SHCJ Charge Master 1 - Specialty Hospital of … › wp-content › uploads › 2019 › ...3110011...

SHCJ Charge Master 1.2019

PROCEDURE NUMBER DESCRIPTION STANDARD AMOUNT

1000001 INT ICU ROOM CHARGE 7600

1000002 DAILY CHARGE - SEMI P 7500

2000001 LEVEL-III HOSP ADMIT (70 MIN) 250

2000002 LEVEL-I SUBSEQTCARE (15 MIN) 95

2000003 LEVEL-II SUBSEQT CARE (25 MIN) 125

2000004 LEVEL-III SUBSEQT CARE(35 MIN) 150

2000005 HOSPITAL DISCHARGE >30MIN 175

2000006 HOSPITAL DISCHARGE <30MIN 150

2000007 CARDIOPULMONARY RESUSCITATION 741

2000008 CHANGE GASTROSTOMY TUBE 1242

2000009 RPLC G/CEC/OTH TB UNDER FLUORO 1183

2000010 DEBR SKN/SUBQ TISS 1ST 20SQCM 1221

2000011 DEBR SKN/SUBQ TIS ADD 20 SQCM 562

2000012 DEBR MUSCLE/FASCIA 1ST 20SQCM 1818

2000013 DEBR MUSC/FASCI EA ADD 20SQCM 562

2000014 DEBRIDE BONE 1ST 20 SQ CM 2345

2000015 DEBRIDE BONE EA ADD 20 SQ CM 11047

2000016 INS TUNLD CVAD W/PORT >5YRS 5313

2000017 INS TUNLD CVAD W/PUMP >5YRS 5775

2000018 INS PICC DEVICE W/O PORT >5YRS 2507

2000019 GASTRIC INTUBATION AND ASPIRAT 578

2000020 PROLONGED SERVICE, FIRST HOUR 300

2000021 PROLONGED SVC EACH ADD'L 30MIN 150

2000023 INS CVA DEVICE W/PORT NON TUNN 3454

2000024 PSYCH CONSULT 20 MIN 175

2000025 PSYCH CONSULT 40 MIN 350

2000026 PSYCH CONSULT 55 MIN 481.25

3100001 SDS- UP TO 1ST 30 MIN 3822

3100002 SDS- SUBSEQUENT MIN 21

�1

3100003 ENDO RM UP TO 1ST HR 3682

3100004 ENDO RECOVERY UP TO 1ST HR 710

3100005 CLIP RESOLUTION BOS SCI 404

3100006 BRUSH BRONCH CYTOLOGY 30

3110001 REM TUN INTRPERNEAL CATH 1254

3110002 MULTI LUMEN CVC KIT 850

3110003 PACU RECOVERY UP TO 1ST 30 MIN 710

3110004 PACU RECOVERY SUBSEQUENT MIN 15

3110005 PICC TRAY 130

3110006 MORPHEOUS PICC/NITINOL ALL SZS 150

3110007 36569 INSERT PICC >5 2507

3110008 FLUORO GUIDE VAD PLCMT/RMVL 783

3110009 ER LEVEL 5 (MOD 25) 2531

3110010 INCISION/REM FB SUBX CPLX 2894

3110011 INS CATH CV NON-TUNL >5YRS 2451

3110012 EGD W/PLACE G-TUBE 1242

3110013 TRIPLE LUMEN CATHETER 212

3110014 CONSCIOUS SED S/MD >5YR 1ST 30 1249

3110015 PERM A CATH TRAY 210

3110016 CATHETER FLEXIMA APD 181

3110017 SET DRAIN ABSC THALQUICK ALLSZ 258

3110018 FILTER VENA CAVA KIT DENALI 2250

3110019 XR ANGIOPLASTY VENOUS 5384

3110020 XR CHANGE TUBE/DRAINAGE CATH 1402

3110021 INS CATH CV TUNL W/O PORT >5YR 3092

3110022 REPL CATH CV TNL W/O PORT 3019

3110023 REMOVE CATH CV TUNL W/O PORT 2489

3110024 XR VENACAVAGRAM SVC 4062

3110025 CHG TUBE NEPHRO/PYELO 1348

3110026 XR INTRODUCTION LONG GI TUBE 467

3110027 INTRO TUBE GI LONG 1052

3110028 ANGIOPL TRNLM VENOUS PERC 2881

�2

3110029 PLEURAL DRAIN PERC W/ IMG LT 1480

3110030 RPLC GASTRO-JEJUN TB FLUORO 1304

3110031 CUFF ASHSPLIT ALL SZ 520

3110032 INS ENDOVAS VENA CAVA FILTR 5691

3110033 DVC TORQUE OLCOTT G13811 32

3110034 THSF-35-180-AUS-BH AMPLATZ 57

3110035 BASIC TRAY 63

3110036 TUBE FEEDING GASTRO MIC 16FR 83

3110037 ENDOTRACHEAL TUBE 128

3110038 SUCTION CANNISTER 129

3110039 TRACH TUBE SHILEY 129

3110040 SCD BOOTS REG 22

3110041 SUCTION SURGICAL 66

3110042 TUBE:SALEM SUMP 20

3110043 IV:RESTRICT FLOW SET 40

3110044 SUTURE MINOR PROCEDURE 50

3110045 DRESSING MINOR 45

3110046 ANESTHESIA 56

3110047 SUCTION CATHETER 45

3110048 PACKING VASELINE 45

3110050 US THORACENTESIS PREP 165

3110051 5 FR MICROPUNCT-NDL 58

3110052 CATH SCHON XL 15CM 189

3110053 TRIPLE LUMEN TRAY 139

3110054 US THORACENTESIS W/TUBE PREP 523

3110055 NEEDLE BIOPSY TROCAR 23

3110056 CT DRAINAGE PREP 410

3110057 FILTER TRAY 200

3110058 TSFB-35-145-BH-BENTSON 35

3110059 CHEST TUBE TRAY 231

3110060 DRAIN CHEST SYS SNG PLEUR-EVAC 67

3110061 DEVICE INFLATION ENCORE 420

�3

3110062 CATH ATLAS ALL SZ 1250

3110063 PERC NEPHROSTOMY TRAY 268

3110064 CATH MULTI-PURPOSE APD LOOP 181

3110065 PEEL AWAY SHEATH W/O WIRE GD 88

3110066 THSCF-35-145-1.5 BH ROSEN 35

3110067 TUNNELER ASH SPLIT CATH III 50

3110068 NASO-GASTRIC/JEJUNAL 8FR 36IN 23

3110069 ULTRA SEL 0.018IN 80CM NITINOL 130

3110070 INTRODUCER ACCUSTICK II KIT 179

3110071 ABSCESS DRAINAGE TRAY 158

3110072 DRESSING MAJOR 158

3110073 PACKING PLAIN 45

3110074 PULSAVAC IRRIGATION TIPS 72

3110075 ADAPTIC 57

3110076 NEEDLE 23

3110077 INJ PYELOGRAM 617

3110078 CHIBA NEEDLE 22G 8IN 37

3110079 RPLC DUODEN/JEJUN TB FLUORO 1304

3110080 INTRODUCER SHEATH PEELAWAY 18F 97

3110081 BOTTLE DRAINAGE ASEPT 1000ML 36

3110082 PMG-18SP 60 COPE NT MANDRIL 69

3110083 G-TUBE 20FR 61

3110084 THORACENTESIS W/TUBE TRAY 244

3110085 INJ AIR/CONTR PERITONEAL CAV 879

3110086 OR MINOR PROCEDURE 1800

3110087 URO:T.U.R. Y SET 158

3110088 TAGADERM/OP-SITE DRESSIN 57

311049 ELECTROCAUTERY PENCIL 87

3110089 FORCEP BIOPSY BOS SCI 120

3110090 PEG KIT GASTROTOMY 380

3110091 PORT A CATH TRAY 221

3110092 REMOVE TUNLD CVAD W/PUMP/PORT 2405

�4

3110093 5 FR STIFF MICROPUNCT KIT-NDL 91

3110094 INS TUNLD CVAD W/PORT >5YRS 5313

3110095 INJ CONTRAST ABSC/CYST 667

3110096 GW NITINOL 5FR 10CM COOK 104

3110098 EXCHG CATH ABSC/CYST DRAIN 2085

3110099 SUPRAPUBIC TUBE TRAY 289

3110100 CHG TUBE CYSTOSTOMY SMP 577

3110101 IV:EXTENSION SET 39

3110102 ABD PARACENTESIS W/ IMAGING 2694

3110103 LEAD, PACESETTER, ATRIAL 1250

3110105 RMVL NDWELLG TUN PLEURAL CATH 2960

3110106 VAS: GLIDEWIRE ANGLES .035 100

3110107 VAS:GUIDEWIRE .035 X 180 CM 25

3110108 INTRODUCER PACESETTER 171

3110109 POSEY WRIST RESTRAINTS 161

3110110 DRP:C-ARM 1013 45

3110111 STAPLER MULTIFIRE PREMIUM 35W 40

3110112 COOK DILATOR 14

3110113 URO:CUTTING LOOP ELECTRO 540

3110114 URO: BALL ELECTRODE 540

3110115 URO:CYSTOSCOPY SET 32

3110116 URO:DRAINAGE BAG & HOSE 66

3110117 IRRIGATION WATER 3000CC 148

3110118 CATH CONQUEST ALL SZ 578

3110119 DVC INFLATION PRESTO BARD 50

3110120 PLACE CATH AB/PEL/LW 1ST ORDER 2104

3110121 GLIDECATH B 95

3110122 CATH RENEGADE STC 790

3110123 XR ANGIO VISCERAL W/W/O FLUSH 4335

3110124 EMBOL/OCCL ART/VEN HEM/LYMPH 17685

3110125 XR ANGIO EA ADD VESSEL 2747

3110126 PLACE CATH AB/PEL/LW 2ND ORDER 3011

�5

3110127 TSFB-35-180-BH-BENTSON 43

3110128 CATH MIKAELSSON 27

3110129 COIL EMBOLIZ M0013120211V BS 145

3110130 COIL EMBOLIZ M0013822031/* BS 179

3110131 MERIDIAN HOSPITAL VISIT 20616

3110132 INTRO CATH VENA CAVA SUP/INF 1027

3110133 PACEMAKER ACCENT DR RF PM2210 10790

3110134 BIPOLAR CORD 92

3110135 BIPOLAR FORCEPS DISP/BAY 128

3110136 DEFIBRILATOR PAD ADLT 34

3110137 NASAL CANNULA 23

3110138 PACM: ELA CABLES DISP 99

3110139 STERI STRIPS 36

3110140 BX MUSCLE NEEDLE PERC 2592

3110141 ASP FINE NDL W/IMAGING GUIDE 1233

3110142 US LIVER BIOPSY PREP 226

3110143 ACE BANDAGE 49

3110144 BAIR HUG UPER BODY QUILT 99

3110145 GIGLI SAW 233

3110146 SUTURE MAJOR PROCEDURE 129

3110147 TELFA 23

3110148 ADH BARRIER SEPRAFILM 538

3110149 SUTURE KIT SUTURE BUTTON 25

3110150 EZ CLION NEEDLE ELECTROD 32

3110151 SURE FIT COLOSTOMY BAG 158

3110152 AUT SUT:MULTIFIRE RELOAD 496

3110153 CONNECTING TUBE 12' 20

3110154 TRANSCTH PL INTRV STNT 1STVEIN 18293

3110155 INS TUNNELED IPER CATHETER 4050

3110156 CATH KIT PLEURX PERITONEAL 1100

3110157 PLEURX PATIENT STARTER KIT 546

3110158 REPL CATH CV NON-TNL W/O PORT 2056

�6

3110159 CATHETER SUCTION BALLARD 37

3110160 TUBE CONNECTING CTUBE DRAINAGE 21

3110161 REMOVE BIL DRN CATH PERC FLUOR 1971

3110162 OR SUBSEQUENT MIN 24

3110163 IMP:EBI BONE STIMULATOR 9791

3110164 SURGICAL PROCEDURE 357

3200001 OXYGEN PER HOUR 32.15

3200002 PATROL ENT PUMP SET W/PIN 8.35

3200003 PRIMARY IV SET 60GTT/ML 12.56

3200004 DRESSING ADAPTIC 3X8 16.45

3200005 DRESSING WOUND VAC/MED 202.91

3200006 TRAY, CATH FOLEY 14FR 56.78

3200007 CONNECTOR, Y 16.7

3200008 BAG, FEED COMPLETE 9

3200009 BAG, DRAINAGE URINARY 21.71

3200010 TAPE MICROPORE 2" 5

3200011 SET SOLUTION DUO VENT 76" 8.35

3200012 SPONGE ALL PURP 4X4 STRL 30

3200013 TEXAS CATH MED 7.5

3200014 TRAY FOLEY CATH 16FR 66.24

3200015 TEXAS CATH LG 7.5

3200016 OSTOMY WAFER NAT 57MM 2 11.18

3200017 OSTOMY POUCH 57MM 2 1/4 4.5

3200018 UNDERPAD BREATHABLE 6.68

3200019 TEGASORB OVAL DRESS SM 20.2

3200020 ORA SWAB PREMOISTENED 4.5

3200021 NO STING SPRAY .5OZ 42.5

3200022 TOOMEY SYS 60CC CATH TIP 1.81

3200023 SYRINGE, IRRIGATION 10.02

3200024 EAKIN WOUND SEAL SM 10

3200025 VERSA DRESSING 5.5X5.5 36.83

3200026 DUODERM SIGNAL 3X3 33.4

�7

3200027 SAF-CLENS AF DERMAL WN S 45.09

3200028 VERSA DRESSING 3.5X3.5 51.61

3200029 ALEO VESTA 2N1 ANTFUN2OZ 33.4

32000297 CATH CENTRAL VENOUSLUMEN 85

3200030 PROTECTOR HEEL/ANKLE 17.5

3200031 DEBRIDEMENT KIT 80

3200032 SET, SUTURE REMOVAL 20.88

3200033 TRAY, IRRIGATION 32.57

3200034 FECAL BAG 35.91

3200035 CATH ROBERTS UTERINE ART 40.08

3200036 INJECTION SITE 12.53

3200037 ELECTRODE, QUICK-COMBO 232.97

3200038 TRAY, WOUND CLOSURE 25.05

3200039 STERILE WATER 1000ML BOT 13.36

3200040 SCALPEL #10 10.02

3200041 NG SECUREMENT DEVICE 10

3200042 LOPEZ VALVE 14.13

3200043 FLEXI SEAL FECAL BAG 33.4

3200044 DRSNG SQ TEGASORB 5.5X5.5 56.78

3200045 FLEXI-SEAL KIT 1377.75

3200046 STERILE SALINE CUPS 0.9% 1.86

3200047 CATH LEG STRAPS 20.2

3200048 SOLUTION SET 3 PORT 109" 10.39

3200049 DAILY IV SOLUTION CHNG 40.08

3200050 3M TEGADERM DRSG HEEL 43.42

3200051 I O BAN DRESSING 30.35

3200052 Hot Pack 2.56

3200053 Cold Pack 2.46

3200054 STOMA PASTE 30.06

3200055 G- TUBE TRAY 194

3200056 DIAPERS X-LARGE 6.02

3200057 SHAMPOO CAPS 15.03

�8

3200058 MEDI HONEY TUBE & APPLICA 71.5

3200059 MEDI HONEY 2X2 DRESSINGEA 23.5

3200060 DRESSING MEPILEX AG 4X8 111




3200064 DRESSING BORDER 10X10 23

3200065 DRESSING BORDER 7.5X7.5 33

3200066 DRESSING MEPILEX BORDER S 78

3200067 HI-FLO 3 WAY 3.43

3200068 ADAPTER IV CANNULA 68.47

3200069 DRESSING, PRISMA 150

3200070 GASTROSTOMY FEED TUBE 20F 582.42

3200071 HEEL WEDGE HEALING SHOE 145.29

3200072 FREEDOM SPLINT 145.5

3200073 DRSG PRISMA MATRIX SM 4" 66.8

3200074 DRSG PRISMA MATRIX LG 19" 171.25

3200075 YANKAUER 43.42

3200076 CATH SECURE STATLOCK 20

3200077 HEAD SUPPORT SLING 167

3200078 MIST KIT 250

3200079 PLUER EVAC ADULT DRY 150

3200080 FOLEY CATH 18FR 62.5

3200081 FOLEY CATH #16FR 62.5

3200082 Abdominal Binder 52.5

3200083 VACUTAINER W/LUER ADAPT 7.5

3200084 ANGIOCATH INSYTE 22GX1 7.5

3200085 ANGIOCATH INSYTE 20GX1 10

3200086 EXTENTION SET INTERLINK 17.5

3200087 IV CATHETER 12.5

3200088 HYPERAL FILTER CLEARLINK 17.5

3200089 CHLORAPREP APPLICATOR 10

�9

3200090 BLOOD ADMINISTRATION SET 17.5

3200091 J-LOOP CONN CLEARLINK 15

3200092 SET CLEARLINK VENTED 17.5

3200093 TUBING IV PRIMARY 17.5

3200094 TUBING IV SECONDARY 7.5

3200095 BACTERIA PLUS ANAEROBIC 40

3200096 BACTERIA PLUS AEROBIC 40

3200097 BAG FECAL COLLECTION 27.5

3200098 OSTOMY POUCH DRAIN 70MM 12.5

3200099 OSTOMY WAFER 70MM 12.5

3200100 IV SOL D5 45 2B1073Q 500M 7.5

3200101 IV SOL D5 9 2B1063 500ML 7.5

3200102 IV SOL D5 H20 2B0087 100M 7.5

3200103 IV SOL .9NACL 2B1323 500M 7.5

3200104 IV SOL.45NACL 2B131Q 500M 7.5

3200105 IV SOL.9NACL 2B1322Q 250M 7.5

3200106 IV SOL D5 H20 2B0086 50ML 7.5

3200107 IV SOL.9NACL 2B1306 50ML 4.5

3200108 IV SOL.9NACL 2B1307 100ML 4.5

3200109 IV SOL.45NACL 2B1314 IL 7.5

3200110 IV SOL 5.9NACL 2B1064 7.5

3200111 IV SOL D10 H20 2B0164 1L 7.5

3200112 IV SOL D5 45NACL 2B1074 4.5

3200113 IV SOL.9NACL 2B1324 1L 4.5

3200114 IV SOL D5.45NACL W20K 2B1 7.5

3200115 STRAIGHT CATH TRAY URETHR 17.5

3200116 IV SOL D5 H20 2B0063 500M 7.5

3200117 IV SOL D5/W 2B0062 1000ML 7.5

3200118 MITTS 70

3200120 KIT STERILE URINE 5

3200121 T PIECE W/DRAIN BAG 4.1

3200122 ADAPTER, Y PORT 37

�10

3200123 CATH KUMPE NGO DYNAM 27

3200124 Antiembolism Stocking 34

3200125 AQUACEL AG W/HYFIB D 4X4 105

3200126 AQUACEL AG ROPE 114

3200127 REPAIR CREAM 19

3200128 Z Float Boot 275

3200129 GW STIFF ANGLED ALL SZ 518

3200130 Z Float Positioner 195

3200131 THUMB ORTHOSIS BRACE 249

3200132 VERSA DRESSING 8X7 41

3200133 VERSA DRESSING 10X8 68

3200134 SYS ORAL QCARE CLEAN & SU 45

3200135 HALF DRAPE SHT 8

3200136 COLLECTION UNIT DRAINAGE 329

3200137 FOAM BELT/VITALGO BED 375

3200138 SURGICAL AQUACEL DRESSING 143

3200139 OSTOMY WATER 4.5M 7

3200140 OSTOMY WAFER 4.5M 9

3200141 GAUZE HYDROGEL 4X4 PKG 10

3200142 CH.12% KIT SUCTION TOOTHB 26

3200143 EPUMP SAFTY SCREW SPIKE S 30

3200144 PUMP SET KANGAROO 1000ML 46

3200145 EPUMP 1000ML SAFTEY SPIKE 46

3200146 PUMP 1000 ML FEED & FLUSH 57

3200147 KIT INDRODUCER MIC G-18FR 378

3200148 G-TUBE 18FR 61

3200149 PLEURX LINE SET LOCK 195

3200150 PLEURX VALUE CAP 55

3200151 CATH KIT STRIGHT 24

3200152 CUFF BP REG 25

3200153 MEPITAL DRESSING 3X4 26.25

3200154 MEPITAL DRESSING 2X3 39

�11

3200155 THERAPLUS TA ORTHOSIS 315

3200156 Chlorhexidine Gluconate 0.02

3200157 EXTENSION SET HOSPIRA DIA 35

3200158 PICC PLUSS 25

3200159 MAX PLUS CONNETOR 10

3200160 Sterile NSS Flush 3.4

3200161 PICC POWER DUAL LUMEN 425

3200162 GASTROGRAFIN PER ML 1

3200163 MINIMED INFISION LOW SORB 51

3200164 OXYGEN TRANSDUCER 30

3200165 COOK G10168 THSF-3580-AUS 44

3200166 TROCHAR DTN NDL15CM 24

3200167 DIGNICARE TUBES 2675

3200168 DIGNICARE BAGS 350

3200169 ELECTRODE EKG 12 27.5

3200170 Restraint 27.5

3200171 Emesis Basin 7.5

3200172 SHOROUD MORGUE BAG 35

3200173 CAVILON SPRAY SKIN 10

3200176 STAPLE REMOVER SKIN 17.5

3200177 SLIPPER BROWN LG 7.5

3200178 ORASWAB MOUTHCARE KIT 32.5

3200180 DRESSING TELFA 7.5

3200181 ABD PAS STERILE 7.5

3200182 GAUZE TOPPER 4X3 7.5

3200184 SPONGE DRAINAGE 7.5

3200185 SPONGE KERLIX 7.5

3200186 KLING WRAP BNDG 20

3200187 BASIN WASH 6QT 7.5

3200188 CVP DRESSING TRAY 22.5

3200189 BEDPAN FRACTURE DISPO 7.5

3200190 SPECI HAT 7.5

�12

3200191 IV PREP KIT 10

3200192 Ace Bandage 18

3200193 URINAL MALE DISPO 7.5

3200194 DRESSING TEGADERM 2X3 7.5

3200195 DRESSING TEGADERM 4X4 7.5

3200196 TEGAFORM DRESSING 25

3200197 DRESSING DUODERM 5X5 30

3200198 TEGASORB OVAL 32.5

3200199 DRESSING DUODERM 4X4 12.5

3200200 ENEMA BAG W/SOAP 12.5

3200201 CONTAINER SPECIMEN 7.5

3200202 Texas Catheter 7.5

3200203 ELECTRODE ADULT RED 37.5

3200204 BARRIER CREAM SKIN 27.5

3200205 CLEANSER SPRAY WOUND 37.5

3200206 URICULT 37.5

3200207 GAUZE VASELINE 3X9 7.5

3200208 BIOPATCH DRESSING 32.5

3200209 SERACULT SLIDE 7.5

3200211 SHILEY TRACH DCT 300

3200212 SHILEY TRACH DFEN 241.6

3200213 SHILEY TRACH CFS 233.2

3200214 SHILEY TRACH DCFN 233.2

3200215 SHILEY XLT PROXIMAL 400

3200216 SHILEY XLT DISTAL 33.35

3200217 SHILEY INNER CAC DIC-FEN 21.25

3200218 SHILEY INNER CAN DIC 16.05

3200219 SHILEY XLT INNER CAN 33.35

3200220 SHILEY DISP DECAN PLUG 220.4

3200221 SHILEY 15MM CAP 13

3200222 SHILEY SPEAKING VALVE 450

3200223 PORTEX TRACH DIC CUFF 360

�13

3200224 PORTEX DIC FEN CUFF 306.5

3200225 PORTEX INNER CAN DIC 375

3200226 BIVONA AIRECUF XLT 945

3200227 BIVONA TTS CUFFED 60

3200228 BIVONA FOME-CUF 660

3200229 OXISENSORS-FINGER 74.5

3200230 RESPIRONICS BIPAP CIRCUIT 60

3200231 BIPAP FULL FACE W/HEAD-S 28.1

3200232 BIPAP FULL FACE W/HEAD-M 67.5

3200233 BIPAP NASAL-S 61

3200234 BIPAP NASAL W/HEAD-L 61

3200235 BIPAP FACE NV-S 62.5

3200236 BIPAP FACE VENTED-M 60

3200237 OXYGEN CONNECTORS 74.55

3200238 VENT CIRCUIT HEATED 91.15

3200239 VENT CIRCUIT NON-HEATED 449.5

3200240 VENT CIRCUIT-TRANSPORT 24.5

3200241 OMNI/AIRLIFE FLEXTUBE 3.9

3200242 HME W/FLEX CONNECTOR 36.55

3200243 OXYGEN STEM WITH PLUG 3.25

3200244 BLUE ADAPTOR-S 4.05

3200245 BLUE ADAPTOR-L 1

3200246 CORR. TUBE ADAPTOR 1

3200247 VALVED TEE ADAPTOR 12.05

3200248 BAFFLED TEE ADAPTOR 0.85

3200249 BACTERIA FILTER AMERIVAC 4.9

3200250 AIRLIFE WATER TRAP 7.4

3200251 STYLET INTUBATION 12.7

3200252 NEBULIZER ADAPTOR CAP 17.15

3200253 DRESSING FOAM 3X3 18

3200254 OPTIFOAM DRESSINGS 13.9

3200255 BALLARD-ET TUBE W/DIRECT 49.9

�14

3200256 PASSYMUIR-PURPLE 316.25

3200257 PASSYMUIR-BLUE 316.25

3200258 AQUAPAK H20 W/NEB 37.45

3200259 AQUAPAK STERILE H20 37.45

3200260 CONCHA H20 STERILE 31.6

3200261 BACTERIAL FILTER FOR 7200 67.5

3200262 FLOW SENSORS 90

3200263 ABG KIT 6.4

3200264 BALLARD TRACH TUBE 49.9

3200265 AMBU BAG ADULT 43.05

3200266 SUCTION CATHETER 14FR 2.45

3200267 TRACH TUBE HOLDER 16.3

3200268 Incentive Spirometer 12.1

3200269 KIT TRACH CARE 3.4

3200270 MASK AEROSOL ADULT 4.65

3200271 Nonrebreather Mask 4.25

3200272 MASK TRACH ADULT 3.6

3200273 MASK VENTI 10.8

3200274 Nasal Cannula Adult 1.5

3200275 NEBULIZER HIGH FLOW 6

3200276 SOL SALINE 15ML 0.75

3200277 SPECIMEN TRAP SPUTUM 6.15

3200278 SUCTION CANNISTER LINER 5.85

3200279 SUCTION YANKAUER 27

3200280 TUBING 10 FEET 3

3200281 ENDOTRACHEAL TUBE 7.9

3200282 ENDOTRACHEAL TUBE HOLDER 150

3200283 BUBBLE HUMIDIFIER 6.55

3200284 EZ-CAP CO2 DETECTOR 47.35

3200285 NASAL OPTIFLOW 110

3200286 VENT CIRCUIT OPTIFLOW 117

3200287 CIRCUIT WO/PEEP 61

�15

3200288 ANTI-DISCONNECT DEVISE 20

3200289 BIPBP FACE VENTED-S 62.5

3200290 BIPBP FACE W/HEADPERF-L 76.5

3200291 CONCHA H2O W/COLUMNS 125

3200292 EAR PROTECTOR 17.8

3200293 HME EDITHTRACH 7

3200294 MDI SPACER 20

3200295 ORAL AIRWAY BAGGED 6.75

3200296 SHILEY TRACH DCFS 233.2

3200297 SPECIALTY CARE SYSTEM 13.25

3200298 THERAPEUTIC BATHING 25.75

3200299 4OZ FOAM CLEANSER 32.5

3200300 PICC 5FR SINGLE LUMEN 405

3200301 PRESSURE BAG 500ML 52.5

3200302 SALEM SUMP 18-16FR 25

3200303 TUBE SALEM SUMP 18FR 45.09

3200304 IMMOBILIZER ARM 690

3200305 FISTULA & WOUND POUCHES 43.5

3200306 IRR SOL.9 250ML BOTTLE 4.5

3200307 STERI STRIP 1/4 X 4 7.5

3200308 SPONGE GUAZE 2X2 8PLY 5.43

3200309 TUBING U CONNECT 2.06

3200310 250 ML STERILE WATER 5

3200311 BANDAGE UNNA BOOT 51.35

3200312 ENDOTRACH TUBE FASTENER 90.35

3200313 CATH BERNSTEIN 27

3200314 ANGIO TRAY 141

3200315 SFT PMR REST HAND SPLINT/SM RT 393.75

3200316 SFT PMR REST HAND SPLINT/MD RT 393.75

3200317 SFT PMR REST HAND SPLINT/LG RT 393.75

3200318 LARGE PALM PILLOW 678.75

3200319 PALM PROTECTOR SPLINT/LEFT 250

�16

3200320 PALM PROTECTOR SPLINT/RIGHT 250

3200321 ROYLAN PALM PROTECOR/RIGHT 146.25

3200322 ROYLAN PALM PROTECOR/LEFT 146.25

3200323 PLASTIC STACKING CONES/ LARGE 201.75

3200324 EASY GRIP PEG BOARD 110

3200325 5 STEP SEQUENCING CARDS 233.75

3200326 WKBK COGNITIVE SKILLS 583.75

3200327 GREEN WEIGHTED DYSPHAGIA CUP 113.75

3200328 STRESS BALL 4.6

3200329 MESH MINI STRESS BALL 2.71

3200330 aScope 3 slim 3.8 mm OD 1475

3200331 aScope 3 regular 5.0 mm OD 1475

3200332 aScope 3 Large 5.8 mm OD 1700

IRS-0097 Ascope 3 Slim 3.8 590

IRS-0098 Ascope 3 Regular 5.0 590

IWS-0051 Allevyn Dressing 4X4 4.7

IWS-0052 Allevyn Dessing 5X5 6

IWS-0053 Allevyn Dressing 6X6 7.05

IWS-0054 Allevyn Dressing 2x2 2.91



IWS-0057 Allevyn Dressing Sacrum 21.58

IWS-0058 TISSUE FORCEPS 5 (12.7cm) 22.2

IWS-0059 5MM DERMAL CURETTE 5.5

INC-0044 CUP 8OZ FOAM 0.06

IMS-0117 AIR & SURFACE SPRAY 2oZ 8.72

IMS-0118 ANGIOCATH INSYTE 18G 5.98

IMS-0119 ANGIOCATH INSYTE 24G 8.52

ISS-0092 NEEDLE BD ECLIPSE 25G 0.54

IMS-0120 Pure Wick 23.8

3200333 CATH:HORIZON PORTA CATH 578

3200334 VAS:DLP ARTERIOTOMY TIP 45

�17

3200335 VAS:VESSEL LOOPS 23

3200336 DRN:PENROSE 23

3200337 VAS:DLP SOFT SUCTION TIP 106

3200338 SUTURE MAJ VASCULAR PROC 240

3200339 ANES:LMA MASK DISPOSABLE 70

3200340 ORTHOGLASS SPLINT 3 & 4 82

3200341 DSG SURG AQUACEL AG 9CM 80

3200342 SHEET WADDING/SOFT ROLL 20

3200343 DRP:STERI #1040 32

3200344 SUCTION FRAZIER 87

IRS-0099 BREATHING BACTURA FLITER 6.88

IMS-0114 MIDLINE KIT 316

IMS-0121 GRIPPER PLUS NEEDLE 17.51

IRS-0094 OXIFLO Air Entrainer 74

IMS-0122 FOLEY CARE WIPES 6.1

3200345 SNAREMASTER BX/POLYP OLYMP 37

3200346 SNARE VASC LOOP 12MM-20MM 650

3200347 SNARE VASC LOOP 18MM-30MM 650

3200348 DILATOR SHEATH MIC-KEY 22FR 184

3200349 GELATIN SURGIFOAM POWDER 133

3200350 VIT:MEROCEL DRAIN POUCH 27

3200351 TUBE FEEDING JEJUNAL 45CM 22FR 429

3200352 CATH SLX HEMO LUMEN 14F 30CM 160

IPT-0020 MUG W/LID 76

IRS-0100 DISPOSABLE BLADES GHMAC2, 3, 4 16

IRS-0101 DISPOSABLE BLADES GHMIL2, 3, 4 16

IRS-0102 DISPOSABLE HANDLES GDHDLSTD 24

IRS-0103 BITE BLOCK 7.56

IRS-0104 VENT KITS 64

IRS-0105 TRACH KITS 74

IWS-0060 STERILE IRIS SCISSORS 6.48

IMS-0123 LEAF SENSOR 796

�18

IMS-0124 COMMODE 7 QUART 31.8

IMS-0125 TROCAR CATHETER KIT 104.08

IMS-0126 THORACENTESIS KIT 222.08

3400001 BUPIVACAINE 0.5% INJ 50ML 40

3400002 GENTAMICIN 80MG/2ML VIAL 14

3400003 HEPARIN INJ 1000 UNITS (5 18

3400004 LIDOCAINE 1% INJ 30ML 9

3400005 PROPOFOL 200 MG/20 ML IV 42

3400006 rOPINIROLE 2.51

3400007 Sodium Bicarbonate 0.07

3400008 SOD CHLORIDE 0.9% IV 100 36

3400009 SOD CHLORIDE 0.9% IV 1000 40

3400010 TACROLIMUS 1 MG CAP 4.46

3400011 THROMBIN 5000 UNITS T 260

3400012 OMNIPAQUE ORAL 350PER 1ML 1

34000123 Furosemide 0.28

3400013 INFLUENZA PF VACC INJ 3YR+ 25

3400014 TERAZOSIN HCL 5MG CAP 1.45

34000149 0.45% Sodium Chloride 0.01

3400015 ATENOLOL 25MG TABS UD^ 5.01

3400016 CALCIUM W/VIT D 500MG TA 0.1

3400017 CEPHALEXIN 250MG CAP 0.2

3400018 DIAZEPAM 5MG TABS 2

3400019 HALOPERIDOL 1MG TAB UD^ 0.49

3400020 HALOPERIDOL 5MG TABS^ 0.97

3400021 Mupirocin Ointment 0.51

34000214 Gentamicin Sulfate 0.67

3400022 NIFEREX 150 CAPS 0.28

3400023 Nystatin Ointment 0.88

3400024 SIMETHICONE CHEW TABS 80 0.09

3400025 ORAL CONTRAST 13

3400026 Aspirin 1.46

�19

3400027 AzaTHIOprine 1.44

3400028 CYPROHEPTADINE 4 MG TABLE 31.73

3400029 Ibuprofen 0.07

3400030 LIDOCAINE 1% 5ML SDV 23.38

3400031 LOSARTAN 25MG TAB 33.4

3400032 MONTELUKAST TAB 10MG 5.51

3400033 Citalopram Hydrobromide 2.69

3400034 HEPARIN/100U/ML 5ML FLUSH 5

3400035 PNEUMOCOCCAL VACCCINE POLYVALE 67

3400036 Ceftazidime 19.97

3400037 PAMIDRONATE 30MG INJ. 48

3400038 CYMBALTA 8.72

3400039 INJECTOR SUPPLIES 44

34000392 Atropine Sulfate 0.48

3400040 TRIAMCINOLONE ACET.1% CRM 0.28

3400041 CATAPRES-TTS 2 99.72

3400042 IODOSORB GEL 1.4 OZ (40GM 3.43

3400043 VISIPAQUE 320 PER ML 2

3400044 OMNI 350 PER ML 3

3400045 UGI LQD EZ PQE BRIUM SLFT SUSP 14

3400046 UGI CONTRASTEZ HD BARIUM SULFA 9

3400047 NADOLOL 20MG TABS 3.39

3400048 PENTASA 2.58

3400049 ACEPHEN 0.71

34000490 Ondansetron HCL - UD 24.78

3400050 Acetaminophen 0.06

3400051 TYLENOL 0.07

3400052 acetaZOLAMIDE 2.88

3400053 Acetylcysteine 2.49


3400055 Acidophilus/Pectin, Citrus 0.04

3400056 SANI-SUPP 0.43

�20

3400057 ADVAIR DISKUS 6.2


3400059 ALBUMIN-ZLB% 2.38

3400060 ALBUMIN-ZLB *100ML* 237.6

3400061 Albuterol Sulfate 0.8

3400062 ALOE VESTA% 28.8

3400063 ALOE VESTA 2-IN-1 AF 0.11

3400064 ALPHAGAN P 28.37

3400065 ALPRAZolam 0.76

3400066 ALPRAZolam 0.65

3400067 AMIODARONE HCL200MG TAB 3.29

34000676 KEPPRA *BRAND* 56.04

3400068 amLODIPine 2.37

3400069 amLODIPine 1.73

3400070 Ammonium Lactate Lotion 0.08

3400071 Ampicillin/Sulbactam 4.67

3400072 Ampicillin/Sulbactam 9.25

3400073 APLISOL 68.4

3400074 ARANESPMCG/0.5 ML 851.04

3400075 ARTIFICIAL TEARS% 0.29

3400076 Aspirin 0.02

3400077 Aspirin 0.05

3400078 Aspirin 0.02

3400079 AVELOX 33.25

3400080 Bacitracin 0.23

3400081 BACTROBAN NASAL 17.81

3400082 BISACODYL 5MG TAB 0.02

34000828 Ampicillin Sodium 2.95

3400083 BISACODYLMG 0.22

3400084 Bumetanide 2.02

3400085 Bumetanide 1mg/4mL vial 2.52

3400086 buPROPion HCL 1.06

�21

3400087 busPIRone HCL 2.02

34000878 Zosyn 16.32

3400090 Calcium Gluconate 0.65

3400091 CALMOSEPTINE 113GM 0.07

3400092 carBAMazepine 3.63

3400093 CARBIDOPA-LEVODOPA 25MG/1 0.6

3400094 Carvedilol 2.13

34000940 SEREVENT DISKUS 7.1


3400096 Bicalutamide 18.56

3400097 CATHFLO ACTIVASE 150.97

3400098 CEFAZOLIN SODIUMGRAM 1.91

34000981 Aranesp 1702.08

3400099 Cefepime 20.33

3400100 CEFEPIME HCLGRAM 40.36

34001000 EPINEPHrine 0.72

34001001 REBIF 1086.74

34001002 ABREVA 8.42

34001003 Acetic Acid 0.03

34001004 ALOE VESTA 2-IN-1 AF 0.06

34001005 AMMENS MEDICATED 0.01

34001006 Ammonium Lactate Cream 0.14

34001007 BACTROBAN *30GM* 6.14

34001008 Benzoin/Aloe Vera/Storax/Tolu 0.12

34001009 QUESTRAN PASTE 54.35

3400101 Ceftazidime 10.46

34001010 Parab/Cet Alc/Stryl Alc/Pg/Sls 0.02

34001011 Ciclopirox Olamine 1.88

34001012 Venlafaxine HCL 1.94

34001013 DAKIN'S- FULL STRENGTH% 0.02

34001014 DESONIDE .05% CRM 60GM 4.01

34001015 BENADRYL *CREAM* 0.15

�22

34001016 Ofloxacin 26.1

34001017 Magnesium Sulfate 0.01

34001018 Ethyl Chloride 0.36

34001019 EXACTACAIN 1.41

3400102 CefTRIAXone 46

34001020 Fluocinolone Acetonide Ointmen 2.25

34001021 Hydrogen Peroxide 3

34001022 Karaya Gum 0.18

34001023 Lidocaine/Prilocaine 2.5%-2.5% 1.7

34001024 Miconazole Nitrate 0.25

34001025 MONISTAT 1 *CREAM* 18.02

34001026 MONISTAT 7 2% CRM 45GM 0.21

34001027 NEOMYCIN-POLYMYXIN BMG-UN 15.94

34001028 NITRO-BID 1.29

34001029 NYSTATIN AND TRIAM CREAM 5.32

3400103 CEPACOL 0.18

34001030 POLYSPORIN 0.31

34001031 PREPARATION H 35

34001032 PROCTOSOL-HC *28GM* 3.08

34001033 REGRANEX 64.88

34001034 SCALACORT 3.28

34001035 SILVER NITRATE APPLICATOR 0.71

34001036 SURGILUBE 0.17

34001037 TERBINAFINE 1% TOP CRM 0.4

34001038 TRIAMCINOLONE AC 0.3

34001039 TRIPLE ANTIBIOTICMG-UNIT- 0.28


34001040 TUCKS 0.16

34001041 TUCKS TAKE-ALONGS 0.22

34001042 VASELINE JELLY PKT 5GM 0.06

34001043 Vits A & D/White Pet/Lanolin 0.05

34001044 XENADERM *60G* 1.11

�23

34001045 EXELON 4.6MG/24 HR PATCH 18.02

34001046 NICOTINE 14MG/24HR PTCH 2.13

34001047 NICOTINE PATCH 7MG 2.13


34001049 HUMALOG 26.72

3400105 TEARS RENEWED15ML OPTH 25

34001050 HUMALOG PEN 34.42

34001051 NOVOLIN 70-30 14.45

34001052 NOVOLOG PEN 34.53

34001053 Gentamicin In Nacl, Iso-Osm 5.36

34001054 Amikacin Sulfate 19.61

34001055 AMIKACIN SULF 2ML 500MG/ 9.8

34001056 AMPICILLIN 2MG VIAL 7.08

34001057 AZITHROMYCIN 10ML VL500MG 8.92

34001058 Cefotetan Disodium 46.16

34001059 Cefotetan Disodium 23.08

3400106 CIPRO I.V.MG/200 ML 3.54

34001060 CEFOXITIN SOD 1GM VAIL 7.2

34001061 ERAXIS 216


34001063 Nafcillin 14.6

34001064 OXACILLIN SODIUM 1GM 14.6

34001065 TEFLARO 192.28

34001066 OFLOXACIN .3% 5ML 4.19

34001067 TOBRAMYCIN-DEX OPTH DROP 26.17

34001068 ZYMAR *5ML* 17.42

34001069 VALCYTE 450MG TAB 84.23

3400107 CIPROFLOXACIN 250MG TAB 5.1

34001070 AMOXICILLIN 250MG CAP 0.25

34001071 AZITHROMYCIN 250MG TAB 7.78

34001072 Cefpodoxime Proxetil 8.46

34001073 CEFUROXIIME 250MG TAB 4.39

�24

34001074 CILOXAN 60.09

34001075 CLINDAMYCIN 150MG CAP 0.63

34001076 Demeclocycline HCL 10.63

34001077 VIBRAMYCIN 28.99

34001078 EPIVIR 0.55

34001079 LamiVUDine 14.32

3400108 CIPROFLOXACIN HCL *UD*MG 5.46

34001080 ERYTHROMYCIN BASE 250MG T 10.66

34001081 Famciclovir 6.32

34001082 Famciclovir 12.69

34001083 Fluconazole 14.01

34001084 Itraconazole 8.91

34001085 SUSTIVA 11.24

34001086 SUSTIVA 33.73

34001087 TRUVADA 54.87

34001088 ValACYclovir HCL 3.97

34001089 VIRAMUNE 14.35

3400109 Ciprofloxacin HCL 9.46

34001090 Ziagen 11.17

34001091 ZYVOX *ORAL SOL* 6.8

34001092 CIPRODEX 28.08

34001093 DENAVIR 1% 2GM 162.83

34001094 Morphine Sulfate 2.26

34001095 HYDROmorphone VIAL (DO NOT USE 2.12

34001096 Ketorolac Tromethamine 2.06

34001097 Acetaminophen With Codeine 0.36

34001098 CARISOPRODOL350MG TAB 0.71

34001099 celeBREX 6.15

3400110 CLEOCIN PHOSPHATE IN D5WM 20.93

34001100 celeBREX 10.09

34001101 HYDROcodone/Acetaminophen 2.14


�25


34001104 LYRICA 6.31

34001105 LYRICA 50MG CAPS 6.94

34001106 MELOXICAM 15MG 4.79

34001107 Morphine Oral Solution 0.08

34001108 Morphine Sulfate - Immed Relea 0.27

34001109 Morphine Sulfate - Extended Re 5.32

3400111 Clonazepam 0.8

34001110 Morphine Sulfate - Extended Re 1.68

34001111 MORPHINE SULFATE *2MG/1ML ORAL 0.4

34001112 Oxycodone HCL - Immediate Rele 3.59

34001113 Oxycodone HCL 7.29

34001114 Oxycodone HCL/Acetaminophen 3.57

34001115 Paregoric 0.66

34001116 SKELAXIN 800MG TAB 7.77

34001117 BENGAY VANISHING SCENT 0.07

34001118 CAPSAICIN .025% CREAM 0.28

34001119 VOLTAREN 0.54

3400112 CLONIDINE 0.1 MG TAB 0.22

34001120 Dextrose 10 % In Water 6.3

34001121 Dextrose 10% In Water 6.3


34001123 Multivitamin w/minerals 0.01

34001124 Dextrose 5%/0.3% Sodium Chlori 6.3


34001126 SODIUM CHLORIDEMEQ/ML 0.18

34001127 0.9 % Sodium Chloride 1.76


34001129 Sodium Chloride 3% 6.54

3400113 Clotrimazole 1 % Cream 0.29


34001131 SOD CHL 9% 200ML 10

�26



34001134 VERSED *PREMIX* 58

34001135 DOBUTamine 1000mg/250ml D5W 19.8

34001136 DOPamine 400mg/250ml D5W 14.62

34001137 DOPamine 800mg/500ml D5W 23.72

34001138 Heparin Sodium/0.45% Nacl 8.41

34001139 Lidocaine HCL/D5W 0.03

3400114 COMBIVENT *14.7GM* 17.66

34001140 M.V.I. ADULT *10ML* 0.91

34001141 NEOSTIGMINE METH 10ML MDV 1.71

34001142 AZACTAM 500MG/50ML *PREMIX* 195

34001143 CIPRO I.V.MG/100 ML 2.87

34001144 CLEOCIN-D5W 25.57

34001145 CLEOCIN-D5W 13.67

34001146 COLYMYCIN *PREMIX* 285

34001147 Fluconazole/D5W 16.03

34001148 Fluconazole/NS 56.85

34001149 GENTAMICIN 60 MG/150ML 5.75

3400115 CYMBALTA 8.72

34001150 TOBRAMYCIN SULFATE *100MG PREM 25


34001154 ADVAIR HFA 40.75

34001156 PROCHLORPERAZINE EDISYLATE 2.76

34001157 BENZTROPINE MESYLATE (COGENTIN 395

34001158 DIGIFAB 3052.8

34001159 Fosphenytoin Sodium 4.65

3400116 DAKINS HALF STRN.25%480ML 0.02

34001160 PROCAINAMIDE HCL 17

34001161 BACITRACIN-POLYMYXIN 1.34

34001162 Dextroamphetamine Sulfate 6.87

34001163 DOXEPIN HCL 10 MG CAPSULE 17

�27

34001164 FLUVOXAMINE TAB 100MG 23

34001165 Citric Acid/Sodium Citrate 0.07

34001166 Diltiazem HCL 2.88

34001167 KLOR-CON 10 0.65

34001168 MESTINON 2.5

34001169 PROPRANOLOL 40 MG TAB 25

3400117 DAKIN'S- 1/4 STRENGTH% 0.02

34001170 RENAL CAPS 0.67

34001171 VITAMIN A 10K (10,000U) 0.02

34001172 RELISTOR 144.12

34001173 A & D BARRIER 0.3


34001175 VIMPAT *IV* 84.82

34001176 VIMPAT 13.24

34001177 Doxepin HCL 1.65

34001178 FluvoxaMINE Maleate 2.63

34001179 Propranolol HCL 0.41

3400118 Earwax Treatment 0.17

34001180 POLYCIN OPTHALMIC OINTMENT 7.46

34001181 Levofloxacin 8.4

34001182 CALCIDOL 1.66

34001183 ELIQUIS 6.3

34001184 K-PHOS ORIGINAL 0.56

34001185 OCUVITE 0.08

34001186 TRIAMTERENE-HCTZ 0.45

34001187 ALTEPLASE 1MG IN (50X) 117

34001188 SOD CHLORIDE 0.9% IV 50 ML 34

34001189 IBUPROFEN 600 MG TAB 3

3400119 Dexamethasone Sod Phosphate 2.64

34001190 MIDAZOLAM INJ 1MG (2X) 15

34001191 CEFAZOLIN INJ 500MG (2X) 17

34001192 CEFTRIAXONE IVPB 250MG (4X) 30

�28

34001193 DIPHENHYDRAMINE 50MG/ML INJ 21

34001194 FENTANYL INJ 0.1MG (1X) 2

34001195 LACTATED RINGER IV SOL 1000ML 34

34001196 MORPHINE 2 MG/1 ML INJ 27

34001197 SUCCINYLCHOLINE INJ 20MG(10X) 27

34001198 FENTANYL 100MCG/2ML (ANES) 4

34001199 PROPOFOL 10MG INJ (20X) 0.74


34001200 LIDOCAINE 1% INJ 10ML 32

34001201 ROCURONIUM 100 MG/10 ML IV SOL 61

34001202 LIDO 1%-EPI 1:100,000 INJ 20ML 14

34001203 SOD BICARBONATE 8.4% IV 500ML 26

34001204 Omega-3 Fatty Acids 0.08

34001205 LEVOFLOXACIN IV 250MG (2X) 42

34001206 CLINDAMYCIN 300MG IVPB INJ 2X 27

34001207 PANTOPRAZOLE 40 MG IV INJ 25

34001208 PIPERCIL/TAZOBA INF 1.125G-3X 26

34001209 KETAMINE 500 MG/10ML INJ SOL 27

3400121 Dextrose 5%/0.45% Sodium Chlor 5.03

34001210 GLYCOPYRROLAT 0.2MG/ML 2ML INJ 64

34001211 EPHEDRINE 50 MG/1 ML INJECT 27

34001212 PHENYLEPHRINE 10 MG/1 ML INJ 30

3400122 Dextrose 5% NS + KCL 40 meq 8.39

3400123 DICYCLOMINE HCL *UD*MG 0.27

3400124 Digoxin 6.6

3400125 Digoxin (Lanoxin) 2.3

3400126 Digoxin 1.9

3400127 Digoxin 0.86



3400130 Diltiazem VIAL for drip (DO NO 0.28

3400131 Diltiazem HCL 1

�29


3400133 Diltiazem VIAL FOR BOLUS 0.52

3400134 DIOVANMG 6.66

3400135 diphenhydrAMINE HCL 0.08

34001354 Dorzolamide HCL/Timolol Maleat 122.6

3400136 Diphenhydramine HCL 3.3

3400137 DOBUTamine 500mg/250ml D5W 15.02

3400138 Docusate capsule 0.17

3400139 Docusate Sodium 0.7

3400140 EAR WAX DROPS 0.17

3400141 ENALAPRIL MALEATEMG 1.94

3400142 ENALAPRIL MALEATE *UD*MG 1.85

3400143 ENEMA 0.01

3400144 FAMOTIDINEMG/2 ML 1.08

3400145 FAMOTIDINE 20MG TAB 1.74

3400146 Fentanyl 14.43

3400147 Fentanyl 26.38

34001475 ONFI 21.97

3400148 Ferrous Sulfate 0.03

3400149 Finasteride 3.13

3400150 FLORASTOR 0.93

3400151 FLOVENT HFA *12G* 19.28



3400154 Fluconazole/D5W 14.51

3400155 FOLIC ACIDMG 0.08

34001554 ULORIC 12.09

34001556 LEVEMIR 29.82

3400156 FOSRENOLMG 11.22

34001563 Diazepam 0.13

34001564 Benazepril HCL 1.05

34001565 UCERIS 58.69

�30

3400157 FUROSEMIDE 100MMG/ML ANSY 59

34001570 Ethambutol HCL - UD 1.56

34001571 DELZICOL 3.3

34001573 Amoxicillin 0.49

34001579 Cefazolin Sodium 1.68


34001580 ZOLOFT 1.07

34001581 3 IN 1 OINTMENT 0.91

34001582 Acyclovir 0.94

34001583 Fenofibrate 1.06

34001584 Ammonium Lactate 0.14

34001585 PONARIS NASAL EMOLLIENT 0.52

34001586 XELODA 47.38

34001587 Sotalol HCL 3.42

34001588 Microfibrillar Collagen 210.6

34001589 Phenobarbital 1.19


34001590 Phenol/Sodium Phenolate 0.01

34001591 Dantrolene Sodium 1.73

34001592 COMBIVENT RESPIMAT 103.48

34001593 Neo/Polymyx B Sulf/Dexameth 3.97

34001594 ZINACEF 13.8

34001595 XOPENEX 9.82

34001596 TEARS NATURALE - II 9.54

34001597 Ganciclovir Sodium 97.27

34001598 KLOR-CON-EF 1.25

34001599 Verapamil HCL ER 1.07


34001601 Sulfasalazine 0.24

34001604 Metformin ER 1.34

34001605 Levobunolol HCL 24.18

34001606 Trifluridine 178.28

�31

34001607 Cabergoline 36.66

34001608 acetaZOLAMIDE ER 4.89



34001610 CLINIMIX 4.25/5 37.8

34001611 Gentian Violet 0.05


34001614 K-PHOS NO.2 0.92

34001615 Cetirizine HCL 0.39

34001616 Ketamine 0.99

34001617 Modafinil 33.33

34001618 Sodium Chloride 12.11

34001619 Rivastigmine 18.02

3400162 FUROSEMIDE *UD*MG 0.88

34001621 Levocarnitine 0.29

34001622 Carbidopa/Levodopa - UD 0.93

34001623 SOL CARB 0.02

34001624 ARALAST NP 0.61

34001625 Fluorometholone 148.26

34001626 Hydroxyurea 1.47

34001627 Promethazine HCL 1.03

34001628 Lidocaine-Hydrocortisone 3%-1% 181.38

34001629 Clozapine 0.5

3400163 Gabapentin 2.42

34001630 Fosfomycin Tromethamine 72.61

34001631 Nitroglycerin 0.1mg/hr Patch 2.56

34001632 BICILLIN L-A 386.96

34001634 Disopyramide Phosphate 2.86

34001635 Medroxyprogesterone Acetate 0.31

3400164 GABAPENTIN *UD*MG 0.58

34001640 Enoxaparin Sodium 121.97

34001641 SOLU-MEDROL 34.09

�32

34001643 Guaifenesin/Dextromethorphan 0.53

34001644 Liothyronine Sodium 0.81

34001645 PREPARATION H 0.58

34001646 PANCREASE 0.86

34001647 Bethanechol Chloride 1.78

34001649 Calcium Glubionate 0.04


34001650 FIBER-LAX 0.12

34001651 CREON 1.53

34001652 Coenzyme Q10 (Ubidecarenone) 1.78

34001653 Ipratropium Bromide 6.38

34001654 Zonisamide 2.19

34001657 Diclofenac Sodium 0.1% Ophth d 14.61

34001658 Phenazopyridine HCL - UD 0.51

34001659 Insta-Char 7.62

3400166 GENTAMICIN SULF IN NS/50M 4.38

34001660 Naphazoline HCL/Pheniramine 0.66

34001662 CLINIMIX 4.25/10 0.03

34001664 SELSUN BLUE 0.02

34001665 DEPACON 31.75

34001666 TRILEPTAL 5.41

34001667 KEPPRA *GENERIC* 3.57

34001668 Silver/Hydrocolloid Dressing 40.97

34001669 Desmopressin Acetate 7.62

3400167 GENTAMICIN SUL.3%DROP5ML 8.57

34001670 Amitriptyline HCL 0.32

34001671 Dantrolene Sodium 1.07

34001672 Rifabutin 17.49

34001674 DEPAKOTE SPRINKLE 2.16

34001675 Pioglitazone HCL 7.01

34001676 Chlorothiazide Sodium 238.8

34001677 C-Gentamicin/Nystatin/Mupiroci 0.88

�33

34001678 Aliskiren Hemifumarate 5.47

34001679 Granulex 0.17

3400168 HALOPERIDOL LACTATEMG/ML 7.19

34001680 Gentamicin Sulfate 2.19

34001682 cycloSPORINE, Modified 1.38

34001683 Morphine VIAL (DO NOT USE) 0.82

34001685 Venelex Ointment 0.63

34001686 CLINIMIX E 4.25/5 (AA/D5W/Lyte 45.12

34001687 Pseudoephedrine HCL 0.1

34001688 VANCOCIN 34.82

3400169 HECTOROL 7.5

34001690 Propylthiouracil 0.9

34001691 Opium Tincture 6.27

34001692 Viokace 3.21

3400170 Heparin Sodium 4.99



3400173 HYDROCERIN 120GM CRM 0.04

3400174 Hydrochlorothiazide 0.08

3400175 Hydrocortisone cream 0.11

3400176 HYDROmorphone HCL 3.07

3400177 HYDROmorphone HCL 3.29

3400178 Hydromorphone HCL 0.48

3400179 Ibuprofen 0.15

3400180 Ipratropium Bromide 0.53

3400181 Ipratropium/Albuterol Sulfate 0.74

3400182 JANUVIA 50MG TAB 13.22

3400183 Ketoconazole Shampoo 0.23

3400184 Ketoconazole Cream 1.74

3400185 LACTULOSE *UD*IGRAM/15 ML 0.03

3400186 LamoTRIgine 4.16

3400187 LANTUS 29.82

�34

3400188 Levofloxacin/D5w 8.4



3400191 LEVAQUIN *UD*MG 9.98

3400192 LEVOPHED 4.54

3400193 Levothyroxine Sodium 0.5







3400200 LEXAPRO 20MG TAB 4.51

3400201 LEXAPROMG 4.32

3400202 LEXAPRO 5MG TAB 4.14

3400203 Lidocaine HCL 5.11

3400204 Lidocaine Viscous 0.06

3400205 LIPITOR *UD* 8.01

3400206 LIPITOR 11.43

3400207 Lisinopril 0.64

3400208 LISINOPRIL10MG TAB 0.94

3400209 LOPERAMIDE *UD*MG 0.87

3400210 LORazepam 3.05

3400211 LORAZEPAM *UD*MG 0.91

3400212 LORAZEPAM 0.5MG TAB 0.7

3400213 LORAZEPAM 2MG TAB 1.32

3400214 LYRICA 25 MG CAP 6.31

3400215 MAG-AL*30ML* MAALOX 1.89

3400216 Magnesium Sulfate 0.83

3400217 Magnesium Sulfate/D5w 8.88

3400218 MEGESTROL ACETATEMG/10 ML 0.6

3400219 METFORMIN 500MG TAB 0.7

�35

3400220 METHYLPREDNISOLONE SS 40M 5.62

3400221 Methylprednisolone Sod Succ 10.75

3400222 METOCLOPRAMIDE HCLMG 0.4

3400223 Metoclopramide HCL 0.07

3400224 METOCLOPRAMIDE HCL *UD*MG 0.29

3400225 Metolazone 2.57

3400226 Metoprolol Tartrate 0.24

3400227 Metoprolol Tartrate 2.4

3400228 METOPROLOL 25MG TAB 0.24

3400229 METOPROLOL 50MG TAB 0.57

3400230 MetroNIDAZOLE 2.75

3400231 METRONIDAZOLE *UD*MG 0.83


3400233 MIDODRINE HCL *UD*MG 2.71

3400234 Magnesium Hydroxide 0.03

3400235 MINERAL OIL ENEMA 135ML 0.01


3400237 Morphine Sulfate/D5w/Pf 10.44

3400238 Multivitamin (MVI) Tablet 0.02

3400239 Nafcillin 28.32

3400240 NASONEX *17G* 15.24

3400241 NITRO-BID OINT2% PKTS 2.51

3400242 NITROGLYCERIN 0.2MG/HR PA 1.9

3400243 NITROGLYCERIN PATCH 0.6MG/HR 2.4

3400244 Nitrostat 0.61

3400245 NOREPINEPHRINE BITARTRATE 0.96

3400246 NOVOLIN N 14.45

3400247 NOVOLIN R 14.45

3400248 novoLOG 34.72

3400249 NOVOLOG MIX 70-30 27.81

3400250 Nystatin Cream 0.88

3400251 Nystatin 0.33

�36

3400252 NYSTOP Powder *30g* 1.79

3400253 Ondansetron HCL/Pf 2.1

3400254 ONDANSETRON HCL *UD*MG 148.68

3400255 OXcarbazepine 1.53

3400256 Oxycodone HCL/Acetaminophen 1.04

3400257 Phenazopyridine HCL 2.05

3400258 ROBINUL 0.39

3400259 PHENYLephrine vial 3.13

3400260 Phenytoin 1.73

3400261 Phenytoin Sodium 1.51

3400262 PHOSLOMG 0.84

3400263 PLAVIXMG 7.73

3400264 PNEUMOVAX 23 *0.5ML* 86.86

3400265 Potassium Chloride 3.22


3400267 POTASSIUM CHLORIDEMEQ 0.68

3400268 PRANDINMG 6.83

3400269 PREDNISONE 10MG TAB 0.23

3400270 predniSONE 1.35

3400271 PRIMAXINMG 20.82

3400272 PRIMAXINMG 39.18

3400273 PROCRIT 267.72

3400274 PROCRIT 20,000U/ML VIAL 535.44

3400275 PROCRIT 1070.88

3400276 Propofol 0.34

3400277 PROPRANOLOL HCL 60MG CAP 0.41

3400278 PROTONIX 10.96

3400279 PROTONIX 40MG IV 6

3400280 Modafinil 22.07

3400281 RAMIPRIL 2.5MG TAB 1.81

3400282 RENAGELMG 7.01

3400283 RISPERIDONEMG 3.89

�37

3400284 RISPERIDONEMG 4.56

3400285 SALINE MIST65%45ML 0.09

3400286 SENOKOT 0.08

3400287 QUEtiapine Fumarate 0.35

3400288 SEROQUELMG 27.09

3400289 SERTRALINE 25MG TAB 2.85

3400290 SIMVASTATINMG 4.92

3400291 SIMVASTATIN *UD*MG 2.79

3400292 Sodium Bicarbonate Syringe 10.39

3400293 SODIUM CHLORIDEGRAM 0.1

3400294 Sodium Phosphate MB-DB 0.33

3400295 SODIUM POLYSTYRENE SULFON 11.25

3400296 SOLU-CORTEFMG/2 ML 9.4

3400297 SOTALOLMG 2.42

3400298 SPIRONOLACTONE 25MG TAB 0.46

3400299 Sucralfate 0.86

3400300 SULFAMETHOXAZOLE-TRIMETHO 1.46

3400301 TEMAZEPAM *UD*15MGCAP 0.71

3400302 Theophylline Anhydrous 0.7

3400303 Silver Sulfadiazine cream 0.3

3400304 Timolol Maleate 2.8

3400305 Tobramycin Sulfate 0.88

3400306 TORSEMIDE 10MG TAB 0.7

3400307 traMADol HCL 0.8

3400308 TRANSDERM-SCOP 25.56

3400309 TRAZODONE HCL *UD*MG 0.44

3400310 TYGACIL 187.8

3400312 Vancomycin 8.4


3400314 VENOFER *5ML* 60

3400315 Thiamine HCL 0.04

3400316 Ascorbic Acid 0.05

�38

3400317 Cholecalciferol (Vitamin D3) 0.06

3400318 VITAMIN E *UD*UNIT 0.51

3400319 Phytonadione 37.69

3400320 Warfarin Sodium 0.66








3400328 XALATAN% 38

3400329 XOPENEX 3.27

3400330 XOPENEX 3.27

3400331 ZEMPLARMCG/ML 7.27

3400332 ZETIA *UD*MG 9.46

3400333 Zinc Sulfate 0.03

3400334 Zolpidem Tartrate 3.66

3400335 Piperacillin/Tazobactam 11.45

3400336 ZYVOX *UD*MG 204.08


3400338 MERREM 80.54

3400339 NITROFURANTOIN MACROCRYST 3.21

3400340 ZYVOX *300ML* 187.44

3400341 RESTORIL 7.5MG 15.74

3400342 COLCRYS *UD* 7.19

3400343 LIDODERM 5% PATCH 11.43

3400344 MIRTAZAPINE 15MG 2.72

3400345 TPN 750

3400346 THEOPHYLLINE80MG/15 12.52

3400347 PHOS-NAK 0.52

3400348 ARANESP 60 mcg 557.28

�39

3400349 DRONABIN 2,5MG 5.89

3400350 REFRESH 0.33

3400351 Timolol Maleate 3.25

3400352 SARNA *222ML* 0.04

3400353 SANTYL *30GM* 7.8


3400355 HYDRALAZINE HCL 50MG TABS 0.56

3400356 TUMS 500MG 0.02

3400357 OXYCONTIN 3.23

3400358 Oxycodone HCL - Immediate Rele 0.54

3400359 Peg 3350/Na Sulf,bicarb,cl/Kcl 82

3400360 CATAPRES-TTS 1 59.23

3400361 METAMUCIL *PACKETS* 0.41

3400362 METHADONE HCL10MG TAB 0.44

3400364 Budesonide 4.71

3400365 BACLOFEN 10MG TAB 0.56

3400366 Citalopram Hydrobromide 2.58

3400367 SODIUM CHLORIDE.9%250MLBA 12

3400368 ERYTHROCIN LACTOBIONATE 62.38


3400370 AVODART 6.72

3400371 TRICOR 48 MG TAB 2.95

3400372 SOD CHL 100ML W/VAIL MATE 15.5

3400373 MOUTHKOTE 0.05

3400374 PREVACID 13.35

3400375 ValACYclovir HCL 7.22

3400376 Sodium Bicarbonate 9.46

3400377 RESTASIS 7.77

3400378 Betamethasone Dipropionate 2.35

3400379 Glimepiride 1.08

3400380 PROCRIT *8,000 UNITS/0.4 ML* 630.25


�40

3400382 RENVELA 16.81

3400383 Codeine Sulfate 0.62

3400384 TOBREX .3% OPT OINT 3.5GM 60.09


3400386 Ursodiol 7.35


3400388 Milrinone Lactate/D5w 38.28

3400389 CARB-LEVO 25-250MG TAB 1.61

3400390 Chloral Hydrate 0.13

3400391 BISOPROLOL 5MG TAB 1.22

3400392 Fentanyl Citrate 18.8

3400393 VFEND 200MG TAB 88.45

3400394 CILOSTAZOL 100MG TAB 1.82


3400396 TAMSULOSIN HCL .4MG CAP 4.21

3400397 Acyclovir 2.55


3400399 PREMARIN 4.76

3400400 Torsemide 0.84

3400401 ANASTROZOLE 1MG TAB 13.48

3400402 DIFICID 200MG TAB 198.46


3400404 Donepezil HCL 7.79

3400405 EFFIENT 12.94

3400406 MEXILETINE HCL 150MG CAP 8.26


3400408 Midodrine HCL 4.84

3400409 Hydrocortisone 0.7


3400411 SIMVASTATIN 20MG TAB 1


3400413 DORZOLAMIDE-TIMOLOL2-0.5% 540

�41

3400414 Pilocarpine HCL 7.05

3400415 LISINOPRIL 5MG TAB 0.91


3400417 EXELON 1.5MG CAP 3.71

3400418 Cyanocobalamin (Vitamin B-12) 0.06

3400419 SYMBICORT 28.22

3400420 ANCEF *PREMIX* 5


3400422 ROPINIROLE 1 MG TAB 2.95

3400423 Tobramycin *** for inhalation* 2.03

3400424 BUMETANIDE 1MG TAB 0.41

3400425 VIMPAT 12.5

3400426 DETROL 4MG CAP 11.14

3400427 LevETIRAcetam 3.51

3400428 Ammonium Lactate 0.13

3400429 XIFAXAN 550MG TAB 33.62

3400430 QUETIAPINE 25MG TAB 4.5

3400431 BIOTENE 0.01

3400432 Chlorthalidone 1.32

3400433 BETHANECHOL CHL10MG TAB 2

3400434 CORTISPORIN 3.5GM OINT 18.59

3400435 BYSTOLIC 5MG TAB 3.78

3400436 NIFEdipine 2.3


3400438 INFUVITE 1.06

3400439 VFEND 200MG IV 10ML PWVL 179.03

3400440 AMIKACIN *PREMIX* 44

3400441 PEDIA-LAX 0.18

3400442 OxyCONTIN 18


3400444 CANCIDAS *PREMIX* 900

3400445 OxyCONTIN 14.61

�42


3400447 ZANTAC 0.39

3400448 EUCERIN 0.06

3400449 XARELTO 13.33


3400451 LATUDA 40MG TAB 33.55

3400452 Morphine Sulfate *sublingual u 0.84

3400453 Dextroamphetamine Sulfate 2.9

3400454 VICODIN 1.98

3400455 ESTRACE 6.78


3400457 DILAUDID *PCA 500* 825

3400458 Divalproex Sodium 1.12

3400459 TACLONEX 16

3400460 Betamethasone Valerate 1.2

3400461 ERYTHROMYCIN OINT3.5GM OP 5.33

3400462 SORIATANE 53.82

3400463 ADVAIR HFA 30.98

3400464 PULMICORT FLEXHALER 166.34

3400465 Omeprazole 3.9

3400466 ABILIFY 35.68

3400467 Carteolol HCL 4.26

3400468 Dextroamphetamine/Amphetamine 7.05

3400469 VESICARE 10MG 9.72

3400470 PRAVASTATIN SOD 40MG TAB 4.77

3400471 cycloSPORINE, Modified 5.99

3400472 Fexofenadine HCL 1.4

3400473 SSD 0.3

3400474 PHENobarbital Sodium 49.83

3400475 DILAUDID *UD* 1

3400476 ATROVENT HFA 24.18

3400477 DUREZOL 36.61

�43

3400478 PROAIR HFA 7.93

3400479 Mirtazapine 2.6

3400480 DILAUDID *PCA 30ML* 51

3400481 BENICAR 5.82

3400482 XARELTO 15MG TAB 13.33

3400483 CLINIMIX 4.25/25 35.23

3400484 OXYBUTYNIN CHLOR 5MG TAB 3.28

3400485 DALIRESP 500MCG TAB 10.32

3400486 CLINIMIX 4.25/10 66.42

3400487 ONFI 4.43

3400488 LIPOSYN 0.07

3400489 Losartan Potassium 1.68

3400490 CEREFOLIN 4.57

3400491 WOUNDRA COLLAGEN TUBE 0.22

3400492 PRADAXA 7.42

3400493 CLONIDINE HCL .3MG TAB 0.48

3400494 Quetiapine Fumarate 6.86

3400495 Dexamethasone 1.2

3400496 SELEGILINE HCL 5MG CAP 2.3

3400497 CYPROHEPTADINE 4MG TAB 1.07


3400499 Nicotine Polacrilex 0.6


3400501 Dexamethasone 0.42

3400502 MIDAZOLAM PF 1MG INJ 2

3400503 FENTANYL 100mcg/2ml INJ 4

3400504 BENZTROPINE MESYLATE INJ 72

3400505 FLUoxetine HCL 2.52


3400507 AZOPT 1% 30

3400508 COMBIGANO 2-0.5% 29.33

3400509 Polyethylene Glycol 3350 1.53

�44

3400510 HYDRALAZINE HCL20MG/ML 14.4

3400511 PRADAXA 7.42

3400512 Methadone HCL 0.32

3400513 BENADRYL 0.02

3400514 MONISTAT 3 200MG-2%SUPP 9.68

3400515 PROVENTIL HFA *6.7G* 11.6

3400516 GuaiFENesin 0.64

3400517 OMNISCAN-INJ. GADOLINIUM/ML 7

3400518 VASOLEX *60GM* 0.91

3400519 ABILIFY *5MG/5ML SYRINGE* 85

3400520 TOBRAMYCIN 0.3%OPTH SOL5M 2.94

3400521 MORPHINE SULFATE *10MG/5ML ORA 2

3400522 MORPHINE SULFATE *5MG/2.5ML OR 1

3400523 NOVOLIN R INSULIN DRIP *1U/ML* 25

3400524 DEXAMETHASONE SOD 2MG TAB 0.79

3400525 CefTRIAXone 90.39


3400527 BENZONATATE 100MG CAPS 0.34

3400528 DORZOLAMIDE HCL 2% OPTH 6.68

3400529 PREDNISOLONE ACETATE 15ML 10.56

3400530 Vancomycin HCL 57.77

3400531 REVATIO 20MB TAB 36.46

3400532 PREPARATION H SUPP 0.28

3400533 Olanzapine ODT 14.27

3400534 Doxazosin Mesylate 1.1

3400535 ARANESP 40 MCG/.4 ML 340.44

3400537 NEOMYCIN-POLYM-GRAMIC 6.19

3400538 SENSIPAR 30MG TAB 23.71

3400539 Verapamil HCL 0.62

3400540 CEFAZOLIN *PREMIX* 14

3400541 FentaNYL 20.3

3400542 SYMBICORT 32.32

�45


3400544 GuaiFENesin/Dextromethorphan 0.65

3400545 Verapamil HCL 1.44

3400546 Sulfamethoxazole/Trimethoprim 0.2

3400547 ERYPED 200MG/5ML 100ML 4.14

3400548 Dextrose 5% 0.45% NS + KCL 40m 9.08

3400549 CYCLOBENZAPRINE HCL5MGTAB 1.68

3400550 ABILIFY 35.68

3400551 ASACOL 2.18

3400552 NICOTINE PATCH 21MG/24 HR 2.13

3400553 Dextrose 5%/Lactated Ringers 5.09

3400554 CALMOSEPTINE 0.14

3400555 AK-POLY-BAC500-10000 U/GM 128.5

3400556 OCTREOTIDE ACETATE 50MCG/ 6.07

3400557 TRICOR 145 MG TAB 8.86

3400558 Hydromorphone HCL 2.5

3400559 Heparin Sodium/D5W 10.24

3400560 AFEDITAB CR 1.26

3400561 RIFAMPIN 300MG CAP 2.01

3400562 NIFEREX 150 PLUS 1.27

3400563 Fluconazole/NS 16.8

3400564 PANTOPRAZOLE SODIUM40MG T 21

3400565 Budesonide 5.54

3400566 AMOX TR-POTASSIUM CLAV875 5.05

3400567 PROCRIT **12,000 UNITS/ 0.6ML* 1089

3400568 Cholecalciferol (Vitamin D3) 0.03

3400569 TOPROL XL 2.16

3400570 CALAGESTIC 1-8% LOTION 0.02

3400571 TACROLIMUS ANHYDROUS .5MG 2.23

3400572 MYCOPHENOLATE MOFETIL250M 0.94

3400573 ARTIFICIAL TEAR ONIT 1.06

3400574 AVELOX 55.75

�46

3400575 Venlafaxine HCL 2.06

3400576 MERREM 40.27

3400577 Fentanyl 61.69

3400578 Amitriptyline HCL 0.64

3400579 Oxycodone HCL 3.51

3400580 Sulfamethoxazole/Trimethoprim 5.58

3400581 Acyclovir 26.59

3400582 CALCITRIOL.25MCG CAPS 1.28

3400583 GENTAK OPTH ONIT .3% 5.62

3400584 Cholestyramine 3.37

3400585 AQUAPHOR 50GM OINT 0.08

3400586 Pyridoxine HCL 0.02

3400587 JUVEN PKT 12.1

3400588 HEPARIN 10U/ML 3ML SYPRIN 4

3400589 HYDROGEN PEROXIDE 118ML B 3.5

3400590 SILVER NITRATE STICKS PKT 16.5

3400591 VIAL-MATE ADAPTER 12.25

3400592 AVITENE FLOUR 1GM PKT 865

3400593 FLUTICASONE 50 MCG/16MG I 5.27

3400594 LOVAZA 1MG CAP 2.91

3400595 TUSSIONEX 10MG/5ML LIQ 0.67

3400596 Clotrimazole 1% Vaginal Cram 4 0.18


3400598 Dextrose 5% NS + KCL 20meq 9.07

3400599 0.9% Sodium Chloride + KCL 40m 10.22

3400600 0.45% NS + KCL 20meq 6.73

3400601 Dextrose 5% water + KCL 20meq 3.02

3400602 0.9% Sodium Chloride + KCL 20m 9.07

3400603 Dextrose 5%-1/2NS+KCL 20meq 2.52

3400604 FORTICAL 27.81

3400605 Piperacillin/Tazobactam 17.18

3400606 HYDROCODONE/APAP 5/500MG 3

�47

3400607 DORIBAX 500MG VIAL 50.09

3400608 DIOVAN 40MG TAB 5.18


3400610 PRAVASTATIN 10MG TAB 2.89

3400611 HUMULIN N PEN 69.12

3400612 LANTUS SOLOSTAR PEN 66.17

3400613 LEVEMIR PEN 26.65

3400614 PROSOURCE 0.6

3400615 SPIRIVA HANDIHALER 12.63

3400616 Midazolam HCL/Pf 1.94

3400617 INVANZ 500MG *PREMIX* 347

3400618 CATAPRES-TTS 3 161.15

3400619 Acetaminophen 0.04

3400620 LEVAQUIN 250MG TAB*U* 8.71

3400621 Clonazepam 0.91


3400623 LORATADINE 10MG TABS 0.86

3400624 ISOSORBIDE MONO ER 30MG 0.52

3400625 TOPROL XL 25MG TABS 1.43


3400627 ARICEPT 18.42

3400628 MAG-OXIDE 400MG TABS 0.09

3400629 NAMENDA 10MG TAB UD 6.78

3400630 ENALAPRIL 2.5 MG TAB 1.46

3400631 ASPRIN EC 0.05

3400632 Diphenoxylate HCL/Atropine 0.7

3400633 ISOSIRBIDE DINITRATE 10M 1.08

3400634 METOLAZONE 2.5MG TABS 2.27

3400635 MUCINEX 0.49

3400636 NEPHRO-VITE TABLETS 0.17

3400637 Prednisone 0.25

3400638 TERAZOSIN HCL 1MG CAPS 1.61

�48

3400639 NITROGLYCERIN 0.4mg/hr Patch 2.17

3400640 GLIPIZIDE 5MG TABLET 0.37

3400641 Simethicone 0.24


3400643 AMOXICILLIN/POT CLAVULANA 3.78

3400644 HYDRALAZINE 10MG TABS 0.41

3400645 NEPHROCAPS 1MG 5.86

3400646 XIFAXAN 200MG TAB 17.64

3400647 PROCRIT *15,000 UNITS/0.75ML* 1354

3400648 Magnesium Citrate 1.99

3400649 acetaZOLAMIDE 43.8

3400650 CANCIDAS 50MG VIAL 1EA 405.25

3400651 Colistin 33.6

3400652 ARANESP 150 mcg 1393.2

3400653 AZACTAM 34.8

3400654 CUBICIN *PREMIX* 2272

3400655 POTASSIUM CHLORIDE40MEQ/1 3

3400656 PARoxetine HCL 2.73

3400657 AMPICILLIN SODIUM 2GM 9.53

3400658 Doxycycline Hyclate 2.76

3400659 CUBICIN 534.59

3400660 ZOSYN 4.5GN VL 136

3400661 Oxacillin Sodium 28.32

3400662 HYDROXYZINE HCL 25 MG TAB 0.39

3400663 FLUOXETINE HCL 20MG CAP 2.67

3400664 LABETALOL 100MG TAB 2.28

3400665 ALLOPURINOL 100MG TAB 0.38

3400666 Amantadine HCL 3.3

3400667 METFORMIN HCL850MG TAB 1.2

3400668 HYDROMORPHONE DRIP *PREMIX* 46


3400670 RENVELA 16.81

�49

3400671 ENALAPRILAT 2.5MG TAB 5

3400672 LEVETIRACETAM 500MG/5ML 39.86

3400673 Hydromorphone HCL/Pf 3.22

3400674 GUAOFENESIN SYR 5ML 0.6

3400675 Losartan Potassium 2.33

3400676 VENLAFAXINE 75MG TAB 2.18

3400677 VALPROIC ACID 10ML CUP 1.48

3400678 PILOCARPINE EYE DRP1%15ML 6.57

3400679 MEPHYTON 70.51

3400680 AZTREONAM 2GM VIAL 80.34

3400681 VALPROIC ACID SYP 250MG/5 0.75

3400682 BOUDREAUXS BUTT PAST 0.07

3400683 INVANZ 1GM 103.65

3400684 BRIMONIDINE TARTRATE .15% 22.88

3400685 LACRI-LUBE S.O.P. 2.9

3400686 Potassium Phosphate 0.33

3400687 MIACALCIN 1192.42

3400688 CYANOCOBALAMIN 1000 MCG T 1

3400689 CRESTOR 10MG TAB 8.64

3400690 BENGAY 0.06

3400691 CYMBALTA 7.78

3400692 TRAVATAN Z .004% DROP 60.56

3400693 FOLBIC 0.91


3400695 BROVANA 13.66

3400696 FLOVENT HFA *10.6GM* 16.3

3400697 FLOVENT HFA *12G* 29.94

3400698 Flunisolide 2.75

3400699 NEBUPENT 154.06

3400700 RAPHON 1.25

3400701 SEREVENT DISKUS 5.61

3400702 Sodium Chloride for Inhalation 0.06

�50


3400704 Lidocaine HCL/Pf 0.27


3400706 chlorproMAZINE HCL 23.04

3400707 FLUPHENAZINE DECANOATE 25 37.19

3400708 GEODON 20MG CAP 36.14

3400709 Haloperidol Decanoate 31.07

3400710 INVEGA SUSTENNA 1607.62

3400711 ZYPREXA 10MG VIAL 46.87

3400712 RECOMBIVAX HBMCG/ML 70.01

3400713 VASOPRESSINUNIT/ML20U 44.4

3400714 DIAZEPAM 10MG/2ML CARP 9.45

3400715 Divalproex Sodium 2.13

3400716 LORazepam VIAL (DO NOT USE) 1.11

3400717 LORazepam for IV Drip 0.81

3400718 Midazolam HCL 1.39

3400719 NORTRIPTYLINE HCL25MG CAP 0.88

3400720 VALPROATE SOD 500MG/5ML V 4.32

3400721 Adenosine 9.6

3400722 Adenosine 7.8

3400723 Albumin Human 0.33

3400724 Amiodarone vial (DO NOT USE) 0.95

3400725 Amiodarone vial for bolus 0.8

3400726 ARANESP 300MCG/.6ML 2553.12

3400727 ARANESP25MCG.42ML 212.76

3400728 ARANESP25MCG.42ML 753.35

3400729 Argatroban 250mg/250ml NS 1576.2


3400731 Bumetanide 10ml vial 0.6

3400732 Calcium Chloride 1.08

3400733 CARIMUNE NF NANOFILTEREDG 1212

3400734 CORTROSYN 127.9

�51

3400735 DANTRIUM 106.37

3400736 Deferoxamine Mesylate 15.54


3400738 DIGIFAB 727.91

3400739 Enalaprilat Dihydrate 3

3400740 FLUMAZENILMG/ML 1.56

3400741 Fosphenytoin Sodium 3.67


3400743 Furosemide 20mg vial 3.71

3400744 Furosemide 40mg vial 3.73

3400745 GLUCAGON EMERGENCY KITMG 258.54

3400746 GLYCOPYROLATE .2MG/ML MDV 16.15

3400747 HECTOROL 17.44

3400748 Heparin Sodium PF 1.1

3400749 Heparin Sodium PF 0.74

3400750 HydrOXYzine HCL 5.31

3400751 Lidocaine 2 gm/250ml D5W 8.89

3400752 MANNITOL 25% 12.5GM 0.04

3400753 MYCAMINE 224.4

3400754 NALOXONE HCL .4MG/ML 19

3400755 NEUPOGEN 300MCG/ML SDV 367.15

3400756 NEUPOGEN 619.74

3400757 NITROGLYCERIN/D5W/250ML 8.6

3400758 Phentolamine Mesylate 180

3400759 PLASBUMIN-5 *250ml* 0.23

3400760 Polymyxin B Sulfate 12

3400761 PROCRIT 107.09

3400762 PROCRIT *3,000 UNITS/0.15ML* 410

3400763 PROCRIT *14,000 UNITS/0.70ML* 1950

3400764 PROCRIT *25,000 UNITS/1.25ML* 2471

3400765 PROCRIT *30,000 UNITS/1.5ML* 2773

3400766 PROCRIT *5,500 UNITS/0.275ML* 594

�52

3400767 PROCRIT *7,000 UNITS/0.35 ML* 556

3400768 PROCRIT *7,500 UNITS/0.375ML* 1944

3400769 PROCRIT *5,000 UNITS/0.25ML* 462

3400770 PROCRIT *5,000 UNITS/0.5ML* 462

3400771 PROCRIT *6,000 UNITS/0.3ML* 267


3400773 SODIUM CHLORIDE% 0.14


3400775 EDECRIN 5520.73

3400776 SOD THIOSULFATE 25% IV 50 1.94

3400777 SOLU-CORTEF250MG/2ML 17.39

3400778 SOLU-MEDROL 4.81

3400779 RILUTEK 30.4

3400780 STERILE WATER FOR INJ 0.06

3400781 THIAMINE HCL 100 MG\ML VI 5.97

3400782 TORSEMIDE 10MG/ML SDV 12.88

3400783 VERAPAMIL HCL 80MG TAB 15.88

3400784 Azelastine HCL 3.51

3400785 Calcitonin,salmon,synthetic 32.04

3400786 Phenylephrine HCL 3.58

3400787 AK-PENTOLATE 1% 7.39

3400788 ALPHAGAN P 26.61


3400790 Bacitracin 19.81

3400791 BETOPTIC S 32.72

3400792 BROMDAY 120.44

3400793 Dorzolamide HCL/Timolol Maleat 6.75

3400794 DEXAMETHASONE 1% DROP 4.22

3400795 GENTEAL 15ML .3% OPTH 0.54

3400796 LUMIGAN .03% 2.5ML DROP 65.52

3400797 NEOM-BAC-POLY3.5MG EYEONT 15.79

3400798 NEOMYCIN/POLY/HC 18.86

�53

3400799 NEVANAC 90

3400800 REFRESH OPTIVE 0.72

3400801 PATANOL 0.1% DROPS 57

3400802 POLYTRIM 10ML BOTTLE 1.34

3400803 Prednicarbate 1.58

3400804 Sulfacetamide Sodium 4.07

3400805 TOBRADEX 0.3/0 1%OPTH OIN 67.15

3400806 TRAVATAN% 41.62

3400807 TROPICAMIDE .5% OPTH 1.78

3400808 EPLERENONE 25MG TAB 4.1

3400809 KETOCONAZOLEMG 3.16

3400810 ABILIFY 35.68

3400811 ARICEPT 18.42

3400812 BENZTROPINE 1MG TABLET 0.19



3400815 chlordiazePOXIDE HCL 0.39

3400816 chlorpromazine HCL 13.83

3400817 CHLORPROMAZINE HCL 9.56

3400818 Desipramine HCL 1.35

3400819 DOXEPIN HCL 25MG CAP 0.65

3400820 EFFEXOR XR 75MG TAB 4.08

3400821 FLUVOXAMINE MALEATE 50MG 2.57

3400822 Galantamine Hbr 4.22

3400823 ZIPRASIDONE HCL 20MG CAP 16.09

3400824 Haloperidol 0.35

3400825 Imipramine HCL 0.72

3400826 KEPPRA 1.6

3400827 LEXAPRO *2.5ML SYRINGE* 1.78

3400828 Lithium Citrate 1.44

3400829 LITHIUM CARBONATE 150MG 0.19

3400830 METHYLPHENIDATE 5MG TABL 0.74

�54


3400832 OXcarbazepine 2.75

3400833 PAXIL 1.19

3400834 PHENOBARBITALMG 0.53

3400835 PHENobarbital 0.19

3400836 Phenytoin 0.2

3400837 PHENYTOIN SODIUM EXTENDED 0.68

3400838 Sertraline HCL 1.12

3400839 SERTRALINE 100MG TAB 2.85

3400840 Temazepam 0.83

3400841 traZODone HCL 0.78

3400842 Valproate Sodium 0.11

3400843 Acarbose 1.03

3400844 ACETYLCYSTEINE 10% 100 MG 27

3400845 ACETYLCYSTEINE 20% 200 MG 33

3400846 Pioglitazone HCL 11.61

3400847 Acyclovir 3.67

3400848 AGGRENOX 7.69

3400849 Alpha Lipoic Acid 0.24

3400850 ATERNAGEL 600MG/5ML 0.02

3400851 AL HYDROXIDE30ML325MG/5ML 0.01

3400852 aMILoride 1.28

3400853 ARMOUR THYROID 90MG TAB 0.68

3400854 Atenolol 0.8

3400855 AVAPRO 150MG TAB 5.64

3400856 Balsalazide Disodium 1.6

3400857 BANATROL 0.92

3400858 BIDIL 3.52

3400859 BRILINTA *UD* 5.71

3400860 Bromocriptine Mesylate 3.75

3400861 Ergocalciferol (Vitamin D2) 3.44

3400862 CALCIUM ANTACID 750mg *UD* 0.04

�55

3400863 CALCIUM CITRACE 950MG 0.06

3400864 Captopril 1.56

3400865 Captopril 1.67


3400867 SINEMET 10-100MG TAB 1.15

3400868 C-BECLOMETHASONE 4ML ORAL SYRI 3

3400869 CELLCEPT 109.06

3400870 CHLOROTHIAZIDES 500MG TAB 1.24

3400871 cloNIDine HCL 0.32

3400872 Clotrimazole 1.61

3400873 NEOMYCIN OS 10

3400874 Ubidecarenone 0.7

3400875 COMTAN 200MG TAB 6.69

3400876 COREG CR 8.78

3400877 COREG CR 8.78

3400878 Cranberry Fruit 0.06

3400879 CREON 3

3400880 CREON 5.89

3400881 DANTROLENE SODIUM 2.17

3400882 Dapsone 1.06

3400883 DAPSONE 100MG TAB 1.3

3400884 Tolterodine Tartrate 3.31

3400885 FOLBEE PLUS 0.71



3400888 DIOVAN 6.19

3400889 DIPYRIDAMOLE 25MG TAB 0.39

3400890 COLACE 0.03

3400891 EDARBI 6.51

3400892 EDECRIN 25MG TAB 26.91

3400893 ENABLEX 7.5MG TAB 11.18

3400894 ENTOCORT EC 27.62

�56

3400895 EVISTA 7.92

3400896 FEMARA 28.08

3400897 FERATAB 60mg Elemental Iron 0.05


3400899 FLUODROCORTISONE 1MG TABS 0.75




3400903 WARFARIN 7.5MG TAB 5.61

3400904 GEMFIBROZIL 600 MG TAB 1.09

3400905 GLIPIZIDE XL 5MG TAB 0.41

3400906 Glyburide 0.53

3400907 GOLYTELY *4000ML* 0.01

3400908 GuaiFENesin 0.01

3400909 HYDROXYZINE HCL 10MG TAB 0.28

3400910 HYFIBER 0.26

3400911 Hyoscyamine Sulfate 0.56

3400912 Indomethacin 0.38

3400913 ISOSORBIDE DINITRATE 40MG 2.38

3400914 ISOSORBIDE MONONTRATE 10M 0.51

3400915 JANUVIA 13.22

3400916 LIPITOR *UD* 11.43

3400917 LUNESTA 14.9

3400918 MAG-AL PLUS *30ML* MYLANTA 2.78

3400919 MECLIZINE HCL 25 MG TABLE 0.87

3400920 MELATONIN 3MG TAB 0.07

3400921 MEPRON 34.76

3400922 METHENAMINE HIPPURATE 1GM 2.09

3400923 METHIMAZOLE 5MG TAB 0.44

3400924 DULEEK- DP 2.29

3400925 METHYLPREDNISOLONE 4MG T 1.43

3400926 METHYLPREDNISOLONE16MGTAB 3.11

�57


3400928 MIRAPEX .25MG TAB 6.63

3400929 Misoprostol 0.82

3400930 MULTAQ 400MG TAB 9.4

3400931 Nadolol 3.97

3400932 NATEGLINIDE 60MG TAB 1.95

3400933 NEORAL 9.29

3400934 NIACIN 250 MG TAB 0.03

3400935 Niacin 0.16

3400936 NICARDIPINE 20MG CAP 2.23

3400937 NIMODIPINE 30MG 18.41

3400938 NITROFURANTOIN MACRO 50MG 1.99

3400939 NUEDEXTA 13.18

3400940 NULLO 0.14

3400941 Ondansetron HCL 4.8

3400942 OXYBUTYNIN 10 MG SR TAB 3.29

3400943 MIRALAX PWD 17GR 0.5

3400944 Calcium Carbonate/Vitamin D3 0.08

3400945 OYSTER SHELL CAL 500MG TA 0.1

3400946 Pantoprazole Sodium 0.43

3400947 PEPCID 3.93

3400948 PHOSPHA 250 NEUTRAL 0.51

3400949 PEPTO-BISMOL 0.12

3400950 POLYCOSE 0.02


3400952 PRANDINMG 6.83

3400953 PREDNISOLONE LIQ 15MG/5ML 0.39


3400955 predniSONE 0.27

3400956 PRIMIDONE 50MG TAB 0.5

3400957 PRIMIDONE 250MG TAB 0.95

3400958 PROCARDIA 2.1

�58

3400959 PROCHLORPERAZINE MALEATE5 0.61

3400960 PROMETHAZINE HCL 12.5MG 0.49

3400961 Promethazine HCL/Codeine 0.08

3400962 PROPAFENONE 225MG HCL 2.33

3400963 PROPAFENONE 150MG TAB 1.64

3400964 PYRIDOSTIGMINE BROMIDE 60 1.28

3400965 RAMIPRIL CAP 1.25 MG 1.53

3400966 Ramipril 2.37

3400967 RANEXA 500MG TAB 5.53

3400968 RAPAMUNE 13.06

3400969 RILUTEX 50MG TAB 41.52

3400970 Robinul 7.72

3400971 SENOKOT 0.08

3400972 Citric Acid/Sodium Citrate 0.07

3400973 Terazosin HCL 1.61


3400975 TIZANIDINE HCL 4MG TABS 2.55

3400976 TOPAMAXMG 0.5

3400977 TOPIRAMATE 25MG TAB 2.55

3400978 VERAPAMIL HCL 120MG TAB 0.75

3400979 VERAPAMIL 80MG TABS UD 0.57


3400981 Pyridoxine HCL 0.05

3400982 Ascorbic Acid 0.04

3400983 VITAMIN D3 5000U TAB 0.38

3400984 Vitamin E 0.08

3400985 WELCHOL 625MG BOTTLE 3.13

3400986 ZEMPLAR 15.61

3400987 Zolpidem Tartrate 4.62

3400988 Antipyrine/Benzocaine/Glycerin 0.86

3400989 CANASA 1,000MG RECTAL SUP 32.62

3400990 COMPRO 25MG SUPP 12.58

�59

3400991 HYDROCORTISONE SUPP 14.43

3400992 COLOCORT 12.65

3400993 OCTREOTIDE ACE 100MCG/ML 11.93

3400994 ARIXTRA 196.31

3400995 ARIXTRA 261.75

3400996 ARIXTRA 5MG/.4ML.SYRN 392.62

3400997 BETASERON 457.56

3400998 ENBREL 980.4

3400999 EPINEPHrine pf 4.38

3401201 Swish and Swallow 0.46

3401202 Nystatin 0.18

3401560 Potassium Bicarbonate/Cit Ac 1.25

34001693 ELIGARD 493.2

34000928 Labetalol HCL 8.11

34001694 Vivonex RTF 7.09

34001695 Calcitriol 11.93

34001696 CLINIMIX E 4.25/10 49.85

34001699 Folic Acid 4.1

34001700 Loteprednol Etabonate 45.3

34001701 ZERBAXA 120.61

34001213 LIDOCAINE 1% PF SOL 5 ML INJ 7

34001704 Nifedical XL 1.36

34001706 Butalb/Acetaminophen/Caffeine 2.94

34001705 Fluzone 23.86

34001709 3-in-1 Ointment 50

34001708 Estradiol 22.1

34001713 Guaifenesin 0.41

34001716 Methylphenidate ER 16.46

34001559 Triple Paste 0.11

34005000 Magic Mouthwash -5ml 15

34005001 Magic Mouthwash #2 15

34000619 Neutra-Phos 0.49

�60

34001715 Atovaquone 6.56

34001718 Povidone-Iodine 0.01

34005002 novoLIN R INSULIN DRIP 0.01

34001553 Abilify 33.41

34000046 ARANESP *1ML* 510.6


34000291 Lamotrigine 4.75

34000410 Clotrimazole/Betamethasone Cre 1.42

34000422 Dextrose 5%/0.9% Sodium Chlori 4.79

34000549 Ergocalciferol (Vitamin D2) 1.46

34000550 Buspirone HCL 1.35

34000610 Hydrocortisone Cream 0.12


34000793 Ringers Solution,lactated 0.35

34000818 ELIXOPHYLLIN 0.22

34000898 Fluocinonide Ointment 4.72

34000988 Pantoprazole Sodium 0.37

34010860 Acyclovir Sodium 2.1


34001279 Olanzapine 14.27

34001296 Donepezil HCL 7.79

34001351 Ciprofloxacin HCL 8.26

34001453 Naproxen 0.78

34001478 Econazole Nitrate 7.25

34001515 Procainamide HCL 27.29

34001529 Bupropion HCL 1.69

34001555 diphenhydrAMINE elixir 1.83

34001578 ARMOUR THYROID *UD* 0.68

34001723 Menthol 0.86

34001722 LUBRIFRESH PM 1.85

34001724 Biaxin 5.37

34001725 Epogen 182.34

�61

34001727 Clarithromycin 6.02

34001740 Vancomycin Oral Solution 5

34001729 Pilocarpine HCL 2.88

34001741 TPN 1 liter (1000ml) 35

34001396 QUEtiapine Fumarate 4

34001730 Hydroxychloroquine Sulfate 4.09

34001214 LABETALOL 20 MG/4ML IV SOL 14

34001215 BACITRACIN 50000 UNITS INJ 27

34001216 LIDOCAINE 0.5% PF INJ 50ML 6

34001731 Milrinone Lactate 0.81

34001732 Preparation H 0.31

34001733 Butrans 84.03

34001734 Flecainide Acetate 2.56

34001217 ETOMIDATE 20 MG/10 ML INJECT 30

34001735 Tradjenta 15.24

34001736 Skelaxin 6.48

34001737 Rapaflo 7.57

34001738 Ketorolac Tromethamine 1.04

34001742 Levetiracetam oral solution 1.34

34001218 LIDOCAINE 2% VISCOUS 20 ML 11

34001743 Phenobarbital 0.21

34001744 Lidocaine HCL 2% 10ml vial 0.53

34001751 MORPHINE PCA 30MG/30ML NS 0.99

34001752 DILAUDID PCA 1.76

34001753 LEVOPHED PREMIXED BAG 1.76

34001754 MORPHINE PCA 60MG/60ML NS 0.99

34001755 DILAUDID PCA 0.99

34001756 MORPHINE IV DRIP 30MG/30ML NS 0.99

34001757 MORPHINE IV DRIP 50MG/50ML NS 0.99

34001758 MORPHINE IV DRIP 100MG/100ML N 0.99

34001759 DILAUDID IV DRIP 0.99

34001760 DILAUDID IV DRIP 0.99

�62

34001761 CARDIZEM PREMIXED DRIP 0.29

34001762 CORDARONE PREMIXED BAG 0.23

34001763 ATIVAN DRIP 0.99

34001764 Colistin (for inhalation) 33.6

34001765 Polymyxin B for injection 13.5

34001766 MORPHINE 0.99

34001767 Acetazolamide Sodium 49.8

34001768 Macular Vitamin 0.42

34001769 Rapaflo 7.57

34001770 Tamoxifen Citrate 3.79

34001771 Xylocaine With Epinephrine 0.36

34001772 Santyl (1) 34

34001773 Eucerin 0.01

34001774 Sodium Chloride for Inhalation 0.5


34001776 Veltassa 35.7

34001777 Vits A & D/White Pet/Lanolin 0.05

34001779 Aminocaproic Acid 0.31

34001780 Aminocaproic acid 5gm/250ml NS 0.26

34001781 Effient 7.66

34001782 Silvadene (400 gm tub) 0.13

34001783 Lactulose Enema 0.07

34001784 Teflaro 192.28

34001785 Propranolol oral solution 0.12

34001786 Lisinopril 3.2

34001787 Clobetasol Propionate 10.36

34001788 Nuedexta 10.98

34001789 Clobetasol Propionate Cream 4.54

34001790 Ondansetron ODT 22.29

34001791 Terbutaline Sulfate 21.59

34001792 Adempas 109.18

34001793 Letairis 294.76

�63

34001794 Tyvaso 585

34001795 Calcium Alginate Dressing 17.82

34001796 Fentanyl Citrate vial (DO NOT 1.2

34001797 FENTANYL IV DRIP 1000MCG/100ML 3

34001798 Clozapine 3.43

34001799 Lidocaine 2% for inhalation 0.32

34001800 Neupro 24.87

34001219 SOD BICARBONATE 8.4% VIAL 50ML 20

34001801 Entresto 7.5


34001803 Clinimix E 4.25/5 (AA/D5W/Lyte 67.98

34001804 Morphine 3.09

34001805 Ofev 160

34001806 Ofev 160

34001807 Mycophenolate Mofetil 6.88

34001808 Cellcept 8.83

34001809 Tobramycin **for injection** 10.15

34001810 Promethazine w/ Codeine 5ml sy 0.01

34001811 Povidone-Iodine 10% Nasal swab 0.24

34001812 Vancomycin 500mg/100ml NS Enem 7.8

34001813 TPN 2 liters (2000ml) 77

34001814 Renacidin 0.32

34001220 HYDROMORPHONE 0.5MG INJ 6

34001221 NEOSTIGMINE INJ 0.5MG (20X) 12

34001222 LIDOCAINE 2% MPF INJ 5ML 7

34001815 Versed 3

34001816 NEOSYNephrine PREMIXED BAG 5

34001817 rOPINIRole 6

34001818 Fluconazole In Nacl,iso-Osm 10

34001819 Lasix 100mg/100ml NS drip 3.5

34001820 Timolol Maleate 3


�64

34001822 OXYcodone ER 4.98

34001823 Velphoro 13.81

34001824 Nix Shampoo 0.16

34001825 Clinimix 4.25/5 65.34

34001826 Acetylcysteine 10% 1.07



34001829 Tikosyn 10.41

34001830 Venclexta 103.25

34001831 Pantothenic Acid 0.13

34001832 Amitiza 3.46

34001833 Nplate 1984.8

34001834 Tracleer 164.4

34001835 Adcirca 50.04

34001836 Dextrose Gel 0.11

34001837 Dextrose chew tab 0.12

34001838 Santyl (2) 64

34001839 Santyl (3) 102

34001840 Santyl (4) 136

34001841 Santyl (5) 170

34001842 Ther-Biotic 0.48

34001843 Fentanyl IV Drip 2500mcg/250ml 10

34001857 TPN 3 liters (3000ml) 195

34001858 Midazolam 100mg/100ml NS 6

34001859 Norvir 10.29

34001860 Prezista 70.59

34001861 Mycophenolate Sodium DR 10

34001862 Moxeza 67.88

34001863 Zeasorb *71g* 0.05

34001864 Pulmozyme 112.61

34001865 Emtriva 0.89

34001866 Furosemide 250mg/250ml NS 5

�65

34001867 Viread 45.61

34001868 Brimonidine Tartrate 6.53

34001869 Torsemide 3.04

34001870 Copaxone 583.2

34001871 Parcopa 4.23

34001873 Acticoat 3 23.77

34001874 Nortriptyline 1

34001875 Mupirocin Nasal MRSA Nares Kit 8

34001876 Avycaz 300

34001877 Senna S 0.18

34001878 Aspercreme 2

34001879 Fluocinonide 45

34001880 Primaquine Phosphate 1.33

34001881 Tudorza Pressair 100

34001882 Ubidecarenone 0.5


34001885 Xylocaine 0.06

34001223 PROPOFOL 10MG INJ (100X) 0.72

34001889 Aminophylline 13.64

34001890 AMINOPHYLLINE 500MG/500ML NS 5

34001891 Dexmedetomidine 200mcg/50ml NS 25

34001895 Neupro 24.87

34001897 Rasagiline Mesylate 27.78

34001898 ERROR DO NOT USE 2.81

34001899 Protamine Sulfate 14.05

34001900 Amoxicillin 0.52

34001901 Galantamine Hbr 3.05


34001903 Mesalamine delayed release 11.23

34001904 Glyxambi 20.94


34001906 Labetalol Oral Suspension 40mg 25

�66


34001908 Ursodiol 4.75


34001910 Digoxin Immune Fab 600

34001911 Stalevo 8.75

34001912 Divalproex Sodium ER 4.07

34001913 Ofirmev 45.02

34001914 Omeprazole 4.15

34001915 Norepinephrine 16mg/250mL NS 113.03

34001916 Hydrophilic Ointment 2

34001917 Uloric 12.82

34001918 Minocycline 185.3

34001919 Vasopressin 100 units/250ml NS 10.39

34001920 Fluphenazine HCL 13.08

34001224 LIDOCAINE 2% MPF 2ML INJ 8

34001225 LIDOCAINE 2% INJ 50 ML 11

34001226 DRUG RECOVERY PROCESS 0.01

34001227 GLUCAGEN 1MG INJ 240

34001228 ONDANSETRON INJ 1MG (4X) 2

34001229 TOBRAMYCIN UPTO 80MG INJ(15X) 34

34001230 BUPIV LIPO 1.3% INJ 1MG(266X) 3

34001231 INSULIN HUMAN REG VIAL 5U(60X) 1

34001232 ENOXAPARIN INJ 10MG (4X) 27

34001233 PHYTONADIONE INJ 1MG (10X) 34

34001234 SOD CHLORIDE 0.9% IV 250 ML 6

34001235 CEFEPIME PREMIX 500MG 50ML(2X) 24

34001236 CEFTAZ-AVIBA 0.5-0.125G INJ(4X 143

34001237 NOREPINEPHR 4MG/NS 250ML PREMX 42

34001238 VANCO 500MG PREMIX (2X) 21

34001921 Oseltamivir Phosphate 15.46

34001922 Keppra 1000mg/100ml premixed I 21

34001923 Lidocaine/Epi 1.5% 10ml syr (D 1.17

�67

34001239 ATROPINE 0.01 MG INJ 1ML (40X) 0.1

34001240 STERILE WATER 20 ML INJ SOL 10

34001924 Tracleer 217.62

34001925 Disopyramide Phosphate 0.42

34001926 Domperidone 90

34001927 Domperidone 27

34001928 Bosentan 217.62

34001929 Genvoya 117.83

34001930 Oseltamivir Phosphate 12.39


34001932 Dilaudid 3.96

34001933 Ketorolac Tromethamine 21

34001934 Sodium chloride w/Aloe 0.46

34001935 Norethindrone Acetate 2.65

34001936 Labetalol HCL 0.68

34001241 FUROSEMIDE INJ 20MG (2X) 27

34001937 Glatiramer Acetate 1063.38

34001938 Rotigotine 9.24

34001939 Bupropion HCL ER 4.77

34001940 Alfuzosin HCL ER 0.42


34001942 D-Mannose 4.95

34001943 Maxi UTI 4.95

34001945 Epinastine HCL 21.39

34001946 Thiamine HCL 0.02

34001947 Sulfacetamide/Prednisolone Sp 3.75

34001242 LIDO-EPI 1-2000002%INJ PF20ML 26

34001948 Atomoxetine HCL 16.69

34001949 Ocuvite 0.28

34001950 Levalbuterol HCL 6.7

34001951 Premarin Vaginal Cream 14.23

34001952 Cefpodoxime 8.46

�68

34001243 BUPIVACAINE 0.5% INJ 30MLSDV 40

34001953 Fentanyl 59.31

34001955 Methylcobalamin 716

34001956 Acetyl L-Carnitine 1.17

34001958 VIMPAT 3.53

34001959 Medroxyprogesterone Acetate 0.49

34001960 Clobetasol Prop 0.05% Lotion 836.67

34001962 Phenytoin Sodium 0.44

34001963 Fenofibrate 0.79

34001965 Methadone Oral Syringe 0.5

34001967 Phenylephrine 0.04

34001968 CefaDROXil 3.72

34001969 busPIRone HCL 0.77

34001970 Ketamine 200mg/100ml NS IV Dri 10

34001971 Naloxegol Oxalate 13.8

34001972 Thyroid Compounded T4/T3 cap 0.14

3450001 SOD CHLORIDE .45% 1000ML 47

3450002 Amantadine HCL 0.26

3450003 CHLORASEPTIC *177ML* 0.03

3450004 MINERAL OIL 133ML 0.02

3450005 ARIXTRA *0.5ML* 133.47

3450006 ZOMETA 4MG\5ML SD 1VL 708

3450007 CANCIDAS 70 MG 421.06

3450008 LOCM 300-349MG/ML IODINE 0.97

3450009 PROPOFOL 100 MG/10 ML VIAL 25

3450010 MAG SULF INJ 10MG 0.02


3450012 Sodium Ferric Gluconat/Sucrose 38.16

3450013 FLEBOGAMMA 5% *200ML* 4.84

3450014 LEVAQUIN IV 750MG ML BAG 0.32

3450015 Fluocinonide 0.05% Oint 4.72

3450016 Fluocinonide Cream 3.04

�69

3450017 Neomycin/Polymyxin B Sulf/Hc 10.07

3450018 LABETALOL HCL 0.14

3450019 MAGONATE 0.03

3450020 COMPAZINE 5MG/ML 10ML 21

3450021 DEFINITY CONTRAST PER 1 ML 126

3500001 ARTERIAL BLOOD GASES 140

3500002 VENIPUNCTURE COLLECTION 30

3500003 CBC WITH MANUAL DIFF 86.75

3500004 PREALBUMIN 60

3500005 COMPLETE METABOLIC PANEL (CMP) 376

3500006 CROSSMATCH IMMED SPIN 94

3500007 URINALYSIS 13

3500008 TROPONIN I 155

3500009 SPUTUM CULTURE 251

3500010 24HR URINE-TOTAL PROTEIN 72

3500011 VITAMIN B-12 123

3500012 URINE C&S 230

3500013 FRUCTOSE (SEMEN) 140

3500014 MYOTONIC DYSTROPHY DNA-5 OF 6 37

3500015 MIC SENSITIVITY 134

3500016 D-DIMER QUANTITATIVE 316

3500017 URINALYSIS MICROSCOPIC 87

3500018 VITAMIN D-125 274

3500019 IRON BINDING CAPACITY 94

3500020 DILANTIN FREE 157

3500021 PROTEIN, BODY FLUID 72

3500022 GAMMAGLOBULIN/ IGG 132

3500023 HEPATITIS C 235

3500024 HEPATIC FUNCTION PANEL (LFTs) 131

3500025 PT PROTHROMBIN 68

3500026 T3 FREE-REF LAB 460

3500027 FIBRINOGEN 183

�70

3500028 VANCOMYCIN-PEAK 201

3500029 LDH 110

3500030 ACID FAST CULTURE 59

3500031 THEOPHYLLINE LEVEL 174

3500032 SPECIAL STAIN GRP A/MICR 229

3500033 DEPAKENE-VALPROIC AC 198

3500034 RH BLOOD TYPING 46

3500035 AMIKACIN RANDOM 120

3500036 ANTIBODY SCREEN 236

3500037 BRAIN NATRIURETIC PEPTID(BNP) 389

3500038 BLOOD CULTURE ONE SET 32

3500039 HEMATOCRIT 44

3500040 AFB SMEAR 89

3500041 FUNGUS ID 127

3500042 BLOOD GAS 235

3500043 GROSS & MICRO LEV 4 501

3500044 CRYS ANALYSIS JOINT FLUID 140

3500045 HEPATITIS A AB IGM 133

3500046 TPPA 101

3500047 CPK MB MASS 130

3500048 TRANS-ANTIBODY ID#2 236

3500049 COOMBS-INDIRECT 77

3500050 COOMBS-DIRECT 74

3500051 THYROID STIM HORMONE 257

3500052 C DIFF ANTIGEN/TOXIN 174

3500053 ANTI-PLATELET AB 145

3500055 COMPLEMENT TOTAL CH50 191

3500056 CORTISOL AM/PM 155

3500057 FERRITIN 146

3500058 FOLATE RBC 136

3500059 FOLATE SERUM 142

3500060 HEMOGLOBIN ELECTROPHORES 53

�71

3500061 HEPATITIS B SURF AG 111

3500062 IRON SERUM 65

3500063 LACTIC ACID 138

3500064 OSMOLALITY BLOOD 84

3500065 PROLACTIN 297

3500066 PROTEIN ELECTROPHOR SERUM 146

3500067 T4 THYROXINE 148

3500068 HEMOGLOBIN A1C 173

3500069 CARBOXYHEMOGLOBIN 94

3500070 CELL COUNT & DIFF BODY FLUID 179

3500071 DIFFERENTIAL MANUAL 87

3500072 FIBRIN SPLIT PROD SEMIQT 89

3500073 CBC AUTO W/O DIFF 51

3500074 CBC & PLATELETS 62

3500075 PROTIME CONT/SEC% 100.75

3500076 RETICULOCYTE COUNT 107

3500077 PTT (HEPARIN TREATED) 120

3500078 HEMOGLOBIN (HGB) 33

3500081 CULTURE BLOOD 141

3500082 CULTURE STL/GC 90

3500083 OCCULT BLOOD STOOL 63

3500084 URINE GRAM STAIN 124

3500085 ALBUMIN SERUM 60

3500086 AMMONIA 144

3500087 AMYLASE SERUM 160

3500088 BILIRUBIN DIRECT 70

3500089 BILIRUBIN TOTAL-SERUM 51

3500090 PORPHYRINS PLASMA 89

3500091 CYP21 GENTIC (5 OF 5) 196

3500092 HERPES VIRUS TYPE 6, IGM, IGG 188

3500093 CALCIUM BLOOD 66

3500094 CALCIUM IONIZED 152

�72

3500095 CARBAMAZEPINE TEGRETOL 270

3500096 CHLORIDE URINE 32

3500097 CK-MB 193

3500098 CREATININE CLEARANCE 96

3500099 CREATININE SERUM 68

3500100 24HR URINE-CREATININE 63

3500101 GAMMA GLUTAMYL TRANSPEPT 71

3500102 HAPTOGLOBIN QUAL 74

3500103 HEPATITIS A AB TOTAL 125

3500104 LIPASE 166

3500105 MAGNESIUM SERUM 90

3500106 ALKALINE PHOSPHATASE (ALP) 179

3500107 PHOSPHORUS SERUM 97

3500108 PROFILE I, LIPID 189

3500109 24HR URINE- SODIUM 48

3500110 URIC ACID SERUM 108

3500111 DIGOXIN LEVEL 141

3500112 BASIC METABOLIC PANEL (BMP) 332

3500113 POTASSIUM URINE 62

3500114 COMPLEMENT; ANTIGEN EA CM 149

3500115 SINGLE DONOR PLATELET 1454

3500116 IMMUNO FIXATION ELT 213

3500117 CYP21 GENTIC SCREEN (3 OF 5) 77

3500118 VITAMIN D 25- HYRDOXY 328

3500119 GROSS & MICRO LEVEL III 358

3500120 FUNGI OTHER SOURCE 156

3500121 GPT TRANSFERASE ALANINE 119

3500122 HEPATITIS B SURF AB 158

3500123 AFB WITH ISOLATION 168

3500124 SCREEN FOR VRE 90

3500125 URINALYSIS W/MICROSCOPIC 123

3500126 INFLUENZA A VIRUS 75

�73

3500127 EOSINOPHILIS URINE 124

3500128 QUANTITATION OF DRUG 259

3500129 TOXOPLASMA IGM 110

3500130 THROMBOGENE FACTR V DNA 5 OF 5 135

3500131 IMMUNOASSAY RIA 436

3500132 GROUP ABO TYPING 84

3500133 HIV 1 AB 76

3500134 TRIGLYCERIDE 102

3500135 INFLUENZA AB TYPE A & B 95

3500136 RH PHENOTYPE 79

3500137 GLUCOSE QT BL 80

3500138 24HR URINE-CALCIUM 99

3500139 C-REACTIVE PROTEIN 150

3500140 PTH INTACT W/CALCIUM 265

3500141 PSA TOTAL 141

3500142 TSH 3RD GENERATION 152

3500143 24HR URINE-UREA NITROGEN 35

3500144 ANTI DIURETIC HORMONE 219

3500145 ANTIGEN SCREEN EA (UNIT S 216

3500146 HEPATITIS B CORE AB BY EI 104

3500147 GLUCOSE, GLUCOMETER 47

3500148 TACROLIMUS (Prograf) 342

3500149 HEPATITIS B CORE AB IGM 75

3500150 MRSA PROBE 257

3500151 ANTIGEN TYPING EA PATIENT 253

3500152 CARDIO CRP 210

3500153 HEPATITIS C RNA QUANT 392

3500154 VITAMIN B1 142

3500155 AMP PROBE CLOSTRIDIUM 320

3500156 PLATELET BOUND AB 99

3500157 FREE PLASMA HEMOGLOBIN 74

3500158 PTT CORRECTED 157

�74

3500159 PORPHYRINS FRACTIONATED U 117

3500160 PORPHOBILINOGEN URINE 35

3500161 GALACTOSE-1PHOS TRANSFERASE QN 170

3500162 COCLEAR ANTIGEN 137

3500163 LEVEL 4 CELL BLOCK 295

3500164 MAGNESIUM ASSAY 88

3500165 PHOSPHOROUS 49

3500166 VENIPUNCTURE 40

3500167 CBC/DIFF/PLT 62

3500168 PLATELET COUNT 69

3500169 TUBERCULOSIS TEST 349

3500170 ALBUMIN FLUID 89

3500171 GLUCOSE FLUID 69

3500172 OSMOLALITY URINE 64

3500173 CMV ANTIBODY IGG 239

3500174 HEPATITIS PANEL 346

3500175 T4 88

3500176 HIV RAPID ASSAY 293

3500177 IMMUNOELECTROPHORESIS SERUM 203

3500178 FTA-AB 158

3500179 VIRAL ENCEPHALITIS PANEL 1 OF4 253

3500180 CALCITONIN ASSAY 263

3500181 GENTAMICIN LEVEL 164

3500182 NEPHELOMETRY EACH ANALYTE 178

3500183 METHYMALONIC AC/HOMOCYST 131

3500184 KEPPRA LEVEL 250

3500185 LEUKOCYTE AB 598

3500186 ANTINEUTROPHIL CYTOPLASMIC AB 444

3500187 INFECTIOUS AGENT ORGANISM 157

3500188 ABO TYPE 58

3500189 CBC AUTO W/AUTO DIFF 130

3500190 PROTHROMBIN TIME 86

�75

3500191 PTT 97

3500192 CBC AUTO W/O DIFF 108

3500193 BLOOD FILM EXAM 87

3500194 C DIFFICILE TOXIN SCR BY PCR 320

3500195 BLOOD CULTURE ISOLATOR 284

3500196 MRSA SCREEN (PCR) 217

3500197 SEDIMENTATION RATE 101

3500198 UA W/O MICRO 108

3500199 GLUCOSE-BLOOD 39

3500200 IRON ASSAY 136

3500201 PANEL NEG BREAKPOINT COMBO 44 192

3500202 PANEL POS COMBO 34 192

3500204 T4 FREE 170

3500205 CK TOTAL 112

3500206 ID OF URINE CULTURE 146

3500208 MOLD 125

3500209 ENZYME DETECTION 25

3500210 VRE CULTURE 182

3500211 MRSA CULTURE SCREEN 182

3500212 COMPLEMENT C4 224

3500213 HEPATITIS PANEL 650

3500214 NEUTROPHIL ANTIBODY 444

3500215 PARATHYROID HORMONE -S 450

3500216 PHOSPHORUS - URINE RANDOM 86

3500217 AMINO ACID SCREEN URINE 244

3500218 CARBAPENEMASE PANEL 98

3500219 STREP A LATEX 57

3500220 STREP B LATEX 57

3500221 STREP C LATEX 57

3500222 STREP F LATEX 57

3500223 STREP G LATEX 57

3500224 RA TEST QUANT 147

�76

3500225 ALBUMIN-SERUM 43

3500226 LACTIC ACID-PLASMA 140

3500227 PROTEIN TOTAL-SERUM 135

3500228 GOT (AST) 68

3500229 SODIUM URINE RANDOM 58

3500230 POTASSIUM PLASMA 44

3500231 PBP2 LATEX ANTIGEN AGGLUTINATI 57

3500232 KB SENSITIVITY 98

3500233 K/L SERUM 168

3500234 ANTI-NUCLEAR ANTIBODY SCREEN 227

3500235 COMPLEMENT C3 224

3500236 LYME ANTIBODY 200

3500237 OCCULT BLD-OTHER SOURCES 19

3500238 ALDOSTERONE 450

3500239 RENIN 289

3500240 MAGNESIUM URINE RANDOM 114

3500241 CALCIUM IONIZED DIRECT MEAS 161

3500242 CORTISOL ASSAY 231

3500243 IGE TOTAL 270

3500244 HEPARIN-PF4 ANTIBODIES (HIT) 598

3500245 HEPATITIS B DNA 392

3500246 HAV TOTAL 161

3500247 MITOCHONDRIAL ANTIBODY 244

3500248 MICROSOMAL ANTIBODIES 232

3500249 SUSCEPTIBILITY STUDY 56

3500250 TESTOSTERONE TOTAL 328

3500251 TESTOSTERONE FREE 292

3500252 DHEA SULFATE 288

3500253 DIHYDRO TESTOSTERONE (DHT) 291

3500254 INFLUENZA A 140

3500255 HEPATITIS BE AG 93

3500256 LIPID PANEL 277

�77

3500257 ASPERGILLUS GALACTOMANNAN AG 115

3500259 BILL ANTIGEN SCREENED-1 173

3500260 CHOLESTEROL B F 102

3500261 PHENYTOIN-SERUM 134

3500262 PROTEIN TOTAL BODY FLUID 90

3500263 AFB CULTURE 205

3500264 BODY FLUID CYTOLOGY 270

3500265 CONCENTRATION (ANY TYPE) 88

3500266 PREGNANCY TEST-URINE 198

3500267 IMMUNOHISTO/CYTOCHEM PER SPEC 316

3500268 VANCOMYCIN TROUGH 192

3500269 PH BODY FLUID EXCEPT BLOOD 62

3500270 SURG PATH-GROSS & MICR LVL III 382

3500271 COOMBS, DIRECT 93

3500272 COOMBS, INDIRECT 93

3500273 BUN 46

3500274 HOMOGENIZATION 63

3500275 PT/INR 86

3500276 ANTI STREPTOLYSIN TITER 112

3500277 PSA TOTAL 222

3500278 BENCE JONES PROTEIN URINE 278

3500279 ACID FAST BACILLI ID 105

3500280 ACID FAST BACILLI SENSITI 56

3500281 CERULOPLASM 169

3500282 CARBON DIOXIDE CONTENT S 72

3500283 RESP PATH PANEL BY PCR 1 669



3500286 CEA 294

3500287 PHENOBARBITAL 189

3500288 RAST TEST SGL ALLERGEN 84

3500289 D-DIMER/FSP 317

�78

3500290 SURG PATH GROSS ONLY 161

3500291 URINE MICROSCOPIC 77

3500292 T SPOT TB TEST 354

3500293 CYCLOSPORIN LEVEL 238

3500294 OCCULT BLOOD FECES 52

3500296 METHEMOGLOBIN QUANT 101

3500297 MALARIA SMEAR 61

3500298 ALPHA 1 ANTITRYPSIN 223

3500299 VDRL/RPR SERUM 79

3500300 SEROLOGY NOS 1

3500301 RISTOCETIN COFACTOR ACTIVITY 423

3500302 CMV (IGG & IGM) 132

3500304 VARICELLA ZOSTER DNA ULTRA CSS 464

3500305 HERPES SIMPLEX VIRUS DNA DETEC 326

3500303 EBV VCA (IGG&IGM) IGG PORTION 234

3500306 HSV CSF AB 96

3500307 SPECIAL STAIN GROUP II 272

3500308 NEURON SPECIFIC ENOLASE 230

3500309 CA 19 9 360

350310 TOBRAMYCIN ASSAY 143

3500311 SPECIAL STAIN GROUP I 315

3500312 CYTOMEGALOVIRUS DNA DETECTR 320

3500313 EBV PANEL 225

3500314 A 1 ANTITRYPSIN PHENOTYPE 150

3500315 ANA REFLEX TO PROFILE 189

3500316 THIN PREP NON GYN 266

3500317 BODY FLUID CYTOLOGY FILTER 112

3500318 ASPERGILLUS ANTIBODY 117

3500319 FUNGITELL 300

3500320 RENAL FUNCTION PANEL 216

3500321 EVAL OF FNA INTERP AND REPORT 514

3500322 PARVOVIRUS AB 209

�79

3500323 CHLORIDE BODY FLUID 50

3500324 HCV VIRAL LOAD 642

3500325 OSMOLALITY STOOL LIQUID 108

3500326 OVA & PARASITES FECES 261

3500327 TRICHROME STAIN 212

3500328 WBC STOOL 156

3500329 STOOL ADDL PATHO 189

3500330 SALMONELLA SHIGELLA CULTU 204

3500331 E COLI SHIGA TOXIN SCREEN 227

3500333 FAT FECAL QUANTATIVE 301

3500334 SODIUM STOOL LIQUID 42

3500335 POTASSIUM STOOL LIQUID 49

3500336 LACTOFERRIN STOOL 145

3500337 MMC GN80 271

3500338 CNS DNA AMP PROBE TYPE 12-25 217

3500339 IGG SUBCLASS 4 163

3500340 ENA AB TO SS A 285

3500341 ENA AB TO SS B 285

3500342 COPPER SERUM 143

3500343 TOPRIMATE ASSAY 140

3500344 LAMOTRIGINE 115

3500345 PROCALCITONIN ASSAY 209

3500346 BETA HYDROXYNBUTYRATE 152

3500347 HCG QUANTATIVE 277

3500348 AFP TUMOR MARKER 308

3500079 CULTURE AEROBIC 251

3500080 CULTURE ANAEROBIC 136

3500203 AEROBIC BACT ID 149

3500207 ANAEROBIC BACT ID 137

3500258 NOSE & THROAT CULTURE 254

3500295 AEROBIC QUANTATIVE 132

3500349 SODIUM SERUM 42

�80

3500350 GABAPENTIN ASSAY 220

3500351 HEPATITIS BE AB 115

3500352 THROMBIN TIME 123

3500353 C TRACH N GONOR RNA TMA TEST 1 241

3500354 C TRACH N GONOR RNA TMA TEST 2 229

3500355 LOWER RESPIRATORY CULTURE 280

3500356 AEROBIC BACT ID 164

3500357 CULTURE OTH SOURCE AEROBIC 280

3500358 SURG PATH GROSS & MICRO LVL V 882

3500359 DECALCIFICATION PROCEDURE 139

3500360 ALK PHOS ISOENZYMES 125

3500361 ANTI DNA ANTIBODY DS 242

3500362 HIV AG/AB 4TH GEN SCREEN 394

3500363 T3 245

3500364 HIV VIRAL LOAD 1157

3500365 OXCARBAMAZEPINE (TRILEPTAL) 174

3500366 CA125 510

3500367 DNA ID DIRECT PROBE 182

3500368 HCG QUALATIVE SERUM 73

3500369 FLOW CYTOMETRY 265

3500370 FLOW CYTOMETRY CD2 265

3510001 Transfuse Platelets 310

3510002 PLASMA PROCESSING-THAW 95

3510003 LEUKO REDUCED 602

3510004 Fresh Frozen Plasma 451

3510005 ELUTION STUDIES 86

3510006 Transfuse PRBC 573

3510007 Transfuse FFP 174

3510008 TRANSFUSION SERVICE FEE 1305

3510009 ANTIBODY SCREEN TUBE 127

3510010 CROSSMATCH IMMED SPIN PORTION 179

3510011 LEUKOCYTE POOR PACKED CELLS 403

�81

3510012 APH RBC CP2D ASE LR2 567

3510013 TYPE AND SCREEN 228

3510014 ADDITIONAL AB ID PANEL 194

3510015 SINGLE DONOR PLT LEUKO REDUCE 1557

3510016 APH RBC CP2D ASE LR2 567

3510017 XM TUBE INTERP 97

3510018 ATYPICAL ANTIBODIES 194

3510019 COOMBS DIRECT 93

3510020 PLASMA FRESH FROZEN PRODUCT 174

3510021 BLOOD IRRADIATION 376

3510022 FFP THAWING 152

3510023 APH RBC CP2D AS3 LR1 567

3510024 RH (D) 66

3510025 RBC LEUKO IRRAD EA U 589

3600001 DUPLEX EXT VEIN COMP 1671

3600002 ECG & RYTHM W/O INTREP 343

3600003 EEG AWAKE/ASLEEP 986

3600004 ECHO DOPPLER ADULT/PEDS 1006

3600005 NERVE CONDUCTION 5-6 STUDIES 1237

3600006 EMG EA EXTREM W/NERVE COND CMP 605

3610001 HIP CMP 2 VWS 491

3610002 CHEST PA 359

3610003 ABDOMEN/CAVALIER 278

3610004 SHOULDER 1 VW 315

3610005 ELBOW COMPL MIN 3VWS 456

3610006 FOREARM 2VW 423

3610007 HIP 1VW 173

3610008 KNEE 2 VIEWS 426

3610009 ANKLE LTD 2V 327

3610010 ABDOMEN KUB 1V 472

3610011 ESOPHAGUS CINE OR VTR 816

3610012 MBS/VIDEO-FLUOROSCOPE SWALLOW 416

�82

3610013 CHEST 1 VIEW FRONTL 359

3610014 ESOPHAGUS 831

3610015 ANKLE 2 VIEWS 131

3610016 HUMERUS>2VWS 416

3610017 ABDOMEN 1 VIEW 370

3610018 HAND 454

3610019 FEMUR 2 VWS LT 460

3610020 US RETRO COMP 1544

3610021 CT CHEST W/CONTRAST 2897

3610022 CT HEAD W-W/O CON 3430

3610023 CT HEAD W/O CONTRAST 2278

3610024 CT ST NECK W/CON 2771

3610025 CTA CHEST W/WO 2957

3610026 PERITONEOGRAM INTERP 824

3610027 UPPER GI W/ KUB 991

3610028 GASTROSTOMY TUBE PERC PLCMT 2165

3610029 FOOT 2 VWS 448

3610030 CT GUIDE NEEDLE PLACEMENT 2015

3610031 TIB/FIB 445

3610032 FOOT CMPL MIN 3 VWS 680

3610033 SPEECH EVALUATION 453

3610034 NECK SOFT TISSUE 424

3610035 LIPID PROFILE 286

3610036 STERNOCLAVICULAR JOINT (S) 524

3610037 IPV INITIAL 95

3610038 INDIUM SCAN 2504

3610039 ABD, SNGL ANT/POST VW 496

3610040 CHEST AP PORTABLE 377

3610041 CERETEC WBC PER DOSE 2141

3610042 G-J TUBE TRAY 179

3610043 THSF-35-145-AUS-BH-AMPLATZ 54

3610044 PERC CNVRT GTUBE 2 GASTOJ FLUR 2435

�83

3610045 G-J TUBE 18FR X 45 410

3610046 UGI/SM BOWEL 1529

3610047 GASTROGRAFIN PER ML 1

3610048 WRIST 2VWS RT 419

3610049 G-TUBE TRAY 194

3610050 WRIST CMPL>3VWS 517

3610051 VISIPAQUE 320 PER ML 2

3610052 US ABD LIMITED 1124

3610054 INJECTOR SUPPLIES & ORAL CONTR 57

3610055 CT ST NECK W/O CON 2245

3610056 THORACIC SPINE 3 VWS 347

3610057 LS SPINE MIN 4 VIEWS 807

3610058 SACRUM & COCCYX MIN 2 VW 525

3610059 HUMERUS MIN 2VWS BILAT 655

3610060 HIPS 2VWS W/AP PEL BILAT 830

3610061 FOREARM 2VWS BILAT 667

3610062 LYSE CHEST FIBRIN SUBQ DAY 1537

3610063 74250 SB W/MULTI SERIAL FILMS 935

3610064 TC99M BONE DOSE UP TO 30 ML UD 76

3610065 78315 WHOLE BODY BONE 3 PHASE 2521

3610066 C-SPINE MIN 2VWS 479

3610067 NM BRAIN IMAG VASC FLOW 1170

3610068 HUMERUS MIN 2VWS 437

3610069 WRIST 2 VWS 401

3610070 PELVIS 1 OR 2 VWS 422

3610071 LS SPINE 2/3 VWS 617

3610072 HAND MIN 3VWS 457

3610074 US PELVIC LIMITED 315

3610075 MRI BRAIN W/O CONTRAST 4095

3610076 SHOULDER CMPL 2 VWS 520

3610077 CT LOWER EXT W/O CONTRAST B/L 3348

3610078 CHEST AP/LAT 2 VWS 425

�84

3610079 FEMUR 2 VWS RT 471

3610080 76000 PHY FLUORO UP TO 1 HOUR 709

3610081 TC-99M MAA UPTO 10MCI TRIAD UD 180

3610082 PULMONARY PERFUSION 1738

3610083 GA-67 GALLIUM CITRATE PER MCI 73

3610084 PET SCAN 2296

3610085 FLUID COLLECTION DRAINAGE 3670

3610086 INJ TRACT SINOGRAM 113

3610087 XR ABSC SINUS/FISTULA 974

3610088 XR INTRO CATH RENAL RT 1323

3610089 XR UROGRAM ANTEGRADE 1366

3610090 INS CATH DRAIN RENAL PELVIS 2208

3610091 ASP/INJ CYST RENAL PERC 2039

3610092 XR ELBOW 2V RT 357

3610093 ASP BLADDER TROCAR/INTRACATH 694

3610094 CTA AORTA W/RUNOFF W/WO CONTST 2761

3610095 GASTROGRAFIN 350-399 PER ML 1

3610096 US THYROID BIOPSY PREP 98

3610097 DRAIN CATH VISCERAL PERC IMG 3670

3610098 XR ANKLE 3+V LT 494

3610099 RPLC G/CEC/OTH TB UNDER FLUORO 1183

3610100 XR FLUORO NEEDLE LOCALIZATION 963

3610101 CT PELVIS W/ CONTRAST 3180

3610102 ASP BLADDER NEEDLE 875

3610103 INJ CYSTOGRAM 2236

3610104 XR CYSTOGRAM 3+V 741

3610105 TC99 + PYRO (MUGA) 36

3610106 INSERT OF PLEURAL CATH 8342

3610107 INSERT DUODEN/JEJUN TBE FLUORO 4123

3610108 XR FEMUR 1V RT 504

3610109 XR HIP UNI W/PELVIS 2-3V LT 494

3610110 XR T-SPINE 2V 662

�85

3610111 INTRO NDL/CATH AV SHUNT 1ST AC 1246

3610112 INTRO NDL/CATH AV SHUNT ADDL 398

3610113 THROMBECT AVF W/GRAFT PERC 5518

3610114 PLACE CATH THOR/BRAC 1ST ORDER 2688

3610115 XR ANGIO EXTREMITY UNI LT 4732

3610116 CATH BALLOON DILATATION FLOW 131

3610117 DIALYSIS TRAY 284

3610118 INDIUM IN111 OXINE PER 0.5 MCI 813

3610119 TC-99M SULF COLLOID UPTO 20MCI 110

3610120 NM GASTRIC EMPTYING IMG STUDY 2417

3610121 EXCHNG DRAIN CATH BIL PERC 2387

3610122 XR ORBITS CMPL 4+V 857

3610123 MRI ABDOMEN W/O CON 4093

3610124 CT L-SPINE W/O CONTRAST 2360

3610126 XR HIP UNI W/PELVIS 1V RT 427

3610127 ISOVUE-370 500ML PER 1ML 0.2

3610128 XR ABDOMEN 3V 490

3610129 XR HIPS BILAT W/PELVIS 2V 720

3610130 TC99M GALL BLADDER TO 15ML UD 95

3610131 NM HEPATOBIL SYS W/GB IF PRES 2401

3610132 INJ NEPHRO/URETER EXIST ACC LT 679

3610133 CHOLECYSTOST PERC COMPL PX 2847

3610134 INJ CONTR W/FLUORO EVAL CV DEV 899

3610135 EXCHNG CATH NEPH PERC LT 1483

3610136 XR SKULL LTD <4V 827

3610137 71035 CHEST SPEC VWS/LAT DECUB 737

3610138 INJ CNTR W/FLUOR EVAL G/D/J TB 856

3610139 PLACE TUBE NASO/OROGASTRIC 908

3610140 DRAIN CATH PERI/RETRO PERC IMG 4037

3610141 ANGIOLP TRNLM SAME VEIN INITL 10046

3610142 XR CHEST 1 VIEW 444

3610143 XR ABDOMEN 1 VIEW 546

�86

3610144 XR CHEST 2 VIEWS 555

3610145 XR COLON ENEMA W/ OR W/O KUB 1006

3610146 THROMB DIALYS W/TBA 12088

3610147 NM KIDNEY W&W/O PHARM INTERVEN 2688

3610148 TC99M MAG-3 MERTIATIDE PER UD 427

3610149 BARIUM SULF VARI 230 ML PUDDIN 20

3610150 BARIUM SULF VARI 240ML NECTAR 26

3610151 BARIUM SULF VAR 250 THN HONEY 24

3610152 BARIUM SULF VARI 148G THIN LIQ 10

3610153 XR ABDOMEN 2 VIEWS 466

3610154 XR C-SPINE 4 OR 5 VIEWS 1101

3610155 XR KNEE 3V RT 626

3610156 DOPPLER ARTERIAL EXTREMTY CMPL 1282

3620001 DUPLEX EXTREM VEIN LTD 1251

3620002 ECHO 2-D F/U LIMITED 1170

3620003 US ABD COMP 1245

3620004 ECHO 2D W/SPECIAL COMPL 2371

3620005 DUP EXT VEIN LT 1251

3620006 ECHO WITH CONTRAST 4146

3620007 US GUIDED FOR VASC ACCESS 690

3620008 TRANSESOPHAGEAL ECHO 2612

3620009 ECHO COLOR FLOW ADULT/PEDS 719

3620010 THORACENTES NDL/CATH W/IMG LT 1480

3620011 THORACENTES NDL/CATH W/IMG RT 1480

3620012 PLEURAL DRAIN PERC W/ IMG BI 2220

3620013 US SCROTUM 887

3620014 DRN CATH FLUID SOFT TISSUE IMG 824

3620015 US GUIDANCE OF NEEDLE PLACEMT 1411

3620016 DUPLEX ART UPR EXT UNI/LTD RT 683

3620017 US PELVIS CMPL NON-OB 1035

3620018 US CHEST 725

3620019 US EXTREMITY NON VASCULAR LTD 610

�87

3620020 US SOFT TISSUE HEAD/NECK 935

3620021 DUPLEX ART LWR EXT UNI/LTD LT 953

3620022 DUPLEX ABD/PEL/RETRO LTD 1304

3630001 CT HEAD W/CONTRAST 2401

3630002 CT CHEST W/O CONTRAST 2177

3630003 CT LOWER EXT W/CONTRAST RT 3082

3630004 ACUTE GI BLEEDING SCAN 1638

3630005 CT LOWER EXT W/O CONTRAST 2250

3630006 CT SPINE CERVICAL W/O CONTRST 2888

3630007 CT ABD/PELVIS W/CONTRAST 2905

3630008 CT ABD/PELVIS W/OUT CONTR 3445

3630009 CTA ABD/PELVIS W/WO 4053

3630011 CT MAXILLOFACIAL W/O CON 2751

3630012 CT ABD/PELVIS W&W/OUT CONTRAST 5100

3630013 CT ABDOMEN W/O CONTRAST 2317

3630014 ASP ABSC/HEMA/CYST/BULLA 564

363010 CT ABDOMEN W/CONTRAST 3451

3630015 CT T-SPINE W/O CONTRAST 2440

3630016 CT PELVIS W/O CONTRAST 2747

3630017 RAD GUIDE PERC DRAIN W/CATH PL 1490

3630018 CT LWR EXT W/ CONTRAST BI 4623

3630019 CT NECK W&W/O CONTRAST 3628

3630020 CT MAX/FACIAL W/ CONTRAST 3626

3630021 CT ORBIT/SEL/FOS/EAR W/O CON 1387

3670001 MRI SPINE LUMB W/O CONT 4823

3670002 MRI-BRAIN W/WO CONTRAST 3181

3670003 MRI JT UP EXT W/O CNTR 4526

3670004 MRI JT UP EXT W/CNTR BI 3576

3670005 MRI THORACIC SPINE W/WO CONTRS 4323

3670006 MRI T-SPINE W/O CON 3752

3670007 MRI L-SPINE W/O CON 3843

3670008 MRI L-SPINE W&W/O CON 6349

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3670009 MRI BREAST BILAT W&W/O CON 5064

3670010 MRI C-SPINE W/O CON 4090

3700002 Chest Physiotherapy-Initial 193

3700003 Continuous Nebulizatn 1st Hour 310

3700004 Vapotherm/Optiflow Initial 118

3700005 Aerosol Delivery- Initial 118

3700006 Aerosol Delivery- Subsequent 200

3700007 Vapotherm/Optiflow Subsequent 200

3700008 Ventilator Settings-Subsequent 1250

3700010 Respiratory Care - 15 minutes 120

3700011 Ventilator Settings-Initial 1450

3700012 Chest Physiotherapy-Subsequent 193

3700013 BiPAP Checks 54.38

3700018 HFN Adult Treatment 200

3700020 Arterial Puncture 250

3700021 CPAP / BIPAP Subsequent 194

3700022 CAC-Code Response 741

3700023 CPAP / BIPAP Initial 194

3700024 ABG W/Measured Sat 663

3700027 Pulse Oximetry Single 220

3700028 Cont Neb Tx, Ea Addl Hour 295

3700029 Insert Emergency Airway 779

3700030 Pulse Oximetry Overnight 350

3700031 Metered Dose Treatment 137

3700033 WEANING PARAMETERS 156

3700009 SPUTUM COLLECTION 120

3700034 CO2 EXPIRED GAS DETERMINATION 190

3800002 PT - GAIT TRAINING EA 15 250

3800003 PT - THER EXERCISE 15M 275

3800004 NEURO RE-ED FUN MOB-15 MI 200

3800005 ORTHOTIC FITTING/TRAIN15 90

3800006 PATIENT/FAM TRAIN 1/4 HR 63

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3800008 PT EVAL LOW COMPLEX 20 MIN 337

3800009 PT EVAL MOD COMPLEX 30 MIN 449

3800010 PT EVAL HIGH COMPLEX 45 MIN 561

3800011 PT RE-EVAL EST PLAN CARE 233

3810001 OT - ADL TRAINING 15 EA 200

3810002 OT - COGNITIVE THER 15MIN 200

3810004 OT- NEURO RE-ED 15 MIN 200

3810006 OT - THER ACTIVITY 15 MIN 200

3810007 OT - THER EXERCISE EA 15 250

3810008 ORTHOTIC FITTING/ 15 MIN 225

3810009 OT EVAL LOW COMPLEX 20 MIN 243

3810010 OT EVAL MOD COMPLEX 30 MIN 324

3810011 OT EVAL HIGH COMPLEX 45 MIN 405

3810012 OT RE-EVAL EST PLAN CARE 172

3820001 SPEECH THERAPY 200

3820002 SWALLOWING EVALUATION EVA 386

3820003 SPEECH EVALUATION 304

3820004 FAMILY INSERVICE/CONSULT 63

3820009 DYSPHAGIA TX 416

3820019 SWALLOWING - G8996-INITIAL-CI 0.01

3820020 SWALLOW-G8997-GOAL&INTERVAL-CI 0.01

3820021 SWALLOWING - G8998 - GOAL-CI 0.01

3820022 SWALLOWING - G8996-INITIAL-CJ 0.01

3820023 SWALLOW-G8997-GOAL&INTERVAL-CM 0.01

3820024 SWALLOWING - G8998 - GOAL-CM 0.01

3820025 SWALLOW-G8997-GOAL&INTERVAL-CK 0.01

3820026 SWALLOWING - G8998 - GOAL-CK 0.01

3820027 Oral Speech Device Eval& Treat 220

3820028 ORAL SPEECH DEVICE TREATMENT 225

3900001 HEMODIALYSIS ACUTE/INPAT 2475

3900002 ESR(SEDRATE) MANUAL 75

3900003 HEMODIALYSIS PROC IP>1EVA 2050

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3900004 HEMODIALYSIS IP>1EVAL BED 2050

3900005 ESRD HEMODIALYSIS TX IP 1063

4000001 PSYCH DIAG EVAL W/ MED SERVICE 1005

4150001 NUTRIT CONSULT INITIAL 15 105

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