Charge Code Description,"Rev
Code","Proc
Code","Rate
Exception",,,,,,,,,
100,PRIVATE ROOM,NRS,A,111,,,,,,584,N,N
1000,METOPROLOL 5MG/5ML INJ,RX,A,636,J3490,,,,,46,N,N
10000,"EXC MAL LES,SC,NK,HD,FT,GN 0,5",CL,I,523,11620,26,,,,146,N,Y
10001,"EXC MAL LES,SC,NK,HD,FT,GN 1.0",CL,A,523,11621,,,,,205,N,Y
10002,"EXC MAL LES,SC,NK,HD,FT,GN 2.0",CL,A,523,11622,,,,,251,N,Y
10003,"EXC MAL LES,SC,NK,HD,FT,GN 3.0",CL,A,523,11623,,,,,316,N,Y
10004,"EXC MAL LES,SC,NK,HD,FT,GN>4.0",CL,A,523,11626,,,,,462,N,Y
10005,"EXC MAL LES,FC,ER,EY,NS,LP 0.5",CL,A,523,11640,,,,,216,N,Y
10006,"EXC MAL LES,FC,ER,EY,NS,LP 1.0",CL,A,523,11641,,,,,418,N,Y
10007,"EXC MAL LES,FC,ER,EY,NS,LP 2.0",CL,A,523,11642,,,,,351,N,Y
10008,"EXC MAL LES,FC,ER,EY,NS,LP 3.0",CL,A,523,11643,,,,,379,N,Y
10009,"EXC MAL LES,FC,ER,EY,NS,LP 4.0",CL,A,523,11644,,,,,462,N,Y
1001,TORADOL 15MG/CC TUBEX,RX,A,252,J1885,,,,,64,N,N
10010,"EXC MAL LES,FC,ER,EY,NS,LP>4.0",CL,A,523,11646,,,,,667,N,Y
10011,"AVULSION OF NAIL,SIMPLE,SINGLE",CL,A,523,11730,,,,,139,N,Y
10012,EVACUATION OF HEMATOMA,CL,A,523,11740,,,,,139,N,Y
10013,"EXC NAIL & NAIL MATRIX, PERM",CL,A,523,11750,,,,,234,N,Y
10014,"LAC SIMPLE,SC,NK,AX,GN,TR 2.5",CL,A,523,12001,,,,,223,N,Y
10015,"LAC SIMPLE,SC,NK,AX,GN,TR 7.5",CL,A,523,12002,,,,,321,N,Y
10016,"LAC SIMPLE,SC,NK,AX,GN,TR 12.5",CL,A,523,12004,,,,,356,N,Y
10017,"LAC SIMPLE,SC,NK,AX,GN,TR 20.0",CL,A,523,12005,,,,,390,N,Y
10018,"LAC SIMPLE,SC,NK,AX,GN,TR 30CM",CL,A,523,12006,,,,,269,N,Y
10019,"LAC SIMPLE,SC,NK,AX,GN,TR >30.",CL,A,523,12007,,,,,333,N,Y
1002,COLOSTOMY BAG,CS,A,272,A4398,,,,,5,N,N
10020,"LAC,SIM,FC,ER,EY,NS,LP 2.5CM",CL,A,523,12011,,,,,223,N,Y
10021,"LAC SIM,FC,ER,EY,NS,LP 2.6-5.0",CL,A,523,12013,,,,,279,N,Y
10022,"LAC SIM,FC,ER,EY,NS,LP 5.1-7.5",CL,A,523,12014,,,,,306,N,Y
10023,"LAC SIM,FC,ER,EY,NS,LP 7.6-12.",CL,A,523,12015,,,,,334,N,Y
10024,"LAC SIM,FC,ER,EY,NS,LP 12.6-20",CL,A,523,12016,,,,,398,N,Y
10025,"LAC SIM,FC,ER,EY,NS,LP 20.1=30",CL,A,523,12017,,,,,421,N,Y
10026,"LAC SIM,FC,ER,EY,NS,LP >30CM",CL,A,523,12018,,,,,579,N,Y
10027,LAC COMPLEX TRUNK 1.1-2.5CM,CL,A,523,13100,,,,,293,N,Y
10028,LAC COMPLEX TRUNK 2.6-7.5,CL,A,523,13101,,,,,351,N,Y
10029,"LAC COMPLEX,SC,AR,LG 1.1-2.5CM",CL,A,523,13120,,,,,316,N,Y
1003,COTTON TIP APPLICATOR N/S,CS,A,271,A4649,,,,,1,N,N
10030,"LAC COMPLEX,SC,AR,LG 2.6-7.5",CL,A,523,13121,,,,,445,N,Y
10031,"LAC,COM,FC,NK,AX,GN,HD,FT 1-2.",CL,A,523,13131,,,,,473,N,Y
10032,"LAC COM,FC,NK,AX,GN,HD,FT 7.5",CL,A,523,13132,,,,,501,N,Y
10033,"LAC COM,EY,NS,ER,LP UP TO 1.0",CL,I,517,13151,26,,,,321,N,Y
10034,"LAC COM, EY,NS,ER,LP 1.1-2.5",CL,A,523,13151,,,,,529,N,Y
10035,"LAC COM,EY,NS,ER,LP 2.6-7.5CM",CL,A,523,13152,,,,,654,N,Y
10036,"LAC COM, TRUNK OVER 7.5CM",CL,A,523,13100,,,,,1169,N,Y
10037,"LAC COM, SC,AR,LG OVER 7.5CM",CL,A,523,13120,,,,,1169,N,Y
10038,"LAC COM,FC,NK,AX,GN,KD,FT >7.5",CL,A,523,13121,,,,,584,N,Y
10039,BURN INITIAL TREAT 1ST DEGREE,CL,A,523,16000,,,,,83,N,Y
1004,"TRAY, CUTDOWN",CS,A,272,A4649,,,,,78,N,N
10040,"BURN DRESS CHG,SM ANESTHESIA",CL,A,523,16020,,,,,70,N,Y
10041,BURN CARE DEBRIDGMENT,CL,A,523,16020,,,,,83,N,Y
10042,BURN CARE MEDIUM,CL,A,523,16025,,,,,117,N,Y
10043,BURN DRESS CHG LARGE NO ANESTH,CL,A,523,16030,,,,,163,N,Y
10044,"DEST LES,FC, 1 LES ELECTROCAUT",CL,A,523,17000,,,,,128,N,Y
10044A,DES BEN LES 2-14,CL,A,523,17003,,,,,61,N,Y
10045,"DEST LES,FC,2-3LES ADD ELECTRO",CL,A,523,17000,,,,,128,N,Y
10046,"DEST LES FC, >3 EA ELECTROCAUT",CL,A,523,17003,,,,,61,N,Y
10047,"DEST BEN LES NOT FACE, 1 LESIO",CL,A,523,17110,,,,,128,N,Y
10048,"DEST BEN LES, NOT FC,2ND AD LS",CL,A,523,17111,,,,,29,N,Y
10049,"DEST BEN LES, NOT FC,3-14 AD L",CL,A,523,99999,,,,,29,N,Y
1005,COTTON TIP APPLICATOR STERILE,CS,A,272,,,,,,2,N,N
10050,"DEST BEN LES, NOT FC,>15EA LES",CL,I,523,99999,,,,,117,N,Y
10051,"DEST BEN LES, NOT FC, COMP",CL,I,523,99999,,,,,65,N,Y
10052,WART DESTRUCTION,CL,A,523,17110,,,,,128,N,Y
10053,INJ TRIGGER POINT/GANG CYST,CL,A,523,20550,,,,,123,N,Y
10054,INJ OR ASP SMALL JOINT,CL,A,523,20600,,,,,139,N,Y
10055,INJ OR ASP INTERMEDIATE JOINT,CL,A,523,20605,,,,,167,N,Y
10056,INJ OR ASP MAJOR JOINT,CL,A,523,20610,,,,,217,N,Y
10057,FX CLAVICLE CLOSED W/OUT MANIP,CL,A,523,23500,,,,,240,N,Y
10058,FX HUMERUS CLOSED W/OUT MANIPU,CL,A,523,23600,,,,,356,N,Y
10059,SHOULDER DISLOC W/MANIP NO ANE,CL,A,523,23650,,,,,293,N,Y
1006,LACERATION TRAY WITH INSTRUMENTS,CS,A,272,,,,,,94,N,N
10060,FX RADIAL HEAD/NECK CLOSED,CL,A,523,24650,,,,,246,N,Y
10061,"FX RADIAL SHAFT, CLOSED W/O MA",CL,A,523,25500,,,,,263,N,Y
10062,"FX RADIAL SHAFT, CLOSED W/MANI",CL,A,523,25505,,,,,504,N,Y
10063,"FX ULNAR SHAFT, W/MANIP",CL,A,523,25560,,,,,263,N,Y
10064,"FX RADIUS, CLOSED W/O MANIP",CL,A,523,25600,,,,,346,N,Y
10065,"FX RADIUS CLOSED COMP, W/O MAN",CL,A,523,24650,,,,,339,N,Y
10066,"FX RADIUS CLOS, COMPLEX W/MANI",CL,A,523,24655,,,,,760,N,Y
10067,"FX METACARPAL CLOSED SNGL, W/0",CL,A,523,26600,,,,,216,N,Y
10068,FX PHALANX CLOSED ANY FINGER,CL,A,523,26725,,,,,234,N,Y
10069,DISCLOCATION FINGER,CL,A,523,26770,,,,,187,N,Y
10070,FX PELVIS CLOSED W/O MANIP,CL,A,523,27193,,,,,537,N,Y
10071,FX CARE ACETABULUM,CL,A,523,27220,,,,,550,N,Y
10072,FX PATELLA CLOSED W/O MANIP,CL,A,523,27520,,,,,333,N,Y
10073,FX TIBIA CLOSED W/O MANIP,CL,A,523,27750,,,,,403,N,Y
10074,FX ANKLE CLOSED W/O MANIP,CL,A,523,27760,,,,,316,N,Y
10075,FX FIBULA CLOSES W/O MANIP,CL,A,523,27780,,,,,269,N,Y
10076,FX METATARSAL CLOSED W/O MANIP,CL,A,523,28470,,,,,234,N,Y
10077,FX PHALANX EXCEPT GREAT TOE CL,CL,A,523,28510,,,,,106,N,Y
10078,CAST APPLICATION LONG ARM,CL,A,523,29065,,,,,99,N,Y
10079,CAST APPLICATION SHORT ARM,CL,A,523,29075,,,,,195,N,Y
10080,CAST APPLICATION HAND/LOW FRAM,CL,A,523,29085,,,,,234,N,Y
10081,SPLINT LONG ARM APPLICATION,CL,A,523,29105,,,,,257,N,Y
10082,SPLINT SHORT ARM APPLICATION,CL,A,523,29125,,,,,257,N,Y
10083,STRAPPING THORAX APPLICATION,CL,A,523,29200,,,,,72,N,Y
10084,STRAPPING LOW BACK APPLICATION,CL,A,523,29520,,,,,56,N,Y
10085,STRAPPING SHOULDER APPLICATION,CL,A,523,29240,,,,,47,N,Y
10086,STRAPPING ELBOW/WRIST APPLICAT,CL,A,523,29260,,,,,41,N,Y
10087,STRAPPING HAND/FINGER APPLICAT,CL,A,523,29280,,,,,47,N,Y
10088,CAST APPLICATION HIP,CL,A,523,29325,,,,,286,N,Y
10089,CAST APPLICATION LONG LEG,CL,A,523,29345,,,,,146,N,Y
1009,NEBULIZER ENTRAINMENT & ADAPTE,CS,A,270,,,,,,38,N,N
10090,CAST APPLICATION LONG LEG WALK,CL,A,523,29355,,,,,158,N,Y
10091,CAST APPLICATION SHORT LEG,CL,A,523,29405,,,,,234,N,Y
10092,CAST APPLICATION SHORT LEG WAL,CL,A,523,29425,,,,,312,N,Y
10093,SPLINT SHORT LEG APPLICATION,CL,A,523,29515,,,,,234,N,Y
10094,STRAPPING KNEE APPLICATION,CL,A,523,29530,,,,,84,N,Y
10095,STRAPPING ANKLE,CL,A,523,29540,,,,,72,N,Y
10096,UNNA BOOT STRAPPING,CL,A,523,29580,,,,,231,N,Y
10097,CAST REMOVAL,CL,A,523,29705,,,,,75,N,Y
10098,"TAPE ANY TYPE, ANY SIZE",CL,A,523,99999,,,,,6,N,Y
10099,EAR IRRIGATION,CL,A,523,69210,,,,,61,N,Y
101,SEMI-PRIVATE ROOM,NRS,A,121,,,,,,510,N,N
1010,OBS DISCHARGE DAY CARE,OBS,A,762,G0378,,,,,64,N,N
10100,EYE TRAY,CL,A,523,99070,,,,,13,N,Y
10101,SUTURE TRAY,CL,A,523,99070,,,,,41,N,Y
10102,EKG INTERPRETATION,CL,A,523,93010,,,,,50,N,Y
10103,BLOOD PRESSURE CHECK,CL,A,523,93770,,,,,5,N,Y
10104,INJECTION ALLERGY (OWN MED),CL,A,523,96372,,,,,12,N,Y
10105,INJ ARISTICORT 1CC,CL,A,523,J3302,,,,,28,N,Y
10106,"INJ BICILLIN CR 600,000 UNITS",CL,A,517,J0558,,,,,45,N,Y
10107,INJ BICILLIN 1.2 MILLION UNITS,CL,A,517,J0558,,,,,45,N,Y
10108,"INJ BICILLIN LA 600,000 UNITS",CL,A,517,J0561,,,,,45,N,Y
10109,INJ BICILLIN LA 1.2 MILLION UN,CL,A,517,J0561,,,,,45,N,Y
1011,NASAL DRESSING,CS,A,272,,,,,,57,N,N
10110,INJ ROCEPHIN 250MG,CL,A,523,J0696,,,,,50,N,Y
10111,INJ ROCEPHIN 500MG,CL,A,523,J0696,,,,,61,N,Y
10112,INJ ROCEPHIN 1 GM,CL,A,523,J0692,,,,,101,N,Y
10113,INJ CELESTONE 4MG,CL,A,523,J0702,,,,,28,N,Y
10114,INJ COLCHICINE 2MG,CL,A,523,J0760,,,,,23,N,Y
10115,INJ KENALOG(CORTISONE) 50MG,CL,A,523,99999,,,,,22,N,Y
10116,INJ DECADRON 4MG,CL,A,523,J1100,,,,,28,N,Y
10117,INJ DELESTERGEN UP TO 40MG,CL,A,517,J1380,,,,,31,N,Y
10118,INJ DEPO-TESTADIOL 1CC,CL,A,523,J1060,,,,,20,N,Y
10119,INJ BENADRYL UP TO 50MG,CL,A,523,J1200,,,,,34,N,Y
10120,INJ ESTRADIOL 10MG,CL,A,523,J1380,,,,,20,N,Y
10121,INJ ESTRADIOL 20MG,CL,A,517,J1380,,,,,20,N,Y
10122,INJ GAMMA GLOBULIN 1CC,CL,A,523,J1460,,,,,16,N,Y
10123,INJ GAMMA GLOBULIN 2CC,CL,A,523,J1460,,,,,21,N,Y
10124,INJ LINCOCIN UP TO 300MG,CL,A,523,J2010,,,,,56,N,Y
10125,INJ LASIX UP TO 20MG,CL,A,523,J1940,,,,,28,N,Y
10126,INJ LASIX 40MG,CL,A,523,J1940,,,,,39,N,Y
10127,INJ PHENERGAN 50MG,CL,A,523,J2550,,,,,56,N,Y
10128,INJ PHENERGAN 25MG,CL,A,523,J2950,,,,,28,N,Y
10129,INJ TETANUS TOXOID UP TO 1ML,CL,A,523,90703,,,,,72,N,Y
10130,INJ TORECAN 10MG,CL,A,523,J3280,,,,,18,N,Y
10131,INJ VISTRARIL UP TO 25MG,CL,A,523,J3410,,,,,72,N,Y
10132,INJ VISTARIL 50MG,CL,A,523,J3410,,,,,72,N,Y
10133,INJ B-12 VITAMIN 1CC,CL,A,523,J3420,,,,,22,N,Y
10134,"INJ WYCILLIN 600,000 UNITS",CL,I,523,99999,,,,,45,N,Y
10135,"INJ WYCILLIN OVER 600,000 UNIT",CL,I,523,99999,,,,,25,N,Y
10136,INJ UNCLASSIFIED DRUGS,CL,A,523,J3490,,,,,0,N,Y
10137,INJ TORADOL 15 MG/30 MG,CL,A,523,J1885,,,,,1,N,Y
10138,INJ STADOL 1MG,CL,A,523,J3490,,,,,24,N,Y
10139,INJ STADOL 2MG,CL,A,523,J3490,,,,,25,N,Y
1014,"TRAY, DRESSING SMALL",CS,A,272,,,,,,38,N,N
10140,INJ DPT,CL,I,523,99999,,,,,50,N,Y
10141,INJ DT,CL,A,523,90702,,,,,39,N,Y
10142,INJ MEASLES BOOSTER,CL,A,523,90705,,,,,56,N,Y
10143,INJ MMR,CL,A,523,90707,,,,,56,N,Y
10144,INJ POLIO,CL,A,523,90712,,,,,36,N,Y
10145,INJ FLU VACCINE,CL,A,523,99999,,,,,20,N,Y
10146,INJ HEPATITIS B,CL,A,523,90746,,,,,139,N,Y
10147,INJ HEPATITIS B PEDIATRIC,CL,A,523,90743,,,,,106,N,Y
10148,INJ PNEUMONIA,CL,A,523,90732,,,,,94,N,Y
10149,ADMIN FEE PNEUMONIA VACCINE,CL,A,523,G0009,,,,,28,N,Y
10150,INJ B-COMPLEX,CL,A,523,J3570,,,,,22,N,Y
10151,INJ NUBAIN 10MG,CL,A,523,J3490,,,,,50,N,Y
10151A,INJ NUBAIN 20MG,CL,A,523,J2300,,,,,50,N,Y
10152,HOLTER INTERPRETATION,CL,A,523,93227,,,,,146,N,Y
10153,INJ ACTH,CL,A,523,J0800,,,,,15,N,Y
10154,INJ COMPAZINE 10MG,CL,A,523,J0780,,,,,23,N,Y
10155,INJ DEPOMEDROL 40MG,CL,A,523,,,,,,61,N,Y
10156,INJ TERRAMYCIN 50MG,CL,A,523,J2460,,,,,22,N,Y
10157,TB TINE TEST,CL,A,523,86580,32,,,,28,N,Y
10158,PROCARDIA (1),CL,A,523,J8499,,,,,6,N,Y
10159,INJ XYLOCAINE,CL,A,523,99999,,,,,17,N,Y
1016,TAPE ELESTAPLAST BANDAGE,CS,A,271,A4452,,,,,29,N,N
10160,INJ MARCAIN,CL,A,523,S0020,,,,,24,N,Y
10161,PAP SMEAR PHYSICIAN CHARGE ONL,CL,A,523,88141,,,,,56,N,Y
10161A,PAP SMEAR,CL,A,523,88142,,,,,50,N,Y
10162,INJ HEMOPHILUS,CL,A,523,,,,,,45,N,Y
10163,SUTURE REMOVAL TRAY,CL,A,523,99070,,,,,23,N,Y
10164,I&D TRAY,CL,A,523,99070,,,,,28,N,Y
10165,PELVIC EXAM KIT,CL,A,523,99070,,,,,36,N,Y
10166,CAST ROOM,CL,A,700,,,,,,206,N,Y
10167,LUMBAR PUNCTURE TRAY,CL,A,523,99070,,,,,41,N,Y
10168,PROLONGED VISIT,CL,A,523,99354,,,,,195,N,Y
10169,PROLONGED VISIT NOT FACE TO FA,CL,A,523,99358,,,,,94,N,Y
1017,TAPE ELASTOPLAST BANDAGE -CASE,CS,A,271,A4452,,,,,208,N,N
10170,CARE PLAN OVERSIGHT,CL,A,523,99375,,,,,88,N,Y
10171,ADMINISTRATION OF INJECTION,CL,A,523,96372,,,,,28,N,Y
10172,VENIPUNCTURE BY PHYSICIAN,CL,A,523,36415,,,,,23,N,Y
10173,ADMIN FEE INFLUENZA VACCINE,CL,A,523,G0008,,,,,28,N,Y
10174,INJ DEPO MEDROL 80MG,CL,A,523,J1040,,,,,89,N,Y
10175,INJ ARTITICORT 40MG,CL,A,523,J3302,,,,,28,N,Y
10176,FRACTURE CARE SHORT LEG W/ AMBULATION,CL,A,523,29425,,,,,445,N,Y
10178,INJ TIGAN 200MG,CL,A,523,J3250,,,,,31,N,Y
10179,EAR TRAY,CL,A,523,,,,,,28,N,Y
1018,EMERGENCY CARE MOBILE UNIT,CS,A,270,,,,,,427,N,N
10180,INJ ZOFRAN 4MG,CL,A,523,J2405,,,,,39,N,Y
10181,INJ REGLAN 10MG,CL,A,523,J2765,,,,,50,N,Y
10182,SDD OBS LEVEL 1,CL,A,523,99234,,,,,334,N,Y
10183,SDD OBS LEVEL 2,CL,A,523,99235,,,,,440,N,Y
10184,SDD OBS LEVEL 3,CL,A,523,99236,,,,,457,N,Y
10187,DIPH/TET ADULT,CL,A,523,90703,,,,,72,N,Y
10190,PULSE OXYMETER,CL,A,523,,,,,,23,N,Y
10195,INJ ANCEF 1 GM,CL,A,523,J0690,,,,,45,N,Y
10199,INJ DEPO MEDROL 80MG,CL,A,523,,,,,,89,N,Y
102,SWING BED ROOM,NRS,A,120,,,,,,325,N,N
1020,"TRAY, ENEMA",CS,A,271,,,,,,25,N,N
1021,TESSALON PERLES,RX,A,252,J8499,,,,,13,N,N
1022,SPLINT FINGER METAL,CS,A,274,A4570,,,,,27,N,N
10224,FRACTURE CARE,CL,A,523,27786,,,,,409,N,Y
10225,REMOVAL OF NAIL,CL,A,523,11730,,,,,139,N,Y
1023,SULFACETAMIDE SOD EYE DROPS,RX,A,251,J8499,SH,,,,24,N,N
1024,CATHETER FOLEY 16-18 FR,CS,A,272,A4338,,,,,71,N,N
1025,ANCA,LAB,A,301,86021,90,,,,576,N,N
10255,FLU VACCINE ADMIN FEE,CL,A,523,G0008,,,,,28,N,Y
10256,HIBS VACCINE,CL,A,523,90706,,,,,61,N,Y
10257,PNEUMONIA ADMIN FEE,CL,A,523,G0009,,,,,28,N,Y
10259,HEPATATIS ADMIN FEE,CL,A,523,G0010,,,,,28,N,Y
1026,CATHETER FOLEY TRAY DISP,CS,A,272,A4310,,,,,57,N,N
1027,IMMUNOASSAY ANALYTE ANTIBODY,LAB,A,301,83516,90,,,,113,N,N
1028,CATHETER FOLEY DISP W/CAT & DR,CS,A,272,A4338,,,,,71,N,N
1029,ANTIBODY TITER,LAB,A,391,86886,90,,,,172,N,N
103,EXTENDED CARE ROOM A,ECR,A,120,,,,,,131,N,N
1031,LUPUS ANTICOAGULANT STUDY,LAB,A,301,85613,90,,,,270,N,N
1032,CATHETER FOLEY 3WAY W/30CC BG,CS,A,272,A4316,,,,,56,N,N
1033,NON REBREATHING MASK,CS,A,271,,,,,,28,N,N
1034,CAST FOOT ADULT,CS,A,274,A4580,,,,,149,N,N
1035,PYRIDIUM 100MG,RX,A,251,J8499,,,,,8,N,Y
1036,CAST FOOT CHILD,CS,A,274,A4580,,,,,131,N,N
1038,CAST FOREARM ADULT,CS,A,274,A4580,,,,,175,N,N
104,EXTENDED CARE ROOM B,ECR,A,120,,,,,,219,N,N
1040,CAST FOREARM CHILD,CS,A,274,A4580,,,,,131,N,N
1042,CAST HAND ADULT,CS,A,274,A4580,,,,,131,N,N
1044,CAST HAND CHILD,CS,A,274,A4580,,,,,125,N,N
10450,SUTURE REMOVAL,TR,A,761,,,,,,25,N,N
1046,SPLINT HAND METAL,CS,A,274,,,,,,52,N,N
10466,BIOPSY CA RIGHT ARM,ED,A,450,24066,,,,,306,N,N
1048,"TUBE, HARRIS FLUSH DISPOSIBLE",CS,A,271,,,,,,18,N,N
105,EMERGENCY ROOM LEVEL 1,ED,A,450,99281,,,,,159,N,N
1050,HEAT LAMP PER TREATMENT,CS,A,270,,,,,,22,N,N
1051,ER LEVEL 1 EMTALA,ED,A,450,,,,,,127,N,N
1052,HEEL PROTECTORS PAIR,CS,A,271,,,,,,36,N,N
1054,"PACK, HYDROCOLLATOR EACH USE",CS,A,270,E0239,,,,,43,N,N
1055,TAX,NRS,A,940,,,,,,0,N,N
1056,ICE PACK PER TREATMENT,CS,A,270,,,,,,24,N,N
1057,ICE BAG REGULAR,CS,A,271,,,,,,13,N,N
1058,INFUSION PUMP PER DAY,CS,A,261,C8957,,,,,65,N,Y
1059,ICE BAG COLLAR,CS,A,271,,,,,,13,N,N
106,EMERGENCY ROOM LEVEL 2,ED,A,450,99282,,,,,265,N,N
1061,AIRWAY NASOPHARYNGEAL,CS,A,272,,,,,,32,N,N
1062,GAUZE IODOFORM 1/2IN,CS,A,272,A6199,,,,,25,N,N
1063,GUAZE KERLEX ROLL NON STERILE,CS,A,271,,,,,,7,N,N
1064,"GAUZE IODOFORM 1""",CS,A,272,A6199,,,,,24,N,N
10659,BIOPSY OF SKIN,CL,A,523,11100,,,,,167,N,Y
10659A,BIOPSY 2ND LES EACH ADDIT,CL,A,523,11101,,,,,206,N,Y
1066,"TRAY, IRRIGATION",CS,A,272,,,,,,38,N,N
1067,IRRIGATION CYSTO SET,CS,A,272,A4355,,,,,24,N,N
1068,"PACK, ISOLATION PER DAY",CS,A,270,,,,,,134,N,N
1069,CATHETER UNIV DRAINAGE BAG,CS,A,272,A4357,,,,,24,N,N
107,EMERGENCY ROOM LEVEL 3,ED,A,450,99283,,,,,345,N,N
1071,I&D ABSCESS,TR,A,761,27603,,,,,418,N,N
1076,CAST LEG LONG ADULT,CS,A,274,A4580,,,,,323,N,N
1078,CAST LEG LONG CHILD,CS,A,274,A4580,,,,,252,N,N
108,OBS SDD 1-3RD HR MOD,OBS,A,762,G0378,,,,,78,N,N
1080,CAST LEG SHORT ADULT,CS,A,274,A4580,,,,,252,N,N
1081,SNARE/POLYPECTOMY LARGE INTEST,AS,A,750,45385,,,,,141,N,N
1082,CAST LEG SHORT CHILD,CS,A,274,A4580,,,,,209,N,N
1083,SNARE/POLYPECTOMY LARGE INTEST,AS,A,750,44604,,,,,141,N,N
1084,"TUBE, LAVINE",CS,A,272,B4083,,,,,15,N,N
1085,GAUZE SURGIFLEX TUBE,CS,A,270,,,,,,7,N,N
1086,IV CATH NEEDLE LONGDWELL,CS,A,272,A4222,,,,,55,N,N
1087,BIPOLAR PROBE,AS,A,750,,,,,,350,N,N
1088,"TRAY, PROCEDURE MAJOR",CS,A,272,A4550,,,,,108,N,N
1090,GAUZE MARLEX MESH 10 X 14,CS,A,272,,,,,,242,N,N
1091,LAYER REPAIR LAC 8CM EXT,ED,A,450,12034,,,,,439,N,N
1092,"TRAY, PROCEDURE MINOR",CS,A,272,A4550,,,,,68,N,N
1093,ACENTESIS ASPRTE INJ JNT MAJOR,ED,A,450,20610,,,,,252,N,N
1094,CAST ARM SHORT APPLY,ED,A,450,29075,,,,,219,N,N
1095,CAST LEG SHORT APPLY,ED,A,450,29405,TC,,,,444,N,N
1096,DRAIN ABSCESS FINGER SIMPLE,ED,A,450,26010,,,,,323,N,N
1097,DRESS DEBRIDE BURN SMALL,ED,A,450,16020,,,,,252,N,N
1098,PENROSE OR CIGARETTE DRAIN,CS,A,272,,,,,,8,N,N
1099,DRESS/DEBRIDE BURN MED,ED,A,450,16025,,,,,340,N,N
10999,CAST ANKLE BELOW KNEE AMBULATING,ED,A,450,29425,,,,,337,N,N
110,OBS 4TH AND UP LEV 2,OBS,A,762,G0378,,,,,36,N,N
1100,PERINEAL LIGHT PER TREAT,CS,A,270,,,,,,22,N,N
1101,SEMI PRIVATE ROOM WITH MONITOR,NRS,A,202,,,,,,775,N,N
1102,OBS 4TH & UP LEV 2 W/MON,OBS,A,762,G0378,,,,,54,N,N
1103,OBSE SUBSEQ VISIT LEVEL 2,OBS,A,762,G0378,25,,,,267,N,N
1104,OBS SUBSEQUENT DAY VISIT LEVEL 3,OBS,A,762,G0378,25,,,,326,N,N
11040,DEBRIDMENT OF WOUND,ED,A,450,11042,,,,,276,N,N
11042,DEBRIDEMENT INFECTED SKIN,TR,A,761,11000,TC,22,LT,,329,N,N
1105,RESUSCITATION BAG FOR CHILD,CS,A,271,,,,,,105,N,N
1106,RESUSCITATION EMERG PER TR,CS,A,270,,,,,,219,N,N
1107,RESUSCITATION BAG,CS,A,271,,,,,,210,N,N
1108,RIB BELT,CS,A,274,,,,,,60,N,N
111,CAST ROOM,NRS,A,700,,,,,,219,N,N
1110,SCROTAL SUPPORT,CS,A,274,,,,,,32,N,N
11100,BIOPSY OF SKIN,TR,A,761,11100,,,,,186,N,N
1111,OXYGEN TUBING,CS,A,271,,,,,,13,N,N
1112,"SLING, SHOULDER & SWATHER",CS,A,270,A4565,,,,,73,N,N
1113,NEBULIZER TUBING HAND HELD,CS,A,271,A4616,,,,,17,N,N
1114,SITZ BATH PER TREATMENT,CS,A,271,,,,,,29,N,N
1115,OXYGEN MASK,CS,A,271,,,,,,24,N,N
1116,"TRAY, SPINAL TAP",CS,A,272,,,,,,94,N,N
1117,SPIROMETER,CS,A,270,,,,,,32,N,N
1118,DEST LESION MALIGNANT,AS,A,360,11602,,,,,439,N,N
1119,IV SUBCLAVIAN,CS,A,272,,,,,,32,N,N
112,RECOVERY ROOM 60MINUTES,RR,A,710,,,,,,298,N,N
1120,SUCTION MACHINE PER DAY,CS,A,270,,,,,,43,N,N
11200,REMOVAL SKIN TAGS,TR,A,761,11200,26,,,,72,N,N
1121,MASK PERCENTO,CS,A,271,,,,,,13,N,N
1122,SUTURE REMOVAL TRAY,CS,A,272,A4550,,,,,38,N,N
1123,IPPB SETS,CS,A,271,A7016,,,,,32,N,N
1125,OXYGEN MASK PEDI,CS,A,271,A4620,,,,,17,N,N
1127,MASK FACE TENT,CS,A,271,E0455,,,,,15,N,N
1128,"TRAY, SUTURE SMALL",CS,A,272,A4550,,,,,57,N,N
1129,RAZOR (DISPOSABLE),CS,A,271,A4550,,,,,5,N,N
113,RECOVERY ROOM 120 MINUTES,RR,A,710,,,,,,413,N,N
1130,ISOLATION ROOM WITH MONITOR,NRS,A,210,,,,,,795,N,N
1132,PORT INFUSION SET,CS,A,272,,,,,,85,N,N
1134,"TRAY, TRACHEOTOMY",CS,A,272,,,,,,103,N,N
1136,TRACTION SETUP,CS,A,270,,,,,,118,N,N
1137,SKIN STAPLER,CS,A,272,,,,,,47,N,N
1138,TRACTION PER DAY,CS,A,270,,,,,,53,N,N
1139,STAPLE REMOVAL TRAY,CS,A,272,,,,,,13,N,N
1140,TRANSCUTAN OXYGEN MONIT P/D,CS,A,270,,,,,,133,N,N
11400,EXCISION LESION,ED,A,450,11400,,TC,,,329,N,Y
1142,"TRAY, TRANSFUSION ADMINISTRATI",CS,A,272,,,,,,92,N,N
11423,EXCISION LESION SCALP 2.1 - 3.0 CM,TR,A,761,11423,22,51,LT,TC,161,N,N
1143,SPLINT COLLAR TUBULAR 1FT,CS,A,274,,,,,,8,N,N
1144,TUR IRRIGATION SET,CS,A,272,A4355,,,,,31,N,N
11440,EXCISION LESION 0.5 CM,TR,A,761,11440,22,51,LT,TC,139,N,N
1145,ZITHROMAX 250MG TAB,RX,A,252,J8499,SH,,,,110,N,N
1146,"TRAY, URETHERAL DILITATION",CS,A,272,,,,,,59,N,N
1147,LOVENOX 30MG INJ,RX,I,252,J1650,,,,,183,N,N
1148,LOVENOX 40MG INJ,RX,I,251,,,,,,234,N,N
1149,HEPARIN LOCK FLUSH 10UML,RX,A,252,J1642,,,,,12,N,N
115,RECOVERY ROOM 180 MINUTES,RR,A,710,,,,,,528,N,N
1150,SALINE FLUSH SYRINGE PREFILLED,RX,A,250,,,,,,23,N,N
1151,ZITHROMAX 500MG IV,RX,A,252,J0456,,,,,110,N,N
1152,"HEEL, WALKING RUBBER",CS,A,271,L3460,,,,,25,N,N
1153,ALLOPURINOL 100MG TAB,RX,A,252,J8499,,,,,5,N,N
1154,ABD PADS STERILE,CS,A,272,,,,,,6,N,N
1155,MS CONTIN 15MG TAB,RX,A,252,J8499,,,,,13,N,N
1156,PRIVATE ROOM WITH MONITOR,NRS,A,210,,,,,,776,N,N
1158,"TAPE ADHESIVE 1""",CS,A,271,A4450,AW,,,,5,N,N
116,EXC HEMORRHOIDAL TAG,AS,A,750,46230,,,,,1090,N,N
1160,"TAPE ADHESIVE 2""",CS,A,270,,,,,,4,N,N
1162,"TAPE ADHESIVE 3""",CS,A,270,A4452,,,,,4,N,N
11622,EXC LESION NECK 1.1 TO 2.0 CM,TR,A,761,11622,51,22,TC,LT,240,N,Y
1164,"TRAY, ENDOMETRIAL",CS,A,272,,,,,,73,N,N
1166,AMITRIPTYLINE 10MG TAB,RX,A,252,J8499,,,,,2,N,N
1168,PRILOSEC 20MG CAP,RX,A,252,J8499,SH,,,,42,N,N
117,RECOVERY ROOM MAXIMUM,RR,A,710,,,,,,642,N,N
1170,"TAPE DERMICEL 1""",CS,A,270,A4452,,,,,5,N,N
1171,DEFIB PADS 4 1/2 X 4 1/2,CS,A,272,,,,,,52,N,N
1172,"TAPE DERMICEL 2""",CS,A,271,A4452,,,,,7,N,N
1173,DEFIB PADS 4 1/2 X 6,CS,A,272,,,,,,52,N,N
1174,DRESSING FLAT 2X2 EACH,CS,A,271,A6253,,,,,5,N,N
1175,LOVENOX 80MG INJECTION,RX,I,252,J1650,,,,,223,N,N
11750,"EXCISION OF NAIL, PERMANENT REMOVAL",TR,A,761,11750,TC,,,,267,N,N
1176,AMONIA,LAB,A,301,82140,90,,,,280,N,N
11765,AVULSION NAIL BED,ED,A,450,11765,,,,,356,N,N
1178,DRESSING 4X4 EACH,CS,A,272,A6253,,,,,3,N,N
1179,LOVENOX 60MG/0.6ML INJ,RX,I,251,J1650,,,,,46,N,N
118,THROMBOLYSIS BY INFUSION,NRS,A,210,36593,,,,,267,N,N
1180,LOVENOX 100MG/ML,RX,I,252,J1650,,,,,136,N,N
1181,TREATMENT ROOM NP L-1,TR,A,761,99201,,,,,167,N,N
1182,"GAUZE ROLL REG 2""X 10 YD",CS,A,271,A6266,,,,,6,N,N
1183,TREATMENT ROOM NP L-2,TR,A,761,99202,,,,,175,N,N
1184,"GAUZE ROLL 3"" X 10 YD",CS,A,271,A6266,,,,,7,N,N
1185,TREATMENT ROOM NP L-3,TR,A,761,99203,,,,,219,N,N
1186,"GAUZE ROLL REG 4"" X 10 YD",CS,A,271,,,,,,8,N,N
1187,TREATMENT ROOM NP L-4,TR,A,761,99204,,,,,264,N,N
1188,GAUZE KERLEX ROLL STERILE,CS,A,272,A6403,,,,,13,N,N
1189,TREATMENT ROOM NP L-5,TR,A,761,99205,,,,,307,N,N
119,LUTEINIZING HORMONE,LAB,A,301,83002,90,,,,172,N,N
1190,"TAPE MICROPORE 1""",CS,A,271,A4450,,,,,4,N,N
1191,TREATMENT ROOM EST PT L-1,TR,A,761,99211,,,,,217,N,N
1192,TREATMENT ROOM EST PT L-2,TR,A,761,99212,,,,,223,N,N
1194,TREATMENT ROOM EST PT L-3,TR,A,761,99213,,,,,250,N,N
1196,TREATMENT ROOM EST PT L-4,TR,A,761,99214,,,,,306,N,N
1198,TREATMENT ROOM EST PT LEV 5,TR,A,761,99215,,,,,435,N,N
1199,RISPERIDAL LEVEL,LAB,A,301,80299,90,,,,323,N,N
120,COLONOSCOPY W/POLYP SNARE,AS,A,750,45385,,,,,1832,N,N
1200,ALBUTEROL 2.6ML,RX,A,252,J7613,,,,,39,N,N
1201,"CROUP TENT, PEDIATRIC SET UP",CS,A,271,A4619,,,,,59,N,N
1202,NUPERCAINAL OINTMENT 1%,RX,A,252,J8499,SH,,,,28,N,N
1203,DESSING TRANSPARENT,CS,A,271,A6257,,,,,11,N,N
1204,DRESSING TELFA 2X3,CS,A,272,A6413,,,,,5,N,N
1205,STERILE 3X3 GUAZE,CS,A,272,,,,,,3,N,N
1206,DRESSING TELFA 3X4,CS,A,272,A6253,,,,,5,N,N
1208,AIR WAY,CS,A,271,,,,,,3,N,N
121,WET MOUNT (PREP),LAB,A,306,87210,90,,,,32,N,N
1210,ALCOHOL PREP BOX 200,CS,A,270,,,,,,31,N,N
1211,ALCOHOL PINT,CS,A,270,,,,,,5,N,Y
1212,BANDAIDS,CS,A,270,,,,,,2,N,Y
1213,OXYGEN HUMIDIFIER,CS,A,271,A7012,,,,,13,N,N
1214,BETADINE SOAK,CS,A,272,A4246,,,,,24,N,N
1215,BETADINE PREP SOLUTION,CS,A,271,A4246,,,,,24,N,N
12151,BETADINE SWABS,CS,A,272,A4247,,,,,20,N,N
1216,BOVIE PENCIL DISPOSABLE,CS,A,272,,,,,,28,N,N
1217,CARDIZEM CD 240MG PO,RX,A,251,J8499,,,,,53,N,N
1218,IV BLOOD Y SET,CS,A,272,A4750,,,,,45,N,N
1219,BLOOD GAS KIT,CS,A,272,,,,,,10,N,N
122,COLONOSCOPY W/POLYP CAUTERY,AS,A,750,45384,,,,,1832,N,N
1220,OXYGEN BREATHING MASK,CS,A,271,A4620,,,,,18,N,N
1221,SCALPEL #15 DISPOSABLE,CS,A,272,,,,,,23,N,N
1222,BENZOIN,CS,A,270,A4649,,,,,10,N,N
1223,BENZIONE TINTURE,CS,A,271,,,,,,8,N,N
1224,SUCTION CATHETER,CS,A,272,,,,,,10,N,N
1225,CAST REMOVAL TRAY,CS,A,274,A4590,,,,,65,N,N
1226,CRASH CART,CS,A,270,,,,,,252,N,N
1227,CAST PADDING,CS,A,274,A4580,,,,,28,N,N
1228,OXYGEN CANNULA ADULT,CS,A,271,A4615,,,,,19,N,N
1229,"CAST PLASTER 2""",CS,A,274,A4580,,,,,38,N,N
123,TISSUE EXAM FOR FUNGI(KOH),LAB,A,310,87220,90,,,,57,N,N
1230,CATHETER EXTERNAL-CASE,CS,A,272,A4326,,,,,328,N,N
1231,"CAST PLASTER 3""",CS,A,274,A4580,,,,,36,N,N
1232,CATHETER EXTERNAL,CS,A,272,A4326,,,,,5,N,N
1233,"CAST PLASTER 4""",CS,A,274,A4580,,,,,43,N,N
1234,CATHETER LEG STRAPES,CS,A,271,,,,,,13,N,N
1235,"CAST PLASTER 6""",CS,A,274,A4580,,,,,46,N,N
1236,SUTURE PROXISTRIP CLOSURE,CS,A,272,A4649,,,,,13,N,N
1237,CAST PLASTER SPLINTS,CS,A,274,A4580,,,,,24,N,N
1238,CATHETER TIP SYRINGE,CS,A,272,A4335,,,,,5,N,N
1239,"STOCKINETTE 2""",CS,A,274,A6442,,,,,10,N,N
124,ENDOSCOPY ROOM,TR,A,760,99211,,,,,551,N,N
1240,CROUP TENT PER DAY,CS,A,270,A4619,,,,,183,N,N
1241,"STOCKINETTE 3""",CS,A,274,A6443,,,,,13,N,N
1242,COMMODE CHAIR PER WEEK,CS,A,270,,,,,,13,N,N
1243,GLOVES EXAM,CS,A,271,A4927,,,,,4,N,Y
12431,GLOVES EXAM,CS,A,271,A4927,,,,,4,N,N
1244,SUTURE 4-0 ETHILON,CS,A,272,A4649,,,,,21,N,N
1245,KY JELLY (TUBE),CS,A,272,A4402,,,,,13,N,N
1246,SUTURE 00 PROLENE,CS,A,272,A4649,,,,,18,N,N
1247,KY JELLY PACKETS EACH,CS,A,272,A4332,,,,,7,N,N
1248,SUTURE CHROMIC,CS,A,272,A4649,,,,,24,N,N
1249,SALINE FLUSH,RX,A,251,,,,,,18,N,N
125,SIG FLEX W/RMVE TUMOR SNARE,AS,A,750,45338,,,,,1612,N,N
1250,SUTURE 3-0 PLAIN,CS,A,272,A4649,,,,,18,N,N
1251,SUTURE 6-0 ETHILON,CS,A,272,A4649,,,,,24,N,N
12512,SUTURE 3-0 VICRYL,CS,A,272,A4649,,,,,36,N,N
12513,SUTURE 4-0 MONOCRYL,CS,A,272,A4649,,,,,36,N,N
12514,SUTURE 5-0 VICRYL,CS,A,272,A4649,,,,,36,N,N
1252,SUTURE O-VICRYL,CS,A,272,,,,,,24,N,N
1253,SUTURE 5-0 ETHILON,CS,A,272,A4649,,,,,32,N,N
1254,SUTURE 3-0 ETHILON,CS,A,272,A4649,,,,,18,N,N
1255,"TRAY, PERITONEAL LAVAGE",CS,A,272,,,,,,171,N,N
1256,SUTURE 2-0 DEXTON,CS,A,272,A4649,,,,,18,N,N
1257,"UNNA BOOT, SPLINT",CS,A,274,L1906,,,,,246,N,N
1258,SUTURE 00 SILK,CS,A,274,A4649,,,,,18,N,N
126,COLONOSCOPY W/CNTRL BLEED,AS,A,750,45382,,,,,1874,N,N
1260,SUTURE 3-0 SILK,CS,A,272,A4649,,,,,18,N,N
1261,SUTURE 4-0 NYLON,CS,A,272,,,,,,24,N,N
1262,SUTURE 5-0 SILK,CS,A,272,A4649,,,,,24,N,N
1263,SUTURE 6-0 SILK,CS,A,272,A4649,,,,,24,N,N
1264,"TRAY, EYE",CS,A,272,,,,,,36,N,N
1265,SUTURE 3-0 PLAIN GUT,CS,A,272,A4649,,,,,18,N,N
1266,"TRAY, BETADINE SCRUB",CS,A,272,A4246,,,,,38,N,N
1267,SUTURE 4-0 SILK SUTURE,CS,A,272,A4649,,,,,19,N,N
1268,"TRAY, SURGERY PLASTIC",CS,A,272,A4550,,,,,57,N,N
127,COLONOSCOPY WITH BIOPSY,AS,A,750,45380,,,,,1832,N,N
1270,SPLINT CLAVICLE SMALL,CS,A,274,L3660,,,,,81,N,N
1272,RAPE KIT,CS,A,272,,,,,,98,N,N
1274,SPLINT FINGERGUARD,CS,A,274,A4570,,,,,57,N,N
1276,"PACK, VAGINAL",CS,A,272,,,,,,34,N,N
1278,SPONGES TONSIL EA,CS,A,272,,,,,,6,N,N
1279,TOUNGE BLADES NON STERILE,CS,A,271,,,,,,4,N,N
128,COLONOSCOPY DX,TR,A,750,45378,,,,,1612,N,N
1280,PREP PAD,CS,A,271,,,,,,10,N,N
1281,TOUNGE BLADES STERILE,CS,A,272,,,,,,4,N,N
1282,"CASTING FIBERGALSS ""4",CS,A,274,A4590,,,,,38,N,N
1283,"CASTING FIBERGLASS ""3",CS,A,274,A4590,,,,,38,N,N
1284,"CASTING LIGHT 2""",CS,A,274,A4590,,,,,40,N,N
1286,"CASTING LIGHT 3""",CS,A,274,A4590,,,,,53,N,N
1287,"CASTING LIGHT 4""",CS,A,274,A4590,,,,,46,N,N
1288,BANDAGE TRIANGULAR,CS,A,271,A4565,,,,,5,N,N
129,COLONOSCOPY W/ABLATION TUM/POL,AS,A,750,45383,,,,,1832,N,N
1290,SPLINT ARM FLEXBOARD P/D,CS,A,274,,,,,,18,N,N
1293,PEROXIDE,CS,A,271,A4244,,,,,7,N,N
1294,TRACTION HEAD HALTER PER DAY,CS,A,274,,,,,,29,N,N
1295,FLUID WARMER EQUIPMENT,CS,A,270,,,,,,214,N,N
1296,MASK FILI,CS,A,271,,,,,,14,N,N
1297,TRACTION TRAPEZE,CS,A,270,,,,,,71,N,N
1298,HEATING PAD P/D EQUIPMENT,CS,A,270,,,,,,7,N,N
1299,ACCESS PICC LINE,RX,A,940,,,,,,92,N,N
13,GLUCAGON LEVEL,LAB,A,301,82943,90,,,,245,N,N
130,TREATMENT ROOM,TR,A,761,,,,,,323,N,N
1300,SPONGES RAYTAC,CS,A,272,,,,,,6,N,N
1301,FOLLICLE STIMULATING HORMONE,LAB,A,301,83001,90,,,,172,N,N
1302,ANTIPHOSPOKIPID ANTIBODY,LAB,A,301,86146,90,,,,374,N,N
1303,OXYGEN CANNULA PEDIATRIC,CS,A,271,A4615,,,,,19,N,N
1304,"PACK, WARM MOIST",CS,A,270,,,,,,24,N,N
1305,PEAK FLOW METER,CS,A,271,S8096,,,,,52,N,N
1306,SHAKE UP,CS,A,270,,,,,,13,N,N
1307,TRACTION PELVIC BELT,CS,A,274,,,,,,83,N,N
1308,SALINE LOCK,CS,A,272,A4222,,,,,34,N,N
131,OPERATING ROOM 150 MINUTES,AS,A,360,,,,,,1809,N,N
1310,SPINAL NEEDLE,CS,A,272,,,,,,21,N,N
1311,"TRAY, SPINAL",CS,A,272,A4550,,,,,92,N,N
1312,TROCAR CATHETER,CS,A,272,,,,,,46,N,N
13132,REPAIR COMPLEX LACERATION HAND,ED,A,450,13132,22,,,,705,N,N
1314,THORACIC CATHETER,CS,A,272,,,,,,29,N,N
13152,REPAIR ORBIT COMPLEX,ED,A,450,13152,,,,,525,N,N
13153,REPAIR LACERATION ORBIT COMPLEX ADDITION,ED,A,450,13153,,,,,225,N,N
1316,DRAIN UNIT FOR CHEST,CS,A,272,,,,,,92,N,N
1318,OXISENSOR PEDI DISPOSABLE,CS,A,271,,,,,,58,N,N
1319,"OXISENSOR, ADULT DISPOSABLE",CS,A,271,,,,,,7,N,N
132,COLONOSCOPY,AS,A,750,45378,,,,,1853,N,N
1320,ENSURE PLUS,CS,A,270,B4150,,,,,15,N,N
1321,SCAPEL #10 DISPOSABLE,CS,A,272,,,,,,23,N,N
1322,IMODIUM,RX,A,251,J8499,,,,,7,N,N
1323,LOVONOX 0.4ML INJECTION,RX,I,252,J1650,,,,,32,N,N
1324,"TRAY, SHAVR PREP",CS,A,272,,,,,,8,N,N
1325,DEFRIBILLATOR EQUIPMENT,CS,A,270,,,,,,252,N,N
1326,"GAUZE KLING STERILE 2""",CS,A,272,A6403,,,,,5,N,N
1327,CPR,ED,A,450,92950,,,,,848,N,N
1328,"GAUZE KLING STERILE 3""",CS,A,272,A6403,,,,,8,N,N
133,IV SPONGE STERILE 2X2 PRENOTCH,CS,A,272,,,,,,18,N,N
1330,DRESSING VASELINE 1OZ,CS,A,272,A6250,,,,,6,N,N
1332,IV ADMINISTRATION KIT,CS,A,272,A4212,,,,,38,N,N
1333,LOFENOX 100ML INJECTABLE,RX,A,252,J1956,,,,,72,N,N
1334,IV EXTENSION,CS,A,272,A4222,,,,,27,N,N
1335,SYRINGE 1CC 25G-1,CS,A,272,A4206,,,,,6,N,N
1336,DRESSING TELFA 3X8 STERILE,CS,A,272,A6253,,,,,7,N,N
1337,SYRINGE 3CC 22G-1,CS,A,272,,,,,,6,N,Y
1338,EXTRACTOR,CS,A,272,A4649,,,,,21,N,N
1339,"SYRINGE 3CC 25G-5/8""",CS,A,272,A4208,,,,,6,N,N
134,SIG FLEX W/BX,AS,A,750,45331,,,,,1395,N,N
1340,EYE PAD,CS,A,272,A6410,,,,,16,N,N
1341,SYRINGE 3CC SUB Q,CS,A,272,,,,,,6,N,N
1342,IV SECONDARY,CS,A,272,A4222,,,,,17,N,N
1343,"SYRINGE 5CC 22G-1""",CS,A,272,,,,,,6,N,N
1345,"SYRINGE 10CC 22G-1""",CS,A,272,,,,,,10,N,N
1346,GAUZE SPONGES 4X10 STERILE,CS,A,272,,,,,,12,N,N
1347,INSULIN SYRINGE,CS,A,272,A4206,,,,,6,N,N
1348,GAUZE SPONGES 4X5 STERILE,CS,A,272,A6402,,,,,13,N,N
1349,GROUND PAD STERILE,CS,A,272,A4649,,,,,16,N,N
135,SIG FLEX W/RMVE TUMOR CAUT,AS,A,750,45333,,,,,1726,N,N
1350,DRESSING VASELINE STERILE,CS,A,272,A6250,,,,,13,N,N
1351,SUCTION COAGULATION STERILE,CS,A,272,,,,,,28,N,N
1352,ADAPTER MULTIPLE,CS,A,272,,,,,,32,N,N
1353,SPONGES 4X4 (10 EACH),CS,A,271,A6217,,,,,13,N,N
1354,SPECIMEN CONTAINER COMMODE,CS,A,271,A4335,,,,,7,N,N
1355,SILVER NITRATE STICKS,CS,A,252,J3490,,,,,23,N,N
1356,SPONGES LAB 12X12 STERILE,CS,A,272,,,,,,6,N,N
1357,SPLINT LEG,CS,A,274,,,,,,134,N,N
1359,SPONGES LAB 18X18 STERILE,CS,A,272,,,,,,6,N,N
136,EDG DX,AS,A,750,43235,,,,,1960,N,N
1360,ARM SPLINT DISP,CS,A,271,A4570,,,,,7,N,N
1361,STERILE 2X2 GUAZE,CS,A,272,,,,,,6,N,N
1363,SYRINGE 20CC,CS,A,272,A4213,,,,,13,N,N
1364,BREATH CIRCUIT,CS,A,271,A4618,,,,,24,N,N
1365,SYRINGE 30CC,CS,A,272,A4213,,,,,15,N,N
1366,MASK FACE MEDIUM,CS,A,271,,,,,,25,N,N
1367,SYRINGE 35CC,CS,A,272,A4213,,,,,18,N,N
1368,EXC/DEST LESION 15 & UP,TR,A,761,17004,,,,,439,N,N
1369,SYRINGE 60CC,CS,A,272,A4213,,,,,15,N,N
137,SIG FLEX DX,AS,A,750,45331,,,,,1370,N,N
1370,DENTURE CUP,CS,A,271,,,,,,5,N,N
1371,SYRINGE NEEDLE STERILE,CS,A,272,A4215,,,,,6,N,Y
1372,UNDER WATER DRAINAGE BTL,CS,A,272,,,,,,38,N,N
1375,IV PRIMARY PLUM SET NEEDLESS,CS,A,272,,,,,,55,N,N
1376,ADMISSION KITS,CS,A,270,,,,,,13,N,N
13761,ADMISSION KITS,CS,A,270,,,,,,13,N,N
1378,URINAL,CS,A,271,E0325,,,,,10,N,N
13781,URINAL,CS,A,271,E0325,,,,,10,N,N
138,OPERATING ROOM 30 MIN,AS,A,360,,,,,,840,N,N
1380,VAGINAL SPECULUM DISPOSABLE,CS,A,271,,,,,,23,N,N
1382,EXC BENIGN LESION TRUNK,AS,A,360,11400,,,,,439,N,N
1386,ELECTRODE (1),CS,A,271,A4456,,,,,5,N,N
13861,ELECTRODE (1),CS,A,271,A4556,,,,,5,N,N
1387,PICC LINE DRESSING CHANGE,TR,A,264,,,,,,68,N,N
1388,SWAB IODINE,CS,A,272,A4247,,,,,6,N,N
1389,PICC STABLIZER,CS,A,272,,,,,,28,N,N
139,IV INFUSION UP TO 1 HR,TR,A,260,Q0081,,,,,267,N,N
1390,SPECIMEN CONTAINER STERILE,CS,A,272,A4335,,,,,7,N,N
1391,SPECIMEN SPUTUM CONTAINER STER,CS,A,272,A4335,,,,,8,N,N
1392,IV INFUSION UP TO 1 HOUR,ED,A,260,Q0081,,,,,239,N,N
1393,GERI CHAIR PER DAY,CS,A,270,,,,,,24,N,N
1394,TELEMETRY POUCH,CS,A,271,A9900,,,,,7,N,N
13941,TELEMETRY POUCH,CS,A,271,,,,,,7,N,N
1396,TOOTHETTE,CS,A,271,,,,,,5,N,N
1397,CHAIR BED PER NIGHT,CS,A,995,,,,,,10,N,N
1398,MASK CHILD CIRCUIT,CS,A,271,A4618,,,,,15,N,N
1399,PICC LINE TUBING,CS,A,272,,,,,,48,N,N
14,PRO INSULIN LEVEL,LAB,A,301,84206,90,,,,125,N,N
140,OPERATING ROOM 60 MINUTES,AS,A,360,,,,,,1085,N,N
1400,MASK CHILD,CS,A,271,,,,,,15,N,N
1404,LOTION KERI,CS,A,270,,,,,,5,N,N
1405,MIRALAX,RX,A,252,J8499,,,,,51,N,N
1406,SUCTION TIP STERILE,CS,A,272,A4649,,,,,17,N,N
1407,EMESIS BAG,CS,A,270,,,,,,7,N,N
1408,SALEM SUMP #16 STERILE,CS,A,272,,,,,,78,N,N
141,OPERATING ROOM 210 MINUTES,AS,A,360,,,,,,2295,N,N
1410,SALEM SUMP #18 STERILE,CS,A,272,,,,,,78,N,N
1411,HALOPERIDOL LEVEL,LAB,A,301,80173,90,,,,307,N,N
1412,CATHETER LEG DRAINAGE BAG,CS,A,272,A4357,,,,,21,N,N
1413,"CATHETER LEG "" ""-CASE",CS,A,272,A4334,,,,,112,N,N
1414,"FILTER, URINE",CS,A,271,,,,,,7,N,N
1415,IV IMMOBLIZER,CS,A,272,,,,,,8,N,N
1416,IV CONNECTING TUBING STERILE,CS,A,272,A4212,,,,,25,N,N
1418,SUCTION CATHETER #18/10,CS,A,272,,,,,,15,N,N
142,OPERATING ROOM 90 MINUTES,AS,A,360,,,,,,1327,N,N
1420,CATHETER URINE METER BAG,CS,A,272,A4335,,,,,24,N,N
1421,SCAPEL #11 DISPOSABLE,CS,A,272,,,,,,23,N,N
1422,RESTRAINT WRIST,CS,A,270,,,,,,38,N,N
1424,BRACE ANKLE MEDIUM,CS,A,274,,,,,,76,N,N
1426,BRACE ANKLE LARGE,CS,A,274,,,,,,76,N,N
1428,BRACE ANKLE XL,CS,A,274,,,,,,78,N,N
143,OPERATING ROOM 180 MINUTES,AS,A,360,,,,,,2053,N,N
1430,SPLINT WRIST PEDI,CS,A,274,,,,,,78,N,N
1432,SPLINT WRIST UNIV. PEDI,CS,A,274,,,,,,76,N,N
1434,BRACE KNEE LOCK MEDIUM,CS,A,274,,,,,,114,N,N
1436,RESTRAINT SAFETY VEST,CS,A,270,,,,,,38,N,N
1438,SPLINT UNIVERSAL WRIST,CS,A,274,,,,,,76,N,N
144,OPERATING ROOM 120MIN,AS,A,360,,,,,,1567,N,N
1440,BRACE WRIST EXTRA SMALL,CS,A,274,,,,,,92,N,N
1441,TUMS,RX,A,251,J8499,,,,,6,N,N
1442,CAST SHOE,CS,A,274,A4590,,,,,38,N,N
1443,DOCUSATE SODIUM 100MG,RX,A,251,J8499,,,,,6,N,N
1444,SPLINT WRISTLET MEDIUM,CS,A,274,,,,,,34,N,N
1446,SPLINT KNEE IMMOBILIZER,CS,A,274,L1830,,,,,119,N,N
1448,BRACE WRIST LARGE,CS,A,274,,,,,,92,N,N
1449,ZOSYN 3.375 GM VIAL,RX,A,252,J2543,,,,,121,N,N
145,IV PUSH OF DRUG INITAL,TR,A,940,96374,,,,,96,N,N
1450,BRACE KNEE MEDIUM,CS,A,274,,,,,,123,N,N
1451,IV PUSH DRUG EACH ADD (SAME),TR,A,940,96376,,,,,96,N,N
14512,IV PUSH DRUG EA ADD (DIFFERENT,TR,A,940,96375,,,,,96,N,N
1456,"GLOVES SURGICAL, STERILE",CS,A,272,A4930,,,,,18,N,N
1458,SPECIMEN MUCOUS TRAP CONTAINER,CS,A,272,,,,,,7,N,N
146,OPERATING RM EA ADD 30 MIN,AS,A,360,,,,,,243,N,N
1460,SCAPEL STERILE,CS,A,272,,,,,,7,N,N
1462,"TUBE, TRACH #7 STERILE",CS,A,272,,,,,,64,N,N
1465,PROLENE MESH 2 X 4,CS,A,272,,,,,,155,N,N
1466,SUTURE PROXIMATE #35/15,CS,A,274,A4649,,,,,74,N,N
1468,SUCTION CONNECTOR TUBING STERI,CS,A,272,31720,,,,,8,N,N
147,THROMBOLYSIS IV INJECTION,ED,A,252,J2995,,,,,466,N,N
1470,"TUBE, TRACH #3 THRU #5 STERILE",CS,A,272,,,,,,28,N,N
1472,"TUBE, TRACHEAL THROUGH 8 STERI",CS,A,272,,,,,,31,N,N
1473,TOWEL STERILE,CS,A,272,,,,,,8,N,N
1474,"TUBE, TRACH #8 STERILE",CS,A,272,,,,,,64,N,N
1475,EYE DRAP STERILE,CS,A,272,A6410,,,,,15,N,N
1476,BOVIE EQUIPMENT,CS,A,270,,,,,,36,N,N
1478,SKIN MARKER,CS,A,272,,,,,,7,N,N
148,ANESTHESIA 30 MINUTES,ANES,A,370,,,,,,647,N,N
1480,STOPCOCK STERILE,CS,A,272,,,,,,13,N,N
1482,LEGGING STERILE,CS,A,272,A4490,,,,,24,N,N
1484,HEMOVAC,CS,A,272,,,,,,65,N,N
1486,ZOLOFT 100MG TABS,RX,A,251,J8499,,,,,20,N,N
1488,PEANUTS,CS,A,272,,,,,,3,N,N
149,THROMBOLYSIS IV INFUSION,ED,A,260,Q0081,,,,,267,N,N
1490,"PACK, PRECEP",CS,A,272,,,,,,53,N,N
1492,SUTURE PROXI STRIP STERILE,CS,A,272,A4649,,,,,18,N,N
1494,"TUBE, MA",CS,A,272,,,,,,200,N,N
1495,CIPRO 400MG IV,RX,I,252,J0744,,,,,145,N,N
1496,HIBICLENS SOAP,CS,A,271,,,,,,28,N,N
1498,CVP CATHETERIZATION KIT,CS,A,272,,,,,,78,N,N
1499,CALCIUM ALGINATE,RX,A,251,J8499,,,,,19,N,N
14991,ZOSYN 3.375 GR,RX,A,252,J2543,,,,,122,N,N
15,CHLORAPREP SEPP APPLICATOR,CS,A,272,,,,,,12,N,N
150,ANESTHESIA 60 MINUTES,ANES,A,370,,,,,,832,N,N
1500,CVP MONITOR,CS,A,272,,,,,,38,N,N
1502,CATHETER BLADDER DRAINAGE STER,CS,A,272,C1729,,,,,153,N,N
1503,LOTRIMIN CREAM,RX,A,257,J8499,,,,,32,N,N
1506,"TUBE, CANTOR",CS,A,272,,,,,,114,N,N
1507,TETRACAINE OPTHALMIC SOLUTION,RX,A,251,J8499,SH,,,,45,N,N
1509,FLUOR-I-STRIP,RX,A,252,J8499,,,,,6,N,N
151,EGD WITH BIOPSY,AS,A,750,43239,,,,,2266,N,N
1511,FLUORESCEIN SODIUM OPTHAL DRPS,RX,A,251,J8499,,,,,51,N,N
1515,CARDIZEM CD 180 TAB,RX,A,252,J8499,,,,,17,N,N
1517,CARDIZEM CD 120 TAB,RX,A,252,J8499,,,,,13,N,N
1519,IMDUR 60MG,RX,A,252,J8499,,,,,21,N,N
152,ANESTHESIA 90 MINUTES,ANES,A,370,,,,,,1015,N,N
1521,K-DUR 20MEQ TAB,RX,A,252,J8499,,,,,7,N,N
1523,"TRAY, LUMBAR SPINAL ADULT",CS,A,272,,,,,,51,N,N
1525,"TRAY, LUMBAR SPINAL PEDI",CS,A,272,,,,,,58,N,N
153,EGD W/ESO DILATE,AS,A,750,43249,,,,,2266,N,N
1531,"CHLAMYDIA, DIRECT PROBE",LAB,A,301,87490,91,,,,113,N,N
1533,NEISSERIA GONORRHOEAE DIR PRO,LAB,A,301,87590,91,,,,113,N,N
154,ANESTHESIA 120 MINUTES,ANES,A,370,,,,,,1200,N,N
155,EDG W/PLCE GASTRO TUBE,AS,A,750,43246,,,,,2530,N,N
1550,DIFLUCAN 100MG TAB,RX,A,252,J8499,,,,,38,N,N
15501,I&D SEBACEOUS CYST,CL,A,523,10060,,,,,217,N,N
1551,DIFLUCIN 200MG IV,RX,A,252,J1450,,,,,85,N,N
156,ANESTHESIA EA ADDED 30 MIN,ANES,A,370,,,,,,186,N,N
157,EGD W/RMVE TUMOR SNARE,AS,A,750,43251,,,,,2530,N,N
158,ANESTHESIA ETHRANE,ANES,A,370,,,,,,75,N,N
1599,HYDRO WOUND GEL,RX,A,251,J8499,,,,,21,N,N
160,ANESTHESIA FLUOTHANE,ANES,A,370,,,,,,75,N,N
16121,I & D ABSCESS COMLICATED,ED,A,450,10061,22,,,,361,N,N
162,ANESTHESIA FORANE,ANES,A,370,,,,,,98,N,N
164,ANESTHESIA HALOTHANE,ANES,A,370,,,,,,75,N,N
166,ANESTHESIA PENTHRANE,ANES,A,370,,,,,,75,N,N
168,ANESTHESIA SUPPLIES LOCAL,ANES,A,370,,,,,,126,N,N
170,ANESTHESIA SUPPLIES SPINAL,ANES,A,370,,,,,,178,N,N
172,ABDOMEN 1 VIEW,RAD,A,320,74000,,,,,138,N,N
174,ABDOMEN 2 VIEWS,RAD,A,320,74020,TC,,,,173,N,N
175,CHEST 3 VIEW W APICAL LORDOTIC,RAD,A,324,71021,TC,,,,229,N,N
1759,NEURONTIN LEVEL,LAB,A,301,80299,91,,,,294,N,N
176,"ANKLE 2 VIEWS, LEFT",RAD,A,320,73600,TC,LT,,,128,N,N
1761,"ANKLE 2 VIEWS, RIGHT",RAD,A,320,73600,TC,RT,,,128,N,N
1764,I&D ABSCESS BACK,TR,A,761,20005,,,,,265,N,N
1777,PELVIC EXAMINATION 12-17 YEARS,ED,A,450,99394,,,,,72,N,N
178,"ANKLE 3 VIEWS, LEFT",RAD,A,320,73610,TC,LT,,,155,N,N
1781,"ANKLE 3 VIEWS, RIGHT",RAD,A,320,73610,TC,RT,,,155,N,N
180,BONE AGE COMPLETE,RAD,I,320,99999,,,,,224,N,N
1800,EKG,EKG,A,730,93005,,,,,207,N,N
1801,"EKG, REPEAT",EKG,A,730,93005,76,59,,,207,N,N
1806,EKG INTERPERTATION,EKG,A,222,,,,,,48,N,N
1807,2D & M-MODE ECHOCARDIOGRAM,ECHO,A,480,93307,,,,,764,N,N
1808,CARDIAC MONITOR,EKG,A,732,93041,,,,,219,N,N
1809,CONTINOUS WAVE DOPPLER (ECHO),ECHO,A,480,93320,,,,,371,N,N
1810,DYNA MAP EQUIPMENT,CS,A,270,C8957,,,,,219,N,Y
18101,DYNA MAP,CS,A,270,,,,,,219,N,N
1811,SPECTRUM ANALYSIS ECHO DOPPLER,ECHO,A,480,93325,,,,,219,N,N
1813,CONTINUOUS WAVE DOPPLER (ECHO),ECHO,A,480,93321,,,,,219,N,N
1817,STRESS ECHOCARDIOGRAPHY,ECHO,A,402,93350,,,,,697,N,N
1818,TRANSESOPHOGEAL ECHOCARDIOGRAP,ECHO,A,402,93312,,,,,697,N,N
1820,DUPLEX SCAN OF VENOUS SYSTEM,ECHO,A,921,93970,,,,,697,N,N
1821,VENOUS PHYSIOLOGIC STUDIES,ECHO,A,921,93965,,,,,209,N,N
1822,LIMITED REPEAT DUPLEX SCAN VS,ECHO,A,921,93971,,,,,386,N,N
1823,UNILATERAL DUPLEX SCAN OF VS,ECHO,A,921,93970,,,,,439,N,N
1824,DUPLEX SCAN ORGAN IN&OUT FLOW,ECHO,A,921,93975,,,,,525,N,N
1825,LMT F/U DUPLEX SCAN ORGAN I/O,ECHO,A,921,93976,,,,,489,N,N
1826,DUPLEX SCAN VISCERAL VASCULATU,ECHO,A,921,93978,,,,,471,N,N
1827,LIMITED F/U DUPLEX SCAN OF V V,ECHO,A,921,93979,,,,,313,N,N
1828,UPPER PHYSIOLOGICAL STUDY,ECHO,A,921,93923,,,,,321,N,N
1829,UPPER PHYSIOLOGICAL STUDY SNGL,ECHO,A,921,93922,,,,,175,N,N
183,CHEST 1 VIEW,RAD,A,324,71010,TC,,,,145,N,N
1830,DUPLEX SCAN/UPPER EXTR.ARTERIE,ECHO,A,921,93930,,,,,439,N,N
1831,LMTD F/I DUPLEX SCAN OF U E A,ECHO,A,921,93931,,,,,313,N,N
1832,UPPER PHYSIOLOGICAL STUDY MULT,ECHO,A,921,93923,,,,,321,N,N
1833,UPP.PHYS.STUDY SNGL LVL UNILAT,ECHO,A,921,93922,,,,,175,N,N
1834,DUPLEX SCAN UPP.EXTR.ART.UNILA,ECHO,A,921,93930,,,,,153,N,N
1835,LWR PHYS STUDY MULT. LEVEL,ECHO,A,921,93923,,,,,321,N,N
1836,LWR PHYS. STUDY SINGLE LEVEL,ECHO,A,921,93922,,,,,175,N,N
1837,PHYS. STDY LWR EX.ART.W/TREADM,ECHO,A,921,93924,,,,,525,N,N
1838,DUPLEX SCAN LWR EXTREMITY ART.,ECHO,A,921,93925,,,,,431,N,N
1839,LMTD F/U DPLX SCN LWR EXT ART,ECHO,A,921,93926,,,,,307,N,N
184,CHEST 2 VIEWS,RAD,A,324,71020,TC,,,,176,N,N
1840,LWR PHYS STDY MULT LVL UNILATE,ECHO,A,921,93923,,,,,321,N,N
1841,LWR PHYS STDY SNGL LVL UNILATE,ECHO,A,921,93922,,,,,175,N,N
1842,DUPLEX SCAN LWR EXTR ART/UNILA,ECHO,A,921,93926,,,,,307,N,N
1843,EXTRACRANIAL PHYSIOLOGIC STDY,ECHO,I,921,99999,,,,,209,N,N
1844,DUPLEX SCAN EXTRACRANIEL ARTER,ECHO,A,921,93880,,,,,464,N,N
1845,LMTD F/U DUPLEX SDN EXTR ART,ECHO,A,921,93882,,,,,464,N,N
1846,COMPLETE TRANSCRANIEL DOPPLER,ECHO,A,480,93886,,,,,525,N,N
1847,LIMITED F/U TRANSCRANIEL DOPPL,ECHO,A,921,93888,,,,,264,N,N
1848,THYROID,RAD,I,402,76536,,,,,236,N,N
1849,"ECHOCARDIOGRAM, 2DW/WO M-MODE",ECHO,A,480,93307,,,,,264,N,N
185,CA 19-9,LAB,A,301,86301,90,,,,90,N,N
1850,OXYGEN PER HOUR,RT,A,410,94002,,,,,73,N,N
1851,DOPPLER ECHOCARDIOGRAPHY,ECHO,A,480,93320,,,,,175,N,N
1852,OXYGEN INITIATION 1ST DAY,RT,A,410,94002,,,,,497,N,N
1854,OXYGEN EACH SUBSEQUENT,RT,A,410,94003,,,,,475,N,N
1856,SPIROMETER PER TREAT,RT,A,410,,,,,,66,N,N
1858,SPIROMETER WITH NEBULIZER PD,RT,A,410,,,,,,740,N,N
186,CHEST 3 VIEWS W OBLIQUES,RAD,A,324,71022,TC,,,,217,N,N
1860,CROUPETTE INCL O2 PER HOUR,RT,A,410,,,,,,28,N,N
1862,CROUPETTE INCL 02 PER DAY,RT,A,410,,,,,,441,N,N
1864,IPPB PER TREATMENT,RT,A,412,94640,,,,,74,N,N
1866,IPPB PER DAY,RT,A,410,94640,,,,,410,N,N
1868,PERCUSSION PER TREATMENT,RT,A,410,,,,,,57,N,N
187,DENGUE IGM,LAB,A,302,86790,90,,,,111,N,N
1870,POSTURAL DRAINAGE PER TREAT,RT,A,410,,,,,,58,N,N
1872,POSTURAL DR & PERC P/C,RT,A,410,,,,,,392,N,N
1874,POSTURAL DRAIN & PERC P/TR,RT,A,410,,,,,,96,N,N
1876,SPUTUM INDUCED PER TIME,RT,A,410,,,,,,65,N,N
1877,"HAND HELD NEBULIZER,UPDRAFT EA",RT,A,410,94640,,,,,107,N,N
1878,ULTRA NEBULIZER W/O2 P/TR,RT,A,410,,,,,,78,N,N
1879,HAND HELD NEBULIZER PER DAY,RT,A,410,94640,76,,,,107,N,N
188,CHEST 4 VIEWS,RAD,A,324,71030,TC,,,,252,N,N
1880,ULTRA NEB W/O2 CONT P/HR,RT,A,410,,,,,,32,N,N
1882,ULTRA NEB W/O2 MAX P/DAY,RT,A,410,,,,,,413,N,N
1884,VOLUME VENTILATOR W/O2 P/HR,RT,A,410,,,,,,219,N,N
1885,VAPORIZER PER DAY,RT,A,410,,,,,,74,N,N
1886,VOLUME VENTILATOR W/O2 P/D,RT,A,410,,,,,,1125,N,N
1887,PULSE OXIMETER CONT. PER DAY,RT,A,410,94762,,,,,368,N,N
1888,PULSE OXIMETRY SINGLE USE,RT,A,460,94760,,,,,28,N,Y
1889,SPIROMETRY (PFT),RT,A,460,,,,,,181,N,N
189,DENGUE IGG,LAB,A,302,86790,90,,,,111,N,N
1891,SPIROMETRY PRE/POST BRONCHODIL,RT,A,460,,,,,,267,N,N
1892,VITAL CAPACITY,RT,A,410,94150,,,,,91,N,N
1893,METERED DOSE INHALER PER TREAT,RT,A,410,,,,,,21,N,N
1894,METERED DOSE INHALER PER DAY,RT,A,410,,,,,,108,N,N
1895,OXYGEN WITH AMBULATION,RT,A,410,,,,,,57,N,N
1896,RESUSITATION EMERGENCY W AMBU,RT,A,410,,,,,,252,N,N
1897,PULSE OXIMETER WITH AMBULANT,RT,I,410,,,,,,57,N,N
1898,AIRWAY CARE SUCTION EACH TIME,RT,A,410,A7002,,,,,7,N,N
1900,COT RENTAL,COT,A,999,,,,,,25,N,N
1902,GUEST TRAY,DIET,A,999,,,,,,8,N,N
1903,NAFCILLIN 1 GRAM,RX,A,252,S0032,,,,,35,N,N
1904,GUEST TRAY EXTENDED CARE,DIET,A,999,,,,,,8,N,N
1905,PROCRIT IV/SC 10000 UNITS,RX,A,635,J0885,EC,,,,1953,N,N
1906,EMLA,RX,A,252,J8499,,,,,23,N,N
191,EMERGENCY ROOM LEVEL 4,ED,A,450,99284,,,,,504,N,N
193,EMERGENCY ROOM LEVEL 5,ED,A,450,99285,,,,,875,N,N
194,"CLAVICLE, LEFT",RAD,A,320,73000,TC,LT,,,158,N,N
1941,"CLAVICLE, RIGHT",RAD,A,320,73000,TC,RT,,,158,N,N
195,CRITICAL CARE 30-74MIN,ED,A,450,99291,,,,,1590,N,N
1951,NEBULIZER ADAPTER,RT,A,270,,,,,,10,N,N
196,COCCYX 2 VIEWS,RAD,A,320,72220,TC,,,,145,N,N
197,CRITICAL CARE ADDITIONAL 30MIN,ED,A,450,99292,,,,,504,N,N
198,PELVIS & HIPS INFANT OR CHILD,RAD,A,320,73540,,,,,209,N,N
1980,TDAP INJECTION 0.5 ML,RX,A,771,90461,,,,,133,N,N
199,IGA-TOTAL,LAB,A,301,,,,,,73,N,N
1998,FLUID WARMER CUFF,CS,A,272,,,,,,59,N,N
200,CAT CERVICAL SPINE W/O CONT,RAD,I,352,72125,,,,,1141,N,N
2001,GASTRIC INTUBATE/ASPRATE,ED,A,450,43753,,,,,289,N,N
2002,ANTIFUNGAL CREAM,RX,A,257,J8499,,,,,32,N,N
2003,LORTAB ELIXER,RX,A,252,J8499,,,,,10,N,N
2004,BUMETANIDE 1MG INJ,RX,A,251,S0171,,,,,13,N,N
2005,MECLIZINE 12.5MG TAB,RX,A,252,J8499,,,,,6,N,N
2006,AMOXICILLIN 250MG CAPSULE,RX,A,252,J8499,,,,,5,N,N
2007,I&D ABSCES SMPLE/SINGLE,ED,A,450,10060,,,,,270,N,N
2008,ANASPAZ TABLET,RX,A,251,J8499,,,,,5,N,N
2009,I&RMVE FB SUBQ SMPLE,ED,A,450,10120,,,,,340,N,N
201,CT HEAD WITHOUT CONTRAST,SCAN,A,351,70450,,,,,1024,N,N
2010,BUMETANIDE 1MG TAB,RX,A,251,J8499,,,,,6,N,N
2011,INTUBATION ENOD TRACK ER,ED,A,450,31500,,,,,785,N,N
2012,TISSUE EXAM PATHOLOGIST,LAB,I,310,99999,90,,,,60,N,N
2013,PUNCT ASPRTE ABSCESS CYST,ED,A,450,10160,,,,,340,N,N
2014,ASPIRIN ENT. COATED 325MG,RX,A,257,J8499,,,,,8,N,N
2015,REMOVE FB EXT EAR,ED,A,450,69200,,,,,239,N,N
2016,BACTRIM DS TABLET,RX,A,251,J8499,,,,,17,N,N
20161,BACTRIM SUSPENSION 200 MG,RX,A,252,J8499,,,,,16,N,N
2017,RMVE FB EYE CONJUNCT EMBED,ED,A,450,65210,,,,,427,N,N
2018,BENADRYL 25MG CAPSULE,RX,A,257,J8499,,,,,8,N,N
2019,RMVE FB EYE CONJUNCT SUP,ED,A,450,65205,,,,,427,N,N
202,CAT LUMBAR SPINE W/O CONT,RAD,I,352,72131,,,,,1141,N,N
2020,INTERPRETATION OF SMEAR BY PAT,LAB,A,310,88173,90,,,,73,N,N
2021,"THYROID HORMONE,FREE (T3)",LAB,A,301,84481,90,,,,264,N,N
2022,CYCLOBENZAPRINE 10MG TAB,RX,A,251,J8499,,,,,15,N,N
2023,PARATHORMONE(PARATHYROID HORM),LAB,A,301,83970,90,,,,386,N,N
2024,BUMEX 1MG TABLET,RX,A,252,J8499,,,,,5,N,N
2025,RMVE FB EYE CORNEAL W/O LAMP,ED,A,450,65220,,,,,427,N,N
2026,CEFAZOLIN 1GM VIAL,RX,I,251,J0690,,,,,38,N,N
2027,RMVE FB NOSE,ED,A,450,30300,,,,,307,N,N
2028,CALAN 80MG TABLET,RX,A,251,J8499,,,,,6,N,N
2029,RPR INT/FCE EAR ELID NOSE 2.5,ED,A,450,12051,,,,,392,N,N
203,CT SINUSES W/O CONT,SCAN,A,350,70488,,,,,1354,N,N
2030,CALAN SR 240MG TABLET,RX,A,251,J8499,,,,,13,N,N
2031,HYDROCHLOROTHIAZIDE (HCTZ),RX,A,251,J8499,,,,,7,N,N
2032,CAPOTEN 25MG TABLET,RX,A,252,J8499,,,,,7,N,N
2033,PIPELLE,CS,A,272,,,,,,27,N,N
2034,ACETAMINOPHEN ELIXER 160MG,RX,A,257,J8499,,,,,7,N,N
2035,"MOTRIN, CHILDRENS",RX,A,257,J8499,,,,,22,N,N
2036,TNKASE PER 50MG IV,RX,A,636,J3101,,,,,9071,N,N
2037,ALBUTEROL SOL 2.5ML,RX,A,252,J7613,,,,,34,N,N
2038,CARAFATE TABLET,RX,A,251,J8499,,,,,6,N,N
2039,AFRIN NASAL SPRAY,RX,A,257,J8499,,,,,15,N,N
204,CAT THORACIC SPINE W/O CONT,RAD,I,352,72128,,,,,1141,N,N
2040,TENECTEPLASE PER 50MG IV,RX,A,251,J3101,,,,,6095,N,N
2041,RPR INT FCE EAR ELID NOSE2.6-5,ED,A,450,12052,,,,,392,N,N
2042,CARDIZEM 60MG TABLET,RX,A,251,J8499,,,,,8,N,N
2043,RPR INT NCK HAND FEET 2.5 <,ED,A,450,12041,,,,,392,N,N
2044,DIPHENHYDRAMINE LIQ PER 5CC,RX,A,257,J8499,,,,,6,N,N
2045,AUGMENTIN 500MG TABS,RX,A,252,J8499,,,,,24,N,N
2046,FLAGYL 500MG TAB,RX,A,252,J8499,,,,,13,N,N
2047,RPR INT NCK HAND FEET 2.6-7.5C,ED,A,450,12042,,,,,392,N,N
2048,CENTRUM TABLET,RX,A,257,J8499,,,,,5,N,N
2049,RPR INT SCLP TRNK EXT 2.5 OR <,ED,A,450,12031,,,,,392,N,N
205,CT SCAN SOFT TISSUE NECK W/O C,SCAN,A,351,70492,,,,,1319,N,N
2050,CIPRO 500MG TABLET,RX,A,252,J8499,,,,,17,N,N
2051,CIPRO 200MG IV (400),RX,A,252,J0744,,,,,145,N,N
2052,CLONIDINE 0.1MG TABLET,RX,A,252,J8499,,,,,6,N,N
2054,ADMINISTRATION OF FLU VACCINE,RX,A,771,G0008,,,,,34,N,N
2055,NITROGLCERINE 0.4MG PATCH,RX,A,251,J3490,SH,,,,5,N,N
2056,PNEUMONIA VACCINE,RX,A,252,90732,,,,,112,N,N
2057,"SNARE/POLYPECTOMY, MULTIPLE",AS,A,750,44603,,,,,229,N,N
2058,COUMADIN 5MG TABLET,RX,A,252,J8499,,,,,7,N,Y
2059,SCAPULA 2 VIEW,RAD,A,320,73010,,,,,175,N,N
206,CAT W/WO CONTRAST ABDOMEN,RAD,I,352,74170,,,,,1507,N,N
2060,ADMINISTRATION OF PNEUMONIA VA,RX,A,771,G0009,,,,,34,N,N
2061,RPR INT SCLP TRNK EXT 2.6-7.5C,ED,A,450,12032,,,,,473,N,N
2062,DARVOCET N 100 TABLET,RX,A,252,J8499,,,,,7,N,N
2063,RPR SMP FACE EAR ELID NOS EXT,ED,A,450,12011,,,,,392,N,N
2065,"RPR SMP FCE,EAR,ELID,NOS 2.6-7",ED,A,450,12013,,,,,392,N,N
2066,HYDROCODONE BLT/GUAFENESIN ELI,RX,A,251,J8499,,,,,7,N,N
2067,RPR COMPLEX LAC,ED,A,450,13131,22,,,,703,N,N
2068,DILANTIN 100MG CAPSULE,RX,A,252,J8499,,,,,5,N,N
2069,RPR SMP FACE EAR ELID NOS 5.1,ED,A,450,12014,,,,,515,N,N
207,CLINDAMYCIN CAPSULES 150MG,RX,A,251,J8499,,,,,21,N,N
2070,ISOETHARINE 1% HHN PER ML,RX,A,251,J7648,,,,,7,N,N
2071,DONNATAL ELIX,RX,A,252,J8499,,,,,6,N,N
20711,I&D ABSCESS,TR,A,761,10060,59,76,V8,,254,N,N
2072,DOUCASATE CALCIUM 240MG,RX,A,257,J8499,,,,,6,N,N
2073,RPR SMP FACE EAR ELID NOS 2.5<,ED,A,450,12001,,,,,392,N,N
2074,DOXYCYCLINE 100MG CAPSULE,RX,A,252,J8499,,,,,10,N,N
2075,DOXYCYCLINE 100 MG IV,RX,A,252,J3490,,,,,54,N,N
2076,DULCOLAX 5MG TABLET,RX,A,257,J8499,,,,,6,N,N
2077,DUODERM,RX,A,252,J8499,,,,,52,N,N
2079,RPR SMP SCLP NCK TRNK EXT 2.6>,ED,A,450,12002,,,,,392,N,N
208,CAT W/WO CONTRAST CHEST,RAD,I,320,71270,,,,,1424,N,N
2080,METRONIDAZOLE 250MG TAB,RX,A,251,J8499,,,,,7,N,N
2081,LORAZEPAM 1MG TAB,RX,A,251,J8499,,,,,8,N,N
2082,E-MYCIN 333MG TABLET,RX,A,252,J8499,,,,,6,N,N
2083,RPR SMP SCLP NCK TRN EXT 7.6>,ED,A,450,12004,,,,,540,N,N
2085,SPINAL LUMBAR DX,ED,A,450,62270,,,,,497,N,N
2087,CHLORAL HYDRATE 500MG LIQ,RX,A,252,J8499,,,,,4,N,N
2088,METAPROTERNOL 0.4% UD INH,RX,A,251,J3490,,,,,7,N,N
2089,SPLINT ARM LONG APPLY,ED,A,450,29105,TC,22,59,,323,N,N
20891,SPLINT SHORT ARM OR FINGER,ED,A,450,29280,TC,,,,334,N,N
209,ER WITH MONITOR LEVEL 1,ED,A,450,99281,,,,,477,N,N
2090,FEOSOL TABLET,RX,A,257,J8499,,,,,6,N,N
2091,SPLINT ARM FOREARM SHORT STATIC APPLY,ED,A,450,29125,TC,,,,323,N,N
2092,"REPAIR, COMPLEX SCALP",ED,A,450,13121,,,,,440,N,N
2093,SPLINT FINGER DYNAMIC APPLY,ED,A,450,29131,,,,,323,N,N
2094,NIFEDIPINE 10MG CAP,RX,A,251,J8499,,,,,8,N,N
2095,SPLINT LEG SHORT APPLY,TR,A,700,29515,,,,,307,N,N
2096,GLUCATROL 5MG,RX,A,251,J8499,,,,,10,N,N
2097,STRAPPING SHOULDER,ED,A,450,29240,,,,,340,N,N
2098,CA 125,LAB,A,301,86304,90,,,,259,N,N
20981,CASTING FRACTURE FOOT TOE,ED,A,450,29550,,,,,254,N,N
2099,1ST BURN 1ST DEGREE,ED,A,450,16000,,,,,368,N,N
20999,VASOTEC 1.5MG IV,RX,A,252,J3490,,,,,34,N,N
210,CAT W/WO CONTRAST HEAD,RAD,I,351,70470,,,,,1295,N,N
2101,REPAIR COMPLEX SCALP EA ADD 5CM,ED,A,450,13122,,,,,139,N,N
2103,REPAIR COMPLEX FOREHEAD,ED,A,450,13132,,,,,406,N,N
2107,VERAPAMIL 120MG TAB,RX,A,251,J8499,SH,,,,7,N,N
211,ALBUMIN; SERUM,LAB,A,301,82040,,,,,48,N,N
2111,OBS 1-3 HR LEV 3,OBS,A,762,G0378,,,,,92,N,N
2113,OBS SDD LOW 4TH & UP,OBS,A,762,G0378,,,,,29,N,N
2114,OBS SDD MOD 4TH HR & UP,OBS,A,762,G0378,,,,,34,N,N
2115,OBS SDD HIGH 4TH & UP,OBS,A,762,G0378,,,,,34,N,N
2116,OBS 1-3 LEVEL 1,OBS,A,762,G0378,,,,,71,N,N
2117,OBS 1-3 LEV 1 WITH MONITOR,OBS,A,762,G0378,,,,,113,N,N
21171,OBS IP 8-48HR LEV 3/MONITOR,OBS,I,762,G0378,,,,,96,N,N
2118,OBS 4TH & UP LEV 1,OBS,A,762,G0378,,,,,29,N,N
2119,OBS 1-3HR LEV 2,OBS,A,762,G0378,,,,,78,N,N
212,CAT W/WO CONTRAST PELVIS,RAD,I,352,72194,,,,,1295,N,N
2120,OBS 4TH &UP LEV 3,OBS,A,762,G0378,,,,,43,N,N
2121,FUROSEMIDE 20MG VIAL,RX,A,251,J1940,,,,,103,N,N
2122,"DUPLEX SCAN VENOUS SYS, BILATE",ECHO,A,921,93970,,,,,917,N,N
2123,METACLOPROMIDE 10MG TAB,RX,A,251,J8499,,,,,6,N,N
2124,ULTRAM 50MG TAB,RX,A,252,J8499,SH,,,,15,N,N
2125,DICYCOMINE HCL 10MG TAB,RX,A,251,J8499,,,,,6,N,N
2126,OBS SDD 1-3 HR LOW,OBS,A,762,G0378,,,,,71,N,N
2127,OBS SDD 1-3 HIGH,OBS,A,762,G0378,,,,,96,N,N
2128,IPRATROPRIUM UD HHN PER MG,RX,A,251,J7644,,,,,7,N,N
2129,ATROVENT UD .5MG VIAL INH SOL,RX,A,251,J7644,,,,,29,N,N
21291,ATROVENT UD .5MG VIAL,RX,A,252,J7644,,,,,28,N,N
213,ER WITH MONITOR LEVEL 2,ED,A,450,99282,,,,,583,N,N
2133,TRIAM 75MG/HCTZ 50MG,RX,A,251,J8499,SH,,,,25,N,N
2135,POTASSIUM CHLORIDE SUSP 20MEQ,RX,A,251,J8499,SH,,,,7,N,N
214,"UPPER EXTREMITY 2 VIEW INFANT, LEFT",RAD,A,320,73092,TC,LT,,,139,N,N
2141,"UPPER EXT 2 VIEW INFANT, RIGHT",RAD,A,320,73092,TC,RT,,,138,N,N
2145,PAVULON 2MG/ML,RX,I,252,J3490,,,,,61,N,N
2146,OXYGEN KITS/BROSELOW KIT,CS,A,270,,,,,,133,N,N
2147,INTUBATION KIT/BROSELOW KIT,CS,A,270,,,,,,199,N,N
2148,IV DELIVERY KITS/BROSELOW KIT,CS,A,270,,,,,,267,N,N
2149,INTRAOSSEOUS KITS/BROSELOW KIT,CS,A,270,,,,,,308,N,N
215,DIABETA 5MG TAB,RX,A,252,J8499,,,,,6,N,N
2150,CO2 DETECTORS FOR ET TUBES,CS,A,270,,,,,,48,N,N
216,"ELBOW 2 VIEWS, LEFT",RAD,A,320,73070,TC,LT,,,152,N,N
2161,"ELBOW 2 VIEWS, RIGHT",RAD,A,320,73070,TC,RT,,,152,N,N
217,"ELBOW 3 VIEW, LEFT",RAD,A,320,73080,TC,LT,,,180,N,N
2171,"ELBOW 3 VIEW, RIGHT",RAD,A,320,73080,TC,RT,,,178,N,N
2177,INFLUENZA VAC 6-35MO IM,RX,A,252,90657,,,,,28,N,N
2178,INFLUENZA VAC 3 YR&UP IM,RX,A,252,90658,,,,,28,N,N
2179,INFLUENZA VAC WHOLE IM,RX,A,252,90654,,,,,59,N,N
219,"HIP, BILATERAL",RAD,A,320,73520,50,TC,,,296,N,N
22,KLEENEX,CS,A,271,,,,,,1.5,N,N
220,FACIAL BONES COMPLETE,RAD,A,320,70150,TC,,,,223,N,N
2200,CULTURE MIC SENSITIVITY,LAB,A,306,87186,91,59,,,51,N,N
22001,CULTURE MIC SENSITIVITY,LAB,A,306,87186,59,91,,,51,N,N
2201,"CULTURE,ANY SOURCE,SYNOVIAL FL",LAB,A,306,87070,90,,,,71,N,N
2202,"CULTURE,VIRUS ID;INNOCULATION",LAB,A,306,87250,90,,,,270,N,N
2203,DURICEF 250MG SUSP,RX,A,252,J8499,,,,,214,N,N
2204,"CULTURE, STOOL",LAB,A,306,87045,90,,,,73,N,N
2205,BIOPSY PUNCH #2,CS,A,272,,,,,,8,N,N
2206,BIOPSY PUNCH #5,CS,A,272,,,,,,8,N,N
2207,"CULTURE, THROAT OR NOSE",LAB,A,306,87070,90,,,,68,N,N
2208,"CULTURE,ANY SOURCE,SKIN",LAB,A,306,87070,90,,,,85,N,N
2209,"CULTURE,ANY SOURCE,VAGINAL",LAB,A,306,87070,90,,,,93,N,N
221,ER WITH MONITOR LEVEL 3,ED,A,450,99283,,,,,716,N,N
2210,"CULTURE,BACTERIAL,BLOOD",LAB,A,306,87040,90,,,,113,N,N
2213,PROGESTERONE,LAB,A,301,84144,90,,,,289,N,N
2216,BORRELIA BURGDOFERI(LYME DISEA,LAB,A,306,86618,90,,,,167,N,N
2217,QUINIDINE,LAB,A,301,80194,90,,,,113,N,N
2220,VASOTEC 1.25MG/ML IV,RX,A,251,J3490,,,,,36,N,N
2221,THIAMINE (VITAMIN B-1),LAB,A,301,84425,,,,,295,N,N
2223,THIAMINE B1 100MG,RX,A,257,J8499,SH,,,,6,N,N
2224,FOLIC ACID 1MG TAB,RX,A,252,J8499,,,,,4,N,N
2225,ANTIVENIN KIT,RX,A,252,J3490,,,,,2950,N,N
2226,PROTONIX 40MG PO,RX,A,252,J8499,,,,,38,N,N
2227,SPIRONOLACTONE 25MG,RX,A,251,J8499,SH,,,,8,N,N
2228,DEPAKOTE (VALPORIC ACID),LAB,A,301,80164,90,,,,125,N,N
2229,INJ DEPO ESTRADIOL 5M,CL,A,523,J1000,,,,,39,N,Y
223,VENIPUNCTURE,LAB,A,300,36415,,,,,15,N,N
2231,FLEXERIL 10MG TAB,RX,A,251,J8499,,,,,15,N,N
2232,ARTERIAL ACCESS CV PORT,TR,A,940,36600,,,,,125,N,N
22321,ACCESS MEDIPORT,OBS,A,940,36000,,,,,125,N,N
22322,ACCESS MEDIPORT,ED,A,940,36600,,,,,125,N,N
22323,ACCESS MEDIPORT,NRS,A,940,36000,,,,,125,N,N
2233,BIOPSY PUNCH 3MM,CS,A,272,,,,,,10,N,N
2235,CIRCUMCISION,AS,A,360,54161,,,,,872,N,N
2237,I&D PERIRECTAL ABSCESS,TR,A,761,46040,,,,,785,N,N
2239,I&D ABCESS,AS,A,360,,,,,,792,N,N
224,"FEMUR 2 VIEWS, LEFT",RAD,A,320,73550,TC,LT,,,162,N,N
2241,"FEMUR 2 VIEWS, RIGHT",RAD,A,320,,,,,,162,N,N
2247,BIOPSY PUNCH 4MM,CS,A,272,,,,,,10,N,N
2249,ACTH,LAB,A,301,82024,91,,,,339,N,N
225,ER WITH MONITOR LEVEL 4,ED,A,450,99284,,,,,832,N,N
2251,VENT SUCTION ELBOW PORT,RT,A,270,,,,,,23,N,N
2254,SPLINT ELBOW,CS,A,274,,,,,,85,N,N
226,"FINGER 3 VIEWS, LEFT",RAD,A,320,73140,TC,LT,,,118,N,N
2261,"FINGER 3 VIEWS, RIGHT",RAD,A,320,73140,TC,RT,,,118,N,N
227,BLOOD GAS KIT,ABGS,I,270,99999,,,,,24,N,N
228,ORBIT COMPLETE,RAD,A,320,70200,TC,,,,152,N,N
229,ACCUPRIL 10MG TAB,RX,A,252,J8499,,,,,10,N,N
2299,VASOTEC 1.5MG IV,RX,A,252,J3490,,,,,34,N,N
230,"FOOT 2 VIEWS, LEFT",RAD,A,320,73620,TC,LT,,,126,N,N
2301,"FOOT 2 VIEWS, RIGHT",RAD,A,320,73620,TC,RT,,,126,N,N
2303,IV WINGED INFUSION SET,CS,A,272,,,,,,6,N,N
2305,MYLANTA GAS,RX,A,257,J8499,,,,,6,N,N
2309,ZINC METAL SCREEN,LAB,A,301,84630,90,,,,61,N,N
231,PROCAINAMIDE ASSAY,LAB,A,301,80190,90,,,,155,N,N
2310,ARSENIC METAL SCREEN,LAB,A,301,82175,90,,,,92,N,N
2312,MERCURY METAL SCREEN,LAB,A,300,83825,90,,,,61,N,N
2313,CADMIUM METAL SCREEN,LAB,A,301,82300,90,,,,78,N,N
2314,LEAD METAL SCREEN,LAB,A,300,83655,90,,,,60,N,N
232,"FOOT 3 VIEWS, LEFT",RAD,A,320,73630,TC,LT,,,153,N,N
2321,"FOOT 3 VIEWS, RIGHT",RAD,A,320,73630,TC,RT,,,153,N,N
2322,COMPLEMENT C3,LAB,A,301,86160,90,,,,167,N,N
2323,COMPLIMENT C4,LAB,A,301,86160,90,,,,167,N,N
2324,DEXTRAN/DEFERRUM INJECTABLE,RX,A,251,J7100,,,,,199,N,N
233,ER WITH MONITOR LEVEL 5,ED,A,450,99285,,,,,1113,N,N
234,"FOREARM 2 VIEWS, LEFT",RAD,A,320,73090,TC,LT,,,139,N,N
2341,"FOREARM 2 VIEWS, RIGHT",RAD,A,320,73090,TC,RT,,,138,N,N
2345,CONSCIOUS SEDATION,AS,A,761,99143,,,,,490,N,N
2346,CONSCIOUS SEDATION EA 15MIN,AS,A,761,99145,,,,,113,N,N
235,IMMODIUM,RX,A,252,J8499,,,,,8,N,N
2355,INFLUENZE VACCINE,RX,A,771,Q2037,,,,,63,N,N
2356,CARDEC DM DROPS (PERCC),RX,A,252,J8499,,,,,5,N,N
236,GALLBLADDER ORAL,RAD,A,320,74290,,,,,279,N,N
237,"ORBIT 1 VIEW, LEFT",RAD,A,320,70030,TC,LT,,,138,N,N
2371,"ORBIT 1 VIEW, RIGHT",RAD,A,320,70030,TC,RT,,,138,N,N
238,"HAND 2 VIEWS, LEFT",RAD,A,320,73120,TC,LT,,,152,N,N
2381,"HAND 2 VIEWS, RIGHT",RAD,A,320,73120,TC,RT,,,152,N,N
2389,MORPHINE 2MG INJ,RX,A,251,J2270,,,,,51,N,N
239,ALCOHOL PREP INDIVIDUAL,CS,A,272,,,,,,3,N,Y
23930,I&D ABSCESS ELBOW AND UPPER ARM,TR,A,761,23930,,,,,195,N,N
240,"HAND 3 VIEW, LEFT",RAD,A,320,73130,TC,LT,,,176,N,N
2401,"HAND 2 VIEW, RIGHT",RAD,A,320,73130,TC,RT,,,176,N,N
241,SODIUM; URINE,LAB,A,301,84300,90,,,,54,N,N
242,"HIP JOINT 1 VIEW, LEFT",RAD,A,320,73500,TC,LT,,,152,N,N
2421,"HIP JOINT 1 VIEW, RIGHT",RAD,A,320,73500,TC,RT,,,152,N,N
243,POTASSIUM; URINE,LAB,A,301,84133,90,,,,57,N,N
244,"HIP JOINT 2 VIEWS, LEFT",RAD,A,320,73510,TC,LT,,,209,N,N
2441,"HIP JOINT 2 VIEWS, RIGHT",RAD,A,320,73510,TC,RT,,,209,N,N
245,TEGADERM PLUS PAD STERILE 3X4,CS,A,272,,,,,,18,N,N
246,"HUMERUS 2 VIEWS, LEFT",RAD,A,320,73060,TC,LT,,,146,N,N
2461,"HUMERUS 2 VIEWS, RIGHT",RAD,A,320,73060,TC,RT,,,146,N,N
247,"HEEL 2 VIEW, LEFT",RAD,A,320,73650,TC,LT,,,126,N,N
2471,"HEEL 2 VIEW, RIGHT",RAD,A,320,73650,TC,RT,,,126,N,N
249,INSULIN ANTIBIODIES,LAB,A,301,86337,90,,,,441,N,N
250,KNEE 2 VIEWS. LEFT,RAD,A,320,73560,TC,LT,,,141,N,N
2501,"KNEE 2 VIEWS, RIGHT",RAD,A,320,73560,TC,RT,,,141,N,N
2502,I & D hematoma arm,ED,A,450,25028,,,,,361,N,N
2509,"THYROXINE, TOTAL",LAB,A,301,84436,90,,,,58,N,N
251,MEFIX DRESSING 4X4 SQUARE,CS,A,272,,,,,,13,N,N
2510,PROMETHAZINE 25MG TABS,RX,A,251,J8499,SH,,,,10,N,N
252,"LEG 2 VIEWS, LEFT",RAD,A,320,73590,TC,LT,,,152,N,N
2521,"LEG 2 VIEW, TIB/FIB, RIGHT",RAD,A,320,73590,TC,RT,,,152,N,N
253,"KNEE 3 VIEW, LEFT",RAD,A,320,73562,TC,LT,,,355,N,N
2531,"KNEE 3 VIEW, RIGHT",RAD,A,320,73562,TC,RT,,,355,N,N
254,MANDIBLE COMPLETE,RAD,A,320,70110,TC,,,,190,N,N
255,"KNEE 4 VIEW, LEFT",RAD,A,320,73564,TC,LT,,,213,N,N
2551,"KNEE 4 VIEW, RIGHT",RAD,A,320,73564,TC,RT,,,213,N,N
2552,D5 DEXTROSE ADVANTAGE 100CC,IVS,A,258,J7060,,,,,99,N,N
,,IVS,A,258,J7060,,,,,99,N,N
2553,NACL 9% ADVANTAGE 100CC,IVS,A,258,J7050,,,,,99,N,N
2554,HEPARIN DRIP 25000U IN 500ML,RX,A,251,,,,,,0,N,N
260,"PELVIS 1 VIEW, LEFT",RAD,A,320,72170,TC,LT,,,152,N,N
2601,"PELVIS 1 VIEW, RIGHT",RAD,A,320,72170,TC,RT,,,152,N,N
261,TOES 2 VIEW,RAD,A,320,73660,TC,,,,126,N,N
262,IV PYELOGRAM,RAD,A,320,74420,,,,,366,N,N
264,RIBS ONE SIDE 3 VIEW BIL,RAD,A,320,71110,TC,50,,,127,N,N
266,"RIBS ONE SIDE 3 VIEWS, LEFT",RAD,A,320,71101,TC,LT,,,164,N,N
2661,"RIBS ONE SIDE 3 VIEWS, RIGHT",RAD,A,320,71101,TC,RT,,,164,N,N
267,"SHOULDER 3 VIEW, LEFT",RAD,A,320,73030,TC,LT,,,219,N,N
2671,"SHOULDER 3 VIEW, RIGHT",RAD,A,320,73030,TC,RT,,,219,N,N
268,RIBS BOTH SIDES 4 VIEWS,RAD,A,320,71111,,,,,289,N,N
269,EMESIS BAG (DISPOSABLE) EACH,CS,A,270,,,,,,7,N,N
270,SACRUM 2 VIEW,RAD,A,320,72220,,,,,145,N,N
2702,"VITAMIN D, 25 HYDROXY, INCLUDES FRACTION",LAB,A,301,82306,90,,,,281,N,N
271,SPINE LUMBAR BENDING ONLY,RAD,A,320,72120,TC,,,,125,N,N
272,"SHOULDER 1 VIEW, LEFT",RAD,A,320,73020,TC,LT,,,126,N,N
2721,SHOULDER 1 VIEW RIGHT,RAD,A,320,73020,TC,RT,,,126,N,N
273,SPINE LUMBAR COMP W BENDING,RAD,A,320,72114,TC,,,,352,N,N
274,"SHOULDER 2 VIEW, LEFT",RAD,A,320,73030,TC,LT,,,158,N,N
2741,"SHOULDER, 2 VIEW BILATERAL",RAD,A,320,73030,50,TC,,,319,N,N
2742,"SHOULDER 2 VIEW, RIGHT",RAD,A,320,73030,TC,RT,,,158,N,N
275,OPTIRAY INFUSION,RAD,A,329,74410,,,,,96,N,N
276,"SINUSES PARANASAL, LEFT",RAD,A,320,70220,TC,LT,,,225,N,N
27603,I&D ABSCESS LOWER EXTREMITY,TR,A,761,27603,,,,,250,N,N
2761,"SINUSES PARANASAL, RIGHT",RAD,A,320,70220,TC,RT,,,225,N,N
277,"EXTREMITY LOWER INFANT, LEFT",RAD,A,320,73592,TC,LT,,,138,N,N
2771,"EXTREMITY LOWER INFANT, RIGHT",RAD,A,320,73592,TC,RT,,,138,N,N
278,SKULL 2 VIEWS,RAD,A,320,70250,TC,,,,170,N,N
2785,CCP AB,LAB,A,301,86200,90,,,,160,N,N
280,SKULL SERIES W/PETROUS BONE,RAD,A,320,70260,,,,,265,N,N
282,SACROILIAC JOINT>3 VIEW,RAD,A,320,72202,,,,,236,N,N
283,KNEES STANDING,RAD,A,320,73565,TC,,,,114,N,N
284,SPINE CERVICAL 1 VIEW,RAD,A,320,72020,TC,,,,127,N,N
288,SPINE CERVICAL COMPLETE,RAD,A,320,72052,TC,,,,281,N,N
2888,REDUCTION DISLOCATION SHOULDER,ED,A,450,23575,,,,,339,N,N
289,CHEST DECUBITUS,RAD,A,324,71035,TC,,,,145,N,N
2896,ENDOSCOPY ROOM FOR OP PROCEDUR,TR,A,361,,,,,,568,N,N
2899,A.F. SMEAR,LAB,A,301,87206,90,,,,113,N,N
29,ANTIDIURETIC HORMONE,LAB,A,301,84588,90,,,,198,N,N
290,SPINE DORSAL 2 VIEWS,RAD,A,320,72070,TC,,,,167,N,N
29065,CAST APPLICATION LONG ARM,CL,A,523,29065,,,,,99,N,Y
291,SPINE DORSAL 3 VIEW,RAD,A,320,72072,TC,,,,209,N,N
2911,PARVOVIRUS (B19 ANTIBODY),LAB,A,302,86747,90,,,,236,N,N
292,SPINE DORSAL 4 VIEWS,RAD,A,320,72074,TC,,,,257,N,N
29280,STARPPING CAST TO HAND,ED,A,450,29280,22,TC,59,,223,N,N
293,SPINE LUMBAR THREE VIEW,RAD,A,320,72100,TC,,,,219,N,N
294,SPINE LUMBAR COMPLETE,RAD,A,320,72110,TC,,,,294,N,N
295,SIMETHICONE,RX,A,251,J8499,SH,,,,7,N,N
2950,CASTING TO LOWER EXTREMITY,ED,A,450,29540,RT,,,,295,N,N
2955,NURSING HOME VISIT LEVEL 1,CL,A,523,99307,,,,,84,N,Y
296,STERNUM 2 VIEWS,RAD,A,320,71120,TC,,,,152,N,N
297,SODIUM CHLORIDE 3CC,RX,A,252,J3490,,,,,8,N,N
298,TEMPROMANDIBULAR JOINT,RAD,A,320,70330,50,TC,,,190,N,N
299,HTLV OR HIV;CONFIRM WEST.BLOT,LAB,A,302,86689,90,,,,155,N,N
2999,TAMIFLU 12.50 SUSPENSION,RX,A,251,J3490,,,,,184,N,N
30,IV INFUSION 1ST HR-THERAPEUTIC,NRS,A,260,96365,,,,,267,N,N
300,SACROILIAC < 3 VIEW,RAD,A,320,72200,,,,,213,N,N
3000,TB TINE TEST,RX,A,250,86480,,,,,47,N,N
3001,NUBAIN 20MG INJ,RX,I,252,J2300,,,,,71,N,N
3002,LACTIC ACID,LAB,A,301,83605,90,,,,270,N,N
3003,INFUSION OF IRON THERAPY,TR,A,260,Q0081,,,,,219,N,N
3008,PHENOBARB ELIXER UD 20MG CUP,RX,A,251,J8499,SH,,,,7,N,N
3009,COOL MIST TREATMENT W/02 P/HR,RT,A,410,,,,,,31,N,N
301,LOPRESSOR 50MG TABS,RX,A,251,J8499,,,,,8,N,N
3010,COOL MIST TREATMENT PER DAY,RT,A,410,,,,,,410,N,N
3011,PACKING STRIPS STERILE,CS,A,272,,,,,,24,N,N
3012,INDERAL 20MG TABLET,RX,A,252,J8499,,,,,7,N,N
3014,PROCAINAMIDE 1GM VIAL,RX,A,251,J2690,,,,,108,N,N
3016,SULFAMETHOXAZOLE 800/160 TAB,RX,A,251,J8499,SH,,,,7,N,N
3018,SUCRALFATE 1GM TAB,RX,A,251,J8499,SH,,,,6,N,N
302,WRIST 2 VIEWS. LEFT,RAD,A,320,73100,TC,LT,,,133,N,N
3020,SODIUM POLYSTYRENE SULFONATE S,RX,A,251,J8499,SH,,,,78,N,N
30201,"WRIST 2 VIEW, RIGHT",RAD,A,320,73100,TC,RT,,,133,N,N
3021,FDP (FIBREN DEGRADATION PROD),LAB,A,301,85362,90,,,,149,N,N
3022,KEFLEX 250MG CAPSULE,RX,A,251,J8499,,,,,10,N,N
3023,KETAMINE 500MG/10ML VIAL,RX,A,252,J3490,,,,,16,N,N
3024,LANOXIN 0.125MG TABLET,RX,A,252,J8499,,,,,4,N,N
3025,MORPHINE SULFATE 25MG/1ML-4ML,RX,A,252,J2270,,,,,64,N,N
3026,LANOXIN 0.25MG TAB,RX,A,252,J8499,,,,,12,N,N
3027,CELESTONE SYRUP 0.6MG/5ML,RX,A,252,J8499,,,,,20,N,N
3028,LASIX 20MG TABLET,RX,A,252,J8499,,,,,15,N,N
3029,ACTIVASE 100 MG,RX,A,252,J2997,,,,,90,N,N
303,COAGULATION FACTOR VII (AHG),LAB,A,305,85240,59,91,,,357,N,N
3030,PROTONIX 40MG IV,RX,A,252,S0164,,,,,151,N,N
3031,RACEMIC EPINEPHRINE 0.1MG,RX,A,251,J0171,,,,,15,N,N
3032,LITHIUM 300MG TABLET,RX,A,252,J8499,,,,,6,N,N
3033,D&C (DILATION AND CURRETAGE),AS,A,360,58120,,,,,1047,N,N
3035,ENDOMYSIAL/IFA,LAB,A,301,86255,90,,,,167,N,N
3036,"MASK, ADULT AEROSOL",CS,A,271,A4620,,,,,15,N,N
3037,AUGMENTIN SUSPENSION 125/5,RX,A,252,S5001,,,,,152,N,N
3038,VISCOUS LIDOCAINE 1%,RX,A,251,J8499,SH,,,,15,N,N
3039,ANTI-RIBOSOMAL-P ANTIBODY,LAB,A,301,86235,90,,,,162,N,N
304,"WRIST 3 VIEW, LEFT",RAD,A,320,73110,TC,LT,,,167,N,N
3040,"DRUG SCREEN, ALCOHOL",LAB,A,301,80100,90,,,,53,N,N
30401,"WRIST 3 VIEW, RIGHT",RAD,A,320,73110,TC,RT,,,167,N,N
3041,ZITHROMAX 033-829,RX,A,252,Q0144,,,,,155,N,N
3042,KLOR CON 10 MEQ,RX,A,252,J8499,,,,,7,N,N
3043,MAGNESIUM SULFATE 500 MG,RX,A,252,J3475,,,,,34,N,N
3044,ATROPINE 0.4MG INJ 0.4MG/ML,RX,A,252,J0461,,,,,5,N,N
3045,FREE T4,LAB,A,301,84439,90,,,,214,N,N
3046,NORTRIPTYLINE 25MG CAP,RX,A,251,J8499,,,,,7,N,N
3047,T3 FREE,LAB,A,301,84481,90,,,,182,N,N
3048,MOTRIN 800MG TABLET,RX,A,257,J8499,,,,,51,N,N
3049,ALBUMIN 25% IV,RX,A,386,P9046,,,,,59,N,N
305,NECK SOFT TISSUE,RAD,A,320,70360,,,,,138,N,N
3050,OBSERVATION DAY CHARGE,OBS,A,762,G0378,,,,,413,N,N
3051,GUAIFENESIN 600MG TAB,RX,A,252,J8499,,,,,20,N,N
3052,CAST HAND AND LOWER FOREARM,ED,A,450,29085,,,,,333,N,N
3053,VITAMIN D,LAB,A,301,82652,90,,,,354,N,N
3054,NITROSTAT 0.4MG SUBLING TAB,RX,A,252,J8499,SH,,,,7,N,N
3055,HOMOCYSTEINE LEVEL,LAB,A,301,83090,90,,,,241,N,N
3056,I&D ABSCESS BREAST (DEEP),TR,A,761,19020,,,,,262,N,N
3057,DEBRIDEMENT OF WOUND,TR,A,761,97602,,,,,515,N,N
3058,HEPATITIS B A.AB,LAB,A,302,86706,90,,,,125,N,N
3059,FORTAZ 1 GRAM IV,RX,A,251,J0713,,,,,194,N,N
306,OPTIRAY 320MG/ML CONTRAST,RAD,A,252,Q9967,,,,,50,N,N
3060,CLEOCIN 300MG IV (600),RX,A,252,S0077,,,,,51,N,N
3061,PREALBUMIN,LAB,A,301,84134,90,,,,162,N,N
3062,INFLUENZA B,LAB,A,301,87804,91,,,,59,N,N
3063,BOWEL DISIMPACTION,ED,A,450,46999,,,,,53,N,N
3064,AMIODARONE 30MG IV,RX,A,251,J0282,,,,,38,N,N
3065,TOBRAMYCIN 80MG PER VIAL,RX,I,251,J3260,,,,,34,N,N
3066,AMIODARONE 150MG VIAL,RX,I,251,J0282,,,,,38,N,N
3067,VASOPRESSOR 20U VIAL,RX,A,251,J3490,,,,,32,N,N
3068,ACYCLOVAIR 800MG,RX,A,252,J8499,,,,,22,N,N
3069,SUTURE OF ARTERY,ED,A,450,35206,,,,,681,N,N
307,PELVIC EXAMINATION,NRS,A,450,99397,,,,,50,N,N
3070,PREDNISONE 5MG TABLET,RX,A,251,J8499,SH,,,,7,N,N
3071,SUTURE LIP,ED,A,450,12051,,,,,420,N,N
3072,PREDNISONE 20MG TABLET,RX,A,251,J8499,SH,,,,7,N,N
3073,I&D ABSCESS BREAST (PUNCTURE),TR,A,761,19000,,,,,177,N,N
3074,WOUND CARE/DRESSING CHANGES,TR,A,272,,,,,,76,N,N
3075,VASOTEC 5MG VIAM,RX,A,251,J3490,,,,,19,N,N
3077,PLAVIX 75MG TAB,RX,A,252,J3490,,,,,15,N,N
308,LISINOPRIL 5MG TABLET,RX,A,251,J8499,,,,,5,N,N
3082,PROCARDIA 10MG CAPSULE,RX,A,251,J8499,,,,,7,N,N
3084,PROCARDIA XL 30MG TABLET,RX,A,252,J8499,,,,,13,N,N
3088,INSERTION OF CHEST TUBE,ED,A,450,99999,,,,,515,N,N
3089,ZITHROMAX SUSP 200MG,RX,A,252,Q0144,,,,,110,N,N
309,COPIES OF FILM (EACH),RAD,I,320,76499,,,,,23,N,N
3090,QUINAGLUTE 324MG TABLET,RX,A,252,J8499,SH,,,,8,N,N
3091,"STERILE ADHESIVE 4"" BANDAGE",CS,A,270,,,,,,7,N,N
3092,CONS SEDATION EA 30MINUTES,ED,A,450,99149,,,,,198,N,N
3094,SPLINT APPLICATION/ SHOULDER,ED,A,450,29240,TC,59,,,552,N,N
3095,REDUCTION FRACTURE FIBULA,ED,A,450,27788,,,,,552,N,N
3096,CONSCIOUS SEDATION 5&UP EA 15M,ED,A,450,99145,,,,,107,N,N
3097,CONSCIOUS SEDATION 5&UP 1ST HR,ED,A,450,99144,,,,,398,N,N
3098,REGLAN 10MG TABLET,RX,A,251,J8499,SH,,,,13,N,N
3099,INSERTION OF SUBCLAVIAN CATHET,ED,A,450,36555,,,,,515,N,N
31,IV INF EA HR 2UP-THERAPEUTIC,NRS,A,260,96366,,,,,24,N,N
3107,OBS & TELEMETRY PER HOUR,OBS,A,762,,,,,,96,N,N
311,CONTRAST CT SCAN (READY CAT),SCAN,I,350,99999,,,,,78,N,N
3111,OBS 1-3 LEV 3 W/MON,OBS,A,762,G0378,,,,,125,N,N
3112,SERUM GASTRIN,LAB,A,301,82941,90,,,,163,N,N
3118,OBS 4TH HR & UP LEV 1 W/MON,OBS,A,762,G0378,,,,,43,N,N
3119,OBS 1-3HR LEV 2 W/MON,OBS,A,762,G0378,,,,,131,N,N
3120,OBS 4TH & UP LEV 3 W/MON,OBS,A,762,G0378,,,,,60,N,N
313,SCOLIOSIS SERIES,RAD,A,320,72069,,,,,170,N,N
315,INSULIN;TOTAL,LAB,A,301,83525,90,,,,114,N,N
3168,SPECIFIC GRAVITY BODY FLUIDS,LAB,A,301,84315,90,,,,99,N,N
317,AC JOINTS BILATERAL,RAD,A,320,73050,,,,,307,N,N
3189,ACETYLCHORINE BLOCKING,LAB,A,301,83519,,,,,48,N,N
319,SILVER NITRATE STICK,ED,A,252,J3490,,,,,23,N,N
3190,ACETYLCHOLINE MODULATING AB,LAB,A,301,83519,90,,,,490,N,N
3191,STRIAIED MUSCLE 1,LAB,A,301,86255,90,,,,429,N,N
3192,STRIAIED MUSCLE 2,LAB,A,301,86256,90,,,,339,N,N
3193,ACETYCHORINE RECEPTOR AB,LAB,A,301,83519,90,,,,324,N,N
3194,ACETYLCHORINE BINDING AB,LAB,A,301,83519,90,,,,324,N,N
3201,TTG AB IGA,LAB,A,301,83516,90,,,,190,N,N
32011,IGA TISSUE TRANSGLLUTAMINASE,LAB,I,301,,,,,,190,N,N
3202,EXC MAL LESION,AS,A,360,11606,,,,,697,N,N
3203,REPAIR INTERMEDIATE AXILLA,AS,A,360,12032,,,,,219,N,N
3204,GLADIN AB IGA,LAB,A,301,,,,,,137,N,N
3205,ANTI (DS) DNA ANTIBODY,LAB,A,301,86225,90,,,,307,N,N
3207,PERIPHERAL SMEAR TO PATHOLOGIS,LAB,A,310,85060,90,,,,90,N,N
321,QUICK PACE,CS,A,272,,,,,,145,N,N
3211,I&D ABSCESS MOUTH/FACE,ED,A,450,40800,,,,,323,N,N
322,CLOSTRIDIUM DIFFICILE TOXIN,LAB,A,301,87324,90,,,,125,N,N
3220,TB INTERDERMAL TEST,CL,A,523,86580,,,,,28,N,Y
3222,BETADINE SCRUB BRUSHE,CS,A,272,A4246,,,,,17,N,N
323,FAST PATCH,CS,A,272,,,,,,78,N,N
3244,TETANUS TOXOID 0.5MG,RX,A,251,90715,,,,,127,N,N
3248,SHBG,LAB,A,301,84270,90,,,,254,N,N
3249,"TESTOSTERONE, FREE",LAB,A,301,84402,90,,,,254,N,N
327,GELOCAST DRESSING,CS,A,274,A6251,,,,,36,N,N
329,ALPHA-FETOPROTEIN; SERUM,LAB,A,301,82105,90,,,,125,N,N
33,GOLYTLY,RX,A,252,J8499,,,,,46,N,N
330,IV INFUSION (1XD),NRS,A,260,Q0081,,,,,267,N,N
3301,LYSIS OF ADHESIONS,TR,A,761,54162,,,,,398,N,N
3302,SERUM IMMUMOGLOBULIN EACH,LAB,A,302,82784,90,,,,340,N,N
3303,ANTI-NEURONA/ABS IGG,LAB,A,302,86255,90,,,,691,N,N
3304,24 HOUR UPEP,LAB,A,301,82570,90,,,,280,N,N
3307,NASAL PACKING,ED,A,450,30901,,,,,219,N,N
3308,REMOVAL OF NAIL,ED,A,450,11730,,,,,239,N,N
3309,CYCLOSPORIN A,LAB,A,301,80158,90,,,,368,N,N
331,IV INFUSION 1ST HOUR-HYDRATION,NRS,A,260,96360,,,,,267,N,N
3310,HGH GROWTH HORMONE,LAB,A,301,83003,90,,,,68,N,N
3311,HSV 1 OR 2 PCR,LAB,A,301,87529,90,,,,479,N,N
3312,SJOGRENS ANTIBODY,LAB,A,301,86235,90,,,,75,N,N
3319,HUMALOG INSULIN 5UNITS,RX,A,252,J1815,,,,,53,N,N
332,ADMIN OF ANTIBIOTIC INJ,NRS,A,940,96372,,,,,96,N,N
3320,LANTUS INSULIN 5UNITS,RX,A,252,J1815,,,,,23,N,N
3321,PREVACID 15MG PO,RX,A,252,J8499,,,,,14,N,N
3322,PREVACID IV,RX,A,252,J3490,,,,,76,N,N
3323,OLIGOCLONAL BANDS A,LAB,A,301,83916,90,,,,119,N,N
3324,OLIGOCLONAL BANDS,LAB,A,301,83916,90,,,,461,N,N
3325,CERULOPLASMIN SERUM,LAB,A,301,82390,90,,,,84,N,N
3326,ESTROGEN LEVEL,LAB,A,301,82671,90,,,,392,N,N
3327,COPPER METAL SCREEN,LAB,A,301,82525,90,,,,152,N,N
3328,URINE PROTEIN 24 HOUR,LAB,A,307,84156,90,,,,88,N,N
3329,CREATININE URINE,LAB,A,307,82570,,,,,46,N,N
333,"TRAY, THORACENTESIS",CS,A,272,,,,,,114,N,N
3331,FLUSH OF PORT,ED,A,940,36593,,,,,96,N,N
3332,FLUSH OF PORT,NRS,A,940,36593,,,,,135,N,N
3333,ZOFRAN 1MG VIAL,RX,I,252,J2405,,,,,13,N,N
3334,FLOMAX 0.4MG / TRAMSULOSIN,RX,A,251,J3490,,,,,16,N,N
3336,PLATELET LEUKOREDUCED PHRESIS,LAB,A,385,P9035,,,,,1285,N,N
3337,RED BLOOD CELLS LEUKODUCED UNI,LAB,A,381,P9016,,,,,461,N,N
3338,BLOOD PROCESSING FOR TRANSFUSI,LAB,A,390,36430,59,91,,,139,N,N
3339,INFUSION BLOOD PRODUCTS,LAB,A,391,36430,59,91,,,295,N,N
334,ADMIN OF THEARP/PROP INJ,NRS,A,940,96372,,,,,96,N,N
3340,EXT FOR DNA MOLECULAR TEST,LAB,A,302,81479,59,91,,,103,N,N
3341,RBC MOLECULAR TYPING,LAB,A,399,81479,59,91,,,460,N,N
3342,PATH INTERP/REPORT LIMITED,LAB,A,312,80500,90,,,,177,N,N
3343,ANTIGEN TYPE EACH,LAB,A,302,86905,59,91,,,281,N,N
3345,BIER BLOCK ANESTHTIC,ED,A,370,,,,,,586,N,N
3349,LEVAQUIN 750MG IV,RX,A,251,J1956,,,,,232,N,N
335,MAXILLOFACIAL CT W/O CONTRAST,SCAN,A,351,70486,,,,,1583,N,N
3356,CCP CYCLIL CITRULLINATED PEPTI,LAB,A,301,86200,90,,,,137,N,N
3359,HGH GROWTH HORMONE,LAB,A,301,83003,90,,,,40,N,N
336,IV PUSH OF DRUG,NRS,A,940,96374,,,,,96,N,N
3361,IV PUSH OF DRUG EACH ADD (SAME,NRS,A,940,96376,76,,,,96,N,N
3362,IV PUSH DRUG (EACH ADD DIFF D),NRS,A,940,96375,76,,,,96,N,N
337,MAXILLOFACIAL CT W/W/O CONTRAS,SCAN,A,351,70488,,,,,1612,N,N
338,IV INFUS PER HR-HYDRATION AFTER INITIAL,NRS,A,260,96361,,,,,13,N,N
339,XALATAN OPTHAL,RX,A,252,J8499,SH,,,,167,N,N
340,IV INFUSION 1XDAY,TR,A,260,Q0081,,,,,267,N,N
341,"KNEE 1 VIEW, LEFT",RAD,A,320,73560,TC,LT,,,118,N,N
3410,REMOVAL FB ARM,ED,A,450,24200,,,,,239,N,N
3411,"KNEE 1 VIEW, RIGHT",RAD,A,320,73560,TC,RT,,,118,N,N
342,IV INFUSION 2-8 HR (EA),TR,A,260,Q0081,,,,,36,N,N
3420,NORMAL SALINE WITH KCL 20 MEQ,IVS,A,258,J7030,,,,,94,N,N
343,ADMIN ANTIBIOTIC INJ,TR,A,761,96372,,,,,96,N,N
344,ADMIN OF THERAP/PROP INJ,TR,A,761,96372,,,,,96,N,N
3445,SANTYL OINTMENT,RX,A,252,,,,,,34,N,N
3449,BENE PROTEIN,RX,A,251,,,,,,13,N,N
348,PREDNISONE ORAL SUSPENSION,RX,A,252,J7506,,,,,39,N,N
3509,HDL CHOLESTEROL RATIO,LAB,A,301,83718,,,,,108,N,N
3510,ELAVIL (AMITRIPTYLINE LEVEL),LAB,A,301,80152,90,,,,265,N,N
356,GASTROESOPHAGEAL REFLUX ST,RAD,I,341,78262,,,,,538,N,N
365,ZYRTIC 2.5 ML,RX,A,252,J8499,,,,,14,N,N
366,CETRIZINE 5MG ML,RX,A,252,J8499,,,,,16,N,N
3701,INFLUENZA B,LAB,A,301,87804,91,,,,59,N,N
38,"PHOSPHATE, PARATHORMONE VITAMIN",LAB,A,301,84378,,,,,121,N,N
3801,PREVNAR 13 INJECTION,RX,A,771,,,,,,403,N,N
3849,CURVED HEMOSTATS,CS,A,272,,,,,,18,N,N
38501,MEROPENEM 1 GRAM,RX,A,252,J2185,,,,,22,N,N
386,MYOCARDIAL IMAG; RESTING,SCAN,I,341,99999,,,,,734,N,N
3905,MELOXICAM 7.5MG TAB (MOBIC),RX,A,251,J3490,,,,,10,N,N
393,UNASYN 1.5GRAM VIAL,RX,A,252,J0295,,,,,90,N,N
395,IV NITRO TUBING,CS,A,272,A4222,,,,,67,N,N
397,SYLFATRIM PEDI SUSP,RX,A,251,J8499,SH,,,,10,N,N
399,MYLICON,RX,A,257,J8499,,,,,6,N,N
4001,CONSC SEDATION 5YR/UND EACH 30,ED,A,450,99144,,,,,198,N,N
4002,LEVER LOCK,CS,A,272,A4222,,,,,27,N,N
4005,ROBAXIN 750MG,RX,A,251,J2800,,,,,16,N,N
4007,NITRO/TRIDIL 200 MCG/ML,RX,A,251,J3490,,,,,53,N,N
401,CT SCAN OF CHEST W/O CONT,RAD,I,352,71250,,,,,1024,N,N
4011,CLEAN WOUND WITH N/S,CS,A,270,,,,,,18,N,N
4014,REPAIR SMP SCALP 20CM,ED,A,450,12035,,,,,1058,N,N
4015,"DEBRIDEMENT, EXCISIONAL",TR,A,761,11042,,,,,306,N,N
4016,SYNTHROID 0.1MG TABLET,RX,A,252,J8499,SH,,,,6,N,N
4017,REPAIR,ED,A,450,12054,,,,,501,N,N
4021,"WOUND CARE PACKING, PLAIN",CS,A,272,,,,,,20,N,N
4022,TEGRETOL 200MG TABLET,RX,A,252,J8499,SH,,,,8,N,N
4023,ANTIMITOCHONDRIAL (NUCLEAR ANT,LAB,A,302,86255,90,,,,219,N,N
4024,THEODUR 200MG TABLET,RX,A,251,J8499,SH,,,,6,N,N
4025,HEPATITIS PROFILE,LAB,A,301,80074,,,,,219,N,N
4026,THEODUR 300MG TABLET,RX,A,252,J8499,SH,,,,7,N,N
4027,WOUND CARE IODAFORM PACKING,CS,A,272,,,,,,23,N,N
4028,AUGMENTIN 200MG SUSPENSION,RX,A,252,J8499,,,,,65,N,N
4029,DILAUDID 2MG VIAL,RX,A,252,J1170,,,,,63,N,N
4030,D-DIMER,LAB,I,301,85379,90,,,,114,N,N
4032,TORADOL 10MG TABLET,RX,A,252,J8499,SH,,,,15,N,N
4034,TRANDATE 100MG TABLET,RX,A,252,J8499,SH,,,,8,N,N
4040,TYLENOL 325MG TABLET,RX,A,257,J8499,SH,,,,10,N,N
4042,TYLENOL 500MG TABLET,RX,A,257,J8499,,,,,10,N,Y
4044,HEAD STAPLER,CS,A,274,,,,,,279,N,N
4048,VASOTEC 5MG TABLET,RX,A,251,J8499,SH,,,,10,N,N
405,D-DIMER,LAB,A,301,85379,90,,,,143,N,N
4052,VISTARIL 25MG CAPSULE,RX,A,251,J8499,SH,,,,13,N,N
4053,ZINACEF IV 750MG,RX,A,252,J0697,,,,,34,N,N
4055,THERAPEUTIC PHLEBOTOMY,LAB,A,940,99195,,,,,384,N,N
4056,ZANTAC 150MG TABLET,RX,A,252,J8499,SH,,,,38,N,N
4061,HUMULIN INSULIN 70/30,RX,A,252,J1815,,,,,23,N,N
4063,PROMETHAZINE 25MG AMP,RX,A,251,J2550,,,,,29,N,N
4064,AMOXIL SUSP. 125MG/5ML BTL,RX,A,252,J8499,,,,,14,N,N
,,RX,A,252,J8499,,,,,10,N,N
4065,HUMULIN N INSULIN 100U PERCC,RX,A,252,J1815,,,,,23,N,N
4066,BENADRYL ELIXER 12.5MG/5ML,RX,A,257,J8499,,,,,13,N,N
4067,HUMULIN R INSULIN 5 UNITS,RX,A,252,J1815,,,,,23,N,N
,,RX,A,252,J1815,,,,,23,N,N
4068,DIPHENHYDRAMINE 25MG TAB,RX,A,251,J8499,,,,,7,N,N
4070,FERROUS SULFATE 325MG TAB,RX,A,257,J8499,,,,,6,N,N
4072,CHARCOAL LIQUID OZ,RX,A,252,J8499,,,,,63,N,N
4074,EES 200MG/5ML DRAM,RX,A,252,J8499,,,,,27,N,N
4075,METOPROLOL 50MG TAB,RX,A,251,J8499,,,,,7,N,N
4077,ZYVOX 200MG,RX,A,252,J2020,,,,,190,N,N
4078,IPECAC SYRUP 15CC,RX,A,257,J8499,,,,,23,N,N
408,MAGNESIUM SULFATE 1 GRAM,RX,A,252,J3475,,,,,51,N,N
4080,PROMETHAZINE 25MG TAB,RX,A,251,J8499,SH,,,,10,N,N
4082,KAOPECTATE SUSP. DRAM,RX,A,257,J8499,,,,,6,N,N
4083,KAYEXOLATE SUSP.,RX,A,252,J8499,,,,,27,N,N
4085,METRONIDAZOLE 500MG IVPB,RX,A,251,S0030,,,,,76,N,N
4086,THEOPHYLLINE EXT RELEASE 200MG,RX,A,251,J8499,SH,,,,10,N,N
4088,MAGNESIUM CITRATE BTL,RX,A,257,J8499,,,,,6,N,N
4090,MILK OF MAGNESIA OZ,RX,A,257,J8499,,,,,7,N,N
4094,NYSTATIN SUSPENSION 5CC,RX,A,252,J8499,SH,,,,7,N,N
4099,"I&D ABSCESS, COMPLICATED",TR,A,761,10061,TC,,,,234,N,N
4102,REPAIR SCALP,ED,A,450,12054,,,,,451,N,N
413,IBUPROFEN 400MG TAB,RX,A,251,J8499,,,,,7,N,N
417,SOLU CORTEF 250MG VIAL,RX,I,252,J1720,,,,,248,N,N
4200,DRUG SCREEN RAPID TEST,LAB,A,307,G0431,59,91,,,128,N,N
4201,"ORTHOGLASS CASTING MATERIAL 4""",ED,A,450,99070,26,,,,48.5,N,N
4202,"ORTHOGLASS CASTING MATERIAL 3""",ED,A,450,99070,TC,,,,44.5,N,N
4203,"ORTHOGLASS CAST SPLINT MATERIAL 5""",ED,A,450,99070,TC,,,,42.5,N,N
4204,"ORTHOGLASS SPLINT/CAST MATEIRAL 6""",ED,A,451,99070,TC,,,,40.5,N,N
4205,CASTING SPLINTING APPLICATION,ED,A,450,29280,,26,,,385,N,N
4206,TDAP INJECTION,RX,A,252,90715,,,,,85,N,N
433,CATH TRAY WITHOUT CATHETHER,CS,A,272,A4310,,,,,7,N,N
439,NEO/POLY/DEXA OPTH OINTMENT,RX,A,251,J8499,,,,,34,N,N
44,SIROLIMUS LEVEL (RAPAMYCIN),LAB,A,301,80195,90,,,,490,N,N
441,FLOVENT INH,RX,A,252,J8499,,,,,204,N,N
442,CARVEDILOL 3.125MG,RX,A,252,J8499,,,,,10,N,N
445,BED PAN DISPOSABLE,CS,A,271,,,,,,18,N,N
45,SODIUM CHLORIDE 1 GRAM 0.4MG,RX,A,251,J8499,,,,,18,N,N
46,KETAMINE 50MG 1CC INJECTABLE,RX,A,251,J3490,,,,,63,N,N
461,LIDOCAINE 2% WITH EPINEPHRINE,RX,A,252,J2001,,,,,32,N,N
462,LIDOCAINE 1% WITH EPINEPHRINE,RX,A,252,J2001,,,,,32,N,N
463,KENALOG 40MG INJECTION,RX,A,252,J3301,,,,,31,N,N
47,ATROPINE 0.4MG VIAL,RX,A,251,J0461,,,,,5,N,N
48,ATROPINE 1MG/10ML IV,RX,A,251,J0461,,,,,53,N,N
481,AUGMENTIN 875MG,RX,A,252,J8499,,,,,19,N,N
4848,TRAUMA TEAM ACTIVATION (75MIN),ED,A,684,99291,,,,,586,N,N
48481,TRAUMA ACTIVATION LEVEL IV,ED,A,684,G0390,,,,,586,N,N
4849,TRAUMA TEAM ACTIV (75 MIN & UP,ED,A,684,99292,,,,,398,N,N
4850,TRAUMA TEAM ACTIVATION,ED,A,684,G0390,,,,,611,N,N
49,THORACENTESIS,TR,A,760,32554,,,,,250,N,N
493,DIAZEPAM 10MG AMP,RX,A,251,J3360,,,,,6,N,N
495,PRILOSEC 20MG CAP,RX,A,252,J8499,SH,,,,37,N,N
497,MEXILETINE HCL 222,RX,A,251,J8499,,,,,34,N,N
499,INTUBATING STYLET,CS,A,272,A4212,,,,,36,N,N
50,TUSSIONEX 10MG/5CC,RX,A,251,J8499,,,,,18,N,N
5001,COMP. ABD REALTIME B SCAN,RAD,I,402,76700,,,,,420,N,N
5003,LIM F/U ABD REALTIME B SCAN,RAD,I,402,76705,,,,,296,N,N
5004,ROBITUSSIN SYRUP 5CC,RX,A,251,J8499,SH,,,,13,N,N
5005,COMP. RETROPERITONEAL RT-B SCA,RAD,I,402,76770,,,,,386,N,N
5007,LIM. RETROPERITONEAL RT-B SCAN,RAD,I,402,76775,,,,,264,N,N
5008,TYLENOL ELIXIR 320MG/10ML 4OZ,RX,A,257,J8499,SH,,,,10,N,N
5009,PELVIC REALTIME B SCAN,RAD,I,402,76856,,,,,219,N,N
501,CKMB RAPID,LAB,I,301,82553,,,,,121,N,N
5011,VISCOUS XYLOCAINE 1%,RX,A,251,J8499,SH,,,,15,N,N
50111,CKMB RAPID REPEAT,LAB,I,301,82553,91,,,,121,N,N
5012,ADENOCARD 6MG/ML VIAL,RX,A,252,J3490,,,,,217,N,N
5013,LIM. F/U PELVIC RT-B SCAN,RAD,I,402,76857,,,,,219,N,N
5014,AMINOPHYLLIN 500MG/20ML VIAL,RX,A,251,J0280,,,,,96,N,N
5016,ANCEF/KEFZOL 1 GRAM VIAL,RX,I,251,J0690,,,,,38,N,N
5017,PELVIC TRANSVAG,RAD,I,402,76830,,,,,219,N,N
5019,ATIVAN 1MG PO,RX,A,251,J8499,,,,,17,N,Y
502,MYOGLOBIN,LAB,A,301,83874,,,,,105,N,N
5020,AQUAMEPHYTON (VIT K) 10MG AMP,RX,A,252,,,,,,13,N,N
50211,MYOGLOBIN REPEAT,ED,A,301,83874,91,90,,,105,N,N
5022,CAPTOPRIL 25MG CAP,RX,A,251,J8499,,,,,6,N,N
5023,IV INFUSION UP TO 8 HR,OBS,A,260,96361,,,,,72,N,N
5024,ATROPINE 0.1MG/ML 5ML SYRINGE,RX,A,252,J0461,,,,,52,N,N
5025,IBUPROFEN 800MG TAB,RX,A,251,J8499,,,,,13,N,N
5026,IV INFUSION UP TO 8 HR,ED,A,260,96361,,,,,36,N,N
5029,FLAGYL 500MG IV,RX,A,252,S0030,,,,,84,N,N
503,TNI,LAB,A,301,84512,,,,,105,N,N
5030,BENTYL 10MG/ML 2ML VIAL,RX,A,252,J0500,,,,,83,N,N
5031,BICILLIN/PENICILLIN 1CC 1.2MU,RX,I,252,J0561,,,,,92,N,N
50311,TNI (TROPONIN) REPEAT,ED,A,301,84512,,,,,105,N,N
5033,ZOFRAN 1 MG INJ,RX,A,251,J2405,,,,,51,N,N
5034,BUMEX 1MG/4ML VIAL,RX,A,251,S0171,,,,,13,N,N
5035,MOTRIN 200MG TAB,RX,A,257,J8499,,,,,7,N,N
50351,ZOFRAN,RX,A,252,,,,,,40,N,Y
5036,CALCIUM CHLORIDE LGM/10CC SYR,RX,A,251,J3490,,,,,52,N,N
5037,CEPHALEXIN 250MG CAP,RX,A,251,J8499,,,,,8,N,N
5038,CALCIUM GLUCONATE 10% 10CC VIA,RX,A,252,J0610,,,,,32,N,N
5039,CAPOTEN 12.5 MG PO,RX,A,251,J8499,,,,,4,N,N
5041,GUAFENESIN SYRUP 5CC,RX,A,257,J8499,,,,,8,N,N
5042,GENTAMICIN OPHTH,RX,A,251,J8499,,,,,52,N,N
5043,COLLODION FLEXIBLE 4OZ TOPICAL,RX,A,252,G0168,,,,,36,N,N
5044,ADMIN OF ANITIBIOTIC INJECTION,OBS,A,940,96372,,,,,96,N,N
5045,IV PUSH OF DRUG INITIAL,OBS,A,940,96374,,,,,96,N,N
50451,IV PUSH DRUG (EA ADD) SAME,OBS,A,940,96376,,,,,96,N,N
50452,IV PUSH DRUG EA ADD (DIFFERENT,OBS,A,940,96375,,,,,96,N,N
5046,HYDROCODONE/APAP/5/500,RX,A,251,J8499,,,,,10,N,N
5047,HYOSCAMINE .125MG TAB,RX,A,251,J8499,,,,,8,N,N
5048,DEXAMETHASONE 1MG/ML VIAL,RX,A,251,J1100,,,,,36,N,N
5049,ADMIN OF THERAP/PROP INJ,OBS,A,940,96372,,,,,96,N,N
505,MAXITROL EYE DROPS,RX,A,251,J8499,,,,,18,N,N
5050,DEPO MEDROL 40MG/ML VIAL,RX,A,252,J1030,,,,,75,N,N
5051,ALBUTEROL MDI,RX,A,251,J8499,,,,,128,N,N
5052,DEXTROSE 50% 50ML VIAL,RX,A,252,J3490,,,,,59,N,N
5053,PROPOXYPHENE NAPSYLATE,RX,A,252,J2720,,,,,85,N,N
5054,ATIVAN 2MG INJECTION,RX,A,252,J2060,,,,,66,N,N
5055,PHEYTOIN 100MG AMP,RX,A,251,J1165,,,,,42,N,N
5056,HYDROXYZINE HCL 50MG VIAL,RX,A,251,J3410,,,,,25,N,N
5057,IV INFUSION (1XD),RX,A,260,Q0081,,,,,267,N,N
5058,DOBUTREX 250MG 20ML VIAL,RX,A,252,J1250,,,,,228,N,N
5059,ACETAMINOPHEN WITH CODIENE #3T,RX,A,251,J8499,,,,,13,N,N
5060,DOPAMINE 400MG VIAL,RX,A,252,J1265,,,,,78,N,N
5061,PHENOBARB 130MG VIAL,RX,I,251,J2560,,,,,12,N,N
5062,IBUPROFEN 200MG,RX,A,257,J8499,,,,,6,N,N
5063,ERYPED 200MG/5ML SUSP,RX,A,251,J8499,,,,,10,N,N
5064,IV INFUSION 1ST HR 4.",CL,A,523,11426,,,,,269,N,Y
9988,"EXC BEN LES,FC,ER,EY,NS,LP,0.5",CL,A,523,11440,,,,,93,N,Y
9989,"EXC BEN LES,FC,ER,EY,NS,LP 1.0",CL,A,523,11441,,,,,117,N,Y
999,TIGAN 100MG CAPS,RX,A,252,J8499,SH,,,,10,N,N
9990,"EXC BEN LES, FC,ER,EY,NS,LP 2.",CL,A,523,11442,,,,,158,N,Y
9991,"EXC BEN LES,FC,ER,EY,NS,LP 3.0",CL,A,523,11443,,,,,199,N,Y
9992,"EXC BEN LES,FC,ER,EY,NS,LP 4.0",CL,A,523,11444,,,,,228,N,Y
9993,"EXC BEN LES,FC,ER,EY,NS,LP>4.0",CL,A,523,11446,,,,,293,N,Y
9994,"EXC MAL LES,TR,AR,LG, UP 2 0,5",CL,A,523,11600,,,,,176,N,Y
9995,"EXC MAL LES,TR,AR,LG 0.6-1.0",CL,A,523,11601,,,,,228,N,Y
9996,"EXC MAL LES, TR,AR,LG 1.1-2.0",CL,A,523,11602,,,,,216,N,Y
9997,"EXC MAL LES, TR,AR,LG 2.1-3.0",CL,A,523,11603,,,,,263,N,Y
9998,"EXC MAL LES TR,AR,LG 3.1-4.0",CL,A,523,11604,,,,,293,N,Y
9999,"EXC MAL LES TR,AR,LG >4.0",CL,A,523,11606,,,,,467,N,Y
99999,BALANCE FORWARD,CL,A,523,,,,,,0,N,Y
CONVBAL,CONVERSION BALANCE,ADM,A,999,,,,,,0,N,N
EMTALA,EMTALA SCREENING,ED,A,450,,,,,,0,N,N
G0008,ADMIN FEE FLU VACCINE,RX,A,771,G0008,,,,,31,N,N
G0009,ADMIN FEE PNEUMONIA VACCINE,RX,A,771,G0009,,,,,31,N,N
G10659A,BIOPSY 2ND LES EA ADDIT,CL,A,523,11101,,,,,41,N,Y
G17003,DEST BEN LES 2-14 EACH ADD,CL,A,523,17003,,,,,61,N,Y
G22999,VASOTEC 1.5MG IV,RX,A,252,J3490,,,,,34,N,N
G82784,SERUM IMMUNOGLOBULIN,LAB,A,302,82784,90,,,,113,N,N
GJ0024,CIPRO PER 200MG IV,RX,A,252,J0744,,,,,72,N,N
GJ0280,AMINOPHYLLINE 250MG,RX,A,251,J0280,,,,,52,N,N
GJ0696,ROCEPHIN 250MG VIAL,RX,A,252,J0696,,,,,74,N,N
GJ0744,CIPRO 200MG IV,RX,A,252,J0744,,,,,145,N,N
GJ1100,DEXAMETHASONE 1MG/ML IM/IV,RX,A,251,J1100,,,,,36,N,N
GJ1165,PHEYTON 50MG AMP IV/IM,RX,A,251,J1165,,,,,36,N,N
GJ1590,TEQUIN 200MG IV,RX,A,252,J1590,,,,,149,N,N
GJ1644,HEPARIN PER 1000 UNITS,RX,A,251,J1644,,,,,13,N,N
GJ1650,LOVENOX 80MG INJ,RX,I,252,J1650,,,,,34,N,N
GJ1720,SOLU COFTEF UP TO 50MG IV/IM,RX,A,250,J1720,,,,,248,N,N
GJ1885,TORADOL UP TO 15MG TUBEX,RX,A,252,J1885,,,,,64,N,N
GJ1940,FUROSEMIDE UP TO 20MG VIAL,RX,A,251,J1940,,,,,72,N,N
GJ2000,LIDOCAINE UP TO 50CC,RX,A,252,J2001,,,,,13,N,N
GJ2001,LIDOCAINE UP TO 50CC,RX,I,252,J2001,,,,,13,N,N
GJ2020,ZYVOX 200MG,RX,A,252,J2020,,,,,190,N,N
GJ2250,VERSED PER 1MG,RX,A,252,J2250,,,,,36,N,N
GJ2297,ACTIVASE 1MG IV/IM,RX,A,252,J2997,,,,,90,N,N
GJ2300,INJ NUBAIN 20MG,CL,A,523,J2300,,,,,61,N,Y
GJ2560,PHENOBARB 120MG IM/IV,RX,A,251,J2560,,,,,61,N,N
GJ2780,ZANTAC PER 25MG VIAL,RX,A,252,J2780,,,,,27,N,N
GJ2912,NACL 3CC 0.9% IM/IV,RX,A,251,A4216,,,,,18,N,N
GJ3360,VALIUM 5MG VIAL IM/IV,RX,I,251,J3360,,,,,38,N,N
GJ3410,VISTARIL 25 MG IM/IV,RX,A,251,J3410,,,,,64,N,N
GJ3430,AQUAMEPHYTON 1MG,RX,A,252,J3430,,,,,13,N,N
GJ3475,MAGNESIUM SULFATE 500 MG,RX,A,252,J3475,,,,,25,N,N
GJ3480,KCL PER 2MEQ VIAL,RX,A,252,J3480,,,,,7,N,N
GJ7044,CIPRO 200MG IV,RX,A,252,J0744,,,,,145,N,N
GJ7603,ALBUTEROL 1MG INH SOL,RX,A,252,J7609,,,,,12,N,N
GJO280,AMINOPHYLLINE 250MG,RX,A,251,J0280,,,,,61,N,N
J0696,ROCEPHIN 1 GRAM,CL,A,523,J0696,,,,,101,N,Y
J0713,FORTAZ 500MG IV,RX,A,252,J0713,,,,,96,N,N
J0885,"PR0CRIT 40,000 UNITS IV/SC",RX,I,636,J0885,EC,,,,1953,N,N
J1165,DILANTIN 50MG AMPULE,RX,A,252,J1165,,,,,31,N,N
J1170,DILAUDID 2MG VIAL,RX,A,252,J1170,,,,,63,N,N
J1185,INJ TORADOL 15MG,CL,A,523,J1885,,,,,39,N,Y
J1335,INVANZ 500MG IV VIAL,RX,A,251,J1335,,,,,270,N,N
J1750,IRON DEXTAN 50MG INJECTABLE,RX,A,252,J1750,,,,,111,N,N
J1751,DEXTRAN IRON INJECT,RX,I,251,J1750,,,,,199,N,N
J1815,INSULIN 5 UNITS,RX,A,252,J1815,,,,,27,N,N
,,RX,A,252,J1815,,,,,27,N,N
J2001,LIDOCAINE 1%,RX,I,251,J2001,,,,,15,N,N
J2045,ZOFRAN 1MG IV,RX,A,252,J2405,,,,,13,N,N
J2300,NUBAIN 10MG INJECT,RX,A,252,J2300,,,,,71,N,N
J2405,ZOFRAN 1MG IV,RX,A,252,J2405,,,,,13,N,N
J3490,VASOTEC 1.5MG IV,RX,A,252,J3490,,,,,34,N,N
J7611,ALBUTEROL SOL 1MG INH,RX,A,252,J7611,,,,,7,N,N
J7613,ALBUTEROL INH 2.6MG,RX,A,252,J7613,,,,,31,N,N
J7620,ALBUTEROL 2.6 ML,RX,A,252,J7620,,,,,21,N,N
J7644,ATROVENT UD .5MG VIAL,RX,A,252,J7644,,,,,7,N,N
Q0136,PROCRIT 1000UNITS IV/SC,RX,I,252,J0885,,,,,54,N,N
Q9950,OPTIRAY 320MG/ML,RAD,A,252,Q9967,,,,,127,N,N
S0020,MARCAINE 25CC .25% VIAL IM/IV,RX,A,252,S0020,,,,,24,N,N
S0077,CLEOCIN 300 MG IV,RX,A,252,S0077,,,,,28,N,N
Number of Charge Code Printed:,2215,,,,,,,,,,,
Charge Code:,All Charge Codes,,,,,,,,,,,
Departments:,All Departments,,,,,,,,,,,
UB Revenue Codes:,All UB Revenue Codes,,,,,,,,,,,
Procedure Codes:,All Procedure Codes,,,,,,,,,,,
Service Codes:,All Service Codes,,,,,,,,,,,
Inventory Item Numbers:,All Inventory Item Numbers,,,,,,,,,,,
Statistic Account Numbers:,All Statistics Account Numbers,,,,,,,,,,,
Taxable:,All,,,,,,,,,,,
Active:,All,,,,,,,,,,,
Report Order:,ChargeCode,,,,,,,,,,,
Price As Of :,01/01/19,,,,,,,,,,,