Price Transparency Matrix
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| Pathway Rehab | ||
| Price Transparency Matrix | ||
| As of 12/31/2020 | ||
| Â | ||
| Pathway receives reimbursement via negotiated contracts with third party payors. The following represents those negotiated rates. Some of these are government mandated. | ||
| Â | ||
| Payor | Fee basis | Additional Information |
| Medicare | Medicare fee schedule | Highest reimbursement |
| Medicaid | $704 per diem | Lowest Reimbursement |
| Blue Cross | $826 per diem | Â |
| United Healthcare | $900 Per diem | Â |
| Workers Compensation (La) | La Worker’s comp fee schedule | Â |
| Cash | Same as Medicare | Â |
| Vantage | Same as Medicare | Â |
| Tri-Care | Tri-Care fee schedule | Â |
| Â | Â | Â |
| Â | Â | Â |
| * Gross Charges can be found on the charge tab on this website. | ||
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| Coursecode | Name | Unit Price |
| 41051107 | 15 ML ADAPTER | $6.00 |
| 27033007 | 16 FR CATH COUDE TIP | $23.57 |
| 27033009 | 18 FR 30CC FOLEY CATH | $38.80 |
| 26031005 | 22G IV NEEDLE | $8.31 |
| 26031006 | 24G IV NEEDLE | $8.31 |
| 27033019 | 4X4 GAUZE 10 PACK | $6.00 |
| 27011067 | ABD BINDER 12 INCH | $64.00 |
| 32045007 | ABDOMINAL SERIES | $132.50 |
| 30040011 | ABG | $109.55 |
| 25005002 | ABILIFY TAB 10MG U/D | $80.00 |
| 25091527 | ABREVA COLD SORE CREAM | $53.24 |
| 25090795 | ACCOLATE 20MG | $36.00 |
| 25090931 | ACCUPRIL 2.5MG | $4.00 |
| 27033025 | ACE 2″ | $8.00 |
| 25005005 | ACETAMINOPHEN 325 MG | $1.00 |
| 25005006 | ACETAMINOPHEN 500 MG TABL | $1.00 |
| 25091075 | ACETAZOLAMIDE 250MG TAB | $12.99 |
| 25091446 | ACETYLCYSTEINE 20% VIAL | $2.60 |
| 25005009 | ACTOS 30mg | $40.00 |
| 25005012 | ACYCLOVIR TAB 400MG | $4.00 |
| 25005014 | ADALAT 60mg TAB | $4.00 |
| 27033031 | ADAPTIC 3X3 | $2.00 |
| 25090293 | ADCIRCA 20MG TAB | $193.64 |
| 25090796 | ADVAIR 250-50 DISKUS | $564.40 |
| 25091151 | ADVAIR 500-50 DISK INH 60 | $1,200.00 |
| 25005123 | ADVAIR DSKS 100/50MG INH | $396.00 |
| 41051105 | AEROSAL FACE MASK | $2.00 |
| 25005019 | AGGRENOX CAP 200MG/25MG | $16.00 |
| 25090041 | ALBUMIN 25% 50 ML | $181.00 |
| 25005023 | ALBUTEROL 0.083% PER VIAL INHA | $2.44 |
| 25005026 | ALDACTONE 100mg | $4.26 |
| 25005120 | ALDACTONE 25 MG | $4.00 |
| 25090076 | ALENDRONATE SODIUM 70MG | $16.20 |
| 25091216 | ALFUZOSIN ER 10MG TAB | $4.68 |
| 25019606 | ALLERGY RELIEF 180MG TAB | $1.45 |
| 27033042 | ALLEVYN 7X7 | $66.44 |
| 25005033 | ALLOPURINOL 100MG TAB | $2.95 |
| 25005108 | ALLOPURINOL 300MG TAB | $4.48 |
| 25091180 | ALOGLIPTIN 12.5MG TAB | $35.68 |
| 25091414 | ALPHAGAN P 0.1% EYE DROPS | $325.00 |
| 25005125 | ALPRAZOLAM 0.25MG | $2.00 |
| 25005036 | ALPRAZOLAM TAB .5 MG | $4.00 |
| 25005041 | AMANTADINE CAP 100MG | $8.00 |
| 25005042 | AMARYL 2mg TAB | $4.00 |
| 25005045 | AMBIEN 5mg | $24.00 |
| 25091592 | AMILORIDE HCL 5MG | $3.08 |
| 25005048 | AMIODARONE HCL TAB 200MG | $8.00 |
| 25091207 | AMITRIPTYLINE 75MG TAB | $6.00 |
| 25005052 | AMITRIPTYLINE HCL 50MG TAB | $4.60 |
| 25005051 | AMITRIPTYLINE TAB 25MG U | $2.00 |
| 25005054 | AMLODIPINE BESYLATE 10MG TAB | $1.64 |
| 25091124 | AMLODIPINE BESYLATE 2.5MG | $1.00 |
| 25005061 | AMLODIPINE BESYLATE 5MG TAB | $1.72 |
| 30040036 | AMMONIA LEVEL | $122.10 |
| 30040482 | AMMONIA PLASMA ARUP | $90.16 |
| 25091536 | AMOX TR-CLV 875-125 MG TAB | $8.96 |
| 25091472 | AMOX TR-K CLV 500-125MG TAB | $8.84 |
| 25005057 | AMOXICILLIN CAP 500MG UD | $2.00 |
| 25090027 | AMPICILLIN 500MG | $3.00 |
| 25090231 | ANASTROZOLE 1MG | $24.00 |
| 25091588 | ANDROGEL 1.62 GEL PUMP | $1,662.00 |
| 27033519 | ANGIOCATH 20GA X 1-1/4″ CATH I | $10.50 |
| 32045009 | ANKLE 2 VIEWS | $440.00 |
| 32045010 | ANKLE COMPLETE 3 VIEWS | $552.00 |
| 25091499 | ANORA ELLIPTA 62.5 MCG | $846.00 |
| 25005067 | ANTIVERT 12.5 MG | $4.00 |
| 44016026 | APHASIA TREATMENT | $100.00 |
| 25091511 | APIDRA SOLOSTAR 1 UNIT | $1.00 |
| 25091115 | APIXABAN 5MG TAB | $24.40 |
| 25091591 | APTIOM 800 MG | $130.12 |
| 25090230 | ARANESP 60 MCG | $1,564.00 |
| 25090745 | ARICEPT 5MG | $38.00 |
| 25005074 | ARICEPT TAB 10MG U/D | $48.00 |
| 30040051 | ARTERIAL PUNCTURE | $4.00 |
| 25005079 | ASPIRIN TAB EC 325 MG | $5.04 |
| 25005079 | ASPIRIN TAB EC 325 MG | $1.00 |
| 25005078 | ASPIRIN TAB EC 81 MG | $5.04 |
| 25005078 | ASPIRIN TAB EC 81 MG | $1.00 |
| 25019623 | ASPIRIN-DIPYRIDAM ER 1 CAP | $10.00 |
| 25091140 | ASPIRIN-DIPYRIDAM ER 25-2 CAP | $12.00 |
| 25005081 | ATACAND 16mg | $12.00 |
| 25005119 | ATENOLOL 100MG | $4.00 |
| 25005083 | ATENOLOL TAB 25MG | $2.00 |
| 25005084 | ATENOLOL TAB 50MG | $2.00 |
| 25005085 | ATIVAN .5MG | $4.00 |
| 25005086 | ATIVAN 1mg INJ | $15.00 |
| 25005088 | ATIVAN TAB 1mg | $4.00 |
| 25091058 | ATORVASTATIN 10 MG | $3.50 |
| 25091262 | ATORVASTATIN 20MG TAB | $4.24 |
| 25091054 | ATORVASTATIN 40 MG TAB | $4.32 |
| 25091363 | ATORVASTATIN 80MG TAB | $4.24 |
| 25005098 | AVAPRO TAB 150MG | $12.00 |
| 25005100 | AVODART CAP 0.5MG | $18.00 |
| 25090104 | AZATHIOPRINE 50MG | $3.00 |
| 25090010 | AZELASTINE 137MCG NASAL SPRAY | $235.40 |
| 25005101 | AZITHROMYCIN TAB 250 MG 3 | $14.00 |
| 25005102 | AZITHROMYCIN TRI-PK 500MG | $26.00 |
| 25005103 | AZITHROMYCIN Z-PAC 250MGX | $23.33 |
| 25005105 | AZULFIDINE 500 MG | $2.00 |
| 25006012 | B-COMPLEX / VIT. C | $1.75 |
| 25006005 | BACITRACIN-NEO-POLY 1/32 | $4.00 |
| 25006007 | BACLOFEN 10MG TAB | $3.52 |
| 25006006 | BACLOFEN 20mg | $7.04 |
| 25090330 | BACLOFEN 5MG | $1.76 |
| 41051010 | BACTERIAL FILTER | $9.00 |
| 25006008 | BACTRIM DS TAB | $8.00 |
| 27033061 | BANDAID (ANY SIZE) | $1.00 |
| 25091365 | BANOPHEN 25MG CAP | $1.00 |
| 32045014 | BARIUM SWALLOW | $1,280.79 |
| 25091049 | BENADRYL CREAM 30GM TUBE | $19.52 |
| 25006015 | BENADRYL TAB 25MG | $4.00 |
| 25091122 | BENAZEPRIL 40MG | $3.08 |
| 25006047 | BENICAR 10MG | $12.00 |
| 25006017 | BENICAR TAB 20MG | $14.00 |
| 25091351 | BENZONATATE 200MG CAP | $2.48 |
| 25006021 | BENZONATATE CAP 100 MG | $2.37 |
| 25091422 | BENZTROPINE MES 1MG TAB | $4.00 |
| 25006024 | BETADINE SOL 16 OZ HSP | $2.00 |
| 27033071 | BETADINE SWAB (EACH) | $1.26 |
| 25090281 | BETAMETHASONE AC-SP 6MG/ML DOS | $38.67 |
| 27033532 | BIOPATCH | $37.00 |
| 25091396 | BIOTIN 5,000MCG CAP | $5.64 |
| 41051012 | BIPAP O2 TUBING | $135.00 |
| 25006030 | BISACODYL 5 MG TABLET | $1.00 |
| 25006031 | BISACODYL EVAC 10MG SUPP | $5.72 |
| 27033084 | BLOOD COLLECTION SET BUTTERFLY | $3.00 |
| 30040067 | BLOOD CULTURE | $117.75 |
| 38400001 | BLOOD PLATELETS | $1,400.00 |
| 30040072 | BMP (BASIC METAB/CHEM8) | $20.40 |
| 30040073 | BNP (B NATRIURATIC PEP.) | $500.00 |
| 25006033 | BOOST 8OZ | $6.00 |
| 25091255 | BREO ELLIPTA 100/25 MCG INH | $727.72 |
| 25091345 | BREO ELLIPTA 200-25 MCG INHALE | $727.72 |
| 25090993 | BRILINTA 90 MG | $25.43 |
| 25090993 | BRILINTA 90 MG | $58.16 |
| 25006035 | BRIMONIDINE0.2% EYE DROP 5ML B | $102.88 |
| 25006037 | BROVANA 15MCG/2ML | $25.96 |
| 27033079 | BSNZOIN SWABSTICK | $1.35 |
| 25091390 | BUDESONIDE 0.5MG/2ML VIAL SUSP | $23.96 |
| 25091178 | BUMETANIDE 0.5MG TAB | $5.24 |
| 25090255 | BUMETANIDE 1MG TAB | $6.08 |
| 25091584 | BUMETANIDE 2.5MG/10ML | $4.00 |
| 25006039 | BUMETANIDE 2mg | $4.00 |
| 25090849 | BUMEX 0.5MG | $1.00 |
| 25090254 | BUMEX 1MG TAB | $2.00 |
| 25006040 | BUMEX 2MG TAB | $4.00 |
| 25091232 | BUPROPION HCL 75MG TAB | $3.72 |
| 25006041 | BUPROPION HCL SR TAB 150M | $4.00 |
| 25006042 | BUPROPION HCL TAB 100MG | $4.00 |
| 25091523 | BUPROPION HCL XL 150MG TAB | $8.00 |
| 25091280 | BUPROPION HCL XL 300MG TAB | $9.40 |
| 25006043 | BUSPAR 10mg | $4.00 |
| 25090257 | BUSPIRONE 10MG | $4.00 |
| 25006044 | BUSPIRONE 15MG TAB | $4.00 |
| 25090256 | BUSPIRONE 5MG | $2.00 |
| 25091213 | BUSPIRONE 7.5MG TAB | $3.12 |
| 25090775 | BYETTA 5MCG 1 VIAL | $749.57 |
| 25006050 | BYSTOLIC 10MG | $9.00 |
| 25091530 | BYSTOLIC 5 MG TABLET | $8.00 |
| 30040125 | C-REACTIVE PROTEIN CARDIAC | $78.00 |
| 30040483 | C-REACTIVE PROTEIN INFLAMMATOR | $78.00 |
| 30040075 | C.DIFF TOXIN,EIA,STOOL | $118.80 |
| 25091088 | CALCARB 600MG TAB | $1.00 |
| 25091243 | CALCITONIN-SALMON 200UNI SPRAY | $315.00 |
| 25090222 | CALCITRIOL 0.25 MCG | $12.00 |
| 25090973 | CALCITRIOL 0.5 MCG CAP | $17.00 |
| 25091535 | CALCIUM 500-VIT D3 400 | $1.00 |
| 25091493 | CALCIUM 600+ VIT D TAB | $5.28 |
| 25091175 | CALCIUM 600+VIT D 400 TAB | $1.00 |
| 25090044 | CALCIUM 600MG | $1.00 |
| 25091410 | CALCIUM ACETATE 667MG CAP | $3.40 |
| 25091265 | CALCIUM ANTACID 500 MG CHW | $5.08 |
| 25040077 | CALCIUM CARB 500 | $17.00 |
| 25090804 | CALCIUM CARB-VIT D 600/200 | $24.00 |
| 25091333 | CALCIUM CARBONATE 650MG TAB | $1.00 |
| 25019621 | CALCIUM CITRATE W/VIT D | $5.16 |
| 25091505 | CALTRATE +D CHEWABLE | $5.40 |
| 25091477 | CALTRATE 600+D TAB | $5.44 |
| 25091110 | CANDESARTAN CILEXETIL 16MG TAB | $17.12 |
| 25007004 | CAPOTEN 12.5mg | $4.00 |
| 25007005 | CAPTOPRIL 25mg | $2.50 |
| 25007007 | CARAFATE 1GM | $18.27 |
| 25091318 | CARAFATE 1GM/ 10ML SUSP | $2.08 |
| 25007010 | CARBAMAZEPINE TAB 200MG U | $2.00 |
| 25007012 | CARBIDOPA/LEVOD 25/100 TAB | $2.04 |
| 25007014 | CARBIDOPA/LEVODOPA 25/250 | $4.00 |
| 25007013 | CARBIDOPA/LEVODOPA 50/200 | $7.92 |
| 30040084 | CARDIAC ENZYMES | $62.00 |
| 25007016 | CARDIZEM CD 180mg | $17.28 |
| 25091489 | CARISOPRODOL 350MG TAB | $1.40 |
| 25007138 | CARVEDILOL 3.125MG | $1.00 |
| 25090259 | CARVEDILOL 12.5MG | $1.35 |
| 25007023 | CARVEDILOL TAB 6.25 MG | $1.00 |
| 25007024 | CARVEDILOL TAB 25 MG | $4.00 |
| 27033100 | CATHETER CARE KIT | $3.75 |
| 27033101 | CATHETER KIT MALE | $9.50 |
| 27033105 | CATHETER, SILICONE FOLEY | $25.00 |
| 30040092 | CBC, PLT. W/AUTO DIFF | $11.85 |
| 25091150 | CEFDINIR 300MG CAP | $5.59 |
| 25091287 | CEFPODOXIME 100MG TAB | $30.60 |
| 25091203 | CEFPROZIL 250MG TAB | $10.16 |
| 25007121 | CEFTIN 250MG TAB | $6.50 |
| 25007031 | CEFTRIAXONE 1GM IV | $90.00 |
| 25090288 | CEFTRIAXONE 2GM IV | $98.56 |
| 25091253 | CEFUROXIME AXETIL 250MG TAB | $10.16 |
| 25007033 | CELEBREX 200mg | $20.00 |
| 25091145 | CELECOXIB 100MG CAP | $22.00 |
| 25091195 | CELECOXIB 200MG CAP | $33.16 |
| 25091539 | CELESTONE 100MG/1ML | $25.52 |
| 25007035 | CELEXA 10MG | $16.00 |
| 25007036 | CELEXA 20mg | $16.00 |
| 25007037 | CENTRUM SILVER TABS 100’S | $2.00 |
| 25007040 | CEPHALEXIN CAP 500MG | $4.00 |
| 25091442 | CEROVITE SENIOR TAB | $5.28 |
| 25007043 | CERTA-VITE SR W/LUTEIN TA | $0.48 |
| 25091557 | CETIRIZINE HCL 5MG TAB | $2.16 |
| 25007044 | CETIRIZINE HCL TAB 10MG | $12.00 |
| 32045029 | CHEST 1-VIEW | $517.50 |
| 25007046 | CHLORASEPTIC LIQ 6OZ CHR | $1.00 |
| 25091236 | CHLORDIAZEPOXIDE 10MG CAP | $1.00 |
| 25091441 | CHLORDIAZEPOXIDE 25MG CAP | $1.00 |
| 25091570 | CHLORHEXIDINE 0.12% RINSE | $50.00 |
| 250915889 | CIALIS 5MG TAB | $49.32 |
| 25007054 | CILOSTAZOL 100 MG TABLET | $4.00 |
| 25007056 | CIPROFLOXACIN 500MG | $10.00 |
| 25090306 | CIPROFLOXACIN 750MG | $48.00 |
| 25091252 | CIPROFLOXACIN HCL 250 MG TAB | $3.36 |
| 25007057 | CITALOPRAM 10MG TAB | $1.00 |
| 25091320 | CITALOPRAM HBR 40MG TAB | $1.72 |
| 25007058 | CITALOPRAM TAB 20MG | $1.50 |
| 25007124 | CITRACAL W/VITAMIN D | $2.19 |
| 25090961 | CITRUCEL | $2.08 |
| 30040106 | CK | $156.00 |
| 30040107 | CKMB | $180.00 |
| 25007125 | CLARITIN 10MG | $7.00 |
| 25007065 | CLINDAMYCIN 300mg | $7.14 |
| 25007066 | CLINDAMYCIN CAP 150MG | $3.57 |
| 25007071 | CLONAZEPAM ODT TAB .25MG | $2.00 |
| 25007072 | CLONAZEPAM TAB 0.5MG U/D | $2.39 |
| 25007073 | CLONAZEPAM TAB 1MG U/D | $2.72 |
| 25007074 | CLONAZEPAM TAB 2MG U/D | $3.72 |
| 25091047 | CLONIDIDNE 0.1MG PATCH | $133.72 |
| 25090303 | CLONIDINE 0.2MG PATCH | $152.00 |
| 25091299 | CLONIDINE 0.3 MG/DAY PATCH | $190.52 |
| 25007075 | CLONIDINE TAB .2 MG 100U | $1.38 |
| 25007076 | CLONIDINE TAB 0.1MG | $2.00 |
| 25007077 | CLONIDINE TAB 0.3MG U/D | $1.42 |
| 25090314 | CLOPIDOGREL 75MG TAB | $6.38 |
| 25007078 | CLOSTRIDIUM DIFF. | $85.00 |
| 30040109 | CLOSTRIDIUM DIFF. TOXIN | $85.00 |
| 25091537 | CLOTRIMAZOLE-BETAMETHASONE | $154.64 |
| 25007084 | CLOZAPINE TAB 100MG U/D | $10.28 |
| 30040113 | CMP (COMP METABOLIC/CHEM14) | $20.40 |
| 25090808 | CO-ENZYME Q10 100MG | $7.60 |
| 25090969 | COENZYME Q10 50 MG | $3.80 |
| 25007086 | COGENTIN 1 & 2mg | $1.00 |
| 25007088 | COLACE 100mg CAP | $3.00 |
| 25007090 | COLCHICINE TAB 0.6MG U/D | $1.00 |
| 25091133 | COMBIGAN EYE DROPS | $349.70 |
| 29136013 | COMPRESSION HOSE DAILY | $20.00 |
| 25007093 | COMTAN TAB 200MG | $9.10 |
| 27033530 | CONDOM CATHETER(MALE EXT MED) | $6.00 |
| 25091601 | CONSTULOSE 10GM/15ML SOL 473ML | $39.88 |
| 25007135 | COREG 12.5MG | $8.34 |
| 25007097 | COREG CR 40mg | $20.00 |
| 25019607 | CORLANOR 5MG TAB | $31.61 |
| 25091068 | COSOPT OPTH 22.3 6.8 MG BOTTLE | $156.00 |
| 25090001 | COUMADIN 2.5 PO | $3.25 |
| 25007104 | COUMADIN TAB 1MG | $3.11 |
| 25007105 | COUMADIN TAB 2MG | $3.25 |
| 25007106 | COUMADIN TAB 3MG | $3.37 |
| 25007107 | COUMADIN TAB 5MG | $3.49 |
| 25090225 | COUMADIN TAB 10MG | $7.00 |
| 25007128 | COUMADIN TAB 4MG | $3.00 |
| 25007103 | COUMADIN TAB 7.5MG | $4.00 |
| 25007108 | COZAAR 50mg | $14.00 |
| 25007109 | COZAAR TAB 25MG U/D | $5.84 |
| 25007110 | COZAAR TAB 100MG | $9.30 |
| 41051112 | CPAP BIPAP NASAL/PRONGS MASK | $426.00 |
| 25019626 | CREON DR 24000 UNIT CAP | $24.64 |
| 25090077 | CRESTOR 20MG TAB | $36.71 |
| 25007130 | CRESTOR 5MG TAB | $17.31 |
| 35048009 | CT SCAN BRAIN W/O CONTRAST | $975.00 |
| 35048011 | CT SCAN C-SPINE W/O CONTRAST | $3,000.00 |
| 35048006 | CT SCAN T-SPINE | $3,900.00 |
| 30040133 | CULTURE, ID | $48.30 |
| 30040134 | CULTURE, ROUTINE/NG | $36.00 |
| 25091156 | CYANOCOBALAMIN 1000MCG INJ 1 M | $41.80 |
| 25091181 | CYCLOBENZAPRINE 5MG TAB | $1.60 |
| 25007112 | CYCLOBENZAPRINE TAB 10MG | $2.91 |
| 25007116 | CYPROHEPTADINE TAB 4MG | $1.28 |
| 30040138 | D DIMER | $43.25 |
| 25090245 | DALIRESP 500 MCG | $34.00 |
| 25091425 | DEEP SEA 0.65% NOSE SPRAY BOTT | $12.56 |
| 25091274 | DEMECLOCYCLINE 300MG TAB | $63.88 |
| 25008008 | DEPAKOTE ER TAB 500MG UD | $9.95 |
| 25008009 | DEPAKOTE SPR CAP 125MG UD | $3.06 |
| 25090890 | DESENEX POWDER BOTTLE | $20.00 |
| 25008013 | DESMOPRESSIN TAB .1 MG 10 | $9.06 |
| 25019612 | DEXAMETHASONE 1MG TAB | $2.28 |
| 25091277 | DEXAMETHASONE 4MG TAB | $2.15 |
| 25090221 | DEXILANT 60MG | $44.00 |
| 25019616 | DEXTROAMP-AMPHET ER 20MG | $28.87 |
| 25008020 | DEXTROSE 50% 1AMP | $32.00 |
| 80100001 | DIALYSIS-INPATIENT | $1,200.00 |
| 25091548 | DIAZEPAM 2MG TAB | $1.16 |
| 25008021 | DIAZEPAM TAB 5MG | $2.00 |
| 25091553 | DICLOFENAC SODIUM 1% GEL | $256.36 |
| 25008022 | DICYCLOMINE CAP 10MG | $1.47 |
| 25090063 | DIFLUCAN 100MG | $16.00 |
| 25008025 | DIFLUCAN 150MG | $13.64 |
| 25008069 | DIFLUCAN IV 200MG/100MG | $110.40 |
| 25091554 | DIGITEK 125 MCG TAB | $6.84 |
| 25091503 | DIGITEK 250 MCG TAB | $7.75 |
| 25008026 | DIGOXIN 0.25mg | $9.33 |
| 25019608 | DIGOXIN 125MCG TAB | $6.71 |
| 30040143 | DIGOXIN LEVEL | $65.00 |
| 25008029 | DIGOXIN TAB 0.125MG U/D | $4.00 |
| 25008079 | DILANTIN 100MG | $2.00 |
| 30040144 | DILANTIN LEVEL | $60.00 |
| 25090101 | DILAUDID 2MG | $14.50 |
| 25090019 | DILAUDID 4MG | $18.00 |
| 25091485 | DILTIAZEM 120 MG TABLET | $0.94 |
| 25019617 | DILTIAZEM 1MG IVP | $8.70 |
| 25008033 | DILTIAZEM 24HR ER 240MG CAP | $10.92 |
| 25091174 | DILTIAZEM 30MG TAB | $1.28 |
| 25008037 | DILTIAZEM 60MG TAB | $7.56 |
| 25008032 | DILTIAZEM ER 120 MG CAPSU | $3.08 |
| 25008035 | DILTIAZEM ER 180MG | $4.00 |
| 25008072 | DILTIAZEM ER 360MG | $10.89 |
| 25008039 | DIOVAN 160mg | $24.16 |
| 25008042 | DIPHENHYDRAMINE 25MG CAP | $0.43 |
| 25008043 | DIPHENHYDRAMINE CAP 50MG | $0.87 |
| 25090905 | DITROPAN 10MG | $8.00 |
| 25008070 | DITROPAN 5MG | $4.00 |
| 25091504 | DIVALPROEX DR 500MG TAB | $2.67 |
| 25008051 | DIVALPROEX ER 500MG TAB | $8.92 |
| 25091508 | DIVALPROEX SOD ER 250 MG TAB | $11.16 |
| 25008052 | DIVALPROEX SPRNKL CAP 125 | $2.13 |
| 25091482 | DOC-Q-LACE 100MG SOFTGEL | $5.20 |
| 25090065 | DOCUSATE CALCIUM 240MG | $2.00 |
| 25008053 | DOCUSATE SOD 100MG 100UD | $1.00 |
| 25090308 | DONEPEZIL 10MG TAB | $2.14 |
| 25091184 | DONEPEZIL HCL 23MG TAB | $11.08 |
| 25090831 | DONEPEZIL HCL 5MG TAB | $3.56 |
| 32045037 | DOPPLER OF LOWER EXTREMITY | $1,500.00 |
| 32045038 | DOPPLER OF UPPER EXTREMITY | $1,941.00 |
| 25091392 | DORZOLAMIDE HCL 2% EYE DROPS | $209.28 |
| 25091387 | DORZOLAMIDE-TIMOLOL EYE DROPS | $289.08 |
| 25090324 | DOXAZOSIN 8MG | $10.00 |
| 25091267 | DOXAZOSIN MESYLATE 4MG TAB | $5.88 |
| 25008055 | DOXAZOSIN MESYLATE TB 2MG | $2.77 |
| 25008056 | DOXEPIN 10MG CAP | $1.00 |
| 25008057 | DOXEPIN CAP 25MG U/D | $1.29 |
| 25008058 | DOXEPIN CAP 50MG U/D | $1.71 |
| 25008059 | DOXYCYCLINE CAP 100MG U/D | $1.80 |
| 25091271 | DOXYCYCLINE HYCLATE 100MG TAB | $15.60 |
| 25091404 | DOXYCYCLINE MONO 100MG CAP | $5.92 |
| 42055043 | DRESSING CHANGE KIT | $24.00 |
| 25091064 | DUCOSATE SODIUM 100MG CAP | $1.00 |
| 25008062 | DULCOLAX 5MG TAB | $5.48 |
| 25008061 | DULCOLAX SUPP | $3.00 |
| 25091055 | DULOXETINE HCL 20MG | $2.00 |
| 25091079 | DULOXETINE HCL 30MG CAP | $3.00 |
| 25091073 | DULOXETINE HCL 60MG CAP | $6.60 |
| 25008065 | DUONEB INH/S 3ML | $28.00 |
| 25091096 | DUTASTERIDE 0.5MG CAP | $8.00 |
| 44061024 | DYSPHAGIA EVALUATION | $315.00 |
| 44016025 | DYSPHAGIA THERAPY IND 15 MIN | $100.00 |
| 32045041 | ECHO CARDIOGRAM | $1,500.00 |
| 25009002 | EFFEXOR XR ERCAP 37.5 MG | $12.41 |
| 25090203 | EFFIENT 5 MG | $28.00 |
| 73000001 | EKG | $150.00 |
| 25090949 | ELIQUIS 2.5MG | $26.41 |
| 25090886 | ELIQUIS 5MG TAB | $28.08 |
| 25009006 | ENABLEX TAB 7.5MG | $24.00 |
| 25090922 | ENALAPRIL 5MG | $8.00 |
| 25090856 | ENALAPRIL MALEATE 10 MG | $16.00 |
| 25090853 | ENALAPRIL MALEATE 20 MG | $32.00 |
| 25009007 | ENEMA DISPOSABLE 4.5 OZ | $0.02 |
| 27033164 | ENEMA KIT | $4.00 |
| 25091072 | ENOXAPARIN 30MG 0.3 SYRINGE | $34.65 |
| 25090280 | ENOXAPARIN 40MG/0.4 | $44.55 |
| 25019613 | ENSURE HIGH PROTEIN VAN | $9.16 |
| 25009009 | ENSURE LIQ INST VAN | $5.52 |
| 25090825 | ENTOCORT 3MG | $100.00 |
| 25091583 | ENTRESTO 24MG-26MG TAB | $31.12 |
| 25009018 | ERYTHROMYCIN EYE OINTMENT | $103.96 |
| 25091118 | ESCITALOPRAM 10MG TAB | $2.30 |
| 25091375 | ESCITALOPRAM 20MG TAB | $2.35 |
| 25091289 | ESCITALOPRAM 5 MG TAB | $2.00 |
| 25091117 | ESOMEPRAZOLE MAG 40MG CAP | $44.20 |
| 25090250 | ESTRADIOL 1MG | $2.00 |
| 25090103 | ESTRADIOL 2MG | $3.00 |
| 25091426 | ESZOPICLONE 3MG TAB | $8.36 |
| 25009023 | EVISTA 60mg TAB | $7.44 |
| 26031055 | EX SET | $3.00 |
| 25090866 | EXELON PATCH 13.3 MG | $56.00 |
| 25091415 | EZETIMIBE 10MG TAB | $4.99 |
| 25091413 | FAMOTIDINE 40MG TAB | $2.76 |
| 25010000 | FAMOTIDINE TAB 20MG U/D | $1.25 |
| 25091228 | FARXIGA 10MG TAB | $58.16 |
| 25091067 | FE C TABLET | $1.00 |
| 27033175 | FEMALE SELF CATHETER | $5.00 |
| 32045048 | FEMUR 2 VIEWS | $250.00 |
| 25091418 | FENOFIBRATE 145MG TAB | $11.00 |
| 25091071 | FENOFIBRATE 160MG TAB | $12.20 |
| 25010008 | FENTANYL PATCH 75MCG | $120.63 |
| 25010009 | FENTANYL PATCH 100MCG | $160.08 |
| 30040170 | FERRITIN LEVEL | $80.00 |
| 25010011 | FERROUS GLUC TABS 325MG | $1.00 |
| 25010012 | FERROUS SULF 325MG TAB | $1.00 |
| 25091315 | FIBER LAXATIVE 625MG CAP | $5.24 |
| 25010014 | FINASTERIDE 5MG TAB | $4.36 |
| 25091357 | FIRST VANCOMYCIN 25MG/ML VIAL | $1.76 |
| 25091497 | FIRST-LANSOPRAZOLE 3MG/ML | $1.68 |
| 25019611 | FIRVANQ 25 MG/ML SOL | $396.72 |
| 25090012 | FISH OIL 1000 UNITS | $3.00 |
| 25091214 | FISH OIL 1200MG CAP | $1.00 |
| 25010016 | FLAGYL 500mg | $9.48 |
| 25090099 | FLAXSEED OIL 1000MG | $1.00 |
| 25091531 | FLECAINIDE ACETATE 50 MG TAB | $3.00 |
| 25010020 | FLEET BISCDYL ENEMA 1.25 | $4.68 |
| 27033507 | FLEETS ENEMA 4.5OZ | $5.00 |
| 25010022 | FLEXERIL TAB | $2.00 |
| 25090054 | FLORA – Q2 | $5.00 |
| 25091261 | FLORANEX CHEWABLE TAB | $6.44 |
| 25010026 | FLOVENT HFA 110MCG INHALER | $740.31 |
| 25090279 | FLUCONAZOLE 150MG | $12.00 |
| 25091440 | FLUCONAZOLE 200MG TAB | $16.96 |
| 25010028 | FLUCONAZOLE TAB 100 MG | $11.68 |
| 25010029 | FLUDROCORTISONE AC 0.1MG | $2.24 |
| 25010031 | FLUOXETINE CAP 10MG | $1.00 |
| 25010032 | FLUOXETINE CAP 20MG U/D | $2.50 |
| 25091307 | FLUOXETINE HCL 40MG CAP | $5.92 |
| 25010035 | FLUPHENAZINE TAB 5MG | $2.70 |
| 25091164 | FLUTICASONE PROP 50MCG 0.5% 16 | $140.12 |
| 25010039 | FOLATE 1mg | $1.00 |
| 25010040 | FOLBIC ACID TAB | $9.44 |
| 25010041 | FOLIC ACID 1MG TAB | $1.80 |
| 25091137 | FOLIC ACID 400MCG TAB | $1.00 |
| 32045053 | FOOT COMPLETE 3 VIEWS | $350.00 |
| 25010046 | FOSAMAX TAB 70MG | $68.30 |
| 25091324 | FOSINOPRIL SODIUM 10MG TAB | $2.92 |
| 25090098 | FOSINOPRIL SODIUM 20MG TAB | $4.00 |
| 25010049 | FUROSEMIDE 20MG TAB | $1.00 |
| 25010051 | FUROSEMIDE 20MG/2ML VL | $9.70 |
| 25010050 | FUROSEMIDE 40MG TAB | $1.69 |
| 25091435 | FUROSEMIDE 40MG/4ML VIAL | $9.70 |
| 25091502 | FUROSEMIDE 80MG TAB | $1.52 |
| 25090930 | GABAPENTIN 600 MG TAB | $3.92 |
| 25090930 | GABAPENTIN 600 MG TAB | $2.24 |
| 25091304 | GABAPENTIN 800MG TAB | $4.60 |
| 25011000 | GABAPENTIN CAP 100 MG 1 | $1.65 |
| 25011001 | GABAPENTIN CAP 300 MG | $1.91 |
| 25011002 | GABAPENTIN TAB 400 MG 1 | $2.00 |
| 27011005 | GAUZE SPONGE 4X4 | $5.00 |
| 27033192 | GAUZE SPONGES 2X2 & 4X4 | $2.00 |
| 25011009 | GEMFIBROZIL TAB 600MG | $3.74 |
| 25011012 | GEODON CAP 20MG | $76.00 |
| 25091323 | GLIMEPIRIDE 1MG TAB | $1.92 |
| 25091331 | GLIMEPIRIDE 4MG TAB | $3.48 |
| 25011016 | GLIMEPIRIDE TAB 2 MG 100U | $1.96 |
| 25011017 | GLIPIZIDE 10mg | $2.00 |
| 25011018 | GLIPIZIDE ER TAB 5 MG 1 | $2.00 |
| 25011020 | GLUCERNA CAN 80Z | $9.00 |
| 25011021 | GLUCERNA R-T-H 1000ML/8 | $44.75 |
| 25011045 | GLUCOPHAGE 1000MG | $6.28 |
| 25011022 | GLUCOPHAGE 500mg | $2.40 |
| 25090928 | GLUCOSAMINE 500MG | $24.00 |
| 25091471 | GLUCOSAMINE CHONDROITIN CAP | $5.64 |
| 30040198 | GLUCOSE LEVEL | $7.00 |
| 25011030 | GLYBURIDE 2.5MG TAB | $1.52 |
| 25011029 | GLYBURIDE 3mg | $1.28 |
| 25011031 | GLYBURIDE TAB 5MG | $2.33 |
| 25011032 | GLYBURIDE/METFORM 2.5/500 | $3.08 |
| 30040206 | GRAM STAIN | $36.00 |
| 25091302 | GS 4X PROBIOTIC CAP | $8.40 |
| 25091276 | GUAIFEN/DEXTROMETH 100-10ML | $5.08 |
| 25091525 | GUAIFENESIN 200MG TAB | $5.88 |
| 25011038 | GUAIFENESIN ER | $4.00 |
| 25016049 | GUAIFENESIN SYRP 100MG /5ML | $1.00 |
| 25012007 | HALOPERIDOL TABS 1MG 100 | $1.19 |
| 25012046 | HCTZ | $2.00 |
| 30040217 | HEMATOCRIT | $20.00 |
| 30040219 | HEMOGLOBIN A1C | $36.50 |
| 30040226 | HEPATIC FUNCTION PAN | $218.00 |
| 30040231 | HEPATITIS PROFILE | $200.00 |
| 30040233 | HGB A1C, (GLYCOHGB) | $38.70 |
| 41051032 | HHN HANDHELD NEB EQUIP | $4.00 |
| 32045062 | HIP UNILATERAL 1 VIEW | $393.60 |
| 32045063 | HIP UNILATERAL 2 VIEWS | $245.00 |
| 24 | HIPPS | $0.00 |
| 30040236 | HIV 1 & 2 SCRN (STD) | $57.60 |
| 25090283 | HUMALOG 100UNITS/ML | $148.45 |
| 25091135 | HUMALOG PER UNIT | $1.00 |
| 25090907 | HYDRALAZINE 100MG | $7.00 |
| 25012025 | HYDRALAZINE TAB 50MG U/D | $1.32 |
| 25012024 | HYDRALAZINE TAB 25MG U/D | $1.06 |
| 25090860 | HYDROCHLOROTHIAZIDE 12.5MG | $1.00 |
| 25012026 | HYDROCHLORTHIAZIDE 25MG TAB | $1.96 |
| 25091168 | HYDROCODONE APAP 5-325MG | $2.80 |
| 25091085 | HYDROCODONE APAP 7.5-325 MG TA | $3.01 |
| 25091173 | HYDROCODONE-CHLORPHENIRAM 1ML | $2.96 |
| 25012030 | HYDROCODONE/APAP 10/325UD | $3.30 |
| 25091182 | HYDROCORTISONE CR 1% 28GM TUBE | $17.52 |
| 25091161 | HYDROMORPHONE 2MG TAB | $1.25 |
| 25012040 | HYDROXYCHLOROQUINE 200MG | $3.70 |
| 25090948 | HYDROXYUREA 500 MG CAP | $6.28 |
| 25012041 | HYDROXYZINE HCL 25MG TAB | $2.45 |
| 25091383 | HYDROXYZINE PAM 25MG CAP | $3.68 |
| 25012042 | HYDROXYZINE TAB 50 MG 1 | $3.36 |
| 25090208 | HYOSCYAMINE 0.125 MG | $4.00 |
| 25090950 | HYOSCYAMINE 0.375 | $3.60 |
| 25012043 | HYTRIN | $5.00 |
| 25013034 | I-CAR PLUS | $10.24 |
| 25013035 | I-VITE TAB | $6.32 |
| 25013001 | IBUPROFEN TAB 200MG U/D | $1.00 |
| 25013002 | IBUPROFEN TAB 400MG | $2.12 |
| 25013003 | IBUPROFEN TAB 600MG U/D | $1.22 |
| 25013004 | IBUPROFEN TAB 800MG U/D | $1.20 |
| 25091590 | IMIPRAMINE HCL 25MG | $3.48 |
| 25013008 | IMMODIUM | $3.00 |
| 41051039 | INCENTIVE SPIROMETER WHITE | $36.00 |
| 25091550 | INCRUSE ELLIPTA 62.5 MCG | $1,038.09 |
| 25019605 | INDAPAMIDE 1.25MG TAB | $3.33 |
| 25013009 | INDERAL | $3.00 |
| 30040491 | INFLUENZA BY PCR | $243.72 |
| 27011059 | INFUSION PUMP 2ND SET | $8.00 |
| 25013036 | INSPRA 25MG | $16.17 |
| 25091317 | INVOKANA 100MG TAB | $56.76 |
| 25091194 | IPRAT-ALBUT 0.5MG PER VIAL | $3.00 |
| 25091059 | IPRAT-ALBUT 2.5 MG PER VIAL | $4.48 |
| 25013027 | IPRATROPIUM BR 0.02% PER 3ML | $1.61 |
| 25091197 | IRBESARTAN 150MG TAB | $5.44 |
| 30040251 | IRON + TIBC | $86.40 |
| 30040252 | IRON PROFILE | $24.00 |
| 27033506 | IRRIGATION TRAY | $10.00 |
| 25091474 | ISOSORBIDE DN 20MG TAB | $6.00 |
| 25091480 | ISOSORBIDE DN 30MG TAB | $8.88 |
| 250910303 | ISOSORBIDE MN 60MG TAB | $4.64 |
| 25013033 | ISOSORBIDE MN ER 30MG U | $3.99 |
| 27011117 | IV 6″ EXTENSION | $16.50 |
| 27033230 | IV ADMIN SET | $5.12 |
| 26031075 | IV PRIMARY | $20.00 |
| 26031088 | IV START KIT | $10.00 |
| 25091241 | JANTOVEN 10MG TAB | $14.68 |
| 25091183 | JANTOVEN 1MG TAB | $3.32 |
| 25091112 | JANTOVEN 2.5MG TAB | $5.80 |
| 25091389 | JANTOVEN 2MG TAB | $3.68 |
| 25091189 | JANTOVEN 3MG TAB | $4.00 |
| 25091190 | JANTOVEN 4MG TAB | $4.00 |
| 25091113 | JANTOVEN 5MG TAB | $4.16 |
| 25091388 | JANTOVEN 6MG TAB | $4.48 |
| 25091242 | JANTOVEN 7.5MG TAB | $4.64 |
| 25014000 | JANUVIA 100MG TAB | $54.16 |
| 25091084 | JANUVIA 25MG TAB | $52.15 |
| 25014005 | JANUVIA 50MG TAB | $58.56 |
| 25014001 | JEVITY 1.5 CAN 24X8OZ | $6.80 |
| 25014003 | JEVITY PLS CAN 24X8 OZ | $6.44 |
| 25014006 | JUVEN 1 PACK | $203.01 |
| 25015016 | K-PHOS NEUTRAL | $6.06 |
| 25015001 | KAYEXALATE | $12.00 |
| 25015002 | KCL 10 MEQ CAP | $12.00 |
| 25090252 | KCL 10 MEQ TAB | $4.00 |
| 25015003 | KCL 20 MEQ | $2.00 |
| 25015004 | KCL 40 MEQ | $8.00 |
| 25091458 | KCL 40MEQ IN NS IV | $268.00 |
| 25015008 | KEFLEX 500mg | $6.00 |
| 25015019 | KEPPRA 250MG | $11.97 |
| 30040469 | KEPPRA LEVEL | $193.00 |
| 25015010 | KEPPRA TAB 500 MG 120 | $11.73 |
| 27033235 | KERLIX | $6.00 |
| 25019609 | KETOROLAC 10MG TAB | $7.66 |
| 25090217 | KETOROLAC 30MG VIAL EYE DROPS | $11.82 |
| 25016055 | KETOROLAC 30MG/1ML VIAL IV | $11.84 |
| 25091540 | KLOR-CON M10 TAB | $4.20 |
| 32045068 | KNEE 1-2 VIEWS UNILATERAL | $543.00 |
| 27033243 | KNEE IMMOBILIZER | $63.00 |
| 32045072 | KUB | $150.00 |
| 25016000 | LABETALOL HCL 200MG TAB | $4.00 |
| 25016001 | LABETALOL TAB 100MG | $1.91 |
| 25016003 | LACTULOSE 10GM/15ML | $5.79 |
| 25090320 | LACULOSE PER 1ML | $1.32 |
| 25016012 | LANTUS PER 1 UNIT (100UNIT VIA | $1.00 |
| 25016016 | LASIX 20mg INJ | $10.00 |
| 25016102 | LASIX 40MG | $2.00 |
| 25090850 | LATANOPROST 0.005% EYE DROPS 2 | $105.80 |
| 25091060 | LEADER ARTH PAIN ER 650MG CAP | $4.02 |
| 25091225 | LEFLUNOMIDE 10MG TAB | $31.20 |
| 25090778 | LEFLUNOMIDE 20MG | $50.00 |
| 27033247 | LEG BAG | $8.00 |
| 25090304 | LETROZOLE 2.5MG | $58.00 |
| 25091132 | LEVALBUTEROL 0.63MG 3ML VIAL | $4.25 |
| 25091329 | LEVALBUTEROL 1.25MG/3ML VIAL | $9.36 |
| 25016020 | LEVAQUIN INJ BG 500MG | $1.37 |
| 25016021 | LEVAQUIN TAB 250MG U/D | $30.00 |
| 25016022 | LEVAQUIN TAB 500MG | $34.00 |
| 25090289 | LEVEMIR PER 1 UNIT | $1.16 |
| 25091260 | LEVETIRACETAM 1000MG TAB | $5.44 |
| 25091090 | LEVETIRACETAM 500MG TAB | $1.80 |
| 25091163 | LEVETIRACETAM 750MG TAB | $2.24 |
| 25090278 | LEVOFLOXACIN 250MG | $2.80 |
| 25090264 | LEVOFLOXACIN 500MG | $5.64 |
| 25091352 | LEVOFLOXACIN 750MG TAB | $11.96 |
| 25016029 | LEVOTHROID TAB 100MCG | $0.52 |
| 25091192 | LEVOTHYROXINE 100 MCG TAB | $5.79 |
| 25090875 | LEVOTHYROXINE 112MCG TAB | $4.80 |
| 25090781 | LEVOTHYROXINE 125 MCG TAB | $4.84 |
| 25091128 | LEVOTHYROXINE 137MCG TAB | $8.72 |
| 25090263 | LEVOTHYROXINE 150MCG | $2.00 |
| 25091370 | LEVOTHYROXINE 175MCG TAB | $5.00 |
| 25091546 | LEVOTHYROXINE 200 MCG TAB | $6.88 |
| 25091142 | LEVOTHYROXINE 25MCG TAB | $3.56 |
| 25016032 | LEVOTHYROXINE 50MCG | $8.00 |
| 25029049 | LEVOTHYROXINE 75 MCG | $8.20 |
| 25091093 | LEVOTHYROXINE 88MCG TAB | $5.77 |
| 25016105 | LEVSIN TAB 0.125MG | $4.80 |
| 25016033 | LEXAPRO TAB 10MG | $18.00 |
| 25016034 | LEXAPRO TAB 20MG | $20.00 |
| 25016036 | LIBRIUM 25 | $3.00 |
| 25016045 | LICOCAINE PATCH 5% | $32.00 |
| 25091169 | LIDOCAINE 12HR PATCH | $43.12 |
| 25091580 | LIDOCAINE 5% PATCH | $41.96 |
| 25016038 | LIDOCAINE AMP 2% 2ML | $1.29 |
| 27033252 | LIMB RESTRAINTS | $48.00 |
| 25091220 | LINEZOLID 600MG TAB | $85.00 |
| 25090980 | LINZESS 145 MG | $47.00 |
| 25090985 | LINZESS 290 MG | $48.00 |
| 25019603 | LIOTHYRONINE 5MCG | $5.71 |
| 30040271 | LIPID PROFILE | $65.00 |
| 25016092 | LIPITOR 40MG | $20.00 |
| 25090987 | LIQUID TEARS | $7.42 |
| 25016050 | LISINOPRIL 10MG TAB | $4.00 |
| 25016101 | LISINOPRIL 2.5MG | $5.76 |
| 25090805 | LISINOPRIL 30 MG | $5.00 |
| 25016093 | LISINOPRIL 40MG | $6.55 |
| 25016094 | LISINOPRIL 5MG | $4.67 |
| 25016051 | LISINOPRIL TAB 20MG | $2.65 |
| 25016052 | LISINOPRIL/HCTZ 20/12.5 | $3.59 |
| 25091014 | LIVALO 2MG | $30.60 |
| 30040275 | LIVER (HEPATIC PANEL) | $19.80 |
| 25016058 | LOPERAMIDE 2MG CAP | $9.92 |
| 27033253 | LOPEZ VALVE | $7.00 |
| 25016096 | LOPRESSOR 100MG | $4.33 |
| 25016060 | LOPRESSOR 25mg | $6.12 |
| 25016062 | LORATADINE TAB 10MG | $1.00 |
| 25090262 | LORAZEPAM 1MG | $2.00 |
| 25016063 | LORAZEPAM TAB 0.5MG | $1.93 |
| 25016064 | LORAZEPAM TAB 2MG U/D | $3.96 |
| 25090779 | LOSARTAN / HCTZ 100/25 | $30.00 |
| 25016061 | LOSARTAN HCTZ 50/12.5 MG TAB | $2.88 |
| 25091328 | LOSARTAN POTASSIUM 100MG TAB | $3.76 |
| 25091205 | LOSARTAN POTASSIUM 25MG TAB | $2.16 |
| 25090075 | LOSARTAN POTASSIUM 50MG | $6.00 |
| 25090107 | LOTEMAX 0.5% OPTH SOL | $520.00 |
| 25016071 | LOTREL 5/20mg | $28.60 |
| 25016073 | LOTRIMIN CREAM | $28.00 |
| 25091306 | LOVASTATIN 10MG TAB | $2.60 |
| 25016111 | LOVAZA 1GM | $8.00 |
| 25016078 | LOVENOX 30MG | $35.04 |
| 25016079 | LOVENOX 40M | $45.52 |
| 25091106 | LOVENOX 80MG | $87.88 |
| 25016110 | LOZOL | $4.00 |
| 32045076 | LUMBAR SPINE 3 VIEWS | $348.00 |
| 25090943 | LUMIGAN 0.01% EYE DROPS | $234.00 |
| 25016086 | LUNESTA TAB 3 MG | $30.00 |
| 25090746 | LUTEIN 20MG CAP | $1.55 |
| 25016090 | LYRICA 100MG CAPSULE | $24.52 |
| 25016108 | LYRICA 150MG CAP | $25.00 |
| 25091378 | LYRICA 200MG CAP | $25.68 |
| 25016087 | LYRICA 50mg | $19.36 |
| 25016089 | LYRICA 75MG CAP | $25.60 |
| 25016088 | LYRICA CAPSULE 25 MG 90 | $7.37 |
| 25017096 | MAALOX 20ML | $6.00 |
| 25017001 | MACROBID 100mg | $5.00 |
| 25017003 | MAG 64 TAB 60 | $0.35 |
| 25091341 | MAG SULFATE 2GM VIAL W/ NS | $341.56 |
| 25017007 | MAG-OX 400MG TAB | $5.12 |
| 25090774 | MAGNESIUM 1 GM IVPB 1 BAG | $100.00 |
| 25017092 | MAGNESIUM CITRATE 1 BTL | $5.00 |
| 25091492 | MAGNESIUM OXIDE 500MG TAB | $23.40 |
| 25090029 | MAGNESIUM SULFATE 4GM/250ML | $355.68 |
| 30040282 | MAGNESIUM, SERUM LEVEL | $42.00 |
| 27033256 | MALE EXTERNAL CATHETER | $3.30 |
| 30040283 | MANUAL DIFF/MORPHOLOGY | $9.75 |
| 27011121 | MAXORB EXTRA AG | $26.52 |
| 25017010 | MECLIZINE 25MG TAB | $1.00 |
| 27011048 | MEDIPORE 3.6″X12″ | $8.00 |
| 25017011 | MEDROL 4mg TAB | $2.00 |
| 25090979 | MEDROXYPROGESTERONE 5 MG | $24.00 |
| 25017015 | MEGACE 40mg TAB | $4.20 |
| 25090800 | MEGESTROL ACETATE 20MG | $2.10 |
| 25017018 | MEGESTROL ACET 40MG TAB | $2.44 |
| 25017019 | MEGESTROL ACETATE 40MG PER ML | $1.80 |
| 25091522 | MELATONIN 10MG CAP | $5.84 |
| 25090797 | MELATONIN 3MG TAB | $1.00 |
| 25090963 | MELATONIN 5 MG | $5.60 |
| 25005127 | MELOXICAM 15MG TAB | $2.04 |
| 25090787 | MELOXICAM 7.5MG TAB | $1.70 |
| 25091098 | MEMANTINE 10MG TAB | $2.96 |
| 25091332 | MEMANTINE HCL 5MG TAB | $2.84 |
| 25019627 | MEMANTINE HCL ER 28MG TAB | $61.75 |
| 25090871 | MEN-PHOR ANIT ITCH LOTION | $20.00 |
| 27011054 | MEPILEX 18X18 | $50.00 |
| 27011089 | MEPILEX 2X5 BORDER | $14.00 |
| 27033529 | MEPILEX 4 X 8 BORDER BOX OF 5 | $136.00 |
| 27011119 | MEPILEX 4X10 | $40.80 |
| 27011057 | MEPILEX 4X12 | $62.00 |
| 27033525 | MEPILEX 4X4 DRESSING BORDER | $20.60 |
| 27011120 | MEPILEX 6X6 | $38.08 |
| 25091597 | MEPILEX 7.2 X 7.2 BX OF 5 | $152.00 |
| 27011086 | MEPILEX BORDER 3X3 | $16.00 |
| 27011045 | MEPILEX BORDER 4X12 BOX OF 5 | $206.00 |
| 27011058 | MEPILEX LIGHT 2.4 X 3.4 | $18.00 |
| 27011041 | MEPILEX SACRUM 7.2 X 7.2 UNIT | $40.00 |
| 26011089 | MEPIPLEX BORDER 2X5 | $14.64 |
| 25017022 | MEROPENEM 1 GM PER DOSE | $195.68 |
| 27033261 | MESALT | $2.40 |
| 25090056 | METAXALONE 800MG | $14.00 |
| 25090072 | METFORMIN 1,000MG | $3.00 |
| 25017028 | METFORMIN HCL 500 MG TABL | $2.16 |
| 25090045 | METHOCARBAMOL 750MG | $2.00 |
| 25017033 | METHOCARBAMOL TAB 500MG | $1.02 |
| 25017034 | METHOTREXATE TAB 2.5MG | $11.16 |
| 25017038 | METHYLPREDNISOLONE 4MG PK | $150.80 |
| 25017040 | METOCLOPRAMIDE 10MG TAB | $3.24 |
| 25090265 | METOCLOPRAMIDE 5MG | $3.00 |
| 25017041 | METOLAZONE 5MG TAB | $29.76 |
| 25017043 | METOPROLOL 50MG | $2.00 |
| 25024020 | METOPROLOL SUCC 100MG TAB ER | $6.71 |
| 25091517 | METOPROLOL SUCC ER 50MG TAB | $6.28 |
| 25017042 | METOPROLOL SUCC ER TB 25M | $5.86 |
| 25017045 | METOPROLOL TAR 25MG TAB | $1.00 |
| 25017046 | METOPROLOL TAR TAB 50MG | $1.72 |
| 25091263 | METOPROLOL TARTRATE 100MG TAB | $1.00 |
| 25091457 | METRONIDAZOLE 500MG/100ML | $17.32 |
| 25017047 | METRONIDAZOLE TAB 500MG | $2.18 |
| 25017091 | METRONIDAZOLE VAGINAL CREAM | $154.08 |
| 25019625 | MICAFUNGIN 100MG IV | $1,212.30 |
| 25017051 | MICARDIS 80mg | $20.00 |
| 26031135 | MIDLINE DECLOT | $340.00 |
| 26031136 | MIDLINE EVALUATION | $300.00 |
| 26031137 | MIDLINE PLACEMENT | $1,200.00 |
| 25017088 | MIDODRINE 10MG | $23.51 |
| 25091469 | MIDODRINE HCL 5MG MH2 | $11.00 |
| 25017055 | MIDODRINE HCL TAB 2.5MG | $3.60 |
| 25091459 | MINERAL OIL (GS) | $5.04 |
| 25017059 | MIRALAX POWDER | $0.14 |
| 25017062 | MIRAPEX TAB 1.0 MG 90 | $8.54 |
| 25090300 | MIRTAZAPINE 30MG | $12.00 |
| 25017063 | MIRTAZAPINE TAB 15MG U/D | $8.15 |
| 25091444 | MODAFINIL 200MG TAB | $16.84 |
| 25017066 | MOM 30cc | $2.00 |
| 25091094 | MONTELUKAST SOD 10MG TAB | $2.68 |
| 25017073 | MORPH SULF ER TAB 15MG | $2.68 |
| 25091434 | MORPHINE SULF ER 15MG TAB | $3.96 |
| 25090081 | MORPHINE SULFATE 30MG | $3.00 |
| 27033502 | MOUTHWASH | $2.00 |
| 25091416 | MOVANTIK 25MG TAB | $45.72 |
| 25017076 | MUCINEX DM 600MG TAB | $7.04 |
| 25017077 | MUCOMIST 10% VIAL | $44.00 |
| 25090000 | MULTAQ 400MG TAB | $41.39 |
| 25091475 | MULTIPLE VITAMINS TAB | $5.08 |
| 25017078 | MULTIVITAMIN- M PLUS TAB | $1.00 |
| 25091476 | MUTIVITAMIN CAP | $5.20 |
| 25017087 | MVI | $1.00 |
| 25091199 | MYCOPHENOLATE 500MG TAB | $7.12 |
| 25017083 | MYLANTA 30cc | $3.00 |
| 30040293 | MYOGLOBIN, SERUM | $122.10 |
| 25090935 | MYRBETRIQ 50 MG | $44.00 |
| 25091283 | MYRBETRIQ ER 25 MG TAB | $43.00 |
| 25018001 | NABUMETONE TAB 500MG | $4.13 |
| 25018055 | NAMENDA 10MG | $18.00 |
| 25090926 | NAMENDA XR 28MG | $64.00 |
| 25091578 | NAMZARIC 28 MG-10 MG CAP | $55.80 |
| 25018006 | NAPROXEN TAB 250MG | $2.00 |
| 41051019 | NASAL CANNULA | $3.00 |
| 25018010 | NASONEX NASAL SPRAY | $75.00 |
| 25090851 | NEFEDIPINE ER 30MG | $26.00 |
| 25090996 | NEO/POLYMYXIN/HC | $160.00 |
| 25091355 | NEOMYCIN-POLYMYXIN-HC EAR DROP | $268.24 |
| 25090209 | NEPHRO-VITE MCG | $1.00 |
| 25018017 | NEPRO W/CARB VAN 8 OZ CAN | $13.40 |
| 42055092 | NEUROMUSC RE-EDUC 15 MIN | $75.00 |
| 25018058 | NEUTROPHOS PACK | $2.50 |
| 25018022 | NEXIUM CAP 40MG | $28.00 |
| 25090220 | NIACIN 100MG | $1.00 |
| 25090284 | NIACIN CR 500 MG | $2.00 |
| 25018026 | NICOTINE PATCH 14MG/24HR | $6.00 |
| 25018027 | NICOTINE PATCH 21MG/24HR | $7.24 |
| 25090210 | NIFEDIPINE 10 MG | $4.00 |
| 25018029 | NIFEDIPINE ER 30MG TAB | $7.13 |
| 25090823 | NIFEDIPINE ER 90MG TAB | $12.80 |
| 25018030 | NIFEDIPINE ER TAB 60MG | $6.87 |
| 25018034 | NITROFURANTOIN MCR 100MG CAP | $15.15 |
| 25018061 | NITROGLYCERIN SUB 0.4MG | $5.98 |
| 41051053 | NON-REBREATHING | $7.00 |
| 25090084 | NORCO 7.5/325 MG | $2.00 |
| 25090114 | NORCO 10/325MG | $2.00 |
| 25090902 | NORCO 5/325 MG | $4.00 |
| 25018038 | NORTRIPTYLINE CAP 10MG UD | $1.34 |
| 25018039 | NORTRIPTYLINE CAP 25MG | $2.41 |
| 25018043 | NOVOLIN PER UNIT | $1.00 |
| 25091411 | NOVOLOG MIX 70/30 PER UNIT | $1.00 |
| 25018057 | NOVOLOG PER UNIT( DOSE) | $1.02 |
| 26031109 | NS 500CC | $21.00 |
| 25090957 | NUCYNTA 50 MG | $23.00 |
| 25090955 | NUEDEXTA 20/10 MG | $44.00 |
| 25091437 | NYSTATIN 100,000 U/GM (30GM) B | $178.72 |
| 25091353 | NYSTATIN 100,000 UNITS/ML BOTT | $60.72 |
| 25090047 | NYSTATIN 100ML BOTTLE | $85.80 |
| 25090951 | NYSTATIN 30 GM TUBE | $260.00 |
| 25018052 | NYSTOP POWDER 30GM BOTTLE | $229.56 |
| 41051055 | O2 HUMIDIFIER MOISTURE 400ML | $8.00 |
| 41051111 | O2 NASAL TUBING CONNECTOR | $38.00 |
| 41051065 | O2 VENTI MASK | $12.50 |
| 30040297 | OCCULT BLOOD | $11.00 |
| 25019002 | OCUVITE PRESER VISION CAP | $5.44 |
| 27011107 | OILEMULSION DSG 3X16 | $5.60 |
| 25091462 | OLANZAPINE 10MG TAB | $3.28 |
| 25019624 | OLMESARTAN MEDOXOMIL 20MG | $27.49 |
| 25091506 | OLMESARTAN-HCTZ 40-25MG TAB | $34.91 |
| 25091373 | OLOPATADINE HCL 0.1%/5ML EYE D | $177.90 |
| 25091381 | OMEGA-3 ETHYL ESTERS 1GM CAP | $10.24 |
| 25019006 | OMEPRAZOLE CAP 20 MG | $8.00 |
| 25091409 | OMEPRAZOLE DR 40MG CAP | $6.05 |
| 25019007 | OMNICEF 300mg | $42.44 |
| 25091291 | ONDANSETRON HCL 4MG/2ML VIAL | $25.08 |
| 25091296 | ONDANSETRON HCL 8MG TAB | $8.64 |
| 25019008 | ONDANSETRON ODT 4MG TAB | $26.48 |
| 25090028 | ONE TOUCH TEST STRIPS | $2.00 |
| 25090200 | ONGLYZA 2.5 MG | $30.00 |
| 25090248 | ONGLYZA 5MG | $52.52 |
| 27033282 | OP SITE | $10.00 |
| 27011072 | OPTICELL AG 2X2 | $24.00 |
| 27011073 | OPTICELL AG 4X5 | $40.00 |
| 27011095 | OPTIFOAM 3X3 | $18.80 |
| 27011093 | OPTIFOAM 4X4 | $25.20 |
| 27011097 | OPTILOCK NON ADHESIVE 6.5X10 | $28.00 |
| 42055094 | ORTHOTICS FITTING 15 MIN | $75.00 |
| 25019014 | OSCAL | $2.00 |
| 25091165 | OSTEO BI-FLEX DS TAB | $1.64 |
| 43000004 | OT EVALUATION | $165.00 |
| 43000001 | OT-ADL 15 MIN | $148.50 |
| 43058063 | OT-FUNCTIONAL TRAINING | $60.00 |
| 43000007 | OT-NEUROMUSC RE-EDUC 15 MIN | $82.50 |
| 43000013 | OT-THERAPEUTIC EXER 15 MIN | $148.50 |
| 43000008 | OT-THERAPUTIC ACT. PER 15 MIN | $66.00 |
| 25019614 | OXCARBAZEPINE 150MG TAB | $2.36 |
| 25019016 | OXCARBAZEPINE TAB 300 MG | $7.88 |
| 25091297 | OXYBUTYNIN CL ER 10MG TAB | $14.52 |
| 25091327 | OXYBUTYNIN CL ER 15MG TAB | $15.36 |
| 25019017 | OXYBUTYNIN ER TAB 5 MG | $9.85 |
| 25090018 | OXYCODONE 15MG | $4.00 |
| 25091120 | OXYCODONE ACETAMINOPHEN 7.5/32 | $4.28 |
| 25091123 | OXYCODONE APAP 7.5/325MG | $3.00 |
| 25091223 | OXYCODONE HCL 10MG TAB | $3.24 |
| 25091563 | OXYCODONE HCL 15MG TAB | $4.32 |
| 25019019 | OXYCODONE HCL 5 MG TAB | $1.72 |
| 25019020 | OXYCODONE HCL ER TAB 20 M | $14.59 |
| 25019618 | OXYCODONE IR 20MG | $7.26 |
| 25019022 | OXYCODONE/APAP 10-325MG TAB | $3.86 |
| 25019021 | OXYCODONE/APAP 5/325 TAB | $1.00 |
| 25091139 | OXYCONTIN 10MG TAB | $17.46 |
| 25091379 | OXYCONTIN 20MG TAB | $31.56 |
| 25091076 | OXYMORPHONE 5MG TAB HCL ER | $11.12 |
| 25091534 | OYSCO 500+D TAB | $5.28 |
| 25019023 | OYSTER CALCIUM | $4.00 |
| 25020000 | P.P.D. SKIN TEST | $3.00 |
| 25091350 | PANTOPRAZOL 40MG/100ML NS | $162.56 |
| 25091358 | PANTOPRAZOLE SOD DR 20MG TAB | $7.68 |
| 25020003 | PANTOPRAZOLE SOD DR 40MG TAB | $2.29 |
| 41051110 | PAP O2/O2 CANNULA CONNECTOR | $2.00 |
| 25090836 | PAROXETINE 10MG | $1.80 |
| 25020004 | PAROXETINE HCL TAB 20MG | $7.93 |
| 32045094 | PELVIS 1 OR 2 VIEWS | $225.00 |
| 25090276 | PENTASA 500MG | $14.00 |
| 25020081 | PERCOCET 10/325MG | $6.23 |
| 25020013 | PERICOLACE | $2.00 |
| 25090940 | PERINDOPRIL 4MG | $28.00 |
| 25020014 | PERMETHRIN CR 5% 60GM | $1.46 |
| 27011071 | PETROLATUM GAUZE 3X9 | $1.00 |
| 25090085 | PHAZYME 125MG SOFTGEL | $5.56 |
| 25091496 | PHENAZOPYRIDINE 100MG TAB | $10.43 |
| 25020019 | PHENAZOPYRIDINE 200MG U/D | $15.36 |
| 25020096 | PHENERGAN 25MG | $6.00 |
| 25020082 | PHENERGAN INJ 12.5MG | $12.00 |
| 25020083 | PHENERGAN TAB | $2.00 |
| 30040308 | PHENOBARB LEVEL | $100.00 |
| 25091089 | PHENOBARBITAL 32.4MG TAB | $3.60 |
| 25020022 | PHENYTOIN CAP 100MG | $3.69 |
| 25091264 | PHENYTOIN SOD EXT 100MG CAP | $3.08 |
| 25090759 | PHOS-NAK 280/160 1PKT | $24.00 |
| 25091152 | PHOSPHA 250 NEUTRAL TAB | $3.02 |
| 30040312 | PHOSPHORUS LEVEL | $20.00 |
| 26031132 | PICC LINE DECLOT | $340.00 |
| 26031025 | PICC LINE DSG KIT | $21.00 |
| 26031133 | PICC LINE EVAL | $300.00 |
| 26031134 | PICC LINE PLACEMENT | $1,200.00 |
| 26031069 | PICC VALVE & CAP DSG KIT | $8.00 |
| 25091119 | PIOGLITAZONE HCL 30MG TAB | $5.60 |
| 25091196 | PIPER/TAZO 3.375GM DOSE IV | $125.60 |
| 25020026 | PLAQUENIL 200mg | $4.00 |
| 30040315 | PLATELET COUNT | $18.99 |
| 27033299 | PLETAL | $2.30 |
| 25020028 | PLETAL 50mg | $6.88 |
| 25091066 | POLYETHELYNE GLYCOL 3350 | $6.66 |
| 25020032 | POTASSIUM CHL ERC 20MEQ TAB | $4.11 |
| 25091521 | POTASSIUM CL 10% 20MEQ/15ML (4 | $40.80 |
| 25091420 | POTASSIUM CL 10MEQ CAP ER | $5.92 |
| 25090899 | POTASSIUM GLUCONATE 595 MG | $28.00 |
| 30040317 | POTASSIUM LEVEL | $36.00 |
| 30040318 | PPD SKIN TEST | $30.00 |
| 25090094 | PRADAXA 75MG | $15.00 |
| 25091330 | PRAMIPEXOLE 0.25MG TAB | $1.72 |
| 25091374 | PRAMIPEXOLE 0.5MG TAB | $2.44 |
| 25090005 | PRAMIPEXOLE 1.5MG | $10.00 |
| 25091211 | PRAMIPEXOLE 1MG TAB | $1.88 |
| 25090879 | PRAVASTATIN 10MG | $4.00 |
| 25023076 | PRAVASTATIN 80MG | $5.27 |
| 25020037 | PRAVASTATIN SOD 40MG TAB | $14.38 |
| 25020036 | PRAVASTATIN SODIUM 20MG TAB | $8.00 |
| 25090839 | PRAZOSIN 5MG | $5.00 |
| 30040319 | PRBC-PER UNIT | $900.00 |
| 30040320 | PREALBUMIN | $128.70 |
| 25020040 | PREDNISOLONE AC 1% EYE DROPS 5 | $258.41 |
| 25090292 | PREDNISONE 1 MG | $24.00 |
| 25020042 | PREDNISONE 10MG TAB | $1.88 |
| 25090762 | PREDNISONE 2.5 MG | $12.00 |
| 25020086 | PREDNISONE 20MG TAB | $1.80 |
| 25020041 | PREDNISONE 5MG TAB | $4.16 |
| 25020044 | PREMARIN .3MG TAB | $4.14 |
| 25090998 | PREMARIN 0.625MG TAB | $21.40 |
| 25020046 | PREMPRO .675/25 | $2.70 |
| 25091044 | PREMPRO 0.45-1.5 TAB | $22.88 |
| 25090038 | PRESERVISION ARED | $1.00 |
| 25020048 | PREVALITE POWD | $6.63 |
| 25020097 | PRIMIDONE 250MG | $3.28 |
| 25020053 | PRIMIDONE TAB 50MG | $1.51 |
| RMPR | PRIVATE ROOM | $935.00 |
| 25090894 | PRO-STAT LIQ PER DOSE | $2.76 |
| 25020054 | PROAIR HFA 90 MCG INHALER | $255.00 |
| 25090748 | PROAMATINE 10MG | $31.00 |
| 25090904 | PROBIOTIC | $3.50 |
| 25020094 | PROCARDIA XL 30MG | $4.00 |
| 25091048 | PROCARDIA XL 60MG | $5.00 |
| 25020087 | PROCARDIA XL 90MG | $6.00 |
| 25091593 | PROGESTERONE 100 MG | $1.49 |
| 25091086 | PROMETHAZINE 12.5MG TAB | $23.68 |
| 25020060 | PROMETHAZINE TAB 25MG | $2.00 |
| 25091158 | PROPAFENONE HCL 150MG TAB | $2.68 |
| 25017005 | PROPAFENONE HCL 225MG TAB | $2.60 |
| 25090913 | PROPAFENONE SR 325 MG | $40.12 |
| 25091179 | PROPRANOLOL 10MG TAB | $1.00 |
| 25020065 | PROPRANOLOL 20MG TAB | $1.00 |
| 25091272 | PROPRANOLOL ER 60 MG CAP | $1.52 |
| 25091366 | PROPRANOLOL ER 80MG CAP | $11.88 |
| 25020095 | PROSCAR 5MG | $7.41 |
| 25091582 | PROSTAT SUGAR FREE LIQUID 1ML | $4.00 |
| 30040330 | PROTIME | $40.00 |
| 25020069 | PROTONIX 40MG | $12.00 |
| 25090317 | PROVENTIL INHALER | $252.00 |
| 25020071 | PROVIGIL TAB 100MG | $26.14 |
| 42000004 | PT EVALUATION | $165.00 |
| 30040334 | PT W/INR | $30.00 |
| 42000001 | PT-ELECT STIM (UNATTENDED) | $94.05 |
| 42058126 | PT-EQUIPMENT INTERVENTION | $122.00 |
| 42055053 | PT-FUNCTIONAL TRAINING | $121.50 |
| 42000002 | PT-GAIT TRAINING 15 MIN | $133.65 |
| 42000003 | PT-HOT OR COLD PACK | $33.00 |
| 42000006 | PT-MASSAGE (ALL TYPES) 15 MIN | $49.50 |
| 42000009 | PT-THERAPEUTIC EXER IND 15 | $82.50 |
| 42000011 | PT-TRANSFERS ACTIVITY 15 MIN | $82.50 |
| 25020075 | PULMICORT RESP 0.25MG/2ML | $9.46 |
| 25020079 | PYRIDIUM TAB | $4.00 |
| 25020080 | PYRIDOXINE 50 MG TABLET | $1.00 |
| 25091219 | Q-SORB Q-10 100MG CAP | $2.20 |
| 25090981 | QUETIAPINE FUMARATE 100MG TAB | $2.20 |
| 25090040 | QUETIAPINE FUMARATE 50MG TAB | $2.24 |
| 25091083 | QUETIAPINE FUMERATE 25MG TAB | $4.44 |
| 25021002 | QUINAPRIL 40MG | $2.24 |
| 25091362 | RABEPRAZOLE SOD DR 20MG TAB | $8.60 |
| 25091069 | RAMIPRIL 10MG | $4.22 |
| 25020011 | RAMIPRIL 2.5MG CAP | $2.37 |
| 25090844 | RANEXA 500MG | $27.00 |
| 25022000 | RANITIDINE TAB 150MG | $4.00 |
| 25091544 | RASAGILINE MESYLATE 1MG TAB | $80.36 |
| 25091488 | REFRESH EYE DROPS | $30.64 |
| 25022004 | REGLAN 10MG TAB | $2.00 |
| 25022005 | REGLAN 5mg | $4.56 |
| 43058127 | REHAB SUMMARY | $150.00 |
| 25022045 | REMERON 30MG | $3.40 |
| 25090891 | REMERON 7.5MG | $8.00 |
| 25022009 | REMERON TAB 15MG | $16.00 |
| 25091095 | RENAL CAPS SOFTGEL | $4.44 |
| 30040342 | RENAL PROFILE | $52.00 |
| 25022042 | RENVELA 800MG | $6.72 |
| 25022010 | REQUIP 1mg | $2.00 |
| 25022046 | REQUIP 3MG | $8.00 |
| 25022047 | REQUIP 4MG | $9.72 |
| 25022012 | REQUIP O.25MG | $3.24 |
| 41051079 | RESP REHAB EVAL SUMMARY | $150.00 |
| 25022016 | RESTASIS EYE DROP 0.05% PER AP | $30.64 |
| 25022017 | RESTORIL 15MG | $4.00 |
| 25022018 | RESTORIL 30MG CAP | $3.56 |
| 25090758 | RESTORIL 7.5 MG | $2.00 |
| 30040344 | RETICULOCYTE COUNT | $40.00 |
| 30040345 | RHEUMATOID FACTOR | $66.00 |
| 32045103 | RIBS UNILATERAL 2 VIEWS | $300.00 |
| 25022022 | RIFAMPIN CAP 300MG | $4.73 |
| 25090266 | RISAQUAD 100MG CAP | $4.83 |
| 25090116 | RISAQUAD 230MG | $3.00 |
| 25091507 | RISAQUAD CAPSULES | $9.40 |
| 25022049 | RISPERDAL 0.5MG | $16.70 |
| 25022026 | RISPERDAL M-TAB 2.0MG | $28.33 |
| 25022029 | RISPERIDONE 1MG TAB | $2.22 |
| 25022028 | RISPERIDONE TAB .5MG 10 | $1.00 |
| 25019620 | RIZATRIPTAN 5MG TAB | $62.60 |
| 25090336 | ROBAXIN 500MG | $2.00 |
| 25022032 | ROBAXIN 750MG TAB | $3.00 |
| 25022034 | ROBITUSSIN DM COUGH SYRUP 5ML | $1.00 |
| 25091275 | ROCEPHIN 1GM IM | $36.40 |
| 25091186 | ROCEPHIN 2GM IV PER DOSE | $150.57 |
| 25090842 | ROCEPHIN IM 500 MG | $160.00 |
| 25022037 | ROCEPHIN IV 1GM | $153.33 |
| 25091074 | ROPINIROLE HCL 0.25MG TAB | $3.04 |
| 25090111 | ROPINIROLE HCL 0.5MG TAB | $2.11 |
| 25091310 | ROPINIROLE HCL 4MG TAB | $3.32 |
| 25022038 | ROPINIROLE TAB 1MG | $2.50 |
| 25091210 | ROSUVASTATIN CALCIUM 10MG TAB | $3.00 |
| 25091258 | ROSUVASTATIN CALCIUM 20 MG TAB | $7.60 |
| 25091237 | ROSUVASTATIN CALCIUM 40MG | $8.16 |
| 25091336 | ROSUVASTATIN CALCIUM 5 MG TAB | $7.60 |
| 30040349 | RPR(SYPHILLIS SEROLOGY) | $33.00 |
| 25090994 | SALAGEN 5MG | $3.52 |
| 25023004 | SALINE FLUSH 10cc | $3.02 |
| 25023007 | SANTYL OINTMENT 30 GM | $7.87 |
| 25091231 | SAVELLA 50MG TAB | $20.92 |
| 25091061 | SB ANTACID SUSP 30ML DOSE | $5.04 |
| 30040354 | SEDIMENTATION RATE | $36.00 |
| 25023084 | SELSUN BLUE MEDICATED 4OZ BTL | $37.80 |
| 25023008 | SENAKOT LAXATIVE | $2.00 |
| 25091515 | SENNA PLUS TAB | $5.48 |
| 25091467 | SENNA-TIME S TAB | $1.00 |
| 25091107 | SENNAGEN TAB | $1.00 |
| 25091401 | SENSIPAR 60MG TAB | $186.72 |
| 25090959 | SEROQUEL 12.5MG | $4.00 |
| 25023013 | SEROQUEL TAB 25MG U/D | $7.89 |
| 25023014 | SEROQUEL TAB 50 MG 100U | $12.97 |
| 25023015 | SEROQUEL TAB 100MG U/D | $13.54 |
| 25023020 | SERTRALINE HCL 25MG TAB | $2.32 |
| 25023021 | SERTRALINE TAB 50 MG 3 | $8.14 |
| 25023022 | SERTRALINE TAB 100 MG | $2.76 |
| 25090807 | SEVELAMER CABORNATE | $24.00 |
| 32045108 | SHOULDER 2 VIEWS | $681.00 |
| 25091599 | SILDENAFIL 20 MG TAB | $2.82 |
| 25090826 | SIMBRINZA 1%-0.2% EYE DROPS | $481.00 |
| 25090982 | SIMETHICONE 125 MG | $1.80 |
| 27011079 | SIMPLY SALINE WOUND WASH | $26.00 |
| 25023027 | SIMVASTATIN 10 MG TAB | $1.00 |
| 25023028 | SIMVASTATIN 20MG TAB | $2.00 |
| 25090333 | SIMVASTATIN 40MG | $5.00 |
| 25090073 | SIMVASTATIN 80MG | $10.00 |
| 25023029 | SINEMET 25/100 | $3.00 |
| 25023030 | SINEMET 25/250 | $3.00 |
| 25091041 | SINGULAIR 5MG CHEWABLE TABLET | $7.65 |
| 25023033 | SINGULAIR TAB 10MG | $14.00 |
| 27011115 | SKIN PREP WAND | $5.00 |
| 27033342 | SKIN STAPLER EXTRACTOR | $10.00 |
| 27033343 | SLIPPER SOCKS | $6.00 |
| 25019615 | SOD CHLORIDE .9% (500MLS) | $26.12 |
| 25090970 | SODIUM BICARB 650 MG TAB | $1.00 |
| 25023040 | SODIUM CHLORIDE TAB 1GM | $1.00 |
| 25091305 | SOLU MEDROL 20MG IV VIAL | $31.88 |
| 25023044 | SOLU-MEDROL VL 125MG 2ML | $8.29 |
| 25091455 | SOLUMEDROL 100MG VIAL | $72.00 |
| 25091007 | SORBITOL PER ML | $1.00 |
| 25023080 | SOTALOL 160MG | $8.65 |
| 25023047 | SOTALOL HCL TAB 80MG | $8.00 |
| 44090000 | SP-COGNITIVE THERAPY | $192.50 |
| 4409000 | SP-COGNITIVE TRAINING | $192.50 |
| 44000001 | SP-DYSPHAGIA EVALUATION | $82.50 |
| 44000006 | SP-SPEECH THERAPY IND | $136.12 |
| 44061021 | SPEECH PATHOLOGY SCREENING | $157.50 |
| 25023088 | SPIRIVA 18MCG CP-HANDIHALER | $1,091.25 |
| 25023048 | SPIRIVA HANDIHALER 30 CAP | $36.00 |
| 25023087 | SPIRONOLACTONE 25MG | $1.86 |
| 25023049 | SPIRONOLACTONE TAB 50MG | $2.45 |
| 43058154 | SPLINT FOLLOW-UP 15 MIN | $45.00 |
| 27011014 | SPLIT SPONGES | $4.00 |
| 25023050 | SPS SUSPENSION 60ML | $21.00 |
| 27011096 | STANDARD ARM SLING | $9.60 |
| 27033521 | STAPLE REMOVAL KIT 25-716 | $6.00 |
| 27011062 | STATLOCK | $36.00 |
| 27033493 | STOMA WAFER | $55.47 |
| 25091191 | STOOL SOFT 240MG CAP | $1.00 |
| 30040385 | STOOL, C. DIFFICILE TOXIN | $50.00 |
| 27011094 | STRATASORB 4X10 | $16.40 |
| 27011101 | STRATASORB 4X14 | $12.84 |
| 25091057 | SUCRALFATE 1 GM TAB | $1.98 |
| 25023060 | SUCRALFATE SUSP 1G/10ML | $1.00 |
| 25023064 | SULFAMETHOXAZOLE TMP DS 800MG | $5.12 |
| 25091251 | SULFASALAZINE 500 MG TAB | $1.00 |
| 27011114 | SUREPREP NO STING SKIN PROTECT | $4.40 |
| 25023089 | SYMBICORT 160-4.5MCG INHAL | $698.66 |
| 25091091 | SYMBICORT 80/4.5MCG INH | $612.66 |
| 25023074 | SYNTHROID 50 MCG | $8.40 |
| 27033378 | SYRINGE 50 OR 60 CC, CATH TIP | $3.00 |
| 29090817 | SYSTANE ULTRA EYE | $65.04 |
| 30040396 | T4, FREE | $37.80 |
| 25091438 | TAMIFLU 750MG TAB | $77.36 |
| 25024001 | TAMIFLU 75mg | $44.28 |
| 25090843 | TAMSULOSIN 0.4MG CAP | $4.07 |
| 25024005 | TED HOSE 2XL | $29.61 |
| 27033395 | TED HOSE KNEE HIGH | $12.00 |
| 27011061 | TEFLA PAD 2X3 | $1.00 |
| 27033399 | TEGADERM 2X2 | $2.00 |
| 27033400 | TEGADERM 4X4 | $7.00 |
| 27033401 | TEGADERM 6X8 | $8.00 |
| 25024007 | TEGRETOL 100mg | $3.61 |
| 25024008 | TEGRETOL TAB 200MG | $2.79 |
| 27011064 | TELFA ISLAND 4X10 | $2.00 |
| 27033407 | TELFA ISLAND DRESSING | $6.00 |
| 25091193 | TELMISARTAN 80MG TAB | $21.96 |
| 25024009 | TEMAZEPAM 15MG CAP | $4.31 |
| 25091206 | TEMAZEPAM 7.5 MG CAP | $2.00 |
| 25024010 | TEMAZEPAM CAP 30MG U/D | $2.50 |
| 25024012 | TERAZOSIN HCL CAP 1MG | $4.81 |
| 25024013 | TERAZOSIN HCL CAP 5MG | $4.82 |
| 25024016 | TESSELON PERLES | $5.00 |
| 25091461 | THERA-M CAPLET | $5.16 |
| 25024023 | THERA-M TAB | $1.00 |
| 25091393 | THEREMS MULTI-VIT | $5.20 |
| 32045124 | TIBIA AND FIBULA 2 VIEWS | $400.00 |
| 25024036 | TIMOLOL OPTH SOL 0.5 % | $10.20 |
| 25090929 | TIZANIDINE HCL 2MG | $2.90 |
| 25024037 | TIZANIDINE HCL TAB 4MG | $4.40 |
| 25090301 | TOBRADEX EYE OINTMENT | $480.54 |
| 25024040 | TOBREX OPTHL. .3% | $80.91 |
| 25091116 | TOLTERODINE TART ER 2MG CAP | $12.00 |
| 25091343 | TOLTERODINE TART ER 4MG CAP | $25.36 |
| 25019610 | TOLTERODINE TARTRATE 2MG TAB | $15.90 |
| 25024042 | TOPAMAX TAB 50MG | $15.48 |
| 25024043 | TOPAMAX TAB 100MG | $21.14 |
| 25090924 | TORADOL 10MG | $28.00 |
| 25024047 | TORADOL 30MG INJ | $18.00 |
| 41051089 | TRACH CARE | $57.00 |
| 41051090 | TRACH CARE KITS | $6.00 |
| 25090202 | TRADJENTA 5 MG | $32.00 |
| 25024050 | TRAMADOL HCL 50MG TAB | $1.00 |
| 25019619 | TRAMADOL HCL ER 200MG | $5.00 |
| 25024051 | TRANDOLAPRIL TAB 2 MG | $3.61 |
| 25024052 | TRANSDERM SCOP | $27.22 |
| 30040412 | TRANSFEIN SERUM | $46.00 |
| 25024055 | TRAZODONE 150MG TAB | $2.00 |
| 25090855 | TRAZODONE 25MG | $5.00 |
| 25024056 | TRAZODONE 50MG TAB | $1.80 |
| 25024057 | TRAZODONE TAB 100MG U/D | $2.35 |
| 25024060 | TRIAMCINLN CR 0.1% 15GM | $39.04 |
| 25091451 | TRIAMCINOLONE 0.1% CREAM 60 GR | $90.12 |
| 25091170 | TRIAMCINOLONE 55MCG NAS SPRAY | $68.32 |
| 25024062 | TRIAMTERENE/HCTZ C37.5/25 | $1.36 |
| 25024063 | TRICOR TAB 48MG | $4.31 |
| 30040416 | TROPONIN I | $97.20 |
| 30040417 | TSH | $85.00 |
| 27033457 | TUBE, SALEM SUMP | $7.50 |
| 25024076 | TUBING IV NON-VNT W/CLAMP | $6.49 |
| 25024077 | TUMS | $1.00 |
| 25024079 | TYLENOL ARTH ER 650MG TAB | $1.00 |
| 25024080 | TYLENOL ES | $0.99 |
| 30040421 | UA MICROSCOPIC | $9.75 |
| 25090030 | ULORIC 40 MG | $22.00 |
| 25090332 | ULTRACET 37.5/325 MG | $2.50 |
| 25025001 | ULTRAM TABS 50 MG | $4.00 |
| 43058185 | ULTRASOUND 15 min | $63.00 |
| 32045129 | ULTRASOUND OF KIDNEY | $318.00 |
| 32045130 | ULTRASOUND OF LEG | $1,941.00 |
| 32045131 | ULTRASOUND OF SCROTUM | $297.00 |
| 30040425 | URIC ACID LEVEL | $35.00 |
| 30040426 | URINALYSIS | $64.40 |
| 30040427 | URINALYSIS W/MICRO NON-AUTMA | $20.00 |
| 27033468 | URINARY DRAINAGE BAG | $25.00 |
| 30040431 | URINE CULTURE | $20.00 |
| 30040435 | URINE OSMOLALITY | $38.00 |
| 30040439 | URINE SODIUM | $48.20 |
| 25025003 | UROXATRAL TAB 10MG | $20.00 |
| 25091037 | URSODIOL / ACTIGALL 300MG | $19.84 |
| 25091126 | VALACYCLOVIR HCL 1GM CAP | $40.00 |
| 25026002 | VALPROIC ACID CAP 250MG U | $2.38 |
| 30040442 | VALPROIC ACID QUANT | $50.00 |
| 30040444 | VALPROIC ACID/DEPAKOTE | $43.20 |
| 25091063 | VALSARTAN 160MG TAB | $13.90 |
| 25091342 | VALSARTAN 320MG TAB | $52.00 |
| 25091335 | VALSARTAN 80 MG TAB | $3.20 |
| 25026005 | VALTREX CAPL 500MG | $22.35 |
| 25026045 | VANCOMYCIN (PREMIX) 1GM | $300.00 |
| 25026006 | VANCOMYCIN 1.25GM / 250MLNS IV | $288.56 |
| 25026010 | VANCOMYCIN 1GM IV VIAL | $224.04 |
| 25090020 | VANCOMYCIN HCL 125 MG | $100.00 |
| 30040446 | VANCOMYCIN PEAK | $167.25 |
| 30040447 | VANCOMYCIN TROUGH | $167.25 |
| 25026012 | VASOTEC 10MG TAB | $5.67 |
| 25026013 | VENLAFAXINE HCL 75MG CAP | $3.88 |
| 25091321 | VENLAFAXINE HCL ER 37.5MG CAP | $3.60 |
| 25091577 | VENLAFAXINE HCL ER 75 MG | $5.48 |
| 25091334 | VENLAFXINE HCL ER 150MG CAP | $4.08 |
| 25091405 | VENTOLIN HFA 90MCG INHALER | $300.68 |
| 25091431 | VERAPAMIL ER 240MG TAB | $5.48 |
| 25026016 | VERAPAMIL ER TAB 120MG UD | $2.81 |
| 25026047 | VESICARE 10MG | $35.20 |
| 25026046 | VESICARE 5MG | $28.00 |
| 25026019 | VICODIN TAB | $4.00 |
| 25090809 | VICTOZA 1.8 MG SQ | $937.23 |
| 25026023 | VISTARIL CAP | $3.00 |
| 25026025 | VIT B CMPX CAP SOFTGEL | $1.00 |
| 25019622 | VIT B-6 50MG TAB | $5.16 |
| 25026026 | VIT C ASCORBIC TAB 500MG | $0.20 |
| 25091436 | VIT D2 1.25MG CAP | $13.48 |
| 25091594 | VITAMIN A 8000 UNIT CAP | $2.00 |
| 25026029 | VITAMIN B COMPLEX CAP | $5.16 |
| 25091526 | VITAMIN B-12 100MCG TAB | $5.08 |
| 25091259 | VITAMIN B-6 100MG TAB | $5.16 |
| 25026030 | VITAMIN B1 100MG TAB | $1.00 |
| 25026031 | VITAMIN B12 | $5.08 |
| 25026032 | VITAMIN B12 1,000 MCG TAB | $1.00 |
| 25091386 | VITAMIN B12 500MCG TAB | $1.00 |
| 30040452 | VITAMIN B12 LEVEL | $108.00 |
| 25091399 | VITAMIN B12 SL 2500MCG TAB | $5.64 |
| 25026034 | VITAMIN C 1000MG | $2.00 |
| 25091500 | VITAMIN C 250 MG TAB | $1.28 |
| 25026035 | VITAMIN C 500MG | $12.93 |
| 25026036 | VITAMIN D 2000 UNITS SOFT | $8.00 |
| 25026037 | VITAMIN D 50,000 UNITS CAP | $18.76 |
| 30040453 | VITAMIN D LEVEL | $472.50 |
| 25090893 | VITAMIN D3 1000 IU | $5.08 |
| 25090824 | VITAMIN D3 5000 | $24.00 |
| 25090749 | VITAMIN E 400IU SOFTGEL | $1.00 |
| 25090070 | VOLTAREN GEL PER GM | $2.79 |
| 25026042 | VYTORIN TAB 10/40 | $10.81 |
| 42055144 | W/C BED POSITIONING | $121.50 |
| 43058192 | W/C BED POSITIONING | $121.50 |
| 25091050 | WELCHOL 3.75G PACKET | $74.23 |
| 25090009 | WELCHOL 625MG | $20.00 |
| 25027002 | WELLBUTRIN 100 MG | $4.00 |
| 25090013 | WELLBUTRIN 150MG | $5.00 |
| 42055157 | WOUND CARE SMALL | $60.00 |
| 27011008 | WOUND CLEANER | $12.00 |
| 30040458 | WOUND CULTURE | $81.00 |
| 32045141 | WRIST COMPLETE 3 VIEWS | $250.00 |
| 25028002 | XANAX 0.25MG | $3.00 |
| 25090212 | XARELTO 10 MG | $51.99 |
| 25090867 | XARELTO 15MG | $40.00 |
| 25091292 | XARELTO 20MG TAB | $51.80 |
| 27033524 | XEROFORM 5X9 DRESSING | $3.00 |
| 25090338 | XIFAXAN 550 MG TAB | $72.00 |
| 25090766 | XOPENEX 0.63MG | $40.00 |
| 25028006 | XOPENEX INH/S 1.25MG/3ML | $40.00 |
| 26031131 | Y TYPE SET | $18.00 |
| 25091311 | ZAFIRLUKAST 20 MG TAB | $8.80 |
| 25029045 | ZANTAC 150MG | $1.00 |
| 25029041 | ZAROXOLYN 2.5MG | $1.00 |
| 25029002 | ZAROXOLYN 5MG TAB | $1.92 |
| 25091595 | ZENPREP 20,000 UNITS | $7.08 |
| 25090066 | ZINC OXIDE CREAM | $26.00 |
| 25029010 | ZINC SULFATE 220MG | $1.00 |
| 25090872 | ZIOPTAN 0.0015% DROPS | $232.00 |
| 25029011 | ZIOX OINT 30GM | $8.00 |
| 25091600 | ZIPRASIDONE HCL 20MG CAP | $3.40 |
| 25091421 | ZIPRASIDONE HCL 80MG CAP | $4.26 |
| 25029015 | ZOCOR 10/20 MG | $7.00 |
| 25029040 | ZOFRAN 4MG | $64.00 |
| 25029019 | ZOLOFT 100MG | $8.28 |
| 25029020 | ZOLOFT 50MG | $8.00 |
| 25029021 | ZOLPIDEM TART 10MG TAB | $2.04 |
| 25029044 | ZOLPIDEM TARTRATE 5 MG TAB | $2.40 |
| 25029024 | ZOSYN 3.375GM 1 DOSE | $126.12 |
| 25029037 | ZYVOX 600MG | $28.29 |
| 27011024 | ZZZRESP-22 MM ADAPTER | $4.00 |