TidalHealth Peninsula Regional "Update May 31, 2023" Negotiated Fee Negotiated Fee Negotiated Maximum Fee Negotiated Maximum Fee Negotiated Minimum Fee Negotiated Minimum Fee Discounted Cash Price Discounted Cash Price Charge Description Master Payor Plan Revenue Code CPT/HCPCS Gross Charge Inpatient Outpatient Inpatient Outpatient Inpatient Outpatient Inpatient Outpatient .035 180CM INQWIRE WIRE J TIP All Payors / Plans All Payors / Plans $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.11 $12.11 1.5MM LONG DRILL BIT All Payors / Plans All Payors / Plans $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $143.94 $143.94 1.6 K-WIRE All Payors / Plans All Payors / Plans $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $299.88 $299.88 1.8 DRILL BIT SHORT All Payors / Plans All Payors / Plans $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $275.18 $275.18 1.8MM DRILL BIT SHORT All Payors / Plans All Payors / Plans $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $169.34 $169.34 1.8MM SHORT DRILL BIT All Payors / Plans All Payors / Plans $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $169.34 $169.34 1.8MM SHORT DRILL BIT MINI PLATING SYSTEM All Payors / Plans All Payors / Plans $176.80 $176.80 $176.80 $176.80 $176.80 $176.80 $176.80 $173.26 $173.26 19GA ACQUIRE NEEDLE All Payors / Plans All Payors / Plans " $1,166.00 " " $1,166.00 " " $1,166.00 " " $1,166.00 " " $1,166.00 " " $1,166.00 " " $1,166.00 " " $1,142.68 " " $1,142.68 " 2.0 DRILL BIT SHORT All Payors / Plans All Payors / Plans $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $169.34 $169.34 2.0 MM K-WIRE 150 MM All Payors / Plans All Payors / Plans $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $64.68 $64.68 2.0MM DRILL BIT HAND INNOVATIONS All Payors / Plans All Payors / Plans $163.75 $163.75 $163.75 $163.75 $163.75 $163.75 $163.75 $160.48 $160.48 2.0MM DRILL BIT SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.0MM DRILL SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.0MM DRILL W AO SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 "2.0MM DRILL W/AO QC, SHORT" All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.0MM K-WIRE All Payors / Plans All Payors / Plans $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $299.88 $299.88 2.0MM LONG DRILL BIT All Payors / Plans All Payors / Plans $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $143.94 $143.94 2.0MM SHORT DRILL BIT All Payors / Plans All Payors / Plans $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $169.34 $169.34 2.4 DRILL BIT All Payors / Plans All Payors / Plans $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $275.18 $275.18 2.5MM DRILL BIT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.5MM DRILL BIT HAND INNOVATIONS All Payors / Plans All Payors / Plans $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $173.95 $173.95 2.5MM DRILL BIT LONG All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.5MM DRILL BIT SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.5MM DRILL SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 "2.5MM DRILL W AO QC, SHORT" All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.5MM DRILL W AO SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 "2.5MM DRILL W/AO QC, SHORT" All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 2.7MM OVER DRILL W AO QC LONG All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 25+ FINESSE FLEX LOOP All Payors / Plans All Payors / Plans $242.94 $242.94 $242.94 $242.94 $242.94 $242.94 $242.94 $238.08 $238.08 3.0 MM X 1000MM BALL TIP GUIDE ROD All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 3.0 MM X1000MM BALL TIP GUIDE ROD All Payors / Plans All Payors / Plans $128.75 $128.75 $128.75 $128.75 $128.75 $128.75 $128.75 $126.18 $126.18 3.0MM BALL TIP GUIDE ROD All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 3.0MM BALL TIP GUIDE WIRE All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 3.0MM X 100MM BALL TIP GUIDE ROD All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 3.0MM X 100MM GUIDE ROD All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 3.0MM X1000MM BALL TIP GUIDE PIN All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 3.0MM X1000MM BALL TIP GUIDE ROD All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 3.2 MM X 343 MM GUIDE PIN All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 3.2MM GUIDE PIN X 343MM All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 3.2MM X 300MM GUIDE PIN All Payors / Plans All Payors / Plans $102.34 $102.34 $102.34 $102.34 $102.34 $102.34 $102.34 $100.29 $100.29 3.2MM X 343MM GUDE PIN All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 3.2MM X 343MM GUIDE PIN All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 3.2MM X 343MM GUIDE PIN SMITH AND NEPHEW All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 3.2MM X343MM GUIDE PIN All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 3.2MMX343MM GUIDE PIN All Payors / Plans All Payors / Plans $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 3.5 MM OVER DRILL All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 3.5MM DRILL BIT All Payors / Plans All Payors / Plans $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $276.20 $276.20 3.5MM OVER DRILL SHORT All Payors / Plans All Payors / Plans $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $143.94 $143.94 3.5MM SHORT DRILL BIT All Payors / Plans All Payors / Plans $250.12 $250.12 $250.12 $250.12 $250.12 $250.12 $250.12 $245.12 $245.12 3.9MM SWIVELOCK ANCHOR All Payors / Plans All Payors / Plans $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 4.0 MM SHORT PILOT DRILL WITH A/O CONNECTOR All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 4.0MM LONG AO PILOT DRILL All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 4.0MM LONG PILOT DRILL All Payors / Plans All Payors / Plans $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 4.0MM SHORT DRILL All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 4.0MM SHORT DRILL BIT All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 4.0MM SHORT PILOT DRILL All Payors / Plans All Payors / Plans $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 4.0MM SHORT PILOT DRILL WITH A/O CONNECTOR All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 4.0MM SHORT PILOT DRILL WITH A/O CONNECTOR All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 4F MICROPUNCTURE INTRODUCER SET 10CM All Payors / Plans All Payors / Plans $34.04 $34.04 $34.04 $34.04 $34.04 $34.04 $34.04 $33.36 $33.36 4F MICROPUNCTURE INTRODUCER SET W/ PLATINUM-TIPPED WIRE 10CM All Payors / Plans All Payors / Plans $43.09 $43.09 $43.09 $43.09 $43.09 $43.09 $43.09 $42.23 $42.23 5 FR SWAN MONITOR RADIAL All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 5 FR SWAN THERMODIL RADIAL All Payors / Plans All Payors / Plans $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $323.40 $323.40 50CC SENSATION PLUS IABP CATHETER All Payors / Plans All Payors / Plans " $2,195.96 " " $2,195.96 " " $2,195.96 " " $2,195.96 " " $2,195.96 " " $2,195.96 " " $2,195.96 " " $2,152.04 " " $2,152.04 " 5F DXTERITY JL 3.5 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $11.25 $11.25 $11.25 $11.25 $11.25 $11.25 $11.25 $11.03 $11.03 5F DXTERITY JL 4.0 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 5F DXTERITY JR 4.0 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $11.25 $11.25 $11.25 $11.25 $11.25 $11.25 $11.25 $11.03 $11.03 5F DXTERITY PIG STR DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 5F JL4 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $16.70 $16.70 $16.70 $16.70 $16.70 $16.70 $16.70 $16.37 $16.37 5F PINNACLE SHEATH 10CM All Payors / Plans All Payors / Plans $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.58 $15.58 6 FR AL1 All Payors / Plans All Payors / Plans $17.80 $17.80 $17.80 $17.80 $17.80 $17.80 $17.80 $17.44 $17.44 6/7FR VASCADE CLOSURE DEVICE All Payors / Plans All Payors / Plans $410.00 $410.00 $410.00 $410.00 $410.00 $410.00 $410.00 $401.80 $401.80 6F 145 PIGTAIL CATHETER 110CM All Payors / Plans All Payors / Plans $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.22 $9.22 6F AL1 DIAGNOSTIC CATHETER 100CM All Payors / Plans All Payors / Plans $15.50 $15.50 $15.50 $15.50 $15.50 $15.50 $15.50 $15.19 $15.19 6F DXTERITY 145 PIGTAIL DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 6F DXTERITY AR MOD DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 6F DXTERITY IMA DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 6F DXTERITY JL 3.5 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 6F DXTERITY JL 4.0 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $11.25 $11.25 $11.25 $11.25 $11.25 $11.25 $11.25 $11.03 $11.03 6F DXTERITY JR 4.0 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 6F DXTERITY PIG STR DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 6F DXTERITY ULTRA 3.5 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 6F DXTERITY ULTRA 4.0 DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 6F FL3.5 DIAGNOSTIC CATHETER 100CM All Payors / Plans All Payors / Plans $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.22 $9.22 6F FR3.5 DIAGNOSTIC CATHETER 100CM All Payors / Plans All Payors / Plans $15.50 $15.50 $15.50 $15.50 $15.50 $15.50 $15.50 $15.19 $15.19 6F FR4 DIAGNOSTIC CATHETER 100CM All Payors / Plans All Payors / Plans $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.22 $9.22 6F GLIDESHEATH SLENDER RADIAL ACCESS KIT 10CM All Payors / Plans All Payors / Plans $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $118.58 $118.58 6F GUIDELINER All Payors / Plans All Payors / Plans $796.00 $796.00 $796.00 $796.00 $796.00 $796.00 $796.00 $780.08 $780.08 6F IM DIAGNOSTIC CATHETER 100CM All Payors / Plans All Payors / Plans $15.50 $15.50 $15.50 $15.50 $15.50 $15.50 $15.50 $15.19 $15.19 6F MERIT PERFORMA PIGTAIL CATHETER All Payors / Plans All Payors / Plans $18.10 $18.10 $18.10 $18.10 $18.10 $18.10 $18.10 $17.74 $17.74 6F PIGTAIL CATHETER 110CM All Payors / Plans All Payors / Plans $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.22 $9.22 6F PINNACLE SHEATH 10CM All Payors / Plans All Payors / Plans $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $16.66 $16.66 6F PINNACLE SHEATH 25CM All Payors / Plans All Payors / Plans $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $43.61 $43.61 6FR OPTISEAL 13CM All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 7 FR SWAN MONITORING CATHETER All Payors / Plans All Payors / Plans $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $150.92 $150.92 7 FR SWAN S-TIP THERMODILUTION CATHETER All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 7.5 FR SWAN THERMODILUTION CATHETER All Payors / Plans All Payors / Plans $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $205.80 $205.80 7F PINNACLE SHEATH 10CM All Payors / Plans All Payors / Plans $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $16.66 $16.66 7FR OPTISEAL 13CM All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 8F PINNACLE SHEATH 10CM All Payors / Plans All Payors / Plans $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $16.66 $16.66 "8F, 45 DEGREE FIXED-CURVE TRANSSEPTAL GUIDING SHEATH" All Payors / Plans All Payors / Plans $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $313.60 $313.60 8FR OPTISEAL 13CM All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 9F SHORT SHEATH All Payors / Plans All Payors / Plans $15.34 $15.34 $15.34 $15.34 $15.34 $15.34 $15.34 $15.03 $15.03 ABBOTT AMPLATZER SIZING BALLOON 34MM X 70CM All Payors / Plans All Payors / Plans " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,470.00 " " $1,470.00 " ABLATION 13 FLEXABILITY AFASE-FJ FLEXABILITY SENSOR ENABLED 4MM FJ All Payors / Plans All Payors / Plans " $4,000.00 " " $4,000.00 " " $4,000.00 " " $4,000.00 " " $4,000.00 " " $4,000.00 " " $4,000.00 " " $3,920.00 " " $3,920.00 " ACCESS VERSACROSS STEERABLE 0.035 IN. 230 PIGTAIL CM RF WIRE 71CM BI-DIRECTIONAL STEERABLE SHEATH MEDIUM D1 CURVE 8.5 FRENCH All Payors / Plans All Payors / Plans " $3,550.00 " " $3,550.00 " " $3,550.00 " " $3,550.00 " " $3,550.00 " " $3,550.00 " " $3,550.00 " " $3,479.00 " " $3,479.00 " "ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) SOLUTION" All Payors / Plans All Payors / Plans $0.63 $0.63 $0.63 $0.63 $0.63 $0.63 $0.63 $0.62 $0.62 ACETAMINOPHEN 120 MG SUPPOSITORY All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 ACETAMINOPHEN 160 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $4.92 $4.92 $4.92 $4.92 $4.92 $4.92 $4.92 $4.82 $4.82 ACETAMINOPHEN 160 MG/5 ML SUSPENSION All Payors / Plans All Payors / Plans $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.62 $2.62 ACETAMINOPHEN 325 MG SUPPOSITORY All Payors / Plans All Payors / Plans $1.34 $1.34 $1.34 $1.34 $1.34 $1.34 $1.34 $1.31 $1.31 ACETAMINOPHEN 325 MG TABLET All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 ACETAMINOPHEN 650 MG SUPPOSITORY All Payors / Plans All Payors / Plans $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.79 $1.79 "ACETAMINOPHEN 80 MG TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 ACETAMINOPHEN-CODEINE 300-30 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 ACETAZOLAMIDE 250 MG TABLET All Payors / Plans All Payors / Plans $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.11 $1.11 "ACETAZOLAMIDE 500 MG CAPSULE, EXTENDED RELEASE" All Payors / Plans All Payors / Plans $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.79 $1.79 ACETAZOLAMIDE PER 500 MG All Payors / Plans All Payors / Plans $53.06 $53.06 $53.06 $53.06 $53.06 $53.06 $53.06 $52.00 $52.00 ACETYLCHOLINE 1 % (10 MG/ML) KIT All Payors / Plans All Payors / Plans $205.09 $205.09 $205.09 $205.09 $205.09 $205.09 $205.09 $200.99 $200.99 ACETYLCYSTEINE PER 100 MG All Payors / Plans All Payors / Plans $2.33 $2.33 $2.33 $2.33 $2.33 $2.33 $2.33 $2.28 $2.28 ACIST NAVVUS CATHETER All Payors / Plans All Payors / Plans " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,225.00 " " $1,225.00 " ACTIVATED CHARCOAL 50 GRAM/240 ML SUSPENSION All Payors / Plans All Payors / Plans $10.40 $10.40 $10.40 $10.40 $10.40 $10.40 $10.40 $10.19 $10.19 ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML SUSPENSION All Payors / Plans All Payors / Plans $84.97 $84.97 $84.97 $84.97 $84.97 $84.97 $84.97 $83.27 $83.27 ACUSON ACUNAV ULTRASOUND CATHETER CONNECTOR COVER All Payors / Plans All Payors / Plans $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $15.68 $15.68 ACYCLOVIR 200 MG CAPSULE All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 ACYCLOVIR 800 MG TABLET All Payors / Plans All Payors / Plans $2.71 $2.71 $2.71 $2.71 $2.71 $2.71 $2.71 $2.66 $2.66 ACYCLOVIR PER 5 MG All Payors / Plans All Payors / Plans $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 ADAPTER ANGIOGRAPHY NAMIC OPTION 125 200 PSI 3/8 IN 24 THREAD ID .125 IN ID SEC .1 IN 3 STERILE All Payors / Plans All Payors / Plans $2.51 $2.51 $2.51 $2.51 $2.51 $2.51 $2.51 $2.46 $2.46 ADAPTER BRONCHOSCOPE ILLUMISITE STERILE LATEX FREE REUSABLE OLYMPUS BRONCHOSCOPE All Payors / Plans All Payors / Plans $107.50 $107.50 $107.50 $107.50 $107.50 $107.50 $107.50 $105.35 $105.35 ADAPTER BRONCHOSCOPE PNEUPAC OD15 MM 2 AXIS SWIVEL FIBER OPTIC O2 STERILE LATEX FREE DISPOSABLE BLUE All Payors / Plans All Payors / Plans $21.06 $21.06 $21.06 $21.06 $21.06 $21.06 $21.06 $20.64 $20.64 ADAPTER CATHETER GATEWAY PLUS Y All Payors / Plans All Payors / Plans $42.64 $42.64 $42.64 $42.64 $42.64 $42.64 $42.64 $41.79 $41.79 ADAPTER FEMORAL GMK 3 MM OFFSET KNEE REVISION CONNECTOR All Payors / Plans All Payors / Plans " $4,544.00 " " $4,544.00 " " $4,544.00 " " $4,544.00 " " $4,544.00 " " $4,544.00 " " $4,544.00 " " $4,453.12 " " $4,453.12 " ADAPTER USB L65 MM X W25 MM X H13.5 MM 19.5 ML 30 GM WIRELESS MODEM SUPERIOR PERFORMANCE DIGITAL SIMPLE All Payors / Plans All Payors / Plans " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " $980.00 $980.00 ADENOSINE PER 6 MG All Payors / Plans All Payors / Plans $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.73 $1.73 ADHESIVE LIQUID MASTISOL STYRAX GUM MASTIC ALCOHOL METHYL SALICYLATE 2/3 ML SKIN VIAL AMPULE PREP STERILE LATEX FREE NONHAZARDOUS All Payors / Plans All Payors / Plans $2.21 $2.21 $2.21 $2.21 $2.21 $2.21 $2.21 $2.17 $2.17 ADHESIVE SKIN CLOSURE DERMABOND ADVANCED .7ML 2 OCTYL CYANOACRYLATE MICROBIAL BARRIER APPLICATOR FLEXIBLE LIQUID All Payors / Plans All Payors / Plans $37.54 $37.54 $37.54 $37.54 $37.54 $37.54 $37.54 $36.79 $36.79 ADHESIVE SKIN CLOSURE DERMABOND MINI .36 ML 2-OCTYL CYANOACRYLATE HIGH VISCOSITY LIQUID APPLICATOR MICROBIAL BARRIER STERILE All Payors / Plans All Payors / Plans $21.77 $21.77 $21.77 $21.77 $21.77 $21.77 $21.77 $21.33 $21.33 ADHESIVE SKIN CLOSURE DERMABOND PRINEO 2 OCTYL CYANOACRYLATE L22 CM 3.8 ML TOPICAL MESH APPLICATOR LIQUID DISPENSER STERILE DISPOSABLE All Payors / Plans All Payors / Plans $164.87 $164.87 $164.87 $164.87 $164.87 $164.87 $164.87 $161.57 $161.57 ADHESIVE SKIN CLOSURE DERMABOND PROPEN 2 OCTYL CYANOACRYLATE XL .75 ML HIGH VISCOSITY LIQUID STRONG FLEXIBLE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $146.44 $146.44 $146.44 $146.44 $146.44 $146.44 $146.44 $143.51 $143.51 ADHESIVE SURGICAL BIOGLUE BOVINE SERUM ALBUMIN GLUTARALDEHYDE L12 MM 10 ML SOFT TISSUE PREFILL SYRINGE PLUNGER 3 SPREADER 4 STANDARD TIP STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans " $10,510.00 " " $10,510.00 " " $10,510.00 " " $10,510.00 " " $10,510.00 " " $10,510.00 " " $10,510.00 " " $10,299.80 " " $10,299.80 " ADO-TRASTUZUMAB 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $37.47 $37.47 $37.47 $37.47 $37.47 $37.47 $37.47 $36.72 $36.72 ADPATER ANGIOGRAPHY NAMIC OPTION 125 200 PSI 3/8 IN 24 THREAD ID .125 IN STERILE All Payors / Plans All Payors / Plans $45.97 $45.97 $45.97 $45.97 $45.97 $45.97 $45.97 $45.05 $45.05 ADPATER TITANIUM FOR TRANSFER KIT All Payors / Plans All Payors / Plans $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $205.80 $205.80 ADULT 2-IN-1 TPN All Payors / Plans All Payors / Plans $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 ADULT 2-IN-1 TPN INFUSION All Payors / Plans All Payors / Plans $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 ADULT 3-IN-1 TPN INFUSION All Payors / Plans All Payors / Plans $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 ADULT CONCENTRATED CYCLIC 2-IN-1 TPN INFUSION All Payors / Plans All Payors / Plans $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 ADULT CONCENTRATED CYCLIC 3-IN-1 TPN INFUSION All Payors / Plans All Payors / Plans $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 ADULT CYCLIC 2-IN-1 TPN INFUSION All Payors / Plans All Payors / Plans $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 ADULT CYCLIC 3-IN-1 TPN INFUSION All Payors / Plans All Payors / Plans $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 "ADULT MULTIVITAMIN 3,300 UNIT- 150 MCG/10 ML SOLUTION 10 ML VIAL" All Payors / Plans All Payors / Plans $4.06 $4.06 $4.06 $4.06 $4.06 $4.06 $4.06 $3.98 $3.98 "ADULT MULTIVITAMIN 3,300 UNIT- 150 MCG/10 ML SOLUTION 100 ML VIAL" All Payors / Plans All Payors / Plans $3.08 $3.08 $3.08 $3.08 $3.08 $3.08 $3.08 $3.01 $3.01 AGALSIDASE BETA PER 1 MG All Payors / Plans All Payors / Plans $226.79 $226.79 $226.79 $226.79 $226.79 $226.79 $226.79 $222.26 $222.26 AGENT HEMOSTATIC SURGIFLO THROMBIN 8 ML KIT MATRIX STERILE All Payors / Plans All Payors / Plans $362.55 $362.55 $362.55 $362.55 $362.55 $362.55 $362.55 $355.30 $355.30 AIRSEAL 8MM ACCESS PORT AND OBTURATOR All Payors / Plans All Payors / Plans $175.58 $175.58 $175.58 $175.58 $175.58 $175.58 $175.58 $172.07 $172.07 ALBUMIN HUMAN 25% PER 50 ML All Payors / Plans All Payors / Plans $75.11 $75.11 $75.11 $75.11 $75.11 $75.11 $75.11 $73.61 $73.61 ALBUMIN HUMAN 5% PER 50 ML All Payors / Plans All Payors / Plans $186.85 $186.85 $186.85 $186.85 $186.85 $186.85 $186.85 $183.11 $183.11 ALBUTEROL 1 (ONE) 90 MCG/PUFF INHALER 8 G INHALER All Payors / Plans All Payors / Plans $73.43 $73.43 $73.43 $73.43 $73.43 $73.43 $73.43 $71.96 $71.96 ALBUTEROL 4 MG TABLET All Payors / Plans All Payors / Plans $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.62 $2.62 ALCOHOL 70% ISOPROPYL 16OZ All Payors / Plans All Payors / Plans $3.06 $3.06 $3.06 $3.06 $3.06 $3.06 $3.06 $3.00 $3.00 ALFUZOSIN 10 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 "ALLERGAN SPEC IGG QUANT, EACH X8" All Payors / Plans All Payors / Plans 0302 86001 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 ALLOPURINOL 100 MG TABLET All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 ALLOPURINOL 300 MG TABLET All Payors / Plans All Payors / Plans $1.94 $1.94 $1.94 $1.94 $1.94 $1.94 $1.94 $1.90 $1.90 ALLOSYNC EXPAND 10CC All Payors / Plans All Payors / Plans " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,548.00 " " $2,548.00 " ALPRAZOLAM 0.25 MG TABLET All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 ALPRAZOLAM 0.5 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 ALPRAZOLAM 1 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 ALTEPLASE 2 MG RECON SOLN All Payors / Plans All Payors / Plans $210.21 $210.21 $210.21 $210.21 $210.21 $210.21 $210.21 $206.00 $206.00 ALTEPLASE 2 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $210.21 $210.21 $210.21 $210.21 $210.21 $210.21 $210.21 $206.00 $206.00 ALTEPLASE PER 1 MG All Payors / Plans All Payors / Plans $81.59 $81.59 $81.59 $81.59 $81.59 $81.59 $81.59 $79.96 $79.96 ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML SUSPENSION All Payors / Plans All Payors / Plans $6.72 $6.72 $6.72 $6.72 $6.72 $6.72 $6.72 $6.59 $6.59 ALVIMOPAN 12 MG CAPSULE All Payors / Plans All Payors / Plans $151.96 $151.96 $151.96 $151.96 $151.96 $151.96 $151.96 $148.92 $148.92 AMANTADINE 100 MG CAPSULE All Payors / Plans All Payors / Plans $4.18 $4.18 $4.18 $4.18 $4.18 $4.18 $4.18 $4.10 $4.10 AMANTADINE 50 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 AMIKACIN PER 100 MG All Payors / Plans All Payors / Plans $4.32 $4.32 $4.32 $4.32 $4.32 $4.32 $4.32 $4.23 $4.23 "AMINO ACID 5 %-DEXTROSE 20 % (CLINIMIX) 5 % PARENTERAL SOLUTION 1,000 ML BAG" All Payors / Plans All Payors / Plans $88.97 $88.97 $88.97 $88.97 $88.97 $88.97 $88.97 $87.19 $87.19 "AMINO ACID 5 %-DEXTROSE 20 % (CLINIMIX) 5 % PARENTERAL SOLUTION 2,000 ML BAG" All Payors / Plans All Payors / Plans $130.25 $130.25 $130.25 $130.25 $130.25 $130.25 $130.25 $127.65 $127.65 "AMINO ACIDS 5 %-LYTES-CA-D20W (CLINIMIX E) 5 % PARENTERAL SOLUTION 1,000 ML BAG" All Payors / Plans All Payors / Plans $107.30 $107.30 $107.30 $107.30 $107.30 $107.30 $107.30 $105.15 $105.15 AMINOCAPROIC ACID PER 5 G All Payors / Plans All Payors / Plans $25.92 $25.92 $25.92 $25.92 $25.92 $25.92 $25.92 $25.40 $25.40 AMINOPHYLLINE PER 250 MG All Payors / Plans All Payors / Plans $19.20 $19.20 $19.20 $19.20 $19.20 $19.20 $19.20 $18.82 $18.82 AMIODARONE 100 MG TABLET All Payors / Plans All Payors / Plans $1.99 $1.99 $1.99 $1.99 $1.99 $1.99 $1.99 $1.95 $1.95 AMIODARONE 200 MG TABLET All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 "AMIODARONE IN DEXTROSE,ISO-OSM 150 MG/100 ML (1.5 MG/ML) SOLUTION" All Payors / Plans All Payors / Plans $105.85 $105.85 $105.85 $105.85 $105.85 $105.85 $105.85 $103.73 $103.73 "AMIODARONE IN DEXTROSE,ISO-OSM 360 MG/200 ML (1.8 MG/ML) SOLUTION" All Payors / Plans All Payors / Plans $104.01 $104.01 $104.01 $104.01 $104.01 $104.01 $104.01 $101.93 $101.93 AMIODARONE PER 30 MG All Payors / Plans All Payors / Plans $5.96 $5.96 $5.96 $5.96 $5.96 $5.96 $5.96 $5.84 $5.84 AMITRIPTYLINE 10 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 AMITRIPTYLINE 25 MG TABLET All Payors / Plans All Payors / Plans $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.79 $1.79 AMITRIPTYLINE 50 MG TABLET All Payors / Plans All Payors / Plans $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.88 $1.88 AMLODIPINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 AMLODIPINE 2.5 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 AMLODIPINE 5 MG TABLET All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 AMMONIUM LACTATE 12 % LOTION 225 G BOTTLE All Payors / Plans All Payors / Plans $65.53 $65.53 $65.53 $65.53 $65.53 $65.53 $65.53 $64.22 $64.22 AMMONIUM LACTATE 12 % LOTION 226 G BOTTLE All Payors / Plans All Payors / Plans $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.10 $16.10 AMMONIUM LACTATE 12 % LOTION 400 G BOTTLE All Payors / Plans All Payors / Plans $106.37 $106.37 $106.37 $106.37 $106.37 $106.37 $106.37 $104.24 $104.24 AMOXICILLIN 1 (ONE) 100 ML BOTTLE 100 ML BOTTLE All Payors / Plans All Payors / Plans $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $10.90 $10.90 AMOXICILLIN 250 MG CAPSULE All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 AMOXICILLIN 250 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 AMOXICILLIN 400 MG/5 ML SUSPENSION FOR RECONSTITUTION 100 ML BOTTLE All Payors / Plans All Payors / Plans $36.62 $36.62 $36.62 $36.62 $36.62 $36.62 $36.62 $35.89 $35.89 AMOXICILLIN 500 MG CAPSULE All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $15.92 $15.92 $15.92 $15.92 $15.92 $15.92 $15.92 $15.60 $15.60 AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $26.76 $26.76 $26.76 $26.76 $26.76 $26.76 $26.76 $26.22 $26.22 AMOXICILLIN-POT CLAVULANATE 500-125 MG TABLET All Payors / Plans All Payors / Plans $1.88 $1.88 $1.88 $1.88 $1.88 $1.88 $1.88 $1.84 $1.84 AMOXICILLIN-POT CLAVULANATE 875-125 MG TABLET All Payors / Plans All Payors / Plans $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.62 $2.62 "AMPHETAMINE-DEXTROAMPHETAMINE XR 10 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $15.70 $15.70 $15.70 $15.70 $15.70 $15.70 $15.70 $15.38 $15.38 AMPICILLIN 500 MG CAPSULE All Payors / Plans All Payors / Plans $1.99 $1.99 $1.99 $1.99 $1.99 $1.99 $1.99 $1.95 $1.95 AMPICILLIN PER 500 MG All Payors / Plans All Payors / Plans $4.04 $4.04 $4.04 $4.04 $4.04 $4.04 $4.04 $3.95 $3.95 AMPICILLIN-SULBACTAM PER 1.5 G All Payors / Plans All Payors / Plans $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.02 $8.02 ANASTROZOLE 1 MG TABLET All Payors / Plans All Payors / Plans $2.80 $2.80 $2.80 $2.80 $2.80 $2.80 $2.80 $2.74 $2.74 ANCHOR LEAD CLIKX STERILE DISPOSABLE All Payors / Plans All Payors / Plans $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 ANCHOR SUTURE HEALIX ADVANCE BR ORTHOCORD OD5.5 MM All Payors / Plans All Payors / Plans $640.50 $640.50 $640.50 $640.50 $640.50 $640.50 $640.50 $627.69 $627.69 ANCHOR SUTURE SWIVELOCK C BIOCOMPOSITE PEEK L19.1 MM OD4.75 MM CLOSED EYELET VENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $784.00 $784.00 ANESTHESIA TUBING All Payors / Plans All Payors / Plans $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.69 $8.69 "ANTIHEMOPHILIC FACTOR-VWF 1,000-1,000 UNIT RECON SOLN" All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 ANTIHEMOPHILIC FACTOR-VWF 500-500 UNIT RECON SOLN All Payors / Plans All Payors / Plans $0.81 $0.81 $0.81 $0.81 $0.81 $0.81 $0.81 $0.79 $0.79 APC PROBE 7 STRAIGHT All Payors / Plans All Payors / Plans $503.59 $503.59 $503.59 $503.59 $503.59 $503.59 $503.59 $493.52 $493.52 APIXABAN 2.5 MG TABLET All Payors / Plans All Payors / Plans $5.05 $5.05 $5.05 $5.05 $5.05 $5.05 $5.05 $4.95 $4.95 APIXABAN 5 MG TABLET All Payors / Plans All Payors / Plans $5.05 $5.05 $5.05 $5.05 $5.05 $5.05 $5.05 $4.95 $4.95 APPLICATOR ENDOSCOPIC SURGIFLO 34CM DISPOSABLE STERILE LF All Payors / Plans All Payors / Plans $100.93 $100.93 $100.93 $100.93 $100.93 $100.93 $100.93 $98.91 $98.91 APPLICATOR LAPROSCOPIC VISTASEAL L 35CM DUAL All Payors / Plans All Payors / Plans $129.97 $129.97 $129.97 $129.97 $129.97 $129.97 $129.97 $127.37 $127.37 APPLICATOR PREP CHLORAPREP FREPP ENTURIA 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 1.5 ML 1 STEP AMPULE DRIP RESISTANT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $3.42 $3.42 $3.42 $3.42 $3.42 $3.42 $3.42 $3.35 $3.35 APPLICATOR PREP CHLORAPREP HI-LITE ORANGE 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 10.5 ML ANTIMICROBIAL 1 STEP DEHP FREE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $4.19 $4.19 $4.19 $4.19 $4.19 $4.19 $4.19 $4.11 $4.11 APPLICATOR PREP CHLORAPREP HI-LITE ORANGE 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 26 ML ANTIMICROBIAL 1 STEP DEHP FREE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $12.77 $12.77 $12.77 $12.77 $12.77 $12.77 $12.77 $12.51 $12.51 APPLIER All Payors / Plans All Payors / Plans " $9,500.00 " " $9,500.00 " " $9,500.00 " " $9,500.00 " " $9,500.00 " " $9,500.00 " " $9,500.00 " " $9,310.00 " " $9,310.00 " APPLIER INTERNAL CLIP 30D MED 11.5IN TITANIUM MULTIPLE LIGATE LIGACLIP STERILE LF All Payors / Plans All Payors / Plans $68.68 $68.68 $68.68 $68.68 $68.68 $68.68 $68.68 $67.31 $67.31 APPLIER INTERNAL CLIP ENDO CLIP TITANIUM 19 MEDIUM LARGE L10 MM CARTRIDGE STERILE LATEX FREE DISPOSABLE K2 All Payors / Plans All Payors / Plans $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $106.82 $106.82 APPLIER INTERNAL CLIP LIGACLIP 30D MED 11.5IN TITANIUM DISPOSABLE STERILE LF LIGATE MULTIPLE OPEN 20 CLIP All Payors / Plans All Payors / Plans $68.68 $68.68 $68.68 $68.68 $68.68 $68.68 $68.68 $67.31 $67.31 APPLIER INTERNAL CLIP LIGACLIP SM 23.8CM TITANIUM DISPOSABLE STERILE LF LIGATE MULTIPLE OPEN All Payors / Plans All Payors / Plans $68.68 $68.68 $68.68 $68.68 $68.68 $68.68 $68.68 $67.31 $67.31 APPLIER INTERNAL CLIP LIGAMAX LIGACLIP MED LG 8.8MM 10MM TITANIUM DISPOSABLE STERILE LF VASCULAR ANGLE JAW DISTAL TIP All Payors / Plans All Payors / Plans $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $130.03 $130.03 APPLIER INTERNAL CLIP LIGAMAX MED LG 5MM TITANIUM DISPOSABLE STERILE ANGLE JAW DISTAL TIP CLOSE ANTIBACKUP LAST LOCKOUT All Payors / Plans All Payors / Plans $254.67 $254.67 $254.67 $254.67 $254.67 $254.67 $254.67 $249.58 $249.58 APREPITANT 7.2 MG/ML EMULSION All Payors / Plans All Payors / Plans $6.03 $6.03 $6.03 $6.03 $6.03 $6.03 $6.03 $5.91 $5.91 APREPITANT PER 5 MG All Payors / Plans All Payors / Plans $46.68 $46.68 $46.68 $46.68 $46.68 $46.68 $46.68 $45.75 $45.75 ARGATROBAN 1 MG/ML SOLUTION All Payors / Plans All Payors / Plans $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.06 $4.06 ARIPIPRAZOLE 10 MG TABLET All Payors / Plans All Payors / Plans $14.13 $14.13 $14.13 $14.13 $14.13 $14.13 $14.13 $13.85 $13.85 ARIPIPRAZOLE 15 MG TABLET All Payors / Plans All Payors / Plans $15.19 $15.19 $15.19 $15.19 $15.19 $15.19 $15.19 $14.89 $14.89 ARIPIPRAZOLE 2 MG TABLET All Payors / Plans All Payors / Plans $14.13 $14.13 $14.13 $14.13 $14.13 $14.13 $14.13 $13.84 $13.84 ARIPIPRAZOLE 5 MG TABLET All Payors / Plans All Payors / Plans $10.85 $10.85 $10.85 $10.85 $10.85 $10.85 $10.85 $10.63 $10.63 ARTIFICIAL TEARS(HYPROMELLOSE) 0.5 % DROPS 15 ML DROP BTL All Payors / Plans All Payors / Plans $107.74 $107.74 $107.74 $107.74 $107.74 $107.74 $107.74 $105.59 $105.59 ASCORBIC ACID (VITAMIN C) 500 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 ASPIRIN 300 MG SUPPOSITORY All Payors / Plans All Payors / Plans $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.06 $4.06 ASPIRIN 325 MG TABLET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 "ASPIRIN 325 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.88 $0.88 "ASPIRIN 81 MG TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.88 $0.88 "ASPIRIN 81 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 ATENOLOL 25 MG TABLET All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 ATENOLOL 50 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 ATOMOXETINE 40 MG CAPSULE All Payors / Plans All Payors / Plans $22.39 $22.39 $22.39 $22.39 $22.39 $22.39 $22.39 $21.94 $21.94 ATORVASTATIN 10 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 ATORVASTATIN 20 MG TABLET All Payors / Plans All Payors / Plans $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.06 $1.06 ATORVASTATIN 40 MG TABLET All Payors / Plans All Payors / Plans $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.06 $1.06 ATROPINE 1 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $156.10 $156.10 $156.10 $156.10 $156.10 $156.10 $156.10 $152.98 $152.98 ATROPINE PER 0.01 MG All Payors / Plans All Payors / Plans $0.63 $0.63 $0.63 $0.63 $0.63 $0.63 $0.63 $0.62 $0.62 AXIS JACKSON CONTOUR TUBING SET All Payors / Plans All Payors / Plans $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 AZACITIDINE 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $6.12 $6.12 $6.12 $6.12 $6.12 $6.12 $6.12 $6.00 $6.00 AZATHIOPRINE PER 50 MG All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 AZITHROMYCIN 100 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $40.41 $40.41 $40.41 $40.41 $40.41 $40.41 $40.41 $39.60 $39.60 AZITHROMYCIN 200 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $11.08 $11.08 $11.08 $11.08 $11.08 $11.08 $11.08 $10.86 $10.86 AZITHROMYCIN 250 MG TABLET All Payors / Plans All Payors / Plans $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.48 $3.48 AZITHROMYCIN 600 MG TABLET All Payors / Plans All Payors / Plans $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.91 $1.91 AZITHROMYCIN PER 500 MG All Payors / Plans All Payors / Plans $11.15 $11.15 $11.15 $11.15 $11.15 $11.15 $11.15 $10.93 $10.93 AZTREONAM PER 500 MG All Payors / Plans All Payors / Plans $154.47 $154.47 $154.47 $154.47 $154.47 $154.47 $154.47 $151.38 $151.38 BACITRACIN 500 UNIT/GRAM OINTMENT 14 G TUBE All Payors / Plans All Payors / Plans $16.07 $16.07 $16.07 $16.07 $16.07 $16.07 $16.07 $15.75 $15.75 BACITRACIN 500 UNIT/GRAM OINTMENT 3.5 G TUBE All Payors / Plans All Payors / Plans $318.78 $318.78 $318.78 $318.78 $318.78 $318.78 $318.78 $312.40 $312.40 BACITRACIN ZINC 500 UNIT/GRAM OINTMENT IN PACKET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 BACLOFEN 10 MG TABLET All Payors / Plans All Payors / Plans $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.85 $1.85 BACTISURE WOUND LAVAGE All Payors / Plans All Payors / Plans " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " "BAG 24"" DOME LARGE" All Payors / Plans All Payors / Plans $5.70 $5.70 $5.70 $5.70 $5.70 $5.70 $5.70 $5.59 $5.59 BAG DRAINAGE ROUND TEARDROP 2000ML DISPOSABLE STERILE LF ANTIREFLUX CHAMBER MICROBICIDAL OUTLET TUBE All Payors / Plans All Payors / Plans $3.34 $3.34 $3.34 $3.34 $3.34 $3.34 $3.34 $3.27 $3.27 BAG DRAINAGE ROUND TEARDROP 2000ML DISPOSABLE STERILE LF ANTIREFLUX CHAMBER OUTLET TUBE All Payors / Plans All Payors / Plans $5.11 $5.11 $5.11 $5.11 $5.11 $5.11 $5.11 $5.01 $5.01 BAG EQUIPMENT MICROSHIELD L40 IN X W20 IN OD40 IN CIRCULAR SEWN ELASTIC BAND STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $3.69 $3.69 $3.69 $3.69 $3.69 $3.69 $3.69 $3.62 $3.62 BAG ICE CLAMP CLOSE 4TIES WHITE 6.5X14 All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 BAG SPECIMEN RETRIEVAL AMI L5 MM 100 ML ABDOMEN TROCAR STERILE DISPOSABLE All Payors / Plans All Payors / Plans $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $142.10 $142.10 BAG SPECIMEN RETRIEVAL ENDOPOUCH PLASTIC LARGE L6 IN X W4 IN OD10 MM 224 ML INTRODUCER TUBE FLEXIBLE THUMB RING HANDLE SYRINGE MOTION DEPLOYMENT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $98.98 $98.98 BALANCED SALT SOLN NO.1 IRRIG. SOLUTION All Payors / Plans All Payors / Plans $195.66 $195.66 $195.66 $195.66 $195.66 $195.66 $195.66 $191.75 $191.75 BALANCED SALT SOLN NO.1 IRRIG. SOLUTION 500 ML BOTTLE All Payors / Plans All Payors / Plans $195.66 $195.66 $195.66 $195.66 $195.66 $195.66 $195.66 $191.75 $191.75 BALANCED SALT SOLUTION SOLUTION 15 ML BOTTLE All Payors / Plans All Payors / Plans $13.05 $13.05 $13.05 $13.05 $13.05 $13.05 $13.05 $12.79 $12.79 BALL TIP GUIDE ROD All Payors / Plans All Payors / Plans $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $201.88 $201.88 BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER PLUS BTT ENDO LUBE FOAM OVAL PREPERITONEAL 3 VALVE RIGID SPRING GRIP LOCK COLLAR BLUNT TIP TROCAR LATEX DISPOSABLE HERNIA All Payors / Plans All Payors / Plans " $1,495.25 " " $1,495.25 " " $1,495.25 " " $1,495.25 " " $1,495.25 " " $1,495.25 " " $1,495.25 " " $1,465.35 " " $1,465.35 " BALLOON PRESTERILIZED LATEX All Payors / Plans All Payors / Plans $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $52.92 $52.92 BALLOON RETRIEVAL EXTRACTOR PRO XL 12-15MM All Payors / Plans All Payors / Plans $208.68 $208.68 $208.68 $208.68 $208.68 $208.68 $208.68 $204.51 $204.51 BALLOON RETRIEVAL EXTRACTOR PRO XL 200CM 6-7FR 12-15MM DISPOSABLE STERILE LATEX BILIARY 3 LUMEN BELOW INJECTION SQUARE All Payors / Plans All Payors / Plans $206.88 $206.88 $206.88 $206.88 $206.88 $206.88 $206.88 $202.74 $202.74 BALLOON RETRIEVAL EXTRACTOR PRO XL 200CM 6-7FR 9-12MM DISPOSABLE STERILE LATEX BILIARY 3 LUMEN ABOVE INJECTION SQUARE All Payors / Plans All Payors / Plans $208.68 $208.68 $208.68 $208.68 $208.68 $208.68 $208.68 $204.51 $204.51 BALLOON RETRIEVAL EXTRACTOR PRO XL 200CM 6-7FR 9-12MM DISPOSABLE STERILE LATEX BILIARY 3 LUMEN BELOW INJECTION SQUARE All Payors / Plans All Payors / Plans $206.88 $206.88 $206.88 $206.88 $206.88 $206.88 $206.88 $202.74 $202.74 BAND BAG All Payors / Plans All Payors / Plans $490.00 $490.00 $490.00 $490.00 $490.00 $490.00 $490.00 $480.20 $480.20 BAND COMPRESSION TRANSRADIAL BAND LG INFLATOR All Payors / Plans All Payors / Plans $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 BAND COMPRESSION TRANSRADIAL BAND STD INFLATOR All Payors / Plans All Payors / Plans $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $31.25 $30.63 $30.63 BANDAGE ADHESIVE COVERLET 3X2IN FABRIC STERILE LF PATCH XL WOUND PAD ABSORBENT ELASTIC All Payors / Plans All Payors / Plans $3.84 $3.84 $3.84 $3.84 $3.84 $3.84 $3.84 $3.76 $3.76 BANDAGE ADHESIVE L5 YD X W4 IN SELF ADHERENT NONSTERILE LATEX FREE All Payors / Plans All Payors / Plans $3.56 $3.56 $3.56 $3.56 $3.56 $3.56 $3.56 $3.49 $3.49 BANDAGE SELF ADHESIVE 4IN X 5YD LATEX FREE STERILE All Payors / Plans All Payors / Plans $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.33 $3.33 BANDAGE SELF ADHESIVE 6IN X 5YD LATEX FREE STERILE All Payors / Plans All Payors / Plans $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.33 $3.33 BARRIER ADHESION INTERCEED L4 IN X W3 IN PELVIS ABSORBABLE STERILE All Payors / Plans All Payors / Plans $642.20 $642.20 $642.20 $642.20 $642.20 $642.20 $642.20 $629.36 $629.36 BASEPLATE GLENOID COMPREHENSIVE SMALL SHOULDER AUGMENT TAPER ADAPTER All Payors / Plans All Payors / Plans " $16,490.00 " " $16,490.00 " " $16,490.00 " " $16,490.00 " " $16,490.00 " " $16,490.00 " " $16,490.00 " " $16,160.20 " " $16,160.20 " BASEPLATE TIBIAL ATTUNE SIZE 5 CEMENTED All Payors / Plans All Payors / Plans " $6,400.00 " " $6,400.00 " " $6,400.00 " " $6,400.00 " " $6,400.00 " " $6,400.00 " " $6,400.00 " " $6,272.00 " " $6,272.00 " BASKET STONE RETRIEVAL ZEROTIP NITINOL L120 CM OD16 MM ODSEC3 FR URETERAL 4 WIRE FLAT DISTAL SURFACE KNOT TIPLESS STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $361.16 $361.16 $361.16 $361.16 $361.16 $361.16 $361.16 $353.94 $353.94 BASKET ZERO TIP 1.9 FR All Payors / Plans All Payors / Plans $413.60 $413.60 $413.60 $413.60 $413.60 $413.60 $413.60 $405.33 $405.33 BATTERY BIOMET THINFLAP PLATING SYSTEM All Payors / Plans All Payors / Plans $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 BATTERY SURGICAL DRIVER MATRIXPRO STERILE DISPOSABLE All Payors / Plans All Payors / Plans $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $811.44 $811.44 "BAYLIS GROUNDING PAD 10' CABLE, ADULT" All Payors / Plans All Payors / Plans $3.18 $3.18 $3.18 $3.18 $3.18 $3.18 $3.18 $3.12 $3.12 BEARING HUMERAL COMPREHENSIVE PROLONG STANDARD OD40 MM SHOULDER REVERSE All Payors / Plans All Payors / Plans " $14,680.00 " " $14,680.00 " " $14,680.00 " " $14,680.00 " " $14,680.00 " " $14,680.00 " " $14,680.00 " " $14,386.40 " " $14,386.40 " BENDAMUSTINE 25 MG/ML SOLUTION 4 ML VIAL All Payors / Plans All Payors / Plans $23.57 $23.57 $23.57 $23.57 $23.57 $23.57 $23.57 $23.10 $23.10 "BENZOCAINE 20 % AEROSOL,SPRAY" All Payors / Plans All Payors / Plans $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 "BENZOCAINE 20 % AEROSOL,SPRAY 57 G CAN" All Payors / Plans All Payors / Plans $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 BENZOCAINE 20 % CREAM 28 G TUBE All Payors / Plans All Payors / Plans $26.42 $26.42 $26.42 $26.42 $26.42 $26.42 $26.42 $25.89 $25.89 BENZOCAINE-MENTHOL 15-2.6 MG LOZENGE All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 BENZOCAINE-MENTHOL 15-3.6 MG LOZENGE All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 BENZOCAINE-MENTHOL 20-0.5 % AEROSOL 85 G CANISTER All Payors / Plans All Payors / Plans $26.43 $26.43 $26.43 $26.43 $26.43 $26.43 $26.43 $25.90 $25.90 BENZOCAINE-MENTHOL 6-10 MG LOZENGE All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 BENZONATATE 100 MG CAPSULE All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 BENZTROPINE 0.5 MG TABLET All Payors / Plans All Payors / Plans $1.88 $1.88 $1.88 $1.88 $1.88 $1.88 $1.88 $1.84 $1.84 BENZTROPINE 1 MG TABLET All Payors / Plans All Payors / Plans $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.88 $1.88 BENZTROPINE 2 MG TABLET All Payors / Plans All Payors / Plans $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $1.99 $1.99 BENZTROPINE MESYLATE PER 1 MG All Payors / Plans All Payors / Plans $67.61 $67.61 $67.61 $67.61 $67.61 $67.61 $67.61 $66.26 $66.26 BETADINE 5% STERILE OPTHALMIC PREP SOLUTION All Payors / Plans All Payors / Plans $19.52 $19.52 $19.52 $19.52 $19.52 $19.52 $19.52 $19.13 $19.13 BETAMETHASONE ACET & SOD PHOS PER 4 MG All Payors / Plans All Payors / Plans $14.54 $14.54 $14.54 $14.54 $14.54 $14.54 $14.54 $14.24 $14.24 BETAMETHASONE DIPROPIONATE 0.05 % CREAM 45 G TUBE All Payors / Plans All Payors / Plans $199.66 $199.66 $199.66 $199.66 $199.66 $199.66 $199.66 $195.67 $195.67 BETAMETHASONE VALERATE 0.1 % LOTION 60 ML BOTTLE All Payors / Plans All Payors / Plans $157.49 $157.49 $157.49 $157.49 $157.49 $157.49 $157.49 $154.34 $154.34 BETHANECHOL 10 MG TABLET All Payors / Plans All Payors / Plans $1.94 $1.94 $1.94 $1.94 $1.94 $1.94 $1.94 $1.90 $1.90 BETHANECHOL 25 MG TABLET All Payors / Plans All Payors / Plans $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.02 $2.02 BEVACIZUMAB-AWWB 25 MG/ML SOLUTION 16 ML VIAL All Payors / Plans All Payors / Plans $79.09 $79.09 $79.09 $79.09 $79.09 $79.09 $79.09 $77.51 $77.51 BEVACIZUMAB-AWWB 25 MG/ML SOLUTION 4 ML VIAL All Payors / Plans All Payors / Plans $61.59 $61.59 $61.59 $61.59 $61.59 $61.59 $61.59 $60.36 $60.36 BEVACIZUMAB-BVZR 25 MG/ML SOLUTION 16 ML VIAL All Payors / Plans All Payors / Plans $53.79 $53.79 $53.79 $53.79 $53.79 $53.79 $53.79 $52.71 $52.71 BEVACIZUMAB-BVZR 25 MG/ML SOLUTION 4 ML VIAL All Payors / Plans All Payors / Plans $123.81 $123.81 $123.81 $123.81 $123.81 $123.81 $123.81 $121.33 $121.33 BHW WIRE 190CM J All Payors / Plans All Payors / Plans $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 BINDER ABDOMINAL 30-45X12IN 4 ELASTIC PANEL COMFORT CONTACT CLOSURE MED All Payors / Plans All Payors / Plans $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.22 $18.22 BINDER ABDOMINAL 46-62X12IN 4 ELASTIC PANEL CONTACT CLOSURE COMFORT LG LATEX All Payors / Plans All Payors / Plans $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.22 $18.22 BINDER ABDOMINAL COMFORT LARGE L46-62 IN X W12 IN 4 ELASTIC PANEL CONTACT CLOSURE LATEX All Payors / Plans All Payors / Plans $19.73 $19.73 $19.73 $19.73 $19.73 $19.73 $19.73 $19.34 $19.34 BINDER ABDOMINAL MEDIUM L30-45 IN X W12 IN 4 ELASTIC PANEL COMFORT CONTACT CLOSURE All Payors / Plans All Payors / Plans $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.22 $18.22 BINDER ABDOMINAL PROCARE XL 12IN 62-74IN FLANNEL COTTON 4 PANEL ELASTIC CONTACT CLOSURE All Payors / Plans All Payors / Plans $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.59 $18.22 $18.22 BINDER BREAST LINED 2XL All Payors / Plans All Payors / Plans $55.70 $55.70 $55.70 $55.70 $55.70 $55.70 $55.70 $54.59 $54.59 BINDER BREAST LINED 3XL All Payors / Plans All Payors / Plans $54.56 $54.56 $54.56 $54.56 $54.56 $54.56 $54.56 $53.47 $53.47 BINDER BREAST LINED XL All Payors / Plans All Payors / Plans $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $83.57 $83.57 BISACODYL 10 MG SUPPOSITORY All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 "BISACODYL 5 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 BISMUTH SUBSALICYLATE 262 MG/15 ML SUSPENSION 118 ML BOTTLE All Payors / Plans All Payors / Plans $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $10.78 $10.78 BISOPROLOL 5 MG TABLET All Payors / Plans All Payors / Plans $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.72 $2.72 BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MG TABLET All Payors / Plans All Payors / Plans $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.91 $1.91 BIT DRILL 110MM 2.5MM GOLD NS QUICK COUPLING All Payors / Plans All Payors / Plans $101.49 $101.49 $101.49 $101.49 $101.49 $101.49 $101.49 $99.46 $99.46 BIT DRILL 145MM 3.2MM NS QUICK COUPLING All Payors / Plans All Payors / Plans $99.99 $99.99 $99.99 $99.99 $99.99 $99.99 $99.99 $97.99 $97.99 BIT DRILL CRANIAL 5.8MM All Payors / Plans All Payors / Plans $129.04 $129.04 $129.04 $129.04 $129.04 $129.04 $129.04 $126.46 $126.46 BIT DRILL LCP STAINLESS STEEL L110 MM OD1.8 MM MINI QUICK COUPLING DEPTH MARK NONSTERILE All Payors / Plans All Payors / Plans $268.70 $268.70 $268.70 $268.70 $268.70 $268.70 $268.70 $263.33 $263.33 BIT DRILL LCP STAINLESS STEEL L96 MM OD1.5 MM MINI QUICK COUPLING DEPTH MARK NONSTERILE All Payors / Plans All Payors / Plans $167.94 $167.94 $167.94 $167.94 $167.94 $167.94 $167.94 $164.58 $164.58 BIT DRILL MULTILOC L145 MM OD3.2 MM 3 FLUTED NEEDLE POINT All Payors / Plans All Payors / Plans $283.50 $283.50 $283.50 $283.50 $283.50 $283.50 $283.50 $277.83 $277.83 BIT DRILL OD2.7 MM PERIPHERAL SCREW COMPREHENSIVE REVERSE SHOULDER SYSTEM All Payors / Plans All Payors / Plans $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $284.20 $284.20 BIT DRILL OD3.2 MM CENTRAL SCREW COMPREHENSIVE REVERSE SHOULDER SYSTEM All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 BIVALIRUDIN PER 1 MG All Payors / Plans All Payors / Plans $0.62 $0.62 $0.62 $0.62 $0.62 $0.62 $0.62 $0.60 $0.60 BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L85 MM OD10.35 MM CANNULATED STERILE TAN All Payors / Plans All Payors / Plans " $1,155.60 " " $1,155.60 " " $1,155.60 " " $1,155.60 " " $1,155.60 " " $1,155.60 " " $1,155.60 " " $1,132.49 " " $1,132.49 " BLADE OPHTHALMIC ASB HOCKEY STICK SHARP ALL AROUND All Payors / Plans All Payors / Plans $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.18 $33.18 BLADE OPHTHALMIC GRIESHABER DSP OD25 GA MVR DISPOSABLE All Payors / Plans All Payors / Plans $90.26 $90.26 $90.26 $90.26 $90.26 $90.26 $90.26 $88.45 $88.45 BLADE REAMER NEXGEN STAINLESS STEEL OD41 MM KNEE PATELLA PILOT HOLE NONSTERILE All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 BLADE SAW HALL L44.6 MM X W40 MM X H.4 MM STERNOTOMY REPEAT STERILE All Payors / Plans All Payors / Plans $12.04 $12.04 $12.04 $12.04 $12.04 $12.04 $12.04 $11.80 $11.80 BLADE SAW L90 MM X W18 MM X H1.19 MM SAGITTAL 2 CUT STERILE All Payors / Plans All Payors / Plans $100.36 $100.36 $100.36 $100.36 $100.36 $100.36 $100.36 $98.35 $98.35 BLADE SAW L90 MM X W21 MM X H1.19 MM SAGITTAL All Payors / Plans All Payors / Plans $117.26 $117.26 $117.26 $117.26 $117.26 $117.26 $117.26 $114.91 $114.91 BLADE SAW MICRO 100 MICROPOWER L25.5 MM X W9.5 MM X H.4 MM SAGITTAL FINE TOOTH STERILE All Payors / Plans All Payors / Plans $26.64 $26.64 $26.64 $26.64 $26.64 $26.64 $26.64 $26.11 $26.11 BLADE SAW MICRO 100 MICROPOWER THK.4MM 5.5MM SS STERILE COARSE TOOTH SAGITTAL All Payors / Plans All Payors / Plans $51.94 $51.94 $51.94 $51.94 $51.94 $51.94 $51.94 $50.90 $50.90 BLADE SAW SAGITTAL HEAVY DUTY All Payors / Plans All Payors / Plans $47.06 $47.06 $47.06 $47.06 $47.06 $47.06 $47.06 $46.12 $46.12 BLADE SAW STAINLESS STEEL L70 MM X W12.5 MM X H.8 MM 2 SIDED RECIPROCATING STERILE LATEX FREE ARTHROPLASTY All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 BLADE SAW STAINLESS STEEL LONG L75 MM X W12 MM X H.8 MM RECIPROCATING HEAVY DUTY STERILE All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 BLADE SAW STAINLESS STEEL THK.038 IN MEDIUM L3.543 IN X W.984 IN 2 CUT SAGITTAL STERILE All Payors / Plans All Payors / Plans $100.36 $100.36 $100.36 $100.36 $100.36 $100.36 $100.36 $98.35 $98.35 BLADE SAW STAINLESS STEEL THK.05 IN L3.543 IN X W.709 IN 2 CUT SAGITTAL STERILE LATEX FREE All Payors / Plans All Payors / Plans $98.32 $98.32 $98.32 $98.32 $98.32 $98.32 $98.32 $96.35 $96.35 BLADE SAW STAINLESS STEEL THK.64 MM XSHORT NARROW THIN L24.5 MM X W9 MM SAGITTAL STERILE All Payors / Plans All Payors / Plans $78.06 $78.06 $78.06 $78.06 $78.06 $78.06 $78.06 $76.50 $76.50 BLADE SAW STAINLESS STEEL THK1.19 MM NARROW THICK L81.5 MM X W12.5 MM SAGITTAL STERILE All Payors / Plans All Payors / Plans $55.36 $55.36 $55.36 $55.36 $55.36 $55.36 $55.36 $54.25 $54.25 BLADE SAW STAINLESS STEEL THK1.37 MM L90 MM X W25 MM SAGITTAL 2 CUT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $100.36 $100.36 $100.36 $100.36 $100.36 $100.36 $100.36 $98.35 $98.35 BLADE SAW THK.64 MM D33 MM THIN W9.4 MM STERNUM STERILE All Payors / Plans All Payors / Plans $9.67 $9.67 $9.67 $9.67 $9.67 $9.67 $9.67 $9.48 $9.48 BLADE SAW THK1.27 MM L90 MM X W18 MM SAGITTAL STERILE All Payors / Plans All Payors / Plans $104.40 $104.40 $104.40 $104.40 $104.40 $104.40 $104.40 $102.31 $102.31 BLADE SHAVER COOLCUT L13 CM OD4 MM STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 BLADE SHAVER COOLCUT L7 CM OD3 MM SMALL JOINT ARTHROSCOPIC DISSECTOR STERILE DISPOSABLE All Payors / Plans All Payors / Plans $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $129.36 $129.36 BLADE SHAVER SABRETOOTH COOLCUT STAINLESS STEEL CURVE L13 CM OD4 MM RESECTION STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 BMW ELITE J-TIP GUIDEWIRE 190CM All Payors / Plans All Payors / Plans $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 BMW J-TIP GUIDEWIRE 190CM All Payors / Plans All Payors / Plans $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 BORTEZOMIB PER 0.1 MG All Payors / Plans All Payors / Plans $4.43 $4.43 $4.43 $4.43 $4.43 $4.43 $4.43 $4.34 $4.34 BOWL BONE CEMENT QUICK-VAC VACUUM MIX LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $128.77 $128.77 $128.77 $128.77 $128.77 $128.77 $128.77 $126.19 $126.19 BOWL CEMENT MIXING ORTHOPAEDIC STERILE WITH SPATULA DISPOSABLE All Payors / Plans All Payors / Plans $73.67 $73.67 $73.67 $73.67 $73.67 $73.67 $73.67 $72.20 $72.20 BOWL GUIDEWIRE 5 TAB BASIN RING GRASPABLE STERILE LATEX All Payors / Plans All Payors / Plans $14.64 $14.64 $14.64 $14.64 $14.64 $14.64 $14.64 $14.35 $14.35 BRA ELIZABETH PINK SURGICAL SIZE 2XL All Payors / Plans All Payors / Plans $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $44.34 $44.34 BRA ELIZABETH PINK SURGICAL SIZE LARGE All Payors / Plans All Payors / Plans $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $44.34 $44.34 BRA ELIZABETH PINK SURGICAL SIZE MED All Payors / Plans All Payors / Plans $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $44.34 $44.34 BRACE WALKING PACESETTER II 11-16 13+ STANDARD XL BLACK FOAM NS LF FOOT ANKLE WRAP LAMINATE ROCKER SOLE CLOSED HEEL All Payors / Plans All Payors / Plans $51.24 $51.24 $51.24 $51.24 $51.24 $51.24 $51.24 $50.22 $50.22 BRAIN LAB SPHERES 41773B All Payors / Plans All Payors / Plans $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $16.72 $16.72 BRILLIANT BLUE 0.025 % SYRINGE All Payors / Plans All Payors / Plans $149.07 $149.07 $149.07 $149.07 $149.07 $149.07 $149.07 $146.09 $146.09 BRIMONIDINE 0.15 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $257.61 $257.61 $257.61 $257.61 $257.61 $257.61 $257.61 $252.46 $252.46 "BRINZOLAMIDE 1 % DROPS,SUSPENSION 10 ML DROP BTL" All Payors / Plans All Payors / Plans $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $673.26 $673.26 BRUSH CYTOLOGY COMBO CATH L200 CM X W2.1 MM OD8 FR BILIARY RAPID EXCHANGE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $220.42 $220.42 $220.42 $220.42 $220.42 $220.42 $220.42 $216.01 $216.01 BRUSH CYTOLOGY SUPERDIMENSION 115MM 10MM 1.9MM 3 NEEDLE All Payors / Plans All Payors / Plans $353.60 $353.60 $353.60 $353.60 $353.60 $353.60 $353.60 $346.53 $346.53 BRUSH ERCP ENDOSCOPIC INFINITY NITINOL L200 CM OD3 MM DRIVE WIRE STIFFER SOFTER BRISTLE STERILE LATEX FREE DISPOSABLE LONG SHORT GUIDEWIRE All Payors / Plans All Payors / Plans $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $274.40 $274.40 "BUDESONIDE EC 3 MG CAPSULE,DELAYED,EXTEND.RELEASE" All Payors / Plans All Payors / Plans $19.46 $19.46 $19.46 $19.46 $19.46 $19.46 $19.46 $19.07 $19.07 BULKAMID URETHRAL BULKING SYSTEM All Payors / Plans All Payors / Plans " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,058.00 " " $2,058.00 " BUMETANIDE 1 MG TABLET All Payors / Plans All Payors / Plans $4.36 $4.36 $4.36 $4.36 $4.36 $4.36 $4.36 $4.27 $4.27 BUMETANIDE 2 MG TABLET All Payors / Plans All Payors / Plans $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.60 $2.60 BUMETANIDE PER 0.5 MG All Payors / Plans All Payors / Plans $15.75 $15.75 $15.75 $15.75 $15.75 $15.75 $15.75 $15.43 $15.43 "BUPIVACAINE 0.125% 0.125 % (1,250 MCG/ML) SOLUTION" All Payors / Plans All Payors / Plans $7.79 $7.79 $7.79 $7.79 $7.79 $7.79 $7.79 $7.64 $7.64 BUPIVACAINE 0.25 % (2.5 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $5.97 $5.97 BUPIVACAINE 0.25 % (2.5 MG/ML) SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $5.97 $5.97 BUPIVACAINE 0.25 % (2.5 MG/ML) SOLUTION 30 ML VIAL All Payors / Plans All Payors / Plans $10.46 $10.46 $10.46 $10.46 $10.46 $10.46 $10.46 $10.25 $10.25 BUPIVACAINE HCL 0.25 % (2.5 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $50.84 $50.84 $50.84 $50.84 $50.84 $50.84 $50.84 $49.82 $49.82 BUPIVACAINE HCL 0.5 % (5 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $20.89 $20.89 $20.89 $20.89 $20.89 $20.89 $20.89 $20.47 $20.47 BUPIVACAINE PF 0.5 % (5 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.29 $10.29 BUPIVACAINE PF 0.5 % (5 MG/ML) SOLUTION 30 ML VIAL All Payors / Plans All Payors / Plans $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.29 $10.29 BUPIVACAINE PF 0.75 % (7.5 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $15.71 $15.71 $15.71 $15.71 $15.71 $15.71 $15.71 $15.40 $15.40 BUPIVACAINE PF 0.75 % (7.5 MG/ML) SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $15.71 $15.71 $15.71 $15.71 $15.71 $15.71 $15.71 $15.40 $15.40 BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $26.32 $26.32 $26.32 $26.32 $26.32 $26.32 $26.32 $25.79 $25.79 "BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 SOLUTION" All Payors / Plans All Payors / Plans $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $20.37 $20.37 "BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 SOLUTION 10 ML VIAL" All Payors / Plans All Payors / Plans $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $20.37 $20.37 "BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 SOLUTION 30 ML VIAL" All Payors / Plans All Payors / Plans $31.84 $31.84 $31.84 $31.84 $31.84 $31.84 $31.84 $31.20 $31.20 "BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 SOLUTION" All Payors / Plans All Payors / Plans $21.45 $21.45 $21.45 $21.45 $21.45 $21.45 $21.45 $21.02 $21.02 "BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 SOLUTION 30 ML VIAL" All Payors / Plans All Payors / Plans $36.44 $36.44 $36.44 $36.44 $36.44 $36.44 $36.44 $35.71 $35.71 "BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 CARTRIDGE" All Payors / Plans All Payors / Plans $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.37 $10.37 "BUPRENORPHINE 8 MG TABLET, SUBLINGUAL" All Payors / Plans All Payors / Plans $4.73 $4.73 $4.73 $4.73 $4.73 $4.73 $4.73 $4.64 $4.64 "BUPRENORPHINE-NALOXONE 8-2 MG TABLET, SUBLINGUAL" All Payors / Plans All Payors / Plans $7.59 $7.59 $7.59 $7.59 $7.59 $7.59 $7.59 $7.44 $7.44 BUPROPION 100 MG TABLET All Payors / Plans All Payors / Plans $5.11 $5.11 $5.11 $5.11 $5.11 $5.11 $5.11 $5.01 $5.01 BUPROPION 75 MG TABLET All Payors / Plans All Payors / Plans $3.38 $3.38 $3.38 $3.38 $3.38 $3.38 $3.38 $3.31 $3.31 BUPROPION SR 100 MG TABLET SUSTAINED-RELEASE 12 HR All Payors / Plans All Payors / Plans $2.68 $2.68 $2.68 $2.68 $2.68 $2.68 $2.68 $2.63 $2.63 BUPROPION SR 150 MG TABLET SUSTAINED-RELEASE 12 HR All Payors / Plans All Payors / Plans $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.91 $1.91 BUPROPION XL 150 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $4.25 $4.25 $4.25 $4.25 $4.25 $4.25 $4.25 $4.17 $4.17 BURR SHAVER COOLCUT FLUSHCUT 12 FLUTE OVAL L13 CM OD5 MM All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 BURR SURGICAL MICROPOWER MICRO100 HALL CARBIDE 8 MM LONG L8 MM OD4 MM SMALL BONE OVAL FLUTED STERILE All Payors / Plans All Payors / Plans $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $44.10 $44.10 BUSPIRONE 10 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 BUSPIRONE 5 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 BUTALBITAL-ACETAMINOPHEN-CAFF 50-325-40 MG TABLET All Payors / Plans All Payors / Plans $3.57 $3.57 $3.57 $3.57 $3.57 $3.57 $3.57 $3.50 $3.50 BUTALBITAL-ASPIRIN-CAFFEINE 50-325-40 MG CAPSULE All Payors / Plans All Payors / Plans $3.54 $3.54 $3.54 $3.54 $3.54 $3.54 $3.54 $3.47 $3.47 BUTTON SUCTION BRONCHOSCOPE All Payors / Plans All Payors / Plans $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $18.62 $18.62 CABAZITAXEL 60 MG/1.5 ML (10 MG/ML DILUTION) 1.5 ML VIAL All Payors / Plans All Payors / Plans $212.09 $212.09 $212.09 $212.09 $212.09 $212.09 $212.09 $207.84 $207.84 CABLE CATHETER COAXIAL UMBILICAL DISPOSABLE All Payors / Plans All Payors / Plans $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $186.20 $186.20 CABLE CRYOTHERAPY DISPOSABLE STERILE LF ELECTRICAL UMBILICAL All Payors / Plans All Payors / Plans $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $421.40 $421.40 CABLE DISP W/IRRIGATION All Payors / Plans All Payors / Plans $72.77 $72.77 $72.77 $72.77 $72.77 $72.77 $72.77 $71.31 $71.31 CABLE PACING SJM L 12FT TEMPORARY EXTENSION STERILE LAXTEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 CABLE SILVERGLIDE BIPOLAR All Payors / Plans All Payors / Plans $9.23 $9.23 $9.23 $9.23 $9.23 $9.23 $9.23 $9.05 $9.05 CABLE/SLEEVE ORTHOPEDIC DALL-MILES 1.6MM DISPOSABLE STERILE LF SET BEAD All Payors / Plans All Payors / Plans $601.20 $601.20 $601.20 $601.20 $601.20 $601.20 $601.20 $589.18 $589.18 CABLE/SLEEVE ORTHOPEDIC DALL-MILES STAINLESS STEEL OD1.6 MM HIP SET BEAD All Payors / Plans All Payors / Plans $601.20 $601.20 $601.20 $601.20 $601.20 $601.20 $601.20 $589.18 $589.18 CABLE/SLEEVE ORTHOPEDIC DALL-MILES VITALLIUM OD2 MM HIP SET All Payors / Plans All Payors / Plans $601.20 $601.20 $601.20 $601.20 $601.20 $601.20 $601.20 $589.18 $589.18 CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $16.85 $16.85 $16.85 $16.85 $16.85 $16.85 $16.85 $16.51 $16.51 CAFFEINE CITRATE PER 5 MG All Payors / Plans All Payors / Plans $11.14 $11.14 $11.14 $11.14 $11.14 $11.14 $11.14 $10.92 $10.92 CALAMINE-ZINC OXIDE 8-8 % LOTION 177 ML BOTTLE All Payors / Plans All Payors / Plans $10.48 $10.48 $10.48 $10.48 $10.48 $10.48 $10.48 $10.27 $10.27 "CALCITONIN 200 UNIT/ACTUATION SPRAY,NON-AEROSOL 3.7 ML SQUEEZ BTL" All Payors / Plans All Payors / Plans $155.77 $155.77 $155.77 $155.77 $155.77 $155.77 $155.77 $152.65 $152.65 CALCITRIOL 0.25 MCG CAPSULE All Payors / Plans All Payors / Plans $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.10 $1.10 CALCIUM ACETATE(PHOSPHAT BIND) 667 MG CAPSULE All Payors / Plans All Payors / Plans $5.01 $5.01 $5.01 $5.01 $5.01 $5.01 $5.01 $4.91 $4.91 "CALCIUM CARBONATE 200 MG CALCIUM (500 MG) TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 "CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET" All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 CALCIUM CHLORIDE 100 MG/ML (10 %) SOLUTION All Payors / Plans All Payors / Plans $40.65 $40.65 $40.65 $40.65 $40.65 $40.65 $40.65 $39.84 $39.84 CALCIUM CHLORIDE 100 MG/ML (10 %) SYRINGE All Payors / Plans All Payors / Plans $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.01 $40.01 CALCIUM CHLORIDE 100 MG/ML (10 %) SYRINGE 10 ML VIAL All Payors / Plans All Payors / Plans $40.64 $40.64 $40.64 $40.64 $40.64 $40.64 $40.64 $39.83 $39.83 CALCIUM CITRATE 200 MG (950 MG) TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 CALCIUM GLUCONATE IN NACL 1 GRAM/50 ML SOLUTION All Payors / Plans All Payors / Plans $0.41 $0.41 $0.41 $0.41 $0.41 $0.41 $0.41 $0.40 $0.40 CALCIUM GLUCONATE IN NACL 2 GRAM/100 ML SOLUTION All Payors / Plans All Payors / Plans $0.42 $0.42 $0.42 $0.42 $0.42 $0.42 $0.42 $0.41 $0.41 CALCIUM GLUCONATE PER 10 ML All Payors / Plans All Payors / Plans $0.46 $0.46 $0.46 $0.46 $0.46 $0.46 $0.46 $0.45 $0.45 CALCIUM GLUCONATE PER 10 ML All Payors / Plans All Payors / Plans $0.46 $0.46 $0.46 $0.46 $0.46 $0.46 $0.46 $0.45 $0.45 CANGRELOR 50 MG RECON SOLN All Payors / Plans All Payors / Plans $28.67 $28.67 $28.67 $28.67 $28.67 $28.67 $28.67 $28.10 $28.10 CANGRELOR 50 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $29.46 $29.46 $29.46 $29.46 $29.46 $29.46 $29.46 $28.88 $28.88 CANISTER SUCTION MEDI-VAC GUARDIAN 90 D 2000 ML LOCK LID OVERFLOW SHUTOFF VALVE POUR SPOUT FILTER LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $2.94 $2.94 CANISTER WOUND DRAIN INFOVAC C500 ML GEL TUBE CLAMP CONNECTOR CHARCOAL FILTER STERILE DISPOSABLE All Payors / Plans All Payors / Plans $35.92 $35.92 $35.92 $35.92 $35.92 $35.92 $35.92 $35.20 $35.20 CANNULA ARTHROSCOPIC L70 MM ID5.5 MM CONICAL TIP THREADED OBTURATOR WITHOUT HOLE SET STERILE LATEX FREE DISPOSABLE ORANGE All Payors / Plans All Payors / Plans $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $53.35 $53.35 CANNULA ARTHROSCOPIC POLYCARBONATE L75 MM ID7 MM 3 SEAL DAM THREAD OBTURATOR PRESSURE CONTROL STERILE LATEX FREE DISPOSABLE CLEAR All Payors / Plans All Payors / Plans $79.49 $79.49 $79.49 $79.49 $79.49 $79.49 $79.49 $77.90 $77.90 CANNULA ARTHROSCOPIC POLYCARBONATE L75 MM ID8.5 MM 3 SEAL DAM THREAD OBTURATOR STABILITY PRESSURE CONTROL STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $73.60 $73.60 $73.60 $73.60 $73.60 $73.60 $73.60 $72.13 $72.13 CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L3 CM ID8 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $62.72 $62.72 CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L4 CM ID8 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $62.72 $62.72 CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L5 CM ID8 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $62.72 $62.72 CANNULA ERCP CONTOUR TAPER L210 CM OD5 FR BILIARY DISPOSABLE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $118.24 $118.24 $118.24 $118.24 $118.24 $118.24 $118.24 $115.88 $115.88 CANNULA ERCP TAPER TIP COOK All Payors / Plans All Payors / Plans $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 CANNULA OPHTHALMIC GRIESHABER SHORT OD25 GA ODSEC.8 MM SOFT TIP STERILE DISPOSABLE All Payors / Plans All Payors / Plans $40.88 $40.88 $40.88 $40.88 $40.88 $40.88 $40.88 $40.06 $40.06 CANNULA OPHTHALMIC OD25 GA CHANDELIER STERILE All Payors / Plans All Payors / Plans $323.40 $323.40 $323.40 $323.40 $323.40 $323.40 $323.40 $316.93 $316.93 CANNULA OPHTHALMIC SHORT OD23 GA SOFT TIP STERILE DISPOSABLE All Payors / Plans All Payors / Plans $40.88 $40.88 $40.88 $40.88 $40.88 $40.88 $40.88 $40.06 $40.06 CANNULA OPHTHALMIC SILICONE OD23 GA SOFT TIP DISPOSABLE All Payors / Plans All Payors / Plans $38.92 $38.92 $38.92 $38.92 $38.92 $38.92 $38.92 $38.14 $38.14 CAP PROTECTIVE L1.1 MM OD.045 IN ORTHOPEDIC HEAD STERILE WHITE .045 IN PIN All Payors / Plans All Payors / Plans $5.52 $5.52 $5.52 $5.52 $5.52 $5.52 $5.52 $5.41 $5.41 CARBAMAZEPINE 100 MG/5 ML SUSPENSION All Payors / Plans All Payors / Plans $0.82 $0.82 $0.82 $0.82 $0.82 $0.82 $0.82 $0.81 $0.81 CARBAMAZEPINE 200 MG TABLET All Payors / Plans All Payors / Plans $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.00 $2.00 CARBAMAZEPINE 200 MG/10 ML SUSPENSION All Payors / Plans All Payors / Plans $9.24 $9.24 $9.24 $9.24 $9.24 $9.24 $9.24 $9.06 $9.06 CARBAMAZEPINE XR 100 MG TABLET EXTENDED RELEASE 12 HR All Payors / Plans All Payors / Plans $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.09 $1.09 CARBAMAZEPINE XR 400 MG TABLET EXTENDED RELEASE 12 HR All Payors / Plans All Payors / Plans $11.40 $11.40 $11.40 $11.40 $11.40 $11.40 $11.40 $11.17 $11.17 CARBAMIDE PEROXIDE 6.5 % DROPS 15 ML DROP BTL All Payors / Plans All Payors / Plans $10.41 $10.41 $10.41 $10.41 $10.41 $10.41 $10.41 $10.20 $10.20 CARBIDOPA-LEVODOPA 10-100 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 CARBIDOPA-LEVODOPA 25-100 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 CARBIDOPA-LEVODOPA 25-100 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.70 $2.70 CARBIDOPA-LEVODOPA 50-200 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.61 $2.61 CARBOPLATIN PER 50 MG All Payors / Plans All Payors / Plans $4.49 $4.49 $4.49 $4.49 $4.49 $4.49 $4.49 $4.40 $4.40 CARBOPROST 250 MCG/ML SOLUTION All Payors / Plans All Payors / Plans $650.55 $650.55 $650.55 $650.55 $650.55 $650.55 $650.55 $637.54 $637.54 CARDINALHEALTH R2 PADS All Payors / Plans All Payors / Plans $32.18 $32.18 $32.18 $32.18 $32.18 $32.18 $32.18 $31.54 $31.54 CARDIOPLEGIC SOLUTION HIGH POTASSIUM All Payors / Plans All Payors / Plans $62.39 $62.39 $62.39 $62.39 $62.39 $62.39 $62.39 $61.14 $61.14 CARDIOPLEGIC SOLUTION LOW POTASSIUM All Payors / Plans All Payors / Plans $62.39 $62.39 $62.39 $62.39 $62.39 $62.39 $62.39 $61.14 $61.14 CARISOPRODOL 350 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 CARTRIDGE OIL MAESTRO CORE All Payors / Plans All Payors / Plans $44.46 $44.46 $44.46 $44.46 $44.46 $44.46 $44.46 $43.57 $43.57 CARVEDILOL 12.5 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 CARVEDILOL 25 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 CARVEDILOL 3.125 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 CARVEDILOL 6.25 MG TABLET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 "CARVEDILOL CR 10 MG CAPSULE, ER MULTIPHASE 24 HR" All Payors / Plans All Payors / Plans $14.25 $14.25 $14.25 $14.25 $14.25 $14.25 $14.25 $13.97 $13.97 "CARVEDILOL CR 20 MG CAPSULE, ER MULTIPHASE 24 HR" All Payors / Plans All Payors / Plans $10.66 $10.66 $10.66 $10.66 $10.66 $10.66 $10.66 $10.45 $10.45 CATH BALLOON All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 CATHETER 5FR 65CM RIM All Payors / Plans All Payors / Plans $22.88 $22.88 $22.88 $22.88 $22.88 $22.88 $22.88 $22.42 $22.42 CATHETER ABLATION BARRX 360 L3 CM L85 CM L4 CM OD7 MM ODSEC28 MM ESOPHAGEAL BIPOLAR ELECTRODE BALLOON RADIOFREQUENCY All Payors / Plans All Payors / Plans " $3,125.02 " " $3,125.02 " " $3,125.02 " " $3,125.02 " " $3,125.02 " " $3,125.02 " " $3,125.02 " " $3,062.52 " " $3,062.52 " CATHETER ABLATION NAVIGATIONAL BIDIRECTIONAL 4 MM SPACE D-F CURVE L115 CM L4 MM OD7 FR All Payors / Plans All Payors / Plans " $5,244.00 " " $5,244.00 " " $5,244.00 " " $5,244.00 " " $5,244.00 " " $5,244.00 " " $5,244.00 " " $5,139.12 " " $5,139.12 " CATHETER ABLATION SMARTTOUCH THERMOCOOL SF D-F CURVE OD 8 FR BIODIRECTIONAL THERMOCOUPLE All Payors / Plans All Payors / Plans " $7,880.00 " " $7,880.00 " " $7,880.00 " " $7,880.00 " " $7,880.00 " " $7,880.00 " " $7,880.00 " " $7,722.40 " " $7,722.40 " CATHETER ABLATION SMARTTOUCH THERMOCOOL SF F CURVE UNIDIRECTIONAL THERMOCOUPLE All Payors / Plans All Payors / Plans " $7,324.00 " " $7,324.00 " " $7,324.00 " " $7,324.00 " " $7,324.00 " " $7,324.00 " " $7,324.00 " " $7,177.52 " " $7,177.52 " CATHETER ABLATION TACTICATH 2-2-2MM SPACEDAMATO TYPE FIX CURVE L115CM L3.5MM OD8 FR BIDIRECTIONAL IRRIGATE CONTACT FORCE FIBER OPTIC All Payors / Plans All Payors / Plans " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,117.16 " " $6,117.16 " CATHETER ABLATION TACTICATH SENSOR ENABLED 2-2-2MM SPACE F-J CURVE L115CM L 3.5MM OD 8 FR IRRIGATE BIDIRECTIONAL All Payors / Plans All Payors / Plans " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,242.00 " " $6,117.16 " " $6,117.16 " "CATHETER ABLATION THERMOCOOLSF 2-5-2 SPACE 3.5MM D-F CURVE, L 115 CMOD 8 FR 6 ELECTRODE TIP BI-DIRECTIONAL NON-NAVIGATIONAL" All Payors / Plans All Payors / Plans " $3,838.00 " " $3,838.00 " " $3,838.00 " " $3,838.00 " " $3,838.00 " " $3,838.00 " " $3,838.00 " " $3,761.24 " " $3,761.24 " CATHETER ANGIOGRAPHIC ACCU-VU PLATINUM .035 IN PIGTAIL CURVE L70 CM L20 CM OD5 FR 21 BAND SIZING FLUSH RADIOPAQUE GUIDEWIRE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $254.80 $254.80 CATHETER ANGIOGRAPHIC AUROUS BEACON TIP PIGTAIL 70CM 5FR NYLON 10 SIDEPORT RADIOPAQUE GOLD BAND ACCEPTS .035IN GUIDEWIRE All Payors / Plans All Payors / Plans $169.67 $169.67 $169.67 $169.67 $169.67 $169.67 $169.67 $166.28 $166.28 CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 3.5 CURVE 100CM 5FR .045IN TRILON VENTRICLE ROBUST SHAFT FULL LENGTH WIRE BRAID All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 4 CURVE OD5 FR All Payors / Plans All Payors / Plans $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.22 $9.22 CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 4.5 CURVE OD6 FR All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 5 CURVE OD6 FR All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO LEFT CORONARY BYPASS CURVE OD6 FR All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL RIGHT 4 CURVE L100 CM OD5 FR ID.045 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP VASCULAR ACCESS All Payors / Plans All Payors / Plans $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.22 $9.22 CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH AMPLATZ RIGHT MODIFIED CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT WIRE BRAID All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH MUTLIPURPOSE A 1 CURVE L100 CM OD6 FR ID.052 IN ROBUST SHAFT WIRE BRAID All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO TRILON PIGTAIL CURVE FULL LENGTH L110 CM OD5 FR ID.041 IN VENTRICLE WIRE BRAIDING All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO TRILON PIGTAIL CURVE L125 CM OD6 FR ID.052 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SOFT TIP All Payors / Plans All Payors / Plans $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $15.05 $14.75 $14.75 CATHETER ANGIOGRAPHIC EXPO WILLIAMS RIGHT CURVE 100CM 6FR .056IN All Payors / Plans All Payors / Plans $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.22 $9.22 CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC ANGLE L100 CM L25 CM OD5 FR ID.047 IN 1 BRAID All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC ANGLE L120 CM OD4 FR ID.041 IN 2 BRAID ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $60.75 $60.75 $60.75 $60.75 $60.75 $60.75 $60.75 $59.54 $59.54 CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC ANGLE L65 CM L15 CM OD4 FR ID.041 IN 2 BRAID All Payors / Plans All Payors / Plans $97.10 $97.10 $97.10 $97.10 $97.10 $97.10 $97.10 $95.16 $95.16 CATHETER ANGIOGRAPHIC GLIDECATH STAINLESS STEEL HYDROPHILIC L100 CM L15 CM OD4 FR ID.041 IN 2 BRAID ANGLE TIP STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $97.20 $97.20 $97.20 $97.20 $97.20 $97.20 $97.20 $95.26 $95.26 CATHETER ANGIOGRAPHIC INFINITI THRULUMEN AMPLATZ RIGHT 1 MODIFIED CURVE 100CM 5FR .067IN .047IN VESTAN RADIOPAQUE THIN All Payors / Plans All Payors / Plans $16.70 $16.70 $16.70 $16.70 $16.70 $16.70 $16.70 $16.37 $16.37 CATHETER ANGIOGRAPHIC INFINITI THRULUMEN VESTAN STAINLESS STEEL AMPLATZ RIGHT 2 MODIFY CURVE L100 CM OD6 FR ODSEC.079 IN ID.057 IN 3 STAGE BRAID RADIOPAQUE SOFT DISPOSABLE ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $16.70 $16.70 $16.70 $16.70 $16.70 $16.70 $16.70 $16.37 $16.37 CATHETER ANGIOGRAPHIC PERFORMA .035 IN PIGTAIL L100 CM 5 FR All Payors / Plans All Payors / Plans $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $176.40 $176.40 CATHETER ANGIOGRAPHIC PERFORMA .035 IN VERT CURVE L100 CM OD5 FR ID.046 IN All Payors / Plans All Payors / Plans $21.20 $21.20 $21.20 $21.20 $21.20 $21.20 $21.20 $20.78 $20.78 CATHETER ANGIOGRAPHIC SOFT-VU KUMPE CURVE ANGLE L40 CM OD4 FR NONBRAIDED SOFT RADIOPAQUE TIP HIGH TORQUE SHAFT SELECTIVE STERILE DISPOSABLE .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $68.80 $68.80 $68.80 $68.80 $68.80 $68.80 $68.80 $67.42 $67.42 CATHETER ANGIOGRAPHIC SOFT-VU SOS OMNI2 CURVE 80CM 5FR DISPOSABLE STERILE VISCERA BRAID ULTRA TORQUE SHAFT RADIOPAQUE All Payors / Plans All Payors / Plans $46.08 $46.08 $46.08 $46.08 $46.08 $46.08 $46.08 $45.16 $45.16 CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP NYLON .035 IN RIM CURVE L65 CM OD4 FR LOW PROFILE HUB TO TIP TAPERED TIP OPTIMAL STEERABILITY All Payors / Plans All Payors / Plans $30.28 $30.28 $30.28 $30.28 $30.28 $30.28 $30.28 $29.67 $29.67 CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE NYLON STAINLESS STEEL .038 IN H1 CURVE L 100CM OD 5FR CEREBRAL FLEXIBLE ATRAUMATIC TIP All Payors / Plans All Payors / Plans $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE NYLON STAINLESS STEEL .038 IN SIM2 CURVE L 100 CM OD 5 FR CEREBRAL FLEXIBLE ATRAUMATIC TIP All Payors / Plans All Payors / Plans $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $50.96 $50.96 CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGEBEACON TIP STAINLESS STEEL NYLON WEINBERG CEREBRAL CURVE LOW PROFILE TAPER L100CM OD 5FR RADIOPAQUE ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $50.96 $50.96 CATHETER ATHERECTOMY SHOCKWAVE C2 IVL 3.0 X 12 MM All Payors / Plans All Payors / Plans " $9,400.00 " " $9,400.00 " " $9,400.00 " " $9,400.00 " " $9,400.00 " " $9,400.00 " " $9,400.00 " " $9,212.00 " " $9,212.00 " CATHETER BALLOON DILATATION EUPHORA 142CM 10MM 3MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE LUER All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA 142CM 12MM 3MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE LUER All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L10 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L10 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L12 MM OD2.1-2.5 FR ODSEC1.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $91.88 $91.88 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L12 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $91.88 $91.88 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L12 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $91.88 $91.88 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L15 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L15 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L15 MM OD2.1-2.5 FR ODSEC3 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $91.88 $91.88 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L20 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L20 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L6 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 15 MM ODSEC 2.75 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 20 MM ODSEC 3.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION MUSTANG .035IN 75CM 60MM 8MM NYBAX HIGH PRESSURE LOW All Payors / Plans All Payors / Plans $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $323.40 $323.40 CATHETER BALLOON DILATATION MUSTANG 135CM 40MM 8MM 6FR NYBAX MEDIGLIDE HIGH PRESSURE All Payors / Plans All Payors / Plans $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $323.40 $323.40 CATHETER BALLOON DILATATION MUSTANG 135CM 60MM 6MM 5FR NYBAX MEDIGLIDE HIGH PRESSURE All Payors / Plans All Payors / Plans $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $323.40 $323.40 CATHETER BALLOON DILATATION MUSTANG 75CM 40MM 8MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 6FR INTRODUCER SHEATH All Payors / Plans All Payors / Plans $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $323.40 $323.40 CATHETER BALLOON DILATATION MUSTANG 75CM 80MM 8MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 6FR INTRODUCER SHEATH All Payors / Plans All Payors / Plans $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $372.40 $372.40 CATHETER BALLOON DILATATION MUSTANG LOW PROFILE 75CM 80MM 5.3FR 7MM NYBAX HIGH All Payors / Plans All Payors / Plans $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $323.40 $323.40 CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L150 MM ODSEC6 MM HIGH PRESSURE All Payors / Plans All Payors / Plans $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $323.40 $323.40 CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L40 CM L40 MM ODSEC7 MM HIGH PRESSURE All Payors / Plans All Payors / Plans $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $372.40 $372.40 CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 2.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $91.88 $91.88 CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 2.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 2MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $91.88 $91.88 CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $91.88 $91.88 CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 2.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 CATHETER BALLOON DILATATION RELIANT POLYURETHANE L100 CM OD8 FR ODSEC10-46 MM DELIVERY ENDOLEAK SEAL ACCEPTS .038 IN GUIDEWIRE AAA STENT GRAFT SYSTEM All Payors / Plans All Payors / Plans $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $872.20 $872.20 CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.75 X 10MM NON COMPLIANT PLUS All Payors / Plans All Payors / Plans $118.75 $118.75 $118.75 $118.75 $118.75 $118.75 $118.75 $116.38 $116.38 CATHETER BALLOON DILATATION STERLING .018 IN L135 CM L40 MM OD6 FR ODSEC4 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH All Payors / Plans All Payors / Plans $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $539.00 $539.00 CATHETER BALLOON DILATATION STERLING .018 IN L135 MM L100 MM OD6 FR ODSEC5 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH All Payors / Plans All Payors / Plans $343.75 $343.75 $343.75 $343.75 $343.75 $343.75 $343.75 $336.88 $336.88 CATHETER BALLOON DILATATION STERLING .018 IN L135 MM L60 MM OD6 FR ODSEC5 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH All Payors / Plans All Payors / Plans $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $539.00 $539.00 CATHETER BALLOON DILATATION STERLING L40 CM L20 MM OD3.8 FR ODSEC5 MM OTW RAPID EXCHANGE INFLATION WIRE PORT ACCEPTS .018 GUIDEWIRE 4 FR INTRODUCER SHEATH ANGIOPLASTY All Payors / Plans All Payors / Plans $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 CATHETER BALLOON DILATATION STERLING L40 CM L40 MM OD3.8 FR ODSEC5 MM OTW ACCEPTS .018 IN GUIDEWIRE 4 FR INTRODUCER SHEATH ANGIOPLASTY All Payors / Plans All Payors / Plans $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 CATHETER BALLOON DILATATION STERLING L40 CM L40 MM OD3.8 FR ODSEC7 MM OTW ACCEPTS .018 IN GUIDEWIRE 4 FR INTRODUCER SHEATH ANGIOPLASTY All Payors / Plans All Payors / Plans $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 CATHETER BALLOON DILATATION STERLING MONORAIL LOW PROFILE TAPER L135 CM L20 MM OD3.8-3.4 FR ODSEC3 MM RAPID EXCHANGE INFLATION PORT ACCEPTS .018 IN GUIDEWIRE PTA All Payors / Plans All Payors / Plans $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 CATHETER BALLOON DILATATION STERLING MONORAIL PEBAX BIOSLIDE L80 CM L40 MM ODSEC5 MM PERIPHERAL TAPER TIP LOW PROFILE INFLATE PORT ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH 6 FR GUIDE CATHETER PTA All Payors / Plans All Payors / Plans $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L135 CM L40 MM OD6 FR ODSEC6 MM ID4 FR OTW LOW PROFILE INFLATION WIRE PORT ACCEPTS .018 IN GUIDEWIRE PTA All Payors / Plans All Payors / Plans $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $539.00 $539.00 CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L150 CM L220 MM OD7 FR ODSEC6 MM ID5 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA All Payors / Plans All Payors / Plans $664.00 $664.00 $664.00 $664.00 $664.00 $664.00 $664.00 $650.72 $650.72 CATHETER BALLOON DILATATION XXL .035 IN L75 CM L40 MM OD5.8 FR ODSEC14 MM PERIPHERAL LARGE VESSEL GUIDEWIRE ACCEPTS 7 FR INTRODUCER SHEATH PTA All Payors / Plans All Payors / Plans $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 CATHETER BALLOON OCCLUSION GORE 10-37 MM L90 CM L4 CM MOLD STENT GRAFT OPTIMIZE SEAL ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans " $1,044.00 " " $1,044.00 " " $1,044.00 " " $1,044.00 " " $1,044.00 " " $1,044.00 " " $1,044.00 " " $1,023.12 " " $1,023.12 " CATHETER CENTRAL VENOUS 36CM 19FR HEPARIN TAL PALINDROME EMERALD SPORTPACK VENATRAC All Payors / Plans All Payors / Plans $580.00 $580.00 $580.00 $580.00 $580.00 $580.00 $580.00 $568.40 $568.40 CATHETER CENTRAL VENOUS TAL PALINDROME EMERALD HEPARIN L40 CM OD23 FR SPORTPACK VENATRAC All Payors / Plans All Payors / Plans $580.00 $580.00 $580.00 $580.00 $580.00 $580.00 $580.00 $568.40 $568.40 CATHETER CRYOABLATION ARCTIC FRONT ADVANCE L28 CM All Payors / Plans All Payors / Plans " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $8,820.00 " " $8,820.00 " CATHETER CRYOABLATION ARTIC FRONT ADVANCE PRO L28CM All Payors / Plans All Payors / Plans " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $9,000.00 " " $8,820.00 " " $8,820.00 " CATHETER DECANAV F CURVE _58397_ All Payors / Plans All Payors / Plans " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,422.56 " " $2,422.56 " CATHETER DIAGNOSTIC DXTERITY INSLIDE PIGTAIL 145 CURVE L110 CM OD 6 FR ID .056 IN LARGE LUMEN 6 SIDEHOLE RADIOPAQUE 2 BRAID WIRE STERILE ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 CATHETER DRAINAGE AMPLATZ ULTRATHANE UNIVERSAL L50 CM OD10.2 FR 6 SIDEPORT STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $229.98 $229.98 $229.98 $229.98 $229.98 $229.98 $229.98 $225.38 $225.38 CATHETER DRAINAGE APD FLEXIMA LOOP 25CM 8FR METAL HYDROPHILIC DISPOSABLE STERILE REGULAR DUROMETER STIFF CANNULA LG All Payors / Plans All Payors / Plans $160.50 $160.50 $160.50 $160.50 $160.50 $160.50 $160.50 $157.29 $157.29 CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EYE STRAIGHT 20IN 28FR CLEAR PVC DISPOSABLE STERILE LF THORACIC SMOOTH All Payors / Plans All Payors / Plans $6.47 $6.47 $6.47 $6.47 $6.47 $6.47 $6.47 $6.34 $6.34 CATHETER DRAINAGE ARGYLE STRAIGHT 20IN 24FR CLEAR PVC DISPOSABLE STERILE THORACIC SMOOTH SIDE EYE RADIOPAQUE OPEN DISTAL All Payors / Plans All Payors / Plans $6.47 $6.47 $6.47 $6.47 $6.47 $6.47 $6.47 $6.34 $6.34 CATHETER DRAINAGE SILICONE STRAIGHT L20 IN OD20 FR THORACIC 5 EYELET KINK RESISTANT RADIOPAQUE STRIPE TAPERED TIP STERILE LATEX FREE DISPOSABLE CLEAR All Payors / Plans All Payors / Plans $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $21.56 $21.56 CATHETER ELECTROHEMOSTASIS GOLD PROBE 300CM 7FR HEMOGLIDE DISPOSABLE STERILE BIPOLAR ROUND DISTAL TIP FIRM SHAFT All Payors / Plans All Payors / Plans $288.40 $288.40 $288.40 $288.40 $288.40 $288.40 $288.40 $282.63 $282.63 CATHETER ELECTROPHYSIOLOGY 2-5-2 MM SPACING LARGE L110 CM OD6 FR DECAPOLAR STEERABLE All Payors / Plans All Payors / Plans $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $666.40 $666.40 CATHETER ELECTROPHYSIOLOGY 2-8-2 MM SPACE P CURVE L 60CM L 1MM OD 5 FR DECAPOLAR FIX AUTO ID All Payors / Plans All Payors / Plans $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $637.00 $637.00 CATHETER ELECTROPHYSIOLOGY 5MM SPACE A CURVE L 115CM L 1MM OD 6FR QUADRAPOLAR AUTO ID All Payors / Plans All Payors / Plans $268.00 $268.00 $268.00 $268.00 $268.00 $268.00 $268.00 $262.64 $262.64 CATHETER ELECTROPHYSIOLOGY ACHIEVE 3D L20 MM MAPPING LOOP All Payors / Plans All Payors / Plans " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,862.00 " " $1,862.00 " CATHETER ELECTROPHYSIOLOGY INQUIRY 2-5-2 MM SPACING LARGE CURVE L110 CM L2 MM OD6 FR MAPPING QUADRIPOLAR STEERABLE All Payors / Plans All Payors / Plans $580.00 $580.00 $580.00 $580.00 $580.00 $580.00 $580.00 $568.40 $568.40 CATHETER ELECTROPHYSIOLOGY OD6 FR CSF10 PIN AUTO ID DODECAPOLAR All Payors / Plans All Payors / Plans " $1,140.00 " " $1,140.00 " " $1,140.00 " " $1,140.00 " " $1,140.00 " " $1,140.00 " " $1,140.00 " " $1,117.20 " " $1,117.20 " CATHETER ELECTROPHYSIOLOGY PENTARRAY 2-6-2 MM D CURVE OD 7 FR NAVIGATION ELECTRODE All Payors / Plans All Payors / Plans " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,263.00 " " $4,263.00 " CATHETER ELECTROPHYSIOLOGY PENTARRAY 2-6-2 MM SPACE F CURVE L115CM OD 7 FR NAVIGATION 20 ELECTRODE All Payors / Plans All Payors / Plans " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,350.00 " " $4,263.00 " " $4,263.00 " CATHETER ELECTROPHYSIOLOGY REDEL WEBSTER 10MM SPACE REGULAR D CURVE L 92CM L 1MM OD 6FR DEFLECTABLE QUADRAPOLAR AUTO ID All Payors / Plans All Payors / Plans $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 CATHETER ELECTROPHYSIOLOGY RESPONSE 1 MM 5 MM SPACE JSN CURVE L120 CM OD6 FR QUADRIPOLAR SUPERB TORQUE CONTROL BAND ELECTRODE CONVENIENT CABLE All Payors / Plans All Payors / Plans $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $199.92 $199.92 CATHETER ELECTROPHYSIOLOGY RESPONSE 2-8-2 MM SPACING CSL CURVE L65 CM OD6 FR DECAPOLAR All Payors / Plans All Payors / Plans $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $705.60 $705.60 CATHETER EMBOLECTOMY LEMAITRE L80 CM OD4 FR ODSEC10.5 MM 75 ML STERILE LATEX DISPOSABLE All Payors / Plans All Payors / Plans $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $135.24 $135.24 CATHETER EMBOLECTOMY LEMAITRE L80 CM OD6 FR ODSEC13.5 MM 16 ML STERILE LATEX DISPOSABLE All Payors / Plans All Payors / Plans $89.70 $89.70 $89.70 $89.70 $89.70 $89.70 $89.70 $87.91 $87.91 CATHETER ENDOSCOPIC ULTRASOUND BALLOON CUFF LATEX All Payors / Plans All Payors / Plans $58.91 $58.91 $58.91 $58.91 $58.91 $58.91 $58.91 $57.73 $57.73 CATHETER EXTERNAL DRAINAGE EDM SILICONE L80 CM LUMBAR CLOSED TIP BARIUM IMPREGNATED STERILE All Payors / Plans All Payors / Plans $495.36 $495.36 $495.36 $495.36 $495.36 $495.36 $495.36 $485.45 $485.45 CATHETER GUIDING CPS AIM CARDIAC VALVE BYPASS TOOL All Payors / Plans All Payors / Plans $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 CATHETER GUIDING ENVOY STRAIGHT L 95CM OD 6FR DISTAL ACCESS All Payors / Plans All Payors / Plans " $1,407.60 " " $1,407.60 " " $1,407.60 " " $1,407.60 " " $1,407.60 " " $1,407.60 " " $1,407.60 " " $1,379.45 " " $1,379.45 " CATHETER GUIDING LAUNCHER AMPLATZ RIGHT 1 CURVE L100 CM OD8 FR ID.09 IN CORONARY RADIOPAQUE LARGE LUMEN FLEXIBLE DISTAL SEGMENT SIDEHOLE ORANGE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER AR1 CURVE L100 CM OD6 FR CORONARY SIDEHOLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER HS1 CURVE L100 CM OD6 FR CORONARY All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER HS1 CURVE OD8 FR CORONARY SIDEHOLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER JL4.5 CURVE L100 CM OD6 FR CORONARY SIDEHOLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER JR3.5 CURVE SIDEHOLE L100 CM OD8 FR CORONARY SIDEHOLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER JR4 CURVE L100 CM OD8 FR CORONARY SIDEHOLE LATEX FREE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON 3 DIMENSIONAL RIGHT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $51.45 $51.45 CATHETER GUIDING LAUNCHER NYLON AMPLATZ 1 LEFT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON AMPLATZ 1 RIGHT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3.5 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $51.45 $51.45 CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3.75 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 4 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 4 LEFT CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $51.45 $51.45 CATHETER GUIDING LAUNCHER NYLON HS2 CURVE OD6 FR ID.071 IN CORONARY MULTIPURPOSE LARGE LUMEN FLEXIBLE DISTAL SEGMENT FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 3.5 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $51.45 $51.45 CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 RIGHT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $51.45 $51.45 CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 RIGHT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 5 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING LAUNCHER NYLON MULTIPURPOSE 1 CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 CATHETER GUIDING QUICK-CROSS .014 IN 15 MM SPACE L135 CM OD1.5 FR RADIOPAQUE MARKER SEAMLESS LOW PROFILE TAPER TIP GUIDEWIRE All Payors / Plans All Payors / Plans $334.00 $334.00 $334.00 $334.00 $334.00 $334.00 $334.00 $327.32 $327.32 CATHETER HEMODIALYSIS GLIDEPATH POLYURETHANE STRAIGHT L55 CM L50 CM OD14.5 FR STANDARD KIT AIRGUARD VALVED INTRODUCER SYMMETRIC TIP PRELOADED LONG TERM NONSTERILE DISPOSABLE All Payors / Plans All Payors / Plans $453.20 $453.20 $453.20 $453.20 $453.20 $453.20 $453.20 $444.14 $444.14 CATHETER ICE WITH 4 WAY STEERING All Payors / Plans All Payors / Plans " $4,658.00 " " $4,658.00 " " $4,658.00 " " $4,658.00 " " $4,658.00 " " $4,658.00 " " $4,658.00 " " $4,564.84 " " $4,564.84 " CATHETER INFUSION DIREXION HI-FLO FATHOM-16 NITINOL PTFE MICRO STRAIGHT L130 CM L180 CM OD2.8-3 FR ID.027 IN PRELOAD TORQUEABLE GUIDEWIRE INNER LUMEN All Payors / Plans All Payors / Plans " $1,899.24 " " $1,899.24 " " $1,899.24 " " $1,899.24 " " $1,899.24 " " $1,899.24 " " $1,899.24 " " $1,861.26 " " $1,861.26 " CATHETER INTERVENTIONAL GUIDELINER STAINLESS STEEL POLYMER L150CM L 25CMOD 5 FR ID .056 IN IDSEC .046 IN RAPID EXCHANGE COAXIAL GUIDE EXTENSION FLEXIBLE COLLAR RADIOPAQUE All Payors / Plans All Payors / Plans $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $487.55 $487.55 CATHETER KUMPE 5FR 65CM All Payors / Plans All Payors / Plans $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $64.68 $64.68 CATHETER MAPPING ADVISOR HD GRID SENSOR ENABLED BI-D All Payors / Plans All Payors / Plans " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,822.00 " " $3,822.00 " CATHETER PACING BARD 1CM PROXIMAL 110CM 5FR NATURAL RUBBER DISPOSABLE STERILE LATEX ELECTRODE BIPOLAR DISTAL TIP BALLOON All Payors / Plans All Payors / Plans $345.25 $345.25 $345.25 $345.25 $345.25 $345.25 $345.25 $338.35 $338.35 CATHETER PERITONEAL DIALYSIS EXTENDED TWO-PIECE WITH EXTENDER FOR LAPROSCOPIC PLACMENT All Payors / Plans All Payors / Plans $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $833.00 $833.00 CATHETER PLEURX All Payors / Plans All Payors / Plans " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,127.00 " " $1,127.00 " CATHETER PULMONARY ARTERY SWAN-GANZ CCO VIP 110CM 7.5FR HEPARIN POLYMER PULMONARY All Payors / Plans All Payors / Plans $148.18 $148.18 $148.18 $148.18 $148.18 $148.18 $148.18 $145.22 $145.22 CATHETER URETERAL FLEXI-TIP STANDARD L70 CM OD5 FR OPEN END LATEX FREE ACCEPTS .038 IN GUIDEWIRE RETROGRADE PYELOGRAM All Payors / Plans All Payors / Plans $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $31.72 $31.72 CATHETER URETERAL PLASTIC WHISTLE L65 CM OD4 FR 2 STAGGER EYE LUER FIT ADAPTER COLOR CODED XRAY OPAQUE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $17.42 $17.42 $17.42 $17.42 $17.42 $17.42 $17.42 $17.07 $17.07 CATHETER URETERAL ROYAL FLUSH PLUS NYLON BEACON TIP VCF CURVE SPIRAL L65 CM OD4 FR 8 SIDEPORT HIGH FLOW RADIOPAQUE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $29.72 $29.72 $29.72 $29.72 $29.72 $29.72 $29.72 $29.13 $29.13 CATHETER URETHRAL BARDEX IC 12FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON All Payors / Plans All Payors / Plans $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.80 $4.80 CATHETER URETHRAL BARDEX IC 14FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON All Payors / Plans All Payors / Plans $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.80 $4.80 CATHETER URETHRAL BARDEX IC 18FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON All Payors / Plans All Payors / Plans $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.80 $4.80 CATHETER URETHRAL BARDEX IC 20FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON All Payors / Plans All Payors / Plans $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.80 $4.80 CATHETER URETHRAL BARDEX IC 20FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON All Payors / Plans All Payors / Plans $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.80 $4.80 CATHETER URETHRAL BARDEX IC BACTI-GUARD NATURAL RUBBER HYDROGEL OD18 FR 5 CC 2 WAY FOLEY BALLOON ATRAUMATIC INSERTION STERILE LATEX DISPOSABLE All Payors / Plans All Payors / Plans $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.80 $4.80 CATHETER URETHRAL DOVER SILICONE L16 IN OD14 FR 5 CC 2 WAY FOLEY COLOR CODED INFLATION VALVE REINFORCE TIP LATEX FREE All Payors / Plans All Payors / Plans $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.90 $4.80 $4.80 CATHETER VENTRICULAR ANTIMICROBIAL All Payors / Plans All Payors / Plans $975.74 $975.74 $975.74 $975.74 $975.74 $975.74 $975.74 $956.23 $956.23 CAUTERY BATTERY DIAGNOSTICK L2 IN OPHTHALMIC PENCIL CORDLESS HIGH TEMPERATURE LOOP STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $17.78 $17.78 $17.78 $17.78 $17.78 $17.78 $17.78 $17.42 $17.42 CEFAZOLIN 2 GRAM RECON SOLN All Payors / Plans All Payors / Plans $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.40 $6.40 CEFAZOLIN 2 GRAM RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $3.26 $3.26 $3.26 $3.26 $3.26 $3.26 $3.26 $3.20 $3.20 CEFAZOLIN PER 500 MG All Payors / Plans All Payors / Plans $12.69 $12.69 $12.69 $12.69 $12.69 $12.69 $12.69 $12.43 $12.43 CEFDINIR 250 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $5.61 $5.61 $5.61 $5.61 $5.61 $5.61 $5.61 $5.50 $5.50 CEFDINIR 300 MG CAPSULE All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 CEFEPIME PER 500 MG All Payors / Plans All Payors / Plans $37.88 $37.88 $37.88 $37.88 $37.88 $37.88 $37.88 $37.12 $37.12 CEFOXITIN PER 1 G All Payors / Plans All Payors / Plans $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.35 $15.35 CEFTAROLINE FOSAMIL PER 10 MG All Payors / Plans All Payors / Plans $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.75 $9.75 CEFTAZIDIME PER 500 MG All Payors / Plans All Payors / Plans $2.52 $2.52 $2.52 $2.52 $2.52 $2.52 $2.52 $2.47 $2.47 CEFTOLOZANE-TAZOBACTAM 1.5 GRAM RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $16.74 $16.74 $16.74 $16.74 $16.74 $16.74 $16.74 $16.40 $16.40 CEFTRIAXONE PER 250 MG All Payors / Plans All Payors / Plans $6.56 $6.56 $6.56 $6.56 $6.56 $6.56 $6.56 $6.43 $6.43 CEFUROXIME 500 MG TABLET All Payors / Plans All Payors / Plans $3.51 $3.51 $3.51 $3.51 $3.51 $3.51 $3.51 $3.44 $3.44 CEFUROXIME PER 750 MG All Payors / Plans All Payors / Plans $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.29 $10.29 CELECOXIB 100 MG CAPSULE All Payors / Plans All Payors / Plans $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.71 $2.71 CELECOXIB 200 MG CAPSULE All Payors / Plans All Payors / Plans $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.83 $1.83 CEMENT BONE PALACOS R 40 GM GREEN All Payors / Plans All Payors / Plans $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $105.84 $105.84 CEMENT BONE SIMPLEX P RADIOPAQUE FULL DOSE STERILE All Payors / Plans All Payors / Plans $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $113.68 $113.68 CEMENT BONE SIMPLEX P SPEEDSET RADIOPAQUE STERILE All Payors / Plans All Payors / Plans $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $113.68 $113.68 CEMENT BONE SIMPLEX P TOBRAMYCIN FULL DOSE RADIOPAQUE PREBLEND STERILE All Payors / Plans All Payors / Plans $471.00 $471.00 $471.00 $471.00 $471.00 $471.00 $471.00 $461.58 $461.58 CEMENT OSTEOTOME STAGING STRAIGHT LINE All Payors / Plans All Payors / Plans $380.54 $380.54 $380.54 $380.54 $380.54 $380.54 $380.54 $372.93 $372.93 CENTRALIZER STEM CEMENTRALIZER PMMA OD13 MM HIP FEMUR STERILE ENDURANCE LUSTER EXCEL SUMMIT SYSTEM All Payors / Plans All Payors / Plans $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $239.12 $239.12 CEPHALEXIN 125 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $3.90 $3.90 $3.90 $3.90 $3.90 $3.90 $3.90 $3.82 $3.82 CEPHALEXIN 250 MG CAPSULE All Payors / Plans All Payors / Plans $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.79 $1.79 CEPHALEXIN 250 MG/5 ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $10.76 $10.76 $10.76 $10.76 $10.76 $10.76 $10.76 $10.54 $10.54 CEPHALEXIN 500 MG CAPSULE All Payors / Plans All Payors / Plans $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.11 $1.11 CETIRIZINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 CETIRIZINE 5 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $7.11 $7.11 $7.11 $7.11 $7.11 $7.11 $7.11 $6.97 $6.97 CETIRIZINE-PSEUDOEPHEDRINE 5-120 MG TABLET EXTENDED RELEASE 12 HR All Payors / Plans All Payors / Plans $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.70 $2.70 CHARGE NEUROMONITORING PROCEDURE-ALL SERVICES EXCEPT NEURO All Payors / Plans All Payors / Plans $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $313.60 $313.60 CHARGE NEUROMONITORING PROCEDURE-NEURO All Payors / Plans All Payors / Plans $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $313.60 $313.60 CHICAGO TIP 12FR SELFCLEANING DISP SUCTION All Payors / Plans All Payors / Plans $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $62.72 $62.72 CHLORDIAZEPOXIDE 25 MG CAPSULE All Payors / Plans All Payors / Plans $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.03 $2.03 CHLORDIAZEPOXIDE 5 MG CAPSULE All Payors / Plans All Payors / Plans $2.72 $2.72 $2.72 $2.72 $2.72 $2.72 $2.72 $2.66 $2.66 CHLORHEXIDINE 0.12 % MOUTHWASH All Payors / Plans All Payors / Plans $5.12 $5.12 $5.12 $5.12 $5.12 $5.12 $5.12 $5.02 $5.02 CHLOROPROCAINE 20 MG/ML (2 %) SOLUTION All Payors / Plans All Payors / Plans $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 CHLOROPROCAINE PER 30 ML All Payors / Plans All Payors / Plans $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 CHLOROTHIAZIDE PER 500 MG All Payors / Plans All Payors / Plans $135.48 $135.48 $135.48 $135.48 $135.48 $135.48 $135.48 $132.77 $132.77 CHLORPROMAZINE PER 25 MG All Payors / Plans All Payors / Plans $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.14 $4.14 CHLORTHALIDONE 25 MG TABLET All Payors / Plans All Payors / Plans $6.96 $6.96 $6.96 $6.96 $6.96 $6.96 $6.96 $6.82 $6.82 CHOLECALCIFEROL 10 MCG (400 UNIT) TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 "CHOLECALCIFEROL 25 MCG (1,000 UNIT) TABLET" All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 CHOLESTYRAMINE 4 GRAM POWDER IN PACKET All Payors / Plans All Payors / Plans $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.64 $8.64 CHONDROITIN SULF-SOD HYALURON 4-3 % (40-30 MG/ML) SYRINGE All Payors / Plans All Payors / Plans $197.65 $197.65 $197.65 $197.65 $197.65 $197.65 $197.65 $193.70 $193.70 CINACALCET 30 MG TABLET All Payors / Plans All Payors / Plans $23.65 $23.65 $23.65 $23.65 $23.65 $23.65 $23.65 $23.18 $23.18 CIPROFLOXACIN 0.3 % DROPS 2.5 ML DROP BTL All Payors / Plans All Payors / Plans $21.09 $21.09 $21.09 $21.09 $21.09 $21.09 $21.09 $20.67 $20.67 CIPROFLOXACIN 0.3 % OINTMENT 3.5 G TUBE All Payors / Plans All Payors / Plans $463.77 $463.77 $463.77 $463.77 $463.77 $463.77 $463.77 $454.49 $454.49 CIPROFLOXACIN 250 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.01 $1.01 CIPROFLOXACIN 500 MG TABLET All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 CIPROFLOXACIN PER 200 MG All Payors / Plans All Payors / Plans $21.86 $21.86 $21.86 $21.86 $21.86 $21.86 $21.86 $21.42 $21.42 "CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % DROPS,SUSPENSION 7.5 ML DROP BTL" All Payors / Plans All Payors / Plans $256.58 $256.58 $256.58 $256.58 $256.58 $256.58 $256.58 $251.45 $251.45 "CIPROFLOXACIN-HYDROCORTISONE 0.2-1 % DROPS,SUSPENSION 10 ML DROP BTL" All Payors / Plans All Payors / Plans $687.79 $687.79 $687.79 $687.79 $687.79 $687.79 $687.79 $674.03 $674.03 CIRCUIT ANESTHESIA ADULT All Payors / Plans All Payors / Plans $8.71 $8.71 $8.71 $8.71 $8.71 $8.71 $8.71 $8.54 $8.54 CISATRACURIUM 10 MG/ML CONC. (ICU USE ONLY) SOLUTION 20 ML VIAL All Payors / Plans All Payors / Plans $145.64 $145.64 $145.64 $145.64 $145.64 $145.64 $145.64 $142.73 $142.73 CISATRACURIUM 2 MG/ML SOLUTION All Payors / Plans All Payors / Plans $16.33 $16.33 $16.33 $16.33 $16.33 $16.33 $16.33 $16.00 $16.00 CISPLATIN PER 50 MG All Payors / Plans All Payors / Plans $7.65 $7.65 $7.65 $7.65 $7.65 $7.65 $7.65 $7.49 $7.49 CITALOPRAM 10 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 CITALOPRAM 20 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 CITALOPRAM 40 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 CLAMP CORD DOUBLE-GRIP PLASTIC DISPOSABLE STERILE LF NEONATE UMBILICAL HINGE GUARD SERRATE JAW All Payors / Plans All Payors / Plans $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 CLARITHROMYCIN 500 MG TABLET All Payors / Plans All Payors / Plans $10.02 $10.02 $10.02 $10.02 $10.02 $10.02 $10.02 $9.82 $9.82 CLEANER ELECTRO LUBE ROBOTIC All Payors / Plans All Payors / Plans $58.90 $58.90 $58.90 $58.90 $58.90 $58.90 $58.90 $57.72 $57.72 CLEVIDIPINE 25 MG/50 ML EMULSION All Payors / Plans All Payors / Plans $359.56 $359.56 $359.56 $359.56 $359.56 $359.56 $359.56 $352.37 $352.37 CLEVIDIPINE 50 MG/100 ML EMULSION All Payors / Plans All Payors / Plans $359.56 $359.56 $359.56 $359.56 $359.56 $359.56 $359.56 $352.37 $352.37 CLINDAMYCIN 150 MG CAPSULE All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 CLINDAMYCIN IN 0.9% NS 900 MG/50 ML PIGGYBACK All Payors / Plans All Payors / Plans $26.73 $26.73 $26.73 $26.73 $26.73 $26.73 $26.73 $26.20 $26.20 CLINDAMYCIN PALMITATE HCL 75 MG/5 ML RECON SOLN All Payors / Plans All Payors / Plans $10.45 $10.45 $10.45 $10.45 $10.45 $10.45 $10.45 $10.24 $10.24 CLINDAMYCIN PER 300 MG All Payors / Plans All Payors / Plans $65.35 $65.35 $65.35 $65.35 $65.35 $65.35 $65.35 $64.04 $64.04 CLIP EXTERNAL DISPOSABLE STERILE SCALP 10 CLIP 20 CARTRIDGE All Payors / Plans All Payors / Plans $49.55 $49.55 $49.55 $49.55 $49.55 $49.55 $49.55 $48.56 $48.56 CLIP HEMOSTATIC RESOLUTION 2.8MM 11MM OPEN 235CM DISPOSABLE STERILE RADIOPAQUE PRELOAD All Payors / Plans All Payors / Plans $346.65 $346.65 $346.65 $346.65 $346.65 $346.65 $346.65 $339.72 $339.72 CLIP HEMOSTATIC RESOLUTION 360 L235 CM BRAID TACTILE FEEDBACK All Payors / Plans All Payors / Plans $442.64 $442.64 $442.64 $442.64 $442.64 $442.64 $442.64 $433.79 $433.79 CLIP INTERNAL WECK HEM-O-LOK LG CHEVRON HEART PURPLE POLYMER DISPOSABLE STERILE LF LIGATE NONABSORBABLE CARTRIDGE All Payors / Plans All Payors / Plans $47.06 $47.06 $47.06 $47.06 $47.06 $47.06 $47.06 $46.12 $46.12 CLIP INTERNAL WECK HEM-O-LOK XL CHEVRON HEART GOLD POLYMER DISPOSABLE STERILE LF LIGATE NONABSORBABLE CARTRIDGE All Payors / Plans All Payors / Plans $52.29 $52.29 $52.29 $52.29 $52.29 $52.29 $52.29 $51.24 $51.24 CLIP LIGATING ENDOSCOPIC HEMOLOK POLYMER GREEN MEDIUM LARGE 5.0MM All Payors / Plans All Payors / Plans $32.68 $32.68 $32.68 $32.68 $32.68 $32.68 $32.68 $32.03 $32.03 CLIP LIGATION RESOLUTION 360 ULTRA 17 MM OPEN L235 CM BRAID ROTATION CONTROL KNOB All Payors / Plans All Payors / Plans $481.05 $481.05 $481.05 $481.05 $481.05 $481.05 $481.05 $471.43 $471.43 CLIP PADLOCK DEFECT CLOSURE SYSTEM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " CLIP SURGICAL DLP L3 MM CORONARY ARTERY RETRACTION All Payors / Plans All Payors / Plans $29.76 $29.76 $29.76 $29.76 $29.76 $29.76 $29.76 $29.16 $29.16 CLOMIPRAMINE 25 MG CAPSULE All Payors / Plans All Payors / Plans $17.39 $17.39 $17.39 $17.39 $17.39 $17.39 $17.39 $17.04 $17.04 CLOMIPRAMINE 50 MG CAPSULE All Payors / Plans All Payors / Plans $18.81 $18.81 $18.81 $18.81 $18.81 $18.81 $18.81 $18.43 $18.43 "CLONAZEPAM 0.25 MG TABLET,DISINTEGRATING" All Payors / Plans All Payors / Plans $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.91 $1.91 CLONAZEPAM 0.5 MG TABLET All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 CLONAZEPAM 1 MG TABLET All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 CLONIDINE 0.1 MG TABLET All Payors / Plans All Payors / Plans $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.12 $1.12 CLONIDINE 0.1 MG/24 HR PATCH WEEKLY All Payors / Plans All Payors / Plans $17.62 $17.62 $17.62 $17.62 $17.62 $17.62 $17.62 $17.27 $17.27 CLONIDINE 0.2 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 CLONIDINE 0.2 MG/24 HR PATCH WEEKLY All Payors / Plans All Payors / Plans $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $24.78 $24.78 CLONIDINE 0.3 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 CLONIDINE 0.3 MG/24 HR PATCH WEEKLY All Payors / Plans All Payors / Plans $30.64 $30.64 $30.64 $30.64 $30.64 $30.64 $30.64 $30.03 $30.03 CLOPIDOGREL 300 MG TABLET All Payors / Plans All Payors / Plans $15.65 $15.65 $15.65 $15.65 $15.65 $15.65 $15.65 $15.34 $15.34 CLOPIDOGREL 75 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 CLOTRIMAZOLE 1 % CREAM 28 G TUBE All Payors / Plans All Payors / Plans $5.63 $5.63 $5.63 $5.63 $5.63 $5.63 $5.63 $5.52 $5.52 CLOTRIMAZOLE 1 % CREAM 30 G TUBE All Payors / Plans All Payors / Plans $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $7.93 $7.93 CLOTRIMAZOLE 10 MG TROCHE All Payors / Plans All Payors / Plans $4.21 $4.21 $4.21 $4.21 $4.21 $4.21 $4.21 $4.13 $4.13 CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % CREAM 15 G TUBE All Payors / Plans All Payors / Plans $65.63 $65.63 $65.63 $65.63 $65.63 $65.63 $65.63 $64.32 $64.32 CODEINE-GUAIFENESIN 10-100 MG/5 ML LIQUID All Payors / Plans All Payors / Plans $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.80 $1.80 COIL TARGET DETACHABLE 360 NANO 1.5MM X 4CM All Payors / Plans All Payors / Plans " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,537.40 " " $4,537.40 " COIL TARGET DETACHABLE 360 ULTRA 3MM X 8CM All Payors / Plans All Payors / Plans " $5,114.00 " " $5,114.00 " " $5,114.00 " " $5,114.00 " " $5,114.00 " " $5,114.00 " " $5,114.00 " " $5,011.72 " " $5,011.72 " COLCHICINE 0.6 MG TABLET All Payors / Plans All Payors / Plans $10.21 $10.21 $10.21 $10.21 $10.21 $10.21 $10.21 $10.01 $10.01 COLLAGENASE 250 UNIT/GRAM OINTMENT 30 G TUBE All Payors / Plans All Payors / Plans $644.01 $644.01 $644.01 $644.01 $644.01 $644.01 $644.01 $631.13 $631.13 COLLAR CERVICAL LG 18.5INX3IN FOAM VELCRO FIRM DENSITY STOCKINETTE COVER All Payors / Plans All Payors / Plans $4.09 $4.09 $4.09 $4.09 $4.09 $4.09 $4.09 $4.01 $4.01 COLLAR CERVICAL VELCRO COTTON FOAM XL SERPENTINE L25.5 IN X H4.5 IN SOFT DENSITY BREATHABLE STOCKINETTE COVER CLOSURE NONSTERILE LATEX FREE All Payors / Plans All Payors / Plans $4.09 $4.09 $4.09 $4.09 $4.09 $4.09 $4.09 $4.01 $4.01 COLLAR CERVICAL VISTA ADULT UNIVERSAL SET REPLACEMENT PAD LATEX FREE All Payors / Plans All Payors / Plans $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $52.92 $52.92 COLLECTOR SPECIMEN VACUTAINER BD BBL ANAEROBIC SWAB NEEDLE SYRINGE STERILE LATEX FREE All Payors / Plans All Payors / Plans $7.16 $7.16 $7.16 $7.16 $7.16 $7.16 $7.16 $7.02 $7.02 COMPONENT FEMORAL GMK 4 KNEE RIGHT SPHERE CEMENTED All Payors / Plans All Payors / Plans " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,468.00 " " $6,468.00 " COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY G L76.5 MM X W70.5 MM KNEE LEFT SET SCREW CEMENTED REVISION STERILE All Payors / Plans All Payors / Plans " $28,564.00 " " $28,564.00 " " $28,564.00 " " $28,564.00 " " $28,564.00 " " $28,564.00 " " $28,564.00 " " $27,992.72 " " $27,992.72 " COMPONENT FEMORAL NEXGEN LPS OPTION E KNEE LEFT All Payors / Plans All Payors / Plans " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $5,880.00 " " $5,880.00 " COMPONENT FEMORAL NEXGEN LPS OPTION G KNEE LEFT All Payors / Plans All Payors / Plans " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $6,000.00 " " $5,880.00 " " $5,880.00 " COMPONENT FEMORAL NEXGEN LPS OPTION ZIMALOY D STANDARD KNEE LEFT CEMENTED POSTERIOR STABILIZE STERILE All Payors / Plans All Payors / Plans " $5,825.00 " " $5,825.00 " " $5,825.00 " " $5,825.00 " " $5,825.00 " " $5,825.00 " " $5,825.00 " " $5,708.50 " " $5,708.50 " COMPONENT GLENOID CORTILOC 25 D SMALL SHOULDER RIGHT AUGMENT All Payors / Plans All Payors / Plans " $12,500.00 " " $12,500.00 " " $12,500.00 " " $12,500.00 " " $12,500.00 " " $12,500.00 " " $12,500.00 " " $12,250.00 " " $12,250.00 " COMPONENT TIBIAL TRAY GMK 4 RIGHT PRIMARY CEMENTED FIXED All Payors / Plans All Payors / Plans " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,076.00 " " $6,076.00 " COMPOUNDING VEHICLE SYRUP NO23 SYRUP All Payors / Plans All Payors / Plans $0.52 $0.52 $0.52 $0.52 $0.52 $0.52 $0.52 $0.51 $0.51 CONJUGATED ESTROGENS 0.625 MG/GRAM CREAM 30 G TUBE/KIT All Payors / Plans All Payors / Plans $780.98 $780.98 $780.98 $780.98 $780.98 $780.98 $780.98 $765.36 $765.36 CONTOUR SOFT PERCUFLEX MATERIAL 6X26 All Payors / Plans All Payors / Plans $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $216.74 $216.74 CONTOUR SOFT PERCUFLEX MATERIAL URETERAL STENT 6F X 26CM All Payors / Plans All Payors / Plans $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $216.74 $216.74 CONTOUR SOFT PERCUFLEX MATERIAL URETERAL STENT 6X 26 All Payors / Plans All Payors / Plans $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $216.74 $216.74 COOK 16F CHECK-FLO PERFORMER SHEATH 30CM All Payors / Plans All Payors / Plans $242.46 $242.46 $242.46 $242.46 $242.46 $242.46 $242.46 $237.61 $237.61 COOK 20F EXTRA LARGE CHECK-FLO SHEATH 40CM All Payors / Plans All Payors / Plans $723.90 $723.90 $723.90 $723.90 $723.90 $723.90 $723.90 $709.42 $709.42 COOK 8F DILATOR 20CM All Payors / Plans All Payors / Plans $16.18 $16.18 $16.18 $16.18 $16.18 $16.18 $16.18 $15.86 $15.86 COONS DILATOR 18 FR All Payors / Plans All Payors / Plans $34.64 $34.64 $34.64 $34.64 $34.64 $34.64 $34.64 $33.95 $33.95 "CORETEMP FLUID WARMING DRAPE 56""X56""" All Payors / Plans All Payors / Plans $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 COSYNTROPIN PER 0.25 MG All Payors / Plans All Payors / Plans $103.39 $103.39 $103.39 $103.39 $103.39 $103.39 $103.39 $101.32 $101.32 COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD24 MM CRANIOMAXILLOFACIAL NONSTERILE BLUE SHUNT All Payors / Plans All Payors / Plans $314.82 $314.82 $314.82 $314.82 $314.82 $314.82 $314.82 $308.52 $308.52 COVER BURR HOLE MATRIXNEURO TITANIUM OD24 MM CRANIAL BLUE All Payors / Plans All Payors / Plans $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $866.32 $866.32 COVER ENDOSCOPE TIP HOT SHEARS DA VINCI ENDOWRIST 8 MM STANDARD CAUTERY MONOPOLAR DISPOSABLE All Payors / Plans All Payors / Plans $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $39.20 $39.20 COVER INLINE CAMERA All Payors / Plans All Payors / Plans $126.93 $126.93 $126.93 $126.93 $126.93 $126.93 $126.93 $124.39 $124.39 COVER PROBE CIV-FLEX L58 IN X W5.5 IN EXTENDED LENGTH STERILE LATEX FREE All Payors / Plans All Payors / Plans $12.22 $12.22 $12.22 $12.22 $12.22 $12.22 $12.22 $11.98 $11.98 COVER PROBE SITE-RITE L48 IN PREGEL LATEX FREE All Payors / Plans All Payors / Plans $30.62 $30.62 $30.62 $30.62 $30.62 $30.62 $30.62 $30.01 $30.01 CRRT DIALYSATE 2/3 All Payors / Plans All Payors / Plans $104.05 $104.05 $104.05 $104.05 $104.05 $104.05 $104.05 $101.97 $101.97 CRRT DIALYSATE 4/3 All Payors / Plans All Payors / Plans $104.05 $104.05 $104.05 $104.05 $104.05 $104.05 $104.05 $101.97 $101.97 CRTD DTPA2D4 COBALT XT DF4 DEVICE _63236_ All Payors / Plans All Payors / Plans " $39,634.00 " " $39,634.00 " " $39,634.00 " " $39,634.00 " " $39,634.00 " " $39,634.00 " " $39,634.00 " " $38,841.32 " " $38,841.32 " CRTD DTPA2QQ COBALT XT QUAD DF4 DEVICE_63238_ All Payors / Plans All Payors / Plans " $35,053.82 " " $35,053.82 " " $35,053.82 " " $35,053.82 " " $35,053.82 " " $35,053.82 " " $35,053.82 " " $34,352.74 " " $34,352.74 " CRT-P PERCEPTA MRI QUAD DEVICE All Payors / Plans All Payors / Plans " $11,300.00 " " $11,300.00 " " $11,300.00 " " $11,300.00 " " $11,300.00 " " $11,300.00 " " $11,300.00 " " $11,074.00 " " $11,074.00 " CRTP QUADRA ALLURE MP CRT-P BIV _55995_ All Payors / Plans All Payors / Plans " $11,180.00 " " $11,180.00 " " $11,180.00 " " $11,180.00 " " $11,180.00 " " $11,180.00 " " $11,180.00 " " $10,956.40 " " $10,956.40 " CRUTCH WALKING ALUMINUM C300 LB ADULT L62-70 IN AXILLARY STYLE PUSH BUTTON All Payors / Plans All Payors / Plans $9.98 $9.98 $9.98 $9.98 $9.98 $9.98 $9.98 $9.78 $9.78 CUFF TOURNIQUET ATS 3000 CYLINDER L18 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE RED All Payors / Plans All Payors / Plans $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 CUFF TOURNIQUET ATS 3000 CYLINDER L24 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE GREEN All Payors / Plans All Payors / Plans $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 CUFF TOURNIQUET ATS 3000 CYLINDER L30 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE BLUE All Payors / Plans All Payors / Plans $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 CUFF TOURNIQUET ATS 3000 CYLINDER L34 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE BROWN All Payors / Plans All Payors / Plans $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD7 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE All Payors / Plans All Payors / Plans $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $637.00 $637.00 CXA280005 EXCLUDER All Payors / Plans All Payors / Plans " $9,820.00 " " $9,820.00 " " $9,820.00 " " $9,820.00 " " $9,820.00 " " $9,820.00 " " $9,820.00 " " $9,623.60 " " $9,623.60 " "CYANOCOBALAMIN 1,000 MCG TABLET" All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 CYANOCOBALAMIN 100 MCG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 CYANOCOBALAMIN PER 1000 MCG All Payors / Plans All Payors / Plans $15.76 $15.76 $15.76 $15.76 $15.76 $15.76 $15.76 $15.44 $15.44 CYCLOBENZAPRINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 CYCLOPENTOLATE 1 % DROPS 2 ML DROP BTL All Payors / Plans All Payors / Plans $63.97 $63.97 $63.97 $63.97 $63.97 $63.97 $63.97 $62.69 $62.69 CYCLOPHOSPHAMIDE 200 MG/ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $51.32 $51.32 $51.32 $51.32 $51.32 $51.32 $51.32 $50.29 $50.29 CYCLOSPORINE 0.05 % DROPPERETTE All Payors / Plans All Payors / Plans $19.07 $19.07 $19.07 $19.07 $19.07 $19.07 $19.07 $18.69 $18.69 CYCLOSPORINE MODIFIED PER 100 MG All Payors / Plans All Payors / Plans $17.86 $17.86 $17.86 $17.86 $17.86 $17.86 $17.86 $17.50 $17.50 CYCLOSPORINE MODIFIED PER 25 MG All Payors / Plans All Payors / Plans $8.96 $8.96 $8.96 $8.96 $8.96 $8.96 $8.96 $8.78 $8.78 CYCLOSPORINE PER 100 MG All Payors / Plans All Payors / Plans $17.08 $17.08 $17.08 $17.08 $17.08 $17.08 $17.08 $16.74 $16.74 CYCLOSPORINE PER 25 MG All Payors / Plans All Payors / Plans $10.54 $10.54 $10.54 $10.54 $10.54 $10.54 $10.54 $10.33 $10.33 D5 % AND 0.9 % SODIUM CHLORIDE PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $9.17 $9.17 $9.17 $9.17 $9.17 $9.17 $9.17 $8.99 $8.99 D5 %-0.45 % SODIUM CHLORIDE PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $17.99 $17.99 "D5 %-0.45 % SODIUM CHLORIDE PARENTERAL SOLUTION 1,000 ML BAG" All Payors / Plans All Payors / Plans $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $17.99 $17.99 DABIGATRAN ETEXILATE 150 MG CAPSULE All Payors / Plans All Payors / Plans $15.07 $15.07 $15.07 $15.07 $15.07 $15.07 $15.07 $14.77 $14.77 DAPSONE 100 MG TABLET All Payors / Plans All Payors / Plans $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.09 $4.09 DAPSONE 25 MG TABLET All Payors / Plans All Payors / Plans $8.89 $8.89 $8.89 $8.89 $8.89 $8.89 $8.89 $8.71 $8.71 DAPTOMYCIN PER 1 MG All Payors / Plans All Payors / Plans $0.29 $0.29 $0.29 $0.29 $0.29 $0.29 $0.29 $0.28 $0.28 "DARATUMUMAB-HYALURONIDASE-FIHJ 1,800 MG-30,000 UNIT/15 ML SOLUTION" All Payors / Plans All Payors / Plans $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 DARBEPOETIN ALFA-ALBUMIN PER 1 MCG All Payors / Plans All Payors / Plans $5.38 $5.38 $5.38 $5.38 $5.38 $5.38 $5.38 $5.27 $5.27 DARBEPOETIN ALFA-POLYSORBATE 100 MCG/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $7.92 $7.92 $7.92 $7.92 $7.92 $7.92 $7.92 $7.76 $7.76 DARBEPOETIN ALFA-POLYSORBATE 150 MCG/0.3 ML SYRINGE All Payors / Plans All Payors / Plans $8.65 $8.65 $8.65 $8.65 $8.65 $8.65 $8.65 $8.47 $8.47 DARBEPOETIN ALFA-POLYSORBATE 200 MCG/0.4 ML SYRINGE All Payors / Plans All Payors / Plans $7.48 $7.48 $7.48 $7.48 $7.48 $7.48 $7.48 $7.33 $7.33 DARBEPOETIN ALFA-POLYSORBATE 25 MCG/0.42 ML SYRINGE All Payors / Plans All Payors / Plans $10.41 $10.41 $10.41 $10.41 $10.41 $10.41 $10.41 $10.20 $10.20 DARBEPOETIN ALFA-POLYSORBATE 300 MCG/0.6 ML SYRINGE All Payors / Plans All Payors / Plans $6.31 $6.31 $6.31 $6.31 $6.31 $6.31 $6.31 $6.19 $6.19 DARBEPOETIN ALFA-POLYSORBATE 40 MCG/0.4 ML SYRINGE All Payors / Plans All Payors / Plans $10.59 $10.59 $10.59 $10.59 $10.59 $10.59 $10.59 $10.38 $10.38 DARBEPOETIN ALFA-POLYSORBATE 60 MCG/0.3 ML SYRINGE All Payors / Plans All Payors / Plans $10.55 $10.55 $10.55 $10.55 $10.55 $10.55 $10.55 $10.34 $10.34 DECANTER FLUID L9 IN BAG LATEX All Payors / Plans All Payors / Plans $1.88 $1.88 $1.88 $1.88 $1.88 $1.88 $1.88 $1.84 $1.84 DECITABINE PER 1 MG All Payors / Plans All Payors / Plans $3.04 $3.04 $3.04 $3.04 $3.04 $3.04 $3.04 $2.98 $2.98 DEFIBRILLATOR CARDIAC MRI ELLIPSE DR DF-4 CONNECTOR DUAL CHAMBER All Payors / Plans All Payors / Plans " $13,790.00 " " $13,790.00 " " $13,790.00 " " $13,790.00 " " $13,790.00 " " $13,790.00 " " $13,790.00 " " $13,514.20 " " $13,514.20 " DEFIBRILLATOR CARDIAC UNIFY ASSURA CRT 40 J CARDIOVERTER All Payors / Plans All Payors / Plans " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,394.20 " " $19,394.20 " DEFIBRILLATOR D232 VIGILANT EL VR DF4 1 LEAD SYSTEM All Payors / Plans All Payors / Plans " $30,620.00 " " $30,620.00 " " $30,620.00 " " $30,620.00 " " $30,620.00 " " $30,620.00 " " $30,620.00 " " $30,007.60 " " $30,007.60 " DEFIBRILLATOR SQ EMBLEM A219 S-ICD PULSE GENERATOR SYSTEM INCLUDES ELECTRODE All Payors / Plans All Payors / Plans " $39,940.00 " " $39,940.00 " " $39,940.00 " " $39,940.00 " " $39,940.00 " " $39,940.00 " " $39,940.00 " " $39,141.20 " " $39,141.20 " DEGARELIX 80 MG RECON SOLN All Payors / Plans All Payors / Plans $8.45 $8.45 $8.45 $8.45 $8.45 $8.45 $8.45 $8.28 $8.28 DELIVERY SYSTEM CLIP MITRACLIP G4 NTW All Payors / Plans All Payors / Plans " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $44,100.00 " " $44,100.00 " DELIVERY SYSTEM CLIP MITRACLIP G4 XTW All Payors / Plans All Payors / Plans " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $45,000.00 " " $44,100.00 " " $44,100.00 " DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $27.80 $27.80 $27.80 $27.80 $27.80 $27.80 $27.80 $27.24 $27.24 DENOSUMAB 60 MG/ML SYRINGE All Payors / Plans All Payors / Plans $35.55 $35.55 $35.55 $35.55 $35.55 $35.55 $35.55 $34.84 $34.84 DESMOPRESSIN PER 1 MCG All Payors / Plans All Payors / Plans $25.94 $25.94 $25.94 $25.94 $25.94 $25.94 $25.94 $25.42 $25.42 DESVENLAFAXINE 50 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.67 $2.62 $2.62 DEUTETRABENAZINE 12 MG TABLET All Payors / Plans All Payors / Plans $3.58 $3.58 $3.58 $3.58 $3.58 $3.58 $3.58 $3.51 $3.51 DEVICE AZURE XT DR MRI SURESCAN All Payors / Plans All Payors / Plans " $6,954.00 " " $6,954.00 " " $6,954.00 " " $6,954.00 " " $6,954.00 " " $6,954.00 " " $6,954.00 " " $6,814.92 " " $6,814.92 " DEVICE CLOSURE ANGIO-SEAL VIP BONDEK-PLUS POLYGLYD L70 CM OD8 FR ODSEC.038 IN VASCULAR HEMOSTATIC BIOABSORBABLE INSERTION SHEATH GUIDEWIRE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $410.00 $410.00 $410.00 $410.00 $410.00 $410.00 $410.00 $401.80 $401.80 DEVICE CLOSURE ANGIO-SEAL VIP COLLAGEN .035 IN L70 CM OD6 FR VASCULAR VALUELINK GUIDEWIRE INSERTION SHEATH J STRAIGHTENER All Payors / Plans All Payors / Plans $256.25 $256.25 $256.25 $256.25 $256.25 $256.25 $256.25 $251.13 $251.13 DEVICE CLOSURE ATRICLIP 45D 35MM 6CM NITINOL POLYESTER FLEXIBLE SHAFT PLUNGER GRIP LEFT ATRIAL APPENDAGE EXCLUSION All Payors / Plans All Payors / Plans " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,352.00 " " $2,352.00 " DEVICE CLOSURE ATRICLIP 45D 40MM 6CM NITINOL POLYESTER FLEXIBLE SHAFT PLUNGER GRIP LEFT ATRIAL APPENDAGE EXCLUSION All Payors / Plans All Payors / Plans " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,352.00 " " $2,352.00 " DEVICE CLOSURE CARTER-THOMASON XL PILOT GUIDES 5MM 10-12 MM All Payors / Plans All Payors / Plans $239.33 $239.33 $239.33 $239.33 $239.33 $239.33 $239.33 $234.54 $234.54 DEVICE CLOSURE EXOSEAL OD5 FR FEMORAL ARTERY ABSORBABLE PLUG APPLIER HANDLE DELIVERY SHAFT STERILE LATEX FREE All Payors / Plans All Payors / Plans $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 DEVICE CLOSURE EXOSEAL OD6 FR FEMORAL ARTERY ABSORBABLE PLUG APPLIER HANDLE DELIVERY SHAFT STERILE LATEX FREE All Payors / Plans All Payors / Plans $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 DEVICE CLOSURE MYNX 6FR7FR All Payors / Plans All Payors / Plans $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $474.32 $474.32 DEVICE CLOSURE MYNX CONTROL VCD 6/7 FRENCH All Payors / Plans All Payors / Plans $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $421.40 $421.40 DEVICE CLOSURE PERCLOSE OD6 FR VASCULAR SUTURE MEDIATE KNOT PUSH STERILE DISPOSABLE All Payors / Plans All Payors / Plans $456.00 $456.00 $456.00 $456.00 $456.00 $456.00 $456.00 $446.88 $446.88 DEVICE CLOSURE STARCLOSE SE VASCULAR STERILE DISPOSABLE All Payors / Plans All Payors / Plans $452.00 $452.00 $452.00 $452.00 $452.00 $452.00 $452.00 $442.96 $442.96 DEVICE CLOSURE VASCULAR MANTA 18 FR All Payors / Plans All Payors / Plans " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,862.00 " " $1,862.00 " DEVICE CLOSURE V-LOC 180 0 GS-21 12IN GREEN ABSORBABLE TAPER POINT All Payors / Plans All Payors / Plans $43.39 $43.39 $43.39 $43.39 $43.39 $43.39 $43.39 $42.52 $42.52 DEVICE CLOSURE V-LOC 180 2-0 GS-21 12IN GREEN ABSORBABLE TAPER POINT All Payors / Plans All Payors / Plans $43.39 $43.39 $43.39 $43.39 $43.39 $43.39 $43.39 $42.52 $42.52 DEVICE CLOSURE V-LOC 180 2-0 GS-22 1/2 CIRCLE L6 IN L27 MM TAPER POINT ABSORBABLE GREEN All Payors / Plans All Payors / Plans $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $40.74 $40.74 DEVICE CLOSURE V-LOC 180 2-0 V-20 1/2 CIRCLE L18 IN L26 MM TAPER POINT ABSORBABLE GREEN All Payors / Plans All Payors / Plans $41.16 $41.16 $41.16 $41.16 $41.16 $41.16 $41.16 $40.34 $40.34 DEVICE CLOSURE V-LOC 180 3-0 P-14 18IN CLEAR ABSORBABLE PREMIUM REVERSE CUT All Payors / Plans All Payors / Plans $29.60 $29.60 $29.60 $29.60 $29.60 $29.60 $29.60 $29.01 $29.01 DEVICE CLOSURE V-LOC 180 SURGALLOY 3-0 V-20 1/2 CIRCLE L9 IN L26 MM TAPER POINT ABSORBABLE GREEN All Payors / Plans All Payors / Plans $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $40.74 $40.74 DEVICE CLOSURE V-LOC 3-0 NON ABSORBABLE WOUND CLOSURE DEVICE All Payors / Plans All Payors / Plans $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $40.74 $40.74 DEVICE CLOSURE V-LOC 90 4-0 SC-2 STRAIGHT L45 CM L60 MM 2 ANGLE CUT ABSORBABLE BARB UNDYED All Payors / Plans All Payors / Plans $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $42.55 $42.55 DEVICE CLOSURE WATCHMAN FXD CURVE OD 15 FR ID 12 FR 2 CURVE ACCESS SYSTEM LEFT ATRIAL APPENDAGE All Payors / Plans All Payors / Plans " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $1,960.00 " " $1,960.00 " DEVICE DRAINAGE STAYFIX OD12-22 FR FIXATION FASTEN SHOWERCAP PERCUTANEOUS CATHETER All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 DEVICE ELECTROSURGICAL LIGASURE MARYLAND 350 D L23 CM OPEN SEALER DIVIDER 1 STEP SEAL FORCETRIAD All Payors / Plans All Payors / Plans " $1,645.23 " " $1,645.23 " " $1,645.23 " " $1,645.23 " " $1,645.23 " " $1,645.23 " " $1,645.23 " " $1,612.33 " " $1,612.33 " DEVICE ENDOSCOPIC PLUNGE BOB POLY OD10 MM PORT CLEANER Q TIP ABSORBENT OBTURATOR All Payors / Plans All Payors / Plans $17.41 $17.41 $17.41 $17.41 $17.41 $17.41 $17.41 $17.06 $17.06 DEVICE ENDOSCOPIC PLUNGE BOB POLY OD5 MM PORT CLEANER Q TIP ABSORBENT OBTURATOR All Payors / Plans All Payors / Plans $51.80 $51.80 $51.80 $51.80 $51.80 $51.80 $51.80 $50.76 $50.76 DEVICE FIXATION SECURESTRAP 5MM DISPOSABLE 25 ABSORBABLE STRAP MESH HERNIA REPAIR All Payors / Plans All Payors / Plans $979.68 $979.68 $979.68 $979.68 $979.68 $979.68 $979.68 $960.09 $960.09 DEVICE FIXATION SECURESTRAP L5 MM ABSORBABLE STRAP HERNIA REPAIR All Payors / Plans All Payors / Plans $651.77 $651.77 $651.77 $651.77 $651.77 $651.77 $651.77 $638.73 $638.73 DEVICE INFLATION CADENCE PRECISION 1 ML SYRINGE INJECTOR THREAD PLUNGER All Payors / Plans All Payors / Plans $248.80 $248.80 $248.80 $248.80 $248.80 $248.80 $248.80 $243.82 $243.82 DEVICE INFLATION CRE STERI-FLATE DISPOSABLE All Payors / Plans All Payors / Plans $92.14 $92.14 $92.14 $92.14 $92.14 $92.14 $92.14 $90.30 $90.30 DEVICE INFLATION ENCORE 26 L3 IN OD12 FR 20 ML PRESSURE GAUGE LATEX FREE All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 DEVICE INFLATION GATEWAY ENCORE 26 ADVANTAGE Y 20 ML KIT ADAPTER TORQUE GUIDEWIRE INTRODUCER All Payors / Plans All Payors / Plans $63.36 $63.36 $63.36 $63.36 $63.36 $63.36 $63.36 $62.09 $62.09 DEVICE LEAD LOCKING LLD 65CM .015-.023IN PLATINUM IRIDIUM DISPOSABLE 19LB LOW PROFILE RADIOPAQUE All Payors / Plans All Payors / Plans " $1,230.00 " " $1,230.00 " " $1,230.00 " " $1,230.00 " " $1,230.00 " " $1,230.00 " " $1,230.00 " " $1,205.40 " " $1,205.40 " DEVICE POSITIONING CANVAS FOAM XL L20.5 IN X W7.5 IN SHOULDER PILLOW ABDUCTION All Payors / Plans All Payors / Plans $3.89 $3.89 $3.89 $3.89 $3.89 $3.89 $3.89 $3.81 $3.81 DEVICE SECUREMENT STAYFIX SMALL OD5-14 FR DRAIN CATHETER FASTENER FIXATION STERILE LATEX FREE PERCUTANEOUS CATHETER All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 DEVICE SPECIMEN RETRIEVAL RAPTOR L230 CM OD2.4 MM HYBRID JAW CONFIGURATION FLEXIBLE DISTAL WIRE GRASP STERILE DISPOSABLE All Payors / Plans All Payors / Plans $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $258.72 $258.72 DEVICE SUTURE 0 23CM STRATAFIX SPIRAL PDS PLUS CT-1 All Payors / Plans All Payors / Plans $50.59 $50.59 $50.59 $50.59 $50.59 $50.59 $50.59 $49.58 $49.58 DEVICE SUTURE 0 30CM STRATAFIX SPIRAL PDS PLUS VIOLET CT-1 All Payors / Plans All Payors / Plans $74.49 $74.49 $74.49 $74.49 $74.49 $74.49 $74.49 $73.00 $73.00 DEVICE SUTURE STRATAFIX PDO 1 CTX L36 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM VIOLET BIDIRECTIONAL All Payors / Plans All Payors / Plans $61.39 $61.39 $61.39 $61.39 $61.39 $61.39 $61.39 $60.16 $60.16 DEVICE SUTURE V-LOC 180 SURGALLOY 3-0 V-20 TAPER POINT L 6IN ABSORBABLE GREEN All Payors / Plans All Payors / Plans $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $41.57 $40.74 $40.74 DEVICE SUTURING ENDO STITCH L15 IN OD10 MM SOFT TISSUE PUSH BUTTON GRIP HANDLE STERILE LATEX FREE DISPOSABLE ENDOSCOPIC All Payors / Plans All Payors / Plans $824.75 $824.75 $824.75 $824.75 $824.75 $824.75 $824.75 $808.26 $808.26 DEVICE TORQUE OLCOTT HYDROPHILIC .014-.045 IN 1 HAND GUIDEWIRE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $19.98 $19.98 $19.98 $19.98 $19.98 $19.98 $19.98 $19.58 $19.58 DEVICE VACUUM EXTRACTION PALMPUMP KIWI OMNICUP NEONATE FLEXIBLE STEM LOW PROFILE CUP TRACTION FORCE INDICATOR All Payors / Plans All Payors / Plans $58.24 $58.24 $58.24 $58.24 $58.24 $58.24 $58.24 $57.08 $57.08 DEXAMETHASONE All Payors / Plans All Payors / Plans $3.05 $3.05 $3.05 $3.05 $3.05 $3.05 $3.05 $2.99 $2.99 DEXAMETHASONE 0.1 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $156.62 $156.62 $156.62 $156.62 $156.62 $156.62 $156.62 $153.49 $153.49 DEXAMETHASONE 2 MG TABLET All Payors / Plans All Payors / Plans $2.64 $2.64 $2.64 $2.64 $2.64 $2.64 $2.64 $2.59 $2.59 DEXAMETHASONE 4 MG/ML SYRINGE All Payors / Plans All Payors / Plans $1.50 $1.50 $1.50 $1.50 $1.50 $1.50 $1.50 $1.47 $1.47 DEXAMETHASONE PER 0.25 MG All Payors / Plans All Payors / Plans $0.22 $0.22 $0.22 $0.22 $0.22 $0.22 $0.22 $0.22 $0.22 DEXAMETHASONE PER 1 MG All Payors / Plans All Payors / Plans $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 DEXMEDETOMIDINE (PRECEDEX) IN 0.9 % NACL 4 MCG/ML SOLUTION All Payors / Plans All Payors / Plans $106.70 $106.70 $106.70 $106.70 $106.70 $106.70 $106.70 $104.57 $104.57 DEXMEDETOMIDINE HCL 100 MCG/ML SOLUTION All Payors / Plans All Payors / Plans $2.26 $2.26 $2.26 $2.26 $2.26 $2.26 $2.26 $2.21 $2.21 DEXMEDETOMIDINE IN 0.9 % NACL 200 MCG/50 ML (4 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $106.70 $106.70 $106.70 $106.70 $106.70 $106.70 $106.70 $104.57 $104.57 DEXMEDETOMIDINE IN 0.9 % NACL 400 MCG/100 ML (4 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $135.72 $135.72 $135.72 $135.72 $135.72 $135.72 $135.72 $133.01 $133.01 DEXMEDETOMIDINE IN DEXTROSE 5% 400 MCG/100 ML (4 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $84.99 $84.99 $84.99 $84.99 $84.99 $84.99 $84.99 $83.29 $83.29 DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.89 $1.89 DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML SYRUP All Payors / Plans All Payors / Plans $6.72 $6.72 $6.72 $6.72 $6.72 $6.72 $6.72 $6.58 $6.58 DEXTROSE 10 % IV BOLUS All Payors / Plans All Payors / Plans $18.66 $18.66 $18.66 $18.66 $18.66 $18.66 $18.66 $18.29 $18.29 DEXTROSE 10 % PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $18.66 $18.66 $18.66 $18.66 $18.66 $18.66 $18.66 $18.29 $18.29 "DEXTROSE 10 % PARENTERAL SOLUTION 1,000 ML BAG" All Payors / Plans All Payors / Plans $18.79 $18.79 $18.79 $18.79 $18.79 $18.79 $18.79 $18.41 $18.41 DEXTROSE 10 % PARENTERAL SOLUTION 500 ML BAG All Payors / Plans All Payors / Plans $18.66 $18.66 $18.66 $18.66 $18.66 $18.66 $18.66 $18.29 $18.29 DEXTROSE 15 GRAM/59 ML LIQUID All Payors / Plans All Payors / Plans $4.91 $4.91 $4.91 $4.91 $4.91 $4.91 $4.91 $4.81 $4.81 DEXTROSE 15G ORAL 40 % GEL All Payors / Plans All Payors / Plans $5.79 $5.79 $5.79 $5.79 $5.79 $5.79 $5.79 $5.67 $5.67 DEXTROSE 20 % PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $48.16 $48.16 $48.16 $48.16 $48.16 $48.16 $48.16 $47.20 $47.20 DEXTROSE 25 % SYRINGE All Payors / Plans All Payors / Plans $51.30 $51.30 $51.30 $51.30 $51.30 $51.30 $51.30 $50.27 $50.27 DEXTROSE 5 % IV BOLUS All Payors / Plans All Payors / Plans $18.11 $18.11 $18.11 $18.11 $18.11 $18.11 $18.11 $17.75 $17.75 DEXTROSE 5 % PIGGYBACK 100 ML BAG All Payors / Plans All Payors / Plans $23.50 $23.50 $23.50 $23.50 $23.50 $23.50 $23.50 $23.03 $23.03 DEXTROSE 5% 5 % PIGGYBACK 100 ML BAG All Payors / Plans All Payors / Plans $19.51 $19.51 $19.51 $19.51 $19.51 $19.51 $19.51 $19.12 $19.12 DEXTROSE 5% IN LACTATED RINGERS PER 1000 ML All Payors / Plans All Payors / Plans $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $17.98 $17.98 DEXTROSE 5% IN NORMAL SALINE PER 1000 ML All Payors / Plans All Payors / Plans $9.17 $9.17 $9.17 $9.17 $9.17 $9.17 $9.17 $8.99 $8.99 DEXTROSE 5% LACTATED RINGER'S WITH KCL 20 MEQ/L 20 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $45.48 $45.48 $45.48 $45.48 $45.48 $45.48 $45.48 $44.57 $44.57 DEXTROSE 5% PER 500 ML All Payors / Plans All Payors / Plans $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.19 $18.19 DEXTROSE 5%-0.2 % SOD CHLORIDE PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $18.37 $18.37 $18.37 $18.37 $18.37 $18.37 $18.37 $18.00 $18.00 DEXTROSE 50 % IN WATER (D50W) 50 % SYRINGE All Payors / Plans All Payors / Plans $70.02 $70.02 $70.02 $70.02 $70.02 $70.02 $70.02 $68.62 $68.62 DEXTROSE 50% PER 500 ML All Payors / Plans All Payors / Plans $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $20.37 $20.37 "DEXTROSE 70% 70 % PARENTERAL SOLUTION 2,000 ML FLEX CONT" All Payors / Plans All Payors / Plans $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 DEXTROSE-SOD CITRATE-CITRIC AC 2.45-2.2 GRAM- 800 MG/100 ML SOLUTION All Payors / Plans All Payors / Plans $83.31 $83.31 $83.31 $83.31 $83.31 $83.31 $83.31 $81.64 $81.64 DIAZEPAM 2 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 DIAZEPAM 5 MG TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 DIAZEPAM 5 MG/ML SYRINGE All Payors / Plans All Payors / Plans $8.06 $8.06 $8.06 $8.06 $8.06 $8.06 $8.06 $7.90 $7.90 DIBUCAINE 1 % OINTMENT 28 G TUBE All Payors / Plans All Payors / Plans $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.33 $20.33 DICLOFENAC EPOLAMINE 1.3 % PATCH 12 HOUR All Payors / Plans All Payors / Plans $36.81 $36.81 $36.81 $36.81 $36.81 $36.81 $36.81 $36.07 $36.07 DICYCLOMINE 10 MG CAPSULE All Payors / Plans All Payors / Plans $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.87 $1.87 DICYCLOMINE 10 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.07 $1.07 DICYCLOMINE PER 20 MG All Payors / Plans All Payors / Plans $85.08 $85.08 $85.08 $85.08 $85.08 $85.08 $85.08 $83.38 $83.38 DICYCLOMINE PER 20 MG All Payors / Plans All Payors / Plans $85.08 $85.08 $85.08 $85.08 $85.08 $85.08 $85.08 $83.38 $83.38 DIFFUSER MAESTRO CORE All Payors / Plans All Payors / Plans $24.70 $24.70 $24.70 $24.70 $24.70 $24.70 $24.70 $24.21 $24.21 DIGOXIN 125 MCG (0.125 MG) TABLET All Payors / Plans All Payors / Plans $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.72 $2.72 DIGOXIN 250 MCG (0.25 MG) TABLET All Payors / Plans All Payors / Plans $3.44 $3.44 $3.44 $3.44 $3.44 $3.44 $3.44 $3.37 $3.37 DIGOXIN 250 MCG/ML (0.25 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $5.17 $5.17 $5.17 $5.17 $5.17 $5.17 $5.17 $5.07 $5.07 DIHYDROERGOTAMINE MESYLATE PER 1 MG All Payors / Plans All Payors / Plans $241.56 $241.56 $241.56 $241.56 $241.56 $241.56 $241.56 $236.73 $236.73 DILATOR ENDOSCOPIC CRE 240CM 5.5CM 7.5FR 10-12MM PEBAX DISPOSABLE STERILE LF ESOPHAGUS PYLORUS COLONIC BILIARY INFLATE All Payors / Plans All Payors / Plans $479.02 $479.02 $479.02 $479.02 $479.02 $479.02 $479.02 $469.44 $469.44 DILATOR ENDOSCOPIC CRE 240CM 5.5CM 7.5FR 12-13.5-15MM PEBAX DISPOSABLE STERILE LF ESOPHAGUS PYLORUS COLONIC BILIARY All Payors / Plans All Payors / Plans $474.72 $474.72 $474.72 $474.72 $474.72 $474.72 $474.72 $465.23 $465.23 DILATOR ENDOSCOPIC CRE 240CM 5.5CM 7.5FR 15-16.5-18MM PEBAX DISPOSABLE STERILE LF ESOPHAGUS PYLORUS COLONIC BILIARY All Payors / Plans All Payors / Plans $479.02 $479.02 $479.02 $479.02 $479.02 $479.02 $479.02 $469.44 $469.44 DILATOR ENDOSCOPIC CRE 240CM 5.5CM 7.5FR 18-20MM PEBAX DISPOSABLE STERILE LF ESOPHAGUS PYLORUS COLONIC BILIARY INFLATE All Payors / Plans All Payors / Plans $479.02 $479.02 $479.02 $479.02 $479.02 $479.02 $479.02 $469.44 $469.44 DILATOR ENDOSCOPIC CRE L3 CM L75 CM OD10-11-12 MM PULMONARY BALLOON RADIOPAQUE RECTILINEAR SHOULDER STERILE DISPOSABLE ACCEPTS .035 IN JAGWIRE All Payors / Plans All Payors / Plans $710.66 $710.66 $710.66 $710.66 $710.66 $710.66 $710.66 $696.45 $696.45 DILATOR ENDOSCOPIC CRE L3 CM L75 CM OD8-9-10 MM PULMONARY BALLOON RADIOPAQUE RECTILINEAR SHOULDER STERILE DISPOSABLE ACCEPTS .035 IN JAGWIRE All Payors / Plans All Payors / Plans $664.40 $664.40 $664.40 $664.40 $664.40 $664.40 $664.40 $651.11 $651.11 DILATOR VASCULAR MAC-LOC COONS ULTRATHANE HYDROPHILIC TAPER L20CM OD 16FR PERCUTANEOUS LOCK LOOP STERILE DISPOSABLE ACCEPTS .038IN GUIDEWIRE CECOSTOMY All Payors / Plans All Payors / Plans $34.64 $34.64 $34.64 $34.64 $34.64 $34.64 $34.64 $33.95 $33.95 DILATOR VASCULAR STANDARD JCD CURVE 20CM 5FR DISPOSABLE STERILE RADIOPAQUE ACCEPTS .035IN GUIDEWIRE All Payors / Plans All Payors / Plans $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.62 $17.62 DILATOR VASCULAR STANDARD JCD CURVE 20CM 6FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE All Payors / Plans All Payors / Plans $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.62 $17.62 DILATOR VASCULAR STANDARD JCD CURVE 20CM 7FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE All Payors / Plans All Payors / Plans $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.62 $17.62 DILATOR VASCULAR STANDARD JCD CURVE 20CM 9FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE All Payors / Plans All Payors / Plans $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.98 $17.62 $17.62 DILTIAZEM 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $38.82 $38.82 $38.82 $38.82 $38.82 $38.82 $38.82 $38.04 $38.04 DILTIAZEM 30 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 DILTIAZEM 5 MG/ML SOLUTION All Payors / Plans All Payors / Plans $16.30 $16.30 $16.30 $16.30 $16.30 $16.30 $16.30 $15.97 $15.97 DILTIAZEM 60 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 DILTIAZEM 90 MG TABLET All Payors / Plans All Payors / Plans $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.09 $1.09 "DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.12 $1.12 "DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.80 $1.80 "DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 "DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $4.92 $4.92 $4.92 $4.92 $4.92 $4.92 $4.92 $4.82 $4.82 "DILTIAZEM SR 120 MG CAPSULE,EXTENDED RELEASE 12 HR" All Payors / Plans All Payors / Plans $14.09 $14.09 $14.09 $14.09 $14.09 $14.09 $14.09 $13.81 $13.81 "DILTIAZEM SR 60 MG CAPSULE,EXTENDED RELEASE 12 HR" All Payors / Plans All Payors / Plans $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.62 $9.62 "DINOPROSTONE 10 MG INSERT, EXTENDED RELEASE" All Payors / Plans All Payors / Plans $443.93 $443.93 $443.93 $443.93 $443.93 $443.93 $443.93 $435.05 $435.05 DIPHENHYDRAMINE 12.5 MG/5 ML LIQUID All Payors / Plans All Payors / Plans $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 DIPHENHYDRAMINE PER 50 MG All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 DIPHENHYDRAMINE PER 50 MG All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 DIPHENOXYLATE-ATROPINE 2.5-0.025 MG TABLET All Payors / Plans All Payors / Plans $2.74 $2.74 $2.74 $2.74 $2.74 $2.74 $2.74 $2.69 $2.69 "DIPHTH,PERTUS(ACELL),TETANUS 2.5-8-5 LF-MCG-LF/0.5ML SYRINGE" All Payors / Plans All Payors / Plans $744.74 $744.74 $744.74 $744.74 $744.74 $744.74 $744.74 $729.85 $729.85 DIRECT SL II -300004_ All Payors / Plans All Payors / Plans $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $686.00 $686.00 DIRECT SUCTION TUBING SET All Payors / Plans All Payors / Plans $75.98 $75.98 $75.98 $75.98 $75.98 $75.98 $75.98 $74.46 $74.46 DIRECT SUCTION TUBING SET UROLOGY All Payors / Plans All Payors / Plans $75.98 $75.98 $75.98 $75.98 $75.98 $75.98 $75.98 $74.46 $74.46 DISCONTINUED AS OF 10/1/16 - STAPLER INTERNAL ENDOPATH ETS FLEX 35MM 340MM WHITE DISPOSABLE STERILE LF VASCULAR 6 All Payors / Plans All Payors / Plans $509.16 $509.16 $509.16 $509.16 $509.16 $509.16 $509.16 $498.98 $498.98 DISH PETRI STERILE All Payors / Plans All Payors / Plans $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.53 $2.53 DISPOSABLE BALLOON CATHETER 5FR 11MM 1050MM KINK RESISTANT EXCELLENT XRAY VISIBILITY DILATATION All Payors / Plans All Payors / Plans $224.24 $224.24 $224.24 $224.24 $224.24 $224.24 $224.24 $219.76 $219.76 "DIVALPROEX 125 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $2.82 $2.82 $2.82 $2.82 $2.82 $2.82 $2.82 $2.76 $2.76 DIVALPROEX 250 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.40 $3.40 "DIVALPROEX 250 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 DIVALPROEX 500 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $4.28 $4.28 $4.28 $4.28 $4.28 $4.28 $4.28 $4.19 $4.19 "DIVALPROEX 500 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 "DIVALPROEX SPRINKLE 125 MG CAPSULE, DELAYED REL SPRINKLE" All Payors / Plans All Payors / Plans $2.80 $2.80 $2.80 $2.80 $2.80 $2.80 $2.80 $2.74 $2.74 DOBUTAMINE PER 250 MG All Payors / Plans All Payors / Plans $19.02 $19.02 $19.02 $19.02 $19.02 $19.02 $19.02 $18.63 $18.63 DOCETAXEL 160 MG/16 ML (10 MG/ML) SOLUTION 16 ML VIAL All Payors / Plans All Payors / Plans $7.97 $7.97 $7.97 $7.97 $7.97 $7.97 $7.97 $7.81 $7.81 DOCETAXEL 20 MG/ML (1 ML) SOLUTION 1 ML VIAL All Payors / Plans All Payors / Plans $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.85 $0.85 DOCETAXEL 20 MG/ML (1 ML) SOLUTION 4 ML VIAL All Payors / Plans All Payors / Plans $1.77 $1.77 $1.77 $1.77 $1.77 $1.77 $1.77 $1.74 $1.74 DOCETAXEL 20 MG/ML (1 ML) SOLUTION 8 ML VIAL All Payors / Plans All Payors / Plans $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.02 $2.02 DOCUSATE 50 MG/5 ML LIQUID All Payors / Plans All Payors / Plans $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.54 $2.54 DOCUSATE SODIUM 100 MG CAPSULE All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 DOLUTEGRAVIR 50 MG TABLET All Payors / Plans All Payors / Plans $71.39 $71.39 $71.39 $71.39 $71.39 $71.39 $71.39 $69.96 $69.96 DONEPEZIL 5 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 DOPAMINE PER 40 MG All Payors / Plans All Payors / Plans $5.24 $5.24 $5.24 $5.24 $5.24 $5.24 $5.24 $5.13 $5.13 DORZOLAMIDE 2 % DROPS 10 ML DROP BTL All Payors / Plans All Payors / Plans $63.24 $63.24 $63.24 $63.24 $63.24 $63.24 $63.24 $61.98 $61.98 DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML DROPS 10 ML DROP BTL All Payors / Plans All Payors / Plans $85.63 $85.63 $85.63 $85.63 $85.63 $85.63 $85.63 $83.92 $83.92 DOXAZOSIN 2 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 DOXAZOSIN 8 MG TABLET All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 DOXEPIN 25 MG CAPSULE All Payors / Plans All Payors / Plans $2.72 $2.72 $2.72 $2.72 $2.72 $2.72 $2.72 $2.67 $2.67 DOXEPIN 50 MG CAPSULE All Payors / Plans All Payors / Plans $3.51 $3.51 $3.51 $3.51 $3.51 $3.51 $3.51 $3.44 $3.44 DOXORUBICIN 2 MG/ML SOLUTION All Payors / Plans All Payors / Plans $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $16.73 $16.73 DOXORUBICIN 50 MG/25 ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $23.15 $23.15 $23.15 $23.15 $23.15 $23.15 $23.15 $22.69 $22.69 DOXYCYCLINE 100 MG CAPSULE All Payors / Plans All Payors / Plans $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $6.88 $6.88 DOXYCYCLINE 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $84.07 $84.07 $84.07 $84.07 $84.07 $84.07 $84.07 $82.39 $82.39 DRAIN INCISION JACKSON-PRATT ROUND 10FR SILICONE DISPOSABLE STERILE LF PERFORATE END WITHOUT TROCAR RADIOPAQUE RESERVOIR All Payors / Plans All Payors / Plans $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.71 $9.71 DRAIN INCISION JACKSON-PRATT SILICONE OD15 FR ROUND HUBLESS CHANNEL STERILE LATEX FREE DISPOSABLE WHITE All Payors / Plans All Payors / Plans $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.71 $9.71 DRAIN INCISION JACKSON-PRATT SILICONE ROUND L1/4 IN OD19 FR END PERFORATE WITHOUT TROCAR RADIOPAQUE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $10.70 $10.70 $10.70 $10.70 $10.70 $10.70 $10.70 $10.49 $10.49 DRAIN INCISION JACKSON-PRATT SILICONE ROUND L3/16 IN OD15 FR END PERFORATE WITHOUT TROCAR RADIOPAQUE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.71 $9.71 DRAIN INCISION JACKSON-PRATT SILICONE ROUND OD19 FR ROUND HUBLESS CHANNEL STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $19.48 $19.48 $19.48 $19.48 $19.48 $19.48 $19.48 $19.09 $19.09 DRAIN INCISION OASIS PLASTIC DISPOSABLE STERILE LF CHEST COLLECTION TUBE DRY SUCTION CONTROL CHAMBER All Payors / Plans All Payors / Plans $77.52 $77.52 $77.52 $77.52 $77.52 $77.52 $77.52 $75.97 $75.97 DRAIN WOUND JACKSON-PRATT SILICONE 3/4 FLUTE OD10 FR ODSEC19 FR ROUND HUBLESS CHANNEL TROCAR All Payors / Plans All Payors / Plans $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.91 $9.71 $9.71 DRAPE EQUIPMENT POLYURETHANE L44 IN X W44 IN SLUSH MACHINE WITHOUT DISC FLUID WARMER All Payors / Plans All Payors / Plans $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.64 $8.64 DRAPE EQUIPMENT ZEISS CLEARLENS STANDARD L120 IN X W46 IN OD65 MM OCULAR COVER LENS PATENT GLARE REDUCE STEREO STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $27.49 $27.49 $27.49 $27.49 $27.49 $27.49 $27.49 $26.94 $26.94 DRAPE SLUSH STERILE 44 X 66 All Payors / Plans All Payors / Plans $81.67 $81.67 $81.67 $81.67 $81.67 $81.67 $81.67 $80.04 $80.04 DRAPE SURGICAL 3M STERI-DRAPE 51X47IN CLEAR POLYETHYLENE DISPOSABLE STERILE LF ADHESIVE U DRAPE All Payors / Plans All Payors / Plans $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.48 $3.48 DRAPE SURGICAL CONTROL PLUS STANDARD L124 IN X W112 IN W30 IN FLUID COLLECTION POUCH HOOK LOOP TUBE ARMBOARD COVER LOW LINT STERILE LAPAROSCOPY All Payors / Plans All Payors / Plans $46.59 $46.59 $46.59 $46.59 $46.59 $46.59 $46.59 $45.66 $45.66 DRAPE SURGICAL CONVERTORS TIBURON L40 IN X W4 IN HIP REINFORCE EMERALD ADHESIVE STRIP SPLIT SHEET STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $17.91 $17.91 $17.91 $17.91 $17.91 $17.91 $17.91 $17.55 $17.55 DRAPE SURGICAL CONVERTORS TIBURON NEONATE L4 IN W3 IN L60 IN X W44 IN L19 IN X W18 1/2 IN REINFORCE FENESTRATE ABSORBENT ADHESIVE STRIP STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.61 $4.61 DRAPE SURGICAL CONVERTORS TIBURON VELCRO L110 IN X W109 IN X H100 IN L18 IN X W16 IN FLUID CONTROL POUCH FENESTRATION ABSORBENT IMPERVIOUS REINFORCEMENT ARMBOARD COVER STERILE DISPOSABLE LAVH All Payors / Plans All Payors / Plans $25.90 $25.90 $25.90 $25.90 $25.90 $25.90 $25.90 $25.38 $25.38 DRAPE SURGICAL LULU L4.5 IN X W3.5 IN X W2.5 IN RADIUS FEMUR ANGIOGRAPHY SHEET APERATURE STERILE All Payors / Plans All Payors / Plans $40.53 $40.53 $40.53 $40.53 $40.53 $40.53 $40.53 $39.72 $39.72 DRAPE SURGICAL PROXIMA SMS L80 IN X W75 IN PERIGROIN PACK BILATERAL SPLIT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $9.78 $9.78 $9.78 $9.78 $9.78 $9.78 $9.78 $9.58 $9.58 DRAPE SURGICAL SMS L44.5 IN X W40 IN L32 IN X W29 IN UNDER BUTTOCK POUCH BACK STERILE LATEX FREE All Payors / Plans All Payors / Plans $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.48 $6.48 DRAPE TRANSPARENT 3M IOBAN 2 23X17IN FABRIC STERILE INCISE ANTIMICROBIAL All Payors / Plans All Payors / Plans $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.19 $9.19 DRAPE WARMING STERILE 44 X 44 All Payors / Plans All Payors / Plans $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 DRESSING GAUZE QUIKCLOT KAOLIN L4 IN X W4 IN 6 PLY NONWOVEN FLEXIBLE XRAY LATEX FREE All Payors / Plans All Payors / Plans $22.49 $22.49 $22.49 $22.49 $22.49 $22.49 $22.49 $22.04 $22.04 DRESSING GAUZE QUIKCLOT L4 YD X W3 IN Z FOLD HEMOSTATIC All Payors / Plans All Payors / Plans $67.52 $67.52 $67.52 $67.52 $67.52 $67.52 $67.52 $66.17 $66.17 DRESSING GERMICIDAL BIOPATCH DISC 1IN 4MM WHITE CHG STERILE LF PERCUTANEOUS ANTIMICROBIAL ADHERENT CENTER HOLE SLIT All Payors / Plans All Payors / Plans $16.38 $16.38 $16.38 $16.38 $16.38 $16.38 $16.38 $16.05 $16.05 DRESSING GUAZE QUICK CLOT CONTROL 12X12 All Payors / Plans All Payors / Plans $412.17 $412.17 $412.17 $412.17 $412.17 $412.17 $412.17 $403.93 $403.93 DRESSING KIT CENTRAL LINE WITH BIOPATCH AND SORBAVIEW DRESSING - CUSTOM KIT All Payors / Plans All Payors / Plans $36.61 $36.61 $36.61 $36.61 $36.61 $36.61 $36.61 $35.88 $35.88 DRESSING PRESSURE SAFEGUARD L24 CM HEMOSTASIS All Payors / Plans All Payors / Plans $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $117.60 $117.60 DRESSING TRANSPARENT 3M TEGADERM 8X6IN STERILE LF FRAME STYLE ADHESIVE HYPOALLERGENIC WATERPROOF All Payors / Plans All Payors / Plans $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.06 $4.06 DRESSING TRANSPARENT 3M TEGADERM OVAL 4.5X4IN POLYURETHANE STERILE LF ADHESIVE WATERPROOF All Payors / Plans All Payors / Plans $1.42 $1.42 $1.42 $1.42 $1.42 $1.42 $1.42 $1.39 $1.39 DRESSING WOUND ABTHERA FOAM OPEN ABDOMEN PAD STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $726.69 $726.69 $726.69 $726.69 $726.69 $726.69 $726.69 $712.16 $712.16 DRESSING WOUND TELFA AMD PHMB L4 IN X W3 IN NONADHERENT ANTIMICROBIAL STRIP STERILE LATEX FREE All Payors / Plans All Payors / Plans $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 DRILL BIT All Payors / Plans All Payors / Plans $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $172.80 $169.34 $169.34 DRILL BIT 2.5MM All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 DRILL SURGICAL TRIGEN SHORT L 161MM OD 4MM TROCHANTER FEMUR AO PILOT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 DRONABINOL PER 2.5 MG All Payors / Plans All Payors / Plans $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.16 $10.16 DRONEDARONE 400 MG TABLET All Payors / Plans All Payors / Plans $20.06 $20.06 $20.06 $20.06 $20.06 $20.06 $20.06 $19.66 $19.66 DROPERIDOL PER 5 MG All Payors / Plans All Payors / Plans $4.58 $4.58 $4.58 $4.58 $4.58 $4.58 $4.58 $4.49 $4.49 D-STAT TOPICAL HEMOSTAT All Payors / Plans All Payors / Plans $86.60 $86.60 $86.60 $86.60 $86.60 $86.60 $86.60 $84.87 $84.87 DTAP-HEPATITIS B RECOMBINANT-IPV 10 MCG-25LF-25 MCG-10LF/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $192.95 $192.95 $192.95 $192.95 $192.95 $192.95 $192.95 $189.09 $189.09 "DULOXETINE 20 MG CAPSULE,DELAYED RELEASE(DR/EC)" All Payors / Plans All Payors / Plans $3.38 $3.38 $3.38 $3.38 $3.38 $3.38 $3.38 $3.31 $3.31 "DULOXETINE 30 MG CAPSULE,DELAYED RELEASE(DR/EC)" All Payors / Plans All Payors / Plans $2.73 $2.73 $2.73 $2.73 $2.73 $2.73 $2.73 $2.68 $2.68 "DULOXETINE 60 MG CAPSULE,DELAYED RELEASE(DR/EC)" All Payors / Plans All Payors / Plans $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.71 $2.71 DUTASTERIDE 0.5 MG CAPSULE All Payors / Plans All Payors / Plans $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.82 $1.82 ELECTRODE CUTTING 24FR All Payors / Plans All Payors / Plans $154.39 $154.39 $154.39 $154.39 $154.39 $154.39 $154.39 $151.30 $151.30 ELECTRODE DEFIBRILLATOR MEDI-TRACE CADENCE ADULT MULTIFUNCTION RADIOLUCENT MEDTRONIC PAD All Payors / Plans All Payors / Plans $31.22 $31.22 $31.22 $31.22 $31.22 $31.22 $31.22 $30.60 $30.60 ELECTRODE ELECTROSURGICAL SUREFIT L10 FT 2 DISPERSIVE ADHESIVE BORDER PULL TAB CABLE NONSTERILE DISPOSABLE All Payors / Plans All Payors / Plans $4.57 $4.57 $4.57 $4.57 $4.57 $4.57 $4.57 $4.48 $4.48 ELECTRODE ELECTROSURGICAL UTAHBALL STAINLESS STEEL BALL L11 CM OD5 MM ODSEC3/32 IN Y SHAFT STERILE DISPOSABLE RED LEEP All Payors / Plans All Payors / Plans $32.20 $32.20 $32.20 $32.20 $32.20 $32.20 $32.20 $31.56 $31.56 ELECTRODE ELECTROSURGICAL UTAHLOOP LETZ SAFE-T-GAUGE STAINLESS STEEL TUNGSTEN PLASTIC ROUND LOOP L12 MM X W20 MM L11 CM OD3/32 IN SHAFT WIRE STERILE DISPOSABLE WHITE All Payors / Plans All Payors / Plans $31.20 $31.20 $31.20 $31.20 $31.20 $31.20 $31.20 $30.58 $30.58 ELECTRODE ELECTROSURGICAL VAPR 90D 40MM DISPOSABLE STERILE LF SUCTION INTEGRATE HANDPIECE All Payors / Plans All Payors / Plans $540.00 $540.00 $540.00 $540.00 $540.00 $540.00 $540.00 $529.20 $529.20 ELECTRODE LOOP OD.3 MM ODSEC22 FR CUT DISPOSABLE All Payors / Plans All Payors / Plans $726.51 $726.51 $726.51 $726.51 $726.51 $726.51 $726.51 $711.98 $711.98 ELECTRODE MONOPOLAR 12 D 30 D ROLLER TRANSPARENT STEM COAGULATION DISPOSABLE GREEN All Payors / Plans All Payors / Plans $921.70 $921.70 $921.70 $921.70 $921.70 $921.70 $921.70 $903.27 $903.27 ELECTROLYTE-A All Payors / Plans All Payors / Plans $23.51 $23.51 $23.51 $23.51 $23.51 $23.51 $23.51 $23.04 $23.04 ELECTROLYTE-A PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $23.51 $23.51 $23.51 $23.51 $23.51 $23.51 $23.51 $23.04 $23.04 EMPAGLIFLOZIN 10 MG TABLET All Payors / Plans All Payors / Plans $20.32 $20.32 $20.32 $20.32 $20.32 $20.32 $20.32 $19.91 $19.91 EMPAGLIFLOZIN 25 MG TABLET All Payors / Plans All Payors / Plans $20.32 $20.32 $20.32 $20.32 $20.32 $20.32 $20.32 $19.91 $19.91 EMTRICITABINE-TENOFOVIR (TDF) 200-300 MG TABLET All Payors / Plans All Payors / Plans $3.39 $3.39 $3.39 $3.39 $3.39 $3.39 $3.39 $3.32 $3.32 EMTRICITABINE-TENOFOVIR ALAFEN 200-25 MG TABLET All Payors / Plans All Payors / Plans $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $70.80 $70.80 ENALAPRIL 10 MG TABLET All Payors / Plans All Payors / Plans $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.03 $2.03 ENALAPRILAT 1.25 MG/ML SOLUTION All Payors / Plans All Payors / Plans $40.98 $40.98 $40.98 $40.98 $40.98 $40.98 $40.98 $40.16 $40.16 ENDOWRIST 12-8MM CANNULA REDUCER All Payors / Plans All Payors / Plans $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 ENOXAPARIN PER 10 MG All Payors / Plans All Payors / Plans $7.98 $7.98 $7.98 $7.98 $7.98 $7.98 $7.98 $7.82 $7.82 ENTRAFLO GASTROSTOMY FEEDING TUBE All Payors / Plans All Payors / Plans $72.12 $72.12 $72.12 $72.12 $72.12 $72.12 $72.12 $70.68 $70.68 ENVELOPE ABSORBABLE TYRX LG 3.3X2.9IN POLYARYLATE MINOCYCLINE RIFAMPIN STERILE ICD All Payors / Plans All Payors / Plans " $1,790.00 " " $1,790.00 " " $1,790.00 " " $1,790.00 " " $1,790.00 " " $1,790.00 " " $1,790.00 " " $1,754.20 " " $1,754.20 " EP CATHETER DECANAV CARTO D CURVE _58398_ All Payors / Plans All Payors / Plans " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,472.00 " " $2,422.56 " " $2,422.56 " EP STEERABLE QUAD LARGE CURVE REPROC All Payors / Plans All Payors / Plans $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $223.44 $223.44 EPHEDRINE 50 MG/ML SOLUTION All Payors / Plans All Payors / Plans $11.08 $11.08 $11.08 $11.08 $11.08 $11.08 $11.08 $10.86 $10.86 EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) SYRINGE All Payors / Plans All Payors / Plans $37.68 $37.68 $37.68 $37.68 $37.68 $37.68 $37.68 $36.93 $36.93 EPHEDRINE SULFATE-0.9%NACL(PF) 25 MG/5 ML (5 MG/ML) SYRINGE All Payors / Plans All Payors / Plans $100.80 $100.80 $100.80 $100.80 $100.80 $100.80 $100.80 $98.78 $98.78 EPINEPHRINE 0.1 MG/ML SYRINGE All Payors / Plans All Payors / Plans $4.54 $4.54 $4.54 $4.54 $4.54 $4.54 $4.54 $4.45 $4.45 EPINEPHRINE 0.3 MG/0.3 ML AUTO-INJECTOR All Payors / Plans All Payors / Plans $111.70 $111.70 $111.70 $111.70 $111.70 $111.70 $111.70 $109.47 $109.47 EPINEPHRINE 1 MG/ML SOLUTION All Payors / Plans All Payors / Plans $3.03 $3.03 $3.03 $3.03 $3.03 $3.03 $3.03 $2.97 $2.97 EPINEPHRINE 1 MG/ML SOLUTION 30 ML VIAL All Payors / Plans All Payors / Plans $4.07 $4.07 $4.07 $4.07 $4.07 $4.07 $4.07 $3.99 $3.99 EPINEPHRINE HCL IN 0.9 % NACL 4 MG/250 ML (16 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $3.50 $3.50 $3.50 $3.50 $3.50 $3.50 $3.50 $3.43 $3.43 EPINEPHRINE HCL IN 5% DEXTROSE 4 MG/250 ML (16 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.02 $2.02 EPINEPHRINE PER 0.1 MG All Payors / Plans All Payors / Plans $4.55 $4.55 $4.55 $4.55 $4.55 $4.55 $4.55 $4.46 $4.46 ERCP BALLOON RETRIEVAL EXTRACTOR XL 11.5 MM All Payors / Plans All Payors / Plans $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 "ERGOCALCIFEROL 1,250 MCG (50,000 UNIT) CAPSULE" All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 "ERGOCALCIFEROL 200 MCG/ML (8,000 UNIT/ML) DROPS" All Payors / Plans All Payors / Plans $1.81 $1.81 $1.81 $1.81 $1.81 $1.81 $1.81 $1.77 $1.77 ERIBULIN 1 MG/2 ML (0.5 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $155.92 $155.92 $155.92 $155.92 $155.92 $155.92 $155.92 $152.81 $152.81 ERTAPENEM PER 500 MG All Payors / Plans All Payors / Plans $45.28 $45.28 $45.28 $45.28 $45.28 $45.28 $45.28 $44.37 $44.37 ERYTHROMYCIN 1 (ONE) 1 G TUBE 1 G TUBE All Payors / Plans All Payors / Plans $40.45 $40.45 $40.45 $40.45 $40.45 $40.45 $40.45 $39.64 $39.64 ERYTHROMYCIN 5 MG/GRAM (0.5 %) OINTMENT All Payors / Plans All Payors / Plans $40.25 $40.25 $40.25 $40.25 $40.25 $40.25 $40.25 $39.45 $39.45 ERYTHROMYCIN 5 MG/GRAM (0.5 %) OINTMENT 1 G TUBE All Payors / Plans All Payors / Plans $40.59 $40.59 $40.59 $40.59 $40.59 $40.59 $40.59 $39.78 $39.78 ERYTHROMYCIN BASE 250 MG TABLET All Payors / Plans All Payors / Plans $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.10 $18.10 ERYTHROMYCIN LACTOBIONATE PER 500 MG All Payors / Plans All Payors / Plans $29.91 $29.91 $29.91 $29.91 $29.91 $29.91 $29.91 $29.31 $29.31 ESCITALOPRAM 10 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 ESMOLOL 100 MG/10 ML (10 MG/ML) SOLUTION All Payors / Plans All Payors / Plans $20.98 $20.98 $20.98 $20.98 $20.98 $20.98 $20.98 $20.56 $20.56 "ESMOLOL IN NACL (ISO-OSM) 2,500 MG/250 ML (10 MG/ML) PARENTERAL SOLUTION" All Payors / Plans All Payors / Plans $253.65 $253.65 $253.65 $253.65 $253.65 $253.65 $253.65 $248.58 $248.58 ESTROGENS CONJUGATED PER 5 MG All Payors / Plans All Payors / Plans $15.01 $15.01 $15.01 $15.01 $15.01 $15.01 $15.01 $14.71 $14.71 ESYSUIT MEDENVISION All Payors / Plans All Payors / Plans $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $237.16 $237.16 ETHAMBUTOL 100 MG TABLET All Payors / Plans All Payors / Plans $2.02 $2.02 $2.02 $2.02 $2.02 $2.02 $2.02 $1.98 $1.98 ETHAMBUTOL 400 MG TABLET All Payors / Plans All Payors / Plans $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.00 $2.00 ETOMIDATE 2 MG/ML SOLUTION All Payors / Plans All Payors / Plans $15.99 $15.99 $15.99 $15.99 $15.99 $15.99 $15.99 $15.67 $15.67 ETOPOSIDE 20 MG/ML SOLUTION 25 ML VIAL All Payors / Plans All Payors / Plans $2.16 $2.16 $2.16 $2.16 $2.16 $2.16 $2.16 $2.12 $2.12 EVOS DISTAL RADIUS 1.8MM DRILL All Payors / Plans All Payors / Plans $424.40 $424.40 $424.40 $424.40 $424.40 $424.40 $424.40 $415.91 $415.91 EVOS DISTAL RADIUS TI 1.8MM DRILL All Payors / Plans All Payors / Plans $425.60 $425.60 $425.60 $425.60 $425.60 $425.60 $425.60 $417.09 $417.09 EVOS DISTAL RADIUS TI 1.8MM DRILL AO OC All Payors / Plans All Payors / Plans $425.60 $425.60 $425.60 $425.60 $425.60 $425.60 $425.60 $417.09 $417.09 EVOS DISTAL RADIUS TI 1.8MM DRILL AO QC All Payors / Plans All Payors / Plans $265.25 $265.25 $265.25 $265.25 $265.25 $265.25 $265.25 $259.95 $259.95 EVOS DISTAL RAIDUS TI 1.98MM AO QC All Payors / Plans All Payors / Plans $424.40 $424.40 $424.40 $424.40 $424.40 $424.40 $424.40 $415.91 $415.91 EVOS SMALL 2.5 MM DRILL- SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 EVOS SMALL 2.5MM DRILL SHORT All Payors / Plans All Payors / Plans $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $155.04 $151.94 $151.94 EZETIMIBE 10 MG TABLET All Payors / Plans All Payors / Plans $11.13 $11.13 $11.13 $11.13 $11.13 $11.13 $11.13 $10.91 $10.91 FAMOTIDINE 20 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 FAMOTIDINE 20 MG/2 ML SOLUTION All Payors / Plans All Payors / Plans $0.80 $0.80 $0.80 $0.80 $0.80 $0.80 $0.80 $0.78 $0.78 FAMOTIDINE 20 MG/2 ML SOLUTION 2 ML VIAL All Payors / Plans All Payors / Plans $0.80 $0.80 $0.80 $0.80 $0.80 $0.80 $0.80 $0.78 $0.78 FAMOTIDINE 40 MG/5 ML (8 MG/ML) SUSPENSION All Payors / Plans All Payors / Plans $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.43 $0.43 FAMOTIDINE PER 20 MG All Payors / Plans All Payors / Plans $10.93 $10.93 $10.93 $10.93 $10.93 $10.93 $10.93 $10.71 $10.71 "FAT EMULSION 20 % EMULSION 1,000 ML BAG" All Payors / Plans All Payors / Plans $0.12 $0.12 $0.12 $0.12 $0.12 $0.12 $0.12 $0.11 $0.11 FAT EMULSION 20 % EMULSION 250 ML BAG All Payors / Plans All Payors / Plans $0.18 $0.18 $0.18 $0.18 $0.18 $0.18 $0.18 $0.17 $0.17 FAT EMULSION 20 % EMULSION 500 ML BAG All Payors / Plans All Payors / Plans $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.18 $0.18 FAT EMULSION 20 % EMULSION 500 ML FLEX CONT All Payors / Plans All Payors / Plans $0.23 $0.23 $0.23 $0.23 $0.23 $0.23 $0.23 $0.22 $0.22 FELT CARDIOVASCULAR THK1.65MM 4X4IN PTFE STERILE All Payors / Plans All Payors / Plans $432.60 $432.60 $432.60 $432.60 $432.60 $432.60 $432.60 $423.95 $423.95 FENOFIBRATE 145 MG TABLET All Payors / Plans All Payors / Plans $9.18 $9.18 $9.18 $9.18 $9.18 $9.18 $9.18 $9.00 $9.00 FENOFIBRATE 48 MG TABLET All Payors / Plans All Payors / Plans $3.52 $3.52 $3.52 $3.52 $3.52 $3.52 $3.52 $3.45 $3.45 FENTANYL 50 MCG/HR PATCH 72 HOUR All Payors / Plans All Payors / Plans $15.78 $15.78 $15.78 $15.78 $15.78 $15.78 $15.78 $15.46 $15.46 FENTANYL CITRATE IN 0.9% NACL 10 MCG/ML SOLUTION All Payors / Plans All Payors / Plans $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.82 $0.82 FENTANYL PER 0.1 MG All Payors / Plans All Payors / Plans $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.85 $0.85 FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML SOLUTION WITH APPLICATOR All Payors / Plans All Payors / Plans $62.64 $62.64 $62.64 $62.64 $62.64 $62.64 $62.64 $61.39 $61.39 FERROUS GLUCONATE 324 MG (38 MG IRON) TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 FERROUS SULFATE 15 MG IRON (75 MG)/ML DROPS All Payors / Plans All Payors / Plans $0.66 $0.66 $0.66 $0.66 $0.66 $0.66 $0.66 $0.65 $0.65 FERROUS SULFATE 300 MG (60 MG IRON)/5 ML LIQUID All Payors / Plans All Payors / Plans $9.80 $9.80 $9.80 $9.80 $9.80 $9.80 $9.80 $9.60 $9.60 FERROUS SULFATE 325 MG (65 MG IRON) TABLET All Payors / Plans All Payors / Plans $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.89 $0.89 FERROUS SULFATE-C-FOLIC ACID 105 MG IRON- 500 MG-800 MCG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.93 $1.93 FIBER LASER FLEXIVA FLEXSHIELD 365 UM HIGH POWER POLISH OUTPUT TIP NONTAPER GUIDE CONNECTOR LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $639.18 $639.18 $639.18 $639.18 $639.18 $639.18 $639.18 $626.40 $626.40 FIBER LASER FLEXIVA TRAC TIP FLEXSHIELD HOLMIUM 200 UM FLEXIBLE CUSTOM GUIDE CONNECTOR LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $948.78 $948.78 $948.78 $948.78 $948.78 $948.78 $948.78 $929.80 $929.80 "FIBRINOGEN-THROMBIN 4.8 X 4.8 CM ADHESIVE PATCH,MEDICATED" All Payors / Plans All Payors / Plans $836.29 $836.29 $836.29 $836.29 $836.29 $836.29 $836.29 $819.56 $819.56 FIDAXOMICIN 200 MG TABLET All Payors / Plans All Payors / Plans $217.06 $217.06 $217.06 $217.06 $217.06 $217.06 $217.06 $212.72 $212.72 FIELDER XT STRAIGHT TIP GUIDEWIRE 190CM All Payors / Plans All Payors / Plans $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $254.80 $254.80 FILLER BONE VOID .5CC DBX ALLOGRAFT PUTTY FREEZE DRIED All Payors / Plans All Payors / Plans $218.88 $218.88 $218.88 $218.88 $218.88 $218.88 $218.88 $214.50 $214.50 FILLER BONE VOID 1CC DBX ALLOGRAFT PUTTY FREEZE DRIED All Payors / Plans All Payors / Plans $387.36 $387.36 $387.36 $387.36 $387.36 $387.36 $387.36 $379.61 $379.61 FILLER BONE VOID 5CC DBX ALLOGRAFT PUTTY FREEZE DRIED All Payors / Plans All Payors / Plans " $1,595.52 " " $1,595.52 " " $1,595.52 " " $1,595.52 " " $1,595.52 " " $1,595.52 " " $1,595.52 " " $1,563.61 " " $1,563.61 " FILTER EMBOLIZATION CELECT NAVALIGN 65CM 49MM 79CM 30MM 7FR PLATINUM HYDROPHILIC DISPOSABLE STERILE VENA CAVA RADIOPAQUE All Payors / Plans All Payors / Plans " $1,850.00 " " $1,850.00 " " $1,850.00 " " $1,850.00 " " $1,850.00 " " $1,850.00 " " $1,850.00 " " $1,813.00 " " $1,813.00 " FILTERWIRE EZ LARGE VESSEL 3.5MM - 5.5MM All Payors / Plans All Payors / Plans " $3,337.20 " " $3,337.20 " " $3,337.20 " " $3,337.20 " " $3,337.20 " " $3,337.20 " " $3,337.20 " " $3,270.46 " " $3,270.46 " FINASTERIDE 5 MG TABLET All Payors / Plans All Payors / Plans $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.00 $2.00 FLECAINIDE 100 MG TABLET All Payors / Plans All Payors / Plans $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.40 $3.40 FLECAINIDE 50 MG TABLET All Payors / Plans All Payors / Plans $2.05 $2.05 $2.05 $2.05 $2.05 $2.05 $2.05 $2.01 $2.01 FLUCONAZOLE 100 MG TABLET All Payors / Plans All Payors / Plans $4.22 $4.22 $4.22 $4.22 $4.22 $4.22 $4.22 $4.14 $4.14 FLUCONAZOLE 200 MG TABLET All Payors / Plans All Payors / Plans $5.15 $5.15 $5.15 $5.15 $5.15 $5.15 $5.15 $5.05 $5.05 FLUCONAZOLE 50 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 FLUCONAZOLE PER 200 MG All Payors / Plans All Payors / Plans $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.42 $10.42 FLUDROCORTISONE 0.1 MG TABLET All Payors / Plans All Payors / Plans $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.53 $2.53 FLUMAZENIL 0.1 MG/ML SOLUTION All Payors / Plans All Payors / Plans $36.10 $36.10 $36.10 $36.10 $36.10 $36.10 $36.10 $35.38 $35.38 FLUORESCEIN 1 MG STRIP All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 "FLUOROMETHOLONE 0.1 % DROPS,SUSPENSION 5 ML DROP BTL" All Payors / Plans All Payors / Plans $198.69 $198.69 $198.69 $198.69 $198.69 $198.69 $198.69 $194.72 $194.72 FLUOROURACIL PER 500 MG All Payors / Plans All Payors / Plans $52.17 $52.17 $52.17 $52.17 $52.17 $52.17 $52.17 $51.12 $51.12 FLUOXETINE 10 MG CAPSULE All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 FLUOXETINE 20 MG CAPSULE All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 FLUPHENAZINE 2.5 MG TABLET All Payors / Plans All Payors / Plans $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $8.88 $8.88 FLUPHENAZINE 5 MG TABLET All Payors / Plans All Payors / Plans $15.91 $15.91 $15.91 $15.91 $15.91 $15.91 $15.91 $15.59 $15.59 FLUPHENAZINE DECANOATE PER 25 MG All Payors / Plans All Payors / Plans $38.42 $38.42 $38.42 $38.42 $38.42 $38.42 $38.42 $37.65 $37.65 FLUTICASONE HFA 110 MCG/ACTUATION HFA AEROSOL INHALER 12 G AER W/ADAP All Payors / Plans All Payors / Plans $430.30 $430.30 $430.30 $430.30 $430.30 $430.30 $430.30 $421.69 $421.69 FLUTICASONE HFA 44 MCG/ACTUATION HFA AEROSOL INHALER 10.6 G AER W/ADAP All Payors / Plans All Payors / Plans $330.30 $330.30 $330.30 $330.30 $330.30 $330.30 $330.30 $323.69 $323.69 "FLUTICASONE PROPIONATE 50 MCG/ACTUATION SPRAY,SUSPENSION 16 G AER W/ADAP" All Payors / Plans All Payors / Plans $25.94 $25.94 $25.94 $25.94 $25.94 $25.94 $25.94 $25.42 $25.42 FLUVOXAMINE 50 MG TABLET All Payors / Plans All Payors / Plans $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.85 $1.85 FOLIC ACID 1 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 FOLIC ACID 5 MG/ML SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $0.60 $0.60 $0.60 $0.60 $0.60 $0.60 $0.60 $0.59 $0.59 FOMEPIZONE PER 15 MG All Payors / Plans All Payors / Plans $859.02 $859.02 $859.02 $859.02 $859.02 $859.02 $859.02 $841.84 $841.84 FORCEPS BIOPSY RADIAL JAW 4 2.8 MM LARGE CAPACITY L240 CM OD2.4 MM NEEDLE DISPOSABLE ORANGE All Payors / Plans All Payors / Plans $38.62 $38.62 $38.62 $38.62 $38.62 $38.62 $38.62 $37.85 $37.85 FORCEPS BIOPSY RADIAL JAW 4 LARGE CAPACITY L100 CM OD2.4 MM PULMONARY PRECISE BITE CONSISTENT SAMPLE RETENTION STREAMLINE CATHETER POSITION MARKER DISPOSABLE All Payors / Plans All Payors / Plans $63.12 $63.12 $63.12 $63.12 $63.12 $63.12 $63.12 $61.86 $61.86 FORCEPS BIOPSY RADIAL JAW 4 STAINLESS STEEL STANDARD CAPACITY L100 CM OD1.8 MM PULMONARY PRECISE BITE CONSISTENT SAMPLE RETENTION STREAMLINE CATHETER POSITION MARKER DISPOSABLE All Payors / Plans All Payors / Plans $67.51 $67.51 $67.51 $67.51 $67.51 $67.51 $67.51 $66.16 $66.16 FORCEPS BIOPSY SUPERTRAX L110 CM L2 MM OD1.7 MM SHAFT REINFORCED STACKED COIL DESIGN PROPRIETARY SHEATH SMOOTH BILATERAL CUP STERILE DISPOSABLE All Payors / Plans All Payors / Plans $221.20 $221.20 $221.20 $221.20 $221.20 $221.20 $221.20 $216.78 $216.78 FORCEPS ENDOSCOPIC RADIAL JAW 4 JUMBO L240 CM OD2.8 MM NEEDLE STERILE DISPOSABLE ORANGE All Payors / Plans All Payors / Plans $105.06 $105.06 $105.06 $105.06 $105.06 $105.06 $105.06 $102.96 $102.96 FORCEPS LENS GRIESHABER MAXGRIP OD25+ GA MICRO TEXTURE BROAD GRASP SURFACE BLUNT DISTAL END HEAVY MEMBRANE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $329.20 $329.20 $329.20 $329.20 $329.20 $329.20 $329.20 $322.62 $322.62 FORCEPS SURGICAL L25 CM END GRASPING TIP POSITIVE All Payors / Plans All Payors / Plans $295.14 $295.14 $295.14 $295.14 $295.14 $295.14 $295.14 $289.24 $289.24 FORCEPS SURGICAL SHARKSKIN OD25+ GA ILLUMINATE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $340.22 $340.22 $340.22 $340.22 $340.22 $340.22 $340.22 $333.42 $333.42 FOSPHENYTOIN 100 MG PE/2 ML SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $8.29 $8.29 $8.29 $8.29 $8.29 $8.29 $8.29 $8.12 $8.12 FULVESTRANT PER 25 MG All Payors / Plans All Payors / Plans $15.84 $15.84 $15.84 $15.84 $15.84 $15.84 $15.84 $15.52 $15.52 FUROSEMIDE 20 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 FUROSEMIDE 40 MG TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 FUROSEMIDE 80 MG TABLET All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 FUROSEMIDE PER 20 MG All Payors / Plans All Payors / Plans $5.21 $5.21 $5.21 $5.21 $5.21 $5.21 $5.21 $5.10 $5.10 GABAPENTIN 100 MG CAPSULE All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 GABAPENTIN 250 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $0.26 $0.26 $0.26 $0.26 $0.26 $0.26 $0.26 $0.25 $0.25 GABAPENTIN 300 MG CAPSULE All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 GABAPENTIN 400 MG CAPSULE All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 GEL ULTRASOUND AQUASONIC 100 STERILE LF 20GM COMPLETE AQUEOUS TRANSMISSION FOIL POUCH All Payors / Plans All Payors / Plans $1.70 $1.70 $1.70 $1.70 $1.70 $1.70 $1.70 $1.67 $1.67 "GELATIN SPONGE,ABSORBABLE SYRINGE 6 EACH SYRINGE" All Payors / Plans All Payors / Plans $60.20 $60.20 $60.20 $60.20 $60.20 $60.20 $60.20 $59.00 $59.00 "GELATIN SPONGE,ABSORB-PORCINE 100 SPONGE" All Payors / Plans All Payors / Plans $103.38 $103.38 $103.38 $103.38 $103.38 $103.38 $103.38 $101.31 $101.31 "GELATIN SPONGE,ABSORB-PORCINE 100 SPONGE 6 EACH PACKET" All Payors / Plans All Payors / Plans $144.87 $144.87 $144.87 $144.87 $144.87 $144.87 $144.87 $141.97 $141.97 "GELATIN SPONGE,ABSORB-PORCINE 12-7 MM SPONGE" All Payors / Plans All Payors / Plans $40.57 $40.57 $40.57 $40.57 $40.57 $40.57 $40.57 $39.76 $39.76 GEMCITABINE 100 MG/ML SOLUTION 20 ML VIAL All Payors / Plans All Payors / Plans $15.48 $15.48 $15.48 $15.48 $15.48 $15.48 $15.48 $15.17 $15.17 GEMCITABINE 200 MG/5.26 ML (38 MG/ML) SOLUTION 26.3 ML VIAL All Payors / Plans All Payors / Plans $15.04 $15.04 $15.04 $15.04 $15.04 $15.04 $15.04 $14.74 $14.74 GEMCITABINE 200 MG/5.26 ML (38 MG/ML) SOLUTION 5.26 ML VIAL All Payors / Plans All Payors / Plans $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.03 $2.03 GEMFIBROZIL 600 MG TABLET All Payors / Plans All Payors / Plans $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.10 $1.10 GENERATOR NEUROSTIMULATOR PROCLAIM ELITE THK1.34 CM 25.5-MA 2-1200HZ 30.4 CU CM L1.95 IN X H2.19 IN 1.7 OZ 5 IMPLANTABLE PULSE TONIC STIMULATION MODE BATTERY All Payors / Plans All Payors / Plans " $34,500.00 " " $34,500.00 " " $34,500.00 " " $34,500.00 " " $34,500.00 " " $34,500.00 " " $34,500.00 " " $33,810.00 " " $33,810.00 " GENTAMICIN 0.1 % CREAM 15 G TUBE All Payors / Plans All Payors / Plans $145.64 $145.64 $145.64 $145.64 $145.64 $145.64 $145.64 $142.73 $142.73 GENTAMICIN 120 MG/100 ML PIGGYBACK All Payors / Plans All Payors / Plans $7.80 $7.80 $7.80 $7.80 $7.80 $7.80 $7.80 $7.64 $7.64 GENTAMICIN PER 80 MG All Payors / Plans All Payors / Plans $5.43 $5.43 $5.43 $5.43 $5.43 $5.43 $5.43 $5.32 $5.32 GLIDESHEATH SLENDER 6FR 10CM All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 GLIDEWIRE.038 X 150CM All Payors / Plans All Payors / Plans $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 GLIMEPIRIDE 2 MG TABLET All Payors / Plans All Payors / Plans $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.93 $1.93 GLIMEPIRIDE 4 MG TABLET All Payors / Plans All Payors / Plans $2.66 $2.66 $2.66 $2.66 $2.66 $2.66 $2.66 $2.61 $2.61 GLIPIZIDE 10 MG TABLET All Payors / Plans All Payors / Plans $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $1.99 $1.99 GLIPIZIDE 10 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.70 $2.70 GLIPIZIDE 2.5 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $3.57 $3.57 $3.57 $3.57 $3.57 $3.57 $3.57 $3.50 $3.50 GLIPIZIDE 5 MG TABLET All Payors / Plans All Payors / Plans $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.11 $1.11 GLIPIZIDE 5 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $2.61 $2.61 $2.61 $2.61 $2.61 $2.61 $2.61 $2.56 $2.56 GLOVE SURGICAL BIOGEL 6.5 285X85MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON All Payors / Plans All Payors / Plans $0.49 $0.49 $0.49 $0.49 $0.49 $0.49 $0.49 $0.48 $0.48 GLOVE SURGICAL BIOGEL 7.5 298X96MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON All Payors / Plans All Payors / Plans $0.49 $0.49 $0.49 $0.49 $0.49 $0.49 $0.49 $0.48 $0.48 GLOVE SURGICAL BIOGEL 8 299X103MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON PYROGENIC All Payors / Plans All Payors / Plans $0.50 $0.50 $0.50 $0.50 $0.50 $0.50 $0.50 $0.49 $0.49 GLOVE SURGICAL BIOGEL ORTHOPRO POLYISOPRENE 8.5 All Payors / Plans All Payors / Plans $130.90 $130.90 $130.90 $130.90 $130.90 $130.90 $130.90 $128.28 $128.28 GLOVER SURGICAL DERMA PRENE ULTRA NEOPRENE POLYURETHANE 8 L11.6 IN CHEMOTHERAPY POWDER FREE SMOOTH BEAD CUFF STERILE LATEX FREE DARK GREEN All Payors / Plans All Payors / Plans $2.98 $2.98 $2.98 $2.98 $2.98 $2.98 $2.98 $2.92 $2.92 GLUCAGON 1 MG RECON SOLN All Payors / Plans All Payors / Plans $100.29 $100.29 $100.29 $100.29 $100.29 $100.29 $100.29 $98.28 $98.28 GLYCERIN SUPPOSITORY All Payors / Plans All Payors / Plans $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $1.96 $1.96 "GLYCERIN-WITCH HAZEL 12.5-50 % PADS, MEDICATED 40 EACH BOX" All Payors / Plans All Payors / Plans $11.15 $11.15 $11.15 $11.15 $11.15 $11.15 $11.15 $10.93 $10.93 GLYCOPYRROLATE 0.2 MG/ML SOLUTION All Payors / Plans All Payors / Plans $62.83 $62.83 $62.83 $62.83 $62.83 $62.83 $62.83 $61.57 $61.57 GOSERELIN PER 3.6 MG All Payors / Plans All Payors / Plans " $1,483.82 " " $1,483.82 " " $1,483.82 " " $1,483.82 " " $1,483.82 " " $1,483.82 " " $1,483.82 " " $1,454.14 " " $1,454.14 " GOWN SURGICAL CONVERTORS SMARTGOWN 2XL DISPOSABLE STERILE LF AAMI LEVEL 4 IMPERVIOUS RAGLAN SLEEVE BREATHABLE All Payors / Plans All Payors / Plans $5.29 $5.29 $5.29 $5.29 $5.29 $5.29 $5.29 $5.18 $5.18 GOWN SURGICAL SIRUS SMS POLYETHYLENE LARGE L43 IN AAMI LEVEL 4 IMPERVIOUS SLEEVE REINFORCE HOOK LOOP CLOSURE STERILE LATEX FREE DISPOSABLE BLUE All Payors / Plans All Payors / Plans $5.97 $5.97 $5.97 $5.97 $5.97 $5.97 $5.97 $5.85 $5.85 GOWN SURGICAL SIRUS SMS POLYETHYLENE XL L47 IN AAMI LEVEL 4 IMPERVIOUS SLEEVE REINFORCE HOOK LOOP CLOSURE STERILE LATEX FREE DISPOSABLE BLUE All Payors / Plans All Payors / Plans $4.08 $4.08 $4.08 $4.08 $4.08 $4.08 $4.08 $4.00 $4.00 GRAFT BONE CANCELLOUS H1-4 MM 15 ML FREEZE DRIED CHIPS All Payors / Plans All Payors / Plans $433.68 $433.68 $433.68 $433.68 $433.68 $433.68 $433.68 $425.01 $425.01 GRAFT BONE CANCELLOUS H1-4 MM 30 ML FREEZE DRIED CHIPS All Payors / Plans All Payors / Plans $748.70 $748.70 $748.70 $748.70 $748.70 $748.70 $748.70 $733.73 $733.73 GRAFT BONE CORNERSTONE L14 MM X W11 MM X H6 MM LASER All Payors / Plans All Payors / Plans " $1,187.50 " " $1,187.50 " " $1,187.50 " " $1,187.50 " " $1,187.50 " " $1,187.50 " " $1,187.50 " " $1,163.75 " " $1,163.75 " GRAFT BONE CORTICAL LORDOTIC H7 MM CERVICAL All Payors / Plans All Payors / Plans " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,862.00 " " $1,862.00 " GRAFT BONE FIBULA SHAFT L40 MM X W14-18 MM ALLOGRAFT FREEZE DRIED All Payors / Plans All Payors / Plans " $1,148.82 " " $1,148.82 " " $1,148.82 " " $1,148.82 " " $1,148.82 " " $1,148.82 " " $1,148.82 " " $1,125.84 " " $1,125.84 " GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L20 CM X H.49 MM OD6 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL All Payors / Plans All Payors / Plans $940.00 $940.00 $940.00 $940.00 $940.00 $940.00 $940.00 $921.20 $921.20 GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L40 CM X H.49 MM OD22 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL All Payors / Plans All Payors / Plans $724.36 $724.36 $724.36 $724.36 $724.36 $724.36 $724.36 $709.87 $709.87 GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L40 CM X H.49 MM OD8 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL All Payors / Plans All Payors / Plans $940.00 $940.00 $940.00 $940.00 $940.00 $940.00 $940.00 $921.20 $921.20 GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L12 CM OD14.5 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID12-13.5 MM ACCEPTS 12FR SHEATH All Payors / Plans All Payors / Plans " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,756.88 " " $9,756.88 " GRAFT ENDOVASCULAR EXCLUDER L12 CM L5.5 CM OD14.5 MM ODSEC23 MM TRUNK IPSILATERAL LEG ACTIVE CONTROL ACCEPTS 15 FR INTRODUCER SHEATH ENDOPROSTHESIS AAA All Payors / Plans All Payors / Plans " $27,950.00 " " $27,950.00 " " $27,950.00 " " $27,950.00 " " $27,950.00 " " $27,950.00 " " $27,950.00 " " $27,391.00 " " $27,391.00 " GRAFT ENDOVASCULAR GORE EXCLUDER L14 CM OD14.5 MM ID12-13.5 MM CONTRALATERAL LEG AAA ACCEPTS 12 FR SHEATH All Payors / Plans All Payors / Plans " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,956.00 " " $9,756.88 " " $9,756.88 " GRAFT ENDURANT 11 AORTO-UNI-ILIAC 25X14X102 All Payors / Plans All Payors / Plans " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,551.00 " " $19,551.00 " GRAFT ENDURANT 11 STENT GRAFT LIMB All Payors / Plans All Payors / Plans " $12,800.00 " " $12,800.00 " " $12,800.00 " " $12,800.00 " " $12,800.00 " " $12,800.00 " " $12,800.00 " " $12,544.00 " " $12,544.00 " GRAFT MEDTRONIC ENDURANT ENDO AAA BIFURCATED All Payors / Plans All Payors / Plans " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,551.00 " " $19,551.00 " GRAFT STENT ENDURANT II 2 BRANCH 93MM 143MM 16MM 14FR NITINOL POLYESTER HYDROPHILIC ENDOVASCULAR ILIAC RADIOPAQUE All Payors / Plans All Payors / Plans " $9,300.00 " " $9,300.00 " " $9,300.00 " " $9,300.00 " " $9,300.00 " " $9,300.00 " " $9,300.00 " " $9,114.00 " " $9,114.00 " GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L124 MM OD16-13 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA All Payors / Plans All Payors / Plans " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,751.00 " " $9,751.00 " GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L124 MM OD16-20 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA All Payors / Plans All Payors / Plans " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,950.00 " " $9,751.00 " " $9,751.00 " GRAFT STENT ENDURANT II POLYESTER NITINOL L49 MM OD25 MM ODSEC18 FR ENDOVASCULAR AORTIC EXTENSION STERILE AAA All Payors / Plans All Payors / Plans " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $8,967.00 " " $8,967.00 " GRAFT STENT ENDURANT II POLYESTER NITINOL L49 MM OD32 MM ODSEC20 FR ENDOVASCULAR AORTIC EXTENSION STERILE AAA All Payors / Plans All Payors / Plans " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $9,150.00 " " $8,967.00 " " $8,967.00 " GRAFT STENT ENDURANT IIS NITINOL PLATINUM POLYESTER 2 BRANCH L103 MM OD14-32 MM ODSEC20 FR INFRARENAL CATHETER RADIOPAQUE C DESIGN SELF EXPAND FLEXIBLE STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE AAA All Payors / Plans All Payors / Plans " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,950.00 " " $19,551.00 " " $19,551.00 " GRAFT VASCULAR GORE INTERING PTFE THIN WALL L60 CM L60 CM ID6 MM RADIAL SUPPORT STRETCH LINE All Payors / Plans All Payors / Plans " $2,412.00 " " $2,412.00 " " $2,412.00 " " $2,412.00 " " $2,412.00 " " $2,412.00 " " $2,412.00 " " $2,363.76 " " $2,363.76 " GRAFT VASCULAR GORE-TEX STANDARD WALL TAPER L45 CM ID4-7 MM PERIPHERAL STRETCH STERILE All Payors / Plans All Payors / Plans " $1,316.00 " " $1,316.00 " " $1,316.00 " " $1,316.00 " " $1,316.00 " " $1,316.00 " " $1,316.00 " " $1,289.68 " " $1,289.68 " GRIPPER MEDENVISION All Payors / Plans All Payors / Plans $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $250.88 $250.88 GUAIFENESIN 100 MG/5 ML LIQUID All Payors / Plans All Payors / Plans $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.80 $1.80 GUAIFENESIN 600 MG TABLET EXTENDED RELEASE 12HR All Payors / Plans All Payors / Plans $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.64 $2.64 GUANFACINE 1 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 GUAR GUM PACKET All Payors / Plans All Payors / Plans $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.85 $1.85 GUARDIAN HEMOSTASIS VALVE All Payors / Plans All Payors / Plans $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $45.33 $45.33 GUIDE PIN All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 GUIDE PIN ORTHOPEDIC BAYONET L 140MM OD 1.3MM STERILE DIPOSABLE 4MM 5MM CANNULATED SCREW All Payors / Plans All Payors / Plans $44.54 $44.54 $44.54 $44.54 $44.54 $44.54 $44.54 $43.65 $43.65 GUIDELINER 5.5F CATHETER All Payors / Plans All Payors / Plans $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $487.55 $487.55 GUIDEWIRE All Payors / Plans All Payors / Plans " $3,522.00 " " $3,522.00 " " $3,522.00 " " $3,522.00 " " $3,522.00 " " $3,522.00 " " $3,522.00 " " $3,451.56 " " $3,451.56 " GUIDEWIRE CORONARY EXTRA FLOPPY 300CM All Payors / Plans All Payors / Plans $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 GUIDEWIRE CORONARY RUNTHROUGH EXTRA FLOPPY 180 CM All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 GUIDEWIRE ENDOSCOPIC ACROBAT 2 HYDROPHILIC L5.8 CM STRAIGHT L450 CM L4 CM OD.035 IN RADIOPAQUE CALIBRATED TIP All Payors / Plans All Payors / Plans $454.00 $454.00 $454.00 $454.00 $454.00 $454.00 $454.00 $444.92 $444.92 GUIDEWIRE ENDOSCOPIC HYDRA JAGWIRE PTFE HYDROPHILIC STRAIGHT L450 CM OD.035 IN BILIARY HIGH PERFORMANCE RAPID EXCHANGE RADIOPAQUE DISTAL STERILE DISPOSABLE All Payors / Plans All Payors / Plans $394.48 $394.48 $394.48 $394.48 $394.48 $394.48 $394.48 $386.59 $386.59 GUIDEWIRE ORTHOPEDIC L150 MM OD1.4 MM All Payors / Plans All Payors / Plans $144.56 $144.56 $144.56 $144.56 $144.56 $144.56 $144.56 $141.67 $141.67 GUIDEWIRE ORTHOPEDIC L220 MM OD1.6 MM All Payors / Plans All Payors / Plans $98.15 $98.15 $98.15 $98.15 $98.15 $98.15 $98.15 $96.19 $96.19 GUIDEWIRE ORTHOPEDIC L220 MM OD2.8 MM All Payors / Plans All Payors / Plans $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 GUIDEWIRE ORTHOPEDIC L400 MM OD3.2 MM TIBIA THREAD NONSTERILE All Payors / Plans All Payors / Plans $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $158.76 $158.76 GUIDEWIRE STRAIGHT AMPLATZ 180CM -- USE PMM 100541 All Payors / Plans All Payors / Plans $76.26 $76.26 $76.26 $76.26 $76.26 $76.26 $76.26 $74.73 $74.73 GUIDEWIRE VASCULAR 1.5MM ROSEN CURVE J 260CM .035IN SS HEPARIN PTFE HEAVY DUTY MANDRIL FIX CORE EXCHANGE FLEXIBLE TIP All Payors / Plans All Payors / Plans $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS STEEL PTFE L3 MM SHORT FLAT TAPER L180 CM L7 CM OD.035 IN STRAIGHT TIP All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS STEEL PTFE STRAIGHT L260 CM L7 CM OD.035 IN FLEXIBLE TIP All Payors / Plans All Payors / Plans $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 GUIDEWIRE VASCULAR BENTSON STANDARD 145CM 6CM .035IN SS HEPARIN PTFE DISPOSABLE STERILE FIX CORE ATRAUMATIC TIP EXTRA All Payors / Plans All Payors / Plans $20.06 $20.06 $20.06 $20.06 $20.06 $20.06 $20.06 $19.66 $19.66 GUIDEWIRE VASCULAR BENTSON STANDARD 145CM 6CM .035IN SS PTFE DISPOSABLE STERILE FIX CORE ATRAUMATIC TIP EXTRA FLOPPY All Payors / Plans All Payors / Plans $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.98 $32.32 $32.32 GUIDEWIRE VASCULAR COONS STAINLESS STEEL PTFE 3.5 CM STRAIGHT TAPER FLOPPY L180 CM L15 CM OD.035 IN HEAVY DUTY FLEXIBLE TIP INTERVENTIONAL ATRAUMATIC All Payors / Plans All Payors / Plans $61.98 $61.98 $61.98 $61.98 $61.98 $61.98 $61.98 $60.74 $60.74 GUIDEWIRE VASCULAR COONS STAINLESS STEEL PTFE 3.5 CM STRAIGHT TAPER FLOPPY L260 CM L15 CM OD.035 IN HEAVY DUTY FLEXIBLE TIP INTERVENTIONAL ATRAUMATIC All Payors / Plans All Payors / Plans $44.99 $44.99 $44.99 $44.99 $44.99 $44.99 $44.99 $44.09 $44.09 GUIDEWIRE VASCULAR CORDIS EMERALD 3MM RADIUS J 260CM 7CM .025IN HEPARIN PTFE DISPOSABLE STERILE LF PERCUTANEOUS FLEXIBLE All Payors / Plans All Payors / Plans $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 GUIDEWIRE VASCULAR CORDIS SV STRAIGHT DISTAL TAPER 300CM 5CM .018IN PLATINUM NICKEL SS PTFE DISPOSABLE STERILE LF All Payors / Plans All Payors / Plans $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $135.24 $135.24 GUIDEWIRE VASCULAR COUGAR XT HYDRO-TRACK J L190 CM OD.014 IN EXTRA SUPPORT All Payors / Plans All Payors / Plans $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $78.40 $78.40 GUIDEWIRE VASCULAR COUGAR XT HYDRO-TRACK STRAIGHT L190 CM OD.014 IN EXTRA SUPPORT All Payors / Plans All Payors / Plans $128.00 $128.00 $128.00 $128.00 $128.00 $128.00 $128.00 $125.44 $125.44 GUIDEWIRE VASCULAR CPS COURIER STAINLESS STEEL OD.014 IN FIRM TIP All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 GUIDEWIRE VASCULAR ENROUTE PTFE HYDROPHILIC L5 CM L95 CM L15 CM OD .014 IN RADIOPAQUE All Payors / Plans All Payors / Plans $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $421.40 $421.40 GUIDEWIRE VASCULAR GLIDEWIRE ANGLE STANDARD 150CM 3CM .035IN HYDROPHILIC JACKET CORE TO TIP ATRAUMATIC All Payors / Plans All Payors / Plans $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 GUIDEWIRE VASCULAR GLIDEWIRE HYDROPHILIC ANGLE L150 CM L3 CM OD.035 IN FLEXIBLE TIP STIFF SHAFT All Payors / Plans All Payors / Plans $90.30 $90.30 $90.30 $90.30 $90.30 $90.30 $90.30 $88.49 $88.49 GUIDEWIRE VASCULAR GLIDEWIRE NITINOL HYDROPHILIC STRAIGHT L260 CM L3 CM OD.035 IN STIFF SHAFT FLEXIBLE All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 GUIDEWIRE VASCULAR GLIDEWIRE TERUMO GLIDE TECHNOLOGY STANDARD ANGLE 180CM 3CM .018IN NITINOL HYDROPHILIC CORE TO TIP All Payors / Plans All Payors / Plans $107.50 $107.50 $107.50 $107.50 $107.50 $107.50 $107.50 $105.35 $105.35 GUIDEWIRE VASCULAR GLIDEWIRE TUNGSTEN NITINOL POLYURETHANE HYDROPHILIC ANGLE STANDARD L180 CM L3 CM OD.035 IN PERIPHERAL JACKET CORE TO TIP ATRAUMATIC All Payors / Plans All Payors / Plans $49.75 $49.75 $49.75 $49.75 $49.75 $49.75 $49.75 $48.76 $48.76 GUIDEWIRE VASCULAR GLIDEWIRE TUNGSTEN NITINOL POLYURETHANE HYDROPHILIC ANGLE STANDARD L260 CM L3 CM OD.035 IN PERIPHERAL JACKET CORE TO TIP ATRAUMATIC All Payors / Plans All Payors / Plans $88.80 $88.80 $88.80 $88.80 $88.80 $88.80 $88.80 $87.02 $87.02 GUIDEWIRE VASCULAR HIWIRE PTFE STAINLESS STEEL STRAIGHT TAPER L145 CM L10 CM OD.035 IN NEWTON LT ATRAUMATIC FLEXIBLE TIP FIXED CORE All Payors / Plans All Payors / Plans $21.34 $21.34 $21.34 $21.34 $21.34 $21.34 $21.34 $20.91 $20.91 GUIDEWIRE VASCULAR LUNDERQUIST STRAIGHT 260CM 15CM .035IN SS PTFE LF EXTRA STIFF FLEXIBLE TIP EXCHANGE All Payors / Plans All Payors / Plans $315.20 $315.20 $315.20 $315.20 $315.20 $315.20 $315.20 $308.90 $308.90 GUIDEWIRE VASCULAR LUNDERQUIST TAPER 260CM 11CM .035IN SS PTFE DISPOSABLE STERILE EXTRA STIFF FLOPPY CURVE TIP EXCHANGE All Payors / Plans All Payors / Plans $322.00 $322.00 $322.00 $322.00 $322.00 $322.00 $322.00 $315.56 $315.56 GUIDEWIRE VASCULAR MICROPUNCTURE NITINOL ANGLE L60 CM OD.018 IN All Payors / Plans All Payors / Plans $32.74 $32.74 $32.74 $32.74 $32.74 $32.74 $32.74 $32.09 $32.09 GUIDEWIRE VASCULAR MICROPUNCTURE NITINOL STRAIGHT L80 CM OD.018 IN All Payors / Plans All Payors / Plans $67.90 $67.90 $67.90 $67.90 $67.90 $67.90 $67.90 $66.54 $66.54 GUIDEWIRE VASCULAR NITREX NITINOL TUNGSTEN SILICONE GOLD 15 D L260 CM L8 CM OD.025 IN INTERMEDIATE ANGLE TIP All Payors / Plans All Payors / Plans $322.50 $322.50 $322.50 $322.50 $322.50 $322.50 $322.50 $316.05 $316.05 GUIDEWIRE VASCULAR OMNIWIRE NITINOL STRAIGHT L185 CM PRESSURE All Payors / Plans All Payors / Plans $843.75 $843.75 $843.75 $843.75 $843.75 $843.75 $843.75 $826.88 $826.88 GUIDEWIRE VASCULAR PT2 POLYMER HYDROPHILIC L185 CM OD.014 IN MODERATE RAIL SUPPORT INTERMEDIATE J TIP All Payors / Plans All Payors / Plans $83.50 $83.50 $83.50 $83.50 $83.50 $83.50 $83.50 $81.83 $81.83 GUIDEWIRE VASCULAR PT2 STAINLESS STEEL NITINOL POLYMER HYDROPHILIC STRAIGHT L185 CM OD.014 IN MODERATE SUPPORT INTERMEDIATE TIP All Payors / Plans All Payors / Plans $133.59 $133.59 $133.59 $133.59 $133.59 $133.59 $133.59 $130.92 $130.92 GUIDEWIRE VASCULAR PUSH-PLUS MICROPUNCTURE 40CM 10CM .018IN 5FR SS 1 PART NEEDLE STIFFENED CANNULA COAXIAL CATHETER All Payors / Plans All Payors / Plans $87.38 $87.38 $87.38 $87.38 $87.38 $87.38 $87.38 $85.63 $85.63 GUIDEWIRE VASCULAR ROADRUNNER HYDROPHILIC NITINOL PLATINUM TAPER L260 CM OD.035 IN RADIOPAQUE FLEXIBLE TIP All Payors / Plans All Payors / Plans $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $86.24 $86.24 GUIDEWIRE VASCULAR ROADRUNNER TAPER FLOPPY ANGLE SPRING COIL 300CM 8.5CM .014IN PLATINUM NITINOL PTFE DISPOSABLE STERILE All Payors / Plans All Payors / Plans $254.98 $254.98 $254.98 $254.98 $254.98 $254.98 $254.98 $249.88 $249.88 GUIDEWIRE VASCULAR ROSEN J CURVE 180CM 1.5MM .035IN SS PTFE DISPOSABLE STERILE FIX CORE HEAVY DUTY EXCHANGE All Payors / Plans All Payors / Plans $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $25.48 $25.48 GUIDEWIRE VASCULAR SAFE-T-J STANDARD CURVE TAPER 145CM 1.5CM .035IN SS PTFE DISPOSABLE STERILE FIX CORE FLEXIBLE TIP All Payors / Plans All Payors / Plans $25.98 $25.98 $25.98 $25.98 $25.98 $25.98 $25.98 $25.46 $25.46 GUIDEWIRE VASCULAR SYNCHRO2 HYDROPHILIC NITINOL STANDARD L200CM L35 CM OD .014 IN DURABLE ATRAUMATIC RIBBON TIP MICROFABRICATED ACCESS LENGTH STERILE DISPOSABLE All Payors / Plans All Payors / Plans " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,274.00 " " $1,274.00 " GUIDEWIRE VASCULAR V-18 CONTROLWIRE SCITANIUM ICE STRAIGHT L110 CM L8 CM OD.018 IN RADIOPAQUE All Payors / Plans All Payors / Plans $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $274.40 $274.40 GUIDEWIRE VASCULAR V-18 CONTROLWIRE SCITANIUM ICE TAPER L300 CM L8 CM OD.018 IN PERIPHERAL RADIOPAQUE STRAIGHT TIP All Payors / Plans All Payors / Plans $157.14 $157.14 $157.14 $157.14 $157.14 $157.14 $157.14 $154.00 $154.00 GUIDEWIRE VASCULAR VICTORY STAINLESS STEEL PTFE HYDROPHILIC STRAIGHT L300 CM OD.014 IN ODSEC18 GA PERIPHERAL BROAD MATRIX EXCELLENT CROSS ENHANCE TORQUE RADIOPAQUE All Payors / Plans All Payors / Plans $185.13 $185.13 $185.13 $185.13 $185.13 $185.13 $185.13 $181.43 $181.43 GUIDEWIRE VASCULAR ZIPWIRE NITINOL POLYMER HYDROPHILIC STANDARD STRAIGHT L150 CM L3 CM OD.035 IN SUPER ELASTIC CORE PRECISE TORQUE CONTROL SUPERIOR VISIBILITY All Payors / Plans All Payors / Plans $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $78.40 $78.40 GW DIAGNOSTIC AMPLATZ INQWIRE .0035 IN 180 CM L 3MM J-TIP _62243_ All Payors / Plans All Payors / Plans $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HAEMOPHILUS B CONJUGATE 10 MCG/0.5 ML RECON SOLN All Payors / Plans All Payors / Plans $62.83 $62.83 $62.83 $62.83 $62.83 $62.83 $62.83 $61.57 $61.57 HALOPERIDOL 1 MG TABLET All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 HALOPERIDOL 2 MG TABLET All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.55 $2.55 HALOPERIDOL 2 MG/ML CONCENTRATE All Payors / Plans All Payors / Plans $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 $0.25 HALOPERIDOL 5 MG TABLET All Payors / Plans All Payors / Plans $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $1.99 $1.99 HALOPERIDOL LACTATE PER 5 MG All Payors / Plans All Payors / Plans $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.85 $0.85 HC NM GI GASTRIC EMPTY IMAGE STUDY All Payors / Plans All Payors / Plans 0340 78264 " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,412.18 " " $1,412.18 " HC SONO PELVIS LIMITED All Payors / Plans All Payors / Plans 0402 76857 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC 10MCI GALLIUM All Payors / Plans All Payors / Plans 0343 $159.10 $159.10 $159.10 $159.10 $159.10 $159.10 $159.10 $155.92 $155.92 "HC 14-3-3 PROTEIN, SPINAL FLUID" All Payors / Plans All Payors / Plans 0300 83520 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $117.60 $117.60 HC 17 HYDROXY PROGESTERONE (17HPG) All Payors / Plans All Payors / Plans 0301 83498 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $86.24 $86.24 HC 3 PHASE BONE SCAN All Payors / Plans All Payors / Plans 0340 78315 " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,412.18 " " $1,412.18 " HC 3D TREATMENT PLANNING All Payors / Plans All Payors / Plans 0333 77295 $909.00 $909.00 $909.00 $909.00 $909.00 $909.00 $909.00 $890.82 $890.82 "HC 5-FLUCYTOSINE, SERUM" All Payors / Plans All Payors / Plans 0300 80299 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 HC 5-HIAA (HIAA) All Payors / Plans All Payors / Plans 0301 83497 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC A/G RATIO (AG) All Payors / Plans All Payors / Plans 0300 84155 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC AB TO EXTRACTABLE NUCLEAR AG(ENA) All Payors / Plans All Payors / Plans 0300 86235 $630.00 $630.00 $630.00 $630.00 $630.00 $630.00 $630.00 $617.40 $617.40 HC ABBREV DRUG SCREEN &ACETEMOPHIN/SALICYLATE All Payors / Plans All Payors / Plans 0300 80307 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $213.64 $213.64 "HC ABBREV DRUG SCREEN, ACETEMINOPHEN & SALICYLATE" All Payors / Plans All Payors / Plans 0300 80307 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $249.90 $249.90 HC ABDOMEN 2 VIEWS All Payors / Plans All Payors / Plans 0320 74019 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC ABDOMEN COMPLETE All Payors / Plans All Payors / Plans 0402 76700 $598.00 $598.00 $598.00 $598.00 $598.00 $598.00 $598.00 $586.04 $586.04 HC ABDOMEN LIMITED B All Payors / Plans All Payors / Plans 0402 76705 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $458.64 $458.64 HC ABDOMEN SINGLE VIEW All Payors / Plans All Payors / Plans 0320 74018 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $101.92 $101.92 HC ABORTED HOLTER CHARGE All Payors / Plans All Payors / Plans 0731 93226 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC ACAPELLA INITIAL RX All Payors / Plans All Payors / Plans 0410 94667 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC ACAPELLA SUB RX All Payors / Plans All Payors / Plans 0410 94668 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC ACETAMINOPHEN (ACE) All Payors / Plans All Payors / Plans 0300 80143 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ACETYCHOLINE RECEPTOR AB (ACEAB) All Payors / Plans All Payors / Plans 0300 83519 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ACETYLCHOLINESTERASE All Payors / Plans All Payors / Plans 0300 82013 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC ACETYLCHOLINESTERASE,RBC (ACHS)" All Payors / Plans All Payors / Plans 0300 82482 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ACID FAST CULT BLOOD (AFBLC) All Payors / Plans All Payors / Plans 0300 87116 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC ACROMIO-CLAV JOINTS All Payors / Plans All Payors / Plans 0320 73050 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC ACTH (ACTH) All Payors / Plans All Payors / Plans 0301 82024 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC ACTIVATED PROTEIN C RESISTENCE All Payors / Plans All Payors / Plans 0300 85307 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC ACUTE ABD MULTIVIEWS W 1 VIEW CXR All Payors / Plans All Payors / Plans 0320 74022 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC ACUTE GI BLOOD LOSS All Payors / Plans All Payors / Plans 0340 78278 " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,427.86 " " $1,427.86 " "HC ADALIMUMAB AB, S (ADLAB)" All Payors / Plans All Payors / Plans 0300 83520 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 "HC ADALIMUMAB QN W/RFLX TO AB, SERUM (ADALX)" All Payors / Plans All Payors / Plans 0300 80299 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $441.00 $441.00 "HC ADALIMUMAB QN WITH REFLEX TO AB, S" All Payors / Plans All Payors / Plans 0300 80145 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC ADDITIONAL TOUCH PREP All Payors / Plans All Payors / Plans 0310 88334 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC ADD'L COMP ANALYSIS W/STR (STR2) All Payors / Plans All Payors / Plans 0300 81266 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 HC ADD'L FROZEN SECTION All Payors / Plans All Payors / Plans 0310 88332 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 "HC ADJ TISS XFER HEAD,FAC, HAND <10 SQCM" All Payors / Plans All Payors / Plans 0761 14040 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC ADMISSION CHARGE All Payors / Plans All Payors / Plans 0221 $436.00 $436.00 $436.00 $436.00 $436.00 $436.00 $436.00 $427.28 $427.28 HC ADRENOCORTICOTROPHIC HORMONE (ACTH) STIM PANEL All Payors / Plans All Payors / Plans 0300 80400 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC AFP MATERNAL 4 MARKER All Payors / Plans All Payors / Plans 0300 81511 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $191.10 $191.10 "HC AFP,AMNIOTIC FLUID (AFPAF)" All Payors / Plans All Payors / Plans 0300 82106 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC AGILE TEST CAPSULE ENDO All Payors / Plans All Payors / Plans 0750 91299 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC AG-NOR/CBL STAIN (BILL ONLY) All Payors / Plans All Payors / Plans 0300 88283 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC AHG PHASE CROSSMATCH ANTIGLOBULIN All Payors / Plans All Payors / Plans 0300 86922 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC AHG PHASE CROSSMATCH INCUBATION All Payors / Plans All Payors / Plans 0300 86921 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $2.94 $2.94 HC ALBUMIN IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC ALBUMIN, URINE/OTHER SOURCE QUANTITATIVE EA." All Payors / Plans All Payors / Plans 0301 82042 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC ALBUMIN;SERUM, PLASMA OR WHOLE BLOOD" All Payors / Plans All Payors / Plans 0301 82040 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 "HC ALCOHOL, URINE (ALCOU)" All Payors / Plans All Payors / Plans 0300 80320 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ALDOLASE (ALSE) All Payors / Plans All Payors / Plans 0301 82085 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ALDOSTERONE All Payors / Plans All Payors / Plans 0301 82088 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ALGIDEX AG 4X4 1/2 IN X 5 YARDS All Payors / Plans All Payors / Plans $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.37 $8.37 HC ALGIDEX AG 4X8 1/4 IN X 5 YARDS All Payors / Plans All Payors / Plans $17.18 $17.18 $17.18 $17.18 $17.18 $17.18 $17.18 $16.84 $16.84 HC ALK PHOSPHATASE (ALKP) All Payors / Plans All Payors / Plans 0301 84075 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC ALKALINE PHOS. ISOENZYMES (APISO) All Payors / Plans All Payors / Plans 0300 84080 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $66.64 $66.64 "HC ALLERGEN SPECIFIC IGE;QUANT OR SEMIQUANT, RECOMBINANT OR PURIFED COMPONENT, EACH" All Payors / Plans All Payors / Plans 0300 86008 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ALPHA FETOPROTEIN All Payors / Plans All Payors / Plans 0300 82105 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ALPHA-1-ANTITRYPSIN (ALA) All Payors / Plans All Payors / Plans 0301 82103 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ALPHA-2 PLASMIN INHIBITOR P All Payors / Plans All Payors / Plans 0300 85410 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC ALPHA-FETOPROTEIN (AFP) SERUM All Payors / Plans All Payors / Plans 0301 82105 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ALPHA-GLOBULIN GENE ANALYSIS All Payors / Plans All Payors / Plans 0300 81269 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 HC ALT (SGPT) All Payors / Plans All Payors / Plans 0301 84460 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC ALUMINUM (ALMU) All Payors / Plans All Payors / Plans 0300 82108 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 "HC ALZHEIMER DISEASE EVAL, SPINAL FLUID" All Payors / Plans All Payors / Plans 0300 83520 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 HC AMBULATION TRAIN All Payors / Plans All Payors / Plans 0420 97116 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC AMIKACIN All Payors / Plans All Payors / Plans 0300 80150 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC AMINO ACID SCREEN BLD. (ACCB) All Payors / Plans All Payors / Plans 0300 82139 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 "HC AMINO ACIDS, 2-5 QUANTITATIVE" All Payors / Plans All Payors / Plans 0300 82136 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC AMINOLEVULINIC ACID(ALA),RAND,UR" All Payors / Plans All Payors / Plans 0300 82135 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $63.70 $63.70 HC AMINOPHYLLINE (THEO)(AMFN) All Payors / Plans All Payors / Plans 0300 80198 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC AMIODARONE (AMID) All Payors / Plans All Payors / Plans 0300 80151 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC AMIODARONE LEVEL All Payors / Plans All Payors / Plans 0300 80151 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC AMMONIA All Payors / Plans All Payors / Plans 0301 82140 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC AMNINOCENTESIS All Payors / Plans All Payors / Plans 0402 76946 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $305.76 $305.76 HC AMNIOCENTESIS All Payors / Plans All Payors / Plans 0720 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC AMNIOINFUSION All Payors / Plans All Payors / Plans 0720 $918.00 $918.00 $918.00 $918.00 $918.00 $918.00 $918.00 $899.64 $899.64 HC AMPHETAMINE CONF All Payors / Plans All Payors / Plans 0300 80324 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC AMPHETAMINES CONFIRMATION, FLUID (CSMP)" All Payors / Plans All Payors / Plans 0300 80326 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 "HC AMPLIFIED PROBE, EA. ORGANISM" All Payors / Plans All Payors / Plans 0300 87798 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC AMPUTATION TOE, I-P JT" All Payors / Plans All Payors / Plans 0761 28825 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC AMYLASE All Payors / Plans All Payors / Plans 0301 82150 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC ANDROSTENEDIONE (ANDRS) All Payors / Plans All Payors / Plans 0300 82157 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ANESTHESIOLOGY All Payors / Plans All Payors / Plans 0370 $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.85 $1.85 "HC ANEUPLOIDY DETECTION,POC,FISH" All Payors / Plans All Payors / Plans 0300 88271 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $686.00 $686.00 HC ANGIOTENSIN I CONVERT ENZYME All Payors / Plans All Payors / Plans 0301 82164 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ANKLE All Payors / Plans All Payors / Plans 0320 73600 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC ANKLE BRACHIAL INDEX VASCULAR CENTER All Payors / Plans All Payors / Plans 0921 93922 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $50.96 $50.96 HC ANT-HEPATITITS C (AHCV) All Payors / Plans All Payors / Plans 0300 86803 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ANTI NUCLEAR ANTIBODY All Payors / Plans All Payors / Plans 0300 86038 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ANTIBODY CYTOMEGALOVIRUS (CMV) All Payors / Plans All Payors / Plans 0302 86645 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ANTIBODY EHRLICHIA All Payors / Plans All Payors / Plans 0302 86666 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 "HC ANTIBODY ELUTION, RBC, EA ELUTION" All Payors / Plans All Payors / Plans 0300 86860 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ANTIBODY IDENTIFICATION All Payors / Plans All Payors / Plans 0300 86870 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC ANTIBODY PROTOZOA, NOT ELSEWHERE SPECIFIED" All Payors / Plans All Payors / Plans 0300 86753 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ANTIBODY SCREEN (ABST) All Payors / Plans All Payors / Plans 0300 86850 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC ANTIBODY TITER (ABTI) All Payors / Plans All Payors / Plans 0302 86886 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $78.40 $78.40 HC ANTI-CORE IGM (COREM) All Payors / Plans All Payors / Plans 0302 86705 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC ANTICYTOPLASMIC NEUT FLUORESCENT AB, SCREEN EA (ANCA)" All Payors / Plans All Payors / Plans 0302 86036 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC ANTIDEPRESSANTS, TRICYCLIC, OTHER CYCLICALS, 1 OR 2" All Payors / Plans All Payors / Plans 0300 80335 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC ANTI-DNA ANTIBODY (ADNA) All Payors / Plans All Payors / Plans 0300 86225 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 HC ANTIGEN TYPING All Payors / Plans All Payors / Plans 0300 86902 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC ANTI-HAV, IGM (HAV)" All Payors / Plans All Payors / Plans 0300 86709 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ANTI-HB CORE (CORE) All Payors / Plans All Payors / Plans 0302 86704 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ANTI-HBE (EAB) All Payors / Plans All Payors / Plans 0302 86707 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ANTI-HBSAG (HAB) All Payors / Plans All Payors / Plans 0300 86706 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ANTIMULLERIAN HORMONE (AMH) All Payors / Plans All Payors / Plans 0300 83520 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $115.64 $115.64 HC ANTI-NEUTRO. CYTO. AB. (ANCAB) All Payors / Plans All Payors / Plans 0300 83516 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC ANTI-SMOOTH MUSCLE AB (ASMUS) All Payors / Plans All Payors / Plans 0300 86255 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ANTISTREPTOLYSIN O SCREEN All Payors / Plans All Payors / Plans 0300 86063 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC ANTI-THROMBIN III (ANTI3) All Payors / Plans All Payors / Plans 0300 85301 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $42.14 $42.14 HC ANTI-THYROGLOBULIN AB (ATHYR) All Payors / Plans All Payors / Plans 0302 86800 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ANT-PHOSPHOLIPID ABS. (APSAB) All Payors / Plans All Payors / Plans 0300 85730 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 "HC APC GENE, FULL GENE ANALYSIS" All Payors / Plans All Payors / Plans 0300 81201 " $2,900.00 " " $2,900.00 " " $2,900.00 " " $2,900.00 " " $2,900.00 " " $2,900.00 " " $2,900.00 " " $2,842.00 " " $2,842.00 " HC APHERESIS PLASMA PHERESIS All Payors / Plans All Payors / Plans 0510 36514 " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,127.00 " " $1,127.00 " HC APHERESIS PLATELETS All Payors / Plans All Payors / Plans 0510 36513 " $11,510.00 " " $11,510.00 " " $11,510.00 " " $11,510.00 " " $11,510.00 " " $11,510.00 " " $11,510.00 " " $11,279.80 " " $11,279.80 " HC APHERESIS RED BLOOD CELLS All Payors / Plans All Payors / Plans 0510 36512 " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,150.00 " " $1,127.00 " " $1,127.00 " HC APHERESIS SUPPLIES All Payors / Plans All Payors / Plans $811.78 $811.78 $811.78 $811.78 $811.78 $811.78 $811.78 $795.54 $795.54 HC APHERESIS WHITE BLOOD CELLS All Payors / Plans All Payors / Plans 0510 36511 " $1,550.00 " " $1,550.00 " " $1,550.00 " " $1,550.00 " " $1,550.00 " " $1,550.00 " " $1,550.00 " " $1,519.00 " " $1,519.00 " HC APICAL LORDOTIC CHEST All Payors / Plans All Payors / Plans 0320 71021 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC APPL FING SPLINT DYN 8-22 All Payors / Plans All Payors / Plans 0420 29131 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC APPL FINGER SPLINT DYNAMIC 23-37 All Payors / Plans All Payors / Plans 0420 29131 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC APPL FINGER SPLINT DYNAMIC 38-52 All Payors / Plans All Payors / Plans 0420 29131 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $523.32 $523.32 HC APPL FINGER SPLINT DYNAMIC 53-67 All Payors / Plans All Payors / Plans 0420 29131 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC APPL FINGER SPLINT DYNAMIC 68-82 All Payors / Plans All Payors / Plans 0420 29131 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $872.20 $872.20 HC APPL FINGER SPLINT STATIC 23-37 All Payors / Plans All Payors / Plans 0420 29130 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $279.30 $279.30 HC APPL FINGER SPLINT STATIC 38-52 All Payors / Plans All Payors / Plans 0420 29130 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC APPL FINGER SPLINT STATIC 53-67 All Payors / Plans All Payors / Plans 0420 29130 $569.00 $569.00 $569.00 $569.00 $569.00 $569.00 $569.00 $557.62 $557.62 HC APPL FINGER SPLINT STATIC 68-82 All Payors / Plans All Payors / Plans 0420 29130 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC APPL FINGER SPLINT STATIC 8-22 All Payors / Plans All Payors / Plans 0420 29130 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $139.16 $139.16 HC APPL LONG ARM SPLINT 23-37 All Payors / Plans All Payors / Plans 0420 29105 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC APPL LONG ARM SPLINT 38-52 All Payors / Plans All Payors / Plans 0420 29105 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC APPL LONG ARM SPLINT 53-67 All Payors / Plans All Payors / Plans 0420 29105 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC APPL LONG ARM SPLINT 68-82 All Payors / Plans All Payors / Plans 0420 29105 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC APPL LONG ARM SPLINT 8-22 All Payors / Plans All Payors / Plans 0420 29105 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC APPL LONG LEG SPLINT 23-37 All Payors / Plans All Payors / Plans 0420 29505 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC APPL LONG LEG SPLINT 38-52 All Payors / Plans All Payors / Plans 0420 29505 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC APPL LONG LEG SPLINT 53-67 All Payors / Plans All Payors / Plans 0420 29505 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC APPL LONG LEG SPLINT 68-82 All Payors / Plans All Payors / Plans 0420 29505 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC APPL LONG LEG SPLINT 8-22 All Payors / Plans All Payors / Plans 0420 29505 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC APPL SHORT ARM DYNAMIC 23-37 All Payors / Plans All Payors / Plans 0420 29126 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC APPL SHORT ARM DYNAMIC 38-52 All Payors / Plans All Payors / Plans 0420 29126 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC APPL SHORT ARM DYNAMIC 53-67 All Payors / Plans All Payors / Plans 0420 29126 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC APPL SHORT ARM DYNAMIC 68-82 All Payors / Plans All Payors / Plans 0420 29126 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC APPL SHORT ARM SPLINT DYNAM 8-22 All Payors / Plans All Payors / Plans 0420 29126 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC APPL SHORT ARM STATIC 23-37 All Payors / Plans All Payors / Plans 0420 29125 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC APPL SHORT ARM STATIC 38-52 All Payors / Plans All Payors / Plans 0420 29125 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $523.32 $523.32 HC APPL SHORT ARM STATIC 53-67 All Payors / Plans All Payors / Plans 0420 29125 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC APPL SHORT ARM STATIC 68-82 All Payors / Plans All Payors / Plans 0420 29125 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $872.20 $872.20 HC APPL SHORT ARM STATIC 8-22 All Payors / Plans All Payors / Plans 0420 29125 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC APPL SHORT LEG SPLINT 23-37 All Payors / Plans All Payors / Plans 0420 29515 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC APPL SHORT LEG SPLINT 38-52 All Payors / Plans All Payors / Plans 0420 29515 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $523.32 $523.32 HC APPL SHORT LEG SPLINT 53-67 All Payors / Plans All Payors / Plans 0420 29515 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC APPL SHORT LEG SPLINT 68-82 All Payors / Plans All Payors / Plans 0420 29515 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $872.20 $872.20 HC APPL SHORT LEG SPLINT 8-22 All Payors / Plans All Payors / Plans 0420 29515 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC APPLICATION ON-BODY INJECTOR TIMED SUBCUTANEOUS INJ All Payors / Plans All Payors / Plans 0361 96377 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $89.18 $89.18 HC APPLY PROFORE All Payors / Plans All Payors / Plans 0761 29581 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $357.70 $357.70 HC APPLY PROFORE BILATERAL All Payors / Plans All Payors / Plans 0761 29581 $547.00 $547.00 $547.00 $547.00 $547.00 $547.00 $547.00 $536.06 $536.06 HC APPLY TL CONTACT LEG CAST All Payors / Plans All Payors / Plans 0761 29445 $632.00 $632.00 $632.00 $632.00 $632.00 $632.00 $632.00 $619.36 $619.36 HC APPLY UNNA BOOT All Payors / Plans All Payors / Plans 0761 29580 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $357.70 $357.70 HC APPLY UNNA BOOT BILATERAL All Payors / Plans All Payors / Plans 0761 29580 $547.00 $547.00 $547.00 $547.00 $547.00 $547.00 $547.00 $536.06 $536.06 HC APT TEST (APT) All Payors / Plans All Payors / Plans 0300 83033 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC APTT MIX 1 TO 1 All Payors / Plans All Payors / Plans 0300 85732 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 HC ARBOVIRUS All Payors / Plans All Payors / Plans 0300 86652 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $230.30 $230.30 HC ARSENIC (ARSU) All Payors / Plans All Payors / Plans 0300 82175 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC ARTERIAL LINE SET UP All Payors / Plans All Payors / Plans 0460 36620 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC ARTHROGRAM ANKLE All Payors / Plans All Payors / Plans 0320 73615 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC ARTHROGRAM KNEE All Payors / Plans All Payors / Plans 0320 73580 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 "HC ASPERGILLUS, ANTIBODY" All Payors / Plans All Payors / Plans 0302 86606 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 "HC ASPERGILUS, ANTIGEN, BRONCHOALEVOLAR LAVAGE" All Payors / Plans All Payors / Plans 0302 87305 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ASSESSMENT/TRIAGE SERVICE All Payors / Plans All Payors / Plans 0720 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $149.94 $149.94 HC AST (SGOT) All Payors / Plans All Payors / Plans 0301 84450 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC ASTO TITER (ASTO) All Payors / Plans All Payors / Plans 0300 86060 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ATERIAL DOPPLER-LOWER-VASCULAR LAB All Payors / Plans All Payors / Plans 0921 93923 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $305.76 $305.76 HC AUTOANTIBODIES TO JO 1 All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC AUTOANTIBODIES TO SCL 70 All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC AUTOANTIBODIES TO SM All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC AUTOANTIBODIES TO SS-A/RO All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC AUTOANTIBODIES TO SS-B/LA All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC AUTOANTIBODIES TO U1RNP All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC AVULSION OF NAIL PLATE SINGLE All Payors / Plans All Payors / Plans 0761 11730 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 "HC AVULSION OF NAIL PLATE, EA ADDL" All Payors / Plans All Payors / Plans 0761 11732 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 "HC B CELLS, TOTAL COUNT" All Payors / Plans All Payors / Plans 0300 86355 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC B TYPE NATURIURETIC PEPTIDE All Payors / Plans All Payors / Plans 0301 83880 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC B-12 (B12) All Payors / Plans All Payors / Plans 0301 82607 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC BACTERIAL ANTIGEN DETECT (BAAG) All Payors / Plans All Payors / Plans 0300 86403 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC BACTERIAL IDENTIFICATION X 1 All Payors / Plans All Payors / Plans 0306 87077 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC BACTERIUM, ANTIBODY" All Payors / Plans All Payors / Plans 0300 86609 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC BARBITURATE CONFIRMATION URINE All Payors / Plans All Payors / Plans 0300 80345 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC BARIUM ENEMA SINGLE CONTRAST W SCOUT/DELAYED IMAGES All Payors / Plans All Payors / Plans 0320 74270 $832.00 $832.00 $832.00 $832.00 $832.00 $832.00 $832.00 $815.36 $815.36 HC BARIUM ENEMA W/AIR DOUBELE CONTRAST W SCOUT/DELAYED IMAGES All Payors / Plans All Payors / Plans 0320 74280 " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,172.08 " " $1,172.08 " HC BARTONELLA AB PANEL All Payors / Plans All Payors / Plans 0300 86611 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC BASIC DOSIMETRY CALC All Payors / Plans All Payors / Plans 0333 77300 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $108.78 $108.78 HC BCR ABL P190 MRNA QUANT All Payors / Plans All Payors / Plans 0300 81207 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC BCR ABL P210 MRNA QUANT All Payors / Plans All Payors / Plans 0300 81206 $403.00 $403.00 $403.00 $403.00 $403.00 $403.00 $403.00 $394.94 $394.94 HC BCR ABL TRANSLOCATION ANALY OTH All Payors / Plans All Payors / Plans 0300 81208 $490.00 $490.00 $490.00 $490.00 $490.00 $490.00 $490.00 $480.20 $480.20 "HC BCR/ABL, RNA, OTHER, QUAL, DIAGNOSTIC" All Payors / Plans All Payors / Plans 0300 81208 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 "HC BCR/ABL, RNA,QUAL, DIAGNOSTIC" All Payors / Plans All Payors / Plans 0300 81206 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 "HC BCR/ABL,RNA, QUAL MINOR QUAL, DIAGNOSTIC" All Payors / Plans All Payors / Plans 0300 81207 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $100.94 $100.94 HC BD CAD MAMMOGRAM DIAG UNILATERAL All Payors / Plans All Payors / Plans 0401 77065 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $50.96 $50.96 HC BD CAD MAMMOGRAM SCREENING BILAT All Payors / Plans All Payors / Plans 0403 77067 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $713.44 $713.44 HC BD CAD MAOMMOGRAM DIAGNOSTIC BILATERAL All Payors / Plans All Payors / Plans 0401 77066 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $866.32 $866.32 HC BD MAMMO DIA DIGITAL WO CAD BILAT All Payors / Plans All Payors / Plans 0401 77066 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $866.32 $866.32 HC BD MAMMO DIAG DIGITAL BILATERAL All Payors / Plans All Payors / Plans 0401 77066 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $866.32 $866.32 HC BD MAMMO DIAG DIGITAL LT All Payors / Plans All Payors / Plans 0401 77065 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $662.48 $662.48 HC BD MAMMO DIAG DIGITAL RT All Payors / Plans All Payors / Plans 0401 77065 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $662.48 $662.48 HC BD MAMMO DIAG DIGITAL WO CAD RT All Payors / Plans All Payors / Plans 0401 77065 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $662.48 $662.48 HC BD MAMMO DIGITAL W/O CAD LT All Payors / Plans All Payors / Plans 0401 77065 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $662.48 $662.48 HC BD MAMMO LOCALIZATION EA ADDL All Payors / Plans All Payors / Plans 0401 19282 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC BD MAMMO SCREEN DIGITAL All Payors / Plans All Payors / Plans 0403 77067 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $713.44 $713.44 HC BD MRI BREAST BILATERAL NO CONTRAST All Payors / Plans All Payors / Plans 0610 77047 " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,290.66 " " $1,290.66 " HC BD MRI BREAST BILATERAL W/WO CONTRAST All Payors / Plans All Payors / Plans 0610 77049 " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,317.00 " " $1,290.66 " " $1,290.66 " HC BD MRI BREAST BIOPSY All Payors / Plans All Payors / Plans 0610 19085 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $150.92 $150.92 HC BD MRI BREAST BIOPSY EA ADDL All Payors / Plans All Payors / Plans 0610 19086 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $150.92 $150.92 HC BD MRI BREAST UNILATERAL NO CONTRAST All Payors / Plans All Payors / Plans 0610 77046 " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,300.46 " " $1,300.46 " HC BD MRI BREAST UNILATERAL W/WO CONTRAST All Payors / Plans All Payors / Plans 0610 77048 " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,327.00 " " $1,300.46 " " $1,300.46 " HC BD US BREAST BIOPSY 1ST LESION All Payors / Plans All Payors / Plans 0402 19083 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC BD US BREAST UNI LIMITED FOCUS All Payors / Plans All Payors / Plans 0402 76642 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC BD US NEEDLE BREAST GUIDE 1ST All Payors / Plans All Payors / Plans 0402 19285 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC BENZODIAZEPINE URINE SCREEN All Payors / Plans All Payors / Plans 0300 80307 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 "HC BENZODIAZEPINES CONFIRMATION, RANDOM, URINE" All Payors / Plans All Payors / Plans 0300 80347 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $44.10 $44.10 HC BENZODIAZIPINE CONFIRMATION URINE All Payors / Plans All Payors / Plans 0301 80346 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 HC BETA 2 GLYCOPROTEIN 1 ANTIBODY EACH All Payors / Plans All Payors / Plans 0306 86146 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC BETA 2 MICROGLOBULIN (B2M) All Payors / Plans All Payors / Plans 0300 82232 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC BETA CAROTENE All Payors / Plans All Payors / Plans 0300 82380 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC BETA HYDROXYBUTYRATE (BHOB) All Payors / Plans All Payors / Plans 0300 82010 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 HC BILICHECK TRANSCUTANEOUS - EACH TIME All Payors / Plans All Payors / Plans 0301 88720 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC BILIRUBIN TOTAL All Payors / Plans All Payors / Plans 0301 82247 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC BIOFEEDBACK TRAINING 23-37 MIN All Payors / Plans All Payors / Plans 0420 90911 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $244.02 $244.02 HC BIOFEEDBACK TRAINING 38-52 MIN All Payors / Plans All Payors / Plans 0420 90911 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $366.52 $366.52 HC BIOFEEDBACK TRAINING 53-67 MIN All Payors / Plans All Payors / Plans 0420 90911 $498.00 $498.00 $498.00 $498.00 $498.00 $498.00 $498.00 $488.04 $488.04 HC BIOFEEDBACK TRAINING 68-82 MIN All Payors / Plans All Payors / Plans 0420 90911 $623.00 $623.00 $623.00 $623.00 $623.00 $623.00 $623.00 $610.54 $610.54 HC BIOFEEDBACK TRAINING 8-22 MIN All Payors / Plans All Payors / Plans 0420 90911 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC BIOPHYS PROFILE W/ NON STRESS All Payors / Plans All Payors / Plans 0402 76819 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $356.72 $356.72 HC BIPAP/CPAP All Payors / Plans All Payors / Plans 0410 94660 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $459.62 $459.62 HC BLADDER INSTILLATION ANTICARCIN All Payors / Plans All Payors / Plans 0361 51720 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 "HC BLEEDING DIATH PROF, LIMITED" All Payors / Plans All Payors / Plans 0300 85246 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $661.50 $661.50 HC BLOOD & URINE ALCOHOL All Payors / Plans All Payors / Plans 0300 80320 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC BLOOD ALCOHOL (ALCO) All Payors / Plans All Payors / Plans 0301 80320 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC BLOOD COUNT, MANUAL EXAM W/O DIFF" All Payors / Plans All Payors / Plans 0300 85008 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 HC BLOOD CULTURE GRAM NEGATIVE All Payors / Plans All Payors / Plans 0300 87149 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC BLOOD CULTURE GRAM NEGATIVE 6 All Payors / Plans All Payors / Plans 0300 87149 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC BLOOD CULTURE GRAM NEGATIVE 7 All Payors / Plans All Payors / Plans 0300 87149 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $429.24 $429.24 HC BLOOD CULTURE GRAM POSITIVE All Payors / Plans All Payors / Plans 0300 87149 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC BLOOD CULTURE GRAM POSITIVE 1 All Payors / Plans All Payors / Plans 0300 87149 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC BLOOD CULTURE GRAM POSITIVE 11 All Payors / Plans All Payors / Plans 0300 87149 $688.00 $688.00 $688.00 $688.00 $688.00 $688.00 $688.00 $674.24 $674.24 HC BLOOD CULTURE GRAM POSITIVE 2 All Payors / Plans All Payors / Plans 0300 87149 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC BLOOD GLUCOSE CHECK All Payors / Plans All Payors / Plans 0300 82962 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC BLOOD TYPING RH (D) All Payors / Plans All Payors / Plans 0300 86901 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 "HC BLOOD TYPING, ABO" All Payors / Plans All Payors / Plans 0300 86900 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 "HC BLOOD, OCCULT, QUAL, FECES, SINGLE SPECIMEN" All Payors / Plans All Payors / Plans 0301 82272 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC BODY FLUID SMEAR AND CULTURE All Payors / Plans All Payors / Plans 0300 87070 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC BODY PLETHYSMOGRAPHY All Payors / Plans All Payors / Plans 0921 94726 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $181.30 $181.30 HC BONE AGE SURVEY All Payors / Plans All Payors / Plans 0320 77072 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $101.92 $101.92 "HC BONE BIOPSY-DEEP BONE HUMERUS,ISCHIUM,FEMUR" All Payors / Plans All Payors / Plans 0761 20245 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $143.08 $143.08 "HC BONE BIOSPY-SUPERFICIAL RIBS, ILIUM, STERNUM,SPINOUS" All Payors / Plans All Payors / Plans 0761 20240 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC BONE MARROW SMEAR All Payors / Plans All Payors / Plans 0300 85540 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC BONE MARROW/ASPIRATION All Payors / Plans All Payors / Plans 0761 38221 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC BONE SCAN-LIMITED All Payors / Plans All Payors / Plans 0341 78300 $729.00 $729.00 $729.00 $729.00 $729.00 $729.00 $729.00 $714.42 $714.42 HC BONE SCAN-WHOLE BODY All Payors / Plans All Payors / Plans 0340 78306 " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " $989.80 $989.80 HC BONE SPECT All Payors / Plans All Payors / Plans 0340 78803 " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,379.84 " " $1,379.84 " HC BONE SURVEY COMPLETE All Payors / Plans All Payors / Plans 0320 77075 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC BONE SURVEY JOINT 2 OR MORE All Payors / Plans All Payors / Plans 0320 77077 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC BORDATELLA All Payors / Plans All Payors / Plans 0300 86615 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC BORDETELLA PERTUSSIS CULT (BPEC) All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC BORRELIA BURGDORFERI(LYME DISEASE) All Payors / Plans All Payors / Plans 0300 86618 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC BORRELIA BURGDORFERI, AMPLIFIED PROBE TECHNIQUE" All Payors / Plans All Payors / Plans 0300 87476 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC BOWEL SCAN-MECKELS All Payors / Plans All Payors / Plans 0340 78290 " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,412.18 " " $1,412.18 " HC BRACHY THERAPY DOS-COMP All Payors / Plans All Payors / Plans 0333 77318 $688.00 $688.00 $688.00 $688.00 $688.00 $688.00 $688.00 $674.24 $674.24 HC BRACHY THERAPY DOS-INT All Payors / Plans All Payors / Plans 0333 77317 $503.00 $503.00 $503.00 $503.00 $503.00 $503.00 $503.00 $492.94 $492.94 HC BRACHY THERAPY DOS-SIMPLE All Payors / Plans All Payors / Plans 0333 77316 $393.00 $393.00 $393.00 $393.00 $393.00 $393.00 $393.00 $385.14 $385.14 HC BRACHY TREATMENT HANDLING-LOAD All Payors / Plans All Payors / Plans 0333 77790 $147.00 $147.00 $147.00 $147.00 $147.00 $147.00 $147.00 $144.06 $144.06 HC BRAF ANALYSIS All Payors / Plans All Payors / Plans 0300 81210 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 HC BRAF MUTATION ANAL (OTH SOLID TUM All Payors / Plans All Payors / Plans 0310 81210 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC BRAF MUTATION ANALYSIS (MELANOMA) All Payors / Plans All Payors / Plans 0310 81210 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $318.50 $318.50 "HC BRAF, GENE ALALYSIS, V60E VARIANT" All Payors / Plans All Payors / Plans 0310 81210 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC BRAIN SCAN <4 VIEWS W VASC FLOW All Payors / Plans All Payors / Plans 0340 78601 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $892.78 $892.78 HC BRAIN SCAN W VASCULAR FLOW All Payors / Plans All Payors / Plans 0340 78606 " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,412.18 " " $1,412.18 " HC BRAIN SPECT All Payors / Plans All Payors / Plans 0340 78803 " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,379.84 " " $1,379.84 " HC BRAVO STUDY-ELECTRODE PH All Payors / Plans All Payors / Plans 0750 91035 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC BRCA 1/2 MUTATION ANALYSIS FOR TUMORS All Payors / Plans All Payors / Plans 0310 81163 " $3,113.00 " " $3,113.00 " " $3,113.00 " " $3,113.00 " " $3,113.00 " " $3,113.00 " " $3,113.00 " " $3,050.74 " " $3,050.74 " HC BRCA1/BRCA2 GENE ANALYSIS All Payors / Plans All Payors / Plans 0300 81162 " $2,125.00 " " $2,125.00 " " $2,125.00 " " $2,125.00 " " $2,125.00 " " $2,125.00 " " $2,125.00 " " $2,082.50 " " $2,082.50 " HC BREAST SURGICAL SPECIMEN (2) All Payors / Plans All Payors / Plans 0401 76098 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $50.96 $50.96 HC BRONCHIAL CHALLENGE All Payors / Plans All Payors / Plans 0460 94070 $818.00 $818.00 $818.00 $818.00 $818.00 $818.00 $818.00 $801.64 $801.64 HC BRUCELLA AGGLUTINATION All Payors / Plans All Payors / Plans 0300 86622 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC BUN (BUN) All Payors / Plans All Payors / Plans 0301 84520 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC BUPRENOR & NORBUPRENOR URINE All Payors / Plans All Payors / Plans 0300 80348 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC BUPRENORPHINE, URINE" All Payors / Plans All Payors / Plans 0300 80307 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC C/T ABD/PELVIS UROGRAM W&W/O All Payors / Plans All Payors / Plans 0352 74178 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $328.30 $328.30 HC C/T-3D/MULTIPLANAR RECONSTRUCTION All Payors / Plans All Payors / Plans 0352 76377 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $661.50 $661.50 HC C/T-ABDOMEN W CONTRAST All Payors / Plans All Payors / Plans 0352 74160 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC C/T-ABDOMEN W/WO CONTRAST All Payors / Plans All Payors / Plans 0352 74170 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $249.90 $249.90 HC C/T-C SPINE W CONTRAST All Payors / Plans All Payors / Plans 0352 72126 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC C/T-C SPINE W/O CONTRAST All Payors / Plans All Payors / Plans 0352 72125 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $171.50 $171.50 HC C/T-C SPINE W/WO CONTRAST All Payors / Plans All Payors / Plans 0352 72127 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $268.52 $268.52 HC C/T-HEAD SCAN W CONTRAST All Payors / Plans All Payors / Plans 0351 70460 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $139.16 $139.16 HC C/T-HEAD SCAN W/WO CONTRAST All Payors / Plans All Payors / Plans 0351 70470 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC C/T-L SPINE W CONTRAST All Payors / Plans All Payors / Plans 0352 72132 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC C/T-L SPINE W/O CONTRAST All Payors / Plans All Payors / Plans 0352 72131 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC C/T-L SPINE W/WO CONTRAST All Payors / Plans All Payors / Plans 0352 72133 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $268.52 $268.52 HC C/T-MAXILLOFACIAL W CONTRAST All Payors / Plans All Payors / Plans 0351 70487 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $143.08 $143.08 HC C/T-MAXILLOFACIAL W/WO CONTRAS All Payors / Plans All Payors / Plans 0351 70488 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $185.22 $185.22 HC C/T-MAXILLOFACIAL WO CONTRAST All Payors / Plans All Payors / Plans 0351 70486 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $124.46 $124.46 HC C/T-NECK SCAN W CONTRAST All Payors / Plans All Payors / Plans 0351 70491 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC C/T-NECK SCAN W/O CONTRAST All Payors / Plans All Payors / Plans 0351 70490 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC C/T-NECK SCAN W/WO CONTRAST All Payors / Plans All Payors / Plans 0351 70492 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $268.52 $268.52 HC C/T-PELVIS SCAN W CONTRAST All Payors / Plans All Payors / Plans 0352 72193 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC C/T-PELVIS SCAN W/WO CONTRAST All Payors / Plans All Payors / Plans 0352 72194 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $258.72 $258.72 HC C/T-T SPINE W CONTRAST All Payors / Plans All Payors / Plans 0352 72129 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC C/T-T SPINE W/O CONTRAST All Payors / Plans All Payors / Plans 0352 72128 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC C/T-T SPINE W/WO CONTRAST All Payors / Plans All Payors / Plans 0352 72130 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $268.52 $268.52 HC C/T-THORAX SCAN W CONTRAST All Payors / Plans All Payors / Plans 0352 71260 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC C/T-THORAX W/WO CONTRAST All Payors / Plans All Payors / Plans 0352 71270 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $268.52 $268.52 HC C-1 ESTERASE INHIBITOR (C1EST) All Payors / Plans All Payors / Plans 0300 83520 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC C1Q IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC C1Q PARAFFIN IMMUNOFLUO STAIN All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC C3 IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC CA 125 AG (C125) All Payors / Plans All Payors / Plans 0300 86304 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC CA 199 (CA199) All Payors / Plans All Payors / Plans 0300 86301 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 "HC CA OXALATE, URINE (OXU)" All Payors / Plans All Payors / Plans 0300 83945 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CAFFEINE (CAF) All Payors / Plans All Payors / Plans 0300 80155 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CALCITONIN (CALTN) All Payors / Plans All Payors / Plans 0300 82308 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC CALCIUM IONIZED All Payors / Plans All Payors / Plans 0300 82330 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CALCIUM RANDOM URINE All Payors / Plans All Payors / Plans 0301 82340 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC CALCIUM TOTAL All Payors / Plans All Payors / Plans 0301 82310 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 "HC CALPROTECTIN, FECAL" All Payors / Plans All Payors / Plans 0301 83993 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $257.74 $257.74 "HC CALR MUTATION ANAL, MYELOPROLIFERATIVE NEOPLASM, REFLEX" All Payors / Plans All Payors / Plans 0300 81219 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 "HC CALR MUTATION ANALYSIS, MYELOPROLIFERATIVE NEOPLASM" All Payors / Plans All Payors / Plans 0300 81219 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 HC CAMPY PLATE All Payors / Plans All Payors / Plans 0300 87046 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC CANALITH REPOSITIONING PROC All Payors / Plans All Payors / Plans 0420 95992 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $69.58 $69.58 HC CANDIDA SPECIES AMPLIFIED PROBE All Payors / Plans All Payors / Plans 0300 87481 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC CANNABINOID (THC) CONF.,MECONIUM" All Payors / Plans All Payors / Plans 0300 80349 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC CANNABINOIDS SCREEN All Payors / Plans All Payors / Plans 0300 80307 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC CARBAMAZEPINE (TEG) All Payors / Plans All Payors / Plans 0301 80156 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CARDIAC DOPPLER All Payors / Plans All Payors / Plans 0480 93320 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $31.36 $31.36 HC CARDIAC DOPPLER FOLLOW-UP All Payors / Plans All Payors / Plans 0480 93321 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $25.48 $25.48 HC CARDIAC EVENT RECORDER HOOK-UP All Payors / Plans All Payors / Plans 0730 93270 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $31.36 $31.36 HC CARDIAC REHAB THERAPY All Payors / Plans All Payors / Plans 0943 93798 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC CARDIAC REHAB THERAPY >36 All Payors / Plans All Payors / Plans 0943 93798 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 "HC CARDIOLIPIN ANTIBODY, EA IG CLASS" All Payors / Plans All Payors / Plans 0302 86147 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CARDIOVASCULAR STRESS TEST All Payors / Plans All Payors / Plans 0482 93017 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 "HC CARNITINE(TOTAL AND FREE) QUANT., EACH SPEC" All Payors / Plans All Payors / Plans 0300 82379 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC CATECHOLAMINES FRACT. All Payors / Plans All Payors / Plans 0300 82384 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC CATH AND INTRO OF SALINE CONTRAST All Payors / Plans All Payors / Plans 0402 58340 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC CBC (CBC) All Payors / Plans All Payors / Plans 0305 85027 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC CBC W/DIFF (CBCD) All Payors / Plans All Payors / Plans 0305 85025 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC CEA (CEAM) All Payors / Plans All Payors / Plans 0300 82378 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC CELIAC DISEASE COMP CASCADE All Payors / Plans All Payors / Plans 0300 86816 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $318.50 $318.50 HC CELIAC DISEASE GLUTEN-FREE CASCADE All Payors / Plans All Payors / Plans 0300 81376 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC CELIAC DISEASE SEROLOGY CASCADE All Payors / Plans All Payors / Plans 0300 82784 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CENTROMERE ANTIBODY (CMA) All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC CEREBROSPINAL FLUID FLOW All Payors / Plans All Payors / Plans 0340 78630 " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,444.52 " " $1,444.52 " HC CERULOPLASMIN (CERMN) All Payors / Plans All Payors / Plans 0301 82390 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CERVICAL ESOPHAGUS W SCOUT/DELAYED W CONTRAST All Payors / Plans All Payors / Plans 0320 74210 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC CERVICAL MYELOGRAM All Payors / Plans All Payors / Plans 0361 62302 " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,822.00 " " $3,822.00 " HC CHECKOUT ORTHO/PROTH EST PT 15 MI All Payors / Plans All Payors / Plans 0420 97763 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC CHEM8(BASIC METABOLIC) All Payors / Plans All Payors / Plans 0301 80048 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $27.44 $27.44 HC CHEMICAL CAUTERIZATION All Payors / Plans All Payors / Plans 0761 17250 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $273.42 $273.42 HC CHEMILUMINESCENT ASSAY All Payors / Plans All Payors / Plans 0300 82397 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CHEMO ADMIN BY INFUS EA ADD 1HR All Payors / Plans All Payors / Plans 0335 96415 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC CHEMO ADMIN BY INFUSE EA ADDL SEQ All Payors / Plans All Payors / Plans 0335 96417 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $30.38 $30.38 HC CHEMO ADMIN BY INFUSE PROL W PUMP All Payors / Plans All Payors / Plans 0335 96416 $558.00 $558.00 $558.00 $558.00 $558.00 $558.00 $558.00 $546.84 $546.84 HC CHEMO ADMIN BY INFUSION 0-1 HR All Payors / Plans All Payors / Plans 0335 96413 $558.00 $558.00 $558.00 $558.00 $558.00 $558.00 $558.00 $546.84 $546.84 HC CHEMO ADMIN IV PUSH-EACH ADD DRUG All Payors / Plans All Payors / Plans 0331 96411 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC CHEMO ADMIN IV PUSH-SINGL/INITIAL All Payors / Plans All Payors / Plans 0331 96409 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $303.80 $303.80 HC CHEMO SUBQ/INTRA HOR ANTI NEO All Payors / Plans All Payors / Plans 0331 96402 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $212.66 $212.66 "HC CHEMO,SUBQ/INTRA NON HOR ANTI NEO" All Payors / Plans All Payors / Plans 0331 96401 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $212.66 $212.66 HC CHEST All Payors / Plans All Payors / Plans 0402 76604 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC CHEST & OBLIQUES All Payors / Plans All Payors / Plans 0324 71022 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC CHEST 2 VIEWS All Payors / Plans All Payors / Plans 0320 71046 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC CHEST SINGLE AP VIEW All Payors / Plans All Payors / Plans 0320 71045 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $101.92 $101.92 HC CHEST-DECUBITUS All Payors / Plans All Payors / Plans 0320 71048 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC CHG ALPHA-1-ANTITRYPSIN, PHENO" All Payors / Plans All Payors / Plans 0301 82104 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 "HC CHG ANTITHROMBIN II TEST, ACTIV" All Payors / Plans All Payors / Plans 0305 85300 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC CHG ASSAY OF ALPOLIPOPROTEIN All Payors / Plans All Payors / Plans 0300 82172 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CHG ASSAY OF ASCORBIC ACID All Payors / Plans All Payors / Plans 0300 82180 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC CHG ASSAY OF CADMIUM All Payors / Plans All Payors / Plans 0300 82300 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC CHG ASSAY OF PROCAINAMIDE W METABOLITES All Payors / Plans All Payors / Plans 0300 80192 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CHG ASSAY OF VASOPRESSIN All Payors / Plans All Payors / Plans 0300 84588 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC CHG CELL CRYOPRESERVE/STORAGE All Payors / Plans All Payors / Plans 0300 88240 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC CHG CLOT INHIB PROTEIN C, ACTIV" All Payors / Plans All Payors / Plans 0305 85303 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC CHG FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS All Payors / Plans All Payors / Plans 0300 81508 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC CHG FUNGUS, ANTIBODY" All Payors / Plans All Payors / Plans 0300 86671 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC CHG LIPOPROTEIN, BLOOD,BY NMR SPECT" All Payors / Plans All Payors / Plans 0300 83704 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC CHG NEUTRALIZATION TEST, VIRAL" All Payors / Plans All Payors / Plans 0300 86382 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC CHG SALMONELLA All Payors / Plans All Payors / Plans 0300 86768 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC CHG TISSUE CULTURE, PLACENTA" All Payors / Plans All Payors / Plans 0300 88235 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 "HC CHG TOXOPLASMA, IGM" All Payors / Plans All Payors / Plans 0300 86778 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC CHLAMYDIA PNEUMONIAE, DNA, AMP PROBE" All Payors / Plans All Payors / Plans 0300 87486 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC CHLAMYDIA SEROLOGY All Payors / Plans All Payors / Plans 0300 86631 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE" All Payors / Plans All Payors / Plans 0306 87491 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC CHLORIDE BLOOD All Payors / Plans All Payors / Plans 0300 82435 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC CHLORIDE URINE All Payors / Plans All Payors / Plans 0301 82436 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC CHLORIDE, OTHER SOURCE" All Payors / Plans All Payors / Plans 0300 82438 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC CHOLESTEROL (CHOL) All Payors / Plans All Payors / Plans 0301 82465 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 "HC CHOLINESTERASE, SERUM" All Payors / Plans All Payors / Plans 0300 82480 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CHROMIUM All Payors / Plans All Payors / Plans 0301 82495 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC CHROMOGENIC SUBSTRATE ASSAY All Payors / Plans All Payors / Plans 0300 85130 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC CHROMOGRANIN A All Payors / Plans All Payors / Plans 0300 86316 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 "HC CHROMOSOMAL MICROARRAY,AUTOPSY, PROD CONCEPTION,STILLBIRTH" All Payors / Plans All Payors / Plans 0300 81229 " $1,625.00 " " $1,625.00 " " $1,625.00 " " $1,625.00 " " $1,625.00 " " $1,625.00 " " $1,625.00 " " $1,592.50 " " $1,592.50 " "HC CHROMOSOME ANAL, IN SITU FOR AMN FLUID 6-12 COLONIES" All Payors / Plans All Payors / Plans 0300 88269 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 "HC CHROMOSOME ANAL,AMN FL OR CHORION VIL,15 CELLS" All Payors / Plans All Payors / Plans 0300 88267 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC CHROMOSOME ANALYSIS 20-25 CELLS All Payors / Plans All Payors / Plans 0300 88264 " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " $980.00 $980.00 HC CIRCUMCISION All Payors / Plans All Payors / Plans 0723 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC CL CARDIAC CATH MINUTES All Payors / Plans All Payors / Plans 0481 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC CL DIFFICILE LATEX TEST (CDT) All Payors / Plans All Payors / Plans 0300 87324 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC CLAVICLE All Payors / Plans All Payors / Plans 0320 73000 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC CLO TEST (CLO) All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CLOMIPRAMINE (CLOM) All Payors / Plans All Payors / Plans 0300 80299 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC CLONAZEPAM LEVEL All Payors / Plans All Payors / Plans 0300 80346 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $42.14 $42.14 HC CLONOPIN (CLNN) All Payors / Plans All Payors / Plans 0300 80346 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $42.14 $42.14 HC CLOSTRIDIUM DIFFICILE PCR(CDTPCR) All Payors / Plans All Payors / Plans 0300 87798 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC CLOSURE SURGICAL WOUND, EXTESIVE/COMPLICATED" All Payors / Plans All Payors / Plans 0761 13160 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $357.70 $357.70 HC CLOZAPINE All Payors / Plans All Payors / Plans 0300 80159 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC CMV BY RAPID PCR (CMVPCR) All Payors / Plans All Payors / Plans 0300 87496 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC CMV, QUANT, PCR, PLASMA" All Payors / Plans All Payors / Plans 0306 87497 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 HC CNS SHUNT EVALUATION All Payors / Plans All Payors / Plans 0340 78645 " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,412.18 " " $1,412.18 " HC CO2 (CO2) All Payors / Plans All Payors / Plans 0300 82374 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC COAG FACTOR II ASSAY (F2ASY) All Payors / Plans All Payors / Plans 0300 85210 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COAG FACTOR IX ASSAY (F9ASY) All Payors / Plans All Payors / Plans 0300 85250 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COAG FACTOR V ASSAY (F5ASY) All Payors / Plans All Payors / Plans 0300 85220 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COAG FACTOR VII ASSAY (F7ASY) All Payors / Plans All Payors / Plans 0300 85230 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COAG FACTOR X ASSAY (F10ASY) All Payors / Plans All Payors / Plans 0300 85260 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COAG FACTOR XI ASSAY(F11ASY) All Payors / Plans All Payors / Plans 0300 85270 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COAG FACTOR XII ASSAY (F12ASY) All Payors / Plans All Payors / Plans 0300 85280 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COCAINE CONFIRMATION URINE All Payors / Plans All Payors / Plans 0300 80353 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 "HC COCAINE CONFIRMATION, MECONIUM" All Payors / Plans All Payors / Plans 0300 80353 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC COCAINE METABOLITE URINE SCREEN All Payors / Plans All Payors / Plans 0300 80307 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 "HC COLD AGGLUTININ, TITER" All Payors / Plans All Payors / Plans 0300 86157 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $63.70 $63.70 HC COLL OF BLOOD VENOUS ACCESS DEV All Payors / Plans All Payors / Plans 0510 36591 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $243.04 $243.04 "HC COLLAGEN CROSS LINKS, ANY METHOD" All Payors / Plans All Payors / Plans 0300 82523 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC COLUMN CHROMATOGRAPHY, EACH SPECIMIN" All Payors / Plans All Payors / Plans 0300 82542 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC COMM/WORK REINTEGRATION 15 MIN All Payors / Plans All Payors / Plans 0420 97537 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC COMP METABOLIC PANEL (CMP) All Payors / Plans All Payors / Plans 0301 80053 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC COMPARITIVE ANALYSIS SHORT TANDEM REPEAT All Payors / Plans All Payors / Plans 0300 81265 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $602.70 $602.70 HC COMPLEMENT C3 (C3) All Payors / Plans All Payors / Plans 0300 86160 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC COMPLEMENT C4 (C4) All Payors / Plans All Payors / Plans 0300 86160 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC COMPLEMENT;ANTIGEN EACH COMPONENT All Payors / Plans All Payors / Plans 0302 86160 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC COMPLEMENT-TL (TCMP) All Payors / Plans All Payors / Plans 0300 86162 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC COMPREHENSIVE PATIENT ASSESSMENTS All Payors / Plans All Payors / Plans 0410 94799 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $54.88 $54.88 HC COMPUTER ISODOSE-COMPLEX All Payors / Plans All Payors / Plans 0333 77307 $454.00 $454.00 $454.00 $454.00 $454.00 $454.00 $454.00 $444.92 $444.92 HC COMPUTER ISODOSE-SIMPLE All Payors / Plans All Payors / Plans 0333 77306 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $241.08 $241.08 HC CONCENTRATION(ANY TYPE)INFECTIOUS AGENTS All Payors / Plans All Payors / Plans 0300 87015 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CONCURRENT CHEMO INFUSION All Payors / Plans All Payors / Plans 0335 96549 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $30.38 $30.38 HC CONGENITAL ECHO (2D)/M All Payors / Plans All Payors / Plans 0480 93303 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $141.12 $141.12 HC CONGENITAL ECHO 2D LTD F/U All Payors / Plans All Payors / Plans 0480 93304 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $62.72 $62.72 "HC CONSULT, OUTSIDE SLIDE(COSPC)" All Payors / Plans All Payors / Plans 0300 88321 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $306.74 $306.74 "HC CONSULT, W/COMP RVW OF HIS (CRHPC)" All Payors / Plans All Payors / Plans 0300 88325 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $306.74 $306.74 "HC CONSULT, W/SLIDE PREP(CSPPC)" All Payors / Plans All Payors / Plans 0300 88323 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $306.74 $306.74 HC CONT NEB W/BRONCHODILAT ADDL HR All Payors / Plans All Payors / Plans 0410 94645 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $77.42 $77.42 HC CONT NEB W/BRONCHODILATOR FIRST HR All Payors / Plans All Payors / Plans 0410 94644 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC CONTINOUS AEROSOL RX INITIAL DAY All Payors / Plans All Payors / Plans 0410 94799 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC CONTINOUS AEROSOL RX SUBSEQ DAY All Payors / Plans All Payors / Plans 0410 94799 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 "HC CONTROLLED SUBSTANCE MONITORING PANEL, URINE" All Payors / Plans All Payors / Plans 0300 80307 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $78.40 $78.40 HC COPPER All Payors / Plans All Payors / Plans 0301 82525 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC CORTISOL FREE All Payors / Plans All Payors / Plans 0301 82530 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC CORTISOL TOTAL All Payors / Plans All Payors / Plans 0301 82533 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC COVERSITE 4X4 PLUS All Payors / Plans All Payors / Plans $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.08 $1.08 HC COVERSITE PLUS 6X6 All Payors / Plans All Payors / Plans $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.76 $1.76 HC CPAP All Payors / Plans All Payors / Plans 0410 94660 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $330.26 $330.26 HC CPAP SET-UP AND MANAGEMENT All Payors / Plans All Payors / Plans 0460 94660 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $286.16 $286.16 HC C-PEPTIDE (CPEP) All Payors / Plans All Payors / Plans 0301 84681 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CPK (CPK) All Payors / Plans All Payors / Plans 0301 82550 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC CPK-MB (CKMB) All Payors / Plans All Payors / Plans 0301 82553 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CPR All Payors / Plans All Payors / Plans 0410 92950 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC CPT&POSTUAL DRAIN INITIAL RX 2POS All Payors / Plans All Payors / Plans 0410 94667 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC CPT&POSTUAL DRAIN INITIAL RX 4POS All Payors / Plans All Payors / Plans 0410 94667 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC CPT&POSTUAL DRAIN SUBSEQ RX 2 POS All Payors / Plans All Payors / Plans 0410 94668 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC CPT&POSTUAL DRAIN SUBSEQ RX 4 POS All Payors / Plans All Payors / Plans 0410 94668 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 "HC CQ ESTERASE INHIBITOR,FUNCTIONAL" All Payors / Plans All Payors / Plans 0300 83520 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CRE SCREEN All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC C-REACTIVE PROTEIN, INFLAMMATORY" All Payors / Plans All Payors / Plans 0302 86140 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CREAT CLEAR 24 HR (CRCL) All Payors / Plans All Payors / Plans 0301 82575 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC CREATININE BLOOD All Payors / Plans All Payors / Plans 0301 82565 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC CREATININE OTHER SOURCE All Payors / Plans All Payors / Plans 0301 82570 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC CROSSMATCH (XM) All Payors / Plans All Payors / Plans 0300 86923 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC CRYOGLOBULIN (CRY) All Payors / Plans All Payors / Plans 0300 82595 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $34.30 $34.30 HC CRYOPRECIPITATE PROCESSING FEE All Payors / Plans All Payors / Plans 0390 P9012 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $343.00 $343.00 HC CRYPTOCOCCAL ANTIGEN (CRAG) All Payors / Plans All Payors / Plans 0300 86403 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CRYPTOCOCCAL ANTIGEN SER. (SCRAG) All Payors / Plans All Payors / Plans 0300 86403 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC CRYPTOSPORDIUM All Payors / Plans All Payors / Plans 0300 87272 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC CSF LEAK All Payors / Plans All Payors / Plans 0340 78650 " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,457.00 " " $1,427.86 " " $1,427.86 " "HC CSF, ROUTINE ANALYSIS (SPFR)" All Payors / Plans All Payors / Plans 0300 89050 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $83.30 $83.30 HC CSF. NEUROLOGIGAL PROF. (SPFN) All Payors / Plans All Payors / Plans 0300 83916 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $347.90 $347.90 HC CT ABD AND PELVIS 1+ SECTION/REG All Payors / Plans All Payors / Plans 0352 74178 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $328.30 $328.30 HC CT ABD AND PELVIS W CONTRAST All Payors / Plans All Payors / Plans 0352 74177 $293.00 $293.00 $293.00 $293.00 $293.00 $293.00 $293.00 $287.14 $287.14 HC CT ABD AND PELVIS W/O CONTRAST All Payors / Plans All Payors / Plans 0352 74176 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $147.98 $147.98 HC CT ABDOMEN W/O CONTRAST All Payors / Plans All Payors / Plans 0352 74150 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $115.64 $115.64 HC CT BONE DENSITY AXIAL 1 OR > SITE All Payors / Plans All Payors / Plans 0352 77078 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $134.26 $134.26 HC CT CTA HEARTCARD STRU MORPH CONGE All Payors / Plans All Payors / Plans 0352 75573 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $342.02 $342.02 HC CT GU SOFT TIS LOC DEVICE 1ST LESION All Payors / Plans All Payors / Plans 0352 10035 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $161.70 $161.70 HC CT GU SOFT TIS LOC DEVICE EA ADD LESION All Payors / Plans All Payors / Plans 0352 10036 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $92.12 $92.12 HC CT GUID CRYOBLATION BONE TUMOR All Payors / Plans All Payors / Plans 0352 20983 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $185.22 $185.22 HC CT GUID CRYOBLATION LIVER TUMOR All Payors / Plans All Payors / Plans 0352 47383 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $185.22 $185.22 HC CT GUID RFREQ BONE TUMOR SFT TISS All Payors / Plans All Payors / Plans 0352 20982 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $185.22 $185.22 HC CT GUIDANCE TISSUE ABLATION All Payors / Plans All Payors / Plans 0352 77013 " $2,550.00 " " $2,550.00 " " $2,550.00 " " $2,550.00 " " $2,550.00 " " $2,550.00 " " $2,550.00 " " $2,499.00 " " $2,499.00 " HC CT GUIDE CATH DRAIN VISCERAL All Payors / Plans All Payors / Plans 0352 49405 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $161.70 $161.70 HC CT GUIDE CATH PERITON RETROPER All Payors / Plans All Payors / Plans 0352 49406 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $161.70 $161.70 HC CT GUIDE CTH PER RETROP TRANSRECT All Payors / Plans All Payors / Plans 0352 49407 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $161.70 $161.70 "HC CT GUIDE DRAIN CATH ABD WALL,NECK" All Payors / Plans All Payors / Plans 0352 10030 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $161.70 $161.70 HC CT GUIDED NEEDLE BIOPSY All Payors / Plans All Payors / Plans 0352 77012 " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,249.50 " " $1,249.50 " HC CT GUIDED TUBE PLACEMENT All Payors / Plans All Payors / Plans 0352 75989 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $808.50 $808.50 HC CT HEAD W/O CONTRAST All Payors / Plans All Payors / Plans 0351 70450 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $97.02 $97.02 HC CT HEART WOUT CONTRST CORO CALC All Payors / Plans All Payors / Plans 0352 75571 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $92.12 $92.12 HC CT LOWER EXTR WWO CONTRAST All Payors / Plans All Payors / Plans 0352 73702 $283.00 $283.00 $283.00 $283.00 $283.00 $283.00 $283.00 $277.34 $277.34 HC CT LOWER EXTREM W CONTRAST All Payors / Plans All Payors / Plans 0352 73701 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC CT LOWER EXTREM WO CONTRAST All Payors / Plans All Payors / Plans 0352 73700 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC CT LUNG CANCER SCREENING All Payors / Plans All Payors / Plans 0352 71271 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC CT LUNG NEEDLE BIOPSY All Payors / Plans All Payors / Plans 0361 32408 " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,205.00 " " $2,205.00 " "HC CT ORBIT, SELLA POST FOSSA W CONTRAST" All Payors / Plans All Payors / Plans 0351 70481 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $268.52 $268.52 "HC CT ORBIT, SELLA POST FOSSA W W/O" All Payors / Plans All Payors / Plans 0351 70482 $302.00 $302.00 $302.00 $302.00 $302.00 $302.00 $302.00 $295.96 $295.96 "HC CT ORBIT, SELLA POST FOSSA W/O CONTRAST" All Payors / Plans All Payors / Plans 0351 70480 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC CT PELVIS W/O CONTRAST All Payors / Plans All Payors / Plans 0352 72192 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $120.54 $120.54 HC CT PERFUSION CEREBRAL W CONTRAST All Payors / Plans All Payors / Plans 0352 0042T $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $333.20 $333.20 HC CT SCAN FOR THERAPY GUIDE All Payors / Plans All Payors / Plans 0333 77387 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $241.08 $241.08 HC CT THORAX W/CONTRAST CARDIAC All Payors / Plans All Payors / Plans 0352 71260 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC CT THORAX W/O CONTRAST All Payors / Plans All Payors / Plans 0352 71250 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC CT TMJ (ALSO FOR SELLA) All Payors / Plans All Payors / Plans 0352 70480 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $217.56 $217.56 HC CT UPPER EXTREM W CONTRAST All Payors / Plans All Payors / Plans 0352 73201 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $212.66 $212.66 HC CT UPPER EXTREM WO CONTRAST All Payors / Plans All Payors / Plans 0352 73200 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 HC CT UPPER EXTREM WWO CONTRAST All Payors / Plans All Payors / Plans 0350 73202 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 HC CTA ABD/PEL W CONTRAST All Payors / Plans All Payors / Plans 0352 74174 $368.00 $368.00 $368.00 $368.00 $368.00 $368.00 $368.00 $360.64 $360.64 HC CTA ABDOMEN All Payors / Plans All Payors / Plans 0352 74175 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 HC CTA AORTA W RUNOFF W CONTRST POST All Payors / Plans All Payors / Plans 0350 75635 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $342.02 $342.02 HC CTA CHEST All Payors / Plans All Payors / Plans 0352 71275 $278.00 $278.00 $278.00 $278.00 $278.00 $278.00 $278.00 $272.44 $272.44 HC CTA HEAD All Payors / Plans All Payors / Plans 0352 70496 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $274.00 $268.52 $268.52 HC CTA HEART CARD W CONTRAST All Payors / Plans All Payors / Plans 0352 75574 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $392.98 $392.98 HC CTA HEART W CONTRAST All Payors / Plans All Payors / Plans 0352 75572 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $254.80 $254.80 HC CTA LOWER EXTREMITY All Payors / Plans All Payors / Plans 0352 73706 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC CTA NECK All Payors / Plans All Payors / Plans 0352 70498 $269.00 $269.00 $269.00 $269.00 $269.00 $269.00 $269.00 $263.62 $263.62 HC CTA PELVIS All Payors / Plans All Payors / Plans 0352 72191 $283.00 $283.00 $283.00 $283.00 $283.00 $283.00 $283.00 $277.34 $277.34 HC CTA UPPER EXTREMITY All Payors / Plans All Payors / Plans 0352 73206 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $309.68 $309.68 HC CT-THERAPY PLAN All Payors / Plans All Payors / Plans 0352 77014 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $241.08 $241.08 HC CULT BETA STREP (BETA) All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CULT LOWER G I (STLC) All Payors / Plans All Payors / Plans 0300 87045 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC CULT NASO (NASO) All Payors / Plans All Payors / Plans 0300 87070 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC CULT THROAT (THRC) All Payors / Plans All Payors / Plans 0300 87070 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC CULT URINE (URNC) All Payors / Plans All Payors / Plans 0300 87086 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CULTURE BLOOD (BLC) All Payors / Plans All Payors / Plans 0306 87040 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 "HC CULTURE MYCOBACTERIAL, DEFINITIVE ID, EA ISOLATE" All Payors / Plans All Payors / Plans 0300 87118 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $186.20 $186.20 "HC CULTURE REFER FOR ID, FUNGUS&CULTURE ID (FUNID(DSF)" All Payors / Plans All Payors / Plans 0300 87153 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 "HC CULTURE TYPING, ID NUCLEIC ACID(DNA OR RNA)PROBE" All Payors / Plans All Payors / Plans 0300 87150 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC CULTURE TYPING, OTHER METHODS" All Payors / Plans All Payors / Plans 0300 87158 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC CULTURE,BACTERIAL,AEROBIC ISOLATE. ADD ID EA ISOLATE" All Payors / Plans All Payors / Plans 0300 87077 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC CULTURE,BACTERIAL,ANAEROBIC ISOLATE, ADD, ID EA ISOLATE" All Payors / Plans All Payors / Plans 0300 87076 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC CULTURE,FUNGI, DEFINITIVE ID, EA ORGANISM,MOLD" All Payors / Plans All Payors / Plans 0300 87107 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC CULTURE,TUBERCLE,AFB, ANY SOURCE W/ISOL&PRESUMP" All Payors / Plans All Payors / Plans 0300 87116 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC CUTANEOUS IMMUNOFLUORESCE BIOPSY All Payors / Plans All Payors / Plans 0314 88346 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC CYCLIC CITRULLINATED PEPTIDE All Payors / Plans All Payors / Plans 0302 86200 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC CYCLOSPORIN (CYCLO) All Payors / Plans All Payors / Plans 0301 80158 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CYSTIC FIB.CARRIER AND DETECTION All Payors / Plans All Payors / Plans 0300 81220 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CYSTOGRAM All Payors / Plans All Payors / Plans 0320 74430 " $3,825.00 " " $3,825.00 " " $3,825.00 " " $3,825.00 " " $3,825.00 " " $3,825.00 " " $3,825.00 " " $3,748.50 " " $3,748.50 " HC CYTOGENIC AND MOLECULAR INTERP/ REPORT All Payors / Plans All Payors / Plans 0300 88291 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC CYTOGENOMIC CHROM MICROARRAY CONGEN All Payors / Plans All Payors / Plans 0300 81229 " $1,438.00 " " $1,438.00 " " $1,438.00 " " $1,438.00 " " $1,438.00 " " $1,438.00 " " $1,438.00 " " $1,409.24 " " $1,409.24 " HC CYTOGENOMIC CONSTITUTIONAL MICROARRAY ANAL All Payors / Plans All Payors / Plans 0300 81228 " $1,175.00 " " $1,175.00 " " $1,175.00 " " $1,175.00 " " $1,175.00 " " $1,175.00 " " $1,175.00 " " $1,151.50 " " $1,151.50 " HC CYTOLOGY All Payors / Plans All Payors / Plans 0311 88164 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC CYTOLOGY AUTO THIN PREP SCREEN All Payors / Plans All Payors / Plans 0311 88175 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC CYTOLOGY SELECT ENHANCEMENT All Payors / Plans All Payors / Plans 0311 88112 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 HC CYTOLOGY THIN PREP MANUAL All Payors / Plans All Payors / Plans 0311 88142 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC CYTOLOGY THIN PREP SCREENING All Payors / Plans All Payors / Plans 0311 G0123 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 "HC CYTOLOGY WASHING, SMEARS" All Payors / Plans All Payors / Plans 0310 88104 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC CYTOLOGY, CYTOSPINS" All Payors / Plans All Payors / Plans 0310 88108 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $171.50 $171.50 HC CYTOMEGALOVIRUS(CMV) All Payors / Plans All Payors / Plans 0302 86644 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC CYTOMEGALOVIRUS, AMPLIFIED PROBE" All Payors / Plans All Payors / Plans 0300 87496 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC CYTOPATH, INSITU HYBRID URINE SPEC 3-5 PROBES, EA. MANUAL" All Payors / Plans All Payors / Plans 0300 88120 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 HC D DIMER QUANTITATIVE All Payors / Plans All Payors / Plans 0305 85379 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $36.26 $36.26 HC D IABETES OP SELF MGMT GROUP All Payors / Plans All Payors / Plans 0942 G0109 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $63.70 $63.70 HC DAILY CARE All Payors / Plans All Payors / Plans 0120 " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,587.60 " " $1,587.60 " HC DAILY CARE CICU All Payors / Plans All Payors / Plans 0200 " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,551.52 " " $3,551.52 " HC DAILY CARE ICU LAYFIELD All Payors / Plans All Payors / Plans 0200 " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,551.52 " " $3,551.52 " HC DAILY CARE L2 All Payors / Plans All Payors / Plans 0120 " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,620.00 " " $1,587.60 " " $1,587.60 " HC DAILY CARE OB All Payors / Plans All Payors / Plans 0122 " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,534.68 " " $1,534.68 " HC DAILY CARE PEDIATRICS All Payors / Plans All Payors / Plans 0123 " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,702.84 " " $2,702.84 " HC DAILY CARE S3A All Payors / Plans All Payors / Plans 0124 " $1,552.00 " " $1,552.00 " " $1,552.00 " " $1,552.00 " " $1,552.00 " " $1,552.00 " " $1,552.00 " " $1,520.96 " " $1,520.96 " HC DAILY CARE-CT INTENSIVE CARE UNIT All Payors / Plans All Payors / Plans 0200 " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,624.00 " " $3,551.52 " " $3,551.52 " HC DAILY CARE-LABOR AND DELIVERY All Payors / Plans All Payors / Plans 0122 " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,566.00 " " $1,534.68 " " $1,534.68 " HC DAILY CARE-NURSERY A All Payors / Plans All Payors / Plans 0170 " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,346.52 " " $1,346.52 " HC DAILY CARE-NURSERY B All Payors / Plans All Payors / Plans 0170 " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,374.00 " " $1,346.52 " " $1,346.52 " HC DAILY CARE-PED NURSERY All Payors / Plans All Payors / Plans 0123 " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,758.00 " " $2,702.84 " " $2,702.84 " HC DAVINCI PACK All Payors / Plans All Payors / Plans $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $275.18 $275.18 HC DEBRIDE BONE All Payors / Plans All Payors / Plans 0761 11044 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC DEBRIDE BONE EA ADD 20 SQ CM All Payors / Plans All Payors / Plans 0761 11047 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC DEBRIDE MUSCLE All Payors / Plans All Payors / Plans 0761 11043 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $416.50 $416.50 HC DEBRIDE MUSCLE EACH ADD. 20SQ All Payors / Plans All Payors / Plans 0761 11046 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC DEBRIDE MUSCLE W/MOD All Payors / Plans All Payors / Plans 0761 11043 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $261.66 $261.66 HC DEBRIDE NAIL >5 All Payors / Plans All Payors / Plans 0761 11721 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC DEBRIDE NAIL 1-5 All Payors / Plans All Payors / Plans 0761 11720 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC DEBRIDE OPEN All Payors / Plans All Payors / Plans 0761 97597 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $357.70 $357.70 HC DEBRIDE OPEN EACH ADD. 20SQ All Payors / Plans All Payors / Plans 0761 97598 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC DEBRIDE OPEN WOUND W/MOD All Payors / Plans All Payors / Plans 0761 97597 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $154.84 $154.84 HC DEBRIDE SUB Q All Payors / Plans All Payors / Plans 0761 11042 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $392.98 $392.98 HC DEBRIDE SUB Q EA ADD 20 SQ CM All Payors / Plans All Payors / Plans 0761 11045 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC DEBRIDE SUB Q W/MOD All Payors / Plans All Payors / Plans 0761 11042 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC DECAL All Payors / Plans All Payors / Plans 0310 88311 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 HC DECLOT THROMBO AGENT DEV/CATHETER All Payors / Plans All Payors / Plans 0510 36593 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $303.80 $303.80 HC DEFINITIVE DRUG OPOIDS/ANALOGS (CSMP) All Payors / Plans All Payors / Plans 0300 80364 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC DEFINITIVE DURG BENZODIAZEPINES (CSMP) All Payors / Plans All Payors / Plans 0300 80347 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC DEGLYCEROLIZED RBC (DRBC) All Payors / Plans All Payors / Plans 0300 P9022 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $784.00 $784.00 HC DELIVERY OUTSIDE HOSPITAL All Payors / Plans All Payors / Plans 0720 " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,799.28 " " $1,799.28 " HC DEMONSTRATION OF NEBULAZATION All Payors / Plans All Payors / Plans 0460 94664 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 HC DENTAL CROWN CHARGE All Payors / Plans All Payors / Plans $20.62 $20.62 $20.62 $20.62 $20.62 $20.62 $20.62 $20.21 $20.21 HC DEPAKENE (DEPK)(VA) All Payors / Plans All Payors / Plans 0301 80164 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC DESIGN MLC DEVICE FOR IMRT All Payors / Plans All Payors / Plans 0333 77338 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $950.60 $950.60 HC DESIPRAMINE (DSIPB) All Payors / Plans All Payors / Plans 0300 80335 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC DEXAMETHASONE LEVEL All Payors / Plans All Payors / Plans 0300 80375 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $171.50 $171.50 HC DEXAMETHSONE LEVEL(DEXA) All Payors / Plans All Payors / Plans 0300 80299 $157.50 $157.50 $157.50 $157.50 $157.50 $157.50 $157.50 $154.35 $154.35 "HC DHEA, SULFATE (DHEAS)" All Payors / Plans All Payors / Plans 0301 82627 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC DHEA,UNCONJUGATED (DHEA)" All Payors / Plans All Payors / Plans 0300 82626 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC DIABETES OP SELF MGMT GROUP 2-4 All Payors / Plans All Payors / Plans 0942 98961 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC DIABETES OP SELF MGMT GROUP 5-8 All Payors / Plans All Payors / Plans 0942 98962 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC DIABETES OP SELF MGMT IND. RN All Payors / Plans All Payors / Plans 0942 98960 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $212.66 $212.66 HC DIABETES OP SELF MGMT INDIV. All Payors / Plans All Payors / Plans 0942 G0108 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $222.46 $222.46 HC DIALYSIS SUPPLIES All Payors / Plans All Payors / Plans $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $99.96 $99.96 HC DIAZEPAM/NORDIAZEPAM (DIAZ) All Payors / Plans All Payors / Plans 0300 80346 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $44.10 $44.10 HC DIBUCAINE (DIBC) All Payors / Plans All Payors / Plans 0300 82638 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC DIFFUSION/VOLUME All Payors / Plans All Payors / Plans 0460 94729 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $191.10 $191.10 "HC DIGOXIN, SERUM (DIG)" All Payors / Plans All Payors / Plans 0300 80162 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC DIHYDROPYRIMIDINE DEHYDROGENASE FULL GENE SEQU All Payors / Plans All Payors / Plans 0300 81232 " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,102.50 " " $1,102.50 " HC DILANTIN (PTN) All Payors / Plans All Payors / Plans 0300 80185 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC DIRECT BILIRUBIN(DBIL) All Payors / Plans All Payors / Plans 0301 82248 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC DIRECT COOMBS All Payors / Plans All Payors / Plans 0300 86880 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC DIRECT LOW DENSITY LIPOPROTEIN All Payors / Plans All Payors / Plans 0300 83721 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC DNA PLOIDY All Payors / Plans All Payors / Plans 0310 88182 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC DOPPLER COLOR FLOW All Payors / Plans All Payors / Plans 0480 93325 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $15.68 $15.68 HC DOPPLER FETAL MIDDLE CEREBRAL ART All Payors / Plans All Payors / Plans 0402 76821 $416.00 $416.00 $416.00 $416.00 $416.00 $416.00 $416.00 $407.68 $407.68 HC DOPPLER FETAL UMBILICAL ARTERY All Payors / Plans All Payors / Plans 0402 76820 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC DOUBLE SET-UP/FAILED FORCEP/VAC All Payors / Plans All Payors / Plans 0720 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $299.88 $299.88 HC DRAW AND HOLD (DH) All Payors / Plans All Payors / Plans 0300 99001 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC DRESS/DEBRIDE PART THICK BURN <5% All Payors / Plans All Payors / Plans 0761 16020 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC DRESS/DEBRIDE PART THICK BURN >10% All Payors / Plans All Payors / Plans 0761 16030 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $249.90 $249.90 HC DRESS/DEBRIDE PART THICK BURN 5-10% All Payors / Plans All Payors / Plans 0761 16025 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $131.32 $131.32 HC DRUG SCREEN (DRUS)(DRUSU) All Payors / Plans All Payors / Plans 0300 80307 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $458.64 $458.64 HC DRUG SCREEN MECONIUM All Payors / Plans All Payors / Plans 0300 80307 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC DRUG SCREEN PRESCRIPTION/OTC U All Payors / Plans All Payors / Plans 0300 80307 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE All Payors / Plans All Payors / Plans 0300 80165 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC DRUG SCREEN URINE, NURSERY & MECONIUM" All Payors / Plans All Payors / Plans 0300 80307 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $274.40 $274.40 HC DRUG SCREEN W/ REFLEX All Payors / Plans All Payors / Plans 0300 80307 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC DRUG SCREEN, ABBREV. (ADRUG)" All Payors / Plans All Payors / Plans 0300 80307 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $176.40 $176.40 "HC DRUG SCREEN, QUANT ALCOHOL BIOMARKERS 1 OR 2" All Payors / Plans All Payors / Plans 0300 80321 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC DRUG SCREENING, FENTANYL" All Payors / Plans All Payors / Plans 0300 80354 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $318.50 $318.50 "HC DRUG SCRN,URINE,NURSERY ONLY(OPDS" All Payors / Plans All Payors / Plans 0300 80307 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $176.40 $176.40 HC EACH ADD'L SINGLE ANTIBODY STAIN All Payors / Plans All Payors / Plans 0310 88350 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC EB VIRUS SEROLOGY (EBVS) All Payors / Plans All Payors / Plans 0302 86663 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC EC ECHO 2D-M DOPPLER/COLOR All Payors / Plans All Payors / Plans 0480 93306 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC ECHO 2D LIMITED/FOLLOW-UP All Payors / Plans All Payors / Plans 0480 93308 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $62.72 $62.72 HC ECHOCARDIOGRAM (2D)/M All Payors / Plans All Payors / Plans 0480 93307 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $141.12 $141.12 HC EEG All Payors / Plans All Payors / Plans 0740 95819 " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,474.50 " " $2,474.50 " HC EFFUSION FLD. ANALYSIS (EFFA) All Payors / Plans All Payors / Plans 0300 84157 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $102.90 $102.90 "HC EGFR GENE ANALYSIS, COMMON VARIANTS" All Payors / Plans All Payors / Plans 0310 81235 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $2.94 $2.94 HC EGFR GENE MUTATION ANALYSIS TUMOR All Payors / Plans All Payors / Plans 0310 81235 " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,347.50 " " $1,347.50 " "HC EHRLICHIA/ANAPLASMA PCR,B" All Payors / Plans All Payors / Plans 0300 87798 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC EK CARDIOVERSION All Payors / Plans All Payors / Plans 0480 92960 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $141.12 $141.12 HC EK TILT TABLE >45 MIN All Payors / Plans All Payors / Plans 0480 93660 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $281.26 $281.26 HC EK TILT TABLE 45 MIN OR LESS All Payors / Plans All Payors / Plans 0480 93660 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 "HC ELASTASE, PANCREATIC FECAL" All Payors / Plans All Payors / Plans 0300 82656 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC ELBOW All Payors / Plans All Payors / Plans 0320 73070 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC ELBOW 3 VIEWS All Payors / Plans All Payors / Plans 0320 73080 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC ELBOW ARTHROGRAM All Payors / Plans All Payors / Plans 0320 73085 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC ELECTROCARDIOGRAM All Payors / Plans All Payors / Plans 0730 93005 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ELECTROLYTES (LYTE) All Payors / Plans All Payors / Plans 0301 80051 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC EMG ANAL OR URETHRAL SPHINCTER All Payors / Plans All Payors / Plans 0922 51785 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 HC EMG CRANIAL NERVES UNI All Payors / Plans All Payors / Plans 0922 95867 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC EMG EA EXTREM 4 OR LESS MUSCLES All Payors / Plans All Payors / Plans 0922 95885 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $269.50 $269.50 HC EMG EA EXTREM 5 OR MORE MUSCLES All Payors / Plans All Payors / Plans 0922 95886 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $318.50 $318.50 HC EMG LMT LIMBS/AXIAL MUSCLES All Payors / Plans All Payors / Plans 0922 95870 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 HC EMG NERVE CONDUCT 13OR MORE STUDY All Payors / Plans All Payors / Plans 0922 95913 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $759.50 $759.50 HC EMG NERVE CONDUCTINO 1-2 STUDIES All Payors / Plans All Payors / Plans 0922 95907 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC EMG NERVE CONDUCTION 11-12 STUDY All Payors / Plans All Payors / Plans 0922 95912 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $686.00 $686.00 HC EMG NERVE CONDUCTION 3-4 STUDIES All Payors / Plans All Payors / Plans 0922 95908 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 HC EMG NERVE CONDUCTION 5-6 STUDIES All Payors / Plans All Payors / Plans 0922 95909 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC EMG NERVE CONDUCTION 7-8 STUDIES All Payors / Plans All Payors / Plans 0922 95910 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $612.50 $612.50 HC EMG NERVE CONDUCTION 9-10 STUDIES All Payors / Plans All Payors / Plans 0922 95911 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $686.00 $686.00 HC EMG NON EXTREMITY All Payors / Plans All Payors / Plans 0922 95887 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC ENCEPHALITIS, WESTERN EQUINE" All Payors / Plans All Payors / Plans 0300 86654 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $115.64 $115.64 HC ENDO AAA All Payors / Plans All Payors / Plans " $5,150.00 " " $5,150.00 " " $5,150.00 " " $5,150.00 " " $5,150.00 " " $5,150.00 " " $5,150.00 " " $5,047.00 " " $5,047.00 " HC ENDOFORM 2X2 FENESTRATED COLLAGEN All Payors / Plans All Payors / Plans $12.97 $12.97 $12.97 $12.97 $12.97 $12.97 $12.97 $12.71 $12.71 "HC ENDOMYSIAL FLUORESCENT AB, SCREEN EA (EMA)" All Payors / Plans All Payors / Plans 0302 86231 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ENDOSCOPY(MINUTES) All Payors / Plans All Payors / Plans 0750 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ENDOTRACHEAL INTUBATION OR ASSIST All Payors / Plans All Payors / Plans 0361 31500 $304.00 $304.00 $304.00 $304.00 $304.00 $304.00 $304.00 $297.92 $297.92 HC ENDOTRACHEAL TUBE CARE NON VENTED All Payors / Plans All Payors / Plans 0410 94799 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 "HC ENTERIC BACTERIAL PANEL, STOOL" All Payors / Plans All Payors / Plans 0300 87506 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC ENTEROHEMORAGIC E. COLI ASSYS All Payors / Plans All Payors / Plans 0300 87427 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ENTEROVIRUS BY PCR (PCRENT) All Payors / Plans All Payors / Plans 0300 87498 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC ENTEROVIRUS, AMPLIFIED PROBE, INCLUDE REVERSE TRANSCRIPTION" All Payors / Plans All Payors / Plans 0300 87498 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC ENZYME ACTIVITY IN CELLS,NOS, NON RADIOACTIVE" All Payors / Plans All Payors / Plans 0300 82657 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC EOSINOPHIL COUNT (EOCT) All Payors / Plans All Payors / Plans 0300 85032 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC EOSINOPHIL SMEAR (EOSM) All Payors / Plans All Payors / Plans 0300 89190 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC EP EP MINUTES All Payors / Plans All Payors / Plans 0481 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC ER-BRIEF VISIT All Payors / Plans All Payors / Plans 0451 99281 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $105.84 $105.84 HC ER-COMPREHENSIVE VISIT All Payors / Plans All Payors / Plans 0452 99285 $756.00 $756.00 $756.00 $756.00 $756.00 $756.00 $756.00 $740.88 $740.88 HC ER-EXTENDED CARE All Payors / Plans All Payors / Plans 0452 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $105.84 $105.84 HC ER-EXTENDED VISIT All Payors / Plans All Payors / Plans 0452 99283 $216.00 $216.00 $216.00 $216.00 $216.00 $216.00 $216.00 $211.68 $211.68 HC ER-INTENSIVE VISIT All Payors / Plans All Payors / Plans 0452 99284 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $423.36 $423.36 HC ER-INTERMEDIATE VISIT All Payors / Plans All Payors / Plans 0452 99282 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $105.84 $105.84 HC ER-SCREENING All Payors / Plans All Payors / Plans 0451 99281 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $105.84 $105.84 HC ERTHROPOIETIN (ERYTP) All Payors / Plans All Payors / Plans 0301 82668 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ESOPHAGEAL MANOMETRY All Payors / Plans All Payors / Plans 0750 91010 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ESOPHAGUS DOUBLE CONTRAST All Payors / Plans All Payors / Plans 0320 74221 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $458.64 $458.64 HC ESOPHAGUS SINGLE CONTRAST INC. SCOUT CHEST/DELAYED IMAGES All Payors / Plans All Payors / Plans 0320 74220 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $458.64 $458.64 HC ESTRADIOL All Payors / Plans All Payors / Plans 0300 82670 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ESTROGENS FRACTIONATED All Payors / Plans All Payors / Plans 0300 82671 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC ESTROGENS,TL (ESTB)" All Payors / Plans All Payors / Plans 0300 82672 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ESTRONE All Payors / Plans All Payors / Plans 0300 82679 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ETHXOSUX-ZARONTIN (ZAR) All Payors / Plans All Payors / Plans 0300 80168 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ETHYLENE GLYCOL All Payors / Plans All Payors / Plans 0300 82693 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC ETHYLENE GLYCOL, SERUM (ETGL)" All Payors / Plans All Payors / Plans 0300 80320 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC EVALUATION HIGH COMPLEXITY 23-37 MIN All Payors / Plans All Payors / Plans 0420 97163 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC EVALUATION HIGH COMPLEXITY 38-52 MIN All Payors / Plans All Payors / Plans 0420 97163 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC EVALUATION HIGH COMPLEXITY 53-67 MIN All Payors / Plans All Payors / Plans 0420 97163 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC EVALUATION HIGH COMPLEXITY 68-82 MIN All Payors / Plans All Payors / Plans 0420 97163 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC EVALUATION HIGH COMPLEXITY 8-22 MIN All Payors / Plans All Payors / Plans 0420 97163 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC EVALUATION LOW COMPLEXITY 23-37 MIN All Payors / Plans All Payors / Plans 0420 97161 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC EVALUATION LOW COMPLEXITY 38-52 MIN All Payors / Plans All Payors / Plans 0420 97161 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC EVALUATION LOW COMPLEXITY 53-67 MIN All Payors / Plans All Payors / Plans 0420 97161 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC EVALUATION LOW COMPLEXITY 68-82 MIN All Payors / Plans All Payors / Plans 0420 97161 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC EVALUATION LOW COMPLEXITY 8-22 MIN All Payors / Plans All Payors / Plans 0420 97161 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC EVALUATION MOD COMPLEXITY 23-37MIN All Payors / Plans All Payors / Plans 0420 97162 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC EVALUATION MOD COMPLEXITY 38-52 MIN All Payors / Plans All Payors / Plans 0420 97162 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC EVALUATION MOD COMPLEXITY 53-67 MIN All Payors / Plans All Payors / Plans 0420 97162 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC EVALUATION MOD COMPLEXITY 68-82 MIN All Payors / Plans All Payors / Plans 0420 97162 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC EVALUATION MOD COMPLEXITY 8-22 MIN All Payors / Plans All Payors / Plans 0420 97162 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 "HC EXCHANGE TRANSFUSION, BLOOD" All Payors / Plans All Payors / Plans 0510 36455 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $637.98 $637.98 HC EXCISION NAIL PARTIAL OR COMPLETE All Payors / Plans All Payors / Plans 0761 11750 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 HC EXCISIONAL BIOPSY MALIGNANT LESION .5CM OR LESS All Payors / Plans All Payors / Plans 0761 11600 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 HC EXCISIONAL BIOPSY MALIGNANT LESION .6-1.0 CM All Payors / Plans All Payors / Plans 0761 11601 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 HC EXCISIONAL BIOPSY MALIGNANT LESION 1.1-2.0 CM All Payors / Plans All Payors / Plans 0761 11602 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 HC EXER TOLERANCE TEST All Payors / Plans All Payors / Plans 0482 93017 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC EXER TOLERANCE TEST All Payors / Plans All Payors / Plans 0482 93017 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 "HC EXON 12-15 SEQUENCING, REFLEX" All Payors / Plans All Payors / Plans 0300 0027U $408.00 $408.00 $408.00 $408.00 $408.00 $408.00 $408.00 $399.84 $399.84 HC EXPOSURE PROFILE (EXP) All Payors / Plans All Payors / Plans 0300 80074 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC EXT ECG CONNECTION >48HR UP TO 7 DAYS All Payors / Plans All Payors / Plans 0731 93242 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $31.36 $31.36 HC EXT ECG CONNECTION >7 UP TO 15 DAYS All Payors / Plans All Payors / Plans 0731 93246 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $31.36 $31.36 HC EXT. NEONATE ROTATION All Payors / Plans All Payors / Plans 0720 " $1,530.00 " " $1,530.00 " " $1,530.00 " " $1,530.00 " " $1,530.00 " " $1,530.00 " " $1,530.00 " " $1,499.40 " " $1,499.40 " HC EXTREM PUMP 23-37 All Payors / Plans All Payors / Plans 0420 97016 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC EXTREM PUMP 38-52 All Payors / Plans All Payors / Plans 0420 97016 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC EXTREM PUMP 53-67 All Payors / Plans All Payors / Plans 0420 97016 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC EXTREM PUMP 68-82 MIN All Payors / Plans All Payors / Plans 0420 97016 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $261.66 $261.66 HC EXTREM PUMP 8-22 MIN All Payors / Plans All Payors / Plans 0420 97016 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $51.94 $51.94 HC EXTREMITY All Payors / Plans All Payors / Plans 0402 76881 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $637.00 $637.00 HC F-18 FDG All Payors / Plans All Payors / Plans 0343 A9552 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 HC FABRICATION/ORTHOTIC All Payors / Plans All Payors / Plans 0420 97760 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC FACET INJECTION All Payors / Plans All Payors / Plans 0361 64412 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $331.24 $331.24 HC FACIAL BONES All Payors / Plans All Payors / Plans 0320 70140 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC FACIAL BONES All Payors / Plans All Payors / Plans 0320 70150 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC FACTOR INHIBITOR TEST All Payors / Plans All Payors / Plans 0300 85335 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC FACTOR V LEIDEN (F5DNA) All Payors / Plans All Payors / Plans 0302 81241 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC FACTOR VIII ANTIGEN (F8AG) All Payors / Plans All Payors / Plans 0305 85240 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC FACTOR VIII PROFILE (F8BAT) All Payors / Plans All Payors / Plans 0300 85397 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $171.50 $171.50 HC FAMILY PSYCHOTHERAPY All Payors / Plans All Payors / Plans 0912 90847 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $111.72 $111.72 HC FEBRILE AGGLUTININS (FEB) All Payors / Plans All Payors / Plans 0300 86000 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 HC FECAL FAT QUANTITATIVE All Payors / Plans All Payors / Plans 0300 82710 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC FECAL LACTOFERRIN All Payors / Plans All Payors / Plans 0300 83630 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC FECAL OCCULT BLOOD IMMUNO All Payors / Plans All Payors / Plans 0300 82274 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC FECAL REDUCING SUB (FRS) All Payors / Plans All Payors / Plans 0300 84376 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC FEMUR All Payors / Plans All Payors / Plans 0320 73552 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC FERRITIN (FER) All Payors / Plans All Payors / Plans 0301 82728 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FETAL DEMISE 2ND OR 3RD TRIMESTER All Payors / Plans All Payors / Plans 0720 " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,497.22 " " $4,497.22 " HC FETAL DEMISE 2ND/3RD TRIM W/EPID All Payors / Plans All Payors / Plans 0720 " $5,507.00 " " $5,507.00 " " $5,507.00 " " $5,507.00 " " $5,507.00 " " $5,507.00 " " $5,507.00 " " $5,396.86 " " $5,396.86 " HC FETAL FIBRONECTIN (FFN) All Payors / Plans All Payors / Plans 0301 82731 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $429.24 $429.24 HC FETALDEX SCREEN (FEDXS) All Payors / Plans All Payors / Plans 0305 85460 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP) (FSP) PARACOAGULATION All Payors / Plans All Payors / Plans 0300 85366 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FIBRINOGEN ACTIVITY All Payors / Plans All Payors / Plans 0305 85384 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $22.54 $22.54 HC FIBRINOGEN ANTIGEN All Payors / Plans All Payors / Plans 0300 85385 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $39.20 $39.20 HC FIBRINOGEN IMMUNOFLUO STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC FIBRINOLYTIC PLASMINOGEN ACTIVATOR All Payors / Plans All Payors / Plans 0300 85415 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC FIBRO TEST ACTI TEST, S (FIBRO)" All Payors / Plans All Payors / Plans 0300 81596 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $318.50 $318.50 HC FINE NEEDLE ASPIRATION All Payors / Plans All Payors / Plans 0310 88172 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC FINGER All Payors / Plans All Payors / Plans 0320 73140 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC FIRST TRIMESTER MATERNAL SCREEN All Payors / Plans All Payors / Plans 0300 84702 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 "HC FISH,BCR/ABL FUSION (BCRABL)" All Payors / Plans All Payors / Plans 0300 88271 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC FITNESS PLUS PROFILE (FPP) All Payors / Plans All Payors / Plans 0300 80061 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC FK506(TACROLIMUS) All Payors / Plans All Payors / Plans 0300 80197 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC FLECAINIDE (FLEC) All Payors / Plans All Payors / Plans 0300 80181 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC FLOW CYTO CELL SURF 1 (BILL ONLY) All Payors / Plans All Payors / Plans 0300 88184 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC FLOW CYTO CELL SURF 1 ADD BILL ON All Payors / Plans All Payors / Plans 0300 88185 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC FLOW CYTO INTERP 16 OR GREAT MARK All Payors / Plans All Payors / Plans 0300 88189 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $134.26 $134.26 HC FLOW CYTO INTERP 2 TO 8 MARKERS All Payors / Plans All Payors / Plans 0300 88187 $41.00 $41.00 $41.00 $41.00 $41.00 $41.00 $41.00 $40.18 $40.18 HC FLOW CYTO INTERP 9 TO 15 MARKERS All Payors / Plans All Payors / Plans 0300 88188 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $111.72 $111.72 HC FLOW CYTOMETRY 9 TO 15 MARKERS All Payors / Plans All Payors / Plans 0300 88188 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $111.72 $111.72 HC FLOW CYTOMETRY EACH ADD'L MARKER All Payors / Plans All Payors / Plans 0300 88185 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC FLOW CYTOMETRY EACH ADD'L MARKER All Payors / Plans All Payors / Plans 0300 88185 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC FLOW CYTOMETRY, CELL CYCLE OR DNA ANALYSIS" All Payors / Plans All Payors / Plans 0310 88182 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 "HC FLOW CYTOMETRY, CELL SFC,CYTOPLASMIC OR NUCLEAR MARKER" All Payors / Plans All Payors / Plans 0300 88184 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC FLUID CELL COUNT (FCC) All Payors / Plans All Payors / Plans 0300 89050 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC FLUID CELL COUNT W/DIFFERENTIAL (FDIF) All Payors / Plans All Payors / Plans 0300 89051 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC FLUID CHOLESTEROL (FCHOL) All Payors / Plans All Payors / Plans 0300 84999 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC FLUID CRYSTALS (FLDC) All Payors / Plans All Payors / Plans 0300 89060 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FLUID RBC (FLDRBC) All Payors / Plans All Payors / Plans 0300 87205 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC FLUID T. PROTEIN (FPRO) All Payors / Plans All Payors / Plans 0301 84157 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC FLUID T. PROTEIN (FPRO) All Payors / Plans All Payors / Plans 0300 84157 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC FLUID WBC (FLDWBC) All Payors / Plans All Payors / Plans 0300 87205 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC FLUIDOTHERAPY 23-37 All Payors / Plans All Payors / Plans 0420 97039 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $69.58 $69.58 HC FLUIDOTHERAPY 38-52 All Payors / Plans All Payors / Plans 0420 97039 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC FLUIDOTHERAPY 53-67 MIN All Payors / Plans All Payors / Plans 0420 97039 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $139.16 $139.16 HC FLUIDOTHERAPY 8-22 MIN All Payors / Plans All Payors / Plans 0420 97039 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 "HC FLUORESCENT NONINFECTIOUS AGENT AB, SCREEN EA (FACS)" All Payors / Plans All Payors / Plans 0302 86363 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC FLUORESCENT NONINFECTIOUS AGENT ANTIBODY, SCREEN EA" All Payors / Plans All Payors / Plans 0302 86255 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FLUORESCENT NONINFECTIOUS AGENT ANTIBODY;TITER EA. All Payors / Plans All Payors / Plans 0302 86256 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC FLUORO ONLY-UP TO 1 HR All Payors / Plans All Payors / Plans 0320 76000 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $280.28 $280.28 HC FLUOXETINE (FLUOX) All Payors / Plans All Payors / Plans 0300 80299 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC FLURO GUIDE NEEDLE PLACEMENT All Payors / Plans All Payors / Plans 0320 77002 " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,528.00 " " $3,528.00 " "HC FMR1(FRAGILE 1 MENTAL RETARDATION) GENE ANALYSIS,EVAL ABNORMAL ALLELES" All Payors / Plans All Payors / Plans 0300 81243 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $274.40 $274.40 "HC FMRI GENE ANALYSIS, CHARAC OF ALLELES" All Payors / Plans All Payors / Plans 0300 81244 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $137.20 $137.20 "HC FNA, EA ADDL IMMEDIATE INTERP SAME SITE" All Payors / Plans All Payors / Plans 0310 88177 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC FNA, INTERPRETATION]" All Payors / Plans All Payors / Plans 0310 88173 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC FOLIC ACID (FOL) All Payors / Plans All Payors / Plans 0300 82746 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FOOT All Payors / Plans All Payors / Plans 0320 73620 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC FOOT ARTHROGRAM All Payors / Plans All Payors / Plans 0320 77002 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC FOREARM All Payors / Plans All Payors / Plans 0320 73090 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC FOREIGN BODY LOCALIZATION All Payors / Plans All Payors / Plans 0320 76010 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC FRANCISELLA TURLARENSIS AB All Payors / Plans All Payors / Plans 0300 86668 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $115.64 $115.64 HC FREE DILANTIN (FPTNB) All Payors / Plans All Payors / Plans 0300 80186 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FREE PSA All Payors / Plans All Payors / Plans 0301 84154 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC FREE T3 (FT3) All Payors / Plans All Payors / Plans 0300 84481 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FROZEN SECTION All Payors / Plans All Payors / Plans 0310 88331 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC FRUCTOSAMINE, SERUM" All Payors / Plans All Payors / Plans 0301 82985 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FSH (FSH) All Payors / Plans All Payors / Plans 0301 83001 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC FTA (FTA) All Payors / Plans All Payors / Plans 0300 86780 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $42.14 $42.14 HC FUNCTIONAL ACTIVITY TH All Payors / Plans All Payors / Plans 0420 97530 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC FUNGITELL, BAL" All Payors / Plans All Payors / Plans 0300 87449 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC FUNGUS SM AND CULT (FUSC) All Payors / Plans All Payors / Plans 0300 87102 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC G6PD QUANTITATIVE (G6PDQ) All Payors / Plans All Payors / Plans 0300 82955 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC GARDNER VAG DNA QUANT All Payors / Plans All Payors / Plans 0306 87512 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 HC GASTRIC OCCULT BLOOD All Payors / Plans All Payors / Plans 0301 82271 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC GASTRIN (GASN) All Payors / Plans All Payors / Plans 0300 82941 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC GASTRIN AFTER SECRETIN STIMULATION All Payors / Plans All Payors / Plans 0300 82938 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC GASTROESOPHAGEAL REFLUX All Payors / Plans All Payors / Plans 0340 78262 " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " $989.80 $989.80 HC GASTROGRAFIN GI W SCOUT W/WO DELAYED IMAGES All Payors / Plans All Payors / Plans 0320 74240 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $560.56 $560.56 HC GC SMEAR (GCSM) All Payors / Plans All Payors / Plans 0300 87205 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC GENE TARGETED SEQUENCE ANALYSIS All Payors / Plans All Payors / Plans 0310 81272 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC GENITAL CULTURE-GC ONLY (GCCU) All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC GENOTYPE BY NUCLEIC ACID,HEPATITIS C" All Payors / Plans All Payors / Plans 0300 87902 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $833.00 $833.00 HC GENTAMICIN All Payors / Plans All Payors / Plans 0301 80170 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC GFT SKIN SUB F/S <100CM EA ADD 25 All Payors / Plans All Payors / Plans 0761 15276 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC GFT SKIN SUB F/S/E <100CM 1ST 25 All Payors / Plans All Payors / Plans 0761 15275 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 HC GFT SKIN SUB F/S/E >100CM 1ST 100 All Payors / Plans All Payors / Plans 0761 15277 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $595.84 $595.84 HC GFT SKIN SUB F/S>100CM EA ADD 100 All Payors / Plans All Payors / Plans 0761 15278 $304.00 $304.00 $304.00 $304.00 $304.00 $304.00 $304.00 $297.92 $297.92 HC GFT SKIN SUB T/A/L <100CM ADD 25 All Payors / Plans All Payors / Plans 0761 15272 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC GFT SKIN SUB T/A/L >100CM 1ST 100 All Payors / Plans All Payors / Plans 0761 15273 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $595.84 $595.84 HC GFT SKIN SUB T/A/L >100CM 1ST 25 All Payors / Plans All Payors / Plans 0761 15271 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $238.14 $238.14 HC GFT SKIN SUB T/A/L >100CM EA ADDL All Payors / Plans All Payors / Plans 0761 15274 $304.00 $304.00 $304.00 $304.00 $304.00 $304.00 $304.00 $297.92 $297.92 HC GGTP (GT) All Payors / Plans All Payors / Plans 0301 82977 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC GIARDIA All Payors / Plans All Payors / Plans 0300 87269 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC GLIADIN (DEAMINATED) AB, IGA" All Payors / Plans All Payors / Plans 0300 83516 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC GLIADIN (DEAMINATED) AB, IGG" All Payors / Plans All Payors / Plans 0300 83516 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC GLIADIN (DEAMINATED) ANTIBODY All Payors / Plans All Payors / Plans 0302 86258 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC GLIADIN ANTIBODY (GLIAB) All Payors / Plans All Payors / Plans 0300 83516 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC GLOM.BASEMENT AB (AGBM) All Payors / Plans All Payors / Plans 0300 83520 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC GLUC. CHALLENGE SCREEN (GLUC) All Payors / Plans All Payors / Plans 0300 82950 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC GLUCOSE FLUID All Payors / Plans All Payors / Plans 0301 82945 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC GLUCOSE MONITOR CONTINOUS PT EQUIP All Payors / Plans All Payors / Plans 0942 95249 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $222.46 $222.46 HC GLUCOSE MONITOR CONTINUOUS All Payors / Plans All Payors / Plans 0942 95250 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $222.46 $222.46 HC GLUCOSE QUANTITATIVE BLOOD All Payors / Plans All Payors / Plans 0301 82947 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC GLUCOSE TOL 5 HR (OGT5) All Payors / Plans All Payors / Plans 0300 82951 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC GLUCOSE TOLERANCE TEST 3 SPECIMENS All Payors / Plans All Payors / Plans 0300 82951 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 "HC GLUCOSE, POST GLUC. DOSE(INCLUDES GLUC)" All Payors / Plans All Payors / Plans 0300 82950 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 "HC GONADOTROPIN, CHORIONIC(HCG);QUANTITATIVE" All Payors / Plans All Payors / Plans 0301 84702 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 HC GRAM STAIN (GRAM) All Payors / Plans All Payors / Plans 0306 87205 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC GROCOTTS METH SILVER ST FOR FUNGI All Payors / Plans All Payors / Plans 0310 88312 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC GROUP B STREP SCREEN (GBST) All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC GROUP PSYCHOTHERAPY All Payors / Plans All Payors / Plans 0912 G0410 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $114.00 $111.72 $111.72 HC GROUP PSYCHOTHERAPY ENTIRE DAY All Payors / Plans All Payors / Plans 0912 90853 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $558.60 $558.60 HC GROUP PSYCHOTHERAPY HALF DAY All Payors / Plans All Payors / Plans 0912 90853 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $279.30 $279.30 HC GROWTH HORMONE (HGH) All Payors / Plans All Payors / Plans 0300 83003 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $78.40 $78.40 HC GYN BIOPSY OF CERVIX All Payors / Plans All Payors / Plans 0361 57500 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN CAUTERIZATION CERVIX/CRYOCAUT All Payors / Plans All Payors / Plans 0361 57511 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 HC GYN COLPO W CERVICAL BIOPSY/ECC All Payors / Plans All Payors / Plans 0361 57454 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN COLPOSCOPY CX/UPPER VAGINA All Payors / Plans All Payors / Plans 0361 57452 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN COLPOSCOPY VAGINA All Payors / Plans All Payors / Plans 0361 57420 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN COLPOSCOPY VAGINA W BIOPSY All Payors / Plans All Payors / Plans 0361 57421 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN COLPOSCOPY VULVA All Payors / Plans All Payors / Plans 0361 56820 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN COLPOSCOPY VULVA W BIOPSY All Payors / Plans All Payors / Plans 0361 56821 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN COLPOSCOPY W CERVICAL BIOPSY All Payors / Plans All Payors / Plans 0361 57455 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN COLPOSCOPY W ECC All Payors / Plans All Payors / Plans 0361 57456 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN DESTR VULVA LESION All Payors / Plans All Payors / Plans 0361 56501 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC GYN ECC All Payors / Plans All Payors / Plans 0361 57505 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC GYN ENDOCERVICAL CURETTAGE All Payors / Plans All Payors / Plans 0361 57505 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 HC GYN ENDOMETRIAL BIOPSY All Payors / Plans All Payors / Plans 0361 58100 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 HC GYN ENDOMETRIAL BIOPSY W COLP ADD All Payors / Plans All Payors / Plans 0361 58110 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN I&D BARTHOLINS GLAND ABSCESS All Payors / Plans All Payors / Plans 0361 56420 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $23.52 $23.52 HC GYN I&D VULVA OR PERINEAL ABSCESS All Payors / Plans All Payors / Plans 0361 56405 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC GYN REMOVAL IUD All Payors / Plans All Payors / Plans 0361 58301 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC GYN VAGINA BIOPSY All Payors / Plans All Payors / Plans 0361 57100 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC GYN VULVAR BIOPSY All Payors / Plans All Payors / Plans 0361 56605 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC H PYLORI AB, IGG, IGM, IGA" All Payors / Plans All Payors / Plans 0300 86677 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC H. PYLORI UREA BREATH TEST (UBT) All Payors / Plans All Payors / Plans 0301 83013 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC H.PYLORI ANTIGEN, STOOL" All Payors / Plans All Payors / Plans 0306 87338 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC HAND All Payors / Plans All Payors / Plans 0320 73120 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC HAND HELD NEBULIZER/IBB/MDI-OP All Payors / Plans All Payors / Plans 0410 94640 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $109.76 $109.76 HC HAND HELD NEBULIZER/IPPB/MDI-IP All Payors / Plans All Payors / Plans 0410 94640 " $1,349.00 " " $1,349.00 " " $1,349.00 " " $1,349.00 " " $1,349.00 " " $1,349.00 " " $1,349.00 " " $1,322.02 " " $1,322.02 " "HC HAPTOGLOBIN, BLD. (HAP)" All Payors / Plans All Payors / Plans 0300 83010 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC HBO PER 30 MINS All Payors / Plans All Payors / Plans 0413 99183 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $720.30 $720.30 HC HBO2 TX - 109-139 MIN All Payors / Plans All Payors / Plans 0413 G0277 " $1,470.00 " " $1,470.00 " " $1,470.00 " " $1,470.00 " " $1,470.00 " " $1,470.00 " " $1,470.00 " " $1,440.60 " " $1,440.60 " HC HBO2 TX - 16-46 MIN All Payors / Plans All Payors / Plans 0413 G0277 $367.50 $367.50 $367.50 $367.50 $367.50 $367.50 $367.50 $360.15 $360.15 HC HBO2 TX - 78-108 MIN All Payors / Plans All Payors / Plans 0413 G0277 " $1,102.50 " " $1,102.50 " " $1,102.50 " " $1,102.50 " " $1,102.50 " " $1,102.50 " " $1,102.50 " " $1,080.45 " " $1,080.45 " HC HDL CHOLESTEROL (HDL) All Payors / Plans All Payors / Plans 0300 83718 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC HEART CHECK PROFILE (HCK) All Payors / Plans All Payors / Plans 0300 83718 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC HEAVY METAL QUANTITATIVE EACH All Payors / Plans All Payors / Plans 0300 83018 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC HEAVY METALS (METAL) All Payors / Plans All Payors / Plans 0300 83655 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $318.50 $318.50 HC HEEL BRODENS VIEW 4 VIEWS All Payors / Plans All Payors / Plans 0320 73650 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC HELICOBACTER PYLORI All Payors / Plans All Payors / Plans 0300 86677 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC HEMATOCRIT (HCT) All Payors / Plans All Payors / Plans 0305 85014 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC HEMOCHROMATOSIS HFE GENE ANALYSIS All Payors / Plans All Payors / Plans 0300 81256 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $171.50 $171.50 HC HEMOGLOBIN (HGB) All Payors / Plans All Payors / Plans 0305 85018 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC HEMOGLOBIN A1C (A1C) All Payors / Plans All Payors / Plans 0301 83036 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC HEMOGLOBIN, FETAL, ROSETTE" All Payors / Plans All Payors / Plans 0300 85461 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC HEMOSIDERIN URINE (HSID) All Payors / Plans All Payors / Plans 0300 83070 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC HEP B ADMINISTRATION All Payors / Plans All Payors / Plans 0771 G0010 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC HEP B. SURFACE AG NEUTRALIZATION All Payors / Plans All Payors / Plans 0300 87341 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC HEPABILRY SYS IMAG INC GALLBLADDER All Payors / Plans All Payors / Plans 0340 78226 " $1,424.00 " " $1,424.00 " " $1,424.00 " " $1,424.00 " " $1,424.00 " " $1,424.00 " " $1,424.00 " " $1,395.52 " " $1,395.52 " HC HEPABILRY SYS IMAG W PHARMA All Payors / Plans All Payors / Plans 0340 78227 " $1,954.00 " " $1,954.00 " " $1,954.00 " " $1,954.00 " " $1,954.00 " " $1,954.00 " " $1,954.00 " " $1,914.92 " " $1,914.92 " HC HEPARIN ASSAY All Payors / Plans All Payors / Plans 0305 85520 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC HEPATIC PANEL (LIVR) All Payors / Plans All Payors / Plans 0301 80076 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $27.44 $27.44 HC HEPATITIS A ANTIBODY (HAAB) All Payors / Plans All Payors / Plans 0302 86708 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC HEPATITIS B SURFACE ANTIGEN All Payors / Plans All Payors / Plans 0300 87340 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC HEPATITIS B VIRAL DNA,QNT(QHBV)" All Payors / Plans All Payors / Plans 0300 87517 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 HC HEPATITIS BE ANTIGEN (EAG) All Payors / Plans All Payors / Plans 0306 87350 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC HEPATITIS C, REVERSE TRANSCRIPTION & QUANTIFICATION" All Payors / Plans All Payors / Plans 0306 87522 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 HC HER-2 FISH BY CLARIENT All Payors / Plans All Payors / Plans 0310 88374 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC HERPES BY PCR (HSVPCR) All Payors / Plans All Payors / Plans 0306 87529 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC HERPES SEROLOGY (HESE) All Payors / Plans All Payors / Plans 0300 86694 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC HERPES SIMPLEX VIRUS, AMPLIFIED PROBE" All Payors / Plans All Payors / Plans 0300 87529 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC HERPES SIMPLEX, NONSPEC TYPE, ANTIBODY" All Payors / Plans All Payors / Plans 0300 86694 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC HERPES SIMPLEX, TYPE 1, ANTIBODY" All Payors / Plans All Payors / Plans 0302 86695 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC HERPES SIMPLEX, TYPE 2, ANTIBODY" All Payors / Plans All Payors / Plans 0302 86696 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC HERPES VIRUS-6, AMPLIFIED PROBE" All Payors / Plans All Payors / Plans 0300 87532 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC HGB INVESTIGATION (HIN)(HELEC) All Payors / Plans All Payors / Plans 0300 83020 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $86.24 $86.24 HC HIGH DOSE RATE BRACHYTHERAPY >12 All Payors / Plans All Payors / Plans 0333 77772 " $1,805.00 " " $1,805.00 " " $1,805.00 " " $1,805.00 " " $1,805.00 " " $1,805.00 " " $1,805.00 " " $1,768.90 " " $1,768.90 " HC HIGH DOSE RATE BRACHYTHERAPY 1CH All Payors / Plans All Payors / Plans 0333 77770 $565.00 $565.00 $565.00 $565.00 $565.00 $565.00 $565.00 $553.70 $553.70 HC HIGH DOSE RATE BRACHYTHERAPY 2-12 All Payors / Plans All Payors / Plans 0333 77771 " $1,105.00 " " $1,105.00 " " $1,105.00 " " $1,105.00 " " $1,105.00 " " $1,105.00 " " $1,105.00 " " $1,082.90 " " $1,082.90 " "HC HIP FOR FX, 2 OR 3 VIEWS" All Payors / Plans All Payors / Plans 0320 73502 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 "HC HIP FOR PROGRESS, 1 VIEW" All Payors / Plans All Payors / Plans 0320 73501 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC HIP SUPPLIES All Payors / Plans All Payors / Plans " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,448.00 " " $7,448.00 " HC HISTONE ANTIBODY (HISTA) All Payors / Plans All Payors / Plans 0300 86235 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC HISTOPLASMA All Payors / Plans All Payors / Plans 0300 86698 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC HIV AG/AB All Payors / Plans All Payors / Plans 0300 87806 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC HIV RNA BY PCR (PCRHIV) All Payors / Plans All Payors / Plans 0306 87536 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 "HC HIV-1 DNA BY PCR, PLASMA" All Payors / Plans All Payors / Plans 0300 87535 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC HIV-1 GENOTYPIC PR RT-RESISTANCE,P" All Payors / Plans All Payors / Plans 0300 87901 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $833.00 $833.00 "HC HIV-Q ANTIGEN(S) W HIV-1/HIV-2 ANTIBODIES,SIMPLE" All Payors / Plans All Payors / Plans 0300 87389 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC HLA B27 (HLA) All Payors / Plans All Payors / Plans 0302 86812 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC HLA CLASS I MOLECULAR TYPING DISEASE ASSOCIATION All Payors / Plans All Payors / Plans 0300 81372 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $233.24 $233.24 HC HLA CLASS II MOLECULAR TYPING DISEASE ASSOCIATION All Payors / Plans All Payors / Plans 0300 81375 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $679.14 $679.14 "HC HLA-B 5701 GENOTYPE,ABACAVIR HYPERSENSIT, BLOOD" All Payors / Plans All Payors / Plans 0300 81381 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC HOLTER 24 HOUR All Payors / Plans All Payors / Plans 0731 93226 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC HOLTER 48 HOUR All Payors / Plans All Payors / Plans 0731 93226 $319.00 $319.00 $319.00 $319.00 $319.00 $319.00 $319.00 $312.62 $312.62 HC HOLTER MONITOR HOOK-UP All Payors / Plans All Payors / Plans 0731 93225 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $31.36 $31.36 "HC HOMOCYSTEINE, TL PLASMA (HCP)" All Payors / Plans All Payors / Plans 0301 83090 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC HPV GENOTYPES 16&18 All Payors / Plans All Payors / Plans 0300 87625 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 "HC HSCRP, CARDIAC" All Payors / Plans All Payors / Plans 0302 86141 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $39.20 $39.20 "HC HSV AB,IGM BY IRA(HSVIGM)" All Payors / Plans All Payors / Plans 0300 86694 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC HTLV I/II AB (HTLV12) All Payors / Plans All Payors / Plans 0300 86790 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 "HC HTLV OR HIV ANTIBODY, CONFIRMATORY TEST(EG. WESTERN BLOT)" All Payors / Plans All Payors / Plans 0300 86689 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC HUMAN PAPILLOMAVIRUS(HPV) All Payors / Plans All Payors / Plans 0300 87624 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC HUMAN T-CELL LYMPHOTROPIC VIRUS I&II (HTLVI) All Payors / Plans All Payors / Plans 0300 86790 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC HUMERUS All Payors / Plans All Payors / Plans 0320 73060 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC HUNTINGTON DISEASE ANALYSIS All Payors / Plans All Payors / Plans 0300 81271 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 "HC HUNTINGTON DISEASE, MOLECULAR ANALYSIS" All Payors / Plans All Payors / Plans 0300 81401 $823.00 $823.00 $823.00 $823.00 $823.00 $823.00 $823.00 $806.54 $806.54 HC HYDROFERA BLUE BACTERIO DRESS 4X4 All Payors / Plans All Payors / Plans $7.62 $7.62 $7.62 $7.62 $7.62 $7.62 $7.62 $7.47 $7.47 HC HYPERCOAGULABILITY CONSULT.(CCHC) All Payors / Plans All Payors / Plans 0300 81240 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $130.34 $130.34 HC HYSTEROSONOGRAPHY SALINE SOL All Payors / Plans All Payors / Plans 0402 76831 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC I&D ABSCESS-MULTIPLE All Payors / Plans All Payors / Plans 0761 10061 $547.00 $547.00 $547.00 $547.00 $547.00 $547.00 $547.00 $536.06 $536.06 HC I&D ABSCESS-SINGLE All Payors / Plans All Payors / Plans 0761 10060 $579.00 $579.00 $579.00 $579.00 $579.00 $579.00 $579.00 $567.42 $567.42 "HC I&D HEMATOMA, SEROMA" All Payors / Plans All Payors / Plans 0761 10140 $462.00 $462.00 $462.00 $462.00 $462.00 $462.00 $462.00 $452.76 $452.76 HC I&D POST-OP WOUND All Payors / Plans All Payors / Plans 0761 10180 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $273.42 $273.42 HC I123 MIBG All Payors / Plans All Payors / Plans 0343 A9582 " $2,992.50 " " $2,992.50 " " $2,992.50 " " $2,992.50 " " $2,992.50 " " $2,992.50 " " $2,992.50 " " $2,932.65 " " $2,932.65 " HC I131 MIBG All Payors / Plans All Payors / Plans 0343 " $1,280.60 " " $1,280.60 " " $1,280.60 " " $1,280.60 " " $1,280.60 " " $1,280.60 " " $1,280.60 " " $1,254.99 " " $1,254.99 " HC IGA (IGA) All Payors / Plans All Payors / Plans 0300 82784 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC IGA IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGA PARAFFIN IMMUNOFLUO STAIN All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGE (IGE) All Payors / Plans All Payors / Plans 0301 82785 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC IGG (IGG) All Payors / Plans All Payors / Plans 0300 82784 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC IGG IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGG IMMUNOSTAIN All Payors / Plans All Payors / Plans 0310 88342 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGG PARAFFIN IMMUNOFLUO STAIN All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGG SUBGLASS (IGGS) All Payors / Plans All Payors / Plans 0301 82787 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC IGG1 IMMUNOFLUO STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGG2 IMMUNOFLUO STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGG3 IMMUNOFLUO STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGG4 IMMUNOFLUO STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGM (IGM) All Payors / Plans All Payors / Plans 0300 82784 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC IGM IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IGM PARAFFIN IMMUNOFLUO STAIN All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IHC ANTIBODY VIA IMAGE ANALYSIS All Payors / Plans All Payors / Plans 0310 88361 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 HC IMIPRAMINE (TOF) All Payors / Plans All Payors / Plans 0300 80335 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC IMMUNO SENDOUT All Payors / Plans All Payors / Plans 0300 88342 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IMMUNO SENDOUT ADDL All Payors / Plans All Payors / Plans 0300 88341 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IMMUNOASSAY ANALYTE QUANTITATIVE BY RADIOIMMUNOASSAY All Payors / Plans All Payors / Plans 0300 83519 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC IMMUNOASSAY FOR ANALYTE, MULTIPLE STEP" All Payors / Plans All Payors / Plans 0300 83516 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC IMMUNOASSAY FOR ANALYTE, QUANTITATIVE NOT SPECIFIED" All Payors / Plans All Payors / Plans 0300 83520 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUANTITATIVE All Payors / Plans All Payors / Plans 0300 86317 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $51.94 $51.94 "HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY(IES), QUALIT/SEMIQUANT, MULTI-STEP COVID-19" All Payors / Plans All Payors / Plans 0300 86769 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $42.13 $41.29 $41.29 "HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY(IES), QUALIT/SEMIQUANT, SINGLE STEP COVID-19" All Payors / Plans All Payors / Plans 0300 86328 $45.23 $45.23 $45.23 $45.23 $45.23 $45.23 $45.23 $44.33 $44.33 HC IMMUNOASSAY TUMOR ANTIGEN All Payors / Plans All Payors / Plans 0302 86300 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 "HC IMMUNOASSAY,NON INFECTIOUS DISEASE;MULTI, STEP" All Payors / Plans All Payors / Plans 0301 83516 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC IMMUNOFIXATION ELECTROPHORESIS, OTHER FLUID" All Payors / Plans All Payors / Plans 0302 86335 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $107.80 $107.80 "HC IMMUNOFIXATION, BLOOD" All Payors / Plans All Payors / Plans 0300 86334 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC IMMUNOFLUORESCENCE All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC IMMUNOGLOB.TL LT.CHAINS, URINE" All Payors / Plans All Payors / Plans 0300 83883 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC IMMUNOGLOBULIN IGA,IGD,IGC,IGM EACH" All Payors / Plans All Payors / Plans 0301 82784 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC IMMUNOHISTOCHEMISTRY, EACH ANTIBODY" All Payors / Plans All Payors / Plans 0310 88342 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IMMUNOPEROXIDASE STAIN All Payors / Plans All Payors / Plans 0310 88342 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IMMUNOPEROXIDASE STAIN ADDL All Payors / Plans All Payors / Plans 0310 88341 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC IMRT PLAN All Payors / Plans All Payors / Plans 0333 77301 " $5,219.00 " " $5,219.00 " " $5,219.00 " " $5,219.00 " " $5,219.00 " " $5,219.00 " " $5,219.00 " " $5,114.62 " " $5,114.62 " HC IMRT TREATMENTS COMPLEX All Payors / Plans All Payors / Plans 0333 77386 " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,347.50 " " $1,347.50 " HC IMRT TREATMENTS SIMPLE All Payors / Plans All Payors / Plans 0333 77385 " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,375.00 " " $1,347.50 " " $1,347.50 " HC IN SITU HYBIRD (FISH) EA ADD SING PROBE All Payors / Plans All Payors / Plans 0310 88364 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $784.00 $784.00 HC INCENTIVE SPIROMETRY INITIAL All Payors / Plans All Payors / Plans 0460 94010 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC INCENTIVE SPIROMETRY SUBSEQUENT All Payors / Plans All Payors / Plans 0460 94010 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC INCISION SUBCUT TOE TENDON All Payors / Plans All Payors / Plans 0761 28010 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC INDUCTION All Payors / Plans All Payors / Plans 0720 $612.00 $612.00 $612.00 $612.00 $612.00 $612.00 $612.00 $599.76 $599.76 HC INEXSUFFILATOR INITIAL RX All Payors / Plans All Payors / Plans 0410 94667 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC INEXSUFFILATOR SUB RX All Payors / Plans All Payors / Plans 0410 94668 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC INFANT OSSEOUS SURVEY All Payors / Plans All Payors / Plans 0320 77076 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC INFANT URINE RED SUB (IURS) All Payors / Plans All Payors / Plans 0300 84376 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC INFCT DS BCT/VIR RESP 22 TARGETS ARS/COV2 All Payors / Plans All Payors / Plans 0300 0202U $416.28 $416.28 $416.28 $416.28 $416.28 $416.28 $416.28 $407.95 $407.95 HC INFEC AGENT DETECTION AMPLIFIED PROBE All Payors / Plans All Payors / Plans 0300 U0005 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC INFECTIOUS AGENT AMPLIFIED PROBE, EA ORGANISM" All Payors / Plans All Payors / Plans 0306 87798 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA) All Payors / Plans All Payors / Plans 0300 87483 " $1,093.00 " " $1,093.00 " " $1,093.00 " " $1,093.00 " " $1,093.00 " " $1,093.00 " " $1,093.00 " " $1,071.14 " " $1,071.14 " "HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID, HIGH THROUGHPUT TECH" All Payors / Plans All Payors / Plans 0300 U0003 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID, RESPIRATORY SYNDROME" All Payors / Plans All Payors / Plans 0300 U0002 $51.31 $51.31 $51.31 $51.31 $51.31 $51.31 $51.31 $50.28 $50.28 HC INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES All Payors / Plans All Payors / Plans 0306 87502 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 HC INFECTIOUS AGENT IMMUNOASSAY NOT SPECIFIED All Payors / Plans All Payors / Plans 0300 87899 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC INFECTIOUS AGENT QUANTIFICATION, EA ORGANISM" All Payors / Plans All Payors / Plans 0300 87799 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 "HC INFECTIOUS AGENT, MULTIPLE ORGS, AMPLIFIED PROBE" All Payors / Plans All Payors / Plans 0302 87801 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $558.60 $558.60 "HC INFECTIOUS DETECTION SARS-COV2,INFLUENZA A/B, RSV" All Payors / Plans All Payors / Plans 0300 0241U $142.63 $142.63 $142.63 $142.63 $142.63 $142.63 $142.63 $139.78 $139.78 "HC INFECTIOUS DISEASE, BACTERIAL VAGINOSIS, QUANT REAL TIME AMP" All Payors / Plans All Payors / Plans 0300 81513 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC INFLAM BOWEL SEROLOGY PANEL SERUM All Payors / Plans All Payors / Plans 0300 83520 $114.50 $114.50 $114.50 $114.50 $114.50 $114.50 $114.50 $112.21 $112.21 HC INFLAMMATION IMAGING-SPECT All Payors / Plans All Payors / Plans 0340 78803 " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,379.84 " " $1,379.84 " HC INFLAMMATION IMAGING-WB All Payors / Plans All Payors / Plans 0340 78306 " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " $989.80 $989.80 "HC INFLAMMATORY BOWEL DISEASE PANEL FLUORESCENT AB, SCREEN EA (IBDPT)" All Payors / Plans All Payors / Plans 0302 86036 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC INFLIXIMAB QN WITH REFLEX TO AB, S" All Payors / Plans All Payors / Plans 0300 80230 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC INFLIXIMAB QUANTIFIC W/ REFLEX TO ANTIBODIES TO INFLIXIMAB SERUM All Payors / Plans All Payors / Plans 0300 80299 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $269.50 $269.50 HC INFLUENZA ADMINISTRATION All Payors / Plans All Payors / Plans 0771 G0008 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC INFLUENZA ANTIGEN (FLUAG) All Payors / Plans All Payors / Plans 0300 87804 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC INFUS NON CHEMO SEQUENTIAL 0-1HR All Payors / Plans All Payors / Plans 0260 96367 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $212.66 $212.66 HC INFUSION HYDRATION 0-1 HR All Payors / Plans All Payors / Plans 0260 96360 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $243.04 $243.04 HC INFUSION HYDRATION EACH ADD HR All Payors / Plans All Payors / Plans 0260 96361 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC INFUSION NON CHEMO EACH ADD HR All Payors / Plans All Payors / Plans 0260 96366 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC INFUSION THERAPY NON CHEMO 0-1HR All Payors / Plans All Payors / Plans 0260 96365 $558.00 $558.00 $558.00 $558.00 $558.00 $558.00 $558.00 $546.84 $546.84 HC INFUSION THERPAY CONCURRENT All Payors / Plans All Payors / Plans 0260 96368 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC INHALATION BRONCHIAL CHALLENGE All Payors / Plans All Payors / Plans 0924 95070 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $286.16 $286.16 HC INITIAL ASSESSMENT - C REHAB All Payors / Plans All Payors / Plans 0943 93798 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC INITIAL DRUG SCREEN AT PRMC All Payors / Plans All Payors / Plans 0300 80307 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $176.40 $176.40 HC INJ NON CHEMO IV PUSH SEQUENTIAL All Payors / Plans All Payors / Plans 0260 96375 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC INJ TIXAGEVIMAB/CILAGAVIMAB All Payors / Plans All Payors / Plans 0771 M0220 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC INJ. NON CHEMO INTRAMUSCULAR/SUB All Payors / Plans All Payors / Plans 0260 96372 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC INJ. NON CHEMO IV PUSH INITIAL All Payors / Plans All Payors / Plans 0260 96374 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $303.80 $303.80 HC INJECT CONTRAST KNEE ARTHORGR All Payors / Plans All Payors / Plans 0320 27369 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $611.52 $611.52 HC INJECTION - SUB Q OR IM All Payors / Plans All Payors / Plans 0510 96372 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC INSICIONAL BIOSPY OF SKIN All Payors / Plans All Payors / Plans 0761 11106 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC INSICIONAL BIOSPY OF SKIN EACH ADD'L All Payors / Plans All Payors / Plans 0761 11107 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC INSTRUMENT TRAY All Payors / Plans All Payors / Plans $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC INSULIN (INLN) All Payors / Plans All Payors / Plans 0301 83525 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC INSULIN ANTIBODIES (INAB) All Payors / Plans All Payors / Plans 0300 86337 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC INSULIN LIKE GROWTH FACTOR-BINDING PROTEIN 3 (IGFBP-3) All Payors / Plans All Payors / Plans 0300 83520 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC INTERCAV. RADIOLEM. COMPLEX All Payors / Plans All Payors / Plans 0333 77763 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $950.60 $950.60 HC INTERCAV. RADIOLEM. INTER All Payors / Plans All Payors / Plans 0333 77762 $749.00 $749.00 $749.00 $749.00 $749.00 $749.00 $749.00 $734.02 $734.02 HC INTERCAV. RADIOLEM. SIMPLE All Payors / Plans All Payors / Plans 0333 77761 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $637.98 $637.98 HC INTERDISCIPLINARY VISIT All Payors / Plans All Payors / Plans 0510 G0175 $362.00 $362.00 $362.00 $362.00 $362.00 $362.00 $362.00 $354.76 $354.76 "HC INTERLEUKIN-6 (IL-6), SERUM" All Payors / Plans All Payors / Plans 0302 83529 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC INTERPHASES, <25 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88274 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 "HC INTERPHASES, >=100 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88275 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $563.50 $563.50 "HC INTERPHASES, 25-99 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88274 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 "HC INTERSTITIAL, COMPLEX" All Payors / Plans All Payors / Plans 0333 77778 $982.00 $982.00 $982.00 $982.00 $982.00 $982.00 $982.00 $962.36 $962.36 "HC INTERSTITIAL, INTERMEDIATE" All Payors / Plans All Payors / Plans 0333 77777 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $649.74 $649.74 "HC INTERSTITIAL, SIMPLE" All Payors / Plans All Payors / Plans 0333 77776 $786.00 $786.00 $786.00 $786.00 $786.00 $786.00 $786.00 $770.28 $770.28 HC INTRAUTERIN PRES CATH MONIT(IUPC) All Payors / Plans All Payors / Plans 0720 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $299.88 $299.88 HC INTRINSIC FACTOR ANTIBODIES All Payors / Plans All Payors / Plans 0300 86340 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $86.24 $86.24 HC IODINE RADIOELEMENT BRACHYTHERAPY All Payors / Plans All Payors / Plans 0270 Q3001 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC IODOFLEX 5 GRAM All Payors / Plans All Payors / Plans $5.72 $5.72 $5.72 $5.72 $5.72 $5.72 $5.72 $5.61 $5.61 HC IONTOPHORESIS ONE OR MORE AREA 15 All Payors / Plans All Payors / Plans 0420 97033 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC IRON BINDING CAPACITY All Payors / Plans All Payors / Plans 0300 83550 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 "HC IRON BINDING CAPACITY, % SAT" All Payors / Plans All Payors / Plans 0301 83550 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 "HC IRON,SERUM (FEE)" All Payors / Plans All Payors / Plans 0301 83540 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC IRRIGATION IMPLANTED VENOUS ACCES All Payors / Plans All Payors / Plans 0260 96523 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC ISLET CELL ANTIBODY All Payors / Plans All Payors / Plans 0302 86341 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC IV PYLEOGRAMS All Payors / Plans All Payors / Plans 0320 74400 " $3,975.00 " " $3,975.00 " " $3,975.00 " " $3,975.00 " " $3,975.00 " " $3,975.00 " " $3,975.00 " " $3,895.50 " " $3,895.50 " "HC JAK2 EXON 12 & OTHER NON V617F MUTATION DETECT BLOOD (JAKXB,JACXM)" All Payors / Plans All Payors / Plans 0300 0027U $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 "HC JAK2 V167F MUTATION DETECTION, BONE MARROW" All Payors / Plans All Payors / Plans 0300 81270 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $306.74 $306.74 HC JAK2 V617F MUTATION All Payors / Plans All Payors / Plans 0310 81270 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC JONES METHENAMINE SILVE ST All Payors / Plans All Payors / Plans 0310 88313 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC KAPPA IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC KAPPA PARAFFIN IMMUNOFLUO STAIN All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC KARYOTYPES, >2 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88280 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC KETONE BODIES SERUM, QUALITATIVE" All Payors / Plans All Payors / Plans 0301 82009 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 HC KIDNEY IMAG STATIC ONLY All Payors / Plans All Payors / Plans 0340 78700 $729.00 $729.00 $729.00 $729.00 $729.00 $729.00 $729.00 $714.42 $714.42 HC KIDNEY IMAG-VASC FLOW/FUN W 1PHAR All Payors / Plans All Payors / Plans 0340 78708 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $551.74 $551.74 HC KIDNEY IMAG-VASC FLOW/FUNC W PHAR All Payors / Plans All Payors / Plans 0340 78709 " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,412.18 " " $1,412.18 " HC KIDNEY SCAN-SPECT All Payors / Plans All Payors / Plans 0340 78803 " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,379.84 " " $1,379.84 " "HC KIT ASP816VAL MUTATION ANALYSIS, BLOOD" All Payors / Plans All Payors / Plans 0300 81273 " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,095.64 " " $1,095.64 " HC KNEE All Payors / Plans All Payors / Plans 0320 73560 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC KNEE COMPLETE All Payors / Plans All Payors / Plans 0320 73564 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC KNEE SUPPLIES All Payors / Plans All Payors / Plans " $31,692.50 " " $31,692.50 " " $31,692.50 " " $31,692.50 " " $31,692.50 " " $31,692.50 " " $31,692.50 " " $31,058.65 " " $31,058.65 " HC KNEES WEIGHT BEAR BOTH All Payors / Plans All Payors / Plans 0320 73565 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC KOH PREP All Payors / Plans All Payors / Plans 0300 87220 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC KRAS GENE ANALYSIS, VARIANTS IN CONDONS 12 13" All Payors / Plans All Payors / Plans 0310 81275 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $519.40 $519.40 HC KRAS GENE MUTATION ANALYSIS All Payors / Plans All Payors / Plans 0310 81275 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $282.24 $282.24 HC L&D OR ADD'L MAJOR SURGERY All Payors / Plans All Payors / Plans 0720 " $5,813.00 " " $5,813.00 " " $5,813.00 " " $5,813.00 " " $5,813.00 " " $5,813.00 " " $5,813.00 " " $5,696.74 " " $5,696.74 " HC L&D OR ADD'L MINOR SURG All Payors / Plans All Payors / Plans 0720 " $1,224.00 " " $1,224.00 " " $1,224.00 " " $1,224.00 " " $1,224.00 " " $1,224.00 " " $1,224.00 " " $1,199.52 " " $1,199.52 " HC LABOR ROOM - NON-SCH CS All Payors / Plans All Payors / Plans 0720 " $5,660.00 " " $5,660.00 " " $5,660.00 " " $5,660.00 " " $5,660.00 " " $5,660.00 " " $5,660.00 " " $5,546.80 " " $5,546.80 " HC LABOR ROOM - SCH CS All Payors / Plans All Payors / Plans 0720 " $2,754.00 " " $2,754.00 " " $2,754.00 " " $2,754.00 " " $2,754.00 " " $2,754.00 " " $2,754.00 " " $2,698.92 " " $2,698.92 " "HC LACOSAMIDE, S" All Payors / Plans All Payors / Plans 0300 80235 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC LACOSAMIDE, SERUM" All Payors / Plans All Payors / Plans 0300 80299 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $179.34 $179.34 HC LACTATE RESPIRATORY All Payors / Plans All Payors / Plans 0300 83605 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC LACTIC ACID (LACT) All Payors / Plans All Payors / Plans 0301 83605 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC LACTOSE TOL. TEST (LATT) All Payors / Plans All Payors / Plans 0300 82951 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC LAMBDA IMMUNOFLUOR STAIN RENAL All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC LAMBDA PARAFFIN IMMUNOFLUOR STAIN All Payors / Plans All Payors / Plans 0310 88346 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC LAMOTRIGINE (LAMO) All Payors / Plans All Payors / Plans 0301 80175 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC LDH All Payors / Plans All Payors / Plans 0301 83615 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC LEAD All Payors / Plans All Payors / Plans 0301 83655 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC LEG All Payors / Plans All Payors / Plans 0320 73590 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC LEGIONAIRES SEROLOGY (LGSE) All Payors / Plans All Payors / Plans 0300 86713 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC LEGIONELLA URINARY ANTIGEN All Payors / Plans All Payors / Plans 0306 87449 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC LEPTOSPIRA SEROLOGY (LPS) All Payors / Plans All Payors / Plans 0300 86720 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC LEUKOPOOR RBC'S All Payors / Plans All Payors / Plans 0390 P9016 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $223.44 $223.44 HC LEVETIRACETAM (LEVE) All Payors / Plans All Payors / Plans 0301 80177 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $36.26 $36.26 HC LH (LH) All Payors / Plans All Payors / Plans 0301 83002 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC LIDOCAINE (LIDO) All Payors / Plans All Payors / Plans 0300 80176 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC LIPASE, SERUM (LPSE)" All Payors / Plans All Payors / Plans 0301 83690 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC LIPID PROFILE (LIPD) All Payors / Plans All Payors / Plans 0301 80061 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC LIPOPROTEIN A (LPA) All Payors / Plans All Payors / Plans 0300 83695 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC LITHIUM,SERUM (LI)" All Payors / Plans All Payors / Plans 0301 80178 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC LITHOTRIPSY All Payors / Plans All Payors / Plans 0790 50590 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $88.20 $88.20 HC LIVER IMAGE W VASCULAR FLOW All Payors / Plans All Payors / Plans 0340 78202 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $843.78 $843.78 HC LIVER IMAGING (SPECT) W VASC FLOW All Payors / Plans All Payors / Plans 0340 78202 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $843.78 $843.78 "HC LIVER IMAGING, STATIC ONLY" All Payors / Plans All Payors / Plans 0340 78201 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $794.78 $794.78 HC LIVER/SPLEEN STATIC ONLY All Payors / Plans All Payors / Plans 0340 78215 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $811.44 $811.44 HC LONG BONE SURVEY All Payors / Plans All Payors / Plans 0320 77074 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $305.76 $305.76 HC LUMB SPINE BENDING VIEWS 2 OR 3 All Payors / Plans All Payors / Plans 0320 72120 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC LUMBAR MYELOGRAM All Payors / Plans All Payors / Plans 0361 62304 " $3,450.00 " " $3,450.00 " " $3,450.00 " " $3,450.00 " " $3,450.00 " " $3,450.00 " " $3,450.00 " " $3,381.00 " " $3,381.00 " HC LUMBAR PUNCTURE All Payors / Plans All Payors / Plans 0361 62328 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $866.32 $866.32 HC LUMBAR SPINE 2 VIEWS All Payors / Plans All Payors / Plans 0320 72100 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC LUMBAR SPINE 6 VIEW W BEND All Payors / Plans All Payors / Plans 0320 72114 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $331.24 $331.24 HC LUMBAR SPINE MIN 4 VIEWS All Payors / Plans All Payors / Plans 0320 72110 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $229.32 $229.32 "HC LYME DISEASE, CONF. (LYMWB)" All Payors / Plans All Payors / Plans 0300 86617 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC LYMPHATICS AND LYMPH NODE IMAGING All Payors / Plans All Payors / Plans 0340 78195 " $1,141.00 " " $1,141.00 " " $1,141.00 " " $1,141.00 " " $1,141.00 " " $1,141.00 " " $1,141.00 " " $1,118.18 " " $1,118.18 " HC LYOFOAM 3X3.4 All Payors / Plans All Payors / Plans $2.64 $2.64 $2.64 $2.64 $2.64 $2.64 $2.64 $2.59 $2.59 HC M TUBERCULOSIS BY QUANTIFERON All Payors / Plans All Payors / Plans 0302 86480 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $86.24 $86.24 "HC MACROSCOPIC EXAM, ARTHROPOD" All Payors / Plans All Payors / Plans 0300 87168 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC MACROSCOPIC EXAM, PARASITE" All Payors / Plans All Payors / Plans 0300 87169 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC MAGNESIUM All Payors / Plans All Payors / Plans 0301 83735 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC MALARIA SMEAR (MAL) All Payors / Plans All Payors / Plans 0300 87207 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC MAMMOGRAM-LOCALIZATION All Payors / Plans All Payors / Plans 0401 19281 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC MANDIBLE All Payors / Plans All Payors / Plans 0320 70110 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC MANNAN BINDING LECTIN COMPLEMENT PATHWAY, FUNCTIONAL, SERUM" All Payors / Plans All Payors / Plans 0300 86161 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC MANNOSE BINDING LECTIN(MANBL) All Payors / Plans All Payors / Plans 0300 83520 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC MANUAL DIFFERENTIAL All Payors / Plans All Payors / Plans 0300 85007 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC MANUAL THERAPY All Payors / Plans All Payors / Plans 0420 97140 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC MANUAL VENTILATION All Payors / Plans All Payors / Plans 0410 94799 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 HC MASS SPECTROMETRY & TANDEM MASS SPECTR NON DRUG ANALYTES NOT SPEC. All Payors / Plans All Payors / Plans 0300 83789 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC MASSAGE 15 MIN All Payors / Plans All Payors / Plans 0420 97124 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $69.58 $69.58 HC MASSONS TRICHROME ST FOR CONN TS All Payors / Plans All Payors / Plans 0310 88313 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC MAXIMUM VOLUME VENT All Payors / Plans All Payors / Plans 0460 94200 $117.00 $117.00 $117.00 $117.00 $117.00 $117.00 $117.00 $114.66 $114.66 "HC MC ABDOMINAL PARACENTESIS, WITH IMAGE GUIDE" All Payors / Plans All Payors / Plans 0361 49083 $328.00 $328.00 $328.00 $328.00 $328.00 $328.00 $328.00 $321.44 $321.44 "HC MC ARTHROCENT, ASPIRAT &/OR INJECT, INTERM JOINT/BURSA" All Payors / Plans All Payors / Plans 0361 20605 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 "HC MC ARTHROCENT,APSIRAT &/OR INJECT, MAJOR JOINT/BURSA" All Payors / Plans All Payors / Plans 0361 20610 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC MC BH FAMILY PSYCHOTHERAPY W/ PATIENT All Payors / Plans All Payors / Plans 0916 90847 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC BH FAMILY PSYCHOTHERAPY W/O PATIENT All Payors / Plans All Payors / Plans 0916 90846 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC BH GROUP THERAPY All Payors / Plans All Payors / Plans 0915 90853 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC BH IOP PER 15 MIN All Payors / Plans All Payors / Plans 0906 H0015 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC BH MED ASSIST IND TX PER 15 MIN All Payors / Plans All Payors / Plans 0900 H0004 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC BH MULTIPLE FAMILY GROUP THERAPY All Payors / Plans All Payors / Plans 0916 90849 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC BH PSYCH ASSESSMENT All Payors / Plans All Payors / Plans 0900 90791 $372.00 $372.00 $372.00 $372.00 $372.00 $372.00 $372.00 $364.56 $364.56 HC MC BH PSYCHOTHERAPY CRISIS 60 MIN All Payors / Plans All Payors / Plans 0914 90839 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $273.42 $273.42 HC MC BH PSYCHOTHERAPY CRISIS ADD 30 MIN All Payors / Plans All Payors / Plans 0914 90840 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC BH THERAPY 30 MIN IND All Payors / Plans All Payors / Plans 0914 90832 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC BH THERAPY 45 MIN IND All Payors / Plans All Payors / Plans 0914 90834 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC BH THERAPY 60 MIN IND All Payors / Plans All Payors / Plans 0914 90837 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $273.42 $273.42 HC MC CERUMEN REMOVAL All Payors / Plans All Payors / Plans 0361 69209 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $23.52 $23.52 HC MC CERUMEN REMOVAL BILATERAL All Payors / Plans All Payors / Plans 0361 69209 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $48.02 $48.02 HC MC CRYOSURGERY SKIN LESIONS UP TO 14 All Payors / Plans All Payors / Plans 0360 17110 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 "HC MC DIAB SELF MGMT, GROUP 30 MIN" All Payors / Plans All Payors / Plans 0942 G0109 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 "HC MC DIAB SELF MGMT, IND 30 MIN" All Payors / Plans All Payors / Plans 0942 G0108 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $212.66 $212.66 HC MC DOT PHYSICAL ESTABLISHED All Payors / Plans All Payors / Plans 0510 99211 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC DOT PHYSICAL NEW All Payors / Plans All Payors / Plans 0510 99202 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC DOT SPORTS/SCHOOL PHYSICAL ESTABLISHED All Payors / Plans All Payors / Plans 0510 99211 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC ENDOCERVICL CURRETAGE All Payors / Plans All Payors / Plans 0361 57505 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC MC EST PREVENTATIVE VISIT 12-17 11-25 MIN All Payors / Plans All Payors / Plans 0510 99394 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC EST PREVENTATIVE VISIT 12-17 26-45 MIN All Payors / Plans All Payors / Plans 0510 99394 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC EST PREVENTATIVE VISIT 12-17 46-90 MIN All Payors / Plans All Payors / Plans 0510 99394 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC EST PREVENTATIVE VISIT 12-17 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99394 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC EST PREVENTATIVE VISIT 18-39 11-25 MIN All Payors / Plans All Payors / Plans 0510 99395 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC EST PREVENTATIVE VISIT 18-39 26-45 MIN All Payors / Plans All Payors / Plans 0510 99395 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC EST PREVENTATIVE VISIT 18-39 46-90 MIN All Payors / Plans All Payors / Plans 0510 99395 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC EST PREVENTATIVE VISIT 18-39 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99395 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC EST PREVENTATIVE VISIT 40-64 11-25 MIN All Payors / Plans All Payors / Plans 0510 99396 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC EST PREVENTATIVE VISIT 40-64 26-45 MIN All Payors / Plans All Payors / Plans 0510 99396 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC EST PREVENTATIVE VISIT 40-64 46-90 MIN All Payors / Plans All Payors / Plans 0510 99396 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC EST PREVENTATIVE VISIT 40-64 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99396 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC EST PREVENTATIVE VISIT AGE 65+ 11-25 MIN All Payors / Plans All Payors / Plans 0510 99397 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC EST PREVENTATIVE VISIT AGE 65+ 26-45 MIN All Payors / Plans All Payors / Plans 0510 99397 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC EST PREVENTATIVE VISIT AGE 65+ 46-90 MIN All Payors / Plans All Payors / Plans 0510 99397 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC EST PREVENTATIVE VISIT AGE 65+ 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99397 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC EST PREVENTIVE VISIT 12-17 0-10 MIN All Payors / Plans All Payors / Plans 0510 99394 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC EST PREVENTIVE VISIT 18-39 0-10 MIN All Payors / Plans All Payors / Plans 0510 99395 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC EST PREVENTIVE VISIT 40-64 0-10 MIN All Payors / Plans All Payors / Plans 0510 99396 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC EST PREVENTIVE VISIT AGE 65+ 0-10 MIN All Payors / Plans All Payors / Plans 0510 99397 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 "HC MC EXCISE BENIGN LESION FACE,EARS,EYELID,NOSE .5CM OR<" All Payors / Plans All Payors / Plans 0361 11440 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $83.30 $83.30 "HC MC EXCISE BENIGN LESION SCALP,NECK,HANDS,FEET .6-1.0CM" All Payors / Plans All Payors / Plans 0361 11421 $73.00 $73.00 $73.00 $73.00 $73.00 $73.00 $73.00 $71.54 $71.54 "HC MC EXCISE BENIGN LESION TRUNK,ARMS,LEGS 1.1-2.0 CM" All Payors / Plans All Payors / Plans 0361 11402 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $106.82 $106.82 "HC MC EXCISE BENIGN LESION TURN, ARM,LEGS .6-1.0 CM" All Payors / Plans All Payors / Plans 0361 11401 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $143.08 $143.08 "HC MC EXCISE MALIG LESION TRUNK,ARMS,LEGS .6-1.0 CM" All Payors / Plans All Payors / Plans 0361 11601 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $95.06 $95.06 "HC MC EXCISE MALIG LESION TRUNK,ARMS,LEGS 1.0-2.0 CM" All Payors / Plans All Payors / Plans 0361 11602 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $154.84 $154.84 HC MC FIRST ANNUAL WELLNESS VISIT MEDICARE 0-10 MIN All Payors / Plans All Payors / Plans 0510 G0438 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 HC MC FIRST ANNUAL WELLNESS VISIT MEDICARE 11-25 MIN All Payors / Plans All Payors / Plans 0510 G0438 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $118.58 $118.58 HC MC FIRST ANNUAL WELLNESS VISIT MEDICARE 26-45 MIN All Payors / Plans All Payors / Plans 0510 G0438 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $206.78 $206.78 HC MC FIRST ANNUAL WELLNESS VISIT MEDICARE 46-90 MIN All Payors / Plans All Payors / Plans 0510 G0438 $453.00 $453.00 $453.00 $453.00 $453.00 $453.00 $453.00 $443.94 $443.94 HC MC FIRST ANNUAL WELLNESS VISIT MEDICARE 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 G0438 $543.00 $543.00 $543.00 $543.00 $543.00 $543.00 $543.00 $532.14 $532.14 "HC MC FIT/INSERTION PESSARY, OTHER INTRAVAGINAL DEVICE" All Payors / Plans All Payors / Plans 0361 57160 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC MC FLU VACCINE ADMIN All Payors / Plans All Payors / Plans 0771 90471 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC GYN COLPO W CERVICAL BIOPSY/ECC All Payors / Plans All Payors / Plans 0361 57454 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $143.08 $143.08 HC MC GYN COLPOSCOPY VAGINA All Payors / Plans All Payors / Plans 0361 57420 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC MC GYN DESTR VULVA LESION All Payors / Plans All Payors / Plans 0361 56501 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $143.08 $143.08 HC MC GYN ENDOMETRIAL BIOPSY All Payors / Plans All Payors / Plans 0361 58100 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $106.82 $106.82 HC MC GYN INSERTION IUD All Payors / Plans All Payors / Plans 0361 58300 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $131.32 $131.32 HC MC GYN REMOVAL IUD All Payors / Plans All Payors / Plans 0361 58301 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $48.02 $48.02 "HC MC I&D ABSCESS, SIMPLE" All Payors / Plans All Payors / Plans 0361 10060 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $95.06 $95.06 HC MC IMMUN ORAL EA ADDL All Payors / Plans All Payors / Plans 0510 90474 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC IMMUN ORAL OR INTRANASAL All Payors / Plans All Payors / Plans 0510 90473 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC IMMUNIZATION All Payors / Plans All Payors / Plans 0771 90471 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC IMMUNIZATION EA ADD All Payors / Plans All Payors / Plans 0510 90472 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 "HC MC INJECT, INTRALESIONAL UP TO & INCLUDE 7 LESIONS" All Payors / Plans All Payors / Plans 0361 11900 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $119.56 $119.56 HC MC INJECTION All Payors / Plans All Payors / Plans 0260 96372 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC INJECTION(S) SINGLE TENDON SHEATH OR LIGAMENT All Payors / Plans All Payors / Plans 0361 20550 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 "HC MC INJECTION(S);SINGLE OR MULTIPLE TRIGGER POINTS, 1 OR 2 MUSCLES" All Payors / Plans All Payors / Plans 0361 20552 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $23.52 $23.52 HC MC IV PUSH All Payors / Plans All Payors / Plans 0260 96374 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $303.80 $303.80 HC MC MED NUT THER IND 2ND REG EA 15 MIN All Payors / Plans All Payors / Plans 0942 G0270 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 "HC MC MED NUT THER, GROUP RE" All Payors / Plans All Payors / Plans 0942 97804 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 "HC MC MED NUT THER, IND RE ASSES" All Payors / Plans All Payors / Plans 0942 97803 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC MED NUTR THER IND INITIAL All Payors / Plans All Payors / Plans 0942 97802 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC MED NUTRU THER GROUP 30 MIN All Payors / Plans All Payors / Plans 0942 G0271 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC NEW PREVENTATIVE VISIT 12-17 11-25 MIN All Payors / Plans All Payors / Plans 0510 99384 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC NEW PREVENTATIVE VISIT 12-17 26-45 MIN All Payors / Plans All Payors / Plans 0510 99384 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC NEW PREVENTATIVE VISIT 12-17 46-90 MIN All Payors / Plans All Payors / Plans 0510 99384 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC NEW PREVENTATIVE VISIT 12-17 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99384 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC NEW PREVENTATIVE VISIT 18-39 11-25 MIN All Payors / Plans All Payors / Plans 0510 99385 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC NEW PREVENTATIVE VISIT 18-39 26-45 MIN All Payors / Plans All Payors / Plans 0510 99385 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC NEW PREVENTATIVE VISIT 18-39 46-90 MIN All Payors / Plans All Payors / Plans 0510 99385 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC NEW PREVENTATIVE VISIT 18-39 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99385 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC NEW PREVENTATIVE VISIT 40-64 11-25 MIN All Payors / Plans All Payors / Plans 0510 99386 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC NEW PREVENTATIVE VISIT 40-64 26-45 MIN All Payors / Plans All Payors / Plans 0510 99386 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC NEW PREVENTATIVE VISIT 40-64 46-90 MIN All Payors / Plans All Payors / Plans 0510 99386 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC NEW PREVENTATIVE VISIT 40-64 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99386 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC NEW PREVENTATIVE VISIT AGE 65+ 11-25 MIN All Payors / Plans All Payors / Plans 0510 99387 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC NEW PREVENTATIVE VISIT AGE 65+ 26-45 MIN All Payors / Plans All Payors / Plans 0510 99387 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC MC NEW PREVENTATIVE VISIT AGE 65+ 46-90 MIN All Payors / Plans All Payors / Plans 0510 99387 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC MC NEW PREVENTATIVE VISIT AGE 65+ 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 99387 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC MC NEW PREVENTIVE VISIT 12-17 0-10 MIN All Payors / Plans All Payors / Plans 0510 99384 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC NEW PREVENTIVE VISIT 18-39 0-10 MIN All Payors / Plans All Payors / Plans 0510 99385 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC NEW PREVENTIVE VISIT 40-64 0-10 MIN All Payors / Plans All Payors / Plans 0510 99386 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC NEW PREVENTIVE VISIT AGE 65+ 0-10 MIN All Payors / Plans All Payors / Plans 0510 99387 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC PNEUMO VACCINE ADMIN All Payors / Plans All Payors / Plans 0771 90471 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC PRE EMPLOYMENT PHYSICAL ESTABLISHED All Payors / Plans All Payors / Plans 0510 99211 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC PRE EMPLOYMENT PHYSICAL NEW All Payors / Plans All Payors / Plans 0510 99202 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC PROLONGED EA ADDITIONAL 30 MIN All Payors / Plans All Payors / Plans 0510 99355 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $89.18 $89.18 HC MC PROLONGED FIRST HOUR All Payors / Plans All Payors / Plans 0510 99354 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $147.98 $147.98 HC MC PSYCHIATRIC EVAL W/MED SERVICES All Payors / Plans All Payors / Plans 0900 90792 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $455.70 $455.70 "HC MC REMOVAL SKIN TAGS, ANY AREA, UP TO & INCLUDE 15" All Payors / Plans All Payors / Plans 0361 11200 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC MC SMOKING CESSATION > 10 MIN All Payors / Plans All Payors / Plans 0942 99407 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC SMOKING CESSATION 3-10 MIN All Payors / Plans All Payors / Plans 0942 99406 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC MC SPORTS/SCHOOL PHYSICAL NEW All Payors / Plans All Payors / Plans 0510 99202 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MC SUBSEQUENT ANNUAL WELLNESS VISIT MEDICARE 0-10 MIN All Payors / Plans All Payors / Plans 0510 G0439 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 HC MC SUBSEQUENT ANNUAL WELLNESS VISIT MEDICARE 11-25 MIN All Payors / Plans All Payors / Plans 0510 G0439 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $118.58 $118.58 HC MC SUBSEQUENT ANNUAL WELLNESS VISIT MEDICARE 26-45 MIN All Payors / Plans All Payors / Plans 0510 G0439 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $206.78 $206.78 HC MC SUBSEQUENT ANNUAL WELLNESS VISIT MEDICARE 90 MIN OR GREATER All Payors / Plans All Payors / Plans 0510 G0439 $543.00 $543.00 $543.00 $543.00 $543.00 $543.00 $543.00 $532.14 $532.14 HC MC SUBSEQUENT WELLNESS VISIT MEDICARE 46-90 MIN All Payors / Plans All Payors / Plans 0510 G0439 $453.00 $453.00 $453.00 $453.00 $453.00 $453.00 $453.00 $443.94 $443.94 HC MDI INITIAL All Payors / Plans All Payors / Plans 0410 94640 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $109.76 $109.76 HC MEASUREMENT OF CO LEVEL All Payors / Plans All Payors / Plans 0460 94250 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $286.16 $286.16 HC MECH VENT ADULT All Payors / Plans All Payors / Plans 0410 94002 $703.00 $703.00 $703.00 $703.00 $703.00 $703.00 $703.00 $688.94 $688.94 HC MECH VENT NEONATE All Payors / Plans All Payors / Plans 0410 94002 $843.00 $843.00 $843.00 $843.00 $843.00 $843.00 $843.00 $826.14 $826.14 HC MECH VENT SUBSEQUENT ADULT All Payors / Plans All Payors / Plans 0410 94003 $703.00 $703.00 $703.00 $703.00 $703.00 $703.00 $703.00 $688.94 $688.94 HC MECH VENT SUBSEQUENT NEONATE All Payors / Plans All Payors / Plans 0410 94003 $843.00 $843.00 $843.00 $843.00 $843.00 $843.00 $843.00 $826.14 $826.14 HC MED SURG SUPPLIES All Payors / Plans All Payors / Plans $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $88.20 $88.20 HC MED SURG SUPPLIES All Payors / Plans All Payors / Plans $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $88.20 $88.20 HC MEDIHONEY HCS 4.3X4.3 All Payors / Plans All Payors / Plans $10.62 $10.62 $10.62 $10.62 $10.62 $10.62 $10.62 $10.41 $10.41 HC MEMBRANE DIFFUSION CAPACITY All Payors / Plans All Payors / Plans 0460 94729 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $191.10 $191.10 HC MEPILEX 3X3 BORDERED FOAM All Payors / Plans All Payors / Plans $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.53 $2.53 HC MEPILEX 4X4 BORDERED FOAM All Payors / Plans All Payors / Plans $4.68 $4.68 $4.68 $4.68 $4.68 $4.68 $4.68 $4.59 $4.59 HC MEPILEX 4X4 FOAM All Payors / Plans All Payors / Plans $3.65 $3.65 $3.65 $3.65 $3.65 $3.65 $3.65 $3.58 $3.58 HC MEPILEX BORDERED HEEL All Payors / Plans All Payors / Plans $11.42 $11.42 $11.42 $11.42 $11.42 $11.42 $11.42 $11.19 $11.19 HC MEPILEX BORDERED SACRUM All Payors / Plans All Payors / Plans $7.60 $7.60 $7.60 $7.60 $7.60 $7.60 $7.60 $7.45 $7.45 HC MEPILEX TRANSFER 6X8 All Payors / Plans All Payors / Plans $8.74 $8.74 $8.74 $8.74 $8.74 $8.74 $8.74 $8.57 $8.57 HC MEPILEX TRANSFER 8X20 All Payors / Plans All Payors / Plans $23.80 $23.80 $23.80 $23.80 $23.80 $23.80 $23.80 $23.32 $23.32 HC MERCURY (HGU) All Payors / Plans All Payors / Plans 0300 83825 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC METANEPHRINES All Payors / Plans All Payors / Plans 0301 83835 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC METAPHASES ADD'L CELLS (BILL ONLY All Payors / Plans All Payors / Plans 0300 88285 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC METAPHASES, 1-14 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88262 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $784.00 $784.00 "HC METAPHASES, 1-19 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88264 " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " $980.00 $980.00 "HC METAPHASES, 15-20 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88262 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $784.00 $784.00 "HC METAPHASES, 20-25 (BILL ONLY" All Payors / Plans All Payors / Plans 0300 88264 " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " $980.00 $980.00 HC METASTATIC BONE SURVEY All Payors / Plans All Payors / Plans 0320 77075 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $305.76 $305.76 HC METHADONE All Payors / Plans All Payors / Plans 0300 80358 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $88.20 $88.20 HC METHADONE CONFIRMATION URINE All Payors / Plans All Payors / Plans 0300 80358 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 "HC METHOTREXATE, SERUM" All Payors / Plans All Payors / Plans 0300 80204 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 "HC METHYLALONIC ACID, SERUM(MMAS)" All Payors / Plans All Payors / Plans 0301 83921 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC METHYLENEDIOXYAMPHETAMINES All Payors / Plans All Payors / Plans 0300 80359 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $17.64 $17.64 "HC MGMT PROMOTER METHYLATION, TUMOR" All Payors / Plans All Payors / Plans 0300 81287 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $759.50 $759.50 HC MICRODISSECTION MANUAL-GLOB All Payors / Plans All Payors / Plans 0310 88381 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $135.24 $135.24 HC MICRODISSECTION MANUAL-INTER All Payors / Plans All Payors / Plans 0310 88381 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 "HC MICRODISSECTION, MANUAL" All Payors / Plans All Payors / Plans 0301 88381 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC MICROSOMAL ANTIBODIES(THYROID/KIDNEY/LIVER) EA. All Payors / Plans All Payors / Plans 0302 86376 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $53.90 $53.90 "HC MITOCHONDRIAL AB, IMMUNOASSAY;MULTI, STEP (AMA)" All Payors / Plans All Payors / Plans 0302 86381 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC MLH1 HYPERMEHTYLATION,BRAF MUTATION ANALYS, TUMOR" All Payors / Plans All Payors / Plans 0300 88381 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $93.10 $93.10 HC MLH1 HYPERMETHYLATION ANALYSIS All Payors / Plans All Payors / Plans 0300 81288 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $551.74 $551.74 HC MNT CHG BENE COND GRP 30 MIN All Payors / Plans All Payors / Plans 0942 G0271 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $63.70 $63.70 HC MNT CHG BENE COND IN 15 MIN EA All Payors / Plans All Payors / Plans 0942 G0270 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $158.76 $158.76 HC MNT INIT/FOLLOWUP GROUP 30MIN All Payors / Plans All Payors / Plans 0942 97804 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $63.70 $63.70 HC MNT INITIAL ASSESS IND 15 MIN All Payors / Plans All Payors / Plans 0942 97802 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $158.76 $158.76 HC MNT INTERV & REASS IND 15 MIN All Payors / Plans All Payors / Plans 0942 97803 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $158.76 $158.76 HC MODIFIED BARIUM SWALLOW W SCOUT/DELAYED IMAGES All Payors / Plans All Payors / Plans 0320 74230 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $713.44 $713.44 HC MOLECULAR CYTOGENETICS;DNA PROBE EACH All Payors / Plans All Payors / Plans 0300 88271 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 "HC MOLECULAR PATHOLOGY PROCEDURE, LEVEL 4" All Payors / Plans All Payors / Plans 0310 81403 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $333.20 $333.20 "HC MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5" All Payors / Plans All Payors / Plans 0310 81404 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $705.60 $705.60 HC MONO TEST (MONO) All Payors / Plans All Payors / Plans 0302 86308 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC MONOCLNAL PROTEIN STUD. 24HR URIN All Payors / Plans All Payors / Plans 0310 86335 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $107.80 $107.80 "HC MONOCLONAL PROTEIN STUDY, BLOOD" All Payors / Plans All Payors / Plans 0300 86334 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $164.64 $164.64 "HC MORPHOMETRIC ANAL,IN SITU HYBRID,MANU,PER SPEC,EACH MULTI PROBE STAIN" All Payors / Plans All Payors / Plans 0300 88377 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $713.44 $713.44 HC MORPHOMETRIC IN SITU MULTIPLEX PROB STAI All Payors / Plans All Payors / Plans 0300 88377 $618.00 $618.00 $618.00 $618.00 $618.00 $618.00 $618.00 $605.64 $605.64 "HC MPL EXON 10 MUTATION DETECTION, BLOOD" All Payors / Plans All Payors / Plans 0300 81339 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 "HC MPL EXON 10 MUTATION DETECTION, REFLEX" All Payors / Plans All Payors / Plans 0300 81339 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 "HC MPL EXON 10 SEQUENCING, REFLEX" All Payors / Plans All Payors / Plans 0300 81339 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 HC MRA ABDOMEN W WO CONTRAST All Payors / Plans All Payors / Plans 0618 74185 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $887.88 $887.88 HC MRA HEAD WO CONTRAST All Payors / Plans All Payors / Plans 0615 70544 $957.00 $957.00 $957.00 $957.00 $957.00 $957.00 $957.00 $937.86 $937.86 HC MRA LOWER EXTREMITY All Payors / Plans All Payors / Plans 0616 73725 $895.00 $895.00 $895.00 $895.00 $895.00 $895.00 $895.00 $877.10 $877.10 HC MRA UPPER EXTREMITY All Payors / Plans All Payors / Plans 0618 73225 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $917.28 $917.28 HC MRA-CHEST All Payors / Plans All Payors / Plans 0618 71555 $895.00 $895.00 $895.00 $895.00 $895.00 $895.00 $895.00 $877.10 $877.10 HC MRA-NECK All Payors / Plans All Payors / Plans 0615 70547 $967.00 $967.00 $967.00 $967.00 $967.00 $967.00 $967.00 $947.66 $947.66 HC MRA-PELVIS All Payors / Plans All Payors / Plans 0618 72198 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $887.88 $887.88 HC MRI ABDOMEN W CONTRAST All Payors / Plans All Payors / Plans 0610 74182 " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,038.80 " " $1,038.80 " HC MRI ABDOMEN W WO CONTRAST All Payors / Plans All Payors / Plans 0610 74183 " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,119.16 " " $1,119.16 " HC MRI ABDOMEN WO CONTRAST All Payors / Plans All Payors / Plans 0610 74181 $751.00 $751.00 $751.00 $751.00 $751.00 $751.00 $751.00 $735.98 $735.98 HC MRI BRAIN WO CONTRAST All Payors / Plans All Payors / Plans 0611 70551 $453.00 $453.00 $453.00 $453.00 $453.00 $453.00 $453.00 $443.94 $443.94 HC MRI CARD W FLOW VEL STRESS IMG All Payors / Plans All Payors / Plans 0610 75565 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $120.54 $120.54 HC MRI CARD W&WO STRESS IMAG All Payors / Plans All Payors / Plans 0610 75563 " $1,039.00 " " $1,039.00 " " $1,039.00 " " $1,039.00 " " $1,039.00 " " $1,039.00 " " $1,039.00 " " $1,018.22 " " $1,018.22 " HC MRI CARDIAC W STRESS IMAGING All Payors / Plans All Payors / Plans 0610 75559 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC MRI FETAL EACH ADD GESTATION All Payors / Plans All Payors / Plans 0610 74713 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $392.98 $392.98 HC MRI FETAL FIRST GESTATION All Payors / Plans All Payors / Plans 0610 74712 $957.00 $957.00 $957.00 $957.00 $957.00 $957.00 $957.00 $937.86 $937.86 HC MRI LOWER EXTREM JOINT W CONT All Payors / Plans All Payors / Plans 0610 73722 $864.00 $864.00 $864.00 $864.00 $864.00 $864.00 $864.00 $846.72 $846.72 HC MRI LOWER EXTREM JOINT WO CONT All Payors / Plans All Payors / Plans 0610 73721 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $474.32 $474.32 HC MRI LOWER EXTREM JOINT WWO CONT All Payors / Plans All Payors / Plans 0610 73723 " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " HC MRI LOWER EXTREM JOINT WWO CONT All Payors / Plans All Payors / Plans 0610 73723 " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " HC MRI LOWER EXTREM W CONTRAST All Payors / Plans All Payors / Plans 0610 73719 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $917.28 $917.28 HC MRI LOWER EXTREM WO CONTRAST All Payors / Plans All Payors / Plans 0610 73718 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC MRI LOWER EXTREM WWO CONTRAST All Payors / Plans All Payors / Plans 0610 73720 " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,142.00 " " $1,119.16 " " $1,119.16 " "HC MRI ORBIT, FACE, OR NECK W" All Payors / Plans All Payors / Plans 0610 70542 $741.00 $741.00 $741.00 $741.00 $741.00 $741.00 $741.00 $726.18 $726.18 "HC MRI ORBIT, FACE, OR NECK W WO" All Payors / Plans All Payors / Plans 0610 70543 $895.00 $895.00 $895.00 $895.00 $895.00 $895.00 $895.00 $877.10 $877.10 "HC MRI ORBIT, FACE, OR NECK W/O" All Payors / Plans All Payors / Plans 0610 70540 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $665.42 $665.42 HC MRI SPECTROSCOPY All Payors / Plans All Payors / Plans 0611 76390 " $1,091.00 " " $1,091.00 " " $1,091.00 " " $1,091.00 " " $1,091.00 " " $1,091.00 " " $1,091.00 " " $1,069.18 " " $1,069.18 " HC MRI UPPER EXTREM JOINT W CONT All Payors / Plans All Payors / Plans 0610 73222 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC MRI UPPER EXTREM JOINT WO CONT All Payors / Plans All Payors / Plans 0610 73221 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $474.32 $474.32 HC MRI UPPER EXTREM JOINT WWO CONT All Payors / Plans All Payors / Plans 0610 73223 " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " HC MRI UPPER EXTREM W CONTRAST All Payors / Plans All Payors / Plans 0610 73219 $926.00 $926.00 $926.00 $926.00 $926.00 $926.00 $926.00 $907.48 $907.48 HC MRI UPPER EXTREM W WO CONTRAST All Payors / Plans All Payors / Plans 0610 73220 " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,109.36 " " $1,109.36 " HC MRI UPPER EXTREM WO CONTRAST All Payors / Plans All Payors / Plans 0610 73218 $864.00 $864.00 $864.00 $864.00 $864.00 $864.00 $864.00 $846.72 $846.72 HC MRI-C SPINE W CONTRAST All Payors / Plans All Payors / Plans 0612 72142 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $665.42 $665.42 HC MRI-C SPINE W/WO CONTRAST All Payors / Plans All Payors / Plans 0612 72156 $761.00 $761.00 $761.00 $761.00 $761.00 $761.00 $761.00 $745.78 $745.78 HC MRI-CARDIAC MORPHOLOGY W CONTRAST All Payors / Plans All Payors / Plans 0610 75561 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC MRI-CARDIAC MORPHOLOGY W/O CONT All Payors / Plans All Payors / Plans 0610 75557 $587.00 $587.00 $587.00 $587.00 $587.00 $587.00 $587.00 $575.26 $575.26 HC MRI-CHEST All Payors / Plans All Payors / Plans 0610 71550 $988.00 $988.00 $988.00 $988.00 $988.00 $988.00 $988.00 $968.24 $968.24 HC MRI-CHEST W CONTRAST All Payors / Plans All Payors / Plans 0610 71551 " $1,080.00 " " $1,080.00 " " $1,080.00 " " $1,080.00 " " $1,080.00 " " $1,080.00 " " $1,080.00 " " $1,058.40 " " $1,058.40 " HC MRI-CHEST W/WO CONTRAST All Payors / Plans All Payors / Plans 0610 71552 " $1,348.00 " " $1,348.00 " " $1,348.00 " " $1,348.00 " " $1,348.00 " " $1,348.00 " " $1,348.00 " " $1,321.04 " " $1,321.04 " HC MRI-C-SPINE All Payors / Plans All Payors / Plans 0612 72141 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $423.36 $423.36 HC MRI-GUIDANCE TISSUE ABLATION All Payors / Plans All Payors / Plans 0610 77022 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $150.92 $150.92 HC MRI-L-SPINE All Payors / Plans All Payors / Plans 0612 72148 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $423.36 $423.36 HC MRI-L-SPINE W CONTRAST All Payors / Plans All Payors / Plans 0612 72149 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $655.62 $655.62 HC MRI-L-SPINE W/WO CONTRAST All Payors / Plans All Payors / Plans 0612 72158 $761.00 $761.00 $761.00 $761.00 $761.00 $761.00 $761.00 $745.78 $745.78 HC MRI-PELVIS All Payors / Plans All Payors / Plans 0610 72195 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $857.50 $857.50 HC MRI-PELVIS W CONTRAST All Payors / Plans All Payors / Plans 0610 72196 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $917.28 $917.28 HC MRI-PELVIS W/WO CONTRAST All Payors / Plans All Payors / Plans 0610 72197 " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,132.00 " " $1,109.36 " " $1,109.36 " HC MRI-T SPINE W/WO CONTRAST All Payors / Plans All Payors / Plans 0612 72157 $772.00 $772.00 $772.00 $772.00 $772.00 $772.00 $772.00 $756.56 $756.56 HC MRI-TMJ All Payors / Plans All Payors / Plans 0610 70336 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $705.60 $705.60 HC MRI-TMJ W CONTRAST All Payors / Plans All Payors / Plans 0610 70336 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $705.60 $705.60 HC MRI-TMJ W/WO CONTRAST All Payors / Plans All Payors / Plans 0610 70336 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $705.60 $705.60 HC MRI-T-SPINE All Payors / Plans All Payors / Plans 0612 72146 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $423.36 $423.36 HC MRI-T-SPINE W CONTRAST All Payors / Plans All Payors / Plans 0612 72147 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $665.42 $665.42 HC MRSA SCREEN CULTURE(MRSAC) All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC MTHFR MUTATION ANALYSIS, COMMON VARIANTS" All Payors / Plans All Payors / Plans 0300 81291 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $159.74 $159.74 HC MUGA-SINGLE STUDY All Payors / Plans All Payors / Plans 0340 78472 $878.00 $878.00 $878.00 $878.00 $878.00 $878.00 $878.00 $860.44 $860.44 HC MULT SLEEP LATENCY TEST All Payors / Plans All Payors / Plans 0740 95805 " $2,575.00 " " $2,575.00 " " $2,575.00 " " $2,575.00 " " $2,575.00 " " $2,575.00 " " $2,575.00 " " $2,523.50 " " $2,523.50 " HC MULTIPLE BIRTH - TRIPLETS All Payors / Plans All Payors / Plans 0720 " $1,377.00 " " $1,377.00 " " $1,377.00 " " $1,377.00 " " $1,377.00 " " $1,377.00 " " $1,377.00 " " $1,349.46 " " $1,349.46 " HC MULTIPLE BIRTH - TWINS All Payors / Plans All Payors / Plans 0720 $918.00 $918.00 $918.00 $918.00 $918.00 $918.00 $918.00 $899.64 $899.64 HC MULTIPLE BIRTH QUADS All Payors / Plans All Payors / Plans 0720 " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,836.00 " " $1,799.28 " " $1,799.28 " HC MULTIPLE DETERIMATION PULSE OX/EXERC All Payors / Plans All Payors / Plans 0460 94761 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $247.94 $247.94 HC MUMPS TITER (MUSE) All Payors / Plans All Payors / Plans 0300 86735 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC MURAMIDASE All Payors / Plans All Payors / Plans 0300 85549 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC MUSCLE BIOPSY All Payors / Plans All Payors / Plans 0310 88355 " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " $980.00 $980.00 "HC MUTYH GENE ANALYSIS, Y165C AND G382D" All Payors / Plans All Payors / Plans 0300 81401 $823.00 $823.00 $823.00 $823.00 $823.00 $823.00 $823.00 $806.54 $806.54 "HC MUTYH GENE, FULL GENE ANALYSIS (MYHZ)" All Payors / Plans All Payors / Plans 0300 81406 " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,102.50 " " $1,102.50 " HC MYCOPLASA All Payors / Plans All Payors / Plans 0300 87109 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC MYCOPLASMA GENITALIUM AMPLIFIED PROBE All Payors / Plans All Payors / Plans 0300 87563 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC MYCOPLASMA GENITALIUM PCR All Payors / Plans All Payors / Plans 0300 87563 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 "HC MYCOPLASMA PNEUMONIAE, AMP PROBE" All Payors / Plans All Payors / Plans 0300 87581 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC MYCOPLASMA SEROLOGY (MYSE) All Payors / Plans All Payors / Plans 0302 86738 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC MYD88 L265P GENE MUTATION ANALYSIS (MYD88) All Payors / Plans All Payors / Plans 0300 81305 $718.00 $718.00 $718.00 $718.00 $718.00 $718.00 $718.00 $703.64 $703.64 "HC MYD88, L265P, SOMATIC GENE MUTATION, SNA ALLELE-PCR" All Payors / Plans All Payors / Plans 0300 81479 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $700.70 $700.70 "HC MYELOGRAM, COMPLETE" All Payors / Plans All Payors / Plans 0320 72270 " $6,675.00 " " $6,675.00 " " $6,675.00 " " $6,675.00 " " $6,675.00 " " $6,675.00 " " $6,675.00 " " $6,541.50 " " $6,541.50 " "HC MYELOPROLIFERATIVE NEOPLASM,JAK2 V617F W REFLEX" All Payors / Plans All Payors / Plans 0300 81270 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $306.74 $306.74 "HC MYELOPROLIFETATIVE NEOPLASM, CALR W REFLEX MPL" All Payors / Plans All Payors / Plans 0300 81219 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $396.90 $396.90 HC MYOCARD STRAIN IMG SPECKLE TRCK ASSMT All Payors / Plans All Payors / Plans 0480 93356 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $31.36 $31.36 HC MYOCARDIAL PERF-SPECT/MULTI All Payors / Plans All Payors / Plans 0340 78452 " $1,904.00 " " $1,904.00 " " $1,904.00 " " $1,904.00 " " $1,904.00 " " $1,904.00 " " $1,904.00 " " $1,865.92 " " $1,865.92 " HC MYOCARDIAL PERF-SPECT/SINGLE All Payors / Plans All Payors / Plans 0341 78451 " $1,325.00 " " $1,325.00 " " $1,325.00 " " $1,325.00 " " $1,325.00 " " $1,325.00 " " $1,325.00 " " $1,298.50 " " $1,298.50 " HC MYOGLOBIN All Payors / Plans All Payors / Plans 0301 83874 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC N. GONO, AMPLIFIED PROBE" All Payors / Plans All Payors / Plans 0300 87591 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 "HC NARCOLEPSY ASSOC ANTIGEN, HLA-DQB1 TYPE, BLOOD" All Payors / Plans All Payors / Plans 0300 81376 $385.00 $385.00 $385.00 $385.00 $385.00 $385.00 $385.00 $377.30 $377.30 HC NASH FIBROSURE All Payors / Plans All Payors / Plans 0300 81599 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $164.64 $164.64 "HC NATURAL KILLER CELLS, TOTAL COUNT" All Payors / Plans All Payors / Plans 0300 86357 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC NEG PRESSURE WOUND TREATMENT >50CM All Payors / Plans All Payors / Plans 0761 97606 $583.00 $583.00 $583.00 $583.00 $583.00 $583.00 $583.00 $571.34 $571.34 HC NEONATAL CARE All Payors / Plans All Payors / Plans 0720 $612.00 $612.00 $612.00 $612.00 $612.00 $612.00 $612.00 $599.76 $599.76 HC NEONATE CRANIAL SONO All Payors / Plans All Payors / Plans 0402 76506 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $611.52 $611.52 "HC NEPHELOMETRY, EA ANALYTE (FLCP)" All Payors / Plans All Payors / Plans 0301 83521 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC NEPHELOMETRY, EA ANALYTE (MSP3)" All Payors / Plans All Payors / Plans 0301 83521 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC NEPHELOMETRY, EA ANALYTE NOT ELSEWHERE SPECIFIED" All Payors / Plans All Payors / Plans 0300 83883 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC NERVE BX All Payors / Plans All Payors / Plans 0310 88356 " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " $980.00 $980.00 HC NEUROMUSCULAR REEDUCATION All Payors / Plans All Payors / Plans 0420 97112 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 "HC NEURON SPECIFIC ENOLASE (NSE), SPINAL FLUID" All Payors / Plans All Payors / Plans 0300 83520 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC NEURONTIN,GABAPENTIN(GABA)" All Payors / Plans All Payors / Plans 0300 80171 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC NEWBORN SCREEN ONE(NBSCR1) All Payors / Plans All Payors / Plans 0300 84437 $458.00 $458.00 $458.00 $458.00 $458.00 $458.00 $458.00 $448.84 $448.84 HC NGS COLORECTAL CANCER PANEL All Payors / Plans All Payors / Plans 0310 81445 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $857.50 $857.50 HC NGS MELANOMA PANEL All Payors / Plans All Payors / Plans 0310 81445 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $857.50 $857.50 "HC NM BONE MARROW IMAGING, WHOLE BODY" All Payors / Plans All Payors / Plans 0340 78104 " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " " $1,010.00 " $989.80 $989.80 HC NM ESOPHAGEAL MOTILITY All Payors / Plans All Payors / Plans 0340 78258 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $892.78 $892.78 HC NM GA67 GALLIUM PER MCI All Payors / Plans All Payors / Plans 0343 A9556 $21.06 $21.06 $21.06 $21.06 $21.06 $21.06 $21.06 $20.64 $20.64 "HC NM GI GASTRIC SM BOWEL, COLON MULTI DAYS" All Payors / Plans All Payors / Plans 0340 78266 " $2,037.00 " " $2,037.00 " " $2,037.00 " " $2,037.00 " " $2,037.00 " " $2,037.00 " " $2,037.00 " " $1,996.26 " " $1,996.26 " HC NM GI GASTRIC W SM BOWEL TRANSIT All Payors / Plans All Payors / Plans 0340 78265 " $1,689.00 " " $1,689.00 " " $1,689.00 " " $1,689.00 " " $1,689.00 " " $1,689.00 " " $1,689.00 " " $1,655.22 " " $1,655.22 " HC NM I131 DX CAP PER MCI All Payors / Plans All Payors / Plans 0343 A9528 $9.98 $9.98 $9.98 $9.98 $9.98 $9.98 $9.98 $9.78 $9.78 HC NM I131 RX CAP 1ST MCI All Payors / Plans All Payors / Plans 0343 A9517 $79.57 $79.57 $79.57 $79.57 $79.57 $79.57 $79.57 $77.98 $77.98 HC NM I131 RX CAP EA ADD MCI All Payors / Plans All Payors / Plans 0343 A9517 $12.48 $12.48 $12.48 $12.48 $12.48 $12.48 $12.48 $12.23 $12.23 HC NM IN111 DTPA PER 0.5 MCI All Payors / Plans All Payors / Plans 0343 A9548 $446.56 $446.56 $446.56 $446.56 $446.56 $446.56 $446.56 $437.63 $437.63 HC NM IN111 OXINE PER 0.5 MCI All Payors / Plans All Payors / Plans 0343 A9547 " $1,572.48 " " $1,572.48 " " $1,572.48 " " $1,572.48 " " $1,572.48 " " $1,572.48 " " $1,572.48 " " $1,541.03 " " $1,541.03 " HC NM IN111 ZEVALIN DX All Payors / Plans All Payors / Plans 0343 A9542 " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,430.00 " " $3,430.00 " HC NM INDIUM 111 WBC All Payors / Plans All Payors / Plans 0343 A9570 " $2,119.09 " " $2,119.09 " " $2,119.09 " " $2,119.09 " " $2,119.09 " " $2,119.09 " " $2,119.09 " " $2,076.71 " " $2,076.71 " HC NM INJ RADIOACT TRAC SENT NODE All Payors / Plans All Payors / Plans 0360 38792 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $97.02 $97.02 "HC NM IODINE I-123 IOFLUPANE, DIAG, UP TO 5MCI" All Payors / Plans All Payors / Plans 0343 A9584 " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,641.50 " " $1,641.50 " HC NM KIDNEY SCAN-VAS FLOW/FUNCT W/O All Payors / Plans All Payors / Plans 0340 78707 $894.00 $894.00 $894.00 $894.00 $894.00 $894.00 $894.00 $876.12 $876.12 HC NM KIDNEY STATIC SCAN W/VASC FLOW All Payors / Plans All Payors / Plans 0340 78701 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $892.78 $892.78 HC NM KINEVAC All Payors / Plans All Payors / Plans 0343 $88.65 $88.65 $88.65 $88.65 $88.65 $88.65 $88.65 $86.88 $86.88 HC NM LIVER IMAGING SPECT All Payors / Plans All Payors / Plans 0340 78803 " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,379.84 " " $1,379.84 " HC NM P32 PHOSPHOCOL PER MCI All Payors / Plans All Payors / Plans 0343 A9564 " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,869.72 " " $4,869.72 " HC NM PROSTASCINT All Payors / Plans All Payors / Plans 0343 A4642 " $2,571.88 " " $2,571.88 " " $2,571.88 " " $2,571.88 " " $2,571.88 " " $2,571.88 " " $2,571.88 " " $2,520.44 " " $2,520.44 " HC NM PULM VENT IMAG AEROSOL-GAS All Payors / Plans All Payors / Plans 0340 78579 $778.00 $778.00 $778.00 $778.00 $778.00 $778.00 $778.00 $762.44 $762.44 HC NM PULMON PERFUSION QUAN DIFF All Payors / Plans All Payors / Plans 0340 78597 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $794.78 $794.78 HC NM PULMON PERFUSION VENT QUAN DIF All Payors / Plans All Payors / Plans 0340 78598 " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,275.00 " " $1,249.50 " " $1,249.50 " HC NM PULMONARY VENT PERFUSION IMAG All Payors / Plans All Payors / Plans 0340 78582 " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,330.84 " " $1,330.84 " HC NM QUADRAMET SR153 All Payors / Plans All Payors / Plans 0343 A9604 " $6,441.37 " " $6,441.37 " " $6,441.37 " " $6,441.37 " " $6,441.37 " " $6,441.37 " " $6,441.37 " " $6,312.54 " " $6,312.54 " HC NM SPECT CT QUANTIFICATION MEASUREMENT All Payors / Plans All Payors / Plans 0340 78835 $381.00 $381.00 $381.00 $381.00 $381.00 $381.00 $381.00 $373.38 $373.38 HC NM SR89 METASTRON PER MCI All Payors / Plans All Payors / Plans 0343 A9600 " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,969.10 " " $4,869.72 " " $4,869.72 " HC NM SULFUR COLLOID FILTERED 2 All Payors / Plans All Payors / Plans 0343 A9541 $285.84 $285.84 $285.84 $285.84 $285.84 $285.84 $285.84 $280.12 $280.12 HC NM SULFUR COLLOID TC99M FILTERED All Payors / Plans All Payors / Plans 0343 A9541 $571.68 $571.68 $571.68 $571.68 $571.68 $571.68 $571.68 $560.25 $560.25 HC NM TC99M DTPA AEROSOL All Payors / Plans All Payors / Plans 0343 A9567 $28.60 $28.60 $28.60 $28.60 $28.60 $28.60 $28.60 $28.03 $28.03 HC NM TC99M LABELED WBC PER DOSE All Payors / Plans All Payors / Plans 0343 A9569 " $1,834.14 " " $1,834.14 " " $1,834.14 " " $1,834.14 " " $1,834.14 " " $1,834.14 " " $1,834.14 " " $1,797.46 " " $1,797.46 " HC NM TC99M SESTAMIBI All Payors / Plans All Payors / Plans 0343 A9500 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC NM TC99M TC04 PER MCI All Payors / Plans All Payors / Plans 0343 A9512 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.59 $11.59 HC NM TL 201 PER MCI All Payors / Plans All Payors / Plans 0343 A9505 $15.45 $15.45 $15.45 $15.45 $15.45 $15.45 $15.45 $15.14 $15.14 HC NM TUMOR IMAGING-SPECT CT SINGLE AREA SINGLE DAY All Payors / Plans All Payors / Plans 0340 78830 " $1,987.00 " " $1,987.00 " " $1,987.00 " " $1,987.00 " " $1,987.00 " " $1,987.00 " " $1,987.00 " " $1,947.26 " " $1,947.26 " HC NM TUMOR IMAGING-SPECT CT SINGLE AREA/2 DAYS OR 2 AREAS/1DAY All Payors / Plans All Payors / Plans 0340 78832 " $3,892.00 " " $3,892.00 " " $3,892.00 " " $3,892.00 " " $3,892.00 " " $3,892.00 " " $3,892.00 " " $3,814.16 " " $3,814.16 " HC NM Y90 ZEVALIN RX All Payors / Plans All Payors / Plans 0343 A9543 " $35,000.00 " " $35,000.00 " " $35,000.00 " " $35,000.00 " " $35,000.00 " " $35,000.00 " " $35,000.00 " " $34,300.00 " " $34,300.00 " "HC NM YTTIRIUM-90, THERASPHERE GLASS MICROSPHERES, BRACHTHERAPY SOURCE" All Payors / Plans All Payors / Plans 0344 C2616 " $16,262.00 " " $16,262.00 " " $16,262.00 " " $16,262.00 " " $16,262.00 " " $16,262.00 " " $16,262.00 " " $15,936.76 " " $15,936.76 " "HC NMO/AQP4 FACS FLUORESCENT NONINFECTIOUS AB, SCREEN EA (NMOFS/NMOFC)" All Payors / Plans All Payors / Plans 0302 86053 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC NMO/AQP4-IGG CBA All Payors / Plans All Payors / Plans 0300 86255 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC NON-SCHED C-SEC W MINOR SURGERY All Payors / Plans All Payors / Plans 0720 " $5,966.00 " " $5,966.00 " " $5,966.00 " " $5,966.00 " " $5,966.00 " " $5,966.00 " " $5,966.00 " " $5,846.68 " " $5,846.68 " HC NON-SELECT DEBRIDEMENT/WOUND CARE All Payors / Plans All Payors / Plans 0420 97602 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC NON-STRESS TEST All Payors / Plans All Payors / Plans 0720 $764.00 $764.00 $764.00 $764.00 $764.00 $764.00 $764.00 $748.72 $748.72 HC NORPACE (NRPC) All Payors / Plans All Payors / Plans 0300 80299 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC NORTRIPTYLENE (NOR)(ELV) All Payors / Plans All Payors / Plans 0300 80335 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC NOSE-NASAL BONES All Payors / Plans All Payors / Plans 0320 70160 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC NRAS, GENE ANALYSIS, VARIANTS IN EXON 2,3" All Payors / Plans All Payors / Plans 0310 81311 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC NUCLEAR ANTIGEN ANTIBODY X8 All Payors / Plans All Payors / Plans 0300 86235 $560.00 $560.00 $560.00 $560.00 $560.00 $560.00 $560.00 $548.80 $548.80 HC OB 1ST TRIMESTER All Payors / Plans All Payors / Plans 0402 76801 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $535.08 $535.08 HC OB 2ND & 3RD TRIMESTER All Payors / Plans All Payors / Plans 0402 76805 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $662.48 $662.48 HC OB COMPLETE DETAILED All Payors / Plans All Payors / Plans 0402 76811 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $611.52 $611.52 HC OBSERVATION CARVE OUT All Payors / Plans All Payors / Plans 0762 G0378 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC OBSERVATION SERVICE All Payors / Plans All Payors / Plans 0762 G0378 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC OCCULT BLD FECES (OCB) All Payors / Plans All Payors / Plans 0300 82270 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 HC OCCULT BLOOD X2 All Payors / Plans All Payors / Plans 0300 82270 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC OCCULT BLOOD X3 All Payors / Plans All Payors / Plans 0300 82270 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OCTREOSCAN All Payors / Plans All Payors / Plans 0343 A9572 " $2,006.47 " " $2,006.47 " " $2,006.47 " " $2,006.47 " " $2,006.47 " " $2,006.47 " " $2,006.47 " " $1,966.34 " " $1,966.34 " HC OLIGOCLONAL IMMUNE(OLIGOCLONAL BANDS) All Payors / Plans All Payors / Plans 0300 83916 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ONCOSCINT All Payors / Plans All Payors / Plans 0343 " $1,915.05 " " $1,915.05 " " $1,915.05 " " $1,915.05 " " $1,915.05 " " $1,915.05 " " $1,915.05 " " $1,876.75 " " $1,876.75 " "HC ONE LOCUS (EG, HLA-DRB1,DRB3/4/5-DQB1,DQA1,DPB1,OR DPA1)EACH" All Payors / Plans All Payors / Plans 0300 81376 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $186.20 $186.20 HC OP APP M/L COMP UP ARM/FING 23-37 All Payors / Plans All Payors / Plans 0430 29584 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OP VISIT EST 0-10 MIN All Payors / Plans All Payors / Plans 0510 99211 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC OP VISIT EST 11-25 MIN All Payors / Plans All Payors / Plans 0510 99212 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC OP VISIT EST 26-45 MIN All Payors / Plans All Payors / Plans 0510 99213 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC OP VISIT EST 46-90 MIN All Payors / Plans All Payors / Plans 0510 99214 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC OP VISIT EST 90 MIN OR > All Payors / Plans All Payors / Plans 0510 99215 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 HC OP VISIT NEW 11-25 MIN All Payors / Plans All Payors / Plans 0510 99202 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC OP VISIT NEW 26-45 MIN All Payors / Plans All Payors / Plans 0510 99203 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC OP VISIT NEW 46-90 MIN All Payors / Plans All Payors / Plans 0510 99204 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $151.90 $151.90 HC OP VISIT NEW 90 MIN OR > All Payors / Plans All Payors / Plans 0510 99205 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $186.00 $182.28 $182.28 "HC OP VISIT, NEW 0-10 MIN" All Payors / Plans All Payors / Plans 0510 99202 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 HC OPER CHOLAGIOGRAM ADDITIONAL IMAGES All Payors / Plans All Payors / Plans 0320 74301 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC OPER CHOLANGIOGRM All Payors / Plans All Payors / Plans 0320 74300 " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,205.00 " " $2,205.00 " HC OPERATING ROOM (MINUTES) All Payors / Plans All Payors / Plans 0360 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OPIATE CONFIRMATION URINE All Payors / Plans All Payors / Plans 0300 80361 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC OPIATE CONFIRMATION, MECONIUM" All Payors / Plans All Payors / Plans 0300 80361 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC OPIATES, 5 OR MORE" All Payors / Plans All Payors / Plans 0300 80364 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC OPTILOCK NON-ADHESIVE 8X12 All Payors / Plans All Payors / Plans $6.58 $6.58 $6.58 $6.58 $6.58 $6.58 $6.58 $6.45 $6.45 HC ORBIT-FOREIGN BODY All Payors / Plans All Payors / Plans 0320 70030 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC ORBIT-FRACTURE All Payors / Plans All Payors / Plans 0320 70200 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 "HC ORGANIC ACID SCREEN, UR. (OASU)" All Payors / Plans All Payors / Plans 0300 83919 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 "HC ORGANISM REFERRED FOR ID, AEROBIC BACTERIA" All Payors / Plans All Payors / Plans 0300 87153 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC ORGANISM REFERRED FOR ID, ANAEROBIC BACTERIA(ISAN,ISAE)" All Payors / Plans All Payors / Plans 0300 87153 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $159.74 $159.74 "HC ORTHOPOXVIRUS(MONKEYPOX) DNA, PCR" All Payors / Plans All Payors / Plans 0300 87798 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 "HC OSMOLALITY,URINE (UOSM)" All Payors / Plans All Payors / Plans 0300 83935 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC OSTEOCALCIN All Payors / Plans All Payors / Plans 0300 83937 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT AP FINGER SPLINT DYNAMIC 23-37 All Payors / Plans All Payors / Plans 0430 29131 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC OT AP FINGER SPLINT DYNAMIC 38-52 All Payors / Plans All Payors / Plans 0430 29131 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $281.26 $281.26 HC OT AP FINGER SPLINT DYNAMIC 53-67 All Payors / Plans All Payors / Plans 0430 29131 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $375.34 $375.34 HC OT AP FINGER SPLINT DYNAMIC 68-82 All Payors / Plans All Payors / Plans 0430 29131 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $469.42 $469.42 HC OT AP FINGER SPLINT DYNAMIC 8-22 All Payors / Plans All Payors / Plans 0430 29131 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC OT AP FINGER SPLINT STATIC 23-37 All Payors / Plans All Payors / Plans 0430 29130 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $149.94 $149.94 HC OT AP FINGER SPLINT STATIC 38-52 All Payors / Plans All Payors / Plans 0430 29130 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT AP FINGER SPLINT STATIC 53-67 All Payors / Plans All Payors / Plans 0430 29130 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $299.88 $299.88 HC OT AP FINGER SPLINT STATIC 8-22 All Payors / Plans All Payors / Plans 0430 29130 $77.00 $77.00 $77.00 $77.00 $77.00 $77.00 $77.00 $75.46 $75.46 HC OT AP SHORT ARM SPL DYNAMIC 23-37 All Payors / Plans All Payors / Plans 0430 29126 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT AP SHORT ARM SPL DYNAMIC 38-52 All Payors / Plans All Payors / Plans 0430 29126 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT AP SHORT ARM SPL DYNAMIC 53-67 All Payors / Plans All Payors / Plans 0430 29126 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT AP SHORT ARM SPL DYNAMIC 68-82 All Payors / Plans All Payors / Plans 0430 29126 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $562.52 $562.52 HC OT AP SHORT ARM SPL DYNAMIC 8-22 All Payors / Plans All Payors / Plans 0430 29126 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT AP SHORT ARM SPL STATIC 23-37 All Payors / Plans All Payors / Plans 0430 29125 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC OT AP SHORT ARM SPL STATIC 38-52 All Payors / Plans All Payors / Plans 0430 29125 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $281.26 $281.26 HC OT AP SHORT ARM SPL STATIC 68-82 All Payors / Plans All Payors / Plans 0430 29125 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $469.42 $469.42 HC OT AP SHORT ARM SPL STATIC 8-22 All Payors / Plans All Payors / Plans 0430 29125 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC OT AP SHRT LEG SP CALF-FOOT 53-67 All Payors / Plans All Payors / Plans 0530 29515 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $375.34 $375.34 HC OT AP SHRT LEG SP CALF-FOOT 68-82 All Payors / Plans All Payors / Plans 0430 29515 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $469.42 $469.42 HC OT AP SHRT LEG SPL CALF-FOOT 8-22 All Payors / Plans All Payors / Plans 0430 29515 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC OT AP SHRT LEG SPL CALF-FOOT23-37 All Payors / Plans All Payors / Plans 0430 29515 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC OT AP SHRT LEG SPL CALF-FOOT38-52 All Payors / Plans All Payors / Plans 0430 29515 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $281.26 $281.26 HC OT APP M/L COMP L LEG/FT 23-37 All Payors / Plans All Payors / Plans 0430 29581 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC OT APP M/L COMP L LEG/FT 38-52 All Payors / Plans All Payors / Plans 0430 29581 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $281.26 $281.26 HC OT APP M/L COMP L LEG/FT 53-67 All Payors / Plans All Payors / Plans 0430 29581 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $375.34 $375.34 HC OT APP M/L COMP L LEG/FT 8-22 All Payors / Plans All Payors / Plans 0430 29581 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC OT APP M/L COMP UP ARM/FING 38-52 All Payors / Plans All Payors / Plans 0430 29584 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT APP M/L COMP UP ARM/FING 53-67 All Payors / Plans All Payors / Plans 0430 29584 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT APP M/L COMP UP ARM/FING 68-82 All Payors / Plans All Payors / Plans 0430 29584 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $562.52 $562.52 HC OT APP M/L COMP UP ARM/FING 8-22 All Payors / Plans All Payors / Plans 0430 29584 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT APP M/L COMP UP ARM/FOR 23-37 All Payors / Plans All Payors / Plans 0430 29583 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC OT APP M/L COMP UP ARM/FOR 38-52 All Payors / Plans All Payors / Plans 0430 29583 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $281.26 $281.26 HC OT APP M/L COMP UP ARM/FOR 53-67 All Payors / Plans All Payors / Plans 0430 29583 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $375.34 $375.34 HC OT APP M/L COMP UP ARM/FOR 68-73 All Payors / Plans All Payors / Plans 0430 29583 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $469.42 $469.42 HC OT APP M/L COMP UP ARM/FOR 8-22 All Payors / Plans All Payors / Plans 0430 29583 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC OT APP M/L L LEG/FT 68-82 All Payors / Plans All Payors / Plans 0430 29581 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $479.00 $469.42 $469.42 HC OT APP MLT-LAY COMP THI/LEG 23-37 All Payors / Plans All Payors / Plans 0430 29582 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT APP MLT-LAY COMP THI/LEG 38-52 All Payors / Plans All Payors / Plans 0430 29582 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT APP MLT-LAY COMP THI/LEG 53-67 All Payors / Plans All Payors / Plans 0430 29582 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT APP MLT-LAY COMP THI/LEG 8-22 All Payors / Plans All Payors / Plans 0430 29582 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT APP MLT-LAY COMP THI/LEG68-73 All Payors / Plans All Payors / Plans 0430 29582 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $562.52 $562.52 HC OT AS/AD EQUIP GRP 8-22 MIN 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT ASSIST/ADAPT EQUIP 8-22 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT ASSIST/ADAPT EQUIP 8-22 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT COGNITIVE SKILL 15 MIN 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT COGNITIVE SKILLS 15 MIN 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT COGNITIVE SKILLS 15 MIN 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT COGNITIVE SLILLS IND EA ADD'L 15 MIN All Payors / Plans All Payors / Plans 0430 97130 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT COGNITIVIE SKILLS IND INITIAL 15 MIN All Payors / Plans All Payors / Plans 0430 97129 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT COMM/WORK REINTEGRATION 15 MIN All Payors / Plans All Payors / Plans 0430 97537 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT CONTRAST BATH 15 MIN All Payors / Plans All Payors / Plans 0430 97034 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $28.42 $28.42 HC OT DAILY LIVING SKILLS 15 MIN All Payors / Plans All Payors / Plans 0430 97535 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT DAILY LIVING SKILLS 15 MIN 2PT All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT DAILY LIVING SKILLS 15MIN 4PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT DEVEL SCREEN W INTER RPT 23-37 All Payors / Plans All Payors / Plans 0430 96110 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $168.56 $168.56 HC OT DEVEL SCREEN W INTER RPT 38-52 All Payors / Plans All Payors / Plans 0430 96110 $258.00 $258.00 $258.00 $258.00 $258.00 $258.00 $258.00 $252.84 $252.84 HC OT DEVEL SCREEN W INTER RPT 53-67 All Payors / Plans All Payors / Plans 0430 96110 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT DEVEL SCREEN W INTER RPT 68-82 All Payors / Plans All Payors / Plans 0430 96110 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $422.38 $422.38 HC OT DEVEL SCREEN W INTER RPT 8-22 All Payors / Plans All Payors / Plans 0430 96110 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT DEVEL TEST EXT W/INT RPT 15MIN All Payors / Plans All Payors / Plans 0430 96110 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT ELEC STIMUL MANUAL 15 MIN All Payors / Plans All Payors / Plans 0430 97032 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT EVALUATION HIGH COMPLEXITY 23-37 All Payors / Plans All Payors / Plans 0430 97167 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT EVALUATION HIGH COMPLEXITY 38-52 All Payors / Plans All Payors / Plans 0430 97167 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT EVALUATION HIGH COMPLEXITY 53-67 All Payors / Plans All Payors / Plans 0430 97167 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT EVALUATION HIGH COMPLEXITY 8-22 All Payors / Plans All Payors / Plans 0430 97167 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT EVALUATION LOW COMPLEXITY 23-37 All Payors / Plans All Payors / Plans 0430 97165 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT EVALUATION LOW COMPLEXITY 38-52 All Payors / Plans All Payors / Plans 0430 97165 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT EVALUATION LOW COMPLEXITY 53-67 All Payors / Plans All Payors / Plans 0430 97165 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT EVALUATION LOW COMPLEXITY 8-22 All Payors / Plans All Payors / Plans 0430 97165 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT EVALUATION MOD COMPLEXITY 23-37 All Payors / Plans All Payors / Plans 0430 97166 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT EVALUATION MOD COMPLEXITY 38-52 All Payors / Plans All Payors / Plans 0430 97166 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT EVALUATION MOD COMPLEXITY 53-67 All Payors / Plans All Payors / Plans 0430 97166 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT EVALUATION MOD COMPLEXITY 8-22 All Payors / Plans All Payors / Plans 0430 97166 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT FINGER SPLINT STATIC 68-82 All Payors / Plans All Payors / Plans 0430 29130 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $375.34 $375.34 HC OT FLUIDTHERAPY 23-37 All Payors / Plans All Payors / Plans 0430 97039 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT FLUIDTHERAPY 8-22 All Payors / Plans All Payors / Plans 0430 97039 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $18.62 $18.62 HC OT FUNCTIONAL ACTIVITY 15 MIN TH All Payors / Plans All Payors / Plans 0430 97530 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $65.66 $65.66 HC OT IONTOPHORESIS 15 MIN All Payors / Plans All Payors / Plans 0430 97033 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT LNG ARM SPLNT SHLDR-HAND 23-37 All Payors / Plans All Payors / Plans 0430 29105 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT LNG ARM SPLNT SHLDR-HAND 38-52 All Payors / Plans All Payors / Plans 0430 29105 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT LNG ARM SPLNT SHLDR-HAND 53-67 All Payors / Plans All Payors / Plans 0430 29105 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT LNG ARM SPLNT SHLDR-HAND 68-82 All Payors / Plans All Payors / Plans 0430 29105 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $562.52 $562.52 HC OT LNG ARM SPLNT SHLDR-HAND 8-22 All Payors / Plans All Payors / Plans 0430 29105 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT LNG LEG SPL THI-ANK/TOES 23-37 All Payors / Plans All Payors / Plans 0430 29505 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT LNG LEG SPL THI-ANK/TOES 38-52 All Payors / Plans All Payors / Plans 0430 29505 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $338.10 $338.10 HC OT LNG LEG SPL THI-ANK/TOES 53-67 All Payors / Plans All Payors / Plans 0430 29505 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC OT LNG LEG SPL THI-ANK/TOES 68-82 All Payors / Plans All Payors / Plans 0430 29505 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $574.00 $562.52 $562.52 HC OT LNG LEG SPL THI-ANK/TOES 8-22 All Payors / Plans All Payors / Plans 0430 29505 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT MANUAL THERAPY 15 MIN All Payors / Plans All Payors / Plans 0430 97140 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT MASSAGE 15 MIN All Payors / Plans All Payors / Plans 0430 97124 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT MECHANICAL TRACT 23-37 All Payors / Plans All Payors / Plans 0430 97012 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT MECHANICAL TRACT 38-52 All Payors / Plans All Payors / Plans 0430 97012 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT MECHANICAL TRACT 53-67 All Payors / Plans All Payors / Plans 0430 97012 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT MECHANICAL TRACT 8-22 All Payors / Plans All Payors / Plans 0430 97012 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OT NEUROMUSCULAR REED 15 MIN All Payors / Plans All Payors / Plans 0430 97112 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT ORTHOTIC MGMT 15 MIN All Payors / Plans All Payors / Plans 0430 97760 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT PARAFFIN BATH 38-52 All Payors / Plans All Payors / Plans 0430 97018 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT PARAFFIN BATH 53-67 All Payors / Plans All Payors / Plans 0430 97018 $77.00 $77.00 $77.00 $77.00 $77.00 $77.00 $77.00 $75.46 $75.46 HC OT PARAFFIN BATH 68-82 All Payors / Plans All Payors / Plans 0430 97018 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC OT PARAFFIN BATH 8-22 All Payors / Plans All Payors / Plans 0430 97018 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $18.62 $18.62 HC OT PROSTHETIC TRAIN UP/LOW EXT 15 All Payors / Plans All Payors / Plans 0430 97761 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT PSY/SOCIAL SKILLS 23-37 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT PSY/SOCIAL SKILLS 23-37 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT PSY/SOCIAL SKILLS 23-47 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT PSY/SOCIAL SKILLS 38-52 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT PSY/SOCIAL SKILLS 38-52 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT PSY/SOCIAL SKILLS 38-52 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT PSY/SOCIAL SKILLS 53-67 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT PSY/SOCIAL SKILLS 53-67 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT PSY/SOCIAL SKILLS 53-67 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT PSY/SOCIAL SKILLS 8-22 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT PSY/SOCIAL SKILLS 8-22 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT PSY/SOCIAL SKILLS 8-22 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT PSY/SOCIAL SKILLS IND 23-37 All Payors / Plans All Payors / Plans 0430 97127 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 HC OT PSY/SOCIAL SKILLS IND 38-52 All Payors / Plans All Payors / Plans 0430 97127 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $141.12 $141.12 HC OT PSY/SOCIAL SKILLS IND 53-67 All Payors / Plans All Payors / Plans 0430 97127 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC OT PSY/SOCIAL SKILLS IND 8-22 All Payors / Plans All Payors / Plans 0430 97127 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT REASSESSMENT INDIVIDUAL 23-37 All Payors / Plans All Payors / Plans 0430 97168 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $168.56 $168.56 HC OT REASSESSMENT INDIVIDUAL 38-52 All Payors / Plans All Payors / Plans 0430 97168 $258.00 $258.00 $258.00 $258.00 $258.00 $258.00 $258.00 $252.84 $252.84 HC OT REASSESSMENT INDIVIDUAL 53-67 All Payors / Plans All Payors / Plans 0430 97168 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $328.30 $328.30 HC OT REASSESSMENT INDIVIDUAL 8-22 All Payors / Plans All Payors / Plans 0430 97168 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT RECHECK PROST/ORTH 15 MIN All Payors / Plans All Payors / Plans 0430 97763 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT SHORT ARM SPL STATIC 53-67 All Payors / Plans All Payors / Plans 0430 29125 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $375.34 $375.34 HC OT STANDARD COGNIT TEST 31MINOR> All Payors / Plans All Payors / Plans 0430 96125 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT STRAPPING UNNA BOOT 23-37 All Payors / Plans All Payors / Plans 0430 29580 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT STRAPPING UNNA BOOT 38-52 All Payors / Plans All Payors / Plans 0430 29580 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $168.56 $168.56 HC OT STRAPPING UNNA BOOT 53-67 All Payors / Plans All Payors / Plans 0430 29580 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT STRAPPING UNNA BOOT 68-82 All Payors / Plans All Payors / Plans 0430 29580 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $281.26 $281.26 HC OT STRAPPING UNNA BOOT 8-22 All Payors / Plans All Payors / Plans 0430 29580 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT TENS NEUROSTIMULATOR 23-37 All Payors / Plans All Payors / Plans 0430 64550 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $78.40 $78.40 HC OT TENS NEUROSTIMULATOR 38-52 All Payors / Plans All Payors / Plans 0430 64550 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $117.60 $117.60 HC OT TENS NEUROSTIMULATOR 53-67 All Payors / Plans All Payors / Plans 0430 64550 $159.00 $159.00 $159.00 $159.00 $159.00 $159.00 $159.00 $155.82 $155.82 HC OT TENS NEUROSTIMULATOR 68-83 All Payors / Plans All Payors / Plans 0430 64550 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $195.02 $195.02 HC OT TENS NEUROSTIMULATOR 8-22 All Payors / Plans All Payors / Plans 0430 64550 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT THERAPEUTIC EXERCISE 15 MIN TH All Payors / Plans All Payors / Plans 0430 97110 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT TRMT SENSORIMO 15 MIN 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT TRMT/PREVENT 23-37 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT TRMT/PREVENT 23-37 MIN 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT TRMT/PREVENT 23-37 MIN 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT TRMT/PREVENT 38-52 MIN 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT TRMT/PREVENT 38-52 MIN 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT TRMT/PREVENT 38-52 MIN 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT TRMT/PREVENT 53-67 MIN 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT TRMT/PREVENT 53-67 MIN 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT TRMT/PREVENT 53-67 MIN 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT TRMT/PREVENT 8-22 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT TRMT/PREVENT 8-22 MIN 2 PTS All Payors / Plans All Payors / Plans 0430 97150 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $55.86 $55.86 HC OT TRMT/PREVENT 8-22 MIN 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT TRMT/SENSORIMO 15 MIN 3 PTS All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC OT TRMT/SENSORIMO 15 MIN 4 PTS All Payors / Plans All Payors / Plans 0430 97150 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT TRMT/SENSORIMO IND 15 MIN All Payors / Plans All Payors / Plans 0430 97533 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OT ULTRASOUND 15 MIN All Payors / Plans All Payors / Plans 0430 97035 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $28.42 $28.42 HC OT WC SELECT DEBRIDE <= 20 CM All Payors / Plans All Payors / Plans 0430 97597 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $112.70 $112.70 HC OT WC SELECT DEBRIDE > 20 CM All Payors / Plans All Payors / Plans 0430 97598 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $225.40 $225.40 HC OT WHEELCHAIR MGMT/PROP 15 MIN All Payors / Plans All Payors / Plans 0430 97542 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $47.04 $47.04 HC OUTPATIENT MATERNAL INTENSIVE CARE All Payors / Plans All Payors / Plans 0720 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $299.88 $299.88 HC OUTPATIENT MATERNAL OBSERVATION All Payors / Plans All Payors / Plans 0720 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $149.94 $149.94 HC OVA AND PARASITES COMPLEX SMEAR All Payors / Plans All Payors / Plans 0300 87209 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC OXCARBAZEPINE All Payors / Plans All Payors / Plans 0300 80183 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC OXYCODONE W METABOLITE All Payors / Plans All Payors / Plans 0300 80365 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC OXYGEN THERAPY INITIAL DAY All Payors / Plans All Payors / Plans 0410 94799 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $54.88 $54.88 HC OXYGEN THERAPY SUBSEQ DAY All Payors / Plans All Payors / Plans 0410 94799 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $54.88 $54.88 HC P/Q TYPE CALCIUM CHANNEL AB QUANT BY RADIOIMMUNOASSAY All Payors / Plans All Payors / Plans 0302 86596 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC P32 All Payors / Plans All Payors / Plans 0343 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC PACEMAKER All Payors / Plans All Payors / Plans " $7,400.00 " " $7,400.00 " " $7,400.00 " " $7,400.00 " " $7,400.00 " " $7,400.00 " " $7,400.00 " " $7,252.00 " " $7,252.00 " HC PAIN CLINIC DRUG SCREEN All Payors / Plans All Payors / Plans 0300 80307 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $137.20 $137.20 HC PALADIUM RADIOELEMENT BRACHYTHER All Payors / Plans All Payors / Plans 0270 Q3001 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 "HC PANCREATIC ELASTASE, FECES" All Payors / Plans All Payors / Plans 0300 82653 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 "HC PANCREATIC ELASTASE, FECES" All Payors / Plans All Payors / Plans 0300 83520 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC PANCREATIC ELASTASE-1 All Payors / Plans All Payors / Plans 0300 82656 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC PANOREX All Payors / Plans All Payors / Plans 0320 70355 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 HC PARAFFIN BATH All Payors / Plans All Payors / Plans 0430 97018 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PARAFFIN BATH 23-37 MIN All Payors / Plans All Payors / Plans 0420 97018 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $69.58 $69.58 HC PARAFFIN BATH 38-52 MIN All Payors / Plans All Payors / Plans 0420 97018 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC PARAFFIN BATH 53-67 MIN All Payors / Plans All Payors / Plans 0420 97018 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $139.16 $139.16 HC PARAFFIN BATH 68-82 All Payors / Plans All Payors / Plans 0420 97018 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC PARAFFIN BATH 8-22 MIN All Payors / Plans All Payors / Plans 0420 97018 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 HC PARANEOPLASTIC AUTOANTIBODY EVAL. All Payors / Plans All Payors / Plans 0300 83520 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $671.30 $671.30 HC PARATHORMONE All Payors / Plans All Payors / Plans 0300 83970 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PARATHYROID PLANAR INC SUBTR All Payors / Plans All Payors / Plans 0340 78070 " $1,259.00 " " $1,259.00 " " $1,259.00 " " $1,259.00 " " $1,259.00 " " $1,259.00 " " $1,259.00 " " $1,233.82 " " $1,233.82 " HC PARATHYROID SCAN W SPECT All Payors / Plans All Payors / Plans 0340 78071 " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,441.00 " " $1,412.18 " " $1,412.18 " HC PARATHYROID SCAN W SPECT & CT All Payors / Plans All Payors / Plans 0340 78072 " $1,623.00 " " $1,623.00 " " $1,623.00 " " $1,623.00 " " $1,623.00 " " $1,623.00 " " $1,623.00 " " $1,590.54 " " $1,590.54 " HC PARIETAL CELL ANTIBODIES (PCABS) All Payors / Plans All Payors / Plans 0300 83516 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC PARING BENIGN LESION - 2-4 All Payors / Plans All Payors / Plans 0761 11056 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $357.70 $357.70 HC PARING BENIGN LESION - ONE All Payors / Plans All Payors / Plans 0761 11055 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $273.42 $273.42 HC PARING BENIGN LESION >4 All Payors / Plans All Payors / Plans 0761 11057 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $476.28 $476.28 HC PARVOVIRUS All Payors / Plans All Payors / Plans 0302 86747 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC PATIENT BLOOD TYPE (BTY) All Payors / Plans All Payors / Plans 0300 86900 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC PBP2A TEST All Payors / Plans All Payors / Plans 0306 87147 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC PEDIATRIC DENTAL CHARGE All Payors / Plans All Payors / Plans $84.80 $84.80 $84.80 $84.80 $84.80 $84.80 $84.80 $83.10 $83.10 HC PELVIC SONOGRAM All Payors / Plans All Payors / Plans 0402 76856 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $535.08 $535.08 HC PELVIS All Payors / Plans All Payors / Plans 0320 72170 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC PELVIS/HIPS All Payors / Plans All Payors / Plans 0320 73523 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $280.28 $280.28 HC PERICARDIALCENTESIS W/ECHO All Payors / Plans All Payors / Plans 0480 76930 " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,470.00 " " $1,470.00 " HC PERIODIC ACID-SCHIFF (PAS) ST All Payors / Plans All Payors / Plans 0310 88313 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC PERIPHERAL ARTERIAL DISEASE REHAB All Payors / Plans All Payors / Plans 0943 93668 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC PERITONEAL DIALYSIS SUPPLY All Payors / Plans All Payors / Plans $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $117.60 $117.60 HC PERITONEAL FLD. ANALYSIS (PERTFA) All Payors / Plans All Payors / Plans 0300 84157 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $130.34 $130.34 HC PERITONEAL VENOUS SHUNT All Payors / Plans All Payors / Plans 0340 78291 " $1,027.00 " " $1,027.00 " " $1,027.00 " " $1,027.00 " " $1,027.00 " " $1,027.00 " " $1,027.00 " " $1,006.46 " " $1,006.46 " HC PEROXIDASE STAIN HEMO (POD) All Payors / Plans All Payors / Plans 0300 88319 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC PF ARTERIAL GASES All Payors / Plans All Payors / Plans 0460 36600 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $143.08 $143.08 HC PF BLOOD GAS ANALYSIS All Payors / Plans All Payors / Plans 0300 82803 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC PF CO-OX ANALYSIS (PCABG) All Payors / Plans All Payors / Plans 0300 36600 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PF PULSE OX All Payors / Plans All Payors / Plans 0460 94760 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 HC PF PULSE OX All Payors / Plans All Payors / Plans 0460 94760 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 "HC PH, BODY FLUID, EXCEPT BLOOD" All Payors / Plans All Payors / Plans 0301 83986 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 "HC PH, HLA MATCHED LEUKORED, EA UNIT" All Payors / Plans All Payors / Plans 0390 P9052 " $1,367.00 " " $1,367.00 " " $1,367.00 " " $1,367.00 " " $1,367.00 " " $1,367.00 " " $1,367.00 " " $1,339.66 " " $1,339.66 " HC PHENCYCLIDINE All Payors / Plans All Payors / Plans 0300 83992 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PHENOBARBITAL (PHEN) All Payors / Plans All Payors / Plans 0300 80184 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PHERESIS (PLATELETS) All Payors / Plans All Payors / Plans 0390 P9035 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $539.00 $539.00 HC PHLEBOTOMY (PHLE) All Payors / Plans All Payors / Plans 0940 99195 $94.50 $94.50 $94.50 $94.50 $94.50 $94.50 $94.50 $92.61 $92.61 HC PHLEBOTOMY-THERAPEUTIC All Payors / Plans All Payors / Plans 0940 99195 $94.50 $94.50 $94.50 $94.50 $94.50 $94.50 $94.50 $92.61 $92.61 "HC PHOSPHOLIPID, HEXAGONAL" All Payors / Plans All Payors / Plans 0300 85598 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC PHOSPHORUS INORGANIC (PHOSPHATE) All Payors / Plans All Payors / Plans 0301 84100 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 "HC PHOSPHORUS, URINE 24HR." All Payors / Plans All Payors / Plans 0300 84105 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC PHYSICS CONSULTATION All Payors / Plans All Payors / Plans 0333 77370 $393.00 $393.00 $393.00 $393.00 $393.00 $393.00 $393.00 $385.14 $385.14 "HC PHYSICS, CONSULT., CONT." All Payors / Plans All Payors / Plans 0333 77336 $258.00 $258.00 $258.00 $258.00 $258.00 $258.00 $258.00 $252.84 $252.84 HC PINWORM PREP All Payors / Plans All Payors / Plans 0300 87172 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 HC PLASMA HGB (PHGB) All Payors / Plans All Payors / Plans 0300 83051 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC PLASMA PROCESSING FEE All Payors / Plans All Payors / Plans 0390 P9017 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 HC PLASMINOGEN ACTIVITY All Payors / Plans All Payors / Plans 0300 85420 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC PLATELET ANTIBODIES All Payors / Plans All Payors / Plans 0302 86022 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC PLATELET COUNT All Payors / Plans All Payors / Plans 0305 85049 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC PLATELET FUNCTION All Payors / Plans All Payors / Plans 0300 85576 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC PLATELET NEUTRALIZATION All Payors / Plans All Payors / Plans 0305 85597 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC PLATELET PHERESIS LEUKOREDUCED IRRADIATED All Payors / Plans All Payors / Plans 0390 P9037 $609.00 $609.00 $609.00 $609.00 $609.00 $609.00 $609.00 $596.82 $596.82 "HC PML/RARA QUANT, PCR" All Payors / Plans All Payors / Plans 0300 81315 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $514.50 $514.50 HC PNEUMOCOCCAL ADMINISTRATION All Payors / Plans All Payors / Plans 0771 G0009 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC POLYMEM 4X12.5 All Payors / Plans All Payors / Plans $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $21.66 $21.66 HC POLYMEM 4X4 All Payors / Plans All Payors / Plans $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $6.86 $6.86 HC POLYSOM AGE <6 W/PARAM 4OR> All Payors / Plans All Payors / Plans 0740 95782 " $6,275.00 " " $6,275.00 " " $6,275.00 " " $6,275.00 " " $6,275.00 " " $6,275.00 " " $6,275.00 " " $6,149.50 " " $6,149.50 " HC POLYSOM AGE 6> SPLIT/CPAP All Payors / Plans All Payors / Plans 0740 95811 " $3,700.00 " " $3,700.00 " " $3,700.00 " " $3,700.00 " " $3,700.00 " " $3,700.00 " " $3,700.00 " " $3,626.00 " " $3,626.00 " HC POLYSOM AGE 6>W/PARAM 4 OR> All Payors / Plans All Payors / Plans 0740 95810 " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,430.00 " " $3,430.00 " "HC PORPHYRINS, URINE, QUANTIFICATION, FRACTIONATION" All Payors / Plans All Payors / Plans 0300 84120 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $86.24 $86.24 HC PORT FILMS All Payors / Plans All Payors / Plans 0333 77417 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $36.26 $36.26 HC POST GLUCOSE TEST All Payors / Plans All Payors / Plans 0301 82952 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC POTASSIUM (K) All Payors / Plans All Payors / Plans 0301 84132 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC POTASSIUM URINE All Payors / Plans All Payors / Plans 0301 84133 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC PPD SKIN TEST All Payors / Plans All Payors / Plans 0302 86580 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC PQNU All Payors / Plans All Payors / Plans 0300 84110 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 HC PRE-ALBUMIN All Payors / Plans All Payors / Plans 0300 84134 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PREGNANCY EXAM MULTIPLE GESTATION All Payors / Plans All Payors / Plans 0402 76810 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $305.76 $305.76 HC PREGNENOLONE All Payors / Plans All Payors / Plans 0300 84140 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC PRENATAL DRUG SCREEN & BUPRENORPHINE,URINE" All Payors / Plans All Payors / Plans 0300 80307 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $176.40 $176.40 HC PRENATAL DRUG SCRN. (PNDS) All Payors / Plans All Payors / Plans 0300 80307 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC PRENATAL PROFILE (PNP) All Payors / Plans All Payors / Plans 0300 80055 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $186.20 $186.20 HC PRENATAL PROFILE INC HIV All Payors / Plans All Payors / Plans 0300 80081 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $247.94 $247.94 HC PRE-OP/POST-OP CARE All Payors / Plans All Payors / Plans 0710 " $1,061.00 " " $1,061.00 " " $1,061.00 " " $1,061.00 " " $1,061.00 " " $1,061.00 " " $1,061.00 " " $1,039.78 " " $1,039.78 " HC PRESUMPTIVE ANAEROBIC ID All Payors / Plans All Payors / Plans 0300 87075 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC PRESUMPTIVE IDENTIFICATION X 1 All Payors / Plans All Payors / Plans 0300 87088 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC PRIMIDONE All Payors / Plans All Payors / Plans 0300 80188 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC PROBE, +2 (BILL ONLY)" All Payors / Plans All Payors / Plans 0300 88271 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC PROCAINAMIDE (PRO)(PRON) All Payors / Plans All Payors / Plans 0300 80190 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PROCALCITONIN (PCT) All Payors / Plans All Payors / Plans 0300 84145 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC PROFORE BANDAGE COMPRESSION PAD All Payors / Plans All Payors / Plans $8.80 $8.80 $8.80 $8.80 $8.80 $8.80 $8.80 $8.62 $8.62 HC PROFORE WRAPS All Payors / Plans All Payors / Plans $13.52 $13.52 $13.52 $13.52 $13.52 $13.52 $13.52 $13.25 $13.25 HC PROGESTERONE (PROG) All Payors / Plans All Payors / Plans 0300 84144 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PROLACTIN (PROL) All Payors / Plans All Payors / Plans 0300 84146 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC PROLACTIN, DILUTED" All Payors / Plans All Payors / Plans 0300 84146 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC PROLONGED ACID REFLUX TEST All Payors / Plans All Payors / Plans 0750 91034 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PROMETHEUS FIBROSPECT II All Payors / Plans All Payors / Plans 0300 83883 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PROMETHEUS FIBROSPECT II All Payors / Plans All Payors / Plans 0300 83520 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC PROMETHEUS IBD IMMUNOASSAY, NOT OTHERWISE SPEC(FIBDD)" All Payors / Plans All Payors / Plans 0300 83520 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $159.74 $159.74 HC PROMETHEUS LACTOTYPE All Payors / Plans All Payors / Plans 0300 81400 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC PROMETHEUS TPMT GENETICS All Payors / Plans All Payors / Plans 0300 81401 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $478.24 $478.24 HC PROMOGRAN/PRISMA 4.34 SQ IN All Payors / Plans All Payors / Plans $9.80 $9.80 $9.80 $9.80 $9.80 $9.80 $9.80 $9.60 $9.60 HC PROSTATIC ACID PHOSPHATASE (PACP) All Payors / Plans All Payors / Plans 0300 84066 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC PROSTHETIC TRAIN UP/LOW 15MIN All Payors / Plans All Payors / Plans 0420 97761 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC PROTEIN (TP) All Payors / Plans All Payors / Plans 0301 84155 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC PROTEIN C (PROTC) All Payors / Plans All Payors / Plans 0300 85302 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC PROTEIN ELECTROPHORETIC, OTHE FLUIDS" All Payors / Plans All Payors / Plans 0301 84166 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC PROTEIN E'PHORES (PE) All Payors / Plans All Payors / Plans 0300 84165 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC PROTEIN S AG, TL" All Payors / Plans All Payors / Plans 0300 85305 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC PROTEIN S FREE All Payors / Plans All Payors / Plans 0305 85306 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC PROTEIN TOTAL URINE All Payors / Plans All Payors / Plans 0301 84156 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC PROTEIN URINE (UP24) All Payors / Plans All Payors / Plans 0300 84156 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC PROTHROMBIN 20210 MUTATION (PTGM) All Payors / Plans All Payors / Plans 0300 81240 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC PROTHROMBIN TIME (PROT)(PROS) All Payors / Plans All Payors / Plans 0305 85610 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 "HC PROTOPORPHYRINS,FRAC,RBC (PFE)" All Payors / Plans All Payors / Plans 0300 84202 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $132.30 $132.30 HC PSA SCREEN (PSAS) All Payors / Plans All Payors / Plans 0300 G0103 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC PSA TOTAL All Payors / Plans All Payors / Plans 0301 84153 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC PSOORALEN TREATED PLATELETS All Payors / Plans All Payors / Plans 0390 P9073 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $637.00 $637.00 HC PSYCHIATRIC DIAGNOSTIC EVALUATION All Payors / Plans All Payors / Plans 0900 90791 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $90.16 $90.16 HC PSYCHOTHERAPY 30 MINUTES All Payors / Plans All Payors / Plans 0912 90832 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $89.18 $89.18 HC PSYCHOTHERAPY 45 MINUTES All Payors / Plans All Payors / Plans 0912 90834 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $89.18 $89.18 HC PT APP MLT-LAY COM L LEG/FT 8-22 All Payors / Plans All Payors / Plans 0420 29581 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC PT APP MLT-LAY COM UP ARM/FI 68-82 All Payors / Plans All Payors / Plans 0420 29584 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC PT APP MLT-LAY COM UP ARM/FI23-37 All Payors / Plans All Payors / Plans 0420 29584 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC PT APP MLT-LAY COM UP ARM/FI38-52 All Payors / Plans All Payors / Plans 0420 29584 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC PT APP MLT-LAY COM UP ARM/FI53-67 All Payors / Plans All Payors / Plans 0420 29584 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC PT APP MLT-LAY COM UP ARM/FI8-22 All Payors / Plans All Payors / Plans 0420 29584 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC PT APP MLT-LAY COM UP ARM/FO23-37 All Payors / Plans All Payors / Plans 0420 29583 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC PT APP MLT-LAY COM UP ARM/FO38-52 All Payors / Plans All Payors / Plans 0420 29583 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $523.32 $523.32 HC PT APP MLT-LAY COM UP ARM/FO53-67 All Payors / Plans All Payors / Plans 0420 29583 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC PT APP MLT-LAY COM UP ARM/FO68-73 All Payors / Plans All Payors / Plans 0420 29583 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $872.20 $872.20 HC PT APP MLT-LAY COM UPARM/FO8-22 All Payors / Plans All Payors / Plans 0420 29583 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC PT APP MLT-LAY COMP L FEG/FT53-67 All Payors / Plans All Payors / Plans 0420 29581 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC PT APP MLT-LAY COMP L LEG/FT 68-82 All Payors / Plans All Payors / Plans 0420 29581 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $872.20 $872.20 HC PT APP MLT-LAY COMP L LEG/FT23-37 All Payors / Plans All Payors / Plans 0420 29581 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC PT APP MLT-LAY COMP L LEG/FT38-52 All Payors / Plans All Payors / Plans 0420 29581 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $523.32 $523.32 HC PT APP MLT-LAY COMP THI/LEG 23-37 All Payors / Plans All Payors / Plans 0420 29583 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC PT APP MLT-LAY COMP THI/LEG 38-52 All Payors / Plans All Payors / Plans 0420 29584 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC PT APP MLT-LAY COMP THI/LEG 53-67 All Payors / Plans All Payors / Plans 0420 29585 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $836.92 $836.92 HC PT APP MLT-LAY COMP THI/LEG 68-73 All Payors / Plans All Payors / Plans 0420 29586 " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,067.00 " " $1,045.66 " " $1,045.66 " HC PT APPL MLT-LAY COMP THIG/LEG8-22 All Payors / Plans All Payors / Plans 0420 29582 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC PT DEVEL SCREEN W INTER RPT 38-52 All Payors / Plans All Payors / Plans 0420 96111 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC PT DEVEL SCREEN W INTER RPT 8-22 All Payors / Plans All Payors / Plans 0420 96114 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC PT DEVEL TEST EXT W INTERP 60 MIN All Payors / Plans All Payors / Plans 0420 96111 $897.00 $897.00 $897.00 $897.00 $897.00 $897.00 $897.00 $879.06 $879.06 HC PT E-STIM NOT WC MANUAL 8-22 All Payors / Plans All Payors / Plans 0420 97032 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $69.58 $69.58 HC PT GROUP THERAPY 23-37 MIN 3 PTS All Payors / Plans All Payors / Plans 0420 97150 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC PT GROUP THERAPY 23-37 MIN 4 PTS All Payors / Plans All Payors / Plans 0420 97150 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC PT GROUP THERAPY 38-52 MIN 2 PTS All Payors / Plans All Payors / Plans 0420 97150 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC PT GROUP THERAPY 38-52 MIN 3 PTS All Payors / Plans All Payors / Plans 0420 97150 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC PT GROUP THERAPY 38-52 MIN 4 PTS All Payors / Plans All Payors / Plans 0420 97150 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC PT GROUP THERAPY 8-22 MIN 2 PTS All Payors / Plans All Payors / Plans 0420 97150 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC PT GROUP THERAPY 8-22 MIN 3 PTS All Payors / Plans All Payors / Plans 0420 97150 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC PT GROUP THERAPY 8-22 MIN 4 PTS All Payors / Plans All Payors / Plans 0420 97150 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC PT MECHANCIAL TRACT 53-67 All Payors / Plans All Payors / Plans 0420 97012 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $279.30 $279.30 HC PT MECHANICAL TRACT 38-52 All Payors / Plans All Payors / Plans 0420 97012 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC PT MECHANICAL TRACT 68-82 All Payors / Plans All Payors / Plans 0420 97012 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC PT MECHANICAL TRACT 8-22 All Payors / Plans All Payors / Plans 0420 97012 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $69.58 $69.58 HC PT SELF CARE/HOME MGMT 15 MIN All Payors / Plans All Payors / Plans 0420 97535 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC PT TRMT/SENSORIMO IND 15 MIN All Payors / Plans All Payors / Plans 0420 97533 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC PT WC SELECT DEBRIDE <=20 CM All Payors / Plans All Payors / Plans 0420 97597 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC PT WC SELECT DEBRIDE >20 CM All Payors / Plans All Payors / Plans 0420 97598 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC PTMIX 1 TO 1 All Payors / Plans All Payors / Plans 0300 85611 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 HC PTT SCREENING All Payors / Plans All Payors / Plans 0305 85730 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC PUCHTLERS MOD BENNHOLDS ST All Payors / Plans All Payors / Plans 0310 88313 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC PULM PERFUSION PARTICULATE All Payors / Plans All Payors / Plans 0340 78580 $977.00 $977.00 $977.00 $977.00 $977.00 $977.00 $977.00 $957.46 $957.46 HC PULMONARY REHAB W/ CONTINUOUS OXIMETRY MONITOR All Payors / Plans All Payors / Plans 0948 94626 $496.00 $496.00 $496.00 $496.00 $496.00 $496.00 $496.00 $486.08 $486.08 HC PULMONARY REHAB W/ CONTINUOUS OXIMETRY MONITOR>36 All Payors / Plans All Payors / Plans 0948 94626 $496.00 $496.00 $496.00 $496.00 $496.00 $496.00 $496.00 $486.08 $486.08 HC PULMONARY REHAB W/O CONTINUOUS OXIMETRY MONITOR All Payors / Plans All Payors / Plans 0948 94625 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $455.70 $455.70 HC PULMONARY REHAB W/O CONTINUOUS OXIMETRY MONITOR>36 All Payors / Plans All Payors / Plans 0948 94625 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $455.70 $455.70 HC PULMONARY REHAB-COPD All Payors / Plans All Payors / Plans 0948 G0424 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $147.98 $147.98 HC PULMONARY REHAB-COPD >36 All Payors / Plans All Payors / Plans 0948 G0424 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $147.98 $147.98 HC PULMONARY REHAB-OTHER All Payors / Plans All Payors / Plans 0410 G0239 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC PULMONARY REHAB-OTHER >36 All Payors / Plans All Payors / Plans 0410 G0239 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $121.52 $121.52 HC PULMONARY STRESS TESTING All Payors / Plans All Payors / Plans 0460 94618 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $286.16 $286.16 HC PULSE OXIMETRY All Payors / Plans All Payors / Plans 0460 94760 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $21.56 $21.56 HC PULSE OXIMETRY CONTINUOUS All Payors / Plans All Payors / Plans 0410 94762 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC PULSE OXIMETRY MULTIPLE READINGS All Payors / Plans All Payors / Plans 0460 94761 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $82.32 $82.32 HC PUNCH BIOPSY OF SKIN All Payors / Plans All Payors / Plans 0761 11104 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $83.30 $83.30 HC PUNCH BIOPSY OF SKIN EACH ADD'L All Payors / Plans All Payors / Plans 0761 11105 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $83.30 $83.30 HC PUNCTURE ASPIRATION OF ABSCESS All Payors / Plans All Payors / Plans 0761 10160 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC PYRIDOXAL PHOSPHATE (VITAMIN B6) All Payors / Plans All Payors / Plans 0301 84207 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC PYROPHOSPHATE All Payors / Plans All Payors / Plans 0343 A9538 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $28.79 $28.79 HC PYRUVIC ACID (PYRV) All Payors / Plans All Payors / Plans 0300 84210 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC QUANT AEROBIC W ISOLATION PRESUMP ID ISOLATES SOURCE EXC UR BLD STL All Payors / Plans All Payors / Plans 0300 87071 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC QUINIDINE (QUID) All Payors / Plans All Payors / Plans 0300 80194 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC RA TEST (RA) All Payors / Plans All Payors / Plans 0300 86430 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC RADIOPHARM THER MONOCLONAL ANTIBO All Payors / Plans All Payors / Plans 0340 79403 $381.00 $381.00 $381.00 $381.00 $381.00 $381.00 $381.00 $373.38 $373.38 HC RADIOPHARMACEUTICAL THERAPY IV All Payors / Plans All Payors / Plans 0340 79101 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $227.36 $227.36 HC RADIOPHARMACEUTICAL THERAPY ORAL All Payors / Plans All Payors / Plans 0340 79005 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $227.36 $227.36 "HC RADIOPHARMACEUTICAL THERAPY, BY INTRA-ARTICULAR ADMIN" All Payors / Plans All Payors / Plans 0340 79445 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $81.34 $81.34 HC RAPAMYCIN (RAPA) All Payors / Plans All Payors / Plans 0300 80195 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC RAST (RST1) All Payors / Plans All Payors / Plans 0302 86003 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC RAST N E REGION (RAST) All Payors / Plans All Payors / Plans 0300 86003 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC RBC LEUKOREDUCED IRRADIATED All Payors / Plans All Payors / Plans 0390 P9040 $229.44 $229.44 $229.44 $229.44 $229.44 $229.44 $229.44 $224.85 $224.85 HC RE EVALUATION 23-37 MIN All Payors / Plans All Payors / Plans 0420 97164 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $313.60 $313.60 HC RE EVALUATION 38-52 MIN All Payors / Plans All Payors / Plans 0420 97164 $480.00 $480.00 $480.00 $480.00 $480.00 $480.00 $480.00 $470.40 $470.40 HC RE EVALUATION 53-67 MIN All Payors / Plans All Payors / Plans 0420 97164 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $627.20 $627.20 HC RE EVALUATION 8-22 MIN All Payors / Plans All Payors / Plans 0420 97164 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 HC RED BLOOD CELL PROCESS FEE All Payors / Plans All Payors / Plans 0390 P9016 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $223.44 $223.44 HC RED BLOOD CELL PROCESS FEE(A) All Payors / Plans All Payors / Plans 0391 86890 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $146.02 $146.02 HC REFRACTOMETER SG BODY FLUID All Payors / Plans All Payors / Plans 0300 84315 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC REFRACTOMETER SPECIFIC GRAVITY All Payors / Plans All Payors / Plans 0300 81002 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 HC RENAL BIOPSY ELECTRON MICROSCOPY All Payors / Plans All Payors / Plans 0310 88348 " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " " $1,000.00 " $980.00 $980.00 HC RENAL PATH LEVEL IV WET TS All Payors / Plans All Payors / Plans 0310 88305 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC RENAL PROFILE (RENAL) All Payors / Plans All Payors / Plans 0301 80069 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC RENIN (REN) All Payors / Plans All Payors / Plans 0301 84244 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC REPTILASE All Payors / Plans All Payors / Plans 0300 85635 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC RESP VIRUS,MULTIPLEX, REVERSE TRANS/AMP, 12-25 TARGETS" All Payors / Plans All Payors / Plans 0300 87633 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $441.00 $441.00 HC RESPIRATORY MOTION MGMT All Payors / Plans All Payors / Plans 0333 77293 " $1,240.00 " " $1,240.00 " " $1,240.00 " " $1,240.00 " " $1,240.00 " " $1,240.00 " " $1,240.00 " " $1,215.20 " " $1,215.20 " HC RETICULOCYTE CT (RET) All Payors / Plans All Payors / Plans 0305 85045 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC RETRO PYLEOGRAM All Payors / Plans All Payors / Plans 0320 74420 $806.00 $806.00 $806.00 $806.00 $806.00 $806.00 $806.00 $789.88 $789.88 HC RETROPERITONEAL COMPLETE All Payors / Plans All Payors / Plans 0402 76770 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $560.56 $560.56 HC RHEUMATOID FACTOR; QUANTITATIVE All Payors / Plans All Payors / Plans 0302 86431 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC RHIG STUDIES (RHG) All Payors / Plans All Payors / Plans 0300 86900 $128.00 $128.00 $128.00 $128.00 $128.00 $128.00 $128.00 $125.44 $125.44 HC RHOGAM (UF) All Payors / Plans All Payors / Plans 0390 90384 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC RHYTHM STRIP All Payors / Plans All Payors / Plans 0730 93041 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $15.68 $15.68 HC RIBOFLAVIN (VITAMIN B-2) All Payors / Plans All Payors / Plans 0300 84252 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC RIBS All Payors / Plans All Payors / Plans 0320 71100 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC RIBS BILATERAL WITH CHEST All Payors / Plans All Payors / Plans 0320 71111 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $229.32 $229.32 HC RIBS WITH CHEST All Payors / Plans All Payors / Plans 0320 71101 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC RICKETTSIA All Payors / Plans All Payors / Plans 0302 86757 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC RISTOCETIN COFACTOR All Payors / Plans All Payors / Plans 0300 85245 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC RNA POLYMERASE III ANTIBODIES, IGG, SERUM" All Payors / Plans All Payors / Plans 0300 83520 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC ROCKY MTN SPOTTED FEVER (RMSF) All Payors / Plans All Payors / Plans 0300 86759 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC ROTOVIRUS (ROTO) All Payors / Plans All Payors / Plans 0300 87425 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC RSV ANTIGEN (RSVA) All Payors / Plans All Payors / Plans 0300 87420 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC RT BLOOD GAS ANALYSIS All Payors / Plans All Payors / Plans 0300 82803 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 HC RT BLOOD GAS PUNCTURE All Payors / Plans All Payors / Plans 0460 36600 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 HC RT CAPILLARY ABG DRAW All Payors / Plans All Payors / Plans 0460 36416 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 HC RT CO-OX ANALYSIS All Payors / Plans All Payors / Plans 0300 82375 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC RT VENOUS BG-ANALYSIS-ONLY (ABGA) All Payors / Plans All Payors / Plans 0300 82800 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC RUBELLA TEST (RUBE) All Payors / Plans All Payors / Plans 0300 86762 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC RUBEOLA SCREEN (RBOLA) All Payors / Plans All Payors / Plans 0300 86765 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC RUSSELL VIPER VENOM TIME DILUTED All Payors / Plans All Payors / Plans 0305 85613 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC SACRO-ILIAC JOINTS All Payors / Plans All Payors / Plans 0320 72202 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC SACRUM AND/OR COCCYX All Payors / Plans All Payors / Plans 0320 72220 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC SALICYLATE SERUM (SALI) All Payors / Plans All Payors / Plans 0300 80179 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC SBRT TREATMENT DELIVERY PER FRAC All Payors / Plans All Payors / Plans 0333 77373 " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,630.00 " " $4,537.40 " " $4,537.40 " HC SCANOGRAM All Payors / Plans All Payors / Plans 0320 77073 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC SCAPULA All Payors / Plans All Payors / Plans 0320 73010 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC SCHEDULED C-SEC W MINOR SURGERY All Payors / Plans All Payors / Plans 0720 " $3,060.00 " " $3,060.00 " " $3,060.00 " " $3,060.00 " " $3,060.00 " " $3,060.00 " " $3,060.00 " " $2,998.80 " " $2,998.80 " HC SCOLIOSIS SERIES All Payors / Plans All Payors / Plans 0320 72081 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC SCREENING SPIRO. C BD All Payors / Plans All Payors / Plans 0460 94060 $360.00 $360.00 $360.00 $360.00 $360.00 $360.00 $360.00 $352.80 $352.80 HC SCREENING SPIROMETRY All Payors / Plans All Payors / Plans 0460 94010 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $239.12 $239.12 HC SCROTUM SONOGRAM All Payors / Plans All Payors / Plans 0402 76870 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $254.80 $254.80 HC SED RATE (ESR) All Payors / Plans All Payors / Plans 0300 85651 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 "HC SED RATE ERYTHROCYTE, AUTOMATED" All Payors / Plans All Payors / Plans 0305 85652 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 HC SELENIUM All Payors / Plans All Payors / Plans 0300 84255 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC SELLA TURCICA All Payors / Plans All Payors / Plans 0320 70240 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC SENSITIVITY TESTING All Payors / Plans All Payors / Plans 0300 87186 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC SERO TYPING X 1 All Payors / Plans All Payors / Plans 0300 87147 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC SEROTONIN,BLOOD (SRTNB)" All Payors / Plans All Payors / Plans 0300 84260 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC SERUM OSMOLALITY (OSM) All Payors / Plans All Payors / Plans 0300 83930 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC SEX HORMONE BINDING GLOBULIN (SHBG) All Payors / Plans All Payors / Plans 0301 84270 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC SHOULDER All Payors / Plans All Payors / Plans 0320 73030 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC SHOULDER ARTHROGRAM All Payors / Plans All Payors / Plans 0322 73040 " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,102.50 " " $1,102.50 " HC SHUNT SERIES All Payors / Plans All Payors / Plans 0320 75809 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC SI JOINT INJECT W ANESTH All Payors / Plans All Payors / Plans 0320 27096 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $611.52 $611.52 HC SIALIOGRAM All Payors / Plans All Payors / Plans 0320 70390 " $3,375.00 " " $3,375.00 " " $3,375.00 " " $3,375.00 " " $3,375.00 " " $3,375.00 " " $3,375.00 " " $3,307.50 " " $3,307.50 " HC SICKLE CELL PREP (SIKL) All Payors / Plans All Payors / Plans 0300 85660 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC SIMULATION SIMPLE INITIAL All Payors / Plans All Payors / Plans 0333 77280 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $793.80 $793.80 "HC SIMULATION, COMPLEX" All Payors / Plans All Payors / Plans 0333 77290 " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,474.00 " " $1,444.52 " " $1,444.52 " "HC SIMULATION, INTERMEDIATE" All Payors / Plans All Payors / Plans 0333 77285 " $1,277.00 " " $1,277.00 " " $1,277.00 " " $1,277.00 " " $1,277.00 " " $1,277.00 " " $1,277.00 " " $1,251.46 " " $1,251.46 " "HC SIMULATION, SIMPLE" All Payors / Plans All Payors / Plans 0333 77280 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $793.80 $793.80 HC SINUS TRACT INJECTION All Payors / Plans All Payors / Plans 0320 76080 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC SINUSES All Payors / Plans All Payors / Plans 0320 70210 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC SINUSES All Payors / Plans All Payors / Plans 0320 70220 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC SKULL - COMPLETE MIN 4 VIEWS All Payors / Plans All Payors / Plans 0320 70260 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC SKULL < 4 VIEWS All Payors / Plans All Payors / Plans 0320 70250 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC SLEEP STUDY UNATTENDED All Payors / Plans All Payors / Plans 0920 95806 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC SLEEP STUDY UNATTENDED WATCH PAT All Payors / Plans All Payors / Plans 0740 95800 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 HC SM CULT CSF (SFSC) All Payors / Plans All Payors / Plans 0300 87070 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC SM CULT GENITAL (GESC) All Payors / Plans All Payors / Plans 0300 87070 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC SM CULT MISC (MISC) All Payors / Plans All Payors / Plans 0300 87070 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC SM CULT RESPIR (RESC) All Payors / Plans All Payors / Plans 0300 87070 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC SMA CARRIER BY DEL/DUP (SMNCS) All Payors / Plans All Payors / Plans 0300 81329 $745.00 $745.00 $745.00 $745.00 $745.00 $745.00 $745.00 $730.10 $730.10 HC SMALL BOWEL GI CAPUSULE ENDO All Payors / Plans All Payors / Plans 0750 91110 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC SMALL BOWEL SERIES W SCOUT/SINGLE CONTRAST All Payors / Plans All Payors / Plans 0320 74250 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $560.56 $560.56 "HC SMEAR, FLUORES AND/OR ACID FAST BACTERIA,FUNGI, PARASITES,VIRUS OR CELL TYPES" All Payors / Plans All Payors / Plans 0300 87206 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC SMEAR, WET MOUNT, SIMPLE STAIN" All Payors / Plans All Payors / Plans 0300 87210 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC SMOKING CESSATION - INTENSIVE All Payors / Plans All Payors / Plans 0942 99407 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $91.14 $91.14 HC SMOKING CESSATION-INTERMEDIATE All Payors / Plans All Payors / Plans 0942 99406 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $60.76 $60.76 "HC SMOOTH MUSCLE FLUORESCENT AB, SCREEN EA (SMA)" All Payors / Plans All Payors / Plans 0302 86015 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC SODIUM (NA) All Payors / Plans All Payors / Plans 0301 84295 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC SODIUM URINE All Payors / Plans All Payors / Plans 0301 84300 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC SODIUM, OTHER SOURCE" All Payors / Plans All Payors / Plans 0300 84302 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC SOFT TISSUES OF NECK All Payors / Plans All Payors / Plans 0320 70360 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC SOLID TUMOR PANEL All Payors / Plans All Payors / Plans 0310 81445 " $1,245.00 " " $1,245.00 " " $1,245.00 " " $1,245.00 " " $1,245.00 " " $1,245.00 " " $1,245.00 " " $1,220.10 " " $1,220.10 " HC SOLUBLE LIVER ANTIGEN (SLA) AUTOANTIBODY All Payors / Plans All Payors / Plans 0300 83520 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $107.80 $107.80 HC SOLUBLE TRANSFERRIN RECEPTOR All Payors / Plans All Payors / Plans 0300 84238 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC SOMATOMEDIN C (SOMC) All Payors / Plans All Payors / Plans 0300 84305 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC SONOGRAM OF TRANSPLANT KIDNEY All Payors / Plans All Payors / Plans 0402 76776 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $866.32 $866.32 HC SPECIAL BEAM PLAN All Payors / Plans All Payors / Plans 0333 77321 $147.00 $147.00 $147.00 $147.00 $147.00 $147.00 $147.00 $144.06 $144.06 HC SPECIAL COAGULATION INTERPRETATION All Payors / Plans All Payors / Plans 0300 85390 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC SPECIAL DOSIMETRY/TLD/MDM All Payors / Plans All Payors / Plans 0333 77331 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC SPECIAL PROCEDURES MINUTES All Payors / Plans All Payors / Plans 0361 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC SPECIAL STAIN I All Payors / Plans All Payors / Plans 0310 88312 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC SPECIAL STAIN II All Payors / Plans All Payors / Plans 0310 88313 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC SPECIAL TREATMENT PROCEDURE All Payors / Plans All Payors / Plans 0333 77470 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 "HC SPECTOPHOTOTOMETRY, ANALYTE" All Payors / Plans All Payors / Plans 0300 84311 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC SPERM COUNT (SPCT) All Payors / Plans All Payors / Plans 0300 89320 $73.00 $73.00 $73.00 $73.00 $73.00 $73.00 $73.00 $71.54 $71.54 HC SPERM POST VAS (SPCK) All Payors / Plans All Payors / Plans 0300 89321 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC SPINAL CANAL All Payors / Plans All Payors / Plans 0402 76800 $598.00 $598.00 $598.00 $598.00 $598.00 $598.00 $598.00 $586.04 $586.04 HC SPINAL FUSION FIXATION SUPPLY All Payors / Plans All Payors / Plans " $19,700.00 " " $19,700.00 " " $19,700.00 " " $19,700.00 " " $19,700.00 " " $19,700.00 " " $19,700.00 " " $19,306.00 " " $19,306.00 " HC SPINAL MUSCULAR ATROPHY CARRIER SCREEN DELETE/DUPLICAT All Payors / Plans All Payors / Plans 0300 81401 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $478.24 $478.24 HC SPINE 1 VIEW All Payors / Plans All Payors / Plans 0320 72020 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $101.92 $101.92 HC SPINE-THORACOLUMBAR All Payors / Plans All Payors / Plans 0320 72080 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC SPONTANEOUS MECHANICS NON VENTED All Payors / Plans All Payors / Plans 0410 94799 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 HC SPUTUM COLLECTED All Payors / Plans All Payors / Plans 0300 89220 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 HC SPUTUM COLLECTED All Payors / Plans All Payors / Plans 0309 89220 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $32.34 $32.34 HC ST ASSESS APHASIA W/RPT PER HR All Payors / Plans All Payors / Plans 0440 96105 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST BASIC TREATMENT/23-37 MIN IND All Payors / Plans All Payors / Plans 0440 92507 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST BASIC TREATMENT/38-52 MIN IND All Payors / Plans All Payors / Plans 0440 92507 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC ST BASIC TREATMENT/53-67 MIN IND All Payors / Plans All Payors / Plans 0440 92507 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST BASIC TREATMENT/8-22 MIN IND All Payors / Plans All Payors / Plans 0440 92507 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST DEVELOP COGNITIVE SKILLS EA ADD'L 15 MIN All Payors / Plans All Payors / Plans 0440 97130 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $48.02 $48.02 HC ST DEVELOP COGNITIVE SKILLS INITIAL 15 MN All Payors / Plans All Payors / Plans 0440 97129 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $48.02 $48.02 HC ST DEVELOP TEST EXTND W/REPT/HR All Payors / Plans All Payors / Plans 0440 96111 $470.40 $470.40 $470.40 $470.40 $470.40 $470.40 $470.40 $460.99 $460.99 HC ST DEVELOPMNTL TEST/LMTD 23-37 All Payors / Plans All Payors / Plans 0440 96110 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC ST DEVELOPMNTL TEST/LMTD 38-52 All Payors / Plans All Payors / Plans 0440 96110 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $261.66 $261.66 HC ST DEVELOPMNTL TEST/LMTD 53-67 All Payors / Plans All Payors / Plans 0440 96110 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC ST DEVELOPMNTL TEST/LMTD 8-22 All Payors / Plans All Payors / Plans 0440 96110 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC ST EV SP GEN AUG/ALT DEVICE 1 HR All Payors / Plans All Payors / Plans 0440 92607 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST EV SP GEN AUG/ALT DEVICE 30MIN All Payors / Plans All Payors / Plans 0440 92608 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST EVAL BEHAV QUAL VOICE 113-127 All Payors / Plans All Payors / Plans 0440 92524 $949.00 $949.00 $949.00 $949.00 $949.00 $949.00 $949.00 $930.02 $930.02 HC ST EVAL BEHAV QUAL VOICE 23-37 All Payors / Plans All Payors / Plans 0440 92524 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST EVAL BEHAV QUAL VOICE 38-52 All Payors / Plans All Payors / Plans 0440 92524 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC ST EVAL BEHAV QUAL VOICE 53-67 All Payors / Plans All Payors / Plans 0440 92524 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST EVAL BEHAV QUAL VOICE 68-82 All Payors / Plans All Payors / Plans 0440 92524 $593.00 $593.00 $593.00 $593.00 $593.00 $593.00 $593.00 $581.14 $581.14 HC ST EVAL BEHAV QUAL VOICE 8-22 All Payors / Plans All Payors / Plans 0440 92524 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST EVAL BEHAV QUAL VOICE 83-97 All Payors / Plans All Payors / Plans 0440 92524 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC ST EVAL BEHAV QUAL VOICE 98-112 All Payors / Plans All Payors / Plans 0440 92524 $831.00 $831.00 $831.00 $831.00 $831.00 $831.00 $831.00 $814.38 $814.38 HC ST EVAL NON SP AUG/ALT DEV 23-37 All Payors / Plans All Payors / Plans 0440 92605 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST EVAL NON SP AUG/ALT DEV 38-52 All Payors / Plans All Payors / Plans 0440 92605 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC ST EVAL NON SP AUG/ALT DEV 53-67 All Payors / Plans All Payors / Plans 0440 92605 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST EVAL NONSP AUG/ALT DEV 8-22 All Payors / Plans All Payors / Plans 0440 92605 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST EVAL ORAL/PHARYN SWALLOW 23-37 All Payors / Plans All Payors / Plans 0440 92610 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST EVAL ORAL/PHARYN SWALLOW 38-52 All Payors / Plans All Payors / Plans 0440 92610 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC ST EVAL ORAL/PHARYN SWALLOW 53-67 All Payors / Plans All Payors / Plans 0440 92610 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST EVAL ORAL/PHARYN SWALLOW 68-82 All Payors / Plans All Payors / Plans 0440 92610 $593.00 $593.00 $593.00 $593.00 $593.00 $593.00 $593.00 $581.14 $581.14 HC ST EVAL ORAL/PHARYN SWALLOW 8-22 All Payors / Plans All Payors / Plans 0440 92610 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST EVAL ORAL/PHARYN/SWALL 113-127 All Payors / Plans All Payors / Plans 0440 92610 $949.00 $949.00 $949.00 $949.00 $949.00 $949.00 $949.00 $930.02 $930.02 HC ST EVAL ORAL/PHARYN/SWALLOW 83-97 All Payors / Plans All Payors / Plans 0440 92610 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC ST EVAL ORAL/PHARYN/SWALLOW98-112 All Payors / Plans All Payors / Plans 0440 92610 $831.00 $831.00 $831.00 $831.00 $831.00 $831.00 $831.00 $814.38 $814.38 HC ST EVAL SOUND/LANG COMPRE 113-127 All Payors / Plans All Payors / Plans 0440 92523 $949.00 $949.00 $949.00 $949.00 $949.00 $949.00 $949.00 $930.02 $930.02 HC ST EVAL SOUND/LANG COMPRE 23-37 All Payors / Plans All Payors / Plans 0440 92523 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST EVAL SOUND/LANG COMPRE 38-52 All Payors / Plans All Payors / Plans 0440 92523 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC ST EVAL SOUND/LANG COMPRE 53-67 All Payors / Plans All Payors / Plans 0440 92523 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST EVAL SOUND/LANG COMPRE 68-82 All Payors / Plans All Payors / Plans 0440 92523 $593.00 $593.00 $593.00 $593.00 $593.00 $593.00 $593.00 $581.14 $581.14 HC ST EVAL SOUND/LANG COMPRE 8-22 All Payors / Plans All Payors / Plans 0444 92523 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST EVAL SOUND/LANG COMPRE 83-97 All Payors / Plans All Payors / Plans 0440 92523 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $697.76 $697.76 HC ST EVAL SOUND/LANG COMPRE 98-112 All Payors / Plans All Payors / Plans 0440 92523 $831.00 $831.00 $831.00 $831.00 $831.00 $831.00 $831.00 $814.38 $814.38 HC ST EVAL USE/FIT VOICE PROS 38-52 All Payors / Plans All Payors / Plans 0440 92597 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 HC ST EVAL USE/FIT VOICE PROS 53-67 All Payors / Plans All Payors / Plans 0440 92597 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST EVAL USE/FIT VOICE PROST 23-37 All Payors / Plans All Payors / Plans 0440 92597 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST EVAL USE/FIT VOICE PROST 8-22 All Payors / Plans All Payors / Plans 0440 92597 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST MOTION FLUORO EVAL SWAL 83-97 All Payors / Plans All Payors / Plans 0440 92611 " $1,009.00 " " $1,009.00 " " $1,009.00 " " $1,009.00 " " $1,009.00 " " $1,009.00 " " $1,009.00 " $988.82 $988.82 HC ST MOTION FLUORO EVAL SWAL 98-112 All Payors / Plans All Payors / Plans 0440 92611 " $1,177.00 " " $1,177.00 " " $1,177.00 " " $1,177.00 " " $1,177.00 " " $1,177.00 " " $1,177.00 " " $1,153.46 " " $1,153.46 " HC ST MOTION FLUORO EVAL SWAL113-127 All Payors / Plans All Payors / Plans 0440 92611 " $1,345.00 " " $1,345.00 " " $1,345.00 " " $1,345.00 " " $1,345.00 " " $1,345.00 " " $1,345.00 " " $1,318.10 " " $1,318.10 " HC ST MOTION FLUORO EVAL SWALL 23-37 All Payors / Plans All Payors / Plans 0440 92611 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $329.28 $329.28 HC ST MOTION FLUORO EVAL SWALL 38-52 All Payors / Plans All Payors / Plans 0440 92611 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $493.92 $493.92 HC ST MOTION FLUORO EVAL SWALL 53-67 All Payors / Plans All Payors / Plans 0440 92611 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $659.54 $659.54 HC ST MOTION FLUORO EVAL SWALLOW8-22 All Payors / Plans All Payors / Plans 0440 92611 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $164.64 $164.64 HC ST MOTION FLUORO SWAL 68-82 All Payors / Plans All Payors / Plans 0440 92611 $841.00 $841.00 $841.00 $841.00 $841.00 $841.00 $841.00 $824.18 $824.18 HC ST ORAL MOTOR EXERC 15 MIN TPR All Payors / Plans All Payors / Plans 0440 97110 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST SP GROUP 5 OR MORE 23-37 All Payors / Plans All Payors / Plans 0440 92508 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $39.20 $39.20 HC ST SP GROUP 5 OR MORE 38-52 MIN All Payors / Plans All Payors / Plans 0440 92508 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST SP GROUP 5 OR MORE 53-68 MIN All Payors / Plans All Payors / Plans 0440 92508 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $77.42 $77.42 HC ST SP GROUP 5 OR MORE 8-22 All Payors / Plans All Payors / Plans 0440 92508 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC ST SP THERAPY GROUP OF 2-4 23-37 All Payors / Plans All Payors / Plans 0440 92508 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST SP THERAPY GROUP OF 2-4 38-52 All Payors / Plans All Payors / Plans 0440 92508 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC ST SP THERAPY GROUP OF 2-4 53-67 All Payors / Plans All Payors / Plans 0440 92508 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST SP THERAPY GRP OF 2-4 8-22 MIN All Payors / Plans All Payors / Plans 0440 92508 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC ST STANDARD COGNITIVE PERFORMANCE TESTING All Payors / Plans All Payors / Plans 0440 96125 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $465.50 $465.50 HC ST TEP CHECKOUT EST PT 15 MIN All Payors / Plans All Payors / Plans 0440 97763 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $48.02 $48.02 HC ST THER EXNEUROMUSC/ 15 MIN All Payors / Plans All Payors / Plans 0440 97112 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST TREAT PROGRM NON SP DEV 8-22 All Payors / Plans All Payors / Plans 0440 92606 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST TREAT SWALLOW/ORAL FEED 8-22MN All Payors / Plans All Payors / Plans 0440 92526 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST TREAT SWALLOW/ORAL FEED/23-37 All Payors / Plans All Payors / Plans 0440 92526 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST TREAT SWALLOW/ORAL FEED/38-52 All Payors / Plans All Payors / Plans 0440 92526 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC ST TREAT SWALLOW/ORAL FEED/53-67 All Payors / Plans All Payors / Plans 0440 92526 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST TREAT/PROG NON SP DEV 23-37 All Payors / Plans All Payors / Plans 0440 92606 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST TREAT/PROG NON SP DEVICE 38-52 All Payors / Plans All Payors / Plans 0440 92606 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $174.44 $174.44 HC ST TREAT/PROG NON SP DEVICE 53-67 All Payors / Plans All Payors / Plans 0440 92606 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST TREAT/PROG SP GEN DEVICE 23-37 All Payors / Plans All Payors / Plans 0440 92609 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $116.62 $116.62 HC ST TREAT/PROG SP GEN DEVICE 38-52 All Payors / Plans All Payors / Plans 0440 92609 $179.00 $179.00 $179.00 $179.00 $179.00 $179.00 $179.00 $175.42 $175.42 HC ST TREAT/PROG SP GEN DEVICE 53-67 All Payors / Plans All Payors / Plans 0440 92609 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $232.26 $232.26 HC ST TREAT/PROG SP GEN DEVICE 8-22 All Payors / Plans All Payors / Plans 0440 92609 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $57.82 $57.82 HC ST TRMT/SENSORIMO IND 15 MIN All Payors / Plans All Payors / Plans 0440 97533 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $48.02 $48.02 HC STAPH. AUREUS SCREEN ORTHO All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC STATE HIV CONF TEST (SHIV) All Payors / Plans All Payors / Plans 0300 86689 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC STEREOSCOPIC GUIDE VOL RAD THER All Payors / Plans All Payors / Plans 0333 77387 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $241.08 $241.08 HC STEREOTACTIC BREAST BIOPSY All Payors / Plans All Payors / Plans 0401 19081 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $611.52 $611.52 HC STERNO-CLAVICULAR JT All Payors / Plans All Payors / Plans 0320 71130 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC STERNUM All Payors / Plans All Payors / Plans 0320 71120 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC STONE ANALYSIS (STONE) All Payors / Plans All Payors / Plans 0301 82365 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC STOOL FOR POLYS (STSM) All Payors / Plans All Payors / Plans 0300 89055 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 HC STOOL OSMALITY All Payors / Plans All Payors / Plans 0300 84999 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC STOOL POTASSIUM All Payors / Plans All Payors / Plans 0300 84999 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC STRAPPING UNA BOOT 23-37 All Payors / Plans All Payors / Plans 0420 29580 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $208.74 $208.74 HC STRAPPING UNA BOOT 53-67 All Payors / Plans All Payors / Plans 0420 29580 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $427.00 $418.46 $418.46 HC STRAPPING UNA BOOT 68-82 All Payors / Plans All Payors / Plans 0420 29580 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $534.00 $523.32 $523.32 HC STRAPPING UNA BOOT 8-22 All Payors / Plans All Payors / Plans 0420 29580 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC STRAPPING UNNA BOOT 38-52 All Payors / Plans All Payors / Plans 0420 29580 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $313.60 $313.60 "HC STREPTOCOCCUS, GROUP A" All Payors / Plans All Payors / Plans 0300 87880 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC STREPTOCOCCUS,GROUP B, AMPLIFIED PROBE" All Payors / Plans All Payors / Plans 0300 87653 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC STRESS TEST All Payors / Plans All Payors / Plans 0720 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $749.70 $749.70 HC STRESS/PHARMACOLOGICAL ECHO All Payors / Plans All Payors / Plans 0483 93350 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 HC STRIATED MUSCLE AB (MUSAB) All Payors / Plans All Payors / Plans 0300 83520 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC SUCTIONING All Payors / Plans All Payors / Plans 0410 31720 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 "HC SUGARS,SINGLE QUANTITATIVE EA SPECIMIN" All Payors / Plans All Payors / Plans 0300 84378 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 "HC SULFATE, URINE" All Payors / Plans All Payors / Plans 0300 84392 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $102.90 $102.90 HC SULFATIDE AUTOANTIBODY (SLFAB) All Payors / Plans All Payors / Plans 0300 83520 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC SURG PATH PROSTATE All Payors / Plans All Payors / Plans 0310 88305 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC SURG PATH, LEVEL I" All Payors / Plans All Payors / Plans 0310 88300 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 "HC SURG PATH, LEVEL II" All Payors / Plans All Payors / Plans 0310 88302 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC SURG PATH, LEVEL III" All Payors / Plans All Payors / Plans 0310 88304 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 "HC SURG PATH, LEVEL IV" All Payors / Plans All Payors / Plans 0310 88305 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 "HC SURG PATH, LEVEL V" All Payors / Plans All Payors / Plans 0310 88307 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 "HC SURG PATH, LEVEL VI" All Payors / Plans All Payors / Plans 0310 88309 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $306.74 $306.74 HC SURGEY MRSA SCREEN (SXMR) All Payors / Plans All Payors / Plans 0306 87641 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC SURGICAL PATH C7 All Payors / Plans All Payors / Plans 0310 88309 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $306.74 $306.74 "HC SWEAT CHLORIDE, CONDUCTIVITY(SWT)" All Payors / Plans All Payors / Plans 0300 89230 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 HC SYNOVIAL FLD. ANALYSIS (SYNA) All Payors / Plans All Payors / Plans 0300 89051 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $107.80 $107.80 "HC SYPHILIS TEST, NON TREPONEMAL ANTIBODY, QUALIT(VDRL,RPR,ART)" All Payors / Plans All Payors / Plans 0302 86592 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 "HC SYPHILLIS, NON-TREPONEMAL ANTIBODY,QUALIT, QUANTIT" All Payors / Plans All Payors / Plans 0300 86593 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC T CELLS, ABSOLUTE CD4 &CD8, INCLUDE RATIO" All Payors / Plans All Payors / Plans 0300 86360 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 "HC T CELLS, TOTAL COUNT" All Payors / Plans All Payors / Plans 0300 86359 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC T3 BY RIA (T3R) All Payors / Plans All Payors / Plans 0300 84480 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC TANGENTIAL BIOPSY OF SKIN All Payors / Plans All Payors / Plans 0761 11102 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 HC TANGENTIAL BIOPSY OF SKIN EACH ADD'L All Payors / Plans All Payors / Plans 0761 11103 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $59.78 $59.78 "HC TARGET GENOMIC SEQU ANALYSIS PANEL, SOLID ORGAN NEOPL 5-50 GENES" All Payors / Plans All Payors / Plans 0310 81445 " $1,120.00 " " $1,120.00 " " $1,120.00 " " $1,120.00 " " $1,120.00 " " $1,120.00 " " $1,120.00 " " $1,097.60 " " $1,097.60 " HC TC04 All Payors / Plans All Payors / Plans 0343 A9512 $23.66 $23.66 $23.66 $23.66 $23.66 $23.66 $23.66 $23.19 $23.19 HC TC99 CERETEC All Payors / Plans All Payors / Plans 0343 A9521 " $1,152.01 " " $1,152.01 " " $1,152.01 " " $1,152.01 " " $1,152.01 " " $1,152.01 " " $1,152.01 " " $1,128.97 " " $1,128.97 " HC TC99 NEUROLITE All Payors / Plans All Payors / Plans 0343 A9557 " $1,380.63 " " $1,380.63 " " $1,380.63 " " $1,380.63 " " $1,380.63 " " $1,380.63 " " $1,380.63 " " $1,353.02 " " $1,353.02 " HC TC99M DISIDA All Payors / Plans All Payors / Plans 0343 $28.28 $28.28 $28.28 $28.28 $28.28 $28.28 $28.28 $27.71 $27.71 HC TC99M DMSA All Payors / Plans All Payors / Plans 0343 A9551 $412.58 $412.58 $412.58 $412.58 $412.58 $412.58 $412.58 $404.33 $404.33 HC TC99M DTPA All Payors / Plans All Payors / Plans 0343 A9539 $17.81 $17.81 $17.81 $17.81 $17.81 $17.81 $17.81 $17.45 $17.45 HC TC99M DTPA KIT All Payors / Plans All Payors / Plans 0343 $22.83 $22.83 $22.83 $22.83 $22.83 $22.83 $22.83 $22.37 $22.37 HC TC99M MAA All Payors / Plans All Payors / Plans 0343 A9540 $138.95 $138.95 $138.95 $138.95 $138.95 $138.95 $138.95 $136.17 $136.17 HC TC99M MAG111 All Payors / Plans All Payors / Plans 0343 $132.95 $132.95 $132.95 $132.95 $132.95 $132.95 $132.95 $130.29 $130.29 HC TC99M MAG3 All Payors / Plans All Payors / Plans 0343 A9562 $168.27 $168.27 $168.27 $168.27 $168.27 $168.27 $168.27 $164.90 $164.90 HC TC99M MDP All Payors / Plans All Payors / Plans 0343 A9503 $10.93 $10.93 $10.93 $10.93 $10.93 $10.93 $10.93 $10.71 $10.71 HC TC99M MEMBROFENIN All Payors / Plans All Payors / Plans 0343 A9537 $79.57 $79.57 $79.57 $79.57 $79.57 $79.57 $79.57 $77.98 $77.98 HC TC99M SULFUR COLLOID All Payors / Plans All Payors / Plans 0343 A9541 $76.91 $76.91 $76.91 $76.91 $76.91 $76.91 $76.91 $75.37 $75.37 HC TCC EZ CAST 3 IN REPLACE NO BOOT All Payors / Plans All Payors / Plans $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $69.83 $69.83 HC TCC EZ CAST 3 IN W/1 BOOT REGULAR All Payors / Plans All Payors / Plans $136.20 $136.20 $136.20 $136.20 $136.20 $136.20 $136.20 $133.48 $133.48 HC TCC EZ CAST 3 INCH NO BOOT All Payors / Plans All Payors / Plans $122.96 $122.96 $122.96 $122.96 $122.96 $122.96 $122.96 $120.50 $120.50 HC TELEPHONE MEDICAL DISCUSSION 11-20 MINUTES All Payors / Plans All Payors / Plans 0510 98967 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 HC TELEPHONE MEDICAL DISCUSSION 21-30 MINUTES All Payors / Plans All Payors / Plans 0510 98968 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 HC TELEPHONE MEDICAL DISCUSSION 5-10 MINUTES All Payors / Plans All Payors / Plans 0510 98966 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 "HC TENOTOMY, TOE SINGLE TENDON" All Payors / Plans All Payors / Plans 0761 28232 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC TENOTOMY,OPEN,FLEXOR,FOOT SNG/MUL" All Payors / Plans All Payors / Plans 0761 28230 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC TESTICULAR IMAGIMG WITH FLOW All Payors / Plans All Payors / Plans 0340 78761 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $843.78 $843.78 "HC TESTOSERONE, FREE" All Payors / Plans All Payors / Plans 0300 84402 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC TESTOSTERONE (TES) All Payors / Plans All Payors / Plans 0300 84403 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC TETRAHYDROCANNABINOL CONF URINE All Payors / Plans All Payors / Plans 0300 80349 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $39.20 $39.20 HC THERAPEUTIC EX. GROUP All Payors / Plans All Payors / Plans 0420 97150 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 HC THERAPEUTIC EX. GROUP All Payors / Plans All Payors / Plans 0430 97150 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 HC THERAPEUTIC EXERCISES TH All Payors / Plans All Payors / Plans 0420 97110 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $104.86 $104.86 "HC THERAPEUTIC,PROPHYLATIC,DIAG INJ EA ADD'L PUSH NEW DRUG" All Payors / Plans All Payors / Plans 0260 96376 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $30.38 $30.38 HC THERASKIN 1X1 All Payors / Plans All Payors / Plans " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " HC THERASKIN 1X2 All Payors / Plans All Payors / Plans " $1,170.00 " " $1,170.00 " " $1,170.00 " " $1,170.00 " " $1,170.00 " " $1,170.00 " " $1,170.00 " " $1,146.60 " " $1,146.60 " "HC THIOPURINE METABOLITES, WHOLE BLOOD" All Payors / Plans All Payors / Plans 0300 80299 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $318.50 $318.50 HC THORACIC MYELOGRAM All Payors / Plans All Payors / Plans 0320 72255 " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,900.00 " " $3,822.00 " " $3,822.00 " HC THORACIC SPINE 2 VIEWS All Payors / Plans All Payors / Plans 0320 72070 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC THORACIC SPINE 3 VIEWS All Payors / Plans All Payors / Plans 0320 72072 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC THROMBIN TIME, PLASMA" All Payors / Plans All Payors / Plans 0300 85670 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC THYR BINDING GLOB (TBG) All Payors / Plans All Payors / Plans 0300 84442 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC THYROGLOBULIN (TG) All Payors / Plans All Payors / Plans 0301 84432 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC THYROID CA METS-WHOLE BODY All Payors / Plans All Payors / Plans 0340 78018 " $1,308.00 " " $1,308.00 " " $1,308.00 " " $1,308.00 " " $1,308.00 " " $1,308.00 " " $1,308.00 " " $1,281.84 " " $1,281.84 " HC THYROID IMAG SING/MUL QM All Payors / Plans All Payors / Plans 0340 78014 " $1,043.00 " " $1,043.00 " " $1,043.00 " " $1,043.00 " " $1,043.00 " " $1,043.00 " " $1,043.00 " " $1,022.14 " " $1,022.14 " HC THYROID SCAN All Payors / Plans All Payors / Plans 0340 78013 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $811.44 $811.44 HC THYROID SONOGRAPHY All Payors / Plans All Payors / Plans 0402 76536 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $637.00 $637.00 HC THYROID STIMULATING IG (TSIG) All Payors / Plans All Payors / Plans 0301 84445 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC THYROID UPTAKE SING/MUL QM All Payors / Plans All Payors / Plans 0340 78012 $348.00 $348.00 $348.00 $348.00 $348.00 $348.00 $348.00 $341.04 $341.04 HC THYROSEQ All Payors / Plans All Payors / Plans 0300 0026U " $1,560.00 " " $1,560.00 " " $1,560.00 " " $1,560.00 " " $1,560.00 " " $1,560.00 " " $1,560.00 " " $1,528.80 " " $1,528.80 " "HC THYROTROPIN RECEPTOR ANTIBODY,SERUM(THYRO)" All Payors / Plans All Payors / Plans 0300 83520 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC THYROXINE FREE All Payors / Plans All Payors / Plans 0301 84439 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC TISSUE CULTURE NEOPLASTIC DISORDERS;BONE MARROW, BLOOD CELLS" All Payors / Plans All Payors / Plans 0300 88237 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 "HC TISSUE CULTURE NON-NEOPLACTIC DISORDERS,LYMPHOCYTE" All Payors / Plans All Payors / Plans 0300 88230 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 "HC TISSUE CULTURE NON-NEOPLASTIC DISORDERS,SKIN/OTHER SOLID TISSUE BIOPSY" All Payors / Plans All Payors / Plans 0300 88233 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $490.00 $490.00 HC TISSUE GRINDING All Payors / Plans All Payors / Plans 0300 87176 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC TISSUE IN-SITU HYBRIDIZATION All Payors / Plans All Payors / Plans 0312 88365 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $784.00 $784.00 HC TISSUE TRANSGLUTAMINASE (TTG) All Payors / Plans All Payors / Plans 0300 83516 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC TISSUE TRANSGLUTAMINASE (TTG) AB All Payors / Plans All Payors / Plans 0302 86364 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC TISSUE TRANSGLUTAMINASE, IGG" All Payors / Plans All Payors / Plans 0300 83516 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC TM JOINTS - BILATERAL All Payors / Plans All Payors / Plans 0320 70330 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $254.80 $254.80 HC TM JOINTS - UNILATERAL All Payors / Plans All Payors / Plans 0320 70328 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC TOBRAMYCIN All Payors / Plans All Payors / Plans 0300 80200 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC TOE All Payors / Plans All Payors / Plans 0320 73660 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC TOE ARTHROGRAM All Payors / Plans All Payors / Plans 0320 77002 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC TOPIRAMATE (TOPI) All Payors / Plans All Payors / Plans 0300 80201 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC TORCH PROFILE LGM 1 All Payors / Plans All Payors / Plans 0300 86694 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC TORCH TEST (TORT) All Payors / Plans All Payors / Plans 0300 86644 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 HC TOTAL WOUND SURFACE >50CM All Payors / Plans All Payors / Plans 0761 97608 $583.00 $583.00 $583.00 $583.00 $583.00 $583.00 $583.00 $571.34 $571.34 HC TOUCH PREP All Payors / Plans All Payors / Plans 0310 88333 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC TOXOPLASMA SEROLOGY (TOSE) All Payors / Plans All Payors / Plans 0302 86777 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC TP53(TUMOR PROTEIN 53), TARGETED SEQUENCE ANALYSIS" All Payors / Plans All Payors / Plans 0310 81352 " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,372.00 " " $1,372.00 " HC TPMG THIOPURINE S-METHYLTRANS GENE ANALYSIS TPNUV All Payors / Plans All Payors / Plans 0310 81335 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 HC TPMT AND NUDT15 GENOTYPE All Payors / Plans All Payors / Plans 0300 0034U $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $478.24 $478.24 HC TRACHEOSTOMY TUBE CARE All Payors / Plans All Payors / Plans 0410 94799 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $54.88 $54.88 HC TRACTION (MECHANICAL) All Payors / Plans All Payors / Plans 0420 97012 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $139.16 $139.16 HC TRANSESOPHAGEAL ECHO All Payors / Plans All Payors / Plans 0483 93312 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $191.00 $187.18 $187.18 "HC TRANSF,BLOOD/BLOOD COMP 151-210MI" All Payors / Plans All Payors / Plans 0391 36430 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $637.98 $637.98 "HC TRANSF,BLOOD/BLOOD COMP 211-270MI" All Payors / Plans All Payors / Plans 0391 36430 $806.00 $806.00 $806.00 $806.00 $806.00 $806.00 $806.00 $789.88 $789.88 "HC TRANSF,BLOOD/BLOOD COMP 271-330MI" All Payors / Plans All Payors / Plans 0391 36430 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $941.78 $941.78 "HC TRANSF,BLOOD/BLOOD COMP 331-390MI" All Payors / Plans All Payors / Plans 0391 36430 " $1,116.00 " " $1,116.00 " " $1,116.00 " " $1,116.00 " " $1,116.00 " " $1,116.00 " " $1,116.00 " " $1,093.68 " " $1,093.68 " "HC TRANSF,BLOOD/BLOOD COMP 391-450MI" All Payors / Plans All Payors / Plans 0391 36430 " $1,271.00 " " $1,271.00 " " $1,271.00 " " $1,271.00 " " $1,271.00 " " $1,271.00 " " $1,271.00 " " $1,245.58 " " $1,245.58 " "HC TRANSF,BLOOD/BLOOD COMP 451-510MI" All Payors / Plans All Payors / Plans 0391 36430 " $1,426.00 " " $1,426.00 " " $1,426.00 " " $1,426.00 " " $1,426.00 " " $1,426.00 " " $1,426.00 " " $1,397.48 " " $1,397.48 " "HC TRANSF,BLOOD/BLOOD COMP 91-150MIN" All Payors / Plans All Payors / Plans 0391 36430 $496.00 $496.00 $496.00 $496.00 $496.00 $496.00 $496.00 $486.08 $486.08 HC TRANSFERRIN (TRANF) All Payors / Plans All Payors / Plans 0301 84466 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC TRANSFUS,BLOOD/BLOOD COMP 0-90MIN" All Payors / Plans All Payors / Plans 0391 36430 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $334.18 $334.18 HC TRANSVAGINAL SONOGRAM All Payors / Plans All Payors / Plans 0402 76830 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $637.00 $637.00 HC TREATMENT DELIVERY SRS LINEAR All Payors / Plans All Payors / Plans 0333 77372 " $3,647.00 " " $3,647.00 " " $3,647.00 " " $3,647.00 " " $3,647.00 " " $3,647.00 " " $3,647.00 " " $3,574.06 " " $3,574.06 " HC TREATMENT DEVICES-COMPLEX All Payors / Plans All Payors / Plans 0333 77334 $307.00 $307.00 $307.00 $307.00 $307.00 $307.00 $307.00 $300.86 $300.86 HC TREATMENT DEVICES-INTERM. All Payors / Plans All Payors / Plans 0333 77333 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $241.08 $241.08 HC TREATMENT DEVICES-SIMPLE All Payors / Plans All Payors / Plans 0333 77332 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $180.32 $180.32 HC TRICHOMONAS VAGINALIS All Payors / Plans All Payors / Plans 0300 87661 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $110.74 $110.74 HC TRIGLYCERIDES All Payors / Plans All Payors / Plans 0301 84478 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 "HC TRIM NONDYSTROPHIC NAILS, ANY NO." All Payors / Plans All Payors / Plans 0761 11719 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC TRIODOTHYRONINE T3, REVERSE" All Payors / Plans All Payors / Plans 0300 84482 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC TRMT DELIVERY =>1 MEV, SIMPLE" All Payors / Plans All Payors / Plans 0333 77402 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $541.94 $541.94 HC TRMT DELIVERY =>1MEV INTERMEDIATE All Payors / Plans All Payors / Plans 0333 77407 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $866.32 $866.32 "HC TRMT DELIVERY =>1MEV, COMPLEX" All Payors / Plans All Payors / Plans 0333 77412 $946.00 $946.00 $946.00 $946.00 $946.00 $946.00 $946.00 $927.08 $927.08 HC TROPONIN-I(TNI) All Payors / Plans All Payors / Plans 0301 84484 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC TRYPTASE (TRYPT) All Payors / Plans All Payors / Plans 0300 83520 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC TSH All Payors / Plans All Payors / Plans 0300 84443 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC T-TUBE CHOLANGIOGRAM All Payors / Plans All Payors / Plans 0320 47531 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 "HC TUMOR IHC QUANT OR SEMI QUANT, EA ANTIBODY" All Payors / Plans All Payors / Plans 0312 88360 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC TUMOR IMAGING 2 OR MORE AREAS 1 OR MORE DAYS/SINGLE AREA 2 OR MORE DAYS All Payors / Plans All Payors / Plans 0340 78801 " $1,076.00 " " $1,076.00 " " $1,076.00 " " $1,076.00 " " $1,076.00 " " $1,076.00 " " $1,076.00 " " $1,054.48 " " $1,054.48 " HC TUMOR IMAGING SINGLE AREA/SINGLE DAY All Payors / Plans All Payors / Plans 0340 78800 $762.00 $762.00 $762.00 $762.00 $762.00 $762.00 $762.00 $746.76 $746.76 HC TUMOR IMAGING-SPECT SINGLE AREA SINGLE DAY All Payors / Plans All Payors / Plans 0340 78803 " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,408.00 " " $1,379.84 " " $1,379.84 " HC TUMOR IMAGING-WB SINGLE DAY All Payors / Plans All Payors / Plans 0340 78802 " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,358.00 " " $1,330.84 " " $1,330.84 " HC TUMOR LOCALIZATION-WB 2 OR > DAYS All Payors / Plans All Payors / Plans 0340 78804 " $2,484.00 " " $2,484.00 " " $2,484.00 " " $2,484.00 " " $2,484.00 " " $2,484.00 " " $2,484.00 " " $2,434.32 " " $2,434.32 " HC UCG SPOT TEST (UCG) All Payors / Plans All Payors / Plans 0300 81025 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC UDP-GLUCURONOSYL TRANSFERASE 1A1 FULL GENE SEQU All Payors / Plans All Payors / Plans 0300 81479 " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,225.00 " " $1,225.00 " HC UGI DOUBLE CONTRAST All Payors / Plans All Payors / Plans 0320 74246 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $662.48 $662.48 HC UGI/SMALL BOWEL All Payors / Plans All Payors / Plans 0320 74248 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $891.80 $891.80 HC UGT1A1 GENE POLYMORPHISM All Payors / Plans All Payors / Plans 0310 81350 $980.00 $980.00 $980.00 $980.00 $980.00 $980.00 $980.00 $960.40 $960.40 HC ULTRASONIC NEEDLE GUIDE BIOPSY All Payors / Plans All Payors / Plans 0402 76942 " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,102.50 " " $1,102.50 " HC ULTRASOUND All Payors / Plans All Payors / Plans 0420 97035 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $51.94 $51.94 HC ULTRASOUND All Payors / Plans All Payors / Plans 0720 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $449.82 $449.82 HC ULTRATAG KIT All Payors / Plans All Payors / Plans 0343 $61.04 $61.04 $61.04 $61.04 $61.04 $61.04 $61.04 $59.82 $59.82 HC UNLIST GI PROC HEPAT/GI BLD LOSS All Payors / Plans All Payors / Plans 0340 78299 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC UNLISTED MOLECULAR PATH PROCEDURE All Payors / Plans All Payors / Plans 0310 81479 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 HC UPPER GI SERIES All Payors / Plans All Payors / Plans 0320 74246 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $662.48 $662.48 HC UREA NITROGEN RANDOM All Payors / Plans All Payors / Plans 0301 84540 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC URETHRAL REFLUX STUDY All Payors / Plans All Payors / Plans 0340 78740 $927.00 $927.00 $927.00 $927.00 $927.00 $927.00 $927.00 $908.46 $908.46 HC URETHROGRAM All Payors / Plans All Payors / Plans 0320 74455 " $1,725.00 " " $1,725.00 " " $1,725.00 " " $1,725.00 " " $1,725.00 " " $1,725.00 " " $1,725.00 " " $1,690.50 " " $1,690.50 " HC URIC ACID (URIC) All Payors / Plans All Payors / Plans 0301 84550 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 HC URIC ACID OTHER SOURCE All Payors / Plans All Payors / Plans 0300 84560 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC URINALYSIS ROUTINE All Payors / Plans All Payors / Plans 0307 81003 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 "HC URINALYSIS, QUALIT OR SEMIQUNAT;EXCEPT IMMUNOASSAY" All Payors / Plans All Payors / Plans 0300 81005 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $22.54 $22.54 HC URINE DIPSTICK TEST(URDIP) All Payors / Plans All Payors / Plans 0300 81000 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $22.54 $22.54 HC URINE DRUG SCREEN INSTRUMENT ASSISTED DIRECT OBSERV All Payors / Plans All Payors / Plans 0300 80307 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC URINE DRUG SCREEN VISUAL OBSERVATION All Payors / Plans All Payors / Plans 0300 80305 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 "HC URINE DRUG SCREEN, INSTRUMENT CHEM ANALYZER" All Payors / Plans All Payors / Plans 0300 80307 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $159.74 $159.74 HC URINE FOR EOSINOPHILS (UREOS) All Payors / Plans All Payors / Plans 0300 87205 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC URINE MICROSCOPIC All Payors / Plans All Payors / Plans 0300 81015 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $13.00 $12.74 $12.74 HC URINE W/MICROSCOPIC (UWM) All Payors / Plans All Payors / Plans 0307 81001 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $22.54 $22.54 "HC URINE,CITRATE 24HR (CITU)" All Payors / Plans All Payors / Plans 0300 82507 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC URINE,MICROALBUMIN" All Payors / Plans All Payors / Plans 0301 82043 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 "HC UROGRAPHY ANTEGRADE, RAD SUP & INTERPRETATION" All Payors / Plans All Payors / Plans 0320 74425 " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,250.00 " " $2,205.00 " " $2,205.00 " HC US AXILLARY All Payors / Plans All Payors / Plans 0402 76882 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $76.44 $76.44 HC US BREAST All Payors / Plans All Payors / Plans 0402 76641 $520.00 $520.00 $520.00 $520.00 $520.00 $520.00 $520.00 $509.60 $509.60 HC US BREAST NEEDLE BIOPSY EA ADD All Payors / Plans All Payors / Plans 0402 19084 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US GUID CTH PER PERITON RETRO All Payors / Plans All Payors / Plans 0402 49407 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 "HC US GUID PERIT,RETRO DRAIN TUBE" All Payors / Plans All Payors / Plans 0361 49406 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US GUID PLEURAL DRAIN TUBE All Payors / Plans All Payors / Plans 0402 49405 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US GUIDANCE TISSUE ABLATION All Payors / Plans All Payors / Plans 0402 76940 " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,102.50 " " $1,102.50 " "HC US GUIDANCE,INTRAOPERATIVE" All Payors / Plans All Payors / Plans 0402 76998 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $280.28 $280.28 HC US GUIDE ABD PARACENTESIS All Payors / Plans All Payors / Plans 0402 49083 " $1,875.00 " " $1,875.00 " " $1,875.00 " " $1,875.00 " " $1,875.00 " " $1,875.00 " " $1,875.00 " " $1,837.50 " " $1,837.50 " HC US GUIDE CRYO ABLAT LIVR OPN 1OR> All Payors / Plans All Payors / Plans 0402 47381 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US GUIDE CRYO ABLAT LIVR PER 1OR> All Payors / Plans All Payors / Plans 0402 47383 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US GUIDE RF ABLAT LIVER OPEN 1OR> All Payors / Plans All Payors / Plans 0402 47380 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US GUIDE RF ABLAT LIVER PERC 1OR> All Payors / Plans All Payors / Plans 0402 47382 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US GUIDE SCLEROTHERAPY All Payors / Plans All Payors / Plans 0402 49185 $371.75 $371.75 $371.75 $371.75 $371.75 $371.75 $371.75 $364.32 $364.32 HC US HIPS BILATERAL All Payors / Plans All Payors / Plans 0402 76885 $806.00 $806.00 $806.00 $806.00 $806.00 $806.00 $806.00 $789.88 $789.88 HC US NEEDLE LOC BREAST GUIDE ADD All Payors / Plans All Payors / Plans 0402 19286 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US OB COMPLETE DETAILED EA ADDL GESTATION All Payors / Plans All Payors / Plans 0402 76812 $832.00 $832.00 $832.00 $832.00 $832.00 $832.00 $832.00 $815.36 $815.36 HC US OB LIMITED All Payors / Plans All Payors / Plans 0402 76815 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC US OB NUCHAL TRANSLUCENCY 1 GEST All Payors / Plans All Payors / Plans 0402 76813 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC US OB NUCHAL TRANSLUCENCY ADD GES All Payors / Plans All Payors / Plans 0402 76814 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC US PERCUT NDL CORE W IMAG 1ST LES All Payors / Plans All Payors / Plans 0361 19083 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC US RETROPERITONEAL LTD All Payors / Plans All Payors / Plans 0402 76775 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC US THORA All Payors / Plans All Payors / Plans 0361 32555 " $1,200.00 " " $1,200.00 " " $1,200.00 " " $1,200.00 " " $1,200.00 " " $1,200.00 " " $1,200.00 " " $1,176.00 " " $1,176.00 " "HC US, PREGNANT UTERUS, TRANSVAGINAL" All Payors / Plans All Payors / Plans 0402 76817 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC VAG DEL PRIOR CSEC(VBAC) All Payors / Plans All Payors / Plans 0720 " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,797.10 " " $4,797.10 " HC VAG DEL W EPID-VAC-FORCEP All Payors / Plans All Payors / Plans 0720 " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,895.00 " " $4,797.10 " " $4,797.10 " HC VAGINAL DELIVERY All Payors / Plans All Payors / Plans 0720 " $3,672.00 " " $3,672.00 " " $3,672.00 " " $3,672.00 " " $3,672.00 " " $3,672.00 " " $3,672.00 " " $3,598.56 " " $3,598.56 " HC VAGINAL DELIVERY VAC-FORCEPS All Payors / Plans All Payors / Plans 0720 " $3,977.00 " " $3,977.00 " " $3,977.00 " " $3,977.00 " " $3,977.00 " " $3,977.00 " " $3,977.00 " " $3,897.46 " " $3,897.46 " HC VAGINAL DELIVERY W/ EPIDURAL All Payors / Plans All Payors / Plans 0720 " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,589.00 " " $4,497.22 " " $4,497.22 " HC VANCOMYCIN All Payors / Plans All Payors / Plans 0301 80202 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC VAP All Payors / Plans All Payors / Plans 0300 83701 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC VARICELLA ZOSTER IMMUNE (VZI) All Payors / Plans All Payors / Plans 0300 86787 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC VARICELLA-ZOSTER All Payors / Plans All Payors / Plans 0300 86787 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC VAS INTS POLYPEPTIDE (VIP) All Payors / Plans All Payors / Plans 0300 84586 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC VEDOLIZUMAB QN WITH ANTIBODIES, S" All Payors / Plans All Payors / Plans 0300 80280 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC VEDOLIZUMBA QN WITH ABS, SERUM" All Payors / Plans All Payors / Plans 0300 80299 $173.00 $173.00 $173.00 $173.00 $173.00 $173.00 $173.00 $169.54 $169.54 HC VENOGRAM All Payors / Plans All Payors / Plans 0320 75820 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC VENTILATOR - 1ST DAY All Payors / Plans All Payors / Plans 0410 94002 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $660.52 $660.52 HC VENTILATOR/SUBSEQUENT DAYS All Payors / Plans All Payors / Plans 0410 94003 $590.00 $590.00 $590.00 $590.00 $590.00 $590.00 $590.00 $578.20 $578.20 HC VERY LONG CHAIN ACLY-COA DEHYDROGENASE DEFICIENCY All Payors / Plans All Payors / Plans 0300 81406 " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,500.00 " " $1,470.00 " " $1,470.00 " HC VIRAL HEPATITIS STUDY All Payors / Plans All Payors / Plans 0300 80074 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 "HC VIRUS INOCULATION, SHELL VIA, INCL ID, EA VIRUS" All Payors / Plans All Payors / Plans 0300 87254 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC VIRUS ISOLATION TISSUE CULTURE INOCULATION, PRESUMP ID CYTOPATHIC EFFECT" All Payors / Plans All Payors / Plans 0300 87252 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $245.00 $245.00 "HC VIRUS ISOLATION, TISSUE CULT, ADD STUDIES OR ID, EA ISOLATE" All Payors / Plans All Payors / Plans 0300 87253 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC VISCOPASTE All Payors / Plans All Payors / Plans $6.77 $6.77 $6.77 $6.77 $6.77 $6.77 $6.77 $6.63 $6.63 "HC VISCOSITY, SERUM (VSC)" All Payors / Plans All Payors / Plans 0300 85810 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC VISUAL EVOKED RESPONSE All Payors / Plans All Payors / Plans 0740 95819 " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,525.00 " " $2,474.50 " " $2,474.50 " HC VITAL CAPACITY All Payors / Plans All Payors / Plans 0460 94150 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $49.98 $49.98 HC VITAMIN A (VITA) All Payors / Plans All Payors / Plans 0301 84590 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC VITAMIN B-1 (VITB1) All Payors / Plans All Payors / Plans 0301 84425 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $120.54 $120.54 HC VITAMIN D - DIHYDROXY (VITDD) All Payors / Plans All Payors / Plans 0301 82652 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC VITAMIN D -25 HYDROXY All Payors / Plans All Payors / Plans 0300 82306 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC VITAMIN E (VITE) All Payors / Plans All Payors / Plans 0301 84446 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 "HC VITAMIN, NOT OTHERWISE SPECIFIED" All Payors / Plans All Payors / Plans 0300 84591 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 HC VL AAA SCREEN INITIAL All Payors / Plans All Payors / Plans 0402 76706 $494.00 $494.00 $494.00 $494.00 $494.00 $494.00 $494.00 $484.12 $484.12 HC VL AORTIC DUPLEX SCAN COMPLETE All Payors / Plans All Payors / Plans 0921 93978 " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,118.00 " " $1,095.64 " " $1,095.64 " HC VL AORTIC DUPLEX SCAN LIMITED All Payors / Plans All Payors / Plans 0921 93979 $702.00 $702.00 $702.00 $702.00 $702.00 $702.00 $702.00 $687.96 $687.96 HC VL CAROTID DUPLEX BILATERAL All Payors / Plans All Payors / Plans 0921 93880 " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,196.00 " " $1,172.08 " " $1,172.08 " HC VL CAROTID DUPLEX UNILATERAL All Payors / Plans All Payors / Plans 0921 93882 $754.00 $754.00 $754.00 $754.00 $754.00 $754.00 $754.00 $738.92 $738.92 "HC VL DUPLEX ART/VEN PRE-OP VESSEL MAPPING, UNILATERAL" All Payors / Plans All Payors / Plans 0921 93986 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $229.32 $229.32 HC VL DUPLEX HD ART AV GRAFT All Payors / Plans All Payors / Plans 0921 93990 $988.00 $988.00 $988.00 $988.00 $988.00 $988.00 $988.00 $968.24 $968.24 HC VL DUPLEX HD ART/VEN PENILE COMPLETE All Payors / Plans All Payors / Plans 0921 93980 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC VL DUPLEX HD ART/VEN PENILE LTD All Payors / Plans All Payors / Plans 0921 93981 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC VL DUPLEX LEA BILATERAL All Payors / Plans All Payors / Plans 0921 93925 " $1,612.00 " " $1,612.00 " " $1,612.00 " " $1,612.00 " " $1,612.00 " " $1,612.00 " " $1,612.00 " " $1,579.76 " " $1,579.76 " HC VL DUPLEX LEA UNILATERAL All Payors / Plans All Payors / Plans 0921 93926 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $917.28 $917.28 HC VL DUPLEX UEA BILATERAL All Payors / Plans All Payors / Plans 0921 93930 " $1,222.00 " " $1,222.00 " " $1,222.00 " " $1,222.00 " " $1,222.00 " " $1,222.00 " " $1,222.00 " " $1,197.56 " " $1,197.56 " HC VL DUPLEX UEA UNILATERAL All Payors / Plans All Payors / Plans 0921 93931 $754.00 $754.00 $754.00 $754.00 $754.00 $754.00 $754.00 $738.92 $738.92 HC VL DUPLEX VENOUS MAP BILAT All Payors / Plans All Payors / Plans 0921 93970 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $535.08 $535.08 HC VL DUPLEX VENOUS MAP UNILAT All Payors / Plans All Payors / Plans 0921 93971 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $713.44 $713.44 HC VL MULTIPLE LEVEL BILATERAL All Payors / Plans All Payors / Plans 0921 93923 $832.00 $832.00 $832.00 $832.00 $832.00 $832.00 $832.00 $815.36 $815.36 HC VL PSA INJECTION U/S GUIDE All Payors / Plans All Payors / Plans 0402 76942 " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,102.50 " " $1,102.50 " HC VL QUANTIT CAROTID INTIMA BILAT All Payors / Plans All Payors / Plans 0921 93895 $754.00 $754.00 $754.00 $754.00 $754.00 $754.00 $754.00 $738.92 $738.92 HC VL RENAL ARTERY DUPLEX COMPLETE All Payors / Plans All Payors / Plans 0921 93975 " $1,638.00 " " $1,638.00 " " $1,638.00 " " $1,638.00 " " $1,638.00 " " $1,638.00 " " $1,638.00 " " $1,605.24 " " $1,605.24 " HC VL RENAL ARTERY DUPLEX LIMITED All Payors / Plans All Payors / Plans 0921 93976 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $891.80 $891.80 HC VL SINGLE LEVEL BILATERAL All Payors / Plans All Payors / Plans 0921 93922 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $535.08 $535.08 "HC VL TRANSCRANIAL DOPPLER, COMPLETE" All Payors / Plans All Payors / Plans 0921 93886 " $1,690.00 " " $1,690.00 " " $1,690.00 " " $1,690.00 " " $1,690.00 " " $1,690.00 " " $1,690.00 " " $1,656.20 " " $1,656.20 " "HC VL TRANSCRANIAL DOPPLER, LIMITED" All Payors / Plans All Payors / Plans 0921 93888 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $891.80 $891.80 HC VL VEIN MAPPING All Payors / Plans All Payors / Plans 0921 93985 $494.00 $494.00 $494.00 $494.00 $494.00 $494.00 $494.00 $484.12 $484.12 HC VL VENOUS DOPPLER All Payors / Plans All Payors / Plans 0921 93965 $525.25 $525.25 $525.25 $525.25 $525.25 $525.25 $525.25 $514.75 $514.75 HC VMA (VMA) All Payors / Plans All Payors / Plans 0300 84585 $74.00 $74.00 $74.00 $74.00 $74.00 $74.00 $74.00 $72.52 $72.52 HC VOLATILE SCREEN (MEOH) All Payors / Plans All Payors / Plans 0300 80320 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $56.84 $56.84 HC VON WILLEBRAND FACTOR All Payors / Plans All Payors / Plans 0300 85247 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC VONWILLEBRAND FACTOR AG All Payors / Plans All Payors / Plans 0300 85246 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 HC VRE SCREEN CULTURE (VRSC) All Payors / Plans All Payors / Plans 0300 87081 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 HC WALK TEST All Payors / Plans All Payors / Plans 0460 94618 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $286.16 $286.16 HC WC NEGATIVE PRESSURE <=50 CM All Payors / Plans All Payors / Plans 0761 97605 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $286.16 $286.16 HC WC TOTAL WOUND SURFACE <=50CM All Payors / Plans All Payors / Plans 0761 97607 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $286.16 $286.16 HC WELLNESS PROFILE (WP) All Payors / Plans All Payors / Plans 0300 83718 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HC WESTERN BLOT W/INTERP AND REPORT;BLOOD/OTHER FLUID All Payors / Plans All Payors / Plans 0300 84182 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 HC WET MOUNT (WTMT) All Payors / Plans All Payors / Plans 0300 87210 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $19.60 $19.60 HC WHEELCHARI MGMT/PROPOLUSION 15MIN All Payors / Plans All Payors / Plans 0420 97542 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $87.22 $87.22 HC WIRE LOCAL LYMPH NODE ONLY All Payors / Plans All Payors / Plans 0402 10035 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 HC WRIST 3 VIEW All Payors / Plans All Payors / Plans 0320 73110 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 HC WRIST ARTHORGRAM All Payors / Plans All Payors / Plans 0320 73115 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $735.00 $735.00 HC WRIST W 20 DEGREE ELEVATION 2 VIE All Payors / Plans All Payors / Plans 0320 73100 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC XE133 10MCI All Payors / Plans All Payors / Plans 0343 A9558 $44.55 $44.55 $44.55 $44.55 $44.55 $44.55 $44.55 $43.66 $43.66 HC XE133 20MCI All Payors / Plans All Payors / Plans 0343 A9558 $64.54 $64.54 $64.54 $64.54 $64.54 $64.54 $64.54 $63.25 $63.25 "HC XR ANKLE, 3 VIEWS" All Payors / Plans All Payors / Plans 0320 73610 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC XR C SPINE 3 VIEWS OR LESS All Payors / Plans All Payors / Plans 0320 72040 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC XR C SPINE 4 OR 5 VIEWS All Payors / Plans All Payors / Plans 0320 72050 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC XR C-SPINE 6 OR MORE VIEWS All Payors / Plans All Payors / Plans 0320 72052 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $280.28 $280.28 HC XR EPIDUR DIAG/THER INJ ONLY All Payors / Plans All Payors / Plans 0320 77003 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC XR EPIDUROGRAPHY All Payors / Plans All Payors / Plans 0320 72275 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $367.50 $367.50 HC XR FEMUR (1)VIEW All Payors / Plans All Payors / Plans 0320 73551 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 HC XR FL CECUM TUBE PLACEMENT All Payors / Plans All Payors / Plans 0320 49442 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $280.28 $280.28 HC XR FL NG TUBE PLACEMENT All Payors / Plans All Payors / Plans 0320 43752 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $280.28 $280.28 HC XR FLUO CONTRAST LARYNOGOGRAPHY All Payors / Plans All Payors / Plans 0320 76499 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC XR FOOT 3 VIEWS All Payors / Plans All Payors / Plans 0320 73630 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 "HC XR HAND, 3 VIEWS" All Payors / Plans All Payors / Plans 0320 73130 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC XR HIP ARTHROGRAM All Payors / Plans All Payors / Plans 0320 73525 " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,125.00 " " $1,102.50 " " $1,102.50 " HC XR HYSTEROSALPINGOGRAM All Payors / Plans All Payors / Plans 0320 74740 " $2,475.00 " " $2,475.00 " " $2,475.00 " " $2,475.00 " " $2,475.00 " " $2,475.00 " " $2,475.00 " " $2,425.50 " " $2,425.50 " HC XR INTRATHECAL INJ OF CHEMO All Payors / Plans All Payors / Plans 0260 96450 " $1,069.50 " " $1,069.50 " " $1,069.50 " " $1,069.50 " " $1,069.50 " " $1,069.50 " " $1,069.50 " " $1,048.11 " " $1,048.11 " HC XR PORT THOR/LUMB SPINE 2-3 VIEW All Payors / Plans All Payors / Plans 0320 72082 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $331.24 $331.24 HC XR REP DUOD/JEJUNO TUBE W FLUORO All Payors / Plans All Payors / Plans 0361 49451 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $106.82 $106.82 HC XR REP GASTRO JEJUNGO UNDER FLUO All Payors / Plans All Payors / Plans 0361 49440 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $106.82 $106.82 HC XR SCOLIOSIS SERIES 2-3 VIEW All Payors / Plans All Payors / Plans 0320 72082 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $338.00 $331.24 $331.24 HC XR SCOLIOSIS SERIES 4-5 VIEW All Payors / Plans All Payors / Plans 0320 72083 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $356.72 $356.72 HC XR SCOLIOSIS SERIES MIN 6 VIEW All Payors / Plans All Payors / Plans 0320 72084 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $433.16 $433.16 HC XR SM B SERIES VIA ENTEROCLYSIS TUBE All Payors / Plans All Payors / Plans 0320 74251 " $2,808.00 " " $2,808.00 " " $2,808.00 " " $2,808.00 " " $2,808.00 " " $2,808.00 " " $2,808.00 " " $2,751.84 " " $2,751.84 " HC XR SM BOWEL SITZMARKER All Payors / Plans All Payors / Plans 0320 74248 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $910.00 $891.80 $891.80 HC XR T TUBE CHOLANGIOG NEW ACCESS All Payors / Plans All Payors / Plans 0320 47532 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $156.00 $152.88 $152.88 HC XR TEETH COMPLETE FULL MOUTH All Payors / Plans All Payors / Plans 0320 70320 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $286.00 $280.28 $280.28 HC XR TEETH PARTIAL < FULL MOUTH All Payors / Plans All Payors / Plans 0320 70310 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $203.84 $203.84 HC XR TEETH SINGLE VIEW All Payors / Plans All Payors / Plans 0320 70300 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $50.96 $50.96 HC XR THOR & LUM SPINE PORT 1 VIEW All Payors / Plans All Payors / Plans 0320 72081 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $182.00 $178.36 $178.36 "HC XYLOSE ABSORPTION TEST, BLOOD AND/OR URINE" All Payors / Plans All Payors / Plans 0300 84620 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $73.50 $73.50 HC Y CHROMOSOME MICRODELETION DNA ANALYSIS All Payors / Plans All Payors / Plans 0310 81403 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 HC YEAST IDENTIFICATION X 1 All Payors / Plans All Payors / Plans 0300 87106 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $24.50 $24.50 HC Z NM I123 CAP WB PER MCI All Payors / Plans All Payors / Plans 0343 A9509 $280.84 $280.84 $280.84 $280.84 $280.84 $280.84 $280.84 $275.22 $275.22 HC Z NM I-123 CAPSULE (200UCI) All Payors / Plans All Payors / Plans 0343 A9516 $46.01 $46.01 $46.01 $46.01 $46.01 $46.01 $46.01 $45.09 $45.09 HC Z NM TC99M TAG RRC PER DOSE 30MCI All Payors / Plans All Payors / Plans 0343 A9560 $35.64 $35.64 $35.64 $35.64 $35.64 $35.64 $35.64 $34.93 $34.93 HC ZIEHL NIELSEN ST FOR AF BACT All Payors / Plans All Payors / Plans 0310 88312 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $37.24 $37.24 HC ZINC All Payors / Plans All Payors / Plans 0301 84630 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 "HC ZINC, BLD. (ZN)" All Payors / Plans All Payors / Plans 0300 84630 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $61.74 $61.74 HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " HEAD FEMORAL V40 LFIT TRITANIUM COCR +0 MM OFFSET TAPER OD28 MM HIP PRIMARY All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " HEAD MATCH 3.0MM PRECISION NEURO All Payors / Plans All Payors / Plans $275.46 $275.46 $275.46 $275.46 $275.46 $275.46 $275.46 $269.95 $269.95 HEMOSPRAY 7 All Payors / Plans All Payors / Plans " $5,000.00 " " $5,000.00 " " $5,000.00 " " $5,000.00 " " $5,000.00 " " $5,000.00 " " $5,000.00 " " $4,900.00 " " $4,900.00 " HEMOSTAT ABSORBABLE FIBRILLAR SURGICEL L4 IN X W2 IN LIGHTWEIGHT LAYER STERILE DISPOSABLE All Payors / Plans All Payors / Plans $199.94 $199.94 $199.94 $199.94 $199.94 $199.94 $199.94 $195.94 $195.94 HEMOSTAT ABSORBABLE SURGICEL 3X2IN STERILE FLEXIBLE All Payors / Plans All Payors / Plans $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $20.58 $20.58 HEMOSTAT ABSORBABLE SURGICEL FIBRILLAR 2X1IN STERILE LIGHTWEIGHT LAYER TUFT All Payors / Plans All Payors / Plans $108.64 $108.64 $108.64 $108.64 $108.64 $108.64 $108.64 $106.46 $106.46 HEMOSTAT ABSORBABLE SURGICEL L14 IN X W2 IN ORIGINAL FLEXIBLE SHEER WEAVE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $20.58 $20.58 HEMOSTAT ABSORBABLE SURGICEL L8 IN X W4 IN SHEER WEAVE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $20.58 $20.58 "HEPARIN (PORCINE) IN 0.9% NACL 5,000 UNIT/500 ML (10 UNIT/ML) PARENTERAL SOLUTION" All Payors / Plans All Payors / Plans $23.61 $23.61 $23.61 $23.61 $23.61 $23.61 $23.61 $23.14 $23.14 HEPARIN (PORCINE) PER 1000 UNITS All Payors / Plans All Payors / Plans $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 HEPARIN (PROCINE) PER 1000 UNITS All Payors / Plans All Payors / Plans $1.57 $1.57 $1.57 $1.57 $1.57 $1.57 $1.57 $1.54 $1.54 "HEPARIN, PORCINE (PF) 1 UNIT/ML SYRINGE" All Payors / Plans All Payors / Plans $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $5.88 $5.88 "HEPARIN, PORCINE (PF) 10 UNIT/ML SYRINGE" All Payors / Plans All Payors / Plans $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 $0.13 "HEPARIN, PORCINE (PF) 10 UNIT/ML SYRINGE 3 ML SYRINGE" All Payors / Plans All Payors / Plans $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 "HEPARIN, PORCINE (PF) 10 UNIT/ML SYRINGE 5 ML SYRINGE" All Payors / Plans All Payors / Plans $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 "HEPARIN, PORCINE (PF) 100 UNIT/ML SYRINGE" All Payors / Plans All Payors / Plans $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 HEPATITIS B IMMUNE GLOBULIN PER 0.5 ML All Payors / Plans All Payors / Plans $85.43 $85.43 $85.43 $85.43 $85.43 $85.43 $85.43 $83.72 $83.72 HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $83.81 $83.81 $83.81 $83.81 $83.81 $83.81 $83.81 $82.13 $82.13 HETASTARCH 6 % IN 0.9 % NACL 6 % SOLUTION All Payors / Plans All Payors / Plans $52.99 $52.99 $52.99 $52.99 $52.99 $52.99 $52.99 $51.93 $51.93 HOLDER LIMB QUICK RELEASE 60 INCH STRAP All Payors / Plans All Payors / Plans $3.42 $3.42 $3.42 $3.42 $3.42 $3.42 $3.42 $3.35 $3.35 HOOD FLYTE SURGICOOL All Payors / Plans All Payors / Plans $44.89 $44.89 $44.89 $44.89 $44.89 $44.89 $44.89 $43.99 $43.99 HOOD SURGEON FLYTE STERI-SHIELD PEELAWAY FACE SHIELD LATEX FREE PERSONAL PROTECTION SYSTEM All Payors / Plans All Payors / Plans $80.19 $80.19 $80.19 $80.19 $80.19 $80.19 $80.19 $78.59 $78.59 HOOK RETRACTION 5 MM BLUNT ELASTIC STAY DISPOSABLE All Payors / Plans All Payors / Plans $20.93 $20.93 $20.93 $20.93 $20.93 $20.93 $20.93 $20.51 $20.51 HOOK RETRACTION LONE STAR 12 MM BLUNT ELASTIC STAY STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $20.93 $20.93 $20.93 $20.93 $20.93 $20.93 $20.93 $20.51 $20.51 "HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) RECON SOLN" All Payors / Plans All Payors / Plans $1.73 $1.73 $1.73 $1.73 $1.73 $1.73 $1.73 $1.69 $1.69 "HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) RECON SOLN 1 EACH VIAL" All Payors / Plans All Payors / Plans $2.11 $2.11 $2.11 $2.11 $2.11 $2.11 $2.11 $2.07 $2.07 HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 HYDRALAZINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 HYDRALAZINE 25 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 HYDRALAZINE 50 MG TABLET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 HYDRALAZINE PER 20 MG All Payors / Plans All Payors / Plans $15.78 $15.78 $15.78 $15.78 $15.78 $15.78 $15.78 $15.46 $15.46 HYDROCHLOROTHIAZIDE 25 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 HYDROCHLOROTHIAZIDE 25 MG TABLET 1 EACH BLIST PACK All Payors / Plans All Payors / Plans $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.82 $0.82 HYDROCHLOROTHIAZIDE 25 MG TABLET 100 EACH BOTTLE All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 HYDROCODONE-ACETAMINOPHEN 10-325 MG TABLET All Payors / Plans All Payors / Plans $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.83 $1.79 $1.79 HYDROCODONE-ACETAMINOPHEN 5-325 MG TABLET All Payors / Plans All Payors / Plans $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.07 $1.07 HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML SOLUTION All Payors / Plans All Payors / Plans $10.21 $10.21 $10.21 $10.21 $10.21 $10.21 $10.21 $10.01 $10.01 HYDROCORTISONE 1 % CREAM 28 G TUBE All Payors / Plans All Payors / Plans $10.43 $10.43 $10.43 $10.43 $10.43 $10.43 $10.43 $10.22 $10.22 HYDROCORTISONE 1 % CREAM 28.35 G TUBE All Payors / Plans All Payors / Plans $13.27 $13.27 $13.27 $13.27 $13.27 $13.27 $13.27 $13.00 $13.00 HYDROCORTISONE 10 MG TABLET All Payors / Plans All Payors / Plans $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.10 $1.10 HYDROCORTISONE 100 MG/60 ML ENEMA All Payors / Plans All Payors / Plans $28.99 $28.99 $28.99 $28.99 $28.99 $28.99 $28.99 $28.41 $28.41 HYDROCORTISONE 2.5 % CREAM 30 G TUBE All Payors / Plans All Payors / Plans $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $15.68 $15.68 HYDROCORTISONE 25 MG SUPPOSITORY All Payors / Plans All Payors / Plans $5.10 $5.10 $5.10 $5.10 $5.10 $5.10 $5.10 $5.00 $5.00 HYDROCORTISONE 5 MG TABLET All Payors / Plans All Payors / Plans $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.48 $3.48 HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML RECON SOLN All Payors / Plans All Payors / Plans $42.16 $42.16 $42.16 $42.16 $42.16 $42.16 $42.16 $41.32 $41.32 HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.62 $6.62 HYDROMORPHONE 0.5 MG/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $16.08 $16.08 $16.08 $16.08 $16.08 $16.08 $16.08 $15.76 $15.76 HYDROMORPHONE 0.5 MG/0.5 ML SYRINGE 0.5 ML SYRINGE All Payors / Plans All Payors / Plans $16.19 $16.19 $16.19 $16.19 $16.19 $16.19 $16.19 $15.87 $15.87 HYDROMORPHONE 2 MG TABLET All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.03 $1.03 HYDROMORPHONE 2 MG/ML SYRINGE All Payors / Plans All Payors / Plans $15.66 $15.66 $15.66 $15.66 $15.66 $15.66 $15.66 $15.35 $15.35 HYDROMORPHONE PER 4 MG All Payors / Plans All Payors / Plans $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $30.40 $30.40 HYDROXYCHLOROQUINE 200 MG TABLET All Payors / Plans All Payors / Plans $3.56 $3.56 $3.56 $3.56 $3.56 $3.56 $3.56 $3.48 $3.48 HYDROXYUREA 500 MG CAPSULE All Payors / Plans All Payors / Plans $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.12 $1.12 HYDROXYZINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 HYDROXYZINE PAMOATE PER 25 MG All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 HYDROXYZINE PAMOATE PER 50 MG All Payors / Plans All Payors / Plans $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.89 $1.89 HYDROXYZINE PER 25 MG All Payors / Plans All Payors / Plans $41.78 $41.78 $41.78 $41.78 $41.78 $41.78 $41.78 $40.94 $40.94 HYPROMELLOSE 2.5 % DROPS 15 ML DROP BTL All Payors / Plans All Payors / Plans $85.43 $85.43 $85.43 $85.43 $85.43 $85.43 $85.43 $83.72 $83.72 "I-123 SODIUM IODIDATE, CAPSULE, DIAGNOSTIC, PER 100 UCI TO 999 UCI 3.7 MBQ (100 MICROCI) CAPSULE" All Payors / Plans All Payors / Plans $70.29 $70.29 $70.29 $70.29 $70.29 $70.29 $70.29 $68.88 $68.88 "I-123 SODIUM IODIDE, CAPSULE, DIAGNOSTIC, PER MCI, 10 CAPS TOTAL 3.7 MBQ (100 MICROCI) CAPSULE" All Payors / Plans All Payors / Plans $260.43 $260.43 $260.43 $260.43 $260.43 $260.43 $260.43 $255.22 $255.22 "I-131 SODIUM IODIDE CAPSULE, THERAPEUTIC, AFTER 6 MCI 1,000 MCI/ML (1 ML) KIT" All Payors / Plans All Payors / Plans $14.09 $14.09 $14.09 $14.09 $14.09 $14.09 $14.09 $13.81 $13.81 "I-131 SODIUM IODIDE, CAPSULE, THERAPEUTIC, FIRST 6 MCI 1,000 MCI/ML (1 ML) KIT" All Payors / Plans All Payors / Plans $23.47 $23.47 $23.47 $23.47 $23.47 $23.47 $23.47 $23.00 $23.00 IBUPROFEN 100 MG/5 ML SUSPENSION All Payors / Plans All Payors / Plans $3.98 $3.98 $3.98 $3.98 $3.98 $3.98 $3.98 $3.90 $3.90 IBUPROFEN 400 MG TABLET All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 IBUPROFEN 600 MG TABLET All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 IBUPROFEN 800 MG TABLET All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 ICD D233 VIGILANT EL DR DF 4 2 LEAD SYSTEM All Payors / Plans All Payors / Plans " $32,340.00 " " $32,340.00 " " $32,340.00 " " $32,340.00 " " $32,340.00 " " $32,340.00 " " $32,340.00 " " $31,693.20 " " $31,693.20 " ICD DDPA2D4 COBALT XT MRI DR SURESCAN DEVICE _63234_ All Payors / Plans All Payors / Plans " $33,091.82 " " $33,091.82 " " $33,091.82 " " $33,091.82 " " $33,091.82 " " $33,091.82 " " $33,091.82 " " $32,429.98 " " $32,429.98 " ICD DVPA2D1 COBALT XT MRI VR DEVICE _63231_ All Payors / Plans All Payors / Plans " $16,982.37 " " $16,982.37 " " $16,982.37 " " $16,982.37 " " $16,982.37 " " $16,982.37 " " $16,982.37 " " $16,642.72 " " $16,642.72 " ICD DVPA2D4 COBALT XT MRI VR DF4 SURESCAN DEVICE -63232- All Payors / Plans All Payors / Plans " $30,797.37 " " $30,797.37 " " $30,797.37 " " $30,797.37 " " $30,797.37 " " $30,797.37 " " $30,797.37 " " $30,181.42 " " $30,181.42 " ICD QUADRA ASSURA MP CRT-D DR4 CONNECTOR All Payors / Plans All Payors / Plans " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,790.00 " " $19,394.20 " " $19,394.20 " ICE SOUNDSTAR 10 FR ULTRASOUND CATHETER All Payors / Plans All Payors / Plans " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,817.28 " " $5,817.28 " ICE SOUNDSTAR 8FR REPROC _61682_ All Payors / Plans All Payors / Plans " $3,012.00 " " $3,012.00 " " $3,012.00 " " $3,012.00 " " $3,012.00 " " $3,012.00 " " $3,012.00 " " $2,951.76 " " $2,951.76 " IMIPENEM-CILASTATIN PER 250 MG All Payors / Plans All Payors / Plans $25.71 $25.71 $25.71 $25.71 $25.71 $25.71 $25.71 $25.20 $25.20 IMMBOLIZER ORTHOPEDIC FOAM L16 IN W 3 IN OD 29 IN KNEE ELASTIC STRAP PERFORATED All Payors / Plans All Payors / Plans $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $27.44 $27.44 IMMOBILIZER ORTHOPEDIC ALUMINUM FOAM 24 IN OD 17.5 IN OD SEC 16 IN KNEE 3 PANEL LOOP LOCK CLOSURE POSTERIOR STAY ADJUSTABLE LATEX FREE All Payors / Plans All Payors / Plans $28.16 $28.16 $28.16 $28.16 $28.16 $28.16 $28.16 $27.60 $27.60 IMMOBILIZER ORTHOPEDIC ALUMINUM FOAM 26 IN OD 20.5 IN ODSEC 22 IN L KNEE 3 PANEL LOOP LOCK CLOSURE POSTERIOR STAY ADJUSTABLE LATEX FREE All Payors / Plans All Payors / Plans $21.93 $21.93 $21.93 $21.93 $21.93 $21.93 $21.93 $21.49 $21.49 IMMOBILIZER ORTHOPEDIC ALUMINUM FOAM NYLON CONTOUR L22 IN OD29 IN KNEE ELASTIC PATELLA STRAP PERFORATE BREATHABLE All Payors / Plans All Payors / Plans $18.25 $18.25 $18.25 $18.25 $18.25 $18.25 $18.25 $17.89 $17.89 IMMOBILIZER ORTHOPEDIC ALUMINUM TRICOT UNIVERSAL L12 IN KNEE POSTERIOR STAY HOOK LOOP CLOSURE 3 PANEL LATEX FREE All Payors / Plans All Payors / Plans $27.14 $27.14 $27.14 $27.14 $27.14 $27.14 $27.14 $26.60 $26.60 IMMUNE GLOBULIN (HUMAN) 10 % SOLUTION All Payors / Plans All Payors / Plans $71.24 $71.24 $71.24 $71.24 $71.24 $71.24 $71.24 $69.81 $69.81 IMMUNE GLOBULIN (HUMAN) 10 GRAM/100 ML (10 %) SOLUTION All Payors / Plans All Payors / Plans $71.24 $71.24 $71.24 $71.24 $71.24 $71.24 $71.24 $69.81 $69.81 IMMUNODIFFUSION OUCHTEROLOGY X5 All Payors / Plans All Payors / Plans 0302 86331 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $233.24 $233.24 IMPLANT ALL POLY PATELLA All Payors / Plans All Payors / Plans " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,675.00 " " $3,675.00 " IMPLANT CORNERSTONE L-SR 7X14X11 All Payors / Plans All Payors / Plans " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,862.00 " " $1,862.00 " IMPLANT HIP FEMORAL STEM ENDURANCE SIZE 4 All Payors / Plans All Payors / Plans " $10,529.00 " " $10,529.00 " " $10,529.00 " " $10,529.00 " " $10,529.00 " " $10,529.00 " " $10,529.00 " " $10,318.42 " " $10,318.42 " IMPLANT MEDTRONIC TRANSLATIONAL PLATE 19MM All Payors / Plans All Payors / Plans " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,225.00 " " $1,225.00 " IMPLANT OPHTHALMIC BAERVELDT 350SQ MM SILICONE ANTERIOR CHAMBER QUADRANT INSERTION FIXATION SUTURE HOLE RECESS KNOT All Payors / Plans All Payors / Plans " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,372.00 " " $1,372.00 " IMPLANT PUTTY OSTEOSTRUX 10CC All Payors / Plans All Payors / Plans " $2,792.32 " " $2,792.32 " " $2,792.32 " " $2,792.32 " " $2,792.32 " " $2,792.32 " " $2,792.32 " " $2,736.47 " " $2,736.47 " IMPLANT STRIP POCKET DBM 20CC All Payors / Plans All Payors / Plans " $6,212.96 " " $6,212.96 " " $6,212.96 " " $6,212.96 " " $6,212.96 " " $6,212.96 " " $6,212.96 " " $6,088.70 " " $6,088.70 " IMPLANT VOCAL CORD PROLARYN SODIUM CARBOXYMETHYLCELLULOSE 1 ML KIT INJECTABLE SYRINGE 2 NEEDLE RESORBABLE STERILE LATEX FREE TEMPORARY All Payors / Plans All Payors / Plans " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,225.00 " " $1,225.00 " INDIGOTINDISULFONATE 8 MG/ML (0.8 %) SOLUTION All Payors / Plans All Payors / Plans $360.65 $360.65 $360.65 $360.65 $360.65 $360.65 $360.65 $353.44 $353.44 INDOCYANINE GREEN 25 MG RECON SOLN All Payors / Plans All Payors / Plans $252.47 $252.47 $252.47 $252.47 $252.47 $252.47 $252.47 $247.42 $247.42 INDOCYANINE GREEN 25 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $252.47 $252.47 $252.47 $252.47 $252.47 $252.47 $252.47 $247.42 $247.42 INDOMETHACIN 25 MG CAPSULE All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 INDOMETHACIN 50 MG SUPPOSITORY All Payors / Plans All Payors / Plans $329.75 $329.75 $329.75 $329.75 $329.75 $329.75 $329.75 $323.16 $323.16 INFLIXIMAB-ABDA PER 10 MG All Payors / Plans All Payors / Plans $85.49 $85.49 $85.49 $85.49 $85.49 $85.49 $85.49 $83.78 $83.78 INFLUENZA QUADRIVALENT 60 MCG (15 MCG X 4)/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $85.45 $85.45 $85.45 $85.45 $85.45 $85.45 $85.45 $83.74 $83.74 "INJECTION, INSULIN PER 5 UNITS" All Payors / Plans All Payors / Plans $2.19 $2.19 $2.19 $2.19 $2.19 $2.19 $2.19 $2.15 $2.15 INSERT ACETABULAR TRIDENT X3 0 D E ID36 MM STERILE LATEX FREE All Payors / Plans All Payors / Plans " $2,754.90 " " $2,754.90 " " $2,754.90 " " $2,754.90 " " $2,754.90 " " $2,754.90 " " $2,754.90 " " $2,699.80 " " $2,699.80 " INSERT CLAMP EVERCLIP FOGARTY HYDRAGRIP L33 MM ATRAUMATIC OCCLUSION SOFT COMPLIANT TRACTION GENTLE SURROUND VESSEL SET STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $42.02 $42.02 $42.02 $42.02 $42.02 $42.02 $42.02 $41.18 $41.18 INSERT CLAMP EVERCLIP FOGARTY HYDRAGRIP L61 MM ATRAUMATIC OCCLUSION SOFT COMPLIANT TRACTION GENTLE SURROUND VESSEL RUBBER PYRAMID SET STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $35.68 $35.68 $35.68 $35.68 $35.68 $35.68 $35.68 $34.97 $34.97 INSERT NEEDLE HOLDER SUTURE RETENTION SLOT DISPOSABLE OCTOBASE RETRACTOR All Payors / Plans All Payors / Plans $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $107.80 $107.80 INSERT TIBIAL GMK 4 H10 MM LEFT FIXED SPHERE FLEX All Payors / Plans All Payors / Plans " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,468.00 " " $6,468.00 " INSERT TIBIAL GMK 4 H11 MM RIGHT FIXED SPHERE FLEX All Payors / Plans All Payors / Plans " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,600.00 " " $6,468.00 " " $6,468.00 " INSERT TIBIAL GMK 5 H11 MM LEFT FIXED SPHERE FLEX All Payors / Plans All Payors / Plans " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,076.00 " " $6,076.00 " INSTRUMENT BIOPSY BARD MAX-CORE ANGLE 22MM 20CM 13.8CM 18GA PINK DISPOSABLE STERILE LF PROSTATIC 2 TRIGGER ULTRA SHARP All Payors / Plans All Payors / Plans $100.90 $100.90 $100.90 $100.90 $100.90 $100.90 $100.90 $98.88 $98.88 INSTRUMENT ELECTROSURGICAL LIGASURE FORCETRIAD TISSUEFECT 28D 3.4V 14.7MM CURVE 18.8CM 16.5X1-4MM DISPOSABLE STERILE LF All Payors / Plans All Payors / Plans $909.38 $909.38 $909.38 $909.38 $909.38 $909.38 $909.38 $891.19 $891.19 INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) INSULIN PEN 3 ML SYRINGE All Payors / Plans All Payors / Plans $104.34 $104.34 $104.34 $104.34 $104.34 $104.34 $104.34 $102.25 $102.25 INSULIN GLARGINE PER 5 UNITS All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 INSULIN LISPRO (HUMAN) PER 5 UNITS All Payors / Plans All Payors / Plans $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $10.32 $10.32 INSULIN LISPRO (HUMAN) PER 5 UNITS All Payors / Plans All Payors / Plans $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $10.32 $10.32 INSULIN LISPRO (U-100) 100 UNIT/ML INSULIN PEN 3 ML SYRINGE All Payors / Plans All Payors / Plans $85.38 $85.38 $85.38 $85.38 $85.38 $85.38 $85.38 $83.67 $83.67 INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) INSULIN PEN 3 ML SYRINGE All Payors / Plans All Payors / Plans $85.38 $85.38 $85.38 $85.38 $85.38 $85.38 $85.38 $83.67 $83.67 INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML (3 ML) INSULIN PEN 3 ML SYRINGE All Payors / Plans All Payors / Plans $64.31 $64.31 $64.31 $64.31 $64.31 $64.31 $64.31 $63.02 $63.02 INSULIN REGULAR HUMAN PER 5 UNITS All Payors / Plans All Payors / Plans $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 INTERTAN 10MM X 18CM 130DEG All Payors / Plans All Payors / Plans " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,646.00 " " $2,646.00 " INTERTAN LAG/COMP KIT 100/95 All Payors / Plans All Payors / Plans " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,206.18 " " $1,206.18 " INTERTAN LAG/COMP KIT 105/100 All Payors / Plans All Payors / Plans " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,206.18 " " $1,206.18 " INTERTAN LAG/COMP KIT 85/80 All Payors / Plans All Payors / Plans " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,206.18 " " $1,206.18 " INTERTAN LAG/COMP KIT 90/85 All Payors / Plans All Payors / Plans " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,206.18 " " $1,206.18 " INTERTAN RIGHT 10MM X 36 125DEG All Payors / Plans All Payors / Plans " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,577.00 " " $3,577.00 " INTERTAN RIGHT 10MM X 40 125DEG All Payors / Plans All Payors / Plans " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,577.00 " " $3,577.00 " INTERTAN RIGHT 10MM X 42 125DEG All Payors / Plans All Payors / Plans " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,650.00 " " $3,577.00 " " $3,577.00 " INTERTAN SUBTROCH 90MM All Payors / Plans All Payors / Plans $992.80 $992.80 $992.80 $992.80 $992.80 $992.80 $992.80 $972.94 $972.94 INTERTAN SUBTROCH 95MM All Payors / Plans All Payors / Plans $992.80 $992.80 $992.80 $992.80 $992.80 $992.80 $992.80 $972.94 $972.94 INTRODUCER CATHETER CHECK-FLO FLEXOR 38.5CM 10FR DISPOSABLE STERILE TRANSJUGULAR INTRAHEPATIC RING GUIDE SHEATH All Payors / Plans All Payors / Plans $220.96 $220.96 $220.96 $220.96 $220.96 $220.96 $220.96 $216.54 $216.54 INTRODUCER CATHETER CHECK-FLO PERFORMER L35 CM OD16 FR ID5.3 MM RADIOPAQUE BAND SET LARGE VALVE SHEATH STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE RCFW All Payors / Plans All Payors / Plans $337.14 $337.14 $337.14 $337.14 $337.14 $337.14 $337.14 $330.40 $330.40 INTRODUCER HEMOSTASIS FAST CATH LUER LOCK GUIDEWIRE AND REPOSITIONING SLEEVE 7 FR 12CM 0.038 IN All Payors / Plans All Payors / Plans $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $131.32 $131.32 INTRODUCER HEMOSTATSIS FAST CATH LUER LOCK GUIDEWIRE AND REPOSITIONING SLEEVE 8.5 FR 12 CM 0.038 IN All Payors / Plans All Payors / Plans $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $131.32 $131.32 INTRODUCER LEAD CPS STANDARD CORONARY SINUS PLACEMENT KIT All Payors / Plans All Payors / Plans $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $975.10 $975.10 INTRODUCER MICRO STIFFEN 4FR All Payors / Plans All Payors / Plans $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $43.12 $43.12 INTRODUCER MICRO STIFFEN 5FR All Payors / Plans All Payors / Plans $44.92 $44.92 $44.92 $44.92 $44.92 $44.92 $44.92 $44.02 $44.02 INTRODUCER ORTHOPEDIC LONG DIAMOND All Payors / Plans All Payors / Plans $427.62 $427.62 $427.62 $427.62 $427.62 $427.62 $427.62 $419.07 $419.07 INTRODUCER SHEATH AGILIS NXT DUAL REACH .032 IN LARGE CURL CURVE L50 MM L71 CM OD8.5 FR STEERABLE ERGONOMIC HANDLE ATRAUMATIC TIP INTEGRATE HEMOSTASIS VALVE RADIOPAQUE TIP MARKER All Payors / Plans All Payors / Plans " $2,060.00 " " $2,060.00 " " $2,060.00 " " $2,060.00 " " $2,060.00 " " $2,060.00 " " $2,060.00 " " $2,018.80 " " $2,018.80 " INTRODUCER SHEATH CHECK-FLO FLEXOR .035 IN L45 CM OD10 FR ID.134 IN ANL0 CURVE STRAIGHT TIP ANSEL MODIFICATION HIGH FLEX DILATOR GUIDEWIRE All Payors / Plans All Payors / Plans $134.14 $134.14 $134.14 $134.14 $134.14 $134.14 $134.14 $131.46 $131.46 INTRODUCER SHEATH FAST-CATH STRAIGHT J L12 CM OD12 FR INTRACARDIAC LARGE LUMEN HEMOSTASIS VALVE SIDEPORT DILATOR ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $52.92 $52.92 INTRODUCER SHEATH FAST-CATH SWARTZ SR .038 IN J SR0 CURVE L63 CM L145 CM OD8 FR TRANSSEPTAL GUIDE HEMOSTASIS VALVE SIDEPORT DILATOR RADIOPAQUE TIP MARKER All Payors / Plans All Payors / Plans $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $348.88 $348.88 INTRODUCER SHEATH PINNACLE HYDROPHILIC L10 CM L2.5 CM OD4 FR PERIPHERAL KINK RESISTANT DESIGN CROSS CUT VALVE SMOOTH TRANSITION DILATOR All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .035 IN L10 CM L2.5 CM ID8 FR PERIPHERAL DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .035 IN L10 CM L2.5 CM OD6 FR MINI GUIDEWIRE DILATOR All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID10 FR PERIPHERAL GUIDEWIRE DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.58 $15.58 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID6 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.42 $10.42 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID7 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $16.66 $16.66 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID8 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $16.66 $16.66 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID9 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $16.66 $16.66 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID10 FR PERIPHERAL DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $51.76 $51.76 $51.76 $51.76 $51.76 $51.76 $51.76 $50.72 $50.72 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID6 FR CORONARY DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $43.61 $43.61 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID8 FR CORONARY DILATOR KINK RESISTANT SMOOTH TRANSITION SNAP ON All Payors / Plans All Payors / Plans $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $43.61 $43.61 INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID9 FR CORONARY DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $51.76 $51.76 $51.76 $51.76 $51.76 $51.76 $51.76 $50.72 $50.72 INTRODUCER SHEATH PINNACLE R/O II L6 CM L2.5 CM ID4 FR DILATOR RADIOPAQUE MARKER All Payors / Plans All Payors / Plans $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $36.75 $36.75 INTRODUCER SHEATH PINNACLE R/O II L6 CM L2.5 CM ID5 FR DILATOR RADIOPAQUE MARKER All Payors / Plans All Payors / Plans $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $36.75 $36.75 INTRODUCER SHEATH PINNACLE R/O II L6 CM L2.5 CM ID6 FR DILATOR RADIOPAQUE MARKER All Payors / Plans All Payors / Plans $37.60 $37.60 $37.60 $37.60 $37.60 $37.60 $37.60 $36.85 $36.85 INTRODUCER SHEATH PINNACLE STAINLESS STEEL HYDROPHILIC PTFE L10 CM L2.5 CM ID5 FR CORONARY DILATOR KINK RESISTANT SMOOTH TRANSITION SNAP ON ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.42 $10.42 IODINE I-123 5 MCI/2.5 ML (185 MBQ/2.5ML) SOLUTION All Payors / Plans All Payors / Plans " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,675.00 " " $1,641.50 " " $1,641.50 " IODINE STRONG 5 % SOLUTION All Payors / Plans All Payors / Plans $137.17 $137.17 $137.17 $137.17 $137.17 $137.17 $137.17 $134.43 $134.43 IOPAMIDOL 300 MG IODINE /ML (61 %) SOLUTION All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 "IPRATROPIUM 21 MCG (0.03 %) SPRAY,NON-AEROSOL 30 ML CANISTER" All Payors / Plans All Payors / Plans $83.54 $83.54 $83.54 $83.54 $83.54 $83.54 $83.54 $81.87 $81.87 "IPRATROPIUM 42 MCG (0.06 %) SPRAY,NON-AEROSOL 15 ML CANISTER" All Payors / Plans All Payors / Plans $83.50 $83.50 $83.50 $83.50 $83.50 $83.50 $83.50 $81.83 $81.83 IRBESARTAN 150 MG TABLET All Payors / Plans All Payors / Plans $1.94 $1.94 $1.94 $1.94 $1.94 $1.94 $1.94 $1.90 $1.90 IRINOTECAN PER 20 MG All Payors / Plans All Payors / Plans $5.97 $5.97 $5.97 $5.97 $5.97 $5.97 $5.97 $5.85 $5.85 IRON DEXTRAN PER 50 MG All Payors / Plans All Payors / Plans $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $68.03 $68.03 IRON SUCROSE 200 MG IRON/10 ML SOLUTION All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 IRON SUCROSE 200 MG IRON/10 ML SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 IRON SUCROSE 200 MG IRON/10 ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.36 $1.36 IRON SUCROSE PER 1 MG All Payors / Plans All Payors / Plans $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.36 $1.36 IRRIGATOR SUCTION All Payors / Plans All Payors / Plans $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $519.40 $519.40 ISONIAZID 300 MG TABLET All Payors / Plans All Payors / Plans $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.48 $3.48 ISOPROTERENOL IN 0.9 % NACL 200 MCG/50 ML (4 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $437.77 $437.77 $437.77 $437.77 $437.77 $437.77 $437.77 $429.01 $429.01 ISOSORBIDE DINITRATE 10 MG TABLET All Payors / Plans All Payors / Plans $2.75 $2.75 $2.75 $2.75 $2.75 $2.75 $2.75 $2.70 $2.70 ISOSORBIDE DINITRATE 20 MG TABLET All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.54 $2.54 ISOSORBIDE MONONITRATE 30 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.11 $1.11 ISOSORBIDE MONONITRATE 60 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 IVABRADINE 5 MG TABLET All Payors / Plans All Payors / Plans $17.66 $17.66 $17.66 $17.66 $17.66 $17.66 $17.66 $17.31 $17.31 IVAS ELITE All Payors / Plans All Payors / Plans " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,372.54 " " $5,372.54 " IVAS ELITE INFLATOR All Payors / Plans All Payors / Plans $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $258.72 $258.72 K WIRE All Payors / Plans All Payors / Plans $94.20 $94.20 $94.20 $94.20 $94.20 $94.20 $94.20 $92.32 $92.32 K WIRE HAND INNOVATIONS All Payors / Plans All Payors / Plans $21.25 $21.25 $21.25 $21.25 $21.25 $21.25 $21.25 $20.83 $20.83 KANGAROO GASTROSTOMY FEEDING TUBE WITH Y-PORTS 22FR/CH All Payors / Plans All Payors / Plans $33.24 $33.24 $33.24 $33.24 $33.24 $33.24 $33.24 $32.58 $32.58 KETAMINE 10 MG/ML SOLUTION All Payors / Plans All Payors / Plans $50.61 $50.61 $50.61 $50.61 $50.61 $50.61 $50.61 $49.60 $49.60 KETAMINE 10 MG/ML SOLUTION 20 ML VIAL All Payors / Plans All Payors / Plans $85.27 $85.27 $85.27 $85.27 $85.27 $85.27 $85.27 $83.56 $83.56 KETAMINE 100 MG/ML SOLUTION All Payors / Plans All Payors / Plans $9.35 $9.35 $9.35 $9.35 $9.35 $9.35 $9.35 $9.16 $9.16 KETAMINE 50 MG/ML SOLUTION All Payors / Plans All Payors / Plans $31.17 $31.17 $31.17 $31.17 $31.17 $31.17 $31.17 $30.55 $30.55 KETOROLAC 0.5 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $21.24 $21.24 $21.24 $21.24 $21.24 $21.24 $21.24 $20.82 $20.82 KETOROLAC TROMETHAMINE PER 15 MG All Payors / Plans All Payors / Plans $6.05 $6.05 $6.05 $6.05 $6.05 $6.05 $6.05 $5.93 $5.93 KIT 13.5FR X 16CM MAHURKAR All Payors / Plans All Payors / Plans " $1,171.12 " " $1,171.12 " " $1,171.12 " " $1,171.12 " " $1,171.12 " " $1,171.12 " " $1,171.12 " " $1,147.70 " " $1,147.70 " KIT ANGIOGRAPHY ACIST CVI ANGIOTOUCH 65IN DISPOSABLE 3 WAY HIGH PRESSURE STOPCOCK PREMIUM HIGH PRESSURE CONTRAST TUBE All Payors / Plans All Payors / Plans " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,400.00 " " $1,372.00 " " $1,372.00 " KIT ARTERIAL PTFE .028 IN 40 CM MINI L6 IN L2.25 IN OD18 GA ODSEC19 GA RADIOPAQUE FEMALE LUER HUB GUIDEWIRE NEEDLE All Payors / Plans All Payors / Plans $29.86 $29.86 $29.86 $29.86 $29.86 $29.86 $29.86 $29.26 $29.26 KIT BONE CEMENT FEMUR 2 RESTRICTOR PRESSURIZER SPONGE BRUSH 2 CURETTES INSERTER STERILE DISPOSABLE All Payors / Plans All Payors / Plans $778.00 $778.00 $778.00 $778.00 $778.00 $778.00 $778.00 $762.44 $762.44 KIT BONE GRAFT OSTEOSET 25ML CALCIUM SULFATE RESORBABLE BEAD All Payors / Plans All Payors / Plans " $2,618.75 " " $2,618.75 " " $2,618.75 " " $2,618.75 " " $2,618.75 " " $2,618.75 " " $2,618.75 " " $2,566.38 " " $2,566.38 " KIT CATHETER L4.5 IN OD9 FR CENTRAL VENOUS 2 LUMEN All Payors / Plans All Payors / Plans $358.75 $358.75 $358.75 $358.75 $358.75 $358.75 $358.75 $351.58 $351.58 KIT CATHETER MAHURKAR L16 CM OD13.5 FR 2 LUMEN HIGH FLOW PRECURVE EXTENSION HEMODIALYSIS All Payors / Plans All Payors / Plans $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $145.53 $145.53 KIT CATHETER MAHURKAR POLYURETHANE .038 IN STRAIGHT J L19.5 CM L70 CM OD13.5 FR 1.7 ML 2 LUMEN HIGH FLOW CURVE EXTENSION GUIDEWIRE STERILE HEMODIALYSIS All Payors / Plans All Payors / Plans $153.73 $153.73 $153.73 $153.73 $153.73 $153.73 $153.73 $150.66 $150.66 KIT CATHETER PALINDROME L19 CM OD 14.5 FR TWO LUMEN LATEX FREE All Payors / Plans All Payors / Plans $534.60 $534.60 $534.60 $534.60 $534.60 $534.60 $534.60 $523.91 $523.91 KIT DRAINAGE JACKSON-PRATT PVC 1/8 IN ROUND OD10 FR 400 ML 3 SPRING RESERVOIR TROCAR Y CONNECTOR STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.45 $18.45 KIT DRAINAGE PLEURX 1000 ML STARTER CATHETER All Payors / Plans All Payors / Plans $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $588.00 $588.00 KIT DRAINAGE PLEURX POLYESTER OD15.5 FR PLEURAL CATHETER ACTIVE VACCUM TECHNOLOGY PROPRIETARY SAFETY VALVE CUFF STERILE DISPOSABLE All Payors / Plans All Payors / Plans " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,225.00 " " $1,225.00 " KIT DRAINAGE PVC ROUND L12 IN OD1/4 IN 400 ML 3 SPRING EVACUATOR TROCAR Y CONNECTOR TUBE HOLE PATTERN STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.45 $18.45 KIT DRAPE SPY-PHI DRUG All Payors / Plans All Payors / Plans " $1,253.57 " " $1,253.57 " " $1,253.57 " " $1,253.57 " " $1,253.57 " " $1,253.57 " " $1,253.57 " " $1,228.50 " " $1,228.50 " KIT DRESSING GRANUFOAM SENSAT.R.A.C. V.A.C. POLYURETHANE FOAM THK3.3 CM SMALL STANDARD L10 CM X W7.5 CM 1 ADHESIVE DRAPE PAD HYDROPHOBIC FLEXIBLE DISPOSABLE All Payors / Plans All Payors / Plans $27.53 $27.53 $27.53 $27.53 $27.53 $27.53 $27.53 $26.98 $26.98 KIT DRESSING GRANUFOAM SENSATRAC VAC POLYURETHANE FOAM THK3.3 CM MEDIUM STANDARD L18 CM X W12.5 CM 2 ADHESIVE DRAPE PAD HARD TO REACH FLEXIBLE HYDROPHOBIC All Payors / Plans All Payors / Plans $34.72 $34.72 $34.72 $34.72 $34.72 $34.72 $34.72 $34.03 $34.03 KIT DRESSING GRANUFOAM VAC POLYURETHANE FOAM HYDROPHOBIC THK3.3 CM LARGE STANDARD L26 CM X W15 CM 2 ADHESIVE DRAPE SENSATRAC PAD HARD TO REACH FLEXIBLE BLACK All Payors / Plans All Payors / Plans $47.89 $47.89 $47.89 $47.89 $47.89 $47.89 $47.89 $46.93 $46.93 KIT DRESSING NEGATIVE PRESSURE VACUUM PEEL AND PLACE PREVENA 20CM All Payors / Plans All Payors / Plans $999.70 $999.70 $999.70 $999.70 $999.70 $999.70 $999.70 $979.71 $979.71 KIT DRESSING WITH VACUUM PEEL AND PLACE PREVENA 13CM All Payors / Plans All Payors / Plans $999.70 $999.70 $999.70 $999.70 $999.70 $999.70 $999.70 $979.71 $979.71 KIT ELECTRODE ENSITE PRECISION SURFACE All Payors / Plans All Payors / Plans " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,352.00 " " $2,352.00 " KIT ELECTRODE SURFACE ENSITE X All Payors / Plans All Payors / Plans " $2,800.00 " " $2,800.00 " " $2,800.00 " " $2,800.00 " " $2,800.00 " " $2,800.00 " " $2,800.00 " " $2,744.00 " " $2,744.00 " KIT EXTERNAL DRAINAGE ACCUDRAIN SPECIAL LATEX FREE INS8400 All Payors / Plans All Payors / Plans $315.86 $315.86 $315.86 $315.86 $315.86 $315.86 $315.86 $309.54 $309.54 KIT EYE MEROCEL WIPE EYE DRAIN CORNEAL LIGHT SHIELD STERILE All Payors / Plans All Payors / Plans $7.92 $7.92 $7.92 $7.92 $7.92 $7.92 $7.92 $7.76 $7.76 KIT FIRST FRACTURE STABILIT All Payors / Plans All Payors / Plans " $5,350.00 " " $5,350.00 " " $5,350.00 " " $5,350.00 " " $5,350.00 " " $5,350.00 " " $5,350.00 " " $5,243.00 " " $5,243.00 " KIT FRACTURE IVAS L15 MM OD10 GA STERILE LATEX FREE DISPOSABLE ELITE All Payors / Plans All Payors / Plans " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,482.18 " " $5,372.54 " " $5,372.54 " KIT INJECTION RS PENINSULA REGIONAL MEDICAL All Payors / Plans All Payors / Plans $43.60 $43.60 $43.60 $43.60 $43.60 $43.60 $43.60 $42.73 $42.73 KIT INSTRUMENT ACL TRANSTIBIAL DISPOSABLE All Payors / Plans All Payors / Plans $236.00 $236.00 $236.00 $236.00 $236.00 $236.00 $236.00 $231.28 $231.28 KIT INTERVENTIONAL ENROUTE TRANSCAROTID NEUROPROTECTION All Payors / Plans All Payors / Plans " $7,500.00 " " $7,500.00 " " $7,500.00 " " $7,500.00 " " $7,500.00 " " $7,500.00 " " $7,500.00 " " $7,350.00 " " $7,350.00 " KIT INTRODUCER GLIDESHEATH SLENDER .021IN 35MM 10CM 45CM 5FR 21GA SS HYDROPHILIC DISPOSABLE STERILE NEEDLE DILATOR All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 KIT INTRODUCER GLIDESHEATH SLENDER .021IN 35MM 10CM 45CM 6FR 21GA SS HYDROPHILIC DISPOSABLE STERILE NEEDLE DILATOR All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 KIT INTRODUCER SILK ROAD .018 IN L50 CM L15 CM OD 4 FR MICROWIRE EXTENSION TUBE NEEDLE STIFF DILATOR All Payors / Plans All Payors / Plans $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 KIT IV CHLORAPREP TEGADERM L2 IN X W2 IN .67 ML IV START STERILE LATEX FREE All Payors / Plans All Payors / Plans $2.28 $2.28 $2.28 $2.28 $2.28 $2.28 $2.28 $2.23 $2.23 KIT LAPAROSCOPIC FILSHIE STERISHOT II STANDARD APPLICATOR 1 PAIR CLIP All Payors / Plans All Payors / Plans $572.80 $572.80 $572.80 $572.80 $572.80 $572.80 $572.80 $561.34 $561.34 KIT MICROINTRODUCER STAINLESS STEEL SILICONE NITINOL .018 IN REGULAR TAPER L40 CM L7 CM OD5 FR ODSEC21 GA DILATOR SMOOTH NEEDLE SOFT TIP WIRE MANDREL All Payors / Plans All Payors / Plans $46.78 $46.78 $46.78 $46.78 $46.78 $46.78 $46.78 $45.84 $45.84 KIT NEEDLE GUIDE CIV FLEX SONOSITE OD21 GA COVER BAND GEL STERILE TEAL L25 All Payors / Plans All Payors / Plans $39.58 $39.58 $39.58 $39.58 $39.58 $39.58 $39.58 $38.79 $38.79 KIT PEG ENDOVIVE SAFETYGLIDE CHLORAPREP XYLOCAINE SILICONE 11 L1 1/2 IN OD20 FR ODSEC22 GA PUSH METHOD AMPULE 2 EXTERNAL BOLSTER SPRING LOAD BLADE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $216.66 $216.66 $216.66 $216.66 $216.66 $216.66 $216.66 $212.33 $212.33 KIT PEG ENDOVIVE SILICONE STANDARD UNIVERSAL OD20 FR 5 ML PULL FENESTRATE DRAPE CLAMP STERILE DISPOSABLE ENTERAL ACCESS DEVICE All Payors / Plans All Payors / Plans $139.62 $139.62 $139.62 $139.62 $139.62 $139.62 $139.62 $136.83 $136.83 KIT PERICARDIOCENTESIS PIGTAIL CURVE L40 CM OD8 FR CATHETER All Payors / Plans All Payors / Plans $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $227.36 $227.36 KIT POSITIONING COBAN S SHOULDER STABILIZATION ARM DRAPE HOOK SUSPENSION STERILE LATEX FREE DISPOSABLE ARTHROSCOPY All Payors / Plans All Payors / Plans $166.25 $166.25 $166.25 $166.25 $166.25 $166.25 $166.25 $162.93 $162.93 KIT POSITIONING PROAXIS PRONEVIEW All Payors / Plans All Payors / Plans $131.42 $131.42 $131.42 $131.42 $131.42 $131.42 $131.42 $128.79 $128.79 KIT POSITIONING TRIMANO BEACH CHAIR ARM HOLDER DRAPE LIGHTWEIGHT DISPOSABLE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 KIT POSITIONING WILSON L7 IN PATIENT CARE FRAME All Payors / Plans All Payors / Plans $44.95 $44.95 $44.95 $44.95 $44.95 $44.95 $44.95 $44.05 $44.05 KIT PREP QUIK USE FEMORAL BONE CEMENT All Payors / Plans All Payors / Plans $282.00 $282.00 $282.00 $282.00 $282.00 $282.00 $282.00 $276.36 $276.36 KIT PRESSURE MONITOR CODMAN MICROSENSOR METAL SKULL All Payors / Plans All Payors / Plans " $2,308.64 " " $2,308.64 " " $2,308.64 " " $2,308.64 " " $2,308.64 " " $2,308.64 " " $2,308.64 " " $2,262.47 " " $2,262.47 " KIT PRESSURE MONITOR CODMAN MICROSENSOR VENTRICULAR All Payors / Plans All Payors / Plans " $1,490.92 " " $1,490.92 " " $1,490.92 " " $1,490.92 " " $1,490.92 " " $1,490.92 " " $1,490.92 " " $1,461.10 " " $1,461.10 " KIT PROCEDURE EDGE 180 D LOCATABLE GUIDE FIRM TIP EXTEND WORK CHANNEL CATHETER All Payors / Plans All Payors / Plans " $3,116.00 " " $3,116.00 " " $3,116.00 " " $3,116.00 " " $3,116.00 " " $3,116.00 " " $3,116.00 " " $3,053.68 " " $3,053.68 " KIT PULSED LAVAGE PULSAVAC PLUS FAN SPRAY TIP RETAIN MECHANISM ROCKER SWITCH TEXTURE PISTOL GRIP HANDLE All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 KIT SCREW INTERTAN L 95MM L 90MM OD 11.5 ODSEC 7MM TROCHANTERIC LAG COMPRESSION INTEGRATE INTERLOCK All Payors / Plans All Payors / Plans " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,230.80 " " $1,206.18 " " $1,206.18 " KIT SUTURE HEART IN-HOUSE CUSTOM All Payors / Plans All Payors / Plans $256.96 $256.96 $256.96 $256.96 $256.96 $256.96 $256.96 $251.82 $251.82 KIT SUTURE VALVE IN-HOUSE CUSTOM All Payors / Plans All Payors / Plans $185.02 $185.02 $185.02 $185.02 $185.02 $185.02 $185.02 $181.32 $181.32 KIT VESSEL HARVESTING VASOVIEW HEMOPRO 2 ENDOSCOPIC All Payors / Plans All Payors / Plans " $2,200.00 " " $2,200.00 " " $2,200.00 " " $2,200.00 " " $2,200.00 " " $2,200.00 " " $2,200.00 " " $2,156.00 " " $2,156.00 " KIT VITRECTOMY PERFLUORON PERFLUORO-N-OCTANE 7 ML PROCEDURAL LIQUID PURIFY LATEX FREE All Payors / Plans All Payors / Plans " $1,073.62 " " $1,073.62 " " $1,073.62 " " $1,073.62 " " $1,073.62 " " $1,073.62 " " $1,073.62 " " $1,052.15 " " $1,052.15 " KNIFE CRESCENT All Payors / Plans All Payors / Plans $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $21.56 $21.56 KNIFE OPHTHALMIC ALCON A-OK 15 D STANDARD W1.52 MM BLADE FULL HANDLE DISPOSABLE All Payors / Plans All Payors / Plans $24.58 $24.58 $24.58 $24.58 $24.58 $24.58 $24.58 $24.09 $24.09 KNIFE OPHTHALMIC A-OK 30 D W1.85 MM FULL HANDLE ANGLE BLADE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $26.30 $26.30 $26.30 $26.30 $26.30 $26.30 $26.30 $25.77 $25.77 KNIFE OPHTHALMIC BD EDGEAHEAD STRAIGHT W1.1 MM OD20 GA MVR SIDEPORT STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $58.03 $58.03 $58.03 $58.03 $58.03 $58.03 $58.03 $56.87 $56.87 KNIFE OPHTHALMIC CLEARCUT ANGLE FULL W1 MM 2 BEVEL SIDEPORT SATIN FINISH STERILE LATEX DISPOSABLE FLUORESCENT PINK All Payors / Plans All Payors / Plans $32.52 $32.52 $32.52 $32.52 $32.52 $32.52 $32.52 $31.87 $31.87 KNIFE OPHTHALMIC CLEARCUT SATINSLIT ANGLE W3.2 MM SLIT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $39.90 $39.90 $39.90 $39.90 $39.90 $39.90 $39.90 $39.10 $39.10 K-WIRE FIXATION All Payors / Plans All Payors / Plans $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $49.98 $49.98 L RHAMNOSUS-B ANIMALIS 2.5BILLION CELL -10 MCG/5 DROPS DROPS All Payors / Plans All Payors / Plans $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $10.32 $10.32 LABETALOL 100 MG TABLET All Payors / Plans All Payors / Plans $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.82 $1.82 LABETALOL 20 MG/4 ML (5 MG/ML) SYRINGE All Payors / Plans All Payors / Plans $36.64 $36.64 $36.64 $36.64 $36.64 $36.64 $36.64 $35.91 $35.91 LABETALOL 200 MG TABLET All Payors / Plans All Payors / Plans $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.93 $1.93 LACOSAMIDE 100 MG TABLET All Payors / Plans All Payors / Plans $4.33 $4.33 $4.33 $4.33 $4.33 $4.33 $4.33 $4.24 $4.24 LACOSAMIDE 200 MG/20 ML SOLUTION All Payors / Plans All Payors / Plans $0.71 $0.71 $0.71 $0.71 $0.71 $0.71 $0.71 $0.70 $0.70 LACOSAMIDE 200 MG/20 ML SOLUTION 20 ML VIAL All Payors / Plans All Payors / Plans $135.02 $135.02 $135.02 $135.02 $135.02 $135.02 $135.02 $132.32 $132.32 LACOSAMIDE 50 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 LACTATED RINGER'S All Payors / Plans All Payors / Plans $9.21 $9.21 $9.21 $9.21 $9.21 $9.21 $9.21 $9.03 $9.03 LACTATED RINGERS PER 1000 ML All Payors / Plans All Payors / Plans $18.15 $18.15 $18.15 $18.15 $18.15 $18.15 $18.15 $17.79 $17.79 LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE All Payors / Plans All Payors / Plans $3.61 $3.61 $3.61 $3.61 $3.61 $3.61 $3.61 $3.54 $3.54 "LACTOBACILLUS RHAMNOSUS GG 5 BILLION CELL TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $2.63 $2.63 $2.63 $2.63 $2.63 $2.63 $2.63 $2.58 $2.58 LACTULOSE 10 GRAM/15 ML SOLUTION All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 LAMOTRIGINE 100 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 LAMOTRIGINE 200 MG TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 LAMOTRIGINE 25 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.98 $0.98 LANGSTON 6F 145 PIGTAIL DIAGNOSTIC CATHETER All Payors / Plans All Payors / Plans $315.20 $315.20 $315.20 $315.20 $315.20 $315.20 $315.20 $308.90 $308.90 LANOLIN 100 % CREAM 7 G TUBE All Payors / Plans All Payors / Plans $15.55 $15.55 $15.55 $15.55 $15.55 $15.55 $15.55 $15.24 $15.24 LANREOTIDE 120 MG/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $85.52 $85.52 $85.52 $85.52 $85.52 $85.52 $85.52 $83.81 $83.81 "LANSOPRAZOLE 30 MG TABLET,DISINTEGRAT, DELAY REL" All Payors / Plans All Payors / Plans $11.32 $11.32 $11.32 $11.32 $11.32 $11.32 $11.32 $11.09 $11.09 LARONIDASE 2.9 MG/5 ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $59.64 $59.64 $59.64 $59.64 $59.64 $59.64 $59.64 $58.45 $58.45 LATANOPROST 0.005 % DROPS 2.5 ML DROP BTL All Payors / Plans All Payors / Plans $21.47 $21.47 $21.47 $21.47 $21.47 $21.47 $21.47 $21.04 $21.04 LEAD PACING ATTAIN STARFIX LEFT VENTRICLE All Payors / Plans All Payors / Plans " $3,400.00 " " $3,400.00 " " $3,400.00 " " $3,400.00 " " $3,400.00 " " $3,400.00 " " $3,400.00 " " $3,332.00 " " $3,332.00 " LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATINUM SILICONE 10 MM SPACE SMALL STRAIGHT L45 CM L20-110 CM OD6.2 FR ODSEC2 MM ATRIUM VENTRICLE BIPOLAR SCREW IN IMPLANTABLE ACTIVE FIXATION All Payors / Plans All Payors / Plans $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $774.20 $774.20 LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATINUM SILICONE 10 MM SPACE SMALL STRAIGHT L52 CM L20-110 CM OD6.2 FR ODSEC2 MM ATRIUM VENTRICLE BIPOLAR SCREW IN IMPLANTABLE ACTIVE FIXATION All Payors / Plans All Payors / Plans $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $774.20 $774.20 LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATINUM SILICONE 10 MM SPACE SMALL STRAIGHT L58 CM L20-110 CM OD6.2 FR ODSEC2 MM ATRIUM VENTRICLE BIPOLAR SCREW IN IMPLANTABLE ACTIVE FIXATION All Payors / Plans All Payors / Plans $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $774.20 $774.20 LEAD PACING DURATA SJ4 STEROID ELUTING SILICONE 11 MM SPACING L58 CM OD6.8 FR ENDOCARDIUM 1 COIL All Payors / Plans All Payors / Plans " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,684.00 " " $5,684.00 " LEAD PACING DURATA SJ4 STEROID ELUTING SILICONE 11 MM SPACING L65 CM OD6.8 FR ENDOCARDIUM All Payors / Plans All Payors / Plans " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,800.00 " " $5,684.00 " " $5,684.00 " LEAD PACING QUARTET OPTIM LOW PROFILE S CURVE NARROW L86 CM X H16 MM OD5 FR LEFT HEART 4 ELECTRODE IS-4 CONNECTOR All Payors / Plans All Payors / Plans " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,352.00 " " $2,352.00 " LEAD PACING SPRINT QUATTRO SECURE DEXAMETHASONE SODIUM PHOSPHATE STEROID ELUTING L62 CM All Payors / Plans All Payors / Plans " $6,214.00 " " $6,214.00 " " $6,214.00 " " $6,214.00 " " $6,214.00 " " $6,214.00 " " $6,214.00 " " $6,089.72 " " $6,089.72 " LEAD PACING STREAMLINE L3 MM OD.48 MM ATRIUM UNIPOLAR TEMPORARY PURPLE All Payors / Plans All Payors / Plans $65.84 $65.84 $65.84 $65.84 $65.84 $65.84 $65.84 $64.52 $64.52 LEAD PACING TENDRIL STS STEROID ELUTING SILICONE HELIX L46 CM OD6 FR ENDOCARDIUM IS-1 CONNECTOR All Payors / Plans All Payors / Plans $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $607.60 $607.60 LEAD PACING TENDRIL STS STEROID ELUTING SILICONE HELIX L52 CM OD6 FR ENDOCARDIUM IS-1 CONNECTOR All Payors / Plans All Payors / Plans $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $607.60 $607.60 LEAD PACING TENDRIL STS STEROID ELUTING SILICONE HELIX L58 CM OD6 FR ENDOCARDIUM IS-1 CONNECTOR All Payors / Plans All Payors / Plans $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $607.60 $607.60 LEAD SCS All Payors / Plans All Payors / Plans " $10,500.00 " " $10,500.00 " " $10,500.00 " " $10,500.00 " " $10,500.00 " " $10,500.00 " " $10,500.00 " " $10,290.00 " " $10,290.00 " LEAD TENDRIL MRI 46CM All Payors / Plans All Payors / Plans $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $607.60 $607.60 LEAD TENDRIL MRI 52CM All Payors / Plans All Payors / Plans $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $620.00 $607.60 $607.60 LEFLUNOMIDE 10 MG TABLET All Payors / Plans All Payors / Plans $53.26 $53.26 $53.26 $53.26 $53.26 $53.26 $53.26 $52.19 $52.19 LEFLUNOMIDE 20 MG TABLET All Payors / Plans All Payors / Plans $5.12 $5.12 $5.12 $5.12 $5.12 $5.12 $5.12 $5.02 $5.02 LENS INTRAOCULAR AKRESO AO 16.5 DIOIPTER POSTERIOR CHAMBER All Payors / Plans All Payors / Plans $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $254.80 $254.80 LETROZOLE 2.5 MG TABLET All Payors / Plans All Payors / Plans $1.99 $1.99 $1.99 $1.99 $1.99 $1.99 $1.99 $1.95 $1.95 LEUCOVORIN CALCIUM PER 50 MG All Payors / Plans All Payors / Plans $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $14.70 $14.70 LEUPROLIDE (6 MONTH) PER 7.5 MG All Payors / Plans All Payors / Plans $225.45 $225.45 $225.45 $225.45 $225.45 $225.45 $225.45 $220.94 $220.94 LEUPROLIDE 7.5 MG (1 MONTH) SYRINGE All Payors / Plans All Payors / Plans $321.41 $321.41 $321.41 $321.41 $321.41 $321.41 $321.41 $314.98 $314.98 LEUPROLIDE ACETATE (3 MONTH) PER 3.75 MG All Payors / Plans All Payors / Plans " $1,742.61 " " $1,742.61 " " $1,742.61 " " $1,742.61 " " $1,742.61 " " $1,742.61 " " $1,742.61 " " $1,707.75 " " $1,707.75 " LEUPROLIDE PER 3.75 MG All Payors / Plans All Payors / Plans " $2,209.40 " " $2,209.40 " " $2,209.40 " " $2,209.40 " " $2,209.40 " " $2,209.40 " " $2,209.40 " " $2,165.21 " " $2,165.21 " LEVETIRACETAM 100 MG/ML SOLUTION All Payors / Plans All Payors / Plans $9.60 $9.60 $9.60 $9.60 $9.60 $9.60 $9.60 $9.41 $9.41 LEVETIRACETAM 250 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 LEVETIRACETAM 500 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 LEVETIRACETAM 500 MG/100 ML PIGGYBACK All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 LEVETIRACETAM 500 MG/5 ML (5 ML) SOLUTION All Payors / Plans All Payors / Plans $14.91 $14.91 $14.91 $14.91 $14.91 $14.91 $14.91 $14.61 $14.61 LEVETRIRACETAM PER 10 MG All Payors / Plans All Payors / Plans $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 $0.21 LEVOFLOXACIN 500 MG TABLET All Payors / Plans All Payors / Plans $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.08 $1.08 LEVOFLOXACIN 750 MG TABLET All Payors / Plans All Payors / Plans $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $1.96 $1.96 LEVOFLOXACIN PER 250 MG All Payors / Plans All Payors / Plans $6.93 $6.93 $6.93 $6.93 $6.93 $6.93 $6.93 $6.79 $6.79 LEVOTHYROXINE 100 MCG TABLET All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 LEVOTHYROXINE 100 MCG/ML SOLUTION All Payors / Plans All Payors / Plans $456.78 $456.78 $456.78 $456.78 $456.78 $456.78 $456.78 $447.64 $447.64 LEVOTHYROXINE 100 MCG/ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $682.47 $682.47 $682.47 $682.47 $682.47 $682.47 $682.47 $668.82 $668.82 LEVOTHYROXINE 112 MCG TABLET All Payors / Plans All Payors / Plans $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.64 $2.64 LEVOTHYROXINE 125 MCG TABLET All Payors / Plans All Payors / Plans $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.70 $2.70 LEVOTHYROXINE 137 MCG TABLET All Payors / Plans All Payors / Plans $2.63 $2.63 $2.63 $2.63 $2.63 $2.63 $2.63 $2.58 $2.58 LEVOTHYROXINE 150 MCG TABLET All Payors / Plans All Payors / Plans $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.72 $2.72 LEVOTHYROXINE 175 MCG TABLET All Payors / Plans All Payors / Plans $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.57 $2.57 LEVOTHYROXINE 20 MCG/ML SOLUTION All Payors / Plans All Payors / Plans $100.60 $100.60 $100.60 $100.60 $100.60 $100.60 $100.60 $98.59 $98.59 LEVOTHYROXINE 20 MCG/ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $174.22 $174.22 $174.22 $174.22 $174.22 $174.22 $174.22 $170.74 $170.74 LEVOTHYROXINE 200 MCG TABLET All Payors / Plans All Payors / Plans $3.39 $3.39 $3.39 $3.39 $3.39 $3.39 $3.39 $3.32 $3.32 LEVOTHYROXINE 25 MCG TABLET All Payors / Plans All Payors / Plans $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $1.99 $1.99 LEVOTHYROXINE 50 MCG TABLET All Payors / Plans All Payors / Plans $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.02 $2.02 LEVOTHYROXINE 75 MCG TABLET All Payors / Plans All Payors / Plans $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.59 $2.59 LEVOTHYROXINE 88 MCG TABLET All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 LIDOCAINE (CARDIAC) 100 MG/5 ML (2 %) SYRINGE All Payors / Plans All Payors / Plans $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $30.38 $30.38 LIDOCAINE 10 MG/ML (1 %) SOLUTION All Payors / Plans All Payors / Plans $6.17 $6.17 $6.17 $6.17 $6.17 $6.17 $6.17 $6.05 $6.05 LIDOCAINE 2 % JELLY IN APPLICATOR All Payors / Plans All Payors / Plans $11.31 $11.31 $11.31 $11.31 $11.31 $11.31 $11.31 $11.08 $11.08 LIDOCAINE 2 % SOLUTION All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 LIDOCAINE 20 MG/ML (2 %) SOLUTION All Payors / Plans All Payors / Plans $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.52 $10.52 LIDOCAINE 4 % (40 MG/ML) SOLUTION 50 ML BOTTLE All Payors / Plans All Payors / Plans $146.26 $146.26 $146.26 $146.26 $146.26 $146.26 $146.26 $143.33 $143.33 LIDOCAINE 4 % GEL 10 G TUBE All Payors / Plans All Payors / Plans $46.34 $46.34 $46.34 $46.34 $46.34 $46.34 $46.34 $45.41 $45.41 LIDOCAINE 4 % SOLUTION All Payors / Plans All Payors / Plans $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $104.85 $104.85 LIDOCAINE 5 % OINTMENT 35.44 G TUBE All Payors / Plans All Payors / Plans $26.42 $26.42 $26.42 $26.42 $26.42 $26.42 $26.42 $25.89 $25.89 LIDOCAINE PER 10 MG All Payors / Plans All Payors / Plans $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 LIDOCAINE PF 10 MG/ML (1 %) SOLUTION All Payors / Plans All Payors / Plans $1.59 $1.59 $1.59 $1.59 $1.59 $1.59 $1.59 $1.56 $1.56 LIDOCAINE PF 10 MG/ML (1 %) SOLUTION 2 ML VIAL All Payors / Plans All Payors / Plans $3.03 $3.03 $3.03 $3.03 $3.03 $3.03 $3.03 $2.97 $2.97 LIDOCAINE PF 10 MG/ML (1 %) SOLUTION 30 ML VIAL All Payors / Plans All Payors / Plans $0.56 $0.56 $0.56 $0.56 $0.56 $0.56 $0.56 $0.55 $0.55 LIDOCAINE PF 10 MG/ML (1 %) SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $2.10 $2.10 $2.10 $2.10 $2.10 $2.10 $2.10 $2.06 $2.06 LIDOCAINE PF 20 MG/ML (2 %) SOLUTION All Payors / Plans All Payors / Plans $15.70 $15.70 $15.70 $15.70 $15.70 $15.70 $15.70 $15.39 $15.39 LIDOCAINE PF 20 MG/ML (2 %) SOLUTION 10 ML AMPUL All Payors / Plans All Payors / Plans $16.30 $16.30 $16.30 $16.30 $16.30 $16.30 $16.30 $15.97 $15.97 LIDOCAINE PF 20 MG/ML (2 %) SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $15.70 $15.70 $15.70 $15.70 $15.70 $15.70 $15.70 $15.39 $15.39 "LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 SOLUTION" All Payors / Plans All Payors / Plans $20.66 $20.66 $20.66 $20.66 $20.66 $20.66 $20.66 $20.25 $20.25 "LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 SOLUTION 10 ML VIAL" All Payors / Plans All Payors / Plans $16.27 $16.27 $16.27 $16.27 $16.27 $16.27 $16.27 $15.94 $15.94 "LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 SOLUTION 30 ML VIAL" All Payors / Plans All Payors / Plans $20.67 $20.67 $20.67 $20.67 $20.67 $20.67 $20.67 $20.26 $20.26 "LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 SOLUTION" All Payors / Plans All Payors / Plans $3.12 $3.12 $3.12 $3.12 $3.12 $3.12 $3.12 $3.06 $3.06 "LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 SOLUTION" All Payors / Plans All Payors / Plans $31.16 $31.16 $31.16 $31.16 $31.16 $31.16 $31.16 $30.54 $30.54 "LIDOCAINE-EPINEPHRINE 1 %-1:100,000 SOLUTION" All Payors / Plans All Payors / Plans $16.11 $16.11 $16.11 $16.11 $16.11 $16.11 $16.11 $15.79 $15.79 "LIDOCAINE-EPINEPHRINE 1 %-1:100,000 SOLUTION 20 ML VIAL" All Payors / Plans All Payors / Plans $16.11 $16.11 $16.11 $16.11 $16.11 $16.11 $16.11 $15.79 $15.79 "LIDOCAINE-EPINEPHRINE 1 %-1:100,000 SOLUTION 30 ML VIAL" All Payors / Plans All Payors / Plans $16.26 $16.26 $16.26 $16.26 $16.26 $16.26 $16.26 $15.93 $15.93 "LIDOCAINE-EPINEPHRINE 1 %-1:100,000 SOLUTION 50 ML VIAL" All Payors / Plans All Payors / Plans $20.93 $20.93 $20.93 $20.93 $20.93 $20.93 $20.93 $20.51 $20.51 "LIDOCAINE-EPINEPHRINE 2% - 1:100,000 2 %-1:100,000 CARTRIDGE" All Payors / Plans All Payors / Plans $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.43 $0.43 LIDOCAINE-EPI-TETRACAINE 4-0.18-0.5 % SOLUTION All Payors / Plans All Payors / Plans $16.05 $16.05 $16.05 $16.05 $16.05 $16.05 $16.05 $15.73 $15.73 "LIDOCAINE-MENTHOL 4-1 % ADHESIVE PATCH,MEDICATED" All Payors / Plans All Payors / Plans $10.75 $10.75 $10.75 $10.75 $10.75 $10.75 $10.75 $10.54 $10.54 LIDOCAINE-PRILOCAINE 2.5-2.5 % CREAM 30 G TUBE All Payors / Plans All Payors / Plans $21.38 $21.38 $21.38 $21.38 $21.38 $21.38 $21.38 $20.95 $20.95 LIDOCAINE-PRILOCAINE 2.5-2.5 % CREAM 5 G TUBE All Payors / Plans All Payors / Plans $36.93 $36.93 $36.93 $36.93 $36.93 $36.93 $36.93 $36.19 $36.19 LIGATOR 18IN ENDOLOOP MONOFILAMENT TIES LOOP SUTURE ENDOSCOPIC PDS II 12 LF VIOLET All Payors / Plans All Payors / Plans $82.97 $82.97 $82.97 $82.97 $82.97 $82.97 $82.97 $81.31 $81.31 LIGATOR ENDOSCOPIC ENDOLOOP 12 18IN VIOLET PDS II LF MONOFILAMENT TIE LOOP SUTURE All Payors / Plans All Payors / Plans $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.24 $12.24 LIGATOR ENDOSCOPIC ENDOLOOP VICRYL 12 L18 IN ABSORBABLE SUTURE BRAID All Payors / Plans All Payors / Plans $74.51 $74.51 $74.51 $74.51 $74.51 $74.51 $74.51 $73.01 $73.01 LIGATOR ENDOSCOPIC SPEEDBAND SUPERVIEW SUPER 7 2.8 MM L2.8 MM OD8.6-11.5 MM ESOPHAGEAL 1 STRING MULTIPLE BAND ERGONOMIC HANDLE AUDIBLE CLICK STERILE LATEX FREE DISPOSABLE HEMOSTASIS All Payors / Plans All Payors / Plans $320.09 $320.09 $320.09 $320.09 $320.09 $320.09 $320.09 $313.68 $313.68 LIGHT RETRACTOR WAVEGUIDE WIDE FLAT FIBER OPTIC STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $774.20 $774.20 LINER ACETABULAR PINNACLE +4MM NEUTRAL 50MM 32MM ALTRX STERILE LF HIP All Payors / Plans All Payors / Plans " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,073.24 " " $8,073.24 " LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 6 1/2 L285 MM X W85 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER All Payors / Plans All Payors / Plans $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.08 $1.08 LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 7 1/2 L298 MM X W96 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER All Payors / Plans All Payors / Plans $0.89 $0.89 $0.89 $0.89 $0.89 $0.89 $0.89 $0.87 $0.87 LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 7 L288 MM X W91 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER All Payors / Plans All Payors / Plans $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.72 $1.72 LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 8 1/2 L301 MM X W109 MM POWDER FREE SMOOTH BEAD CUFF NONPYROGENIC STERILE LATEX DISPOSABLE GREEN CURVE All Payors / Plans All Payors / Plans $0.89 $0.89 $0.89 $0.89 $0.89 $0.89 $0.89 $0.87 $0.87 LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 8 L299 MM X W103 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER All Payors / Plans All Payors / Plans $0.79 $0.79 $0.79 $0.79 $0.79 $0.79 $0.79 $0.77 $0.77 LINEZOLID 600 MG TABLET All Payors / Plans All Payors / Plans $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.66 $8.66 LINEZOLID PER 200 MG All Payors / Plans All Payors / Plans $15.30 $15.30 $15.30 $15.30 $15.30 $15.30 $15.30 $15.00 $15.00 LIOTHYRONINE 5 MCG TABLET All Payors / Plans All Payors / Plans $2.75 $2.75 $2.75 $2.75 $2.75 $2.75 $2.75 $2.70 $2.70 LISDEXAMFETAMINE 10 MG CAPSULE All Payors / Plans All Payors / Plans $19.97 $19.97 $19.97 $19.97 $19.97 $19.97 $19.97 $19.57 $19.57 LISDEXAMFETAMINE 30 MG CAPSULE All Payors / Plans All Payors / Plans $19.97 $19.97 $19.97 $19.97 $19.97 $19.97 $19.97 $19.57 $19.57 LISINOPRIL 10 MG TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 LISINOPRIL 2.5 MG TABLET All Payors / Plans All Payors / Plans $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $1.99 $1.99 LISINOPRIL 20 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 LISINOPRIL 20 MG TABLET 100 EACH BLIST PACK All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 LISINOPRIL 5 MG TABLET All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 LITHIUM CARBONATE 150 MG CAPSULE All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 LITHIUM CARBONATE 300 MG CAPSULE All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 LITHIUM CARBONATE 300 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.83 $1.83 LITHIUM CARBONATE 450 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 LONG PILOT DRILL All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 LOPERAMIDE 2 MG CAPSULE All Payors / Plans All Payors / Plans $2.75 $2.75 $2.75 $2.75 $2.75 $2.75 $2.75 $2.70 $2.70 LORAZEPAM 0.5 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 LORAZEPAM 1 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 LORAZEPAM 2 MG TABLET All Payors / Plans All Payors / Plans $0.79 $0.79 $0.79 $0.79 $0.79 $0.79 $0.79 $0.77 $0.77 LORAZEPAM PER 2 MG All Payors / Plans All Payors / Plans $6.16 $6.16 $6.16 $6.16 $6.16 $6.16 $6.16 $6.04 $6.04 LOSARTAN 25 MG TABLET All Payors / Plans All Payors / Plans $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.87 $1.87 LOSARTAN 50 MG TABLET All Payors / Plans All Payors / Plans $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.12 $1.12 LOSARTAN-HYDROCHLOROTHIAZIDE 50-12.5 MG TABLET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 LOVASTATIN 20 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 LOXAPINE 25 MG CAPSULE All Payors / Plans All Payors / Plans $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.73 $2.73 LUBRICANT INSTRUMENT ROTAGLIDE 20 CC PERIPHERAL VIAL ROTABLATOR All Payors / Plans All Payors / Plans $242.66 $242.66 $242.66 $242.66 $242.66 $242.66 $242.66 $237.81 $237.81 LURASIDONE 20 MG TABLET All Payors / Plans All Payors / Plans $51.71 $51.71 $51.71 $51.71 $51.71 $51.71 $51.71 $50.68 $50.68 LURASIDONE 40 MG TABLET All Payors / Plans All Payors / Plans $51.71 $51.71 $51.71 $51.71 $51.71 $51.71 $51.71 $50.68 $50.68 LV WORLEY RENAL CURVE INTRODUCER KIT _62560_ All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 LV WORLEY STD CURVE CSG GUIDE KIT _62559_ All Payors / Plans All Payors / Plans $780.18 $780.18 $780.18 $780.18 $780.18 $780.18 $780.18 $764.58 $764.58 "MAGNESIUM CHLORIDE 64 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 MAGNESIUM HYDROXIDE 400 MG/5 ML SUSPENSION All Payors / Plans All Payors / Plans $3.50 $3.50 $3.50 $3.50 $3.50 $3.50 $3.50 $3.43 $3.43 MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 MAGNESIUM SULFATE 1 GRAM/100 ML PIGGYBACK All Payors / Plans All Payors / Plans $18.53 $18.53 $18.53 $18.53 $18.53 $18.53 $18.53 $18.16 $18.16 MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) PIGGYBACK All Payors / Plans All Payors / Plans $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.73 $7.73 MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $26.71 $26.71 $26.71 $26.71 $26.71 $26.71 $26.71 $26.18 $26.18 MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $26.71 $26.71 $26.71 $26.71 $26.71 $26.71 $26.71 $26.18 $26.18 MAGNESIUM SULFATE 40 MG/ML (NEO/PED) 40 MG/ML SYRINGE All Payors / Plans All Payors / Plans $0.40 $0.40 $0.40 $0.40 $0.40 $0.40 $0.40 $0.39 $0.39 MAGNESIUM SULFATE PER 500 MG OF MAGNESIUM All Payors / Plans All Payors / Plans $5.21 $5.21 $5.21 $5.21 $5.21 $5.21 $5.21 $5.10 $5.10 MAHURKAR 20CM All Payors / Plans All Payors / Plans $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $145.53 $145.53 MANIFOLD SUCTION NEPTUNE 2 4 PORT SPECIMEN COLLECTION All Payors / Plans All Payors / Plans $53.30 $53.30 $53.30 $53.30 $53.30 $53.30 $53.30 $52.23 $52.23 MANIFOLD SUCTION NEPTUNE 2 STANDARD 1 PORT WASTE MANAGEMENT SYSTEM All Payors / Plans All Payors / Plans $27.80 $27.80 $27.80 $27.80 $27.80 $27.80 $27.80 $27.24 $27.24 MANIPULATOR ENDOSCOPIC VCARE DX CURVE UTERINE GRADUATED SHAFT LUER CHANNEL LOCK SCREW LAPAROSCOPIC HYSTERECTOMY All Payors / Plans All Payors / Plans $138.88 $138.88 $138.88 $138.88 $138.88 $138.88 $138.88 $136.10 $136.10 MANIPULATOR ENDOSCOPIC VCARE SM 32MM DISPOSABLE STERILE LF CERVIX UTERUS 2 CUP LOCK SCREW HOLE INFLATE BALLOON All Payors / Plans All Payors / Plans $158.28 $158.28 $158.28 $158.28 $158.28 $158.28 $158.28 $155.11 $155.11 MANNITOL 20 % PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $84.93 $84.93 $84.93 $84.93 $84.93 $84.93 $84.93 $83.23 $83.23 MANNITOL PER 50 ML All Payors / Plans All Payors / Plans $10.69 $10.69 $10.69 $10.69 $10.69 $10.69 $10.69 $10.48 $10.48 MARKER ENDOSCOPIC SPOT STERILE 5 ML GI TRACT SYRINGE PREFILL All Payors / Plans All Payors / Plans $76.00 $76.00 $76.00 $76.00 $76.00 $76.00 $76.00 $74.48 $74.48 MASK O2/CO2 CAPNOMASK ADULT TRANSPARENT GAS SAMPLING LINE DEHP PVC FREE LATEX FREE All Payors / Plans All Payors / Plans $8.80 $8.80 $8.80 $8.80 $8.80 $8.80 $8.80 $8.62 $8.62 MASK OXYGEN POM ADULT MALE TO MALE MEDIUM CONCENTRATION CO2 MONITOR NONSTERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $16.33 $16.33 $16.33 $16.33 $16.33 $16.33 $16.33 $16.00 $16.00 MASK OXYGEN POM ELITE MSA ADULT HIGH CONCENTRATION CO2 MONITOR LATEX FREE MICROSTREAM All Payors / Plans All Payors / Plans $27.07 $27.07 $27.07 $27.07 $27.07 $27.07 $27.07 $26.53 $26.53 MATTRESS TRANSFER HOVERMATT W34 IN BREATHABLE NONSTERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $85.63 $85.63 $85.63 $85.63 $85.63 $85.63 $85.63 $83.92 $83.92 MECLIZINE 12.5 MG TABLET All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 MECLIZINE 25 MG TABLET All Payors / Plans All Payors / Plans $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $1.96 $1.96 MEDLINE CARDIAC CATH PACK All Payors / Plans All Payors / Plans $35.94 $35.94 $35.94 $35.94 $35.94 $35.94 $35.94 $35.22 $35.22 MEDROXYPROGESTERONE 10 MG TABLET All Payors / Plans All Payors / Plans $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.08 $1.08 MEDROXYPROGESTERONE 150 MG/ML SUSPENSION All Payors / Plans All Payors / Plans $0.30 $0.30 $0.30 $0.30 $0.30 $0.30 $0.30 $0.30 $0.30 MEDTRONIC DXTERITY PIG 145 All Payors / Plans All Payors / Plans $17.80 $17.80 $17.80 $17.80 $17.80 $17.80 $17.80 $17.44 $17.44 MEGESTROL 20 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 MEMANTINE 5 MG TABLET All Payors / Plans All Payors / Plans $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.80 $1.80 MENTHOL-ZINC OXIDE 0.44-20.6 % OINTMENT IN PACKET All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 MEPERIDINE (PF) 25 MG/ML SOLUTION All Payors / Plans All Payors / Plans $7.92 $7.92 $7.92 $7.92 $7.92 $7.92 $7.92 $7.76 $7.76 MERIT PERFORMA PIGTAIL CATHETER All Payors / Plans All Payors / Plans $18.10 $18.10 $18.10 $18.10 $18.10 $18.10 $18.10 $17.74 $17.74 MERIT PERICARDIOCENTESIS KIT All Payors / Plans All Payors / Plans $183.10 $183.10 $183.10 $183.10 $183.10 $183.10 $183.10 $179.44 $179.44 MERIT PIGTAIL CATHETER All Payors / Plans All Payors / Plans $18.10 $18.10 $18.10 $18.10 $18.10 $18.10 $18.10 $17.74 $17.74 "MESALAMINE 1,000 MG SUPPOSITORY" All Payors / Plans All Payors / Plans $5.11 $5.11 $5.11 $5.11 $5.11 $5.11 $5.11 $5.01 $5.01 MESALAMINE 4 GRAM/60 ML ENEMA All Payors / Plans All Payors / Plans $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $20.77 $20.77 "MESALAMINE 800 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $14.83 $14.83 $14.83 $14.83 $14.83 $14.83 $14.83 $14.53 $14.53 MESH BARD PERFIX BARD POLYPROPYLENE LARGE L1.6 IN X W 1.9 IN PLUG MONOFILAMENT STERILE PREPERITONEAL REPAIR All Payors / Plans All Payors / Plans $173.88 $173.88 $173.88 $173.88 $173.88 $173.88 $173.88 $170.40 $170.40 MESH BARD PERFIX BARD POLYPROPYLENE MEDIUM L1.55 IN X W 1.3 IN PLUG MONOFILAMENT STERILE PREPERITONEAL REPAIR All Payors / Plans All Payors / Plans $274.20 $274.20 $274.20 $274.20 $274.20 $274.20 $274.20 $268.72 $268.72 MESH CRANIAL LORENZ L85 MM X W53 MM X H.6 MM NEURO PANEL 1.5 MM SCREW All Payors / Plans All Payors / Plans " $2,370.00 " " $2,370.00 " " $2,370.00 " " $2,370.00 " " $2,370.00 " " $2,370.00 " " $2,370.00 " " $2,322.60 " " $2,322.60 " MESH OVITEX 1S SIX LAYER 25 X 30 CM PERMANENT All Payors / Plans All Payors / Plans " $12,468.75 " " $12,468.75 " " $12,468.75 " " $12,468.75 " " $12,468.75 " " $12,468.75 " " $12,468.75 " " $12,219.38 " " $12,219.38 " MESH SURGICAL 3DMAX POLYPROPYLENE XL 3D CURVE L7 IN X W5 IN GROIN LEFT CONTOUR SEAL EDGE STERILE LAPAROSCOPIC INGUINAL HERNIA REPAIR All Payors / Plans All Payors / Plans $257.25 $257.25 $257.25 $257.25 $257.25 $257.25 $257.25 $252.11 $252.11 MESH SURGICAL 3DMAX POLYPROPYLENE XL 3D CURVE L7 IN X W5 IN GROIN RIGHT CONTOUR SEAL EDGE STERILE LAPAROSCOPIC INGUINAL HERNIA REPAIR All Payors / Plans All Payors / Plans $411.60 $411.60 $411.60 $411.60 $411.60 $411.60 $411.60 $403.37 $403.37 MESH SURGICAL ABSORBABLE PATCH 2.5 IN DIAMETER All Payors / Plans All Payors / Plans $956.80 $956.80 $956.80 $956.80 $956.80 $956.80 $956.80 $937.66 $937.66 MESH SURGICAL BARD 3DMAX LG 3D CURVE CONTOUR 6X4IN POLYPROPYLENE STERILE GROIN LEFT SEAL EDGE LAPAROSCOPIC INGUINAL All Payors / Plans All Payors / Plans $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $336.14 $336.14 MESH SURGICAL BARD 3DMAX LG 3D CURVE CONTOUR 6X4IN POLYPROPYLENE STERILE GROIN RIGHT SEAL EDGE LAPAROSCOPIC INGUINAL All Payors / Plans All Payors / Plans $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $336.14 $336.14 MESH SURGICAL BARD POLYPROPYLENE L6IN X W3 IN GROIN MONOFILAMENT VENTRAL INGUINAL HERNIA REPAIR All Payors / Plans All Payors / Plans $75.80 $75.80 $75.80 $75.80 $75.80 $75.80 $75.80 $74.28 $74.28 MESH SURGICAL BARD POLYPROPYLENE L6IN X W6 IN GROIN MONOFILAMENT VENTRAL INGUINAL HERNIA REPAIR All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE ELLIPSE L6IN X W 4IN MONOFILAMENT LOW PROFILE MEDIUM WEIGHT UNCOATED STERILE LATEX FREE LAPROSCOPIC VENTRAL HERNIA REPAIR All Payors / Plans All Payors / Plans $793.20 $793.20 $793.20 $793.20 $793.20 $793.20 $793.20 $777.34 $777.34 META-NAIL TIBIAL 10MM X 40CM All Payors / Plans All Payors / Plans " $3,240.00 " " $3,240.00 " " $3,240.00 " " $3,240.00 " " $3,240.00 " " $3,240.00 " " $3,240.00 " " $3,175.20 " " $3,175.20 " META-NAIL TIBIAL 8.5MM X 38CM All Payors / Plans All Payors / Plans " $2,025.00 " " $2,025.00 " " $2,025.00 " " $2,025.00 " " $2,025.00 " " $2,025.00 " " $2,025.00 " " $1,984.50 " " $1,984.50 " METFORMIN 500 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 METFORMIN 850 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 METHADONE 10 MG TABLET All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 METHADONE 10 MG/5 ML All Payors / Plans All Payors / Plans $109.67 $109.67 $109.67 $109.67 $109.67 $109.67 $109.67 $107.48 $107.48 METHADONE 10 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $130.03 $130.03 METHADONE 5 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 METHAZOLAMIDE 1 (ONE) 50 MG TABLET All Payors / Plans All Payors / Plans $10.33 $10.33 $10.33 $10.33 $10.33 $10.33 $10.33 $10.12 $10.12 METHAZOLAMIDE 50 MG TABLET All Payors / Plans All Payors / Plans $6.73 $6.73 $6.73 $6.73 $6.73 $6.73 $6.73 $6.60 $6.60 METHIMAZOLE 10 MG TABLET All Payors / Plans All Payors / Plans $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.00 $2.00 METHIMAZOLE 5 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 METHOTREXATE PER 2.5 MG All Payors / Plans All Payors / Plans $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $6.88 $6.88 METHOTREXATE SODIUM PER 5 MG All Payors / Plans All Payors / Plans $1.22 $1.22 $1.22 $1.22 $1.22 $1.22 $1.22 $1.20 $1.20 METHYL SALICYLATE-MENTHOL 29-7.6 % OINTMENT 99.2 G JAR All Payors / Plans All Payors / Plans $26.33 $26.33 $26.33 $26.33 $26.33 $26.33 $26.33 $25.80 $25.80 METHYLENE BLUE 5 MG/ML SOLUTION All Payors / Plans All Payors / Plans $433.06 $433.06 $433.06 $433.06 $433.06 $433.06 $433.06 $424.40 $424.40 METHYLENE BLUE 5 MG/ML SOLUTION 10 ML AMPUL All Payors / Plans All Payors / Plans $433.06 $433.06 $433.06 $433.06 $433.06 $433.06 $433.06 $424.40 $424.40 METHYLERGONOVINE MALEATE PER 0.2 MG All Payors / Plans All Payors / Plans $86.25 $86.25 $86.25 $86.25 $86.25 $86.25 $86.25 $84.53 $84.53 METHYLNALTREXONE 12 MG/0.6 ML SOLUTION All Payors / Plans All Payors / Plans $347.56 $347.56 $347.56 $347.56 $347.56 $347.56 $347.56 $340.61 $340.61 METHYLPHENIDATE HCL 18 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $9.70 $9.70 $9.70 $9.70 $9.70 $9.70 $9.70 $9.50 $9.50 METHYLPHENIDATE HCL 27 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.60 $8.60 METHYLPREDNISOLONE PER 125 MG All Payors / Plans All Payors / Plans $18.73 $18.73 $18.73 $18.73 $18.73 $18.73 $18.73 $18.35 $18.35 METHYLPREDNISOLONE PER 4 MG All Payors / Plans All Payors / Plans $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.40 $3.40 METHYLPREDNISOLONE PER 40 MG All Payors / Plans All Payors / Plans $36.93 $36.93 $36.93 $36.93 $36.93 $36.93 $36.93 $36.19 $36.19 METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML RECON SOLN All Payors / Plans All Payors / Plans $40.41 $40.41 $40.41 $40.41 $40.41 $40.41 $40.41 $39.60 $39.60 METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML RECON SOLN All Payors / Plans All Payors / Plans $26.31 $26.31 $26.31 $26.31 $26.31 $26.31 $26.31 $25.78 $25.78 METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $6.32 $6.32 $6.32 $6.32 $6.32 $6.32 $6.32 $6.19 $6.19 METOCLOPRAMIDE 10 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 METOCLOPRAMIDE 5 MG TABLET All Payors / Plans All Payors / Plans $2.66 $2.66 $2.66 $2.66 $2.66 $2.66 $2.66 $2.60 $2.60 METOCLOPRAMIDE 5 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $4.29 $4.29 $4.29 $4.29 $4.29 $4.29 $4.29 $4.20 $4.20 METOCLOPRAMIDE PER 10 MG All Payors / Plans All Payors / Plans $5.64 $5.64 $5.64 $5.64 $5.64 $5.64 $5.64 $5.53 $5.53 METOLAZONE 10 MG TABLET All Payors / Plans All Payors / Plans $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.64 $8.64 METOLAZONE 2.5 MG TABLET All Payors / Plans All Payors / Plans $9.29 $9.29 $9.29 $9.29 $9.29 $9.29 $9.29 $9.10 $9.10 METOLAZONE 5 MG TABLET All Payors / Plans All Payors / Plans $8.88 $8.88 $8.88 $8.88 $8.88 $8.88 $8.88 $8.70 $8.70 METOPROLOL 12.5 MG All Payors / Plans All Payors / Plans $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.88 $0.88 METOPROLOL 5 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.90 $0.88 $0.88 METOPROLOL SUCCINATE XL 100 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.03 $2.03 METOPROLOL SUCCINATE XL 200 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 METOPROLOL SUCCINATE XL 25 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 METOPROLOL SUCCINATE XL 50 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.91 $1.91 METOPROLOL TARTRATE 100 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 METOPROLOL TARTRATE 25 MG TABLET All Payors / Plans All Payors / Plans $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.89 $0.89 METOPROLOL TARTRATE 50 MG TABLET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 METRONIDAZOLE 250 MG TABLET All Payors / Plans All Payors / Plans $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.08 $1.08 METRONIDAZOLE 50 MG/ML All Payors / Plans All Payors / Plans $0.09 $0.09 $0.09 $0.09 $0.09 $0.09 $0.09 $0.08 $0.08 METRONIDAZOLE 500 MG TABLET All Payors / Plans All Payors / Plans $2.05 $2.05 $2.05 $2.05 $2.05 $2.05 $2.05 $2.01 $2.01 METRONIDAZOLE 500 MG/100 ML PIGGYBACK All Payors / Plans All Payors / Plans $6.15 $6.15 $6.15 $6.15 $6.15 $6.15 $6.15 $6.03 $6.03 MEXILETINE 150 MG CAPSULE All Payors / Plans All Payors / Plans $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.09 $4.09 MICAFUNGIN 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $1.44 $1.44 $1.44 $1.44 $1.44 $1.44 $1.44 $1.41 $1.41 MIC-KEY LOW PROFILE GASTROSTOMY FEEDING 12FR 2.5CM STOMA All Payors / Plans All Payors / Plans $142.66 $142.66 $142.66 $142.66 $142.66 $142.66 $142.66 $139.81 $139.81 MICONAZOLE 2 % CREAM 15 G TUBE All Payors / Plans All Payors / Plans $15.89 $15.89 $15.89 $15.89 $15.89 $15.89 $15.89 $15.57 $15.57 MICROCATHETER CEREBROVASCULAR EXCELSIOR SL-10 HYDROPHILIC .014 IN 45 D C CURVE L150CM L6CM OD2.4-1.7 FR 2 TIP MARKER PRESHAPED PEEL AWAY INTRODUCER STERILE DISPOSABLE All Payors / Plans All Payors / Plans " $2,514.00 " " $2,514.00 " " $2,514.00 " " $2,514.00 " " $2,514.00 " " $2,514.00 " " $2,514.00 " " $2,463.72 " " $2,463.72 " MICROCATHETER CEREBROVASCULAR MAMBA FLEX L 135CM STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans " $1,090.00 " " $1,090.00 " " $1,090.00 " " $1,090.00 " " $1,090.00 " " $1,090.00 " " $1,090.00 " " $1,068.20 " " $1,068.20 " MICROKNIFE XL TRIPLE-LUMEN NEEDLE KNIFE All Payors / Plans All Payors / Plans $313.76 $313.76 $313.76 $313.76 $313.76 $313.76 $313.76 $307.48 $307.48 MIDAS REX MR8 All Payors / Plans All Payors / Plans $327.16 $327.16 $327.16 $327.16 $327.16 $327.16 $327.16 $320.62 $320.62 MIDAZOLAM (PF) 1 MG/ML SOLUTION All Payors / Plans All Payors / Plans $0.33 $0.33 $0.33 $0.33 $0.33 $0.33 $0.33 $0.32 $0.32 MIDAZOLAM 10 MG/5 ML (2 MG/ML) SYRUP All Payors / Plans All Payors / Plans $11.06 $11.06 $11.06 $11.06 $11.06 $11.06 $11.06 $10.84 $10.84 MIDAZOLAM IN 0.9 % NACL 1 MG/ML SOLUTION All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 MIDAZOLAM PER 1 MG All Payors / Plans All Payors / Plans $1.20 $1.20 $1.20 $1.20 $1.20 $1.20 $1.20 $1.17 $1.17 MIDODRINE 2.5 MG TABLET All Payors / Plans All Payors / Plans $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.40 $3.40 MIDODRINE 5 MG TABLET All Payors / Plans All Payors / Plans $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.03 $2.03 MILRINONE 40 MG/200 ML (200 MCG/ML) PIGGYBACK All Payors / Plans All Payors / Plans $2.29 $2.29 $2.29 $2.29 $2.29 $2.29 $2.29 $2.24 $2.24 MINERAL OIL OIL All Payors / Plans All Payors / Plans $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 MINOXIDIL 10 MG TABLET All Payors / Plans All Payors / Plans $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.08 $1.08 MINOXIDIL 2.5 MG TABLET All Payors / Plans All Payors / Plans $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $2.03 $1.98 $1.98 MIRTAZAPINE 15 MG TABLET All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 "MIRTAZAPINE 15 MG TABLET,DISINTEGRATING" All Payors / Plans All Payors / Plans $2.71 $2.71 $2.71 $2.71 $2.71 $2.71 $2.71 $2.66 $2.66 MIRTAZAPINE 30 MG TABLET All Payors / Plans All Payors / Plans $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.07 $1.07 "MIRTAZAPINE 30 MG TABLET,DISINTEGRATING" All Payors / Plans All Payors / Plans $7.01 $7.01 $7.01 $7.01 $7.01 $7.01 $7.01 $6.87 $6.87 MISOPROSTOL 100 MCG TABLET All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 MISOPROSTOL 1000 MCG TABLET All Payors / Plans All Payors / Plans $2.81 $2.81 $2.81 $2.81 $2.81 $2.81 $2.81 $2.75 $2.75 MISOPROSTOL 200 MCG TABLET All Payors / Plans All Payors / Plans $7.06 $7.06 $7.06 $7.06 $7.06 $7.06 $7.06 $6.92 $6.92 MISOPROSTOL 25 MCG All Payors / Plans All Payors / Plans $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.83 $1.83 MITOMYCIN PER 5 MG All Payors / Plans All Payors / Plans $88.02 $88.02 $88.02 $88.02 $88.02 $88.02 $88.02 $86.26 $86.26 MODAFINIL 100 MG TABLET All Payors / Plans All Payors / Plans $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.34 $11.34 MODULAR POST 25MM All Payors / Plans All Payors / Plans " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,092.00 " " $15,092.00 " MONTELUKAST 10 MG TABLET All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 "MONTELUKAST 4 MG TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $2.72 $2.72 $2.72 $2.72 $2.72 $2.72 $2.72 $2.67 $2.67 "MONTELUKAST 5 MG TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 $2.65 $2.65 MORPHINE 0.5 MG/ML SYRINGE All Payors / Plans All Payors / Plans $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 MORPHINE 10 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.09 $4.09 MORPHINE 15 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $1.96 $1.96 MORPHINE 2 MG/ML SYRINGE All Payors / Plans All Payors / Plans $11.11 $11.11 $11.11 $11.11 $11.11 $11.11 $11.11 $10.89 $10.89 MORPHINE 30 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.14 $4.14 MORPHINE 30 MG/30 ML (1 MG/ML) PATIENT CONTROL.ANALGESIA SOLN All Payors / Plans All Payors / Plans $16.93 $16.93 $16.93 $16.93 $16.93 $16.93 $16.93 $16.59 $16.59 MORPHINE 4 MG/ML SYRINGE All Payors / Plans All Payors / Plans $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.74 $10.74 MORPHINE IMMEDIATE RELEASE 15 MG TABLET All Payors / Plans All Payors / Plans $2.79 $2.79 $2.79 $2.79 $2.79 $2.79 $2.79 $2.73 $2.73 MORPHINE PER 10 MG All Payors / Plans All Payors / Plans $6.24 $6.24 $6.24 $6.24 $6.24 $6.24 $6.24 $6.12 $6.12 MORPHINE SULFATE PER 100 MG All Payors / Plans All Payors / Plans $8.42 $8.42 $8.42 $8.42 $8.42 $8.42 $8.42 $8.25 $8.25 MOXIFLOXACIN 0.5 % DROPS 3 ML DROP BTL All Payors / Plans All Payors / Plans $45.61 $45.61 $45.61 $45.61 $45.61 $45.61 $45.61 $44.70 $44.70 MRI BRAIN W CONTRAST All Payors / Plans All Payors / Plans 0611 70552 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $655.62 $655.62 MRI BRAIN W WO CONTRAST All Payors / Plans All Payors / Plans 0611 70553 $761.00 $761.00 $761.00 $761.00 $761.00 $761.00 $761.00 $745.78 $745.78 MULTIVITAMIN WITH FERROUS GLUCONATE 9 MG IRON/15 ML LIQUID All Payors / Plans All Payors / Plans $0.07 $0.07 $0.07 $0.07 $0.07 $0.07 $0.07 $0.06 $0.06 MULTIVIT-IRON-FA-CALCIUM-MINS 9 MG IRON-400 MCG TABLET All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 MUPIROCIN 2 % OINTMENT 22 G TUBE All Payors / Plans All Payors / Plans $16.23 $16.23 $16.23 $16.23 $16.23 $16.23 $16.23 $15.91 $15.91 MYCOPHENOLATE MOFETIL PER 250 MG All Payors / Plans All Payors / Plans $1.77 $1.77 $1.77 $1.77 $1.77 $1.77 $1.77 $1.73 $1.73 MYCOPHENOLATE PER 180 MG All Payors / Plans All Payors / Plans $9.87 $9.87 $9.87 $9.87 $9.87 $9.87 $9.87 $9.67 $9.67 "MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $7.37 $7.37 $7.37 $7.37 $7.37 $7.37 $7.37 $7.22 $7.22 MYLANTA AND DICYCLOMINE All Payors / Plans All Payors / Plans $6.19 $6.19 $6.19 $6.19 $6.19 $6.19 $6.19 $6.07 $6.07 "MYLANTA, LIDOCAINE VISCOUS, DICYCLOMINE" All Payors / Plans All Payors / Plans $18.82 $18.82 $18.82 $18.82 $18.82 $18.82 $18.82 $18.44 $18.44 NA FERRIC GLUC CPLX PER 12.5 MG All Payors / Plans All Payors / Plans $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.02 $8.02 NABUMETONE 750 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 NADOLOL 20 MG TABLET All Payors / Plans All Payors / Plans $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.62 $9.62 NADOLOL 40 MG TABLET All Payors / Plans All Payors / Plans $9.33 $9.33 $9.33 $9.33 $9.33 $9.33 $9.33 $9.14 $9.14 NAFCILLIN 10 GRAM RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $140.62 $140.62 $140.62 $140.62 $140.62 $140.62 $140.62 $137.81 $137.81 NAFCILLIN 2 GRAM RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $36.57 $36.57 $36.57 $36.57 $36.57 $36.57 $36.57 $35.84 $35.84 NAIL INTRAMEDULLARY TITANIUM 9-11 YR L440 MM OD3.5 MM DIAPHYSIS METAPHYSIS EPIPHYSIS ELASTIC SYMMETRICAL BRACING ACTION NONSTERILE BLUE All Payors / Plans All Payors / Plans $603.34 $603.34 $603.34 $603.34 $603.34 $603.34 $603.34 $591.27 $591.27 NAIL SYNTHES TFNA 9MM 130DEG 360MM LEFT All Payors / Plans All Payors / Plans " $3,887.10 " " $3,887.10 " " $3,887.10 " " $3,887.10 " " $3,887.10 " " $3,887.10 " " $3,887.10 " " $3,809.36 " " $3,809.36 " NALBUPHINE PER 10 MG All Payors / Plans All Payors / Plans $16.29 $16.29 $16.29 $16.29 $16.29 $16.29 $16.29 $15.96 $15.96 NALOXONE 1 MG/ML 1 MG/ML SYRINGE All Payors / Plans All Payors / Plans $25.50 $25.50 $25.50 $25.50 $25.50 $25.50 $25.50 $24.99 $24.99 NALOXONE 1 MG/ML 1 MG/ML SYRINGE 2 ML SYRINGE All Payors / Plans All Payors / Plans $25.50 $25.50 $25.50 $25.50 $25.50 $25.50 $25.50 $24.99 $24.99 NALOXONE PER 1 MG All Payors / Plans All Payors / Plans $25.87 $25.87 $25.87 $25.87 $25.87 $25.87 $25.87 $25.35 $25.35 NALTREXONE 50 MG TABLET All Payors / Plans All Payors / Plans $5.81 $5.81 $5.81 $5.81 $5.81 $5.81 $5.81 $5.69 $5.69 NAMIC LEFT HEART KIT All Payors / Plans All Payors / Plans $53.06 $53.06 $53.06 $53.06 $53.06 $53.06 $53.06 $52.00 $52.00 NAMIC RIGHT HEART KIT All Payors / Plans All Payors / Plans $49.72 $49.72 $49.72 $49.72 $49.72 $49.72 $49.72 $48.73 $48.73 NAPROXEN 250 MG TABLET All Payors / Plans All Payors / Plans $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.06 $1.06 NAPROXEN 375 MG TABLET All Payors / Plans All Payors / Plans $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.06 $1.06 NAPROXEN 500 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 NATALIZUMAB PER 1 MG All Payors / Plans All Payors / Plans $28.52 $28.52 $28.52 $28.52 $28.52 $28.52 $28.52 $27.95 $27.95 NAVILYST .035 J-TIP GUIDEWIRE 260CM All Payors / Plans All Payors / Plans $26.46 $26.46 $26.46 $26.46 $26.46 $26.46 $26.46 $25.93 $25.93 NAVILYST .035 STRAIGHT TIP GUIDEWIRE 260CM All Payors / Plans All Payors / Plans $23.16 $23.16 $23.16 $23.16 $23.16 $23.16 $23.16 $22.70 $22.70 NEBIVOLOL 10 MG TABLET All Payors / Plans All Payors / Plans $14.21 $14.21 $14.21 $14.21 $14.21 $14.21 $14.21 $13.93 $13.93 NEBIVOLOL 5 MG TABLET All Payors / Plans All Payors / Plans $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.69 $8.69 NEEDLE ASPIRATION ARCPOINT METAL L137 MM OD21 GA ODSEC1.9 MM PULMONARY BRAID TAPER SHEATH SHORT RIGID LENGTH 2 MM CHANNEL All Payors / Plans All Payors / Plans $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $431.20 $431.20 NEEDLE ASPIRATION EXCELON 15MM 130CM 21GA 1.8MM 20ML DISPOSABLE TRANSBRONCHIAL SYRINGE LOCK ERGONOMIC HANDLE CATHETER All Payors / Plans All Payors / Plans $176.34 $176.34 $176.34 $176.34 $176.34 $176.34 $176.34 $172.81 $172.81 NEEDLE ASPIRATION EXCELON L15 MM L130 CM OD19 GA ODSEC1.8 MM TRANSBRONCHIAL 1 HAND LOCK ERGONOMIC HANDLE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $176.34 $176.34 $176.34 $176.34 $176.34 $176.34 $176.34 $172.81 $172.81 NEEDLE ASPIRATION EXPECT SLIMLINE 8- CM 137.5-141.5CM 22GA 1.83MM 20CC COCR ECHOGENIC PATTERN ULTRASOUND STYLET CAP 2.4 All Payors / Plans All Payors / Plans $494.80 $494.80 $494.80 $494.80 $494.80 $494.80 $494.80 $484.90 $484.90 NEEDLE ASPIRATION L40 MM L700 MM OD22 GA ODSEC1.8 MM ECHOGENIC DIMPLE FLEXIBLE PRESTERILIZE SAFE RELIABLE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $182.74 $182.74 $182.74 $182.74 $182.74 $182.74 $182.74 $179.09 $179.09 NEEDLE ASPIRATION VIZISHOT L70 CM L40 MM OD21 GA ID1.9 MM ECHOGENIC DIMPLED TIP DESIGN MAXIMUM EXTRUDING STROKE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $224.46 $224.46 $224.46 $224.46 $224.46 $224.46 $224.46 $219.97 $219.97 NEEDLE BIOPSY JAMSHIDI 4IN 11GA DISPOSABLE STERILE LF BONE MARROW TAPER DISTAL ADAPTER SHARP BEVEL TIP All Payors / Plans All Payors / Plans $30.02 $30.02 $30.02 $30.02 $30.02 $30.02 $30.02 $29.42 $29.42 NEEDLE BIOPSY SUPERDIMENSION SHORT L130 MM L2 MM OD21 GA ODSEC1.8 MM PREMARK ASPIRATE CATHETER All Payors / Plans All Payors / Plans $295.20 $295.20 $295.20 $295.20 $295.20 $295.20 $295.20 $289.30 $289.30 NEEDLE BIOPSY TRU-CUT THIN WALL 6IN 20MM 14GA STEEL DISPOSABLE KIDNEY LIVER SPECIMEN NOTCH REMOVABLE STYLET DEPTH MARK All Payors / Plans All Payors / Plans $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.19 $18.19 NEEDLE BREAST LOCALIZATION All Payors / Plans All Payors / Plans $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $32.14 $32.14 NEEDLE EPIDURAL PERIFIX TUOHY BISPHENOL A L3 1/2 IN OD18 GA WING HUB PVC FREE DEHP FREE LATEX FREE CLEAR All Payors / Plans All Payors / Plans $11.99 $11.99 $11.99 $11.99 $11.99 $11.99 $11.99 $11.75 $11.75 NEEDLE EPIDURAL PERIFIX TUOHY BISPHENOL A L3 1/2 IN OD20 GA WING HUB PVC FREE DEHP FREE LATEX FREE CLEAR All Payors / Plans All Payors / Plans $11.99 $11.99 $11.99 $11.99 $11.99 $11.99 $11.99 $11.75 $11.75 NEEDLE HYPODERMIC BD REGULAR WALL 1.5IN 25GA BLUE POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP FREE All Payors / Plans All Payors / Plans $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 NEEDLE INSUFFLATION 120MM 14GA ENDOPATH ULTRA VERESS STOPCOCK LUER LOCK BLUNT STYLET All Payors / Plans All Payors / Plans $24.28 $24.28 $24.28 $24.28 $24.28 $24.28 $24.28 $23.79 $23.79 NEEDLE INSUFFLATION 150MM 14GA ENDOPATH SPRING LOAD BLUNT HANDLE STOPCOCK STERILE All Payors / Plans All Payors / Plans $25.14 $25.14 $25.14 $25.14 $25.14 $25.14 $25.14 $24.64 $24.64 NEEDLE INSUFFLATION ENDOPATH ULTRA VERESS STAINLESS STEEL PLASTIC L120 MM OD14 GA STOPCOCK LUER LOCK BLUNT STYLET HANDLE STERILE DISPOSABLE PNEUMOPERITONEUM All Payors / Plans All Payors / Plans $43.52 $43.52 $43.52 $43.52 $43.52 $43.52 $43.52 $42.65 $42.65 NEEDLE SCLEROTHERAPY INTERJECT L4 MM L240 CM OD23 GA ODSEC2.3 MM ID.32 MM INNER CATHETER SHEATH STERILE DISPOSABLE CLEAR All Payors / Plans All Payors / Plans $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $73.48 $73.48 NEEDLE SCLEROTHERAPY STAR CATHETER INTERJECT L4 MM L240 CM OD25 GA ODSEC2.3 MM BEVEL STRONG PUSHABLE CONTRAST SHEATH SPACER CLIP DISPOSABLE RED All Payors / Plans All Payors / Plans $70.10 $70.10 $70.10 $70.10 $70.10 $70.10 $70.10 $68.70 $68.70 NEEDLE SUTURE EXPRESSEW III DISPOSABLE FLEX All Payors / Plans All Payors / Plans $601.60 $601.60 $601.60 $601.60 $601.60 $601.60 $601.60 $589.57 $589.57 NEEDLE SUTURE FERGUSON RICHARD-ALLAN STAINLESS STEEL 1/2 CIRCLE L2.323 IN OD.05 IN REGULAR FREE EYE TAPER POINT STERILE LATEX FREE All Payors / Plans All Payors / Plans $8.89 $8.89 $8.89 $8.89 $8.89 $8.89 $8.89 $8.71 $8.71 NEEDLE SUTURE MAYO CATGUT 3 1/2 CIRCLE TAPER STERILE DISPOSABLE All Payors / Plans All Payors / Plans $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.67 $11.67 NEEDLE SUTURE MULTIFIRE SCORPION All Payors / Plans All Payors / Plans $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $333.20 $333.20 NEEDLE SUTURE RICHARD-ALLAN MAYO STAINLESS STEEL CATGUT 5 1/2 CIRCLE REGULAR TAPER L1.26 IN OD.043 IN TEMPER STRENGTH DEPENDABLE LIGHT STERILE LATEX FREE DISPOSABLE TISSUE CLOSURE All Payors / Plans All Payors / Plans $7.38 $7.38 $7.38 $7.38 $7.38 $7.38 $7.38 $7.23 $7.23 NEEDLE SUTURE RICHARD-ALLAN STAINLESS STEEL 3 1/2 CIRCLE REGULAR L.984 IN OD.024 IN INTESTINAL TAPER POINT FREE EYE STERILE LATEX FREE TISSUE CLOSURE All Payors / Plans All Payors / Plans $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.67 $11.67 "NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM OINTMENT 28 G TUBE" All Payors / Plans All Payors / Plans $10.90 $10.90 $10.90 $10.90 $10.90 $10.90 $10.90 $10.68 $10.68 "NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM OINTMENT 28.4 G TUBE" All Payors / Plans All Payors / Plans $11.15 $11.15 $11.15 $11.15 $11.15 $11.15 $11.15 $10.93 $10.93 "NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML SOLUTION" All Payors / Plans All Payors / Plans $50.70 $50.70 $50.70 $50.70 $50.70 $50.70 $50.70 $49.69 $49.69 "NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML SOLUTION 1 ML AMPUL" All Payors / Plans All Payors / Plans $50.70 $50.70 $50.70 $50.70 $50.70 $50.70 $50.70 $49.69 $49.69 "NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML SOLUTION 20 ML VIAL" All Payors / Plans All Payors / Plans $8.12 $8.12 $8.12 $8.12 $8.12 $8.12 $8.12 $7.96 $7.96 "NEOMYCIN-POLYMYXIN-DEXAMETHASONE 3.5MG/ML-10,000 UNIT/ML-0.1 % DROPS,SUSPENSION 5 ML DROP BTL" All Payors / Plans All Payors / Plans $64.43 $64.43 $64.43 $64.43 $64.43 $64.43 $64.43 $63.14 $63.14 "NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% DROPS,SUSPENSION 10 ML DROP BTL" All Payors / Plans All Payors / Plans $158.60 $158.60 $158.60 $158.60 $158.60 $158.60 $158.60 $155.43 $155.43 NEOSTIGMINE METHYLSULFATE 3 MG/3 ML (1 MG/ML) SYRINGE All Payors / Plans All Payors / Plans $8.46 $8.46 $8.46 $8.46 $8.46 $8.46 $8.46 $8.29 $8.29 NEOSTIGMINE PER 0.5 MG All Payors / Plans All Payors / Plans $6.26 $6.26 $6.26 $6.26 $6.26 $6.26 $6.26 $6.14 $6.14 NICARDIPINE 25 MG/10 ML SOLUTION All Payors / Plans All Payors / Plans $69.04 $69.04 $69.04 $69.04 $69.04 $69.04 $69.04 $67.66 $67.66 NICARDIPINE 25 MG/10 ML SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $45.46 $45.46 $45.46 $45.46 $45.46 $45.46 $45.46 $44.55 $44.55 NICOTINE 14 MG/24 HR PATCH 24 HOUR All Payors / Plans All Payors / Plans $4.27 $4.27 $4.27 $4.27 $4.27 $4.27 $4.27 $4.18 $4.18 NICOTINE 2 MG GUM All Payors / Plans All Payors / Plans $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.10 $1.10 NICOTINE 21 MG/24 HR PATCH 24 HOUR All Payors / Plans All Payors / Plans $7.05 $7.05 $7.05 $7.05 $7.05 $7.05 $7.05 $6.91 $6.91 NICOTINE 7 MG/24 HR PATCH 24 HOUR All Payors / Plans All Payors / Plans $10.94 $10.94 $10.94 $10.94 $10.94 $10.94 $10.94 $10.72 $10.72 NIFEDIPINE 10 MG CAPSULE All Payors / Plans All Payors / Plans $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.57 $2.57 NIFEDIPINE XL 30 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $3.44 $3.44 $3.44 $3.44 $3.44 $3.44 $3.44 $3.37 $3.37 NIFEDIPINE XL 60 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.05 $7.05 NIFEDIPINE XL 90 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $4.98 $4.98 $4.98 $4.98 $4.98 $4.98 $4.98 $4.88 $4.88 NIMODIPINE 30 MG CAPSULE All Payors / Plans All Payors / Plans $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.14 $4.06 $4.06 NITROFURANTOIN 100 MG CAPSULE All Payors / Plans All Payors / Plans $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $8.82 $8.82 NITROFURANTOIN 50 MG CAPSULE All Payors / Plans All Payors / Plans $5.08 $5.08 $5.08 $5.08 $5.08 $5.08 $5.08 $4.97 $4.97 NITROGLYCERIN 0.1 MG/HR PATCH 24 HOUR All Payors / Plans All Payors / Plans $0.65 $0.65 $0.65 $0.65 $0.65 $0.65 $0.65 $0.64 $0.64 NITROGLYCERIN 0.2 MG/HR PATCH 24 HOUR All Payors / Plans All Payors / Plans $0.53 $0.53 $0.53 $0.53 $0.53 $0.53 $0.53 $0.52 $0.52 "NITROGLYCERIN 0.4 MG TABLET, SUBLINGUAL" All Payors / Plans All Payors / Plans $0.29 $0.29 $0.29 $0.29 $0.29 $0.29 $0.29 $0.28 $0.28 NITROGLYCERIN 0.4 MG/HR PATCH 24 HOUR All Payors / Plans All Payors / Plans $0.59 $0.59 $0.59 $0.59 $0.59 $0.59 $0.59 $0.58 $0.58 NITROGLYCERIN 0.8 MG/HR PATCH 24 HOUR All Payors / Plans All Payors / Plans $188.28 $188.28 $188.28 $188.28 $188.28 $188.28 $188.28 $184.51 $184.51 NITROGLYCERIN 2 % OINTMENT All Payors / Plans All Payors / Plans $8.81 $8.81 $8.81 $8.81 $8.81 $8.81 $8.81 $8.63 $8.63 "NITROGLYCERIN 400 MCG/SPRAY SPRAY,NON-AEROSOL 12 G BOTTLE" All Payors / Plans All Payors / Plans $673.49 $673.49 $673.49 $673.49 $673.49 $673.49 $673.49 $660.02 $660.02 NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $45.08 $45.08 NITROGLYCERIN IN 5 % DEXTROSE 50 MG/250 ML (200 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $50.61 $50.61 $50.61 $50.61 $50.61 $50.61 $50.61 $49.60 $49.60 NOREPINEPHRINE BITARTRATE 1 MG/ML SOLUTION All Payors / Plans All Payors / Plans $25.97 $25.97 $25.97 $25.97 $25.97 $25.97 $25.97 $25.45 $25.45 NOREPINEPHRINE BITARTRATE 1 MG/ML SOLUTION 4 ML VIAL All Payors / Plans All Payors / Plans $25.97 $25.97 $25.97 $25.97 $25.97 $25.97 $25.97 $25.45 $25.45 NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $32.52 $32.52 $32.52 $32.52 $32.52 $32.52 $32.52 $31.87 $31.87 NOREPINEPHRINE IN D5W 8 MG/250 ML (32 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $135.97 $135.97 $135.97 $135.97 $135.97 $135.97 $135.97 $133.25 $133.25 NORMAL SALINE 0.9% SOLUTION All Payors / Plans All Payors / Plans $0.53 $0.53 $0.53 $0.53 $0.53 $0.53 $0.53 $0.52 $0.52 "NORMAL SALINE 0.9% SOLUTION 1,000 ML FLEX CONT" All Payors / Plans All Payors / Plans $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 NORMAL SALINE 0.9% SOLUTION 10 ML SYRINGE All Payors / Plans All Payors / Plans $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 NORMAL SALINE 0.9% SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $0.89 $0.89 $0.89 $0.89 $0.89 $0.89 $0.89 $0.87 $0.87 NORMAL SALINE 0.9% SOLUTION 20 ML VIAL All Payors / Plans All Payors / Plans $5.71 $5.71 $5.71 $5.71 $5.71 $5.71 $5.71 $5.60 $5.60 NORMAL SALINE 0.9% SOLUTION 5 ML SYRINGE All Payors / Plans All Payors / Plans $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 $0.11 NORTRIPTYLINE 25 MG CAPSULE All Payors / Plans All Payors / Plans $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.88 $1.88 "NYSTATIN 100,000 UNIT/GRAM CREAM 30 G TUBE" All Payors / Plans All Payors / Plans $31.79 $31.79 $31.79 $31.79 $31.79 $31.79 $31.79 $31.15 $31.15 "NYSTATIN 100,000 UNIT/GRAM OINTMENT 15 G TUBE" All Payors / Plans All Payors / Plans $16.47 $16.47 $16.47 $16.47 $16.47 $16.47 $16.47 $16.14 $16.14 "NYSTATIN 100,000 UNIT/GRAM POWDER 15 G BOTTLE" All Payors / Plans All Payors / Plans $26.33 $26.33 $26.33 $26.33 $26.33 $26.33 $26.33 $25.80 $25.80 "NYSTATIN 100,000 UNIT/GRAM POWDER 15 G SQUEEZ BTL" All Payors / Plans All Payors / Plans $31.55 $31.55 $31.55 $31.55 $31.55 $31.55 $31.55 $30.92 $30.92 "NYSTATIN 100,000 UNIT/ML SUSPENSION" All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.54 $2.54 OBSOLETE PER VENDOR - OBTURATOR 8MM BLADELESS All Payors / Plans All Payors / Plans $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 OBTURATOR 8MM BLADELESS OPTICAL All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 OBTURATOR 8MM BLADELESS OPTICAL LONG All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 OBTURATOR LAPAROSCOPIC DA VINCI S/SI ENDOWRIST SHORT OD8 MM STERILE DISPOSABLE All Payors / Plans All Payors / Plans $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 OCCLUDER VASCULAR VESSEL-CLUDE MEDIUM L4 IN RADIOPAQUE STERILE LATEX DISPOSABLE All Payors / Plans All Payors / Plans $24.38 $24.38 $24.38 $24.38 $24.38 $24.38 $24.38 $23.89 $23.89 OCTREOTIDE PER 25 MCG All Payors / Plans All Payors / Plans $2.55 $2.55 $2.55 $2.55 $2.55 $2.55 $2.55 $2.50 $2.50 "OCTREOTIDE,MICROSPHERES 20 MG SUSPENSION,EXTENDED REL RECON" All Payors / Plans All Payors / Plans $231.23 $231.23 $231.23 $231.23 $231.23 $231.23 $231.23 $226.61 $226.61 "OCTREOTIDE,MICROSPHERES 30 MG SUSPENSION,EXTENDED REL RECON" All Payors / Plans All Payors / Plans $219.23 $219.23 $219.23 $219.23 $219.23 $219.23 $219.23 $214.84 $214.84 OFLOXACIN 0.3 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $36.25 $36.25 $36.25 $36.25 $36.25 $36.25 $36.25 $35.53 $35.53 OLANZAPINE 10 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $84.93 $84.93 $84.93 $84.93 $84.93 $84.93 $84.93 $83.23 $83.23 OLANZAPINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.93 $1.93 OLANZAPINE 2.5 MG TABLET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 OLANZAPINE 5 MG TABLET All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 OLANZAPINE 7.5 MG TABLET All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 "OLANZAPINE ODT 10 MG TABLET,DISINTEGRATING" All Payors / Plans All Payors / Plans $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.02 $2.02 "OLANZAPINE ZYDIS 5 MG TABLET,DISINTEGRATING" All Payors / Plans All Payors / Plans $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.71 $2.71 OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE All Payors / Plans All Payors / Plans $9.43 $9.43 $9.43 $9.43 $9.43 $9.43 $9.43 $9.24 $9.24 ONDANSETRON 4 (FOUR) 4 MG TABLETS All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 ONDANSETRON PER 1 MG All Payors / Plans All Payors / Plans $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.14 $0.13 $0.13 ONDANSETRON PER 8 MG All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 ONDANSETRON PER 8 MG All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 ONYX FRONTIER RX CORONARY STENT 2.25 X 12MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 2.25 X 22MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 2.25 X 38MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 2.25 X 8MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 2.5 X 12MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 2.5 X 15MM All Payors / Plans All Payors / Plans $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $551.25 $551.25 ONYX FRONTIER RX CORONARY STENT 2.5 X 38MM All Payors / Plans All Payors / Plans $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $551.25 $551.25 ONYX FRONTIER RX CORONARY STENT 2.5 X 8MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 2.75 X 15MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 3.0 X 12MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 3.0 X 15MM All Payors / Plans All Payors / Plans $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $551.25 $551.25 ONYX FRONTIER RX CORONARY STENT 3.0 X 18MM All Payors / Plans All Payors / Plans $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $551.25 $551.25 ONYX FRONTIER RX CORONARY STENT 3.0 X 22MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 3.0 X 8MM All Payors / Plans All Payors / Plans $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $551.25 $551.25 ONYX FRONTIER RX CORONARY STENT 3.5 X 12MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 3.5 X 15MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 3.5 X 18MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 3.5 X 22MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 3.5 X 8MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 4.0 X 12MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 ONYX FRONTIER RX CORONARY STENT 4.5 X 18MM All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 OPSENS OPTOWIRE PRESSURE GUIDEWIRE All Payors / Plans All Payors / Plans " $1,210.00 " " $1,210.00 " " $1,210.00 " " $1,210.00 " " $1,210.00 " " $1,210.00 " " $1,210.00 " " $1,185.80 " " $1,185.80 " OSELTAMIVIR 6 MG/ML SUSPENSION FOR RECONSTITUTION All Payors / Plans All Payors / Plans $26.43 $26.43 $26.43 $26.43 $26.43 $26.43 $26.43 $25.90 $25.90 OSELTAMIVIR 75 MG CAPSULE All Payors / Plans All Payors / Plans $23.81 $23.81 $23.81 $23.81 $23.81 $23.81 $23.81 $23.33 $23.33 OSTEOBALLAST 45X17.5MM All Payors / Plans All Payors / Plans " $3,160.00 " " $3,160.00 " " $3,160.00 " " $3,160.00 " " $3,160.00 " " $3,160.00 " " $3,160.00 " " $3,096.80 " " $3,096.80 " OSTEOSET BEAD KIT All Payors / Plans All Payors / Plans " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,106.20 " " $4,106.20 " OVERDRILL FOR 2.4MM SCREWS All Payors / Plans All Payors / Plans $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $146.88 $143.94 $143.94 OXALIPLATIN PER 0.5 MG All Payors / Plans All Payors / Plans $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.43 $0.43 OXAZEPAM 10 MG CAPSULE All Payors / Plans All Payors / Plans $6.70 $6.70 $6.70 $6.70 $6.70 $6.70 $6.70 $6.57 $6.57 OXAZEPAM 15 MG CAPSULE All Payors / Plans All Payors / Plans $8.92 $8.92 $8.92 $8.92 $8.92 $8.92 $8.92 $8.74 $8.74 OXAZEPAM 30 MG CAPSULE All Payors / Plans All Payors / Plans $4.91 $4.91 $4.91 $4.91 $4.91 $4.91 $4.91 $4.81 $4.81 OXCARBAZEPINE 300 MG TABLET All Payors / Plans All Payors / Plans $2.74 $2.74 $2.74 $2.74 $2.74 $2.74 $2.74 $2.69 $2.69 OXYBUTYNIN 5 MG TABLET All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 OXYCODONE 15 MG TABLET All Payors / Plans All Payors / Plans $2.05 $2.05 $2.05 $2.05 $2.05 $2.05 $2.05 $2.01 $2.01 OXYCODONE 30 MG TABLET All Payors / Plans All Payors / Plans $3.45 $3.45 $3.45 $3.45 $3.45 $3.45 $3.45 $3.38 $3.38 OXYCODONE 5 MG TABLET All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 OXYCODONE 5 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $9.12 $9.12 $9.12 $9.12 $9.12 $9.12 $9.12 $8.94 $8.94 "OXYCODONE ER 10 MG TABLET,ORAL ONLY,EXT.REL.12 HR" All Payors / Plans All Payors / Plans $10.41 $10.41 $10.41 $10.41 $10.41 $10.41 $10.41 $10.20 $10.20 "OXYCODONE ER 15 MG TABLET,ORAL ONLY,EXT.REL.12 HR" All Payors / Plans All Payors / Plans $14.44 $14.44 $14.44 $14.44 $14.44 $14.44 $14.44 $14.15 $14.15 "OXYCODONE ER 40 MG TABLET,ORAL ONLY,EXT.REL.12 HR" All Payors / Plans All Payors / Plans $20.70 $20.70 $20.70 $20.70 $20.70 $20.70 $20.70 $20.29 $20.29 OXYCODONE-ACETAMINOPHEN 5-325 MG TABLET All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 "OXYMETAZOLINE 0.05 % SPRAY,NON-AEROSOL 30 ML SQUEEZ BTL" All Payors / Plans All Payors / Plans $6.18 $6.18 $6.18 $6.18 $6.18 $6.18 $6.18 $6.06 $6.06 OXYTOCIN IN 0.9 NACL 30 UNIT/500 ML SOLUTION All Payors / Plans All Payors / Plans $21.65 $21.65 $21.65 $21.65 $21.65 $21.65 $21.65 $21.21 $21.21 OXYTOCIN PER 10 UNITS All Payors / Plans All Payors / Plans $10.79 $10.79 $10.79 $10.79 $10.79 $10.79 $10.79 $10.57 $10.57 PACEMAKER ASSURITY MRI DR-RF-MERLIN PKG_45059_ All Payors / Plans All Payors / Plans " $5,472.00 " " $5,472.00 " " $5,472.00 " " $5,472.00 " " $5,472.00 " " $5,472.00 " " $5,472.00 " " $5,362.56 " " $5,362.56 " PACEMAKER AZURE S XT SR W1SR01 MRI SYSTEM SYSTEMSYSTEM All Payors / Plans All Payors / Plans " $6,279.50 " " $6,279.50 " " $6,279.50 " " $6,279.50 " " $6,279.50 " " $6,279.50 " " $6,279.50 " " $6,153.91 " " $6,153.91 " PACEMAKER L321 ACCOLADE EL DEVICE _42916_ All Payors / Plans All Payors / Plans " $6,503.70 " " $6,503.70 " " $6,503.70 " " $6,503.70 " " $6,503.70 " " $6,503.70 " " $6,503.70 " " $6,373.63 " " $6,373.63 " PACK ANKLE All Payors / Plans All Payors / Plans $138.33 $138.33 $138.33 $138.33 $138.33 $138.33 $138.33 $135.56 $135.56 PACK ARTERIOGRAM CUSTOM All Payors / Plans All Payors / Plans $73.29 $73.29 $73.29 $73.29 $73.29 $73.29 $73.29 $71.82 $71.82 PACK BASIC NEURO All Payors / Plans All Payors / Plans $208.79 $208.79 $208.79 $208.79 $208.79 $208.79 $208.79 $204.61 $204.61 PACK BIOPSY BASIN CUSTOM All Payors / Plans All Payors / Plans $19.72 $19.72 $19.72 $19.72 $19.72 $19.72 $19.72 $19.33 $19.33 PACK CERVICAL ACCESSORY All Payors / Plans All Payors / Plans $68.24 $68.24 $68.24 $68.24 $68.24 $68.24 $68.24 $66.88 $66.88 PACK CUSTOM SHAKUR All Payors / Plans All Payors / Plans $304.38 $304.38 $304.38 $304.38 $304.38 $304.38 $304.38 $298.29 $298.29 PACK DAVINCI DR IM All Payors / Plans All Payors / Plans $438.94 $438.94 $438.94 $438.94 $438.94 $438.94 $438.94 $430.16 $430.16 PACK DAVINCI UROLOGY All Payors / Plans All Payors / Plans $427.16 $427.16 $427.16 $427.16 $427.16 $427.16 $427.16 $418.62 $418.62 PACK FEMPOP BYPASS All Payors / Plans All Payors / Plans $327.73 $327.73 $327.73 $327.73 $327.73 $327.73 $327.73 $321.18 $321.18 PACK HEART All Payors / Plans All Payors / Plans $352.11 $352.11 $352.11 $352.11 $352.11 $352.11 $352.11 $345.07 $345.07 PACK HEART CABG ACCESSORY All Payors / Plans All Payors / Plans $250.31 $250.31 $250.31 $250.31 $250.31 $250.31 $250.31 $245.30 $245.30 PACK ICE 12X5IN DISPOSABLE NS LF FACE BILATERAL SOFT OUTER COVER HOOK LOOP CLOSURE All Payors / Plans All Payors / Plans $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.71 $2.71 PACK ICE SMALL RECTANGLE L 12IN X W 5 IN 3 LAYER BAG TIE CLOSURE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.77 $2.71 $2.71 PACK LAPAROSCOPIC All Payors / Plans All Payors / Plans $155.86 $155.86 $155.86 $155.86 $155.86 $155.86 $155.86 $152.74 $152.74 PACK MAJOR ABDOMINAL All Payors / Plans All Payors / Plans $65.24 $65.24 $65.24 $65.24 $65.24 $65.24 $65.24 $63.94 $63.94 PACK MINOR All Payors / Plans All Payors / Plans $45.74 $45.74 $45.74 $45.74 $45.74 $45.74 $45.74 $44.83 $44.83 PACK PLIF ACCESSORY All Payors / Plans All Payors / Plans $109.79 $109.79 $109.79 $109.79 $109.79 $109.79 $109.79 $107.59 $107.59 PACK REVEAL LINQ All Payors / Plans All Payors / Plans $23.53 $23.53 $23.53 $23.53 $23.53 $23.53 $23.53 $23.06 $23.06 PACK SHOULDER ARTHROSCOPY All Payors / Plans All Payors / Plans $149.70 $149.70 $149.70 $149.70 $149.70 $149.70 $149.70 $146.71 $146.71 PACK SURGICAL 175 MM 200 MM 1 WIDE FIELD LENS 1 CORRECTION LENS BIOM THUMBSCREW CAP STERILE DISPOSABLE All Payors / Plans All Payors / Plans $289.14 $289.14 $289.14 $289.14 $289.14 $289.14 $289.14 $283.36 $283.36 PACK SURGICAL ARTHROSCOPY All Payors / Plans All Payors / Plans $123.81 $123.81 $123.81 $123.81 $123.81 $123.81 $123.81 $121.33 $121.33 PACK SURGICAL BASIN CUSTOM CV DRAPE All Payors / Plans All Payors / Plans $207.21 $207.21 $207.21 $207.21 $207.21 $207.21 $207.21 $203.07 $203.07 PACK SURGICAL CUSTOM AAA All Payors / Plans All Payors / Plans $449.76 $449.76 $449.76 $449.76 $449.76 $449.76 $449.76 $440.76 $440.76 PACK SURGICAL CUSTOM AV FISTULA All Payors / Plans All Payors / Plans $133.91 $133.91 $133.91 $133.91 $133.91 $133.91 $133.91 $131.23 $131.23 PACK SURGICAL CUSTOM C SECTION All Payors / Plans All Payors / Plans $150.19 $150.19 $150.19 $150.19 $150.19 $150.19 $150.19 $147.19 $147.19 PACK SURGICAL CUSTOM C SECTION LATEX FREE All Payors / Plans All Payors / Plans $88.76 $88.76 $88.76 $88.76 $88.76 $88.76 $88.76 $86.98 $86.98 PACK SURGICAL CUSTOM CAROTID All Payors / Plans All Payors / Plans $218.70 $218.70 $218.70 $218.70 $218.70 $218.70 $218.70 $214.33 $214.33 PACK SURGICAL CUSTOM CHEST All Payors / Plans All Payors / Plans $219.94 $219.94 $219.94 $219.94 $219.94 $219.94 $219.94 $215.54 $215.54 PACK SURGICAL CUSTOM CRANI ACCESSORY All Payors / Plans All Payors / Plans $402.71 $402.71 $402.71 $402.71 $402.71 $402.71 $402.71 $394.66 $394.66 PACK SURGICAL CUSTOM DENTAL All Payors / Plans All Payors / Plans $44.09 $44.09 $44.09 $44.09 $44.09 $44.09 $44.09 $43.21 $43.21 PACK SURGICAL CUSTOM GYN LAPAROSCOPY All Payors / Plans All Payors / Plans $124.21 $124.21 $124.21 $124.21 $124.21 $124.21 $124.21 $121.73 $121.73 PACK SURGICAL CUSTOM MAJOR ORTHO HAND All Payors / Plans All Payors / Plans $85.33 $85.33 $85.33 $85.33 $85.33 $85.33 $85.33 $83.62 $83.62 PACK SURGICAL CUSTOM PACEMAKER All Payors / Plans All Payors / Plans $82.63 $82.63 $82.63 $82.63 $82.63 $82.63 $82.63 $80.98 $80.98 PACK SURGICAL CUSTOM PACEMAKER DYNJ59287 All Payors / Plans All Payors / Plans $55.48 $55.48 $55.48 $55.48 $55.48 $55.48 $55.48 $54.37 $54.37 PACK SURGICAL CUSTOM TAVR All Payors / Plans All Payors / Plans $160.51 $160.51 $160.51 $160.51 $160.51 $160.51 $160.51 $157.30 $157.30 PACK SURGICAL CUSTOM TOTAL HIP ACCESSORY All Payors / Plans All Payors / Plans $78.18 $78.18 $78.18 $78.18 $78.18 $78.18 $78.18 $76.62 $76.62 PACK SURGICAL CUSTOM TOTAL SHOULDER ACCESSORY All Payors / Plans All Payors / Plans $138.31 $138.31 $138.31 $138.31 $138.31 $138.31 $138.31 $135.54 $135.54 PACK SURGICAL ECLIPSE LITHOTOMY IV GYN T SHEET NO GOWN STERILE LATEX FREE All Payors / Plans All Payors / Plans $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.56 $10.56 PACK SURGICAL ECLIPSE T L76 IN X W44 IN L23 IN X W16 IN CYSTOSCOPY VI DRAPE ABSORBENT REINFORCEMENT MESH SCREEN STERILE LATEX FREE All Payors / Plans All Payors / Plans $9.05 $9.05 $9.05 $9.05 $9.05 $9.05 $9.05 $8.87 $8.87 PACK SURGICAL EP All Payors / Plans All Payors / Plans $66.65 $66.65 $66.65 $66.65 $66.65 $66.65 $66.65 $65.32 $65.32 PACK SURGICAL HYSTEROSCOPY D C All Payors / Plans All Payors / Plans $35.73 $35.73 $35.73 $35.73 $35.73 $35.73 $35.73 $35.02 $35.02 PACK SURGICAL TOTAL JOINT All Payors / Plans All Payors / Plans $482.61 $482.61 $482.61 $482.61 $482.61 $482.61 $482.61 $472.96 $472.96 PACK SURGICAL TOTAL KNEE ACCESSORY All Payors / Plans All Payors / Plans $31.95 $31.95 $31.95 $31.95 $31.95 $31.95 $31.95 $31.31 $31.31 PACK TRENGUARD PROCEDURE 450 PAC 450LBS All Payors / Plans All Payors / Plans $131.47 $131.47 $131.47 $131.47 $131.47 $131.47 $131.47 $128.84 $128.84 PACK TROCH NAIL All Payors / Plans All Payors / Plans $117.10 $117.10 $117.10 $117.10 $117.10 $117.10 $117.10 $114.76 $114.76 PACK VITRECTOMY ACCURUS TOTAL PLUS PROBE 2500 All Payors / Plans All Payors / Plans $328.80 $328.80 $328.80 $328.80 $328.80 $328.80 $328.80 $322.22 $322.22 PACK VITRECTOMY CONSTELLATION ENGAUGE RUBBER OD25 GA OD20 GA ODSEC23 GA 10 CC VISCUOUS FLUID CONTROL SYRINGE NEEDLE CANNULA STERILE LATEX FREE DISPOSABLE VFC All Payors / Plans All Payors / Plans $133.94 $133.94 $133.94 $133.94 $133.94 $133.94 $133.94 $131.26 $131.26 PACK VITRECTOMY CONSTELLATION ENGAUGE V-LOCITY C3F8 SF6 GAS FILL SYRINGE RFID AUTOMATIC PURGE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $133.94 $133.94 $133.94 $133.94 $133.94 $133.94 $133.94 $131.26 $131.26 PACK VITRECTOMY CONSTELLATION OD20 GA PROBE FRAGMENTATION HANDPIECE LIGHTWEIGHT LATEX FREE All Payors / Plans All Payors / Plans $153.58 $153.58 $153.58 $153.58 $153.58 $153.58 $153.58 $150.51 $150.51 PACK VITRECTOMY CONSTELLATION TOTAL PLUS 5000 CPM OD23 GA 20 CC 3 WAY STOPCOCK PROBE STRAIGHT ENDOILLUMINATOR AUTO INFUSION VALVE LATEX FREE All Payors / Plans All Payors / Plans " $1,106.22 " " $1,106.22 " " $1,106.22 " " $1,106.22 " " $1,106.22 " " $1,106.22 " " $1,106.22 " " $1,084.10 " " $1,084.10 " PACK VITRECTOMY II All Payors / Plans All Payors / Plans $93.03 $93.03 $93.03 $93.03 $93.03 $93.03 $93.03 $91.17 $91.17 PACK VITRECTOMY TOTAL PLUS HYPERVIT 20000 CPM OD25 GA BEVEL All Payors / Plans All Payors / Plans " $1,213.38 " " $1,213.38 " " $1,213.38 " " $1,213.38 " " $1,213.38 " " $1,213.38 " " $1,213.38 " " $1,189.11 " " $1,189.11 " PACKING WOUND CURITY COTTON GAUZE L5 YD X W1 IN STRIP SELVAGE EDGE PLAIN MESH STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 PACKING WOUND CURITY IODOFORM COTTON GAUZE L5 YD X W1/4 IN STRIP STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 PACKING WOUND CURITY IODOFORM COTTON MESH GAUZE L5 YD X W1/2 IN STRIP All Payors / Plans All Payors / Plans $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $4.90 $4.90 PACLITAXEL PER 30 MG All Payors / Plans All Payors / Plans $0.10 $0.10 $0.10 $0.10 $0.10 $0.10 $0.10 $0.10 $0.10 PAD ELECTROSURGICAL GROUNDING NESSY ADULT L168 CM L10 FT CABLE MONITORING SPLIT DISPOSABLE All Payors / Plans All Payors / Plans $8.14 $8.14 $8.14 $8.14 $8.14 $8.14 $8.14 $7.98 $7.98 PADS CLOSURE D-STAT 4000 All Payors / Plans All Payors / Plans $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $278.32 $278.32 PALIPERIDONE 1.5 MG TABLET EXTENDED RELEASE 24HR All Payors / Plans All Payors / Plans $14.49 $14.49 $14.49 $14.49 $14.49 $14.49 $14.49 $14.20 $14.20 PALIVIZUMAB 50 MG/0.5 ML SOLUTION All Payors / Plans All Payors / Plans " $2,344.78 " " $2,344.78 " " $2,344.78 " " $2,344.78 " " $2,344.78 " " $2,344.78 " " $2,344.78 " " $2,297.88 " " $2,297.88 " PALONOSETRON PER 25 MCG All Payors / Plans All Payors / Plans $3.65 $3.65 $3.65 $3.65 $3.65 $3.65 $3.65 $3.57 $3.57 "PANCRELIPASE (LIP-PROT-AMYL) 12,000-38,000 -60,000 UNIT CAPSULE,DELAYED RELEASE(DR/EC)" All Payors / Plans All Payors / Plans $10.42 $10.42 $10.42 $10.42 $10.42 $10.42 $10.42 $10.21 $10.21 "PANCRELIPASE (LIP-PROT-AMYL) 24,000-76,000 -120,000 UNIT CAPSULE,DELAYED RELEASE(DR/EC)" All Payors / Plans All Payors / Plans $16.20 $16.20 $16.20 $16.20 $16.20 $16.20 $16.20 $15.88 $15.88 "PANCRELIPASE (LIP-PROT-AMYL) 6,000-19,000 -30,000 UNIT CAPSULE,DELAYED RELEASE(DR/EC)" All Payors / Plans All Payors / Plans $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $6.88 $6.88 PANITUMUMAB PER 10 MG All Payors / Plans All Payors / Plans $170.69 $170.69 $170.69 $170.69 $170.69 $170.69 $170.69 $167.27 $167.27 PANNUS RETENTION SYSTEM 4 PAD 2 STRAP STERILE All Payors / Plans All Payors / Plans $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $142.10 $142.10 "PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.07 $1.07 PANTOPRAZOLE 40 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $20.77 $20.77 "PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE (DR/EC)" All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 PAPAVERINE PER 60 MG All Payors / Plans All Payors / Plans $106.47 $106.47 $106.47 $106.47 $106.47 $106.47 $106.47 $104.34 $104.34 PARENTERAL AMINO ACID 10% 10 % PARENTERAL SOLUTION 500 ML FLEX CONT All Payors / Plans All Payors / Plans $0.23 $0.23 $0.23 $0.23 $0.23 $0.23 $0.23 $0.23 $0.23 PARICALCITOL 5 MCG/ML SOLUTION All Payors / Plans All Payors / Plans $8.66 $8.66 $8.66 $8.66 $8.66 $8.66 $8.66 $8.49 $8.49 PAROXETINE 10 MG TABLET All Payors / Plans All Payors / Plans $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.88 $1.88 PAROXETINE 20 MG TABLET All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 PARTICLES EMBOLIZATION CONTOUR PVA 355-500 UM All Payors / Plans All Payors / Plans $321.30 $321.30 $321.30 $321.30 $321.30 $321.30 $321.30 $314.87 $314.87 PASSER SUTURE GABBAY-FRATER GUIDE ORGANIZER LATEX FREE VALVE All Payors / Plans All Payors / Plans $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $49.98 $49.98 PASSER SUTURE GABBAY-FRATER GUIDE ORGANIZER STERILE LATEX FREE VALVE IMPLANTATION All Payors / Plans All Payors / Plans $34.33 $34.33 $34.33 $34.33 $34.33 $34.33 $34.33 $33.64 $33.64 PASSIVE SPHERES All Payors / Plans All Payors / Plans $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $139.65 $139.65 PATCH DURAL DURAMATRIX-ONLAY PLUS COLLAGEN L5 IN X W4 IN REGENERATION MEMBRANE STERILE All Payors / Plans All Payors / Plans " $2,158.16 " " $2,158.16 " " $2,158.16 " " $2,158.16 " " $2,158.16 " " $2,158.16 " " $2,158.16 " " $2,115.00 " " $2,115.00 " PATCH REFERENCE CARTO 3 EXTERNAL All Payors / Plans All Payors / Plans " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " "PATCH, PHOTOFIX CAROTID 0.8X8" All Payors / Plans All Payors / Plans $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $313.60 $313.60 PATELLA DOME 41MM All Payors / Plans All Payors / Plans " $14,000.00 " " $14,000.00 " " $14,000.00 " " $14,000.00 " " $14,000.00 " " $14,000.00 " " $14,000.00 " " $13,720.00 " " $13,720.00 " PATELLA REAMING BLADE 41MM All Payors / Plans All Payors / Plans $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $122.50 $122.50 PEAK PLASMABLADE 4.0 DISPOSABLE All Payors / Plans All Payors / Plans $596.74 $596.74 $596.74 $596.74 $596.74 $596.74 $596.74 $584.81 $584.81 "PEDIATRIC MULTIVIT NO.46-IRON 1,500 UNIT-400 UNIT-10 MG/ML DROPS" All Payors / Plans All Payors / Plans $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 PEDIATRIC MULTIVITAMIN 80 MG-400 UNIT- 200 MCG/5 ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $0.16 $0.16 $0.16 $0.16 $0.16 $0.16 $0.16 $0.16 $0.16 PEDIATRIC MULTIVITAMIN LIQUID All Payors / Plans All Payors / Plans $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.89 $0.89 "PEDIATRIC MULTIVITAMIN TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.89 $0.89 PEG FIXATION DVR FULL THREAD L24 MM OD2 MM FOOT SMOOTH LOCKING NONSTERILE ANATOMIC VOLAR PLATING SYSTEM All Payors / Plans All Payors / Plans $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $67.81 $67.81 PEG FIXATION DVR L18 MM OD2 MM SMOOTH LOCKING NONSTERILE ANATOMIC VOLAR PLATING SYSTEM All Payors / Plans All Payors / Plans $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $67.81 $67.81 PEG FIXATION DVR L22 MM OD2 MM SMOOTH LOCKING NONSTERILE ANATOMIC VOLAR PLATING SYSTEM All Payors / Plans All Payors / Plans $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $67.80 $67.80 "PEGFILGRASTIM 6 MG/0.6 ML SYRINGE, W/ WEARABLE INJECTOR" All Payors / Plans All Payors / Plans $433.01 $433.01 $433.01 $433.01 $433.01 $433.01 $433.01 $424.35 $424.35 PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SYRINGE All Payors / Plans All Payors / Plans $261.43 $261.43 $261.43 $261.43 $261.43 $261.43 $261.43 $256.20 $256.20 PEGFILGRASTIM-CBQV 6 MG/0.6 ML SYRINGE All Payors / Plans All Payors / Plans $190.03 $190.03 $190.03 $190.03 $190.03 $190.03 $190.03 $186.23 $186.23 PEGINTERFERON ALFA-2A 180 MCG/ML SOLUTION All Payors / Plans All Payors / Plans " $1,649.68 " " $1,649.68 " " $1,649.68 " " $1,649.68 " " $1,649.68 " " $1,649.68 " " $1,649.68 " " $1,616.69 " " $1,616.69 " PEMBROLIZUMAB 25 MG/ML SOLUTION 4 ML VIAL All Payors / Plans All Payors / Plans $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 PEMETREXED 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $15.21 $15.21 $15.21 $15.21 $15.21 $15.21 $15.21 $14.91 $14.91 PEMETREXED DISODIUM 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.54 $2.54 PEMETREXED PER 10 MG All Payors / Plans All Payors / Plans $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.37 $1.37 PENICILLIN G BENZATHINE PER 1200000 UNITS All Payors / Plans All Payors / Plans $38.18 $38.18 $38.18 $38.18 $38.18 $38.18 $38.18 $37.41 $37.41 PENICILLIN G BENZATHINE PER 2400000 UNITS All Payors / Plans All Payors / Plans $32.96 $32.96 $32.96 $32.96 $32.96 $32.96 $32.96 $32.30 $32.30 PENICILLIN G POTASSIUM PER 600000 UNITS All Payors / Plans All Payors / Plans $2.97 $2.97 $2.97 $2.97 $2.97 $2.97 $2.97 $2.91 $2.91 PENICILLIN V POTASSIUM 250 MG TABLET All Payors / Plans All Payors / Plans $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.06 $1.06 PENICILLIN V POTASSIUM 250 MG/5 ML RECON SOLN All Payors / Plans All Payors / Plans $0.85 $0.85 $0.85 $0.85 $0.85 $0.85 $0.85 $0.83 $0.83 PENTOXIFYLLINE 400 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.09 $1.09 PERFORATOR SURGICAL DGR-II PEDIATRIC 11 MM 7 MM STERILE DISPOSABLE All Payors / Plans All Payors / Plans $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $450.80 $450.80 PERFUSION OPEN HEART SUPPLIES All Payors / Plans All Payors / Plans " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,862.00 " " $1,862.00 " PERI-LOC K-WIRE All Payors / Plans All Payors / Plans $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $49.98 $49.98 "PERITONEAL DIALYSATE #6 1.5% CA 2.5 MEQ/L- MG 0.5 MEQ/L SOLUTION 2,500 ML BAG" All Payors / Plans All Payors / Plans $45.21 $45.21 $45.21 $45.21 $45.21 $45.21 $45.21 $44.31 $44.31 PERTUZUMAB 420 MG/14 ML (30 MG/ML) SOLUTION 14 ML VIAL All Payors / Plans All Payors / Plans $16.75 $16.75 $16.75 $16.75 $16.75 $16.75 $16.75 $16.42 $16.42 PHENAZOPYRIDINE 100 MG TABLET All Payors / Plans All Payors / Plans $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.12 $1.12 PHENAZOPYRIDINE 200 MG TABLET All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 PHENOBARBITAL 100 MG TABLET All Payors / Plans All Payors / Plans $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.64 $2.64 PHENOBARBITAL 15 MG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 PHENOBARBITAL 30 MG TABLET All Payors / Plans All Payors / Plans $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.88 $1.88 PHENOBARBITAL PER 120 MG All Payors / Plans All Payors / Plans $113.35 $113.35 $113.35 $113.35 $113.35 $113.35 $113.35 $111.08 $111.08 "PHENOL 1.4 % AEROSOL,SPRAY 177 ML BOTTLE" All Payors / Plans All Payors / Plans $21.54 $21.54 $21.54 $21.54 $21.54 $21.54 $21.54 $21.11 $21.11 PHENTOLAMINE MESYLATE PER 5 MG All Payors / Plans All Payors / Plans $795.87 $795.87 $795.87 $795.87 $795.87 $795.87 $795.87 $779.95 $779.95 PHENYLEPH-MIN OIL-PETROLATUM 0.25-14-74.9 % OINTMENT 28 G TUBE All Payors / Plans All Payors / Plans $31.55 $31.55 $31.55 $31.55 $31.55 $31.55 $31.55 $30.92 $30.92 "PHENYLEPHRINE 0.5 % SPRAY,NON-AEROSOL 15 ML SQUEEZ BTL" All Payors / Plans All Payors / Plans $20.67 $20.67 $20.67 $20.67 $20.67 $20.67 $20.67 $20.26 $20.26 PHENYLEPHRINE 0.5 MG/5 ML (100 MCG/ML) SYRINGE All Payors / Plans All Payors / Plans $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.11 $6.11 PHENYLEPHRINE 10 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $141.03 $141.03 $141.03 $141.03 $141.03 $141.03 $141.03 $138.21 $138.21 PHENYLEPHRINE 2.5 % DROPS 2 ML BOTTLE All Payors / Plans All Payors / Plans $140.38 $140.38 $140.38 $140.38 $140.38 $140.38 $140.38 $137.57 $137.57 PHENYLEPHRINE 2.5 % DROPS 2 ML DROP BTL All Payors / Plans All Payors / Plans $137.02 $137.02 $137.02 $137.02 $137.02 $137.02 $137.02 $134.28 $134.28 PHENYLEPHRINE IN 0.9% NACL 40 MG/250 ML (160 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $83.39 $83.39 $83.39 $83.39 $83.39 $83.39 $83.39 $81.72 $81.72 PHENYLEPHRINE IN D5W 40 MG/250 ML (160 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $140.13 $140.13 $140.13 $140.13 $140.13 $140.13 $140.13 $137.33 $137.33 PHENYLEPHRINE PER 1 ML All Payors / Plans All Payors / Plans $10.45 $10.45 $10.45 $10.45 $10.45 $10.45 $10.45 $10.24 $10.24 PHENYTOIN 100 MG CAPSULE All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 PHENYTOIN PER 50 MG All Payors / Plans All Payors / Plans $5.24 $5.24 $5.24 $5.24 $5.24 $5.24 $5.24 $5.14 $5.14 PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $105.18 $105.18 $105.18 $105.18 $105.18 $105.18 $105.18 $103.08 $103.08 PHYTONADIONE (VITAMIN K1) 10 MG/ML SOLUTION All Payors / Plans All Payors / Plans $10.34 $10.34 $10.34 $10.34 $10.34 $10.34 $10.34 $10.13 $10.13 PHYTONADIONE (VITAMIN K1) 10 MG/ML SOLUTION 1 ML AMPUL All Payors / Plans All Payors / Plans $10.34 $10.34 $10.34 $10.34 $10.34 $10.34 $10.34 $10.13 $10.13 PHYTONADIONE 1 MG/ML ORAL SOLUTION All Payors / Plans All Payors / Plans $20.85 $20.85 $20.85 $20.85 $20.85 $20.85 $20.85 $20.44 $20.44 PILLOW ABDUCTION FOAM LARGE SHOULDER ENVELOPE SLING THUMB LOOP PAD D RING CLOSURE NONSTERILE LATEX FREE All Payors / Plans All Payors / Plans $3.89 $3.89 $3.89 $3.89 $3.89 $3.89 $3.89 $3.81 $3.81 PILLOW ABDUCTION FOAM MEDIUM L17 IN X W6.5 IN SHOULDER PADDED SLING SHOULDER WAIST STRAP PILLOW ABDUCTION DEVICE NONSTERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $3.89 $3.89 $3.89 $3.89 $3.89 $3.89 $3.89 $3.81 $3.81 PILOCARPINE 5 MG TABLET All Payors / Plans All Payors / Plans $9.02 $9.02 $9.02 $9.02 $9.02 $9.02 $9.02 $8.84 $8.84 PILOT 150 J-TIP GUIDEWIRE 190CM All Payors / Plans All Payors / Plans $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 PILOT 200 J-TIP GUIDEWIRE 190CM All Payors / Plans All Payors / Plans $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 PILOT 50 J-TIP GUIDEWIRE 190CM All Payors / Plans All Payors / Plans $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $156.80 $156.80 PIN SKULL MAYFIELD PLASTIC ADULT CRANIUM WING GROOVE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $36.33 $36.33 $36.33 $36.33 $36.33 $36.33 $36.33 $35.60 $35.60 PIOGLITAZONE 30 MG TABLET All Payors / Plans All Payors / Plans $9.13 $9.13 $9.13 $9.13 $9.13 $9.13 $9.13 $8.95 $8.95 PIPERACILLIN SOD-TAZOBACTAM PER 1 G All Payors / Plans All Payors / Plans $16.86 $16.86 $16.86 $16.86 $16.86 $16.86 $16.86 $16.53 $16.53 PLATE BIOMET MAXON 2 LEVEL All Payors / Plans All Payors / Plans " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,600.00 " " $2,548.00 " " $2,548.00 " PLATE BONE ATLANTIS TITANIUM L42.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL All Payors / Plans All Payors / Plans " $2,500.00 " " $2,500.00 " " $2,500.00 " " $2,500.00 " " $2,500.00 " " $2,500.00 " " $2,500.00 " " $2,450.00 " " $2,450.00 " PLATE BONE ATLANTIS TITANIUM L45 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL All Payors / Plans All Payors / Plans " $1,800.00 " " $1,800.00 " " $1,800.00 " " $1,800.00 " " $1,800.00 " " $1,800.00 " " $1,800.00 " " $1,764.00 " " $1,764.00 " PLATE BONE ATLANTIS TITANIUM L57.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL All Payors / Plans All Payors / Plans " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $2,000.00 " " $1,960.00 " " $1,960.00 " PLATE BONE DVR FAST GUIDE TITANIUM SHORT L51.3 MM X W24.4 MM RADIUS LEFT DISTAL VOLAR 3 HOLE 2 TIER NONSTERILE All Payors / Plans All Payors / Plans $637.31 $637.31 $637.31 $637.31 $637.31 $637.31 $637.31 $624.56 $624.56 PLATE BONE EVOS STAINLESS STEEL 12MM SPACE 1/3 TUBULAR L 70MM X W 9.5MM X H 1.5MM 6 HOLE LOCK STERILE 3.5MM SCREW All Payors / Plans All Payors / Plans $409.36 $409.36 $409.36 $409.36 $409.36 $409.36 $409.36 $401.17 $401.17 PLATE BONE EVOS Y 7 HOLE SHAFT TINE STERILE LATEX FREE 2.7MM SCREW All Payors / Plans All Payors / Plans " $1,768.00 " " $1,768.00 " " $1,768.00 " " $1,768.00 " " $1,768.00 " " $1,768.00 " " $1,768.00 " " $1,732.64 " " $1,732.64 " PLATE BONE LCP COMBI 98X11X3.4MM SS NS 7 HOLE 3.5MM SCREW SM FRAGMENT All Payors / Plans All Payors / Plans $442.79 $442.79 $442.79 $442.79 $442.79 $442.79 $442.79 $433.93 $433.93 PLATE BONE LCP COMBI STAINLESS STEEL NARROW L170 MM X W13.5 MM X H4.2 MM 9 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SET All Payors / Plans All Payors / Plans $684.85 $684.85 $684.85 $684.85 $684.85 $684.85 $684.85 $671.15 $671.15 PLATE BONE LCP STAINLESS STEEL T L53 MM 3 HOLE HEAD 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM All Payors / Plans All Payors / Plans $475.91 $475.91 $475.91 $475.91 $475.91 $475.91 $475.91 $466.39 $466.39 PLATE BONE LCP TITANIUM L36 MM 4 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM All Payors / Plans All Payors / Plans $758.54 $758.54 $758.54 $758.54 $758.54 $758.54 $758.54 $743.37 $743.37 PLATE BONE LCP TITANIUM L68 MM 8 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM All Payors / Plans All Payors / Plans $758.54 $758.54 $758.54 $758.54 $758.54 $758.54 $758.54 $743.37 $743.37 PLATE BONE LEVEL ONE TITANIUM L208 MM SPINE THORACIC STERNAL 14 HOLE STERILE 2.3 MM SCREW 2.1/2.5 MM PEEK All Payors / Plans All Payors / Plans " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " PLATE BONE MATRIXNEURO TITANIUM 2 Y L21 MM X H.4 MM CRANIOMAXILLOFACIAL 6 HOLE RIGID NONSTERILE BLUE All Payors / Plans All Payors / Plans $366.83 $366.83 $366.83 $366.83 $366.83 $366.83 $366.83 $359.49 $359.49 PLATE BONE TITANIUM STERILE 2T TALL STERNUM 18 HOLE LOCKING STERILE All Payors / Plans All Payors / Plans " $1,892.36 " " $1,892.36 " " $1,892.36 " " $1,892.36 " " $1,892.36 " " $1,892.36 " " $1,892.36 " " $1,854.51 " " $1,854.51 " PLATE BONE TITANIUM X STERNAL 10 HOLE LOCK NONSTERILE 2.4 MM SCREW All Payors / Plans All Payors / Plans $700.09 $700.09 $700.09 $700.09 $700.09 $700.09 $700.09 $686.09 $686.09 PLATE BONE TRAUMAONE MATRIX TITANIUM RECTANGLE MIDFACE 2 X 3 HOLE STERILE SILVER 1.5 MM SCREW All Payors / Plans All Payors / Plans $532.00 $532.00 $532.00 $532.00 $532.00 $532.00 $532.00 $521.36 $521.36 PLATE SQUARE 4 HOLE 12MM All Payors / Plans All Payors / Plans $417.20 $417.20 $417.20 $417.20 $417.20 $417.20 $417.20 $408.86 $408.86 PLATE TIBIAL NEXGEN TIVANIUM UHMWPE 4 L66 MM X W46 MM X H4 MM KNEE CEMENTED MODULAR STEM PRECOAT STERILE All Payors / Plans All Payors / Plans " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,600.00 " " $3,528.00 " " $3,528.00 " PLIF FROZEN SPACER 10MM All Payors / Plans All Payors / Plans " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,409.20 " " $6,409.20 " PLIF FROZEN SPACER 8MM All Payors / Plans All Payors / Plans " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,540.00 " " $6,409.20 " " $6,409.20 " PLIF FROZEN SPACER 9MM All Payors / Plans All Payors / Plans " $5,035.80 " " $5,035.80 " " $5,035.80 " " $5,035.80 " " $5,035.80 " " $5,035.80 " " $5,035.80 " " $4,935.08 " " $4,935.08 " PLUG SURGICAL PERFIX LG TAPER 1.6IN 1.9IN POLYPROPYLENE STERILE GROIN MONOFILAMENT NONABSORBABLE HERNIA REPAIR All Payors / Plans All Payors / Plans $283.60 $283.60 $283.60 $283.60 $283.60 $283.60 $283.60 $277.93 $277.93 PLUMEPEN ULTRA SURGICAL SMOKE EVAC PENCIL All Payors / Plans All Payors / Plans $48.13 $48.13 $48.13 $48.13 $48.13 $48.13 $48.13 $47.17 $47.17 PNEUMOCOCCAL CONJUGATE 0.5 ML SYRINGE All Payors / Plans All Payors / Plans $598.37 $598.37 $598.37 $598.37 $598.37 $598.37 $598.37 $586.40 $586.40 PNEUMOCOCCAL CONJUGATE PCV20 0.5 ML SYRINGE All Payors / Plans All Payors / Plans $630.51 $630.51 $630.51 $630.51 $630.51 $630.51 $630.51 $617.90 $617.90 POLYETHYLENE GLYCOL 17 GRAM POWDER IN PACKET All Payors / Plans All Payors / Plans $3.39 $3.39 $3.39 $3.39 $3.39 $3.39 $3.39 $3.32 $3.32 POLYETHYLENE GLYCOL 236-22.74-6.74 -5.86 GRAM RECON SOLN All Payors / Plans All Payors / Plans $26.71 $26.71 $26.71 $26.71 $26.71 $26.71 $26.71 $26.18 $26.18 "POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML DROPS 10 ML DROP BTL" All Payors / Plans All Payors / Plans $21.40 $21.40 $21.40 $21.40 $21.40 $21.40 $21.40 $20.97 $20.97 POM WITH MICROSTREAM PHILIPS All Payors / Plans All Payors / Plans $15.40 $15.40 $15.40 $15.40 $15.40 $15.40 $15.40 $15.09 $15.09 PORACTANT ALFA 120 MG/1.5 ML SUSPENSION All Payors / Plans All Payors / Plans $866.08 $866.08 $866.08 $866.08 $866.08 $866.08 $866.08 $848.76 $848.76 PORACTANT ALFA 240 MG/3 ML SUSPENSION All Payors / Plans All Payors / Plans " $1,618.60 " " $1,618.60 " " $1,618.60 " " $1,618.60 " " $1,618.60 " " $1,618.60 " " $1,618.60 " " $1,586.23 " " $1,586.23 " PORT ACCESS AIRSEAL L100 MM OD12 MM OBTURATOR BLADELESS OPTICAL TIP STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $178.11 $178.11 $178.11 $178.11 $178.11 $178.11 $178.11 $174.55 $174.55 PORT AIRSEAL 5MM ACCESS PORT AND OBTURATOR All Payors / Plans All Payors / Plans $175.04 $175.04 $175.04 $175.04 $175.04 $175.04 $175.04 $171.54 $171.54 PORT HAND ACCESS ALEXIS GELPORT L120 MM ABDOMEN WOUND RETRACTOR LAPAROSCOPIC MARK PEN INCISION TEMPLATE GELSEAL TECHNOLOGY LATEX FREE All Payors / Plans All Payors / Plans " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,274.00 " " $1,274.00 " PORT IMPLANTABLE INFUSION VACCESS CT 6FR POWER INJECTABLE All Payors / Plans All Payors / Plans $370.00 $370.00 $370.00 $370.00 $370.00 $370.00 $370.00 $362.60 $362.60 PORT IMPLANTABLE INFUSION VACCESS CT 6FR TITANIUM POLYURETHANE POWER INJECTABLE LOW PROFILE SILICONE FILL SUTURE PLUG All Payors / Plans All Payors / Plans $370.00 $370.00 $370.00 $370.00 $370.00 $370.00 $370.00 $362.60 $362.60 PORT PLUG IS-1 PORT _63518_ All Payors / Plans All Payors / Plans $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 POSITIONER IMPLANT SPINE PIN PLATE HOLD All Payors / Plans All Payors / Plans $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $61.25 $61.25 POSITIONER OR FOAM H2 IN OD9 IN ID4 IN HEAD HIGH RESILIENT RING CUSHION LATEX FREE RASPBERRY All Payors / Plans All Payors / Plans $1.58 $1.58 $1.58 $1.58 $1.58 $1.58 $1.58 $1.55 $1.55 POTASSIUM ACETATE 2 MEQ/ML SOLUTION 20 ML VIAL All Payors / Plans All Payors / Plans $0.83 $0.83 $0.83 $0.83 $0.83 $0.83 $0.83 $0.82 $0.82 POTASSIUM ACETATE 2 MEQ/ML SOLUTION 50 ML VIAL All Payors / Plans All Payors / Plans $0.86 $0.86 $0.86 $0.86 $0.86 $0.86 $0.86 $0.84 $0.84 "POTASSIUM BICARB-CITRIC ACID 10 MEQ TABLET, EFFERVESCENT" All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 "POTASSIUM BICARB-CITRIC ACID 20 MEQ TABLET, EFFERVESCENT" All Payors / Plans All Payors / Plans $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $2.04 $1.99 $1.99 POTASSIUM CHLORID-D5-0.45%NACL 20 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.01 $11.01 POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $16.24 $16.24 $16.24 $16.24 $16.24 $16.24 $16.24 $15.92 $15.92 "POTASSIUM CHLORIDE 10 MEQ TABLET,ER PARTICLES/CRYSTALS" All Payors / Plans All Payors / Plans $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.07 $1.07 "POTASSIUM CHLORIDE 20 MEQ TABLET,ER PARTICLES/CRYSTALS" All Payors / Plans All Payors / Plans $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.33 $3.33 POTASSIUM CHLORIDE IN 0.9%NACL 40 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.02 $2.02 POTASSIUM CHLORIDE IN 5 % DEX 20 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $2.37 $2.37 $2.37 $2.37 $2.37 $2.37 $2.37 $2.32 $2.32 POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML PIGGYBACK All Payors / Plans All Payors / Plans $4.60 $4.60 $4.60 $4.60 $4.60 $4.60 $4.60 $4.51 $4.51 POTASSIUM CHLORIDE IN WATER 10 MEQ/50 ML PIGGYBACK All Payors / Plans All Payors / Plans $2.26 $2.26 $2.26 $2.26 $2.26 $2.26 $2.26 $2.21 $2.21 POTASSIUM CHLORIDE PER 2 MEQ All Payors / Plans All Payors / Plans $10.51 $10.51 $10.51 $10.51 $10.51 $10.51 $10.51 $10.30 $10.30 POTASSIUM CHLORIDE PER 2 MEQ OF POTASSIUM All Payors / Plans All Payors / Plans $0.61 $0.61 $0.61 $0.61 $0.61 $0.61 $0.61 $0.60 $0.60 POTASSIUM CHLORIDE-D5-0.9%NACL 20 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $15.76 $15.76 $15.76 $15.76 $15.76 $15.76 $15.76 $15.44 $15.44 POTASSIUM CHLORIDE-D5-0.9%NACL 40 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $16.23 $16.23 $16.23 $16.23 $16.23 $16.23 $16.23 $15.91 $15.91 POTASSIUM IODIDE 1 GRAM/ML SOLUTION All Payors / Plans All Payors / Plans $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.08 $2.08 POTASSIUM PHOSPHATES 3 MMOL/ML SOLUTION 15 ML VIAL All Payors / Plans All Payors / Plans $64.74 $64.74 $64.74 $64.74 $64.74 $64.74 $64.74 $63.45 $63.45 POTASSIUM PHOSPHATES 3 MMOL/ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $25.03 $25.03 $25.03 $25.03 $25.03 $25.03 $25.03 $24.53 $24.53 "POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG POWDER IN PACKET" All Payors / Plans All Payors / Plans $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.11 $1.11 POUCH OSTOMY NEW IMAGE LOCK N ROLL COMFORTWEAR L12 IN OD4 IN 2 PIECE DRAINABLE TRANSPARENT BELT TAB LATEX ULTRA CLEAR All Payors / Plans All Payors / Plans $0.58 $0.58 $0.58 $0.58 $0.58 $0.58 $0.58 $0.57 $0.57 POUCH SPECIMEN RETRIEVAL ENDO CATCH II 34.5CM 29.5CM 15MM METAL POLYURETHANE DISPOSABLE LF FLEXIBLE ERGONOMIC HANDLE All Payors / Plans All Payors / Plans $80.40 $80.40 $80.40 $80.40 $80.40 $80.40 $80.40 $78.79 $78.79 POVIDONE-IODINE 10 % OINTMENT All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 PRAMIPEXOLE 0.125 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 PRAMIPEXOLE 0.5 MG TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 PRASUGREL 10 MG TABLET All Payors / Plans All Payors / Plans $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.06 $1.06 PRASUGREL 5 MG TABLET All Payors / Plans All Payors / Plans $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.08 $1.08 PRAVASTATIN 10 MG TABLET All Payors / Plans All Payors / Plans $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.80 $1.80 PRAVASTATIN 20 MG TABLET All Payors / Plans All Payors / Plans $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.90 $1.86 $1.86 PRAZOSIN 1 MG CAPSULE All Payors / Plans All Payors / Plans $4.31 $4.31 $4.31 $4.31 $4.31 $4.31 $4.31 $4.22 $4.22 PRAZOSIN 2 MG CAPSULE All Payors / Plans All Payors / Plans $6.97 $6.97 $6.97 $6.97 $6.97 $6.97 $6.97 $6.83 $6.83 PRAZOSIN 5 MG CAPSULE All Payors / Plans All Payors / Plans $10.08 $10.08 $10.08 $10.08 $10.08 $10.08 $10.08 $9.88 $9.88 "PREDNISOLONE ACETATE 1 % DROPS,SUSPENSION 5 ML DROP BTL" All Payors / Plans All Payors / Plans $333.42 $333.42 $333.42 $333.42 $333.42 $333.42 $333.42 $326.75 $326.75 PREDNISOLONE PER 5 MG All Payors / Plans All Payors / Plans $3.45 $3.45 $3.45 $3.45 $3.45 $3.45 $3.45 $3.38 $3.38 PREDNISONE PER 5 MG All Payors / Plans All Payors / Plans $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 PREGABALIN 100 MG CAPSULE All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 PREGABALIN 25 MG CAPSULE All Payors / Plans All Payors / Plans $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.95 $1.91 $1.91 PREGABALIN 50 MG CAPSULE All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 PREGABALIN 75 MG CAPSULE All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 PRENATAL VITAMIN WITH IRON AND FOLIC ACID 27 MG IRON- 800 MCG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 PREVENA 13CM DUAL KIT All Payors / Plans All Payors / Plans " $1,403.62 " " $1,403.62 " " $1,403.62 " " $1,403.62 " " $1,403.62 " " $1,403.62 " " $1,403.62 " " $1,375.55 " " $1,375.55 " PRIMIDONE 250 MG TABLET All Payors / Plans All Payors / Plans $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.03 $2.03 PRIMIDONE 50 MG TABLET All Payors / Plans All Payors / Plans $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.53 $2.53 PROBE ELECTROSURGICAL ARTHREX APOLLORF 90 D 1 PIECE HAND CONTROL MULTIPLE PORT PLASMA BASE BIPOLAR RF TECHNOLOGY All Payors / Plans All Payors / Plans $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $294.00 $294.00 PROBE ELECTROSURGICAL FIAPC L220 CM OD2.3 MM FLEXIBLE STRAIGHT FIRE STERILE DISPOSABLE ARGON PLASMA COAGULATION All Payors / Plans All Payors / Plans $471.00 $471.00 $471.00 $471.00 $471.00 $471.00 $471.00 $461.58 $461.58 PROBE ELECTROSURGICAL FIAPC L7 FT 2 IN OD2.3 MM CIRCUMFERENTIAL PLUG AND PLAY FUNCTIONALITY All Payors / Plans All Payors / Plans $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $459.62 $459.62 PROBE ENDOSCOPIC FIAPC L7.2 IN OD9.6 FR FLEXIBLE FILTER INTEGRATED STERILE DISPOSABLE All Payors / Plans All Payors / Plans $437.90 $437.90 $437.90 $437.90 $437.90 $437.90 $437.90 $429.14 $429.14 PROBE LASER ENGAUGE VEKTOR OD25 GA ARTICULATE ILLUMINATE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $454.06 $454.06 $454.06 $454.06 $454.06 $454.06 $454.06 $444.98 $444.98 PROBE LASER PUREPOINT 40 D L6 MM OD25 GA RETINA RFID FLEXIBLE NITINOL TIP EASY INSERTION ANGLED STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $363.24 $363.24 $363.24 $363.24 $363.24 $363.24 $363.24 $355.98 $355.98 PROBE NERVE STIMULATOR NIM-RESPONSE STANDARD OD.33 MM PRASS MONOPOLAR FLUSH TIP SLIMLINE HANDLE STERILE All Payors / Plans All Payors / Plans $328.80 $328.80 $328.80 $328.80 $328.80 $328.80 $328.80 $322.22 $322.22 PROBE VASCULAR POLYMER STANDARD L45 CM OD1-1.5 MM BULB FLEXIBLE SHAFT EXTRA SUPPLE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $211.80 $211.80 $211.80 $211.80 $211.80 $211.80 $211.80 $207.56 $207.56 PROBE VITRECTOMY GRIESHABER 30 D OD25 GA DSP POINTED TIP DIATHERMY ERGONOMIC HANDLE ACCURUS CONSTELLATION All Payors / Plans All Payors / Plans $95.36 $95.36 $95.36 $95.36 $95.36 $95.36 $95.36 $93.45 $93.45 PROBE VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM OD23 GA EDGEPLUS VALVED CANNULA STRAIGHT ENDOILLUMINATOR All Payors / Plans All Payors / Plans " $1,143.30 " " $1,143.30 " " $1,143.30 " " $1,143.30 " " $1,143.30 " " $1,143.30 " " $1,143.30 " " $1,120.43 " " $1,120.43 " PROBE VITRECTOMY ULTRAVIT 27+ 20000 CPM OD27 MM CONSTELLATION VISION SYSTEM All Payors / Plans All Payors / Plans $510.00 $510.00 $510.00 $510.00 $510.00 $510.00 $510.00 $499.80 $499.80 PROBENECID 500 MG TABLET All Payors / Plans All Payors / Plans $2.74 $2.74 $2.74 $2.74 $2.74 $2.74 $2.74 $2.69 $2.69 PROCAINAMIDE PER 1 G All Payors / Plans All Payors / Plans $187.04 $187.04 $187.04 $187.04 $187.04 $187.04 $187.04 $183.30 $183.30 PROCHLORPERAZINE EDISYLATE PER 10 MG All Payors / Plans All Payors / Plans $7.87 $7.87 $7.87 $7.87 $7.87 $7.87 $7.87 $7.71 $7.71 PROCHLORPERAZINE MALEATE PER 10 MG All Payors / Plans All Payors / Plans $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.15 $4.15 PROGEL AIR SEALANT All Payors / Plans All Payors / Plans " $2,307.20 " " $2,307.20 " " $2,307.20 " " $2,307.20 " " $2,307.20 " " $2,307.20 " " $2,307.20 " " $2,261.06 " " $2,261.06 " PROMETHAZINE 25 MG SUPPOSITORY All Payors / Plans All Payors / Plans $18.82 $18.82 $18.82 $18.82 $18.82 $18.82 $18.82 $18.44 $18.44 PROMETHAZINE PER 25 MG All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 PROMETHAZINE PER 50 MG All Payors / Plans All Payors / Plans $5.43 $5.43 $5.43 $5.43 $5.43 $5.43 $5.43 $5.32 $5.32 PROPOFOL 10 MG/ML EMULSION All Payors / Plans All Payors / Plans $0.62 $0.62 $0.62 $0.62 $0.62 $0.62 $0.62 $0.61 $0.61 PROPRANOLOL 10 MG TABLET All Payors / Plans All Payors / Plans $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.06 $1.06 PROPRANOLOL 20 MG TABLET All Payors / Plans All Payors / Plans $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.87 $1.83 $1.83 PROPRANOLOL 40 MG TABLET All Payors / Plans All Payors / Plans $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.11 $1.11 PROPRANOLOL 80 MG TABLET All Payors / Plans All Payors / Plans $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.88 $1.88 "PROPRANOLOL LA 60 MG CAPSULE,EXTENDED RELEASE 24 HR" All Payors / Plans All Payors / Plans $7.14 $7.14 $7.14 $7.14 $7.14 $7.14 $7.14 $7.00 $7.00 "PROPRANOLOL LA 80 MG CAPSULE,EXTENDED RELEASE 24 HR" All Payors / Plans All Payors / Plans $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.03 $7.03 PROTAMINE SULFATE PER 10 MG All Payors / Plans All Payors / Plans $9.23 $9.23 $9.23 $9.23 $9.23 $9.23 $9.23 $9.05 $9.05 PROTECTOR EXTREMITY KODEL UNIVERSAL HEEL ELBOW DELUXE FULL FOOT DESIGN VENTILATION HOLE STRAP HOOK LOOP CLOSURE NONSTERILE LATEX FREE All Payors / Plans All Payors / Plans $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.58 $2.53 $2.53 PROTECTOR TISSUE ALEXIS LARGE FLEXIBLE RETRACTION RING ATRAUMATIC 360 DEGREE PROTECTION LATEX FREE 9-14 CM INCISION All Payors / Plans All Payors / Plans $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $96.04 $96.04 PSEUDOEPHEDRINE 30 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 PYRAZINAMIDE 500 MG TABLET All Payors / Plans All Payors / Plans $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.58 $10.58 PYRIDOSTIGMINE 60 MG TABLET All Payors / Plans All Payors / Plans $3.42 $3.42 $3.42 $3.42 $3.42 $3.42 $3.42 $3.35 $3.35 PYRIDOXINE 100 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 PYRIDOXINE 50 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 QUETIAPINE 100 MG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 QUETIAPINE 200 MG TABLET All Payors / Plans All Payors / Plans $2.01 $2.01 $2.01 $2.01 $2.01 $2.01 $2.01 $1.97 $1.97 QUETIAPINE 25 MG TABLET All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 QUETIAPINE XR 300 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $4.13 $4.13 $4.13 $4.13 $4.13 $4.13 $4.13 $4.05 $4.05 QUETIAPINE XR 50 MG TABLET EXTENDED RELEASE 24 HR All Payors / Plans All Payors / Plans $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.72 $2.72 RABIES IMMUNE GLOBULIN PER 150 INT'L UNITS All Payors / Plans All Payors / Plans $309.28 $309.28 $309.28 $309.28 $309.28 $309.28 $309.28 $303.09 $303.09 RABIES VACCINE PER 1 ML All Payors / Plans All Payors / Plans $690.13 $690.13 $690.13 $690.13 $690.13 $690.13 $690.13 $676.33 $676.33 RADIAL .035 INQWIRE J-TIP WIRE 210CM All Payors / Plans All Payors / Plans $12.75 $12.75 $12.75 $12.75 $12.75 $12.75 $12.75 $12.50 $12.50 RADPAD SHIELD All Payors / Plans All Payors / Plans $68.13 $68.13 $68.13 $68.13 $68.13 $68.13 $68.13 $66.77 $66.77 RALOXIFENE 60 MG TABLET All Payors / Plans All Payors / Plans $14.33 $14.33 $14.33 $14.33 $14.33 $14.33 $14.33 $14.04 $14.04 RALTEGRAVIR 400 MG TABLET All Payors / Plans All Payors / Plans $37.29 $37.29 $37.29 $37.29 $37.29 $37.29 $37.29 $36.54 $36.54 RAMIPRIL 1.25 MG CAPSULE All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 RAMIPRIL 2.5 MG CAPSULE All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 RAMIPRIL 2.5 MG CAPSULE 100 EACH BOTTLE All Payors / Plans All Payors / Plans $0.74 $0.74 $0.74 $0.74 $0.74 $0.74 $0.74 $0.73 $0.73 RAMIPRIL 5 MG CAPSULE All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 RAMUCIRUMAB 10 MG/ML SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $66.82 $66.82 $66.82 $66.82 $66.82 $66.82 $66.82 $65.48 $65.48 RAMUCIRUMAB 10 MG/ML SOLUTION 50 ML VIAL All Payors / Plans All Payors / Plans $73.82 $73.82 $73.82 $73.82 $73.82 $73.82 $73.82 $72.34 $72.34 RANOLAZINE 500 MG TABLET EXTENDED RELEASE 12 HR All Payors / Plans All Payors / Plans $4.26 $4.26 $4.26 $4.26 $4.26 $4.26 $4.26 $4.17 $4.17 RASBURICASE PER 0.5 MG All Payors / Plans All Payors / Plans $381.51 $381.51 $381.51 $381.51 $381.51 $381.51 $381.51 $373.88 $373.88 REAMER BLADEPATELLA W/ PILOT HOLE SZ38 All Payors / Plans All Payors / Plans $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $171.50 $171.50 REGADENOSON 0.4 MG/5 ML SYRINGE All Payors / Plans All Payors / Plans $84.54 $84.54 $84.54 $84.54 $84.54 $84.54 $84.54 $82.84 $82.84 REINFORCEMENT STAPLE LINE SEAMGUARD BIOABSORBABLE STERILE LATEX FREE DISPOSABLE BLUE GOLD GREEN WHITE ENDOPATH ECHELON FLEX 60 All Payors / Plans All Payors / Plans $208.33 $208.33 $208.33 $208.33 $208.33 $208.33 $208.33 $204.16 $204.16 REINFORCEMENT STAPLE LINE SEAMGUARD BIOABSORBABLE STERILE LATEX FREE DISPOSABLE DST SERIES CEEA 25 CIRCLE STAPLER All Payors / Plans All Payors / Plans $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $361.38 $361.38 RELOAD STAPLER ECHELON ENDOPATH 2.6MM WHITE VASCULAR THIN TISSUE All Payors / Plans All Payors / Plans $219.45 $219.45 $219.45 $219.45 $219.45 $219.45 $219.45 $215.06 $215.06 RELOAD STAPLER ECHELON ENDOPATH H2.6 MM VASCULAR THIN TISSUE WHITE All Payors / Plans All Payors / Plans $324.72 $324.72 $324.72 $324.72 $324.72 $324.72 $324.72 $318.23 $318.23 RELOAD STAPLER ECHELON ENDOPATH H4.1 MM THICK TISSUE GREEN All Payors / Plans All Payors / Plans $219.45 $219.45 $219.45 $219.45 $219.45 $219.45 $219.45 $215.06 $215.06 RELOAD STAPLER ECHELON ENDOPATH L45 MM X H3.6 MM H1.5 MM REGULAR TISSUE BLUE All Payors / Plans All Payors / Plans $324.72 $324.72 $324.72 $324.72 $324.72 $324.72 $324.72 $318.23 $318.23 RELOAD STAPLER ECHELON ENDOPATH L60 MM X H3.6 MM H1.5 MM REGULAR TISSUE BLUE All Payors / Plans All Payors / Plans $219.45 $219.45 $219.45 $219.45 $219.45 $219.45 $219.45 $215.06 $215.06 RELOAD STAPLER ECHELON ENDOPATH L60 MM X H3.8 MM H1.8 MM REGULAR THICK TISSUE GOLD All Payors / Plans All Payors / Plans $351.12 $351.12 $351.12 $351.12 $351.12 $351.12 $351.12 $344.10 $344.10 RELOAD STAPLER ENDO GIA TRI-STAPLE 2MM 2.5MM 3MM 60MM TAN TITANIUM DISPOSABLE STERILE LF MED VASCULAR TISSUE ARTICULATE All Payors / Plans All Payors / Plans $561.21 $561.21 $561.21 $561.21 $561.21 $561.21 $561.21 $549.99 $549.99 RELOAD STAPLER ENDO GIA TRI-STAPLE 3MM 3.5MM 4MM 60MM PURPLE TITANIUM DISPOSABLE STERILE LF MED THICK TISSUE ARTICULATE All Payors / Plans All Payors / Plans $577.58 $577.58 $577.58 $577.58 $577.58 $577.58 $577.58 $566.03 $566.03 RELOAD STAPLER ENDO GIA TRI-STAPLE 4MM 4.5MM 5MM 60MM BLACK PVC DISPOSABLE STERILE LF EXTRA THICK TISSUE ARTICULATE All Payors / Plans All Payors / Plans $665.77 $665.77 $665.77 $665.77 $665.77 $665.77 $665.77 $652.45 $652.45 RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 2 MM 2.5 MM 3 MM L45 MM MEDIUM VASCULAR TISSUE ARTICULATE KNIFE BLADE FIX ANVIL LARGE BUCKET STERILE LATEX FREE DISPOSABLE TAN All Payors / Plans All Payors / Plans $399.04 $399.04 $399.04 $399.04 $399.04 $399.04 $399.04 $391.06 $391.06 RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 3 MM 3.5 MM 4 MM L45 MM MEDIUM THICK TISSUE ARTICULATE KNIFE BLADE FIX ANVIL LARGE BUCKET STERILE LATEX FREE DISPOSABLE PURPLE All Payors / Plans All Payors / Plans $414.30 $414.30 $414.30 $414.30 $414.30 $414.30 $414.30 $406.01 $406.01 RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 3 MM 3.5 MM 4 MM L45 MM MEDIUM THICK TISSUE ARTICULATE REINFORCE STERILE LATEX FREE DISPOSABLE PURPLE All Payors / Plans All Payors / Plans $742.51 $742.51 $742.51 $742.51 $742.51 $742.51 $742.51 $727.66 $727.66 RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 4 MM 4.5 MM 5 MM L60 MM EXTRA THICK TISSUE ARTICULATE REINFORCE STERILE LATEX FREE DISPOSABLE BLACK All Payors / Plans All Payors / Plans " $1,027.41 " " $1,027.41 " " $1,027.41 " " $1,027.41 " " $1,027.41 " " $1,027.41 " " $1,027.41 " " $1,006.86 " " $1,006.86 " RELOAD STAPLER ENDOPATH ETS 35MMX2.5MM 1MM WHITE DISPOSABLE STERILE LF THIN VASCULAR TISSUE 6 STAPLE LINEAR All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 RELOAD STAPLER PROXIMATE TITANIUM H3.85 MM H1.5 MM REGULAR TISSUE STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC All Payors / Plans All Payors / Plans $134.98 $134.98 $134.98 $134.98 $134.98 $134.98 $134.98 $132.28 $132.28 RELOAD STAPLER PROXIMATE TITANIUM L55 MM X H3.81 MM H3.81 MM REGULAR TISSUE 4 ROW LINEAR CUTTER CARTRIDGE SAFETY LOCK OUT DISPOSABLE BLUE All Payors / Plans All Payors / Plans $134.98 $134.98 $134.98 $134.98 $134.98 $134.98 $134.98 $132.28 $132.28 RELOAD STAPLER SIGNIA SMALL DIAMETER THIN L45 MM OD8 MM VASCULAR CURVE TIP STERILE LATEX FREE DISPOSABLE CANNULA All Payors / Plans All Payors / Plans " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,050.00 " " $1,029.00 " " $1,029.00 " RELOAD STAPLER SIGNIA TRI-STAPLE BUTTRESS REINFORCED 60MM MED/THK All Payors / Plans All Payors / Plans " $1,080.50 " " $1,080.50 " " $1,080.50 " " $1,080.50 " " $1,080.50 " " $1,080.50 " " $1,080.50 " " $1,058.89 " " $1,058.89 " RELOAD STAPLER SUREFORM 45 D2.5 MM STERILE LATEX FREE DISPOSABLE WHITE All Payors / Plans All Payors / Plans $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 RELOAD STAPLER SUREFORM 45 D4.3 MM STERILE LATEX FREE DISPOSABLE GREEN All Payors / Plans All Payors / Plans " $4,800.00 " " $4,800.00 " " $4,800.00 " " $4,800.00 " " $4,800.00 " " $4,800.00 " " $4,800.00 " " $4,704.00 " " $4,704.00 " RELOAD STAPLER SUREFORM 45 D4.6 MM STERILE LATEX FREE DISPOSABLE BLACK All Payors / Plans All Payors / Plans $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $392.00 $392.00 RELOAD STAPLER TRI-STAPLE 2MM 45MM DISPOSABLE STERILE LF EXTRA THICK TISSUE ARTICULATE SIGNIA STAPLING SYSTEM All Payors / Plans All Payors / Plans $461.04 $461.04 $461.04 $461.04 $461.04 $461.04 $461.04 $451.82 $451.82 RELOAD SUTURE ASSISTANT ENDO STITCH POLYSORB BRALON LACTOMER NYLON 3-0 ES-9 L48 IN 1 STITCH STERILE DISPOSABLE VIOLET All Payors / Plans All Payors / Plans $133.62 $133.62 $133.62 $133.62 $133.62 $133.62 $133.62 $130.95 $130.95 RELOAD SUTURE ENDO STITCH SURGIDAC LACTOMER 2-0 ES-9 L7 IN 1 STITCH DISPOSABLE GREEN All Payors / Plans All Payors / Plans " $1,175.24 " " $1,175.24 " " $1,175.24 " " $1,175.24 " " $1,175.24 " " $1,175.24 " " $1,175.24 " " $1,151.74 " " $1,151.74 " REMDESIVIR 100 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $12.20 $12.20 $12.20 $12.20 $12.20 $12.20 $12.20 $11.96 $11.96 REMIFENTANIL 2 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $250.29 $250.29 $250.29 $250.29 $250.29 $250.29 $250.29 $245.28 $245.28 RESERVOIR DRAINAGE JACKSON-PRATT BULB 100CC SILICONE DISPOSABLE STERILE LF All Payors / Plans All Payors / Plans $8.35 $8.35 $8.35 $8.35 $8.35 $8.35 $8.35 $8.18 $8.18 RESERVOIR DRAINAGE JACKSON-PRATT BULB 100CC SILICONE DISPOSABLE STERILE LF All Payors / Plans All Payors / Plans $8.35 $8.35 $8.35 $8.35 $8.35 $8.35 $8.35 $8.18 $8.18 "RESPIRATORY VIRUS, INFLUENZA TYPE A&BM 3-5 TARGETS" All Payors / Plans All Payors / Plans 0300 87631 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 RETRACTOR SURGICAL ALEXIS 360 D MEDIUM FLEXIBLE RING ATRAUMATIC SELF RETAINING WOUND PROTECTOR 5-9 CM INCISION All Payors / Plans All Payors / Plans $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $54.88 $54.88 RETRACTOR SURGICAL ALEXIS 360 D XL FLEXIBLE RING ATRAUMATIC SELF RETAINING WOUND PROTECTOR 11-17 CM INCISION All Payors / Plans All Payors / Plans $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $105.84 $105.84 RETRACTOR SURGICAL ALEXIS 360D SM ATRAUMATIC SELF RETAIN FLEXIBLE RING WOUND PROTECTOR 2.5-6CM INCISION All Payors / Plans All Payors / Plans $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $54.88 $54.88 RETRACTOR SURGICAL ALEXIS O 360 D LARGE RIGID RING ATRAUMATIC UNIQUE C SECTION 9-14 CM INCISION All Payors / Plans All Payors / Plans $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $86.00 $84.28 $84.28 RETRACTOR/ELEVATOR LAPAROSCOPIC VCARE LG 37MM DISPOSABLE STERILE LF CERVIX UTERUS 2 CUP HOLE MANIPULATOR INFLATABLE All Payors / Plans All Payors / Plans $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $172.48 $172.48 RETRACTOR/ELEVATOR LAPAROSCOPIC VCARE MED 34MM DISPOSABLE STERILE LF CERVIX UTERUS 2 CUP LOCK SCREW HYSTERECTOMY All Payors / Plans All Payors / Plans $158.28 $158.28 $158.28 $158.28 $158.28 $158.28 $158.28 $155.11 $155.11 RETRIEVER ENDOSCOPIC RESCUENET PROMESH OMNILOOP L5.5 CM X W3CM L230CM OD2.5MM RETRIEVAL NET FOREIGN BODY REMOVAL GREATER VISIBILITY ULTRA STRONG BLUE All Payors / Plans All Payors / Plans $183.62 $183.62 $183.62 $183.62 $183.62 $183.62 $183.62 $179.95 $179.95 RETRIEVER SUTURE ISOTAC STRAIGHT ROTATOR CUFF ISOMETRY STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $84.08 $84.08 "RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) SYRINGE" All Payors / Plans All Payors / Plans $332.14 $332.14 $332.14 $332.14 $332.14 $332.14 $332.14 $325.50 $325.50 RIFABUTIN 150 MG CAPSULE All Payors / Plans All Payors / Plans $16.66 $16.66 $16.66 $16.66 $16.66 $16.66 $16.66 $16.33 $16.33 RIFAMPIN 150 MG CAPSULE All Payors / Plans All Payors / Plans $4.26 $4.26 $4.26 $4.26 $4.26 $4.26 $4.26 $4.17 $4.17 RIFAMPIN 300 MG CAPSULE All Payors / Plans All Payors / Plans $3.43 $3.43 $3.43 $3.43 $3.43 $3.43 $3.43 $3.36 $3.36 RIFAXIMIN 550 MG TABLET All Payors / Plans All Payors / Plans $55.17 $55.17 $55.17 $55.17 $55.17 $55.17 $55.17 $54.07 $54.07 RING RETRACTOR LONE STAR NORYL PLASTIC L14.1 CM X W14.1 CM 2 PEEL POUCH SELF RETAINING FLEXIBLE LIGHTWEIGHT ELASTIC STAY STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $115.23 $115.23 $115.23 $115.23 $115.23 $115.23 $115.23 $112.93 $112.93 RISPERIDONE 0.5 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 "RISPERIDONE 0.5 MG TABLET,DISINTEGRATING" All Payors / Plans All Payors / Plans $3.54 $3.54 $3.54 $3.54 $3.54 $3.54 $3.54 $3.47 $3.47 RISPERIDONE 1 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 RISPERIDONE 2 MG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 RISPERIDONE 3 MG TABLET All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 RITUXIMAB PER 100 MG All Payors / Plans All Payors / Plans $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 RITUXIMAB-PVVR 10 MG/ML SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $60.35 $60.35 $60.35 $60.35 $60.35 $60.35 $60.35 $59.14 $59.14 RITUXIMAB-PVVR 10 MG/ML SOLUTION 50 ML VIAL All Payors / Plans All Payors / Plans $74.36 $74.36 $74.36 $74.36 $74.36 $74.36 $74.36 $72.87 $72.87 RIVAROXABAN 10 MG TABLET All Payors / Plans All Payors / Plans $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.17 $21.17 RIVAROXABAN 15 MG TABLET All Payors / Plans All Payors / Plans $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.17 $21.17 RIVAROXABAN 2.5 MG TABLET All Payors / Plans All Payors / Plans $15.34 $15.34 $15.34 $15.34 $15.34 $15.34 $15.34 $15.03 $15.03 RIVAROXABAN 20 MG TABLET All Payors / Plans All Payors / Plans $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.17 $21.17 RIVASTIGMINE 1.5 MG CAPSULE All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03 RIVASTIGMINE 13.3 MG/24 HOUR PATCH 24 HOUR All Payors / Plans All Payors / Plans $14.48 $14.48 $14.48 $14.48 $14.48 $14.48 $14.48 $14.19 $14.19 RIVASTIGMINE 3 MG CAPSULE All Payors / Plans All Payors / Plans $2.01 $2.01 $2.01 $2.01 $2.01 $2.01 $2.01 $1.97 $1.97 RIVASTIGMINE 9.5 MG/24 HOUR PATCH 24 HOUR All Payors / Plans All Payors / Plans $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.67 $10.67 ROCURONIUM 10 MG/ML SOLUTION All Payors / Plans All Payors / Plans $31.04 $31.04 $31.04 $31.04 $31.04 $31.04 $31.04 $30.42 $30.42 ROCURONIUM 50 MG/5 ML (10 MG/ML) SYRINGE All Payors / Plans All Payors / Plans $40.70 $40.70 $40.70 $40.70 $40.70 $40.70 $40.70 $39.89 $39.89 ROD MARNIER PRECONTOURED 5.5MM X 70 All Payors / Plans All Payors / Plans " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $4,949.00 " " $4,949.00 " ROD REAMING 950MM 3MM STERILE STRAIGHT BALL TIP EXPERT NAIL SYSTEM All Payors / Plans All Payors / Plans $320.16 $320.16 $320.16 $320.16 $320.16 $320.16 $320.16 $313.76 $313.76 ROD REAMING L950 MM OD2.5 MM BALL TIP STERILE DISPOSABLE All Payors / Plans All Payors / Plans $211.60 $211.60 $211.60 $211.60 $211.60 $211.60 $211.60 $207.37 $207.37 ROD SPINAL L50 MM OD3.5 MM PRECUT All Payors / Plans All Payors / Plans " $6,650.00 " " $6,650.00 " " $6,650.00 " " $6,650.00 " " $6,650.00 " " $6,650.00 " " $6,650.00 " " $6,517.00 " " $6,517.00 " ROD SPINAL L60 MM OD3.5 MM PRECUT All Payors / Plans All Payors / Plans " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,036.00 " " $8,036.00 " ROD SPINAL L60 MM OD5.5 MM PRECONTOURED All Payors / Plans All Payors / Plans " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $5,050.00 " " $4,949.00 " " $4,949.00 " ROFLUMILAST 500 MCG TABLET All Payors / Plans All Payors / Plans $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.33 $20.33 ROMIPLOSTIM PER 10 MCG All Payors / Plans All Payors / Plans $104.08 $104.08 $104.08 $104.08 $104.08 $104.08 $104.08 $102.00 $102.00 ROPINIROLE 0.25 MG TABLET All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 ROPINIROLE 1 MG TABLET All Payors / Plans All Payors / Plans $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.82 $1.82 ROPIVACAINE PER 1 MG All Payors / Plans All Payors / Plans $0.79 $0.79 $0.79 $0.79 $0.79 $0.79 $0.79 $0.78 $0.78 ROSUVASTATIN 10 MG TABLET All Payors / Plans All Payors / Plans $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.93 $0.91 $0.91 ROSUVASTATIN 20 MG TABLET All Payors / Plans All Payors / Plans $2.66 $2.66 $2.66 $2.66 $2.66 $2.66 $2.66 $2.61 $2.61 ROSUVASTATIN 40 MG TABLET All Payors / Plans All Payors / Plans $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.89 $0.89 ROSUVASTATIN 5 MG TABLET All Payors / Plans All Payors / Plans $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.15 $4.15 ROTABLATOR - ROTAWIRE DRIVE FLOPPY All Payors / Plans All Payors / Plans $311.88 $311.88 $311.88 $311.88 $311.88 $311.88 $311.88 $305.64 $305.64 ROTAPRO 1.50MM BURR All Payors / Plans All Payors / Plans " $3,850.00 " " $3,850.00 " " $3,850.00 " " $3,850.00 " " $3,850.00 " " $3,850.00 " " $3,850.00 " " $3,773.00 " " $3,773.00 " ROTAPRO 2.00MM BURR All Payors / Plans All Payors / Plans " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,190.00 " " $4,106.20 " " $4,106.20 " SACUBITRIL-VALSARTAN 24-26 MG TABLET All Payors / Plans All Payors / Plans $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.45 $18.45 SACUBITRIL-VALSARTAN 49-51 MG TABLET All Payors / Plans All Payors / Plans $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.45 $18.45 SACUBITRIL-VALSARTAN 97-103 MG TABLET All Payors / Plans All Payors / Plans $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.83 $18.45 $18.45 SAPPHIRE II PRO BALLOON 2.5 X 10 MM All Payors / Plans All Payors / Plans $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $186.20 $186.20 SAW BLADE SAGITTAL All Payors / Plans All Payors / Plans $117.26 $117.26 $117.26 $117.26 $117.26 $117.26 $117.26 $114.91 $114.91 SCISSORS OPHTHALMIC GRIESHABER OD23 GA VERTICAL ADVANCE TIP DISPOSABLE MPS All Payors / Plans All Payors / Plans $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $302.82 $302.82 SCISSORS OPHTHALMIC GRIESHABER REVOLUTION 25+ D CURVED TIP All Payors / Plans All Payors / Plans $465.38 $465.38 $465.38 $465.38 $465.38 $465.38 $465.38 $456.07 $456.07 SCOPOLAMINE BASE 1 MG OVER 3 DAYS PATCH 3 DAY All Payors / Plans All Payors / Plans $14.10 $14.10 $14.10 $14.10 $14.10 $14.10 $14.10 $13.82 $13.82 SCREW 4.0MM HEADLESS CANNULATED COMP 36MM All Payors / Plans All Payors / Plans $759.20 $759.20 $759.20 $759.20 $759.20 $759.20 $759.20 $744.02 $744.02 SCREW 4.0MM HEADLESS CANNULATED COMP 44MM All Payors / Plans All Payors / Plans $759.20 $759.20 $759.20 $759.20 $759.20 $759.20 $759.20 $744.02 $744.02 SCREW ACETABULAR TRIDENT II TRITANIUM 6.5MM X 25MM SCREW HOLE CLUSTER STERILE All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 SCREW BONE 14MM 3.5MM TITANIUM NS CORTICAL DVR ANATOMIC VOLAR PLATE SYSTEM All Payors / Plans All Payors / Plans $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $69.19 $67.80 $67.80 SCREW BONE 26MM 3.5MM SS NS CORTICAL SELF TAPPING SM FRAGMENT SET All Payors / Plans All Payors / Plans $33.84 $33.84 $33.84 $33.84 $33.84 $33.84 $33.84 $33.16 $33.16 SCREW BONE 28MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET All Payors / Plans All Payors / Plans $33.08 $33.08 $33.08 $33.08 $33.08 $33.08 $33.08 $32.41 $32.41 SCREW BONE ATLANTIS TITANIUM L17 MM OD4 MM SPINE CERVICAL ANTERIOR SELF DRILL FIX ANGLE All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 SCREW BONE ATLANTIS TITANIUM L17 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 SCREW BONE EVOS L 11MM OD 3.5MM CORTEX STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 12MM OD 3.5 MM SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 13MM OD 2.7MM ODSEC 4.5MM CORTEX T8 DRIVER2 END DRILL GUIDE SELF TAP All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 13MM OD 3.5MM SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 13MM OD 3.5MM CORTEX STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 14MM OD 3.5MM SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 15MM OD 3.5MM CORTEX STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 16MM OD 3.5MM SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 18MM OD 2.7MM ODSEC 4.5MM CORTEX T8 DRIVER2 END DRILL GUIDE SELF TAP All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 24 MM OD 3.5 MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 26 MM OD 3.5 MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 34 MM OD 3.5 MM CORTEX SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 40 MM OD 3.5 MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L 40MM OD 3.5MM SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 44 MM OD 3.5 MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 50MM OD 3.5MM SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 60MM OD 3.5MM SELF TAP LOCK STERILE All Payors / Plans All Payors / Plans $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $215.60 $215.60 SCREW BONE EVOS L 8MM OD 3.5MM CORTEX STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS L12 MM OD 3.5 MM CORTEX SELF TAP All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS MINI T7 L 12 MM OD 2.4MM ODSEC3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS MINI T7 L 13 MM OD 2.4MM ODSEC 3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS MINI T7 L 14 MM OD 2.4MM ODSEC3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS MINI T7 L 15 MM OD 2.4MM ODSEC3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS MINI T7 L18 MM OD 2.4 MM ODSEC 3.8 MM LONG BONE SMALL BONE LOCK DRIVER STERILE All Payors / Plans All Payors / Plans $202.40 $202.40 $202.40 $202.40 $202.40 $202.40 $202.40 $198.35 $198.35 SCREW BONE EVOS MINI T7 L20 MM OD 2.4 MM ODSEC 3.8 MM LONG BONE SMALL BONE LOCK DRIVER STERILE All Payors / Plans All Payors / Plans $202.40 $202.40 $202.40 $202.40 $202.40 $202.40 $202.40 $198.35 $198.35 SCREW BONE EVOS STAINLESS STEEL T7 L 14MM OD 3.5MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS STAINLESS STEEL T7 L 16MM OD 3.5MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS STAINLESS STEEL T7 L 20MM OD 3.5MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS STAINLESS STEEL T7 L 22MM OD 3.5MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS T7 L 10MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS T7 L 11MM CORTEX SELF TAP STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE EVOS T7 L 16MM OD2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE All Payors / Plans All Payors / Plans $202.40 $202.40 $202.40 $202.40 $202.40 $202.40 $202.40 $198.35 $198.35 SCREW BONE EVOS T8 L 14MM OD 2.7 MM ODSEC 4.5MM CORTEX SELF TAP MINI PLATE SYSTEM All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE FULL THREAD T25 36MM 4MM BLUE TITANIUM STERILE SELF TAP LOCK BLUNT TIP STARDRIVE INTRAMEDULLARY NAIL All Payors / Plans All Payors / Plans $452.10 $452.10 $452.10 $452.10 $452.10 $452.10 $452.10 $443.06 $443.06 SCREW BONE L 37.5MM OD 5MM FEMUR LOW PROFILE INTERAL HEX All Payors / Plans All Payors / Plans $360.00 $360.00 $360.00 $360.00 $360.00 $360.00 $360.00 $352.80 $352.80 SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD HEXAGON L30 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAP NONSTERILE SMALL FRAGMENT SET All Payors / Plans All Payors / Plans $33.84 $33.84 $33.84 $33.84 $33.84 $33.84 $33.84 $33.16 $33.16 SCREW BONE LCP STAINLESS STEEL L30 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAPPING LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET All Payors / Plans All Payors / Plans $33.08 $33.08 $33.08 $33.08 $33.08 $33.08 $33.08 $32.42 $32.42 SCREW BONE LCP STAINLESS STEEL T6 L12 MM OD2 MM SMALL BONE LOCK SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM All Payors / Plans All Payors / Plans $126.72 $126.72 $126.72 $126.72 $126.72 $126.72 $126.72 $124.18 $124.18 SCREW BONE LCP STAINLESS STEEL T6 L14 MM OD2 MM FOOT HAND WRIST CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MINI FRAGMENT SET All Payors / Plans All Payors / Plans $52.14 $52.14 $52.14 $52.14 $52.14 $52.14 $52.14 $51.10 $51.10 SCREW BONE LCP STAINLESS STEEL T6 L14 MM OD2 MM SMALL BONE LOCK SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET All Payors / Plans All Payors / Plans $126.71 $126.71 $126.71 $126.71 $126.71 $126.71 $126.71 $124.18 $124.18 SCREW BONE LCP TITANIUM L7 MM OD2.4 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET All Payors / Plans All Payors / Plans $108.64 $108.64 $108.64 $108.64 $108.64 $108.64 $108.64 $106.47 $106.47 SCREW BONE LCP TITANIUM L7 MM OD2.4 MM ORTHOPEDIC SELF TAPPING LOCKING NONSTERILE MINI FRAGMENT SET All Payors / Plans All Payors / Plans $227.96 $227.96 $227.96 $227.96 $227.96 $227.96 $227.96 $223.40 $223.40 SCREW BONE MARINER L55 MM OD6.5 MM SPINAL SOLID All Payors / Plans All Payors / Plans " $1,683.32 " " $1,683.32 " " $1,683.32 " " $1,683.32 " " $1,683.32 " " $1,683.32 " " $1,683.32 " " $1,649.65 " " $1,649.65 " SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.5 MM CRANIOMAXILLOFACIAL SELF DRILLING NONSTERILE All Payors / Plans All Payors / Plans $139.30 $139.30 $139.30 $139.30 $139.30 $139.30 $139.30 $136.51 $136.51 SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.55 MM ODSEC2.55 MM CRANIOMAXILLOFACIAL SELF DRILL NONSTERILE All Payors / Plans All Payors / Plans $114.92 $114.92 $114.92 $114.92 $114.92 $114.92 $114.92 $112.62 $112.62 SCREW BONE MAXAN L14 MM OD4 MM SPINE FIX ANGLE All Payors / Plans All Payors / Plans " $1,600.00 " " $1,600.00 " " $1,600.00 " " $1,600.00 " " $1,600.00 " " $1,600.00 " " $1,600.00 " " $1,568.00 " " $1,568.00 " SCREW BONE OD 3.5 MM T7 L 18MM OD 2.4MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE PERI-LOC STAINLESS STEEL 2.5 MM FLUTE L 36MM L 14MM OD 4MM ODSEC 6MM HIP SELF TAP CANNULATED TROCAR STERILE All Payors / Plans All Payors / Plans $370.60 $370.60 $370.60 $370.60 $370.60 $370.60 $370.60 $363.19 $363.19 SCREW BONE PINNACLE 25MM 6.5MM STERILE ACETABULAR CANCELLOUS REVISION SYSTEM All Payors / Plans All Payors / Plans " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,238.00 " " $8,073.24 " " $8,073.24 " SCREW BONE STAINLESS STEEL L 34MM OD 2.7MM CORTICAL STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE STAINLESS STEEL L 70MM OD 2.7MM CORTICAL STERILE All Payors / Plans All Payors / Plans $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $41.16 $41.16 SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L30 MM OD4 MM ODSEC3.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE BLUE INTRAMEDULLARY NAIL All Payors / Plans All Payors / Plans $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $362.50 $362.50 SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L40 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL All Payors / Plans All Payors / Plans $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $362.50 $362.50 SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L42 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL All Payors / Plans All Payors / Plans $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $362.50 $362.50 SCREW BONE TITANIUM L16 MM OD3 MM STERNUM SELF TAP LOCK STERILE STABLE INTERNAL FIXATION All Payors / Plans All Payors / Plans $208.10 $208.10 $208.10 $208.10 $208.10 $208.10 $208.10 $203.94 $203.94 SCREW BONE TITANIUM L18 MM OD3 MM STERNAL SELF DRILL LOCK NONSTERILE FIXATION SYSTEM All Payors / Plans All Payors / Plans $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $357.70 $357.70 SCREW BONE TITANIUM L18 MM OD3 MM STERNUM SELF TAP LOCK STERILE STABLE INTERNAL FIXATION All Payors / Plans All Payors / Plans $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $354.03 $354.03 SCREW BONE TITANIUM L55 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE All Payors / Plans All Payors / Plans $922.50 $922.50 $922.50 $922.50 $922.50 $922.50 $922.50 $904.05 $904.05 SCREW BONE TITANIUM L60 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE All Payors / Plans All Payors / Plans $922.50 $922.50 $922.50 $922.50 $922.50 $922.50 $922.50 $904.05 $904.05 SCREW BONE TITANIUM L65 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE All Payors / Plans All Payors / Plans $922.50 $922.50 $922.50 $922.50 $922.50 $922.50 $922.50 $904.05 $904.05 SCREW BONE TITANIUM T25 FULL THREAD L34 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL All Payors / Plans All Payors / Plans $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $369.90 $362.50 $362.50 SCREW BONE TRAUMAONE LORENZ TITANIUM L5 MM OD1.5 MM MIDFACE SELF DRILL HIGH TORQUE CROSS DRIVE GREEN All Payors / Plans All Payors / Plans $117.60 $117.60 $117.60 $117.60 $117.60 $117.60 $117.60 $115.25 $115.25 SCREW BONE TRIDENT II L20 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 SCREW BONE TRIDENT II L30 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 SCREW BONE TRIDENT II L40 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 SCREW BONE TRIDENT II L50 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 SCREW BONE TRIGEN L 32.5 MM OD 4.5 MM LOW PROFILE STERILE LATEX FREE All Payors / Plans All Payors / Plans $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 SCREW BONE TRIGEN L 35MM OD 5MM TIBIAL INTERNAL CAPTURE All Payors / Plans All Payors / Plans $360.00 $360.00 $360.00 $360.00 $360.00 $360.00 $360.00 $352.80 $352.80 SCREW BONE TRIGEN L 60 MM OD 4.5 MM LOW PROFILE STERILE LATEX FREE All Payors / Plans All Payors / Plans $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $220.50 $220.50 SCREW DISTRACTION 14MM SS DISPOSABLE STERILE LF SPINE CERVICAL ANTERIOR SHARP TIP SELF TAP THREAD PIN UNIVERSAL BULLET All Payors / Plans All Payors / Plans $56.24 $56.24 $56.24 $56.24 $56.24 $56.24 $56.24 $55.12 $55.12 SCREW MARINER SOLID 6.5MM X 50MM All Payors / Plans All Payors / Plans " $1,750.00 " " $1,750.00 " " $1,750.00 " " $1,750.00 " " $1,750.00 " " $1,750.00 " " $1,750.00 " " $1,715.00 " " $1,715.00 " SCREW SET CD HORIZON TITANIUM SPINAL BREAK OFF 5.5 MM ROD All Payors / Plans All Payors / Plans " $1,700.00 " " $1,700.00 " " $1,700.00 " " $1,700.00 " " $1,700.00 " " $1,700.00 " " $1,700.00 " " $1,666.00 " " $1,666.00 " SCREW SET INFINITY M6 SPINE OCCIPITOCERVICAL UPPER THORACIC NONSTERILE LATEX FREE All Payors / Plans All Payors / Plans " $1,026.04 " " $1,026.04 " " $1,026.04 " " $1,026.04 " " $1,026.04 " " $1,026.04 " " $1,026.04 " " $1,005.52 " " $1,005.52 " SEAL 12MM STAPLER CANNULA All Payors / Plans All Payors / Plans $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $39.20 $39.20 SEAL 5-8MM UNIVERSAL All Payors / Plans All Payors / Plans $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $35.28 $35.28 SEALANT TISSUE CLOSURE DURASEAL EXACT 5ML DISPOSABLE STERILE LF SPINE All Payors / Plans All Payors / Plans " $2,634.32 " " $2,634.32 " " $2,634.32 " " $2,634.32 " " $2,634.32 " " $2,634.32 " " $2,634.32 " " $2,581.63 " " $2,581.63 " SEALER TISSUE ENSEAL STRAIGHT L37 CM OD5 MM TISSUE SEAL JAW All Payors / Plans All Payors / Plans $868.99 $868.99 $868.99 $868.99 $868.99 $868.99 $868.99 $851.61 $851.61 SEALER TISSUE SYNCHROSEAL DA VINCI L8MM All Payors / Plans All Payors / Plans " $1,380.00 " " $1,380.00 " " $1,380.00 " " $1,380.00 " " $1,380.00 " " $1,380.00 " " $1,380.00 " " $1,352.40 " " $1,352.40 " SEALER VESSEL All Payors / Plans All Payors / Plans " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,225.00 " " $1,225.00 " SEALER/DIVIDER BIPOLAR LIGASURE 180D STRAIGHT 37CM 19.5MM 5MM DISPOSABLE STERILE LF HANDSWITCH 2 ACTION CONTOUR BLUNT All Payors / Plans All Payors / Plans " $1,567.58 " " $1,567.58 " " $1,567.58 " " $1,567.58 " " $1,567.58 " " $1,567.58 " " $1,567.58 " " $1,536.23 " " $1,536.23 " SEALER/DIVIDER BIPOLAR LIGASURE IMPACT 180 D L34 MM LARGE L7.1 IN L36 MM OD13.5 MM HAND ACTIVATION CURVE JAW THERMAL SPREAD LIGHTWEIGHT STERILE DISPOSABLE FORCETRIAD All Payors / Plans All Payors / Plans " $2,250.54 " " $2,250.54 " " $2,250.54 " " $2,250.54 " " $2,250.54 " " $2,250.54 " " $2,250.54 " " $2,205.53 " " $2,205.53 " SEALER/DIVIDER LAPAROSCOPIC LIGASURE 350 D L18.5 MM L44 CM L20.3 MM MARYLAND CURVE JAW NANO COAT VALLEYLAB FT10 LS10 FORCETRIAD ENERGY PLATFORM All Payors / Plans All Payors / Plans " $1,847.53 " " $1,847.53 " " $1,847.53 " " $1,847.53 " " $1,847.53 " " $1,847.53 " " $1,847.53 " " $1,810.58 " " $1,810.58 " SENNA 8.6 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 SENNOSIDES 8.8 MG/5 ML SYRUP All Payors / Plans All Payors / Plans $10.87 $10.87 $10.87 $10.87 $10.87 $10.87 $10.87 $10.65 $10.65 SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG TABLET All Payors / Plans All Payors / Plans $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.99 $0.97 $0.97 SENSOR PULSE OXIMETER FINGER DISPOSABLE ADULT 18IN All Payors / Plans All Payors / Plans $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.58 $10.58 SERTRALINE 25 MG TABLET All Payors / Plans All Payors / Plans $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.85 $1.85 SERTRALINE 50 MG TABLET All Payors / Plans All Payors / Plans $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.84 $1.80 $1.80 SET ACCESS MICROPUNCTURE STAINLESS STEEL PLATINUM .018 IN L40 CM L10 CM L7 CM OD4 FR ODSEC21 GA GUIDEWIRE PART NEEDLE TRANSITIONLESS TIP COAXIAL CATHETER STERILE DISPOSABLE All Payors / Plans All Payors / Plans $55.88 $55.88 $55.88 $55.88 $55.88 $55.88 $55.88 $54.76 $54.76 SET ADMINISTRATION INFUSOMAT 15GTT/ML L122IN 22ML SPACE PUMP FREE FLOW PROTECTION CLAMP SPIN LOCK CONNECTOR UNIVERSAL SPIKE LATEX FREE All Payors / Plans All Payors / Plans $14.28 $14.28 $14.28 $14.28 $14.28 $14.28 $14.28 $13.99 $13.99 SET IMPLANT ARTHREX FIBERTAK BICEPS STERILE LATEX FREE All Payors / Plans All Payors / Plans " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,250.00 " " $1,225.00 " " $1,225.00 " SET INTRODUCER MICROPUNCTURE PUSH-PLUS NITINOL .018 IN L40 CM L10 CM OD4 FR TRANSITIONLESS STIFFENED CANNULA PLATINUM TIP NITINOL WIREGUIDE COAXIAL CATHETER STERILE DISPOSABLE All Payors / Plans All Payors / Plans $98.34 $98.34 $98.34 $98.34 $98.34 $98.34 $98.34 $96.37 $96.37 SET INTRODUCER MICROPUNCTURE SILHOUETTE STAINLESS STEEL L40 CM L10 CM OD5 FR OD.018 IN WIRE GUIDE PLATINUM TIP TRANSITIONLESS COAXIAL CATHETER DILATOR STERILE DISPOSABLE All Payors / Plans All Payors / Plans $55.88 $55.88 $55.88 $55.88 $55.88 $55.88 $55.88 $54.76 $54.76 SET INTRODUCER PERFORMER L13 CM OD16 FR ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $237.60 $237.60 $237.60 $237.60 $237.60 $237.60 $237.60 $232.85 $232.85 SET IRRIGATION MALIS BIPOLAR CORD INTEGRATE TUBE ROTARY DISPOSABLE All Payors / Plans All Payors / Plans $106.39 $106.39 $106.39 $106.39 $106.39 $106.39 $106.39 $104.26 $104.26 SET STENT ZIMMON POLYETHYLENE 2 PIGTAIL CURVE L5 CM OD10 FR BILIARY PUSH CATHETER SMOOTH CANNULATION TAPER TIP STERILE PURPLE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $292.04 $292.04 SET TUBING AIRSEAL ACTIVATE CHARCOAL 3 LUMEN FILTER STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $183.68 $183.68 $183.68 $183.68 $183.68 $183.68 $183.68 $180.01 $180.01 SET TUBING COOL POINT L2.6 MR 2 WAY COMMUNICATION IRRIGATION PUMP CATHETER All Payors / Plans All Payors / Plans $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $158.76 $158.76 SET TUBING DUALWAVE CASSETTE OUTFLOW STERILE DISPOSABLE ARTHROSCOPY PUMP All Payors / Plans All Payors / Plans $65.60 $65.60 $65.60 $65.60 $65.60 $65.60 $65.60 $64.29 $64.29 SET TUBING ULTRASONIC ASPIRATOR SONASTAR All Payors / Plans All Payors / Plans $345.60 $345.60 $345.60 $345.60 $345.60 $345.60 $345.60 $338.69 $338.69 SET VENTRICULAR DRAINAGE TRAUMACATH L35 CM OD10 FR ODSEC3.3 MM ID1.9 MM CONNECTOR TROCAR SUTURE COLLAR STYLET STERILE LATEX FREE All Payors / Plans All Payors / Plans $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $94.08 $94.08 SEVELAMER 800 MG TABLET All Payors / Plans All Payors / Plans $6.84 $6.84 $6.84 $6.84 $6.84 $6.84 $6.84 $6.70 $6.70 SEVELAMER CARBONATE 0.8 GRAM POWDER IN PACKET All Payors / Plans All Payors / Plans $6.80 $6.80 $6.80 $6.80 $6.80 $6.80 $6.80 $6.66 $6.66 SHEARS ELECTROSURGICAL HARMONIC ACE+ CURVE 36CM 5MM TITANIUM DISPOSABLE STERILE 2 HAND CONTROL BUTTON TAPER TIP All Payors / Plans All Payors / Plans $965.39 $965.39 $965.39 $965.39 $965.39 $965.39 $965.39 $946.08 $946.08 SHEARS ELECTROSURGICAL HARMONIC FOCUS+ CURVE TAPER 9CM DISPOSABLE STERILE 2 HAND CONTROL ADAPTIVE TISSUE TECHNOLOGY SOFT All Payors / Plans All Payors / Plans $904.94 $904.94 $904.94 $904.94 $904.94 $904.94 $904.94 $886.84 $886.84 SHEATH 8FR X 63CM COOK 210338 _106142_ All Payors / Plans All Payors / Plans $106.92 $106.92 $106.92 $106.92 $106.92 $106.92 $106.92 $104.78 $104.78 SHEATH ACCESS NAVIGATOR HD STAINLESS STEEL HYDROPHILIC L28 CM OD11-13 FR URETERAL 2 DUROMETER DILATOR RADIOPAQUE INNOVATIVE HUB LATEX FREE URETEROSCOPIC All Payors / Plans All Payors / Plans $240.40 $240.40 $240.40 $240.40 $240.40 $240.40 $240.40 $235.59 $235.59 SHEATH ACCESS NAVIGATOR HD STAINLESS STEEL HYDROPHILIC L36 CM OD11-13 FR URETERAL 2 DUROMETER DILATOR RADIOPAQUE INNOVATIVE HUB LATEX FREE URETEROSCOPIC All Payors / Plans All Payors / Plans $240.40 $240.40 $240.40 $240.40 $240.40 $240.40 $240.40 $235.59 $235.59 SHEATH GUIDING FLEXOR CHECK-FLO MULTIPURPOSE CURVE 90CM 6FR 2.2MM ACCEPTS .018/.038IN GUIDEWIRE All Payors / Plans All Payors / Plans $184.40 $184.40 $184.40 $184.40 $184.40 $184.40 $184.40 $180.71 $180.71 SHEATH GUIDING FLEXOR RAABE AQ L70 CM OD5 FR ID1.9 MM CHECK-FLO VALVE SOFT TIP RADIOPAQUE BAND STIFF SHAFT STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE All Payors / Plans All Payors / Plans $57.50 $57.50 $57.50 $57.50 $57.50 $57.50 $57.50 $56.35 $56.35 SHEATH INTRODUCER BRITE TIP L11 CM OD6 FR CANNULA INTERVENTIONAL LATEX FREE GREEN ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $21.56 $21.56 SHEATH INTRODUCER FLEXCATH PEBAX BARIUM SULFATE 135 D L65 CM L81 CM OD15 FR ID12 FR STERRABLE ARCTIC FRONT ADVANCE CRYOBALLOON ACHIEVE MAPPING CATHETER DILATOR RADIOPAQUE MARKER STERILE REUSABLE All Payors / Plans All Payors / Plans " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,700.00 " " $2,646.00 " " $2,646.00 " SHEATH INTRODUCER GORE DRYSEAL L33 CM OD12 FR ODSEC4.7 MM ID4 MM DILATOR VALVE INFLATION SYRINGE All Payors / Plans All Payors / Plans $982.00 $982.00 $982.00 $982.00 $982.00 $982.00 $982.00 $962.36 $962.36 SHEATH INTRODUCER GORE DRYSEAL L33 CM OD16 FR ODSEC6.1 MM ID5.3 MM DILATOR VALVE INFLATION SYRINGE All Payors / Plans All Payors / Plans $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $942.76 $942.76 SHEATH INTRODUCER GORE DRYSEAL L33 CM OD18 FR ODSEC6.7 MM ID6 MM DILATOR VALVE INFLATION SYRINGE All Payors / Plans All Payors / Plans " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,274.00 " " $1,274.00 " SHEATH INTRODUCER PINNACLE .038IN 10CM 2.5CM 5FR HYDROPHILIC PTFE KINK RESISTANT DILATOR GUIDEWIRE All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 SHEATH INTRODUCER PINNACLE DESTINATION PTFE HYDROPHILIC L10 CM L2.5 CM OD7 FR PERIPHERAL KINK RESISTANT DESIGN CROSS CUT VALVE SMOOTH TRANSITION DILATOR All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 SHEATH INTRODUCER PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM OD11 FR PERIPHERAL GUIDEWIRE DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $17.80 $17.80 $17.80 $17.80 $17.80 $17.80 $17.80 $17.44 $17.44 SHEATH INTRODUCER PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM OD9 FR GUIDEWIRE DILATOR KINK RESISTANT All Payors / Plans All Payors / Plans $17.60 $17.60 $17.60 $17.60 $17.60 $17.60 $17.60 $17.25 $17.25 SHEATH INTRODUCER PINNACLE STAINLESS STEEL .035 IN L10 CM L2.5 CM ID5 FR PERIPHERAL SNAP ON DILATOR LOCK KINK RESISTANT SMOOTH TRANSITION SPRING COIL GUIDEWIRE All Payors / Plans All Payors / Plans $331.60 $331.60 $331.60 $331.60 $331.60 $331.60 $331.60 $324.97 $324.97 SHEATH INTRODUCER PINNACLE STAINLESS STEEL .035IN L10 CM L2.5 CM ID11 FR PERIPHERAL SNAP ON DILATOR LOCK KINK RESISTANT SMOOTH TRANSITION SPRING COIL GUIDEWIRE All Payors / Plans All Payors / Plans $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.15 $17.15 SHEATH INTRODUCER VIZIGO CURVE ID8.5 FR MDC All Payors / Plans All Payors / Plans " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,201.08 " " $2,201.08 " SHEATH INTRODUCER VIZIGO CURVE ID8.5 FR SMC All Payors / Plans All Payors / Plans " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,246.00 " " $2,201.08 " " $2,201.08 " SHEATH LAPAROSCOPIC L45 MM STAPLER All Payors / Plans All Payors / Plans $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $39.20 $39.20 SHEATH SAFE 7 FRENCH All Payors / Plans All Payors / Plans $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 SHEATH VERSA CROSS STEERABLE 8.5F LARGE BIDIRECTIONAL All Payors / Plans All Payors / Plans " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,058.00 " " $2,058.00 " SHEATH VERSA CROSS STEERABLE 8.5F MEDIUM BIDIRECTIONAL All Payors / Plans All Payors / Plans " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,100.00 " " $2,058.00 " " $2,058.00 " SHELL ACETABULAR PINNACLE 50MM POROCOAT STERILE LF HIP SECTOR All Payors / Plans All Payors / Plans " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,448.00 " " $7,448.00 " SHELL ACETABULAR PINNACLE 52MM POROCOAT STERILE LF HIP SECTOR All Payors / Plans All Payors / Plans " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,448.00 " " $7,448.00 " SHELL ACETABULAR PINNACLE 54MM POROCOAT STERILE LF HIP SECTOR All Payors / Plans All Payors / Plans " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,600.00 " " $7,448.00 " " $7,448.00 " SHELL ACETABULAR TRIDENT II TRITANIUM E OD52 MM HIP CLUSTER HOLE STERILE All Payors / Plans All Payors / Plans " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,036.00 " " $8,036.00 " SHELL ACETABULAR TRIDENT II TRITANIUM E OD52 MM HIP SOLID BACK STERILE All Payors / Plans All Payors / Plans " $11,800.00 " " $11,800.00 " " $11,800.00 " " $11,800.00 " " $11,800.00 " " $11,800.00 " " $11,800.00 " " $11,564.00 " " $11,564.00 " SHOE POSTOPERATIVE AEGIS 10.5-12 LG RUBBER NS LF MALE FOOT BILATERAL SEMIRIGID SOLE LOOP LOCK CLOSURE REINFORCED PAD All Payors / Plans All Payors / Plans $5.83 $5.83 $5.83 $5.83 $5.83 $5.83 $5.83 $5.71 $5.71 SHOE POSTOPERATIVE AEGIS 8.5-10 LG RUBBER NS LF FEMALE FOOT BILATERAL SEMIRIGID SOLE LOOP LOCK CLOSURE REINFORCED PAD All Payors / Plans All Payors / Plans $5.83 $5.83 $5.83 $5.83 $5.83 $5.83 $5.83 $5.71 $5.71 SHOE POSTOPERATIVE AEGIS 8.5-10 MED RUBBER NS LF MALE FOOT BILATERAL SEMIRIGID SOLE LOOP LOCK CLOSURE REINFORCED PAD All Payors / Plans All Payors / Plans $5.83 $5.83 $5.83 $5.83 $5.83 $5.83 $5.83 $5.71 $5.71 SHORT MICRO PROCEDURE TRAY All Payors / Plans All Payors / Plans $993.30 $993.30 $993.30 $993.30 $993.30 $993.30 $993.30 $973.43 $973.43 SHORT PILOT DRILL All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 SHUNT CAROTID BARD JAVID TAPER L27.5 CM OD10-17 FR TYPE 1852 KINK RESISTANT POLISH TIP BYPASS All Payors / Plans All Payors / Plans $25.40 $25.40 $25.40 $25.40 $25.40 $25.40 $25.40 $24.89 $24.89 SILDENAFIL (PULM.HYPERTENSION) 20 MG TABLET All Payors / Plans All Payors / Plans $2.63 $2.63 $2.63 $2.63 $2.63 $2.63 $2.63 $2.58 $2.58 SILVER NITRATE 75-25 % STICK All Payors / Plans All Payors / Plans $3.14 $3.14 $3.14 $3.14 $3.14 $3.14 $3.14 $3.08 $3.08 SILVER SULFADIAZINE 1 % CREAM 50 G JAR All Payors / Plans All Payors / Plans $36.34 $36.34 $36.34 $36.34 $36.34 $36.34 $36.34 $35.61 $35.61 "SIMETHICONE 40 MG/0.6 ML DROPS,SUSPENSION" All Payors / Plans All Payors / Plans $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 "SIMETHICONE 80 MG TABLET,CHEWABLE" All Payors / Plans All Payors / Plans $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.91 $0.89 $0.89 SIMPLE SYRUP SYRUP All Payors / Plans All Payors / Plans $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 $0.05 SIMVASTATIN 10 MG TABLET All Payors / Plans All Payors / Plans $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.97 $0.95 $0.95 SIMVASTATIN 20 MG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 SIMVASTATIN 40 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 SIROLIMUS PER 1 MG All Payors / Plans All Payors / Plans $16.14 $16.14 $16.14 $16.14 $16.14 $16.14 $16.14 $15.82 $15.82 SITAGLIPTIN PHOSPHATE 100 MG TABLET All Payors / Plans All Payors / Plans $25.23 $25.23 $25.23 $25.23 $25.23 $25.23 $25.23 $24.73 $24.73 SITAGLIPTIN PHOSPHATE 25 MG TABLET All Payors / Plans All Payors / Plans $25.23 $25.23 $25.23 $25.23 $25.23 $25.23 $25.23 $24.73 $24.73 SLEEVE COMPRESSION KENDALL SCD EXPRESS LG KNEE LENGTH NYLON DISPOSABLE NS LF ADJUSTABLE CIRCUMFERENTIAL BLADDER All Payors / Plans All Payors / Plans $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.18 $33.18 SLEEVE COMPRESSION KENDALL SCD EXPRESS MEDIUM KNEE LENGTH OD21- IN ADJUSTABLE CIRCUMFERENTIAL BLADDER STREAMLINE CONNECTOR NONSTERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.18 $33.18 SLEEVE COMPRESSION MED KNEE LENGTH KENDALL SCD EXPRESS ADJUSTABLE CIRCUMFERENTIAL All Payors / Plans All Payors / Plans $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.86 $33.18 $33.18 SLEEVE LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW UNIVERSAL L100 MM OD11 MM BLUNT TIP RADIOPAQUE TROCAR CANNULA STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $96.04 $96.04 SLEEVE LAPAROSCOPIC ENDOPATH XCEL UNIVERSAL 100MM 12MM DISPOSABLE STERILE STABILITY BLADELESS OBTURATOR OPTIONAL PISTOL All Payors / Plans All Payors / Plans $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $32.14 $32.14 SLEEVE LAPAROSCOPIC ENDOPATH XCEL UNIVERSAL 100MM 5MM DISPOSABLE STERILE STABILITY BLADELESS OBTURATOR OPTIONAL PISTOL All Payors / Plans All Payors / Plans $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $32.14 $32.14 SLEEVE SCLERAL SILICONE ROUND STYLE 72 BUCKLING All Payors / Plans All Payors / Plans $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $21.56 $21.56 SLEEVE W/BALLOON 12MM X 100MM All Payors / Plans All Payors / Plans $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 SLING ORTHOPEDIC TIETEX SMALL ARM ENVELOPE SHOULDER STRAP SLIDE BUCKLE All Payors / Plans All Payors / Plans $3.58 $3.58 $3.58 $3.58 $3.58 $3.58 $3.58 $3.51 $3.51 SMITH&NEPHEW 3.2MM X 343MM GUIDE PIN All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 SMITH&NEPHEW 4.0MM SHORT PILOT DRILL WITH A/O CONNECTOR All Payors / Plans All Payors / Plans $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $196.00 $196.00 SNARE ENDOSCOPIC CAPTIFLEX MICRO OVAL L240 CM OD2.4 MM ODSEC13 MM FLEXIBLE STERILE DISPOSABLE POLYPECTOMY All Payors / Plans All Payors / Plans $20.19 $20.19 $20.19 $20.19 $20.19 $20.19 $20.19 $19.79 $19.79 SNARE ENDOSCOPIC CAPTIFLEX XS OVAL L240 CM W11 MM OD2.4 MM LOOP FLEXIBLE BRAID WIRE HOT COLD INDICATION STERILE DISPOSABLE POLYPECTOMY All Payors / Plans All Payors / Plans $28.01 $28.01 $28.01 $28.01 $28.01 $28.01 $28.01 $27.45 $27.45 SNARE ENDOSCOPIC JUMBO LARGE OVAL MEDIUM STIFF DISPOSABLE OLYMPUS All Payors / Plans All Payors / Plans $36.67 $36.67 $36.67 $36.67 $36.67 $36.67 $36.67 $35.94 $35.94 SNARE ENDOSCOPIC SNAREMASTER SPIRAL L230 CM OD2.8 MM ODSEC20 MM RIDGE WIRE DISPOSABLE All Payors / Plans All Payors / Plans $409.36 $409.36 $409.36 $409.36 $409.36 $409.36 $409.36 $401.17 $401.17 SNARE SURGICAL ROUND OD20 MM COLD All Payors / Plans All Payors / Plans $37.10 $37.10 $37.10 $37.10 $37.10 $37.10 $37.10 $36.36 $36.36 SODIUM ACETATE 2 MEQ/ML SOLUTION 100 ML VIAL All Payors / Plans All Payors / Plans $0.30 $0.30 $0.30 $0.30 $0.30 $0.30 $0.30 $0.29 $0.29 SODIUM ACETATE 2 MEQ/ML SOLUTION 20 ML VIAL All Payors / Plans All Payors / Plans $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 SODIUM BICARBONATE 1 MEQ/ML (8.4 %) SOLUTION All Payors / Plans All Payors / Plans $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $30.40 $30.40 SODIUM BICARBONATE 1 MEQ/ML (8.4 %) SOLUTION 50 ML VIAL All Payors / Plans All Payors / Plans $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $30.87 $30.87 SODIUM BICARBONATE 650 MG TABLET All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) SYRINGE All Payors / Plans All Payors / Plans $50.78 $50.78 $50.78 $50.78 $50.78 $50.78 $50.78 $49.76 $49.76 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) SYRINGE 50 ML SYRINGE All Payors / Plans All Payors / Plans $62.87 $62.87 $62.87 $62.87 $62.87 $62.87 $62.87 $61.61 $61.61 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) SYRINGE 50 ML VIAL All Payors / Plans All Payors / Plans $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $30.40 $30.40 SODIUM CHLORIDE All Payors / Plans All Payors / Plans $0.09 $0.09 $0.09 $0.09 $0.09 $0.09 $0.09 $0.09 $0.09 SODIUM CHLORIDE 0.45% 0.45 % All Payors / Plans All Payors / Plans $18.17 $18.17 $18.17 $18.17 $18.17 $18.17 $18.17 $17.81 $17.81 SODIUM CHLORIDE 0.45% 0.45 % PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $17.99 $17.99 "SODIUM CHLORIDE 0.45% 0.45 % PARENTERAL SOLUTION 1,000 ML BAG" All Payors / Plans All Payors / Plans $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $18.36 $17.99 $17.99 SODIUM CHLORIDE 0.45% 0.45 % PARENTERAL SOLUTION 500 ML BAG All Payors / Plans All Payors / Plans $18.17 $18.17 $18.17 $18.17 $18.17 $18.17 $18.17 $17.81 $17.81 "SODIUM CHLORIDE 0.65 % AEROSOL,SPRAY 44 ML SQUEEZ BTL" All Payors / Plans All Payors / Plans $0.83 $0.83 $0.83 $0.83 $0.83 $0.83 $0.83 $0.81 $0.81 "SODIUM CHLORIDE 0.65 % AEROSOL,SPRAY 45 ML SQUEEZ BTL" All Payors / Plans All Payors / Plans $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $5.88 $5.88 SODIUM CHLORIDE 0.9 % All Payors / Plans All Payors / Plans $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $17.88 $17.88 SODIUM CHLORIDE 0.9 % SOLUTION All Payors / Plans All Payors / Plans $18.43 $18.43 $18.43 $18.43 $18.43 $18.43 $18.43 $18.06 $18.06 "SODIUM CHLORIDE 0.9 % SOLUTION 1,000 ML BOTTLE" All Payors / Plans All Payors / Plans $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.04 $9.04 SODIUM CHLORIDE 0.9 % WITH KCL 20 MEQ/L INFUSION 20 MEQ/L PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.11 $1.11 "SODIUM CHLORIDE 0.9 % WITH KCL 20 MEQ/L INFUSION 20 MEQ/L PARENTERAL SOLUTION 1,000 ML BAG" All Payors / Plans All Payors / Plans $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.13 $1.11 $1.11 "SODIUM CHLORIDE 1,000 MG TABLET,SOLUBLE" All Payors / Plans All Payors / Plans $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.09 $1.07 $1.07 SODIUM CHLORIDE 3 % PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $18.64 $18.64 $18.64 $18.64 $18.64 $18.64 $18.64 $18.27 $18.27 SODIUM CHLORIDE 3% 3 % PARENTERAL SOLUTION All Payors / Plans All Payors / Plans $18.64 $18.64 $18.64 $18.64 $18.64 $18.64 $18.64 $18.27 $18.27 SODIUM CHLORIDE 4 MEQ/ML PARENTERAL SOLUTION 100 ML VIAL All Payors / Plans All Payors / Plans $0.53 $0.53 $0.53 $0.53 $0.53 $0.53 $0.53 $0.52 $0.52 SODIUM CHLORIDE 4 MEQ/ML PARENTERAL SOLUTION 30 ML VIAL All Payors / Plans All Payors / Plans $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 $0.19 SODIUM CHLORIDE 5 % OINTMENT 3.5 G TUBE All Payors / Plans All Payors / Plans $66.68 $66.68 $66.68 $66.68 $66.68 $66.68 $66.68 $65.35 $65.35 SODIUM CHLORIDE PER 250 ML All Payors / Plans All Payors / Plans $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $17.88 $17.88 SODIUM CHLORIDE PER 250ML All Payors / Plans All Payors / Plans $23.50 $23.50 $23.50 $23.50 $23.50 $23.50 $23.50 $23.03 $23.03 SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $9.43 $9.43 $9.43 $9.43 $9.43 $9.43 $9.43 $9.24 $9.24 SODIUM HYALURONATE 10 MG/ML SYRINGE All Payors / Plans All Payors / Plans $347.38 $347.38 $347.38 $347.38 $347.38 $347.38 $347.38 $340.43 $340.43 SODIUM HYPOCHLORITE 0.125 % SOLUTION 473 ML BOTTLE All Payors / Plans All Payors / Plans $45.57 $45.57 $45.57 $45.57 $45.57 $45.57 $45.57 $44.66 $44.66 SODIUM HYPOCHLORITE 0.25 % SOLUTION 473 ML BOTTLE All Payors / Plans All Payors / Plans $62.79 $62.79 $62.79 $62.79 $62.79 $62.79 $62.79 $61.53 $61.53 SODIUM HYPOCHLORITE 0.5 % SOLUTION 473 ML BOTTLE All Payors / Plans All Payors / Plans $45.57 $45.57 $45.57 $45.57 $45.57 $45.57 $45.57 $44.66 $44.66 SODIUM PHOSPHATE 3 MMOL/ML SOLUTION 15 ML VIAL All Payors / Plans All Payors / Plans $142.51 $142.51 $142.51 $142.51 $142.51 $142.51 $142.51 $139.66 $139.66 SODIUM PHOSPHATE 3 MMOL/ML SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $45.38 $45.38 $45.38 $45.38 $45.38 $45.38 $45.38 $44.47 $44.47 SODIUM PHOSPHATES 19-7 GRAM/118 ML ENEMA All Payors / Plans All Payors / Plans $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.87 $0.85 $0.85 SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM POWDER IN PACKET All Payors / Plans All Payors / Plans $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.40 $10.40 SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM POWDER IN PACKET All Payors / Plans All Payors / Plans $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.40 $10.40 "SODIUM, POTASSIUM, AND MAGNESIUM SULFATES 17.5-3.13-1.6 GRAM RECON SOLN 177 ML BOTTLE" All Payors / Plans All Payors / Plans $140.43 $140.43 $140.43 $140.43 $140.43 $140.43 $140.43 $137.62 $137.62 "SODIUM, POTASSIUM, AND MAGNESIUM SULFATES 17.5-3.13-1.6 GRAM RECON SOLN 354 ML KIT" All Payors / Plans All Payors / Plans $140.41 $140.41 $140.41 $140.41 $140.41 $140.41 $140.41 $137.60 $137.60 SOLUTION ANTISEPTIC 70% ISOPROPYL ALCOHOL 16 OZ BOTTLE LATEX FREE All Payors / Plans All Payors / Plans $3.41 $3.41 $3.41 $3.41 $3.41 $3.41 $3.41 $3.34 $3.34 SOLUTION IRRIGATION 1000ML WATER STERILE LF PLASTIC POUR BOTTLE All Payors / Plans All Payors / Plans $2.16 $2.16 $2.16 $2.16 $2.16 $2.16 $2.16 $2.12 $2.12 SOLUTION IRRIGATION SODIUM CHLORIDE 0.9% POUR BOTTLE 500ML All Payors / Plans All Payors / Plans $3.44 $3.44 $3.44 $3.44 $3.44 $3.44 $3.44 $3.37 $3.37 SOLUTION IRRIGATION UROMATIC 2000ML WATER STERILE LF PLASTIC CONTAINER All Payors / Plans All Payors / Plans $9.28 $9.28 $9.28 $9.28 $9.28 $9.28 $9.28 $9.09 $9.09 SOLUTION IV INJECTION SODIUM CHLORIDE 0.9% 1000ML All Payors / Plans All Payors / Plans $3.15 $3.15 $3.15 $3.15 $3.15 $3.15 $3.15 $3.09 $3.09 SOLUTION IV IRRIGATION 3000ML All Payors / Plans All Payors / Plans $5.56 $5.56 $5.56 $5.56 $5.56 $5.56 $5.56 $5.45 $5.45 SOLUTION IV IRRIGATION GLYCINE 1.5% UROMATIC PLASTIC BAG 3000ML All Payors / Plans All Payors / Plans $7.01 $7.01 $7.01 $7.01 $7.01 $7.01 $7.01 $6.87 $6.87 SOLUTION IV IRRIGATION SODIUM CHLORIDE 0.9% 3000ML All Payors / Plans All Payors / Plans $5.56 $5.56 $5.56 $5.56 $5.56 $5.56 $5.56 $5.45 $5.45 SOLUTION IV IRRIGATION SODIUM CHLORIDE 0.9% PLASTIC BAG 1000ML All Payors / Plans All Payors / Plans $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $29.40 $29.40 SOLUTION IV IRRIGATION WATER STERILE 3000ML All Payors / Plans All Payors / Plans $5.06 $5.06 $5.06 $5.06 $5.06 $5.06 $5.06 $4.96 $4.96 SOLUTION OPHTHALMIC SILIKON 1000 8.5ML POLYDIMETHYLSILOXANE STERILE LF OIL All Payors / Plans All Payors / Plans $863.56 $863.56 $863.56 $863.56 $863.56 $863.56 $863.56 $846.29 $846.29 SOLUTION PREP 10% PVP IODINE 3/4 OZ POUCH PACKET CONTAINER STERILE LATEX FREE All Payors / Plans All Payors / Plans $5.43 $5.43 $5.43 $5.43 $5.43 $5.43 $5.43 $5.32 $5.32 SOLUTION PREP 3M DURAPREP 26ML 74% ISOPROPYL ALCOHOL 0.7% IODINE POVACRYLEX STERILE SKIN COATED SELF CONTAIN APPLICATOR All Payors / Plans All Payors / Plans $7.38 $7.38 $7.38 $7.38 $7.38 $7.38 $7.38 $7.23 $7.23 SOLUTION PREP 3M DURAPREP 74% ISOPROPYL ALCOHOL 0.7% IODINE POVACRYLEX 6 ML SKIN 1 COAT SELF CONTAIN APPLICATOR STERILE PREOPERATIVE All Payors / Plans All Payors / Plans $2.96 $2.96 $2.96 $2.96 $2.96 $2.96 $2.96 $2.90 $2.90 SOTALOL 80 MG TABLET All Payors / Plans All Payors / Plans $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.06 $2.02 $2.02 SPACER FEMORAL ACCOLADE UNIVERSAL OD10 MM HIP DISTAL CEMENTED All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " SPACER FEMORAL ACCOLADE UNIVERSAL OD9 MM HIP CEMENTED All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " SPACER SPINAL PROLIFT 15 D L28 MM X W10 MM X H8 MM EXPAND STERILE LATEX FREE All Payors / Plans All Payors / Plans " $10,000.00 " " $10,000.00 " " $10,000.00 " " $10,000.00 " " $10,000.00 " " $10,000.00 " " $10,000.00 " " $9,800.00 " " $9,800.00 " SPHINCTEROTOME ENDOSCOPIC HUIBREGTSE L200 CM L4 MM OD5 FR 1 LUMEN NEEDLE KNIFE PAPILLOTOME EXPOSED CUTTING WIRE PURPLE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $409.64 $409.64 SPHINCTEROTOME ENDOSCOPIC ULTRATOME XL L5 MM L200 CM L5 MM OD5.5 FR BILIARY PANCREAS 3 LUMEN CUT WIRE SHORT NOSE STERILE DISPOSABLE ACCEPTS .035 IN DREAMWIRE All Payors / Plans All Payors / Plans $286.94 $286.94 $286.94 $286.94 $286.94 $286.94 $286.94 $281.20 $281.20 SPIKE ANGIOGRAPHY L6.5 IN 3 WAY STOPCOCK MANAGEMENT All Payors / Plans All Payors / Plans $4.22 $4.22 $4.22 $4.22 $4.22 $4.22 $4.22 $4.14 $4.14 SPIRONOLACTONE 100 MG TABLET All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.55 $2.55 SPIRONOLACTONE 25 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 SPIRONOLACTONE-HYDROCHLOROTHIAZIDE All Payors / Plans All Payors / Plans $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.44 $0.43 $0.43 SPLINT NASAL DOYLE II SILICONE SEPTUM COMPRESS ANTERIOR TIP INTEGRAL AIRWAY STERILE LATEX FREE DISPOSABLE WHITE All Payors / Plans All Payors / Plans $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $158.76 $158.76 SPLINT ORTHOPEDIC FOAM LARGE L8 IN RIGHT WRIST LOW PROFILE PALMAR STAY D-RING CLOSURE NONSTERILE LATEX FREE BLACK All Payors / Plans All Payors / Plans $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.64 $8.64 SPLINT ORTHOPEDIC MED 8IN BLACK FOAM NS LF LEFT WRIST LATEX SAFE LOW PROFILE All Payors / Plans All Payors / Plans $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.82 $8.64 $8.64 SPONGE LAPAROTOMY L18 IN X W18 IN STERILE All Payors / Plans All Payors / Plans $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 $0.24 ST FLEXIBLE FIBEROPTIC ENDOSC EVAL SWALLOW 23-37 All Payors / Plans All Payors / Plans 0440 92612 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $426.30 $426.30 ST FLEXIBLE FIBEROPTIC ENDOSC EVAL SWALLOW 38-52 All Payors / Plans All Payors / Plans 0440 92612 $653.00 $653.00 $653.00 $653.00 $653.00 $653.00 $653.00 $639.94 $639.94 ST FLEXIBLE FIBEROPTIC ENDOSC EVAL SWALLOW 53-67 All Payors / Plans All Payors / Plans 0440 92612 $870.00 $870.00 $870.00 $870.00 $870.00 $870.00 $870.00 $852.60 $852.60 ST FLEXIBLE FIBEROPTIC ENDOSC EVAL SWALLOW 8-22 All Payors / Plans All Payors / Plans 0440 92612 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $213.64 $213.64 STANDARD NEONATAL TPN All Payors / Plans All Payors / Plans $106.57 $106.57 $106.57 $106.57 $106.57 $106.57 $106.57 $104.44 $104.44 STAPLER INTERNAL CONTOUR CURVE 40MMX3.5MM 1.5MM BLUE TITANIUM DISPOSABLE STERILE LF REGULAR TISSUE 4 ROW LINEAR CUTTER All Payors / Plans All Payors / Plans " $1,007.67 " " $1,007.67 " " $1,007.67 " " $1,007.67 " " $1,007.67 " " $1,007.67 " " $1,007.67 " $987.52 $987.52 STAPLER INTERNAL ECHELON FLEX ENDOPATH L45 MM L340 MM 6 ROW 12 FIRING ARTICULATION ROTATE KNOB STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $581.24 $581.24 $581.24 $581.24 $581.24 $581.24 $581.24 $569.62 $569.62 STAPLER INTERNAL ECHELON FLEX POWERED PLUS LONG 440MM 60MM LINEAR CUTTER ENDOSCOPIC All Payors / Plans All Payors / Plans $465.45 $465.45 $465.45 $465.45 $465.45 $465.45 $465.45 $456.14 $456.14 STAPLER INTERNAL ENDO GIA ULTRA TRI-STAPLE SHORT UNIVERSAL 6CM 12MM TITANIUM DISPOSABLE STERILE LF THIN VASCULAR TISSUE All Payors / Plans All Payors / Plans $224.52 $224.52 $224.52 $224.52 $224.52 $224.52 $224.52 $220.03 $220.03 STAPLER INTERNAL ENDO GIA ULTRA TRI-STAPLE UNIVERSAL STANDARD 16CMX4MM PVC DISPOSABLE STERILE LF EXTRA THICK TISSUE All Payors / Plans All Payors / Plans $249.43 $249.43 $249.43 $249.43 $249.43 $249.43 $249.43 $244.44 $244.44 STAPLER INTERNAL ENDO GIA ULTRA TRI-STAPLE XL UNIVERSAL 26CMX4MM BLACK TITANIUM EXTRA THICK TISSUE ARTICULATE HAND GRASP All Payors / Plans All Payors / Plans $399.04 $399.04 $399.04 $399.04 $399.04 $399.04 $399.04 $391.06 $391.06 STAPLER INTERNAL ENDOPATH CURVE CIRCLE 5.5MM 28CMX1-2.5MM 29MM DISPOSABLE STERILE LF INTRALUMINAL LINEAR CUTTER All Payors / Plans All Payors / Plans $525.29 $525.29 $525.29 $525.29 $525.29 $525.29 $525.29 $514.78 $514.78 STAPLER INTERNAL ENDOPATH CURVE CIRCLE H5.5 MM L28 CM X H1-2.5 MM OD25 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 16.4 MM LUMEN ENDOSCOPIC All Payors / Plans All Payors / Plans $525.29 $525.29 $525.29 $525.29 $525.29 $525.29 $525.29 $514.78 $514.78 STAPLER INTERNAL PROTACK TITANIUM L35.5 MM X W5 MM VASCULAR 30 HELICAL FASTENER STERILE LATEX FREE DISPOSABLE HERNIA MESH All Payors / Plans All Payors / Plans " $1,367.48 " " $1,367.48 " " $1,367.48 " " $1,367.48 " " $1,367.48 " " $1,367.48 " " $1,367.48 " " $1,340.13 " " $1,340.13 " STAPLER INTERNAL PROXIMATE PPH 33MM DISPOSABLE STERILE LF SET PROLAPSE HEMORRHOID All Payors / Plans All Payors / Plans $795.06 $795.06 $795.06 $795.06 $795.06 $795.06 $795.06 $779.16 $779.16 STAPLER INTERNAL PROXIMATE PX STAINLESS STEEL TITANIUM WIDE L3.9 MM X W6.9 MM X H1 MM OD.58 MM 35 COUNT FIX HEAD ERGONOMIC PISTOL GRIP HANDLE RELOADABLE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $208.98 $208.98 $208.98 $208.98 $208.98 $208.98 $208.98 $204.80 $204.80 STAPLER INTERNAL PROXIMATE TITANIUM L30 MM X H1-2.5 MM H1 MM STANDARD TISSUE 2 ROW LINEAR CUTTER ADJUSTABLE HEAVY WIRE STERILE LATEX FREE DISPOSABLE ENDOSCOPIC All Payors / Plans All Payors / Plans $176.27 $176.27 $176.27 $176.27 $176.27 $176.27 $176.27 $172.74 $172.74 STAPLER INTERNAL PROXIMATE TITANIUM STANDARD H1.5 MM L75 MM X H4.5 MM H2 MM REGULAR TISSUE 4 ROW LINEAR CUTTER SAFETY LOCKOUT HEAVY WIRE STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 STAPLER INTERNAL PROXIMATE TITANIUM STANDARD L55 MM X H3.81 MM H1.5 MM REGULAR TISSUE 4 ROW LINEAR CUTTER CARTRIDGE SAFETY LOCK OUT STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC All Payors / Plans All Payors / Plans $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $130.03 $130.03 STAPLER INTERNAL PROXIMATE TITANIUM STANDARD L60 MM X H3.5 MM H1.5 MM REGULAR TISSUE 2 ROW LINEAR RELOADABLE PARALLEL JAW CLOSURE STERILE LATEX FREE DISPOSABLE BLUE All Payors / Plans All Payors / Plans $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $132.68 $130.03 $130.03 STAPLER INTERNAL PROXIMATE TX TITANIUM L30 MM X H2.5 MM H1 MM VASCULAR TISSUE 3 ROW LINEAR RELOAD STERILE LATEX FREE DISPOSABLE WHITE All Payors / Plans All Payors / Plans $166.25 $166.25 $166.25 $166.25 $166.25 $166.25 $166.25 $162.93 $162.93 STAPLER INTERNAL SUREFORM 45 OD14 MM STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $901.60 $901.60 STAPLER RELOAD ENDOWRIST 30 RELOAD GREEN All Payors / Plans All Payors / Plans $341.67 $341.67 $341.67 $341.67 $341.67 $341.67 $341.67 $334.84 $334.84 STAPLER RELOAD ENDOWRIST 30 RELOAD WHITE All Payors / Plans All Payors / Plans $341.67 $341.67 $341.67 $341.67 $341.67 $341.67 $341.67 $334.83 $334.83 STAPLER SKIN PROXIMATE PX STAINLESS STEEL WIDE RECTANGULAR L3.9 MM X W6.9 MM OD.58 MM 35 COUNT MULTIDIRECTIONAL RELEASE FIX HEAD ERGONOMIC PISTOL GRIP HANDLE STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.07 $12.07 STEM FEMORAL ACCOLADE 127 D 4 46 MM OFFSET L137 MM L35 MM HIP CEMENTED All Payors / Plans All Payors / Plans " $7,000.00 " " $7,000.00 " " $7,000.00 " " $7,000.00 " " $7,000.00 " " $7,000.00 " " $7,000.00 " " $6,860.00 " " $6,860.00 " STEM FEMORAL ACCOLADE 132 D 3 39 MM OFFSET L131 MM L35 MM HIP CEMENTED NECK All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " STEM FEMORAL ACCOLADE 132 D 4 42 MM OFFSET L137 MM L35 MM HIP CEMENTED NECK All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " STEM FEMORAL ACCOLADE 132DEG CEMENTED SIZE 5 All Payors / Plans All Payors / Plans " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,500.00 " " $6,370.00 " " $6,370.00 " STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L155 MM OD18 MM HIP MODULAR SYSTEM All Payors / Plans All Payors / Plans " $15,703.20 " " $15,703.20 " " $15,703.20 " " $15,703.20 " " $15,703.20 " " $15,703.20 " " $15,703.20 " " $15,389.14 " " $15,389.14 " STEM HUMERAL ARTHREX UNIVERS REVERS 6 SHOULDER STERILE All Payors / Plans All Payors / Plans " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,092.00 " " $15,092.00 " STEM HUMERAL ARTHREX UNIVERS REVERS 9 SHOULDER STERILE All Payors / Plans All Payors / Plans " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,400.00 " " $15,092.00 " " $15,092.00 " STENT - EXPRESS LD 7.0X27X135 All Payors / Plans All Payors / Plans " $2,485.90 " " $2,485.90 " " $2,485.90 " " $2,485.90 " " $2,485.90 " " $2,485.90 " " $2,485.90 " " $2,436.18 " " $2,436.18 " STENT ARGYLE CAROTID All Payors / Plans All Payors / Plans $78.74 $78.74 $78.74 $78.74 $78.74 $78.74 $78.74 $77.17 $77.17 STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L40 MM L37 MM L75 CM OD7 MM OTW PREMOUNT BALLOON EXPAND STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH All Payors / Plans All Payors / Plans " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,900.00 " " $1,862.00 " " $1,862.00 " STENT BILIARY EXPRESS SD MONORAIL METAL SMALL L18 MM L90 CM OD6 MM RENAL PREMOUNT BALLOON EXPAND All Payors / Plans All Payors / Plans " $1,218.75 " " $1,218.75 " " $1,218.75 " " $1,218.75 " " $1,218.75 " " $1,218.75 " " $1,218.75 " " $1,194.38 " " $1,194.38 " STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L19 MM L90 CM OD5 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA FG All Payors / Plans All Payors / Plans " $1,950.00 " " $1,950.00 " " $1,950.00 " " $1,950.00 " " $1,950.00 " " $1,950.00 " " $1,950.00 " " $1,911.00 " " $1,911.00 " STENT BILIARY FLEXIMA PLASTIC DUODENAL BEND L7 CM OD10 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $225.32 $225.32 $225.32 $225.32 $225.32 $225.32 $225.32 $220.81 $220.81 STENT BILIARY FLEXIMA PLASTIC L12 CM OD10 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans $238.84 $238.84 $238.84 $238.84 $238.84 $238.84 $238.84 $234.06 $234.06 STENT BILIARY WALLFLEX METAL L60 MM OD10 MM ODSEC8 FR UNCOVER RAPID EXCHANGE DELIVERY SYSTEM SELF EXPAND ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans " $3,464.60 " " $3,464.60 " " $3,464.60 " " $3,464.60 " " $3,464.60 " " $3,464.60 " " $3,464.60 " " $3,395.31 " " $3,395.31 " STENT BILIARY WALLFLEX PERMALUME L194 CM L40 MM OD10 MM ODSEC8.5 FR RAPID EXCHANGE FULL COVER ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans " $5,459.78 " " $5,459.78 " " $5,459.78 " " $5,459.78 " " $5,459.78 " " $5,459.78 " " $5,459.78 " " $5,350.58 " " $5,350.58 " STENT BILIARY WALLFLEX PERMALUME L60 MM OD10 MM ODSEC8.5 FR RAPID EXCHANGE SELF EXPAND ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans " $5,787.36 " " $5,787.36 " " $5,787.36 " " $5,787.36 " " $5,787.36 " " $5,787.36 " " $5,787.36 " " $5,671.61 " " $5,671.61 " STENT COLONIC WALLFLEX NITINOL L230 CM L90 CM L270 CM OD25-30 MM ODSEC10 FR DELIVERY SYSTEM STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE All Payors / Plans All Payors / Plans " $5,119.22 " " $5,119.22 " " $5,119.22 " " $5,119.22 " " $5,119.22 " " $5,119.22 " " $5,119.22 " " $5,016.84 " " $5,016.84 " STENT ENDOPROSTHESIS VIABAHN HEPARIN L10 CM L120 CM OD7 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM 0.014-0.018 IN GUIDEWIRE All Payors / Plans All Payors / Plans " $8,466.00 " " $8,466.00 " " $8,466.00 " " $8,466.00 " " $8,466.00 " " $8,466.00 " " $8,466.00 " " $8,296.68 " " $8,296.68 " STENT ENDOPROSTHESIS VIABAHN HEPARIN L5 CM L120 CM OD8 MM ODSEC8 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM 0.014-0.018 IN GUIDEWIRE 0.035 IN GUIDEWIRE All Payors / Plans All Payors / Plans " $6,004.00 " " $6,004.00 " " $6,004.00 " " $6,004.00 " " $6,004.00 " " $6,004.00 " " $6,004.00 " " $5,883.92 " " $5,883.92 " STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L25 CM L120 CM OD5 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 6 FR INTRODUCER SHEATH 4-4.7 MM VESSEL All Payors / Plans All Payors / Plans " $14,760.00 " " $14,760.00 " " $14,760.00 " " $14,760.00 " " $14,760.00 " " $14,760.00 " " $14,760.00 " " $14,464.80 " " $14,464.80 " STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L25 CM L120 CM OD6 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 6 FR INTRODUCER SHEATH 4.8-5.5 MM VESSEL All Payors / Plans All Payors / Plans " $15,056.00 " " $15,056.00 " " $15,056.00 " " $15,056.00 " " $15,056.00 " " $15,056.00 " " $15,056.00 " " $14,754.88 " " $14,754.88 " STENT PANCREATIC ZIMMON POLYETHYLENE TAPER PIGTAIL CURVE SPIRAL L5 CM OD5 FR STERILE DISPOSABLE BLUE All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L 22 CM OD 6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN All Payors / Plans All Payors / Plans $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $216.74 $216.74 STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L24 CM OD6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE All Payors / Plans All Payors / Plans $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $216.74 $216.74 STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L26 CM OD7 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE All Payors / Plans All Payors / Plans $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $216.74 $216.74 STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L28 CM OD6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE All Payors / Plans All Payors / Plans $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $221.16 $216.74 $216.74 STENT VASCULAR ENROUTE L30 MM L57 CM OD7 MM ODSEC.065 IN DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER MICROMESH GEOMETRY ACCEPTS .014/.038 IN GUIDEWIRE 5-6 MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION All Payors / Plans All Payors / Plans " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,491.25 " " $3,491.25 " STENT VASCULAR ENROUTE UBER FLEX NITINOL L40 MM L57 CM OD 10MM ODSEC .078IN DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 8-9 MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION All Payors / Plans All Payors / Plans " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,491.25 " " $3,491.25 " STENT VASCULAR ENROUTE UBER FLEX NITONOL SHORT STRAIGHT L30MM L57CM OD 10 MM OD 6 FR PRELOAD DELIVERY SYSTEM SELFEXPAND CATHETER ACCEPTS .014 IN GUIDEWIRE 8-9MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION All Payors / Plans All Payors / Plans " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,562.50 " " $3,491.25 " " $3,491.25 " STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L30 MM L57 CM OD 8MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 6-7MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION All Payors / Plans All Payors / Plans " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,586.00 " " $5,586.00 " STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L30 MM L57 CM OD 9MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 7-8MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION All Payors / Plans All Payors / Plans " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,586.00 " " $5,586.00 " STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L40 MM L57 CM OD 8MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 6-7MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION All Payors / Plans All Payors / Plans " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,586.00 " " $5,586.00 " STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L40 MM L57 CM OD 9MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 7-8MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION All Payors / Plans All Payors / Plans " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,700.00 " " $5,586.00 " " $5,586.00 " STENT VASCULAR EPIC NITINOL .035 IN L40 MM L75 CM OD8 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE MARKER ACCEPTS 6 FR SHEATH All Payors / Plans All Payors / Plans " $1,716.00 " " $1,716.00 " " $1,716.00 " " $1,716.00 " " $1,716.00 " " $1,716.00 " " $1,716.00 " " $1,681.68 " " $1,681.68 " "STERILE WATER PARENTERAL SOLUTION 1,000 ML FLEX CONT" All Payors / Plans All Payors / Plans $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.31 $11.31 STERILE WATER SOLUTION All Payors / Plans All Payors / Plans $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 $0.15 "STERILE WATER SOLUTION 1,000 ML BOTTLE" All Payors / Plans All Payors / Plans $9.11 $9.11 $9.11 $9.11 $9.11 $9.11 $9.11 $8.92 $8.92 STOCKING COMPRESSION CAP NYLON 19 MMHG REGULAR XL KNEE LENGTH OD18-21 IN ODSEC11-12 IN COOL LIGHTWEIGHT INSPECTION TOE FLOAT DESIGN LATEX FREE GREEN All Payors / Plans All Payors / Plans $4.32 $4.32 $4.32 $4.32 $4.32 $4.32 $4.32 $4.23 $4.23 STOCKING COMPRESSION SMALL THIGH LENGTH ANTIEMBOLISM All Payors / Plans All Payors / Plans $7.62 $7.62 $7.62 $7.62 $7.62 $7.62 $7.62 $7.47 $7.47 STOPCOCK ANGIOGRAPHY MARQUIS POLYCARBONATE DELRIN 1050 PSI 3 WAY FIXED MALE LUER DARK BLUE All Payors / Plans All Payors / Plans $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $33.32 $33.32 STOPCOCK INTRAVENOUS PLASTIC ID .07IN PERIPHERAL 1 WAY FEMALE TO MALE LUER LOCK STERILE DISPOSABLE All Payors / Plans All Payors / Plans $11.40 $11.40 $11.40 $11.40 $11.40 $11.40 $11.40 $11.17 $11.17 STRAP CATHETER VELCRO FOAM UNIVERSAL L22 IN X W2 IN ELASTIC SKIN IRRITATE TAPE HOOK LOOP FASTENER SOFT NONSTERILE LATEX FREE All Payors / Plans All Payors / Plans $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.17 $4.09 $4.09 STRIP SCLERAL SILICONE L125 MM X W3.5 MM X H.75 MM STYLE 41 All Payors / Plans All Payors / Plans $34.80 $34.80 $34.80 $34.80 $34.80 $34.80 $34.80 $34.10 $34.10 STRIP SKIN CLOSURE L4 IN X W.5 IN ADHERENT HYPOALLERGENIC POROUS REINFORCED FILAMENT STERILE LATEX FREE All Payors / Plans All Payors / Plans $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.39 $1.36 $1.36 STYLET STRAIGHTENING All Payors / Plans All Payors / Plans $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $147.00 $147.00 STYLETS ABBOTT/ST JUDE CRM _34810_ All Payors / Plans All Payors / Plans $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $21.56 $21.56 SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) SYRINGE All Payors / Plans All Payors / Plans $18.39 $18.39 $18.39 $18.39 $18.39 $18.39 $18.39 $18.02 $18.02 SUCCINYLCHOLINE PER 20 MG All Payors / Plans All Payors / Plans $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.45 $8.45 SUCRALFATE 1 GRAM TABLET All Payors / Plans All Payors / Plans $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.87 $1.87 SUCRALFATE 100 MG/ML SUSPENSION All Payors / Plans All Payors / Plans $11.53 $11.53 $11.53 $11.53 $11.53 $11.53 $11.53 $11.30 $11.30 SUGAMMADEX 100 MG/ML SOLUTION All Payors / Plans All Payors / Plans $319.94 $319.94 $319.94 $319.94 $319.94 $319.94 $319.94 $313.54 $313.54 SULFACETAMIDE 10 % DROPS 15 ML DROP BTL All Payors / Plans All Payors / Plans $156.94 $156.94 $156.94 $156.94 $156.94 $156.94 $156.94 $153.80 $153.80 SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML SUSPENSION All Payors / Plans All Payors / Plans $0.61 $0.61 $0.61 $0.61 $0.61 $0.61 $0.61 $0.60 $0.60 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG TABLET All Payors / Plans All Payors / Plans $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.09 $1.09 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML SOLUTION 10 ML VIAL All Payors / Plans All Payors / Plans $36.43 $36.43 $36.43 $36.43 $36.43 $36.43 $36.43 $35.70 $35.70 SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG TABLET All Payors / Plans All Payors / Plans $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.95 $0.93 $0.93 SULFASALAZINE 500 MG TABLET All Payors / Plans All Payors / Plans $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.07 $1.05 $1.05 SUMATRIPTAN 25 MG TABLET All Payors / Plans All Payors / Plans $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.80 $6.80 SUMATRIPTAN SUCCINATE 6 MG/0.5 ML SOLUTION All Payors / Plans All Payors / Plans $30.94 $30.94 $30.94 $30.94 $30.94 $30.94 $30.94 $30.32 $30.32 SUPERBAG 15 2XL NYLON SPECIMEN RETRIEVAL BAG All Payors / Plans All Payors / Plans $130.98 $130.98 $130.98 $130.98 $130.98 $130.98 $130.98 $128.36 $128.36 SUPERBAG 1O MED NYLON SPECIMEN RETRIEVAL BAG All Payors / Plans All Payors / Plans $60.98 $60.98 $60.98 $60.98 $60.98 $60.98 $60.98 $59.76 $59.76 SUPPORT MAMMARY SURGI-BRA 42-44IN 2XL 96% COTTON 4% SPANDEX VELCRO LF BREAST PAD All Payors / Plans All Payors / Plans $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $45.24 $44.34 $44.34 SUPPORTER ATHLETIC BAUER & BLACK LG 39-44IN 3IN LATEX ADULT ELASTIC WAISTBAND All Payors / Plans All Payors / Plans $4.98 $4.98 $4.98 $4.98 $4.98 $4.98 $4.98 $4.88 $4.88 SUREFORM 60 RELOAD BLUE All Payors / Plans All Payors / Plans $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $450.80 $450.80 SUREFORM 60 RELOAD WHITE All Payors / Plans All Payors / Plans $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $450.80 $450.80 SUREFORM 60 STAPLER All Payors / Plans All Payors / Plans " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,060.00 " " $1,038.80 " " $1,038.80 " SUTURE ABSORBABLE CHROMIC 0 CT-1 L27 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $5.19 $5.19 $5.19 $5.19 $5.19 $5.19 $5.19 $5.09 $5.09 SUTURE ABSORBABLE CHROMIC 1 CT L36 IN MONOFILAMENT All Payors / Plans All Payors / Plans $3.85 $3.85 $3.85 $3.85 $3.85 $3.85 $3.85 $3.77 $3.77 SUTURE ABSORBABLE CHROMIC 1 CT-1 L27 IN MONOFILAMENT All Payors / Plans All Payors / Plans $5.39 $5.39 $5.39 $5.39 $5.39 $5.39 $5.39 $5.28 $5.28 SUTURE ABSORBABLE CHROMIC 2-0 CT-1 L27 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $5.04 $5.04 $5.04 $5.04 $5.04 $5.04 $5.04 $4.94 $4.94 SUTURE ABSORBABLE CHROMIC 2-0 SH L27 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $5.06 $5.06 $5.06 $5.06 $5.06 $5.06 $5.06 $4.96 $4.96 SUTURE ABSORBABLE CHROMIC 3-0 CT-1 L36 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $5.57 $5.57 $5.57 $5.57 $5.57 $5.57 $5.57 $5.46 $5.46 SUTURE ABSORBABLE CHROMIC 3-0 FS-2 L27 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $4.98 $4.98 $4.98 $4.98 $4.98 $4.98 $4.98 $4.88 $4.88 SUTURE ABSORBABLE CHROMIC 3-0 SH L27 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $5.19 $5.19 $5.19 $5.19 $5.19 $5.19 $5.19 $5.09 $5.09 SUTURE ABSORBABLE CHROMIC 4-0 J-1 L18 IN MONOFILAMENT All Payors / Plans All Payors / Plans $5.28 $5.28 $5.28 $5.28 $5.28 $5.28 $5.28 $5.17 $5.17 SUTURE ABSORBABLE CHROMIC 4-0 RB-1 L27 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $5.44 $5.44 $5.44 $5.44 $5.44 $5.44 $5.44 $5.33 $5.33 SUTURE ABSORBABLE MONOCRYL 0 CT-1 L36 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $4.03 $4.03 $4.03 $4.03 $4.03 $4.03 $4.03 $3.95 $3.95 SUTURE ABSORBABLE MONOCRYL 2-0 CT-1 L36 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $4.11 $4.11 $4.11 $4.11 $4.11 $4.11 $4.11 $4.03 $4.03 SUTURE ABSORBABLE MONOCRYL 2-0 UR-6 27IN VIOLET MONOFILAMENT All Payors / Plans All Payors / Plans $5.03 $5.03 $5.03 $5.03 $5.03 $5.03 $5.03 $4.93 $4.93 SUTURE ABSORBABLE MONOCRYL 3-0 CT-1 L36 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $4.07 $4.07 $4.07 $4.07 $4.07 $4.07 $4.07 $3.99 $3.99 SUTURE ABSORBABLE MONOCRYL 3-0 KS L27 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $5.95 $5.95 $5.95 $5.95 $5.95 $5.95 $5.95 $5.83 $5.83 SUTURE ABSORBABLE MONOCRYL 3-0 SH L27 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $132.36 $132.36 $132.36 $132.36 $132.36 $132.36 $132.36 $129.71 $129.71 SUTURE ABSORBABLE MONOCRYL 5-0 RB-1 L27 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $147.84 $147.84 $147.84 $147.84 $147.84 $147.84 $147.84 $144.88 $144.88 SUTURE ABSORBABLE MONOCRYL MULTIPASS 4-0 PS-2 L27 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $10.11 $10.11 $10.11 $10.11 $10.11 $10.11 $10.11 $9.91 $9.91 SUTURE ABSORBABLE MONOCRYL MULTIPASS 6-0 P-3 L18 IN MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.58 $10.58 SUTURE ABSORBABLE MONOCRYL PLUS MULTIPASS 3-0 PS-2 27IN UNDYED MONOFILAMENT All Payors / Plans All Payors / Plans $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $9.80 $9.80 SUTURE ABSORBABLE MULTIPASS 5-0 PS-4 18IN YELLOWISH TAN PLAIN MONOFILAMENT All Payors / Plans All Payors / Plans $10.34 $10.34 $10.34 $10.34 $10.34 $10.34 $10.34 $10.13 $10.13 SUTURE ABSORBABLE MULTIPASS CHROMIC 5-0 P-3 L18 IN MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $10.55 $10.55 $10.55 $10.55 $10.55 $10.55 $10.55 $10.34 $10.34 SUTURE ABSORBABLE PDS II 0 CT-1 L27 IN MONOFILAMENT VIOLET All Payors / Plans All Payors / Plans $4.42 $4.42 $4.42 $4.42 $4.42 $4.42 $4.42 $4.33 $4.33 SUTURE ABSORBABLE PDS II 0 CTX L60 IN MONOFILAMENT LOOP VIOLET All Payors / Plans All Payors / Plans $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.62 $9.62 SUTURE ABSORBABLE PDS II 1 CT-1 L27 IN MONOFILAMENT VIOLET All Payors / Plans All Payors / Plans $4.50 $4.50 $4.50 $4.50 $4.50 $4.50 $4.50 $4.41 $4.41 SUTURE ABSORBABLE PDS II 1 CTX L36 IN MONOFILAMENT VIOLET All Payors / Plans All Payors / Plans $5.08 $5.08 $5.08 $5.08 $5.08 $5.08 $5.08 $4.97 $4.97 SUTURE ABSORBABLE PDS II 1 TP-1 L96 IN MONOFILAMENT LOOP VIOLET All Payors / Plans All Payors / Plans $8.74 $8.74 $8.74 $8.74 $8.74 $8.74 $8.74 $8.57 $8.57 SUTURE ABSORBABLE PDS II 2-0 SH L27 IN MONOFILAMENT VIOLET All Payors / Plans All Payors / Plans $19.86 $19.86 $19.86 $19.86 $19.86 $19.86 $19.86 $19.46 $19.46 SUTURE ABSORBABLE PDS II 3-0 SH L27 IN MONOFILAMENT VIOLET All Payors / Plans All Payors / Plans $4.57 $4.57 $4.57 $4.57 $4.57 $4.57 $4.57 $4.48 $4.48 SUTURE ABSORBABLE PLAIN 3-0 CT-1 L18 IN MONOFILAMENT 3 STRAND All Payors / Plans All Payors / Plans $14.83 $14.83 $14.83 $14.83 $14.83 $14.83 $14.83 $14.53 $14.53 SUTURE ABSORBABLE QUILL PDO 2 1/2 CIRCLE L36 CM L48 MM 2 ARM MONOFILAMENT BARB TAPER POINT VIOLET All Payors / Plans All Payors / Plans $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $39.29 $39.29 SUTURE ABSORBABLE ULTIMA CHROMIC 7-0 CS175-8 L18 IN 2 ARM MONOFILAMENT BROWN All Payors / Plans All Payors / Plans $36.67 $36.67 $36.67 $36.67 $36.67 $36.67 $36.67 $35.94 $35.94 SUTURE ABSORBABLE VICRYL 0 CP-1 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $3.20 $3.20 $3.20 $3.20 $3.20 $3.20 $3.20 $3.14 $3.14 SUTURE ABSORBABLE VICRYL 0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED UNDYED All Payors / Plans All Payors / Plans $19.76 $19.76 $19.76 $19.76 $19.76 $19.76 $19.76 $19.36 $19.36 SUTURE ABSORBABLE VICRYL 0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET All Payors / Plans All Payors / Plans $19.72 $19.72 $19.72 $19.72 $19.72 $19.72 $19.72 $19.33 $19.33 SUTURE ABSORBABLE VICRYL 0 CT-1 L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.54 $2.54 SUTURE ABSORBABLE VICRYL 0 CT-1 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.57 $2.57 SUTURE ABSORBABLE VICRYL 0 CT-1 L36 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.76 $2.70 $2.70 SUTURE ABSORBABLE VICRYL 0 CTX L36 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.86 $2.86 $2.86 $2.86 $2.86 $2.86 $2.86 $2.80 $2.80 SUTURE ABSORBABLE VICRYL 0 STANDARD SHORT L18 IN BRAID TIES 3 STRAND COATED VIOLET All Payors / Plans All Payors / Plans $4.21 $4.21 $4.21 $4.21 $4.21 $4.21 $4.21 $4.13 $4.13 SUTURE ABSORBABLE VICRYL 0 UR-5 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $3.26 $3.26 $3.26 $3.26 $3.26 $3.26 $3.26 $3.19 $3.19 SUTURE ABSORBABLE VICRYL 0 UR-6 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $3.20 $3.20 $3.20 $3.20 $3.20 $3.20 $3.20 $3.14 $3.14 SUTURE ABSORBABLE VICRYL 1 CP L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $2.84 $2.84 $2.84 $2.84 $2.84 $2.84 $2.84 $2.78 $2.78 SUTURE ABSORBABLE VICRYL 1 CT L36 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.86 $2.86 $2.86 $2.86 $2.86 $2.86 $2.86 $2.80 $2.80 SUTURE ABSORBABLE VICRYL 1 CT-2 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $3.07 $3.07 $3.07 $3.07 $3.07 $3.07 $3.07 $3.01 $3.01 SUTURE ABSORBABLE VICRYL 2 CP L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $3.16 $3.16 $3.16 $3.16 $3.16 $3.16 $3.16 $3.10 $3.10 SUTURE ABSORBABLE VICRYL 2-0 CP-1 L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $2.81 $2.81 $2.81 $2.81 $2.81 $2.81 $2.81 $2.75 $2.75 SUTURE ABSORBABLE VICRYL 2-0 CP-2 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED UNDYED All Payors / Plans All Payors / Plans $14.99 $14.99 $14.99 $14.99 $14.99 $14.99 $14.99 $14.69 $14.69 SUTURE ABSORBABLE VICRYL 2-0 CT L36 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $3.17 $3.17 $3.17 $3.17 $3.17 $3.17 $3.17 $3.11 $3.11 SUTURE ABSORBABLE VICRYL 2-0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET All Payors / Plans All Payors / Plans $19.65 $19.65 $19.65 $19.65 $19.65 $19.65 $19.65 $19.26 $19.26 SUTURE ABSORBABLE VICRYL 2-0 CT-1 L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.53 $2.53 SUTURE ABSORBABLE VICRYL 2-0 CT-1 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.53 $2.53 SUTURE ABSORBABLE VICRYL 2-0 CT-2 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET All Payors / Plans All Payors / Plans $229.56 $229.56 $229.56 $229.56 $229.56 $229.56 $229.56 $224.97 $224.97 SUTURE ABSORBABLE VICRYL 2-0 SH L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.53 $2.53 SUTURE ABSORBABLE VICRYL 2-0 UR-6 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $3.24 $3.24 $3.24 $3.24 $3.24 $3.24 $3.24 $3.18 $3.18 SUTURE ABSORBABLE VICRYL 3-0 CT-1 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.61 $2.61 $2.61 $2.61 $2.61 $2.61 $2.61 $2.56 $2.56 SUTURE ABSORBABLE VICRYL 3-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET All Payors / Plans All Payors / Plans $19.38 $19.38 $19.38 $19.38 $19.38 $19.38 $19.38 $18.99 $18.99 SUTURE ABSORBABLE VICRYL 3-0 SH L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.55 $2.55 SUTURE ABSORBABLE VICRYL 3-0 SH L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.59 $2.54 $2.54 SUTURE ABSORBABLE VICRYL 3-0 SH-1 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $3.03 $3.03 $3.03 $3.03 $3.03 $3.03 $3.03 $2.97 $2.97 SUTURE ABSORBABLE VICRYL 4-0 FS-2 L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $10.93 $10.93 $10.93 $10.93 $10.93 $10.93 $10.93 $10.71 $10.71 SUTURE ABSORBABLE VICRYL 4-0 SH L27 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.41 $2.41 SUTURE ABSORBABLE VICRYL 4-0 SH-1 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.64 $2.64 SUTURE ABSORBABLE VICRYL 4-0 TF L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET All Payors / Plans All Payors / Plans $26.86 $26.86 $26.86 $26.86 $26.86 $26.86 $26.86 $26.32 $26.32 SUTURE ABSORBABLE VICRYL 5-0 RB-1 L27 IN BRAID COATED VIOLET All Payors / Plans All Payors / Plans $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.60 $2.60 SUTURE ABSORBABLE VICRYL LIGAPAK 2-0 L54 IN BRAID REEL COATED VIOLET All Payors / Plans All Payors / Plans $3.71 $3.71 $3.71 $3.71 $3.71 $3.71 $3.71 $3.64 $3.64 SUTURE ABSORBABLE VICRYL LIGAPAK 3-0 L54 IN BRAID REEL COATED VIOLET All Payors / Plans All Payors / Plans $3.67 $3.67 $3.67 $3.67 $3.67 $3.67 $3.67 $3.60 $3.60 SUTURE ABSORBABLE VICRYL LIGAPAK 4-0 L54 IN BRAID REEL COATED VIOLET All Payors / Plans All Payors / Plans $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 SUTURE ABSORBABLE VICRYL MICROPOINT 6-0 S-14 12IN VIOLET 2 ARM BRAID COATED All Payors / Plans All Payors / Plans $24.39 $24.39 $24.39 $24.39 $24.39 $24.39 $24.39 $23.90 $23.90 SUTURE ABSORBABLE VICRYL MICROPOINT 7-0 TG140-8 18IN VIOLET 2 ARM BRAID COATED All Payors / Plans All Payors / Plans $23.40 $23.40 $23.40 $23.40 $23.40 $23.40 $23.40 $22.93 $22.93 SUTURE ABSORBABLE VICRYL MULTIPASS 3-0 PS-1 27IN UNDYED BRAID COATED All Payors / Plans All Payors / Plans $7.60 $7.60 $7.60 $7.60 $7.60 $7.60 $7.60 $7.45 $7.45 SUTURE ABSORBABLE VICRYL MULTIPASS 3-0 PS-2 18IN UNDYED BRAID COATED All Payors / Plans All Payors / Plans $6.80 $6.80 $6.80 $6.80 $6.80 $6.80 $6.80 $6.66 $6.66 SUTURE ABSORBABLE VICRYL MULTIPASS 4-0 PS-2 27IN UNDYED BRAID COATED All Payors / Plans All Payors / Plans $6.97 $6.97 $6.97 $6.97 $6.97 $6.97 $6.97 $6.83 $6.83 SUTURE ABSORBABLE VICRYL MULTIPASS 5-0 P-3 18IN UNDYED BRAID COATED All Payors / Plans All Payors / Plans $8.27 $8.27 $8.27 $8.27 $8.27 $8.27 $8.27 $8.10 $8.10 SUTURE ABSORBABLE VICRYL MULTIPASS 5-0 PS-3 L18 IN BRAID COATED UNDYED All Payors / Plans All Payors / Plans $7.88 $7.88 $7.88 $7.88 $7.88 $7.88 $7.88 $7.72 $7.72 SUTURE ABSORBABLE VICRYL MULTIPASS 8-0 BV130-5 5IN VIOLET BRAID COATED All Payors / Plans All Payors / Plans $27.92 $27.92 $27.92 $27.92 $27.92 $27.92 $27.92 $27.36 $27.36 SUTURE ABSORBABLE VICRYL PLUS 4-0 SH L27 IN BRAID ANTIBACTERIAL COATED VIOLET All Payors / Plans All Payors / Plans $2.21 $2.21 $2.21 $2.21 $2.21 $2.21 $2.21 $2.17 $2.17 SUTURE CLOSURE V-LOC 2-0 V-20 L12IIN NONABSORBABLE BLUE All Payors / Plans All Payors / Plans $25.73 $25.73 $25.73 $25.73 $25.73 $25.73 $25.73 $25.22 $25.22 SUTURE ETHILON MONOFILAMENT BLACK NEEDLE:PS-1 SIZE:3-0 LENGTH:18IN All Payors / Plans All Payors / Plans $7.48 $7.48 $7.48 $7.48 $7.48 $7.48 $7.48 $7.33 $7.33 SUTURE FIBERTAPE CERCLAGE All Payors / Plans All Payors / Plans $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $882.00 $882.00 SUTURE NONABSORBABLE ETHIBOND 0 CT-1 L30 IN BRAID GREEN All Payors / Plans All Payors / Plans $2.88 $2.88 $2.88 $2.88 $2.88 $2.88 $2.88 $2.82 $2.82 SUTURE NONABSORBABLE ETHIBOND 0 CTX 18IN GREEN POLYESTER CONTROL RELEASE BRAID 8 STRAND All Payors / Plans All Payors / Plans $233.62 $233.62 $233.62 $233.62 $233.62 $233.62 $233.62 $228.95 $228.95 SUTURE NONABSORBABLE ETHIBOND 1 CT-1 L30 IN BRAID GREEN All Payors / Plans All Payors / Plans $3.28 $3.28 $3.28 $3.28 $3.28 $3.28 $3.28 $3.21 $3.21 SUTURE NONABSORBABLE ETHIBOND 2 V-37 L30 IN BRAID 4 STRAND GREEN All Payors / Plans All Payors / Plans $26.82 $26.82 $26.82 $26.82 $26.82 $26.82 $26.82 $26.28 $26.28 SUTURE NONABSORBABLE ETHIBOND 2-0 CT-2 18IN GREEN POLYESTER CONTROL RELEASE BRAID 8 STRAND All Payors / Plans All Payors / Plans $236.12 $236.12 $236.12 $236.12 $236.12 $236.12 $236.12 $231.40 $231.40 SUTURE NONABSORBABLE ETHIBOND 2-0 SH L36 IN 2 ARM BRAID GREEN All Payors / Plans All Payors / Plans $7.08 $7.08 $7.08 $7.08 $7.08 $7.08 $7.08 $6.94 $6.94 SUTURE NONABSORBABLE ETHIBOND 3-0 SH L30 IN BRAID GREEN All Payors / Plans All Payors / Plans $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.55 $3.47 $3.47 SUTURE NONABSORBABLE ETHIBOND 5 V-37 L30 IN BRAID 4 STRAND GREEN All Payors / Plans All Payors / Plans $27.08 $27.08 $27.08 $27.08 $27.08 $27.08 $27.08 $26.53 $26.53 SUTURE NONABSORBABLE ETHILON 2 LR 20IN BLACK MONOFILAMENT All Payors / Plans All Payors / Plans $3.78 $3.78 $3.78 $3.78 $3.78 $3.78 $3.78 $3.70 $3.70 SUTURE NONABSORBABLE ETHILON 2 LR L30 IN 2 ARM MONOFILAMENT BLACK All Payors / Plans All Payors / Plans $4.04 $4.04 $4.04 $4.04 $4.04 $4.04 $4.04 $3.96 $3.96 SUTURE NONABSORBABLE ETHILON 2-0 FS L18 IN MONOFILAMENT BLACK All Payors / Plans All Payors / Plans $3.37 $3.37 $3.37 $3.37 $3.37 $3.37 $3.37 $3.30 $3.30 SUTURE NONABSORBABLE ETHILON 2-0 FSLX L30 IN MONOFILAMENT BLACK All Payors / Plans All Payors / Plans $3.48 $3.48 $3.48 $3.48 $3.48 $3.48 $3.48 $3.41 $3.41 SUTURE NONABSORBABLE ETHILON 3-0 KS L30 IN MONOFILAMENT BLACK All Payors / Plans All Payors / Plans $3.56 $3.56 $3.56 $3.56 $3.56 $3.56 $3.56 $3.49 $3.49 SUTURE NONABSORBABLE ETHILON 4-0 PS-2 L18 IN BLACK All Payors / Plans All Payors / Plans $6.85 $6.85 $6.85 $6.85 $6.85 $6.85 $6.85 $6.71 $6.71 SUTURE NONABSORBABLE ETHILON MICROPOINT 10-0 TG160-6 6IN BLACK 2 ARM MONOFILAMENT All Payors / Plans All Payors / Plans $31.77 $31.77 $31.77 $31.77 $31.77 $31.77 $31.77 $31.13 $31.13 SUTURE NONABSORBABLE ETHILON MULTIPASS 3-0 PS-1 18IN BLACK MONOFILAMENT All Payors / Plans All Payors / Plans $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.32 $7.32 SUTURE NONABSORBABLE ETHILON MULTIPASS 5-0 PS-2 18IN BLACK MONOFILAMENT All Payors / Plans All Payors / Plans $6.92 $6.92 $6.92 $6.92 $6.92 $6.92 $6.92 $6.78 $6.78 SUTURE NONABSORBABLE ETHILON ULTIMA NYLON 66 8-0 CS175-8 L12 IN 2 ARM MONOFILAMENT BLACK All Payors / Plans All Payors / Plans $30.42 $30.42 $30.42 $30.42 $30.42 $30.42 $30.42 $29.81 $29.81 SUTURE NONABSORBABLE FIBERLINK FIBERWIRE 2 L26 IN L1.5 IN BRAID TIES MULTISTRAND CLOSE LOOP BLUE All Payors / Plans All Payors / Plans $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $107.80 $107.80 SUTURE NONABSORBABLE FIBERSTICK TIGERSTICK 2 L50 IN L12 IN 1 END STIFFEN BRAID MONOFILAMENT TIES BLUE All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 SUTURE NONABSORBABLE FIBERWIRE 2 T-5 L38 IN BRAID TIES MULTISTRAND LOWER KNOT PROFILE BLUE All Payors / Plans All Payors / Plans $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $30.38 $30.38 SUTURE NONABSORBABLE FIBERWIRE 2 T-8 L38 IN 2 ARM BRAID MULTISTRAND LOWER KNOT PROFILE BARB BLUE All Payors / Plans All Payors / Plans $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $43.12 $43.12 SUTURE NONABSORBABLE FIBERWIRE 5 CCS-1 L38 IN BRAID TIES MULTISTRAND LOWER KNOT PROFILE BLUE All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 SUTURE NONABSORBABLE GORE-TEX CV-0 TH-50 L48 IN All Payors / Plans All Payors / Plans $58.84 $58.84 $58.84 $58.84 $58.84 $58.84 $58.84 $57.66 $57.66 SUTURE NONABSORBABLE GORE-TEX CV-0 THX-36 L36 IN 2 ARM MONOFILAMENT UNDYED All Payors / Plans All Payors / Plans $58.84 $58.84 $58.84 $58.84 $58.84 $58.84 $58.84 $57.66 $57.66 SUTURE NONABSORBABLE GORE-TEX CV-6 PT-9 L30 IN 2 ARM MONOFILAMENT WHITE All Payors / Plans All Payors / Plans $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $64.68 $64.68 SUTURE NONABSORBABLE LABRALTAPE 1.5 MM L36 IN WHITE All Payors / Plans All Payors / Plans $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $68.60 $68.60 SUTURE NONABSORBABLE NUROLON 4-0 TF 18IN BLACK NYLON 6 6 CONTROL RELEASE BRAID 8 STRAND All Payors / Plans All Payors / Plans $26.24 $26.24 $26.24 $26.24 $26.24 $26.24 $26.24 $25.72 $25.72 SUTURE NONABSORBABLE PERMA-HAND 0 18IN BLACK SILK BRAID TIE 6 STRAND PRECUT All Payors / Plans All Payors / Plans $58.78 $58.78 $58.78 $58.78 $58.78 $58.78 $58.78 $57.60 $57.60 SUTURE NONABSORBABLE PERMA-HAND 0 30IN BLACK SILK BRAID TIE 6 STRAND PRECUT All Payors / Plans All Payors / Plans $2.45 $2.45 $2.45 $2.45 $2.45 $2.45 $2.45 $2.40 $2.40 SUTURE NONABSORBABLE PERMA-HAND 1 30IN BLACK SILK BRAID TIE 6 STRAND PRECUT All Payors / Plans All Payors / Plans $2.43 $2.43 $2.43 $2.43 $2.43 $2.43 $2.43 $2.38 $2.38 SUTURE NONABSORBABLE PERMA-HAND 2-0 18IN BLACK SILK BRAID TIES 12 STRAND PRECUT All Payors / Plans All Payors / Plans $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.62 $2.57 $2.57 SUTURE NONABSORBABLE PERMA-HAND 2-0 30IN BLACK SILK BRAID TIE 12 STRAND PRECUT All Payors / Plans All Payors / Plans $4.25 $4.25 $4.25 $4.25 $4.25 $4.25 $4.25 $4.16 $4.16 SUTURE NONABSORBABLE PERMA-HAND 3-0 18IN BLACK SILK BRAID TIES 12 STRAND PRECUT All Payors / Plans All Payors / Plans $3.07 $3.07 $3.07 $3.07 $3.07 $3.07 $3.07 $3.00 $3.00 SUTURE NONABSORBABLE PERMA-HAND 3-0 30IN BLACK SILK BRAID TIE 12 STRAND PRECUT All Payors / Plans All Payors / Plans $5.17 $5.17 $5.17 $5.17 $5.17 $5.17 $5.17 $5.06 $5.06 SUTURE NONABSORBABLE PERMA-HAND 4-0 18IN BLACK SILK BRAID TIES 12 STRAND PRECUT All Payors / Plans All Payors / Plans $3.60 $3.60 $3.60 $3.60 $3.60 $3.60 $3.60 $3.53 $3.53 SUTURE NONABSORBABLE PERMA-HAND MULTIPASS SILK 3-0 PS-1 L18 IN BRAID BLACK All Payors / Plans All Payors / Plans $6.74 $6.74 $6.74 $6.74 $6.74 $6.74 $6.74 $6.61 $6.61 SUTURE NONABSORBABLE PERMA-HAND SILK 0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND BLACK All Payors / Plans All Payors / Plans $15.66 $15.66 $15.66 $15.66 $15.66 $15.66 $15.66 $15.35 $15.35 SUTURE NONABSORBABLE PERMA-HAND SILK 0 KS L30 IN BRAID BLACK All Payors / Plans All Payors / Plans $2.79 $2.79 $2.79 $2.79 $2.79 $2.79 $2.79 $2.73 $2.73 SUTURE NONABSORBABLE PERMA-HAND SILK 0 MH L30 IN BRAID BLACK All Payors / Plans All Payors / Plans $2.22 $2.22 $2.22 $2.22 $2.22 $2.22 $2.22 $2.18 $2.18 SUTURE NONABSORBABLE PERMA-HAND SILK 0 SH L30 IN BRAID 4 STRAND BLACK All Payors / Plans All Payors / Plans $13.37 $13.37 $13.37 $13.37 $13.37 $13.37 $13.37 $13.10 $13.10 SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 MH L30 IN BRAID BLACK All Payors / Plans All Payors / Plans $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.41 $2.41 SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND BLACK All Payors / Plans All Payors / Plans $15.10 $15.10 $15.10 $15.10 $15.10 $15.10 $15.10 $14.80 $14.80 SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 SH L30 IN BRAID BLACK All Payors / Plans All Payors / Plans $2.19 $2.19 $2.19 $2.19 $2.19 $2.19 $2.19 $2.15 $2.15 SUTURE NONABSORBABLE PERMA-HAND SILK 3-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND BLACK All Payors / Plans All Payors / Plans $15.16 $15.16 $15.16 $15.16 $15.16 $15.16 $15.16 $14.86 $14.86 SUTURE NONABSORBABLE PERMA-HAND SILK 3-0 SH L30 IN BRAID BLACK All Payors / Plans All Payors / Plans $2.17 $2.17 $2.17 $2.17 $2.17 $2.17 $2.17 $2.13 $2.13 SUTURE NONABSORBABLE PERMA-HAND SUTUPAK SILK 1 L18 IN BRAID TIES 6 STRAND PRECUT BLACK All Payors / Plans All Payors / Plans $1.49 $1.49 $1.49 $1.49 $1.49 $1.49 $1.49 $1.46 $1.46 SUTURE NONABSORBABLE PROLENE 1 CTX L30 IN MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $4.15 $4.15 $4.15 $4.15 $4.15 $4.15 $4.15 $4.07 $4.07 SUTURE NONABSORBABLE PROLENE 1 XLH 60IN BLUE MONOFILAMENT All Payors / Plans All Payors / Plans $5.14 $5.14 $5.14 $5.14 $5.14 $5.14 $5.14 $5.03 $5.03 SUTURE NONABSORBABLE PROLENE 2-0 CT-1 L30 IN MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.78 $2.72 $2.72 SUTURE NONABSORBABLE PROLENE 2-0 FS L18 IN MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $2.93 $2.93 $2.93 $2.93 $2.93 $2.93 $2.93 $2.87 $2.87 SUTURE NONABSORBABLE PROLENE 2-0 SH L36 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $10.08 $10.08 $10.08 $10.08 $10.08 $10.08 $10.08 $9.88 $9.88 SUTURE NONABSORBABLE PROLENE 3-0 FS-1 L18 IN MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $5.59 $5.59 $5.59 $5.59 $5.59 $5.59 $5.59 $5.48 $5.48 SUTURE NONABSORBABLE PROLENE 3-0 KS L30 IN MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $5.64 $5.64 $5.64 $5.64 $5.64 $5.64 $5.64 $5.53 $5.53 SUTURE NONABSORBABLE PROLENE 3-0 MH L36 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $9.03 $9.03 $9.03 $9.03 $9.03 $9.03 $9.03 $8.85 $8.85 SUTURE NONABSORBABLE PROLENE 3-0 SH L36 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $10.25 $10.25 $10.25 $10.25 $10.25 $10.25 $10.25 $10.05 $10.05 SUTURE NONABSORBABLE PROLENE 4-0 RB-1 L36 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.06 $10.06 SUTURE NONABSORBABLE PROLENE 4-0 SH L36 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $10.36 $10.36 $10.36 $10.36 $10.36 $10.36 $10.36 $10.15 $10.15 SUTURE NONABSORBABLE PROLENE 5-0 C-1 L36 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $26.12 $26.12 $26.12 $26.12 $26.12 $26.12 $26.12 $25.59 $25.59 SUTURE NONABSORBABLE PROLENE 6-0 BV-1 L24 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $31.05 $31.05 $31.05 $31.05 $31.05 $31.05 $31.05 $30.43 $30.43 SUTURE NONABSORBABLE PROLENE 6-0 BV-1 L30 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $31.05 $31.05 $31.05 $31.05 $31.05 $31.05 $31.05 $30.43 $30.43 SUTURE NONABSORBABLE PROLENE 6-0 C-1 L30 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $27.42 $27.42 $27.42 $27.42 $27.42 $27.42 $27.42 $26.87 $26.87 SUTURE NONABSORBABLE PROLENE 6-0 P-1 L18 IN MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.63 $10.42 $10.42 SUTURE NONABSORBABLE PROLENE 7-0 BV-1 L30 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $32.13 $32.13 $32.13 $32.13 $32.13 $32.13 $32.13 $31.49 $31.49 SUTURE NONABSORBABLE PROLENE MULTIPASS 4-0 P-3 18IN BLUE MONOFILAMENT All Payors / Plans All Payors / Plans $9.92 $9.92 $9.92 $9.92 $9.92 $9.92 $9.92 $9.72 $9.72 SUTURE NONABSORBABLE PROLENE MULTIPASS 4-0 PS-2 18IN BLUE MONOFILAMENT All Payors / Plans All Payors / Plans $9.74 $9.74 $9.74 $9.74 $9.74 $9.74 $9.74 $9.55 $9.55 SUTURE NONABSORBABLE PROLENE MULTIPASS 5-0 P-3 18IN BLUE MONOFILAMENT All Payors / Plans All Payors / Plans $8.60 $8.60 $8.60 $8.60 $8.60 $8.60 $8.60 $8.43 $8.43 SUTURE NONABSORBABLE PROLENE MULTIPASS 8-0 BV130-5 24IN BLUE 2 ARM MONOFILAMENT All Payors / Plans All Payors / Plans $45.20 $45.20 $45.20 $45.20 $45.20 $45.20 $45.20 $44.30 $44.30 SUTURE NONABSORBABLE PROLENE POLYPROPYLENE 0 CT L30 IN MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $4.40 $4.40 $4.40 $4.40 $4.40 $4.40 $4.40 $4.31 $4.31 SUTURE NONABSORBABLE PROLENE POLYPROPYLENE 5-0 C-1 L36 IN 2 ARM MONOFILAMENT BLUE All Payors / Plans All Payors / Plans $27.90 $27.90 $27.90 $27.90 $27.90 $27.90 $27.90 $27.34 $27.34 SUTURE NONABSORBABLE SUTURETAPE L40 IN OD1.3 MM X 2 STRAND BLACK BLUE WHITE All Payors / Plans All Payors / Plans $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $127.40 $127.40 SUTURE NONABSORBABLE TAPERCUT STAINLESS STEEL 6 V-40 L18 IN MONOFILAMENT 4 STRAND All Payors / Plans All Payors / Plans $23.85 $23.85 $23.85 $23.85 $23.85 $23.85 $23.85 $23.37 $23.37 SUTURE NONABSORBABLE TIGERLINK FIBERWIRE 2 L26 IN CLOSED LOOP BLACK WHITE All Payors / Plans All Payors / Plans $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $107.80 $107.80 SUTURE NONABSORBABLE TIGERSTICK TIGERWIRE 2 50IN 12IN BLACK WHITE 1 END STIFFEN All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 SUTURE PROLENE 7/0 24IN BV175-6 All Payors / Plans All Payors / Plans $45.20 $45.20 $45.20 $45.20 $45.20 $45.20 $45.20 $44.30 $44.30 SUTURE SILK 2-0 BLK BR BB 30IN All Payors / Plans All Payors / Plans $3.70 $3.70 $3.70 $3.70 $3.70 $3.70 $3.70 $3.63 $3.63 SUTURE VICRYL 2-0 All Payors / Plans All Payors / Plans $3.04 $3.04 $3.04 $3.04 $3.04 $3.04 $3.04 $2.98 $2.98 "SUTURE VLOC NON ABS DVC 1BL 18""L GS-21" All Payors / Plans All Payors / Plans $43.39 $43.39 $43.39 $43.39 $43.39 $43.39 $43.39 $42.52 $42.52 SWAB CULTURE BD CULTURESWAB LIQUID STUART MED STERILE All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 SWITCH FLOW HIGH PRESSURE All Payors / Plans All Payors / Plans $5.52 $5.52 $5.52 $5.52 $5.52 $5.52 $5.52 $5.41 $5.41 SYRINGE ANGIOGRAPHY MEDALLION 1 ML CLEAR POLYCARBONATE BARREL FIXED MALE LUER PLUNGER YELLOW All Payors / Plans All Payors / Plans $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.40 $3.33 $3.33 SYRINGE ANGIOGRAPHY MEDRAD FASTURN 150ML DISPOSABLE STERILE LF FILL TUBE MARK V PROVIS All Payors / Plans All Payors / Plans $10.28 $10.28 $10.28 $10.28 $10.28 $10.28 $10.28 $10.07 $10.07 SYRINGE MEDICAL PERIFIX BISPHENOL A PLASTIC 8 ML LOSS OF RESISTANCE LUER LOCK DEHP FREE PVC FREE LATEX FREE All Payors / Plans All Payors / Plans $3.34 $3.34 $3.34 $3.34 $3.34 $3.34 $3.34 $3.27 $3.27 SYSTEM ATHERECTOMY PHOENIX L130 CM OD2.2 MM ROTATIONAL OTW FRONT CUT LOW PROFILE STERILE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 3 MM VESSEL All Payors / Plans All Payors / Plans " $5,400.00 " " $5,400.00 " " $5,400.00 " " $5,400.00 " " $5,400.00 " " $5,400.00 " " $5,400.00 " " $5,292.00 " " $5,292.00 " SYSTEM BONE CEMENT REVOLUTION FEMORAL MIX BREAKAWAY NOZZLE LATEX All Payors / Plans All Payors / Plans $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $184.24 $184.24 SYSTEM CARDIAC MONITOR LINQ II RECORDER All Payors / Plans All Payors / Plans " $9,290.00 " " $9,290.00 " " $9,290.00 " " $9,290.00 " " $9,290.00 " " $9,290.00 " " $9,290.00 " " $9,104.20 " " $9,104.20 " SYSTEM CLOSURE VASCADE MVP ID6-12 FR VENOUS All Payors / Plans All Payors / Plans " $1,040.00 " " $1,040.00 " " $1,040.00 " " $1,040.00 " " $1,040.00 " " $1,040.00 " " $1,040.00 " " $1,019.20 " " $1,019.20 " SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 28MM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 32MM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 28MM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 12MM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 20MM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 24MM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 20MM All Payors / Plans All Payors / Plans " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,100.00 " " $1,078.00 " " $1,078.00 " SYSTEM DELIVERY SAPIEN 3 OD20 MM COMMANDER DELIVERY SYSTEM STERILE LATEX FREE All Payors / Plans All Payors / Plans " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $46,550.00 " " $46,550.00 " SYSTEM DELIVERY SAPIEN 3 OD23 MM COMMANDER DELIVERY SYSTEM STERILE LATEX FREE All Payors / Plans All Payors / Plans " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $46,550.00 " " $46,550.00 " SYSTEM DELIVERY SAPIEN 3 OD26 MM COMMANDER DELIVERY SYSTEM STERILE LATEX FREE All Payors / Plans All Payors / Plans " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $46,550.00 " " $46,550.00 " SYSTEM DETACHMENT INZONE All Payors / Plans All Payors / Plans $578.00 $578.00 $578.00 $578.00 $578.00 $578.00 $578.00 $566.44 $566.44 SYSTEM FIXATION TIGHTROPE XP STAINLESS STEEL SYNDESMOSIS REPAIR All Payors / Plans All Payors / Plans " $2,990.00 " " $2,990.00 " " $2,990.00 " " $2,990.00 " " $2,990.00 " " $2,990.00 " " $2,990.00 " " $2,930.20 " " $2,930.20 " SYSTEM INTRODUCER ACCUSTICK II L15 CM OD21 GA NEEDLE STYLET RADIOPAQUE All Payors / Plans All Payors / Plans $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $39.54 $39.54 SYSTEM NEGATIVE PRESSURE PICO 7 L20 CM X W10 CM STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $165.36 $165.36 $165.36 $165.36 $165.36 $165.36 $165.36 $162.05 $162.05 SYSTEM SUCTION REVOLVE STERILE DISPOSABLE ADVANCE ADIPOSE SYSTEM All Payors / Plans All Payors / Plans $702.50 $702.50 $702.50 $702.50 $702.50 $702.50 $702.50 $688.45 $688.45 TACROLIMUS PER 1 MG All Payors / Plans All Payors / Plans $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.23 $4.14 $4.14 TAMSULOSIN 0.4 MG CAPSULE All Payors / Plans All Payors / Plans $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.85 $1.81 $1.81 TAPE UMBILICAL 36X1/8IN COTTON STERILE LF TIE WOVEN NONABSORBABLE MULTIPACK All Payors / Plans All Payors / Plans $3.70 $3.70 $3.70 $3.70 $3.70 $3.70 $3.70 $3.63 $3.63 TAVR CONFIDA BRECKER GUIDEWIRE 260CM All Payors / Plans All Payors / Plans $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $382.20 $382.20 TAVR DRYSEAL 20F FLEX SHEATH 33CM All Payors / Plans All Payors / Plans " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,300.00 " " $1,274.00 " " $1,274.00 " TAVR Z-MED II BALLOON 20MM X 4CM All Payors / Plans All Payors / Plans $955.74 $955.74 $955.74 $955.74 $955.74 $955.74 $955.74 $936.63 $936.63 TBO-FILGRASTIM PER 1 MCG All Payors / Plans All Payors / Plans $1.63 $1.63 $1.63 $1.63 $1.63 $1.63 $1.63 $1.60 $1.60 "TC99M DTPA, UP TO 25 MCI 20 MG RECON SOLN" All Payors / Plans All Payors / Plans $142.62 $142.62 $142.62 $142.62 $142.62 $142.62 $142.62 $139.77 $139.77 "TC99M EXEMETAZINE (CERETEC) LABELED AUTOLOGOUS WBC, DIAGNOSTIC, PER STUDY DOSE 0.5 MG KIT" All Payors / Plans All Payors / Plans " $2,664.79 " " $2,664.79 " " $2,664.79 " " $2,664.79 " " $2,664.79 " " $2,664.79 " " $2,664.79 " " $2,611.49 " " $2,611.49 " "TC99M MACROAGGREGTED ALBUMIN (MAA), DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MCI 2.5 MG RECON SOLN" All Payors / Plans All Payors / Plans $168.46 $168.46 $168.46 $168.46 $168.46 $168.46 $168.46 $165.09 $165.09 "TC99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MCI 45 MG RECON SOLN" All Payors / Plans All Payors / Plans $46.10 $46.10 $46.10 $46.10 $46.10 $46.10 $46.10 $45.18 $45.18 "TC99M OXIDRONATE (HDP), DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MCI 3.15 MG RECON SOLN" All Payors / Plans All Payors / Plans $46.14 $46.14 $46.14 $46.14 $46.14 $46.14 $46.14 $45.22 $45.22 "TC99M PERTECHNETATE, DIAGNOSTIC, PER MCI" All Payors / Plans All Payors / Plans $19.76 $19.76 $19.76 $19.76 $19.76 $19.76 $19.76 $19.36 $19.36 "TC99M PYROPHOSPHATE (HOT PYP) DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MCI 12 MG RECON SOLN" All Payors / Plans All Payors / Plans $60.96 $60.96 $60.96 $60.96 $60.96 $60.96 $60.96 $59.74 $59.74 TECHNETIUM FILTERED SULFUR COLLOID All Payors / Plans All Payors / Plans $952.96 $952.96 $952.96 $952.96 $952.96 $952.96 $952.96 $933.90 $933.90 TECHNETIUM SESTAMIBI RECON SOLN All Payors / Plans All Payors / Plans $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $36.26 $36.26 TECHNETIUM SULFUR COLLOID 2 MG RECON SOLN All Payors / Plans All Payors / Plans $119.52 $119.52 $119.52 $119.52 $119.52 $119.52 $119.52 $117.13 $117.13 TEMAZEPAM 15 MG CAPSULE All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 TEMAZEPAM 7.5 MG CAPSULE All Payors / Plans All Payors / Plans $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.53 $9.53 TERAZOSIN 1 MG CAPSULE All Payors / Plans All Payors / Plans $2.68 $2.68 $2.68 $2.68 $2.68 $2.68 $2.68 $2.62 $2.62 TERAZOSIN 5 MG CAPSULE All Payors / Plans All Payors / Plans $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.02 $1.00 $1.00 TERBUTALINE PER 1 MG All Payors / Plans All Payors / Plans $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.65 $2.60 $2.60 TESTOSTERONE CYPIONATE 200 MG/ML OIL All Payors / Plans All Payors / Plans $0.32 $0.32 $0.32 $0.32 $0.32 $0.32 $0.32 $0.32 $0.32 TETANUS AND DIPHTHERIA TOXIN 5-2 LF UNIT/0.5 ML SYRINGE All Payors / Plans All Payors / Plans $140.33 $140.33 $140.33 $140.33 $140.33 $140.33 $140.33 $137.52 $137.52 TETRACAINE HCL (PF) 0.5 % DROPS 4 ML DROP BTL All Payors / Plans All Payors / Plans $37.19 $37.19 $37.19 $37.19 $37.19 $37.19 $37.19 $36.45 $36.45 THIAMINE 100 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 THIAMINE PER 100 MG All Payors / Plans All Payors / Plans $10.68 $10.68 $10.68 $10.68 $10.68 $10.68 $10.68 $10.47 $10.47 THIOTHIXENE 2 MG CAPSULE All Payors / Plans All Payors / Plans $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.47 $3.40 $3.40 "THROMBIN (BOVINE) 20,000 UNIT RECON SOLN" All Payors / Plans All Payors / Plans $368.96 $368.96 $368.96 $368.96 $368.96 $368.96 $368.96 $361.58 $361.58 "THROMBIN (BOVINE) 20,000 UNIT RECON SOLN 1 EACH VIAL" All Payors / Plans All Payors / Plans $436.38 $436.38 $436.38 $436.38 $436.38 $436.38 $436.38 $427.65 $427.65 "THROMBIN (BOVINE) 5,000 UNIT NASAL SPRAY SYRINGE" All Payors / Plans All Payors / Plans $155.59 $155.59 $155.59 $155.59 $155.59 $155.59 $155.59 $152.48 $152.48 "THROMBIN (BOVINE) 5,000 UNIT RECON SOLN" All Payors / Plans All Payors / Plans $92.85 $92.85 $92.85 $92.85 $92.85 $92.85 $92.85 $91.00 $91.00 "THROMBIN (BOVINE) 5,000 UNIT RECON SOLN 1 EACH VIAL" All Payors / Plans All Payors / Plans $152.50 $152.50 $152.50 $152.50 $152.50 $152.50 $152.50 $149.45 $149.45 "THROMBIN (BOVINE) 5,000 UNIT SPRAY SYRINGE" All Payors / Plans All Payors / Plans $98.18 $98.18 $98.18 $98.18 $98.18 $98.18 $98.18 $96.22 $96.22 "THROMBIN (RECOMBINANT) 20,000 UNIT RECON SOLN 1 EACH KIT" All Payors / Plans All Payors / Plans $637.49 $637.49 $637.49 $637.49 $637.49 $637.49 $637.49 $624.74 $624.74 THROMBIN(HUMAN)-FIBRIN-CALCIUM 500 UNIT-80 MG /ML (10 ML) SYRINGE All Payors / Plans All Payors / Plans " $1,213.66 " " $1,213.66 " " $1,213.66 " " $1,213.66 " " $1,213.66 " " $1,213.66 " " $1,213.66 " " $1,189.39 " " $1,189.39 " THROMBIX HEMOSTATIC PATCH All Payors / Plans All Payors / Plans $31.20 $31.20 $31.20 $31.20 $31.20 $31.20 $31.20 $30.58 $30.58 THYROID (PORK) 60 MG TABLET All Payors / Plans All Payors / Plans $3.51 $3.51 $3.51 $3.51 $3.51 $3.51 $3.51 $3.44 $3.44 TIBIAL COMPONANT NEXGEN STEMMED SIZE 5 All Payors / Plans All Payors / Plans " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,750.00 " " $3,675.00 " " $3,675.00 " TICAGRELOR 60 MG TABLET All Payors / Plans All Payors / Plans $15.63 $15.63 $15.63 $15.63 $15.63 $15.63 $15.63 $15.32 $15.32 TICAGRELOR 90 MG TABLET All Payors / Plans All Payors / Plans $15.63 $15.63 $15.63 $15.63 $15.63 $15.63 $15.63 $15.32 $15.32 TIMOLOL 0.25 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $15.83 $15.83 $15.83 $15.83 $15.83 $15.83 $15.83 $15.51 $15.51 TIMOLOL 0.5 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $62.87 $62.87 $62.87 $62.87 $62.87 $62.87 $62.87 $61.61 $61.61 TIMOLOL MALEATE (PF) 0.25 % DROPPERETTE All Payors / Plans All Payors / Plans $7.87 $7.87 $7.87 $7.87 $7.87 $7.87 $7.87 $7.71 $7.71 TIP APPLICATOR LIQUIBAND ADHESIVE TISSUE DOME STERILE All Payors / Plans All Payors / Plans $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $23.52 $23.52 TIP APPLICATOR PROGEL L29 CM SPRAYER EXTENDED All Payors / Plans All Payors / Plans $327.04 $327.04 $327.04 $327.04 $327.04 $327.04 $327.04 $320.50 $320.50 TIP PHACOEMULSIFICATION GRIESHABER REVOLUTION DSP POLYMERIC 360 D OD 25 GA TISSUE BACK FLUSH LIGHTWEIGHT ERGONOMIC HANDLE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $193.96 $193.96 $193.96 $193.96 $193.96 $193.96 $193.96 $190.08 $190.08 TIP PULSED LAVAGE L12.7 CM MULTIORIFICE FAN SPRAY SPLASH SHIELD HIGH CAPACITY STERILE INTRAMEDULLARY NAIL All Payors / Plans All Payors / Plans $7.56 $7.56 $7.56 $7.56 $7.56 $7.56 $7.56 $7.41 $7.41 TIP PULSED LAVAGE L22.86 CM OD.89 CM FEMUR RADIAL SPRAY HIGH CAPACITY STERILE INTRAMEDULLARY NAIL PULSAVAC PLUS PULSAVAC PLUS AC All Payors / Plans All Payors / Plans $14.40 $14.40 $14.40 $14.40 $14.40 $14.40 $14.40 $14.11 $14.11 TIP SUCTION MEDI-VAC YANKAUER BULBOUS WITHOUT CONTROL VENT HANDLE STERILE LATEX FREE CLEAR All Payors / Plans All Payors / Plans $0.82 $0.82 $0.82 $0.82 $0.82 $0.82 $0.82 $0.80 $0.80 TIP SUCTION YANKAUER PLASTIC STANDARD TUBE RIGID TRANSPARENT SLIP RESISTANT HANDLE STERILE LATEX FREE CLEAR All Payors / Plans All Payors / Plans $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.10 $1.08 $1.08 TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) SOLUTION All Payors / Plans All Payors / Plans $6.50 $6.50 $6.50 $6.50 $6.50 $6.50 $6.50 $6.37 $6.37 TIZANIDINE 4 MG TABLET All Payors / Plans All Payors / Plans $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.89 $1.89 TOBRAMYCIN 0.3 % DROPS 5 ML DROP BTL All Payors / Plans All Payors / Plans $26.70 $26.70 $26.70 $26.70 $26.70 $26.70 $26.70 $26.17 $26.17 "TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % DROPS,SUSPENSION 10 ML DROP BTL" All Payors / Plans All Payors / Plans $456.26 $456.26 $456.26 $456.26 $456.26 $456.26 $456.26 $447.13 $447.13 TOLNAFTATE 1 % CREAM 14.18 G TUBE All Payors / Plans All Payors / Plans $6.18 $6.18 $6.18 $6.18 $6.18 $6.18 $6.18 $6.06 $6.06 TOLTERODINE 2 MG TABLET All Payors / Plans All Payors / Plans $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.92 $1.88 $1.88 TOOL DISSECTING FLUTE DRUM L8.9 MM OD4 MM SIDE CUT BURR QD11 MEDIUM All Payors / Plans All Payors / Plans $458.00 $458.00 $458.00 $458.00 $458.00 $458.00 $458.00 $448.84 $448.84 TOOL DISSECTING MIDAS REX LEGEND BALL FLUTE L10 CM OD2 MM BURR All Payors / Plans All Payors / Plans $339.30 $339.30 $339.30 $339.30 $339.30 $339.30 $339.30 $332.51 $332.51 TOOL DISSECTING MIDAS REX LEGEND CYLINDER L10 CM OD4 MM STERILE BURR All Payors / Plans All Payors / Plans $349.74 $349.74 $349.74 $349.74 $349.74 $349.74 $349.74 $342.75 $342.75 TOOL DISSECTING MIDAS REX LEGEND L10 CM OD6 MM ACORN STERILE BURR All Payors / Plans All Payors / Plans $356.70 $356.70 $356.70 $356.70 $356.70 $356.70 $356.70 $349.57 $349.57 TOOL DISSECTING MIDAS REX LEGEND MATCH HEAD FLUTE L14 CM OD3 MM BURR All Payors / Plans All Payors / Plans $231.64 $231.64 $231.64 $231.64 $231.64 $231.64 $231.64 $227.01 $227.01 TOOL DISSECTING MIDAS REX LEGEND MATCH HEAD FLUTE L9 CM OD3 MM BURR All Payors / Plans All Payors / Plans $368.88 $368.88 $368.88 $368.88 $368.88 $368.88 $368.88 $361.50 $361.50 TOOL DISSECTING MIDAS REX LEGEND OVAL L10 CM OD4 MM STERILE BURR All Payors / Plans All Payors / Plans $365.40 $365.40 $365.40 $365.40 $365.40 $365.40 $365.40 $358.09 $358.09 TOOL DISSECTING MIDAS REX LEGEND TAPER FLUTE L8 CM L6.4 MM OD1.1 MM All Payors / Plans All Payors / Plans $276.66 $276.66 $276.66 $276.66 $276.66 $276.66 $276.66 $271.13 $271.13 TOOL DISSECTING MIDAS REX LEGEND TAPER L8 CM L15.9 MM OD2.3 MM BURR FOOT ATTACHMENT All Payors / Plans All Payors / Plans $306.24 $306.24 $306.24 $306.24 $306.24 $306.24 $306.24 $300.12 $300.12 TOOL DISSECTING MR8 MATCH HEAD L10 CM OD2.2 MM STERILE DISPOSABLE All Payors / Plans All Payors / Plans $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $305.76 $305.76 TOOL DISSECTING MR8 MATCH HEAD L10 CM OD3 MM STERILE DISPOSABLE All Payors / Plans All Payors / Plans $327.12 $327.12 $327.12 $327.12 $327.12 $327.12 $327.12 $320.58 $320.58 TOPICAL SKIN ADHESIVE LQB003 0.5 ML KIT All Payors / Plans All Payors / Plans $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.17 $21.17 TOPIRAMATE 100 MG TABLET All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 TOPIRAMATE PER 25 MG All Payors / Plans All Payors / Plans $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.14 $1.12 $1.12 TORSEMIDE 10 MG TABLET All Payors / Plans All Payors / Plans $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.11 $1.09 $1.09 TORSEMIDE 100 MG TABLET All Payors / Plans All Payors / Plans $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.89 $1.85 $1.85 TORSEMIDE 20 MG TABLET All Payors / Plans All Payors / Plans $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.87 $1.87 TR BAND REGULAR All Payors / Plans All Payors / Plans $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $42.88 $42.88 "TRACE ELEMENT ZN-CU-MN-SE 1,000MCG-60MCG- 3 MCG-6 MCG/ML SOLUTION 1 ML VIAL" All Payors / Plans All Payors / Plans $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $40.44 $40.44 TRACE ELEMENTS ZN-CU-MN-SE 3 MG-0.3 MG-55 MCG-60 MCG/ML SOLUTION 1 ML VIAL All Payors / Plans All Payors / Plans $70.54 $70.54 $70.54 $70.54 $70.54 $70.54 $70.54 $69.13 $69.13 TRAMADOL 50 MG TABLET All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 "TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION" All Payors / Plans All Payors / Plans $16.11 $16.11 $16.11 $16.11 $16.11 $16.11 $16.11 $15.79 $15.79 "TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION 10 ML VIAL" All Payors / Plans All Payors / Plans $16.49 $16.49 $16.49 $16.49 $16.49 $16.49 $16.49 $16.16 $16.16 "TRANEXAMIC ACID IN NACL 1,000 MG/100 ML (10 MG/ML) PIGGYBACK" All Payors / Plans All Payors / Plans $45.54 $45.54 $45.54 $45.54 $45.54 $45.54 $45.54 $44.63 $44.63 TRAP POSITIONING DIGIT TRAP SMALL FINGER ATRAUMATIC HOOK GRASP STERILE DISPOSABLE TRACTION TOWER All Payors / Plans All Payors / Plans $25.46 $25.46 $25.46 $25.46 $25.46 $25.46 $25.46 $24.95 $24.95 TRASTUZUMAB-ANNS 150 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $100.63 $100.63 $100.63 $100.63 $100.63 $100.63 $100.63 $98.62 $98.62 TRASTUZUMAB-QYYP 420 MG RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $72.54 $72.54 $72.54 $72.54 $72.54 $72.54 $72.54 $71.09 $71.09 TRAY CATHETER POWERLINE 577ML/HR 5FR POLYURETHANE STERILE LF 2 LUMEN POWER INJECTABLE MICROINTRODUCER All Payors / Plans All Payors / Plans " $1,151.40 " " $1,151.40 " " $1,151.40 " " $1,151.40 " " $1,151.40 " " $1,151.40 " " $1,151.40 " " $1,128.37 " " $1,128.37 " TRAY CATHETER POWERPICC NITINOL .018 IN L70 CM OD5 FR 2 LUMEN GUIDEWIRE All Payors / Plans All Payors / Plans $147.25 $147.25 $147.25 $147.25 $147.25 $147.25 $147.25 $144.31 $144.31 TRAY CATHETER SURESTEP LUBRI-SIL IC COMPLETE CARE OD 16 FRENCH 350ML FOLEY URINE METER TEMPERATURE SENSING STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $77.28 $77.28 $77.28 $77.28 $77.28 $77.28 $77.28 $75.73 $75.73 TRAY CATHETERIZATION BARD OD16 FR 350ML URINE METER All Payors / Plans All Payors / Plans $66.80 $66.80 $66.80 $66.80 $66.80 $66.80 $66.80 $65.46 $65.46 TRAY CATHETERIZATION BARDEX 18FR 350ML SILVER HYDROGEL LATEX FOLEY URINE METER All Payors / Plans All Payors / Plans $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.24 $12.24 TRAY CATHETERIZATION BARDEX COMPLETE CARE OD16 FR FOLEY URINE METER ADVANCE STERILE 400 All Payors / Plans All Payors / Plans $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.24 $12.24 TRAY CATHETERIZATION BARDEX STATLOCK 16FR BACTI-GUARD HYDROGEL NATURAL RUBBER DISPOSABLE STERILE LATEX FOLEY URINE METER All Payors / Plans All Payors / Plans $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.49 $12.24 $12.24 TRAY CATHETERIZATION COMPLETE CARE BARDEX IC STATLOCK BARD 60IN 16FR 5ML BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE All Payors / Plans All Payors / Plans $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.33 $8.33 TRAY CATHETERIZATION COMPLETE CARE BARDEX IC STATLOCK BARD BACTI-GUARD NATURAL RUBBER HYDROGEL L60 IN OD18 FR 5 ML ADVANCE FOLEY ANTIREFLUX CHAMBER DRAINAGE BAG STERILE LATEX DISPOSABLE All Payors / Plans All Payors / Plans $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.33 $8.33 TRAY CATHETERIZATION LUBRI SIL ADVANCE 16 FR 2 CONNECTOR FOLEY URINE METER TEMP SENSING LATEX FREE All Payors / Plans All Payors / Plans $75.86 $75.86 $75.86 $75.86 $75.86 $75.86 $75.86 $74.34 $74.34 TRAY GASTRIC LAVAGE MONOJECT ARGYLE EDLICH PVC LARGE L36 IN OD34 FR 140 CC 4 EYE CLOSED END GRADUATED SYRINGE TRANSPARENT STERILE LATEX FREE All Payors / Plans All Payors / Plans $14.22 $14.22 $14.22 $14.22 $14.22 $14.22 $14.22 $13.94 $13.94 TRAY SKIN PREP PVP-1 SCRUB CARE All Payors / Plans All Payors / Plans $5.76 $5.76 $5.76 $5.76 $5.76 $5.76 $5.76 $5.64 $5.64 TRAY SKIN SCRUB VINYL WET SMALL WING SPONGE STICK COTTON TIP APPLICATOR LATEX FREE All Payors / Plans All Payors / Plans $11.78 $11.78 $11.78 $11.78 $11.78 $11.78 $11.78 $11.54 $11.54 TRAY STERLIZATION SPHERES All Payors / Plans All Payors / Plans $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $139.65 $139.65 TRAY SUTURE REMOVAL E KITS ADSON IRIS 3X3IN ALCOHOL GAUZE DISPOSABLE STERILE LF FORCEPS SCISSORS PREP PAD All Payors / Plans All Payors / Plans $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.76 $1.76 TRAY TIBIAL GMK HINGE 3 KNEE LEFT FIX NONSTERILE All Payors / Plans All Payors / Plans " $37,217.30 " " $37,217.30 " " $37,217.30 " " $37,217.30 " " $37,217.30 " " $37,217.30 " " $37,217.30 " " $36,472.95 " " $36,472.95 " TRAY TIBIAL GMK T3I4 KNEE RIGHT CEMENT FIX All Payors / Plans All Payors / Plans " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,200.00 " " $6,076.00 " " $6,076.00 " TRAZODONE 100 MG TABLET All Payors / Plans All Payors / Plans $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.04 $1.02 $1.02 TRAZODONE 50 MG TABLET All Payors / Plans All Payors / Plans $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.98 $0.98 TREK BALLOON 2.0 X 8 MM All Payors / Plans All Payors / Plans $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $219.52 $219.52 TREK BALLOON 3.5 X 8 MM All Payors / Plans All Payors / Plans $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $219.52 $219.52 TRIAMCINOLONE 0.1 % CREAM 80 G TUBE All Payors / Plans All Payors / Plans $31.69 $31.69 $31.69 $31.69 $31.69 $31.69 $31.69 $31.06 $31.06 TRIAMCINOLONE 0.1 % OINTMENT 15 G TUBE All Payors / Plans All Payors / Plans $11.28 $11.28 $11.28 $11.28 $11.28 $11.28 $11.28 $11.05 $11.05 TRIAMCINOLONE 0.1 % OINTMENT 80 G TUBE All Payors / Plans All Payors / Plans $26.73 $26.73 $26.73 $26.73 $26.73 $26.73 $26.73 $26.20 $26.20 TRIAMCINOLONE 0.5 % CREAM 15 G TUBE All Payors / Plans All Payors / Plans $50.60 $50.60 $50.60 $50.60 $50.60 $50.60 $50.60 $49.59 $49.59 TRIAMCINOLONE PER 10 MG All Payors / Plans All Payors / Plans $3.07 $3.07 $3.07 $3.07 $3.07 $3.07 $3.07 $3.01 $3.01 TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5-25 MG TABLET All Payors / Plans All Payors / Plans $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.69 $2.64 $2.64 TRIDEN 0 DEG INSERT 36MM All Payors / Plans All Payors / Plans " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,036.00 " " $8,036.00 " TRIDENT 0 X3 INSERT 36MM ID All Payors / Plans All Payors / Plans " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,200.00 " " $8,036.00 " " $8,036.00 " TRIHEXYPHENIDYL 5 MG TABLET All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 TROCAR BLADELESS W/BALLOON 12MMX100MM All Payors / Plans All Payors / Plans $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $137.20 $137.20 TROCAR FALLER TUNNELER All Payors / Plans All Payors / Plans $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $166.60 $166.60 TROCAR HASSON 12MM All Payors / Plans All Payors / Plans $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $137.20 $137.20 TROCAR LAPAROSCOPIC AUTOSUTURE WOODFORD SPIKE PEDIPORT SHORT OD5.5 MM LOCK CANNULA HUB STERILE DISPOSABLE All Payors / Plans All Payors / Plans $171.14 $171.14 $171.14 $171.14 $171.14 $171.14 $171.14 $167.71 $167.71 TROCAR LAPAROSCOPIC ENDOPATH XCEL 100MM 11MM DISPOSABLE STERILE LF STABILITY SLEEVE BLADELESS OBTURATOR OPTIONAL PISTOL All Payors / Plans All Payors / Plans $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $46.22 $46.22 TROCAR LAPAROSCOPIC ENDOPATH XCEL 100MM 11MM DISPOSABLE STERILE STABILITY SLEEVE DILATE All Payors / Plans All Payors / Plans $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $45.08 $45.08 TROCAR LAPAROSCOPIC ENDOPATH XCEL 100MM 12MM DISPOSABLE STERILE STABILITY SLEEVE DILATE All Payors / Plans All Payors / Plans $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $46.22 $46.22 TROCAR LAPAROSCOPIC ENDOPATH XCEL 150MM 5MM DISPOSABLE STERILE STABILITY SLEEVE All Payors / Plans All Payors / Plans $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $45.08 $45.08 TROCAR LAPAROSCOPIC ENDOPATH XCEL L100 MM OD12 MM BLADELESS OPTICAL TIP OBTURATOR RADIOLUCENT SLEEVE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $46.46 $46.46 $46.46 $46.46 $46.46 $46.46 $46.46 $45.53 $45.53 TROCAR LAPAROSCOPIC ENDOPATH XCEL L100 MM OD15 MM BLADELESS OPTICAL TIP OBTURATOR RADIOLUCENT SLEEVE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $82.00 $82.00 $82.00 $82.00 $82.00 $82.00 $82.00 $80.36 $80.36 TROCAR LAPAROSCOPIC ENDOPATH XCEL L100 MM OD8 MM STABILITY SLEEVE BLADELESS OPTICAL TIP OBTURATOR STERILE DISPOSABLE All Payors / Plans All Payors / Plans $46.46 $46.46 $46.46 $46.46 $46.46 $46.46 $46.46 $45.53 $45.53 TROCAR LAPAROSCOPIC ENDOPATH XCEL L150 MM OD12 MM STABILITY SLEEVE BLADELESS LOW SYSTEM DRAG FORCE OPTIONAL PISTOL HANDLE STERILE DISPOSABLE All Payors / Plans All Payors / Plans $59.46 $59.46 $59.46 $59.46 $59.46 $59.46 $59.46 $58.27 $58.27 TROCAR LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW 100MM 12MM DISPOSABLE STERILE SMOOTH SLEEVE OBTURATOR BLUNT TIP PISTOL HANDLE All Payors / Plans All Payors / Plans $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $46.22 $46.22 TROCAR LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW 100MM 5MM DISPOSABLE STERILE STABILITY SLEEVE BLADELESS OBTURATOR RADIOLUCENT All Payors / Plans All Payors / Plans $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $47.16 $46.22 $46.22 TROCAR LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW L100 MM OD5 MM STABILITY SLEEVE DILAT TIP STERILE DISPOSABLE All Payors / Plans All Payors / Plans $46.46 $46.46 $46.46 $46.46 $46.46 $46.46 $46.46 $45.53 $45.53 TROCAR SLEEVE W/BALLOON 5MM X 100MM All Payors / Plans All Payors / Plans $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $58.80 $58.80 TROCAR TIP WIRE 1.4MM X 100MM All Payors / Plans All Payors / Plans $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $49.98 $49.98 TROCAR W BALLOON 5MM X 100MM All Payors / Plans All Payors / Plans $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $117.60 $117.60 TROPICAMIDE 0.5 % DROPS 15 ML DROP BTL All Payors / Plans All Payors / Plans $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.21 $26.21 TROPICAMIDE 1 % DROPS 15 ML DROP BTL All Payors / Plans All Payors / Plans $36.44 $36.44 $36.44 $36.44 $36.44 $36.44 $36.44 $35.71 $35.71 TRUE DILATATION BALLOON 20MM X 4.5CM All Payors / Plans All Payors / Plans " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,352.00 " " $2,352.00 " TRUE DILATATION BALLOON 24MM X 4.5CM All Payors / Plans All Payors / Plans " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,400.00 " " $2,352.00 " " $2,352.00 " TUBE CONNECTING DRAINAGE BAG All Payors / Plans All Payors / Plans $23.35 $23.35 $23.35 $23.35 $23.35 $23.35 $23.35 $22.88 $22.88 TUBE GASTROSTOMY ENDOVIVE STRAIGHT OD20 FR STANDARD PROFILE REPLACEMENT BALLOON BOLSTER All Payors / Plans All Payors / Plans $72.92 $72.92 $72.92 $72.92 $72.92 $72.92 $72.92 $71.46 $71.46 TUBE GASTROSTOMY KANGAROO 16FR 20ML SILICONE Y PORT GRADUATE SHAFT ROUND TIP OPEN DISTAL END All Payors / Plans All Payors / Plans $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $34.89 $34.89 TUBE JEJUNOSTOMY MIC SECUR-LOK SILICONE STANDARD J OD16 FR 7-10 ML TRIMMABLE DISTAL TIP RADIOPAQUE STRIPE UNIVERSAL FEED PORT CONNECTOR INTERNAL RETENTION BALLOON STERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $238.50 $238.50 $238.50 $238.50 $238.50 $238.50 $238.50 $233.73 $233.73 TUBE NASOGASTRIC TUM-E-VAC ADULT L48 IN OD32 FR 1 LUMEN RADIOPAQUE NONSTERILE LATEX FREE DISPOSABLE All Payors / Plans All Payors / Plans $16.71 $16.71 $16.71 $16.71 $16.71 $16.71 $16.71 $16.38 $16.38 TUBE VENTILATION ARMSTRONG FLUOROPLASTIC BEVEL GROMMET ID1.14 MM EAR All Payors / Plans All Payors / Plans " $1,565.40 " " $1,565.40 " " $1,565.40 " " $1,565.40 " " $1,565.40 " " $1,565.40 " " $1,565.40 " " $1,534.09 " " $1,534.09 " TUBERCULIN 5 TUB. UNIT /0.1 ML SOLUTION All Payors / Plans All Payors / Plans $45.46 $45.46 $45.46 $45.46 $45.46 $45.46 $45.46 $44.55 $44.55 TUBING ABLATION CARTO SMARTABLATE PUMP STERILE All Payors / Plans All Payors / Plans $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $194.04 $194.04 TUBING ANGIOGRAPHY PVC 900 PSI L48 IN OD.158 IN ID.071 IN RIGID CONTRAST INJECTION FIXED MALE CONNECTOR CLEAR All Payors / Plans All Payors / Plans $4.72 $4.72 $4.72 $4.72 $4.72 $4.72 $4.72 $4.63 $4.63 TUBING HIGH FLOW SONASTAR AND IRRIGATION All Payors / Plans All Payors / Plans $345.60 $345.60 $345.60 $345.60 $345.60 $345.60 $345.60 $338.69 $338.69 TUBING INSUFFLATION DYOPNEUMATIC .1UM 10FT STERILE LF ABDOMINAL BACTERIAL VIRAL FILTER 1 LUER LOCK CPC CONNECTOR All Payors / Plans All Payors / Plans $24.24 $24.24 $24.24 $24.24 $24.24 $24.24 $24.24 $23.76 $23.76 TUBING INSUFFLATION L10 FT 40 L LUER LOCK HIGH FLOW HEATED PATIENT KIT STERILE DISPOSABLE All Payors / Plans All Payors / Plans $36.23 $36.23 $36.23 $36.23 $36.23 $36.23 $36.23 $35.51 $35.51 TUBING IRRIGATION TIP DISPOSABLE All Payors / Plans All Payors / Plans $63.79 $63.79 $63.79 $63.79 $63.79 $63.79 $63.79 $62.51 $62.51 TUBING SUCTION MEDI-VAC L12 FT ID1/4 IN NONCONDUCTIVE MALE TO MALE CONNECTOR STERILE LATEX FREE CLEAR All Payors / Plans All Payors / Plans $1.59 $1.59 $1.59 $1.59 $1.59 $1.59 $1.59 $1.55 $1.55 TUBING SUCTION MEDI-VAC MAXI-GRIP L6 FT ID1/4 IN NONCONDUCTIVE MALE TO MALE STERILE CLEAR All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 ULIPRISTAL 30 MG TABLET All Payors / Plans All Payors / Plans $45.09 $45.09 $45.09 $45.09 $45.09 $45.09 $45.09 $44.19 $44.19 UNIT ELECTROSURGICAL GENESYS HTA PROCEDURE SET All Payors / Plans All Payors / Plans " $3,580.00 " " $3,580.00 " " $3,580.00 " " $3,580.00 " " $3,580.00 " " $3,580.00 " " $3,580.00 " " $3,508.40 " " $3,508.40 " UNIVERSAL SLITTER _300003_ All Payors / Plans All Payors / Plans $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $98.00 $98.00 URIDINE TRIACETATE 10 GRAM GRANULES IN PACKET All Payors / Plans All Payors / Plans " $4,056.07 " " $4,056.07 " " $4,056.07 " " $4,056.07 " " $4,056.07 " " $4,056.07 " " $4,056.07 " " $3,974.95 " " $3,974.95 " URSODIOL 300 MG CAPSULE All Payors / Plans All Payors / Plans $10.33 $10.33 $10.33 $10.33 $10.33 $10.33 $10.33 $10.12 $10.12 US GE SOUNDSTAR 8FR All Payors / Plans All Payors / Plans " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,936.00 " " $5,817.28 " " $5,817.28 " VALACYCLOVIR 500 MG TABLET All Payors / Plans All Payors / Plans $4.20 $4.20 $4.20 $4.20 $4.20 $4.20 $4.20 $4.12 $4.12 VALPROATE 250 MG/5 ML SOLUTION All Payors / Plans All Payors / Plans $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.96 $0.94 $0.94 VALPROATE 500 MG/5 ML (100 MG/ML) SOLUTION 5 ML VIAL All Payors / Plans All Payors / Plans $11.16 $11.16 $11.16 $11.16 $11.16 $11.16 $11.16 $10.94 $10.94 VALPROIC ACID 250 MG CAPSULE All Payors / Plans All Payors / Plans $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.12 $1.10 $1.10 VALPROIC ACID 250 MG/5 ML (5 ML) SOLUTION All Payors / Plans All Payors / Plans $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.87 $1.87 VALSARTAN 160 MG TABLET All Payors / Plans All Payors / Plans $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $1.96 $1.96 VALSARTAN 320 MG TABLET All Payors / Plans All Payors / Plans $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.60 $2.55 $2.55 VALSARTAN 40 MG TABLET All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 VALSARTAN 80 MG TABLET All Payors / Plans All Payors / Plans $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.91 $1.87 $1.87 VALVE AORTIC EDWARDS SAPIEN 3 COMMANDER OD 29MM DELIVERY SYSTEM All Payors / Plans All Payors / Plans " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $46,550.00 " " $46,550.00 " VALVE AORTIC SAPIEN 3 EDWARDS OD23 MM HEART TRANSCATHETER STERILE LATEX FREE All Payors / Plans All Payors / Plans " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $46,550.00 " " $46,550.00 " VALVE AORTIC SAPIEN 3 EDWARDS OD26 MM HEART TRANSCATHETER STERILE LATEX FREE All Payors / Plans All Payors / Plans " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $47,500.00 " " $46,550.00 " " $46,550.00 " VALVE SUCTION VISERA FLEXIBLE ATTACHMENT STERILE DISPOSABLE BRONCHOSCOPE All Payors / Plans All Payors / Plans $23.64 $23.64 $23.64 $23.64 $23.64 $23.64 $23.64 $23.17 $23.17 VANCOMYCIN 10 GRAM RECON SOLN All Payors / Plans All Payors / Plans $15.82 $15.82 $15.82 $15.82 $15.82 $15.82 $15.82 $15.50 $15.50 VANCOMYCIN 10 GRAM RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.75 $6.75 VANCOMYCIN 125 MG CAPSULE All Payors / Plans All Payors / Plans $3.41 $3.41 $3.41 $3.41 $3.41 $3.41 $3.41 $3.34 $3.34 VANCOMYCIN 25 MG/ML SYRINGE All Payors / Plans All Payors / Plans $0.43 $0.43 $0.43 $0.43 $0.43 $0.43 $0.43 $0.42 $0.42 VANCOMYCIN 5 GRAM RECON SOLN 1 EACH VIAL All Payors / Plans All Payors / Plans $35.84 $35.84 $35.84 $35.84 $35.84 $35.84 $35.84 $35.12 $35.12 VANCOMYCIN PER 500 MG All Payors / Plans All Payors / Plans $118.95 $118.95 $118.95 $118.95 $118.95 $118.95 $118.95 $116.57 $116.57 VARENICLINE 0.5 MG TABLET All Payors / Plans All Payors / Plans $14.66 $14.66 $14.66 $14.66 $14.66 $14.66 $14.66 $14.37 $14.37 VASOPRESSIN 0.4 UNIT/ML SOLUTION All Payors / Plans All Payors / Plans $361.36 $361.36 $361.36 $361.36 $361.36 $361.36 $361.36 $354.13 $354.13 VASOPRESSIN 20 UNIT/ML SOLUTION All Payors / Plans All Payors / Plans $135.78 $135.78 $135.78 $135.78 $135.78 $135.78 $135.78 $133.06 $133.06 VASOPRESSIN 20 UNIT/ML SOLUTION 1 ML VIAL All Payors / Plans All Payors / Plans $135.78 $135.78 $135.78 $135.78 $135.78 $135.78 $135.78 $133.06 $133.06 VASOPRESSIN IN 0.9 % NACL 100 UNIT/250 ML (0.4 UNIT/ML) SOLUTION All Payors / Plans All Payors / Plans " $1,571.55 " " $1,571.55 " " $1,571.55 " " $1,571.55 " " $1,571.55 " " $1,571.55 " " $1,571.55 " " $1,540.12 " " $1,540.12 " VASOPRESSIN IN 0.9% NACL 40 UNIT/100 ML (0.4 UNIT/ML) SOLUTION All Payors / Plans All Payors / Plans $746.59 $746.59 $746.59 $746.59 $746.59 $746.59 $746.59 $731.66 $731.66 VECURONIUM 10 MG RECON SOLN All Payors / Plans All Payors / Plans $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.20 $21.20 VENLAFAXINE 25 MG TABLET All Payors / Plans All Payors / Plans $3.37 $3.37 $3.37 $3.37 $3.37 $3.37 $3.37 $3.30 $3.30 VENLAFAXINE 37.5 MG TABLET All Payors / Plans All Payors / Plans $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.96 $1.92 $1.92 VENLAFAXINE 75 MG TABLET All Payors / Plans All Payors / Plans $2.61 $2.61 $2.61 $2.61 $2.61 $2.61 $2.61 $2.56 $2.56 "VENLAFAXINE XR 150 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.97 $1.93 $1.93 "VENLAFAXINE XR 37.5 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.98 $1.94 $1.94 "VENLAFAXINE XR 75 MG CAPSULE,EXTENDED RELEASE 24HR" All Payors / Plans All Payors / Plans $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.93 $1.89 $1.89 VERAPAMIL 2.5 MG/ML SOLUTION All Payors / Plans All Payors / Plans $21.38 $21.38 $21.38 $21.38 $21.38 $21.38 $21.38 $20.95 $20.95 VERAPAMIL 40 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 VERAPAMIL SR 120 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $4.95 $4.95 $4.95 $4.95 $4.95 $4.95 $4.95 $4.85 $4.85 VERAPAMIL SR 240 MG TABLET EXTENDED RELEASE All Payors / Plans All Payors / Plans $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.86 $1.82 $1.82 VERSA CROSS TRANSSEPTAL ACCESS 8.5F FIXED SYSTEM W/45 SHEATH AND PIGTAIL_62301_ All Payors / Plans All Payors / Plans " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $1,999.20 " " $1,999.20 " VERSA CROSS TRANSSEPTAL STEERABLE BIDIRECTIONAL ACCESS 8.5F SYSTEM W/45 SHEATH AND PIGTAIL All Payors / Plans All Payors / Plans " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,430.00 " " $3,430.00 " VERSACROSS CONNECT All Payors / Plans All Payors / Plans " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,146.20 " " $2,146.20 " VERSACROSS CONNECT LAAC ACCESS SOLUTION All Payors / Plans All Payors / Plans " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,190.00 " " $2,146.20 " " $2,146.20 " VIABAHN - 7 FR All Payors / Plans All Payors / Plans " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,540.12 " " $7,540.12 " VIABAHN VBX - 8 FR All Payors / Plans All Payors / Plans " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,540.12 " " $7,540.12 " VIABAHN VBX -8 FR All Payors / Plans All Payors / Plans " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,694.00 " " $7,540.12 " " $7,540.12 " VINCRISTINE 2 MG/2 ML SOLUTION 1 ML VIAL All Payors / Plans All Payors / Plans $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.27 $20.27 VINCRISTINE 2 MG/2 ML SOLUTION 2 ML VIAL All Payors / Plans All Payors / Plans $25.46 $25.46 $25.46 $25.46 $25.46 $25.46 $25.46 $24.95 $24.95 VIT B COMP NO.3-FOLIC-C-BIOTIN 1-60-300 MG-MG-MCG TABLET All Payors / Plans All Payors / Plans $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.03 $1.01 $1.01 VLP MINI MOD 2.4MM OVERDRILL AO OC All Payors / Plans All Payors / Plans $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $280.80 $275.18 $275.18 VOLCANO EAGLE EYE PLATINUM IVUS CATHETER All Payors / Plans All Payors / Plans $906.25 $906.25 $906.25 $906.25 $906.25 $906.25 $906.25 $888.13 $888.13 VOLCANO REVOLUTION CATHETER All Payors / Plans All Payors / Plans " $1,450.00 " " $1,450.00 " " $1,450.00 " " $1,450.00 " " $1,450.00 " " $1,450.00 " " $1,450.00 " " $1,421.00 " " $1,421.00 " VOLCANO REVOLUTION IMAGING CATHETER All Payors / Plans All Payors / Plans $906.25 $906.25 $906.25 $906.25 $906.25 $906.25 $906.25 $888.13 $888.13 VSI .018 GUIDEWIRE All Payors / Plans All Payors / Plans $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $44.10 $44.10 VSI TRU-TORQUE STRAIGHT TIP GUIDEWIRE 180CM All Payors / Plans All Payors / Plans $91.25 $91.25 $91.25 $91.25 $91.25 $91.25 $91.25 $89.43 $89.43 WARFARIN 1 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 WARFARIN 2 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 WARFARIN 2.5 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 WARFARIN 3 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 WARFARIN 4 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 WARFARIN 5 MG TABLET All Payors / Plans All Payors / Plans $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $1.01 $0.99 $0.99 WARFARIN 7.5 MG TABLET All Payors / Plans All Payors / Plans $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.06 $1.04 $1.04 WARMER SCOPE All Payors / Plans All Payors / Plans $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $10.78 $10.78 WATCHMAN FLX 20MM _62663_ All Payors / Plans All Payors / Plans " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $31,360.00 " " $31,360.00 " WATCHMAN FLX 24MM _62665_ All Payors / Plans All Payors / Plans " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $31,360.00 " " $31,360.00 " WATCHMAN FLX 27MM _62666_ All Payors / Plans All Payors / Plans " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $31,360.00 " " $31,360.00 " WATCHMAN FLX 31 MM _62667_ All Payors / Plans All Payors / Plans " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $31,360.00 " " $31,360.00 " WATCHMAN FLX 35 _62668_ All Payors / Plans All Payors / Plans " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $32,000.00 " " $31,360.00 " " $31,360.00 " "WATER FOR INJECTION, STERILE SOLUTION" All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 "WATER FOR INJECTION, STERILE SOLUTION 10 ML VIAL" All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 "WATER FOR INJECTION, STERILE SOLUTION 20 ML VIAL" All Payors / Plans All Payors / Plans $1.60 $1.60 $1.60 $1.60 $1.60 $1.60 $1.60 $1.57 $1.57 "WATER FOR INJECTION, STERILE SOLUTION 5 ML VIAL" All Payors / Plans All Payors / Plans $11.34 $11.34 $11.34 $11.34 $11.34 $11.34 $11.34 $11.11 $11.11 "WATER FOR INJECTION, STERILE SOLUTION 50 ML BOTTLE" All Payors / Plans All Payors / Plans $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 $0.02 "WATER FOR INJECTION, STERILE SOLUTION 50 ML VIAL" All Payors / Plans All Payors / Plans $1.15 $1.15 $1.15 $1.15 $1.15 $1.15 $1.15 $1.13 $1.13 WEDGE FEMORAL GMK 5 H5 MM KNEE POSTERIOR REVISION All Payors / Plans All Payors / Plans " $38,874.90 " " $38,874.90 " " $38,874.90 " " $38,874.90 " " $38,874.90 " " $38,874.90 " " $38,874.90 " " $38,097.40 " " $38,097.40 " WHITE PETROLATUM 41 % OINTMENT 50 G TUBE All Payors / Plans All Payors / Plans $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.17 $21.17 WHITE PETROLATUM 41 % OINTMENT 99 G JAR All Payors / Plans All Payors / Plans $30.99 $30.99 $30.99 $30.99 $30.99 $30.99 $30.99 $30.37 $30.37 WHITE PETROLATUM-MINERAL OIL 94-3 % OINTMENT 3.5 G TUBE All Payors / Plans All Payors / Plans $36.73 $36.73 $36.73 $36.73 $36.73 $36.73 $36.73 $36.00 $36.00 WHITE PETROLATUM-MINERAL OIL-LANOLIN-CERESIN CREAM 113 G JAR All Payors / Plans All Payors / Plans $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $10.90 $10.90 WHITE PETROLATUM-MINERAL OIL-LANOLIN-CERESIN CREAM 454 G JAR All Payors / Plans All Payors / Plans $16.18 $16.18 $16.18 $16.18 $16.18 $16.18 $16.18 $15.86 $15.86 WIRE FIXATION KIRSCHNER STAINLESS STEEL L 150MM OD 1.6MM TROCAR POINT STERILE All Payors / Plans All Payors / Plans $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $299.88 $299.88 WIRE FIXATION KIRSCHNER STAINLESS STEEL L 150MM OD 2MM TROCAR POINT STERILE All Payors / Plans All Payors / Plans $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $49.98 $49.98 WIRE FIXATION KIRSCHNER STAINLESS STEEL L229 MM OD1.6 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE All Payors / Plans All Payors / Plans $9.75 $9.75 $9.75 $9.75 $9.75 $9.75 $9.75 $9.56 $9.56 WIRE FIXATION KIRSCHNER STAINLESS STEEL L9 IN OD.045 IN 2 BAYONET POINT SMOOTH All Payors / Plans All Payors / Plans $12.71 $12.71 $12.71 $12.71 $12.71 $12.71 $12.71 $12.46 $12.46 WIRE FIXATION KIRSCHNER STAINLESS STEEL L9 IN OD.062 IN 2 BAYONET POINT SMOOTH All Payors / Plans All Payors / Plans $76.24 $76.24 $76.24 $76.24 $76.24 $76.24 $76.24 $74.72 $74.72 WIRE FIXATION L 100 MM OD 1.4 MM TROCAR TIP All Payors / Plans All Payors / Plans $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $64.68 $64.68 WIRE VERSA CORSS ACCESS 8.5F FIXED SYSTEM W/45 SHEATH AND PIGTAIL All Payors / Plans All Payors / Plans " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $2,040.00 " " $1,999.20 " " $1,999.20 " WIRE VERSA CROSS STEERABLE BIDIRECTIONAL ACCESS 8.5F SYSTEM W/45 SHEATH AND PIGTAIL All Payors / Plans All Payors / Plans " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,500.00 " " $3,430.00 " " $3,430.00 " WORLEY STANDARD VEIN SELECTER 5FR X 75CM _62561_ All Payors / Plans All Payors / Plans $240.00 $240.00 $240.00 $240.00 $240.00 $240.00 $240.00 $235.20 $235.20 WRAP THERAPEUTIC ACTIVEWRAP PLUSH LARGE XL OD16+ IN LEG KNEE THERMAL SUPPORT GEL PACK POST OPERATIVE NONSTERILE LATEX FREE All Payors / Plans All Payors / Plans $71.44 $71.44 $71.44 $71.44 $71.44 $71.44 $71.44 $70.01 $70.01 WRAP THERAPEUTIC FOAM L25.5 IN X W14 IN KNEE 4 COLD PACK ADJUSTABLE PAD All Payors / Plans All Payors / Plans $26.81 $26.81 $26.81 $26.81 $26.81 $26.81 $26.81 $26.27 $26.27 WRENCH SURGICAL HEXAGON LEAD All Payors / Plans All Payors / Plans $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $49.00 $49.00 XENON XE 133 PER 10 MCI 370 MBQ (10 MCI) GAS All Payors / Plans All Payors / Plans $94.95 $94.95 $94.95 $94.95 $94.95 $94.95 $94.95 $93.05 $93.05 ZINC OXIDE-COD LIVER OIL 40 % PASTE 28 G TUBE All Payors / Plans All Payors / Plans $15.85 $15.85 $15.85 $15.85 $15.85 $15.85 $15.85 $15.53 $15.53 ZINC OXIDE-CORN STARCH 15-81 % POWDER 142 G BOTTLE All Payors / Plans All Payors / Plans $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.10 $16.10 "ZINC OXIDE-GAUZE BANDAGE 25 %- 4 X 10 YARD BANDAGE""" All Payors / Plans All Payors / Plans $15.26 $15.26 $15.26 $15.26 $15.26 $15.26 $15.26 $14.95 $14.95 ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE All Payors / Plans All Payors / Plans $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.08 $1.06 $1.06 ZIP WIRE HYDROPHILIC GUIDE WIRE All Payors / Plans All Payors / Plans $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $78.40 $78.40 ZIPRASIDONE 20 MG CAPSULE All Payors / Plans All Payors / Plans $9.46 $9.46 $9.46 $9.46 $9.46 $9.46 $9.46 $9.27 $9.27 ZIPRASIDONE 40 MG CAPSULE All Payors / Plans All Payors / Plans $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $9.06 $8.88 $8.88 ZIPRASIDONE MESYLATE PER 10 MG All Payors / Plans All Payors / Plans $33.42 $33.42 $33.42 $33.42 $33.42 $33.42 $33.42 $32.75 $32.75 ZOLEDRONIC ACID PER 1 MG All Payors / Plans All Payors / Plans $31.08 $31.08 $31.08 $31.08 $31.08 $31.08 $31.08 $30.46 $30.46 ZOLPIDEM 10 MG TABLET All Payors / Plans All Payors / Plans $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.92 $0.90 $0.90 ZOLPIDEM 5 MG TABLET All Payors / Plans All Payors / Plans $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.94 $0.92 $0.92 ZONISAMIDE 100 MG CAPSULE All Payors / Plans All Payors / Plans $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.98 $0.96 $0.96 ZONISAMIDE 50 MG CAPSULE All Payors / Plans All Payors / Plans $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.05 $1.03 $1.03