[PDF]REHAB CHARGE DESCRIPTION PROCEDURE...
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REHAB
CHARGE DESCRIPTION Carpal Tunnel Injection Pro Fee Injection Single Tendon Shealth or Ligament Pro Fee Inj Tendon Origin/Insertion Pro Fee Injection Single or Multiple Trigger Point 1-2 Muscles Injection Single or Multiple Trigger Point 1-2 Muscles Pro Fee Injection Single or Multiple Trigger Point 3+ Muscles Injection Single or Multiple Trigger Point 3+ Muscles Pro Fee Arthrocentesis Small Joint Pro Fee w/o US Guid Arthrocentesis Intermediate Joint w/o US Guid Arthrocentesis Intermediate Joint Pro Fee w/o US Guid Arthrocentesis Major Joint w/o US Guid Arthrocentesis Major Joint Pro Fee w/o US Guid Application of Long Arm Splint Splint/Cast Fabrication Each 15 Minutes Application of Short Arm Splint Static Application of Finger Splint Static Application of Multi Layer Compression System Below Knee Application of Vein Wound Compression Sys Upper Arm, Forearm, Hand and Fingers Catheter Aspiration Nasotracheal Routine Venipuncture Specimen Collection Fee Collection Of Cap Blood Specimen Arterial Puncture for ABG Bone Marrow Aspiration By Path Bone Marrow Aspiration By Phys Bone Marrow Collection By Path Bone Marrow Collection By Phys Bladder Scan Lumbar Puncture Diagnostic Lumbar Puncture Diagnostic Pro Fee Spinal Puncture Therapeutic Spinal Puncture Therapeutic Pro Fee Injection Anesthetic Agent Other Peripheral Nerve Injection Anesthetic Agent Other Peripheral Nerve Pro Fee OT Application of Surface Neurostimulator Chemodenervation Salivary Glands Chemodenervation of Salivary Glands Bilateral Pro Fee Chemodenervation of Facial Muscle Unilateral Chemodenervation of Facial Muscle Unilateral Pro Fee Chemodenervation of Muscle for Migrane Bilateral Pro Fee Chemodenervation of Muscle for Migrane Bilateral Chemodenervation of Neck Muscle Unilateral Pro Fee Chemodenervation of Neck Muscle Unilateral Chemodenervation of Neck Muscle Bilateral Pro Fee Chemodenervation of Neck Muscle Bilateral Chemodenervation of Muscle Larynx w/ EMG Bilateral Pro Fee Chemodenervation of Muscle Larynx w/ EMG Bilateral Chemodenervation 1 Extremity (1-4 Muscles) Pro Fee Chemodenervation 1 Extremity (1-4 Muscles) Chemodenervation Ea Addl Extremity (1-4 Muscles) Pro Fee Chemodenervation Ea Addl Extremity (1-4 Muscles) Chemodenervation 1 Extremity (5+ Muscles) Pro Fee Chemodenervation 1 Extremity (5+ Muscles) Chemodenervation Ea Addl Extremity (5+ Muscles) Pro Fee Chemodenervation Ea Addl Extremity (5+ Muscles) Chemodenervation Trunk Muscle (1-5 Muscles) Profee Chemodenervation Trunk Muscle (1-5 Muscles) Chemodenervation Trunk Muscle 6 or More Muscles Profee Chemodenervation Trunk Muscle 6 or More Muscles
PROCEDURE CODE 20526 20550 20551 20552 20552 20553 20553 20600 20605 20605 20610 20610 29105 29105 29125 29130 29581 29584 31720 36415 36415 36416 36600 38220 38220 38221 38221 51798 62270 62270 62272 62272 64450 64450 64550 64611 64611 64612 64612 64615 64615 64616 64616 64616 64616 64617 64617 64642 64642 64643 64643 64644 64644 64645 64645 64646 64646 64647 64647
CHARGE AMOUNT 216.00 122.00 168.00 322.00 153.00 279.00 174.00 155.00 448.00 169.00 283.00 224.00 361.00 157.00 270.00 153.00 278.00 445.00 77.00 20.00 24.00 24.00 120.00 1430.00 1430.00 1468.00 1468.00 60.00 526.00 86.00 674.00 119.00 577.00 54.00 98.00 262.00 108.00 296.00 159.00 197.00 335.00 171.00 332.00 342.00 664.00 274.00 1248.00 139.00 608.00 93.00 329.00 164.00 621.00 116.00 393.00 143.00 577.00 181.00 557.00
Nasal Bones Complete Minimum 3 Views Xray Exam Chest 2 Views X-Ray Neck Spine 2-3 Views Pro Fee - Chi X-Ray Neck Spine 4-5 Views Pro Fee - Chi X-Ray Neck Spine 6 + Views Pro Fee - Chi X-Ray Spine Thoracic 2 Views Pro Fee - Chi X-Ray Spine Lumbosacral 2-3 Views Pro Fee - Chi Spine Lumbosacral Minimum 4 Views Pelvis 1 Or 2 Views Shoulder Complete Bilateral Minimum 2 Views Each X-Ray Shoulder Complete Min 2 Views Pro Fee - Chi Elbow Complete 3 Views Contrast X-Ray of Elbow Pro Fee - Chi Forearm 2 views Wrist AP & Lateral Contrast X-Ray of Wrist Pro Fee - Chi Hand X-Ray Hip, Unilateral w/ Pelvis; 2-3 Views X-Ray Hips, Bilateral w/ Pelvis; 2 Views X-Ray Hips, Bilateral w/ Pelvis; 3-4 Views X-ray Exam of Femur; Minium 2 Views Knee 2 Views X-Ray Knee 4 or More Pro Fee - Chi Tibia/Fibular Ankle Complete Minimum 3 Views Contrast X-Ray of Ankle Pr Fee - Chi Foot Complete 3 Views Xray Exam Abdomen 1 View Radiological Exam Surg Specimn Chem 8 Basic Metabolic Panel General Health Survey Health Panel 1 Electrolytes Electrolytes Offsite Comprehensive Metabolic Panel Prenatal Profile HDL Profile Lipid Profile NMR Lipid Profile -Mayo Renal Function Panel Acute Hepatitis Panel Liver Profile Amikacin Level Tegretol (Carbamazepine) Cyclosporine Level-Mayo Digoxin Valproic Acid Ethosuximide-Mayo Gentamicin Gabapentin Level-Mayo Lamotrigine-Mayo Levetiracetam Level-Mayo Lithium Mycophenolic Acid-Mayo Oxcarbazepine Met (MHC)-Mayo Phenobarbital Phenobarbital Serum Dilantin (Phenytoin) Level Free Phenytoin Primidone Sirolimus Level-Mayo
70160 71046 72040 72050 72052 72070 72100 72110 72170 73030 73030 73080 73085 73090 73100 73115 73120 73502 73521 73522 73552 73560 73564 73590 73610 73615 73630 74018 76098 80048 80050 80050 80051 80051 80053 80055 80061 80061 80061 80069 80074 80076 80150 80156 80158 80162 80164 80168 80170 80171 80175 80177 80178 80180 80183 80184 80184 80185 80186 80188 80195
260.00 396.00 79.00 132.00 145.00 90.00 90.00 402.00 282.00 658.00 75.00 252.00 228.00 260.00 261.00 206.00 252.00 362.00 724.00 724.00 313.00 252.00 83.00 252.00 252.00 251.00 252.00 248.00 0.00 153.00 248.00 248.00 141.00 158.00 170.00 290.00 154.00 154.00 84.00 252.00 377.00 189.00 192.00 167.00 106.00 152.00 236.00 181.00 171.00 123.00 139.00 192.00 125.00 236.00 205.00 57.00 129.00 159.00 171.00 64.00 144.00
Tacrolimus Level-Mayo Theophylline Tobramycin Topiramate Level-Mayo Vancomycin Amiodarone Level-Mayo Methotrexate Mexiletine Posaconazole Level - ARUP Nicotine And Metabolites-Mayo Nortriptyline Level-Mayo Nortriptyline Amitriptyline Pentobarbital Level RBC Enzyme Eval Comp 1 DOT Urine Dipstick Offsite Urinalysis Offsite Urine Single XZ Urinalysis Auto Offsite Urinalysis Routine Urine Dipstick Urine Dipstick Offsite Urine Auto Dipstick Offsite Urine Auto W/O Microscopic Urine Specific Gravity Reducing-Substance Feces Urine Microscopic Offsite Quik Trak Pregnancy Test Preg Screen (HCG) Preg Screen (HCG) Urine Urine HCG Screen Offsite Timed UR Volume Measure Cystic Fib Dx And Car Det-Mayo ZB1KV Prothrombin G20210A Mut-Mayo ZB1IY Factor V Leiden (R506Q) Mut-Mayo ZB014 Frag X Syn Molec Anal-Mayo ZB1T4 Hemochromatosis HFE Gene Analy ZB1LX Mthfr Mutation Detection-Mayo ZB1J9 Narcolepsy Assc Antigen-Mayo ZB1IZ Apolipoprotein E Genotype-Mayo ZB1JF Galactosemia Gene Analys-Mayo ZB1OK Beta-Hydroxybutyrate (BHB) Acylcarnitines Quant-Mayo ACTH Albumin Serum B Burgdorferi Ab CNS Inf 1 Serum Alb B Burgdorferi Ab CNS Inf 2 CSF Alb Fluid Albumin Microalbumin Urine Microalbumin Offsite Aldolase Serum Aldosterone Blood Aldosterone Urine-Mayo A1 Anti-Trypsin A1A Phen Comp 1 A1A Phen Comp 2 Alpha-Fetoprotein Alphafetoprotein Tumor Marker Aluminum 24 Hour Urine-Mayo
80197 80198 80200 80201 80202 80299 80299 80299 80299 80323 80335 80335 80335 80345 80500 81000 81000 81000 81001 81001 81002 81002 81003 81003 81003 81005 81015 81025 81025 81025 81025 81050 81220 81240 81241 81243 81256 81291 81376 81401 81401 82010 82017 82024 82040 82040 82040 82042 82042 82042 82043 82043 82085 82088 82088 82103 82103 82104 82105 82105 82108
200.00 126.00 171.00 197.00 274.00 138.00 232.00 207.00 213.00 212.00 110.00 49.00 49.00 232.00 166.00 0.00 56.00 56.00 56.00 51.00 29.00 29.00 38.00 34.00 34.00 56.00 28.00 97.00 97.00 97.00 97.00 24.00 549.00 467.00 299.00 986.00 575.00 672.00 487.00 684.00 1315.00 81.00 215.00 240.00 72.00 78.00 81.00 78.00 81.00 81.00 79.00 88.00 92.00 311.00 311.00 189.00 55.00 55.00 108.00 96.00 189.00
Aluminum Level-Mayo ALA Acid 24 Hr Urine-Mayo Cystinuria Prf Qnt 24Hr Urine-Mayo Cystinuria Prf Qnt Randon Urine-Mayo Am Acd Qn Ion Exch Urine-Mayo Ammonia Arterial Ammonia Amylase Pancreatic Amylase Serum Amylase Total Amylase Urine Fluid Amylase Androstenedione-Mayo Angiotensin Conv Enzyme Arsenic Blood Quantitative Arsenic Quant-Mayo Arsenic Urine Vitamin C Level-Mayo Beta-2 Microglobulin Urine Bilirubin Total Total Bilirubin Bilirubin Conjugated Fecal Occult Blood Screening Feces Occult Blood Offsite Occult Blood Fecal Occult Blood Gastric Cadmium Blood Cadmium Urine Vitamin D 25 OH Calcitonin Level-Mayo Calcium Serum Ionized Calcium Ionized Calcium 43756545 Calcium Urine 24 Hr Calcium Urine Random Stone Analysis-Mayo Carbo Defic Transferrin Mayo Carbon Dioxide Co2 Bicarbonate Carcinoem Ag (CEA) CSF-Mayo CEA CEA Fluid Carnitine Urine-Mayo Carnitine-Mayo Carotene-Mayo Catecholamine Fract Free-Arup Catecholamines Urine Comp-Mayo Ceruloplasmin PTH-Related Peptide-Mayo Chloride Chloride Offsite Chloride Serum Fluid Chloride Chloride Urine Random Chloride Analysis Chloride Urine 24 Hr Fecal Cl Chloride, Fecal-Mayo Cholesterol Total Fluid Cholesterol PCHE Dibuc Inhib Comp 1
82108 82135 82136 82136 82139 82140 82140 82150 82150 82150 82150 82150 82157 82164 82175 82175 82175 82180 82232 82247 82247 82248 82270 82270 82270 82271 82300 82300 82306 82308 82310 82330 82330 82340 82340 82365 82373 82374 82374 82378 82378 82378 82379 82379 82380 82384 82384 82390 82397 82435 82435 82435 82435 82436 82438 82438 82438 82438 82465 82465 82480
115.00 253.00 416.00 449.00 522.00 140.00 189.00 297.00 103.00 115.00 103.00 115.00 240.00 123.00 53.00 181.00 50.00 180.00 158.00 69.00 62.00 90.00 32.00 32.00 29.00 32.00 53.00 50.00 98.00 139.00 72.00 75.00 84.00 87.00 78.00 123.00 146.00 66.00 66.00 179.00 153.00 171.00 236.00 227.00 109.00 147.00 180.00 97.00 200.00 50.00 38.00 38.00 38.00 82.00 74.00 74.00 120.00 104.00 62.00 69.00 69.00
Acetylcholinesterase RBC-Mayo Chromium Serum Chromium 24 Hour Urine - Mayo Citrate Excretion 24 Hr Urine-Mayo Copper Level 24 Hour Urine-Mayo Copper Level-Mayo Cortisol Free Urine-Mayo Free Cortisol Cortisol Cortisol Timed 18-Hydroxycorticosterone-Mayo CPK CK-MB Isoenzyme Creatinine Offsite Creatinine Serum Creatinine 43756546 Creatinine Urine 24 Hr Creatinine Urine Random Fluid Creatinine Clearance Creatinine 24 Hr Cryoglobulin Comp 1 Cryoglobulin Comp 2 B12 Serum Cystatin C - Mayo Cystatin C DHEA-Mayo DHEA-Sulfate Deoxycorticosteroids Plas-Mayo PCHE Dibuc Inhib Comp 2 Dihydroxyvitamn D 125 Lv-Mayo Pancreatic Elastase Stool-Mayo Adenosine Deaminase B-Mayo Alpha-Galactosidase-Mayo Arylsulfatase Aleuk-Mayo Beta-Galactosidase Leuk-Mayo Brush Border Enzyme-Mayo Methemoglobin Reductase-Mayo RBC Enzyme Eval Comp 2 Alpha-Galactosidase, Leuk - Mayo Erythropoietin Level-Mayo Estradiol Estradiol Child Male Postmenop Estriol Unconjugated-Mayo Estrone-Mayo Ethylene Glycol Fecal Fat Quant-Mayo Fat Acid Prf Peroxisomal-Mayo Ferritin Fetfibronect Cerv/Vag Secr IA Folic Acid Folate Serum Folate RBC Galactose Quantitative Urine-Mayo Gal-1-Phosuridyltrans Qnt-Mayo B Burgdorferi Ab CNS Inf 3 B Burgdorferi Ab CNS Inf 4 CSF Igg Fluid Immunoglobulin Sgl Qty Gammaglobulin Iga Gammaglobulin Igg Gammaglobulin Igm IGD-Mayo
82482 82495 82495 82507 82525 82525 82530 82530 82533 82533 82542 82550 82553 82565 82565 82565 82570 82570 82570 82575 82585 82595 82607 82610 82610 82626 82627 82634 82638 82652 82656 82657 82657 82657 82657 82657 82657 82657 82657 82668 82670 82670 82677 82679 82693 82710 82726 82728 82731 82746 82747 82760 82775 82784 82784 82784 82784 82784 82784 82784 82784
151.00 190.00 164.00 198.00 156.00 190.00 127.00 358.00 189.00 207.00 371.00 79.00 212.00 73.00 65.00 73.00 66.00 66.00 74.00 124.00 56.00 56.00 172.00 141.00 119.00 240.00 143.00 178.00 69.00 154.00 260.00 269.00 390.00 335.00 379.00 476.00 492.00 166.00 496.00 119.00 187.00 132.00 215.00 249.00 203.00 158.00 335.00 169.00 671.00 172.00 213.00 253.00 268.00 78.00 78.00 124.00 124.00 111.00 111.00 111.00 240.00
Igg Antibody Total Immunoglobulin Single Quant Serum Igg IGE Quant Immunoglobulin Subclass Igg 1 Immunoglobulin Subclass Igg 2 Immunoglobulin Subclass Igg 3 Immunoglobulin Subclass Igg 4 Ph Arterial Venous Or Capillary Blood Gases Blood Gases 43756591 Blood Gases 43756540 Cooximetry Gastrin Level-Mayo Glucagon Level-Mayo Fluid Glucose Glucose CSF Glucose Blood Glucose Offsite 43763568 Glucose Glucose Offsite Glucose Tol 2 Hr Spec Glucose Total 1 Hr Glucose Tol Init 3 Spec Glucose Tol 3 Hr Spec Glucose-6-Pd Quantitative-Mayo RBC Enzyme Eval Comp 3 DOT Whole Blood Glucose Offsit Glucose Blood Test Gamma GT RBC Enzyme Eval Comp 6 Reflex Glutathione B Alpha-1-Acid Glycoprotein-Mayo Fructosamine-Mayo FSH LH Human Growth Hormone (HGH) Haptoglobin H.Pylori Urease Act Br Test C13 H. Pylori Urease Ped BR Tst C13 H.Pylori Substrate & Brth Coll Hemoglobin A2 F Quant Hemoglobin A2 Quant Hemoglobin F Quant Hemoglobin S Evaluation Hemoglobin Variant Evaluation Quantitation By HPLC Fetal Hemoglobin Qual (APT) Test Glycated HGB HBA1C With EAG Hemoglobin A1C Offsite Rapid Hemoglobin A1C Assay Plasma Hemoglobin-Mayo Hemoglobin Unstable-Mayo Histamine-Mayo Homocysteine Homovanillic Acid 24 Hr Urine-Mayo HVA 17 - Hydroxycorticosteroids UVI 5-HIAA-Mayo 17-Hydroxyprogesterone
82784 82784 82784 82785 82787 82787 82787 82787 82800 82803 82803 82803 82805 82941 82943 82945 82945 82947 82948 82948 82948 82950 82950 82951 82952 82955 82955 82962 82962 82977 82978 82978 82985 82985 83001 83002 83003 83010 83013 83013 83014 83020 83020 83020 83020 83020 83021 83033 83036 83036 83036 83036 83051 83068 83088 83090 83150 83150 83491 83497 83498
40.00 111.00 124.00 103.00 40.00 40.00 40.00 40.00 45.00 192.00 180.00 171.00 221.00 102.00 240.00 81.00 81.00 75.00 27.00 24.00 84.00 30.00 30.00 189.00 30.00 181.00 166.00 0.00 26.00 103.00 166.00 483.00 282.00 132.00 116.00 116.00 124.00 126.00 423.00 403.00 60.00 133.00 133.00 133.00 133.00 133.00 153.00 73.00 96.00 108.00 96.00 108.00 144.00 181.00 278.00 96.00 221.00 147.00 169.00 192.00 113.00
17-OH Progesterone 17-OH Progesterone, Pedi-ARUP 17 - Hydroxyprog 24 Hr Ur - Mayo ANCA Vasculitis Comp 1 ANCA Vasculitis Comp 2 Gad65 Antibody Assay- Arup Gliadin Antibody Iga-Mayo Gliadin Antibody Igg-Mayo Mitochondrial Ab M2-Mayo Myeloperoxidase Antibody-Mayo Neuronal Ab Hu Ri Yo Igg-Arup Parietal Cell Antibod Igg-Mayo Proteinase 3 Ab (PR3)-Mayo Tiss Transglut Iga Tiss Transglut Igg Gad65 Antibody Assay - Mayo TTG IGG ARUP TTG IGA ARUP Gliadin IGG ARUP Gliadin IGA ARUP 21-Hydroxylase Antibody-Mayo Acetylcholine Receptor Ab-Mayo ACH Receptor Modulating Alpha-Sub (HCG TSH FSH LH) Mayo Elastase (Pancr Elastase1) -Mayo IGF Binding Protein 3 MG Eval Ach Receptor Ab Pancreatic Polypeptide-Mayo Thyrotropin Recep Ab-Mayo ACHHR Gangl Neur AB Reflex Neuronal VGKC AB Reflex Anti-Striated Muscle Ab-Mayo C1 Esterase Inhibitor Ant-Mayo Caffeine Level-Mayo Glomerular Basemnt Memb Igg Ab IBD Panel Comp 1 IL2R By Elisa-Mayo Inhibin B (Infertility) Mayo MG Eval Striational Ab NMO Ab Igg Serum - Mayo S Cerevisiae Ab Iga-Mayo ST2-Mayo Mullerian Hormone Ab-ARUP Tryptase, Serum-Mayo Insulin Assay Iron Liver Tissue-Mayo Iron Total Only Iron Binding Cap CSF Lactic Acid Lactic Acid 43756543 Lactic Acid Lactic Acid Arterial Fluid LDH LDH LDH Iso Comp 1 LDH Iso Comp 2 Lead Blood Quantitative Lead Urine Lead With Demographics-Mayo Lead Occupational-Mayo Lamellar Body Count LBC
83498 83498 83498 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83516 83519 83519 83519 83519 83519 83519 83519 83519 83519 83519 83519 83520 83520 83520 83520 83520 83520 83520 83520 83520 83520 83520 83520 83520 83525 83540 83540 83550 83605 83605 83605 83605 83615 83615 83615 83625 83655 83655 83655 83655 83664
95.00 124.00 707.00 124.00 124.00 240.00 140.00 140.00 101.00 243.00 447.00 144.00 200.00 187.00 187.00 269.00 49.00 49.00 49.00 49.00 302.00 210.00 119.00 169.00 872.00 239.00 119.00 269.00 187.00 175.00 326.00 180.00 147.00 102.00 130.00 228.00 433.00 143.00 119.00 457.00 232.00 447.00 279.00 125.00 133.00 188.00 92.00 79.00 132.00 125.00 118.00 132.00 103.00 92.00 90.00 90.00 53.00 50.00 88.00 68.00 101.00
Lipase Lipase Fluid Lipoprotein (A) NMR Lipoprofile-Mayo NMR Total LDL Particle Concent HDL Cholesterol Direct LDL Cholesterol 24 Hr Urine Mg Fecal Mg Urine Magnesium Random Magnesium Magnesium, Fecal-Mayo Lysosom Enz Disord Screen Mayo PUrineine Pyrimidine Pan Urine Mayo Thiocyanate Level-Mayo Thiopur Methyltransfr RBC-Mayo Mercury Blood-Mayo Mercury Quantitative Mercury Urine Metanep Frac 24 Hr Urine-Mayo Metanep Frac Free-Mayo Metanep Frac Random Urine-Mayo Mucopolysacchride Urine Mayo Myoglobin Serum Myoglobin Urine-Mayo B-Type Natriuretic Peptide Alpha-2-Macroglobulin-Mayo Kappa Light Chains Lambda Light Chains 5' Nucleotidase-Mayo Oligoclonal Banding Comp 1 Oligoclonal Banding Comp 2 Organic Acid Serum Organic Acids Screen Urine-Mayo Methylmalonic Acid Quant-Mayo Orotic Acid Urine-Mayo Osmolality Serum Osmolality Urine Osteocalcin Human-Mayo Oxalate Urine 24 Hr Parathormone Rapid Assay PTH Intact Ph Feces Ph Urine Quantitive Ph Fluid Calprotectin Fecal-Arup Birth Survey (PKU) Prostatic Acid Phosphatas-Mayo Alk Phos Total Fluid Alkaline Phosphatase Phosphatase Alkaline Alk Phos Isoenzymes RBC Enzyme Eval Comp 4 Fluid Phosphorous Phosphorus (P) (Po4) Phosphorus, Fecal-Mayo Phosphorus Urine 24 Hr Phosphorus Urine Random Porphobilinogen Porpho Quant Urine-Mayo Fluid Potassium
83690 83690 83695 83704 83704 83718 83721 83735 83735 83735 83735 83735 83789 83789 83789 83789 83825 83825 83825 83835 83835 83835 83864 83874 83874 83880 83883 83883 83883 83915 83916 83916 83918 83919 83921 83921 83930 83935 83937 83945 83970 83970 83986 83986 83986 83993 84030 84066 84075 84075 84075 84080 84087 84100 84100 84100 84105 84105 84106 84110 84132
118.00 125.00 133.00 123.00 123.00 102.00 96.00 84.00 120.00 84.00 75.00 130.00 274.00 216.00 438.00 438.00 164.00 53.00 50.00 108.00 249.00 139.00 190.00 180.00 123.00 306.00 197.00 130.00 130.00 155.00 101.00 101.00 495.00 213.00 132.00 329.00 112.00 112.00 236.00 130.00 108.00 159.00 69.00 69.00 69.00 581.00 97.00 148.00 103.00 103.00 92.00 123.00 166.00 69.00 62.00 102.00 102.00 102.00 69.00 188.00 56.00
Potassium Potassium Offsite Potassium Serum (K) Potassium Urine 24 Hr Potassium Urine Random Prealbumin Progesterone Procalcitonin Serum Prolactin Prostate Specific Antigen Total Protein Serum Protein Quant Urine Fluid Total Protein Total Protein CSF Electrophor Prot Serum W/Interp Electrophor Prot Fluid W/Interp Electrophoresis Protein Fluid 14-3-3 Protein CRMP-5-IGG West Blot Reflex Protoporphyrin Fract RBC-Mayo Zinc Protoporphyrin Occup-Mayo Proinsulin-Mayo Vitamin B6 Level-Arup Pyruvic Acid RBC Enzyme Eval Comp 5 Soluble Transf Recep -Mayo Renin Activity-Mayo Selenium Serotonin 24 Hour Urine-Mayo Sex Horm Binding Globulin-Mayo Sex Hormone Binding Globulin Sodium Sodium Offsite Sodium Serum (Na) Sodium Urine 24 Hr Sodium Urine Random Fecal Na Fluid Sodium Sodium, Fecal-Mayo Somatomedin-C Somatostatin Level - ARUP Bromide Level-Mayo Specific Gravity Body Fluid Oligosacchride Urine Mayo Galactose-1-Phos RBC-Mayo Glycomark - Mayo Sulfate Urine-Mayo Testosterone Free Testosterone Testosterone Total Testosterone Tot Child/Female Niacin (Nicotinic Acid)-Mayo Thiamin Level-Mayo Thyroglobulin T4 T4 EC Free T4 Thyroxine Bind Globulin TSH Thyroid Stimulating Igg-Mayo Vitamin E Level-Mayo
84132 84132 84132 84133 84133 84134 84144 84145 84146 84153 84155 84156 84157 84157 84165 84166 84166 84182 84182 84202 84202 84206 84207 84210 84220 84238 84244 84255 84260 84270 84270 84295 84295 84295 84300 84300 84302 84302 84302 84305 84307 84311 84315 84376 84378 84378 84392 84402 84403 84403 84403 84425 84425 84432 84436 84436 84439 84442 84443 84445 84446
56.00 56.00 50.00 87.00 95.00 137.00 143.00 225.00 116.00 129.00 75.00 102.00 101.00 101.00 126.00 126.00 0.00 157.00 247.00 241.00 73.00 240.00 104.00 109.00 166.00 147.00 120.00 426.00 196.00 162.00 60.00 52.00 52.00 46.00 74.00 82.00 120.00 69.00 103.00 190.00 492.00 170.00 26.00 158.00 614.00 222.00 205.00 120.00 144.00 107.00 170.00 288.00 260.00 215.00 90.00 90.00 172.00 171.00 177.00 211.00 156.00
SGOT SGPT Transferrin Triglyceride Fluid Triglycerides T3 Uptake T3 Uptake EC True T3 Free T3 By Immunoassay Cardiac Troponin I Offsite Istat Troponin I Troponin Bun (Urea Nitrogen) Bun Fluid Bun Urea Urine 24 Hr Urea Urine Random Uric Acid Serum Fluid Uric Acid Uric Acid Urine 24 Hr Uric Acid Urine Random VMA VMA Pediatric Vasoact Intestnal Poptide (VIP) Arginine Vasopressin-Mayo Vitamin A Level-Mayo Vitamin K1-Mayo Blood Volatiles Zinc Level-Mayo C-Peptide Beta HCG Quant HCG Quant Fecal K Fecal Osmol-Arup Potassium, Fecal-Mayo Osmolality, Fecal-Mayo Differential Count Manual Diff Offsite Blood Smear Without Diff Hematocrit Spun Hematocrit Hematocrit 43756520 Hemoglobin HGB Offsite CBC W/Auto Partial Diff Offsite CBC Diff Plt Auto Blood Count Hemogram & Plts CBC Offsite Reticulocyte Count, Automated Eosinophils Count Platelet Count Platelet - Offsite Consultation Peripheral Smear Consult BM, Periph Smr, Profee Bone Marrow Diff Factor II Assay-Mayo Factor V Assay-Mayo Factor XII Assay-Mayo Factor VIII Activity-Mayo Factor VIII Assay FVII Inh Scr Comp 1
84450 84460 84466 84478 84478 84479 84479 84480 84481 84484 84484 84484 84520 84520 84520 84540 84540 84550 84560 84560 84560 84585 84585 84586 84588 84590 84597 84600 84630 84681 84702 84702 84999 84999 84999 84999 85007 85007 85008 85013 85014 85014 85018 85018 85025 85025 85027 85027 85046 85048 85049 85049 85060 85060 85097 85210 85220 85230 85240 85240 85240
92.00 91.00 137.00 76.00 87.00 86.00 86.00 129.00 218.00 228.00 255.00 228.00 38.00 43.00 43.00 87.00 78.00 72.00 66.00 66.00 59.00 140.00 147.00 268.00 196.00 143.00 353.00 370.00 97.00 111.00 162.00 181.00 120.00 114.00 26.00 40.00 59.00 66.00 36.00 47.00 38.00 43.00 38.00 43.00 126.00 126.00 87.00 97.00 59.00 27.00 70.00 34.00 0.00 0.00 522.00 237.00 237.00 237.00 132.00 653.00 562.00
Ristocetin Cofactor-Mayo Reflexed Ristocetin-Mayo Von Willebrand Factor Ag-Mayo Von Wille Fact Mult Assay-Mayo Factor 9 Factor XI Assay-Mayo Anti-Thrombin III Protein C Functional Protein S Functional Activated Protein Resis V-Mayo FVII Inh Scr Comp 2 Reflx Coag Factor VIII Inhib Screen Activated Clotting Time Coag Time Activated TEG D-Dimer Quantitative Fibrinogen Fibrinogen Activity TEG Special Coagulation Interpret Von Willebrand Factor Act-Mayo VWF Activ Reflex to Risto-Mayo ADAMTS13 Activity-ARUP Plasminogen Activity-Mayo Kleihauer Stain Heparin Assay PTT-D Heparin Reflex Comp 2 Osmotic Fragility RBC-Mayo P2Y12 Inhibition Comp 1 Platelet Aggregation Teg Platelet Function Analysis Platelet Function Analysis-Supplemental Platelet Aggregation TEG -59 Hex Phos Reflex Bill Only Platelet Neutralization Bill Only Heparinase PT Offsite Coaguchek INR Offsite Istat INR Prothrobin Time Prothrombin Time (PT) Prothrombin Time Hemosense Prothrombin Time CGFM PT/INR Mixing PT Dil Russll Viper Ven Bill Only DRVVT Confirm Test Bill Only RVVT Diluted Reptilase Time Reflex Bill Only Sed Rate (ESR) Sickle Cell Prep Sickle Cell Screen Thrombin Time Thrombin Time Reflex Bill Only Heparinase PTT Partial Thrombo Time PTT PTT-D Heparin Reflex Comp 1 Mixing PTT PTT-D Corr Reflex Bill Only Viscosity Mayo RMSF Ab Allergen Specific-1 Allergen Allergen Specific-Ea Addl
85245 85245 85246 85247 85250 85270 85300 85303 85306 85307 85335 85335 85347 85347 85379 85384 85384 85390 85397 85397 85397 85420 85460 85520 85525 85557 85576 85576 85576 85576 85576 85597 85597 85610 85610 85610 85610 85610 85610 85610 85610 85611 85613 85613 85613 85635 85652 85660 85660 85670 85670 85730 85730 85730 85730 85732 85732 85810 86000 86003 86003
205.00 150.00 202.00 279.00 653.00 237.00 233.00 337.00 391.00 297.00 562.00 276.00 90.00 90.00 170.00 98.00 109.00 124.00 165.00 391.00 376.00 196.00 103.00 450.00 76.00 239.00 93.00 172.00 158.00 78.00 172.00 295.00 151.00 170.00 109.00 114.00 48.00 91.00 0.00 109.00 103.00 743.00 57.00 93.00 212.00 108.00 56.00 59.00 31.00 171.00 56.00 170.00 87.00 30.00 76.00 1048.00 57.00 196.00 123.00 26.00 26.00
Allergen Specific IGE - ARUP Allergen Specific IGE Add - ARUP Alpha - Galactose-1, 3 IGE Panel Cell Bound Platelet Autoan-Mayo HIT Associated Antibody Serotonin Release Assay-Mayo ANA Anti-Nuclear Antibody Antinuclear antibodies (ANA) ASO Titer (ASTO) Path Blood Bank Antibody Review Path Blood Bank Elution Review Path Blood Bank Titer Review BB Phys Investigate Of Tx Rxn C-Reactive Protein (CRP) C-Reactive Proteincardiac Rsk Beta 2 Glycoprotein Ab Comp 1 Beta 2 Glycoprotein AB Comp 2 Beta 2 Glycoprotein AB Comp 3 B2GP1 IGG - Mayo B2GP1 IGM - Mayo Cardiolipin Antibody, IGG Cardiolipin Antibody, IGM C3 Complement C3 Complement Fluid C4 Complement C5 Complement Antigen-Mayo Complement C1Q-Mayo C1 Ester Inhib Funct Qnt-Mayo C1Q Complement Functional-Mayo C2 Complement Functional-Mayo C8 Complement Functional-Mayo Complement Total-Mayo CCP Antibody CCP Antibody-Mayo Anti-DNA Native/DS Anti-RNP Anti-SM Anti-SSA Anti-SSB Centromere B Antibody Histone Antibody Jo-1 Antibody SCL-70 Antibody Cytoplsm Neutrophil Antib-Mayo IBD Panel Comp 2 Myocardial Antibody-Mayo NMO-IFA (Reflex) Reticulin Ab Smooth Muscle Antibody-Mayo Neuromyelitis Optica AB-Mayo Endomysial Antibody Iga-Mayo Reticulin Ab Titer Ca 27.29 Ca 19-9 Cancer Antigen 125 Monospot (Heterophile) Monospot Screen Offsite Alpha Fetoprotein CSF Chromogranin A-Mayo S Pneumo Igg 23 Serotyp Comp 1 S Pneumo Igg 23 Serotyp Comp 10
86003 86003 86003 86022 86022 86022 86038 86039 86060 86077 86077 86077 86078 86140 86141 86146 86146 86146 86146 86146 86147 86147 86160 86160 86160 86160 86160 86161 86161 86161 86161 86162 86200 86200 86225 86235 86235 86235 86235 86235 86235 86235 86235 86255 86255 86255 86255 86255 86255 86255 86256 86256 86300 86301 86304 86308 86308 86316 86316 86317 86317
25.00 25.00 210.00 224.00 236.00 918.00 128.00 76.00 87.00 0.00 0.00 0.00 0.00 156.00 129.00 24.00 24.00 24.00 93.00 93.00 84.00 84.00 123.00 123.00 123.00 202.00 189.00 212.00 215.00 215.00 166.00 119.00 172.00 154.00 87.00 87.00 87.00 87.00 87.00 87.00 87.00 87.00 87.00 147.00 228.00 202.00 419.00 70.00 110.00 414.00 189.00 70.00 130.00 164.00 144.00 63.00 53.00 144.00 148.00 27.00 27.00
S Pneumo Igg 23 Serotyp Comp 11 S Pneumo Igg 23 Serotyp Comp 12 S Pneumo Igg 23 Serotyp Comp 13 S Pneumo Igg 23 Serotyp Comp 14 S Pneumo Igg 23 Serotyp Comp 15 S Pneumo Igg 23 Serotyp Comp 16 S Pneumo Igg 23 Serotyp Comp 17 S Pneumo Igg 23 Serotyp Comp 18 S Pneumo Igg 23 Serotyp Comp 19 S Pneumo Igg 23 Serotyp Comp 2 S Pneumo Igg 23 Serotyp Comp 20 S Pneumo Igg 23 Serotyp Comp 21 S Pneumo Igg 23 Serotyp Comp 22 S Pneumo Igg 23 Serotyp Comp 23 S Pneumo Igg 23 Serotyp Comp 3 S Pneumo Igg 23 Serotyp Comp 4 S Pneumo Igg 23 Serotyp Comp 5 S Pneumo Igg 23 Serotyp Comp 6 S Pneumo Igg 23 Serotyp Comp 7 S Pneumo Igg 23 Serotyp Comp 8 S Pneumo Igg 23 Serotyp Comp 9 S Pneumo Igg 7 Serotyp Comp 2 S Pneumo Igg 7 Serotyp Comp 3 S Pneumo Igg 7 Serotyp Comp 4 S Pneumo Igg 7 Serotyp Comp 5 S Pneumo Igg 7 Serotyp Comp 6 S Pneumo Igg 7 Serotyp Comp 7 S Pneumo Igg 7 Serotyp Comp 8 Tau Protein IEP Serum W/Interp Immuno Electrophoresis Serum Beta-2 Transferrin Fluid-Mayo IEP Fluid W/Interp Immuno Electrophoresis Fluid Inhibin A Mayo Inhibin A Insulin Antibody-Mayo Intrins Fact Block Antib-Mayo Islet Cell Ab Gad65 AB-Reflex Reflex Immunofixatn Cryoglobul Flow Cyto Comp 1 Lymph Subset S-B Cell - ARUP Flow Cyto Comp 2 Lymph Subset 5 - Monuc AG - ARUP Flow Cyto Comp 3 Lymph Subset 5-NK Total - ARUP Flow Cyto Comp 4 Lymph Subset 5-T Cell - ARUP ATPO Liver/Kidney Microsome Type 1 Cryptococcus Antigen CSF Fungab CSF Comp 1 Fungal Ab Comp 1 Fluid Immunodifusion Quant RF Rheumatoid Factor Quantitative Quantiferon Gold Mayo RPR Blood VDRL CSF Aspergillus Antibody Aspergillus Fumig Ab Igg-Mayo
86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86317 86334 86334 86335 86335 86335 86336 86336 86337 86340 86341 86341 86344 86355 86355 86357 86357 86359 86359 86360 86360 86376 86376 86403 86403 86403 86431 86431 86480 86592 86592 86606 86606
27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 27.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00 137.00 225.00 0.00 424.00 264.00 0.00 143.00 101.00 189.00 170.00 119.00 88.00 315.00 84.00 71.00 84.00 71.00 84.00 71.00 84.00 71.00 92.00 174.00 151.00 32.00 31.00 84.00 97.00 386.00 56.00 78.00 102.00 155.00
Bart Ab G And M Comp 1 Bart Ab G And M Comp 2 Bart Ab G And M Comp 3 Bart Ab G And M Comp 4 Bart Ab Pn Comp 1 Bart Ab Pn Comp 2 Bart Ab Pn Comp 3 Bart Ab Pn Comp 4 Blastomyces Ab CSF Igm Fungab CSF Comp 2 Fungab CSF Comp 3 Fungal Ab Comp 2 Fungal Ab Comp 3 B Pertussis Ab Igg B Pertussis Ab Igm Lyme Ab Confirm Comp 1 Lyme Ab Confirm Comp 2 B Burgdorferi Ab CNS Inf 5 B Burgdorferi Ab CNS Inf 6 B Burgdorferi Ab CNS Inf 7 B Burgdorferi Ab CNS Inf 8 Lyme Diseas Antib Scr CSF-Mayo Lyme Serology Lyme IgG Ab Lyme IgM Ab Brucella G Brucella M Brucella total AB Agglutinatn C Pneuomia Total C Psittaci Total C Trachomatis Iga C Trachomatis Igg C Pneumonia Igm C Psittaci Igm C Trachomatis Igm Fungab CSF Comp 4 Fungab CSF Comp 5 Fungab CSF Comp 6 Fungal Ab Comp 4 Fungal Ab Comp 5 Fungal Ab Comp 6 Q Fever CMV Antibody Igg CMV Antibody Igm Diphtheria Igg Diptheria Antitoxoid Ab Cox A Ab Comp 1 Cox A Ab Comp 2 Cox A Ab Comp 3 Cox A Ab Comp 4 Cox A Ab Comp 5 Cox A Ab Comp 6 Cox A Ab CSF Comp 1 Cox A Ab CSF Comp 2 Cox A Ab CSF Comp 3 Cox A Ab CSF Comp 4 Cox A Ab CSF Comp 5 Cox A Ab CSF Comp 6 Cox B Ab Comp 1 Cox B Ab Comp 2 Cox B Ab Comp 3
86611 86611 86611 86611 86611 86611 86611 86611 86612 86612 86612 86612 86612 86615 86615 86617 86617 86618 86618 86618 86618 86618 86618 86618 86618 86622 86622 86622 86631 86631 86631 86631 86632 86632 86632 86635 86635 86635 86635 86635 86635 86638 86644 86645 86648 86648 86658 86658 86658 86658 86658 86658 86658 86658 86658 86658 86658 86658 86658 86658 86658
53.00 53.00 53.00 53.00 114.00 114.00 114.00 114.00 110.00 32.00 32.00 31.00 31.00 93.00 93.00 121.00 121.00 78.00 78.00 78.00 78.00 179.00 152.00 88.00 88.00 94.00 94.00 391.00 74.00 74.00 80.00 80.00 74.00 74.00 80.00 32.00 32.00 32.00 31.00 31.00 31.00 103.00 103.00 108.00 96.00 239.00 57.00 57.00 57.00 57.00 57.00 57.00 54.00 54.00 54.00 54.00 54.00 54.00 57.00 57.00 57.00
Cox B Ab Comp 4 Cox B Ab Comp 5 Cox B Ab Comp 6 Cox B AB CSF Comp 1 Cox B AB CSF Comp 2 Cox B AB CSF Comp 3 Cox B AB CSF Comp 4 Cox B AB CSF Comp 5 Cox B AB CSF Comp 6 EBV Early Antigen Igg Ab EBV G M Ebna Comp 1 EBV Nuclear Antigen Igg Ab EBV G M Ebna Comp 2 EBV G M Ebna Comp 3 EBV Viral Capsid Ag Igg Ab EBV Viral Capsid Ag Igm Ab E Chaff Igg Antibody-Mayo H. Pylori Igg Ab Helicobactr Pylori Ab Igm-Mayo Cysticercosis Igg Ab Wb-Mayo HTLV I/II Igg Antibody-Mayo Reflex HIV Type1 Ab Immunofluo HSV Type Non-Specific Igm Reflexed HSV Ab Igm S By IFA HSV Type 1 Igg HSV Type 1 Igg Mayo HSV Type 1 Igm Ab Titer Mayo HSV Type 2 Igg HSV Type 2 Igg Mayo HSV Type 2 Igm Ab Titer Mayo Fungab CSF Comp 7 Fungab CSF Comp 8 Fungab CSF Comp 9 Fungal Ab Comp 10 Fungal Ab Comp 7 Fungal Ab Comp 8 Fungal Ab Comp 9 Histoplasma Iga Antibodies Histoplasma Igg Antibodies Histoplasma Igm Antibodies Reflexed Histoplasma Ab S HIV Antibody Type 2-Mayo HIV 1/2 Validation By Multispot Rapid HIV 1/2 Screen Offsite Hepatitis B Core Ab Hepatitis B Core Antibody Hepatitis B Core Igm Ab Hepatitis B Antibody Hepatitis B Surface Ab Hepatitis Be Antibody-Mayo Hep A Virus Ab (Total) Arup Anti-HAV-IGM Hepatitis A Ab-Igm Flu A Igg Flu A Igm Flu B Iga Flu B Igg Legionella Pneumophil Ab-Mayo Leptospira Antibody-Mayo Mumps Igg Ab Mycoplasma Igm Antibody
86658 86658 86658 86658 86658 86658 86658 86658 86658 86663 86664 86664 86665 86665 86665 86665 86666 86677 86677 86682 86687 86689 86694 86694 86695 86695 86695 86696 86696 86696 86698 86698 86698 86698 86698 86698 86698 86698 86698 86698 86698 86702 86703 86703 86704 86704 86705 86706 86706 86707 86708 86709 86709 86710 86710 86710 86710 86713 86720 86735 86738
57.00 57.00 57.00 54.00 54.00 54.00 54.00 54.00 54.00 81.00 55.00 96.00 55.00 55.00 114.00 114.00 226.00 98.00 108.00 255.00 162.00 255.00 43.00 74.00 43.00 63.00 75.00 81.00 63.00 75.00 32.00 32.00 32.00 31.00 31.00 31.00 31.00 63.00 63.00 63.00 133.00 306.00 213.00 213.00 78.00 141.00 81.00 126.00 78.00 125.00 67.00 198.00 78.00 74.00 74.00 74.00 74.00 125.00 193.00 103.00 120.00
Parvovirus Igg Ab Parvovirus Igm Ab Entamoeba Histolytica Ant-Mayo RSV Ab Igg RSV Ab Igm Rickettsia Ab Comp 1 Rickettsia Ab Comp 2 Rickettsia Ab Comp 3 Rickettsia Ab Comp 4 Rubella Antibody Screen Rubella Igm Ab Rubeola (Measles) Ab Igm-Mayo Rubeola Igg Antibody Rubeola AB G/M CSF Comp 1 Rubeola AB G/M CSF Comp 2 Rubeola AB G/M CSF Comp 3 Rubeola AB G/M CSF Comp 4 Rubeola IGG AB - ARUP Tetanus Tetanus Toxoid Ab Igg-Mayo Toxoplasma Igg Antibody Toxoplasma Igm Antibody MHA-TP Trichinella Antibody Varcella-Zoster Virus Igm Ab Varicella Igg Antibody West Nile Virus Igm West Nile Virus Antithyroglobulin Ab Thyroglobulin Ab Hepatitis C Ab Hepatitis C Antibody HLA B27-Mayo HLA Typing Antibody Screen RBC Antibody Identification Panel Direct Antiglobulin Test ABID Each Select Reagent Red Cell Indirect Antibody Titer ABO Typing Rh Typing Antigen Typing With Reag Anti-Ser Crossmatch Electronic Referral (Micro-Sero) Concentration Specimen Culture Blood Culture Feces Aerobic Culture Feces Addl Path E Coli 0157:H7 (Stool) Culture Vibrio (Stool) Culture Yersinia (Stool) Culture Culture Misc Culture MRSA Screen Culture Sputum Culture Throat Nose Op Culture Transgrow GC Culture Quant Bronch Al Lavage Strep Culture Culture Smear Anaerobe Rapid Urease Test Culture Sens Urine Col Ct
86747 86747 86753 86756 86756 86757 86757 86757 86757 86762 86762 86765 86765 86765 86765 86765 86765 86765 86774 86774 86777 86778 86780 86784 86787 86787 86788 86789 86800 86800 86803 86803 86812 86813 86850 86870 86880 86885 86886 86900 86901 86905 86923 86999 87015 87040 87045 87046 87046 87046 87046 87070 87070 87070 87070 87070 87071 87071 87075 87077 87086
92.00 92.00 241.00 102.00 102.00 248.00 248.00 248.00 248.00 73.00 71.00 124.00 103.00 56.00 56.00 56.00 56.00 99.00 96.00 215.00 103.00 103.00 125.00 77.00 115.00 103.00 127.00 127.00 124.00 124.00 79.00 125.00 125.00 485.00 198.00 277.00 56.00 231.00 167.00 72.00 74.00 240.00 176.00 0.00 71.00 97.00 71.00 71.00 103.00 84.00 84.00 103.00 0.00 74.00 65.00 64.00 138.00 50.00 144.00 102.00 78.00
Culture Fungus Isolation Culture Blood Fungus Culture Fungus Definitive Id Mycoplasma/Ureaplasma Cult Chlamydia Culture Culture AFB Pin Worm Prep Ova & Parasites D-Test ESBL Confirmatory Modified Hodge Test Beta Lactamase (Enzyme Detect) Susceptibility AFB Rapid Grow Susceptibility From Culture Susceptibility Panel Yeast Gram Stain AFB Smear AFB Smear Comp Modified Acid Fast Stain Malaria Smear Trichrome Stain Koh Prep Offsite Smear Fungus (India Ink) Wet Prep Wet Prep Offsite Smear Fungus (Koh) CMV Culture Rapid Misc Viral Culture Respiratory Virus Culture CMV Virus Id Herpes Virus Detection Aspergillus Antigen-Mayo Cryptosporidium Ag Giardia Ag H. Pylori Antigen, Stool H. Pylori Ag Offsite Hepatitis B Surface Ag Hepatitis B Surface Ag Pro Hepatitis Be Antigen-Mayo Histoplasma Antigen CSF-Mayo Histoplasma Antigen-Mayo HIV1 Ab RSV Antigen Rotavirus Antigen Shigella Toxin Direct Grp A Strep Antigen Histoplasma Ag Urine Legionella Antigen Urine-Mayo Norwalk-Like Virag Stool-Mayo Beta D-Glucan-Mayo/Viracor Lyme Disease By Rapid PCR-Mayo Chlamydia DNA Probe C Difficile Molecular Assay CMV By Rapid PCR-Mayo CMV DNA Quant Rapid PCR-Mayo HBV DNA Ultraquant Hep C Virus Subtype- Arup Hepatitis C RNA PCR Quant Herpes Smplx Rapd PCR/DNA-Mayo HHV-6 By Rapid PCR-Mayo HIV1 RNA Ultraquant
87102 87103 87106 87109 87110 87116 87172 87177 87184 87184 87184 87185 87186 87186 87186 87205 87206 87206 87206 87207 87209 87210 87210 87210 87210 87220 87252 87252 87252 87254 87255 87305 87328 87329 87338 87339 87340 87340 87350 87385 87385 87389 87420 87425 87427 87430 87449 87449 87449 87449 87476 87491 87493 87496 87497 87517 87521 87522 87529 87536 87536
56.00 156.00 115.00 346.00 109.00 71.00 48.00 72.00 81.00 72.00 81.00 48.00 256.00 47.00 421.00 46.00 153.00 71.00 73.00 96.00 49.00 48.00 52.00 43.00 48.00 69.00 127.00 162.00 143.00 121.00 97.00 241.00 59.00 59.00 190.00 103.00 126.00 78.00 125.00 399.00 399.00 177.00 198.00 96.00 43.00 80.00 361.00 131.00 444.00 318.00 625.00 123.00 105.00 255.00 540.00 486.00 295.00 515.00 166.00 423.00 402.00
Mycoplas Pneum DNA Detect GC DNA Probe HPV, DNA Probe Thin Prep Bartonella By Rapid PCR-Mayo EBV CSF By Rapid PCR-Mayo Enterovirus CSF Rapid Pcr-Mayo Human Metapneumo Virrna-Mayo JC Virus Detector Parvovirus B19 By Rapid PCR-Mayo Toxoplasma DNA Detector Var-Zost Vir By Rapid PCR-Mayo BKV Quant By PCR, Blood Mayo BKV Quant PCR, Urine-Mayo Bordetella By Rapid PCR-Mayo Flu A Offsite Flu B Offsite Influenza A Influenza B OSOM Trichomonas Rpd Tst - Offsite Strep A Antigen Screen Offsite Strep Pneumo Ag Urine - Mayo HIV1 Genot Only Noviral Load HIV1 Phenotype Comp 1 HIV1 Phenotype Comp 2 HIV1 Phenotype Comp 3 HIV1 Phenotype Comp 4 HIV1 Phenotype Comp 5 HIV1 Phenotype Comp 6 HIV1 Phenotype Comp 7 HIV1 Phenotype Comp 8 Bact Vagin Rapid Test - Offsite Autopsy Comp W/Brain & CNS Autopsy Comp Infant W/Brain Autopsy Comp Still/Newborn W/Brain Autopsy Limited Regional Autopsy Limited Single Organ Body Fluid Extragenital Non Gyn Cytology By Thin Prep Urothelial Cancer Fish Testing Pathologist Review Pap Smear Screening Thin Prep Thin Prep Pap Smear Maturation Index Smear Prepared Outside Each Cervical Pap Smear Pap Smear Screening Conv Smear FNA Stat FNA Final Cytology FNA Eval Adequacy 59 Cytology FNA Eval Of Adequacy % CD4 Helper T-Cells Auto Lymp Syn Comp 1 CD4 Marker Flow Cyto First Marker CHOA Neut Ox Burst Comp 1 Pi-Linked Ag Comp 1 Pi-Linked Ag Comp 2 PNH By Flow Uslabs Component 1 Leuk AD Def Comp 1 Absolute CD4 Helper T-Cells Auto Lymp Syn Comp 2
87581 87591 87624 87798 87798 87798 87798 87798 87798 87798 87798 87799 87799 87801 87804 87804 87804 87804 87808 87880 87899 87901 87903 87903 87903 87903 87903 87903 87903 87903 87905 88027 88028 88029 88036 88037 88104 88112 88120 88141 88142 88142 88155 88160 88164 88164 88172 88173 88177 88177 88184 88184 88184 88184 88184 88184 88184 88184 88184 88185 88185
255.00 123.00 278.00 376.00 426.00 280.00 879.00 1054.00 426.00 428.00 215.00 209.00 304.00 290.00 84.00 84.00 84.00 84.00 63.00 74.00 151.00 800.00 255.00 255.00 255.00 255.00 255.00 255.00 255.00 255.00 63.00 0.00 0.00 0.00 0.00 0.00 141.00 354.00 659.00 0.00 127.00 127.00 115.00 32.00 59.00 59.00 318.00 170.00 34.00 34.00 208.00 208.00 208.00 208.00 208.00 208.00 208.00 208.00 239.00 82.00 131.00
Auto Lymp Syn Comp 3 Auto Lymp Syn Comp 4 Auto Lymp Syn Comp 5 CD3 Marker CD8 Marker Flow Cyto Additional Marker CHOA Neut Ox Burst Comp 2 Pi-Linked Ag Comp 3 Pi-Linked Ag Comp 4 PNH By Flow Uslabs Component 2 PNH By Flow Uslabs Component 3 Leuk AD Def Comp 2 PNH By Flow Uslabs Component 4 Flow Cyto 16 Or More Markers Chrom Congenital Comp 1 Chrom Aut/Concept/Still 1 Cancer Cytogenetics Component 1 Fish No Cytology Tissue Culture Chrom Aut/Concept/Still 2 Chrom Congenital Comp 2 Cancer Cytogenetics Component 2 Chromosome Analysis 22Q11.2 Comp 1 22Q11.2 Comp 2 AML Target Gene Panel Comp 3 AML Target Gene Panel Comp 4 Aneu Detect Comp 1 Aneu Detect Comp 2 Aneu Detect Comp 3 Aneu Detect Comp 5 Aneu Detect Comp 4 Aneu Detect Comp 6 Aneu Detect Comp 7 BCR/Abl Fish Component 1 BCR/Abl Fish Component 2 CLL Target Gene Panel Comp 1 CLL Target Gene Panel Comp 2 MDS Target Gene Panel Comp 3 MDS Target Gene Panel Comp 4 MM-MGUS Target Gene Panel Comp 1 MM-MGUS Target Gene Panel Comp 2 Nbn Aneuploidy Det Comp 1 Nbn Aneuploidy Det Comp 2 Subtel Reg Anom Fish A Comp 1 Subtel Reg Anom Fish A Comp 10 Subtel Reg Anom Fish A Comp 11 Subtel Reg Anom Fish A Comp 12 Subtel Reg Anom Fish A Comp 13 Subtel Reg Anom Fish A Comp 14 Subtel Reg Anom Fish A Comp 15 Subtel Reg Anom Fish A Comp 16 Subtel Reg Anom Fish A Comp 17 Subtel Reg Anom Fish A Comp 18 Subtel Reg Anom Fish A Comp 19 Subtel Reg Anom Fish A Comp 2 Subtel Reg Anom Fish A Comp 20 Subtel Reg Anom Fish A Comp 21 Subtel Reg Anom Fish A Comp 22 Subtel Reg Anom Fish A Comp 23 Subtel Reg Anom Fish A Comp 24
88185 88185 88185 88185 88185 88185 88185 88185 88185 88185 88185 88185 88187 88189 88230 88233 88237 88237 88237 88262 88262 88264 88264 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271
131.00 131.00 131.00 53.00 53.00 30.00 166.00 123.00 123.00 34.00 34.00 239.00 34.00 72.00 598.00 937.00 267.00 321.00 181.00 937.00 598.00 124.00 181.00 276.00 276.00 141.00 141.00 197.00 197.00 197.00 197.00 197.00 197.00 197.00 155.00 155.00 148.00 148.00 153.00 153.00 144.00 144.00 311.00 311.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00
Subtel Reg Anom Fish A Comp 25 Subtel Reg Anom Fish A Comp 26 Subtel Reg Anom Fish A Comp 27 Subtel Reg Anom Fish A Comp 28 Subtel Reg Anom Fish A Comp 29 Subtel Reg Anom Fish A Comp 3 Subtel Reg Anom Fish A Comp 30 Subtel Reg Anom Fish A Comp 4 Subtel Reg Anom Fish A Comp 5 Subtel Reg Anom Fish A Comp 6 Subtel Reg Anom Fish A Comp 7 Subtel Reg Anom Fish A Comp 8 Subtel Reg Anom Fish A Comp 9 Subtel Reg Anom Fish B Comp 1 Subtel Reg Anom Fish B Comp 10 Subtel Reg Anom Fish B Comp 11 Subtel Reg Anom Fish B Comp 2 Subtel Reg Anom Fish B Comp 3 Subtel Reg Anom Fish B Comp 4 Subtel Reg Anom Fish B Comp 5 Subtel Reg Anom Fish B Comp 6 Subtel Reg Anom Fish B Comp 7 Subtel Reg Anom Fish B Comp 8 Subtel Reg Anom Fish B Comp 9 15Q Del Char Ref Fish Comp 1 15Q Del Char Ref Fish Comp 2 22Q11.2 Comp 3 Subtel Reg Anom Fish B Comp 12 Subtel Reg Anom Fish B Comp 13 15Q Del Char Ref Fish Comp 3 AML Target Gene Panel Comp 1 AML Target Gene Panel Comp 2 Aneu Detect Comp 8 BCR/Abl Fish Component 3 CLL Target Gene Panel Comp 3 CLL Target Gene Panel Comp 4 MDS Target Gene Panel Comp 1 MDS Target Gene Panel Comp 2 MM-MGUS Target Gene Panel Comp 3 MM-MGUS Target Gene Panel Comp 4 Cancer Cytogenetics Component 3 Cancer Cytogenetics Component 4 Chromosome Karyotype Study Chromosome Karyotype Study Addl Nbn Aneuploidy Det Comp 3 Gross Only Path Tissue Micro Path Tissue Small Path Level III Profee Only Path Tissue Large Path Level IV Profee Only Path Tissue Complex Path Tissue Comprehensive Processing Charge Decal Cyclospora Exam Special Stain I Special Stain I Profee Only Special Stain II Special Stain II Profee Only Consultation Pro Fee Pathology Introp Gross Consult
88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88271 88273 88273 88273 88273 88275 88275 88275 88275 88275 88275 88275 88275 88275 88275 88280 88280 88280 88280 88291 88300 88302 88304 88304 88305 88305 88307 88309 88311 88312 88312 88312 88313 88313 88321 88329
45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 45.00 323.00 323.00 276.00 45.00 45.00 323.00 141.00 141.00 197.00 155.00 148.00 148.00 153.00 153.00 144.00 144.00 124.00 124.00 181.00 181.00 311.00 30.00 66.00 114.00 0.00 170.00 0.00 248.00 522.00 56.00 81.00 84.00 0.00 109.00 0.00 0.00 0.00
Frozen 1-2 Frozen 3+ Cyto Touch Prep Initial Cyto Touch Prep, Additional Site Immhistchem W/Immperox Addl Ab Immunohistoch Addl AB Same Sld Immhistchem W/Immperox Initial Single Ab Immhistchem w/ Immperox Each - 26 Immhistchem w/ Immperox Each - TC Immhistoch Semi Quant ERPR Archiv Tiss Molec anal Profee ISH In Situ Hybridization 88365 ISH In Situ Hybridization 88367 ISH In Situ Hybridization 8836759 Tissue Exam/Prep Each W/O Touch Tissue Exam/Prep Each W/Touch Cell Count Without Diff Cell Count With Diff Fecal Leukocyte Count WBC Crystal Ident By Light Microsc Crystals Joint Fluid Fat Estimate Feces Eosinophils Nasal Smear Nasal Eosinophils Iontophoresis Sweat Collectin Semen Analysis Semen Screen Post Vasectomy Dialysis Hemo Speech/Language Therapy Speech/Language Therapy Group Evaluation Speech Fluency Evaluation Speech Snd Productn Evaluation Speech Snd Lang Cmp Behavioral Qualit Analys Voice Dysphagia Treatment Evaluation for Use and/or Fitting of Voice Prosthetic Device to Supplement Oral Speech Eval & Prescription of Non-Speech Communication Device 1st Hour Non Speech Gen Device Therapy w/ Prog and Mod ST Therapeutic Services For Speech Generating Device Dysphagia Assessment Eval and Prescription for Non-Speech Gen Aug & Alt Device CPR PCNH/CGRH EKG Tracing Only Doppler Ultrasound Carotid Complete Bilateral Ultrasound Arterial Lower Extremity Complete Bilateral Ultrasound Peri Vas Veno Ultrasound Bilateral Ultrasound Veno Ultrasound Unilateral Extremity Doppler Complete Vital Capacity Total Incentive Spirometry 1st Treatment Incentive Spirometry Treatment Each Addl Hyperinflation Therapy First Treatment Hyperinflation Therapy Each Additional Treatment MDI Therapy First Treatment MDI Therapy Treatment Each Addl MDI Treatment Each Updraft Aerosol First Treatment Updraft Aerosol Treatment Each Addl Bipap Ventilation Day 1 Bipap Ventilation Day 2+
88331 88332 88333 88334 88341 88341 88342 88342 88342 88360 88363 88365 88367 88367 88387 88388 89050 89051 89055 89060 89060 89125 89190 89190 89230 89320 89321 90935 92507 92508 92521 92522 92523 92524 92526 92597 92605 92606 92609 92610 92618 92950 93005 93320 93880 93925 93970 93971 93975 94150 94640 94640 94640 94640 94640 94640 94640 94640 94640 94660 94660
192.00 269.00 522.00 108.00 232.00 232.00 232.00 0.00 229.00 229.00 0.00 232.00 232.00 232.00 19.00 9.00 120.00 162.00 56.00 48.00 48.00 69.00 30.00 30.00 197.00 141.00 101.00 1659.00 177.00 98.00 397.00 397.00 397.00 397.00 177.00 390.00 249.00 220.00 98.00 355.00 122.00 1005.00 207.00 686.00 820.00 922.00 876.00 593.00 708.00 169.00 180.00 180.00 113.00 113.00 180.00 180.00 180.00 180.00 180.00 1678.00 1678.00
HS CPAP Chest Physiotherapy First Treatment CPT Chest Physiotherapy Treatment Each Addl Pulse Oximeter Single Reading Respiratory Care Miscellaneous Routine Therapist CGRH Needle EMG 1 Extremity Needle EMG 1 Extremity Pro Fee Needle EMG 2 Extremities Needle EMG 2 Extremities Pro Fee Needle EMG 3 Extremities Needle EMG 3 Extremities Pro Fee Needle EMG 4 Extremities Needle EMG 4 Extremities Pro Fee Needle EMG Larynx Needle EMG Cranial Unilateral Needle EMG Cranial Unilateral Pro Fee Needle EMG Specific Muscle Needle EMG Specific Muscle Pro Fee Needle EMG 1 Extremity Limited Pro Fee Needle Electromyography Sngl Fiber Electrode w/ Quant Measure of Jitter/Blocking/Fiber Density, E Stim Guidance for Chemodenervation Profee EMG Guidance For Denervation Pro Fee EMG Guidance for Denervation Needle EMG Each Extremity Limited MDIA Needle EMG Each Extremity Limited Needle EMG Each Extremity Complete MDIA Needle EMG Each Extremity Cmpl Needle EMG Non-Extremity MDIA Needle EMG Non Extremity MDIA Motor and/or Sens Nrv Cnd Test Nerve Conduction Studies 1-2 MDIA Nerve Conduct Studies 1-2 Nerve Conduction Studies 3-4 MDIA Nerve Conduct Studies 3-4 Nerve Conduction Studies 5-6 MDIA Nerve Conduct Studies 5-6 Nerve Conduction Studies 7-8 MDIA Nerve Conduct Studies 7-8 Nerve Conduction Studies 9-10 MDIA Nerve Conduct Studies 9-10 Nerve Conduction Studies 11-12 MDIA Nerve Conduct Studies 11-12 Nerve Conduction Studies 13 + MDIA Nerve Conduct Studies 13+ Autonomic Nerve Parasym Inervj Autonomic Nerve System Function Test QSART Neuromuscular Junction Testing Each Nerve Neuromuscular Junction Testing Each Nerve Pro Fee Assessment of Aphasia w/ Interp and Rpt per Hour Standard Cognitive Perf Test LHI Stndrd Cognitive Perf Test Admin Fee IM or SQ Medication Pro Fee Hot/Cold Packs Therapy Moist Heat/Cold Treatment Traction Mechanical Mechanical Traction Therapy Pro Fee - Chi OT Electrical Stimulation Unattended OT Electrical Stimulation Unattended With Heat PT Electrical Stimulation Unattended PT Electrical Stim Unattended With Heat
94660 94667 94667 94668 94760 94799 95860 95860 95861 95861 95863 95863 95864 95864 95865 95867 95867 95869 95869 95870 95872 95873 95874 95874 95885 95885 95886 95886 95887 95887 95905 95907 95907 95908 95908 95909 95909 95910 95910 95911 95911 95912 95912 95913 95913 95921 95923 95937 95937 96105 96125 96125 96372 97010 97010 97012 97012 97014 97014 97014 97014
300.00 128.00 122.00 104.00 $0.00 132.00 387.00 264.00 373.00 384.00 167.00 464.00 291.00 541.00 134.00 $297.00 215.00 189.00 131.00 166.00 488.00 161.00 161.00 78.00 170.00 68.00 268.00 106.00 320.00 99.00 79.00 225.00 109.00 265.00 135.00 270.00 162.00 463.00 213.00 487.00 259.00 487.00 304.00 487.00 352.00 147.00 105.00 355.00 93.00 127.00 392.00 97.00 28.00 42.00 40.00 98.00 47.00 72.00 107.00 72.00 112.00
Electrical Stimulation Pro Fee - Chi OT Paraffin Bath Therapy PT Paraffin Bath Therapy OT Fluidotherapy PT Fluidotherapy OT Infrared Therapy PT Infrared Therapy OT Electrical Stimulation Manual Each 15 Minutes PT Electrical Stimulation Manual Each 15 Minutes OT Iontophoresis Each 15 Minutes PT Iontophoresis Each 15 Minutes PT Contrast Bath Each 15 Minutes OT Ultrasound Each 15 Minutes PT Ultrasound Each 15 Minutes OT Phonophoresis Each 15 Minutes PT Phonophoresis Each 15 Minutes Ultrasound Therapy Pro Fee - Chi OT Therapeutic Procedure Direct Each 15 Minutes OT Therapeutic Procedure Direct With Heat Each 15 Minutes PT Therapeutic Procedure Direct Each 15 Minutes PT Therapeutic Procedure Direct With Heat Each 15 Minutes OT Neuromuscular Re-Education Each 15 Minutes PT Neuromuscular Re-Education Each 15 Minutes OT Aquatic Therapy Each 15 Minutes PT Aquatic Therapy Each 15 Minutes Gait Training Each 15 Minutes OT Massage Therapy Each 15 Minutes PT Massage Therapy Each 15 Minutes Compression Bandage Application OT Manual Therapy Each 15 Minutes OT Manual Therapy With Heat Each 15 Minutes PT Manual Therapy Each 15 Minutes PT Manual Therapy With Heat Each 15 Minutes PT Modality Each 15 Minutes OT Therapeutic Procedure Group PT Therapeutic Procedure Group PT Eval Low Complexity 20 Minutes PT Eval Moderate Complexity 30 Minutes PT Eval High Complexity 45 Minutes PT Re-Eval Established Plan of Care 20 Minutes OT Eval Low Complexity 30 Minutes OT Eval Moderate Complexity 45 Minutes OT Eval High Complexity 60 Minutes OT Re-Eval Established Plan of Care 30 Minutes Athletic Training Eval Low Complex 15 Min - Chi Athletic Training Eval Mod Complexity 30 Min - Chi Athletic Training Eval High Complexity 45 Min - Chi Athletic Training Re-Eval 20 Min - Chi OT Therapeutic Activities Direct Each 15 Minutes PT Therapeutic Activities Direct Each 15 Minutes OT Sensory Integrative Techniques Each 15 Minutes Sensory Integration OT Self Care Management/Training Each 15 Minutes PT Self Care Management/Training Each 15 Minutes OT Community/Work Reintegration Training Each 15 Minutes PT Community/Work Reintegration Training Each 15 Minutes PT Wheelchair Management Each 15 Minutes OT Selective Debridement Up To 20 Sq CM Wound Care/Debridement 15 Min OT Selective Debridement Each Addl 20 Sq CM PT Physical Performance Test With Report Each 15 Minutes
97014 97018 97018 97022 97022 97026 97026 97032 97032 97033 97033 97034 97035 97035 97035 97035 97035 97110 97110 97110 97110 97112 97112 97113 97113 97116 97124 97124 97139 97140 97140 97140 97140 97140 97150 97150 97161 97162 97163 97164 97165 97166 97167 97168 97169 97170 97171 97172 97530 97530 97533 97533 97535 97535 97537 97537 97542 97597 97597 97598 97750
15.00 57.00 57.00 59.00 59.00 44.00 44.00 98.00 98.00 98.00 98.00 98.00 98.00 98.00 98.00 98.00 15.00 98.00 137.00 98.00 137.00 98.00 98.00 98.00 98.00 98.00 186.00 98.00 96.00 98.00 138.00 98.00 138.00 98.00 98.00 98.00 355.00 360.00 365.00 200.00 355.00 360.00 365.00 190.00 60.00 65.00 70.00 60.00 98.00 98.00 98.00 98.00 98.00 98.00 98.00 98.00 98.00 284.00 179.00 322.00 68.00
OT Orthotics Fitting And Training Each 15 Minutes PT Orthotics Fitting And Training Each 15 Minutes PT Prosthetic Training Each 15 Minutes PT Orthotic/Prosthetic Mgmt/Train Upper Ext/Lower Ext/Trunk Subsq Orthostic Prosthetic Encount Acupuncture Without Stimul 15 Minutes Pro Fee Acupuncture Without Stimul Addl 15 Minutes Pro Fee Acupuncture With Stimul 15 Minutes Pro Fee Acupuncture With Stimul Addl 15 Minutes Pro Fee Chiropractic Manipulative Tx Spinal 1-2 Reg Pro Fee - Chi Chiropractic Manipulative Tx Spinal 3-4 Reg Pro Fee - Chi Chiropractic Manipulative Tx Spinal 5 Reg Pro Fee - Chi Chiropractic Manipulative Tx Extraspinal 1+ Reg Pro Fee Chi Patient/Family Training Each 15 Minutes Education & Train for Patient Self Mgmt by a Qual,Non-Physician Health Care Professional Face to Clinical Study Spec Procesing DNA Paternity Specimen Collect QTC Medical Opinion (IMO) LHI Medical Opinion (MO) - TBI LHI C File Review New Patient Visit Level 1 New Patient Visit Level 1 Pro Fee New Patient Visit Level 1 Pro Fee - Chi New Patient Visit Level 2 New Patient Visit Level 2 Pro Fee New Patient Visit Level 2 Pro Fee - Chi New Patient Visit Level 3 New Patient Visit Level 3 Pro Fee New Patient Visit Level 4 New Patient Visit Level 4 Pro Fee New Patient Visit Level 5 New Patient Visit Level 5 Pro Fee QTC Initial TBI Exam LHI VA Disability Exam - TBI Established Patient Visit Level 1 Established Patient Visit Level 1 Pro Fee Established Patient Visit Level 2 Established Patient Visit Level 2 Pro Fee Established Patient Visit Level 2 Pro Fee - Chi Established Patient Visit Level 3 Established Patient Visit Level 3 Pro Fee Established Patient Visit Level 4 Established Patient Visit Level 4 Pro Fee Established Patient Visit Level 5 Established Patient Visit Level 5 Pro Fee Established Patient Visit Level 5 Pro Fee - Chi Initial Inpatient Hospital Care Low Complexity Initial Inpatient Hospital Care Moderate Complexity Initial Inpatient Hospital Care High Complexity Subsequent Inpatient Hospital Care Low Complexity Subsequent Inpatient Hospital Care Moderate Complexity Subsequent Inpatient Hospital Care High Complexity Inpatient Discharge <= 30 Minutes Inpatient Discharge > 30 Minutes Inpatient Consult Level 3 Inpatient Consult Level 4 Inpatient Consult Level 5 Prolonged Outpatient Service First Hour Prolonged Outpatient Service First Hour Pro Fee LHI VA Disab Ex Prlng MD Cntct Prolonged Outpatient Service Each Addl 30 Minutes LHI Prolonged Svc (Ea Add 30 Min)
97760 97760 97761 97763 97810 97811 97813 97814 98940 98941 98942 98943 98960 98960 99001 99001 99080 99080 99090 99201 99201 99201 99202 99202 99202 99203 99203 99204 99204 99205 99205 99205 99205 99211 99211 99212 99212 99212 99213 99213 99214 99214 99215 99215 99215 99221 99222 99223 99231 99232 99233 99238 99239 99253 99254 99255 99354 99354 99354 99355 99355
98.00 98.00 98.00 98.00 78.00 39.00 88.00 49.00 85.00 96.00 108.00 $85.00 98.00 105.00 150.00 59.00 150.00 50.00 50.00 232.00 109.00 60.00 290.00 190.00 108.00 $362.00 274.00 454.00 339.00 566.00 527.00 350.00 210.00 174.00 51.00 217.00 67.00 65.00 271.00 184.00 339.00 273.00 424.00 369.00 204.00 274.00 374.00 549.00 109.00 197.00 282.00 194.00 286.00 217.00 252.00 340.00 130.00 152.00 100.00 65.00 50.00
Team Conference Face To Face NonPhysician Team Conference w/o Pat/Fam by Phys 30+ Minutes Team Conf Non Face to Face 30 min or more Advance Care Planning First 30 Min PSA Screen Home Health Certification Evaluation Required for Power Mobility Device OT Cognitive Skills Development Each 15 Minutes ST Cognitive Skills Development Each 15 Minutes Development-Cognitive 15 Min OT Mobility Current 0% OT Mobility Current 100% OT Mobility Current 1-19% OT Mobility Current 20-39% OT Mobility Current 40-59% OT Mobility Current 60-79% OT Mobility Current 80-99% PT Mobility Current 0% CH PT Mobility Current 100% CN PT Mobility Current 1-19% CI PT Mobility Current 20-39% CJ PT Mobility Current 40-59% CK PT Mobility Current 60-79% CL PT Mobility Current 80-99% CM OT Mobility Goal 0% OT Mobility Goal 100% OT Mobility Goal 1-19% OT Mobility Goal 20-39% OT Mobility Goal 40-59% OT Mobility Goal 60-79% OT Mobility Goal 80-99% PT Mobility Goal 0% CH PT Mobility Goal 100% CN PT Mobility Goal 1-19% CI PT Mobility Goal 20-39% CJ PT Mobility Goal 40-59% CK PT Mobility Goal 60-79% CL PT Mobility Goal 80-99% CM OT Mobility Discharge 0% OT Mobility Discharge 100% OT Mobility Discharge 1-19% OT Mobility Discharge 20-39% OT Mobility Discharge 40-59% OT Mobility Discharge 60-79% OT Mobility Discharge 80-99% PT Mobility Discharge 0% CH PT Mobility Discharge 100% CN PT Mobility Discharge 1-19% CI PT Mobility Discharge 20-39% CJ PT Mobility Discharge 40-59% CK PT Mobility Discharge 60-79% CL PT Mobility Discharge 80-99% CM OT Body Position Current 0% OT Body Position Current 100% OT Body Position Current 1-19% OT Body Position Current 20-39% OT Body Position Current 40-59% OT Body Position Current 60-79% OT Body Position Current 80-99% PT Body Position Current 0% CH PT Body Position Current 100% CN
99366 99367 99368 99497 G0103 G0180 G0372 G0515 G0515 G0515 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8978 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8979 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8980 G8981 G8981 G8981 G8981 G8981 G8981 G8981 G8981 G8981
120.00 109.00 109.00 92.00 125.00 86.00 100.00 98.00 98.00 98.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01
PT Body Position Current 1-19% CI PT Body Position Current 20-39% CJ PT Body Position Current 40-59% CK PT Body Position Current 60-79% CL PT Body Position Current 80-99% CM OT Body Position Goal 0% OT Body Position Goal 100% OT Body Position Goal 1-19% OT Body Position Goal 20-39% OT Body Position Goal 40-59% OT Body Position Goal 60-79% OT Body Position Goal 80-99% PT Body Position Goal 0% CH PT Body Position Goal 100% CN PT Body Position Goal 1-19% CI PT Body Position Goal 20-39% CJ PT Body Position Goal 40-59% CK PT Body Position Goal 60-79% CL PT Body Position Goal 80-99% CM OT Body Position Discharge 0% OT Body Position Discharge 100% OT Body Position Discharge 1-19% OT Body Position Discharge 20-39% OT Body Position Discharge 40-59% OT Body Position Discharge 60-79% OT Body Position Discharge 80-99% PT Body Position Discharge 0% CH PT Body Position Discharge 100% CN PT Body Position Discharge 1-19% CI PT Body Position Discharge 20-39% CJ PT Body Position Discharge 40-59% CK PT Body Position Discharge 60-79% CL PT Body Position Discharge 80-99% CM OT Handling Current 0% OT Handling Current 100% OT Handling Current 1-19% OT Handling Current 20-39% OT Handling Current 40-59% OT Handling Current 60-79% OT Handling Current 80-99% PT Handling Current 0% CH PT Handling Current 100% CN PT Handling Current 1-19% CI PT Handling Current 20-39% CJ PT Handling Current 40-59% CK PT Handling Current 60-79% CL PT Handling Current 80-99% CM OT Handling Goal 0% OT Handling Goal 100% OT Handling Goal 1-19% OT Handling Goal 20-39% OT Handling Goal 40-59% OT Handling Goal 60-79% OT Handling Goal 80-99% PT Handling Goal 0% CH PT Handling Goal 100% CN PT Handling Goal 1-19% CI PT Handling Goal 20-39% CJ PT Handling Goal 40-59% CK PT Handling Goal 60-79% CL PT Handling Goal 80-99% CM
G8981 G8981 G8981 G8981 G8981 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8982 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8983 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8984 G8985 G8985 G8985 G8985 G8985 G8985 G8985 G8985 G8985 G8985 G8985 G8985 G8985 G8985
0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01
OT Handling Discharge 0% OT Handling Discharge 100% OT Handling Discharge 1-19% OT Handling Discharge 20-39% OT Handling Discharge 40-59% OT Handling Discharge 60-79% OT Handling Discharge 80-99% PT Handling Discharge 0% CH PT Handling Discharge 100% CN PT Handling Discharge 1-19% CI PT Handling Discharge 20-39% CJ PT Handling Discharge 40-59% CK PT Handling Discharge 60-79% CL PT Handling Discharge 80-99% CM OT Self Care Current 0% OT Self Care Current 100% OT Self Care Current 1-19% OT Self Care Current 20-39% OT Self Care Current 40-59% OT Self Care Current 60-79% OT Self Care Current 80-99% PT Self Care Current 0% CH PT Self Care Current 100% CN PT Self Care Current 1-19% CI PT Self Care Current 20-39% CJ PT Self Care Current 40-59% CK PT Self Care Current 60-79% CL PT Self Care Current 80-99% CM OT Self Care Goal 0% OT Self Care Goal 100% OT Self Care Goal 1-19% OT Self Care Goal 20-39% OT Self Care Goal 40-59% OT Self Care Goal 60-79% OT Self Care Goal 80-99% PT Self Care Goal 0% CH PT Self Care Goal 100% CN PT Self Care Goal 1-19% CI PT Self Care Goal 20-39% CJ PT Self Care Goal 40-59% CK PT Self Care Goal 60-79% CL PT Self Care Goal 80-99% CM OT Self Care Discharge 0% OT Self Care Discharge 100% OT Self Care Discharge 1-19% OT Self Care Discharge 20-39% OT Self Care Discharge 40-59% OT Self Care Discharge 60-79% OT Self Care Discharge 80-99% PT Self Care Discharge 0% CH PT Self Care Discharge 100% CN PT Self Care Discharge 1-19% CI PT Self Care Discharge 20-39% CJ PT Self Care Discharge 40-59% CK PT Self Care Discharge 60-79% CL PT Self Care Discharge 80-99% CM OT Other Primary Current 0% OT Other Primary Current 100% OT Other Primary Current 1-19% OT Other Primary Current 20-39% OT Other Primary Current 40-59%
G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8986 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8987 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8988 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8989 G8990 G8990 G8990 G8990 G8990
0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 $0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 $0.01 $0.01 0.01 0.01 0.01 $0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 $0.01 $0.01 0.01 0.01 0.01 0.01 $0.01 0.01 0.01 0.01 0.01 0.01
OT Other Primary Current 60-79% OT Other Primary Current 80-99% PT Other Primary Current 0% CH PT Other Primary Current 100% CN PT Other Primary Current 1-19% CI PT Other Primary Current 20-39% CJ PT Other Primary Current 40-59% CK PT Other Primary Current 60-79% CL PT Other Primary Current 80-99% CM OT Other Primary Goal 0% OT Other Primary Goal 100% OT Other Primary Goal 1-19% OT Other Primary Goal 20-39% OT Other Primary Goal 40-59% OT Other Primary Goal 60-79% OT Other Primary Goal 80-99% PT Other Primary Goal 0% CH PT Other Primary Goal 100% CN PT Other Primary Goal 1-19% CI PT Other Primary Goal 20-39% CJ PT Other Primary Goal 40-59% CK PT Other Primary Goal 60-79% CL PT Other Primary Goal 80-99% CM OT Other Primary Discharge 0% OT Other Primary Discharge 100% OT Other Primary Discharge 1-19% OT Other Primary Discharge 20-39% OT Other Primary Discharge 40-59% OT Other Primary Discharge 60-79% OT Other Primary Discharge 80-99% PT Other Primary Discharge 0% CH PT Other Primary Discharge 100% CN PT Other Primary Discharge 1-19% CI PT Other Primary Discharge 20-39% CJ PT Other Primary Discharge 40-59% CK PT Other Primary Discharge 60-79% CL PT Other Primary Discharge 80-99% CM OT Other Subsequent Current 0% OT Other Subsequent Current 100% OT Other Subsequent Current 1-19% OT Other Subsequent Current 20-39% OT Other Subsequent Current 40-59% OT Other Subsequent Current 60-79% OT Other Subsequent Current 80-99% PT Other Subsequent Current 0% PT Other Subsequent Current 100% PT Other Subsequent Current 1-19% CI PT Other Subsequent Current 20-39% PT Other Subsequent Current 40-59% PT Other Subsequent Current 60-79% PT Other Subsequent Current 80-99% OT Other Subsequent Goal 0% OT Other Subsequent Goal 100% OT Other Subsequent Goal 1-19% OT Other Subsequent Goal 20-39% OT Other Subsequent Goal 40-59% OT Other Subsequent Goal 60-79% OT Other Subsequent Goal 80-99% PT Other Subsequent Goal 0% PT Other Subsequent Goal 100% PT Other Subsequent Goal 1-19%
G8990 G8990 G8990 G8990 G8990 G8990 G8990 G8990 G8990 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8991 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8992 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8993 G8994 G8994 G8994 G8994 G8994 G8994 G8994 G8994 G8994 G8994
0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01
PT Other Subsequent Goal 20-39% PT Other Subsequent Goal 40-59% PT Other Subsequent Goal 60-79% PT Other Subsequent Goal 80-99% OT Other Subsequent Discharge 0% OT Other Subsequent Discharge 100% OT Other Subsequent Discharge 1-19% OT Other Subsequent Discharge 20-39% OT Other Subsequent Discharge 40-59% OT Other Subsequent Discharge 60-79% OT Other Subsequent Discharge 80-99% PT Other Subsequent Discharge 0% PT Other Subsequent Discharge 100% PT Other Subsequent Discharge 1-19% CI PT Other Subsequent Discharge 20-39% CJ PT Other Subsequent Discharge 40-59% PT Other Subsequent Discharge 60-79% PT Other Subsequent Discharge 80-99% CM ST Swallowing Current 0% ST Swallowing Current 100% ST Swallowing Current 1-19% ST Swallowing Current 20-39% ST Swallowing Current 40-59% ST Swallowing Current 60-79% ST Swallowing Current 80-99% ST Swallowing Goal 0% ST Swallowing Goal 100% ST Swallowing Goal 1-19% ST Swallowing Goal 20-39% ST Swallowing Goal 40-59% ST Swallowing Goal 60-79% ST Swallowing Goal 80-99% ST Swallowing Discharge 0% ST Swallowing Discharge 100% ST Swallowing Discharge 1-19% ST Swallowing Discharge 20-39% ST Swallowing Discharge 40-59% ST Swallowing Discharge 60-79% ST Swallowing Discharge 80-99% ST Motor Speech Current 0% ST Motor Speech Current 100% ST Motor Speech Current 1-19% ST Motor Speech Current 20-39% ST Motor Speech Current 40-59% ST Motor Speech Current 60-79% ST Motor Speech Current 80-99% ST Motor Speech Discharge 0% ST Motor Speech Discharge 100% ST Motor Speech Discharge 1-19% ST Motor Speech Discharge 20-39% ST Motor Speech Discharge 40-59% ST Motor Speech Discharge 60-79% ST Motor Speech Discharge 80-99% ST Language Comprehension Current 0% ST Language Comprehension Current 100% ST Language Comprehension Current 1-19% ST Language Comprehension Current 20-39% ST Language Comprehension Current 40-59% ST Language Comprehension Current 60-79% ST Language Comprehension Current 80-99% ST Language Comprehension Goal 0%
G8994 G8994 G8994 G8994 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8995 G8996 G8996 G8996 G8996 G8996 G8996 G8996 G8997 G8997 G8997 G8997 G8997 G8997 G8997 G8998 G8998 G8998 G8998 G8998 G8998 G8998 G8999 G8999 G8999 G8999 G8999 G8999 G8999 G9158 G9158 G9158 G9158 G9158 G9158 G9158 G9159 G9159 G9159 G9159 G9159 G9159 G9159 G9160
0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01
ST Language Comprehension Goal 100% ST Language Comprehension Goal 1-19% ST Language Comprehension Goal 20-39% ST Language Comprehension Goal 40-59% ST Language Comprehension Goal 60-79% ST Language Comprehension Goal 80-99% ST Language Comprehension Discharge 0% ST Language Comprehension Discharge 100% ST Language Comprehension Discharge 1-19% ST Language Comprehension Discharge 20-39% ST Language Comprehension Discharge 40-59% ST Language Comprehension Discharge 60-79% ST Language Comprehension Discharge 80-99% ST Language Expression Current 0% ST Language Expression Current 100% ST Language Expression Current 1-19% ST Language Expression Current 20-39% ST Language Expression Current 40-59% ST Language Expression Current 60-79% ST Language Expression Current 80-99% ST Language Expression Goal 0% ST Language Expression Goal 100% ST Language Expression Goal 1-19% ST Language Expression Goal 20-39% ST Language Expression Goal 40-59% ST Language Expression Goal 60-79% ST Language Expression Goal 80-99% ST Language Expression Discharge 0% ST Language Expression Discharge 100% ST Language Expression Discharge 1-19% ST Language Expression Discharge 20-39% ST Language Expression Discharge 40-59% ST Language Expression Discharge 60-79% ST Language Expression Discharge 80-99% ST Attention Current 0% ST Attention Current 1-19% ST Attention Current 20-39% ST Attention Current 40-59% ST Attention Current 60-79% ST Attention Current 100% ST Attention Current 80-99% ST Attention Goal 0% ST Attention Goal 100% ST Attention Goal 1-19% ST Attention Goal 20-39% ST Attention Goal 40-59% ST Attention Goal 60-79% ST Attention Goal 80-99% ST Attention Discharge 0% ST Attention Discharge 100% ST Attention Discharge 1-19% ST Attention Discharge 20-39% ST Attention Discharge 40-59% ST Attention Discharge 60-79% ST Attention Discharge 80-99% ST Memory Current 0% ST Memory Current 100% ST Memory Current 1-19% ST Memory Current 20-39% ST Memory Current 40-59% ST Memory Current 60-79%
G9160 G9160 G9160 G9160 G9160 G9160 G9161 G9161 G9161 G9161 G9161 G9161 G9161 G9162 G9162 G9162 G9162 G9162 G9162 G9162 G9163 G9163 G9163 G9163 G9163 G9163 G9163 G9164 G9164 G9164 G9164 G9164 G9164 G9164 G9165 G9165 G9165 G9165 G9165 G9165 G9165 G9166 G9166 G9166 G9166 G9166 G9166 G9166 G9167 G9167 G9167 G9167 G9167 G9167 G9167 G9168 G9168 G9168 G9168 G9168 G9168
0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 $0.01 0.01 0.01 $0.01 0.01 0.01 $0.01 0.01 0.01 0.01 0.01 $0.01 0.01 $0.01 0.01 $0.01 0.01 $0.01 0.01 0.01 $0.01 0.01 0.01 0.01 0.01
ST Memory Current 80-99% ST Memory Goal 0% ST Memory Goal 100% ST Memory Goal 1-19% ST Memory Goal 20-39% ST Memory Goal 40-59% ST Memory Goal 60-79% ST Memory Goal 80-99% ST Memory Discharge 0% ST Memory Discharge 100% ST Memory Discharge 1-19% ST Memory Discharge 20-39% ST Memory Discharge 40-59% ST Memory Discharge 60-79% ST Memory Discharge 80-99% ST Voice Current 0% ST Voice Current 100% ST Voice Current 1-19% ST Voice Current 20-39% ST Voice Current 40-59% ST Voice Current 60-79% ST Voice Current 80-99% ST Voice Goal 0% ST Voice Goal 100% ST Voice Goal 1-19% ST Voice Goal 20-39% ST Voice Goal 40-59% ST Voice Goal 60-79% ST Voice Goal 80-99% ST Voice Discharge 0% ST Voice Discharge 100% ST Voice Discharge 1-19% ST Voice Discharge 20-39% ST Voice Discharge 40-59% ST Voice Discharge 60-79% ST Voice Discharge 80-99% ST Other Speech Language Pathology Current 0% ST Other Speech Language Pathology Current 100% ST Other Speech Language Pathology Current 1-19% ST Other Speech Language Pathology Current 20-39% ST Other Speech Language Pathology Current 40-59% ST Other Speech Language Pathology Current 60-79% ST Other Speech Language Pathology Current 80-99% ST Other Speech Language Pathology Goal 0% ST Other Speech Language Pathology Goal 100% ST Other Speech Language Pathology Goal 1-19% ST Other Speech Language Pathology Goal 20-39% ST Other Speech Language Pathology Goal 40-59% ST Other Speech Language Pathology Goal 60-79% ST Other Speech Language Pathology Goal 80-99% ST Other Speech Language Pathology Discharge 0% ST Other Speech Language Pathology Discharge 100% ST Other Speech Language Pathology Discharge 1-19% ST Other Speech Language Pathology Discharge 20-39% ST Other Speech Language Pathology Discharge 40-59% ST Other Speech Language Pathology Discharge 60-79% ST Other Speech Language Pathology Discharge 80-99% ST Motor Speech Goal 0% ST Motor Speech Goal 100% ST Motor Speech Goal 1-19% ST Motor Speech Goal 20-39%
G9168 G9169 G9169 G9169 G9169 G9169 G9169 G9169 G9170 G9170 G9170 G9170 G9170 G9170 G9170 G9171 G9171 G9171 G9171 G9171 G9171 G9171 G9172 G9172 G9172 G9172 G9172 G9172 G9172 G9173 G9173 G9173 G9173 G9173 G9173 G9173 G9174 G9174 G9174 G9174 G9174 G9174 G9174 G9175 G9175 G9175 G9175 G9175 G9175 G9175 G9176 G9176 G9176 G9176 G9176 G9176 G9176 G9186 G9186 G9186 G9186
$0.01 0.01 $0.01 0.01 0.01 0.01 0.01 $0.01 0.01 $0.01 0.01 0.01 0.01 $0.01 $0.01 0.01 $0.01 0.01 0.01 0.01 0.01 0.01 0.01 $0.01 0.01 0.01 0.01 $0.01 $0.01 0.01 $0.01 0.01 0.01 0.01 0.01 $0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01
ST Motor Speech Goal 40-59% ST Motor Speech Goal 60-79% ST Motor Speech Goal 80-99% Botulinum (Botox) Type A 1 Unit 47871581 Injection Onabotulinumtoxina 1 U 47878901 Rimabotulinumtoxin B 100U Inj 79000015 Rimabotulinumtoxin B 100U Inj 79000016 Diphenhydramine 50 Mg/Ml Inj Orthosis Stat L Elbow W Wrist Orthosis Wrist Hand Finger w/ Attachments Orthosis Static Wrist/Hand/Finger Orthosis Stat Wrist/Hnd Cockup Orthosis Stat Hand/Finger Orthosis Stat Hand Orthosis Dynamic Hand/Finger Finger Orthosis w/o Joints Custom Fabricated Prolotherapy Lumbar Spine Pro Fee Leukoreduced Red Cell Service Fresh Frozen Plasma Service Leukd Platletpheresis Service Irrad Leukd Red Cell Service Albumin (Human) A, 25%A, 50 Ml 47870284 LOA Private Room Rehab Semi Private Room Rehab Aripiprazole 5 MG Tab Atorvastatin 40 MG Tab Azithromycin 600 MG Tab Botulinum (Botox) Type A 100 U Bupropion 100 MG Tab Bupropion 100 MG Tab SA Cefpodoxime 100 MG Tab Cefuroxime 500 MG Tab Chlorothiazide 500 MG Tab Ciprofloxacin 0.3% Ophth Soln Cyanocobalamin 2500 MCG Tab SL Darunavir 600 MG Tab Doxycycline 50 MG Cap Lacosamide 50 MG Tab Levofloxacin 750 MG Tab Norco 10/325 Tab Norco 5/325 Tab Norco 7.5/325 Tab Primaquine 26.3 MG Tab Raltegravir 400 MG Tab Ramipril 1.25 MG Cap Rifaximin 550 MG Tab Ropinirole 2 MG Tab Rotigotine 4 MG Patch Saxagliptin 2.5 MG Tab Sevelamer Carbonate 800 MG Tab Thioridazine 25 MG Tab Verapamil 80 MG Tab Acarbose 25 MG Tab RH Acarbose 50 MG Tab RH Accu-Chek RH Acebutol 200 MG Tab RH Acetamincod #3 C-3 Tab RH Acetaminophen 20 ML 32 MG Elx Acetaminophen 325 MG Tab RH Acetaminophen 500 MG Tab
G9186 G9186 G9186 J0585 J0585 J0587 J0587 J1200 L3763 L3806 L3808 L3906 L3913 L3919 L3921 L3933 M0076 P9016 P9017 P9035 P9040 P9047
0.01 0.01 0.01 24.51 13.79 33.44 33.44 8.50 1142.00 1647.00 436.00 607.00 391.00 391.00 987.00 265.00 260.00 995.00 302.00 1928.00 1175.00 106.58 0.00 799.00 799.00 27.72 24.31 46.70 0.00 13.66 10.43 16.85 69.47 4.53 130.43 3.80 56.45 3.65 20.27 49.55 9.70 7.72 8.72 5.22 64.50 5.99 72.88 12.30 43.42 21.35 34.89 5.79 4.40 5.12 9.09 14.56 15.49 9.09 10.75 2.73 2.73
RH Acetaminophen 650 MG Supp RH Acetazolamide 250 MG Tab RH Acetazolamide Seq 500 MG Cap RH Acetic Acid 0.25% Irr RH Acetylcysteine Neb 20% Sol RH Aclidinium MDI RH Acyclovir 500 MG Inj RH Acyclovir Cream 200 MG Cap RH Acyclovir Oint 15 GR Oint RH Albuterol 3 ML Inhal Sol RH Albuterol Inhaler RH Albuterol Sulf 2 MG Tab RH Alendronate 70 MG Tab RH Alendronate Sod 10 MG Tab RH Aliskiren 150 MG RH Allopurinol 100 MG Tab RH Allopurinol 300 MG Tablet RH Alprazolam C-IV 0.25 MG Tab RH Alprazolam C-IV 0.5 MG Tab RH Alteplase 2 MG Inj RH Amantadine 100 MG Cap RH Amantadine 100 MG/10 ML Syrup RH Amikacin 500 MG Inj RH Amiodarone 200 MG Tab RH Amitriptyline 10 MG Tab RH Amitriptyline 25 MG Tab RH Amitriptyline 75 MG Tab RH Amlodipine 10 MG Tab RH Amlodipine 2.5 MG Tab RH Amlodipine 5 MG Tab RH Ammonium Lactate 0.12 Lot RH Amoxicillin 50 MG Susp RH Amoxicillin 500 MG Cap RH Amoxicillin/Cla 50 MG/ML Susp RH Amoxicillin/Cla Susp 80 MG Liq RH Amoxicillin/Clav 250 MG Tab RH Amoxicillin/Clav 500 MG Tab RH Amoxicillin/Clav 875 MG Tab RH Ampicillin 1 GM Inj RH Ampicillin 2 GM Inj RH Ampicillin 250 MG Cap RH Ampicillin 500 MG Cap RH Ampicillin/Sulbactam 3 GM Inj RH Anagrelide 0.5 MG Cap RH Anastrozole 1 MG Tab RH Anticoag Cit Dext (Acd) 500 ML RH Anusol Oint 30 G RH Anusol Supp RH Anusol-HC CR 2.55 Cr RH Apap/Butalbit/Caff Tab RH Apap/Dichlora/IS CIV Cap RH Apap/Oxycodone C-II 5 MG Tab RH Arformoterol Inh 15 MCG/2 ML RH Aripiprazole 10 MG Tab RH Aripiprazole 2 MG Tab RH Arto/Diphenoxy C-V 2.5 MG Tab RH Ascorbic Acid 500 MG Tab RH Aspirin 325 MG EC Tab Aspirin 325 MG Tab RH Aspirin 81 MG Chew Tab RH Aspirin 81 MG EC Tab
2.73 9.09 12.75 36.41 85.56 755.36 271.30 16.03 280.93 20.01 144.73 7.28 102.19 25.49 9.68 6.38 7.28 11.83 12.75 355.13 7.28 3.22 180.29 36.41 7.28 7.28 7.28 21.85 15.83 17.29 147.48 45.15 9.09 119.08 218.49 28.21 40.06 40.99 24.56 47.64 7.44 9.09 54.63 34.19 42.86 143.14 27.32 10.93 93.78 7.28 5.45 10.93 24.45 39.89 32.32 7.28 9.09 5.45 2.73 2.73 2.73
RH Atenolol 25 MG Tab RH Atenolol 50 MG Tab RH Atorvastatin 10 MG Tab RH Atorvastatin 20 MG Tab RH Atovaquone 150 MG Liq RH Atropine 1 MG Inj RH Atropine O-S 1% RH Azathioprine 50 MG Tab RH Azelastine Nas Spray 137 MCG/Sp RH Azithromycin 250 MG Tab RH Azithromycin 500 MG Inj RH Aztreonam 1 Gram VL RH Bacit/Neo/Poly Oin RH Bacitracin Oint RH Bacitracin Zn/Pol Oint RH Bacitracin/Neo/Poly RH Baclofen 10 MG Tab RH Beclomethasone Oral 40 MCG Inh RH Benazepril 10 MG Tab RH Benzonatate 100 MG Cap RH Benztropine 0.5 MG Tab RH Benztropine 1 MG Tab RH Betamethasone Dip RH Betaxolol O-S RH Bethanechol 10 MG Tab RH Bethanechol 25 MG Tab RH Bicalutamide 50 MG Tab RH Bidil Tab RH Bimatoprost 0.03% Oph 2.5 ML RH Bisacodyl 10 MG Supp RH Bisacodyl 5 MG Tab RH Bismuth Subsal 240 ML Susp RH Bismuth Subsal 252 MG Tab RH Bisoprolol 5 MG Tab RH Bisoprolol/Hctz 10 MG Tab RH Bisoprolol/Hctz 2.5 MG Tab RH Bisoprolol/Hctz 5 MG Tab RH Blistex 4.25 GM Ointment RH B-Plex Tab RH Brimonidine O-S RH Brinzolamide 1% Oph Susp 10 ML RH Bromfenac Oph Soln 1.7 ML RH Bromocriptine 2.5 MG Tab RH Budenoside Inhaler 180 MCG RH Budesonide EC 3 MG RH Budesonide Resp 0.5 MG RH Bumetanide 1 MG Tab RH Bupivacaine 0.25% Injection RH Bupivacaine Inj RH Bupropion 75 MG Tab RH Bupropion Sust-Rel 150 MG Tab RH Bupropion XL 150 MG Tab RH Buspirone 10 MG Tab RH Buspirone 5 MG Tab RH Cabergoline 0.5 MG Tab RH Calcitonin Injection 200 U/ML RH Calcitonin-Salmon Na 200 IU/ML RH Calcitriol 0.25 MCG Cap RH Calcium 500 + Vit D 500 MG Tab RH Calcium Acetate 667 MG Cap RH Calcium Carbonate 500 MG Tab
7.28 16.37 33.44 34.24 95.37 62.20 18.22 14.56 218.49 58.26 172.15 93.94 69.20 29.14 12.75 39.73 7.28 136.56 10.75 7.28 5.45 4.21 111.08 236.88 17.29 6.38 60.55 9.36 173.74 2.73 6.38 11.29 5.45 8.12 18.22 11.18 18.22 11.83 5.45 99.14 190.30 398.85 10.35 536.24 23.14 26.09 7.28 8.68 9.90 11.83 15.03 34.18 21.85 12.75 42.42 150.45 260.87 18.22 7.28 5.45 6.38
RH Calmoseptine Oint 113 Gram RH Candesartan 16 MG Tab RH Capsaicin Cream 0.025% RH Captopril 12.5 MG Tab RH Carbamazepine 200 MG Tab RH Carbamazepine XR 100 MG Tab RH Carbidopa/Levodop 10/100 Tab RH Carbidopa/Levodop 25/100 Tab RH Carbidopa/Levodop 25/250 Tab RH Carbidopa/Levodopa2 25/100 Tab RH Carisoprodol C-IV 350 MG Tab RH Carvedilol 12.5 MG Tab RH Carvedilol 25 MG Tab RH Carvedilol 3.125 MG Tab RH Carvedilol 6.25 MG Tab RH Cefazolin 1 GM Inj Cefdinir 300 MG Cap RH Cefepime 1 G Inj RH Cefepime 2 G Inj Ceftazidime 1 G Inj RH Ceftriaxone 2 GM Inj RH Ceftriazone 1 Gram Inj RH Cefuroxime Axetil 250 MG Tab RH Celecoxib 100 MG Cap RH Cepacol Throat Loz RH Cephalexin 250 MG Cap RH Cephalexin 500 MG Cap RH Cephalexin Susp 50 MG Liq RH Cerumenex Otic Sol RH Cetirizine 10 MG Tab RH Chloraseptic Spray 180 ML RH Chlordiazepox/Clid Cap RH Chlordiazepoxide 5 MG Cap RH Chlorhexidine 0.12% Rinse 15 ML RH Chlorpheniramine 4 MG Tab RH Chlorpromazine 10 MG Tab RH Chlorpromazine 25 MG Tab RH Chlorthalidone 25 MG Tab RH Chlorzoxazone 500 MG Tab RH Cholestyramine 9 G Pow RH Cilostazol 100 MG Tab RH Cinacalcet 30 MG Tab RH Ciprofloxacin 250 MG Tab RH Ciprofloxacin 400 MG Premix RH Ciprofloxacin 500 MG Tab RH Citalopram 20 MG Tab RH Citric Acid/Sod Citra 15 ML Sol RH Clarithromycin 500 MG Tab RH Clindamycin 150 MG Cap RH Clindamycin 300 MG Inj RH Clonazepam 0.5 MG Tab RH Clonidine 0.1 MG Tab RH Clonidine 0.2 MG Tab RH Clonidine 0.3 MG Tab RH Clonidine Patch RH Clonidine Patch TTS 1 Dis RH Clonidine Patch TTS 2 Dis RH Clopidogrel 75 MG Tab RH Clorazepate C-IV 7.5 MG Tab RH Clotrima/Betamethas Crm RH Clotrimazole Crm
16.76 13.20 26.37 12.75 5.45 7.74 7.28 10.93 12.75 5.94 12.75 15.03 15.03 15.03 15.03 26.41 28.40 93.52 171.32 65.55 293.60 209.39 29.14 15.03 27.32 12.75 14.56 106.07 16.13 16.37 34.60 5.45 5.45 4.25 7.28 5.45 5.45 5.45 16.37 23.66 13.66 36.91 38.24 102.88 38.24 15.03 4.14 35.51 16.37 54.63 14.56 7.28 7.28 7.28 90.46 66.44 66.44 20.93 21.85 96.52 47.37
RH Clotrimazole Troche Tab RH Codeine C-II 30 MG Tab RH Colchicine 0.6 MG Tab RH Colesevelam 625 MG Tab RH Collagenase Oint 30 Gram RH Combigan Oph Soln 5 ML RH Cyanocobalamin 100 MCG Tab RH Cyanocobalamin 1000 MCG Inj RH Cyanocobalamin 500 MCG Tab RH Cyclobenzaprine 10 MG Tab RH Cyclophosphamide 50 MG Tablet RH Cyclosporine (Neoral) 25 MG Cap RH Cyclosporine 100 MG Cap RH Cyclosporine Microem 100 MG Cap RH Cyclosporine Microem 25 MG Cap RH Cyclosporine Oph Soln 0.005% RH Cyproheptadine 4 MG Tab RH Dabigatran 75 MG Cap RH Dakins 16 Oz RH Dantrolene 25 MG Cap RH Dapsone 100 MG Tab RH Daptomycin 500 MG Inj RH Darigatran 150 MG Caps RH Demeclocycline 150 MG Cap RH Desipramine 25 MG Tab RH Desmopressin 0.1 MG Tab RH Desvenlafaxine 50 MG Tab RH Dexamethasone 1 MG Tab RH Dexamethasone 4 MG Tab RH Dexamethasone Na 4 MG Inj RH Dext 5% NaCl 0.225% 1000 ML IV RH Dext 5% NaCl 0.45% IV RH Dext 5% NaCl 0.9% 1000 ML IV RH Dext 5% Water 1000 ML IV RH Dext 5% Water 250 ML IV RH Dextrose 50% Syringe 0.5 GR Inj RH Diazepam C-IV 2 MG Tab RH Diazepam C-IV 5 MG Inj RH Diazepam C-IV 5 MG Tab RH Diclofenac Gel 1% 100 Gram RH Diclofenac Patch 1.3% RH Diclofenac Sod 25 MG Tab RH Diclofenac Sod 75 MG Tab RH Dicyclomine 10 MG Cap RH Digoxin 0.125 MG Tab RH Digoxin 0.25 MG Inj RH Digoxin 0.25 MG Tab RH Diltiazem 120 MG CD Tab RH Diltiazem 180 MG CD Tab RH Diltiazem 240 MG CD Tab RH Diltiazem 60 MG Tab RH Diltiazem CD 30 MG Tab RH Diltiazem CD 300 MG Tab RH Diltiazem SR 60 MG Tab RH Diphenhydramine 2.5 MG Elx RH Diphenhydramine 25 MG Tab RH Diphenhydramine Cr RH Dipyr/Asa Ext Rel 200 MG Cap RH Dipyridamole 25 MG Tab RH Divalproex 125 MG Sprinkle Cap RH Divalproex Del-Rel 125 MG Tab
23.66 5.00 17.68 4.62 301.51 200.77 5.45 27.32 5.45 7.28 13.50 8.15 47.73 64.91 16.31 295.77 5.45 12.96 72.84 23.66 4.39 839.28 12.96 36.41 5.45 15.03 14.99 7.28 7.28 24.56 62.80 62.80 62.80 58.26 58.26 48.24 10.93 27.32 5.45 105.60 20.51 7.28 19.12 5.45 7.28 27.32 7.28 21.85 21.85 29.14 7.28 7.28 40.06 8.19 10.19 5.45 36.41 9.78 7.28 3.83 7.74
RH Divalproex Del-Rel 250 MG Tab RH Divalproex Del-Rel 500 MG Tab RH Divalproex Ext-Rel 250 MG Tab RH Divalproex Ext-Rel 500 MG Tab RH Docusate Sod 10 MG Liq RH Docusate Sodium 100 MG Cap RH Dofetilide 125 MCG Cap RH Donepezil 5 MG Tab RH Donnatal Tab RH Dorzolamide 2% O-S RH Dorzolamide-Timolol RH Doxazosin 2 MG Tab RH Doxepin 10 MG Cap RH Doxepin 25 MG Cap Doxycycline 100 MG Tab RH Dronabinol C-III 5 MG Cap RH Dronedarone 400 MG Tab RH Duloxetine 20 MG Cap RH Duloxetine 30 MG Cap RH Efavirenz 200 MG Cap RH Enalapril 5 MG Tab RH Enalaprilat Dihydrate VL RH Enoxaparin 100 MG/1 ML Inj RH Enoxaparin 120 MG/0.8 ML Inj RH Enoxaparin 150 MG/1 ML Inj RH Enoxaparin 30 MG Inj RH Enoxaparin 40 MG Inj RH Enoxaparin 60 MG Inj RH Enoxaparin 80 MG Inj RH Entacapone 200 MG Tab RH Epinephrine 1:1000 1 MG Inj RH Epinephrine 1:10000 1 MG Syr RH Eplerenone 25 MG Tab RH Epoetin Alfa 10000 Un Inj RH Epoetin Alfa 2000 Un Inj RH Epoetin Alfa 20000 Un Inj RH Epoetin Alfa 3000 Un Inj RH Epoetin Alfa 4000 Un Inj RH Epsom Salts Top RH Ertapenem 1 Gram Inj RH Erythromycin 250 MG Tab Erythromycin Ethyl 40 MG Liq RH Erythromycin O-O ORH Escitalopram 10 MG Tab RH Esomeprazole 40 MG Cap RH Estazolam C-IV 1 MG Tab RH Estradiol 0.0375 MG Patch RH Estradiol 0.05 MG Patch RH Estradiol 0.05 Patch RH Estradiol 1 MG Tab RH Estradiol TDBW 0.1 MG/24 Pat RH Estradiol Vag Cream 1.5 OZ RH Estratest HS Cap RH Estratest Tab RH Estrogen Conj Vag Cr RH Estrogen Conjugated 0.625 MG tab RH Estrogen Esterified .625 MG Tab RH Estrogens Conjugated 0.3 MG Tab RH Estropipate 0.625 MG Tab RH Estropipate 1.25 MG Tab RH Eszopiclone 1 MG Tablet
12.75 20.01 6.64 12.41 10.19 7.28 9.78 34.60 10.93 91.95 180.73 14.56 4.39 7.28 12.75 43.53 17.36 14.13 17.71 31.88 16.37 48.68 336.86 404.22 423.18 100.15 123.82 193.00 246.74 11.18 7.28 60.38 18.61 595.88 119.16 1191.79 178.76 238.37 7.28 271.00 7.28 407.19 41.67 14.51 29.32 16.37 22.69 43.45 18.22 7.28 19.28 343.12 12.75 14.56 424.46 9.09 8.47 5.45 7.28 7.28 22.43
RH Ezetimibe 10 MG Tab RH Famotidine 10 MG Inj Famotidine 20 MG Tab Febuxostat 40 MG Tablet RH Felodipine Ext-Rel 5 MG Tab RH Fenofibrate 145 MG Tab RH Fenofibrate 48 MG Tab RH Fentanyl Patch 12 MCG RH Fentanyl Patch C-II 100 MCG RH Fentanyl Patch C-II 25 MCG RH Fentanyl Patch C-II 50 MCG RH Fentanyl Patch C-II 75 MCG RH Ferr Sulfate 60 MG 5 ML Liq RH Ferrous Sul 325 MG Tab RH Fexofenadine 180 MG Tab RH Fibercon Tab RH Filgrastim 480 MCG Inj RH Finasteride 5 MG Tab RH Flecainide 100 MG Tab RH Fleet Enema RH Flex-All 454 8 Oz Top RH Florastor 250 MG RH Fluconazole 100 MG Tab RH Fluconazole 200 MG Inj RH Fluconazole/D5W 400 MG P-B RH Fludrocortisone 100 MCG Tab RH Flumazenil 0.1 MG Inj RH Fluorometholone O-S RH Fluoxetine 10 MG Cap RH Fluoxetine 20 MG Cap RH Fluphenazine 5 MG Tab RH Fluticasone Nasal Spr RH Fluticasone Oral 110 MCG Inh RH Fluticasone Oral 220 MCG Inh RH Fluticasone Oral 44 MCG Inh RH Folic Acid 1 MG Tab RH Foltx Tab RH Fondaparinux 10 MG Inj RH Fondaparinux 2.5 MG RH Fondaparinux Inj 5 MG RH Fondaparinux Injection 7.5 MG RH Formoterol Fumarate 12 MCG Cap RH Fosinopril 10 MG Tab RH Fosphenytoin NA Inj 50 MG/ML RH Furosemide 20 MG Tab RH Furosemide 40 MG Tab RH Furosemide 40 MG/4 ML Inj RH Gabapentin 100 MG Cap RH Gabapentin 300 MG Cap RH Gabapentin 400 MG Cap RH Galantamine 4 MG Tab RH Galantamine ER 8 MG Cap RH Gebauers Spray/Stretch 3.5 OZ RH Gemfibrozil 600 MG Tab RH Gentamicin 40 MG Inj RH Gentamicin Opth Oint 3.5 G RH Gentemicin 0.3% Eye Sol RH GI Cocktail RH Glimepiride 2 MG Tab RH Glipizide 10 MG Tab RH Glipizide 5 MG Tab
16.00 36.41 19.12 17.23 24.56 15.14 10.46 42.82 134.67 52.82 71.00 89.22 7.94 6.38 14.99 5.45 1215.51 27.32 20.11 20.01 52.91 4.42 50.07 269.29 198.63 9.09 218.49 65.55 38.24 38.24 8.78 227.60 236.69 395.68 168.01 6.38 6.38 489.67 144.01 271.50 391.07 117.93 12.75 16.33 6.38 6.38 46.91 10.01 18.22 19.88 14.32 26.58 42.12 10.01 24.56 62.79 39.97 25.49 7.28 10.93 7.28
RH Glipizide Ext-Rel 10 MG Tab RH Glipizide Ext-Rel 2.5 MG Tab RH Glipizide Ext-Rel 5 MG Tab RH Glucagon 1 MG Inj RH Glyburide 5 MG Tab RH Glyburide Prestab 3 MG Tab RH Glycerin Adult Supp RH Glycopyrrlocate 1 MG Tab RH Golytely Liq RH Guaifenesin LA 600 MG Tab RH Guaifenesin Liq 10 ML Syp RH Guaifenesin/Codeine 10 ML Liq RH Guaifenesin/Dextromo Tab RH Guaifensin/DM 10 ML Syp RH Halls Lozenges 25 RH Haloperidol 0.5 MG Tab RH Haloperidol 1 MG Tab RH Haloperidol 5 MG Inj RH Haloperidol 5 MG Tab RH Haloperidol Decanoate 50 MG/1 ML RH Heparin 1000 Units/ML 10 ML RH Heparin 5000 Units Inj RH Heparin Flush 100 U Inj RH Hydralaxine 25 MG Tab RH Hydralazine 10 MG Tab RH Hydralazine 50 MG Tab RH Hydrochlorothiazide 12.5 MG Tab RH Hydrochlorothiazide 25 MG Tab RH Hydrocodone/Apap 1 ML Liq RH Hydrocortisone 0.01 Crm RH Hydrocortisone 2.50% Crm RH Hydrocortisone 5 MG Tab RH Hydrocortisone Aceta 25 MG Sup RH Hydrocortisone Na Su 100 MG Inj RH Hydrogen Peroxide Liq RH Hydromorphone C-II 2 MG Tab RH Hydroxychloroquine 200 MG Tab RH Hydroxyurea 500 MG Cap RH Hydroxyzine Pamoate 25 MG Cap RH Hyoscyamine 0.125 MG Tab Hydroxyzine HCL 10 MG Tab RH Ibandronate 150 MG RH Iberet-Folic 500 Tab RH Ibuprofen 20 MG Piq RH Ibuprofen 200 MG Tab Ibuprofen 400 MG Tab RH Ibuprofen 600 MG Tab RH Imipramine Hcl 25 MG Tab RH Immune Globulin IV 1 GM Inj RH Indapamide 2.5 MG Tab RH Indomethacin 25 MG Cap RH Influenza Virus Vac 0.5 ML Inj RH Ins Aspart 70/30 100 Unit VL RH Insta Glucose Soln RH Insulin Human 50/50 100 Un Inj RH Insulin Human 70/30 100 Un Inj RH Insulin Human NPH 100 Unit Inj RH Insulin Human Regular 100 Un Inj RH Insulin Lispro 100 Un Inj RH Insulin Lispro 75/25 100 U Inj RH Ipratro/Albut Oral
12.75 3.65 7.28 265.94 7.28 9.09 10.93 4.39 76.48 9.09 7.44 8.47 5.45 5.45 7.04 12.90 6.38 47.73 6.38 198.27 27.81 16.37 9.09 6.38 5.45 5.45 7.74 7.28 7.28 23.66 32.79 5.00 9.09 9.52 7.28 10.93 21.85 15.83 6.38 9.09 5.45 285.64 10.93 20.70 9.09 7.28 7.28 6.38 255.27 7.28 6.38 33.12 115.89 14.56 122.80 122.80 122.80 122.80 145.68 157.91 450.90
RH Ipratropium Nasal RH Ipratropium Oral 14 GM Inh RH Iratropium Inhal Soln RH Irbesartan 150 MG Tab RH Iron Polysaccharide 150 MG Cap RH Iron Sucrose Inj 100 MG RH Isoniazid 100 MG Tab RH Isosorbide Dinit 40 MG SA Tab RH Isosorbide Dinitrate 10 MG Tab RH Isosorbide Mononitrate 20 MG Tab RH Isosorbide Mononitrate 30 MG Tab RH Isradipine SA 10 MG Tab RH Kayexalate/Sorbitol 0.25 GR Liq RH Ketoconazole 200 MG Tab RH Ketoconazole Crm RH Ketorolac 30 MG Inj RH Ketorolac Oph Soln Drp RH Labetalol 100 MG Tab RH Labetalol 300 MG Tab RH Lacosamide 100 MG RH Lacosamide Inj 200 MG RH Lacri-Lube O-O RH Lactated Ringers 1000 ML IV RH Lactobacillus Gran RH Lactulose 30 ML Syr RH Lamivudine 100 MG Tab RH Lamivudine/Zidovudine Tab RH Lamotrigine 100 MG Tab RH Lamotrigine 25 MG Tab Lanthanum Carbonate 500 MG Tab RH Latanoprost O-S Oph RH Leflunomide 10 MG RH Letrozole 2.5 MG Tab RH Levalbuterol 0.63 MG Soln RH Levalbuterol 3M 1.25 MG Soln RH Levalbuterol MDI Inh RH Levetiracetam 250 MG Tab RH Levetiracetam 500 MG Tab RH Levetiracetam Soln 500 MG/5 ML Levofloxacin 250 MG Premix RH Levofloxacin 250 MG Tab Levofloxacin 500 MG Tab RH Levofloxacin Premix 500 MG RH Levothroxine 112 MCG Tab RH Levothyroxine 100 MCG Inj RH Levothyroxine 100 MCG Tab RH Levothyroxine 125 MCG Tab RH Levothyroxine 25 MCG Tab RH Levothyroxine 50 MCG Tab RH Levothyroxine 75 MCG Tab RH Levothyroxine 88 MCG Tab RH Lidocaine 1% Inj 10 ML RH Lidocaine 2% Jelly RH Lidocaine 2% Sol RH Lidocaine Inj RH Lidocaine Patch 5% 5 RH Lidocaine Uro-Jet 2% RH Lidocaine Viscous Soln RH Linagliptin 5 MG Tab RH Linezolid 600 MG Tab RH Linezolid Premix 600 MG Inj
142.47 583.00 24.85 15.03 7.28 219.52 4.56 10.93 6.38 13.76 13.59 15.74 28.69 9.16 100.15 51.88 236.69 7.28 7.28 23.36 134.01 72.84 18.22 6.78 32.14 33.53 68.29 18.12 18.72 9.09 163.86 7.95 31.05 13.25 13.25 164.70 9.78 16.37 11.40 99.97 45.89 53.54 216.31 6.38 191.01 6.38 7.28 5.45 5.45 5.45 5.45 5.25 29.14 24.56 24.56 27.73 23.39 15.29 25.96 270.89 334.55
RH Liothyronine 25 MCG Tab RH Liothyronine 5 MCG Tab RH Lisinopril 10 MG Tab RH Lisinopril 20 MG Tab RH Lisinopril 5 MG Tab Lithium Carbonate 300 MG Cap RH Loperamide 2 MG Cap RH Loperamide Susp 4 Oz RH Loratadine 10 MG Tab RH Loratadine/Pseudoep 5/120 MG Tb RH Lorazepam C-IV 0.5 MG Tab RH Lorazepam C-IV 1 MG Tab RH Lorazepam C-IV 2 MG Inj RH Losartan 25 MG Tab RH Losartan 50 MG Tab RH Loteprednol Etabonate .50% Drp RH Lotrisone 45 Gram Crm RH Lubiprostone 24 MCG Cap RH Lubiprostone 8 MCG Cap RH Lubriderm Lotion RH Magic Mouthwash RH Magnesium Citrate 300 ML Soln RH Magnesium Cl 64 MG Tab RH Magnesium Oxide 400 MG Tab RH Magnesium Sulfate 500 MG Inj RH Mannitol 25% 50 ML Inj RH Meclizine 12.5 MG Tab RH Medroxyprogesterone 5 MG Tab RH Megestrol 400 MG/10ML Susp RH Megestrol Acetate 20 MG Tab RH Melatonin 3 MG Tab RH Meloxiacm 7.5 MG Tab RH Memantine 5 MG Tab RH Meperidine C-II 50 MG Inj RH Meperidine C-II 50 MG Tab RH Meropenem 1 GM Inj RH Mesalamine 400 MG Tab RH Mesalamine Cr 250 MG RH Mesalamine Enema 4 Grams RH Metaxalone 800 MG Tab RH Metformin 500 MG Tab RH Metformin 500 MG XR Tab RH Metformin 850 MG Tab RH Methadon C-II 10 MG Tab RH Methimazole 5 MG Tab RH Methocarbamol 500 MG Tab RH Methocarbamol 750 MG Tab RH Methotrexate 2.5 MG Tab RH Methotrexate 25 MG Inj RH Methylphenidate C-II 5 MG Tab RH Methylpred Na Succ 125 MG Inj RH Methylpred Na Succ 40 MG Inj RH Methylpredisolone 80 MG Inj RH Methylprednisolone 4 MG Tab RH Methylprednisolone 40 MG Inj RH Metoclopramide 5 MG Inj RH Metoclopramide 5 MG Tab RH Metolazone 2.5 MG Tab RH Metoprolol 100 MG Tab RH Metoprolol 25 MG Tab RH Metoprolol 50 MG Tab
5.62 4.31 7.28 16.03 8.19 6.38 10.93 20.48 37.33 29.14 10.93 9.09 27.32 15.83 19.12 165.54 245.81 13.95 14.05 32.51 88.77 23.66 5.45 7.28 47.64 10.86 5.45 5.61 12.27 5.45 3.22 16.13 15.38 15.49 8.47 287.68 10.93 5.00 157.77 11.59 9.09 7.02 14.56 5.45 3.55 7.28 7.28 12.75 36.41 11.83 26.41 25.49 50.03 7.28 28.85 24.56 6.38 11.72 11.29 5.00 9.57
RH Metoprolol Succ 25 MG XL Tab RH Metoprolol Succinate 100 MG XL RH Metoprolol Succinate 50 MG XL T RH Metronidazole 250 MG Tab RH Metronidazole 500 MG Tab RH Metronidazole Premix 500 MG Inj RH Mexiletine 150 MG Cap RH Mexiletine Hcl 200 MG Cap RH Micafungin 100 MG Inj RH Miconazole 100 MG Vag Supp RH Miconazole Nit 2% Cr RH Miconazole Nit Crm RH Miconazole Vag 200 MG Supp RH Midodrine 2.5 MG Tab RH Midodrine 5 MG Tab RH Milk Of Mag Conc 30 ML Sus RH Mineral Oil 30 ML RH Minocycline 50 MG RH Minoxidil 10 MG Tab RH Minoxidil 2.5 MG Tab RH Mirtazapine 15 MG Tab RH Misoprostol 100 MCG Tab RH Modafinil C-IV 100 MG Tab RH Montelukast 10 MG Tab RH Morphine 15 MG Tab RH Morphine Inj C-II 10 MG Inj RH Morphine Soln C-II 2 MG Soln RH Morphine SR C-II 15 MG Tab RH Moxifloxacin 0.5% Oph 3 ML RH Multivitamin & Mineral Tab RH Multivitamin 5 ML Liq RH Multivitamin Tab RH Mupirocin 2% Oint 22 G RH Mycophenolate 250 MG Cap RH Mylanta 30 ML Susp RH Nabumetone 500 MG Tab RH Nadolol 20 MG Tab RH Nafcillin 1 GM Inj RH Nafcillin 2 GM Inj RH Naloxone 0.4 MG Inj RH Naproxen 250 MG Tab RH Nateglinide 60 MG Tab RH Nebivolol 5 MG Tab RH Neo/Poly/Gram O-S RH Neom/Poly/HC Otic Sus Neomycin/Bac/Hc Oph RH Nephrocaps Cap RH Neutra-Phos 250 MG Packet RH Niacin 100 MG Tab RH Niacin 250 MG ER Cap RH Niacin 500 MG ER Cap RH Nicardipine 20 MG Tab RH Nicardipine 30 MG SR Cap RH Nicotine Patch 14 MG/Day RH Nicotine Patch 21 MG/Day RH Nicotine Patch 7 MG/Day RH Nifedipine 10 MG Cap RH Nifedipine 30 MG XL Tab RH Nifedipine 60 MG XL Tab RH Nimodipine 30 MG Cap RH Nisoldipine 10 MG XR Tab
5.00 13.59 9.57 7.28 7.28 60.09 4.47 4.47 473.63 78.29 78.29 27.32 78.29 6.96 15.03 7.28 9.09 5.97 13.76 5.45 30.93 7.28 63.90 15.03 7.28 27.59 11.29 13.59 149.72 7.28 11.29 7.28 144.50 16.37 11.29 20.01 16.03 65.73 69.20 27.59 8.19 6.12 6.98 93.22 116.10 282.46 4.56 7.28 5.45 5.45 13.59 4.12 7.28 16.37 36.41 16.37 7.28 12.75 10.01 45.52 14.56
RH Nitro Oral Spray RH Nitrofurantoin 100 MG Cap RH Nitrofurantoin 50 MG Tab RH Nitroglycerin 0.4 MG Tab RH Nitroglycerin 0.8 MG/Hr Patch RH Nitroglycerin 1 Gram Oint RH Nitroglycerin 30 GR Oint RH Nitroglycerin Patch 0.1 MG/Hr RH Nitroglycerin Patch 0.2 MG/Hr RH Nitroglycerin Patch 0.3 MG/Hr RH Nitroglycerin Patch 0.4 MG/Hr RH Nitroglycerin Patch 0.6 MG/Hr RH Nortriptyline 10 MG Cap RH Nortriptyline 25 MG Cap RH Nystatin 5 ML Susp RH Nystatin Cream RH Nystatin Powder RH Nystatin/Triamcin Cream RH Octreotide Acetate 0.05 MG Amp RH Ocuvite RH Odansetron 4 MG Tab RH Olanzapine 2.5 MG Tab RH Olmesartan 20 MG Tab Olmesartan 5 MG Tab RH Olopatadine O-S RH Omacor 1000 MG Cap RH Omeprazole 20 MG Cap RH Ondansetron 2 MG Inj RH Orajel Mouth Gel RH Orphenadrine 100 MG ER Tab RH Oxacillin 2 GM Inj RH Oxcarbazepine 300 MG Tab RH Oxybutynin 3.9 MG Patch RH Oxybutynin 5 MG Tab RH Oxybutynin 5 MG XL Tab RH Oxycodone C-II 15 MG Tab RH Oxycodone C-II 5 MG Tab RH Oxycodone CR C-II 10 MG Tab RH Oxycodone CR C-II 40 MG Tab RH Oxycodone/Apap 10 MG Tab RH Oxycodone/Apap 7.5 MG Tab RH Oxymetazoline Spr RH Pancrelipase Cap RH Pantoprazole 40 MG Inj RH Pantoprazole 40 MG Tab RH Pantoprazole Packet 40 MG RH Paricalcitol 1 MCG Cap RH Paricalcitol 2 MCG/ML Inj RH Paricalcitol 5 MCG/1 ML Inj RH Paroxetine 10 MG Tab RH Paroxetine 20 MG Tab RH Paroxetine CR 12.5 MG Tab RH Peg 3350 17 GR PDR RH Pen G 20 Million RH Penicillin G Benzathine 2.4 Mln RH Penicillin VK 250 MG RH Pentazocine/Nal C-IV 50 MG Tab RH Pentoxifylline 400 MG Tab RH Phenazopyridine 100 MG Tab RH Phenobarbital C-IV 15 MG Tab RH Phenobarbital C-IV 30 MG Tab
103.79 20.01 12.75 5.38 33.71 7.28 39.14 12.75 12.75 12.75 21.85 16.37 7.28 7.28 17.84 25.49 91.07 39.97 51.31 7.28 61.34 47.37 8.36 7.22 271.67 5.38 50.98 109.24 39.97 17.96 65.73 10.75 50.84 7.28 15.03 6.64 10.93 14.94 31.51 13.06 8.78 11.83 9.03 17.37 19.62 18.35 30.93 23.23 58.01 18.56 28.21 18.61 13.25 93.71 395.78 3.83 12.75 11.83 7.28 5.45 5.45
RH Phenytoin 100 MG Cap RH Phenytoin 100 MG Susp RH Phenytoin Sodium 50 MG/ML VL RH Phytonadione 10 MG/ML Inj RH Phytonadione 5 MG Tab RH Pilocarpine 6% O-S RH Pilocarpine O-S RH Pindolol 5 MG Tab RH Pioglitazone 15 MG Tab RH Pioglitazone 30 MG Tab RH Pioglitazone 45 MG Tab RH Pipracillin/Tazobact 2.25 GM Inj RH Pipracillin/Tazobact 3.375 GM Inj RH Pipracillin/Tazobact 4.5 GM Inj RH Pneumococcal Vaccine 25 MCG RH Polytrim Opth Soln 10 ML RH Potassium Cl 10 MEQ Tab RH Potassium Cl 20 MEQ Inj RH Potassium Cl 20 MEQ Liq RH Potassium Cl 20 MEQ Tab RH Povidone-Iodine Sol RH Pramipexole 0.25 MG Tab RH Pramipexole 1 MG Tab RH Prasugrel 10 MG Tab RH Pravastatin 20 MG Tab RH Prazosin 1 MG Cap RH Prednisolone Ace O-S RH Prednisone 1 MG Tab RH Prednisone 10 MG Tab RH Prednisone 20 MG Tab RH Prednisone 5 MG Tab RH Pregabalin 25 MG Cap RH Pregabalin 50 MG Cap RH Pregabalin 75 MG Cap RH Pregablin 100 MG Cap RH Prenatal Vitamin RH Preparation H Oint RH Primaxin 500 MG IV RH Primidone 250 MG Tab RH Primidone 50 MG Tab RH Probenecid 500 MG Tab RH Prochlorperazine 5 MG Tab RH Proctofoam-HC Foam 10 G RH Promethazine 25 MG Inj RH Promethazine 25 MG Supp RH Promethazine 25 MG Tab RH Propafenone 150 MG Tab RH Propafenone 225 MG SR Cap RH Propafenone 325 MG SR Cap RH Propranolol 10 MG Tab RH Propranolol 40 MG Tab RH Propranolol 60 MG LA Cap RH Propranolol 80 MG LA Cap RH Pseudoephedrine 60 MG Tab RH Psyllium Pkt Pow RH Pyridostigmine 60 MG Tab RH Pyridoxine 50 MG Tab RH Pyrimethamine 50 MG RH Quetiapine 100 MG Tab RH Quetiapine 25 MG Tab RH Quinapril 10 MG Tab
7.28 10.19 23.16 29.14 11.29 41.88 10.93 7.28 18.88 32.68 33.95 72.84 95.34 141.71 206.64 30.94 6.38 24.56 11.29 9.09 25.49 7.02 14.82 23.01 4.22 5.45 65.55 5.45 7.28 5.45 7.28 8.53 8.53 8.53 8.53 3.73 14.56 112.89 5.45 5.45 7.28 5.00 128.36 24.56 20.01 6.38 14.56 21.61 28.40 6.38 6.38 7.28 7.28 6.38 7.28 5.00 5.45 3.51 26.03 15.03 14.56
RH Quinidine Gluconate 324 MG Tab RH Quinidine Sulfate 200 MG Tab RH Quinine Sulfate 324 MG Cap RH Raloxifene 60 MG Tab RH Ramipril 2.5 MG Cap RH Ramipril 5 MG Cap RH Ranitidine 150 MG Tab RH Ranolazine 500 MG ER Tab RH Rifampin 300 MG Cap RH Rifampin 600 MG Inj RH Risedronate 35 MG Tab RH Risperidone 0.25 MG Tab RH Risperidone 1 MG Tab RH Ritonavir 100 MG Cap RH Rivaroxaban 10 MG Tab RH Rivastigmine 1.5 MG Cap RH Rivastigmine 4.5 MG Cap RH Rivastigmine 4.6 MG/24 Hr Patch RH Rivastigmine 9.5 MG/24 Hr Patch RH Ropinirole 0.25 MG Tab RH Ropinirole 1 MG Tab RH Rosuvastatin 10 MG Tab RH Saline Nose Drops RH Saliva Substitute RH Sargramostim 250 MCG VL RH Scopolamine Patch RH Selegiline 5 MG Tab RH Selenium Sulfide 1% Shampoo 21 RH Senna Syrup 10 ML RH Sertraline 25 MG Tab RH Sertraline 50 MG Tab RH Sevelamer 800 MG Tab RH Silver Nitrate Stick RH Silver Sulfadiazine 1% Cr 50 G RH Simethicone 80 MG Chew Tab RH Simvastatin 10 MG Tab RH Simvastatin 20 MG Tab RH Simvastatin 40 MG Tab RH Sitagliptin 50 MG Tab RH Sodium Bicarbonate 650 MG Tab RH Sodium Chloride 0.45% 1000 ML RH Sodium Chloride 0.9% 100 ML RH Sodium Chloride 0.9% 1000 ML RH Sodium Chloride 0.9% 250 ML RH Sodium Chloride 0.9% 500 ML RH Sodium Chloride 1 G Tab RH Sodium Chloride 3% 500 ML RH Sodium Chloride Flush RH Sodium Chloride Irr 1000 ML Solifenacin 5 MG Tab RH Sorbitol 70% Soln 30 ML RH Sotalol 120 MG Tab RH Sotalol 80 MG Tab RH Spironolactone 25 MG Tab RH Sterile Water Irrig 1000 ML RH Sucralfate 1 G Tab RH Sucralfate 1 G/10 ML Susp RH Sulfa/Trimetho DS Tab RH Sulfa/Trimethoprim 20 ML Susp RH Sulfasalazine 500 MG Tab RH Sumatriptan 25 MG Tab
5.62 7.28 20.51 15.03 13.76 18.22 24.56 14.26 10.01 353.44 91.07 18.47 29.14 31.30 25.84 14.89 14.89 27.36 27.07 9.09 9.93 17.39 30.60 20.70 561.23 15.49 32.79 11.55 11.29 11.83 11.83 12.00 5.45 34.60 5.45 27.32 27.77 29.20 25.17 5.45 96.52 43.70 58.26 85.56 85.56 5.38 37.02 9.09 47.64 14.74 9.09 24.50 23.66 6.38 47.64 13.66 21.85 13.66 16.03 4.39 47.64
RH Sumatriptan 6 MG/0.5 ML Inj RH Symbicort 160/4.5 RH Symbicort 80/4.5 RH Tacrolimus 1 MG Cap RH Tamoxifen 10 MG Tab RH Tamsulosin 0.4 MG Cap RH TB Skin Test RH Tears Artificial 15 ML 0-S RH Telmisartan 40 MG Tab RH Temazepam 15 MG Cap Temozolomide 20 MG Cap RH Tenofovir Disproxil 300 MG Tab RH Terazosin 1 MG Tab RH Terazosin 5 MG Cap RH Terbinafine Hcl 250 MG Tab RH Testosterone Cypionate 200 MG/1 RH Tetracycline 250 MG Cap RH Theophylline 200 MG Cap 24 Hr RH Theophylline 80 MG/15 ML Liq RH Theophylline Anhy SR 100 MG Tab RH Theophylline ER 200 MG Tab RH Theravac-Plus Enema RH Thiamine 100 MG Inj RH Thiamine 100 MG Tab RH Thiothixene 1 MG Cap RH Thyroid 30 MG Tab RH Ticagrelor 90 MG Tab Tigecycline 500 MG Inj RH Timolol O-Gel RH Tiotropium 18 MCG Inhalation Ca RH Tizanidine 4 MG Tab RH Tobradex Oph Oint RH Tobramycin 40 MG Inj RH Tobramycin O-S RH Tobramycin/Dexameth Sus RH Tolvaptan 15 MG Tab RH Topiramate 100 MG Tab RH Topiramate 25 MG Tab RH Torsemide 20 MG Tab RH Tramadol 50 MG Tab RH Trandolapril 4 MG Tab RH Travoprost 0.004% Ophth 2.5 ML RH Trazodone 50 MG Tab RH Triamcinolone 0.1% Cream RH Triamcinolone Acet 0.10% Oint RH Triamcinolone Acet 0.10% Top RH Triamcinolone Acet 40 MG Inj RH Triamcinolone Acet Cream RH Triamcinolone Dental RH Triamterene/Hctz 25 MG Tab RH Trifluoperazine 5 MG Tab RH Trihexyphenidyl 2 MG Tab RH Trihexyphenidyl 5 MG Tab RH Trimethoprim 100 MG Tab RH Truvada 200/300 Tab RH Tucks 40s RH Ursodiol 300 MG Cap RH Valacyclovir 500 MG Tab RH Valganciclovir 450 MG Tab RH Valproic Acid 250 MG Cap RH Valproic Acid Syrup 50 MG/ML
140.67 385.04 334.75 26.41 12.75 14.94 25.49 21.85 8.78 10.93 70.26 68.61 20.01 21.85 38.88 91.26 19.70 4.14 12.41 5.00 6.38 16.03 10.93 5.45 4.39 7.28 13.01 253.58 70.11 202.59 15.49 198.63 30.06 72.84 150.23 791.30 20.53 15.03 10.93 11.83 6.64 215.19 7.28 69.50 40.06 98.32 56.45 40.06 72.84 7.28 6.04 5.45 5.92 5.45 134.89 8.95 31.88 33.71 150.56 20.01 0.62
RH Valsartan 160 MG Tab RH Valsartan 40 MG Tab RH Valsartan 80 MG Tab RH Vancomycin 1000 MG Inj RH Vancomycin 500 MG Inj RH Venlafaxine 25 MG Tab RH Venlafaxine 37.5 MG Tab RH Venlafaxine 37.5 MG XR Cap RH Venlafaxine 75 MG Tab RH Venlafaxine 75 MG XR Cap RH Verapamil 120 MG Tab RH Verapamil 40 MG Tab RH Verapamil SR 120 MG Tab RH Verapamil SR 180 MG Tab RH Verapamil SR 240 MG Tab RH Vitamin A 10000 U Cap RH Vitamin D 1000 Units Tab RH Vitamin D 400 Units RH Vitamin D 400 Units Tab RH Vitamin E 1000 IU Cap RH Vitamin E 400 IU Cap RH Warfarin 1 MG Tab RH Warfarin 10 MG Tab RH Warfarin 2 MG Tab RH Warfarin 2.5 MG Tab RH Warfarin 3 MG Tab RH Warfarin 4 MG Tab RH Warfarin 5 MG Tab RH Warfarin 7.5 MG Tab RH Zinc Sulfate 220 MG Cap RH Ziprasidone 20 MG Cap RH Ziprasidone Inj 20 MG RH Zolpidem C-IV 5 MG Tab ABO/Rh Typing (E) Respiratory Care Miscellaneous Routine Oxygen Therapy Short Stay Oxygen Use/Day Estim Auric Acupuncture Pnt 15 Minutes Pro Fee Evaluation Each 15 Minutes OT Modality Each 15 Minutes Prolotherapy Cervical/Thoracic Pro Fee Prolotherapy Elbow/Wrist/Hand Pro Fee Prolotherapy Hip Pro Fee Prolotherapy Knee/Ankle/Foot Pro Fee Prolotherapy Localized Prolotherapy Shoulder Pro Fee Radiology Offsite Service Therapist 1 Hour Tr Group Therapy Each 15 Minutes Tr Individual Therapy Apixaban 2.5MG Tab Apixaban 5MG Tab Tapentadol 50MG Tab Tapentadol 75MG Tab Testosterone 4MG Patch Hydralazine Inj 20 MG/ML Metoprolol Inj 5 MG/5 ML Metronidazole Gel 0.75% 45 Gram Vitamin D 5000 Units Cap Filgrastim 300 MCG Injection Lactobacillus GG
10.27 9.48 20.48 57.36 30.06 17.29 20.01 13.74 15.03 23.66 20.01 7.28 16.37 10.93 8.19 9.09 4.68 3.73 7.28 5.45 6.38 6.38 7.28 6.38 7.28 12.75 7.28 7.28 7.28 5.45 26.90 61.51 23.66 0.00 $0.00 112.00 225.00 66.00 98.00 98.00 203.00 133.00 232.00 180.00 98.00 191.00 0.00 134.00 98.00 98.00 14.48 15.05 8.72 10.26 38.56 43.42 13.31 740.88 4.63 764.03 3.82
Levetiracetam 750 MG Tab 22Q11.2 Del/Dup Fish-Mayo ABG With Cooximetry Alk Phosphatase Isoenzymes Allergen Specific-10 Allergens Allergen Specific-11 Allergens Allergen Specific-12 Allergens Allergen Specific-13 Allergens Allergen Specific-14 Allergens Allergen Specific-15 Allergens Allergen Specific-16 Allergens Allergen Specific-17 Allergens Allergen Specific-18 Allergens Allergen Specific-19 Allergens Allergen Specific-2 Allergens Allergen Specific-20 Allergens Allergen Specific-3 Allergens Allergen Specific-4 Allergens Allergen Specific-5 Allergens Allergen Specific-6 Allergens Allergen Specific-7 Allergens Allergen Specific-8 Allergens Allergen Specific-9 Allergens Alpha-1-Antitrpsn Phenoty-Mayo Amitrip Nortrip-Mayo AML Target Gene Panel Uslabs Amylase Isoenzymes-Arup 20804 ANA Profile Expanded ANCA Panel For Vasculitis-Mayo Aneuploidy Det Fish-Mayo AP Cytogenetics AP Cytogenetics Bill Only Autoim Lymphoprolf Syn Pn-Mayo B Burgdorferi Ab CNS Inf-Mayo B Pertussis Ab Igg Igm-Arup Bart Ab Pn CSF By IFA-Mayo Bart Ab Pn Igg And Igm-Mayo BCR/Abl Fish Beta 2 Glycoprotein Ab Panel Bilirubin Fractionated Bilirubin Neonatal Blood Gases & Lactate Istat Brucella Ab Igg And Igm-Mayo Bun/Creatinine Calcium W Corrected Ca And Alb Cancer Cytogenetics Cardiolipin Ab Screen-Mayo Catecholamines Urine-Mayo CBC Plt Manual Diff CBC With Manual Diff CD4 Helper T-Cells Arup 95885 CD4/CD8-Arup-95950 Chlamydia Serology-Mayo Chrom Analysis Congenital-Mayo Chrom Autopsy/Conc/Still-Mayo Chronic Hepatitis Panel CLL Target Gene Panel Uslabs Clostridium Difficile Tox Assy CMV Culture Comp Chem 1 Comp Chem 2
17.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 112.00 223.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 110.00 0.00 0.00 0.00
Comp Chem Survey I Comp Chem Survey II Comprehensive Hepatitis Profile Cortisol 24 Hour Urine-Mayo Coxiella Burnetti Antibodies Coxsackie A Ab Pn CSF-Mayo Coxsackie A Ab Pn-Mayo Coxsackie B Ab Pn-Mayo Cryoglobulin-Mayo Culture Afb Smear Culture Feces Pathogens Culture Only Fungus Drugs Of Ab Scr Meconium-Mayo EBV Ab Igg Igm And Ebna-Mayo Electrolytes Urine Epstein-Barr Virus Antibody Pr Factor VIII Inhib Scr Pn-Mayo Fecal Electrolytes Flow Cyto 16 Or More Markers CHOA Flu A/B Offsite Fungal Ab Survey CSF-Mayo Fungal Ab Survey-Mayo GC/Chlamydia DNA Probe General Health Profile Giardia/Cryptosporidium Ag Gliadin Ab Eval Iga & Igc-Mayo Glucose Tol Prenatal 3 Hr Glucose Tot Oral 2 H.Pylori Breath Analy And Coll Heavy Metal Screen 24 Hr Urine-Mayo Heavy Metals Screen-Mayo Hemoglobin & Hematocrit Histoplasma Antibody Screen-Mayo HIV Antib 1/2 Confir Eval Mayo HIV1 Phenotype Arup HSV Type 1 & 2 Igg HSV Type 1 & 2 Igg/Igm Ab HSV Type 1/2 Igm Ab Mayo HSV Types 1 And 2 Ab Igg-Mayo IC Source Bill Only Igg Index CSF Igg Subclasses-Mayo Immunoglobulin Complete Quant Inflamm Bowel Dis Pn-Mayo Influ Vir A Ab Igg Igm-Mayo Influ Vir B Ab Igg Igm-Mayo Influenza A/B Inhibin A And B Tumor Mkr Mayo Iron & IBC Kappa/Lambda Free Light Chains L/S Ratio (INC Creatinine) LDH Isoenzymes-Mayo Liver Tests Without Albumin Lupus Type Anticoagulant Lyme Dis Ab Confirm CSF-Mayo Maternal Quad Screen MDS Target Gene Panel Uslabs Mercury Level 24 Hr Urine-Mayo MM-MGUS Target Gene Panel Uslab Myasthenia Gravis Eval Adult Nbn Aneuploidy Det Fish-Mayo
0.00 0.00 309.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 78.00 0.00 0.00 0.00 0.00 222.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Neutroph Oxidative Burst-Mayo NMR Lipoprofile - Mayo O And P Comprehensive Offsite Istat Chem 7 Oligoclonal Banding-Mayo OR Electrolytes OR Panel 6 OR Panel 7 Arterial OR Panel 7 Venous OR Panel 8 Arterial OR Panel 8 Venous Oxalate 24 Hour Urine-Mayo P2Y12 Inhibition Parvovirus B19 Antibodies PCHE Dibuc Inhib-Mayo Pi-Linked Antigen PNH By Flow Uslabs Panel 8 EC UCC Lab Panel 3 Lab Panel 7 Porphyrins Quantitative Urine-Mayo Prenatal Profile II Primidone & Phenobarbital-Mayo Prion Testing Protein/Creatinine 24 Hr Urine Protein/Creatinine Random Urine PTT-D Heparin Reflex Bill Only RBC Enzyme Evaluation-Mayo Reference Lab Test Reticulin Antibody-Mayo Rickettsia Antibody Panel-Mayo RSV Antibody Igg/Igm-Mayo S Pneumo Igg 23 Serotyp-Mayo S Pneumo Igg 7 Serotyp Comp 1 Subtel Reg Anom Fish-Mayo A Subtel Reg Anomal Fish-Mayo B Sweat Chloride Analysis T- & B-Cell Qn By Flow-Mayo Testosterone Free Mayo Tetan & Diphth Igg Sgl Srm Thyroid Profile Tiss Transglut Ab Iga Igg-Mayo Torch Igm Without Rubella T-Uptake T4 And Cal FTI VMA/Homovanillic Ped Urine-Mayo Von Willebrand Profile-Mayo W Nile Vir Ab Igg Igm CSF-Mayo Rivaroxan 15MG Tab Insulin Detemir 10 ML Darunavir 800 MG Tab Albumin 25% Inj 25 G/100 Ml Myobloc 2500U Rimabotulintx B Myobloc 5000U Rimabotulintx B Senna 8.6 Mg Tab Senna/Docusate Sodium 8.6 Mg Tab Timolol O-S Mesalamine Del-Rel 1.2 Grams Synthetic Cannab, Expand - Mayo Roflumalist 500 Mcg Tab Lead Occup Exp Profile-Mayo Crossmatch AHG Gel (E)
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 118.00 0.00 0.00 0.00 0.00 0.00 0.00 28.94 104.74 120.28 $0.00 0.00 0.00 9.09 9.09 81.94 22.05 0.00 32.53 0.00 $0.00
Danazol 50 Mg Cap Fecal Lytes/Osmol Panel-Mayo Betamethasone Dipro Lotion Tapentadol 100 MG Tab Tacrolimus 0.5 Mg Cap Herpes Simplex Virus 1 and 2 IC Source Panel Order Leukocyte Adhesion Def - Mayo Rubeola AB IGG IGM, CSF-Mayo 15Q Del Char Reflex Fish - Mayo Testost Tot/Free - Child/Female Recurrent GI Distress PNL - ARUP Bumetanide 1 Mg Inj Coxsackie B AB PN CSF - Mayo Cardiolipin IGG/IGM Panel - Mayo B2GP1 IGG/IGM - Mayo Lithium Carbonate 150 Mg Levofloxacin Inj 750 Mg Mirabegron 25mg SA Tab Dapagliflozin 10 Mg Tab Lymph Sub 5-CD19/CD4/CD8 - ARUP Advair HFA 45/21 Advair HFA 115/21 Advair HFA 230/21 Docosanol Cream 10% Rapid Thromboelastography TEG Thromboelastography TEC Thromboelastography TEG Heparinase Platelet Mapping TEG CMG Buprenorphine 20 Mcg Patch QTC No Show Fee Onabotulinumtoxin A (Botox) Inj 200 Units Ivabradine 5 Mg Tab Torsemide 10 Mg Tab Linaclotide 145 mcg Cap Emergency Room Offsite Service Respiratory Offsite Service Levocarnitine Inj 1 Gram MCN Independent Medical Eval MCN No Show / 24 Hr Late Cancel LHI Appointment Cancel / No Show Entresto 24 mg-26 mg tab Morphine SR 100 Mg Tab Pneumococcal-13 Inj Chlorothiazide Inj 500 mg Nuedexta 20 - 10 Mg Cap Canagliflozin 300 Mg Tablet Sodium Bicarbonate Inj 50 Meq Methylnaltrexone 12mg Inj Trach Care CGRH Oseltamivir 75 MG Cap (10/Pk) CGRH Albuterol Repetab 4 Mg Tab Amphetamine Salt 20mg Oxazepam Cap 15mg Tadalafil 5 Mg Tablet Empagliflozin 10mg Tab Lyme IgG/IgM total Ab Penciclovir Cream 1% RH Clonazepam C-IV 1 Mg Tab RH Theophylline ER 300 Mg Tab
6.07 0.00 124.04 13.50 7.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.99 0.00 0.00 0.00 3.31 198.45 27.25 31.97 0.00 483.00 483.00 714.00 40.52 0.00 0.00 0.00 0.00 0.00 227.85 50.00 0.00 15.00 9.51 32.30 0.00 0.00 100.00 750.00 35.00 50.00 14.40 22.00 394.00 480.00 34.00 30.00 21.40 240.00 111.00 38.01 11.01 5.15 3.30 26.50 $39.20 $0.00 858.85 11.98 7.75
Mexilitine 250mg Cap Guaifenesin/Pseudo 600/60 Ferric Citrate 210 mg Tab Misc Home Medication Anoro Inhaler 625.mcg-25mcg Ticagrelor 60mg Tablet Ciprodex 7.5 mL Dymista Nasal Spray 23gm Lidocaine/Prilocaine Cream 5gm Dibucaine Oint 2oz Lidocaine Cream 15gm Levetiracetam Inj 500mg Dolutegravir Tab 50mg Tedizolid Tab 200mg Griseofulvin 500 mg Tab Duoneb Inhalation 3 mL Midodrine 10mg tab Vancomycin 750mg Inj Magnesium Premix 1 gram Magnesium Premix 4 gram
8.75 3.30 $16.05 0.00 265.50 13.55 525.00 450.30 20.10 13.90 48.00 31.50 165.80 833.85 21.30 15.15 24.30 35.40 22.20 22.20
