV PUSH SING OR INT SUB/DRUG 2596374 142.20 96374

EACH ADD IV PUSH NEW DRUG 2596375 71.10 96375

EACH ADD IV SAME DRUG 2596376 59.30 96376

CHEMO ADMINISTRATION 2596401 41.50 96401

IV PORT FLUSH 2596523 123.60 96523

MODERATE SEDATION 5YRS & UP 2599144 114.90 99144

HOSPITAL ER LEVEL I 2599281 106.70 99281

HOSPITAL ER LEVEL II 2599282 143.40 99282

HOSPITAL ER LEVEL III 2599283 241.70 99283



HOSPITAL ER LEVEL IV 2599284 369.60 99284

HOSPITAL ER LEVEL V 2599285 581.60 99285

EVALUATION AND MANAGEMENT 2599354 260.60 99354

BB BLOOD ADMINISTRATION 67851 445.05 36430

ATTENDENCE AT DELIVERY 2599464 169.40 99464

Provider

ANESTHESIA ADDITONAL 15 MIN PROFEE 2600001 75.90

ANESTH EXT MIDDLE INNER EAR 2600120 379.50 00120QZ

ANESTH INTRAORAL PROC INC BIOPS 2600170 379.50 00170QZ

MD RECERTIFICATION HHAPT 2600179 165.70 G0179QB

MD CERTIFICATION HHAPATIENT 2600180 216.30 G0180QB

HOME HEALTH CARE SUPERVISION 2600181 377.00 G0181QB

HOSPICE CARE SUPERVISION 2600182 395.90 G0182QB

ANESTHESIA CYST 2600300 379.50 00300QZ

ANESTHESIA INTEGUMENTARY SYSTEM 2600400 227.70 00400QZ

ANESTH FOR ACCESS TO CENTRAL VE 2600532 303.60 00532QZ

ANESTH PROCEDURES ABDOMINAL WAL 2600700 303.60 00700QZ

ANEST UPPER GASTRO ENDOSCOPIC 2600731 379.50 00731QZ

ANEST HERNIA 2600750 379.50 00750QZ

ANESTHESIA CHOLECYSTECTOMY 2600790 531.30 00790QZ

ANESTH LOWER INTESTINAL ENDOSCO 2600811 379.50 00811QZ

ANESTH LOWER SCREENING ENDOSCOPE 2600812 379.50 00812QZ

ANESTH COMBINED UPPER & LOWER GASTRO 2600813 379.50 00813QZ

ANESTH HERNIA INGUINAL REPAIR 2600830 303.60 00830QZ

ANESTH EXPLORATORY LAPAROTOMY 2600840 455.40 00840QZ

ANORECTAL PROCEDURE 2600902 455.40 00902QZ

ANESTH CIRCUMCISION 2600920 227.70 00920QZ

ANES NERVES MUSCEL TENDONS FIS 2601320 75.90 01320QZ

ANESTH LOWER LEG FOOT ANKLE 2601462 227.70 01462QZ

ANESTH PROC ON NERVES MUSCKES T 2601470 227.70 01470QZ

ANESTH OPEN TREATMENT ANKLE 2601480 227.70 01480QZ

ANESTH HAND FOREARM WRIST NER M 2601810 227.70 01810QZ

ANES NONINVASIVE IMAGING OR RADIATION TH 2601922 72.80 1922

FINE NEEDLE ASPIRATION WO GUIDANCE 2610021 265.70 10021

ACNE SURGERY 2610040 204.30 10040

DRAIN ABSCESS CYST HEMA SIMPLE 2610060 500.90 10060

I&D ABSCESS COMPLIC MX 2610061 572.20 10061


INCISION & REMOVE FOREIGN BODY 2610120 363.10 10120

INCISION & DRAINAGE OF HEMATOMA 2610140 607.20 10140

PUNCTURE ASPIRATION ABSCESS 2610160 357.50 10160

DEBRID SKIN & SUBCUTANEOUS TIS 2611042 249.20 11042

DEBRID MUSCLE FASCIA 20SQ CM 2611043 442.80 11043

PUNCH BIOSPY 2611104 382.80 11104

SHAV EPIDERMAL OR DERMAL 2.0CM > 2611303 474.90 11303



EXCISION BENIGN 2611400 383.80 11400

EXCISION LESION HAND FEET 1.1-2.0 2611622 480.90 11622

DEBRIDEMENT OF NAILS ANY METHOD 1 TO 5 2611720 254.30 11720

REMOVAL NAIL SINGLE 2611730 466.80 11730

AVULSION OF NAIL EACH ADDITIONAL 2611732 145.50 11732

EVACUATION OF SUBUNGUAL HEMATOMA 2611740 302.50 11740

PART COMP PERM NAIL REMOVAL 2611750 430.10 11750

INSERTION NON BIODERADABLE DRUG IMPLANT 2611981 401.50 11981

REMOVAL NON BIODERADABLE DRUG IMPLANT 2611982 286.00 11982

REPAIR WOUND SIMPLE 2.5CM-LESS 2612001 500.90 12001

REPAIR SIMPLE 2.6CM - 7.5CM 2612002 500.90 12002

REPAIR/LACERATION 7.6/12.5CM 2612004 549.00 12004



SIMPLE REPAIR SUPERFICIAL WOUN 2612011 454.10 12011

SIMPLE REPAIR WOUND FACE 2.6/5 2612013 316.30 12013

REPAIR WOUND NK HAND FEET GEN 2612014 569.30 12014

REPAIR SIMPLE 7.6CM TO 12.5CM 2612015 438.00 12015

TREAT SUPERFICIAL WOUND SIMPLE CLOSURE 2612020 506.00 12020

TREAT SUPERFICIAL WOUND SIMPLE PACKING 2612021 437.70 12021

REPAIR INT WND 2.5CM OR < 2612031 517.40 12031

REPAIR INTERMEDIATE 2.6/7.25 2612032 712.20 12032

REPAIR INT WND 7.6cm to 12.5cm 2612034 1,012.70 12034

REPAIR INTER NECK HAND FT 2.6/7.5 2612042 490.80 12042

REPAIR COMPLEX 1.1CM-2.5CM 2613100 779.20 13100

REPAIR COMPLEX 1.1CM TO 2.5CM 2613120 817.20 13120

REPAIR COMPLEX 2.6-7.5CM 2613121 1,012.00 13121

REPAIR EACH AD 5CM OR LESS 2613122 296.00 13122

RPR COMPLX FORHD AX FT 1.1-2.5 2613131 974.10 13131

REP COMPLX FORHD AX FT 2.6-7.5 2613132 847.00 13132

REPAIR COMPLEX LIP1.1CM TO 2.5CM 2613151 695.80 13151

DEBRIDEMENT WO ANESTH 2616020 237.80 16020

DRESSING DEBRIDEMENT PARTIAL THICKNESS 2616025 379.50 16025

REM FOREIGN BODY SIMPLE 2616090 363.10 10120

REMOVAL OF FOREIGN COMPLEX 2616091 965.20 10121

SIMPLE CLOSURE SCALP TRUNK EXT 2616092 500.90 12001

COMPLEX CLOSURE SCALP TRUNK EX 2616093 383.30 12031


SUTURES SCALP TRUNK EXT COMP 2616095 465.50 12032


SUTURES SCALP TRUNK EXT COM 2616097 526.20 12034


SUTURES SCALP TRUNK EXT C 2616099 526.20 12035

SUTURES SCALP TRUNK EXT S 2616100 1,056.30 12007

SUTURES SCALP TRUNK EXT C 2616101 1,284.00 12037



SUTURES FACE UP TO 2.5CM 2616102 342.40 12011






SUTURES FACE SIMPLE 7.6 TO 12. 2616108 457.90 12015

SUTURES FACE COM 7.6-12.5 CM 2616109 533.80 12054

DISLOCATION REDUCTION OF SHOUL 2616110 630.00 23650

DISLOCATION REDUCTION OF FINGE 2616111 855.10 26770

DISLOCATION REDUCTION OF HIP 2616112 1,696.40 27250

DISLOCATION REDUCTION OF TOE 2616113 516.10 28660

NASAL PACKING ANTERIOR 2616121 298.50 30901

NASAL PACKING POSTERIOR INTIA 2616123 308.70 30905


CENTRAL VEIN CANNULATION 2616126 150.50 36620



I&D PERINEAL ABSCESS 2616136 408.60 56405

LUMBAR PUNCTURE 2616137 375.70 62270



REMOVAL IMPACTED CERUMEN EAR 2616140 136.60 69210

DIGITAL BLOCK 2616141 275.00 64400


I&D HEMATOMA SEROMA FLUID COLL 2616155 607.20 10140

OUTPATIENT CLINIC 2616200 25.30

ER PHYSICIAN BRIEF 2618000 79.70 99281

ER PHYSICIAN ROUTINE 2618010 124.00 99282

ER PHYSICIAN I 2618020 226.40 99283

ER PHYSICIAN II 2618030 344.10 99284

ER PHYSICIAN III 2618040 540.20 99285


SUTURES FACE COMPLEX 2618105 395.90 12052


PERIPHERAL VENUS CANNULATION 2618126 139.20 36620


EXCISION HEMORRHOID 2618130 139.20 46320

LUMBAR PUNCTURE 2618137 375.70 62270



REMOVAL IMPACTED CERUMEN 2618140 136.60 69210

DIGITAL BLOCK 2618141 82.20 64400


TRANSPORTATION-ESCIRT IF 2618147 68.30 99082



CARDIOPULMONARY RESUSCITATION 2618148 369.40 92950

CONVERSION MAJOR ARRHYTHMIA 2618149 278.30 92960

EXPLORATION OF PENETRATE WOUND 2620103 1,012.00 20103

REMOVE FB MUSCL TEND SIMPLE 2620520 465.30 20520

INJ SING MULT MUSCLE TRIG <2 2620552 205.00 20552

ARTHROCENTS ASPIR INJ INTRM JT 2620605 234.00 20605

ARTHROCENTESIS MAJ JOINT BURSA 2620610 244.10 20610

TEMPOROMANDIBULAR DISLOCATE CLOSED TREAT 2621480 316.30 21480

CLAVICULAR FX CLOSED TREATMENT 2623500 506.00 23500

REDUCTION SHOULDER NO ANESTH 2623650 554.10 23650

CLOSED SHOULDER DISLOC ANETH 2623655 414.20 23655

REMOVAL FOREIGN BODY ARM 2624200 440.00 24200

CLSD TREAT ELBOW DISL WO ANES 2624600 1,391.50 24600

CLSD TREAT ELBOW DISL W ANES 2624605 1,366.20 24605

CLSD TRT RADIAL HEAD W MAN CHI 2624640 220.10 24640

MANIPULATION WRIST UNDER ANESTHESIA 2625259 1,340.60 25259

CLSD TX RADIAL ULNAR FX W MANI 2625565 771.70 25565

CLOSED TREATMENT DISTAL RAD FX W MANIPUL 2625605 1,859.60 25605

CLSD TRT DIS RADULN DISL W MAN 2625675 829.80 25675

DRAINAGE OF FINGER ABSCESS SIM 2626010 695.80 26010

REMOVAL FOREIGN BODY HAND 2626070 843.80 26070

ARTHROTOMY LOOSE FB METACARPOP 2626075 683.10 26075

REPAIR TENDON FINGER EACH TENDON 2626418 1,430.00 26418

FX TREATMENT REDUC METACARP 2626605 743.80 26605

CLSD TRMT PHAL FX W MANIPULAT 2626725 633.80 26725

DISLOCATION TR IP JT REDUCTION 2626770 855.10 26770

AMPUTATION FINGER THUMB 2626951 1,729.30 26951

CLSD TRTMNT KNEE DISL WO ANEST 2627550 1,707.20 27550

CLSD TRTMNT PET DISL WO ANEST 2627560 650.20 27560

I&D LEG OR ANKLE DEEP ABSCESS 2627603 1,075.50 27603

CLOSE TRMT ANKLE FX W MANIP 2627810 1,256.10 27810

CLOSE TREAT ANKLE FX W/MANIPULATION 2627818 935.00 27818

CLOSED TREAT OF ANKLE DISLOCATION W/O AN 2627840 611.60 27840

ANKLE MANIPULATION WITH ANESTHESIA 2627860 594.00 27860

REMOVAL FOREIGN BODY SUBCUT 2628190 475.20 28190

CLSD TREAT FX PHALANX 2628515 316.30 28515

CLOSED TREAT OF METATARSOPHALANGEAL JOIN 2628630 335.20 28630

APPL CAST HAND LOWER FOREARM 2629085 316.30 29085

CAST APP SHOULDER HAND 2629105 221.40 29105


APP FINGER SPLINT STATIC 2629130 180.90 29130

STRAPPING SHOULDER 2629240 180.90 29240

STRAPPING ELBOW AND WRIST 2629260 151.80 29260


APP SHORT LEG CAST 2629405 245.40 29405



APPL CAST WALKING AMBULATORY 2629425 234.00 29425

CAST APP ANKLE TOES 2629505 177.10 29505

SPLINT APP SHORT LEG FOOT 2629515 183.40 29515

STRAPPING KNEE 2629530 126.50 29530

STRAPPING ANKLE FT 2629540 132.80 29540

DENIS BROWNE SPLINT STRAPPING 2629590 98.60 29590

STRAPPING KNEE 2629799 124.00 29799


CAUTERY NASAL HEMORRHAGE SIMPL 2630901 298.50 30901

INTUBATION ENDOTRACHEAL EMERG 2631500 369.40 31500

TRANSTRACHEAL INTRO OF NEEDLE 2631730 506.00 31730

THORACENTESIS 2632000 509.80 32421

TUBE THORACOSTOMY 2632551 645.20 32551

THORACENTESIS ASPIRATION OF PLEURAL SPAC 2632554 1,524.30 32554

THORACENTESIS ASPIR PLEU SPACE W GUIDE 2632555 1,524.30 32555

PLEURAL DRAINAGE CHEST TUBE 2632556 1,537.00 32556

REPAIR BLOOD VESSEL HAND, FINGER 2635207 1,640.10 35207

INTRO NEEDLE INTRACATH VEIN 2636000 105.00 36000

INJECTION OF SCLEROSING SOLUTION SIN VEI 2636470 316.30 36470

INSERTION CENTRAL VENOUS CATHE 2636556 442.80 36556

INSRT TUNLED INSRT WO SUB 2636558 860.20 36558

CENTRAL VENOUS CATH INSER 2636569 385.00 36569

PLACEMENT OF NEEDLE INTRAOSSEOUS INFUSIO 2636680 196.10 36680

REPAIR LAC 2.5CM> ANT 2/3 TONG 2641250 575.60 41250

DRAIN ABSCESS HEMATOMA DENTOALVEOLAR 2641800 432.60 41800

CTRL NASOPHARYN HEM SIMPLE 2642970 1,125.90 42970

NASO GASTRIC TUBE PLACEMENT 2643752 110.10 43752

CHANGE OF G TUBE 2643760 309.90 43762

NM STRESS TEST READ SINGLE 2645009 219.70 78451

NM STRESS READ MULTI 2645018 259.00 78452

INCISION OF THROMBOSED HEMORRHOID EXT 2646083 346.50 46083

BLADDER SCAN 2651798 99.00 51798

IUD INSERTION 2658300 198.00 58300

IUD REMOVAL 2658301 192.50 58301

VAG DELIVERY ONLY 2659409 1,961.40 59409

SPINAL PUNCTURE THERAPEUTIC BY NEEDLE 2662272 618.60 62272

INJ ANES PERIPHERAL NERVE BRAN 2664450 282.80 64450

REMOVAL FOREIGN BODY 2665205 154.30 65205

REMOVAL FB EYE EXT CORNEA 2665220 158.10 65220

DRAINAGE EXTERNAL EAR ABCESS SIMPLE 2669000 474.40 69000

IMMUNIZATION ADMIN 2690471 25.30 90471

PSYCHIATRIC DIAG EVALUATION 2690791 502.20 90791

PSYCHIATRIC DIAG EVALUATION W MED SERVIC 2690792 512.30 90792

PSYCHOTHERAPY 30 MINUTES 2690832 154.30 90832





FAMILY THERAPY W PT PRESENT 2690846 208.70 90846

PSYCHO PHARM 2690863 150.50 90863

CPR HEART LUNG RESUSCITATION 2692950 846.30 92950

THROMBOLYSIS BY INTRAVENOUS INFUSION 2692977 222.60 92977

EKG INTERPRETATION & REPORT 2693010 31.90 93010

STRESS TEST READING EXERCISE 2693015 218.80 93015

STRESS TEST SUPERVISION 2693016 83.60 93016

STRESS TEST INTERPRETATION AND REPORT 2693017 97.40 93017

STRESS EKG READING 2693018 56.10 93018

ECHO 2D W/OUT DOPPLER 2693306 240.20 93306

ECHO 2D LIMITED 2693308 210.70 93308

DOPPLER ECHO MAPPING 2693325 10.40 93325

MODERATE SEDATION 5YRS & UP 2699144 122.70 99144

MODERATE SEDATION 5Y & UP>01999 FIRST 30 2699149 303.60 99149

MODERATE SEDATION 5YRS UP>01999 EACH 15 2699150 69.60 99150

MODERATE SEDATION 5Y & UP>FIRST 15MIN 2699152 176.00 99152

OV NEW PATIENT LEVEL I 2699201 77.00 99201

OV NEW PATIENT LEVEL II 2699202 126.50 99202

OV NEW PATIENT LEVEL III 2699203 187.00 99203

OV NEW PATIENT LEVEL IV 2699204 280.50 99204

OV NEW PATIENT LEVEL V 2699205 379.50 99205

OV EST PATIENT LEVEL I 2699211 44.30 99211

OV EST PATIENT LEVEL II 2699212 93.50 99212

OV EST PATIENT LEVEL III 2699213 126.50 99213

OV EST PATIENT LEVEL IV 2699214 176.00 99214

OV EST PATIENT LEVEL V 2699215 220.00 99215

OBSERVATION DISCHARGE 2699217 218.80 99217

OBSERVATION LEVEL I 2699218 208.70 99218

OBSERVATION LEVEL II 2699219 349.10 99219

OBSERVATION LEVEL III 2699220 489.60 99220

HV ADMISSION LEVEL I 2699221 210.00 99221

HV ADMISSION LEVEL II 2699222 350.40 99222

HV ADMISSION LEVEL III 2699223 488.30 99223

OBSERVATION VISIT LEVEL 1 2699224 120.20 99224



HV SUBSEQUENT LEVEL I 2699231 105.00 99231

HV SUBSEQUENT LEVEL II 2699232 173.30 99232

HV SUBSEQUENT LEVEL III 2699233 245.40 99233

OBSERVATION CARE 2699234 433.90 99234



HV DISCHARGE 2699238 217.60 99238

HV DISCHARGE 30 OR MORE 2699239 253.00 99239



CONSULT OFFICE BRIEF 2699241 78.40 99241

CONSULT 2699242 146.70 99242

CONSULT 2699243 192.30 99243

CONSULT 2699244 273.20 99244

CONSULT 2699245 352.90 99245

CONSULT 2699251 0.00 99251

CONSULT 2699252 0.00 99252

CONSULT 2699253 0.00 99253

CONSULT 2699254 442.80 99254

CONSULT 2699255 608.50 99255

CONSULTATION FOLLOW UP LEVEL I 2699261 0.00 99261

FU INPT CONSULT 2699262 0.00 99262

PRO FEE ER LEVEL I 2699281 111.30 99281

PRO FEE ER LEVEL II 2699282 153.10 99282

PRO FEE ER LEVEL III 2699283 298.50 99283

PRO FEE ER LEVEL IV 2699284 431.40 99284

PRO FEE ER LEVEL V 2699285 638.80 99285

CRITICAL CARE FIRST HOUR 2699291 967.70 99291

CRITICAL CARE ADDITIONAL 30 2699292 433.90 99292

NCF SWING INTITIAL 2699302 313.70 99305

NCF LEVEL III COMPREHEN 2699303 397.20 99306

NSG HOME VISIT LEVEL IV 2699310 316.30 99310

NCF VISIT LEVEL I 2699311 103.70 99307

NCF VISIT LEVEL II 2699312 159.40 99308

NCF VISIT LEVEL III 2699313 210.00 99309

NURSING HOME DISCHARGE 2699315 169.50 99315

ANNUAL NSG FACILITY ASSESSMENT 2699318 222.60 99318

PERSONAL CARE HOME NEW I 2699321 131.60 99324

PERSONAL CARE HOME NEW II 2699322 189.80 99325

PERSONAL CARE HOME NEW III 2699323 328.90 99326

REST HOME VISIT NEW LEVEL IV 2699327 430.10 99327

REST HOME VISIT NEW LEVEL V 2699328 436.40 99328

PERSONAL CARE HOME EST I 2699331 139.20 99334

PERSONAL CARE HOME EST II 2699332 189.80 99335

PERSONAL CARE HOME EST III 2699333 253.00 99336

REST HOME VISIT EST LEVEL IV 2699337 442.80 99337

HOME VISIT NEW LEVEL IV 2699344 354.20 99344

HOME VISIT NEW LEVEL V 2699345 436.40 99345

HOME VISIT EST LEVEL I 2699347 97.40 99347

HOME VISIT ESTABLISH LEVEL II 2699348 164.50 99348

HOME VISIT EST LEVEL III 2699349 253.00 99349

EVALUATION AND MANAGEMENT 2699354 278.30 99354

PROLONGED EVALUTAION AND MANAGEMENT 2699358 330.00 99358

ATTENDENCE AT DELIVERY 2699464 165.60 99464

ADVANCE CARE PLANNING 2699497 202.40 99497



Laboratory

KETONE BODIES SERUM 30260001 50.10 82010

PAP IG, RFX HPV ASCU 194074 30390019 108.80

ICTOTEST 3001900 0.00 81015

STREP B CULTURE 3021003 131.70 87081

CBC AUTO DIFF & PLAT CT 3021004 52.70 85025

DIFFERENTIAL WBC COUNT 3021005 20.10 85007

EOSINOPHILE COUNT 3021006 10.30 85008

HEMATOCRIT 3021008 16.00 85014

HEMOGLOBIN 3021009 16.00 85018

INDICES 3021010 32.10 85030

PARTIAL THROMBOPLASTIN PTT 3021011 41.20 85730

PLATELET COUNT 3021012 29.80 85049

PROTHROMBIN TIME/ INR 3021013 36.60 85610

RBC ERYTHROCYTE COUNT 3021014 20.60 85041

RETICULOCYTE COUNT 3021015 28.60 85045

ESR SEDIMENTATION RATE 3021016 38.90 85651

PKU AND T4 NEWBORN SCREENING 3021021 37.80 84030

HAPTOGLOBIN 3021022 85.90 83010

HLA B27 3021027 153.40 86812

HEMOGLOBIN CHROMATOGRAPHY 3021028 87.00 83021

MERCURY 3021029 101.80 83825

CA 1-25 3021030 140.80 86304

CA 15-3 3021031 140.80 86300

RENIN PLASMA 3021032 121.30 84244

DRUG SCREEN POST ACCIDENT 3021033 72.10 80307

ROHYPNOL URINE SCREEN W RFX TO CONFIRM 3021034 176.00 80307

ROHYPNOL URINE CONFIRMATION 3021035 100.70 80307

BLOOD COUNT RETICULOCYTE COUNT 3021038 28.60 85045

DATE RAPE PANEL 3021042 945.60

FK506 TACROLIMUS 3021043 185.50 80197

AFP XTRA SERUM 3021044 0.00

AFP XTRA 3021045 144.20 82677

BETA-HCG, QUANT (LAB CORP) 3021046 90.40 84702

PSA FREE & TOTAL 3021047 111.00 84154

ACID FAST SMEAR 3021049 63.60 87206

ANTICARIDOLIPIN IGG/IGM 3021051 0.00

VENIPUNCTURE <3 YEARS OF AGE 3021052 42.40 36406

PRE EMPLOYMENT DRUG SCREEN 3021054 68.04

RANDOM EMPLOYEE DRUG SCREEN 3021055 72.10

OXYCODONE DRUG SCREEN 3021057 69.80 80307

BORDETELLA PERTUSSIS/PARAPERTUSSIS PCR 3021060 686.90 87798

HERPES SIMPLEX VIRAL CULTURE 3021062 29.80 87254

THYROGLOBULIN AB & THYROGLOBULIN IMA-RIA 3021063 143.10 86800

HEPATITIS C GENOTYPING 3021071 649.10 87902



PROSTATE SPECIFIC ANTIGEN SCREENING 3021074 123.60 G0103

PAP IG, RFX HPV ALL PATH DIAGNOSTIC 3021080 108.80 88175

BNP 3021081 286.20 83880

TOPIRAMATE 3021087 156.80 80201

CA 27-29 3021088 104.20 86300

THORAZINE LEVEL 3021089 84.70 80342

HYDROCODONE URINE 3021090 253.00 80361

ANTISCLERODERMA 70 ANTIBODIES 3021117 90.40 86235

GC CHLAMYDIA NAA 3021122 0.00

CANNABINOIDS (THC) CONFIRMATION, URINE 3021123 164.90 G0480

URINE COCAINE 3021124 343.40 80301

URINE BENZODIAZEPINE 3021125 343.40 80301

URINE AMPHETAMINES 3021126 314.80 80301

URINE BARBITURATES 3021127 314.80 80301

URINE PHENCYCLIDINE 3021128 314.80 80301

URINE METHADONE 3021129 91.60 80301

OPIATE 2 CONFIRMATION, URINE 3021130 164.90 80361

OPIATE 4 CONFIRMATION, URINE 3021131 164.90 80361

URINE OXYCODONE 3021132 314.80 80365

SERUM METHADONE 3021133 72.10 80358

MEPERIDINE 3021134 164.90 80365

KLEINFELTERS SYNDROME 3021141 377.80 88230

CHROMOSOME ANALYSIS 15-20 CELL 3021142 404.10 88262

CYTO AND MOLE INTER/REPORT 3021143 229.00 88291

HEPATITIS A PROFILE, IgM AND TOTAL 3021145 0.00

HEPATITIS B/C PROFILE 3021146 0.00

HEPATITIS B CORE AB TOTAL 3021147 74.40 86704

HEPATITIS B CORE AB IgM 3021148 97.30 86705

HEPATITIS Be Ag 3021149 74.40 87350

HEPATITIS Be AB 3021150 80.10 86707

PNEUMOCOCCAL ANTIBODIES 14 SEROTYPE 3021151 0.00

CHROMOGRANIN A 3021152 263.30 86316

H PYLORI IgA 3021153 125.90 86677

H PYLORI IgG 3021154 125.90 86677

H PYLORI IgM 3021155 125.90 86677

IMMUNOGLOBULINS A, E, G, M 3021156 0.00

IMMUNOGLOBULINS A, G, M 3021157 0.00

IMMUNOGLOBULIN G SUBCLASS 1 3021158 114.50 82787




PNEUMOCOCCAL ANTIBODIES 3021162 45.80 86609

CHLAMYDIA NAA 3021163 171.70 87491

GONOCOCCUS NAA 3021164 171.70 87591

FSH/LH 3021165 0.00



HISTAMINE URINE 3021166 337.70 83088

YEAST CULTURE 3021167 68.70 87101

URINE PROTEIN/CREATININE RATIO SPOT 3021168 0.00

UREA AND CREATININE URINE 24 HR 3021169 0.00

HERPES VIRUS 1&2 IGG 3021170 0.00

CHLAMYDIA/GC PHARYNGEAL SWAB 3021171 0.00

CHLAMYDIA/GC RECTAL SWAB 3021172 0.00

CELL COUNT, SYNOVIAL 3021173 76.70 89051

IFE AND PE, SERUM 3021174 0.00

CYSTIC FIBROSIS PROFILE 32 MUTATION DNA 3021175 858.60 81220

RENIN ACTIVITY AND ALDOSTERONE 3021176 0.00

ANTIHISTONE ANTIBODIES 3021177 137.40 86235

TESTOST.BIOAVAILABLE W/O SHBG 3021178 0.00

VITAMIN D 25 HYDROXY D2 + D3 3021179 0.00 82306

CULTURE- AEROBIC AND ANAEROBIC 3021180 0.00

CELL COUNT, SYNOVIAL W/ CRYSTALS 3021181 0.00

CULTURE- AEROBIC, ANAEROBIC, GRAM STAIN 3021182 0.00

UREA NITROGEN URINE RANDOM 3021183 42.40 84540

CARCINOEMBRYONIC ANTIGEN (CEA) (SERIAL) 3021184 137.40 82378

INSULIN FREE AND TOTAL 3021185 0.00

WEST NILE VIRUS ANTIBODIES 3021186 188.90

FUNGAL ANTIBODIES QUANT 3021187 0.00

ASPERGILLUS 3021188 114.50 86606

BLASTOMYCES 3021189 114.50 86612

COCCIDIOIDES 3021190 114.50 86635

HISTOPLASMA 3021191 114.50 86698

AMIKACIN PEAK 3021192 114.50 80150

AMIKACIN PEAK AND TROUGH 3021194 0.00

HIV 1 3021195 60.70 86701

COOMBS' DIRECT 3021196 51.50 86880

VON WILLEBRAND FACTOR ANTIGEN 3021197 269.00 85246

VON WILLEBRAND FACTOR ACTIVITY 3021198 200.30 85245

VON WILLEBRAND FACTOR MULTIMETERS 3021199 229.00 85247

BETA 2 GLYOPROTEIN ANITBODY IgG 3021200 108.80 86146

BETA 2 GLYOPROTEIN ANTIBODY IgM 3021201 108.80 86146

BETA 2 GLYOPROTEIN ANTIBODY IgA 3021202 108.80 86146

BETA 2 GLYOPROTEIN ANTIBODY IgG, IgM 3021203 0.00

BETA 2 GLYOPROTEIN AB IgA, IgG, IgM 3021204 0.00

ACTIVATED PROTEIN C RESISTANCE 3021205 74.40 85307

MTHFR THERMOLABILE VARIANT DNA ANALYSIS 3021206 343.40 81291

PLASMINOGEN ACTIVITY 3021207 183.20 85420

PROTEIN C FUNCTIONAL 3021208 183.20 85303

THROMBOTIC RISK PROFILE CONGENITAL 3021209 0.00

VARICELLA ZOSTER IgG 3021210 79.00 86787

CLOBAZAM 3021211 195.80 80339



DRUG SCREEN SERUM OPIATE 3022050 51.50 80307

MRO CHARGE 3022222 70.40

CELIAC DISEASE AB COMP PROFILE 3022998 0.00

CELIAC DISEASE AB PROFILE W RFLX TO tTG 3022999 286.20 86255

HPV HIGH-RISK RFX 3023000 129.40 87624

ANTI STREPTOLYSIN O ANTIBODIES 3023002 46.90 86063

C REACTIVE PROTEIN SEND-OUT 3023005 51.50 86140

MONO SPOT 3023006 76.70 86790

PREGNANCY TEST URINE 3023007 43.50 81025

RHEUMATIOD ARTHRITIS FACTOR 3023008 37.80 86431

RUBELLA IGG ANTIBODIES 3023011 87.00 86762

PREGNANCY TEST SERUM QUALITATIVE 3023012 50.40 84703

HYDROCODONE SCREEN 3023013 69.80 80307

PREGNANCY TEST SERUM QUANTITATIVE 3023014 101.90 84702

SJOGRENS ANTIBODIES SSA/SSB 3023015 53.20 86235

HEPATITIS A AB, TOTAL 3023017 84.70 86708

HIV 1/2 ABS 3023020 0.00

HEPATITIS B SURFACE AB QUAL 3023021 72.10 86706

HIV ANTIBODY 2 3023022 56.20 86701

IRON 3023025 43.50 83540

CRYOGLOBULIN QUAL W RFX TO QUANT 3023026 20.60 82595

CHLORPROMAZINE 3023028 93.90 80342

ANTINUCLEAR ANTIBODIES ANA 3023029 81.30 86038

FLUINTRA 3023030 149.50 80307

G H B 3023031 180.90 82491

HEPATITIS A AB, IgM 3023032 72.10 86709

HEPATITIS B SURFACE AG SCREEN 3023033 57.20 87340

GLIADIN IgG/IgA PROFILE 3023034 0.00

GLIADIN IGG 3023035 152.30 83516

GLIADIN IGA 3023036 152.30 83516

ENDOMYSIAL IGA 3023037 143.10 86256

METHADONE UA 3023038 37.80 80307

HETEROPHILE ANTIBODY 3023041 40.10 86308

KEPPRA 3023042 114.50 80177

ANTITHROMBIN DEFICIENCY PROFILE 3023043 0.00

RPR W REFLEX QUANT 3023052 17.20 86592

COMPLEMENT C1q QUANT 3023053 121.30 86160

ANA W REFLEX 3023054 32.10 86038

ANTI IGE RECEPTOR ANTIBODY 3023055 137.40 80061

GONORRHEA SERUM 3023061 246.10 86609

DO NOT USE 3023070 240.00 82306

HAFH PHLEBOTOMY CHARGE 3023078 22.90 36415

TROPONIN I 3023100 58.40 84484

QUANT OF LIPOPROTEIN PARTICLE 3023105 85.90 80061

PHLEBOTOMY CHARGE 3023110 13.70 36415



STAT PHLEBOTOMY CHARGE 3023111 21.80 36415

ESTROGEN TOTAL 3023114 146.50 82672

PROGESTERONE 3023115 130.50 84144

LEGIONELLA PNEUMOPHILIA AB 3023117 108.80 86713

ARTERIAL PUNCTURE 3023118 61.80 36600

LEGIONELLA PNEUMOPHILIA DFA 3023119 105.30 87278

MITOCHONDRIAL M2 ANTIBODY 3023122 132.50 83516

MICROALBUMIN URINE 24 HR 3023150 48.10 82043

CARBOXYHEMOGLOBIN 3023202 67.50 82375

ETHOSUXIMIDE 3023203 64.10 80168

BORDETELLA PERTUSSIS IgG & IgM 3023204 0.00

VANILLYLMANDELIC ACID, 24 HR URINE 3023314 74.40 84585

HEPATITIS C QNT, RNA PCR W RFX TO GENOT 3023317 515.20 87522

AMYLASE URINE RANDOM OR 24HR 3024001 43.50 82150

URINALYSIS 3024002 21.80 81003

CREATININE URINE 3024005 34.30 82570

PHOSPHORUS URINE 3024008 34.30 84105

POTASSIUM URINE 3024009 28.60 84133

PROTEIN TOTAL URINE 3024010 25.20 84156

SODIUM URINE 3024011 32.10 84300

URINALYSIS W/MICROSCOPIC 3024015 51.50 81001

BILIRUBIN DIRECT 3024017 25.20 82247

SPECIFIC GRAVITY URINE 3024018 14.90 81005

KETONES QUANT, URINE 3024019 20.10 81005

PH URINE 3024020 17.20 83986

PROTEIN SEMI QUANT URINE 3024021 14.90 81005

GLUCOSE QUALITATIVE URINE 3024022 14.90 81005

NITRITE URINE 3024023 14.90 81005

UROBILINOGEN SEMI QUANT 3024024 14.90 81005

URINE MICROSCOPIC EXAM ONLY 3024025 20.60 81015

OSMOLALITY URINE, RANDOM OR 24HR 3024026 43.50 83935

METANEPHRINES PLASMA FREE 3024027 343.40 83835

CRYSTALS, SYNOVIAL FLUID 3024030 48.10 89060

CITRIC ACID 24 HR U 3024032 187.70 82507

OXALATE QUANT 24 HR U 3024033 257.60 83945

CALCULI URINARY 3024034 72.10 82360

CORTISOL URINARY FREE 24 HR 3024035 114.50 82530

BORDETELLA PERTUSSIS IgG 3024038 174.00 86615

CLONAZEPAM LEVEL 3024039 66.40 80339

BASIC METABOLIC PANEL 3024040 50.40 80048

OXYCODONE CONFIRMATION, URINE 3024041 96.20 80365

COMPREHENSIVE METABOLIC PANEL 3024042 98.50 80053

HEPATIC FUNCTION PANEL 3024043 115.60 80076

LIPID PANEL 3024044 128.20 80061

HERPES SIMP VIRS T I&II IGG 3024048 68.70 86694



HERPES VIRUS 1&2 IGM (INDIRECT) 3024049 0.00

ACETAMINOPHEN 3024050 71.00 80306

RENAL FUNCTION PANEL 3024052 108.80 80069

HEPATITIS PROFILE, ACUTE 3024054 296.50 80074

PAP IG, RFX HPV ALL PATH ROUTINE 3024055 108.80 88175

PAP SMEAR DIAG 1 SLIDES 3024056 81.30 88164

LDL CHOLESTEROL DIRECT 3024058 63.00 83721

EPSTEIN BARR VIRUS EARLY AG ABS IgG 3024059 77.80 86663

EPSTEIN BARR VIRUS VCA ABS IgG 3024060 81.30 86665

EPSTEIN BARR VIRUS VCA IgM 3024061 81.30 86665

INSULIN LIKE GROWTH FACTOR 1 3024063 127.10 84305

ROCKY MOUNTAIN SPOTTED FEVER IGM 3024065 76.70 86757

FLOW CYTOMETRY 16 OR MORE 3024067 131.70 88188

ANTINEUTROPHIL CYTOPLASMIC AB 3024068 143.10 86256

ANTINEUTROPHIL CYTOPLASMIC AB PROFILE 3024069 143.10 83520

INFLUENZA TYPE B FLU 3024073 60.70 87804

PARASITE ID ARTHROPOD 3024074 71.00 87168

EPSTEIN BARR VIRUS NUCLEAR AG ABS IgG 3024075 28.60 86664

ANTIEXTRACTABLE NUCLEAR AG 3024076 68.70 86235

COMPLEMENT C3 3024077 68.70 86160

ANTICARDIOLIPIN IgM 3024078 85.90 86147

MUMPS ANTIBODIES IGG 3024079 68.70 86735

MUMPS ANTIBODIES IGM 3024080 68.70 86735

CYCLIC CITRULLINATED PEPTIDE IGG/IGA 3024081 80.10 86200

INDEPENDENT URINE DRUG SCREEN 3024106 93.90 80307

CYSTINE URINE QUANT 3024107 80.10 82131

WALMART UDS COLLECTION 3024108 16.20

DRUG SCREEN COLLECTION 3024109 49.68 80301

CLOZARIL LEVEL 3024110 144.20 80339

GRAFTON PRE-EMP UDS 3024111 16.20

WV LABORERS LEAD PROGRAM UDS 3024112 15.00

PARKERSBURG MARIETTA UDS 3024113 15.00

ACTIN SMOOTH MUSCLE ANTIBODIES 3024114 77.80 83516

CITY OF GRAFTON UDS 3024115 16.20

MITOCHONDRIAL M2 ANTIBODY 3024116 51.50 83516

DODDRIDGE COUNTY COUNCIL UDS 3024117 16.20

METANEPHRINES FRACTIONATED, 24 HR URINE 3024119 25.20 83835

ARCH COAL TOX PANEL 3024123 384.48 80301

FMC CALCIUM SERUM 3024130 16.10 82310

FMC CBC DIFF AUTO PLAT CT 3024131 11.20 85025

FMC GLUCOSE 3024132 5.70 82947

FMC HEMOGLOBIN 3024133 3.40 85018

FMC HEMATOCRIT 3024134 3.40 85014

FMC PHOSPHORUS SERUM 3024135 6.80 84100

FMC PROTHROMBIN TIME/ INR 3024136 5.70 85610



FMC PARTIAL THROMBOPLASTIN PTT 3024137 5.70 85730

FMC VANCOMYCIN TROUGH 3024138 19.60 80202

FMC PHLEBOTOMY CHARGE 3024139 13.70 36415

CLOMIPRAMINE 3024309 170.60 82492

WALMART BLOOD DRAW 3024440 20.52

ACID FAST SMEAR & CULTURE W RFX 3025002 84.80 87116

ANAEROBIC CULTURE 3025003 64.10 87075

FUNGUS CULTURE 3025006 51.50 87101

AEROBIC CULTURE 3025008 57.20 87070

BLOOD CULTURE 3025009 79.00 87040

QUICK STREP CLINIC 3025010 61.80 87880

STOOL OVA AND PARASITE EXAM 3025012 52.70 87177

GRAM STAIN 3025013 21.80 87205

KOH PREP 3025014 25.20 87220

PINWORM EXAM 3025017 36.60 87172

QUICK STREP LAB 3025019 61.80 87880

STREP A CULTURE 3025020 21.80 87081

CELL COUNT, SEROUS FLUID 3025021 27.50 89051

PROTEIN BODY FLUID 3025023 79.00 84157

GLUCOSE 3025024 26.30 82947

CHLORIDE SPINAL FLUID 3025025 32.10 82438

SEROLOGY BODY FLUID 3025026 28.60 86592

FECAL LEUKOCYTES 3025028 21.80 89055

CULTURE WOUND DRAINAGE 3025031 53.00 87070

GENITAL CULTURE 3025032 72.10 87070

STOOL CULTURE 3025034 79.00 87045

UPPER RESPIRATORY CULTURE 3025036 57.20 87070

URINE CULTURE 3025038 57.20 87086

LOWER RESPIRATORY CULTURE RFX 3025039 65.30 87070

DOXEPIN LEVEL 3025041 105.30 80355

COXSACKIE A VIRUS IGM 3025043 184.30 86658

COXSACKIE A VIRUS IGG 3025044 162.60 86658

LUPUS ANTICOAGULANT W/REFLEX 3025045 0.00

ANTICARDIOLIPIN IGG 3025046 195.80 86147

ANTI DNASE B STREP ANTIBODIES 3025049 79.00 86215

HERPES VIRUS LESIONS CULTURE & TYPING 3025051 108.80 87255

HERPES SIMPLEX VIRUS AG.DFA 3025052 45.80 87300

MYCOPLASMA PNEUMONIAE CULTURE 3025053 85.90 87109

PARATHYROID INTACT 3025101 246.10 83970

C4 3025102 41.20 86161

COMPLEMENT C1 INHIBITOR FUNCTIONAL 3025103 171.70 86161

RSV IN-HOUSE 3025105 72.10 87807

INFLUENZA TYPE A FLU 3025106 60.70 87804

C REACTIVE PROTEIN CARDIAC HIGH SENS 3025111 65.30 86141

INSULIN COPY 3025112 166.00 84305



CERULOPLASMIN 3025119 40.10 82390

ARSENIC SCREENING 3025120 188.90 82175

CADMIUM 3025121 188.90 82300

MERCURY 3025123 188.90 83825

ALBUMIN SERUM 3026004 33.20 82040

ALKALINE PHOSPHATASE 3026005 36.60 84075

AMYLASE 3026006 43.50 82150

BILIRUBIN TOTAL 3026007 25.20 82247

BILIRUBIN TOTAL AND DIRECT 3026008 36.60 82248

ARTERIAL BLOOD GASES 3026009 130.50 82805

GLUCOSE TOLERANCE 1HR NONFASTING 3026010 32.10 82950

UREA NITROGEN SERUM 3026011 26.30 84520

AMIKACIN TROUGH 3026012 101.90 80150

GENTAMICIN TROUGH 3026013 111.00 80170

THEOPHYLLINE 3026015 95.00 80198

CALCIUM 3026016 34.30 82310

CARBAMAZEPINE 3026017 98.50 80156

GLUCOSE EA AFTER 1HR 3026018 26.30 82952

CHLORIDE SERUM 3026020 30.90 82435

CHOLESTEROL TOTAL 3026021 28.60 82465

CREATINE KINASE 3026022 44.60 82550

CKMB 3026023 56.10 82553

CREATININE CLEARANCE 3026024 64.10 82575

CREATININE SERUM 3026025 34.30 82565

DIGOXIN 3026026 90.40 80162

PHENYTOIN 3026027 89.30 80185

ELECTROLYTE PANEL 3026028 37.80 80051

GLUCOSE TOLERANCE 3 HOURS 3026031 87.00 82951

ALKALINE PHOSPHATASE ISOENZYMES 3026032 99.60 84080

ALANINE AMINOTRANSFERASE 3026033 34.30 84460

LACTATE DEHYDROGENASE ISOENZYM 3026035 87.00 83625

LACTATE DEHYDROGENASE S 3026036 41.20 83615

PHENOBARBITAL 3026038 53.80 80184

PHOSPHORUS SERUM 3026039 32.10 84100

PROTEIN TOTAL 3026040 25.20 84155

ASPARTATE AMINOTRANSFERASE 3026041 34.30 84450

CARCINOEMBRYONIC ANTIGEN CEA 3026042 127.10 82378

T3 UPTAKE 3026043 43.50 84479

T4 TOTAL 3026044 46.90 84436

LAMICTAL 3026045 217.50 80175

URIC ACID 3026046 29.80 84550

FREE THYROXINE INDEX 3026047 0.00

ALCOHOL QUANT 3026049 61.80 80306

CO2 3026050 28.60 82374

SODIUM SERUM 3026051 32.10 84295



POTASSIUM 3026052 30.90 84132

TRIGLYCERIDES 3026053 38.90 84478

GLUCOSE FINGER STICK 3026054 21.80 82962

GASTRIC ANALYSIS 3026055 41.30 82930

FERRITIN 3026056 91.60 82728

FOLATE, FOLIC ACID, SERUM 3026057 99.60 82746

FSH SERUM 3026058 124.80 83001

GAMMA GLUTAMYLTRANSFERASE 3026060 49.20 82977

HEMOGLOBIN A1C 3026061 66.40 83036QW

HIGH DENSITY LIPOPROTEIN 3026062 55.00 83718

IRON & TOTAL IRON BINDING CAPACITY 3026063 58.40 83550

LITHIUM SERUM 3026065 44.60 80178

MAGNESIUM SERUM 3026066 44.60 83735

OSMOLALITY SERUM 3026067 43.50 83930

ORGANISM CULTURE SENSITIVITY 3026068 51.50 87186

PROCAINAMIDE 3026069 113.30 80192

THYROID STIMULATING HORMONE 3026071 113.30 84443

VALPROIC ACID 3026072 53.80 80164

VITAMIN B12 3026073 101.90 82607

AUTOIMMUNE CHRONIC URTICARIA 3026078 515.20 86343

THYROID STIMULATING HORMONE CASCADE 3026079 113.30 84443

DRUG ABUSE SCREEN URINE 5 3026080 55.00 80301

DRUG PROFILE URINE 9 DRUGS 3026081 375.50 80307

DRUG SCREEN 12, URINE 3026082 28.60 80307

GENTAMYCIN PEAK 3026083 111.00 80170

VANCOMYCIN PEAK 3026085 53.80 80202

VANCOMYCIN TROUGH 3026086 53.80 80202

CORTISOL 3026089 111.00 82533

IMIPRAMINE 3026090 109.90 80335

TESTOSTERONE TOTAL 3026091 127.10 84403

ANDROSTENEDIONE LC/MS 3026092 196.90 82157

PROTEIN ELECTROPHORESIS W RFX TO IFE 3026093 143.10 84165

CERULOPLASMIN 3026094 66.80 82390

DHEA SULFATE 3026095 150.00 82627

PROTEIN ELECTROPHORESIS U RANDOM 3026096 143.10 84166

PROTEIN ELECTROPHORESIS U 24HR 3026097 143.10 84166

AMITRIPTYLINE 3026098 120.20 80335

CYCLOSPORINE LEVEL 3026100 108.80 80158

FACTOR V ISOLATION 3026101 32.90 83891

FACTOR V LEIDEN MUTATION 3026103 446.50 81241

FACTOR V PROBES 3026105 24.00 83896

EPSTEIN BARR VIRUS ACUTE AB PANEL 3026110 0.00

EPSTEIN BARR IGG 3026111 106.50 86665

CREATINE KINASE CPK 3026112 30.70 82550

CREATINE KINASE ISOENZYMES 3026113 62.50 82552



RHEUMATOID ARTHRITIS PROFILE 3026114 154.50 86200

LYME DISEASE WESTERN BLOT 3026144 90.10 86617

LYME AB IgM EARLY W RFX TO W BLOT 3026145 127.20 86618

ALDOLASE 3026146 66.40 82085

ALDOSTERONE URINE 3026147 274.80 82088

ALPHA FETOPROTEIN 3026148 113.30 82105

AMMONIA SEND-OUT 3026149 145.40 82140

ANTI ADRENAL ABS 3026150 81.30 86255

ANTI CENTROMERE ANTIBODIES 3026151 81.30 86235

ANTI MITOCHONDRIAL SCREEN (DO NOT ORDER) 3026153 81.30 86255

ANTI THYROID ANTIBODIES 3026154 55.00 86280

CAROTENE-BETA 3026155 63.00 82380

DISOPYRAMIDE NORPACE 3026156 61.80 80299

GROWTH HORMONE 3026158 113.30 83003

ANTI MITOCHONDRIAL EACH 3026159 72.10 86256

IMMUNOGLOBULIN E 3026160 111.00 82785

IONIZED CALCIUM 3026161 92.70 82330

LIPASE 3026162 46.90 83690

NORTRIPTYLINE AVENTYL 3026164 53.80 80335

MYCOPLASMA PNEUMONIAE 3026165 98.50 86738

PROLACTIN 3026166 127.10 84146

PRIMIDONE 3026167 112.20 80188

PROSTATE SPECIFIC ANTIGEN 3026168 123.60 84153

CHLAMYDIA NAA 3026169 257.60 87491

SALICYLATES ASPIRIN 3026170 48.10 G0480

TRANSFERRIN 3026171 95.00 84466

TRIMIPRAMINE 3026172 108.80 82491

ALPHA GALACTOSIDASE WBCS 3026173 322.80 82657

AFP TETRA 3026174 223.20 86336

IMMUNOGLOBULIN G 3026175 111.00 82784

IMMUNOGLOBULIN A 3026176 111.00 82784

IMMUNOGLOBULIN M 3026177 111.00 82784

CD4:CD8 RATIO PROFILE 3026179 257.60 86360

FACTOR II, DNA ANALYSIS 3026180 343.40 81240

FACTOR II AMPLIFICATION 3026182 99.60 83898

FACTOR II MUTATION 3026183 99.60 83903

FACTOR II INTERPRETATION 3026184 24.00 83912

COLD AGGLUTININS TITER 3026185 53.80 86157

RBC FOLATE A 3026186 103.00 88014

FOLATE, RBC 3026187 103.00 82747

CHLAMYDIA TRACHOMATIS APT 3026188 168.30 87491

NEISSERIA GONORRHOEAE 3026189 168.30 87591

GONORRHOEAE PROBE 3026192 111.30 87590

GIARDIA LAMBLIA STOOL, EIA 3026193 73.30 87329

ANTI HCV RIBA 3026194 485.40 86804



H PYLORI STOOL ANTIGEN 3026195 142.00 87338

METHYLMALONIC ACID QUANT 3026196 256.40 83921

PROPRANOLOL 3026197 108.80 80299

THYROTROPIN RECEPTOR AB 3026198 85.90 83520

FACTOR II PROBES 3026199 24.00 83896

MTHRF ISOLATION 3026200 24.00 83891

MTHFR AMPLIFICATION 3026201 99.60 83898

MTHFR PROBES 3026202 24.00 83896

MTHFR MUTATION 3026203 100.70 83903

MTHFR INTERPRETATION 3026204 24.00 83912

BORDETELLA PERTUSSIS IgM 3026205 114.50 86615

BORDETELLA PERTUSSIS IgA 3026206 114.50 86615

BORDETELLA PERTUSSIS IgA IgG IgM 3026207 0.00

RUBEOLA IgM ANTIBODIES 3026208 103.00 86765

RUBELLA IgM ANTIBODIES 3026209 114.50 86762

SOLUBLE TRANSFERRIN RECEPTOR 3026210 171.70 84238

IMMUNOGLOBULIN A SUBCLASS 1 3026211 51.50 83883

IMMUNOGLOBULIN A SUBCLASS 2 3026212 51.50 83883

FREE KAPPA AND LAMBDA LIGHT CHAINS QUANT 3026213 0.00

INTERLEUKIN 28B POLYMORPHISM 3026214 412.10 81479

CORTISOL PM 3026215 98.50 82533

CORTISOL AM AND PM 3026216 0.00

CORTISOL 2 SPECIMENS 3026217 0.00







CORTISOL FREE SERUM W ENDOCRINE SPEC 3026224 212.90

CORTICOSTEROID BINDING GLOBULIN 3026225 103.00 84449

CORTISOL ACTH SIMULATION 3026226 219.80

FECAL FAT QUALITATIVE 3026227 97.30 82705

PRENATAL PROFILE I 3026228 400.70 80055

THROMBOTIC RISK PROFILE ACQUIRED COMPREH 3026229 1,774.40 86849

THROMBOTIC RISK PROFILE CHARGE ONLY 3026230 0.00 86849

HEPATITIS C AB W RFX TO RNA QUAL NAA 3026232 114.50 86803

ANA W REFLEX TO MULTIPLE 3026233 91.60 86038

QUANTIFERON TB GOLD IN TUBE 3026234 229.00 86480

ALPHA 1 ANTITRYPSIN DEFICENCY, DNA 3026235 343.40 81332

PROTEIN S FUNCTIONAL 3026236 211.80 85306

PROTEIN ELECTROPHORESIS & INTERPRETATION 3026238 91.60 84165

TOBRAMYCIN PEAK 3026239 91.60 80200

TOBRAMYCIN PEAK & TROUGH 3026240 0.00

ALPHA 1 ANTITRYPSIN PHENOTYPING 3026241 223.20 82104



GLUCOSE CSF 3026242 63.00 82945

TISSUE TRANSGLUTAMINASE tTG IGA 3026243 137.40 83516

pH BODY FLUID 3026244 57.20 83986

T4 FREE DIRECT LAB CORP 3026245 97.30 84439

PAP ACOG W STD 193025 3026246 97.30 88175

HPV HIGH RISK DNA, NAA 3026248 211.80 87624

CHLAMYDIA CHARGE ONLY 3026249 137.40 87491

GONOCOCCUS CHARGE ONLY 3026250 0.00 87591

NU SWAB VAGINITIS PLUS VG+ 3026251 1,030.30

PARVOVIRUS B19 DNA PCR 3026252 572.40 87798

PARVOVIRUS B19 (CHARGE ONLY) 3026253 0.00 87798

NU SWAB CHARGE ONLY 3026254 0.00 87481

HERPES VIRUS 1&2 IGM (EIA) 3026255 103.00 86694

CRYPTOSPORIDIUM STOOL EIA 3026256 166.00 87328

GIARDIA & CRYPTOSPORIDIUM STOOL EIA 3026257 0.00

RESPIRATORY VIRUS PANEL PCR 3026258 686.90 87633

LYME AB IgG/IgM TOTAL W RFX TO W BLOT 3026259 127.20 86618

ASPERGILLUS ABS QUANT DID 3026260 274.80

ASPERGILLUS FLAVUS ANITBODIES IGG 3026261 88.10 86606

ASPERGILLUS FUMIGATUS ANITBODIES IGG 3026262 88.10 86606

ASPERGILLUS NIGER ANTIBODIES IGG 3026263 88.10 86606

ASPERGILLUS GLAUCUS ANTIBODIES IGG 3026264 88.10 86606

ASPERGILLUS NIDULANS ANTIBODIES IGG 3026265 88.10 86606

CHAIN OF CUSTODY UDS COLLECTION 3026266 16.20 99000

BK VIRUS QUANT BLOOD DNA PCR 3026267 515.20 87799

ANTICARDIOLIPIN ABS IgA 3026268 97.30 86147

ANTICARDIOLIPIN ABS IgA IgG IgM 3026269 0.00

GASTROCCULT 3026270 76.70 82271

COBALT PLASMA 3026271 171.70 83018

CHROMIUM PLASMA 3026272 143.10 82495

COBALT AND CHROMIUM, WHOLE BLOOD 3026273 0.00

DEXAMETHASONE SERUM 3026274 114.50 82542

VZV REAL TIME PCR 3026275 486.50 87798

HERPES VIRUS 1&2 PCR 3026276 0.00 87529

HERPES & VARICELLA ZOSTER LESIONS, PCR 3026277 0.00

NICOTINE AND METABOLITE QUANT 3026278 103.00 80323

QUALITY HYDRAULICS TOX PANEL 3026279 171.70

QH DRUG SCREEN CONFIRMATION 3026280 51.50

TRIIODOTHYRONINE T3 3026281 103.00 84480

HSV 1 PCR 3026282 200.30 87529

HSV 2 PCR 3026283 200.30 87529

PAP IG, CT-NG RFX HPV 3026284 0.00

HEPATITIS B SURFACE AB QUANT 3026285 85.90 86317

PROTEIN S PANEL 3026286 0.00

PROTEIN S TOTAL 3026287 229.00 85305



THROMBIN TIME 3026288 85.90 85670

FIBRINOGEN ANTIGEN 3026289 200.30 85385

FIBRINOGEN ACTIVITY 3026290 85.90 85384

MYOGLOBLIN URINE 3026291 114.50 83874

ISOHEMAGGLUTININ 3026292 114.50 86940

TETANUS/DIPHTHERIA Ab 3026293 0.00

TETANUS ANTITOXOID Ab 3026294 114.50 86317

DIPTHERIA ANTITOXOID Ab 3026295 114.50 86317

T AND B LYMPH/NK CELL PROFILE 3026296 0.00

NK CELLS TOTAL 3026297 171.70 86357

B CELLS TOTAL 3026298 171.70 86355

BATH SALTS URINE SCREEN 3026300 171.70 80371

FACTOR V LEIDEN RFLX TO R2 3026301 257.60 81241

HYPERSENSITIVITY PNEUMONITIS PROFILE 3026302 0.00

PIGEON SERUM Abs IgG 3026303 57.20 86331

THERMOACTINOMYCES SACCHARII Abs IgG 3026304 108.80 86602

AUREOBASIDIUM PULLULANS ABS IgG 3026305 108.80 86671

THERMOACTINOMYCES VULGARIS Abs IgG 3026306 64.10 86602

MICROPOLYSPORA FAENI Abs IgG 3026307 108.80 86602

VENOUS BLOOD PH 3026308 71.00 82800

ARTERIAL BLOOD PH 3026309 71.00 82800

PROTEIN S AG FREE & TOTAL 3026310 0.00

CREATINE URINE 3026311 33.20 82540

ALLERGEN PROFILE NUTS 3026312 0.00

PEANUT IgE 3026313 42.40 86003

HAZELNUT (FILBERT) NUT IgE 3026314 42.40 86003

BRAZIL NUT IgE 3026315 42.40 86003

ALMOND IgE 3026316 42.40 86003

PECAN IgE 3026317 42.40 86003

CASHEW IgE 3026318 42.40 86003

WALNUT IgE 3026319 42.40 86003

IFE AND PE, RANDOM URINE 3026320 171.70 86335

OVA AND PARASITE SMEAR 3026321 0.00 87209

CMV QUANT DNA PCR 3026322 457.90 87497

BILIRUBIN NEONATAL 3026323 25.20 82247

HEPATITIS B VIRUS PROFILE VI 3026324 0.00

HBV SURF AB QUAL 3026325 85.90 86706

ANTIFUNGAL SUSCEP 8 DRUGS 3026326 1,668.00 87186

PAP LB 192005 3026327 91.60 88142

TESTOSTERONE TOTAL LC/MS 3026328 194.60 84403

JAK2 MUTATION ANALYSIS QUAL 3026329 515.20 81270

LYME ABS TOTAL & IgM W RFX TO W BLOT 3026330 127.20 86618

C6 B BURGDORFERI W RFX TO WESTERN BLOT 3026331 229.00 86618

FIBRIN MONOMER QUAL 3026332 135.10 85362

FDP PLASMA 3026333 114.50 85362



PROTOPORPHYRIN FEP/ZPP 3026334 97.30 84202

CALCIUM/CREATININE RATIO URINE 3026335 0.00

SODIUM URINE 24HR 3026336 32.10 84300

RETICULIN AB IGA 3026337 125.90 86255

CMV Ab IgG 3026338 114.50 86644

CMV Ab IgM 3026339 114.50 86645

CREATININE URINE 24HR 3026340 45.80 82570

CHLORIDE URINE 24HR 3026341 51.50 82436

POTASSIUM URINE 24HR 3026342 40.10 84133

PROTEIN URINE 24 HR 3026343 40.10 84156

CALCIUM URINE 24 HR 3026344 42.40 82340

PORPHOBILINOGEN URINE 24HR 3026345 108.80 84110

PORPHOBILINOGEN URINE 3026346 108.80 84110

ALA DELTA URINE 24 HR 3026347 251.90 82135

ALA DELTA URINE 3026348 251.90 82135

PORPHYRINS URINE 24HR 3026349 114.50 84120

PORPHYRINS URINE 3026350 114.50 84120

ANTIPROTEINASE 3 ABS 3026351 160.30 83520

ANTIMYELOPERXIDASE ABS 3026352 160.30 83520

VITAMIN B7 3026353 285.10 84591

N-METHYLHISTAMINE UR 24HR 3026354 391.50 83789

CALPROTECTIN FECAL 3026355 274.80 83993

FECAL REDUCING SUBST/OSMOLALITY 3026356 81.30 84377

THYROGLOBULIN BY RIA 3026357 154.50 84432

SACCHAROMYCES CEREVISIAE PANEL 3026358 276.70

SACCHAROMYCES CEREVISIAE IgA 3026359 200.30 86671

VIRAL CULTURE - FLU A 3026360 160.30 87254

VIRAL CULTURE - FLU B 3026361 160.30 87254

VIRAL ID 3026362 125.90 87253

VIRAL CULTURE - INFLUENZA 3026363 0.00

HEMOGLOBIN FRAC W/O SOLUBILITY 3026364 120.20 83021

VON WILLEBRAND DISEASE PANEL 3026365 0.00

VON WILLEBRAND FACTOR COLLAGEN BINDING 3026366 143.10 83520

URINE MICROALB CREAT RATIO QUANT SENDOUT 3026367 0.00

RPR QUANTITATIVE 3026368 63.00 86593

TREPONEMA PALLIDUM ABS 3026369 63.00 86780

ANTICHROMATIN ANTIBODIES 3026370 125.90 86235

HEREDITARY HEMOCHROMATOSIS DNA 3026371 457.90 81256

LIPOPROTEIN ASSOC PHOSPHOLIPASE A2 3026372 114.50 83698

SYSTEMIC LUPUS PROFILE B 3026373 0.00

HEPATITIS C FIBROSURE 3026374 0.00

ALLERGEN PROFILE W TOTAL IgE AREA 5 3026375 0.00

ALPHA 2 MACROGLOBULINS QUANT 3026376 122.50 83883

HEXAGONAL PHASE PHOSPHOLIPID 3026377 192.30 85598

DILUTE RUSSELL'S VIPER VENOM TIME 3026378 142.00 85613



ANTIPHOSPHATIDYLSERINE IgA, IgG, IgM 3026379 508.30 86148

PROTHROMBIN ABS IgG, IgM 3026380 343.40 86849

THROMBOSIS VENOUS RISK COMPREHENSIVE 3026381 0.00

C TELOPEPTIDE 3026382 206.10 82523

VALPROIC ACID FREE 3026383 160.30 80165

HIV 1/2 AB DIFFERENTIATION MULTISPOT 3026384 0.00

STOOL PH 3026385 73.30 83986

MANNOSE-BINDING LECTIN 3026386 153.40 83520

C DIFF TOXIN GENE NAA 3026387 171.70 87493

FUNGITELL SERUM 3026388 343.40 87449

DRUG PROFILE BLOOD 10 DRUGS 3026389 343.40 80307

BENZODIAZEPINE, QUANT, SERUM 3026390 164.90 80347

PTT LUPUS ANTICOAGULANT 3026391 124.80 85732

PTT LUPUS ANTICOAGULANT MIXING STUDY 3026392 124.80 85732

PTT LUPUS ANTICOAG INCUBATED MIXING STUD 3026393 123.60 85732

DILUTE RUSSELL'S VIPER VENOM TIME MIX ST 3026394 142.00 85613

DILUTE RUSSELL'S VIPER VENOM TIME CONFIR 3026395 142.00 85613

THROMBIN NEUTRALIZATION 3026396 75.60 85670

aPTT 1:1 NORMAL PLASMA 3026397 63.00 85732

HCV AB VERIFICATION 3026398 531.20 86804

HEPATITIS C RNA, QUALITATIVE, NAA 3026399 477.40 87521

PISTACHIO NUT IgE 3026400 42.40 86003

PINE NUT IgE 3026401 42.40 86003

SWEET CHESTNUT IgE 3026402 42.40 86003

TRICYCLIC ANTIDEPRESSANT SCREEN URINE 3026403 80.10 80301

TRICYCLIC ANTIDEPRESSANT QUANT SERUM 3026404 152.30 80337

EGG WHITE IgE 3026405 42.40 86003

MILK IgE 3026406 42.40 86003

CLAM IgE 3026407 42.40 86003

CODFISH IgE 3026408 42.40 86003

CRAB IgE 3026409 42.40 86003

SALMON IgE 3026410 42.40 86003

SHRIMP IgE 3026411 42.40 86003

WHEAT IgE 3026412 42.40 86003

SOYBEAN IgE 3026413 42.40 86003

MACADAMIA NUT IgE 3026414 42.40 86003

CORTISOL DEXAMETHASONE SUP W RFX 3026415 112.20 82533

DEXAMETHASONE REFLEX 3026416 136.20 80375

METHYLPHENIDATE SERUM 3026417 220.90 80360

LATEX IgE 3026418 42.40 86003

CINNAMON IgE 3026419 42.40 86003

AMMONIA 3026420 145.40 82140

LACTIC ACID 3026421 79.00 83605

ANTIGLOMERULAR BASEMENT MEMBRANE ABS 3026422 220.90 83516

PROTEIN C ACTIVITY (CHROMOGENIC) 3026423 183.20 85303



HLA CLASS 1 ANITBODY HD 3026424 508.80 86832

HLA CLASS 2 ANITBODY HD 3026425 508.80 86833

TOMATO IgE 3026426 42.40 86003

EGG YOLK IgE 3026427 42.40 86003

WHEY IgE 3026428 42.40 86003

CASEIN IgE 3026429 42.40 86003

ALPHA LACTALBUMIN IgE 3026430 42.40 86003

BETA LACTOGLOBULIN IgE 3026431 42.40 86003

17-OH PROGESTERONE LC/MS 3026432 148.40 83498

FEBRILE ANITBODY PROFILE 3026433 0.00

TYPHUS FEVER IgG 3026434 216.20 86757

TYPHUS FEVER IgM 3026435 216.20 86757

BRUCELLA ABS IgG 3026436 101.80 86622

BRUCELLA ABS IgM 3026437 101.80 86622

C DIFF TOXIN 3026438 171.70 87493

PNEUMOCOCCAL ANITBODIES 23 SEROTYPE 3026439 0.00

HONEYBEE VENOM IgE 3026440 39.20 86003

WASP, PAPER VENOM IgE 3026441 32.90 86003

YELLOW JACKET VENOM IgE 3026442 39.20 86003

HORNET YELLOW VENOM IgE 3026443 39.20 86003

HORNET WHITE FACE VENOM IgE 3026444 39.20 86003

BUMBLEBEE VENOM IgE 3026445 39.20 86003

HYMENOPTERA PROFILE 3026446 0.00

HYMENOPTERA PROFILE 2 & BUMBLEBEE 3026447 0.00

SODIUM FRACTIONAL EXCRETION 3026448 0.00

11-DESOXYCORTISOL 3026449 216.20 82634

HEPATITIS B QUANT PCR 3026450 662.50 87517

HIV 1 RNA QUALITATIVE 3026451 419.80 87535

FOLATE, RBC AND SERUM 3026452 0.00

COMPLIANCE URINE DRUG SCREEN 3026453 0.00 80301

COMPLIANCE DRUG ANALYSIS 3026454 386.90 80302

AMPHETAMINES 3026455 0.00 80326

ANALGESICS NON OPI 3026456 0.00 80331

ANTIDEPRESSANTS SEROTO CL 3026457 0.00 80334

TRICYCLIC ANTIDEPRESSANTS 3026458 0.00 80337

ANTIDEPRESSANTS NOS 3026459 0.00 80338

ANTIEPILEPTICS NOS 3026460 0.00 80341

ANTIPSYCHOTICS NOS 3026461 0.00 80344

BENZOS 1-12 3026462 0.00 G0480

COCAINE 3026463 0.00 80353

FENTANYL 3026464 0.00 80354

GABAPENTIN 3026465 0.00 80355

KETAMINE & NORKETAMINE 3026466 0.00 80357

METHADONE 3026467 0.00 80358

MDMA, MDA 3026468 0.00 80359



METHYLPHENIDATE 3026469 0.00 80360

OPIATES, 1 OR MORE 3026470 0.00 80361

OPIATES & OPI ANA 3026471 0.00 80364

OXYCODONE 3026472 0.00 80365

PREGABALIN 3026473 0.00 80366

SEDATIVE HYPNO NON-BENZO 3026474 0.00 80368

MUSCLE RELAXERS 3 OR MORE 3026475 0.00 80370

STIMULANTS, SYNTHETIC 3026476 0.00 80371

TAPENTADOL 3026477 0.00 80372

TRAMADOL 3026478 0.00 80373

DRUG/SUB NOS 3026479 0.00 80377

CREATININE, OTHER 3026480 0.00 82570

BUPRENORPHINE 3026481 0.00 80348

PROPOXYPHENE 3026482 0.00 80367

PHENCYCLIDINE 3026483 0.00 83992

CHRONIC URTICARIA 3026484 190.80 86352

LETTUCE IgE 3026485 42.40 86003

CUCUMBER IgE 3026486 42.40 86003

CLONAZEPAM AS METABOLITE, URINE 3026487 214.10 G0480

ALPHA 1 ANTITRYPSIN STOOL 3026488 241.70 82103

HEAVY METALS PROFILE 2, BLOOD 3026489 0.00

LEMON IgE 3026490 42.40 86003

ORANGE IgE 3026491 42.40 86003

CHOCOLATE/CACAO IgE 3026492 42.40 86003

CORN IgE 3026493 42.40 86003

ANTI MULLERIAN HORMONE 3026494 130.40 82397

HEPATITIS C AB W RFX TO QUANT PCR 3026495 113.40 86803

HEPATITIS C QUANT PCR RFX 3026496 540.60 87522

BCR-ABL 1, CML/ALL PCR, QUANT 3026497 1,236.00

BCR 1 GENE MAJOR 3026498 0.00 81206

BCR 1 GENE MINOR 3026499 0.00 81207

IMMUNOFLUORESCENT AB STAIN, INTIAL 3026500 239.80 88346

IMMUNOFLUORESCENT AB STAIN, ADDITIONAL 3026501 239.80 88350

GENOTYPE ASSAY 1 3026502 237.70 87900

GENOTYPE ASSAY 2 3026503 469.80 87901

RNA POLYMERASE III IgG ABS 3026504 100.70 83520

NOROVIRUS, PCR, STOOL 3026505 357.20

NOROVIRUS GI 3026506 0.00 87798

NOROVIRUS GII 3026507 0.00 87798

CYSTATIN C 3026508 204.60 82610

FUNGUS STAIN 3026509 70.00 87206

CANNABINOIDS SYNTHETIC URINE SCREEN&CONF 3026510 159.00 80307

CANNABINOIDS SYNTHETIC URINE, DEFINITIVE 3026511 167.50 80352

CANNABINOIDS (THC) SYNTHETIC, BLOOD 3026512 167.50 80352

DRUG PROFILE BLOOD 16 DRUGS 3026513 265.00 80307



AMPHETAMINES/MDMA MS WB RFX 3026514 190.80 G0480

COCAINE MS WB RFX 3026515 190.80 80353

SEROQUEL (QUETIAPINE) QUANT, SERUM 3026516 144.20 80342

BUPRENORPHINE CONFIRMATION, URINE 3026517 152.60 80348

BUPRENORPHINE QUANT, BLOOD 3026518 166.40 80348

RSV SEND-OUT 3026519 72.10 87807

RSV ANTIBODIES 3026520 90.10 86756

THYROGLOBULIN BY IMA 3026521 154.50 84432

TESTOSTERONE FREE AND WEAKLY BOUND 3026522 159.00 84410

LEFLUNOMIDE 3026523 235.30 80306

FOOD ALLERGY PROFILE 3026524 0.00

SCALLOP IgE 3026525 42.10 86003

SESAME SEED IgE 3026526 42.40 86003

DNA PARENTAGE COLLECTION 3026527 15.00

HELPER T-LYMPHOCYTE CD4 3026528 143.10 86361

TAYLOR CO/CITY UDS13 3026529 120.00 80306

CHAIN OF CUSTODY ALCOHOL COLLECTION 3026530 120.00 G0480

HIV 1 QUANT PCR (ONE TIME) 3026531 498.20 87536

HIV 1 QUANT PCR (SERIAL MONITORING) 3026532 498.20 87536

CHAIN OF CUSTODY DRUG BLOOD COLLECTION 3026533 324.00 80307

LACTOFERRIN FECAL QUANT 3026534 169.60 83631

COPPER, URINE RANDOM OR 24 HR 3026535 0.00

COPPER URINE 3026536 53.00 82525

HLA B57:01 ABACAVIR HYPERSENS HLS ASSOC 3026537 183.40 81381

UREA NITROGEN URINE 24 HR 3026538 42.40 84540

CANNABINOIDS (THC) SYNTHETIC CONFIRM 3026539 0.00

TRAMADOL QUANT SERUM 3026541 142.00 80373

APOLIPOPROTEIN B 3026542 68.90 82172

LIPOPROTEIN (a) 3026543 100.70 83695

MATERNIT21 PLUS CORE 3026544 991.10 81420

FUNGUS CULTURE W RFX RAPID ID 3026545 106.00 87101

STACHYBOTRYS ATRA 3026546 31.80 86003

ALLERGEN PROFILE- MOLD 3026547 39.20 86003

CORTISOL SALIVARY 3026548 82.70 82533

LDH BODY FLUID 3026549 26.50 83615

AMYLASE BODY FLUID 3026550 42.40 82150

CANNABINOIDS SYNTHETIC CONFIRMATION 3026551 102.20 80352

GRAM STAIN W SPUTUM CULTURE RFX 3026552 42.40 87205

SPUTUM CULTURE RFX 3026553 74.20 87070

LOWER RESPIRATORY CULTURE NOT SPUTUM 3026554 74.20 87070

PLATELET COUNT- SEND OUT 3026555 29.70 85049

VASOACTIVE INTESTINAL POLYPEPTIDE 3026556 291.50 84586

LEUKEMIA/LYMPHOMA IMMUNOPHENOTYPE PROFIL 3026557 0.00

FLOW MARKER 1ST 3026558 111.30 88184

FLOW MARKERS x3 3026559 63.60 88185x3



FLOW MARKERS x15 3026560 68.90 88185x15

FLOW INTERP 16 OR MORE 3026561 381.60 88189

SCABIES EXAMINATION 3026562 59.40 87169

GENITAL/URINE MYCOPLASMA PROFILE, NAA 3026563 296.80

MYCOPLASMA GENITALIUM 3026564 0.00 87798

MYCOPLASMA HOMINIS, NAA 3026565 0.00 87798

UREAPLASMA SPP, NAA 3026566 0.00 87798

DRUG PROFILE BLOOD, W GHB & ROHYPNOL 3026567 779.10 80307

ROHYPNOL, QUANT, WHOLE BLOOD 3026568 0.00 G0480

KETAMINE & METABOLITE, QUANT 3026569 126.10 80357

INFLUENZA A/B 3026570 185.50 87502

STREP A 3026571 100.70 87651

RSV 3026572 212.00 87801

COBALT LYMPHOCYTE STIMULATION 3026573 450.50

NICKEL LYMPHOCYTE STIMULATION 3026574 450.50

CHROMIUM LYMPHOCYTE STIMULATION 3026575 450.50

BERYLLIUM LYMPHOCYTE STIMULATION 3026576 450.50

CLINICAL PATHOLOGY CONSULTATION 3026577 0.00 80500

QUALITATIVE OR SEMIQUANT IMMUNOASSAY 3026578 0.00 86353

DEAMINATED GLIADIN ANTIBODIES IgA 3026579 126.10 83516

DEAMINATED GLIADIN ANTIBODIES IgG 3026580 126.10 83516

BARTONELLA ANTIBODY PROFILE 3026581 275.60

BARTONELLA HENSELAE IgG 3026582 0.00 86611

BARTONELLA HENSELAE IgM 3026583 0.00 86611

BARTONELLA QUINTANA IgG 3026584 0.00 86611

BARTONELLA QUINTANA IgM 3026585 0.00 86611

EHRLICHIOSIS GRANULOCYTIC/MONOCYTIC PROF 3026586 686.90

EHRLICHIA CHAFFEENSIS IgG TITER 3026587 0.00 86666

EHRLICHIA CHAFFEENSIS IgM TITER 3026588 0.00 86666

HUMAN GRANULOCYTIC EHRLICHIOSIS IgG/IgM 3026589 0.00 86666

HUMAN MONOCYTIC EHRLICHIOSIS IgG/IgM 3026590 0.00 86666

COC OPIATES-4 CONFRIM 3026591 152.60 80361

RESPIRATORY PATHOGEN PROFILE PCR 3026592 848.00 0099U

CORONAVIRUS NAA LABCORP 3026593 100.00 87635

MEN2 RET GENE SEQUENCING ANALYSIS 3026594 1,240.20 81405

SARS-CoV-2 IgG IN-HOUSE 3026595 42.13 86769

COVID-19 HCW/LTC 3026596 0.00

AUTOIMMUNE PROFILE 3026952 0.00

PHENCYCLIDINE MS WB/SP RFX 3026953 190.80 83992

THC MS WB/SP RFX 3026954 190.80 G0480

BENZODIAZEPINES, MS, WB/SP RFX 3026955 190.80 80347

COCAINE, MS, WB/SP RFX 3026956 190.80 80353

OXYCODONES, MS, WB/SP RFX 3026957 190.80 80365

OPIATES, MS, WB/SP RFX 3026958 190.80 80361

METHADONE, MS, WB/SP RFX 3026959 190.80 80358



PROPOXYPHENE, MS, WB/SP RFX 3026960 190.80 80367

GENERAL HEALTH PANEL 3026961 264.40 80050

TREPONEMA PALLIDUM DNA, PCR 3026962 556.50 87798

ACETYLCHOLINE RECEPTOR AB PROFILE 3026963 0.00

ACETYLCHOLINE RECEPTOR MODULATING ABS 3026964 330.70 83519

ACETYLCHOLINE RECEPTOR BINDING ABS 3026965 330.70 83519

ACETYLCHOLINE RECEPTOR BLOCKING ABS 3026966 294.70 83519

QUANTIFERON TB GOLD PLUS 3026967 240.60 86480

TRICYCLIC ANTIDEPRESSANTS CONFIRM URINE 3026968 152.60

MUSCLE RELAXERS 1 OR 2 3026969 0.00 80369

TRICYCLIC ANTIDEPRESSANT URINE 3026970 0.00 80337

COMPLEMENT C1 ESTERASE INHIBITOR 3026971 110.20 86160

HEREDITARY ANGIOEDEMA PROFILE 3026972 0.00

C1 INHIBITOR FUNCTIONAL RFX 3026973 171.70 86161

COAT UDS 13 3026974 371.00 80306

HISTOPLASMA CAPSULATUM ANTIBODIES 3026975 383.70

HISTOPLASMA MYCELIAL CF AB 3026976 0.00 86698

HISTOPLASMA YEAST CF AB 3026977 0.00 86698

HISTOPLASMA MYCELIAL ID AB 3026978 0.00 86698

COC DRUG/ALC PROFILE URINE 3026979 127.20 80307

THYROGLOBULIN AB & THYROGLOB IMA OR LCMS 3026980 108.10 86800

THYROGLOBULIN BY LC/MS-MS 3026981 154.80 84432

WEST NILE IGG 3027001 77.80 86789

WEST NILE IGM 3027002 77.80 86788

HPV LOW VOLUME REFLEX 3027003 215.20 87624

CHROMOSOME ANALYSIS WHOLE BLOOD 3027004 585.10 88230

CHROMOSOME KARYOTYPE ANALYSIS 3027005 737.80 88262

LIVER-KIDNEY MICROSOMAL ABS 3027006 103.90 86376

LEAD, PEDIATRIC CAPILLARY 3027007 78.40 83655

FECAL FAT & MUSCLE FIBERS QUALITATIVE 3027008 0.00

FECAL MUSCLE FIBERS 3027009 45.10 89160

THROMBOTIC RISK EVALUATION 3027010 0.00

C REACTIVE PROTEIN 3027011 47.70 86140

HIV 1/2 AG/AB SCREEN (IN-HOUSE) 3027012 121.90 87806

DRUG TESTS/SAMPLE VALIDATION 3027013 0.00 80307

AMPHET & METHAMPHET 3027014 0.00 G0480

ACETYMORPHINE 3027015 0.00 80356

OPIATE & OPIATE ANALOGS 3027016 0.00 80362

BETA HYDROXYBUTYRATE KETONE 3027017 65.30 82010

COMPLIANCE TOXASSURE 19 3027018 386.90

COMPLIANCE TOX UDS 3027019 0.00 80306

DRUG SCREEN 13, URINE 3027020 371.00 80306

IA2 AUTOANTIBODIES 3027021 169.60 86341

INSULIN AUTOANTIBODIES 3027022 180.20 86337

ELECTROLYTES BACK UP 3027023 37.80 80051



PROTEIN C DEFICIENCY PROFILE 3027024 0.00

LEPTOSPIRA IgM 3027025 247.00 86720

HUMAN ANTIMOUSE ANTIBODIES 3027026 311.60 83520

KIDNEY STONE 24HR URINE W SAT. CALC 3027027 1,244.40

UA AUTO MISC 3027028 0.00 81003

AMINO ACIDS MISC 3027029 0.00 82131

AMMONIA MISC 3027030 0.00 82140

CALCIUM URINE MISC 3027031 0.00 82340

CHLORIDE URINE MISC 3027032 0.00 82436

CITRATE URINE MISC 3027033 0.00 82507

MAGNESIUM MISC 3027034 0.00 83735

OSMOLALITY URINE MISC 3027035 0.00 83935

OXALATE URINE MISC 3027036 0.00 83945

PHOSPHORUS URINE MISC 3027037 0.00 84105

POTASSIUM URINE MISC 3027038 0.00 84133

SODIUM URINE MISC 3027039 0.00 84300

SULFATE URINE MISC 3027040 0.00 84392

URIC ACIC MISC 3027041 0.00 84560

HIV1 AG HIV 1/2 SGL RESULT 3027042 203.00 87389

COVID-19 NAA IN-HOUSE 3027043 51.31 87635

COVID COLLECTION 3027044 25.00 G2023

UA W MICRO (SENDOUT) 3027045 27.60 81001

MEN2: RET GENE SEQUENCING 3027046 1,240.20 81405

SPECIMEN TO STATE LAB 3027047 0.00

FECAL OSMOLALITY 3027100 31.80 84999

DIURETIC SCREEN 3027500 66.80 80299

LEVEL 2 GROSS & MICRO 2ND SITE 3027999 101.80 88302TC

TRILEPTAL 3028000 169.40 80183

GIARDIA IGG 3028001 70.60 86674

GIARDIA IGA 3028002 70.60 86674

GIARDIA IGM 3028003 70.60 86674

FECAL PANCREATIC ELASTASE 3028004 286.20 82656

BASIC METABOLIC PANEL SENDOUT 3028005 50.40 80048

HERPES VIRUS 1&2 IgG W RFX TO HSV2 3028006 0.00

HERPES VIRUS 1 AB IgG 3028007 265.00 86695

HERPES VIRUS 2 AB IgG 3028008 265.00 86696

HERPES VIRUS 2 AB IgG RFX 3028009 113.40 86696

ISLET CELL DYSFUNCTION GROUP 1 3028010 165.40

INSULIN 3028011 0.00 83525

PROINSULIN 3028012 0.00 84206

PROINSULIN 3028013 292.60 84206

PROSTATE SPECIFIC ANTIGEN SENDOUT 3028014 123.60 84153

TESTICULAR CANCER MONITOR PROFILE 3028015 248.00

AFP TUMOR MARKER 3028016 0.00 82105

HCG TUMOR MARKER 3028017 0.00 84702



MUMPS VIRAL CULTURE 3028018 245.90 87254

PATHOLOGY AEROBIC CULTURE 3028019 57.20 87070

ALKALINE PHOSPHATASE TOTAL 3028020 0.00 84075

e13a2(b2a2) 3028021 0.00 81206

e14a2(b3a2) TRANSCRIPT 3028023 0.00 81207

FUNGAL ID BY MOLECULAR METHOD 3028024 139.90 87106

COCKROACH AMERICAN IgE 3028025 42.40 86003

DERMATOPHAGOIDES PTERONYSSINUS IgE 3028026 42.40 86003

DERMATOPHAGOIDES FARINAE IgE 3028027 42.40 86003

OYSTER IgE 3028028 42.40 86003

MUSSEL IgE 3028029 42.40 86003

LOBSTER IgE 3028030 42.40 86003

HERRING IgE 3028031 42.40 86003

HALIBUT IgE 3028032 42.40 86003

TUNA IgE 3028033 42.40 86003

TROUT IgE 3028034 42.40 86003

URIC ACIC BODY FLUID 3028035 45.80 84560

HERPES SIMPLEX VIRUS 1&2 NAA 3028036 386.90

HERPES VIRUS 1, NAA 3028037 0.00 87529

HERPES VIRUS 2, NAA 3028038 0.00 87529

HEPATITIS C NS5A DRUG RESISTANCE 3028039 727.20

HCV NS5A DRUG RESISTANCE 3028040 0.00 87900

HCV GENOTYPE 3028041 0.00 87902

ASPERGILLUS FUMIGATUS IgE 3028042 42.40 86003

BERMUDA GRASS IgE 3028043 42.40 86003

PIGWEED, COMMON IgE 3028044 42.40 86003

OAK, LIVE/VIRGINIA IgE 3028045 42.40 86003

OAK, WHITE IgE 3028046 42.40 86003

CLADOSPORIUM HERBARUM IgE 3028047 42.40 86003

JOHNSON GRASS IgE 3028048 42.40 86003

TIMOTHY GRASS IgE 3028049 42.40 86003

PLANTAIN, ENGLISH IgE 3028050 42.40 86003

ELM AMERICAN IgE 3028051 42.40 86003

ELM CEDAR IgE 3028052 42.40 86003

RAGWEED, SHORT IgE 3028053 42.40 86003

ALTERNARIA ALTERNATA IgE 3028054 42.40 86003

DOG DANDER IgE 3028055 42.40 86003

CAT DANDER IgE 3028056 42.40 86003

MAPLE/BOX ELDER IgE 3028057 42.40 86003

COCKROACH, GERMAN IgE 3028058 42.40 86003

SYCAMORE, MAPLE LEAF IgE 3028059 42.40 86003

LAMBS QUARTERS IgE 3028060 42.40 86003

BIRCH COMMON SILVER IgE 3028061 42.40 86003

SETOMELANOMMA ROSTRATA IgE 3028062 42.40 86003

PENICILLIUM CHRYSOGENUM IgE 3028063 42.40 86003



ANTIFUNGAL SUSCEP FLUCONAZOLE 3028064 203.50 87186

ANTIFUNGAL SUSCEP MICAFUNGIN 3028065 203.50 87186

HIV RNA QUAL RFX 3028066 419.80 87535

TESTOSTERONE FREE DIRECT & TOTAL 3028067 0.00

HIV 1/2 ABS & AG PRELIM TEST W RFX 3028068 121.90 87389

ALBUMIN SERUM SEND-OUT 3028069 39.20 82040

EOSINOPHIL URINE 3028070 60.40 87205

ROHYPNOL SERUM 3028071 297.90 80346

T4 FREE SEND-OUT 3028072 107.10 84439

BARTONELLA DNA PCR 3028073 400.70 87471

BABESIA MICROTI ABS IgG/IgM 3028074 271.40

NASH FIBROSURE 3028075 504.60

PORPHYRIN FRACTIONATION PLASMA 3028076 306.30 82542

ANA BIOMARKERS PROFILE 3028077 1,445.80

ZC ANTIRIBOSOMAL P ABS 3028078 0.00 83516

ZC ANTI-DS DNA ABS 3028079 0.00 86225

ZC ANTICENTROMERE B ABS 3028080 0.00 86235

ZC ANTI JO 1 3028081 0.00 86235

ZC ANTICHROMATIN ABS 3028082 0.00 86235

ZC ANTISCLERODERMA 70 ABS 3028083 0.00 86235

ZC RNP ABS 3028084 0.00 86235

ZC SMITH ABS 3028085 0.00 86235

ZC ANTI-ENA ABS 3028086 0.00 86235

ZC SJOGRENS ANTI-SSB 3028087 0.00 86235

ZC SJOGRENS ANTI SSA 3028088 0.00 86235

ZC BABESIA MICROTI IgG 3028089 0.00 86753

ZC BABESIA MICROTI IgM 3028090 0.00 86753

ZC APOLIPOPROTEIN A1 3028091 0.00 82172

ZC TOTAL BILIRUBIN 3028092 0.00 82247

ZC TOTAL CHOLESTEROL 3028093 0.00 82465

ZC GLUCOSE 3028094 0.00 82947

ZC GGT 3028095 0.00 82977

ZC HAPTOGLOBIN 3028096 0.00 83010

ZC ALPHA2 MACROGLOB 3028097 0.00 83883

ZC AST 3028098 0.00 84450

ZC ALT 3028099 0.00 84460

ZC TRIGLYCERIDES 3028100 0.00 84478

VITAMIN D 1,25 DIHYDROXY & 25 HYDROXY 3029000 309.10 82306

URINE DRUG SCREEN 13 EMS 3029001 0.00 80306

SARS-CoV-2 IgG LABCORP 3029002 42.13 86769

ANTIBODY ID/TITER 3029003 111.30 86870

SARS-CoV-2 IgG DLT 3029204 42.13 86769

PAT/HISTO CONSULT 3029205 371.00 88323

INFLIXIMAB & ANTIBODY 3029206 508.80

INFLIXIMAB 3029207 0.00 80230



INFLIXIMAB ANTIBODY 3029208 0.00 82397

HISTAMINE PLASMA 3029209 320.10 83088

PTT SEND OUT 3029210 46.60 85730

INFLAMMATORY BOWEL DISEASE PROFILE 3029211 0.00

HU ANTIBODY TITER 3029212 0.00 86256

YO ANTIBODY TITER 3029213 0.00 86256

RI ANTIBODY TITER 3029214 0.00 86256

ANTIPARIETAL CELL ANTIBODY 3029215 126.10 83516

MAGNESIUM RBC SENDOUT 3029216 118.70 83735

ZINC RBC 3029217 117.70 84630

PARANEOPLASTIC PROFILE 1 3029218 1,060.00

CHEMISTRY PROFILE DLT 3030031 30.00

T4 FREE CASCADE 3036091 53.80 84439

FLOW CYTOMETRY FIRST MARKER 3036156 257.60 88184

FLOW CYTOMETRY EACH ADD MARKER 3036157 105.30 88185

FLOW CYTOMETRY INTERP 2-8 MARK 3036158 360.60 88187

FLOW CYTOMETRY INTERP 9-15 MARK 3036159 389.20 88188

URINE HISTAMINE 3080062 492.30 83088

URINE HYDROMORPHONE 3080063 360.60 80307

DRUG SCR UR GCH 3080100 383.50 80307

SCREEN URINE DRUG 13 3080101 28.60 80307

DRUG SCR CONFIRM 3080102 231.20 80301

COMPLEMENT C2 3080140 74.40 86160

COMPLEMENT C4 3080141 74.40 86160

COMPLEMENT TOTAL CH50 3080142 97.30 86162

CHLAMYDIA COMPLETION 3080143 131.70 87490

GONORRHEA COMPLETION 3080144 131.70 87590

BENZODIAZEPINE CONFIRMATION, URINE 3080154 164.90 G0480

LIDOCAINE 3080176 88.10 80176

PHENYTOIN FREE 3080186 66.40 80186

TOBRAMYCIN TROUGH 3080200 96.20 80200

ALDACTONE 3080299 194.60 80299

COAT DIP STICK UDS 3080305 25.20 80305

ACTH ADRENAL 3080400 194.60 80400

ACTH 210H DEF 3080402 520.90 80402

ACTH 3 BETA DEF 3080406 467.10 80406

ALDOSTERONE SERUM LC/MS 3080408 274.80 82088

CA PENTA STIM 3080410 555.20 80410

GONADOTROP STIM 3080426 478.50 8372790

INSULIN TOL ACTH 3080434 604.50 80434

INSULIN TOL GH 3080435 615.90 80435

URINE DIP MANUAL CLINIC 3081002 30.90 81002

URINE VOLUME 3081050 22.90 81050

ACETALDEHYDE 3082000 89.30 82000

KETONE QUAL S 3082009 28.60 82009



KETONES QUANT 3082010 65.30 82010

HOMOCYSTEINE 3082020 264.40 83090

ACTH 3082024 231.20 82024

ALBUMIN UR QUANT 3082042 37.80 82042

URINE MICROALB CREAT RATIO QUAL IN-HOUSE 3082044 0.00

MICROALBUMIN URINE RANDOM 3082045 36.60 82043

MICRO CREAT 3082046 33.90 82044

ETHANOL BREATH 3082075 84.80 82075

STRYCHININE QUANT 3082101 100.70 80323

DRUG SCREEN CONFIRMATION 3082102 125.90 80301

ALPHA 1 ANTITRYPSIN 3082103 92.70 82103

AFP AMNIOTIC FLD 3082106 99.60 82106

ALUMINUM 3082108 152.30 82108

ALA 3082135 99.60 82135

AMNIOTIC FLD SCAN 3082143 74.40 82143

AMPHET & METHAMPHET CONFIRMATION, URINE 3082145 164.90 G0480

ANDROSTERONE 3082160 160.30 82160

ANGIOTENSIN II 3082163 123.60 82163

ANGIOTENSIN CONVERTING ENZYME 3082164 143.10 82164

APOLIPOPROTEIN A1 3082172 144.20 82172

ARSENIC 3082175 120.20 82175

VITAMIN C ASORBIC ACID 3082180 65.30 82180

BETA 2 MICROGLO 3082232 87.00 82232

BILE ACIDS CHOLGLY 3082240 161.40 82240

CBC PATHOLOGY REVIEW 3082241 74.40 85060

3 HOUR INSULIN TOLERANCE 3082242 57.20 83525

ANTI JO 1 3082243 85.90 86235

CADMIUM 3082300 128.30 82300

VITAMIN D 1 25 HYDROXY 3082306 164.30 82306

VITAMIN D 25 HYDROXY 3082307 192.30 82306

CALCITONIN 3082308 166.00 82308

OCCULT BLOOD GASTRIC 3082309 76.70 82271QW

CALCIUM TOTAL 3082310 28.60 82310

FUNGAL AB 86612 3082311 34.30 86612

FUNGAL AB 86635 3082312 34.30 86635

FUNGAL AB 3082313 34.30 86698

FUNGAL AB 86606 3 3082314 34.30 86606

PARASITE ID WORM 3082315 34.30 87169

SICKLE CELL TEST HEMOGLOBIN 3082317 63.00 85660

HEMA-SCREEN ANNUAL ON-SITE 3082318 76.70 82270

HEMA-SCREEN DIAGNOSTIC ON-SITE 3082319 76.70 82274QW

HEMA-SCREEN ANNUAL LAB 3082320 76.70 G0328QW

HEMA-SCREEN DIAGNOSTIC LAB 3082321 76.70 82274QW

CALCIUM IONIZED 3082330 92.70 82330

CALCIUM POST INFUSION 3082331 37.80 82331



CALCIUM URINE 3082340 42.40 82340

CALCULUS QUAL 3082355 64.10 82355

CALCULUS INFRARED 3082365 80.10 82365

CALCULUS XRAY 3082370 69.80 82370

ACETYLCHOLINE RECEPTOR ANTIBOD 3082372 179.70 83519

CATECHOL UR TOTAL 3082382 115.60 82382

CATECHOLAMINES, FRACTIONATED 3082383 158.00 82384

CATECHOLAMINES FRACTIONATED, 24 HR URINE 3082384 168.30 82384

CATHEPSIN D 3082387 124.80 82387

CD4 T LYMPHOCYTE COUNT 3082388 143.10 86361

HYDROCODONE SERUM 3082389 121.30 80361

SCL 170 3082390 79.50 86235

PMI SCL 3082391 97.30 86331

CHEMILUMINSCENT 3082397 84.70 82397

HYPERCOAGULATION PHASE I 3082398 111.00 85303

HYPERCOAGULATION PHASE II 3082399 93.90 85300

HYPERCOAGULATION PHASE III 3082400 112.20 85306

HYPERCOAGULATION PHASE IV 3082401 57.20 83891

HYPERCOAGULATION PHASE V 3082402 57.20 83894

HYPERCOAGULATION PHASE VI 3082403 57.20 83912

HYPERCOAGULATION PHASE VII 3082404 57.20 83892

CHLORAMPHENICOL 3082415 79.00 82415

CL BLOOD 3082435 28.60 82435

CHLORIDE URINE 3082436 51.50 82436

CL MISC SOURCE 3082438 34.30 82438

CHLOR HYDRO SCR 3082441 42.40 82441

CHOLINESTERASE SERUM 3082480 63.00 82480

CHOLINESTER RBC 3082482 71.00 82482

CHON B SULF QUANT 3082485 123.60 82485

CHROMATO COLUMN 3082486 108.80 82486

CHROMATO PAPER 3082487 100.70 82487

CHROM PAPER 2 DEM 3082488 143.10 82488

CHROM TLC 3082489 111.00 82489

CHROM COLUMN QUANT 3082491 257.60 82491

CHROMIUM 3082495 121.30 82495

COCAINE METABOLITE CONFIRMATION, URINE 3082520 164.90 80353

COPPER, SERUM OR PLASMA 3082525 106.50 82525

CORTICOSTERONE 3082528 135.10 82528

CORTISOL AM 3082530 99.60 82533

CREATINE 3082540 33.20 82540

CK CPK TOTAL 3082550 38.20 82550

CK ISOENZYMES 3082552 80.10 82552

CK CPK ISOFORMS 3082554 65.70 82554

FACTOR HI MOL WAT 3082593 124.80 85293

VIT B12 UNSAT 3082608 85.90 82608



DHEA 3082626 286.20 82626

DESOXYCORTICOSTERONE 11 3082633 185.50 82633

DEOXYCORTISOL 11 3082634 175.20 82634

DRUG OPIATES CONFIRMATION 3082635 85.90 80365

OXYCODONE & METABOLITE, SERUM 3082636 171.70 80365

BARBITUATE CONFIRMATION, URINE 3082637 37.80 80345

PROPOXYPHENE CONFIRMATION, URINE 3082640 164.90 80367

VITAMIN D 1,25 DIHYDROXY 3082652 230.10 82652

ZSTATFLU 3082657 108.80 82657

ESTRADIOL 3082670 180.90 82670

ESTROGEN FRACT 3082671 193.50 82671

ESTRIOL 3082677 150.00 82677

ERYTHROPOIETIN 3082688 108.80 82668

FECAL FAT QUANT 3082710 114.50 82710

FECAL FAT DIFF QUANT 3082715 95.40 82715

IMMUNOGLOBULIN G SUBCLASSES 1-4 3082787 0.00

BLOOD PH ONLY 3082800 71.00 82800

HEMOGLOBINOPATHY PROFILE 1 3082801 91.60 83021

HEMOGLOBINOPATHY PROFILE 2 3082802 28.60 85660

BIOTINIDASE DEFICIENCY 3082803 234.70 82261

MAGNESIUM URINE 3082804 34.30 83735

LISTERIA ANTIBODY 3082805 332.00 86609

MRSA SCREEN 3082806 263.30 87081

ANTI GLOMERULAR BASE ANTIBODY 3082807 85.90 83516

THYROID STIMULATING IMMUNOGLOBULIN 3082808 332.00 84445

HEPATITIS B VIRUS DNA 3082809 429.30 87517

ABG 02SAT ONLY 3082810 55.00 82810

NEUROMYOLITIS OPTICA ANTIBODY 3082811 801.40 86255

GASTRIN POST STIM 3082938 106.50 82938

GASTRIN 3082941 105.30 82941

GLUCOSE BODY FLUID 3082945 24.00 82945

GLUCOSE 6PD 3082955 45.80 82955

LUTEINIZING HORMONE 3083002 111.00 83002

HVY METAL SCR 3083015 121.30 83015

HVY METAL EA QUANT 3083018 130.50 83018

HEMOGLOBIN A1C W/ eAG 3083036 66.40 83036

5 HIAA 3083497 84.70 83497

17 HYDROXY PROGESTERONE 3083498 162.60 83498

TISSUE TRANSGLUTAMINASE tTG IGG 3083516 226.70 83516

INSULIN TOTAL, FASTING 3083525 71.00 83525

INSULIN FREE 3083527 76.70 83527

INTRINSIC FACTOR ABS 3083528 99.60 86340

LACTIC ACID SEND-OUT 3083605 79.00 83605

LACTOSE UR QUAL 3083633 51.90 83633

LACTOSE QUANT 3083634 71.00 83634



LEAD, ADULT 3083655 72.10 83655

LEAD, PEDIATRIC 3083656 72.10 83655

LS RATIO QUANT 3083661 134.60 83661

LAP 3083670 58.40 83670

NMR LIPO PROFILE 3083704 57.20 83704

HDL CHOLESTEROL 3083718 51.50 83718

VLDL NOT CALC 3083719 69.80 83719

MANGANESE 3083785 146.50 83785

METHADONE CONFIRMATION, URINE 3083840 164.90 80358

SNYNOVIAL FLD MUCIN 3083872 42.40 83872

MYELIN BASIC PROTEIN 3083873 103.00 83873

MYOGLOBIN 3083874 76.70 83874

LAMBDA LEVEL 3083883 75.30 83883

NICKEL 3083885 146.50 83885

NICOTINE 3083887 103.00 80323

AMP FIRST 2 DNA 3083900 131.70 83900

AMP GREATER THAN 2 DNA 3083901 67.50 83901

LYSIS PRIOR TO DNA EXTRACTION 3083907 53.80 83907

DNA PREPERATION 3083909 67.50 83909

ENZYMATIC ID- ID SS-OLA, SBCE, ASPE 3083914 67.50 83914

5 NUCLEOTIDASE 3083915 66.40 83915

OLIGOCLONAL IMMUNE BANDS 3083916 120.20 83916

PTH RELATED PEPTIDE 3083917 85.90 82397

METHADONE QUANT, SERUM 3083925 240.40 80358

OSTEO CALCIN 3083937 165.40 83937

PH BODY FLUID 3083989 42.40 83986

PCP CONFIRMATION, URINE 3083992 164.90 83992

PHENOTHIAZIME 3084022 98.50 80342

ACID PHOS PROSTATE 3084066 63.00 84066

FEBRILE AGGLUTININS 3084075 27.60 86000

ALK PHOS HEAT 3084078 44.60 84078

PREALBUMIN 3084134 88.10 84134

PROGESTRIN 3084144 115.50 84144

WEST BLOT W INTREP 3084181 146.50 84181

WEST BLOT W INTREP& BAND 3084182 146.50 84182

PROINSULIN 3084206 106.50 84206

VITAMIN B6 3084207 168.30 84207

VITAMIN B2 3084252 121.30 84252

SELENIUM 3084255 152.30 84255

SEROTONIN 3084260 185.50 84260

SOMATOMEDIN 3084305 123.00 84305

SOMATOSTATIN 3084307 282.00 84307

TESTOSTERONE FREE 3084402 152.30 84402

VITAMIN B1, THIAMINE 3084425 127.10 84425

T4 NEONATAL 3084437 36.00 84437



T4 FREE 3084439 53.80 84439

VITAMIN E 3084446 85.90 84446

TRANSCORTIN 3084449 108.80 84449

T3 FREE 3084481 100.70 84481

T3 REVERSE 3084482 209.50 84482

TRYPSIN DUODENAL FLD 3084485 56.10 84485

TRYPSIN FECAL QUAL 3084488 50.40 84488

TRYPSIN FECAL 24 HR 3084490 66.40 84490

TYROSINE 3084510 63.00 84510

URIC ACID URINE 3084560 45.80 84560

VASOPRESSIN 3084588 202.60 84588

VITAMIN A 3084590 77.80 84590

VITAMIN K 3084597 81.30 84597

DURG SCREEN VOLATILES 3084600 96.20 84600

ZINC PLASMA 3084630 68.70 84630

C PEPTIDE 3084681 124.80 84681

CBC MANUAL DIFF ONLY 3085007 26.30 85007

HEMOGLOBIN BY HEMOCUE 3085018 16.00 85018

CBC W/O DIFF 3085021 38.90 85027

CBC MANUAL REVIEW 3085031 0.00 85031

WBC AUTOMATED 3085048 34.30 85048

BONE MARROW PATH 3085097 257.60 85097

CHROMOGENIC SUB 3085130 42.40 85130

FACTOR V 3085220 106.50 85220

FACTOR VII 3085230 105.30 85230

FACTOR VIII INHIBITOR PROFILE 3085240 0.00

FACTOR VIII AG 3085244 251.90 83520

FACTOR VIII RISTOCETIN 3085245 231.20 85245

FACTOR VIII ACTIVITY 3085246 275.90 85240

VON WILLEBRAND FACTOR PROFILE 3085247 0.00

BODY FLUID CULTURE 3085248 41.20 87070

POC PROFILE PART A 3085249 400.70 88233

FACTOR VIX 3085250 113.30 85250

POC PROFILE PART B 3085251 400.70 88262

POC PROFILE PART C 3085252 400.70 88291

FACTOR X 3085260 121.30 85260

FACTOR XI 3085270 105.30 85270

FACTOR XII 3085280 105.30 85280

FACTOR XIII 3085290 101.90 85290

FACTOR XIII SCR 3085291 65.30 85291

FACTOR FLETCHER 3085292 122.50 85292

ANTITHROMBIN III ACTIVITY 3085300 117.90 85300

ANTITHROMBIN III ANTIGEN 3085301 79.00 85301

PROTEIN C ANTIGEN 3085302 150.00 85302

PROTEIN C ACTIVITY 3085303 314.80 85303



PROTEIN S TOTAL 3085305 139.90 85305

PROTEIN S FREE 3085306 229.00 85306

D DIMER SEMI QUANTATIVE 3085378 73.10 85378

D DIMER QUANTITATIVE 3085379 49.20 85379

D DIMER ULTRASENTATIVE 3085380 73.10 85380

HEPARIN ASSAY 3085520 40.10 85520

IRON STAIN 3085535 43.50 85536

RBC FRAGILITY 3085547 47.70 85547

PLAT AGGREGATION 3085576 66.40 85576

VISCOSITY 3085810 69.80 85810

ALLERGENS EACH 3086003 30.90 86003

IGF QUAL 3086005 108.80 86005

PLATELET AUTO-ANTIBODY PANEL 3086022 145.40 86022

ANA TITER IFA 3086039 69.80 86038

ANTISTREPTOLYSIN O (ASO) ANTIBODIES 3086060 58.40 86060

CHEMOTAXIS 3086155 95.00 86155

COMPLEMENT AG EA 3086160 84.70 86160

COMPLEMENT FUNC EA 3086161 85.90 86161

CH50 3086162 148.40 86162

COMP FIXATION 3086171 60.70 86171

DNA 3086215 79.00 86215

CAT SCRATCH PANEL X 4 3086216 50.40 86611

DS DNA ABS DOUBLE STRANDED 3086225 105.30 86225

DNA (SINGLE STRANDED) ABS IgG QUANT 3086226 93.90 86226

SJOGRENS ANTIBODIES SSB 3086227 53.20 86235

ANTI LIVER KIDNEY MICROSOMAL A 3086255 65.30 86376

HEPATITIS C AB 3086302 81.30 86803

CA 19-9 3086316 163.70 86301

IMMUNOELECTRO SERUM 3086320 122.50 86320

IMMUNOELECTRO OTHER 3086325 122.50 86325

IMMUNOELECTRO 2 D ASSAY 3086327 121.30 86327

IMMUNE COMPLEX 3086332 145.40 86332

IFE, SERUM 3086334 174.00 86334

INSULIN ABS 3086337 128.20 86337

LEUKO PHAGOCYTOSIS 3086344 52.70 86344

T CELLS TOTAL 3086359 225.50 86359

T CELL T4/T8 RATIO 3086360 281.60 86360

THYROID PEROXIDASE ABS 3086376 88.10 86376

RF QUANT 3086431 38.20 86431

CANDIDA SKIN TEST 3086485 41.30 86485

TUBERCULOSIS INTRA DERMAL 3086580 19.50 86580

STREPTOKINASE AB 3086590 61.50 86590

ADENOVIRUS AB 3086603 79.00 86603

ROCKY MOUNTAIN SPOTTED FEVER IGG 3086609 76.70 86757

LYME AB 3086618 100.70 86618



LYME RELAPSE AB 3086619 101.90 86619

CAMPYLOBACTER AB 3086625 99.60 86625

CANDIDA AB 3086628 99.60 86628

CHLAMYDIA AB IGG 3086631 108.80 86631

CHLAMYDIA AB IGM 3086632 117.90 86632

CMV AB 3086644 93.90 86644

CMV IGM AB 3086645 101.90 86645

WESTERN EQUINE AB 3086654 93.90 86654

SACCHAROMYCES CEREVISIAE IgG 3086671 200.30 86671

H PYLORI IgG IgM IgA 3086677 0.00

H PYLORI QUALITATIVE 3086678 87.00 86677

HERPES NON SPECIFIC 3086694 87.00 86694

HERPES VIRUS TYPE 1, IGG 3086695 88.10 86695

HERPES VIRUS TYPE 2, IGG 3086696 129.40 86696

URINARY HISTOPLASMIC ANTIGEN 3086698 129.40 86698

HIV 2 3086702 60.70 86702

LEISHMAMA AB 3086717 73.30 86717

LEPTOSPIRA AB 3086720 93.90 86720

MEASLES MUMPS RUBELLA 3086735 0.00

PARVOVIRUS AB 3086747 137.40 86747

MALARIA AB 3086750 88.10 86750

ROTAVIRUS 3086759 92.70 86759

RUBEOLA IGG ANTIBODIES 3086765 98.50 86765

SALMONELLA AB 3086768 79.00 86768

COSYNTROPIN STIMULATION 3086769 194.60 80400

SHIGELLA AB 3086771 79.00 86771

TETANUS AB 3086774 116.80 86774

TOXOPLASMA AB 3086777 87.00 86777

TOXOPLASMA IGM AB 3086778 120.20 86778

VARICELLA ZOSTER IgM 3086787 81.30 86787

YERSINIA AB 3086793 91.60 86793

THYROGLOBULIN AB 3086800 111.30 86800

HEPATITIS C AB W RFX TO AB VERIFICATION 3086804 171.70 86803

CONCENTRATION SMEAR 3087015 40.10 87015

STOOL CULTURE EXTRA PLATE 3087046 14.90 87046

ANAEROBIC CULTURE ID 3087076 48.10 87076

ORGANISM CULTURE ID 3087077 50.40 87077

CULT URINE ID EA 3087088 50.40 87088

YEAST ID 3087106 97.30 87106

MERITEC STREP ID 3087147 29.80 87147

WET PREP 3087210 33.20 87210

VIRAL CULTURE UPPER RESPIR 3087212 192.90 87252

C DIFF TOXIN A/B 3087230 99.60 87324

VIRUS ID 3087250 116.80 87250

VIRUS ID 3087252 156.80 87252



VIRUS ID 3087253 113.40 87253

CULTURE STAIN 3087254 28.60 87254

C DIFF extra item 3087324 99.60 87324

LEGIONELLA AG URINE 3087450 48.10 87450

HEPATITIS C QUANT, PCR 3087522 256.40 87522

HIV 1 QUANT PCR W RFX TO GENOTYPE 3087536 498.20 87536

MICROBIOLOGY UPS 3087999 66.40 87999

PAP SMEAR W MATURATION I 3088155 31.80 88155

PAP SMEAR W MATURATION II 3088164 47.70 88164

TISSUE CULTURE 3088230 580.40 88230

CHROMOSONE ANALYSIS > 20 CELLS 3088262 621.60 88262

MOLECULAR CYTOGENETICS DNA PRO 3088271 145.40 88271

CHROMOSOMAL IN 10-30 3088273 218.70 88273

ADDITIONAL CELLS COUNTED/EACH 3088285 114.50 88285

BM PROCESSING AND INTERPRETATI 3088305 137.40 88305TC

BM DECALCIFICATION 3088311 30.90 88311TC

WBC BODY FLUID 3089050 21.80 89050

CELL COUNT, CSF 3089051 32.10 89050

SHELLFISH PANEL X 11 3089052 0.00 86003

G6 PD QUANT 3089053 0.00 81250

=>BLOOD BANK ORDER<= 3090000 0.00

=>CANCEL ORDER<= 3090001 0.00

=>PATHOLOGY ORDER<= 3090002 0.00

URINALYSIS 3090004 0.00

PT/INR & APTT 3090005 0.00

HGB & HCT 3090006 0.00

NON-COVERED VENIPUNCTURE 3090007 0.00

BB TYPE & SCREEN 3090008 0.00

BB ABO/RH 3090009 0.00

GLUCOSE TOLERANCE 1HR FASTING 3090012 32.10 82950

GTT 2 HOUR 3090013 87.00 82951

GTT 3 HOUR 3090014 87.00 82951

GTT 4 HOUR 3090015 87.00 82951

GTT 5 HOUR 3090016 87.00 82951

GLUTAMIC ACID DECARBOXYLASE AUTO AB 3090017 55.00 86341

INFLUENZA TYPE A/B FLU 3090020 0.00

BLOOD TYPING DLT 3090030 10.00

CHEMISTRY PROFILE DLT 3090031 30.00

LIPID PANEL DLT 3090032 15.00

THYROID PROFILE DLT 3090033 25.00

CBC W AUTO DIFF DLT 3090034 20.00

PSA DLT 3090035 20.00

A1C DLT 3090036 15.00

VIT D 25 HYDROXY DLT 3090037 30.00

MULTIPHASIC PROFILE DLT 3090038 75.00



O/P LABS 3099999 0.00

CYTO NON GYN SMEAR INTER 3112236 51.50

LEVEL 2 GROSS & MICRO 1ST SITE 3112309 136.20 88302TC

IMM EVAL FOR ADEGNACY FNA 3112900 115.60 88172TC

ESTROGEN RECEPTOR IP 3112901 161.40 88342TC

IHC 1ST AB 3112903 233.20 88342TC

IMMUNOFLUORESCENT STUDY 3112905 159.10 88346TC

IMMUNOCYTOCHEMICAL STUDY 3112907 161.40 88342TC


LEVEL 3 GROSS & MICRO 3RD SITE 3112911 108.80 88304TC

LEVEL 3 GROSS & MICRO 4TH SITE 3112912 108.80 88304TC





LEVEL 4 GROSS & MICRO 3RD SITE 3112917 180.90 88305TC



IHC 1ST AB STAIN X1 GLBL 3112920 233.20 88342TC

HER2 BREAST MD 3112921 948.70 88377TC

IHC EA ADDL AB STAIN x1 3112922 270.30 88341TC

IHC EA ADDL AB STAIN x2 GLBL 3112923 0.00

IHC EA ADDL AB STAIN x4 GLBL 3112924 0.00

CYTOLOGY MISC FLUID 3112930 179.10 88112TC

SPECIAL STAIN, GROUP 1, 2ND SITE 3112931 174.90 88312TC

SPECIAL STAIN, GROUP 1, 3RD SITE 3112932 174.90 88312TC

SPECIAL STAIN, GROUP 2, 2ND SITE 3112933 122.50 88313

SPECIAL STAIN, GROUP 2, 3RD SITE 3112934 122.50 88313

SPECIAL STAIN, GROUP 2, 4TH SITE 3112935 142.00 88313

SPECIAL STAIN, GROUP 2, 5TH SITE 3112936 142.00 88313

LEVEL 1 GROSS ONLY 3112951 51.50 88300TC

LEVEL 3 SIMPLE 3112952 108.80 88304TC

CONSULT FROZEN SECTION 3112954 92.70 88331TC

LEVEL 4 COMPLICATED 3112956 137.40 88305TC

FLUIDS BRUSHINGS WASHINGS 3112961 84.70 88108TC

SMEAR & FILTER/INTERP 3112962 84.70 88108TC

CYTOLOGY SMEAR MISCELLANEOUS 3112975 166.00 88112TC

BREAST DISCHARGE CYTOLOGY 3112976 114.50 88161TC

FINE NEEDLE ASPIRATE FNA 3112977 77.80 88172TC

CYTOLOGY URINE 3112978 166.00 88112

PLEURAL FLUID CYTOLOGY 3112979 127.20 88112TC

DECALCIFICATION PROCEDURE 3112990 36.60 88311TC

SPECIAL STAIN, GROUP 1, 1ST SITE 3112991 159.10 88312TC

CONSULT OUTSIDE SLIDE 3112993 319.40 88321

CONSULT OUTSIDE BLKS SLIDES 3112994 504.90 88323TC



SPECIAL STAIN, GROUP 2, 1ST SITE 3112995 122.50 88313TC







LEVEL 4 COMPLICATED > SLIDE 3113076 180.90 88305TC


LEVEL 5 COMPLEX > 10 SLIDES 3113079 286.20 88307TC


CONSULT OUTSIDE BLOCKS 3 5 BLO 3113083 167.10 88323TC

CONSULT OUTSIDE BLOCKS 6 10 BL 3113084 167.10 88323TC

CONSULT OUTSIDE BLOCKS > 10 3113085 167.10 88323TC

FROZEN ADDITIONAL BLOCKS 3113086 45.80 88332TC

HISTOCHEM WITH FROZEN SECTION 3113088 322.80 88314TC

CYTOCHEM FOR CELL CONSTIRUENTS 3113089 305.70 88319TC

SOLID TUMOR TISSUE CULTURE 3113090 743.00 88239

INTERPHASE ISH 100 300 CELL 3113091 202.60 88275

MOLECULAR CYTOLOGY DNA PRODE 3113092 267.90 88271

PHYSICIAN READ PAP 3113093 103.00 88141

MORPHOMETRIC ANALYSIS TUMOR 3113145 273.60 88342TC

ISH WITH TECHNICAL 3113146 234.70 88365TC

MORPHMETRIC ANALYSIS TUMOR EACH 3113147 171.70 88360TC

IHC 1ST AB STAIN X2 GLBL 3113148 0.00

BK QUANT PCR URINE 3187799 457.90 87799

BB PANEL AB SCREEN 3221053 120.20 86870

BB BLOOD ADMINISTRATION 3222002 471.80 36430

BB PLATE APHER REDUCED IRRADIATED x1 3222003 909.00 P9037

BB CROSSMATCH 3222004 44.60 86922

BB DIRECT ANTIGLOBULIN TEST 3222005 21.80 86880

BB COOMBS INDIRECT 3222006 17.20 86885

BB PRBC LEUKO REDUCED/IRRADIATED 3222007 337.70 P9040

THERAPEUTIC PHLEBOTOMY 3222008 160.10 99195

BB ANTIBODY IDENTIFICATION 3222009 120.20 86870

BB ANTIBODY TITER QUANTITATIVE 3222010 100.70 86886

BB ABO BLOOD TYPE 3222011 29.80 86900

BB ANTIBODY SCREEN 3222012 50.40 86850

BB RH BLOOD TYPE 3222013 22.90 86901

BB 1 UNIT FFP TRANSFUSED 3222014 97.30 P9017

BB ADSORPTION DIFFERENTIAL 3222015 72.10 86978

BB PLATELET CONCENTRATE x1 3222016 131.70 P9019

BB CRYOPRECIPITATES 3222017 75.60 P9012

BB 1 UNIT PACKED RBCS TRANSFUSED 3222018 337.70 P9016

BB COMPAT TEST IMMED SPIN 3222019 61.80 86920



BB PLATELET APHERESIS x1 3222020 909.00 P9035

BB RED CELL ANTIGEN TYPING 3222021 43.50 86905

BB PRESELECTED UNIT 3222022 107.60 86904

BB CROSSMATCH X 1 3222024 0.00

AB ID RBC SERUM TEC 3222025 272.40 86870

ANTIHUMAN GLOBULIN TEST DIRECT EACH ANTI 3222026 36.80 86880

BB OTHER BLOOD 3222999 0.00 86999

COC AMP/METHAM CONFIRM 3223000 51.50 G0480

COC BARBITURATES CONFIRM 3223001 108.20 80345

COC BENZO CONFIRM 3223002 108.20 G0480

COC COCAINE CONFIRM 3223003 108.20

COC METHADONE CONFIRM 3223004 108.20

COC OPIATES-2 CONFRIM 3223005 108.20 80361

COC OXYCODONE CONFRIM 3223006 108.20 80365

COC PHENCYCLIDINE CONFRIM 3223007 108.20 83992

COC PROPOXYPHENE CONFRIM 3223008 108.20 80367

COC CANNABINOID THC CONFIRM 3223009 108.20

COC BUP CONFIRM 3223010 108.20 80301

BB ELUTION 3286860 104.20 86860

BB AB ID EACH 3286870 120.20 86870

BB CROSS AG NEG UNIT 3286904 107.60 86904

BB RH PHENOTYPE COMPLETE 3286906 77.80 86906

BB COMP TEST AHG 3286921 107.60 86904

BB FFP THAWING EA 3286927 158.00 86927

BB AUTO AGGLU SCR 3286940 30.90 86940

BB AUTO AGGLU INCUBAT 3286941 42.40 86941

BB CROSSMATCH X 3 3286942 0.00 P9037

BB CROSSMATCH X 2 3286943 0.00 P9037

BB CROSSMATCH X 4 3286944 0.00

BB PRBC IRRADIATION 3286945 361.80 86945

BB PLATELET POOLING 3286965 44.60 86965

BB PLATELET FILTER 3286966 271.30

BB RED BLOOD CELL FILTER 3286967 129.40

BB PRETEATMENT WITH ENZYMES 3286971 56.10 86971

BB MISC BLOOD BANK 3286999 1,476.80 86999

EKG

EKG-12 LEAD COMP 3327010 155.80 93005

RHYTHM ECG 1-3 LEADS 3327020 54.60 93041

Radiology

ABDOMEN KUB FLAT PLATE 4036000 81.30 74018TC

ACUTE ABDOMINAL SERIES 4036005 321.70 74022TC

ABDOMEN 2 VIEWS 4036010 241.60 74019TC

ACROMIO CLAVICULAR JOINTS 4036020 98.50 73050TC

ANKLE COMPLETE 4036040 95.00 73610TC

ANKLE 2 VIEW 4036041 58.40 73600TC



BARIUM ENEMA 4036050 282.80 74270TC

BARIUM ENEMA WITH AIR CONTRAST 4036060 383.50 74280TC

BARIUM SWALLOW ESOPHOGRAM 4036070 192.30 74220TC

BARIUM SWALLOW WITH FLUOROSCOP 4036080 356.00 74220TC

CERVICAL SPINE 4036120 184.30 72052TC

CERVICAL SPINE AP & LATERAL 4036130 182.00 72040TC

CHEST 2 VIEW 4036140 122.50 71046TC

CHEST SINGLE VIEW 4036150 114.50 71045TC

CHEST WITH LORDOTIC VIEW 4036160 129.40 71047TC

CHOLANGIOGRAM INTRAOPERATIVE 4036190 159.10 74300TC

CHOLANGIOGRAM T TUBE 4036200 147.70 74305TC

CLAVICLE 4036210 77.80 73000TC

DORSAL SPINE THORACIC SPINE 3 VIEWS 4036270 116.80 72072TC

THORACIC SPINE 2 VIEW 4036271 73.30 72070TC

SCREENING MAMMO W/ CAD BILAT OR UNILAT 4036287 424.00 77067TC

DIAGNOSTIC MAMMO W/CAD UNILAT 4036288 344.50 77065TC

DIAGNOSTIC MAMMO W/CAD BILATERAL 4036289 424.00 77066TC

ELBOW COMPLETE 4036310 81.30 73080TC

ELBOW 2 VIEW 4036311 59.50 73070TC

UPPER EXTREMITY INFANT 2 VIEW 4036320 71.00 73092TC

FACIAL BONES COMPLETE 4036330 120.20 70150TC

FACIAL BONES<3 VIEWS 4036331 65.30 70140TC

FEMUR MINIMUM 2 VIEWS 4036340 103.00 73552TC

FEMUR 1 VIEWS 4036341 84.70 73551TC

FINGER MINIMUM OF 2 VIEWS 4036350 81.30 73140TC

FLUOROSCOPY NO FILMS PER 1 HR 4036370 163.70 76000TC

FOOT MINIMUM OF 3 VIEWS 4036380 88.10 73630TC

FOOT 2 VIEW 4036381 58.40 73620TC

FOREARM 2 VIEWS 4036390 76.70 73090TC

UGI SINGLE CONTRAST W KUB 4036430 274.50 74240TC

UGI DOUBLE CONTRAST W/KUB 4036431 321.20 74246TC

SM BOWEL FOLLOW THRU 4036432 163.30 74248TC

HAND MINIMUM OF 3 VIEWS 4036440 85.90 73130TC

HAND 2 VIEW 4036441 58.40 73120TC

CALCANEUS 2 VIEW 4036450 72.10 73650TC

HIP 2-3 VIEWS 4036460 131.70 73502TC

HIP 1 VIEW 4036461 81.30 73501TC

HIP MINIMUM OF 4 4036462 166.00 73503TC

HIPS BILAT W/PELVIS 2 VIEW 4036463 125.90 73521TC

HIPS BILAT W/PELVIS 3-4 VIEW 4036464 154.50 73522TC

HIPS BILAT W/PELVIS MIN 5 VIEWS 4036465 183.20 73523TC

HUMERUS MINIMUM OF 2 VIEWS 4036480 83.60 73060TC

IVP 50CC 4036510 246.10 74400TC

KNEE 1 OR 2 VIEW 4036561 60.70 73560TC

KNEE 4 VIEW 4036562 98.50 73564TC



KNEE WITH SUNRISE VIEW 4036570 98.50 73564TC

LUMBAR SPINE MINIMUM OF 4 VIEWS 4036590 160.30 72110TC

LUMBAR SPINE AP AND LATERAL 4036600 151.10 72100TC

MANDIBLE COMPLETE MIN OF 3 VIEWS 4036610 101.90 70110TC

MASTOIDS MIN OF 3 VIEWS 4036620 133.90 70130TC

NASAL BONES MIN OF 3 VIEWS 4036640 79.00 70160TC

NECK SOFT TISSUE 4036650 69.80 70360TC

ORBITS COMPLETE MIN 4 VIEWS 4036670 123.60 70200TC

PELVIS 1 OR 2 VIEWS 4036710 77.80 72170TC

RIBS UNILATERAL 2 VIEWS 4036740 92.70 71100TC

RIBS UNILAT 2 VIEW PA CHEST 4036742 99.60 71101TC

RIBS BILATERAL 3 VIEWS 4036750 120.20 71110TC

RIBS BILAT INCLUDE PA CHEST 4036751 137.40 71111TC

SACRUM AND COCCYX MIN 2 VIEWS 4036760 84.70 72220TC

SACRO ILIAC JOINTS 3 OR MORE VIEWS 4036770 92.70 72202TC

SCAPULA COMPLETE 4036780 79.00 73010TC

SHOULDER COMPLETE MIN OF 2 VIEWS 4036810 91.60 73030TC

SHOULDER 1 VIEW 4036811 51.50 73020TC

SHOULDER WITH CLAVICLE 4036820 120.20 73030TC

SINUSES MINIMUM OF 3 VIEWS 4036835 139.70 70220TC

SINUSES < 3 VIEWS 4036836 97.30 70210TC

SKELETAL SURVEY ADULT 4036840 229.00 77075TC

SKELETAL SURVEY CHILD 4036845 125.90 77076TC

SKULL COMPLETE MIN OF 4 VIEWS 4036850 139.70 70260TC

SKULL AP AND LATERAL LESS THAN 4 4036860 101.90 70250TC

STERNO CLAVICULAR JOINT MIN OF 3 VIEWS 4036890 99.60 71130TC

STERNUM MINIMUM OF 2 VIEWS 4036900 97.30 71120TC

TEMPRO MANDIBULAR JOINT BILATERAL 4036905 122.50 70330TC

TIB FIB 2 VIEWS 4036910 77.80 73590TC

TOE MINIMUM OF 2 VIEWS 4036915 63.00 73660TC

VOIDING CYSTOURETHROGRAM 4036935 243.80 74450TC

WRIST MINIMUM OF 3 VIEWS 4036940 81.30 73110TC

WRIST 2 VIEWS 4036941 61.80 73100TC

WT BEARING OF KNEES 1 OR 2 VIEWS 4036945 77.80 73560TC

WT BEARING OF FOOT MIN OF 3 VIEWS 4036950 81.30 73630TC

ZYGOMA 4036955 120.20 70150TC

MODIFIED BARIUM SWALLOW 4037005 303.40 74230TC

BONE DENSITY AXIL SKELETON 4037009 480.80 77080TC

CTA NECK 4139999 954.00 70498TC

CT ABDOMEN UNH 4140004 820.40 74150TC

CT ABDOMEN ENH 4140005 992.20 74160TC

CT ABDOMEN ENH & UNH 4140006 1,229.60 74170TC

CT CERVICAL SPINE ENH 4140007 1,025.00 72126TC

CT CERVICAL SPINE UNH 4140008 856.50 72125TC

CT CERVICAL SPINE ENH & UNH 4140009 1,280.50 72127TC



CTA HEAD 4140010 954.00 70496TC

CT HEAD ENH 4140013 820.40 70460TC

CT HEAD UNH 4140014 685.80 70450TC

CT HEAD ENH & UNH 4140015 1,025.00 70470TC

CT LOWER EXTREMITY ENH 4140017 856.50 73701TC

CT LOWER EXTREMITY UNH 4140018 718.70 73700TC

CT LOWER EXTREMITY ENH & UNH 4140019 1,075.90 73702TC

CT LUMBAR SPINE ENH 4140020 1,025.00 72132TC

CT LUMBAR SPINE UNH 4140021 856.50 72131TC

CT LUMBAR SPINE ENH & UNH 4140022 1,280.50 72133TC

CT MAXILLOFACIAL AREA ENH 4140023 820.40 70487TC

CT MAXILLOFACIAL AREA UNH 4140024 685.80 70486TC

CT MAXILLOFACIAL AREA ENH &UNH 4140025 1,025.00 70488TC

CT ORBIT SELLA POST FOSSA ENH 4140026 820.40 70481TC

CT ORBIT SELLA POST FOSSA UNH 4140027 685.80 70480TC

CT ORB SEL P FOSSA ENH &UNH 4140028 1,025.00 70482TC

CT PELVIS ENH 4140029 992.20 72193TC

CT PELVIS UNH 4140030 856.50 72192TC

CT PELVIS ENH & UNH 4140031 1,229.60 72194TC

CT SOFT TISSUE NECK ENH 4140032 820.40 70491TC

CT SOFT TISSUE NECK UNH 4140033 685.80 70490TC

CT SOFT TISSUE NECK ENH & UNH 4140034 1,025.00 70492TC

CT THORACIC SPINE ENH 4140035 1,025.00 72129TC

CT THORACIC SPINE UNH 4140036 856.50 72128TC

CT THORACIC SPINE ENH & UNH 4140037 1,280.50 72130TC

CT THORAX ENH 4140038 1,025.00 71260TC

CT THORAX UNH 4140039 856.50 71250TC

CT THORAX ENH & UNH 4140040 1,280.50 71270TC

CT UPPER EXTREMITY ENH 4140041 856.50 73201TC

CT UPPER EXTREMITY UNH 4140042 718.70 73200TC

CT UPPER EXTREMITY ENH & UNH 4140043 1,075.90 73202TC

CT W WO CONTRAST STUDIES ADDITION 4140065 483.40 A9579TC

CT ABDOMEN AND PELVIS WO CONT 4140085 729.50 74176TC

CT ABDOM & PELVIS W CONTRAST 4140086 963.50 74177TC

CT ABD & PELVIS W WO CONTRAST 4140087 1,802.00 74178TC

CTA NECK W WOUT CONTRAST 4140100 887.20 70498TC

CTA AORTA W RUNOFF 4140101 1,033.50 75635TC

CTA ABDOMEN 4140102 1,033.50 74175TC

CTA CHEST 4140103 1,033.50 71275TC

CTA PELVIS 4140104 1,033.50 72191TC

CTA LOWER EXTREMITY 4140105 1,033.50 73706TC

CTA UPPER EXTREMITY 4140106 1,035.10 73206TC

CTA ABDOMEN AND PELVIS 4140107 1,033.50 74174TC

CT BONE STUDY AXIAL SKELETON 4141000 381.60 77078TC

MRI THORACIC WO CONTR W CONTR 4240001 3,290.20 72157TC



MRI C-SPINE WO CONTR & W CONT 4240002 3,290.20 72156TC

MRI BRAIN WO CONTRAST W CONTR 4240003 3,290.20 70553TC

MRI ORBIT FACE AND NECK 4240044 1,592.10 70540TC

MRI BRAIN WO CONTRAST 4240045 1,626.00 70551TC

MRI CERVICAL SPINE WO CONTRAS 4240046 1,626.00 72141TC

MRI DORSAL SPINE WO CONTRAST 4240047 1,802.00 72146TC

MRI LUMBAR SPINE WO CONTRAST 4240048 1,802.00 72148TC

MRI UPPER EXTR JOINT WO CONTR 4240049 1,592.10 73221TC

MRI LOWER EXT JOINT WO CONTRA 4240050 1,592.10 73721TC

MRI ABDOMEN WO CONTRAST 4240051 1,601.70 74181TC

MRI PELVIS w/ CONTRAST 4240052 1,838.00 72196TC

MRI CHEST WO CONTRAST 4240053 1,601.70 71550TC

MRI CHEST GATED WO CONTRAST 4240054 1,601.70 71550TC

MRI ORB FACE NECK WO CONTRAST 4240055 830.00 70540TC

MRI BRAIN WITH CONTRAST 4240056 1,947.20 70552TC

MRI CERVICAL SPINE W CONTRAST 4240057 1,947.20 72142TC

MRI THORAC SPINE W CONTRAST 4240058 1,947.20 72147TC

MRI LUMBAR SPINE W CONTRAST 4240059 1,947.20 72149TC

MRI SPINAL CANAL WO CONT W CO 4240060 3,290.20 72156TC

MRI ORB FACE NECK W CONTRAST 4240061 1,056.80 70542TC

MRI ORB FACE NECK W WO CONT 4240062 1,290.00 70543TC

MRI LUMBAR SPINE WO CONT W CO 4240064 3,248.90 72158TC

MRI TEMPOROMANDIBULAR JOINT 4240065 1,584.70 70336TC

MRI UPPER EXTREMITY NONJOINT 4240066 1,576.20 73218TC

MRI LOWER EXT NON JOINT WO CO 4240067 1,576.20 73718TC

MRI ABDOMEN W CONTRAST 4240069 1,756.40 74182TC

MRI ABDOMEN WO CONTRAST W CON 4240070 3,248.90 74183TC

MRI LOWER EXTR JOINT W CONTRAS 4240071 1,751.10 73722TC

MRI LOWER EXT JOINT WO & W CO 4240072 3,241.50 73723TC

MRI LOW EXT N JOINT W CONTRAST 4240073 1,751.10 73719TC

MRI LOW EXT N JOINT WO & W CO 4240074 3,241.50 73720TC

MRI UPPER EXT WO CONT W CONTR 4240075 3,241.50 73223TC

MRI UPPER EXT NON JOINT W CONT 4240076 1,751.10 73219TC

MRI UPPER EXT N J WO C W CONT 4240077 3,241.50 73220TC

MRI UPPER EXT JOINT W CONTRAST 4240079 1,751.10 73222TC

MRA NECK 4240080 1,609.10 70547TC

MRA HEAD 4240081 1,609.10 70544TC

MRA ABDOMEN 4240082 1,609.10 74185TC

MRA LOWER EXTREMITY 4240083 1,155.40 73725TC

MRI PELVIS w/o CONTRAST 4240084 828.90 72195TC

MRA NECK W CONT FOLLOW W O CONTRAST 4240085 2,120.00 70549TC

MRI PELVIS w/o CONTRAST FOLLOWw/CONTRAST 4240086 2,226.00 72197TC

US COMPLETE ABDOMINAL SCAN 4338000 312.30 76700TC

US GUIDED THORACENTESIS 4338001 106.00 76942TC

US ABDOMEN LIMITED 4338015 227.10 76705TC



US KIDNEY LIMITED 4338020 301.30 76775TC

US BREAST UNILATERAL 4338023 223.80 76641TC

US BREAST UNILATERAL LIMITED 4338024 175.80 76642TC

US KIDNEY COMPLETE 4338026 301.30 76770TC

US PANCREAS SCAN 4338030 227.10 76705TC

US SOFT TISSUE HEAD NECK 4338035 222.70 76536TC

US AORTA SCAN 4338040 301.30 76770TC

US SCROTUM/TESTICULAR 4338045 244.60 76870TC

US COMPLETE PREGNANCY SCAN 4338050 353.70 76805TC

US PREGNANCY SCAN < 14 WEEKS 4338051 273.00 76801TC

US EXTREMITY NON VASCULAR 4338055 215.10 76881TC

US FETAL AGE US 4338060 223.80 76815TC

US OF THE CHEST 4338065 242.40 76604TC

US PELVIS 4338070 253.30 76856TC

US BLADDER 4338075 169.20 76705TC

US LIVER 4338080 227.10 76705TC

US UPPER ABDOMEN 4338090 315.50 76700TC

US ABDOMINAL DUPLEX SCAN 4338092 715.10 93975TC

US COLOR DOPPLER 4338095 349.40 93976TC

US GUIDE VASCULAR ACCESS 4338096 227.90 76937TC

US UNLISTED ULTRASOUND PROC. 4338999 215.10 76999TC

DOPPLER ECHO COMPLETE 4339001 436.70 93320TC

ECHO COLOR FLOW 4339002 436.70 93325TC

US CAROTID DUPLEX SCAN 4339003 444.40 93880TC

US VENOUS DUPLEX BI LATERAL 4339004 493.50 93970TC

US ARTERIAL SCAN 4339005 312.70 93923TC

US ARTERIAL ABI SCAN 4339006 207.80 93922TC

US LEA W/DUPLEX BILAT 4339007 505.60 93925TC

US VENOUS DUPLEX UNI LATERAL 4339008 409.40 93971TC

US ECHOCARDIOGRAM 4339009 1,696.00 93306TC

US LEA W/DUPLEX UNILAT 4339010 344.50 93926TC

US UEA W/DUPLEX BILAT 4339011 461.10 93930TC

US UEA W/DUPLEX UNI 4339012 282.00 93931TC

US CHEST REAL TIME W IMAGE DOCUM 4376604 152.90 76604TC

US TRANSVAGINAL OB 4376817 163.80 76817TC

US TRANSVAGINAL US 4376830 198.70 76830TC

US EXTREMITY NONVASCULAR REAL TIME 4376882 114.60 76882TC

US ECHO 2D LIMITED 4393308 466.08 93308TC

US ECHO DURING STRESS TEST 4393350 207.40 93350TC

US CHEST 43376604 375.80 76604TC

NM BONE SCAN WHOLE BODY 4445000 586.30 78306TC

NM BONE SCAN LIMITED 4445005 343.80 78300TC

NM TOMOGRAPHIC SINGLE STUDY 4445009 804.50 78451TC

NM STRESS EXERCISE 4445014 865.50 93017

NM RADIOISOTOPE SESTAMIBI 4445015 579.00 A9500



NM CARDIAC SPECT 4445018 2,341.70 78452TC

NM BONE SCAN TRIPLE PHASE 4445025 657.00 78315TC

NM GI BLEEDING BLOOD LOSS STUDY 4445030 669.20 78278TC

NM HEPATOBILIARY SCAN 4445040 503.40 78227TC

NM CHOLECYSTOKININ CCK 5MCG 4445041 182.90 A9510

NM THALLIUM PER MILLICURRIES 4445042 106.70 A9505

NM LIVER SPLEEN SCAN 4445050 401.10 78215TC

NM PULMONARY IMAGING 4445060 471.80 78580TC

NM MECKELS SCAN 4445080 419.30 78290TC

NM KIDNEY SCAN W FLOW 4445090 487.60 78701TC

NM TESTICULAR SCAN W FLOW 4445100 440.10 78761TC

NM I-123 RADIOPHARMACEUTICAL 4445111 231.60 A9516

NM SESTAMIBI PARATHYROID SCAN 4445112 848.00 78010TC

NM DTPA UPTO 25 MCI 4445151 320.00 A9539

NM TC-99 OXIDRONATE DIAG 30 MILLI 4445152 228.60 A9561

NM LEXISCAN REGADENOSON 0.1MG 4445153 520.50 J2785

NM TC-99 M SULFUR COLLOID 4445155 304.80 A9541

NM GASTRIC EMPTYING STUDY 4445156 822.80 78261TC

NM TC-99 m MERTIATIDE MAG3 4445157 763.20 A9562

NM RENAL SCAN W FLOW MULTIPLE STUDY 4445158 816.20 78709TC

NM OTHER NUCLEAR MEDICINE 4445999 0.00 78999

NM THYROID UPTAKE SINGLE OR MULT DETER 4478012 188.90 78012TC

NM THYROID SCAN INCLUDING VASC FLOW 4478013 384.00 78013TC

NM THYROID SCAN SINGLE OR MULTIP DETER 4478014 621.70 78014TC

Pharmacy

FAMOTIDINE (PEPCID) 20MG TAB 5046281 4.20

QUETIAPINE (SEROQUEL) 25MG TAB 5046282 4.20

GEL DRESSING (SAF-GEL) 85GM (NF) 5046283 39.20

INSULIN NPH-REG (NOVOLIN 70-30) 10ML VIA 5046284 48.20 J1815

FAMOTIDINE (PEPCID) 20MG INJ 5046288 15.10 S0028

COLESEVELAM (WELCHOL) 625MG TAB (NF) 5046291 5.80

CEFDINIR (OMNICEF) 300MG CAP 5046292 4.20

IPRATROPIUM (ATROVENT) 0.5MG/2.5ML NEB 5046305 4.20 J7644

1/2 NS WITH 20MEQ KCL 1000ML 5050012 29.90

NS 100ML MINIBAG PLUS 5050014 23.70

D5 1/2 NS WITH 20MEQ KCL 1000ML 5050039 29.90


NS WITH 20MEQ KCL 1000ML 5050047 29.90

MANNITOL (OSMITROL) 20% 500ML 5050052 72.20

POTASSIUM CHLORIDE 20MEQ/100ML 5050450 14.50

POTASSIUM CHLORIDE 10MEQ/100ML 5050451 14.00

D5NS WITH 20MEQ KCL 1000ML 5050452 29.90


NS 100ML ADVANTAGE BAG 5051565 23.70

BANANA BAG 1000ML 5054127 133.90



D5NS WITH 40MEQ KCL 1000ML 5054373 29.90

NS WITH 40MEQ KCL 1000ML 5054375 29.90

VALACYCLOVIR (VALTREX) 500MG TAB 5060002 7.30

GLYCOPYRROLATE (ROBINUL) 0.2MG/ML V 5060004 8.60 J7643

CLARITHRO (BIAXIN) 250MG/5ML (FOR ER USE 5060009 20.10

POTASSIUM CL (KLOR-CON) 20MEQ TAB 5060012 4.20

HYDRALAZINE (APRESOLINE) 10MG TAB 5060013 4.20


LORAZEPAM (ATIVAN) 2MG/ML INJ 5060015 4.20 J2060

AMOX-CLAV (AUGMENTIN) 500-125MG TAB (NF) 5060018 4.20

AMOX-CL (AUGMENTIN) 250-62.5/5 100ML 5060021 147.30

ADENOSINE (ADENOCARD) 6MG/2ML INJ 5060031 39.80 J0153

ALLOPURINOL (ZYLOPRIM) 100MG TAB 5060032 4.20

CEPHALEXIN (KEFLEX) 250MG CAP 5060039 4.20

PEG-ELECTROLYTE (GOLYTELY) 4000ML 5060044 24.40

INSULIN (NOVOLN 70-30) 100U/ML 5060047 0.90 J1815

CALCIUM (OYSTER SH) 500MG TAB (NF) 5060056 4.20

MORPHINE 30MG/30ML PCA (NF) 5060058 29.30 J2270

MEPERIDINE (DEMEROL) 300MG/30ML PCA (NF) 5060059 30.60 J2175

LISINOPRIL (ZESTRIL) 5MG TAB 5060060 4.20

HYDROCORTISONE (SOLU-CORTEF) 100MG 5060063 39.40 J1720

ACETAMINOPHEN (TYLENOL) 500MG TAB 5060072 4.20

ACETAMIN (TYLENOL) 160MG/5ML PER 5ML 5060079 4.20 J3490

CLONIDINE (CATAPRES-TTS-1) 0.1MG/24 5060081 42.40

CEPHALEXIN (KEFLEX) 500MG CAP 5060083 4.20

CIPROFLOXACIN (CIPRO) 200MG/100ML 5060087 7.50 J0744

CIPROFLOXACIN (CIPRO) 400MG/200ML 5060088 8.10 J0744

LIDOCAINE VISC (XYLO VISC) 2% 15ML 5060090 4.20

DIVALPROEX (DEPAKOTE SPRINK) 125MG 5060096 4.20

FLUCONAZOLE (DIFLUCAN) 100MG TAB (NF) 5060099 4.20

ERYTHROMYCIN 5MG/GM EYE OINT 5060104 58.50

BACLOFEN (LIORESAL) 10MG TAB 5060112 4.20

MUPIROCIN (BACTROBAN) OINT X1 DOSE (ER) 5060115 4.20 J3490

IMIPENEM-CILA (PRIMAXIN) 500MG VIAL 5060133 47.50 J0743

CLOTRIMAZOLE (LOTRIMIN) 1% CR 30GM 5060141 5.50

SULFACETAMIDE (SULAMYD) 10% EYE SOLN 5060142 116.30

TRAZODONE (DESYREL) 50MG TAB 5060148 4.20

VERAPAMIL ER (CALAN SR) 180MG TAB (NF) 5060150 4.20


IRON DEXTRAN (INFED) 100MG/2ML VL (NF) 5060174 101.10 J1750

ISOSORB MONO (ISMO/MONOKET) 20MG (NF) 5060176 4.20

MAGNESIUM SULFATE 1GM/2ML VIAL 5060190 6.60 J3475

LORAZEPAM (ATIVAN) 0.5MG TAB 5060193 4.20

AMLODIPINE (NORVASC) 5MG TAB 5060208 4.20

PROMETHAZINE (PHENERGAN) 25MG TAB 5060213 4.20




BUPIVACAINE (MARCAINE) 0.5% SDV 5060224 6.20


MECLIZINE (ANTIVERT) 12.5MG TAB (NF) 5060230 4.20

SIMETHICONE (GAS-X) 80MG TAB 5060234 4.20

SODIUM BICARBONATE 650MG TAB 5060237 4.20

SODIUM BICARBONATE 4.25% 10ML SYRG 5060238 33.60

MECLIZINE (ANTIVERT) 25MG TAB 5060240 4.20

LEVOTHYROXINE (SYNTHROID) 125MCG (NF) 5060244 4.20

ASCORBIC ACID (VITAMIN C) 500MG TAB 5060261 4.20

CEFUROXIME (ZINACEF) 1.5GM VIAL 5060263 15.00 J0697

AZITHROMYCIN (ZITHROMAX) 250MG TAB 5060264 4.20

SERTRALINE (ZOLOFT) 50MG TAB 5060267 4.20

MIDAZOLAM (VERSED) 10MG/2ML INJ 5060270 4.20 J2250

MIDAZOLAM (VERSED) 2MG/2ML INJ 5060271 4.00 J2250

PENTOXIF ER (TRENTAL) 400MG TAB (NF) 5060278 4.20

FENTANYL (DURAGESIC) 100MCG/HR (NF) 5060280 115.30

OXYCODONE CR (OXYCONTIN) 20MG TAB (NF) 5060281 21.70

CLOPIDOGREL (PLAVIX) 75MG TAB 5060282 4.20

NOREPINEPHRINE (LEVOPHED) 4MG/4ML 5060290 40.50

TROLA SALIC (ASPERCREME) 10% 90GM 5060294 11.00

LEVOTHYROXINE (SYNTHROID) 25MCG TAB 5060300 4.20

NITRO (NITROSTAT) 0.4MG TAB 5060301 4.20 J3490

PROMETHAZINE (PHENERGAN) 25MG/ML VL 5060302 8.90 J2550

ASPIRIN-DIPY ER (AGGRENOX) 25-200MG (NF) 5060303 15.50

ENOXAPARIN (LOVENOX) 80MG/0.8ML 5060307 26.90 J1650


SENNOSIDES (SENOKOT) 8.6MG TAB 5060312 4.20

SOTALOL (BETAPACE) 80MG TAB (NF) 5060314 4.20

ISOSORB MONO ER (IMDUR) 60MG TAB (NF) 5060316 4.20

ALENDRONATE (FOSAMAX) 70MG TAB 5060319 4.20

LORATADINE (CLARITIN) 5MG/5ML UD (NF) 5060324 4.20

PHENB-HY-ATR-SC (DONNATAL) TAB (NF) 5060325 15.70

GABAPENTIN (NEURONTIN) 100MG CAP 5060329 4.20

BACITRAC-POLY (POLYSPORIN) POWD (NF) 5060332 39.80

NITRO (NITRO-BID) OINT X1 DOSE (ER ONLY) 5060333 4.20

GLIPIZIDE (GLUCOTROL) 5MG TAB 5060334 4.20

LEVOTHYROXINE (SYNTHROID) 100MCG TA 5060340 4.20

GUAIFEN-COD (ROBTUSS AC) 100-10/5ML 5060341 4.20

INFLUENZA (FLUZONE) 0.5ML - DO NOT USE 5060347 68.44 90686


CHARCOAL/SORB (ACTIDOSE-SORB) 25GM 5060353 67.40

AMOXICILLIN 250MG/5ML 5ML (FOR ER USE) 5060354 4.20

VALPROIC ACID (DEPAKENE) 250MG CAP (NF) 5060356 4.20

DIPHENHYDR (BENADRYL) 50MG/ML INJ 5060357 4.20 J1200



CIPROFLOXACIN (CIPRO) 500MG TAB 5060358 4.20

RALOXIFENE (EVISTA) 60MG TAB (NF) 5060359 15.50

LIDOCAINE (XYLOCAINE) 100MG/5ML SYR 5060360 11.10 J2001

GLYCERIN CHILD SUPPOSITORY 5060361 4.20

PREDNISOLONE (ORAPRED) 15MG/5ML UD 5060365 4.20 J7510

PYRIDOXINE (VITAMIN B6) 100MG/ML VL 5060367 37.00 J3415

DIGOXIN (LANOXIN) 0.5MG/2ML AMP 5060371 15.30 J1160

LAMIV-ZIDOV (COMBIVIR) 150-300MG TA (NF) 5060374 5.30

INDINAVIR (CRIXIVAN) 400MG CAP (NF) 5060378 10.90

POTASSIUM CL (KLOR-CON) 10MEQ TAB 5060383 4.20

AL-MAG HYDR-SIMETH (MYLANTA) 30ML 5060386 4.20

TRIAM-HCTZ (DYAZIDE) 37.5MG-25MG CAP 5060387 4.20

TETANUS-DIPH TOX (TENIVAC) 0.5ML SY 5060394 96.90 90714

MEDROXYPROGEST (PROVERA) 2.5MG TAB 5060398 4.20

AMMONIUM LACT (LAC-HYDRIN) 12% LOT 5060411 13.70

MEGESTROL (MEGACE) 400MG/10ML UD (NF) 5060412 11.40

PHENYTOIN ER (DILANTIN) 100MG CAP 5060413 4.20

HALOPERIDOL (HALDOL) 5MG/ML VIAL 5060414 5.50 J1630

BENZONATATE (TESSALON) 100MG CAP 5060415 4.20

CLOTRIM-BETA (LOTRISONE) CR 15GM 5060416 60.60

DILTIAZEM CD (CARDIZEM CD) 300MG (NF) 5060417 4.20

DILTIAZEM CD (CARDIZEM CD) 240MG (NF) 5060418 4.20

CEFDINIR (OMNICEF) 125MG/5ML (FOR ER USE 5060422 7.70

GLIPIZ ER (GLUCOTROL XL) 2.5MG TAB (NF) 5060424 4.20

LIDOCAINE (XYLOCAINE) 2% JELLY 30ML 5060430 298.90

GLUCAGON (GLUCAGEN) 1MG VIAL 5060431 445.50 J1610

PHENYLEPHRINE (NEO-SYN) 10MG/ML VIAL 5060432 23.80 J2370

ORPHENADRINE (NORFLEX) 60MG/2ML INJ 5060433 35.50 J2360

AMIODARONE (CORDARONE) 150MG/3ML INJ 5060438 4.20 J0282

LIDOCAINE (XYLOCAINE) 1% SDV 5060439 6.80 J2001

BUSPIRONE (BUSPAR) 5MG TAB 5060440 4.20


PHYTONADIONE (VITAMIN K) 10MG/ML 5060443 125.70 J3430

SODIUM CHLORIDE 1GM TAB (NF) 5060450 4.20

FLUOXETINE (PROZAC) 20MG CAP 5060451 4.20

LIDO-EPI (XYLO-EPI) 2%-1:100,000 MD 5060453 6.20

CLINDAMYCIN (CLEOCIN) 600MG/50ML 5060459 19.00 S0077

CLINDAMYCIN (CLEOCIN) 900MG/50ML 5060460 34.60 S0077

COCAINE 4% TOP SOLN 4ML VL 5060461 855.00

PROPARACAINE (ALCAINE) - 1 APPLIC 5060468 4.20

NABUMETONE (RELAFEN) 500MG TAB (NF) 5060469 4.20

NICOTINE (NICODERM CQ) 21MG/24HR PATCH 5060470 5.20


FLUCONAZOLE (DIFLUCAN) 150MG TAB 5060476 4.20

METOPROLOL ER (TOPROL XL) 25MG TAB 5060477 4.20



NEO-POLY-HC (CORTISPORIN) OTIC SUSP 5060478 91.00


CEPHALEXIN (KEFLEX) 250MG/5ML 100ML 5060482 32.30

DICLOFENAC POT (CATAFLAM) 50MG TAB (NF) 5060484 4.20

SODIUM BICARBONATE 8.4% 10ML SYRG 5060485 30.00

LIDOCAINE (XYLOCAINE) 4% TOP - 1 AP 5060488 11.70

RABIES IG (HYPERRAB) 300 U/ML 5ML 5060489 11,109.00 90375

TUBERCULIN (TUBERSOL) 5 TU/0.1ML 5060490 13.50 86580

FLUOR-BENOX (FLURATE) - 1 APPLIC 5060491 4.20

TROPICAMIDE (MYDRIACYL) 1% - 1 APPL 5060492 12.70

PROTAMINE 250MG/25ML VL 5060494 147.50 J2720

DROPERIDOL (INAPSINE) 5MG/2ML AMP (NF) 5060495 4.20 J1790

BUPIVACAINE (MARCAINE) 0.25% MDV 5060496 5.60

TICARCILLIN-CLV (TIMENTIN) 3.1GM VL (NF) 5060502 50.90 S0040

CARBAMIDE PEROX (DEBROX) 6.5% OTIC 5060506 5.60

OXYTOCIN (PITOCIN) 10 UNITS/ML VL 5060510 5.80 J2590

NITROGLYCERIN (NITRO-DUR) 0.1MG/HR (NF) 5060511 4.20

NITROGLYCERIN (NITRO-DUR) 0.2MG/HR 5060512 4.20

LOPERAMIDE (IMODIUM) 2MG CAP 5060513 4.20

HEPATITIS B (RECOMBIVAX) 10MCG/ML 5060516 152.90 90746

HEPATITIS B IMMUNE GLOB (NABI-HB) 5060517 2,096.60 J1571

VALSARTAN (DIOVAN) 80MG TAB 5060524 4.20

AZITH (ZITHROMAX) 200MG/5ML (FOR ER USE) 5060526 15.50

TOLTERODINE ER (DETROL LA) 2MG CAP (NF) 5060529 16.00

ACETIC ACID 0.25% 1000ML IRRIG SOLN 5060532 22.30

RACEPINEPHRINE (S2) 2.25% 0.5ML NEB 5060538 4.20

CILOSTAZOLE (PLETAL) 100MG TAB (NF) 5060543 4.20

OMEGA-3 FISH OIL 1000MG CAP 5060544 4.20

LIDOCAINE (LIDODERM) 5% PATCH 5060545 29.87

ATORVASTATIN (LIPITOR) 80MG TAB (NF) 5060551 4.20

LINEZOLID (ZYVOX) 600MG TAB 5060554 7.30

BALS-PETR-ZINC (FLANDERS) OINT 120G 5060563 26.40

SENNOSIDES-DOCUSATE (SENOKOT-S) TAB 5060564 4.20

TIOTROPIUM (SPIRIVA) HNDHALER 18MCG 5060565 1,020.20

CALCIUM (CALTRATE 600) 600MG TAB 5060568 4.20

CALCIUM 600-VIT D (CALTRATE + D) 5060575 4.20

MEMANTINE (NAMENDA) 10MG TAB 5060577 4.20

LEVALBUTEROL (XOPENEX) 1.25MG/3ML 5060581 5.30 J7614

QUETIAPINE (SEROQUEL) 100MG TAB 5060591 4.20

MELOXICAM (MOBIC) 7.5MG TAB 5060592 4.20

INSULIN ASPART (NOVOLOG) 10ML VIAL (340B 5060596 0.00 J1815

MENINGOCOCCAL (MENACTRA) 0.5ML VL 5060599 464.00 90734

SCOPOLAMINE (TRANSDERM SCOP) PATCH 5060606 48.00

FENOFIBRATE (TRICOR) 145MG TAB 5060607 4.40

METAXALONE (SKELAXIN) 800MG TAB (NF) 5060608 16.10



HYDROXYCHLRQ (PLAQUENIL) 200MG (NF) 5060615 6.20

ROPINIROLE (REQUIP) 0.5MG TAB (NF) 5060618 4.20

MORPHINE 2MG/ML INJ 5060631 11.10 J2270


TOPIRAMATE (TOPAMAX) 25MG TAB 5060639 4.20

DULOXETINE (CYMBALTA) 30MG CAP 5060640 4.20

NYSTATIN (MYCOSTATIN) CR 30GM 5060643 26.50

MORPHINE 100MG/10ML MDV (NF) 5060644 26.60 J2270

ZIPRASIDONE (GEODON) 40MG CAP (NF) 5060645 28.10

FOSPHENYTOIN (CEREBYX) 500MG PE/10M 5060649 103.30


ROSUVASTATIN (CRESTOR) 5MG TAB (NF) 5060652 4.20


VENLAFAXINE ER (EFFEXOR XR) 75MG CAP 5060654 4.20

FEXOFENADINE (ALLEGRA) 180MG TAB (NF) 5060656 4.20

ADENOSINE (ADENOCARD) 12MG/4ML SYRG 5060659 111.00 J0153

TOBRA-DEXA (TOBRADEX) - 1 APPLIC 5060660 9.90

CINACALCET (SENSIPAR) 30MG TAB (NF) 5060662 21.20

PREGABALIN (LYRICA) 50MG CAP 5060667 22.20

DUTASTERIDE (AVODART) 0.5MG CAP (NF) 5060669 4.20

TETANUS-DIPH-APER (ADACEL) 0.5ML INJ 5060677 133.90 90715

ERGOCALCIFEROL (VITAMIN D2) 50,000U CAP 5060681 4.20


DULOXETINE (CYMBALTA) 20MG CAP (NF) 5060686 5.70

MULTIVITAMIN TABLET 5060690 4.20

HUMAN PAPIL 9 (GARDASIL 9) 0.5ML 5060693 724.50 90651

RANOLAZINE ER (RANEXA) 500MG TAB (NF) 5060699 18.20

HYDROXYZINE HCL (ATARAX) 25MG/ML VI (NF) 5060700 10.60 J3410

LABETALOL (TRANDATE) 100MG/20ML MDV 5060702 14.00

ENALAPRIL (VASOTEC) 5MG TAB (NF) 5060703 4.20

PERMETHRIN (NIX) 1% LOTION 60ML 5060713 28.70

HETASTARCH (HESPAN) 6% 500ML 5060716 54.10

SITAGLIPTIN (JANUVIA) 50MG TAB (NF) 5060717 30.40

FEBUXOSTAT (ULORIC) 40MG TAB (NF) 5060720 35.90

ACETYLCYS (MUCOMYST) 20% 30ML VIAL 5060724 32.50

ISOSORB MONO ER (IMDUR) 30MG TAB (RX) 5060725 4.20

DRONEDARONE (MULTAQ) 400MG TAB (NF) 5060733 18.10

BUDES-FORM (SYMBICORT) 160-4.5MCG 5060734 435.40

HEPATITIS B (RECOMBIVAX) 5MCG/0.5ML 5060737 40.10 90744

VITAMIN B12 1000MCG TAB 5060739 4.20

PROPAFENONE (RYTHMOL) 150MG TAB (NF) 5060746 4.20

NYSTATIN (NYSTOP) TOP POWDER 15GM 5060748 22.70

ENALAPRIL (VASOTEC) 20MG TAB (NF) 5060752 4.20


ISOSORBIDE DN (ISORDIL) 20MG TAB (NF) 5060757 4.20



CHOLECALCIFEROL (VIT D3) 1000IU (25MCG) 5060759 4.20

PANTOPRAZOLE (PROTONIX) 40MG TAB 5060767 4.20

DABIGATRAN (PRADAXA) 150MG CAP (NF) 5060801 19.90

SODIUM CHLORIDE 0.9% FLUSH 10ML 5060802 4.20

ACETAM ER (TYLENOL ARTH) 650MG (NF) 5060805 4.20

BUDES-FORM (SYMBICORT) 80-4.5MCG 5060808 431.20


IBUPROFEN (MOTRIN) 400MG TAB 5060810 4.20 J3490

DILTIAZEM (CARDIZEM) 100MG VIAL 5060811 48.40

AMIODARONE (NEXTERONE) 150MG/100ML 5060813 145.80 J0282

AMIODARONE (NEXTERONE) 360MG/200ML 5060814 184.40 J0282

PRAVASTATIN (PRAVACHOL) 40MG TAB 5060816 4.20

DIVALPROEX ER (DEPAKOTE ER) 250MG (NF) 5060817 7.50

ROFLUMILAST (DALIRESP) 500MCG TAB (NF) 5060818 25.50

TRIAMCINOLONE (KENALOG) 0.5% CR 15G 5060819 24.60

IBUPROFEN (MOTRIN) 600MG TAB 5060820 4.20

INFLUENZA INTRANASAL QUAD (FLUMIST) 5060821 93.00 90672

NEBIVOLOL (BYSTOLIC) 2.5MG TAB (NF) 5060824 4.20

CEFAZOLIN (ANCEF) 1GM/50ML DUPLEX 5060825 14.80 J0690

CEFOXITIN/NS (MEFOXIN) 1GM/100ML 5060826 42.40 J0694

CEFTRIAXONE (ROCEPHIN) 1GM/100ML 5060827 0.00 J0696

RIVAROXABAN (XARELTO) 10MG TAB 5060841 37.80

PANTOPRAZOLE (PROTONIX) 20MG TAB 5060845 4.20

LABETALOL (TRANDATE) 100MG TAB (NF) 5060848 4.20

PROBENECID (BENEMID) 500MG TAB (NF) 5060849 4.20

GENTAMICIN 80MG/2ML VIAL (NF) 5060968 8.40 J1580

MAGNESIUM SULFATE 1GM/100ML PREMIX 5060969 20.40 J3475

FENTANYL (DURAGESIC) 50MCG/HR 5061012 18.10

HYDROCOD-ACET (LORCET PLUS) 7.5-650 (NF) 5061017 4.20

COLLAGENASE (SANTYL) OINT 30GM 5061020 807.40

INSULIN NPH (HUMULIN N) 100U/ML 5061031 0.90 J1815

SUMATRIPTAN (IMITREX) 6MG/0.5ML INJ 5061044 32.00 J3030

POT-SOD PHOS (K-PHOS NEUT) 250MG TAB 5061059 4.20

LIDO-EPI (XYLO-EPI) 1%-1:100,000 MD 5061069 4.20 J3490

LIDOCAINE (XYLOCAINE) 2GM/500ML 5061070 26.00 J2001

ATENOLOL (TENORMIN) 25MG TAB 5061079 4.20

MILK OF MAGNESIA 30ML UD 5061086 4.20

MORPHINE ER (MS CONTIN) 15MG TAB 5061097 4.20

ACETAM-COD (TYLENOL #3) 300-30MG TA 5061099 4.20

NALOXONE (NARCAN) 2MG/2ML SYRG 5061112 124.90 J2310


TOBRA-DEXA (TOBRADEX) OPTH 2.5ML 5061134 161.80

METOPROLOL ER (TOPROL XL) 50MG TAB 5061136 4.20

CALCIUM CARB (TUMS) 500MG TAB (NF) 5061142 4.20

TRAMADOL (ULTRAM) 50MG TAB 5061145 4.20



LIDOCAINE (XYLOCAINE) UROJET 5061146 22.30

OXYBUTYNIN (DITROPAN) 5MG TAB 5061150 4.20

VASOPRESSIN (VASOSTRICT) 20 UNITS/ML 5061154 549.70

BISMUTH SUBSAL (PEPTO-BISMOL) 240ML 5061160 5.60

THIAMINE (VITAMIN B1) 100MG TAB 5061161 4.20

WATER FOR INJECTION, STERILE 20ML 5061165 4.20

BUPROPION SR (WELLBUTRIN SR) 100MG (NF) 5061166 4.20

ONDANSETRON (ZOFRAN) 4MG TAB 5061185 4.20



SODIUM CHL (SALINE MIST) 0.65% NSL 5061202 4.20

PAROXETINE (PAXIL) 20MG TAB 5061215 4.20

PHENYTOIN (DILANTIN) 100MG/2ML VL (NF) 5061227 5.00 J1165

PNEUMO 23 VAL (PNEUMOVAX 23) 0.5ML INJ 5061232 321.70 90732

DONEPEZIL (ARICEPT) 5MG TAB 5061235 4.20

PRAVASTATIN (PRAVACHOL) 20MG TAB 5061236 4.20

ESTROGEN (PREMARIN) 0.625MG/GM CRM (NF) 5061241 1,014.10

FINASTERIDE (PROSCAR) 5MG TAB 5061254 4.20

LIDOCAINE VISC (XYLO VISC) 2% 100ML 5061278 36.70

LEVOTHYROXINE (SYNTHROID) 112MCG TA 5061287 4.20


CLARITHROMYCIN (BIAXIN) 500MG TAB (NF) 5061321 14.50

CLARITHROMYCIN (BIAXIN) 250MG TAB 5061322 4.70

BISOPROLOL HCT (ZIAC) 10-6.25MG TAB (NF) 5061332 4.20

CLONIDINE (CATAPRES-TTS-2) 0.2MG/24 5061342 109.00

MULTIVITAMIN WITH MINERALS TAB (NF) 5061346 4.20

PHENOL (CHLORASEPTIC) SPRAY 180ML 5061356 9.40

HYOSCYAMINE (LEVSIN SL) 0.125MG TAB 5061357 4.20

CIPROFLOX (CILOXAN) 0.3% OPTH 5ML 5061359 46.80

LORATADINE (CLARITIN) 10MG TAB 5061363 4.20

CLINDAMYCIN (CLEOCIN) 150MG CAP 5061367 4.20

WARFARIN (COUMADIN) 1MG TAB 5061385 4.20

WARFARIN (COUMADIN) 4MG TAB (NF) 5061386 4.20

TORSEMIDE (DEMADEX) 20MG TAB 5061396 4.20

DIVALPROEX DR (DEPAKOTE) 250MG TAB 5061397 4.20

DEXTROSE/WATER 25% 10ML INF SYRINGE 5061401 18.50

FLUCONAZOLE (DIFLUCAN) 200MG/100ML 5061407 21.70 J1450

DIGOXIN IMMUNE FAB (DIGIFAB) 40MG V (NF) 5061408 12,236.00 J1162

FLUORESCEIN (FLUOR-I-STRIP) 1MG 5061439 4.20

SODIUM CHLORIDE 0.9% FLUSH 3ML 5061443 4.20

GLIPIZ ER (GLUCOTROL XL) 5MG TAB (NF) 5061458 4.20

ACETYLCYS (MUCOMYST) 20% 4ML VL NEB SOLN 5061469 14.80 J7608

NAPROXEN (NAPROSYN) 250MG TAB 5061481 4.20

ALLOPURINOL (ZYLOPRIM) 300MG TAB 5061482 4.20

AMPICILLIN 500MG VIAL (NF) 5061486 6.30 J0290



HYDROCOD-ACET (LORCET) 10-650MG (NF) 5061502 4.20

EZETIMIBE (ZETIA) 10MG TAB 5061503 19.20

LATANOP (XALATAN) 0.005% OPTH 2.5ML 5061551 35.90

NITROFUR MONO/MAC (MACROBID) 100MG 5061596 9.60

ANASTROZOLE (ARIMIDEX) 1MG TAB (NF) 5061609 4.20


FLUTICASONE (FLONASE) 50MCG NSL 5061616 12.40

CEFUROXIME (ZINACEF) 750MG VIAL 5061617 7.30 J0697

CHARCOAL (ACTIDOSE-AQUA) 25GM 5061636 57.00

TAMSULOSIN (FLOMAX) 0.4MG CAP 5061646 4.20

VITAMIN E 400IU CAP (NF) 5061647 4.20

ZOLPIDEM (AMBIEN) 5MG TAB 5061655 4.20

CARBIDOPA-LEVO (SINEMET) 10MG-100MG (NF) 5061660 4.20

CEFAZOLIN (ANCEF) 1GM VIAL 5061661 4.20 J0690

BUPROPION SR (WELLBUTRIN SR) 150MG 5061663 4.20

GEMFIBROZIL (LOPID) 600MG TAB (NF) 5061671 4.20

ALPRAZOLAM (XANAX) 0.25MG TAB 5061672 4.20

ASPIRIN ENTERIC COATED 81MG TAB 5061678 4.20

PROPYLTHIOURACIL 50MG TAB (NF) 5061679 4.20

RISPERIDONE (RISPERDAL) 1MG TAB 5061687 4.20

SULFA-TRIM (BACTRIM DS) 800-160 TAB 5061688 4.20

ALBUTEROL HFA (VENTOLIN HFA) 90MCG 5061693 151.20

TEMAZEPAM (RESTORIL) 15MG CAP (NF) 5061694 4.20

CLONAZEPAM (KLONOPIN) 0.5MG TAB 5061698 4.20

HALOPERIDOL (HALDOL) 5MG TAB 5061701 4.20

TRIAMCIN (KENALOG-40) 40MG/ML VIAL 5061706 38.10 J3301

KETOROLAC (TORADOL) 60MG/2ML INJ 5061715 8.10 J1885

METOPROLOL (LOPRESSOR) 50MG TAB 5061717 4.20

SODIUM BICARBONATE 8.4% 50ML INJ 5061720 35.70

DILTIAZEM CD (CARDIZEM CD) 120MG 5061722 4.20

CLARITHRO (BIAXIN) 250MG/5ML 50ML 5061724 200.80

SPIRONOLACTONE (ALDACTONE) 25MG TAB 5061730 4.20

DILTIAZEM (CARDIZEM) 30MG TAB (NF) 5061734 4.20

SUCRALFATE (CARAFATE) 1GM TAB 5061735 4.20

CARBIDOPA-LEVO (SINEMET) 25MG-100MG 5061736 4.20

POTASSIUM CL (MICRO-K) 10MEQ CAP 5061741 4.20

SILVER SULF (SILVADENE) 1% CR 50GM 5061742 43.80

SILVER SULF (SILVADENE) 1% CR 400GM 5061743 156.60

GUAIFEN-DM (ROBITUSS DM) 200-20/10 5061747 4.20

NITROPRUSSIDE (NITROPRESS) 50MG/2ML 5061750 98.80

OLANZAPINE (ZYPREXA) 5MG TAB (NF) 5061752 4.20

OXYCODONE CR (OXYCONTIN) 10MG TAB (NF) 5061755 13.30

PROPRANOLOL (INDERAL) 1MG/ML VL 5061756 8.50 J1800

SOD PLY SULF (KAYEXALATE) 15GM/60ML 5061761 31.40

AZITHROMYCIN (ZITHROMAX) 500MG VIAL 5061763 11.80 J0456



ACETAMINOPHEN (TYLENOL) 325MG TAB 5061764 4.20

DICYCLOMINE (BENTYL) 10MG CAP (NF) 5061766 4.20

LIDOCAINE-PRILO (EMLA) CR - 1 APPLI 5061768 5.10

METHYLPRED (SOLU-MEDROL) 125MG INJ 5061771 23.90 J2930

NITROGLYCERIN (NITRO-DUR) 0.6MG/HR (NF) 5061775 4.20

ZINC SULFATE 220MG CAP (NF) 5061776 4.20

MULTIVITAMIN (INFUVITE) 10ML INJ 5061780 22.10

CARVEDILOL (COREG) 3.125MG TAB 5061789 4.20

METOCLOPRAMIDE (REGLAN) 10MG/2ML VL 5061795 4.20 J2765

SOD PHOS MB-DB (FLEET CHILD) 59ML 5061797 6.10

LOSARTAN (COZAAR) 25MG TAB 5061803 4.20

CEFTRIAXONE (ROCEPHIN) 500MG VIAL 5061804 4.40 J0696

PIPERACILLIN-TAZO (ZOSYN) 3.375GM V 5061806 12.60 J2543


FENTANYL (SUBLIMAZE) 100 MCG/2 ML INJ 5061809 7.20 J3010

PROMETH-COD (PHENRGN AC) 6.25-10/5M 5061816 4.20

MIRTAZAPINE (REMERON) 15MG TAB 5061818 4.20

GLIPIZ ER (GLUCOTROL XL) 10MG TAB (NF) 5061827 4.20

CELECOXIB (CELEBREX) 100MG CAP 5061830 4.30

NYSTATIN-TRIAM (MYCOLOG) CR 30GM 5061833 101.70

VANCOMYCIN (VANCOCIN) 1GM VL 5061834 37.10 J3370

PROPRANOLOL (INDERAL) 20MG TAB (NF) 5061835 4.20

IBUPRO (MOTRIN) 100MG/5ML PER 5ML 5061838 4.20 J3490

NYSTATIN (MYCOSTAT) 500MU/5ML UD 5061846 6.10

DIPHENHYDR (BENADRYL) 12.5MG/5ML UD 5061850 4.20 J3490

DIPHENOX-ATRO (LOMOTIL) 2.5-0.025MG (NF) 5061853 4.20

ALBUTEROL (PROVENTIL) 2.5MG/3ML NEB 5061854 4.20 J7613

FENTANYL (DURAGESIC) 25MCG/HR 5061857 31.20

AMOX-CL (AUGMENTIN) 250-62.5/5ML (ER USE 5061859 10.30

LACTULOSE (ENULOSE) 20GM/30ML UD 5061863 4.20

AZITHRO (ZITHROMAX) 200MG/5ML 30ML 5061865 61.10

PHENYLEPHRINE (NEO-SYN) 0.25% NSL 5061869 16.00

GUAIFENESIN ER (MUCINEX) 600MG TAB 5061875 4.20

DILTIAZEM CD (CARDIZEM CD) 180MG 5061876 4.20

KETOROLAC (TORADOL) 30MG/ML VIAL 5061886 6.40 J1885

MORPHINE 10MG/5ML ORAL SOLN (NF) 5061897 4.20

METFORMIN (GLUCOPHAGE) 500MG TAB 5061898 4.20

PHENB-HYOS-ATR-SCOP (DONNATAL) ELX (NF) 5061902 15.40

IBUPROFEN (MOTRIN) 100MG/5ML 120ML 5061903 16.30

CITALOPRAM (CELEXA) 20MG TAB 5061907 4.20

NIACIN ER (NIASPAN) 500MG TAB (NF) 5061912 11.40

AMIODARONE (PACERONE) 200MG TAB 5061913 4.20

CLONIDINE (CATAPRES) 0.2MG TAB (NF) 5061914 4.20 J3490

LEVALBUTEROL (XOPENEX) 0.63MG/3ML 5061918 6.40 J7614

EPTIFIBATIDE (INTEGRILIN) 75MG/100M 5061919 660.40 J1327



EPTIFIBATIDE (INTEGRILIN) 20MG/10ML 5061920 480.10 J1327

POLYETHYLENE GLYCOL (MIRALAX) 17GM 5061925 4.20

PIOGLITAZONE (ACTOS) 15MG TAB 5061929 4.20

OXYCOD-ACET (PERCOCET) 5-325MG TAB 5061930 4.20



VERAPAMIL (CALAN) 80MG TAB 5061937 4.20


MEDROXYPROGEST (DEPO-PROVERA) 150MG 5061940 127.60 J1050

GLYBURIDE (DIABETA) 5MG TAB (NF) 5061942 4.20

PHENYLEPHRINE (ANUSOL) SUPP (NF) 5061947 4.20

METOPROLOL (LOPRESSOR) 5MG/5ML VL 5061956 4.20

SOLIFENACIN (VESICARE) 5MG TAB (NF) 5061962 35.10

ENOXAPARIN (LOVENOX) 100MG/ML 5061981 33.70 J1650

MUPIROCIN (BACTROBAN) 2% OINT 22GM TUBE 5061982 29.30

METOPROLOL (LOPRESSOR) 25MG TAB 5061991 4.20

TENECTEPLASE (TNKASE) 50MG KIT 5062003 13,581.40 J3101

ACETAZOLAMIDE (DIAMOX) 250MG TAB (NF) 5062004 10.30

ACETAZOLAMINE (DIAMOX) 500MG VIAL 5062006 213.30 J1120

OSELTAMIVIR (TAMIFLU) 75MG CAP 5062008 20.90

MOXIFLOXACIN (AVELOX) 400MG/250ML (NF) 5062010 37.20 J2280

MONTELUKAST (SINGULAIR) 10MG TAB 5062094 4.20

HYDROCOD-ACET (LORTAB) 5-500MG TAB (NF) 5062095 4.20

PEN G BENZ (BICILLIN LA) 1.2MU/2ML 5062110 257.50 J0561

CIPROFLOXACIN (CIPRO) 250MG TAB 5062201 4.20

IPRATROP HFA (ATROVENT HFA) (NF) 5062204 778.90

MOXIFLOXACIN (AVELOX) 400MG TAB (NF) 5062211 75.70

PROMETHAZINE (PHENERGAN) 25MG SUPP 5062214 20.60

PROMETHAZINE (PHENERGAN) 12.5MG SUP 5062215 29.20

BENZTROPINE (COGENTIN) 1MG TAB (NF) 5062280 4.20

BENZTROPINE (COGENTIN) 2MG/2ML INJ 5062300 129.40 J0515

MULTIVITAMIN WITH IRON TAB (NF) 5062380 4.20

NAFCILLIN 1GM VL 5062481 21.00 S0032

NAFCILLIN 2GM VL 5062484 86.40 S0032


VERAPAMIL (CALAN) 5MG/2ML VL 5062649 33.90

ACETAMIN (TYLENOL) 160MG/5ML 120ML 5062861 9.30

ACETAM-COD (TYLENOL-COD) 120-12/5ML (NF) 5062862 4.20

ACETAMINOPHEN (TYLENOL) 120MG SUPP 5062879 4.20


BISACODYL EC (DULCOLAX) 5MG TAB 5063140 4.20

BISACODYL (DULCOLAX) 10MG SUPP 5063150 4.20

CALCIUM CHLORIDE 1GM/10ML INJ 5063300 32.00

CALCIUM GLUCONATE 1GM/10ML VIAL 5063311 25.80 J0610

AMITRIPTYLINE (ELAVIL) 10MG TAB (NF) 5063330 4.20



AMITRIPTYLINE (ELAVIL) 25MG TAB 5063340 4.20

AMOXICILLIN (AMOXIL) 250MG CAP 5063370 4.20

AMOXICILLIN (AMOXIL) 500MG CAP 5063380 4.20

ARTIFICIAL TEARS (LIQUITEARS) 15ML 5063390 10.30

ASPIRIN 325MG TAB 5063400 4.20

ASPIRIN ENTERIC (ECOTRIN) 325MG TAB 5063410 4.20

ASPIRIN CHEWABLE 81MG TAB 5063420 4.20

AMPICILLIN-SULB (UNASYN) 3GM VIAL 5063444 14.00 J0295

ATROPINE 0.4MG/ML VIAL 5063461 16.90

ATROPINE 1MG/10ML SYRINGE 5063462 36.40

BACITRACIN EYE OINT 5063520 248.90

DOXYCYCLINE 100MG TAB 5063700 6.70

INSULIN (LEVEMIR) 100U/ML 5063703 0.90 J1815

INSULIN DETEMIR (LEVEMIR) 10ML VIAL (NF) 5063704 234.80 J1815

CLOBETASOL (TEMOVATE) 0.05% CR 15GM 5063705 118.90

OXYCODONE IR (OXY IR) 5MG TAB 5064014 4.20

EPOETIN A (EPOGEN) 20,000 UNITS/ML 5064031 1,012.60 J0885

FOLIC ACID 1MG TAB 5064040 4.20

CEFTAZIDIME (FORTAZ) 1GM VIAL 5064041 12.30 J0713

INSULIN (NOVOLOG) 100U/ML 5064053 0.90 J1815

FOLIC ACID 5MG/ML 10ML MDV 5064060 47.40

FUROSEMIDE (LASIX) 20MG TAB 5064080 4.20

ESCITALOPRAM (LEXAPRO) 10MG TAB 5064081 4.20

FUROSEMIDE (LASIX) 40MG TAB 5064090 4.20

FUROSEMIDE (LASIX) 100MG/10ML VIAL (NF) 5064140 11.60 J1940

GENTAMICIN EYE SOLN 0.3% 5ML 5064200 22.90

GENTAMICIN EYE OINT 3MG/GM 5064210 107.40

CEPHALEX (KEFLEX) 250MG/5ML (FOR ER USE) 5064280 4.20

PHYSOSTIGMINE 2MG/2ML AMP 5064503 136.30

HYDROXYZINE PAM (VISTARIL) 25MG CAP 5064508 4.20

HYDROCHLOROTHIAZIDE 25MG TAB 5064670 4.20

AMPICILLIN 1GM VIAL 5064770 11.20 J0290

AMPICILLIN 2GM VIAL (NF) 5064780 32.80 J0290

METHYLPRED (SOLU-MEDROL) 40MG INJ 5064785 10.10 J2920

AMOXICILLIN (AMOXIL) 250MG/5ML 150M 5064820 9.32

VANCOMYCIN (VANCOCIN) 500MG VIAL 5064925 12.40 J3370

MICONAZOLE (MICADERM) 2% CREAM (NF) 5064947 9.30

DIAZEPAM (VALIUM) 2MG TAB 5064960 4.20

ZINC OXIDE 20% OINT 60GM 5064966 13.40

DIAZEPAM (VALIUM) 5MG TAB 5064970 4.20

HYDROCORTISONE (ANUSOL-HC) 2.5% CR 5064980 46.30

METOLAZONE (ZAROXOLYN) 2.5MG TAB 5064985 8.90

DIAZEPAM (VALIUM) 10MG/2ML SYRINGE 5065144 73.90 J3360

PROPOFOL (DIPRIVAN) 200MG/20ML VL 5065201 8.50

HYDROCORTISONE (CORTAID) - 1 APPLIC 5065207 4.20



CHLORDIAZEPOXIDE (LIBRIUM) 25MG CAP (NF) 5065480 4.20

SUCCINYLC (QUELICIN) 200MG/10ML MDV 5065519 76.30 J0330

ROCURONIUM (ZEMURON) 50MG/5ML MDV 5065521 14.00

KETAMINE (KETALAR) 50MG/ML 10ML MDV 5065525 12.70

LIDOCAINE (XYLOCAINE) 2% SDV 5065527 5.00 J2001

ONDANSETRON (ZOFRAN) 4MG/2ML VL 5065529 4.20 J2405

ESMOLOL (BREVIBLOC) 100MG/10ML VIAL 5065535 26.40

POTASSIUM PH 5065561 4.20

PENICILLIN VK (VEETIDS) 250MG TAB 5065570 4.20

POTASSIUM CL 20MEQ/15ML ORAL SOLN 5065675 42.70

INSULIN REG (NOVOLIN R) 10ML VIAL 5065767 47.60 J1815

COLCHICINE (COLCRYS) 0.6MG TAB 5065775 23.00

CYANOCOBAL (VIT B12) 1000MCG/ML VI 5065855 16.50 J3420

AL-MAG-HYOS-LIDO (GI COCKTAIL) 28ML 5065920 4.20 J3490

CEFTRIAXONE (ROCEPHIN) 1GM VIAL 5066066 4.90 J0696

CEFTRIAXONE (ROCEPHIN) 250MG VIAL 5066068 4.20 J0696

CEFUROXIME (CEFTIN) 250MG TAB 5066069 4.20

MAGNESIUM CITRATE (CITROMA) 296ML 5066511 4.90

CLONIDINE (CATAPRES) 0.1MG TAB 5066635 4.20 J3490

NITROGLYCERIN (NITRO-DUR) 0.4MG/HR 5066646 4.20

ESTROGEN (PREMARIN) 0.625MG TAB (NF) 5066670 12.80

GLYCERIN ADULT SUPPOSITORY 5066775 4.20

GUAIFEN (ROBITUSS) 200MG/10ML UD 5066800 4.20

ANTIPYR-BENZ (AURALGAN) OTIC 10ML 5066857 29.90

HALOPERIDOL (HALDOL) 1MG TAB (NF) 5066880 4.20

HEPARIN 5000 UNITS/ML INJ 5066906 7.20 J1644

HEPARIN 25,000 UNITS/500ML PREMIX 5066907 46.10

HEPARIN FLUSH 10 UNITS/ML 5ML 5066915 4.20 J1642

DEXTROSE/WATER 50% 50ML SYRINGE 5067020 40.70

DEXAMETHASONE (DECADRON) 4MG/ML VIA 5067105 4.20 J1100

DEXAMETHASONE (DECADRON) 0.5MG TAB (NF) 5067125 4.20

DEXAMETHASONE (DECADRON) 4MG TAB (NF) 5067135 4.20

SULFA-TRIM (BACTRIM) 800-160/20ML (NF) 5067175 11.00

PREDNISONE (DELTASONE) 5MG TAB 5067180 4.20 J7510



MICONAZOLE (MONISTAT 7) 2% VAG 45GM 5067225 29.30

PROCAINAMIDE 1000MG/10ML INJ 5067265 103.00 J2690

NIFEDIPINE ER (PROCARDIA XL) 30MG T 5067270 4.60

INDOMETHACIN (INDOCIN) 25MG CAP (NF) 5067290 4.20

INSULIN NPH (NOVOLIN N) 10ML VIAL 5067302 49.80 J1815

INSULIN (NOVOLIN R) 100U/ML 5067306 0.90 J1815

ENALAPRILAT (VASOTEC) 1.25MG/ML VIA 5067325 15.70

DILTIAZEM (CARDIZEM) 25MG/5ML VIAL 5067326 8.80

VECURONIUM (NORCURON) 10MG/10ML VL 5067327 21.50



MAGNESIUM OXIDE (MAG-OX) 400MG TAB 5067328 4.20

IPRA-ALB (COMBIVENT RESPIMAT) INH (NF) 5067329 951.90

HYDROCORTISONE (CORTAID) 1% CR 30GM 5067400 6.20


DOCUSATE (COLACE) 100MG CAP 5067490 4.20

DIGOXIN (LANOXIN) 0.125MG TAB 5067560 4.80

DIGOXIN (LANOXIN) 0.25MG TAB (NF) 5067565 10.10

DIPHENHYDRAMINE (BENADRYL) 25MG CAP 5067610 4.20

DIPHENHYDRAMINE (BENADRYL) 50MG CAP (NF) 5067615 4.20

TETANUS IMM GLOB (HYPERTET) 250U/ML 5067630 1,546.80 J1670

THEO ER (THEO-DUR) 200MG TAB (NF) 5067685 4.20

THIAMINE (VITAMIN B1) 200MG/2ML MDV 5067710 23.60 J3411

SILVER (SILVADENE) CR- X1 DOSE (ER ONLY) 5067774 4.20


LITHIUM (ESKALITH) 300MG TAB (NF) 5068009 4.20

PETROLAT-MIN OIL (EUCERIN) CR 454GM (NF) 5068046 15.20

FERROUS SULF 325MG (IRON 65MG) TAB 5068055 4.20


BACITRACIN OINT 30GM TUBE 5068062 8.70

METRONIDAZOLE (FLAGYL) 500MG/100ML 5068095 7.40 S0030

FUROSEMIDE (LASIX) 40MG/4ML VIAL 5068150 6.10 J1940

FUROSEMIDE (LASIX) 20MG/2ML VIAL 5068155 11.60 J1940

RABIES VACCINE (RABAVERT) 2.5 U/ML 5068165 1,210.10 90675

EPHEDRINE 50MG/ML INJ 5068180 42.60

EPINEPHRINE (ADRENALIN) 1MG/ML INJ 5068195 62.90 J0171

EPINEPHRINE 0.1MG/ML 10ML SYRINGE 5068215 19.50 J0171

ERYTHROMYCIN BASE 250MG TAB (NF) 5068260 9.30

AMPICILLIN-SULB (UNASYN) 1.5GM VIAL 5068273 6.30 J0295

CARBAMAZEPINE (TEGRETOL) 200MG TAB 5068286 4.20

FLUMAZENIL (ROMAZICON) 0.5MG/5ML VI 5068288 19.30

BENZ-TETRA-BUTA (CETACAINE) SPRAY 5068402 4.20

PHENAZOPYRIDINE (PYRIDIUM) 100MG TA 5068415 7.30

PHENOBARBITAL 32.4MG TAB 5068430 4.20

PHENOBARBITAL 65MG/ML VL 5068435 60.30 J2560

METOCLOPRAMIDE (REGLAN) 10MG TAB 5068451 4.20

METOCLOPRAMIDE (REGLAN) 5MG TAB (NF) 5068452 4.20

SOD PHOS MB-DB (FLEET ADULT) 133ML 5068550 4.20

CYCLOBENZAPRINE (FLEXERIL) 10MG TAB 5068556 4.20

MINERAL OIL (FLEET MINERAL OIL) 118 5068565 8.40

PHYTONADIONE (MEPHYTON) 5MG TAB (NF) 5068595 66.90


WARFARIN (COUMADIN) 2.5MG TAB 5068705 4.20

WARFARIN (COUMADIN) 5MG TAB 5068710 4.20

SILVER NITRATE APPLICATORS 5068845 4.20

NEO-BACI-POLY (NEOSPORIN) - 1 AP ER USE 5068930 4.20 J3490



NEOSTIGMINE (BLOXIVERZ) 10MG/10ML 5068940 75.70 J2710

NITRO (NITRO-BID) OINT 30GM TUBE 5069021 130.30

CARVEDILOL (COREG) 25MG TAB (NF) 5069036 4.20

METRONIDAZOLE (FLAGYL) 500MG TAB 5069103 4.20

METHYLENE BLUE 100MG/10ML VL 5069156 29.10

METHYLPRED AC (DEPO-MEDROL) 40MG/ML 5069220 11.60 J1030

METHYLPRED AC (DEPO-MEDROL) 80MG/ML 5069221 39.60 J1040

CHOLECALCIFEROL (VITAMIN D3) 400IU (NF) 5069322 4.20

DOPAMINE (INTROPIN) 400MG/250ML 5069323 31.80 J1265

DOBUTAMINE (DOBUTREX) 500MG/250ML 5069324 37.60 J1250

NITROGLYCERIN 50MG/250ML PREMIX 5069325 49.80

CALCIUM 500-VIT D (OS-CAL 500 + D) (NF) 5069326 4.20

NALOXONE (NARCAN) 0.4MG/ML VL 5069327 63.40 J2310

METHYLPREDNISOLONE (MEDROL) 4MG PAK 5069328 78.70 J7509

FENTANYL (DURAGESIC) 75MCG/HR (NF) 5069329 86.90

MEPERIDINE (DEMEROL) 25MG/ML INJ 5069355 9.10 J2175

HYDROCORTISONE (ANUSOL-HC) 25MG SUP 5069383 41.20

MEPERIDINE (DEMEROL) 50MG/ML SYRG 5069385 18.90 J2175

MEPERIDINE (DEMEROL) 75MG/ML SYRG (NF) 5069400 17.60 J2175

MEPERIDINE (DEMEROL) 100MG/ML SYRG (NF) 5069420 17.60 J2175

CARISOPRODOL (SOMA) 350MG TAB (NF) 5069422 4.20

CEFDINIR (OMNICEF) 125MG/5ML SUSP 5069478 39.30

FLAVOXATE (URISPAS) 100MG TAB (NF) 5069490 4.20

INFLIXIMAB (REMICADE) 100MG VL 5069520 3,153.50 J1745

DEXAMETHASONE (DECADRON) 4MG/ML 30M 5070000 4.20 J1100

ENOXAPARIN (LOVENOX) 150MG/ML 5070001 127.20 J1650

GENTAMICIN 100MG/100ML PREMIX 5070002 7.50 J1580



HEPATITIS A (HAVRIX) 1440 ELU/ML ADULT 5070005 267.30 90632

INFLUENZA (FLUCELVAX) 0.5ML - DO NOT USE 5070006 64.20 90674

INFLUENZA PEDS (FLUZONE) 0.25ML - DO NOT 5070007 78.64 90685

INFLUENZA (FLUARIX) 0.5ML 5070008 65.60 90686

INFLUENZA (FLUVIRIN) 0.5ML - DO NOT USE 5070009 43.70 90656

PROMETH-COD (PHENRGN AC) 120ML 5070010 11.90

PROMETH-COD (PHENRGN AC) 480ML:30 (NF) 5070011 4.20

VANCOMYCIN (VANCOCIN) 125MG ORAL SO 5070012 4.20

VARICELLA VIRUS (VARIVAX) 0.5ML 5070013 402.10 90716

AMPICILLIN/NS 500MG/100ML IVPB 5070014 0.00

AMPICILLIN/NS 1GM/100ML IVPB 5070015 0.00

AMPICILLIN/NS 2GM/100ML IVPB 5070016 0.00

CALCIUM CHLORIDE/NS 1GM/100ML IVPB 5070017 0.00

CEFAZOLIN/NS 1GM/100ML 5070018 0.00

CEFUROXIME/NS 1.5GM/100ML 5070019 0.00

CEFUROXIME/NS 750MG/100ML 5070020 0.00



DILTIAZEM/NS 100MG/100ML IVPB 5070021 0.00

FORTAZ/NS 1GM/100ML 5070022 0.00

FOSPHENYTOIN/NS 1GM PE/50ML IVPB 5070023 0.00

INSULIN REG/NS 100 UN/100ML IVPB 5070024 0.00

LABETALOL/NS 100MG/100ML IVPB 5070025 0.00

MORPHINE/NS 100MG/100ML IVPB 5070029 0.00

NAFCILLIN/NS 1GM/100ML 5070030 0.00

NAFCILLIN/NS 2GM/100ML 5070031 0.00

NITROPRUSSIDE/D5W 100MG/250ML 5070032 0.00

OXYTOCIN/NS IVPB : 10UN/1000ML 5070033 0.00




PHENYTOIN/NS 1GM/50ML IVPB (NF) 5070037 0.00

PRIMAXIN 500MG/100ML IVPB 5070038 0.00

PROCAINAMIDE/D5W 1GM/250ML 5070039 0.00

ROCEPHIN/NS 250MG/50ML 5070040 0.00

ROCEPHIN/NS 500MG/50ML 5070041 0.00

TIMENTIN/NS IVPB : 3.1GM/100ML (NF) 5070042 0.00

UNASYN/NS 1.5GM/100ML IVPB 5070043 0.00

UNASYN/NS 3GM/100ML IVPB 5070044 0.00

VANCOMYCIN 1500MG/300ML IVPB 5070045 132.40

VANCOMYCIN/NS 1250MG/250ML IVPB 5070046 0.00

VANCOMYCIN 1GM/200ML IVPB 5070047 75.70

VANCOMYCIN 2GM/400ML IVPB 5070048 109.30



ZITHROMAX/NS 500MG/250ML IVPB 5070051 0.00

G ACETAMIN (TYLENOL) 650MG SUPP 5070052 0.00

G ACET ER (TYLENOL ARTHRITIS) 650MG (NF) 5070053 0.00

G ACETAMIN (TYLENOL) 325MG TAB 5070054 0.00

G ACETAMIN (TYLENOL) 500MG TAB 5070055 0.00

G AL-MAG HYDR-SIMETH (MYLANTA) 30ML 5070056 0.00

G AMMONIUM LACT (LAC-HYDRIN) LOT 5070057 0.00

G ARTIF TEAR PEG-PG (SYSTANE) 15ML 5070058 0.00

G ARTIFIC TEAR (LACRI-LUBE) OINT 5070059 0.00

G ARTIFIC TEARS (LIQUITEAR) PVA 15ML 5070060 0.00

G ASCORB ACID (VITAMIN C) 500MG TAB 5070061 0.00

G ASPIRIN 325MG TAB 5070062 0.00

G ASPIRIN CHEWABLE 81MG TAB 5070063 0.00

G ASPIRIN EC (ECOTRIN) 81MG TAB 5070064 0.00

G ASPIRIN EC (ECOTRIN)325MG TAB 5070065 0.00

G BACITRACIN OINT 30GM 5070066 0.00

G BACITRACIN OINT UD 5070067 0.00

G BACITRAC-POLY (POLYSPORIN) POWD 5070068 0.00



G BALS-PETR-ZINC (FLANDERS) OINT 5070069 0.00

BENZOCAINE (ORAJEL/ANBESOL) 10% GEL 5070070 15.40

G BISACODYL (DULCOLAX) 10MG SUPP 5070071 0.00

G BISACODYL (DULCOLAX) 5MG TAB 5070072 0.00

G CALC POLYCAR (FIBERCON) 625MG TAB 5070073 0.00

G CALCIUM (CALTRATE 600) 600MG TAB 5070074 0.00

G CALCIUM 600-VIT D (CALTRATE + D) 5070075 0.00

G CALCIUM CARB (TUMS) 500MG TAB 5070076 0.00

G CALCIUM CIT (CITRACAL) 200MG TAB 5070077 0.00

G CARBAMIDE PER (DEBROX) 6.5% OTIC 5070078 0.00

G CLOTRIMAZOLE (LOTRIMIN) 1% CR 30G 5070079 0.00

G DIPHENHYDR (BENADRYL) 12.5MG/5ML 5070080 0.00

G DIPHENHYDR (BENADRYL) 25MG CAP 5070081 0.00

G DOCUSATE (COLACE) 100MG CAP 5070082 0.00

G FERROUS SULFATE 325MG TAB 5070083 0.00

FEXOFENADINE (ALLEGRA) 180MG TAB (RX) 30 5070084 0.00

G FOLIC ACID 400MCG TAB 5070085 0.00

G GEL DRESSING (SAF-GEL) 85GM 5070086 0.00

G GLUCOSE (GLUTOSE 15) ORAL GEL 5070087 0.00

G GUAIFEN (ROBITUSSIN) SYRUP 5070088 0.00

G GUAIFEN-DM (ROBITUSS DM) SYRUP 5070089 0.00

G GUAIFENE ER (MUCINEX) 600MG TAB 5070090 0.00

G HYDROCORT (CORTAID) 1% CR 30GM 5070091 0.00

G IBUPROFEN (MOTRIN) 100MG/5ML SUSP 5070092 0.00

G IBUPROFEN (MOTRIN) 200MG TAB 5070093 0.00

G LOPERAMIDE (IMODIUM) 2MG TAB 5070094 0.00

G LORATADINE (CLARITIN) 10MG TAB 5070095 0.00

G MAG HYDR (MILK OF MAG) SUSP 5070096 0.00

G MAGNESIUM OX (MAG-OX) 400MG TAB 5070097 0.00

MICONAZOLE (SECURA) 2% EXTRA THICK (NF) 5070098 13.70

G MICONAZOLE (MONISTAT 7) VAG 45GM 5070099 0.00

G MINERAL OIL (FLEET MINERAL OIL) 5070100 0.00

G MULTIVITAMIN TABLET 5070101 0.00

G MULTIVITAMIN WITH IRON TAB 5070102 0.00

G MULTIVITAMIN WITH MINERALS TAB 5070103 0.00

G NEO-BACI-POLY (NEOSPORIN) OINT 5070104 0.00

NICOTINE GUM 4MG MINT (RX) 110 5070105 0.00

NICOTINE GUM 4MG ORIG (RX) 110 5070106 0.00

G NICOTINE (NICODERM CQ 7) 7MG 5070107 0.00

G PERMETHRIN (NIX) 1% LOTION 60ML 5070108 0.00

G PETRO-MIN OIL (EUCERIN) CR 454GM 5070109 0.00

G PHENOL (CHLORASEPTIC) SPRAY 180ML 5070110 0.00

G PHENYLEPH (ANUSOL) 0.25% SUPP 5070111 0.00

G PHENYLEPH (NEO-SYNEPH) 0.25% NSL 5070112 0.00

G POLYETHYLENE GLYC (MIRALAX) 17GM 5070113 0.00



PSYLLIUM (METAMUCIL) 3.4GM POWD (RX) 5070114 0.00

G PYRIDOXINE (VITAMIN B6) 100MG TAB 5070115 0.00

G SENNOSIDES (SENNA) 8.6MG TAB 5070116 0.00

G SENNOSIDES-DOCUSATE (SENNA-S) TAB 5070117 0.00

SIMETHICONE (GAS-X) 80MG TAB (RX) 5070118 0.00

G SOD PHOS MB-DB (FLEET ADULT) 5070119 0.00

G SODIUM BICARBONATE 650MG TAB 5070120 0.00

G SODIUM CL (MURO-128) 5% 15ML OPTH 5070121 0.00

G SODIUM CL (SALINE MIST) 0.65% NSL 5070122 0.00

G THIAMINE (VITAMIN B1) 100MG TAB 5070123 0.00

G TROLA SALIC (ASPERCREME) 10% 90GM 5070124 0.00

G VITAMIN B-12 1000MCG TAB 5070125 0.00

VITAMIN E 200IU CAP (NF) 5070126 4.20

G ZINC OXIDE 20% OINT 60GM 5070127 0.00

Z ACET-COD (TYLENOL #3) 300-30MG TA 5070128 0.00

Z ACET-COD (TYLENOL-COD) 120-12/5ML 5070129 0.00

Z ACETYLCYSTEINE (MUCOMYST) 20% VL 5070130 0.00

Z ALBUTEROL (VENTOLIN HFA) 90MCG 5070131 0.00

ALENDRONATE (FOSAMAX) 70MG TAB (RX) 5070132 0.00

ALLOPURINOL (ZYLOPRIM) 100MG TAB (340B) 5070133 0.00

ALLOPURINOL (ZYLOPRIM) 300MG TAB (340B) 5070134 0.00

Z AL-MG-DON-LIDO (GI COCKTAIL) 30ML 5070135 0.00

Z ALPRAZOLAM (XANAX) 0.25MG TAB 5070136 0.00

Z ALPRAZOLAM (XANAX) 0.5MG TAB 5070137 0.00

Z ALPRAZOLAM (XANAX) 1MG TAB 5070138 0.00

Z ALBUTEROL (PROVENTIL) 2.5MG NEB 5070139 0.00

Z AMLOD-BENAZ (LOTREL) 5-10MG TAB 5070140 0.00

AMLODIPINE (NORVASC) 10MG TAB (340B) 5070141 0.00

AMLODIPINE (NORVASC) 2.5MG TAB (340B) 5070142 0.00

AMLODIPINE (NORVASC) 5MG TAB (340B) 5070143 0.00

Z AMOXICILLIN (AMOXIL) 250MG CAP 5070144 0.00

Z AMOXICILLIN (AMOXIL) 500MG CAP 5070145 0.00

Z AMOX-POT (AUGMENTIN) 500-125MG TAB 5070146 0.00

Z ANTIPYR-BENZ (AURALGAN) OTIC 10ML 5070147 0.00

Z ASPIRIN-DI ER (AGGRENOX) 25-200MG 5070148 0.00

ATENOLOL (TENORMIN) 25MG TAB (340B) 5070149 0.00


Z AZITHRO (ZITHROMAX) 250MG TAB 5070151 0.00

BENZONATATE (TESSALON) 100MG CAP (340B) 5070152 0.00

BENZTROPINE (COGENTIN) 0.5MG TAB (340B) 5070153 0.00

Z BENZTROPINE (COGENTIN) 1MG TAB 5070154 0.00

BUDES-FORM (SYMBICORT) 160-4.5MCG (340B) 5070155 0.00

Z BUDES-FORM (SYMBICORT) 80-4.5MCG 5070156 0.00

BUDESONIDE (PULMICORT) 180MCG FLEX (340B 5070157 0.00

Z BUDESONIDE (PULMICORT) 0.5MG NEB 5070158 0.00



BUSPIRONE (BUSPAR) 5MG TAB (340B) 5070159 0.00

Z CALCITRIOL (ROCALTROL) 0.25MCG CA 5070160 0.00

Z CARBAM ER (TEGRETOL XR) 200MG TAB 5070161 0.00

Z CARBAMAZE (TEGRETOL) 200MG TAB 5070162 0.00

Z CARBIDOPA-LEVO (SINEMET) 10-100MG TAB 5070163 0.00

CARBIDOPA-LEVO (SINEMET) 25-100MG (340B) 5070164 0.00

Z CARVEDILOL (COREG) 12.5MG TAB 5070165 0.00

Z CARVEDILOL (COREG) 25MG TAB 5070166 0.00

Z CARVEDILOL (COREG) 3.125MG TAB 5070167 0.00

CARVEDILOL (COREG) 6.25MG TAB (340B) 5070168 0.00

Z CEFUROXIME (CEFTIN) 250MG TAB 5070169 0.00

Z CEPHALEXIN (KEFLEX) 250MG CAP 5070170 0.00

Z CEPHALEXIN (KEFLEX) 500MG CAP 5070171 0.00

Z CHLORHEX GLUC (PERIDEX) ORAL SOLN 5070172 0.00

CIPROFLOXACIN (CIPRO) 250MG TAB (340B) 5070173 0.00

Z CIPROFLOXACIN (CIPRO) 500MG TAB 5070174 0.00

CITALOPRAM (CELEXA) 10MG TAB (340B) 5070175 0.00



Z CLARITHROMYCIN (BIAXIN) 250MG TAB 5070178 0.00

Z CLARITHROMYCIN (BIAXIN) 500MG TAB 5070179 0.00

Z CLINDAMYCIN (CLEOCIN) 150MG CAP 5070180 0.00

Z CLONAZEPAM (KLONOPIN) 0.5MG TAB 5070181 0.00

Z CLONIDINE (CATAPRES) 0.1MG TAB 5070182 0.00

Z CLONIDINE (CATAPRES) 0.2MG TAB 5070183 0.00

CLONIDINE (CATAPRES-TTS-1) 0.1MG/ (340B) 5070184 0.00


CLOPIDOGREL (PLAVIX) 75MG TAB (340B) 5070186 0.00

Z CLOZAPINE (CLOZARIL) 100MG TAB 5070187 0.00



CYANOCOB (VIT B-12) 1000MCG/ML VL (340B) 5070190 0.00

CYCLOBENZAPRINE (FLEXERIL) 5MG TAB (340B 5070191 0.00

CYCLOSPORIN (RESTASIS) 0.05% OPTH (340B) 5070192 0.00

Z DIAZEPAM (VALIUM) 2MG TAB 5070193 0.00

Z DIAZEPAM (VALIUM) 5MG TAB 5070194 0.00

Z DICLOFENAC POT (CATAFLAM) 50MG TA 5070195 0.00

DIGOXIN (LANOXIN) 0.125MG TAB (340B) 5070196 0.00

Z DIGOXIN (LANOXIN) 0.25MG TAB 5070197 0.00

Z DILTIAZEM (CARDIZEM) 30MG TAB 5070198 0.00

Z DILTIAZEM CD (CARDIZEM CD) 120MG 5070199 0.00




Z DIPHX-ATR (LOMOTIL) 2.5-0.025MG T 5070203 0.00



Z DIVALPRO (DEPAKOTE SPRINK) 125MG 5070204 0.00

DIVALPROEX DR (DEPAKOTE) 250MG TAB (340B 5070205 0.00

Z DIVALPRO DR (DEPAKOTE) 500MG TAB 5070206 0.00

Z DIVALPRO ER (DEPAKOTE ER) 250MG T 5070207 0.00

Z DIVALPRO ER (DEPAKOTE ER) 500MG T 5070208 0.00

Z DONEPEZIL (ARICEPT) 10MG TAB 5070209 0.00

Z DONEPEZIL (ARICEPT) 5MG TAB 5070210 0.00

Z DULOXETINE (CYMBALTA) 20MG CAP 5070211 0.00

DULOXETINE (CYMBALTA) 30MG CAP (340B) 5070212 0.00

DULOXETINE (CYMBALTA) 60MG CAP (340B) 5070213 0.00

Z ENALAPRIL (VASOTEC) 2.5MG TAB 5070214 0.00

ENALAPRIL (VASOTEC) 5MG TAB (340B) 5070215 0.00

Z EPOETIN (PROCRIT) 1,000 UNITS/0.05ML 5070216 0.00

VITAMIN D 50,000 UNITS CAP (340B) 5070217 0.00

ESCITALOPRAM (LEXAPRO) 10MG TAB (340B) 5070218 0.00

ESCITALOPRAM (LEXAPRO) 20MG TAB (340B) 5070219 0.00

Z ESCITALOPRAM (LEXAPRO) 5MG TAB 5070220 0.00

ESOMEPRAZOLE (NEXIUM) 20MG CAP (340B) 5070221 0.00

ESOMEPRAZOLE (NEXIUM) 40MG CAP (340B) 5070222 0.00

FAMOTIDINE (PEPCID) 20MG TAB (340B) 5070223 0.00

FAMOTIDINE (PEPCID) 40MG TAB (340B) 5070224 0.00

Z FENOFIB MICRO (LOFIBRA) 200MG CAP 5070225 0.00

FENOFIBRATE (TRICOR) 145MG TAB (340B) 5070226 0.00

FLUOXETINE (PROZAC) 20MG CAP (DNU) 5070227 0.00

FLUTICASONE (FLONASE) 50MCG NSL (340B) 5070228 0.00

FLUTIC-SALM (ADVAIR HFA) 115-21MCG (340B 5070229 0.00

Z FLUTIC-SALM (ADVAIR HFA) 230-21MC 5070230 0.00

Z FLUTIC-SALM (ADVAIR) 100-50MCG 5070231 0.00

Z FLUTIC-SALM (ADVAIR) 250-50MCG 5070232 0.00

FOLIC ACID 1MG TAB (340B) 5070233 0.00

FUROSEMIDE (LASIX) 20MG TAB (340B) 5070234 0.00

FUROSEMIDE (LASIX) 40MG TAB (340B) 5070235 0.00

Z FUROSEMIDE (LASIX) 80MG TAB 5070236 0.00

GABAPENTIN (NEURONTIN) 100MG CAP (340B) 5070237 0.00

GABAPENTIN (NEURONTIN) 300MG CAP (340B) 5070238 0.00

Z GABAPENTIN (NEURONTIN) 400MG CAP 5070239 0.00

Z GABAPENTIN (NEURONTIN) 600MG TAB 5070240 0.00

Z GEMFIBROZIL (LOPID) 600MG TAB 5070241 0.00

Z GLIMEPIRIDE (AMARYL) 4MG TAB 5070242 0.00

GLIPIZIDE (GLUCOTROL) 10MG TAB (340B) 5070243 0.00

GLIPIZIDE (GLUCOTROL) 5MG TAB (340B) 5070244 0.00

Z GUAIF-COD (ROBTUSS AC) 100-10/5ML 5070245 0.00

Z HALOPERIDOL (HALDOL) 0.5MG TAB 5070246 0.00

Z HALOPERIDOL (HALDOL) 1MG TAB 5070247 0.00

Z HALOPERIDOL (HALDOL) 5MG TAB 5070248 0.00



Z HALOPERIDOL (HALDOL) 5MG/ML VL 5070249 0.00

Z HEPARIN LOCK FLUSH 10 UNITS/ML 5070250 0.00

Z HYDRALAZINE (APRESOLINE) 25MG TAB 5070251 0.00


Z HYDROC-ACET (LORCET PLUS) 7.5-650 5070253 0.00

Z HYDROC-ACET (LORCET) 10-650MG TAB 5070254 0.00

Z HYDROC-ACET (LORTAB) 5-500MG TAB 5070255 0.00

Z HYDROCHLOROTHIAZIDE 12.5MG TAB 5070256 0.00

HYDROCHLOROTHIAZIDE 25MG TAB (340B) 5070257 0.00

HYDROCHLOROTHIAZIDE 50MG TAB (340B) 5070258 0.00

HYDROCORTISONE (ANUSOL-HC) 2.5% CR (340B 5070259 0.00

Z HYDROCORT (ANUSOL-HC) 25MG SUPP 5070260 0.00

HYDROXYCHLRQ (PLAQUENIL) 200MG (340B) 5070261 0.00

HYDROXYZINE PAM (VISTARIL) 25MG CAP (340 5070262 0.00

HYDROXYZINE PAM (VISTARIL) 50MG C (340B) 5070263 0.00

Z IBUPROFEN (MOTRIN) 400MG TAB 5070264 0.00

IBUPROFEN (MOTRIN) 600MG TAB (340B) 5070265 0.00

IBUPROFEN (MOTRIN) 800MG TAB (340B) 5070266 0.00

Z INSULIN 70-30 (NOVOLIN/HUMULIN) VIAL 5070267 0.00

Z INSULIN ASPAR-ASPAR (NOVOLOG 70-30) VL 5070268 0.00

Z INSULIN ASPART (NOVOLOG) VIAL 5070269 0.00

Z INSULIN DETEM (LEVEMIR) 10ML VL 5070270 0.00

INSULIN GLARG (LANTUS SOLOSTAR) (340B) 5070271 0.00

Z INSULIN LISPRO (HUMALOG) VIAL 5070272 0.00

Z INSULIN NPH (NOVOLIN/HUMULIN) VIAL 5070273 0.00

Z INSULIN REG (NOVOLIN R/HUMULIN R) VIAL 5070274 0.00

IPRATROPIUM (ATROVENT) 0.02% NEB (340B) 5070275 0.00

Z IPRATROP HFA (ATROVENT HFA) 12.9G 5070276 0.00

Z IPRATROP-ALBUT (COMBIVENT) 14.7GM 5070277 0.00

ISOSORB MONO ER (IMDUR) 30MG TAB (340B) 5070278 0.00

Z ISOSORB MONO ER (IMDUR) 60MG TAB 5070279 0.00

Z KETOROLAC (TORADOL) 30MG/ML VIAL 5070280 0.00

Z LABETALOL (TRANDATE) 200MG TAB 5070281 0.00

LAMOTRIGINE (LAMICTAL) 100MG TAB (DNU) 5070282 0.00

Z LAMOTRIGINE (LAMICTAL) 150MG TAB 5070283 0.00

Z LANSOPRAZOLE (PREVACID) 15MG CAP 5070284 0.00

LANSOPRAZOLE (PREVACID) 30MG CAP (340B) 5070285 0.00

Z LEVALBUTEROL (XOPENEX) 0.63MG NEB 5070286 0.00

Z LEVALBUTEROL (XOPENEX) 1.25MG NEB 5070287 0.00

Z LEVETIRACETAM (KEPPRA) 250MG TAB 5070288 0.00



Z LEVO-C-E (STALEVO 50) 50-12.5-200 5070291 0.00

Z LEVOTHYROX (SYNTHROID) 100MCG TAB 5070292 0.00

LEVOTHYROXINE (SYNTHROID) 112MCG (340B) 5070293 0.00











LIDOCAINE 4% PATCH (NF) 5070302 0.00

Z LIDOCAINE (XYLOCAINE) 2% UROJET 5070303 0.00

LISINOPRIL (ZESTRIL) 10MG TAB (340B) 5070304 0.00

LISINOPRIL (ZESTRIL) 2.5MG TAB (340B) 5070305 0.00


LISINOPRIL (ZESTRIL) 30MG TAB (NF) 5070307 4.20


Z LORAZEPAM (ATIVAN) 0.5MG TAB 5070309 0.00

Z LORAZEPAM (ATIVAN) 1MG TAB 5070310 0.00

LOSARTAN (COZAAR) 100MG TAB (340B) 5070311 0.00



MELOXICAM (MOBIC) 15MG TAB (DNU) 5070314 0.00

Z MEMANTINE (NAMENDA) 10MG TAB 5070315 0.00

Z MEMANTINE (NAMENDA) 5MG TAB 5070316 0.00

Z METFORM ER (GLUCOPHAGE XR) 500MG 5070317 0.00

METFORMIN (GLUCOPHAGE) 1000MG TAB (340B) 5070318 0.00


METHOTREXATE 2.5MG TAB (RX) 5070320 0.00

Z METOLAZONE (ZAROXOLYN) 2.5MG TAB 5070321 0.00

METOPROLOL (LOPRESSOR) 100MG TAB (340B) 5070322 0.00



METOPROLOL ER (TOPROL XL) 25MG TAB (340B 5070325 0.00

DAPAGLIFLOZIN (FARXIGA) 5MG TAB (340B) 5070326 0.00

MIRTAZAPINE (REMERON) 15MG TAB (340B) 5070327 0.00

MONTELUKAST (SINGULAIR) 10MG TAB (340B) 5070328 0.00

Z MORP (ROXANOL) 10MG/5ML ORAL SOLN 5070329 0.00

Z MORP (ROXANOL) 20MG/5ML ORAL SOLN 5070330 0.00

Z MORP (ROXANOL) 20MG/ML ORAL SOLN 5070331 0.00

Z MOXIFLOXACIN (AVELOX) 400MG TAB 5070332 0.00

NABUMETONE (RELAFEN) 500MG TAB (340B) 5070333 0.00

NABUMETONE (RELAFEN) 750MG TAB (340B) 5070334 0.00

NAPROXEN (NAPROSYN) 500MG TAB (340B) 5070335 0.00

Z NAPROXEN DR (NAPROSYN EC) 375MG T 5070336 0.00

Z NEO-POLY-HC (CORTISPORIN) OTIC SP 5070337 0.00

Z NIACIN ER (NIASPAN) 500MG TAB 5070338 0.00



Z NITROFUR MO/MAC (MACROBID) 100MG 5070339 0.00

Z NITROGLYCERIN (NITRO-DUR) 0.1MG/H 5070340 0.00





NITRO (NITROSTAT) 0.4MG TAB BOTTLE (340B 5070345 0.00

NYSTATIN 500MU/5ML SUSP (340B) 5070346 0.00

Z OLANZAPINE (ZYPREXA) 10MG TAB 5070347 0.00

OLANZAPINE (ZYPREXA) 2.5MG TAB (340B) 5070348 0.00

OLANZAPINE (ZYPREXA) 5MG TAB (RX) 5070349 0.00

Z OLANZAPINE (ZYPREXA) 7.5MG TAB 5070350 0.00

Z OLOPATADINE (PATANOL) 0.1% OPTH 5070351 0.00

OMEGA-3-ACID EE (LOVAZA) 1GM CAP (340B) 5070352 0.00

OMEPRAZOLE (PRILOSEC) 20MG CAP (340B) 5070353 0.00

OMEPRAZOLE (PRILOSEC) 40MG CAP (340B) 5070354 0.00

Z ONDANSETRON (ZOFRAN) 4MG TAB 5070355 0.00

OXYBUTYNIN ER (DITROPAN XL) 10MG (340B) 5070356 0.00

Z OXYBUTY ER (DITROPAN XL) 5MG TAB 5070357 0.00

Z OXYCOD-ACET (PERCOCET) 5-325MG TAB 5070358 0.00

Z OXYCOD-ACET (PERCOCET) 7.5-500MG TAB 5070359 0.00

Z OXYCODONE CR (OXYCONTIN) 10MG TAB 5070360 0.00


Z OXYCODONE IR (OXY IR) 5MG TAB 5070362 0.00

Z OXYCODONE (OXYFAST) 20MG/ML ORAL S 5070363 0.00

PANTOPRAZOLE (PROTONIX) 20MG TAB (340B) 5070364 0.00

PANTOPRAZOLE (PROTONIX) 40MG TAB (340B) 5070365 0.00

Z PAROXETINE (PAXIL) 10MG TAB 5070366 0.00

PAROXETINE (PAXIL) 20MG TAB (340B) 5070367 0.00

PAROXETINE (PAXIL) 30MG TAB (340B) 5070368 0.00

Z PAROXETINE (PAXIL) 40MG TAB 5070369 0.00

Z PENICILLIN VK (VEETIDS) 250MG TAB 5070370 0.00

Z PENTOXIFYLL ER (TRENTAL) 400MG T 5070371 0.00

Z PHENAZOPYRID (PYRIDIUM) 100MG TAB 5070372 0.00

Z PHENYTOIN (DILANTIN) 50MG INFATAB 5070373 0.00

Z PHENYTOIN ER (DILANTIN) 100MG CAP 5070374 0.00

Z PHYTONADIONE (MEPHYTON) 5MG TAB 5070375 0.00

Z POTASSIUM CL (KLOR-CON) 10MEQ TAB 5070376 0.00

Z POTASSIUM CL (KLOR-CON) 20MEQ TAB 5070377 0.00

Z POTASSIUM CL (MICRO-K) 10MEQ CAP 5070378 0.00

PRAVASTATIN (PRAVACHOL) 20MG TAB (340B) 5070379 0.00


Z PREDNISONE (DELTASONE) 20MG TAB 5070381 0.00

Z PREGABALIN (LYRICA) 100MG CAP 5070382 0.00





PRIMIDONE (MYSOLINE) 50MG TAB (340B) 5070385 0.00

Z PROM-COD (PHENRGN AC) 6.25-10/5ML 5070386 0.00

Z PROMETH (PHENERGAN) 12.5MG SUPP 5070387 0.00

Z PROMETH (PHENERGAN) 25MG SUPP 5070388 0.00

Z PROMETH (PHENERGAN) 25MG/ML VL 5070389 0.00

PROMETHAZINE (PHENERGAN) 25MG TAB (340B) 5070390 0.00

PROPRANOLOL ER (INDERAL LA) 120MG (340B) 5070391 0.00

Z QUETIAPINE (SEROQUEL) 100MG TAB 5070392 0.00



Z RABEPRAZOLE (ACIPHEX) 20MG TAB 5070395 0.00

Z RACEPINEPH (S2) 2.25% 0.5ML NEB 5070396 0.00

RANITIDINE (ZANTAC) 150MG CAP (340B) 5070397 0.00

Z RISPERIDONE (RISPERDAL) 0.25MG TA 5070398 0.00

Z RISPERIDONE (RISPERDAL) 0.5MG TAB 5070399 0.00

Z RISPERIDONE (RISPERDAL) 1MG TAB 5070400 0.00

Z RISPERIDONE (RISPERDAL) 2MG TAB 5070401 0.00

RIVASTIGMINE (EXELON) 4.6MG/24HR (340B) 5070402 0.00

ROPINIROLE (REQUIP) 1MG TAB (340B) 5070403 0.00

Z SAXAGLIPTIN (ONGLYZA) 2.5MG TAB 5070404 0.00

Z SAXAGLIPTIN (ONGLYZA) 5MG TAB 5070405 0.00

SERTRALINE (ZOLOFT) 100MG TAB (340B) 5070406 0.00



Z SEVELAMER (RENVELA) 800MG TAB 5070409 0.00

Z SIMVASTATIN (ZOCOR) 10MG TAB 5070410 0.00

SIMVASTATIN (ZOCOR) 20MG TAB (340B) 5070411 0.00

SIMVASTATIN (ZOCOR) 40MG TAB (340B) 5070412 0.00



SITAGLIPTIN (JANUVIA) 100MG TAB (340B) 5070415 0.00


Z SITAGLIPTIN (JANUVIA) 50MG TAB 5070417 0.00

Z SODIUM CHLORIDE 0.9% FLUSH 10ML 5070418 0.00

SPIRONOLACTONE (ALDACTONE) 25MG (RX) 5070419 0.00

SPIRONOLACTONE (ALDACTONE) 50MG (DNU) 5070420 0.00

Z SULFA-TRIM (BACTRIM DS) 800-160 T 5070421 0.00

TAMSULOSIN (FLOMAX) 0.4MG CAP (340B) 5070422 0.00

Z TEMAZEPAM (RESTORIL) 15MG CAP 5070423 0.00

Z TERAZOSIN (HYTRIN) 1MG CAP 5070424 0.00



Z THEOPHYLL ER (THEO-DUR) 200MG TAB 5070427 0.00

TIOTROPIUM (SPIRIVA) 18MCG (RX) 5070428 0.00



Z TOLTERODINE ER (DETROL LA) 2MG CA 5070429 0.00

Z TOLTERODINE ER (DETROL LA) 4MG CA 5070430 0.00

Z TOPIRAMATE (TOPAMAX) 100MG TAB 5070431 0.00

TOPIRAMATE (TOPAMAX) 25MG TAB (DNU) 5070432 0.00

TOPIRAMATE (TOPAMAX) 50MG TAB (DNU) 5070433 0.00

Z TRAMADOL (ULTRAM) 50MG TAB 5070434 0.00

TRAZODONE (DESYREL) 100MG TAB (340B) 5070435 0.00

TRAZODONE (DESYREL) 50MG TAB (340B) 5070436 0.00

TRIAMTER-HCTZ (DYAZIDE) 37.5-25MG (340B) 5070437 0.00

VALACYCLOVIR (VALTREX) 500MG TAB (340B) 5070438 0.00

Z VALPROIC ACID (DEPAKENE) 250MG CA 5070439 0.00

Z VALSARTAN (DIOVAN) 160MG TAB 5070440 0.00

VALSARTAN (DIOVAN) 80MG TAB (340B) 5070441 0.00

VALS-HCT (DIOVAN HCT) 160-12.5MG (340B) 5070442 0.00

VALSART-HCT (DIOVAN HCT) 160-25MG (340B 5070443 0.00

VALS-HCT (DIOVAN HCT) 80-12.5MG TAB (340 5070444 0.00

VENLAFAXINE ER (EFFEXOR XR) 37.5MG (340B 5070445 0.00

VENLAFAXINE ER (EFFEXOR XR) 75MG (340B) 5070446 0.00

Z WARFARIN (COUMADIN) 1MG TAB 5070447 0.00

Z WARFARIN (COUMADIN) 2.5MG TAB 5070448 0.00






Z WARFARIN (COUMADIN)7.5MG TAB 5070454 0.00

Z ZOLPIDEM (AMBIEN) 10MG TAB 5070455 0.00

Z ZOLPIDEM (AMBIEN) 5MG TAB 5070456 0.00

BACITRACIN EYE OINT - X1 DOSE (ER ONLY) 5070457 26.50

ERYTHROMYCIN EYE OINT - 1 APPLIC 5070458 5.90

GENTAMICIN EYE SOLN - 1 APPLIC 5070459 5.90

GENTAMICIN EYE OINT - 1 APPLIC 5070460 4.80

SULFACETAMIDE (SULAMYD) - 1 APPLIC 5070461 13.80

ANTIPYR-BENZ (AURALGAN) - 1 APPLIC 5070462 4.20 J3490

CARBAMIDE PEROX (DEBROX) - 1 APPLIC 5070463 4.20

NEO-POLY-HC (CORTISPORIN) - 1 APPLIC 5070464 4.40

DIPH-PERT-TET-POL (KINRIX) 0.5ML VL 5070465 201.50 90696

HAEMOPH B CONJ (ACTHIB) 0.5ML VL 5070466 41.92 90648

HEPATITIS A (HAVRIX) 720 ELU/0.5ML PED 5070467 120.60 90633

INACTIV POLIOVIRUS (IPOL) 0.5ML MDV 5070468 124.10 90713

MEASLES-MUMPS-RUB (MMRII) 0.5ML VL 5070469 268.00 90707

PNEUMO 13 VAL (PREVNAR 13) 0.5ML 5070470 670.60 90670

ROTAVIRUS (ROTATEQ) ORAL SUSP 2ML 5070471 282.20 90680

BACITRACIN OINT - X1 DOSE (ER ONLY) 5070472 4.20 J3490

CLOTRIMAZONE (LOTRIMIN) - 1 APPLIC 5070473 4.20



LIDOCAINE (XYLOCAINE) JELLY - X1 DOSE (E 5070474 4.20

LEVOPHED/D5W 4MG/500ML IVPB 5070500 0.00

LEVOPHED/D5W 8MG/500ML 5070501 0.00

LEVOPHED/D5W 8MG/250ML 5070502 0.00

BLOOD GLUCOSE CHECK 5070504 0.00

Z DOXAZOSIN (CARDURA) 4MG TAB 5070505 0.00

LACTOBACILLUS (PROBIOTIC) TAB (NF) 5070506 4.20

Z LACTULOSE (ENULOSE) 10GM/15ML 5070508 0.00

Z POTASSIUM CHL 20MEQ/15ML ORAL SOLN 5070510 0.00

Z CILOSTAZOLE (PLETAL) 100MG TAB 5070511 0.00


MECLIZINE (ANTIVERT) 25MG TAB (340B) 5070513 0.00

VITAMIN D3 1000IU GUMMY (NF) 5070514 0.00

MELOXICAM (MOBIC) 7.5MG TAB (DNU) 5070516 0.00

G PHENAZOPYR (AZO) 95MG TAB 5070517 0.00

Z ROPINIROLE (REQUIP) 0.5MG TAB 5070518 0.00

BRIMONIDINE (ALPHAGAN) 0.15% EYE SLN (NF 5070519 438.10

MISC PHARMACY ITEM (RX) 5070520 0.00

ESOMEPRAZOLE (NEXIUM) 40MG CAP (NF) 5070521 26.50

SIMVASTATIN (ZOCOR) 40MG TAB (NF) 5070522 4.20

CINNAMON CAP (NF) 5070523 0.15

CETIRIZINE (ZYRTEC) 10MG TAB (NF) 5070524 12.30

RANITIDINE (ZANTAC) 300MG TAB (NF) 5070525 8.40

ZINC 50MG TAB (NF) 5070527 0.16

APPLE CIDER VINEGAR COMPLEX TAB (NF) 5070528 0.25

ZOSYN/NS 3.375GM/100ML 5070529 0.00

BIMATOPROST (LUMIGAN) 0.01% EYE SOLN (N 5070530 472.90

FLUTIC-SAL (ADVAIR DISKUS) 250-50 (NF) 5070531 976.70

BRIMON-TIMOLOL (COMBIGAN) EYE SOLN (NF) 5070532 448.50

FLUVOXAMINE (LUVOX) 100MG TAB (NF) 5070533 8.20

LUTEIN TAB (NF) 5070535 0.00

Z FEBUXOSTAT (ULORIC) 40MG TAB 5070536 0.00

ATORVASTATIN (LIPITOR) 80MG TAB (340B) 5070537 0.00

Z PROM-DM (PHENERGAN DM) 6.25-15MG/5ML 5070541 0.00

Z FENOFIBRATE (LOFIBRA) 160MG TAB 5070542 0.00

Z DOXEPIN 25MG CAP 5070543 0.00

G VITAMIN B COMPLEX TABLET 5070544 0.00


IRON POLYSAC (FERREX 150) CAP (NF) 5070549 4.20

PRAMIPEXOLE (MIRAPEX) 0.25MG TAB (NF) 5070550 4.20

RIVASTIGMINE (EXELON) 9.5MG/24HR (NF) 5070551 62.50

DOXAZOSIN (CARDURA) 4MG TAB (NF) 5070552 3.00

SALSALATE (DISALCID) 750MG TAB (NF) 5070555 4.90

LIRAGLUTIDE (VICTOZA) 18MG/3ML X2 (340B) 5070556 0.00

Z KETOROLAC (TORADOL) 10MG TAB 5070557 0.00



BIOTIN TAB (NF) 5070558 4.20

ENALAPRIL (VASOTEC) 20MG TAB (RX) 5070559 4.60

G PROSOURCE PROTEIN ORAL POWDER 5070560 0.00

G PROSOURCE PROTEIN ORAL LIQUID 5070561 0.00

G TWOCAL HN LIQUID 5070562 0.00

TERBUTALINE (BRETHINE) 5MG TAB (NF) 5070563 2.70

IBUPROFEN (MOTRIN) 200MG TAB (RX) 5070564 4.20

SYNTHROID 175MCG TAB (RX) 5070565 4.20



SERTRALINE (ZOLOFT) 100MG TAB (RX) 5070568 4.20

GABAPENTIN (NEURONTIN) 300MG CAP (RX) 5070569 4.20

BIOTIN 1000MCG TAB (RX) 5070570 4.20

ACETAMINOPHEN (TYLENOL) 500MG TAB (RX) 5070571 4.20

DIPHENHYDRAMINE (BENADRYL) 25MG CAP (RX) 5070572 4.20

LEVOTHYROXINE 100MCG TAB (RX) 5070573 4.20

PANTOPRAZOLE (PROTONIX) 40MG TAB (RX) 5070574 4.20

CLONAZEPAM (KLONOPIN) 0.5MG TAB (RX) 5070575 4.20

BACLOFEN (LIORESAL) 20MG TAB (NF) 5070576 4.20

GINKGO BILOBA TAB (NF) 5070577 0.00


METFORMIN (GLUCOPHAGE) 500MG TAB (RX) 5070580 4.20

METOPROLOL (LOPRESSOR) 25MG TAB (RX) 5070581 4.20

EZET-SIMVAST (VYTORIN) 10-20MG TAB (NF) 5070583 16.80

Z SILVER SULF (SILVADENE) CREAM 50GM 5070585 0.00

G NEPRO LIQUID 5070589 0.00

Z HYDROC-ACET (LORTAB) 7.5-500MG TAB 5070590 0.00

Z CEFUROXIME (CEFTIN) 500MG TAB 5070591 0.00

CLARITIN 5MG/5ML SYRUP (RX) 5070592 4.20

IPRATROPIUM (ATROVENT) 0.06% NASAL (NF) 5070595 20.00

MELOXICAM (MOBIC) 15MG TAB (NF) 5070599 15.00

ACETAMINOPHEN (TYLENOL) 325MG TAB (RX) 5070603 4.20

ASPIRIN CHEWABLE 81MG TAB (RX) 5070604 4.20

ASPIRIN ENTERIC COATED 81MG TAB (RX) 250 5070605 0.00

ASPIRIN 325MG TAB (RX) 5070606 4.20

ASPIRIN EC 325MG TAB (RX) 5070607 4.20

CALCIUM CARB (TUMS) 500MG TAB (RX) 150 5070608 4.20

CALCIUM 600-VIT D TAB (RX) 180 5070609 4.20

DIPHENHYDR (BENADRYL) 12.5MG/5ML (RX) 5070610 4.20

FEXOFENADINE (ALLEGRA) 180MG TAB (RX 100 5070611 4.20

LORATADINE (CLARITIN) 10MG TAB (RX) 300 5070612 4.20

GLIMEPIRIDE (AMARYL) 4MG TAB (NF) 5070613 7.40


FOLIC ACID 1MG TAB (RX) 5070615 4.20

HYDROCHLOROTHIAZIDE 25MG TAB (RX) 5070616 4.20



LISINOPRIL (ZESTRIL) 30MG TAB (RX) 5070617 4.20

PRAVASTATIN (PRAVACHOL) 40MG TAB (RX) 5070618 4.20


TRIAMCINOLONE (KENALOG) 0.1% CR (NF) 5070620 1.30

MOMETASONE (NASONEX) NASAL (NF) 5070621 28.50


ACEBUTOLOL (SECTRAL) 200MG CAP (NF) 5070623 4.20

LOSARTAN (COZAAR) 50MG TAB (NF) 5070624 9.00

FUROSEMIDE (LASIX) 20MG TAB (RX) 5070626 4.20

MELOXICAM (MOBIC) 15MG TAB (RX) 5070627 4.20

FAMOTIDINE (PEPCID) 20MG TAB (RX) 5070628 4.20

ERTAPENEM (INVANZ) 1GM VIAL 5070629 380.40 J1335

INVANZ/NS 1GM/100ML IVPB 5070630 0.00

REMICADE/NS 400MG/250ML 5070631 0.00

CHLORHEX (PERIDEX) 0.12% LIQ 15ML (NF) 5070633 4.20

NITRO (NITROSTAT) 0.4MG TAB BOTTLE (RX) 5070634 59.20

SOTALOL (BETAPACE) 80MG TAB (RX) 5070635 4.20

ZOLPIDEM (AMBIEN) 10MG TAB (RX) 5070636 4.20

DRONABINOL (MARINOL) 2.5MG CAP (NF) 5070638 14.80

METHEN-HYOS-ME-BL (URIBEL) CAP (NF) 5070639 8.50

G PHENYLEPHR (SUDAFED PE) 10MG TAB (NF) 5070640 0.00


SERTRALINE (ZOLOFT) 25MG TAB (NF) 5070643 4.20

LATANOP (XALATAN) 0.005% OPTH (340B) 5070644 0.00

AMIODARONE (PACERONE) 200MG TAB (340B) 5070645 0.00


CASPOFUNGIN (CANCIDAS) 50MG VIAL (NF) 5070647 1,425.30

CASPOFUNGIN/NS IVPB : 50MG/250ML 5070648 0.00

TIGECYCLINE (TYGACIL) 50MG VIAL (NF) 5070649 495.80

TIGECYLINE/NS 50MG/100ML IVPB 5070650 0.00

NF-SUDOGEST PE TAB 10MG 5070651 0.25

FENOFIBRATE (LOFIBRA) 200MG CAP (NF) 5070652 25.00

METFORMIN (GLUCOPHAGE) 1000MG (NF) 5070653 4.20

HYDROCHLOROTHIAZIDE 50MG TAB (RX) 5070654 4.20


AMLODIPINE (NORVASC) 5MG TAB (RX) 5070656 4.20

GASTROGRAFIN SOLUTION 5070662 1.20


NYSTATIN (NYSTOP) TOP POWDER 15GM (340B) 5070664 0.00

Z BRIMONIDINE (ALPHAGAN) 0.15% EYE DROP 5070665 0.00

DIP-TET-PER-HEPB-POL (PEDIARIX) 0.5ML VL 5070666 296.00 90723

MENTHOL-CAMPHOR (SARNA) LOTION (NF) 5070667 11.10

AL-MAG HYDR-SIMETH (MYLANTA) 12 OZ (RX) 5070668 4.20

GLIPIZIDE (GLUCOTROL) 10MG TAB (RX) 5070670 4.20

PNEUMO 23 VACCINE AND ADMIN - CASH ONLY 5070671 137.50 90732



INFLUENZA VACCINE AND ADMIN - CASH ONLY 5070672 32.50 90656

FERROUS SULFATE 325MG TAB (RX) 5070675 4.20

MAGNESIUM OXIDE (MAG-OX) 400MG TAB (RX) 5070676 0.00


LISIN-HCTZ (ZESTORETIC) 20-25MG (NF) 5070679 0.00

MELATONIN 1MG TAB (NF) 5070680 0.17

DIPH-TET-APER (INFANRIX) 0.5ML SYRG 5070684 87.80 90700

LANSOPRAZ (PREVACID) 15MG CAP (NF) 5070685 4.20

METOCLOPRAMIDE (REGLAN) 10MG TAB (RX) 5070687 4.20


CITALOPRAM (CELEXA) 40MG TAB (RX) 5070689 4.20

BENZOCAINE (ANBESOL) 20% GEL (NF) 5070690 23.00

Z FLUCONAZOLE (DIFLUCAN) 150MG TAB 5070691 0.00

OXYCOD (OXYFAST) 20MG/ML ORL SOLN (NF) 5070694 8.80

CALCIUM ACETATE (PHOSLO) 667MG TAB (NF) 5070695 4.20

TRANDOLAPRIL (MAVIK) 2MG TAB (NF) 5070696 3.00

SEVOFLURANE (ULTANE) LIQUID 5070697 337.10


CHLORTHALIDONE (HYGROTON) 25MG T (NF) 5070700 4.20


MOXIFLOXACIN (VIGAMOX) 0.5% OPTH (NF) 5070702 0.00

Z NEO-POLY B-GRAM (NEOSPORIN) EYE SOLN 5070703 0.00

METHOTREXATE 2.5MG TAB (NF) 5070706 9.30

OXYCOD-ACET (PERCOCET) 7.5-325MG (NF) 5070707 18.10

FOLIC ACID 400MCG TAB (NF) 5070708 0.06

QUINAPRIL (ACCUPRIL) 20MG TAB (NF) 5070710 7.30

NF-CEREFOLIN NAC ORAL TABLET 5070711 9.40

AMLODIPINE (NORVASC) 10MG TAB (RX) 5070712 4.20

CALCIUM 600MG TAB (RX) 5070713 4.20

MULTIVITAMIN WITH IRON TAB (RX) 5070714 4.20



RAMIPRIL (ALTACE) 10MG CAP (NF) 5070720 9.10

ALISKIREN (TEKTURNA) 300MG TAB (NF) 5070723 12.80

ISOSORB MONO ER (IMDUR) 30MG TAB 5070724 4.20

Z NYSTATIN-TRIAM (MYCOLOG) CR 5070725 0.00

OLANZAPINE (ZYPREXA) 2.5MG TAB 5070726 4.20

LOVASTATIN (MEVACOR) 40MG TAB (NF) 5070727 4.20

QUININE (QUALAQUIN) 324MG CAP (NF) 5070728 20.50

Z ONDANSETRON (ZOFRAN) 4MG VIAL 5070729 0.00

TRAMADOL (ULTRAM) 50MG TAB (RX) 5070731 4.20

FLUOXETINE (PROZAC) 20MG CAP (RX) 5070732 4.20


G SALICYCLIC ACID (T-SAL) 3% SHAMPOO 5070734 0.00

BENAZEPRIL (LOTENSIN) 20MG TAB (NF) 5070735 6.10



ATORVASTATIN (LIPITOR) 40MG TAB 5070736 4.20

VITAMIN B COMPLEX CAP (NF) 5070739 4.20

PYRIDOXINE (VITAMIN B6) 50MG TAB (NF) 5070740 4.20

Z TRIHEXYPHENIDYL (ARTANE) 2MG TAB 5070744 0.00

LEVETIRACETAM (KEPPRA) 500MG TAB 5070745 4.20

DISULFIRAM (ANTABUSE) 250MG TAB (NF) 5070746 8.00

ARTIF TEAR HM (GENTEAL) EYE GEL (NF) 5070749 33.30

LISIN-HCTZ (ZESTORETIC) 20-12.5MG (NF) 5070752 0.00

TERAZOSIN (HYTRIN) 1MG CAP (NF) 5070753 4.20


ALPRAZOLAM (XANAX) 0.5MG TAB (RX) 5070755 0.00


Z FELODIPINE ER (PLENDIL) 5MG TAB 5070757 0.00

EXENATIDE (BYETTA) 10MCG/0.4ML (NF) 5070761 2,105.90

MIDODRINE (PROAMATINE) 10MG TAB (NF) 5070765 4.20

PYRIDOSTIGMINE (MESTINON) 60MG TAB (NF) 5070766 4.20

ROPINIROLE (REQUIP) 2MG TAB (NF) 5070767 7.80

Z LORAZEPAM (ATIVAN) 2MG/ML INJ 5070769 0.00


SAXAGLIPTIN (ONGLYZA) 5MG TAB (NF) 5070772 26.40

HYDROCHLOROTHIAZIDE 50MG TAB (NF) 5070773 0.00

PRAMIPEXOLE (MIRAPEX) 1MG TAB (NF) 5070774 4.20

METFORMIN ER (GLUCOPHAGE XR) 500MG (RX) 5070775 0.00

AMLODIPINE (NORVASC) 10MG TAB (NF) 5070778 0.00

LISINOPRIL (ZESTRIL) 40MG TAB (NF) 5070779 0.00

NF-METAMUCIL MULTIHEALTH FIBER 5070780 0.38

RIVASTIGMINE (EXELON) 3MG CAP (NF) 5070781 11.00

SAXAGLIPTIN (ONGLYZA) 2.5MG TAB (NF) 5070782 0.00


ATORVASTATIN (LIPITOR) 10MG TAB (NF) 5070784 4.20

ATORVASTATIN (LIPITOR) 20MG TAB 5070785 4.20

NF-CRANGEL CAPSULE 5070787 0.70

FLUOXETINE (PROZAC) 10MG CAP (DNU) 5070789 0.00


PREGABALIN (LYRICA) 100MG CAP (NF) 5070791 0.00


RANOLAZINE ER (RANEXA) 1000MG TAB (NF) 5070795 4.20

CETIRIZINE (ZYRTEC) 10MG TAB (RX) 300 5070796 0.00

ARIPIPRAZOLE (ABILIFY) 5MG TAB (NF) 5070797 47.20

ENAL/HCTZ (VASERETIC) 5-12.5MG TAB (NF) 5070798 4.20

FELODIPINE ER (PLENDIL) 10MG TAB (NF) 5070799 0.00



RALOXIFENE (EVISTA) 60MG TAB (340B) 5070802 0.00

FENOFIBRATE (LOFIBRA) 134MG CAP (NF) 5070805 6.10



OXYCOD-ACET (PERCOCET) 10-325MG (NF) 5070806 19.80

IBUPROFEN (MOTRIN) 200MG TAB (NF) 5070810 0.18

VITAMIN D3 5000IU TAB (NF) 5070812 0.25

OLMESARTAN (BENICAR) 20MG TAB (NF) 5070813 10.70

LORAZEPAM (ATIVAN) 1MG TAB (NF) 5070814 15.90

FLUOCINOLONE 0.05% CRM (NF) 5070816 6.60

METOPROLOL (LOPRESSOR) 100MG TAB (NF) 5070817 2.90

VARENICLINE (CHANTIX) 0.5MG TAB (NF) 5070818 13.00

N-ACETYL CYSTEINE (NAC) 600MG CAP (NF) 5070820 0.00

BIOTENE MOISTURIZING MOUTH SPRAY (NF) 5070822 18.10

NEBIVOLOL (BYSTOLIC) 5MG TAB (NF) 5070823 14.20

Z AZITHRO (ZITHROMAX) 200MG/5ML SUSP 5070824 0.00

RISPERIDONE (RISPERDAL) 0.5MG TAB (NF) 5070825 4.20

Z TIMOLOL (TIMOPTIC) 0.5% EYE SOLN 5070826 0.00

PEG (MIRALAX) POWDER 510GM (RX) 5070828 0.00

VITAMIN D3 1000 IU TAB (RX) 200 5070829 0.00

CYCLOBENZAPRINE (FLEXERIL) 10MG TAB (RX) 5070830 0.00

CARVEDILOL (COREG) 6.25MG TAB (RX) 5070833 0.00

GALANTAMINE (RAZADYNE) 4MG TAB (NF) 5070835 8.50

NEO-BACI-POLY (NEOSPORIN) OINT (RX) 5070842 0.00


CLOPIDOGREL (PLAVIX) 75MG TAB (RX) 5070844 0.00

INSULIN GLUL (APIDRA) 100 U/ML (NF) 5070845 4.20

TIMOLOL (TIMOPTIC) 0.25% EYE SOLN (NF) 5070848 46.00

LISIN-HCTZ (ZESTORETIC) 10-12.5MG (NF) 5070849 0.00

Z ENOXAPARIN (LOVENOX) 40MG INJ 5070850 0.00

TIMOLOL (TIMOPTIC) 0.5% EYE SOLN (NF) 5070851 23.90

Z OXYCOD-ACET (PERCOCET)10-325MG TAB 5070854 0.00

ATENOLOL (TENORMIN) 100MG TAB (RX) 5070855 0.00

GEMFIBROZIL (LOPID) 600MG TAB (RX) 5070856 0.00

Z HYDROXYZ HCL (ATARAX) 25MG TAB 5070857 0.00

ESZOPICLONE (LUNESTA) 3MG TAB (NF) 5070858 0.00

RIFAXIMIN (XIFAXAN) 550MG TAB (NF) 5070861 97.90

Z FENTANYL (DURAGESIC) 25MCG/HR PATCH 5070862 0.00


PROMETH-DM (PHENR DM) 6.25-15/5ML (NF) 5070864 0.15

NEO-BACI-POLY (NEOSPORIN) OINT 5070865 11.40

Z COLLAGENASE (SANTYL) OINT 5070868 0.00

IRBESARTAN (AVAPRO) 300MG TAB (NF) 5070869 13.80

CENTRUM SILVER TAB (NF) 5070870 0.00

ESTER C TABLET (NF) 5070871 0.00



METHYLDOPA (ALDOMET) 250MG TAB (NF) 5070875 1.20

METHYLDOPA (ALDOMET) 500MG TAB (NF) 5070876 2.20



BUPROPION SR (WELLBUTRIN SR) 150MG (RX) 5070877 0.00

MORPHINE 20MG/ML ORAL SOLN 5070878 4.20

TRIAMCINOLONE 0.5% CREAM 15GM (340B) 5070880 0.00

Z CLOTRIMAZOLE-BETA (LOTRISONE) CREAM 5070881 0.00

Z ATORVASTATIN (LIPITOR) 20MG TAB 5070882 0.00


PANTOPRAZOLE (PROTONIX) 20MG TAB (RX) 5070884 0.00

DIPHENHYDRAMINE (BENADRYL) 50MG CAP (RX) 5070885 0.00

OCUVITE (I-VITE) EYE VITAMIN TAB (NF) 5070886 0.60

GLIPIZ ER (GLUCOTROL XL) 10MG TAB (RX) 5070889 0.00

MENTH-CAMP-SAL (BENGAY ULTRA) CR (NF) 5070890 0.18

Z AMITRIPTYLINE (ELAVIL) 25MG TAB 5070891 0.00

ARTIFICIAL TEAR (LACRI-LUBE) OINT (NF) 5070892 41.20

Z LEVOFLOXACIN (LEVAQUIN) 500MG TAB 5070895 0.00

MECLIZINE (ANTIVERT) 25MG TAB (RX) 5070896 0.00

Z TORSEMIDE (DEMADEX) 20MG TAB 5070898 0.00

G MAGNESIUM CIT (CITROMA) 300ML ORL SOLN 5070900 0.00

WARFARIN (COUMADIN) 6MG TAB (RX) 5070901 0.00

Z METHYLPREDNISOLONE (MEDROL) 4MG PAK 5070902 0.00

INFLUENZA (AFLURIA) 0.5ML - DO NOT USE 5070905 44.00 90656

LIOTHYRONINE (CYTOMEL) 25 MCG TAB (NF) 5070906 5.70

Z SULFACETAMIDE (SULAMYD) EYE SOLN 10% 5070908 0.00

DOXYCYCLINE 100MG TAB (340B) 5070909 0.00

MOMETASONE (NASONEX) NASAL SPRAY (340B) 5070912 0.00

MAGIC MOUTHWASH 5070914 4.20

ATENOLOL (TENORMIN) 50MG TAB (NF) 5070916 2.70

MEGESTROL (MEGACE) 40MG TAB (NF) 5070917 4.20

NADOLOL (CORGARD) 40MG TAB (NF) 5070920 10.90

LORAZEPAM (ATIVAN) 0.5MG TAB (RX) 5070921 0.00

OSELTAMIVIR (TAMIFLU) 75MG CAP (340B) 5070924 0.00

ESCITALOPRAM (LEXAPRO) 20MG TAB (NF) 5070930 4.20

NF-POTASSIUM GLUCONATE ORAL TABLET 595MG 5070934 0.11



DESLORATADINE (CLARINEX) 5MG TAB (NF) 5070937 21.10

NF-PHENTERCOT CAPSULE 37.5MG 5070938 0.29

PIOG-MET (ACTOPLUS MET) 15-850 (NF) 5070939 14.90

DESLORAT (CLARINEX) 0.5MG/ML SYRP (NF) 5070940 1.90



FLURBIPROFEN (OCUFEN) 0.03% EYE SLN (NF) 5070945 11.80

CITALOPRAM (CELEXA) 40MG TAB (NF) 5070946 1.10

CALCIUM POLYCAR (FIBERCON) 625MG TAB (NF 5070948 4.20

POTASSIUM GLUCONATE 595MG TAB (NF) 5070950 0.11




CAMP-MENTH-EUC (VICKS VAPORUB) OINT (NF) 5070954 0.22

HYOSCYAMINE (LEVSIN) 0.125MG TAB (340B) 5070956 0.00

DONEPEZIL (ARICEPT) 10MG TAB (NF) 5070958 4.20

KETOTIFEN (ALAWAY) 0.025% EYE SOLN (NF) 5070959 9.70

Z AMOX-POT (AUGMENTIN) 875-125MG TAB 5070961 0.00

NAPROXEN (ALEVE) 220MG TAB (NF) 5070963 4.20

DIFLUNISAL (DOLOBID) 500MG TAB (NF) 5070964 4.80

ALENDRONATE (FOSAMAX) 35MG TAB (NF) 5070969 59.80

G CAMP-MENTH-EUC (VICKS VAPORUB) OINT 5070971 0.00

Z LIOTHYRONINE (CYTOMEL) 25MCG TAB 5070972 0.00

NF-GUAIFENESIN ORAL TABLET 400MG 5070976 2.40

MEMANTINE (NAMENDA) 5MG TAB (NF) 5070977 17.10

Z MUPIROCIN (BACTROBAN) OINT 5070978 0.00

Z FINASTERIDE (PROSCAR) 5MG TAB 5070980 0.00

Z RIVAROXABAN (XARELTO) 10MG TAB 5070981 0.00

RIVAROXABAN (XARELTO) STARTER PACK (340B 5070982 0.00

RIVAROXABAN (XARELTO) 20MG TAB (340B) 5070983 0.00

DAPTOMYCIN (CUBICIN) 500MG VL 5070985 598.40 J0878

CUBICIN/NS 500MG/100ML 5070986 0.00

CUBICIN/NS 450MG/100ML 5070987 0.00

RIVAROXABAN (XARELTO) 15MG TAB 5070988 40.20

RIVAROXABAN (XARELTO) 20MG TAB (NF) 5070989 29.00

CEFEPIME/NS (MAXIPIME) 2GM/100ML 5070990 47.20



PAROXETINE (PAXIL) 40MG TAB (NF) 5070994 8.90

AMLODIPINE (NORVASC) 2.5MG TAB (NF) 5070995 0.00

HYDROXYZINE HCL (ATARAX) 25MG TAB (NF) 5070997 2.90

SULINDAC (CLINORIL) 150MG TAB (NF) 5070999 0.00

SULINDAC (CLINORIL) 200MG TAB (NF) 5071000 4.20




BETHANECHOL (URECHOLINE) 25MG TAB (NF) 5071006 5.60




Z TRAVOPROST Z (TRAVATAN Z) EYE SOLN 5071014 0.00

TRIHEXYPHENIDYL (ARTANE) 2MG TAB (NF) 5071017 4.20

LOSARTAN (COZAAR) 100MG TAB (NF) 5071019 0.00

TRAVOPROST (TRAVATAN) EYE SOLN (NF) 5071020 308.60

Z SOD PLY SULF (KAYEXALATE) 15GM/60ML 5071021 0.00

PRIMIDONE (MYSOLINE) 50MG TAB 5071022 4.20

METHOTREXATE 25MG/ML INJ (NF) 5071028 20.60 J9260

ESTRADIOL (ESTRACE) 0.5MG TAB (NF) 5071030 1.50



BUDESONIDE INHLR (PULMICORT) 90MCG 5071031 445.70

GLUCOSAMINE-CHONDROITIN CAP (NF) 5071033 2.90

BUDESONIDE INHLR (PULMICORT) 180MCG (NF) 5071035 614.60

ZOLPIDEM (AMBIEN) 10MG TAB (NF) 5071037 0.00

GUANFACINE (TENEX) 2MG TAB (NF) 5071039 12.90


GUANFACINE (TENEX) 1MG TAB (NF) 5071041 0.00



TRIAMCINOLONE 0.1% CREAM 15GM (340B) 5071044 0.00

Z PROPRANOLOL (INDERAL) 10MG TAB 5071045 1.10

Z GENTAMYCIN EYE SOLN 5071046 13.40

MULTIVITAMIN TAB (RX) 5071047 0.00

MAGNESIUM SULF (EPSOM SALT) (NF) 5071049 11.80

Z GLUCAGON (GLUCAGEN) 1MG INJ 5071052 0.00

HYDROMORPHONE (DILAUDID) 2MG TAB (NF) 5071053 4.20

TOPIRAMATE (TOPAMAX) 50MG TAB (NF) 5071055 0.00


PAROXETINE (PAXIL) 10MG TAB 5071059 4.20

PAROXETINE (PAXIL) 30MG TAB (NF) 5071060 4.20


ATROPINE (ISOPOT ATROP) 1% EYE SLN (NF) 5071062 4.80

PREDNISOLONE 1% EYE SUSP (NF) 5071063 156.40

DANAZOL (DANOCRINE) 200MG CAP (NF) 5071064 16.80

Z ATROPINE (ISOPTO ATROPINE) EYE SOLN 5071065 0.00




PIOGLITAZONE (ACTOS) 30MG TAB (NF) 5071069 0.00

PIOGLITAZONE (ACTOS) 45MG TAB (NF) 5071070 0.00

DOXEPIN (SINEQUAN) 25MG CAP (NF) 5071071 4.20

INSULIN GLARGINE (LANTUS) 100U/ML (NF) 5071072 46.10

MULTIVITAMIN-MINERALS LIQ (NF) 5071078 4.20

PRAVASTATIN (PRAVACHOL) 80MG TAB (NF) 5071079 19.80

Z TRIMETH-POLY (POLYTRIM) EYE SOLN 5071085 0.00

Z ERYTHROMYCIN EYE OINT 5071086 9.10

Z METHYLPRED (SOLU-MEDROL) 125MG INJ 5071088 0.00

CUBICIN/NS 800MG/100ML 5071089 0.00

BACI-POLY (POLYSPORIN) POWD - 1 APPL 5071090 4.20 J3490

HYDROCHLOROTHIAZIDE 12.5MG (RX) 5071091 0.00

DOCUSATE (COLACE) 100MG/10ML LIQ (NF) 5071092 4.20

TRYP-BALS-CAST (GRANULEX) SPRAY (NF) 5071093 35.90

LEVOCETIRIZINE (XYZAL) 5MG TAB (NF) 5071096 10.60

Z ISOSORB DN (ISORDIL) 30MG TAB 5071098 0.00

OLMESAR-HCT (BENICAR HCT) 40-12.5MG TAB 5071099 21.90



AMLOD-BENAZ (LOTREL) 10-20MG CAP (NF) 5071103 19.40

FLUTICASONE (FLOVENT HFA) 220MCG (NF) 5071105 0.00

LISINOPRIL (ZESTRIL) 2.5MG TAB (NF) 5071106 4.20


PROPRANOLOL (INDERAL) 40MG TAB (RX) 5071108 0.00

ZONISAMIDE (ZONEGRAN) 50MG CAP (NF) 5071109 3.80

G DOCOSANOL (ABREVA) TOPICAL CREAM 10% 5071113 0.00

CUBICIN/NS 350MG/100ML 5071114 0.00

BISOPROLOL (ZEBETA) 10MG TAB (NF) 5071116 7.00

MEPROBAMATE (EQUANIL) 400MG TAB (NF) 5071117 5.70

MINOCYCLINE 100MG CAP (340B) 5071122 0.00

ESTRADIOL (ESTRACE) 1MG TAB (NF) 5071123 11.30

ATEN-CHLORTH (TENORETIC) 50-25MG TAB (NF 5071124 1.70

METHADONE 10MG TAB (NF) 5071125 0.45

TAMOXIFEN (NOLVADEX) 20MG TAB (340B) 5071126 14.20

ESTRO-PROGEST (PREMPRO) 0.625-2.5MG (NF) 5071127 11.80

UREA 40% CR (340B) 5071129 0.00

AZATHIOPRINE (IMURAN) 50MG TAB (NF) 5071131 2.70

HYDROCOD-ACET (LORTAB) 7.5-500MG (NF) 5071133 5.10

VENLAFAXINE (EFFEXOR) 75MG TAB (NF) 5071138 4.20

ROSUVASTATIN (CRESTOR) 10MG TAB (RX) 5071140 0.00

FILGRASTIM (NEUPOGEN) 300MCG/ML INJ 5071142 1,121.90 J1442

NF-NIACIN ORAL TABLET 100MG 5071145 0.09

MOMETASONE (ASMANEX) 220MCG TWIST (NF) 5071146 656.30

MELATONIN 3MG TAB 5071147 4.20

LAMOTRIGINE (LAMICTAL) 100MG TAB 5071151 4.20

ABATACEPT (ORENCIA) 250MG VL 5071152 2,582.00 J0129

ORENCIA/NS IVPB : 1000MG/100ML 5071153 0.00



GABAPENTIN (NEURONTIN) 100MG CAP (RX) 5071156 0.00

SOD FLUORIDE (PREVIDENT 5000 PLUS) C (RX 5071157 0.00



Z BIMATOPROST (LUMIGAN) 0.01% EYE DROP 5071163 0.00

TOCILIZUMAB (ACTEMRA) 400MG/20ML VL 5071164 6,043.80 J3262



NAPROXEN (NAPROSYN) 500MG TAB (RX) 100 5071167 0.00

GLUCOSAMINE 750MG CAP (NF) 5071172 0.40

LOSART-HCTZ (HYZAAR) 100-25MG TAB (NF) 5071175 14.30

RIVASTIGMINE (EXELON) 1.5MG CAP (NF) 5071176 16.10

Z HYDROMORPH (DILAUDID) 1MG/ML ORAL SOLN 5071177 1.30

RIVASTIGMINE (EXELON) 6MG CAP (NF) 5071179 16.10

RIVASTIGMINE (EXELON) 4.5MG CAP (NF) 5071180 0.00



LOSART-HCTZ (HYZAAR) 100-12.5MG TAB (NF) 5071181 0.00

LOSART-HCTZ (HYZAAR) 50-12.5MG TAB (NF) 5071182 0.00

ESZOPICLONE (LUNESTA) 1MG TAB (NF) 5071184 13.80

ACTEMRA/NS IVPB : 400MG/100ML 5071186 0.00




GENTAMICIN 160MG/100ML PREMIX 5071190 0.00

Z FERROUS FUMARATE 325MG TAB 5071192 0.00

Z PREDNISOL (PRED FORTE) 1% EYE SOLN 5071193 0.00


CLOBAZAM (ONFI) 5MG TAB (NF) 5071196 11.60

IPRAT-ALB (DUONEB) NEB (NON-FORM) 5071203 2.80

ALPRAZOLAM (XANAX) 0.5MG TAB (NF) 5071204 7.30

OLMESARTAN (BENICAR) 20MG TAB (340B) 5071211 0.00

MULTIVITAMIN WITH MINERALS TAB (RX) 5071212 0.00

Z OLMESARTAN (BENICAR) 5MG TAB 5071213 0.00

Z OLMESARTAN (BENICAR) 40MG TAB 5071214 0.00

TIZANIDINE (ZANAFLEX) 4MG TAB (NF) 5071216 4.20

DIVALPROEX DR (DEPAKOTE) 500MG TAB (NF) 5071217 0.00

TIZANIDINE (ZANAFLEX) 2MG CAP (NF) 5071218 4.20

TIZANIDINE (ZANAFLEX) 6MG CAP (NF) 5071219 0.00

DRONABINOL (MARINOL) 5MG CAP (NF) 5071221 29.30

Z HYDROCORTISONE (CORTEF) 10MG TAB 5071222 0.00

Z RAMIPRIL (ALTACE) 5MG CAP 5071225 0.00

Z RAMIPRIL (ALTACE) 2.5MG CAP 5071226 0.00

Z RAMIPRIL (ALTACE) 10MG CAP 5071227 0.00

Z RAMIPRIL (ALTACE) 1.25MG CAP 5071228 0.00



Z DEXLANSOPRAZOLE (DEXILANT) 30MG CAP 5071231 0.00


IPRATROPIUM (ATROVENT) 0.03% NASAL (NF) 5071236 0.00

BACLOFEN (LIORESAL) 10MG TAB (340B) 5071237 0.00

SALMETEROL (SEREVENT) DISKUS (NF) 5071238 795.70

VITAMIN D3 2000IU TAB (NF) 5071244 0.00

ENALAPRIL (VASOTEC) 2.5MG TAB (NF) 5071245 0.00

CEFEPIME/NS (MAXIPIME) 1GM/100ML 5071246 41.20

ESTRADIOL (ESTRACE) 0.5MG TAB (RX) 5071247 0.00

LISINOPRIL (ZESTRIL) 2.5MG TAB (RX) 5071248 0.00

PIRBUTEROL (MAXAIR) 200MCG INH (NF) 5071249 0.00

NF-OCUVITE TABLET 5071252 0.41


FOSINOPRIL (MONOPRIL) 40MG TAB (NF) 5071254 2.60

G LACTOBACILLUS (LACTINEX) TAB 5071256 0.00



NF-OSMOLITE 1.5 CAL ORAL LIQUID 5071258 0.03

NORFLOXACIN (NOROXIN) 400MG TAB (NF) 5071260 14.30

DIAZEPAM (DIASTAT) 10MG RECTAL GEL 5071261 541.30

G ACETAMINOPHEN (TYLENOL) 160MG/5ML LIQ 5071262 0.00

Z CALCITRIOL (ROCALTROL) 1MCG/ML ORL SLN 5071263 0.00

NF-OSMOLITE 1.2 CAL LIQUID 5071264 0.03

FLUOXETINE (PROZAC) 10MG CAP (NF) 5071265 4.20

DABIGATRAN (PRADAXA) 150MG CAP (340B) 5071267 0.00

IBANDRONATE (BONIVA) 150MG TAB (NF) 5071269 476.90

FOSINOPRIL (MONOPRIL) 20MG TAB (NF) 5071271 3.70

BUMETANIDE (BUMEX) 1MG TAB (NF) 5071272 4.20

NF-OSMOLITE 1.5 CAL ORAL SOLUTION 5071273 0.02

BUPROPION SR (WELLBUTRIN SR) 150MG (340B 5071274 0.00

Z HYDROC-ACET (NORCO) 7.5-325MG TAB 5071276 0.00

ASCORBIC ACID (VITAMIN C) 500MG TAB (RX) 5071277 0.00

SODIUM CL (MURO-128) 5% OPTH SOLN (NF) 5071278 7.20

DULOXETINE (CYMBALTA) 60MG CAP (NF) 5071279 0.00

NF-CORTISPORIN OTIC SOLN 1%-0.35%-10,000 5071280 10.00

TACROLIMUS (PROGRAF) 1MG CAP (NF) 5071283 14.70

Z TOBRAMYCIN (TOBREX) EYE OINT 0.3% 5071286 0.00

Z TOBRAMYCIN (TOBREX) EYE SOLN 0.3% 5071289 0.00

HEPATITIS A (VAQTA) 25 UNITS/0.5ML PED/A 5071290 95.90 90633

HEPATITIS A (VAQTA) 50 UNITS/ML ADULT 5071291 263.34 90632

DENOSUMAB (PROLIA) 60MG INJ 5071292 2,884.70 J0897

HYDROCOD-ACET (NORCO) 5-325MG TAB 5071293 4.20

RISEDRONATE (ACTONEL) 5MG TAB (NF) 5071295 12.20

PROCHLORPER (COMPAZINE) 10MG TAB (340B) 5071296 0.00

FOLIC ACID 400MCG TAB (RX) 5071297 0.00

METOPROLOL ER (TOPROL XL) 50MG TAB (340B 5071299 0.00

NADOLOL (CORGARD) 20MG TAB (340B) 5071300 0.00

RISPERIDONE (RISPERDAL) 1MG/ML ORAL SO 5071302 0.00


G CRANBERRY JUICE 5071304 0.00

Z PRAVASTATIN (PRAVACHOL) 10MG TAB 5071306 0.00

DEXTROMETHORPHAN 30MG/5ML SUSP (NF) 5071307 4.20

VORTIOXETINE (TRINTELLIX) 20MG TAB (340B 5071309 0.00

MOMETASONE (ELOCON) 0.1% CR (NF) 5071310 7.90

LEVOCETIRIZINE (XYZAL) 5MG TAB (RX) 5071313 0.00

ACYCLOVIR (ZOVIRAX) 400MG TAB (340B) 5071315 0.00

VALSARTAN (DIOVAN) 160MG TAB (NF) 5071317 0.00


Z MORPHINE 5MG/ML INJ 5071319 0.00

ZOSYN/NS 2.25GM/100ML 5071320 0.00

ATORVASTATIN (LIPITOR) 10MG TAB (RX) 5071321 0.00

Z FERROUS GLUCONATE 324MG TAB 5071340 0.00



PEGFILGRASTIM (NEULASTA) 6MG INJ 5071341 17,432.00 J2505

TEMAZEPAM (RESTORIL) 30MG CAP (NF) 5071342 2.60

ACET-DIPH (TYLENOL PM) 500-25MG TAB (NF) 5071345 4.20

PSYLLIUM (METAMUCIL) 3.4GM PWD (NF) 5071348 4.20

PRASUGREL (EFFIENT) 10MG TAB (NF) 5071350 40.50

HYDROCORTISONE (CORTEF) 5MG TAB (NF) 5071355 4.20



NF-CORTEF ORAL TABLET 10MG 5071358 1.60

PULMOCARE LIQUID 5071359 0.00

TRAZODONE (DESYREL) 100MG TAB (RX) 5071360 0.00

ENAL/HCTZ (VASERETIC) 10-25MG TAB (NF) 5071361 4.20

Z MORPHINE IR 30MG TAB 5071364 0.00

Z HYDROC-ACET (NORCO) 10-325MG TAB 5071365 0.00

Z HYDROC-ACET (NORCO) 5-325MG TAB 5071366 0.00

HYDROCOD-ACET (NORCO) 7.5-325MG (NF) 5071367 4.20

HYDROCOD-ACET (NORCO) 10-325MG (NF) 5071368 4.20

SEVELAMER (RENVELA) 800MG TAB (NF) 5071369 9.00

PARICALCITOL (ZEMPLAR) 1MCG CAP (NF) 5071370 43.50

G ENSURE LIQUID 5071371 0.00

G GLUCERNA 5071372 0.00

Z CEFUROXIME (CEFTIN) 250MG/5ML SUSP 5071374 0.00

ONDANSETRON ODT (ZOFRAN ODT) 4MG (340B) 5071375 0.00

BENZOIN COMPOUND TOPICAL 5071377 11.40

FORTAZ/NS 2GM/100ML 5071380 0.00

Z TETRABENAZINE (XENAZINE) 12.5MG TAB 5071381 0.00

Z TETRABENAZINE (XENAZINE) 25MG TAB 5071382 0.00

AMANTADINE (SYMMETREL) 100MG CAP (340B) 5071385 0.00

Z LINEZOLID (ZYVOX) 600MG TAB 5071386 0.00

Z NYSTATIN (MYCOSTATIN) CREAM 5071387 0.00

GABAPENTIN (NEURONTIN) 600MG TAB (NF) 5071388 0.00

GABAPENTIN (NEURONTIN) 800MG TAB (NF) 5071389 0.00

ROPINIROLE (REQUIP) 1MG TAB 5071392 4.20

SERTRALINE (ZOLOFT) 100MG TAB (NF) 5071393 12.60

G WHISKEY 5071396 0.00

MEROPENEM (MERREM) 500MG VL 5071398 21.50

MILNACIPRAN (SAVELLA) 100MG TAB (NF) 5071399 7.90

KETOCONAZOLE (NIZORAL) 200MG TAB (NF) 5071400 4.20

MEROPENEM/NS 500MG/100ML 5071401 0.00

OLOPATADINE (PATANOL) 0.1% EYE SOL (NF) 5071402 99.10

QUETIAPINE (SEROQUEL) 300MG TAB (NF) 5071404 25.00











LIDOCAINE 4% LOJ 5071413 17.00

Z HYDROC-ACET (LORTAB) 10-500MG TAB 5071414 12.90

Z PANTOPRAZOLE (PROTONIX) 40MG PCKT 5071419 0.00

ENOXAPARIN (LOVENOX) 80MG SYRINGE (340B) 5071420 0.00

CHOLESTYRAMINE (QUESTRAN) 4GM PWD (NF) 5071421 7.80

ADALIMUMAB (HUMIRA) 40MG INJ (NF) 5071422 4,060.20

ACETAMINOPHEN (OFIRMEV) 1000MG/100ML INJ 5071424 147.30 J0131

TERBINAFINE (LAMISIL) 250MG TAB (NF) 5071425 4.20

APIXABAN (ELIQUIS) 2.5MG TAB 5071426 20.50

DAPSONE 25MG TAB (NF) 5071427 4.20



ROTAVIRUS (ROTARIX) ORAL SUSP 1ML 5071430 445.90 90681

APIXABAN (ELIQUIS) 5MG TAB 5071431 20.50

LETROZOLE (FEMARA) 2.5MG TAB (NF) 5071432 4.20

NF-GUIATUSS AC ORAL SYRUP 10MG-100MG/5ML 5071436 0.41


AMLOD-OLME-HCTZ (TRIBENZOR) 5-40-25 TAB 5071438 0.00

CARB-LEV-EN 18.75-75-200 (STALEVO 75) TA 5071439 15.60

CARB-LEV-EN 12.5-50-200 (STALEVO 50) TAB 5071440 0.00

CARB-LEV-EN 25-100-200 (STALEVO 100) TAB 5071441 0.00

CARB-LEV-EN 31.25-125-200 (STALEVO 125) 5071442 0.00

FAMOTIDINE (PEPCID) 40MG TAB (RX) 5071443 0.00

SPIRONOLACTONE (ALDACTONE) 50MG (NF) 5071444 2.60


VALACYCLOVIR (VALTREX) 1GM TAB (340B) 5071446 0.00

TOLTERODINE ER (DETROL LA) 4MG CAP (NF) 5071448 31.70

RANITIDINE (ZANTAC) 15MG/ML SYRUP (NF) 5071450 4.90

NF-RANITIDINE ORAL SOLUTION 15MG/1ML 5071451 2.30

CHLORPROMAZINE (THORAZINE) 25MG TAB (NF) 5071452 20.20



AMLOD-BENAZ (LOTREL) 2.5-10MG CAP (NF) 5071455 15.10


EPINEPHRINE (EPI-PEN) 0.3MG/0.3ML (340B) 5071457 0.00


Z ERYTHROMYCIN 250MG TAB 5071459 0.00



Z LOSART-HCTZ (HYZAAR) 100-12.5MG TAB 5071462 0.00

LOSART-HCTZ (HYZAAR) 100-25MG TAB (340B) 5071463 0.00



LOSART-HCTZ (HYZAAR) 50-12.5MG TAB (340B 5071464 0.00

G GLYCERIN ADULT SUPP 5071465 0.00


Z PRAZOSIN (MINIPRESS) 2MG CAP 5071471 0.00

Z ZIPRASIDONE (GEODON) 60MG CAP 5071472 0.00

G GOLD BOND LOTION 5071473 0.00

Z VALPROIC AC (DEPAKENE) 250MG/5ML SYRUP 5071474 0.00

URSODIOL (ACTIGALL) 300MG CAP (NF) 5071475 12.20

G CRANBERRY 405MG CAP 5071476 0.00

AM-VAL-HCT (EXFORGE HCT) 10-160-25MG TAB 5071477 16.90


LOSARTAN (COZAAR) 100MG TAB (RX) 5071479 0.00

AM-VAL-HCT (EXFORGE HCT) 10-160-12.5MG T 5071480 0.00


AM-VAL-HCT (EXFORGE HCT) 5-160-12.5MG TA 5071482 0.00




GLIMEPIRIDE (AMARYL) 2MG TAB (340B) 5071486 0.00

Z GLIMEPIRIDE (AMARYL) 1MG TAB 5071487 0.00

G FIBER GUMMIES (NON-FORM) 5071488 0.00

PHENOBARBITAL 16.2MG TAB (NF) 5071489 0.17

LAMOTRIGINE (LAMICTAL) 25MG TAB (NF) 5071490 4.20

ESCITALOPRAM (LEXAPRO) 20MG TAB (RX) 5071491 0.00

BUPREN-NALOX (SUBOXONE) 8-2MG SL FILM 5071493 26.20

TESTOST CY (DEPO-TEST) 200MG/ML INJ (NF) 5071494 197.30

CYCLOSPORINE (GENGRAF) 100MG CAP (NF) 5071497 20.00

NORTRIPTYLINE (PAMELOR) 50MG CAP (NF) 5071499 5.00

ZONISAMIDE (ZONEGRAN) 100MG CAP (340B) 5071500 0.00


CALCIUM SUPPLEMENT NON-FORM (NF) 5071502 2.00


BUPROPION SR (WELLBUTRIN SR) 100MG (RX) 5071505 0.00

ITRACONAZOLE (SPORANOX) 100MG CAP (340B) 5071506 0.00


HALOPERIDOL (HALDOL) 2MG TAB (NF) 5071508 0.00

ALPRAZOLAM (XANAX) 1MG TAB (NF) 5071509 0.00

MEAS-MUMP-RU-VAR (PROQUAD) 0.5ML INJ 5071510 608.90 90710

OXYBUTYNIN (DITROPAN) 5MG TAB (340B) 5071511 0.00

LIDOCAINE-ANTACID SUSP 5071512 4.20

THYROID (ARMOUR THYROID) 15MG TAB (NF) 5071513 0.17

METFORMIN (RIOMET) 500MG/5ML ORAL SOLN 5071514 0.00

NF-OFLOXACIN OTIC SOLUTION 0.3% 5071515 45.90

NF-GLEEVEC 400MG ORAL TABLET 5071516 566.20

IMATINIB (GLEEVEC) 100MG TAB (NF) 5071518 164.90



IMATINIB (GLEEVEC) 400MG TAB (NF) 5071519 790.50

EZETIMIBE (ZETIA) 10MG TAB (340B) 5071520 0.00


Z FLUTICASONE (FLOVENT HFA) 220MCG 5071522 0.00

ENALAPRIL (VASOTEC) 10MG TAB 5071523 4.20

ONDANSETRON (ZOFRAN) 8MG TAB (NF) 5071524 0.00

G KETOCONAZOLE (NIZORAL) SHAMPOO 1% 5071525 0.00

Z FLUOCINOLONE (CAPEX) 0.01% CR 5071526 0.00

CLOBETASOL (TEMOVATE) 0.05% CR (340B) 5071527 0.00

OMEPRAZOLE (PRILOSEC) 40MG CAP (RX) 5071528 0.00

PRIMIDONE (MYSOLINE) 250MG TAB (NF) 5071533 4.20

TADALAFIL (CIALIS) 5MG TAB (RX) 5071534 0.00

DOXYCYCLINE 50MG CAP (340B) 5071535 0.00

MIRTAZAPINE (REMERON) 45MG TAB (NF) 5071536 4.20

MEDROXYPROG (PROVERA) 10MG TAB (RX) 5071537 0.00

LORAZEPAM (ATIVAN) 1MG TAB (RX) 5071538 0.00

PROPRANOLOL (INDERAL) 20MG TAB (RX) 5071539 0.00

TOLTERODINE (DETROL) 2MG TAB (NF) 5071543 10.60

G MELATONIN 5MG TAB (NON-FORM) 5071544 0.00

HYDROCOD-ACET (NORCO DOSE PACK) 5-325MG 5071545 10.30


NF-VITAMIN B12 ORAL TABLET 1000MCG 5071548 0.17

NF-SKIN-PREP WIPES PAD 5071549 11.50

NF-B12-METHYL ORAL CAPSULE 1000MCG 5071551 0.25

SULINDAC (CLINORIL) 150MG TAB (340B) 5071552 0.00

NF-FISH OIL CAPSULE 500MG 5071553 0.13

NF-VITAMIN D ORAL TABLET 1000IU 5071554 1.20

NF-VITAMIN D3 TAB 1,000IU 5071555 0.16

LEVETIRACETAM (KEPPRA) 750MG TAB (NF) 5071556 0.00



LEVETIRACETAM ER (KEPPRA XR) 500MG TAB 5071559 0.00

LEVETIRACETAM ER (KEPPRA XR) 750MG TAB 5071560 0.00

GLYB-METF (GLUCOVANCE) 5-500MG TAB (NF) 5071561 3.30

CALCITRIOL (ROCALTROL) 0.25MCG CAP (NF) 5071562 4.20




ETODOLAC (LODINE) 200MG CAP (NF) 5071566 0.00


GLYB-METF (GLUCOVANCE) 2.5-500MG (NF) 5071568 0.00

G PROSOURCE NOCARB ORAL SOLUTION 5071569 0.00






METFORMIN (GLUCOPHAGE) 850MG TAB (NF) 5071574 4.20

METFORM-SITA (JANUMET) 1000-50MG TAB (NF 5071576 15.30

METFORM-SITA (JANUMET) 500-50MG TAB (NF) 5071577 0.00

Z PERMETHRIN (ELIMITE) 5% TOP CR 5071578 0.00

G BENZ/BENZ (DERMOPLAST) SPR (NON-FOR 5071579 0.00

CUBICIN/NS 600MG/100ML 5071580 0.00

CUBICIN/NS 650MG/100ML 5071581 0.00

NF-NORVASC 10MG ORAL TABLET 5071582 10.60

PRAZOSIN (MINIPRESS) 1MG CAP (NF) 5071583 1.80

FLECAINIDE (TAMBOCOR) 100MG TAB (NF) 5071584 9.60

FENOFIBRATE (LOFIBRA/TRIGLIDE) 160MG (NF 5071585 17.70

HYDROCOD-ACET (LORTAB) 10-500MG (NF) 5071586 1.70

CANDESARTAN (ATACAND) 8MG TAB (NF) 5071588 7.40

MAGNESIUM 250MG TAB (NF) 5071589 0.06

NORTRIPTYLINE (PAMELOR) 50MG CAP (340B) 5071591 0.00

NF-AUGMENTIN ORAL TABLET 500MG-125MG 5071592 18.50





Z PHENOBARBITAL 32.4MG TAB 5071598 0.00

CEFTRIAXONE (ROCEPHIN) 2GM/100ML 5071599 0.00






FER FUM/VIT C/B12/IF (FEROCON) CAP (NF) 5071605 4.20

CHLORPROMAZINE (THORAZINE) 100MG TAB (NF 5071606 0.00


CEFAZOLIN/NS 2GM/100ML 5071609 0.00


CELECOXIB (CELEBREX) 100MG CAP (RX) 5071612 0.00

CELECOXIB (CELEBREX) 200MG CAP (340B) 5071613 0.00

NF-TRIAMCINOLONE ACETONIDE CREAM 0.1% 5071614 0.24

CETIRIZINE (ZYRTEC) 10MG TAB (RX) 90 5071615 0.00

MINOCYCLINE 50MG CAP (340B) 5071616 0.00

Z MEMANTINE ER (NAMENDA XR) 28MG CAP 5071618 0.00




INFLUENZA VACCINE - MEDICARE 5071622 0.00 90656

PNEUMO 23 VACCINE - MEDICARE 5071623 0.00 90732

NF-SERTRALINE HCL TAB 100MG 5071624 10.80

FERROUS SULF 134MG (IRON 27MG) TAB (NF) 5071625 0.00



G BENZOCAINE (ANBESOL) 20% GEL 5071626 0.00

Z DOXAZOSIN (CARDURA) 2MG TAB 5071627 0.00


Z BENZTROPINE (COGENTIN) 2MG TAB 5071629 0.00

Z RANITIDINE (ZANTAC) 300MG TAB 5071630 0.00


Z CLONAZEPAM (KLONOPIN) 1MG TAB 5071633 0.00

Z MECLIZINE (ANTIVERT) 12.5MG TAB 5071634 0.00

ZOLPIDEM (AMBIEN) 5MG TAB (RX) 5071635 4.20

NF-SODIUM BICARBONATE 650MG ORAL TABLET 5071636 0.04

INVEGA TRINZA 819MG INJ (NF) 5071638 0.10

Z SEVELAMER (RENAGEL) 800MG TAB 5071640 0.00

CLONIDINE (CATAPRES) 0.3MG TAB (NF) 5071641 1.50

NICOTINE 2MG LOZENGE 5071642 20.60

RASAGILINE (AZILECT) 1MG TAB (NF) 5071643 50.80

RASAGILINE (AZILECT) 0.5MG TAB (NF) 5071644 0.00

VALPROIC ACID (DEPAKENE) 250MG/5ML (NF) 5071645 4.20

CLONAZEPAM ODT (KLONOPIN) 0.25MG (NF) 5071646 0.00

LINAGLIPTIN (TRADJENTA) 5MG TAB 5071647 45.10


FUROSEMIDE (LASIX) 80MG TAB (NF) 5071650 1.90

AMIODARONE (PACERONE) 100MG TAB (NF) 5071651 0.00

Z AMIODARONE (PACERONE) 100MG TAB 5071652 0.00

PHENAZOPYRID (PYRIDIUM) 200MG TAB (340B) 5071653 0.00

Z DIAZEPAM (VALIUM) 10MG/2ML INJ 5071654 0.00



ZONISAMIDE (ZONEGRAN) 100MG CAP (NF) 5071657 16.80

LACTULOSE 200GM/1000ML RECTAL ENEMA 5071658 14.86

RAMIPRIL (ALTACE) 5MG TAB (NF) 5071659 0.00

CELECOXIB (CELEBREX) 200MG CAP (NF) 5071660 0.00

RAMIPRIL (ALTACE) 2.5MG CAP (NF) 5071661 0.00

RAMIPRIL (ALTACE) 1.25MG CAP (NF) 5071662 0.00

CITALOPRAM (CELEXA) 10MG TAB (NF) 5071663 0.00

MOMETASONE HFA (ASMANEX) 200MCG (NF) 5071664 0.00

NF- 5071665 3.60

TRIAM-HCTZ (MAXZIDE-25) 37.5-25 TAB (NF 5071666 2.40

PROPRANOLOL ER (INDERAL LA) 80MG CAP (NF 5071667 5.20

OLMESAR-HCT (BENICAR HCT) 40-25MG (NF) 5071668 17.30

PRAVASTATIN (PRAVACHOL) 10MG TAB (NF) 5071669 10.00


EPOETIN A (EPOGEN) 10,000 UNITS/ML (NF) 5071671 659.40 J0885


OLMESAR-HCT (BENICAR HCT) 20-12.5MG TAB 5071674 0.00

CLONIDINE (CATAPRES-TTS-3) 0.3MG/ (NF) 5071675 0.00



Z METHYLPRED AC (DEPO-MEDROL) 80MG/ML 5071676 0.00

Z METHOTREXATE 10MG TAB 5071677 0.00



IBUPROFEN (MOTRIN) 800MG TAB (NF) 5071680 0.00

LINACLOTIDE (LINZESS) 145MCG CAP (NF) 5071681 0.00

G MICONAZOLE 200MG VAGINAL SUPP (NON-FOR 5071682 0.00

Z METOCLOPRAMIDE (REGLAN) 5MG TAB 5071683 0.00

Z HYDRO-ACET (LORTAB ELIXR) 7.5-325/15ML 5071684 0.00

ZOLEDRONIC ACID (RECLAST) 5MG/100ML 5071685 1,694.70 J3489

PALIPERIDONE ER (INVEGA) 3MG TAB (NF) 5071686 0.00

LORAZEPAM (ATIVAN) 2MG TAB (NF) 5071687 0.00



GUAIFENESIN (ROBITUSSIN) 400MG TAB (NF) 5071690 9.30

FLUOXETINE (PROZAC) 40MG CAP (NF) 5071691 52.20

DIAZEPAM (VALIUM) 10MG TAB (NF) 5071692 0.00

Z GABAPENTIN (NEURONTIN) 800MG TAB 5071693 0.00

Z ZIPRASIDONE (GEODON) 20MG CAP 5071694 0.00

NF-LIQUITEARS OPHTH SOLUTION 1.4% 5071696 0.80

ELTROMBOPAG (PROMACTA) 25MG TAB (NF) 5071697 0.00

DULAGLUTIDE (TRULICITY) 1.5MG (340B) 5071698 0.00



LIDOCAINE 3% CR (RX) 5071702 0.00

OFLOXACIN (OCUFLOX) 0.3% EYE SOLN (NF) 5071703 37.50

Z NEOMYCIN 500MG TAB 5071704 0.00

Z BENZONATATE (TESSALON) 200MG CAP 5071705 0.00

G MENTHOL-CAMPHOR (SARNA) LOTION 5071707 0.00

MILK OF MAGNESIA (RX) 5071708 0.00

MEGESTROL (MEGACE) 400MG/10ML SUSP (RX) 5071712 0.00

INDAPAMIDE (LOZOL) 2.5MG TAB (NF) 5071713 4.20

FUROSEMIDE/NS 100MG/100ML IVPB 5071714 0.00

Z OXYCOD-ACET (PERCOCET) 7.5-325MG TAB 5071715 0.00

NF-SENNALAX-S 50MG-8.6MG ORAL TABLET 5071716 0.90

Z AMPICILLIN 500MG CAP 5071717 0.00


DICLOFENAC (VOLTAREN) GEL 1% (340B) 5071720 0.00

DICLOFENAC SOD (VOLTAREN) 75MG TAB (340B 5071721 0.00

MORPHINE ER (MS CONTIN) 100MG TAB (NF) 5071722 0.00



FAMCICLOVIR (FAMVIR) 500MG TAB (NF) 5071727 4.20

Z RIVASTIGMINE (EXELON) 9.5MG/24HR PATCH 5071728 0.00



Z LIDOCAINE VISC (XYLO VISC) 15ML 5071729 0.00


NF-SENOKOT S 50MG-8.6MG ORAL TABLET 5071731 1.80

Z ISOSORB DN (ISORDIL) 10MG TAB 5071732 0.00

KETOCONAZOLE (NIZORAL) 1% SHAMPOO (NF) 5071734 55.10

SIMETHICONE (GAS-X) 125MG TAB (NF) 5071735 1.30

TWOCAL HN 5071736 0.00

CALCIUM CITRATE (CITRACAL) TAB (NF) 5071738 4.20

NF-ONE DAILY WOMEN'S TABLET 5071739 0.19

DICYCLOMINE (BENTYL) 20MG TAB 5071740 4.20

Z NAPROXEN (NAPROSYN) 250MG TAB 5071741 0.00

Z METHYLPHENIDATE (RITALIN) 5MG TAB 5071742 0.00

AMLOD-OLMESART (AZOR) 10-40MG TAB (NF) 5071743 0.00

ARIPIPRAZOLE (ABILIFY) 5MG TAB (RX) 5071744 0.00

G WINE 5071745 0.00

TRIAMCINOLONE (NASACORT AQ) SPRAY (NF) 5071747 16.00

METHOCARBAMOL (ROBAXIN) 750MG TAB (340B) 5071748 0.00

TIZANIDINE (ZANAFLEX) 4MG TAB (RX) 5071749 0.00

CEFOXITIN/NS (MEFOXIN) 2GM/100ML 5071750 0.00


LEVETIRACETAM (KEPPRA) 500MG/5ML SOLN 5071752 8.00

GLATIRAMER (COPAXONE) 20MG/ML INJ (NF) 5071753 6,996.60

BUT/ASA/CAF (FIORINAL) 50-325-40MG CAP 5071754 4.20

NF-ADIPEX-P 37.5MG ORAL CAPSULE 5071755 2.00

PHENTERMINE (ADIPEX-P) 37.5MG TAB (NF) 5071756 6.00

NF-LABETALOL HCL 100MG ORAL TABLET 5071757 1.90

Z KETOROLAC (ACULAR LS) 0.4% EYE DROP 5071759 0.00

DASATINIB (SPRYCEL) 20MG TAB (NF) 5071760 539.00

NF-LATANOPROST OPHTHALMIC SOLUTION 0.005 5071761 117.80


AMOX-CLAV (AUGMENTIN) 875-125MG TAB 5071765 4.00



Z TEMAZEPAM (RESTORIL) 7.5MG CAP 5071768 0.00

Z KETOROLAC (ACULAR) 0.5% EYE SOLN 5071769 0.00

CAPECITABINE (XELODA) 500MG TAB (NF) 5071770 123.30

GLIPIZ ER (GLUCOTROL XL) 5MG TAB (340B) 5071773 0.00

NF-FUROSEMIDE ORAL TABLET 40MG 5071775 0.60

NF-NITROGLYCERIN SL TAB 0.4MG 5071776 1.70

ALBUTEROL HFA (PROAIR HFA) (340B) 5071777 0.00

NF-METFORMIN HCL ORAL TABLET 1000MG 5071780 6.50

NF-DIAZEPAM ORAL TABLET 2MG 5071781 0.42

HYDRALAZINE 20MG/ML INJ 5071782 25.80

AZELASTINE 0.15% (205.5MCG) (340B) 5071783 0.00

NF-SERTRALINE HCL ORAL TABLET 100MG 5071786 8.15



NF-TRAZODO ORAL TABLET 50MG 5071787 5.10

TRAMADOL-ACET (ULTRACET) 37.5-325MG (NF) 5071789 3.20

TICAGRELOR (BRILINTA) 90MG TAB (NF) 5071790 19.00

MEMANTINE ER (NAMENDA XR) 28MG CAP (NF) 5071791 49.20

MEMANTINE ER (NAMENDA XR) 14MG CAP (NF) 5071792 0.00

Z MORPHINE ER (MS CONTIN) 30MG TAB 5071795 0.00

PENTOSAN (ELMIRON) 100MG CAP (NF) 5071796 13.50

NF-FIORICET TAB 325MG-50MG-40MG 5071798 5.30

CLONAZEPAM (KLONOPIN) 1MG TAB (NF) 5071800 5.30

Z LOVASTATIN (MEVACOR) 20MG TAB 5071801 0.00

Z COLCHICINE (COLCRYS) 0.6MG TAB 5071802 0.00

IRON POLYSAC (NU-IRON/FERREX) 150 (RX) 5071803 0.00

BENAZEPRIL-HCT (LOTENSIN HCT) 20-25MG T 5071804 4.60

MIDAZOLAM (VERSED) 10MG/5ML SYRUP 5071806 22.20

Z SALMETEROL (SEREVENT) INHALER 5071807 0.00

PANTOPRAZOLE (PROTONIX) 40MG VIAL 5071808 14.80

PROTONIX/NS 80MG/100ML IVPB 5071809 0.00

OXAZEPAM (SERAX) 10MG CAP (NF) 5071813 4.20

PREDNISONE (DELTASONE) 1MG TAB (NF) 5071814 4.20

Z FORMOTEROL (FORADIL) 12MCG INHALER 5071815 0.00

DTAP-IPV/HIB (PENTACEL) VACCINE 5071816 274.30 90698

ONDANSETRON (ZOFRAN) 8MG TAB (RX) 5071817 0.00

ELTROMBOPAG (PROMACTA) 50MG TAB (NF) 5071818 0.00

SUCRALFATE (CARAFATE) 1GM TAB (340B) 5071819 0.00

G MAGNESIUM 200MG/30ML LIQUID (NF) 5071820 0.00

Z CARBAMAZE (TEGRETOL) 100MG CHEW TAB 5071821 0.00

ACYCLOVIR (ZOVIRAX) 800MG TAB (NF) 5071822 2.90

ACYCLOVIR (ZOVIRAX) 200MG CAP (NF) 5071823 3.10

MYCOPHENOLATE DR (MYFORTIC) 360MG T (NF) 5071824 0.00

POTASSIUM CL (KLOR-CON) 10MEQ TAB (340B) 5071825 0.00

CLONIDINE (CATAPRES) 0.1MG TAB (RX) 5071826 0.00

Z TRIAMCINOLONE (KENALOG) TOPICAL SPRAY 5071827 0.00

FORMOTEROL (FORADIL) INHALER (NF) 5071828 15.40

ARTIF TEAR PEG-PG (SYSTANE) EYE DROP (NF 5071829 5.40

BENAZEPRIL (LOTENSIN) 20MG TAB (340B) 5071830 0.00

AZELASTINE (ASTELIN) 0.1% NASAL SPR (RX) 5071834 70.70

BUPROPION (WELLBUTRIN) 75MG TAB (NF) 5071836 4.20

Z ARIPIPRAZOLE (ABILIFY) 2MG TAB 5071837 0.00

OCUSOFT LID SCRUB (NF) 5071838 4.20

Z LITHIUM ER 450MG TAB 5071839 0.00

FLUOXETINE (PROZAC) 40MG CAP (RX) 5071841 0.00

Z MORPHINE ER (MS CONTIN) 60MG TAB 5071842 0.00

EPLERENONE (INSPRA) 50MG TAB (NF) 5071844 0.00

EMPAGLIFLOZIN (JARDIANCE) 10MG TAB (NF) 5071846 0.00

EMPAGLIFLOZIN (JARDIANCE) 25MG TAB (NF) 5071847 0.00



DULOXETINE (CYMBALTA) 60MG CAP (RX) 5071848 0.00

G VITAMIN D3 5000UI/ML ORAL SOLN (NF) 5071849 0.00

Z METOCLOPRAMIDE (REGLAN) 10MG TAB 5071850 0.00

LITHIUM ER 450MG TAB (NF) 5071851 4.20

VITAMIN B12 250MCG TAB (NF) 5071852 0.00

Z PRAZOSIN (MINIPRESS) 1MG CAP 5071853 0.00


LEVOFLOXACIN (LEVAQUIN) 500MG TAB 5071855 4.20

CEFEPIME/NS (MAXIPIME) 500MG/100ML 5071856 41.20

CARB-LEV-EN 50-200-200 (STALEVO 200) TAB 5071857 11.90

CARB-LEV-EN 37.5-150-200 (STALEVO 150) T 5071858 7.20

SODIUM CL (MURO-128) 5% EYE OINT (NF) 5071859 76.90

Z OLANZAPINE (ZYPREXA) 10MG INJ 5071860 0.00

KETOROLAC (ACULAR) 0.5% EYE DROP (NF) 5071861 51.90

BRIMONIDINE (ALPHAGAN) 0.2% EYE SLN (NF) 5071862 10.30

BUPROPION ER (WELLBUTRIN XL) 300MG (340B 5071863 0.00

Z PHENYTOIN (DILANTIN) 125MG/5ML SUSP 5071864 0.00

FONDAPARINUX (ARIXTRA) 2.5MG/0.5ML (NF) 5071868 41.60

LIRAGLUTIDE (VICTOZA) 18MG/3ML PEN (NF) 5071869 706.30

CHLORTHALIDONE 50MG TAB (340B) 5071870 0.00

NF-GOOD NEIGHBOR PHARMACY MICONAZORB AF 5071871 0.00

BENAZEPRIL (LOTENSIN) 40MG TAB (340B) 5071872 0.00

Z VANCOMYCIN (VANCOCIN) 125MG CAP 5071873 0.00

VANCOMYCIN (VANCOCIN) 125MG CAP (NF) 5071874 14.60

PAROXETINE (PAXIL) 30MG TAB (RX) 5071875 0.00

Z METOLAZONE (ZAROXOLYN) 5MG TAB 5071876 0.00

Z ENOXAPARIN (LOVENOX) 30MG INJ 5071877 0.00

FOLIC ACID 800MCG TAB (NF) 5071878 0.00

HYDROMORPHONE (DILAUDID) 1MG/ML (NF) 5071879 8.30

HYDROMORPHONE (DILAUDID) 2MG/ML INJ 5071880 15.20

HYDROMORPHONE (DILAUDID) 4MG/ML (NF) 5071881 8.30

Z CARBAMAZEPINE ER (CARBATROL) 300MG TAB 5071882 0.00

LINAGLIPTIN (TRADJENTA) 5MG TAB (340B) 5071883 0.00

PROPRANOLOL (INDERAL) 20MG TAB (340B) 5071884 0.00

NF-VYVANSE CAP 50MG 5071885 20.40

MONTELUKAST (SINGULAIR) 5MG CHEW (NF) 5071886 0.00

NF-LOESTRIN FE 1.5/30 30MCG-1.5MG ORAL T 5071889 12.40

LEVOFLOXACIN (LEVAQUIN) 250MG TAB 5071890 4.20

LEVOFLOXACIN (LEVAQUIN) 750MG TAB (NF) 5071891 4.20

LEVOFLOXACIN (LEVAQUIN) 500MG/100ML 5071892 19.00

Z MAGNESIUM OX (MAG-OX) 420MG TAB 5071893 0.00

ONDANSETRON (ZOFRAN) 8MG TAB (340B) 5071894 0.00

LINA-METF (JENTADUETO) 2.5-1000MG (340B) 5071895 0.00

SUMATRIPTAN (IMITREX) 100MG TAB (340B) 5071896 0.00

NF-GOOD SENSE ANTIHISTAMINE ALLERGY RELI 5071897 0.22



DOXYCYCLINE 100MG TAB (RX) 5071899 0.00

NF-REGLAN 10MG ORAL TABLET 5071900 4.00

NADOLOL (CORGARD) 40MG TAB (340B) 5071901 0.00

LORATADINE (CLARITIN) 10MG TAB (340B) 5071902 0.00

NF-SPIRIVA 18MCG INHALATION CAPSULE 5071903 27.60

ALBUT-IPRAT (DUONEB) 2.5-0.5MG (340B) 5071904 0.00

MONTELUKAST (SINGULAIR) 5MG CHEW (RX) 5071905 0.00

TEMAZEPAM (RESTORIL) 30MG CAP (RX) 5071909 42.30

ACITRETIN (SORIATANE) 10MG CAP (NF) 5071910 114.70

PALBOCICLIB (IBRANCE) 100MG TAB (NF) 5071913 0.08

ALOE VESTA OINT (NF) 5071914 0.23

TRAZODONE (DESYREL) 100MG TAB (NF) 5071916 2.30

Z VANCOMYCIN 250MG/5ML ORAL SOLN 5071917 0.00

FERRIC GLUC (FERRLECIT) 62.5MG INJ (NF) 5071918 39.20 J2916

FERRIC GLUC/NS 125MG/100ML IVPB 5071919 0.00

NF-MACRODANTIN CAPSULE 50MG 5071920 7.10

DOCUSATE (COLACE) 100MG CAP (RX) 5071921 0.11



MONTELUKAST (SINGULAIR) 10MG TAB (RX) 5071924 0.00

MULTIVITAMIN LIQUID 15ML (NF) 5071925 4.20

TERBINAFINE (LAMISIL) 250MG TAB (340B) 5071926 0.00

DICLOFENAC SOD (VOLTAREN) 50MG TAB (340B 5071927 0.00

NF-JEVITY 1.5 CAL LIQUID 5071930 0.02

SITA-METF ER (JANUMET XR) 100-1000MG (34 5071931 0.00

NF-JEVITY 1.2 CAL LIQUID 5071932 0.05



NF-HYDROXYCHLOROQUINE SULFATE TAB 200MG 5071940 2.20

NF-PLAQUENIL ORAL TABLET 200MG 5071941 14.11

Z MIRTAZAPINE (REMERON) 30MG TAB 5071942 0.00

NF-TRIAMTERENE-HYDROCHLOROTHIAZIDE 50MG- 5071943 0.00

GOLD BOND LOTION (NF) 5071944 29.70


CLONAZEPAM (KLONOPIN) 1MG TAB (RX) 5071946 0.00


CARVEDILOL (COREG) 25MG TAB (RX) 5071948 0.00

CLONIDINE (CATAPRES) 0.2MG TAB (RX) 5071949 0.00

Z KETOROLAC (TORADOL) 60MG/2ML VIAL 5071950 0.00

Z ORPHENADRINE (NORFLEX) 60MG/2ML VL 5071951 0.00

Z CEFIXIME (SUPRAX) 400MG TAB 5071952 0.00

DICLOFENAC SOD (VOLTAREN) 50MG TAB (RX) 5071953 0.00

NIFEDIPINE ER 90MG TAB (340B) 5071954 0.00

NF-ACULAR LS OPHTH SOLN 0.4% 5071955 56.80

NF-KLONOPIN TABLET 0.5MG 5071956 10.10



NF-VITAMIN B6 ORAL TABLET 100MG 5071958 1.70

FENOFIBRATE 120MG TAB (NF) 5071959 0.45

VITAMIN B6 100MG TAB (NF) 5071960 0.90


GABAPENTIN (NEURONTIN) 800MG TAB (RX) 5071969 13.20

GLIPIZIDE (GLUCOTROL) 5MG TAB (RX) 5071970 0.00

CARIPRAZINE (VRAYLAR) 4.5MG CAP (NF) 5071971 4.20


LEVOFLOXACIN (LEVAQUIN) 250MG SUSP (NF) 5071973 9.30


UMEC-VIL (ANORO ELLIPTA) 62.5-25 INH (NF 5071976 17.40

NF-OXYCODONE HCL CAP 5MG 5071977 1.30

LIPOFLAVONOID TAB (NF) 5071978 0.60

NF-OPTI-VITAMINS TABLET 5071979 0.31

NF-KEPPRA ORAL TABLET 1000MG 5071982 46.80

LEVETIRACETAM (KEPPRA) 250MG TAB (RX) 5071983 0.00

NF-TRAVATAN OPHTH SOLN 0.004% 5071985 101.10

RAMELTEON (ROZEREM) 8MG TAB (NF) 5071986 7.60

DIAZEPAM (DIASTAT) 2.5MG RECTAL GEL 5071987 355.10

VANCOMYCIN (VANCOCIN) 750MG VIAL 5071988 36.40 J3370

NS 250ML ADVANTAGE BAG 5071989 23.70

BISOPROLOL (ZEBETA) 5MG TAB (NF) 5071990 0.00

RIFAMPIN 300MG CAP (NF) 5071991 4.20

NATEGLINIDE (STARLIX) 60MG TAB (NF) 5071992 3.10


CARBAMAZEPINE (TEGRETOL) 100MG CHEW (NF) 5071994 4.20

ONDANSETRON ODT (ZOFRAN ODT) 4MG TAB 5071995 4.20

FENOFIBRATE (TRICOR) 48MG TAB (NF) 5071997 4.20

THEO ER (THEOCHRON) 300MG TAB (NF) 5071998 0.00

NF-Cozaar Oral Tablet 50MG 5071999 11.40

OXCARBAZEPINE (TRILEPTAL) 150MG TAB (NF) 5072000 4.50

BICALUTAMIDE (CASODEX) 50MG TAB (NF) 5072002 4.20

HYDROCOD-ACET 7.5-325MG/15ML SOLN 5072003 14.70

LEUPROLIDE (ELIGARD) 22.5MG (3 MONTH) 5072004 0.00

NOR-ETH-FE (LO LOESTRIN FE) PACK (340B) 5072005 0.00

NF-LITHIUM CARBONATE CAP 300MG 5072006 0.70

NF-QUETIAPINE FUMARATE ORAL TABLET 50MG 5072007 20.30

HYDROGEL (SOLOSITE) X1 APPLICATION 5072008 4.20

INSULIN GLARG (LANTUS) 10ML VIAL (340B) 5072009 0.00

HYDROCHLOROTHIAZIDE 12.5MG (340B) 5072010 0.00

HALOBETASOL (ULTRAVATE) 0.05% OINT (NF) 5072011 17.10

METHADONE ORAL SOLN (NF) 5072013 0.31

PIPERACILLIN-TAZO (ZOSYN) 2.25GM VL 5072014 14.30

Z ANASTROZOLE (ARIMIDEX) 1MG TAB 5072015 52.60

EXENATIDE ER (BYDUREON) 2MG PEN (340B) 5072017 0.00



NF-Welchol Oral Tablet 625MG 5072018 8.30

AZELASTINE (ASTELIN) 0.1% NASAL SPR (NF) 5072019 51.50

EPLERENONE (INSPRA) 25MG TAB (NF) 5072020 15.50


ENTACAPONE (COMTAN) 200MG TAB (NF) 5072022 4.20

ESTRADIOL (ELESTRIN) 0.06% GEL (340B) 5072023 0.00


NF-Morphine Sulfate Tablet 30MG 5072025 7.30

METOLAZONE (ZAROXOLYN) 5MG TAB (NF) 5072027 7.30

PRAZOSIN (MINIPRESS) 2MG CAP (NF) 5072028 4.20

ZALEPLON (SONATA) 10MG CAP (NF) 5072029 10.70

ARFORMOTEROL (BROVANA) 15MCG NEB (NF) 5072030 18.50

NF-CeleBREX Oral Capsule 200MG 5072031 23.70

G FEXOFENADINE (ALLEGRA) 60MG TAB (NF) 5072032 8.30


APREPITANT (EMEND) 150MG VIAL (NF) 5072034 1,079.70 J1453

NF-Terazosin Oral Capsule 5MG 5072036 4.20

BETHANECHOL (URECHOLINE) 5MG TAB (NF) 5072037 4.20

FLUOXETINE (PROZAC) 10MG TAB (RX) 5072038 0.00

TETRACYCLINE 250MG CAP (NF) 5072039 0.00

SEVELAMER (RENVELA) 0.8GM PACKET (NF) 5072040 49.00

DEXAMETHASONE 10MG/ML INJ (NF) 5072041 0.00

PANTOPRAZOLE PKT (PROTONIX) 40MG 5072043 42.10

FONDAPARINUX (ARIXTRA) 10MG/0.8ML (NF) 5072044 0.00

OSELTAMIVIR (TAMIFLU) 30MG CAP 5072047 32.00

1 PHARMACY CONSULT 5072048 0.00

MIRABEGRON ER (MYRBETRIQ) 25MG TAB (NF) 5072049 37.10

MIRABEGRON ER (MYRBETRIQ) 50MG TAB (NF) 5072050 0.00

NF-ANASTROZOLE ORAL TABLET 1MG 5072051 41.20

NF-LEVOTHROID TAB 0.15MG 5072053 2.50

NF-VITAMIN C PURE ORAL TABLET 1000MG 5072055 0.23

NYSTATIN (NYSTOP) TOP POWDER 60GM (NF) 5072056 55.00

G PRESERVISION AREDS 2 CAP (NF) 5072057 0.00

Z PIOGLITAZONE (ACTOS) 30MG TAB 5072058 0.00

LIDOCAINE-PRIL (EMLA) 2.5-2.5% CR (340B) 5072059 0.00

VENLAFAXINE ER (EFFEXOR XR) 150MG C (RX) 5072060 0.00

Z OSELTAMIVIR (TAMIFLU) 30MG CAP 5072061 0.00

NF-Anastrozole Oral Tablet 1MG 5072062 41.20

POTASSIUM BI-CIT (EFFER-K) 20MEQ TAB (NF 5072063 4.20

CEFPODOXIME (VANTIN) 100MG TAB (NF) 5072064 15.00

INS LISPRO (HUMALOG KWIKPEN) 100U/ML (34 5072065 0.00

EMPAGLIFLOZIN (JARDIANCE) 25MG TAB (340B 5072066 0.00

MORPHINE IR 30MG TAB (NF) 5072067 2.90

TERBINAFINE (LAMISIL) 250MG TAB (RX) 5072068 14.50

Z OLANZAPINE (ZYPREXA ZYDIS) 5MG ODT 5072069 0.00



ESTROGEN (PREMARIN) 0.625MG/G CR (340B) 5072070 0.00

LEDI-SOF (HARVONI) 90MG-400MG TAB (NF) 5072071 4,171.50

BENZTROPINE (COGENTIN) 0.5MG TAB 5072072 4.20

RISPERIDONE (RISPERDAL) 2MG TAB (NF) 5072073 34.40

VENLAFAXINE (EFFEXOR) 37.5MG TAB (NF) 5072074 4.20

DICYCLOMINE (BENTYL) 10MG CAP (340B) 5072075 0.00

TRIFLUOPERAZINE 2MG TAB (NF) 5072076 3.10

NF-Benztropine Mesylate Oral Tablet 1MG 5072077 1.10

METHOCARBAMOL (ROBAXIN) 500MG TAB 5072078 4.20

CEFUROXIME (CEFTIN) 500MG TAB (NF) 5072079 4.60

NF-RIBAVIRIN CAP 200MG 5072080 32.80

CAPSAICIN 0.025% CR (NF) 5072081 0.00

FLUTIC-SAL (ADVAIR) 500/50 (340B) 5072082 0.00

Z HYDROMORPHONE (DILAUDID) 2MG TAB 5072083 0.00

CALCIUM GLUC 1GM/50ML PREMIX 5072084 37.40

LEG CRAMPS PAIN RELIEF TAB (NF) 5072085 0.40

LURASIDONE (LATUDA) 60MG TAB (NF) 5072087 95.20


SAXA-METF 5-1000MG (KOMBIGLYZE XR) TAB 5072090 0.00

SAXA-METF 5-500MG (KOMBIGLYZE XR) TAB 5072091 0.00

VENLAFAXINE (EFFEXOR) 75MG TAB (RX) 5072092 0.00

LITHIUM 150MG CAP (NF) 5072093 4.20

SODIUM CHLORIDE 3% 500ML 5072094 23.70


LIRAGLUTIDE (VICTOZA) 18MG/3ML X3 (340B 5072099 0.00

NF-HydrOXYzine HCl Oral Tab 50MG 5072100 3.10

Z KETOCONAZOLE (NIZORAL) 2% SHAMPOO 5072101 0.00

NIZATIDINE (AXID) 300MG CAP (NF) 5072102 22.80

NF-DIAMODE TABLET 2MG 5072103 1.00

NF-ACETAZOLAMIDE ORAL TABLET 250MG 5072104 3.00

FLUOCINONIDE (VANOS) 0.05% GEL (340B) 5072105 0.00

PRASUGREL (EFFIENT) 10MG TAB (RX) 5072106 0.00

Z CALAMINE-ZINC (DERMAGRAN) OINT 5072107 0.00

NF-Alive! Women's 50+ Oral Tablet 5072108 0.00

Z TETRACYCLINE 250MG CAP 5072109 0.00

ACYCLOVIR (ZOVIRAX) 400MG TAB (NF) 5072110 4.20

NF-Vitamin D3 Oral Capsule 5000IU 5072114 0.00

LIDOCAINE-PRILO (EMLA) 2.5-2.5% CREAM 5072115 32.80

Z CIPROFLOX (CILOXAN) 0.3% EYE DROP 5072116 0.00

HYDROXYUREA (HYDREA) 500MG CAP (NF) 5072117 4.20

Z LITHIUM 150MG CAP 5072118 0.00

Z TRIFLUOPERAZINE (STELAZINE) 2MG TAB 5072119 0.00

G EYE VITAMINS (OCUVITE) TAB (NF) 5072120 0.00

Z ACLIDINIUM (TUDORZA PRESSAIR) INHALER 5072121 0.00




MIDODRINE (PROAMATINE) 5MG TAB 5072123 4.20

MESALAMINE (CANASA) 1000MG SUPP (NF) 5072124 57.80

LIDOCAINE/TETRA (SYNERA) 70-70MG PATCH 5072125 63.90

NF-MAXZIDE TAB 75MG-50MG 5072126 2.80

NF-Vitamin D Oral Capsule 50000IU 5072127 5.00

FIDAXOMICIN (DIFICID) 200MG TAB (NF) 5072128 520.70

NF-Revlimid Oral Capsule 5MG 5072129 1,739.70

Z BRIMONIDINE (ALPHAGAN) 0.2% EYE DROP 5072130 0.00


METHOCARBAMOL (ROBAXIN) 500MG TAB (340B) 5072132 0.00

PETROLATUM (AQUAPHOR) OINT (NF) 5072133 0.00

Z METHOTREXATE 25MG/ML INJ 5072135 0.00

NF-TUBERSOL INJECTION 5TU/0.1ML 5072136 119.70

SENNA 8.6MG TAB (RX) 5072137 0.00

SENNA-DOCUSATE TAB (RX) 5072138 0.00

ACET-ASPIRIN-CAFF (ANACIN) TAB (NF) 5072139 0.00

ESTRO-PROGEST (PREMPRO) 0.3-1.5MG (NF) 5072140 10.20

PROPRANOLOL 20MG/5ML ORAL SOLN (NF) 5072141 0.00


NF-CITRUS CALCIUM + D ORAL TAB 315MG-250 5072143 0.26

LETROZOLE (FEMARA) 2.5MG TAB (RX) 5072144 0.00

NF-GENERLAC SOLN 10GM/15ML 5072145 0.16

PRAMIPEXOLE (MIRAPEX) 0.5MG TAB (340B) 5072146 0.00

NICOTINE GUM 2MG (NF) 5072148 4.20

ALISKIREN (TEKTURNA) 150MG TAB (NF) 5072149 13.40

Z CIPRO-DEXA (CIPRODEX) 0.3-0.1% EAR DRO 5072150 0.00

CHLORPROMAZINE (THORAZINE) 50MG TAB (NF) 5072151 27.10

NICOTINE GUM 4MG (NF) 5072154 0.00

Z PEG-ELECTROLYTE (GOLYTELY) 4000ML 5072156 0.00

LINEZOLID (ZYVOX) 600MG/300ML PREMIX 5072157 204.10

NF-CYCLOSET ORAL TABLET 0.8MG 5072158 11.30

FLUNISOLIDE (NASALIDE) NASAL SPRAY (NF) 5072159 8.20

PIOGLITAZONE (ACTOS) 15MG TAB (RX) 5072160 0.00

VENLAFAXINE ER (EFFEXOR XR) 75MG (RX) 5072161 0.00

FOSFOMYCIN (MONUROL) 3GM PACKET (NF) 5072162 254.30

VERAPAMIL ER (VERELAN PM) 100MG CAP (NF) 5072164 0.00

SPIRONOLACTONE (ALDACTONE) 50MG (RX) 5072165 0.00

PERPHENAZINE 2MG TAB (NF) 5072166 4.80

Z PERPHENAZINE 4MG TAB 5072167 0.00

FERROUS GLUCONATE TAB (NF) 5072168 0.00

MULTIVITAMIN-MINERALS-IRON ORAL LIQ (NF) 5072169 4.20

LISIN-HCTZ (ZESTORETIC) 20-12.5MG (340B) 5072170 0.00

BUSPIRONE (BUSPAR) 7.5MG TAB (NF) 5072171 3.40

MELOXICAM (MOBIC) 7.5MG TAB (RX) 5072172 0.00

MERIPLEX DRESSING 5072173 0.00



NF-Nature's Blend Lactobacillin Acidophi 5072174 0.00

Z MOMETASONE (ELOCON) 0.1% CREAM 5072175 0.00

PROCHLORPER (COMPAZINE) 10MG TAB (NF) 5072176 4.20


Z DEXAMETHASONE (DECADRON) 4MG TAB 5072178 0.00

CIMETIDINE (TAGAMET) 400MG TAB (340B) 5072180 0.00

BETAMETHASONE DIPRO 0.05% CR (NF) 5072181 3.10

NF-CITRUCEL ORAL TABLET 500MG 5072182 0.41

AMITRIPTYLINE (ELAVIL) 25MG TAB (RX) 5072183 0.00

HALOPER (HALDOL) 2MG/ML ORAL SOLN (NF) 5072184 4.20

Z HALOPERIDOL (HALDOL) 2MG/ML ORAL SOLN 5072185 0.00

NF-Meloxicam Oral Tablet 15MG 5072186 13.40

LEVOCETIRIZINE (XYZAL) 5MG TAB (340B) 5072187 0.00

CYCLOBENZAPRINE (FLEXERIL) 10MG (340B) 5072188 0.00

NF-METAMUCIL MULTIHEALTH CAP 0.52GM 5072189 0.35

Z K PHOS NEUTRAL TAB 5072191 0.00

PILOCARPINE 1% EYE DROP (NF) 5072192 0.00

TRAZODONE (DESYREL) 150MG TAB (NF) 5072194 4.20

NF-RAMIPRIL CAP 5MG 5072196 7.20

AZELASTINE (ASTELIN) 0.1% (137MCG) (340B 5072197 0.00

SACC BOUL (FLORASTOR) CAP (NF) 5072198 4.20

NF-Claritin Tablet 10MG 5072205 3.10

NF-Vitamin B Complex Capsule 5072206 0.00

FAMOTIDINE (PEPCID) 10MG TAB 5072207 4.20

NF-LORATADINE ORAL TABLET 10MG 5072208 1.80


DILTIAZEM (CARDIZEM) 60MG TAB 5072211 4.20

Z CARISOPRODOL (SOMA) 350MG TAB 5072212 0.00

FLUORIDE (PREVIDENT) DENTAL CR (NF) 5072213 0.00

NF-Restasis Ophthalmic Emulsion 0.05% 5072214 23.70

OASIS MOUTH WASH (NF) 5072215 0.00

CLOBETASOL (CLOBEX) LOTION (NF) 5072216 32.00

FLUORIDE (GEL-KAM) GEL (NF) 5072217 0.00

MINOCYCLINE (MINOCIN) 100MG CAP (NF) 5072219 10.30

NF-ICaps Original Oral Tablet 5072220 0.00

SENNA 528MG/15ML LIQUID (NF) 5072221 10.30

NF-Triamcinolone Acetonide Ointment 0.1% 5072222 1.10

FAMOTIDINE (PEPCID) 40MG TAB (NF) 5072223 0.00

NEO-POLY-GRAM (NEOSPORIN) EYE SOLN (NF) 5072224 185.40

ETOMIDATE (AMIDATE) 20MG/10ML VIAL 5072225 23.60

CEVIMELINE (EVOXAC) 30MG CAP (NF) 5072226 18.50

DEXTRO-QUIN (NUEDEXTA) 20-10MG (NF) 5072229 40.80

ETANERCEPT (ENBREL) 50MG/ML INJ (NF) 5072230 1,166.70

PENICILLIN VK 250MG/5ML ORAL SOLN (RX) 5072232 0.00

LINACLOTIDE (LINZESS) 290MCG CAP (NF) 5072233 34.30



PAROXETINE (PAXIL) 20MG TAB (RX) 5072234 0.00

METHIMAZOLE (TAPAZOLE) 5MG TAB (NF) 5072236 4.20

NF-Pen Needle Device 5072237 0.00


LEVETIRACETAM (KEPPRA) 500MG TAB (RX) 5072239 0.00

FERROUS SULF 220MG/5ML UD (NF) 5072240 4.20

ACETAM-COD (TYLENOL #3) DOSE PACK 5072241 10.30

NF-Vitamin B12 Oral Tablet 1000MCG 5072242 0.00

NF-Loratadine Oral Tablet 10MG 5072243 3.10

CLOBETASOL 0.05% OINT 60GM (RX) 5072245 0.00

FLUOROURACIL (EFUDEX) 5% CR (340B) 5072246 0.00

BACLOFEN (LIORESAL) 10MG TAB (RX) 5072247 0.00

INS ASPART (NOVOLOG FLEXPEN) (340B) 5072248 0.00

NF-WELCHOL ORAL TABLET 625MG 5072249 9.70

NF-DESIPRAMINE HCL ORAL TABLET 25MG 5072250 2.84

BALSAM PERU-CASTOR (VENELEX) OINT (NF) 5072251 82.00

NF-MURO-128 OPHTH SOLUTION 2% 5072252 17.00

ENSURE 5072253 0.00

PROSOURCE 5072254 0.00

GLUCERNA 5072255 0.00

INFLUENZA (FLULAVAL) 0.5ML 5072256 65.60 90688

NF-METHOTREXATE INJECTION SOLUTION 25MG/ 5072258 3.40

OXYCODONE IR (OXY IR) 15MG TAB (NF) 5072261 5.90

NF-ROXANOL CONCENTRATE 20MG/ML 5072262 2.10

NF-ROXANOL SOLN 20MG/1ML 5072263 2.10

NF-ROXANOL SOLN 20MG/1ML 5072264 2.01

IMIPRAMINE (TOFRANIL) 25MG TAB (NF) 5072265 1.10

ESCITALOPRAM (LEXAPRO) 5MG TAB (NF) 5072266 25.80

NF-TOFRANIL TAB 25MG 5072267 48.00

IMIPRAMINE (TOFRANIL) 50MG TAB (NF) 5072268 0.00

Z NAPROXEN (NAPROSYN) 375MG TAB 5072269 0.00

G NIACIN 500MG CAP/TAB 5072270 0.00

NF-Nitrostat Tablet 0.4MG 5072271 0.00

NF-Aspirin Oral Tablet 81MG 5072273 1.10

NF-Allopurinol Tablet 300MG 5072274 2.10

NF-metFORMIN Oral Tablet 500MG 5072275 2.10


NF-Cipro Tablet 500mg 5072277 27.90

MAGNESIUM 500MG TAB (NF) 5072278 0.39

ROPINIROLE (REQUIP) 0.25MG TAB (NF) 5072279 0.00

NF-Allegra Oral Tablet 180MG 5072280 8.30

NF-Allegra Oral Tablet 180MG 5072281 8.30

THYROID (NATURE THROID) 97.5MG TAB (RX) 5072283 0.00

Z LURASIDONE (LATUDA) 40MG TAB 5072284 0.00

NF-Aspirin Oral Tablet 81MG 5072285 0.00



NF-Norvasc Tablet 5MG 5072286 8.30

ALFUZOSIN ER (UROXATRAL) 10MG (NF) 5072287 4.20

CUBICIN/NS 750MG/100ML 5072288 0.00

CUBICIN/NS 700MG/100ML 5072289 0.00

ROPINIROLE (REQUIP) 1MG TAB (RX) 5072290 0.00

ALBUTEROL (PROVENTIL) 0.083% NEB (340B) 5072291 0.00

NF-TL ICON CAP 5072292 2.10

NF-TRIAMCINOLONE ACETONIDE CREAM 0.025% 5072293 0.30

NF-MICARDIS HCT TAB 80MG-25MG 5072294 20.00

ZOSTER (ZOSTAVAX) VACCINE 0.65ML INJ 5072295 811.90 90736

CHLORTHALIDONE (HYGROTON) 100MG (NF) 5072297 3.10


DOXEPIN (SINEQUAN) 10MG CAP (NF) 5072300 4.20

VALSART-HCT (DIOVAN HCT) 320-25MG (NF) 5072301 19.10

Z FLUT-VIL (BREO ELLIPTA) 100-25MCG INH 5072302 0.00

Z FLUT-VIL (BREO ELLIPTA) 200-25MCG INH 5072303 0.00

DIVALPROEX DR (DEPAKOTE) 250MG TAB (RX) 5072304 0.00

PRENATAL MULTIVITAMIN TAB (NF) 5072305 4.20

AMITRIP-PERPH (ETRAFON) TAB (NF) 5072306 0.00

NF-Melatonin Oral Tablet 5MG 5072307 0.00

NF-Lexapro Tablet 20MG 5072309 28.90

NF-Cetirizine Oral Tab 10MG 5072310 7.30

HYDROXYZINE PAM (VISTARIL) 50MG CAP (NF) 5072311 3.10

NF-Vitamin C Oral Tablet 1000MG 5072312 0.00

NF-GENTEAL OPHTHALMIC SOLUTION 0.3% 5072315 1.40

CARBAMAZEPINE ER (TEGRETOL-XR) 100MG 5072316 0.00

COLESTIPOL (COLESTID) 1GM TAB (NF) 5072317 5.20

G VITAMIN A & D OINT 5072318 0.00

AMLOD-VALS (EXFORGE) 10-320MG TAB (340B) 5072319 0.00

DICLOFENAC SOD (VOLTAREN) 75MG TAB (RX) 5072321 0.00


NF-DIOVAN HCT ORAL TABLET 160MG-12.5MG 5072323 12.20

NF-Tikosyn Capsule 0.25MG 5072325 23.70

VENLAFAXINE ER (EFFEXOR XR) 150MG (340B) 5072327 0.00

NF-Vitamin B12 Tablet 500mcg 5072328 0.00

VENLAFAXINE (EFFEXOR) 75MG TAB (340B) 5072329 0.00

SPIRON-HCTZ (ALDACTAZIDE) 50-50MG (340B) 5072331 0.00

OLOPATADINE (PATADAY) 0.2% EYE SOLN (RX) 5072332 60.70

NF-Zoloft Concentrate 20MG/ML 5072333 9.30

NF-oxyCODONE Hydrochloride Solution 5MG/ 5072334 1.10

NF-Ranitidine Oral Solution 15MG/1ML 5072335 2.10

NF-DOCUSATE SODIUM-SENNA TAB 50MG-8.6MG 5072336 0.27

NF-POTASSIUM GLUCONATE TABLET 500MG 5072337 0.10

NF-B Complex & B12 Tablet 5072339 0.00

QUETIAPINE (SEROQUEL) 50MG TAB (RX) 5072340 0.00



AMOXICILLIN (AMOXIL) 250MG/5ML (340B) 5072341 0.00

INVANZ/NS 500MG/50ML IVPB 5072342 0.00

AZITHROMYCIN (ZITHROMAX) 250MG PACK (RX) 5072343 0.00

NF-Pen Needle Device 5072344 0.00

NF-Insulin Syringes Device 5072345 0.00

Z DORZOL-TIMOLOL (COSOPT) EYE SOLN 5072346 0.00

BUPROPION ER (WELLBUTRIN XL) 300MG (NF) 5072348 0.00

FLUT-SAL (ADVAIR DISKUS) 250/50 (340B) 5072349 0.00

MAGNESIUM SULFATE 2GM/200ML PREMIX 5072350 0.00

NADOLOL (CORGARD) 20MG TAB (NF) 5072351 0.00

NF-Centrum Silver Oral Tablet 5072353 0.00

NF-Turmeric Powder 5072355 0.00

PREVNAR 13 VACCINE - MEDICARE 5072356 0.00 90670

NF-DIOVAN HCT ORAL TABLET 80MG-12.5MG 5072357 21.60

NF-Levothroid Tablet 75MCG 5072359 2.10

NF-Norvasc Tablet 10MG 5072360 7.30

NF-Hydrochlorothiazide Oral Tablet 25MG 5072361 0.00

NF-Catapres Tablet 0.1MG 5072362 7.30

Z ALENDRONATE (FOSAMAX) 35MG TAB 5072363 0.00


TOPIRAMATE (TOPAMAX) 25MG TAB (RX) 5072365 0.00

Z LIP-PROT-AMYL (CREON 24) CAP 5072366 0.00

Z ADALIMUMAB (HUMIRA) 40MG INJ 5072367 0.00

Z ALBUTEROL-IPRATROP (DUONEB) NEB 5072368 0.00

LACOSAMIDE (VIMPAT) 50MG TAB (NF) 5072369 33.90


NF-SSD CREAM 1% 5072371 1.30


POT-SOD PHOSPHATE (PHOS-NAK) PKT (NF) 5072373 4.20

CHLORDIAZ-CLID (LIBRAX) 5-2.5MG CAP (NF) 5072374 1.90

MEMANTINE ER (NAMENDA XR) 21MG (NF) 5072376 0.00

POLY-TRIMETH (POLYTRIM) EYE SOLN 5072378 19.70

VITAMIN B6 50MG TAB (NF) 5072379 4.20

Z LAMOTRIGINE (LAMICTAL) 200MG TAB 5072380 0.00

G ACETAMIN (TYLENOL) 120MG SUPP 5072381 0.00

NF-Iron Tablet 324MG 5072382 0.00

NF-Levemir Subcutaneous Solution 100U/1M 5072383 98.90

NF-Levemir Subcutaneous Solution 100U/1M 5072384 98.90

Z ZOSTER (ZOSTAVAX) VACCINE 0.65ML 5072385 0.00

NF-Spiriva Inh/Neb Cap 18MCG 5072386 37.10

NALOXEGOL (MOVANTIK) 25MG TAB (NF) 5072387 29.90

FLUT-VIL (BREO ELLIPTA) 200-25MCG INH (N 5072388 332.40

BUMETANIDE (BUMEX) 2MG TAB (NF) 5072390 2.70

NF-One Touch Ultra Test Strips Device 5072391 4.20

NF-One Touch UltraMini Kit 5072392 55.70



RISPERIDONE (RISPERDAL) 0.25MG TAB (NF) 5072393 4.20

NF-DEXAMETHASONE TAB 1MG 5072394 1.30

NF-Senokot Oral Tablet 8.6MG 5072395 2.10

NF-tolnaftate Topical Solution 1% 5072397 1.10

LISIN-HCTZ (ZESTORETIC) 10-12.5MG (340B) 5072398 0.00

Z ROTIGOTINE (NEUPRO) 2MG/24HR PATCH 5072400 0.00

NF-Cetirizine Oral Tablet 10MG 5072401 1.10



NF-One-A-Day Women's Tablet 5072405 0.00

DROSPIRENONE/ETH EST (YAZ) 3-0.02MG (340 5072406 0.00

FENOFIBRATE (TRICOR) 145MG TAB (RX) 5072407 0.00


NF-Dorzolamide HCl-Timolol 22.3MG-6.8MG/ 5072409 37.10

Z DILTIAZEM (CARDIZEM) 120MG TAB 5072410 0.00

METHENAMINE HIP (HIPREX) 1GM TAB (NF) 5072411 7.40

NF-APAP Tablet 325MG 5072412 0.00

NF-Breo Ellipta Inhalation Powder 5072413 17.00

NF-Escitalopram Oral Tablet 20MG 5072415 13.40


NF-Fluticasone Prop Nasal Spray 0.05MG/1 5072417 22.70

NF-Multivitamin Oral Tablet 5072419 0.00


NF-Docusate Sodium-Sennosides 50MG-8.6MG 5072421 0.00

NF-Methotrexate Oral Tablet 2.5MG 5072422 10.30


TRAZODONE (DESYREL) 50MG TAB (RX) 5072426 6.20

NF-Nystop Powder 100,000U/GM 5072428 5.20

LANSOPRAZOLE 30MG/10ML ORAL LIQ (NF) 5072429 16.20

NF-Folic Acid Oral Tablet 1MG 5072430 1.10

Z-GUARD CREAM (NF) 5072431 42.90

FEBUXOSTAT (ULORIC) 80MG TAB (NF) 5072432 0.00

NF-Flanders Buttocks Ointment 5072433 0.00

NF-Diazepam Tablet 5MG 5072434 3.10

NF-traMADol Hydrochloride Oral Tablet 50 5072435 2.10

NF-Lyrica Oral Capsule 150MG 5072436 20.60

VORTIOXETINE (TRINTELLIX) 5MG TAB (340B) 5072437 0.00

NF-Promethazine HCl/Codeine Oral Syrup 5072438 0.00

MERCAPTOPURINE (PURINETHOL) 50MG TAB (NF 5072440 23.40


NF-QUALITY CHOICE MULTI-VITE ORAL TABLET 5072442 0.10

PROPAFENONE (RYTHMOL) 225MG TAB (NF) 5072443 4.20

MEMANTINE (NAMENDA) 2MG/ML ORAL SOLN 5072444 6.40

G MELATONIN 3MG TAB (NON-FORM) 5072446 0.00




LINA-METF (JENTADUETO) 2.5-1000MG TAB (N 5072448 22.10

GLYBURIDE (DIABETA) 2.5MG TAB (RX) 5072449 0.00

NF-Lactulose Syrup 10GM/15ML 5072450 0.00

NF-Pletal Tablet 100MG 5072451 7.30


BENAZEPRIL-HCT (LOTENSIN HCT) 20-12.5MG 5072454 4.20

IRON SUCROSE (VENOFER) 100MG/5ML (NF) 5072455 168.10

Z CHLORDIAZEPOX (LIBRIUM) 10MG CAP 5072456 0.00

ACYCLOVIR 200MG CAP (340B) 5072457 0.00


NF-Cycloset Oral Tablet 0.8MG 5072459 11.40

IPRATROPIUM (ATROVENT) 0.06% NASAL (340B 5072461 0.00

NF-SYSTANE ULTRA OPHTHALMIC SOLN 0.4%-0. 5072462 3.30

NF-Flanders Buttocks Ointment 5072464 0.00

NF-TUBERCULIN ID SOLN 5TU/0.1ML 5072467 13.60

NF-Gabapentin Oral Capsule 300MG 5072468 3.10

MILNACIPRAN (SAVELLA) 50MG TAB (340B) 5072469 0.00

TAMSULOSIN (FLOMAX) 0.4MG CAP (RX) 5072470 0.00

VARDENAFIL (LEVITRA) 20MG TAB (340B) 5072471 0.00

NF-Ranitidine 150 Oral Tablet 150MG 5072472 0.00

NF-CEREFOLIN NAC ORAL TABLET 5072473 12.30

LAMOTRIGINE ER (LAMICTAL XR) 50MG T (DNU 5072475 0.00

NF-CARBINOXAMINE MALEATE ORAL TABLET 4MG 5072477 2.50

NF-Carbinoxamine Maleate Oral Tablet 4MG 5072478 2.10

Z LIDOCAINE 1% VIAL 5072480 0.00

NIFEDIPINE ER (ADALAT CC) 30MG TAB (RX) 5072481 0.00


NF-GENTEAL OPHTHALMIC SOLUTION 0.2% 5072483 1.40


JEVITY 1.2 CAL LIQUID 5072486 0.00

JEVITY 1.5 CAL LIQUID 5072489 0.00

NF-Abilify Oral Tablet 5MG 5072490 110.30

TIOTROP-OLOD (STIOLTO) RESPIMAT (NF) 5072491 292.70


DOXYCYCLINE 100MG VIAL 5072493 75.00

DOXYCYCLINE/NS 100MG/100ML IVPB 5072494 0.00

CUBICIN/NS 550MG/100ML 5072495 0.00

MEROPENEM 1GM VL 5072496 26.60

FULVESTRANT (FASLODEX) 250MG/5ML INJ (NF 5072499 3,894.60

NF-LAXATIVE MAXIMUM STRENGTH TABLET 25MG 5072500 0.36

NF-WOMEN'S DAILY MULTIVITAMIN ORAL TABLE 5072501 0.16

SOTALOL (BETAPACE) 80MG TAB (DNU) 5072502 0.00

LAMOTRIGINE ER (LAMICTAL XR) 100MG (DNU 5072503 0.00

Z MIRTAZAPINE (REMERON) 7.5MG TAB 5072504 0.00

METHYLPRED (SOLU-MEDROL) 1GM VIAL (NF) 5072505 92.80



BUSPIRONE (BUSPAR) 5MG TAB (RX) 5072509 0.00

Z BUMETANIDE (BUMEX) 1MG TAB 5072510 0.00

MORPHINE 250MG/10ML SDV (NF) 5072511 27.40

MORPHINE/NS 250MG/250ML IVPB 5072512 0.00

NF-SOTALOL HCL TAB 120MG 5072514 64.30

NF-GLIPIZIDE ORAL TABLET 10MG 5072515 2.40

NF-Multivitamin Tablet 5072516 0.00

HYALURONATE (SYNVISC-ONE) 48MG/6ML INJ 5072517 1,802.10

METOPROLOL (LOPRESSOR) 75MG TAB (NF) 5072518 0.00

CHLORTHALIDONE (HYGROTON) 50MG T (NF) 5072520 4.20

CLOZAPINE (CLOZARIL) 100MG TAB (NF) 5072521 4.20

NF-Contour Next Device 5072522 2.10


BETAMETH (CELESTONE SOLU) 6MG/ML INJ 5072524 41.20 J0702

METO-HCTZ (LOPRESSOR HCT) 100-25MG (NF) 5072525 4.20

AMIODARONE (PACERONE) 400MG TAB (NF) 5072526 0.00

TRIAMCINOLONE 0.1% CREAM 453GM (RX) 5072527 0.00

TEMAZEPAM (RESTORIL) 7.5MG CAP (NF) 5072528 0.00

NF-MELATONIN EXTRA STRENGTH TABLET 5072529 0.39


SODIUM PHOSPHATE 15MMOL/5ML 5072531 50.50

SODIUM PHOSPHATE/NS 15MMOL/250ML 5072532 0.00

POTASSIUM PHOS 15MMOL/5ML 5072533 50.80

POTASSIUM PHOS/NS 15MMOL/250ML 5072534 0.00

FLUOXETINE (PROZAC) 60MG TAB (RX) 5072536 0.00

NF-FreeStyle Lite Test Strip Device 5072537 5.20

NF-Synthroid Tablet 175MCG 5072538 4.20


NF-GLYXAMBI ORAL TABLET 25MG-5MG 5072540 62.90

NF-VITAMIN B COMPLEX 100 INJECTION SOLUT 5072541 3.00

NF-SENSI-CARE MOISTURIZING BODY CREAM 5072542 0.21


NF-Q-TUSSIN LIQUID 100MG/5ML 5072547 0.04


NF-LOSARTAN POTASSIUM ORAL TAB 100MG 5072550 9.60

ACETYLCYS (ACETADOTE) 6GM/30ML INJ 5072552 432.10

Z METHADONE 10MG TAB 5072553 0.00

CILOSTAZOLE (PLETAL) 50MG TAB (NF) 5072554 4.20

DAPAGLIFLOZIN (FARXIGA) 5MG TAB (NF) 5072555 38.60

ELUXADOLINE (VIBERZI) 100MG TAB (NF) 5072556 59.40

NF-Senna Soft Oral Tablet 15MG 5072557 0.00

NF-Spiriva Inh/Neb Cap 18MCG 5072558 57.70

NF-Carafate Tablet 1GM 5072559 9.30


NF-LEVSIN ORAL TABLET 0.125MG 5072561 2.90




INSULIN GLARGINE (TOUJEO) 300 U/ML (NF) 5072566 276.10

NF-Reglan Oral Tablet 10MG 5072567 7.30

NF-Plavix Tab 75MG 5072568 23.00

NF-Zantac Oral Tablet 150MG 5072569 13.00

PERMETHRIN 5% CR 5072570 88.60


NF-Aspirin Low Dose Tablet 81MG 5072572 0.00

NF-Lipitor Oral Tablet 40MG 5072573 36.10

NF-Ferrex 150 Capsule 150MG 5072574 0.00

NF-HYDROcodone-Acetaminophen Tab 7.5-325 5072575 0.00

NF-Diazepam Oral Tablet 5MG 5072576 0.00

HYDROCHLOROTHIAZIDE 12.5MG (NF) 5072577 4.20

ACYCLOVIR 500MG VIAL 5072578 12.70

NF-ONE DAILY PLUS MINERALS TABLET 5072579 0.12

NF-Diovan Oral Tablet 40MG 5072581 4.20


PREVNAR 13 AND ADMIN - CASH ONLY 5072584 222.50

NF-Protective w/Vitamin A & D Ointment 5072585 0.00

LAMOTRIGINE (LAMICTAL) 150MG TAB (NF) 5072586 16.10

FLUTICASONE (FLOVENT DISKUS) 250MCG (340 5072587 0.00

ATOMOXETINE (STRATTERA) 40MG CAP (340B) 5072588 0.00


NF-GLUCOSAMINE CHONDROITIN 1500 COM CAPS 5072592 1.00

NF-GLUCOSAMINE CHONDROITIN 1500 COM CAPS 5072594 0.90

METOPROLOL ER (TOPROL XL) 100MG (RX) 5072595 0.00


CLOMIPRAMINE (ANAFRANIL) 25MG CAP (NF) 5072597 17.80

FLUDROCORT (FLORINEF) 0.1MG TAB (NF) 5072598 4.20

SILDENAFIL (VIAGRA) 50MG TAB (340B) 5072599 0.00



MODAFINIL (PROVIGIL) 100MG TAB (NF) 5072604 30.00

AZTREONAM/NS (AZACTAM) 1GM/100ML 5072605 138.40

Z MIRABEGRON ER (MYRBETRIQ) 25MG TAB 5072606 0.00


PEROXIDE 1.5% MOUTH RINSE (NF) 5072608 23.40

NF-Tucks Pad 50% 5072609 0.00

DULOXETINE (CYMBALTA) 20MG CAP (RX) 5072610 0.00

CLINDAMYCIN (CLINDAGEL) 1% GEL (340B) 5072612 0.00

CLINDAMYCIN (CLEOCIN) 300MG CAP (NF) 5072613 4.20


AZTREONAM/NS (AZACTAM) 2GM/100ML 5072615 214.50

NF-LANOLIN-GRX TOPICAL OINTMENT 5072616 0.08

NF-Paxil Oral Tablet 40MG 5072617 14.00



ROPINIROLE (REQUIP) 0.5MG TAB (RX) 5072618 0.00

NF-NAMENDA ORAL SOLUTION 2MG/1ML 5072619 7.50

Z TRIAZOLAM (HALCION) 0.25MG TAB 5072620 0.00

NF-Contour Next Device 5072622 2.00

CHLORTHALIDONE 25MG TAB (340B) 5072623 0.00

Z RIFAXIMIN (XIFAXAN) 550MG TAB 5072624 0.00

NF-One Touch Ultra Test Strips Device 5072626 4.00

DESOGES-ETH ESTRA (APRI) 0.15-0.03MG (34 5072628 0.00


SULFASALAZINE (AZULFIDINE) 500MG (340B) 5072630 0.00

NF-PLAQUENIL TAB 200MG 5072631 27.56

Z CEFEPIME (MAXIPIME) 1GM VIAL 5072632 0.00

SORAFENIB (NEXAVAR) 200MG TAB (NF) 5072633 467.20

IBRUTINIB (IMBRUVICA) 140MG CAP (NF) 5072634 422.00


NF-BAYER CONTOUR BLOOD GLUCOSE TEST STRI 5072637 4.10


DEXTROSE/WATER 10% 1000ML 5072640 22.30

ATENOLOL (TENORMIN) 100MG TAB (NF) 5072641 3.10


Z PALIPERIDONE ER (INVEGA) 9MG TAB 5072643 0.00

Z CALCIPOTRIENE (DOVONEX) 0.005% CR 5072644 0.00

Z METHADONE 5MG TAB 5072645 0.00

METHADONE 5MG TAB (NF) 5072646 4.20

MYCOPHENOLATE (CELLCEPT) 500MG T (NF) 5072647 57.70

Z APIXABAN (ELIQUIS) 2.5MG TAB 5072648 0.00

Z APIXABAN (ELIQUIS) 5MG TAB 5072649 0.00

TRIFLUPERAZINE (STELAZINE) 5MG TAB (NF) 5072650 8.50

G HEMORRHOIDAL (TUCKS) PADS 5072651 0.00

G BIOTENE MOUTHWASH 5072652 0.00

Z PALIPERIDONE (INVEGA SUSTENNA) 234MG 5072653 0.00

Z PROPAFENONE (RYTHMOL) 225MG TAB 5072654 0.00

G CALMOSEPTINE OINT 5072655 0.00

Z DICLOXACILLIN 500MG CAP 5072656 0.00

NF-GLUCOSAMINE SULFATE CAP 500MG 5072657 0.00

NF-Spironolactone/HCTZ Tablet 25-25MG 5072659 3.10

ACYCLOVIR 1000MG VIAL 5072660 25.80

ACYCLOVIR/NS 1000MG/250ML 5072661 0.00

AMMONIUM LAC (LAC-HYDRIN 5) LOTION (RX) 5072662 0.00

OMEGA-3-ACID EE (LOVAZA) 1GM CAP (NF) 5072663 0.00

MIRTAZAPINE (REMERON) 30MG TAB (NF) 5072664 4.20

NF-Cellcept Tablet 500MG 5072665 57.70

LEFLUNOMIDE (ARAVA) 20MG TAB (NF) 5072666 14.80

PIOGLITAZONE (ACTOS) 30MG TAB (RX) 5072667 0.00

NF-SODIUM POLYSTYRENE SULFONATE POWDER 5072668 1.40



NF-ADVIL TAB 200MG 5072669 0.00

NF-AMITRIPTYLINE HCL ORAL TABLET 75MG 5072670 3.70

NF-BROVANA INH SOLN 15MCG/2ML 5072671 24.80

NF-NORVASC ORAL TABLET 10MG 5072672 14.10

NF-Vitamin D Oral Tablet 5000IU 5072673 5.20

NF-LEVOTHYROXINE ORAL TABLET 150MCG 5072674 2.00

LINA-METF (JENTADUETO) 2.5-500MG (NF) 5072675 22.10

TICAGRELOR (BRILINTA) 60MG TAB (NF) 5072676 0.00

DABIGATRAN (PRADAXA) 75MG CAP (NF) 5072677 0.00

Z DABIGATRAN (PRADAXA) 75MG CAP 5072678 0.00

LISIN-HCTZ (ZESTORETIC) 20-25MG (340B) 5072679 0.00

NF-MELATONIN ORAL CAPSULE 10MG 5072680 0.00

ALTEPLASE (CATHFLO ACTIVASE) 2MG/2ML 5072681 356.40

BUSPIRONE (BUSPAR) 30MG TAB (NF) 5072682 10.30

DICLOFENAC 0.1% OPTH SOLN (RX) 5072683 0.00

METHOCARBAMOL (ROBAXIN) 750MG TAB (NF) 5072684 4.20

CADEXOMER IODINE (IODOSORB) 0.9% GEL (NF 5072685 184.80

VALACYCLOVIR (VALTREX) 1GM TAB (NF) 5072686 51.90

ORBACTIV/D5W 1200MG/1000ML 5072687 0.00 J2407

NF-FLUTICASONE FUROATE-VILANTEROL TRIFEN 5072688 15.20

DAPAGLIFLOZIN (FARXIGA) 10MG TAB (NF) 5072689 0.00

AMMONIA INHALENT 5072690 0.00

NF-CALCIUM CARBONATE/VIT D TAB 600MG-125 5072691 0.27

Z BUSPIRONE (BUSPAR) 10MG TAB 5072692 0.00

NF-Senna Soft Oral Tablet 15MG 5072693 0.00

Z NIFEDIPINE ER (PROCARDIA XL) 60MG TAB 5072694 0.00

FORMOTEROL (PERFOROMIST) 20MCG NEB (NF) 5072695 18.80

NF-FOSINOPRIL SODIUM TAB 10MG 5072696 7.80

OXYCODONE CR (OXYCONTIN) 15MG TAB (NF 5072697 0.00

NF-CALCITONIN (SALMON) INJ SOLN 200IU/1M 5072698 4,233.60

NF-raNITIdine Oral Tablet 150MG 5072700 5.20

NF-Unisom Tablet 25MG 5072701 0.00

NF-UNISOM TABLET 25MG 5072702 1.10

SACUBITRIL-VALSAR (ENTRESTO) 97-103MG T 5072703 24.80

GLIPIZIDE (GLUCOTROL) 10MG TAB (NF) 5072704 2.20

SACUBITRIL-VALSAR (ENTRESTO) 49-51MG TAB 5072705 20.60

NF-AMLODIPINE BESYLATE ORAL TABLET 10MG 5072706 7.40

NF-LORTAB 5/325 TAB 5MG-325MG 5072707 8.30

RILUZOLE (RILUTEK) 50MG TAB (NF) 5072708 114.20

NF-UNNA-FLEX ELASTIC UNNA BOOT 5072709 436.30

AMOX-CL (AUGMENTIN) 400-57MG/5ML (NF) 5072710 31.20



Z ACYCLOVIR (ZOVIRAX) 5% OINT 5072713 0.00

NF-LEVEMIR FLEXTOUCH SUBQ SOLN 100U/1ML 5072715 99.80



LAMOTRIGINE (LAMICTAL) 25MG TAB (RX) 5072717 0.00

NF-Senna Tablet 8.6MG 5072719 0.00

SUPREP BOWEL PREP KIT (NF) 5072720 101.20

SPINOSAD (NATROBA) 0.9% TOPICAL SUSP 5072724 726.10

LOVASTATIN (MEVACOR) 40MG TAB (340B) 5072725 0.00

PRAMIPEXOLE (MIRAPEX) 1.5MG TAB (340B) 5072726 0.00

RISPERIDONE (RISPERDAL) 0.5MG TA (RX) 60 5072727 0.00

NF-Cellcept Tablet 500MG 5072728 62.90

IRON SUCROSE (VENOFER) 200MG/10ML (NF) 5072729 168.10

ROPINIROLE (REQUIP) 0.25MG TAB (340B) 5072730 0.00


BUPROPION (WELLBUTRIN) 100MG TAB (340B) 5072732 0.00

INSULIN GLARGINE (BASAGLAR) 100 U/ML (NF 5072733 0.00

ETONOGESTREL (NEXPLANON) 68MG IMPLANT 5072734 443.21 J7307

NALTREXONE (REVIA) 50MG TAB 5072736 7.20

Z DEXTRO-QUIN (NUEDEXTA) 20-10MG CAP 5072737 0.00



NF-Proctozone-Hc Rectal Cream 2.5% 5072742 8.30

NF-Zantac 150 Tablet 150MG 5072744 21.70

BECLOMETHASONE (QVAR) 80MCG INHALER (NF) 5072745 0.00

CLOMIPRAMINE 50MG CAP (NF) 5072746 34.80

BECLOMETHASONE (BECONASE AQ) NAS (340B) 5072747 0.00

LORAZEPAM (ATIVAN) INTENSOL 2MG/ML SOLN 5072748 4.20

NF-Lantus SoloStar SubQ Solution 100U/1M 5072749 91.70

PROPRANOLOL 80MG TAB (NF) 5072750 4.20

DORZOLAMIDE (TRUSOPT) 2% EYE SOLN (NF) 5072751 78.50

SODIUM BICARB 50MEQ WITH 1/2 NS 1000ML 5072753 0.00

SODIUM BICARB 50MEQ WITH D5W 1000ML 5072754 0.00



HYDROXYZINE PAM (VISTARIL) 25MG CAP (RX) 5072757 0.00

INSULIN DEGLUDEC (TRESIBA) 200 U/ML (NF) 5072758 109.80

INSULIN DEGLUDEC (TRESIBA) 100 U/ML (NF) 5072759 0.00

OXCARBAZINE (TRILEPTAL) 600MG TAB (NF) 5072760 54.10

ATEN-CHLORTH (TENORETIC) 100-25MG TAB (N 5072761 0.00


NF-Metanx Oral Capsule 5072763 8.30

NF-CENTRUM ORAL TABLET 5072764 0.00

MINOCYCLINE (MINOCIN) 50MG CAP (NF) 5072766 5.20

BAG BALM OINT 5072768 25.10

TERIPARATIDE (FORTEO) PREFILL PEN (NF) 5072770 4,214.60

TIMOLOL GFS 0.5% SOLN (NF) 5072771 285.30

LAMOTRIGINE (LAMICTAL) 100MG TAB (RX) 5072772 0.00

CAPTOPRIL (CAPOTEN) 25MG TAB (NF) 5072773 5.20



G CERAVE CREAM (NF) 5072774 0.00

NF-NABUMETONE ORAL TABLET 750MG 5072775 7.70

NF-NABUMETONE ORAL TABLET 750MG 5072776 6.00

PARAGARD IUD 5072777 251.39 J7300

TESTOST CY (DEPO-TEST) 100MG/ML INJ (NF) 5072778 0.00

CUBICIN/NS 300MG/50ML 5072779 0.00

HALOPERIDOL (HALDOL) 0.5MG TAB (NF) 5072780 1.10

CYCLOBENZAPRINE (FLEXERIL) 5MG TAB (NF) 5072781 4.20

NF-METOPROLOL-HCTZ ORAL TABLET 100MG-25M 5072782 6.10

LEVONORGESTREL (MIRENA) 52MG SYSTEM 5072783 1,236.00 J7298

OLANZAPINE (ZYPREXA) 7.5MG TAB (NF) 5072784 4.20

DONEPEZIL (ARICEPT) 23MG TAB (NF) 5072785 35.10

NF-AMPICILLIN CAP 250MG 5072786 0.80


INS DETEMIR (LEVEMIR FLEXPEN) (340B) 5072790 0.00

NF-LEVEMIR FLEXPEN SUBQ SOLN 100U/1ML 5072791 107.10

Z LINDANE (KWELL) LOTION 5072792 0.00

Z LINDANE (KWELL) SHAMPOO 5072793 0.00

TELAVANCIN (VIBATIV) 750MG VIAL 5072794 1,190.90 J3095

TELAVANCIN/NS 885MG/250ML IVPB 5072795 0.00

NIZATIDINE (AXID) 150MG CAP (NF) 5072796 7.50

NF-PYRIDOXINE HCL TABLET 100MG 5072798 0.04

NF-SAW PALMETTO CAPSULE 450MG 5072799 0.16

BUPREN-NALOX (SUBOXONE) 4-1MG SL FILM 5072800 15.50

NF-ACETAMINOPHEN CAPSULE 500MG 5072803 0.00

TICAGRELOR (BRILINTA) 90MG TAB (340B) 5072804 0.00

DICLOXACILLIN 250MG CAP (NF) 5072805 0.00

DICLOXACILLIN 500MG CAP (NF) 5072806 0.00

NF-FOLIC + B12 TABLET 5072808 0.26

METRONIDAZOLE (FLAGYL) 250MG TAB (NF) 5072809 4.20

NF-AMLODIPINE BESYLATE ORAL TABLET 5MG 5072810 5.40


DULAGLUTIDE (TRULICITY) 0.75MG/0.5ML (NF 5072812 1,253.40

NF-PREDNISONE TAB 50MG 5072813 10.10

HEPATITIS B (ENGERIX-B) 20MCG/ML 5072814 152.90 90740


NF-EXCEDRIN MIGRAINE TAB 250-250-65 5072816 0.44

NF-hydroCHLOROthiazide Oral Tablet 12.5M 5072817 2.10

VENLAFAXINE ER (EFFEXOR XR) 37.5MG (RX) 5072818 0.00

NF-Microgestin 1/20 Oral Tablet 5072819 10.30

NF-PLAQUENIL ORAL TABLET 200MG 5072820 12.26

FERRIC CITRATE (AURYXIA) 210MG TAB (NF) 5072822 14.50

NF-Heparin Sodium Inj Solution 5000U/0.5 5072823 21.70

NF-ORTHO TRI-CYCLEN TAB 35MCG-0.18MG;35M 5072826 3.50

ESTRADIOL 1MG TAB (340B) 5072827 0.00



NF-predniSONE Oral Tablet 2.5MG 5072828 0.00


G VITAMIN C 125MG GUMMY (NF) 5072830 0.00

MICONAZOLE TOPICAL POWDER (NF) 5072831 108.00

EZETIMIBE (ZETIA) 10MG TAB (RX) 5072833 0.00

NF-Vitamin D3 Solution 5072834 7.30

NF-DIABETIC TUSSIN DM MAXIMUM STREN LIQU 5072835 0.13

UMECLIDINIUM (INCRUSE ELLIPTA) INH (NF) 5072837 657.60

DESONIDE (DESONATE) 0.05% GEL (NF) 5072838 1,348.50

NORGES-ETH (CRYSELLE) 0.3-0.03MG (340B) 5072840 0.00

NF-EDOXABAN TAB 60MG 5072841 38.90

NF-Flurazepam Oral Capsule 30MG 5072843 3.10

NF-Methotrexate Injection Solution 25MG/ 5072844 4.20

FLUTICASONE (ARNUITY ELLIPTA) 100MCG (NF 5072847 0.00

METHOTREXATE 50MG/2ML INJ (NF) 5072848 871.40

NF-CLOPIDOGREL BISULFATE TAB 75MG 5072849 23.90

NF-CARVEDILOL ORAL TABLET 12.5MG 5072850 6.70

NF-CHLORASEPTIC MUCOUS MEMBRANE SPRAY 1. 5072851 0.08

ELETRIPTAN (RELPAX) 20MG TAB (340B) 5072852 0.00

VALBENAZINE (INGREZZA) 40MG CAP (NF) 5072854 0.00

NF-Saw Palmetto Capsule 450MG 5072855 0.00

NF-PHILLIPS' COLON HEALTH ORAL CAPSULE 5072856 1.20

NF-OSTEO BI-FLEX ORAL TABLET 200MG-250MG 5072857 0.00

NF-IRON ORAL TABLET 325MG 5072860 0.04

NF-VITAMIN B12 TABLET 100MCG 5072861 0.06

PHENAZOPYRIDINE (PYRIDIUM) 200MG (NF) 5072863 4.20

NF-ONE DAILY ESSENTIAL ORAL TABLET 5072864 0.00

POTASSIUM CITRATE 10MEQ TAB (NF) 5072866 0.00

NF-METOPROLOL TARTRATE ORAL TABLET 25MG 5072867 0.70

NF-Fiber Oral Capsule 0.52GM 5072869 0.00

NF-Vitamin E Tablet 400iu 5072870 0.00

NF-HydrOXYzine HCl Tablet 10MG 5072871 1.10

RANITIDINE (ZANTAC) 75MG TAB (340B) 5072872 0.00

NF-PROCTOFOAM-HC RECTAL FOAM 5072873 25.50

NF-Colchicine Oral Capsule 0.6MG 5072874 19.60

NF-Multi Vitamins Oral Tablet 5072875 0.00

NF-Calcium 600 + D3 Oral Tablet 600MG-80 5072876 2.10

NIACIN ER (NIASPAN) 1000MG TAB (340B) 5072877 0.00

NF-Tylenol Extra Strength Oral Cap 500MG 5072878 0.00

NF-Neurontin Capsule 300MG 5072880 19.60

NF-Claritin Tablet 10MG 5072881 3.10

ELETRIPTAN (RELPAX) 40MG TAB (340B) 5072883 0.00

SITA-METF ER (JANUMET XR) 50-1000MG (340 5072884 0.00

VERAPAMIL ER (VERELAN PM) 100MG CAP (340 5072885 0.00

NF-MagOx 400 Oral Tablet 241.3MG 5072886 0.00



NF-INVOKANA ORAL TABLET 100MG 5072887 52.80


DULAGLUTIDE (TRULICITY) 1.5MG/0.5ML (NF) 5072889 1,253.40

NF-busPIRone Oral Tablet 15MG 5072890 8.30

CETIRIZINE (ZYRTEC) 5MG TAB (340B) 5072891 0.00


NF-Calcium 600 + D3 Oral Tablet 600MG-80 5072894 2.00

NF-Ferrous Sulfat Tab 325MG 5072895 0.00

NF-One Touch Ultrasoft Lancet Device 5072896 0.00

NF-Welchol Oral Tablet 625MG 5072897 11.40

NF-THERATEARS OPHTHALMIC SOLUTION 5072898 1.50

NF-Humira Subcutaneous Solution 20MG/0.4 5072899 8,233.90

ACYCLOVIR/NS 500MG/100ML 5072900 0.00

ROSUVASTATIN (CRESTOR) 5MG TAB (DNU) 5072902 0.00

CEFTAROLINE (TEFLARO) 600MG VIAL 5072903 453.20

CEFTAROLINE/NS (TEFLARO) 600MG/100ML 5072904 0.00

NF-Melatonin Tablet 3MG 5072905 0.00


SACUBITR-VAL (ENTRESTO) 24-26MG TAB (NF) 5072909 25.80


HYDROGEL (SOLOSITE) WOUND GEL 5072911 26.80

NF-Milk Of Magnesia Liquid 400MG/5ML 5072912 0.00

EPINEPHRINE/NS 1MG/250ML IVPB 5072913 0.00



NF-Singulair Tablet 10MG 5072916 27.00

PENICILLIN G (PFIZERPEN) 20,000,000IU VL 5072919 127.40


NF-Montelukast Sodium Oral Tablet 10MG 5072921 16.50

NF-Simvastatin Oral Tablet 80MG 5072923 0.00

HEPATITIS B (ENGERIX-B) 10MCG/0.5ML 5072924 71.20 90744

FENOFIBRATE (LOFIBRA) 134MG CAP (340B) 5072925 0.00

PROPRANOLOL (INDERAL) 40MG TAB (340B) 5072926 0.00

SULFA-TRIM (BACTRIM) 400-80 TAB (NF) 5072927 5.20


NF-MEMANTINE HCL ORAL TABLET 10MG 5072930 18.90

NF-EPLERENONE ORAL TABLET 25MG 5072931 13.50

KETOCONAZOLE 2% CR (NF) 5072932 95.30

NF-AMLODIPINE BESYLATE ORAL TABLET 2.5MG 5072933 5.40

NF-PROBENECID-COLCHICINE TAB 500MG-0.5MG 5072934 3.00

ESTRADIOL (ESTRACE) VAG CR (NF) 5072935 337.90

NF-CRANBERRY FRUIT CAPSULE 425MG 5072939 0.16

VITAMIN B12 500MCG TAB (NF) 5072941 1.00

MAGIC MOUTH RINSE (RX) 5072943 0.00




MIDAZOLAM/NS 50MG/50ML 5072945 0.00

NF-Vitamin B Complex Tablet 5072946 0.00

TIOTROP (SPIRIVA RESP) 2.5MCG (NF) 5072948 157.60


MOMETASONE (ASMANEX) HFA 100MCG (NF) 5072950 0.00

AMOX/CLAV (AUGMENTIN) 250-62.5/5 (340B) 5072951 0.00

NF-Sodium Bicarbonate Tablet 650MG 5072952 0.00

NF-Prenatal Tablet 5072953 0.00

FLUPHENAZINE 2.5MG TAB (NF) 5072954 4.20

PALIPERIDONE ER (INVEGA) 9MG TAB (NF) 5072955 0.00

PRASUGREL (EFFIENT) 5MG TAB (RX) 5072956 0.00

NF-OPTIMUM MILK THISTLE ORAL TABLET 175M 5072957 0.24

NF-GLYBURIDE MICRONIZED ORAL TABLET 6MG 5072958 1.10

LAMOTRIGINE (LAMICTAL) 25MG TAB (DNU) 5072959 0.00

BUPROPION ER (WELLBUTRIN XL) 150MG (340B 5072960 0.00

GALANTAMINE ER (RAZADYNE ER) 24MG C (NF) 5072961 0.00

VORTIOXETINE (TRINTELLIX) 10MG TAB (340B 5072963 0.00


NF-OXYCODONE HCL ORAL TAB 15MG 5072966 5.10

NF-VERAPAMIL HCL ORAL TABLET 40MG 5072967 0.90

IRON POLYSAC (FERREX 150) CAP (340B) 5072968 0.00



FLURAZEPAM (DALMANE) 30MG CAP (NF) 5072973 4.20

NF-HYDROXYCHLOROQUINE SULFATE ORALTAB 20 5072974 12.70

NF-ONE DAILY WOMEN'S ORAL TABLET 5072975 0.00

EXENATIDE ER (BYDUREON BCISE) 2MG (NF) 5072976 0.00

NF-NEPRO WITH CARB STEADY ORAL LIQUID 5072977 0.04

ESTRADIOL (VAGIFEM) 10MCG VAG (340B) 5072978 0.00

GUAIFENESIN 200MG TAB (NF) 5072979 0.60

NF-MACRODANTIN CAPSULE 50MG 5072980 4.80


NF-Ibuprofen Tablet 600MG 5072982 0.00

NF-Bactrim Oral Tablet 400MG-80MG 5072983 5.20

NF-Bactroban Ointment 2% 5072984 15.50

NF-CRANBERRY CAP 500MG 5072985 0.26

NF-ONE DAILY ORAL TABLET 5072986 0.18


FL-UM-VIL (TRELEGY ELLIPTA) 100-62.5-25 5072989 477.80



NF-VITAMIN D2 ORAL TABLET 2000IU 5072994 0.18

NF-hydroCHLOROthiazide Oral Tablet 12.5M 5072995 2.00

NF-Amiodarone HCl Tablet 200MG 5072997 9.30

NF-Plaquenil Oral Tablet 200MG 5072998 35.10



NF-Morphine Sulfate Oral Solution 20MG/1 5072999 2.10

NF-OCUSOFT EYELID CLEANSING PAD 5073000 0.24

NF-PHILLIPS' COLON HEALTH ORAL CAPSULE 5073002 1.70

NF-PRORENAL VITAL ORAL TABLET 5073005 1.10

SUMATRIPTAN (IMITREX) 100MG TAB (NF) 5073006 77.70

CALCITONIN NASAL SPRAY (NF) 5073008 99.00

ALTEPLASE (ACTIVASE) 100MG 5073009 21,276.40

NF-METAMUCIL MULTIHEALTH CAP 0.52GM 5073011 0.42


NF-BUSPIRONE HCL ORAL TABLET 15MG 5073013 6.20

NF-glyBURIDE Tablet 6MG 5073014 2.10

NF-Acarbose Oral Tablet 50MG 5073015 3.10

NF-ACARBOSE ORAL TABLET 50MG 5073016 3.00

NF-Senna Pod 5073017 0.00

NF-Xiidra Ophthalmic Solution 5% 5073018 0.00

NF-Calcium 600 Capsule 600MG 5073019 0.00

NF-SOTALOL HCL ORAL TABLET 80MG 5073020 8.00

NF-ACLOVATE CRM 0.05% 5073021 10.90

NF-NEXIUM PKT 10MG/1PKT 5073022 33.50

NF-Minoxidil Tablet 2.5MG 5073023 1.10

IRBESART-HCTZ (AVALIDE) 150-12.5MG (NF) 5073026 4.20

NF-Irbesartan and HCTZ Tablet 150-12.5MG 5073027 11.40

NF-COMBIGAN OPHTH SOLN 0.2%-0.5% 5073029 119.50

FILGRASTIM (NEUPOGEN) 480MCG/0.8ML INJ 5073030 1,394.50 J1442


NORGES-ETH ESTRA (SPRINTEC) 28-DA (340B 5073034 0.00

MOMETASONE (ELOCON) 0.1% LOTION (RX) 5073036 0.00

NF-YASMIN TAB 3MG-0.03MG 5073037 13.70

NF-REFRESH PLUS OPHTH SOLUTION 5073038 0.70

NF-Ascorbic Acid Oral Tablet 250MG 5073040 0.00

BUDESONIDE (ENTOCORT EC) 3MG CAP (NF) 5073041 4.20


AEROCHAMBER PLUS W/MASK MEDIUM 5073044 0.00

NF-Sensipar Oral Tablet 30MG 5073045 98.90

CAPECITABINE (XELODA) 150MG TAB (340B) 5073046 0.00

CAPECITABINE (XELODA) 500MG TAB (340B) 5073047 0.00


NF-DABIGATRAN ETEXILATE MESYLATE CAP 150 5073050 24.80


NF-Viibryd Oral Tablet 20MG 5073052 29.90

NF-CLARITIN ORAL TABLET 10MG 5073053 2.00

DAPTOMYCIN/NS 250MG/100ML 5073057 0.00

NF-Folic Acid Tablet 1MG 5073058 0.00


NF-Roxicodone Oral Tablet 15MG 5073060 18.60




LUBIPROSTONE (AMITIZA) 24MCG CAP (340B) 5073062 0.00

TRETINOIN (RETIN-A) 0.025% CR (340B) 5073063 0.00

NF-LIVALO ORAL TABLET 4MG 5073064 0.00

NALTREXONE (VIVITROL) 380MG INJ 5073065 4,125.20 J2315

DESIPRAMINE (NORPRAMIN) 75MG TAB (NF) 5073066 8.60

NF-Bentyl Capsule 10MG 5073068 1.10

RIFAMPIN 150MG CAP (NF) 5073069 4.20

NF-Xifaxan Oral Tablet 550MG 5073070 135.00

NF-Haloperidol Oral Solution 2MG/1ML 5073071 48.50

NF-Haldol Intramuscular Solution 5MG/1ML 5073073 41.20

TENECTEPLASE (TNKASE) 50MG KIT (DNU) 5073074 4,826.50

LINACLOTIDE (LINZESS) 290MCG CAP (340B) 5073075 0.00


NF-Lactose Powder 5073077 1.10


NF-KLONOPIN TABLET 2MG 5073080 15.00

NF-Sensipar Oral Tablet 30MG 5073081 98.90

NF-Linezolid Oral Tablet 600MG 5073082 567.60

NF-HYDROcodone and APAP 7.5MG-325MG/15ML 5073083 0.00

NF-ALOGLIPTIN BENZOATE TAB 25MG 5073085 46.30


ALBUMIN 25% 50ML 5073087 170.00

NF-SULFASALAZINE ORAL TABLET 500MG 5073090 0.80

MIRTAZAPINE (REMERON) 7.5MG TAB (NF) 5073091 4.20

NF-Livalo Oral Tablet 4MG 5073092 16.50

NF-VITAMIN B12 TABLET 2500MCG 5073094 0.00

NF-HYDROXYCHLOROQUINE ORAL TABLET 200MG 5073095 12.00

NF-KETOROLAC ORAL TABLET 10MG 5073096 5.00

NF-TRIDERM CREAM 0.1% 5073097 43.90

LOPERAMIDE 2MG/15ML UD (NF) 5073098 4.20

CLOBETASOL (TEMOVATE) 0.05% CR 60GM (RX) 5073099 0.00

NF-Vitamin C Tablet 100MG 5073100 0.00



NF-Glucosamine Chondroitin 1500 Com Caps 5073103 0.00

NF-Zantac Oral Tablet 150MG 5073104 13.00

NF-Hydroxychloroquine Oral Tablet 200MG 5073105 11.40

NF-AMLODIPINE BESYLATE AVPAK TABLET 2.5M 5073106 2.70

NF-HYDROcodone bitartrate-acetaminophen 5073107 2.10

NF-HYDROcodone bitartrate-acetaminophen 5073108 2.00

NF-Metamucil Clear and Natural Oral Powd 5073110 0.00

NF-Econazole Nitrate Cream 1% 5073111 21.70

NF-LOPERAMIDE HCL ORAL SOLN 1MG/7.5ML 5073112 0.14

NF-Nizoral A-D Topical Shampoo 1% 5073114 0.00



NF-Ocusoft Lid Scrub Eyelid Cleanser Pad 5073115 1.10

NF-Artificial Tears Ophth Solution 5073116 0.00



NF-ARMODAFINIL ORAL TABLET 250MG 5073119 67.60

NF-AMLODIPINE BESYLATE-OLMESARTAN MEDOXO 5073121 13.10

SILDENAFIL (REVATIO) 20MG TAB (NF) 5073122 176.90

NF-Tylenol w/Codeine #4 Tablet 300MG-60M 5073124 3.10

AMLOD-ATORV (CADUET) 5-20MG TAB (NF) 5073126 71.70

DARBEPOETIN ALFA (ARANESP) 40MCG INJ 5073127 858.80

OXCARBAZEPINE (TRILEPTAL) 300MG TAB (NF) 5073128 8.20

CEFTAZIDIME-AVIBACT (AVYCAZ) 2.5GM VIAL 5073129 1,036.20

CEFTAZ-AVIBAC/NS 0.94GM/100ML 5073130 0.00


NF-Artificial Tears Ophth Solution 5073133 1.10

NF-Pulmicort Flex Inh/Neb Pwd 180MCG/1AC 5073134 579.90

NF-Levsin Oral Tablet 0.125MG 5073135 2.10

NEBIVOLOL (BYSTOLIC) 2.5MG TAB (340B) 5073137 0.00

NF-TYLENOL PM ORAL TABLET 500MG-25MG 5073138 0.70

NF-SENSIPAR ORAL TABLET 30MG 5073139 38.00

NF-SENSIPAR TAB 30MG 5073140 38.00

NF-potassium phosphate dibasic Powder 5073141 1.10

ENTACAPONE (COMTAN) 200MG TAB (340B) 5073142 11.40

NF-Blood Glucose Monitoring System 5073143 45.40

FERRIC CARBOXYMLT (INJECTAFER) 750MG INJ 5073145 2,213.70

ZIPRASIDONE (GEODON) 20MG INJ (NF) 5073146 208.70

NF-MAGNESIUM OXIDE ORAL TABLET 400MG 5073148 0.27


NF-Albuterol Sulfate Inh/Neb Soln 0.042% 5073150 1.10

NF-Glyxambi Oral Tablet 25MG-5MG 5073151 63.90

NF-finasteride Oral Tablet 1MG 5073152 7.30

NF-FENOFIBRATE AVPAK ORAL TABLET 160MG 5073153 0.00

NF-Procrit Injection 10,000U/ML 5073154 952.80

NF-Chloraseptic Mucous Membrane Spray 1. 5073155 0.00

NF-Sodium Bicarbonate Oral Tablet 650MG 5073156 0.00

NF-FERROUS SULFATE ELIX 220MG/5ML 5073157 0.05

NF-BARRIER MUCOSAL PROTECTANT WAFER NO S 5073158 8.00


NF-Procrit Injection 40,000U/ML 5073160 0.00

TYPHOID (TYPHIM) 25MCG/0.5ML INJ 5073161 263.50

NF-Promethazine VC Oral Syr 6.25MG-5MG/5 5073162 1.10

NF-SEVELAMER CARBONATE ORAL TABLET 800MG 5073163 18.90

NF-HUMULIN R CONCENTRATED U-500 KWIKPEN 5073164 354.90

NF-Basic's Melatonin Oral Tablet 3MG 5073165 0.00

NF-Betadine Topical Solution 10% 5073166 0.00



NF-Finasteride Oral Tablet 1MG 5073167 8.30

NF-Nutritional Supplement Drink Liquid 5073168 0.00

NF-COMTAN TAB 200MG 5073169 28.60

CYPROHEPTADINE 4MG TAB (NF) 5073170 5.00

DIPHENHYDRAMINE (BENADRYL) 2% CR (NF) 5073171 10.30

SILODOSIN (RAPAFLO) 8MG CAP (NF) 5073172 4.20

NF-THEREMS-M ORAL TABLET 5073173 0.12

NF-COUMADIN TAB 5MG 5073174 4.20

NF-NAPROXEN AVPAK TABLET 500MG 5073175 0.00

NF-Pantoprazole Sodium Powder 5073176 518.10

CYCLOPHOSPHADMIDE 50MG CAP (NF) 5073177 21.70


NF-SILDENAFIL AVPAK ORAL TABLET 20MG 5073179 0.00

NF-Nitroglycerin Sublingual Tablet 0.4MG 5073180 1.10

NF-CELEXA TAB 40MG 5073183 34.90

NF-Refresh Ophth Solution 5073184 1.10

REMICADE/NS 600MG/250ML 5073185 0.00

NF-GABITRIL TABLET 16MG 5073186 58.70

NF-IPRATROPIUM BROMIDE INH/NEB 0.02% 5073187 1.70

NF-CoQ10 Oral Capsule 100MG 5073189 0.00

NF-1ST TIER UNIFINE PENTIPS PLUS DEVICE 5073191 0.90

NF-Labetalol HCl Tablet 100MG 5073192 1.10

NF-Captopril Oral Tablet 12.5MG 5073193 4.20

MICAFUNGIN 50MG VIAL 5073194 219.90

MICAFUNGIN (MYCAMINE) 100MG VIAL 5073195 440.90

MICAFUNGIN/NS 150MG/100ML 5073196 0.00

CEFTOLOZANE-TAZO (ZERBAXA) 1.5GM VIAL 5073197 239.50

CEFTOLOZANE-TAZO/NS 3GM/100ML 5073198 0.00

STATE SUPPLY IMMUNIZATIONS BEXSERO 5073199 0.00 90620

NF-Tylenol Extra Strength Oral Tablet 50 5073201 0.00

NF-BD Ultra-Fine II Lancets 5073202 0.00

NF-True Metrix Glucose Meter Device 5073203 50.50

NF-True Metrix Self Monitoring Strips 5073204 2.10

NF-Latuda Oral Tablet 80MG 5073205 150.40

NF-Magnesium Oxide Tablet 200MG 5073206 0.00


IRBESART-HCTZ (AVALIDE) 300-12.5MG (NF) 5073208 4.20

TIOTROP (SPIRIVA RESP) 1.25MCG (NF) 5073209 789.60

NF-Zantac 150 Tablet 150MG 5073210 21.70

NF-Polyethylene Glycol 3350 Powder 5073211 0.00

CAFFEINE CITRATE 60MG/3ML INJ 5073212 17.30

D5W 25ML 5073213 10.30

CAFFEINE CIT/D5W 60MG/25ML IVPB 5073214 0.00

NF-MAGNESIUM OXIDE TABLET 420MG 5073215 0.33

NF-Prosource Protein Oral Liquid 5073217 0.00



NF-Latuda Oral Tablet 80MG 5073218 0.00



NF-Probiotic Oral Capsule 250MG 5073221 1.10

NF-OLODATEROL INH SPRAY 2.5MCG/1ACT 5073222 196.40

NF-OXYCODONE HCL ORAL TAB 15MG 5073223 4.86

NF-LAMISIL AT ATHLETE'S FOOT CREAM 1% 5073224 2.90

NF-LATUDA ORAL TABLET 80MG 5073225 151.30

MEROPENEM/NS 1GM/100ML 5073226 0.00

PHENYL-PRAM-GLYC-PET (PREP H) CR (NF) 5073228 0.00


MEROPENEM/NS 2GM/100ML 5073231 0.00

NF-AMITRIPTYLINE HCL ORAL TABLET 75MG 5073233 0.90

NF-Lisinopril Tablet 10mg 5073234 2.10

BIOTENE DRY MOUTH WASH/RINSE (NF) 5073238 28.90

TRASTUZUMAB (HERCEPTIN) 440MG/250ML (NF) 5073239 0.00

NF-Plavix Tab 75MG 5073240 23.70

VALSART-HCTZ (DIOVAN HCT) 160-25MG (NF) 5073241 14.50

NF-Famotidine Oral Tablet 10MG 5073242 0.00

NF-GUAIFENESIN ORAL TABLET 400MG 5073243 0.24

TBO-FILGRASTIM (GRANIX) 300MCG INJ 5073244 492.10

NF-Potassium Gluconate Tablet 500MG 5073245 0.00

NF-Lynparza Oral Tablet 150MG 5073246 432.60

NF-Lasix Tablet 20MG 5073247 2.10


NF-Systane Ultra Ophthalmic Soln 0.4%-0. 5073250 3.10

NF-KETOROLAC TROMETHAMINE OPHTH SOLN 0.4 5073251 200.00

NF-LATANOPROST OPHTH SOLN 0.005% 5073252 142.10


NF-Milk Thistle Capsule 5073257 0.00

NF-LABETALOL HCL ORAL TABLET 100MG 5073258 0.00

NF-VICKS SINEX 12 HOUR NASAL SPRAY 0.05% 5073259 1.00

NF-Water For Irrigation Solution 5073260 0.00

NF-VALCYTE TAB 450MG 5073261 327.80

NF-METOPROLOL TARTRATE ORAL TABLET 25MG 5073262 1.10



NF-Imiquimod Topical Cream 5% 5073265 22.70

NF-MORPHINE SULFATE ORAL SOLUTION 20MG/1 5073266 2.60

NF-DIALYVITE 800/ULTRA D ORAL TABLET 5073268 0.60

NEO-POLY-DEXA (MAXITROL) EYE OINT (NF) 5073269 4.40

LISDEXAMFETAMINE (VYVANSE) 60MG C (NF) 5073270 37.10

NF-Estradiol Tablet 2MG 5073271 2.10

SULFASALAZINE 500MG TAB (NF) 5073272 4.20

NF-Alphagan P Opthamalic Solution 0.1% 5073273 118.50




MELATONIN 10MG/ML ORAL SOLN (NF) 5073276 0.10

NF-XOPENEX INH/NEB SOLN 0.63MG/3ML 5073277 7.70

MOMETASONE (ASMANEX) 110MCG INH (NF) 5073278 657.80

AZELASTINE-FLUT (DYMISTA) NAS SPRAY (NF) 5073279 453.60

RENA-VITE TAB (NF) 5073280 4.20

ACETIC ACID 2% OTIC SOLN (NF) 5073281 56.50

CARBIDOPA 25MG TAB (NF) 5073282 33.00

DROXIDOPA (NORTHERA) 100MG CAP (NF) 5073283 106.10

LODOSYN 25MG TAB (NF) 5073284 0.00

INJECTAFER/NS 750MG/250ML (NF) 5073285 0.00 J1439

NF-IFE-BIMIX 30/1 30MG-1MG/1ML 5073286 232.10

WATER 5073287 0.00

NF-ProSource Plus Oral Solution 5073289 0.00


GUAF-DM (MUCINEX MAX) 400-20MG/20ML (NF) 5073291 0.00

CLOZAPINE (CLOZARIL) 200MG TA (NF) 5073292 18.60

NF-Fenofibrate Oral Capsule 134MG 5073293 5.20

SOLU-MEDROL/NS 1GM/100ML 5073295 0.00

PHENYLEPHRINE/NS 30MG/250ML 5073296 0.00

NF-Yuvafem Vaginal Tablet 10MCG 5073298 74.20

NF-Glucosamine Complex Tablet 5073299 0.00

NF-Calcium w/ Vit D Tab 400IU-600MG-5MG 5073301 0.00

NF-Bilberry Capsule 5073302 0.00

NF-LABETALOL HCL ORAL TABLET 100MG 5073304 1.70


PROGESTERONE 100MG CAP (340B) 5073307 0.00

NF-predniSONE Tablet 2.5MG 5073308 0.00

SODIUM BICARB 100MEQ WITH 1/2 NS 1000ML 5073309 0.00



NF-Refresh Ophth Solution 5073312 1.10

NF-Beano Oral Tablet 150U 5073314 0.00

NF-Geritol Liquid 5073315 0.00

NF-EPINEPHRINE HCL INJ SOLN 0.1MG/1ML 5073316 1.70


NF-Morphine Sulfate OralSolution 10MG/0. 5073320 0.00


NF-Polyethylene Glycol 1450 5073322 0.00

NF-Ocuvite Tablet 5073324 0.00

CULTURELLE CAP (NF) 5073325 3.10



HYDROXYPROGEST (MAKENA) 275MG/1.1ML (NF) 5073328 0.00

NF-Bisoprolol/Hctz Oral Tablet 5MG-6.25M 5073329 10.30



NF-Cyclobenzaprine HCl Tablet 10MG 5073331 0.00

PENICILLIN G/NS 4 MU/250ML 5073332 0.00

VENOFER/NS 200MG/100ML 5073333 0.00

NF-Torsemide Oral Tablet 100mg 5073335 10.30

NF-Metoprolol Tartrate Tablet 25MG 5073336 0.00



NF-predniSONE Tablet 50MG 5073339 0.00

NF-Dialyvite 800 With Zinc 15 Oral Table 5073343 0.00


NF-Nitroglycerin SL Spray 0.4MG/1Act 5073345 141.20

NF-Probiotic Complex Oral Tablet 5073346 1.10

NF-amLODIPine Besylate/Atorvastatin Calc 5073347 28.90

NF-Senna Docusate Tablet 50MG 5073348 0.00

NF-Robitussin Lingering Cold Long-Acting 5073349 0.00


NF-Optimum Milk Thistle Oral Tablet 175M 5073352 0.00

NF-Ipratropium/Albuterol Soln 0.5MG-3MG/ 5073353 0.00

NF-Benicar Oral Tablet 5MG 5073354 22.70


NF-Dapsone Oral Tablet 100MG 5073356 7.36

DALBAVANCIN (DALVANCE) 500MG VIAL 5073357 5,947.56

DALVANCE/D5W 1500MG/325ML IVPB 5073358 0.00


NF-REXULTI ORAL TABLET 3MG 5073360 144.00

VERAPAMIL (CALAN) 40MG TAB (NF) 5073361 0.00

NF-WIXELA INHUB INHALATION DISK 100/50 5073362 18.60

NF-OCEAN SALINE NASAL SPRAY 0.65% 5073363 0.10

NF-Sodium Bicarbonate Oral Tablet 650MG 5073364 0.00

NF-Faslodex Intramascular Solution 50MG/ 5073369 718.90

NF-Ibrance Oral Capsule 100MG 5073371 2,198.00

NF-Nystatin Topical Powder 100000U/1GM 5073372 3.10

NF-Belsomra Oral Tablet 20MG 5073373 0.00

NF-Perdiem Tablet 15MG 5073374 0.00

NF-Advil PM Oral Tablet 38MG-200MG 5073375 0.00

NF-TRI-SPRINTEC 28 ORAL TABLET 5073377 4.30

NF-Blood Glucose 5073378 1.00

NF-Optimum Milk Thistle Oral Tablet 175M 5073379 0.00

CUBICIN/NS 530MG/100ML 5073380 0.00

NF-Clobetasol Prop Topical Ointment 0.05 5073383 2.10

NF-Metoprolol Tartrate Tablet 25MG 5073384 0.00

NF-Iron Tablet 325MG 5073385 0.00

NF-Basaglar KwikPen SubQ Soln 100U/1ML 5073386 78.00

NF-Norco Oral Tablet 5MG-325MG 5073387 10.00

NF-RISPERIDONE AVPAK TAB 3MG 5073388 0.00



SEMAGLUTIDE (OZEMPIC) 0.25MG OR 0.5MG (N 5073390 1,946.52

SEMAGLUTIDE (OZEMPIC) 1MG PEN (NF) 5073391 1,946.52

NF-ATORVASTATIN CALCIUM ORAL TAB 20MG 5073392 1.57

NF-Geodon Capsule 60MG 5073393 84.00

NF-BUPRENORPHINE HCL INJ SOLN 0.3MG/1ML 5073394 54.61

DIPHEN-IBU (ADVIL PM) 38MG-200MG TAB (NF 5073395 0.00

SUVOREXANT (BELSOMRA) 20MG TAB (NF) 5073396 0.00

SENNA (PERDIEM) 15MG TAB (NF) 5073397 0.00

PIPERACILLIN-TAZO (ZOSYN) 4.5GM VL 5073398 18.91

ZOSYN/NS 4.5GM/100ML 5073399 0.00

INSULIN R/NS 100 UNITS/100ML PREMIX 5073400 75.65

SULFA-TMP 400-80MG VIAL 5073401 16.55

SULFA-TMP/D5W 400-80MG/500ML IVPB 5073402 0.00

DANTROLENE 20MG VIAL 5073403 201.16

NF-METOPROLOL AND HCTZ TABLET 100MG-25MG 5073404 5.32

CEFTAROLINE (TEFLARO) 400MG VIAL 5073405 751.57

CEFTAROLINE/NS 400MG/100ML 5073406 0.00


NF-Metoprolol Tartrate Oral Tablet 25MG 5073408 0.00


NF-Multi-Vitamin w/Minerals Tablet 5073410 0.00


DAPTOMYCIN (CUBICIN) 350MG VIAL 5073413 101.16



NF-OZEMPIC 0.25 MG OR 0.5 MG DOSES SUBQ 5073416 1,946.52

NF-Bisoprolol/Hctz Oral Tablet 5MG-6.25M 5073417 10.00


NF-Remedy Phytoplex Topical Ointment 2% 5073419 0.00


NF-Cavilon Durable Barrier Cream 1.3% 5073423 0.00

EMTRIC-TENOFO (TRUVADA) 200-300MG TAB 5073424 169.72

RALTEGRAVIR (ISENTRESS) 400MG TAB 5073425 107.45

DORZOL-TIMOLOL (COSOPT) EYE SOLN (NF) .5 5070904 434.90

CYCLOSPORIN (RESTASIS) EYE DROP (NF) 0 5070738 570.80

ORITAVANCIN (ORBACTIV) 1200MG 1200MG 5073412 11,271.56 J2407

GUAIFEN-DEXTRO (ROBITUSS DM) SYRUP (RX) 237ML 5070944 0.00

GUAIFENESIN (ROBITUSSIN) SYRUP (RX) 473ML 5070677 4.20

B/GCO-OX SENSOR CASSETTE 55 80001130 0.00

CALCIUM CARB (TUMS E-X) 750MG TAB (NF) CHEWABL 5070841 0.00

LACTASE ENZYME (LACTAID) TAB (NF) CHEWABL 5071024 0.70

PHENYTOIN (DILANTIN) 50MG CHEWABLE (NF) CHEWABL 5071077 4.20

MONTELUKAST (SINGULAIR) 4MG CHEW (NF) CHEWABL 5071110 19.50

G PRENATAL VITAMIN TAB CHEWABL 5071257 0.00

AL-MG (GAVISCON) LIQUID ANTACID (NF) CHEWABL 5071793 4.20



NF-TUMS E-X CHEWABLE TAB 750MG CHEWABL 5072445 0.12

NF-IMODIUM MULTI-SYMPTOM RELIEF 2MG-125M CHEWABL 5072485 1.20

NF-TUMS CHEWABLE TAB 500MG CHEWABL 5072621 0.09

NF-Calcium with D3 Chew Tab 600MG-400IU CHEWABL 5072767 0.00

NF-Gas-X Extra Strength Chewable Tab 125 CHEWABL 5073032 0.00

NF-LAMOTRIGINE CHEW TAB 5MG CHEWABL 5073381 45.82

OMEPRAZOLE (PRILOSEC) 20MG CAP (NF) DELAYE 5070526 19.70

LANSOPRAZ (PREVACID) 30MG CAP (NF) DELAYE 5070579 29.00

DEXLANSOPRAZOLE (DEXILANT) 60MG CAP (NF) DELAYE 5070582 16.00

OMEPRAZOLE (PRILOSEC) 40MG CAP (NF) DELAYE 5070597 14.00

ESOMEPRAZOLE (NEXIUM) 20MG CAP (NF) DELAYE 5070722 29.40

FENOFIBRIC ACID (TRILIPIX) 135MG CAP (NF DELAYE 5070794 19.80

DEXLANSOPRAZOLE (DEXILANT) 30MG CAP (NF) DELAYE 5070941 16.00

LIP-PROT-AMYL (CREON 24) CAP (NF) DELAYE 5070965 21.80


DEXLANSOPRAZOLE (DEXILANT) 60MG (340B) DELAYE 5071223 0.00

NF-OMEPRAZOLE ORAL CAP DR 20MG DELAYE 5071529 24.90

NF-OMEPRAZOLE CAP DR 20MG DELAYE 5071771 16.50

NF-CYMBALTA 30MG ORAL CAPSULE, DELAYED R DELAYE 5071833 20.70

NF-CYMBALTA 30MG ORAL CAPSULE, DELAYED R DELAYE 5071845 21.76


NF-Omeprazole Delayed-Release Capsule 20 DELAYE 5072308 26.00

NF-NexIUM Capsule 40MG DELAYE 5072424 55.70

NF-CREON ORAL DELAYED RELEASE CAPSULE DELAYE 5072580 9.70

NF-Creon Oral Delayed Release Capsule DELAYE 5072602 18.60

NF-Omeprazole Delayed Release Capsule 20 DELAYE 5072922 26.80

NF-DIVALPROEX SODIUM CAP DR 125MG DELAYE 5072929 6.30

NF-DULOXETINE CAPSULE DELAYED RELEASE 60 DELAYE 5073049 21.60

NF-Creon Oral Delayed Release Capsule DELAYE 5073420 12.00

NF-CREON CAP DR DELAYE 5073421 0.00

DIVALPROEX DR (DEPAKOTE) 125MG TAB (NF) DELAYED 5071772 4.20

NF-Asacol HD Delayed Release Tablet 800M DELAYED 5072338 23.70

ACAMPROSATE (CAMPRAL) 333MG TAB (NF) DELAYED 5072590 4.20

NF-VIMOVO DELAYED RELEASE TABLET 500MG-2 DELAYED 5072714 127.40

NF-Aspirin-Omeprazole Tab DR 81MG-40MG DELAYED 5073319 128.80

LAMOTRIGINE (LAMICTAL) 200MG TAB (NF) DISINTE 5071794 30.70

MIRTAZAPINE (REMERON SOLTAB) 15MG (NF) DISINTE 5072375 4.20

NF-DONEPEZIL HCL DISINTEGRATING TAB 5MG DISINTE 5072716 26.80

NF-HYOSCYAMINE SULFATE ODT TABLET 0.125M DISINTE 5073088 1.80

NF-RIZATRIPTAN BENZOATE DISINTEGRATING T DISINTE 5073109 135.90

MAGNESIUM CHLOR (SLOW-MAG) TAB ENTERIC 5070758 4.20

NAPROXEN (NAPROSYN) 375MG TAB (NF) ENTERIC 5070931 3.30

MESALAMINE (ASACOL) 400MG TAB (NF) ENTERIC 5071135 7.30

MYCOPHENOLATE DR (MYFORTIC) 180MG TAB (N ENTERIC 5071281 13.70

NF-NAPROXEN EC ORAL TAB EC 375MG ENTERIC 5071550 5.00



NF-ASPIRIN ADULT LOW STRENGTH TAB EC 81M ENTERIC 5071695 0.10

NF-ASPIRIN EC 325MG ORAL TABLET, ENTERIC ENTERIC 5071810 0.08

RABEPRAZOLE (ACIPHEX) 20MG TAB (NF) ENTERIC 5072001 28.40

NAPROXEN (NAPROSYN) 500MG TAB (RX) 60 ENTERIC 5072112 0.00

NF-Pantoprazole Sodium Oral Tab EC 40MG ENTERIC 5072272 16.50

G MAGNESIUM CHLOR (SLOW-MAG) TAB ENTERIC 5072326 0.00

DICLOFENAC SOD (VOLTAREN) 50MG TAB (NF) ENTERIC 5072399 4.20

NF-Protonix Tablet 20MG ENTERIC 5072564 37.10

NAPROXEN (NAPROSYN) 500MG TAB (NF) ENTERIC 5073120 4.20

NF-Aspirin Oral Enteric Coated Tablet 81 ENTERIC 5073144 0.00

NF-LAXATIVE TABLET 5MG ENTERIC 5073294 0.60

THEO ER (THEO-24) 200MG CAP (NF) ER 5071032 13.80

VENLAFAXINE ER (EFFEXOR XR) 37.5MG (NF) EXTEND 5070682 4.20

VENLAFAXINE ER (EFFEXOR XR) 150MG C (NF) EXTEND 5070815 24.10

MESALAMINE ER (APRISO) 0.375GM CAP (NF) EXTEND 5071050 14.70

DILTIAZEM CD (CARDIZEM CD) 360MG (NF) EXTEND 5071418 37.10

THEO ER (THEO-24) 300MG CAP (NF) EXTEND 5071492 4.70

NIACIN 500MG TAB/CAP (NF) EXTEND 5071764 4.20

LEVOMILNACIPRAN ER (FETZIMA) 40MG CAP (N EXTEND 5071797 25.10

MORPHINE ER (MS CONTIN) 30MG TAB (NF) EXTEND 5072026 18.00

NF-NAMENDA XR ORAL CAPSULE ER 21MG EXTEND 5072193 39.90

NF-VERAPAMIL HCL CAP ER 300MG EXTEND 5072195 11.40

THEOPHYLLINE ER 400MG TAB (NF) EXTEND 5072227 4.20

CARBAMAZ ER (CARBATROL) 300MG CAP (NF) EXTEND 5072257 6.00

NF-Diamox Sequels Oral Cap ER 500MG EXTEND 5072324 4.20

MEMANTINE ER (NAMENDA XR) 7MG CAP (NF) EXTEND 5072474 49.20

NF-RYTARY CAP ER 23.75MG-95MG EXTEND 5072563 9.00

NF-PHENYTOIN ORAL CAP ER 100MG EXTEND 5072589 2.20

NF-TAZTIA XT 24 HR CAP ER 300MG EXTEND 5072699 7.20

NF-TOPIRAMATE CAPSULE ER 150MG EXTEND 5072722 55.80

NF-COREG CR CAP ER 20MG EXTEND 5072723 34.10

MORPHINE ER (MS CONTIN) 60MG TAB (NF) EXTEND 5072752 44.30

NF-Cardizem CD Oral Capsule ER 120MG EXTEND 5072842 89.70

VERAPAMIL (CALAN) 120MG TAB (NF) EXTEND 5072853 5.20

NF-POTASSIUM CHLORIDE CAP ER 10MEQ EXTEND 5073035 6.30

NF-Cardizem CD Oral Capsule ER 120MG EXTEND 5073043 89.70

MEMAN-DONE (NAMZARIC) 28-10MG CAP (NF) EXTEND 5073054 52.30

NF-PROPRANOLOL HCL CAP ER 120MG EXTEND 5073067 12.80

NF-dilTIAZem Oral Cap ER 240MG EXTEND 5073072 5.20

NF-Aggrenox Oral Cap ER 200MG-25MG EXTEND 5073113 12.40

CARVEDILOL ER (COREG CR) 40MG C (NF) EXTEND 5073254 34.00

CARVEDILOL ER (COREG CR) 20MG C (NF) EXTEND 5073255 34.00

VERAPAMIL ER 360MG CAP (NF) EXTEND 5073275 19.80

NF-Coreg CR Oral Capsule ER 10MG EXTEND 5073382 15.50

NF-Coreg CR Oral Capsule ER 10MG EXTEND 5073389 33.00



FELODIPINE ER (PLENDIL) 5MG TAB (NF) EXTENDE 5070538 5.70

Z RANOLAZINE ER (RANEXA) 500MG TAB EXTENDE 5070737 0.00

NF-B COMPLEX + C TABLET EXTENDE 5070743 0.00

Z RANOLAZINE ER (RANEXA) 1000MG TAB EXTENDE 5070788 0.00

DICLOFENAC SOD (VOLTAREN) 75MG TAB EXTENDE 5070894 4.20

CARBAMAZEPINE ER (TEGRETOL-XR) 200MG T EXTENDE 5070967 3.70

CARBAMAZEPINE ER (TEGRETOL-XR) 400MG T EXTENDE 5070970 8.20

DIVALPROEX ER (DEPAKOTE ER) 500MG (NF) EXTENDE 5071010 6.70

METOPROLOL ER (TOPROL XL) 100MG (NF) EXTENDE 5071025 7.60

DESVENLAFAXINE ER (PRISTIQ) 50MG TAB (NF EXTENDE 5071185 18.30

OXYBUTYNIN ER (DITROPAN XL) 10MG TAB (NF EXTENDE 5071233 12.80

METOPROLOL ER (TOPROL XL) 100MG (340B) EXTENDE 5071298 0.00

QUETIAPINE ER (SEROQUEL XR) 300MG TAB (N EXTENDE 5071403 55.30

OXYBUTYNIN ER (DITROPAN XL) 5MG TAB (NF) EXTENDE 5071435 8.90

METFORMIN ER (GLUCOPHAGE XR) 500MG (NF) EXTENDE 5071541 3.10

METFORMIN ER (GLUCOPHAGE XR) 750MG (NF) EXTENDE 5071542 3.70

Z ISOSORB MONO ER (IMDUR) 120MG TAB EXTENDE 5071575 0.00

ZOLPIDEM ER (AMBIEN CR) 12.5MG TAB (NF) EXTENDE 5071610 31.30

VITAMIN B12 2000MCG TAB (NF) EXTENDE 5071711 0.35

POTASSIUM CL (KLOR-CON) 8MEQ TAB (NF) EXTENDE 5071725 1.70

DALFAMPRIDINE ER (AMPYRA)10MG TAB (NF) EXTENDE 5071758 89.40

ISOSORB MONO ER (IMDUR) 120MG TA (NF) EXTENDE 5071763 4.20

NF-ISOSORBIDE MONONITRATE ORAL TAB ER 30 EXTENDE 5071774 1.60

GLIPIZ ER (GLUCOTROL XL) 10MG TAB (340B) EXTENDE 5071779 0.00

METOPROLOL ER (TOPROL XL) 50MG TAB (RX) EXTENDE 5071784 0.00

POTASSIUM CL (KLOR-CON) 20MEQ TAB (RX) EXTENDE 5071785 3.10

NF- EXTENDE 5071865 5.59

NF-KLOR-CON 10 TABLET 10MEQ EXTENDE 5071898 1.80

SAXA-METF 2.5-1000MG (KOMBIGLYZE XR) TAB EXTENDE 5072088 18.30

NIFEDIPINE ER (PROCARDIA XL) 90MG T (NF) EXTENDE 5072113 8.01

METOPROLOL ER (TOPROL XL) 25MG TAB (RX) EXTENDE 5072209 0.00

METOPROLOL ER (TOPROL XL) 200MG (NF) EXTENDE 5072218 6.20

NF-OXYBUTYNIN CHLORIDE ORAL TAB ER 15MG EXTENDE 5072260 10.50

NIFEDIPINE ER (PROCARDIA XL) 60MG T (NF) EXTENDE 5072313 6.20

METFORMIN ER (GLUCOPHAGE XR) 500MG (340B EXTENDE 5072352 0.00

NF-Mucinex Tablet 600MG EXTENDE 5072418 1.10

OXYBUTYNIN ER (DITROPAN XL) 15MG (NF) EXTENDE 5072452 10.50

NF-POTASSIUM CHLORIDE ER ORAL TAB ER 10M EXTENDE 5072545 1.10

NF-SUPER B100 ORAL TABLET EXTENDE 5072548 0.47

NF-Ditropan XL Extended-Release Tablet 5 EXTENDE 5072582 12.40

NF-metFORMIN HCl Tab ER 500MG EXTENDE 5072735 2.10

CARB/LEVO ER (SINEMET CR) 50-200MG (NF) EXTENDE 5072797 4.20

NF-MUCINEX D ORAL TAB ER 1200MG-120MG EXTENDE 5072865 3.00

NF-Isosorbide Extended-Release Tablet 30 EXTENDE 5072892 6.20

NF-THEOPHYLLINE 24 HR TAB ER 400MG EXTENDE 5072908 4.20



NALTREX-BUPROP ER (CONTRAVE) 8-90MG (340 EXTENDE 5072962 0.00

NF-Ranexa Extended-Release Tablet 500MG EXTENDE 5072965 0.00

NF-METOPROLOL SUCCINATE ORAL TAB ER 25MG EXTENDE 5072991 7.30



NF-Mucinex DM Tab ER EXTENDE 5073024 1.10

NF-TYLENOL ARTHRITIS ORAL TABLET 650MG EXTENDE 5073025 0.24

NF-Toviaz Oral Extended Release Tablet 4 EXTENDE 5073028 38.20

NF-MUCINEX EXTENDED-RELEASE TABLET 1200M EXTENDE 5073056 2.50

NF-Ditropan XL Tablet 10MG EXTENDE 5073147 12.40

NF-THEOPHYLLINE ORAL TAB ER 300MG EXTENDE 5073181 2.20

NF-Vitamin B12 Tablet 1000mcg EXTENDE 5073200 0.00

NF-POTASSIUM CHLORIDE ORAL TAB ER 20MEQ EXTENDE 5073216 2.00


NF-POTASSIUM CHLORIDE ORAL TAB ER 20MEQ EXTENDE 5073236 2.00

NF-NIFEDICAL XL TAB ER 30MG EXTENDE 5073237 4.20

NF-Melatonin Oral Tablet Extended Releas EXTENDE 5073297 0.00

NF-Melatonin Oral Tablet Extended Releas EXTENDE 5073334 0.00

BUPROPION SR (WELLBUTRIN SR) 200MG T (NF EXTENDE 5073376 51.10

TIMOLOL GFS 0.25% (NF) ING SOL 5070847 0.00

ACLIDINIUM (TUDORZA PRESSAIR) INHALR (NF INHAL 5071888 252.20

LANSOPRAZ (PREVACID SOLUTAB) 30MG (NF) ISINTEG 5071111 28.40

BUPROPION ER (WELLBUTRIN XL) 150MG (NF) L 5072035 6.10

FLUTIC-SAL (ADVAIR HFA) 115-21 INH (NF) LIQUID 5071168 98.80

FLUTIC-SAL (ADVAIR HFA) 230-21 INH (NF) LIQUID 5071169 90.10

Z PRESERVISION AREDS CAPSULE LIQUID 5070539 0.00

PRESERVISION LUTEIN CAP (NF) LIQUID 5070659 1.00

LUBIPROSTONE (AMITIZA) 24MCG CAP (NF) LIQUID 5070686 17.70

VITAMIN E 100IU CAP (NF) LIQUID 5070741 0.08

AMANTADINE (SYMMETREL) 100MG CAP (NF) LIQUID 5070768 3.70

RENAL CAPS CAPSULE (NF) LIQUID 5070776 4.20

PRESERVISION CAP (NF) LIQUID 5070836 0.80

CRANBERRY CAP (NF) LIQUID 5070846 4.20

OMEGA-3 FISH OIL CAP (NF) LIQUID 5070872 0.32

Z NEPHROCAPS CAP LIQUID 5070960 0.00

GARLIC CAP (NF) LIQUID 5071171 0.00

G LUTEIN TAB (NON-FORM) LIQUID 5071241 0.00

NF-RENO CAPS 100MG-150MCG-6MCG-1M ORAL C LIQUID 5071308 0.70

NF-PRESERVISION LUTEIN ORAL LIQUID CAPSU LIQUID 5071344 0.80

LUBIPROSTONE (AMITIZA) 8MCG CAP (NF) LIQUID 5071362 13.30

G OMEGA-3 FISH OIL 1000MG CAP LIQUID 5071447 0.21

CYCLOSPORINE (GENGRAF) 100MG/ML ORAL SOL LIQUID 5071496 17.00

NF-VITAMIN D3 LIQUID FILLED CAPSULE 1000 LIQUID 5071530 0.00

ICAPS AREDS CAP (NF) LIQUID 5071540 0.80

CALCITRIOL (ROCALTROL) 0.5MCG CAP (NF) LIQUID 5071593 6.00



COENZYME Q10 (CO Q10) CAP (NF) LIQUID 5071639 1.30

DOCUSATE (COLACE) 50MG CAP (NF) LIQUID 5071912 0.90

PRESERVISION AREDS 2 FORMULA CAP LIQUID 5071984 4.20

NF-Ocuvite Adult 50+ Liquid-Filled Capsu LIQUID 5072086 0.00


VITAMIN D 50,000 UNITS CAP (RX) LIQUID 5072153 18.10

NF-Fish Oil Concentrate Capsule 1000MG LIQUID 5072231 0.00

NF-Omega-3 Oil Liquid Filled Capsule 100 LIQUID 5072330 0.00

BETA CAROTENE 25,000IU CAP (NF) LIQUID 5072347 0.18

NF-TIROSINT LIQ CAP 50MCG LIQUID 5072389 12.30

NF-Dok Capsule 100MG LIQUID 5072427 0.00

VITAMIN E 1000IU CAP (NF) LIQUID 5072487 4.20

NF-FLAXSEED OIL CAPSULE 1000MG LIQUID 5072551 0.20

NF-AquADEKs Oral Liquid Filled Capsule LIQUID 5072603 1.10

NF-COQ10/VITAMIN E LIQ CAP 100MG-10IU LIQUID 5072658 0.70

NF-VITAMIN A CAPSULE 10,000IU LIQUID 5072789 0.13

NF-VITAMIN D CAP, LIQUID-FILLED 50000IU LIQUID 5072821 6.10

NF-Vitamin D Capsule, Liquid Filled LIQUID 5072832 0.00

NF-STOOL SOFTENER LIQ CAP 100MG LIQUID 5072858 0.12

NF-Docusate Oral Capsule LiquidFilled 10 LIQUID 5072862 1.10

NF-STOOL SOFTENER ORAL LIQ CAP 100MG LIQUID 5072868 0.13

NF-Leader Natural Fish Oil Liq Cap 300MG LIQUID 5072901 0.00

NF-FISH OIL LIQUID CAPSULE 160MG-100MG LIQUID 5072940 0.16

NF-Omega-3 Oil Liquid Filled Capsule 100 LIQUID 5072947 0.00

NF-PreserVision Areds Liquid Filled Caps LIQUID 5072969 0.00

NF-PreserVision Areds Liquid Filled Caps LIQUID 5072971 0.00

VITAMIN A 10,000IU CAP (NF) LIQUID 5072988 4.20

NF-DOCUSATE NA LIQUID-FILLED CAPSULE 250 LIQUID 5073010 0.70

NF-PreserVision Areds 2 Oral Liq Cap LIQUID 5073055 0.00

NF-CALCIUM 1200 W/VITAMIN D CAPSULE LIQUID 5073089 0.22

NF-Nephrocaps Oral Liquid-Filled Capsule LIQUID 5073123 2.10

NF-Docusate Oral Capsule LiquidFilled 10 LIQUID 5073125 1.10

NF-GAS-X ES ORAL LIQUIDFILLED CAPSULE 12 LIQUID 5073136 0.70

NF-ADVIL LIQUI-GELS LIQ CAP 200MG LIQUID 5073182 0.00

NF-Fish Oil Oral Liquid Capsule 1000MG LIQUID 5073188 0.00

NF-Flaxseed Oil Capsule 1000MG LIQUID 5073300 0.00

NF-Lutein Liquid Filled Capsule 20MG LIQUID 5073303 1.10


NF-Vitamin D3 Liquid-Filled Capsule 2000 LIQUID 5073341 0.00

NF-ROBITUSSIN LINGERING COLD COUGHGELS 1 LIQUID 5073351 0.00

FERUMOXYTOL (FERAHEME) 510MG INJ ML VL 5071957 2,147.50 Q0138

Z MEGESTROL (MEGACE) 400MG/10ML SUSP ON 5070515 0.00

Z HALDOPER DEC (HALDOL) 100MG/ML INJ ON 5070546 0.00

SUCRALFATE (CARAFATE) 1GM/10ML SUSP (NF) ON 5070839 24.80

BUDESONIDE (PULMICORT) 0.5MG/2ML NEB ON 5070840 11.30



INSULIN LISPRO (HUMALOG) 100U/ML (NF) ON 5071073 56.40

PHENYTOIN (DILANTIN) 125MG/5ML SUSP UD ON 5071075 4.20

Z TOBRA-DEXA (TOBRADEX) EYE SUSP ON 5071287 0.00

NF-NEOMYCIN-POLYMYXIN B-PREDNISOLONE OPH ON 5071495 0.00

NF-MYLANTA SUSPENSION ON 5071531 0.04

Z NEPAFENAC (NEVANAC) 0.1% EYE SOLN ON 5071617 0.00

BRINZOLAMIDE (AZOPT) 1% EYE SUSP (NF) ON 5071637 0.00

NF-PREDNISOLONE ACETATE OPHTH SUSP 1% ON 5071805 34.20

CARBAMAZE (TEGRETOL) 100MG/5ML SUSP (NF) ON 5071832 0.16

FLUOROMETHOLONE 0.1% EYE SUSP (NF) ON 5071980 10.10

NF-PREDNISOLONE ACETATE OPHTH SUSP 0.12% ON 5072012 66.10

NF-Mylanta Suspension ON 5072465 0.00

BETAXOLOL (BETOPTIC S) 0.25% EYE SUSP (N ON 5072535 1,140.10

NF-MILK OF MAGNESIA ORAL SUSP 400MG/5ML ON 5072546 0.05

NF-PHILLIPS MILK OF MAG ORAL SUSP 400MG/ ON 5072562 0.05

NF-Proair HFA Inh Susp 0.09MG/1Act ON 5072787 12.00

NF-Sucralfate Oral Suspension 1GM/10ML ON 5072801 2.10

NF-RULOX ORAL SUSP 200MG-200MG-20MG/5ML ON 5072836 0.02

NF-Milk of Magnesia Oral Susp 1200MG/15M ON 5072879 0.00

NAPROXEN (NAPROSYN) 125MG/5ML SUSP (NF) ON 5073031 4.20

NF-Proair HFA Inh Susp 0.09MG/1Act ON 5073039 25.80

NF-NovoLIN 70/30 SubQ Susp 70U-30U/1ML ON 5073093 50.50

NF-PREDNISOLONE ACETATE OPHTH SUSP 1% ON 5073253 32.90

NF-Children's Ibuprofen 100 Susp 100MG/5 ON 5073267 0.00

NF-Jevity 1.5 Cal Suspension ON 5073288 0.00

NF-Megestrol Acetate Suspension 40MG/ML ON 5073313 1.10

NF-Ventolin HFA Inhaler 0.09MG/Inh ON 5073317 11.40

NF-ENSURE COMPLETE ORAL SUSPENSION ON 5073342 0.03

NF-INVEGA SUSTENNA IM SUSP ER 234MG ON, EXT 5073084 6,184.20

Z CEFTRIAXONE (ROCEPHIN) 1GM VIAL OR SOLU 5070852 0.00

POTASSIUM CL (KLOR-CON) 20MEQ/PKT (NF) OR SOLU 5071275 4.20

NF-MIRALAX PWD FOR SOLN 17GM/DOSE OR SOLU 5071329 0.30

NF-TIGECYCLINE IV PWD FOR SOLN 50MG OR SOLU 5071709 0.00

FORTAZ/NS 500MG/100ML OR SOLU 5071975 0.00

NF-TANZEUM SUBCUTANEOUS PWD FOR SOLN 30M OR SOLU 5072498 407.30

NF-Nafcillin Intravenous Pwd for Soln 1G OR SOLU 5072639 58.80

NF-FORTAZ INJ PWD FOR SOLN 500MG OR SOLU 5072718 22.00

NF-ZOSYN INTRAVENOUS PWD FOR SOLN 4GM-0. OR SOLU 5072936 51.00

ETANERCEPT (ENBREL) 25MG/0.5ML INJ (NF) OR SOLU 5073232 2,397.90

NF-Ampicillin Inj Pwd for Soln 2GM OR SOLU 5073330 40.20

NF-MYCAMINE INTRAVENOUS PWD FOR SOLN 100 OR SOLU 5073365 693.40

NF-XERAVA INTRAVENOUS PWD FOR SOLN 50MG OR SOLU 5073366 181.70

NF-Xerava Intravenous Pwd for Soln 50MG OR SOLU 5073367 181.30

NF-Micafungin IV Pwd for Soln 100MG OR SOLU 5073368 0.00

NF-Herceptin IV PwdforSoln 420MG OR SOLU 5073370 0.00



Z LEUPROLIDE (LUPRON DEPOT) 15MG KIT OR SUSP 5071158 0.00

NF-DIFLUCAN SUSPENSION 200MG/5ML OR SUSP 5071268 22.60

NF-ERYPED 400 SUSPENSION 400MG/5ML OR SUSP 5071672 0.32

G PHOS-NAK PACKET (NF) OR SUSP 5072179 0.00

COLESTIPOL (COLESTID) 5GM/PACK (NF) OR SUSP 5072320 15.90

ASPIRIN-CAFF (STANBACK) POWDER (NF) OR SUSP 5072358 0.60

NF-RisperDAL Consta IM Pwd for Susp ER 2 OR SUSP 5072403 1,421.40

CHOLESTYRAMINE (QUESTRAN) 4GM (340B) OR SUSP 5072476 0.00

NF-Bc Powder Arthritis OR SUSP 5072519 0.00

NF-AMOXICILLIN ORAL PWD FOR SUSP 400MG/5 OR SUSP 5072802 0.30

NF-Abilify Maintena IM PwdforSusp ER 400 OR SUSP 5073132 8,033.00

NF-PROMETHEGAN RECTAL SUPPOSITORY 50MG ORY 5071351 59.80

CAFF-ERGOT (MIGERGOT) RECTAL SUPP (NF) ORY 5071799 109.50

NF-HYDROCORT ACET RECTAL SUPPOSITORY 25M ORY 5072396 2.50

NF-PREPARATION H SUPPOSITORY ORY 5073229 1.40

NF-Phenergan Rectal Suppository 25MG ORY 5073235 72.10

FLUT-VIL (BREO ELLIPTA) 100-25MCG INH (N OSE) 5071887 913.50

LEVALBUTEROL (XOPENEX) HFA (NF) POWDER 5070717 11.90

FLUTICASONE (FLOVENT HFA) 110MCG (NF) POWDER 5070719 756.80

FLUTICASONE (FLOVENT HFA) 44MCG (NF) POWDER 5071102 50.90

NF-ALBUTEROL SULFATE HFA AER PWD 0.09MG/ POWDER 5071778 21.90

MOMET-FORM (DULERA) 100-5MCG INH (340B) POWDER 5072046 0.00

NF-Proair HFA Inh Aer Pwd 0.09MG/1Act POWDER 5072423 22.00

G COUGH DROPS (NON-FORM) TROCHE 5071081 0.00

CLOTRIMAZOLE (MYCELEX) TROCHE 10MG (NF) TROCHE 5071929 4.20

RIVASTIGMINE (EXELON) 4.6MG/24HR (NF) XTENDED 5070888 41.20

Z FENTANYL (DURAGESIC) 50MCG/HR PATCH XTENDED 5070973 0.00

Z SCOPOLAMINE (TRANSDERM SCOP) 1.5MG PAT XTENDED 5071057 0.00

FENTANYL (DURAGESIC) 12MCG/HR XTENDED 5071242 35.30

Z FENTANYL (DURAGESIC) 12MCG/HR PATCH XTENDED 5071587 209.50

BUPRENORPHINE (BUTRANS) 5MCG/HR (NF) XTENDED 5071996 157.60

NF-NEUPRO TD PATCH ER 4MG/24HR XTENDED 5072190 65.40

NF-NITRO-DUR TRANSDERM PATCH ER 0.8MG/1H XTENDED 5072259 20.00

NF-Nitro-Dur Transderm Patch ER 0.8MG/1H XTENDED 5072743 20.60

NF-CATAPRES-TTS TD PATCH ER 0.2MG/24HR XTENDED 5073078 363.70

NF-Xulane TD Patch ER 35MCG-150MCG/24HR XTENDED 5073190 156.60

NF-Estradiol Transdermal Patch ER 0.075 XTENDED 5073306 71.10

G ARTIF TEAR HM (GENTEAL) EYE GEL Y 5070547 3.40

GLUCOSE (GLUTOSE 15) 15GM ORAL GEL Y 5070602 13.00

NF-METHYLCELLULOSE GEL 1% Y 5070747 0.21

MENTHOL (BIOFREEZE) GEL (NF) Y 5070827 7.00

DICLOFENAC (VOLTAREN) GEL 1% (NF) Y 5070919 79.80

NF-GENTEAL 0.3% OPHTHALMIC GEL/JELLY Y 5071733 2.30

NF-Diastat AcuDial Rectal Kit 20MG Y 5072228 1,087.70

MEDIHONEY Y 5072282 0.00



NF-GENTEAL GEL OPHTHALMIC 0.3% Y 5072314 3.40

NF-Biofreeze Cold Therapy Pain Relief Ge Y 5072439 0.00

NF-DEEP BLUE RELIEF TOPICAL GEL Y 5072463 0.18

NF-Refresh Celluvisc Gel 1% Y 5073249 1.10

NF-Biofreeze Topical Gel 4% Y 5073323 0.00

Respiratory

OXYGEN INITIAL 55802354 0.00

EEG EXTENDED LESS THAN 1 HR 5534002 694.10 95812TC

EEG PHYSICIAN FEE LESS THAN 1 HR 5534003 154.50 9581226

EEG 3 HOUR 5534004 836.40 95813TC

EEG 3 HOUR PHYSICIAN FEE 5534005 229.70 9581326

EEG AWAKE AND DROWSY 20 MINUTES 5534006 792.10 95816TC

EEG PHYSICIAN AWAKE AND DROWSY 20 MINUTE 5534007 154.50 9581626

EEG AWAKE AND ASLEEP 20 MINUTES 5534008 932.20 95819TC

EEG PHYSICIAN AWAKE AND ASLEEP 20 MINUTE 5534009 154.50 9581926

CONT AEROSOL TX 1ST HR 5534010 206.00 94644

CONT AEROSOL TX SUBS HR 5534011 154.50 94645

ETCO2 MONITORING EMMA 5534012 309.00 94770

SMOKING & TOBACCO COUNSELING>3MIN 5534013 77.30 99406

POLYSOM <6YRS CPAP/BILVL 5534015 3,605.00 95783TC

PT TELEHEALTH SLEEP LAB 5534016 61.80 Q3014

ACAPELLA FLUTTER VALVE PROCEDURE INTIAL 5534017 87.60 94667

ACAPELLA FLUTTER VALVE PROCEDURE SUBSEQ 5534018 56.70 94668

METERED DOSE INHALER FOLLOW UP 5534019 51.50 9464076

METERED DOSE INHALER INSTRUCT 5534020 103.00 94664TC

EVENT MON HOOK UP 5543460 152.80 93270

EVENT MON TRANSMISSION AND ANALYSIS 5543461 268.50 93271

AEROSOL TREATMENTS SUBSEQUENT 5546000 69.00 9464076

AEROSOL TREATMENT INITIAL 5546001 74.30 94640

INITIAL EVALUATION RESPIRATORY 5546005 0.00 94799

AMB BLOODPRESSURE RECORDING 5546007 79.60 93786

AMB BLOODPRESSURE SCAN/RPT 5546008 44.60 93788

EVENT MON PHYSICIAN INTERP 5546012 268.50 93272

SPIROMETRY INCENTIVE TRAINING 5546015 0.00 94799

CARDIOPULMONARY RESUSCITATION 5546021 700.20 92950

SPIROMETRIC TEACH/RECORD 5546022 63.70 94015

HOME VISIT RESP THER 5546026 191.00 99503

SPUTUM COLLECTION 5546030 39.30 89220

SUCTION 5546045 180.40 31720

CARBOXY HEMOGLOBIN QUANTITATIV 5546051 50.90 82375

EDUCATION SKILLS INDIV TRAININ 5546052 63.70 98960

PULSE OXIMETRY SINGLE DETERMIN 5546070 42.70 94760

PULSE OXIMETRY MULTIPLE DETERM 5546071 214.40 94761

NOCTURNAL PULSE OXIMETRY 5546072 348.00 94762

AEROSOL TX 2nd MED 5546100 69.00 9464076



OXYGEN STANDBY 5546110 0.00

EVENT SUBSEQUENT 5546116 0.00

CHEST PERCUSSION INITIAL 5546130 87.60 94667

CHEST PERCUSSION VEST 5546131 123.60 94669

CHEST PERCUSSION SUBSEQUENT 5546140 51.50 94668

PULMONARY FUNCTION TEST 5546150 200.90 94010

MAXIMUM VOLUNTARY VENTILATION 5546154 35.10 94200TC

PULMONARY FUNC W BRONCHIAL DILATOR 5546155 252.40 94060

LUNG VOLUME (FRC) 5546156 164.80 94727TC

SINGLE BREATH DIFFUSION 5546158 104.00 94729

VENTILATOR INITIAL DAY 5546170 229.20 94002

VENTILATOR SUBSEQUENT DAYS 5546180 164.50 94003

CPAP MANAGEMENT & INITIATION 5546182 180.40 94660

OXYGEN PER HOUR UP TO 12 HRS 5546190 10.70

OXYGEN PER DAY 5546200 127.40

ARTERIAL BLOOD DRAW 5546210 62.80 36600

HOLTER MON SCAN W RPT 5546339 244.10 93226

HOLTER MON RECORDING 5546340 138.00 0296T

INCENTIVE SPIROMETRY INITIAL 5546342 0.00

CROUP TENT SET UP 5546343 0.00

DO NOT USE 5546344 360.50 95806

OTHER RESPIRATORY THERAPY 5546999 0.00 94799

=>CANCEL/CHANGE/DC ORDER<= 5580253 0.00

=>RESPIRATORY ORDER<= 5580254 0.00

=>EKG ORDER<= 5580255 0.00

DEMONSTRATION AND/OR EVALUATION 5580256 103.00 94664TC

SIX MINUTE WALK DISTANCE W WO OXYGEN 5580257 172.70 94618TC

SUCTIONING PRN 5580260 136.00 31720

HEMOGLOBIN 5588738 15.50 88738

HOLTER MON PHYSICIAN REVIEW AND INTE 5593227 74.30 0298T

EVENT 30 DAYTRANS REV AND INTERPRETATION 5593228 53.80 93228

EVENT MON 30 DAY HOOK UP 5593229 276.70 93229

AMB PHYSICIAN REVIEW AND INTERPRETATION 5593790 74.30 93790

PFT PHYSICIAN REVIEW AND INTERPRETATION 5594016 77.30 94016

AEROSOL TREATMENT PRN 5594640 69.00 9464076

CPAP PER DAY 5594660 180.40 94660

MULTIPLE SLEEP LATENCY TEST 5640500 1,014.60 95805TC

SLEEP STUDY INITIAL 5640600 1,987.90 95810TC

SLEEP STUDY DR 5640601 0.00

SLEEP STUDY W TITRATION 5640700 2,163.00 95811TC

HOME SLEEP STUDY 5640701 371.40 95806TC

POLYSOM<6YRS4/>PARAMTRS 5640702 3,090.00 95782TC

Physical Therapy

PT MAN MUSCLE TEST INCLUDING HAND 6048016 106.10 95834GP

PT VASOPNEUMATIC DEVICE 6048018 38.20 97016GP



PT COMMUNITY WORK REINTERGRATION 15 MIN 6048021 77.50 97537GP

PT EVALUATION LOW COMPLEX 20 MINUTES 6048030 171.00 97161GP

PT EVALUATION MOD COMPLEX 30 MINUTES 6048031 170.00 97162GP

PT EVALUATION HIGH COMPLEX 45 MINUTES 6048032 171.00 97163GP

PT RE EVAL EST PLAN OF CARE 6048033 109.50 97164GP

PT DEBRIDEMENT SELECTIVE <20SQCM 6048090 82.80 97597GP

PT DEBRIDEMENT SELECT>20SQCM 6048091 109.20 97598GP

PT DIATHERMY SHORTWAVE 6048100 86.00 97024GP

PT ELECTRICAL STIMULATION UNATTENDED 6048110 51.00 97014GP

PT E STIM UNATTENDED WOUND CARE 6048111 51.00 G0281GP

PT EXERCISE THERAPEUTIC EA 15 MN 6048120 104.00 97110GP

PT PHYSICAL PERFORM FCE 15 MIN 6048155 70.10 97750GP

PT SHORT LEG SPLINT 6048170 178.90 29515

PT ELECT STIM 1-1 15 MIN 6048175 51.00 97032GP

PT STRAPPING FINGER 6048180 112.60 29280

PT STRAPPING ELBOW OR WRIST 6048200 130.30 29260

PT GAIT TRAINING 15 MIN 6048220 95.50 97116GP

PT HOT COLD 1 OR MORE AREAS 6048240 70.10 97010

PT STRAPPING KNEE 6048250 183.60 29530

PT MASSAGE 15 MIN 6048260 63.70 97124GP

PT STRAPPING HIP 6048275 115.70 29520

PT MECHANICAL TRACTION 6048300 95.50 97012

PT PROSTHETIC TRAINING EA 15 MIN 6048311 123.10 97761

PT THERAPEUTIC ACTIVITIES 15 MIN 6048312 104.00 97530GP

PT NEUROMUSCULAR RE EDUCATION 6048320 107.20 97112GP

PT ULTRASOUND 15 MIN 6048350 43.50 97035GP

PT WHIRLPOOL 6048360 43.50 97022GP

PT SELF CARE MANAGEMENT TRAINING 15 MIN 6048370 95.50 97535

PT PARAFFIN BATH 6048430 25.50 97018

PT ORTHOTIC MGT/TRAIN EA 15 6048450 86.00 97760

PT MUSCLE TESTING MANUAL 6048570 286.50 95831

PT IONTOPHRESIS 15 MIN 6048600 60.50 97033

PT STRAPPING ANKLE 6048700 118.50 29540

PT FINGER SPLIT DYNAMIC 6048770 96.60 29131

PT DEBRIDEMENT NON-SELECTIVE 6048800 191.00 97602

PT PREV MED COUNSELING 15 MIN 6050003 63.70 99401

PT PREV MED COUNSELING 30 MIN 6050004 111.40 99402

PT TELEHEALTH ORIGINATION 6050005 37.20 Q3014

PT WGHT MAN CLASSES 15 SESSION 6050006 21.30 S9449

PT NEG PRESSURE WOUND THERAPY <50CM 6050008 210.20 97605

PTG MOBILITY CURRENT STATUS 0% 6060000 0.01 G8978GPCH

PTG MOBILITY GOAL STATUS 0% 6060001 0.01 G8979GPCH

PTG MOBILITY D/C STATUS 0% 6060002 0.01 G8980GPCH

PTG BODY POS CURRENT STATUS 0% 6060003 0.01 G8981GPCH

PTG BODY POS GOAL STATUS 0% 6060004 0.01 G8982GPCH



PTG BODY POS D/C STATUS 0% 6060005 0.01 G8983GPCH

PTG CARRY CURRENT STATUS 0% 6060006 0.01 G8984GPCH

PTG CARRY GOAL STATUS 0% 6060007 0.01 G8985GPCH

PTG CARRY D/C STATUS 0% 6060008 0.01 G8986GPCH

PTG SELF CARE CURRENT STATUS 0% 6060009 0.01 G8987GPCH

PTG SELF CARE GOAL STATUS 0% 6060010 0.01 G8988GPCH

PTG SELF CARE D/C STATUS 0% 6060011 0.01 G8989GPCH

PTG OTHER PT CURRENT STATUS 0% 6060012 0.01 G8990GPCH

PTG OTHER PT GOAL STATUS 0% 6060013 0.01 G8991GPCH

PTG OTHER PT D/C STATUS 0% 6060014 0.01 G8992GPCH

PTG SUB PT CURRENT STATUS 0% 6060015 0.01 G8993GPCH

PTG SUB PT GOAL STATUS 0% 6060016 0.01 G8994GPCH

PTG SUB PT D/C STATUS 0% 6060017 0.01 G8995GPCH

PTG MOBILITY CURRENT STATUS 1-19% 6060018 0.01 G8978GPCI

PTG MOBILITY CURRENT STATUS 20-39% 6060019 0.01 G8978GPCJ

PTG MOBILITY CURRENT STATUS 40-59% 6060020 0.01 G8978GPCK

PTG MOBILITY CURRENT STATUS 60-79% 6060021 0.01 G8978GPCL

PTG MOBILITY CURRENT STATUS 80-99% 6060022 0.01 G8978GPCM

PTG MOBILITY CURRENT STATUS 100% 6060023 0.01 G8978GPCM

PTG MOBILITY GOAL STATUS 1-19% 6060024 0.01 G8979GPCI

PTG MOBILITY GOAL STATUS 20-39% 6060025 0.01 G8979GPCJ

PTG MOBILITY GOAL STATUS 40-59% 6060026 0.01 G8979GPCK

PTG MOBILITY GOAL STATUS 60-79% 6060027 0.01 G8979GPCL

PTG MOBILITY GOAL STATUS 80-99% 6060028 0.01 G8979GPCM

PTG MOBILITY GOAL STATUS 100% 6060029 0.01 G8979GPCN

PTG MOBILITY D/C STATUS 1-19% 6060030 0.01 G8980GPCI

PTG MOBILITY D/C STATUS 20-39% 6060031 0.01 G8980GPCJ

PTG MOBILITY D/C STATUS 40-59% 6060032 0.01 G8980GPCK

PTG MOBILITY D/C STATUS 60-79% 6060033 0.01 G8980GPCL

PTG MOBILITY D/C STATUS 80-99% 6060034 0.01 G8980GPCM

PTG MOBILITY D/C STATUS 100% 6060035 0.01 G8980GPCN

PTG BODY POS CURRENT STATUS 1-19% 6060036 0.01 G8981GPCI

PTG BODY POS CURRENT STATUS 20-39% 6060037 0.01 G8981GPCJ

PTG BODY POS CURRENT STATUS 40-59% 6060038 0.01 G8981GPCK

PTG BODY POS CURRENT STATUS 60-79% 6060039 0.01 G8981GPCL

PTG BODY POS CURRENT STATUS 80-99% 6060040 0.01 G8981GPCM

PTG BODY POS CURRENT STATUS 100% 6060041 0.01 G8981GPCN

PTG BODY POS GOAL STATUS 1-19% 6060042 0.01 G8982GPCI

PTG BODY POS GOAL STATUS 20-39% 6060043 0.01 G8982GPCJ

PTG BODY POS GOAL STATUS 40-59% 6060044 0.01 G8982GPCK

PTG BODY POS GOAL STATUS 60-79% 6060045 0.01 G8982GPCL

PTG BODY POS GOAL STATUS 80-99% 6060046 0.01 G8982GPCM

PTG BODY POS GOAL STATUS 100% 6060047 0.01 G8982GPCN

PTG BODY POS D/C STATUS 1-19% 6060048 0.01 G8983GPCI

PTG BODY POS D/C STATUS 20-39% 6060049 0.01 G8983GPCJ



PTG BODY POS D/C STATUS 40-59% 6060050 0.01 G8983GPCK

PTG BODY POS D/C STATUS 60-79% 6060051 0.01 G8983GPCL

PTG BODY POS D/C STATUS 80-99% 6060052 0.01 G8983GPCM

PTG BODY POS D/C STATUS 100% 6060053 0.01 G8983GPCN

PTG CARRY CURRENT STATUS 1-19% 6060054 0.01 G8984GPCI

PTG CARRY CURRENT STATUS 20-39% 6060055 0.01 G8984GPCJ

PTG CARRY CURRENT STATUS 40-59% 6060056 0.01 G8984GPCK

PTG CARRY CURRENT STATUS 60-79% 6060057 0.01 G8984GPCL

PTG CARRY CURRENT STATUS 80-99% 6060058 0.01 G8984GPCM

PTG CARRY CURRENT STATUS 100% 6060059 0.01 G8984GPCN

PTG CARRY GOAL STATUS 1-19% 6060060 0.01 G8985GPCI

PTG CARRY GOAL STATUS 20-39% 6060061 0.01 G8985GPCJ

PTG CARRY GOAL STATUS 40-59% 6060062 0.01 G8985GPCK

PTG CARRY GOAL STATUS 60-79% 6060063 0.01 G8985GPCL

PTG CARRY GOAL STATUS 80-99% 6060064 0.01 G8985GPCM

PTG CARRY GOAL STATUS 100% 6060065 0.01 G8985GPCN

PTG CARRY D/C STATUS 1-19% 6060066 0.01 G8986GPCI

PTG CARRY D/C STATUS 20-39% 6060067 0.01 G8986GPCJ

PTG CARRY D/C STATUS 40-59% 6060068 0.01 G8986GPCK

PTG CARRY D/C STATUS 60-79% 6060069 0.01 G8986GPCL

PTG CARRY D/C STATUS 80-99% 6060070 0.01 G8986GPCM

PTG CARRY D/C STATUS 100% 6060071 0.01 G8986GPCN

PTG SELF CARE CURRENT STATUS 1-19% 6060072 0.01 G8987GPCI

PTG SELF CARE CURRENT STATUS 20-39% 6060073 0.01 G8987GPCJ

PTG SELF CARE CURRENT STATUS 40-59% 6060074 0.01 G8987GPCK

PTG SELF CARE CURRENT STATUS 60-79% 6060075 0.01 G8987GPCL

PTG SELF CARE CURRENT STATUS 80-99% 6060076 0.01 G8987GPCM

PTG SELF CARE CURRENT STATUS 100% 6060077 0.01 G8987GPCN

PTG SELF CARE GOAL STATUS 1-19% 6060078 0.01 G8988GPCI

PTG SELF CARE GOAL STATUS 20-39% 6060079 0.01 G8988GPCJ

PTG SELF CARE GOAL STATUS 40-59% 6060080 0.01 G8988GPCK

PTG SELF CARE GOAL STATUS 60-79% 6060081 0.01 G8988GPCL

PTG SELF CARE GOAL STATUS 80-99% 6060082 0.01 G8988GPCM

PTG SELF CARE GOAL STATUS 100% 6060083 0.01 G8988GPCN

PTG SELF CARE D/C STATUS 1-19% 6060084 0.01 G8989GPCI

PTG SELF CARE D/C STATUS 20-39% 6060085 0.01 G8989GPCJ

PTG SELF CARE D/C STATUS 40-59% 6060086 0.01 G8989GPCK

PTG SELF CARE D/C STATUS 60-79% 6060087 0.01 G8989GPCL

PTG SELF CARE D/C STATUS 80-99% 6060088 0.01 G8989GPCM

PTG SELF CARE D/C STATUS 100% 6060089 0.01 G8989GPCN

PTG OTHER PT CURRENT STATUS 1-19% 6060090 0.01 G8990GPCI

PTG OTHER PT CURRENT STATUS 20-39% 6060091 0.01 G8990GPCJ

PTG OTHER PT CURRENT STATUS 40-59% 6060092 0.01 G8990GPCK

PTG OTHER PT CURRENT STATUS 60-79% 6060093 0.01 G8990GPCL

PTG OTHER PT CURRENT STATUS 80-99% 6060094 0.01 G8990GPCM



PTG OTHER PT CURRENT STATUS 100% 6060095 0.01 G8990GPCN

PTG OTHER PT GOAL STATUS 1-19% 6060096 0.01 G8991GPCI

PTG OTHER PT GOAL STATUS 20-39% 6060097 0.01 G8991GPCJ

PTG OTHER PT GOAL STATUS 40-59% 6060098 0.01 G8991GPCK

PTG OTHER PT GOAL STATUS 60-79% 6060099 0.01 G8991GPCL

PTG OTHER PT GOAL STATUS 80-99% 6060100 0.01 G8991GPCM

PTG OTHER PT GOAL STATUS 100% 6060101 0.01 G8991GPCN

PTG OTHER PT D/C STATUS 1-19% 6060102 0.01 G8992GPCI

PTG OTHER PT D/C STATUS 20-39% 6060103 0.01 G8992GPCJ

PTG OTHER PT D/C STATUS 40-59% 6060104 0.01 G8992GPCK

PTG OTHER PT D/C STATUS 60-79% 6060105 0.01 G8992GPCL

PTG OTHER PT D/C STATUS 80-99% 6060106 0.01 G8992GPCM

PTG OTHER PT D/C STATUS 100% 6060107 0.01 G8992GPCN

PTG SUB PT CURRENT STATUS 1-19% 6060108 0.01 G8993GPCI

PTG SUB PT CURRENT STATUS 20-39% 6060109 0.01 G8993GPCJ

PTG SUB PT CURRENT STATUS 40-59% 6060110 0.01 G8993GPCK

PTG SUB PT CURRENT STATUS 60-79% 6060111 0.01 G8993GPCL

PTG SUB PT CURRENT STATUS 80-99% 6060112 0.01 G8993GPCM

PTG SUB PT CURRENT STATUS 100% 6060113 0.01 G8993GPCN

PTG SUB PT GOAL STATUS 1-19% 6060114 0.01 G8994GPCI

PTG SUB PT GOAL STATUS 20-39% 6060115 0.01 G8994GPCJ

PTG SUB PT GOAL STATUS 40-59% 6060116 0.01 G8994GPCK

PTG SUB PT GOAL STATUS 60-79% 6060117 0.01 G8994GPCL

PTG SUB PT GOAL STATUS 80-99% 6060118 0.01 G8994GPCM

PTG SUB PT GOAL STATUS 100% 6060119 0.01 G8994GPCN

PTG SUB PT D/C STATUS 1-19% 6060120 0.01 G8995GPCI

PTG SUB PT D/C STATUS 20-39% 6060121 0.01 G8995GPCJ

PTG SUB PT D/C STATUS 40-59% 6060122 0.01 G8995GPCK

PTG SUB PT D/C STATUS 60-79% 6060123 0.01 G8995GPCL

PTG SUB PT D/C STATUS 80-99% 6060124 0.01 G8995GPCM

PTG SUB PT D/C STATUS 100% 6060125 0.01 G8995GPCN

PT WORK HARD/CONDITIONING INTIAL 2 HRS 6060126 201.60 97545GP

PT WORK HARD/CONDITIONING EACH ADD HR 6060127 79.60 97546GP

NON PHYS ONLINE ASSESS/MANG 5-10 MINUTES 6060128 25.80 G2061

NON PHYS ONLINE ASSESS/MANG 11-20 MINUTE 6060129 45.40 G2062

NON PHYS ONLINE ASSESS/MANG 21+ MINUTES 6060130 70.10 G2063

PT WHEELCHAIR MANAGEMENT 15 MIN 6097542 79.60 97542

ST TREATMENT OF SPEECH LANGUAGE V 6175001 160.20 92507GN

ST SWALLOW EVALUATION WO RAD 6175002 141.10 92610GN

ST TX SWALLOW DYSFUNCTION 6175003 83.90 92526GN

ST EVAL FOR SPEECH DEVICE 6175004 236.60 92607GN

ST TRAINING FOR SPEECH DEVICE 6175005 165.60 92609GN

ST RAD EVAL OF SWALLOWING 6175006 153.90 92611GN

ST EVAL SPEECH DEVICE ADD 30 MIN 6175007 74.30 92608GN

ST TREATMENT GROUP 6175008 95.50 92508GN



ST COGNITIVE TRAINING MEDICARE 6175009 76.40 G0515GN

ST STANDARD COGNITIVE PERFORM TESTING 6175010 291.80 96125GN

ST COGNITIVE TRAINING 6175018 76.40 97127GN

STG SWALLOW CURRENT STATUS 0% 6175020 0.01 G8996GNCH

STG SWALLOW GOAL STATUS 0% 6175021 0.01 G8997GNCH

STG SWALLOW D/C STATUS 0% 6175022 0.01 G8998GNCH

STG MOTOR SPEECH CURRENT STATUS 0% 6175023 0.01 G8999GNCH

STG MOTOR SPEECH D/C STATUS 0% 6175024 0.01 G9158GNCH

STG LANG COMP CURRENT STATUS 0% 6175025 0.01 G9159GNCH

STG LANG COMP GOAL STATUS 0% 6175026 0.01 G9160GNCH

STG LANG COMP D/C STATUS 0% 6175027 0.01 G9161GNCH

STG LANG EXPRESS CURRENT STATUS 0% 6175028 0.01 G9162GNCH

STG LANG EXPRESS GOAL STATUS 0% 6175029 0.01 G9163GNCH

STG LANG EXPRESS D/C STATUS 0% 6175030 0.01 G9164GNCH

STG ATTEN CURRENT STATUS 0% 6175031 0.01 G9165GNCH

STG ATTEN GOAL STATUS 0% 6175032 0.01 G9166GNCH

STG ATTEN D/C STATUS 0% 6175033 0.01 G9167GNCH

STG MEMORY CURRENT STATUS 0% 6175034 0.01 G9168GNCH

STG MEMORY GOAL STATUS 0% 6175035 0.01 G9169GNCH

STG MEMORY D/C STATUS 0% 6175036 0.01 G9170GNCH

STG VOICE CURRENT STATUS 0% 6175037 0.01 G9171GNCH

STG VOICE GOAL STATUS 0% 6175038 0.01 G9172GNCH

STG VOICE D/C STATUS 0% 6175039 0.01 G9173GNCH

STG SPEECH LANG CURRENT STATUS 0% 6175040 0.01 G9174GNCH

STG SPEECH LANG GOAL STATUS 0% 6175041 0.01 G9175GNCH

STG SPEECH LANG D/C STATUS 0% 6175042 0.01 G9176GNCH

STG MOTOR SPEECH GOAL STATUS 0% 6175043 0.01 G9186GNCH

STG MOTOR SPEECH PROJECTED GOAL 0% 6175044 0.01 G9157GNCH

STG SWALLOW CURRENT STATUS 1-19% 6175045 0.01 G8996GNCI

STG SWALLOW CURRENT STATUS 20-39% 6175046 0.01 G8996GNCJ

STG SWALLOW CURRENT STATUS 40-59% 6175047 0.01 G8996GNCK

STG SWALLOW CURRENT STATUS 60-79% 6175048 0.01 G8996GNCL

STG SWALLOW CURRENT STATUS 80-99% 6175049 0.01 G8996GNCM

STG SWALLOW CURRENT STATUS 100% 6175050 0.01 G8996GNCN

STG SWALLOW GOAL STATUS 1-19% 6175051 0.01 G8997GNCI

STG SWALLOW GOAL STATUS 20-39% 6175052 0.01 G8997GNCJ

STG SWALLOW GOAL STATUS 40-59% 6175053 0.01 G8997GNCK

STG SWALLOW GOAL STATUS 60-79% 6175054 0.01 G8997GNCL

STG SWALLOW GOAL STATUS 80-99% 6175055 0.01 G8997GNCM

STG SWALLOW GOAL STATUS 100% 6175056 0.01 G8997GNCN

STG SWALLOW D/C STATUS 1-19% 6175057 0.01 G8998GNCI

STG SWALLOW D/C STATUS 20-39% 6175058 0.01 G8998GNCJ

STG SWALLOW D/C STATUS 40-59% 6175059 0.01 G8998GNCK

STG SWALLOW D/C STATUS 60-79% 6175060 0.01 G8998GNCL

STG SWALLOW D/C STATUS 80-99% 6175061 0.01 G8998GNCM



STG SWALLOW D/C STATUS 100% 6175062 0.01 G8998GNCN

STG MOTOR SPEECH CURRENT STATUS 1-19% 6175063 0.01 G8999GNCI

STG MOTOR SPEECH CURRENT STATUS 20-39% 6175064 0.01 G8999GNCJ

STG MOTOR SPEECH CURRENT STATUS 40-59% 6175065 0.01 G8999GNCK

STG MOTOR SPEECH CURRENT STATUS 60-79% 6175066 0.01 G8999GNCL

STG MOTOR SPEECH CURRENT STATUS 80-99% 6175067 0.01 G8999GNCM

STG MOTOR SPEECH CURRENT STATUS 100% 6175068 0.01 G8999GNCN

STG MOTOR SPEECH PROJECTED GOAL 1-19% 6175069 0.01 G9157GNCI

STG MOTOR SPEECH PROJECTED GOAL 20-39% 6175070 0.01 G9157GNCJ

STG MOTOR SPEECH PROJECTED GOAL 40-59% 6175071 0.01 G9157GNCK

STG MOTOR SPEECH PROJECTED GOAL 60-79% 6175072 0.01 G9157GNCL

STG MOTOR SPEECH PROJECTED GOAL 80-99% 6175073 0.01 G9157GNCM

STG MOTOR SPEECH PROJECTED GOAL 100% 6175074 0.01 G9157GNCN

STG MOTOR SPEECH D/C STATUS 1-19% 6175075 0.01 G9158GNCI

STG MOTOR SPEECH D/C STATUS 20-39% 6175076 0.01 G9158GNCJ

STG MOTOR SPEECH D/C STATUS 40-59% 6175077 0.01 G9158GNCK

STG MOTOR SPEECH D/C STATUS 60-79% 6175078 0.01 G9158GNCL

STG MOTOR SPEECH D/C STATUS 80-99% 6175079 0.01 G9158GNCM

STG MOTOR SPEECH D/C STATUS 100% 6175080 0.01 G9158GNCN

STG LANG COMP CURRENT STATUS 1-19% 6175081 0.01 G9159GNCI

STG LANG COMP CURRENT STATUS 20-39% 6175082 0.01 G9159GNCJ

STG LANG COMP CURRENT STATUS 40-59% 6175083 0.01 G9159GNCK

STG LANG COMP CURRENT STATUS 60-79% 6175084 0.01 G9159GNCL

STG LANG COMP CURRENT STATUS 80-99% 6175085 0.01 G9159GNCM

STG LANG COMP CURRENT STATUS 100% 6175086 0.01 G9159GNCN

STG LANG COMP GOAL STATUS 1-19% 6175087 0.01 G9160GNCI

STG LANG COMP GOAL STATUS 20-39% 6175088 0.01 G9160GNCJ

STG LANG COMP GOAL STATUS 40-59% 6175089 0.01 G9160GNCK

STG LANG COMP GOAL STATUS 60-79% 6175090 0.01 G9160GNCL

STG LANG COMP GOAL STATUS 80-99% 6175091 0.01 G9160GNCM

STG LANG COMP GOAL STATUS 100% 6175092 0.01 G9160GNCN

STG LANG COMP D/C STATUS 1-19% 6175093 0.01 G9161GNCI

STG LANG COMP D/C STATUS 20-39% 6175094 0.01 G9161GNCJ

STG LANG COMP D/C STATUS 40-59% 6175095 0.01 G9161GNCK

STG LANG COMP D/C STATUS 60-79% 6175096 0.01 G9161GNCL

STG LANG COMP D/C STATUS 80-99% 6175097 0.01 G9161GNCM

STG LANG COMP D/C STATUS 100% 6175098 0.01 G9161GNCN

STG LANG EXPRESS CURRENT STATUS 1-19% 6175099 0.01 G9162GNCI

STG LANG EXPRESS CURRENT STATUS 20-39% 6175100 0.01 G9162GNCJ

STG LANG EXPRESS CURRENT STATUS 40-59% 6175101 0.01 G9162GNCK

STG LANG EXPRESS CURRENT STATUS 60-79% 6175102 0.01 G9162GNCL

STG LANG EXPRESS CURRENT STATUS 80-99% 6175103 0.01 G9162GNCM

STG LANG EXPRESS CURRENT STATUS 100% 6175104 0.01 G9162GNCN

STG LANG EXPRESS GOAL STATUS 1-19% 6175105 0.01 G9163GNCI

STG LANG EXPRESS GOAL STATUS 20-39% 6175106 0.01 G9163GNCJ



STG LANG EXPRESS GOAL STATUS 40-59% 6175107 0.01 G9163GNCK

STG LANG EXPRESS GOAL STATUS 60-79% 6175108 0.01 G9163GNCL

STG LANG EXPRESS GOAL STATUS 80-99% 6175109 0.01 G9163GNCM

STG LANG EXPRESS GOAL STATUS 100% 6175110 0.01 G9163GNCN

STG LANG EXPRESS D/C STATUS 1-19% 6175111 0.01 G9164GNCI

STG LANG EXPRESS D/C STATUS 20-39% 6175112 0.01 G9164GNCJ

STG LANG EXPRESS D/C STATUS 40-59% 6175113 0.01 G9164GNCK

STG LANG EXPRESS D/C STATUS 60-79% 6175114 0.01 G9164GNCL

STG LANG EXPRESS D/C STATUS 80-99% 6175115 0.01 G9164GNCM

STG LANG EXPRESS D/C STATUS 100% 6175116 0.01 G9164GNCN

STG ATTEN CURRENT STATUS 1-19% 6175117 0.01 G9165GNCI

STG ATTEN CURRENT STATUS 20-39% 6175118 0.01 G9165GNCJ

STG ATTEN CURRENT STATUS 40-59% 6175119 0.01 G9165GNCK

STG ATTEN CURRENT STATUS 60-79% 6175120 0.01 G9165GNCL

STG ATTEN CURRENT STATUS 80-99% 6175121 0.01 G9165GNCM

STG ATTEN CURRENT STATUS 100% 6175122 0.01 G9165GNCN

STG ATTEN GOAL STATUS 1-19% 6175123 0.01 G9166GNCI

STG ATTEN GOAL STATUS 20-39% 6175124 0.01 G9166GNCJ

STG ATTEN GOAL STATUS 40-59% 6175125 0.01 G9166GNCK

STG ATTEN GOAL STATUS 60-79% 6175126 0.01 G9166GNCL

STG ATTEN GOAL STATUS 80-99% 6175127 0.01 G9166GNCM

STG ATTEN GOAL STATUS 100% 6175128 0.01 G9166GNCN

STG ATTEN D/C STATUS 1-19% 6175129 0.01 G9167GNCI

STG ATTEN D/C STATUS 20-39% 6175130 0.01 G9167GNCJ

STG ATTEN D/C STATUS 40-59% 6175131 0.01 G9167GNCK

STG ATTEN D/C STATUS 60-79% 6175132 0.01 G9167GNCL

STG ATTEN D/C STATUS 80-99% 6175133 0.01 G9167GNCM

STG ATTEN D/C STATUS 100% 6175134 0.01 G9167GNCN

STG MEMORY CURRENT STATUS 1-19% 6175135 0.01 G9168GNCI

STG MEMORY CURRENT STATUS 20-39% 6175136 0.01 G9168GNCJ

STG MEMORY CURRENT STATUS 40-59% 6175137 0.01 G9168GNCK

STG MEMORY CURRENT STATUS 60-79% 6175138 0.01 G9168GNCL

STG MEMORY CURRENT STATUS 80-99% 6175139 0.01 G9168GNCM

STG MEMORY CURRENT STATUS 100% 6175140 0.01 G9168GNCN

STG MEMORY GOAL STATUS 1-19% 6175141 0.01 G9169GNCI

STG MEMORY GOAL STATUS 20-39% 6175142 0.01 G9169GNCJ

STG MEMORY GOAL STATUS 40-59% 6175143 0.01 G9169GNCK

STG MEMORY GOAL STATUS 60-79% 6175144 0.01 G9169GNCL

STG MEMORY GOAL STATUS 80-99% 6175145 0.01 G9169GNCM

STG MEMORY GOAL STATUS 100% 6175146 0.01 G9169GNCN

STG MEMORY D/C STATUS 1-19% 6175147 0.01 G9170GNCI

STG MEMORY D/C STATUS 20-39% 6175148 0.01 G9170GNCJ

STG MEMORY D/C STATUS 40-59% 6175149 0.01 G9170GNCK

STG MEMORY D/C STATUS 60-79% 6175150 0.01 G9170GNCL

STG MEMORY D/C STATUS 80-99% 6175151 0.01 G9170GNCM



STG MEMORY D/C STATUS 100% 6175152 0.01 G9170GNCN

STG VOICE CURRENT STATUS 1-19% 6175153 0.01 G9171GNCI

STG VOICE CURRENT STATUS 20-39% 6175154 0.01 G9171GNCJ

STG VOICE CURRENT STATUS 40-59% 6175155 0.01 G9171GNCK

STG VOICE CURRENT STATUS 60-79% 6175156 0.01 G9171GNCL

STG VOICE CURRENT STATUS 80-99% 6175157 0.01 G9171GNCM

STG VOICE CURRENT STATUS 100% 6175158 0.01 G9171GNCN

STG VOICE GOAL STATUS 1-19% 6175159 0.01 G9172GNCI

STG VOICE GOAL STATUS 20-39% 6175160 0.01 G9172GNCJ

STG VOICE GOAL STATUS 40-59% 6175161 0.01 G9172GNCK

STG VOICE GOAL STATUS 60-79% 6175162 0.01 G9172GNCL

STG VOICE GOAL STATUS 80-99% 6175163 0.01 G9172GNCM

STG VOICE GOAL STATUS 100% 6175164 0.01 G9172GNCN

STG VOICE D/C STATUS 1-19% 6175165 0.01 G9173GNCI

STG VOICE D/C STATUS 20-39% 6175166 0.01 G9173GNCJ

STG VOICE D/C STATUS 40-59% 6175167 0.01 G9173GNCK

STG VOICE D/C STATUS 60-79% 6175168 0.01 G9173GNCL

STG VOICE D/C STATUS 80-99% 6175169 0.01 G9173GNCM

STG VOICE D/C STATUS 100% 6175170 0.01 G9173GNCN

STG SPEECH LANG CURRENT STATUS 1-19% 6175171 0.01 G9174GNCI

STG SPEECH LANG CURRENT STATUS 20-39% 6175172 0.01 G9174GNCJ

STG SPEECH LANG CURRENT STATUS 40-59% 6175173 0.01 G9174GNCK

STG SPEECH LANG CURRENT STATUS 60-79% 6175174 0.01 G9174GNCL

STG SPEECH LANG CURRENT STATUS 80-99% 6175175 0.01 G9174GNCM

STG SPEECH LANG CURRENT STATUS 100% 6175176 0.01 G9174GNCN

STG SPEECH LANG GOAL STATUS 1-19% 6175177 0.01 G9175GNCI

STG SPEECH LANG GOAL STATUS 20-39% 6175178 0.01 G9175GNCJ

STG SPEECH LANG GOAL STATUS 40-59% 6175179 0.01 G9175GNCK

STG SPEECH LANG GOAL STATUS 60-79% 6175180 0.01 G9175GNCL

STG SPEECH LANG GOAL STATUS 80-99% 6175181 0.01 G9175GNCM

STG SPEECH LANG GOAL STATUS 100% 6175182 0.01 G9175GNCN

STG SPEECH LANG D/C STATUS 1-19% 6175183 0.01 G9176GNCI

STG SPEECH LANG D/C STATUS 20-39% 6175184 0.01 G9176GNCJ

STG SPEECH LANG D/C STATUS 40-59% 6175185 0.01 G9176GNCK

STG SPEECH LANG D/C STATUS 60-79% 6175186 0.01 G9176GNCL

STG SPEECH LANG D/C STATUS 80-99% 6175187 0.01 G9176GNCM

STG SPEECH LANG D/C STATUS 100% 6175188 0.01 G9176GNCN

STG MOTOR SPEECH GOAL STATUS 1-19% 6175189 0.01 G9186GNCI

STG MOTOR SPEECH GOAL STATUS 20-39% 6175190 0.01 G9186GNCJ

STG MOTOR SPEECH GOAL STATUS 40-59% 6175191 0.01 G9186GNCK

STG MOTOR SPEECH GOAL STATUS 60-79% 6175192 0.01 G9186GNCL

STG MOTOR SPEECH GOAL STATUS 80-99% 6175193 0.01 G9186GNCM

STG MOTOR SPEECH GOAL STATUS 100% 6175194 0.01 G9186GNCN

ST SLP SPEECH SOUNDS EVALUATION 6175195 230.30 92522GN

ST SLP SPEECH SOUNDS AND LANG EVALUATION 6175196 476.40 92523GN



ST SLP SPEECH APHASIA ASSESSMENT 6175197 253.60 96105GN

OT SPLINT ARM DYNAMIC 6249002 123.10 29126GO

OT SPLINT FINGER 6249003 80.70 29130GO

OT MMT WITH HAND 6249004 56.30 95832GO

OT TOTAL EVALUATION WITH HAND 6249005 126.30 95834GO

OT ROM 6249006 27.60 95852GO

OT THERAPEUTIC ACTIVITIES 15 MIN 6249007 104.00 97530GO

OT SELF CARE MANAGEMENT TRAINING 15 MIN 6249008 95.50 97535GO

OT COMMUNITY WORK REINTERGRATION 15 MIN 6249009 77.50 97537GO

OT COGNITIVE TRAINING 6249010 76.40 97127GO

OT NEURO RE EDUCATION 15 MIN 6249011 107.20 97112GO

OT COGNITIVE TRAINING 15 MIN MEDICARE 6249012 76.40 G0515GO

OT THERAPEUTIC EXERCISE 15 MIN EA 6249013 104.00 97110GO

OT CONTRAST BATH 15 MIN 6249014 51.00 97034GO

OT THERA PROC GROUP 6249015 57.30 97150GO

OT WHEELCHAIR MANAGEMENT 15 MIN 6249016 79.60 97542GO

MANUAL THER TECH 15MIN 6249018 79.60 97140GP

OTG OTHER OT CURRENT STATUS 0% 6249020 0.01 G8990GOCH

OTG OTHER OT GOAL STATUS 0% 6249021 0.01 G8991GOCH

OTG OTHER OT D/C STATUS 0% 6249022 0.01 G8992GOCH

OTG SUB OT CURRENT STATUS 0% 6249023 0.01 G8993GOCH

OTG SUB OT GOAL STATUS 0% 6249024 0.01 G8994GOCH

OTG SUB OT D/C STATUS 0% 6249025 0.01 G8995GOCH

OTG MOBILITY CURRENT STATUS 0% 6249026 0.01 G8978GOCH

OTG MOBILITY GOAL STATUS 0% 6249027 0.01 G8979GOCH

OTG MOBILITY D/C STATUS 0% 6249028 0.01 G8980GOCH

OTG BODY POS CURRENT STATUS 0% 6249029 0.01 G8981GOCH

OTG BODY POS GOAL STATUS 0% 6249030 0.01 G8982GOCH

OTG BODY POS D/C STATUS 0% 6249031 0.01 G8983GOCH

OTG CARRY CURRENT STATUS 0% 6249032 0.01 G8984GOCH

OTG CARRY GOAL STATUS 0% 6249033 0.01 G8985GOCH

OTG CARRY D/C STATUS 0% 6249034 0.01 G8986GOCH

OTG SELF CARE CURRENT STATUS 0% 6249035 0.01 G8987GOCH

OTG SELF CARE GOAL STATUS 0% 6249036 0.01 G8988GOCH

OTG SELF CARE D/C STATUS 0% 6249037 0.01 G8989GOCH

OTG SELF CARE D/C STATUS 20-39% 6249038 0.01 G8989GOCJ

OTG SELF CARE D/C STATUS 40-59% 6249039 0.01 G8989GOCK

OTG SELF CARE D/C STATUS 60-79% 6249040 0.01 G8989GOCL

OTG SELF CARE D/C STATUS 80-99% 6249041 0.01 G8989GOCM

OTG SELF CARE D/C STATUS 100% 6249042 0.01 G8989GOCN

OTG OTHER OT GOAL STATUS 1-19% 6249043 0.01 G8991GOCI

OTG OTHER OT GOAL STATUS 20-39% 6249044 0.01 G8991GOCJ

OTG OTHER OT GOAL STATUS 40-59% 6249045 0.01 G8991GOCK

OTG OTHER OT GOAL STATUS 60-79% 6249046 0.01 G8991GOCL

OTG OTHER OT GOAL STATUS 80-99% 6249047 0.01 G8991GOCM



OTG OTHER OT GOAL STATUS 100% 6249048 0.01 G8991GOCN

OTG OTHER OT D/C STATUS 1-19% 6249049 0.01 G8992GOCI

OTG OTHER OT D/C STATUS 20-39% 6249050 0.01 G8992GOCJ

OTG OTHER OT D/C STATUS 40-59% 6249051 0.01 G8992GOCK

OTG OTHER OT D/C STATUS 60-79% 6249052 0.01 G8992GOCL

OTG OTHER OT D/C STATUS 80-99% 6249053 0.01 G8992GOCM

OTG OTHER OT D/C STATUS 100% 6249054 0.01 G8992GOCN

OTG SUB OT CURRENT STATUS 1-19% 6249055 0.01 G8993GOCI

OTG SUB OT CURRENT STATUS 20-39% 6249056 0.01 G8993GOCJ

OTG SUB OT CURRENT STATUS 40-59% 6249057 0.01 G8993GOCK

OTG SUB OT CURRENT STATUS 60-79% 6249058 0.01 G8993GOCL

OTG SUB OT CURRENT STATUS 80-99% 6249059 0.01 G8993GOCM

OTG SUB OT CURRENT STATUS 100% 6249060 0.01 G8993GOCN

OTG SUB OT GOAL STATUS 1-19% 6249061 0.01 G8994GOCI

OTG SUB OT GOAL STATUS 20-39% 6249062 0.01 G8994GOCJ

OTG SUB OT GOAL STATUS 40-59% 6249063 0.01 G8994GOCK

OTG SUB OT GOAL STATUS 60-79% 6249064 0.01 G8994GOCL

OTG SUB OT GOAL STATUS 80-99% 6249065 0.01 G8994GOCM

OTG SUB OT GOAL STATUS 100% 6249066 0.01 G8994GOCN

OTG SUB OT D/C STATUS 1-19% 6249067 0.01 G8995GOCI

OTG SUB OT D/C STATUS 20-39% 6249068 0.01 G8995GOCJ

OTG SUB OT D/C STATUS 40-59% 6249069 0.01 G8995GOCK

OTG SUB OT D/C STATUS 60-79% 6249070 0.01 G8995GOCL

OTG SUB OT D/C STATUS 80-99% 6249071 0.01 G8995GOCM

OTG SUB OT D/C STATUS 100% 6249072 0.01 G8995GOCN

OTG MOBILITY CURRENT STATUS 1-19% 6249073 0.01 G8978GOCI

OTG MOBILITY CURRENT STATUS 20-39% 6249074 0.01 G8978GOCJ

OTG MOBILITY CURRENT STATUS 40-59% 6249075 0.01 G8978GOCK

OTG MOBILITY CURRENT STATUS 60-79% 6249076 0.01 G8978GOCL

OTG MOBILITY CURRENT STATUS 80-99% 6249077 0.01 G8978GOCM

OTG MOBILITY CURRENT STATUS 100% 6249078 0.01 G8978GOCN

OTG MOBILITY GOAL STATUS 1-19% 6249079 0.01 G8979GOCI

OTG MOBILITY GOAL STATUS 20-39% 6249080 0.01 G8979GOCJ

OTG MOBILITY GOAL STATUS 40-59% 6249081 0.01 G8979GOCK

OTG MOBILITY GOAL STATUS 60-79% 6249082 0.01 G8979GOCL

OTG MOBILITY GOAL STATUS 80-99% 6249083 0.01 G8979GOCM

OTG MOBILITY GOAL STATUS 100% 6249084 0.01 G8979GOCN

OTG MOBILITY D/C STATUS 1-19% 6249085 0.01 G8980GOCI

OTG MOBILITY D/C STATUS 20-39% 6249086 0.01 G8980GOCJ

OTG MOBILITY D/C STATUS 40-59% 6249087 0.01 G8980GOCK

OTG MOBILITY D/C STATUS 60-79% 6249088 0.01 G8980GOCL

OTG MOBILITY D/C STATUS 80-99% 6249089 0.01 G8980GOCM

OTG MOBILITY D/C STATUS 100% 6249090 0.01 G8980GOCN

OTG BODY POS CURRENT STATUS 1-19% 6249091 0.01 G8981GOCI

OTG BODY POS CURRENT STATUS 20-39% 6249092 0.01 G8981GOCJ



OTG BODY POS CURRENT STATUS 40-59% 6249093 0.01 G8981GOCK

OTG BODY POS CURRENT STATUS 60-79% 6249094 0.01 G8981GOCL

OTG BODY POS CURRENT STATUS 80-99% 6249095 0.01 G8981GOCM

OTG BODY POS CURRENT STATUS 100% 6249096 0.01 G8981GOCN

OTG BODY POS GOAL STATUS 1-19% 6249097 0.01 G8982GOCI

OTG BODY POS GOAL STATUS 20-39% 6249098 0.01 G8982GOCJ

OTG BODY POS GOAL STATUS 40-59% 6249099 0.01 G8982GOCK

OTG BODY POS GOAL STATUS 60-79% 6249100 0.01 G8982GOCL

OTG BODY POS GOAL STATUS 80-99% 6249101 0.01 G8982GOCM

OTG BODY POS GOAL STATUS 100% 6249102 0.01 G8982GOCN

OTG BODY POS D/C STATUS 1-19% 6249103 0.01 G8983GOCI

OTG BODY POS D/C STATUS 20-39% 6249104 0.01 G8983GOCJ

OTG BODY POS D/C STATUS 40-59% 6249105 0.01 G8983GOCK

OTG BODY POS D/C STATUS 60-79% 6249106 0.01 G8983GOCL

OTG BODY POS D/C STATUS 80-99% 6249107 0.01 G8983GOCM

OTG BODY POS D/C STATUS 100% 6249108 0.01 G8983GOCN

OTG CARRY CURRENT STATUS 1-19% 6249109 0.01 G8984GOCI

OTG CARRY CURRENT STATUS 20-39% 6249110 0.01 G8984GOCJ

OTG CARRY CURRENT STATUS 40-59% 6249111 0.01 G8984GOCK

OTG CARRY CURRENT STATUS 60-79% 6249112 0.01 G8984GOCL

OTG CARRY CURRENT STATUS 80-99% 6249113 0.01 G8984GOCM

OTG CARRY CURRENT STATUS 100% 6249114 0.01 G8984GOCN

OTG CARRY GOAL STATUS 1-19% 6249115 0.01 G8985GOCI

OTG CARRY GOAL STATUS 20-39% 6249116 0.01 G8985GOCJ

OTG CARRY GOAL STATUS 40-59% 6249117 0.01 G8985GOCK

OTG CARRY GOAL STATUS 60-79% 6249118 0.01 G8985GOCL

OTG CARRY GOAL STATUS 80-99% 6249119 0.01 G8985GOCM

OTG CARRY GOAL STATUS 100% 6249120 0.01 G8985GOCN

OTG CARRY D/C STATUS 1-19% 6249121 0.01 G8986GOCI

OTG CARRY D/C STATUS 20-39% 6249122 0.01 G8986GOCJ

OTG CARRY D/C STATUS 40-59% 6249123 0.01 G8986GOCK

OTG CARRY D/C STATUS 60-79% 6249124 0.01 G8986GOCL

OTG CARRY D/C STATUS 80-99% 6249125 0.01 G8986GOCM

OTG CARRY D/C STATUS 100% 6249126 0.01 G8986GOCN

OTG SELF CARE CURRENT STATUS 1-19% 6249127 0.01 G8987GOCI

OTG SELF CARE CURRENT STATUS 20-39% 6249128 0.01 G8987GOCJ

OTG SELF CARE CURRENT STATUS 40-59% 6249129 0.01 G8987GOCK

OTG SELF CARE CURRENT STATUS 60-79% 6249130 0.01 G8987GOCL

OTG SELF CARE CURRENT STATUS 80-99% 6249131 0.01 G8987GOCM

OTG SELF CARE CURRENT STATUS 100% 6249132 0.01 G8987GOCN

OTG SELF CARE GOAL STATUS 1-19% 6249133 0.01 G8988GOCI

OTG SELF CARE GOAL STATUS 20-39% 6249134 0.01 G8988GOCJ

OTG SELF CARE GOAL STATUS 40-59% 6249135 0.01 G8988GOCK

OTG SELF CARE GOAL STATUS 60-79% 6249136 0.01 G8988GOCL

OTG SELF CARE GOAL STATUS 80-99% 6249137 0.01 G8988GOCM



OTG SELF CARE GOAL STATUS 100% 6249138 0.01 G8988GOCN

OTG SELF CARE D/C STATUS 1-19% 6249139 0.01 G8989GOCI

OTG SELF CARE D/C STATUS 20-39% 6249140 0.01 G8989GOCJ

OTG SELF CARE D/C STATUS 40-59% 6249141 0.01 G8989GOCK

OTG SELF CARE D/C STATUS 60-79% 6249142 0.01 G8989GOCL

OTG SELF CARE D/C STATUS 80-99% 6249143 0.01 G8989GOCM

OTG SELF CARE D/C STATUS 100% 6249144 0.01 G8989GOCN

OT EVAL LOW COMPLEX 30 MIN 6249145 170.00 97165GO

OT EVAL MOD COMPLEX 45 MIN 6249146 170.00 97166GO

OT EVAL HIGH COMPLEX 60 MIN 6249147 170.00 97167GO

OT RE EVAL EST PLAN CARE 6249148 109.50 97168GO

Clinic

NEG PRESSURE WOUND THERAPY >50CM 7000001 107.50 97606

ESTABLISHED PATIENT MINIMAL NURSE VISIT 7000002 44.00 99211

ESTABLISHED PATIENT PROBLEM FOCUSED 7000003 93.50 99212

ESTABLISHED PATIENT EXPANDED PROBLEM 7000004 126.50 99213

ESTABLISHED PATIENT DETAILED HISTORY 7000005 176.00 99214

ESTABLISHED PATIENT COMPREHENSIVE HISTOR 7000006 220.00 99215

PREVENTATIVE EST UNDER 1 YR 7000007 119.90 99391

PREVENTATIVE MED EST AGE 1-4 YRS 7000008 132.00 99392



PREVENTATIVE EST AGES 18-39YRS 7000011 170.50 99395

PREVENTATIVE MED EST AGES 40-64 YRS 7000012 182.60 99396

PREVENTATIVE MED EST AGE 65+ YRS 7000013 195.80 99397

NEW PATIENT PROBLEM FOCUSED 7000015 77.00 99201

NEW PATIENT EXPANDED PROBLEM 7000016 126.50 99202

NEW PATIENT DETAILED HISTORY 7000017 187.00 99203

NEW PATIENT COMPREHENSIVE HISTORY 7000018 280.50 99204

NEW PATIENT HIGH COMPREHENSIVE 7000019 379.50 99205

PREVENTATIVE NEW INITIAL UNDER 1 YR 7000020 154.00 99381

PREVENTATIVE MED NEW INITIAL AGE 1-4 YR 7000021 170.50 99382

PREVENTATIVE MED NEW INITIAL AGE 5-11 Y 7000022 182.60 99383

PREVENTATIVE MED NEW INITIAL AGE 12-17 7000023 195.80 99384

PREVENTATIVE MED NEW INITIAL AGES 18-39 7000024 202.40 99385

PREVENTATIVE MED NEW INITIAL AGES 40-64 7000025 221.10 99386

PREVENTATIVE NEW INITIAL AGE 65 YRS+ 7000026 231.00 99387

PREVENTATIVE MED NEW ENHANCED BENEFIT FO 7000027 31.60 99420

PSYCHOLOGICAL TESTING REPORT 7000033 200.20 96101

PSYCHOLOGICAL OUTPATIENT CONSULT 7000034 126.50 99213

BEHAVIOR MEDICINE INPATIENT CONSULT 7000035 111.30 99251

AUDIOMETRY 7000036 21.50 92551

CERUMEN REMOVAL W/INSTRUMENT 7000037 136.60 69210

NEBULIZER 7000038 82.20 94640

TYMPANOMETRY 7000039 75.90 92567



VISUAL ACUITY 7000040 13.90 99173

ON SITE LABS GLUCOSE 7000041 9.90 82947

ON SITE LABS HCG URINE 7000042 27.80 81025

ON SITE LABS KOH SKIN HAIR NAILS 7000043 22.00 87220

ON SITE LABS WET MOUNT 7000044 28.60 87210

ON SITE LABS STREP GROUP A SCREEN 7000045 52.80 87880

ON SITE LABS URINE DIPSTICK 7000046 9.90 81002

ON SITE LABS URINE DIPSTICK W MICROSCOPY 7000047 14.30 81000

ON SITE LABS URINE MICROSCOPY 7000048 18.70 81015

ON SITE LABS HEMOGLOBIN 7000049 9.90 85018

ADMIN INJ SQ OR IM NON IMMUNIZATION 7000050 30.40 96372

ALLERGY INJECTION SINGLE 7000051 21.70 95115

ALLERGY INJECTION MULTIPLE 7000052 27.80 95117

ADMIN IMMUNIZATION FIRST 7000053 53.30 90471

ADMIN IMMUNIZATION EACH ADDITIONAL 7000054 33.20 90472

BUS DRIVER EXAMS 7000055 60.00 99211

ADMIN OF INFLUENZA VAC 7000057 23.70 G0008

ADMIN OF PNEUMOCOCCAL 7000058 23.70 G0009

DERMABOND WOUND CLOSURE 7000059 167.00 G0168

HOME HEALTH RECERTIFICATION 7000060 161.90 G0179

HOME HEALTH INITIAL CERTIFICATION 7000061 212.50 G0180

INR PHYSICAN REVIEW 7000062 34.20 G0250

WELCOME TO MEDICARE 1ST 12 MONTHS OF ELI 7000064 126.50 G0402CG

MEDICARE ANNUAL WELLNESS VISIT NEW 7000065 126.50 G0438CG

MEDICARE ANNUAL WELLNESS ESTAB 7000066 221.40 G0439CG

GRANDPARENT PHYSICAL 7000067 40.00 99211

SPORTS/CAMP PHYSICALS 7000069 15.00 99211

FINE NEEDLE ASPIRATION 7000070 500.90 10060

STATE SUPPLY IMMUNIZATIONS HEP B 7000071 0.00 90744

ADMIN OF INFLUENZA VAC MEDICARE 7000072 0.00 G0008

ADMIN OF PNEUMOCOCCAL MEDICARE 7000073 0.00 G0009

DOT PHYSICALS 7000074 100.00 99211

ADMIN OF HEPATITIS B VACCINE 7000075 17.80 G0010

ADMIN OF PREVNAR MEDICARE 7000076 0.00 G0009

MEDICARE ALLERGY INJECTION SINGLE 7000077 19.75 95115

MEDICARE ALLERGY INJECTION MULTIPLE 7000078 25.30 95117

AM/FM EMPLOYMENT PHYSICALS 7000079 30.00 99211

MEDICARE WELL WOMAN 7000080 176.00 G0101CG

OP IM SUBCUTANEOUS INJECTION 7000082 28.50 96372

FOSTER PARENT PHYSICAL 7000083 30.00 99211

TELEPHONE ESTABLISHED PATIENT PROBLEM 7000084 93.50 99441

TELEPHONE ESTABLISHED PATIENT EXPANDED 7000085 126.50 99442

TELEPHONE ESTABLISHED PATIENT DETAILED 7000086 176.00 99443

ROSEWOOD EMPLOYEE 7000087 30.00 99211

STATE SUPPLY IMMUNIZATIONS DTAP 7010001 0.00 90700



STATE SUPPLY IMMUNIZATIONS GARDASIL 9 7010002 0.00 90651

STATE SUPPLY IMMUNIZATIONS HEP A ADULT 7010003 0.00 90632

STATE SUPPLY IMMUNIZATIONS HEP A PED ADO 7010004 0.00 90633

STATE SUPPLY IMMUNIZATIONS HIB 7010005 0.00 90648

STATE SUPPLY IMMUNIZATIONS IPV 7010006 0.00 90713

STATE SUPPLY IMMUNIZATIONS INFLUENZA 6 3 7010007 0.00 90657

STATE SUPPLY IMMUNIZATIONS INFLUENZA 3 Y 7010008 0.00 90658

STATE SUPPLY IMMUNIZATIONS KINRIX 7010009 0.00 90696

STATE SUPPLY IMMUNIZATIONS MENACTRA 7010010 0.00 90734

STATE SUPPLY IMMUNIZATIONS MMR 7010011 0.00 90707

STATE SUPPLY IMMUNIZATIONS MMRV 7010012 0.00 90710

STATE SUPPLY IMMUNIZATIONS PEDIARIX 7010013 0.00 90723

STATE SUPPLY IMMUNIZATIONS PNEUMOVAX 7010014 0.00 90732

STATE SUPPLY IMMUNIZATIONS PREVNAR 7010015 0.00 90670

STATE SUPPLY IMMUNIZATIONS ROTAVIRUS 7010016 0.00 90681

STATE SUPPLY IMMUNIZATIONS Td 7010017 0.00 90714

STATE SUPPLY ADACEL 7010018 0.00 90715

STATE SUPPLY IMMUNIZATIONS VARICELLA 7010019 0.00 90716

STATE SUPPLY IMMUNIZATIONS PENTACEL 7010020 0.00 90698

STATE SUPPLY FLUMIST 7010021 0.00 90672

STATE SUPPLY IMMUNIZATIONS DT 7010022 0.00 90702

ACNE SURGERY 7010040 585.80 10040

I & D ABCESS SIMPLE 7010060 500.90 10060

I & D ABSCESS COMPLICATED OR MULTI 7010061 572.20 10061

I & D PILONIDAL CYST SIMPLE 7010080 471.80 10080

REMOVAL FOREIGN BODY SIMPLE 7010120 363.10 10120

I & D HEMATOMA SEROMA 7010140 607.20 10140

ASPIRATION OF ABSCESS 7010160 357.50 10160

DEBRIDEMENT SKIN PARTIAL THICKN 7011040 249.20 11042

DEBRIDEMENT SKIN & SUBCUTANEOUS 7011042 249.20 11042

SHAVE CORN OR CALLUS ONE 7011055 141.70 11055

SHAVE CORN OR CALLUS 2 TO 4 7011056 230.20 11056

SHAVE CORN OR CALLUS 4 OR MORE 7011057 155.60 11057

BIOPSY ON SKIN SIMPLE CLOSURE EACH ADDIT 7011101 46.20 11101

EXC SKIN TAG UP TO 15 7011200 167.00 11200

EXC SKIN TAG ADD'L 10 7011201 54.40 11201

SHAVING BENIGN LESION < 0.5 7011300 221.40 11300

SHAVING BENIGN LESION LESS 0.6 1. 7011301 265.70 11301

SHAVING DERMAL EPIDERMAL LE 7011302 172.00 11302

SHAVING LESION HANDS FEET SCALP 7011305 371.90 11305

SHAVING BENIGN LESION 0.5 LESS 7011310 148.50 11310

SHAVING BENIGN LESION 0.6-1.0CM 7011311 209.00 11311

SHAVING BENIGN LESION 1.1 TO 2.0 7011312 254.10 11312

EXC LESION 0.6 1.0CM TRUNK ARM LEG 7011401 428.80 11401

EXC BENIGN LESION 2CM TRUNK ARM LEG 7011402 398.50 11402



EXC BENIGN LESION 3.1-4.0 CM TRUNK ARMS 7011404 506.00 11404

EXC BENIGN LESION >4.0 CM TRUNK ARMS 7011406 671.00 11406

EXC BEN LES <.05 CM HD FA NK SP 7011420 378.40 11420

EXC BEN LES 0.6 1.0CM SCALP NECK HAND GE 7011421 449.10 11421

EXC BEN LES 1.1-2.0 SCALP NECK HAND FEET 7011422 407.80 11422

EXC BEN LES 2.1-3.0cm SCALP NECK HAND FT 7011423 498.30 11423

EXC BEN LES <0.5CM FACE SCALP EYEL 7011440 334.40 11440

EXC BEN LES 0.6-1.0CM FACE SCALP EYEL 7011441 449.10 11441

EXC BEN LES 0.6-1.0CM FACE, SCALP 7011491 449.10 11441

EXC MALIG LESION 0.6-1.0 CM TRUNK ARM LE 7011601 401.50 11601




EXC MALIG LES SCALP NK HAND FEET 1.1-2.0 7011622 1,533.80 11622

EXC MALIG LES SCALP NK HAND FEET 2.1-3.0 7011623 682.00 11623

EXC MALIG LESION CA FACE 0.5 or LESS 7011640 373.20 11640

EXC MALIG LESION CA FACE 0.6-1.0 7011641 468.10 11641

EXC MALIG LESION CA FACE 1.1 to 2.0 7011642 495.00 11642

EXC MALIG LESION CA FACE 2.1 - 3.0CM 7011643 742.50 11643

EXC MALIG LESION CA FACE 3.1 - 4.0CM 7011644 866.50 11644

TRIMMING NAILS ANY NUMBER 7011719 75.90 11719

DEBRIDEMENT OF NAILS ANY METHOD 7011720 254.30 11720

REMOVAL TOENAIL SINGLE 7011730 466.80 11730

REMOVAL TOENAILS EACH ADD 7011732 145.50 11732

REMOVAL OF NAIL PERMANENT 7011750 430.10 11750

EXC OF CYST SINUS SIMPLE 7011770 237.80 11770

INTRALESIONAL INJECTION UP TO 7 7011900 137.50 11900

INTRALESIONAL INJECTION > THAN 7 7011901 209.00 11901

REMOVAL NON BIODEGRADABLE DRUG IMPLANT 7011982 286.00 11982

APPLICATION DERMABOND 2.5CM OR LESS 7012001 500.90 12001

APPLICATION DERMABOND 2.6CM TO 7.5CM 7012002 500.90 12002

LAC RPR 2.5 FOREHEAD 7012011 342.40 12011

DEBRIDEMENT BURN W O ANESTH 7016020 237.80 16020

DESTRUCT LESION BENIGN ONE 7017000 177.10 17000

DESTRUCT OF BENIGN LESION 2-14 7017003 38.00 17003

DESTRUCT BENIGN LESION 15 OR MORE 7017004 249.20 17004

WARTS UP TO 14 7017110 285.90 17110

WARTS 15 OR MORE 7017111 465.50 17111

DEST MALIG LESION FACE,EARS 0.5 OR LESS 7017280 242.00 17280

ASPIRATION OF BREAST CYST 7019000 141.70 19000

REMOVE FB MUSCLE TEND SIMPLE 7020520 465.30 20520

REMOVE FB MUSCLE TEND COMPLICATED 7020525 172.00 20525

INJ TENDON SHEATH OR LIGAMENT SINGLE 7020550 202.60 20550

INJ SINGLE TENDON ORGIN INSERTION 7020551 199.00 20551

TRIGGER POINT INJ 1 OR 2 SITE 7020552 205.00 20552



TRIGGER POINT INJ 3 OR MORE SITES 7020553 205.00 20553

ARTHROCENTESIS & OR INJECT SMALL JT 7020600 115.50 20600

ARTHROCENTESIS & OR INJECT INTERMED JT 7020605 234.00 20605

ARTHROCENTESIS & OR INJECTION MAJOR JT 7020610 244.10 20610

ASPIRATION OF GANGLION CYST ANY LOCATION 7020612 189.80 20612

EXCISION OF GANGLION WRIST 7025111 839.30 25111

APPLICATION OF SHORT ARM CAST 7029075 233.20 29075

APPLICATION OF LONG ARM SPLINT 7029105 221.40 29105


APPLICATION OF FINGER SPLINT 7029130 180.90 29130

STRAPPING WRIST 7029260 151.80 29260

PACK OR CAUTERY OF NASAL SIMPLE 7029261 298.50 30901


APPLICATION OF SHORT LEG CAST 7029405 245.40 29405

UNNA BOOT 7029580 112.20 29580


NASAL PACKING COMPLEX 7030903 304.50 30903

ANOSCOPY EXPLORE 7046600 246.70 46600

STRAIGHT CATH INSERTION 7051701 168.20 51701

FOLEY CATH INSERTION 7051702 354.20 51702

BLADDER SCAN 7051798 99.00 51798

OCCIPITAL NERVE BLOCK 7064405 209.00 64405

INJ ANESTH AGENT PERIPHERAL NER 7064450 282.80 64450


REMOVAL FB EYE EXT CORNEA 7065220 158.10 65220

REMOVAL FB EAR 7069200 221.40 69200

CERUMEN REMOVAL W/IRRAG & LAVAGE 7069209 110.10 69209

ADMIN IMMUNIZATION NASAL FLU 7090473 19.00 90473

INTERACTIVE COMPLEXITY 7090785 19.00 90785

PSYCHIATRIC DIAG EVAL 7090791 502.20 90791

PSYCHIATRIC DIAG EVAL W MED SERVICE 7090792 512.30 90792

PSYCHOTHERAPY 30 MINUTE 7090832 154.30 90832

PSYCHOTHERAPY ADD ON 30 MIN W E/M 7090833 94.60 90833

PSYCHOTHERAPY 45 MINUTE THERAPY 7090834 246.70 90834


PSYCHOTHERAPY 60 MINUTE THERAPY 7090837 312.50 90837


PHARMACOLOGIC MANGEMENT 7090863 150.50 90863

EKG TRACING ONLY W O INTERPRETA 7093005 48.10 93005

PHYS SUPERVISION W O INTERP & R 7093016 83.60 93016

NEBULIZER TREATMENT 7094640 82.20 94640

PULSE OX O2 SATURATION 7094760 45.50 94760

NEUROBEHAVIORAL STATUS EXAM 7096116 192.50 96116

PSYCHOLOGICAL TESTING/EVAL 1ST HR 7096130 245.30 96130

PSYCHOLOGICAL TESTING/EVAL ADD HR 7096131 187.00 96131



PSYCHOLOGICAL TESTING/ADMIN FIRST 30 MIN 7096136 82.50 96136

PSYCHOLOGICAL TESTING/ADMIN ADD 30 MIN 7096137 66.00 96137

ADMIN SQ/IM INJECTION MEDICARE 7096372 30.40 96372

OMT 1-2 BODY REGIONS 7098925 77.00 98925

OMT 3-4 BODY REGIONS 7098926 95.70 98926

OMT 5-6 BODY REGIONS 7098927 127.60 98927

OMT 7-8 BODY REGIONS 7098928 160.60 98928

OMT 9-10 BODY REGIONS 7098929 193.60 98929

SPECIAL NARRATIVE INSURANCE FOR 7099080 0.00 99080

NCF OR SWING ADMIT LEVEL 1 7099304 220.10 99304CG

NCF SWING ADMIT LEVEL II 7099305 313.70 99305CG

NCF OR SWING ADMIT LEVEL III 7099306 397.20 99306

NURSING HOME LEVEL ONE 7099307 103.70 99307

NURSING CARE FACILITY LEVEL II 7099308 159.40 99308CG

NURSING HOME LEVEL III 7099309 210.00 99309CG

NSG HOME VISIT IV 7099310 316.30 99310CG

NCF OR SWING DISCHARGE 7099315 213.80 99315CG

NCF OR SWING DISCHARGE > 30 MIN 7099316 307.40 99316CG

ANNUAL NSG FACILITY ASSESSMENT 7099318 222.60 99318

PERSONAL CARE HOME NEW II 7099322 119.90 99322CG

PERSONAL CARE HOME NEW III 7099323 149.60 99323CG

PERSONAL CARE HOME NEW LEVEL I 7099324 131.60 99324

PERSONAL CARE HOME NEW LEVEL II 7099325 176.00 99325CG

PERSONAL CARE HOME NEW III 7099326 328.90 99326CG

REST HOME VISIT - NEW LEVEL IV 7099327 430.10 99327


PERSONAL CARE HOME EST I 7099334 139.70 99334CG

PERSONAL CARE HOME EST II 7099335 165.00 99335CG


PERSONAL CARE HOME EST IV 7099337 442.80 99337

HOME VISIT NEW PATIENT LEVEL II 7099342 180.90 99342

HOME VISIT - NEW LEVEL IV 7099344 354.20 99344

HOME VISIT LEVEL I 7099347 97.40 99347

HOME VISIT LEVEL II ESTABLISH P 7099348 164.50 99348

HOME VISIT LEVEL III ESTABLISHE 7099349 253.00 99349

MANAGEMENT & EVALUATION 7099354 278.30 99354

PROLONGED EVALUTAION AND MANAGEMENT 7099358 330.00 99358

SMOKING CESSATION 3-10 MINUTES 7099406 38.50 99406

SMOKING CESSATION > 10 MINUTES 7099407 77.00 99407

HEALTH RISK ASSESSMENT 7099420 31.60 99420

EVALUATION FOR DISABILITY OR BA 7099450 81.00 99450

INDIVIDUAL THERAPY 30MIN 7190804 42.90 90804

MEDICAID PARTIAL HOSP 4 HOURS 7190808 343.20 H0035

INTENSIVE OP 1 HOURS 7190809 85.80 90853






FAMILY THERAPY 7190847 211.00 90847

PROCESS GROUP 7190853 85.80 90853

IM SUBCUTANEOUS INJECTION MEDICARE 7296372 30.40 96372

Provider Based Clinic

OUTPATIENT VISIT NEW PAT LEVEL I 7399201 66.00 99201

OUTPATIENT VISIT NEW PAT LEVEL II 7399202 110.00 99202

OUTPATIENT VISIT NEW PAT LEVEL III 7399203 165.00 99203

OUTPATIENT VISIT NEW PAT LEVEL IV 7399204 247.50 99204

OUTPATIENT VISIT NEW PAT LEVEL V 7399205 330.00 99205

OUTPATIENT VISIT LEVEL I 7399211 38.50 99211

OUTPATIENT VISIT LEVEL II 7399212 82.50 99212

OUTPATIENT VISIT LEVEL III 7399213 110.00 99213

OUTPATIENT VISIT LEVEL IV 7399214 154.00 99214

OUTPATIENT VISIT LEVEL V 7399215 192.50 99215
























OUTPATIENT VISIT NEW PAT LEVEL IV 8299204 55.00 99204


























OUTPATIENT TELE MED 8499213 51.50 Q3014


























OUTPATIENT NEW VISIT LEVEL IV 8799204 280.50 99204



OUTPATIENT NEW VISIT LEVEL V 8799205 379.50 99205






OP TELEPHONE III 8799443 126.50 99443


Effective: September 1, 2020 DESCRIPTION NUMBER Price CPT … · 2020. 11. 7. · coaptite...

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