gmha fee schedule updated - april 01, 2018gmha.org/wp-content/uploads/fee_schedule/current...gmha...
TRANSCRIPT
GMHA FEE SCHEDULE
UPDATED - APRIL 01, 2018
CHARGE CPT CHARGE CHARGE REV
CODE CODE DESCRIPTION RATE CODE
1501000 ROOM & BOARD ICU 1624.50 2001501001 ROOM & BOARD NURSERY 463.19 1711501002 ROOM & BOARD INTMED NURSERY 697.89 1721501003 ROOM & BOARD NICU 1053.30 1741501004 ROOM & BOARD TELEMETRY 912.46 2091501006 ROOM & BOARD PICU 1402.26 2031501008 ROOM & BOARD MED/SURG PRIVATE 695.34 1111501009 ROOM & BOARD MED/SURG SEMI-PRI 631.53 1211501011 ROOM & BOARD MEDICAL PRIVATE 750.38 1111501012 ROOM & BOARD MEDICAL SEMI-PRIV 686.56 1211501014 ROOM & BOARD PEDS PRIVATE 934.48 1131501015 ROOM & BOARD PEDS SEMI-PRIVATE 870.68 1231501017 ROOM & BOARD OB/GYN PRIVATE 766.56 1121501018 ROOM & BOARD OB/GYN SEMI-PRIVA 702.74 1221501020 ROOM & BOARD SURGICAL PRIVATE 731.57 1111501021 ROOM & BOARD SURGICAL SEMI-PRI 667.76 1211501055 ROOM & BOARD SNF 506.11 1601501057 ROOM & BOARD ICF 420.07 1601511006 ROOM & BOARD PCU 1268.48 2091524009 OBSERVATION/HOUR MED/SURG 26.31 7621524012 OBSERVATION/HOUR MEDICAL 28.61 7621524013 OBSERVATION/HOUR TELE 38.01 7621524015 OBSERVATION/HOUR PEDS 36.28 7621524018 OBSERVATION/HOUR OB 29.27 7621524021 OBSERVATION/HOUR SURGICAL 27.81 7621524022 OBSERVATION/HOUR PCU 52.86 7621524023 OBSERVATION/HOUR ICU 67.68 762900088 PHYSICAL EXAM-ANNUAL 108.34 969900178 99283 ER-OB/GYN SERVICE FEE 229.67 450900185 99282 ER-SPECIALTY SERVICE FEE 130.57 450900194 99285 ER-TRAUMA SERVICE FEE 1275.79 450
1
900227 99281 EMERGENCY ROOM 86.12 450900243 99284 ER-OBSERVATION SERVICE FEE 386.41 450901021 A4565 SLING ARM ENVELOPE SML 28.12 271901022 A4565 SLING ARM ENVELOPE MED 28.12 271901056 A4649 ANOSCOPE DISP 11.52 272901152 A4649 STRAP CLAVICLE-SMALL 81.83 271901153 A4649 STRAP CLAVICLE-MEDIUM 81.83 271901154 A4649 STRAP CLAVICLE-LARGE 81.83 271901155 A4649 STRAP CLAVICLE-XLARGE 81.83 271901223 A4565 SLING ARM ENVELOPE LGE 28.12 271901224 A4565 SLING ARM ENVELOPE XLGE 28.12 271901282 A4649 CATHETER BARTHOLIN GLAND 10/12 109.60 272902000 A4649 MORGAN MEDI-FLO LENS 127.52 272910202 A4649 MORGAN LENS DELIVERY SET 36.98 272910221 A4649 SPANDAGE MTF2 /FT 6.08 272910222 A4649 SPANDAGE MTO1 /FT 6.08 272910223 A4649 SPANDAGE MTO2 /FT 6.08 272910224 A4649 SPANDAGE MTO3 /FT 6.08 272910225 A4649 SPANDAGE MTO4 /FT 6.08 272910226 A4649 SPANDAGE MTO5 /FT 6.08 272910227 A4649 SPANDAGE MTO6 /FT 6.08 272910228 A4649 SPANDAGE MTO7 /FT 6.08 272910229 A4649 SPANDAGE MT22 /FT 6.08 272910230 A4649 SPANDAGE MTO8 /FT 6.08 272910942 A4649 SET ADMIN GRAVITY FLOW 40.70 272911010 A4649 SPONGE RHINO ROCKET XLGE 94.05 272911270 A4649 GAUZE SURGITUBE 5/8/2FT 1.18 272911272 A4649 GAUZE SURGITUBE 1/2FT 1.47 272911300 A4649 SPONGE RHINO ROCKET SML 63.95 272911500 A4649 SPONGE RHINO ROCHET MED 72.14 272911800 A4649 SPONGE RHINO ROCKET LGE 83.62 272912140 A4649 LARYNGEAL MASK AIRWAY S-4 262.41 272912142 A4649 PACK NASAL RHINO 5.5CM ANT #55 238.94 272912147 A4649 PACK NASAL RHINO 7.5CM A-P BIL 170.47 272912149 A4649 PACK NASAL RHINO 7.5CM A-P BIL 564.63 272912150 A4649 LARYNGEAL MASK AIRWAY S-5 262.41 272920151 99201 URGENT CARE FEE 69.46 4561100049 MED REC COPIES </=10 COPIES 24.15 9991100064 MED REC COPIES >10-PER PAGE 2.36 9991104001 ITEMIZED BILLING=1-5COPIES 6.38 9991104002 ITEMIZED BILLING=>5-PER COPY 0.96 999
2
1195001 HOSPITAL BIRTH CERTIFICATE 6.38 9991195002 CERTIFICATION OF DEATH 3.20 9991300440 A4649 BILIRUBIN THERAPY 25.28 2721303336 A4649 MASK BILIRUBIN 26.85 2701310449 A4649 CANNULA NASAL CPAP SZ-0 101.68 2721310450 A4649 CANNULA NASAL CPAP SZ-1 101.68 2721310451 A4649 CANNULA NASAL CPAP SZ-2 101.68 2721332100 A4649 TRAY PER-Q-CATH SINGLE-LUMEN 2 252.30 2721335000 A4649 TRAY NEO V-CATH SINGLE-LUMEN 2 640.89 2721370742 A4649 CATHETER SUCTION ARGYLE 10FR 76.80 2721392585 92585 NB HEARING SCREEN 2ND STEP 126.77 4711392587 92587 NB HEARING SCREEN IST STEP 165.55 4711395001 A4649 PEDS INTUBATION KIT 3.0 32.89 2721395002 A4649 PEDS INTUBATION KIT 3.5 32.89 2721395003 A4649 IV PUMP SET (SYRINGE) 34.30 2721395004 A4649 IV PUMP SET (TUBING) 28.58 2721395005 A4649 MICROBORE 60 EXT SET 11.20 2721395006 A4649 PEDS INTUBATION KIT 2.5 44.02 2721395007 A4649 T-CONNECTOR WITH M.L.S. 7.93 2721396001 A4649 MASK OXYGEN-INFANT 26.80 2721410060 10060 I&D ABSCESS; SIMPLE OR SINGLE 187.43 9401411042 11042 DEBRIDE SUBQ TISSUE 20 SQ CM/< 327.64 9401411043 11043 DEBRIDE MUSC/FASCIA 20 SQ CM/< 327.64 9401411044 11044 DEBRIDE BONE 20 SQ CM/< 956.50 9401411045 11045 DEB SUBQ TISSUE ADD 20 SQ CM 62.49 9401411046 11046 DEB MUSC/FASCIA ADD 20 SQ CM 133.38 9401411047 11047 DEB BONE ADD 20 SQ CM 237.41 9401429105 29105 LONG ARM SPLINT (SHOULDER HAND 153.97 9401429125 29125 SHORT ARM SPLINT STATIC 103.69 9401429126 29126 SHORT ARM SPLINT DYNAMIC 126.59 9401429130 29130 FINGER SPLINT STATIC 72.86 9401429131 29131 FINGER SPLINT DYNAMIC 84.87 9401429240 29240 STRAPPING SHOULDER 113.24 9401429260 29260 STRAPPING ELBOW/WRIST 96.25 9401429280 29280 STRAPPING HAND/FINGER 94.21 9401429505 29505 LONG LEG SPLINT (THIGH/ANKLE) 191.47 9401429515 29515 SHORT LEG SPLINT (CALF/FOOT) 129.94 9401431500 31500 INTUBATION 150.17 9401431603 31603 TRACHEOSTOMY EMERG TRANSTRCHL 748.30 9401431605 31605 TRACHEOSTOMY EMERG CRICOTHYRD 748.30 9401431622 31622 DX BRONCOSCOPE W/ WASH 1220.96 920
3
1431623 31623 DX BRONCOSCOPE W/ BRUSH 1220.96 9201431624 31624 DX BRONCOSCOPE W/ LAVAGE 1220.96 9201436420 36420 VEIN ACCESS CUTDOWN <1 YR 152.44 9201436450 36450 EXCHNG BLOOD TRNSFUSE NEWBORN 344.02 9401436625 36625 ARTERIAL CATH/CANNULA CUTDOWN 247.32 9201443753 43753 NG/OG PLACEMENT 59.94 9401451701 51701 INSERT BLADDER CATHETER 152.44 9401451702 51702 FOLEY OR I&O CATH 77.77 9401486580 86580 TB SKIN TEST 20.73 9201490471 90471 IMMUNIZATION 1 VACCINE 24.76 7711490472 90472 IMMUNIZATION EACH ADD VACCINE 16.95 7711492950 92950 CODE 72 (ARREST) PCV 275.56 9401492953 92953 TEMP TRANCUTANEOUS PACING 544.46 9201492960 92960 DEFIBRILLATION/CARDIOVERSION 544.67 9401496360 96360 IV INFUS HYDR;31 MIN TO 1 HR 96.43 9401496361 96361 IV INFUS HYDR;EA ADD HOUR 35.19 9401496365 96365 IV INFUS TX; UP TO 1 HOUR 117.27 9401496366 96366 IV INFUS TX;EA ADD HOUR 47.57 9401496367 96367 IV INFUS TX; ADD DRUG UP 1 HR 70.36 9401496368 96368 IV INFUS TX;CONCURRENT INFUS 39.09 9401496372 96372 TX INJ SQ OR IM 28.01 9401496374 96374 TX INJ IV 80.14 9401496375 96375 TX IV EA ADD IV NEW DRUG 47.57 9401496376 96376 TX INJ EA ADD IV SAME DRUG 35.84 9401596401 96401 CHEMO ANTINEO NONHORMON SQ/IM 101.87 2801596402 96402 CHEMO ANTINEO HORMON SQ/IM 46.65 2801596409 96409 CHEMO IV PUSH SGL/INIT DRUG 190.93 2801596411 96411 CHEMO IV PUSH EA ADD DRUG 101.87 2801596413 96413 CHEMO IV 1 HR SGL/INIT DRUG 308.99 2801596415 96415 CHEMO IV EACH ADDL HOUR 46.65 2801596416 96416 CHEMO IV > 8 HOURS W/PUMP 308.99 2801596417 96417 CHEMO IV DIFF DRUG 1 HOUR 46.65 2801596420 96420 CHEMO INTRA-ARTERIAL PUSH 308.99 2801596422 96422 CHEMO INTRA-ARTERIAL 1 HOUR 308.99 3351596423 96423 CHEMO INTRAARTERIAL EA ADD HR 46.65 2801596425 96425 CHEMO ARTERIAL > 8HRS W/PUMP 308.99 2801596446 96446 CHEMO PERITONEUM VIA PORT 308.99 2801596450 96450 CHEMO CNS W/ SPINAL PUNCTURE 308.99 2801596521 96521 REFILL & MAINTAIN PUMP 190.93 2801596523 96523 IRRIGATE DRUG DELIVERY DEVICE 61.68 2801596542 96542 CHEMO INTRAVTRCL VIA RESERVOIR 190.93 280
4
1600028 DELIVERY ROOM 904.64 7221600044 59025 FETAL NON-STRESS TEST 164.59 7201600047 L&D-MAJOR SURGERY 1ST HOUR 1564.16 3601600105 LR-OUTPT OBSERVATION NO DELIVE 244.58 7211600110 ABC DELIVERY 1027.17 7241600120 L&D-MAJOR SURGERY ADD 15 MIN 260.68 3601600135 A4649 TUBE ENDOTRACH W/ HOLDER 3.5MM 44.91 2721600190 A4649 TUBE ENDOTRACH UNCUFF 2.0MM 17.55 2721600250 LABOR SPECIALTY CARE 1494.99 7211600291 A4649 LARYNGOSCOPE FIBEROPTIC 281.13 2721600350 LABOR CARE 719.33 7211600500 A4649 BALLOON POSTPARTUM BAKRI 1464.42 2721600709 A4649 KIT FETAL SCALP PH 15.34 2721600805 A4649 AMNIHOOK AMNIOTIC MEMBRANE 11.26 2721600835 A4649 RESUSCITATOR T-PIECE INFANT 56.62 2721600836 A4649 TUBING RESUSCITATION T-PIECE 81.86 2721600837 A4649 MASK T-PIECE 50MM 81.86 2721600838 A4649 GAS LINE T-PIECE LONG 75.05 2721600844 A4649 ELECTRODE FETAL SCALP 9.33 2721601463 A4649 PRESSURE INFUSOR BTA 116.72 2721601850 A4649 NEEDLE SPINAL 18GAX5.0 73.82 2721604001 A4649 TUBE ENDOTRACH W/ HOLDER 2.5MM 47.16 2721607000 A4649 SENSOR SPO2 (NONIN)-NEO/ADT 84.02 2721610027 A4649 CATHETER IUP MONITORING 258.33 2721610110 A4649 LARYNGEAL MASK AIRWAY SZ-1 269.28 2721610115 A4649 LARYNGEAL MASK AIRWAY SZ-1.5 269.28 2721610130 A4649 LARYNGEAL MASK AIRWAY SZ-3 269.28 2721611654 A4649 MECONIUM ASPIRATOR 34.02 2721611688 A4649 KIT OB VACUUM DELIVERY 384.55 2721611865 J3490 BABY SHAMPOO 120ML 4.21 2501612317 A4649 SET EXTENSION MICROBORE QUAD-L 60.75 2721612509 A4649 TRAY GENERAL CATHETERIZATION 315.03 2721616922 A4649 SENSOR SPO2 (MASIMO)-NEO/ADT 133.68 2721620752 A4649 BLADE SURGICAL CLIPPER #9660 25.84 2721663800 A4649 MASK T-PIECE 42MM 81.86 2721700007 A4649 CATHETER BALLOON VERI PACE 885.53 2721700009 A4649 LEAD INTRO SUBCLAVIAN 8FR 132.38 2721700010 A4649 LEAD INTRO SUBCLAVIAN 10.5FR 625.91 2721700011 A4649 LEAD INTRO SUBCLAVIAN 9FR 1277.91 2721700019 A4649 ISOLATION CART 12.32 2701700030 A4649 PAD DEFIBRILLATOR 35.22 272
5
1700032 A4649 ARMBOARD W/ COVER 9 3.96 2721700033 A4649 ARMBOARD W/ COVER 18 5.60 2701700041 A4649 SYRINGE ECCENTRIC TIP 60CC 4.33 2721700042 A4649 SYRINGE INSULIN 1CC M/FINE 1.30 2701700043 A4649 AIR MATTRESS MACH/D 13.58 2701700047 B4082 TUBE NASOGAST W/ SENT 18FR 19.35 2721700067 A4649 NEEDLE SPINAL 18GAX3-1/2 14.45 2721700069 A4649 NEEDLE SPINAL 20GAX3-1/2 9.19 2721700070 A4649 NEEDLE SPINAL 22GAX3-1/2 10.32 2721700079 A4649 BAG BODY CADAVER-PEDS 72.16 2701700085 A4649 CATHETER RADIAL ARTERY 55.98 2721700086 A4649 TRAY CATH C/V 3-LUMEN 7FR 20CM 859.34 2721700088 A4649 TUBING PENROSE 1X18 5.16 2721700092 A4649 SYRINGE ASCEPTO DISP 29.51 2721700094 A4649 TUBING PENROSE 5/16X18 5.19 2721700095 A4649 TUBING PENROSE 3/8X18 10.67 2721700097 A4649 SYRINGE IRRIG C/TIP 50CC 4.08 2721700100 A4649 BAG BILE 18.39 2721700101 A4649 GLOVES EXAM LTX PDLESS SML 0.66 2721700102 A4649 STERI-STRIP 1/2X4 8.12 2721700103 A4649 CATH ANGIOCATH 20GAX2 7.47 2721700104 A4649 TUBE ENDOTRACH W/CUFF 3.5M 14.23 2721700105 A4649 NUGAUZE PLAIN 1X5YD 27.60 2721700107 A4649 TUBE ENDOTRACH W/CUFF 6MM 18.86 2721700108 A4649 TUBE ENDOTRACH W/CUFF 9.5M 25.97 2721700109 A4649 TUBE ENDOTRACH W/CUFF 8MM 22.53 2721700110 A4649 CATH ANGIOCATH 22GAX1 7.69 2721700111 A4649 TUBE ENDOTRACH W/CUFF 7.5MM 19.91 2721700113 A4649 TUBE ENDOTRACH W/CUFF 7MM 21.70 2721700114 A4649 CATH ANGIOCATH 24GAX3/4 8.79 2721700115 L0120 CERVICAL COLLAR FOAM LGE 50.19 2741700122 A4649 GLOVES EXAM LTX PDLESS MED 0.66 2721700126 A4649 COLOSTOMY BAG-PEDS 23.38 2721700131 A4649 BANDAGE ELASTOPLAST 4X5YD 26.02 2701700140 A4649 BAG BODY CADAVER-WHITE 62.75 2711700141 A4649 NUGAUZE IODOFORM 1X5YD 32.35 2721700143 A4649 TUBE STOMACH 18FRX50 4.64 2721700144 A4649 TUBE TRACHEOSTOMY 36FR SZ-8 527.33 2721700145 A4649 STERI-STRIP 1/4X4 8.60 2721700146 A4649 CATH ANGIOCATH 18GAX1-1/4 7.94 2721700147 A4649 TUBE FEEDING 8FRX42 5.16 272
6
1700149 A4649 TUBE ENDOTRACH W/CUFF 6.5M 23.66 2721700150 A4649 TUBE ENDOTRACH W/CUFF 8.5M 26.69 2721700151 A4649 BUTTERFLY 25GA 3/4X12 6.65 2721700152 A4649 TUBE ENDOTRACH W/CUFF 9MM 24.35 2721700153 A4649 CATHETER SUCTION 18FR 22 2.61 2721700154 A4649 SLIPPER NON-SKID TODDLER 2.82 2711700155 A4649 GLOVES EXAM LTX PDLESS LGE 0.66 2721700156 A4649 NUGAUZE IODOFORM 8X10YD 189.09 2721700157 A4615 CANNULA NASAL O2 7FT-PEDS 9.42 2721700158 A4615 CANNULA NASAL O2 7FT-INFANT 13.76 2721700160 A4649 SLIPPER NON-SKID SMALL 2.82 2711700164 A4649 SLIPPER NON-SKID ADULT XLGE 4.08 2711700165 A4649 TUBE ENDOTRACH W/CUFF 4.5M 31.54 2721700168 A4649 TUBE ENDOTRACH W/CUFF 10MM 23.91 2721700169 A4649 PAD TELFA 3X8 0.54 2721700170 B4082 TUBE NASOGAST W/ SENT 14FR 14.55 2721700171 A4649 TUBE NASOGAST W/ SENT 16FR 14.89 2721700172 A4624 CATHETER SUCTION 14FR 22 3.06 2721700173 A4649 NUGAUZE PLAIN 2 40.83 2721700174 A4649 CATH ANGIOCATH 18GAX2 6.11 2721700175 A4649 SET UNDERWATER CHEST DRAIN 73.14 2721700176 A4649 CATHETER SUCTION 10FR 22 3.13 2721700177 A4649 TUBE ENDOTRACH W/CUFF 5MM 22.02 2721700178 A4649 NUGAUZE PLAIN 1/4X5YD 27.05 2721700179 A4649 TUBE ENDOTRACH W/CUFF 4MM 32.01 2721700182 A4649 NUGAUZE PLAIN 1/2X5YD 30.32 2721700184 A4649 TUBE ENDOTRACH W/CUFF 5.5M 23.06 2721700185 A4649 TUBE ENDOTRACH UNCUFF 3.0MM 12.96 2721700188 A4649 NUGAUZE IODOFORM 2X5YD 54.39 2721700189 A4649 TUBE TRACHEOSTOMY 39FR SZ-10 305.68 2721700192 A4649 TUBE TRACHEOSTOMY 30FR SZ-6 414.07 2721700193 B4082 TUBE NASOGAST W/ SENT 12FR 13.64 2721700196 A4649 IMMOBILIZER KNEE 26 367.98 2701700197 A4649 IMMOBILIZER KNEE 18 277.19 2701700200 A4649 COBAN 1 8.65 2711700202 A4649 COBAN 2 13.99 2711700204 A4649 COBAN 3 17.96 2711700241 A6449 GAUZE KERLIX 4.5 8.31 2721700249 A4649 STYLET INTUBATING 6FR 8.77 2721700262 B4082 TUBE NASOGASTRIC 20FR-ADULT 583.05 2721700308 A4649 BANDAGE SLING 6.43 271
7
1700380 A4649 GAUZE GELFOAM 31.03 2721700384 A4649 MASK OXYGEN-PEDS 13.03 2721700385 A4649 MASK AEROSOL-ADULT 13.03 2721700389 A4565 SLING ARM 17.00 2731700431 A4649 KIT MONITOR SORENSON 119.53 2711700464 A4649 CATHETER SUCTION 5/6FR 4.59 2721700466 A4649 CATHETER FOGARTY 2FR 166.97 2721700482 A4649 TRAY C/S PACK 136.21 2721700529 A4649 NUGAUZE IODOFORM 1/2X5YD 32.01 2721700573 A4649 STAPLE SKIN EXTRACTOR 44.30 2721700589 A6402 GAUZE DRESSING 2X2 2.47 6231700605 A6402 GAUZE DRESSING 4X4 2.47 6231700619 A6257 DRESSING TRANSP 2X3 1.03 2721700620 A6257 DRESSING TRANSP 4X5 3.24 2721700662 A4316 TRAY URETHRAL CATHETERIZATION 18.47 2721700663 A4649 CATHETER THORACIC 10FR 23.30 2721700673 A4649 ETHILON BLK MONO 30 3-0 20.84 2721700676 A4649 SILK BLK BR 18 3-0 16.14 2721700683 A4649 SILK BLK BR 18 4-0 21.25 2721700685 A4649 SILK BLK BR 18 2-0 20.45 2721700695 A4649 TUBE IV EXTENSION 4.36 2721700699 A4649 ETHILON BLK MONO 18 4-0 44.44 2721700796 A4649 TUBE CONNECTOR PLASTIC 2.25 2721700800 A4649 MASK NON-REBREATHING-ADULT 13.35 2721700860 A4649 MINICATH 19GA 7/8X12 9.48 2721700928 A4649 PAD ABDOMINAL 2.47 2721700935 A4649 NUGAUZE IODOFORM 1/4X5YD 29.14 2721700944 A4649 PAD EYE DRESSING 2.47 2721701024 A4649 PROTECTION PACK 7.71 2721701076 A4649 SET IV CARTRIDGE-ADULT 13.18 2721701078 A4649 SET IV CARTRIDGE-NEONATAL 13.18 2721701080 A4649 SET HALF Y MEDSYSTEM III 41.13 2721701081 A4649 SET 2 Y MEDSYSTEM III 77.65 2721701108 A4649 SET IV BLOOD-VI9 16.17 2721701124 A4649 SET ENEMA DISP 9.69 2721701249 A4649 SET METRI BURRETRO 37.96 2721701280 A4649 SET IV-PEDS 7.62 2721701322 A4649 SET IV-ADULT 8.57 2721701348 A4649 SET TRACHEOSTOMY CARE 14.69 2721701421 A4649 SITZ BATH 20.65 2721701426 A4649 CAPNOMETER-ADULT 97.20 272
8
1701451 A4649 COLOSTOMY FLANGE-PEDS 30.01 2721701461 A4649 COLOSTOMY FLANGE-ADULT 37.24 2721701645 A4649 SET UP TRACTION EQUIPMENT 61.55 2701701669 A4649 ETHILON BLK MONO 18 3-0 43.55 2721701744 A4649 TRAY BURN DRESSING 24.60 2721701843 A4649 TRAY IRRIGATION 12.06 2721701876 A4649 TRAY MINOR SUTURE 27.09 2721701921 A4649 FILTERLINE H ADULT/PEDS 101.03 2721701923 A4649 FILTERLINE H INFANT/NEONATE 129.86 2721702007 A4649 TRAY LUMBAR PUNCTURE-ADULT 51.90 2721702049 A4649 TRAY LUMBAR PUNCTURE-PEDS 57.75 2721702261 A4649 TRU/MEASURE URI-METER W/BG 19.87 2721702288 A4649 TUBE FEEDING 5FRX15 4.81 2721702320 A4649 TUBE O2 CONNECTING 4.54 2721702361 A4649 TUBE STOMACH 14FRX50 4.91 2721702363 A4649 TUBE STOMACH 16FRX50 5.12 2721702365 A4649 TUBE FEEDING 8FRX15 5.38 2721702370 A4212 STYLET INTUBATING 14FR 21.21 2721702372 A4649 STERI-STRIP 1/4X3 5.13 2721702373 A4649 SLIPPER NON-SKID ADULT MED 4.56 2701702376 A4649 PAD TELFA 3X4 0.86 2721702377 A4649 NEEDLE SPINAL 22GAX1-1/2 11.73 2721702379 A4620 MASK OXYGEN-ADULT 4.55 2721702380 A4649 CATH ANGIOCATH 16GAX2 6.45 2721702381 A4649 BUTTERFLY 25GA 3/8X3 5.70 2721702383 L0120 CERVICAL COLLAR FOAM MED 62.75 2741702384 A4649 CATHETER SUCTION 8FR 15 3.93 2721702385 A4649 BAG BODY CADAVER-YELLOW 56.62 2711702389 A4649 BANDAGE ELASTOPLAST 3X5YD 32.68 2721702445 A4554 UNDERPADS 2.47 2711702452 A4649 CATHETER UMBILICAL ART 5FR 12.11 2721702460 A4520 BRIEF INCONTINENT ADULT 4.58 2711702486 A4649 GAUZE XEROFORM 5X9 6.29 2721702741 A4649 BANDAGE CASTING TAPE 3X4YD 19.86 2721702742 A4649 BANDAGE CASTING TAPE 4X4YD 18.72 2721702743 A4649 BANDAGE CASTING TAPE 5X4YD 41.38 2721703010 A4649 HEEL/ELBOW PROTECTOR 80.88 2711703036 A4649 WOUND CARE-UNDERPAD QUILTED 17.18 2721703302 A4357 BAG URINARY DRAINAGE 22.51 2721703369 A4649 PAD EYE SHIELD 6.91 2721703591 A4649 CANNULA OXYGEN-ADULT 11.48 272
9
1703744 A4649 BAG BODY CADAVER-INFANT 20.90 2711703815 A4649 TOWEL SURGICAL ABSORBENT 5.28 2721704128 A4649 IV EXTENSION W/ STP COCK 12.17 2721704144 A4649 SET IV EXTENSION TUBING W/ CLA 4.19 2721704186 A4649 MASK ISOLATION (100) 11.48 2701704320 A4649 TUBE GASTROSTOMY 14FR 20CC 127.35 2721704354 A4649 TUBE GASTROSTOMY 24FR 20CC 131.45 2721704383 A4346 CATHETER FOLEY 24FR 30CC 3-WAY 123.83 2721704384 A4649 KIT CATHETER CARE 0.75 2721704391 A4346 CATHETER FOLEY 10FR 3CC 18.81 2721704409 A4346 CATHETER FOLEY 12FR 5CC 18.81 2721704425 A4346 CATHETER FOLEY 14FR 5CC 28.10 2721704441 A4346 CATHETER FOLEY 16FR 5CC 21.17 2721704466 A4346 CATHETER FOLEY 18FR 5CC 29.01 2721704482 A4346 CATHETER FOLEY 20FR 5CC 20.94 2721704508 A4346 CATHETER FOLEY 22FR 5CC 26.54 2721704524 A4346 CATHETER FOLEY 24FR 5CC 18.13 2721704540 A4346 CATHETER FOLEY 26FR 5CC 18.81 2721704565 A4346 CATHETER FOLEY 28FR 5CC 18.81 2721704607 A4346 CATHETER FOLEY 12FR 30CC 24.15 2721704623 A4346 CATHETER FOLEY 14FR 30CC 26.00 2721704649 A4346 CATHETER FOLEY 16FR 30CC 22.43 2721704664 A4346 CATHETER FOLEY 18FR 30CC 29.80 2721704680 A4346 CATHETER FOLEY 20FR 30CC 20.94 2721704681 A4649 CAPNOLINE H O2 NASAL PEDS 106.58 2721704689 A4649 CAPNOLINE H ADULT 94.96 2721704691 A4649 CAPNOLINE H INFANT/NEONATE 94.96 2721704706 A4346 CATHETER FOLEY 22FR 30CC 21.96 2721704722 A4346 CATHETER FOLEY 24FR 30CC 21.96 2721704748 A4346 CATHETER FOLEY 30FR 35CC 21.96 2721704763 A4346 CATHETER FOLEY 28FR 30CC 20.71 2721704789 A4346 CATHETER FOLEY 30FR 30CC 20.71 2721704821 A4346 CATHETER FOLEY 10FR 5CC 24.15 2721704831 A4615 CANNULA NASAL JR PEDS 404.34 2721704832 A4649 CIRCUIT AIRVO 2 OPTIFLOW 566.99 2721704891 A4649 SET CHEST TUBE T-Q 16FR 14CM 684.31 2721705000 A4649 STOPCOCK 3-WAY W/O EXTN 4.36 2721705067 A4649 DIAPER PAMPERS-TODDLER 10.83 2711705083 A4649 TRAY SUTURE REMOVAL DISP 6.84 2721705109 A4649 SLIPPER NON-SKID ADULT LGE 4.11 2711705141 A4649 BREAST PUMP 21.37 270
10
1705182 A4649 TUBE LUKENS 14FR 7.74 2721705240 A4649 SYRINGE BULB 14.42 2721705422 A4649 CATHETER PLUG 2.47 2721705803 A4649 FELT ORTHO 1/4 24.97 2701705804 A4649 FELT ORTHO 1/2 67.75 2701705948 A4649 SET MONITORING FEM/AORTIC 166.98 2721706008 A4649 CRASH CART 98.53 2701706404 A4213 SYRINGE CATHETER TIP 60CC DISP 5.43 2721706641 A4649 ETHILON BLK MONO 18 2-0 21.85 2721707316 A4649 TRAY FOLEY CATH 16FR 5CC 97.42 2721707400 A4649 SET CATH RADIAL ART 30FR 20GA 199.61 2721707431 A4649 TRAY CATH C-V 2-LUMEN 5FR 8CM 656.39 2721707432 A4649 SET CATH FEMORAL ART 4FR 18CM 226.97 2721707438 A4649 SET CATH DRAIN PL/PP 8.5F 15CM 665.87 2721708640 A4649 CAPNOLINE H O2 NASAL ADULT 106.58 2721709030 A4649 INJECTION CAP 1.52 2721709034 A4649 SPECULUM VAGINAL SML DISP 1.31 2721709038 A4649 SPECULUM VAGINAL MED DISP 1.39 2721709045 A4649 SPECULUM VAGINAL LGE DISP 1.37 2721710000 A4649 BAG SPIKE ADAPTER NEEDLE-FREE 20.92 2721710010 L0172 CERVICAL COLLAR PHILA SML 17.44 2741710015 A4649 AIRWAY ORAL 40MM-NEONATAL 1.56 2721710016 A4649 AIRWAY ORAL 60MM-PEDS 1.44 2721710017 A4649 AIRWAY ORAL 80MM-ADULT 2.18 2721710018 A4649 AIRWAY ORAL 90MM-ADULT 1.84 2721710019 A4649 AIRWAY ORAL 100MM-ADULT 1.84 2721710028 L0172 CERVICAL COLLAR PHILA MED 17.44 2741710036 L0172 CERVICAL COLLAR PHILA LGE 17.44 2741710120 A4649 ARMBOARD W/ COVER 2.5 5.63 2711710121 A4649 ARMBOARD W/ COVER 4 5.33 2711710122 A4649 ARMBOARD W/ COVER 5 6.57 2711710123 A4649 ARMBOARD W/ COVER 7 8.95 2711710136 A4649 TUBE SALEM SUMP W/ SENT 16FR 2.57 2721710146 A6448 BANDAGE ACE 2X5YD 4.42 2721710147 A6449 BANDAGE ACE 3X5YD 9.39 2721710148 A4649 BANDAGE ACE 4X5YD 11.03 2721710149 A4649 BANDAGE ACE 6X5YD 16.71 2721710150 A6404 GAUZE STRETCH 2 2.91 2721710151 A6404 GAUZE STRETCH 3 3.64 2721710152 A6404 GAUZE STRETCH 4 4.03 2721710153 A6404 GAUZE STRETCH 6 2.47 272
11
1710156 A4649 BANDAGE WEBRIL 2 2.57 2721710157 A4649 BANDAGE WEBRIL 3 3.64 2721710158 A4649 BANDAGE WEBRIL 4 1.67 2721710159 A4649 BANDAGE WEBRIL 6 7.74 2721710160 A4649 CATHETER THORACIC 20FR 18.18 2721710161 A4649 CATHETER THORACIC 24FR 29.31 2721710162 A4649 CATHETER THORACIC 28FR 23.67 2721710163 A4649 CATHETER THORACIC 32FR 27.64 2721710164 A4649 CATHETER THORACIC 36FR 18.13 2721710165 A4649 CATHETER UMBILICAL ART 3.5FR 70.02 2721710193 A4649 DRESSING BIOPATCH 1X4MM 40.70 2721710194 A4649 DRESSING BIOPATCH 1X7MM 42.11 2721710215 A4649 BANDAGE ELASTOPLAST 2X5YD 14.27 2701710296 A4649 STOCKING THIGH HI-LENGTH-MED 42.14 2711710297 A4649 STOCKING THIGH HI-LENGTH-LGE 46.71 2701710304 A4649 PUMP ALTERNATING LEG PRESSURE 20.62 2711710309 A4649 BANDAGE CASTING TAPE 2X 4 YD 21.88 2721710310 A4649 BANDAGE CASTING TAPE 2X4YD 7.84 2721710311 A4649 BANDAGE CASTING TAPE 3X 4 YD 34.91 2721710312 A4649 BANDAGE CASTING TAPE 4X 4 YD 34.80 2721710313 A4649 BANDAGE CASTING TAPE 5X 4 YD 42.80 2721710314 A4649 BANDAGE PLASTER PARIS 6 25.57 2701710325 A4570 SPLINT ONE-STEP 2X10 51.52 2711710330 A4570 SPLINT ONE-STEP 3X12 59.77 2711710335 A4570 SPLINT ONE-STEP 4X15 88.00 2711710340 A4570 SPLINT ONE-STEP 5X30 135.07 2711710341 A4570 SPLINT ONE-STEP 5X45 167.06 2711710386 A4649 LIMB STABILIZER WEDGE 41.81 2711710387 A4649 VEST CRISS-CROSS RESTRAINT MED 125.82 2711710388 A4649 VEST CRISS-CROSS RESTRAINT LGE 125.82 2711710389 A4649 VEST CRISS-CROSS RESTRAINT XLG 125.82 2701710390 A4649 RESTRAINT CUFF WRIST 206.61 2711710391 A4649 RESTRAINT CUFF ANKLE 206.61 2711710392 A4649 HOLDER BREEZELINE PELVIC MED 86.27 2711710393 A4649 HOLDER BREEZELINE PELVIC LGE 86.27 2711710445 A4649 NEEDLE-FREE VALVE ALARIS 10.38 2721710486 A4649 KIT CATH INFANT 5FR 22.32 2721710487 A4649 KIT CATH PEDS 8FR 22.32 2721710499 A4649 CATHETER CONDOM 5.05 2721710500 A4346 CATHETER FOLEY 8FR 3CC 33.75 2721710600 A4649 KIT CEN/VEN ACCESS 2-LUMEN 9FR 711.87 272
12
1710668 A4649 SCALPEL BLADE #10 W/ HANDLE 6.08 2721710669 A4649 SCALPEL BLADE #11 W/ HANDLE 6.08 2721710671 A4649 SCALPEL BLADE #15 W/ HANDLE 6.08 2721710725 A4649 NEEDLE GRIPPER PORT-A-CATH 30.61 2721710733 A4649 CATHETER SUCTION DELEE 8FR 9.93 2721710752 A4649 CATHETER THORACIC 16FR 37.08 2721710850 L0120 CERVICAL COLLAR FOAM SML 21.99 2721711092 A4649 WOUND CARE-DRESSING COLOPLAST 61.99 2721711126 A6212 DRESSING TEGADERM F-A 5.5"X5.5 29.06 2721711127 A6237 DRESSING TEGADERM HDC 5.25"x6" 21.48 2721711128 A6238 DRESSING TEGADERM 6 3/4X6 3/8" 45.61 2721711130 A4649 ELECTRODE ECG PLIA-CEL-INFANT 2.94 2711711131 A4649 ELECTRODE EKG QUICK COMBO-PEDS 190.00 2711711132 A4649 ELECTRODE EKG QUICK COMBO-ADUL 190.00 2711711133 A4649 ELECTRODE LIFE PAK-ADULT 2.52 2721711218 A4649 GAUZE PETROLATUM 1/2X72 10.10 2721711280 A4649 GAUZE VASELINE PETROLATUM 3X9 3.82 2721711412 A4649 BUTTERFLY 23GA 3/4X12 4.89 2721711425 A4649 CATH ANGIOCATH 14GAX1-1/4 16.50 2721711444 A4649 KIT IV PREP W/ CHLORAPREP 2.18 2721711610 A4649 MASK AEROSOL-PEDS 6.81 2721711630 A4649 MASK MULTI-VENT-PEDS 25.96 2721711633 A4649 MASK MULTI-VENT-ADULT 12.57 2721711634 A4649 MASK NON-REBREATHING-PEDS 10.45 2721711653 A4649 LANCET FINGER BLOOD 0.88 2721711692 E0445 OXISENSOR-ADULT 116.19 2711711772 A4649 UNDERGARMENT MATERNITY 15.66 2711711774 A4649 PAD TELFA 2X3 0.50 2721711880 A4649 DRAPE THYROID SHEET CONVERTORS 63.65 2721711955 Q4049 SPLINT FINGER ALUM 1/2X9 10.64 2701711965 Q4049 SPLINT FINGER ALUM 3/4X18 6.75 2701711970 Q4049 SPLINT FINGER ALUM 1X18 26.18 2701712075 A4649 STERI-STRIP 1/8X3 4.11 2721712085 A4649 STOCKINETTE TUBULAR 2 /YD 1.71 2701712086 A4649 STOCKINETTE TUBULAR 3 /YD 2.69 2711712087 A4649 STOCKINETTE TUBULAR 4 /YD 3.14 2711712088 A4649 STOCKINETTE TUBULAR 6 /YD 4.18 2721712090 A4649 STOCKING ANTI-EMBOLECTOMY-SML 14.11 2711712091 A4649 STOCKING ANTI-EMBOLECTOMY-MED 33.69 2711712092 A4649 STOCKING ANTI-EMBOLECTOMY-LGE 17.12 2711712093 A4649 STOCKING ANTI-EMBOLECTOMY-XLGE 29.06 271
13
1712095 A4649 STOCKING THIGH HI-LENGTH-SML 64.10 2701712096 A4649 STOCKING THIGH HI-LENGTH-MED 42.14 2701712097 A4649 STOCKING THIGH HI-LENGTH-LGE 46.71 2711712140 A4649 TRACTION STRIP (SKIN TRAC) SML 120.57 2711712145 A4649 TRACTION STRIP (SKIN TRAC) MED 68.20 2711712150 A4649 TRACTION STRIP (SKIN TRAC) LGE 165.95 2711712160 A4649 SUPPORT LUMBOSACRAL SML 307.78 2711712161 A4649 SUPPORT LUMBOSACRAL MED 153.43 2711712162 A4649 SUPPORT LUMBOSACRAL LGE 136.38 2711712224 A4649 SET ENTERAL PUMP W/ BAG 1000CC 29.23 2721712325 A4213 SYRINGE LUER LOCK TIP 60CC 2.73 2721712507 A4649 TRAY BONE MARROW BIOPSY/ASP 177.22 2721712595 A4649 TUBE CONICAL GRADUATED 50ML 5.33 2721712724 B4082 TUBE NASOGASTRIC 8FR 88.04 2721712729 A4649 TUBE SALEM SUMP W/ SENT 10FR 20.59 2721712730 A4649 TUBE SALEM SUMP W/ SENT 12FR 20.99 2721712731 A4649 TUBE SALEM SUMP W/ SENT 14FR 10.51 2721712733 A4649 TUBE SALEM SUMP W/ SENT 18FR 11.07 2721712829 A4649 TUBE ENDOTRACH W/ HOLDER 2.0MM 16.92 2721712830 A4649 TUBE ENDOTRACH UNCUFF 2.5MM 8.69 2721712836 A4649 TUBE ENDOTRACH W/ HOLDER 3.0MM 43.65 2721712838 A4649 TUBE ENDOTRACH UNCUFF 3.5MM 28.94 2721712895 A4649 TUBE TRACHEOSTOMY 26FR SZ-4 579.53 2721713035 A4649 IV EXTENSION W/ LUER LOCK PEDS 5.17 2721713041 A4554 UNDERPAD-PLUS 6.08 2711713050 A4649 URINE COLLECTOR-PEDS 6.08 2721713261 A4930 GLOVES SURGEON NEOPRENE SZ-6 7.55 2721713262 A4649 GLOVES SURG S-6 N/ALLERGENIC 7.22 2721713311 A4649 GLOVES SURG S-6.5 N/LATEX 10.26 2721713361 A4649 GLOVES SURG S-7 N/LATEX 10.26 2721713411 A4649 GLOVES SURG S-7.5 N/LATEX 10.26 2721713461 A4649 GLOVES SURG S-8 N/LATEX 12.64 2721713512 A4649 GLOVES SURG S-8.5 N/ALLERGIC 3.43 2721714261 A4649 CAPNOMETER-PEDS 97.20 2721714462 A4649 IMMOBILIZER KNEE 21 234.15 2701716921 E0445 OXISENSOR-INFANT 132.28 2711718301 A4649 LIMB HOLDER-FOAM CUFF 12.14 2711721420 A4649 VALVE PEEP-PEDS 28.88 2721723646 A4649 INTRODUCER INTUBATE 14FR 65CM 478.25 2721724601 A4649 TOOTHETTE SUCTION SYSTEM 12.45 2721726410 A4649 COLOSTOMY CLAMP-ADULT 17.19 272
14
1726441 A4649 IMMOBILIZER KNEE 20 234.15 2701728401 A4649 TUBE ENDOTRACH UNCUFF 4.0MM 43.84 2721728431 A4649 TUBE ENDOTRACH UNCUFF 4.5MM 43.44 2721728451 A4649 TUBE ENDOTRACH UNCUFF 5.0MM 47.05 2721730005 A4649 CATHETER DUAL LUMEN 11.5FRX13. 631.16 2721730007 A4649 CATHETER DUAL LUMEN 11.5FRX19. 670.36 2721730022 A4649 TRAY CATH C/V 3-LUMEN 7FR 15CM 859.36 2721730030 A4649 BLADE SCALPEL #10 1.30 2721730035 A4649 BLADE SCALPEL #11 1.53 2721730040 A4649 BLADE SCALPEL #12 0.82 2721730045 A4649 BLADE SCALPEL #15 1.53 2721730050 A4649 BLADE SCALPEL #20 1.17 2721730055 A4649 BLADE SCALPEL #21 1.23 2721730100 A4649 KIT VESSEL CATH 20GA 12CM 153.25 2721730289 A4649 NEEDLE SPINAL 25GAX3-1/2 11.05 2721730474 A4649 RESUSCITATOR-AMBU SET DISP-INF 107.40 2721730477 A4649 RESUSCITATOR-AMBU SET DISP-ADU 178.45 2721730479 A4649 RESUSCITATOR-AMBU SET DISP-PED 173.55 2721748768 A4623 CANNULA SHILEY 8.0MM DIC 15.20 2721750050 A4649 SET ADMIN IV-INFUSMAT TUBING 34.43 2721750051 A4649 SET EXTENSION-SYRINGE PUMP 19.90 2721753177 A4649 TRAY INTRO TRACHEO 5FR 29CM 941.38 2721756535 A4649 SET PNEUMOTHORAX 14FR 29CM 742.44 2721760059 L1830 IMMOBILIZER KNEE 16 232.20 2701760101 A4649 CALF GARMENT REGULAR 18 132.88 2711760102 A4649 CALF GARMENT LARGE 24 221.52 2711760105 A4649 CALF GARMENT X-LARGE 297.76 2711761733 A4649 DRESSING MEFIX 2X11YD 44.40 2721762482 A4649 WOUND CARE-DRESSING SACRAL 7X7 70.53 2721764101 A4649 COLOSTOMY BAG-ADULT 18.62 2721764800 A4649 SILK BLK BR 30 2-0 8.63 2721785083 A4649 EXTERNAL CSF DRAINAGE SYSTEM 788.58 2721787970 A4649 DUODERM DRESSING 2.5X2.5 30.08 2721787971 A4649 DUODERM DRESSING 6X6 47.25 2721790483 A4615 CANNULA NASAL JR INFANT 404.34 2721790743 A4649 TRAY CATH C-V 2-LUMEN 4FR 5CM 655.39 2721790940 A4649 WOUND CARE-DRESSING SACRAL 4X4 16.36 2721795004 A4649 PAD DUO THERM 14X20 DISP 43.46 2721795005 A4649 SPECIMEN MEASURE TOILET TOP 4.91 2721795006 A4649 KIT CATHETER FEMALE 47.30 2721795007 A4649 CATH ANGIOCATH 20GAX1-1/4 10.11 272
15
1795008 A4649 K MOD HEAT THERAPY PUMP 2.12 2721795120 A4649 DUODERM DRESSING 4X4 18.71 2721797000 A6222 TRAY GAUZE 4X4 4.46 2721997000 X-RAY COPY-FILM&IMAGING INIT 31.91 9991997001 X-RAY COPY-CD 6.38 9992000001 93880 US-EXT CAROTIDS COMPLETE BIL 219.51 9202000003 61050 CISTERN/LAT CERVIC W/O INJ 79.44 3202000004 76942 US-GUIDED NEEDLE PLACEMENT 378.82 4022000006 75984 X-RAY CONTROL CATH CHANGE 38.59 3202000012 76827 US-FETAL HEART PV/CW COMP 331.47 4022000015 61055 CISTERN/LAT CERVIC W/ INJ 777.99 3202000016 93882 US-EXT CAROTIDS UNIL/LIMIT 219.51 4022000019 50684 INJECTION OF URETER X-RAY 158.89 3202000021 68850 INJECT FOR TEAR SAC X-RAY 79.44 3202000022 73050 ACROMIOCLAVICULAR JT BIL 110.00 3202000024 61070 PUNCTURE SHUNT TUBING 158.89 3202000025 75630 ABD AORTOGRW/ BIL ILIOFEMORAL 2964.00 3232000028 92284 INJECT MYELOGRAM/CT LUMBAR 119.16 3202000032 38790 INJECT FOR LYMPHATIC X-RAY 158.89 3202000033 76825 US-FETAL HEART 2-D 489.38 4022000034 42550 INJECTION FOR SIALOGRAPHY 158.89 3202000035 49180 PERC NDL BX ABD/RETROPERI MASS 1218.55 3202000038 27093 HIP ARTHROGRAPHY INJ W/O ANEST 79.44 3202000046 51605 INJECT FOR URETHROCYSTOGRAPHY 103.02 3202000047 60100 THYROID BIOPSY PERCUTANEOUS 564.17 3202000048 74022 ABDOMEN INCL CHEST PA 110.00 3202000051 A4641 NM-RADIOPHARM COMPOUND 246.29 3432000055 50690 INJECT FOR URETEROPYELOGRAPHY 158.89 3202000059 51600 PREP FOR BLADDER X-RAY 79.44 3202000061 75989 ABSCESS DRAIN UNDER X-RAY 77.16 3202000063 74020 ABDOMEN COMP INC DECUB/ERECT 110.00 3202000064 76872 US-TRANSRECTAL 268.34 4022000067 76098 SURGICAL SPECIMEN 98.61 3202000068 76830 US-NON-OB TRANSVAGINAL 268.34 4022000070 73562 KNEE 3 VIEWS 110.00 3202000071 75600 CT-AORTO THORA W/O SERIA 2964.00 3232000076 76970 US EXAM FOLLOW-UP 138.53 4022000077 51610 INJECT URETHRA/BLADDER X-XRAY 79.44 3202000079 76818 US-BIOPHYSICAL PROFLW/NON-ST 315.70 4022000080 76998 US-GUIDE INTRAOPERATIVE 138.53 4022000086 73700 CT-LOWER EXT W/O CONTRAST 616.36 350
16
2000089 74000 ABDOMEN SINGLE AP VIEW 85.07 3202000091 72131 CT-LUMBAR SPINE W/O CONTRAST 668.45 3502000093 73701 CT-LOWER EXT W/ CONTRAST 688.72 3502000100 70371 BARIUM SPEECH EVAL COMPLEX 184.68 3202000103 50390 ASP/INJ RENAL CYST/PELV PERC 1218.55 3202000105 32200 DRAINAGE OF LUNG LESION 158.89 3202000109 19030 INJECTION FOR BREAST X-RAY 79.44 3202000115 43760 CHANGE GASTROSTOMY TUBE 158.89 3202000117 71021 CHEST 2VWS FR&LAT W/AP LORD 70.55 3242000118 31899 BRONCHOSCOPY INJECT X-RAY 79.44 3202000120 48102 PERC NEEDLE BIOPSY PANCREAS 1218.55 3202000125 32400 NEEDLE BIOPSY CHEST LINING 1218.55 3202000126 20206 NEEDLE BIOPSY MUSCLE 1218.55 3202000127 50200 BIOPSY OF KIDNEY 1218.55 3202000128 47001 NEEDLE BX LIVER AT PROCEDURE 255.20 3202000129 77077 JT SURVEY SINGLE VW 2/> JTS 110.00 3202000130 93505 BIOPSY OF HEART LINING 158.89 3202000132 32405 BIOPSY LUNG/MEDIASTINUM 1218.55 3202000135 50688 CHANGE URETER TUBE 158.89 3202000138 70490 CT-NECK SOFT TISSUE W/O CONT 293.91 3502000139 73565 KNEE BOTH STANDING AP 64.02 3202000140 72128 CT-THORACIC SPINE W/O CONTRST 668.45 3502000144 70491 CT-NECK SOFT TISSUE W/ CONTR 338.36 3502000146 75827 VEIN X-RAY CHEST 149.18 3202000147 73610 ANKLE COMPLETE MIN 3 VIEWS 110.00 3202000151 77012 CT-GUIDE NEEDLE BIOPSY 624.08 3502000152 76948 US-GUIDE OVA ASPIRATION 556.10 4022000162 73600 ANKLE 2 VIEWS 110.00 3202000402 74280 COLON AIR CONTRAST W/ BARIUM 162.40 3202000469 77072 BONE AGE STUDIES 95.71 3202000485 77073 BONE LENGTH STUDIES 101.50 3202000501 77075 BONE SURVEY COMPLETE 151.87 3202000527 77076 BONE SURVEY INFANT 60.91 3202000543 76499 BRONCHOGRAPHY BILATERAL 162.40 3202000568 76499 BRONCHOGRAPHY UNILATERAL 101.50 3202000600 71022 CHEST 2VS FR&LAT W/OBL PROJ 110.00 3242000626 71023 CHEST 2VS FRO/LAT W/FLUORO 127.62 3242000667 71010 CHEST SINGLE VIEW 85.07 3242000683 71020 CHEST TWO VIEWS 95.71 3242000725 74301 CHOLANGIOGRAM ADDL INTRAOP 121.78 3202000741 74300 CHOLANGIO/PANCREATO INTRAOP 101.50 320
17
2000808 74290 CHOLECYSTOGRAPHY ORAL CONTRST 101.50 3202000865 73000 CLAVICLE COMPLETE 95.71 3202000881 74270 COLON BAR ENEMA W/OR W/O KUB 174.79 3202000907 74430 CYSTOGRAPHY MIN 3 VIEWS 307.06 3202000960 A4641 KIT TECHNESCAN MAG3 2262.46 3432000964 73070 ELBOW 2 VIEWS 85.07 3202000980 73080 ELBOW COMPLETE MIN 3 VIEWS 68.73 3202001004 74210 BARIUM ESOPHAGUS & PHARYNX 117.72 3202001020 76499 PORTABLE BEDSIDE 20.31 3292001062 26010 DRAIN FINGER ABSCESS SIMPLE 656.37 3202001129 70140 FACIAL BONES LESS 3 VIEWS 68.73 3202001145 70150 FACIAL BONES COMP MIN 3 VWS 110.00 3202001175 A4649 PROBE COVER ECLIPSE 2.37X9.5 4.47 2722001186 73140 FINGERS MIN 2 VIEWS 85.07 3202001202 76080 FISTULA/SINUS TRACT STUDY 101.50 3202001244 73630 FOOT COMPLETE MIN 3VS 68.73 3202001269 73650 HEEL MIN 2 VIEWS 85.07 3202001285 73620 FOOT 2 VIEWS 85.07 3202001301 73090 FOREARM 2 VIEWS 85.07 3202001327 73130 HAND MINIMUM 3 VIEWS 95.71 3202001426 73060 HUMERUS > 2 VIEWS 68.73 3202001442 74740 HYSTEROSALPINGOGRAPHY 170.15 3202001483 73564 KNEE 4/> VIEWS 110.00 3202001491 73580 KNEE ARTHRO S&I 155.61 3222001509 73560 KNEE 1 OR 2 VIEWS 95.71 3202001517 27370 INJ CONTRAST KNEE ARHTROGRAPHY 52.68 3202001582 73592 LOW EXTREMITY INFANT MIN 2VS 85.07 3202001608 75805 LYMPHANGIO PELVIC/ABD UNILAT 304.50 3202001624 75801 LYMPHANGIOGRAM EXTREMTY UNIL 142.12 3202001681 70110 MANDIBLE COMPLETE MIN 4 VWS 110.00 3202001707 70100 MANDIBLE PARTIAL LESS 4 VWS 68.73 3202001723 70130 MASTOIDS COMP MIN 3 VS/SIDE 101.50 3202001749 70120 MASTOIDS <3 VIEWS PER SIDE 73.08 3202001764 72270 MYELOGRAPHY 2/> SPINAL CANAL 319.01 3202001780 72240 MYELOGRAPHY CERVICAL 255.20 3202001806 72265 MYELOGRAPHY LUMBOSACRAL 255.20 3202001822 70160 NASAL BONES COMP MIN 3 VIEWS 68.73 3202001848 70170 NASOLACRIMAL DUCT 81.20 3202001863 70360 NECK SOFT TISSUE 95.71 3202001905 74415 UROGRAPHY INFUSE W/NEPHRTOMO 304.50 3202001921 70190 OPTIC FORAMINA 60.91 320
18
2001947 70200 ORBITS COMPLETE MIN 4 VIEWS 110.00 3202001962 70220 PARANASAL SINUS COMP MIN 3VS 110.00 3202002002 70210 PARANASAL SINUS <3 VIEWS 95.71 3202002044 74710 PELVIMETRY W/WO PLACNTA LOCAL 101.50 3202002069 72170 PELVIS 1 OR 2 VIEWS 110.00 3202002085 72190 PELVIS > 3 VIEWS 162.40 3202002101 72202 SACROILIAC JOINTS 3/> VWS 81.20 3202002127 72220 SACRUM & COCCYX MIN 2 VIEWS 68.73 3202002168 70370 LARYNX-PHARYNX 81.20 3202002309 71111 RIBS BIL W/PA CHEST MIN 4VS 89.31 3202002325 71101 RIBS UNILW/PA CHEST MIN 3VS 110.00 3202002341 70380 SALIVARY GLAND CALCULUS 60.91 3202002364 A4649 NEEDLE TRANSSEPTAL TSNC-18-71 388.51 2722002365 A4649 NEEDLE TRANSSEPTAL TSNC-19-56 698.47 2722002366 73010 SCAPULA COMPLETE 68.73 3202002408 70240 SELLA TURCICA 106.33 3202002424 73030 SHOULDER COMPLETE MIN 2VS 110.00 3202002440 73020 SHOULDER 1 VIEW 68.73 3202002457 23350 SHOULDER ARTHRO INJECTION 52.68 3202002465 70390 SIALOGRAPHY 191.40 3202002481 70260 SKULL COMPLETE MIN 4 VIEWS 110.00 3202002507 70250 SKULL LESS 4 VIEWS 110.00 3202002523 74250 SMALL BOWEL BA W/MULTI IMAGES 121.78 3202002549 72040 SPINE CERVICAL 2 OR 3 VIEWS 110.00 3202002564 72052 SPINE CERVICAL 6/> VIEWS 121.78 3202002580 72050 SPINE CERVICAL 4 OR 5 VIEWS 110.00 3202002622 72100 SPINE L-SACRAL 2 OR 3 VIEWS 110.00 3202002648 72120 SPINE L-SACRAL BEND 2/3 VWS 142.12 3202002663 72110 SPINE L-SACRAL MIN 4 VIEWS 116.96 3202002689 72080 SPINE T-LUMBAR MIN 2 VIEWS 68.73 3202002705 72070 SPINE THORACIC 2 VIEWS 110.00 3202002721 71130 STERNOCLAVICULAR JNT MIN 3VS 81.20 3202002747 71120 STERNUM MIN 2 VIEWS 68.73 3202002762 74470 RENAL CYST TRNSLUMBR CONTRST 941.38 3202002788 70330 T-MANDIBULAR JT BILATERAL 81.20 3202002887 73590 TIBIA & FIBULA 2 VIEWS 95.71 3202002903 73660 TOES MIN 2 VIEWS 85.07 3202002929 74450 URETHROGRAM RETROGRADE 307.06 3202002945 74455 GU-URETHROCYSTOGRAPHY VOID 307.06 3202002960 74240 UPPER G-I BARIUM W/O KUB 174.79 3202002986 74249 BARIUM UGI W/ SMALL BOWEL 202.99 320
19
2003026 73092 UP EXTREMITY INFANT MIN 2VS 110.00 3202003042 74400 IVP W/WOKUB W/WO TOMO 155.91 3202003067 74425 GU-UROGRAPHY ANTEGRADE 307.06 3202003083 74420 GU-UROGRAPHY RETROGRADE 307.06 3202003109 75822 VENOGRAPHY EXTREMITY BIL 941.38 3202003125 75825 VENOGRAM INF V CAVA W/SERIAL 2964.00 3202003166 75820 VENOGRAM EXTREMITY UNILATERAL 957.97 3202003208 73100 WRIST 2 VIEWS 85.07 3202003224 73110 WRIST COMPLETE MIN 3 VIEWS 95.71 3202003281 72074 SPINE THORACIC MIN 4 VIEWS 121.78 3202003331 75605 ANG AOR THO S&I 2964.00 3232003455 75625 AORTOGRA ABD SERIALOGRAPHY 2964.00 3232003527 A4649 SYRINGE CONTRAST 150ML/QFT ANG 79.38 2722004230 75710 ANGIO EXTREMITY UNIL 2964.00 3232004321 75716 ANG EXT BIL S&I 2964.00 3232004503 75726 ANGIO VISCERAL SEL/SUPRASEL 6163.90 3232004594 75731 ANG ADR UNIL SEL S&I 2964.00 3232004651 75733 ANG ADR BIL SEL S&I 921.68 3232004719 75736 ANG PELVIC SEL S&I 2964.00 3232004776 75741 ANG PUL UNIL SEL S&I 2964.00 3232004834 75743 ANG PUL BIL SEL S&I 2964.00 3232004883 76536 US-THYROID 164.59 4022004891 75774 ANGIO SELECTIVEEA ADD VESSEL 184.33 3232004933 76700 US-ABDOMEN (LIVERPANCREASB-D 199.68 4022004941 76770 US-RETROPERITONEAL COMPLETE 164.59 4022004966 76506 US-BRAIN NEWBORN 164.59 4022004974 76805 US-OB >= 14 WKS SINGLE FETUS 164.59 4022004984 76856 US-PELVIC(NON-OB) COMPLETE 164.59 4022004990 70470 CT-HEAD/BRAIN W&WO CONTRAST 1046.70 3512005000 A4641 0NM-RADIOPHARM SIMPLE TCO4 184.73 3432005005 70450 CT-HEAD W/O CONTRAST 640.33 3502005013 70460 CT-HEAD W/ CONTRAST 689.60 3512005039 74170 CT-ABDOMEN W/O & W/ CONTRAST 985.12 3522005047 74150 CT-ABDOMEN W/O CONTRAST 615.70 3522005054 74160 CT-ABDOMEN W/ CONTRAST 677.27 3522005153 72127 CT-SPINE COMBINED 985.12 3502005161 72125 CT-CERVICAL SPINE/ W/O CONTRST 615.70 3502005179 72126 CT-CERVICAL SPINE W/ CONTRAST 677.27 3502005195 72194 CT-PELVIS COMBINED 985.12 3502005203 72192 CT-PELVIS W/O CONTRAST 615.70 3502005211 72193 CT-PELVIS W/ CONTRAST 677.27 350
20
2005237 71270 CT-THORAX W/O & W/ CONTRAST 985.12 3502005245 71250 CT-CHEST W/O CONTRAST 615.70 3502005252 71260 CT-CHEST W/ CONTRAST 677.27 3502005278 73202 CT-UPPER EXT W&WO CONTRAST 985.12 3502005286 73200 CT-UPPER EXT W/O CONTRAST 615.70 3502005294 73201 CT-UPPER EXT W/ CONTRAST 677.27 3502005344 76870 US-SCROTUM 164.59 4022005428 76499 POST MORTEM BODY 132.17 3202006987 A4649 NEEDLE BX CHIBA DCHN-21-65.5-U 290.44 2722007600 A4649 INTRODUCER PERF RCFW-10.0-38 237.09 2722007762 A4649 INTRODUCER PERF RCFW-9.0-38 194.70 2722010021 10021 FINE NDL ASPIRATE W/O IMAGING 248.67 3202010022 10022 FINE NEEDLE ASP W/ IMAGE-GUIDE 137.38 3202010030 10030 DRAINAGE SOFT TISSUE PERC 1002.46 3202010059 A4641 NM-RADIOPHARM THALLIUM 470.74 3432010160 10160 PUNC ASPI OF ABSCESS HEMATOMA 187.49 3202011014 A4641 KIT DTPA 515.15 3432019000 19000 PUNC ASPIR BRST CYST 594.37 3202019102 19083 PUNC ASPIR BRST CYST ADD CYST 1218.55 3202020001 A9576 GADOTERIDOL IV 229.73 2552020097 Q9967 ISOVUE 300-150 ML 174.97 2552020101 Q9967 ISOVUE 370 76% 50ML VIAL 41.02 2552020102 Q9967 ISOVUE 370 76% 200ML BTL 162.63 2552020220 20220 BONE BIOPSY SUPERFICIAL 956.88 3202020225 20225 BONE BIOPSY DEEP 1552.85 3202020501 20501 SINUS TRACT INJ DIAGNOSTIC 344.28 3202020604 20604 ASP/INJ SML JOINT/BURSA W/US 246.70 3202020605 20605 ARTHROCENTESIS INTRMD W/O US 254.68 3202020606 20606 ASP/INJ ITM JOINT/BURSA W/US 246.70 3202020610 20610 ASP/INJ MAJ JOINT/BURSA W/O US 246.70 3202020611 20611 ASP/INJ MAJ JOINT/BURSA W/US 246.70 3202020612 20612 ASPIRATE/INJECT GANGLION CYST 246.70 3202024220 24220 ARTHRO-INJECT ELBOW PROCEDURE 344.28 3202025246 25246 ARTHRO-INJECT WRIST PROCEDURE 344.28 3202026011 26011 DRAIN FINGER ABSCESS COMPLIC 968.42 3202026020 26020 DRAIN HAND TENDON SHEATH EA 1032.59 3202026025 26025 DRAIN PALM BURSA SINGLER 1003.21 3202026030 26030 DRAIN PALM BURSA MULTIPLE 1163.34 3202026990 26990 DRAIN PELVIS/HIP DEEP ABSCESS 1922.61 3202026994 COIL, EMBOLIZATION, 6DIA 14L 275.96 2722026995 COIL, EMBOLIZATION, 8DIA 14L 275.96 272
21
2027095 27095 ARTHRO-INJECT HIP ANESTHESIA 344.28 3202027289 A4649 INTRODUCER VALVE CHECK-FLO 155.81 2722027301 27301 DRAIN THIGH/KNEE DEEP ABSCESS 1893.61 3202027603 27603 DRAIN LEG/ANKLE DEEP ABSCESS 1893.61 3202027648 27648 ARTHRO-INJECT ANKLE PROCEDURE 344.28 3202028673 NEEDLE CENTESIS CATHETER 173.31 2722028675 CATHETER CENTESIS YUEH 10CM 5F 259.39 2722028700 A4649 CATHETER BILIARY DRAINAGE 707.31 2722029997 INTRO, 6FR X 55CM, TUOHY- BORS 191.05 2722030200 A4649 SYRINGE PRESSURIZE INJECTION 63.03 2722030305 CANNULA DUCTOGRAM 173.31 2722030307 CATHETER PICC POWER DUAL 6FR 837.55 2722030359 A4649 STENT URETERAL 6FR 22CM 940.62 2722030364 KIT STENT URETERAL 8FR 28CM 855.11 2722030365 A4649 MICRO COIL PLATINUM .018 2X5 526.42 2722030367 A4649 MICRO COIL PLATINUM .018 2X4 526.42 2722030368 DRAINAGE SYSTEM W/PORT SUCTION 236.29 2722030369 DRAINAGE BAG 60ML W/TUBING 118.17 2722030392 A4649 GUIDEWIRE ROSEN CURVED 145CM 220.25 2722030393 A4649 GUIDEWIRE PUSHER MICROCOIL 291.24 2722030395 A4649 GUIDEWIRE AMPLATZ ULTRASTIFF 1 336.04 2722030397 SHEATH BRIGHT BALKIN 704.74 2722030399 INTRODUCER FLX TUOHYBORST 7FR 728.75 2722030402 SHEATH PINNACLE 5FR 10CM 264.89 2722030403 SHEATH PINNACLE 6FR 10CM 264.89 2722030404 CATHETER DRAINAGE APDL 8FR 25C 894.59 2722030405 CATH DRAINAGE APDL 10FR 25CM 894.59 2722030408 A4649 STENT NEPHROURETERAL 8FR 22CM 962.97 2722030409 A4649 STENT NEPHROURETERAL 8FR 24CM 962.97 2722030410 A4649 STENT NEPHROURETERAL 8FR 26CM 962.97 2722030411 ANG WIRE TRANSEND 8" 165CM 1236.50 2722030413 CATHETER BALLOON PTA 6X4.75CM 1064.42 2722030417 CATHETER BALLOON PTA DIL 10X4. 1064.42 2722030686 A4649 SET DRAINAGE POUCH COOK 112.75 2722032550 32550 INSERT TUNNEL PLEURAL CATH 344.28 3202032551 32551 INSERTION OF CHEST TUBE OPEN 566.49 3202032552 32552 REMOVE TUNNEL PLEURAL CATH 247.30 3202032554 32554 THORACENTESIS W/O IMAGING 168.07 3202032555 32555 THORACENTESIS W/IMAGING 566.49 3202032556 32556 DRAIN PLEURA PERC W/O IMGNG 240.11 3202032557 32557 DRAIN PLEURA PERC W/ IMGNG 566.49 320
22
2032560 32560 PLEURODESIS VIA TUBE/CATH 566.49 3202032561 32561 LYSE VIA CHEST TUBE/CATH INIT 566.49 3202033010 33010 PERICARDIOCENTESIS INIT 566.49 3202033011 33011 PERICARDIOCENTESIS SUBSEQ 566.49 3202034217 PROBE COVER PRE-GELLED NON-LAT 17.18 2722034882 SET DRAIN MULTIPURPOSE 8.5FR 910.31 2722034883 SET DRAIN MULTIPURPOSE 10.2FR 910.31 2722035476 37248 PTA-VENOUS 5254.71 3202036000 36000 INTRO-NEEDLE/INTRACATH/VEIN 470.83 3202036002 36002 INJ PERC EXTR ANEURYSM 219.43 3202036005 36005 INTRO-NEEDLE CATH EXT VENO 470.83 3202036010 36010 INTRO-CATH SUP/INF VENA CAVA 470.83 3202036011 36011 SELECT CATH VEIN 1ST ORD FAM 470.83 3202036012 36012 SELECT CATH VEIN 2ND ORDER 470.83 3202036013 36013 INTRO CATH RT HEART/PULMO ART 470.83 3202036014 36014 ANGIO-CATH PLACEMNT RT/LT PULM 470.83 3202036015 36015 ANGIO-CATH SEG OR SUBSEG PULMO 470.83 3202036100 36100 INTRO-NDL CATH CAROTID OR VERT 470.83 3202036120 36120 INTRO-NDL CATH RETROGRADE BRAC 470.83 3202036140 36140 INTRO-NDL EXTREMITY ARTERY 470.83 3202036160 36160 INTRO-NDL CATH AORTIC LUMBAR 470.83 3202036200 36200 INTRO-CATHETER AORTA 470.83 3202036215 36215 ANGIO-THORACIC BRACHIO 1 ORDER 470.83 3202036216 36216 ANGIO-THORACIC BRACHIO 2 ORDER 470.83 3202036217 36217 ANGIO-THORACIC BRACHIO 3 ORDER 470.83 3202036218 36218 ANGIO-THORACIC BRACHIO >3 ORDE 470.83 3202036221 36221 NON SELECT CATH THORA AORTA 399.46 3202036222 36222 SEL CATH CCA/IA UNI XTRCRN CAR 540.45 3202036223 36223 SEL CATH CCA/IA UNI NTRCRN CAR 2964.00 3202036224 36224 SEL CATH ICA UNI NTRCRN CAR 6163.90 3202036225 36225 SEL CATH SCA UNI VERTEBRAL 2964.00 3202036226 36226 SELECT CATH VERTEBRAL UNIL 6163.90 3202036227 36227 SEL CATH ECA UNI CAROTID 234.99 3202036228 36228 PLACE CATH INTRACRANIAL ART 446.47 3202036245 36245 ANGIO-ABD/PELV/LE ARTERY 1 ORD 470.83 3202036246 36246 ANGIO-ABD/PELV/LE ARTERY INITI 470.83 3202036247 36247 ANGIO-ABD/PELV/LE ARTERY INITI 470.83 3202036248 36248 ANGIO-ABD/PELV/LE ARTERY 3> OR 470.83 3202036251 36251 INS CATH RENAL ART 1ST UNIL 2962.85 3202036252 36252 RENAL SEL CATH (1ST-ORDER) BI 2964.00 3202036253 36253 RENAL SEL CATH(2ND-ORDER) UNI 2964.00 320
23
2036254 36254 RENAL SEL CATH (2ND-ORDER) BI 2964.00 3202036282 GW, HIGHWIRE, ANGLE .035IN D 1 394.84 2722036475 36475 ENDOVENOUS RF 1ST VEIN 2477.69 3202036476 36476 ENDOVENOUS RF VEIN ADD-ON 723.38 3202036481 36481 ANGIO-CATH PERCUTANEOUS PORTAL 470.83 3202036555 36555 CV INSERTION NON TUNNELED UN 976.46 3202036556 36556 INS NON-TUNNEL CV CATH 5 YRS/> 976.46 3202036557 36557 CVC TUNL W/O PORT/PUMP <5 YRS 2587.76 3202036558 36558 INSERT TUNNEL CV CATH AGE 5/> 2588.76 3202036560 36560 CVC TUNL W/ PORT/PUMP <5 YRS 2587.76 3202036561 36561 INSERT TUNNEL CV CATH 5YRS/> 2477.69 3202036563 36563 CVC INS TUNL DVC W/SUBQ PUMP 2587.76 3202036565 36565 ANGIO-INSERT TWIN TUNNEL LINE 2588.76 3202036566 36566 CVC TNL DVC 2 CATH/SITE W/PORT 2587.76 3202036568 36568 INSERT PICC W/O PORT/PUMP <5YR 976.46 3202036569 36569 INSERT PICC W/O PORT 5 YRS/> 976.46 3202036570 36570 CVC W/SUBQ PORT <5YRS OLD SIMP 2587.76 3202036571 36571 INSERT PICC W/ PORT 5 YRS/> 2587.76 3202036575 36575 REPAIR NON-TUNL/TUNL CV CATH 564.98 3202036576 36576 REPAIR CVC W/ PORT/PUMP 976.08 3202036578 36578 REPLACE CATH CVD W/ PORT 2587.76 3202036580 36580 REPLACE NON-TUNL CV SAME SITE 976.46 3202036581 36581 REPLACE CV TUNNEL SAME SITE 2588.76 3202036582 36582 REPLACE TUNNELED VAD W/ PORT 2587.76 3202036583 36583 REPLACE TUNNEL CVAD W/PUMP 2587.76 3202036584 36584 REPLACE PICC SAME SITE 976.46 3202036585 36585 REPLAC CVC W/SUB PRT SAME SITE 2587.76 3202036589 36589 REMOVE TUNNL CV CATH W/O PORT 564.98 3202036590 36590 REMOVE TUNL CVC W/PORT 976.08 3202036593 36593 DECLOTTING BY THROMBOLYTIC AGE 225.97 3202036595 36595 REMOVE VIA VENOUS PERICATH 2588.76 3202036596 36596 REMOVE VIA VENOUS INTRACATH 417.12 3202036597 36597 REPOSITIOIN CV LINE W/ FLURO 976.46 3202036598 36598 CV CATH CONTRAST INJ EVAL 225.97 3202036620 36620 CATH RADIAL ART PRESSURE MONIT 417.12 3202036860 36860 DECLOTTING W/O BALLOON CATH 225.88 3202036861 36861 EXT DECLOT W/ BALLOON CATH 2587.76 3202036901 36901 CATH DIALYSIS CIRCUIT/ANG/IMG 754.26 3202036902 36902 DIALYSIS CIRCUIT W/ANGIOPLASTY 5319.78 3202036903 36903 DIALYSIS CIRCUIT W/STENT/IMG 10752.05 3202036904 36904 PERQ TRANLMN THRBECTMY D-C IMG 5319.78 320
24
2036905 36905 PERQ THRBECTMY D-C ANGIOP/IMG 10752.05 3202037182 37182 INSERT TIPS SHUNT 7666.97 3202037183 37183 REVISE TIPS SHUNT 5062.85 3202037184 37184 PRIMARY ARTERIAL THROMBI INITI 3728.55 3202037185 37185 PRIMARY ARTERIAL THROMBI 2ND > 376.30 3202037186 37186 SECONDARY TRANSLUM NONCORONARY 376.30 3202037187 37187 PERC TRANS MECH INCL INJECT 376.30 3202037188 37188 PERC TRANS MECH INCL INJECT RP 376.30 3202037192 37192 REPOSITION IVC FILTER 2587.76 3202037193 37193 REMOVAL ENDOVASC OF IVC FILTER 2588.76 3202037195 37195 INFUSION IV THROMBOLYSIS CEREB 224.63 3202037197 37197 TRANSCATH RETRIEVAL FB PERC 2588.76 3202037200 37200 TRANSCATHETER BIOPSY 2587.76 3202037211 37211 THRMBLYSIS ART NON-COR INIT 976.46 3202037212 37212 THROMBOLYSIS VENOUS INITIAL 976.46 3202037213 37213 THRBLYSIS ART/VEN NO-COR SSQ 2588.76 3202037214 37214 THRBLYSIS CESSTION REMC CATH 2588.76 3202037215 37215 INTRA STENT CER ART EMBOL PROT 475.77 3202037216 37216 TRANSCATH STENT CCA W/O EPS 410.06 3202037217 37217 STENT PLACEMT RETRO CAROTID 2685.02 3202037218 37218 STENT PLACEMT ANTE CAROTID 2685.02 3202037220 37220 REVASC ILIAC ART UNIL W/ANGIO 5252.67 3202037221 37221 REVASC ILIAC UNI STNT ANGIO 11141.11 3202037222 37222 ILIAC REVASC ADD-ON 2716.12 3202037223 37223 ILIAC REVASC W/STENT ADD-ON 3052.83 3202037224 37224 FEM/POPL REVAS W/TLA UNIL 5062.85 3202037225 37225 REVASC FEM/POP UNI ATHER ANG 11141.11 3202037226 37226 REVASC FEM/POP INI STNT 11141.11 3202037227 37227 REVAS FEM/POP UNI STNT ATH/ANG 17179.93 3202037228 37228 REVAS TIB/PER UNI ANGIO INIT 11141.11 3202037229 37229 REVAS TIB/PER UNI ATH ANGIO 17179.55 3202037230 37230 REVAS TIB/PER UNI STNT ANG 17179.89 3202037231 37231 REVAS TIB/PER UNI STNT ATH/ANG 17179.55 3202037232 37232 REVASC TIB/PERO ART UNI ADD 3222.03 3202037233 37233 REVASC TIB/PERO UNI ATHE ADD 3222.03 3202037234 37234 REVASC TIB/PERO UNI STNT ADD 3222.03 3202037235 37235 REVA TIB/PER UNI STNT ATH ADD 3222.03 3202037236 37236 TRANSCATH NTRVASC INIT ART 11145.45 3202037237 37237 OPEN/PERQ PLACE STENT EA ADD 399.46 3202037238 37238 OPEN/PERQ PLACE STENT SAME 11145.45 3202037239 37239 OPEN/PERQ PLACE STENT EA ADD 305.47 320
25
2037241 37241 EMBOLIZE VEN NOT HEMORRHAGE 11145.45 3202037242 37242 EMBOLIZE ART NOT HEMOR/TUMOR 11145.45 3202037243 37243 EMBOLIZE ART TUMOR/ORGANS 11145.45 3202037244 37244 EMBOLIZE ART/VEN HEMMORHAGE 11145.45 3202037252 37252 INTRVASC US NON-CORANARY INIT 1806.62 3202037253 37253 INTRVASC US NONCORONARY ADDL 267.81 3202037508 SET BIOPSY Q-C 20GA 15CMX10MM 354.21 2722037620 37191 IVC FILTER PARTIAL/COMPLETE 2588.76 3202037682 CATHETER CENTESIS YUEH 7CM 5FR 259.39 6212038220 38220 BONE MARROW ASPIRATION ONLY 1038.53 3202038221 38221 BONE MARROW BIOPSY 956.88 3202038500 38500 OPEN BX OR EXC LN; SUPERFICIAL 2713.00 3202038505 38505 LYMPH NODE BX/EXC SUPERFICIAL 1218.55 3202038792 38792 RA TRACER ID OF SENTINL NODE 324.32 3202039406 A4649 SET GI SUTURE ANCHOR 477.68 2722042400 42400 SALIVARY GLAND BX NEEDLE 119.30 3202042405 42405 INCISIONAL BX SALIVARY GLAND 541.59 3202042423 COIL, EMBOL, MREYE 35IN 5CM 8M 212.28 2722042467 COIL, EMBOL, MREYE 38IN 8CM 15 212.28 2722042540 COIL TARGET 360 NANO 2.5X4 3234.69 2722042920 STENT, BALLOON EXP 4MM X 16MM 2961.27 2722042925 STENT, BILI 5/6FR 5MM DI 16MM 2961.27 2722042927 STENT, BALLOON EXP 5MM X 24MM 2961.27 2722042930 STENT, BILI 5/6FR 6MM DI 16MM 2961.27 2722042932 STENT, BILI 5/6FR 6MM DI 24MM 2961.27 2722042936 STENT, BILI 6/7FR 7MM DI 20MM 2961.27 2722043040 COIL TARGET 360 NANO 3X4 3234.69 2722043752 43752 NASO/ORO-GASTRIC TUBE PLACEMEN 122.69 3202043756 43756 DUODENAL INTUB/ASPIRATE W/IMG 111.01 3202043761 43761 REPOSITION FEED TUBE DUODENUM 863.12 3202043850 STENT, VASCULAR 7MM DIA 30MM L 3821.00 2722043851 STENT, VASCULAR 7MM DIA 40MM L 3821.00 2722043855 STENT, VASCULAR 8MM DIA 30MM L 3821.00 2722043856 STENT, VASCULAR 8MM DIA 40MM L 3821.00 2722043857 STENT, VASCULAR 8MM DIA 60MM L 4033.26 2722043861 STENT, VASCULAR 9MM DIA 40MM L 3821.00 2722043862 STENT, VASCULAR 9MM DIA 60MM L 4033.26 2722046305 GUIDEWIRE HYDRO .035"X150CM 541.54 2722047000 47000 BIOPSY OF LIVER PERCUTANEOUS 1218.55 3202047380 47380 OPEN ABLATE LIVER TUMOR RF 3288.54 3202047381 47381 OPEN ABLATE LIVER TUMOR CRYO 3141.51 320
26
2047382 47382 PERC ABLATE LIVER TUMOR RF 4540.35 3202047383 47383 PERC ABLATE LIVER TUMOR CRYO 4540.35 3202047490 47490 CHOLECYSTOSTOMY PERCUTANEOUS 2122.49 3202047531 47531 INJ CHOLANGIOGRAM EXIST ACCESS 387.77 3202047532 47532 INJ CHOLANGIOGRAM NEW ACCESS 2400.27 3202047533 47533 PLMT BILIARY DRAIN CATH EXT 2400.27 3202047534 47534 PLMT BILIARY DRN CATH INT/EXT 2400.27 3202047535 47535 CONVERT EXT BIL DRAIN CATH 2400.27 3202047536 47536 EXCHANGE BILIARY DRAIN CATH 2400.27 3202047537 47537 REMOVE BILIARY DRAIN CATH 532.32 3202047538 47538 PERQ PLMT BIL DUCT STNT EXIST 4540.35 3202047539 47539 PLMT BIL STENT NEW W/O PLMT 4540.35 3202047540 47540 PLMT BIL STENT NEW W/ PLMT 4540.35 3202047541 47541 PLMT ACCESS BIL TREE SM BWL 2400.27 3202047542 47542 BALLN DILATE BILIARY/AMPULLA 299.22 3202047543 47543 PERC ENDOLUM BX BILIARY TREE 377.78 3202047544 47544 REMOVE DUCT GLBLDR CALCULI 495.66 3202047552 47552 BILIARY ENDO PERQ DX W/SPECI 2122.49 3202047553 47553 BILI ENDO PERC VIA T-TUBE W/BX 4741.50 3202047554 47554 BILIARY ENDO PERC REMVE CALC 2122.49 3202047555 47555 PRQ DIL BILIARY STRICT WO STNT 2122.49 3202047556 47556 DILATE BILIARY STRICTR W/STENT 4741.50 3202047942 INTRO, MICROPUNCTURE SET 4FR 95.54 2722048400 48400 INJECT INTRAOP PANCREATOGRAPHY 245.50 3202049082 49082 ABD PARACENTESIS W/O IMAGE 532.32 3202049083 49083 ABD PARACENTESIS W/ IMAGING 566.49 3202049084 49084 PERITONEAL LAVAGE W/ IMAGING 532.32 3202049400 49400 INJECT AIR/CONTRAST PERITONEAL 417.12 3202049405 49405 CATH DRAIN VISCERAL PERC 1218.55 3202049406 49406 DRAIN RETRO/PERITONEAL PERC 1218.55 3202049407 49407 DRAIN RETRO/PERITONEAL TV/TR 1218.55 3202049418 49418 INSERT TUN IP CATH PERC 2647.89 3202049419 49419 INSERT TUN IP CATH W/PORT 2587.76 3202049421 49421 INSERTION CATH DRAIN DIALYSIS 417.12 3202049422 49422 REMOVE TUNNEL INTRAPERITO CATH 1823.76 3202049423 49423 EXCHANGE PREVIOUS DRAIN CATH 1492.26 3202049424 49424 ABSCESS CYST CONSTRAST INJ 417.12 3202049427 49427 INJ TO EVAL PERITONEAL-VENOUS 119.33 3202049440 49440 PLACE GASTROSTOMY TUBE PERC 1199.52 3202049441 49441 PLACE DUOD/JEJ TUBE PERQ 1199.52 3202049442 49442 PLACE CECOSTOMY TUBE PERQ 1831.81 320
27
2049446 49446 CONVERT G-TUBE TO G-J PERC 1199.52 3202049450 49450 REPLACE GASTRO/CECO TUBE PERC 532.32 3202049451 49451 REPLACE DUOD/JEJ TUBE PERC 532.32 3202049452 49452 REPLACE GASTRO-JEJ TUBE PERC 564.98 3202049460 49460 MECH REMOVAL OBSTRUCT MATERIAL 79.18 3202049465 49465 FLUORO EXAM OF G-I/COLON TUBE 111.01 3202050000 76000 FLUOROSCOPY UP TO 1 HOUR 191.40 3202050003 CATHETER CXI SUPRT 2.6FR 150CM 825.79 6212050010 76001 FLUOROSCOPE EXAM EXTENSIVE 100.63 3202050018 SET INTRO MICROPUNCTURE 5FR 370.84 6212050030 73040 SHOULDER ARTHRO 94.63 3222050040 76100 TOMOGRAPHY (ANATOMICAL) 343.95 3202050130 70134 INTERNAL AUDITORY MEATI COMP 106.33 3202050150 73120 HAND 2 VIEWS 110.00 3202050187 76506 US-BRAIN INFANT 156.10 4022050190 19281 BREAST MASS LOCALIZATION 240.31 3202050194 76604 US-CHEST 156.10 4022050382 50382 URETRAL STNT REMOVE AND REPLA 417.12 3202050384 50384 URETRAL STNT REMOVAL S&I 417.12 3202050385 50385 CHANGE STENT VIA TRANSURETH 2412.52 3202050387 50387 URETRAL NEPH REMOVE AND REPLC 417.12 3202050389 50389 REMOVE NEPHRO TUBE W/ FLUORO 635.46 3202050395 50395 INTRO GUIDE PELVIS URETER DIL 2413.47 3202050396 50396 MANOMETRY THRU INDWELLING CATH 247.39 3202050430 50430 NEPHROSTOGRAM INJ NEW ACCESS 578.24 3202050431 50431 NEPPHROSTOGRAM INJ EXIST ACCES 578.24 3202050432 50432 PLACEMENT NEPHROSTOMY CATHETER 1660.83 3202050433 50433 PLMT NEPHROURETERAL CATHETER 1660.83 3202050434 50434 CONVERT NEPHROSTOMY CATHETER 578.24 3202050435 50435 EXCHANGE NEPHROSTOMY CATHETER 578.24 3202050606 50606 ENDOLUMINAL BX URTR RNL PLVS 363.63 3202050693 50693 PLMT URETER STENT PRE-EXIST 2473.44 3202050694 50694 PLMT URETERAL STENT PRQ NEW 2473.44 3202050695 50695 PLMT URETR STNT NEW W/ CATH 2473.44 3202050706 50706 BALLOON DILATE URTRL STRICTURE 440.58 3202051011 NEEDLE 11G AFAFLEX+CURVED NIT 1204.82 2722051012 A4649 KIT DMSA 647.81 2702051018 A4649 KIT SULFUR COLLOID 847.39 2702051019 J2805 KINEVAC (SINCALIDE) 5MCG VIAL 102.21 2502051022 A4649 KIT ULTRA TAG RBC 902.88 2702051102 51102 SUPRAPUBIC CATHETER INSERTION 1592.62 320
28
2051110 TROCAR/BEVEL 11GX12CM AVAMAX 487.90 2722051705 51705 CHANGE CYSTOSTOMY TUBE 247.39 3202051710 51710 CHANGE CYSTOSTOMY TUBE COMP 564.76 3202052310 52310 CYSTOURETHROSCOPY FB REMOVAL 705.35 3202052326 A4649 CATHETER BALLOON PTA 3MMX4CM 852.50 6212052332 52332 CYSTOURETHROSCOPY INSERT STENT 417.12 3202052346 CATH, BALLOON, PTA 5F .035 6MM 742.96 2722052353 CATH, BALLOON, PTA 5F .035 7MM 742.96 2722052360 CATH, BALLOON, PTA 5F .035 8MM 742.96 2722052397 CATH, BALLOON, PTA 6F .035 9MM 742.96 2722052650 A4649 GUIDEWIRE EMERALD 5FR .035"X15 148.64 2722053122 A4649 SET PNEUMOTHORAX 676.54 2722053899 53899 UNLISTED URINARY DILATION 118.28 3202055700 55700 BIOPSY OF PROSTATE 1692.80 3202055887 A4649 SET ABSCESS DRAINAGE MALECOT 916.45 2722060300 60300 ASPIRATE/INJ THYROID CYST 529.90 3202060810 A4649 WIRE ANGLED GLIDE .018 413.96 6212061623 61623 ENDOVASC TEMPORARY VESSEL OCCL 10520.44 3202061624 61624 TRANSCATHETER OCCLUSION CNS 2578.37 3202061626 61626 TRANSCATH OCCLUSION NON-CNS 1976.85 3202061630 61630 BALLON ANGIOPLSTY INTRCRANIAL 3028.11 3202061635 61635 INTRACRAN ANGIOPLSTY W/STENT 3261.33 3202061640 61640 DILATE INTRCRN VASOSPASM INIT 1406.79 3202061641 61641 DILATE IC VASOSPASM ADD SAME 496.13 3202061642 61642 DILATE IC VASOSPASM ADD DIFF 992.25 3202061650 61650 INFUSION NON-THRMBLYSIS INIT 589.62 3202061651 61651 INFUSE NON-THRMBLYSIS EA ADD 250.35 3202062267 62267 ASPIRATE NUCLEOUS PULPOSUS 1038.53 3202062268 62268 PERQ ASPIRATE SPINAL CORD CYST 645.15 3202062270 62270 LUMBAR PUNCTURE 431.35 3202062281 62281 NEUROLYTIC INJ EPI CERV/THOR 357.20 3202062282 62282 NEUROLYTIC INJ EPI LUMB/SACR 384.69 3202062290 62290 INJECT SPINE DISK X-RAY LUMBAR 863.19 3202062291 62291 INJ SPINE DISK X-RAY CERV/THOR 874.41 3202062552 A4649 STOPCOCK ONE/THREE-WAY 24.60 2722064150 GUIDEWIRE EXPO 6FR 100CM 148.64 2722065320 GW COONS .035X145CM G02356 67.15 6212066306 ANG, VENA CAVA TRAPESE-SHORT 1767.79 2722068110 CATHETER VENOUS PIC 6FR 750.80 2722068920 A4649 NEEDLE BX CHIBA DCHN-20-20.0-U 89.57 2722070010 70010 MYELOGRAPHY POSTERIOR FOSSA 450.35 320
29
2070015 70015 CISTERNOGRAPHY POSITIVE CONTR 450.35 3202070030 70030 RADIO EXAM EYE FB DETECT 57.04 3202070310 70310 TEETH PART EXAM <FULL MOUTH 57.04 3202070320 70320 TEETH COMPLETE FULL MOUTH 57.04 3202070328 70328 TMJ OPEN/CLOSED UNIL 41.51 3202070332 70332 ARTHROGRAPHY TMJ 114.06 3202070350 70350 CEPHALOGRAM ORTHODONTIC 41.51 3202070355 70355 ORTHOPANTOGRAM 41.51 3202070394 A4649 SET NEPHROSTOMY ULTRATHANE 949.85 2722070480 70480 CT-ORB/SEL MI/IN EARW/O CONTR 334.86 3502070481 70481 CT-ORB SEL EAR W/ CONTRAST 442.74 3502070482 70482 CT-ORBIT SELLA POST FOSSA C 525.23 3512070486 70486 CT-MAXIFAC/SINUS/MAND W/O CNT 867.88 3502070487 70487 CT-MAXIFAC/SINUS/MAND W/ CNTR 1109.08 3502070488 70488 CT-MAXIFACIAL W&WO CONTR 1301.17 3502070492 70492 CT-NECK SOFT TISS W&WO CONTR 957.21 3502070496 70496 CT-HEAD ANGIOGRAPHY 786.20 3512070498 70498 CT-NECK ANGIO W/RECONSTRUCTION 793.21 3502070540 70540 MRI-ORBIT/FACE/NECK W/O DYE 1148.65 6102070542 70542 MRI-ORBIT/FACE/NECK W/DYE 697.24 6102070543 70543 MRI-ORBIT FACE AND/OR NECK C 942.22 6102070544 70544 MRA-HEAD W/O CONTRAST 1409.02 6152070545 70545 MRA-HEAD W/ CONTRAST 1715.32 6102070546 70546 MRA-HEAD W/O & W/ CONTRAST 2021.63 6102070547 70547 MRA-NECK W/O CONTRAST 1409.02 6102070548 70548 MRA-NECK W/ CONTRAST 1715.32 6102070549 70549 MRA-NECK W/O & W/ CONTRAST 2021.63 6152070551 70551 MRI-BRAIN W/O CONTRAST 1148.65 6112070552 70552 MRI-BRAIN WITH CONTRAST 1286.49 6112070553 70553 MRI-BRAIN W/O & WITH CONTRAST 1837.85 6112070554 70554 MRI-BRAIN FUNCTIONAL W/O NEU 684.15 6112070557 70557 MRI-BRAIN OPEN INTRACRANIAL 323.18 6112070558 70558 MRI-BRAIN OPEN INTRACRANIAL 392.03 6112071015 71015 CHEST STEREO FRONTAL 57.04 3242071030 71030 CHEST MIN 4 VIEWS 110.00 3242071034 71034 CHEST MIN 4 VIEWS W/ FLURO 139.99 3242071100 71100 RIBS UNILATERAL 2 VIEWS 77.05 3202071110 71110 RIBS BILATERAL 3 VIEWS 110.00 3202071275 71275 CT ANGIOGRAPHY CHEST (NON-COR) 913.17 3522071551 71551 MRI-CHEST FOR HILA AND MEDIAST 795.65 6102071552 71552 MRI-CHEST FOR HILA AND MEDIAST 1079.87 610
30
2071555 71555 MRA-CHEST EXC MYOCARDIUM 1466.07 6102072020 72020 SPINE SINGLE SPECIFY LEVEL 77.05 3202072072 72072 SPINE THORACIC 3 VIEWS 110.00 3202072081 72081 SPINE ENTIRE INC SKULL 1 VW 97.02 3202072082 72082 SPINE ENTIRE 2 OR 3 VWS 176.40 3202072083 72083 SPINE ENTIRE 4 OR 5 VWS 191.84 3202072084 72084 SPINE ENTIRE W/SKULL MIN 6V 232.63 3202072114 72114 SPINE L-SACRAL COMP MIN 6VS 132.39 3202072129 72129 CT-THORACIC SPINE W/ CONTRAST 442.74 3522072130 72130 CT-THORACIC SPINE COMBINED 525.23 3522072132 72132 CT-LUMBAR SPINE W/ CONTRAST 442.74 3502072133 72133 CT-LUMBAR SPINE W&WO CONTRAST 525.23 3502072141 72141 MRI-SPINE CERVICAL W/O CONTR 1286.49 6122072142 72142 MRI-SPINE CERVICAL WITH CONT 1409.02 6122072146 72146 MRI-SPINE THORACIC W/O CONTR 1286.49 6122072147 72147 MRI-SPINE THORACIC WITH CONT 1409.02 6122072148 72148 MRI-SPINE LUMBAR W/O CONTRAS 1286.49 6102072149 72149 MRI-SPINE LUMBAR WITH CONTRA 1409.02 6122072156 72156 MRI-CERV SPINE W&WO CONTRAST 1837.85 6122072157 72157 MRI-TORACIC SPINE W&WO CONTR 1837.85 6122072158 72158 MRI-LUMBAR SPINE W&WO CONTRST 1837.85 6122072159 72159 MRA-SPINE 1599.07 6102072191 72191 CT-PELVIS ANGIO W/&W/O DYE 1151.85 3522072195 72195 MRI-PELVIS W/O CONTRAST 644.36 6102072196 72196 MRI-PELVIS 1148.65 6102072197 72197 MRI-PELVIS W &WO CONTRAST 951.10 6102072198 72198 MRA-PELVIS 1472.15 6102072200 72200 SACROILIAC JOINT <3 VIEWS 77.05 3202072255 72255 MYELOGRAPHY THORACIC 450.35 3202072275 72275 EPIDUROGRAPHY 114.06 3202072285 72285 DISCOGRAPHY CERV OR THORACIC 156.51 3202072295 72295 DISCOGRAPHY-LUMBAR 151.78 3202073085 73085 ARTHROGRAPHY-ELBOW 245.32 3202073115 73115 ARTHROGRAPHY-WRIST 245.32 3202073206 73206 CT-UP EXTRMTY ANGIO W/O&W/DYE 1011.47 3502073218 73218 MRI-UPPER EXT. OTHER THAN JOIN 650.64 6102073219 73219 MRI-UPPER EXT. OTHER THAN JOIN 708.23 6102073220 73220 MRI-UP EXT NOT JNTW&WO CONT 1148.65 6102073221 73221 MRI-UP EXT ANY JNT WO CONTRST 1148.65 6102073222 73222 MRI-UPPER EXT. ANY JOINT W/ C 666.35 6102073223 73223 MRI-UPPER EXT. ANY JOINT COMB 904.01 610
31
2073225 73225 MRA-UPPER EXTREMITY 1361.34 6102073501 73501 HIP UNIL W/ PELVIS 1 VW 66.15 3202073502 73502 HIP UNIL W/ PELVIS 2-3 VWS 99.23 3202073503 73503 HIP UNIL W/ PELVIS MIN 4 VS 122.38 3202073521 73521 HIPS BIL W/ PELVIS 2 VIEWS 92.61 3202073522 73522 HIPS BIL W/ PELVIS 3-4 VWS 111.35 3202073523 73523 HIPS BIL W/ PELVIS. 5/> VWS 132.30 3202073525 73525 HIP ARTHROGRAM 245.32 3202073551 73551 FEMUR 1 VIEW 63.95 3202073552 73552 FEMUR 2/> VWS 76.07 3202073615 73615 ARTHROGRAPHY-ANKLE 245.32 3202073702 73702 CT-LOWER EXT W&WO CONTRAST 525.23 3502073706 73706 CT-ANGIO LOW EXT W/O&W/DYE 1031.89 3502073718 73718 MRI-LOWER EXT W/O CONTRAST 638.60 6102073719 73719 MRI-LOWER EXT. OTHER THAN JOIN 699.34 6102073720 73720 MRI-LOWER EXTREMITY EXCLUDING 1148.65 6102073721 73721 MRI-LOW EXT JOINT WO CONTRST 1148.65 6102073722 73722 MRI-LOW EXT JNT W/ CONTRAST 673.68 6102073723 73723 MRI-LOW EXT JNT W&WO CONTRST 901.91 6102073725 73725 MRA-LOWER EXT W&WO CONTRAST 1548.77 6102074010 74010 ABDOMEN AP ADD OBL/CONE VIEW 77.05 3202074174 74174 CT-ABD&PELV ANGIO W/&W/O CONT 1550.99 3522074175 74175 CT-ABDOMEN ANGIO W/&W/O DYE 1035.70 3522074176 74176 CT-ABD & PELVIS W/O CONTRAST 433.93 3522074177 74177 CT-ABD & PELVIS W/ CONTRAST 839.92 3522074178 74178 CT-ABD & PELV W/O & W/ CONTRAS 1109.76 3522074181 74181 MRI-ABDOMEN W/O CONTRAST 1148.65 6102074182 74182 MRI-ABDOMEN W/ CONTRAST 778.89 6102074183 74183 MRI-ABDOMEN W &WO CONTRAST 952.69 6102074185 74185 MRA-ABDOMEN W & WO CONTRAST 1561.10 6102074190 74190 PERITONEOGRAM INJ AIR/CONTRST 114.06 3202074220 74220 ESOPHAGUS BARIUM 155.18 3202074230 74230 SWALLOW FUNCTION W/CINE/VIDEO 155.18 3202074235 74235 REMOVE FB ESOPH W/BALN CATH 351.92 3202074241 74241 UPPER-GI WITH KUB 122.69 3202074245 74245 UGI W/SMALL BOWEL W/ MUL IMG 191.05 3202074246 74246 UGI W/AIR CONTRST BA W/O KUB 122.69 3202074251 74251 SMALL BOWEL W/ MULTI IMAGES 240.92 3202074260 74260 GU DUODENOGRAPHY HYPOTONIC 155.18 3202074261 74261 CT-COLONOGRAM DX W/O CONTRST 468.48 3502074262 74262 CT-COLONOGRAPHY DX W&WO CNTR 529.73 350
32
2074263 74263 CT-COLONOGRAPHY SCREENING 85.07 3502074283 74283 TX ENEMA CNTRT/AIR RXN INTUS 179.01 3202074328 74328 ENDO CATH BILIARY DUCT SYSTEM 171.11 3202074330 74330 ENDOCATH BILIARY/PANCREATIC 171.11 3202074340 74340 INTRO G-I TUBE W/ FLUORO/IMGS 171.11 3202074355 74355 PLACE ENTEROCLYSIS TUBE PERC 171.11 3202074360 74360 INTRALUMINAL DILATION; STRICTU 228.13 3202074363 74363 PTHD BILE DUCT STRICTURE 541.77 3202074410 74410 UROGRAPHY INFUSION DRIP BOL 158.68 3202074440 74440 VASOGRAPHY VESICULOGRAPHY EP 158.68 3202074485 74485 DILATE NEPHROSTMY URTRS/URTHR 126.68 3202074775 74775 PERINEOGRAM SEX DETERM/ANOMAL 114.06 3202075557 75557 MRI-CARDIAC MORPH FUNCTION W/ 518.22 6102075559 75559 MRI-CARDIAC MORPH FUNCTION W/ 787.80 6102075561 75561 MRI-CARDIAC MORPH FUNCTION CO 733.36 6102075563 75563 MRI-CARDIAC MORPH FUNCTION CO 913.95 6102075565 75565 MRI-CARDIAC VELOCITY FLOW MAP 114.06 6102075571 75571 CT-HEART W/O DYE W/CA TEST 98.41 3502075572 75572 CT-HEART W/ 3D IMAGE 287.36 3502075573 75573 CT-HEART W/3D IMG CONGENITAL 405.15 3502075574 75574 CT-ANGIO HEART/ W/3D IMAGE 712.93 3502075635 75635 CT-ABDOMINAL ARTERIES ANGIO 695.67 3522075658 75658 ANGIO BRACHIAL RETROGRADE 2964.00 3202075705 75705 ANGIO-SPINAL SELECTIVE 308.31 3202075746 75746 ANG-PULMO NONSELECTIVE CATH O 957.97 3202075756 75756 ANGIO-INTERNAL MAMMARY 957.97 3202075803 75803 LYMPHANGIOGRAPHY EXTRMTY BIL 114.06 3202075809 75809 SHUNT EVALUATION 339.32 3202075810 75810 SPLENOPORTOGRAPHY 114.06 3202075840 75840 VENOGRAPHY ADRENAL UNIL SEL 253.34 3202075842 75842 VENOGRAPHYADRENAL BIL SEL 285.29 3202075860 75860 VENOGRAPHYVENOUS SINUS/JUGULR 957.97 3202075870 75870 VENOGRAMSUPERIOR SAGITL SINUS 641.79 3202075872 75872 VENOGRAPHY EPIDURAL 641.79 3202075880 75880 VENOGRAPHY ORBITAL 171.11 3202075885 75885 PERC TRANSHEP PORTOGRAM W/HDM 2964.00 3202075887 75887 PRQ TRANSHEP PORTOGRPHY WO HE 957.97 3202075889 75889 HEPATIC VENOGRAMW/ HDM EVAL 2964.00 3202075891 75891 HEPATIC VENOGRAPHY W/O HEMODYN 2964.00 3202075893 75893 VENOUS SAMPLINGW/ORW/O ANGIO 2964.00 3202075894 75894 TRANSCATH EMBOLIZATION TX 114.06 320
33
2075898 75898 FOLLOW-UP ANGIOGRAPHY 957.97 3202075901 75901 REMOVE OBSTRUCTION FROM CVD 190.02 3202075902 75901 CV MECH REMOVAL OF PERICATH M 83.21 3202075952 75952 INFRAREN ABD ANEURYSM REPAIR 269.72 3202075953 75953 PROSTH TO REPLACE IR/ILIAC AA 233.85 3202075954 75954 ILIAC ANEURYSM ENDOVAS RPR 371.60 3202075956 75956 ENDOVASC REPAIR DESC THOR AOR 1131.00 3202075957 75957 ENDO REP THOR AO NOT SCLV ORIG 977.04 3202075958 75958 PLACE PROSTH PROX EXT THOR AO 649.43 3202075959 75959 PLACE PROSTH DIST EXT THOR AO 563.77 3202075970 75970 BIOPSY TRANSCATHETER 171.11 3202076010 76010 NOSE TO RECTUM FB 1VW CHILD 41.51 3202076086 77053 MAMMARY DUCTOGRAM SINGLE 287.32 3202076088 77054 MAMMARY DUCTOGRAM MULTIPLE 398.15 3202076093 77058 MRI-BREAST UNILATERAL 1705.81 6102076094 77059 MRI-BREAST BILATERAL 2246.54 6102076095 19081 BX BREAST 1ST LESION STRTCTC 559.59 3202076101 76101 COMPLX MOTION NOT UROGR UNIL 194.41 3202076120 76120 CINERADIO/VIDEOGRAPHY 79.11 3202076121 A4649 ADAPTER SIDEARM 151.70 2712076125 76125 CINERADIO/VIDEOGRAPHY ADD-ON 171.11 3202076376 76376 3D RENDERING; INTERPRET/REPORT 93.17 3502076380 76380 CT-LIMITED LOCALIZED FOLLOW-UP 171.11 3502076390 76390 MR SPECTROSCOPY 1372.29 6102076400 77084 MRI-BONE MARROW BLOOD SUPPLY 1361.34 6102076510 76510 US-EYE B-SCAN/QUANTI A-SCAN 171.11 4022076511 76511 US-OPTHALMIC DX QUANT A-SCAN 171.11 4022076512 76512 US-OPTHALMIC DX B-SCAN 171.11 4022076513 76513 US-EYE ANTERIOR DX B-SCAN 171.11 4022076514 76514 US-EYE CORNEAL PACHYMETRY 171.11 4022076516 76516 US-EYE BIOMETRY ECHO A-SCAN 171.11 4022076519 76519 US-ECHO OPTHALMIC BIOMETRY 171.11 4022076529 76529 US-OPTHALMIC FB LOCALIZATION 114.06 4022076641 76641 US-BREAST UNIL COMPLETE 200.55 4022076642 76642 TC US BREAST UNI LIMITED 165.90 4022076705 76705 US-ABDOMEN LIMITED 164.59 4022076775 76775 US-RETROPERITONEAL REAL TIME 156.10 4022076776 76776 US KIDKEY TRANSPL W/DOPPLER 325.24 4022076801 76801 US-OB <14 WKS SINGLE GESTATION 226.09 4022076802 76802 OB US < 14 WEEKS ADDL FETUS 85.55 4022076811 76811 US-OB REAL TIME TO INCL DET FE 219.51 402
34
2076812 76812 US-OB REAL TIMEINCL DET FETAL 85.55 4022076813 76813 US-OB REAL TIME1ST TRIM FETAL 156.10 4022076814 76814 OB US FIRST NUCHAL MEAS ADD-ON 93.77 4022076815 76815 US-GESTATIONAL LIMITED 156.10 4022076816 76816 OB US-FOLLOW-UP PER FETUS 106.13 4022076817 76817 US-PREGNANT UTERUS TRANSVAG 156.10 4022076819 76819 US-FETAL BIOPHYSICAL W/O NST 156.10 4022076820 76820 UMBILICAL ART ECHO FETAL 106.13 4022076821 76821 MIDDLE CEREBRAL ART ECHO FETAL 85.55 4022076826 76826 US-FETAL CV REAL TIME W/2D 489.38 4022076828 76828 US-DOPPLER ECHO FETAL PW/CW 106.13 4022076831 76831 US-SONOHYSTEROGRAPHY SALINE I 219.51 4022076857 76857 US-PELVIC(NON-OB) LIMIT/FF-UP 118.83 4022076871 A4649 SET ABSCESS DRAINAGE THAL-QUIC 703.21 2722076881 76881 US-EXTREMITY NON-VASC COMP 228.51 4022076882 76882 US-EXTREMITY NON-VASC LMTD 106.13 4022076885 76885 US-INFANT HIPS RT IMG DYNAMC 153.37 4022076886 76886 US-INFANT HIPS REAL TIME IMAG 115.15 4022076930 76930 US-GUIDEPERICARDIOCENTESIS 114.06 4022076932 76932 US-GUIDEENDOMYOCARDIAL BIOPSY 114.06 4022076937 76937 ULTRA-GUIDE VASCULAR ACCESS 51.96 4022076940 76940 US-GUIDE TISSUE ABLATION 114.06 4022076941 76941 US-GUIDE INTRAUT FETL TXFUSION 114.06 4022076945 76945 US-GUIDE CHORIONIC VILLUS SAMP 114.06 4022076946 76946 US-GUIDANCE AMNIOCENTESIS 114.06 4022076965 76965 US-GUIDE INTERSTTL RADIOELEMNT 114.06 4022076977 76977 US-BONE DENSITY PERIPHERAL 114.06 4022077001 77001 FLUOROGUIDE FOR VEIN VEIN 584.13 3202077002 77002 FLUOROGUIDE NEEDLE PLACEMENT 584.13 3202077003 77003 FLUOROGUIDE FOR SPINE INJECT 114.06 3202077011 77011 CT-GUIDE STEREOTATIC LOCALIZ'N 924.95 3502077014 77014 CT-GUIDE PLCMNT RAD TX FIELDS 217.23 3502077021 77021 MRI-GUIDANCE NEEDLE PLACEMENT 521.88 6102077065 77065 DX MAMMO INCL CAD UNIL 76.65 4012077066 77066 DX MAMMO INCL CAD BIL 114.45 4012077067 77067 0SCREEN MAMMO BIL INCL CAD 89.25 4032077074 77074 BONE SURVEY LIMITED 159.23 3202077080 77080 DEXA BONE DENSITY 1/> AXIAL 426.92 3202077280 77280 TX RADIO SIMULATION SIMPLE 221.95 3332077285 77285 TX RAD SIMULATION INTERMED 394.68 3332077290 77290 TX RAD SIMULATION COMPLEX 630.37 333
35
2077295 77295 THERA SIMULATION-AIDED FIELD S 857.42 3332077300 77300 RADIATION DOSIMETRY CALCULATIO 114.06 3332077301 77301 RADIOTHERAPY PLAN INTENSITY M 2700.99 3332077321 77321 TELETHERAPY PORT PLAN SPECIAL 246.25 3332077331 77331 DOSIMETRY SPECIAL SPECIFY 114.06 3332077332 77332 DEVICES TREATMENT DESIGN AND 114.06 3332077333 77333 TREATMENT DEVICES INTERMED 114.06 3332077334 77334 TREATMENT DEVICES COMPLEX 176.24 3332077470 77470 RO-SPECIAL TREATMENT PROCEDURE 351.90 3332077600 77600 HYPERTHRMIA EXT SUPERF +<4CM 462.20 3332077605 77605 HYPERTHERMIA EXTL DEEP 4+ CM 975.19 3332077610 77610 HYPERTHERMIA INTERST 5/< APPL 814.49 3332077615 77615 RO-HYPERTHERMIA VIA INTERSTIT 1184.04 3332077620 77620 HYPERTHERMIA INTRACAV PROBE 515.59 3332077750 77750 INFUSE RADIOACTIVE MATERIALS 143.52 3332077761 77761 INTRACAV RAD SOURCE SIMPLE 279.50 3332077762 77762 INTRACAVTRY RAD APPLY INTERM 279.50 3332077763 77763 INTRACVTRY RS APPL COMPLEX 519.27 3332077778 77778 APPLY INTERTIT RADIAT COMPX 826.13 3332077789 77789 RO-SURFACE APPLICATION OF RADI 85.79 3332077790 77790 SUPERVISE HAND/LOAD RADIATION 114.06 3332078012 78012 NM-THYROID UPTKE SL/MUL QUANT 194.20 3412078013 78013 NM-THYROID IMAGE INC VASC FLOW 503.93 3412078014 78014 NM-THYROID IMG W/V-FLOW QUANT 602.78 3412078015 78015 NM-METS THYROID LIMITED 306.50 3412078016 78016 NM-THYROID CA METS ADD IMG 476.51 3412078018 78018 NM-THYROID CA METS WHOLE BODY 1437.79 3412078020 78020 NM-THYROID CA METS UPTAKE 122.86 3412078070 78070 NM-PARATHYROID IMAGING 833.90 3412078071 78071 NM-PARATHYROID IMG W/ SPECT 944.44 3412078072 78072 NM-PARATHYROID IMG W/SPECT&CT 2058.67 3412078075 78075 NM-ADRENAL CORTEX/MEDULLA 476.51 3412078102 78102 NM-BONE MARROW LIMITED 213.98 3412078103 78103 NM-BONE MARROW MULTI AREAS 833.90 3412078110 78110 NM-PLASMA VOL SINGLE SAMPLE 238.26 3412078120 78120 NM-RBC VOLUME SINGLE SAMPLE 238.26 3412078121 78121 NM-RBC VOLUME MULTI SAMPLE 238.26 3412078122 78122 NM-WHOLE BLOOD VOLUME 317.69 3412078135 78135 NM-RED CELL SURVIVAL KINETICS 357.39 3412078140 78140 NM-RED CELL SEQUESTRATION 357.39 3412078185 78185 NM-SPLEEN IMAGING ONLY 238.26 341
36
2078190 78190 NM-KINETICS PLATELET SURVIVAL 436.81 3412078191 78191 NM-PLATELET SURVIVAL STUDY 476.51 3412078195 78195 NM-LYMPHATICS/LYMPH NODE 357.39 3412078201 78201 NM-LIVER IMAGING STATIC 223.16 3412078202 78202 NM-LIVER IMAGING V-FLOW 375.57 3412078205 78205 NM-LIVER IMAGING (SPECT) 397.11 3412078206 78206 NM-LIVEER SPECT W/VASC FLOW 476.51 3412078215 78215 NM-LIVER/SPLEEN IMG STATIC 342.57 3412078216 78216 NM-LIVER/SPLEEN IMGW/VAS FLOW 554.12 3412078230 78230 NM-SALIVARY GLAND IMAGING 238.26 3412078231 78231 NM-SALIVARY GLAND SERIAL IMG 238.26 3412078232 78232 NM-SALIVARY GLAND FUNCTION 258.12 3412078258 78258 NM-ESOPHAGEAL MOTILITY 241.82 3412078261 78261 NM-GASTRIC MUCOSA IMAGING 360.58 3412078262 78262 NM-GASTRO-ESOPHAGEAL REFLUX 296.16 3412078264 78264 NM-GASTRIC EMPTYING IMG STUDY 321.17 3412078267 78267 NM-UREA BREATH TEST ISOTOPIC 197.57 3412078268 78268 NM-UREA BREATH TEST ISO ANAL 197.57 3412078270 78270 NM-VIT B-12 W/O INTRINSIC FAC 238.26 3412078271 78271 NM-VIT B-12 ABSORPTION STUDY 167.14 3412078272 78272 NM-VIT B-12 ABSORP W/WO IF 238.26 3412078278 78278 NM-ACUTE GI BLEED STUDY 554.12 3412078290 78290 NM-INTESTINE MECKELS 238.26 3412078291 78291 NM-PERITO-VENOUS SHUNT PATENCY 288.41 3412078300 78300 NM-BONE SCAN LIMITED 492.58 3412078305 78305 NM-BONE/JNT IMG MULTIPLE 825.02 3412078306 78306 NM-WHOLE BODY BONE SCAN 427.99 3412078315 78315 NM-BONE/JNT IMG 3 PHASE STY 574.55 3412078320 78320 NM-BONE/JNT IMG SPECT 230.57 3412078351 78351 NM-BONE MINERAL 2 PHTN 1/> 197.57 3412078428 78428 NM-CARDIAC SHUNT DETECTION 448.18 3412078445 78445 NM-VASCULAR FLOW STUDY 326.87 3412078451 78451 NM-MYOCARD PERF SPECT SINGLE 716.65 3412078452 78452 NM-MYOCARD PERF SPECT MULTIPLE 716.65 3412078453 78453 NM-MYOCARD PERF PLANAR SINGLE 716.65 3412078454 78454 NM-MYOCARD PERF PLANAR MULTI 716.65 3412078456 78456 NM-ACUTE VENOUS THROMBOSIS 581.72 3412078457 78457 NM-VENOGRAM UNILATERAL 326.87 3412078458 78458 NM-VENOGRAM BILATERAL 326.87 3412078466 78466 NM-MYOCARD IMAG INFARCT QL/QN 282.73 3412078468 78468 NM-MYOCARD IMAG INFARCT EJECT 282.73 341
37
2078469 78469 NM-MYOCARDIAL PLAN SPECT 427.99 3412078472 78472 NM-CARDIAC BLD POOL GATED SI 360.56 3412078473 78473 NM-CARDIAC BLD POOL 1ST MULT 427.99 3412078481 78481 NM-CARDIAC BLD POOL 1ST SING 427.99 3412078483 78483 NM-CARD BLOOD POOL/FL 307.85 3412078494 78494 NM-CARDIAC BLOOD POOL GATED E 282.73 3412078496 78496 NM-CARDIAC BLOOD POOL GATED E 122.86 3412078580 78580 NM-PULM PERFUSION IMAGING 677.27 3412078600 78600 NM-BRAIN IMG STATIC <4 VWS 615.70 3412078601 78601 NM-BRAIN IMG <4VS W/VAS FLOW 927.05 3412078605 78605 NM-BRAIN IMG MIN 4 STATIC VS 980.55 3412078606 78606 NM-BRAIN IMG COMP W/ V-FLOW 980.55 3412078607 78607 NM-BRAIN IMAGING TOMO (SPECT) 1086.46 3412078610 78610 NM-BRAIN IMAGING VASCULAR 503.53 3412078635 78635 NM-CSF FLOW IMG VENTRICLGRPHY 378.74 3412078645 78645 NM-CEREBRAL FLUID FLOW SHUNT 378.74 3412078647 78647 NM-CSF FLOW IMG TOMO (SPECT) 821.13 3412078650 78650 DETECTION AND LOCALIZATION CS 535.02 3202078660 78660 RADIOPHARMACEUTICAL DACRYOSYST 201.01 3202078700 78700 NM-KIDNEY IMAGING MORPHOLOGY 371.13 3412078701 78701 NM-KIDNEY SCAN W/ VAS FLOW 632.09 3412078707 78707 NM-KIDNEY IMG VF/FUNC SINGLE 636.85 3412078708 78708 NM-KIDNEY IMGW/VF/FUNC SING 1068.55 3412078709 78709 NM-KIDNEY IMAG VASC FLOW/FUNC 438.41 3412078710 78710 NM-KIDNEY IMG W/ TOMO (SPECT) 371.13 3412078725 78725 NM-KIDNEY FUNCTION NON-IMG RI 636.85 3412078730 78730 NM-URINARY BLADDER RETENTION 303.05 3412078740 78740 NM-URETERAL REFLUX STUDY 619.99 3412078761 78761 NM-TESTICULAR W/ BLD FLOW 342.57 3412078800 78800 NM-TUMOR LOCALIZATION LIMITED 490.29 3412078801 78801 NM-TUMOR LOCALIZ'N MULTIPLE 1362.06 3412078802 78802 NM-RADPHARM LOCAL OF TUMOR 640.80 3412078803 78803 NM-TUMOR LOCALIZ SPECT (3d) 889.36 3412078804 78804 NM-TUMOR IMG WHOL BODY 2+ DAY 1230.65 3412078805 78805 NM-RADPHARM INFLAM LIMIT AREA 432.98 3412078806 78806 NM-RADPHARM LOCAL'NWHOLE BODY 714.17 3412078807 78807 NM-RADPHARM INFLAM SPECT 872.06 3412079005 79005 NM-RADPHARM THERAPY ORAL 345.09 3422079101 79101 NM-RADPHARM THERAPY IV 345.09 3422079200 79200 NM-RADIOPH RXINTRCAVITY ADMIN 575.13 3422079300 79300 NM-RADPHARM TX INTERS COLLOID 345.09 342
38
2079403 79403 NM-RADIOPHARM MONOCLONAL AB TX 575.13 3422079440 79440 NM-RADPHARM TX INTRA-ARTICLAR 575.13 3422079445 79445 NM-RADIOPHARM TX INTRA-ART 345.09 3422089471 A4649 DRAPE BRACHIAL ANGIO 44INX31IN 21.99 2722089597 A4649 TORQUE DEVICE 65.60 2722090780 A4641 NM-ISOT PULMO PERF 307.85 3432093925 93925 US-DUPLEX LE ART COMP BIL 326.51 4022093926 93926 US-DUPLEX LE ARTERIES UNIL 163.25 4022093930 93930 US-DUPLEX UE ARTERIES BIL 326.51 4022093931 93931 US-DUPLEX UE ARTERIES UNIL 163.25 4022093975 93975 US DUPLX SCAN ART IN VEN OUT 422.44 4022093976 93976 US DUPLX SCAN ART IN VEN OUT 232.42 4022093980 93980 US DUPLX SCAN ART IN VEN OUT 177.98 4022093990 93990 US DUPLX SCAN HEMO ACC (ART I 261.20 4022094140 A4649 SET WIRE GUIDE EXCHANGE 725.75 2722095001 ANG CONNECTING TUBE 800PS 37.21 2722095002 A9500 NM-TC CARDIOLITE 600.84 3432095004 A9505 NM-RADIOPHARM THALLIUM 470.74 3432095006 A4641 NM-RADIOPHARM SPECIAL 595.74 3432096014 70336 MRI-TEMPOROMANDIBULAR JOINT 682.50 6102096018 74247 UPPER GI BARIUM W/ KUB 222.80 3202096019 76810 US-OB >= 14 WKS ADDL FETUS 237.92 4022096020 93970 US-DUPLEX EXTREMITY COMP BIL 326.51 4022096030 93971 US-DUPLEX EXTREMITY UNIL 237.92 4022096031 A4649 NEEDLE BIOPSY, QUICK-CORE 254.51 2722096040 A9556 NM-GALLIUM RADIOPHARMACEUTIC 151.46 3432096374 96374 THER/PROPH/DIAG INJ IV PUSH 344.28 3202097001 76377 CT-3-D RECONSTRUCTION 586.29 3502098001 77078 CT-BONE DENSITY STY AXIAL 221.32 3502098002 71035 CHEST DECUBITUS LEFT 78.35 3242098003 71035 CHEST DECUBITUS RIGHT 78.35 3242098004 74020 ABDOMEN DECUBITUS BILATERAL 117.56 3202098005 71035 CHEST DECUBITUS STUDY 78.35 3242098006 74020 ABDOMEN DECUBITUS LEFT 117.56 3202098007 74020 ABDOMEN DECUBITUS RIGHT 117.56 3202100002 A4649 CATHETER CXI-2.6-18-90 G50002 786.47 2722100003 A4649 CATHETER CXI-2.6-18-150 G50003 786.47 2722100121 A4649 DILATOR .038 16FR 20CM 43.74 2722100122 A4649 STOPCOCK LARGE-BORE 1-WAY 33.79 2722100123 C1769 GUIDEWIRE ROSEN .035INX80CM 64.65 2722100124 A4649 BALLOON PTA 4MMX4CMX80CM 938.26 272
39
2100125 A4649 NEEDLE SINGLE WALL 18GA 9CM 24.05 2722100126 A4649 CATHETER PIGTAIL 5FR 90CM 98.94 2722100127 C1769 WIRE CURVED .018 145CM 67.15 2722100128 C1769 GUIDE WIRE RUH HPWA-18-320 353.07 2722100129 C1769 WIR STRAIGHT .018 145CM 67.15 2722100130 C1769 WIRE EX STRAIGHT .035 260CM 67.15 2722100131 C1769 WIRE J GUIDEWIRE NEWTON .035 67.15 2722100132 A4649 NEEDLE BX CHIBA 20GA 15CM 64.73 2722100133 A4649 BALLOON OCCLCN 8.5MM 5.3-35-80 551.41 2722100134 A4649 CATHETER BERENSTEIN 5FR 100CM 98.94 2722100135 A4649 SHEATH 6FR 60CM 460.41 2722100136 A4649 DILATOR .038 6FR 20CM 39.48 2722100137 A4649 DILATOR .038 7FR 20CM 39.48 2722100138 A4649 DILATOR .038 5FR 20CM 39.48 2722100139 A4649 DILATOR .038 9FR 20CM 39.48 2722100140 A4649 DILATOR .038 10FR 20CM 39.48 2722100141 A4649 DILATOR .038 11FR 20CM 39.48 2722100142 A4649 DILATOR .038 12FR 20CM 39.48 2722100143 A4649 DILATOR .038 14FR 20CM 39.48 2722100144 C1769 WIRE GUIDE SHORTY .018 180CM 499.66 2722100145 A4649 COIL TORNADO 0.35 8MMX5MM 705.73 2722100146 A4649 CATHETER OMNI SOS 5FR 80CM 98.94 2722100147 A4649 SHEATH FLEXOR 5FR 45CM 413.40 2722100148 A4649 CATHETER OMNI FLUSH 5FR 90CM 98.94 2722100149 A4649 CATHETER SIM 4FR 100CM 98.94 2722100150 A4649 DILATOR .038 18FR 20CM 43.74 2722100151 A4649 BRUSH CYTLGY 3MM BCB-5-120-3-S 105.56 2722100152 A4649 CATHETER VAN ANDEL 5FR 391.20 2722100153 A4649 URETERAL CONECTR O-RING 7-10FR 29.31 2722100154 A4649 URETERAL CONECTR O-RING 3-7FR 47.23 2722100155 A4649 DILATOR .038 20FR 20CM 43.74 2722100156 A4649 CATHETER VC SPECT 5-LUMEN 15CM 666.05 2722100157 A4649 CATHETER BLRY FLEX 6.3FR 25CM 584.67 2722100158 A4649 SHEATH PEELAWAY 9FR 15CM 321.86 2722100159 A4649 SHEATH PEELAWAY 10FR 15.5CM 321.86 2722100160 A4649 COIL CUSTOM .035 5CMX6MM 588.08 2722100161 A4649 CATHETER OMNI FLUSH 5FR 65CM 98.94 2722100162 A4649 BALLOON 5MMMX4CMX80CM 778.51 2722100163 A4649 BALLOON 6MMX4CMX80CM 778.51 2722100164 C1769 GW COONS .035X80CM G12268 67.15 2722100165 A4649 CATHETER DAV CXI 4FR 135CM 825.79 272
40
2100166 A4649 CATHETER DAV CXI 4FR 90CM 825.79 2722100167 A4649 SET INTRO NON-VASCLR 21GA 15CM 722.53 2722100168 A4649 COIL NESTER .035 14CMX6MM 697.68 2722100169 A4649 COIL NESTER .035 14CMX8MM 697.68 2722100170 A4649 COIL NESTER 0.15 14CMX6MM 697.68 2722100171 A4649 COIL NESTER .035 14CMX10MM 697.68 2722100172 A4649 COIL NESTER EMBOL 3CMX2MM 620.09 2722100173 A4649 SHEATH 6FR 5.5CM 253.93 2722100174 A4649 SHEATH ANSEL 2 6FR 45CM 422.50 2722100175 A4649 SHEATH FLEXOR 6FR 45CM 422.50 2722100176 A4649 SHEATH PEELAWAY 16FR 15.5CM 312.96 2722100177 A4649 SHEATH ANSEL 1 6FR 45CM 422.50 2722100178 A4649 SHEATH FLEXOR 6FR 90CM 737.07 2722100179 A4649 SHEATH PEELAWAY 10FR 30CM 351.72 2722100180 A4649 INFLATION DEVICE CID-20-30 NG 249.65 2722100181 A4649 KIT NEEDLE HASKEL 1023.53 2722100182 A4649 CATHETER OMNI SIZING 5FR 100CM 657.78 2722100183 A4649 SET VENA CAVA FILTER RETRIEVAL 938.26 2722100184 C1769 GUIDEWIRE AMPLATZ XSTIFF 260CM 67.15 2722100185 C1769 GUIDEWIRE AMPLATZ XSTIFF 180CM 67.15 2722100186 A4649 KIT HASTEL TRANSJUG ACCESS 1393.05 2722100187 A4649 STENT 12MMX80MMX80CM 1710.40 2722100188 A4649 CATHETER BILIARY AMPLATZ 10FR 479.48 2722100189 A4649 STENT 12MMX60MMX80CM 1710.40 2722100190 A4649 STENT 14MMX60MMX80CM 1710.40 2722100191 A4649 STENT 14MMX80MMX80CM 1710.40 2722100192 A4649 COIL EMBOLIZATION .035 4CMX4MM 588.08 2722100193 A4649 CATHETER SIM 1 4FR 100CM 98.94 2722100194 A4649 CATHETER VERTEBRAL 4FR 100CM 98.94 2722100195 A4649 STENT 6MMX60MMX80CM 1697.08 2722100196 A4649 STENT 6MMX80MMX80CM 1697.08 2722100197 A4649 STENT 8MMX60MMX80CM 1697.08 2722100198 A4649 STENT 8MMX80MMX80CM 1697.08 2722100199 A4649 COIL EMBOLIZATION 6MMX7CM 1390.49 2722100200 A4649 COIL EMBOLIZATION 10MMX14CM 1451.06 2722100201 A4649 FORCEPS GRASPING 5FR 60CMX20MM 816.38 2722100202 A4649 COIL EMBOLZATION 0.35 5CMX8MM 588.08 2722100203 A4649 BALLOON DILATION CATH 3MMX2CM 938.26 2722100204 A4649 CATHETER BALLOON PTA 4MMX4CM 938.26 2722100205 A4649 STENT 7FR 10MMX60MMX75CM 1697.08 2722100206 A4649 KIT MICROPUNCTURE NEEDLE 5FR 190.05 272
41
2100207 A4649 BALLOON 14MMX4XCMX80CM 745.23 2722100208 A4649 SET GASTRO TUBE SML 14FR 794.48 2722100209 A4649 SET GASTRO TUBE SML 18FR 794.48 2722100210 A4649 COIL HILAL STR .018 0.5CM 323.21 2722100211 A4649 NEEDLE SINGLE WALL 18GA 25.32 2722100212 A4649 FORCEPS PULMONARY BX RDIAL JAW 213.39 2722100213 A4649 NEEDLE SINGLE WALL 19GA 25.82 2722100214 C1769 WIRE LUNDRQIST .035 145CMX15CM 322.84 2722100215 A4649 ADAPTOR LUER LOCK PFLLC-MLL-RA 39.48 2722100216 A4649 NEEDLE ECHO TIP 18GA 15CM 252.37 2722100217 A4649 CATHETER CORRA 1 4FR 65CM 98.94 2722100218 A4649 CATHETER BAL PTA 8MMX4CMX135CM 778.51 2722100219 A4649 CATHETER BAL PTA 8MMX4CMX80CM 778.51 2722100220 A4649 BALLOON 9MMX4CMX80CM 778.51 2722100221 A4649 CATHETER FEEDING TUBE MILLER 291.27 2722100222 A4649 KIT GASTROPEXY 824.15 2722100223 A4649 TUBE GASTRO FEED BALLOON 16FR 713.60 2722100224 A4649 CATHETER OMNI SOS 4FR 80CM 98.94 2722100225 A4649 ADAPTOR TOUCHY-BORST PTBYC-RA 85.28 2722100226 A4649 CATHETER INFSION 5FR 130CMX7CM 713.60 2722100227 A4649 SHEATH INTRODUCER 18FR 321.86 2722100228 A4649 SHEATH PEELAWAY 20FR 13CM 281.96 2722100229 A4649 SHEATH PEELAWAY 14FR 15.5CM 312.96 2722100230 A4649 STOPCOCK LOW-PRESSURE 1-WAY 32.93 2722100231 A4649 STOPCOCK HIGH-PRESSURE 1-WAY 32.93 2722100232 A4649 KIT ROSCH (TJ LIVER) ACCESS 1150.35 2722100233 A4649 COIL NESTER EMBOL 14CMX4MM 676.49 2722100234 A4649 CATHETER N-U STENT 8.5FR 10CM 804.59 2722100235 A4649 MICROCOIL HIAL .018IN 2CM 2M 275.96 2722100236 A4649 BASKET 6-WIRE STONE REMOVAL 554.09 2722100237 A4649 CATHETER GASTROJNSTMY SHETTY 533.45 2722100238 A4649 SHEATH 11FR 13CM 398.52 2722100240 A4649 SHEATH 9FR 30CM 296.67 2722100241 A4649 CATHETER CV TRIPLE-LUMEN 15CM 554.09 2722100242 A4649 CATHETER CV TRIPLE-LUMEN 20CM 549.18 2722100243 A4649 SHEATH 6FR 13CM 213.66 2722100244 A4649 SHEATH 8FR 30CM 296.67 2722100245 A4649 SET LIVER BIOPSY ACCESS 1211.89 2722100246 A4649 SHEATH PEELAWAY 9FR 30CM 466.75 2722100247 A4649 SHEATH PEELAWAY 11FR 30CM 466.75 2722100248 A4649 SHEATH PEELAWAY 12FR 30CM 351.72 272
42
2100249 A4649 SHEATH PEELAWAY 13FR 30CM 380.32 2722100250 A4649 SHEATH PEELAWAY 14FR 30CM 351.72 2722100251 A4649 SHEATH PEELAWAY 16FR 30CM 351.72 2722100252 A4649 CATHETER SIMMONS 2 5FR 100CM 98.94 2722100253 A4649 SHEATH 5FR 13CM 232.87 2722100254 A4649 CATHETER SIMMONS 1 5FR 100CM 98.94 2722100255 A4649 CATHETER HEADHNTER 1 5FR 100CM 98.94 2722100256 A4649 SHEATH 6FR 30CM 296.67 2722100257 A4649 INTRODUCER 10FR 30CM 296.75 2722100258 A4649 NEEDLE PERCUTANEOUS 21GA 15CM 25.82 2722100259 A4649 SHEATH 8FR 11CM 232.81 2722100260 C1769 WIRE NITINOL .018 125CM 261.82 2722100261 A4649 SET BIOPSY Q-C 20GA 20CMX20MM 354.21 2722100262 A4649 SET BIOPSY Q-C 18GA 20CMX20MM 354.21 2722100263 A4649 DILATOR .038 8FR 20CM 39.48 2722100264 A4649 SHEATH RCFW 12FR 30CM 585.10 2722100265 A4649 SHEATH 7FR 11CM 253.93 2722100266 A4649 CATHETER MIKAELSON 5FR 98.94 2722100267 A4649 CATHETER STRGHT FLUSH 5FR 90CM 98.94 2722100268 A4649 CATHETER KUMPE TORCON 5FR 65CM 98.94 2722100269 A4649 CATHETER BLRY 8.5FR .038INX40C 584.67 2722100270 A4649 CATHETER BLIARY FLEX 12FR 25CM 584.67 2722100272 A4649 CATHETER MULTIDRN 10.2FR 254CM 583.24 2722100274 A4649 CATHETER KUMPE TORCON 5FR 40CM 98.94 2722100275 A4649 EMBOLIZATION PVA-200 724.79 2722100276 A4649 EMBOLIZATION PVA-300 724.79 2722100277 A4649 CATHETER NEPHROSTOMY 10FR 25CM 610.71 2722100278 A4649 STENT URETERAL AMPZ 835FR 22CM 721.26 2722100279 A4649 STENT URETERAL 8.5FR 24CM 721.26 2722100281 C1769 WIRE NITINOL .018 80CM 540.29 2722100282 A4649 SET PNEUMOTHORAZ INTRO-TIP 731.45 2722100283 A4649 CATHETER DRAIN MLTP 8.5FR 45CM 576.14 2722100284 A4649 SHEATH 7FR 45CM 375.33 2722100285 A4649 CATHETER GASTRO WILLS-OGLESBY 707.36 2722100286 A4649 SHEATH 6FR 45CM 375.33 2722100287 C1769 WIRE AMPLATZ .035 180CMX8CM 138.26 2722100288 A4649 SHEATH PEELAWAY 5FR 366.18 2722100289 A4649 SHEATH 5FR 30CM 296.67 2722100290 A4649 SET BIOPSY Q-C 18GA 15CMX10MM 354.21 2722100291 A4649 SHEATH 7FR 35CM 479.33 2722100292 A4649 EMBOLIZATION PVA-500 724.79 272
43
2100293 A4649 EMBOLIZATION PVA-700 724.79 2722100294 A4649 SET VAS VITAL-PORT IP-S6013 1148.60 2722100295 A4649 STENT URETERAL 8FR 22CM 843.62 2722100296 A4649 STENT URETERAL 8FR 24CM 843.62 2722100297 A4649 STENT URETERAL 8FR 26CM 843.62 2722100298 A4649 NEEDLE BIOPSY CHIBA 21GA 15CM 64.73 2722100299 A4649 CATHETER BLRY 10FR .038INX40CM 584.67 2722100300 A4649 SHEATH 7FR 55CM 375.33 2722100301 A4649 CATHETER COBRA 2 5FR 65CM 98.94 2722100302 A4649 STENT 8MMX40CMX80CM 1697.08 2722100303 C1769 WIRE ROSEN EXCHANGE .035 260CM 64.65 2722100304 A4649 NEEDLE CENTESIS YUEH 15CM 108.11 2722100305 A4649 COIL EMBOL MREYE 35IN 2CM 3M 212.28 2722100306 A4649 COIL EMBOL MREYE 35IN 3CM 4M 212.28 2722100307 A4649 COIL EMBOL MREYE 38IN 5CM 10 212.28 2722100308 A4649 COIL EMBOL MREYE 38IN 5CM 12 212.28 2722100309 A4649 STENT VASCULAR 9MM DIA 30MM L 3821.00 2722100310 A4649 STENT VASCULAR 10MM DIA 30MM 3821.00 2722100311 A4649 STENT VASCULAR 10MM DIA 40MM 3821.00 2722100312 A4649 PTA5-35-80-7-4 778.51 2722100313 A4649 SHEATH 4FR 13CM 138.20 2722100314 A4649 COIL NESTER EMBOL 7CMX2MM 620.09 2722100315 C1769 GW COONS .035X145CM G02356 67.15 2722100316 A4649 DILATOR .035 4FR 20CM 60.82 2722100317 A4649 CATHETER GASTROJEJUNOSTMY PEDS 727.04 2722100318 A4649 IVC FILTER UNI-CELECT-PT 2109.78 2722100319 A4649 STENT 7FR 10MMX10MMX75MM 1697.08 2722100320 C1769 WIRE GUIDWR BENTSON .035 150CM 67.15 2722100502 A4649 GLIDEWIRE 5FRX65CM COBRA CG502 373.93 2722100507 A4649 GLIDEWIRE 5FRX65CM ANGTP CG507 373.93 2722100508 A4649 CATHETER 5FRX100CM CG508 373.93 2722100511 A4649 CATHETER SIM2 5FRX100CM CG511 373.93 2722100691 A4649 GW BNTSON CEREBRAL .35D 145 55.19 2722100840 A4649 SET MICROPUNCTURE ACCESS 5FR 343.76 2722100950 A4649 SYSTEM DETACHMENT INZONE 2.0 851.73 2722100998 A4649 DILATOR 5FR X 15CM 22.29 2722101059 A4649 CATHETER VENOUS PIC 3FR 549.72 2722101060 A4649 CATHETER VENOUS PIC 4FR 582.75 2722101061 A4649 CATHETER VENOUS PIC 5FR 582.75 2722101104 A4649 ANGIO SEAL PLATEFORM VIP 8FR 1046.55 2722101105 A4649 GUIDEWIRE HYDRO .035X180CM 282.63 272
44
2101151 A4649 NEEDLE BIOPSY OSTYCUT 716.00 2722101152 A4649 NEEDLE BIOPSY HANDGRIP 443.22 2722101153 A4649 CATHETER BALLOON 6X4 75CM 20AT 966.15 2722101155 A4649 CATHETER BALLOON CON 7MMX4MMX7 966.15 2722101156 A4649 CATHETER BALLOON 10X4 75CM 20A 966.15 2722101157 A4649 CATHETER BALLOON QUEST 12MMX4C 966.15 2722101188 A4649 CATHETER PICC SINGLE LUMEN 5FR 828.24 2722101220 A4649 ANG INTRA-AORTIC BALLOON DEVI 1837.85 2722101253 A4649 GW CURVED ROSEN .35IN 260CM 65.79 2722101263 A4649 GW CURVED ROSEN .35IN 180CM 44.57 2722101264 A4649 CATHETER HEADHUNTER 5FR .038IN 178.78 2722101265 A4649 CATHETER SIDEWINER 5FR .038IN 178.78 2722101268 A4649 CATHETER CORDIS COBRA 0.38INX1 178.78 2722101272 A4649 CATHETER BERENSTEIN 5FR 100CM 178.78 2722101295 A4649 PROBE COVER ULTRASOUND LARGE 93.49 2722101531 A4649 ANG PVA FOAM 500 799.52 2722101620 A4649 ANG ANGIOGRAM PACK DISP 723.56 2722101628 A4649 DRESSING TEGADERM 6INX6IN 21.63 2722101629 A4649 DRESSING TEGADERM 8INX12IN 28.35 2722101811 A4649 GLIDEWIRE 18X180CM GW1818 801.22 2722101812 A4649 GLIDEWIRE GOLD .018 CM1811 719.25 2722102016 A4649 NEEDLE BIOPSY QUICKCORE 18-9.0 396.42 2722102020 A4649 NEEDLE BIOPSY QUICKCORE 18-9.0 396.42 2722102021 A4649 NEEDLE BX Q-CORE 18-15.0-10T 396.42 2722102090 A4649 CATHETER BALLOON CUT 7MMX2CM 2233.50 2722102379 A4649 BALLOON PTA 12MMX4CMX80CM 778.51 2722102413 A4649 CATHETER 2.4FR MCPB2413Y 1008.19 2722102524 A4649 GUIDEWIRE EMERALD .025INX150CM 181.39 2722102560 A4649 GUIDEWIRE SOFT STR TIP BENTSON 189.02 2722102640 A4649 WIRE ROSEN .035 1.5CMX180CM 67.15 2722102694 A4649 COIL NESTER .035 14CMX6MM 697.68 2722102726 A4649 ANG GUIDEWIRE APTZ .035INX150 331.28 2722102735 A4649 GUIDEWIRE EMERALD .035INX260CM 181.39 2722102813 A4649 CATHETER 3X130X53 MCPE28131Y 1430.65 2722102972 A4649 SET INTRO MICROPNCT 4FR G02972 459.91 2722103501 A4649 GLIDEWIRE STR 35X250CM GR03501 226.32 2722103506 A4649 GLIDEWIRE ANG 35X180CM GR3506 226.32 2722103509 A4649 GLIDEWIRE ANG 35X260 GR3509 339.64 2722103759 A4649 BALLOON DORADO 8MMX4CMX80CM 98.94 2722104286 A4649 STENT 10MMX40MMX80CM 1697.08 2722104384 A4649 STENT 6MMX40MMX80CM 1697.08 272
45
2104568 A4649 GUIDEWIRE STD J-TIP 0.05"X15 22.44 2722104604 A4649 SHEATH INTRO 4FR 11CM 178.78 2722104605 A4649 SHEATH BRITE TIP 6FR 5.5CM 975.85 2722104606 A4649 INTRODUCER ADVANTIX 6FRX11CM 168.05 2722104608 A4649 INTRODUCER 8FR .38INX11CM 45.83 2722104610 C1769 GUIDEWIRE FRM J-TIP 0.038INX15 22.44 2722104617 C1769 GUIDEWIRE STD J-TIP 0.038INX26 22.44 2722104800 A4649 SET MICROPNCTRE 5F 10CM G48008 327.39 2722104877 A4649 NDL THINWALL PERCUTANEOUS 14.85 2722105118 A4649 TRAY PICC DUAL LUMEN 5FR 824.48 2722105229 A4649 BALLOON PTA 35X135X10X4 G52293 778.51 2722105233 A4649 BALLOON PTA 35X80X4X4 G52332 778.51 2722105237 A4649 BALLOON PTA 35X80X10X4 G52373 778.51 2722105273 A4649 COIL COMPLEX 4MMX40MM 676.49 2722105279 A4649 COIL NESTER .018 7CMX8MM 676.49 2722105308 A4649 RETRIEVER VSCLR CLVRSNR 4-LOOP 1256.19 2722105625 C1769 GUIDEWIRE EXPO 5FR 100CM 148.64 2722105839 A4649 SET G-J 2-LUMEN C-A-COONS 1029.97 2722106005 A4649 CATH HNB5.0-38-100-P G06005 481.79 2722106036 A4649 TUBING M/M LEUR LOCK 36 22.41 2722106048 A4649 TUBING M/M LEUR LOCK 48 22.41 2722106080 A4649 STENT BILIARY LUM 6MMX80MMX135 2329.20 2722106118 A4649 TRAY PICC DUAL LUMEN 6FR 824.48 2722106438 A4649 POWER INJECT PORT 9.5FR G26438 1136.88 2722106570 C1894 INTRODUCER FRENCH SHEATH 7FR 194.32 2722106584 A4649 INTRODUCER FRENCH SHEATH 6FR 194.32 2722107157 A4649 COIL EMBOL TORNADO .018 P4 275.96 2722107158 A4649 MICROCOIL HIAL .018IN 3CM 3M 275.96 2722107557 C1769 GW XTRASUPORT ROADRUN. 18 180 301.44 2722108356 A4649 COIL EMBOL TORNADO .018 P5 275.96 2722108376 A4649 CATH PICC 3FR 50CM G08376 536.37 2722108503 A4649 CATHETER P/F 5F 110CM 10708503 125.99 2722108777 C1769 GW XTRASUPORT ROADRUN. 14 180 301.44 2722108801 C1769 GW XTRASUPORT ROADRUN. 14 300 324.79 2722109406 A4649 CATHETER PIG 4FR 70CM G09406 94.23 2722109489 A4649 NEEDLE YUEH 5FR 7CM G09489 162.04 2722109490 A4649 NEEDLE YUEH 5FR 10CM G09490 187.98 2722109710 A4649 SET STENT AMPLATZ 8.5FR 26CM 686.91 2722109803 A4649 CATHETER P/F 5F 100CM 13709803 718.11 2722109956 C1769 GW ULTRASTIFF AMPLTZ .035IN 76.42 2722110000 A4649 TORQUE DEVICE TD01 44.51 272
46
2110050 C1729 SET DRAIN CATH 10.2FR G10050 845.53 2722110208 A4649 DILATOR 7-38-20 AQ HDRPHL 65.93 2722110210 A4649 SET NEPHROSTOMY 8FR 822.78 2722110289 A4649 DILATOR 8-38-20 AQ HDRPHL COAT 65.93 2722110290 A4649 DILATOR AQ HYDROPHILIC 9-38-20 65.93 2722110411 A4649 COIL EMBOL TORNADO PROX 8MM 275.96 2722110413 A4649 COIL EMBOL TORNADO PROX 10M 275.96 2722110415 A4649 COIL EMBOL TORNADO PROX 5MM 275.96 2722110416 A4649 COIL EMBOL TORNADO PROX 6MM 275.96 2722110417 A4649 COIL EMBOL TORNADO PROX 7MM 275.96 2722110446 A4649 CATH G-J ULT MC COAXIAL 398.83 2722110448 A4649 SET G-J COAXIAL SYSTEM 1048.01 2722110530 A4649 GLIDEWIRE STF SHFT .035X260CM 381.38 2722111001 A4649 ANGIOGRAPHY FLOWSWITCH 172.11 2722111161 A4649 COMPRESS SYSTEM FEMOSTOP PLUS 798.96 2722111211 A4649 INTRODUCER 7FR X 13CM 148.60 2722111633 A4649 INTRODUCER 7FR X 55CM 169.83 2722111636 A4649 INTRODUCER 6FR X 70CM 212.28 2722111991 A4649 CATHETER CEREBRAL 5FR 100CM 178.32 2722112057 A4649 NEEDLE BIOPSY COAXIAL 155.81 2722112156 A4649 CATH VISCERAL KMP 5FR 65CML 178.32 2722112421 A4649 VALVE HEMOSTATIC ROTATING 327.19 2722112552 A4649 CATHETER BALLOON BM 5.8FR 8MMX 1212.48 2722113287 A4649 FILTER VENACAVA 11F 60CM L 6 275.96 2722114045 A4649 CATHETER VER 4F 100CM 10714045 125.99 2722114300 A4649 STENT USE-14-300A 651.79 2722114659 A4649 GUIDEWIRE MAGICTORQUE .035INX1 431.83 2722115105 A4649 INFLATION DEVICE ENCORE 26 791.30 2722115521 A4649 SET PNEUMOTHORAX TURNER PIG 6. 819.97 2722115730 A4649 SHEATH PINNACLE 5FR 25CM 235.26 2722115731 A4649 SHEATH PINNACLE 6FR 25CM 235.26 2722118034 A4649 NEEDLE BX Q-C 20X9X20T G27019 396.42 2722118035 A4649 NEEDLE BX Q-CORE 20-15.0-10T 396.42 2722118300 A4649 STENT USE-18-300A 651.79 2722118502 A4649 CATHETER C-2 4FR 65CM 10718502 125.99 2722118830 A4649 NEEDLE BIOPSY QUICKCORE 20-9.0 396.42 2722118832 A4649 NEEDLE BX Q-C 18X15X20 G08790 396.42 2722118861 A4649 SET BILIARY STONE REMOVAL 1145.15 2722118866 A4649 SET INTRAVASCULAR RETRIEVER CU 983.24 2722118867 A4649 SET INTRAVASCULAR RETRIEVER DO 1159.75 2722119503 A4649 CATHETER HH1 5F 100CM 10719503 125.99 272
47
2119630 A4649 CATHETER SPORTPACK 14.5FR 19CM 1220.44 2722119708 A4649 CATHETER C2 5FR 65CM 10719708 125.99 2722120000 A4649 CATHETER ANG CXI 2.6FR 90CM 825.79 2722120200 A4649 NEEDLE ASPIRATION CHIBA 20GX20 64.09 2722120405 A4649 CATHETER SO-2 5F 80CM 10720405 125.99 2722120408 A4649 CATHETER SO-0 5F 80CM 10720408 125.99 2722120608 A4649 SHEATH BANANA PEEL 12FR 15CM 375.05 2722121520 A4649 COIL TARGET 360 NANO 1.5X2 3234.69 2722122102 A4649 CATHETER BER 5FR 65CM 10722102 125.99 2722122566 A4649 STENT URETERAL 8FR 25CM 889.56 2722123162 A4649 CATH CXI-2.3-14-135-269 819.33 2722123400 A4649 CATHETER SPORTPACK 14.5FR 23CM 1220.44 2722123523 A4649 COIL NESTER MWCE-35-7-3 669.90 2722123644 C1769 GW TSHF-35-180-AUS-ST G23644 185.55 2722126991 A4649 COIL EMBOLIZATION 10DIA 14L 275.96 2722126992 A4649 COIL EMBOLIZATION 12DIA 14L 275.96 2722126993 A4649 COIL NESTER MWCE-35-14-4 652.22 2722126994 A4649 COIL EMBOLIZATION 6DIA 14L 275.96 2722126995 A4649 COIL EMBOLIZATION 8DIA 14L 275.96 2722127045 A4649 CATH BER 5FR 65CM 11722704 367.50 2722127047 A4649 SET G-J 2-LUMEN ULT C-A-COONS 658.60 2722127289 A4649 INTRODUCER VALVE CHECK-FLO 155.81 2722128673 A4649 NEEDLE CENTESIS CATHETER 173.31 2722128675 A4649 CATHETER CENTESIS YUEH 10CM 5F 259.39 2722128700 A4649 CATHETER BILIARY DRAINAGE 707.31 2722129996 A4649 INTRO 6FR X 55CM TUOHY- BORS 191.05 2722129997 A4649 INTRO 6FR X 55CM TUOHY- BORS 191.05 2722130023 A4649 CATH C-V .032X7FRX20CM AK15703 318.39 2722130110 A4649 ANG ANGIO-SEAL 6FR 1046.55 2722130305 A4649 CANNULA DUCTOGRAM 173.31 2722130307 A4649 CATHETER PICC POWER DUAL 6FR 837.55 2722130359 A4649 STENT URETERAL 6FR 22CM 940.62 2722130364 A4649 KIT STENT URETERAL 8FR 28CM 855.11 2722130365 A4649 MICRO COIL PLATINUM .018 2X5 526.42 2722130367 A4649 MICRO COIL PLATINUM .018 2X4 526.42 2722130368 A4649 DRAINAGE SYSTEM W/PORT SUCTION 236.29 2722130369 A4649 DRAINAGE BAG 60ML W/TUBING 118.17 2722130392 A4649 GUIDEWIRE ROSEN CURVED 145CM 220.25 2722130393 A4649 GUIDEWIRE PUSHER MICROCOIL 291.24 2722130395 A4649 GUIDEWIRE AMPLATZ ULTRASTIFF 1 336.04 2722130397 A4649 SHEATH BRIGHT BALKIN 704.74 272
48
2130399 A4649 INTRODUCER FLX TUOHYBORST 7FR 728.75 2722130402 A4649 SHEATH PINNACLE 5FR 10CM 264.89 2722130403 A4649 SHEATH PINNACLE 6FR 10CM 264.89 2722130404 A4649 CATHETER DRAINAGE APDL 8FR 25C 894.59 2722130405 A4649 CATH DRAINAGE APDL 10FR 25CM 894.59 2722130408 A4649 STENT NEPHROURETERAL 8FR 22CM 962.97 2722130409 A4649 STENT NEPHROURETERAL 8FR 24CM 962.97 2722130410 A4649 STENT NEPHROURETERAL 8FR 26CM 962.97 2722130411 A4649 ANG WIRE TRANSEND 8 165CM 1236.50 2722130413 A4649 CATHETER BALLOON PTA 6X4.75CM 1064.42 2722130417 A4649 CATHETER BALLOON PTA DIL 10X4. 1064.42 2722130528 A4649 COIL EMBOL MWCE-18-7-6 G52738 644.28 2722130686 A4649 SET DRAINAGE POUCH COOK 112.75 2722130823 A4649 BALLOON PTA4-18-170-3-20G30832 875.18 2422130832 A4649 BALLOON PTA4-18-170-3-20G30832 875.18 2722130933 A4649 CATH BAL PTA4-18-150-2-4 30933 893.58 2722131027 A4649 INFLATE DVC CID-20-30 G31027 698.58 2722132201 A4649 CATHETER O/F 5FR 65CM 10732201 125.99 2722132702 A4649 CATHETER KMP 5FR 40CM 10732702 125.99 2722134217 A4649 PROBE COVER PRE-GELLED NON-LAT 17.18 2722134319 A4649 CATH BAL PTA4-18-150-3-4 34319 893.58 2722134321 A4649 CATH BAL PTA4-18-150-3-8 34321 893.58 2722134882 A4649 SET DRAIN MULTIPURPOSE 8.5FR 910.31 2722134883 A4649 SET DRAIN MULTIPURPOSE 10.2FR 910.31 2722135015 A4649 CATH BER 4FR 100CM 11723501 367.50 2722136282 A4649 GW HIGHWIRE ANGLE .035IN D 1 394.84 2722137456 A4649 SET DRAINAGE 12FR 25CM G10261 848.19 2722137508 A4649 SET BIOPSY Q-C 20GA 15CMX10MM 354.21 2722137511 A4649 NEEDLE BX 20-15.0-20T G08790 404.82 2722137513 A4649 NEEDLE BX Q-C 18X15X20T G08788 404.82 2722137682 A4649 CATHETER CENTESIS YUEH 7CM 5FR 259.39 2722138049 A4649 SET DRAINAGE 8.5FR 25CM G10049 846.54 2722138052 A4649 SET DRAINAGE 14FR 25CM G10352 840.64 2722138087 A4649 SHEATH INTR 5FR 11CM 504-605X 71.26 2722139406 A4649 SET GI SUTURE ANCHOR 477.68 2722142423 A4649 COIL EMBOL MREYE 35IN 5CM 8M 212.28 2722142467 A4649 COIL EMBOL MREYE 38IN 8CM 15 212.28 2722142540 A4649 COIL TARGET 360 NANO 2.5X4 3234.69 2722142920 A4649 STENT BALLOON EXP 4MM X 16MM 2961.27 2722142925 A4649 STENT BILI 5/6FR 5MM DI 16MM 2961.27 2722142927 A4649 STENT BALLOON EXP 5MM X 24MM 2961.27 272
49
2142930 A4649 STENT BILI 5/6FR 6MM DI 16MM 2961.27 2722142932 A4649 STENT BILI 5/6FR 6MM DI 24MM 2961.27 2722142936 A4649 STENT BILI 6/7FR 7MM DI 20MM 2961.27 2722143040 A4649 COIL TARGET 360 NANO 3X4 3234.69 2722143850 A4649 STENT VASCULAR 7MM DIA 30MM L 3821.00 2722143851 A4649 STENT VASCULAR 7MM DIA 40MM L 3821.00 2722143855 A4649 STENT VASCULAR 8MM DIA 30MM L 3821.00 2722143856 A4649 STENT VASCULAR 8MM DIA 40MM L 3821.00 2722143857 A4649 STENT VASCULAR 8MM DIA 60MM L 4033.26 2722143861 A4649 STENT VASCULAR 9MM DIA 40MM L 3821.00 2722143862 A4649 STENT VASCULAR 9MM DIA 60MM L 4033.26 2722143870 A4649 SET MICROPNCTRE 5F 10CM G43870 319.20 2722146305 A4649 GUIDEWIRE HYDRO .035X150CM 541.54 2722147942 A4649 INTRO MICROPUNCTURE SET 4FR 95.54 2722150002 A4649 CATH ANG CXI-2.6-18-90-PNS 795.69 2722150003 A4649 CATH ANG CXI-2.6-18-150-P-NS 795.69 2722150018 A4649 SET INTRO MICROPUNCTURE 5FR 370.84 2722150140 A4649 GW CURVED 35X145X1.5 G01382 155.13 2722150319 A4649 BALLOON PTA4-14-170-2-20G50319 1006.49 2722150326 A4649 BALON PTA4-14-170-2.5-20G50326 1006.49 2722150333 A4649 BALLOON PTA4-14-170-3-20G50333 1006.49 2722150791 A4649 BALLOON PTA5-35-80-7-4.0 756.29 2722151011 A4649 NEEDLE 11G AFAFLEX+CURVED NIT 1204.82 2722151110 A4649 TROCAR/BEVEL 11GX12CM AVAMAX 487.90 2722151501 A4649 CATHETER 5FR .035X65 451-501V5 803.93 2722152260 A4649 BALLOON PTA5-35-135-5-8 G52260 700.09 2722152265 A4649 BALLOON PTA5-35-135-6-4.0 700.09 2722152266 A4649 BALLOON PTA5-35-135-6-6 G52266 700.09 2722152267 A4649 BALLOON PTA5-35-135-3-8 G52267 700.09 2722152268 A4649 BALLOON PTA5-35-135-6-10G52268 700.09 2722152286 A4649 BALLOON PTA5-35-135-9-4 G52286 0.00 2722152326 A4649 CATHETER BALLOON PTA 3MMX4CM 852.50 2722152334 A4649 BALLOON PTA5-35-80-4-10 G52334 700.09 2722152338 A4649 BALLOON PTA5-35-80-5-4 G52238 700.09 2722152346 A4649 CATH BALLOON PTA 5F .035 6MM 742.96 2722152348 A4649 BALLOON PTA5-35-80-6-10.0 700.09 2722152352 A4649 BALLOON PTA5-35-80-7-4.0 700.09 2722152353 A4649 CATH BALLOON PTA 5F .035 7MM 742.96 2722152360 A4649 CATH BALLOON PTA 5F .035 8MM 742.96 2722152371 A4649 BALLOON PTA5-35-80-9-14 G52371 700.09 2722152379 A4649 BALLOON PTA5-35-80-12-4 G52379 700.09 272
50
2152397 A4649 CATH BALLOON PTA 6F .035 9MM 742.96 2722152546 A4649 CATH CXI-4.0-35-90-P-NS-0 795.69 2722152547 A4649 CATH CXI-4.0-35-90-P-NS-DAV 795.69 2722152650 A4649 GUIDEWIRE EMERALD 5FR .035X15 148.64 2722152737 A4649 COIL NESTER MWCE-18-7-4 648.34 2722152739 A4649 COIL NESTER MWCE-18-7-8 648.34 2722152742 A4649 COIL NESTER MWCE-35-7-4 648.34 2722152743 A4649 COIL NESTER MWCE-35-7-6 648.34 2722152939 A4649 CATHETER HMW-14-300-ST 767.53 2722153122 A4649 SET PNEUMOTHORAX 676.54 2722155045 A4649 CATH MPA 5FR 100CM 10735504 153.29 2722155887 A4649 SET ABSCESS DRAINAGE MALECOT 916.45 2722156015 A4649 CATH MPA 5FR 65CM 10735601 153.29 2722160530 A4649 GLIDEWIRE STIF 35X180CM GS6506 329.03 2722160810 A4649 WIRE ANGLED GLIDE .018 413.96 2722162552 A4649 STOPCOCK ONE/THREE-WAY 24.60 2722164150 A4649 GUIDEWIRE EXPO 6FR 100CM 148.64 2722165320 A4649 GW COONS .035X145CM G02356 67.15 2722166306 A4649 ANG VENA CAVA TRAPESE-SHORT 1767.79 2722168110 A4649 CATHETER VENOUS PIC 6FR 750.80 2722170394 A4649 SET NEPHROSTOMY ULTRATHANE 949.85 2722173250 A4649 BALLOON PTA 35X80X10X4 G52373 778.51 2722176121 A4649 ADAPTER SIDEARM 151.70 2722176871 A4649 SET ABSCESS DRAINAGE THAL-QUIC 703.21 2722188882 A4649 CATHETER MAHURKAR 12FR 13CM 713.73 2722189471 A4649 DRAPE BRACHIAL ANGIO 44INX31IN 21.99 2722189597 A4649 TORQUE DEVICE 65.60 2722194140 A4649 SET WIRE GUIDE EXCHANGE 725.75 2722195001 A4649 ANG CONNECTING TUBE 800PS 37.21 2722196031 A4649 NEEDLE BIOPSY QUICK-CORE 254.51 2722196065 A4649 CATH SW1 5FR 100CM 10719606 125.99 2722196075 A4649 CATH SW2 5FR 100CM 10719607 125.99 2722198035 A4649 CATH PIG 5FR 100CM 13709803 718.14 2722298001 MIP CO-PAYMENT-ER 5.51 2202298002 MIP CO-PAYMENT-PHARMACY 3.20 2203300001 HOSP PRIVILEGES APPL FEE 293.55 2293300002 PHYSICIAN REAPPOINT FEE 0.00 2293300003 PT ESCORT/DAY-HI SF WADC 223.36 2293300004 PT ESCORT/DAY-ALL OTHERS 191.45 2293300005 PT ESCORT/DAY-CNMI 159.54 2293303001 VTC FEE 153.16 229
51
3394001 OFF-ISLAND TRANSPORT-MINIMAL C 1584.11 5423394002 OFF-ISLAND TRANSPORT-INTERMEDI 2594.38 5423394003 OFF-ISLAND TRANSPORT-CRITICAL 4171.61 5424000008 78018 NM-METS I-131, MULTIPLE 197.13 3414000039 78014 NM-THYROID IMG, W/BLOOD FLOW 342.57 3414001500 78012 NM-THYROID UPTAKE, MEASUREMENT 294.98 3414005370 78013 NM-THYROID SCAN 306.50 3414078807 78807 NM-RADPHARM INFLAM, SPECT 872.06 3414100068 J3490 AGENTS-FLAXEDIL 10 CC 11.00 2504100134 J3490 AGENTS-PENTHRANE 18.09 2504200000 J3490 HOME MEDS 0.00 2504200001 J3490 ACETIC ACID 1% SOLN 1000ML 5.27 2504200002 J3490 ZANTAC 25MG/ML 6ML VIAL 49.85 2524200003 J3490 TIGECYCLINE 50MG VIAL 220.74 2524200004 J3470 MAGNESIUM S04 1GM/2ML AMP 4.32 2514200005 Q2037 INFLUENZA VACCINE .05ML DOSE 21.77 2514200006 J3490 LACTULOSE SOLN 50% 300ML 14.57 2514200007 J3490 KAYEXALATE SUSP 20ML 5.08 2524200008 J3490 NICORETTE GUM 0.78 2524200009 J3490 METOCLOPRAMIDE SOLN 10MG/10ML 1.13 2514200010 J3490 ACETAMINOPHEN DROP 15ML 4.92 2574200011 J3490 MORPHINE ELIX 5CC DOSE 3.60 2514200012 J3490 KAYEXALATE POWDER 25GM 14.54 2524200014 J3490 KAYEXALATE SUSP 10ML 2.51 2524200016 J3490 MORPHINE 20MG/5ML ORAL UD 1.08 2514200017 J3490 LACTULOSE SYRUP 100ML 15.25 2514200020 J3490 ACETAMINOPHEN SYR 160MG/5ML UD 1.11 2574200021 J3490 HEPARIN FLUSH 100U/ML 30ML 7.08 2514200022 J3490 NITROGLYCERIN 1/150 GR 25 5.12 2514200023 J3490 FOLIC ACID 5MG/ML 10ML VL 33.01 2514200024 J3490 QUESTRAN POWDER 450MG 4.21 2524200025 J3490 TIMOPTIC OPHTH 0.5% 10ML 75.09 2524200026 J3490 ELASE OINTMENT 10 GM 35.96 2524200027 J3490 EUCERIN CREAM 30 GM 3.08 2574200028 J3490 ELASE-CHLORO OINT 10GM 39.27 2524200029 J3490 LUBERIDERM/HC/MENTHOL 4OZ 19.53 2504200030 J3490 ACETAMINOPHEN 325MG TABLET 1.11 2574200031 J3490 ANTIHEMOPHILIC F8 1000IU VI 1147.66 2514200032 J3490 ACETAZOLAMIDE 250MG TABLET 1.11 2514200033 J3490 KAYEXALATE W/SORBITOL 500M 103.13 2524200034 J3490 ACTHAR LYOPHILIZED 40U 1M 70.56 252
52
4200035 J3490 FER-IN-SOL DROPS 50ML 22.22 2574200037 J3490 DOCUSATE SODIUM 10MG/10ML UD 1.11 2514200038 J3490 LACTULOSE 50CC DOSE 4.85 2514200039 J3490 CECLOR 250MG/5ML 75ML 52.28 2524200040 J3490 ACETEST TABLET 100'S 17.66 2504200041 J3490 ACETIC ACID GL 99.7% 1GAL 30.32 2504200043 J3490 ACTIVATED CHARCOAL 10GR TA 1.23 2504200044 J7060 DEXTROSE 5% ISOLYTE P 150ML 10.06 2584200046 J3490 DEXTROSE 5% ISOLYTE P 1000ML 12.32 2584200047 J3490 STREPTOKINASE 750000 UNIT 301.11 2514200048 J3490 NEO IN NORM SALINE RET 2% 67.88 2514200049 J3490 LASIX 10MG/ML ORAL DOSE 0.42 2524200050 J3490 ACETOHEXAMIDE 250MG TABLET 1.11 2514200051 J3490 INTRALIPID 10% 250ML 29.07 2504200052 J3490 ACETAZOLAMIDE 250MG 0.40 2514200053 J3490 TEGISON 25 MG CAP 5.83 2524200054 J3490 MERCUROCHROME 10% 2.26 2574200055 J3490 SODIUM CL PER IV DOSE 1.35 2514200056 J3490 POTASSIUM ACET PER IV DOSE 3.32 2514200057 J3490 FOLIC ACID 1MG/0.5ML DOSE INJ 3.31 2514200058 J3490 SYNALAR OINTMENT 0.025% 36.67 2524200059 J3490 SORBITAL 25% 200ML 9.47 2524200061 J3490 ACETONE 16OZ 9.89 2574200062 J3490 ACETONE 60ML 2.26 2574200063 J3490 KAYEXALATE SUSP 30ML 7.59 2524200064 J3490 POTASSIUM CL ORAL DOSE 0.62 2514200065 J3490 NITROGLYCERIN 1/150GR SL 2 9.07 2514200066 J3490 DIAMOX ORAL LIQUID DOSE 3.60 2524200067 J3490 SORBITOL 20% 30ML 3.60 2524200068 J3490 GLYBURIDE MICRO 3MG TAB 2.40 2514200069 J3490 HYDROCHLOROTHIAZIDE 50MG/5ML 5 1.95 2514200070 J3490 APAP W/ CODEINE 240/24 10ML UD 2.38 2514200072 J3490 CETAPHIL LOTION 8OZ 12.00 2524200073 J3490 ZAROXOLYN 2.5MG TABLET 0.98 2524200074 J3490 TENEX 1MG TABLET 0.95 2524200075 J3490 MAGNESIUM S04 5GM/10ML 18.13 2514200076 J3490 MILK OF MAGNESIA 45ML 0.41 2574200077 J3490 SODIUM CL ORAL DOSE 6.16 2514200079 J3490 ISOSORBIDE MONO ER 60MG TAB 1.45 2514200080 J3490 ACETYLCYSTEINE 20% 10ML 19.30 2514200081 J3490 NORMAL SALINE 100ML 9.01 258
53
4200082 J3490 CLEOCIN 300MG INJECTION 26.02 2524200083 J3490 THORAZINE CONC DOSE 0.46 2524200084 J3490 CALADRYL LOTION 180ML BT 7.62 2574200085 J3490 ALDACTONE SUSP DOSE 1.95 2524200087 J3490 AMPICILLIN 125MG/5ML DOSE 4.85 2514200088 J3490 AMPICILLIN 250MG/5ML DOSE 0.78 2514200089 J3490 AMOXICILLIN 250MG/5ML DOSE 4.61 2514200090 J3490 ASPIRIN 325MG TABLET 1.11 2514200091 J3490 AMOXICILLIN 125MG/5ML DOSE 1.13 2514200092 J3490 GOLYTELY 4L BOTTLE 41.50 2504200093 J3490 CLOBETASOL 0.05% 30GM OINTMENT 14.13 2514200094 J3490 CLOBETASOL 0.05% 15GM CREAM 8.49 2514200095 J3490 CLOBETASOL 0.05% 30GM CREAM 10.74 2514200096 J3490 ISOSORBIDE MONO ER 30MG TAB 1.76 2514200097 J3490 CECLOR 125MG/5ML 75 ML 29.74 2524200098 J3490 CALAN SR 240MG 2.27 2524200099 J3490 LIORESAL ORAL LIQ DOSE 2.57 2524200100 J3490 NEOMYCIN 2% RET ENEMA 200 68.34 2514200102 J3490 COUMADIN 2MG TABLET 0.68 2524200103 J3490 MOTRIN 800MG TABLET 1.03 2524200104 J3490 VEPESID 100MG/5ML VIAL 247.30 2524200105 J3490 CYCLOCORT 0.1% 60GM OINT 84.48 2524200106 J3490 T/GEL SHAMPOO 4-1/2 OZ 14.54 2574200107 J3490 LIDEX GEL 0.05% 60GM 80.08 2524200108 J3490 INDERAL ORAL 20MG/5ML DOSE 2.26 2574200109 J3490 NEOSYNEPHRINE NOSE DRP 1/4 7.94 2574200110 J3490 ACNOMEL CREAM 30GM 6.03 2524200112 J3490 SODIUM THIOSULFITE 1GM VL 24.23 2514200113 J3490 TREXAN 50MG TABLET 8.23 2524200114 J3490 CORDARONE 200MG TABLET 5.33 2524200116 J3490 AMPICILLIN 2GM INJECTION 27.68 2514200117 J3490 MUTAMYCIN 20MG INJECTION 875.61 2524200120 J3490 ACTIFED SYRUP 5ML DOSE 1.11 2524200121 J3490 ACTIFED 60MG TABLET 1.11 2524200122 J3490 AMOXICILLIN 125MG/5ML 150ML 25.67 2514200123 J0295 UNASYN 1.5GM VIAL 18.80 2524200124 J0295 UNASYN 3GM VIAL 35.46 2524200125 J3490 AMMONIUM CL 100MEQ/20ML VIAL 5.97 2514200127 J3490 HEALON 150U/ML 264.56 2524200128 J3490 ANTIHEMOPHILIC F8 520IU VI 579.33 2514200129 J3490 ACTIVASE 50MG VIAL 2244.71 252
54
4200130 J3490 ERYTHROMYCIN 200MG/5ML DOSE 0.71 2514200131 J3490 BSS PLUS 500ML 182.35 2504200132 J3490 VERSED 10MG/2ML VIAL 19.98 2524200133 J3490 GLYCINE IRRIG SOLN 1.5% 4000ML 50.39 2504200134 J3490 SOTRADECOL 3% 2ML AMP 16.53 2524200136 J3490 CLARITHROMYCIN 250MG TAB 17.33 2514200137 J3490 NILSTAT CREAM 15GM 2.91 2524200138 J3490 PONTOCAINE 1% 2ML AMP 7.93 2524200140 J3490 POLY-VI-FLOR DROPS 50ML 15.71 2574200141 J3490 CYCLOGYL 1% EYE DROP 2ML 13.49 2524200142 J3490 VERSONATE 200MG/ML 5ML 46.52 2514200143 J3490 CIPRO 250MG TABLET 5.13 2514200144 J3490 VASOTEC 5MG TABLET 1.56 2524200145 J3490 PENTAN 300MG INJ 393.72 2524200146 J3490 VASOTEC 10MG TABLET 1.79 2524200147 J3490 SELDANE 60MG TABLET 1.76 2524200148 J0696 ROCEPHIN 1GM INJ 87.90 2524200149 J3490 CIPRO 500MG TABLET 6.02 2524200152 J3490 MEVACOR 20MG TAB 4.87 2524200153 J3490 NOROXIN 400 MG TABLET 5.58 2524200154 J3490 BUSPAR 5MG TABLET 1.31 2524200155 J3490 PROZAC 20MG CAPSULE 4.28 2524200156 J3490 ZIDOVUDINE (AZT) 100MG CAP 5.82 2524200157 J3490 HALDOL DECANOATE 250MG/5ML VL 68.40 2524200158 J3490 LOPRESSOR 5MG AMP 12.51 2524200159 J3490 CHEMO COMPOUNDING 13.14 2504200160 J3490 EPOGEN 2000 U/ML VIAL 96.89 6344200161 J3490 CECLOR 250MG CAPSULE 3.74 2524200162 J0713 FORTAZ 2GM VIAL 91.89 2524200163 J3490 AZACTAM 2GM VIAL 79.54 2524200164 J3490 ARISTOCORT FORTE 40MG/ML 10.27 2524200165 J3490 BACITRACIN 500U/GM 0.9GM OINT 0.21 2524200168 J3490 DIFLUCAN 100MG TAB 8.88 2524200169 J3490 DIFLUCAN 200 MG TAB 14.53 2524200170 J3490 NIACIN 500MG TAB 1.06 2514200171 J8560 VEPESID 50 MG CAPSULE 45.45 2524200172 J3490 PROCARDIA XL 30MG TAB 1.71 2524200173 J3490 MEXITIL 150MG 0.72 2524200174 J3490 PROCARDIA XL 60MG 3.07 2524200175 J3490 BENZOIN COMP TINCT 473ML 12.42 2504200176 J8521 XELODA 500MG TAB 51.44 252
55
4200177 J1580 GENTAMICIN PREMIX 80MG INJ 5.73 2514200178 J3490 AZACTAM 1GM VIAL 20.13 2524200179 S0073 AZACTAM 500MG VIAL 11.11 2524200180 J3490 CYANIDE ANTIDOTE 482.11 2504200181 J3490 ALCOHOL ISOPROPYL 70% 1 GAL 21.07 2574200182 J3490 ETHOMOLIN 5% INJ 2 ML 52.11 2524200183 J3490 K-PHOS NEUTRAL 0.17 2524200185 J3490 DEPAKOTE 250MG TABLET 1.42 2524200186 J3490 TRASTUZUMAB 440MG VIAL 3831.84 2514200189 Q4081 EPOGEN 3000 UNITS 161.31 6344200190 J3490 ALCOHOL DEHYD 98% 1ML AMP 5.51 2504200191 J3490 ALCOHOL ETHYL 95% 1GAL 14.82 2504200192 J3490 ALCOHOL ETHYL 100% 1GAL 16.45 2504200193 J3490 FAT EMULSION 20% 200ML 19.68 2514200194 J3490 EPOGEN 4000 UNITS 205.84 6344200195 J3490 HALCION 0.125MG TAB 1.61 2524200196 J3490 CAPOTEN 12.5MG TABLET 2.22 2524200197 J3490 ANUSOL HC CREAM 1% 1OZ 73.72 2524200198 J3535 ATROVENT INHALER 14GM 127.30 2524200199 J3490 BCG IL 81MG SVD 478.40 2514200200 J3535 PROVENTIL .5% INHAL SOLN 20ML 51.77 2524200201 J3490 ALLBEE WITH C CAP 1.11 2574200202 J1205 DIURIL 500MG INJ 43.38 2524200203 J3490 LACTULOSE SYRUP 20GM/30ML 4.08 2514200204 J3490 CIPRO 750MG TABLET 20.98 2524200205 J3490 TAGAMET 400MG TABLET 2.92 2524200206 J3490 SUPRAX 400MG 24.15 2524200207 S0191 CYTOTEC 200MCG TAB 3.34 2524200209 J9045 PARAPLATIN 50MG VIAL 230.13 2524200210 J3490 PRILOSEC 20MG CAPSULE 14.74 2524200211 J3490 ALLOPURINOL 300MG TAB 1.11 2514200212 J3490 BREVIBLOC 100MG/10ML VIAL 56.69 2524200213 J3490 MARCAINE SPINAL 2ML AMP 14.64 2524200214 J3490 XYLOCAINE 5% W/DEXT 2ML 34.19 2514200215 J3490 DIPRIVAN 10MG/ML 20ML 52.98 2524200216 J3490 SUFENTA 50MG/ML 2ML 96.40 2524200217 J3490 ALFENTA 500MCG/ML 2ML AMP 28.84 2524200218 J3490 SURVANTA 25MG/ML 8ML VIAL 1098.16 2524200219 J3490 ADENOCARD 3MG/ML 2ML 94.17 2524200220 J3490 ALLOPURINOL 100MG TAB 1.11 2514200221 J8600 ALKERAN 2MG TABLET 1.11 252
56
4200222 J3490 DACROISE EYE IRRIG 118ML 13.45 2524200223 J3490 NEUPOTEN 300MCG 52.26 2524200225 J3490 AUGMENTIN 500MG TABLET 13.45 2524200226 J3490 AUGMENTIN 250MG TABLET 5.19 2524200228 J1570 CYTOVENE 500MG VIAL 212.24 2524200229 J3490 FOSCAVIR 24MG/ML 250ML 427.13 2524200230 J3490 ALPHA-CHYMOT 750 34.57 2524200231 J3490 MAZICON 0.5 MG VIAL 128.57 2524200232 J3490 HYSKON 100 ML 141.88 2524200233 J3490 FANSIDAR TABLET 11.21 2524200234 J3490 LARIMA TABLET 28.05 2524200235 J3490 MAVICRON 2 MG/ML 10 ML 29.16 2524200236 J0744 CIPRO 10MG/ML 20ML INJ 38.80 2524200237 J3030 IMITREX 6 MG INJECTION 157.22 2524200238 J3490 INTRALIPID 20% 500ML 48.76 2524200239 J3490 PREPIDIL CERVICAL GEL 179.70 2524200240 J3490 ALPHA-KERI LOTION 8OZ 11.53 2574200241 J3490 VITAMIN A 50000 UNIT CAP 1.11 2524200243 J3490 PRIMAXIN 500MG INJECTION 93.79 2524200244 J3490 NORVASC 2.5MG TABLET 3.93 2524200245 J3490 NORVASC 5MG TABLET 3.93 2524200246 J3490 NORVASC 10MG TABLET 6.73 2524200247 J2400 NESACAINE 3% 30 ML 69.47 2524200248 J3490 XYLOCAINE MPF 1% 10ML 8.35 2524200249 J3490 XYLOCAINE MPF 2% 10ML 25.96 2524200250 J3490 DOMEBORO SOLUTION 30ML 1.11 2504200251 J3490 DANTRIUM 40MG VIAL 228.59 2524200252 G9017 AMANTADINE 100 MG CAP 1.11 2514200253 J3490 XYLOCAINE W/ EPI MPF 1% 30 ML 25.60 2524200254 A4649 EMPTY TUBEX 1 ML 2.28 2704200255 J3490 XYLOCAINE W/ EPI MPF 2% 20 ML 27.96 2524200256 A4649 EMPTY TUBEX 2 ML 2.28 2704200258 J3490 OPHTHALGEN 7.5 ML 19.83 2524200259 J3490 GUAIFENESIN 100MG/5ML UD 4.60 2514200261 J3490 HYPERAB 10 ML 640.42 2524200262 J3490 HYPERAB 2ML VIAL 192.93 2524200263 J3490 TRIMETHOBENZAMIDE 300MG CAP 1.94 2514200264 J3490 IODINE POVIDONE 1% 1.5 GM 0.21 2514200265 J3490 KAOLIN-PECTIN 30 ML 1.11 2514200268 J3490 LACTIC ACID 16 OZ 60.33 2514200269 J3490 LIDOCAINE HCL 2% 2 ML 2.24 251
57
4200270 S0017 AMINOCAPROIC ACID 5GM/20ML VI 38.54 2514200271 J3490 MANGANESE 0.1 MG/ML 10 ML 2.24 2514200273 J3490 METOPIRONE 250 MG 4.35 2524200274 J3490 MINERAL OIL 10ML 3.51 2574200275 J3490 PAPAVERINE HCL 30MG/ML 10ML 15.38 2514200276 J3490 PENTOTHAL READY-TO-MIX 250MG 13.86 2514200277 J3490 PHENOBARBITAL ELIX 30MG/7.5ML 2.81 2514200278 J3490 KAYEXALATE POWDER 480GM 536.96 2524200279 J3490 POTASSIUM CL ORAL 15MG 1.08 2514200280 J3490 AMINOCAPROIC ACID 500MG TAB 1.11 2514200281 J3490 POTASSIUM CL ORAL 30MG 1.08 2514200282 J3490 POTASSIUM CL ORAL 40MG 1.08 2514200285 J8999 MATULANE 50MG CAPSULE 2.39 2524200286 J3490 ROBITUSSIN 10ML 1.17 2524200287 J3490 ROBITUSSIN DM 10ML UD 2.14 2524200288 J3490 SODIUM LACTATE 10 ML 16.19 2514200289 J3490 BACTROBAN 2% 15GM 15GM 93.79 2514200290 J3490 AMINOPHYLLINE 500MG VIAL 5.51 2514200291 A4649 EMPTY CONTAINER STER 10ML 4.39 2724200292 A4649 EMPTY CONTAINER STER 30ML 8.11 2724200293 J3490 SURGILUBE 3GM 0.09 2504200294 J3490 TETRACYCLINE 1% SOLN 4ML 20.82 2524200295 J3490 THYMOL CRYSTAL 4OZ 60.71 2504200296 J3490 TRIPLE-DYE 0.65ML 2.98 2504200298 A4216 WATER STERILE 10ML INJ 2.23 2504200299 J3490 XYLOCAINE 1.5% 20ML 36.14 2524200300 J3490 AMINOPHYLLINE 100MG SUPP 3.30 2514200301 J3490 ZINC GLUCONATE 100 MG 0.09 2514200303 J3490 ACACIA GUM 1OZ 8.07 2514200304 J3490 ACETAMINOPHEN 325MG/10ML UD 0.49 2574200305 J3490 ACETAMINOPHEN 650MG/20ML UD 0.75 2574200306 J3490 ACETYLCYSTEINE 10% INHAL 10ML 72.38 2514200307 J3490 ALUM/MAGNES SIMETH-II 30ML 1.08 2514200308 J3490 HYDROPHILIC OINTMENT 1LB 11.14 2524200312 J3490 KAYEXALATE 1GM 1.42 2524200314 J3490 IOPAMIDOL INJECTION 232.38 2554200317 J3490 RENOGRAPHIN 19.53 2554200320 J3490 AMINOPHYLLINE 100MG TABLET 1.11 2514200322 J3490 DOXORUBICIN HCL 50MG INJ 342.27 2514200329 J3490 DROTRECOGIN ALFA 20MG INJ 1322.38 2514200330 J3490 AMITRIPTYLINE 25MG TABLET 1.11 251
58
4200331 J3490 GABAPENTIN 300MG CAPSULE 1.35 2514200333 J3490 VORICONAZOLE 50MG TAB 21.12 2514200334 J3490 VORICONAZOLE 200MG TAB 86.11 2514200335 J3490 VORICONAZOLE 200MG INJ 294.58 2514200336 J3490 TDAP VACCINE 0.5ML INJ 113.06 2514200337 J3490 ALBUTEROL 4MG TAB 1.11 2514200338 J1642 HEPARIN FLUSH 10U/ML 1.24 2514200340 J3490 AMMONIA AROMATIC 1 OZ 1.63 2514200344 J3490 BECLOMETHASONE 40MCG INHAL 301.48 2514200361 J3490 AMPHOJEL SUSP 30ML DOSE 1.11 2524200362 J3490 KCL 40MEQ/100ML BAG INJ 6.71 2514200370 J3490 AMPICILLIN 250MG CAPSULE 1.11 2514200379 J3490 PANTOPRAZOLE 20MG TAB 9.46 2514200380 J3490 AMPICILLIN 500MG CAPSULE 1.11 2514200389 J0295 UNASYN 1.5GM INJ ADDV 17.99 2524200390 J0295 UNASYN 3GM INJ ADDV 35.02 2524200392 J3490 AMPICILLIN 125MG/5ML 100ML 8.78 2514200395 J1956 LEVOFLOXACIN P/MX 250MG/50ML 18.20 2514200396 J1956 LEVOFLOXACIN 25MG/ML 30ML SDV 96.97 2514200397 J3490 LEVOFLOXACIN P/MX 750MG/150ML 67.47 2514200398 J1956 LEVOFLOXACIN P/MX 500MG/100ML 55.76 2514200399 J3490 LEVOFLOXACIN 250MG TAB 11.04 2514200400 J3490 AMPICILLIN 250MG INJECTION 5.38 2514200401 J3490 MAGNESIUM SULFATE 4GM/100ML 8.63 2514200402 J3490 MAGNESIUM SULFATE 4OGM/1000ML 15.53 2514200403 J3490 SCLEROSOL INTRAPLEURAL TALC 4G 456.63 2524200405 90670 PNEUMOCOCCAL VAC 13-VAL 0.5ML 361.94 2514200406 J3490 PNEUMOCOCCAL VAC 7-VALENT 225.97 2514200410 J0290 AMPICILLIN 500MG INJECTION 7.13 2514200411 J0290 AMPICILLIN 1GM INJECTION 8.89 2514200414 J3490 AMPICILLIN 250MG/5ML 100ML BT 11.84 2514200419 S0178 LOMUSTINE 10MG CAP 34.11 2514200420 J8999 LOMUSTINE 40MG CAP 73.14 2514200424 J3490 DECADRON ELIX 0.5MG/5ML 240ML 16.36 2524200432 J3490 DEXAMETHASONE 1MG/ML 30ML OS 2.85 2514200433 J3490 VANCOMYCIN 1GM/D5W 200ML INJ 23.53 2514200434 J3490 VANCOMYCIN 500MG/D5W 100ML INJ 18.29 2514200436 J3490 DOXYCYCLINE 100MG INJ 124.95 2514200440 J3490 ANALGESIC BALM-BENGAY 85GM 2.21 2574200447 J3490 LEVOFLOXACIN 500MG VIAL 72.04 2514200448 J9065 CLADRIBINE 1MG/ML 10ML VIAL 951.79 251
59
4200456 J3490 NEUTRA-PHOS-K 1.45GM PACKET 1.44 2524200458 J3490 SODIUM NITRITE 300MG/10ML VIAL 522.48 2514200460 J3490 ANUSOL SUPPOSITORY 7.21 2524200467 G9020 RIMANTADINE 100MG TAB 3.55 2514200468 J3490 DASATINIB 70MG TAB 203.35 2514200469 J3490 RIBAVIRIN 200MG CAP 4.32 2514200470 J3490 ANUSOL-HC 25MG SUPPO 3.30 2524200471 J3490 DEXMEDETOMIDINE 400MCG/100ML P 242.61 2514200472 J1815 INSULIN REGULAR-PER ML 5.93 2514200475 J3490 INSULIN HUMAN NPH 70/30 10ML 54.40 2514200480 J3490 VITAMIN C 250MG TABLET 1.11 2524200489 J3490 DEXTROSE 10% 5ML AMP 3.01 2504200495 J3490 MILRINONE 1MG/ML 10ML SDV 16.33 2514200497 J3490 MILRINONE 20MG/100ML D5W BAG 31.78 2514200498 J3490 CARDIOPLEGIC IRRIG SOLN 1000ML 93.84 2514200500 J3490 ATROPINE 0.4MG/ML 1ML AMP 5.51 2514200504 J3490 BACTROBAN NS 2% 1GM OINT 19.53 2524200505 J3490 LEVALBUTEROL 0.63MG/3ML INHAL 6.26 2514200506 J3490 ARSENIC TRIOXIDE 10MG/10ML VI 796.37 2514200507 J3490 FAT EMULSION 20% 250ML 44.11 2514200508 J3490 LORAZEPAM 4MG/ML 1ML VIAL 6.48 2514200509 J3490 ARIPIPRAZOLE 5MG TAB 33.74 2514200510 J3490 ATROPINE 1% OPHTH OINT 3.5GM 8.12 2514200511 J3490 VITAMIN C DROPS-CECON 50ML 12.09 2574200512 J3490 ATOMOXETINE 40MG CAP 16.68 2514200514 J3490 QUETIAPINE 100MG TAB 13.35 2514200515 J3490 HYPERLYTE CR 250 MOL 4.67 2504200517 J3490 PEGINTERFERON ALFA-2B 50MCG 591.70 2514200518 J3490 ARIPIPRAZOLE 15MG TABLET 30.16 2514200519 J3490 VENLAFAXINE 75MG TABLET 8.10 2514200520 J7636 ATROPINE 2% SOLN 5ML 2.00 2514200521 J3490 ZIPRASIDONE 40MG CAPSULE 10.24 2514200525 J3490 ZIPRASIDONE 80MG CAPSULE 9.69 2514200526 J3490 FLUOXETINE 10MG CAPSULE 1.11 2514200530 J3490 ATROPINE 1% EYE DRP 15ML 2.00 2514200532 J3490 ATOMOXETINE 25MG CAPSULE 16.14 2514200533 J3490 SERTRALINE 25MG TABLET 1.11 2514200534 J3490 OLANZAPINE 5MG TABLET 16.71 2514200535 J3490 OLANZAPINE 10MG TABLET 48.45 2514200536 J3490 OLANZAPINE 15MG TABLET 43.89 2514200537 J3490 OLANZAPINE 20MG TABLET 57.79 251
60
4200538 J3490 DIVALPROEX ECT 500MG TABLET 10.97 2514200539 J3490 AZACITIDINE 100MG VIAL 660.93 2514200540 J3490 ATROPINE 2% SOLN 15ML 13.60 2514200541 J3490 ATROPINE 1MG/10ML ABBOJECT 11.84 2514200542 J3490 PSEUDOEPHEDRINE 30MG/5ML 120ML 3.89 2514200543 J3490 HEPARIN/D5W 12500U/250ML 11.73 2514200544 J1815 INSULIN ASPART 100U/ML 10ML VI 336.84 2514200545 J1815 INSULIN GLARCINE 100U/ML 10ML 310.16 2514200546 J3490 LINEZOLID SUSP 100MG/5ML DOSE 31.09 2514200547 J3490 NORTRIPTYLINE 50MG CAP 6.30 2514200550 J3490 AURALGAN OTIC DROPS 15ML 6.24 2524200551 J3490 CARBAMAZEPINE-XR 400MG TABLET 3.73 2514200552 J3490 TRAZODONE 100MG TAB 1.11 2514200556 J3490 RISPERIDONE 2MG TAB 13.94 2514200557 J3490 RISPERIDONE 3MG TAB 18.86 2514200558 J3490 RISPERIDONE 4MG TAB 25.33 2524200559 J3490 PHENYTOIN SODIUM 100MG/4ML UD 6.08 2514200560 J3490 MORPHINE 15MG TAB UD 1.13 2514200561 J3490 MORPHINE 30MG TAB UD 2.01 2514200563 J3490 PRUSSIAN BLUE 500MG CAP 8.18 2514200564 J3490 CA-DTPA 1000MG/5ML AMP 202.94 2524200565 J3490 ZN-DTPA 1000MG/5ML AMP 206.90 2524200566 J3490 MEGESTROL SUSP 400MG/10ML 19.09 2514200568 J3490 RANITIDINE SUSP 150MG/10ML UD 30.51 2514200569 J3490 VALPROIC ACID SUSP 250MG/5ML 2.98 2514200570 J3490 BACITRACIN OPHTH OINT 3.5GM 3.30 2524200571 J3490 BACITRACIN 30GM OINTMENT 2.50 2524200573 J3490 BUPROPION 100MG TABLET 1.11 2514200575 J3490 BUPROPION 75MG TABLET 1.11 2514200577 J3490 FLUTICASONE NASAL SPRAY 16GM 283.74 2514200578 J3490 PROMETHAZINE SUPP 25MG 1.18 2514200579 J3490 PROMETHAZINE SUPP 12.5MG 3.07 2514200580 J3490 BACITRACIN TOP OINT 1LB 7.02 2524200581 J3490 BACTRIM SINGLE STRENGTN TAB 1.11 2524200582 J3490 BACTRIM DOUBLE STRENGTH TAB 1.11 2524200583 J2405 ONDANSETRON 2MG/ML 2ML INJ 15.08 2514200587 J3490 MAGNESIUM SULFATE 2GM/50ML 41.64 2514200589 J3490 DOBUTAMINE 500MG/D5W 500ML 115.96 2514200590 J3490 MEGESTROL SUSP40MG/ML 480ML 174.03 2514200592 J3490 HEPARIN 12500U/0.45% NS 250ML 18.86 2514200593 J3490 BASALJEL CAPSULE 1.11 257
61
4200594 J3490 BASALJEL SUSPENSION DOSE 1.11 2574200595 J3490 MILRINONE 40MG/200ML INJ BAG 137.49 2514200596 J3490 ANASTROZOLE 1MG TABLET 22.89 2514200597 J3490 NORMAL SALINE 0.9% FLUSH 5ML 1.59 2504200598 J3490 LEVOTHYROXINE 200MCG VIAL 42.08 2514200600 J3490 ZEPHIRAN AQ 1:750 1 GAL 2.08 2574200601 J3490 LAPATINIB 250MG TABLET 64.95 2514200603 J3490 SITAGLIPTIN 25MG TABLET 16.22 2514200604 J3490 SITAGLIPTIN 100MG TABLET 15.80 2514200605 J3490 IXABEPILONE KIT 15MG INJ 1378.57 2514200606 J3490 IXABEPILONE KIT 45MG INJ 3628.60 2514200607 J3490 BUMETAMIDE 2.5MG/10ML VIAL 5.34 2514200610 J3490 BENZOIN TINCTURE 30ML 2.50 2574200611 S0119 ONDANSETRON 4MG TABLET UD 1.11 2514200612 J3490 TESSALON CAPSULE 1.11 2524200618 J3490 POVIDONE 10% OINT 30GM 10.97 2514200620 J8999 IMATINIB 400MG TABLET 292.06 2514200621 J3490 COGENTIN 0.5MG TABLET 1.11 2524200622 J3490 COGENTIN 1MG TAB 1.11 2524200623 J0515 COGENTIN 1MG/ML 2ML AMP 5.07 2524200624 J3490 FLUCYTOSINE 250MG CAP 58.59 2514200625 J3490 MORPHINE SULF 60MG TER 1.10 2514200629 J3490 LENALIDOMIDE 25MG CAP 562.18 2514200630 J3490 NITAZOXANIDE 500MG TAB 46.87 2514200632 J3490 BECLOMETHASONE 80MCG INHAL 219.42 2514200634 J3490 POLYCITRA LIQUID 480ML BOTTLE 51.20 2524200637 J2185 MEROPENEM 500MG VIAL 61.69 2514200638 J3490 MEROPENEM 1GM VIAL 137.52 2514200639 J3490 LORAZEPAM 4MG/ML 10ML VIAL 39.09 2514200640 J3490 BETADINE AEROSOL SPRAY 90GM 10.84 2574200641 J3490 KEPPRA SUSP 100MG/ML 480ML 186.05 2524200642 Q0173 KEPPRA 250MG TABLET 1.22 2524200643 J3490 KEPPRA 500MG TABLET 0.15 2524200644 J3490 REVATIO 20MG TABLET 26.08 2524200645 J3490 LINEZOLID SUSP 100MG/5ML 150ML 932.43 2514200647 J3490 TOLVAPTAN 15MG TABLET 752.00 2514200648 J3490 NORMAL SALINE 0.9% FLUSH 3ML 3.89 2504200649 J3490 BENDAMUSTINE 25MG/8ML VIAL 1460.76 2514200650 J3490 BETADINE SOLUTION 30ML 1.00 2574200651 J3490 BETADINE DOUCHE CONC 8OZ 13.28 2574200652 J3490 ALPRAZOLAM 0.25MG TAB UD 6.08 251
62
4200655 J3490 LISINOPRIL 2.5MG TAB UD 6.08 2514200657 J3490 VORINOSTAT 100MG CAPSULE 192.55 2514200658 J3490 BORTEZOMID 3.5MG SDV 1600.03 2514200659 J3490 DOBUTAMINE 250MG/D5W 250ML 36.45 2514200660 J3490 BETADINE SCRUB 1OZ 1.11 2574200661 J3490 BETAMETHASONE 3MG/ML 5ML VI 5.82 2514200662 J3490 BETAMETHASONE TABLET 1.11 2514200663 J3490 INTERFERON ALFA-2B 18MU/3ML IN 548.91 2514200664 J3490 INTERFERON ALFA-2B 25MU/2.5ML 668.65 2514200665 J3490 HEPARIN 25000U/D5W 50OML 28.74 2514200666 J3490 HEPARIN 25000U/0.45% NS 500ML 18.99 2514200667 J3490 PEMETREXED 100MG VIAL 1058.48 2514200668 J3490 PEMETREXED 500MG VIAL 4118.14 2514200670 J3490 VALISONE 15GM CREAM 13.93 2524200671 J3490 VALISONE OINTMENT 15 GM 15.89 2524200674 J3490 VICODIN 5MG-500MG TAB UD 6.08 2524200675 J3490 NICARDIPINE/NACL .2MG/ML 200ML 593.87 2524200676 J3490 NICARDIPINE/D5W 0.2MG/ML 200ML 418.49 2524200677 J3490 NICARDIPINE 2.5MG/ML 10ML VIAL 608.92 2524200680 J3490 TRAMADOL HCL 50MG TABLET UD 6.08 2514200681 J3490 BETHANECHOL 5MG INJ 4.54 2514200687 J3490 CEFTRIAXONE/DEXTROSE 2GM/50ML 101.30 2514200688 J3490 CEFTRIAXONE DEX 1GM/5OML 50.65 2514200690 J3490 BISACODYL 10MG SUPP 3.30 2574200692 J3490 AMIODARONE P/MIX 150MG/100ML 150.29 2514200693 J3490 AMIODARONE P/MIX 360MG/200ML 199.86 2514200700 J3490 BISACODYL 5MG TABLET 1.11 2574200701 J3490 BORIC ACID OPHTH OINTMENT 2.40 2514200706 J3490 SODIUM CHLORIDE 14.6% 40ML INJ 6.55 2584200708 J3490 HYDROCODONE/APAP 5/325MG TAB 3.82 2514200710 J3490 BORIC ACID TOP OINT 30 GM 1.63 2514200721 J3490 BRONKOTABS 1.11 2574200724 J3490 DIMERCAPROL 300MG/3ML INJ 95.42 2514200730 J8510 MYLERAN 2MG TABLET 1.11 2524200731 J3490 CAFERGOT TABLET 1.11 2514200740 J3490 CALADRYL CREAM 1-1/2 OZ 5.59 2574200750 J3490 CALADRYL LOTION 2-1/2 OZ 6.03 2574200760 J3490 CALAMINE LOTION 120ML BT 1.86 2574200771 J3490 CALCIUM CL ABBOJECT 21G 10 11.20 2514200772 J3490 CALCIUM CL 1GM/10ML SRN 12.62 2514200773 J0610 CALCIUM GLUCONATE 1GM/10ML VI 5.51 251
63
4200774 J0640 CALCIUM LEUCOVORIN INJECT 10.84 2514200775 J3490 CALCIUM GLUCONATE 500MG TAB 1.11 2514200781 J3490 TEGRETOL 200MG TABLET 1.11 2524200820 J3490 CASCARA EXTRACT 5ML 1.11 2574200821 J0690 KEFZOL 500MG INJECTION 9.11 2524200823 J0694 ANCEF 1GM INJECTION 17.66 2524200826 J3490 SENOKOT-S 8.6MG-50MG TAB 1.11 2524200830 J3490 CASTOR OIL 60ML 2.21 2574200831 J3490 CLARITHROMYCIN 125MG/5ML 100ML 147.00 2514200832 J3490 KEFLEX 125MG/5ML 100ML BT 13.51 2524200863 J3490 CETAPRED OPHTH OINTMENT 13.84 2524200864 J3490 VELOSEF 250MG CAPSULE 1.63 2524200865 J3490 VELOSEF 500MG CAPSULE 3.17 2524200869 J3490 CENTRAL VENOUS ACCESS KIT 28.09 2504200870 J3490 CEPACOL GARGLE 120ML 3.17 2574200880 J3490 CEPACOL SOLN 5 FL OZ 2.87 2574200881 J3490 CHERRY SYRUP 30ML DOSE 1.11 2524200882 J8999 LEUKERAN 2MG TABLET 1.11 2524200890 J3490 CHLOROMYCETIN 250MG CAP 2.00 2524200900 J3490 CHLOROMYCETIN OPHTH OINT 12.74 2524200901 J3490 CHLOROMYCETIN OPHTH SOLN 17.21 2524200910 J3490 CHLOROMYCETIN 150MG/5ML 60ML 31.70 2524200911 J0720 CHLOROMYCETIN 1GM INJECT 17.56 2524200920 J3490 CHLORASEPTIC SPRAYER 180ML 5.27 2504200951 J3490 DIURIL 500MG TABLET 1.11 2524200952 J3490 DECADRON 0.5MG TABLET 1.11 2524200953 J3490 CHLOROFORM 16OZ 26.32 2514200954 J3490 DIURIL SUSPENSION DOSE 1.11 2524200961 J3490 TACE 12MG CAPSULE 1.11 2524200962 J3490 PILOCARPINE 1% 15ML OPHTH 10.29 2514200963 J3490 PILOCARPINE 4% 10.29 2514200980 J3490 CHLOR-TRIMETON 4MG TAB 1.11 2524200982 J3490 CHLOR-TRIMETON 2MG/5ML SYR 1.11 2524200985 J3490 CHLOR-TRIMETON 12MG TR CAP 1.11 2524200990 J3230 THORAZINE 25MG/ML 1ML AMP 5.51 2524200991 J3230 THORAZINE 25MG/ML 10ML VL 12.74 2524201000 J3490 THORAZINE SYR 10MG/5ML DOSE 1.11 2524201010 J3490 THORAZINE 10MG TABLET 1.11 2524201020 J3490 THORAZINE 25MG TABLET 1.11 2524201030 J3490 THORAZINE 50MG TABLET 1.11 2524201040 J3490 THORAZINE 100MG TABLET 1.11 252
64
4201041 J3490 THORAZINE CONC 30MG/5ML 12 16.13 2524201042 J3490 THORAZINE CONC 100MG/5ML 47.96 2524201043 J3490 THORAZINE 200MG TABLET 1.11 2524201044 J3490 THORAZINE 150MG CAPSULE 1.11 2524201045 J3490 THORAZINE 75MG SPANSULE 1.11 2524201047 J3490 THORAZINE 300MG SPANSULE 1.11 2524201050 J3490 DIABINESE 250MG TABLET 1.11 2524201052 J3490 TARACTAN 50MG TABLET 1.11 2524201061 J3490 CIDEX GALLON 55.97 2504201062 J3490 CLEOCIN 75MG CAPSULE 1.11 2524201063 J3490 CLEOCIN 150MG CAPSULE 2.00 2524201065 S0077 CLEOCIN 600MG INJECTION 22.37 2524201066 J3490 CLEOCIN TOPICAL 1% 60ML 24.26 2524201070 J3490 CLINITEST TABLET 24'S 5.27 2544201071 J3490 CLINITEST TABLET 1.11 2504201072 J3490 CLINITEST TABLET 100'S 9.51 2504201080 J3490 CLINITEST SET 11.84 2544201091 J3490 CLOMID 50MG TABLET 6.70 2524201100 J3490 COAL TAR APPLICATION 1.11 2504201105 J3490 NITROFURANTOIN 25MG/5ML 240ML 787.48 2514201112 J0760 COLCHICINE 1MG/2ML AMP 5.51 2514201113 J3490 COLYMYCIN-S 25MG/5ML 60ML 24.33 2524201120 J3490 COLYMYCIN-M 150MG VIAL 43.46 2524201127 J3490 PRAVASTATIN SODIUM 10MG TAB UD 3.34 2514201130 J3490 COLYMYCIN-S OTIC DROP 5ML 11.84 2524201131 J3490 AVEENO BATH 8GM PCK 10.84 2524201132 J3490 COLLODION 30ML DOSE 1.45 2504201141 J3490 COMBID SPANSULE 1.11 2524201150 J3490 COMBISTIX 100'S 39.38 2504201160 J3490 CORICIDIN-D TABLET 1.11 2524201170 J3490 ACTH-GEL 40U/ML 5ML 25.63 2514201191 J3490 CORYBAN-D CAPSULE 1.11 2504201211 J3490 INTAL 20MG CAPSULE 1.11 2524201212 J3535 INTAL (SPINHALER) INHALER 9.89 2504201220 J3490 EURAX CREAM 60GM 4.18 2524201221 J3490 CRYOPHAKE 59.26 2504201222 J3490 CYTOXAN 50MG TABLET 1.30 2524201224 J3490 CYTOMEL 5MCG TABLET 1.11 2524201225 J3490 CYTOMEL 25MCG TABLET 1.11 2524201229 J3490 VALPROIC ACID 250MG/5ML 473ML 42.08 2514201230 J3490 PERIACTIN 4MG TABLET 1.11 252
65
4201232 J3490 PERIACTIN SYR 2MG/5ML DOSE 1.11 2524201240 J3490 DAPSONE 100MG TABLET 1.11 2524201241 J3490 DAPSONE 25MG TABLET 1.11 2524201251 J3490 DARVOCET-N 50MG TABLET 1.11 2524201260 J3490 DARVON COMPOUND 65 CAPSULE 1.11 2524201262 J3490 DARVON-N 100MG TABLET 1.11 2524201270 J3490 DELADUMONE-OB 2ML INJECT 49.70 2524201271 J3490 PRAVASTATIN SODIUM 20MG TAB UD 3.68 2514201280 J3490 DESENEX OINTMENT 1.8OZ 8.89 2524201290 J3490 DESENEX POWDER 1.5OZ 7.13 2524201310 J3490 DESITIN 40% 30GM OINTMENT 3.30 2524201320 J3490 DECADRON 4MG/ML 1ML INJECT 11.95 2524201321 J3490 DECADRON .1% OPHTH SOL 5ML 13.51 2524201322 J3490 DECADRON 0.75MG TABLET 1.11 2524201323 J3490 DECADRON 4MG/ML 5ML INJECT 26.45 2524201324 J3490 DECADRON TURBINAIRE 12.6GM 35.13 2524201330 J3490 ILOPAN INJ 2ML 8.34 2524201340 J3490 LEUCOVORIN 100MG VIAL 8.98 2514201351 J3490 DEXTROSE 50% 50ML SYRINGE 17.13 2514201357 J3490 BISMUTH SUB 262MG/15ML 480ML 17.83 2524201358 A4649 PEPTOBISMOL SUSP 30ML UD 6.26 2524201402 J3490 DIBUCAINE 1% 30GM OINTMENT 4.39 2524201420 J3490 BENTYL SYRUP 5ML DOSE 1.11 2524201421 J3490 BENTYL 10MG CAPSULE 1.11 2524201422 J0500 BENTYL 10MG/ML 2ML INJ 9.21 2524201430 J3490 DIENESTROL VAG (DV) CREAM 21.74 2524201441 J3490 DIETHYLSTILBESTROL 1MG TAB 1.11 2524201460 J3490 DIGOXIN ELIX 50MCG/ML 60ML 5.13 2514201470 J1160 DIGOXIN 0.5MG 2ML AMP 5.51 2514201480 J3490 DIGOXIN 0.25MG TABLET 1.11 2514201482 J3490 DRAMAMINE 50MG TABLET 1.11 2524201490 J3490 DIMETAPP ELIXIR 30ML 1.30 2574201491 J3490 DIMETAPP ELIXIR 5ML DOSE 1.11 2574201500 J3490 DIMETAPP EXTENTAB 1.11 2574201510 J3490 COLACE 50MG CAPSULE 1.11 2574201520 J3490 COLACE 100MG CAPSULE 1.11 2574201530 J3490 COLACE 100MG/5ML DOSE 7.70 2524201540 J3490 BENADRYL 25MG CAPSULE 1.11 2524201550 J3490 BENADRYL 50MG CAPSULE 1.11 2524201560 J3490 BENADRYL 2% 30GM CREAM 10.54 2524201570 J3490 BENADRYL ELIX 12.5MG/5ML 5ML D 1.77 257
66
4201590 J1200 BENADRYL 50MG/ML INJECTION 5.51 2524201600 J3490 MORPHINE 20MG/5ML 500ML OS 119.92 2514201601 J3490 BENYLIN EXPT 5ML DOSE 1.11 2524201610 J3490 LOMOTIL TABLET 1.11 2524201621 J3490 DILANTIN 50MG INFATAB 1.11 2524201630 J3490 DILANTIN 100MG CAPSULE 1.11 2524201640 J3490 DILANTIN 250MG/5ML AMP 14.50 2524201648 J3490 PHENYTOIN SUSP 125MG/5ML 240ML 45.86 2514201650 J3490 DILANTIN SUSP 30MG/5ML DOS 1.11 2524201661 J3490 PERSANTINE 25MG TABLET 1.11 2524201690 J3490 DONNATAL ELIXIR 5ML DOSE 1.11 2524201701 J3490 DONNATAL 16.2MG TABLET 1.11 2524201710 J3490 DONNAGEL SUSPENSION DOSE 1.11 2574201721 J3490 ACYCLOVIR 1000MG/20ML VIAL 137.05 2514201730 J3490 DONNAGEL-PG SUSP DOSE 1.11 2524201742 J3490 SINEQUAN 10MG CAPSULE 1.11 2524201743 J3490 SINEQUAN 25MG CAPSULE 1.11 2524201745 J3490 VIBRAMYCIN 100MG TABLET 3.94 2524201746 J3490 VIBRAMYCIN SUSP 5ML DOSE 1.11 2524201747 J3490 DRIXORAL TABLET 1.11 2574201748 J3490 VIBRAMYCIN 100MG INJECT 38.19 2524201749 J3490 SINEQUAN 50MG CAPSULE 1.11 2524201750 J3490 SINEQUAN 100MG CAPSULE 1.30 2524201760 J3490 DYAZIDE CAPSULE 1.11 2524201770 J3490 ELASE OINTMENT 30GM 44.31 2524201780 J3490 ELASE-CHLORO OINT 30GM 49.27 2524201781 J3490 EMETE-CON 50MG VIAL 7.55 2524201790 J3490 ENEMA FLEET ADULT 4.39 2574201800 J3490 ENEMA FLEET OIL RETENTION 4.39 2574201809 J1670 TETANUS IG 250U/2ML INJ 137.83 2514201810 J3490 ENEMA FLEET PEDIATRIC 4.39 2574201811 J3490 ENUCLENE 15ML 9.89 2504201821 J3490 EPHEDRINE 25MG INJECTION 5.51 2524201823 J3490 EPHEDRINE 25MG CAPSULE 1.11 2524201836 J3490 EPIFRIN 1% OPHTH 5ML 9.75 2524201840 J3490 EPINEPHRINE 1MG/ML AMP 5.51 2514201842 J3490 EPINEPHRINE ABBOJECT 21G 1 12.95 2514201843 J3490 ERGOTRATE 0.2MG TABLET 1.11 2524201844 J3490 EPINEPHRINE 1MG/10ML SRN 11.53 2514201851 J1364 ERYTHROMYCIN 500MG INJ 8.78 2514201852 J3490 ERYTHROMYCIN 1GM IV 14.50 251
67
4201860 J3490 ERYTHROMYCIN 250MG TABLET 1.11 2514201880 J3490 ILOSONE 100MG/ML 10ML 11.53 2524201890 J3490 ILOSONE 125MG/5ML 100ML 13.39 2524201900 J3490 ILOSONE 125MG CHEWABLE TAB 1.11 2524201911 J3490 DELESTROGEN 20MG/ML 1ML 13.84 2524201920 J3490 PREMARIN 1.25MG TABLET 1.11 2524201922 J3490 PREMARIN 0.625MG TABLET 1.11 2524201924 J3490 PREMARIN 2.5MG TABLET 1.11 2524201930 J3490 EDECRIN 50MG TABLET 1.11 2524201931 J3490 EDECRIN 50MG INJ 50ML 14.72 2524201940 J3490 MYAMBUTOL 400MG TABLET 1.00 2524201951 J3490 ETHER 4OZ 9.32 2504201954 J3490 PARSIDOL 100MG TABLET 1.11 2524201962 J3490 ETRAFON FORTE TABLE 1.11 2524201980 J3490 EUTRON 25MG TABLET 1.11 2524201991 J3490 FESTAL TABLET 1.11 2524201992 J3490 BSS EYE SOLN 15ML 21.07 2524202000 J3490 FERGON 325MG TABLET 1.11 2524202010 J3490 FERROUS SO4 DROPS 50 ML 12.20 2574202012 J3490 FER-IN-SOL SYRUP 5ML DOSE 1.11 2574202020 J3490 FERROUS SULFATE 325MG TAB 1.11 2574202030 J3490 FEOSOL SPANSULE 1.11 2524202031 J3490 FILTER RPM 1.30 2504202032 J3490 EFUDEX CREAM 5% 25GM 23.15 2524202033 J3490 FLOURESCIN OPH SOL 2% 15ML 2.60 2524202034 J3490 EFUDEX SOLN 2% 10ML 2.32 2524202035 J3490 FLOUROURACIL 500MG/10ML VIAL 5.51 2514202040 J3490 SYNALAR 0.025% CREAM 15GM 10.44 2524202041 J3490 SYNALAR SOLUTION 20ML 13.19 2524202042 J3490 SYNALAR 0.025% CREAM 30GM 12.09 2524202060 J3490 PROLIXIN ENANTHATE DOSE 15.50 2524202062 J3490 PROLIXIN 5MG TABLET 1.11 2524202071 J3490 CORDRAN-SP CRM 0.05% 15GM 12.62 2524202080 J3490 CORDRAN-SP CRM 0.025% 30GM 14.05 2524202081 J3490 CORDRAN OINT 0.025% 30GM 14.05 2524202090 J3490 CORDRAN-N CREAM 15GM 14.05 2524202100 J3490 CORDRAN LOTION 0.05% 15ML 10.97 2524202110 J3490 CORDRAN OINT 0.025% 15GM 12.62 2524202113 J3490 FOLVITE 1MG TABLET 1.11 2524202114 J3490 LIDEX 0.05% 15GM CREAM 12.74 2524202120 J3490 FORMALDEHYDE 37% 1GAL 23.72 251
68
4202121 J3490 FORMALDEHYDE SOLN PINT 4.54 2504202123 J3490 LASIX 100MG 10ML INJ 17.34 2524202124 J1940 LASIX 20MG/2CC INJ 5.51 2524202125 J3490 LASIX 20MG TABLET 1.11 2524202150 J3490 ACETYLCYSTEINE 10% 1CC DOSE 2.78 2514202170 J3490 GELUSIL SUSPENSION DOSE 1.11 2524202180 J3490 GELUSIL TABLET 1.11 2524202190 J3490 GARAMYCIN 1% CREAM 15GM 15.14 2524202191 J3490 GARAMYCIN OPHTH SOLUTION 12.74 2524202192 J3490 GARAMYCIN OINTMENT 15GM 15.14 2524202193 J3490 GARAMYCIN OPHTH OINT 3.5GM 12.74 2524202200 J1580 GARAMYCIN 80MG/2ML INJECT 14.50 2524202202 J3490 GEOCILLIN 382MG TABLET 1.45 2524202211 J3490 GLAUCON OPHTH SOLN 1% 10ML 16.24 2524202212 J3490 GLAUCON OPHTH SOLN 2% 2ML 16.80 2524202213 J3490 ROBITUSSIN EXPECTORANT 5ML 1.11 2524202214 J3490 ROBITUSSIN DM SYRUP 5ML UD 1.11 2524202221 J3490 GLYCERIN SOLUTION 16OZ 11.20 2514202222 J3490 GLYCERIN SUPPOSITORY PEDS 3.30 2574202234 J3490 ROBITUSSIN AC SYRUP 5ML UD 1.11 2524202241 J3490 ROBINUL 1MG TABLET 1.11 2524202243 J3490 NITROGLYCERIN 1/100 GR 100 4.69 2514202244 J3490 NITROGLYCERIN 1/150 GR 100 4.69 2514202245 J3490 NITROGLYCERIN 1/200 GR 100 4.69 2514202251 J3490 ISMELIN 10MG TABLET 1.11 2524202252 J3490 GRISEOFULVIN 250MG TABLET 1.11 2514202253 J3490 ISMELIN 25MG TABLET 1.11 2524202254 J3490 HALDOL 2MG TABLET 1.11 2524202255 J3490 HALOG CREAM 0.1% 60GM 38.73 2524202261 J3490 HALOTEX 30GM CREAM 23.05 2524202262 J3490 HALOTHANE 250ML 36.94 2514202290 J3490 HEB CREAM 30GM 1.11 2524202300 J3490 PHISOHEX 30ML 1.11 2504202321 J3490 HYDREA 500MG CAP 1.63 2524202326 J3490 APRESOLINE 25MG TABLET 1.11 2524202327 J3490 APRESOLINE 20MG INJECTION 4.28 2524202328 J3490 APRESOLINE 50MG TABLET 1.11 2524202330 J3490 HCTZ 50 MG TABLET 1.11 2514202331 J3490 HYDROCORTISONE POWDER 1GM 8.57 2514202332 J3490 HCTZ 25MG TABLET 1.11 2514202350 J3490 HYDROCORTISONE 0.5% CRM 30GM 5.59 251
69
4202360 J3490 HYDROCORTISONE CRM 1% 30GM 6.16 2514202380 J3490 SOLU-CORTEF 100MG/2ML VIAL 11.40 2524202400 J3490 DELALUTIN 250MG/ML 5ML VL 18.09 2524202410 J3490 VISTARIL 50MG/ML 1ML INJ 5.51 2524202411 J3490 ATARAX SYRUP 5ML DOSE 1.11 2524202412 J3490 ATARAX 25MG TABLET 1.11 2524202413 J3490 ATARAX 10MG TABLET 1.11 2524202415 J3490 TOFRANIL 25MG TABLET 1.11 2524202416 J3490 MOTRIN 400MG TABLET 1.11 2524202420 J3490 INDOMETHACIN 25MG CAPSULE 1.11 2514202431 J3490 SODIUM IODIDE CRYSTAL 3.61 2514202440 J3490 TELEPAQUE TABLET 1.20 2554202450 J3490 PANTOPAQUE INJECTION 22.84 2554202454 J3490 IPECAC SYRUP 30ML 2.32 2574202460 J1750 IMFERON 10ML INJ 36.98 2524202480 J3490 INH 50MG/5ML SOLUTION 1.11 2514202481 J3490 INH 100MG/5ML INJECTION 5.51 2514202490 J3490 INH 100MG TABLET 1.11 2514202495 J3490 ISUPREL 10MG SL GLOSSET 1.11 2524202503 J3490 ISUPREL 0.2MG INJ 5.51 2524202504 J3490 SORBITRATE 5MG TABLET 1.11 2524202505 J3490 ISORDIL TB 10MG 1.11 2524202512 J3490 ISOPTO PLAIN 15ML 10.97 2524202514 J3490 ISOPTO CETAMID 15% 13.84 2524202516 J3490 ISOPTOCARPINE OPHT 2% 15ML 12.83 2524202517 J3490 ISOPTOCARPINE OPHT 3% 15ML 13.39 2524202518 J3490 ISOPTO CETAPRED 5ML 16.34 2524202519 J3490 ISOPTO P-ES 15ML 17.02 2524202560 J3490 KAOPECTATE SUSP 30ML 1.74 2524202562 J3490 KARAYA GUM PWD 30GM 4.92 2524202570 J3490 KETALAR 500MG/10ML VIAL 35.31 2524202580 J3490 KETALAR 200MG/20ML VIAL 17.02 2524202613 J3490 LEVOPHED 0.1% 4ML AMP 6.16 2524202620 J3490 LIBRAX CAP 1.11 2524202621 J3490 LIDOCAINE BRISTOJECT 11.53 2514202630 J2001 LIDOCAINE 1% 30ML INJ 11.53 2514202631 J2001 LIDOCAINE 2% 30ML INJ 11.53 2514202640 J3490 LIDOCAINE 5% 35GM OINT 9.89 2514202641 J3490 XYLOCAINE VISCOUS 2% 100ML 12.20 2524202642 J3490 XYLOCAINE 2% W/ EPI 50ML 5.92 2524202644 J3490 XYLOCAINE 1% W/ EPI 50ML 4.92 252
70
4202645 J3490 XYLOCAINE CARDIAC 100MG 12.62 2524202646 J3490 XYLOCAINE JELLY 2% 30ML 9.80 2524202648 J3490 XYLOCAINE CARD 1GM 25ML SD 8.57 2524202650 J3490 LINCOCIN 500MG CAPSULE 1.77 2524202651 J3490 LINCOCIN 250MG CAPSULE 1.13 2524202660 J3490 LINCOCIN 600MG INJECTION 10.29 2524202671 J3490 ESKALITH 300MG CAPSULE 1.11 2524202690 J3490 SURGILUBE 4OZ 1.45 2524202710 J3490 MAALOX SUSP PER DOSE 1.11 2574202712 J3490 MAALOX SUSP 12OZ 13.19 2574202740 J3490 MILK OF MAGNESIA SUSP 30ML UD 1.11 2514202741 J3490 MILK OF MAGNESIA SUSP 60OZ 2.00 2574202750 J3490 MAGNESIUM SO4 ABBO 10ML 5.51 2514202751 J3490 MAGNESIUM SO4 ABBO 5ML 12.83 2514202754 J3490 MANNITOL 20% 500ML 30.85 2514202760 J2150 MANNITOL 25% 50ML 5.59 2514202761 J3490 MARAX TABLET 1.11 2524202762 J3490 MARAX DF SYRUP 5ML DOSE 1.11 2524202770 J3490 MASSENGILL POWDER 3OZ 4.28 2524202771 J3490 MAXITROL OPHTH SOLN 5ML 25.45 2514202774 J3490 MAXITROL OPHTH OINT 3.5GM 21.53 2514202781 J8597 ANTIVERT 12.5MG TABLET 1.11 2524202782 J3490 ANTIVERT 25MG TABLET 1.11 2524202788 J3490 BONINE 25MG CHEW TABLET 1.11 2524202810 J3490 PROVERA 10MG TABLET 1.20 2524202820 J3490 PONSTEL 250MG CAPSULE 1.11 2524202830 J3490 GASTROGRAFIN 37% 120ML 22.04 2554202850 J3490 MEPHYTON 5MG TAB 1.11 2524202861 J3490 MEPIVACAINE 1% 50ML 8.34 2514202863 J3490 MEPIVACAINE 2% 50ML 9.66 2514202891 J8999 PURINETHOL 50MG TABLET 1.11 2524202900 J3490 LEVOCARNITINE 100MG/ML DOSE 1.11 2514202901 J3490 LEVOCARNITINE 200MG/ML 5ML AMP 122.15 2514202961 J3490 HIPREX 1GM TABLET 1.11 2524202970 J3490 MANDELAMINE 1GM 1.11 2524202971 J3490 ROBAXIN 500MG TABLET 1.11 2524202980 J3490 STAPHCILLIN 1GM INJ 9.75 2524202981 J3490 TAPAZOLE 10MG TABLET 1.11 2524202985 J8610 METHOTREXATE 2.5MG TABLET 1.11 2514202986 J9260 METHOTREXATE 50MG VIAL 44.66 2514203003 J3490 METHANOL 473ML 13.60 250
71
4203020 J3490 ALDOMET 250MG TABLET 1.11 2524203021 J3490 ALDOMET 500MG TABLET 1.11 2524203030 J2210 METHERGINE 0.2MG/ML 1ML AMP 5.51 2524203040 J3490 METHERGINE 0.2MG TABLET 1.11 2524203050 J7509 MEDROL TB 4MG 1.11 2524203060 J3490 MEDROL TOP 0.25% 30MG 22.18 2524203061 J8999 MEGACE 40MG TABLET 3.10 2524203070 J2920 SOLU-MEDROL 40MG VIAL 15.90 2524203071 J3490 SOLU-MEDROL 1000MG VIAL 229.13 2524203072 J1030 DEPO-MEDROL 40MG/ML 13.84 2524203073 J3490 SANSERT 2MG TABLET 1.11 2524203075 J3490 MINTEZOL SUSP 5CC DOSE 1.11 2524203077 J3490 FLAGYL 250MG TABLET 2.21 2524203079 J3490 MICRONEFRIN INHAL 30ML 21.40 2524203081 J3490 MYCOLOG CREAM 15GM 20.41 2524203091 J3490 MYDRIACYL OPHTH 0.5% 15ML 23.93 2524203092 J3490 MYDRIACYL 1% 15ML OS 27.64 2524203101 J3490 NALDECON SYRUP DOSE 1.11 2524203103 J3490 NARCAN 0.4MG AMP 16.45 2524203104 J3490 DECA-DURABOLIN 100MG/ML 2M 53.34 2524203110 J3490 NATALIN TABLET 1.11 2524203122 J3490 NEO-CORTEF 0.5% DROPS 15.34 2524203150 J3490 NEO-MEDROL OINT 30 GM 22.18 2524203160 J3490 NEOMYCIN OINTMENT 30GM 7.25 2514203161 J3490 NEOMYCIN SOLN 125MG/5ML DOSE 1.11 2514203163 J3490 NEOMYCIN 500MG TABLET 1.11 2514203164 J3490 NEOMYCIN 500MG INJECTION 14.50 2514203180 J3490 NEOSPORIN OPHTH OINT 7.81 2524203181 J3490 NEOSPORIN OPHTH SOLN 10.11 2524203190 J3490 TRIBIOTIC OINT 30GM 7.81 2524203191 J3490 NEOSPORIN GU IRRIG 1ML AMP 5.51 2524203200 J3490 NICOTINIC 50MG TABLET 1.11 2514203204 J3490 FURADANTIN 50MG CAPSULE 1.11 2524203220 J3490 MACRODANTIN 50MG CAP 1.11 2524203230 J3490 MACRODANTIN 100MG CAP 1.30 2524203283 J3490 NORLUTATE 5MG TABLET 1.11 2524203285 J1800 PROPRANOLOL 1MG INJECTION 23.68 2514203310 J3490 AVENTYL 25MG CAPSULE 1.11 2524203370 J3490 NYSTATIN OINTMENT 15GM 12.62 2524203380 J3490 NYSTATIN ORAL SUSP 60ML 36.08 2524203390 J3490 NYSTATIN 500000U TAB 1.11 252
72
4203410 J3490 ORNADE SPANSULE 1.11 2524203440 J3490 AFRIN 0.05% NASAL SPRAY 15ML 5.92 2524203450 J3490 TETRACYCLINE 500MG CAP 1.11 2514203452 J3490 TETRACYCLINE 250MG CAP 1.11 2514203453 J3490 TERRAMYCIN 100MG AMP 5.51 2524203470 J3490 TERRAMYCIN OPHTH OINT 7.81 2524203500 J3490 TERRAMYCIN VAGINAL TAB #1 1.11 2524203510 J2590 PITOCIN 10U/ML VIAL 5.51 2524203511 J3490 CHOLEDYL 100MG TABLET 1.11 2524203530 J3490 PENICILLIN G K 1MU INJ 5.51 2514203540 J3490 PENICILLIN G K 5M U INJ 9.51 2514203550 J3490 PENICILLIN G 400000U TAB 1.11 2514203570 J3070 TALWIN 30MG/ML INJ 5.51 2524203580 J3490 TALWIN-NX 50MG TABLET 1.11 2524203590 J3490 PERI-COLACE CAPSULE 1.11 2574203591 J3490 PERI-COLACE SYRUP 1OZ 1.11 2574203600 J3490 PETROLATUM OINTMENT 30GM 1.20 2574203601 J3490 PERI DIALYSIS 4.25% 2000ML 35.13 2504203610 J3490 MINERAL OIL 30ML 1.20 2574203661 J3490 NITRAZINE PAPER 16.59 2544203662 J3490 PYRIDIUM 100MG TABLET 1.11 2524203663 J3490 PYRIDIUM 200MG TABLET 1.11 2524203680 J1610 GLUCAGON 1MG/ML INJ 61.27 2514203682 J3490 PHENOBARBITAL ELIX 5ML DOSE 1.11 2514203683 J3490 PHENOL CRYSTAL 1OZ 2.21 2504203700 J3490 PENICILLIN VK 125MG/5ML 100ML 6.80 2514203720 J3490 PENICILLIN VK 250MG TABLET 1.11 2514203721 J3490 PENICILLIN VK 500MG TABLET 1.11 2514203741 J3490 BUTAZOLIDIN 100MG TABLET 1.11 2524203742 J3490 PHOSPHOLINE IODIDE .06% 5M 10.21 2524203743 J3490 PHOSPHOLINE IODIDE.125% 5M 11.84 2524203744 J3490 PHOSPHOLINE IODIDE .03% 5M 9.51 2524203750 J3490 PHOSHO SODA 6OZ 2.87 2574203770 J3430 VITAMIN K 1MG/0.5ML AMP 5.51 2524203790 J3490 PROTENATE 5% 250ML 171.83 2524203810 J3490 POLY-VI-SOL DROPS 50ML 13.04 2574203821 J3490 POTABA CAPSULE 1.11 2524203830 J3480 POTASSIUM CL 40MEQ 20ML AMP 6.16 2514203831 J3480 POTASSIUM CL 20MEQ IV DOSE 5.51 2514203832 J3480 POTASSIUM CL 30MEQ IV DOSE 5.51 2514203833 J3490 POTASSIUM CL 10% 15ML DOSE 1.11 251
73
4203834 J3480 POTASSIUM CL 60MEQ 30ML VL 5.51 2514203851 J3490 EFODINE OINT 0.9GM/PK 1.11 2574203871 J3490 PREDNISONE 5MG TABLET 1.11 2514203880 J3490 PRIMIDONE 250MG TABLET 1.11 2514203900 J3490 BENEMID 500MG TABLET 1.11 2524203901 J3490 PRONESTYL 250MG INJECTION 1.11 2524203902 J2690 PRONESTYL 100MG INJECTION 21.07 2524203910 J0780 COMPAZINE 5MG/ML 2ML AMP 5.51 2524203911 S0183 COMPAZINE 5MG SYRUP DOSE 1.11 2524203912 Q0164 COMPAZINE 5MG TABLET 1.11 2524203920 J3490 SPARINE 50MG INJECTION 5.51 2524203930 J2550 PHENERGAN 25MG AMP 5.51 2524203940 J2550 PHENERGAN 50MG AMP 5.51 2524203941 J3490 PHENERGAN SYRUP 5ML 1.11 2524203951 J3490 PROBANTHINE 15MG TABLET 1.11 2524203970 J3490 DARVON 65MG CAPSULE 1.11 2524203972 J3490 PROPRANOLOL 10MG TABLET 1.11 2514203981 J3490 PROPYLTHIOURACIL 50MG TAB 1.11 2514204000 J3490 DOCUSATE SODIUM 50MG/5ML 480ML 9.72 2514204001 J3490 SUDAFED 30MG TABLET 1.11 2524204010 J3490 METAMUCIL 454GM 1.11 2524204020 J3490 PYRIDOXINE 50MG TABLET 1.11 2514204021 J3415 PYRIDOXINE 100MG INJ 7.89 2514204030 J3490 QUINIDIN GLUCO 80MG/ML 10M 14.05 2514204041 J3490 QUINIDIN 200MG TABLET 1.11 2514204050 J3490 QUIBRON CAPSULE 1.11 2524204060 J3490 QUIBRON ELIXIR DOSE 1.11 2524204072 J3490 RENOGRAFIN-60 50ML 11.84 2554204080 J3490 RESERPINE INJECTION 5.51 2514204090 J3490 RESERPINE 0.25MG TABLET 1.11 2514204091 J3490 RIFAMPIN 300MG CAPSULE 2.63 2514204100 J3490 ROBAXISAL TABLET 1.11 2524204122 J3490 AZULFIDIN 500MG TABLET 1.11 2524204130 J3490 SALICYLIC ACID POWDER 100GM 1.11 2514204160 J3490 SCOPOLAMINE 0.4MG/1ML VIAL 5.51 2514204161 J3490 SEBULEX SHAMPOO 120ML 6.58 2574204162 J3490 SEBUTONE SHAMPOO 120ML 8.12 2524204163 J3490 KWELL SHAMPOO 2OZ 8.45 2524204165 J3490 KWELL LOTION 2OZ 8.45 2524204171 J3490 SELSUN LOTION 2.5% 120ML 11.53 2574204183 J3490 SEPTRA 400-80MG TABLET 1.11 252
74
4204190 J3490 SILVER NITRATE APP 100'S 26.23 2514204242 J3490 SODIUM BICARB 10GR TAB 1.11 2514204244 J3490 SODIUM BICARBONATE 5GR TAB 1.11 2514204250 J3490 TUBERCULIN 5TU/0.1ML 1ML VIAL 66.93 2504204251 J3490 TEGOPEN 250MG CAPSULE 1.52 2524204253 J3490 SODIUM CL 0.9% 5ML INHAL 1.11 2514204254 J3490 SODIUM CL INJECT 5ML 5.51 2514204255 J1644 HEPARIN 1000 UNITS 9.21 2514204256 J1644 HEPARIN 1000U/ML 10ML 9.21 2514204261 J3490 S0DIUM IODIDE 1GM INJECT 5.51 2514204266 J3490 SYNTHROID 0.1MG TABLET 1.11 2524204267 J3490 SYNTHROID 0.15MG TABLET 1.11 2524204268 J3490 SULFACETAMIDE 10% OP/SOL 15ML 12.62 2514204270 J3490 PROSTAPHLIN 250MG CAP 1.45 2524204271 J2700 PROSTAPHLIN 250MG INJECT 5.38 2524204272 J3490 PROSTAPHLIN 250MG/5ML 100ML 29.19 2524204273 J3490 PROSTAPHLIN 500MG INJECT 10.11 2524204274 J3490 PROSTAPHLIN 1GM INJ 19.43 2524204275 J3490 PROSTAPHLIN 500MG CAPSULE 2.63 2524204281 J3490 SODIUM THIOSULFATE INJECT 5.51 2514204292 J3490 BICILLIN LA 2.4MU/4ML INJ 102.73 2524204293 J9040 BLEOMYCIN 15U VIAL 373.25 2514204301 J3490 BLEOMYCIN 30U VIAL 136.76 2524204302 J3490 CAFFEINE CIT 20MG/ML 3ML VIAL 150.79 2514204303 J3490 CAFFEINE CITRATE 60MG/3ML OS 100.99 2514204310 J3490 ALDACTONE 25MG TABLET 1.11 2524204315 J3490 LEUCOVERIN CALCIUM 350MG INJ 50.22 2514204317 J3490 LEUCOVORIN CALCIUM 5MG TAB UD 8.32 2524204319 J3490 CETACAINE 56GM SPRAY 74.68 2514204322 J3490 BENZOCAINE SPRAY 136.20 2514204332 J3000 STREPTOMYCIN 1GM INJECT 5.51 2514204333 J3490 CISPLATIN 1MG/ML 100ML VIAL 492.20 2514204340 J3490 ANECTINE 500MG VIAL 5.51 2524204350 J3490 GANTRISIN SUSP 5ML DOSE 1.11 2524204356 J3490 NEO/POLY/BACI 15GM OINT 11.08 2514204357 J9120 DACTINOMYCIN 0.5MG/3ML INJ 53.83 2514204371 J3490 SUS-PHRINE AQ SUSP INJ 5.51 2524204384 J3490 DEXTROSE 25% 10ML INJ 31.08 2504204387 J2597 DESMOPRESSIN 4MCG/ML AMP 19.09 2514204388 J3490 DESMOPRESSIN 40MCG/10ML VIAL 421.33 2514204392 J3490 DIPROSONE 0.05% 45GM CREAM 112.52 252
75
4204402 J3490 DOXAPRAM 400MG/20ML INJ 124.29 2514204405 J3490 DIPH-TET VACC ADULT 7.5ML VIAL 495.20 2524204408 J3490 DIP-TET VACC ADULT 0.5ML INJ 32.59 2514204411 J3490 DACARBAZINE 200MG VIAL 49.39 2514204425 J3490 BENZOCAINE 20% ORAL ANESTH UD 46.82 2514204438 J3490 ALBENDAZOLE 200MG TABLET 30.29 2514204440 J3490 TESTOSTERONE 100MG INJECT 9.89 2514204441 J3490 TES-TAPE 100 TEST 150 10.97 2544204442 J3490 ETHIN EST 35MCG/NORETH 0.4MG T 5.07 2514204445 J3490 ETHIN EST 20MCG/NORETH ACET 1M 4.95 2514204447 J3490 RITUXIMAB 10MG/ML 10ML VIAL 602.32 2514204448 J3490 RITUXIMAB 10MG/ML 50ML VIAL 1995.44 2514204452 J3490 VITAMIN C 500MG/ML 50ML VIAL 48.52 2524204454 J3490 ASCORBIC ACID 1GM/2ML AMP 6.41 2514204458 J3490 PRAZIQUANTEL 600MG TAB UD 55.27 2514204459 J3490 INDIGO CARMINE 8MG/ML 5ML AMP 29.49 2514204460 J3490 METHYLENE BLUE 1% 1ML VIAL 63.49 2514204461 J3490 TETRACAINE OPHTH SOLN 15ML 10.54 2514204469 J3490 MITOXANTRONE 25MG/12.5ML VIAL 1738.85 2514204476 J3490 MYCOLOG OINTMENT 15GM 6.79 2524204487 J3490 NALOXONE 0.4MG/ML 1ML SYR 5.38 2514204489 J3490 CALCIUM GLUB 1.8GM/5ML 480ML B 48.10 2514204500 J1270 DOXERCALCIFEROL 4MCG/2ML AMP 26.31 2514204503 J3490 LABETALOL 300MG TABLET 1.94 2514204520 J3490 TETRACYCLINE SYR 125MG/5ML DOS 1.11 2514204521 J3490 THIAMINE 100MG TABLET 1.11 2514204522 J3411 THIAMINE 100MG INJECTION 5.51 2514204524 J1580 GENTAMICIN 100MG VIAL ADV 7.05 2514204525 J1580 GENTAMICIN 800MG/20ML VIAL 58.94 2514204530 J3490 MERTHIOLATE 1:1000 1.30 2574204541 J3490 MERTHIOLATE TINCTURE 30ML 1.63 2574204542 J3490 THIOGUANINE 40MG TABLET 1.52 2514204550 J3490 MELLARIL 25MG TABLET 1.11 2524204560 J3490 MELLARIL 50MG TABLET 1.11 2524204570 J3490 MELLARIL 100MG TABLET 1.11 2524204572 J3490 NAVANE CONCENTRATE 120ML 79.20 2524204573 J3490 NAVANE 10MG CAPSULE UD 1.11 2524204574 J3490 NAVANE 20MG CAPSULE UD 1.30 2524204580 J3490 NAVANE 2MG CAPSULE UD 1.11 2524204581 J3490 NAVANE 1MG CAPSULE 1.11 2524204582 J3490 NAVANE 2MG IM DOSE 5.51 252
76
4204590 J3490 NAVANE 5MG CAPSULE UD 1.11 2524204591 J3490 THYROID 1GR TABLET 1.11 2514204595 J3490 THYROID 1/4GR TABLET 1.11 2514204600 J3490 TINVER LOTION 6OZ 17.56 2524204601 J3490 TITRALAC 650MG TABLET 1.11 2574204610 J3490 TOLINASE 250MG TABLET 1.11 2524204620 J3490 ORINASE 500MG TABLET 1.11 2524204630 J3490 TINACTIN 1% CREAM 15GM 8.78 2574204640 J3490 TINACTIN 1% POWDER 45GM 5.92 2574204650 J3490 TINACTIN 1% SOLN 10ML 7.55 2574204661 J3490 KENALOG-40 1ML INJ 11.53 2524204662 J3490 KENALOG 0.1% CREAM 30GM 12.83 2524204670 J3490 KENALOG-10 5ML INJ 14.28 2524204690 J3490 DYRENIUM 100MG CAPSULE 1.11 2524204710 J3490 NAQUA 2MG TABLET 1.11 2524204730 J3490 CERUMENEX OTIC SOLN 15ML 18.53 2524204731 J3490 CERUMENEX OTIC SOLN 8ML 12.20 2524204740 J3490 STELAZINE 2MG TABLET 1.11 2524204750 J3490 STELAZINE 5MG TABLET 1.11 2524204760 J3490 STELAZINE 10MG TABLET 1.11 2524204762 J3490 ARTANE 5MG TABLET 1.11 2524204763 J3490 ARTANE 2MG TABLET 1.11 2524204771 J3490 TEMARIL 2.5MG SYRUP 5ML 1.11 2524204772 J3490 TEMARIL 2.5MG TABLET 1.11 2524204780 J3250 TIGAN 200MG INJECTION 5.51 2524204782 J3490 TIGAN 100MG CAPSULE 1.11 2524204792 J3490 TRI-VI-SOL 50ML 11.09 2524204800 J3490 SULTRIN VAGINAL CREAM 24.69 2524204811 J3490 TUBOCURARINE 3MG/ML 10ML 12.09 2524204820 J3490 DOPAMINE 400MG/D5W 250ML 48.18 2514204850 J3490 UNICAP CHEWABLE TABLET 1.11 2574204860 J3490 UNICAP M TABLET 1.11 2574204861 J3490 URISED TABLET 1.11 2524204870 J3490 UNICAP T TABLET 1.11 2574204871 J3370 VANCOCIN 500MG INJECTION 39.07 2524204881 J3490 PITRESSIN 10 UNIT AMP 7.70 2524204890 J3490 COUMADIN 5MG TABLET 1.11 2524204900 J3490 WATER BACTERIOSTATIC 30ML 3.61 2504204910 J3490 A&D OINTMENT 60GM 2.96 2574204911 J3490 VITAMIN A&D OINTMENT 120GM 4.92 2514204915 Q9967 ISOVUE 300/370 50ML INJ 76.60 255
77
4204916 J3490 ISOVUE 200ML 88.59 2554204920 J3490 WHITEFIELD'S OINT 1OZ 3.61 2504204930 J3490 LANOLIN 30GM 2.21 2574204941 J3490 X-PREP LIQUID 74ML 8.22 2554204960 J3490 ZINC OXIDE 30GM OINT 1.52 2574204970 J3490 ZINC OXIDE PASTE 30GM 2.02 2574205040 J7110 DEXTRAN-75 6% NSS 500ML 29.62 2584205050 J3490 DEXTRAN-40 DEXTROSE 5% 500ML 29.62 2584205060 J7100 DEXTRAN-40 NSS 500ML 29.62 2584205070 J7121 DEXTROSE 5% LR 500ML 15.34 2584205080 J3490 DEXTROSE 5% LR 1000ML 19.74 2584205090 J3490 DEXTROSE 5% NS 250ML 12.62 2584205100 J3490 DEXTROSE 5% NS 500ML 15.34 2584205110 S5010 DEXTROSE 5% NS 1000ML 19.74 2584205114 J3490 ACETIC ACID 0.25% 1000 ML SOLN 7.20 2514205119 J3490 ACETYLCYSTEINE 10% 30ML IH 26.21 2514205120 J3490 DEXTROSE 5% NACL .2% 500ML 15.34 2584205122 S5010 DEXTROSE 5% NACL .2% 1000ML 19.74 2584205126 J3490 MUCOMYST 20% 1CC DOSE 1.67 2524205132 J3490 BOTOX 100U INJ 545.14 2524205134 P9046 ALBUMIN (HUMAN) 25% 20ML VIAL 112.14 2514205138 J3490 ETHYL CHLORIDE SPRAY 105ML 65.09 2514205140 J7042 DEXTROSE 5% NACL .45% 500ML 15.34 2584205143 P9041 ALBUMIN 5% 50ML INJ 87.82 2514205145 J3490 ALBUMIN (HUMAN) 25% 100ML VIAL 327.46 2514205150 J7042 DEXTROSE 5% NACL .45% 1000ML 19.74 2584205165 J3490 ENALAPRILAT 1.25MG/ML VIAL 8.11 2514205166 J3490 ENALAPRILAT 2.5MG/2ML VIAL 12.85 2514205168 J3490 ANTIHEMOPHILIC FACTOR/VW COMPL 975.37 2514205169 J3490 ANTIHEMOPHILIC FACTOR/VW COMPL 1707.64 2514205170 J3490 DEXTROSE 5% WATER 150ML 12.62 2584205175 J3490 ANTI-INHIB COAGULANT(FEIBA) 20 1229.34 2514205180 J7060 DEXTROSE 5% WATER 250 ML 12.62 2584205190 J7060 DEXTROSE 5% WATER 500ML 15.34 2584205200 J3490 DEXTROSE 5% WATER 1000ML 19.74 2584205210 J3490 DEXTROSE 10% WATER 500ML 17.21 2584205220 J3490 DEXTROSE 10% WATER 1000ML 22.17 2584205230 J3490 DEXTROSE 20% WATER 500ML 17.21 2584205231 J3490 DEXTROSE 50% 50ML VIAL 6.17 2584205261 J3490 TRAVASOL HYPERAL 8.5% KIT 67.75 2504205331 J3490 DEXTROSE 5% ISOLYTE P 500ML 17.21 258
78
4205332 J3490 DEXTROSE 5% ISOLYTE P 250ML 14.16 2584205410 J7030 NORMAL SALINE 0.9% 1000 ML 22.17 2584205422 J3490 SODIUM BICARB 5% 500ML 17.21 2504205450 J1815 INSULIN GLARCINE-PER ML 32.37 2514205460 J3490 SODIUM CHLORIDE 5% 500ML 17.21 2584205500 J3490 SODIUM LACTATE 1/6M 500ML 17.21 2584205510 J3490 SODIUM LACTATE 1/6M 1000ML 22.17 2584205520 A4217 WATER IRRIGATION 1500ML 18.47 2504205530 A4217 WATER IRRIGATION 3000ML 22.17 2504205531 J3490 NORMAL SALINE UROGAT 1500ML 18.47 2504205600 J3490 BENDAMUSTINE 100MG/20ML VIAL 2313.30 2514205910 J3490 ACETAMINOPHEN SUPP 650MG 3.71 2574205911 J3490 OSELTAMIVIR LIQ 6MG/ML 60ML 167.14 2514205912 J3490 OSELTAMIVIR 45MG CAPSULE 30.32 2514205913 J3490 OSELTAMIVIR 30MG CAPSULE 30.32 2514205920 J3490 ACTH-GEL 40 UNIT DOSE 22.17 2514205960 J3490 AKINETON 2MG TABLET 1.25 2524205980 J3490 ALDACTAZIDE 25/25 TABLET 1.25 2524206010 J0280 AMINOPHYLLINE 250MG VIAL 6.17 2514206050 J0330 ANECTINE 20MG/ML 10ML INJ 6.17 2524206080 J3490 APLISOL 1ML 10 TEST 6.17 2544206090 J3490 ARFONAD 500MG INJECTION 27.69 2524206101 J3490 R-GENE 10% W/ADM SET 300ML 91.13 2504206110 J3490 ASPIRIN 60MG SUPPOSITORY 3.71 2514206120 J3490 ASPIRIN 300MG SUPPOSITORY 3.71 2514206140 J3490 ASPIRIN W/CODEINE 30MG TAB 1.25 2514206160 J3490 BELLA/OPIUM SUPPOSITORY 3.71 2514206180 J3490 BACTRIM SUSPENSION DOSE 1.25 2524206230 J3490 BICILLIN CR 1.2MU/2ML INJ 12.57 2524206250 J3490 BICILLIN LA 1.2MU/2ML INJ 14.63 2524206380 J3490 CARBOCAINE 1.5% 30ML 8.85 2524206390 J3490 CEFADYL 1GM INJECTION 10.96 2524206400 J3490 KEPPRA 500MG/5ML VIAL 63.48 2524206410 J3490 CEVALIN 500MG/2ML VIAL 6.17 2524206420 J3490 NOCTEC 500MG CAPSULE 1.25 2524206430 J3490 NOCTEC SYRUP 5ML DOSE 1.46 2524206450 90625 CHOLERA VACCINE 0.5CC DOSE 13.69 2504206510 J3490 CODEINE ALKALINE POWDER 9.23 2514206540 J3490 CODEINE 30MG TABLET 1.25 2514206550 J3490 COMPAZINE 15MG SPANSULE 1.25 2524206560 J8498 COMPAZINE 2.5MG SUPP 3.30 252
79
4206570 J8498 COMPAZINE 25MG SUPP 3.71 2524206580 J8498 COMPAZINE 5MG SUPP 3.30 2524206610 J3490 CORTISONE 25MG INJECTION 5.51 2514206612 J3490 POVIDONE 7.5% SURG 120ML 3.18 2514206650 J3490 CYTOXAN 500MG INJECTION 46.86 2524206660 J3490 DALMANE 15MG CAPSULE 1.11 2524206670 J3490 DALMANE 30MG CAPSULE 1.11 2524206680 J3490 DANTRIUM 25MG CAPSULE 1.11 2524206710 J3490 DELTALIN 50000IU CAPSULE 1.11 2514206720 J2175 DEMEROL 100MG INJECTION 5.51 2524206730 J2175 DEMEROL 25MG INJECTION 5.51 2524206740 J2175 DEMEROL 50MG INJECTION 5.51 2524206750 J2175 DEMEROL 75MG INJECTION 5.51 2524206760 J3490 DEMEROL 50MG TABLET 1.11 2524206780 J3490 DEPO-ESTRADIOL INJECTION 16.68 2524206790 J3490 DEPO-TESTADIOL INJECTION 10.44 2524206800 J3490 DEPO-PROVERA 100MG/ML 5ML 12.09 2524206830 J3490 DEXEDRINE 15MG SPANSULE 1.11 2524206860 J3490 DEXTROSE 10% INJECTION 5.51 2514206870 J3490 DEXTROSE 50% 50ML VIAL 5.51 2584206920 J1170 DILAUDID 2MG INJECTION 5.51 2524206930 J3490 DIP/PERTUSSIS/TETANUS VACC 5.51 2504206980 J3490 DOXIDAN CAPSULE 1.11 2524206990 J3490 DRAMAMINE 50MG INJECTION 11.28 2524207071 J3490 AMITRIPTYLINE 10MG TABLET 1.11 2514207120 J3490 EQUANIL 200MG TABLET 1.11 2524207150 J3490 ERGOTRATE INJECTION 5.51 2524207170 J3490 ERYTHROMYCIN 200MG/5ML 100 14.13 2514207231 J3490 HYDROCORTISONE 1% 30GM OINT 12.66 2514207260 J3490 FIORINAL TABLET 1.11 2524207300 J3490 FLORINEF 0.1MG TABLET 1.11 2524207330 J3490 AMPHOTERICIN B 50MG INJECT 30.32 2514207370 J3490 GAVISCON TABLET 1.11 2524207387 J3490 HCTZ/TRIAMTERENE CAPSULE 25/50 6.08 2524207390 J3490 GLYCERIN SUPPOSITORY ADULT 3.30 2574207400 J3490 PRECEDEX 100MCG/ML 2ML SDV 283.65 2524207410 J3490 HALDOL CONC 2MG/ML 120ML 83.16 2524207430 J1630 HALDOL 5MG/ML AMP 5.51 2524207500 J3490 HISTOPLASMIN INJECTION 5.51 2504207510 J3490 HU-TET 250UNITS 11.20 2524207555 J3490 DOCETAXEL 20MG/0.5ML INJECTION 639.38 251
80
4207556 J3490 DOCETAXEL 80MG/2ML INJECTION 2207.74 2514207570 J3490 HYDROCORTISONE 20MG TABLET 9.45 2514207590 J3490 HYTAKEROL 0.25MG/ML 15ML 28.63 2504207630 J3490 IMMUNE SERUM GLOBULIN 2ML 9.89 3874207640 J7500 IMURAN 50MG TABLET 1.11 2524207660 J3490 PROPRANOLOL 40MG TABLET 1.11 2514207670 J3490 INNOVAR 2CC INJ 9.75 2524207690 J3490 INSULIN-NPH BEEF U100 10ML 26.32 2514207700 J3490 INSULIN-NPH PORK U100 10ML 48.29 2514207770 J3490 ISOPTO CARPINE OPHT 1% 15ML 12.41 2524207780 J3490 ISOPTO FRIN OPHTH SOLN 13.39 2524207790 J3490 HOMATROPINE 5% OPHTH SOLN 5ML 10.97 2524207800 J3490 ISOPTO TEAR OPHTH DRP 15ML 12.83 2524207810 J3490 BABY OIL 4OZ 5.09 2574207830 J3490 KENALOG IN ORABASE 0.1% 5GM 11.09 2524207840 J3490 KENALOG SPRAY 23GM 14.39 2524207850 J3490 KETOSTIX 100'S 21.74 2504207860 J3490 KWELL CREAM 60GM 8.89 2524207870 J3490 LACRI-LUBE 3.5GM EYE OINT 8.22 2524207890 J3490 LASIX 40MG TABLET 1.11 2524207900 J3490 LIBRIUM 10MG CAP 1.11 2524207910 J3490 LIBRIUM 25MG CAP 1.11 2524207940 J3490 LIQUIFILM 30ML 12.74 2504207960 J3490 MARCAINE 0.75% 30ML VIAL 14.58 2524207970 J3490 MARCAINE 0.25% 30ML VIAL 16.88 2524208010 J3490 MESTINON 60MG TABLET 1.11 2524208030 J3490 METHADONE 10MG TABLET 1.11 2514208100 J3490 MINIPRESS 1MG CAPSULE 1.11 2524208110 J3490 MINIPRESS 5MG CAPSULE 1.11 2524208130 J3490 MORPHINE 15MG/ML INJ 5.51 2514208140 J3490 MORPHINE 8MG INJECTION 5.51 2514208150 J2270 MORPHINE 10MG/10ML INJ 5.51 2514208170 J2270 MORPHINE 8MG TABLET 1.11 2514208174 J3490 MUTAMYCIN 5MG INJECTION 127.70 2524208180 J9280 MYCOSTATIN VAGINAL TAB 1.11 2524208189 J3490 SMZ/TMP 800/600 10ML VIAL 11.47 2514208194 J3490 CALCIUM 500MG/VIT D TABLET 1.11 2514208210 J3490 NAPHCON OPHTH DROP 15ML 11.20 2524208250 J3490 NEMBUTAL 100MG CAPSULE 1.11 2524208260 J3490 NEMBUTAL 100MG INJECTION 5.51 2524208270 J3490 NEMBUTAL 1GR SUPPOSITORY 3.30 252
81
4208330 J3490 NIPRIDE 50MG INJECTION 32.60 2524208350 J3490 ALBUMIN (HUMAN) 25% 50ML VIAL 113.45 2514208380 P9047 INSULIN-NPH U100 10ML 26.32 2514208410 J3490 NYSTATIN OINTMENT 30GM 23.37 2524208421 J3490 OPTEMP EACH 17.34 2504208440 J3490 OS-CAL 250MG TABLET 1.11 2524208500 J3490 PAPAVERINE 150MG CAPSULE 1.11 2514208510 J3490 PARALDEHYDE INJECTION 5.51 2514208530 J3490 PAREGORIC 5ML DOSE 1.11 2524208570 J3490 PENICILLIN G NA 5M U INJ 12.83 2514208580 J3490 PENTOTHAL 1GM 2.5% KIT 18.66 2524208590 J3490 PERCODAN TABLET 1.11 2524208600 J3490 PERPHENAZINE 16MG TABLET 1.11 2514208610 J3490 PERPHENAZINE 2MG TABLET 1.11 2514208620 J3490 PERPHENAZINE 8MG TABLET 1.11 2514208650 J3490 PHENISTIX 50'S 15.90 2504208660 J3490 PHENOBARBITAL 130MG/ML INJ 5.51 2514208670 J3490 PHENOBARBITAL 100MG TABLET 1.11 2514208680 J3490 PHENOBARBITAL 30MG TABLET 1.11 2514208710 J3490 PENICILLIN VK 250MG/5ML 20 10.11 2514208720 J3490 PENICILLIN VK 250MG/5ML 100ML 9.32 2514208780 J3490 POLIO VACCINE DOSE 6.48 2504208830 J3490 POTASSIUM CL 10GR TABLET 1.11 2514208850 J3490 PENICILLIN GK 20M U INJ 23.24 2514208870 J7510 PREDNISOLONE 5MG TABLET 1.11 2514208910 J3490 PREMARIN 0.3MG TABLET 1.11 2524208920 J3490 PROLIXIN DECANOATE DOSE 23.58 2524208930 J2680 PROLIXIN 2.5MG INJECTION 5.51 2524208950 J3490 INSULIN-PROTAMINE ZINC DOS 6.70 2514208970 J3490 PROTOPAM 1GM VIAL 10.97 2524208990 J3490 PYRIBENZAMIN 50MG TABLET 1.11 2514209000 J3490 QUESTRAN PACKET 9GM 2.00 2524209010 J3490 QUINAGLUTE TABLET 1.00 2524209020 J3490 QUININE 5GR CAPSULE 1.11 2514209050 J3490 INSULIN-REGULAR U40 10ML 5.51 2514209080 J3490 ACTH-GEL 80U/ML 5ML 22.62 2514209090 J3490 RHOGAM INJECTION 152.39 2514209100 J3490 RITALIN 10MG TABLET 1.11 2524209110 J3490 RITALIN 5MG TABLET 1.11 2524209120 J2800 ROBAXIN 10ML INJ 4.83 2524209130 J3490 ROBINUL FORTE 2MG TABLET 1.11 252
82
4209150 J3490 RUBELLA VACCINE DOSE 14.50 2514209200 J3490 PHENTOLAMINE 5MG INJ 461.90 2514209250 J3490 SECONAL 100MG CAPSULE 1.11 2524209320 J3490 STELAZINE 2MG INJECTION 5.51 2524209350 J3490 STRESSTAB 1.11 2574209380 J3490 FENTANYL 0.05MG/ML 2ML AMP 4.39 2514209390 J3490 SULTRIN VAGINAL TAB 20'S 22.27 2524209400 J3490 SURFAK CAPSULE 1.11 2574209410 A4649 SYRINGE U-100 1.11 2724209460 J3490 TENSILON 10MG/15ML VIAL 14.39 2524209480 J3490 TETANUS ANTITOXIN 72.42 2514209500 J3490 TETANUS TOXOID ABSORB 0.5ML 5.51 2514209510 J3490 TETANUS TOXOID FLUID DOSE 5.51 2514209550 J9340 THIOTEPA 15MG INJECTION 23.24 2524209560 J3490 THORAZINE 25MG SUPPOSITORY 3.30 2524209570 J3490 THORAZINE 100MG SUPP 3.30 2524209590 J3490 THROMBOLYSIN 78.03 2514209610 J3490 THYROLAR 1GR TABLET 1.11 2524209640 J3490 TIGAN 200MG SUPPOSITORY 3.30 2524209690 J3490 TRANXENE 3.75MG CAPSULE 1.11 2524209730 J3310 TRILAFON 5MG/ML AMPULE 5.51 2524209740 J3490 TRILAFON 2MG/5CC 1.11 2524209800 90690 TYPHOID VAC 5CC DOSE 6.70 2514209820 J3490 INSULIN-ULTRALENTE U100 10 20.63 2514209880 J3490 URISPAS 100MG TABLET 1.11 2524209900 J3490 VALISONE LOTION 20 ML 17.21 2524209910 J3490 VALIUM 10MG INJECTION 5.51 2524209920 J3490 VALIUM 10MG TABLET 1.11 2524209930 J3490 VALIUM 2MG TABLET 1.11 2524209940 J3490 VALIUM 5MG TABLET 1.11 2524209950 J3490 AMYL NITRATE INHALATION 1.45 2514210050 J3490 ONCOVIN 1MG/ML VIAL 43.68 2524210070 J3490 WATER FOR INJECTION 5ML 1.63 2504210090 J3490 WYCILLIN 1.2MU/2ML INJ 5.92 2524210100 J3490 WYCILLIN 2.4M UNIT INJECT 11.31 2524210110 J3490 WYCILIIN 600000U/ML INJ 5.51 2524210120 J3490 WYDASE 1500 UNIT 10ML VIAL 16.24 2524210130 J3490 XYLOCAINE CAR ARR 50MG 5.51 2524210140 J2001 XYLOCAINE 1% 50ML 7.25 2524210150 J3490 XYLOCAINE 2% 50ML 60.38 2524210160 J3490 XYLOCAINE TOPICAL 4% 50ML 5.51 252
83
4210472 J1100 DEXAMETHASONE 10MG/ML PF SDV 4.45 2514210500 J3490 ARIPIPRAZOLE 10MG TAB 47.53 2514210603 J3490 ACETAMINOPHEN SUPP 325MG 3.30 2574210605 J3490 ACETAZOLAMIDE 500MG CAP 1.11 2514210610 J3490 ALCOHOL ISOPROPYL 70% 1 PINT 3.17 2514210614 J3490 AMBENONIUM CHLORIDE 10MG 1.11 2514210615 J3490 AMIKACIN 250MG/ML 2ML VIAL 37.74 2514210616 J0278 AMIKACIN 1GM/4ML VIAL 74.08 2514210617 J3490 AMITRIPTYLINE 50MG TABLET 1.11 2514210618 J3490 AMMONIA INHAL SOLN 1/3CC 1.11 2514210621 J3490 AMOXICILLIN 250MG CAPSULE 1.11 2514210622 J3490 AMOXICILLIN 500MG CAPSULE 1.11 2514210623 J3490 AMOXICILLIN 50MG/ML 15ML DRPS 9.11 2514210624 J3490 AMOXICILLIN 125MG/5ML 100ML BT 17.02 2514210626 J3490 ANTIHEMOPHLIC F8 250IU VI 334.75 2514210627 J3490 ANTIHEMOPHILIC HEMOFIL-T 148.11 2514210629 J3490 ANTILIRIUM 2ML INJ 5.51 2524210631 J3490 APLISOL 5ML 50 TEST 23.93 2524210632 J3490 AQUASOL-A 5000U DROP 30ML 12.09 2524210633 J3490 VITAMIN C 500MG AMP 5.51 2524210635 J3490 ASPIRIN 81MG CHEW-TABLET 1.11 2514210636 J3490 ATROPINE 1% OPHTH SOLN 15 ML 13.60 2514210637 J7500 AZATHIOPRINE 50MG TABLET 1.11 2514210640 J3490 BASALJEL X-STRENGTH DOSE 1.11 2524210642 J3490 COGENTIN 2MG TAB 1.11 2524210643 J3490 BENZOIN COMP TINCT 30ML 3.30 2504210646 J3490 BETHANECHOL 25MG TABLET 1.00 2514210647 J3490 BETHANECHOL 10MG TABLET 1.11 2514210649 J3490 BREAST CREAM 2OZ MASSE 6.58 2504210653 J3490 BURROW'S SOLN 1:40 1000ML 12.74 2504210654 J8510 BUSULFAN 2MG TABLET 1.11 2514210655 J3490 CALCIUM CL 10% 1GM/10ML VIAL 5.51 2514210659 J3490 KEFZOL 1GM INJECTION 17.99 2524210660 J3490 CEPACOL LOZENGE 18'S 1.11 6364210661 J3490 LIBRIUM 5MG CAP 1.11 2524210663 J3490 CHLORPHENIRAMINE 12MG TAB 1.11 2514210665 J3490 CHLORPHENIRAMINE 8MG TAB 1.11 2514210668 J3490 CIMETIDINE 300MG/2ML DOSE 7.25 2514210669 J3490 CIMETIDINE 300MG TABLET 1.11 2514210670 J3490 KLONOPIN 0.5MG TABLET 1.11 2524210671 J3490 TRANXENE 7.5MG CAPSULE 1.11 252
84
4210673 J3490 CORTISPORIN OPHTH OINT 12.09 2524210674 J3490 CORTISPORIN OTIC SUSP 10ML 15.50 2524210676 J3490 CYTOSAR 100MG/5ML VIAL 15.58 2524210677 J3490 DARVOCET-N 100MG TABLET 1.11 2524210679 J3490 DESIPRAMINE TB-25 1.11 2514210683 J3490 STILPHOSTEROL 0.25GM AMP 8.78 2524210685 J1160 DIGOXIN 0.1MG INJECTION 5.51 2514210694 J3490 ZARONTIN 250MG CAPSULE 1.11 2524210695 J3490 LASIX 10MG/ML 60ML O/SOLN 17.44 2524210696 J3490 HALOG CREAM 0.1% 15GM 15.71 2524210697 J3490 HYDROCORTISONE ENEMA 60ML 3.50 2514210698 J3490 HYDROGEN PEROXIDE 16OZ 2.32 2504210699 J3490 IMMUNE SERUM GLOBULIN 10ML 29.62 3874210701 J3490 TOFRANIL 10MG TABLET 1.11 2524210706 J3490 PERI DIALYSIS 1.5% 1000ML 15.34 2504210707 J3490 PERI DIALYSIS 4.25% 1000ML 21.92 2504210708 J3490 INSULIN-PROTAMINE U100 10ML 26.32 2514210709 J3490 INSULIN-REG BEEF U100 10ML 5.51 2514210710 J3490 INSULIN-LENTE U100 10ML 26.32 2514210712 J3490 INSULIN-SEMILENTE U100 10ML 26.32 2514210714 J3490 INTRALIPID 10% 500ML 114.79 2504210716 J3490 ISUPREL 1:5000 5ML AMP 10.64 2524210718 J3490 ISUPREL MISTOMETER 10ML 17.56 2524210719 J3490 CARBACHOL 3% 15ML OPHTH DRP 19.96 2514210720 J3490 ISOPTOCARPINE OPHT 6% 15ML 15.50 2524210721 J3490 ISOPTO CARBACHOL 1.5% 15ML 18.98 2524210722 J3490 ISOPTO HOMATROPINE 5% 5ML 15.71 2524210723 J3490 CORTISPORIN EAR SUSP 10ML 78.79 2524210724 J3490 WATER DISTILLED 1000ML 19.74 2504210726 A4649 FILTER IN-LINE 6.58 2724210728 J3490 GLYCINE IRRIGATE 1500ML 29.76 2504210729 J3490 GLYCINE IRRIGATE 2000ML 29.76 2504210738 J7120 LACTATED RINGER'S 500ML 15.34 2584210739 J7120 LACTATED RINGER'S 1000ML 19.74 2584210741 A4217 NORMAL SALINE IRRIG 1000ML 19.74 2504210742 A4217 NORMAL SALINE IRRIG 2000ML 26.32 2504210744 J7050 NORMAL SALINE 0.9% 250ML 12.62 2584210745 J7040 NORMAL SALINE 0.9% 500ML 15.34 2584210746 J3490 SODIUM CHLORIDE UG 1500ML 28.53 2504210748 A4217 WATER IRRIGATION 2000ML 17.56 2504210754 J3490 DEXTROSE 50% WATER 500ML 26.32 258
85
4210756 J3490 KAYEXALATE POWDER 20GM 5.59 2524210757 J3490 LIDOCAINE 4% TOP SOLN 4ML 14.13 2514210758 J3490 LIDOCAINE 2% SOLN 20ML 2.96 2514210759 J3490 LOXITANE 50MG CAPSULE UD 1.30 2524210764 J3490 LOXITANE 25MG CAPSULE UD 1.00 2524210765 J3490 LOXITANE 50MG/ML AMP 5.59 2524210766 J3490 LEVORPHANOL 2MG AMP 5.51 2514210768 J3490 MEASLES VACCINE DOSE 8.22 2504210769 J3490 CARBOCAINE CA&EP 2% 9.66 2524210770 J3490 CARBOCAINE 1% 50ML 8.34 2524210772 J3490 ALUPENT SYRUP 5ML DOSE 1.11 2524210773 J3490 ROBAXIN 750MG TABLET 1.11 2524210775 J3490 MONISTAT CREAM 19.74 2524210777 J1600 MYOCHRYSINE 50MG INJECTION 6.16 2524210778 J3490 MULTISTIX 100'S 75.38 2504210779 J3490 NAIL POLISH REMOVER 30ML 3.30 2504210780 J3490 NALIDIXIC ACID 500MG TAB 1.11 2514210781 J2710 NEOSTIGMIN 1:4000 AMP 5.51 2514210782 J3490 NEOSPORIN FOIL PACK 1.11 2574210787 P9045 ALBUMIN (HUMAN)5% 250ML VIAL 184.33 2514210789 J3490 NYSTATIN 100MU VAGINAL TAB 1.11 2524210790 J3490 OPTEMP 12'S BOX 207.36 2504210793 J3490 PAVULON 2MG/ML 2ML AMP 5.82 2524210795 J3490 PERI DIALYSIS 1.5% 2000ML 32.92 2504210798 J3490 PHENYLEPHRINE 10MG/1ML INJ 5.51 2524210801 J3490 POTASSIUM IODINE 60ML 4.92 2514210803 J3490 MINIPRESS 2MG CAPSULE 1.11 2524210807 J3490 SUDAFED SYRUP 5ML 1.11 2524210808 J3490 ANTIMINTH SUSPENSION 1ML 1.11 2524210810 J3490 RENOGRAFIN-76 50ML 25.67 2554210812 J3490 SILVADENE CREAM 1% 20GM 5.07 2524210813 J3490 SINEMET 10/100 TABLET 1.11 2524210814 J3490 SINEMET 25/250 TABLET 1.11 2524210815 J3490 SINOGRAFIN 38% 10ML VIAL 26.54 2554210816 J3490 SMALLPOX VACCINE DOSE 5.51 2514210818 J3490 SODIUM BICARB 10MEQ SYRINGE 12.20 2514210820 J3490 SODIUM BICARB 4.2% 10ML SYR 5.07 2514210821 J3490 SODIUM CL 10ML INJ 5.51 2504210822 J3490 SODIUM CL 20ML INJ 5.51 2524210823 J3490 SODIUM CL 23.4% 100ML 5.51 2584210824 J3490 SODIUM CL 23.4% 30ML 5.51 250
86
4210828 J3490 PROSTAPHLIN 2GM INJECTION 37.32 2524210833 J3490 TETRA SPINAL ANESTHETIC 5.13 2514210835 J3490 THIMEROSAL SOLN 30ML 1.52 2514210836 J3490 THIMEROSAL TINCTURE 30ML 1.52 2504210839 J3490 VANCERIL 40MCG INHALER 32.15 2524210840 J3490 VELBAN 10MG 10ML AMP 45.08 2524210841 J3490 VITAMIN A 25000 UNIT CAP 1.11 2514210843 J3490 Z-BEC TABLET 1.11 2574210844 J3490 ZINCFRIN OPHTH DROPS 15ML 11.53 2524210850 J3490 METAPREL 20MG TABLET 1.11 2524210853 A4649 CONDOM 4'S 6.58 2724210856 J3490 TEGOPEN 125MG/5ML 100ML 21.61 2524210859 J3490 KEFLEX 250MG/5ML 200ML BT 25.34 2524210862 J3430 AQUAMEPHYTON 10MG AMP 5.51 2524210868 J3490 STELAZINE 1MG TABLET 1.11 2524210871 J3490 DIGOXIN 0.125MG TABLET 1.11 2514210880 J3490 CEPACOL/H2O2/NSS 1:1:1 12O 8.22 2574210883 J3490 ACETAMINOPHEN/COD 30MG #3TAB 1.11 2514210886 J3490 PLACEBO-EMPTY TUBEX 5.51 2504210892 J3490 TUCKS 40'S 6.48 2504210895 J3490 RESERPINE 1MG TABLET 1.11 2514210910 J3490 BAKING SODA 15GM 1.11 2504210913 J3490 PREDNISONE 10MG TABLET 1.11 2514210916 J3490 AMPICILLIN 125MG INJ 5.51 2514210942 J3490 ASCRIPTIN 5GR TABLET 1.11 2574210944 J3490 MYLANTA SUSPENSION 5OZ 3.61 2574210945 J3490 HALDOL 10MG TABLET UD 1.20 2524210946 J3490 ASPIRIN BUFFERED 325MG TAB 1.11 2514210948 J3490 ARALEN 500MG TABLET 1.30 2524210949 J3490 LOXITANE 10MG CAPSULE UD 1.11 2524210951 J3490 KAY CIEL 20MEQ/PACKET 1.11 2524210952 J3490 SALT TABLET 1.11 2504210954 J3490 TIGAN 100MG PED SUPP 3.30 2524210955 J3490 THORAZINE 200MG CAPSULE 1.11 2524210957 J3490 SODIUM CL 0.2% 1000ML 19.74 2584210958 J3490 SINEQUAN 75MG CAPSULE 1.11 2524210959 J3490 MYLANTA SUSPENSION 5CC UD 1.11 2574210960 J3490 GELUSIL SUSPENSION 360ML 7.02 2524210961 Q0175 TRILAFON 4MG TABLET 1.11 2524210965 J3490 INH 300MG TABLET 1.11 2514210966 J3490 LOXITANE-C 25MG/ML 120ML 133.65 252
87
4210968 J3490 MAGNESIUM SO4 50% SOL 60ML 1.11 2514210970 J1644 HEPARIN 5000U/ML 6.24 2514210973 J3490 VIOFORM HC MILD CRM 30GM 15.14 2504210974 J3490 VITAMIN B12 1000MCG/ML INJ 5.51 2524210975 J3490 L-THYROXINE 0.1MG TABLET 1.11 2524210976 J3490 DEPO-TESTOSTERONE 200MG/ML INJ 9.66 2524210977 J3490 AMOXICILLIN 250MG/5ML 100ML BT 22.55 2514210978 J3490 SENOKOT 8.6MG TABLET 1.11 2524210979 J3490 ACETAMINOPHEN 500MG TAB 1.11 2574210980 J3490 NEO-CALGLUCON 1.8GM/5ML DOSE 1.11 2524210981 J3490 CORN STARCH 30GM 2.50 2504210982 J3490 CLINORIL 150MG TABLET 2.08 2524210984 J3490 TRILAFON CON 16MG/5ML 120ML 22.84 2524210987 J3490 THEOPHYLLINE ELIX 80MG/15ML 5M 1.11 2514210989 J3490 PATHIBAMATE 400MG TABLET 1.11 2514210990 J3490 ASPIRIN EC 325MG TABLET 1.11 2514210993 J3490 CHLOR-TRIMETON 8MG REPETAB 1.11 2524210997 J3490 GRANULEX AEROSOL 120GM 25.92 2504211000 J3490 PHENERGAN COD SYRUP 5ML DOSE 1.11 2524211001 J3490 NORMAL SALINE NASAL DRP 30 1.11 2504211003 J7060 DEXTROSE 10% ISOLYTE-P 500ML 15.34 2584211005 J3490 ISOPTOCARPINE OPHT 4% 15ML 13.60 2524211006 J3490 DEXTROSE 10% ISOLYTE-P 250ML 12.62 2584211007 J2270 MORPHINE 2MG INJECTION 5.51 2514211008 J3490 ACETAMINOPHEN/COD 15MG TAB 1.11 2514211009 J3490 LOTRIMIN 1% 30GM CREAM 18.09 2524211010 J3490 POLYSPORIN OPHTH OINT 7.89 2524211012 J3490 MAALOX NO.2 TABLETS 1.30 2524211014 J3490 PHENERGAN 25MG TABLET 1.11 2524211015 J3490 METAPREL SYRUP 5ML 1.11 2524211017 J3490 ASPIRIN SUPPOSITORY 2GR 3.30 2514211020 J3490 MVI CONCENTRATE 5ML 5.59 2514211021 J3490 PHENOBARBITAL 60MG TABLET 1.11 2514211022 J3490 ATIVAN 2MG TABLET 1.11 2524211023 J3490 PLACEBO-CAPSULE 1.11 2504211024 J3490 DEPAKENE 25OMG CAPSULE 1.11 2524211027 J3490 LIORESAL 10MG TABLET 1.11 2524211033 J3490 PHENERGAN CODEINE SYR 5ML 1.11 2524211034 J3490 VIOFORM 3% OINTMENT 30GM 6.70 2524211038 J3490 SYNTHROID 0.5MG 10ML INJ 55.18 2524211040 S0169 ROCALTROL 0.25MCG CAPSULE 2.00 252
88
4211042 J3490 AVITENE 1GM JAR 121.78 2524211045 J3490 XYLOCAINE 2GM INF 20% 10ML 12.62 2524211048 J3490 QUINIDEX EXTENTAB 1.11 2524211049 J3490 EYE STREAM 4OZ 9.75 2504211050 J3490 PRED SYRUP 5MG/5ML DOSE 5.13 2514211051 J3490 ALUMINUM 1% SOLN 60ML 5.13 2504211052 J3490 PATHIBAMATE 200MG TABLET 1.11 2514211056 J0595 STADOL 1MG INJECTION 5.51 2524211057 J3490 KLONOPIN 1MG TABLET 1.11 2524211059 J3490 DIABINESE 100MG TABLET 1.11 2524211060 J7512 PREDNISONE 20MG TABLET 1.11 2514211062 J3490 ANTABUSE 250MG TABLET 1.11 2524211064 J3490 POTASSIUM CL 20% 15ML DOSE 1.11 2514211066 J3490 POLY-VI-SOL CHEW TABLET 1.11 2574211068 J3490 PROSTIGMIN 1:1000 1ML DOSE 5.51 2524211069 J3490 ALDOMET 250MG/5ML VIAL 11.31 2524211070 J3490 GLYCERIN SOLUTION 30ML 2.50 2504211071 J3490 NORPACE 100MG CAPSULE 1.11 2524211072 J3490 NATABEC TABLET 1.11 2524211074 J3490 EURAX LOTION 10% 60ML 9.51 2524211075 J3490 ACETAMINOPHEN/COD 5ML UD 1.11 2514211078 J3490 DECADRON ELIX 0.5MG/5ML DOSE 1.11 2524211080 J3490 PROPRANOLOL 20MG TABLET 1.11 2514211083 J3490 DEBROX 6.5% 15ML ERR DRP 10.29 2574211084 J3490 HEPTAVAX-B 20MCG/ML 1ML 105.35 2524211085 J9060 CISPLATIN 10MG 10ML VIAL 76.68 2514211086 J3490 MUCOMYST 20% 10ML INHAL 19.30 2524211092 J3490 CORGARD 40MG TABLET UD 1.11 2524211094 J3490 BICILLIN LA 600000U/1ML 8.89 2524211095 J1940 LASIX 40MG/4ML INJ 8.89 2524211096 J1940 PROSTIGMIN 1:2000 AMP 1.11 2524211097 J3490 MESTINON TIMESPAN 180MG 1.11 2524211098 J3490 ACETAMINOPHEN SUPP 120MG 3.30 2574211099 J3490 LASIX 80MG SYRINGE 13.84 2524211100 J3490 SLOW K 600MG TABLET 1.11 2524211101 J3490 HYDERGINE 1MG ORAL TABLET 1.11 2524211103 J3490 POTASSIUM ACE 2MEQ/ML 100M 5.51 2514211104 J3490 APRESOLINE 10MG TABLET 1.11 2524211106 J3490 NAPROSYN 250MG TABLET 1.11 2524211108 J3490 URISTIX 100'S 26.78 2504211115 J3490 BENZAGEL 5 42.5GM 7.55 252
89
4211119 J3490 PAVULON 2MG/ML 5ML AMP 11.84 2524211120 J3490 FOLVITE 1MG INJECTION 5.51 2524211122 J3490 PROCAN SR 500MG TABLET 1.11 2524211125 J3490 CAPOTEN 25MG TABLET 1.11 2524211126 J3490 SODIUM CL 0.33% 500ML 15.34 2584211127 J3490 FLAGYL P/MIX 500MG VIAL 38.27 2524211128 J3490 VI-DAYLIN W/IRON DROPS 1ML 1.11 2574211130 J3490 HALDOL 5MG TABLET UD 1.11 2524211131 J3490 TICARCILLIN 3GM VIAL 27.98 2524211132 J3490 VI-DAYLIN LIQUID 5ML DOSE 1.11 2574211133 J3490 DESFERAL 500MG/VIAL 12.29 2504211135 J0895 FLAGYL 500MG INJECTION 34.24 2524211136 S0030 TUBERCULIN PPD 1TU INJECT 5.51 2504211137 J3490 ISOPTO HOMATROPINE 2% 5ML 15.71 2524211138 J3490 ISORDIL 5MG SL 1.11 2524211140 J3490 TUBERCULIN PPD 5TU 0.1ML DOSE 5.51 2544211141 J3490 VERAPAMIL 5MG/2ML AMP 37.32 2524211142 J3490 CYCLOGYL 1% 15ML OPHTH 30.51 2524211143 J3490 VALISONE/BALTAR 45GM 43.33 2524211144 J3490 TUBERCULIN PPD 1ML VIAL 5.51 2544211149 J3490 TOBRAMYCIN 80MG INJECTION 16.34 2524211150 J3260 TERBUTALINE 1MG INJECTION 5.51 2524211151 J3105 SALICYLIC ACID 10% 30ML 6.58 2514211152 J3490 THYMOL/HC/CHLOROFORM 30GM 12.62 2504211155 J3490 CYANOCOBALAMIN 1MG/ML AMP 5.51 2514211156 J3420 PODOPHYLLUM/BENZOIN 30ML 11.09 2504211157 J3490 REGLAN 10MG AMPULE 5.38 2524211159 J2765 PALADAC SYRUP 5ML DOSE 1.11 2524211162 J3490 MENTHOL/PHENOL/KENALOG 39.51 2504211164 J3490 CHROMIUM 4MCG/ML 10ML VIAL 5.51 2514211165 J3490 DILAUDID 2MG TABLET 1.11 2524211166 J3490 DANOCRINE 200MG CAPSULE 3.50 2524211167 J3490 BRETYLOL 500MG INJECTION 47.96 2524211169 J3490 ACETIC ACID 1% 500ML 15.34 2504211174 J3490 VITAMIN E 400IU CAPSULE 1.11 2514211175 J3490 BCNU 100MG INJECTION 64.52 2524211176 J3490 BUPIVACAINE W/ EPI 0.5% 10ML V 14.54 2514211177 J3490 CATAPRES 0.2MG TABLET 1.11 2524211180 J3490 SINEQUAN CONCENTRATE 120ML 25.67 2524211181 J3490 PROCAN SR 250MG TABLET 1.11 2524211183 J3490 SINEQUAN CONCENTRATE DOSE 1.11 252
90
4211184 J3490 CLAFORAN 1GM INJECTION 37.94 2524211185 J3490 AFRINOL REPTAB 1.11 2524211186 J3490 FELDENE 20MG CAPSULE 3.93 2524211187 J3490 MYLANTA II SUSPENSION 150ML 13.19 2574211188 J3490 MYLANTA II SUSPENSION 30ML UD 1.11 2574211189 J3490 GYNE-LOTRIMIN VAG CRM 45GM 21.25 2524211190 J3490 SPECTROBID 125MG/5ML 100ML 25.67 2524211192 J3490 NAVANE 5MG IM DOSE 1.11 2524211194 J3490 PRISCOLIN 25MG/ML DOSE 5.51 2524211195 J3490 FULVICIN U/F 250MG TABLET 1.11 2524211197 J3490 SODIUM PHOSPHATE INJECTION 5.51 2514211199 J3490 FENTANYL 100MCG PATCH 88.39 2514211200 J3490 FULVICIN P/G 125MG TABLET 1.11 2524211201 J3490 DTIC DACARBAZIN INJECTION 21.19 2514211202 J3490 MELLARIL 30MG/ML CONC 120ML 35.13 2524211205 S0021 CEFOBID 1GM INJECTION 31.29 2524211206 J3490 SODIUM FLUORIDE 2.2MG TAB 0.25 2514211208 J3490 ROBINUL 0.2MG/ML INJECTION 5.51 2524211210 J3490 CEFOBID 2GM INJECTION 62.55 2524211219 J3490 ETRAFON 2-25 TABLET 1.11 2524211220 J3490 MYAMBUTOL 100MG TABLET 1.11 2524211222 J3490 IMMUGLOBULIN 10% 3GM/100ML IV 430.12 2514211224 J3490 SEROMYCIN 250MG CAPSULE 1.45 2524211225 J3490 MAALOX TABLETS NO.1 0.15 2574211227 J3490 LIDEX 0.05% 30GM CREAM 25.92 2524211228 J3490 HALOTESTIN 5MG TABLET 1.45 2524211229 J3490 TRANSDERM NITRO 5 PATCH 3.69 2514211232 J3490 LIDEX 0.05% 60GM CREAM 43.33 2524211233 J3490 TRANSDERM NITRO 10 PATCH 4.13 2514211235 J3490 CARMOL 10 LOTION 30GM 1.45 2524211236 J3490 LOPRESSOR 50MG TABLET 1.11 2524211237 J3490 COUMADIN 2.5MG TABLET 0.59 2524211238 J3490 NITROGLYCERIN 50MG INJECT 90.92 2514211239 J3490 DILANTIN S 125MG/5ML DOSE 1.11 2524211240 J3490 CUPRIMINE 250MG CAPSULE 1.11 2524211243 J3490 PHENERGAN VC SYRUP 5ML 1.11 2524211244 J3490 FELDENE 10MG CAPSULE 1.52 2524211245 J3490 BETADINE/SUGAR PASTE 120GM 11.88 2574211247 Q0164 COMPAZINE SYR 5MG/ML 120ML 34.78 2524211249 J3490 CARDIZEM 30MG TABLET 0.88 2524211251 J3490 SUDAFED 60MG TABLET 1.11 252
91
4211253 J3490 ECONOPRED OPHTH 1/8% DP 5M 24.23 2524211256 J3490 CLINORIL 200MG TABLET 2.57 2524211259 J1410 PREMARIN 25MG INJECTION 87.10 2524211261 J3490 HEPARIN LOCK 100U/5ML 30ML 7.08 2514211262 J3490 PROSTIN 20MG VAG SUPP 114.74 2524211263 J3490 KENALOG 0.025% CREAM 15GM 8.89 2524211264 J3490 SODIUM SULAMYD 10% 15ML OPHTH 13.51 2514211265 J3490 MYCELEX TROCHE 10MG 1.62 2524211267 J3490 TRIAVIL 2-10 TABLET 1.29 2524211268 J3490 MELLARIL 25MG/5ML SUSP 15M 1.11 2524211269 J3490 DIPROSONE 0.05% LOTN 60ML 94.15 2524211270 J3490 DIPROLENE 0.05% OINT 45GM 71.28 2524211271 J3490 VANCENASE 25GM INHALER 28.10 2524211272 J3490 PRAVASTATIN SODIUM 40MG TAB UD 6.53 2514211273 J3490 SYNTHROID 0.075MG TABLET 0.38 2524211276 J3490 SINEMET 25/100 TABLET 1.11 2524211278 J3490 SODIUM CL 100MEQ VIAL 9.32 2514211279 J3490 DEXTROSTIX 25'S 51.23 2504211280 J3490 TRAVASOL HYPERAL 8.5% 500M 44.66 2504211281 J3490 DESYREL 50MG TABLET 1.19 2524211282 J3490 BETADINE SWABSTICK 0.78 2574211283 J3490 CHLOROQUINE PO4 250MG TAB 1.11 2514211284 J3490 ZINC 50MG TABLET 1.11 2514211285 J3490 NORMODYNE 200MG TABLET 1.12 2524211287 J3490 DEBRISAN 60GM 116.52 2504211288 J3490 PREDNISONE LIQ 5MG/5ML DOSE 1.11 2514211289 J3490 CHENIX 250MG TABLET 1.71 2524211292 J3490 FURADANTIN 100MG TABLET 1.11 2524211293 J3490 BUMEX 1MG TABLET 0.68 2524211294 J3490 ZINC 100MG TABLET 0.05 2514211295 J3490 SODIUM CHLORIDE 3% 500ML 15.34 2584211296 J3490 NEO-SYNEPHRINE OPHTH 10% 10.44 2524211297 S0171 BUMEX 0.5MG/2ML AMP 5.12 2524211299 J3490 MIDRIN CAPSULE 1.11 2504211300 J3490 NEO-SYNEPHRINE OPHTH 2.5% 9.75 2524211301 J3490 FLUORI-METH SPRAY 16.37 2504211302 J3490 INSULIN REG HUMALIN 10ML 41.59 2514211303 J3490 LITHOBID 300MG TABLET 1.11 2524211304 J3490 ORAL REHYDRATION COMPOUND 6.58 2504211306 J3490 CECLOR 125MG/5ML 150ML 55.29 2524211307 Q0177 VISTARIL 25MG CAPSULE 1.11 252
92
4211312 J3490 MELLARIL 15MG TABLET 1.11 2524211316 J3490 HALOG OINTMENT 0.1% 15GM 20.19 2524211317 J3490 ECONOPRED PLUS 1% OPHTH 26.25 2524211318 J3490 MIOCHOL OPHTH SOLN 20MG 2M 60.55 2524211320 J1170 DILAUDID 4MG INJECTION 5.51 2524211323 J3490 MAGNESIUM CITRATE 300ML BOT 3.30 2514211324 J3490 TRIDESILON CREAM 60GM 39.51 2524211328 J3490 LOXITANE 5MG CAPSULE UD 1.11 2524211331 J3490 THEO-DUR 50MG SPRINKLE 1.11 2524211334 J3490 MICRO K 10MEQ CAPSULE 0.29 2524211336 J3490 DEXTROSE 5% NACL .1% 1000M 23.05 2584211337 J3490 REGLAN 150MG/30ML INJ 79.12 2524211340 J3490 ALBUTEROL 2MG TABLET 1.11 2514211341 J3490 LIDO-EPI 1% 1:100000 10ML MDV 9.43 2514211348 J3490 SORBITOL 70% 15ML DOSE 1.11 2524211354 J3490 DAKIN'S SOLUTION 1000ML 6.02 2504211363 J3490 DITROPAN SYRUP 5ML DOSE 1.11 2524211364 J3490 ASENDIN 100MG TABLET UD 3.27 2524211367 A4217 WATER STERILE 500ML INJ 15.34 2504211368 J3490 ALCOHOL 15% DOSE 1.62 2504211372 J3490 MYLICON 80MG TABLET 0.32 2574211373 J3490 NIZORAL 200MG TABLET 5.33 2524211376 J3490 MEXITIL 200MG CAPSULE 1.48 2524211377 J3490 MAXZIDE TABLET UD 1.47 2524211378 J3490 GYNE-LOTRIMIN 100MG VAGTAB 5.16 2524211379 J3490 LUDIOMIL 25MG TABLET 1.11 2524211381 J3490 CHLOROQUINE PO4 0.5GM TAB 4.80 2514211382 J3490 METUBINE IODINE 2MG 57.93 2514211383 J3490 CALAN 80MG TABLET 1.11 2524211385 J3490 TRACRIUM 10MG/ML 10ML AMP 54.67 2524211386 J3490 CERUBIDIN 20MG VIAL 250.43 2524211387 J3490 NAVANE 10MG IM DOSE 5.51 2524211391 J3490 SORBITOL 20% 100ML 1.11 2524211394 J3490 ZINC SULFATE 220MG CAP 0.22 2514211397 J3490 SODIUM CL .33% 1000ML 6.90 2584211398 J3490 LOTRISONE 45GM CREAM 62.98 2524211401 J3490 DURICEF SUSP 125MG/5ML 100ML 51.31 2524211402 J3490 MYSOLINE 250MG/5ML DOSE 1.12 2524211403 J3490 LIDEX GEL 0.05% 15GM 18.66 2524211405 J3490 CORTISONE ACETATE 25MG TAB 1.11 2514211413 J3490 GLYCINE IRRIGATE 3000ML 28.12 250
93
4211417 J3490 PERCOCET 5/325MG TABLET 1.11 2524211419 J3490 DECLOMYCIN 150MG TABLET 2.32 2524211421 J3490 MENTHOL.15GM/PETROLATUM30G 11.27 2504211423 J3490 SYNTHROID 0.05MG TABLET 1.11 2524211424 J3490 MAXIDEX OPHTH OINT 3.5GM 15.50 2524211427 J3490 ISORDIL 40MG 1.11 2524211428 J3490 MAXIDEX OPHTH SOLN 5ML 19.64 2524211432 J3490 METAPREL MIST REFILL 18.24 2524211433 J3490 INTRA-SITE GEL 15GM 46.60 2524211434 J3490 DERMASYN WOUND GEL 3OZ 26.33 2524211435 J3490 SHOLHS SOLUTION 15ML 1.11 2504211436 J3490 METAPREL MIST W/ ADPT 20.19 2524211439 J3490 INTRALIPID 10% 50ML 65.85 2504211440 J3490 MEDIHALER ISO REFILL 15ML 19.54 2524211443 J3490 WATER STERILE 1000ML INJ 5.39 2504211444 J3490 DUO-MEDIHALER 15ML 22.04 2524211446 J3490 TONOCARD 400MG UD TABLET 1.90 2524211447 J1250 DOBUTAMINE 250MG INJECTION 88.49 2524211448 J3490 AFRIN PED NASAL DROP 20ML 5.51 2574211449 J3490 LOPID 300 MG CAPSULE 0.98 2524211450 J3490 TONOCARD 600MG UD TABLET 2.29 2524211452 J0833 CORTROSYN 0.25MG 1ML INJ 14.68 2524211453 J3490 BRONKOSOL INHALATION 10ML 27.12 2524211454 J3490 ZINC GLUCONATE 50MG/5ML 0.05 2514211458 J3490 CHEMO DISPENSING PIN 7.28 2504211459 J3490 CYCLOCORT 0.1% 30GM OINT 39.96 2524211460 J3490 VISTARIL 25MG INJECTION 5.25 2524211461 J3490 DEXTROSE 10% NACL .2% 500M 7.68 2584211462 J1815 INSULIN PER 1ML INJECTION 4.03 2514211463 J3490 SODIUM CHLORIDE 0.2% 500ML 15.34 2584211464 J3490 INSULIN-NPH HUMAN-N 10ML 38.43 2514211465 J3490 HEPTAVAX-B 20MCG/ML 3ML 492.45 2504211466 J3490 VIOFORM 3% CREAM 30GM 13.60 2524211467 J3490 VISTARIL SUSP 25MG/5ML DOSE 2.03 2524211468 J3490 V-ZIG 125 UNIT INJ 403.04 2524211469 J0280 AMINOPHYLLINE 1MG/ML DOSE 1.95 2514211470 J3490 CARDIZEM 60MG TABLET 1.44 2524211472 J3490 TEGRETOL 100MG CHEW TABLET 1.11 2524211474 J3490 KAYEXALATE POWDER 30GM 17.43 2524211475 J3490 DEXTROSE 10% NACL .2% 250M 18.46 2584211477 J3490 HYDROGEN PEROXIDE 30ML 0.18 257
94
4211478 J3490 SORBITOL 20% 150ML 4.37 2524211480 J3490 DHT 0.125MG TABLET 1.69 2514211482 J3490 PHENYLEPHRINE 2.5% 15ML OPHTH 26.21 2524211483 J3490 ACYCLOVIR 5% 15GM OINT 69.30 2514211484 J3490 DHT 0.2MG TABLET 1.71 2514211495 J3490 FUROXONE 50MG/15ML 5ML DOSE 1.11 2514211509 J3490 EPHEDRINE SO4 50MG/ML AMP 3.84 2524211510 J3490 LEVOPROME 20MG/ML 1ML INJ 630.92 2524211511 J3490 AVEENO BAR SOAP 3.5OZ 8.02 2524211512 J3490 LUBRIDERM LOTION 8OZ 18.72 2504211513 J3490 POTASSIUM PO4 40MEQ/15ML 13.85 2514211518 J3490 HALDOL 0.5MG TABLET UD 0.91 2524211519 J3490 MUMPS SKIN TEST 1ML 82.36 2504211522 J3490 ACETAMINOPHEN 10GR TAB DOS 0.07 2574211523 J3490 DURICEF 500MG CAPSULE 2.59 2524211525 J3490 FURACIN SOLUBLE DRESS 30GM 5.30 2504211528 J1644 HEPARIN 1000U/ML 30ML 25.63 2514211529 J3490 CEPACOL LOZENGE EACH 0.08 2574211531 J3490 GLUCOTROL 5MG TABLET 0.70 2524211532 J3490 DURICEF SUSP 250MG/5ML 100ML B 96.32 2524211533 J3490 PETROLATUM OINT FOILPC 0.18 2574211534 J3490 SOMOPHYLLINE SOLN 1ML DOSE 2.11 2524211535 J3490 MUCOMYST 20% 30ML INHAL 154.04 2524211536 J3490 LEUCOVORIN 3MG/ML 20.12 2514211537 J3490 HESPAN INFUSION 500ML 109.95 2584211538 J3490 SODIUM CHLORIDE 0.2% 250ML 10.06 2584211539 J3490 PARAFON FORTE TABLET 0.09 2524211540 J3490 MICRONASE 1.25MG TABLET 0.41 2524211543 J3490 MICRONASE 5MG TABLET 1.10 2524211544 J3490 MICRONASE 2.5MG TABLET 0.65 2524211551 J3490 HALOG SOLUTION 0.1% 60ML 90.68 2524211552 J3490 WESTCORT CREAM 0.2% 45GM 48.30 2524211555 J3490 VALISONE/15% PET/ OZ 36.51 2524211556 J3490 POLYCILLIN 250MG/5ML 150ML 22.81 2524211560 J3490 SYNTHROID 0.2MG TABLET 0.62 2524211562 J3490 HYDROGEN PEROXIDE 8OZ 1.71 2504211563 J3490 HALOG SOLUTION 0.1% 20ML 41.37 2524211567 J3490 MYLANTA TABLET 0.15 2524211568 J3490 ACTH-GEL 80 UNIT DOSE 48.24 2514211570 J3490 CYCLOCORT 0.1% 15GM CRM 33.77 2524211571 J3490 TRANSDERM SCOP DISC EACH 26.31 252
95
4211572 J3490 MARCAINE O.5% 30ML VIAL 13.01 2524211573 J3490 TRANSDERM NITRO 2.5 PATCH 3.59 2524211574 J3490 ALPHA-KERI BATH OIL 8OZ 5.45 2574211575 J3490 SODIUM CHLORIDE 5% 200ML 13.67 2584211577 J3490 MEASLES/RUBELLA DOSE 69.67 2504211578 J0696 ROCEPHIN 250MG VIAL 29.84 2524211581 J3490 VIOFORM HC 1% CREAM 20GM 37.77 2514211582 J3490 PYRIDOXINE 100MG TABLET 0.05 2514211587 J3490 HALCION 0.5MG TABLET UD 1.11 2524211588 J3490 ALDOMET SUSP 250MG/5ML DOSE 1.11 2524211591 J3490 BASALJEL SUSPENSION 12OZ 10.52 2574211592 J3490 CORDRAN CREAM 0.05% 60GM 54.99 2524211595 J3490 THEO-DUR 200MG TABLET 1.11 2524211596 J3490 THEO-DUR 125MG SPRINKLE 1.11 2524211599 J3490 THEO-DUR 75MG SPRINKLE 1.11 2524211610 J3490 WESTCORT CREAM 0.2% 60GM 59.71 2524211611 J3490 VAPONEFRIN SOLUTION 15ML 28.70 2524211613 J3490 PETROL W/MENTHOL 0.5% 120G 16.68 2504211614 J3490 KENALOG 0.05% CREAM 60GM 74.87 2524211615 J3490 DHT 0.2MG/ML 30ML 61.86 2514211616 J3490 GLUCOTROL 10MG TABLET 1.29 2524211617 J3490 PRED FORTE OPHTH 1% 5ML 26.45 2514211618 J3490 INDOMETHACIN SUSP 25MG/25M 4.53 2514211619 J3490 CARAFATE 1GM TABLET 1.38 2524211622 J0702 CELESTONE 6MG/ML 5ML INJ 18.73 2524211623 J0278 AMIKACIN 50MG/ML 2ML VIAL 58.44 2514211625 J3490 ATROPINE 0.4MG TABLET 0.15 2514211626 J3490 LIDOCAINE VISCOUS 2% 5ML U/D 2.01 2524211630 J3490 ERYTHROMYCIN 200/5ML 200ML 35.51 2514211634 J3490 SANDIMMUNE 100MG/ML 50ML OS 609.16 2524211638 J3490 INSULIN-LENTE HUMAN-L 10ML 41.59 2514211639 J2930 SOLU-MEDROL 125MG VIAL 6.09 2524211640 J3490 YUTOPAR 150MG VIAL 438.34 2524211642 J3490 SILVER NITRATE APP 10'S 2.23 2514211643 J3490 TRACE ELEMENTS ADDITIVE 10ML 34.36 2504211644 J3490 TRIPLE DYE 15ML VIAL 3.23 2504211647 J3490 HALCION 0.25MG TABLET 1.20 2524211648 J3490 MICRO K 8MEQ CAPSULE 0.26 2524211649 J3490 ALBUTEROL SYR 2MG/5ML DOSE 3.53 2514211650 S0109 METHADONE 5MG TABLET 0.18 2514211651 J7040 NORMAL SALINE 0.45% 500ML 4.41 258
96
4211653 J3490 PHENOBARBITAL 15MG TABLET 0.02 2514211655 J0696 ROCEPHIN 500MG VIAL 51.36 2524211656 J3490 DEXTROSE 10% NACL .45 1000 11.12 2584211657 J3490 MINERAL OIL DOSE 0.80 2504211658 J3490 DEXTROSE 10% NACL .45 250M 7.08 2584211659 J3490 NITROGLYCERIN OINT 2% 30GM 7.36 2514211660 J3490 BETADINE DOUCHE MIXED 1000 6.02 2574211661 J3490 TOPICORT CREAM 0.25% 60GM 67.65 2524211662 J3490 PROTAMINE SULFATE 50MG INJ 13.60 2514211663 J3490 BURROW'S SOLN 1:20 1000ML 7.50 2504211664 J3490 CEPACOL/NSS 1:1 240ML 6.47 2574211665 J3490 TRENTAL 400MG TABLET 1.03 2524211666 J0696 ROCEPHIN 2GM VIAL 190.52 2524211667 J3490 CALCIUM GLUCONATE 10GR TAB 0.19 2514211668 J3490 LOTRISONE 15GM CREAM 32.73 2524211669 J3490 NORFLEX 100MG TABLET 2.49 2524211670 J3490 E E S DROPS 100MG/2.5 50ML 15.13 2524211671 J3490 AMPHOJEL SUSPENSION 348ML BT 12.09 2574211672 J3490 ASPIRIN 10GR TABLET DOSE 0.41 2514211673 J3490 ACYCLOVIR 200MG CAPSULE 1.93 2514211674 J3490 ACYCLOVIR 500MG 10ML VIAL 134.85 2514211676 J3490 PITRESSIN 20U/ML VIAL 26.02 2524211677 J3490 CECLOR 250MG/5ML 150ML 100.24 2524211678 J3490 SILVADENE CREAM 1% 400GM 75.51 2524211679 J3490 OS-CAL 500MG TABLET 0.41 2524211680 J3490 DIPROLENE 0.05% 15GM OINT 38.94 2524211681 J3490 PEDIAZOLE SUSPENSION 100ML 63.80 2524211684 J3490 AVEENO OILATED BATH 8OZ 40.05 2574211685 J3490 TEGRETOL 100MG/5ML DOSE 2.26 2524211686 J3490 HALOG OINTMENT 0.1% 30GM 55.48 2524211687 J3490 POTASSIUM CHLORIDE INJECT 2.71 2514211688 J3490 POTASSIUM PO4 INJ DOSE 3.74 2514211689 A4217 NORMAL SALINE IRRIG 4000ML 25.57 2504211690 J3490 SORBITOL UROGEN 3.3% 2000ML 24.69 2504211701 J3490 SORBITOL UROGEN 3.3% 4000ML 49.54 2504211702 J3490 AMINOACETIC 1.5%IRR 2000ML 12.00 2504211703 J3490 MVI CONCENTRATE DOSE 3.30 2504211705 J3490 AMINOACETIC 1.5%IRR 4000ML 24.03 2504211707 J3490 NEOSPORIN OINTMENT 30GM 13.69 2514211708 J3490 FERROUS SO4 ELIX 5ML DOSE 1.07 2574211711 J3490 OIL OF WINTERGREEN 30ML 1.44 250
97
4211712 J2690 PROCAINAMIDE 500MG INJECT 23.76 2514211713 J3490 XANAX 0.5MG TABLET 1.26 2524211714 J3490 MAGNESIUM S04 15GM POWDER 4.69 2514211715 J2690 PROCAINAMIDE 1000MG INJECT 39.36 2514211716 J3490 APLISOL 5TU/0.1ML INJECT 0.76 2524211717 J3490 SILVADENE CREAM 1% 30GM 5.64 2524211718 J3490 ACTIVATED CHARCOAL 25GM 120ML 5.68 2514211719 J3490 SODIUM CHLORIDE 30MG INJ 5.70 2514211720 J3490 HEPARIN INJECTION 19.23 2514211721 J3490 PAVULON 1MG/ML 10ML VIAL 44.82 2524211723 J3490 MONISTAT-DERM CREAM 15GM 69.55 2524211724 J3490 LIDEX 0.05% 60GM OINTMENT 80.08 2524211725 J3490 NITROGLYCERIN MICRODRIP SE 25.27 2514211726 J3490 DEXTROSE 10% NS 1000ML 11.27 2584211727 J3490 DURICEF SUSP 125MG/5ML DOSE 2.13 2524211728 J3490 DURICEF SUSP 250MG/5ML DOSE 4.83 2524211729 J3490 NIACIN 50MG TABLET 0.18 2514211730 J3490 QUESTRAN POWDER 180MG 4.21 2524211731 J3490 NAFCILLIN 500MG INJECTION 14.11 2524211732 J3490 NAFCILLIN 1GM INJECTION 27.92 2524211734 J3490 GANTRISIN 500MG TABLET 0.43 2524211735 J3490 MICODERM CRM 90GM 30.19 2524211736 J3490 STOXIL OPHTH DRP 0.1% 15ML 41.50 2524211737 J3490 HIBICLENS CLEANSER 30ML 1.80 2504211738 J3490 TRACE ELEMENTS ADDITIVE 1ML 12.59 2504211739 J3490 SOLU-CORTEF INJ DOSE 4.95 2524211740 J3490 ACETAMINOPHEN 80MG CHEW TA 0.25 2574211742 J3490 KAYEXALATE POWDER 50GM 29.07 2524211744 J3490 ZANTAC 150MG TABLET 3.69 2524211747 J3490 BACITRACIN 15GM OINTMENT 4.49 2524211748 J3490 HIBICLENS CLEANSER 1GAL 105.83 2504211750 J3490 FREAMINE HYPERAL 8.5% 500M 39.62 2504211751 J3490 ERYC 250MG CAPSULE 0.80 2524211754 J3490 ARISTOCORT 40MG/ML 5ML VL 73.77 2524211756 J3490 PRIMATENE MIST W/APPLICATO 26.68 2524211757 J3490 AMOXICILLIN 250MG/5ML 150ML 33.64 2514211758 J3490 EMETROL SOLUTION 30ML 3.57 2574211759 J3490 NORMAL SALINE 0.9% 30ML 3.00 2504211760 A4217 WATER IRRIGATION 4000ML 25.45 2504211764 J3490 DEXTROSE 10% NACL .45 500M 7.68 2584211766 J3490 NATURACIL CHEWABLE EACH 0.62 250
98
4211768 J3490 HEPTAVAX-B 20MCG/ML 0.5ML 82.09 2524211770 J0702 CELESTONE 6MG/ML 1ML INJ 8.09 2524211773 J3490 MAGNESIUM S04 50% SOL 30ML 4.21 2514211774 J3490 ACETIC ACID 0.5% SOLN 1000ML 5.10 2504211776 J3490 HEPATITIS B IMM GLOB 0.5ML 88.81 2514211777 J3490 CAPOTEN 50MG TABLET 2.14 2524211781 J1810 INAPSINE 2.5MG/ML 2ML AMP 9.75 2524211785 J3490 ACHROMYCIN OPHTH OINT 13.19 2524211793 J3490 PEPTO BISMOL LIQUID 4OZ 1.11 2574211795 J3490 THYMOL/HYDROCORTISONE 30GM 4.39 2514211796 J3490 SODIUM THIOSULFATE 25% 50ML VL 3.30 2514211799 J3490 ISOPTO HYOSCINE 0.25% 5ML 13.70 2524211800 J3490 PYRAZINAMIDE 500MG TABLET 1.11 2514211802 J3490 GYNE-LOTRIMIN VAG TABS 7'S 19.74 2524211806 J3490 SODIUM CHLORIDE 2% 250ML 12.62 2584211807 J3490 BACITRACIN OPHTH SOLN 21.92 2524211808 J3490 BACITRACIN 50000U VIAL 19.74 2524211809 J3490 ACETONE 30ML 1.11 2574211810 J3490 CYLERT 18.75MG TABLET 1.11 2524211812 J1320 AMITRIPTYLINE 10MG/ML 10ML 10.11 2514211813 J3490 AMINOPHYLLINE 200MG TABLET 1.11 2514211814 J3490 LIMBRITOL 10-25 TABLET 1.11 2524211815 J3490 PROCAINAMIDE 375MG CAPSULE 1.11 2514211817 J3490 CARMOL 20 CREAM 90GM 7.89 2504211818 J3490 TUCKS 100 PADS 10.29 2504211819 J3490 MOTRIN 600MG TABLET 1.11 2524211820 A4217 WATER IRRIGATION 1000ML 10.97 2504211821 J3490 ELIXOPHYLLIN 80MG/15ML UD 1.11 2524211822 J3490 SODIUM ACET2MEQ/ML 20ML INJ 5.51 2514211823 J3490 PROCARDIA 10MG CAPSULE 1.11 2524211824 J3490 KAYEXALATE POWDER 15GM 3.94 2524211826 J3490 VELOSEF SUSP 250MG/5ML 100ML 32.26 2524211827 J1265 DOPAMINE 200MG 15.50 2514211831 J1265 DOPAMINE 400MG/5ML VIAL 29.19 2514211832 J3490 PREPARATION H OINT 30GM 7.13 2524211833 J3490 ROBITUSSIN CF SYRUP 5ML 1.11 2524211834 J3490 HYPERLYTE 25ML INJ 7.80 2524211838 J3490 NEUTRA-PHOS-K CAPSULE 1.11 2524211839 J3490 ILOTYCIN 3.5GM OPHTH OINT 7.13 2524211842 J3490 PREGNYL 10000U VIAL 80.97 2524211843 J3490 CYCLOGYL 0.5% OPHT DROP 15ML 24.15 252
99
4211844 J3490 MECLOMEN 100MG CAPSULE UD 1.11 2524211845 J3490 VITAMIN C 500MG TABLET 1.11 2574211846 J3490 INTRALIPID 10% 100ML 58.96 2504211849 J3490 FILIBON F.A. TABLET 1.11 2574211854 J3490 VISTARIL 100MG/2ML INJECT 10.97 2524211855 S0139 LONITEN 10MG TABLET 1.11 2524211857 J3490 TESTOSTERONE 200MG VIAL 16.34 2514211858 J3490 MITHRACIN 2.5MG VIAL 87.79 2524211859 J3490 METHYLENE BLUE 1% 10ML INJ 5.51 2504211860 J3490 CEFADYL 2GM INJECTION 24.90 2524211861 J3490 TOLECTIN 200MG TABLET 1.11 2524211862 J3490 ISORDIL 20MG 1.11 2524211863 J3490 INSULIN-REG PORK U100 10ML 5.51 2514211864 J3490 LOTRIMIN SOLN 1% 10ML 12.51 2524211868 A4649 VIAFLEX-EMPTY CONTAINER 250ML 4.91 2724211869 J3490 YUTOPAR 10MG TABLET 2.00 2524211872 J3490 NORMAL SALINE 0.9% 50ML 5.51 2584211873 J3490 YUTOPAR 50MG AMP 53.55 2524211875 J3490 CARMOL HC CREAM 1OZ 16.03 2504211877 J3490 TIMOPTIC OPHTH SOLN 5ML 27.98 2524211878 J3490 DEXTROSE 5% WATER 50ML 5.51 2584211880 J9000 ADRIAMYCIN 10MG VIAL 76.48 2524211881 J3490 VELOSEF 125/5ML 100ML 17.21 2524211883 J3490 MYLANTA SUSPENSION 360ML 13.19 2574211885 J3490 KAYEXALATE SUSP 60ML 11.53 2524211887 J3490 PRIMAQUINE 26.3MG TABLET 1.11 2524211888 J3490 NOLVADEX 10MG TABLET 3.16 2524211892 J3490 TEGOPEN 500MG CAPSULE 3.08 2524211893 J3490 KERALYT GEL 1OZ 15.03 2524211899 J3490 ASCENDIN 50MG TABLET UD 1.11 2524211901 J3490 SYNTHROID 0.025MG TABLET 1.11 2524211902 J3490 SULFADIAZINE 500MG TABLET 1.11 2524211903 J3490 DARAPRIM 25MG TABLET 1.11 2524211904 J3490 ZINC TRACE ELEMENT 1MG/ML 10ML 5.51 2504211905 J3490 CLEOCIN SUSP 75MG/5ML 100ML BT 35.13 2524211906 J3490 FLEXERIL 10MG TABLET 1.11 2524211907 J3490 MANGANESE TRACE ELEM ADDIT 5.51 2504211908 J3490 COPPER TRACE METAL 10ML VIAL 5.51 2514211909 J3490 PIPRACIL 4GM 43.46 2524211910 J3490 ERYTHROMYCIN 500MG TABLET 1.11 2514211912 J3490 CHOLEDYL PEDS SYR 5ML 1.11 252
100
4211913 J3490 LIDOCAINE 2GM IV 13.51 2514211914 J3490 LITHIUM SYR 300MG/5ML 1.11 2514211915 J3490 ATENOLOL 50MG TABLET 1.11 2514211916 J3490 CHOLEDYL SYRUP 5ML 1.11 2524211917 J3490 SEPTRA IV INFUSION 5ML AMP 21.25 2524211918 J3490 PIPRACIL 3GM 34.24 2524211919 J3490 PROLIXIN ELIXIR 5ML DOSE 1.11 2524211921 J3490 CATAPRES 0.1MG TABLET 1.11 2524211922 J3490 REGLAN 10MG TABLET 1.11 2524211923 J3490 STELAZINE 10MG/ML 60ML 45.35 2524211925 J3490 OPHTHALGAN EYE SOLN 11.40 2524211926 J3490 LONITEN 2.5MG TABLET 1.11 2524211927 J3490 HYDROCORTISONE 1% SOLN 60M 1.11 2514211929 J3490 ACTIVATED CHARCOAL 30GM 1.11 2504211930 J3490 SODIUM CHLORIDE 3% 200ML 10.97 2584211931 J3490 TITRALAC LIQUID 15ML 1.11 2574211932 J3490 VALISONE CREAM 45GM 28.42 2524211933 J3490 CIMETIDINE 200MG TABLET 1.11 2514211934 S0023 CIMETIDINE LIQ 300MG/5ML DOSE 1.63 2514211936 J3490 PARLODEL 2.5MG TABLET 1.86 2524211937 J3490 FERRO SEQUELS CAPSULE UD 1.11 2574211938 J3490 THIAMINE 10MG TABLET 1.11 2514211939 J3490 BORIC ACID 1% SOLN 30ML 5.51 2514211944 J3490 ATIVAN 1MG TABLET 1.11 2524211945 J3490 DEXTROSE 5% NACL .33% 1000ML 19.74 2584211946 J3490 ZINC SULFATE 50MG/5ML DOSE 1.11 2514211947 J1840 KANTREX 500MG IM 27.98 2524211948 J2270 MORPHINE 4MG INJECTION 5.51 2514211949 J3490 ALDACTAZIDE SOLUTION 1.11 2524211950 J3490 OSELTAMIVIR LIQ 2.5ML DOSE 16.73 2514211951 J3490 SUSTAIRE 100MG SR TABLET 1.11 2524211953 J3490 GARAMYCIN 20MG/2ML INJECT 8.89 2524211954 J3490 LIDOCAINE 1GM INFUSION 8.57 2514211956 J3490 CENTRUM TABLET 1.11 2574211958 J3490 NUTRACORT LOTION 1% 120ML 25.56 2524211959 J3490 DIGOXIN 0.375MG TAB 1.11 2514211960 J3490 TERBUTALINE 2.5MG TABLET 1.11 2514211961 J3490 DIBENZYLINE 10MG CAPSULE 1.11 2524211965 J3490 ISORDIL 5MG TABLET 1.11 2524211966 J3490 INSULIN-LENTE PORK 10ML 48.29 2514211967 J3490 DEPAKENE SYRUP 250MG/5ML UD 1.11 252
101
4211970 J3490 STOXIL OPHTH OINT 17.99 2524211971 J3490 INSULIN-REGULAR U100 10ML 5.51 2514211973 J3490 CYTARABINE 500MG VIAL 69.25 2514211979 J3490 KAYEXALATE W/SORBITOL 200M 17.56 2524211982 J3490 PHENAPHEN 650 W/COD CAP 1.11 2524211985 J3490 SSKI 30ML 2.00 2504211986 J3490 VERMOX 100MG CHEW TABLET 4.28 2524211987 J3490 LASIX 80MG 1.11 2524211988 J7060 DEXTROSE 5% WATER 100ML 8.78 2584211989 J3490 DECADRON 4MG TABLET 1.86 2524211990 J3490 FENTANYL 50MCG PATCH 46.29 2514211991 J3490 STRESSTAB 600 W/ IRON 1.11 2574211992 J3490 FENTANYL 25MCG PATCH 32.68 2514211993 J3490 PLAQUENIL 200MG TABLET 1.11 2524211996 J3490 LACTULOSE SYRUP 15ML 2.50 2514211997 J3490 AQUAPHOR 1OZ 4.92 2504211998 B4103 PEDIALYTE LIQUID 1L BT 5.92 2504211999 J3490 DOMEBORO POWDER PACKET 1.11 2524212000 J3490 BICILLIN CR 6000000 UNIT 6.80 2524212002 J3490 POLY-VI-FLOR CHEW TABLET 1.11 2574212006 J3490 DEXTROSE 10% WATER 250ML 12.62 2584212007 J3490 TERBUTALINE 5MG TABLET 1.11 2514212010 J3490 NORMAL SALINE 0.45% 1000ML 19.74 2584212011 J3490 EPSOM SALT 1OZ 1.11 2524212012 J3490 AVC VAGINAL CREAM 4OZ 18.09 2524212013 J3490 APRESOLINE SUSP 25MG/5 DOS 1.11 2524212015 J3490 ISORDIL SL 2.5MG 1.11 2524212016 J3490 MEDIHALER ISO W/ ADPT 15ML 21.40 2524212017 J3490 LUGOL'S SOLUTION 30ML 1.11 2504212018 J3490 STRESSTAB W/ ZINC 1.11 2574212019 J3490 DEBRISAN 4GM/PKT 8.57 2524212022 J3490 SOMOPHYLLINE SOLUTION 15ML 1.11 2524212024 J3490 SUSTAIRE 300MG SR TABLET 1.11 2514212025 J3490 STADOL 2MG INJECTION 5.51 2524212026 J3490 GENTIAN VIOLET 2% 30ML 2.87 2504212027 J3490 SORBITOL 70% 50GM 1.11 2524212028 J3490 RONDEC DROPS 30ML 17.56 2524212029 J3490 MYLICON 40MG TABLET 1.11 2574212030 J3490 MELLARIL 10MG TABLET 1.11 2524212031 J3490 MYI MULTI-VITAMIN INJ 5.51 2574212033 J3490 DITROPAN 5MG TABLET 1.11 252
102
4212036 J3490 METAPREL INHALAT 5% 10ML 13.84 2514212041 J3490 VITAMIN E CREAM 120GM 8.57 2514212043 J3490 NORMAL SALINE/H2O2 1:1 8OZ 8.22 2504212044 J3490 BRONKOMETER AEROSOL 10ML 12.51 2524212045 J3490 FML OPHTH SOLN 10ML 21.25 2524212046 J3490 VINEGAR DOUCHE 16OZ 4.92 2504212047 J3490 THYROID 1/2GR TABLET 1.11 2514212049 J3490 TOPICORT CREAM 0.25% 15GM 12.29 2524212051 J3490 DIPROSONE 0.05% 45GM OINT 28.63 2524212052 J3490 TOFRANIL 12.5MG/ML 2ML AMP 5.51 2524212055 J3490 NORPACE 150MG CAPSULE 1.11 2524212056 J3490 NITRO-BID 2.5MG CAPSULE 1.11 2524212057 J3490 SUS-PHRINE 5ML VIAL 39.17 2524212058 J3490 KENALOG/PETROLATUM 15% 30G 17.56 2524212059 J3490 NITRO-BID 6.5MG CAPSULE 1.11 2524212060 J3490 NITROGLYCERIN OINT 2% 60GM 16.45 2514212310 J3490 NORMAL SALINE 0.9% 150ML 7.91 2584212471 J2543 PIPERACILLIN/ZOSYN 3.375GM VL 60.93 2514212473 J3490 PIPERACILLIN/TAZO 36GM-4.5GM 461.38 2514212530 J3490 MVI-12 2X50ML COMBO PKG INJ 131.23 2524212563 J3490 SOLU-MEDROL 500MG VIAL 40.32 2524212600 J3490 ACTHIB VACCINE 10MCG 0.5ML INJ 95.13 2524212612 J3490 DINOPROSTONE VG INSERT 5MG/12M 84.75 2514212621 J3490 DINOPROSTONE SUPP 20MG 338.92 2514212655 J0572 NALOXONE 2MG/2ML SYRINGE INJ 66.89 2514212850 J3490 SIMVASTATIN 10MG TAB UD 10.01 2514212851 J3490 SIMVASTATIN 20MG TAB UD 10.95 2514212852 J3490 SIMVASTATIN 40MG TAB UD 16.49 2514212853 J3490 SIMVASTATIN 80MG TAB UD 23.42 2514212855 J3490 LOSARTAN 25MG TAB 7.21 2514212856 J3490 LOSARTAN 50MG TAB 9.25 2514212857 J3490 LOSARTAN 100MG TAB 12.57 2514212860 J3490 MIDODRINE 5MG TAB 7.27 2514212865 S0138 FINASTERIDE 5MG TAB 7.68 2514212870 J3490 ATORVASTATIN 10MG TAB 14.13 2514212871 J3490 ATORVASTATIN 20MG TAB 19.80 2514212872 J3490 ATORVASTATIN 40MG TAB 21.17 2514212873 J3490 ATORVASTATIN 80MG TAB 24.83 2514212875 J3490 PROPAFENONE 150MG TABLET 19.23 2514212880 J3490 ACYCLOVIR 800MG CAPSULE 2.10 2514212885 J3490 BUMETANIDE 1MG/4ML VIAL 9.78 251
103
4212895 J3490 BERINERT 500IU SDV 7681.09 2524212901 J3490 ETOMIDATE 2MG/ML 20ML SDV 83.56 2514212902 J3490 ETOMIDATE 20MG/10ML AMP 31.37 2514212911 J3490 HYDROCORTISONE 5MG TABLET 3.64 2514213002 J3490 ACETAMINOPHEN 1000MG/100ML INJ 48.32 2514213006 J3364 UROKINASE 5000 IU VIAL 179.96 2514213008 J3490 METHOTREXATE 250MG VIAL 29.34 2514213026 J3490 INDOCIN 1MG VIAL 911.57 2524213046 J3490 MAGNESIUM SO4 10GM/20ML VIAL 4.32 2514213053 J2270 MORPHINE ORAL SOLN 10MG/5ML 50 95.34 2514213067 J3490 MVI PEDIATRIC 5ML INJECTION 16.33 2514213077 J3490 MISOPROSTOL 200MCG TAB UD 6.55 2514213080 J3490 SALMETEROL 21MCG/INH 13GM 119.67 2514213085 J3490 MISOPROSTOL 100MCG TAB UD 2.36 2514213092 J3490 FLUTICASONE 220MCG 12GM INHAL 240.78 2514213099 J3490 ETOPOSIDE 500MG/25ML INJ 138.88 2514213106 J3490 MULTITRACE-4 CONCENTRATED 10ML 45.30 2524213126 J3490 AMIODARONE 50MG/ML 3ML VIAL 166.87 2514213139 J3490 LIDOCAINE 1% 10ML MDV 4.41 2514213140 J3490 LIDOCAINE 2% 10ML MDV 4.32 2514213156 J3490 FERROUS SO4 ELIX 300MG/5ML UD 1.11 2514213171 J3490 CLOPIDOGREL 75MG TAB UD 7.56 2514213175 J3490 ANTI HEMO FACTOR 8 2000 3723.54 2514213185 J1162 DIGIBIND 40MG INJECTION 652.59 2524213200 J3490 GABAPENTIN 100MG CAPSULE 1.11 2514213209 J3490 HEMABATE 250MCG/1ML INJ 40.12 2524213210 J3490 LAMIVUDINE 150MG CAP UD 10.11 2514213211 J3490 INDINAVIR 400MG CAP UD 6.37 2514213214 J3490 ZIDOVUDINE 50MG/5ML SYRUP UD 2.94 2514213220 J1450 FLUCONAZOLE 200MG/100ML INJ 147.54 2514213221 J3490 FLUCONAZOLE 400MG/200ML INJ 215.63 2514213230 J3490 ENALAPRIL TAB 2.5MG UD 6.08 2514213235 J3490 ZIDOVUDINE 200MG/20ML VIAL 63.45 2514213242 J3490 METOLAZONE 5MG TABLET 2.49 2514213253 J3490 MESNA 100MG/ML 10ML VIAL 407.24 2514213260 J9208 IFOSFAMIDE 1GM VIAL 213.30 2514213270 J3490 HYDROCORTISONE 0.5% OINT 30GM 5.91 2514213276 J3490 POVIDONE 10% TOP SOLN 120ML 5.01 2514213277 J3490 POVIDONE 10% TOP SOLN 480ML 8.45 2514213279 J3490 ADENOSINE 3MG/ML 20ML SDV 404.32 2514213281 J3490 ADENOSINE 3MG/ML 30ML SDV 467.13 251
104
4213283 J9201 GEMCITABINE 200MG INJ 220.73 2514213284 J3490 GEMCITABINE 1GM INJ 567.40 2514213296 J3490 CARBOPLATIN 150MG INJECTION 653.40 2514213299 J2704 PROPOFOL 10MG/ML 50ML VIAL 83.50 2514213300 J9185 FLUDARABINE 50MG VIAL 633.29 2514213301 J2704 PROPOFOL 10MG/ML 100ML VIAL 72.04 2514213302 J3490 BREVIBLOC 10MG/ML 250ML 302.11 2514213313 J3490 GATIFLOXACIN 200MG TAB 17.69 2514213314 J3490 GATIFLOXACIN 400MG TAB 15.09 2514213316 J1590 GATIFLOXACIN 400MG INJ 53.27 2514213317 J3490 CARVEDILOL 6.25MG TAB 3.59 2514213318 J3490 CARVEDILOL 12.5MG TAB 3.59 2514213319 J3490 CARVEDILOL 25MG TABLET 4.25 2514213329 J3490 DIMETHYL SULFOXIDE 50% 50ML VL 122.10 2514213460 J3490 BOTULINUM TOXIN TYPE A 100U VI 902.10 2514213490 Q2009 FOSPHENYTOIN 50MG/ML 2ML VIAL 56.92 2514213491 Q2009 FOSPHENYTOIN 50MG/ML 10ML VIAL 170.75 2514213495 J7644 IPRATROPIUM BR 0.02% INHAL SOL 4.03 2514213496 J7620 DUONEB 0.5MG/0.3MG 3ML INHAL 1.03 2524213498 J3490 SANDOSTATIN 500MCG/ML 1ML AMP 176.79 2524213499 J3490 SANDOSTATIN 100MCG/ML 1ML AMP 36.91 2524213500 J3490 GABAPENTIN SOL 250MG/5ML DOSE 1.11 2514213501 J3490 LIDOCAINE MPF 1% 5ML AMP 12.10 2514213506 J3490 SANDOSTATIN 50MCG/ML INJ 25.48 2524213511 J3490 ONDANSETRON 2MG/ML 20ML VIAL 31.97 2514213517 J3490 DINOPROSTONE 10MG INSERT 490.11 2514213527 J3490 BICILLIN CR 2.4MUN INJ 60.12 2524213528 J3490 FILGASTIM 480MCG/1.6ML VIAL 604.07 2524213537 J3490 MONSEL'S SOLUTION 60ML 206.25 2524213565 J3490 NEVIRAPINE 200MG TABLET 16.88 2514213566 J3490 NEVIRAPINE 50MG/5ML 240ML SUSP 219.48 2514213594 J3490 IBUPROPEN 100MG/5ML SUSP 120ML 13.59 2514213609 J3490 CALCIUM ACETATE 667MG TAB UD 1.11 2514213645 J3490 MORPHINE 15MG/ML 20ML VIAL 27.29 2524213651 J3490 LABETALOL 5MG/ML 20ML INJ 4.69 2514213652 J3490 EPOGEN 10000U/ML VIAL 466.48 6354213659 J3490 PEDIAZOLE SUSP 5 ML DOSE 1.11 2524213660 A4649 AEROCHAMBER W/ MASK-MEDIUM 196.27 2724213662 J3490 AMOXIL/CLAVULINATE 400MG/5ML-5 170.36 2514213663 J3490 AUGMENTIN 250MG/5ML 150ML BT 112.59 2524213674 J0692 CEFEPIME 1GM VIAL 44.88 251
105
4213675 J2430 PAMIDRONATE DISODIUM 30 MG INJ 417.99 2514213676 J3490 PAMIDRONATE DISODIUM 60 MG INJ 696.76 2514213678 J3490 CEFEPIME 2GM VIAL 89.01 2514213680 J3490 AZITHROMYCIN 100MG/5ML 15ML OS 63.53 2514213681 J3490 AZITHROMYCIN 200MG/5ML 15ML OS 63.58 2514213682 J3490 SOTALOL 120MG TABLET 6.53 2514213700 A4217 NORMAL SALINE IRRIG 3000ML 27.76 2504213701 J3490 PREDNISOLONE 15MG/5ML 240ML 24.10 2514213705 J0456 AZITHROMYCIN 500MG VIAL 48.51 2514213707 J3490 NIMODIPINE 30MG CAP UD 12.94 2514213709 J3490 DEX/LIDO SPINAL 7.5%-5% 2ML AM 5.92 2514213713 J3490 NICOTINE PATCH 7MG/24HR 4.33 2504213718 J3490 PACLITAXEL 100MG INJ 656.62 2514213721 J3490 BUPIVACAINE 0.5% 10ML INJ 5.39 2514213722 J3490 EPOGEN INJ 20000 UNIT/ML 1MG 563.46 2514213725 J1650 LOVENOX 30MG/0.3ML INJ 90.78 2524213730 J1650 ENOXAPARIN 40MG/0.4ML INJ 52.75 2514213732 J2780 RANITIDINE 25MG/ML 2ML INJ 16.61 2514213739 J3490 LORAZEPAM 1MG/0.5ML OS UD 1.11 2514213741 J3490 INFLUENZA VACCINE NASAL SPRAY 83.42 2514213744 J3490 MAGNESIUM OXIDE 400MG TAB UD 1.11 2514213746 J3490 MIDAZOLAM 50MG/10ML INJ 37.63 2514213748 J3490 TROPHAMINE 10% 500ML 131.46 2524213749 J3490 MIDAZOLAM 10MG/5ML ORAL SYRUP 46.76 2514213758 J3490 SODIUM BICARB 50MEQ/50ML VIAL 1.67 2514213762 J3490 BICITRA ORAL SOLN 30ML UD 1.81 2524213765 J0636 CALCITRIOL 1 MCG/ML AMP 42.59 2514213768 J3490 ALTEPLASE 100 MG VIAL 2507.38 2514213775 J3490 SILVADENE CREAM 1% 50GM 4.15 2524213777 J1650 LOVENOX 60MG/0.6ML INJ 72.74 2524213778 J3490 LOVENOX 100MG/1ML INJ 121.25 2524213780 J1650 ENOXAPARIN 120MG/0.8ML SRN 30.62 2514213781 J1650 ENOXAPARIN 150MG/1ML SRN 35.11 2514213790 J3490 TRANEXAMIC ACID 1000ML/10ML IN 129.36 2514213800 J3490 ROCURONIUM 10MG/ML 5ML VIAL 71.89 2514213900 S0164 PANTOPRAZOLE 40MG VIAL 101.88 2514214000 J3490 PANTOPRAZOLE 40MG TAB 2.86 2514214008 J3490 LIQUID PER DOSAGE 1.11 2504214010 J3490 LOTION OINTMENT CREAM 3.30 2504214018 J3490 SNS FOR IRRIG 500CC 10.97 2504214019 J3490 NACL FOR IRRIG 1500CC 23.05 250
106
4214020 J3490 SW FOR IRRIG 1500CC 19.74 2504214022 J3490 SW FOR IRRIG 3000CC 26.32 2504214040 J3490 NACL FOR IPPB 3.30 2504214041 J3490 BRONKOSOL FOR IPPB 14.83 2524214042 J3490 ISUPREL FOR IPPB 6.58 2524214044 J3490 MUCOMYST FOR IPPB 6.58 2504214046 J3490 MICRONEPHRIN FOR IPPB 6.58 2524214250 J3490 VITAMIN E DROPS 15IU/0.3ML 12M 78.30 2514214300 J3490 VALSARTAN 40MG TAB 5.38 2514214400 J3490 VALSARTAN 80MG TAB 6.43 2514214500 J3490 VALSARTAN 160MG TAB 6.93 2514214600 J3490 SEVELAMER 400MG TAB 2.64 2514214700 J3490 SEVELAMER 800MG TAB 5.26 2514214800 J3490 ROCURONIUM 10MG/ML 10ML VIAL 56.00 2524214900 J3490 ATENOLOL 25MG TABLET 1.11 2514215400 J3490 DOXAZOSIN 1MG TAB 1.11 2514215500 J3490 DOXAZOSIN 2MG TAB 1.11 2514215600 J3490 DOXAZOSIN 4MG TAB 1.11 2514215668 J1815 INSULIN NPH-PER ML 5.59 2514215700 J3490 DOXAZOSIN 8MG TAB 1.11 2514215773 J1730 DIAZOXIDE 300MG/20ML INJ 165.17 2514215800 J3490 DILTIAZEM CD 120MG CAP 1.74 2514215900 J3490 DILTIAZEM CD 180MG CAP 2.07 2514215920 J3490 PHISOHEX 150ML 13.22 2504216100 J3490 DTAP 0.5ML INJ SDV 98.70 2514216177 J3490 CLINDAMYCIN P04 900MG/6ML ADDV 18.90 2514216400 J3490 CYCLOMYDRIL OPHT DRP 2ML 46.75 2524216500 J3490 CYCLOMYDRIL OPHT DRP 5ML 10.80 2524216600 J3490 CEFUROXIME 1.5GM VIAL 49.33 2514216700 J3490 CEFUROXIME PREMIX 1.5GM INJ 51.54 2514216800 J3490 CEFUROXIME PREMIX 750MG INJ 49.43 2514216900 J0697 CEFUROXIME 750MG VIAL 18.22 2514217000 J3490 LOPERAMIDE 2MG CAP 1.11 2514217100 J3490 LOPERAMIDE LIQ 1MG/5ML DOSE 1.11 2514217154 J0690 CEFAZOLIN 2GM/50ML PMX 41.35 2514217157 J3490 CEFAZOLIN 10GM VIAL 41.62 2514217200 J3490 POLIO VACCINE 0.5ML DOSE INJ 92.78 2514217240 J3490 COAL TAR 2.5% BATH LOTION 240M 83.19 2514217295 J3490 METFORMIN HCL 500MG TAB UD 1.23 2514217296 J3490 METFORMIN HCL 850MG TAB UD 2.05 2514217590 J3490 BENADRYL ELIX 12.5MG/5ML 120ML 3.43 252
107
4217605 J3490 RHO-D IMMUNE GLOBULIN 2500U VI 1113.61 3874217606 J3490 WINRHO SDF 5000IU 4.4ML INJ 1901.77 2524217800 J1580 GENTAMICIN PREMIX 100MG INJ 5.73 2514217900 J3490 CLINDAMYCIN PREMIX 600MG INJ 41.72 2514218000 J3490 CLINDAMYCIN PREMIX 900MG INJ 51.06 2514218100 J0690 CEFAZOLIN PREMIX 1GM INJ 9.52 2524218820 J3490 IMMUNEGLOBULIN 10% 1GM/10ML 104.55 3874218821 J3490 IMMUNEGLOBULIN 10% 6GM PWR INJ 727.11 3874218822 J1575 IMMUNEGLOBULIN 10% 10MG/100ML 1184.96 3874218824 J3490 IMMUNEGLOBULIN 10% 2.5GM/25ML 513.39 3874218825 J3490 IMMUNEGLOBULIN 10% 5GM/50ML 731.38 3874219000 J3490 CEFOTAXIME PREMIX 1GM INJ 24.09 2514219100 J3490 CEFOTAXIME PREMIX 2GM INJ 44.23 2514219200 J3490 FAT EMULSION 10% 200ML 20.20 2514219400 J3490 FLOVENT 110MCG 13GM INHAL 322.93 2524219435 J3490 ATROPINE 0.05MG/ML 5ML SYRINGE 26.69 2514219500 J3490 NITROGLYCERIN 2% 1GM OINT 2.76 2514219600 J3490 ERLOTINIB 25MG TAB 86.45 2514219700 J3490 ERLOTINIB 100MG TAB 231.02 2514220004 J8499 BARIUM EZ HD 750 96% W-W 17.26 2554220006 J3490 BARIUM SULFATE SUSP 250ML 14.60 2554220008 J8499 BARIUM EZ HD 764 98% W-W 27.39 2554220061 J3490 ERBITUX 2MG/ML 50ML VIAL 1043.03 2524220091 Q9966 ISOVUE 300 100ML 30.38 2554220102 Q9966 ISOVUE 370-76% 100ML BTL 32.43 2554220110 J3490 GADOTERIDOL 279.3MG/ML 10ML VI 81.13 2514220131 J3490 HEPATITIS B VAC 5MCG/0.5ML PED 0.00 2514220132 G.I. COCKTAIL ORAL SOLN 0.00 2504220133 J3490 MAGIC MOUTHWASH SOLN 0.00 2504220134 WOUND CARE STAGE I 0.00 2504220135 WOUND CARE STAGE II 0.00 2504220136 WOUND CARE STAGE III 0.00 2504220137 J3490 WOUND CARE STAGE IV 0.00 2504220151 DISPENSING FEE-DOC 4.63 2294220152 J3490 DAPTOMYCIN 500MG INJ 629.57 2524220161 A4649 MICRON 15 IN-LINE FILTER SET 10.31 2724221100 J3490 FLUOCINONIDE 0.05% 30GM OINT 37.67 2514221600 S0182 PROCARBAZINE 50MG CAPSULE 156.27 2514221800 J3490 CYSTEINE HCL 50MG/ML 10ML INJ 9.04 2514221851 J3490 TRIAMCINOLONE 0.1% 15GM CREAM 2.11 2514221852 J3490 TRIAMCINOLONE 0.1% 454GM CREAM 76.59 251
108
4221855 J3490 TRIAMCINOLONE 0.5% 15GM CREAM 5.81 2514222116 J3535 ALBUTEROL 17GM INHALER 48.94 2514222117 J3490 ALBUTEROL 6.7GM REFILL INHAL 110.55 2514222373 J3490 RANITIDINE 15MG/ML SYRUP 480ML 496.79 2514222400 J3490 ZOLEDRONIC ACID 4MG/5ML INJ 1494.30 2514222562 J3490 NEVIRAPINE 200 MG TAB UD 11.58 2514222702 J3490 THROMBIN 5000U VIAL 32.81 2514222703 J3490 THROMBIN 10000U/ML INJ 40.12 2514222704 J3490 THROMBIN 20MU VIAL 476.30 2514222715 J3490 HEPATITIS A VACCINE 1440U 273.79 2514222922 J3490 COCAINE 10% TOP SOLN 4ML 44.42 2514223000 J3490 FLUOXETINE SOLN 20MG/5ML UD 13.49 2514223200 J3490 LISINOPRIL 40MG TAB 1.11 2514223300 J3490 PERMETHRIN CREAM 5% 2OZ 53.45 2514223500 J9217 LEUPROLIDE 7.5MG INJ 1079.88 2514223600 J3490 LEUPROLIDE 22.5MG INJ 2812.72 2514223700 J3490 BEVACIZUMAB 25MG/ML 16ML INJ 2929.53 2514223800 J3490 BEVACIZUMAB 25MG/ML 4ML INJ 923.83 2514223900 J3490 GOSERELIN 10.8MG SQ INJ 736.87 2514224000 J3490 GOSERELIN 3.6MG SQ INJ 415.79 2514224100 J3490 OXALIPLATIN 100MG INJ 2211.55 2514224200 J3490 OXALIPLATIN 50MG INJ 1233.75 2514224300 J3490 PEGINTERFERON ALFA0-2B 150MCG 648.30 2514224400 J3490 CYTARABINE 1GM SDV 35.85 2514224700 J3490 VINORELBINE 50MG INJ 593.08 2514224800 J9390 VINORELBINE 10MG INJ 94.07 2514224871 J3490 HYDROCHLOROTHIAZIDE 12.5MG TAB 6.08 2514224900 J1756 IRON SUCROSE 100MG/5ML INJ 128.68 2514224959 J3240 THYROTROPIN ALFA INJ KIT 1190.27 2514225090 J7510 PREDNISOLONE 5MG/5ML 500ML 256.92 2514225200 J3490 DIP-TET VACC PEDS 0.5ML INJ 48.46 2514225500 J3490 THIABENDAZOLE 500MG CHEWTAB 2.98 2514226111 J7504 ATGAM 250MG/5ML AMP 536.39 2514226140 J3490 ISENTRESS 400MG TABLET 52.66 2524226145 J3490 METOPROLOL SUCC ER 25MG TAB 6.25 2514226146 J3490 METOPROLOL SUCC ER 50MG TAB 6.66 2514226147 J3490 METOPROLOL SUCC ER 100MG TAB 7.01 2514226973 J3490 TRUVADA 200MG-300MG TABLET 119.89 2524227131 J3490 TNKASE 50MG INJECTION 3615.08 2524227300 J3490 AUGMENTIN 875MG TAB 4.41 2524227500 J9300 MYLOTARG 5MG VIAL 4371.61 252
109
4227570 J3490 RISPERIDONE 1MG TAB 9.27 2514227607 J3490 ERYTHROMYCIN 1GM OPHTH OINT 2.46 2514228000 J3490 CEFDINIR 300MG CAP 13.93 2514228100 J3490 CEFDINIR 125MG/5ML SUSP 60ML 118.22 2514228200 J3490 TEGRETOL SUSP 200MG/10ML UD 3.59 2524228800 J3490 BACTROBAN 2% 22GM OINTMENT 75.53 2524229000 J3490 CLOBETASOL 0.05% 15GM OINT 6.90 2514230920 J3490 FLUTICASONE 44MCG 13GM INHAL 150.79 2514231118 J3490 LIDOCAINE(LARYNG-O-JET) 4% 5 M 16.05 2514231261 J3490 AMIODARONE 50MG/ML 9ML VIAL 74.64 2514231262 J3490 AMNIODARONE 50MG/ML 18ML VIAL 44.61 2514231700 J3490 POLYVIT W/FLU/IRON 0.25MG/50ML 22.88 2514231722 90371 HEPATITIS B IG HUMAN 5ML VIAL 762.67 2524231831 J2997 ALTEPLASE/CATHFLO 2MG VIAL 149.01 2514232240 J3490 BENZOCAINE TOP SPRAY-PER DOSE 5.79 2524232600 J3490 CORTISPORIN 15GM OINTMENT 70.42 2524232642 J3490 AZTREONAM 1GM/50ML GALAXY INJ 86.18 2514232643 J3490 AZTREONAM 2GM/50ML GALAXY INJ 146.12 2514232661 J3490 CIPROFLOXACIN 0.3% 5ML OPTIC 29.17 2514233000 J3490 DROTRECOGIN ALFA 5MG INJ 521.70 2514233003 B4189 CLINIMIX S/F 4.25%/5% 2L INJ 144.38 2504233004 B4189 CLINIMIX S/F 5%/20% 2L INJ 144.38 2504233030 J3490 MEROPENEM 500MG/50ML PMX 89.99 2514233031 J3490 MEROPENEM 1000MG/50ML PMX 121.67 2514233045 J3490 ARGATROBAN 100MG/2ML 2.5ML 1227.73 2514233065 J2248 MICAFUNGIN 50MG VIAL 146.54 2514233066 J2248 MICAFUNGIN 100MG VIAL 285.09 2514233069 C9132 PROTHROMBIN COMPLEX 500IU VIAL 1273.13 2514233070 C9132 PROTHROMBIN COMPLEX 1000IU VL 2336.25 2514233080 J0572 SUBOXONE 2MG/0.5MG TABLET 8.63 2524233081 J0574 SUBOXONE 8MG/2MG TABLET 11.32 2524233165 J9299 NIVOLUMAB 400MG/10ML VIAL 4201.68 2514233166 J9299 NIVOLUMAB 40MG/4ML VIAL 1806.66 2514233210 J3490 MOXIFLOXACIN 400MG TABLET 49.75 2514233255 J7189 FACTOR VII A 2205.00 2514233265 J2783 RASBURICASE 1.5MG VIAL 1672.22 2514233270 J3490 ZEGERID ORAL SUSP 20MG PACKET 134.63 2574233320 J3490 ITRACONAZOLE 100MG CAPSULE 42.43 2514233380 J3490 CAVILON SKIN CLEANER 8OZ 41.54 2524233392 J3490 CAVILON 3.25OZ CREAM 37.24 2524233410 J8499 TICAGRELOR 90MG TAB UD 13.28 251
110
4233415 J0130 ABCIXIMAB 10MG/5ML VIAL 1658.42 2514233420 J1327 EPTIFIBATIDE 20MG/10ML VIAL 298.37 2514233421 J1327 EPTIFIBATIDE 75MG/100ML VIAL 572.25 2514233422 J1327 EPTIFIBATIDE 200MG/100ML VIAL 1377.13 2514233425 J8499 ENTRESTO 24MG/26MG TAB 20.43 2524233426 J8499 ENTRESTO 49MG/51MG TAB 20.43 2524234859 J3490 LICE KILLING SHAMPOO 4% 60ML 23.76 2504235000 J3490 DEPO-LUPRON 11.25MG INJ 2525.48 2524235161 J3490 CIPRO 200MG/D5W PREMIX 100ML 9.12 2524235211 J3490 POLYVIT W/FLUORIDE 0.25MG/50ML 10.02 2514236065 J3490 POLYETHELENE GLYCOL PWDR 17GM 4.56 2514236070 J3490 PROBIOTICS ADULT 7.79 2504236071 J3490 PROBIOTIC PEDIATRICS 2.16 2504236075 J3490 CYCLOSERINE 250MG CAP 131.03 2514236080 J3490 PASER 4GM GRANULES 32.31 2524236100 J3490 KCL 20MEQ/100ML BAG INJ 5.51 2514236211 J3490 PROSTIN VR 500MCG INJ 640.99 2524236510 J3490 LABETALOL 5MG/ML 40ML INJ 11.36 2514236511 J3490 LABETALOL 5MG/ML 4ML INJ 8.82 2514236867 J3490 METOPROLOL 25MG TAB 1.11 2514237100 J3490 DILAUDID 4MG TAB 3.13 2524237321 J3490 RANITIDINE 50MG/0.45 NS 50ML I 11.95 2514237322 J3490 RANITIDINE 75MG/5ML SYRUP 5ML 6.01 2514237542 J3490 VANCOMYCIN 10GM VIAL 210.23 2514237583 J3490 OXYCODONE 5MG TAB 1.03 2514237650 J3490 PARICALCITOL 5MCG/ML INJ 99.57 2514237720 J3490 CEFOTAN 2GM INJ 118.69 2524239961 J3490 SILDENAFIL 100MG TABLET 36.35 2514239975 J3490 BEDAQUILINE 100MG TAB 431.47 2514240000 J3490 LEVOFLOXACIN 500MG TAB 11.04 2514240300 J3490 ACETAZOLIMIDE 500MG/10ML INJ 53.14 2514241231 J3490 ZIDOVUDINE 50MG/5ML 240ML 131.23 2514242540 J3490 ASPIRIN EC 81MG TABLET 1.11 2514243100 J3490 GABAPENTIN 400MG CAPSULE 3.84 2514243111 J3490 LINEZOLID 600MG/300 ML INJ 212.39 2514243191 J3490 CETIRIZINE(ZYRTEC) 10MG TAB 4.18 2514243600 J3490 POLYCITRA LIQUID 30ML UD 3.21 2524244006 J0572 BUPRENORPHINE 2MG SL TAB 7.63 2514244007 J0574 BUPRENORPHINE 8MG SL TAB 13.18 2514244008 J3490 JEVTANA 60MG/1.5ML INJ 10072.09 2514244059 J3490 GRANULEX SPRAY 4 OZ 70.62 251
111
4244060 J3490 XENADERM 30GM OINT 49.11 2524244061 J3490 COLLAGENASE 250U/GM 15GM OINT 107.25 2514244062 J3490 COLLAGENASE 30GM OINTMENT 181.85 2514244063 J3490 TEMOZOLOMIDE 20MG CAPSULE 96.21 2514244064 J3490 TEMOZOLOMIDE 100MG CAPSULE 483.63 2514244065 J3490 TEMOZOLOMIDE 200MG CAPSULE 709.68 2514244066 J3490 AFFINITOR 10MG TABLET 484.27 2524244067 J3490 HALAVEN 1MG/2ML VIAL 1303.11 2514244111 J3490 LINEZOLID 600MG TAB UD 156.99 2514244500 J1815 INSULIN ASPART U-100 50U DOSE 16.84 2514245604 J3490 SEVOFLURANE-15 MIN 15.90 2524246305 J3490 MELATONIN 5MG TABLET 1.01 2524249000 J1642 HEPARIN LOCK PF 10U/ML VIAL 21.98 2514250110 J3490 NITROFURANTOIN 25MG/5ML DOSE 13.66 2514250474 J3490 KEPPRA SUSP 100MG/ML 5ML UD 1.93 2524251108 90716 VARICELLA VIRUS VACC 0.5CC 137.10 2514251211 J3490 ACETYLCYSTEINE 20% 30ML INJ 30.51 2514253080 J3490 COLCRYS 0.6MG TABLET 16.63 2524253100 J3490 GABAPENTIN SYRUP 473ML 406.47 2514253111 J3490 LIDOCAINE-EPI MPF 1% 30ML AMP 5.00 2514254500 J1815 INSULIN GLARCINE U-100 50U DOS 15.52 2514255557 J3490 BECLOMETHASONE 25GM INHAL 265.17 2514257126 S0040 TIMENTIN 3.1GM INJ 56.82 2524257400 J1815 INSULIN 7030-PER ML 5.59 2514258000 J3490 MORPHINE 50MG/ML 50ML VIAL 50.69 2524258200 J3490 WARFARIN 1MG TAB 1.11 2514259231 J3490 CARBOPLATIN 450MG INJECTION 1960.26 2514260001 J3490 DELFLEX 2.5% 2000ML PERI SOLN 33.58 2524260002 J3490 DELFLEX 1.5% 2000ML PERI SOLN 32.92 2524260003 J3490 DELFLEX 4.25% 2000ML PERI SOLN 34.13 2524260004 J3490 DELFLEX 2.5% 5000ML PERI SOLN 87.13 2524260005 J3490 DELFLEX 4.25% 5000ML PERI SOLN 89.51 2524260006 J3490 DELFLEX 2.5% 2500ML PERI SOLN 58.20 2524260007 J3490 VITAMIN A 50000U/ML 2ML INJ 33.02 2514260009 J3490 DELFLEX 4.25% 2500ML 123.01 2524260369 J1644 HEPARIN 1000U/ML 2ML SDV 19.30 2514260370 J1644 HEPARIN 1000U/ML 10ML MDV 8.82 2514261000 J3490 RELENZA DISKHALER 5MG 11.40 2524261106 90707 MMR VACCINE 0.5ML SDV 59.99 2514263111 J3490 LIDOCAINE 2% JELLY 30ML 26.32 2514263600 J3490 TOPOTECAN 4MG VIAL 662.85 251
112
4264000 J3490 CARVEDILOL 3.125MG TABLET UD 1.11 2514264015 J3490 NS 3% INHALATION 15ML 2.63 2514264901 J3490 INFUVITE 5ML INJ 29.84 2524265000 J3490 TAMSULOSIN 0.4MG CAP 7.30 2514265162 J3490 CIPRO 400MG/D5W PREMIX 200ML 29.48 2524265211 J2590 OXYTOCIN 10U/ML 10ML VIAL 184.19 2514266020 J3490 PANAFIL 30GM OINTMENT 118.18 2514266645 J3490 ERTAPENEM 1GM VIAL 173.59 2514267911 J3490 GUAITUSS DM SYRUP 120ML 3.16 2524268000 J3490 ACYCLOVIR 5% 30GM OINT 497.88 2514269000 J3490 GLYBURIDE MICRO 6MG TAB 1.11 2514269250 J3490 WATER IRRIGATION 500ML 6.65 2504270006 J3490 DELFLEX 1.5% DEX 2500ML 54.21 2524270190 J3490 TROVAFLOXACIN 100 MG TAB UD 14.73 2514270191 J3490 TROVAFLOXACIN 200 MG TAB UD 17.82 2514270195 J3490 TROVAFLOXACIN 200 MG INJ 91.41 2514270196 J3490 TROVAFLOXACIN 300 MG INJ 137.91 2514271100 J3490 LOPERAMIDE LIQ 1MG/5ML 120ML 6.04 2514271200 J3490 VAPONEFRIN 2.25% 0.5CC INH SOL 2.25 2524272000 J3490 SERTRALINE 50MG TABLET 5.85 2514273000 J3490 SERTRALINE 100MG TABLET 6.04 2514273100 J3490 CLARITHROMYCIN 500MG TAB 19.30 2514277200 J3490 AMPHOTERICIN B LIPO 50MG INJ 212.05 2514277631 J3490 AREDIA 90MG INJECTION 1071.57 2524278930 J3490 FONDAPARINUX 2.5MG/0.5ML VIAL 84.05 2514279111 J3010 FENTANYL 50MCG/ML 5ML VIAL 10.97 2514280000 J3490 BENADRYL ELIX 12.5MG/5ML DOSE 1.11 2524280001 J1990 LIBRIUM 100MG INJECTION 33.58 2524280007 J3490 TRETINOIN 10 MG CAP 37.86 2514280100 J3490 SORAFENIB 200MG TABLET 168.87 2514280111 J3490 CORTISPORIN EAR SOLN 10ML 78.79 2524282270 J3490 CYPROHEPTIDINE 2MG/5ML 480ML B 65.42 2514288000 J3490 NIZORAL SHAMPOO 1% 120ML 63.90 2524289000 J3490 KETOCONAZOLE 2% 30GM CRM 46.17 2514289605 J3490 CHLORHEXIDINE ORAL RINSE 480ML 30.88 2514290154 J3490 DIGOXIN ELIX 50MCG/ML 5ML DOSE 6.37 2514290267 J3490 VINCRISTINE 2MG/2ML VIAL 72.50 2514290676 J3490 PHENERGAN 6.25MG/5ML 120ML 6.02 2524290940 J3490 QUETIAPINE 25MG TABLET 8.34 2514290941 J3490 QUETIAPINE 50MG TABLET 13.32 2514291150 J3490 TAMIFLU ORAL SUSP 6MG/ML 60ML 138.52 252
113
4291385 J3490 METOCLOPRAMIDE 5MG/5ML SOLN 5M 1.11 2514292588 J3490 METOPROLOL 100MG TABLET 1.22 2514295000 G9019 OSELTAMIVIR 75MG CAPSULE 18.02 2514295001 J3490 ACETAMINOPHEN 500MG TAB UD 0.19 2574295002 J3490 ACTIVATED CHARCOAL 50GM 240ML 28.26 2514295003 A4649 AEROCHAMBER ADULT 64.58 2724295004 A4649 AEROCHAMBER PEDS 64.58 2724295005 J7609 ALBUTEROL .083% INHAL 3ML UD 1.45 2514295006 J3490 ALCOHOL DENATURED 70% 1 GAL 95.79 2504295007 J3490 AMIPAQUE 3.75ML 20ML 321.66 2554295008 J3490 ANTIMINTH 250MG/5ML 60ML 138.31 2524295009 J3490 AROMATIC ELIXIR 16FL OZ 115.22 2504295010 J3490 ATROPINE 0.5MG/5ML SYRINGE 5.29 2514295011 J3490 AUGMENTIN 125MG/5ML 100ML BT 33.12 2524295013 J3490 BETADINE SOLUTION 60ML 2.51 2574295014 J3490 BREVIBLOC 2.5GM/10ML 129.36 2524295015 J3490 CALCIUM CARB 500MG CHEWTAB 0.28 2514295016 J3490 CARDIZEM 25MG/5ML INJ 26.09 2524295017 J3490 CARDIZEM 50MG/10ML INJ 47.01 2524295018 J3490 CECLOR 250MG CAP UD 7.20 2524295019 J3490 CEPHALEXIN 250MG CAPSULE 0.41 2514295020 J3490 CEPHALEXIN 500MG CAPSULE 0.57 2514295021 J3490 CETAPRED OPHTH 5ML 53.10 2524295022 J3490 CHILDRENS MOTRIN 100MG/5ML 1.23 2524295023 J3490 CHLORPROMAZINE 150MG TAB 1.08 2514295024 J3490 CHLORPROMAZINE 300MG TAB 1.52 2514295025 J3490 CHLORPROMAZINE 75MG TAB 0.87 2514295026 J3490 CHOLESTYRAMINE 4GM PK 3.96 2514295027 J3490 CHYMOTRYPSIN OPHTH 750U/ML 120.67 2514295028 J3490 CIMETIDINE 300MG/5ML 240ML 120.92 2514295029 J0744 CIPRO 10MG/ML 40ML INJ 100.47 2524295030 J3490 CITRIC ACID 16OZ 87.30 2514295031 J3490 CITRIC ACID CRYSTALS 1LB 29.16 2514295032 J3490 CODEINE 30MG INJ 3.56 2514295033 J3490 COLLODION 500ML 58.53 2504295034 J3490 COLLODION FLEXIBLE 1PINT 67.59 2504295035 J3490 COLLYRIUM EYE WASH 118ML 12.53 2524295036 J3490 CORTISONE ACETATE 10MG TAB 0.50 2514295037 J3490 CORTISPORIN EYE DROPS 5ML 33.77 2524295038 J3490 CORTISPORIN EYE OINT 3.5GM 20.27 2524295039 J3490 CYCLOCORT 0.1% 30GM CRM 52.68 252
114
4295040 J3490 CYCLOPENTOLATE 2% EYE DRP 2ML 35.35 2514295041 J3490 DESITIN 60GM OINT 9.91 2574295042 J3490 DICYCLOMINE 10MG/5ML 480ML 36.19 2514295043 J3490 DIMENHYDRINATE 50MG/ML 5ML 19.09 2514295044 J3490 DIPROLENE 0.05% 15GM CREAM 43.53 2524295045 J2270 DURAMORPH 10MG/10ML AMP 39.04 2524295046 J2270 DURAMORPH 5MG/10ML AMP 36.44 2524295047 J3490 EPINEPHRINE 1MG/ML 30ML VIAL 14.23 2514295049 J3490 EUCERIN CREAM 454GM 49.39 2574295050 J3490 FLUANDENOLIDE 0.05% 30GM 59.88 2514295051 J3490 FLUOCINOLONE 0.25% 15GM 3.78 2514295052 J3490 FLUPHENAZINE 1MG TAB UD 1.84 2514295053 J3490 FLUPHENAZINE 2.5MG TAB UD 2.59 2514295054 J3490 HEB CREAM BASE 1LB 57.74 2524295055 J3490 HEXAVITAMIN TABLET UD 1.23 2524295056 J3490 HYDROCORTISONE 1%LTN 118ML 33.09 2514295057 J3490 HYDROGEN PEROXIDE 120ML 1.80 2504295058 J1741 IBUPROFEN 100MG/5ML UD 0.27 2514295059 J3490 IBUPROFEN 200MG TAB UD 1.11 2514295060 J3490 INSTA-CHAR 25GM/120ML 14.90 2524295061 J3490 INSTA-CHAR 50GM/240ML 17.89 2524295062 J3490 INSTA-GLUCOSE 31GM 10.48 2524295063 J3490 IOPHENOYLATE 3ML 25.21 2504295064 J1245 PERSANTINE 10MG/2ML IV 289.53 2524295065 J3490 KAYEXALATE POWDER 454GM 230.16 2524295066 J3490 LACTOSE HYD POWDER 480GM 464.97 2514295068 J3490 LIDOCAINE 1% 2ML AMP 2.27 2514295069 J3490 LIDOCAINE/D5W 250ML INJ 34.92 2514295070 J3490 LORAZEPAM 0.5MG TAB UD 0.22 2524295071 J3490 MAZICON 0.1MG/ML 5ML VIAL 96.93 2524295072 J3490 MECLOFENAMATE 50MG CAP 0.47 2514295073 J0694 MEFOXIN 1GM VIAL 35.35 2524295074 J3490 MERCURY DISTILLED 1LB 319.50 2504295075 J3490 METAL ADD CAPS GLASS 25MM 0.57 2504295076 J3490 METHYLTESTOSTERONE 10MG 0.82 2514295077 J3490 METRONIDAZOLE 500MG TAB UD 2.67 2514295078 J3490 MONSELS SOLUTION 1PINT 83.92 2504295079 J3490 MULTIVITAMIN THERA TAB UD 0.24 2574295080 J3490 NAPHAZOLINE EYE DROPS 15ML 29.97 2514295081 J3490 NEUPOGEN 300MCG/ML 1ML VIAL 447.09 2524295082 J3490 NIACIN 100MG TAB 0.06 251
115
4295083 J3490 NICLOCIDE 500MG TAB 5.80 2524295084 J3490 NITROFURANTOIN 100MG CAP 3.02 2514295085 J3490 NITROSTAT 600MCG TAB SL100 19.25 2524295086 J3490 CALCIUM 500MG TABLET 0.22 2514295087 J3490 PEDIAZOLE SUSPENSION 200ML 30.45 2524295088 J3490 PILOCARPINE 5% EYEDRP 15ML 29.37 2514295089 J3490 POTASSIUM IODIDE GRANULES 328.03 2514295090 J3490 PRELONE 15MG/5ML SYRUP 5ML 1.16 2524295091 J3490 PRINIVIL 10MG TABLET UD 3.42 2524295092 J3490 PRINIVIL 5MG TAB UD 3.32 2524295093 J3490 PROCAINAMIDE 500MG CAP 0.24 2514295094 J3490 PROCAINE 1%(NOVOCAINE) 2ML 12.65 2514295095 J3490 PROPOXYPHENE-N 100/650TAB 1.23 2514295096 90675 RABIES VACCINE 2.5IU SDV 215.24 2514295098 J3490 SODIUM THIOSULFATE 2270GM 99.89 2514295099 J3490 SOTALOL 80MG TABLET 3.75 2514295100 J3490 SUFENTA 100MCG/2ML AMPULE 88.26 2524295101 J3490 SUFENTA 50MCG/1ML AMPULE 52.42 2524295102 J3490 SUPRAX 200MG TABLET 5.86 2524295103 J3490 SURGILUBE 4OZ 2.27 2504295104 J3490 TETRACAINE 0.5% EYE DROPS 15ML 36.30 2514295105 J3490 THERAPEUTIC MVI 5ML UD 1.48 2504295106 J3490 THERMO-TAB 0.08 2504295107 J3490 THIORIDAZINE 100MG/ML LIQ 19.47 2514295108 J3490 TIMOLOL 10MG TAB UD 1.94 2514295109 J3490 TIMOPTIC 0.25% EYEDRP 5ML 31.50 2524295110 J3490 TORADOL 10MG TABLET UD 2.29 2524295111 J1885 TORADOL 15MG/ML INJECTION 17.92 2524295112 J1885 TORADOL 30MG/ML INJECTION 18.29 2524295113 J1885 TORADOL 60MG/ML INJECTION 18.91 2524295114 J3490 TRANXENE 3.75MG TABLET 0.53 2524295115 J3490 TRIAMCINOLONE 4MG TABLET 0.32 2514295116 J3490 TRIMETHOBENZAMIDE 100MG SU 0.68 2514295117 J2250 VERSED 2MG/2ML VIAL 10.22 2524295118 J3490 VITAMIN E 200IU CAPSULE 0.06 2514295121 J3490 KALTOSTAT 7.5CMX12CM 11.19 2504295122 J3490 KALTOSTAT 2GM 13.93 2504295123 J3490 DARVON COMPOUND TABLET 0.38 2524295124 A4649 PLASTIC ORAL SYRINGE 5ML 0.97 2704295232 J3490 SORBITOL 70% SOLN 480ML 24.59 2514295402 90732 PNEUMOCOCCAL VAC 23-VAL 0.5ML 85.19 251
116
4295566 J3490 LINDANE 1% 60ML LOTION 407.96 2514295701 J3490 PREMARIN VAG CREAM 42GM 92.38 2524295730 J3490 HEP B VACC RENAL INJ 264.89 2514295740 J3490 HEPATITIS B VACCINE 20MCG 95.52 2514295746 J3490 HEPARIN 10000U/ML VIAL 2.94 2514295756 J3490 SOLU-CORTEF 250MG/2ML VIAL 12.44 2514295788 J3490 GLYCOPYRROLATE 0.2MG/ML 20ML 3.48 2514295802 J3490 IRINOTECAN 100MG/5ML INJ 771.20 2514295803 J1750 IRON DEXTRAN 100MG/2ML INJ 48.12 2524295805 J3490 IRINOTECAN 40MG/2ML VIAL 553.13 2514295869 J3490 NITROFURANTOIN 100MG CAP 8.98 2514295886 J3490 NITROGLYCERIN 0.4MG SL TAB 43.97 2514295895 J3490 PHENYTOIN 100MG/2ML AMP 3.66 2514295905 J2560 PHENOBARBITAL 65MG/ML INJ 6.17 2514295942 J3490 THYROTROPIN 10 IU/ML AMP 179.98 2514295968 J9320 STREPTOZOCIN 1GM INJECTION 157.25 2514295978 A4217 NORMAL SALINE IRRIG 500ML 6.35 2504295982 J3490 SODIUM BICARB 8.4% 50ML SYR 5.46 2514296001 J3490 AMINOPHYLLINE 500MG/20ML INJ 3.24 2514296002 J3490 PRINIVIL 20MG TABLET UD 1.67 2524296003 J3490 XYLOCAINE SPINAL 1.5% 2ML 16.93 2524296004 J3490 NORCURON 10MG INJ 53.29 2524296005 S4995 NICOTINE GUM 2MG 0.87 2514296006 J3490 NICOTINE PATCH 21MG 9.09 2514296007 J3490 NICOTINE PATCH 14MG 8.33 2514296008 J3490 NICOTINE PATCH 7MG 6.85 2514296009 J3490 HYPERLYTE-R 25ML INJ 3.90 2504296010 J2060 LORAZEPAM 2MG/ML 1ML INJ 10.98 2514296011 J1631 HALDOL DECANOATE 50MG/5ML VL 96.22 2524296012 J3490 ZITHROMAX 250MG TABLET 14.08 2524296013 J3490 HEPARIN 10000U/ML 4 ML 18.01 2514296016 J3490 AQUAMEPHYTON 10MG INJ 10.44 2524296017 J3490 INTAL INHALATION SOLN 2 ML 2.40 2524296018 J3490 ALUMINUM AMMONIUM SO4 4OZ 8.20 2514296019 J3230 THORAZINE 25MG/ML 2ML AMP 13.76 2524296020 A4649 PLASTIC ORAL SYRINGE 10ML 1.13 2704296021 A4649 PLASTIC ORAL SYRINGE 3ML 0.97 2704296023 J3490 KENALOG 0.1% OINT 15GM 41.03 2524296024 J3490 TOBRAMYCIN 0.3% OPH SOLN 5ML 70.90 2514296025 J3490 LOPID 600MG TABLET 0.97 2524296026 J3490 ROBITUSSIN AC 120ML 12.79 252
117
4296027 J3490 DIMETAPP ELIXIR 120ML 3.21 2524296028 J3490 ROBITUSSIN 100MG/5ML 120ML 6.85 2524296029 J3370 VANCOMYCIN 1GM INJECTION 21.11 2514296030 J3490 ZARONTIN 250 MG/5 ML SUSP 5 ML 2.27 2524296031 J3490 SUPRAX 100MG/5ML SUSP 5 ML DOS 11.17 2524296032 J3490 TYLENOL 32MG/ML 120 ML 19.25 2524296035 J3490 PROVERA 2.5MG TABLET 1.08 2524296036 J3490 CISPLATIN 1MG/ML 50ML VIAL 482.97 2514296037 J3490 PILOCARPINE 0.5% OPHTH RENAL 7.51 2514296038 J3490 NTG 50MG/D5W 250ML 16.52 2514296039 S0032 NAFCILLIN 2GM INJECTION 23.76 2514296041 J3490 MEFOXIN 2GM INJECTION 66.16 2524296043 J3490 ATROPINE 0.4MG/ML 20ML VIAL 3.78 2514296044 J3490 DIPHENHYDRAMINE CREAM 15GM 10.98 2514296045 J3490 METAPROTERENOL 0.4% 2.5ML 2.37 2514296046 J3490 METAPROTERENOL 0.6% 2.5ML 1.86 2514296047 J3490 ANALGESIC BALM 454GM 25.21 2574296048 J3490 DICYCLOMINE 20 MG TAB 0.68 2514296049 J9050 BICNU 100 MG INJ 285.82 2524296050 J3490 CHLORTHALIDONE 25MG TAB 0.28 2514296051 J3490 COLYMYCIN OTIC 10 ML 44.27 2524296053 J3490 COUMADIN 10 MG TABLET 3.24 2524296054 J3490 COUMADIN 7.5 MG TABLET 3.13 2524296055 J3490 D5 1/2 NS KCL 20MEQ 1000ML 4.39 2584296056 J3490 D5 1/4 NS KCL 20MEQ 1000ML 5.26 2584296057 J3490 DEPOPROVERA 150 MG INJ 78.08 2524296058 J3490 DEXAMETHASONE OPHTH OINT 7.23 2514296059 J3490 DONNATAL ELIXIR 480ML 24.08 2524296060 J3490 ERYPED DROPS 50ML 14.69 2524296061 A4649 EVAC CONTAINER 1000ML 3.73 2704296062 A4649 EVAC CONTAINER 500ML 3.31 2704296063 J0713 CEFTAZIDIME 1GM INJ 51.22 2514296064 J3490 FURACIN SOL DRESS 454GM 274.65 2504296065 J3490 HALDOL 1MG TABLET 2.27 2524296066 J3490 BISMUTH SUBSALIC 262MG TAB 0.28 2574296067 J3490 BISMUTH SUBSALICYLATE 15ML DOS 1.05 2574296068 J3490 PANCRELIPASE CAPSULE 0.44 2514296069 J3490 AMINO ACIDS 10% 500ML INJ 19.55 2504296070 J3490 MAGNESIUM HYDROXIDE 400MG TAB 0.32 2514296071 J3490 TAXOL 30MG INJ 490.16 2524296073 J3490 AMINOPHYLLINE 21MG/ML 100ML 4.11 251
118
4296074 J3490 BENYLIN DM 120ML 9.41 2524296075 J3490 BENYLIN 120ML 3.24 2524296077 J3490 MILK OF MAGNESIA 473ML 5.54 2524296078 J3490 PHENERGAN VC 120ML 4.03 2524296079 J3490 PHENERGAN W/ CODEINE 120ML 7.34 2524296080 J3490 FERROUS SO4 220MG/5ML 480ML 4.81 2514296081 J3490 TRIMETH/SULFA 8/4O/ML 100ML 4.95 2514296082 J3490 ALBUTEROL 2MG/5ML 480ML 10.66 2514296124 J3490 SELENIUM 40MCG/ML 10ML VIAL 3.13 2524296847 J3490 FAT EMULSION 20% 50ML 21.86 2514296848 J3490 FAT EMULSION 20% 100ML 21.48 2514297000 J3490 URSODIOL 300MG CAP 8.89 2514297001 J3490 RIFAMPIN 600MG VIAL 288.94 2514297002 J0630 CALCITONIN 200IU/ML 2ML VIAL 61.58 2514297003 J3490 FLUOTHANE-15 MIN 1.92 2524297004 J3490 ETHRANE-15 MIN 8.19 2524297005 J3490 FORANE-15 MIN 14.49 2524298000 J3490 ROSIGLITAZONE 2MG TAB 7.73 2514299000 J3490 ROSIGLITAZONE 4MG TAB 11.01 2515000022 92507 SPEECH THERAPY INDIVIDUAL 116.66 4405000026 V5008 HEARING SCREENING 116.66 4705000027 V5362 PRE-CONSULT LARYNGECTOMY 116.66 4405000038 92508 SPEECH TX GROUP 116.66 4435000039 97532 COGNITIVE EVAL EACH 15 MIN 58.35 4405000040 92507 SPEECH TX CASE CONFERENCE 158.18 4405000391 A4649 TRACHTALK 77.54 2705002529 92526 ST-MODIFIED BARIUM SWALLOW STU 191.45 4405031575 31575 ENDOSCOPIC VOICE EVAL 190.06 4405069250 92523 SPEECH-LANGUAGE EVAL 1ST 15 M 58.34 4445079250 92507 SPCH/LNGE COG TX INDIVIDUAL 58.34 4405080005 L8501 PASSY MUIR SPK VALVE 005 310.56 2745080007 L8501 PASSY MUIR SPK VALVE 007 423.81 2745080298 V5336 PASSY MUIR VALVE ATACHMENT 8.77 4405092506 92523 BEDSIDE DYSPHAGIA COMPREHENSIV 58.34 4445092507 92507 SPEECH THERAPY INDIVIDUAL 31.08 4405092520 92526 MODIFIED BARIUM SWALLOW 58.34 4445092610 92610 SWALLOW FUNCTION EVAL 121.99 4405092611 92611 MOTION SWALLOW BY CINE/VIDEO 182.98 4405092616 92616 ST-FIBEROPTIC SWALLOW W/ SENSO 504.13 4405095003 92523 SPEECH-LANGUAGE COMPREHENSIVE 39.25 4445096001 92507 DYSPHAGIA TX INDIVIDUAL 31.09 440
119
5096003 92507 COGNITIVE TX INDIVIDUAL 31.09 4405097112 97112 ST-NEUROMUSCULAR REEDUC-15 MIN 56.92 4405097150 97150 ST-THERAPEUTIC SERVICES GROUP 64.85 4405097533 97533 ST-SENSORY INTEGRATION-15 MIN 76.58 4405200023 97535 ADL TRAINING ADD 15 MIN 69.02 4305200042 97110 CONT PASSIVE MTN EACH 15 MIN 93.11 4305200043 97799 JOBST MEASURING 107.11 4305200049 97799 BASE FEE PER PATIENT 69.02 4305200056 97112 NEUROMUSC REEDUC EACH 15 MIN 69.49 4305200057 97799 OT CASE CONFERENCE 158.18 4305200060 97760 SPLINTING ADD'L 15 MIN 78.79 4305200063 97110 NEUROMUSC FACIL ADD 15 MIN 69.49 4305200064 97112 COORDINATION TEST EA 15 MIN 69.49 4305200080 97112 COORD EXERCISE/ACT EA 15 MIN 69.02 4305200134 A4649 DORSIFLEXION ASSIST 122.30 2705200148 97110 MUSCLE STRENGTH ADD 15 MIN 69.02 4305200189 97110 ROM EXERCISE ADD 15 MIN 69.02 4305200205 97761 PROSTHETIC TRNG EACH 15 MIN 69.02 4305200390 A4649 THERAPLAST 10.83 2705200405 97124 EDEMA REDUCTION PER 15 MIN 18.15 4305200406 97110 THERAPEUTIC EXER ADD 15 MIN 18.15 4305200437 A4649 0VELCRO (PER 6") 1.26 2705200669 A4649 SPLINT FINGER EXT WIRE FOAM 34.90 2705201179 97110 HAND THERAPY - 15 MIN 69.02 4305202000 97110 ROM ACTIVITIES PER 15 MIN 23.61 4305202010 97112 COORD/FINE MOTOR EA 15 MIN 21.20 4305202020 97535 DAILY LIVING TRAING EA 15MIN 23.61 4305209711 97110 MUSCLE STRENGTH EACH 15 MIN 69.48 4305210971 97110 ROM EXERCISE EACH 15 MIN 69.48 4305211097 97110 THERAPEUTIC EXER EACH 15 MIN 46.62 4305229702 97022 OT-WHIRLPOOL-15 MIN 44.23 4305249750 97760 ORTHOTICS TRNG EXT ADD 15 MI 69.48 4305261801 A4649 ORTHOSIS FOOT-DROP 574.37 2705282601 A4649 SPLINT FOOT PREFABRICATED 267.84 2705292506 92523 OT-BEDSIDE DYSPHAGIA COMPREHEN 179.45 4445292507 92507 OT-DYSPHAGIA TREATMENT 95.72 4305292520 92526 OT-MODIFIED BARIUM SWALLOW 179.45 4305296001 97010 FLUIDOTHERAPY 1+ AREAS 53.33 4305296002 97018 PARAFFIN BATH TX 1+ AREAS 13.32 4305296003 97545 WORK HARD/IND REHAB INIT 2HRS 39.99 4305296008 A4570 SPLINT HAND PRE-FABRICATED 198.36 271
120
5296009 A4570 SPLINT ANTISPASTICITY 276.68 2715296010 A4649 SPLINT ASSIST NEOPRENE 81.21 2705297000 A4649 THERAPUTTY-3 OZ 19.71 2705297004 A4649 THERMOPLASTIC MATERIAL-1/4 SHE 99.37 2705297017 A4649 SILICONE GEL-SQUARE INCH 9.18 2705297018 A4649 OTOFORM/ELASTOMER-1 OZ 22.55 2705297020 97602 DRESSING APPLICATION 169.18 4305297035 97035 OT-THERAPEUTIC US EACH 15 MIN 151.80 4305297110 97110 NEUROMUSC FACIL EACH 15 MIN 69.48 4305297112 97112 OT-NEUROMUSC REEDUC EA 15 MIN 46.56 4305297140 97140 OT-JNT MOBILIZATION EA 15MIN 70.19 4305297150 97150 OT-GROUP THERAPY 62.54 4305297165 97165 OT EVAL-LOW COMPLEX 30 MIN 109.87 4345297166 97166 OT EVAL-MOD COMPLEX 45 MIN 119.04 4345297167 97167 OT EVAL-HIGH COMPLEX 60 MIN 128.18 4345297168 97168 OT RE-EVAL EST PLAN CARE 73.05 4345297504 97760 ORTHOTICS TRNG EXT 1ST 15 MI 69.48 4305297520 97761 OT-PROSTHETIC TRNG INIT 15 MI 69.02 4305297532 97532 OT-COGNITIVE TRAINIG-15 MIN 66.71 4305297535 97535 ADL TRAINING 1ST 15 MIN 69.48 4305297542 97542 WHEELCHAIR MANAGEMENT EA 15MIN 76.23 3405297750 97750 PHYSICAL PERF/MEASURE EA 15MIN 86.96 4305297755 97755 ASSISTIVE TECH ASSESS EA 15MIN 88.56 4305297760 97760 ORTHOTIC MANAGEMENT EA 15MIN 108.95 4305298000 97033 OT-IONTOPHORESIS EACH 15 MIN 189.43 4305299977 97760 SPLINTING EACH 15 MIN 39.08 4305299999 97799 MISC OCC TX PER 15 MIN 18.15 4305300004 94060 PEAK FLOWMETER INITIAL 274.20 4605300007 94726 LUNG VOLUMES 47.83 4605300008 A4649 OXYGEN ANALYSIS/ANALYSER 40.58 2705300011 A4649 CPAP NASAL 47.83 2705300014 94640 INCENTIVE SPIROMETRY SUBSEQUE 190.58 4605300016 94799 THERAPIST STANDBY 0.00 4105300021 94799 WEANING PARAMETERS 186.64 4105300025 94667 CHEST PHYSIO INITIAL 190.58 4605300026 94799 CUFF PRESSURE MEASUREMENT 186.70 4605300027 94799 SUCTION (PROCEDURE) 186.70 4105300046 94060 PEAK FLOWMETER SUBSEQUENT 40.58 4605300047 94762 O2 SATURATION CONTINUOUS 130.48 4605300056 94761 O2 SATURATION MULTIPLE 40.58 4605300057 94668 CHEST PHYSIO SUBSEQUENT 60.63 460
121
5300065 94660 CPAP TITRATION 375.49 4105300089 94640 AEROSOL INHAL SUBSEQ 190.58 4605300090 94642 PENTAMIDINE TREATMENT 40.58 4605300100 A4649 CLOSED TRACH SUCT PER UNIT 22.52 2725300105 94640 AEROSOL INHAL 190.58 4605300106 94010 SPIROMETRY TOTAL & TIMED 81.71 4605300110 94760 O2 SATURATION SINGLE 39.06 4605300171 94640 INCENTIVE SPIROMETRY INITIAL 190.58 4605300214 A4649 NEBULIZER PREFILLED 12.69 2705300238 A4649 NEBULIZER REFILL 15.15 2505300338 94644 BRONCHODILATOR (HHN) TX FIRST 152.52 4605300360 94645 BRONCHODILATOR (HHN) TX EACH 15.34 4605300383 A4649 TUBING CORRUGATED 13.58 2725300386 A4649 AEROSOL T ADAPTOR 2.47 2705300387 A4649 HUMIDIFIER 14.16 2725300392 A4649 COMPRESSED AIR/HOUR 8.64 2705300396 E0440 OXYGEN/HR-1 LITER 0.98 2705300397 E0440 OXYGEN/HR-2 LITER 2.47 2705300398 E0440 OXYGEN/HR-3 LITER 3.71 2705300400 E0440 OXYGEN/HR-4 LITER 4.91 2705300401 E0440 OXYGEN/HR-5 LITER 6.17 2705300402 E0440 OXYGEN/HR-6 LITER 7.39 2705300403 E0440 OXYGEN/HR-7 LITER 8.64 2705300404 E0440 OXYGEN/HR-8 LITER 9.87 2705300405 E0440 OXYGEN/HR-9 LITER 11.09 2705300408 E0440 OXYGEN/HR-10 LITER 12.32 2705300409 E0440 OXYGEN/HR-11 LITER 6.11 2705300410 E0440 OXYGEN/HR-12 LITER 6.45 2705300411 E0440 OXYGEN/HR-13 LITER 7.28 2705300412 E0440 OXYGEN/HR-14 LITER 7.74 2705300413 E0440 OXYGEN/HR-15 LITER 8.32 2705300568 94640 SPUTUM INDUCTION PER TX 190.58 4605300610 A4649 KIT NEBULIZER CONTINUOUS 118.00 2725300742 A4619 CIRCUIT VENTILATOR-INFANT 45.29 2705300759 E0425 OXYGEN/HR VENTILATOR 31.37 2705300783 A4649 CONCHA PAK 125.56 2705300798 A4649 CIRCUIT VENTILATOR-ADULT 64.17 2705300811 A4649 FILTER PALL 20.70 2705300825 A4649 OXYHOOD 12.69 2705300912 A7525 MASK TRACHEOSTOMY 13.03 2705301000 94003 VENT ASSIST & MGMT SUBSEQUENT 522.41 410
122
5301002 94002 VENT ASSIST & MGMT 1ST DAY 612.79 4105301420 A4649 PEEP VALVE-ADULT 80.49 2725302197 A4649 INCENTIVE SPIROMETER 64.03 2705304950 A4649 FULL FACE MASK 260.01 2725304953 A4649 MASK CPAP/BIPAP-PEDS 758.90 2725307142 A4649 DRAINAGE BAG 9.93 2705310001 A4649 MDI INLINE MULTI ADAPTOR 8.97 2725311102 A4649 INFANT BREATHING CIRCUIT 343.33 2725311665 A4649 HANDHELD NEBULIZER KIT 7.25 2725313930 A4649 BIPAP CIRCUIT ADULT 68.72 2725319250 A4649 VEST SPU WRAP-MED 469.72 2705319251 A4649 WRAP VEST SPU-LGE 469.72 2705321000 A4649 ADAPTER OXYGEN 12.86 2725321289 A4649 CANNULA PREMMIES 93.98 2725321290 A4649 CANNULA NEWBORN 93.98 2725321291 A4649 CANNULA INFANT 93.98 2725321762 A4649 TRESHOLD PEP VALVE 211.71 2725325604 94660 CONT POS AIRWAY PRESSURE 190.58 4605338241 A7030 MASK CPAP FULL FACE-MED 682.45 2725338242 A7030 MASK CPAP FULL FACE-SML 682.45 2725338243 A7030 MASK CPAP FULL FACE-LGE 682.45 2725352023 A4649 HEADGEAR BIPAP-SMALL 191.80 2725352027 A4649 HEADGEAR BIPAP-MEDIUM 191.80 2725352032 A4649 MASK BIPAP-PETITE 141.40 2725352034 A4649 MASK BIPAP-SMALL 141.40 2725352036 A4649 MASK BIPAP-MEDIUM 141.40 2725352040 A4649 PAD SEALING BIPAP 20.84 2725352041 A4649 MASK FACE BIPAP SIZING GAUGE 41.64 2725356611 A4649 NEBULIZER W/ T-ADAPTOR 7.97 2725371374 A4649 OSCILLATOR VENT CIRCUIT 817.65 2725378022 A4649 CIRCUIT VENTILATOR-PEDS 106.00 2725382803 82803 CAPILLARY BLOOD GAS PROCUR 35.15 3005382805 82805 ABG/VBG ANALYSIS 109.04 3005394003 94799 PIP/NIF TEST 47.83 4105394640 94640 AEROSOL INH-SPUTUM INDUCT INI 190.58 4605394641 94640 AEROSOL INH-SPUTUM INDUCT SUB 190.58 4605394644 94644 CONTINUOUS INH TREATMENT 1ST 172.33 4605394645 94645 CONTINUOUS INH TREATMENT EACH 62.82 4605394664 94664 DEMO & EVAL UTILIZ AERO GEN M 190.58 4605394770 94770 CAPNOGRAPHY 274.20 4605394772 94772 BREATH RECORD 12-24HR INFANT 976.27 460
123
5395805 95805 MULTIPLE SLEEP LATENCY TEST 826.06 7405395807 95807 SLEEP STUDY ATTENDED 1276.63 7405395808 95808 POLYSOMNOGRAPHY 1-3 1276.63 7405395810 95810 SLEEP STAGE 4 PARAMETERS 2177.78 7405397755 97755 ASSISTIVE TECH ASSESS,EA 15MIN 88.56 4305400146 97022 PT-WHIRLPOOL TX 1+ AREAS 56.92 4205400245 97799 TRANS 5 MILE RADIUS 30.92 4295400260 97799 TRANS P/M BEYOND 5 MILES 5.99 4295400302 97799 CASE CONFERENCE ADD 15 MIN 19.91 4205400394 A4649 CANE QUAD 213.66 2705400429 A4649 THERABAND (PER 1 FT) 0.80 2705403294 A4649 CANE WOODEN 49.25 2705409381 A4649 STOCKINETTE TENSOGRIP S-B /FT 7.15 2715409388 A4649 STOCKINETTE TENSOGRIP S-C /FT 10.02 2715409389 A4649 STOCKINETTE TENSOGRIP S-D /FT 11.47 2715410920 A4649 CRUTCHES ADJ-YOUTH 98.73 2705410925 A4649 CRUTCHES ADJ-ADULT MED 109.11 2705410930 E0112 CRUTCHES ADJ-ADULT LGE 111.77 2905421179 97112 PT-NEUROMUSCULAR RETRNG-15 MIN 70.19 4205425410 A4649 CORSET AQUAFORM SMALL 658.02 2715425411 A4649 CORSET AQUAFORM MEDIUM 690.10 2715425412 A4649 CORSET AQUAFORM LARGE 714.27 2715470359 97035 PT-THERAPEUTIC ULTRASOUND-15 M 42.77 4205471109 97110 PT-CONT PASSIVE MOTION-15 MIN 61.91 4205471129 97112 PT-KINETIC EXERCISE-15 MIN 70.19 4205475097 97750 PT-EXTREMITY ASSESSMENT-15 MIN 82.33 4205475309 97530 PT-FUNCTIONAL TX ACTIVITY-15 M 70.19 4205477509 97750 PT-EVALUATION/ASSESSMENT-15 MI 82.95 4205493797 93797 CARDIAC REHAB O-P W/O EKG MON 119.58 9435493798 93798 CARDIAC REHAB O-P W/ EKG MONI 119.58 9435493810 A4649 STOCKINETTE TENSOGRIP S-E /FT 11.47 2715493811 A4649 STOCKINETTE TENSOGRIP S-F /FT 12.90 2715495003 97010 PT-HOT/COLD PACKS 1+ AREAS 33.36 4205495005 97602 DRESSING APPLICATION 169.18 4205495006 97014 PT-ELECTRICAL STIMULATION UNA 33.36 4205495007 97110 THERAPEUTIC EXERCISE EA 15MIN 33.36 4205495008 97010 FLUIDOTHERAPY 1+ AREAS 32.34 4205495012 97799 HOME EVALUATION 266.86 4245495013 97010 PT-HOT/COLD PACKS 1+ AREAS 33.36 4205495016 97124 MASSAGE ADD 15 MIN 56.92 4205495020 97018 PARAFFIN BATH TX 1+ AREAS 33.36 420
124
5495026 97545 WORK HARD/CONDIT 1ST 2 HOUR 266.86 4205495027 97546 WORK HARDENING ADD 1 HOUR 133.44 4205495028 97532 PT-COGNITIVE TRAINING-15 MIN 66.71 4205495029 97116 GAIT TRAINING EACH 15 MIN 56.92 4205497012 97012 PT-TX TRACTION 1+ AREAS 44.68 4205497032 97032 PT-ELECTRIC STIM MNL EA 15MIN 50.04 4205497110 97110 CARDIAC REHAB IN-PAT EA 15MIN 57.09 9435497113 97113 PT-HYDROTX W/EXRCSE EA 15 MIN 65.73 4205497116 97116 GAIT TRAINING INIT 15 MIN 33.36 4205497124 97124 MASSAGE INIT 15 MIN 33.36 4205497140 97140 MANUAL THERAPY 1/> EA 15 MIN 70.19 4245497150 97150 PT-GROUP THERAPY 62.54 4245497161 97161 PT EVAL-LOW COMPLEX 20 MIN 113.72 4245497162 97162 PT EVAL-MOD COMPLEX 30 MIN 123.20 4245497163 97163 PR EVAL-HIGH COMPLEX 45 MIN 132.67 4245497164 97164 PT RE-EVAL EST PLAN CARE 77.73 4245497597 97597 PT-WOUND DEBRIDE1ST 20SQCM/< 169.18 4205497598 97598 PT-WND DEBRIDEEA ADD 20SQCM/< 128.91 4205497761 97761 PT-PROSTHETIC TRAIN EA 15MIN 63.82 4205497799 97799 CASE CONFERENCE INIT 15 MIN 34.63 4205498000 97033 PT-IONTOPHORESIS EACH 15 MIN 189.43 4205499125 A4649 FINGER COT-SML 10.96 2715499126 A4649 FINGER COT-MED 10.96 2715499127 A4649 FINGER COT-LGE 10.96 2716000001 250 EF-PULMOCARE 8 OZ 2.38 2506000002 250 EF-PEDIASURE 8 OZ 1.89 2506000003 250 EF-SUPP-VITAL POWDER 2.79 OZ 4.92 2506000004 250 WATER STERILE 1 QUART 7.69 2506000005 250 EF-JEVITY RTH 1000 CC 12.25 2506000007 942 DIET CONSULTATION 32.92 9426000010 250 EF-SUPP-PROMOD 6.6 GM SCOOP 17.28 2506000023 991 DIETARY BREAKFAST 7.55 9916000027 250 EF-NEPRO 8 OZ 2.92 2506000031 991 DIETARY LUNCH 9.32 9916000040 250 EF-ENSURE 8 OZ 1.84 2506000048 991 DIETARY DINNER 8.79 9916000074 250 SUSTAGEN BY DOSAGE 1.71 2506000086 250 EF-SUPP-POLYCOSE PER HALF CUP 0.88 2506000110 250 SUSTACAL PUDDINGS 1.69 2506000129 250 SUSTACAL 8 OZ 1.52 2506000137 250 SUSTACAL 12 OZ 1.98 250
125
6000141 991 CLEAR LIQUID DIET 2.18 9916000157 991 FULL LIQUID DIET 4.61 9916000158 250 EF-GLUCERNA 8 OZ 3.37 2506000222 991 CLEAR LIQUID W/ ROSS SLD 4.02 9916800001 S3620 NEWBORN METABOLIC SCREEN (FIRS 100.30 3006800002 S3620 NEWBORN METABOLIC SCREEN (SECO 74.61 3006800007 84443 THYROID STIMULATING HORMONE 86.21 3016800008 84702 HCG QUANTITATIVE 91.13 3016800016 80156 CARBAMAZEPINE (TEGRETOL) 86.74 3016800048 80051 ELECTROLYTE PROFILE 45.50 3016800073 A4649 BAG DOUBLE-BLOOD PACK CPDA 75.02 2726800127 MORGUE FEE PER DAY 18.97 9996800335 80061 LIPID PROFILE(TRIGVLDLHDLLD 67.75 3006801020 87147 SEROLOGICAL SLIDE TYPING 48.89 3066801081 80349 THC URINE QUALITATIVE 36.74 3016802046 86920 INCOMPATIBLE X-MATCH 144.85 3006802112 80150 AMIKACIN PEAK 92.68 3016803068 86927 F F P 125.30 3906806311 86687 HTLV-I 69.11 3026806548 84560 URIC ACID URINE 23.37 3016806591 87449 STREP B TEST 33.73 3066807078 87070 CULTURE WOUND 65.91 3066807087 87070 CULTURE THROAT 65.91 3066808101 80346 BENZODIAZEPINE URINE QUALITAT 36.74 3016808707 87070 CULTURE MISCELLANEOUS 65.91 3066809399 UNCLAIMED FETAL DISP 252.84 3196810004 81000 URINALYSIS COMPLETE 13.60 3076810053 81001 URINALYSIS AUTOMATED W/ MICR 9.04 3076810108 80307 PHENCYCLIDINE(PCP) URINE QUAL 36.74 3016810810 80361 OPIATES URINE QUALITATIVE 36.74 3016811434 36430 ADMINISTRATION:BLD/BLD COMPONE 344.17 3916812000 80324 AMPHETAMINES URINE QUALITATIV 36.74 3016820102 82009 ACETONE SERUM QUALI 45.32 3016820121 87070 CULTURE GENITAL 65.91 3066820122 87070 CULTURE NASAL 65.91 3066820123 87070 CULTURE RESPIRATORY 65.91 3066820124 87070 CULTURE EYE 65.91 3066820125 87070 CULTURE EAR 65.91 3066820126 87070 CULTURE ENVIRONMENTAL 65.91 3066820127 87070 CULTURE CATHETER 65.91 3066820348 84302 SODIUM CSF 38.76 301
126
6820409 82040 ALBUMIN/GLOBULIN 22.66 3016820557 80307 ALCOHOL URINE 34.01 3016821123 80150 AMIKACIN LEVEL TROUGH 109.92 3016821406 82140 AMMONIA 112.94 3016821506 82150 AMYLASE BLOOD 34.01 3016821605 82150 AMYLASE URINE 34.01 3016822073 80329 ACETAMINOPHEN(TYLENOL) 94.40 3016822504 82247 BILIRUBIN TOTAL SERUM 27.16 3016822553 82248 BILIRUBIN DIRECT 27.16 3016823106 82310 CALCIUM SERUM 24.94 3016823353 82340 CALCIUM URINE QUALI 15.84 3016823403 82340 CALCIUM URINE QUANTI 36.29 3016824351 82435 CHLORIDE BLOOD 22.66 3016824450 82436 CHLORIDE URINE 22.66 3016824559 82438 CHLORIDE CSF 22.66 3016824658 82465 CHOLESTEROL TOTAL 24.94 3016825556 82550 CREATINE PHOSPHOKINASE 22.66 3016825605 82552 CPK-MB 96.08 3016825655 82565 CREATININE BLOOD 22.66 3016825705 82570 CREATININE URINE 22.66 3016825754 82575 CREATININE CLEARANCE 54.38 3016826431 80162 DIGOXIN 77.54 3016826553 80185 PHENYTOIN (DILANTIN) 133.17 3016826621 80337 TRICYCLIC ANTIDEPRESS SCRN 99.46 3016827057 82705 FAT FECAL QUALITATIVE 11.33 3016827205 82728 FERRITIN 99.46 3016828402 82374 CARBON DIOXIDE CONTENT 22.66 3016829251 82930 GASTRIC ACID ANALYSIS 22.66 3016829417 80170 GENTAMYCIN TROUGH 107.88 3016829419 80170 GENTAMYCIN PEAK 107.88 3016829458 82945 GLUCOSE URINE 23.37 3016831604 81025 PREGNANCY TEST QUALI-URINE 38.51 3076832754 80178 LITHIUM BLOOD 53.88 3016835407 83540 IRON SERUM 34.01 3016835506 83550 IRON BINDING CAPACITY TOTAL(T 36.29 3016836207 83615 LDH BLOOD 22.66 3016836900 83690 LIPASE 36.29 3016837353 83735 MAGNESIUM 28.34 3016840605 84060 PHOSPHATASE ACID TOTAL 36.29 3016840753 84075 PHOSPHATASE ALKALINE 36.29 3016840803 84080 PHOSPHATASE ALK ISOENZYME 85.90 301
127
6841009 84100 PHOSPHORUS BLOOD 27.16 3016841058 84105 PHOSPHORUS URINE 27.16 3016841405 84132 POTASSIUM BLOOD 27.16 3016841454 84133 POTASSIUM URINE 27.16 3016841553 84155 PROTEIN TOTAL BLOOD 22.66 3016841801 84155 URINARY PROTEIN 37.09 3016841850 86335 PROTEIN BENCE JONES 22.66 3026841959 84155 PROTEIN BODY FLUID 22.66 3016842957 84295 SODIUM BLOOD 27.16 3016843005 84300 SODIUM URINE 27.16 3016843302 82947 GLUCOSE BLOOD 22.66 3016843401 82951 GLUCOSE TOLERANCE 3-HRS 67.97 3016843807 82945 GLUCOSE BODY FLUID 22.66 3016844200 80198 THEOPHYLLINE 94.40 3016844557 84450 TRANSAMINASE AST(SGOT) 22.66 3016844656 84460 TRANSAMINASE ALT(SGPT) 22.66 3016844755 84478 TRIGLYCERIDES 34.01 3016845208 84520 UREA NITROGEN BLOOD 22.66 3016845408 84540 UREA NITROGEN URINE 23.59 3016845505 84550 URIC ACID BLOOD 20.19 3016849175 80184 PHENOBARBITAL 22.66 3016850000 85002 BLEEDING TIME 91.13 3056850208 85041 COUNT ERYTHROCYTE 11.33 3056850307 85048 COUNT WBC BLOOD 11.33 3056850309 89055 COUNT WBC STOOL 11.33 3056850406 85007 DIFFERENTIAL 11.33 3056850505 85018 HEMOGLOBIN ROUTINE 11.33 3056850553 86803 HEPATITIS C VIRUS AB 85.33 3026850554 85014 HEMATOCRIT 11.33 3056850604 85027 HEMOGRAM (HGB HCT RBC WBC 18.12 3056851008 38220 BONE MARROW ASPIRATION 956.88 3006851057 85097 BONE MARROW SMEAR:INTERPRETATI 340.63 3106851099 88313 BONE MARROW STAINING 62.83 3126853509 89190 EOSINOPHIL NASAL SMEAR 13.60 3056853625 85362 FIBRIN DEGRADATION FDP 37.09 3056853756 85385 FIBRINOGEN QUANTITATIVE 45.32 3056853905 85175 FIBRINOLYSIN QUAL CLOTLYSI 22.66 3056854928 82945 GLUCOSE CSF 23.37 3016855481 85060 RBC MORPHOLOGY 15.15 3056855601 88319 LEUKOCYTE MYLOPEROXIDASE 340.63 3106855801 85032 PLATELET COUNT MANUAL 13.60 305
128
6856106 85610 PROTHROMBIN TIME 22.66 3056856205 85555 RED CELL FRAGILITY 49.85 3056856213 85557 RED CELL INCUBATION 118.94 3056856403 85045 RETICULOCYTE COUNT AUTOMATED 15.84 3056856502 85652 SEDIMENTATION RATE ERYTHROCYT 15.84 3056856601 85660 SICKLE CELL SOLUBILITY 15.84 3056857302 85730 THROMBOPLASTIN TIME ACT PARTI 34.01 3056860108 86000 AGGLUTININS FEBRILE 67.97 3026860215 86870 ANTIBODY IDENTIFICATION 212.64 3006860256 86886 ANTIBODY TITER RH.ET 212.64 3006860264 86860 ANTIBODY ELUTION 144.85 3006860272 86978 ANTIBODY ABSORPTION 88.05 3006860280 86971 ANTIBODY DETECT W/ ENZYMES 144.85 3026860603 86060 ANTISTREPTOLYSIN O TITER 45.32 3026860702 86922 COMPATIBILITY TEST ANTIGLOB 144.85 3006860710 86078 TRANSFUSION RXN WORKUP 212.64 3106860801 86900 ABO SERUM GROUP 88.05 3006861007 86901 RH TYPING D 88.05 3006861106 86906 RH SUBTYPES EACH 88.05 3026861205 86905 RBC ANTIGEN TYPING-PATIENT 88.05 3006861403 86140 C-REACTIVE PROTEIN 22.66 3026861502 86157 COLD AGGLUTININS 45.32 3026862100 86592 RPR 18.53 3026862500 86880 ANTIBODY SCRN DIR COOMBS 144.85 3006862609 86885 AB SCREEN INDIRECT COOMBS 144.85 3006862872 87340 HEPATITIS B SURFACE AG(HBSAG) 54.38 3026862891 86704 HEPATITIS B CORE AB(HBCAB) 69.11 3026862962 86706 HEPATITIS BS AB(HBSAB) 52.95 3026863003 86308 HETEROPHILE ANTIBODY 26.03 3026863524 86741 CSF DIRECT AG FOR MENINGITIDI 79.21 3026863607 86430 LATEX FIXATION RA 45.32 3026863805 85009 L E PREP 45.32 3056863945 86762 RUBELLA TITER 102.82 3026863946 86762 RUBELLA SCREEN 67.41 3026865148 84156 PROTEIN URINE 23.37 3016869995 86703 HIV 1/2 ANTIBODY 87.65 3026869996 86701 HIV 1 ANTIBODY 85.33 3026870008 87205 SMEAR STAIN FOR BACTERIA 22.66 3066870107 87177 OVA AND PARASITE TEST 22.66 3066870110 87210 WET MOUNT BACTERIA FUNGI 21.91 3066870503 87040 CULTURE BLOOD DEFINITIVE 54.38 306
129
6870708 87070 CULTURE BODY FLUID 65.91 3066870870 87070 CULTURE CSF 65.91 3066870909 87070 CULTURE BACTERIAL 36.29 3066871105 87086 URINE SCREEN COLONY COUNT 45.32 3066871303 87088 BACTERIAL ID ADDITIONAL 22.66 3066871857 87186 SENSITIVITY MIC 45.32 3066873507 87166 DARKFIELD EXAMINATION 56.64 3066880007 88000 AUTOPSY GROSS ONLY 453.15 3106880048 80048 BASIC METABOLIC PANEL 80.79 3016880101 80353 COCAINE URINE QUALITATIVE 36.74 3016880205 88020 AUTOPSY EXC BRN/SPC(G+M) 906.31 3106880304 88027 AUTOPSY INC BRAIN/SPC 1246.20 3106880353 88099 AUTOPSY SPECIAL FORMAL REQ 934.64 3106881003 81003 URINALYSIS AUTO W/O SCOPE 7.40 3076881005 88164 CYTOLOGY DIAGNOCTIC 22.66 3116881054 88155 CYTOLOGY DX ESTROGEN INDEX 34.01 3116881104 88104 CYTOLOGY EXC GENITAL SMEARS 33.85 3116881302 88130 BUCCAL SMEAR CHROMATIN ID 45.32 3116882042 82042 ALBUMIN BODY FLUID QUANT 23.37 3016882150 82150 AMYLASE BODY FLUID 34.01 3016882271 82271 OCCULT BLOOD GASTRIC FLUID 20.03 3016882436 82436 CHLORIDE 24-HOUR URINE 29.20 3016882508 80329 SALICYLATES URINE\BLOOD 67.97 3016882570 82570 CREATININE BODY FLUID 23.37 3016882962 82962 GLUCOSE BLD BY MONITOR DEVICE 23.42 3016883001 88300 GROSS ONLY 33.85 3196883012 88332 TISSUE BLOCK PREP 15.15 3106883100 88304 TISSUE EXAM:SMALL-UNCOMPLICATE 74.77 3126883118 88311 DECALCIFICATION:BONE 22.66 3126883126 88312 SPECIAL STAIN:GROUP 1 62.83 3126883159 88305 GROSS & MICRO MULT SPEC-E 93.46 3126883202 88321 TISSUE SLIDES EACH 33.85 3106883357 88307 GROSS & MICRO COMPLIC 212.64 3106883605 83605 LACTIC ACID BODY FLUID 60.11 3016883721 83721 LDL CHOLESTEROL DIRECT 32.35 3016883880 83880 B-NATRIURETIC PEPTIDE (B-NP) 130.43 3016884133 84133 POTASSIUM 24-HOUR URINE 29.20 3016884156 84156 PROTEIN 24-HOUR URINE 26.23 3016884157 84157 PROTEIN OTHER BODY FLUID 26.23 3016884158 84157 PROTEIN CSF 49.63 3006884300 84300 SODIUM 24-HOUR URINE 29.20 301
130
6884302 84302 SODIUM BODY FLUID 38.76 3016884311 84311 CHOLESTEROL BODY FLUID 33.38 3016884315 84315 SPECIFIC GRAVITY BODY FLUID 16.71 3016884478 84478 TRIGLYCERIDE BODY FLUID 36.74 3016884512 84484 TROPONIN-I QUANTITATIVE 67.89 3016884560 84560 URIC ACID URINE 24-HR. 36.65 3016884703 84703 HCG SERUM QUALITATIVE 40.08 3016885025 85025 CBC W/ AUTOMATED DIFF 24.94 3056885027 85049 PLATELET COUNT AUTOMATED 18.12 3056885044 85044 RETICULOCYTE COUNT MANUAL 15.84 3056885460 85460 KLEIHAUER-BETKE TEST 77.34 3056885611 85611 PROTHROMBIN TIME MIXING STUDY 26.72 3056885732 85732 PTT MIXING STUDY 26.72 3056886593 86593 RPR TITER 49.83 3026886705 86705 HEPATITIS B CORE IGM 26.71 3026886850 86850 ANTIBODY PREWARM 134.28 3026886903 86902 ANTIGEN SCREEN-FOR COMPATIBLE 88.05 3006886921 86921 CROSSMATCH PREWARM 88.05 3026886923 86923 CROSSMATCH ELECTRONIC 144.85 3026887040 87040 CULTURE BONE MARROW 54.26 3066887070 87070 CULTURE SPUTUM 65.91 3066887086 87086 CULTURE URINE 65.91 3066887103 87103 FUNGAL CULTURE BLOOD 84.50 3066887184 87184 SUSCEPTIBILITY TEST KIRBY BAU 58.15 3066887449 87449 CLOSTRIDIUM DIFFICILE QUALI 34.52 3066887799 87799 BK VIRUS DNA QUANTITATIVE BY 326.82 3006887804 87804 INFLUENZA A & B SCREEN QUALIT 100.51 3066887807 87807 RESP SYNCYTIAL VIRUS QUALI 34.52 3066889999 89060 CRYSTALS SYNOVIAL FLUID 70.31 3006890501 89050 CELL CNT CSF 13.60 3006890503 89050 CELL CNT SYNOVIAL FLUID 12.11 3006890505 89050 CELL CNT OTHER BODY FLUIDS 13.60 3006890519 89051 DIFFRENTIAL CSF 22.66 3006890521 89051 CELL CNT W/ DIFF SYNOVIAL FL 22.66 3006890523 89051 DIFFERENTIAL OTHER BODY FLUID 22.66 3006891202 82270 OCCULT BLOOD FECES FAT 22.66 3016892002 86910 PATERNITY TEST 9 ANTRS 113.27 3006893208 89320 SEMEN ANALYSIS 90.66 3006895001 A4649 FILTER LEUKOCYTE PALL RC10 348.34 2726895002 A4649 LEUCOCYTE REMOVAL FILTER PL100 637.76 2726895003 80320 ALCOHOL BLOOD: QUANTITATIVE 54.02 301
131
6895004 88305 BONE MARROW:CELL BLOCK 224.90 3126895005 88313 SPECIAL STAIN:GROUP 2 107.30 3126895006 88302 TISSUE EXAM:IDENTIFICATION 176.87 3126895007 88309 TISSUE EXAM:RADICAL/SPECIAL 361.70 3106895008 86985 BLOOD UNIT:SPLITTING 144.85 3906895009 36513 PLATELET CONCENTRATE:PHERESIS 567.95 9406895010 86965 PLATELETS:POOLED 144.85 3906895011 36514 THERAPEUTIC PLASMAPHERESIS 581.89 3006895012 36430 TRANSFUSION:PANEL 195.95 3916895013 86890 AUTOLOGOUS BLOOD:PREDEPOSITED 175.53 3906895015 80307 DRUG ABUSE SCRN:URINE/QUAL(5-6 93.91 3016896001 A4649 BOWL:THERAPEUTIC PLASMA EXCHAN 748.24 2726896002 A4649 SDP:PACK 702.60 2726896003 83540 IRON:LIVER TISSUE 128.98 3016896004 87798 HCV-RNA QUANTITATIVE BY PCR 224.68 3066896005 87798 RSV RNA PCR (RESPI SYNCYNTIAL 123.09 3006896006 87798 BK VIRUS DNA QUALITATIVE BY P 379.77 3006896007 81015 URINALYSIS MICROSCOPIC 8.91 3076896008 80307 TOX SCREEN:6 TEST (GOVGUAM) 0.00 3016896009 80307 TOX:DRUG CONFIRM /TEST (GOVGUA 49.78 3016896010 80307 TOX SCREEN:5 TEST (GOVGUAM) 31.91 3016896011 80307 TOX:NIDA 5 (FEDERAL) 0.00 3016896012 86677 H. PYLORI IGA & IGG 57.45 3026896013 86682 ECHINOCOCCUS AB IGG 77.15 3026896014 80375 AMIODARONE LEVEL 28.32 3016896015 84134 PRE-ALBUMIN LEVEL 23.13 3016896021 82157 ANDROSTENEDIONE 69.73 3016896022 87390 HIV-1 ANTIGEN TEST 153.91 3026896023 88184 T4 CELL COUNT 212.64 3116896024 82948 GLUCOSE-CHEMSTRIP 21.99 3016896025 84479 T3 UPTAKE 35.19 3016896026 84436 T4 TOTAL 35.19 3016897000 81002 URINE COMPONENT 13.80 3076897010 87207 MALARIA SMEAR 49.82 3066897012 MORGUE PROCESSING FEE 63.82 9996899001 P9060 FRESH FROZEN PLASMA ALIQUOT 497.73 3836899002 P9017 FRESH FROZEN PLASMA EACH UNIT 937.30 3836899003 P9011 PACKED RED CELL ALIQUOT 431.72 3816899004 P9021 RED BLOOD CELLS EACH UNIT 937.30 3816899005 P9011 BLOOD SPLIT UNIT 387.64 3906899006 P9010 WHOLE BLOOD PER UNIT 937.30 382
132
6899007 P9019 PLATELET SINGLE ISSUE 937.30 3846899008 P9034 PLATELETS PHERESIS EACH UNIT 1356.88 3846899014 80162 DIGOXIN LANOXIN 77.54 3016899999 LAB MISCELLANEOUS 0.00 3096990004 89240 LAB HANDLING FEE 62.83 3106991955 99195 PHLEBOTOMY THERAPEUTIC 91.25 9407000001 A4649 SUTURE VICRYL 0 12X18 LIG 76.14 2727000003 A4649 NERVE LOCATOR NEURO-PULSE 210.65 2727000005 A4649 SUTURE CHROMIC 1 8X18 MO-2 136.12 2727000010 A4649 STEM CENTRALIZER 10MM 548.03 2727000011 A4649 SUTURE CHROMIC 1 8X18 CT-1 226.01 2727000012 A4649 CAUTERY TIP TEFLON 58.82 2727000013 A4649 SUTURE SILK 3-0 8X18 SH 123.49 2727000015 A4649 MASK FACE SAFETY SHIELD 8.66 2727000016 A4649 SUTURE SILK 2-0 8X30 SH 92.87 2727000017 A4649 SUTURE SILK 3-0 8X30 SH 111.08 2727000018 A4649 TUBING INSUFFLATOR PNEUMOSURE 10.80 2727000020 A4649 LIGACLIP APPLIER TITANIUM TIM- 905.23 2727000021 MINOR SURGERY 1ST 30 MIN 721.60 3617000024 A4649 CATHETER GROSHONG 1-LUMEN 9.5F 1263.52 2727000025 A4649 SET INFLATION DEVICE 562.91 2727000026 A4649 SUTURE STEEL 0 17X18 11.62 2727000028 A4649 SUTURE STEEL 2-0 17X18 10.96 2727000029 A4649 DAVIS LOOP ST EXT FR4-70 67.41 2727000030 A4649 FORCEPS GRASPING FR3.7-65 400.49 2727000031 A4649 TUBE SUCTION IRRIG W/ TIP 258.64 2727000032 A4649 SUTURE STEEL 0 4-0 17X18 10.35 2727000035 A4649 CUTTER LINEAR ENDO TSB-35 1329.20 2727000037 A4649 BUR ROUND FLUTED XKP 3.0MMX50M 820.27 2727000038 A4649 BUR ROUND FLUTED XKP 3.5MMX50M 713.71 2727000039 A4649 BUR ROUND FLUTED XKP 4.0MMX50M 811.37 2727000040 A4649 BUR ROUND FLUTED XKP 5.0MMX50M 817.48 2727000041 A4649 SUTURE CHROMIC 0 8X18 CT-1 14.18 2727000042 A4649 CATHETER BROVIAC 1-LUMEN 2.7FR 711.70 2727000043 A4649 SUTURE PLAIN 3-0 8X18 CT-1 94.41 2727000044 A4649 SUTURE CHROMIC 0 27 XLH 23.98 2727000045 A4649 SUTURE CHROMIC 1 27 XXLH 61.08 2727000046 A4649 BUR ROUND XKP 3.0MMX70MM 816.73 2727000047 MAJOR SURGERY 1ST HOUR 1564.16 3607000048 A4649 SUTURE CHROMIC 1 27 BP-1 36.83 2727000050 A4649 BUR ROUND XKP 6.0MMX70MM 749.88 272
133
7000051 A4649 SUTURE CHROMIC 0 8X18 CT 77.60 2727000052 L5999 PROSTHESIS HIP AUSTIN MOORE 52 2074.19 2747000053 A4649 DISSECTOR CURVED W/ CAUTERY 972.81 2727000054 A4649 SUTURE SILK 3-0 144 REEL 89.23 2727000055 A4649 CUTTER LINEAR TLC-55 1049.90 2727000056 A4649 BUR DIA ROUND XKP 7.0MMX70MM 860.24 2727000057 A4649 BUR ACORN XKP 5.0MMX70MM 860.24 2727000058 A4649 SUTURE NUROLON 4-0 8X18 RB-1 39.53 2727000059 A4649 BUR MATCH HEAD XKP 3.0MMX70MM 756.53 2727000060 A4649 STAPLER LINEAR TL-60 1031.27 2727000061 A4649 BUR ROUND XKP 3.5MMX90MM 713.71 2727000062 A4649 DVT 10 GARMENT LOWER EXTRM 333.23 2727000066 A4649 SUTURE SILK 0 17X18 27.32 2727000067 A4649 BUR ROUND FLUTED XKP 4.0MMX110 774.55 2727000069 A4649 BUR ROUND FLUTED XKP 6.0MMX110 825.14 2727000070 A4649 INSTRUMENTS-ADDITIONAL 64.91 2727000071 A4649 TRAY MINOR SET 216.43 2727000072 A4649 TRAY MAJOR SET 276.77 2727000073 A4649 CRANIOTOME ADT XKP 1.8MMX16MM 442.45 2727000075 A4649 CUTTER LINEAR TLC-75 1213.18 2727000080 A4649 SUTURE VICRYL 0 V 8X27 MO-5 236.24 2727000081 A4649 LIGACLIP STAINLESS STEEL MED 50.95 2727000082 A4649 BLADE ARTHRO CUTTER AGGRES 2.5 581.66 2727000086 A4649 SUTURE MERSILENE 10X30 11.26 2727000089 A4649 TUBING PENROSE 5/8X18 7.54 2727000090 A4649 STAPLER LINEAR TL-90 1051.33 2727000091 A4649 TUBING PENROSE 1/2X18 3.08 2727000093 A4649 NITROUS OXIDE 0.00 2707000095 A4649 VALVULATOME 1000-95 1539.43 2727000100 A4649 TROCAR ENDOSCOPIC 11MM 786.29 2727000101 A4649 SET SINGLE PUNCTURE INTRODUCER 520.39 2727000102 A4649 TROCAR ENDOSCOPIC 12MM 791.73 2727000103 A4649 SUTURE PLAIN 2-0 54REEL 40.18 2727000104 MINOR SURGERY ADD 15 MIN 120.29 3617000107 A4649 SUTURE PDS 0 18 ENDOLOOP 215.32 2727000111 A4649 SUTURE CHROMIC 4-0 54 STD 10.10 2727000112 A4649 SUTURE CHROMIC 3-0 27 TE 18.80 2727000114 A4649 SUTURE CHROMIC 0 54 REEL 7.32 2727000115 A4649 SUTURE CHROMIC 1 54 REEL 28.78 2727000116 A4649 SUTURE CHROMIC 2 54 STD 9.21 2727000120 MAJOR SURGERY ADD 15 MIN 260.68 360
134
7000121 A4649 SUTURE CHROMIC 4-0 27 SH 35.67 2727000123 A4649 SUTURE CHROMIC 2-0 27 SH 29.38 2727000124 A4649 SUTURE VICRYL 0 V 27 SH 13.51 2727000125 A4649 SUTURE CHROMIC 1 27 SH 10.29 2727000127 A4649 SUTURE CHROMIC 1 30 GS-12 20.33 2727000129 A4649 SUTURE CHROMIC 1 27 MH 11.40 2727000130 A4649 SUTURE VICRYL 2-0 U 12X18 105.00 2727000132 A4927 GLOVES SURG S-8-1/2 SPEC 4.47 2727000134 A4927 GLOVES SURG S-7 SPEC 3.36 2727000135 A4927 GLOVES SURGEON S-7 1.49 2727000138 A4927 GLOVES SURGEON S-7-1/2 4.17 2727000139 A4649 BELT RIBS 36X42 FEMALE 47.30 2747000142 A4649 SUTURE SILK 4-0 8X18 SH 117.08 2727000148 A4927 GLOVES SURGEON S-8-1/2 3.14 2727000151 A4649 SUTURE CHROMIC 1 12X18 37.93 2727000154 A4649 IMPLANT DEFIBRILLATOR D154VWC 25256.08 2727000160 A4649 COUDE TIP HEMATURIA 22FR 30CC 55.72 2727000163 A4927 GLOVES SURG S-7-1/2 ULTRA 10.29 2727000166 A4927 GLOVES SURGEON S-7 ULTRA 3.99 2727000168 A4352 CATHETER COUDE TIP 16FR 5CC 92.07 2727000169 A4352 CATHETER COUDE TIP 18FR 5CC 92.07 2727000170 A4652 CATHETER COUDE TIP 20FR 5CC 92.07 2727000182 A4649 SUTURE SILK 5-0 12X18 7.96 2727000184 A4649 SUTURE SILK 3-0 12X18 17.55 2727000185 A4649 SUTURE SILK 2-0 12X18 16.44 2727000186 A4927 GLOVES SURG S-8 SPEC 3.26 2727000187 OR P.E. TUBE 1ST 15 MIN 190.93 3607000201 A4649 TROCAR 5MM 701.19 2727000202 A4649 0NAIL FEMUR TFNA LT 10MMX400MM 4110.96 2727000203 OR P.E. TUBE ADD 15 MIN 89.10 3607000208 A4649 NEEDLE VERESS 150MM DISP 305.30 2727000210 A4649 SUTURE PDS 5-0 P-3 18 82.23 2727000221 A4649 KIT ENDOSCOPIC LIGATOR 488.42 2727000227 A4649 SET CONT BLADDER IRRIG 25.38 2727000228 A4649 BLADE SURGICAL #101115 1.49 2727000231 A4649 TUBING U.V.A.C. 77.89 2727000233 A4649 SET TUR SINGLE 46.53 2727000245 A4649 SUTURE CHROMIC 2-0 27 UR-5 16.88 2727000246 A4649 SUTURE CHROMIC 0 27 UR-5 13.44 2727000256 A4649 SUTURE CHROMIC 0 27 UR-4 17.77 2727000258 A4649 DEVON INSTRUMENT WIPE 16.62 272
135
7000259 A4649 SUTURE VICRYL 2-0 U 27 CT-1 28.93 2727000261 A4649 SUTURE VICRYL 1 U 27 CT-1 25.28 2727000266 A4649 NEEDLE A-V FISTULA 4.91 2727000278 A4649 NEURO PATTIE 3/4X3/4 16.62 2727000279 A4649 NEURO PATTIE 1X1 16.62 2727000296 A4649 CDH21 ILS 1508.58 2727000297 A4649 CDH25 ILS 1508.58 2727000298 A4649 CDH29 ILS 1508.58 2727000299 A4649 CDH33 ILS 1508.58 2727000300 A4649 STAPLER LINEAR TL-30 1021.25 2727000301 A4649 RELOAD STAPLER LINEAR TR-30 704.71 2727000302 A4649 KIT SOFTCELL PERMACATH 12.5FRX 866.60 2727000303 A4649 KIT SOFTCELL CATH 12.5FR 17CM 797.67 2727000312 A4649 ELECTRODE LEEP 3.0MMX12CM 125.48 2727000314 A4649 LIGACLIP TC100 SML TITANIUM 27.32 2727000315 A4649 LIGACLIP TC200 MED TITANIUM 32.01 2727000317 A4649 LIGACLIP TC300 LGE TITANIUM 42.34 2727000318 A4649 LIGACLIP TC400 XLGE TITANIUM 56.12 2727000320 A4649 NAIL FEMUR TFNA RT 10MMX420MM 4110.96 2727000325 A4649 EXT FIX MINI CARB ROD 3MMX25MM 224.70 2727000326 A4649 ENDOLOOP VICRYL 199.59 2727000345 A4649 EXT FIX MINI CARB ROD 3MMX45MM 224.70 2727000350 A4649 STAPLER SKIN CLOSURE 35MM 247.79 2727000351 A4649 RELOAD CUTTER LINEAR ENDO TR35 991.17 2727000360 A4649 EXT FIX MINI CARB ROD 3MMX60MM 224.70 2727000370 A4649 DENTAL ARCH BAR BENDICK 120.09 2727000375 A4649 EXT FIX MINI CARB ROD 3MMX75MM 221.78 2727000423 A4649 CATHETER CUTDOWN 4.94 2727000426 A4649 SUTURE MONOCRYL 4-0 27 PS-2 N 79.46 2727000437 A4649 SPECIMEN TRAP 40ML 7.50 2727000441 A4649 SUTURE VICRYL 4-0 U 27 FS-1 28.93 2727000450 A4649 SCREW CANC POLARUS 5MMX40MM 411.02 2727000461 A4649 LEAD PACEMAKER 5076-52 1732.27 2757000462 A4649 LEAD PACEMAKER 5076-58 1732.27 2757000470 A4649 BUR ROUND XKP 3.5MMX70MM 713.71 2727000472 A4649 NAIL UNIV FEMUR 10MMX340MM 1676.20 2727000482 A4649 SUTURE SILK 2LR/LR DA 22.44 2727000483 A4649 CYSTO SUPUB DRAIN #330-8 112.13 2727000484 A4649 PACK CYSTOSCOPY 21.34 2727000486 A4649 PACK ARTHROSCOPY 149.59 2727000491 A4649 LEAD PACEMAKER 5568-45 1595.51 275
136
7000492 A4649 SUTURE VICRYL 6-0 U 18 P-3 54.63 2727000493 A4649 SUTURE VICRYL 5-0 U 18 P-3 68.20 2727000496 A4649 SUTURE ETHIBOND 2 30 LR 18.27 2727000499 A4649 LIGATURE-MERSILENE R499 31.95 2727000512 A4649 ELECTRODE LEEP 5.0MMX12CM 125.48 2727000516 A4649 LIGACLIP LS300 LGE STEEL 47.99 2727000520 A4649 BUR DIA ROUND XKP 3.0MMX70MM 786.84 2727000522 A4649 CATHETER BROVIAC 1-LUMEN 4.2FR 811.71 2727000527 A4649 SCREW CORTEX MD HD 1.0MMX7MM 274.74 2727000528 A4649 SCREW CORTEX MD HD 1.0MMX8MM 274.74 2727000529 A4649 SCREW CORTEX MD HD 1.0MMX9MM 274.74 2727000530 A4649 SCREW CORTEX MD HD 1.0MMX10MM 274.74 2727000531 A4649 SCREW CORTEX MD HD 1.0MMX11MM 274.74 2727000532 A4649 SCREW CORTEX MD HD 1.0MMX12MM 274.74 2727000533 A4649 SCREW CORTEX MD HD 1.0MMX13MM 274.74 2727000534 A4649 SCREW CORTEX MD HD 1.0MMX14MM 387.28 2727000535 A4649 SCREW XIA MONOAXIAL 5.5X7MM 1982.33 2727000540 A4649 CATHETER BROVIAC 1-LUMEN 6.6FR 879.35 2727000542 A4649 CATHETER BROVIAC W/ SURECUFF 6 803.45 2727000550 A4649 BUR DIA ROUND XKP 6.0MMX70MM 830.84 2727000551 A4649 RELOAD CUTTER LINEAR TCR-55 895.21 2727000564 A4649 DERMACARRIERS II 51.24 2727000571 A4216 WATER DISTILLED STERILE 4.91 2727000572 A4649 CATHETER HICKMAN 2-LUMEN 7FR 986.88 2727000600 A4649 KIT CATH HICKMAN 2-LUMEN 13.5F 960.04 2727000601 A4649 RELOAD STAPLER LINEAR TR-60 833.63 2727000603 A4649 CURETTE UVAC STRAIGHT 10MM 16.15 2727000619 A4649 SUTURE SILK 4-0 30 TS 10.23 2727000621 A4649 SUTURE SILK 4-0 30 KS 8.74 2727000622 A4649 CATHETER HICKMAN 2-LUMEN 12FR 1009.86 2727000623 A4649 SUTURE SILK 2-0 30 KS 9.94 2727000626 A4649 SUTURE ETHILON 4-0 18 KS 9.80 2727000627 A4649 SUTURE ETHILON 3-0 18 KS 16.10 2727000630 A4649 BUR ROUND XKP 5.0MMX90MM 795.10 2727000635 A4649 SCREW XIA MONOAXIAL 6.5X35MM 2204.35 2727000636 A4649 SUTURE CHROMIC 3-0 27 FS-2 32.54 2727000638 A4649 CATHETER BILIARY STONE REMOVAL 842.21 2727000640 A4649 BUR ROUND XKP 6.0MMX90MM 803.93 2727000653 A4649 SUTURE VICRYL 3-0 V 27 KS 37.04 2727000654 A4649 SUTURE VICRYL 4-0 V 27 KS 25.86 2727000656 A4649 SUTURE VICRYL 4-0 18 PS-4 32.82 272
137
7000661 A4649 SUTURE ETHILON 5-0 18 FS-2 27.27 2727000662 A4649 SUTURE ETHILON 4-0 18 FS-2 27.62 2727000673 A4649 SUTURE ETHILON 3-0 30 FSLX 23.54 2727000675 A4649 SUTURE SILK 3-0 30 FSL 10.61 2727000676 A4649 SUTURE SILK 3-0 18 FSL 16.14 2727000679 A4649 SHUNT CAROTID BYPASS 10FRX13CM 229.58 2727000681 A4649 SHUNT CAROTID BYPASS 12FRX13CM 250.94 2727000682 A4649 SUTURE SILK 5-0 18 FS-2 30.78 2727000683 A4649 SUTURE SILK 4-0 18 FS-2 25.79 2727000684 A4649 SUTURE SILK 3-0 18 FS-1 23.93 2727000685 A4649 SUTURE SILK 2-0 18 FS 31.09 2727000687 A4649 SCREW CORTEX MD HD 1.3MMX7MM 365.36 2727000688 A4649 SCREW CORTEX MD HD 1.3MMX8MM 365.36 2727000689 A4649 SCREW CORTEX MD HD 1.3MMX9MM 365.36 2727000690 A4649 SCREW CORTEX MD HD 1.3MMX10MM 365.36 2727000691 A4649 SUTURE VICRYL 4-0 U 27 FS-2 9.78 2727000692 A4649 SCREW CORTEX MD HD 1.3MMX12MM 260.14 2727000693 A4649 SCREW CORTEX MD HD 1.3MMX13MM 260.14 2727000694 A4649 GUIDEWIRE BILIARY SS 0.035X450 329.44 2727000696 A4649 SUTURE ETHILON 6-0 18 P-3 49.31 2727000698 A4649 SUTURE ETHILON 5-0 18 P-3 56.12 2727000699 A4649 SUTURE ETHILON 4-0 18 P-3 62.55 2727000701 A4649 SUTURE PROLENE 7-0 18 DA BV-1 165.95 2727000703 A4649 SUTURE PROLENE 6-0 30 BV-1 116.63 2727000707 A4649 SUTURE PROLENE 6-0 24 DA CC 185.02 2727000710 A4649 BUR MATCH HEAD XKP 3.0MMX110MM 763.54 2727000711 A4649 TUBEGAUZE ELASTIC NET SZ 10 /Y 6.29 2727000736 A4649 SUTURE SILK 4-0 18 C-3 99.46 2727000739 A4649 SUTURE SILK 4-0 18 M-2 12.06 2727000741 A4649 SUTURE PLAIN 4-0 12 M-1 20.67 2727000746 C1820 ANALYZER-AV PACING SYSTEM 842.78 2787000751 A4649 RELOAD CUTTER LINEAR TCR-75 981.15 2727000754 A4649 SUTURE VICRYL 0 U 3X18 OS-6 117.21 2727000757 A4649 SUTURE VICRYL 1 U 3X18 OS-8 117.21 2727000776 A4649 VACUTAINER ANAEROBIC SPEC 28.01 2727000784 A4649 SUTURE VICRYL 3-0 V 8X27 SH 161.49 2727000791 C1785 PACEMAKER PERM KSR 900SR 8698.52 2757000792 A4649 SUTURE CHROMIC 5-0 18 G-3 152.87 2727000801 A4649 SUTURE SILK 6-0 18 BV-1 100.04 2727000802 A4649 SUTURE CHROMIC 0 27 CT 27.71 2727000803 A4649 SUTURE CHROMIC 1 27 CT 44.26 272
138
7000807 A4649 SCREW CORTEX ST 1.5MMX7MM 74.91 2727000808 A4649 SCREW CORTEX ST 1.5MMX8MM 74.91 2727000809 A4649 SCREW CORTEX ST 1.5MMX9MM 74.91 2727000810 A4649 SUTURE VICRYL 3-0 V 27 CT 26.40 2727000811 A4649 SUTURE CHROMIC 2-0 27 CT-1 33.16 2727000812 A4649 SCREW CORTEX ST 1.5MMX12MM 74.91 2727000813 A4649 SUTURE CHROMIC 1 27 CT-1 30.04 2727000814 A4649 SCREW CORTEX ST 1.5MMX14MM 74.91 2727000816 A4649 SCREW CORTEX ST 1.5MMX16MM 137.01 2727000817 A4649 SUTURE CHROMIC 0 27 CP-1 3.90 2727000818 A4649 SCREW CORTEX ST 1.5MMX18MM 137.01 2727000820 A4649 ROD HUMERAL POLARUS 8MMX200MM 1368.48 2727000822 A4649 SUTURE VICRYL 3-0 U 27 FS-2 31.12 2727000824 A4649 ROD HUMERAL POLARUS 8MMX240MM 1219.40 2727000826 A4649 ROD HUMERAL POLARUS 8MMX260MM 1219.40 2727000828 A4649 ROD HUMERAL POLARUS 8MMX280MM 1219.40 2727000830 A4649 SCREW CORTEX ST 1.5MMX30MM 113.26 2727000831 A4649 SUTURE SILK 4-0 30 SH 21.04 2727000832 A4649 SUTURE SILK 3-0 30 SH 20.12 2727000833 A4649 SUTURE SILK 2-0 30 SH 19.37 2727000836 A4649 IMPLANT DEFIB VVI D274VRC 21575.24 2707000837 C1785 IMPLANT DEFIB D274DRG VIRT 27961.02 2757000839 A4649 IMPLANT DEFIB D224TRK CONS 34473.69 2727000840 A4649 IMPLANT DEFIB VVI D284VRC 25069.81 2707000841 C1785 PACEMAKER PERM KDR 900DR 10229.67 2757000842 C1785 PACEMAKER ENPULSE E2 DRO1 9664.73 2757000843 C1786 PACEMAKER ENPULSE E2 SR01 8297.06 2757000844 C1785 PACEMAKER ENRHYTHM DUAL-CHAMBE 10211.79 2757000845 C1786 PACEMAKER ENRHYTHM SINGEL-CHAM 10211.79 2757000846 C1786 PACEMAKER SIGMA SSR303 5698.51 2757000847 C1785 PACEMAKER ADAPTA ADDR01 10211.79 2757000848 C1785 PACEMAKER VERSA VEDRO1 9664.73 2757000849 C1785 PACEMAKER SENSIA SESR01 9748.36 2757000854 A4649 SUTURE VICRYL 0 U 27 29.01 2727000864 A4649 SUTURE CHROMIC 0 27 CTX 33.61 2727000865 A4649 SUTURE CHROMIC 1 27 CTX 27.39 2727000871 A4649 SUTURE SILK 4-0 30 RB-1 21.78 2727000877 A4649 SUTURE VICRYL 0 V 27 UR-6 30.11 2727000880 A4649 NEEDLE LOOSE EYE 2.48 2727000883 A4649 SUTURE CHROMIC 2-0 27 CT-2 24.61 2727000901 A4649 RELOAD STAPLER LINEAR TR-90 882.30 272
139
7000903 A4649 SUTURE VICRYL 4-0 V 12X18 111.00 2727000904 A4649 SUTURE CHROMIC 0 36 CTX 33.16 2727000905 A4649 SUTURE VICRYL 2-0 V 12X18 107.87 2727000910 A4649 SUTURE VICRYL 3-0 U 12X18 107.53 2727000911 A4649 SUTURE ETHIBOND 2-0 8X18 CT-1 20.16 2727000912 A4649 SUTURE VICRYL 0 U 12X18 97.24 2727000913 A4649 SUTURE CHROMIC 2-0 36 CT 32.37 2727000914 A4649 SUTURE VICRYL 0 U 36CT 26.60 2727000915 A4649 SUTURE VICRYL 1 V 36 CT 26.01 2727000920 A4649 MICRODON 0.00 2727000922 A4649 SUTURE CHROMIC 3-0 36 CT-1 32.88 2727000923 A4649 SUTURE CHROMIC 2-0 36 CT-1 47.65 2727000924 A4649 SUTURE CHROMIC 0 36 CT-1 11.11 2727000925 A4649 SUTURE CHROMIC 1 36 CT-1 32.88 2727000942 A4649 RELOAD ETS 45MM 4.1MM TR45G 351.92 2727000943 A4649 RELOAD ETS 45MM 2.5MM TR45W 649.28 2727000945 A4649 SUTURE VICRYL 2-0 U 36 CT-1 28.38 2727000952 A4649 SUTURE CHROMIC 1 8X18 MO-5 313.11 2727000955 A4649 SUTURE VICRYL 1 U 36 CT-1 32.37 2727000962 A4649 SUTURE VICRYL 3-0 U 36 CT 31.16 2727000963 A4649 SUTURE VICRYL 2-0 U 36 CT 25.03 2727000982 A4649 SUTURE CHROMIC 3-0 54 CT-1 51.81 2727000983 A4649 SUTURE CHROMIC 2-0 54 CT-1 31.65 2727001000 A4649 HEMOCONCENTRATOR HPH1000 CBP 822.78 2727001001 C1713 PLATE KLS STR 2.3MM 16 HOLE 1116.82 2787001002 A4649 CATHETER PERCUTANEOUS CHOLANGI 163.30 2727001008 A4649 BAIR BLANKET UNDERBODY 635 336.41 2727001010 A4649 SUTURE PLAIN 4-0 54STD 8.69 2727001011 A4649 BAIR BLANKET LOWER BODY 94.45 2727001012 A4649 BAIR BLANKET SML LOWER BODY 151.12 2727001013 A4649 BAIR BLANKET FULL BODY 75.56 2727001014 A4649 BAIR BLANKET UNDERBODY 585 265.62 2727001015 A4649 BAIR BLANKET UNDERBODY 545 206.52 2727001020 A4649 ELECTRODE LEEP 2.0CMX1.0CM 125.48 2727001035 A4649 SHEATH URETERAL 10/12FR 35 CM 775.11 2727001037 A4649 CLIP RANEY/PK 47.37 2727001038 A4649 DRILL BIT JL 1.0MMX60MM 610.98 2727001041 A4649 DRILL BIT JL 1.3MMX65MM 610.98 2727001042 A4649 DRILL BIT JL STOP 0.76MMX8MM 791.30 2727001045 A4649 DRILL BIT JL STOP 0.76MMX10MM 791.30 2727001046 A4649 DRILL BIT JL STOP 0.76MMX12MM 791.30 272
140
7001047 A4649 DRILL BIT JL STOP 0.76MMX14MM 791.30 2727001048 A4649 DRILL BIT MQC 1.1MMX55MM 610.98 2727001050 A4649 SCREW CANNUL PT 3.5MMX10MM 666.41 2727001061 A4649 SUTURE MERSILENE 0 8X18 CT-1 120.36 2727001100 A4649 KIT PERCUTANEOUS TRACT 1718.80 2727001111 A4649 SUTURE VICRYL 2-0 U 18 140.95 2727001115 A4649 ROD HUMERAL POLARUS 11MMX150MM 1483.31 2727001121 A4649 SUTURE CHROMIC 3-0 54 REEL 31.93 2727001131 A4649 SUTURE CHROMIC 2-0 54 STD 10.51 2727001132 A4649 SUTURE CHROMIC 2-0 54 REEL 39.25 2727001140 A4649 OXYGENATOR SX25 CBP 1084.85 2727001141 A4649 SUTURE PDS 2-0 27 UCL 50.59 2727001151 A4649 SUTURE CHROMIC 1 54 STD 9.94 2727001175 A4649 BLADE SAW GIGLI ROUND 97.42 2727001182 C1713 PLATE DHS 135* 10 HOLE 1272.73 2787001200 A4649 INTRODUCER SHEATH SAFETY WIRE 306.52 2727001214 A4649 SUTURE VICRYL 4-0 27 RB-1 30.56 2727001216 A4649 CANNULA RETRO CARDIOPLEGIA CBP 796.40 2727001220 A4649 SET INTRODUCER NEEDLE 20CM 267.84 2727001221 A4649 SUTURE VICRYL 3-0 V 27 SH 24.55 2727001231 A4649 SUTURE VICRYL 2-0 V 27 SH 31.06 2727001235 A4649 SHEATH URETERAL 12/14FR 35CM 775.11 2727001241 A4649 SUTURE CHROMIC 0 27 SH 30.78 2727001249 A4649 SET ADMINISTRATION HOTLINE 129.85 2727001250 A4649 SUTURE SUPRAMID 5-0 1/2C REV C 34.43 2727001260 A4649 SUTURE SUPRAMID 6-0 1/2C REV C 34.43 2727001277 A4649 CANNULA TAPER TIP - ERCP 681.88 2727001278 C1769 GUIDEWIRE HYDRA JAG 260CM ANG 1280.94 2727001289 C1769 GUIDEWIRE HYDRA JAG 460CM STR 1280.94 2727001290 A4649 KNIFE NEEDLE TRIPLE LUMEN 7FR 952.11 2727001309 A4649 DRAIN JACKSON-PRATT 10MM 287.91 2727001312 A4649 SUTURE CHROMIC 2-0 12X18 45.83 2727001314 A4649 SUTURE GII QUICKANCHOR PLUS 2539.26 2727001399 A4649 NEURO PATTIE 1/4X1/4 10.22 2727001400 A4649 SET MULTIPLE PERFUSION-CBP 137.12 2727001402 A4649 NEURO PATTIE 1/2X1 1.54 2727001411 A4649 SUTURE CHROMIC 0 12X18 108.66 2727001412 A4649 PROBE TEMP RECTAL/ESOPH DISP 13.57 2727001422 C1713 PLATE DCP NR 4.5MM 10-HOLE 825.52 2787001430 A4649 LEAD INTRO PERCUT 7FR-BROVIAC 411.08 2727001439 A4649 IMPLANT SUBTALAR TITANIUM 2089.88 272
141
7001472 A4649 NAIL UNIV FEMUR 11MMX340MM 1224.89 2727001507 A4649 ELECTRODE LEEP 1.5MMX0.7CM 125.48 2727001535 A4649 SCREW XIA MONOAXIAL 5.5X7MM 2204.35 2727001552 A4649 ELECTRODE NEEDLE TIP 8.25 2727001577 A4649 REDUCER CAP ONE SEAL 5-12MM 76.36 2727001594 A4649 SUTURE VICRYL 5-0 27 RB-1 29.61 2727001602 A4649 FILTER BLOOD TRANSFUSION MICRO 101.13 2727001603 A4649 SUTURE ETHILON 4-0 CLR 18 PS- 47.40 2727001604 A4649 BRUSH CYTOLOGY-BRONCHOSCOPY 16 187.64 2727001613 A4649 BRUSH CYTOLOGY-COLON 2.2MMX220 120.09 2727001614 A4649 SUTURE VICRYL 5-0 U 18 PS-5 67.88 2727001615 A4649 NEEDLE BIOPSY QUICKCORE 16-15. 296.86 2727001620 A4649 BALLOON HP NEPHROMAX 30FR 3104.23 2727001626 A4649 SUTURE VICRYL 5-0 U 18 PS-3 63.87 2727001627 A4649 SUTURE PLAIN 4-0 18 PS-2 31.23 2727001628 A4649 SUTURE VICRYL 3-0 U 18 PS-2 54.08 2727001635 A4649 SCREW XIA POLYAXIAL 6.5X35MM 2204.35 2727001640 A4649 SCREW XIA POLYAXIAL 6.5X40MM 2204.35 2727001657 A4649 WATER TRAP TUBING 18.20 2727001663 A4649 SUTURE ETHILON 3-0 18 PS-1 49.26 2727001665 A4649 SUTURE ETHILON 6-0 18 PS-3 57.69 2727001666 A4649 SUTURE ETHILON 5-0 18 PS-2 57.14 2727001667 A4649 SUTURE ETHILON 4-0 18 PS-2 54.89 2727001669 A4649 SUTURE ETHILON 3-0 18 PS-2 54.84 2727001674 A4649 SUTURE ETHILON 2-0 30 FSLX 22.98 2727001690 A4649 SUTURE VICRYL 4-0 U 18 P-3 55.53 2727001697 A4649 SUTURE ETHILON 6-0 18 P-1 49.39 2727001698 A4649 SUTURE ETHILON 5-0 18 P-3 49.39 2727001742 A4649 SUTURE VICRYL 6-0 V 12 S-29 177.93 2727001744 A4649 SUTURE CHROMIC 7-0 18 TG100-8 264.23 2727001756 A4649 SUTURE PROLENE 10-0 12 CS-140 167.19 2727001770 A4649 SUTURE ETHILON 10-0 12 140-6 137.53 2727001790 A4649 SUTURE PROLENE 10-0 12 TG-160 84.03 2727001794 A4649 SUTURE CHROMIC 6-0 18 DA S-14 177.06 2727001795 A4649 SUTURE PROLENE 9-0 12 TG-140- 84.41 2727001797 A4649 SUTURE CHROMIC 7-0 18 TG140-8 149.35 2727001800 A4649 SCREW CORTEX ST 1.5MMX10MM 74.91 2727001801 A4649 VESSELCLAMP SOFT SPRING-CBP 212.39 2727001803 A4649 TUBE ORAL RAE CUFFED 3.0MM 27.18 2727001808 A4649 SCREW CORTEX ST 2.0MMX8MM 115.08 2727001810 A4649 SCREW CORTEX ST 2.0MMX10MM 115.08 272
142
7001812 A4649 SCREW CORTEX ST 2.0MMX12MM 115.08 2727001814 A4649 SCREW CORTEX ST 2.0MMX14MM 115.08 2727001816 A4649 SCREW CORTEX ST 2.0MMX16MM 115.08 2727001818 A4649 SCREW CORTEX ST 2.0MMX18MM 115.08 2727001820 A4649 SCREW CORTEX ST 2.0MMX20MM 115.08 2727001822 A4649 SCREW CORTEX ST 2.0MMX22MM 115.08 2727001824 A4649 SCREW CORTEX ST 2.0MMX24MM 115.08 2727001826 A4649 SCREW CORTEX ST 2.0MMX26MM 115.08 2727001828 A4649 SCREW CORTEX ST 2.0MMX28MM 115.08 2727001830 A4649 SCREW CORTEX ST 2.0MMX30MM 115.08 2727001835 A4649 TRAY I&D 20.32 2727001840 A4649 SCREW CORTEX ST 3.5MMX10MM 96.81 2727001851 A4649 SUTURE SILK 2-0 17X18 11.70 2727001870 A4649 GLOVES SURGEON S-8 3.72 2727001880 A4649 TRAY W/ BETADINE SKIN PREP 21.28 2727001916 A4649 SUTURE PLAIN 6-0 18 PC-1 55.53 2727001926 A4649 TRAY OB PRECIPITATE 67.75 2727001942 A4649 TRAY PARACENTESIS 40.65 2727001964 A4649 SUTURE ETHILON 4-0 18 PC-3 68.06 2727001965 A4649 SUTURE ETHILON 5-0 18 PC-3 66.20 2727001966 A4649 SUTURE ETHILON 6-0 18 PC-3 67.79 2727001991 A4649 TRAY EPIDURAL ANESTHESIA 57.65 2727001995 A4649 SUTURE ETHILON 5-0 18 PC-5 66.47 2727002001 A4649 TKR-FEMORAL COMPONENT 3156.62 2727002002 A4649 TKR-TIBIAL TRAY 2465.93 2727002003 A4649 TKR-TIBIAL INSERT 1585.29 2727002004 A4649 TKR-PATELLA COMPONENT 1297.50 2727002005 A4649 CMT-PALACOS BONE CEMENT 779.06 2707002006 A4649 CMT-MIXING BOWL/SPATULA 131.22 2707002007 A4649 THR-PRESS FIT FEMORAL STEM 5033.02 2727002008 A4649 THR-COCR FEMORAL HEAD 1297.50 2727002009 A4649 THR-CERAMIC FEMORAL HEAD 1637.09 2727002010 A4649 THR-ACETABULAR SHELL 2183.91 2727002011 A4649 THR-ACETABULAR LINER 1464.41 2727002012 A4649 THR-BONE SCREW 584.30 2727002013 A4649 SHK-SAWBLADE 787.25 2707002014 A4649 TSR-GLENOID COMPONENT 1996.25 2727002015 A4649 TSR-HUMERAL STEM 3865.74 2727002016 A4649 TSR-HUMERAL HEAD 1925.64 2727002017 A4649 TSR-CEMENT GUN KIT 941.80 2727002018 A4649 NAIL FEMUR TFNA LT 10MMX320MM 4110.96 272
143
7002019 A4649 NAIL FEMUR TFNA RT 10MMX340MM 4110.96 2727002021 A4649 SUTURE CHROMIC GUT 5-0 RB-1 U2 40.04 2727002022 A4649 NAIL FEMUR TFNA LT 10MMX360MM 4110.96 2727002023 A4649 NAIL FEMUR TFNA 10MMX360MM 4110.96 2727002024 A4649 NAIL FEMUR TFNA 10MMX380MM 4110.96 2727002025 A4649 NAIL FEMUR TFNA 10MMX380MM 4110.96 2727002031 A4649 SUTURE CHROMIC 4-0 27 RB-1 30.99 2727002047 A4649 SUTURE CHROMIC 3-0 27 RB-1 28.70 2727002055 A4649 BLADE HOOK ECTR 405.25 2727002060 A4649 SUTURE SUPRAMID 6-0 3/8C TAP P 20.62 2727002080 A4649 TRAY THORACENTESIS 194.09 2727002100 C1713 PLATE ACP TETHER 20MM 2747.21 2787002106 A4649 CATH-URETERAL WHISTLE TIP 6FR 158.11 2727002120 A4649 FILTER FEMORAL-2120F 1780.15 2727002122 A4649 TRAY TRACHEOSTOMY 40.65 2727002189 A4649 TRAY VENISECTION 40.65 2727002201 A4649 DRILL TWIST KLS 2.2MMX70MM 647.85 2727002203 A4649 DRILL TWIST KLS 2.2MMX105MM 697.05 2727002206 A4649 CATH-URETERAL WHISTLE TIP 6FR 158.11 2727002210 A4649 DRESSING MICROSURG 2X4 6.65 2727002212 A4649 MESH STRIP 6 X 2 HOLES 892.67 2787002312 C1713 PLATE H EXT MD HD RT 1.3MM 8-H 724.88 2727002350 A4649 EVACUATOR SMOKE CAUTERY ACCUVA 51.14 2727002440 A4649 PATTIES NEUROSURGICAL 1X3 8.73 2727002450 A4649 RAPID HANDSWITCH 173.27 2727002505 A4649 SUCTION COAGULATOR 111.87 2727002541 A4649 SCREW CANNUL PT 4.5MMX20MM 840.57 2727002600 A4649 ROD XIA SPINAL 600MM 1366.44 2727002701 A4649 SUTURE VICRYL 0 U 27 CT-2 30.47 2727002741 A4649 SCREW CANNUL FT 4.5MMX20MM 837.00 2727002781 A4649 NEEDLE CHIBA 22GAX15CM 67.60 2727002800 A4649 SUTURE VICRYL 8-0 V BV-130- 5 213.89 2727002806 A4649 SCREW CORTEX MINI FRAG 6-24X2. 120.32 2727002808 A4649 SCREW CORTEX ST 2.7MMX8MM 115.08 2727002810 A4649 KIT PORT-A-CATH GROSHONG 8FR 398.19 2727002812 A4649 SCREW CORTEX ST 2.7MMX12MM 115.08 2727002814 A4649 SCREW CORTEX ST 2.7MMX14MM 115.08 2727002816 A4649 SCREW CORTEX ST 2.7MMX16MM 115.08 2727002818 A4649 SCREW CORTEX ST 2.7MMX18MM 115.08 2727002820 A4649 SCREW CORTEX ST 2.7MMX20MM 115.08 2727002822 A4649 SCREW CORTEX ST 2.7MMX22MM 115.08 272
144
7002824 A4649 SCREW CORTEX ST 2.7MMX24MM 115.08 2727002826 A4649 SCREW CORTEX ST 2.7MMX26MM 115.08 2727002828 A4649 SCREW CORTEX ST 2.7MMX28MM 115.08 2727002830 A4649 SCREW CORTEX ST 2.7MMX30MM 115.08 2727002850 A4649 SUTURE ETHILON 10-0 5 BV75-4 222.87 2727002881 A4649 SUTURE ETHILON 11-0 5 BV50-3 324.51 2727002956 A4649 CATHETER SET SLIT INDWELLING 258.86 2727003000 A4649 SUTURE PLAIN 3-0 12X18 103.17 2727003030 A4649 NEEDLE RETROBULBAR 25GAX38MM 24.41 2727003031 A4649 SUTURE PDS 5-0 27 RB-1 29.53 2727003039 A4649 TUBE ENDOBRONCHIAL STR LT 39FR 830.92 2727003040 A4649 NEEDLE RETROBULBAR 23GAX38MM 24.41 2727003041 A4649 SUTURE PDS 4-0 27 RB-1 29.15 2727003060 A4649 CONNECTOR XIA CROSS 60MM 1483.89 2727003061 A4649 SCREW CANCEL PT-16 6.5MMX30MM 242.96 2727003062 A4649 TRAY CUTDOWN-ADULT 24.60 2727003100 A4927 GLOVES SURG S-6-1/2 ULTRA 3.91 2727003120 A4649 STAPLE ZIMALOY 75.38 2727003122 A4649 CATHETER GROSHONG 1-LUMEN 8FR 1002.07 2727003146 A4649 BONE WAX 5.16 2707003151 A4649 SUTURE VICRYL 4-0 V 27 SH 25.50 2727003152 A4649 NAIL UNIV TIBIAL 11MMX300MM 1298.94 2727003175 A4649 SCREW CORT POLARUS 3.5MMX17.5M 411.02 2727003200 A4649 SCREW CORT POLARUS 3.5MMX20MM 411.02 2727003225 A4649 SCREW CORT POLARUS 3.5MMX22.5M 411.02 2727003250 A4649 SCREW CORT POLARUS 3.5MMX25MM 411.02 2727003260 A4649 BLADE DERMATONE 43.47 2727003275 A4649 SCREW CORT POLARUS 3.5MMX27.5M 411.02 2727003285 A4649 K-WIRE TROCAR PT 3.0MMX285MM 55.90 2727003300 A4649 SCREW CORT POLARUS 3.5MMX30MM 411.02 2727003325 A4649 SCREW CORT POLARUS 3.5MMX32.5M 411.02 2727003391 A4649 SUTURE PDS 2-0 27 CT-1 35.41 2727003409 A4649 P.E. TUBE 59.52 2727003411 A4649 SUTURE PDS 1 27 CT-1 32.88 2727003419 A4649 BLADE ARTHRO FULL RADIUS 2.9MM 458.02 2727003444 A4649 BLADE ARTHRO FULL RADIUS 5.5MM 471.66 2727003449 A4649 BLADE ARTHRO TURBO CUTTER 4MM 458.02 2727003450 A4649 PACK LAP 56.43 2727003451 A4649 BLADE ARTHRO ABRADER 5.5MM 458.02 2727003452 A4649 BLADE ARTHRO ACROMINIZER 4.0MM 422.77 2727003461 A4649 SUTURE PDS 0 36 CT-1 54.21 272
145
7003472 A4649 NAIL UNIV FEMUR 13MMX340MM 1676.23 2727003476 A4649 PACK ORTHO 70.68 2727003492 A4649 PACK PERI/GYN 47.05 2727003511 A4649 SUTURE VICRYL 2-0 V 24 CT 27.27 2727003521 A4649 SUTURE VICRYL 0 V 27 CT 25.28 2727003553 A4649 BLADE ARTHRO ABRADER 2.9MM 471.66 2727003590 A4649 ATTACHMENT SMOKE EVACUATOR 107.53 2727003591 A4649 SUTURE PDS 1 36 CT 39.46 2727003606 A4649 BLADE ARTHRO CUTTER 2.9MM 471.66 2727003622 A4649 CATHETER GROSHONG 2-LUMEN 9.5F 1002.07 2727003641 A4649 SUTURE VICRYL 0 V 27 CTX 28.38 2727003642 A4649 SUTURE VICRYL 0 36 CTX 29.48 2727003645 A4649 TUBING STERILE SMOKE EVACUATOR 91.37 2727003651 A4649 SUTURE VICRYL 1 V 27 CTX 26.30 2727003662 A4649 CATHETER GROSHONG 1-LUMEN 7FR 1002.07 2727003680 A4649 STENT URETERAL 6FR VAR LGTH 925.30 2727003681 A4649 STENT URETERAL 7FR VAR LGTH 925.30 2727003705 A4649 RAPID TUBING 1/4X10 175.99 2727003708 A4649 SUTURE BOOTIES 7.39 2727003713 A4649 SUTURE VICRYL 1 V 36 CTX 27.84 2727003718 A4649 PROBE ELECTRO ENDO UNDERWATER 369.54 2727003724 A4649 RAPID TUBING 3/8X10 175.99 2727003728 A4649 RAPID TUBING 1/4 LAP SMOKE 421.61 2727003729 A4649 RAPID LASER HAND WAND 264.97 2727003732 A4649 CASSETTE COVER 14.30 2727003840 A4649 SUTURE SUPRAMID 4-0 3/8C BT RE 15.57 2727003880 A4649 KIT PORTACATH 6.6FR PEDIATRIC 272.76 2727003960 A4649 ENDOTRACHEAL TUBE CURVED REIN 332.05 2727003965 A4649 ENDOTRACHEAL TUBE CURVED REIN 332.05 2727004001 A4649 VISCERA RETAINER SURGIFISH 123.01 2727004004 C1713 PLATE FX 4 HOLE 35MM 931.02 2787004131 A4649 CIRCUIT BREATHING ANESTHESIA 2 52.72 2727004132 A4649 CIRCUIT BREATHING ANESTHESIA 3 28.50 2727004136 A4649 BLADE ARTHRO INCISOR 4.5MM 597.82 2727004138 A4649 BLADE ARTHRO SYNOVATOR 4.5MM 597.82 2727004150 A4649 SCREW MALLEOLAR 4.5MMX40MM 230.18 2727004152 A4649 NAIL UNIV TIBIAL 11MMX400MM 1565.40 2727004161 A4649 SUTURE VICRYL 3-0 U 27 SH 25.50 2727004171 A4649 SUTURE VICRYL 2-0 U 27 SH 26.18 2727004190 A4649 BLADE ARTHRO SYNOVATOR 5.5MM 458.02 2727004204 C1713 PLATE FX 4 HOLE 40MM 946.40 272
146
7004252 A4649 NAIL UNIV TIBIAL 12MMX400MM 1152.38 2727004267 A4649 SUTURE VICRYL 4-0 U 27 PS-2 52.92 2727004280 A4649 BLADE ARTHRO RAZOR CUT 4.5MM 422.77 2727004284 A4649 BLADE ARTHRO RAZOR CUT 5.5MM 422.77 2727004306 A4649 BLADE ARTHRO ABRADER 4.0MM 409.14 2727004343 A4649 BLADE SAW 6MMX13MM 512.77 245.51 2727004349 A4649 BLADE ARTHRO FULL RADIUS 4.5MM 708.02 2727004472 A4649 NAIL UNIV FEMUR 14MMX340MM 1149.10 2727004500 A4649 SUTURE STEEL 4-0 14 149.80 2727004537 A4649 TUBING IRRIGATION TUR 2 BTL 80.19 2727004606 C1713 PLATE FX 6 HOLE 45MM 1015.46 2787004812 A4649 SCREW CORTEX ST 3.5MMX12MM 200.82 2727004814 A4649 SCREW CORTEX ST 3.5MMX14MM 96.81 2727004816 A4649 SCREW CORTEX ST 3.5MMX16MM 96.81 2727004818 A4649 SCREW CORTEX ST 3.5MMX18MM 96.81 2727004820 A4649 SCREW CORTEX ST 3.5MMX20MM 96.81 2727004822 A4649 SCREW CORTEX ST 3.5MMX22MM 96.81 2727004824 A4649 SCREW CORTEX ST 3.5MMX24MM 99.38 2727004826 A4649 SCREW CORTEX ST 3.5MMX26MM 74.54 2727004828 A4649 SCREW CORTEX ST 3.5MMX28MM 64.31 2727004830 A4649 SCREW CORTEX ST 3.5MMX30MM 64.31 2727004832 A4649 SCREW CORTEX ST 3.5MMX32MM 64.31 2727004834 A4649 SCREW CORTEX ST 3.5MMX34MM 64.31 2727004836 A4649 SCREW CORTEX ST 3.5MMX36MM 64.31 2727004838 A4649 SCREW CORTEX ST 3.5MMX38MM 64.31 2727004840 A4649 SCREW CORTEX ST 3.5MMX40MM 116.92 2727004842 A4649 SCREW CORTEX ST 3.5MMX42MM 115.08 2727004845 A4649 SCREW CORTEX ST 3.5MMX45MM 105.97 2727004846 A4649 SCREW CORTEX ST 3.5MMX46MM 115.08 2727004848 A4649 SCREW CORTEX ST 3.5MMX48MM 115.08 2727004850 A4649 SCREW CORTEX ST 3.5MMX50MM 96.81 2727004948 A4649 CANNULA PERFUSION AORTIC 7MM C 400.27 2727004961 A4649 SUTURE MERSILENE 2 30 LR/LR 51.00 2727005001 A4649 SILASTIC SHEETING 0.005 NRFD 981.76 2727005008 C1713 PLATE FX 8 HOLE 60MM 1046.15 2787005013 A4649 SCREW CANNUL PT 3.5MMX12MM 666.41 2727005014 A4649 SCREW CANNUL PT 3.5MMX14MM 666.41 2727005016 A4649 SCREW CANNUL PT 3.5MMX16MM 666.41 2727005018 A4649 SCREW CANNUL PT 3.5MMX18MM 666.41 2727005020 A4649 SCREW CANNUL PT 3.5MMX20MM 666.41 2727005022 A4649 SCREW CANNUL PT 3.5MMX22MM 666.41 272
147
7005024 A4649 SCREW CANNUL PT 3.5MMX24MM 666.41 2727005026 A4649 SCREW CANNUL PT 3.5MMX26MM 817.31 2727005028 A4649 SCREW CANNUL PT 3.5MMX28MM 817.31 2727005030 A4649 SCREW CANNUL PT 3.5MMX30MM 817.31 2727005032 A4649 SCREW CANNUL PT 3.5MMX32MM 666.41 2727005034 A4649 SCREW CANNUL PT 3.5MMX34MM 817.31 2727005036 A4649 SCREW CANNUL PT 3.5MMX36MM 817.31 2727005038 A4649 SCREW CANNUL PT 3.5MMX38MM 666.41 2727005040 A4649 SCREW CANNUL PT 3.5MMX40MM 822.18 2727005042 A4649 SCREW CANNUL PT 3.5MMX42MM 666.41 2727005044 A4649 SCREW CANNUL PT 3.5MMX44MM 666.41 2727005046 A4649 SCREW CANNUL PT 3.5MMX46MM 666.41 2727005048 A4649 SCREW CANNUL PT 3.5MMX48MM 666.41 2727005050 A4649 SCREW CANNUL PT 3.5MMX50MM 817.27 2727005100 A4649 SCREW SCHANTZ 5.0MMX100MM 412.55 2727005105 A4649 FILTER FUME BONE CEMENT 161.91 2727005116 C1758 CATHETER URETERAL OPEN-END 6FR 65.72 2727005125 A4649 SCREW SCHANTZ 5.0MMX125MM 412.55 2727005130 A4649 SCREW MALLEOLAR 4.5MMX30MM 230.18 2727005135 A4649 SCREW MALLEOLAR 4.5MMX35MM 230.18 2727005140 A4649 NEEDLE SPINAL WHITACARE 22GA 100.05 2727005145 A4649 SCREW MALLEOLAR 4.5MMX45MM 230.18 2727005150 A4649 SCREW MALLEOLAR 4.5MMX50MM 230.18 2727005155 A4649 SCREW MALLEOLAR 4.5MMX55MM 230.18 2727005160 A4649 SCREW MALLEOLAR 4.5MMX60MM 230.18 2707005165 A4649 SCREW MALLEOLAR 4.5MMX65MM 230.18 2727005170 A4649 SCREW MALLEOLAR 4.5MMX70MM 230.18 2727005200 A4649 SCREW CANC POLARUS 5MMX20MM 411.02 2727005208 C1713 PLATE FX 8 HOLE 70MM 1061.52 2787005218 A4649 SCREW CANNUL FT 3.5MMX18MM 822.18 2727005220 A4649 SCREW CANNUL FT 3.5MMX20MM 822.18 2727005222 A4649 SCREW CANNUL FT 3.5MMX22MM 822.18 2727005224 A4649 SCREW CANNUL FT 3.5MMX24MM 822.18 2727005226 A4649 SCREW CANNUL FT 3.5MMX26MM 822.18 2727005228 A4649 SCREW CANNUL FT 3.5MMX28MM 822.18 2727005230 A4649 SCREW CANNUL FT 3.5MMX30MM 822.18 2727005232 A4649 SCREW CANNUL FT 3.5MMX32MM 822.18 2727005234 A4649 SCREW CANNUL FT 3.5MMX34MM 822.18 2727005236 A4649 SCREW CANNUL FT 3.5MMX36MM 822.18 2727005238 A4649 SCREW CANNUL FT 3.5MMX38MM 822.18 2727005240 A4649 SCREW CANNUL FT 3.5MMX40MM 822.18 272
148
7005242 A4649 SCREW CANNUL FT 3.5MMX42MM 822.18 2727005244 A4649 SCREW CANNUL FT 3.5MMX44MM 822.18 2727005246 A4649 SCREW CANNUL FT 3.5MMX46MM 822.18 2727005248 A4649 SCREW CANNUL FT 3.5MMX48MM 835.35 2727005250 A4649 SCREW CANNUL FT 3.5MMX50MM 822.18 2727005270 A4649 COMBITUBE ESOPHAGEAL SML ADULT 416.51 2727005300 A4649 SCREW CANC POLARUS 5MMX30MM 411.02 2727005350 A4649 SCREW CANC POLARUS 5MMX35MM 411.02 2727005359 A4649 BLADE ARTHRO FULL RAD CONV 4.5 318.24 2727005400 A4649 HALO TRACTION SYSTEM-MED 3284.58 2707005416 C1713 PLATE FX 16 HOLE 120MM 1153.60 2787005433 A4649 CABLE PACING 5433A 182.67 2727005450 A4649 SCREW CANC POLARUS 5MMX45MM 411.02 2727005472 A4649 NAIL UNIV FEMUR 15MMX340MM 1191.76 2727005500 A4649 SCREW CANC POLARUS 5MMX50MM 411.02 2727005550 A4649 SCREW CANC POLARUS 5MMX55MM 411.02 2727005606 C1713 PLATE MANDIB R/L X-LONG 1076.87 2787005699 A4649 CORNEAL CROUCH PROTECTOR 69.71 2727005806 C1713 PLATE MANDIB LT 60* 2.7MM 6-HO 966.38 2787005885 A4649 BLADE GIGLI SAW 36.96 2727005968 A4649 P.E. BOBBIN 74.88 2727006000 A4649 BUR ROUND XKP 3.0MMX90MM 834.08 2727006002 A4649 HOOK XIA LAMINA MEDIUM 1807.61 2727006004 C1713 PLATE MANDIB R/L SHORT 1030.81 2787006010 A4649 SCREW CANCELL FT 4.0MMX10MM 96.81 2727006011 A4649 HOOK XIA PEDICLE LARGE 1807.61 2727006012 A4649 HOOK XIA PEDICLE SMALL 1807.61 2727006014 A4649 SCREW CANCELLOUS FT 4.0MMX14MM 72.33 2727006016 A4649 SCREW CANCELL FT 4.0MMX16MM 72.33 2727006018 A4649 SCREW CANCELL FT 4.0MMX18MM 50.86 2727006019 A4649 SUTURE SUPRAMID 5-0 3/8C BT RE 34.39 2727006020 A4649 SCREW CANCELLOUS FT 4.0MMX20MM 50.86 2727006021 A4649 SUTURE SUPRAMID 5-0 3/8C TAP P 20.62 2727006022 A4649 SCREW CANCELL FT 4.0MMX22MM 72.33 2727006023 A4649 SUTURE SUPRAMID 4-0 3/8C WT RE 36.25 2727006024 A4649 SCREW CANCELL FT 4.0MMX24MM 96.81 2727006025 A4649 SUTURE SUPRAMID 4-0 1/2C REV C 36.25 2727006026 A4649 SCREW CANCELL FT 4.0MMX26MM 47.49 2727006028 A4649 SCREW CANCELL FT 4.0MMX28MM 50.86 2727006030 A4649 SCREW CANCELL FT 4.0MMX30MM 96.81 2727006032 A4649 SCREW CANCELL FT 4.0MMX32MM 96.81 272
149
7006035 A4649 SCREW CANCELL FT 4.0MMX35MM 96.81 2727006036 A4649 SCREW CANCELLOUS FT 4.0MMX36MM 50.86 2727006040 A4649 SCREW CANCELLOUS FT 4.0MMX40MM 72.33 2727006045 A4649 SCREW CANCELLOUS FT 4.0MMX45MM 50.78 2727006050 A4649 SCREW CANCELL FT 4.0MMX50MM 56.26 2727006055 A4649 SCREW CANCELLOUS FT 4.0MMX55MM 71.46 2727006060 A4649 SCREW CANCELLOUS FT 4.0MMX60MM 96.81 2727006131 A4649 INTRODUCER PEELAWAY 6FR 13CM 755.70 2727006204 C1713 PLATE MANDIB LT 60* 2.7MM 4-HO 932.19 2787006305 A4649 SIGMOIDOSCOPE 18.47 2727006314 A4649 SUTURE NUROLON 3-0 8X18 X-1 89.95 2727006388 A4649 CHLORAPREP APPLICATOR 10.5ML 49.26 2727006392 A4649 STEINMAN PIN CT 3.0MMX150MM 394.59 2727006397 A4649 STONE RETRIEVER PFISTER-SHWART 777.24 2727006495 A4649 LEAD MYOCARD PACING TEMP CBP 450.63 2727006530 A4649 SUTURE STEEL 5 4X18 CCS 244.73 2727006550 A7520 TUBE TRACHEOSTOMY XLT 8.0MM 664.62 2727006560 A4649 CANNULA-TRACH TUBE XLT 8.0MM 53.63 2727006593 A4649 EXT FIX SML CRB ROD 4MMX60MM 211.91 2727006641 A4649 SUTURE ETHILON 2-0 18 FS 24.71 2727006648 A4649 IOBAN ANTIMICROB INCISE DRAPE 60.53 2727006901 A4649 SUTURE VICRYL 5-0 U 27 FS-2 28.35 2727006947 A4649 IMPLANT DEFIBRILLATOR RV 6947 8844.11 2727006968 A4649 SCREW CORTEX MD HD 1.5MMX6MM 246.60 2727007000 A4649 BUR DIA RD EX CRSE XKP 3.0MMX1 785.42 2727007004 C1713 PLATE KLS 35MM 2.7 4 HOLE 946.40 2787007010 A4649 SCREW CANCELL PT 4.0MMX10MM 96.81 2727007014 A4649 SCREW CANCELL PT 4.0MMX14MM 96.81 2727007016 A4649 SCREW CANCELL PT 4.0MMX16MM 96.81 2727007018 A4649 SCREW CANCELL PT 4.0MMX18MM 96.81 2727007020 A4649 SCREW CANCELL PT 4.0MMX20MM 96.81 2727007022 A4649 SUTURE GORETEX CV-7 24 TT9 120.47 2727007023 A4649 NEEDLE PERCUTANEOUS 18FR 247.40 2727007024 A4649 SCREW CANCELL PT 4.0MMX24MM 96.81 2727007026 A4649 SCREW CANCELL PT 4.0MMX26MM 96.81 2727007028 A4649 SCREW CANCELL PT 4.0MMX28MM 96.81 2727007030 A4649 SCREW CANCELLOUS PT 4.0MMX30MM 49.33 2727007035 A4649 SCREW CANCELLOUS PT 4.0MMX35MM 49.33 2727007038 A4649 GUIDEWIRE VASCATH 53.56 2727007040 A4649 SCREW CANCELLOUS PT 4.0MMX40MM 84.03 2727007045 A4649 SCREW CANCELLOUS PT 4.0MMX45MM 45.66 272
150
7007050 A4649 SCREW CANCELLOUS PT 4.0MMX50MM 45.66 2727007131 A4649 INTRODUCER PEELAWAY 7FR 13CM 755.70 2727007204 C1713 PLATE FX EDCP 4 HOLE 40MM 977.08 2787007316 A4649 KIT FOLEY 16FR NON-LATEX 35.52 2727007404 A4649 SCREW CD MICRO 1.5MMX4.0MM 292.29 2727007405 A4649 SCREW CD MICRO 1.5MMX5.0MM 284.97 2727007407 A4649 SCREW CD MICRO 1.5MMX7.0MM 292.29 2727007511 A4649 SUTURE CHROMIC 4-0 12 M-2/M-2 41.53 2727007521 A4649 SUTURE CHROMIC 4-0 12 M-2 19.44 2727007593 A4649 EXT FIX CONNECT BAR 4MMX60MM 98.64 2727007607 A4649 SCREW CD MICRO 1.8MMX7.0MM 292.29 2727007711 A4649 SUTURE ETHILON 10-0 8 TG160-4 136.87 2727007717 A4649 SUTURE ETHILON 9-0 12 TG140-8 159.02 2727007756 A4649 SUTURE ETHILON 10-0 12 TG160- 155.05 2727007990 A4649 GRAFT DEBAK BIF 14MMX7MMX40CM 1142.26 2727007992 A4649 GRAFT DEBAK BIF 18MMX9MMX40CM 1107.81 2727007993 A4649 GRAFT DEBAK BIF 20MMX10MMX40MM 1142.26 2727007994 A4649 GRAFT DEBAK BIF 22MMX11MMX40CM 380.92 2727007996 A4649 GRAFT DEBAK BIF 12MMX6MMX40CM 1142.26 2727008000 A4649 LIGACLIP STAINLESS STEEL SML 35.23 2727008006 A4649 GRAFT DEBAK STR 6MMX75CM 893.40 2727008007 A4649 GRAFT DEBAK STR 8MMX75CM 893.40 2727008008 A4649 GRAFT DEBAK STR 10MMX75CM 1007.41 2727008009 A4649 GRAFT DEBAK STR 12MMX75CM 893.40 2727008010 A4649 GRAFT DEBAK STR 14MMX65CM 893.40 2727008011 A4649 GRAFT DEBAK STR 16MMX65CM 931.69 2727008012 A4649 GRAFT DEBAK STR 18MMX65CM 931.69 2727008013 A4649 GRAFT DEBAK STR 20MMX65CM 1007.41 2727008014 A4649 GRAFT DEBAK STR 22MMX65CM 893.40 2727008015 A4649 GRAFT DEBAK STR 25MMX65CM 893.40 2727008030 A4649 SCREW CANNUL PT 7MMX30MM 803.36 2727008035 A4649 SCREW CANNUL PT 7MMX35MM 802.54 2727008040 A4649 SCREW CANNUL PT 7MMX40MM 810.47 2727008045 A4649 SCREW CANNUL PT 7MMX45MM 810.47 2727008050 A4649 SCREW CANNUL PT 7MMX50MM 810.47 2727008055 A4649 SCREW CANNUL PT 7MMX55MM 810.47 2727008060 A4649 SCREW CANNUL PT 7MMX60MM 810.47 2727008065 A4649 SCREW CANNUL PT 7MMX65MM 810.47 2727008070 A4649 SCREW CANNUL PT 7MMX70MM 794.88 2727008075 A4649 SCREW CANNUL PT 7MMX75MM 885.16 2727008080 A4649 SCREW CANNUL PT 7MMX80MM 788.58 272
151
7008085 A4649 SCREW CANNUL PT 7MMX85MM 803.36 2727008090 A4649 SCREW CANNUL PT 7MMX90MM 788.58 2727008095 A4649 SCREW CANNUL PT 7MMX95MM 812.12 2727008100 A4649 SCREW CANNUL PT 7MMX100MM 962.27 2727008101 A4649 SUTURE CHROMIC 3-0 27 CT-1 26.60 2727008105 A4649 SCREW CANNUL PT 7MMX105MM 828.24 2727008110 A4649 SCREW CANNUL PT 7MMX110MM 811.01 2727008131 A4649 INTRODUCER PEELAWAY 8FR 13CM 755.70 2727008200 A4649 BIOPSY ENDOMETRIAL SUCTION 46.76 2727008305 A4649 IMPLANT ORBITAL FLOOR 1191.98 2727008325 A4649 SCREW INTERFERENCE 7MMX25MM 836.10 2727008412 A4649 SUTURE PROLENE 0 30 CT-2 32.60 2727008421 A4649 SUTURE PROLENE 3-0 27 CT-1 30.11 2727008422 A4649 SUTURE PROLENE 3-0 30 CT-1 55.17 2727008424 A4649 SUTURE PROLENE 0 30 CT-1 28.64 2727008433 A4649 SUTURE PROLENE 2-0 30 CT 23.74 2727008434 A4649 SUTURE PROLENE 0 30 CT 31.85 2727008435 A4649 SUTURE PROLENE 1 30 CT 31.65 2727008441 A4649 SUTURE SILK 0 30 MH 26.39 2727008448 A4649 SUTURE PLAIN 0 27 CT-1 28.64 2727008500 A4649 SET LOOP CATHETER INTRODUCER 624.88 2727008521 A4649 SUTURE PROLENE 4-0 SH/SH 67.08 2727008523 A4649 SUTURE PROLENE 2-0 36 DA SH 60.14 2727008525 A4649 SCREW INTERFERENCE 9MMX25MM 785.73 2727008540 A4649 SHUNT ASCITES DENVER 1585.22 2727008541 A4649 SHUNT PERC ACCESS KIT DENVER 1528.13 2727008613 A4649 SCREW CD BONE 2.5MMX13MM 299.60 2727008618 A4649 SCREW CD ST 2.7MMX18MM 319.82 2727008620 A4649 SCREW CD ST 2.7MMX20MM 295.22 2727008655 A4649 CLAMP INSERTS 86MM F/F CBP 258.32 2727008695 A4649 SUTURE PROLENE 6-0 18 P-3 72.26 2727008698 A4649 SUTURE PROLENE 5-0 18 P-3 55.24 2727008705 A4649 SUTURE PROLENE 7-0 M8705 733.25 2727008706 A4649 SUTURE PROLENE 6-0 30 DA C-1 55.10 2727008725 A4649 SUTURE PROLENE 5-0 M8725 382.95 2727008743 A4649 SUTURE PROLENE 8-0 24 BV-175- 744.15 2727008756 A4649 SUTURE PROLENE 5-0 18 DA RB-1 41.29 2727008757 A4649 SUTURE PROLENE 4-0 18 DA RB-1 69.43 2727008762 A4649 SUTURE PROLENE 3-0 30 DA SH 45.48 2727008800 A4649 SUTURE PROLENE 7-0 18 DA C-1 67.74 2727008806 A4649 SUTURE PROLENE 6-0 18 DA BV-1 138.40 272
152
7008818 A4649 BRUSH CYTOLOGY-GI 1.8CMX160CM 339.47 2727008830 A4649 SCREW CANNUL PT 7.3MMX30MM 887.05 2727008835 A4649 SCREW CANNUL PT 7.3MMX35MM 887.05 2727008840 A4649 SCREW CANNUL PT 7.3MMX40MM 812.12 2727008845 A4649 SCREW CANNUL PT 7.3MMX45MM 812.12 2727008848 A4649 SUTURE CHROMIC 0 27 CT-2 10.29 2727008850 A4649 SCREW CANNUL PT 7.3MMX50MM 812.12 2727008855 A4649 SCREW CANNUL PT 7.3MMX55MM 812.12 2727008860 A4649 SCREW CANNUL PT 7.3MMX60MM 812.12 2727008865 A4649 SCREW CANNUL PT 7.3MMX65MM 812.12 2727008870 A4649 SCREW CANNUL PT 7.3MMX70MM 812.12 2727008875 A4649 SCREW CANNUL PT 7.3MMX75MM 812.12 2727008880 A4649 SCREW CANNUL PT 7.3MMX80MM 897.46 2727008885 A4649 SCREW CANNUL PT 7.3MMX85MM 916.04 2727008890 A4649 SCREW CANNUL PT 7.3MMX90MM 885.16 2727008895 A4649 SCREW CANNUL PT 7.3MMX95MM 866.85 2727008900 A4649 SCREW CANNUL PT 7.3MMX100MM 819.78 2727008905 A4649 SCREW CANNUL PT 7.3MMX105MM 866.85 2727008910 A4649 SCREW CANNUL PT 7.3MMX110MM 819.78 2727008915 A4649 SCREW CANNUL PT 7.3MMX115MM 885.16 2727008920 A4649 SCREW CANNUL PT 7.3MMX120MM 819.78 2727008925 A4649 SCREW CANNUL PT 7.3MMX125MM 819.78 2727008930 A4649 SCREW CANNUL 16MM TH 7.3MMX130 821.05 2727008935 A4649 SCREW CANNUL PT 7.3MMX135MM 896.63 2727008940 A4649 SCREW CANNUL PT 7.3MMX140MM 896.63 2727008945 A4649 SCREW CANNUL PT 7.3MMX145MM 896.63 2727008950 A4649 SCREW CANNUL PT 7.3MMX150MM 896.63 2727009000 A4649 TUBING PENROSE 1/4X18 4.76 2727009004 A4649 PATCH GORETEX 1038.49 2727009010 A4649 TUBING W/ FILTER LAPAROSCOPY 57.28 2727009032 A4649 SUTURE ETHILON 10-0 12 CS175- 202.11 2727009045 A4649 SCREW CANNUL FT 7MMX45MM 828.24 2727009050 A4649 SCREW CANNUL FT 7MMX50MM 828.24 2727009055 A4649 SCREW CANNUL FT 7MMX55MM 802.54 2727009058 A4649 SUTURE CHROMIC 1 36 CTX 33.11 2727009060 A4649 SCREW CANNUL FT 7MMX60MM 802.54 2727009065 A4649 SCREW CANNUL FT 7MMX65MM 803.36 2727009070 A4649 SCREW CANNUL FT 7MMX70MM 811.01 2727009075 A4649 SCREW CANNUL FT 7MMX75MM 803.36 2727009080 A4649 SCREW CANNUL FT 7MMX80MM 818.67 2727009085 A4649 SCREW CANNUL FT 7MMX85MM 818.67 272
153
7009090 A4649 SCREW CANNUL FT 7MMX90MM 788.58 2727009095 A4649 SCREW CANNUL FT 7MMX95MM 828.24 2727009100 A4649 SCREW CANNUL FT 7MMX100MM 828.24 2727009105 A4649 SCREW CANNUL FT 7.0MMX105MM 896.63 2727009131 A4649 SUTURE VICRYL 1 U 18 108.42 2727009141 A4649 SUTURE CHROMIC 0 36 CT 43.20 2727009150 A4649 TUBE NASAL RAE UNCUFFED 5.0MM 20.91 2727009155 A4649 TUBE NASAL RAE UNCUFFED 5.5MM 9.47 2727009158 A4649 SUTURE CHROMIC 1 36 CT 15.34 2727009160 A4649 TUBE NASAL RAE UNCUFFED 6.0MM 9.47 2727009164 A4649 TUBE NASAL RAE UNCUFFED 6.5MM 9.47 2727009165 A4649 STYLET DEFIBRILLATOR LEAD 6093 292.29 2727009365 A4649 STYLET DEFIBRILLATOR LEAD 6091 292.29 2727009440 A4649 TUBE ORAL RAE UNCUFFED 4.0MM 23.37 2727009505 A4649 SCREW CD MINI 2.0MMX5MM 255.76 2727009507 A4649 SCREW CD MINI 2.0MMX7.0MM 255.76 2727009509 A4649 SCREW CD MINI 2.0MMX9MM 200.95 2727009511 A4649 SCREW CD MINI 2.0MMX11MM 200.95 2727009513 A4649 SCREW CD MINI 2.0MMX13MM 200.95 2727009515 A4649 SCREW CD MINI 2.0MMX15MM 200.95 2727009519 A4649 SCREW CD MINI 2.0MMX19MM 200.95 2727009530 C1713 PLATE DIS/RAD LCP NRW RT 2.4MM 4509.75 2787009531 C1713 PLATE DIS/RAD LCP NRW LT 2.4MM 4509.75 2787009630 C1713 PLATE DIS/RAD LCP 6HH RT 2.4MM 4509.75 2787009631 C1713 PLATE DIS/RAD LCP 6HH LT 2.4MM 4509.75 2787009730 C1713 PLATE DIS/RAD LCP 7HH RT 2.4MM 4509.75 2787009731 C1713 PLATE DIS/RAD LCP 7HH LT 2.4MM 4509.75 2787009850 A4649 SCREW CANNUL FT 7.3MMX50MM 819.78 2727009855 A4649 SCREW CANNUL FT 7.3MMX55MM 819.78 2727009860 A4649 SCREW CANNUL FT 7.3MMX60MM 819.78 2727009865 A4649 SCREW CANNUL FT 7.3MMX65MM 819.78 2727009870 A4649 SCREW CANNUL FT 7.3MMX70MM 819.78 2727009875 A4649 SCREW CANNUL FT 7.3MMX75MM 828.05 2727009880 A4649 SCREW CANNUL FT 7.3MMX80MM 828.05 2727009885 A4649 SCREW CANNUL FT 7.3MMX85MM 812.12 2727009890 A4649 SCREW CANNUL FT 7.3MMX90MM 812.12 2727009895 A4649 SCREW CANNUL FT 7.3MMX75MM 812.12 2727009900 A4649 SCREW CANNUL FT 7.3MMX100MM 819.78 2727009905 A4649 SCREW CANNUL FT 7.3MMX105MM 819.78 2727009910 A4649 SCREW CANNUL FT 7.3MMX110MM 819.78 2727009915 A4649 SCREW CANNUL FT 7.3MMX115MM 819.78 272
154
7009920 A4649 SCREW CANNUL FT 7.3MMX120MM 819.78 2727009925 A4649 SCREW CANNUL FT 7.3MMX125MM 819.78 2727009930 A4649 SCREW CANNUL FT 7.3MMX130MM 819.78 2727010002 A4649 NEEDLE VERESS 120MM DISP 296.87 2727010014 A4649 SET URETERAL BAL DILATOR 7FR 789.67 2727010015 A4649 SET URETERAL BAL DILATOR 5FR 811.17 2727010016 A4352 CATHETER COUDE TIP 16FR 30CC 99.57 2727010018 A4352 CATHETER COUDE TIP 18FR 30CC 99.57 2727010020 A4352 CATHETER COUDE TIP 20FR 30CC 99.57 2727010054 A4649 SCREW INTERFERENCE 8MMX25MM 616.36 2727010100 A4649 ACUMATCH-L FEMORAL STEM 125MM 2347.72 2727010101 A4649 PATCH HERNIA-SMALL 1022.23 2727010105 A4649 PATCH HERNIA-MEDIUM 1083.60 2727010113 A4649 DRILL BIT JL 1.1MMX65MM 610.98 2727010114 A4352 CATHETER COUDE STRAIGHT 16FR 387.28 2727010120 A4352 CATHETER COUDE STR 20FR 36.15 2727010134 A4649 FILTER BACTERIAL/VIRAL 8.33 2727010141 A4649 DRILL BIT MQC 1.5MMX65MM 610.98 2727010142 A4649 ELECTRODE PACING EXTERNAL 65.49 2727010143 A4649 DRILL BIT JL 1.5MMX75MM 610.98 2727010178 A4649 EZ DERM (ALL SIZES) 12.60 2727010201 A4649 DRILL BIT MQC 2.0MMX65MM 209.00 2727010203 A4649 DRILL BIT JL 2.0MMX75MM 610.98 2727010220 POST-OP RECOVERY ROOM 1ST HOU 153.71 7107010222 POST-OP RECOVERY ROOM ADD 15 31.91 7107010313 A4649 CAST SCOTCH PLUS 5X4 38.45 2707010413 A4649 CIRCUIT BREATHING ANESTHESIA 1 32.46 2727010461 A4649 CATHETER FOGARTY 4FR 80CM 330.70 2727010463 A4649 CATHETER FOGARTY 2FR 60CM 262.33 2727010464 A4649 CATHETER FOGARTY 3FR 80CM 289.64 2727010465 A4649 CATHETER FOGARTY 4FR 40CM 289.26 2727010466 A4649 CATHETER FOGARTY 5FR 80CM 196.90 2727010467 A4649 CATHETER FOGARTY 6FR 80CM 491.22 2727010468 A4649 CATHETER FOGARTY 7FR 80CM 491.22 2727010491 A4649 SUTURE ETHIBOND 0 6X30 33.83 2727010492 A4649 SUTURE ETHIBOND 3-0 36 SH1/SH 104.42 2727010493 A4649 SUTURE ETHIBOND 3-0 36 RB1/RB 71.78 2727010494 A4649 SUTURE PROLENE 36 RB1/RB1 93.36 2727010511 A4346 CATHETER FOLEY 30FR 5CC 13.09 2727010522 A4346 CATHETER FOLEY 26FR 30CC 13.09 2727010650 A4649 CATHETER URETHRAL 8FR 5.38 272
155
7010655 A4649 CATHETER URETHRAL 10FR 5.17 2727010660 A4649 CATHETER URETHRAL 12FR 3.40 2727010665 A4649 CATHETER URETHRAL 14FR 4.83 2727010670 A4649 CATHETER URETHRAL 16FR 7.02 2727010671 A4649 CATHETER URETHRAL 18FR 6.21 2727010680 A4649 CATHETER URETHRAL 20FR 6.14 2727010690 A4649 CATHETER URETHRAL 24FR 3.43 2727010695 A4649 CATHETER URETHRAL 26FR 3.55 2727010717 A4649 ELECTRODE TEFL COAT CAUTERY 6 43.77 2727010723 A4649 KIT PORT-A-CATH 9FR-UNASBL 1114.00 2727010724 A4649 KIT PORT-A-CATH 9FR-PREASBL 1235.85 2727010750 A4649 CATHETER TROCAR 10FR 96.69 2727010790 A4649 TUBE-T CATTELL 12FR 112.37 2727010791 A4649 TUBE-T CATTELL 14FR 112.37 2727010792 A4649 TUBE-T CATTELL 16FR 119.41 2727010793 A4649 TUBE-T CATTELL 18FR 120.41 2727010801 A4649 EXT FIX OPEN COMPRESSOR LGE 1305.80 2727010811 A4649 CATHETER CHOLANGIOGRAM 16GAX30 88.81 2727010812 A4649 SET ENDO CHOLANGIOGRAM OLSEN 480.07 2727010842 A4649 PRESSURE MONITOR 240.24 2727010882 A4649 RETROGRADE GUNDRY-CBP 835.74 2727010890 A4649 GUIDE WIRE BASKET TRAPEZOID 1135.89 2727010908 A4649 KIT FALOPE RING BAND APPL 2731.74 2727011010 A4649 CHLORAPREP APPLICATOR 1.5ML 7.71 2727011013 A4649 SUTURE MERSILENE STRIP 12 MO- 550.60 2727011020 A4649 NAIL FEMUR TFNA 12MMX170MM 3084.68 2727011070 A4649 DRAPE LAPAROTOMY TRANSVERSE 25.48 2727011075 A4649 DRAPE MAGNETIC INSTR 10X16 18.55 2727011080 A4649 SUTURE VICRYL 0 V 8X18 MO-5 223.23 2727011106 C1713 PLATE FX 6 HOLE 40MM 2.3MM SY 1053.84 2787011108 C1713 PLATE FX 8 HOLE 55MM 2.3MM SY 1122.90 2787011185 A4649 ANTIFOG SOLUTION FRED 52.51 2727011215 A4649 SURGICEL 2X3 182.06 2727011254 A4649 GUIDE PIN-TRANSTIBIAL 2.0MM 146.15 2727011268 A4649 MESH MARLEX 3X6 113.87 2727011270 A4649 GAUZE TUBEGAUZE W/ APPL #1 8.84 2727011272 A4649 GAUZE TUBEGAUZE W/ APPL #2 10.74 2727011273 A4649 GAUZE TUBEGAUZE W/ APPL #4 281.61 2727011284 A4649 GAUZE XEROFORM 1X8 5.99 2727011286 A4649 GAUZE RAYTECS 4X4 6.24 2727011304 C1713 PLATE FX 4 HOLE 30MM 2.3MM SY 969.41 278
156
7011351 A4649 GRAFT GORETEX 6MMX70CM 1804.37 2727011352 A4649 CATHETER GROSHONG 1-LUMEN 3.5F 1147.28 2727011353 A4649 GRAFT GORETEX 4-7MMX40CM 1514.30 2727011365 A4649 GOWN SURGICAL ECLIPSE DISP-LAR 25.23 2727011394 A4649 HEMOVAC 400ML 1/8 5 TROCAR 399.13 2727011400 A4649 CHEST DRAIN VALVE-HEIMLICH 116.01 2727011437 A4649 RESERVOIR JACKSON-PRATT 100CC 28.17 2727011438 A4649 RESERVOIR JACKSON-PRATT 400CC 142.71 2727011504 C1713 PLATE FX 4 HOLE 35MM 2.3MM SY 977.08 2787011530 A4649 SUTURE VICRYL Z-0 U CT J351H 25.84 2727011620 A4649 MASK LOW PRESSURE-NEONATAL 17.72 2727011656 A4649 DRESSING MELOLIN 5.0CMX5.0CM 0.82 2727011657 A4649 DRESSING MELOLIN 10CMX10CM 2.26 2727011703 A4649 PACK EXTREMITY STERILE 190.65 2727011706 C1713 PLATE FX 6 HOLE 45MM 2.3MM SY 1069.19 2787011745 A4649 PLATE BOVIE-INFANT 33.82 2727011750 A4649 PLATE BOVIE-PEDIATRIC 24.84 2727011758 A4649 PAD BOVIE-ADULT 52.31 2727011800 A4649 SCREW CORTEX ST 1.5MMX11MM 137.01 2727011802 A4649 CATHETER GROSHONG 1-LUMEN 8FR 1147.28 2727011851 A4649 CATHETER FOGARTY 5FR 23CM 314.80 2727011852 A4649 CATHETER FOGARTY 5FR 40CM 589.55 2727011853 A4649 CATHETER FOGARTY 6FR 23CM 304.34 2727011861 A4649 FACE SHIELD FULL SAFETY 10.50 2727012000 A4649 SPONGE KITNER 16.30 2727012020 A4649 NAIL FEMUR TFNA 10MMX340MM 4110.96 2727012032 A4649 SUTURE SUPER QUICK ANCHOR 1120.99 2727012036 A4649 SUTURE TACIT QUICK ANCHOR 1067.66 2727012086 A4649 STOCKINETTE TUBULAR 3 /YD 4.32 2727012087 A4649 STOCKINETTE TUBULAR 4 /YD 4.32 2727012088 A4649 STOCKINETTE TUBULAR 6 /YD 5.73 2727012089 A4649 STOCKINETTE TUBULAR 8 /YD 8.59 2727012154 A4649 CANNISTER SUCTION 1200CC 25.18 2727012155 A4649 CANNISTER SUCTION 1500CC 16.44 2727012156 A4649 SUCTION CANNISTER 2000CC 20.07 2727012159 A4649 SUCTION CANNISTER LINER 1500CC 13.01 2727012174 A4649 SURGICAL SPEARS-WECK CEL 1.98 2727012266 A4649 SUTURE MINI QUICK ANCHOR 1048.11 2727012554 A4649 TRAY PEG PONSKY PULL 20FR 855.51 2727012556 A4649 TRAY PEG PONSKY PULL 28FR 832.79 2727012557 A4649 TRAY PEG PONSKY PULL 16FR 1021.03 272
157
7012565 A4649 TRAY SPINAL ANESTHESIA-PONTOCA 108.80 2727012568 A4649 TRAY SPINAL ANESTHESIA-MARCAIN 154.26 2727012600 A4649 TUBING CONNECTING 1/4X6' 5.73 2727012601 A4649 DRILL TWIST KLS 2.5MMX76MM 694.19 2727012602 A4649 TUBING CONNECTING 1/4X12' 12.90 2727012605 A4649 TUBING CONNECTING 3/16X6' 5.73 2727012606 A4649 DRILL TWIST KLS 2.5MMX105MM 694.19 2727012720 A4649 TUBE BLAKEMORE PED 12FR 980.07 2727012790 A4649 SET SUCTION POOLE 24.90 2727012795 A4649 TIP SUCTION YANKAUER 2.52 2727012800 A4649 SET SUCTION YANKAUER 13.09 2727012811 A4649 SUTURE MICRO QUICK ANCHOR 1022.86 2727012859 A4649 FIXATOR DISTAL RADIUS 200MM 3502.03 2727012877 A4649 SET EXTENSION SECUR-LOK MIC 76.73 2727012965 A4649 TUBING PENROSE 3/4X18 4.16 2727013035 A4649 CONNECTOR-T W/ MALE LUER 5.45 2727013252 A4649 NAIL UNIV TIBIAL 12MMX315MM 1152.38 2727013261 A4649 GLOVES SURGEON NON-LATEX SZ-6 10.37 2727013306 A4649 LEAD PACEMAKER 5068-58 1698.07 2757013355 A4649 STONE EXTRACTOR HELICAL 3-WIRE 724.50 2727013363 A4649 GLOVES ORTHOPEDIC TRIFLEX S-7 5.73 2727013364 A4649 GLOVES SURGEON NITRILE SZ-7 14.61 2727013413 A4649 GLOVES ORTHOPEDIC S-7.5 10.29 2727013414 A4649 GLOVES SURGEON NITRILE SZ-7.5 4.89 2727013462 A4649 GLOVES SURGEON LATEX SZ-8 2.56 2727013463 A4649 GLOVES ORTHOPEDIC S-8 12.50 2727013511 A4649 GLOVES SURGEON NON-LATEX SZ-8. 14.10 2727013512 A4649 GLOVES SURGEON LATEX SZ-8.5 2.71 2727013513 A4649 GLOVES SURGEON LATEX SZ-9 2.73 2727013537 A4649 MONSELS SOLUTION 30 CC 10.86 2507013700 J3490 SODIUM CL IRRIG 3000CC BAG 30.33 2507014000 A4649 BUR DIA RD EX CRSE XKP 3.0MMX5 733.14 2727014010 A4649 SUTURE PLAIN 0 54 STD 12.29 2727014012 A4649 SCREW FIXED ANGLE TETHER 4X12M 1039.87 2727014013 A4649 SCREW FIXED ANGLE TETHER 4X13M 1039.87 2727014016 A4649 SCREW CORTEX ASIF 4.5MMX16MM 85.85 2727014018 A4649 SCREW CORTEX ASIF 4.5MMX18MM 85.85 2727014020 A4649 SCREW CORTEX ASIF 4.5MMX20MM 85.85 2727014022 A4649 SCREW CORTEX ASIF 4.5MMX22MM 85.85 2727014024 A4649 SCREW CORTEX ASIF 4.5MMX24MM 85.85 2727014026 A4649 SCREW CORTEX ASIF 4.5MMX26MM 85.85 272
158
7014028 A4649 SCREW CORTEX ASIF 4.5MMX28MM 85.85 2727014030 A4649 SCREW CORTEX ASIF 4.5MMX30MM 85.85 2727014032 A4649 SCREW CORTEX ASIF 4.5MMX32MM 85.85 2727014034 A4649 SCREW CORTEX ASIF 4.5MMX34MM 61.36 2727014036 A4649 SCREW CORTEX ASIF 4.5MMX36MM 45.61 2727014038 A4649 SCREW CORTEX ASIF 4.5MMX38MM 70.15 2727014040 A4649 SCREW CORTEX ASIF 4.5MMX40MM 85.85 2727014042 A4649 SCREW CORTEX ASIF 4.5MMX42MM 138.42 2727014044 A4649 SCREW CORTEX ASIF 4.5MMX44MM 138.42 2727014046 A4649 SCREW CORTEX ASIF 4.5MMX46MM 85.85 2727014048 A4649 SCREW CORTEX ASIF 4.5MMX48MM 42.75 2727014050 A4649 SCREW CORTEX ASIF 4.5MMX50MM 42.75 2727014052 A4649 SCREW CORTEX ASIF 4.5MMX52MM 85.85 2727014054 A4649 SCREW CORTEX ASIF 4.5MMX54MM 42.75 2727014056 A4649 SCREW CORTEX ASIF 4.5MMX56MM 85.85 2727014058 A4649 SCREW CORTEX ASIF 4.5MMX58MM 85.85 2727014060 A4649 SCREW CORTEX ASIF 4.5MMX60MM 42.75 2727014062 A4649 SCREW CORTEX ASIF 4.5MMX62MM 85.85 2727014064 A4649 SCREW CORTEX ASIF 4.5MMX64MM 85.85 2727014066 A4649 SCREW CORTEX ASIF 4.5MMX66MM 85.85 2727014068 A4649 SCREW CORTEX ASIF 4.5MMX68MM 42.75 2727014070 A4649 SCREW CORTEX ASIF 4.5MMX70MM 42.75 2727014072 A4649 SCREW CORTEX ASIF 4.5MMX72MM 85.85 2727014080 A4649 SCREW CORTEX ASIF 4.5MMX80MM 157.12 2727014085 A4649 SCREW CORTEX ASIF 4.5MMX85MM 157.12 2727014090 A4649 SCREW CORTEX ASIF 4.5MMX90MM 157.12 2727014291 A4649 ANGIOCATHETER 20GAX1-1/4 9.90 2727014355 A4649 STONE EXTRACTOR HELICAL 4-WIRE 724.50 2727014522 A4649 SCREW CANNUL PT 4.5MMX22MM 713.18 2727014524 A4649 SCREW CANNUL PT 4.5MMX24MM 840.57 2727014526 A4649 SCREW CANNUL PT 4.5MMX26MM 713.18 2727014528 A4649 SCREW CANNUL PT 4.5MMX28MM 814.57 2727014530 A4649 SCREW CANNUL PT 4.5MMX30MM 814.57 2727014532 A4649 SCREW CANNUL PT 4.5MMX32MM 730.73 2727014534 A4649 SCREW CANNUL PT 4.5MMX34MM 701.49 2727014536 A4649 SCREW CANNUL PT 4.5MMX36MM 701.49 2727014538 A4649 SCREW CANNUL PT 4.5MMX38MM 701.49 2727014540 A4649 SCREW CANNUL PT 4.5MMX40MM 814.57 2727014542 A4649 SCREW CANNUL PT 4.5MMX42MM 814.57 2727014544 A4649 SCREW CANNUL PT 4.5MMX44MM 774.55 2727014546 A4649 SCREW CANNUL PT 4.5MMX46MM 730.73 272
159
7014548 A4649 SCREW CANNUL PT 4.5MMX48MM 701.49 2727014550 A4649 SCREW CANNUL PT 4.5MMX50MM 701.49 2727014552 A4649 SCREW CANNUL PT 4.5MMX52MM 613.81 2727014554 A4649 SCREW CANNUL PT 4.5MMX54MM 701.49 2727014556 A4649 SCREW CANNUL PT 4.5MMX56MM 701.49 2727014560 A4649 SCREW CANNUL PT 4.5MMX60MM 701.49 2727014564 A4649 SCREW CANNUL PT 4.5MMX64MM 826.62 2727014568 A4649 SCREW CANNUL PT 4.5MMX68MM 826.62 2727014572 A4649 SCREW CANNUL PT 4.5MMX72MM 840.57 2727014722 A4649 SCREW CANNUL FT 4.5MMX22MM 837.00 2727014724 A4649 SCREW CANNUL FT 4.5MMX24MM 826.86 2727014726 A4649 SCREW CANNUL FT 4.5MMX26MM 826.86 2727014728 A4649 SCREW CANNUL FT 4.5MMX28MM 837.00 2727014730 A4649 SCREW CANNUL FT 4.5MMX30MM 826.86 2727014732 A4649 SCREW CANNUL FT 4.5MMX32MM 826.86 2727014734 A4649 SCREW CANNUL FT 4.5MMX34MM 826.86 2727014736 A4649 SCREW CANNUL FT 4.5MMX36MM 837.00 2727014738 A4649 SCREW CANNUL FT 4.5MMX38MM 826.86 2727014740 A4649 SCREW CANNUL FT 4.5MMX40MM 837.00 2727014742 A4649 SCREW CANNUL FT 4.5MMX42MM 874.25 2727014744 A4649 SCREW CANNUL FT 4.5MMX44MM 837.00 2727014746 A4649 SCREW CANNUL PT 4.5MMX46MM 897.74 2727014748 A4649 SCREW CANNUL FT 4.5MMX48MM 837.00 2727014750 A4649 SCREW CANNUL FT 4.5MMX50MM 837.00 2727014752 A4649 SCREW CANNUL PT 4.5MMX52MM 802.53 2727014754 A4649 SCREW CANNUL FT 4.5MMX54MM 837.00 2727014756 A4649 SCREW CANNUL FT 4.5MMX56MM 897.74 2727014760 A4649 SCREW CANNUL FT 4.5MMX60MM 837.00 2727014764 A4649 SCREW CANNUL FT 4.5MMX64MM 837.00 2727014768 A4649 SCREW CANNUL FT 4.5MMX68MM 837.00 2727014772 A4649 SCREW CANNUL FT 4.5MMX72MM 814.28 2727014814 A4649 SCREW CORTEX ST 4.5MMX14MM 155.61 2727014816 A4649 SCREW CORTEX ST 4.5MMX16MM 155.61 2727014818 A4649 SCREW CORTEX ST 4.5MMX18MM 155.61 2727014820 A4649 SCREW CORTEX ST 4.5MMX20MM 155.61 2727014822 A4649 SCREW CORTEX ST 4.5MMX22MM 155.61 2727014824 A4649 SCREW CORTEX ST 4.5MMX24MM 155.61 2727014826 A4649 SCREW CORTEX ST 4.5MMX26MM 155.61 2727014830 A4649 SCREW CORTEX ST 4.5MMX30MM 144.48 2727014832 A4649 SCREW CORTEX ST 4.5MMX32MM 144.48 2727014834 A4649 SCREW CORTEX ST 4.5MMX34MM 155.61 272
160
7014836 A4649 SCREW CORTEX ST 4.5MMX36MM 155.61 2727014838 A4649 SCREW CORTEX ST 4.5MMX38MM 155.61 2727014840 A4649 SCREW CORTEX ST 4.5MMX40MM 89.52 2727014842 A4649 SCREW CORTEX ST 4.5MMX42MM 159.56 2727014844 A4649 SCREW CORTEX ST 4.5MMX44MM 144.48 2727014846 A4649 SCREW CORTEX ST 4.5MMX46MM 159.56 2727014848 A4649 SCREW CORTEX ST 4.5MMX48MM 65.77 2727014850 A4649 SCREW CORTEX ST 4.5MMX50MM 65.77 2727014852 A4649 SCREW CORTEX ST 4.5MMX52MM 65.77 2727014854 A4649 SCREW CORTEX ST 4.5MMX54MM 65.77 2727014856 A4649 SCREW CORTEX ST 4.5MMX56MM 116.92 2727014858 A4649 SCREW CORTEX ST 4.5MMX58MM 181.84 2727014860 A4649 SCREW CORTEX ST 4.5MMX60MM 181.84 2727014862 A4649 SCREW CORTEX ST 4.5MMX62MM 120.47 2727014864 A4649 SCREW CORTEX ST 4.5MMX64MM 120.47 2727014866 A4649 SCREW CORTEX ST 4.5MMX66MM 120.47 2727014868 A4649 SCREW CORTEX ST 4.5MMX68MM 120.47 2727014870 A4649 SCREW CORTEX ST 4.5MMX70MM 120.47 2727014872 A4649 SCREW CORTEX ST 4.5MMX72MM 195.15 2727015000 A4649 BUR ROUND XKP 7.0MMX70MM 839.83 2727015106 C1713 PLATE MANDIB UNIV 3X3 2.3MM SY 1184.31 2787015108 C1713 PLATE MANDIBLE ANGLE KLS 4X4 2 1199.66 2787015150 A4649 ROTH POLYPECTOMY NET 139.29 2727015211 A4649 DRILL TWIST KLS 1.1MMX70MM 621.12 2727015215 A4649 DRILL TWIST KLS 1.5MMX70MM 621.12 2727015412 A4649 SCREW BONE HERBERT 12MMX3MM 913.61 2727015414 A4649 SCREW BONE HERBERT 14MMX3MM 913.61 2727015416 A4649 SCREW BONE HERBERT 16MMX3MM 913.61 2727015418 A4649 SCREW BONE HERBERT 18MMX3MM 913.61 2727015420 A4649 SCREW BONE HERBERT 20MMX3MM 480.32 2727015422 A4649 SCREW BONE HERBERT 22MM 428.00 2727015424 A4649 SCREW BONE HERBERT 24MMX3MM 480.32 2727015426 A4649 SCREW BONE HERBERT 26MMX3MM 913.61 2727015428 A4649 SCREW BONE HERBERT 28MM 428.00 2727015430 A4649 SCREW BONE HERBERT 30MM 428.00 2727015516 A4649 ELECTRODE EXTENDED BLADE 6 38.86 2727015833 A4649 PACEMAKER CABLE DISP 172.21 2727016010 A4927 GLOVES SURG S-7-1/2 SPEC 3.97 2727016035 A4649 SCREW CANCEL PT-16 6.5MMX35MM 242.96 2727016037 A4649 TUBE ENDOBRONCHIAL STR LT 37FR 857.47 2727016040 A4649 SCREW CANCEL PT-16 6.5MMX40MM 242.96 272
161
7016045 A4649 SCREW CANCELLOUS PT 6.5MMX45MM 113.26 2727016055 A4649 SCREW CANCEL PT-16 6.5MMX55MM 242.96 2727016060 A4649 SCREW CANCEL PT-16 6.5MMX60MM 242.96 2727016065 A4649 SCREW CANCEL PT-16 6.5MMX65MM 242.96 2727016070 A4649 SCREW CANCEL PT-16 6.5MMX70MM 242.96 2727016075 A4649 SCREW CANCEL PT-16 6.5MMX75MM 242.96 2727016080 A4649 SCREW CANCEL PT-16 6.5MMX80MM 242.96 2727016090 A4649 SCREW CANCEL PT-16 6.5MMX90MM 268.55 2727016095 A4649 SCREW CANCEL PT-16 6.5MMX95MM 268.55 2727016201 A4649 MASK LOW PRESSURE-INFANT 17.72 2727016202 A4649 MASK LOW PRESSURE-PEDS 17.72 2727016203 A4649 MASK LOW PRESSURE-ADULT 19.11 2727016204 A4649 MASK LOW PRESSURE-ADULT LGE 33.21 2727016303 A4649 DRILL BIT JL STOP 0.76MMX6MM 447.21 2727016396 A4649 DRILL BIT MQC 1.0MMX50MM 195.84 2727016402 A4649 DRILL BIT MQC 1.3MMX55MM 195.84 2727016671 A4649 SUTURE ETHILON 4-0 18 PS-2 54.01 2727016961 A4649 SUTURE ETHILON 7-0 18 P-1 72.48 2727017000 A4649 SUTURE VICRYL 4-0 U 12X18 120.07 2727017050 A4649 SCREW CANCEL PT 6.5MMX50MM 113.26 2727017055 A4649 SCREW CANCELLOUS PT 6.5MMX55MM 113.26 2727017060 A4649 SCREW CANCELLOUS PT-32 6.5MMX6 113.26 2727017065 A4649 SCREW CANCELLOUS PT-32 6.5MMX6 113.26 2727017070 A4649 SCREW CANCELLOUS PT-32 6.5MMX7 113.26 2727017075 A4649 SCREW CANCELLOUS PT-32 6.5MMX7 113.26 2727017080 A4649 SCREW CANCEL PT-32 6.5MMX80MM 242.96 2727017085 A4649 SCREW CANCEL TH-32 6.5MMX85MM 268.55 2727017090 A4649 SCREW CANCEL TH-32 6.5MMX90MM 268.55 2727017095 A4649 SCREW CANCEL TH-32 6.5MMX95MM 268.55 2727017100 A4649 SCREW CANCEL TH-32 6.5MMX100MM 268.55 2727017105 A4649 SCREW CANCEL PT-32 6.5MMX105MM 268.55 2727017835 A4649 TUBE NASAL RAE CUFFED 3.5MM 33.60 2727017840 A4649 TUBE NASAL RAE CUFFED 4.0MM 33.60 2727017845 A4649 TUBE NASAL RAE CUFFED 4.5MM 33.60 2727017861 A4649 DRILL BIT MQC 1.8MMX80MM 181.22 2727017865 A4649 TUBE NASAL RAE CUFFED 6.5MM 38.72 2727017867 A4649 DRILL BIT JL 1.8MMX90MM 610.98 2727017871 A4649 DRILL BIT MQC 2.4MMX80MM 207.52 2727017872 A4649 DRILL BIT JL 2.4MMX90MM 610.98 2727018000 A4649 TROCAR THORACIC SLEEVE 10/12MM 200.95 2727018025 A4649 SCREW CANCEL FT 6.5MMX25MM 242.96 272
162
7018030 A4649 SCREW CANCEL FT 6.5MMX30MM 242.96 2727018035 A4649 SCREW CANCEL FT 6.5MMX35MM 242.96 2727018040 A4649 SCREW CANCEL FT 6.5MMX40MM 242.96 2727018069 A4649 SCREW ST TI 2 MM X 6-32 MM 241.92 2727019103 A4649 BLADE SAW 10MMX26MM 519.103 79.87 2727019105 A4649 BLADE SAW 6MMX25MM 519.230 394.59 2727019106 A4649 BLADE SAW 20MMX50MM 519.105 131.53 2727019412 C1713 PLATE MANDIRECON RT ANG 12 HOL 1506.62 2787019441 A4649 TUBE ENDOBRONCHIAL STR LT 41FR 571.08 2727019600 A4649 SCREW CORTEX MD HD 1.3MMX11MM 260.14 2727019608 C1713 PLATE MANDIRECON STR 8 HOLE 1168.95 2787019611 C1713 PLATE MANDIRECON STR 11 HOLE 1215.00 2787019614 C1713 PLATE MANDIRECON STR 14 HOLE 1245.68 2787019617 C1713 PLATE MANDIRECON STR 17 HOLE 1322.43 2787019715 C1713 PLATE MANDIRECON RT ANG 15 HOL 1583.37 2787019718 C1713 PLATE MANDIRECON RT ANG 18 HOL 1629.42 2787019902 A4649 SUTURE PDS TP-1 LOOP 78.76 2727019912 C1713 PLATE MANDIRECON LT ANG 2.7 1 1342.47 2787019913 C1713 PLATE MANDIRECON KLS LT 2.7 18 1451.90 2787019915 C1713 PLATE MANDIRECON KLS LT 2.7 15 1410.87 2787020010 A4649 NAIL FEMUR TFNA RT 10MMX400MM 4110.96 2727020011 A4649 GLOVES RADION-X SIZE 8 309.72 2727020012 A4649 DERMABOND SKIN ADHESIVE 212.13 2727020014 A7526 TUBE TRACHEOSTOMY PEDS 3.5 190.07 2727020015 A4649 TUBE TRACHEOSTOMY PEDS 4.5 190.07 2727020016 A4649 AIRWAY-NASOPHARYNGEAL 16FR 28.95 2727020018 A4649 AIRWAY-NASOPHARYNGEAL 18FR 19.38 2727020020 A4649 AIRWAY-NASOPHARYNGEAL 20FR 19.38 2727020023 A4649 SUTURE MERSILENE STRIP R5MM 477.34 2727020024 A4649 AIRWAY-NASOPHARYNGEAL 24FR 19.38 2727020026 A4649 AIRWAY-NASOPHARYNGEAL 26FR 24.10 2727020028 A4649 AIRWAY-NASOPHARYNGEAL 28FR 18.32 2727020030 A4649 AIRWAY-NASOPHARYNGEAL 30FR 19.11 2727020032 A4649 AIRWAY-NASOPHARYNGEAL 32FR 17.49 2727020034 A4649 AIRWAY-NASOPHARYNGEAL 34FR 17.49 2727020036 A4649 AIRWAY-NASOPHARYNGEAL 36FR 17.49 2727020060 A4649 CONNECTOR TERUMO 1/4X1/4 CBP 58.43 2727020063 A4649 TOURNICOT-SMALL 16.08 2717020064 A4649 TOURNICOT-MEDIUM 20.73 2717020065 A4649 TOURNICOT-LARGE 20.73 2717020066 A4649 TOURNICOT-X-LARGE 20.73 271
163
7020071 A4649 SUTURE STANDARD 54 11.76 2727020072 A4649 SUTURE LABRYNTH 12X18 69.64 2727020074 A4649 SUTURE SUTUPAK 6-12X18 73.66 2727020075 A4649 SET CARDIOPLEGIA 4:1 CBP 856.96 2727020076 A4649 TUBING PRESSURE 48 CBP 9.49 2727020077 A4649 ADAPTER MALE DBL LL CLEAR CBP 16.81 2727020078 A4649 TABLE LINE-CAPIOX CP50 CBP 260.93 2727020079 A4649 TRAY SKIN PREP GEL PVP CBP 20.53 2727020091 A4649 BIPOLAR FORCEPS CORD 12FT 42.08 2727020092 A4649 EXTRACTOR BALLOON 15MM/18MM - 925.30 2727020093 A4649 PROBE GOLD 10FRX300CM - ERCP 981.20 2727020094 A4649 PROBE GOLD 7FRX300CM - ERCP 981.20 2727020100 A4649 SUTURE PLAIN 3-0 54 REEL 11.84 2727020101 A4649 SCREW CORTEX MD HD 2.4MMX11MM 275.14 2727020102 A4649 SCREW CORTEX MD HD 2.4MMX12MM 275.14 2727020103 A4649 SCREW CORTEX MD HD 2.4MMX13MM 275.14 2727020104 A4649 SCREW CORTEX MD HD 2.4MMX14MM 275.14 2727020106 A4649 SCREW CORTEX MD HD 2.4MMX16MM 275.14 2727020116 A4649 CATHETER OPEN-END W/ WIRE SZ-6 74.68 2727020122 A4649 NEEDLE CYTOLOGY TRANSBRONCHIAL 534.67 2727020146 A4649 PROBE ARTHRO SERFAS 3.5MM 90-S 909.69 2727020150 A4649 NAIL FEMUR TFNA RT 10MMX320MM 4110.96 2727020160 A4649 CATHETER LUBRICATH 3-WAY 20FR 44.88 2727020171 A4649 CO2-15MIN 8.46 2707020188 C1769 GUIDEWIRE TERUMO ANGLED 0.038 109.58 2727020212 A4649 SUTURE VICRYL 6-0 U 27 RB-1 26.60 2727020213 A4649 SUTURE VICRYL 5-0 U 27 RB-1 25.92 2727020226 A4649 BAG FABRIC BACK LEG 23.54 2707020244 A4649 NEURO PATTIE 1/2X3 97.42 2727020247 A4649 BLADE NEURO SPIRAL FLUTED 279.06 2727020274 A4649 PROBE DOPPLER 2.3MM CBP 678.49 2727020275 A4649 PROBE DOPPLER 3.5MM CBP 678.49 2727020280 A4649 SCREW CORTEX 2.7MMX6MM 115.08 2727020281 A4649 SCREW CORTEX ST 2.7MMX10MM 115.08 2727020298 A4649 SUTURE ETHIBOND 5 LR B499T 69.38 2727020320 A4649 LIGACLIP ERCA 882.44 2727020330 A4649 SET TRACTION TONG 1002.92 2727020350 A4649 NEEDLE TEFLON PROBLOC 22GAX2 127.52 2727020357 A4649 BLADE SAW SMALL BATT DRIVE 53 906.90 2727020359 A4649 BLADE SAW SMALL BATT DRIVE 53 906.90 2727020371 A4649 HOOK ARTHRO SERFAS 3.5MM 835.51 272
164
7020372 A4649 GUIDEWIRE NITINOL 15MMX14IN 37.28 2727020375 A4649 TUBING ARTHRO STRYKER 460.27 2727020376 A4649 BLADE ARTHRO RESECTOR 4.0MM 404.43 2727020378 A4649 BLADE ARTHRO AGGRESSIVE PLUS 4 297.23 2727020379 A4649 BLADE ARTHRO AGGRESSIVE PLUS 5 351.78 2727020380 A4649 NEEDLE TEFLON PROBLOC 22GAX3 127.52 2727020381 A4649 BLADE ARTHRO AGGRESSIVE PLUS 5 305.62 2727020384 A4649 BLADE ARTHRO FLUTE BB 12 5.0MM 529.22 2727020385 A4649 BLADE ARTHRO FLUTE BB 6 4.0MM 421.13 2727020386 A4649 BLADE ARTHRO FLUTE BB 6 5.0MM 490.97 2727020387 A4649 BLADE ARTHRO FLUTE BB 6 5.5MM 375.26 2727020388 A4649 BLADE ARTHRO FLUTE RB 12 4.0MM 464.30 2727020400 A4649 LIGACLIP LT400 XLGE TITANIUM 84.83 2727020405 A4649 TUBE TRACHEOSTOMY NEO 3.0 387.28 2727020406 A7520 TUBE TRACHEOSTOMY NEO 3.5 387.28 2727020434 A4649 CUTTING BUR ENT 2.3X51MM 441.61 2727020435 A4649 CUTTING BUR ENT 3.7X51MM 441.61 2727020436 A4649 CUTTING BUR ENT 5.0X44MM 441.61 2727020437 A4649 CUTTING BUR ENT 6.9X44MM 428.62 2727020438 A4649 CUTTING BUR ENT 8.5X44MM 474.09 2727020439 A4649 IRRIGATION PUMP 21.14 2707020444 A4649 SCREW CORTEX ST 3.5MMX44MM 115.08 2727020466 A4649 BLADE WITH HANDLE #10 70.59 2727020467 A4649 BLADE WITH HANDLE #11 70.59 2727020468 A4649 BLADE WITH HANDLE #15 70.59 2727020484 A4649 PILLOW PRONE POSITION-DISP 289.88 2727020497 A4649 SUTURE MONOCRYL 3-0 18 PS-2 64.35 2727020500 A4649 SET STONE EXT BAL 3-LUMEN 7.5F 895.00 2727020501 A4649 STONE EXT BALLOON 3-LUMEN 7.5F 1107.17 2727020502 A4649 STONE EXT BALLOON 2-LUMEN 5FR 814.58 2727020503 A4649 STONE EXT BALLOON 2-LUMEN 7FR 814.58 2727020508 A4649 STONE EXT BASKET 4-WIRE 20MMX1 805.65 2727020510 A4649 STONE EXT BASKET 4-WIRE 25MMX2 805.65 2727020511 A4649 STONE EXT BASKET 4-WIRE 30MMX2 805.65 2727020520 A4649 SYRINGE SLIP TIP 20CC 2.33 2727020521 A4649 SYRINGE SLIP TIP 10CC 1.24 2727020522 A4649 SYRINGE SLIP TIP 30CC 4.16 2727020551 A4649 AORTIC PUNCH 4.0MM-CBP 111.43 2727020552 A4649 AORTIC PUNCH 5.2MM CBP 219.22 2727020591 A4649 FORCEP HOT BIOPSY 47.37 2727020602 A4649 SUTURE GORETEX CV-6 24 TT9 130.32 272
165
7020604 A4649 SUTURE GORETEX CV-6 24 TT13 115.72 2727020606 A4649 SUTURE GORETEX CV-6 24 PT9 147.11 2727020607 A4649 GRID-VIEW SYSTEM 870.92 2717020610 A4649 SUTURE GORETEX CV-6 24 TT12 119.41 2727020655 A7520 TUBE TRACHEOSTOMY XLT 6.0MM 664.62 2727020656 A4649 CANNULA-TRACH TUBE XLT 6.0MM 53.63 2727020658 A4649 BLADE SAW SMALL BATT DRIVE 53 906.90 2727020686 A4649 HEMOCLIP TITANIUM MED 179.09 2727020687 A4649 HEMOCLIP TITANIUM LGE 213.60 2727020688 A4649 HALO TRACTION SYSTEM-SML 2318.31 2727020698 A4649 SUTURE ETHIBOND 4-0 18 P-3 37.64 2727020704 A4649 SUTURE GORETEX CV-7 24 PT9 120.98 2727020706 A4649 SUTURE GORETEX CV-7 24 TT13 41.25 2727020712 A4649 SUTURE GORETEX CV-7 30 TT12 116.20 2727020726 A4649 SUTURE MICRO TAPERPOINT 80.20 2727020750 A4649 DUALMESH GORE 1MM 26CMX34XM 3689.40 2727020754 A4649 BLADE SURGICAL CLIPPER #9670 24.71 2727020756 A4649 BLADE SURGICAL CLIPPER #9600 20.10 2727020774 A4649 SUTURE PLAIN 6-0 18 G-1 80.39 2727020779 A4649 PATCH HEMACAROTID 8 248.13 2727020794 A4649 SUTURE CHROMIC 6-0 G6/G6 18 181.11 2727020805 A4649 DRAIN JACKSON-PRATT 7MM 614.90 2727020809 A4649 TUBE ENDOBRONCHIAL LT 28FR 571.08 2727020810 A4649 TUBE ENDOBRONCHIAL STR LT 32MM 571.08 2727020811 A4649 TUBE ENDOBRONCHIAL LT 35FR 571.08 2727020833 A4649 SUTURE MONOCRYL 6-0 18 PC-1 71.18 2727020834 A4649 SUTURE MONOCRYL 5-0 18 PC-1 71.18 2727020835 A4649 SUTURE MONOCRYL 4-0 18 PC-1 67.38 2727020845 A4649 SUTURE MONOCRYL 4-0 18 PC-3 71.18 2727020870 A4649 STONE EXTRACTOR NO TIP 1.5FRX1 1025.05 2727020916 A4649 CATHETER MALECOT 24FR 519.54 2727020925 A4649 ELECTRODE TUR HOOK 26/28FR 264.97 2727020944 A4649 SUTURE MICRO TAPERCUT 266.02 2727020978 A4649 SUTURE MONOCRYLYL 0 36 U CTX 40.83 2727020991 A4649 ETHICON MONOFILAMENT LOOP S-2 88.81 2727021000 A4649 SUTURE SILK 2-0 8X18 SH 115.90 2727021020 A4649 NAIL FEMUR TFNA RT 10MMX300MM 4110.96 2727021060 A4649 SCREW CANCELL FT 4.0MMX12MM 96.81 2727021070 A4649 SCREW CANCELL PT 4.0MMX12MM 102.31 2727021104 C1758 CATHETER URETERAL FLEXI TIP RT 90.35 2727021105 C1758 CATHETER URETERAL FLEXI TIP RT 90.35 272
166
7021106 C1758 CATHETER URETERAL FLEXI TIP RT 90.35 2727021203 A4649 CATHETER NEURO VENT CLR 30CM 982.75 2727021204 A4649 CATHETER URETERAL FLEXI TIP LT 90.35 2727021205 C1758 CATHETER URETERAL FLEXI TIP LT 90.35 2727021292 A4649 K-WIRE TROCAR PT 1.25MMX150MM 52.31 2727021301 A4649 CATHETER NEURO D/S VLV 91CM 1046.49 2727021306 C1713 PLATE STR TI 6-HOLE 1.3 1.5 MM 774.96 2727021310 A4649 ELECTRODE CUT LOOP TUR LGE 22F 306.90 2727021312 C1713 PLATE STR TI 12-HOLE 1.3 1.5 M 901.87 2787021321 C1713 PLATE H EXT MD HD LT 1.3MM 8-H 724.88 2787021333 C1713 PLATE-T TI 3-HOLE 1.3 1.5 MM 886.55 2787021334 C1713 PLATE T HEAD MD HD 1.3 4 HOLE 941.80 2787021335 C1713 PLATE Y MD HD 1.3 932.59 2727021380 A4649 CATHETER NEURO BA OPEN 91CM 911.01 2727021410 A4649 ELECTRODE CUTTING LOOP 22FR 398.23 2727021411 A4649 RESERVOIR SGL DOME FLAT-NEURO 993.97 2727021504 A4649 CONNECTOR NEURO STR 17MM 598.35 2727021507 A4649 CONNECTOR NEURO RT ANG 17.4MM 745.66 2727021508 A4649 CATHETER FOLLOW THREADED 8FR 438.11 2727021510 A4649 CATHETER FOLLOW THREADED 10FR 438.11 2727021512 A4649 CATHETER FOLLOW THREADED 12FR 501.27 2727021514 A4649 CATHETER FOLLOW THREADED 14FR 438.11 2727021516 A4649 CATHETER FOLLOW THREADED 16FR 438.11 2727021518 A4649 CATHETER FOLLOW THREADED 18FR 501.27 2727021520 A4649 CATHETER FOLLOW THREADED 20FR 501.27 2727021522 A4649 CATHETER FOLLOW THREADED 22FR 438.11 2727021524 A4649 CATHETER FOLLOW THREADED 24FR 438.11 2727021552 A4649 HUMID VENT HEAT/MOISTURE EXCHA 53.32 2727021563 A4649 EVACUATOR SMOKE 103.65 2727021592 A4649 OBTURATOR SYSTEM TVT 2016.53 2727021622 C1713 PLATE DCP BR 4.5MM 12 HOLE 822.78 2787021630 A4649 RESERVOIR CATH VENT RT ANGL 3C 1357.97 2727021632 A4649 RESERVOIR CATH VENT RT ANGL 4C 1357.97 2727021634 A4649 RESERVOIR CATH VENT RT ANGL 5C 993.97 2727021800 A4649 SUTURE CHROMIC 0 27 CT-1 39.41 2727021904 A4649 CATHETER STR FILIFORM 4FR 255.73 2727021905 A4649 CATHETER STR FILIFORM 5FR 255.73 2727021920 A4649 SNARE POLYPECTOMY 3.0MMX230CM 192.72 2727021921 A4649 SNARE POLYPECTOMY 2.8MMX240CM 261.39 2727021991 A4649 WASHER 10MM 151.70 2727021998 A4649 WASHER 7MM 127.10 272
167
7021999 A4649 WASHER 13MM 135.31 2727022000 A4649 ACUMATCH-L UNIPOLAR SLEEVE 657.63 2727022006 A4649 CATHETER SPL FILIFORM 6FR 313.68 2727022043 A4649 ACUMATCH-L UNI PROSTHESIS 43MM 1185.20 2727022070 A4649 SCREW CANCELL PT 4.0MMX22MM 96.81 2727022100 A4649 SUTURE CHROMIC 3-0 27 SH 30.18 2727022103 A4649 CATHETER SPL FILIFORM 3FR 286.40 2727022104 A4649 CATHETER SPL FILIFORM 4FR 255.73 2727022105 A4649 CATHETER SPL FILIFORM 5FR 255.73 2727022204 C1713 PLATE SEMI-TUBULAR DCP 4 HOLE 313.69 2787022205 C1713 PLATE SEMI-TUBULAR DCP 5 HOLE 325.96 2787022206 C1713 PLATE SEMI-TUBULAR DCP 6 HOLE 346.48 2787022207 C1713 PLATE SEMI-TUBULAR DCP 7 HOLE 373.14 2787022304 A4352 CATHETER COUDE FILIFORM 4FR 255.73 2727022305 A4352 CATHETER COUDE FILIFORM 5FR 255.73 2727022404 C1713 PLATE NR DCP 4.5 4-5 HOLE 692.97 2787022405 C1713 PLATE DCP NR 4.5MM 5-HOLE 668.60 2787022406 C1713 PLATE NARROW DCP 4.5 6-9 HOLE 787.25 2787022407 C1713 PLATE DCP NR 4.5MM 7-HOLE 759.94 2787022409 C1713 PLATE DCP NR 4.5MM 8-HOLE 759.94 2787022410 C1713 PLATE NR DCP 4.5 10-12 HOLE 909.55 2787022412 C1713 PLATE DCP NR 4.5MM 12-HOLE 852.83 2787022500 A4649 SUTURE PROLENE 3-0 36 SH/SH 63.87 2727022512 A4649 CATHETER URETHRAL 22FR 43.84 2727022600 A4649 SUTURE SILK 3-0 30 KS 9.36 2727022607 C1713 PLATE DCP BR 4.5MM 7-HOLE 856.41 2787022609 C1713 PLATE DCP BR 4.5MM 9 HOLE 809.10 2787022610 C1713 PLATE DCP BR 4.5MM 10-HOLE 949.97 2787022611 A4649 CLIP DEVICE RESOL 235CM-ERCP 887.02 2727022614 C1713 PLATE DCP BR 4.5MM 14-HOLE 967.75 2787022616 A4649 PLATE DCP BR 16-HOLE 1006.24 2787022800 A4649 ROD HUMERAL POLARUS 8MMX220MM 1219.40 2727022901 A4649 ELECTRODE MICROTIP SPATULA 206.28 2727022933 C1713 PLATE RECON STR 4.5 3 HOLE 1052.31 2787022934 C1713 PLATE RECON STR 4.5 4 HOLE 1067.66 2787022935 C1713 PLATE RECON STR 4.5 5 HOLE 1098.35 2787022940 C1713 PLATE RECON STR 4.5 10 HOLE 1219.61 2787023012 A4649 VALVE CYL W/ PRECHAMBER LO PRE 993.97 2727023041 A4649 CATHETER NEURO VENT STR 14CM 832.84 2727023400 A4649 TRAY UROLOGIST HEYMAN 930.73 2727023470 A4649 HEMOCLIP TITANIUM SML 179.09 272
168
7024000 A4649 BUR DIA RD EX CRSE XKP 4.0MMX5 848.43 2727024005 C1713 PLATE SPOON DCP 5 HOLE 975.56 2787024006 C1713 PLATE SPOON DCP 6 HOLE 995.52 2787024008 A4649 CATHETER BOUGIE THREADED 8FR 460.72 2727024014 C1713 PLATE T DCP 4 HOLE 947.93 2787024015 C1713 PLATE T DCP 5 HOLE 963.30 2787024016 C1713 PLATE T DCP 6 HOLE 984.76 2787024018 C1713 PLATE T DCP 8 HOLE 1092.20 2787024026 A4649 KIT UNISHUNT RESERVOIR 78CM 2142.58 2727024034 A4649 PLATE T BUTTRESS DCP 4 HOLE 1056.92 2787024035 C1713 PLATE T BUTTRESS DCP 5 HOLE 1064.57 2787024036 C1713 PLATE T BUTTRESS DCP 6 HOLE 1095.28 2787024044 C1713 PLATE L-BUTTRESS DCP TIBIA L/R 1023.14 2787024058 C1713 PLATE TIBIA HEAD BUTT 9-H LT 1065.11 2787024095 C1713 PLATE COND DCP RT 190MM 9 HOLE 1300.67 2787024110 A4649 SET BAIR FLUID WARMING #241 53.71 2727024113 C1713 PLATE T HEAD RT ANGLE 3.5 X 3 1043.09 2787024114 C1713 PLATE T HEAD RT ANGLE 3.5 X 4 1056.92 2787024123 C1713 PLATE T HEAD OBL 3.5 X 3 HOLE 914.15 2787024125 C1713 PLATE T HEAD OBL 3.5 X 5 HOLE 914.15 2787024132 C1713 PLATE TUBULAR 1/3 2 HOLE 268.58 2787024133 C1713 PLATE TUBULAR 1/3 3 HOLE 280.85 2787024134 C1713 PLATE TUBULAR 1/3 4 HOLE 325.96 2787024135 C1713 PLATE TUBULAR 1/3 5 HOLE 325.96 2787024136 C1713 PLATE TUBULAR 1/3 6 HOLE 336.22 2787024137 C1713 PLATE TUBULAR 1/3 7 HOLE 336.22 2787024138 C1713 PLATE TUBULAR 1/3 8 HOLE 350.57 2787024144 C1713 PLATE L-BUTTRESS DCP ANG LT 4- 934.93 2787024154 C1713 PLATE L-BUTTRESS DCP ANG RT 4- 934.93 2787024161 C1713 PLATE CALCANEAL 60MMX9MM 1019.46 2787024162 C1713 PLATE CALCANEAL 70MM 1216.52 2787024165 C1713 PLATE-Y CALCANEAL 87MM 1026.83 2787024183 C1713 PLATE CLOVERLEAF 3 HOLE 995.52 2787024184 C1713 PLATE CLOVERLEAF 4 HOLE 1015.46 2787024203 C1713 PLATE TUBULAR 1/4 3 HOLE 323.91 2787024204 C1713 PLATE TUBULAR 1/4 4 HOLE 348.53 2787024205 A4649 PLATE TUBULAR 1/4 5 HOLE 369.03 2787024206 C1713 PLATE TUBULAR 1/4 6 HOLE 407.98 2787024207 C1713 PLATE TUBULAR 1/4 7 HOLE 426.44 2787024208 C1713 PLATE TUBULAR 1/4 8 HOLE 451.04 2787024231 C1713 PLATE L 2.7MM 3 HOLE 32MM LT 190.00 278
169
7024232 C1713 PLATE-L 27MMX32MM RT 3-HOLE 263.06 2787024233 C1713 PLATE L OBLIQUE LT 2.7 276.77 2787024234 C1713 PLATE L OBLIQUE RT 2.7 276.77 2787024241 C1713 PLATE T 2.7 X 3 HOLE 272.69 2787024313 C1713 PLATE STRAIGHT 2.0X3 HOLE 272.69 2787024314 C1713 PLATE STRAIGHT 2.0X4 HOLE 301.39 2787024315 C1713 PLATE STRAIGHT 2.0X5 HOLE 323.91 2787024316 C1713 PLATE STRAIGHT 2.0X6 HOLE 356.73 2787024332 C1713 PLATE-L 2.0MMX17MM RT 3-HOLE 263.06 2787024333 C1713 PLATE L LEFT 2.0 272.69 2787024334 C1713 PLATE L RIGHT 2.0 272.69 2787024341 A4649 PLATE T 2.0 272.69 2787024404 C1758 CATHETER URETERAL SPIRAL TIP 4 92.40 2727024405 C1758 CATHETER URETERAL SPIRAL TIP 5 92.40 2727024406 C1713 PLATE L-BUTTRESS ANG LT 6-HOLE 1131.87 2787024407 C1713 PLATE L-BUTTRESS ANG RT 6-HOLE 1131.87 2787024408 C1713 PLATE L-BUTTRESS ANG LT 7-HOLE 1155.12 2787024409 C1713 PLATE L-BUTTRESS ANG RT 7-HOLE 1155.12 2787024410 C1713 PLATE L-BUTTRESS ANG LT 8-HOLE 1181.11 2787024411 C1713 PLATE L-BUTTRESS ANG RT 8-HOLE 1181.11 2787024500 C1713 PLATE RECON STR 118MM 10 HOLE 1172.03 2787024501 C1713 PLATE RECON 3.5MM 130MM 11-HOL 1178.36 2787024502 C1713 PLATE RECON 142MM 3.5 12 HOLE 1215.00 2787024514 C1713 PLATE RECONSTRUCTION 4H 46MM 921.24 2787024515 C1713 PLATE RECONSTRUCTION 5H 58MM 921.24 2787024516 C1713 PLATE RECONSTRUCTION 6H 70MM 954.38 2787024517 C1713 PLATE RECONSTRUCTION 7H 82MM 966.65 2787024518 C1713 PLATE RECONSTRUCTION 8H 94MM 977.71 2787024519 C1713 PLATE RECON 3.5MM 9 HOLE 1071.69 2787024520 C1713 PLATE RECONSTRUCTION 6H 48MM 913.55 2787024521 C1713 PLATE RECONSTRUCTION 8H 64MM 903.42 2787024522 C1713 PLATE RECONSTRUCTION 10H 80MM 935.66 2787024523 C1713 PLATE RECONSTRUCTION 12H 96MM 952.54 2787024524 C1713 PLATE RECONSTRUCTION 14H 112MM 1007.80 2787024605 C1758 CATHETER URETERAL CONE TIP 5FR 90.35 2727024606 C1758 CATHETER URETERAL CONE TIP 6FR 53.90 2727024608 A4649 CATH-URETERAL CONE TIP 8FR 183.51 2727024800 A4649 SUTURE VICRYL 3-0 U 27 CT-1 25.36 2727024806 C1713 PLATE 3.5X6 HOLE 725.75 2787024807 C1713 PLATE 3.5X7 HOLE 754.48 2787024808 C1713 PLATE 3.5X8 HOLE 795.46 278
170
7024809 C1713 PLATE DCP 3.5MM 9-HOLE 788.58 2787024810 C1713 PLATE 3.5X10 HOLE 844.66 2787024879 C1713 PLATE COND DCP LT 221MM 11-HOL 1166.06 2787024880 C1713 PLATE COND DCP RT 221MM 11-HOL 1166.06 2787025000 A4649 SUTURE VICRYL 1 U 6X18 61.03 2727025027 A4649 NAIL UNIV TIBIAL 10MMX270MM 1246.05 2727025028 A4649 NAIL UNIV TIBIAL 10MMX285MM 1246.05 2727025030 A4649 NAIL UNIV TIBIAL 10MMX300MM 1246.05 2727025031 A4649 NAIL UNIV TIBIAL 10MMX315MM 1246.05 2727025033 A4649 NAIL UNIV TIBIAL 10MMX330MM 1246.05 2727025034 A4649 NAIL UNIV TIBIAL 10MMX345MM 1152.38 2727025036 A4649 NAIL UNIV TIBIAL 10MMX360MM 1152.38 2727025038 A4649 NAIL UNIV TIBIAL 10MMX380MM 1152.38 2727025040 A4649 NAIL UNIV TIBIAL 10MMX400MM 1152.38 2727025121 A4649 STENT MARDIS SOFT 6FRX22CM 848.73 2727025127 A4649 NAIL UNIV TIBIAL 11MMX270MM 1152.38 2727025128 A4649 NAIL UNIV TIBIAL 11MMX285MM 1298.94 2727025130 A4649 STENT MARDIS SOFT 6FRX20CM 848.73 2727025131 A4649 NAIL UNIV TIBIAL 11MMX315MM 1298.94 2727025132 A4649 STENT MARDIS SOFT 6FRX24CM 848.73 2727025133 A4649 STENT MARDIS SOFT 6FRX26CM 847.44 2727025134 A4649 STENT MARDIS SOFT 6FRX28CM 559.16 2727025136 A4649 NAIL UNIV TIBIAL 11MMX360MM 1152.38 2727025138 A4649 NAIL UNIV TIBIAL 11MMX380MM 1152.38 2727025140 A4649 STENT MARDIS SOFT 7FRX20CM 848.73 2727025141 A4649 STENT MARDIS SOFT 7FRX22CM 848.73 2727025142 A4649 STENT MARDIS SOFT 7FRX24CM 848.73 2727025143 A4649 STENT MARDIS SOFT 7FRX26CM 847.44 2727025210 A4649 SCREW CANNUL FT 3.5MMX10MM 821.35 2727025212 A4649 SCREW CANNUL FT 3.5MMX12MM 821.35 2727025214 A4649 SCREW CANNUL FT 3.5MMX14MM 872.00 2727025216 A4649 SCREW CANNUL FT 3.5MMX16MM 872.00 2727025227 A4649 NAIL UNIV TIBIAL 12MMX270MM 1152.38 2727025228 A4649 NAIL UNIV TIBIAL 12MMX285MM 1152.38 2727025230 A4649 NAIL UNIV TIBIAL 12MMX300MM 1152.38 2727025231 A4649 STENT MARDIS FIRM 6FRX22CM 847.44 2727025232 A4649 STENT URETERAL PERC 6FR 24CM 811.25 2727025233 A4649 STENT MARDIS FIRM 6FRX26CM 848.73 2727025234 A4649 STENT MARDIS FIRM 6FRX28CM 848.73 2727025236 A4649 NAIL UNIV TIBIAL 12MMX360MM 1152.38 2727025238 A4649 NAIL UNIV TIBIAL 12MMX380MM 1152.38 272
171
7025240 A4649 STENT MARDIS FIRM 7RX20CM 847.44 2727025311 A4649 GRAFT GORETEX 8MMX70CM 1804.37 2727025327 A4649 NAIL UNIV TIBIAL 13MMX270MM 1565.40 2727025328 A4649 NAIL UNIV TIBIAL 13MMX285MM 1182.48 2727025330 A4649 NAIL UNIV TIBIAL 13MMX300MM 1565.40 2727025331 A4649 NAIL UNIV TIBIAL 13MMX315MM 1565.40 2727025333 A4649 NAIL UNIV TIBIAL 13MMX330MM 1201.65 2727025334 A4649 NAIL UNIV TIBIAL 13MMX345MM 1201.65 2727025336 A4649 NAIL UNIV TIBIAL 13MMX360MM 1201.65 2727025338 A4649 NAIL UNIV TIBIAL 13MMX380MM 1151.23 2727025340 A4649 NAIL UNIV TIBIAL 13MMX400MM 1565.40 2727025605 A4649 SURFIT FLEXIBLE WAFER 21.07 2717025699 A4649 SURFIT DRAINABLE POUCH 11.83 2727025901 A4649 ELECTRODE MICROTIP RT. ANGLE 206.28 2727025928 A4649 BOLT LOCKING 4.9MMX28MM 426.73 2727025930 A4649 BOLT LOCKING 4.9MMX30MM 426.73 2727025932 A4649 BOLT LOCKING 4.9MMX32MM 426.73 2727025934 A4649 BOLT LOCKING 4.9MMX34MM 727.06 2727025936 A4649 BOLT LOCKING 4.9MMX36MM 426.73 2727025938 A4649 BOLT LOCKING 4.9MMX38MM 318.97 2727025940 A4649 BOLT LOCKING 4.9MMX40MM 806.37 2727025942 A4649 BOLT LOCKING 4.9MMX42MM 675.91 2727025944 A4649 BOLT LOCKING 4.9MMX44MM 479.36 2727025946 A4649 BOLT LOCKING 4.9MMX46MM 426.73 2727025948 A4649 BOLT LOCKING 4.9MMX48MM 426.73 2727025950 A4649 BOLT LOCKING 4.9MMX50MM 504.20 2727025954 A4649 BOLT LOCKING 4.9MMX54MM 504.20 2727025956 A4649 BOLT LOCKING 4.9MMX56MM 504.20 2727025958 A4649 BOLT LOCKING 4.9MMX58MM 599.18 2727025960 A4649 BOLT LOCKING 4.9MMX60MM 599.18 2727025964 A4649 BOLT LOCKING 4.9MMX64MM 534.89 2727025968 A4649 BOLT LOCKING 4.9MMX68MM 534.89 2727025972 A4649 BOLT LOCKING 4.9MMX72MM 534.89 2727025976 A4649 BOLT LOCKING 4.9MMX76MM 826.86 2727025980 A4649 BOLT LOCKING 4.9MMX80MM 799.52 2727025985 A4649 BOLT LOCKING 4.9MMX85MM 799.52 2727025990 A4649 BOLT LOCKING 4.9MMX90MM 799.52 2727025995 A4649 BOLT LOCKING 4.9MMX95MM 819.88 2727026000 A4649 BUR ROUND XKP 4.0MMX90MM 827.28 2727026202 A4649 SHUNT LUMBAR PERITONEAL 80CM 1413.48 2727027000 A4649 CRANIOTOME PED XKP 1.8MMX12MM 449.46 272
172
7027001 C1785 PACEMAKER VERSA VEDR0101D 9664.73 2757027002 C1785 PACEMAKER VERSA VEDR011D 9664.73 2757027003 C1785 PACEMAKER ADAPTA ADSR061 8297.06 2757027004 C1786 PACEMAKER ADAPTA ADSR031D 8297.06 2757027005 C1785 PACEMAKER ADAPTA ADSR01P1D 8297.06 2757027006 C1785 PACEMAKER ADAPTA ADSR011D 8297.06 2757027007 C1785 PACEMAKER ADAPTA ADDRL1011D 10211.79 2757027008 C1785 PACEMAKER ADAPTA ADDRL11D 10211.79 2757027009 C1785 PACEMAKER ADAPTA ADDR06011D 10211.79 2757027010 A4649 DRAIN SILICONE BLAKE 19FR 289.73 2727027011 A4649 CATHETER CARDIOPLEGIA RETRO CB 234.56 2727027012 C1785 PACEMAKER ADAPTA ADDR01P011D 10211.79 2757027013 C1785 PACEMAKER ADAPTA ADDR0311D 10211.79 2757027014 C1785 PACEMAKER ADAPTA ADDR0101D 10211.79 2757027015 C1785 PACEMAKER ADAPTA ADDR061D 10211.79 2757027016 C1785 PACEMAKER ADAPTA ADDR031 10211.79 2757027017 C1785 PACEMAKER ADAPTA ADDR01P1D 10211.79 2757027018 C1785 PACEMAKER ADAPTA ADDR011D 10211.79 2757027019 C1785 PACEMAKER ADAPTA ADDRS1011D 10211.79 2757027020 C1785 PACEMAKER ADAPTA ADDRS11D 10211.79 2757027021 C1785 PACEMAKER SENSIA SESR011D 7202.92 2757027022 C1785 PACEMAKER SENSIA SEDR011D 8570.58 2757027023 C1785 PACEMAKER SENSIA SEDR01011D 8570.58 2757027024 A4649 SUTURE CHROMIC 5-0 27 SH 10.10 2727027050 A4649 ELECTRODE COAG BALL 24FR 692.69 2727027069 A4649 ELECTRODE STRAIGHT COLD KNIFE 795.28 2727027093 A4649 PROBE ULTRASON W/ OSC BURR TIP 1306.97 2727027210 A4649 CANNULA SAPHENOUS VEIN-CBP 165.57 2727027283 A4649 GLOVES SURGEON ORTHO SZ-7 4.83 2727027284 A4649 GLOVES SURGEON ORTHO SZ-7.5 4.83 2727027285 A4649 GLOVES SURGEON ORTHO SZ-8 4.83 2727027401 A4649 NAIL UNIV FEMUR 10MMX360MM 1561.33 2727027402 A4649 NAIL UNIV FEMUR 10MMX380MM 1461.47 2727027403 A4649 NAIL UNIV FEMUR 10MMX400MM 1096.32 2727027404 A4649 NAIL UNIV FEMUR 10MMX420MM 1561.33 2727027405 A4649 NAIL UNIV FEMUR 10MMX440MM 1149.10 2727027406 A4649 NAIL UNIV FEMUR 10MMX460MM 1149.10 2727027407 A4649 NAIL UNIV FEMUR 10MMX480MM 1149.10 2727027408 A4649 NAIL UNIV FEMUR 10MMX300MM 1149.10 2727027409 A4649 NAIL UNIV FEMUR 11X320-480 1640.15 2727027411 A4649 NAIL UNIV FEMUR 11MMX3360M 1154.57 272
173
7027412 A4649 NAIL UNIV FEMUR 11MMX380MM 1676.20 2727027413 A4649 NAIL UNIV FEMUR 11MMX400MM 1179.74 2727027414 A4649 NAIL UNIV FEMUR 11MMX420MM 1944.27 2727027415 A4649 NAIL UNIV FEMUR 11MMX440MM 1148.30 2727027416 A4649 NAIL UNIV FEMUR 11MMX460MM 1096.32 2727027417 A4649 NAIL UNIV FEMUR 11MMX480MM 1944.27 2727027418 A4649 NAIL UNIV FEMUR 11MMX300MM 1179.74 2727027419 A4649 NAIL UNIV FEMUR 11MMX320MM 1179.74 2727027420 A4649 NAIL UNIV FEMUR 12MMX340MM 1461.47 2727027421 A4649 NAIL UNIV FEMUR 12MMX360MM 1280.59 2727027422 A4649 NAIL UNIV FEMUR 12MMX380MM 1149.10 2727027423 A4649 NAIL UNIV FEMUR 12MMX400MM 1561.33 2727027424 A4649 NAIL UNIV FEMUR 12MMX420MM 1461.47 2727027425 A4649 NAIL UNIV FEMUR 12MMX440MM 1121.23 2727027426 A4649 NAIL UNIV FEMUR 12MMX460MM 1561.33 2727027427 A4649 NAIL UNIV FEMUR 12MMX480MM 1461.47 2727027428 A4649 NAIL UNIV FEMUR 12MMX300MM 1179.74 2727027429 A4649 NAIL UNIV FEMUR 12MMX320MM 1561.33 2727027431 A4649 NAIL UNIV FEMUR 13MMX360MM 1461.47 2727027432 A4649 NAIL UNIV FEMUR 13MMX380MM 1676.20 2727027433 A4649 NAIL UNIV FEMUR 13MMX400MM 1096.32 2727027434 A4649 NAIL UNIV FEMUR 13MMX420MM 1096.32 2727027435 A4649 NAIL UNIV FEMUR 13MMX440MM 1149.10 2727027436 A4649 NAIL UNIV FEMUR 13MMX460MM 1149.10 2727027437 A4649 NAIL UNIV FEMUR 13MMX480MM 1121.23 2727027438 A4649 NAIL UNIV FEMUR 13MMX300MM 1179.74 2727027439 A4649 NAIL UNIV FEMUR 13MMX320MM 1179.74 2727027441 A4649 NAIL UNIV FEMUR 14MMX360MM 1561.33 2727027442 A4649 NAIL UNIV FEMUR 14MMX380MM 1676.20 2727027443 A4649 NAIL UNIV FEMUR 14MMX400MM 1561.33 2727027444 A4649 NAIL UNIV FEMUR 14MMX420MM 1461.47 2727027445 A4649 NAIL UNIV FEMUR 14MMX440MM 1179.74 2727027446 A4649 NAIL UNIV FEMUR 14MMX460MM 1149.10 2727027447 A4649 NAIL UNIV FEMUR 14MMX480MM 1561.33 2727027448 A4649 NAIL UNIV FEMUR 14MMX300MM 1461.47 2727027449 A4649 NAIL UNIV FEMUR 14MMX320MM 1676.20 2727027451 A4649 NAIL UNIV FEMUR 15MMX360MM 1226.23 2727027452 A4649 NAIL UNIV FEMUR 15MMX380MM 1633.81 2727027453 A4649 NAIL UNIV FEMUR 15MMX400MM 1191.76 2727027454 A4649 NAIL UNIV FEMUR 15MMX420MM 1134.88 2727027455 A4649 NAIL UNIV FEMUR 15MMX440MM 1191.76 272
174
7027456 A4649 NAIL UNIV FEMUR 15MMX460MM 1259.07 2727027457 A4649 NAIL UNIV FEMUR 15MMX480MM 1226.23 2727027458 A4649 NAIL UNIV FEMUR 15MMX300MM 1226.23 2727027459 A4649 NAIL UNIV FEMUR 15MMX320MM 1633.81 2727027935 A4649 COAGULATOR 90* SERFAS ENERGY 3 935.60 2727028000 A4649 SCREW LAG DHS/DCS 12.7MMX100MM 840.57 2727028015 A4649 SCREW LAG DHS/DCS 12.7MMX115MM 944.60 2727028020 A4649 SCREW LAG DHS/DCS 12.7MMX120MM 862.44 2727028025 A4649 SCREW LAG DHS/DCS 12.7MMX125MM 862.44 2727028030 A4649 SCREW LAG DHS/DCS 12.7MMX130MM 862.44 2727028035 A4649 SCREW LAG DHS/DCS 12.7MMX135MM 862.44 2727028050 A4649 SCREW LAG DHS/DCS 12.7MMX50MM 862.44 2727028055 A4649 SCREW LAG DHS/DCS 12.7MMX55MM 854.24 2727028070 A4649 SCREW LAG DHS/DCS 12.7MMX70MM 918.51 2727028080 A4649 SCREW LAG DHS/DCS 12.7MMX80MM 909.26 2727028085 A4649 SCREW LAG DHS/DCS 12.7MMX85MM 976.47 2727028095 A4649 SCREW LAG DHS/DCS 12.7MMX95MM 948.54 2727028099 A4649 SCREW COMPRESSION DHS 36MM 219.35 2727028110 C1713 PLATE SB DHS 135 10-12 HOLE 1380.76 2787028111 C1713 PLATE DHS 135* 12HOLE 38MM 1272.73 2787028113 C1713 PLATE SB DHS 135 14-16 HOLE 1601.78 2787028116 C1713 PLATE DHS 135* 6 HOLE 38MMX110 1082.62 2787028118 C1713 PLATE DHS 135* 8 HOLE 38MMX142 1230.34 2787028125 C1713 PLATE DHS 140* 5 HOLE 38MMX94M 1333.65 2787028126 C1713 PLATE DHS 140* 6 HOLE 38MMX110 1114.10 2787028135 C1713 PLATE DHS 145* 5 HOLE 38MM 1114.10 2787028136 C1713 PLATE DHS 145* 6 HOLE 38MMX110 995.10 2787028144 C1713 PLATE SB DHS 150 4-6 HOLE 1215.00 2787028145 C1713 PLATE DHS 150* 5 HOLE 94MM 995.10 2787028146 C1713 PLATE DHS 150* 6 HOLE 110MM 995.10 2787028151 A4649 HEMORRHOID O-RINGS 1-10 8.77 2727028154 C1713 PLATE SB DHS 135 4 HOLE 1215.00 2787028194 C1713 PLATE DCP SB 95* 25MM 16 HOLE 1758.90 2787028198 C1713 PLATE DCS 95* 8 HOLE 146MM 1620.13 2787028541 A4649 KIT UNISHUNT RESERVOIR 102CM 2223.29 2727029101 A4649 WIRE CIRCLAGE W/EYE 1.0MM 44.29 2727029102 A4649 WIRE CIRCLAGE W/EYE 1.25MM 44.29 2727029105 A4649 WIRE CIRCLAGE COIL 1.0MM 37.05 2727029106 A4649 WIRE CIRCLAGE COIL 1.25MM 37.05 2727029182 C1713 PLATE DCS 95* 10 HOLE 178MM 1577.73 2787029206 A4649 K-WIRE TROCAR PT 0.6MMX70MM 41.40 272
175
7029208 A4649 K-WIRE TROCAR PT 0.8MMX70MM 39.46 2727029210 A4649 K-WIRE TROCAR PT 1.0MMX150MM 48.38 2727029211 A4649 K-WIRE TROCAR PT 1.0MMX285MM 30.51 2727029213 A4649 K-WIRE TROCAR PT 1.25MMX285MM 57.65 2727029216 A4649 K-WIRE TROCAR PT 1.6MMX150MM 46.03 2727029218 A4649 K-WIRE TROCAR PT 1.6MMX285MM 57.65 2727029220 A4649 K-WIRE TROCAR PT 2.0MMX150MM 59.04 2727029221 A4649 K-WIRE TROCAR PT 2.0MMX285MM 59.04 2727029225 A4649 K-WIRE 2.5MMX150MM 271.85 2727029226 A4649 K-WIRE TROCAR PT 2.5MMX285MM 33.83 2727029230 A4649 K-WIRE TROCAR PT 3.0MMX150MM 26.60 2727029262 A4649 GUIDEWIRE THREADED TIP 1.25MMX 795.46 2727029265 A4649 GUIDEWIRE THREADED TIP 2.0MMX2 121.30 2787029268 C1769 GUIDEWIRE THREADED TIP 2.8MMX3 248.05 2727029271 A4649 K-WIRE THREADED TROCAR 1.6X150 91.02 2727029272 C1769 GUIDEWIRE THREADED TIP 1.6MMX1 180.41 2727029275 A4649 K-WIRE THREADED TROCAR 2.5MMX1 100.05 2727029276 A4649 K-WIRE THREADED TROCAR 2.5MMX2 104.96 2727029336 A4649 STEINMAN PIN 3.5MMX150MM 211.91 2727029340 A4649 STEINMAN PIN 4.0MMX150MM 211.91 2727029341 A4649 STEINMAN PIN 4.0MMX180MM 211.91 2727029342 A4649 STEINMAN PIN 4.0MMX200MM 211.91 2727029343 A4649 STEINMAN PIN 4.5MMX300MM 394.59 2727029345 A4649 STEINMAN PIN 4.5MMX150MM 394.59 2727029346 A4649 STEINMAN PIN 4.5MMX180MM 394.59 2727029347 A4649 STEINMAN PIN 4.5MMX200MM 394.59 2727029348 A4649 STEINMAN PIN 4.5MMX250MM 394.59 2727029350 A4649 STEINMAN PIN 4.5MMX150MM 394.59 2727029351 A4649 STEINMAN PIN 5.0MMX180MM 420.17 2727029352 A4649 STEINMAN PIN 5.0MMX200MM 420.17 2727029353 A4649 STEINMAN PIN 5.0MMX250MM 420.17 2727029354 A4649 STEINMAN PIN 5.0MMX300MM 394.59 2727029361 A4649 STEINMAN PIN CT 3.5MMX150MM 394.59 2727029362 A4649 STEINMAN PIN CT 4.0MMX150MM 394.59 2727029443 A4649 SCREW SCHANTZ 4.0MMX60MM 257.59 2727029445 A4649 EXT FIX LGE SCHANTZ SCREW 4X10 381.44 2727029454 A4649 SCREW SCHANTZ 5.0MMX150MM 377.09 2727029455 A4649 SCREW SCHANTZ 5.0MMX170MM 377.09 2727029456 A4649 SCREW SCHANTZ 5.0MMX200MM 377.09 2727029457 A4649 SCREW SCHANTZ 5.0MMX250MM 377.09 2727029474 A4649 EXT FIX LGE SCHANTZ SCREW 4.5X 430.54 272
176
7029475 A4649 EXT FIX LGE SCHANTZ SCREW 4.5X 430.54 2727029476 A4649 EXT FIX LGE SCHANTZ SCREW 4.5X 520.74 2727030002 A4649 KIT LEAD ADAPTER #5866-37 985.45 2727030003 A4649 KIT SERVICE MEDTRONIC 5873-C 328.82 2727030005 A4649 BUR DIA RD XKP 4.0MMX70MM 818.45 2727030006 A4649 KIT MAHURKAR 2-LUMEN 13.5FR 928.65 2727030009 A4649 CATHETER HICKMAN 2-LUMEN 13.5F 1059.92 2727030020 A4649 CATHETER SWAN GANZ 7.5FR 533.42 2727030027 A4649 TRAY TRACH INTRODUCER 100-A-HC 1082.45 2727030028 A4649 TRAY TRACH INTRODUCER 100-HC 1114.35 2727030033 C1779 LEAD PACEMAKER SPRINT 6947-65 15303.23 2757030035 C1779 LEAD PACEMAKER SPRINT 6947-58 14099.87 2757030046 A4649 LEAD PACEMAKER 5076-45 1732.27 2757030047 A4649 LEAD PACEMAKER 4076-58 1595.51 2757030048 A4649 LEAD PACEMAKER 4076-52 1732.27 2727030049 A4649 LEAD PACEMAKER 5568-53 1595.51 2727030050 A4649 LEAD PACEMAKER 5034-53 1867.75 2757030051 A4649 LEAD PACEMAKER 5034-58 1867.75 2757030052 A4649 LEAD PACEMAKER 5554-53 1945.08 2757030053 A4649 LEAD PACEMAKER 4558-58 2013.85 2727030054 A4649 LEAD PACEMAKER 5554-45 1945.08 2757030055 A4649 LEAD PACEMAKER 5054-58 1945.08 2757030056 A4649 LEAD PACEMAKER 5054-52 2091.20 2757030057 A4649 LEAD PACEMAKER 5534-53 1867.75 2757030058 A4649 LEAD PACEMAKER 4568-53 1867.75 2727030060 A4649 BLADE SCALPEL #22 1.08 2727030062 A4649 LEAD PACEMAKER 5068-52 1906.42 2757030073 A4649 KIT LEAD ADAPTER #5866-24 1100.03 2727030075 A4649 KIT LEAD END CAP #5867-3 206.25 2727030079 C1786 PACEMAKER PERM KSR 700SR 8698.52 2757030080 C1785 PACEMAKER THERA SR 89661B 5972.02 2757030081 C1785 PACEMAKER THERA DR 7960/62B 8707.36 2757030082 C1785 PACEMAKER PRODIGY SR 8162B 8160.29 2757030083 C1785 PACEMAKER THERA SR 8962B 7476.46 2757030084 C1785 PACEMAKER PERM KDR 700DR 9926.01 2757030088 A4649 KIT STYLETTE #6082-58 329.44 2727030089 A4649 KIT STYLETTE #6093-58 292.29 2727030092 A4649 ELECTROCAUTERY PEN HNDSWTH 30.33 2727030100 A4649 TROCAR 5.0MMX100MM 783.70 2727030101 C1769 GUIDE WIRE TERUMO RADIOFUCUS 252.16 2727030200 A4649 TROCAR 12MM 778.22 272
177
7030205 A4649 ELECTRODE COAGULATING LGE 22/2 855.17 2707030210 A4649 ELECTRODE CAUTERY NEDDLE 15.61 2727030216 A4649 NEEDLE SPINAL WHITACARE 25GAX3 42.69 2727030294 A4649 NEEDLE KEITH 2 1/2 30.78 2727030295 A4649 NEEDLE KEITH 2 7/8 25.03 2727030299 A4649 NEEDLE FERGUSON 4D 4.5 24.20 2727030300 A4649 NEEDLE FERGUSON 6.5 21.56 2727030400 C1713 PLATE MICRO STR 4 HOLE 434.64 2787030455 C1713 PLATE KLS STR 1.5 4 HOLE 410.04 2787030545 A4649 MARKER SKIN STERILE 16.28 2727030570 A4649 SURGICLIP APPLIER M-9.5-SML 593.06 2727030571 A4649 SURGICLIP APPLIER M-11-MED 593.06 2727030575 A4649 CURETTE UVAC CURVED 8MM 33.27 2727030580 A4649 CURETTE UVAC STRAIGHT 8MM 33.55 2727030585 A4649 CURETTE UVAC CURVED 9MM 19.22 2727030590 A4649 CURETTE UVAC STRAIGHT 9MM 20.10 2727030595 A4649 CURETTE UVAC CURVED 10MM 22.22 2727030600 C1713 PLATE MICRO STR 6 HOLE 475.63 2787030605 A4649 CURETTE UVAC CURVED 11MM 22.44 2727030610 A4649 TAPE UMBILICAL 1/8X18 2.47 2727030615 A4649 CURETTE UVAC CURVED 12MM 13.91 2727030655 C1713 PLATE KLS ELG STR 1.5 6 HOLE 475.63 2787030755 A4649 CURETTE EAR WAX-SML 63.63 2727030756 A4649 CURETTE EAR WAX-LGE 56.25 2727030800 C1713 PLATE MICRO STR 8 HOLE 639.65 2787030905 A4649 ELECTRODE TUR HOOK 22/24FR 569.97 2727031001 A4649 CANNULA DLP-IMA 1.8 1MM TIP C 87.70 2727031002 A4649 CATHETER ENDOSCOPIC CHOLANGIO 150.01 2727031006 A4649 LIGATURE-MERSILENE RS20 415.52 2727031010 A4649 NEEDLE BIOPSY TRUCUT 14GA 792.49 2727031011 A4649 DRILL BIT MQC 1.1MMX60MM 198.77 2727031015 A4649 DRILL BIT MQC 1.1MMX85MM 214.84 2727031019 A4649 DRILL BIT MQC 2.0MMX100MM 236.76 2727031020 A4649 SUTURE SUPRAMID 2-0 1/2C TA PT 26.52 2727031021 A4649 SUTURE SUPRAMID 3-0 1/2C TA PT 26.52 2727031022 A4649 SUTURE SUPRAMID 4-0 1/2C TA PT 19.82 2727031025 A4649 DRILL BIT QC 2.5MMX110MM 130.59 2727031030 A4649 NEEDLE BREAST BX LOC'ZN 20GAX3 160.76 2727031031 A4649 DRILL BIT QC 3.2MMX145MM 365.16 2727031035 A4649 DRILL BIT QC 3.5MMX110MM 128.07 2727031044 A4649 DRILL BIT QC 4.5MMX145MM 236.76 272
178
7031050 A4649 NEEDLE BREAST BX LOC'ZN 20GAX5 197.31 2727031063 A4649 DRILL BIT CANNULATED 5.0MM 775.15 2727031065 A4649 DRILL BIT CANNULATED 3.2MM 683.97 2727031066 A4649 DRILL BIT CANNULATED 4.5MM 788.49 2727031067 A4649 DRILL BIT CANNULATED 2.7MM 791.21 2727031070 C1713 PLATE KLS ELG L L/R 1.5 898.80 2787031085 C1713 PLATE T KLS 1.5 6 HOLE 803.66 2787031100 A4649 NEEDLE BREAST BX LOC'ZN 20GAX1 197.31 2727031118 A4649 SPLINT NASAL W/ FELT SML 15.84 2717031119 A4649 SPLINT NASAL W/ FELT MED 15.84 2717031120 A4649 SPLINT NASAL W/ FELT LGE 15.84 2717031121 A4570 SPLINT NASAL W/O FELT MED 12.64 2717031122 A4649 SPLINT NASAL W/O FELT LGE 12.64 2717031123 A4649 SPLINT NASAL W/ FOREHEAD EXT 14.26 2717031124 A4649 SPLINT NASAL W/ FOREHEAD-XLGE 16.66 2717031131 A4649 SPHINCTEROTOME CANNULATING - E 1037.62 2727031170 C1713 PLATE-L MICRO RT 1.5MM 788.58 2787031185 C1713 PLATE XTR LONG KLS L-LEFT 1.5 803.66 2787031485 C1713 PLATE-L MICRO R/L 803.66 2787031585 C1713 PLATE Y KLS 1.5 803.66 2787031600 C1713 PLATE MICRO STR 16 HOLE 1011.34 2787031863 A4649 SUTURE PLAIN 2-0 27 FN-2 18.74 2727032000 A4649 BLADE ARTHRO RESECTOR 3.5MM 563.68 2727032005 A4649 SCREW CANC POLARUS 5MMX25MM 411.02 2727032010 A4649 PATCH HERNIA-LARGE 1167.27 2727032070 C1713 PLATE-Y MICRO LONG 803.66 2787032255 C1713 PLATE-DBLE-Y MICRO 1.5MM 800.90 2787032655 C1713 PLATE-X MICRO REGULAR 820.06 2787033008 C1713 PLATE KLS STR 1.0MM 8 HOLE 802.25 2787033152 A4649 NAIL UNIV TIBIAL 11MMX330MM 1565.40 2727033230 A4649 KIT SOFTCELL CATH 12.5FR 23CM 895.21 2727033252 A4649 NAIL UNIV TIBIAL 12MMX330MM 1148.98 2727033500 A4649 GRAFT DEBAKEY BIF 16X8MM 457.17 2727033800 A4649 GUIDE PIN DHS 2.5MMX230MM 218.22 2727034000 A4649 BUR DIA RD EX CRSE XKP 5.0MMX5 819.11 2727034031 A4649 VEIN STRIPPER 159.08 2727034109 A4649 STENT METALLIC URETERAL 6FR 1724.80 2727034110 A4649 STENT METALLIC URETERAL 6FR 1724.80 2727034111 A4649 STENT METALLIC URETERAL 6FR 1724.80 2727034112 A4649 STENT METALLIC URETERAL 6FR 1724.80 2727034120 A4649 KIT SOFTCELL CATH 12.5FR 12CM 895.21 272
179
7034241 L5999 PROSTHESIS HIP AUSTIN MOORE 41 2270.71 2747034242 L5999 PROSTHESIS HIP AUSTIN MOORE 42 2270.71 2747034243 L5999 PROSTHESIS HIP AUSTIN MOORE 43 2270.71 2747034245 L5999 PROSTHESIS HIP AUSTIN MOORE 45 2265.66 2747034247 L5999 PROSTHESIS HIP AUSTIN MOORE 50 2265.66 2747034800 A4649 SUTURE PLAIN 2-0 27 CT-1 28.93 2727035000 A4649 BLADE ARTHRO TOMCAT 3.5MM 317.87 2727035105 A4649 STENT MARDIS SOFT 4.8FRX20CM 470.51 2727035501 A4649 MEDULLARY TUBE 782.49 2727035590 A4649 DRILL BIT QC 4.0MM/4.5MMX22MM 128.61 2727036000 A4649 SUTURE SILK 4-0 17X18 27.88 2727036196 C1713 PLATE CONDYLAR MD HD R/L 2.0 1000.13 2787036296 C1713 PLATE CONDYLAR MD HD RT 2.0MM 891.17 2787036816 C1713 PLATE LP STR 16 HOLE 713.46 2787037210 A4649 CANNULA BLUNT 15GAX1.5 6.79 2727037504 C1713 PLATE H KLS 2.0 803.66 2787037563 A4649 BLADE ARTHRO SM JT TOMCAT 3.5M 342.86 2727037704 C1713 PLATE L KLS LEFT 2.0 803.66 2787037904 C1713 PLATE L ELG KLS RT/LT 2.0 803.66 2787038008 C1758 CATHETER URETERAL CONE TIP 8FR 75.01 2727038104 C1713 PLATE-L ELONG LT 2.0MM 4-HOLE 792.69 2787038606 C1713 PLATE T KLS 2.0 803.66 2787039000 A4649 TUBING PENROSE 7/8X18 5.19 2727039005 A4649 PLATE Y KLS 2.0 803.66 2787039042 C1713 PLATE COND DCP LT 9 HOLE 1300.67 2787039072 A4649 PROBE LITHOTRIPSY 3.5X400CM 925.92 2727039352 A4649 TUBE STAINLESS 11MMX150MM 813.19 2727039353 A4649 TUBE STAINLESS 11MMX200MM 813.19 2727039354 A4649 TUBE STAINLESS 11MMX250MM 837.82 2727039355 A4649 TUBE STAINLESS 11MMX300MM 837.82 2727039356 A4649 TUBE STAINLESS 11MMX350MM 837.82 2727039357 A4649 TUBE STAINLESS 11MMX400MM 865.18 2727039364 A4649 EXT FIX LGE ADJUSTABLE CLAMP 1178.16 2727039366 A4649 EXT FIX LGE TRANSVERSE CLAMP 1308.85 2727039369 A4649 EXT FIX LGE OPEN CLAMP 990.91 2727039371 A4649 EXT FIX LGE UNIV JOINT 2 TUBES 1563.41 2727039375 A4649 EXT FIX LGE UNIVERSAL CLAMP 1402.65 2727039390 A4649 EXT FIX CONNECT BAR 5MMX100MM 175.36 2727039391 A4649 EXT FIX CONNECT BAR 5MMX150MM 175.36 2727039392 A4649 EXT FIX CONNECT BAR 5MMX200MM 175.36 2727039393 A4649 EXT FIX CONNECT BAR 5MMX250MM 175.36 272
180
7039394 A4649 EXT FIX CONNECT BAR 5MMX300MM 175.36 2727039480 A4649 EXT FIX LGE ROD 11MMX100MM 970.96 2727039481 A4649 EXT FIX LGE ROD 11MMX125MM 878.85 2727039482 A4649 EXT FIX LGE ROD 11MMX150MM 878.85 2727039483 A4649 EXT FIX LGE ROD 11MMX200MM 878.85 2727039484 A4649 EXT FIX LGE ROD 11MMX250MM 990.91 2727039485 A4649 EXT FIX LGE ROD 11MMX300MM 898.00 2727039486 A4649 EXT FIX LGE ROD 11MMX350MM 898.00 2727039487 A4649 EXT FIX LGE ROD 11MMX400MM 1015.46 2727039488 A4649 EXT FIX LGE ROD 11MMX450MM 921.25 2727039489 A4649 EXT FIX LGE ROD 11MMX500MM 921.25 2727039490 A4649 EXT FIX LGE ROD 11MMX550MM 945.87 2727039491 A4649 EXT FIX LGE ROD 11MMX600MM 945.87 2727039497 A4649 EXT FIX LGE CAP ROD 11MM 9.02 2727039554 A4649 EXT FIX SML OPEN CLAMP 4MM/2.5 1064.57 2727039555 A4649 EXT FIX SML OPEN CLAMP 4MM/4MM 1064.57 2727039556 A4649 EXT FIX SML CLAMP 4MM/2.5MM 1043.09 2727039557 A4649 EXT FIX SML CLAMP 4MM/4MM 1043.09 2727039558 A4649 EXT FIX SML SPRING LOADED NUT 188.61 2727039561 A4649 EXT FIX SML CRB ROD 4MMX80MM 211.91 2727039562 A4649 EXT FIX SML CRB ROD 4MMX100MM 211.91 2727039563 A4649 EXT FIX SML CRB ROD 4MMX120MM 211.91 2727039565 A4649 EXT FIX SML CRB ROD 4MMX160MM 288.63 2727039566 A4649 EXT FIX SML CRB ROD 4MMX180MM 288.63 2727039567 A4649 EXT FIX SML CRB ROD 4MMX200MM 288.63 2727039571 A4649 EXT FIX CONNECT BAR 4MMX80MM 157.12 2727039572 A4649 EXT FIX CONNECT BAR 4MMX100MM 98.64 2727039573 A4649 EXT FIX CONNECT BAR 4MMX120MM 98.64 2727039575 A4649 EXT FIX CONNECT BAR 4MMX160MM 122.77 2727039576 A4649 EXT FIX CONNECT BAR 4MMX180MM 204.61 2727039577 A4649 EXT FIX CONNECT BAR 4MMX200MM 204.61 2727039606 C1713 PLATE-DBLE-Y LP REGULAR 861.06 2787040000 A4649 SUTURE CHROMIC 0 8X18 MD-5 180.85 2727040020 A4649 NAIL FEMUR TFNA LT 10MMX420MM 4110.96 2727040076 A4649 IMPLANT PISTON FLUORO 0.6MMX4M 115.93 2727040078 A4649 IMPLANT PISTON FLUORO 0.6MMX4. 115.93 2727040080 A4649 IMPLANT PISTON FLUORO 0.6MMX5M 115.93 2727040222 C1758 CATHETER URETERAL WTL LT 4FR 74.68 2727040338 A4649 IMPLANT PISTON MCGEE 5MMX4.25M 671.34 2727040339 A4649 IMPLANT PISTON MCGEE 5MMX4.5MM 671.34 2727040340 A4649 IMPLANT PISTON MCGEE 5MMX4.75M 671.34 272
181
7040415 A4649 STONE BASKET HELICAL EXPAND 21 942.02 2727040422 C1713 PLATE DCP NR 4.5MM 4-HOLE 668.60 2787040622 A4649 FORCEP COLD BIOPSY 40622 138.32 2727040804 C1713 PLATE-Z LP R/L LONG 803.66 2787040904 C1713 PLATE-Z LT 100* 2.0MM 4-HOLE 788.58 2787041000 A4649 SUTURE PLAIN 0 54 REEL 42.45 2727041002 A4649 CATHETER OPEN-END W/ WIRE SZ-4 74.68 2727041012 A4649 BLADE ARTHRO BB 4MM 12 FLUTE 465.69 2727041020 A4649 NAIL FEMUR TFNA 10MMX300MM 4110.96 2727041041 A4649 SCREW CORTEX ASIF 4.5MMX14MM 46.76 2727041042 A4649 CATHETER BOUGIE THREADED 14FR 429.94 2727041170 A4649 SYRINGE TOOMEY 70CC 18.74 2727041341 A4649 CATHETER CAPD-ADULT 1040.38 2727041410 A4649 ELECTRODE CUTTING LOOP 24FR 306.90 2727042000 A4649 KIT REPAIR GROSHONG 2-LUMEN 9. 668.26 2727042011 A4649 TAPE UMBILICAL 1/8X30 17.45 2727042041 A4649 BURR 4MM COARSE DIAMOND BALL 131.86 2727042042 A4649 BURR 5MM COARSE DIAMOND BALL 131.86 2727042043 A4649 FLUTED ROUTER 1.8MM X 16MM A 143.01 2727042045 A4649 SUTURE PASS DRILL 1.9MM ANS 143.01 2727042050 A4649 BURR 5MM COARSE DIAMOND BALL 131.86 2727042051 A4649 PACK CUSTOM OPEN HEART 945.97 2727042052 A4649 PACK DRAPE OPEN HEART 694.19 2727042053 A4649 KIT E-PACK PROCEDURE 869.13 2727042060 A4649 SUTURE SUPRAMID 5-0 3/8C WT RE 36.25 2727042085 A4649 SCREW CORTEX MD HD 2.4MMX6MM 295.61 2727042086 A4649 SCREW CORTEX MD HD 2.4MMX7MM 295.61 2727042087 A4649 SCREW CORTEX MD HD 2.4MMX8MM 295.61 2727042096 C1713 PLATE CONDYLAR MD HD RT 2.4MM 1084.08 2787042097 C1713 PLATE CONDYLAR MD HD LT 2.4MM 1084.08 2787042098 A4649 SCREW CORTEX MD HD 2.4MMX9MM 295.61 2727042099 A4649 SCREW CORTEX MD HD 2.4MMX10MM 275.14 2727042182 C1713 PLATE DHS 140* 4 HOLE 38MMX78M 1082.62 2787042800 A4649 SCREW CORTEX ST 1.5MMX24MM 137.01 2727043000 A4649 BLADE ARTHRO CUTTER DBL BITE 4 441.93 2727043152 A4649 NAIL UNIV TIBIAL 11MMX345MM 1097.50 2727043182 C1713 PLATE DHS 145* 4 HOLE 78MM 1114.10 2787043252 A4649 NAIL UNIV TIBIAL 12MMX345MM 1152.38 2727043500 A4649 GRAFT DEBAK BIF 19X9.5MM 457.17 2727044000 A4649 BUR ACORN XKP 5.0MMX50MM 860.24 2727044182 C1713 PLATE DHS 150* 4 HOLE 38MMX78M 995.10 278
182
7044392 A4649 STEINMAN PIN 4.5MMX120MM 394.59 2727044800 A4649 SUTURE VICRYL 0 U 27 CT-1 24.61 2727044916 A4649 DRILL TWIST KLS 1.5MMX50MM 635.73 2727045000 A4649 BUR DIA RD XKP 5.0MMX70MM 828.07 2727045100 C1721 IMPLANT DEFIBRILLATOR D154AWG 29359.07 2787045200 A4649 DRILL TWIST KLS 1.1MMX50MM 708.80 2727045271 A4649 BILIARY LOCKING DEVICE-ERCP 115.93 2727045900 A4649 CATHETER BILIARY BALLOON 4MMX4 1065.70 2727045920 A4352 CATHETER BILIARY BALLOON 6MMX4 1065.70 2727046000 A4649 SUTURE SILK 3-0 17X18 32.87 2727046001 A4649 LARYNGEAL MASK AIRWAY SZ-2 164.71 2727046031 C1713 PLATE STR MD HD 1.5 6 HOLE 901.87 2787046032 C1713 PLATE STR MD HD 1.5 12 HOLE 952.54 2787046233 C1713 PLATE T HEAD MD HD 1.5 3 HOLE 932.59 2787046234 C1713 PLATE T HEAD MD HD 1.5 4 HOLE 941.80 2787046480 C1713 PLATE H 1.5MM 4 HOLE 889.31 2787046482 C1713 PLATE H EXT MD HD 1.5MM RT 8-H 941.80 2787046483 C1713 PLATE EXT MD HD LT 1.5MM 8-HOL 754.10 2787046593 A4649 EXT FIX SML CRB ROD 4MMX140MM 288.63 2727046612 C1713 PLATE Y MD HD 1.5 932.59 2787046911 A4649 DRILL TWIST KLS 1.5MMX105MM 708.80 2727047000 A4649 SUTURE CHROMIC 0 27 BP-1 80.13 2727047031 C1713 PLATE STR TI 6-HOLE 2.0 MM 861.06 2787047032 C1713 PLATE STR TI 12-HOLE 2.0 MM 909.55 2787047232 C1713 PLATE T HEAD MD HD 2.0 2 HOLE 932.59 2787047233 C1713 PLATE STR TI 3-HOLE 2.0 MM 909.55 2787047593 A4649 EXT FIX CONNECT BAR 4MMX140MM 135.68 2727047612 C1713 PLATE Y MD HD 2.0 932.59 2787048001 A4649 LARYNGEAL MASK AIRWAY SZ-2.5 164.71 2727049000 L5999 PROSTHESIS HIP AUSTIN MOORE 49 2074.19 2747049600 A4649 SCREW CORTEX MD HD 1.3MMX14MM 260.14 2727049906 C1713 PLATE STR TI 6-HOLE 2.4 MM 894.20 2787049912 C1713 PLATE STR TI 12-HOLE 2.4 MM 926.44 2787049913 C1713 PLATE T HEAD MD HD 2.4 2 HOLE 970.96 2787049914 C1713 PLATE T HEAD MD HD 2.4 3 HOLE 987.83 2787049915 C1713 PLATE Y MD HD 2.4 978.63 2787049924 C1713 PLATE LC-DCP MD HD 2.4 4 HOLE 1033.88 2787049926 C1713 PLATE LC-DCP MD HD 2.4 6 HOLE 1073.79 2787049928 C1713 PLATE LC-DCP MD HD 2.4 8 HOLE 1104.47 2787049931 C1713 PLATE LC-DCP MD HD 2.0 4 HOLE 941.80 2787049936 C1713 PLATE LC-DCP MD HD 2.0 6 HOLE 983.24 278
183
7049938 C1713 PLATE LC-DCP MD HD 2.0 8 HOLE 1021.59 2787050020 A4649 NAIL FEMUR TFNA RT 10MMX440MM 4110.96 2727050040 L5999 PROSTHESIS HIP AUSTIN MOORE 40 1492.97 2747050044 L5999 PROSTHESIS HIP AUSTIN MOORE 44 1979.82 2747050046 L5999 PROSTHESIS HIP AUSTIN MOORE 46 2189.07 2747050051 A4649 PROSTHESIS HIP AUSTIN MOORE 51 2405.07 2727050053 A4649 PROSTHESIS HIP AUSTIN MOORE 53 2405.07 2727050054 A4649 PROSTHESIS HIP AUSTIN MOORE 54 2405.07 2727050081 C1713 PLATE MINI 8 HOLE 467.44 2787050100 A4649 SILASTIC SHEETING 0.007 RFD 1002.29 2727050101 C1769 GUIDEWIRE LUBRIGLIDE 185.21 2727050201 A4649 BAIR HUGGER MACHINE 21.20 2707050320 A4649 CANNULA BILIARY 5FR 0.35/200CM 110.28 2727050401 A4649 COAGULATOR STR SERFAS ENERGY 3 794.51 2727050500 E0830 HALO TRACTION SYSTEM-LGE 3284.58 2707050522 A4649 TUBE ENDOTRACH REINFORCED 7.5 362.88 2727050553 A4649 TUBE ENDOTRACH REINFORCED 7.0 362.88 2727050602 A4649 SET IV EXTENSION 6 PORT 54.21 2707050696 A4649 SCREW ST TI 2.4 MM X 6-32 MM 336.22 2727050900 A4649 TUBE IRRIG W/ HANDPIECE/SMOKE 426.20 2727050905 A4649 PROBE EHL 9FR 892.89 2727051020 A4649 NEEDLE TOUHY 14GA 788.05 2727051021 A4649 GLOVES RADIATION REDUCTION 561.48 2727051113 A4649 WOOD DOWEL 1/2INX48IN 12.90 2717051220 A4649 KIT BALLOON DILATION CATH 4CM 1117.23 2727051255 A4649 BLADE SAW 26MMX0.65MM 512.55 78.92 2727051278 A4649 BLADE SAW 8MMX13MM 512.78 51.15 2727051279 A4649 BLADE SAW 8MMX18MM 512.79 245.51 2727051280 A4649 KIT BALLOON DILATION CATH 6CM 1117.23 2727051896 A4649 SCREW CORTEX MD HD 2.4MMX18MM 336.50 2727051915 A4649 BLADE SAW 60MMX14MM 519.15 233.82 2727051917 A4649 BLADE SAW 80MMX27MM 519.17 407.57 2727051919 A4649 BLADE SAW 80MMX50MM 519.19 458.79 2727051925 A4649 BLADE SAW 35MMX14MM 519.25 272.76 2727052052 A4649 NAIL UNIV TIBIAL 10MMX255MM 1289.56 2727052096 A4649 SCREW CORTEX MD HD 2.4MMX20MM 336.50 2727052100 A4927 GLOVES SURG S-6 ULTRA 11.91 2727052150 A4649 SCREW MALLEOLAR 4.5MMX25MM 230.18 2727052152 A4649 NAIL UNIV TIBIAL 11MMX255MM 1819.80 2727052252 A4649 NAIL UNIV TIBIAL 12MMX255MM 1152.38 2727052296 A4649 SCREW CORTEX MD HD 2.4MMX22MM 336.50 272
184
7052352 A4649 NAIL UNIV TIBIAL 13MMX255MM 1161.32 2727052496 A4649 SCREW CORTEX MD HD 2.4MMX24MM 336.50 2727052696 A4649 SCREW CORTEX MD HD 2.4MMX26MM 336.50 2727052896 A4649 SCREW CORTEX MD HD 2.4MMX28MM 336.50 2727053096 A4649 SCREW CORTEX MD HD 2.4MMX30MM 336.50 2727053296 A4649 SCREW CORTEX MD HD 2.4MMX32MM 375.05 2727053319 A4649 KIT SOFTCELL CATH 12.5FR 19CM 908.10 2727053392 A4649 STEINMAN PIN 3.5MMX120MM 211.91 2727054000 A4649 BUR ACORN XKP 6.0MMX50MM 812.58 2727055004 C1713 PLATE MINI 4 HOLE 352.62 2787055008 C1713 PLATE KLS STR 2.0 8 HOLE 1107.56 2787055016 A4649 CATHETER WHISTLE TIP LATEX 16 35.46 2727055018 A4649 CATHETER WHISTLE TIP LATEX 18 35.46 2727055020 A4649 CATHETER WHISTLE TIP LATEX 20 35.46 2727055022 A4649 CATHETER WHISTLE TIP LATEX 22 35.46 2727055024 A4649 CATHETER WHISTLE TIP LATEX 24 35.46 2727055026 A4649 CATHETER WHISTLE TIP LATEX 26 35.46 2727055080 A4649 TUBE GAS SAMPLE 6.14 2727055204 C1713 PLATE KLS ELG STR 2.0 4 HOLE 1023.14 2787056000 A4649 BUR DIA RD EX CRSE XKP 3.0MMX9 835.79 2727056082 A4649 SCREW LAG DHS/DCS 12.7MMX65MM 918.51 2727058061 A4649 SCREW CANCEL PT-16 6.5MMX8.5MM 268.55 2727058113 C1713 PLATE KLS ELG L-ELONG RT 1.5MM 822.78 2787058352 A4649 RELOAD ENDOPATH REG 35MM 794.89 2727058948 A4649 BLADE SAW STERNAL SARNS 438.35 2727059032 A4649 BLADE SAW STERNUM 67.60 2727059042 A4649 TROCAR NEURO SPLIT 10CM DISP 889.71 2727059100 A4649 BOLT LOCKING 4.9MMX100MM 799.52 2727059120 A4649 V-LANCE OPHTHALMIC 20GA 910.31 2727059203 A4649 NEEDLE FERGUSON 2D 2.5 25.03 2727059222 A4649 BLADE NEURO STRAIGHT FLUTED 899.28 2727059522 A4649 BOLT LOCKING 4.9MMX52MM 398.22 2727060000 A4649 PROBE INJECTION GOLD 7FR - ERC 1110.38 2727060003 A4649 CONNECTOR TERUMO 3/8X3/8 CBP 58.43 2727060005 A4649 CONNECTOR TERUMO 1/2X1/2 CBP 58.43 2727060007 A4649 CONNECTOR TERUMO W/LL 1/4X1/4 68.20 2727060009 A4649 CONNECTOR TERUMO W/LL 3/8X3/8 68.20 2727060010 A4649 CONNECTOR TERUMO W/LL 1/2X1/2 68.20 2727060011 A4649 CONNECTOR TERUMO 1/4X3/8 CBP 58.43 2727060012 A4649 CONNECTOR TERUMO 1/2X3/8 CBP 58.43 2727060015 A4649 CONNECTOR TERUMO W/LL 1/2X3/8 68.20 272
185
7060016 A4649 CATHETER HICKMAN 1-LUMEN 9.6FR 1257.59 2727060020 A4649 NAIL FEMUR TFNA 10MMX440MM 4110.96 2727060069 A4649 CATHETER HICKMAN HEMO PC 13.5F 925.30 2727060082 A4649 SURGICAL TOWEL ABSORBENT 19.04 2727060100 A4649 KIT CEN/VEN ACCESS 2-LUMEN 9FR 633.07 2727060101 A4649 BAIR BLANKET UPPER BODY 94.45 2727060120 A4649 TRAY THORACOTOMY 40.65 2727060127 A4649 SCREW LAG DHS/DCS 12.7MMX60MM 939.04 2727060154 A4649 CATHETER FOGARTY 5FR 40CM 208.27 2727060280 A4649 TUBE MILLER-ABBOTT 16FR 517.22 2727060290 A4649 TUBE MILLER-ABBOTT 18FR 517.22 2727060400 A4649 CHLORAPREP APPLICATOR 3ML 16.81 2727060422 C1713 PLATE DCP NR 4.5MM 6-HOLE 759.94 2787060442 C1758 CATHETER URETERAL SPIRAL TIP 6 92.40 2727060622 C1713 PLATE DCP BR 4.5MM 6-HOLE 856.41 2787060800 A4649 SCREW CORTEX ST 1.5MMX6MM 74.91 2727060810 A4649 SCREW CORTEX ST 2.0MMX6MM 115.08 2727060825 A4649 CHLORAPREP APPLICATOR 26ML 81.76 2727061010 A4649 SCREW CD ST 2.7MM X 10MM 303.43 2727061028 A4649 TUBE ENDOBRONCHIAL ANG LT 28MM 479.87 2727061035 A4649 TUBE ENDOBRONCHIAL RT ANG LT 3 479.87 2727061037 A4649 TUBE ENDOBRONCHIAL RT ANG LT 3 623.66 2727061039 A4649 TUBE ENDOBRONCHIAL 2-LUMEN RT 666.04 2727061041 A4649 TUBE ENDOBRONCHIAL 2-LUMEN RT 666.04 2727061042 A4649 CATHETER BOUGIE THREADED 16FR 460.72 2727061292 A4649 K-WIRE 1.6MMX150MM 56.98 2727061320 A4649 ELECTRODE CUTTING LOOP 26FR 350.75 2727061510 A4649 ELECTRODE EVAP WING 26FR 694.85 2727062000 A4649 BLADE ARTHRO RESECTOR 5.5MM 526.63 2727062026 A4649 TUBE ENDOBRONCHIAL RT ANG RT 2 524.00 2727062035 A4649 TUBE ENDOBRONCHIAL RT ANG RT 3 524.00 2727062500 A4649 SCREW CORTEX MD HD 1.0MMX6MM 274.74 2727062510 A4649 ADAPTER BRONCHOSCOPE FIBEROPTI 110.46 2727062800 A4649 SCREW CORTEX ST 1.5MMX26MM 113.26 2727062952 A4649 BOLT LOCKING 4.9MMX26MM 792.25 2727064800 A4649 SUTURE SILK 2 30 MH 8.63 2727066000 A4649 BUR ROUND FLUTED XKP 3.0MMX110 810.03 2727066201 A4649 GUIDEWIRE PFTE 0.038X150CM 149.36 2727066396 C1713 PLATE CONDYLAR MD HD LT 1.5MM 1000.13 2787066496 C1713 PLATE CONDYLAR MD HD RT 1.5MM 891.17 2787066660 A4649 BILIARY INFLATION DEVICE-ERCP 784.18 272
186
7066990 A4346 SUTURE PDS 0-CTX Z990G 97.08 2727067041 A4649 SCREW CORTEX ASIF 4.5MMX76MM 157.12 2727068600 A4649 SCREW CORTEX MD HD 1.3MMX6MM 260.14 2727069018 A4649 SCREW CORTEX MD HD 1.5MMX10MM 175.36 2727069028 A4649 SCREW CORTEX MD HD 1.5MMX20MM 246.60 2727069118 A4649 SCREW CORTEX MD HD 1.5MMX11MM 175.36 2727069182 C1713 PLATE DCS 95* 12 HOLE 210MM 1173.18 2787069218 A4649 SCREW CORTEX MD HD 1.5MMX12MM 175.36 2727069228 A4649 SCREW CORTEX MD HD 1.5MMX22MM 246.60 2727069318 A4649 SCREW CORTEX MD HD 1.5MMX13MM 246.60 2727069418 A4649 SCREW CORTEX MD HD 1.5MMX14MM 175.36 2727069428 A4649 SCREW CORTEX MD HD 1.5MMX24MM 175.36 2727069600 A4649 SCREW CORTEX MD HD 1.3MMX16MM 260.14 2727069608 A4649 SCREW CORTEX MD HD 2.0MMX6MM 187.07 2727069708 A4649 SCREW CORTEX MD HD 1.5MMX7MM 175.36 2727069808 A4649 SCREW CORTEX MD HD 1.5MMX8MM 175.36 2727069818 A4649 SCREW CORTEX MD HD 1.5MMX18MM 175.36 2727069896 A4649 PIN BUTTRESS MD HD 1.8X18 305.48 2727069908 A4649 SCREW CORTEX MD HD 1.5MMX9MM 175.36 2727070000 A4649 PROBE INJECTION GOLD 10FR - ER 1110.38 2727070003 A4649 RELOAD ENDOSTITCH 0 SILK 194.73 2727070004 A4649 RELOAD ENDOSTITCH 2-0 SILK 194.73 2727070012 A4649 RELOAD ENDOSTITCH 0 BRALON 179.62 2727070016 A4649 PACK CV TUBING-CBP 1142.27 2727070020 A4649 NAIL FEMUR TFNA 10MMX170MM 3084.68 2727070053 A4649 RELOAD ENDOSTITCH 2-0 POLY 179.62 2727070071 A4649 RELOAD ENDOSTITCH 3-0 POLY 179.62 2727070125 A4649 ELECTRODE TUR COAG REG 26/28FR 284.97 2727070358 A4649 CATHETER THORACIC TAPER TIP 32 46.98 2727070432 A4649 CATHETER THORACIC RT ANG 28FR 67.82 2727070500 A4649 ELECTRODE CUT LOOP MONO 24FR 692.69 2727070506 A4649 ELECTRODE CUT LOOP MONO 27FR 799.34 2727070700 A4649 TUBEGAUZE ELASTIC NET SZ 6 2.80 2727071505 A4649 PROBE EHL 5.0FR 941.90 2727071680 A4649 SUTURE ETHILON 8-0 12 TG175-8 140.95 2727071925 A4649 ELECTRODE KNIFE 26/28FR 681.88 2727072005 A4649 CONNECTOR Y-TUBING LGE 7.22 2727072105 A4649 BITE BLOCK 38FR PED 51.95 2727072305 A4649 PROBE EHL 3.3FR 941.90 2727072500 A4649 LIGACLIP LS400 XLGE STEEL 63.60 2727073000 A4649 SET URETHRAL DILATION 955.36 272
187
7074000 A4649 NEEDLE RETROBULBAR 23GAX35MM 31.23 2727074031 A4649 SCREW CD MICRO 1.5MMX3.5MM 227.64 2727074091 A4649 SCREW CD MICRO 1.5MMX9.0MM 241.15 2727074201 A4649 PAD PERINEAL POST 71.93 2727074202 A4649 CANNULA AORTIC ROOT W/VENT CBP 142.49 2727074204 A4649 BURR 4MM COARSE DIAMOND BALL 322.97 2727074205 A4649 BURR 5MM EXTRA COARSE DIAMOND 325.49 2727074206 A4649 VALVE VACUUM RELIEF CBP 122.41 2727074208 A4649 KIT UNISHUNT RESERVOIR 53CM 2142.58 2727074209 A4649 SUTURE 0 PDS 60 TP-1 82.87 2727074500 A4649 SET SURGILAV HANDPIECE 692.13 2727075000 A4649 SET RENAL DILATOR 980.32 2727075780 A4649 SUTURE PROLENE 4-0 RB-1 #8557 69.43 2727076031 A4649 SCREW CD MICRO EM 1.8MMX3.5MM 287.03 2727076051 A4649 SCREW KLS EMERG 1.8MMX5MM 255.76 2727077028 A4649 DILATOR NEPHROSTOMY TRACT 981.86 2727077200 A4649 NEURO PATTIE 1/2X1/2 16.62 2727077513 A4649 BLADE MICROSHARP 5MMX1.5-CBP 69.09 2727078100 A4649 SUTURE SILK 1 6X18 4.55 2727078220 A4649 CANNULA AORTIC 20FR 315.92 2727079006 A4649 BLADE SAW STERNUM RECIPROCATIN 889.56 2727079026 A4649 TOURNIQUET DLP-CBP 48.10 2727079364 A4649 BLADE MICRO-SHARP 15 3.0MM 15.97 2727079365 A4649 BLADE MICRO-SHARP 15 5.0MM 7.67 2727080000 A4649 EXTRACTOR BALLOON 9M/12M - ERC 925.30 2727080002 A4649 PACK TRANFER FENWAL 300CC 30.11 2727080020 A4649 ELECTRODE LEEP 2.0CMX0.8CM 125.48 2727080035 A4649 TUBE ORAL RAE CUFFED 3.5MM 25.92 2727080040 A4649 TUBE ORAL RAE CUFFED 4.0MM 25.92 2727080045 A4649 TUBE ORAL RAE CUFFED 4.5MM 25.92 2727080100 A4649 BASKET SEGURA 3.0FR 16MMX120CM 994.02 2727080110 A4649 BASKET SEGURA 3.0FR 20MMX120CM 994.02 2727080425 A4649 PROBE EHL 2.4FR 867.62 2727080622 C1713 PLATE DCP BR 4.5MM 8 HOLE 809.10 2787080750 A4649 SCREW LAG DHS/DCS 12.7MMX75MM 939.04 2727080760 A4649 TUBEGAUZE ELASTIC NET SZ 4 /YD 2.38 2727080796 A4649 SCREW CORTEX MD HD 2.0MMX7MM 187.07 2727080896 A4649 SCREW CORTEX MD HD 2.0MMX8MM 187.07 2727080900 A4649 SCREW LAG DHS/DCS 12.7MMX90MM 970.76 2727080902 A4346 FALLOPE RING BAND Z990G 253.94 2727080996 A4649 SCREW CORTEX MD HD 2.0MMX9MM 187.07 272
188
7081000 A4649 CUP GRADUATED 1000CC 32OZ 15.13 2727081010 C1713 PLATE DHS 130* 10HOLE 38MM 1272.73 2787081014 C1713 PLATE DHS 130* 14HOLE 38MM 1272.73 2787081050 A4649 TUBE NASAL RAE CUFFED 5.0MM 38.85 2727081060 A4649 SUTURE SUPRAMID 6-0 3/8C REV C 34.43 2727081070 A4649 TUBE NASAL RAE CUFFED 7.0MM 38.72 2727081075 A4649 TUBE NASAL RAE CUFFED 7.5MM 27.73 2727081096 A4649 SCREW CORTEX MD HD 2.0MMX10MM 187.07 2727081101 A4352 CATHETER COUDE STRAIGHT 18FR 387.28 2727081105 A4649 SCREW LAG DHS/DCS 12.7MMX105MM 971.86 2727081110 A4649 SCREW LAG DHS/DCS 12.7MMX110MM 971.86 2727081136 A4649 SCREW LAG DHS 12.7MMX140MM 1025.18 2727081137 A4649 SCREW LAG DHS/DCS 12.7MMX145MM 971.86 2727081140 C1713 PLATE DHS 135* 4 HOLE 38MMX78M 1292.41 2787081150 C1713 PLATE DHS 135* 5HOLE 38MMX94MM 1248.71 2787081196 A4649 SCREW CORTEX MD HD 2.0MMX11MM 187.07 2727081296 A4649 SCREW CORTEX MD HD 2.0MMX12MM 187.07 2727081396 A4649 SCREW CORTEX MD HD 2.0MMX13MM 187.07 2727081430 A4649 BLADE ARTHRO TURBO WHISK 2.9MM 458.02 2727081496 A4649 SCREW CORTEX MD HD 2.0MMX14MM 187.07 2727081600 A4649 SCREW CORTEX MD HD 2.0MMX16MM 187.07 2727081696 A4649 SCREW CORTEX MD HD 1.5MMX16M 175.36 2727081791 A4649 KIT SHOULDER CANNULA 7CM 181.91 2727081896 A4649 SCREW CORTEX MD HD 2.0MMX18MM 187.07 2727081930 C1713 PLATE DCP SB 95* 25MM 14 HOLE 1866.31 2787081960 C1713 PLATE DCS 95* SB 6 HOLE 1767.83 2787082000 A4649 SCREW CORTEX ST 1.5MMX20MM 80.39 2727082002 A4649 CAST SCOTCH PLUS 2X4 33.00 2707082003 A4580 CAST SCOTCH PLUS 3X4 40.70 2707082004 A4580 CAST SCOTCH PLUS 4X4 53.51 2717082096 A4649 SCREW CORTEX MD HD 2.0MMX20MM 290.46 2727082150 A4649 BIOURETHRAL SUPPORT PELVILACE 1908.04 2727082200 A4649 SCREW CORTEX ST 1.5MMX22MM 137.01 2727082296 A4649 SCREW CORTEX MD HD 2.0MMX22MM 290.46 2727082496 A4649 SCREW CORTEX MD HD 2.0MMX24MM 290.46 2727082696 A4649 SCREW CORTEX MD HD 2.0MMX26MM 290.46 2727082841 A4649 SCREW CORTEX ST 4.5MMX28MM 144.48 2727082896 A4649 SCREW CORTEX MD HD 2.0MMX28MM 290.46 2727083005 L5999 PROSTHESIS HIP AUSTIN MOORE 38 2189.07 2747083096 A4649 SCREW CORTEX MD HD 2.0MMX30MM 290.46 2727083296 A4649 SCREW CORTEX MD HD 2.0MMX32MM 290.46 272
189
7083510 A4649 ELECTRODE WIRE 0.35MM 28FR 760.96 2727084000 A4649 BUR ROUND XKP 4.0MMX70MM 801.21 2727084100 A4649 IMMOBILIZER SHOULDER UNIVERSAL 137.06 2707084392 A4649 STEINMAN PIN 4.5MMX275MM 394.59 2727085000 A4649 BUR ACORN XKP 6.0MMX70MM 824.57 2727085071 A4649 SCREW CD BONE 2.3MM X 7MM 237.83 2727085091 A4649 SCREW CD BONE 2.3MM X 9MM 246.03 2727085111 A4649 SCREW CD BONE 2.3MM X 11MM 254.23 2727085131 A4649 SCREW CD BONE 2.3MM X 13MM 270.62 2727085151 A4649 SCREW CD BONE 2.3MM X 15MM 278.81 2727085171 A4649 SCREW CD BONE 2.3MM X 17MM 303.43 2727085191 A4649 SCREW CD BONE 2.3MM X 19MM 311.62 2727085208 A4649 VESSEL LOOP REGULAR 153.43 2727085240 A4649 VESSEL LOOP SMALL 14.30 2727085800 A4649 SCREW CORTEX ST 1.5MMX28MM 113.26 2727085808 A4649 TUBE LAVAGE 40FRX86 107.43 2727085849 C1713 SREW LOCKING TI 5.0MMX26MM 803.62 2787085863 C1713 SCREW LOCKING TI 5.0MMX28MM 803.62 2787085887 C1713 SCREW LOCKING TI 5.0MMX30MM 803.62 2787085900 C1713 SCREW LOCKING TI 5.0MMX32MM 803.62 2787085924 C1713 SCREW LOCKING TI 5.0MMX34MM 803.62 2787085949 C1713 SCREW LOCKING TI 5.0MMX36MM 803.62 2787085962 C1713 SCREW LOCKING TI 5.0MMX38MM 803.62 2787085986 C1713 SCREW LOCKING 5.0MMX40MM 803.62 2787086000 A4649 BUR ROUND FLUTED XKP 5.0MMX110 858.83 2727086006 C1713 SCREW LOCKING TI 5.0MMX42MM 803.62 2787086020 C1713 SCREW LOCKING TI 5.0MMX44MM 803.62 2787086044 C1713 SCREW LOCKING TI 5.00MMX46MM 803.62 2787086068 C1713 SCREW LOCKING TI 5.0MMX48MM 803.62 2787086082 C1713 SCREW LOCKING TI 5.0MMX50MM 803.62 2787086091 A4649 SCREW CD BONE 2.5MM X 9MM 254.23 2727086105 C1713 SCREW LOCKING TI 5.0MMX52MM 803.62 2787086121 A4649 SCREW CD ST 2.7MMX12MM 202.41 2727086129 C1713 SCREW LOCKING TI 5.0MMX54MM 803.62 2787086131 A4649 SCREW KLS 13X2.3 262.41 2727086141 A4649 SCREW CD ST 2.7MMX14MM 202.41 2727086143 C1713 SCREW LOCKING TI 5.0MMX56MM 803.62 2787086161 A4649 SCREW CD ST 2.7MMX16MM 212.64 2727086167 C1713 SCREW LOCKING TI 5.0MMX58MM 803.62 2787086171 A4649 SCREW CD BONE 2.5MM X 17MM 311.62 2727086181 C1713 SCREW LOCKING TI 5.0MMX60MM 803.62 278
190
7086200 A4649 TUBE ORAL RAE CUFFED 5.0MM 29.06 2727086201 A4649 TUBE ORAL RAE CUFFED 5.5MM 29.06 2727086202 A4649 TUBE ORAL RAE CUFFED 6.0MM 29.06 2727086203 A4649 TUBE ORAL RAE CUFFED 6.5MM 29.06 2727086204 A4649 TUBE ORAL RAE CUFFED 7.0MM 29.06 2727086205 A4649 TUBE ORAL RAE CUFFED 7.5MM 29.06 2727086206 A4649 TUBE ORAL RAE CUFFED 8.0MM 29.06 2727086207 A4649 TUBE ORAL RAE CUFFED 8.5MM 29.06 2727086208 A4649 TUBE ORAL RAE CUFFED 9.0MM 29.06 2727086228 C1713 SCREW LOCKING TI 5.0MMX64MM 803.62 2787086266 C1713 SCREW LOCKING TI 5.0MMX68MM 803.62 2787086303 C1713 SCREW LOCKING TI 5.0MMX72MM 803.62 2787086341 C1713 SCREW LOCKING TI 5.0MMX76MM 803.62 2787086389 C1713 SCREW LOCKING TI 5.0MMX80MM 803.62 2787086402 C1713 SCREW LOCKING TI 5.0MMX85MM 803.62 2787086426 C1713 SCREW LOCKING TI 5.0MMX90MM 803.62 2787088121 A4649 SCREW CD EST 32MM X 12MM 393.62 2727088161 A4649 SCREW CD EST 32MM X 16MM 401.82 2727089600 A4649 SCREW CORTEX MD HD 1.3MMX18MM 365.36 2727089862 A4649 BLADE HELICAL TFNA 85MM 1581.34 2727090000 A4649 EXTRACTOR BALLOON 12MM/15MM - 925.30 2727090020 A4649 0NAIL FEMUR TFNA 11MMX170MM 3084.68 2727090180 A4649 PILLOW HIP ABDUCTION 52.94 2727090181 A4649 VALVE PEEP ANESTHESIA 10CM H2O 64.00 2727090422 C1713 PLATE DCP NR 4.5MM 9-HOLE 824.16 2787090472 A4649 NAIL UNIV FEMUR 10MMX320MM 1179.74 2727091041 A4649 RETRACT-O-TAPE 207.36 2727091246 A4649 CANNULA VENOUS 2-ST36/46FR CBP 237.49 2727091430 A4649 PACK BASIC 34.99 2727092100 A4927 GLOVES SURGEON S-6-1/2 3.06 2727092120 A4649 CATHETER NIAGARA 2-LUMEN 13.5F 409.14 2727092150 A4649 CATHETER NIAGARA 2-LUMEN 13.5F 409.14 2727092610 A4649 EXT FIX K-WIRE THRD TIP 1.25X1 257.83 2727092708 A4649 EXT FIX MINI K-WIRE TRD 1.6MM 257.50 2727092800 A4649 DRILL TWIST KLS 1.8MMX34 657.63 2727093000 A4649 HEMOVAC 400ML D.D. 1/4 19F 252.15 2727094000 A4649 BUR ROUND XKP 5.0MMX70MM 787.57 2727094475 A4649 IMPLANT DEFIBRILLATOR RVL 6944 8844.11 2727094758 C1895 LEAD DEFIBRILLATOR 694758 8844.11 2757094765 C1895 LEAD DEFIBRILLATOR 694765 8844.11 2757094771 A4649 SCREW SCHANTZ SD 4.0/3.0MMX80M 767.27 272
191
7094991 A4649 EXT FIX LGE CAP PIN 4.0MM 12.86 2727094993 A4649 EXT FIX LGE CAP PIN 5.0MM 19.37 2727095005 A4649 ENDOSHEARS 5 MM 932.07 2727095007 A4649 ROTICULATOR ENDO SCIZ 957.97 2727095008 A4649 V. CAVA FILT SYSTEM:FEMORAL 2222.88 2727095011 A4649 UTERINE MANIPULATOR 172.90 2727095051 A4649 SCREW CD MINI 2.0MMX5MM 205.00 2727095103 A4649 EXT FIX MINI ANGLED CONNECTING 291.12 2787095125 A4649 EXT FIX MINI K-WIRE HOLD CLAMP 1506.62 2727095126 A4649 EXT FIX MINI K-WIRE HOLD CLAMP 1506.62 2727095133 A4649 EXT FIX MINI CONNECT CLAMP 3MM 1449.83 2727095134 A4649 EXT FIX MINI CONNECT CLAMP 3MM 1449.83 2727095171 A4649 SCREW CD MINI 2.0MMX17MM 270.36 2727095597 A4649 CLAMP ADJUSTABLE 4.0MM 1446.44 2727095781 A4649 PROTECTIVE CAP 8MM 19.72 2727095782 A4649 ROD DISTAL RADIUS 8MMX200MM 821.40 2727095784 A4649 ROD DISTAL RADIUS 8MMX220MM 787.21 2727095786 A4649 ROD DISTAL RADIUS 8MMX240MM 623.66 2727095822 A4649 FIXATOR DISTAL RADIUS 220MM 3502.03 2727095824 A4649 FIXATOR DISTAL RADIUS 240MM 3050.70 2727096001 A4649 CORSON PROBE W/ SPIKE DISP 543.33 2727096002 A4649 SET SUPRAPUBIC CATHERIZATION 172.28 2727096017 A4649 MYRINGOTOMY LANCET DISP 89.67 2727096018 A4649 POPE OTO-WICK 24MM 17.15 2707096019 A4649 NEEDLE ENDO INJECTION 336.71 2727096021 A4649 SHEEHY MODIFIED PORP PROST 484.07 2727096022 A4649 SHEEHY MODIFIED TORP PROST 638.22 2727096027 A4649 ELECTRODE Y LOOP STERILE 125.30 2727096028 A4649 ENDOPOUCH 364.78 2707096030 A4649 CELLSAVER COLLECTION RESERVOIR 488.65 2727096031 A4649 CELLSAVER BASIC HIGH SPEED 125 669.40 2727096032 A4649 CELLSAVER BASIC HIGH SPEED 225 649.03 2727096033 A4649 CELLSAVER ASP & ANTICOAG ASSEM 223.49 2727096038 A4649 IMMOBILIZER KNEE 24 155.84 2707096040 A4649 CATHETER BROVIAC W/ SURECUFF 4 908.73 2727096045 A4649 AUTOMATED PRESSURE INFUSION 527.11 2727096046 A4649 SET IV FLUID WARMING DISP 324.37 2727096048 A4649 DRESSING ADAPTIC 3X3 4.33 2727096049 A4649 DRESSING ADAPTIC 3X8 10.26 2727096052 A4649 NEEDLE STRT MENISCAL STITCH 143.52 2727096120 A4649 TRAY NIAGARA CATH INSERTION 12 600.15 272
192
7096150 A4649 TRAY NIAGARA CATH INSERTION 15 600.15 2727096267 A4649 FORCEPS GRASPING 3-PRONG 2.4FR 979.71 2727096268 A4649 FORCEPS GRASPING 3-PRONG 3.0FR 979.71 2727096269 A4649 FORCEPS GRASPING 4-PRONG 3.0FR 952.51 2727097000 A4649 ELECTRODE MENISCECTOMY 348.87 2727097001 A4649 KIT VENTRICULOSTOMY 1084.62 2727097003 A4649 KIT EPIDURAL CATH REPAIR 524.69 2727097004 A4649 KIT EPIDURAL CATHETER 1020.13 2727097005 A4649 IRRIGATION SPIKE NONVENTED 34.46 2727097006 A4649 IRRIGATION SPIKE VENTED 24.74 2727097009 A4649 SCOPE-EQUIPMENT CHARGE 102.75 2707097403 A4649 CATHETER CAPD-PEDIATRIC 494.19 2727097600 A4649 SUTURE SILK 2-0 30 FSL 13.22 2727098002 A4649 TROCAR BLUNT TIP 12 MM DISP 939.24 2727098012 A4649 NEEDLE SPINAL WHITACRE 25GAX5 81.68 2727098014 A4649 PERFORATOR CODMAN DISP 900.57 2727098900 A4649 BLADE HELICAL TFNA 70MM 1581.34 2727098924 A4649 BLADE HELICAL TFNA 75MM 1581.34 2727098948 A4649 BLADE HELICAL TFNA 80MM 1581.34 2727098986 A4649 BLADE HELICAL TFNA 90MM 1581.34 2727099006 A4649 BLADE HELICAL TFNA 95MM 1581.34 2727099020 A4649 BLADE HELICAL TFNA 100MM 1581.34 2727099044 A4649 BLADE HELICAL TFNA 105MM 1581.34 2727099068 A4649 BLADE HELICAL TFNA 110MM 1581.34 2727099082 A4649 BLADE HELICAL TFNA 115MM 1581.34 2727099105 A4649 BLADE HELICAL TFNA 120MM 1581.34 2727099129 A4649 BLADE HELICAL TFNA 125MM 1581.34 2727099143 A4649 BLADE HELICAL TFNA 130MM 1581.34 2727800001 86316 CA 125 67.34 3027800002 84588 VASOPRESSIN LEVEL 104.50 3017800003 86628 CANDIDA ANTIBODY 87.91 3027800004 86606 ASPERGILLUS ANTIBODY 50.14 3027800016 83930 OSMOLALITY SERUM 22.66 3017800108 80307 DRUG SCREEN-THERAPEUTIC & ABUS 332.30 3017801008 80377 DIURETIC SURVEY URINE 318.00 3017802307 82306 VITAMIN D LEVEL 261.17 3017802538 83520 GANGLIOSIDE GQ1B IGG AB ELISA 220.57 3017802998 80175 LAMOTRIGINE LEVEL 119.49 3007804001 80183 TRILEPTAL LEVEL 202.90 3017804207 84207 VITAMIN B6 LEVEL 195.00 3017804840 80200 TOBRAMYCIN TROUGH 102.75 301
193
7804842 80200 TOBRAMYCIN PEAK 102.75 3017805102 80307 DRUG CONFIRMATION:BY GC/MS 184.73 3017806172 86603 ADENOVIRUS TITER 96.01 3027806173 86710 INFLUENZA VIR TYPE-B TITER 104.43 3027806174 86710 INFLUENZA VIR TYPE-A TITER 104.43 3027806227 86696 HERPES VIR AB TYPE-II 86.74 3027806228 86695 HERPES VIR AB TYPE-I 86.74 3027806229 86787 VARICELLA-ZOSTER 102.75 3027806248 84260 SEROTONIN PLATELET 412.63 3017806329 86160 COMPLEMENT C-5 107.79 3027807528 82570 URINE PROTEIN/CREATININE RATIO 71.47 3017808352 83520 NEURON SPECIFIC ENOLASE (NSE) 158.54 3017809768 86790 HANTAVIRUS ANTIBODY 189.62 3027812068 86021 PROTEINASE 3 ANTIBODY (PR3) 102.61 3027813520 83520 ANTI-GLIADIN ANTIBODY IGG 172.21 3017815668 86651 CALIFORNIA ENCEPHALITIS AB SE 242.07 3027816235 86235 ANTI-CENTROMERE ANTIBODY 103.72 3027819835 83519 IGF BINDING PROTEIN 3 96.98 3017820071 83520 SUBSTANCE P 649.97 3017820081 83520 INTERLEUKIN-6 694.40 3017820091 80177 LEVITIRACETAM (KEPPRA) LEVEL 324.07 3017820141 83520 SOLUBLE LIVER AG AUTOAB 105.89 3017820309 82030 CYCLIC AMP 207.25 3017820835 83520 TUMOR NECROSIS FACTOR-ALPHA 134.01 3017820850 82085 ALDOLASE 63.14 3017820890 82088 ALDOSTERONE URINE 241.06 3017821307 82128 AMINO ACID SCREEN 39.41 3017821366 82135 AMINOLEVULINIC ACID(ALA) 117.09 3017821728 82172 APOLIPOPROTEIN B 138.21 3017822008 80345 BARBITURATE U/A QUALI 35.71 3017822068 86022 HEPARIN INDUCED PLATELET AB 321.39 3027822095 80342 HALOPERIDOL(HALDOL) LEVEL 140.25 3017822124 80176 LIDOCAINE(XYLOCAINE) 102.75 3017823080 82308 CALCITONIN LEVEL 159.65 3017823520 83520 ANTI-GLIADIN ANTIBODY IGA 172.21 3017823551 82355 CALCULUS (STONE) QUALI 45.32 3017823586 86235 SCL-70 AB IGG 160.42 3027823762 82375 CARBOXYHEMOGLOBIN LEVEL 79.57 3017823808 82380 CAROTENE 56.64 3017823824 82382 CATECHOLAMINES URINE 195.45 3017823845 83835 METANEPHRINES FRACTIONATED 336.24 301
194
7823907 82390 CERULOPLASMIN 66.93 3017824388 88342 ACTIN DESMIN HMB 45 226.88 3107824807 82480 CHOLINESTERASE SERUM 67.97 3017824861 80339 MESANTOIN 89.27 3017825258 82525 COPPER 57.89 3017825380 83520 GLUTAMIC ACID DECARBOXYLASE AN 195.23 3017825668 86652 EASTERN EQUINE ENCEPHALITIS AB 244.94 3027825951 86334 CRYOGLOBULINS 124.27 3027826203 82615 CYSTINE URINE 84.64 3017826363 80307 TETRAHYDRO COMPOUND URINE 224.10 3017826555 80299 NORPACE LEVEL 89.27 3017826603 80307 DRUG ABUSE SCREEN/DRUG 27.09 3017826686 82668 ERYTHROPOIETIN SERUM 133.09 3017826697 84202 PROTOPORPHYRINS RBC 98.96 3017826710 82671 ESTROGEN FRACTIONATED 305.01 3017826728 82672 ESTROGEN TOTAL 150.79 3017827439 82607 VITAMIN B12 86.74 3017827452 82746 FOLIC ACID (FOLATE) 79.57 3017827466 82747 RBC FOLATE 133.09 3017828668 86682 FILARIASIS ANTIBODY 96.34 3027829432 82943 GLUCAGON PLASMA 134.76 3017829478 82947 REDUCING SUBSTANCES FECAL 145.43 3017829516 82941 GASTRIN 86.21 3017829805 82977 GAMMA GLUTAMYLTRANSFERASE 35.71 3017829839 83036 HEMOGLOBIN GLYCATED 50.49 3017830027 83002 LUTEINIZING HORMONE (LH) 104.43 3017830028 86618 LYME DISEASE AB IGG/IGM 134.84 3027830038 83003 GROWTH HORMONE (HGH) 91.81 3017830101 83010 HAPTOGLOBIN 93.91 3017830209 83020 HEMOGLOBIN ELECTROPHORESIS 83.25 3017830309 83030 HEMOGLOBIN FETAL 45.32 3017830331 82108 ALUMINUM SERUM 193.77 3017830332 83033 APT TEST 70.31 3017830333 82175 ARSENIC SCREEN HAIR 232.54 3017830334 82175 ARSENIC SCREEN NAIL 232.54 3017830335 82175 ARSENIC URINE 156.26 3017830515 83051 FREE HEMOGLOBIN PLASMA 86.74 3017830701 83070 HEMOSIDERIN URINE 58.09 3017831009 82024 ACTH BLOOD 197.02 3017831033 84146 PROLACTIN 108.34 3017831034 84135 PREGNANEDIOL URINE 143.62 301
195
7831108 82088 ALDOSTERONE SERUM 209.33 3017831306 82383 CATECHOLAMINES PLASMA 162.53 3017831403 80164 VALPROIC ACID(DEPAKENE) 94.74 3017831404 80202 VANCOMYCIN PEAK 117.51 3017831405 84585 VANILLYLMANDELIC(VMA) 73.90 3017831406 80202 VANCOMYCIN TROUGH 117.51 3017831454 83835 METANEPHRINES TOTAL 80.04 3017831850 83491 17-OH CORTICOSTEROIDS 94.79 3017831900 82530 CORTISOL FREE 81.27 3017831959 82533 CORTISOL TOTAL 123.15 3017832353 84233 ESTROGEN RECEPTOR ASSAY TISSU 305.01 3017832451 82677 ESTRIOL URINE 116.98 3017832453 82677 ESTRIOL BLOOD 101.90 3017832455 82670 ESTERIOL PLACENTAL 128.47 3017832569 86255 ANTI-PARIETAL CELL AB 86.31 3027833105 83001 FSH SERUM 95.60 3017833401 84138 PREGNANETRIOL 161.75 3017833609 84244 RENIN ACTIVITY 113.27 3017833658 86225 ANTI-DNA DOUBLE-STRANDED 84.64 3027834052 84403 TESTOSTERONE TOTAL 126.84 3017834981 84144 PROGESTERONE 95.60 3017834987 83498 17-HYDROXYPROGESTERONE 149.10 3017835198 83519 18-HYDROXYCORTICOSTERONE 243.16 3017835208 83520 GANGLIOSIDE GQ1B IGG AB ELISA 234.90 3017835257 83525 INSULIN LEVEL 59.12 3017835270 86341 ISLET CELL ANTIBODY 118.78 3027835668 86653 ST LOUIS ENCEPHALITIS AB SERU 233.47 3027835760 80299 ISONIAZID(INH) 228.52 3017835761 83593 17-KETOSTEROIDS FRACT URINE 224.10 3017835862 86235 ANTI-HISTONE SERUM 103.72 3027836057 83605 LACTIC ACID 57.89 3017836254 80438 TRH STIMULATION PANEL 1 HOUR 692.69 3007836255 83625 LDH ISOENZYMES 78.80 3017836555 83655 LEAD BLOOD 65.26 3017836556 83661 LECITHIN/SPHINGOMYELIN RATIO 161.75 3017837058 83700 LIPOPROTEIN ELECTROPHORESIS 185.42 3017837188 83718 HIGH DENSITY LIPID(HDL) 41.88 3017837200 83586 17-KETOSTEROIDS 80.43 3017838731 83873 MYELIN BASIC PROTEIN 122.15 3017838740 83874 MYOGLOBIN SERUM 127.62 3017838756 83874 MYOGLOBIN URINE SCREEN 52.95 301
196
7839153 83915 5 NUCLEOTIDASE 68.62 3017839160 83916 OLIGOCLONAL BANDS CSF 113.28 3017839359 83935 OSMOLALITY URINE 22.66 3017839457 83945 OXALATE URINE 84.64 3007840208 80343 PHENOTHIAZINES 49.23 3017840304 84030 PKU SCREENING 49.23 3017840663 84066 PHOSPHATASE ACID PROSTATIC 66.93 3017841108 84110 PORPHOBILINOGEN QUANTI 22.66 3017841115 84106 PORPHOBILINOGEN 38.18 3017841181 84120 24-HR URINE COPROPORPHYRIN 141.09 3017841248 84126 PORPHYRINS TOTAL 65.28 3017841413 80188 PRIMIDONE(MYSOLINE) 104.43 3017841423 80190 PROCAINAMIDE/NAPA 96.01 3017841603 84166 PROTEIN ELECTROPHORESIS URINE 99.37 3017841649 84153 PROSTATE SPECIFIC ANTIGEN 125.51 3017841650 85305 PROTEIN S 198.83 3057841651 84165 PROTEIN ELECTROPHORESIS SERUM 48.05 3017841652 85302 PROTEIN C PLASMA 198.83 3057842072 82963 BETA-GLUCOSIDASE LEVEL 191.24 3017842102 84220 PYRUVATE KINASE LEVEL 77.46 3017842303 80194 QUINIDINE 78.80 3017842312 84681 C-PEPTIDE 131.42 3017842313 86160 COMPLEMENT COMPONENT 98.12 3027842346 84234 ESTROGEN & PROGEST RECEP ASSAY 377.78 3017842659 83497 5-HIAA 90.94 3017843118 83018 BROMIDE SERUM 200.12 3017843755 82776 GALACTOSEMIA SCREEN 56.41 3017844034 84402 TESTOSTERONE FREE 141.95 3017844087 80349 THC LEVEL(CANNABUS) 86.74 3017844251 84425 THIAMINE 166.78 3017844341 80344 THIORIDAZINE (MELLARIL) 86.74 3017845278 87254 CULTURE HERPES SIMPLEX VIRUS 236.02 3067845668 86654 WESTERN EQUINE ENCEPHALITIS AB 257.83 3027845754 82955 G6PD QUANTITATIVE 107.79 3017845802 84580 UROBILINOGEN QUANTI 27.47 3017846304 84630 ZINC PLASMA 54.19 3017846734 83970 PTH C-TERMINAL 224.10 3017847542 80162 DIGITOXIN 86.21 3017847617 80299 DISOPYRAMIDE(NORPACE) 93.91 3017848766 80299 METHOTREXATE LEVEL 112.72 3017849991 87252 VIRAL CULTURE 439.86 306
197
7851983 83519 ALPHA SUBUNIT 105.93 3017852083 83520 ANTI-GLUTAMIC ACID DECARBOXYLA 120.32 3017852422 85240 FACTOR VIII 113.28 3057853248 84235 THYROTROPIN BINDING INHIBITORY 387.02 3017853268 86235 SJOGRENS ANTIBODY SS-B 97.15 3027853484 85612 LUPUS ANTICOAGULANT 141.95 3057855268 86255 ANTI-YO ANTIBODY 221.90 3027860067 86720 LEPTOSPIRA ANTIBODY 91.81 3027860080 86765 RUBEOLA (MEASLES) AB IGM 97.27 3027860108 86622 BRUCELLA ANTIBODY 61.48 3027860313 86226 ANTI-DNA SINGLE-STRANDED 138.57 3027860503 86038 ANTINUCLEAR ANTIBODY(ANA) 70.19 3027860636 86800 ANTI-THYROGLOBULIN 88.43 3027860637 85301 ANTI-THROMBIN III EVAL 355.58 3057860642 82103 ALPHA-1-ANTITRYPSIN TOTAL 90.11 3017860660 82104 ALPHA-1-ANTITRYPSIN PHENO 129.33 3017861626 86162 COMPLEMENT CH-50 118.22 3027861634 86160 COMPLEMENT C-3 57.89 3027861642 86160 COMPLEMENT C-4 61.55 3027861712 86593 VDRL CSF 53.88 3027861715 86753 PROTOZOA ANTIBODY 104.43 3027861718 86698 HISTOPLASMA ANTIBODY IMMUN 117.09 3027861720 86658 COXSACKIE A ANTIBODY 114.89 3027862351 86235 ANTI-ENA(SM/RNP)ANTIBODIES 122.15 3027862353 83520 ANTI-GLOM BSMT MEMBRANE 193.83 3017862358 86235 J01 ANTIBODY 65.89 3027862446 82105 ALPHA FETOPROTEIN 103.59 3017862550 86256 ANTI-MITOCHONDRIAL AB 86.74 3027862558 86255 ENDOMYSIAL ANTIBODY IGA (EMA) 119.88 3027862561 86665 EPSTEIN-BARR VIRUS VCA 139.88 3027862569 86255 ANTI-SMOOTH MUSCLE AB 101.90 3027862570 86256 IMMUNOFLUORESCENT STY IND 312.97 3027862806 87250 VIRAL ISOLATION 254.52 3067862840 86756 RSV TITER 80.92 3027862896 86707 HEPATITIS BE AB(HBEAB) 72.41 3027862904 87350 HEPATITIS BE AG(HBEAG) 72.41 3027862913 86708 HEPATITIS A AB(HAAB) TOTAL 81.26 3027862991 86709 HEPATITIS A AB(HAAB) IGM 91.81 3027863002 86644 CYTOMEGALOVIRUS AB IGG 143.62 3027863168 82784 IGM 46.77 3017863200 86320 IMMUNOELECTROPHORESIS 145.31 302
198
7863291 84466 TRANSFERRIN SERUM 79.57 3017863326 82784 IGG 61.48 3017863334 82784 IGA 61.48 3017863342 82784 IGD 86.74 3017863358 82785 IGE 78.80 3017863378 86337 INSULIN ANTIBODY TITER 157.95 3027863507 86664 EPSTEIN-BARR VIRUS EBNA 208.93 3027863756 86376 ANTI-THYROID MICROSOMAL AB 88.43 3027864210 86003 RAST ALLERGENS SERUM PER 52.17 3027864905 86635 COCCIDIOIDES ANTIBODY 107.79 3027865268 86255 ADRENAL ANTIBODY SCREEN 48.46 3027865405 86735 MUMPS ANTIBODY IGM 102.75 3027865406 83825 MERCURY BLOOD 135.69 3017865918 86329 TEICHOIC ACID ANTIBODIES 101.07 3027866004 84430 THIOCYANATE 125.09 3017866005 86777 TOXOPLAMA ANTIBODY 199.65 3027866006 84490 TRYPSIN FECAL 122.15 3017866849 82378 CARCINOEMBRYONIC ANTIGEN (CEA) 83.74 3017867368 86376 THYROID PEROXIDASE (TPO) AB 154.33 3027867908 86790 HEPATITIS E AB IGG 113.93 3027868128 86812 HLA-B27 127.62 3027868286 86682 SCHISTOSOMIASIS ANTIBODY 67.76 3027869998 86003 ALLERGEN TEST-ERI 52.17 3027870908 87015 CULTURE ACID FAST MYCOBACTER 89.69 3067871061 87106 FUNGAL IDENTIFICATION 89.69 3067871105 86738 MYCOPLASMA TITER 86.74 3027871429 86615 PERTUSSIS ANTIBODY SERUM 131.47 3027871705 86713 LEGIONELLA ANTIBODY 91.81 3027871741 87230 BOTULISM TOXIN SERUM 218.10 3067871753 87230 DIFFICILE TOXIN TITER 121.93 3067871880 80299 CEFOBID LEVEL 81.59 3017872501 86849 CSF VIRAL STUDIES 225.79 3027872768 86727 LYMPHOCYTIC CHORIOMENINGITIS A 75.90 3027874498 87449 LEGIONELLA ANTIGEN URINE 243.33 3067880100 80307 DRUG SCREEN-SEXUAL ASSAULT PRO 1276.21 3017880201 80201 TOPIRAMATE LEVEL 135.60 3007880299 80329 IBUPROFEN LEVEL 67.49 3007881210 81210 BRAF GENE ANALYSIS 489.44 3107881275 81275 KRAS GENE ANALYSIS 515.87 3107881311 81311 NRAS GENE ANALYSIS 440.40 3107882010 82010 ACETONE QUANTITATIVE 46.29 301
199
7882017 82017 ACYLCARNITINES QUAN EA SPEC 142.49 3017882131 82131 METHIONINE LEVEL 296.29 3017882145 80325 DL ISOMER-AMPHETAMINE 381.00 3017882172 82172 APOLIPOPROTEIN A1 89.88 3017882175 82175 ARSENIC BLOOD 164.52 3017882180 82180 VITAMIN C/ASCORBIC ACID LEVEL 181.67 3017882239 82239 BILE ACIDS FRACTION & TOTAL 124.68 3017882379 82379 CARNITINE (FREE&TOTAL) QUANTI 206.25 3017882397 86316 CHROMOGRANIN A 156.45 3027882506 82482 CHOLINESTERASE RBC 96.84 3017882507 88267 CHROM ANALY; AF/CV 15 CELLS 788.09 3007882542 80342 RISPERIDONE LEVEL 396.75 3017882570 82570 CREATININE 24HR-URINE 26.23 3017882634 82634 11-DEOXYCORTISOL 85.95 3017882651 80327 DIHYDROTESTOSTERONE 227.82 3017882652 82652 VITAMIN D (125 DIHYDROXY) SE 124.06 3017882670 82670 ESTRADIOL 290.12 3017882693 82693 ETHYLENE GLYCOL 200.91 3017882726 82726 FREE FATTY ACID VERY LONG 525.74 3017882784 82784 IGG SUBCLASSES 467.58 3017882866 86682 TOXOCARA CANIS ANTIBODY 94.21 3027883050 83050 METHEMOGLOBIN QUANTITATIVE 72.78 3017883088 83088 HISTAMINE LEVEL 295.06 3017883090 83090 HOMOCYSTEINE TOTAL 133.20 3017883428 88342 PATHO-IMMUNOHISTOCHEMISTRY STA 212.64 3127883516 83516 TISSUE TRANSGLUTAMINASE AB IG 94.84 3007883518 83518 ROTAVIRUS ANTIGEN 64.86 3017883519 83519 PTH-RELATED PROTEIN (PTH-RP) 187.49 3017883520 80197 TACROLIMUS LEVEL 244.27 3017883615 83615 LDH BODY FLUID 54.81 3017883695 83695 LIPOPROTEIN A 186.73 3017883735 83735 MAGNESIUM URINE 46.36 3017883840 80358 METHADONE SERUM 133.35 3017883890 81275 KRAS 499.99 3017883896 81220 CYSTIC FIBROSIS CARRIER SCREEN 460.02 3017883898 81479 SPINAL MUSCULAR ATROPHY-DNA TE 614.46 3017883900 81291 MTHFR MUTATION TEST 280.53 3017883921 83921 METHYLMALONIC ACID LEVEL 186.73 3017883937 83937 OSTEOCALCIN 177.77 3017883986 83986 PH FECAL 99.38 3017884120 84119 PORPHYRIN URINE 140.25 301
200
7884143 84143 17-HYDROXYPREGNENOLONE 104.57 3017884210 84210 PYRUVATE 102.97 3017884235 84235 TSH RECEPTOR ANTIBODY 245.69 3017884252 84252 VITAMIN B2/RIBOFLAVIN BLOOD 221.40 3017884260 84260 SEROTONIN BLOOD 463.08 3017884305 84305 SOMATOMEDIN C IGF-1 61.71 3007884307 84307 SOMATOSTATIN 174.10 3007884311 84311 ADENOSINE DEAMINASE 363.81 3017884425 84425 VITAMIN B1/THIAMINE BLOOD 184.52 3017884442 84442 THYROXINE BINDING GLOBULIN 75.31 3017884445 84445 THYROID STIMULATING IMMUNE GLO 194.79 3017884446 84446 VITAMIN E LEVEL SERUM 95.60 3017884480 84480 T3 TOTAL 74.68 3017884481 84481 T3 FREE 112.38 3017884482 84482 T3 REVERSE 90.62 3017884586 84586 VASOACTIVE INTESTINAL POLYPEPT 377.76 3017884590 84590 VITAMIN A LEVEL SERUM 116.22 3017884660 80320 METHANOL 177.15 3017884999 84999 OSMOLALITY FECES 39.64 3017885220 85220 FACTOR V - LEIDEN 397.03 3057885246 85246 VON WILLEBRAND FACTOR AG 197.87 3057885250 85250 FACTOR IX(CHRISTMAS) ASSAY 80.50 3057885260 85260 FACTOR X ASSAY 310.05 3057885270 85270 FACTOR XI ACTIVITY 150.65 3057885280 85280 FACTOR XII ASSAY 333.52 3057885291 85291 FACTOR XIII SCREEN 194.73 3057885379 85379 D-DIMER QUANTITATIVE 112.11 3057885397 85397 ADAMTS-13 292.83 3057885520 85520 LOW MOLECULAR WEIGHT HEPARIN 140.71 3057885540 85540 LEUKOCYTE ALKALINE PHOSPHATASE 27.77 3057885549 85549 LYSOZYME 158.96 3057885613 85613 RUSSELL VIPER VENOM TIME 65.44 3057885668 86658 COXSACKIE B ANTIBODY 156.12 3027885670 85670 THROMBIN TIME 50.28 3057886000 86000 WIDAL TEST 102.48 3027886021 86021 MYELOPEROXIDASE ANTIBODY 102.61 3027886022 86022 PLATELET ANTIBODY INDIRECT 120.91 3027886023 86023 PLATELET ANTIBODY DIRECT 105.46 3027886024 86022 HEPARIN INDUCED THROMBOCYTOPEN 182.61 3027886063 86063 STREPTOZYME 18.72 3027886146 86146 BETA 2 GLYCOPROTEIN AB PANEL 393.52 302
201
7886147 86147 ANTI-CARDIOLIPIN AB PANEL 191.45 3027886148 86148 PHOSPHATIDYLSERINE AB PANEL 570.96 3027886160 86160 COMPLEMENT C-2 80.62 3027886200 86200 CYCLIC CITRULLINATED PEPTIDE 185.18 3027886235 86235 SJOGRENS ANTIBODY SS-A 97.15 3027886255 86255 ANTI-NEURONAL ANTIBODY SCREEN 221.90 3027886256 87081 CULTURE LEGIONELLA 192.09 3067886257 86256 MITOCHONDRIAL ANTIBODIES 82.50 3027886300 86300 CA 27-29 102.10 3027886316 86316 CA 15-3 58.78 3027886318 86318 ANTI-RIBOSOMAL P ANTIBODY 273.64 3027886329 86329 C1 ESTERASE INHIBITOR 51.31 3027886335 86335 IMMUNOFIXATION ELECTROPHORESIS 416.65 3027886360 86360 T-CELLS SUBSET (CD4 CD8) COUN 412.79 3027886376 86376 LIVER/KIDNEY MICROSOMAL AB 114.59 3027886611 86611 BARTONELLA HENSELAE SCREEN 139.00 3027886625 86625 CAMPYLOBACTER JEJUNI AB 174.76 3027886632 86632 CHLAMYDIA DIFFERENTIATION IGM 63.15 3027886645 86645 CYTOMEGALOVIRUS AB IGM 50.13 3027886651 86651 CALIFORNIA ENCEPHALITIS AB CS 256.39 3027886652 86652 EASTERN EQUINE ENCEPHALITIS AB 263.55 3027886653 86653 ST LOUIS ENCEPHALITIS AB CSF 247.79 3027886654 86654 WESTERN EQUINE ENCEPHALITIS AB 273.58 3027886658 86658 ECHOVIRUS ANTIBODY 56.71 3027886663 86663 EPSTEIN-BARR VIRUS EARLY AG 27.65 3027886671 86671 SACCHAROMYCES CEREVISIAE AB 203.70 3027886682 86682 CYSTICERCOSIS ANTIBODY 97.02 3027886685 83519 ACETYLCHOLINE RECEPTOR AB 203.89 3007886689 86689 HTLV I/II - WESTERN BLOT 111.16 3027886694 86694 HERPES VIRUS TYPE SPECIFIC IGG 84.50 3027886727 86727 LYMPHOCYTIC CHORIOMENINGITIS A 233.47 3027886735 86735 MUMPS ANTIBODY IGG 50.13 3027886747 86747 PARVOVIRUS B-19 AB IGG 39.17 3027886750 86750 MALARIA ANTIBODY 447.51 3027886765 86765 RUBEOLA (MEASLES) AB IGG 50.13 3027886774 86774 TETANUS ANTIBODY 42.87 3027886781 86780 TREPONEMA PALLIDUM (FTA-ABS) 47.08 3027886790 86790 DENGUE FEVER ANTIBODY 69.59 3027886793 86793 YERSINIA ANTIBODY 76.24 3027886804 86804 HEPATITIS C AB - RIBA 162.66 3027886941 86941 DONATH LANDSTEINER TEST 190.50 300
202
7887081 87081 LEPTOSPIRA CULTURE 93.26 3067887082 87206 LEPTOSPIRA STAIN 79.08 3067887102 87102 FUNGAL CULTURE OTHER SOURCE 45.84 3067887109 87109 CULTURE MYCOPLASMA PNEUMONIAE 90.04 3067887205 87205 EOSINOPHILS URINE 35.05 3067887206 87206 AFB SMEAR 43.75 3067887252 87252 CULTURE RESPIRATORY SYNCYTIAL 138.53 3067887254 87254 CULTURE CYTOMEGALOVIRUS 110.05 3067887265 87265 PERTUSSIS CULTURE & DFA 254.95 3067887450 87450 CRYPTOCOCCUS ANTIGEN CSF 57.75 3067887491 87491 CHLAMYDIA TRACHOMATIS-PCR 155.03 3067887496 87496 CYTOMEGALOVIRUS DNA-PCR 241.84 3067887522 87522 HEPATITIS C RNA QUANTITATIVE 412.49 3067887536 87535 HIV I DNA-PCR 235.83 3067887555 87555 M. TUBERCULOSIS COMPLEX DNA P 237.65 3067887556 87556 M. TUBERCULOSIS AMPLIFIED RNA 300.92 3067887591 87591 GONOCOCCUS-PCR 157.56 3067887801 87801 HERPES SIMPLEX PCR 685.14 3067887802 87801 BORDATELLA PERTUSSIS PCR 185.39 3067887901 87901 HIV GENOTYPE 485.00 3067887902 87902 HEPATITIS C GENOTYPE 956.74 3067888230 88230 TISSUE CULTURE LYMPHOCYTE 346.34 3127888233 88233 CHROMOSOME ANALYSIS TISSUE 1280.81 3117888237 88237 CHROMOSOME ANALYSIS MARROW 521.86 3117888271 88271 HERCEPTIN-2 FISH 451.01 3117888313 88313 RENAL BIOPSY LIGHT MICROSCOPY 235.78 3127888323 88323 SLIDE REVIEW 1-8 SLIDES 233.64 3127888325 88325 CONSULTATION COMPREHENSIVE 367.23 3127888341 88341 IMMUNOHISTO AB ADD STAIN 159.86 3107888342 88360 HERCEPTIN-2 IHC 343.34 3107888346 88346 PATHO-STAIN IMMUNOFLUOR DIREC 389.62 3127888348 88348 ELECTRON MICROSCOPY DIAGNOSTI 577.56 3127888350 88350 IMMUNOFLUOR AB ADD STAIN 111.35 3107888361 88361 TUMOR IMMUNOHISTOCHE COMPUTER 288.86 3107888366 88366 FISH PROBE EACH STAIN 229.32 3107889838 81240 PROTHROMBIN GENE MUTATION 330.87 3107891538 83519 PANCREATIC POLYPEPTIDE 422.81 3007896016 86689 HIV 1 AB:WESTERN BLOT 53.64 3027896017 86747 PARVOVIRUS B-19 AB IGM 30.37 3027896018 87190 SUSCEPTIBILITY:TBC 90.30 3067896019 87045 CULTURE STOOL 27.88 306
203
7896020 87075 CULTURE ANAEROBIC 37.57 3067896027 83519 SOMATOMEDIN-C 28.63 3017896028 83505 HYDROXYPROLINE TOTAL 86.33 3017896029 83500 HYDROXYPROLINE FREE 39.25 3017896030 82330 CALCIUM IONIZED 25.77 3017896033 82626 DEHYDROEPIANDROSTERONE (DHEA) 82.09 3017896034 86692 HEPATITIS DELTA AB 32.36 3027897001 86215 DNASE B TITER 46.59 3027897002 87536 HIV RNA-QUANTITATIVE-PCR 197.87 3067897003 82759 GALACTOKINASE BLOOD 287.93 3017897004 82775 GPUT BLOOD 153.69 3017897005 87110 CULTURE CHLAMYDIA 61.72 3067897006 84432 THYROGLOBULIN 56.44 3017897007 87517 HEPATITIS B VIRAL DNA:PCR 281.40 3067897008 82542 CIPROFLOXACIN 78.79 3017897010 80158 CYCLOSPORINE 87.96 3017897011 83018 HEAVY METAL SCREEN URINE 106.26 3017897012 83018 HEAVY METAL SCREEN BLOOD 106.26 3017897013 82164 ANGIOTENSIN CONVERTING ENZYME 28.94 3017897014 83918 ORGANIC ACIDS TOTAL QUANTI 571.61 3017897016 82043 MICROALBUMIN QUANTITATIVE 40.55 3017897017 82595 CRYOGLOBULIN QUALITATIVE 13.91 3017897018 85245 RISTOCETIN COFACTOR 106.42 3057897019 82507 CITRATE URINE 51.32 3017897020 86256 ANTINEUTROPHIL CYTOPLASMIC AB 48.60 3027897021 83864 MUCOPOLYSACCHARIDES UA QUAL 101.58 3017897022 84081 PHOSPHATIDYLGLYCEROL 185.42 3017897023 82128 AMINO ACID SCREEN URINE 26.93 3017897031 82232 BETA-2 MICROGLOBULINS 38.12 3017897032 84439 T4 FREE 19.48 3017898000 80332 FLUOXETINE 40.31 3017898001 86316 CA 19-9 43.43 3027899208 80299 ERYTHROMYCIN LEVEL 100.26 3019000001 CAPD SERVICES 0.00 8209000002 CCPD SERVICES 1011.34 8209000003 POST OPERATIVE CATH CARE 252.84 8209000005 EXIT SITE CHARGE 168.55 8209000009 J3490 ACO-P ANTI COAG SOLUTION 38.81 2509000010 J3490 DIANEAL SOLN 4.25% 2L BAG 33.76 2509000011 A4649 MINICAP WITH PROVIDINE 2.78 2729000012 J3490 DIANEAL SOLN 2.5% 2L BAG 33.76 250
204
9000013 J3490 DIANEAL SOLN 1.5% 2L BAG 33.76 8209000014 A4649 ULTRA TUBING Y-SET 14.96 2729000015 A4649 PD TRANSFER SET W/MINICAP 250.48 2729000020 A4649 COMPACT EXCHANGE DEVICE 2911.24 2729094600 90999 HEMO STABIL 5 1/2 HR 461.78 8219094601 PERI DIALYSIS NURSE T 187.32 8209094602 PERITONEAL DIALYSIS PHYS T 0.00 8209094700 90999 HEMO LTUD CARE 5 1/2 404.11 8219095001 A4755 ARTERIAL-VENOUS TUBING 58.11 2729095002 A4649 BICAR ON-LINE BICARBONATE 73.61 2729095003 A4690 HOLLOW FIBER DIALYZER 234.55 2729096000 90935 HEMO ACUTE CARE 1HR 710.28 8019096100 90935 HEMO ACUTE CARE UP 710.28 8019096300 90999 HEMO EMERGENGY CARE 46.16 8219096604 A4649 PEDS INT JUG PUNCT KIT 31.44 2729300002 93005 EKG TRACING 12-LEAD 90.84 7309300038 C1769 GUIDEWIRE CRN NS .014"X180CM 653.00 2729300385 C1769 GUIDEWIRE CRN NS .014"X180CM 653.00 2729301510 A4649 BALLOON SPRINTER 1.5MMX10MM 808.50 2729302251 A4649 STENT COR DES 2.25MMX14MM 2100.00 2729302512 A4649 STENT COR DES 2.5MMX12MM 2100.00 2729302514 A4649 STENT COR DES 2.5MMX14MM 2100.00 2729302518 A4649 STENT COR DES 2.5MMX18MM 2100.009302520 A4649 BALLOON SPRINTER 2.5MMX20MM 808.509303015 A4649 STENT COR DES 3.0MMX15MM 2100.00 2729303026 A4649 STENT COR DES 3.0MMX26MM 2100.00 2729303415 C1769 GUIDEWIRE CRN MG 130CM 1.8FR 653.00 2729303512 A4649 0STENT COR DES 3.5MMX12MM 2100.00 2729303518 A4649 STENT COR DES 3.5MMX18MM 2100.00 2729303526 A4649 STENT COR DES 3.5MMX26MM 2100.00 2729303851 C1769 GUIDEWIRE NS EXT .014"X150CM 136.77 2729304001 C1887 CATHETER GUIDE SBS4 2 S-H 6FR 299.03 2729304007 93041 EKG RHYTHM 1-2 LEADS TRACING 60.63 7309304015 A4649 STENT COR DES 4.0MMX15MM 2100.00 2729304750 A4649 KIT 3 VALVE MANIFOLD 663.87 2729307042 C1769 GUIDEWIRE FC JTIP .035"X145CM 714.00 2729308351 A4649 CATHETER JL4 6FR 0.38X100CM 74.46 2729308352 A4649 CATHETER JR4 6FR 0.38X100CM 74.46 2729308631 C1769 GUIDEWIRE FC JTIP .035"X280CM 714.00 2729310016 C1887 CATHETER GUIDE AL1 LT 2S-H 6FR 299.03 2729310024 A4649 RADIAL TR BAND 21 W/INFLATOR 323.12 272
205
9310025 A4649 RADIAL TR BAND 29 W/INFLATOR 323.12 2729310038 A4649 CATHETER HOCKEY STICK 90.32 2729310225 A4649 BALLOON SPRINTER 2.25MMX10MM 808.50 2729310259 A4649 BALLOON SPRINTER NC 2.5MMX9MM 808.50 2729310309 A4649 STENT COR DES 3.0MMX9MM 21000.00 2729310312 A4649 BALLOON SPRINTER NC 3MMX12MM 808.50 2729310325 A4649 BALLOON SPRINTER NC 3.25MMX12M 808.50 2729310351 A4649 BALLOON SPRINTER NC 3.5MMX12MM 808.50 2729310415 A4649 BALLOON SPRINTER NC 4MMX15MM 808.50 2729310510 A4649 GLIDESHEATH SLENDER 6FR 701.84 2729310697 A4649 FEMO STOP II DOME 250.05 2709320550 20550 INJECT TENDON SHEATH/LIGAMENT 246.70 9409324501 A4649 MULTIPACK CARDIAC 6FR 5-0 .038 399.67 2729327719 A4649 CATHETER HIFLO JR3.5 7FR 100CM 238.67 2729327720 A4649 CATHETER JL4 7FR .038X110CM 178.78 2729327721 A4649 CATHETER JR4 7FR .038X100CM 178.78 2729327722 A4649 CATHETER JL5 7FR .038X100CM 178.78 2729327723 A4649 CATHETER HIFLO JR5 7FR 100CM 229.13 2729327740 A4649 CATHETER AL1 7FR .038X100CM 178.78 2729327741 A4649 CATHETER AL2 7FR .038X100CM 178.78 2729327750 A4649 CATHETER PIG 7FR .038X100CM 178.78 2729327760 A4649 CATHETER IM 7FR .038X100CM 178.78 2729327770 A4649 CATHETER RCB 7FR .038X100CM 178.78 2729327772 A4649 CATHETER LCB 7FR .038X100CM 178.78 2729327784 A4649 CATHETER MPAI 7FR .038X125CM 178.78 2729330016 C1887 CATHETER GUIDE AL3 LT 6FR 299.03 2729330303 A4649 CONTRAST INJECTION LINE 60" 189.93 2729330400 A4649 CATHETER AMPLTZ SUP STIF 260CM 712.46 2729333181 A4649 GLIDEWIRE STR .018X150CMX3CM 409.29 2729333182 A4649 GLIDEWIRE ANG .018X150CM X3CM 411.25 2729333184 A4649 GLIDEWIRE ST AN .018X80CMX3CM 411.25 2729333208 33208 INSRT HEART PM ATRIAL & VENT 10985.56 4809333210 33210 INSERT TEMP TRNSV SNGL CHAMBER 7577.05 4809333211 33211 INSERT TEMP TRNSV DUAL CHAM 7577.05 4809333218 33218 REPAIR LEAD PACE-DEFIB ONE 2716.16 4809333234 33234 REMOVE 1-PACER LEAD ONLY 2716.16 4809333618 A4649 CATHETER SUPTR JL3.5 6FR 100CM 238.67 2729333619 A4649 CATHETER SUPTR JR3.5 6FR 100CM 238.67 2729333620 A4649 CATHETER SUPTR JL4 6FR 100CM 229.13 2729333621 A4649 CATHETER SUPTR JR4 6FR 100CM 238.67 2729333627 A4649 CATHETER SUPTR JL4.5 6FR 100CM 238.67 272
206
9333643 A4649 CATHETER AMPLATZ RT 6FR 2 MOD 255.73 2729333660 A4649 CATHETER IM 6FR .038X100CM 178.78 2729333720 A4649 CATHETER SUPTR JL4 7FR 100CM 238.67 2729334621 A4649 CATHETER INFINITI JR4 6FR 229.13 2729338103 A4649 CATHETER RCB 6FR .038X100CM 372.24 2729338124 A4649 CATHETER PIGTAIL 6FR 110CM 365.13 2729338163 A4649 CATHETER ANGIO WR 6FR 100CM 73.57 2729352023 A4649 CATHETER SONES 6FR 100CM 81.29 2729353001 C1887 CATHETER GUIDE 3.5 2 S-H 6FR 299.03 2729370110 A4649 CATHETER AMPLATZ RT 6FR 1017.84 2729370112 A4649 CATHETER AMPLATZ RT 6FR 12.070 1017.84 2729378110 A4649 CATHETER AMPLATZ RT 7FR 1.078 1017.84 2729379109 A4649 BALLOON SPRINTER NC 4MMX9MM 808.50 2729380932 A4649 CATH JDK RT 4CM 5F 100CM 0 S-P 81.29 2729380933 A4649 CATH JDK LT 4CM 5F 100CM 0 S-P 81.29 2729380934 A4649 CATH MLTP B1 6FR 100CM 0 S-P 81.29 2729380935 A4649 CATH MLTP A2 5FR 100CM 2 S-P 81.29 2729380941 A4649 CATHETER JL5 JUDKINS LT 100CM 223.55 2729381161 A4649 CATHETER JR5 JUDKINS RT 100CM 223.55 2729381211 A4649 CATH TIG RADIAL 6FR 100CM0 323.12 2729381212 A4649 CATH JACKY RADIAL 6FR 100CM 323.12 2729381213 A4649 CATH AMPLATZ LT SML AL1 100CM 223.55 2729381214 A4649 CATH AMPLATZ LT MED AL2 100CM 223.55 2729381241 A4649 CATHETER PIGTAIL STR 6FR 100CM 223.55 2729381242 A4649 CATHETER PIGTAIL ANG 6FR 100CM 223.55 2729381830 C1894 INTRODUCER SHTH .038"X11CM 6FR 74.52 2729382101 A4649 0RAY PARACENTESIS PIGTAIL 406.44 2729391039 A4649 BALLOON SPRINTER NC 3MMX9MM 808.50 2729392537 92537 ELECTRONYSTAMOGRAPHY 211.07 9209393017 93017 CARDIO STRESS TEST TRACING 275.56 4829393279 93279 PCMKR PROGRAM SINGLE LEAD 65.65 4809393280 93280 PCMKR PROGRAM DUAL LEAD 71.72 4809393281 93281 PCMKR PROGRAM MULTIPLE LEAD 88.73 4809393282 93282 AICD PROGRAM SINGLE LEAD 81.44 4809393283 93283 AICD PROGRAM DUAL LEAD 85.09 4809393284 93284 AICD PROGRAM MULTIPLE LEAD 102.10 4809393286 93286 PCMKR EVAL PERI-PROCEDURAL 38.89 4809393287 93287 BIOPSY SALIVARY GLAND; INCISIO 43.75 9209393288 93288 PACEMAKER INTERROGATION 65.65 4809393289 93289 AICD INTERROGATION 71.72 4809393303 93303 TTE CONGENITAL CARDIAC COMP 448.72 483
207
9393304 93304 TTE CONGENITAL CARDIAC LIM/FU 190.73 4839393306 93306 TTE W/ DOPPLER COMPLETE 674.93 4839393307 93307 TTE W/O DOPPLER 2-D COMPLETE 489.38 4839393308 93308 ECHO FOLLOW UP 219.51 4839393312 93312 TRANSESOPHAGEAL ECHO COMPLETE 688.14 4839393318 93318 TEE 2-D IMAGE ACQUISITION 688.14 4839393320 93320 DOPPLER ECHO-PW/CW COMP 96.64 4839393321 93321 DOPPLER ECHO-PW/CW FF-UP/LIMI 205.49 4839393325 93325 DOPPLER ECHO-COLOR FLOW MAP 163.25 4839393350 93350 ECHO 2-D INC STRESS TEST 849.38 4839393351 93351 STRESS TTE COMPLETE 528.10 4839393451 93451 ANG RIGHT HEART CATHETERIZATI 2982.44 4819393453 93453 R&L HEART CATH W/O CORONARY A 2982.44 4819393458 93458 CORS + LVG 5901.98 4819393459 93459 CORS + GRAFTS + LHC 8211.48 4819393460 93460 R&L HC + CORS +LVG 5901.98 4819393461 93461 R & L CORS & GRAFTS 8211.48 4819393503 93503 INSERTION SWANZ-GANZ MONITOR 1824.47 4819395812 95812 EEG PROLONGED 41-60 MIN 267.21 7409395816 95816 EEG RECORD AWAKE AND DROWSY 444.14 7409395819 95819 EEG RECORD AWAKE AND SLEEP 349.70 7409395822 95822 EEG RECORD COMA OR SLEEP 376.51 7409395824 95824 EEG CEREBRAL DEATH 315.69 7409400003 94375 FLOW VOLUME LOOP 186.70 4609400006 94729 DLCO 87.79 4609400031 94727 LUNG VOLUME-FRC 186.70 4609494060 94060 SPIROMETRY P/P BRONCHODIL 274.20 4609494070 94070 METACHOLINE CHALLENGE 40.58 4609494200 94200 MAXIMUM VOLUNTARY VENTILATION 152.52 4609494620 94620 PULMONARY STRESS TEST SIMPLE 152.44 460
208